Prevalence of breast cancer in a defined population of Iran

Prevalence of breast cancer In Asian developing countries is much lower than western developed countries. The main aim of this study was to measure breast cancer prevalence in a defined population of Iran. A total of 25201 women who were under coverage of [Imam Khomeini Relief Foundation [IKRF]], which is an organization for delivering supportive social and cultural services to the deprived and poor subgroups of the society, were involved in the study. The study was conducted during years 2007 and 2008. All subjects were interviewed for their sociodemographic features and underwent precise clinical and paraclinical breast examination. Mean age was 47 years with standard deviation 10 ranging from 11 to 88 years. Subjects were from deprived subgroups of the community; were mainly illiterate or had primary school education [86%] and majority of them [93%] had their first full-term pregnancy at age less than 26 years and also were multiparous. With confirmed diagnosis by breast biopsy, breast cancer prevalence was 0.15% [95%CI; 0.10-0.20]. Compared with developed countries, Asian developing countries have been at a lower risk of breast cancer development. It is seen that more deprived subgroups are at much lower risk. The more industrialized life is accompanied with more hazards

Mortality from pandemic influenza a [H1N1] in Iran

Due to worldwide spread of influenza A [H1N1] virus, the World Health Organization declared the first pandemic of influenza in four decades. This study aims to report the mortality from pandemic influenza A [H1N1] in Iran population and its epidemiologic and clinical characteristics up to December 21, 2009. The data were obtained from all provinces and reported to center for disease control of Ministry of Health and Medical Education [MOHME] of Iran through nationwide surveillance system for influenza A [H1N1] was implemented by MOHME since April 2009. Of 3672 confirmed cases of influenza A [H1N1] in Iran between 22 May and 21 December 2009, 140 [3.8%] deaths were reported, mostly in 15-65 year old [yo] age group [67%]. The highest admission mortality rate was in > 65 yo group [107 deaths/1000 hospitalized cases]. Of decedent patients, 54% had no long term condition or risk factor, 34% had one, 11% had two, and 1% had three. Diabetes mellitus, pregnancy, chronic respiratory diseases and hypertension were the most common underlying conditions. The most common clinical pictures of death were acute respiratory distress syndrome and viral pneumonia. Although 66% of decedent patients received oseltamivir, enough information was not available about time of onset of antiviral therapy. As death due to influenza A [H1N1] occurs in all age groups and in those with and without any predisposing factors, we recommend health policy makers to provide influenza vaccination for people with underlying conditions and respiratory hygiene for all people

Talents for future: report of the second national medical science Olympiad in Islamic Republic of Iran

This report describes a unique experience of Second National Medical Science Olympiad that was held in August 2010 in Shiraz, Islamic Republic of Iran. The history of medical science Olympiad in Iran and the development, process and domains in the Olympiad and the way for future will be discussed

Hepatitis A prevention strategies, Haiti case: should rescuers be immunized

Hepatitis A virus [HAV], a small non-enveloped RNA virus from Picornaviridea family, causes approximately 1.5 million cases of acute hepatitis each year, and is still a major world health problem especially in developing countries. As the risk of getting infected by HAV increases at the time of crisis such as earthquakes, we tried to perform a brief review on current situation of HAV in Haiti, a country that experienced an earthquake measuring 7.0 on the Richter scale recently, and that it might be in danger of experiencing outbreaks of enterically transmittable infective agents such as HAV

Introduction of a pyramidal model based on primary health care: a paradigm for management of 2009 H1N1 Flu pandemic

Primary health care [PHC] as the first level of contact of all individuals, the family and the community with the national health system has a prominent role in response to different health events such as H1N1 pandemic. Regarding the great potentials of PHC and several experiences achieved in previous natural disasters and epidemics in Iran, in this study there is an attempt to propose a pyramidal model to combat against H1N1 pandemic. Pyramidal model puts all key components such as community, NGOs, PHC, hospitals, policy makers together to confront concurrent H1N1 pandemic and other health issues by a comprehensive, integrated and organized approach. This model should be regarded as a continuous, flexible and dynamic solution to pandemics. H1N1 pandemic, as a multi-wave and unpredictable event of the 21st century that involved most countries, threatens communities and confronts hospitals with growing demands of patients for health services. By defining the role of PHC and other important parts of pyramidal models such as community, we can fight against H1N1 pandemic appropriately with the least human and financial resources

Influenza A [H1N1] virus pandemic in Fars Province: a report from southern Iran, July-December 2009

Influenza type A [H1N1] virus is considered as a major concern for health care system all over the world and imposes a considerable burden on the community. The aim of this study was to evaluate the pattern of the disease in order to help health administrators in making decision for preventive measures. 297 definite cases of influenza A [H1N1] diagnosed from 15 July to 3 December 2009 in Fars province, south of Iran, were included in this study. Diagnosis was confirmed performing Real time-PCR. The patients' information including age, gender, occupation, nationality, education, residency area and history of overseas or domestic travel, history of contact with other influenza patients, and symptoms were collected and analyzed. The mean age at the time of diagnosis was 24.4 +/- 15.8 years. 76 [25.6%] patients were admitted in the hospitals, of whom, 11 cases died due to related influenza complications with Case Fatality Ratio [CFR] of 4.4%. The most common reported symptoms were fever, cough and sore throat. There were two waves in the disease incidence, one about 1 month after emergence of the disease and another around 1 month after school openings. The first peak was observed mainly among adults with a history of foreign travel while the second peak was mainly observed among school students. The magnitude of the epidemic was much higher when the disease was transmitted between students at the beginning of the school year. Considering the high incidence of H1N1 flu among the students [41%], vaccination programs and preventive measures should target this age group

Vulnerable household women's health assessment [VH-WHAT]: protocol design and implementation

The gender-based approach can identify women's health problems on the basis of biological differences and their social, familial and individual roles. Unequal power relationship between men and women, fewer chances of education and employment, repeated pregnancies, longer life-spans, a greater proportion of the world's poor, inappropriate familiarity with their health risks increase their need to better benefit from primary healthcare. As determinants of health, poverty and social class indicate that women and especially deprived women require a greater focus on their health. This study attempts to identify modifiable health risk factors of these individuals. The women-headed households under cover in 11 provincial centers were included in the study. Medical consultation, general physical examination, fasting blood sugar level, blood cell count, lipid profile and systematic examinations, specific examinations of breast, pelvis, mammography and Pap Smear were performed according to the protocol. As a pilot study, 2730 individuals were assessed and their demographic features were obtained. The mean age of participants in the pilot study was 47.6 +/- 10.2 years ranging from 22 to 88 years of age. We expect that the study's findings would provide the opportunity to compare the differences of the special subgroups of vulnerable women with the data available in the country, and if necessary implement changes suitable with the vulnerable groups' health status

Epidemiology of HCV infection among thalassemia patients in Eastern Mediterranean countries: a quantitative review of literature

Hepatitis C infection [HCV] is the major co-morbidity in thalassemia patients; however, literature lacks data from many EMRO counties. There is also enormous heterogeneity in the available study results in this region, and distribution of HCV infection among these patients living in this region is still unknown. This study provides a comprehensive and reliable tabulation of available data on the epidemiological characteristics and risk factors for hepatitis C virus [HCV] infection in thalassemia patients in eastern mediterranean countries. A systematic review was carried out based on the computerized literature database. 95% confidence intervals of infection rates were calculated using the approximate normal distribution model. Pooled Odds ratios and 95% CI were calculated by fixed or random effects models. The heterogeneity was assessed by either Q or X[2] statistics. Publication bias was evaluated by either Harbor's modified or Egger's test. We identified 40 studies that fulfilled our inclusion criteria involving 8554 thalassemia subjects. Pooled HCV seroprevalence was 18% [95% CI 14-21], 45% [95% CI 43-48], 63% [95% CI 56-69] and 69% [95% CI 58-80] in Iran, Pakistan, Saudi Arabia and Egypt, respectively. Among Iranian thalassemia patients, splenectomy OR=4.1 [95% CI 1.5-11.2], high transfusion OR=3.5 [95% CI 1.8-7], high age OR=6.1[95% CI 1.2-31.2] and first transfusion before 1996 OR=7.6 [95% CI 4.7-12.3] were major risk factors of HCV infection. There are no data from many EMRO countries. Among major EMRO countries, Iran has the least seroprevalence of HCV infection among thalassemia patients. This underscores more advanced blood safety in this country compared with other countries with comparable population in this region

efficacy of hepatitis B vaccination among school age children in southern Iran

Primary prevention by vaccination to increase herd immunity remains the main thrust in the control of hepatitis B virus [HBV] infection and many countries such as Islamic Republic of Iran have incorporated HBV vaccination into their national expanded program of immunization. This study was performed to determine the vaccine efficacy of hepatitis B infection between vaccinated and non-vaccinated school-aged children. Three hundred and ninety four students aged 6 to 8 years who received the hepatitis vaccine in the infancy and 314 students aged 9 to 10 years who did not receive it in Sepidan, southern Iran were enrolled. We also determined the titer of anti HBs Ab in the vaccinated students. Two students [0.5%] were HBV infected [positive HBC Ab] and none were a chronic carrier. Two hundred and forty nine students [63.2%] had anti HBs titer greater than 10 IU/ml. One hundred and seventeen students [30%] had anti HBs titer between 1 and 10 IU/ml and only 28 children had anti HBs titer less than 1 IU/ml. Five [1.6%] were HBV infected [positive HBc Ab] and 2 [0.6%] were chronic carriers [positive HBs Ag]. The efficacy of the vaccine 6-8 years after vaccination was 67.9% [95 Cl 78-92]. Our results showed that similar to other studies, vaccination could not reduce the infection rate but had a significant effect on the reduction of chronic infection and carrier state, emphasizing on the role of vaccination in the control of HBV infection in an endemic region

Distribution of hepatitis C virus genotypes in iranian patients with congenital bleeding disorders

Chronic hepatitis C virus [HCV] infection is the major cause of liver disease related morbidity and mortality in hemophilic patients who needs regular blood product administration. Although genotype of infecting HCV is one of the prime predictors of response to antiviral therapy however, its distribution in hemophilic patients is still unclear and just few studies with low sample sizes have investigated this issue. Therefore, in this study, we aimed to identify this distribution in 367 Iranian hemophilic patients. Blood samples were received from 367 hemophilic patients with chronic hepatitis C detected during a nationwide screening program who referred to our center for therapeutic measures. HCV RNA viral load was detected using Amplicor test [Version 2]. Genotyping was performed by genotype specific primers. HCV genotype distribution was 1a in 58%, 3a in 18.5%, 1b in 14.7%, 4 in 1.1%, 2 in 0.8% and mixed in 6.2% and finally 0.5% of isolates were non-typable. Serum liver enzymes were not associated with HCV viral load and genotypes. Patients with severe bleeding tendency had significantly lower serum liver enzymes than those with a mild bleeding tendency. Genotype 1a followed by 3a and 1b were the most frequently detected HCV genotypes in Iranian hemophilic patients and there was no association between splenomegaly and viral markers and liver enzymes in these patients

Outcome and characteristics of patients on the liver transplant waiting list: Shiraz experience

The only curative therapy for end-stage liver disease is transplantation but due to a shortage of available donor livers the waiting list mortality is high. This study aimed to evaluate the outcome and characteristics of patients on the waiting list for liver transplantation in Shiraz, southern Iran during the period from April 2004 to March 2007. Medical records of all chronic liver disease patients >/= 14 years that were on the waiting list for liver transplantation at the Nemazee Hospital Organ Transplant Center during April 2004 to March 2007 were reviewed. Hospital records were used to retrieve demographic, clinical and laboratory data. Records of the referring gastroenterologists provided information about the etiology and complications of liver disease. The patients were followed at the end of the study period by clinic visits or telephone contact. There were 646 patients on the waiting list for liver transplant during April 2004 to March 2007. Hepatitis B was the most common etiology of liver disease [31.2%]. Of those on the waiting list, 144 patients 22.3%] underwent liver transplant and 166 [25.7%] died while waiting for a transplant. The mean waiting period for transplant was 6.6 months. Receiving a transplant was correlated with the etiology of liver disease and Rh blood group [p<0.05] but had no significant association with gender or ABO blood type. Among non-transplanted patients, survival was lower in those who had a history of encephalopathy, SBP or uncontrolled ascites and in patients with a Child-Turcotte-Puph [CTP] class C and/or a Model of End-stage Liver Disease [MELD] score >/= 15. Hepatitis B virus is the most common cause of end-stage chronic liver disease amongst patients on the waiting list for liver transplant in Shiraz, southern Iran. Patients with a MELD score >/= 15 particularly those with a history of SBP, hepatic encephalopathy or uncontrolled ascites are recommended for waiting list enrollment

Therapeutic response to folinic acid in methanol poisoning epidemic in Shiraz

Methanol poisoning may result to death and permanent complications, sporadic cases of methanol poisoning are fairly rare and the largest experience are generally gained from managing methanol intoxication epidemics. The main metabolite of methanol is acid formic that is the prime metabolite responsible for toxic effects of methanol and since folate dependent systems are responsible for the oxidation of formic acid to CO2 and water. It is believed that administration of folic acid enhances the metabolism of formate. Though therapeutic effects of folic or folinic acid has never been fully tested in clinical trails in human. Our objective was to evaluate therapeutic effect of folinic acid in methanol poisoned persons. In recent methanol poisoning epidemic due to "bootleg" Liquor consumption in Shiraz at 2004, Sixty-two patients have hospitalized. Folinic acid was administered to 19 patients and therapeutic effect of folinic acid was studied. There was no significant difference between two groups of patients and number of decreased visual acuity, renal function, hospital stays and needs to bicarbonate therapy and hemodialysis. The only effect was decreasing acidosis in folate treated patients. Regardless of prior animal studies and case reports, with attention to our study limitation we didn't found significant protective effect of folinic acid infusion among methanol poisoning patients. The only effect was decreasing acidosis in folate received patients. Further studies in optimal situation is needed for definite judgment

serum thyrotropin level and subclinical hypothyroidism predisposing factors for coronary artery disease?

Overt hypothyroidism has been found to be associated with cardiovascular diseases. Whether or not subclinical hypothyroidism is also a risk factor for cardiovascular disease is controversial. The aim of this study was to investigate serum thyrotropin levels and subclinical hypothyroidism in relation to presence and extent of coronary artery disease [CAD]. In a sample of 390 persons [239 men and 151 women] with mean age of 55.12 +/- 10.52 years who had referred for coronary angiography, data on general health, thyroid status, medications and previous myocardial infarction were obtained at baseline. They were screened for impaired thyroid function using a sensitive immunoradiometric assay for thyrotropin. Subclinical hypothyroidism was defined as an elevated serum thyrotropin level [>/= 4. 0mU/L] and a normal serum free thyroxine level. A single-, two- or triple vessel disease or normal vessels was documented by coronary angiography. Subclinical hypothyroidism was present in 6.4% of persons and was not associated with a higher frequency [P=0.51] or greater severity [x2=2.172; P=0.70] of CAD. The mean serum thyrotropin level was significantly higher in women [P<0.001]. There was neither correlation between serum thyrotropin level and the presence of CAD [P=0.37] in either sex [men: P=0.67 /women: P=0.97] nor with the extent of CAD [P=0.30] in either of the two groups [men: P=0.70 /women: P=0.34]. Also, serum thyrotropin level was not higher significantly in patients who had has previous myocardial infarction [P=0.95]. There was no correlation between thyrotropin levels or subclinical hypothyroidism and presence or severity of CAD in a cohort of patients who referred for coronary angiography.cohort of patients who referred for coronary angiography

Hyperhomocysteinaemia, hyperlipidaemia and risk of venous thromboembolism in Shiraz

To assess the risk of venous thromboembolism [VTE] associated with hyperhomocysteinaemia [hyper-Hcy] and hyperlipidaemia, we performed a case-control study. Fasting total homocysteine [Hcy], triglyceride and cholesterol levels were assessed in 43 patients with VTE and 43 controls. Mean Hcy level was significantly higher in the test group. Odds ratio [OR] for VTE in patients with hyper-Hcy was 2.7, with the association stronger in women and those under 50. The OR for those with both hypertriglyceridaemia and hypercholesterolaemia was significantly greater in those under 50. Increased risk for venous thrombosis was found among those under 50 having both lipid abnormalities