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 45, No 3 (2007)
Articles
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The increasing incidence of systemic candidiasis, which parallels the use of invasive and immunosuppressive medical procedures, necessitates development of rapid and cost effective tests for diagnosis of systemic candidiasis. Therefore in this study 85 mice were first immunosuppressed by cyclophosphamide and then infected by Candida albicans NCPF 3153. Other 85 mice were employed as control. The case and control mice were bled and then autopsied. Hearts and kidneys were checked by direct, histopathological and cultural examination for systemic candidiasis. The 85 sera from histological proven cases and 85 control mice were adsorbed with heat killed blastospores of same strain of C. albicans. Anti-Candida albicans germ tube antibodies were detected by indirect immunofluorescence assay for diagnosis of invasive candidiasis in case and control mice. In addition, sera from 35 mice with proven cryptococcosis were also tested. While 84 mice with proven systemic candidiasis (100%) had anti-germ tube antibodies, these antibodies were absent in all controls and mice with cryptococcosis. The specificity was 100%, indicating a high degree of discrimination was possible between systemic candidiasis and cryptococcosis in the mice studied. It must be concluded that anti-germ tube responses did not appear to be significantly reduced in immunocompromised mice.
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The use of panoramic radiography, due to its numerous advantages, is increasing. Radiographic films used in this technique are of double emulsion (DE) type which are used with intensifying screens. Single emulsion (SE) films can also be used. The purpose of this study was to determine the exposure parameters to achieve an appropriate optical density in these two types of films, and to estimate under such parameters, radiation doses to mandibular bone marrow (MBM), thyroid gland and parotid gland. This study was performed through a tissue equivalent phantom. First, with various tube voltage and tube current, 128 radiographs were taken of phantom with these two types of films. After examining the optical densities, the exposure parameters under which both films have the same density, were determined. Then, phantom again was exposed and MBM, thyroid gland and parotid gland absorbed doses were measured, using TLDs. It was demonstrated that: 1) SE films, in order to provide appropriate optical density, require two times radiation in comparison with double emulsion film; 2) using SE films increases MBM dose, up to 2-2.5 times, thyroid gland dose up to 1.7-2 times and parotid gland dose up to 1.3 times, in comparison with DE films; 3) in DE films, under lower exposure parameters and desirable processing, MBM dose up to 3.5 times, thyroid gland dose up to 1.5 times and parotid gland dose up to 2.5 times will increase. Considering that the risk of radiation induced cancers increases with repeated radiation doses, using SE films is not recommended.
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The purpose of the present study was to estimate the frequency of HPV DNA in four groups of oral lesions, including oral squamous cell carcinoma. Sixty paraffin-embedded oral tissue samples were examined for the presence of HPV DNAs using the PCR technique. These specimens were obtained from patients with oral squamous cell carcinoma (OSCC), leukoplakia, oral lichen planus (OLP), and pyogenic granuloma (PG). Consensus primers for L1 region (MY09 and MY11) and specific primers were used for detection of HPV DNA sequences in this study. we detected HPV DNA in 60% (9 out of 15) of OSCCs, 26.7% (4 out of 15) of leukoplakia, 13.3% (2 out of 15) of OLPs, and 6.7% (1 out of 15) of PGs. Statistical analysis showed that the prevalence of HPV in OSCC was significantly higher than other groups (P < 0.05). The frequency of HPV-16 and 18 detection in OSCC samples were 40% and 20%, respectively. The prevalence of these high risk HPVs was significantly higher in OSCC group (P < 0.05). The results of the present study show a successive increase of detection rate of HPV-16 and 18 DNAs from low level in samples of pyogenic granuloma and non-premalignant or questionably premalignant lesions of OLP to premalignant leukoplakia and to OSCC.
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Liquid paraffin has been suggested as a good laxative comparing to lactulose as a treatment option in pediatric constipation. This study was performed to compare liquid paraffin with lactulose in pediatric constipation. A total of 247 patients (127 males and 120 females) aged 2-12 years (mean 4.1 ± 2.7 years) with chronic functional constipation were included in an 8 week, randomized, controlled trial. After faecal disimpaction, patients received oral liquid paraffin (1-2 cc/kg/day) or lactulose (1-2 cc/kg/day). Primary outcome measures were: defecation and encopresis frequency per week and successful treatment after 8 weeks. Success was defined as a defecation frequency ≥ 3 per week and encopresis ≤ 1 every two weeks. Secondary outcome measures were side effects during 8 weeks of treatment. A significant increase in defecation frequency, liquid paraffin group, 3 pre, versus, 12 post treatment per week and lactulose group: 3 pre, versus 8 post, per week was found. A significant decrease in encopresis frequency, liquid paraffin: 10 pre, versus 1 post per week; lactulose: 9 pre, versus 3 post per week, was found in both groups. However success was significantly higher in the liquid paraffin group (85%) compared with the lactulose group (29%). Liquid paraffin patients reported less abdominal pain, straining and pain at defecation than children using lactulose. Liquid paraffin is more effective than lactulose in the treatment of chronic functional constipation of childhood. It provided a higher success rate with fewer side effects. Liquid paraffin should be the laxative of first choice in childhood functional constipation.
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Although there have been various studies on the agents reducing pain in infants, but inadequate researches are available in which the effect of low dose of fentanyl in pain reducing in infants has been investigated. To find out the low dose effect of fentanyl on the pain reducing resulted from lumbar puncture in infants. This randomized double blind clinical trial was done on the 82 infants in age group 2-7 years old age were undertaking lumbar puncture. Subjects were randomly divided to two equal groups receiving different trials. The trial given to patients in group I was 0.15 mg/kg venous midazolam plus placebo (saline normal) and in group II was midazolam with the same dosage plus venous fentanyl 1.5 microgram/kg. There were no sex and age discrepancies between two groups. It was observed that the mean pain score was significantly lower in group receiving fentanyl (2.4 ± 1.5) compared with placebo group (5.1 ± 2.1) (P < 0.001). The mean heart rate during puncture was also significantly lower among subjects in fentanyl group (105.6 ± 5.86) than in placebo group (119.2 ± 10.17) (P < 0.001). Our study showed that venous fentanyl plus midazolam compared to combination of midazolam and placebo lowers significantly pain due to cerebrospinal puncture in infants.
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There had been few if any study for second pancreas transplant outcome and consequences in patients with simultaneous kidney pancreas transplant after failure of the first pancreas allograft. The aim of this study was to compare the patient and graft survival and clinical outcomes and complication of the second pancreas transplant in patients with simultaneous kidney pancreas, compared with pancreas after kidney transplantation in patients with no history of previous failed pancreas graft failure. Two groups of patients, patients with simultaneous kidney pancreas transplantation with pancreas graft failure (11 patients) and kidney transplant patients with no history of previous pancreas transplant having first pancreas transplantation (6 patients) were statistically compared. Immediate and short time difference in survival rate between group 1 and group 2 was 63% and 33%, respectively. The difference was attributable to more vascular thrombosis ending in graft loss in group 1, but this dose not achieve a statistical significance (P = 0.7); although long term survival rate difference was more evident and significant (P = 0.002). The only other statistically difference found between two groups was the donor's age with a P value of 0.02, in favor of the patients in group 2, who have received grafts from younger donors. The long term pancreas graft survival rate in patients with the history of previous pancreas transplantation in the setting of SKP is worse than pancreas graft survival in previously kidney transplanted patients, receiving their first pancreas in pancreas after kidney setting.
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Combination therapy with clomiphene citrate plus gonadotropin (clomiphene citrate plus HMG) in induction ovulation reduce the gonadotropins dose but antiestrogenic effect of c.c. can decrease pregnancy rate. In a randomized clinical trial we compared 3 treatment protocol for induction ovulation and intra uterine insemination (I/o plus IUI) in women with infertility history more than one year, normal hysterosalpingogram (HSG), normal spermiogram and follicular stimulating hormone (FSH) < 10 IU/ml. 52 women were taken clomiphene citrate plus HMG, 52 women were received letrozole plus HMG and 28 women were taken HMG alone. Gonadotropin dose for induction ovulation in clomiphene citrate plus HMG group [mean 4.9 (1.5)] and letrozole plus HMG group significantly was lower than HMG group [mean 11 (4.5)](P < 0.05). Although size and number of mature follicule in 3 group were equal. In clomiphene citrate plus HMG group endometrial thickness was lower but level of estradiol obviously was higher than others (P < 0.05). Pregnancy rate in letrozole plus HMG group was 28%, in clomiphene citrate plus HMG group was 23% and in HMG group was 25%. In conclusion aromatase inhibitors like letrozole same as clomiphene can reduce gonadotropin dose in induction ovulation without anti estrogenic effect.
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The original biophysical profile is time consuming and costly. This study was performed to compare diagnostic value of the original fetal biophysical profile to the modified biophysical profile. Patients were selected from high risk pregnancies referred for fetal assessment and were randomly assigned to two groups. The measures of outcomes were perinatal mortality, Cesarean section for abnormal test, meconium-stained amniotic fluid and 5-minute Apgar score < 7. Diagnostic values of tests were assessed in terms of the incidence of abnormal outcome. In addition comparisons between the positive and negative predictive values of each of these tests as well as the sensitivity and specificity of the tests were reviewed. A total of 200 patients were entered into the study; 104 pregnancies were managed by the original biophysical profile and 96 pregnancies by the modified biophysical profile. There were 30 abnormal (31.3%) in modified biophysical profile and 24 (23.1%) abnormal tests in original one. There was significant difference in the incidence of meconium passage between two groups. Cesarean section for abnormal tests was 27 of 30 abnormal test (90%) in modified and 22 of 24 (91.6%) in original profile that was similar in both groups. There was not significant difference in Apgar score < 7 between two groups. We did not find significant difference with comparison of the sensitivity, specificity and negative predictive value of two tests for all measures of outcome except the positive predictive value of meconium passage. Original biophysical profile is more costly and time consuming than modified one.
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Data suggest that the multifocal electroretinography (mfERG) may have a role in the assessment of patients with central retinal vein occlusion (CRVO). To explore the mfERG responses in patients with CRVO. mfERG responses were recorded at 61 discrete retinal locations from both eyes of 25 patients diagnosed with retinal vein occlusions within 3 weeks of onset. The latencies and amplitudes of average responses of 5 eccentric rings from 0 to 26 degrees relative to fixation, and grouped central and peripheral rings of involved eyes were compared with values obtained from 13 normal fellow eyes of these subjects. The mfERG responses obtained from eyes with CRVO were significantly different from those derived from the fellow eye, especially when the rings are grouped as central and peripheral. mfERG is a new, safe, non-invasive, and quick investigative tool to assess retinal function. Our results suggest that mfERG could be a useful electrophysiologic test in clinical evaluation and determination of the severity of underlying ischemia in patients with retinal vein occlusion. Further studies are needed to evaluate its role as a prognostic method to determine which eyes are prone to serious complications. This is the first report of mfERG results in Iran.
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Screening interval urinalysis has long been considered essential to pediatric health care. A urinalysis is recommended at four times: in infancy, early childhood, late childhood, and in adolescence. Several chemical parameters can be measured as commercially available in dipstick test. This test is relatively inexpensive and it takes less than 5 minutes to be completed. In a 3 month follow up program, mass urine screening tests was conducted in four educational areas of Shiraz, Iran, randomly in 1601 students. The questionnaire was filled by their parents and general physical exam was done by general physicians. Fresh urine specimens were screened using a dipstick for chemical analysis including: protein, glucose, blood, urobilinogen, leukocyte-esterase, bilirubin and nitrite. In those who had urinary abnormalities by dipstick or who were symptomatic or had physical abnormalities further investigations were carried out. In 1601 apparently healthy children (809 boys, 799 girls) urinary abnormalities were detected in 76 (4.7%) subjects at first screening. There were urinary symptoms in 63 patients. The most common form of urinary abnormalities was proteinuria (56 subjects, 3.6%). Followed by hematuria (1%), nitrite (0.6%), leukocyte estrase (0.4%) and glucosuria (0.2%). Abnormality in sonography of kidneys were found in 22 cases. Positive dipstick findings had significant correlation with abnormal ultrasound findings. This study shows that it is possible to screen a large population of patients at relatively low cost, providing the framework for further action that may help in the prevention and timely diagnosis of renal diseases.
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The correlation of vesicoureteral reflux (VUR), urinary tract infection (UTI) and renal scarring is well known. Several risk factors for renal parenchymal lesions have been reported previously. We determine the incidence of renal parenchymal damage and outcome in the siblings of children with primary VUR. A total of 96 siblings of patients with VUR, were evaluated with direct voiding cystography, 99m-technetium (Tc)-dimercaptosuccinic acid (DMSA) renal scintigraphy and renal ultrasonography (US). Of 96 siblings, 34 were found to have VUR, representing an incidence of 35.4%. The majority of siblings with abnormal DMSA scans were asymptomatic. Parenchymal abnormalities were determined by DMSA in 23 (69.6%) of the 33 siblings studied (37 of 46 refluxing renal units or 80.4% P <0.001). Of these, 10 (30.3%) were normal. Renal damage was mild, moderate and severe in 30.3%, 54.5%, and 15.2% of children, respectively. Renal US in 34 siblings with VUR was normal in 27 (79.4%) and abnormal in 7 (20.5%). Of the 33 siblings with VUR who had both renal cortical scintigraphy and renal US, DMSA and US findings were abnormal in 23 and 7 of the siblings, respectively. Parenchymal abnormalities on scintigraphy were associated with mild-to-moderate reflux in 51.5% and severe reflux in 72.7% renal units. This study confirms a significant overall incidence of renal parenchymal damage in 69.6% and VUR in 35.4% of siblings studied. Most importantly, the lack of symptoms within the siblings group can not be used as a reason to avoid screening process. DMSA scintigraphy of asymptomatic siblings appears to be beneficial in preventing renal injury.
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Base deficit is a non-respiratory indicator of acid base status. Aim of this study is to assess relationship between the base deficit value in immediate post operative period of CABG and valvular heart disease with cardiopulmonary and in hospital outcome of patient. A total of 136 consecutive with CABG and valvular heart disease scheduled in study. 20 variables were determined during the pre-intra-and postoperative period. Statistical univariate analysis was performed differentiating patients whose initial base deficit after weaning from cardiopulmonary bypass was -8 meq and these whose base deficit was equal or more than -8 meq. Secondly a logistic regression model was performed on the variables shown to have a statistically significant difference in univariate analysis with determination of the odd ratio. 3 variables had a statistically significant difference in univariate analysis and 2 of them high lighted by the linear logistic model. The value of base deficit measured during the immediate postoperative open-heart surgery is correlated with volume of fresh frozen plasma and blood transfusion after open heart surgery and using of intra aortic balloon pump after surgery.
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Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most important disease of the hexose monophosphate pathway. Deficiency of this enzym can lead to hemolysis of red blood cells. Our aim was to study the prevalence of G6PD deficiency in relation to neonatal jaundice. We studied 456 clinically icteric neonates Laboratory investigations included determination of direct and indirect serum bilirubin concentrations, blood group typing, direct coomb's test, hemoglobin, blood smear, reticulocyte count and G6PD level. We divided these neonates to 3 groups based on total serum bilirubin level (TSB): TSB< 20 mg%, TSB=20-25 mg%, and TSB>25 mg%. In only 35 (7.6%) of cases G6PD deficiency was diagnosed. All of these babies were male. From 456 icteric neonates, 213 cases belong to group 1 (TSB<20 mg%), 158 cases belong to group 2 (TSB=20-25 mg%) and 85 cases belong to group 3 (TSB>25 mg%). 16 neonates from 213 neonates of group 1, 6 neonates from 158 neonates of group 2 and 13 neonates from 85 neonates of group 3 had G6PD deficiency. There was statistically significant difference of prevalence of G6PD deficiency between group 2 and 3 ( 15.3% vs 3.8%)( P = 0.001). Between groups 1 vs 2 and 1 vs 3 no statistically significant difference was found. Early detection of this enzymopathy regardless of sex and close surveillance of the affected newborns may be important in reducing the risk of severe hyperbilirubinemia. This emphasizes the necessity of neonatal screening on cord blood samples for G6PD deficiency.
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Thyroglossal duct cysts are the most common congenital anomalies in thyroid development, which in less than 1% of cases are malignant. In most cases the diagnosis is made postoperatively. Up to now, a few cases have been reported which had been papillary carcinoma. Controversies exist concerning its nature and treatment. We present a 30 years old woman with papillary carcinoma of thyroglossal duct cyst, identified in pathologic study after sistrunk procedure. In our case there was neither invasion to adjacent tissue nor lymph node involvement. No further procedure was performed. After 2 years of followup, the patient was asymptomatic and there was no evidence of recurrence. Based on otolaryngologic refrences, we recommend sistrunk procedure and long term follow up for management of thyroglossal duct cyst with papillary carcinomas without marginal invasion and node metastasis.
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Secondary aortoenteric fistula (SAF) is an uncommon but very important complication of abdominal aortic reconstruction. The complication often occurs months to years after aortic surgery. The clinical manifestation of the aortoenteric fistula is always upper gastrointestinal bleeding. Treatment of the disease is early surgical intervention. If operative treatment is not performed promptly, the mortality is high. We present a case of secondary aortoduodenal fistula found 6 years after aortic reconstructive surgery, with the clinical presentation of upper gastrointestinal bleeding. On Immediate exploratory laparatomy, proximal part of abdominal Aorta was clamped. Duodonorrhaphy and aortic reconstruction with patch graft at the proximal suture line of aortic prosthesis was performed. Fortunately there was no pus, so tissue culture was not done. The intervention was concluded with an omentoplasty in order to protect the patch graft and to separate it from duodenorhaphy. Patient did well after the surgical management. Because of the increasing number of elective aortic aneurysm repairs in the aging population, it is likely that more patients with secondary aortoenteric fistula will present to the clinical physicians in the future. So, a high index of suspicion is necessary for prompt diagnosis and treatment of this actually life threatening event.
