Vol 57, No 4 (2019)

Published: 2019-04-16


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    Multiple sclerosis (MS) is a neurodegenerative disease arising from interactions of both environmental and genetic factors. The SNP rs6897932 is located in IL‐7Ra gene associated with MS susceptibility in some population. In this study, we investigated the possible association of SNP rs6897932 with MS susceptibility in 157 Iranian MS patients and 152 healthy controls. We also studied genotype-dependent severity and response to IFN-β in MS. Unlike some previous studies, our results clearly demonstrate that there are no significant differences in distribution of the SNP rs6897932 in our chosen Iranian MS patients and controls. Furthermore our results show, Interferon beta (IFN-β) therapy over a period of two years demonstrated an IL‐7Ra genotype-dependent therapeutic effect in MS population. Patients carrying TT or TC genotypes gave a better response to IFN-β treatment, whereas patients carrying the homozygous CC genotype were the worst responders to IFN-β treatment. In other words, despite the lack of linkage the therapeutic response to the severity and progression of MS was related to the genotype of SNP rs6897932 presented in our patient. Therefore, in light of our findings reported here, to reach higher certainties, further studies are needed to associate IL-7Ra gene with the pathogenesis of MS.

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    Antegrade colonic irrigation enema (ACIE) is established as an old treatment for child fecal incontinence and recently is approved as a treatment for different causes of adult fecal incontinence (cancer surgery, neurogenic bowel, spinal cord injury, sphincter trauma, etc.). Despite the benefits of emptying the large bowel and prevention of fecal incontinence or constipation, this method is time-consuming and requires thorough instruction and training. The purpose of this study was to innovate and assess novel technique to decrease time-consuming and improve performance of irrigation. We designed and electromechanical pump for colon irrigation and assessed by a randomized crossover clinical trial study, involving two-four weeks treatment phases. 30 patients have included that suffered fecal incontinence and had been managed with appendicostomy antegrade colon irrigation. The results showed that the pump decrease time and volume of irrigation compare with the traditional method. All patients had a reduction in toileting times. Traditional mean toileting time was 67 minutes, versus pump-toileting time that was 24.6 minutes (P:0.00). The volume of water was reduced in 13 patients. Mean of the volume was 1712 ml in the traditional method and 1128 ml in pump method (P:0.279). Mean Cleveland Clinic Florida Fecal Incontinence score (CCF_FIS) for the pump was 5.84 compare 6.24 for traditional method (P:0.000). Our study provides evidence for the first time that our novel method can facilitate and speed-up colon irrigation without any adverse effect on the outcome.

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    Helicobacter pylori (HBP) is reported as one of the main causes of peptic ulcer disease (PUD) and gastric cancer in the world. The challenge for finding an optimal treatment regimen for HBP eradication is still a matter of concern. The aim of this study was to compare the HBP eradication rate as well as side effects between two 10-days treatments of the standard triple and sequential regimen. This study was performed on patients with dyspepsia and HBP positive. Patients were categorized in two treatment groups including; standard (Omeprazole, Amoxicillin, and Clarithromycin) and sequential treatment (Omeprazole, Amoxicillin, Clarithromycin, and Metronidazole). HBP eradication rate, side effects, and treatment costs were compared between two groups. One hundred thirty-two patients (58 males, 74 females) with a mean age of 42.7±14.2-year-old were studied in two groups of Standard Treatment (n=66) and Sequential Treatment (n=66). There were not any significant differences between two groups regarding baseline features. The overall rate of HBP eradication was estimated to be 79.5%. Although, there was not any significant difference between the observed side effects, the mean cost of treatment in standard was significantly lower than that in the sequential group (P=0.001). It seems that there are not any clinical differences between 10-day treatment plan of the standard triple and sequential therapy in the case of HBP eradication and side effects. However, the sequential treatment might be a better option as the economic point of view.

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    Lumbosacral radiculopathy is a challenging diagnosis, and Electrodiagnostic study (EDX) is a good complementary test for Magnetic Resonance Imaging (MRI). Physical examination, MRI and electrodiagnosis have different diagnostic values in this regard. MRI can provide anatomical evidence and is useful in choosing a treatment process, but it could also have false positive results. In this study, we assessed the correlation of clinical and electrodiagnostic findings in patients with positive MRI findings for S1 radiculopathy. EDX was performed for 87 patients referred with clinical and MRI diagnosis of S1 radiculopathy. The consistency between EDX results, MRI, and clinical findings were evaluated by Pearson chi 2 and odds ratio. Fifty-eight percent of patients had disc protrusion, and 42% had extrusion. Physical examination revealed absent Achilles reflex in 83% and decreased S1 dermatome sensation in 65%. In this study, EDX sensitivity was about 92%. The highest consistency among EDX parameters and physical examination findings was between absent H-reflex and decreased Achilles reflex (OR=6.20, P=0.014), but there was no significant consistency between H-reflex and neither muscular weakness nor SLR test result (P>0.05). There was also no relationship between type of disc herniation in MRI and H reflex. There was correlation between H-reflex abnormalities and absent ankle reflex in patients with unilateral L5-S1 disc herniation in MRI. Results of this study showed that in patients with positive MRI for L5-S1 disc protrusion and S1 nerve root compression, it is still beneficial to perform EDX for selected patients.

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    The main objective of the present study was to compare the distribution of underlying factors such as neurological soft signs, obstetric complications, and family history of psychiatric disorders between two groups of schizophrenic patients and patients with prolonged methamphetamine-induced psychosis. In a case-control study, 30 patients with prolonged methamphetamine-induced psychosis and 30 patients with schizophrenia were selected. Data were collected through a demographic questionnaire, the Buchanan and Heinrichs’ Neurological Evaluation Scale (NES), the Lewis-Murray’s Obstetric Complications Scale (LMOCS), and the Weissman’s Family History Screen (FHS). Mean scores of the neurological soft signs (±SD) in the two groups of schizophrenic patients and patients with prolonged methamphetamine-induced psychosis were 15.7±8.7 and 11.7±6.2, respectively (P=0.040), and a significant difference was observed in the sensory integration between the two groups (P=0.022). Obstetric complications revealed similar distributions in the two groups. Patients with prolonged methamphetamine-induced psychosis reported higher prevalence of alcohol and other substances use disorders (P=0.003 and P=0.001, respectively) in their close relatives; however, the distributions of other disorders were not statistically different between the two groups’ close relatives. Similarities and differences in certain aspects were observed between the two groups, suggesting susceptibility for psychosis in patients with prolonged methamphetamine-induced psychosis; yet we found diversities that distinguish the two disorders.

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    There has been little attention to sexual dysfunction (SD) in women undergoing hemodialysis (HD), therefore few studies are found in this field. The aim of this study was to determine the incidence of SD, assess its association with biochemical factors, employment and educational status, economic situation, depression, anxiety, and medication. End stage renal disease (ESRD) married women aged 18 to 60 years presenting to Tehran University of Medical Sciences (TUMS) hospitals’ (Imam Khomeini, Sina, and Baharloo) from April to September 2017 were included in the study. Female Sexual Function Index (FSFI) questionnaire was used to evaluate SD. Patients were divided into two groups with SD (scores≤28) and without SD (scores˃28). Hospital Anxiety and Depression Scale (HADS) questionnaire was used to investigate anxiety and depression; patients with scores equal to or more than 11 were implied as depressed or anxious. Demographic data, duration of dialysis, ESRD causes and biochemical tests were also collected. Thirty patients (81.1%) out of 37 showed SD who were older, had lower educational and economic status, had higher hemoglobin levels and used erythropoietin products and Venofer® (iron sucrose injection) less; most of these patients were housewives. The incidence of SD among patients was high. Erythropoietin and Venofer use was less frequent in patients with SD compared to the other group. This suggests that these two products have a role in treatment of SD rather than the treatment of anemia.

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    Psoriasis is a common chronic inflammatory skin disease, which is gradually being recognized as a systemic inflammatory disorder. Psoriasis and obesity are strongly linked, but there is not enough data whether obese psoriatic patients present differently from non-obese psoriatic patients. To compare the phenotype, clinical features, severity, baseline comorbidities and laboratory findings among psoriatic patients with/without obesity all the psoriatic patients, from three centers, who were receiving systemic therapy were included in the study. Patients were divided into two groups: those with obesity and those without obesity. We included 497 patients: 154 (31%) patients were obese and 343 (69%) were non-obese. Obese patients had more comorbidities, particularly hyperlipidemia, followed by hypertension and diabetes. Fasting blood sugar and serum lipids were significantly higher among obese subjects. Given the differences between obese patients and non-obese patients, the former group should be followed and managed more closely and with specific attention..

Case Report(s)

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    Secondary scrotal tumors originating from viscera are rare and indicate a poor prognosis. We report a patient who underwent abdominoperineal resection due to his rectal cancer. Tumor recurrence at the surgical site led to prostate involvement. About 1 month after the prostatectomy, scrotal skin metastasis presented as bilateral papulonodular lesions. Finally, brain metastasis occurred and caused his death. Also, several ways by which malignancies can metastasize to scrotum have been discussed.

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    Sarcoidosis is a systemic idiopathic disease, characterized by non-caseating granulomas, primarily affecting the lungs and the lymphatics. Skin involvement is common and lesions may appear in scar tissues. In the present report, four cases of scar sarcoidosis following rhinoplasty are presented which were diagnosed based on serology tests, radiography imaging and histopathology findings. Three women and one man between 32 to 54-year-old are discussed in this report. Skin lesions on their nose were found after an average of 3.8 years of their septorhinoplasty surgeries. Two of the patients had systemic signs such as fever, cough and arthritis. Patients with diagnosed sarcoidosis were treated appropriately. Rhinoplasty is a common procedure today, and the fact that rhinoplasty may lead up to scar sarcoidosis in susceptible people can be an item for surgeons for consideration.

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    Collision tumors are type of tumors where two histologically distinct type of tumors occur at the same anatomic location. Breast collision tumors comprising carcinoma and lymphoma or invasive ductal carcinoma with invasive lobular carcinoma are relatively common. However, a collision tumor between metaplastic breast carcinoma (MBC) and invasive lobular carcinoma (ILC) is extremely rare. Here, we report a case of collision tumor in breast comprising MBC and ILC. A 60-year-old female patient presented in outdoor department with palpable painless firm mass in left breast. FNAC diagnosis of class V smears was made. Wide local excision was done and specimen sent for frozen section analysis. On frozen section, diagnosis of malignant neoplasm was made and suspicion of malignant phyllodes and MBC was raised. All margins were reported free as free of the tumor. Further sectioning revealed another tumor, 0.1 cm away from main tumor. Sections from this tumor showed a malignant neoplasm arranged in cords with tumor cells having eccentric nuclei and moderate amount of cytoplasm. Immunohistochemical (IHC) analysis showed spindle cell tumor with profile favoring MBC while IHC analysis of second tumor was consistent with the diagnosis of ILC. Final diagnosis of collision tumor was made.

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    Male breast enlargement as gynecomastia may be as a sign of underlying systemic diseases. Male breast malignancy is also considered in differential diagnosis. We present a young man with primary chest wall lymphoma as gynecomastia, without pre-existing problem or other disease. Here, we present his clinical manifestation, management, and his early outcome. Chest wall lymphoma as an initial presentation of isolated chest wall mass in males is a rare clinical entity and its presentation as gynecomastia is even extremely unusual.