Archives of Iranian Medicine
Volume:8 Issue: 1, jan2005

The prevalence of overweight and obesity in most developed and developing countries have been increasing markedly over the past two decades. This increase includes all ages, genders, racial and ethnic groups, income, and educational levels. A variety of genetic, environmental, physiological, psychological and sociocultural factors influence the development of obesity. Iran like many other developing countries is now experiencing the global epidemic of obesity and its consequences. Recent epidemiological studies have revealed that the prevalence of obesity, overweight, and metabolic syndrome in Iran is equal to or higher than Europe and the United States and it is the primary cause of the rising prevalence of type 2 diabetes and the important comorbid states such as hypertension, cardiovascular, renal, and gastrointestinal diseases along with increasing the burden of cancers. This is also in line with the present etiologies of death in Iran with cardiovascular disease and cancer accounting for nearly 60% of causes of nontraumatic death. The prevalence of obesity in Iran has reached epidemic proportions and is specifically affecting women and younger age groups also. The increased consumption of calorie-dense regular and fast foods and sucrose-enriched drinks, together with an increasingly sedentary lifestyle, appear to be major factors contributing to this epidemic. The per capita consumption of carbonated beverages in Iran is 42 liters per year and 40% of Iranians consume more food than they need, and the average Iranian consumes 40% more carbohydrate and 30% more fat than needed. To deal with this epidemic, prevention should receive high priority and social measures such as taxing fast foods, subsidizing fresh food and vegetables, and spending more public money on projects to promote physical activity are necessary. There is also emerging evidence that treating obese subjects, particularly those with metabolic syndrome or type 2 diabetes, has short-term effects on the prevention of diabetes; improves glucose, lipid, and blood pressure parameters; and is likely to have beneficial effects on long-term health outcomes.

To investigate the effects of drainage of premacular subhyaloid hemorrhage into the vitreous with Nd:YAG laser in 13 eyes of 12 patients with 3 months follow-up. The study was conducted between January 2001 and December 2001. Thirteen eyes of 12 patients had a circumscribed premacular hemorrhage and were treated with Nd:YAG laser to drain the blood into the vitreous cavity. The hemorrhage originated from diabetic retinopathy (8 eyes), retinal macroaneurysm (2 eyes), acute myeloblastic leukemia (AML) (2 eyes), and branch retinal vein occlusion (1 eye). The size of the hemorrhage was expressed in disc diameters. The success of the laser procedure was defined as clearing of premacular hemorrhage within 3 months. By this definition drainage of premacular subhyaloid hemorrhage into the vitreous with Nd:YAG laser succeeded within three months in eleven out of thirteen eyes treated without requiring further membranotomy. One eye had persistent, dense, and nonclearing vitreous opacity for at least 3 months. One clotted hemorrhage did not drain into the vitreous. Overall visual improvement was best in eyes with AML and macroaneurysm. During the follow-up, neither macular epiretinal membranes nor tractional retinal detachments occurred in any eyes. Drainage of premacular subhyaloid hemorrhage into the vitreous with Nd:YAG laser is a viable treatment alternative for eyes with recent bleeding. However, to establish Nd:YAG laser treatment as a routine procedure, the risks and benefits have to be weighed in a randomized trial and compared with those of deferral of treatment or primary vitrectomy.

Airway hyperresponsiveness (AHR) is the most characteristic feature of asthma, which is reported in chronic obstructive pulmonary disease (COPD) patients and smoker subjects. However, there are controversies regarding airway responsiveness to β-adrenergic agonists in asthma, as well as COPD and smoker subjects. Our previous studies have shown AHR to β-agonists in asthmatic patients. Therefore, in the present study, airway sensitivity to a β-agonist was examined in smoker subjects. The threshold concentration of inhaled salbutamol required for a 20% increase in forced expiratory volume in 1 sec (FEV1), as PC20, or a 35% increase in specific airway conductance (sGaw), as PC35, was measured in 12 nonsmoker and 12 smoker subjects. Airway responsiveness to salbutamol was greater in smokers (PC20 = 65.83 ± 14.77 mg/L and PC35 = 27.75 ± 18.41 mg/L) than nonsmokers (PC20 = 244.17 ± 44.2 mg/L and PC35 = 90.50 ± 28.67 mg/L, P < 0.001 for both cases). There was a significant correlation between FEV1 with PC20 salbutamol (r = 0.547, P < 0.005). The relationship between the amount of smoking and PC 35 salbutamol was also statistically significant (r = –0.654, P < 0.001). The slope of concentration-response curve for salbutamol was significantly greater in smokers than nonsmoker subjects, by measuring both FEV1 and sGaw (P < 0.001 for both cases). The increased sensitivity of smokers to inhaled salbutamol suggests that they could also be more sensitive to their endogenous adrenaline, which may thus dilate and stabilize their airways.

Atrial fibrillation (AF) after coronary artery bypass graft surgery (CABG) constitutes the most commonly sustained arrhythmia and results in prolonged hospitalization. The purpose of this study was to assess simultaneous right and left atrial pacing as prophylaxis for postoperative atrial fibrillation. One-hundred and twenty patients, without structural heart disease, who underwent CABG were classified into one of the following 3 groups: biatrial pacing (BAP), left atrial pacing (LAP), and no pacing (control). Atrial pacing was performed for 4 days. Post-CABG AF was significantly reduced in BAP group compared to single-site and control groups (BAP, 17.5%; LAP, 30%; control, 45%; P < 0.01). The mean length of hospital stay was significantly reduced in BAP group. Hospital charges were less in the BAP group compared to the other two groups. P-wave duration was significantly reduced by biatrial pacing and LAP compared to control group (before pacing, BAP: 69.2 ms; LAP: 73 ms, and after pacing, BAP: 58 ms; LAP: 64.2 ms respectively, P < 0.01). However, only those patients who remained in sinus rhythm had a significant reduction in mean P-wave duration after pacing therapy. Simultaneous right and left atrial pacing is well tolerated and is more effective in preventing post-CABG AF than single-site pacing and results in a shortened hospital stay. Identifying patients at risk for developing postoperative AF and using this prophylactic method may be the optimal cost-effective strategy.

Previous studies have shown that progesterone increases the ventilatory performance in healthy individuals and in patients with chronic obstructive pulmonary disorders. The study was designed to investigate the effect of a single intramuscular administration of progesterone on ventilatory performance in adult trauma patients during partial support mechanical ventilation. Forty adult trauma patients undergoing partial support mechanical ventilation with a spontaneous minute ventilation of 30 – 50% of their total minute ventilation were randomly given a single intramuscular injection of either progesterone 1 mg/kg or normal saline as placebo. Airway resistance and pressure, lung compliance, spontaneous tidal volume and respiratory rate, pulse oxymetric oxygen saturation, end tidal CO2 concentration, heart rate, and blood pressure were measured and compared between two groups before administration of progesterone (or placebo) and three and six hours after it. Three hours after progesterone administration maximum negative inspiratory pressure, spontaneous tidal volume, dynamic compliance, and oxygen saturation were increased while peak airway pressure, airway resistance, and end tidal CO2 concentration decreased significantly compared to the basal values and those in the placebo group. These changes returned to baseline between three to six hours after progesterone administration. The results of this study show the beneficial effect of a single intramuscular administration of progesterone on the ventilatory performance during partial support mechanical ventilation, which lasts for three to six hours. Whether more frequent administration of progesterone is of value for the management of mechanical ventilation and in particular the weaning process, remains to be elucidated in future studies.

Considering the outbreak of different types of tuberculosis including genital tract tuberculosis in developing countries, and due to the differences in the symptoms of this disease, this study has been carried out in Imam Khomeini Hospital (affiliated to Tehran University of Medical Sciences), Tehran, Iran, for the last 20 years. This retrospective study was conducted with fifty-two patients with the definite pathological diagnosis of genital tract tuberculosis. In this study the clinical symptoms, marital status, organ involvement, hysterosalpingography (HSG), chest X-ray, and age were variables that were all taken into consideration. The highest incidence of the disease was between the ages of 26 and 30, but the ages of the patients ranged from 17 to 80 years. The mean age was 31 years. One unmarried 17-year-old patient (2%) had no sexual activity. The other 51 patients (98%) were married. Twenty-seven (52%) patients had infertility problems for a period of between 1 and 25 years, twenty-three cases (85%) of the primary, and 4 (15%) of secondary type. In thirteen patients HSG was conducted of whom 2 cases were normal and in the remainder the fallopian tubes had been occluded. Chest X-rays in two patients showed primary pulmonary tuberculosis. The second and third symptoms of genital tract tuberculosis were abdominal pain and pelvic mass (38%), and abnormal uterine bleeding (AUB) (29%), respectively. The pathological studies indicated that the area affected in most cases was endometrium (59%). Tuberculous salpingitis counted as the second cause of pathology in these patients (34%). Tuberculosis of the genital tract is more common in patients between the ages of 26 to 30 years. The most affected area is the endometrium. Infertility is the most common clinical symptom of pelvic tuberculosis even if the fallopian tubes are not obstructed. Tuberculosis should be considered in differential diagnosis of causes of infertility, pelvic mass, and AUB, particularly in areas where tuberculosis is common.

A small dose of intravenous bolus injection of lobeline (LB) gives rise to a range of sensations in the upper respiratory tract (named J sensations) including dryness, swelling, burning, suffocation in the upper respiratory tract, and dry cough. We were interested in investigating: a) whether people with coronary artery disease (CAD) feel the same kind of sensations with LB as those of healthy subjects, b) we also attempted to compare these sensations with those felt when they were exercising moderately, and c) finally, a similar comparison, undertaken in healthy subjects, allowed us to examine the origin of exercise-related sensations experienced by subjects with CAD. J sensations were evoked by threshold doses of LB in 10 CAD patients and 10 healthy subjects as control. These sensations were then experienced in treadmill exercise tolerance testing (Bruce Protocol) and compared. Diversity and incidence of J sensations felt with the above protocol were ignificantly higher amongst CAD patients than the control subjects. CAD patients usually reported experiencing more than one kind of J sensations, when exercising. It is worth mentioning that dry cough was present in 30% of CAD patients while exercising, but was absent in the healthy subjects. The notable similarity between J sensations evoked by threshold doses of LB and those felt while exercising, as reported by CAD patients, points to the common origin of these sensations in the two conditions. The foreseeable conclusion is that the similarity of J sensations encountered while exercising with those of the LB-induced ones in CAD patients points to the fact that the origin of these exercise-induced sensations is the stimulation of juxta-pulmonary capillary (J) receptors by transient increment in interstitial volume and/or increase in pulmonary blood flow.

The aim of this study was to compare lipid-altering effects of an almond-based diet with a reference diet. In a randomized single blind, cross-over clinical trial study, the effect of almond (25 g/day) on serum lipoproteins of mild hypercholesterolemic patients were studied. This eight-week dietary trial was divided into two consecutive four-week intervention periods. Both diets conformed to National Cholesterol Educational Program (NECP) step 1 diet and contained identical foods and macronutrients, except for almond. After a washout period, each patient consumed the opposite dietary regimen for 4 weeks. In the almond group, subjects used 25 g/ day of almond powder. Thirty hyperlipidemic adult men and women were considered eligible, after a preliminary medical history review and laboratory screening for lipid profile. Combined average for both of the cross-over phases showed that almond induced a reduction in total cholesterol (TC) of 8 ± 27mg/dL and in low-density lipoprotein-cholesterol (LDL-C) of 9 ± 29 mg/dL. The reference diet did not induce a significant reduction in TC and LDL-C (for TC P < 0.01, and LDL-C, P < 0.05). Neither treatments induced significant changes in high-density lipoprotein-cholesterol (HDL-C) and triglyceride (TG). Our findings suggest a favorable lipid-altering effect induced by the almond, even in lower dose than previous studies (25 g vs. 100 g). These may be due to the interactive or additive effects of the numerous bioactive constituents found in almond.

Crimean-Congo hemorrhagic fever is a zoonotic arboviral disease, which is transmitted to humans via tick bite or via human or domestic animal blood transmission, in particular sheep, goats, and cows.

Familial Mediterranean fever (FMF) is a genetic disease characterized by periodic fever and/or painful inflammatory manifestations. Repeated attacks at irregular intervals and in an unpredictable sequence are typical of the disease. Most of the patients become symptomatic between ages 5 to 15 years. Rarely, the disease may manifest as early as during the first year.Until recently, the diagnosis of FMF was mainly based on the presence of typical clinical picture and dramatic response to colchicine. Recent insight to the genetic basis of the disease has made DNA study available for diagnosis of FMF. We report a 20-month-old Iranian boy with recurrent attacks of abdominal pain and fever since the 4th month of birth. A molecular analysis was carried out, confirming mutation of the FMF-gene.

Inversion of the uterus is a rare clinical problem. It is encountered as an obstetric emergency and a diagnostic challenge in gynecology. Nonpuerperal inversion usually results from a tumor implanted on fundus of the uterus. Treatment depends on the associated pathology and the stage of the inversion.A rare case of nonpuerperal uterine inversion caused by a large fundal leiomyoma in a 38-year-old woman resulting in severe lower abdominal pain and profuse vaginal bleeding is reported. After incomplete myomectomy, reduction of the inversion vaginally was successful and then an abdominal hysterectomy was performed.

Inversion of the uterus is a rare clinical problem. It is encountered as an obstetric emergency and a diagnostic challenge in gynecology. Nonpuerperal inversion usually results from a tumor implanted on fundus of the uterus. Treatment depends on the associated pathology and the stage of the inversion.A rare case of nonpuerperal uterine inversion caused by a large fundal leiomyoma in a 38-year-old woman resulting in severe lower abdominal pain and profuse vaginal bleeding is reported. After incomplete myomectomy, reduction of the inversion vaginally was successful and then an abdominal hysterectomy was performed.