IRANIAN JOURNAL OF MEDICAL SCIENCES (IJMS)
Year:2009 | Volume:34 | Issue:3|Papers Count:13

Sulphur mustard is a chemical warfare agent, which was largely used during the World War One and in Iraq-Iran conflict. It may also be used as a chemical terrorism agent. Therefore, medical professions should have sufficient knowledge and be prepared for medical intervention of any such chemical attack. Sulphur mustard exerts direct toxic effects on the eyes, skin, and respiratory tract, with subsequent systemic actions on the nervous, immunologic, hematologic, digestive, and reproductive systems. It is an alkylating agent that affects DNA synthesis and thus, delayed complications have been considered since the World War One. Cases of malignancies in the target organs particularly in hematopoietic, respiratory, and digestive systems were reported. Common delayed respiratory complications include chronic bronchitis, bronchiectasis, frequent bronchopneumonia, and pulmonary fibrosis, all of which tend to deteriorate with time. Severe dry skin, delayed keratitis, and reduction of natural killer cells with subsequent increased risk of infections and malignancies are also among the most distressing long-term consequences of sulphur mustard intoxication. However, despite extensive research that has been conducted on Iranian veterans during the past decades, major gaps continue to remain in the sulphur mustard literature. Immunological and neurological dysfunctions and the relationship between exposure to sulphur mustard and mutagenicity, carcinogenicity, and teratogenicity are important fields that require further studies, particularly on Iranian veterans with chronic health problems caused by sulphur mustard poisoning. There is also a paucity of information on the medical management of acute and delayed toxic effects of sulphur mustard poisoning, a subject that greatly challenges the medical professions.

Background: Recurrent abortion is defined as three or more consecutive pregnancy losses. We aimed to determine the relationship between male sperm parameters and hypo-osmotic swelling score and recurrent abortion. We also studied whether washing of spermatozoa and intrauterine insemination in patients with recurrent miscarriage and low score hypoosmotic swelling test in male partners could improve the outcome of pregnancy.Methods: Between February 2003 and September 2006 in gynecology clinics affiliated to Shiraz University of Medical Sciences, 176 women with a history of recurrent abortion and their male partners were selected as study group. And 159 healthy and fertile couples without a history of recurrent abortion were selected as control group. The relationship between male sperm parameters and hypo-osmotic swelling test and recurrent spontaneous abortion in their female partners was evaluated after intrauterine insemination for those with abnormal hypo-osmotic swelling test. Outcome of pregnancy in patients with recurrent abortion whose male partners had low score hypo-osmotic swelling test was evaluated after intrauterine insemination. Results: Low scores of hypo-osmotic swelling test were more frequently seen in the study group than the controls: 116 (65%) versus 24 (15%). The mean hypo-osmotic swelling score was significantly lower in the study group (P< 0.001). The outcome of pregnancy improved after intrauterine insemination in those with low score hypoosmotic swelling test. The pregnancy success rate in the treated group (pregnant with intrauterine insemination) was 77.77% while in the untreated group (pregnant without intrauterine insemination) was 30.76% with a success rate ratio of 2.04.Conclusion: There was a positive relationship between low hypo-osmotic swelling test score in male partners and recurrent abortion in their wives. Intrauterine insemination improved the outcome of pregnancy in these couples.

Background: Serum prolactin level has been used as an alternative determinant to help differentiate epileptic from non-epileptic seizures. We aimed to analyze the association between serum prolactin concentration and epileptic seizure versus febrile seizure as well as seizure duration, single versus multiple seizure attacks and time lapse between seizure onset and blood sampling.Methods: Seventy patients aged 6 months to 5 years with seizure who admitted to the emergency department between March 2004 and February 2005 were selected and divided into group I (epileptic seizure) and group II (febrile seizure). Group III consisted of 35 pediatric patients without seizure. Blood samples were collected within 2 hours after seizure. Serum prolactin levels were measured, and statistical analyses were performed to detect possible associations between variables. Results: Serum prolactin level increased about twice the normal level after epileptic seizures but not after febrile seizures or in the control group. The length of seizure and multiple seizure attacks were positively associated, whereas the lapse between seizure onset and blood drawing was negatively correlated with an increase in serum prolactin level. Conclusion: Febrile (non-epileptic) seizures were not associated with increased serum prolactin level. Elevated prolactin level within 2 hours of a seizure may be suggestive of epileptic origin of the seizure.

Background: Alzheimer's disease is the most common form of dementia in the elderly. Serum levels of homocysteine have been related to increased cortical and hippocampal atrophy. We aimed to determine the serum levels of homocysteine, folate, and vitamin B12 in patients with Alzheimer's disease. Methods: Blood levels of homocysteine and its biological determinants, folate, and vitamin B12 were measured in 51 patients who were diagnosed as having Alzheimer's disease according to DSM-IV criteria and compared with the serum levels obtained from 49 control individuals. Results: The mean serum homocysteine concentration was significantly higher in patients with Alzheimer's disease than the controls (20.4±16.5 mmol/L v 14.5±5 mmol/L; P= 0.02). There were no statistically significant differences between the mean serum levels of vitamin B12 (P=0.6) and folate (P= 0.3) in the patients and the controls. There was no correlation between age and serum homocysteine concentration in both groups (P= 0.8).Conclusion: Serum homocysteine concentration was significantly higher in the patients with Alzheimer's disease. This biomarker might be considered as a predictor of cognitive performance.

Background: Aberrant methylation of cytosine-guanine dinucleotide islands leads to inactivation of tumor suppressor genes in breast cancer. Tumor suppressor genes are unmethylated in normal tissue and often become hypermethylated during tumor formation, leading to gene silencing. We investigated the association between E-cadherin (CDH1) and estrogen receptor-a (ESRa) gene promoter methylation and major clinical and pathological features of breast cancer in Iranian women.Methods: DNA was extracted from 67 primary breast tumors and gene promoter methylation was ana yzed by methylationspecific polymerase chain reaction method.Results: Fifty percent of the samples showed aberrant methylation in at least one of the two tested loci. We detected CDH1 hypermethylation in 41% of invasive tumors and receptor-a gene hypermethylation in 18% of invasive tumor samples. We found no association between CDH1 and receptor- a gene hypermethylation (P=0.45). There was a correlation between hypermethylation of CDH1 locus and tumor size ³5 cm (P=0.019).Conclusion: Our data suggest that the malignant progression of human ductal and lobular breast carcinoma in Iranian women involves a heterogeneous pattern of cytosine-guanine dinucleotide island hypermethylation of the CDH1 gene.

Background: Tuberculosis (TB) is currently one of the greatest problems in public health. Mycobacterium tuberculosis infects about one third of the world's population, of whom more than 80% are living in developing countries. The incidence and prevalence of TB are very different in various parts of Iran and also throughout the world. Golestan province is one of the areas in the country where the risk of TB is the highest because of its ethnically varied population and special location. We aimed to describe the prevalence of TB and related demographic data in Golestan province (northeast of Iran).Methods: We collected all data of patients with TB who registered in 2005 and 2006 in each of the 11 districts of Golestan province. Data were entered into the computer database and age-specific incidence rates per 100 000 population were calculated.Results: There were 321 new smear-positive cases. The incidence and prevalence of TB were 20.88 and 38.15 per 100 000 population, respectively. The male to female ratio was 0.96. Relapse of TB was reported in 20 patients. We found 141 cases of extrapulmonary TB, with a significant predominance in women. The organ most frequently involved in extrapulmonary TB was the lymph nodes. Generally, smear-negative TB was more common in men and extrapulmonary TB was more common in women.Conclusion: The incidence and prevalence of TB were higher in Golestan province in comparison with other provinces in Iran. We suggest using improved screening strategies and better education about TB for high-risk groups and physicians.

Background: There is extensive variety of chemical compounds with antiulcer activity, which are isolated from medicinal plants. Matricaria chamomilla or Matricaria recutita or German chamomile, also spelled chamomile (MC), is one of the most widely used medicinal plants. In the present study, the extract of MC flowers was evaluated for antiulcerogenic activity and acute toxicity profile.Methods: To evaluate antiulcer effect of MC extract, 15 female bulb-c mice were divided into three groups (five mice in each group). The first and second groups received 400 mg/kg sucralfate and 400 mg/kg MC extract respectively by the intragastric route. The control group received 1.0 ml distilled water. After 30 min, gastric ulceration was induced by oral administration of 1.0 ml of a 0.3 M solution of HCl in 60% ethanol in all animals. One hour later, the area of the gastric lesions and hemorrhage was measured by stereological method. To evaluate the toxicity of MC extract, 10 male and 10 female mice were divided into control and experimental groups (5 mice in each group). The experimental and control groups received by the intragastric route a single dose of 5000 mg/kg MC extract and water respectively. After 14 days the mice’s liver, kidneys, lung, and heart were examined macroscopically and the relative weights (organ/body) were determined. Statistical comparisons between the groups were performed by Mann-Whitney U test. Results: Oral administration of MC extract at 400 mg/kg can be effective in preventing gastric ulceration in mice and does not produce toxic effects in doses up to 5000 mg/kg. Conclusion: Matricaria chamomilla can prevent experimental gastric ulcer in mice. 

Background: Well-controlled clinical studies in the developed world have shown that probiotics can shorten the duration of acute non-bacterial diarrhea. We aimed to evaluate the efficacy of a probiotic consisting of a mixture of Lactobacillus acidophilus and Bifidobacterium bifidum in the treatment of young children with acute diarrhea in Mashad, Iran.Methods: Sixty-two hospital inpatients aged 6 to 36 months with acute non-bloody, non-bacterial diarrhea of a less than 2 days' duration and moderate dehydration were enrolled. Thirty-two were treated with probiotic powder three times daily for 5 days plus the routine oral rehydration solution (study group) and the other 30 were given a placebo plus oral rehydration solution (control group). Results: Mean age at the time of admission was 14.5±7 months for the study group and 13.7±6 months for controls. The mean duration of diarrhea was 3.4 days in the study group and 4.5 days in controls (P = 0.027). Duration of hospital admission was 2.1±0.7 days in the probiotic group compared with 2.7±0.6 days in the control group (P = 0.033). Average weight gain was 425 ± 9 and 370 ± 85 g for the study and control groups, respectively. Average reduction in the frequency of diarrhea per day was 4.4 ± 1.5 times for the study group and 3.6 ± 1.3 times for the control group.Conclusion: Lactobacillus acidophilus and Bifidobacterium bifidum shortened the duration of diarrhea and hospital stay, and normalized stool frequency. The use of probiotics might be recommended for treating acute diarrhea in young children.

Estrogen might play an important role in the pathogenesis of diabetes mellitus type 2. Estrogens inhibit diabetes via distinct mechanisms particularly by reducing both hyperglycemia and plasma insulin levels. Estrogen exerts its physiological effects mainly through estrogen receptors including a and b types. Estrogen receptors are found in many tissues that participate in the pathogenesis of type 2 diabetes. Two common polymorphisms, PvuII and XbaI in estrogen receptor α gene, are reported to be associated with decreased receptor activity and increased risk of diabetes. We aimed to investigate the association between estrogenreceptor a polymorphisms and diabetes, where a genetic component may be the major risk factor for this disease. One hundred women with diabetes type 2 were compared with one hundred women without diabetes for PvuII and XbaI polymorphisms. Of whom 61% of cases and 29% of controls had coronary artery disease. The participants were genotyped for these polymorphisms using polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) analysis. The genotype distribution and frequency of mutated allele showed no significant differences between diabetic and non-diabetic groups in PvuII (c2=0.981; P=0.612) and XbaI (c2=0.362; P=0.83) polymorphisms. When coronary artery disease as the potential confounding factor was controlled by logistic regression analysis, it was found that the PvuII and XbaI variants were not related to the type 2 diabetes mellitus (P=0.60 and P=0.99, respectively). Neither PvuII nor XbaI genotypes was associated with increased susceptibility to the type 2 diabetes mellitus in selected Iranian women with diabetes and coronary artery disease.

Abdominal tuberculosis is one of the most prevalent forms of extra-pulmonary tuberculosis. Various regions of gastrointestinal tract including cecum, terminal ileum, peritoneum, lymphatic system, and solid viscera can be affected by tuberculosis. Here we report a 33-year-old woman presented with fever, chills, and a history of abdominal discomfort. Lymphadenopathy was detected on physical examination. Contrast computed tomography of chest and abdomen showed patchy densities and thickening of the ileocecal wall respectively. Histological studies of the biopsy samples documented the existence of tuberculosis.

Congenital absence of left circumflex artery is a rare congenital anomaly of the coronary arteries. The prevalence of the anomaly in different studies ranges from 0.6% to 1.3%. Of these, 80% are benign and asymptomatic and 20% are clinically important. We report a 56-year-old man presented with acute resting chest pain who was diagnosed as having acute anterolateral infarction accompanied by electrocardiographic changes and elevated cardiac enzymes. Coronary angiography in different views was conducted, however, no left circumflex artery was found. The territory supplied by the artery had been perfused by the super dominant right coronary artery. There was no left circumflex coronary artery with anomalous origin. Sever stenosis of left anterior ascending artery superimposed to the absent left circumflex artery was presented as acute anterolateral infarction. Although absence of the artery is mostly considered as a benign condition, atherosclerotic lesions may be more important in such cases because of diminished compensating mechanisms.

Ectopic eruption of teeth occurs in a variety of locations. Commonly seen in palate and maxillary sinus, they have also been reported in nasal cavity, orbit, mandibular condyle, coronoid process, and facial skin. Here, we report a rare case of recurrent sinusitis caused by ectopic tooth in right ethmoid sinus and successful endoscopic removal of it. The symptoms of the patient disappeared after surgery. Such case has not been yet reported in the English literature.Ectopic tooth is an uncommon cause of sinusitis. It should be considered in patients presenting with recurrent sinusitis unresponsive to medical treatment. Computed tomography of the sinuses is the modality of choice for diagnosis. Endoscopic sinus surgery is the best method for management of such cases.

Dear Editor, In spite of recent advances in treatment of infection and emphasis on adequate nutritional intake, patients with cystic fibrosis (CF) frequently have less than ideal body weight and adults are often shorter than their target height. Owing to a state of relative growth hormone (GH) insensitivity, the anabolic and growth promoting effects of recombinant human GH (rhGH) treatment have been explored in children with CF. A number of open-labeled uncontrolled studies of small numbers of undernourished prepubertal children with CF documented improvements in weight and height with rhGH treatment.