JOURNAL OF RESEARCH IN MEDICAL SCIENCES (JRMS)
Year:2003 | Volume:7 | Issue:4|Papers Count:21

All along the history of medicine, case reports have always been a rich resource for teaching and research. Nowadays case reports are published in many medical journals. Publishing these reports often sounds easy, but if not provided in a systematic approach, usually have little value for other researchers and the rejection rate can be extremely high. As the number of submitted reports to medical journals are increasing, the author should know how he/she can select and report the case in order to persuade editors to accept the report. Recently, the case reports have been considered as a source of reliable evidence in evidence based medicine. Interestingly, evidence based reporting of cases has come to the center of attention of modern article writers.The case must be chosen properly and presented in a brief but informative way. Both positive and negative outstanding results related to the case must be noted. Discussing characteristics and unique aspects of the case is of paramount importance. The author should try to cite some important references in the discussion section of the article. In the present review, We tried to describe the way in which a clinician  can write and publish a classical case report.

Respect for persons is one of the basic principles of medical ethics. This is prouded when adequate standards of informed consent are fulfilled in a medical research. There is ubiquitous agreement that the consent process could be analyzed as containing three elements: 1-lnformation 2-Comprehension 3-Voluntaries. So, in any research on a human being, each potential subject must be adequately informed about the aims, methods, potential risks, the anticipated benefits, and time required for the study.Investigators are responsible for ascertaining that the subject has comprehended the information. Besides, voluntaries require conditions free of coercion and undue influence. Unfortunately getting informed consent from subjects is not common in medical researches in Iran. On the other hand, an elaborated guideline for analyzing medical researches is not available for many local research committees.To address ethical issues, the Ministry of Health should provide a proper guideline for getting informed consent in medical researches. This paper could be useful as a reference for this manner.

Introduction. Regarding the increasing trend of obesity in children and adolescents and the sequelae of childhood obesity in adulthood, its treatment should be intensified from early age. In the present study, different methods of controlling obesity in children and adolescents are evaluated. Methods. In this clinical trial, 120 children and adolescents aged between 2-18 years, have been randomly divided in four groups: two groups received herbal drugs, one group placebo and the fourth received no medication. All groups were taught similarly for physical activity and diet therapy. All subjects were visited after 6, 12 and 24 weeks. Their serum cholesterol, triglyceride, HDL-C and LDL-C were measured after 12 and 24 weeks. Data have been analyzed by SPSS V10/Win software using ANOVA, Friedman and Wilcoxon Signed Rank tests. P-values less than 0.05 were considered statistically significant. Results. The finding showed that in the first follow up visit (after 6 weeks), the mean weight loss was higher in the fourth than the other three groups (30% vs. 16.6%, 0%,10%,P<0.05).In further follow up visits, there was no significant weight loss from the first follow up visit. Discussion. Since the group not receiving drug and placebo had better results in losing weight, it seems that those receiving drugs (or placebo) gave up other recommendations. Since weight loss was not continuous in further follow up, more compliance of families and change in lifestyle seems necessary.

Introduction. Elevated blood pressure is among the most common risk factors for cardiovascular disease. Most studies assessing the association of diet to hypertension have focused on micronutrients with less emphasis being placed on macronutrients. Hence this study was undertaken to compare maronutrient intake, anthropometric indices and lipid profiles of hypertensive women with their normotensive counterparts. Methods. In this study 96 hypertensive women (SPBô 140 mmHg or DBPô 90 mmHg) were selected and after matching for age, 104 normotensive ones were chosen randomely. Height, weight, waist and hip circumferences were measured and BMI and waist-hip ratio were calculated. Dietary data was collected by means of two 24-hour dietary recalls. Serum lipid indices were measured after 12 hour fasting according to standard protocols. Results. Hypertensives had higher energy, protein, carbohydrate and fat intake than normotensives (P< 0.05 for all). Energy derived from fat in hypertensives was higher than in normotensives (P<0.05). There was positive relationship between fat intake and blood pressure after controlling for other confounding variables (OR=1.09, P<0.05). Hypertensives had significantly higher anthropometric and lipid indices (except for HDL-C) but lower HDL-C than normotenslves (P<0.05 for all). Higher BMI and LDL-C were positively associated with hypertension after adjusting the effect of other factors (OR=1.62, P<0.01 and OR=1.05, P<0.05, respectively). Discussion. The results demonstrated a positive correlation of fat intake, BMI and LDL-C to hypertension. So, it seems that lifestyle modification especially healthy nutrition is of great importance in the prevention of hypertension.

Introduction: Hepatitis B is one of the most common viral infections in the world. Seroepidemiological surveys have been generally used to estimate its prevalence in different parts of the world. Mass vaccination against HBV has been implemented in Iran since 1993. Comparing rates of HbsAg carrier state in children of 2-14 years old before and after implementation of mass vaccination program may be an indirect evidence of the effectiveness of this program in an underdeveloped country. Methods: Two large seropepidemiological surveys of hepatitis B were conducted in Iran between 1991 and 1999 as part of the health and disease survey in the Islamic republic of Iran (HDSIRI 1 and 2) on a representative sample of about 1/1000 of the population. During the first health survey 39841 individuals were evaluated serologically for HbsAg in their sera and during the second survey, 46631 individuals were tested. Rates of positivity for different age and sex groups, and for urban and rural areas were calculated and compared using a confidence interval (Cl) of 95% for comparison. Results: In HDSlRl-1, rate of positivity was 1.7% with 95% Cl being 1.6%-1.8%. HbsAg positivity rate in HDSIRI-2 was again 17% (95% Cl: 1.6%-1.9%). There seems to be no difference between the HbsAg positivity rates between the two surveys overally but a significant reduction in HbsAg positivity rate in the age subgroup 2-14 years has occurred (1.3% vs. 0.8%, P<0.05, 95% Cl for difference between proportions: 0.003-0.007). Interestingly, we observed a significantly higher decline in hepatitis B virus carrier rate in rural parts compared to urban areas (1.5% vs. 0.6% for rural areas, 1.1% vs. 0.9% in urban areas). Discussion: There seems a reduction in hepatitis B carrier rate have occurred in a subgroup of young children in Iran after mass vaccination program implementation against hepatitis B. The decline appears to be more significant in rural parts against urban areas despite lower socioeconomic level in rural areas. This may be due to a better vaccination surveillance and coverage in rural areas as part of the "Health Houses. program in Iran.

Introduction: Hepatitis B may be transmitted via several pathways, within them sexual transmission plays an important role during adulthood. The strong epidemiologic evidence on intra-familial spouse-spouse transmission of this illness is lacking, and this study is to investigate this issue. Methods: The study sample was selected by random cluster sampling all over Iran. Blood samples were transferred to one reference lab, and tests of HbsAg were performed using ELISA method.Results: Generally,15944 case were studied, within them 2.64%were positive for HbsAg. Prevalence in married men was 2.92% whereas prevalence in married woman was found to be 1.97%. In exposed men 9.24% was positive for HbsAg, and in unexposed men 1.52% were positive (absolute risk increase in men= 7.72%, relative risk= 6.08). Among patients wives the ratio was 6.43%, whereas in unexposed women 1.02 found to be positive for HbsAg .Absolute risk increase in wives of affected husbands was calculated 5.41% and relative risk was 6.30 (RRI=530.38%). Discussion: The results support the probability of sexual transmission of hepatitis B in non-riskful sexual contacts ie, between spouses within family. It is now also evident that the transmission is not only from wife to husband, but also from husband to wife by an almost similar rate.

Introduction: To determine the prevalence of Anti-HCV, Anti-HIV and HBS Ag positive in addict prisoners and some related factors for infection. Methods: Descriptive cross sectional study with physical examination and a questionire was performed. Four hundred and seventy nine addict prisoners were interviewed and their blood samples were obtained. Results: Of 479 addict prisoners, 280 (58.45%) were non-N drug abusers and the remaining (41%-54) were IV-drug abusers. Frequency of HCV Ab, HBS Ag and HIV Ab was 131(7.35%), 7 (1.46%) and 5 (1.04%), respectively. The relation between IVDU and Anti- HCV positive was statistically significant. Discussion: Infection with hepatitis C secondary to use of injected drugs is endemic in Hamadan prisoners. Better access to harm reduction strategies is needed in this setting.

Introduction. One of the most common and dangerous diseases is cardiovascular disease (CVD) that hyperglycemia (high blood glucose) is one of its main risk factors regarding huge development of technology. On one hand, and economic problems and on the other, the importanc of pharmaceutical investigations for a drug with the least side-effects is proposed that can be replaced with oral anti-diabetic ones. So, we performed this study targeted to study on the blood sugar decreasing effect of salvia officinalis, garden sage in patients with type II diabetes. Method. This experimental interventional study was a single-blind clinical trial done in Isfahan Cardiovascular Research Center 1998-99. Subjects were 26 type II diabetic patients (30 men, 30 women) reffered from Isfahan Endocrine and Metabolism Research Center. The blood samples were taken for assessing fasting blood sugar (F.B.S) , glycosylated hemoglobin (GHb) and fasting insulin level from each patient. Subjects were simple-randomly divided between two drug and placebo groups. Data was entered by EP16 Software and statiscally analyzed through repeated measures analysis of variance (ANOVA) ,independent t. test by SPSS. By comparison at first and GHb were -1.4 ± 2.48,-0.007 ± 1.4, & of Fasting insulin level were -12.3 ± 131.9 and -9.5 ± 133.6in drug &placebo groups, respectively with no significant differences (P>0.05). Discussion. Notably, in these patients, those factors having an increasing effect on insulin receptors should be followed. Non significant results in this study maybe due to low dosage and insufficient sample size especially with the decreas in FBS level as 25mgldl being higher in drug group than placebo group, although no significant difference was obtained between the two groups, we hope that, more investigations open a new horizon to diabetes mellitus management with lower need to drugs as insulin.

Introduction: Prolonged QTc has been reported in several diseases, including chronic liver diseases. It is assumed that prolonged QTc interval in chronic liver diseases is caused by autonomic system disorders. Methods: In this study, prolonged QTC interval and its correlation with the severity of liver failure or child class cirrhosis was evaluated. QTC interval in 90 cirrhotic patient (17 patients with child class A, 23 with child class 8, 50 with child class C) with different etiologies (55 patients with hepatitis 8, 7 with hepatitis C, 28 with cryptogenic cirrhosis) were compared with 90 group control using 12 leads EKG (50 mm/s speed) interpreted by a cardiologist. Liver cirrhosis has been affirm by clinical finding or sonography and liver biopsy among the patients. Results: Prolongation of QTc interval (> 440 ms) was seen in 43 patients (child class A 5%, child class 8 40%, child class C 70%) (P= 0.0042). The mean of QTc intervals was 0.40 second in child class A, 0.42 second in child class 8 and 0.45 second in child class C. The mean of QTc intervals was 0.40 second in control group. Discussion: This study suggests that child group cirrhosis influences QTC interval as an independent variable.

Introduction: Cirrhosis has pathological specificities representing clinical manifestations. Portal hypertension is a complication of cirrhosis that produces a specific lesion in gastrointestinal system. The most important of these lesions are varices of esophagus and stomach. Other interesting lesions are portal hypertensive gastropathy (PHG), portal hypertensive dudenopathy (PHD), Jejunopathy, and colopathy PHG and PHD are the causes of 8-20% of gastrointestinal bleeding in patients with portal hypertension. Controversies exist regarding the relationship of PHG and PHD with other factors. Because of many complications of gastrointestinal bleeding in Cirrhotic patients we decided to study the relationship of many factors with PHG and PHD. Methods: In a descriptive analytic study we enrolled 120 cirrhotic patients for whom sclerotherapy had not been done. All data about their personal characteristics, serum albumin, prothrombin time, serum billirubin, etiology of cirrhosis, propranolol consumption, previous or present history of gastrointestinal bleeding were obtained from their charts. Endoscopy was done for all of them and H.pylori status by urease test and histopathology was determined.Results: From 120 patients, 41 (34.2%) were female and 79 (65.8%)were male most of whom were between 50-61 years old. All the patients were in age range of 14-73 years old. Result of correlation analysis didnt show a meaningful relation between PHG and PHD with grading of esophageal varices, varices of stomach, history of gastrointestinal bleeding, sex, age, H.pylori status, childs classification and etiology of cirrhosis. The only indirect meaningful relation was between PHG and propranolol consumption (r=-0.28,p<0.01). The only direct meaningful relation was between PHG and PHD (r=0.443,p<0.01). Discussion: Factor analysis showed a more clear cut relationship amongst variables. Grading of esophageal varices , history of gastrointestinal bleeding and childs classification had the first role of correlation with PHG . Propranolol consumption had a negative direction with PHG. Age, etiology of cirrhosis as a significant collection had an indirect effect on PHD by the route of PHG. H.pylori status and sex had a less important role and we can omit them in the other same study.

Introduction: Among the colorectal physiologic tests, the assessment of colonic transit time (C.T.T) is a simple and useful one. The aim of this study was to evaluate the occurance of  C.T.T abnormalities in chronic idiopathic constipation, correlate C.T.T patterns with symptoms, and to evaluate the effect of age, gender, psychological factors, IBS and daily physical activity on total and segmental colon transit.Methods: A total of 31 patients with chronic idiopathic constipation completed questionnaires; and underwent C.T.T by radio-opaque markers. Correlation were performed between the above variables and C.T.T. Results: Out of 31 patients (24 women, 7men; mean age 38.7yr), 14 patients (45.2%) had abnormal C.T.T Colon transit. The results could be categorized into four groups: normal C.T.T (n=17), right colonic stasis (n=6), isolated left colonic stasis (n=7) and rectosigmoid stasis (n=1). There was a significant correlation between the age above 50 yr and abnormal C.T.T (p<0.05). There was also a significant correlation between the hard stool and abnormal C.T.T (p<0.05). There were no correlation between gender, daily physical activity, psychological status, IBS and C.T.T. Discussion: Our study suggested that chronic idiopathic constipation represent a heterogeneous group of disorders. Defining constipation on the basis of patients reported stool frequency is not reliable and ,hard stool is the best reliable symptom. C.T.T study is a simple, useful and noninvasive test for patients with constipation.

Introduction: Alterations in the HFE protein compromise its function and are likely to induce the development of hereditary hemochromatosis (HH). Although most HH subjects homozygous for a Cys282Tyr polymorphism the His63Asp variant of the HFE gene accounts for a fraction of the HH. In this study, We have developed a new assay that combines a multiplex polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) analysis for genotyping suspected HH patients.Methods: The allelic variants of the HFE gene in genomic DNA from 24 subjects were analysed for assay validation. Two pairs of the HFE gene specific primers were pooled into a multiplex reaction whose products were subtyped by digestion with two restriction endonucleases.  Employing optimized PCR buffer, primers ratio and thermocycling regimen prevented PCR products under representing, caused by preferential amplification of the shorter fragment under suboptimal conditions. Results: The selected conditions for multiplex PCR-RFLP allowed uniform, reproducible DNA amplification and restriction endonuclease digestion of both DNA targets within one tube per sample that minimized labor and cost requirements and probability of PCR product carry- over. The results were reproducibly concordant with the data obtained by standard PCR analysis proving that the proposed method is reliable and could be of value in genotypig application.Discussion: The assay is robust and readily adaptable to the clinical molecular diagnostic laboratory.

Introduction: Wilson disease (WD),which is characterized by chronic hepatic inflammation and central nervous system (CNS) disorder, is caused by various mutations on ATP7B .This genetic disorder induces abnormal copper metabolism and its deposition in multiple organs. Considering the increasing role of molecular biology in the diagnosis of WD, mapping the whole mutations of ATP7B is mandatory. Methods: In search for the mutation pattern of ATP7B in Iran for the first time, 30 patients were selected depending on known clinical and para-clinical criteria. Their DNA was extracted and sent for the laboratory study. Results: The patients with a mean age of 16 years old were suffering from hepatic (90%) and CNS (50%) symptoms. The mutation profile in Iranian people was completely different from European population and some new mutations were reported (e.g. (1232)3696 Del; 51392). Discussion: With respect to the wide geographic variation in mutations of ATP7B, using genetic probes for diagnosis and screening of WD is not convenient. Before the availability of commercial diagnostic tools for this purpose, knowledge of the whole mutation map of ATP7B and its phenotypic correlation is indispensable. During this study we found and reported new mutations of ATP7B.

Introduction: Esophageal squamous cell carcinoma is the third most common gastrointestinal malignancy and is ranked among the first ten worldwide. The effect of some genetic mutations especially those involving cell cycle regulation such as p53, and Rb genes in development, progression and prognosis of the disease has been shown: We studied expression changes of these genes in our samples. Methods: The paraffin-embedded tissue samples of 135 patients (68 male and 67 female) with documented esophageal squamous cell carcinoma were provided. The samples were collected from 22 pathology centers in Tehran during a period of 3 years from 1999 to 2001.Using immunohistochemistry method (Avidin -Biotin- Peroxidase), they were stained in our laboratory for detection of p53 , and Rb proteins. The results were expressed as frequency and odds ratio. Mann-Whitney Test was used to find any association between expression changes of these genes and the degree of tumor differentiation in each sample.Results: The mean p SD age of patients was 57.39Þ10.66 (M/F=1) and the highest frequency (40%) was seen in the sixth decade of life. Sixty (44.4%) and 66(48.9%) patients were positive for p53 and Rb respectively. Among those with positive p53, 36(60%) were Rb positive while among those with negative p53, 30(40%) were Rb positive. Comparing with the p53 negative cases, p53 positive ones showed a higher (2.25 times) risk of being positive for Rb gene. We could find no significant difference between p53 gene expression changes and the degree of tumor differentiation in each sample (p>0.5). The results were the same for Rb gene (p>0.5).Discussion: Like other parts of the world, the development of mutation in p53 and Rb genes appears to have a key role in the carcinopathogenesis of esophageal squamous cell carcinoma in Iran. Also a significant association between the frequency of mutations in each of these genes during development of this cancer is likely.

Introduction: Diarrheal diseases are among the most common causes of death in the world, with a greater medical and economical burden in developing countries. In spite of the lack of accurate investigations in developing countries, the problem of diarrheal diseases in these regions is much bigger than it seems.Methods: We reviewed 108 studies about the epidemiology of acute diarrhea pathogens among which 45 were from Iran and compared the findings with other studies from different parts of the world.Results: The pattern of major diarrhea pathogens in our country seems to be different form that of many developed countries. Escherichia coli (E. coli) species have been the most frequently isolated pathogen in Iran, followed by Salmonella, Shigella, and Campylobacter; while in developed countries, Campylobacter has been more prevalent. Among E.coli species, Enteropathogenic Escherichia coli (EPEC) has been reported as the most common species. Salmonella has been the next frequent bacterial pathogen, with S. enteritidis, S. typhimurium, and S. typhi being the most common species. Shigella has been positive up to 71.35 percent in bloody diarrhea. Among Shigella species, S. flexneri, S. sonnei, S. boydii, and S. dysenteriea have been reported in a decreasing order of frequency. Yersiniosis has been found infrequently in Iran, where pork is never used. A few studies that have investigated viral agents in diarrhea samples, propose that rotaviruses have been positive in about 17 percent of cases, particularly in children between six months and two years. The frequency of Giardia lamblia infection has been detected in three of the studies in acute diarrhea and has been about 3.5 percent. The studies that investigated antimicrobial resistance of diarrhea pathogens have shown that EPEC has been resistant to ampicillin, penicillin, erythromycin, chloramphenicol, trimethoprim-sulfomethoxazole, and tetracycline; Salmonella to penicillin, erythromycin, ampicillin, colistin, tetracycline, and streptomycin; Shigella to penicillin, colistin, rifampin, and ampicillin.Discussion: Most studies indicate that the frequency of diarrhea decreases as the age increases. We recommend that multiple cross-sectional studies has to be done in different parts of Iran in order to identify the incidence of diarrheal pathogens in the country and the foundation of a specialized center capable of controling diarrhea  outbreaks in Iran is of utmost importance.

We present the case of a 3D-year-oldman, who was admitted to our institution with jaundice.He had nausea, anorexia, pruritis, dark urine and epigastric & RUQ shooting pain radiating to back and lasting for 10 days, with no other evidence of a generalized disease. Liver function tests were abnormal but other laboratory studies were almost within normal limits. lmaging procedures revealed multiple small gallstones plus a cystic lesion, 5 by 5 cm in diameter, in the left lobe of the liver. The patient underwent an elective cholecystectomy, hepatic needle biopsy and excisional biopsy of liver mass. The pathology report ascertained the presence of a benign mesenchymal hamartoma of the liver. Needle biopsy was normal.