Archives of Iranian Medicine
Volume:14 Issue: 2, Mar 2011

The purpose of this study was to examine whether the degree of air trapping in high resolution computed tomography (HRCT) of patients with histories of sulfur mustard gas exposure during suspended full expiration correlated with various parameters of the cardiopulmonary exercise test as the gold standard for assessment of pulmonary function. In this analytic study 75 male patients, each with a history of sulfur mustard gas exposure, were investigated. Each participant underwent an incremental cardiopulmonary exercise test, pulmonary function test and arterial oxygen saturation for hemoglobin measurement. For HRCT examination, both lungs were divided into three parts (upper, middle, and lower) and in each part images were separately observed from the involved area point of view (<25% = <6/24; >25% = >6/24). A total of 49.3% of the patients (37/75) had evidence of air trapping in over 25% of their lung segments. The mean age±SD in the patients with air trapping of ≥25% or <25% were 41.1±6.8 and 39.7±4.0 years, respectively (P=0.281). In our study there was no significant difference in pulmonary function test findings (FEV1, FVC and FEV1/FVC) between the two groups. There was no significant correlation with air trapping of ≥25% and any of the exercise test parameters. Also, no correlation was found between significant air trapping and exercise test findings in maximum exercise and anaerobic situations. No correlation was found between HRCT and cardiopulmonary exercise test findings. HRCT is neither pathognomic of the disease nor a good predictor of disease severity but it might be suggestive of mustard lung injuries.

Several adverse events following immunization (AEFI) have been attributed to immunization with live attenuated measles, mumps, and rubella (MMR) vaccines. The MMR vaccine was introduced into the routine infant immunization schedule in 2003, followed by a second dose of vaccine at school-entry for children 4 to 6 years of age. The objective of this study was to characterize adverse reactions following MMR vaccination in Iran. Children who received the MMR vaccine and resided in five selected provinces of Iran were examined weekly for four weeks to detect well-known AEFIs that included: parotitis, fever and convulsions, convulsions without fever, encephalopathy, and anaphylactic reactions. Incidence of AEFIs were calculated and compared among recipients in both age groups. During the follow-up period, trained providers reported 792 AEFIs. Parotitis was the most frequent event occurring in 1.8% of recipients. Of 14,109 children vaccinated at 12 months of age the following AEFIs occurred: parotitis (147), fever and convulsions (8), convulsions (7), encephalopathy (1), and anaphylactic reactions (1). Of 29,338 children vaccinated at 4 to 6 years of age, parotitis, fever and convulsions, encephalopathy, and anaphylaxis occurred in 626, 5, 1, and 1 child, respectively; no convulsions without fever were reported in this age group. Parotitis is the most frequent AEFI among MMR vaccine recipients in Iran. Incidence rates of AEFIs following MMR vaccination in Iran are similar to rates of AEFIs reported in other studies.

Despite the suitability of a mouse model for preclinical investigations; little is known regarding mesenchymal stem cells derived from murine amniotic fluid. This is the subject of the present study. Amniotic fluid was collected from NMRI mice during the second weeks of pregnancy and plated. The cells that adhered to the culture surfaces were propagated with three successive subcultures and then characterized. To determine the differentiation potential, the cells were cultivated under osteogenic, adipogenic, and chondrogenic conditions, and followed by specific staining and RT-PCR analysis for differentiation. The proliferative potential of the cells were measured with clonogenic assays, population doubling time and number and by growth curve plotting. Cellular aging was investigated with the senescence-associated ß-galactosidase staining method. The amniotic fluid primary cell culture was composed of round flattened and fibroblastic cells. The latter dominated the culture after several passages. Successful tripotent differentiation of the isolated cells into bone, cartilage and adipose cells were indicative of their mesenchymal stem cells nature. The isolated cells appeared to be relatively proliferative cells as confirmed by the population doubling time value which was equal to about 69 hours. Furthermore, the cells were relatively clonogenic and they tended to initiate proliferation immediately after plating (there was no lag phase in their growth curve). ß-galactosidase positive cells were first observed at passage 3 and increased in number with subsequent passages. Collectively it was concluded that murine amniotic fluid contained mesenchymal stem cells with relatively high proliferation property and typical tripotent differentiation potential.

Increasing demand for memory assessment in clinical settings in Iran, as well as the absence of a comprehensive and standardized task based upon the Persian culture and language, requires an appropriate culture- and language-specific version of the commonly used neuropsychological measure of verbal learning and memory, the Rey Auditory Verbal Learning Test (RAVLT). The Persian adapted version of the original RAVLT and two other alternate word lists were generated based upon criteria previously set for developing new word lists. A total of 90 subjects (three groups of 30 persons), aged 29.75±7.10 years, volunteered to participate in our study and were tested using the original word list. The practice effect was assessed by retesting the first and second groups using the same word list after 30 and 60 days, respectively. The test-retest reliability was evaluated by retesting the third group of participants twice using two new alternate word lists with an interval of 30 days. The re-administration of the same list after one or even two months led to significant practice effects. However, the use of alternate forms after a one-month delay yielded no significant difference across the forms. The first and second trials, as well as the total, immediate, and delayed recall scores showed the best reliability in retesting by the alternate list. The difference between the generated forms was minor, and it seems that the Persian version of the RAVLT is a reliable instrument for repeated neuropsychological testing as long as alternate forms are used and scores are carefully chosen.

Screening can prevent colorectal cancer from becoming advanced by early detection of precancerous lesions. Cost-effectiveness analysis of colorectal cancer screening methods is highly necessary due to increased prevalence, decreased age at onset and the limited budget in Iran. Methods of screening currently available in Iran were selected. A systematic search revealed the sensitivity and specificity of each method. For this study, a model for a 20 year screening period of a population of 100000 apparently healthy persons of ages 45 – 65 years in Isfahan Province was used. The cost-effectiveness of each method and the ratio of cost-effectiveness were calculated based on this model. The most and the least effective methods were CT colonography and fecal occult blood test, respectively. The highest and lowest expenditures in the governmental sector were related to fecal occult blood test and flexible sigmoidoscopy and in the private sector, to CT colonography and fecal occult blood test, respectively. The cost per cancer detected in 20 years of screening in the governmental sector was 0.28, 0.22 and 0.42 billion Rials, respectively for screening by colonoscopy, flexible sigmoidoscopy and fecal occult blood test. In the private sector, these were 1.54 (colonoscopy), 1.68 (flexible sigmoidoscopy), and 1.60 (fecal occult blood test) billion and 2.58 billion Rials for CT colonography, respectively. Although CT colonography is the most effective method, it needs a budget of 2.58 billion Rials for each screened patient. If costs in the governmental sector are considered, flexible sigmoidoscopy would be the most cost-effective method for screening the 45 – 65-year-old population in Iran.

Celiac disease has been reported to be associated with gastric abnormalities. The aim of this study was to assess the relationship between the prevalence of celiac disease and Helicobacter pylori infection in an Iranian population of 250 patients. Biopsies were taken from the gastric antrum and duodenum. Morphology and histology were evaluated using the updated Sydney system and modified Marsh criteria, respectively. To simplify the interpretation of gastric lesions we classified gastritis in macroscopic and microscopic stages. Serology for anti-tissue transglutaminase antibody was performed to determine the presence of celiac disease. Among 250 patients, 232 (93%) had histological evidence of Helicobacter pylori infection. Histological abnormalities (Marsh I to IIIc) were present in 24 (10%). Of 24 patients, 20 (83%) with histological abnormalities were infected with Helicobacter pylori. Of 250 patients, 25 (10%) had a positive anti-tissue transglutaminase antibody. Of 25 anti-tissue transglutaminase antibody positive patients, 9 (3.6%) had microscopic and macroscopic enteritis (Marsh I to IIIc). Clinical presentation of celiac disease was not distinguishable from cases infected with Helicobacter pylori. Histology, even in patients with positive serology, was non-specific and unhelpful. We found a high prevalence of Helicobacter pylori infection and chronic gastritis, but neither was associated with celiac disease, in agreement with studies in Western populations.

This report analyses an experience with 42 liver resections for metastatic colorectal carcinoma. Forty-two patients underwent curative resection for liver metastasis from colorectal cancer between January 2004 and December 2007, with a follow up period that ranged from 3 to 66 months. In this retrospective study, early postoperative 30 day mortality and morbidity in addition to the effects of Dukes’ stage, type of resection, number and size of the tumor, synchronous or metachronous metastases, resection margin, sex, age and chemotherapy protocol on three year survival were analyzed retrospectively. Univariate analyses of survival were estimated using the Kaplan-Meier method. Multivariate analysis was evaluated using Cox regression method. The value of P<0.05 was accepted as significant. Early postoperative morbidity and mortality rates were 7.14% and 0%, respectively. Fourteen patients died during the follow-up period of 3 to 66 months (mean, 40.40±12.87). Median survival was 56 months and three year survival rate was 71.30%. Recurrence occurred in 11 patients (26.00%) after liver resection and additional surgery was performed for two of them. At univariate analysis, the number of tumors (<4), tumor size (<4 cm), type of resection and negative resection margins were significantly correlated with three year survival. Sex, age, Dukes’ stage, synchronous or metachronous metastasis, recurrence and chemotherapy protocol were not predictive of long-term prognosis. Multivariate analysis revealed that tumor size >4 cm and presence of more than four tumors before surgery were associated with a 5.89 and 2.18-fold increased risk of death, respectively. Curative resection is one of the most important treatment options that can demonstrate long-term survival for patients.

Wrong beliefs about risky actions such as sunbathing and tanning are common due to media advertisements or general lack of knowledge. This work has focused on the knowledge and attitude of a group of citizens in Tehran, Iran and the protective actions they take regarding undesirable effects of the sun. A descriptive-analytic cross-sectional study has been conducted on 400 randomly selected individuals from the citizens of Shahrak-E-Gharb, an area in northwest Tehran. A questionnaire comprising 24 questions including demographic information, individuals’ knowledge about sun exposure, and their opinions and behaviors on protective actions towards solar radiation were used to assess study objectives. Crude and adjusted odds ratios and 95% confidence intervals for socio-demographic factors were calculated through univariate and multivariable logistic regression. The majority of participants had good knowledge about sun protective behaviors. Knowledge about sun exposure duration and tanning was higher among women and those with higher education. As for attitude, only 15% were concerned about skin cancer and 61.8% thought skin cancer can be prevented by sun protection. Higher education was associated with a more positive attitude towards tanning. Among respondents, 41% had suitable clothing to protect themselves against sun burn and only 32% used sunscreen most of the time. University graduates had significantly better practice towards using sunscreen cream compared to high school graduates. Although our study sample possessed good knowledge towards sun protection, their attitude and practices were unsatisfactory. Thereby, they need to be informed and educated as how to be safely protected against excessive sun exposure.

Iran is presently designing a long-term plan for promoting science, technology and innovation in medicine. An important part of this plan will be a strategy for future planning for medical education considering the important trends affecting the future of health status and medical education in Iran. Here, we sought to clarify such trends in Iran and compare them to trends reported for similar developing countries. For this qualitative study, the opinions of stakeholders and experts were obtained during three focus group discussions, each lasting four hours and including 10 – 12 participants (132 total man-hours). Data were collected using audiotapes, which were then transcribed. Interim analysis was used for member checking and triangulated data from other recent studies were used to increase the trustworthiness of findings. Participants identified the following trends as affecting the health system and medical education in Iran: aging of the population; epidemiologic transition; changes in patients’ expectations of health services; increases in the popularity of alternative and traditional Iranian medicine; growth in information and communication technologies; changes in the roles of tutors; new emphasis on basic sciences and new and interdisciplinary fields; increases in the emphasis on research and scientific production; loss of educated persons to other countries (e.g., brain drain); and new advances in diagnostic and therapeutic technologies. The circumstances and future of a given community’s health should be kept in mind when policymakers plan for changes in medical education. The present study found that trends affecting healthcare and medical education in Iran are similar to those in other countries (even developed countries), suggesting that Iranian policymakers could potentially adopt the policies and strategies that have proven useful in other countries when planning for medical education.

Air pollution is defined as: “the contamination of air by unwanted gases, smoke, particles, and other substances.”1 In recent decades, in many large and crowded cities of developing countries, traffic-related air pollution (TRAP) is a major public health concern. Exhaust emissions of motor vehicles are the foremost source of outdoor air pollution in developing countries. The combustion of substandard fossil fuels such as leaded gasoline also enhances air pollution. Temperature inversion is another contributing factor, particularly during cold seasons.2 The elderly, children and those with cardiopulmonary disorders are mainly at risk from TRAP. Additionally, TRAP adversely affects the socioeconomic status of highly polluted cities.

A 49-year-old female presented with autoimmune hemolytic anemia and positive warm antibodies. She was diagnosed with chronic pulmonary sarcoidosis. The patient was given prednisolone after which she had complete remission of autoimmune hemolytic anemia and stabilization of her pulmonary status. A review will follow on association of sarcoidosis with autoimmune disease and its possible role in the development of such phenomenon.

Thyroid carcinoma is not uncommon in patients with hyperthyroidism. However, the risk of malignancy in patients with autonomously functioning nodules continues to be underestimated in clinical practice, possibly due to the belief of rare co-existence of a “hot” nodule and thyroid carcinoma. We present hereby a man with hyperthyroidism due to a thyroid toxic adenoma, who was subjected to surgery and incidentally found to have a papillary thyroid microcarcinoma on the contralateral thyroid lobe. By reviewing the literature, incidental thyroid carcinoma in patients subjected to thyroidectomy for a hyperfunctioning nodule, both within and out of the nodule is not a rare event. However, the incidental finding of thyroid carcinoma out of a hyperfunctioning nodule is not adequately reviewed in the literature.

The syndrome of hemiparkinsonism-hemiatrophy is an uncommon form of secondary Parkinsonism that presents with unilateral body Parkinsonism plus variable atrophy on the same side. Diagnosis of this syndrome needs a complete past medical history taking, as well as assessment of the familial history, clinical examination and complete paraclinical tests. The response to medical therapy has been variable in various researches. This case showed a good response to the addition of a dopamine agonist to levodopa therapy.

This manuscript offers a brief review of the orthopedic subjects in the Canon of Medicine. Highlights include, but are not limited to, the anatomy of the musculoskeletal system, fractures and dislocations, nerve and tendon injuries, different types of wounds and ulcers, and bone infections. Some of the concepts regarding musculoskeletal disorders remain relevant to current orthopedic knowledge. Reviewing the orthopedic subjects in the Canon of Medicine reveals that Avicenna has made a significant contribution to the evolution of orthopedic knowledge.