2023 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 44, No 2 (2006)
Articles
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NO ABSTRACT
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Leptin affects paraventricular nucleus of hypothalamus and reduces appetite while activation of α2-adrenoceptors at this site has opposite action. The reducing effect of α2-adrenoceptors inhibition on body weight and appetite and also enhancing effects on lipolysis, sympathetic activation and plasma insulin levels in animals have been reported. We studied the effect of yohimbine treatment (2 mg/kg/day orally) as α2-adrenoceptor antagonist on plasma levels of leptin, insulin and glucose and also body weight in rats. Five normal yohimbine treated, five diabetic insulin treated (10 u/kg/day) and five diabetic insulin (l0 u/kg/day) and yohimbine (2 mg/kg/day) treated male Sprague Dawley rats were used and treatment continued for six days. One blood sample before treatment and three blood samples after treatment (with one day interval) were collected from all rats. Our results showed statistically significant increase in leptin (P < 0.037) and insulin (P < 0.042) and decrease in body weight (P <0.004) in normal yohimbine treated rats. In diabetic rats insulin levels before and after treatment were similar in two groups but leptin, glucose and body weight were significantly reduced in yohimbine and insulin treated compared with just insulin treated rats. The present results indicate that yohimbine treatment can reduce body weight by increasing stimulation of lipolysis and increasing plasma levels of leptin. This plasma leptin enhancement in normal rats may be contributed to the weight reducing effect of α2-receptor antagonist drugs. Our study introduces the α2-receptor antagonists as body weight reducing, glucose restoring and insulin and leptin increasing drugs.
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Cisplatin-based chemotherapy is the standard treatment for advanced non-small cell lung cancer (NSCLC). Many novel drugs have been used in combination with cisplatin in this setting. Of these drugs, gemcitabine is reported to have a high response rate and acceptable toxicity. The aim of this study was to evaluate the efficacy and safety of gemcitabine and cisplatin combination. Twentythree patients with NSCLC were enrolled from January 2001 till September 2003. All of them were confirmed by histology and were in advanced stage, i.e. stage IIIB or stage IV. Cisplatin with the dose of 70 mg/m2 was given every 21 days, in combination with gemcitabine at a dose of 1250 mg/m2 administered on days 1, 8 of a 21-day cycle. Of the 23 patients, 1 showed complete remission, 5 achieved partial remission and 7 had stable disease and 2 patients showed progressive disease, 8 patients were not evaluable for response. The overall response in 15 evaluable patients was 40% (95% CI.), median survival was 13.5 months (95% CI, 3.5-27.4 months), and median progression free survival was 11 months (95% CI, 1.04-20.9 months). Hematological toxicity’s included anemia, neutropenia and thrombocytopenia. Non-hematological toxicities included nausea/vomiting, peripheral neuropathy, skin rashes, mild renal impairment and one case of acute respiratory distress syndrome;another case developed transient acute psychosis. The regimen of combined gemcitabine with cisplatin is safe and effective and well tolerated in patients. In this combination, a lower dose of cisplatin seems to have an efficacy similar to that seen in previous reports.
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Treatment of hydrocephalus in posterior fossa tumors in children is still a matter of controversy and different centers have their own routines. In this regard, hospital records of all children with posterior fossa tumors treated in our center during the interval of 1985-1995 were reviewed. Patients’ demographic and diagnostic data were analyzed and the frequencies of shunting procedures were determined. Fisher exact test was employed to compare the frequency of postoperative complications in different groups. A total of 108 patients with age ranging from 3 months to 18 years and a male to female ratio of 1.5 comprised the study population. Ninety-nine cases had hydrocephalus at the time of diagnosis and 81 patients underwent preoperative shunting. Of the remaining 18 patients, 13 underwent external ventricular drainage at tumor operation session plus preoperative corticosteroid therapy. The rest of the patients got no primary treatment for hydrocephalus. Three of these 5 patients had postoperative shunting after tumor removal, but the other 2 remained shunt free. The rate of postoperative complications including cerebrospinal fluid leakage and septic meningitis were significantly lower in patients with preoperative shunting. The results of this study are in favor of those that approve the effect of preoperative shunting in decreasing postoperative complications. This is well established when the tumor size is big or when the diagnosis of posterior fossa tumor is made in later stages or when hydrocephalus is severe. It could be concluded that preoperative shunting can decrease the rate of postoperative complications.
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Violence and the threat of violence against pregnant women are main barriers to women’s empowerment and equal participation in society. When stress and violence increase in developing societies, women’s safety in the home, workplace and community is often seriously affected. To determine the prevalence of physical abuse in pregnant women and to assess association between physical violence during pregnancy and maternal complications and birth outcomes, we used clinicbased data from a sample of 403 women who delivered live born infants during the summer of 2002 in our hospital. Data of physical violence against women’s during pregnancy and 3 months before that were based on questionnaire and interview. Outcomes data including antenatal hospitalization, labor and delivery complications were obtained from the records. Prevalence of physical violence during pregnancy was reported as 10.7%. Prevalence of experience of physical abuse 3 months before pregnancy was 11.9%. Women who experienced physical violence compared with those not reporting abuse were more likely to be smoker and hospitalized before delivery for maternal complications such as preterm labor, kidney infections, premature rupture of membranes and vaginal bleeding with pain. There was a significant association between physical violence and low birth weight and mother’s education. Physical violence during pregnancy is common and is associated with maternal complications and adverse birth outcomes. We suggest including methods to determine frequency of violence during pregnancy and assessment of violence in pregnancy by a screening program integrated in prenatal care.
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Amniotic fluid volume (AFV) is one of the important parameters in the assessment of fetal well-being. The ability of ultrasound measurements to represent the actual AFV is unproven. This study was undertaken to compare correlation of conventional amniotic fluid index (AFI) and radial amniotic fluid index (RAFI) as a new method with actual fluid volume on phantom. As an experimental study, 10 to 100 ml of water with 5 ml intervals was injected to a rubber bladder as a uterus phantom containing a 15 week gestational age fetus. The vertical diameter was measured in largest fluid pouch at each quadrant. Four diameters were summed as conventional AFI. The largest radial diameter perpendicular to uterus and fetus was measured at four quadrants and were summed as RAFI. Databases were analyzed based on correlation and regression methods. RAFI and conventional AFI predicted 91.6% and 65% of variations of fluid volume, respectively (P < 0.001). In conclusion, RAFI is more accurate and reliable than conventional AFI in the prediction of injected fluid volume.
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Persistent microalbuminuria is predictive of nephropathy in patients with type I diabetes mellitus (DM) and has led to the development of screening programs and intervention studies. We report a longitudinal evaluation of urinary albumin excretion in 118 children with type I DM, attending a single clinic over a period of seven years. Collected blood and urine samples were analyzed for glycated hemoglobin (Hb A1c), cholesterol, triglyceride (TG), creatinine and for 12 h urinary albumin and creatinine concentrations. Blood pressures were recorded and clinical data collected. Twenty– three (19.5%) children had persistent microalbuminuria (urine albumin 30-300 mg/24 h) on at least three consecutive occasions. Factors associated with microalbuminuria in diabetic children included longer duration of DM, higher mean age, higher mean Hb A1c, higher mean arterial blood pressure and higher cholesterol and TG levels (P < 0.001). Significantly more girls than boys and more pubertal and post pubertal patients had microalbuminuria but one patient developed microalbuminuria under the age of 11 years. In conclusion, microalbuminuria may appear as early as the prepubertal period, suggesting that metabolic control of DM is an important factor of diabetic nephropathy.
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Previous studies have shown that diabetes mellitus (DM) increases the risk of cardiovascular disease in women to a greater extent than in men. It seems that DM may alter lipid profiles more adversely in women compared to men. In this study we evaluated serum lipoprotein differences in type 2 diabetic men and women. The study included 350 type 2 diabetic patients (100 men and 250 women), aged 19-82 years. Demographic data were and biochemistry tests including serum lipoproteins were measured. There was no difference between men and women with respect to duration of DM and type of treatment. Body mass index (BMI), systolic and diastolic blood pressures were significantly higher in women than age matched men. Women also had significantly higher plasma levels of total cholesterol (233.7 vs. 190.3 mg/dl, P < 0.001), triglycerides (219.7 vs. 180.6 mg/dl, P < 0.05), lowdensity lipoprotein cholesterol (LDL-C) (141.2 vs. 116.1 mg/dl, P < 0.001), high-density lipoprotein cholesterol (HDL-C) (47.1 vs. 39.4 mg/dl, P < 0.001), non-HDL cholesterol (186.1 vs. 150.8 mg/dl, P <0.05), Lp(a) (50.7 vs. 38.2 mg/dl, P < 0.05) and apo-B (117.6 vs. 101.2 mg/dl, P < 0.001). All types of dyslipidemia were significantly more prevalent in females. Women had higher plasma levels of HDL-C compared to men. Higher prevalence of hypertriglyceridemia in females was due to their higher BMI, and sex was not an independent risk factor for hypertriglyceridemia. Type 2 diabetic women are exposed more profoundly to risk factors including atherogenic dyslipidemia and higher BMI, systolic and diastolic blood pressures compared to men.
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Numerous etiologies are responsible for cases of stroke in young adults. This study reviews the causes of two types of stroke (ischemic and intracerebral hemorrhage) in young adults aged 15 to 40years, admitted to our center (a tertiary care center) from 1997 to 2002. The purpose of this study is to determine the relative frequency of causes of stroke in young adults and compare this with published data in the literature. Using the codes 46.0 to 46.8 of the International Classification of Diseases- 10th Edition (ICD-10), cases were identified from the records of the stroke patients admitted in Imam Khomeini Hospital and the data were collected from their files using a comprehensive questionnaire. Forty-two cases of ischemic stroke (62%) and 26 cases of intracerebral hemorrhage (38%) were identified. The leading cause of ischemic stroke was cardioembolism (38.1%), followed by atherosclerosis in 5 cases (11.9%). Among cardiac causes infarction was attributable to consequences of rheumatic heart disease in 8 cases. In 3 cases a cessation or decrease in dose of warfarin was followed directly by an ischemic stroke. The most leading cause of intracerebral hemorrhage was hypertension (30.8%). Other causes were anticoagulant therapy, intratumoral hemorrhage, aplastic anemia, leukemia, arteriovenous malformations, and chronic active hepatitis. In conclusion, cardioembolism and hypertension were the most leading causes of ischemic and hemorrhagic stroke in young adults admitted in our hospital.
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Ocular trauma is an important cause of ocular morbidity in children. At present only limited studies regarding distribution of ocular trauma exist in Iran. This study was performed to define epidemiologic characteristics and clinical profile of ocular trauma in children and to discuss management and final outcomes of such injuries. The files of 60 patients aged 16 years or younger who had been admitted for eye trauma at Shahid Sadoughi Hospital from April 2003 to March 2004 were analyzed. Sixty cases were studied. Majority of injuries occurred in the age group of 8-12 years (58.3%). There were 40 (66.6%) boys and 20 (33.3%) girls. The highest proportion of injuries occurred in streets-roads (41.6%), followed by home (25%). Open globe injuries accounted for 51.7% of injuries, closed globe for 35% and chemical injuries for 13.3%. The most common causes were pointed objects, stones, bow-arrow and accidental blows and falls. Best corrected visual acuity of 20/40 or better was achieved in 10 patients (47.9%) in closed globe group. However, only 5 eyes (16.1%) in open globe group could achieve this vision. Seventeen patients (28.3%) achieved visual acuity of 20/200 or less. In conclusion, most ocular injuries are preventable and occur due to unsupervised use of objects like pointed things and bow–arrow. Initial visual acuity is statistically an important predictor of final visual acuity.
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In Guilan province, near the end of spring and summer each year at the time of rice gathering, some of the farmers run high fevers. This disease is named as “Shaltook Fever” (Paddy or Husked rice fever) in the region. Review of literature showed outbreak of leptospirosis between rice farmers in Italy and Spain. We decided to measure antibody levels (IgM and IgG) against leptospirosis in patients with Shaltook fever. Samples were chosen from any patient who was diagnosed as Shaltook fever by health care clinics between end of spring and summer of 2002 in Guilan province. Patients should have fever above 38° C, with myalgia and history of recent work at rice fields. All other diagnosis for these patients should have been ruled out by clinical or laboratory investigations. Antibodies levels were measured by ELISA method. IgM was measured in 87 out of 100 serum samples and IgG was measured in 84 out of 87 of above serum samples. In 26 samples IgM anti Leptospira were positive (IgM > 20 u/ml), and 5 specimens were borderline (IgM = 15-20 u/ml). In measuring IgG, 10 samples were positive (IgG > 9 u/ml), and 13 samples were borderline (IgG = 5-9 u/ml). The above findings were suggestive of acute leptospirosis infection in 30% of Shaltook fever patients. It is of interest that in only 17 out of 26 positive samples for IgM positive IgG titers were observed. It could be concluded that these patients had, for the first time recently, encountered the disease.
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Peritoneal dialysis is an established form of renal replacement therapy used in many patients with end-stage renal disease. The key to a successful chronic peritoneal dialysis is a permanent and safe access to the peritoneal cavity. This study was conducted in order to evaluate the catheter survival and its related factors in Imam Khomeini Hospital. A total of 80 catheters were inserted into 69 patients (52 men and 28 women) with end-stage chronic renal failure during a period of 84 months. Retrospectively the correlation between catheter survival (overall and event free) with demographic factors (sex and age), surgical factors (surgeons and surgical methods), nephrologic factors (the causes of peritoneal dialysis selection and the history of hemodialysis) and peritonitis factors (the history and number of peritonitis) has been evaluated. The mean age of the patients was 48.35 years (16 to 79 years). The overall survival of catheters or the probability of having a functioning catheter after one, two and three years was 53%, 41%, 22%, respectively. The event free survival of the catheter or the probability of having a functioning catheter without any problems after one year was 14%. It has been found out that among all factors in this study only history of hemodialysis had statistically significant effect on the overall survival of continuous ambulatory peritoneal dialysis catheter (P = 0.04). It seems that the overall survival of catheters is better when CAPD is started before any other attempts for hemodialysis.
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Uretero pelvic junction (UPJ) obstruction is a common cause of hydronephrosis in infants. The frequent use of fetal ultrasound is allowing early (prenatal) diagnosis of numerous uropathies previously delayed until the child either became symptomatic or had a palpable mass. Newborn with severe obstruction often has marked improvement following correction, therefore, early diagnosis and operation are important. From 1993 to 2002, 21 patients were operated on for severe UPJ obstruction who were diagnosed before 6 weeks of age. Only 10 patients (63%) had antenatal ultrasonographic diagnosis, the remaining were diagnosed by postnatal ultrasound and IVP or radionuclide scan for palpable renal enlargement or for associated anomalies. Eighteen of them had unilateral and three had bilateral obstruction. Twenty-four pyeloplasties were done; all pyeloplasties were dismembered with tailoring of the dilatated renal pelvis. Postoperative renal function was followed with laboratory blood test, urine test or radionuclide scan or IVP. Postoperative complications included urinary tract infection in three patients and postoperative stenosis in one patient were seen. No mortality occurred on infants in unilateral but one occurred in bilateral obstruction. Also, there was one unrelated late death. We report documented functional improvement with minimal complications in unilateral or bilateral pyeloplasty in newborns with UPJ obstruction. We recommend that if the initial scan shows substantially reduced function in the obstructed kidney, a pyeloplasty (rather than nephrectomy) generally should be performed, because the newborn kidney has tremendous capacity for improvement in renal function following decompression.
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Non-Hodgkin lymphoma (NHL) is one of the masquerade syndromes of malignant melanoma that can occur with two main patterns of presentations in the eye: metastatic involvement of uveal tract, and primary involvement of retina. We report ophthalmic, imaging and histopathological findings in the first case diagnosed as primary choroidal NHL without central nervous system or systemic involvement. A 37-year-old woman presented with the complaint of severe visual loss in her right eye. Significant ocular finding included light perception of vision (LP), 2+ APD, 2+ cells in vitreous and intraocular pressure of 46 mmHg. Fundoscopic examination revealed exudative retinal detachment. Ocular echography showed choroidal thickening in addition to retinal detachment. MRI showed semilunar shape lesion in the posterior right globe suggesting choroidal melanoma. Systemic work-up could not reveal any underlying cause. The patient underwent enucleation with clinical suggestion of choroidal melanoma. Result of histological examination showed NHL (diffuse large Bcell type) of choroid. Immunohistochemical staining showed negative staining for HMB-45 and CD3, positive staining for LCA, and CD20. Multiple periodic lumbar puncture, bone marrow biopsies and MRI were unremarkable. No recurrence of tumor in systemic work-up was noted during the 36-months follow-up. Primary choroidal NHL is one of the causes of generalized thickening of choroid and should be considered in differential diagnosis of malignant melanoma. It is recommended to perform fine needle biopsy before performing surgery in any patient who has had an atypical malignant melanoma. This is, so far as we know, the first case diagnosed as primary choroidal NHL.
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Mitochondrial neurogastrointestinal encephalo-myopathy (MNGIE) is a rare autosomal recessive disease caused by thymidine phosphorylase (TP) gene mutation. Here we report a patient with MNGIE in whom sensorimotor polyneuropathy was the first presenting symptom and had a fluctuating course. This 26-year-old female patient developed acute-onset demyelinating polyneuropathy from the age of 6 with two relapses later on. In addition, she had gastrointestinal symptoms (diarrhea, recurrent abdominal pain), progressive weight loss and ophthalmoparesis. Brain magnetic resonance imaging showed white matter abnormalities, and muscle biopsy showed ragged red fibers. This constellation of clinical and laboratory findings raised the diagnosis of mitochondrial neurogastrointestinal encephalomyopathy (MNGIE). This report highlights the uncommon clinical characteristics of this rare disease.
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The term congenital hypopituitarism defines deficiency of all of the pituitary hormones. Hypoglycemia and microphallus (in males) are common findings, and some infants have shown evidence of the neonatal hepatitis syndrome. We report a case of congenital panhypopituitarism with deficiency of six major hormones and association with severe hypoglycemia, impaired liver function tests and congenital heart disease.
