2024 CiteScore: 0.7
pISSN: 0044-6025
eISSN: 1735-9694
Editor-in-Chief:
Ahmadreza Dehpour, PharmD, PhD
This journal is a member of, and subscribes to the principles of, the Committee on Publication Ethics (COPE).
Vol 40, No 2 (2002)
Original Article(s)
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Prompt detection of renal involvement through evaluation of microalbuminuria can both reduce mortality in diabetic patients and significantly reduce the cost of managing these patients. To this end, Micral test strips have been used as a screeing tool in this group of patients though not yet in our country. The present study aimed to evaluate this test and to abtain a simpler and less expensive method of screening for microlbuminuria. In this study, 200 type 1 and type 2 diabetic patients referred to the Endocrine & Metabolims Research Center of the Tehran university of medical Sciences were evaluated for microabluminuria. Entry criteria consisted of a history of recognized diabetes longer than or equal to 5 years. Exclusion criteria included development of urinary tract infection, pyrexia, and a history of uncontrolled hypertension. Every patient first completed a data questionnaire and then provided a first-void urine sample, which was tested for microalbuminuria with a urinary protein test strip (an Iranian-made Uri-Yab and a German-made BM-test-GP strip) and the sulphasalicylic acid chemical method. Negative samples were tested further using Micral test strips (based on gold-lable immunochromatograpy) and the microalbumin measurement kit manufactured by Dako. Germany (based on turbidometry using a Hitachi autoanalyser). 126 women and 74 men were recruited into the study. The average age of the sample was 40.7 years (range=16 to 63 years); 17 patients had IDDM and 173, NIDDM. Average duration of recognized diabetes was 8.75 years. Based on results obtained using chemical analysis and foreign-made tests strips, 46 patients (23%) had macroalbuminuria, though the detection rate using Iranian-made test strips was 18 percent (36 patients). A further 16.2 percent of patients had microalbuminuria, with an average urinary albumin excertion of 28.7 mg per liter. Compared with colorimetric methos, the Micral test yieled a sensitivity of 93% and a specificity of 87 percenct. Furthermore, the negative predictive value of the Micral test was 0.92, compared with a figure of 0.94 for a combination of the sulphasalicylic acid method and the BM-Test-GP strips. The results we obtained for the Micral test as a screening tool concurs with the results of numerous other studies. Diurnal variations in albumin excretion dicatate the performance of screening tests on three different occasions at specified regular intervals. Given the relatively high cost of Micral strips, it seems that a simpler and less expensive method should be devised for our country. We observed a higher negative predictive value for the combined suluphasalicylic+BM-Test-GP method than for the Micral strips. The cost of the latter combination comes to 2,000 Rials (@0.25 USS) , which is easily affordable for most patients; the methodology falls comfortably within the experits of medical diagnostic laboratories in Iran. More detailed studies, using 24-
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Achalasia is a well- defined esophageal motor disorder. Graded pneumatic dilation using Rigiflex ballon is one of the therapeutic modalities that had not been evaluated in a large long-term study. We aimed at evaluating long-term efficacy of graded Rigiflex pneumatic dilation in the treatment of achalasia. Symptomatic patients with achalasia who had been referred to our center were consecutively enrolled. The diagnosis was established by clinical, radiographic and endoscopic criteria. Exclusion criteria included pregnancy, coagulopathy, serious medical illness or malignancy. Initially all patients were clinically scored based on the severity of five main symptoms and then underwent pneumatic dilation wit at 3 cm ballon. Symptom scores were evaluated at 1, 6, 12 .. months. Clinical recurrence was defined as an increase of symptom with 3.5 cm balloon dilation. If recurrence occurred again, third dilation was done with a 4 cm ballon. Over a five-year period, 99 patients [mean age: 35.6 (3.0-72) years.] were followed to an average length of 47.4 (18-20) months. 35 patients needed- retreatment, only 6 of them required third dilation. After third dilation two patients did not reveal improvement and underwent cardiomyotomy. Over this time period, cumulative remission rate was 65% without redilation and 94% with redilation. The mean remission period was 44.7 months (95% CI, 43.52-51.27) for single pneumatic dilation by use of Kaplan- Meier survival analysis. There was no significant predictive value for age, gender, previous treatment and severity of initial score to outcome (P>0.4) by use of Cox regression analysis. Pneumatic dilation by a Rigiflex balloon using a graded approach is effective long-term therapy for achalasia in majority of patients.
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Stereologic methods are used to abtain quantitative information about 3-dimensional structures from histologic sections. The aim of the present study was using new and unbiased stereologic techniques to investigate changes in volume and number of glomeruli after chronic lead acetate intoxication both quantitatively and in 3-dimensional spaces.Lead is one of the heavy metals that has adverse effects on renal function. These effects may involve the renal tubules as well as the glomeruli. Several qualitative histologic studies have been performed regarding the effects of lead on renal tissue and the glomeruli some of which report changes in volume and number of the glomeruli.Male adult wistar rats in four groups (each including 9 rats) were randomly selected. The case groups (treatment groups) were first given 0.5% and then 1% lead acetate in their drining water for 8 weeks. The negative and positive control groups were given distilled water and 0.4% acetic acid solution in the same period respectively.Stereologic analysis was performed based on Cavalierie’s principle to determine the reference volume (VReference), the fraction volume of glomeruli (VVGlom), and total glomerular volume (VTGlom). Furthermore the numerical density (NVGlom) and total number of glomeruli (NTGlom) were estimated using the physical dissector.Results showed that the number of glomeruli in case group which had received 1% lead acetate in drinking water decreased significantly (P<0.05), but on changes occurred in 0.5% group (P>0. This study confirms qualitative observational histologic studies with an unbiased and exact method, and expresses the chages in the number and volume of renal glomeruli after lead intoxication.05). on the other hand, glomerular total volume in both 1% and 0.5% groups increased significantly after lead intoxication. Comparing positive and negative control groups (P<0.01
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Females abortion is one of the most important sequela of genital infection with chlamydia trachomatis, Mycoplasma hominis and Ureaplasma urealyticum.In this study frequency of Chlamydia trachomatis, Mycoplasma hominis and Ureaplasma urealyticum was studied in 125 females with habitual abortion by direct and indirect immunofluorescence tests and culture method and compared with 250 normal population. The results obtained were as follow: Mycoplasma hominis was isolated from 18 (14.4%) females with habitual abortion and 18 (7.2%) normal population (P=0.0139). Ureaplasma urealyticum was isolated from 39(31.2%) females with habitual aboration and 48 (19.2%) normal population (P=0.0045). Chlamydia trachomatis was detected by direct immunofluorescence test in 9 (7.2%) of cases and 2 (0.8%) of control groups (P=0.0002). the antibody titer against D-K serotypes of Chlamydia trachomatis was also measured. The valuable titer of antibody (>1/16) was detected in 15 (12% of cases and 8 (3.2%) of control groups (P=0.0004).The results show that chlamydia trachomatis and Ureaplasma urealyticum may be responsible for some cases of abortion.
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Premature rupture of membrane (PROM) is one of the complications of pregnancy which is blamed for increasing the rate of cesarean. Therefore, we studied pregnant women who were admitted in Shariati hospital during March 1996 and March 2000, to determine the rate of cesarean delivery in cases with PROM after 36th week of pregnancy (Term PROM). In a retrospective study, we included pregnant women who had these criteria;1-PROM 2- Gestational age>36 weeks 3- Single pregnancy 4- cephalic presentation and 5- no prior history of cesaren delivery. We extracted their demographic factors, age of pregnancy, induced labor its absence, interval duration between the onset of PROM and induction of labor, interval duration between the onset of PROM and normal vaginal delivery or cesarean delivery, the circumstances of cervix before beginning of induction of labor, type of delivery, indications of cesarean section and new born weight, from their files and entered them in a check list.We reviewed 7544 cases and only 536 cases matched to our criten and were registered. The Rate of PROM and cesarean delivery in the study group was 7.5% and 28.06%, respectively. Indications of cesarean section contained; Fetal distress, 30.8% CPD, 27.3% failure to progress, 18.6% High risk pregnancy, 16.9% and Macrosomia, 6.4% the rate of cesarean section decreased significantly when cervix dilatation or effacement significantly when cervix dilatation or effacement (each alone) increased (Dil, p=5×10-7; Eff, p=7× 107). Interval duration between the rupture of amniotic sac and the onset of induction had no effect on the cesarean rate (p=0.58). An increase in induction cases did not increase the rate of cesarean section (p<107). PROM at 36th week of pregnancy and later did not increase the chance of cesarean delivery, and neither did not increase in induction rates. Longer interval duration between rupture of membranes and onset of induction played no role in decreasing the rate of cesarean section but it is possible to shorten hospitalization time by decreasing that interval duration without increasing cesarean rate. Thus, we suggest immediate induction of labor in the term PROM. PROM at 36th week of pregnancy and later didn’t increase the cesarean rate
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Involvement of genetic alterations in breast cancer, one of the most common types of female malignancie, has been well documented . Among the possible alterations, mutations in several genes including p53 as an important prognostic factor, have been extensively studied. Mutated p5 Protein has longer half-life than the wild type protein that is detectable by immunohistochemistry (IHC). Our study included 72 tumor samples from unselected Iranian breast cancer patients. Tissue samples were stained with H&E to determin the histopathological type and malignancy grade of patients’ tumors. Nuclear p53 protein levels were also determined in tissue samples by IHC using DO-7 anti-p53 immunostaining and other prognostic factors. Results of our study indicated that the pattern of p53 immunostaining was significantly related to high malignancy grade (p=0.08) and age at diagnosis above 45 years (p=0.03). in conclusion, resultes of the present study indicated the validity and simplicity of application of IHC in determining the status of p53 protein. Our data support the results of other studies that have suggested that over expression of p53 protein can be considered as an indicator of increased malignancy potential and worse prognosis in breast cancer patients.
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In a double blind, parallel-group, clinical trial we compared the effects of conjugated estrogen with estrogen plus methyltestosterone in surgically menopausal women. In this study, 251 women were randomly assigned to one of the two regimens: 1-conjugated estrogen 0.625 mg/day +placebo. 2-conjungated estrogen 0.625 mg/day+methyltestosterone 1.25 mg/day (E+A group). Study parameters were psychologic, urinary and sexual symptoms, lipid profile,liver function test (LFT) and side effects. Significantly greater improvement in psychologic, urinary and sexual symptoms was observed in the E+A group .(P<0.002). Changes in hairgrowth were similar in both groups. No clinically significant side effects were seen except body mass index (BMI) which was more increased in E+A group, but its changes were in normal limit. (no obesity, no overweight was seen) (P<0.002). Changes in LFT were similar in both groups. LDL was increased only in E+A group, but HDL rising was higher in estrogen alone group, in contrast, triglyceride and cholesterol levels were increased in E+A group more than other groups (P<0.002), but the changes were in normal limit. As compared to estrogen alone, E+A significantly improved menopausal symptoms in surgical menopause without added side effects.
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In a randomized, double blind study , we compared post operative pain and analgesic requirement in patients undergoing cesarean section with two types of general anesthesia: standardized general anesthesia (control group=26 cases) and preemptive low-dose ketamine (0.2 mg/kg) administered prior to anesthesia induction (keratmine group=27 cases). Postoperative analgesia was provided for both groups using morphine intravenously based on visual analogue scale (VAS). After the operation we found that the time from the end of surgery to the first request for analgesic was longer in ketamine group (10.22±8 hrs) than in the control group (1.65±1.01 hrs0 (P<0.001) Mean dose of morphine consumption over 24 hrs was less in the ketamine group (625±3.45 mg) than in the control group (17.73±4.08 mg) (P<0.001) VAS of pain scores were lower in ketamine group during 24 hr (P<0.001). APGAR Scores were similar between the groups. No patient in either group had postoperative hallucination. In conclusion, ketamine in low dose has a preemptive analgesia effect that reduces central sensitization in cesarean section and reduces postoperative analgesic requirement.
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Hydatidsis is a zoonosis transmitted by domestic and wild animals. Two distinct clinical presentations are as followes: unilocular of cystic hydatid disease and the more malignant form, called alveolar hydatid disease.This case report presents a patient who complained of chest pain and hemoptysis and his lung CT scan suggested solid tumor. He was found to have alveolar diseae which responded to albendazole medical therapy
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Regrding pathophysiology of direct inguinal hernias the following are pointed our:1-Absence of contribution of fascia of transverses abdominis muscle along with fascia transversalis in making posterior wall of the inguinal canal causing defect point in Hesselbachs triangle.2- Defects in protectin mechanisms of the inguinal canal such as: I) shutter like effect of the arch of internal oblique and transverses abdominis muscles. ii) Sphincter like effect of fascia of oblique muscle (anterior wall of canl).During several years of observation and practice in the field of surgical repair of hernias, a new phenomenon was observed regarding the etiology of direct hernias.Evaluation of superficial ring and Ant. Wall of inguinal canal in 25 patients showed that the ant. Wall was not perfect and the defect was seen as a spectrum of moderate defect to complete absence of the wall. This phenomenon may be a newly observed mechanism in pathology of direct inguinal hernia that might help the operative repair. Taking this into account, i.e. repair of this defect, might help the classic herniorrhaphy techniques
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Intramascular (IM) administration of apomorphine (a mixed D1/D2 dopamine receptors agonist 0.2-1.6 mg/kg) induced pecking, a stereotype behavior in pigeons in a dose- dependent manner. In this study the effect of lithium (Li+, 240 mg/kg, IM) and AMI-193 (a new 5-HT2 antagonist, 0.003 mg/pigeon) on apomorphine-induced peking (AIP) were investigated. This study showed that Li+ and AMI-193 did not induce pecking by itself but administration of each of these agents before apomorphine increased and decreased the AIP (apomor-phine 0.8 mg/kg) respectively whereas concomitant use of Li+ (240 mg/kg IM) and AMI-193 decreased AIP significantly. These results suggested that 5-HT2 antagonists inhibit the inhibitory effect of serotonin on the dopamine release in the raphe-striatal pathway but Li+ can modulate dopamine and serotonin function by different mechanisms and decrease this effect. As a result, it is mechanisms and decrease this effect. As a result, it is concluded serotonin can decrease the AIP through 5-HT2 receptors indirectly by decrease the dopamine release.
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Adbominal pregnancy is a rare and life-threatening from of ectopic pregnancy. The incidence is 10.9 per 100000 births and 9.2 per 1000 ectopic gestations. The abdominal pregnancy may rarely continue to term and if it happens the maternal and perinatal mortality and morbidity are increased. This paper reports on a 26-year-old multigravida with 41 weeks abdominal pregnancy managed successfully with good maternal and perinatal outome.
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Schwartz-Jampel syndrome, (SJS) is a rare disorder characterized by myotonia, joint contracture, facial dysmorphism and growth retardation, we present three siblings (two sisters and one brother) 19,24 and 27 years old from consanguineous healthy parents with SJS. Their clinical features were similar to those previously described. Motor and sensory nerve conduction study (NCS) were compatible with a sensorimotor polyneuro pathy. Myotonic discharges, complex repetitive discharges, myokymic discharges, positive sharp waves and fibrillation potentials were seen on EMG needle examination and MUPs were prominently neurogenic. One of the sisters had mental retardation and hypothyroidism from infancy. Thus, this is the first known report of sensorimotor polyneuropath and hypothyroidism in SJS and the first reported family with SJS from Iran.
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During the last 10 years, we have had 11 cases of radioulnar (RU) synostosis, a very rare congenital amomaly of the upper extremity. Only 3 of them required surgical intervention. So we evaluated these three cases of proximal radioulnar synostosis corrected by proximal derotational osteotomy. The indication for surgery was severe pronation deformity that caused functional problem. Mean age at the time of surgery was 4.5 years (3-6 years) and mean postoperative follow up was 3.5 years(1-5 years). Forearm position after surgery was 15 supination. Anesthetic and functional results in all patients were good. In only one patient it was complicated by impending compartment syndrome that was treated by conservative measures. We recommend derotational osteotomay for correcting RU synostosis in earlier age.
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Lip pits are among the rarest congenital deformities recorded. Initially reported in 1845, it’s familial occurrence has been reported just once. These developmental anomalies occur either as an isolated defect or in association with other developmental deformities including cleft lip, cleft palate or both. It may be located at the commisures of the lips or in the midline of the lower lip. It is often inherited as an autosomal dominant trait with variable penetrance.Our report of a family in which all of the three children (two girls and a boy) and their father wre involved in concert with the latter statement.
