Archives of Iranian Medicine
Volume:16 Issue: 1, Jan 2013

This study evaluated the outcome of a comprehensive, community-based healthy lifestyle program on cardiometabolic risk factors. The Isfahan Healthy Heart Program (IHHP) was a comprehensive action-oriented, multi-component intervention with a quasi-experimental design and reference area. IHHP targeted the population-at-large (n = 2,180,000) in three districts in central Iran. Data from independent sample surveys before (2000 – 2001) and after (2007) this program were used to compare differences in the intervention area and reference area over time after controlling for age, education level and income. The samples in 2000 – 2001 and 2007 included 6175 and 4719 participants in intervention area, and 6339 and 4853 in reference area, respectively. Multiple interventional activities were performed based on the four main strategies of healthy nutrition, increased physical activity, tobacco control and coping with stress. The prevalence of abdominal obesity, hypertension, hypercholesterolemia, hypertriglyceridemia and high LDL-C decreased significantly in the intervention area versus the reference area in both sexes. However the reduction in overweight and obesity was significant only in females (P< 0.05 for all). There were no significant changes in the prevalence of diabetes mellitus. In the intervention area, the prevalence of hypercholesterolemia decreased from 23.5% to 12.5% among females without any changes in females in the reference area (p < 0.0001). In males, hypercholesterolemia decreased significantly in both intervention area (18.5% to 9.6%) and reference area (14.4% to 9.8%; p = 0.005). Mean triglyceride levels had a significant decrease in the intervention area and a non-significant decrease in the reference area (p < 0.0001). A comprehensive healthy lifestyle program comprising preventive and promotional activities that considers both population and high risk approaches can be effective in controlling cardiometabolic risk factors in a middle-income country.

Diseases of the gall bladder have been reported to be the most common cause for non-obstetrical hospitalizations during the first year postpartum. Therefore we designed a prospective study to evaluate the incidence and natural outcome of pregnancy-related biliary sludge and stones, and to define the potential risk factors in a population of pregnant women in Sari, Iran. A total of 380 pregnant women were scheduled for three ultrasound assessments: 1) during the first trimester of pregnancy (9 – 12 weeks), 2) during the early third trimester (26 – 32 weeks), and 3) during the fourth to sixth weeks postpartum. The incidence of biliary sludge, new stones and progression from sludge to stones in addition to the probable risk factors were analyzed with the t-test and chi-square test as appropriate (SPSS software, version 15). According to the first ultrasonography, 14 (3.7%) participants had evidence of biliary sludge and 3 (0.7%) had gallstones. Among those with normal baseline ultrasound findings, 28 (7.7%) developed biliary sludge and 7 (1.9%) formed stones by their second ultrasound examination (P < 0.05). Among the 14 participants with biliary sludge in their first ultrasound assessment, 1 (7.1%) developed gall stone and sludge remained in the other 13 as seen on the third trimester ultrasound results. According to the third ultrasound (performed postpartum), out of 41 participants with prior biliary sludge, 16 (39%) had no evidence of sludge, 22 (53.7%) had persistent sludge, and 3 (7.3%) developed stones. Out of 11 participants with prior gallstones, 1 had a normal ultrasound postpartum, but stones persisted in the other 10 (P < 0.05). In those with stones, 9.1% underwent cholecystectomies postpartum. The incidence of sludge and stones significantly correlated with the number of pregnancies and higher age at pregnancy. Since the annual rate of pregnancy is high in Iran, pregnancy-related biliary disorders are important in this country. According to our results, the number of parities and age at pregnancy are potentially modifiable risk factors for lowering pregnancy-related biliary disorders.

Diabetic neuropathy is one of the most common complications of diabetes mellitus, of which it''s most prevalent form is chronic sensorimotor neuropathy. The aim of this study is to assess the prevalence of diabetic peripheral neuropathy (DPN) and its associated risk factors among diabetic patients who reside in Hamedan, Iran. A cross-sectional study of 600 types 1 and 2 diabetic patients was performed using the standard Neuropathy Symptom Score (NSS) and Neuropathy Disability Score (NDS) criteria for the diagnosis of diabetic neuropathy. Overall prevalence of DPN in this population was 45.7% (95% CI: 42.6%-48.8%). The prevalence of DPN in type 1 diabetic patients was 21.5%, whereas in type 2 diabetic patients it was 49.3% (P<0.001). Duration of diabetes and education level were significantly associated with DPN in type 1 diabetic patients and a history of foot ulcer, age, duration of diabetes, weight, education level, and sex had a significant association with DPN in type 2 diabetic patients according to multiple logistic regression analysis. The results of our study showed a relatively high prevalence of DPN in our diabetic population. A significant difference existed in the prevalence of DPN between types 1 and 2 diabetic patients.

The Consolidated Standards for Reporting of Trials (CONSORT) statement is a device to standardize reporting and improve the quality of controlled trials. The aim of this study is to determine the quality of controlled clinical trial reports by national peer-reviewed journals in Iran. In a cross-sectional study, we evaluated clinical trial reports by national peer-reviewed Iranian journals between 2008 and 2010 by CONSORT2010. The sample was selected from Iran Medex. The proportion of adherence to each item of the CONSORT checklist was assessed for each clinical trial. The reliability of evaluation by reviewers was calculated by Pearson correlation coefficient, and was determined to be 0.73 – 0.89, with a significance level of P < 0.01 between reviewers. A total of 509 articles published in 80 peer-reviewed national journals were evaluated. The average adherence of evaluated randomized controlled trials (RCTs) to the 37 items of the CONSORT statement was 43.8%. The mean CONSORT score significantly differed across each year of publication. None of the articles mentioned the location where the full trial protocol could be accessed. The quality of reporting RCTs published in national peer-reviewed journals needs significant improvement as the majority did not adhere to CONSORT guidelines. It is necessary for the editors of Iranian journals to consider CONSORT criteria for evaluation of all future RCTs.

α-1 antitrypsin (AAT) deficiency is one of the most important genetic causes of childhood liver diseases in some parts of the world, but its geographic distribution is highly variable. There are many reports from Asian countries such as India, the Philippines, and China which show a very low incidence of this disease. However few studies exist from Iran regarding this genetic deficiency as the cause for prolonged neonatal jaundice. In this study we attempt to investigate the possible role of AAT deficiency as a cause of prolonged neonatal jaundice in the largest pediatric referral center of Southern Iran. We included 126 neonates with the clinical diagnosis of neonatal cholestasis in this study. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was performed on the extracted DNA from their blood samples. DNA sequencing confirmed the results of the PCR-RFLP tests. All patients were genetically normal regarding level of AAT, i.e., all were MM homozygotes. AAT deficiency is a rare disease in Iran and is not a major cause of neonatal cholestasis in this country.

Facial involvement in psoriasis is accomplished with poor prognosis. In this study, clinical features and severity of psoriasis were compared between facial and nonfacial psoriasis involvement groups in Iran. It also evaluated these characteristics in different subtypes of facial psoriasis. One hundred and thirty- eight psoriatic patients having referred to our clinic entered in this cross- sectional study in 2006 – 2007. Medical information, whole body and scalp Psoriasis Area and Severity Index (PASI) scores were obtained. Variables were compared between the facial and nonfacial involvement groups and also in different subtypes of the former including peripherofacial (PF), centrofacial (CF), and mixedfacial (MF). A P-value of < 0.05 was considered as significant. We found 55.0% facial involvement in Iranian psoriatic patients. MF (52.6%), CF (28.9%), and PF (18.4%), respectively were the common forms of facial involvement. The median whole body and scalp PASI scores, the number of male participants, and tongue involvement were significantly higher in patients with facial involvement. Comparing different subtypes of facial psoriasis, whole body PASI and scalp PASI scores were significantly higher in MF subtype and lower in CF subtype. Despite the least severity in the latter subtype, psoriatic arthritis and geographic tongue were shown to be more common in this subtype. Moreover, relapse history was correlated with PF subtype. Facial involvement in psoriasis had significantly higher whole body and scalp PASI scores in Iran which may be an indication of more severe disease. This difference was more prominent in MF subtype.

To determine the distribution of mortality in 1 – 59 month-old children across Iranian provinces in a national mortality surveillance system. This national survey was conducted in 2009. A questionnaire was designed and standardized for collecting mortality data of children aged 1 – 59 months. The project team, consisting of collaborators from the whole 40 medical universities, filled in the questionnaires and returned them to the Ministry of Health and Medical Education (MOHME). The mortality in 1 – 59 month-old children was unequally distributed across provinces. The mortality was higher among children of less- educated mothers than in children of more- educated mothers. There was a reverse association between 1 – 59 months mortality and socioeconomic status across Iran as a whole and within most provinces. Our results suggest that socioeconomic distribution in mortality of 1 – 59 month-old children favors the better-off in Iran as a whole and in most of its provinces. Investigating why mortality is higher in some provinces deserves special attention. Furthermore, it is advisable to conduct provincially-representative surveys to provide update estimates of different health situations and to allow their monitoring over time.

The amnesic effect of morphine is well known in the laboratory animals. But, it is unclear that morphine at what times can exactly affect different phases of memory, including acquisition, consolidation, and retrieval. Therefore, we investigated the time profile of morphine''s amnesic effect on passive (inhibitory) avoidance learning and memory in male Wistar rats. In order to evaluate the outcomes of pre- and post-training administrations of morphine, the animals were trained in a step-through type of passive avoidance task at various time points, and were tested 24 h after training to measure memory retrieval. The results showed that acquisition of memory was impaired in the animals that received a dose of 7.5 mg/kg of morphine (Intraperitoneally) at 0, 30 min, and 1 h before training, as evidenced by a decrease in step-through latency on the test day. Post-training administrations of morphine at 30 min and 1h, 4h except for the time immediately after training, did not impair memory consolidation. The results also showed that pre-test administrations of morphine at 0 and 30 min before the test, impaired retrieval of inhibitory avoidance memory. Taken together, the results suggest that morphine, when injected at different time points before training, after training, or before testing affects different phases of inhibitory avoidance memory. With regard to the time of injections related to each phase, other experiments can be designed to investigate molecular mechanisms involved in the impairing effect of morphine in each phase.

In Iran, the measles, mumps and rubella vaccine (MMR) is administered in a two-dose protocol where the first dose is scheduled at 12 months of age. This study aims to determine the efficacy of the MMR vaccine by testing IgM and IgG antibody levels 4 – 7 weeks after primary vaccination. A single group cohort study was performed on healthy children, 12 – 15 months of age, who were vaccinated at health centers affiliated with Shahid Beheshti University of Medical Sciences in Tehran, from January to April 2009. Children with negative vaccination and/or clinical history for measles, mumps or rubella were administered the first dose of the MMR live attenuated vaccine. IgG and IgM antibodies were checked by enzyme linked immunoassay (ELISA) in serum samples 4 – 7 weeks after vaccination. A child was considered seropositive if antibody levels were higher than the assay cut-off level set by the ELISA kit. Samples from 240 children were checked for antibodies against measles and rubella. Measles serum IgM level was positive in 71.7% of samples and IgG in 75.8%. The rubella serum IgM level was positive in 71.7% of children and IgG in 73.8%. From 190 blood samples that were checked for mumps antibodies, serum IgM was positive in 68.9% and IgG in 95.3%. No significant relationship was found between seropositivity and age or gender. IgG and IgM antibody levels were below the assay cut-off levels against measles and rubella in approximately one-fourth of the children following primary MMR vaccination. A second dose was necessary to raise the level of protection against measles and rubella.

An important health problem in students is pediculosis capitis (head lice infestation) which causes physical, mental, and social complications. Social stigma induces feeling of shame, anger, and embarrassment for families and may prevent people from coming forward. This study was a quasi-experimental (case – control) study which was done during periods of 2008 – 2009. Data collection tools were questionnaire, checklist, and head examination. Two schools were randomly selected among female primary schools in Chabahar, where 153 students were divided into case and control groups. After collecting the data, an educational program was designed and performed in the experimental group and was evaluated after two months. The results showed a significant difference in knowledge, attitude, and practice of the students in the case group, before and after the intervention (P < 0.0001), but in the control group it was not significant (P > 0.05). The infestation rate was 69.3% in the case group before the intervention, and 82.1 % in the control group, which decreased to 26.7% in the case group after the education (P < 0.0001), but there was no significant difference in the control group (P < 0.05). The health education program had a positive effect on the reduction of pediculosis capitis among students; thus, it is suggested to perform and evaluate educational programs in students and their parents.

The Gastro-Esophageal Malignancies in Northern Iran (GEMINI) research project is an example of recent progress in health research in Iran. The original aim of this project was to identify etiologic factors and prevention measures for upper gastrointestinal cancers in Northern provinces of Iran, but its achievements have gone much beyond this initial goal. GEMINI consists of several projects including cancer registries, pilot studies, case-control studies, and the Golestan Cohort Study. GEMINI has been conducted through extensive collaborations between the Digestive Disease Research Center of Tehran University of Medical Sciences with other domestic and international health organizations. The achievements of GEMINI include producing new knowledge, introducing new research methods, developing and expanding health research and health care infrastructures, investing in human resources, and increasing the awareness and knowledge of policy makers and officials at all levels about the importance of chronic diseases in Iran’s health priorities. The success of GEMINI reveals the feasibility of large-scale health research studies in developing countries and serves as a successful model not only for health research in Iran, but also for similar research studies in other developing nations.

Rectovaginal fistula (RVF) is one of the intractable complications following chemoradiation and total mesorectal excision (TME) for rectal cancer. It is supposed that there is a strong possibility of this complication occurring in patients after radiation therapy and having underlying sepsis. We describe herein two female patients (73 and 40 years old) who developed RVF after chemoradiation and TME for rectal cancer, who were successfully managed by gracilis muscle transposition. Fecal diversion was done as a preliminary step to the fistula repair. Success was defined as healed fistula after stoma closure. The strategy in the present report is a useful option for RVF management in such patients as other successful modalities are very limited.

Congenital absence of the abductor pollicis brevis is a very rare condition and is usually associated with other congenital anomalies. Here we report a case of bilateral congenital absence of the abductor pollicis brevis without any other abnormalities, which has not been previously reported. A 24-year-old Caucasian male patient presented to our clinic with flattening in the palmar region, pain and discomfort in writing, and weakness in both hands. USG and MRI revealed bilateral absence of the abductor pollicis brevis muscle. Bilateral congenital absence of the abductor pollicis brevis muscle requires no treatment due to satisfactory hand function, and results in cosmetic problems. Congenital absence of the abductor pollicis brevis muscle should be kept in mind in patients with flattening of the thenar eminences.