Archives of Iranian Medicine
Volume:16 Issue: 10, Oct 2013

Coronary angiography is the most accurate and standard method for investigating the anatomic status and blood supply to the heart tissue; however, this method has been overused during the past decade. The present study aimed to investigate the appropriateness of coronary angiography in the patients referred to the selected hospital clinics in Shiraz, Iran. This study included 280 outpatients who were referred to seven selected hospitals of Shiraz for coronary angiography. In order to collect the data regarding the patients and the angiography use, a questionnaire and a checklist were utilized. All the analyses were performed in SPSS, version 15. Among 280 angiography cases, 206 (73.6%), 34 (12.2%), and 40 (14.3%) cases were considered as appropriate, uncertain, and inappropriate, respectively. Due to the 40 cases of inappropriate use of angiography, 19000 US dollars have been imposed on the insurance organizations as well as the patients. Senior managers of healthcare centers are recommended to pay special attention to the performance of diagnostic as well as therapeutic procedures according to the reliable and standard guidelines. Besides, insurance organizations and other institutes which reimburse the expenses should consider the appropriateness of application of angiography as a basis for the imbursement.

Prenatal diagnosis of β-thalassemia carrier couples has helped to prevent bearing affected children. Among 177 couples referred to our laboratory for prenatal diagnosis, 14 mothers had twin pregnancies. By using direct and indirect methods, we determined their mutations and linkage analysis using polymorphic markers (restriction fragment length polymorphism [RFLP]). It was shown that in five families both fetuses were heterozygote carriers. In another five families, one fetus was normal and the other one was carrier. In two families, one fetus was affected and the other one was heterozygous carrier; in one case one fetus was affected and the other one was homozygote normal. In the last family both fetuses were homozygote normal. If all fetuses were fraternal then one would expect to see seven homozygote normal and the same number affected, and 14 carriers. Our results indicated that at least in cases where both fetuses had identical genotypes, then they may be identical twins. Molecular testing indeed showed that in three cases the twins were identical.Another point is that in three cases, one of the twin fetuses was affected and the other one was either normal or heterozygote in which only the affected fetuses were aborted by the specialist.

The increase in mortality and morbidity of traumatized patients in developing countries might be due to disorganized medical services and credit tightness. This study was designed to describe the characteristics of injury, the strategies for the trauma prevention, and to improve the healthcare system. This was part of a national research project about trauma, conducted in the main trauma center of Mashhad, in North East Iran; it was a prospective cross-sectional study which comprised of all consecutively admitted patients to the emergency department from December 2003 through July 2004. Most of the traumatized patients were male, uneducated, housewives, or workers. Motor vehicle accidents (during the time when fastening seat belts and wearing helmets were not compulsory) and falling (height less than four meters and falling on the ground) were considered as the most common mechanisms. Almost 68.5% of the patients transferred to the hospitals did not have prehospital care. With an average injury severity score (ISS) value of 10.3, lower extremities and head and neck were the most common traumatized anatomic areas leading to their related morbidity and mortality. A large number of traumatized cases among uneducated and nonoccupational population makes the role of mass media more prominent. Public education about traffic law, streets, and vehicle security check seems to be crucial to decrease the mortality and morbidity.

Medications, a main strategic commodity in any country, are strictly related to community health and sustainable development. Self-medication and irregular use of medications can increase their adverse effects. This study investigated the factors related to irregular and arbitrary use of medications in pregnant women admitted to health centers and clinics of Yazd, Iran, and their practice in this context. This was a descriptive- analytic cross-sectional study conducted among 180 pregnant women. Participants were selected by cluster sampling. We chose six health centers and clinics from all medical centers in Yazd by a simple random method. A questionnaire was completed by the pregnant women who were consecutively admitted to each center. Data were analyzed by ANOVA, t-test, Chi-square, and Pearson tests with SPSS-15 software. More than 35% of the women self-medicated during pregnancy. Women with academic degrees scored higher in the knowledge section; however, this difference was not significant. The mean attitude scores for academic and nonacademic graduates were 34.92 (from 60) and 29.87, respectively while the mean practice scores were 15 (from 20) and 14.25 for academic and non-academic graduates, respectively. The results of this study showed an increased prevalence of self-medication among pregnant women. Because of potential fetomaternal hazards related to medications, it is necessary to conduct educational programs to prevent this harmful habit and attitude in pregnant women.

This study aimed to investigate the prevalence, metabolic risk factors, and thyroid dysfunction among a healthy urban population. In a cross-sectional study, the patients were evaluated for nonalcoholic fatty liver disease (NAFLD) using ultrasonography. The participants’ characteristics such as age, sex, weight, height, body mass index (BMI), waist circumference, hip circumference, waist-to-hip ratio, systolic and diastolic blood pressure, and history of diabetes, ischemic heart disease (IHD), hypertension, and hyperlipidemia were recorded using a data gathering form. The patients were compared to those without NAFLD in terms of metabolic factors and thyroid abnormalities. From 832 participants, 127 (15.3%) individuals had NAFLD. Metabolic syndrome was detected in 39 participants (30.70 %) with NAFLD and in 85 participants (12.05%) without NAFLD (P < 0.001) (OR: 3.22; 95 % CI: 2.07–5.01). In multivariate logistic regression analysis BMI, waist-to-hip ratio, and higher serum ALT levels were independent predictors for NAFLD (P < 0.001). There was no statistically significant difference in serum TSH, free T4, and free T3 levels between the participants with NAFLD and the participants without NAFLD (P > 0.05). Neither hypothyroidism nor markers of thyroid autoimmunity were associated with NAFLD in our study population (P > 0.05). Serum TSH was categorized according to 25th, 50th, and 75th percentile to <1.29 mIU/L, 1.29–1.91 mIU/L, 1.91–2.77 mIU/L, and >2.77 mIU/L. Compared with non-NAFLD participants, the diagnosis of NAFLD was significantly higher in the low TSH group (P = 0.004). Central obesity as reflected by waist-to-hip ratio is one of the major risk factors for NAFLD. However, thyroid dysfunction was not correlated with NAFLD and the observed alterations in thyroid hormones are due to sick euthyroid syndrome.

Following the Islamic Revolution of 1979 in Iran, the trend of migration of physicians from the country continued. The total number of Iranian physicians migrated to the United States (US) increased from 1625 before revolution in 1974, to 5045 in 2010, thirty years post-revolution. The percentage of medical graduates migrating to the US, in the same period dropped from 15% to 5%. The reasons for this drop were restrictions imposed, along with creation of good postgraduate residency and fellowship programs in Iran. Following the revolution, the number of medical schools increased from 13 to 48. Despite all the restrictions and impediments for post-revolution medical graduates, over 500 medical graduates from newly established medical schools found their ways into the healthcare system of the US. In spite of all hardships of eight years of imposed war, and 30 years of the US sanctions, Iran has been able to maintain good progress in its healthcare, education, and research in medicine and other branches of science and technology.

About 44 million induced abortions take place worldwide annually, of which 50% are unsafe. The results of studies investigated the induced abortion rate in Iran are inconsistent. The aim of this meta-analysis was to estimate the incidence rate of induced abortion in Iran. National and international electronic databases, as well as conference databases until July 2012 were searched. Reference lists of articles were screened and the studies’ authors were contacted for additional unpublished studies. Cross-sectional studies addressing induced abortion in Iran were included in this meta-analysis. The primary outcome of interest was the induced abortion rate (the number of abortions per 1000 women aged 15–44 years in a year) or the ratio (the number of abortions per 100 live births in a year). The secondary outcome of interest was the prevalence of unintended pregnancies (the number of mistimed, unplanned, or unwanted pregnancies per total pregnancies). Data were analyzed using random effect models. Of 603 retrieved studies, using search strategy, 10 studies involving 102,394 participants were eventually included in the meta-analysis. The induced abortion rate and ratio were estimated as 8.9 per 1000 women aged 15–44 years (95% CI: 5.46, 12.33) and 5.34 per 100 live births (95% CI: 3.61, 7.07), respectively. The prevalence of unintended pregnancy was estimated as 27.94 per 100 pregnant women (95% CI: 23.46, 32.42). The results of this meta-analysis helped a better understanding of the incidence of induced abortion in Iran compared to the other developing countries in Asia. However, additional sources of data on abortion other than medical records and survey studies are needed to estimate the true rate of unsafe abortion in Iran.

Methadone detoxification is among the widely used treatment programs for opioid dependence. The aims of this study were to identify which patient baseline factors and treatment regimen features are predictors of the treatment outcome in an outpatient flexible dose-duration methadone detoxification program. We studied 126 opioid dependents in a naturalistic nonexperimental clinical setting. The patients were assessed for baseline demographic characteristics, and drug abuse characteristics. Treatment regimen features were recorded during the program. Successful treatment completion was defined as the last daily dose of methadone being less than 15 mg, negative urine analysis in the last two weeks of treatment, and based on the final clinician-client’s decision. Out of 126 patients, 60 patients completed detoxification successfully. Younger age, longer duration of the opioid abuse, and higher subjective opiate intoxication severity before treatment entry were all significantly associated with negative treatment outcome. Among treatment regimen features, higher maximum methadone dose had a marginally significant independent effect on treatment failure. Patients with maximum methadone dose of more than 75 mg per day had around ten times worse success rate when compared to those who received lesser doses.The study findings could be used to predict treatment outcome and prognosis in a more individualized and patient-tailored approach in the real clinical setting. Guideline development for treatment selection and outcome monitoring in addiction medicine based on similar studies could enhance treatment outcome in clinical services.

Splenic angiosarcoma is a rare and aggressive malignancy with an incidence of less than one per million and a fatality rate over 90%. Early diagnosis is of great importance for optimal management. Here, we report the case of a patient with splenic angiosarcoma who presented with prominent schistocytes, echinocytes, thrombocytopenia, and iron deficiency anemia, which in combination with radiographic evidence of a splenic mass, raised the suspicion for angiosarcoma and resulted in a prompt surgical intervention with curative intent. Resolution of the hematologic findings following splenectomy suggests that patients with this malignancy should be monitored for recurrent hematologic abnormalities as they may herald recurrence of the disease. We present a literature review on the hematologic manifestations that is associated with this malignant disease.

Primary intracranial leiomyosarcomas are rare tumors that arise from the mesenchymal cells of the dura mater or cerebral blood vessels Here we report the case of an extra axial leiomyosarcoma in the right parieto-occipital region of a 19-year-old male who had normal clinical and laboratory findings. Diagnostic imaging showed bony destruction, dural involvement and no parenchymal invasion. No primary site was found after metastasis work up. Specific serology tests were negative. The patient underwent a craniotomy, total tumor resection, duraplasty and skull reconstruction. He received radiotherapy and after 18 months of follow-up, no clinical and radiological signs of recurrence have been found.

We report a 45-year-old male presenting with an intraoral mass originating from the right maxillary alveolar ridge. Radiologic investigations revealed osteolytic lesions in the right maxilla, skull, and lumbar vertebrae. This finding led to further investigations like electrophoresis of serum proteins for M band, quantitative estimation of immunoglobulins, urine electrophoresis for monoclonal light chain, and bone marrow biopsy. All these findings were inconclusive. Incision biopsy revealed the features of plasmacytoma. Since the other reports were incongruent with the histopathology report, for establishing a diagnosis of plasmacytoma, Immunohistochemistry of the specimen was done which revealed it to be a case of plasmablastic plasma cell neoplasm favoring plasmablastic lymphoma. The diagnostic confusion which arose in this setting is discussed in details.

The history of human and animal cancers date back to antiquity. The earliest written document on cancer appeared on Egyptian papyrus. For centuries, the theory of «four humors» was the primary hypothesis that explained the cause for cancer. Finally, in the 19th century a new era began with the detection of the cellular origin of cancer; in due course, the nature of this lethal disease was better recognized and led to further achievements in cancer treatment. During the 20th century researchers investigated several risk factors for cancer such as tobacco smoking and environmental chemicals, in addition to the carcinogenic role of certain viruses, occupational association of cancer, its relationship with certain hormones and dietary habits, and the genetic basis of cancer. These investigations resulted in more efficient cancer management. After the advent of radiotherapy and chemotherapy as two complementary therapeutic modalities to surgery, the campaign against cancer has improved. However, cancer remains a major health challenge that accounts for substantial morbidity and mortality worldwide. The present paper briefly reviews the history of cancer in Iran, particularly during the last decades of the 20th century.