Alireza Ghaffari

MEFV mutations in Iranian Azeri Turkish patients with familial Mediterranean fever

Familial Mediterranean fever (FMF) is an autosomal recessive autoinflammatory disorder with more than 60 disease‐associated mutations in the responsible gene, MEFV. In the present study, we determined 15 MEFV mutations in Iranian Azeri Turkish FMF patients. Five hundred and twenty‐four unrelated patients were tested for 15 known mutations in the MEFV gene using amplification refractory mutation system‐polymerase chain reaction and polymerase chain reaction‐restriction fragment length polymorphism methods. Thirty‐five different genotypes were characterized among the studied patients. Of the alleles investigated, the most common mutation was p.M694V (42.4%), followed by p.V726A (17%), p.E148Q (16.2%), and p.M680I (c.2040G>C) (15.2%). The p.R761H mutation (4.7%) was found to be the most frequent among the rare mutations. The mutations p.M680I (c.2040G>A), p.I692del, p.M694del and p.K695R were not found in this cohort. The remaining mutations account for 7.7% of the identifiable mutations. Five different types of complex alleles were also identified. The results show the diversity and the frequency of the mutations in the Iranian Azeri Turkish FMF patients. The p.R761H mutation is rather prevalent in Azeri Turks; therefore, it should be included in the routine molecular diagnosis of FMF patients from this ethnic group.

Ultrasonography in diagnosis of pulmonary hydatid cysts

methods are more reliable and less operator-dependent than ultrasound for the diagnosis of pulmonary hydatid cysts, the scarcity of these methods in developing countries is a major concern. Therefore, non-invasive and cost-effective imaging methods such as ultrasonography should not be overlooked for the diagnosis of pulmonary hydatid cysts. Accordingly, appropriate ultrasonographic criteria should be developed for more accurate and reliable diagnosis.

Effect of pirfenidone on pulmonary fibrosis due to paraquat poisoning in rats

Background. This study investigated the effectiveness of pirfenidone compared with antioxidants, in the prevention of pulmonary fibrosis and increasing the survival in acutely paraquat poisoned rats. Methods. Five groups of ten rats were included in this study. Three groups were poisoned with intraperitoneal injection of 15 mg/kg paraquat. Among these poisoned groups, one group was treated with vitamin C (500 mg/kg, intraperitoneal), vitamin E (200 mg/kg, intraperitoneal) and N-acetylcysteine (250 mg/kg, intravenous); two others were treated with either normal saline or pirfenidone (200 mg/kg, intravenous); two groups were not poisoned and received normal saline or pirfenidone (200 mg/kg, intravenous). All injections except paraquat were repeated in four consecutive days. On the 15th day of study a semi-quantitative determination of lung fibrosis was done using Ashcroft staging criteria on the lung sections. Results. Pirfenidone decreased paraquat induced lung fibrosis (p < 0.001) while antioxidants did not decrease the lung fibrosis (p = 0.413). Life expectancy decreased in paraquat + normal saline (11 days, 95% CI 7.94–14.05) and paraquat + antioxidant (11 days, 95% CI 7.77–14.23) groups. The increase in the survival of rats in paraquat/pirfenidone group was insignificant (13.4 days, 95% CI 11.13–15.67). Conclusion. This study showed that pirfenidone is able to decrease pulmonary fibrosis following paraquat poisoning in a rat model.

The antioxidants dilemma: are they potentially immunosuppressants and carcinogens?

Antioxidants and a large number of natural supplements were introduced in recent decades (Lu et al., 2013). It has been hypothesized that antioxidant consumption might reverse oxidative stress which decreases the adverse effects elicited as outcomes of oxidative stress including inflammation, carcinogenesis, and atherosclerosis (Ghorbanihaghjo et al., 2012; Bjelakovic et al., 2014). A large number of studies have been conducted in order to convey evidence for beneficial effects of antioxidants in health and disease (Bjelakovic et al., 2012). However, most of these studies were conducted for a short time interval evaluating limited numbers of targeted biochemical markers both in animal and human studies. Only a small number of prolonged cohort studies have been performed to critically assess the effects of chronic consumption of antioxidants. Unexpectedly, in a recently published systematic review by Bjelakovic et al. on 78 randomized clinical trials on antioxidants supplementation including selenium, β-carotene, vitamin C, vitamin A, and vitamin E, not only have no favorable effects been observed, but additionally, mortality rates have risen (Bjelakovic and Gluud, 2007; Bjelakovic et al., 2012). Surprisingly, it has been shown that antioxidant supplementation may increase the risk of skin malignancy in women (Hercberg et al., 2007). There are also a number of reports, in which a history of longtime supplementation with carotenoids has increased risk of malignancy in smokers and patients with tuberculosis (Albanes et al., 1996; Omenn et al., 1996; Holick et al., 2002; Shiels et al., 2011). Natural and green products are assumed to be harmless in common belief. The general faith toward the health benefits of products containing antioxidants is partly because of misinformation conveyed by industries manufacturing these food products, which promoted putative overuse of these products as dietary supplements. However, the harmful effects of these products have remained obscured for unknown reasons (Lu et al., 2013). It is crucial to emphasize the harmful effects of the chronic consumption of antioxidants, including potential toxicity, in addition to promotion of potential benefits. According to Watson “the time has come to seriously ask whether antioxidant use much more likely causes than prevents cancer” (Watson, 2013). In this article we have tried to discuss probable mechanisms by which chronic antioxidant consumption provokes adverse effects. We have attempted to depict the role of antioxidants in a comprehensive model of inflammation, oxidative stress, and cancer.

Generalized peritonitis requiring re-operation after leakage of omental patch repair of perforated peptic ulcer.

Background/Aim: Peptic ulcer perforations are a common emergency, but available literature is silent on the exact definition, incidence, management, and complications of peritonitis due to omental patch leakage. Patients and Methods: Retrospective data were collected on 422 patients who underwent omental patch repair of perforated peptic ulcer between March 20, 1999 and March 20, 2006. The definitive diagnosis of perforated peptic ulcer and omental patch leakage was obtained at surgery. Results: Seventeen (4%) patients experienced generalized peritonitis due to omental patch leakage. Mean age was 60.6 years. Mortality rate was 29.4%, and the mean hospital stay was 23.6 days. Delay in surgical approach, shock on admission, and age were all significantly associated with increased mortality. Conclusions: Peritonitis due to omental patch leakage can result in significant morbidity and mortality. The most common causes of omental patch leakage and operative procedures were unknown and reinsertion of omentum, respectively. Factors such as shock on admission or delayed surgery, have significantly contributed to fatal outcomes and need careful attention.

Spinal Injuries in the 2012 Twin Earthquakes, Northwest Iran

On 11 August 2012, twin earthquakes measured 6.3 and 6.4 on the Richter scale hit three towns (Ahar, Varzaqan, and Heris) in East Azerbaijan Province, Iran resulting in tragic loss of three hundred lives and leaving thousands of injured. The aim of the present study was to report the spinal injuries during recent earthquake in northwest Iran, its consequences and management. Of the 923 hospitalized patients, 26 (2.8%) had neurosurgical complications. The imaging and clinical data of the patients were retrospectively studied regarding the anatomical location of the injury, the severity of spinal injury and associated neurological deficit. To further analyze the findings, Magerl (AO) and Frankel’s classifications were used. The injuries without any fracture were considered as minor spinal injuries. The mean age of the patients was 44.54±22.52 (range: 5-88) years. We detected a total of 38 vertebral injuries including 24 major (63.15%) and 14 minor injuries (36.85%). The most common injuries were observed in the lumbar spine (19 injuries, 50%). The 24 major injuries chiefly included Magerl type A (14 injuries, 58.3%). According to the Frankel’s classification, majority of the patients (88.46%) had no neurological deficit. In this study, three patients had nerve injuries. In conclusion, the number and proportion of spinal fractures patients in the recent twin earthquakes, northwest Iran was limited and caused less nerve injuries compared to the previous similar disasters. This might be due to the milder earthquake consequences since the incident happened in the middle of the day when men were working their fields. Potential complications in patients traumatized in earthquake incidents should be monitored for and early assessment of the neurological function is required to prioritize care for the victims.

Pulmonary valve balloon valvuloplasty compared across three age groups of children

The aim of this study was to investigate the characteristics and outcomes of treating pulmonary stenosis with percutaneous valvuloplasty, and to compare them among three childhood age groups. All children under 15 years of age who had undergone pulmonary valve balloon valvuloplasty in Madani Heart Center from 2005–2009 were enrolled in this study. Data were analyzed using IBM SPSS software (SPSS, Inc, Chicago, IL). Mean (± standard deviation) age of patients was 55.5 ± 47.4 months. Two-thirds of the subjects had moderate pulmonary valve stenosis. Balloon valvuloplasty failed in nearly one-fifth of the treated patients. There were 17 failures and two cases of mortality, descriptively less frequent among children >5 years; however, the observed difference was not statistically significant. Mild pulmonary valve insufficiency was a common finding.

Effect of age on semen parameters in infertile men after varicocelectomy.

Background The effectiveness of varicocelectomy in restoration of fertility and improvement of semen parameters is still controversial. The purpose of this study was to determine the effect of age on semen parameters following varicocelectomy in a group of infertile men. Methods Improvements in sperm count, morphology, and motility were studied in 67 infertile patients 4–10 months after varicocelectomy. Results The mean age of the patients was 30.48 ± 7.49 years. Significant improvements in total sperm count, percentage normal morphology, and motility were noted in all age groups (P < 0.05). Patients aged <25 years demonstrated the greatest increase in sperm counts, normal morphology, and motility following varicocelectomy. There was a significant negative correlation between age and sperm count, sperm morphology, and sperm motility (P < 0.05). Conclusion The effect of age on improvement in sperm parameters after varicocelectomy is inconsistent with some reports in the literature, and could be attributable to the duration of infertility prior to surgery; in the long term, varicoceles are known to have deleterious effects on testis biology.

Iran's Bushehr Earthquake at a Glance.

On 9 April 2013, an earthquake of 6.1 magnitude hit southwestern Iran near the city of Khvormuj and the towns of Kaki and Shonbeh in Bushehr province. The official disaster mitigation committee took immediate actions to coordinate rescue teams equipped with 24-hour medical air assistance. Overall, 160 victims were transferred to and treated in the Khvormuj hospital, while 139 survivors were transferred to the hospitals in Bushehr for specialized care. The survivors have been settled in temporary shelters with adequate primary supplies. Considering the hot climate of the area, immediate measures should be taken in order to avoid any further casualties particularly heatstroke, dehydration, diarrheal and vector-borne diseases.