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Moayeri H,
Volume 60, Issue 3 (6-2002)
Volume 60, Issue 3 (6-2002)
Abstract
The development of testicular masses in male patients with congenital adrenal hyperplasia due to 21 hydroxylase deficiency has been recognized for many years. We present here the eighth and ninth reported patient with bilateral testicular tumors associated with 11 hydroxylase deficiency. They were two brothers aged 7.5 and 5 yr. who had bilateral testicular tumors and diagnosed because of signs and symptoms of true precocious puberty and high blood pressure. The patients testicular enlargement is suggestive of bilateral testicular adrenal rest.
M Farzan , M. B Darabpour , R Espandar ,
Volume 65, Issue 10 (1-2008)
Volume 65, Issue 10 (1-2008)
Abstract
Background: Ulnar club hand (ulnar deficiency) is a rare congenital disorder of the upper extremity. In the Flatt series among 2758 congenital disorders of upper extremity only 28 cases of ulnar deficiency were reported. Due to its rarity and variations in presentation current data in the management of the deformity is very limited. Here we present our experience and results in comparing management of ulnar deficiency.
Methods: We include all of the ulnar club hand patients (five boys and one girl with seven involved extremities) from 1993 to 2006. After recognizing the type of deformity the classic management approach was performed that was splinting in corrective position until six months of age and then anlage resection. Syndactyly release was done in appropriate age according to involved rays, other operations for restoration of apposition was done after 18 months of age. Two of our patients were neglected, the first one was a 12 years old boy without any ulnar deviation but with syndactyly of the remaining rays and the other was a 32 years old male with severe ulnar deviation and partial syndactyly who is a skillful worker. We determined the effect of anlage resection on ulnar deviation of the wrist and restoration of opposition and syndactyly release on function of the limb.
Results: In short term follow up, anlage resection was effective in prevention and correction of ulnar deviation, however the deformity was partially recurred later. Surprisingly, the function of the limb was not significantly affected with the extent of the deformity. On the other hand, the operations used for opposition of the thumb like first metacarpal rotational osteotomies and tendon transfers for powerful opposition, were more effective in the hand and also limb function compared with anlage resection alone.
Conclusions: Due to our observation of the neglected cases, the most important factor in the function of the hand is the function of the thumb, thus we believe that restoration of opposition and syndactyly release may be more effective than anlage resection on limb function in Ulnar Club Hand patients
Kashi Ah, Yadyad Mj, Hajiabdolbaghi M, Jafari S,
Volume 66, Issue 9 (12-2008)
Volume 66, Issue 9 (12-2008)
Abstract
Background: Behavioral Consultation Centers are the main organizations responsible for providing HIV/AIDS patients with services according to the Iranian Ministry of Health guidelines. In this study we assessed provision of these supposed services to Iranian HIV/AIDS patients referring to Behavioral Consultation Centers.
Methods: One hundred seventy one clinical files were selected by systematic random sampling from the files of all new HIV/AIDS patients accepted at Imam Khomeini behavioral consultation center who were registered during 2005-2006 and were followed for at least six months. Data were extracted from files and included consultation, vaccination, laboratory and treatment services.
Results: Family planning and HIV prevention methods consultation were performed for 32.5% and 2.29% of patients respectively. CD4 count was done for 69% of patients. 65.6% of patients who needed anti-retroviral treatment were given medication. Hepatitis B and Td vaccination were done for 21.7% and 3.5% of patients respectively. Coverage of pneumococal and influenza vaccinations was less than 5%. 79.5% of patients who needs tuberculosis prophylaxis were given medication. TB case finding was 14% during one year and the cure rate for patients under anti TB treatment were 95.8%.
Conclusion: Coverage of consultations and vaccination services are very low. Antiretroviral therapy coverage is intermediate. TB case finding and its cure rate are appropriate.
Borna S, Haghollahi F, Golestan B, Norouzi M, Hanachi P, Shariat M, Sarafnejad A, Niroomanesh Sh,
Volume 67, Issue 5 (8-2009)
Volume 67, Issue 5 (8-2009)
Abstract
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Background: Zinc
is one of the elements necessary for growth and health in human. Some evidences
indicate that zinc deficiency is one of real difficulties for the public health
in both developed and developing countries. Since the pregnant women are more at
risk of zinc deficiency, the objective of this study was to determine the rate
of zinc deficiency in pregnant women in the 3 trimesters and to compare these data
with that of the healthy controls.
Methods: This research was an analytic- descriptive study which
was done on 677 pregnant women in 3 Trimesters and 140 non pregnant groups who referred to clinic of Tehran
University. Blood sample were taken And serum zinc was assessed By Enzymatic
technique.
Results: The prevalence of zinc deficiency is 16% in pregnancy
and 0%
in non pregnant women with a significant difference between two groups (p<0.001). Zinc
deficiency had no relation to mother's age, gestational age, Iron
supplementation, Parity and mothers BMI. Hemoglobin level showed a direct relation to zinc
deficiency and was grossly found to be more prevalent in Hb levels less than 12 (CI: 1/36-4/26, OR=2/4).
Conclusion: Acording to the finding of
presented study, zinc deficiency is more prevalent in Hb<12 inspite of iron
supplementation. Iron and zinc supplements in pregnancy period seem to be more
effective for Hb repair in each case.
Jafari S, Rasoolinejad M, Emadi Kouchak H, Mokarami F,
Volume 67, Issue 7 (10-2009)
Volume 67, Issue 7 (10-2009)
Abstract
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Background: CD4 T-Lymphocyte counts have proven to be a standard
laboratory marker of disease progression and severity of immunodeficiency in
adults infected with HIV is used to initiate and monitor highly active
antiretroviral therapy however, its application may not be feasible for its
expensive equipments and reagent in resource-limited setting. There is a need
to have another marker of immunodeficiency that is less resource-demanding. In
April 2002, the World Health Organization (WHO) recommended that, when CD4 cell count is not available, a
TLC of
1200cell/mm3
or less in individuals with stage 2 or 3 of the disease may be used as an indication to
initiate ART.
Methods: The aim of this study was to determine the
relationship between total lymphocyte count and CD4 count in HIV-infected
adults. This was a retrospective cross-sectional study. Subject characteristics
were patients who had positive serologic HIV test results, confirmed via western blot. Analysis unit was the
results of CBC and CD4 measurements on the same blood sample each time. Data
of 100
patients were collected. In this study, TLC accounts for the main predictor of CD4 count. The
amounts of TLC which can predict CD4 less than 200cell/mm3 were considered eligible.
Results: Our data revealed high sensitivity and specificity of TLC as a surrogate
measure of CD4 count. In this study, TLC cutoff of 1300cell/mm3 indicated the optimal combined sensitivity and specificity altogether.
Conclusion: Total lymphocyte count and its changes can be used as
alternative to CD4
count and its changes in the management of HIV-infected individuals.
Hadadi A, Moradmand Badie S, Roham M, Rasulinejad M, Mirzai N,
Volume 67, Issue 8 (11-2009)
Volume 67, Issue 8 (11-2009)
Abstract
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Background: One of the clinical manifestations of Human Immunodeficiency Virus (HIV)
infected patients is cardiovascular disorder. The aim of this study was to
evaluate the prevalence of cardiovascular disorders in HIV
infected patients for the beginning treatment of these patients and reducing
mortality and morbidity in these patients.
Methods: This cross-sectional study was performed on 134 HIV
infected patients who referred to Imam Khomeini hospital, Tehran University of
Medical sciences, Tehran Iran during years 2007-2008.
Demographic characteristics, history of smoking and opium addiction,
antiretroviral therapy, class of drugs and duration of consumption were
recorded. After completion of physical examination, electrocardiography and
echocardiography studies were done.
Results: In this study 98(73.1%) patients were male.
The mean age of the patients was 36.5±10.3
years. The mean of the CD4 number were 296±181. Injection drug users were 54.4%
of the study patients. Cardiovascular disorders were found in 84(62.7%)
patients. Among patients with heart diseases, 75%
were male. The most Electrocardiographic change was the axis deviation of the
heart found in 32(23.7%) patients.
Pericardial effusion and LVEF<50% were
noted in 7(5.2%) and 23(17.2%)
patients respectively. The involvement of the mitral valve
in 59(44%), tricuspid valve in 21(15.7%)
and aortic valve in 6(4.5%) patients were
noted. Myocardial dysfunctions existed in 10(7.4%)
patients.
Conclusions: Our results showed a high prevalence of cardiovascular disorder in HIV
infected patients. We recommend the evaluation of the cardiovascular
system in all HIV infected patients
even if they are symptom free.
Abdollahzade S, Aghamohammadi A, Soheili H, Salehi Sadaghiani M, Abolhassani H, Rezaei N,
Volume 68, Issue 10 (1-2011)
Volume 68, Issue 10 (1-2011)
Abstract
Background: Common Variable Immunodeficiency (CVID) is a primary immunodeficiency disease, characterized by hypogammaglobulinemia and heterogeneous clinical manifestations. This study was performed to evaluate the clinical and immunological features of pediatric patients with CVID.
Methods: We reviewed the records of 69 children diagnosed under age of 16 years with CVID (35 males and 34 females).
Results: By the year 2008, 15 patients (21%) had died. The total follow-up period was 333 patient-years. The mean diagnostic time between onset and diagnosis in our patient group was 4.40 years. The overall rate of consanguineous marriages was 58%. 10 patients had a positive family history of immunodeficiency. At the time of diagnosis, the mean levels of serum immunoglobulin G (IgG), IgM, and IgA levels were 286.86, 39.92, and 18.39 mg/dl, respectively which were below the normal levels for age. All of the patients presented with infectious diseases at the time of onset, the most common of which were pneumonia, diarrhea and sinusitis. Acute and recurrent infections were also found in almost all of the patients, particularly involving respiratory and gastrointestinal systems. The most common infections during follow-up period were pneumonia (31.9%), acute diarrhea (18.8%), acute sinusitis (18.8%), and otitis media (14.5%). Post-diagnosis survival was estimated to be 79% during the first five years. The survival rate was not shown to be influenced by delayed diagnosis, serum levels of IgG and B-lymphocyte count at the time of diagnosis.
Conclusions: Any child with a history of recurrent infections, decreased levels of serum immunoglobulin isotypes and consanguineous parents should be considered as a CVID patient.
Mehrnaz Rasoolinejad , Azar Hadadi , Mojtaba Hedayat Yaghoobi , Banafshe Moradmand Badie , Neda Alijani ,
Volume 71, Issue 7 (10-2013)
Volume 71, Issue 7 (10-2013)
Abstract
Background: HIV infection reduces the immune system and is the most significant factor in the spread of TB in recent years and one of the causes of death in HIV -seropositive patients. TB is the most commonly diagnosed opportunistic infection and the most frequent direct cause of death among HIV infected patients. The HIV infection can accelerate progression of TB infection to active TB disease. Among patients with active TB, those with HIV co-infection have the greatest risk for relapse. Regardless of increasing rate of TB and HIV in Iran, we decided to s urvey outcome of TB in HIV positive patients who treated with standard regimens in the years 2003-2012.
Methods: This retrospective cohort study was conducted on HIV-positive patients with TB referred to Behavioral Diseases Consultation Center and Infectious Diseases Ward of Imam Khomeini Hospital from 2003 to 2012. Outcome was defined as failure, relapse and mortality. Moreover, the relationship between outcomes and number of CD4, co-trimoxazole and antiretroviral intake, type of TB and AIDS defining illness was studied. Results: This study had 135 patients, 8 (5.9%) were females and 127 (94.1%) were males. The mean age of the patients was 40.14+10.02 and the most way to catch HIV in this study was intravenous drug user. There were 3 (2.22%) cases of failure, 15 ( 11.1%) relapse , and 21 ( 15.8%) deaths. Antiretroviral therapy, AIDS defining illness, type of TB and co-trimoxazole intake did not soley affect relapse. CD4 level was the most effective variables in relapse [ Hazard ratio: 0.392 (0.11-1.4) Relative Risk: 0.809 (0.593-1.103) (P=0.068) ]. However, regard to CI95%, the impact of CD4 on relapse is not significant and antiretroviral intake was the most important and effective variable in increasing their survival. Hazard ratio: 0.137 (0.141-0.45) Relative Risk: 0.686 (0.513-0.918) (P=0.001) Conclusion: Overall, receiving antiretroviral was the most important factor influencing the outcome of patients. |
Mahboobeh Haji-Abdolbaghi , Mehrnaz Rasoolinejad , Laden Abbasian , Aliakbar Amir Zargar, Hamid Emadi Koochak, Pardis Moradnejad, Naseh Mohammadi , Ali Pashae Zanjani , Saeed Bayanolhagh , Parisa Sadr Poor,
Volume 72, Issue 1 (4-2014)
Volume 72, Issue 1 (4-2014)
Abstract
Background: Abacavir is an anti-retroviral medication used to treat HIV infected/AIDS patients and its efficacy has been proven in randomized clinical trials. The most significant adverse reaction associated with abacavir is the acute hypersensitivity phenomenon which manifests in many forms and in severe cases could result in death. Hypersensitivity reaction to abacavir has been closely linked to the presence of HLA-B*57:01 allele. Avoidance of abacavir initiation in allele-positive patients is the most effective strategy in preventing possible severe hypersensitivity reactions. Previous epidemiologic studies have made great strides toward delineating HLA-B*57:01 allele frequency in different regions of the World and the available results indicate significant discrepancy between geographical regions. Despite these efforts, no study to date has determined the allele frequency among Iranian HIV-positive patients. The aim of the present study was to determine the proportion of allele-positive patients among a group of Iranian HIV-infected patients. Methods: Between September 2012 and February 2013, 122 HIV-positive patients were selected among patients referred to Imam Khomeini Hospital’s Consultation cen-ter for high risk behaviors using the convenience sampling method. Sampling scheme was designed in a manner to include equal number of infected patients with and without clinical Acquired Immunodeficiency Syndrome (AIDS). Patient data was collected using available records and a blood sample for DNA analysis was also obtained. Presence of HLA-B*57:01 allele was determined using the Polymerase Chain Reaction- Sequence Specific Method (PCR-SSP). Results: Seventy three patients (59.8%) were male. Co-infection with hepatitis B and C was observed in 1.7% and 40.7% of the patients, respectively. History of addiction and anti-retroviral therapy was positive in 50.0% and 60.7% of the patients, respectively. Overall, three patients were allele-positive which corresponds to a frequency of 2.46% (95% CI: 0.005-7.30). No association between presence of allele and investigated vari-ables were identified. Conclusion: Frequency of HLA-B*57:01 allele among a group of Iranian HIV-infected patients is estimated to be 2.5%. This rate is comparable to those reported in other Middle-Eastern countries, yet is relatively lower than reports generated from South-Eastern Asia, Europe, and the United States. Future studies with larger sample sizes are needed to corroborate these findings.
Zahra Alizadeh , Farzin Halabchi , Mastaneh Rajabian Tabesh,
Volume 73, Issue 6 (9-2015)
Volume 73, Issue 6 (9-2015)
Abstract
Background: Today obesity and overweightness are the major health problem all over the world. The relation between decreasing serum level of vitamin D and some chronic diseases such as diabetes and obesity was shown in the available studies. The aim of this study was to determine the prevalence of vitamin D deficiency among obese and overweight Iranian population and its relation with age, sex, occupation, body fat percentage and body weight according to body mass index. Methods: In a descriptive cross-sectional study, all patients who were referred to obesity clinic of Imam Khomeini Hospital, Tehran, for weight management throughout one year were included to the study. The prevalence of vitamin D deficiency with serum level lower than 30 ng/ml among 107 subjects was evaluated. The data were analyzed by SPSS, ver. 19 (SPSS, Inc., Chicago, IL, USA). Quantitative variables were presented as mean±SD and qualitative variables were presented as relative frequency. The groups were compared with independent samples t-test and Chi-square test. The level of significance for comparing the groups was considered at P<0.05. Results: In 107 participants, vitamin D deficiency in 81 subjects (75.7%) was reported. The prevalence of deficiency in participants with body mass index between 25 to 29.9, 30 to 34.9 and equal or greater than 35 kg/m2 was 77.3%, 83.7% and 69.4%, respectively. However, the differences between overweight and obese groups were not significant (P=0.193). The prevalence of moderate and severe vitamin D deficiencies among the participants was 50.5% and 25.2 %, respectively. Vitamin D deficiency was more common in participants below 50 years of age compared with those older than fifty (P=0.001). Conclusion: The prevalence of vitamin D deficiency was high in obese and overweight population especially among individuals younger than 50 years. It seems that, it is necessary to add prevention and management of this deficiency to obesity treatment protocols especially in the young adults.
Sara Jambarsang , Alireza Akbarzadeh Baghban , Seyed Saeed Hashemi Nazari, Farid Zayeri , Ali Nikfarjam ,
Volume 73, Issue 9 (12-2015)
Volume 73, Issue 9 (12-2015)
Abstract
Background: After primary infection, the number of CD4 T-cells decreases with disease progress. The patient’s immunological status could inform by The CD4 T-cell counts over the time. The main purpose of this study is to assess the trend of CD4 cell count in HIV+ patient that received Antiretroviral Therapy (ART) by using a multistate Markov model to estimate transition intensities and transition probabilities among various states.
Methods: A total of 122 HIV+ patients were included in this cohort study who are undergoing Antiretroviral Therapy treatment in the Iran AIDS center in Imam Khomeini Hospital in Tehran that inter during March 1995 to January 2005 and then fallow up to October 2014. All adults with at least two follow-up visits in addition to their pre-ART treatment were considered to be eligible for inclusion in the study. Continuous-time Markov processes are used to describe the evolution of a disease over different states. The mean sojourn time for each state was estimated by multi state Markov model.
Results: Sample included 22 (18%) female with a mean age of 43.32 (standard deviation 8.33) years and 100 (82%) male with a mean age of 45.28 (standard deviation 8.34) year. Age was divided in to two categories, 40 years old and lower than that 66 (54.1) patents and persons older than 40 years old 56 (45.9) patents. A total of 122 patients were included. 29 patients died during follow-up. One year transition probability for staying in state 1 of CD4 cell count was 51%. This probability for six year was 33%. The mean sojourn time for sate 4 was 21 month. The hazard ratio of transition from state 3 to state 4 was 4.4 in men related to women.
Conclusion: The use of antiretroviral therapy in the treatment of HIV infected persons reduce viral replication and increase in CD4 T lymphocyte count, and delay the progression of disease. This paper is shown the progression of this trend.
Anousheh Safarcherati , Masoumeh Amin-Esmaeili , Behrang Shadloo , Minoo Mohraz , Afarin Rahimi-Movaghar ,
Volume 73, Issue 10 (1-2016)
Volume 73, Issue 10 (1-2016)
Abstract
HIV/AIDS is among the leading causes of morbidity and mortality in world. There are more than 35 million people living with HIV/AIDS in the world. Although the annual incidence of HIV infection is decreasing globally, HIV prevalence is rising due to development of more effective treatment and higher survival. Iran suffers from concentrated HIV epidemics among injecting and non-injecting drug users. There are more than 27 thousand registered cases of HIV infection and it is estimated that there are above seventy eight thousand cases in the country. Regarding the burden of disease, it is projected that HIV/AIDS will have the highest growth during the next 10 years. The outcome of this epidemics will be determined by human behavior. HIV, psychiatric disorders and substance use disorders are closely correlated and are accompanied by similar risk factors. They also share common consequences such as stigma and discrimination. Correlation of psychiatric disorders, as one of the most influential determinants of our behavior, and HIV/AIDS infection is reviewed in this narrative article. Psychiatric disorders are associated with greater risk of HIV acquisition. Substance use disorders, both injecting and non-injecting, as well as severe mental illnesses put the individual at higher risk of acquiring HIV infection. Impaired judgment, diminished inhibition and control over behaviors, lack of insight and poor self-care have been proposed as the underlying mechanisms. On the other hand, HIV infection may put the individual at greater risk of developing a mental illness. Coping with a chronic and life-threatening illness, fear of stigma and discrimination, CNS invasion of the virus as well as the adverse neuropsychiatric side effects of anti-retroviral medications may all contribute to establishment of a psychiatric disorder. Although there exists a bi-directional correlation between mental health problems and HIV/AIDS infection, this reciprocity goes beyond. Psychiatric disorders can affect the patient’s adherence, access to treatment and care and can worsen the course and clinical outcome of the infection. The clinical importance, underlying mechanism and other implications of this correlation are reviewed in this article.
Salman Daliri , Khairollah Asadollahi , Nazila Rahimi, Kourosh Sayehmiri ,
Volume 75, Issue 9 (12-2017)
Volume 75, Issue 9 (12-2017)
Abstract
Background: The deficiency of enzyme glucose-6-phosphate dehydrogenase (G6PD) is among the most common genetic diseases in human. The deficiency of G6PD enzyme is one of the most common encountered enzymes, affecting about 400 million people and causing a wide range of undesirable clinical complications worldwide. The performed studies have reported a variety of statements about the relationship between malaria and survival of people with defect, but these kinds of studies are limited in Iran. This study aimed to estimate the incidence of G6PD deficiency among newborns in malarious areas of Fars province.
Methods: The present study was conducted ecologically and descriptively-analytically on 59745 neonates with G6PD deficiency in Fars province, Iran from April 2011 to March 2015. To determine the defect, a point fluorescence test and Kimia commercial kit (KimiaPajoohan Co., Tehran, Iran) were used. To determine the areas with malaria, factors associated with malaria-causing cells in Fars province, including the presence of carriers, the presence of malaria, the incidence of new malaria and the presence of malaria activated sites were studied. The incidence of defect was calculated using the statistical method of estimating the annual incidence rate. ArcGIS software, version 10.3 (ESRI, Redlands, CA, USA) was used to provide geographic mappings and distribution patterns in malarious areas.
Results: The total incidence of G6PD deficiency in newborns was estimated as 15.58 per 100 live births, including 16.25 for boys and 14.85 for girls. The incidence of this defect in malaria-prone areas was higher than other areas. As a region was more malaria-prone, the incidence of G6PD deficiency increased too, which was statistically significant (P= 0.039).
Conclusion: Based on the findings of this study, Fars province is among areas with high incidence of G6PD deficiency. The incidence of G6PD deficiency in malaria-prone areas of Fars province, Iran, is higher than other regions, which indicates better survival of patients against malaria in the past.
Methods: The present study was conducted ecologically and descriptively-analytically on 59745 neonates with G6PD deficiency in Fars province, Iran from April 2011 to March 2015. To determine the defect, a point fluorescence test and Kimia commercial kit (KimiaPajoohan Co., Tehran, Iran) were used. To determine the areas with malaria, factors associated with malaria-causing cells in Fars province, including the presence of carriers, the presence of malaria, the incidence of new malaria and the presence of malaria activated sites were studied. The incidence of defect was calculated using the statistical method of estimating the annual incidence rate. ArcGIS software, version 10.3 (ESRI, Redlands, CA, USA) was used to provide geographic mappings and distribution patterns in malarious areas.
Results: The total incidence of G6PD deficiency in newborns was estimated as 15.58 per 100 live births, including 16.25 for boys and 14.85 for girls. The incidence of this defect in malaria-prone areas was higher than other areas. As a region was more malaria-prone, the incidence of G6PD deficiency increased too, which was statistically significant (P= 0.039).
Conclusion: Based on the findings of this study, Fars province is among areas with high incidence of G6PD deficiency. The incidence of G6PD deficiency in malaria-prone areas of Fars province, Iran, is higher than other regions, which indicates better survival of patients against malaria in the past.
Fatemeh Haidari , Mohammad-Hossein Haghighi-Zade, Gholam-Abas Kayedani , Negar Karimi Birgani ,
Volume 76, Issue 2 (5-2018)
Volume 76, Issue 2 (5-2018)
Abstract
Background: Anemia is the most common nutritional disorder in the world in which iron deficiency is one of its main causes. The prevalence of obesity and risk of iron deficiency anemia in these individuals is increasing. The present study examined the association between iron deficiency, dietary intake and obesity and obesity-induced inflammation in female students.
Methods: This descriptive cross-sectional study was conducted in Ahvaz University of Medical Sciences, Ahvaz, Iran, from May to March of 2016. A total of 170 female students were selected by stratified random sampling. Being in the age of 18-35 years, having a regular menstrual cycle, not following a specific diet and not taking any medication or dietary supplements that could affect iron status were indicators of inclusion in the study. General information and physical activity questionnaire were completed and a semi-quantitative feed frequency questionnaire was used to obtain food intake information. Anthropometric indicators including weight, height, body mass index (BMI), waist circumference and body fat were measured. Obesity was evaluated with 3 different definitions. Biochemical indices such as iron, hemoglobin, hematocrit, transferrin, total iron binding capacity (TIBC), ferritin, and hs-CRP were also measured.
Results: The dietary intake of iron and some nutrients related to iron (including energy, protein, vitamin C and calcium) showed no significant difference in dietary intake between different groups of obesity definitions. Serum iron levels and hemoglobin concentration had a significant negative correlation with BMI and hs-CRP concentrations (P=0.026 and P=0.01 respectively). The relationship between transferrin levels and total iron binding capacity with the index of waist circumference was positive and significant (P=0.040, P=0.034, respectively). Also, there was a significant positive correlation between obesity and hs-CRP levels (P=0.014). There was no significant relationship between other evaluated factors with different degrees of obesity.
Conclusion: Chronic obesity and inflammation which could be caused by obesity, can contribute to iron deficiency, regardless of dietary iron intake.
Methods: This descriptive cross-sectional study was conducted in Ahvaz University of Medical Sciences, Ahvaz, Iran, from May to March of 2016. A total of 170 female students were selected by stratified random sampling. Being in the age of 18-35 years, having a regular menstrual cycle, not following a specific diet and not taking any medication or dietary supplements that could affect iron status were indicators of inclusion in the study. General information and physical activity questionnaire were completed and a semi-quantitative feed frequency questionnaire was used to obtain food intake information. Anthropometric indicators including weight, height, body mass index (BMI), waist circumference and body fat were measured. Obesity was evaluated with 3 different definitions. Biochemical indices such as iron, hemoglobin, hematocrit, transferrin, total iron binding capacity (TIBC), ferritin, and hs-CRP were also measured.
Results: The dietary intake of iron and some nutrients related to iron (including energy, protein, vitamin C and calcium) showed no significant difference in dietary intake between different groups of obesity definitions. Serum iron levels and hemoglobin concentration had a significant negative correlation with BMI and hs-CRP concentrations (P=0.026 and P=0.01 respectively). The relationship between transferrin levels and total iron binding capacity with the index of waist circumference was positive and significant (P=0.040, P=0.034, respectively). Also, there was a significant positive correlation between obesity and hs-CRP levels (P=0.014). There was no significant relationship between other evaluated factors with different degrees of obesity.
Conclusion: Chronic obesity and inflammation which could be caused by obesity, can contribute to iron deficiency, regardless of dietary iron intake.
Mahsa Nazari, Farid Zayeri , Seyed Saeed Hashemi Nazari , Sara Jambarsang, Ali Nikfarjam , Alireza Akbarzadeh Baghban ,
Volume 77, Issue 2 (5-2019)
Volume 77, Issue 2 (5-2019)
Abstract
Background: The Multi state Markov models have extensively application with categorization of laboratory marker of CD4 cells for evaluation of HIV disease progression. These models with different states result in different effects of covariates and prediction of HIV disease trend. The main purpose of this study was comparison of four and five states models with the three- state in order to select the model with better prediction ability of occurrence of HIV and finally death in HIV positive people.
Methods: A total of 305 HIV positive people were included in this cohort study in the Iran AIDS center in Imam Khomeini Hospital in Tehran that entered during March 1995 to January 2005 and then fallowed up to October 2014. The three continuous- time Markov models of three-, four- and five- state models were fitted to data to describe the evolution of a HIV disease Trend over different states.
For comparison of models, two criteria of modification of Akaike’s criterion (DRAIC) and likelihood cross-validation criterion (DRLCV) along with their 95% tracking interval was used. For fitting of these models and estimation of transition matrix and the hazard ratio of gender and treatment independent variables, the msm package of R project for statistical computing, version R 3.2.4 (www.r-project.org) was used.
Results: The results showed that the four- state model has more prediction ability than five-state model for evaluation of HIV disease Trend. In the four-state model, the progression hazard ratio to death for people who received highly active antiretroviral therapy (HAART) was 0.64 lower than who didn’t get this therapy. Moreover, the progression hazard ratio for men was 2.33 fold in comparison to women. The disease progression hazard ratio to death was 4.9 fold for men in comparison to women.
Conclusion: The (DRAIC) and (DRLCV) criterions showed that the four-state model has more predictive ability of the progression trend of HIV disease in comparison of five-state model.
Methods: A total of 305 HIV positive people were included in this cohort study in the Iran AIDS center in Imam Khomeini Hospital in Tehran that entered during March 1995 to January 2005 and then fallowed up to October 2014. The three continuous- time Markov models of three-, four- and five- state models were fitted to data to describe the evolution of a HIV disease Trend over different states.
For comparison of models, two criteria of modification of Akaike’s criterion (DRAIC) and likelihood cross-validation criterion (DRLCV) along with their 95% tracking interval was used. For fitting of these models and estimation of transition matrix and the hazard ratio of gender and treatment independent variables, the msm package of R project for statistical computing, version R 3.2.4 (www.r-project.org) was used.
Results: The results showed that the four- state model has more prediction ability than five-state model for evaluation of HIV disease Trend. In the four-state model, the progression hazard ratio to death for people who received highly active antiretroviral therapy (HAART) was 0.64 lower than who didn’t get this therapy. Moreover, the progression hazard ratio for men was 2.33 fold in comparison to women. The disease progression hazard ratio to death was 4.9 fold for men in comparison to women.
Conclusion: The (DRAIC) and (DRLCV) criterions showed that the four-state model has more predictive ability of the progression trend of HIV disease in comparison of five-state model.
Ali Alami , Fatemeh Zarei , Hadi Tehrani , Zahra Hosseini , Alireza Jafari ,
Volume 77, Issue 4 (7-2019)
Volume 77, Issue 4 (7-2019)
Abstract
Background: Iron deficiency in the body is the main cause of anemia, and iron supplementation is probably the best option for iron deficiency and iron deficiency anemia in women and young children. This study aimed to explain the challenges of national iron supplementation in female school’s base on the perspective of the stakeholders.
Methods: This study was a qualitative study of content analysis. The data of this study were conducted by focus group discussion, semi-deep interviews with the participation of the target community of students, parents of students, school principals and school health instructors, general manager of the Office of Community Nutrition (Department of Education) includes manager, deputy and school health officer, from October 2016 to January 2017 in city of Gonabad, Iran. Participants were selected through targeted sampling and data collection continued to saturation. Data were analyzed using contractual content analysis method based on five steps of Graneheim and Lundman. Data management was done with NVivo software, version 11 (QSR International, Victoria, Australia), but data analysis and interpretation were done manually.
Results: The findings from group discussions and semi-deep interviews with stakeholders were categorized into twelve themes. The main strength, perceived in "Perceived Individual Benefits" and "Perceived Executive or Management Benefits". The main perceived weakness was "Physical Disadvantages", "Tablets Disadvantages", "Disadvantages of Programming" and "Disadvantages of the Program". The main perceived barriers was "Educational and Information Barriers", "Barriers of Pill Consumption" and "Management and Administrative Barriers". "Modifying the Executive Program", "Individual Perception Modification" and "Reform the Shape of Pills" were suggested as a corrective mechanism from participants’ view point.
Conclusion: According to the results of this study, the most important challenges of the "Schools Iron Aid National Plan" were "Educational and Information Barriers", "Administrative barriers", and "Barriers to Pill Consumption". Therefore, in order to do better, the Iron Supplementation Program requires intervention at individual, interpersonal, inter-organizational, and intra-organizational levels to provide comprehensive support for the program and, ultimately, increase program productivity.
Methods: This study was a qualitative study of content analysis. The data of this study were conducted by focus group discussion, semi-deep interviews with the participation of the target community of students, parents of students, school principals and school health instructors, general manager of the Office of Community Nutrition (Department of Education) includes manager, deputy and school health officer, from October 2016 to January 2017 in city of Gonabad, Iran. Participants were selected through targeted sampling and data collection continued to saturation. Data were analyzed using contractual content analysis method based on five steps of Graneheim and Lundman. Data management was done with NVivo software, version 11 (QSR International, Victoria, Australia), but data analysis and interpretation were done manually.
Results: The findings from group discussions and semi-deep interviews with stakeholders were categorized into twelve themes. The main strength, perceived in "Perceived Individual Benefits" and "Perceived Executive or Management Benefits". The main perceived weakness was "Physical Disadvantages", "Tablets Disadvantages", "Disadvantages of Programming" and "Disadvantages of the Program". The main perceived barriers was "Educational and Information Barriers", "Barriers of Pill Consumption" and "Management and Administrative Barriers". "Modifying the Executive Program", "Individual Perception Modification" and "Reform the Shape of Pills" were suggested as a corrective mechanism from participants’ view point.
Conclusion: According to the results of this study, the most important challenges of the "Schools Iron Aid National Plan" were "Educational and Information Barriers", "Administrative barriers", and "Barriers to Pill Consumption". Therefore, in order to do better, the Iron Supplementation Program requires intervention at individual, interpersonal, inter-organizational, and intra-organizational levels to provide comprehensive support for the program and, ultimately, increase program productivity.
Ahmad Tavakoli , Maryam Esghaei , Angila Ataei-Pirkooh , Mohsen Moghoofei , Hadi Ghaffari , Farah Bokharaei-Salim ,
Volume 77, Issue 5 (8-2019)
Volume 77, Issue 5 (8-2019)
Abstract
Currently, there are about 37 million people worldwide living with human immunodeficiency virus (HIV) /AIDS, with an estimated two million new cases per year globally. According to estimates from the World Health Organization (WHO), only 75% of the population with HIV know their status. Initially, HIV infection was associated with significantly increased rates of mortality and morbidity. However, the rapid advances in treatment and the advent of different classes of antiretroviral drugs over time have led to change the face of HIV/AIDS from a deadly infection to chronic and manageable disease. There is strong evidence that HIV-infected patients undergoing antiretroviral therapy have longer lives and are less likely to transmit infection to their sexual partners. Since the introduction of zidovudine in 1987 as the first antiretroviral drug, significant strides have been made in antiretroviral therapy. The introduction of potent antiretroviral drugs for the treatment of HIV infection has been one of the significant events in the evolution of modern medicine. Antiretroviral therapy refers to the use of drugs in the treatment of HIV. Generally, these drugs are categorized based on the steps of the HIV life cycle suppressed by them. There are six main classes of antiretroviral agents including nucleoside/ nucleotide reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, protease inhibitors, fusion inhibitors, co-receptor inhibitors, and integrase inhibitors. Combination antiretroviral therapy should be considered for HIV patients to achieve the highest viral suppression rate, and to reduce the risk of resistance development and morbidity and mortality associated with AIDS. Achieving and maintaining HIV viral load suppression among treated patients has remarkably increased over the last years due to the development of potent and well-tolerated agents which can be co-formulated as a once-daily single-tablet or fixed-dose combination for simplification. However, there are some limitations preventing patients to benefit from this treatment. The main goals of HIV therapy in the future are to overcome the limitations of current treatment, including side effects. This review will provide an overview of advances in the current antiretroviral drugs by focusing on their pharmacokinetics, mechanism of action, dosing recommendations, and adverse events for each drug class.
Homayoun Sadeghi Bazargani , Jafar Sadegh Tabrizi , Mohammad Asghari Jafar Abadi , Reza Yousefi , Mehdi Mohammadzadeh , Asad Ahmadi , Masoud Mohammadi ,
Volume 77, Issue 10 (1-2020)
Volume 77, Issue 10 (1-2020)
Abstract
Background: AIDS is an emerging disease, and despite the fact that it has not been recognized for the first half-century since its inception, it has been known as a century-old disaster. This disease, by proliferation in immune cells and ultimately by weakening the immune system, makes people vulnerable to diseases. Our study seeks to examine existing cases of HIV/AIDS patients in East Azerbaijan province in Iran and provides useful guidance for patient diagnosis, treatment, and care.
Methods: This is a descriptive-analytic study in which the target group includes all HIV-positive or AIDS patients identified or reported from 2004 to 2014 in Tabriz Medical Sciences or Health Centers of East Azerbaijan province. The demographic information of all patients were recorded by a researcher-made questionnaire during visiting the disease-management counseling centers. All data including transmission of the illness (including all possible ways), the diagnostic date, the onset of treatment and the date of death were collected, and then entered into the software Stata, version 11.0 (Stata Corp., College Station, TX, USA). The information were imported in the ArcGIS software, version 10.7.1 (ESRI Inc., Redlands, CA, USA), maps were created, and geographic and spatial data were analyzed.
Results: According to the results of this study, most patients with 89.9% were male, 28.9% were under the age of 36 years, 32.3% had elementary education, and the most common way of transmission with 42.3% is through the shared infusion.
Conclusion: According to the results of this study, the highest prevalence of AIDS in East Azerbaijan province was observed in men under the age of 36 years and primary and lower secondary education in Tabriz and Maragheh cities.
Methods: This is a descriptive-analytic study in which the target group includes all HIV-positive or AIDS patients identified or reported from 2004 to 2014 in Tabriz Medical Sciences or Health Centers of East Azerbaijan province. The demographic information of all patients were recorded by a researcher-made questionnaire during visiting the disease-management counseling centers. All data including transmission of the illness (including all possible ways), the diagnostic date, the onset of treatment and the date of death were collected, and then entered into the software Stata, version 11.0 (Stata Corp., College Station, TX, USA). The information were imported in the ArcGIS software, version 10.7.1 (ESRI Inc., Redlands, CA, USA), maps were created, and geographic and spatial data were analyzed.
Results: According to the results of this study, most patients with 89.9% were male, 28.9% were under the age of 36 years, 32.3% had elementary education, and the most common way of transmission with 42.3% is through the shared infusion.
Conclusion: According to the results of this study, the highest prevalence of AIDS in East Azerbaijan province was observed in men under the age of 36 years and primary and lower secondary education in Tabriz and Maragheh cities.
Asghar Aghamohammadi , Mohammadreza Shaghaghi , Hassan Abolhassani , Reza Yazdani , Seyed Mohsen Zahraie , Mohammad Mehdi Goya , Susan Mahmoudi , Nima Rezaei , Shohreh Shahmahmoodi ,
Volume 78, Issue 1 (4-2020)
Volume 78, Issue 1 (4-2020)
Abstract
Primary immunodeficiency diseases (PIDs) is a diverse group of diseases, characterized by a defect in the immune system. These patients are susceptible to recurrent respiratory infections, gastrointestinal problems, autoimmune diseases, and malignancies. In most cases, patients with primary immunodeficiency disorders have genetic defects and are monogenic disorders that follow a simple Mendelian inheritance, however, some PIDs recognize a more complex polygenic origin. Overall, almost 70 to 90 percent of patients with primary immunodeficiency are undiagnosed. Given that these patients are exposing to respiratory infectious agents and some live-attenuated vaccines, thus they have a high risk to some clinical complications. The administration of oral polio vaccine in patients with PIDs especially can increase the possibility of acute flaccid paralysis. These patients will excrete the poliovirus for a long time through their feces, even though they are not paralyzed. Long-term virus proliferation in the vaccinated individuals causes a mutation in the poliovirus and creates a vaccine-derived polioviruses (VDPVs), which is a major challenge to the final stages of the worldwide eradication of polio.
To increase the diagnosis and identification of patients with immunodeficiency and carrying out a national plan for screening patients with immunodeficiency from the fecal excretion of the poliovirus, a possible polio epidemic can be prevented during post-eradication. Development of laboratory facilities in provincial and city centers, improvement of communications among physicians regarding medical consultation and establishment of referring systems for patients by national network lead to improve status of diagnosis and treatment of patients with primary immunodefiicencies. In this context, launching and activating the national network of immunodeficiency diseases is essential for improving the health of children and reducing the cost of the health system of the country. A national network of immunodeficiency can lead to increase awareness of physicians regarding primary immunodeficiency disorders, improve collaboration among physicians about genetic consultation and establish a practical referral system in Iran that results in increased diagnosis and improve treatment of patients with primary immunodeficiency disorders.
To increase the diagnosis and identification of patients with immunodeficiency and carrying out a national plan for screening patients with immunodeficiency from the fecal excretion of the poliovirus, a possible polio epidemic can be prevented during post-eradication. Development of laboratory facilities in provincial and city centers, improvement of communications among physicians regarding medical consultation and establishment of referring systems for patients by national network lead to improve status of diagnosis and treatment of patients with primary immunodefiicencies. In this context, launching and activating the national network of immunodeficiency diseases is essential for improving the health of children and reducing the cost of the health system of the country. A national network of immunodeficiency can lead to increase awareness of physicians regarding primary immunodeficiency disorders, improve collaboration among physicians about genetic consultation and establish a practical referral system in Iran that results in increased diagnosis and improve treatment of patients with primary immunodeficiency disorders.
Mahboobeh Sheikhzadeh, Mohsen Monadi , Yones Lotfi, Abdolah Moosavi, Enayatollah Bakhshi,
Volume 78, Issue 11 (2-2021)
Volume 78, Issue 11 (2-2021)
Abstract
Background: Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo and nystagmus in clinics. Vertigo has many causes and the recurrence of vertigo is unknown. Among a lot of factors, vitamin D deficiency is more important. This study was conducted to determine the effect of vitamin D supplementation on torsional nystagmus in BPPV patients. This study wants to show the deficiency of vitamin D leads to the recurrence of BPPV.
Methods: This case-control study was conducted from April 2017 to May 2018. All eligible patients with BPPV were presented to the Audiology clinic of Babol Rouhani hospital consecutively. Diagnosis of BPPV and the presence of nystagmus were confirmed and serum vitamin D was assessed. Dix-halpike maneuver and videonystagmography (VNG) for assessing nystagmus were done and for serologic assessment, ELISA was performed for analyzing the level of hydroxy 25 vitamin D.Vitamin D sufficient patients (more than 20 ng/ml) with BPPV were considered as the control group and vitamin D deficient patients (less than 20 ng/ml) were as the test group.
In all the patients of two groups, torsional nystagmus (vertical, horizontal and oblique) were studied and compared.
Methods: This case-control study was conducted from April 2017 to May 2018. All eligible patients with BPPV were presented to the Audiology clinic of Babol Rouhani hospital consecutively. Diagnosis of BPPV and the presence of nystagmus were confirmed and serum vitamin D was assessed. Dix-halpike maneuver and videonystagmography (VNG) for assessing nystagmus were done and for serologic assessment, ELISA was performed for analyzing the level of hydroxy 25 vitamin D.Vitamin D sufficient patients (more than 20 ng/ml) with BPPV were considered as the control group and vitamin D deficient patients (less than 20 ng/ml) were as the test group.
In all the patients of two groups, torsional nystagmus (vertical, horizontal and oblique) were studied and compared.
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Results: Twenty-seven patients in each group have completed the study. The mean age of the control group and test group was 48.2+4.8, 47.8+5.7 and 47.2+4.9 years respectively (P=0.91). Two groups were comparable regarding nystagmus severity. All patients had at least two attacks During the last six months. The mean of serum 25 OHD was 33.81 in the control group and 11.41 in the test group that was statistically significant (P=0.001 for all) and the severity of torsional nystagmus in three axes of horizontal, vertical and oblique in the control group was 4.98, 9.06, 5.40 respectively and 3.32, 8.86, 6.93 in the test group that was statistically significant as compared with the control group (P=0.001).
Conclusion: Findings of this study indicate a relationship between vitamin D deficiency and recurrence of nystagmus in BPPV patients |
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