ACTA MEDICA IRANICA
Year:2018 | Volume:56 | Issue:8|Papers Count:13

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Mycobacterium tuberculosis, the etiologic agent of Tuberculosis, is a pathogen that is widely distributed geographically. Tuberculosis is classified as a granulomatous inflammatory condition where effector cells accumulate at the site of mycobacterial infection to form the characteristic tubercle. Regulating proteins of Th1 and Th17 cells participate in the formation of Mycobacterium-induced granuloma. The predominance of Th2 phenotype cytokines increases the severity of Tuberculosis. Treg cells are increased in patients with active Tuberculosis but decrease with anti-Tuberculosis treatment. The increment of these cells causes down-regulation of adaptive immune response facilitating the persistence of the bacterial infection. Mycobacterium tuberculosis-induced Treg cells to secrete cytokines that inhibit the immune response. This has been considered an important evasion mechanism although it is not the only that intervenes. The evolution of the Mycobacterium tuberculosis infection will depend on the cytokines' network that traduces pathological change in cells and tissues which explain the clinical manifestations existing in affected patients.

A 3. 5-year-old girl, the third child of a second-degree consanguineous marriage, was referred to the outpatient clinic of Children’ s Medical Center with a history of skin rash, redness and recurrent abscesses (Figure 1-A). She had two apparently healthy siblings, and her family history did not disclose atopy, chronic skin diseases or any other immunological disorders. Her birth weight, height, and head circumference were in normal range, and she had reached developmental milestones as expected. . . .

Chlorpheniramine, a first-generation antihistamine, is widely used for allergic reactions. Previous studies showed the interaction between antidepressant activity and nitric oxide and cyclic guanosine monophosphate (NO/cGMP) pathway. Thus, we aimed to assess the possible involvement of NO/cGMP pathway in this effect using forced swim test (FST) in male mice. To evaluate the locomotor activity and immobility time, we performed open field test (OFT) and FST on each mouse. Chlorpheniramine was administered intraperitoneally (i. p. ) (0. 1, 0. 3, 1, 10 mg/kg) 30 minutes before FST. To assess the involvement of NO/cGMP pathway, a non-selective nitric oxide synthase (NOS) inhibitor, L-NAME (10mg/kg, i. p. ), a selective inducible NOS (iNOS) inhibitor, aminoguanidine (50 mg/kg, i. p. ), a selective neural NOS (nNOS) inhibitor, 7-nitroindazole (7-NI, 30 mg/kg, i. p. ), a NO precursor, L-arginine (750 mg/kg, i. p. ) and a selective phosphodiesterase-5 (PDE-5) inhibitor, sildenafil (5 mg/kg, i. p. ) was co-administered with chlorpheniramine. Chlorpheniramine significantly decreased the immobility time at doses of 1mg/kg (P<0. 01) and 10 mg/kg (P<0. 001). Administration of L-NAME (P<0. 01) and 7-NI enhanced the anti-immobility activity of chlorpheniramine (P<0. 001), while aminoguanidine did not have any significant effects on the immobility time (P>0. 05). Moreover, pretreatment with L-arginine (P<0. 01) and sildenafil (P<0. 001) significantly reduced the anti-immobility effect of chlorpheniramine. These treatments did not alter the locomotor activity of mice in OFT. Our results revealed that the antidepressant-like effect of chlorpheniramine is mediated through inhibition of NO/cGMP pathway.

The Autoimmune thyroid diseases (AITDs) are among the most common endocrine disorders. Vitamin D as an immunomodulator and Vitamin D receptor (VDR) gene polymorphisms may be effective in AITDs pathogenesis. The aim of this study was to evaluate the vitamin D level and VDR BsmI and TaqI polymorphisms in Iranian Azeri Turkish patients with AITDs. This case-control study included 121 adults with AITDs and 117 non-AITDs controls. Serum level of 25-hydroxyvitamin D was measured by electrochemiluminescence (ECL) immunoassay. BsmI and TaqI polymorphisms were assessed by polymerase chain reaction fragment length polymorphism technique. The serum level of 25-hydroxyvitamin D in AITDs patients were lower than controls (P=0. 03). The frequencies of TT, TC, CC, T and C genotypes/alleles at TaqI (rs731236) marker were 52. 1%, 34. 7%, 13. 2%, 69. 4% and 30. 6% in AITDs and 44. 4%, 41. 9%, 13. 7%, 65. 4% and 34. 6% in controls, respectively. The frequencies of AA, AG, GG, A and G genotypes/alleles at BsmI (rs1544410) marker were 14%, 64. 5%, 21. 5%, 46. 3% and 53. 7% in AITDs and 26. 5%, 58. 1%, 15. 4%, 55. 6% and 44. 4% in controls, respectively. BsmI (rs1544410) GG+AG genotypes and G allele were more frequent among patients with Hashimoto compared with control group (86. 6% vs. 73. 5% (OR: 2. 34, 95% CI: 1. 16-4. 70, P = 0. 014) and 54. 29% vs. 44. 44% (OR: 1. 48, 95% CI: 1. 02-2. 15, P = 0. 038), respectively). Vitamin D status can be related to AITDs pathogenesis. BsmI (rs1544410) GG+AG genotypes and G allele may play an important role in the predisposition to Hashimoto.

The number of child and adolescence with type 1 diabetes mellitus (T1DM) is increasing. This study was conducted to assess glycemic control in child and adolescence with type 1 diabetes mellitus and its associated factors in Hamadan (Iran). This was a prospective observational study, dealing with 110 child and adolescence with type 1 diabetes mellitus, who referred to a pediatric diabetes clinic, affiliated to Hamadan University of Medical Sciences in 2012-2014. All blood tests were performed in a single laboratory. In this study, HbA1c levels of 6-7. 9%, 8-9. 9 and >10% were considered as good, moderate, and poor control. All collected data were recorded in the questionnaire. The number of male and female was equal. HbA1c level was equal to 6-7. 9 in 48 patients (43. 6%), 8-9. 9 in 38 patients (34. 5%), and more than 10 in 24 individuals (21. 8%). Poor glycemic control was associated with: older age, duration of disease more than 5 years, less glucose monitoring, greater insulin dose, illiterate mothers, and more number of children, and residency in rural regions. Moreover, intensive insulin regimen and more times of insulin injection increased HbA1c level, though the difference was not significant. We concluded that in T1DM child and adolescence, the age, long duration of disease, number of glycemic control, insulin dose and living in urban regions are effective factors on the better control of the HbA1c levels. To improve glycemic control, we suggest more education and social support especially for mothers and rural patients and more blood glucose monitoring.

Bullous Pemphigoid is a chronic immunobullous disease, characterized by subepidermal bulla on the skin and mucosa. The purpose of the present study was to investigate the clinicoepidemiological features of bullous pemphigoid in Iranian patients. In this retrospective descriptive study, we reviewed 82 bullous pemphigoid patients within 2014-2016. The mean age of the patients was 67. 13 years (range between 25 and 97) including 32(39. 1%) males and 50(60. 9%) females. Mucosal involvement was positive in 33(40. 2%) of the patients, and oral mucosa was most commonly involved. Head and neck area were involved in 43 (52. 4%) of the patients. Clinical and epidemiological characteristics of bullous pemphigoid are different in different regions of the world.

Adolescent smoking status is the powerful predictor for adult smoking where the most people who start smoking at lower ages continue to smoke later. The smoking process is complicated and is not limited to smokers and non-smokers, but includes patterns and different stages that need to be identified and evaluated. The main objectives of the current study were to identify the stages of smoking in adolescents and to assess factors influencing the patterns of smoking in this population. Using the multistage random sampling, 56 high schools with a total of 205 classrooms were randomly selected. The total number of 4907 high school students in Tabriz, Iran participated in the current study and completed a self-administered questionnaire. The multilevel latent class analysis was used in smoking stage determination. Three stages of smoking were identified non-smokers, moderate, and heavy smokers with prevalence 71. 3%, 22. 4%, and 6. 3%, respectively. In gender-specific analysis, such figures were 82. 6%, 14. 5%, and 2. 7% for girls and 77. 3%, 15. 6%, and 7% for boys, respectively. Age, the grade point average, living with parents, having smoking friends and family, risk-taking behaviors, self-injury, attitude and positive thinking about smoking were significantly associated with smoking stages in students. The social-economic status did not have significant association with the smoking stage. Using multilevel classification technique that considers the hierarchal construct of data, a more reliable stage of smoking was measured in male and female adolescents.

Cardiopulmonary exercise test has been raised through recent decades as a brilliant prognostic tool in a wide field of diseases and clinical conditions which makes it valuable to be used in prognostic assessment during the current study among chronic heart failure (CHF) patients. This study recruited 71 patients with severe CHF who were candidates for heart transplantation. Bicycle-protocol Cardiopulmonary Exercise Test was done, and several parameters were measured and compared between four groups of patients based on their VO2/kg to show four grades of the disease from G1 to G4. Total 71 CHF subjects from 18 to 46 year of age enrolled in the study. Statistically significant correlations were determined between HRR, VE/VCO2, VE/VO2, BR and the severity of CHF. VO2max, HRR, VE/VO2, VE/VCO2, BR, and AT were the most prominent factors of CPET which showed their validity and reliability in terms of prognosis of CHF. It seems that combination of CPET and other cardiac prognostic tools like echocardiography and measurement of the pressure in cardiac chambers can improve the prognosis in CHF.

Leukocyte adhesion deficiency type 1 (LAD-1) is a rare autosomal recessive immunodeficiency disorder, characterized by recurrent bacterial and fungal infections without pus formation. Herein, we report a case of LAD-1 that developed into gastrointestinal cytomegalovirus (CMV) disease and manifested with persistent abdominal pain and bloody diarrhea. Although the presence of concurrent gastrointestinal CMV infection with LAD-1 is a rare condition, this case highlights the need for further research to evaluate the complex mechanisms between LAD-1 and CMV occurrence.

Seventy-five percent of salivary gland tumors occur in parotid tumors. These tumors are mainly (75% to 85%) benign and around 25% turn out to be malignant. The most common cases of malignancy are mucoepidermoid carcinoma and adenoid cystic carcinoma (they totally represent half of the malignant tumors). Acinic cell carcinoma (ACC) is not of high incidence and is often seen in major salivary glands, particularly parotid gland. ACC makes up for 1-3% of salivary gland tumors and 3% of total parotid tumors. It is a low-grade malignant tumor with metastatic and invasive ability. Advanced stage, painful and fixed tumor, desmoplasia, anaplasia and differential character of the tumor, high mitosis, and necrosis, and nerve invasion, incomplete removal of the tumor, large size, and invasion to the deeper lobe of parotid worsen the prognosis of this tumor. We present a case report of a 52-year-old man with ACC metastasis to superior left humerus 15 years after surgery.

Metastatic neoplasms to the ocular surface are extremely rare. Here, we describe a case of A 56-year-old man developed simultaneously a limbal and parotid gland masses in his left side. He underwent excisional biopsy of limbal mass, parotidectomy, and systemic evaluation. Histopathologically, multislice sections of both limbal and parotidal masses disclosed an undifferentiated carcinoma of both sites. Further evaluation revealed no other site of involvement and metastasis. The patient underwent systemic chemotherapy and local radiotherapy for parotid gland tumor. Distal metastasis from undifferentiated carcinoma of the parotid gland to ocular surface is very rare and to the best of our knowledge has not been previously reported. This is the first report of the manifestation of metastasis from undifferentiated carcinoma of parotid gland origin to the limbus. The limbal mass may be the initial manifestation of metastasis from this origin and should be considered in the differential diagnosis of a metastatic limbal tumor.

One of the most significant changes in medical education during the last decade was a paradigm shift to Competency-Based Medical Education (CBME) (1). The first competency-based medical framework in Iran has been designed in Tehran University of Medical Sciences (TUMS) and replaced a time-based education framework (2). This appears to be a remarkable accomplishment, but still some changes could be made to improve this framework in one way or another. For instance, the importance of leadership, collaborator and life-long learning roles of a physician is required to be addressed clearly, as it has not been previously fully recognized. . . .