Medical Journal of The Islamic Republic of Iran (MJIRI)

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Non-epithelial, benign extracranial neurogenic tumors of the nasal cavities are reported in the literature with extreme rarity. These tumors differ from the more common congenital gliomas, encephaloceles, etc. in that they sometimes are detached from the brain tissues. These tumors have intracranial origins. They are congenital or acquired and may involve any of the nerves inside the nose. These tumors can grow to quite a large size and in such cases, lateral rhinotomy is often necessary for complete excision.

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The "Tehran Blood Pressure Study" (TBPS) is an observational cross-sectional study performed on men and women aged 15 years or more during the years 1990-1991. The study has been designed and performed by the Tehran University of Medical Sciences' Cardiovascular Research Center, with the primary objective of determining the prevalence and distribution of high blood pressure in Tehrani adults. In addition, awareness levels, control rates, and the prevalence of other cardiovascular risk factors among those with high blood pressure, as well as associations between blood pressure (BP) levels and certain epidemiologic and anthropometric factors have been studied. The study population comprised 10180 male and female inhabitants of Tehran aged above 15, selected by random sampling in 50 districts of the city. The mean and the 95% confidence interval for systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 123 (122.8-123.4) and 75.4 (75.2-75.6), respectively. The prevalence of high blood pressure (SBP≥ 140 mmHg or DBP> 90 mmHg or drug consumption) was 17.6% in males, 17.9% in females, and 17.7% in generaL About 47% of the patients with high DBP readings were aware of their condition. In 20% of these, control of hypertension had been achieved by drug therapy in 11 %, drug therapy had failed to control hypertension, and 16% were not receiving treatment despite their awareness. High body mass index and a history of diabetes were more frequent in those with high BP readings than the general population. Of those with high BP readings, most had only mild elevations of BP (90≤ DBP≤99 or 140≤SBP≤159). Isolated high systolic blood pressure (SBP ≥140 mm Hg and DBP< 90 mmHg) was found in 36% of females and 30% of males aged above 64. The noticeable prevalence of high BP, the remarkable prevalence of isolated high systolic blood pressure in the elderly, the very low level of patient awareness and low control rates all necessitate the adoption of appropriate personal and community health policies.

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A rare case of diffuse lymphomatous polyposis of the gastrointestinal tract is reported in which the patient presented with abdominal pain, weight loss and bloody diarrhea. X-rays revealed multiple polyps involving the stomach, small intestine and colon. Biopsies confirmed the diagnosis of lymphomatous polyposis. The duration of symptoms and signs was 3 months. Diffuse lymphomatous polyposis of the gastrointestinal tract is a distinct entity, separated from diffuse gastrointestinal lymphoma or Mediterranean-type lymphoma

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A retrospective study was done on 130 AML patients treated in Shariati and Imam Hospitals in Tehran from 1991 to 1997 to investigate the value of three post-remission methods of treatment. All patients who were in complete remission (CR) (Group I) had been treated with ARA-C (300 mg/m2/day continuous infusion for 5 days) and Daunorubicine (45 mg/m2/day for 3 days) as induction and early consolidation therapy. Forty patients were treated by additional similar chemotherapy as second consolidation and no further treatment was offered. Fifty patients (Group II) were treated by ARA-C (120 mg/m2 subcutaneously for 5 days), Etoposide (120 mg/m2 on day one), and Mitoxantrone (12 mg/m2 on day one) on each successive month as short-term miniconsolidation. Forty patients (Group III) were treated similarly to Group II until relapse for up to two years as long-term miniconsolidation. There was no difference in the three groups regarding mean age and other prognostic factors. Treatment related mortality and morbidity were also similar. Median duration of disease-free survival (DFS) was 36 (3.5-68 with 95% CI), 17 (12.5-21.5) and 19 (14.7-23.3) months respectively in these three groups. In a 14- month median observation there was no difference in DFS and overall survival (OS) among the three groups (p=0.7). We concluded that short- or long-term miniconsolidation chemotherapy compared to standard treatment does not improve DFS and OS in AML patients.

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Our aim was to evaluate the short and long term efficacy of botulinum toxin therapy in Iranian patients with achalasia. In a randomized, double blind trial, 20 patients with achalasia, referring to Imam Khomeini Hospital, received either 80 units of botulinum toxin (BT) or placebo (PL) from 1995 to 1998. Two weeks later, the response to treatment was assessed on the basis of changes in the symptom score (measured on a scale from o to 9). Patients who received PL initially were subsequently treated with BT. After two weeks and six months, assessment was repeated. Two weeks after treatment, clinical evaluation revealed that in the BT group all clinical symptoms were improved and the total symptom score had significantly decreased from 6.2±1.4 to 1.9±1.66 (p<0.05) and no significant changes were seen in the clinical score of the PL group. No significant differences were seen in the BT group comparing thoracic pain after the first two weeks. Two weeks after the first injection, patients who did not show clinical improvement received toxin with the same previous dose and re-evaluation was performed two weeks after the second injection and six months after the first injection. After six months mean symptom score was 3.4±1.9 (p<0.005) in the BT group and 2.4±1.51 (p<0.005) in the PL group. At this time clinical responses persisted in 12 patients (60%). In conclusion, injection of botulin urn toxin into the lower esophageal sphincter is an effective, safe and simple method of treatment for achalasia, especially in patients who cannot use other methods.

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Ex vivo expansion of human umbilical cord blood cells (HUCBC) is explored by several investigators to enhance the repopulating potential of HUCBC. The proliferation and expansion of human hematopoietic stem cells (HSC) in ex vivo culture was examined with the goal of generating a suitable clinical protocol for expanding HSC for patient transplantation. Using primary human mesenchymal stem cells, we established a serum-free culture system to expand human primitive progenitors and transplantable stem cells. Non-enriched cord blood CD34+ cells were cultured on a monolayer of human mesenchymal stem cells in the presence of tlu-ombopoietin (TPO), flt31flk2 ligand (FL), and/or stem cell factor (SCF), interleukin 6 (IL-6), interleukin 3 (IL-3) under serum-free conditions. After I or 2 weeks of culture, cells were examined for clonogenic progenitors and percentage of CD34+ CD38- cells. In the presence of TPO, FL, and SCF, fetal MSC cells supported more than a 35- and 20-fold expansion of CD34+ cells and colonyforming units in culture after 1 and 2 weeks of incubation, respectively. In addition, LTC-IC assay were expanded more than 7- and 16-fold after 1 and 2 weeks of culture, respectively. UCB-HSC can be expanded in culture to numbers theoretically adequate for safe, rapid engraftment of adult patients. Additional studies are needed to establish the functional activity of expanded UCB-HSC. This ex vivo expansion system should prove valuable in clinical settings in which stromal cells are available from recipients or stem cell donors.

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Background: Every year more than 2 million people depart from Iran to Saudi Arabia for Hajj ritual which can be faced with some different diseases. There are not much information about frequencies and trend of diseases in Hajj. The main objective of this study was to determine the trend of prevalent diseases during five consecutive Hajj rituals among Iranian pilgrims.

 

Methods: We established a specific surveillance system for all Iranian pilgrims who had participated in Hajj from 2004 to 2008. We monitored the pilgrims’ health status before departure, through their journey. The understudied diseases were 19 selected types of diseases in the Hajj. The occurrences of diseases were recorded on a researchers-made questionnaire. We used chi-square test for analysis with the alpha lower than 5% to reject the null hypothesis.

 

Results: During 5 consecutive periods, a total of 254,823 of Iranian pilgrims were monitored for more common diseases with this system. The most prevalent diseases were as follows: at least one type of respiratory involvement (71.26%), common cold like syndrome (47.15%), and musculoskeletal disorders (18.67%), The frequency of respiratory involvement was lower in 2006 than other years (p <0.001).There were statistically significant differences between the numbers of hospitalization and patients who were referred back to Iran with the year of Hajj (p <0.001).

 

Conclusion: Health managers should be informed about trend and frequency of more prevalent diseases in Hajj. Easy access to health information via such surveillance system can be possible.

 

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  Background: Gestational diabetes mellitus (GDM) is common during pregnancy. This survey was designed based on the frequency of GDM among an urban population according to the American Diabetes Association (ADA) and the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria.

  Methods : We included all pregnant women who were admitted to a gynecology clinic from September 2012 until May 2013. The fasting blood sugar (FBS) was measured. Those having FBS≥ 126 mg/dl were excluded from the study. All women underwent a standard OGTT (oral glucose tolerance test) by ingesting 75g of glucose in the 24th to 32nd week of their pregnancy.

  Results : Two hundred ninety pregnant women with a mean±SD age of 27.72±5.091 years were included in the study. The mean±SD FBS, blood glucose one hour and two hours after ingesting 75g of glucose were 82.48±9.41, 146.86±34.22 and 114.21±27.79 mg/ dl, respectively. Based on the criteria of the ADA, 9.3% (n= 27) of the admitted patients suffered from GDM. For the IADPSG and the WHO, those numbers were 31% (n= 90) and 15.2% (n= 44), respectively.

  Conclusion : The prevalence of GDM was 1.5-times and 3 times higher when the IADPSG based data were compared to those of the WHO or the ADA.

  

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Background: Low back pain (LBP) is one of the most common problems among the workers of different industries. The role of occupational factors in causing the LBP has been indicated previously. LBP has great socio-economic costs and most of its costs are related to the chronic LBP. The aim of this study was to identify the occupational risk factors that are related to the progression of the LBP from acute to chronic phase. Methods: This cohort study has been conducted on 185 workers with acute LBP. Information related to their occupational exposure at baseline has been measured with a valid questionnaire using the self-report approach. Patients follow up was done monthly for three months after the start of the pain. Those workers whose occupational exposure had not changed during the follow up were divided into two groups of chronic LBP (n = 49) and cured (n = 136) according to the duration of the pain period (more or less than 3 months), and their job exposures were compared. Results: Among the physical and psychosocial risk factors, social support (OR= 0.466, CI= 0.231- 0.940) and job satisfaction (OR= 0.455, CI= 0.232-0.891), and lifting weights more than 15kg (OR=2.482, CI= 1.274-4.834) indicated a significant relationship with the chronicity of the LBP. After putting the variables into the regression model, only lifting>15kg remained statistically significant. Conclusion: According to the observed relationship between these occupational risk factors (social support, job satisfaction, lifting>15kg) and the chronicity of the LBP, there is hope that eliminating these factors in the workers with acute LBP will prevent its progression to the chronic phase.

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Background: Identifying the predisposing factors of neck and shoulder complaints and finding solutions to avoid them could improve the occupational health condition of the nurses. In this study, we aimed at determining the role of psychological and physical occupational factors in developing neck and shoulder complaints among the participants.

  Methods: This analytic cross-sectional study was conducted on the nurses of main hospitals of Tehran. To study the prevalence of neck and shoulder pain, the Nordic questionnaire was used, and job content questionnaire was used to assess the psychological and physical occupational factors. Data were analyzed using SPSS and statistical methods. Independent sample t-test was used to compare the qualitative variables, and chi-square test was utilized for the statistical analysis of the qualitative variables.

  Results: Prevalence of neck and shoulder complaints among the nurses with high physical workload was significantly higher than in those nurses with low physical workload. Unlike physical workload, the prevalence of neck and shoulder complaints was not significantly different between the nurses with low or high psychological workload. Prevalence of neck and shoulder complaints among the female nurses was significantly higher than in the male nurses. In our study, only female nurses with high physical workload had been known as independent predictors of neck and shoulder complaints.

  Conclusion: Those nurses who had more workload, especially physical workload, had a higher prevalence of neck and shoulder complaints, and this fact could affect their work tasks.

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Background: There are some challenges about the role of work- related stress on development of musculoskeletal complaints. The present prospective study was conducted on nurses of Milad hospital in Tehran (Iran) to assess the role of work- related stress on development of neck and shoulder pain among nurses.

  Methods: From the 1,900 nurses who completed the registry forms, 1,450 nurses met the inclusion criteria. We divided the participants into exposed and unexposed groups according to their DASS-21 scores. We collected the data of neck and shoulder pain among the nurses at two points of the first and the second year after the study, using the Nordic Questionnaire. Qualitative and quantitative variables were compared between the exposed and unexposed variables with chi-square and independent sample t-test, respectively.

  Results: One year after the commencement of the study, 62 (9.1%) nurses in the exposed group and 36 (4.7%) in the unexposed group had been reported as new cases of neck and shoulder pain, respectively. The incidence of the new cases of neck and shoulder pain was significantly higher in the exposed group compared to the unexposed group (p= 0.001). Two years after the start of the study, at the second follow-up point, 135 (19.8%) nurses in the exposed group and 76 (9.9%) in the unexposed group had been reported as new cases of neck and shoulder pain, respectively. The incidence of new cases of neck and shoulder pain was significantly higher in the exposed group compared to the unexposed group (p<0.001).

  Conclusions: The incidence of neck and shoulder pain was higher in those nurses with high level of work- related stress. According to our results, more attention should be paid to mental health as well as physical symptoms and limitations of the healthcare workers when they refer to occupational health services with musculoskeletal pain complaints.

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    Background: Different outcomes of parvovirus B19 (B19V) infection in immunocompromised patients, including HIV1-infected persons, may be life-threatening. Considering the hematologic disorders associated with B19V infection, this study aimed to investigate the prevalence of B19V infection among HIV1-infected individuals in Iran.
   Methods: Serum samples from 100 HIV1-infected patients were analyzed for B19 viral DNA using real-time PCR assay. COBAS TaqMan HIV-1 test was performed for quantitative measurements of HIV-1 RNA in the patients’ sera.
   Results: Real-time PCR analysis revealed that 10 out of 100 cases (10%) were positive for B19V infection. Across various age groups, the B19V infection was more prevalent among patients within the age range of 21-40 years. Higher prevalence of B19V infection was observed among HIV1-infected patients with a viral load of higher than 400 copies/mL.
   Conclusion: Despite limitations, this study may set the stage for further evaluations with larger sample sizes to elucidate the potential role of B19V in hematologic disorders, which may result in exacerbation of the disease in HIV1-infected patients. Moreover, as it has been shown that B19V infection can be treated using intravenous immunoglobulin (IVIG) therapy, available treatments may help improve the quality of life in HIV-infected persons.

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Background: Older adults are at higher risk for severe illness and death associated with coronavirus disease 2019 (COVID-19). As Iran was affected by COVID-19 pandemic, the elderly population soon were told to self-isolate for a very long time. We aimed to identify the coverage, efficacy, and integrity of self-isolation and its predictors in the Iranian older adults (≥60 years) from February 19 to 19 March 2020.
   Methods: Quota sampling was performed to recruit respondents from 16 cities that were selected based on their population size (4, 7, and 5 cities for localities with ≤500 000, 500 000-1 000 000, and ≥1 000 000 populations) and geographical direction (West = 4 cities; North, East, South, Center = 3 each). At least 30 respondents per locality were selected. Phone interviews of 558 respondents (out of 560; response rate = 99.6%) were performed by local trained interviewers using a validated interview form. Association between age, sex, and living condition (with family vs alone) was assessed with Pearson Chi Square and logistic regression analyses.  
   Results: Complete self-isolation was reported by 61% of the respondents. In 72%, self-isolation led to 80%-100% contact reduction. Self-isolation was broken by 26% of the respondents. Females had better self-isolation behaviors (OR adjusted: 2.3, 95% CI: 1.5, 3.3) and higher contact reduction rates (p: 0.067). They kept the integrity of self-isolation better (OR adjusted: 1.8; 95% CI: 1.2, 2.7). Those aged older than 80 years were 2.3-folds more likely to completely self-isolate than younger elderly (95% CI adjusted: 1.2, 4.3). Living alone did not significantly predict self-isolation features in the elderly.
   Conclusion: About one third of the interviewed Iranian older adults did not adhere to important self-isolation measures, with males and younger ages showing lower adherence. With the relaxation of social distancing measures, protection measures of the elderly should be strengthened. Given that prolonged self-isolation adversely affects physical and mental health status of the elderly, it is highly recommended to think of creative and gender-specific methods that best tailor the needs of this population in Iran.

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Background: Despite studies about anxiety in the older adult, the prevalence of anxiety in this age group is not exactly clear, which may be due to the use of tools and criteria that were not born for this age group. One of the instruments designed to assess anxiety in the elderly is the Geriatric Anxiety Inventory (GAI). The aim of this research was to analyze the psychometric properties of the Persian version of the Geriatric Anxiety Inventory (GAI-PV) and its short form (GAI-PV-SF) in a sample of older adults in Iran.
   Methods: In this cross-sectional study, a sample of 150 community-dwelling and a psychogeriatric sample of 48 adults older than 60 years completed the GAI-PV and GAI-PV-SF, the anxiety sub-scale of the General Health Questionnaire (GHQ-28), the Geriatric Depression Scale (GDS-15), and the Structured Clinical Interview for DSM-IV (SCID-I). Different types of validity and reliability were evaluated for GAI-PV and GAI-PV-SF using SPSS and the LISREL software.
   Results: Both the GAI-PV and GAI-PV-SF exhibited excellent internal consistency (over 80 %) and desirable concurrent validity against GHQ-28 and GDS-15. The optimal cutpoint score to detect current generalized anxiety disorder (GAD) was 10/11 and 13/14 for GAI-PV in the community-dwelling and psychogeriatric samples, respectively, and 3/4 for GAI-PV-SF in both study samples.  Good test-retest reliability (correlation coefficient: 0.96 and 0.88 for GAI-PV and GAI-PV-SF, respectively) and a single-factor structure were also demonstrated.
   Conclusion: Sound psychometric properties of the GAI-PV in both subsamples suggest that the instrument could be used successfully as an accurate screening instrument in the elderly Iranian population.
 

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Background: Objectives were to investigate aspects of the COVID-19 epidemics via testing the individuals who were referred to Aramesh Medical Laboratory in Tehran and to integrate the molecular results with epidemiological data since the beginning of the epidemic.
    Methods: In this cross-sectional Study 77528 outpatients were referred to Aramesh Medical laboratory by physicians for the diagnosis of SARS-CoV-2 infection between March 2019 and May 2021. Viral acid nucleic extracted from nasal and throat specimens and subsequently amplified using Reverse Transcriptase Real-Time PCR. Laboratory data including Ct values compared with epidemic peaks of COVID-19 countrywide. Statistical Analysis was done by SPSS 21 Software.
   Results: 14312 (18.46%) tested positive.36.5% of the positive cases were in the 30 to 39 years old age group. The positive result rate was significantly different based on months, ranging from 6% to 28%, compatible with four recognized epidemic peaks encompassing the end of March through the first week of April (first epidemic peak), from June to July 2020 (second epidemic peak),  October until mid of November 2020 (third epidemic wave) followed by the end of April to May 2021 (until the end period of study, in the middle of 4th peak). In 37.8% of cases, the Ct value was between 21 and 28. Two separate trends were seen for Ct ≤ 25 and Ct ≤ 20  for the first and fourth epidemic peaks, respectively. There was an association between the number of total monthly positive results and total deaths in the country, especially with the  second to third peaks (in the course of summer 2020) and fourth epidemic peak.
   Conclusion: It might be useful to consider laboratory admission rates as an indicator for changes in the epidemic level in the country to continue the SARS-CoV-2 surveillance in accordance with public decision-makers.

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Background: The exact description of asthma and chronic obstructive pulmonary disease overlap syndrome (ACOS) is uncertain. This study aims to determine the frequency and symptoms of ACOS and to verify certain risk factors associated with ACOS.
   Methods: Severe asthmatic patients with and without ACOS above 40 years old participated in this cross-sectional study. The receiver operating curve analysis (ROC) was used to assess the best cutoff values of age, body mass index (BMI), and spirometric data to distinguish asthma patients with overlap syndrome from asthma patients without overlap syndrome. Univariable and multivariable binary logistic regression was used to determine demographic and clinical factors that were associated with ACOS and asthma.
   Results: Of the 88 patients, 46 (52.2%) had ACOS and 42 (47.7%) had just severe asthma. The mean age of ACOS patients (Sd) was 54.91(12.57) years and in asthma-only patients was 48.69 (13.51). The ROC analysis for age and BMI showed that age ⩾ 49 years and BMI ⩾ 27 kg/m² were the best predictors of ACOS in this study. Spirometry data showed that the forced vital capacity (FVC) (lit) > 2.16, forced expiratory volume in the first second (FEV1) > 69, FEV1 / FVC > 96.5, and FVC (%) > 63 cut points could be used to determine the diagnostic criteria between ACOS and asthma only, respectively. Multivariate modeling showed that among the demographic and clinical variables, only age over 49 years (odds ratio [OR], 3.53 [95% CI, 1.07-11.63] p = 0.025) and living in a big city (OR, 7.42 [95% CI, 1.75-31.49] p = 0.007) were significant.
   Conclusion: Age over 49 and BMI above 27 have a significant association with ACOS. Also, living in a big city is considered to be another risk factor for ACOS compared with asthma. Spirometry can help distinguish ACOS from severe asthma in this study.
 

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Background: Large-volume paracentesis has become the first treatment choice for patients with severe and refractory ascites. The studies have reported several complications after therapeutic paracentesis. But there are few published data on the complications with or without Albumin therapy.  We aimed to analyze the safety and complications of large-volume paracentesis in children with or without albumin therapy.
   Methods: This study was conducted on children with severe ascites with chronic liver disease who underwent large-volume paracentesis. They were divided into albumin-infused and albumin non-infused groups. In the case of coagulopathy, no adjustment was made. Albumin was not administered after the procedure. The outcomes were monitored to evaluate the complications. To compare two groups, a t-test was utilized, and the ANOVA test was used to compare several groups. If the requirements for using these tests were not met, Mann-Whitney and Kruskal-Wallis tests were applied.
   Results: Decreased heart rate was observed in all time intervals and was meaningful six days after paracentesis. MAP also decreased statistically at 48 hours and six days after the procedure (P < 0.05). Other variables did not show any meaningful change.
   Conclusion: Children having tense ascites with thrombocytopenia, prolonged PT, Child-Pugh class C, and encephalopathy can undergo large-volume paracentesis without any complication. Albumin administration before the procedure in patients with low levels of Albumin (<2.9) can effectively overcome the problems of tachycardia and increased mean arterial pressure. There will be no need for Albumin administration after paracentesis.