A. R. Dehpour, PharmD, PhD
A. Javadian, MD
Vol 57, No 8 (2019)
Aberrant promoter methylation of CpG islands of tumor-suppressor genes has been recognized as one of the important tumor markers for cancer detection. The aim of this study was to investigate the promoter methylation status of protocadherin 10 (PCDH10), a tumor suppressor gene, in Iranian colorectal cancer (CRC) patients. Cancerous and the adjacent normal tissues obtained from 38 CRC patients were used to assess the methylation status of PCDH10 with Methylation Specific PCR, in addition, to study the expression level of this gene by quantitative PCR. The relationship between hypermethylation and the demographic characteristics of these patients was analyzed. The promoter methylation level of PCDH10 was statistically different between tumoral and normal tissues in CRC patients. Twenty-seven out of 38 patients showed hypermethylation with a sensitivity of 73% and a specificity of 97%. PCDH10 expression decreased in 15 cases (46%) as 16 cases (50 %) showed overexpression and 1 case (4%) had no changes. Not a significant association was reported between PCDH10 hypermethylation and the clinicopathological characteristics (P>0.05). Our results indicated that PCDH10 methylation has a critical function in CRC, with a nearly elevated sensitivity and a high specificity in the Iranian population, qualify it as a potential candidate biomarker.
Hyperglycemia may associate with improper use of glucocorticoids, impaired insulin function, or both, and is associated with many complications such as hyperlipidemia and Hyperglycemia. Researches suggest that proper use of glucocorticoids can delay the onset and progression of complications of hyperglycemia and hyperlipidemia. In the present study, we compare two of these compounds on glucose and lipid profile level. We use 40 male Wistar rats from the Yazd Animal infertility center. Initially, the rats were randomly divided into 2 groups, and then each group was divided into 4 groups. Subsequently, fludrocortisone doses of 12, 24 and 36 mg/kg were administered to rats, and dosages of 6, 12 and 18 mg/kg for betamethasone administered to rats on a daily basis at 1 o'clock for 21 days by intraperitoneal injection. Betamethasone and Fludrocortisone increased blood glucose and AST, ALT, TG, LDL, VLDL, and decreased HDL, causing red pigmentation in the skin, and obesity and puffiness of the rats. In all of the measured factors, fludrocortisone changes were more than betamethasone. Fludrocortisone and betamethasone also had significant effects on weight, which was more pronounced with fludrocortisone. As the dose increased, the levels of AST, ALT, and cholesterol, TG, VLDL and LDL in the blood increased significantly and HDL levels decreased more in the blood, but fludrocortisone showed a stronger effect than betamethasone. Therefore, it can be expected that the use of Betamethasone would be logical due to fewer side effects than fludrocortisone.
This study aimed to compare the efficacy of rituximab versus Cyclophosphamide on active secondary progressive multiple sclerosis (SPMS). The randomized clinical trial was performed from 2015 to 2017 in multiple sclerosis (MS) clinics affiliated to Isfahan MS society (IMSS). Patients were randomized to two groups, and one of them received Rituximab that was repeated every six months in case of medical indication. The other one received a monthly pulse of methylprednisolone plus cyclophosphamide (Endoxan, Baxter, UK) until two years. Expanded disabilities status scale (EDSS), clinical, and MRI findings were assessed every six months. Statistical analysis was performed using SPSS software. 39 patients in the Rituximab group and 30 in the Cyclophosphamide group with similar age and gender distribution were entered for analysis. At baseline, the mean number of attacks in the Rituximab group was significantly more than the Cyclophosphamide group (P=0.0001). After 6, 12, and 18 months of treatment, the rate of attacks was similar between groups although it increased significantly in the Rituximab group (P=0.030) after 24 months of treatment. EDSS was increased in the Rituximab group more than the other group at the end of the study. Both drugs were well-tolerated by patients. The EDSS was increased in the Rituximab group but the disability score did not worsen in the Cyclophosphamide group. Both therapies were associated with a reduction in disease attacks and improvement in radiologic findings in a two-year period of follow-up.
A single episode of breath-holding (BH) is known to elevate the blood pressure, and regular breathing exercise lowers the blood pressure. This prompted us to investigate how a series of BH epochs would affect the cardiovascular system. To observe arterial blood pressure (ABP) and heart rate (HR) changes associated with a series of “BH epochs” following maximum inspiration and maximum expiration and find the underlying mechanisms for the change by autonomic activity. Thirty-five healthy young adults were instructed to hold their breath repetitively, for 5 minutes, in two patterns, one following maximum inspiration and other following maximum expiration. ABP and ECG (for Heart Rate Variability) were continuously recorded at rest and during both the maneuvers. Capillary blood gases (BG) were zanalyzed at baseline and at the breakpoint of the last epoch of BH. ABP rose significantly at the breakpoint during both the maneuvers. No change in HR was observed. There was significant fall in PO2 from 94.7 (4.1) mmHg at baseline to 79.1 (9.0) mmHg during inspiratory and 76.90 (12.1) mmHg during expiratory BH. Similarly, SPO2 decreased from 96.3 (1.9) % at baseline to 95.4 (1.5) % and 94.5 (2.7) % during inspiratory and expiratory BH, respectively. Rise in PCO2 from 39.5(3.1) mmHg at baseline to 42.9 (2.7) mmHg and 42.1 (2.8) mmHg during inspiratory and expiratory BH respectively was observed. There was no significant correlation between blood gases and arterial blood pressure. Among HRV parameters, a significant decrease in SDNN, RMSSD, HFnu, total power and SD1/SD2 and the significant increase in LFnu, LF/HF and SD2 were observed during both BH patterns. Rhythmic BH patterns affect the cardiovascular system in similar way as a single episode of BH. Sympathetic overactivity could be the postulated mechanism for the same.
It is known that liver biopsy is the gold standard of diagnosing liver iron deposition. By considering liver biopsy complication and cost, introducing a method to restrict unnecessary biopsy or even an alternative for liver biopsy can be useful. This study examined the relationship between serum iron profile and liver density on CT-Scan without contrast material injection. In this study, 76 patients were referred from different Rasoul-Akram Hospital parts in 2015-2016 (People who have undergone abdominal CT-scan for any reason, and blood tests included iron and lipid profiles). To calculate the liver mean density of a CT-scan, densities of 12 sites with an individual area of 1 cm2 on 3 different sections of the liver were obtained, and their average was recorded. Data were analyzed by SPSS V.16 using Kolmogorov-Smirnov, independent T-test, and two-sample T-tests with a significance level of P<0.05. There is a significant relationship between the serum iron and serum ferritin levels with liver density. By increasing TIBC levels, the difference between liver and spleen densities increases, but no significant correlation was found between TIBC level and liver density. Moreover, there was no relationship between serum iron levels and serum ferritin with the difference between liver and spleen densities. The evaluation of liver density may be an alternative to liver biopsy in some cases or at least can be considered to restrict unnecessary biopsies.
Accurate diagnosis and timely treatment of pneumonia, as one of the most common infectious diseases in elderly patients, require careful attention to the clinical and paraclinical findings, which may be different between the elderly and non-elderly patients. The aim of the present study was to compare the clinical, laboratory, and radiological findings of elderly and non-elderly patients with pneumonia and pneumosepsis. This cross-sectional study was performed on 97 elderly and 93 non-elderly patients with pneumonia, admitted to Sina hospital in Hamadan, west of Iran, in 2017. Patients in both groups were also compared in terms of the underlying diseases, sepsis rate, electrolyte disturbances and CURB-65 criteria. All underlying diseases, except for HIV infection, in addition to clinical findings such as tachypnea, lethargy, decreased consciousness, hypotension, and respiratory alkalosis were significantly more common in the elderly, compared to the non-elderly group. In the elderly group, the average length of hospital stay, sepsis rate, and mortality rate were 9.4 days, 74.2%, and 21.7%, respectively versus 6.2 days, 46.3%, and 3.2%, respectively in the non-elderly group. Patients in the two groups were significantly different in terms of CkkURB-65 criteria and radiological findings. For the timely diagnosis of pneumonia and pneumosepsis in the elderly, it is necessary to consider any alteration in respiratory rate and consciousness status. Also, for proper treatment, the clinicians should pay attention to the existence of any comorbidities and electrolyte disturbances.
The implementation of the Health System Evolution Plan has resulted in an increase in the rate of patient’s referral to hospitals of medical universities, and thus, hospitals’ performance indicators. The aim of the present study is to investigate the changes in hospital indicators after the implementation of the Health System Evolution Plan and the relationship between this plan and distribution of human resources in hospitals of Tehran University of Medical Sciences. This was a descriptive-analytical and cross-sectional study. The research population consisted of information about human resources and performance indicators before and after the implementation of the Health System Evolution Plan in the hospitals. The research tool was a data collection form. The collected data were analyzed in SPSS software, and analytical results were obtained using the Pearson correlation test and Two Sample t-test. The results showed that there was a significant relationship between hospitals performance indicators and the distribution of human resources after the implementation of the Health System Evolution Plan. In fact, this plan has increased the deficit of nursing and paraclinical staff. In addition, the results showed as hospitals’ performance indicators have increased, more human resources has been recruited in these hospitals. The success of Implementation of Health System Evolution Plan and development of general hospitals indicators need comprehensive. Planning for retainment of all groups of health workers and paying attention to appropriate distribution of physicians, nurses, and paraclinical staff in public hospitals and finally a comprehensive review of human resources standards by the Iranian Ministry of Health.
The Syntaxin Binding Protein 1 (STXBP1) plays an important role in regulating neurotransmitter release and synaptic vesicle fusion through binding to syntaxin-1A (STX1A) and changing its conformation. In this study, we identified a de novo mutation (c.C1162T: p.R388X) in exon 14 of the STXBP1 gene causing an epileptic encephalopathy, early infantile, non-epileptic movement, and unclassified infantile spasms disorders in a 5-year-old boy by whole-exome sequencing. The segregation of this genetic variant was examined in the patient as well as in his parents. We found the R388X in heterozygous state in the proband but not in his parents. This genetic change could be due to de nova mutation or germlinemosaicism.
Down syndrome or trisomy 21 is the most common genetic disorder with a prevalence of 1 in 700 live-born infants. It is characterized by the intellectual disability of varying range, developmental delay, distinctive facial features and various physical abnormalities. The most frequent clinical features include hypotonia, short stature, short neck, upward slanting eyes, ﬂat nasal bridge, bulging tongue, small ears and a single palmar crease of the hands. Mainly there are three cytogenetic forms of Down syndrome including free trisomy 21, mosaicism and Robertsonian translocation. We describe the case of a 1-year-old Iranian female child who presented to our genetic counseling center with intellectual and physical disabilities. The most common features of Down syndrome were present. The cytogenetic analysis confirmed the diagnosis, with detection of the Robertsonian translocation t(21q; 21q). The patient's parents were found to be both phenotypically and cytogenetically normal, so the identified Robertsonian translocation t(21q; 21q) probably have arisen de novo.
Ectopic gallbladder (GB) is a very rare anomaly. Ectopic GB can be found in intrahepatic, suprahepatic, retrohepatic, retroperitoneal sites as well as in falciform ligament, intra-abdominal wall, left abdominal quadrant and intrathoracic localizations. A 43-year-old male patient presented with a right upper quadrant pain in the abdomen. Upon detection of a cystic lesion with lobulated contour associated with GB in the liver in ultrasound examination, dynamic magnetic resonance imaging (MRI), MRI cholangiopancreatography, and contrast-enhanced MRI cholangiography were performed on the patient. MRI revealed that the lesion was a partial ectopic intrahepatic GB. In this article, we presented an ectopic partial intrahepatic gall bladder anomaly, which is very uncommon and has been previously described by surgical operations and cadaver studies, according to our literature review.
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