Researcher Bulletin of Medical Sciences
Year:2008 | Volume:13 | Issue:2 (62)|Papers Count:16

Background: Since the need for transfusions in thalassemia intermediate (TI) patients is limited into some rare occasions they are almost always referred complaining of problems due to chronic anemia, bone marrow hyper-functioning (such as gall stones, osteoporosis) and also extramedullary hematopoiesis masses (EMH). Different treatment modalities have been reported for managing the latter complication. We carried out this study to evaluating the effects of Hydroxyurea in reducing the size of such masses.Materials and Methods: The study was clinical trial comparing before and after characteristics of the patients referred to the Talassemia Research center from 2003 to 2006. Presentation of all was pain, weakness, paresthesia of legs and paraparesia Jparaplegia. Diagnosis of EHM was confirmed by Spinal MRI (a 1.5 Tesla, Toshiba machine) Hydroxiurea (Syrea, Medac, Germany) was administered 10-20 mg/kg/day. CBC, Urea, Creatinin were checked monthly. A Neurologist was observing the progression of patients. The second MRI was performed 3-6 months later. Another radiologist unaware of the sequence of imaging reported the changes of EHM during the period. Paired-t test and McNemar test were applied to compare the results. P< 0.05 was considered as statistically significant.Results: Eight patients (7 males and 1 female) were enrolled in our study. Their age ranged from 26-44 years old. None had undergone transfusion, nor had they used pain killers. Neurologic symptomswere initiated from one week to a couple of months prior to their admission. They had administered Hydroxyurea in recommended dosage. The follow up takes 0.7 - 4.7 years. All subjects improved within 2 weeks, whereas none of them needed surgical procedures and radiotherapy. Both the MCV and NRBC changes were significant (P<0.02). No considerable side effects were noticed with in the follow up period.Conclusion: HU is proved to be both effective and safe in treatment of EHM amongst patients with thalassemia intermediate who develop neurological symptoms. We suggest hydroxyurea as a "prophylactic agent" for several complications of TI.

Background: Liver fibrosis is an inevitable result of chronic liver diseases which may ultimately lead into liver cirrhosis. Diagnosis and grading of liver fibrosis is of considerable importance in treatment strategy, treatment response, prognosis and potential risk factors for the disease complications. Although liver biopsy is the best known technique for evaluation of liver fibrosis, researchers have been searching for a more appropriate alternative to be used instead due to its harsh nature along with several side effects. One of the suggested ones is the use of biochemical markers. Our aim in this study, therefore, was the assessment of some of these biochemical markers.Materials and Methods: In a retrospective trial, 130 patients (94 men (72.3%) and 36 women (27.7%)) of whom had undergone liver biopsy, were studied. Former biopsy samples were reviewed. Gathered data from their medical file and pathology reports were analyzed by SPSS 11.5.Results: It was revealed that there was a positive correlation between age and severity fibrosis. There was no significant relationship between liver fibrosis and gender. Comparing the patients with liver fibrosis and non-fibrotic ones, we found that the AST/platelet index is an appropriate marker for distinction of these patients. To distinguish the patients without liver fibrosis from ones with moderate liver fibrosis, a cutoff point=0.39, PPV=0.7& NPV=0.54 was obtained, whereas for differentiating them from severe liver fibrosis patients, the cutoff point of 0.25, PPV=0.76 & NPV=0.7 was achieved. Distancing the mild and moderate fibrosis, platelet was found to be an appropriate variable, having a cut off point of 158500.Moreover, to set mild and sever fibrosis apart, platelet and albumin were more valuable. In this study cut off point of 151000 for platelet and 3.6 for albumin was obtained, respectively. Similar to other relevant studies we also could not find any appropriate marker for making the distinction between moderate and severe fibrosis.Conclusion: Our study outlines that AST/platelet index has an appropriate cut off point for distinction between on-fibrotic and moderate and sever liver fibrosis. Distinguishing the mild cases from both moderate and sever fibrosis, platelet is a good marker. Furthermore, albumin is another marker for distinction between mild and sever fibrosis. The studied markers are not able to distinct all stages of fibrosis. Due to their limitations, they cannot be applied in various clinical situations.In this regard, no demote substitute for liver biopsy has been found yet. Acquiring a test or technique that contains all necessary standards for evaluation of liver fibrosis requires further studies and researches.

Background: Classically, one's heart function is mostly based upon its systolic function, whereas the diastolic function steps on second order. In recent years it has been revealed that diastolic function plays an important role in both cardiac mortality and cardiac morbidity. On the other hand is hypertension which due to increasing the afterload, interferes with these functions of heart. In this study we assessed the diastolic function of hypertensive patients using pulse tissue Doppler.Materials and Methods: 30 patients with high blood pressure that had not consumed antihypertensive agents and along with 30 healthy control ones enrolled in our survey, all of whom had normal sinus rhythm without detectable symptoms corresponding to congestive heart failure, ischemia, valvular diseases and pulmonary problems. 2D echocardiography was performed in both groups as well asM Mode and Doppler echo The PTD echo was performed by the lateral annulus of both tricuspid and mitral valves. Systolic and diastolic findings were measured by PTD.Results: Hypertensive patients had negative diastolic findings but no negative systolic ones. PTS illustrated that E/A ratio (early peak velocity / late peak velocity) in right ventricle had significantly decreases (P<0.01) among these patients. In right ventricle, both RT (relaxation time) (P<0.01), DT (decelation time)(P<0.04) and Am (Late Peak Velocity) (P<0.03) were conversely increased. Right ventricular E/A ratio had a significant correlation with that of left ventricl (P<0.005, r =0.5).Conclusion: It seems that hypertension is longitudinally related with diastolic dysfunction of right ventricle. This disturbance would be represented by the lengthened RT and decreasing of E/A ratio which are both resulted from interfering of two ventricle's function and increased pressure of left ventricle. Therefore, PTD can be applied to evaluate the right ventricular diastolic function among patients with high blood pressure.

Background: Linseed (seed of flax) contains high amounts of 00-3 Fatty acids, whichis said to have antihyperlipidemic effects.Materials and Methods: In this study, blood lipid levels (Triglycerids, Cholesterol, LDL, HDL) of 56 hyperlipidemic patients were measured before and after Linseed administration (6 gr linseed powder daily as a biscuit formulation for 3 months as a supplementation to their simple diet). The results were analyzed by t-test using SPSS software.Results: There were some decreases in the mean level of serum total cholesterol (about 10% decrease, P=0.001), mean serum triglyceride (about 12% decrease, P=0.001), and mean serum LDL (about 10% decrease, P=0.001) before and after Linseed administration. The total- Cholesterol/HDL and LDL/HDL ratios decreased concordantly as well. However, there was no significant alteration in serum HDL level after linseed administration.Conclusion: Linseed administration combined with a simple diet, clinically decreases blood lipid levels. Hence, supplementation of simple diet with 6 gr Linseed powder daily, seems to be helpful in reducing patients blood lipid levels.

Background: Deeming the very fact that synovectomy is still being performed due to various diseases of the knee joint and having no published document comparing the outcome of arthroscopic synovectomy with open synovectomy, this study was conducted at Akhtar hospital. Materials and Methods: The design was historical cohort study. All patients who underwent synovectomy of the knee joint during 1997to 2004 and were followed up for at least two years were enrolled. Arthroscopic synovectomy were the case group and the open synovectomy were the control one. The groups were matched through their age, sex, duration of disease and follow up. Mismatched cases were excluded. The outcome of treatment was evaluated by subjective feelings, range of motion, recurrence, postoperative pain and the days of admission.Results: Recurrence rate were more common in arthroscopic group (P<0.008). Limitation in range of motion of the knee joint were 5 times more in open group (P<0.000) Fisher's test showed that subjective feelings were equal in both groups (P<0.5). Duration of in-hospital course was 9.8 days in open group and 6 days in arthroscopic group. Opioid analgesics were utilized less in the arthroscopic group (P<0.007).Conclusion: This study showed that limitation of range of motion, duration of hospitalization and the use of upload analgesics were more in open group, compared to arthroscopic group.In contrast, the arthroscopic group had more recurrence. Subjective feelings were same in both groups.

Background: Among children, there are several painful diagnostic or therapeutic procedures especially in malignant disease which may evoke fear and anxiety that may interfere with the treatment. Due to various reports on the efficacy of midazolam, we compared the effects of intranasal versus intravenous midazolam in reducing the pain, fear, and anxiety in children undergoing painful procedures at Loghman hospital between 2005-2006.Materials and Methods: This randomized clinical trial was conducted on two 30-participant groups of patients aged 4-15 years who were to undergo painful procedures (including bone marrow aspirations and lumbar punctures). One group received intravenous Midazolam and the other one did intranasal Midazolam before the procedures. Pain was measured based on Bieri facial pain scale, whereas anxiety was determined based on Yale-Pas scale. Fear was measured and analyzed between the two groups by Chi-square and fisher's exact tests. Side affects were documented in both groups as well.Results: 50% of patients in the IV group, and 53.3% in the intranasal group had the Yale-PAS anxiety score of above 37, which was yielding a significant difference (P<0.9). 90% of the subjects in the intranasal group had mild pain while 10% had moderate one. In the IV group 74% experienced a mild pain and 25.9% suffered from moderate pain, whereas 10% experienced none at all. No significant difference was observed between the levels of pain amongst two groups (P<0.9). In both groups fear became less during and after the procedure and it was significantly decreased in intranasal group.Conclusion: Since the effect of intranasal and IV Midazolam on reducing the pain, anxiety, and fear is not significantly different, regarding the simplicity of intranasal administration, this approach may be of further compliance and more practicality for analgesia of painful procedures.

Background: Results of tendon transfer in birth palsy have been evaluated in the USA and Europe, but there is no report on this type of treatment in Iran. The present study discusses the transferring of latissimus dorsi muscle for improvement of shoulder abduction.Materials and Methods: The results of tendon transfer were reviewed in patients with problems of shoulder abduction. They have been evaluated and followed up for about 6 months. Variation of their stage was calculated by sign test and the abduction range of shoulder was evaluated by paired-t test.Results: 22 patients out of 33 cases were evaluated. The mean age was 5.4±3.2 years and 63.6% were females. Before operation 36% of patients were in stage 2 while 64% were in satge 3. After tendon transfer 73% patients were in stage 3 and 23% were in stage 4 (P<0/05).The abduction angle of shoulder increased from 63.5±9.9 (before tendon transfer) upto 109.2±22.7 (after tendon transfer) (P<0/001).Conclusion: As a surgical treatment for birth palsy, latissimus dorsi muscle transfer improved the abduction angle of shoulder with no considerable complications.

Background: All the three nitric Qxidesynthase (NOS) isoforms are presented in the kidney. Some data provided evidences that eNOS activity leads to restoration of renal function after injury, but activation of iNOS aggravates renal failure. In the present study, we investigated that whether in gentamicin-induced renal failure selective iNOS blockade is beneficial.Materials and Methods: Four groups of rats were studied: Control with saline injections; gentamicin (GM) with GM injections only (iv, 4 mg/kg); GM + L-NAME : N-omega –Larginine methyl ester (L-NAME) administrated simultaneously with (iv, 30 mg/kg) or two and four hours after GM (ip,30 mg/kg); GM + L-NIL: N-imino-ethyillysine (L-NIL) administrated simultaneously with (iv, 3 mg/kg) or two and four hours after GM(ip,3 mg/kg). In all groups, serum and urine creatinine were measured. Creatinine clearance were calculated and considered as GFR. Urine N-acethyle-b-D -glocose aminidase (NAG) was assayed. After surgery, kidney sections were histologically studied.Results: GFR was significantly lower in GM group compared to control and L-NIL groups (P<0.01). It was also lower in L-NAME group compared to GM group (P<0.05). Creatinine levels were significantly higher in GM group compared to that of control ones (P<0.01).L-NIL group had lower creatinine levels when compared to GM group. NAG had higher activities in the urine of GM group when compared to the controls (P<0.01). Enzyme activities in L-NIL group were numerically between the control and GM groups. L-NAME increased GM-induced enzyme release (P<0.05). Histological studies showed that GM-treated kidneys had clear evidences of tubular damages and these damages were decreased by simultaneous administration of L-NIL and GM, although not significant.Conclusion: Selective inhibition of iNOS by L-NIL may prevent whereas, non-selective inhibition of NOS by L-NAME aggravates GM-induced renal failure.

Background: According to the importance of fluoride in water based on "DMFT" and 2 other reports which indicates that Spectrophotometer method for measurement the fluoride water can not show the real amount of flouride, Potentiometer seems to be better than Spectrophotometer. To compare these two methods for measuring the amount of flouride, this research carried out inorganic chemistry laboratory of Tehran Universitybetween2006 and 2007.Materials and Methods: In this descriptive study, after obtaining the distilled water, they were prepared in 7 groups with 0 ,0.35, 0.67, 0.7, 1, 1.2, 1.5 ppm of fluoride in 14 polyethylene containers and 2 samples were prepared from each type. In following, half of them were measured by standard spectrophotometer method (with the use of visible instrument in the same wave length, amount of light coefficient with standard solutions). Using standard solutions of 10-1M up to 10-5 M fluoride in the other half of samples, the calibration curve according to the findings was drawn. By studying the potentiometer amounts of samples and compare them with calibration curve, sample density was found. At the end, findings were changed to ppm. Therefore, the amount of fluoride in water was determined and the difference to the real fluoride in samples in each method was indicated. This difference in each method was calculated by paired-t test, whereas Mann-Whitney U test evaluated two groups with each other.Results: The research studied 14 water samples with real fluoride of 0.77±0/58. In spectrophotometer method the fluoride amount was 0.99±0/58 with the difference of 0/82±0.23 from real amount (P<0.5). In potentiometer this amount was 0.77±0/52 with the difference of 0.02±0. 01. (P<0.4). Amount of fluoride in spectrophotometer is 19.5% higher than potentiometer.Conclusion: Potentiometer method is better than spectrophotometer for indicating the fluoride in water and this method is, therefore, recommended.

Background: Dentigerous cyst is the most common type of developmental odontogenic cyst which originates from REE. It has the capacity for transformation to ameloblastoma, mucoepidermoid carcinoma and squamous cell carcinoma. ki-67 and PCNA are two cell proliferation markers which can be both detected in cysts and tumors of epithelial origin. In this study we detected these two markers to evaluate the role of cell proliferation in the pathogenesis of dentigerous cysts.Materials and Methods: This study was a descriptive one. Twenty cases of dentigerous cysts and twenty cases of dental follicles were selected from paraffin-embedded blocks stored in pathology department of Shaheed Beheshti Dental School. The slides were stained with IHC method and streptavidin-avidin biotin technique. Statistical were applied to evaluate the results. Results: 25% dental follicles stained with ki-67 and this was 70% in dentigerous cyst. 35% of dental follicles were positive for PCNA and this amount was 80% in dentigerous cyst.Conclusion: It seems that higher expression of these two markers in dentigerous cyst has an indisputable role in pathogenesis of such cysts. Further studies in this field are recommended.

Background: Leukemia is the most common malignancy among adults and children which may develop several side affects such as anemia, infection and thrombocytopnia-related hemorrage. Many modalities have been suggested for prevention of Alloimunization and one of them is using of leukocytes free products. In fact, platelets could not solely stimulate immune reaction. This study is conducted at two hospials of "Shohada" and" Taleghani" to demonstrate the usefulness of such products.Materials and Methods: This research is a single- blinded clinical trial. All the patients had acute leukemia. In control group (24 subjects) we used a routin infusion set for transfusion and in experimental group (20 subjects) a beefeater was applied during the transfusion. Platelet was counted one hour and 24 hr after transfusion. CCI formulate was used to represent a signs for Alluimunization. If CCI was less than lOx10 L/M2 after transfusion or it became below 5-7x 10 L/M2 after 18-24hr, the subject was considered alhtimmune.Results: After one hour, 21 cases out of 24 were alluimmuned in control group whereas in experimental group 13 cases from 20 patients became alluimmune. After 24 hours, 5 cases in control group and 5 ones in experiments were found to be Alluimmune. Conclusion: we did not prove any preventive properties from leukocyte-depletion filters in reducing the risk factors of Alluimunization amongst patients with acute leukemia.

Background: Premature rupture of membranes (PROM) increases the rate of neonatal sepsis. Using a clinical guideline for initiating the laboratory evaluation and treatment of such neonates, for instance PROM-Scoring system, particularly in developing countries in which the availability of rapid and accurate clinical conveniences are limited, may surprisingly result in reducing the antibiotic consumption, hospital charges and neonatal morbidity. We performed this survey to outline these issues.Materials and Methods: In this cross-sectional study 270 newborns of who were born 18 hours or more after PROM were enrolled and studied at Mahdieh hospital for a one year period. The neonates underwent a thorough evaluation and the symptomatic ones were treated for sepsis, whereas the asymptomatc newborns and the ones with a PROM score of less than 3 went under a in-hospital supervision for 3 days.Results: Among the studied newborn, 79 cases were symptomatic and 199 were symptom free. The threshold score of 3 was of an accurate specificity (100%) in diagnosing the affected infants. All the asymptomatic ones have a score below 3. Five cases developed several symptoms mostly during their first 12 hours of lives whom were considered as having sepsis and, therefore, were assessed and treated. None of asymptomatic cases were referred again after their discharge thus far. 14 neonates (5.2%) who all weighed less than 2500gr, died due to either RDS, Asphyxia or congenital anomalies.Conclusion: Based on the achieved results we suggest all the symptomatic newborns and the asymptomatic ones with PROM score of above 3 to be precisely evaluated and consequently treated for sepsis, whereas for asymptomatic infants with a score of less than 3 a 24-72 hours of in-hospital supervision is sufficient.