IRANIAN JOURNAL OF MEDICAL SCIENCES (IJMS)
Year:2018 | Volume:43 | Issue:5|Papers Count:16

Background: Chronic and abnormal increase of different types of dyslipidemia leads to some important diseases, such as constriction and abstraction of vessels in various parts of the body, especially in the heart. High lipid profile, such as increased total cholesterol and LDL as well as decreased HDL are recognized as cardiovascular disease risk factors. The present study aimed to estimate the prevalence of different types of dyslipidemia in Iran by a meta-analysis method. Methods: A literature search for studies published during 1998-2015 was carried out using both Persian and English databases (SID, Magiran, IranMedex, MedLib, PubMed, and Scopus). Keywords such as lipid, dyslipidemia, CVD, cardiovascular risk factors, hypercholesterolemia, high LDL-C, low HDL-C, and prevalence were used in the search. Random-effects model was used for the analysis using STATA (version 11. 2). Results: In total, 163 articles were identified of which 49 articles fulfilled the inclusion criteria. The estimated prevalence (95% confidence interval) of eligible articles for high cholesterol ≥ 200 mg/dl and ≥ 240 mg/dl was 42% (95% CI: 38-45) and 17% (95% CI: 14-20), respectively. Moreover, the prevalence (95% confidence interval) for high LDL-C ≥ 130 mg/dl and ≥ 160 mg/dl was 40% (95% CI: 32-48) and 19% (95% CI: 16-23), respectively. The pooled prevalence estimate for low HDL-C (<40 among males, <50 among females) was 43% (95% CI: 33-53) in both sexes of the Iranian people. All types of lipid component abnormalities (hypercholesterolemia, high LDL-C, and low HDL-C) were more prevalent in women. Conclusion: The results indicate that the prevalence of different types of dyslipidemia in Iran is substantial. Given the risk of complications (e. g. cardiovascular disease and control of different types of dyslipidemia) in Iranian people, it is important to reduce the burden of cardiovascular diseases.

Background: Considering the association between cardiac abnormalities and non-alcoholic fatty liver disease (NAFLD), the present study aimed to evaluate the relationship between biopsy-proven NAFLD and functional echocardiographic parameters, including left ventricular (LV) global longitudinal strain (GLS) in asymptomatic individuals. Methods: Thirty asymptomatic patients with liver biopsy-proven NAFLD and the same number with no evidence of fatty liver in ultrasonography were enrolled in the study as cases and controls, respectively. The measured echocardiographic parameters included LV ejection fraction (LVEF), LV end-systolic and end-diastolic dimensions (ESD, EDD), LV end-systolic and end-diastolic volumes (ESV, EDV), E/e’ ratio (early-diastolic mitral inflow velocity/early-diastolic myocardial velocity), E/A ratio (early-diastolic mitral inflow velocity/late-diastolic mitral inflow velocity), and GLS. Data were analyzed using the SPSS statistical software (version 18. 0) by performing the independent t test, Chi-square, and non-parametric Mann-Whitney U tests. P values <0. 05 were considered statistically significant. Results: A significant difference in ESD (32. 1± 1. 4 mm vs. 34± 1. 8 mm), EDD (41. 9± 1. 7 mm vs. 45. 2± 3. 1 mm), and E/e’ ratio (8. 4± 0. 8 vs. 7. 4± 1. 2) was detected among individuals with NAFLD compared with those without NAFLD (P<0. 001 for the first two parameters and P=0. 002 for the last one). GLS was also significantly lower in NAFLD patients than in controls, but within normal levels (19. 3%± 2. 0 vs. 21. 2%± 1. 4, P<0. 001). Conclusion: The findings support the presence of subclinical cardiovascular structural and functional changes in patients affected by NAFLD. It also indicates that the use of GLS is more sensitive than LVEF for the detection of LV systolic dysfunction in NAFLD patients.

Background: Perianal fistula is a complicated disorder and most difficult to manage. New treatment methods would help surgeons to achieve a better outcome in patients with perianal fistula. Human amniotic membrane (HAM) has positive effects on wound healing in several conditions. The present study aimed to further determine the effect of HAM on wound healing of perianal fistula in rabbits. Methods: In a prospective experimental study, 14 male rabbits (aged 4-6 months and weighing 3-4 kg) were randomly divided into 2 groups. After 12 weeks, the high type perianal fistula was repaired with endorectal flap (ERF) and ERF plus HAM in the control and case groups, respectively. In all rabbits of the case group, a 1×1 cm width wrap of HAM was applied and fixed around the ERF site. Three weeks later, the repaired site of the perianal fistula was sent for pathologic wound healing scoring. The results were analyzed with the SPSS 21. 0 software using Mann-Whitney test. Results: Six rabbits of each group survived the study period. There was a statistically significant difference in wound healing between the case and control groups (P<0. 001). Wound healing process in the case group occurred better and faster than the control group. Conclusion: HAM has an effective role in enhancing the ERF procedure and considered appropriate. A combination of HAM with other methods is recommended.

Background: Mentha mozaffarianii, an endemic species from the Labiatae family, is used in Iranian traditional medicine. This study evaluated the acute and repeated oral toxicity of the Mentha mozaffarianii essential oil (MMEO) in rats and mice. Methods: To assess the toxicity profile of the MMEO, we administered the essential oil to 48 rats and mice of both sexes by gavage in acute and repeated models. In acute toxicity, the animals were administered the MMEO (2000 mg/kg) and were monitored for 14 days. In the repeated toxicity, the MMEO was administered (100 mg/kg) daily for 4 weeks. On the 28th day, all the animals were scarified and blood and tissue samples were prepared. All the clinical, biochemical, and histopathological changes were assessed and compared with those in the controls. Statistical significance was determined by one-and two-way analyses of variance, followed by the Tukey test using GraphPad Prism 6. Results: In the acute test, there was no mortality; therefore, the oral LD50 value determined in the mice and rats of both sexes was greater than 2000 mg/kg. In the repeated test, the animals received the MMEO and there was no mortality. In the biochemical analysis, there were significant increases in blood glucose, cholesterol, ALT, AST, ALP, and TSH in the female rats and also in BUN in the male rats. The histopathological studies revealed evidence of microscopic lesions in the liver, kidney, stomach, and small intestine tissues of the MMEO group. Conclusion: The results indicated that the acute toxicity of the MMEO in the mice and rats was of a low order and it revealed slight tissue damage to several organs when given subchronically at a dose of 100 mg/kg.

Background: This study aimed to investigate the occurrence of aminoglycoside resistance and the prevalence of the resistancemodifying enzyme genes, ant(3” )-III, ant(6’ )-Ia, aac(6′ )-Ieaph( 2” )-Ia, and aph(2’ )-Id, in Enterococcus strains isolated in Kermanshah Province, west of Iran. Methods: In this cross-sectional study, 108 enterococcal isolates from urine, wound, blood, and cerebrospinal fluid samples were collected. The Enterococcus species were recognized by standard phenotypic/biochemical tests. The antimicrobial resistance forms were detected using a disc diffusion method. Polymerase chain reaction was designed to identify aminoglycoside resistance genes, including ant(3” )-III, ant(6’ )-Ia, aac(6′ )-Ie-aph(2” )-Ia, and aph(2’ )-Id. Results: Totally, 108 strains with a final diagnosis of Enterococcus were extracted from 84 (77. 8%) urine, 14 (13%) wound, 6 (5. 6%) blood, and 4 (3. 7%) cerebrospinal fluid samples. Among the 108 Enterococcus specimens, 94 (87%) cases were Enterococcus faecalis and 14 (13%) were Enterococcus faecium. The highest frequency of resistance was observed for erythromycin (88. 9%), while the lowest was found for streptomycin (44. 4%). The frequency of high-level gentamicin resistance was 42. 2%. Among the identified specimens, 42. 6% contained the aac(6′ )-Ie-aph(2” )-I gene, 20. 4% contained the ant(6’ )-Ia gene, and 15. 7% contained the ant(3” )-III gene. A significant correlation was found between phenotypic gentamicin resistance and the presence of the aminoglycoside resistance genes (P<0. 05). Conclusion: This study showed the high resistance of Enterococcus strains isolated from hospital samples. Compared with the previous studies, the strains isolated in our study showed a higher percentage of resistance to aminoglycosides.

Background: Success of infection treatment depends on the availability of accurate, reliable, and comprehensive data, information, and knowledge at the point of therapeutic decisionmaking. The identification of a national minimum data set will support the development and implementation of an effective surveillance system. The goal of this study was to develop a national antimicrobial resistance surveillance minimum data set. Methods: In this cross-sectional and descriptive study, data were collected from selected pioneering countries and organizations which have national or international antimicrobial resistance surveillance systems. A minimum data set checklist was extracted and validated. The ultimate data elements of the minimum data set were determined by applying the Delphi technique. Results: Through the Delphi technique, we obtained 80 data elements in 8 axes. The resistance data categories comprised basic, clinical, electronic reporting, infection control, microbiology, pharmacy, World Health Organization-derived, and expert-recommended data. Relevance coding was extracted based on the Iranian electronic health record coding system. Conclusion: This study provides a set of data elements and a schematic framework for the implementation of an antimicrobial resistance surveillance system. A uniform minimum data set was created based on key informants’ opinions to cover essential needs in the early implementation of a global antimicrobial resistance surveillance system in Iran.

Background: The synergistic effects of valproic acid (VPA), lithium (Li), and celecoxib (CX) have been shown in combination therapy against the proliferation and metastasis of numerous cancers. Angiogenesis plays a critical role in the pathogenesis of tumor growth and metastasis. The aim of the present study was to evaluate the antiangiogenic effects of VPA, lithium chloride (LiCl), and CX, alone or in 2-by-2 combinations, using the chicken chorioallantoic membrane (CAM) assay. Methods: Fertilized chicken eggs were randomly divided into 10 groups: control, VPA (1. 8 and 3. 6 μ mol/CAM), Li (0. 15 and 0. 60 μ mol/CAM), CX (0. 02 and 0. 08 μ mol/CAM), VPA+Li, VPA+CX, and CX+Li (n=10 per group). A window was made on the eggshells and the CAMs were exposed to a filter disk containing VPA, LiCl, and CX, alone or in 2-by-2 combinations. The control CAMs were treated with distilled water (vehicle). Three days after the treatment, the number of vessel branch points was counted in each CAM. The data were analyzed using SPSS, version 15. One-way ANOVA, followed by the Tukey tests, was used to compare the groups. A P<0. 05 was considered a statistically significant difference between the groups. Results: According to the results, all the tested drugs decreased the number of the vessel branch points in a dose-dependent manner compared to the control group (P<0. 001). In addition, combinations of the drugs were more effective in decreasing angiogenesis than the use of each drug alone. Conclusion: These findings suggest that 2-by-2 combinations of VPA, CX, and LiCl can be considered an effective antiangiogenesis therapeutic modality.

Background: Diazinon (DZN) is an organophosphate pesticide commonly used for pest control in agriculture. It may engender a variety of negative effects in non-target species, including humans and animals. The objective of the present study was to evaluate the ameliorative properties of captopril (CAP), as a thiol containing an angiotensin-converting enzyme inhibitor, against DZN-induced oxidative stress. Methods: Twenty-eight male Wistar rats were divided randomly into 4 groups. All the rats were treated orally via gavage once a day for 7 weeks: control (corn oil), CAP (10 mg/kg), DZN (10 mg/kg), and CAP+DZN combination (as mentioned above). Oxidative stress indices in blood serum, liver and kidney homogenates (malondialdehyde [MDA], total thiol groups, and total antioxidant capacity), and erythrocyte hemolysis (superoxide dismutase [SOD] and glutathione peroxidase) were evaluated. Statistical analysis was performed using GraphPad Prism software, version 6. 0 (GraphPad, San Diego, CA, USA), by ANOVA, followed by the Tukey post hoc analysis. Results: The MDA content and SOD activity increased significantly in the DZN group compared with those in the control group. Treatment with CAP in the DZN-exposed group significantly decreased (P<0. 05) the MDA concentration and the SOD activity. The total thiol groups were decreased in the DZN group and elevated again by CAP treatment. Conclusion: The co-administration of CAP and DZN was able to attenuate lipid peroxidation and enzyme changes caused by DZN.

Background: Differentiating oligodendrocyte precursor cells (OPCs) into oligodendrocytes could be improved by inhibiting signaling pathways such as Wnt and Notch. 9-cis-retinoic acid (9-cis-RA) and 1, 25-dihydroxyvitamin D3 (1, 25[OH]2D3) can ameliorate oligodendrogenesis. We investigated whether they could increase oligodendrogenesis by inhibiting the Wnt and Notch signaling pathways. Methods: Cortical neural stem cells were isolated from 14-dayold rat embryos and cultured using the neurosphere assay. The cells were treated in 4 different conditions for 1 week: the negative control group received only the basic fibroblast growth factor, the positive control group received only T3 without growth factors, the RA group was treated with 9-cis-RA, and the Vit D3 group was treated with 1, 25(OH)2D3. The effects of 9-cis-RA and 1, 25(OH)2D3 on the level of the myelin basic protein (MBP) and the gene expression of the SOX10, MBP gene, HES5, and LRP6 were studied using flow cytometry and real-time PCR. The data were analyzed using one-way ANOVA with GraphPad Prism. A P value less than 0. 05 was considered significant. Results: The mRNA expressions of the SOX10, MBP, and MBP gene were significantly increased in the treated groups compared with the negative control group; the increase was similar in the 9-cis-RA group and the positive control group. Furthermore, 9-cis-RA significantly decreased the expression of the HES5 gene, a Notch signaling pathway transcription factor, and 1, 25(OH)2D3 significantly reduced the expression of the LRP6 gene, a Wnt signaling pathway co-receptor. Conclusion: It seems that 9-cis-RA and 1, 25(OH)2D3 are good candidates to improve the differentiation of OPCs into oligodendrocytes.

Background: Promoter hyper-methylation of tumor suppressor genes is a common event that occurs in cancer. As methylation is a reversible modification, agents capable of reversing an abnormal methylation status should help to combat cancer. 5-Aza-CdR is a DNA methyl-transferase inhibitor. The present study aimed to evaluate the effect of 5-Aza-CdR on the proliferation of human pancreatic cancer cell line (PANC-1) and the expression of RASSF1A and Bax genes. Methods: PANC-1 cells were cultured and treated with 5 and 10 μ M/L of 5-Aza-CdR for 24, 48, 72, and 96 hours and the percentages of cell viability and apoptosis were measured by MTT and flow cytometry. RASSF1A gene promoter methylation was assessed by methyl-specific primer-PCR (MSP-PCR) and the expression of RASSF1A and Bax genes was measured using quantitative real-time PCR (qPCR). All quantitative data are presented as mean± SD (standard deviation). The one-way analysis of variance (ANOVA) with the LSD post hoc test was performed for statistical analysis using the SPSS software package, version 16. 0. Results: 3-[4, 5-dimethythiaziazol-2yl]-2, 5-diphenyl tetrazoliumbr omide (MTT) assay revealed that 5-Aza-CdR significantly inhibit the growth and proliferation of PANC-1. The flow cytometry results showed over 40% and 70% of early and late apoptotic cells after treatment with 5 and 10 μ m/L of 5-Aza-CdR, respectively. MSPPCR data indicated that the treatment of cells with 10 μ m/L 5-Aza-CdR resulted in partial demethylation of RASSF1A gene promoter. qPCR results showed significant re-expression of RASSF1A and up-regulation of Bax genes after 96 hours treatment of cells with 10 μ m/L 5-Aza-CdR versus control cells (P<0. 01). Conclusion: The result demonstrated that 5 and 10 μ M of 5-Aza-CdR induce cell death and apoptosis by epigenetic reactivation of RASSF1A and up-regulation of Bax genes.

Cooling method was proposed to maintain the sperm quality for several days. Nevertheless, during this procedure, sperm is encountered to “ cold shock” , and its quality decreases timedependently. This study was designed to improve the in vitro sperm preservation methods. Thirty normal semen samples were examined in Shiraz, Iran, 2017. Fifteen samples were incubated at 22-27 ° C and 15 samples were cooled moderately to 4 ° C. Each sample was divided into five subgroups; control, solvent, 200 μ M Trolox, 40 μ M Coenzyme Q10, and 10 mM ATP. ATP was added only 15 minutes before the analysis. Assessments of motility parameters and sperm viability were done every 24 hours. Statistical analysis was performed using SPSS 16 software. The differences between two main groups and subgroups were compared by t test and one-way ANOVA, respectively. The effect of time was analyzed by repeated measurement test. Sperm motility and viability were the same in both groups until 24 hours, except the straight line velocity was greater in the cold group. Even after 48 hours, progressive motility and sperm velocity, but not viability, were still the same. The greatest reduction in progressive motility occurred on the second day; and after 72 hours, sperm quality was better preserved in 22-27 ° C. Treatment with Trolox, coenzyme-Q10, and extracellular ATP did not have effect on sperm quality. Cold temperature is recommended for in-vitro sperm preservation up to 24 hours, and 22-27 ° C is preferred for longer time storage. The sperm does not need antioxidant therapy for quality maintenance, but the extender media must be supplied with nutrients and antibiotics.

Cutaneous involvement is an unusual complication in brucellosis that has been reported to range between 0. 4% and 17%. We here introduce a 40-year-old shepherd, who presented with two ulcerative abscesses in his lower left leg. Cultivation of the abscess aspirate was positive for Brucella abortus. The first titer of his serological test was 1/160, which subsequently rose to 1/640. In countries like Iran where brucellosis is still endemic, it is important to take Brucella species into account among other pyogenic bacteria as a causative agent of cutaneous abscesses.

The mirror foot is a rare congenital foot anomaly which is often associated with 6-to 8-toed polydactyly. Postaxial polydactyly is the most common form of this anomaly, while central polydactyly is seen infrequently. We report on 2 cases of the central mirrorfoot anomaly. Calcaneus duplication and fibular hypoplasia were present in 1 case. We treated both patients by resecting the middle foot rays and narrowing the foot width through cuneiform excision and use of cerclage wires or heavy suture approximation of the remaining adjacent rays. In the mirror foot, the old and more common treatment was the resection of the border extra toes or rays. Central-ray amputation with dorsal and plantar incisions and narrowing the foot with soft-tissue reduction and cuneiform excision confer excellent functional and cosmetic results.

Pectus excavatum is the most common congenital deformity of the chest wall. The most frequently used techniques include Ravitch (costochondral resection) and Nuss (minimally invasive pectus repair of pectus excavatum [MIRPE]). The Nuss technique includes using temporary metallic bars without costochondral resection to correct the chest wall deformity. Modified MIRPE can be learned easily and performed safely with few complications. There are no reports of successful MIRPE in Iran, although the Ravitch technique is well known. In the present study, we report the first Iranian experience with the modified Nuss procedure in 5 patients with pectus excavatum (age range=13– 48 y). All the patients suffered from low self-esteem, and one of them complained of low exercise capacity and occasional chest pain. With single-lung ventilation and sternal elevation, an introducer was entered into the right thoracic cavity and retrosternal tunneling was performed under thoracoscopic vision. The introducer was passed to the left thoracic cavity and exited on the left thoracic wall. A titanium plate bar was implanted and fixed with stabilizers. There were no cases of mortality, and all the patients were discharged in good conditions within 2 weeks. Postoperative complications consisted of 1 case of pneumothorax and 2 cases of fixed bar protrusion. The present case series indicated that a skilled thoracoscopic surgeon is able to do the Nuss procedure in Iranian patients with symmetrical pectus excavatum with few complications. However, mixed or redo cases require more expertise.

Nocardiae are Gram-positive, filamentous, aerobic, relatively slow-growing, and weakly acid-fast bacteria which cause nocardiosis in humans. We describe a 53-year-old patient with chronic bronchitis referred to Al-Zahra Hospital, Isfahan. A bronchial washing sample was taken from the patient. A Nocardia-like microorganism was detected in microscopic evaluation. Based on the phenotypic and 16S rRNA gene sequencing, the isolate was identified as Nocardia thailandica. The patient was treated with trimethoprim-sulfamethoxazole and linezolid. This is the first report of the isolation of Nocardia thailandica from Iran.

Dear Editor, Mycetoma is a chronic indolent, slowly progressive granulomatous infection which eventually causes bone destruction. 1 Its diagnosis is difficult until the advanced stage, which is characterized by sinus formation, discharge of dark-colored grains, extensive soft tissue, and bone damage with deformity often necessitating amputation. Although biopsy and microbiological culture provide definitive diagnosis, these are difficult to achieve consistently. 2 Early diagnosis and prompt treatment can significantly limit disability and avoid amputation. MRI (magnetic resonance imaging) features of mycetoma are characteristic, especially the dot-in-circle sign, which allow early and confident diagnosis when typical clinical features such as sinuses and grains are not manifested or histopathological diagnosis and aspiration cytology are negative or indeterminate....