IRANIAN JOURNAL OF MEDICAL SCIENCES (IJMS)
Year:2005 | Volume:30 | Issue:4|Papers Count:14

Never in the human history have so many changes happened in the life style and the environments. This was done due to the revolution in the science and technology.During last decades, reproductive medicine as a whole and male infertility in particular has changed tremendously. This change happened in the field of proper evaluation, findings of numerous etiological factors such as anatomical, genetic environmental, underlying diseases and so on. This helped clinicians to have more relevant understandings regarding this social problem that has roots in the history of man kind as well as civilization. The knowledge about infertility paralleled with the progress made in the techniques of the treatment.

Exposure to pesticides could be one of the contributing cause to the falling sperm counts and rising levels of male infertility.Adverse effects of pesticides in the environment first received widespread attention in the 1960s. However, only recently it has been postulated that long term, low exposure of these chemicals are increasingly linked to human health effects such as immuno-suppression, endocrine disruption, reproductive abnormalities and cancer. This article critically reviewed the epidemiological studies of reproductive toxicity of different pesticides in males. According to previous studies it is shown that exposure to pesticides was significantly associated with sperm levels well below the limit for male fertility. No large-scale studies assessing pesticide exposure and its relationship to infertility have been done. To overcome the difficulties in interpretation and to reach strong conclusions, future studies on human male reproductive effects of different types of pesticides should consider several methodological problems. So, we conclude integrated studies considering many factors are warranted to draw definite conclusion and also in the view of adverse health effects observed to some extent in workers with few pesticides, it is necessary now to find out ecologically sound alternatives to pesticides and also to educate the workers/farmers about the safe use of these pesticides to reduce reproductive health risk associated with exposure.

Background: Obsessive-compulsive disorder (OCD) symptoms and the related disorders are subsumed under chronic psychiatric disorders which are of psychosocial and therapeutic importance. In most studies, the mean age of onset of significant OCD symptoms is adolescence period. The aim of this study was to evaluate OCD symptoms, Tic disorder, Body Dysmorphic Disorder (BDD) and Trichotilomania among middle school students in Shiraz, Iran.Method: From the four educational district of Shiraz, South of Iran, 1682 middle school students, aged 14-16 yrs-old, were selected using a cluster random sampling. Persian standardized Moudsely Obsessive-Compulsive Inventory was used to assess obsessional symptoms. For evaluating BDD, Tic Disorder and Trichotilomania symptoms, a semi-structured interview was done according to Diagnostic and Statistical Manual-IVTR (DSM-IV-TR) criteria.Results: Students with more obsessional symptoms were mostly girls and showed more positive family history. They were more likely from low socioeconomic class, and their average school grades were lower. They also showed high association with BDD and Tic disorders.Conclusion: This study confirmed body dysmorphic and Tic disorders to be more prevalent in individuals with obsessive-compulsive disorder symptoms. Girls, especially those from lower socioeconomic class, demonstrated increasing obsessional symptoms. Obsessive-compulsive disorder symptoms were found to affect school performance so its early diagnosis and management should be considered as a mental health priority.

Background: Leukoaraiosis (LA) or white matter thinning and rarefaction are common in stroke patients. This pilot double- center study was designed to evaluate LA risk factors in stroke patients.Methods: This cross sectional study was conducted on 100 consecutive stroke patients in Waiter Mackenzie Hospital, Canada and 100 consecutive stroke patients in Valie-Asr Hospital, Iran in 2004. Diagnosis of ischemic stroke and LA was performed by stroke neurologists using CT scan. The effects of race, gender, age groups, hypertension, diabetes, hypercholesterolemia and smoking on frequency rate of LA were evaluated.Results: The frequency rate of LA was the same in stroke patients living in North America or Iran. But, the frequency of LA in female stroke patients was more frequent than males (p<0.005). LA was significantly predominant in stroke patients with age ³ 65-yrs than those with age<6S-yrs (p<0.05).The frequency of LA was significant in hypertensive patients.However, the frequency rate of LA was not influenced by diabetes, hypercholestrolemia and smoking.Conclusion: Female gender, age and hypertension seem to be the main risk factors of leukoaraiosis. In addition, there was no difference between the frequency rates of LA in patients living in Iran or North America.

Background: Pentoxifylline (PTX) is used in human for intermittent claudication and cerebral vascular disorders including cerebrovascular dementia. It also inhibits the synthesis of tumor necrosis factor-a (TNF-α), which is believed to be neurotoxic in animal models of cerebral ischemia. The objective of this study was to examine the role of PTX on ischemia/reperfusion injures in rat model of transient focal cerebral ischemia induced by middle cerebral artery occlusion (MCAO).Methods: Male Sprague Dawley rats (n=31) were assigned to sham, saline or PTX (30 or 60 mg/kg)-treated groups. Ischemia was induced by MCAO, followed by 24-hrs reperfusion.Intraperitoneal saline or PTX was administered at 30 min before ischemia. Neurological deficit score test (NOS) was performed after 24-hrs, and the animals was sacrificed for evaluation of cortical and striatal infarct volumes using triphenyltetrazolium chloride staining.Results: The sham group did not have neural dysfunction or cerebral infarction. Cortical infarct volumes in 30 or 60 mg/kg PTX-treated groups, 149±12 and 129±19 mm3 respectively, were significantly lower than that of saline-treated group (208±12 mm3). Similar results were also obtained about the striatal infarct volumes (39±5 and 40±6 vs. 58±5mm3). However, there was no significant difference among the neurological dysfunctions from saline and PTX-treated rats.Conclusion: the results of this study indicate that pentoxifylline reduced cerebral infarctions, possibly by diminishing the TNF- a-induced neurotoxicity in transient focal cerebral ischemia. This finding also suggests that pentoxifylline might be suitable for clinical trials.

Background: P wave dispersion (PWD) is defined as the difference between the maximum P wave duration (Pmax) and the minimum P wave duration (Pmin) in 12-leads of the surface electrocardiography. The aim of this study was to evaluate the values of PWD during atrial fibrillation (AF) after acute myocardial infarction (AMI).Methods: We prospectively evaluated atrial rhythms of 350 patients (251 males, 99 females) at their first AMI. The measurements included left ventricular ejection fraction (LVEF) and left atrial dimensions (LAD) by means of echocardiography.On admission an ECG was obtained and repeated daily during hospitalization.Results: Fifty patients had AF after AMI. Pmax was significantly higher (140.8±18.9 ms) among patients with AF than patients without AF (106.5±17.3 ms). This was also true about Pmin (66.4±18.3 ms vs. 57.7±15.7 ms), PWD (74.4±20.6 ms vs. 48.7±18.9 ms) and LVEF (35.2±9.4% vs. 39.3±10.9%).Whereas, there was no significant difference between the two groups in respect to LAD (36.5±7.4mm vs. 35.1±5.9 mm) Conclusion: Based on the univariate analysis results, Pmin Pmax, PWD, LVEF and age were significant predictors of atrial fibrillation in patients with first acute myocardial infarction.However, multivariate analysis failed to disclose such independent predictors for atrial fibrillation in these patients.

Background: Upper gastrointestinal (GI) bleeding remains a problem in critically ill-newborns. The use of H2 blockers, by maintaining gastric pH≥4, reduces the risk of stress-ulceration and gastric hemorrhage. This study therefore, has evaluated the effects of short-term prophylactic ranitidine in controlling gastric pH and prevention of GI bleeding in neonates.Methods: This randomized controlled study was carried out on 80 neonates admitted to Neonatal Intensive Care Unit ward of Nemazee Hospital, Shiraz, Iran. They were randomly divided into case and control groups and their gastric pH, stool occult blood and macroscopic bleeding were determined. Intravenous ranitidine was administrated (5 mg/kg/day) for four days in case group. Their gastric pH was measured before, one hrs, and two or three days after injection and successful prophylactic treatment was considered if gastric pH was ³4. Results: Upper GI bleeding was observed in 41% of all patients. After ranitidine, there was a significant increase in gastric pH which accompanied with the reduction of the frequency of upper GI bleeding. Furthermore, no significant changes were noted in gastric pH of control group.Conclusion: Prophylaxis with ranitidine seems to reduce the frequency of upper GI bleeding by significantly increasing gastric pH.

Background: Turner syndrome (TS) is a sporadic disorder caused by the absence of all or some parts one X-chromosome with major developmental consequences such as short stature and ovarian failure etc. The minor manifestations of TS are cubitus valgus, micrognatism, high-arched palate, short and/or webbed neck, hypothyroidism, etc. Different karyotype abnormalities may lead to different clinical features; therefore, in this study we have tried to postulate karyotype-phenotype correlations in these patients.Methods: In order to assess karyotype-phenotype correlations, 209 proven TS patients were studied and chromosomal analysis was performed on the basis of G-banding technique at high resolution.Results: According to cytogenetic findings, karyotype abnormalities were classified into four groups: classic form 19%; mosaic form 76%; long arm isochromosome 4% and short arm deletion 1%. Clinical manifestations were more severe in classic TS rather than the other forms of chromosomal abnormalities.Conclusion: The results of this study suggest that karyotype variations might affect phenotype of Turner syndrome. Therefore, chromosomal investigation for all suspected cases of Turner syndrome should be considered in order to approach an appropriate treatment protocol.

Background: Preeclampsia along with its complications seems to be one of the major causes of maternal morbidity and mortality. Despite numerous studies, the pathology of preeclampsia has not yet been fully elucidated. This study, therefore, determines whether maternal serum levels of androgen and progesterone are higher in patients with preeclampsia than in matched control subjects. Methods: Serum progesterone, free and total testosterone, and dehydroepiandrosterone levels were measured in 19 women in their third trimester of pregnancy having preeclampsia, as patient group, and in 17 healthy normotensive pregnant women, as control group, with similar maternal and gestational ages. All women were primigravida with singleton pregnancy.Results: There were no significant differences between the two groups in body mass index, maternal and gestational ages.Progesterone and free testosterone levels were significantly lower (P<0.01) in patients (75.1±8.6 ng/dl and 2.27±1.74 pg/dl) than of control group (111.6±9.71 ng/dl and 3.73±1.31 pg/dl). Whereas, the levels of total testosterone (1.02±0.10 ng/dl vs. 1.37±0.19 ng/dl) and dehydroepiandrosterone (0.99±0.13 µg/dl vs. 0.98±5.15 µg/dl) of patients and control groups were not significantly different.Conclusion: Levels of progesterone were pathologically and statistically lower in preeclampsia than of control women with similar age, gestational age and body mass index. It seems that accentuate increase sex hormone binding globulin is the cause of deceased free testosterone in preeclampsia.

Anthracosis is black pigment discoloration of bronchi which can cause bronchial destruction and deformity (anthracofibrosis).A prospective, case-control study was performed to evaluate potential underlying causes of anthracosis on 190 subjects who referred for various indications. Age of patients ranged from 10-85 yrs. 46% of male patients were farmers and 27% were manual workers, whereas 91% of female patients were housewives. During bronchoscopy, special attention was given to anthracotic plaque, bronchial deformity, infiltration, or vegetation. Broncho-alveolar lavage was performed for further cytopathological, acid-fast bacilli staining (AFB) and culture in all cases. No correlation between occupational exposure to dust and two kinds of anthracosis (anthracotic plaque and antracofibrosis) was present. In anthracofibrotic patients, 81% were nonsmokers.The principal finding in bronchoscopy was simple plaque of anthracosis in 21% and anthracofibrosis in 12%. Sputum smear showed macrophages containing anthracotic granules in 71%. Patients with anthracosis had positive histopathology for tuberculosis (21%) that was not significantly different from subjects without anthracosis. Of 40 patients with simple anthracotic plaque and 22 with anthracofibrosis, only two and one patients, respectively were proven to have bronchogenic carcinoma that was not statistically more common than in the control group. Other etiology for anthracofibrosis should be investigated.

Behcet's disease is a multi system vasculitis. Its neurological involvement mostly includes parenchymal and nonparenchymal central nervous system manifestations. Peripheral nervous system presentations are rare. A 32-yr-old male patient who fulfilled the international study group criteria for Behcet's disease, referred to our center with walking difficulty and repeated falling downs. Neurological examination revealed weakness, wasting and fasciculation of distal muscles associated with corticospinal signs. Neuroimaging data were insignificant but electrodiagnostic studies were in favor of motor neuron disease. To best of our knowledge, this is the first report of association of amyotrophic lateral sclerosis (ALS) and Behcet's disease.

A 65-yrs-old man referred for an ocular discomfort and red eye. The clinical diagnosis was leech in the left eye and its species confirmed as being Limnatis nilotica. Ocular leech infestation should be considered in patients with a history of swimming or washing their face in streams and lakes. Attention should also be given to ocular leech infestation in the differential diagnosis of ocular trauma with iris prolapse.

Wart is a common dermatologic disease caused by infection with various strains of human apilloma virus, and mostly seen in children. Age, immunologic status and compliance of the individual, as well as extent and the duration of the lesion may help to determine the treatment modality.

Intercellular adhesion molecules-1 (ICAM-1) is a glycoprotein belongs to the immunoglobulin superfamily, and constitutively expressed by endothelial cells and some leukocytes. It can be induced in many other cell types in vivo as well as in vitro. ICAM-1 does not express on colonic tissue and gastric normal epithelial, but it express on malignant cell surface on both colon and gastric cancer as well as some other malignant. In addition, in vitro studied show ICAM-1 is shed by tumor cell line and is detectable in cell culture supernatants. In addition, the surrounding infiltrated lymphocytes in cancer tissue, express the ICAM-1 and this protein molecule as tumor activity or immune response function or both could be detect in tissue environment or circulation. Although, ICAM-1 has been identified on different origin of tumor, it has not been known as a tumor antigen marker. We tried to determine the human soluble ICAM-1 in the serums by sandwich enzyme immunoassay principal. The ICAM-1 molecule levels in both gastric and colon cancer patients before operation were determined 701±189 ng/ml and 761±205ng/ml respectively. The level of ICAM-1 increased approximately by four folds in the patient group. In post-operative state the reduction level was 26% in gastric cancer and 19.3% for colon cancer group respectively. In a comparative analysis it was concluded that the fluctuation of ICAM-1, CEA and CA19-9 in patient serums was independent from each other. Maruo et al indicated a physiological sICAM-1 level equal to 262±64 ng/ml for healthy persons. Similar data was indicated by Alexions et al. These ranges of the protein molecules could be considered for healthy persons However, in patient with positive metastasis the ICAM-1 concentrations were much higher. In our study, the serum level of majority of patients show elevated CA19-9, CEA levels that indicated a sign of developing malignancy; this augmentation is similar with sICAM-1 concentration in patient serums. Similar conclusions were achieved by polychronidi and others, but using sICAM-1 molecule as a definite tumor marker (tumor association marker) has been stated that needs more confirmation. In the present study the serum levels of ICAM were higher in tumor with well-differentiated grade than the other two pathological grades. However, the percentage of patients who their protein markers remain constant with pre-operative state for sICAM-1 was lower than the both CEA and CA19-9. This might be an advantage for sICAM-1, but it still needs more sought.