Pathophysiological role of Atg5 in human ulcerative colitis

Background/Aims@#Ulcerative colitis (UC), along with Crohn’s disease, is one of the main types of inflammatory bowel disease (IBD). On the other hand, deregulated autophagy is involved in many chronic diseases, including IBD. In this study, we aimed to investigate the role of Atg5 and microRNA-181a (miR-181a) in the pathophysiology of UC. @*Methods@#Colon biopsy, stool, and blood samples of 6 men and 9 women were confirmed for UC. Also, 13 men and 17 women were selected as healthy control (HC). Enzyme-linked immunosorbent assay (ELISA) and immunohistochemistry were used to measure the Atg-5 content of the colon biopsies. Besides, the serum and stool levels of Atg5 were measured using ELISA. Moreover, the total RNA of blood cells was extracted and evaluated for the expression of miR-181a. @*Results@#We found 1.2 ng/mL versus 0.46 ng/mL, 0.34 ng/mL versus 0.24 ng/mL, and 0.082 ng/mL versus 0.062 ng/mL of Atg5 in stool, intestinal tissue, and serum of UC and HCs, respectively. There was no significant difference in the expression of miR-181a in the blood samples of UC and HCs. Immunohistochemistry showed high positivity without any significant difference between the 2 groups in the quantitative analysis. @*Conclusions@#The significant difference observed between the stool Atg5 content of the HCs and UC patients may provide new insight into using this protein as a diagnostic biomarker, however, considering the small size of our studied population further studies are needed.

Burden of traffic accidents among pedestrians of Fars province, southern Iran; estimate of years of life lost in a sample of Iranian population from 2009 to 2013 / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>Traffic injuries are among the leading causes of mortality and morbidity worldwide. Pedestrians have been considered as a high-risk group among road users, especially in middle- or low-income communities. This study attempted to determine the burden of pedestrians' fatalities in Fars, the southern province of Iran using years of life lost (YLL) approach.</p><p><b>METHODS</b>The data used in this study were retrieved from Fars Forensic Medicine Organization database on pedestrian traffic accidents. The YLL from 2009 to 2013 was estimated using the method presented by World Health organization. Some epidemiological characteristics of pedestrians' fatalities were analyzed by SPSS.</p><p><b>RESULTS</b>Although YLL among 1000 male pedestrians decreased from 2.5 in 2009 to 1.5 in 2013, it increased from 0.9 to 2.1 among 1000 females during the same period. Higher proportion of death was found in female, illiterate, and married pedestrians (p < 0.001). In addition, mortality was higher in pedestrians living the cities, during daytime, at home, and in hospitals (p < 0.001).</p><p><b>CONCLUSION</b>Consistent with the global trends, burden of pedestrian accidents in Fars was also exceptionally high. Considering the national and cultural aspects of different countries, improving the safety of pedestrians demands a multi-dimensional approach with interventional factors concerning policies, rules, pedestrians, motor vehicles and environmental conditions taken into consideration.</p>

Denture stomatitis and candida albicans in iranian population: a systematic review andmeta-analysis

Statement of the Problem: Denture stomatitis is the common form of oral candidiasis, which is seen in the form of diffused inflammation in the areas covered by dentures. Many primary studies report the prevalence of denture stomatitis and candida albicans among patients in the Iranian population; therefore, using meta-analysis is valuable for health policy makers

Purpose: The purpose of the present study is to determine the prevalence of denture stomatitis and candida albicans in Iran

Materials and Method: Using relevant keywords, national and international databases were searched. After limiting the search strategy and deleting the duplicates, the remaining papers were screened by examining the title and abstract. In order to increase the sensitivity of search reference lists of papers were examined. Finally the index of heterogeneity between studies was defined using Cochran test [Q] and Isquared [I2]. According to heterogeneity, the random effects model was used to estimate the prevalence of denture stomatitis and candida albicans in Iran

Result: The prevalence of denture stomatitis in 12 studies, and the prevalence of candida albicans in patients with denture stomatitis have been reported in 6 studies. The number of sample under investigated and its age range among primary studies included meta- analysis was 2271 individuals and 32.7 till 87.5 years respectively. The prevalence of denture stomatitis in preliminary studies imported to a meta-analysis varied from 1.9% to 54.6%, and its rate in Iran using the meta-analysis was estimated 28.9 % [CI 95%: 18.2-39.6]. Also the overall prevalence of candida albicans in patients with denture stomatitis in Iran was estimated 60.6% [CI 95%:50.1-71.2]

Conclusion: This study showed that the prevalence of denture stomatitis and candida albicans among patient infected denture stomatitis is relatively significant in Iran

Determinant of road traffic crash fatalities in Iran: a longitudinal econometric analysis

Background: Injuries and deaths from road traffic crashes are one of the main public health problems throughout the world. This study aimed to identify determinants of fatality traffic accident in Iran for the twenty-span year from 1991 to 2011

Methods: A time series analysis [1991-2011] was used to examine the effects of some of the key explanatory factors [GDP per capita, number of doctors per 10,000 populations, degree of urbanization, unemployment rate and motorization rate] on deaths from road traffic in Iran. In order to examine long- and short-run effects of variables, we employed autoregressive distributed lag [ARDL] approach and error correction method [ECM]. The data for the study was obtained from the Central Bank of Iran [CBI], Iranian Statistical Center [ISC] and Legal medical organizations [LMO]

Results: GDP per capita, doctor per 10,000 populations, degree of urbanization and motorization rate had a significant impact on fatality from road traffic in Iran. We did not observe any short- and long-term effects of the unemployment rate on fatality from road traffic

Conclusion: GDP per capita, doctor per 10,000 populations, degree of urbanization and motorization rate were identified as main determinant of fatality from road traffic accidents in Iran. We hope the results of the current study enable health policy-makers to understand better the factors affecting deaths from road traffic accidents in the country

prevalence and risk factors of hepatitis delta virus in hiv/hbv co-infected patients in Shiraz, Iran, 2012

Evidence has shown that liver disease caused by hepatitis viruses can be more aggressive and severe in HIV infected subjects. Therefore, the present cross-sectional study aimed to evaluatejhe seroprevalence of HDV infection among HIV/HBV co-infected clients in Shiraz, southwest Iran. In this study, 178 patients co-infected with HBV and HIV individuals were enrolled. The diagnosis of HIV infection was documented based on serological assays. The demographic and complementary data were collected by a questionnaire. HBsAg and HDV Ab were detected by commercial quantitative enzyme linked immunosorbent assay kits according to the manufacturer's instructions. Alanine aminotransferase [ALT] and aspartate aminotransferase [AST] were also measured. The mean age of the participants was 37.4+/-7.4 years [range 22-63]. 175 [98.4%] patients were male and 3 [1.6%] were female. Among 178 patients co-infected with HIV/HBV, 35 cases [19.7%, 95% CI: 14%-25%] were anti-HDV positive and 143 [80.3%] were negative for anti-HDV. HDV exposure in HIV/HBV co-infected patients was associated with blood transfusion [P-0.002, OR: 14.3] and prison history [P=0.01, OR: 2.31] but not with age, marital status, unsafe sex contact, and injection drug abuse. Our data showed a relatively high prevalence of HDV infection in HIV infected population in Shiraz, Iran. The high frequency of HDV Ab in patients with blood transfusion and prison history reveals that HDV transmission occurs more frequently in the parental route than sexual contacts; therefore, blood screening for HDV diagnosis in the high-risk group is recommended

Burden of transportation injuries among children and adolescents of Fars province: analysis of Iran's 20-year trends / 한국역학회지

OBJECTIVES: Transportation injuries are among the top ten causes of burden of disease in all age groups worldwide. The burden of transportation injuries among children and adolescents in Iran is higher than the world average and that of other developing countries. The aims of this study were to investigate the burden of transportation injuries in children and adolescents in the province of Fars in Iran from 2009 to 2013, and to report the burden of these kinds of injuries in children and adolescents in Iran from 1990 to 2010. METHODS: The number of deaths due to transportation injuries and the location of fatal injuries in the province of Fars in Iran from 2009 to 2013 were analyzed using data from the Fars Forensic Medicine Organization. The 20-year trend in the burden of transportation injuries in Iran was analyzed using data from the Institute for Health Metrics and Evaluation. RESULTS: Similarly to the long-term trend in Iran, the burden of transportation injuries among the male population of Fars province was generally higher than in females. Most fatal accident injuries occurred on roads (males: n=4151, 61.51%; females: n=1182, 65.95%) and in urban areas (males: n=1994, 29.54%; females: n=473, 26.40%). CONCLUSIONS: Considering that children and adolescents are high risk groups for transportation injuries, adopting an effective comprehensive multi-sectoral approach, including enacting and enforcing appropriate laws and regulations, developing general knowledge, and facilitating the availability of Personal protective equipment, could be helpful for reducing the burden of these injuries.

Medical paraclinical standards, political economy of clinic, and patients' clinical dependency: a critical conversation analysis of clinical counseling in south of Iran

Despite its benefits and importance, clinical counseling affects the patient both psychosocially and socially. Illness labeling not only leads to many problems for patient and his/her family but also it imposes high costs to health care system. Among various factors, doctor-patient relationship has an important role in the clinical counseling and its medical approach. The goal of this study is to evaluate the nature of clinical counseling based on critical approach. The context of research is the second major medical training center in Shiraz, Iran. In this study, Critical Conversation Analysis was used based on the methodologies of critical theories. Among about 50 consultation meetings digitally recorded, 33 were selected for this study. Results show that the nature of doctor-patient relationship in these cases is based on paternalistic model. On the other hand, in all consultations, the important values that were legitimated with physicians were medical paraclinical standards. Paternalism in one hand and standardization on the other leads to dependency of patients to the clinic. Although we can't condone the paraclinical standards, clinical counseling and doctor-patient relationship need to reduce its dominance over counseling based on interpretation of human relations, paying attention to social and economical differences of peoples and biosocial and biocultural differences, and focusing on clinical examinations. Also, we need to accept that medicine is an art of interaction that can't reduce it to instrumental and linear methods of body treatment

Clinical paternalistic model and problematic situation: a critical evaluation of clinical counseling

Background: Many of health system services are done in clinical counseling. A patient's expectation of clinical consultation and physician office visits is to obtain diagnostic-remedial results, while such an expectation can be fulfilled only through an active relationship between the doctor and the patient. The aim of this study is to evaluate the quality of doctor- patient interaction in an educational clinic in southern Iran

Methods: This is a conversation analysis based on critical approach. So, 33 clinical consultations were analyzed critically

Results: Results showed that paternalistic model is the overall pattern in consultations. This leads to limitation of the patients' opportunity to participate in their diagnosis and treatment. Powers' asymmetrical relations lead to conditions in which physicians determine the clinical counseling process. Also, physicians determine the subject of consultation in the counseling period. In this situation, the patients' concerns were ignored. This ignorance leads to the patients' suppression in problematic situations. The main point is that the clinical counseling occurs in one general contract that is unwritten but has been known for the two sides of interaction

Conclusion: Clinical counseling can be an active consultation when it included the symmetrical distribution of power and the patient has an active participation in the consultation. Therefore, the new patient-centered approaches can be an appropriate model for access to a type of consultation based on symmetrical power distribution between physician and patient

An epidemiologic survey of road traffic accidents in Iran: analysis of driver-related factors / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>Road traffic accident (RTA) and its related injuries contribute to a significant portion of the burden of diseases in Iran. This paper explores the association between driver-related factors and RTA in the country.</p><p><b>METHODS</b>This cross-sectional study was conducted in Iran and all data regarding RTAs from March 20, 2010 to June 10, 2010 were obtained from the Traffic Police Department. We included 538 588 RTA records, which were classified to control for the main confounders: accident type, final cause of accident, time of accident and driver-related factors. Driver-related factors included sex, educational level, license type, type of injury, duration between accident and getting the driving license and driver's error type.</p><p><b>RESULTS</b>A total of 538 588 drivers (91.83% male, sex ratio of almost 13:1) were involved in the RTAs. Among them 423 932 (78.71%) were uninjured; 224 818 (41.74%) had a diploma degree. Grade 2 driving license represented the highest proportion of all driving licenses (290 811, 54.00%). The greatest number of accidents took place at 12:00-13:59 (75 024, 13.93%). The proportion of drivers involved in RTAs decreased from 15.90% in the first year of getting a driving license to 3.13% after 10 years'of driving experience. Neglect of regulations was the commonest cause of traffic crashes (345 589, 64.17%). Non-observance of priority and inattention to the front were the most frequent final causes of death (138 175, 25.66% and 129 352, 24.02%, respectively). We found significant association between type of accident and sex, education, license type, time of accident, final cause of accident, driver's error as well as duration between accident and getting the driving license (all P less than 0.001).</p><p><b>CONCLUSION</b>Our results will improve the traffic law enforcement measures, which will change inappropriate behavior of drivers and protect the least experienced road users.</p>

Hospital mortality associated with stroke in southern Iran

Background: Unlike the western hemisphere, information about stroke epidemiology in southern Iran is scarce. The aim of this study was to determine the main epidemiological characteristics of patients with stroke and its mortality rate in southern Iran

Methods: A retrospective, single-center, hospital-based longitudinal study was performed at Nemazee Hospital in Shiraz, Southern Iran. Patients with a diagnosis of hemorrhagic and ischemic strokes were identified based on the International Classification of Diseases, 9th and 10th editions, for the period between 2001 and 2010. Demographics including age, sex, area of residence, socioeconomic status, length of hospital stay, and discharge destinations were analyzed in association with mortality

Results: 16351 patients with a mean age of 63.4 years [95% CI: 63.1, 63.6] were included in this analysis. Men were slightly predominant [53.6% vs. 46.4%]. Forty-seven percent of the total sample was older than 65,17% were younger than 45, and 2.6% were children younger than 18. The mean hospital stay was 6.3 days [95% CI: 6.2, 6.4]. Among all types of strokes, the overall hospital mortality was 20.5%. Multiple logistic regression revealed significantly higher in-hospital mortality in women and children [P<0.001] but not in patients with low socioeconomic status or from rural areas. During the study period, the mortality proportions increased from 17.8% to 22.2%

Conclusion: In comparison to western countries, a larger proportion of our patients were young adults and the mortality rate was higher

Outcomes of liver transplantation for patients with acute liver failure

Liver transplantation is a treatment for patients who have acute liver failure [ALF]. This study aims to evaluate the outcomes following liver transplantation in patients with ALF and compare them with cirrhotic patients who underwent liver transplantation. This retrospective cross-sectional study was conducted at Shiraz Organ Transplant Center between June 2004 and March 2011 to evaluate the clinical presentation and underlying etiology of patients with ALF and their outcomes following liver transplantation. Out of 750 patients who underwent liver transplants, 12 [8 males and 4 females] had a diagnosis of ALF. The cirrhotic group [control] consisted of 20 transplanted patients. ALF patients were younger with a mean age of 18.7 +/- 12.9 years compared to 37.4 +/- 13.6 years in the cirrhotic group [P = 0.001]. In the ALF group, 5 [41.66%] underwent partial living related liver transplantation compared to 1 [5%] in the cirrhotic group [P = 0.018]. There were significantly more early post-transplant complications observed among patients with ALF compared to the cirrhotic group [P = 0.002]. Liver transplantation is safe, effective and should be considered in patients diagnosed with ALF

Establishment of a population-based registry of inflammatory bowel diseases in Fars province, Iran

Inflammatory bowel diseases [IBD] are debilitating diseases that lead to a variety of problems in a patient's daily life and are a huge burden for the health care system. Since this group of diseases are multifactorial and complex, long-term longitudinal studies are clearly needed to understand them better. A population- based registry [IBD-FaR] has been established in Fars, a southern Iranian province, with the intent to create a reliable data source. This registry will be of considerable help in future planning of health care resources necessary to deal with IBD and to enable investigators to test their theories on the origin and/or treatment of IBD. This registry is managed by both the Gastroenterohepatology Research Center and Health Policy Research Center at Shiraz University of Medical Sciences. A governing committee is responsible for decisions regarding budget allocations and use of data. The designed questionnaire includes a consent form, basic history data, risk factors, related procedures, medical therapy, and follow-up data. The establishment process has two parallel phases: in the first phase, data is collected from numerous sources, including annual hospital discharge data, referral from university affiliated physicians and private practices, pathologic reports, death certificates, self-referral, and insurance system data. In the interview, the questionnaire is completed and blood samples are taken. The gathered data are entered in a custom-designed, computerized data base. In the second phase, annual follow up interviews will be conducted. New IBD patients are also being registered. This phase will continue indefinitely, in order to include new incident cases. Briefly, from May 2011 until December 2011, there were 188 patients [94 [50%] females and 94 [50%] males] diagnosed with IBD who were registered in IBD-FaR. Patients' age range was between 15 and 80 years. A total of 164 [87.2%] patients out of 188 were registered as diagnosed with ulcerative colitis [UC] and 23 [12.2%] were registered as having Crohn's disease [CD]. Most patients 164 [87.2%] had negative family histories of IBD. By retrospective and prospective data collection methods, this central database of IBD cases can determine the incidence, prevalence, and demographic characters of IBD in a defined population. It can facilitate future research to identify etiology, disease process, new treatment options, factors affecting prognosis, recurrences, optimal health care, morbidity and mortality of IBD, and at last but not least, provide educational and social support for patients by educational materials and organizing nongovermental organizations [NGOs]

Maternal mortality rate in Fars province: trends and associated factors in a community-based survey

The high rate of maternal mortality [MM] remains a challenge, especially in developing countries. In 2000, the World Health Organization [WHO] targeted a 75% reduction by the end of 2015. In this survey, we determine trends in MM rates and associated factors in Pars Province, southwestern Iran. All MM in Pars Province from March 2003 to March 2010 were considered in this cross-sectional study. Data were recorded for demographic characteristics, autopsy findings, medical and obstetric histories. The data were then analyzed with a z-test to identify differ- ences in the rate of MM during the study period. The mean MM rate was 22.18 per 100 000 live births [95% Cl, 17.55-26.8] during the seven year study period, and was highest [32.3/100 000] in the first year. Most deaths [71.3%] occurred in the postpartum period, and the lowest proportion occurred during delivery [5%]. High-risk mothers accounted for 79.2% of maternal deaths. Among the mothers who died, 62% received satisfactory prenatal care, and at least two years elapsed between successive pregnancies in 78%. Hemorrhage was the main cause of death [35.6%] and the least frequent cause was H1N1 virus infection [2%].This study provides evidence of serious deficiencies in postpartum care that need urgent action. Priority should be given to vaginal bleeding and high-risk status mothers

H1N1 influenza infection complicated with diabetic ketoacidosis

The 2009 H1N1 Influenza virus was the first infectious pandemic of the 21[st] century which spread rapidly throughout the world. High-risk groups, such as diabetics, suffered more and showed higher hospital admission and death rates due to this virus. Patients with diabetes mellitus [DM] may develop the fulminant picture of their disease after being infected with influenza. From June to December 2009 at Nemazee Hospital, affiliated with Shiraz University of Medical Sciences, two patients with diabetic ketoacidosis [DKA] were admitted. The H1N1 influenza virus triggered DKA and its complications in these patients. Both patients were female, of ages 16 and 40 years. When admitted, they had signs of influenza-like illness [ILI], tachypnea, laboratory confirmation of acidosis, and high blood sugar levels. The 2009 H1N1 influenza viral RNAwas detected in their nasopharyngeal specimens by real time polymerase chain reaction [RT-PCR]. Both patients received oseltamivir, but eventually both died. This was the first report of an association between DKA and H1N1 influenza in Iran. Conclusively, rapid diagnosis of influenza by RT-PCR and early treatment with oseltamivir should be considered in diabetics and/or DKA patients with flu-like symptoms

Castleman's disease of the porta hepatis

Castleman's disease is an uncommon cause of lymph node enlargement that mostly involves the mediastinum and lung hilum. It is divided into 2 types: localized, which is usually asymptomatic and presents with a mass lesion; and multicentric, which is characterized by chills, anemia, generalized lymphadenopathy and hepatosplenomegaly. An extrathoracic site of involvement is very uncommon, and may be located in the mesentery of the intestines, axilla, and pelvis. Hepatic localization of this disease is a rare event. Herein, we report our experience with a symptomatic case of Castleman's disease in the porta hepatis who has been treated successfully by excision of the hilar lymph nodes, but recurred after 2 years with the same clinical picture plus abnormal liver function tests. However, at the time of recurrence, no lymphadenopathy was detected and liver biopsy showed giant lymphoid follicles with germinal centers. She was treated with steroids and showed a dramatic response

Lipid Profiles and Hepatitis C Viral Markers in HCV-Infected Thalassemic Patients

BACKGROUND/AIMS: The distribution of blood lipids, glucose and their determinants in thalassemic patients with chronic hepatitis C virus (HCV) infection has rarely been investigated. Thus, we aimed to investigate the relationship between both liver histologic findings and viral markers and serum lipids in thalassemic patients chronically infected with HCV. METHODS: We enrolled 280 polytransfused thalassemic patients with chronic hepatitis C. HCV viral load was determined using the Amplicor test. Genotyping was performed using genotype specific primers. Fasting serum lipid, glucose, ferritin and liver function enzyme concentrations were measured. A modified Knodell scoring system was used to stage liver fibrosis and to grade necroinflammatory activity. Perls' staining was used to assess hepatic siderosis. RESULTS: Just one subject had total cholesterol >200 mg/dL, and 7% had triglycerides >150 mg/dL. The mean high-density lipoprotein cholesterol (HDL-C) and glucose levels were 37 and 104 (97-111) mg/dL, respectively. Viral markers, liver histological findings and aminotransferase activity were not associated with serum lipid levels. Serum triglycerides, total cholesterol and ferritin were independent risk factors for impaired glucose tolerance or diabetes in these patients. CONCLUSIONS: The majority of the patients had blood lipid levels (with the exception of HDL) within the defined normal range; viral and liver histological factors do not appear to play a significant role in changing the levels of serum lipids or glucose in these patients.