JOURNAL OF MEDICAL RESEARCH (JMR)
Year:2004 | Volume:2 | Issue:4|Papers Count:11

Background: In Iran, the clinical presentation of cutaneous leishmaniasis is mainly in the form of dry type (urban form) or wet type (rural form). The microscopic finding of amastigotes in Giemsa-stained smears is the most practical laboratory test for the diagnosis of cutaneous leishmaniasis. However, determination of parasite species is not possible when using this method. Parasite characterization is made by various biochemical, immunological and molecular methods based on massive culture of the parasites. Materials and Methods: In this study nested PCR was used both for diagnosis as well as species identification. Giemsa-stained slides from fortynine patients, that had been included in a drug resistance survey, were used in this study. Results: From the available slides, forty-seven were diagnosed as having leishmaniasis using the nested PCR technique. Twenty of these were Leishmania tropica (L. tropica) and the remaining were Leishmania major (L. major). Amastigotes were recovered from twenty-nine of these patients after standard treatment. This study revealed that clinically drug-resistant cases are more likely to be infected with L. tropica than with L. major, although this difference was not statistically significant. L. tropica was mostly present in facial lesions while L. major was mostly detected in hand and foot lesions. In patients with more than two lesions, L. major was the predominant cause. L. tropica was the cause of a more prolonged duration of disease. None of the above findings were, however, statistically significant. Conclusion: It can be concluded that nested PCR is a useful technique for studying the molecular epidemiology of leishmaniasis in the field.

Background: Diabetes mellitus is associated with an increased risk of certain complications including those involving the liver. However, most studies have focused on the biochemical, physiological and qualitative pathologic alterations of the liver in diabetes and the quantitative aspects of liver structure has received less attention. The aim of this study was to evaluate the quantitative changes in liver volume, volume-weighted mean volume of hepatocytes and their nuclei, and proportional and absolute volumes of liver sinusoids in streptozotocin-induced diabetic rats, using stereological methods. Materials and Methods: Streptozotocin was injected to male rats and their livers were removed after 4, 8 and 12 weeks. Liver volume and weight were measured and uniform isotropic random sections of the liver were obtained using the orientator method and stained with Feulgen periodic acid schiff. Microscopic fields were chosen and volume-weighted mean volume of the hepatocytes and their nuclei were estimated using the point-sampled intercepts method in three histological zones of the liver acini. Proportional and absolute volumes of liver sinusoids were measured using point counting. Results: The results showed that liver volume and weight and mean volume of the hepatocytes were mainly decreased 4 and 8 weeks after diabetes induction. The mean volume of hepatocytes nuclei decreased at 4, 8 and 12 weeks in diabetic rats. The absolute volume of liver sinusoids decreased 4 weeks after diabetes induction but no significant differences were noted after 8 and 12 weeks. Conclusion: From this study it can be concluded that induced diabetes mellitus in rats can alter liver volume, morphology of hepatocytes and their nuclei and sinusoids in the early stages of the disease.

Background: Despite widespread imaging techniques which have significantly improved the managemnet of acute appendicitis, cost-effective clinical decision-making concerning this condition is still a matter of debate. The aim of this study was to design a simple scoring system based on routine clinical and paraclinical data in patients suspected of having acute appendicitis. Patients and Methods: In this cross-sectional study, 402 consecutive patients, clinically suspected of having acute appendicitis and who were referred for general surgery consultation were evaluated. Nine common clinical and laboratory data including abdominal guarding, fever, shifting pain, leukocytosis, rebound tenderness, tenderness on rectal examination, vomiting, right lower quadrant tenderness and anorexia/nausea were recorded in each case and individually evaluated for sensitivity, specificity, positive predicted value and accuracy based on final outcome. Ascore of 3 was attributed to sign/symptoms with an accuracy of ≥80%, 2 to sign/symptoms with an accuracy of 60-70%, and 1 to sign/symptoms with an accuracy of 50-70%. Results: By selecting a cut-off point of more than 7 for operation and 6-7 for observation, the proposed scoring system decreased the negative appendectomy rate to 6.6% and observation rate to 3.5% as compared to 29% and 18% respectively, in conventional decision making. Conclusion: Applying this scoring system can improve clinical decision-making in acute appendicitis and effectively reduce negative appendectomy rates without increasing the rate of complications.

Background: Head-injured patients demonstrate an increased metabolic and catabolic rate, hyperglycemia, negative nitrogen balance, weight loss, muscle atrophy and multiple organ failure, including gastrointestinal and respiratory failure. These events may be due to hormonal changes and secretion of acute phase reactants. Therefore, this study was undertaken to assess the effect of parenteral-enteral versus enteral nutritional therapy on several serum parameters in head-injured patients in order to determine the preferred method of controlling these parameters. Patients and Methods: This prospective, quasi-experimental randomized study was performed in a 36 months period on 66 head-injured patients. Fifty-five males and 11 females with an age range of 18 to 72 years, who were admitted within 24 hours of their injury and who had a Glasgow Coma Scale (GCS) score of 4 to 10, were enrolled in this study. The patients were  randomly allocated into two groups in order to receive either parenteral- enteral nutrition (Group 1) or enternal nutrition alone (Group 2). They were followed for 14 days during their admission in the hospital. Results: Group 1 received a statistically significant higher caloric intake (p<0.001). This group had a higher mean total serum protein (p=0.037), total bilirubin and triglyceride (p<0.001), while serum albumin in both groups showed no statistically significant difference. Mean total bilirubin and triglyceride were higher in Group 1 (p<0.001 and p<0.001, respectively). However, these findings were not found at the end of the second week. Although mean serum glucose was higher in Group 1 during the first week (p<0.001), no significant difference was noted during the second week. Conclusion: The parenteral-enteral method can provide more calorie and protein to head-injured patients in the early post-traumatic critical days. This method is more successful in maintaining serum protein within normal limits. However, increase in serum levels of triglyceride, bilirubin and blood sugar are more common while using this route and hyperglycemia must be controlled carefully.

Background: The optimal time and sequence of adjuvant radiation therapy and chemotherapy after breast surgery is controversial. Radiation therapy is the most effective method for preventing locoregional recurrence following primary surgery for invasive breast cancer. Delay in radiation therapy after surgery can lead to increased local recurrence and delay in chemotherapy after surgery is associated with an increasing rate of failure in the systemic control of breast cancer. This study was undertaken to determine the optimal sequencing of adjuvant chemotherapy and radiotherapy for patients with locoregional breast cancer after modified radical mastectomy. Additionally, this study aimed at determining the possible effect of time of radiotherapy on local and distant cancer control and the overall survival in these patients. Patients and Methods: Over a 2.5 year period, 100 patients received chemotherapy and radiation herapy for a locoloregional breast cancer after modified radical mastectomy. The population was randomly divided into two equal groups based on the timing of radiation treatment. Fifty patients (Group I) began their radiation after completion of chemotherapy and about 21 weeks after surgery. Group II began their radiation therapy about 3 weeks after surgery in combination with chemotherapy. Results: There was no statistically significant difference between the two groups with respect to nodal status, stage of breast cancer, age, sex and type of surgery performed. Comparison of local and distant failure and overall survival rate between the delayed radiation group (Group I), and early radiation group (Group II) was not significant. Conclusion: In patients who require both chemotherapy and radiation therapy for a localoregional breast cancer, a delay in the initiation of radiotherapy for completion of adjuvant chemotherapy appears safe and may be preferable in patients with high risk of dissemination.

Background: Sinus endoscopic surgery requires sufficient anatomical knowledge of the area. The objective of this study was to determine the variations of anatomic landmarks in patients undergoing functional endoscopic sinus surgery. Patients and Methods: This retrospective study was based on reviewing the recorded video tapes obtained during operation of 100 patients with chronic sinusitis or other sinonasal diseases who underwent endoscopic sinus surgery. At the beginning of each operation, both nasal cavities were reviewed by 0 and 30 degrees, 4 millimeter telescope. Anatomic structures of the lateral nasal wall was viewed and findings were recorded on VHS videotapes. These videotapes were re-evaluated later. Results: The following data were obtained by reviewing these anatomic variations in 170 nasal cavities in 100 patients: Middle turbinate: typical (70%), concha bullosa (10%), sagittal cleft (4.5%), lateral displacement (5%), lateral bending (4.5%), medial bending (3%), medial displacement (3%) and transverse cleft (0%). Uncinate process: typical (82%) and medially rotated (18%). Bulla ethmoidalis: balloon shaped (typical) (60%), sausage shape (22%) and flat (18%). Accessory ostium: round (67%) and oval (33%). Sphenoid sinus ostium: oval (50%), slit (35%) and round (15%). Conclusion: This study attempted to determine the anatomic variations of the lateral nasal wall. Knowledge of these variations is important for differentiating pathologic conditions from normal anatomic variations and offers a safer and more effective endoscopic sinus surgery with less complications.

Background: There are many different published articles about cirrhosis from all over the world, however, only limited articles related to Iran and the Middle East region exist on this subject. Patients and Methods: In this retrospective study, 406 patients who had suffered from cirrhosis and who were referred to affiliated hospitals of Shiraz University of Medical Sciences were investigated during 1991-2001. The patients’ medical history, clinical and laboratory findings were reviewed and an attempt was made to find the etiology of the disease and to assess the complications that accompanied it. Results: Out of 406 patients, 272 were males and 134 were females with a male to female ratio of 2. The mean age of the patients was 51 years with a range from 14 to 93 years. The most predominant signs were ascitis (49%), jaundice (42%) fever (34%) and hepatic encephalopathy (32%). The most common etiological factor was hepatitis B. Upper gastrointestinal endoscopy was performed in 55% of the patients and revealed esophageal varices, grades I-IV, and varicosal bleeding in 16.4%. Conclusion: Cirrhotic patients in our area seek medical care at a late and advanced stage of the disease. Additionally, viral hepatitis, mostly due to hepatitis B is the most common etiological factor for cirrhosis in our region.

Although carcinogenesis is a well-known late side effect of ionizing radiation, development of malignant glioma in patients who have received low dose superficial radiation many years ago for the treatment of tinea capitis has been rarely reported. This is a case report of a patient with glioblastoma multiforme in the parietal lobe after treatment with superficial radiation for tinea capitis 35 years before referral. The patient was a 62- year- old lady who presented with left-sided weakness. Physical examination revealed decreased motor power in the left upper and lower extremities. CT-scan showed a ringenhancing lesion in the right parietal lobe with peripheral edema. She underwent surgery and histological examination of the lesion was in favor of glioblastoma multiforme. She received post-operative radiotherapy (5400 CGY in 27 fractions) but after six months the tumor recurred. In patients with a history of previous radiation to the head and neck region, and who present with neurological disturbances, a complete evaluation to rule out the presence of a tumor is suggested.