ARCHIVES OF IRANIAN MEDICINE
Year:2008 | Volume:11 | Issue:2|Papers Count:22

Background: Increased duodenal intraepithelial lymphocytes is a key histological finding in celiac disease. Available studies suggest a wide normal range (10 – 40 intraepithelial lymphocytes /100 epithelial cells, EC). We assessed the normal range of distal duodenal intraepithelial lymphocytes.  Methods: Biopsies from the normal-looking distal duodenum from individuals referring for endoscopy for reasons other than intestinal pathologies were stained with hematoxylin-eosin and immuno-histochemistry (immuno-histochemistry, CD45). At least 1000 cells from the tip and body of the villi were assessed. Villous height to crypt depth ratio was calculated. Results: Fifty individuals were enrolled. Four were excluded (inadequate biopsies). Mean intraepithelial lymphocyte count was similar in villous tip and body. In the whole villous, upper limit of normal (mean+2SD) was 35 intraepithelial lymphocytes/100EC (95% CI: 31 – 39) in immunohistochemistry and 34 intraepithelial lymphocytes/100EC (95%CI: 29 – 37) in H&E staining. The villous height to crypt depth ratio was 3.9. Hematoxylin-eosin and immunohistochemistry had excellent agreement. Conclusion: Intraepithelial lymphocyte counts less than 35/100EC in IHC and 34/100EC in hematoxylin-eosin staining can be considered normal. Counts between 36-39 (immunohistochemistry) and 35 – 37 (hematoxylin-eosin) are borderline and more than 39 (immunohistochemistry) and 37 (hematoxylin-eosin) are increased. The hematoxylin-eosin staining method seems adequate for clinical purposes. Regional differences in the normal upper limit for intraepithelial lymphocytes as well as changes over time should be considered when interpreting duodenal biopsies.

Background: Contrast sensitivity is an important aspect of visual function and is even more important for ordinary daily tasks than visual acuity. Contrast sensitivity function may be deteriorated to a significant level in diabetic retinopathy, especially in diabetic macular edema. The objective of this study was to determine the impact of macular laser photocoagulation-as the standard treatment of clinically significant macular edema-on contrast sensitivity function. Methods: In a prospective noncomparative interventional case series, 17 patients with clinically significant bilateral macular edema and no history of prior macular laser photocoagulation were enrolled. Baseline visual acuity, contrast sensitivity function, and fluorescein angiography were obtained and reassessed three months after macular laser photocoagulation. Results: Clinically significant macular edema resolved in 22 (65%) of 34 eyes, three months after their first session of macular laser photocoagulation. The mean pretreatment visual acuity was 24.5/40 (0.21 logMAR) ±10.3/40. Three months after macular photocoagulation, visual acuity remained stable in 19 eyes, decreased in 12 eyes, and increased in three eyes. The mean posttreatment visual acuity was 24/40 (0.24 logMAR) ±10.8/40. There was a statistically significant (P = 0.02) decrease in visual acuity following laser therapy. In subgroup analysis, this decrease in visual acuity was only observed in those with unresolved clinically significant macular edema. The mean contrast sensitivity threshold increased in all spatial frequencies by three months after macular photocoagulation. The maximum rise was observed in the frequency of 6.4 cycles per degree in the mid range of frequencies, with a pretreatment mean of 9.41 dB and a post-treatment mean of 11.50 dB (P<0.05). Conclusion: Contrast sensitivity function improved after macular laser photocoagulation in clinically significant macular edema patients.

Background: Congenital anomalies play a significant role in perinatal and infantile morbidity and mortality. There is a variation in the frequency of congenital anomalies in different populations. Determination of the prevalence of different types of congenital anomalies may help plan primary prevention measures for these anomalies. The objective of this study was to determine the prevalence at birth of overt congenital anomalies in Urmia, in the northwest of Iran. Methods: In a cross-sectional hospital-based study, charts of 14,121 deliveries including livebirths and stillbirths during the period from January 2001 through June 2005 were studied. Results: A total of 264 (187 per 10,000 births) anomalies were detected. The anomaly categories with the highest prevalence were nervous system defects (52.65%) followed by musculoskeletal defects (23.86%). The total prevalence at birth of overt congenital anomalies was 1.87%. The rates for live- and stillbirths were 1.17% and 40.7%, respectively. Conclusion: Considering the high frequency of central nervous system anomalies recorded in our study, it seems to be reasonable to pay more attention to the role of periconception vitamin supplementation for the primary prevention of congenital anomalies, particularly neural tube defects.

Background: Altitude illness results from hypobaric hypoxia at altitudes higher than 2500 meters above sea level. To determine whether vital signs can be used as predictors for severe acute mountain sickness, we carried out a prospective observational study. Methods: A cohort of 90 individuals (male/female ratio: 2; age: 13 – 65 years) in a mountain hotel’s clinic at 3450 meters in Iran were studied from September through October 2006. Demographics and vital signs were measured during the first hour of ascent. The individuals were followed for acute mountain sickness symptoms including headache, dizziness, nausea or vomiting, insomnia, and fatigue. Lake Louise criteria were used to diagnose acute mountain sickness. Severe acute mountain sickness was considered if a score of equal or more than 5 was present. Significance was assigned to values of P<0.05. Results: Acute mountain sickness was diagnosed in 34 (37.8%) participants after 24 hours of ascent. Severe acute mountain sickness was detected in 14 (15.6%) participants. A respiratory rate of 20 or more during the first hour of ascent was recorded for nine (64.3%) patients with severe acute mountain sickness and 15 (19.7%) individuals in the negative/mild acute mountain sickness group. This suggests an association between early high respiratory rates and risk of subsequent severe acute mountain sickness (P=0.001). Conclusion: There is an association between a rise in the respiratory rate and susceptibility to acute mountain sickness. This can enable us to predict severe acute mountain sickness and prevent it. Furthermore, Tochal Mountain Hotel guests should be aware of the risk of acute mountain sickness and should be recommended to use prophylactic acetazolamide or dexamethasone before ascent.

Background: Iodine deficiency has been identified as a significant public health problem in Iran. The main strategy for controlling iodine deficiency was nationwide salt iodination. Over 10 years after starting this program, goiter is still endemic in school children. Iron deficiency may have interfered with the iodine intervention program. The objective of the present study was to evaluate the relationships between iron status, thyroid hormone profile, and the prevalence of goiter 11 years after implementation of the salt iodination program. Methods: In this study which was conducted in Marvdasht, Shiraz, 1188 students aged eight to 13 years were enrolled. Goiter was graded according to the classification by the World Health Organization (WHO). Serum concentrations of thyroid hormones and thyroid stimulating hormone were determined using commercial kits. The urinary iodine level was measured using the digestion method. Results: Goiter was endemic (39.6%); the majority of participants had grade 1 thyromegally. Despite the endemic status of goiter in southern Iran, the urine content of iodine reflected a normal iodine intake. The prevalence of iron deficiency was 16.4%.The iron-deficient patients had a significantly higher thyroid stimulating hormone level and lower free T4 concentrations than those with a normal serum ferritin level (P<0.001). Conclusion: Iron supplementation may improve thyroid metabolism in children but we still have to investigate the role of other goitrogens in this area.

Background: Psoriatic arthritis is an inflammatory arthritis which is associated with psoriasis. There is no general agreement in the literature regarding the epidemiology of psoriatic arthritis. In this study, we evaluated the prevalence of psoriatic arthritis in a relatively large number of psoriatic patients. Methods: Three hundred and twenty patients with psoriasis were evaluated in a crosssectional study. The psoriasis area and severity index, family history, demographic variables, and some other factors (e.g., clinical type and location of the disease) were assessed. The patients were examined for signs of arthropathy and the suspects were referred to a rheumatologist for further evaluation and confirmation of the diagnosis. Results: Psoriatic arthritis was observed in 29 (9.1%) patients. The prevalence of Psoriatic arthritis in men (10.1%) was not statistically different from that of women (7.8%). The most common type of psoriasis in all patients, with and without psoriatic arthritis, was chronic plaque psoriasis. The mean±SD psoriasis area and severity index was significantly (P<0.05) higher in patients with psoriatic arthritis (24.33±10.36) than those without psoriatic arthritis (10.70±8.44). Nail involvement was significantly more common in patients with psoriatic arthritis than those without psoriatic arthritis. HLA B27 was the most common HLA detected in patients with psoriatic arthritis.Conclusion: Dermatologists are usually the first physicians to detect signs and symptoms of psoriatic arthritis and need to work closely with rheumatologists to establish the diagnosis and start appropriate treatments which will address both the skin and the joint disease.

Background: Lithium has been shown to relieve mania and induce antinociception. In the present study, swim stress at 8°C induced antinociception in both phases of the formalin test. Intraperitoneal administration of lithium chloride (LiCl) (0.05, 0.25, and 0.5 mg/kg) also induced antinociception in both phases of the formalin test. Methods: Antinociception was assessed by the formalin test method. Swim stress was achieved in the 8°C water in a container 5 cm in diameter and 20 cm tall filled with water do a depth of 11 cm. Results: The drug (0.5 and 5 mg/kg) potentiated swim stress-induced antinociception in the second phase of the test. Repeated exposure to water swimming stress with a period of 40 sec, once daily for three days, in combination with lithium chloride did not alter stress-induced antinociception in either phases of the formalin test, when swim stress-induced antinociception was tested on the fourth day. Subchronic treatment with morphine (25 mg/kg), once daily for three days, in the presence or absence of lithium chloride (5 mg/kg) did not alter swim stress-induced antinociception, either, when swim stress-induced antinociception was tested on the fourth day. Conclusion: It may be concluded that lithium chloride potentiates swim stress-induced antinociception, but the drug has no influence on the response of subchronic administration swim stress or morphine.

Background: Hepatitis C virus is one of the main causes of chronic hepatitis in developing countries. There are 170 million affected people around the world as reported by the World Health Organization. The treatment of hepatitis C is not successful in most cases; it is extremely costly, and requires prolonged therapy, therefore it is desirable to develop a vaccine to prevent the spread of hepatitis C virus. Methods: Hepatitis C virus RNA was extracted from a hepatitis C virus-infected serum sample. cDNA was synthesized and the hepatitis C virus core gene was amplified by polymerase chain reaction. The polymerase chain reaction product was cloned in pGEMEX-1 expression vector and expressed in Escherichia coli BL21 strain with DE3 (a l prophage carrying the T7 RNA polymerase gene) host by induction of promoter using one millimolar isopropyl b-Dthiogalactopyranoside in laboratory scale. Induced lysate cells were electrophoresed on SDS polyacrylamide gel.Results: A protein band was detected in induced cells in comparison with non-induced cells. Expressed protein was confirmed by gel diffusion and dot blot analysis using induced lysate cells as antigen and hepatitis C virus-infected serum as antibody.Conclusion: In present study, we have provided a recombinant plasmid based on hepatitis C virus core gene.

Background: The reversed sural artery flap is a well-described method for lower limb reconstruction. However, in the standard technique, the flap is usually not harvested from the proximal third of the leg. We conducted this study to evaluate the efficiency, safety, and success rate of the reversed sural flap harvested from the proximal third of the leg. Methods: The authors harvested medium to very large sized flaps from or extended to the upper third of the calf in 28 patients to cover the defects in the distal tibia, ankle, heel, foot, and sole. Results: With proximal extension of the flap, we would have a longer and larger flap with a safer pedicle. The majority of flaps resulted in a good coverage of defects. Only the distal 1cm of a large flap developed marginal necrosis in the distal border, which was treated with a secondary skin graft. Six flaps developed venous congestion. In seven other patients, minor complications such as hypertrophic scar in the donor site, rupture of sutures, and superficial epidermolysis occurred. In these 13 patients, the complications did not influence the final outcome.  Conclusion: Extension of reversed sural island flap to the proximal third of the leg was safe and reliable. It was efficiently used to treat patients with large and far wounds, from the distal leg to the distal foot and the sole with more versatility and easier reach to the recipient site.

Although various elements of the immune system are involved in detection and elimination of neoplastic cells, immune surveillance mechanisms are not always successful in eradicating cancer. Invariant natural killer T cells are potent immunomodulatory lymphocytes that secrete large amounts of Th-1 and/or Th-2 cytokines in response to glycolipid agonists. The observed role of invariant natural killer T cells in antitumor immunity in various animal models and the relatively recent identification and availability of Invariant natural killer T cell glycolipid ligands with anticancer properties such as α-galactosylceramide have led to several invariant natural killer T cell-based clinical trials in cancer patients with somewhat promising outcomes. The objective of this article is to provide a short overview on immunobiology of invariant natural killer T cells followed by their potential applications in treatment of cancer.

In this study, we reviewed the surgical findings in a series of revision tympanomastoidectomy to determine the most common causes of failure in chronic otitis media surgery. The intraoperative findings at revision mastoidectomy with tympanoplasty of 116 patients were analyzed. The most common sites of pathologic tissue at revision surgery (with cholesteatoma and/ or granulation tissue) were unexenterated cells of the sinodural angle. The most common mechanical cause of retention of debris in canal wall down procedures was facial ridge.

Animal bites are major public health issues, not only for the risk of acquiring secondary infections but also for the possibility of contracting rabies. The objective of this study was to determine the epidemiology of animal bites in Tehran, Iran. During a three- year period, through a questionnaire- based study, 8806 bitten persons were enrolled into our study. Of these, 79.16% were males and 20.84% were females. Bites were most frequent among the age group of 20-29 years. Most cases were self employed. Upper extremities were the most frequent bite site (53.8%). The offending animals, in order of frequency were dogs, cats, squirrels, monkeys, hamsters, and other animals, responsible in 5804 (65.9%), 2241 (25.44%), 343 (3.89%), 134 (1.52%), 125 (1.41%), and 159 (1.84%) cases, respectively. We found that animal bites are still prevalent in Iran and thus preventive measures and health education are required for the public.

Markers of bone turnover are becoming an important tool for practitioners in the management of osteoporosis. Therefore, it is essential to establish a reference database of the markers before using them in various clinical settings. A total of 785 individuals (37% males, 63% females) without apparent or suggested abnormalities affecting bone mass were randomly selected from 13 clusters in Bushehr Port in southern Iran. The serum CrossLaps ELISA and the N-MID Osteocalcin ELISA were used for the quantitative measurement of CrossLaps and osteocalcin in sera. Bone mineral density was determined for the lumbar spines (L2-L4), proximal femur (neck), and forearm (the distal part) using dual-energy X-ray absorptiometry. Men had higher biochemical serum bone markers (P<0.0001). In women, there were progressive increases in serum CrossLaps after 30 years of age, peaking at >60 years. In men, serum CrossLaps levels were decreased progressively by increases in age, with the peak at 20 – 29 years. In women, there was a significant decrease in serum osteocalcin from 20 – 29 years to 30–49 years, followed by a progressive increases during 50 – 59 years, with the peak at >60 years. In men, the highest concentrations for serum osteocalcin occurred at 20 – 29 years. At all sites checked for bone mineral densitys, women in the high osteocalcin quartile had the lowest mean bone mineral densitys values, but women in the high Cross Laps quartile had the lowest mean bone mineral densitys at lumbar and radial sites. However, in men, bone mineral densitys values at neither site differed between the lowest and the highest quartiles of serum biochemical bone markers. We presented a five- year age-specific mean values of bone markers in a general healthy Iranian population. Only women in the high osteocalcin and CrossLaps quartiles had the lowest mean bone mineral densitys values at the lumbar and radial sites. Our results suggest that the significance of osteoclastic bone resorption or bone formation as a determinant of bone mineral densitys may depend on sex.

This study was conducted to determine the prevalence of oral aphthosis in a normal population in Iran, using the data of the WHO-ILAR COPCORD study in Iran. We conducted this study in Tehran, the capital of Iran which was selected as the COPCORD study field. In 22 districts of Tehran, 50 clusters were randomly selected. Of the selected houses, 4,096 households were visited and 10,291 persons were interviewed (response rate of 75%). Out of the 10291 subjects interviewed, 2592 had aphthous ulcers which translated to a prevalence of 25.2% (95% confidence interval: 24.4% to 26.0%). The prevalence of oral aphthosis was rather high in this normal population.

Triceps skinfold thickness charts of a random sample of 2,234 healthy school children (1,161 boys and 1,073 girls) in Shiraz, Iran are presented. Triceps skinfold thickness increases by age and  is higher in girls than boys, except for upper extreme centiles. Triceps skinfold thickness may be used with reasonable success to detect childhood obesity, which would be of great importance in public health promotion. It favors adequacy and simplicity in screening for adiposity. The charts presented here are likely to be applied to urban population of school-aged children in Iran, however, it should be updated periodically.

Carotid body tumor (paraganglioma) is a rare tumor which presents as a mass in the lateral part of the neck. It is typically a slow-growing and nonsymptomatic mass at the beginning. Fever is not an usual symptom of this tumor. Here, we report a 78- year-old woman presenting with this tumor as a cause of fever of unknown origin.

This 66-year-old Iranian gentle man had a one-year history of asymptomatic keratotic papules with a linear distribution on the skin of his right palm near the wrist. On histopathologic examination-cornoid lamella-like parakeratotic columns above eccrine ducts were observed. The acrosyringium was also dilated. The diagnosis was porokeratotic eccrine ostial and dermal duct nevus. The late-onset development of the disease in our patient was interesting to us, because it is considered a congenital hamartoma.

The human face is a very important feature as it contains vital elements like the eyes, nose, lips, and eyelids. Numerous factors can damage soft tissue in the face causing functional and cosmetic defects. One of the common causes of disfiguring facial scars is burns. There are different methods of reconstruction each with their own merits and demerits. Herein, we describe a method for the facial reconstruction of an extensive unilateral burn scar using an expanded pedicled flap from the cervical area, with special attention to the hair line of the face.

Angiomyofibroblastoma is a benign well-circumscribed tumor characterized by alternating hypocellular and hypercellular areas with abundant thin-walled blood vessels. The tumor cells are bland and spindle-shaped or epitheloid and tend to concentrate around the vessels or cluster in small nests. Herein, we report a case of angiomyofibroblastoma of the left labia major in a 50-yearold female. The tumor measured 18×16×11 cm and appeared as an ulcerated rubbery vulvar mass with rapid enlargement during one month. Ultrasonography demonstrated a soft tissue tumor with homogeneous echo and normal vascularity. Histologically, cells were positive for vimentine, desmin, and estrogen and progesterone receptors but negative for cytokeratin; all in favor of the diagnosis of angiomyofibroblastoma.

See the next page for the diagnosis 17-year-old man was referred for evaluation of a hip mass. He had a history of local swelling with limitationof motion in his right hip. There was no history of Tumoral calcinosis is a rare disease characterized by calcified soft tissue masses near large joints. Approximately one-third of the cases exhibit familial inheritance.1 Nearly 80% of reported patients are black. Typically, it presents in young African men with swelling around large joints which could be painful. However, the mass is generally painless and grows slowly over a year...

according to Biruni,1 Abu Bakr Mohammad Zakariya Razi (Latin Rhazes) was born in Rayy (an ancient town south of present day Tehran) in the year 865 C.E. (251 A.H.) and died there in 925 C.E. (313 A.H.) or a few years later at the age of 60 or so. As Biruni mentions in his “Catalogue”, Razi spent his youth as an alchemist but around the age of thirty, due to failing vision, gave up alchemy and started his career as a physician. There is scant information available regarding Razi’s personal life, but it seems that he played the lute in his youth2 and wrote an encyclopedia of music At that time, he was apparently a goldsmith by profession and as Ibn Abi Usaibia recounts in his “Lives of the Physicians” (1245 C.E.) he had come across an old manuscript of “Kitab al-Mansuri fi Tebb” hand written by Razi himself in which he had inscribed the title of the author as “Mohammad Zakariya al Razi al-Seirafi (the  oldsmith)

professor Werner Felix Dutz (Figure 1), an Austrian pathologist, joined the faculty of the School of Medicine of Shiraz University in southern Iran in 1959. He and his wife, Dr. Elfriede Kohout, also a pathologist, had come to Iran for only a two-year appointment at an academic institution in a Third World Country, to meet the existing requirements for eligibility of immigrant status in the U.S. They stayed for fifteen years until 1974, when they left for America and subsequently joined the University of Vienna, Professor Dutz’s alma mater. Werner died unexpectedly of a heart attack in Vienna in 1984. After World War II, many scientists, medical or nonmedical, from Europe or America, ventured across the globe to transfer their skill and knowledge abroad, in return for the satisfaction of having served where they were needed. Upon returning home, they would usually close that chapter of their life by publishing fascinating accounts of their sojourn overseas. Werner Dutz's undertaking was an altogether different proposition. He belonged to a very rare and special class of scientist – travelers.