The projection of burden of disease in Islamic Republic of Iran to 2025.

OBJECTIVE: Iran as a developing country is in the transition phase, which might have a big impact on the Burden of Disease and Injury (BOD). This study aims to estimate Burden of Disease and Injury (BOD) in Iran up to 2025 due to four broad cause groups using Disability-Adjusted Life Year (DALY). METHODS: The impacts of demographic and epidemiological changes on BOD (DemBOD and EpiBOD) were assessed separately. We estimated DemBOD in nine scenarios, using different projections for life expectancy and total fertility rate. EpiBOD was modeled in two scenarios as a proportion of DemBOD, based on the extracted parameters from an international study. FINDINGS: The BOD is projected to increase from 14.3 million in 2003 to 19.4 million in 2025 (95% uncertainty interval: 16.8, 21.9), which shows an overall increase of 35.3%. Non-communicable diseases (12.7 million DALY, 66.0%), injuries (4.6 million DALY, 24.0%), and communicable diseases, except HIV/AIDS (1.8 million DALY, 9%) will be the leading causes of losing healthy life. Under the most likely scenario, the maximum increase in disease burden due to DemBOD is projected to be observed in HIV/AIDS and Non-communicable diseases (63.9 and 62.4%, respectively) and due to EpiBOD in HIV/AIDS (319.5%). CONCLUSION: It seems that in the following decades, BOD will have a sharp increase in Iran, mainly due to DemBOD. It seems that communicable diseases (except HIV/AIDS) will have less contribution, and especially non-communicable diseases will play a more significant role.

Development of a quantitative real-time PCR assay for detection of unknown alpha-globin gene deletions.

BACKGROUND: Alpha-Thalassemia is the most common inherited disorder of hemoglobin (Hb) synthesis in the world. Unlike beta-thalassemia, in which non-deletional mutations predominate, most of recognized alpha-thalassemia mutations include deletion of one or both alpha-globin genes. The importance of alpha-thalassemia detection is mainly due to its shared blood parameters with beta-thalassemia and its impact on discrimination between unknown alpha-thalassemia and normal HbA2 beta-thalassemia during thalassemia prevention program. MATERIALS AND METHODS: Cases with hematologic profile of low MCV, MCH, and normal HbA2 were enrolled in this study. Common alpha-globin deletional mutations including alpha(3.7)kb, alpha(4.2)kb, alpha(20.5)kb, and alpha(MED) and point mutation including 5 nt, Constant Spring (CS), and C19 were checked using either GAP-PCR or ARMS-PCR. Cases with unknown molecular defects were investigated further by direct gene sequencing. Finally, further study was done for probable unknown deletions by gene dosage analysis using real-time PCR. For this, five pairs of primers were used spanning from theta-globin gene up to the 3' upstream of alpha(2) gene. RESULTS: After validation of primers specificity and performing serial dilution analysis in order to calculate PCR efficiency, the assay was performed on normal samples and cases with known alpha-globin gene deletions as positive and negative controls, respectively. The assay was able to diagnose the control groups successfully. In 21 out of 29 unknown cases (72.4%), the assay showed various patterns of deletions in at 2 to 5 screened regions (theta gene up to the upstream of alpha2 gene). In 8 (27.6%) cases, deletions were seen in all regions. CONCLUSION: Gene dosage study by quantitative real-time PCR can be suggested as a rapid and reliable assay to screen probable carrier of alpha-thalassemia for unknown alpha-globin gene deletions.

Leptospirosis in Guilan, a northern province of Iran: assessment of the clinical presentation of 74 cases.

BACKGROUND: This study was carried out to define the major clinical presentation and laboratory findings of leptospirosis in Guilan province, an agricultural and fishery area in the Caspian littoral. MATERIAL/METHODS: Cases with a clinically compatible illness and positive serology (immunofluorescence antibody method (IFA)), were included. Clinical information and other lab data were collected. RESULTS: Seventy-four cases, with a mean age of 47.3 +/- 12.4 years and of whom 52 (70.3%) were male, were recruited. All had had contact with stagnant water of a farm within the week prior to their admission. Fever and chills were the most frequent chief complaint in 47 (63.5%). Fever, headache, and myalgia were reported by 73 (98.6%), 69 (93.2%), and 57 (77%) cases, respectively. Increased serum creatinine was detected in 18 (27.3%). Only in 27% of patients did CPK rise to 3-fold or more above the Normal Upper Limit, and in 43% of patients its level was within the normal range. Thrombocytopenia was noticed in 87.3%, and 15.5% of cases had platelets less than 20,000/mm(3). Anemia was detected in 78.4%. ESR was more than 100 mm/hour in 28.3%. CONCLUSIONS: History of fever, headache, and myalgia in patients who have been in contact with the stagnant water of rice fields should raise the possibility of leptospirosis in Guilan province.