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 3 (2009)
Original Article(s)
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The basic pathogenic step in the process of tumor growth, invasion and metastasis is tumor-induced angiogenesis. The aim of this study was to evaluate the angiogenesis in colorectal carcinoma by microvascular density (MVD) determination with IHC (immunohistochemistry) method and to determine if and how angiogenesis correlates with clinicopathologic parameters. Sixty two archival, paraffin embedded tissue samples of colorectal carcinoma from Omid Hospital (Mashhad, Islamic republic of Iran) were selected. Microvessels were identified immunohistochemically, using monoclonal CD34 antibody. Two investigators examined the microvessel density then the median value of MVD was determined and correlated with clinicopathologic parameters. Tumor-induced angiogenesis of colorectal carcinoma statistically correlated with histological tumor grade (P=0.000). There was no significant correlation between intratumoral microvessel density and sex and age of patients, localization, and stage and histologicalal tumor type (P > 0.1). Intratumoral microvessel density quantification in histologic specimens of colorectal carcinoma reflects the grade of tumors and may be a useful additional prognostic factor.
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DNA sequencing is the most conclusive method for emm (M protein gene) typing of Streptococcus pyogenes. This method is not a feasible approach in developing countries where streptococcal infection is widespread among adults and children. Alternatively the PCR-RFLP has the potential for rapid screening of different types of S. pyogenes. To document the emm type distribution of S. pyogenes in a group of patients suffering from pharyngitis, the restriction fragment length polymorphism (RFLP) profile of 50 isolates were analyzed. By using Hae III+ HincII (double digestion) and Dde I restriction enzymes and based on RFLP, the profile patterns of the isolates were compared. The analysis of data identified 15 distinct RFLP patterns for Hae III+ Hinc II and 13 patterns for Dde I. They differ from each other by at least one band. Although the number of isolates was not sufficient to make any epidemiological conclusion, but the finding demonstrated that the S. pyogenes population among pateints was heterogeneous. Regarding the PCR method, we managed to improve the results by modification of CDC protocol in three different ways. This study was conducted in normal circumstances when pharyngitis was at the peak seasonal incident. However emm amplicon restriction digest analysis is a valuable tool for rapid analysis of S. pyogenes infection in more important situation like outbreaks and in selected type of study like consideration of nosocomial infection.
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Mumps infection is endemic in Iran. Our objective was to evaluate the presence of anti mumps antibodies ( IgM & IgG) in cerebrospinal fluid in mumps meningoencephalitic children. A prospective/cross-sectional study was performed in Tehran, Iran (2003 to 2004) and serum anti mumps antibodies (IgM) were detected (quantitive; ELISA) in meningoencephaltis patients. Specific anti mumps antibodies (IgM & IgG) were detected in cerebrospinal fluids of mumps meningoencephalitis cases. 43 meningoencephalitic patients were tested (59.2% male and 40.8% female). The age of patients was 79.96 ± 4.7 month. 23 (78.7%) cases had specific mumps IgM in serum. None of cases had IgM antibodies in CSF. Anti mumps IgG antibody was detected in CSF of 7.5% (2/23) cases. We detected lower than expected frequency of local immunity to mumps virus in CSF of our cases. For better serologic diagnosis we recommend more sensitive methods like virus detection (PCR) or short-term culture of lymphocytes from cerebrospinal fluid in future studies.
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Chronic cough is a common problem in patients visiting physicians and its prevalence in different populations range from 3 to 40%. Postnasal drip, asthma and gastroesophageal reflux are the known cause of chronic cough. Although diagnosis of asthma is usually made by clinical signs and spirometeric results, methacholine challenge test is a good diagnostic test in patients who show normal physical examination and spirometeric results. In this study, the results of methacholine challenge test in chronic cough patients are investigated. This is a cross sectional study performed on patients suffering from chronic cough (over 8 weeks), who went to Pulmonary Disease Clinic of Imam Khomeini Hospital in 2006. Postnasal drip, gastroesophageal reflux was evaluated and ruled out in all patients. Then they were tested by methacholine inhalation using low to high doses of methacholine. The results of test was defined as 20% fall in FEV1 and its relationship with age, sex, history of allergic disease, family history of asthma and smoking status was investigated. 81 patients (36 female and 45 male) entered this study who had mean age of 32.5 ± 13.06 years. 81.5% of patients had never smoked or closed contact with smokers, 6.2% were passive smokers, 8.6% were smokers and 3.7% had quit smoking. 37% had suffered from chronic cough less than 6 months, 11% for 6-11 months and 52% for more than 12 months. In 26% of patients, family history of asthma was present and 34.5% had a history of one type of allergy. In 29.5% the results of methacholine challenge test was positive, among them 45.8% showed an intense response and 54.2% a moderate response. The test results and its intensity had no statistically significant relationship with age, sex, smoking status, the duration of cough and family history of asthma, but the relationship between methacholine challenge test and the history of allergic disease was significant. Methacholine challenge test can be used as a diagnostic test in patients suffering from chronic cough of unknown origin and patients whose clinical and paraclinical finding are normal. A positive test indicates hypersensitivity of airways which can be used for planning their treatment.
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Regarding to prevalence of preterm labor and its consequences, there are different reports on relationship between bacterial vaginosis and preterm labor. This study was performed to evaluate the effect of etronidazole therapy on preterm labor in women with bacterial vaginosis. This randomized clinical trial was performed on 120 women suffering from bacterial vaginosis at 20-34 weeks of pregnancy, to evaluate the therapeutic effect of metronidazole to delay preterm labor in Shabih Khani maternity hospital in Kashan, Iran in 2002. Bacterial vaginosis was diagnosed based on clinical and laboratory findings. The patients were randomly divided into two groups. The patients in the case group received 500 mg metronidazole BID for 7 consecutive days, but the control group did not receive it. The demographic characteristics of the patients such as, pregnancy age, educational level and job of the spouse were similar at both case and control groups. Double-blind follow up of the patients at the whole stages of parturition and after delivery with respect to the de-livery method, infection, and fever was done by other practitioner besides the main researcher. The results were analyzed statistically by chi-square, and Fischer's exact tests. 420 patients entered the study, of whom 120 (28.6%) had bacterial vaginosis. The antibiotic and control groups were not significantly different for maternal age, job of the spouse, and education. No difference was observed in spontaneous preterm birth before 37 weeks of gestation in antibiotic-treated compared with control group. Treatment with metronidazole in symptomatic women with a bacterial vaginosis in the late second trimester does not decrease the incidence of preterm delivery.
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Balloon dilatation of stricture is one of the new treatment methods among patients with gastric outlet obstruction (GOO). However, the prevalence and underlying etiologies of GOO in various populations are different. The goal of the present study was to determine the effectiveness of endoscopic balloon dilatation and factors that would affect its success rate patients with benign etiology for GOO. Forty-five patients with the symptoms of benign GOO were randomly selected. Gastric outlet was delineated using double channel videoendoscopy. The information of initial balloon dilation was collected from recorded files. Balloon dilatation was repeated during the mean follow up of 9.9 ± 5.8 months. The severity of gastric pain was measured immediately before balloon dilatation and one month after procedure and was rated on a 10 cm visual analogue scale. The mean age of patients was 43.7 ± 18.1 years and 86.7% of them were men. Furthermore, 71.1% were H pylori positive. Response rate to endoscopic balloon dilatation was 80% and 8 patients underwent surgical resection. Weight loss was more frequent in non-responding group. The pain severity was significantly reduced more in responding subjects. No meaningful relationships were found between the responses to balloon dilatation and positive H pylori and cigarette smoking. Endoscopic balloon dilation is safe and effective for most patients with benign gastric outlet obstruction and has favorable long-term outcome.
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The deciduous teeth play a very important role in proper alignment, placing and occlusion of permanent teeth. Calcification of deciduous teeth begins during the fourth month of fetal life, and by the end of sixth month all of the deciduous teeth have begun calcification. Eruption date is variable and timing of eruption "runs in families". Delay of deciduous teeth eruption, especially the first teeth cause nutritional problem for infant and some worries for family. In this study we compare the time of eruption of first deciduous teeth in infant with their birth weight. A total of 148 infant who born at Shariati Hospital in Tehran in 2004- 2005 consecutively entered the study. Other data such as sex, birth weight, gestational age and time of first tooth eruption were collected. The mean birth weight was 3220 ± 420 grams. 5.5% of cases were less than 2500 grams and 19.9% were over 3500 grams. The patients were followed weekly since third month of birth till the time of their first tooth eruption and the data was analyzed. The mean age of eruption of first tooth was 7.68 ± 1.84 months. The results showed a reverse linear relationship between first deciduous tooth eruption and birth weight. So delayed tooth eruption may relate to birth weight.
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HIV/AIDS because of its transmission methods has cultural, social and psychiatric impacts on patients especially in Islamic countries. We investigated depression frequency in an Iranian referral center for HIV/AIDS patients. All patients attending the counseling centre of Imam Khomeini Hospital during 2006 and 2007 who agreed to participate were enrolled. Depression was measured by Beck Depression Inventory-II (BDI-II) questionnaire. Patients with score 15 and above were considered depressed. 199 patients (27 female; age 37.9 ± 9.5) filled the questionnaire. BDI-II scores 13 and above and 15 and above were detected in 74/1% and 71/7% of patients, respectively. We observed statistically significant relationship between depression (as defined by BDI-II score > 15) and CD4 count, duration of diagnosed seropositivity, history of depression in the patients and his/her family, imprisonment, job status and education level. The relationship between depression and addiction was not statistically significant. The observed frequency of depression in our study (74%) is one of the highest ever reported. we recommend regular psychiatric visits for these patients in Islamic countries.
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Cerebral vein thrombosis (CVT) is an infrequent condition with a large variety of causes that can lead to serious disabilities. However, in 20% to 35% of cases, no cause is found. In this study we evaluated the hereditary (P & C Proteins, antithrombin, mutation of prothrombin G20210A and factor V Leiden), other risk factors (hyperhomocycteinemia, factor VIII, ACL-ab, APL-ab, and OCP) and clinical manifestations among a population of Iranian patients with CVT. 18 women and 10 men aged 16 to 50 years with CVT were screened for inherited and acquired coagulation risk factors. No one had an abnormal ACL-ab, APL-ab or antithrombin III deficiency. One had prothrombin G20210A mutation (heterozygot) (3.6%). Hyperhomocycteinemia was observed in 5 patients (17.9%). APC-R was decreased in 3 (10.7%). 2 had positive factor V Leiden mutation (heterozygot) (7.1%). 17 had an increased of factor VIII (60.7). PS and PC deficiencies were each detected in two cases (7.1%). Conclusion: Our study suggests that screening for inherited thrombophilia may be an integral part in the diagnostic workup and duration of treatment in patients with CVT.
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Ministry of health and Medical Education (MOH&ME) with the goals of attaining the comprehensive self sufficiency in medical fields and accountability of universities to public health needs were established in Iran in 1985. After that, ministry moved one step towards the integration of medical education into the health services in 1994. A dilemma about returning the system into the prior situation was increased in 2002, during which the parliament tried to change the situation toward disintegration. We have studied the attitudes of key academic persons regarding the segregation of medical universities (MOH&ME establishment) and "Integration" of medical education into the health delivery system. A descriptive, cross sectional and correlation study was conducted on 556 universities staffs in 11 universities throughout the country. We applied a questionnaire with 28 questions on 5 axes. The analytical test used in this study was Pearson chi-square. The most understudied staffs, agreed with Integration philosophy. They believed that, although it seems the quality of medical education has declined, but some effective factors such as increasing admitted students, irregular increasing of universities and self controlling of educational hospitals, deficit of educational budget and other reasons were the main effective causes in this declining of quality, and most of them believed that the reintegration of MOH&ME into the ministry of sciences organization will not benefit for the country. This study has presented some reasons of proposed declining the quality of medical education and some suggestions for development of present system.
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Vitamin D is essential for growth and vitamin D deficiency is important issue in adolescent girls as they have a limited rapid growth period .This cross sectional study was done on 167 female students in secondary guidance school in 2006. Growth Parameters, taking supplementary vitamin D, using sunscreen creams and the type of housing and their avoidance from exposure to sunlight was recorded. Symptoms such as weakness, muscle pain, cramp and early fatigability were asked. 25-Hydroxyvitamin D was measured by RIA method, level less than 20ng /ml was considered as deficiency and less than 8ng/ml as sever deficiency. Study showed only 67 girl(40%) have normal vitamin D level,60% suffered vitamin D deficiency (95% CI 52.3-67.5) and 21% out of them suffered sever deficiency (95% CI 14.8- 27.2).No correlation existed between vitamin D level and BMI in our students.There was a correlation between taking supplementary vitamin D and the serum level of 25-Hydroxyvitamin D (P 0.05) Present study showed that despite the fact that Yazd is a sunny city most of the days even in winter; prevalence of vitamin D deficiency among growing female is concerning and requires preventive interference.
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Buerger's disease is an occlusive inflammatory disease of the small and medium-sized arteries and accounts for a variable proportion of patients with peripheral vascular disease throughout the world. The aim of this study was to review the records of Buerger's disease patients admitted to surgery wards of our university hospitals. 277 patients with Buerger's disease were surgically treated between 1987 and 2002, in affiliated hospitals of Tehran University of Medical Sciences, in Iran. Two hundred and seventy three (98.6%) of the patients were male, aged 41.5 ± 11 years (mean ± SD); 99.6% of which were smokers with an average of 22.9 pack/years tobacco use. The major complaints included: ischemic ulcers in 203 (73.3%, CI 95%: 0.68-0.77) patients, rest pain in 201 (72.6%, CI 95%: 0.64-0.73), paresthesia in 143 (51.3%, CI 95%: 0.48- 0.58). Vascular bypass, sympathectomy and amputation were performed in 9.7% (CI 95%: 0.08-0.14) and 69.3% (CI 95%: 0.51-0.60) and 59.6% (CI 95%: 0.65-0.73) of the patients, respectively. Lumbar sympathectomy was carried out in 177 (63.9%) patients, while 15 (5.4%) patients underwent thoracic sympathectomy. In our study, afflicted patients were mostly young males, inveterate tobacco smokers. Patients presented frequently with ischemic ulcers or severe rest pain; thrombophlebitis and Raynaud's phenomenon were infrequent. Vascular reconstruction was rarely possible due to distal and segmental involvement; therefore sympathectomy and amputation were inevitable in a large group of patients in this study.
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One of the important causes of strabismus in all ages is extraocular muscles paralysis due to 3rd, 4th and 6th cerebral nerve palsies. Exact and on-time treatment can result in improvement of deviation, am-blyopia and abnormal head posture. We studied epidemiological characteristics of extraocular muscles paralysis. This retrospective study performed on 131 subjects (58% male). Records of patients with diagnosis of paralytic strabismus referred to private clinics between 1995 and 2005 were studied and their demographic data and clinical characters were extracted and evaluated. Average age of patients was 23 years old. Unilateral involvement was seen in 94% of cases. The types of paralysis were 4th nerve (70.2%), 6th nerve (17.8%), 3rd nerve (12%) and all nerves palsy (3,4 Nerves) (2.2%). The most common causes of nerve injury were congenital (62.5%), trauma (19.8%), vascular (3.8%), iatrogenic (3%), tumor and aneurysm (2.2%) and miscellaneous (9%). The most common causes in 3rd nerve palsy were trauma (40%), congenital (20%), iatrogenic (10%), aneurysm (5%), vascular (5%) and miscellaneous (10%). Pupilary involvement was seen in 55% of cases and complete form of 3th nerve in 50% of patients. The most common causes in 4th nerve palsy were congenital (81.5%), traumatic (8.5%) and miscellaneous (10%). In 6th nerve palsy, the most common causes were trauma (50%), vascular (13.6%), congenital (9%). This study indicates that the most common type of palsy is 4th, 6th and 3rd nerves and the most common causes are congenital and trauma.
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Febrile seizure is the most common form of childhood seizures that occur in 2-5% of them. The purpose of this study was to compare serum sodium level in first simple, multiple and recurrent febrile con-vulsions to answer whether serum sodium levels can predict febrile seizure recurrence in 24 hours and in other febrile episodes? In a retrospective study, sodium serum levels of all children aged 6 months to 6 years with final diagnosis of first febrile seizure admitted between March 2004 and August 2005 to Yazd Shaheed Sadoughi Hospital, were compared in simple, multiple and recurrence febrile convulsions. 139 cases with final diagnosis of first febrile seizure found among whom serum sodium checked in 112.54 girls and 58 boys with mean age of 2.01 ± 1.2 years evaluated. Type of febrile convulsions was complex in 36.6% of them. 18% had multiple (occurrence of more than one seizure during the febrile illness) seizures and 35.7% showed seizure recurrence in other fever episodes among whom 88% occurred in first year. Mean survival recurrence rate was 6.7 ± 5.9 months. There is no significant differences in age and serum sodium level among the three groups. Association of relative hyponatremia and febrile seizure recurrence was not confirmed. These findings reaffirm the recommendation of the American Academy of Pediatrics to not routinely obtain electrolytes in febrile convulsion unless clinically indicated.
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Febrile convulsion (FC) is the most common seizure disorder in young children. Different predisposing factors have been suggested to enhance the susceptibility to febrile seizure and its recurrence. The main objective of this study was to identify the adverse effect of electrolytes disturbance in FC and its recur-rence. The medical records of 175 children with convulsive disorders were reviewed. Patients were divided into 3 groups. Group A (n=71) with simple febrile convulsion (FC) and group B (n=54) with recurrent FCs. Fifty children (group C) with non-FC served as control. Serum sodium and calcium concentrations were significantly lower in groups A and B compared to the control group. Serum sodium level was not significantly different between group A and B patients (134.4 vs. 134.7 mEq/l) but was significantly lower in group A than the control group (P= 0.014). Serum calcium concentration did not differ among the 3 groups. Minor abnormal levels of serum sodium concentration were detected in children with febrile convulsions. Thus, routine serum electrolytes screening are not recommended in febrile seizure.
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Duplications of chromosome 16p are often the products of unbalanced maternal reciprocal translocations and consequently the phenotype of patients is not typical of pure partial trisomy 16p. R-banding and fluorescence in situ hybridization (FISH) in our patients were in favour of de novo pure partial trisomy of 16p. Furthure clinical and paraclinical analysis of our three cases in addition to a review of literature and analysis of published clinical and cytogenetic data on five cases of pure partial duplications of chromosome 16p reported until now lead to the delineation of three groups of duplications. Patients with short proximal 16p11~p12 euchromatic duplication considered as "silent" duplication and no clinical anomaly are included in the first group. The second group with a larger 16p11-p12~p13 duplication is caracterised by a particular phenotype including severe mental retardation, dysmorphism, variable malformations and recurrent infections. The third group has terminal 16p13-pter duplication and is not well defined to date. Based on our cases and reported cases of pure partial trisomy of 16p in the literature we propose diagnostic measures in case of an elongated 16p chromosome encountered in prenatal chromosome analysis.
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All surgical positions carry some degree of position-related risks. The most common serious positional injuries are peripheral nerve injuries. We present a case of 23 years old man with obturator nerve injury with clinically evident sequelae following a scapulopexy of the right shoulder in prone position. Basis on our knowledge, no similar cases have been described in the literature. The purpose of this report is to increase awareness of this unreported potential complication in the prone position.
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Wandering spleen, defined as a spleen without its usual peritoneal attachments, is a rare entity. We report a 34-year-old woman with acute abdomen due to torsion of the long vascular pedicle of a wandering spleen, displaced in the abdominal cavity, and infarction of the spleen. Wandering spleen was diagnosed by ultrasound and computed tomography (CT) scan, and was managed by splenectomy in this patient. Wandering spleen usually occurs in 20 to 40 years old women. The most common presentation is acute abdominal pain, although signs and symptoms vary widely. Due to the risk of splenic infarction, rapid and accurate diagnosis is essential. A confirmatory diagnosis of a wandering spleen depends heavily upon imaging studies such as abdominal ultrasound, abdominal and pelvic CT scanning, nuclear scintigraphy or a liver-spleen scan. Treatment options include splenopexy or splenectomy.
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