Iranian Red Crescent Medical Journal
Volume:12 Issue: 3, 2010

Hepatitis A virus (HAV), a small non-enveloped RNA virus from Picornaviridea family, causes approximately 1.5 million cases of acute hepatitis each year, and is still a major world health problem especially in developing countries. As the risk of getting infected by HAV increases at the time of crisis such as earthquakes, we tried to perform a brief review on current situation of HAV in Haiti, a country that experienced an earthquake measuring 7.0 on the Richter scale recently, and that it might be in danger of experiencing outbreaks of enterically transmittable infective agents such as HAV.

Primary health care (PHC) as the first level of contact of all individuals, the family and the community with the national health system has a prominent role in response to different health events such as H1N1 pandemic. Regarding the great potentials of PHC and several experiences achieved in previous natural disasters and epidemics in Iran, in this study there is an attempt to propose a pyramidal model to combat against H1N1 pandemic. Pyramidal model puts all key components such as community, NGOs, PHC, hospitals, policy makers together to confront concurrent H1N1 pandemic and other health issues by a comprehensive, integrated and organized approach. This model should be regarded as a continuous, flexible and dynamic solution to pandemics. H1N1 pandemic, as a multi-wave and unpredictable event of the 21st century that involved most countries, threatens communities and confronts hospitals with growing demands of patients for health services. By defining the role of PHC and other important parts of pyramidal models such as community, we can fight against H1N1 pandemic appropriately with the least human and financial resources.

Influenza type A (H1N1) virus is considered as a major concern for health care system all over the world and imposes a considerable burden on the community. The aim of this study was to evaluate the pattern of the disease in order to help health administrators in making decision for preventive measures. 297 definite cases of influenza A (H1N1) diagnosed from 15 July to 3 December 2009 in Fars province, south of Iran, were included in this study. Diagnosis was confirmed performing Real time-PCR. The patients'' information including age, gender, occupation, nationality, education, residency area and history of overseas or domestic travel, history of contact with other influenza patients, and symptoms were collected and analyzed. The mean age at the time of diagnosis was 24.4±15.8 years. 76 (25.6%) patients were admitted in the hospitals, of whom, 11 cases died due to related influenza complications with Case Fatality Ratio (CFR) of 4.4%. The most common reported symptoms were fever, cough and sore throat. There were two waves in the disease incidence, one about 1 month after emergence of the disease and another around 1 month after school openings. The first peak was observed mainly among adults with a history of foreign travel while the second peak was mainly observed among school students. The magnitude of the epidemic was much higher when the disease was transmitted between students at the beginning of the school year. Considering the high incidence of H1N1 flu among the students (41%), vaccination programs and preventive measures should target this age group.

Presence of malaria immune factors induced by erythrocytic stages is widely used as an epidemiological approach to diagnose the infection mainly to distinguish the current, recent and past infections. This study was performed to find out the status of malaria, using microscopical and serological (IFA) methods in Bandar- Abbas and Minab, two malarious districts in Hormozgan Province of Iran. 408 patients with suspected malaria symptoms were enrolled. Conventional microscopic examination and serological IFA test were employed for diagnosis of malaria. The rates of agreement between microscopical and serological diagnosis were analyzed by Kappa test. 17.9% and 1.7% of the samples were microscopically diagnosed as P. vivax and P. falciparum, respectively. On the other hand, the serum samples were sero-positive with P. vivax and P. falciparum antigens in 54.2% and 32.1% of the samples, respectively. Serological IFA method could mainly determine the past history of malaria infection, but it was not helpful in detection of current infections. Moreover, there was no significant agreement between microscopical and serological (IFA) methods in diagnosis of malaria.

An essential determinant for designing accurate strategies in malaria control is the precise knowledge of local epidemiology, which is time and location dependent. This study was designed to analyze the data on the verified malaria cases, reported in the southeast Province of Iran, Sistan and Baluchistan, from March 2005 to 2008. All the reported cases of malaria in the mentioned period were defined and epidemiologic characteristics of each case were registered and statistically analyzed. The annual incidence rates were 469, 345, and 359 (per 100000) in the 3 consecutive years, respectively. Malaria patients were mainly 15-44 year old males, mostly living in the rural areas. Imported malaria from Afghanistan and Pakistan was considerable (15-20%). While malaria was more prevalent in the southern part of the province, the percentage of Plasmodium falciparum was higher in the western areas. The incidence of malaria reached its annual peak from July to October. This study clearly reveals that malaria is a significant disease in southeast Iran. The geographic pattern may implicate an important role of cross-border traffic in the importation of malaria in this area.

Pregnancy is regarded as a condition which is usually accompanied by oxidative stress. This study was undertaken to investigate the effect of maternal selenium supplementation during gestation on the level of oxidative stress in neonates and the pregnancy outcome. In this double-blind trial, 179 primigravid pregnant women in the first trimester of pregnancy were randomly assigned to receive 100 μg of selenium (Se group) or a placebo (control group) per day until delivery. The level of oxidative stress and serum selenium concentration was determined in the maternal and umblical cord sera of the subjects. Oxidative stress was measured by means of a novel assay of prooxidant-antioxidant balance (PAB). The incidence of any pregnancy complications and outcomes was also evaluated in all neonates, being fully examined and followed up until 45 days. Although maternal selenium concentration was significantly higher in the Se group (p<0.001), there was no statistically significant differences in the umblical cord selenium content between the two groups. Selenium supplementation was not associated with any significant decrease in PAB values in the Se group. The incidence of neonatal complications and outcomes did not differ significantly between the groups. Maternal selenium supplementation during pregnancy was safe but was not associated with a significant change in the extent of oxidative stress in neonates.

Medicinal plants have been investigated for possible anti-cancer effects. The aim of the present study was to examine the cytotoxic activity of several medicinal native plants on different tumor cell lines. Plants including Salvia santolinifolia, Salvia eremophil, Salvia macrosiphon, Salvia reuterana, Teucrium persicum, Anvillea gracini and Francoeuria undulate were collected from different sites of Fars Province in southern Iran. The methanolic extracts of the plants were prepared and their effects at concentrations of 5-200 μg/ml on various tumor cell lines were examined using a colorimetric assay. Among the extracts of Salvia species, the strongest inhibitory effect was observed for S. reuterana extract. This extract showed a strong cytotoxic effect on the Raji lymphoma cell line. More than 50% of Raji cells growth was inhibited by 21 μg/ml of this extract. S. macrosiphon extract also showed a strong inhibitory effect on this tumor cell line (IC50=77±1 μg/ml). The greatest inhibitory effect of T. persicum extract was on Hela tumor cell line. This extract at concentration of 69±2 μg/ml causes 50% inhibition of Hela cell growth. Corresponding data for A. gracini extract was obtained at concentrations of 83.5±2 and 86±3 μg/ml on Jurkat and Hela cells, respectively. F. undulata reduced the proliferation of all the tumor cell lines used in this study but this inhibition did not reach 50%. All the extracts, more and less, showed inhibitory effects on the tumor cell lines. The most cytotoxic activity was observed in S. reuterana with an IC50 value less than 25 μg/ml towards Raji cell line.

Some reports suggest that the cytokine gene polymorphisms can contribute to the resistance or susceptibility to brucellosis. The aim of this study was to find out any probable association of genetic polymorphisms of Interleukin-12 (+1188 A/C) and TNF-β (+252 A/G) with susceptibility to the disease. One hundred and ninety-six patients with brucellosis and 81 healthy farmers (controls) who owned infected animals and consumed their contaminated dairy products were included in this study. IL-12 (+1188 A/C) and TNF-β (+252 A/G) genotyping were carried out for all of the subjects. The results showed that the frequencies of IL-12 AA genotype and A allele were higher in controls than in patients while TNF-β AA genotype and A allele were significantly higher in patients compared to the controls. These findings suggest that the inheritance of the above-mentioned genotypes and alleles can be considered as genetic factors conferring resistance or susceptibility to brucellosis.

Squamous cell carcinoma (SCC) is the most common malignancy in the oral cavity. Angiogenesis is essential for development and progression of SCC. Recently, some studies have reported that mast cells play a role in tumor progression, via promoting angiogenesis. The aim of this study was to determine CD31 (an endothelial marker) expression and mast cell count in oral dysplastic lesions and SCC. The CD31 expression and mast cell count were investigated in paraffin-embedded specimens of 10 cases of fibroma (control group), 10 cases of epithelial dysplasia, and 20 cases of SCC. CD31 expression was examined by IHC and mast cell count was evaluated by Giemsa staining. The mean of CD31 expression did not show any significant difference between groups, but in the tumors, peritumoral stroma revealed a significantly higher CD31 expression than intratumoral stroma. A significant difference in the mast cell count was observed between the groups and between peri- and intratumoral stroma of SCCs. The mean of CD31 expression and mast cell count did not show any correlation. Pre- and posttreatment studies and double staining methods are suggested for more definitive results.

P-glycoprotein (P-gp), an ATP-dependent efflux pump, is a membrane protein encoded by MDR1 gene. P-gp has an important role in protection of the cell against xenobiotics and toxic compounds. Recently, a silent C3435T polymorphism in exon 26 of MDR1 has been reported to be associated with a decreased expression of P-gp in TT genotypes carriers compared with CC genotypes carriers. To evaluate the distribution of allelic variants of C3435T MDR1 in a group of healthy population in Iran and find the association between MDR1 C3435T polymorphism and the incidence of ALL, 126 patients with ALL and 139 healthy controls were included in our study and their MDR1 polymorphisms were detected by PCRRFLP assay. 71.9% of the healthy people had 3435TC genotype, 15.8% had 3435TT genotype and 12.2% had 3435CC genotype. Also, the frequency of T allele was 51.8% and C allele 48.2%. The mutant homozygous TT and TC genotypes were found to be associated with the incidence of ALL (OR=1.96 for TT genotype and OR=0.53 for TC genotype). MDR1 C3435T polymorphism may contribute to the incidence of ALL. TT genotypes carriers are more at risk of developing ALL than other genotypes carriers.

Non-alcoholic fatty liver disease (NAFLD) is one of the most prevalent liver diseases, being associated with type II diabetes mellitus, obesity and dyslipidemia. It seems that insulin resistance observed in those with type II diabetes or in obese persons plays an important role in the pathogenesis of NAFLD. The aim of this study was to evaluate the relationship between NAFLD and insulin resistance, disregarding obesity and diabetes. This case-control study was performed on those patients with NAFLD referring to Sari Imam Khomeini Hospital in 2007 after obtaining informed consent from patients. After repeated sonography and proved fatty liver, 80 patients were enrolled (34 cases and 46 controls) matched for age, gender and body mass index (BMI). NAFLD was documented in the case group, using ultrasonographic indices. Those in the control group were healthy. ALT and AST were normal in both groups. Fasting plasma glucose, fasting insulin, 2-hour oral glucose tolerance test (OGTT) and insulin-resistance were compared between the two groups. Insulin resistance was calculated using HOMA-IR formula. There were 20 men (58.8%) and 14 women (41.2%) in the case group with the mean age of 38.0±9.4 years. Those in the control group were 27 men (58.7%) and 19 women (41.3%) with the mean age of 39.4±10.5 years. There was no significant difference between the two groups concerning their age, gender or BMI. The mean level of FPG was 91.8±8.4 mg/dl in the case and 92.5±10.1 mg/dl in the control group. The mean level of OGTT was 110.9±18.8 mg/dl in the case group and 103.1±25.8 mg/dl in the control group and the difference was not significant. The mean levels of fasting insulin were 16.1±4.2 mg/dl and 10.3±4.8 mg/dl in the case and control groups, respectively (p<0.001). Insulin resistance was 3.6±0.8 μu/l.mmol/l in the case and 2.3±1.2 μu/l.mmol/l in the control group. Since the intervening factors were identical in both groups, we can conclude that the role of insulinresistance in the pathogenesis of NAFLD is not dependent on age, gender and BMI.

Hyperglycemia and hypocalcemia have separately been attributed to adverse outcomes in critically ill patients. This study aimed to investigate the simultaneous effects of the two conditions on mortality and morbidity in a pediatric intensive care unit. All children aged 1 month to 18 years, admitted for at least 24 hours to medical pediatric intensive care unit (PICU), Nemazee Hospital, Shiraz, Iran were reviewed over one year period. Those with a history of diabetes mellitus and any calcium disorders were excluded. Data on blood glucose and calcium during the first 6 hours of admission, in-PICU length of stay, need for mechanical ventilation, vassopressor drugs administration, and mortality were assessed. The incidence of hyperglycemia [≥150 mg/dl (8.3mmol/L)] and hypocalcemia [serum calcium < 8.5 mg/dl (2.12mmol/L)] were 26.5% and 43.9%, respectively. Hyperglycemia and hypocalcemia were associated with increased mortality. Among the survivors, hyperglycemia and hypocalcemia had no significant effect on PICU length of stay. The interaction of hyperglycemia and hypocalcemia did not intensify their separate effects on mortality, the need for mechanical ventilation and vasopressor infusion. Although hyperglycemia and hypocalcemia separately increase the mortality rate, their simultaneous presence is not associated with poorer outcomes in critically ill patients.

Accurate temperature measurement is crucial in pediatric population. Before diagnostic tests are implemented in practice، it is suggested that their accuracy or ability to discriminate to be studied. The accuracy of a diagnostic test can be summarized in a Receiver Operating Characteristic (ROC) curve. This study was carried out to compare the accuracy of tympanic and axillary methods with rectal measurement in children less than 6 years old. A total of 220 pair of ears، axillaries، and rectal sites were used to determine the body temperature in patients aged between 3 months and 6 years، who referred to Emergency Department of Ali Asghar Hospital affiliated to Bushehr University of Medical Sciences. Rectal temperature (RT) was considered as gold standard. Fever was defined as RT ³ 38oC. RT، axillary، right and left tympanic temperature were measured. Measure agreement was assessed by covariate-adjusted ROC regression. By comparing the area under the curves in Hanely method and the results from ROC regression analysis، we found out a significant agreement among the three measuring techniques and none of them was more accurate than the others. None of these techniques (axillary، right and left tympanic) was more accurate than the others and it is better to use a technique that is more convenient، painless، and safer than rectal temperature. We also propose using a modified parametric distribution-free ROC estimator which is conceptually easy and is simple to implement with the existing softwares for comparing the accuracy of medical tests.

One of the most common events, after the release of aortic cross-clamp in patients undergoing coronary artery bypass grafting surgery is reperfusion induced ventricular fibrillation, which occurs in 74% of 96% of patients. Regarding the controversies over the use of lidocaine or magnesium sulfate for the prevention of ventricular fibrillation following the release of aortic cross-clamp, this study was designed to compare the effectiveness of magnesium sulfate and lidocaine to suppress ventricular fibrillation. In a double blind, prospective, randomized, controlled trial study, 76 patients who were candidates for elective coronary artery bypass grafting surgery were divided into three groups including Group A (lidocaine, n=26), group B (magnesium sulfate, n=25), and group C (normal saline, n=26). Lidocaine (1.5 mg/Kg), magnesium sulfate (30 mg/Kg) and normal saline were administered 5 minutes before the release of aortic cross clamp. The incidence of ventricular fibrillation significantly decreased in patients receiving magnesium sulfate (12% vs. 26.9% and 44% in patients who received lidocaine and normal saline, respectively) There was no statistically significant difference between the groups with respect to age, ejection fraction (L/ min), anesthetic time (min), cross-clamping time (min), PH, HCT (%), and serum K+ level (meq). The administration of lidocaine and magnesium sulfate before the release of aortic cross-clamp reduces the incidence of postoperative ventricular fibrillation in adult patients undergoing coronary artery bypass grafting surgery with cardiopulmonary bypass. In our study, magnesium sulfate was more efficient in prevention of ventricular fibrillation than lidocaine. Administration of magnesium sulfate (30 mg/kg) caused no toxic effect and wais safe for patients undergoing coronary artery bypass grafting surgery with cardiopulmonary bypass.

The specific goal of this study was quality assessment the educational programs of basic and clinical sciences of Tehran University of Medical Sciences (TUMS) according to the graduates’ viewpoints. We obtained the list of all 1200 graduates of TUMS in 2007. Using a random generation table, 350 subjects were selected from the seven faculties of TUMS in proportion to the number of graduates from each faculty. The data collection device was a 15 item researcher-made questionnaire according to the existing problems in the educational system of the university. All the items of the questionnaire were constructed and standardized in terms of validity and reliability based on the latest reliable sources and textbooks on educational assessment (Likert indices). Cronbach alpha was estimated to be 0.85. The most satisfaction from educational programs in basic sciences and clinical sciences was related to practical skills (4.36±1.22) versus satisfaction with education (4.76±1.66). The quantity indices in basic sciences were 68.44% (3.42) which is in a fairly optimal range; for clinical sciences it was 77.2% (3.86), being also in an optimum range. TUMS must make an attempt to reach the optimal point in every educational aspect.

Earthquakes cause horrendous devastation with lots of deaths. This study was conducted to determine the patterns of thoracic injuries in the 2005 earthquake victims of Indian Kashmir referred to the CVTS Dept. of Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Soura, India. Of the 468 patients received by SKIMS, 87 patients had either isolated chest injuries or multiple organ trauma. Chest injuries were identified and categorized for appropriate management to be instituted. The patients were followed up for next four years for functional outcome. There were 51 females and 36 males. Their mean age was 35 years. 83.91% had isolated chest injuries while 16.09% had associated injuries. For patients with isolated chest trauma, the Mean Injury Severity Score (MISS) was 8.79 and for multiple organ trauma it was 36.42. 27.59% were treated conservatively, and 41.38% had only chest tube. 31.03% were operated; 37 surgeries were done. 87.36% of the patients showed excellent recovery in functional outcomes. Females have shown more long term PTSD than males. Massive calamities like earthquakes cause multiple types of injuries in the affected population. Categorization of the victims in different groups so as to provide specialized and multi-specialty integrated care is imperative. In accordance with earlier studies, we found that high MISS is associated with high mortality.

Geographic tongue (GT) is a fairly common and usually asymptomatic disorder that is often detected on routine dental examinations. Characteristic lesions appear as multiple, well-demarcated zones of erythema, concentrated at the tip and lateral borders of tongue. Although the etiology of the condition is unknown, it may be related to stress. The purpose of this study was to evaluate the association between GT and stress. This study was performed on 60 patients with GT and 60 patients without GT. All the patients filled a questionnaire and a psychologist evaluted them. The total mean score of stress was 19.8 in GT group and 15.8 in the control group. According to the results, there is an association between stress and GT. Decreasing stress in GT patients can lead to the healing of the lesion. Other factors that may be associated with GT should be studied in future.

Understanding the characteristics of blood donors donating in disasters may help predicting the blood safety and adequacy. We investigated the blood supply and safety during Bam earthquake in east of Iran. Both pre and post studies were performed on the donors without considering any control group in Shiraz blood donors after the earthquake and one month before it. We compared the demographic characteristics and prevalence of hepatitis B (HBV), hepatitis C (HCV) and HIV among them. Then, they were followed for 24 months to find out their return rate. The number of donors, especially first-time donors, was significantly increased after the earthquake. The prevalence rates of HBS Ag, HCV Ab, and HIV Ab were not significantly different. The return rate of the firsttime blood donors after the earthquake was lower than that of the first-time donors before it (P<0.05). The number of blood donors after the earthquake increased. In spite of the increased rate of the first-time donations, the prevalence of HBS antigen, HCV antibody and HIV antibody did not change. It seems that disaster has only a short-term effect on the desire of donors for donation.

Here we report a 20-year-old male, a known case of chronic granulomatous disease (CGD), who presented with fever and splenomegaly. After splenectomy, primary splenic Hodgkin’s disease was diagnosed. Immunohistochemistry confirmed the diagnosis (positive CD15 and CD30). With chemotherapy, his fever was subsided and now after 6 months, he is doing well. Although primary immune deficiencies have been reported to show an increased tendency to develop malignancies, until now there has been no report of a patient with CGD and Hodgkin’s disease.

Neuroendocrine tumors of the larynx comprise a rare group of tumors categorized as typical carcinoid, atypical carcinoid, small-cell neuroendocrine carcinomas, and paragangliomas. Atypical carcinoid type occasionally denotes carcinoid syndrome. Typical carcinoid is extremely rare. The primary diagnosis is based on light histochemical studies that should be confirmed by immunocytological and/or ultrastuctural investigation. The different biological behaviors of these tumors lead to a specific diagnosis of paramount importance.

Cholestatic jaundice is a potentially dangerous condition which is often misdiagnosed by paediatricians as physiological or breast milk jaundice. The two most common causes of neonatal cholestasis (NC) are biliary atresia (BA) and neonatal hepatitis (NH). Early and accurate differentiation of these two entities is very important as early surgery in BA improves the biliary drainage but the delay leads to irreversible hepatocellular damage. There has been much discussion over the value of hepatobiliary radioisotopic scans, liver histopathological features, serum g-glutamyl transpeptidase (GGTP) levels, and other tests which are widely used for differentiation of BA from NH. Stereology provides practical techniques for extracting quantitative information about a threedimensional material from measurements made on two-dimensional planar sections of the tissues. We suggest that the stereological study of different components of liver tissue may be useful in determining the function of liver and differentiating some liver diseases such as biliary atresia and neonatal hepatitis.

In the last few decades, the idea of being able to repair the brain by introducing new cells to repair the damaged areas has become an accepted potential treatment for neurodegenerative diseases. The stromal cell fraction of many tissues and organs has shown in vitro neurogenic differentiation; however, these cell types are limited by availability, invasiveness of extraction and in some cases limited proliferative capacity. Human endometrial adult stem cells have many clinical advantages over the other stem cells. Here, we propose the hypothesis that endometrial adult stem cells may be induced into neural cells.