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 47, No 2 (2009)
Original Article(s)
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Dyslipidemia has become a common problem in human immunodeficiency virus (HIV) disease, especially in patients on combination antiretroviral therapy. We investigated the prevalence of and factors associated with dyslipidemia in HIV-infected patients in Iran. In this cross-sectional study, 190 HIV positive patients who referring to behavioral disease consulting centers (Shemiranat, Varamin) and Iranian Research Center for HIV/AIDS in Tehran, were studied from December 2005 to December 2006.A standardized questionnaire with epidemiological, clinical, and therapeutic data was completed by physicians. Blood samples were obtained for metabolic measurements. CD4 cell count was measured by flow cytometry. Levels of total cholesterol, triglycerides, and lactate were elevated in 16.9%, 29.9%, and 22.5% of patients, respectively. The prevalence of elevated triglyceride and cholesterol levels was significantly higher among patients receiving antiretroviral therapy than it was among those who were not receiving treatment. Fasting hyperglycemia was noted in 10.1% of patients overall, but this was not significantly associated with antiretroviral treatment group. Low HDL levels were noted in 52.4% of patients overall, and this finding did not vary by treatment group. There is a high prevalence of dyslipidemia in patients taking antiretroviral therapy in Iran. We conclude that the prevalence of and factors associated with metabolic abnormalities in HIV-infected Iranian patients are similar to those reported for Western and Asian studies.
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Tuberculosis (TB) is one of the 10 leading cause of deaths in developing countries. Understanding the cause and risk factors of TB death and lowering them can reduce its mortality rate. The aim of this study was to assess the cause and risk factors for death of tuberculosis. A retrospective descriptive study was conducted in Khuzestan province in the south west of Iran, from 2002 to 2006. Medical records of tuberculosis cases over the 5-year period were reviewed and death data were analyzed. Including criteria were documented TB diagnosed based on National Tuberculosis Program (NTP). Extracted data were analyzed in SPSS 11.5 system and by chi squared test. One hundred and twenty five deaths (3.15%) with mean age of 48.96±10.03 years were detected. Risk factors for death were: cigarette smoking, diabetes, chronic peritoneal dialysis, MDR-TB, imprisonment, AIDS and injection drug usage. 93 deaths (74.4%) were directly attributed to tuberculosis. Overwhelming TB disease, hemoptysis, AIDS/HIV and MDR-TB were the cause of death with the rate of 69.9%, 11.8%, 9.7% and 8.6%, respectively. 32 (25.6%) deaths were due to medical problems unrelated to TB, among which were cardiovascular diseases, bacterial super infection and cancers with the rate of 25%, 21.9% and 15.6%, respectively. The deaths of TB not only are directly related to TB, but also are caused due to comorbid conditions. Overwhelming TB disease, hemoptysis, cardiovascular diseases, bacterial super infection and cancers are the main cause of death. MDR-TB, imprisonment, AIDS and injection drug usage are the main risk factors for TB mortality.
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To determine the prognostic value of response to treatment in patients with focal segmental glomerulo-sclerosis. FSGS includes 10-15% of idiopathic Nephrotic syndrome in children. Bulk of evidence supports disease relationship with immune system. Unfortunately, responses to immunosuppressive drugs are not desirable and progression to end-stage renal disease is common. We analyzed 62 out of 99 cases of biopsy proven idiopathic FSGS who were followed for at least 5-years or until renal failure occurred during study. Study design was historical cohort and patients were divided into two groups: exposed (resistant to treatment) and non-exposed (responsive to treatment). Correlation between prognosis and response to treatment was statistically evaluated. P-value (0.05 and relative risk ( 1 was considered significant. In 3 out of 25 steroid responsive patients (12%) and 22 out of 37 steroid resistant patients (59.5%), disease progressed to renal failure. Disease progressed to renal failure in 2 out of 11 cyclophosphamide responsive patients (18.1%), 17 out of 23 cyclophosphamide resistant patients (74.3%), and 8 out of 14 cyclosporine resistant patients (57.1%). 2 patients who responded to cyclosporine had normal renal function at the time of the last follow up. We concluded that favorable response to steroid and cyclophosphamide treatment is a protective factor against disease progression to end stage renal disease and resistance to these drugs imply a poor prognosis. For making any definite conclusion concerning response to cyclosporine treatment and prognosis, similar studies with a larger sample are required.
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At present, some clinical presentations and serological parameters such as products of complement activation and elevation of autoantibodies (e.g. dsDNA antibodies), erythrocyte sedimentation rate (ESR), levels of C-reactive protein (CRP), or cytokines such as IL-2/IL-2 receptor, IL-6 and IL-10 are used as indirect serological markers with variable degrees of significance. To date, no specific serological parameter is available to assess disease activity in SLE. Soluble serum thrombomodulin is a new marker of endothelial cell injury and vasculitis. The objective of this study was to determine in vivo soluble thrombomodulin as a marker of disease activity in SLE pa-tients and compare serum thrombomodulin in SEL patients with and without renal involvement and inactive SLE patients. Sixty-four patients fulfilling ACR criteria with proven SLE with differ-ent disease activities were tested for serum levels of Thrombomodulin and dsDNA by ELISA. C3, C4 and FANA were also measured by standard laboratory tests. The clinical disease activity was evaluated by the Systemic Lupus Erythematosus Activity Index (SLEDAI). Elevated soluble thrombomodulin had significant correlations with an increased ANA level (P= 0.037), decrease level of C3 (P =0.017), increase of SLEDAI (P=0.003) and strongly associated with renal in-volvement in SLE. Thrombomodulin level and Anti dsDNA in active patients with and without re-nal disease were higher than inactive patients. In SLE, serum thrombomodulin seems to be impor-tant marker for evaluation of disease activity.
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To Compare colonization of group B streptococcus (GBS) in diabetic and non-diabetic pregnant women. In this prospective study 50 pregnant women with diabetes mellitus (both pregestational and gestational) and 43 pregnant women without diabetes between 33 and 37 weeks' gestation were evaluated. Three samples for Group B streptococcal culture detection were obtained from each subject in the following order: perinea sample, vaginal sample, and an anorectic sample. All had singleton gestations, negative tests for human immunodeficiency virus, and intact membranes at enrollment. Pearson chi-square and fisher, Exact test were used when appropriate. Most common site of GBS colonization in all women was vagina (11.8%). Colonization of group B streptococcus in control group included vagina (7%) perineum (0.3%) and rectum 0.3%) and in diabetic group included vagina (16%) perineum (16%) and rectum (16%). Although comparison was shown higher vaginal colonization rate in diabetic group (16% versus 7%) but difference was not significant (P=0.154).The prevalence of group B streptococcus colonization in gestational diabetes was 20% and higher than pregestational diabetic women. Among women with pregestational diabetes, the prevalence of group B streptococcus colonization was 15% in non-insulin dependent diabetic women and 10% in insulin dependent diabetic women (P> 0.05). Comparison between two groups showed high rectal colonization in diabetic group and difference was significant (P= 0.027). Pregnant diabetic patients have higher carriage rates of group B streptococcus (GBS) in rectum than non-diabetic pregnant women and diabetes is a risk factor for group B streptococcus colonization during pregnancy.
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The aim of this study is to evaluate early and late results of surgery in children with congenital heart disease and decreased pulmonary blood flow, who underwent a palliative systemic-to-pulmonary shunt. During the past 9 years, 157 systemic-to-pulmonary artery shunts were performed in 130 patients (69 males, 61 females) with ages from 1 day to 31 years old. They had been evaluated for their clinical effectiveness, the need for a repeat operation and the mortality and morbidity. There were 101 (77.7%) modified Blalock-Tausig (BT) shunts, 19 (14.6%) modified Waterston shunts, 8 (6.2%) Central shunts, 1 Waterston shunt, and 1 Glenn shunt created throughout the study. Tetralogy of Fallot comprised the majority of cases (113; 86.9%) while the remaining 17 (13.1%) included transposition of the great arteries with pulmonary stenosis, tricuspid atresia, pulmonary atresia, atrioventricular septal defect (canal) with pulmonary stenosis, and univentricular heart complex. Early mortality was 12.3% (16 patients). Second shunts were created in 25 (19.2%) patients. Forty patients (30.8%) have undergone subsequent intracardiac repair 37.7 ± 17.8 months after original shunt procedure. There were four (3%) late deaths. Follow-up was achieved in 105 of 114 early survivors for a pe-riod of 3 to 117 months (mean 31.7 ± 19.4 months). Modified BT shunt was performed most frequently in our service; it was associated with less closure and mortality than other types of shunt and had excellent clinical palliation and patency rates.
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Headache is a common symptom that constitutes a major health problem to all countries in the world. This study was conducted to estimate the prevalence of migraine and tension -type headaches(TTH), its associated occupational risk factors among Shiraz hospitals staffs, and to report on clinical characteristics of migraine and TTH with using the International Headache Society (IHS) diagnosis criteria. A random sample of 1023 staffs constituting a 20% sample of the hospitals staff population was selected. Sampling method was categorical random sampling. Within each group sampling was carried out systematically. Data were collected by screening questionnaire followed by clinical interviews, general physical and neurological examination, and diagnostic criteria of IHS. Prevalence of migraine, TTH and coexisting migraine and TTH were estimated as 11.2% (115 cases), 19.5% (199 subjects) and 3.2% (33 subjects) respectively. In this study , clinical characteristics of headache including type, site, number , intensity ,concomitant symptom of headaches had been surveyed. TTH and migraine headaches were significantly associated with self reported abnormal sleep pattern and female gender (P < 0.001). Also TTH was negatively associated with total 24hr duration of sleep and history of involvement in second job significantly (P<0.026). The average of prevalence of migraine and TTH were lower than their counter parts in western countries but higher than previous studies conducted in other Asian countries. Clinical characteristics were almost parallel with IHS criteria, headacherelated missed work rates were higher for subjects with migraine headache, and also TTH and migraine were separate disorders and were not as a part of a continuum of headache disorders. Headache disorders deserve more attention, especially concerning strategies leading to adequate primary prevention, diagnosis and treatment.
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Shigellosis is an important public health problem, especially in developing countries. Antibiotic treatment of bacterial dysentery, aimed at resolving diarrhea or reducing its duration is especially indicated whenever malnutrition is present. First-line drugs include ampicillin and trimethoprim sulfamethoxazole(TMP-SMX); however multidrug-resistance has occurred and careful antibiotic selection must be considered in prescribing .When epidemiologic data indicate a rise in resistancy, fluoroquinolones may be used in adults and oral third-generation cephalosporins and nalidixic acid in children. All children (n=2400) with acute diarrhea who were admitted to the Pediatric department of Dr.sheykh Hospital Mashhad, Iran from March 2004 to March 2005 were selected and their stool culture were obtained, then positive cultures (312 cases,13% ) were evaluated by antibiogram. This study showed that in heavily populated areas of IRAN like Mashhad, 97% shigella strain isolated from children with bloody diarrhea were sensitive to nalidixic acid, ciprofloxacin and cefixime and rarely susceptible to ampicillin and cotrimoxazole. There is increasing resistance of Shigella to most of the antibiotics in use, and for this reason, careful selection of antibiotics must use considered in each area. Development and use of new drugs are expensive and have severe limitations in the third world. Simple prophylactic alternatives are therefore, required, such as awareness of hygienic child care practices and early promotion of breast feeding. For treatment of shigellosis in infants Ceftriaxon, and in children Nalidixic Acid is recommended.
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Dietary antioxidants including phenolic compounds are believed to be effective nutrients in the prevention of oxidative stress related disease. Pomegranate has been used for centuries in ancient cultures for its medicinal purpose and is widely acknowledged for antioxidant properties. The present study was designed to assess the effect of pomegranate fresh fruit consumption on the plasma antioxidant capacity. Thirty healthy volunteers were recruited for the study. Volunteers were randomly divided into three groups (pomegranate, vitamin E and water consumption). Blood samples were collected, after at least 12 hours overnight fast, the day before beginning supplementation period and the day after supplementation had finished. Total antioxidant capacity measurement by FRAP method and clinical laboratory test were performed for all volunteers in two selected times. The obtained data revealed that consumption of 100 grams pomegranate and vitamin E per day for ten days resulted in a significant rise (14.05%, 8.28%) plasma antioxidant capacity respectively, but this difference was not significant for water group.
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To define efficacy of pre-operative chemotherapy in down staging of advanced non-round cell soft tissue sarcomas. From Sep 2002 to Dec 2005, 70 patients were treated by Ifosfamid, MESNA, cisplatin, adriamycin, mitomycin and subsequent surgery. Postoperatively, patients received radiotherapy in cases of microscopically incomplete resection or local recurrence. The median age of the patients was 34 years and the median tumor size was 14 cm. According to AJCC classification 46 patients had stage 3 and 24 had stage 4 diseases. The most common subtypes were MFH and leiomyosarcoma. The most common sites of tumors were lower extremity and trunk. Toxicity grades three or higher consisted of nausea, Leucopenia and infection. About 50% of the patients received G-CSF. Response to chemotherapy was assessable in 63 patients; 9 patients achieved complete response and 16 showed partial response. Disease progressed in 8 and did not change in 37. The best response was seen with MFH, fibrosarcoma and synovial sarcoma. After chemotherapy seventy percent of patients underwent complete surgery. Disease relapsed in 41 patients and twenty two patients died of metastasis. Median survival of patients was 30 months. IMAP plus G-CSF is safe and effective as preoperative chemotherapy in some subtypes of sarcomas, although the metastasis problem has not been eliminated.
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The purpose of this study is to investigate the age -related improvement of defecation function in high type anorectal malformation in relation to the assessment of the internal anal sphincter. The function of defecation was studied every 5 years up to 15 years postoperatively according to the Japanese scoring system in our hospital in 50 patients operated for high type (recto-urethral fistula) imperforate anus with posterior sagital anorectoplasty (PSARP) procedure in 25 patients, and 25patients with endorectal pull-through (ERPT). The internal anal sphincter was assessed by anorectal manometry and histology, and the results were analyzed with the clinical outcomes. The defecation scores of the PSARP cases exceeded those of ERPT cases at all age groups, the averaged total score were 7.0 in the PSARP cases vs. 4.6 for ERPT cases at 5 years old, 7.5 vs. 5.2 at 10 years old, and 8.0 vs. 6.7 at 15 years old. The anorectal reflex was seen in 17 of 25 (68%) PSARP cases examined, whereas seen in 5 (20%) of ERPT cases examined. Histologically, the well-developed and thickened internal circular muscle at the rectal end was found only in 40% of the cases, whereas discontinuation and hypoplasty of the muscle were seen in most of the cases examined. The present results indicate that the internal sphincter muscle at the rectal end may be histologically maldeveloped in high type anorectal malformations; however, they can potentially develop after transplanted and contribute to the improvement of passive continence in the late post-operative period.
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Bone-patellar tendon auto graft is probably the most widely used graft for ACL reconstruction. Several methods for graft fixation have been described. To avoid intra-articular hardware we adopt biological fixation with a femoral trapezoidal press-fit fixation. A prospective study was performed on 30 consecutive active people who underwent ACL reconstruction with this technique by two surgeons between september2004 and march2007 (mean follow-up 15.2 months). Results were evaluated by an independent examiner using radiography, subjective and objective evaluation. Assessment using the IKDC knee scoring revealed 92% of the patients with a normal or nearly normal knee joint. Lysholm's score was 63.6(40- 86) preoperatively and 91.88(73-100) at the latest follow up (P < 0.005). No patient complained of instability at latest follow up. The quadriceps muscle showed mild atrophy at 3 and 6 months and at final follow-up. Five Patients complained of anterior knee pain and had a positive kneeling test. We found no graft displacement on follow up radiographs. All cases showed radiological evidence of graft osteointegration at last follow up. Our results show that press-fit fixation of trapezoidal bone graft in femoral tunnel is a simple, reliable, and cost-effective alternative for ACL recon-struction using bone-patellar tendon-bone graft.
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Congenital malformation (CM) will begin to emerge as one of the major childhood health problems .Treatment and rehabilitation of children with congenital malformations are costly and complete recovery is usually impossible. The aim of this study was to determine frequency of CM in Yazd central city of the Islamic Republic of Iran to find out if there has been any difference in the rate and types of CM in this area. This descriptive-observational study carried on 4800 births delivered at all maternity hospitals in Yazd from October 2003 to June 2004. Prevalence of CM was 2.83% (2.86 % in male and 2.68 % in female) out of the 136 cases 69(51.88%) were males and 64 (48.12%) were females and 3 with ambiguous genitalia. Positive family history of CM in sibling was in only 6 cases (4.41%).Overall, musculoskeletal (0.83%), central nerv-ous system (0.47%) and genital system (0.37%) were accounted as the most common. Frequency of CM was more seen in still birth (12.5%) as in comparison to live birth (2.71%). There was not statistical difference be-tween prevalence of CM and neonatal's gender, gestational age, birth order and mother's age, drug ingestion, illness and parental consanguinity. In this study the overall prevalence of congenital malformation among the newborn was higher than those previous reported in Iran and determining the causes of this difference needs more extensive studies.
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Abdominal wall endometriosis, the commonest type of extra-pelvic endometriosis, may rarely develop spontaneously in the absence of prior surgical scar. We aim to report 3 cases with this unique characteristic, two of them with a diagnosis of unusual development of umbilical endometriosis and one with inguinal endometriosis, from the perspective of a general surgeon. Because of the potential pitfalls in its diagnosis, endometriosis should be emphasized in the differential diagnosis of abdominal wall masses.
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A 46 year old man had been undergone Aortic valve replacement (AVR) due to mechanical aortic valve endocarditis two month ago. He was referred to Imam Khomeini hospital because of dyspnea since two weeks ago. Echocardiography showed the false aneurysm, with an area of flow beyond the lumen of the aorta. This patient underwent reoperation, the previously implanted aortic valve was removed, meticulous debridement was performed in aortic valve annulus and adjacent part of the ascending aorta, and aortic valve and root replacement were performed.
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Laparoscopy has made a revolution in surgical procedures and treatment of various diseases but its complications are still under investigation. Intra-abdominal visceral and vessel injuries, trocar site hernia, and leaving foreign bodies into the peritoneal cavity are among some laparoscopic surgery complications. This is a rare report of Penrose drain migration following incomplete laparoscopic Fundoplication surgery. The patient was a 47- year- old woman, who was a candidate for Touplet Fundoplication via laparoscopic approach due to refractory gastro-esophageal reflux disease (GERD). While wrapping a Penrose drain around the esophagus, the patient had a cardiorespiratory arrest. Attempts to remove the Penrose drain were unsuccessful and the surgical procedure was terminated due to patient's condition. Four months later, after a long period of dysphagia and abdominal pain, the Penrose drain was defecated via rectum.
