Iranian Journal of Medical Sciences
Year:2007 | Volume:32 | Issue:4|Papers Count:15

Background: Atrial fibrillation (AF) is one of the most common arrhythmias after coronary artery bypass graft (CABG) surgery. AF can result in hemodynamic instability, thromboembolic events, increase the perioperative myocardial infarction, congestive heart failure, stroke, more length of hospital stay (LOHS) and cost of treatment. The aim of this study was to evaluate the independent effect of digoxin in preventing AF after CABG in patients who had a predictor for AF and had already been on other anti-arrhythmic drugs.Methods: In a prospective randomized clinical trail, using alternate randomization, 239 patients categorized into three different groups. Group one consisted of 72 patients who had at least one predictor for developing AF after CABG.Group two consisted of 67 patients with the same predictors who received 0.5 mg intravenous digoxin after disconnecting from bypass pump followed by 0.25 mg intravenous digoxin one hour and four hours later. Oral daily digoxin (0.25 mg) was continued from the first post operation day to the 14th day with 2 days off per week. One hundred patients without those predictors for AF were randomly allocated in group three to confirm the impact of those predictors on developing AF.Results: AF occurred in 16 patients (22.2%) in group 1, six patients (8.8%) in group 2, and seven patients (7%) in group 3.The duration of AF was 6.43±4.23 min in group 1, 1.2±1.41min in group 2, and 47.18±67.29 min in group 3.Conclusion: Intraoperative digoxin can independently decrease the incidence of AF after CABG surgery in patients with high risk factors for AF.

Background: Some antigens of H. pylori are excreted into the stool of infected people. These antigens can be used to detect the infection by immunoassays such as ELISA. Our aim was to identify these antigens by immunoblotting and affinity chromatography techniques.Methods: Four different antigenic preparations, namely, whole cell sonicate (WCS), outer membrane proteins (OMPs), cytoplasmic antigens (CAs) and cell surface-associated antigens (CSAAs) were obtained from H. pylori. Rabbit antiserum against these preparations was used to detect them in fecal antigenic extracts (FAEs) of infected patients.Results: By immunoblotting, we were able to detect a 26 kDa band in the positive stool samples. Anti-OMPs acted more specifically, so, it was used to isolate the Helicobacter pylori diagnostic antigens (HpDAs) from the stool. More antigens (at least 4 antigens with the molecular weights of about 14, 26, 55 and 57 kDa) were isolated by affinity chromatography. But, the 26 kDa antigen had a higher concentration and was seen in almost all positive samples.Conclusion: Since the 26 kDa antigen is detectable by these two techniques in all positive samples, we are confident that this antigen is one of the major antigens of H. pylori, which is released into the stool and can be considered as a candidate diagnostic antigen to be used in diagnostic kit development.

Background: The purpose of this study was to calculate and compare the specificity and sensitivity of impulse oscillometry (IOS) as a new technique in the detection of airways dysfunction by means of a simple pulmonary function test in chemical warfare injured cases suffering from respiratory diseases.Methods: The study was performed prospectively in 100 patients, who complained of dyspnea as a result of sulfur mustard gas exposure in the Iran-Iraq war, between 1981 and 1988. Following a physical examination, IOS and spirometery were performed for all the patients. Then, the specificity and sensitivity of IOS parameters were calculated and compared with those of spirometery.Results: With a routine cut-off point, R at 5Hz and R at 20Hz have a sensitivity and specificity of 48.9%, 70.4% and 40.0% and 85.2%, respectively. With a normal cut-off point of R at5Hz=<240 or R at20Hz=<180 or x at5Hz=>-0.20 kpal/l/s, there is a 100% specificity (PPV=100%).Conclusion: While IOS is a new, cooperation independent technique and specific in the detection of airways dysfunction, it is less sensitive than spirometery in spotting small airways obstructions. IOS is a good diagnostic method in the detection of pulmonary involvements in uncooperative patients.

Background: The status of measles elimination is best summarized by evaluation of the effective reproduction number R; maintaining R < 1 is necessary and sufficient to achieve elimination.In the present article, we estimated reproduction number R for the measles data reported for the Fars province of Iran in 2001–03.Methods: We estimated R by using sizes and durations of chains of measles transmission and the proportion of cases imported, when offspring distribution is either Poisson or geometric. In each case, we calculated the profile 95% confidence intervals. These comprised 575 cases, forming 191 chains of transmission, of which 79 had > 1 case. 128 cases were classified as importations.Results: The results using the Poisson and geometric distribution for offspring and the proportion of cases imported differed slightly, but all 3 methods gave an R < 1. The results were not sensitive to the minimum size and duration of outbreak considered, as long as single-case chains were excluded, or to exclusion of chains without a known important source.Conclusion: These results demonstrated that susceptibility to measles was beneath the epidemic threshold and that endemic transmission was eliminated.

Background: The purpose of this study was to determine the relationship between early onset sepsis and increased levels of Creactive protein (CRP) and interleukin-6 (IL-6) in cord plasma.Methods: A prospective study was conducted in 141 premature infants delivered with gestational ages of 26-35 weeks.IL-6 and CPR were measured by enzyme-linked immunoassay in the cord plasma of the neonates. According to clinical, laboratory findings and blood culture results, newborn infants were allocated into four groups (A-D): documented early onset infection, clinical sepsis, possible infection, and control groups respectively.Results: Mean IL-6 levels in group A-D was 264, 212, 160, and 33.3 pg/ml respectively. Difference between groups was statistically significant (p=.002). With cut off point of 18 pg/ml, the sensitivity and specificity of IL-6 for diagnosis of early onset sepsis was 72% and 55% respectively. There was not significant difference between mean levels of CRP among groups (p=0.28).Conclusion: Having considered the relatively good sensitivity and moderate specificity of cord IL-6, using this test can be recommended as a useful detector of early onset sepsis and non-infected sick neonates.

Background: It was shown that olive leave extract has antifungal, antibacterial and antiviral activities. The effects of OLE on herpes simplex virus-1 (HSV-1) have not been systematically investigated yet. The aim of this study was to examine the in vitro effect of olive leaf hydroalcoholic extract (OLHE) on HSV-1.Methods: Veridical effect and viral replication in Vero cell line were studied in the presence of various concentrations of OLHE applied at different time intervals using a standard plaque assay method. The 50% cytotoxic concentration (CC50), 50% inhibitory concentration (IC50), and therapeutic index of OLHE were determined.Results: OLHE showed veridical effect on HSV-1 in concentrations >1 mg/mL. The CC50 of OLHE for Vero cells and IC50 were 1.75 and 0.66 mg/mL, respectively. When applied to cell culture infected with the HSV-1, one hour earlier, OLHE showed no antiviral activities. When applied to the cells followed by the virus infection one hour later, or to the media containing the virus and the combination was added to cell culture one hour later, OLHE showed anti-HSV-1 activities at concentrations >1 mg/mL.Conclusion: OLHE has anti-HSV-1 activity likely due to the prevention of virus entry into the cells.

Background: Calcium overload and free radical mediated damage in the mitochondria is the most important pathological changes associated with myocardial ischemicreperfusion injury. The verapamil post-treatment has been previously reported to prevent reperfusion-induced myocardial injury but functional recovery may be delayed due to the drug's inherent direct myocardial depression effect.In the present study the effect of verapamil on mitochondrial enzymes and sarcoplasmic ATPase system was examined during the myocardial preconditioning and ischemic reperfusion in rat heart.Methods: Four groups of isolated rat hearts were perfused with KH buffer in a retrograde manner by Lagendroff apparatus.A time controlled ischemia, ischemic reperfusion and classical precondition was produced by restoring the flow of KH buffer in ischemic rat heart. The hearts were then processed to isolate the mitochondria and sarcoplasmic reticulum for the biochemical estimation.Results: Mitochondrial enzyme and sarcoplasmic ATPase activities were diminished in the ischemic period and further decreased during reperfusion. However, preconditioning the rat heart before the insult of ischemia and reperfusion improved the enzyme activities. The preconditioning procedure consisted of 4 cycles of 4 min. short ischemic periods followed by 4 min. KH buffer perfusion applied before 30 min. global ischemia and reperfusion caused an improvement in the mitochondrial enzyme activities. On the other hand, sarcoplasmic ATPase enzymes required a precondition procedure of 7 cycles of 2 min. short ischemic periods followed by 2 min. reperfusion. The activities of the above enzymes were improved further when verapamil was administered before the insult of ischemic reperfusion.Conclusion: This study shows the beneficial effect of classical preconditioning with verapamil.

Background: Molecular genetic factors regulating hemoglobin F (Hb F) expression are important modifiers of the severity of sickle cell anemia (SS).Methods: The prevalence of XmnI polymorphic site, the Gg:Ag ratio and the Hb F level were determined using PCR-RFLP procedure, HPLC and alkaline denaturation method, respectively, in various haplotypes of 52 patients with SS, 18 patients with sickle/b-thalassemia (S/Thal), 17 with sickle cell trait (AS) and 53 normal subjects from Fars and Khuzestan provinces who attended the Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran during 2002–03.Results: The prevalence of XmnI (+/+) site in patients with SS was 53.8% which was higher than that for S/Thal (23.5%), AS (22.2%) and normal individuals (7.5%). There was a correlation between the presence of XmnI site and high Gg:Ag ratio in SS and S/Thal patients with Arab-Indian homozygous or heterozygous haplotypes (contingency coefficient=0.43, P=0.002). In the present study, the Hb F level was significantly higher in SS patients with one or two Arab-Indian haplotypes as compared to Bantu, Benin and Cameroon haplotypes. However, the Hb F level was significantly higher in patients with S/Thal having two XmnI sites carrying Arab-Indian and Senegal haplotypes as compared to Bantu, Benin and Cameroon haplotypes. The increasing effect of presence XmnI site on Hb F level appears only when hemolytic stress is present as in SS and S/Thal patients (contingency coefficient=0.35, P=0.01).Conclusion: The presence of XmnI polymorphic site in haplotype backgrounds of Arab-Indian and Senegal in sickle cell anemia is correlated with high level of Hb F and Gg:Ag ratio.

Hospitalized patients have a potential risk for nosocomial infections. Airborne fungi are one of the main causes of fungal infections in this group. The objective of this study was to investigate the concentrations and species of airborne fungi in two general hospitals in Shiraz, southern Iran. Air samples were collected from high-risk wards, using settle plate method. Fungal colonies were identified, enumerated, and reported. A total of 1075 microbial colonies were detected, 419 of which were fungi. Fungal isolates from two hospitals belonged to 15 genera. 4.25% of rooms in hospital A and 16% in hospital B were clean rooms.Cladosporium followed by Aspergillus spp were the predominant genus in two hospitals studied. The highest fungal deposition rates were 1016 and 1797 CFU/m2 in Emergency and Surgery rooms. Monitoring airborne fungi is one of the best ways for prevention and control of these infections. Caring for high-risk patients in hospital rooms has lead to reduced rates of nosocomial fungal infections.

Mycetoma is a chronic and pustular infection usually involves foot. Mycetoma in Iran is not common and most cases have been reported from the South and North of Iran. The objective of present study was to review the mycetoma and the distribution of its etiologic agents in Iran. Moreover, a 60-year-old woman with actinomycetoma lesions in her left foot was presented.Direct smear of the grains showed positive, non-acid fast and branching filaments of actinomycetes. Negative result was obtained from the cultures of grains.

Herein, we reported on a case of solid type of pulmonary actinomycosis in a 10-year-old boy. He had productive cough for 40 days. Bronchoscopy was normal. Cmputed tomography revealed a solid large mass in the upper lobe of his left lung with mimicking malignant leisions. He was referred for surgery and underwent left upper lobectomy. Macroscopically, the specimen measured 13×9×5 cm and was creamy to whitish on cut section. Microscopic findings included a large number of inflammatory cells and colonies of actinomyces. Pulmonary actinomycosis should be included in the differential diagnoses of pulmonary mass lesions, especially in the young adults.

Blueberry muffin rash is a characteristic multiple bluish skin nodules associated with perinatal infection, severe and chronic anemia, and neoplastic infiltrative diseases. We present an unusually severe case of hemolytic disease of the newborn. He required exchange transfusions for several times. The complete work up led to the diagnosis of anti-Cw. The skin lesion regressed spontaneously within one month.

Brain foreign bodies and penetrating missile injuries of the brain are familiar topics for Iranian physicians, especially after Iran and Iraq war. But it’s not easily plausible that there is a couple of sewing needles in the cranium of a patient who has not any history of head trauma or penetrating injury. The patient was a 42-year-old man who admitted in neurology ward of Mottahari Hospital in Urmia city with a complaint of headache.Brain computed tomography revealed some hyperdense foci with artifact shadows adjacent to them in frontoparietal region of the brain. Skull plain radiography indicated two sewing needles in his cranium. Probably these needles were inserted in cranial fossa at infancy when the fontanels were steel patent.

This book explores the mathematical view of selected body systems and organs and as claimed by its author, “it has an objective to facilitate modern treatment with mathematical precision.”The author, Dr. Adhikari has PhD in mathematics and is the Head of the Institution and Department of Mathematics, Ghusuri Uchcha Madhyamic Vidyalaya, West Bengal, India. The motivation of the author in writing this book has been the mathematical views and ideas of Leonardo DaVinci and Rene Descartes on structural anatomy and physiological principles, respectively. He expects the physicians, medical surgeons and research workers to use his book in calculating physiological movements.The book comprises of 14 chapters, which shall be approached as follows: The first chapter is the preface and the second devotes to the introduction of Leonardo Da Vinci as the “anatomist of great ability.”The third chapter is devoted to “physiological concepts of Rene Descartes” on human physiology, followed by detailed mathematical explanation of his concept of pineal gland throughout the fourth chapter.The fifth chapter focuses on "the mechanism of movements of heart.” In this chapter, the author introduces the thermo-dynamical movement as the cause of contraction and expansion due to the variation of heat carried by blood into the heart. In the sixth chapter, the author expresses the causes of cervical and cartilage deformations on a mathematical basis. The traction weights for different injury levels are tabulated at the end of this chapter. Throughout the seventh chapter, he analyzes the structure and mechanism involving in the skeletal shoulder-joint and its efficiency through mathematical processes.

A 35-year-old man presented with severe headache and left sided hemiparesis since one day prior to admission. He reported frequent bouts of oral and genital aphthous ulcers, an attack of deep venous thrombosis of left lower extremity, one episode of right knee arthritis, and several attacks of headache, neck rigidity, and fever. He had been a victim of mustard-gas poisoning at the time of Iran-Iraq war (14 years before). The symptoms of poisoning were tearing, photophobia, dyspnea, nausea, vomiting, anorexia, and papules and pustules on legs that were the sites of exposure to the gas. These symptoms had improved after about 2 months but he experienced reactivation of skin symptoms in the same parts of the body in the following years.