HEPATITIS C VIRUS GENOTYPES IN IRAN IN 1996: A PILOT STUDY
The hepatitis C virus is genetically varied and has been divided into 6 main groups and 40 subgroups. Since the geographical distribution of viral genotypes is very diverse, the following study was performed as a pilot study to identify the different genotypes of the virus in Iran.
This descriptive study was performed on 21 hepatitis C patients who were observed by physicians in Shariati, Taleghani and Mehrad hospitals, Tehran, Iran. Among these patients, 4 had chronic liver disease, 6 had kidney transplants, 3 were under hemodialysis, and 8 were blood donors afflicted by hepatitis C. Hepatitis C virus infection was diagnosed primarily in all patients using an ELISA II serologic test on the serum sample. The infection was confirmed using a two-staged polymerase chain reaction. The second-generation genotype identification method was used to determine the five common types of hepatitis C virus, and the Holland method was used for those genotypes, which did not qualify for any of the five common types.
Among the 21 cases studied, infection was documented in 15 (72%) serum samples. Fourteen samples were divided among the five genotypes; 7 samples (47%) were I/1a, 3 samples (20%) were II/1b, and 4 samples (27%) were V/3a. One remaining sample (6%) did not qualify for any of the groups. There was not any significant difference between the studied groups and the genotypes.
This pilot study proved the presence of four genotypes (I/la, II/lb, V/3a and 4) in Iran. Due to the small number of cases, wide range of the patient age, different routes of treatment before the study, more extensive studies are needed to precisely determine the geographical distribution of hepatitis C virus genotypes among the healthy population and other at-risk groups.
Authors: Zali, M R, Mayomi M, Raoufi M, Noroozi A.
Source: Pejouhandeh 1999; 4 (1): 3-8
FINE NEEDLE ASPIRATION CYTOLOGY COMPARED WITH SCRAPING METHOD FOR MICROSCOPIC DIAGNOSIS OF CUTANEOUS LEISHMANIASIS
Cutaneous leishmaniasis is endemic in northern and north-eastern parts of Isfahan province, central Iran. The main step in the diagnostic approach is confirmation or exclusion of the presence of organism in the lesions. The conventional method consists of preparing the smears from the material obtained by scraping the inner wall of the lesion. In this study, the two methods, scraping and fine needle aspiration cytology (FNAC) have been compared, both qualitatively and quantitatively.
This cross-sectional study was performed on 130 patients at Amin’s hospital, Isfahan during 1997. After the initial cleansing of the skin, the wall of the lesion was aspirated by a 20-gauge needle attached to a 10 ml syringe. If no adequate tissue material was obtained, the procedure was repeated after injection of 0.1 ml of normal saline. Scraping of the lesion wall was performed by scalpel blade no.11. Separate smears were prepared from the materials, then stained with Giemsa stain and studied.
In scraping, 109 out of 130 and in FNAC, 77 out of 130 samples revealed organisms. The difference was significant (P =0.001). In adults, FNAC seems to be less painful than scarping. Therefore, FNAC can be used as complementary to scarping in lesions on the face and other delicate tissues, though it can not substitute the scraping method.
Authors: Rajabi P, Jalayer T, Asilian A, Abbas-Zadeh MR.
Source: Res Med (Pajouhesh dar Pezeshki) 1999; 4 (1): 3-6
A SURVEY OF BACTERIAL AGENTS CAUSING ACUTE DIARRHEA IN TEHRAN’S CHILDREN UNDER 5
In order to study the etiologic bacterial agents causing diarrhea, 1125 stool specimens from children under 5 years of age were collected in transport medium at five educational and therapeutic centers, and were investigated under standard conditions in those centers from June 1995 to October 1997 in Tehran.
In the present study, 498 positive cases (44.3%) were found. The most common pathogens were Enteropathogenic E. coli (65.7%), Shigella (19.6%), Salmonella (12.8%) and Campylobacter jejuni (1.9%). Most cases of acute diarrhea were found to be in the age group 2-3 years. There was a statistically significant correlation between age and season with the disease (P<0.001), but there was no statistically significant correlation between sex and acute diarrhea. Sensitivity testing indicated that a high propotion of them were resistant to many antibiotics, and some of them were highly sensitive to amikacin, nitrofurantoin and nalidixic acid.
Authors: Modarres Sh.
Source: J Med Council IR Irn 1999; 17 (3): 222-225
COMPARATIVE EVALUATION OF MCV AND MCH VALIDITY IN BETA-THALASSEMIA SCREENING
Due to the prevalence of thalassemia in Iran, a descriptive cross-sectional study was conducted to determine a more valid variable for screening minor thalassemia patients. In this study, blood variable MCV was compared with MCH. A sample of 1783 male students in their last grade of high school were evaluated. Complete blood count was performed by Sysmax cellcounter and HbA2 electrophoresis using ion-exchange column chromatography. Iron therapy was carried out for at least two months in each case if the HbA2 was found to be between 3.2 to 3.5%.
In this study, 1391 cases were Farsi, 391 Baluchi and one Afghani. Hundred eleven cases (6.2%) were diagnosed as having ß-thalassemia trait (HbA2 equal or higher than3.4%). The prevalence of ß-thalassemia trait in Fars and Baluchi was 4.8% and 10.9%, respectively. This study indicated that MCV was more valid than MCH in screening ß-thalassemia trait. When MCV with a cut-off pick of 80 femtoliter was used, almost all carriers could be detected, so this index was found to be more reliable and economically more beneficial.
Because our results are different from that proposed by the International Federation of Thalassemia, this subject deserves further investigation.
Authors: Tabatabaie SMTH, Khazaie MR.
Source: J Med Council IR Irn 1999; 17 (3): 189-194.
EVALUATION OF THE TUBERCULIN TEST INDURATION DIAMETER 6 YEARS AFTER THE SECOND BCG VACCINATION IN TEHRAN’S JUNIOR HIGH SCHOOL STUDENTS
Tuberculosis is a main world health problem, and each year 10 million new cases and 3 million deaths occur in the world due to the disease. Tuberculosis is one of our country’s regional diseases, and BCG inoculation is one of the ways hoped to prevent it. Vaccination is performed once at the neonatal period and once before entering primary school. In this study, to assess the efficacy of the second BCG vaccination 6 years after inoculation, a tuberculin test was performed in 703 students.
This descriptive study was performed in 703 male and female junior high school students in Tehran. Among Tehran’s 19 districts, primarily in 5 districts and then in each district, an average of one boys’ and one girls’ public junior high school were randomly selected. In each school, 12-year-old (6th grade) students whose BCG vaccination had been recorded in their health card before entering the school were selected, and intradermal Mantoux inoculation was performed for each student. After 72 hours, the tuberculin test result was evaluated with a ballpoint pen, and two physicians separately measured induration diameter.
Among 703 students evaluated, 352 students (50.1%) were boys and 351 students (49.9%) were girls, with a mean age of 12±0.2 years. Test result evaluation after 72 hours showed that mean PPD induration diameter was significantly higher in boys compared to girls (P<0.05). In 248 subjects (35.3%), with induration diameters under 5 millimeters, the test result was considered negative. In 455 subjects (64.7%), with induration diameters equal to or higher than 5 millimeters, the test result was positive. Eventually, BCG vaccination does not have a long-term effect on maintaining tuberculin test positivity, and reaction to vaccine diminishes with time.
Authors: Taghavi N, Moradi A, Abusaiidi E.
Source: Pejouhandeh 1999; 4 (2): 161-165
PREVALENCE OF ZINC DEFICIENCY AMONG JUNIOR-HIGH SCHOOL STUDENTS IN TEHRAN
Considering the importance of zinc deficiency as a health problem in various populations, especially in the age groups experiencing growth spurt, and also considering previous reports on zinc deficiency, this study was performed to determine the state of zinc deficiency among junior-high school students in Tehran in1997.
This descriptive study was performed on 881 students (452 boys and 429 girls) with a mean age of 13.2±1.0 years (range: 11-16 years). Students were selected by stepwise random sampling. The zinc level of plasma, erythrocyte and hair was measured by atomic absorption. Food style was determined by a 24-hour intake recall. Students with at least two zinc indices below normal (erythrocyte zinc below 10µg/ml, plasma zinc below 100µg/dl, hair zinc below 125µg/g) were defined as zinc deficient.
The prevalence of zinc deficiency was 31% among the population, and zinc deficiency based upon plasma, erythrocyte and hair indices were 65%, 49% and 1.3%, respectively. Fifty percent of cases were receiving zinc below RDA. The best index to assess body zinc was erythrocyte zinc measurement by the method used in this study.
Considering the number of students receiving less than 50% RDA and the prevalence of zinc deficiency based upon erythrocyte zinc index, about half of our sample were deficient. The notable prevalence of zinc deficiency among junior high school students and during the adolescence growth spurt, together with none-efficient energy and nutrient intake, renders adolescents vulnerable to zinc deficiency.
Authors: Mahmoodi M R, Kimiagar S M, Valaii N, Ghaffarpoor M.
Source: Pejouhandeh 1999; 4 (1): 61-68
A STUDY OF OPHTALMIC COMPLICATIONS DUE THE MUSTARD GAS IN THE INJURIES OF THE CHEMICAL WAR
After termination of the Iran-Iraq war, soldiers exposed to chemical warfare agents developed ophthalmic complications. Diagnosis and treatment of these complications are of great importance. The present retrospective study was carried out on 73 patients who had a history of being affected by mustard gas. All victims were male with an age range between 23 to 60 years. The period of their involvement was at least 10 and at most 15 years. In all the patients, accurate Ophthalmologic examinations and tear-quantity testing were performed, and corrected visual acuity by glasses was recorded.
Results revealed that 6 patients had no obvious ophthalmic complications, 15 had mild involvements, 24 patients had moderate problems, 21 had severe involvements and 7 patients had very severe complications, four of whom had a history of corneal transplantation. Present study proves that ophthalmic involvements are a late complication of chemical injuries due to Mustard Gas. These complications are eye dryness due to conjunctival involvement that ultimately lead to corneal lesions as non-infectious keratitis, which are similar to immune disease of the cornea.
Authors: Einollahi B, Jadidi Kh
Source: Kowsar Med J 1999; 4 (4): 285-287.
OCULAR INJURIES CAUSED BY MUSTARD GAS: DIAGNOSIS, TREATMENT AND MEDICAL DEFENSE
Sulfur Mustard (SM) has been used as a vesicant chemical warfare agent. To investigate the ocular damages it causes, we studied the effects on chemical casualties in the Iran-Iraq war. The patient material comprised of over 500 chemical casualties including both military and civilian populations. The results obtained showed that the range of ocular damage was wide. The most common ocular lesions were conjunctivitis and photophobia. Patients with significant involvement were at risk for corneal ulceration, and rarely for anterior chamber scarring and neovascularization, any of which would result in prolonged disability.
In conclusion, the eye is the organ most sensitive to sulfur mustard vapor. Ocular injury generally heal completely. In severe cases blindness may occur. The need for corneal transplantation is uncommon.
Authors: Mossavi SA, Safarinejad MR
Source: Kowsar Med J 1999; 4 (4): 289-295.
THE EFFECT OF HELIUM-NEON LOW ENERGY LASER BEAM ON THE HEALING OF INJURED TISSUES
Considering controversies about the effects of laser therapy on the processes of wound healing, connective tissue repair and collagen biosynthesis and the impact of various factors such as nutritional status and vitamins the effects of Helium-Neon low energy laser at a wavelength of 630 nm on the metabolic processes and the proliferation of cells in the repairing connective tissue were studied.
The case-control strategies of this research were performed on 59 mature and healthy rats at a weight range of 250-300 g and 3-4 months of age. On the day of surgery, under sterilized conditions a wound at the nape of generally anesthetized rats were incised to the right side of the vertebral column at a diameter of 1 cm. The day of surgery was considered as day 0. Thereafter the animals were kept in specially designed and sterilized cages for one day and then randomly divided in to control and cases groups. The animals in control group received only gauze patch replacement. In addition to this procedure, the animals in case group were exposed to laser rays at a wavelength of 630 nm for a period of 4 min. After 1 week, tissue specimen at the site of wound were obtained by biopsy under similar conditions, sectioned, stained with hematoxilineosin and carefully studied microscopically. For analysis of data, t-test was used.
The present findings showed that low energy lasers at a wavelength of 630nm and with an energy density of 5 mj /cm2 can lead to increased density of small blood vessels in the budding tissue in the case group and can significantly decrease the extent of wound compared to the control group.
Therefore, Helium-Neon low energy laser is effective in wound healing and after performing its clinical trails. It is recommended to apply the procedure in human populations.
Authors: Tak-Zare N, Sarkandy M, Foroutan MR, Yarmohammadi K, Tak-Zare S, Tak-Zare AR.
Source: Irn J Plastic & Reconstructive Surg 1999; 2 (6): 45-49
AN EPIDEMIOLOGICAL STUDY OF ORAL CLEFTS IN IRAN (ANALYSIS OF 1669 CASES)
To assess the epidemiology and some genetic aspects of oral cleft in Iran.
A 15-year cross-sectional (prevalence) study was performed on 1669 consecutive surgical cases with oral clefts (79% between 1 day and 18 months of age) in two plastic surgery departments (both mostly referral centers) and a maternity hospital in Iran.
In the parallel study, 19369 livebirths in a maternity hospital, within the same period, surveyed to ascertain prevalence at birth. Normal children of this population were used as the control group. Samples were analyzed by: prevalence at birth, type of oral cleft, side of cleft, sex ratio, associated malformations, clefts in relatives and parental consanguinity.
The prevalence of clefts was 1.03 per 1000 births. Cleft lip (without cleft palate) had a higher (34.9) and cleft palate alone had significantly lower prevalence (17.4%) than expected. Cleft lip (without cleft palate) was more common in females than in males. The rate of associated malformations in cleft patients 7.73% was higher than controls (0.093%). Association between cleft and consanguinity was significant (45.8% versus 43.1%). Occurrence of non-cleft congenital malformations among first degree relatives of our cases was nearly two times more than controls. Our study revealed that the population incidence of oral cleft in Iran are much closer to European than Arab-African or South East Asian countries. However, significant variations in other epidemiological and some genetic features were observed.
Authors: Rajabian MH., Sherkat M
Source: Irn J Plastic & Reconstruction Surg 1999; 2 (6): 17-26
CYTOGENIC STUDY OF 120 PATIENTS WITH PRIMARY AMENORRHEA
This study was intended to determine the prevalence of different chromosomal abnormalities causing primary amenorrhea in patients referred to the department of medical genetics in a major tutorial hospital in Tehran.
During 2.5 years, a total of 120 referred patients with primary amenorrhea underwent cytogenetic study.
Results showed that from these patients, 70 (58.3%) had a normal female (46, XX) karyotype. Fifty other patients displayed one of the following abnormal karyotypes:
According to this study, chromosomal aberrations are major contributing factors in primary amenorrhea and should be considered in patients with such manifestations.
Authors: S. Abbasi, C. Azimi, M. Shariati
Source: Teb & Tazkieh 1999; 34: 9-17
CLINICAL FEATURES OF CUTANEOUS LEISHMANIASIS IN CHILDREN YOUNGER THAN 12 YEARS IN ISFAHAN
Cutaneous leishmaniasis is one of the most common parasitic diseases in Isfahan and Centeral Iran. Its scar could be found in the majority of residents of some areas of the city. This disease can affect all age groups but it is more common in children in endemic and hyperendemic areas.
The purpose of this study was to evaluate clinical features of cutaneous leishmaniasis in children below 12 years of age in Isfahan.
The study was conducted at the "Center of Leishmaniasis" in Isfahan. The diagnosis of cutaneous leishmaniasis was confirmed by direct smear in all cases.
The results showed that among 2000 patients, 656 cases (32.8%) were less than 12 years of age 53.4% were male and 46.6% female. The most common site of involvement was the face (38.6%) and the number of lesions ranged from 1 to 20, most of the patients however, had only one lesion (46.3%).
Most lesions were papules. Lupoid and sporotrichoid cases were rare (1.9% and 2.4% of the cases respectively. This might be due to earlier detection and referral in these children.
Authors: S. Enshayeh, A. Kiani
Source: Irn J Derm 1999; 3 (1): 11-15
COMPARISON OF DIFFERENT ANTIGENS FOR LEISHMANIN SKIN TEST IN PATIENTS WITH CUTANEOUS LEISHMANIASIS
Cell-mediated immunity (CMI) plays an important role in resistance against leishmaniasis. Leishmanin test (Montenegro skin test) is a method for evaluation of immune system reaction against cutaneous leishmaniasis. The TDR / WHO reference leishmanin produced by the Pasteur Institute of Iran, is used worldwide. Two other antigens produced by Razi Serum Institute of Iran, Killed Leishmania Major (KLM) and Autoclaved Leishmania Major (ALM), take advantage of vaccine strains of L. major, and under supervision of WHO, have been investigated as leishmaniasis vaccine.
In this study KLM, ALM and standard leishmanin skin test were compared with eachother. Fifty patients with cutaneous leishmaniasis were randomly selected. They attended the educational clinics of Isfahan University of Medical Sciences Isfahan, Central Iran. All 3 antigens were injected intradermally and the size of erythema and induration were measured and recorded after 48 hours. Data were grouped and analyzed with ANOVA.
The results showed that there was a significant difference between the mean size of erythema and induration of antigens in "two by two" comparison. The mean of erythema and induration sizes due to KLM were greater than ALM, and mean of erythema and induration sizes due to ALM were greater than Pasteur Institute reference leishmanin.
It is concluded that KLM and ALM are preferable to the Pasteur Institute reference leishmanin. Although the mean size of erythema and induration of KLM is greater than ALM, the latter is more recommended due to practical reasons such as the need for an easy storage method.
Authors: A. Momeni, A. Khamesipour, A. Bagherzadeh, M. Aminjavaheri
Source: Irn J Derm 1999; 3 (1): 24-30
COMPARISON OF THE RATE OF CONTINUOUS USE, EFFICACY AND SIDE EFFECTS OF NORPLANT AND THE A-380 IUD IN THE THIRD YEARS OF
USE IN TEHRAN
With the introduction of Norplant as a long-acting method, of contraception hope for a better family planning emerged. There have been contradictory reports concerning its non-continuous use due to abnormal uterine bleeding. Since no studies have been previously performed on the continuous use of Norplant in Iran, (or at least there is no published data about it), this study was performed to compare the continuous use of Norplant and IUD.
We performed this prospective study on 408 women who were referred to Imam Hossein Hospital and shaheed Jafari hospital and used either the A-380 IUD or Norplant as a contraception method since. The subjects were divided into two groups, the case group (204 subjects using Norplant) and control group (204 subjects using A-380 IUD). Demographic data such as age, job level of education and delivery status were recorded. After classification and extraction of data, the rates of continuous use, efficacy and side effects of each method were compared.
Results showed that according to the life table, the cumulative survival ratio of Norplant and IUD was 42 and 76 percent, in 36 months respectively. The rate of continuous use of IUD was higher than Norplant. The failure rates for Norplant and IUD were zero and 0.46% in 3 years respectively. Norplant side effects such as abnormal uterine bleeding, headache, dizziness and weight changes rendered its use troublesome. Eventually, it may be commented that although Norplant has higher efficacy and leads to minor side effects, its continuous use is arduous.
Authors: Fallahian, M, Haghollahi F, Amiri Z.
Source: Pejouhandeh 1999; 4 (2): 173-177