Archives of Iranian Medicine
Volume:5 Issue: 3, Jul 2002

Although there are only a few centers in Iran specializing in genetic research, the numbers are increasing rapidly. All key research centers are now under the supervision of an organization called The Molecular Medicine Network. With the growing trend in genetic research, health care officials have recognized the need to draw up a detailed guideline on ethical issues. The Iranian Ministry of Health and Medical Education recently established a national ethics committee to develop some regulations in the field of bioethics. A 27-clause document was issued by the committee. However, references to genetic studies have been minimal. As such, we are trying to finalize the first draft of a guideline which encompasses the most challenging ethical implications in the field of genetics including informed consent, confidentiality, genetic counseling and potential for social harm or psychologic distress imposed by disclosure of individuals’ genetic information. Shia, a branch of Islam and the official religion of Iran has a number of rules and concepts about some important issues of bioethics which are different to the West. In addition, Gnostic concepts integrated in Persian literature are firmly respected by the Iranian population and these lead to different interpretation of bioethical issues. In this article, the current situation of bioethics in genetics and the best way to produce simple, applicable and effective guidelines in this area are discussed.

Background– The main area of Iran affected by relapsing fever (RF) is Ardabil Province, for which Borrelia persica is the most common cause in this country. The aim of this study was to determine the epidemiologic characteristics of the disease, and the frequency of infection among ticks in this region.Method– This clinical epidemiology and entomology study was performed on a total of 391 patients diagnosed with tickborne relapsing fever between 1998 to 2001. The presence of Borrelia with any species as well as the clinical characteristics were observed. Borrelia was identified in blood smears of 1,421 ticks collected from 130 indoor and 14 outdoor sites. The ticks were crushed and the suspension obtained was injected into the peritoneum of two mice and two guinea pigs to determine the frequency of infection among the ticks living in this region. Data including the tick species determination were collected through a questionnaire and analyzed using Chi-square and ANOVA tests. Results– The most prevalent clinical manifestations were fever, chills and headache. Other findings included nausea, vomiting, sweating, abdominal pain, arthralgia, cough, photophobia, eosinophilia, hematuria, jaundice, petechiae and scleral congestion. Laboratory tests performed on 60 patients showed leukocytosis, high erythrocyte sedimentation rate (ESR) and anemia. Of the 1,421 ticks collected, 45.9%, 40.3% and 13.8% were of the Ornithodoros lahorensisi, Ornithodoros tholozani and Argas persicus species, respectively. The prevalence of ticks was highest in Khandabil village. The ticks collected from three villages were found to be infected with Borrelia.Conclusion– This study is the first large-sized published report of tick-born RF until that time. The clinical manifestations were similar to those reported in other studies. Petechiae occurred less frequently in our study compared to louse-borne RF. The high frequency of anemia, which was not stated in most other reference articles, requires further investigation.

Background– Streptococcal pharyngitis is not prevalent among individuals above 15 years of age and as a result, there is little research conducted on this age group. Hence, the aim of this study was to detect the prevalence of group A β–hemolytic Streptococcus (GABHS) among healthy individuals between 15 to 18 years of age.Methods– Using cluster sampling methods, 546 individuals aged from 15 to 18 years were randomly selected from a population of high school students in District 3 of Education Organization (Tehran, Iran). The results of throat cultures, demographic data, contents of tonsillar enlargement, cryptic tonsillitis and the level of education of individuals’ parents were evaluated.Results– Of the total of 546 students, 49 (9%) had GABHS in their pharynxes. Seventeen (60%) of the 28 students in which asymptomatic pharyngitis and/or cryptic tonsillitis was documented had GABHS in their pharynxes. Tonsillar enlargement was not a significant risk factor for being a carrier of GABHS. Lower level of parents’ education was associated with a positive rate of GABHS.Conclusion– Compared to developed countries, the higher prevalence of GABHS carriers in our study probably indicates that there is a significant number of children with untreated or partially-treated streptococcal pharyngitis. With the recent removal of legal restrictions in the prescription of injectable penicillins for children, a complete course of antibiotic treatment is highly recommended.

Background– Preeclampsia is a common and serious complication of pregnancy that affects both mother and newborn. This study was designed to evaluate the effects of low–dose aspirin or calcium supplements, taken during pregnancy, on the incidence of preeclampsia.Methods– The study was a randomized clinical trial on 990 healthy nulliparous women performed at the Isfahan Health Center between April 1998 and March 2001. The women, in their first half of pregnancy, were randomly assigned to one of three groups (group 1 received 75 mg aspirin each day; group 2 were treated with 500 mg oral calcium daily; and group 3 was designated as the control group, receiving no medication). Data were recorded using a standardized questionnaire. Statistical analyses was performed using Chi-square, ANOVA and Duncan tests.Results– Preeclampsia occurred in 15 women in the aspirin group (15/330, 4.6%), 13 women in the calcium group (13/330, 4 %), and 33 women in the control group (33/330, 10.1%). There were significant differences between the aspirin and control groups (p < 0.05), and between the calcium and control groups (p < 0.05). There was no significant difference between the aspirin and calcium groups (p = 0.7).Conclusion– Our results suggest that prescription of low-dose aspirin or calcium-D during pregnancy in healthy nulliparous women is effective in reducing the occurrence of preeclampsia.

Background– Electroencephalography (EEG) is capable of determining the foci and intensity of epileptic discharges. The long-term use of antiepileptic drugs (AEDs) in children may be accompanied by side effects in 50% of cases; hence, drug therapy should be discontinued as early as possible. Before a decision is made to discontinue a drug, the recurrence of seizures could be predicted by interpreting the characteristics of the EEG. Methods– This study was conducted on 106 children who were without recurrent seizures for at least 1 year. They had been under AED therapy continuously. An EEG was taken while the child was awake, and the trace was assessed by a single neurologist with respect to background activity, focal slowing of waves, focal spike waves and generalized sharp spike waves. The children were monitored for signs of recurrent seizures every 3 months for at least 1 year. The results were assessed according to Kaplan-Meier survival analysis and the Log-Rank test. Results– The probability of recurrent seizures was 24.8 % (95% CI, 22.5–28.5 %) after 1 year of follow-up. A significant relationship existed between the state of the present EEG and previous EEGs (p < 0.05). Among the children with abnormal EEG results on drug discontinuation, seizure recurrence was more frequent in boys (p = 0.045). Comparing present and previous EEGs, the relative risk was calculated to be about 1.98 (95 % CI, 1.01–3.91, p < 0.05). Conclusion– The risk of seizure recurrence was quite similar to the findings of other studies. Overall, there was no significant relationship between the presence of abnormal EEG findings and recurrence of the seizures. An important result of our study was the importance of comparing EEGs prior to drug withdrawal with primary EEGs (p < 0.05). Estimation of the probability of recurrent epileptic seizures must be only one part of the process of the physician’s decision. Attention must be paid to other factors such as the physical, social and economical consequences as well as the estimation of AED side effects.

Background– Certain trace elements such as zinc and copper have been studied in head injury patients. In this study, we decided to determine whether serum chromium concentrations were affected by the severity of a head injury.Methods– The study was conducted on 30 male patients aged from 10 to 30 years. Patients were divided into three groups based on the Glascow Coma Scale; 1-mild, 2-moderate and 3-severe head injury. Serum samples for chromium were obtained during the first four hours after head injury and analyzed by neutron activation analysis technique. Two independent sample t test was used to compare the mean serum concentration of chromium in different groups.Results– Mean ± SD of serum concentration of chromium was 1.41 ± 0.2 mg/L in the first, 1.58 ± 0.23 mg/L in the second and 1.42 ± 0.23 mg/L in the third group of patients. There was no significant difference among the three groups with respect to the serum concentration of chromium.Conclusion– To define the time-related changes of chromium and severity of the head injury, the total intake of chromium and other relevant factors should be considered in future studies.

Background– Although the influence of gonadotropins and steroid sex hormones on human growth and development are very well established, little is known concerning the role of these hormones in breast milk.Methods– In the present study, the concentrations of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol and progesterone in the blood and milk of 19 lactating mothers were measured by radioimmunoassay 1 and 6 months after delivery. Weight, height, head circumference and development of the infants were simultaneously clinically examined at 1 and 6 months. Results– Serum levels of LH, FSH and estradiol were 3–fold higher in the samples collected 6 months after delivery as compared to the first month, whereas progesterone levels were lower (55%) at six months than at one month. A positive correlation was found between the levels of all hormones in serum and in breast milk. The levels of FSH, LH and estradiol in the milk correlated directly with growth and developmental indices, whereas milk progesterone levels were negatively correlated with infant growth and development.Conclusion– The results suggest that the levels of FSH, LH and estradiol in human breast milk play an important role in the growth and development of infants. For progesterone, the opposite is true

Background– Fundermol is a topical agent for partial-thickness burns. Silver sulphadiazine is a topical agent for treatment of burn wounds. The aim of this study was to compare the efficacy of silver sulphadiazine dressing versus fundermol for burn healing and consequently prevention of infection in rats. Methods– Eighty-four Albino NMRI rats were scalded with boiling water for 6 seconds, resulting in second degree burns involving 10% total body surface area (TBSA). The rats were randomly divided into groups A and B; each group was further divided into three subgroups (A1, A2, A3, B1, B2, B3) of 14 rats each. The burned skin of group A rats was swabbed with Pseudomonas aeruginosa culture 1 day after burn induction; group B rats were not exposed to the bacteria. As P. aeruginosa is the most common and important bacteria in our epidemiological setting, we chose P. aeruginosa for this study. Rats in subgroups A1 and B1 were treated with silver sulphadiazine, and those in subgroups A2I and B2I with fundermol. Subgroups A3 and B3 received no treatment. All the rats were observed for 30 days and then sacrificed by Ether. Infection/contamination was determined by the culture of burn wound; looking for microorganisms such as P. aeruginosa and S. aureus. During histologic examinations, healing was evaluated by the following factors: surface vessel density, numerical vessel density, and surface epithelial density.Results- Silver sulphadiazine decreased the incidence of burn-wound infection by up to 85% in contaminated rats during the 30-day study period, while fundermol were effective in 58%. There were statistically significant differences between mean surface vessel density of burn wound in groups A1 and A2 with control group (P < 0.01) on 15th day. Mean numerical vessel density in groups A1 and A2 was significantly higher than control group on 15th and 30th day (p < 0.01). There was statistically significant association between mean surface epithelial density of burn wounds in group A1 with groups A2 and control on 15th day post burns (p < 0.01).Conclusion– Treatment of partial-thickness burn wounds with fundermol was not superior to silver sulphadiazine. We measured healing process by histological examinations and culture of the burn wounds. It could be considered as a hypothesis, because fundermol as a new topical agent was clinically comparable to silver sulphadiazine in treatment of burn wounds

Background– There are many reports of defective neutrophil function in patients with thalassemia major that lead them to increased susceptibility to acquire infections.Methods– In this study, neutrophil function (i.e. chemotaxis, Candida albicans killing, phagocytosis, opsonization and nitro blue tetrazolium [NBT] reduction) were evaluated in 30 patients with thalassemia major (16 splenectomized and 14 nonsplenectomized) and 30 controls. Results– There were no significant differences in phagocytosis, NBT reduction, and opsonization in neutrophil function between patients and controls. Chemotactic migration and C. albicans killing in the thalassemic patients were found to be defective. There was also a significant difference in chemotactic migration between splenectomized and nonsplenectomized patients.Conclusion– Patients with thalassemia major showed a greater degree of susceptibility to infections than controls.

Background– An agent that many pregnant women may be exposed to is opium or one of its alkaloids such as morphine and heroin. Recent observations of central nervous system (CNS) defects such as cyclopia among the infants of addicted mothers have suggested that opiate agents might be a cause of neural tube defects. The purpose of this study was to test morphine for CNS teratogenicity in mice and to identify the primordial structures affected. Methods– Timed pregnant BALB/c mice were intraperitoneally injected with 10 mg/kg morphine given in the early morning on days 10 and 11 of gestation. After dissection of fetuses and fixation in Bouin’s or 10% formalin solution, CNS abnormalities were evaluated using a dissecting microscope. Data were analyzed using Fisher’s exact test. Results– There was a higher incidence of CNS fetal malformations including exencephaly and spina bifida in fetuses whose mothers were exposed to morphine than in control fetuses exposed to NaCl. There were defects in 33% of fetuses from mothers who received morphine on both days 10 and 11 of gestation.Conclusion– Critical morphine injection times were determined to be days 10 to 11 of gestation. Our results indicate that morphine can be embryopathic during critical stages of CNS development.

Background– Multiple sclerosis (MS) is one of the most common acquired demyelinating diseases with geographic variability in both prevalence and incidence. The goal of this study was to review the epidemiologic data and to assess the risk factors for MS in Iran.Methods– From 1997 to 1999, 149 definite cases of MS were selected for study. The disease was confirmed according to clinical information and magnetic resonance imaging (MRI) findings by a neurologist and radiologist. The patients were evaluated by interview and a questionnaire. A control group of 100 sex- and age-matched non-neurologic patients were also enrolled in the study.Results– The male–female ratio was 1:1.2. Among female cases, the disease began in 61% soon after childbirth. Depression was noted in 67% of the patients. Fourteen percent of patients had a history of about one year in the recent war between Iran and Iraq. Fifty percent of patients had a history of viral exanthemas during childhood. Conclusion– MS appears to be prevalent in Iran, necessitating a large cohort study to evaluate a precise risk factor analysis.

Myiasis is the infestation of live human and animals by dipteran larvae. One of the causes of human myiasis is Oestrus Ovis (ship nasal botfly) which in the facial area reported cases mostly include eyes, nose, ears and pharynx. A case of oral mucosa myiasis in a three-year-old boy from a shepherd family living in a rural area of Iran is being reported. To our knowledge, this is the first reported case of oral mucosa myiasis.

A 22-year-old white female presented with multiple asymptomatic brownish flat papules on her face and upper neck. The lesions appeared when she was 18 and gradually increased in size and number until now. She had a positive family history of similar lesions in her 25-year-old and 30-year-old sisters, 64-year-old father and 78-year-old grand mother who developed their lesions around puberty. The lesions were histologically consistent with dermatosis papulosa nigra. She was treated with light curettage on one side and cauterization on the other side of the face. The results with both methods were excellent.

An 11-year-old male patient was referred to us with a right upper neck mass of 4 months’ duration. Ultrasonography, computed tomography (CT) scan and magnetic resonance imaging (MRI) showed a cystic lesion in the right parapharyngeal space. Aspiration of the cyst did not show any evidence of hydatid cyst or protoscolex. Serum immunoelectorophoresis was also negative for hydatid cyst. When surgery was performed, the histopathologic report was consistent with a hydatid cyst and serum immunoelectorophoresis for hydatid cyst became positive.

Background– Bleeding duodenal ulcer (BDU) may reduce the positive rate of urease test. This study evaluates if bleeding can affect other diagnostic tests for H. pylori.Methods– In this study, during 1997–99, 60 patients with BDU (group 1) and 60 patients with non-bleeding duodenal ulcer (NBDU) (group 2) were enrolled. All patients were endoscopied and three-biopsy specimen, urea breath test (UBT) and serologic assay for anti-H. pylori antibody (IgG) were performed. Any patient with positive anti-H. pylori antibody was considered as an infected patient. Results– There were 59 (98%) and 58 (96%) infected patients in group 1 and group 2 respectively. The positive rates for urease, biopsy and UBT in group 1 were 50 %, 75% and 95% while these rates were 90%, 90% and 96% in group 2, respectively. The patients in group 1 were divided into subgroups based on the presence (1a) or absence (1b) of blood in the antrum. The positive rate for urease, biopsy and UBT were 50% vs. 70%, 75% vs. 80%, and 95% vs. 93% in subgroup 1a and 1b, respectively. There was significant (p < 0.05) difference between BDU patients and NBDU patients in urease test results while for other tests, there were not any significant differences. Also, there was not any significant difference in subgroups 1a and 1b in their test results for H. pylori.Conclusion– BDU significantly reduces true positive rate of urease test while its effect on positive rate of other tests in negligible. We recommend using other diagnostic tests for H. pylori infection in the case of BDU rather than urease test.