JOURNAL OF MEDICAL RESEARCH (JMR)
Year:2005 | Volume:3 | Issue:4|Papers Count:19

Background: Diabetic macular edema (DME) is the most common cause of decreased visual acuity among diabetic subjects but its pathogenesis is still poorly understood. This study was undertaken to determine if the levels of angiotensin II (AII) and other related cytokines in the aqueous humor have any relationship to DME. The effect of captopril administration was also studied in this regard. Patients and Methods: Aqueous humor samples were obtained during cataract surgery from 58 eyes of which 37 were diabetic patients. From these subjects, 16 had taken captopril and 21 cases had not taken any angiotensin converting enzyme inhibitors (ACEIs). The level of vascular endothelial growth factor (VEGF) in the aqueous fluid was measured by enzyme-linked immunosorbent assay. Angiotensin level was assessed by radioimmunoassay. Severity of macular edema was evaluated by clinical examination after surgery. Results: The aqueous levels of angiotensin II and VEGF were significantly higher in patients with DME compared to non-diabetic cases (p<0.001 and p=0.0005, respectively). Aqueous concentrations of both angiotensin II and VEGF were significantly lower in patients with diabetic macular edema treated with captopril than in patients with diabetic macular edema not treated with ACEIs (p<0.0003 and p<0.0001, respectively). Conclusion:  The findings of this study suggest that the aqueous level of angiotensin II has a significant correlation with the severity of macular edema and this may play a role in the pathogenesis of macular edema in correlation with VEGF. It seems that modulation of the renin-angiotensin system may become a very important target for drug treatment in patients with DME.

Background: Anxiety and depression are the most common psychological phenomena from which human beings suffer. Recent research has shown that anxiety and depression have biases in different areas of the information processing system. These findings can not be simply explained by the theories of Beck or Bower who believe that anxiety and depression are related with similar mood-congruent biases in all areas of the information processing system. The aim of the present study was to assess the performance of patients with major depressive disorders (MDD) and generalized anxiety disorders (GAD) versus normal controls in two different tasks, judgment of frequency and recall, in order to evaluate William's theory. Materials and Methods: To the end, 16 patients with MDD and 16 patients with GAD were selected from the clients of clinics in Shahr-e-Kord via clinical interview and BDI and BAI inventories. These two patient groups were matched by age, gender and education variables with 17 normal controls. Participants responded to the "Judgment of Frequency and Recall Computerized Task". In this task, participants were confronted with 3 groups of words (threatening, depressive and neutral) that appeared with different frequency in a randomized order. Then they estimated the frequency of each word in the presentation phase and finally recalled words. Results: The results of this study showed that bothclinical groups had judgmental bias with mood-congruent affective words. However, only depressed patients showed a mood-congruent bias towards depressive words in the recall memory task. Conclusion: The present study confirmed that the difference between clinical anxiety and clinical depression in explicit and implicit memory could be explained by William's theory rather than the previous theories such as those of Beck and Bower.

Background: The thyroid and the stomach have many embryologic and structural similarities and are involved simultaneously in some disease processes. There have been few studies on the relationship between Helicobacter pylori gastritis and autoimmune thyroid diseases (AITD). The objective of this study was to investigate the frequency of different types of gastritis and Helicobacter infection among patients with autoimmune thyroid diseases. Patients and Methods: Ninety patients with AITD including 55 patients with Graves' disease, 35 patients with autoimmune hypothyroidism and 57 patients with functional dyspepsia (as the control group) underwent upper GI endoscopy followed by urease test and histological examination of multiple biopsy specimens from the gastric fundus and antrum. Results: The prevalence of H. pylori infection in the case and control groups was 92 and 90 percent, respectively and the difference was not statistically significant. The prevalence of fundal and antral gastritis in the case as well as control groups had no significant difference, but the mean grade of antral inflammation and density of H. pylori in the fundus were higher in the AITD group (p=0.031 and p=0.045, respectively). Conclusion: There was no relationship between H. pylori infection per se and AITD, however, heavy infection (higher density of organism and higher degree of inflammation) was associated with AITD. Contrary to reports from western countries, predominant fundal gastritis was not more prevalent in patients with AITD.

Background: Breast cancer comprises 28 percent of all cancers and is the most prevalent cancer in women. It is the second cause of mortality due to cancers in Iran. The objectives of this study were to find and compare risk factors, survival times as well as life expectancies for the different types of surgery in treating breast cancer. Patients and Methods: This study was undertaken on 310 patients who were followed for a ten-year period. Cox and logistic regression models were used to analyze causes of death. The log rank tests were used to compare survival times of different groups while actuarial life table methods were used to find and compare life expectancies of different types of surgery. Results: Statistical analysis of the data showed that, stage (p<0.001), age (p<0.001), benign breast tumor (p<0.01) and family history (p<0.006) had a significant relation to death. The relative mortality risk in patients with a higher stage of disease was 20.5 times while it was 2.62 times in patients with a higher grade of disease. This figure was 4.15 times for patients with a history of benign tumor. The life expectancy for all patients was 10.03 years. This life expectancy was 10.06 and 8.35 years for patients that underwent mastectomy or lumpectomy, respectively. The differences between life expectancy of patients in the stage "early" and in the "locally advanced" and "advanced" stages were statistically significant (p<0.001). Conclusion: It can be concluded that age, stage, grade, family history and benign breast tumor were the most important risk factors related to death in breast cancer.

Background: "SCIWORA" is a syndrome occurring when the spinal cord sustains neural damage during a traumatic event without positive radiographic findings. Anatomic and biomechanical characteristics of the pediatric spine place children at risk for this syndrome. The purpose of this study was to define the incidence and characteristics of patients with SCIWORA. Patients and Methods: This prospective epidemiologic study was performed in a 24-month period on 233 traumatic spine-injured patients admitted to Nemazee Hospital, a major referral center for these patients in Fars province. Eleven patients (10 males and 1 female) with an age range of 1 month to 18 years had SCIWORA syndrome based on positive neurological and MRI findings while a technically adequate plain radiographic series revealed no injury. The Frankel grading system was used to evaluate neurological deficits in the patients. Results: The total incidence of SCIWORA in our study was 2.36 percent, while it was 83.33 percent and 22.22 percent in 0-9 and 10-19 year-old age groups, respectively. Male to female ratio was 10/1. The most common cause of SCIWORA was collision accidents (54.54 percent) followed by falls (18.18 percent). The most common site of spinal cord damage was the lumbar area (45.45 percent) followed by the cervical region (36.36 percent). According to the Frankel grading system, 72.72 percent of the patients were in grade A, and had spinal cord hemorrhage and edema with signs of soft tissue injury on MRI. All of the patients with lumbar SCIWORA were in this grade. Patients in Frankel grades B and C had spinal cord edema and hemorrhage without evidence of surrounding soft tissue damage on MRI. Conclusion: In our study, the percentage of collision accidents was much more than other reports which stress the significance of better control of roads with stricter traffic laws. Also, the number of patients in grade A was more than in other studies which could be due to inappropriate pre-hospital management and patient transfer methods. Early detection and pre-hospital fixation of cases with SCIWORA can decrease delayed neurological problems and improve the final outcome.

Background: Flat foot is a generic term used to describe any condition of the foot in which the longitudinal arch is abnormally low or absent. Although the exact prevalence of flat foot in children is unknown, it is undoubtedly one of the most common deformities observed by pediatric orthopedists. The prevalence of flat foot is different in various studies from different societies, hence the true prevalence of flat foot is unknown. Materials and Methods: In this cross-sectional study, we clinically examined both feet in 812 male elementary school students of Shiraz, in both sitting and standing positions. The presence of flat foot and the degree of its severity according to Tachdjian's system of grading for flatfoot was assessed. Also, weight, height and body mass index (BMI) of each subject was measured. Results: The data showed that the overall prevalence of flat foot was 35.7 percent out of which 23.4 percent were mild, 10.7 percent were moderate and 1.6 percent were severe. Additionally, significant relationship between the prevalence of flat foot and body measurements was observed. The data showed that the prevalence and degree of severity of flat foot increased with higher values for weight, height and BMI. Conclusion: This study showed that flat foot is a common problem among male children in our society and should be addressed by responsible organizations especially if it persists through adulthood.

Background: The purpose of this study was to evaluate the diagnostic value of IGF-1 and IGFBP-3 in the evaluation of children and adolescents with short stature in whom growth hormone deficiency (GHD) was suspected. Materials and Methods: In this case series study, children and adolescents with short stature who were referred to Nemazee Hospital in Shiraz in 2003 were studied. Inclusion criteria included proved short stature based on physical examination, weight, height and standard deviation score (SDS) of height < -2 , sexual maturity and predicted height in normal children without any genetic or chronic disorders. The exclusion criteria included any positive physical or laboratory data suggesting hypothyroidism, rickets or liver disorders. For all patients a provocative growth hormone test was performed with propranolol and L-dopa and serum IGF-1 and IGFBP-3 levels were measured. Suspected GHD was defined as a peak (cut-off) serum GH level less than 10 μg/L while low IGF-1 and IGFBP-3 was considered as a cut-off serum level under two standard deviations. Results: Eighty-one patients with short stature (39 boys and 42 girls) with a mean age of 10.6±3.5 years completed the study. Seventeen patients with suspected GHD were found and in 18 patients IGF-1 level was low. Only in 6 patients GH and IGF-1 were both low and among them 2 patients also had a low IGFBP-3. There was no correlation between levels of GH in cases suspected of GHD with IGF-1 as well as IGFBP-3 levels. The sensitivity and specificity of IGF-1 and IGFBP-3 in the assessment of suspected GHD cases were 35 and 81 percent for IGF-1 and 12 and 94 percent for IGFBP-3, respectively. Conclusion: No correlation was found between the level of GH in patients with suspected GHD and serum levels of IGF-1 and IGFBP-3 in short patients and the sensitivity of these tests in the assessment of suspected GHD patients was poor.

Background: Tuberculous spondylitis (TS) is considered the most dangerous and prevalent form of skeletal tuberculosis. Complications of TS can be devastating because of bone destruction, deformity and paraplegia. Therefore, early diagnosis and proper treatment are necessary to avoid long-term disabilities. Patients and Methods: In this retrospective study, tuberculous spondylitis and spinal tuberculosis were reported during a five-year period (1998-2003). Only those with clinical manifestations, laboratory or pathological confirmation or those who responded to treatment were included. Results: The study revealed 29 patients with tuberculous spondylitis, five patients with radiculomyelitis, one case with intramedullary tuberculosis and one case with syringomyelia secondary to tuberculous meningitis. Most of the patients were men aged 35-55 years. The most frequent clinical manifestations were fever and backache. In more than 80% of the cases PPD and ESR were helpful in the diagnosis. In 13 patients the results of pathology, smear and culture of the tissue aspirate were compatible with tuberculosis. Multiorgan involvement was observed in 42% of the patients. Thoracolumbar spines were the most frequent site of involvement in the vertebral column (41%). Eight patients (22%) needed surgical intervention. Complete recovery was seen in 29 (80%) cases. Conclusion: There are several reports of tuberculous spondylitis and spinal tuberculosis especially in endemic regions of the world. Clinical manifestations, imaging surveys and response to treatment are extremely helpful for diagnosis, and tissue aspirate is a good confirmatory method. Unfortunately, in comparison to other studies, positive results of the latter were not observed in our country. Early diagnosis and treatment (chemotherapy, corticosteroid therapy and surgery) are recommended to prevent severe neurologic deficits.‍

This study was designed to determine the effect of apomorphine after failure to respond to sildenafil citrate in patients with erectile dysfunction (ED). In a randomized double-blind clinical trial from April 2002 to August 2004, a total of 60 men aged 20 to 50 years (mean age 33±12) entered the study. Sixty patients with ED who had received 25-100 milligram per dose of oral sildenafil citrate and had not responded to it, were randomly divided into two equal groups. In group A (n=30) apomorphine (2-4 milligram per dose) was started sublingually for 3 months. Group B (n=30) received placebo. The patients were followed for three months. Afterwards, they were evaluated by IIEF-5 self assessment questionnaire. The initial mean score was 9.1 and increased to 10.4 in group A and 10.1 in group B which was not significant (p value= 0.259). In patients with ED, apomorphine was not effective when the patient did not show a response to sildenafil citrate. Therefore, we do not recommend its use in patients who have not responded to SC.

Study of consanguineous marriages, and their clinical consequences have an important place in genetics. Consanguineous marriage is a major feature of the family system in Iran as well as most eastern societies. Regarding the high prevalence of consanguineous unions in most of the Iranian population and inbreeding as an important risk factor for genetic abnormalities, it is necessary to pay attention to some genetic conditions, which are more frequent in progenies of related parents. Statistical analysis of frequencies of various defects among progenies of consanguineous and unconsanguineous marriages is the main purpose of this study. Twenty-five hundred files of consultants from the genetic counseling center in Shiraz from 2000 to 2003 have been included in this study. According to the diagnosis of genetic counselors and drawn pedigrees, different abnormalities and degrees of consanguinity were specified. Chi-square statistical test was used to detect significant differences of frequencies. The average of consanguineous marriages was 86 and 76.5 percent of the marriages were among first cousins. The most frequent registered genetic conditions, out of 6900 detected conditions, were mental retardation (842 cases), deafness (440 cases), eye abnormalities (215 cases), paralysis (196 cases), frequent abortions (190 cases), beta thalassemia (157 cases), mental retardation together with congenital abnormalities (155 cases), hearing impairment (148 cases), Down syndrome (145 cases), epilepsy (144 cases), and congenital heart defects (140 cases). By analysis of frequencies, mental retardation, deafness, eye abnormalities, frequent abortions, paralysis, physical and mental retardation, congenital malformations and abnormalities, infantile and neonatal deaths, low IQ, developmental delay, mental retardation with paralysis, skeletal defects, microcephaly and mental retardation together with microcephaly were more frequent among progenies of consanguineous parents than unconsanguineous parents (p<0.05). These findings imply the potential risk of consanguineous marriage in the occurrence and recurrence of 14 types of abnormalities. Regarding the high prevalence of consanguineous marriages, not only in the consultants but also in the general population, abnormalities with low frequencies are nonrandom and take place in special subpopulations. In contrast, abnormalities with high frequencies such as mental retardation and hearing loss are genetically more heterogeneous in the population.