A. R. Dehpour, PharmD, PhD
A. Javadian, MD
Vol 52, No 2 (2014)
Multiple Sclerosis (MS) is a chronic inflammatory disease that leads to degeneration of the brain and spinal tissue. Imbalances of CD4+ T cells including Thelper1 (Th1)/Thelper2 (Th2) and Thelper17 (Th17)/Tregulatory (Treg), their secreted cytokines and gene expressions, are important aspects of in immunopathogenesis of MS. Vitamin A and its metabolites can regulate the immune system and appears to be effective in preventing progression of the autoimmune disease such as MS. Disease progression was evaluated By Magnetic Resonance Imaging (MRI), Expanded Disability States Scale (EDSS) and Multiple Sclerosis Functional Composite (MSFC) tests. Cytokine levels were measured using ELISA kits and gene expression was quantified by Real time PCR (RT-PCR) system. According to the difference between the epidemiological and clinical data on the relationship between vitamin A and immune system regulation, this study of the first time assesses Immune function as well as gene expression and progression of the disease following administration of vitamin A supplement.
The study aimed to investigate the protective effects of crocin (Cro) against streptozotocin (STZ)-induced oxidative damage in rat striatum. Animals were randomly divided into four groups (five each). Group 1 (sham) were treated with normal saline (2 ml/kg, p.o.). Group 2 (STZ-lesioned or lesion) were injected with ICV-STZ (3 mg/kg bilaterally, on day 1 and 3) and treated with normal saline (2 ml/kg, p.o.) respectively, for 21 days. Group 3 (sham+Cro) were injected ICV on day 1 and 3 with artificial CSF and treated with crocin (100 mg/kg, p.o.) for 21 days. Group 4 (lesion+Cro) were injected with ICV STZ (3 mg/kg bilaterally, on day 1 and 3) and treated with crocin (100 mg/kg, p.o.) for 21 days. The homogenized striatum was used for measuring malondialdehyde (MDA), and total thiol contents besides glutathione peroxidase (GPx) activity. Crocin treatment resulted in a significant reduction in MDA concentration as compared to the STZ-lesioned rats. Moreover, crocin produced a significant elevation in total thiol content and GPx activity, as compared with STZ-lesioned group. The present findings provide evidence that crocin may have a therapeutic significance for neurodegenerative diseases such as Alzheimer's disease (AD).
Preterm birth means the birth before thirty seven week of pregnancy that causes a lot of complications for the baby. Variety factors are suggested to be involved in disease. In this study, we decided to evaluate haptoglobin (Hp) phenotypes association with clinical features of patients suffered from premature delivery to understand better the possible correlation of genetic and clinical features in this disease. This cross-sectional analytic descriptive study has been carried out in two groups of 120 women, 60 with preterm and 60 with term labor. Patients were selected with previously diagnosed by gynecologist with preterm birth in the labor during the study period. After performing diagnostic tests, the frequency of each haptoglobin phenotype in the two groups was analyzed using the Chi-square test (X2) test and SPSS software. The maximum serum haptoglobin phenotype frequency in patients with Hp2-2, was 43 (71.7%) whereas in healthy individuals, 35 (58.3%). No, statistically significant differences between the two groups were found (p=0.310). But based on some patients clinical features such as their history of preterm delivery, previous history of recurrent abortions and history of preterm delivery in their family, significant association was found with Hp2-2 compared with healthy control (p<0.003). This study showed that Hp2-2 phenotypes levels in the case group was higher than in control but the factors influencing the presence or absence of preterm labor is clinically various.
Vestibular involvements have long been observed in otosclerotic patients. Among vestibular structures saccule has the closest anatomical proximity to the sclerotic foci, so it is the most prone vestibular structure to be affected during the otosclerosis process. The aim of this study was to investigate the saccular function in patients suffering from otosclerosis, by means of Vestibular Evoked Myogenic Potential (VEMP). The material consisted of 30 otosclerosis patients and 20 control subjects. All participants underwent audiometric and VEMP testing. Analysis of tests results revealed that the mean values of Air-Conducted Pure Tone Average (AC-PTA) and Bone-Conducted Pure Tone Average (BC-PTA) in patients were 45.28 ± 15.57 and 19.68 ± 10.91, respectively and calculated 4 frequencies Air Bone Gap (ABG) was 25.64 ± 9.95. The VEMP response was absent in 14 (28.57%) otosclerotic ears. A statistically significant increase in latency of the p13 was found in the affected ears (P=0.004), differences in n23 latency did not reach a statistically significant level (P=0.112). Disparities in amplitude of p13-n23 in between two study groups was statistically meaningful (P=0.009), indicating that the patients with otosclerosis had lower amplitudes. This study tends to suggest that due to the direct biotoxic effect of the materials released from the otosclerosis foci on saccular receptors, there might be a possibility of vestibular dysfunction in otosclerotic patients.
The balance between reactive oxygen species production and antioxidant activity has an important role in oxidative stress associated diseases including coronary artery disease. In this study, the prooxidant-antioxidant balance (PAB) and its correlations with serum lipid levels, uric acid levels, and severity of coronary artery involvement were examined. The aim of this study was to determine the diagnostic value of PAB as a predictor in coronary artery disease (CAD). Seventy two patients and 68 healthy subjects were selected. PAB was determined using standard solutions and ELISA. Triglyceride, total cholesterol, LDL-cholesterol, HDL-cholesterol and uric acid levels were measured by enzymatic method. Mean PAB was 66.4 ± 2.84 (HK units) in healthy people, 77.37 ± 33.51 (HK units) in patients with one vessel CAD, 63.76 ± 29.47 (HK units) in patients with two vessel CAD and 68.59 ± 24.51 (HK units) in patients with three or more vessel CAD. There was no significant difference between PAB values in different severity groups (P=0.41). PAB significantly and indirectly correlated with uric acid level in two vessels CAD. The study shows that PAB can be a predictor of CAD associated with other risk factors, but not alone.
The painful nature of fractures has made it inevitable to use various anesthetic techniques to reduce or immobilize fractured parts. In the present study, axillary nerve block was compared with intravenous midazolam/fentanyl to induce anesthesia for Painless Reduction of Upper Extremity Fractures. The subjects in the present clinical trial consisted of 60 patients with upper extremity fractures. They were randomly divided into two equal groups of intravenous sedation (IVS) with midazolam/fentanyl and axillary nerve block (ANB). Rate of anesthesia induction, recovery time, and pain intensities at baseline, during the procedure and at the end of the procedure were recorded in both groups. Data was analyzed and compared between the two groups with SPSS 18 statistical software using appropriate tests. Demographic data, vital signs and means of pain intensities at the beginning of the procedure were equal in the two groups. In the IVS group, the overall duration of the procedure was shorter with more rapid onset of anesthesia (P<0.05). In contrast, the recovery time was much shorter in the ANB group (P<0.001). No life or organ threatening complications were observed in the two groups. Axillary nerve block can be considered an appropriate substitute for intravenous sedation in painful procedures of the upper extremity.
Traffic fatalities are a major cause of morbidity and mortality in Iran. Occupational sleep medicine field needs more cost-effective and applicable tests for screening purposes. This study reports on a pilot screening study for drowsy drivers in an urban Iranian sample of commercial drivers. The Maintenance of Wakefulness Test (MWT) measures the ability to remain awake objectively. Sleep latency in MWT is a reasonable predictor of driving simulator performance in drivers. In this study, we evaluate whether the Epworth Sleepiness Scale (ESS) and MWT are equally useful in drivers with possible Excessive Daytime Sleepiness (EDS). 46 consecutive road truck drivers in a transportation terminal entered into this study. The ESS score of patients with normal and abnormal MWT was 3.24±2.4 and 4.08±3 respectively which was not significantly differenced (P value = 0.34). No significant correlation was found between the ESS and sleep latency in MWT (r=-0.28, 95%CI= -0.58 to 0.02). By using the receiver operating characteristic analysis, the area under the curve was found to be 0.57 (95% confidence interval = 0.37- 0.77) which is not statistically acceptable (P value=0.46). Our finding showed that the MWT and ESS do not measure the same parameter.
The present study was conducted with the aim of identifying and evaluating the internal and external factors, affecting the Sina Trauma and Surgery Research Center, affiliated to Tehran University of Medical Sciences and propose some of related strategies to senior managers. We used a combined quantitative and qualitative methodology. Our study population consisted of personnel (18 individuals) at Sina Trauma and Surgery Research Center. Data-collection tools were the group discussions and the questionnaires. Data were analyzed with descriptive statistics and SWOT (Strength, Weakness, Opportunities and Threats) analysis. 18 individuals participated in sessions, consisting of 8 women (44.4%) and 10 men (55.6%). The final scores were 2.45 for internal factors (strength-weakness) and 2.17 for external factors (opportunities-threats). In this study, we proposed 36 strategies (10 weakness-threat strategies, 10 weakness-opportunity strategies, 7 strength-threat strategies, and 9 strength-opportunity strategies). The current status of Sina Trauma and Surgery Research Center is threatened weak. We recommend the center to implement the proposed strategies.
Over the past decade, clinical governance approach with aims to improve the quality of health services has been proposed in Iran. Considering the obvious problems especially patients' length of stay (LOS) in the emergency departments (EDs); the present study has been carried out with the purpose of Investigating the effect of clinical governess approach on patients' LOS in the one of the largest medical centers in the country. After the problem was specified by the 17 interviews with employees and managers of the ED; the emergency clinical governance committee was formed by two academic researchers and seven ED staff (key participants) that had the most involvement with the subject of study. The activities of the committee, including planning, acting, observing and reflecting, was organized by using participatory action research approach and action research cycle (Kemmis 1995). During this time, three formal meetings with key participants were held in 6-month intervals. Monthly records of patients' average LOS and interview with ED staff were used to analyze the findings. The research was completed with two cycles in one year. Committee members took the following actions. As a result, the patients' LOS reduced from 2.68 days to 1.73 days. Make regular patients visits by medical groups especially orthopedists and neurologists; Decision making about patients situation by emergency physicians and transferring patients to the relevant units by bed managers; Refusing to admit elective patients during overcrowding times; to regulate the list of patients requiring ICU by anesthesiologists. Prolonged LOS can be due to various causes and a team approach, which is one of the requirements of clinical governance approach, is needed to manage it. The results showed that the multidisciplinary team could make positive changes and reduce LOS in emergency setting.
Cement dust exposure is associated with increased respiratory impairment. As the major occupational hazard in the cement production industry is cement particles, our aim was to more thoroughly examine the acute effects of occupational exposure to cement dust on the respiratory system. A cross-shift study was conducted in a cement factory in Iran. 100 high exposed workers from production and packing sections and 100 low exposed from office workers were included. Environmental total dust was measured in each section. Assessment of lung function was done by pre and post shift spirometry. At the end of the day shift, acute respiratory symptoms were recorded. The means of total dust among high and low exposed workers were 16.55 mg/m3 and 0.9 mg/m3, respectively. The most common acute respiratory symptoms in high exposed workers were stuffy nose (52%) and shortness of breath (49%). A statistically significant post shift reduction in PEF, FEV1, FEF 25-75, FVC and FEV1/ FVC was demonstrated in high exposed group. Multivariate linear regression showed a significant relationship between the percentage of the cross-shift decrease in spirometric indices and exposure to cement dust. We detected significant relationship between exposure to cement dust and acute respiratory symptoms and pulmonary function indices. Effective dust-control measures and preparing a suitable strategy for respiratory protection are highly recommended.
The aim of the current study was to assess the extent to which complementary and alternative medicine (CAM) has been used in children and adults to treat seizures and to compare the perceptions and usage of CAM between adult patients who decides for themselves and adults who decide for their sick children.In this cross-sectional study, patients who have been treated for epilepsy for at least one year at the outpatient epilepsy clinic at the Shiraz University of Medical Sciences were interviewed from January 2012 through March 2012. The questionnaire collected specific information of CAM perceptions and usage among patients. Pearson Chi-Square and Student's t-test were used to compare variables among children group with adults group. Ninety-eight children (their caregivers) and 158 adults (themselves) participated. Adult patients (53%) more frequently believed that CAM might be useful in treating seizures than adults with sick kids (35%) (P = 0.0004). Herbal drugs, traditional medicine and exercise were more often considered as being helpful in treating seizures among adult patients compared to adults with sick children. CAM usage was not different among adult patients compared to adults with sick kids (P = 0.3). CAM is an option considered by many people with epilepsy to treat seizures. The individual who makes the decision as to use any of these unconventional treatment options is probably not different when it comes to self (the patient himself) vs. non-self (the parents/care-givers), despite the observed difference that adult patients more frequently believed that CAM might be useful in treating seizures than adults with sick kids.
Self-immolation is a fatal and devastating method of committing suicide used around the world. The chief aim of the present article is to look at the trend of indexed papers in PubMed covering different aspects of self-immolation. PubMed search engine (http://www.ncbi.nlm.nih.gov) was searched by using six keywords i.e. "self-immolation", "self-inflicted burn", "self-burning", "self-incineration", "suicidal burns" and "suicide by burning". These keywords should appear either in the title or the abstract of the articles. The time frame was set as to retrieve papers expanding from early indexing time up to end of the year 2011. Based on the search strategy 132 papers were retrieved from these total numbers; 12 (9%) were categorized as review papers; 24 (18%) as case reports and the rest 96 (73%) were original studies. It seems that the number of papers increased during the years of investigations and the highest indexed papers i.e. 14 (10.6%) belonged to the year 2011. While most journals, published only one article the highest indexed papers i.e. 35 (26.5%) belonged to Burns. There was an increasing trend in the number of self-immolation articles indexed in PubMed since 1965. Three journals i.e. Burns, Journal of Burn Care and Rehabilitation and Journal of Forensic Sciences hosted for more than 37% of all those indexed articles. However, given the increasing trend of self-immolation still more studies are needed to shed light on the diverse aspects of this appalling human behavior.
Amyloidosis cutis dyschromica (ACD) is a rare form of macular amyloidosis characterized by hypo and hyperpigmented macules. Here we described a 20 year old girl with diffuse hypo and hyperpigmentation since she was four years old. Five other members of her family are also involved. Biopsy of hyperpigmented lesions revealed increase of melanin in the basal layer, pigment incontinence and amorphous eosinophilic masses stained positive with Congo red in the papillary dermis. The histopathologic findings were consistent with amyloidosis cutis dyschromica. Other investigations were normal. Dermatologists should consider amyloidosis cutis dyschromica when visit a patient with diffuse hypo and hyperpigmentation.
Chondrosarcoma is the second most common primary mesenchymal malignant tumor of the bone. The most common form is central chondrosarcoma and the rarest is intracortical chondrosarcoma. Here, we describe the clinical, pathological, and imaging features of a case of intracortical chondrosarcoma as well as the outcome of surgical treatment. This is the third case reported in the literature.
Rhabdomyosarcomas are the most common soft tissue sarcoma in adult and children that accompany with skeletal muscle differentiation. Skin metastasis of rhabdomyosarcomas is unusual and has only been sporadically reported in literature. In this paper we present a case of skin metastasis of rhabdomyosarcoma in an 8-year-old girl that has treated with chemotherapy.
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