ARCHIVES OF IRANIAN MEDICINE
Year:2002 | Volume:5 | Issue:1|Papers Count:13

Background-Supracondylar fracture of the humerus is a relatively common injury in children and is the most common fracture in this age that requires surgery. Absence of the radial pulse is not a rare accompanying sign of this type of fracture. Cases displaying this condition are occasionally referred to centers with vascular and orthopedic surgery facilities, including Sina Hospital, a trauma referral center, downtown Tehran. The patients are dispatched to these centers with minimum intervention at the time of presentation. This act will lead to undue loss of time and patient inconvenience. The present study was designed to establish a logical approach to this important orthopedic emergency. Methods-Out the 61 patients admitted for displaced supracondylar fracture over a 5-year interval, 21 had absent radial pulse. The orthopedic or vascular surgery interventions along with the aftermath were studied. Results-From the 21 patients with absent radial pulse, vascular surgery had been performed only in 4 patients. Exploration of vessels was normal with spasm and without structural injury or occlusion in 2 cases. Venous graft for repair was done in the other 2 cases who had delayed capillary filling. In the remaining 17 patients with normal capillary filling, vascular surgery had not been performed and therapeutic results were satisfactory. Conclusion-In a child with a displaced supracondylar fracture of the humerus and absent radial pulse, the presence of normal capillary filling, similar to the other limb, is a reliable sign for effective circulation. With this finding, the orthopedic surgeon can manage the patient without vascular surgery facilities. Delayed capillary filling however needs emergency vascular surgery consultation.

Background-Recent reports have shown a probable association between certain HLA antigens and acute graft versus host disease (GVHD) after allogeneic bone marrow transplantation (BMT). Methods-Medical records of 162 patients who had undergone allogeneic BMT from an HLA-identical sibling in the Hematology, Oncology and Bone Marrow Transplantation Center of Shariati Hospital in Tehran between 1991 and 1999, were studied and analyzed by univariate and multivariate analyses. All factors including HLA antigens, age, sex and diagnosis were examined jointly using a logistic regression analysis. The relationship between HLA antigens and acute GVHD was re-examined within the regression setting. Results- The diagnosis was thalassemia in 81 (50%), CML in 27 (16.7%), AML in 16 (9.9%), ALL in 6 (3.7%) and aplastic anemia in 22 (13.6 %) cases. Overall, 36 (22.2%) patients developed clinical Grade III and IV acute GVHD. Univariate analysis confirmed an increased risk of severe acute Grade III and IV GVHD, which was associated with the diagnosis of AML, donor to recipient sex mismatch and probably with the allele HLA-DR7 (p=0.01, 0.051 and 0.07, respectively). The risk of GVHD was reduced in the presence of the HLA-B35 allele (p=0.04). Multivariate analysis confirmed a decreased risk of acute GVHD associated with HLA-B35 (p=0.01), while the risk was increased in patients with AML (p=0.009) and in those with a sex-mismatched donor. Conclusion-In this study, AML, donor-to-recipient sex mismatch and probably HLA-DR7 were found to be probable risk factors associated with GVHD, and HLA-B35 was found to be a protective factor against severe acute GVHD. These data might be useful as prognostic factors in predicting the risk of GVHD and also in defining risk-related methods for GVHD prophylaxis.

Background-Neonates born to HBsAg positive mothers are at high risk of hepatitis B virus (HBV) infection. The aim of this study was to evaluate the efficacy of hepatitis B immunoglobulin and HBV vaccine in these infants. Methods-From September 1998 to September 2000, 103 infants born to HBsAg and HBeAg positive mothers were followed. All infants received HBIG and the first dose of vaccine at birth and the second and third doses of vaccine at 1.5 and 9 months of age, respectively. Post-vaccination tests were performed on 93 infants at 12 to15 months of age. Data were then analyzed by the Chi-square and Fisher exact tests. Results-Nine mothers (9.7%) were HBeAg positive. Fifty-nine (63.4%) infants were anti- HBs positive. The differences between the rate of anti-HBs were not significant in either sex (p=0.64). An antibody titer of more than 100 IU/mL was defined as responder and seen in 41 (48.8%) infants who were born to HBsAg-positive mothers, significantly higher than infants of HbeAg positive mothers (p=0.0062). HBsAg was positive in 3 (3.6%) infants born to HBeAg negative mothers, significantly lower than the incidence of HBsAg positivity (33.3%) in infants born to HBeAg positive mothers (p=0.011). Seventeen infants (18.3%) were poor responders and 34 (36.6%) were non-responders. Conclusion-In this study children who were poor or non-responders to HBV vaccination in these groups of children are relatively high and additional doses of the vaccine were required for satisfactory immunization. Some of these infants may become chronic carriers. Postvaccination testing is necessary

Background-Multiple sclerosis (MS) is a multi-factorial disease with different epidemiological patterns and clinical presentations in various populations. Study of these different patterns can help us find the possible etiologic factors of this disease.Methods-Following announcement in two national newspapers inviting MS patients to participate in this study، 411 individuals responded. By taking a complete medical history and reviewing medical record documents such as magnetic resonance imaging (MRI)، 318 patients were diagnosed with MS and were included in this study. Data was collected by a self-administered questionnaire، which was mailed to the patients.Results-The mean age in this group was 35.4 ±9.6 years (mean±SD) and the female:male ratio was 1.5:1. The average age of onset for this disease was 26.6±8.1 years (mean±SD). Sensory and visual disturbance were the most common initial presentations with a prevalence of 30.5% and 24.6%، respectively.Conclusion-Data analysis showed that the demographic pattern of MS in Iran is similar to countries in the same geographical region such as Saudi Arabia، Kuwait، and Jordan.

Background-Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are still two major public health problems in Iran. Our objective was to assess the status of acute rheumatic fever in children and adults admitted to four major teaching hospitals during the last 20 years. Methods-The number of annual hospital admissions of patients coded as ARF from March 1979 to March 1998 was obtained from medical records. The diagnosis of ARF was confirmed only if the patients fulfilled the modified Jones Criteria. The presenting signs and symptoms and the annual in-hospital prevalence were determined and the annual incidence per 100,000 cases hospitalized was calculated. Results-There were 675 cases with ARF of which 585 were initial and 90 were recurrent attacks. Female to male ratio was 3:4. The age of the patients was 15.4±7.5 years (mean±SD) with a range of 4 to 78 years. The groups most at risk were children and young adults aged 6 to 20 years (n=364). The major presenting complaints included polyarthritis (92.44%), carditis (57.48%), chorea (4.6%), erythema marginatum (1.9%) and subcutaneous nodules (0.15%). The attack rate was higher between the years 1979 and 1995 and lower thereafter. Conclusion-The changing pattern of the frequency of ARF during the last few years might be attributed to an improvement in the status of education and awareness in the general population, availability of a larger number of physicians in the primary health care settings, especially in rural areas, and earlier diagnosis and treatment of patients suspected with streptococcal pharyngeal infection

Background-Apart from direct dose assessment of radiation exposure, analysis of chromosomal aberrations using the standard method has been widely used in monitoring the cytogenetic effects of long-term occupational radiation exposure. Chromosomal damage in human somatic cells may serve as an early indicator of hazard, thus enabling prevention of adverse effects. Methods-The frequency of chromosomal aberrations were evaluated in the peripheral blood lymphocytes obtained from 51 nuclear medicine technologists (NMT) who were exposed to chronic doses of gamma rays and 15 healthy controls. Lymphocytes were cultured in RPMI-1640 and metaphase plates were prepared using standard cytogenetic method. One hundred mitoses were analyzed for the presence of chromosomal aberrations for each sample. Radiation exposure was measured using film badge and thermoluminescent dosimeter (TLD). Results-The monthly dose equivalent received by the nuclear medicine technologists was between 0.03 to 2.80 mSv as measured by TLD and film badges. The frequencies of all types of aberrations (gaps, breaks and dicentrics) in exposed subjects were higher than those observed in the control group (p<0.0001). This study showed a linear dose-response relationship for total chromosomal deletions and dicentrics (p< 0.0001). Conclusion-The findings in this study are important, because radiation workers who have been exposed to doses well below accepted standards for exposure to radiation also show elevated levels of all types of chromosomal aberrations. Therefore, these results might imply that workers receiving very low doses of radiation during a long period of time could be considered as individuals at risk.

Background-Construction of complementary DNA (cDNA) is the first step to produce a recombinant protein and reverse transcription of mRNA is the best way to construct cDNA. Construction of cDNAs for biologically active domains of factor VIII has advantages of joining two domains to form a second generation of factor VIII and expression of domains separately for especial purposes. Method-Total RNA was purified from HepG2 and 293 cell lines, were quantitated and analyzed for presence of factor VIII mRNA by Dot RNA Blotting. One and two step reverse transcription polymerase chain reaction (RT-PCR) were applied. Primers (including nested primers) were designed for both sides of A1-A2 (cDNA1) and A3-C1-C2 (cDNA2) domains with respect to saving open reading frame (ORF) of cDNAs and deleting of B-domain, 3` and 5` untranslated region (UTR). Restriction mapping and sequencing were applied for analysis and confirmation. cDNAs were cloned into the vector and then into the ultracompetent cells by electroporation. Plasmids were purified, restriction analyzed and sequenced. Results-Five clones of cDNA1 and seven clones of cDNA2 were produced and checked for sequence similarity with factor VIII sequence from database. Some of them had point mutations and were suitable for the assessment of biological activity and yield of production. Conclusion-The construction of cDNA for A1-A2 and A3- C1-C2 domains and cloning of these two domains, which will be later linked with metal ions, is a way for production of second generation recombinant factor VIII. Another application for recombinant domains would be immune tolerance induction in hemophiliacs with inhibitors against these domains without need for administration of whole molecules.

Background-Crocus sativus L. stigma (CSS) has sedative properties and is used in traditional medicine for its anticonvulsant property. Objective-We studied the anticonvulsant activity of the aqueous and ethanolic extracts of CSS in mice in order to evaluate the traditional use of this plant. Methods-The pentylenetetrazole (PTZ) and the maximal electroshock seizure (MES) tests were used for assessing the anticonvulsive effects of this plant. Results-In the PTZ test, CSS delayed the onset of tonic convulsions, but failed to produce complete protection against mortality. In the MES test, both extracts decreased the duration of tonic seizures. Conclusion-The results of this study indicate that the extracts of CSS may be beneficial in both absence and tonic clonic seizures.

Background-The two principal subgroups of A antigen are A1 and A2. About 80% of group A individuals have red blood cells (RBCs) that are agglutinated by anti-A1. At appropriate dilution, Dolichos biflorus (lectin) acts as an anti-A1 and agglutinates A1 but not A2 RBCs. The main goal of this study was to test and introduce a standardized lectin in order to differentiate the subgroups of A antigen in Iran. Methods-The powder form of the plant Dolichos biflorus was subjected to a series of sequential operations according to current standard protocols with some modifications. The prepared reagent was used to detect A1 and A2 cells based upon the agglutination reaction. The reagent was initially used to detect incompatibility reaction in 450 transfused patients at Al- Zahra teaching hospital (Isfahan, Iran) and all the results were rechecked using a standard lectin. Results-Five of 450 patients with blood group A or AB showed incompatibility with a high anti-A1 titer after transfusion of isogroup blood. Among them, 2 patients were of A2 and 3 were of A2B types. The same results were obtained by using standard lectin. Conclusion-Considering the great importance of subgroup incompatibility in transfusion medicine, we recommend the use of standardized lectin for the differentiation of A antigen subgroups before transfusion of RBCs containing the A antigen.

no absteract

no absteract

Chrysomya bezziana, one of the parasites causing myiasis, exists as an obligate ectoparasite in the animals and afflicts humans. Poor hygiene and working in contaminated areas particularly during warm seasons provides a setting for infestation with this parasite. Infestation in human and livestock are often observed in wounds, normal body orifices such as the eyes, ears, nose and mouth. The manifestations include pruritus, pain, inflammation, redness, eosinophilia, and secondary bacterial infections and rarely death. A 55-year-old man who presented with pain in the left ear, severe pruritus and vertigo was followed up and treated. After physical examination and during radical mastoidectomy, 65 larvae were obtained from his ear. These were identified as Chrysomya bezziana. Treatment included use of sterile oil, 15% chloroform-containing sterile oil and/or surgery.

Eumycotic mycetoma is a chronic infection of the cutaneous and subcutaneous tissues which also invades the nearby surrounding tissues. Over 70 percent of lesions involve the feet. Herein, we present a male farmer with a chronic eumycetoma of the buttock, which was unnoticed and untreated for about ten years and ultimately become malignant.