Medical Journal of The Islamic Republic of Iran (MJIRI)

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We report a 26 year old woman with erosive vulvo-vaginal mucositis followed by desquamative gingivitis, and typical histopathologic features of lichen planus (vulvo-vaginal-gingival syndrome). This is to our knowledge the first report of this syndrome from Iran and probably the youngest one in the world (with regard to the English literature)

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The purpose of this study is to show the effect of extraamniotic administration of corticosteroids to shorten the times to either active labor and/or delivery. This is a double blind randomized study. 65 patients who were candidates for the termination of pregnancy between the ages of 16-45, with intact membranes and unripe cervix were randomly divided into two groups, a study group (n=34) and a control group (n=31). In the study group, 20mg of dexamethasone was infused through a Foley catheter into the extraamniotic space and the infusion was continued with normal saline in both groups. The result of the study showed that the interval of induction to active phase of labor was 6.6±2.33 hours in the study group and 8.2±3 hours in the control group (t= 2.413, p=O.0187). The interval of induction to delivery was 8.4±2.62 hours in the study group and 1O.05±3.35 hours in the control group (t= 2.828, p=O.0063). In conclusion, corticosteroids may have a role in shortening the interval of induction to active phase of labor and the interval of induction to delivery.

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Patients with coagulation factor(s) deficiency who use coagulation therapy are susceptible to forming inhibitors against coagulation factor(s). In this survey we detected factor V and VIII inhibitor in ten patients with combined deficiency of factors V and VIII from north east of Iran (Khorassan province). It was revealed in our survey that eight patients had both factor V and factor VIII inhibitors and two patients had none. Because factor V and factor VIII share approximately 40% amino acid sequence homology in their A and C domains, it remains to be elucidated if it is one molecule that recognizes both factor V and VIII or whether there are two inhibitor molecules against common sites.

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 ABSTRACT

 Background: The prognosis of SLE is int1uenced by the onset of glomerulonephtitis. Clinical ttials in lupus nephritis have demonstrated that cyclophosphamide therapy is the superior regimen in the management oflupus nephritis for preserving renal function.

 Objective: The purpose of this study is to define the outcome of renal function with bolus pu lses of cyclophosphamide and steroid according to our protocol and also to determine an appropriate pattern of treatment of lupus nephritis.

 Methods: In this open-label clinical triaL to evaluate the results, the short-term prognosis and the rate of complications of an immunosuppressive regimen with corticosteroids and cyclophosphamide, twenty-five patients with biopsy-proven lupus nephritis were studied. Treatment was structured in 4 phases: I) Induction with bolus methylprednisolone and cyclophosphamide. 2) Maintenance with oral prednisolone for 4 weeks and monthly cyclophosphamide pulses for 6 months. 3) Tapeting with reduction of prednisolone by 10% each month and continuing cyclophosphamide every other month till one year and for the second year every 3 months. 4) Discontinuation with oral prednisolone slowly tapered to the least effective daily dose and cyclophosphamide discontinued after 2 yr of therapy. We defined primary outcome measures according to these criteria: renal function return to normal limits or become stable, regression of systemic and local inflammatory symptoms. urine protein excretion h1lling below 0.3 gr/ elL or by at least SOo/c. RBC cast disappearance, C3, C4, Hb, and ESR return to notmallimits.

 Result: Twenty-three patients wi th lupus nephritis completed our therapeutic protocol. Renal biopsy was perfonned in 22 cases and indicated type IV in 20 patients (95.2%), and type V in 2 patients. After an average of 4+ 1.95 months 22 patients achieved remission (95.65%) and only one case remained non-responsive. She became pregnant in her fourth month of therapy. Significant statistical differences were achieved between creatinine, proteinuria, hematuria, leukocyturia, urinary cast, C3, C4, ESR, and Hb before and after therapy (p<0.05). Plasma creatinine fell from 1 .44+0.95 mg/dL to 0.97+0. 78 (p<0.004). Proteinuria fell from 1879.78+ 1854.46 to 408.34+572.92 mg/24h (p

 Conclusion: Intensive immunosuppression with steroid and cyclophosphamide provides excellent results with an acceptable rate of complications in the treatment of lupus nephritis.

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I enjoyed the article by 1. Eivazi Ziai, et al. concerning "Use of myeloperoxidase index as a suitable tool to monitor response to therapy in patients with megaloblastic anemia" that was published in the last issue of the Medical Journal ofIslamic Republic of Iran. I I would like to make some points regarding this study. A. The authors mentioned that in primary evaluation of 50 anemic patients who had referred to their center, the peripheral blood smear and bone marrow aspirations had shown typical megaloblastic features. As all of the patients had been prescribed Vitamin BI2 and folate, it shows that the study has been on the basis of megaloblastic anemia due to vitamin BI2 and folate deficiency. The patients have entered the study without assessing excluding criteria for megaloblastic anemia, because there are several other hematologic disorders with megaloblastic findings in both peripheral blood smear and bone marrow aspiration such as myelodysplastic anemia, liver disease, and aplastic anemia. It seems that evaluation of vitamin BI 2 and folate levels in these patients would have been a necessary part of diagnosis after observation of blood and bone marrow smears that has been missed in this study. B. It has been cited that a total primary number of 50 patients entered the study. Some of them have been ex- cluded from the study due to existence of other diagnoses, but not only have final numbers not been cited but also all 50 have been included in the last extraction of data, and no complementary patients were added.

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  Abstract

  Background : Although, different studies on end-to-side nerve repair, results are controversial. The importance of this method in case is unavailability of proximal nerve. In this method, donor nerves also remain intact and without injury. In compare to other classic procedures, end-to-side repair is not much time consuming and needs less dissection. Overall, the previous studies in this field have just evaluated nerve recovery by non functional or functional parameters. As it has proven, the results of functional and non functional studies are not always matched. Therefore, this study was designed to evaluate this method by functional (Sciatic function index) and non functional parameters (histochemical study).

  Methods: In this experimental study, forty adult male Wistar rats (200-250g) were used their left proneal nerve was cut and divided into four groups: 1- control group (n=10). In this group, nerve was exposed and cut and implanted onto adductor muscles, 2- end-to-end anastomosis (n=10). In this group, peroneal nerve cut and two segments were anastomosed end-to-end, 3- end-to-side anastomosis with window (n=10). In this group, peroneal nerve was cut and anastomosed with window to tibial nerve, 4- end-to-side anastomosis without window (n=10). In this group, peroneal nerve was cut and anastomosed without window to tibial nerve. After 1, 8 and 16 weeks, functional (Sciatic function index) and after 16 weeks non functional studies (histochemical study) were performed and the results compared.

  Results: All experimental groups (group 2, 3, 4) motor recovery at 8th, 16 th week were not statistically different (p>0.05). In histological study axons count in end -to-side with window anastomosis were higher than other experimental groups (p<0.05).

  Conclusion: According to our findings, the authors believe that end to side neuroraphy leads to axon growth and comparable functional recovery with end to end neuroraphy in rat model. Due to the fact that the diameter of nerves and muscles which might be neurotised in human are much bigger and not comparable with rat, it is suggested to set up some set of experiments on the bigger size animals such as primates in further studies for generalization of results to human being.

 

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Background: Number of Iranian articles published in ISI journals has increased significantly in recent years. Despite the quantitative progress, studies performed in Iran represent low collaboration in research therefore, we decided to evaluate collaboration in Golestan University of Medical Sciences (GOUMS) research projects.

 

Methods: In this cross-sectional study, all GOUMS research projects that had got grants from the university between 2005-2007 were studied. Among 107 research projects included in our study, 102 projects were evaluated and checklists were completed. The researcher's questionnaire was sent to the principle investigators (n= 46) of the projects and eventually 40 questionnaires were collected.

 

Results: The review of 102 research proposals shows that 10 projects (9.8%) have been performed in collaboration with other organizations. Scientific outputs in these projects have been more than projects which were confined to the university (98% compare to 68% p= 0.04). The total cost of the projects under study was a little more than 300,000 US$. In just 12 projects (11.8%) a part of the cost had been provided by organizations outside the university. About 50% of researchers declared that they had chosen their research topic based on their "personal interest". Only 1 project was performed by the demand of nongovernmental organizations and 12 researchers reported no collaboration in their activities.

 

Conclusion: This study shows that collaboration in GOUMS research projects is low. Moreover, collaborations with governmental and nongovernmental organizations are trivial. The scientific outputs in collaborative research projects are much more than other projects.

 

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  Background: HIV/AIDS patients are mainly hospitalized for HIV-related diseases and opportunistic infections. Thisstudy was performed todetermine thecauses ofhospitalization and its related factors in HIV/AIDS patients in Tehran’s Imam Khomeini Hospital during 2009-2012.

  Methods: Thisstudy wasa descriptive cross-sectionalstudy . HIV patients admitted to the Imam Khomeini Hospital were included in the study through censusmethod, during the study. Demographic variables, hepatitis co-infection, CD4 count, history of receiving anti- retroviral therapy (ART), cause of admission, length of hospitalization and patient's outcome were recorded . Data were analyzed by SPSS software and by means of Chi-square and Mann Whitney U tests .

  Results: Duringthe study,555HIV patientswere included in,84.9 % of whom were male, with the mean age of 36.59±8.51years and the average length of hospitalization for 16.04±18.82 days.

  Opportunistic infections were the most common cause of hospitalization (46.5%) with prevalent of which was pulmonary tuberculosis being the most prevalent (37.6%).

  Patientssuffering fromopportunistic infectionshadsignificantlylowerCD4countand longer hospitalizationthan theother diseases.

  A significant difference was detected between patients outcome and the history of ART.

  Conclusion: Low CD4 count may contribute to an increase in number and length of hospitalization in HIV/AIDS patients. Accordingly, it appears to affect outcome of their treatment and ART was accompanied by a drop in the death rate of hospitalized patients.

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Background: Infantile colic, cry-fuss and sleep problems are transient in the initial months of life, but they contribute to maternal depression, parenting stress and family mental health problems. In this randomized clinical trial, we aimed to explore the efficacy of massage therapy compared to rocking in reducing infantile colic symptoms including duration and number of cries, sleep duration and severity of infant colic.

  Methods: This was a single blind RCT study with a one-week follow-up. One hundred colicky infants aged younger than 12 weeks old were randomly assigned into massage and rocking groups. Infants in the massage group received a massage for 15-20 minutes once during a day and once at night before sleeping for a week. In the control group, mothers rocked their infants gently for 5-25 minutes when the symptoms of colic appeared. Parents recorded the details of the colic symptoms in a diary every day. A GEE approach was applied to explore the effect of the intervention.

  Results: Efficiency of massage therapy was significantly higher than rocking. At the end of the study, the mean number of daily cries was 4.26±1.40 in the massage and 6.9±2.14 the rocking groups (p<0.01). The mean of the severity score was 1.39±0.19 less in the massage group (p<0.01). Moreover, the mean differences of massage and rocking groups were -0.82±0.20 hour (p<0.01) and 0.72±0.35 (p= 0.04) in the duration of cries and duration of sleep, respectively.

  Conclusion: Massaging significantly improved colic symptoms during a one-week intervention for all outcomes. In addition, significant differences were found between the intervention and control groups in favor of massaging. Therefore, massage therapy is more effective than rocking for treating infant colic symptoms.

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Background: Poisoning is a major public health problem and is one of the most frequent causes of emergency hospital admissions. The aim of this study was to identify the main risk factors for unintentional childhood poisoning in Tehran, Iran and to suggest possible causes and preventative measures.

  Methods: In this case-control study (case, n=140; control, n=280), two controls were selected for every case. Controls were matched by age, sex, and date of hospital attendance. All children and their guardians were then interviewed by the same person using a standard questionnaire that covered the demographic, behavioral, and risk factors associated with accidental poisonings.

  Results: The most common type of poisoning was related to narcotics (58.6%); and among the narcotics, methadone was the most prevalent poisoning agent (74.7%). Multivariate conditional logistic regression model revealed that addiction in the family (OR=14.6; 95% CI:6.2-34.6), previous poisoning (OR=7; 95% CI:2.4-20.2), maternal occupation (OR=4; 95% CI:1.3- 12.3), and inaccessibility of poisoning products (OR=0.03; 95% CI:0.01- 0.12) were the main risk factors in unintentional childhood poisoning.

  Conclusion: Addiction in the family as a risk factor and inaccessibility of poisoning products as a protecting factor were recognized to have the highest correlation with the unintentional child poisoning. These two factors were considered as priorities in health education programs.

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Background: In this study, the efficacy of nitazoxanide in the treatment of Helicobacter pylori isolates, which were resistant to metronidazole, was examined.

  Methods: One hundred twenty two patients who underwent endoscopy examinations at Kasra and Laleh hospitals in Tehran from November 2014 to July 2015 were enrolled. Helicobacter pylori strains were isolated from the patients’ endoscopy biopsies by bacteriological culture. Those bacterial isolates resistant to metronidazole were examined for susceptibility to nitazoxanide. Serial agar dilution method was utilized to determine the minimum inhibitory concentrations for the antibiotics.

  Results: From 122 gastric biopsy specimens, 55 H. pylori isolates were recovered (45%); of which, 40 (72.7%) were resistant to metronidazole. Comparing the MIC values of nitazoxanide with metronidazole revealed significant differences (p<0.05). The MIC₅₀ and MIC₉₀ values for nitazoxanide and metronidazole were 8 and ≥8µg/ml, and 32 and 64µg/ml, respectively.

  Conclusion: The high levels of metronidazole resistance suggest that this medication may not be beneficial for first-line therapy in Iran. However, considering the relative effectiveness of nitazoxanide, it may be considered a suitable alternative for patients in Iran.

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Background: Children in all countries, especially in developing countries, constitute a vulnerable group. Therefore, attention to their health issues is very important. The aim of this study was to determine the prevalence of stunting in Iranian children under-five years.
   Methods: All original studies were searched by complex search syntax from international databases including Medline (PubMed), Web of sciences, Google scholar, Scopus, CINHAL and the Iranian databases consist of SID (Scientific Information Database, www.sid.ir), Irandoc (Iranian Research Institute for Information Science and Technology, Irandoc.ac.ir), Iranmedex (www.iranmedex.com), and Magiran (www.magiran.com) from January 1989 to August 2017. Two independent reviewers identified relevant studies in several steps. We employed a random effect model to generate a pooled prevalence. The reported prevalence is presented as percent and 95% confidence interval (CI). Sources of heterogeneity among the studies were determined using subgroup analysis and meta-regression.
   Results: Finally, 16 studies from different settings remained for meta-analysis in order to have a pooled prevalence estimate, which prevalence of total stunting was 12% (95%CI: 10–14). Subgroup analysis for gender showed that the prevalence of stunting in both boys and girls children were equal to 10% (95%CI: 8–11) and 9% (CI 95% 8–10), respectively. Also pooled prevalence of stunting in southern provinces are higher than other provinces.
   Conclusion: The prevalence of stunting in some regions of Iran is higher than others. Although, in recent years much effort has been made to address deprivation such as economical, nutritional and social supporting, improvement of the quality of life, there are still nutritional problems in these areas of Iran.
 
 

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Background: Data types are recurrent events in studies in which each person may experience an event at different times. One of the most popular approaches to analyze recurrent event data is obtaining an estimate of the means/rate of events at different times. In this context, determining the variability over time can help better understand the effect of factor on the response. In this study, we applied smoothing methods to estimate coefficients in time-dependent rate model, and we also showed its application in data of psoriasis patients.
Methods: In the present study, psoriasis patients who experienced relapse that led to hospitalization during 2005 and 2014 in the Dermatology Department of Imam Khomeini hospital in Tehran were examined. To investigate the rate of relapse during a year, time-dependent rate model was used and variability of the effects was assessed using Wald test. Both b-spline and kernel methods were used to estimate time varying coefficients in rates model. Finally, results from methods were compared based on the obtained estimates.
Results: Based on the results of the Wald test, the effect of season on the occurrence of psoriasis was significantly different (p<0.01). Also according to the estimated coefficients from both b-spline and kernel methods, there was little difference between them.
Conclusion: In situations in which the effect of a variable is different at different times, using time-dependent coefficients rate model can lead to a better estimate of the effect of variable on the response. On the other hand, smoothing methods can smooth the effects of the variables that vary over time.
 

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Background: Coriandrum sativum (coriander) is prescribed as a treatment for headache in traditional Persian medicine. Several investigations have been carried out to find the medicinal properties of this plant. However, no study has evaluated the effectiveness of this plant on becoming migraine-free.
   Methods: Sixty-eight migraineurs were randomly allocated to two equal groups of intervention and control. Each received 500 mg of sodium valproate in addition to 15 mL of coriander or placebo syrup three times a day. We followed subjects and recorded their migraine duration in the 1^st, 2^nd, 3^rd, and 4^th weeks. We applied an appropriate statistical model so as to consider special features of the data, which led to more accurate results using SAS 9.4
   Results: Our findings showed that the probability of being migraine-free was not only considerably higher in final weeks of the study (p<0.001) in all patients of the intervention group than placebo group, but it was also significantly higher in patients less than 30 years of age compared to patients older than 30 years old. Migraine duration in migraineurs using coriander syrup reduced considerably during the study (p<0.001).
   Conclusion: The finding of this study revealed that coriander has a significant effect both on the probability of being migraine free and the duration of migraine attacks. Its effects were more significant during the final weeks of study.
 

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Background: GD2 synthase (GD2S) is the key enzyme required for ganglioside GD2 synthesis. It is commonly expressed in normal tissues and various cancers. Ganglioside GD2 is identified as a breast cancer stem cells (BCSCs) marker that promotes tumorigenesis. As GD2S has been found to be a useful molecular marker in neuroblastoma and retinoblastoma tumors, we suggest that it can be considered as a suitable candidate for the detection of CSCs in breast cancer tissues.
    Methods: Expression of GD2S was examined in 65 breast tumors compared to adjacent normal tissues, applying quantitative real-time PCR (qRT-PCR) and enzyme-linked immunosorbent assay (ELISA). The association between GD2S expression level and patients’ clinical characteristics was also assessed.
   Results: Our findings showed that GD2S mRNA expression was significantly higher in breast cancer tissues in comparison to normal adjacent tissue samples (4.92-fold change, p<0.001) in advanced grades (p<0.001) and stages (p<0.001). It was also shown that GD2S protein expression was significantly higher in breast cancer tissues in comparison to normal adjacent tissues (4.86-fold change, p=0.010) in advanced grades (p=0.010), stages (p=0.005) and larger tumor size (p=0.002).
   Conclusion: The current study showed that increased expression of GD2S in advanced breast cancer potentiates it as a promising tumor marker in these patients.

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Background: Training needs assessment is the process of recognizing educational needs. This study aimed to apply a community-based nutrition education needs assessment to revise the nutrition course plan in the curriculum of the doctorate of medicine and that of the baccalaureate of nursing.
   Methods: The study was designed in 2 phases: (1) nutritional needs assessment; (2) community-based revision of nutrition course plan. In the first phase, 13 nutrition professionals working in the region set out 5 priorities of nutrition-related health problems in the community by a training need assessment based on a survey and scoring system. Then, an expert panel determined the priorities of behavioral and nonbehavioral causes of the nutrition-related health problems by the nominal group technique (NGT). The results of the first phase were used to review the topics of nutrition course plans up to 20%.
   Results: The priorities identified in Abadan, Khorramshahr, and Shadegan were obesity and type 2 diabetes mellitus in adults as well as anemia in pregnant women, respectively. Also, wrong eating habits and insufficient nutrition knowledge were among the most important behavioral causes of nutrition-related health problems in the target community. These results were applied to a community-based review of nutrition course plans for medical and nursing students.
   Conclusion: The use of nutritional needs assessment approaches by a survey and nominal group technique with a group of professionals provided an opportunity for a community-based review of the nutrition course plan for medical and nursing students as a first phase in the development of a community-based nutrition course plane.
 

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Background: Following global commitments to prevent and control non-communicable diseases,  we sought to estimate national and sub-national trends in diabetes mortality in Iran and assess its association with socioeconomic factors.
   Methods: In a systematic analytical study, to assess the correlation between diabetes mortality and socioeconomic factors, we used data obtained from the Death Registration System (DRS), the Spatio-temporal model and Gaussian Process Regression (GPR) levels and the diabetes mortality trends, which were estimated by sex, age and year at national and sub-national levels from 1990 to 2015.
   Results: Between the years 1990 and 2015, the age-standardized diabetes mortality rate (per 100,000) increased from 3.40 (95% UI: 2.33 to 4.99) to 7.72 (95% UI: 5.51 to 10.78) in males and from 4.66 (95% UI: 3.23 to 6.76) to 10.38 (95% UI: 7.54 to 14.23) in females. In 1990, the difference between the highest age-standardized diabetes mortality rate among males was 3.88 times greater than the lowest (5.97 vs. 1.54), and in 2015 this difference was 3.96 times greater (14.65 vs. 3.70). This provincial difference was higher among females and was 5.13 times greater in 1990 (8.41 vs. 1.64) and 5.04 times greater in 2015 (19.87 vs. 3.94). The rate of diabetes mortality rose with urbanization yet declined with an increase in wealth and years of schooling as the main socio-economic factors.
   Conclusion: The rising trend of diabetes mortality rate at the national level and the sub-national disparities associated with socioeconomic status in Iran warrant the implementation of specific interventions recommended by the ‘25 by 25’ goal.

 

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Background: Mobile health (m-Health) is a combination of electronic communications and medical information technology that has helped patients and health care workers during the COVID-19 outbreak. This study aimed to aggregate and highlight findings from existing review studies about applications of m-health to prevent COVID-19.
   Methods: This scoping review was conducted based on the Arksey and O'Malley framework after searching the PubMed, Web of Science, and Scopus databases from March 2020 to February 2022. Keywords for the search included the English words "Mobile health";" mobile apps"; "corona disease"; "COVID-19"; and "review." Screening of articles was done in 4 stages.
   Results: Out of 37,569 papers found in the search, after the screening and review process, 22 articles were finally selected. From the analysis of the studies, 2 main categories emerged with the titles of "primary preventive applications" and "secondary preventive applications."
   Conclusion: M-health is used in both primary and secondary prevention. The m-health tools can be effective in controlling the spread of COVID-19 and improving the treatment process of this disease by providing various pieces of training related to COVID-19 as well as installing various programs to monitor the condition of patients. Also, m-Health can provide services through the exchange of treatment data between health care providers or between patients and health care providers, as well as provide appropriate training for the remote care needs of patients with COVID-19.