IRANIAN JOURNAL OF MEDICAL SCIENCES (IJMS)
Year:2018 | Volume:43 | Issue:4|Papers Count:15

Background: CTX-M-type extended-spectrum β-lactamases (ESBLs) are the most prevalent ESBLs in bacterial members of Enterobacteriaceae family including Klebsiella pneumoniae. The global spread of CTX-M-producing K. pneumoniae is a major concern in most countries including Iran. The aim of this meta-analysis was to determine the relative frequency (RF) of blaCTX-M gene among ESBLs-producing K. pneumoniae clinical isolates in Iran and to report an overall prevalence. Methods: A comprehensive literature search of studies published up to July 2016 was carried out. The keywords “ Enterobacteriaceae” , “ Klebsiella pneumoniae” , “ ESBLs” , “ CTX-M” and “ Iran” were searched in PubMed, Scopus, EBSCO, Google Scholar, Scirus, SID and IranMedex in both English and Persian. Selected articles were published between July 2010 and July 2016 and all of them were in English. STATA SE version 11. 0 was used for statistical analysis. Results: Twenty-four articles/abstracts were included in this analysis. Selected studies were performed in Ahvaz, Arak, Ilam, Kashan, Kerman, Mashhad, Shiraz, Tabriz, Tehran, Zabol, and Zahedan. Our pooled evidence showed that the RF of blaCTX-M gene among ESBLs-producing K. pneumoniae clinical isolates varied from 7. 7% in Tabriz to 100% in Mashhad, Tehran, and Zahedan, with an overall RF of 56. 7%. Conclusion: Our meta-analysis revealed that the RF of CTX-M-type ESBLs-producing K. pneumoniae is diverse in different regions of Iran, and the central and eastern regions had higher prevalence rates compared to western regions.

Background: Researchers suggest that benign breast disease (BBD) is a key risk factor for breast cancer. The present study aimed to determinate the risk level of breast cancer in terms of various BBD subgroups. Methods: A meta-analysis was performed to determinate the risk of breast cancer associated with BBD. Observational studies (traditional case-control studies, nested case-control studies, and cohort studies) published from January 2000 to June 2015 were assessed to evaluate the risk of developing breast cancer related to BBD. Various databases such as Medline (PubMed), Web of Science (ISI), Scopus, and Google Scholar were searched. The additional search included the Journal of Breast Cancer Research and Treatment and the Journal of Cancer Research. Results: Twenty studies out of 21 were used to estimate the risk of developing breast cancer related to proliferative disease without atypia versus non-proliferative disease and the reported risk ranged from 1. 04 to 1. 83. The reported risk of developing breast cancer related to proliferative disease with atypia versus non-proliferative disease in 21 studies ranged from 1. 59 to 4. 74. Based on 20 studies, the pooled risk estimates for developing breast cancer related to proliferative disease without atypia versus non-proliferative disease was 1. 58 (95% CI: 1. 51-1. 66). Based on 21 studies, the pooled risk estimates for developing breast cancer related to proliferative disease with atypia versus non-proliferative disease was 3. 49 (95% CI: 3. 23-3. 77). Conclusion: The overall result of this review showed an elevated risk for breast cancer related to BBD subtypes. We propose better strategies for screening recommendations for such women.

Background: Medullary breast carcinoma (MBC) is a unique histological subtype of breast cancer. The present study aimed to evaluate the classic and non-classic characteristics of MBC and its differences with IDC. The present review study incorporates 22 years of practical experience from a breast disease research center-based series of cases. Methods: Retrospectively, the medical records of 3, 246 patients were reviewed in the Breast Disease Research Center, Shiraz University of Medical Science (Shiraz, Iran), from December 1993 to December 2015. The tumor size, lymph node metastasis, pathologic stage, nuclear and histological grade, hormonal receptor status, recurrence, disease-free, and overall survival were reviewed. Differences between medullary breast carcinoma and invasive ductal carcinoma were analyzed statistically using the Chi-square, Fischer, independent-sample t test, and Kaplan-Meier analysis (SPSS version 19. 0). P<0. 05 were considered statistically significant. Results: A total of 179 patients were identified with MBC and 3, 067 patients were identified with IDC. The MBC group had a significant association with a higher histological grade (P<0. 001) as well as negative estrogen receptor (P<0. 001), progesterone receptor (P<0. 001), and HER-2 (P=0. 004) status. The MBC patients predominantly had triple-negative breast cancer (TNBC) according to the molecular subtype (P<0. 001). In local invasion, MBC was less invasive compared to IDC (P<0. 001). The disease-free survival (DFS) and overall survival (OS) differed significantly between the MBC and IDC groups (5-year DFS: 94. 2% vs. 86. 3%, P=0. 008; 5-year OS: 98. 1% vs. 92. 8%, P=0. 004). Conclusion: Despite the poor and aggressive pathological features of MBC, its clinical outcome is more favorable compared to IDC. Our findings can be useful in improvement of diagnosis and treatment of less known breast cancer subtypes, such as MBC.

Background: Prostate cancer is the most common malignancy among the male population in the United States and the 3rd most common non-skin cancer among men in Iran. Its prevalence has shown a rising trend in recent decades. The aim of this study was to report the epidemiological features of prostate cancer in patients referred for prostate biopsy in the south of Iran and to evaluate the accuracy of the levels of the prostatespecific antigen (PSA) and the PSA-density (PSAD) as well as the extension of the disease in the prediction of the biological behavior of prostate cancer. Methods: This is a retrospective study on the medical records of 1982 consecutive patients who underwent transrectal ultrasoundguided biopsy due to an abnormal digital rectal examination and/ or an elevated PSA level following referral from the Urology Ward to the Radiology Department of Shahid Faghihi Hospital in Shiraz, southern Iran, between December 2003 and July 2014. Results: The overall cancer detection rate was 33. 1%. Although the cancer was more prevalent among the elderly patients, a significant fraction (7%) of the patients were aged < 55 years. The sensitivity and specificity of the PSA were 97. 4% and 8. 7% and those of the PSAD were 82. 9% and 52%, respectively. Of the 637 patients with prostate cancer, 250 (39. 2%) had unilateral disease, 378 (59. 4%) had bilateral disease, and 9 (1. 4%) had inner-gland involvement. Most of the patients with bilateral involvement had high-grade Gleason scores. Conclusion: Our study underlines the relationship between age and the frequency of cancer; the levels of the PSA and the PSAD and the Gleason score; and the extent of tumor involvement and the grade of prostate cancer and also highlights the significance of screening, especially in younger patients.

Background: The incidence of tuberculosis (TB) has increased in recent years in both developed and developing countries. Skeletal tuberculosis occurs in approximately 1% of patients with tuberculosis. The present study aimed to evaluate the epidemiology of skeletal tuberculosis in Golestan province in northeastern Iran during 2005-2014. Methods: In the present retrospective study, the epidemiology of skeletal tuberculosis was studied in 229 skeletal tuberculosis patients who were diagnosed during 2005-2014. The prevalence rate of skeletal TB has been reported according to demographic and clinical features. Results: Over the 10-year period of this study, 229 known skeletal TB cases were identified in which 56. 3% were male. The mean age of the patients was 44. 0± 17. 7 (range 7-87). All of the patients were new cases. Most of the patients (56. 8%) were from the rural areas and most were diagnosed by the private healthcare system (63. 8%). The highest rate of skeletal TB was seen in 2013 (15. 3%). Spinal TB (81. 2%) scored the highest rate and pain (96. 9%) was the most prevalent symptom of skeletal TB. Conclusion: The findings suggest that skeletal tuberculosis in northeastern Iran should always be considered as a differential diagnosis for fever and pain on the spinal column. Due to the high level of tuberculosis in the Golestan province (Iran), further research on continued awareness of skeletal TB is stressed.

Background: Syntax has a high importance among linguistic parameters and the prevalence of syntax deficits is relatively high in children with language disorders. As such, independent examination of syntax in language development is of paramount importance. In this regard, Iranian language pathologists are faced with the lack of standardized tests. The present study aimed to determine the most frequent and essential morphosyntactic structures of the Persian-speaking children aged 4-6 years, as an initial step in the design of a test to assess their expressive morphosyntactic features. Methods: The present descriptive qualitative study was designed and conducted in two phases in Tehran (Iran) during 2014-2015. The first phase involved an extensive review of the Persian grammar sources, language development texts, modeling a test called SPELT-3, and morphosyntactic analysis of samples of spontaneous speech from 30 Persian-speaking children aged 4-6 years. In this phase, 30 structures were extracted as the most frequent morphosyntactic features used by children aged 4-6 years. The second phase of the research involved directed content analysis via in-depth and semi-structured interviews with 10 specialists in the fields of linguistics, language, and speech pathology. Results: In total, 30 morphosyntactic structures were extracted in the first phase of the study as the most frequent morphosyntactic structures of the Persian-speaking children aged 4-6 years. The overall validity of these structures was estimated at 70%. Conclusion: Based on the results, the selected morphosyntactic structures could be the foundation for morphosyntactic assessments in Persian-speaking children aged 4-6 years.

Background: Dengue, chikungunya, and Zika viruses are emerging infectious disease threats wherever suitable vectors, hosts, and habitat are present. The aim of the present study was to use the bioagent transport and environmental modeling system (BioTEMS) to identify the potential for arbovirus-infected Aedes species to invade the Chabahar area in southeastern Iran. Methods: ArcGIS geospatial analysis software, Statistica software, and BioTEMS were used to analyze geographic information and conduct data analysis. BioTEMS utilizes up to several hundred abiotic and biotic factors to produce risk and vulnerability assessments for biological agents and infectious diseases. The output of BioTEMS was validated using published predictive models, and most importantly published collection data of Aedes species in Iran. Results: There appears to have been two separate invasion events by Ae. albopictus into the southern region of Iran, first preceding 2009 and then again in 2013. BioTEMS identified two probable areas of introduction during the 2009 time frame, either through one or both the Chabahar ports or the Iranshahr airport with subsequent spread through vehicular transport. BioTEMS identified the port as an introduction zone for ZIKAV with highrisk zones and identifies gap zones during the 2013 time frame. Recommended surveillance sites are provided. Conclusion: The air and maritime ports of Iran serve international customers, and are therefore vulnerable to import and invasion of mosquito vectors and arboviruses. Based on comparisons with other published low-resolution models, BioTEMS provides information for medical and public health professionals conducting integrated mosquito management, preventive medicine, and epidemiological surveillance.

Background: Transforming growth factor-β (TGF-β ) in addition to the C-terminal region can phosphorylate receptorregulated Smads (R-Smads) in their linker region. The aim of the present study was to evaluate the role of signaling mediators such as NAD(P)H oxidases (reactive oxygen species [ROS] generators), ROS, and ROS-sensitive p38 mitogen-activated protein kinase (p38MAPK) in this signaling pathway in cultured human vascular smooth muscle cells (VSMCs). Methods: The present in vitro study was performed on human VSMCs. Proteins were detected by western blotting utilizing an anti-phospho-Smad2 (Ser245/250/255) rabbit polyclonal antibody and a horseradish peroxidase-labeled secondary antibody. Glyceraldehyde-3-phosphate dehydrogenase was used as a loading control. The phospho-Smad2 linker region (pSmad2L) was detected in all the experimental groups: a control group (untreated group), a group treated with TGF-β (2 ng/mL), and a group treated with TGF-β plus different inhibitors. The data were normalized and presented as mean± SEM. The statistical analyses were performed using SPSS, version 16. 0, and the nonparametric Kruskal– Wallis test. A P value smaller than 0. 05 was considered statistically significant. Results: The VSMCs treated with TGF-β (2 ng/mL) showed a time-dependent increase in the pSmad2L level. The highest level was observed at 15 minutes (P=0. 03). The inhibitors of NAD(P) H oxidases (diphenyleneiodonium and apocynin) (P=0. 04), ROS scavenger (N-acetylcysteine) (P=0. 04), and p38MAPK inhibitor (SB-202190) (P=0. 04) were able to reduce the increased level of the pSmad2L by TGF-β . Conclusion: Our results suggested that NAD(P)H oxidases played an important role in the Smad2L phosphorylation in the human VSMCs. Furthermore, our results confirmed that ROS and p38MAPK were involved in this signaling pathway. Thus, TGF-β via a ROS-dependent mechanism can transmit its signals to the pSmad2L.

Background: Due to the unfavorable side effects of some commonly used chemical drugs, the trend in the public has shifted towards using herbal medicines to treat central nervous system disorders like depression. The present experimental study was designed to evaluate the effect of Marze (Satureja bachtiarica Bunge) essential oil on reserpine-induced depression in rats. Methods: In total, 48 male Wistar rats were randomly divided into 6 groups: 1) control, 2) reserpine, 3-5) reserpine with 50, 75 and 100 mg/kg of Marze essential oil, respectively, and 6) reserpine and fluoxetine. The forced swimming test was used to evaluate the antidepressant activity of the essential oil. Total antioxidant capacity (TAC) and MDA levels of serum and brain were also determined. Results: Reserpine induced a significant increase in the immobility time of rats in the forced swimming test (P=0. 02) and treatment with Marze essential oil (50, 100 mg/kg) ameliorated the reserpine induced changes (P=0. 04, P=0. 03, respectively). Reserpine-induced reduction in brain TCA was improved using Marze essential oil at a dose of 100 mg/kg (P=0. 04). Marze essential oil at 100 mg/kg dose significantly decreased the MDA level in the brain tissues of reserpine-treated rats (P=0. 04). Conclusion: Marze (Satureja bachtiarica Bunge) essential oil has the ability to prevent depression induced by reserpine probably via its antioxidant activity.

Leprosy is a neglected disease. The insidious onset of leprosy results in its late diagnosis and therefore the spread of the disease. Characterization of leprosy in areas with higher risk and collection of enough information about these spots to adopt more effective controlling measures are of great importance. In the present study, data for every patient who either referred to the health care center for leprosy or had had similar leprous symptoms between 2002 and 2016 were collected. Forty-two new cases of leprosy were identified with 28 of them being Iranian and 14 from Afghanistan. All patients were older than 15. 26. 2% of the patients were women and 73. 8% were men. According to World Health Organization (WHO) protocol, 36 patients (85. 7%) were diagnosed to have been affected by the Multi Bacillary form; and among those patients, 61. 9%, 19. 05%, and 19. 05% suffered from grade 1, 0, and 2 of the disease, respectively. There was a significant relationship between disability grading and sex (P=0. 032), with grade 1 disability happening more often in men. Another significant relationship was also observed between Multi Bacillary form and nationality (P=0. 011) indicating that Multi Bacillary form is more common among Iranians. With 0. 02 leprosy cases in 10000 people, Iran is at elimination phase of the disease; however, identification of new cases in our region demands constant controlling programs and establishment of strict policies. Fortunately, the few numbers of patients diagnosed with leprosy in Northeast of Iran shows successful implementation of such policies under the scrutiny of the public health authorities.

The Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are two ends of the spectrum of severe immunobullous state characterized by keratinocyte apoptosis. The present study aimed to draw attention to various epidemiological features of SJS and TEN diseases such as causative drugs, underlying diseases, duration of hospitalization, and types of treatment. The records of all patients with the diagnosis of SJS, TEN, and SJS/TEN overlap during 2010-2015 were retrospectively reviewed. The records belonged to patients who were admitted to the Dermatology Tertiary Referral Center of Shahid Faghihi Hospital affiliated to the Shiraz University of Medical Sciences, Shiraz, Iran. From a total of 97 patients with such skin disorders, we identified SJS in 89 (91. 8 %), TEN in 5 (5. 1%), and SJS/TEN overlap in 3 (3. 1%) patients. The most commonly consumed drug was Lamotrigine (21. 6%) and the most common drug category was anticonvulsants (46. 4%). In line with many studies, especially in Iran, Lamotrigine and anticonvulsant drugs were the most common causative drug and epilepsy was the most common underlying disease. Patients with SJS/TEN overlap or TEN were treated with combination therapy, whereas SJS patients received systemic corticosteroids.

Choriocarcinoma and placental site trophoblastic tumor (PSTT) are rare varieties of gestational trophoblastic disease (GTD). PSTT alone constitutes about 1-2% of all trophoblastic tumors, which presents at early reproductive age and the serum betahCG level is much lower than choriocarcinoma. This tumor usually invades the myometrium and its depth of penetration is a prognostic factor. The first case report is regarding a 33-year-old woman with vaginal bleeding 3 months after abortion. The ultrasound exhibited heterogeneous and hypervascular mass related to previous cesarean scar. Serum beta-hCG level was 67 mIU/ml and chemotherapy was administered. However, due to severe vaginal bleeding and no regression in mass size, total abdominal hysterectomy was performed. Histopathological examination and IHC staining confirmed PSTT from previous cesarean section. The second case report is regarding a 33-year-old woman with cervicoisthmic choriocarcinoma, which was mistaken as cesarean scar pregnancy. The ultrasonography and elevated serum beta-hCG level suggested cesarean scar pregnancy. The patient was treated with methotrexate without any effect. Eventually, cervicoisthmic choriocarcinoma was detected after hysterectomy. A diagnostic error was made leading to possible uterus perforation along with incorrect chemotherapy that resulted in a life-threatening condition. It is concluded that PSTT and choriocarcinoma are the two important differential diagnoses of sustained elevated beta-hCG when imaging evidence is also suggestive. Although PSTT and cervicoisthmic choriocarcinoma are rare, they do exist and are on the rise.

Ascariasis is a common worm infestation in developing and under-developed countries. It is caused by the ingestion of food contaminated with Ascaris eggs from faeces and is more common in places with poor sanitation. Almost 25% of the world population is infested by Ascaris lumbricoides. Although ascariasis is a chronic disease, it can present as acute abdomen rarely. The wandering nature of Ascaris in and out of the bowel causes various abdominal complications such as intestinal obstruction, perforation, biliary ascariasis, pancreatic ascariasis, liver abscess, appendicitis, and Meckel’ s diverticulitis. Intestinal obstruction is the most common complication seen in children and is usually due to mechanical bowel obstruction, volvulus or intussusception. Mechanical obstruction by a bolus of worms is the most common cause of bowel obstruction. Perforation of bowel is rarely reported and it usually occurs in the diseased segment of bowel or following trauma. Perforation of an ileal volvulus secondary to ascariasis has been reported rarely. We present a 4-year-old boy who presented to the emergency room with features of bowel perforation and sepsis, after unsuccessful management for intestinal obstruction in another hospital. On laparotomy, the small bowel was teaming with Ascaris worms. Ileum showed a volvulus with closed loop obstruction and perforation. Peritoneal lavage with resection and ileostomy was done, which was closed at a later date. Anti-helminthic agents were started postoperatively and the boy recovered uneventfully.

We report an extremely rare case of Turner syndrome mosaicism in a 30-year-old woman. At least 100 metaphases were observed and analyzed through GTG banding with over 550 band resolutions observed. G-banded chromosome analysis revealed a mosaic female karyotype involving 3 different cell lines. One cell line (90% of the analyzed metaphases) presented monosomy X, while 6% of the cells showed trisomy of chromosome 21 and 4% of the cells exhibited a normal female karyotype. Fluorescence in situ hybridization with a locus-specific probe for trisomy 21 and CEP X for monosomy X substantiated the results obtained from karyotyping. Our patient had 2 natural pregnancies, both of which produced children with Down syndrome. In our patient, as is the case with other women with infertility, the necessary routine is cytogenetic analysis (together with genetic counseling). The same analysis can be helpful in implementing assisted reproductive techniques.

In India, pulmonary tuberculosis accounts for 85% of cases and extrapulmonary tuberculosis accounts for 15% of cases with bone and joint involvement is seen in 1 to 3% of cases. Primary tuberculous osteomyelitis of the sternum is a rare form of extrapulmonary tuberculosis. A 51-year-old male presented with 10 years history of swelling over the anterior chest wall and pain for past 6 months. Fine-needle aspiration cytology (FNAC) revealed a markedly granular necrotic background. Ziehl-Neelsen staining was positive for acid-fast bacilli and a diagnosis of the tubercular abscess was made. Chest X-ray was normal. Contrast-enhanced computed tomography was done, which gave an evidence of the erosion of the anterior surface of the sternum. Tuberculosis of the sternum is a rare form of flat bone tuberculosis. The possibility of sternal tuberculosis should be kept in mind in any patient with a mass, non-healing ulcer, or abscess in the sternal region.