JOURNAL OF MEDICAL RESEARCH (JMR)
Year:2004 | Volume:2 | Issue:3|Papers Count:12

Background: Soft tissue sarcomas are aggressive tumors with a relatively high mortality rate in comparison to carcinomas. Grading is one of the most important determinators of biological behavior in these tumors. The aim of the present study was to compare the ploidy status and DNA content in soft tissue sarcomas versus benign soft tissue tumors and to determine the value of the objective method of grading in soft tissue sarcomas. Materials and Methods: Fifty–two soft tissue tumors, including thirty-four sarcomas and eighteen benign tumors as well as non-neoplastic lesions were collected. Histologic diagnoses were reviewed and the grading system (FNCLCC grading system) was reassessed for sarcomas. DNA contents of all cases were determined on paraffin-embedded tissue blocks by flow cytometry. DNAs were analyzed for ploidy status, S-phase fraction and grading. Results: Twelve cases among 18 benign soft tissue lesions were DNA diploid. One lymphangioma, one intramuscular hemangioma and one atypical benign fibrous histiocytoma exhibited hyperdiploidy while two granular cell tumors and one paraganglioma were tetraploid. The mean of S-phase fraction for benign diploid and aneuploid lesions was 23.9 and 41.5 percent, respectively. About one-third of the sarcomas were diploid and two-third exhibited aneuploidy. The mean of S-phase fraction for diploid sarcomas was 23 percent, as compared to 42 percent in aneuploid sarcomas (with a cut–off value of 20). No relationship was found between aneuploidy and grading or ploidy status and tumor differentiation. The mean of S-phase fraction significantly correlated with higher grades (p=0.001). Conclusion: Evaluation of DNA ploidy status is an unreliable method for predicting prognosis in soft tissue sarcomas. Nevertheless, S-phase fraction determination in soft tissue tumors may be considered as a prognostically valuable adjuvant.

Background: Group A beta hemolytic streptococci (GABHS) is a potentially pathogenic bacteria which causes various infections among children and adults. For over 60 years, penicillin has been used as the drug of choice for treatment of infections caused by this bacterium. Yet, there is no published article on the resistance of this bacterium to penicillin. However, some species of this family such as enterococci are highly resistant to this antibiotic. Materials and Methods: In the present investigation, 125 isolates of GABHS isolated from patients with pharyngitis, sinusitis and burn infections were subjected to antibiotic sensitivity by standard methods of disk diffusion and minimum inhibitory concentration (MIC) tests using penicillin, vancomycin, ciprofloxacin, cephalothin, erythromycin, tetracycline and chloramphenicol. Results: All isolates of GABHS (100%) were sensitive to penicillin (MIC: 0.002-0.032 μgr/ml) and vancomycin (MIC: 0.125-2 μgr/ml). Other sensitivity rates included: cephalothin 97.6% (MIC: 0.01-8 μgr/ml), chloramphenicol 88.8% (MIC: 1-32 μgr/ml), erythromycin 87.2% (MIC: 0.032-64 μgr/ml), tetracycline 75.2% (MIC: 0.125-128 μgr/ml) and ciprofloxacin 92.8% (MIC: 0.125-4 μgr/ml). Conclusion: Penicillin is still the drug of choice for treatment of GABHS infections. Patients allergic to penicillin are recommended to use erythromycin or other macrolides.

Background: There is a wide variation in the frequency of HBeAg among HBsAg infected patients in the world with possible prognostic significance. Patients and Methods: In this prospective study, three-hundred and seven patients who were found to be HBsAg positive either during a blood donation or incidentally in a routine check-up, were evaluated by testing HBeAg, HBeAb, serum alanine transaminase (ALT) and serum alfa-fetoprotein. Liver ultrasound was performed in all patients. Patients were then divided into two groups: Group A (HBeAg positive) and Group B (HBeAg negative). The correlation of this viral marker (HBeAg) with a necroinflammatory index (ALT) was evaluated. Results: HBeAg was positive in 50 cases (16.3%) and its antibody (HBeAb) was detected in the remaining 257 patients (83.7%). Serum ALT was abnormal (>2.5 times the normal level) in 16 (32%) of HBeAg positive and 39 (15) of HBeAg negative cases. Among 55 patients with an increase in ALT, 16 (29%) cases were positive for HBeAg while 39 (71%) patients were HBeAg negative. The rate of HBeAg in patients with a normal enzyme level was 13.5% (34 out of 252). Conclusion: The rate of HBeAg negativity among chronic HBsAg infected patients in our area (southwestern Iran) is in the range reported from other parts of the world. Additionally, HBeAg has a positive correlation with the level of ALT.

Background: Nosocomial infections are a group of infectious diseases acquired during hospitalization. Catheter-associated urinary tract infection is the most common nosocomial disease in catheterized patients. The first sign of this infection is symptomatic or asymptomatic bacteriuria or funguria. The aim of this study was to determine the point prevalence of funguria and urinary tract infection as well as their etiological agents in foley catheter users. Patients and Methods: Over a seven-month period, a total of 509 urine samples from 101 catheterized patients at Shariati Hospital, Tehran, were collected. Uncentrifuged urine samples were used for colony count. Culture, direct examination and leucocyte count were done on urine sediments. Identification of etiological agents was performed by conventional methods and API 20C-Aux commercial system. Results: Bacteriuria, funguria and mixed infections were observed in 33.7 percent (34 cases), 11.9 percent (12 cases) and 16.8 percent (17 cases) of the cases, respectively. The prevalence rate of funguria was 21.27 percent for males and 35.1 percent for females. The etiological agents were: Candida albicans (24 cases), Candida glabrata (4 cases) and Cryptococcus laurentii (1 case). The highest number of colony forming units in 1 milliliter of the urine was 185000. None of the patients showed signs of urinary tract infection. Nine patients developed funguria after replacement of the catheter. Conclusion: The presence of yeasts in the urine should not be considered as a sign of urinary tract infection, particulary in the presence of foley catheters, however, it may increase the risk of urinary tract infection.

Background: Brain damage resulting from perinatal cerebral hypoxia-ischemia is a major cause of acute mortality and chronic neurological disability in infants and children. Statistics suggest an incidence of systemic asphyxia up to 20 per 1000 full-term neonates. Between 20 to 50 percent of asphyxiated newborns who exhibit hypoxic-ischemic encephalopathy die during the neonatal period. Among the available neuroimaging modalities, brain CT-scan is superior as a new technique with a low cost. It is a non-invasive technique which can provide information about the nature and extent of cerebral damage. Patients and Methods: This is a cross-sectional analytical study performed for evaluation of neonates with asphyxia who were admitted in the neonatal wards of Nemazee and Hafez Hospitals, Shiraz. Inclusion criteria were a gestational age of more than 37 weeks, appropriate weight for gestational age, severe peripartum asphyxia, abnormal neurological signs and absence of major congenital anomalies. Staging of clinical findings was according to the Sarnat staging of hypoxic-ischemic encephalopathy which divided the cases into three groups. Correlation of clinical findings with brain CT-scan was performed during the first two weeks of life and the data were analysed using chi-square and Fisher’s exact tests. Results: Forty-five neonates with asphyxia were enrolled in this study. There was a statistically significant difference between the three stages of clinical findings and brain edema (p=0.02) and possibility of brain edema was more in the higher stages (stage one: 10 percent, stage two: 45 percent, stage three: 66.7 percent). Intracranial hemorrhage (ICH) was present in 15 cases (33.3 percent). The incidence of intracranial hemorrhage in stages 1, 2 and 3 were 20, 20 and 60 percent, respectively (p=0.027). There were 9 cases (20 percent) with normal and 36 cases (80 percent) with abnormal CT-scan findings which correlated directly with higher clinical stages. Abnormal findings in CT-scan were found in 75, 75 and 93.3 percent of the neonates in stages 1, 2 and 3, respectively, with 30 percent specificity and 83 percent sensitivity. Conclusion: According to clinical findings, severity of damage in asphyxiated neonates and its complications such as brain edema, intracranial hemorrhage and convulsion are directly related to brain CT-scan findings. Therefore, in the absence of access to CT-scan, patients may be managed according to clinical findings.

Background: Habitual abortion is defined as the occurrence of three or more consecutive pregnancy losses before the twentieth week of gestation. This is a challengeable clinical issue, as no cause can be found for abortion in over 50% of patients. There is increasing evidence to support an alloimmune mechanism in the unexplained group. It has been stated that the absence of maternal antibodies against the paternal leukocyte antigen (APLA) presented by the fetus causes abortion in this group. The objective of this study was to determine the value of APLA in the diagnosis of immunological causes of unexplained habitual abortion. Patients and Methods: One-hundred-thirty women with primary habitual abortion who had referred to Motahari Clinic, Shiraz, were enrolled in the study. In patients with nonspecific causes for abortion (unexplained abortion) white blood cell cross match was done for determination of APLA. Also, in the control group (women with at least one term pregnancy who had referred for kidney donation), APLA was determined. Immunization with paternal leukocytes was done for patients with negative APLA in several steps. Results: In fifty (38.5%) women out of 130 cases with habitual abortion, no recognized cause was found. APLA was positive in 8% and 20% in the case and control groups, respectively. There was no statistical difference between the two groups. Overall, 88% of the patients with negative APLA were immunized with paternal leukocytes. Conclusion: A negative APLA test does not correlate with the immunological basis of unexplained habitual abortion.

Background: Thalassemia is a common hereditary disease with a high prevalence rate in Iran. The most ideal treatment of thalassemia major is bone marrow transplantation. The aim of this study was to assess the liver function of thalassemia major patients who underwent bone marrow transplantation. Patients and Methods: Liver function test and complete blood count were assessed during a 12-month period in 43 patients with thalassemia major who had undergone bone marrow transplantation. Data were analyzed using t tests and analysis of variance. Results: The majority of cases were between 5 to 15 years with an equal sex distribution and had a hemoglobin level of less than 7 mg/dL with regular desferal injections. In most of the cases, desferal injection had started between the ages of one to four years. The age in which blood transfusion was initiated was under the age of one year. Most of the cases had iron deposition in the liver and negative serum hepatitis B surface antigen. In classes II and III, there was a statistically significant relationship between liver enzyme changes in pre and post-transplantation period (p<0.05). Increase in the level of liver enzymes in class II and III patients were also found (p<0.05). However, protein and albumin were within normal ranges. Total and direct bilirubin levels showed great variation but were within normal range. The hemoglobin, platelet and white blood cells decreased in early post-transplantation months then increased to reach a normal level. Conclusion: The results of this study showed that changes in the liver function after bone marrow transplantation are directly related to liver function before bone marrow transplantation. Unfortunately, if there is more iron deposition in the liver before transplantation, more liver damage will be unavoidable after bone marrow transplantation. Therefore, bone marrow transplantation as a treatment for thalassemia major is not indicated in patients with end stage liver disease or in patients with class II or III liver function unless concomitant bone marrow and liver transplantations can be performed.

A 32-year-old woman presented with abrupt localized scalp hair loss since one day before referral. The patient’s nails, skin and mucosa were normal. On the scalp a round-shaped, localized hairless patch was seen over the vertex. The hairs were broken at approximately equal lengths. Several red sting points were seen over the area, but no scales, twisted hairs or "exclamation mark" hairs were detected. In a closer examination of the hair, several ants were observed which were diagnosed to be of the Pheidole species. This case is one of the several cases who has referred to our department with the complaint of localized hair loss induced by ants, and to our knowledge this is the third documented case.