ARCHIVES OF IRANIAN MEDICINE
Year:2010 | Volume:13 | Issue:3|Papers Count:16

Background: Antimicrobials have been useful in the treatment of H.pylori-related dyspeptic diseases. However, emergence of resistant strains often decreases the eradication rates of H.pylori infections. Large-scale use of antimicrobials will lead to the diminishment of susceptible strains while allowing resistant survivors to outgrow and spread resistance genes. The aim of this study was to assess the change in antimicrobial resistance rate of H.pylori isolates from 2005 to 2008 and indicate the consequences of indiscriminate and widespread use of antimicrobials against H. pylori- and non-H.pylori-related infections.Methods: A total of 110 H. pylori strains were isolated from dyspeptic patients during 2005 to 2008 and tested for their susceptibility to antimicrobials using the disk diffusion method. MICs were determined for metronidazole (8mg/mL), tetracycline (0.5mg/mL), clarithromycin (2mg/mL), amoxicillin (1mg/mL) and furazolidone (0.5mg/mL). Since the rates of resistance to metronidazole and tetracycline were remarkably high, another 50 isolates were tested for their susceptibility to metronidazole at the same MIC (8mg/mL) and tetracycline at MICs of 0.5,1 and 2mg/mL. Resistance rates were compared to those obtained in our two previous studies between 1997 – 2000 and 2001 – 2004. Results: The resistance rates of 110 H.pylori isolates to clarithromycin, amoxicillin and furazolidone were 7.3%, 7.3%, and 4.5%, respectively. Among 160 H.pylori isolates, 55.6% exhibited resistance to metronidazole and 38.1% to tetracycline. Discussion: Compared to our two previous studies, the resistance rates of H.pylori isolates to current antimicrobials has changed over time. The change in resistance rates of clarithromycin, amoxicillin and furazolidone was not statistically significant. However, resistance to metronidazole and tetracycline showed a considerable increase from 33-36.3% to 55.6% and 0-0.7% to 38.1%, respectively. Emergence of resistance due to the intensive use of antibiotics has become a global public health problem. It appears that plasmid-carried genes are involved in the spread of resistance traits among bacteria. Results obtained in this study indicate that the increase in resistance rates of H.pylori isolates to metronidazole and tetracycline could be the indication of indiscriminate and frequent use of antibiotics in Iran.

Background: Multiple sclerosis (MS) has numerous neurologic signs and symptoms, including hearing impairment. The reports concerning the type and severity of hearing loss in MS patients vary and little is known about an association of the disease characteristics with changes in hearing status. Objective: To find the otologic and neuro-otologic manifestations of MS with the use of routine hearing assessment tools. Methods: The presence of neuro-otologic signs and symptoms were studied in 30 patients diagnosed with MS. Patients underwent pure tone audiometry, speech audiometry and acoustic brain stem response (ABR) tests. The results were compared with 30 healthy age and sex matched controls. Results: The most common finding was sensory-neural hearing loss followed by dizziness and nystagmus. The shape of the audiogram and severity of hearing loss was associated with both chronicity and disease activity. There were abnormal latencies in ABR waves which were more significant with high velocity stimulus. Conclusion: Hearing status deserves careful attention in MS patients. It may be used as a diagnostic means or an indicator for evaluating the characteristics of the underlying disease.

Background: Data on histological activity and HBV DNA levels in patients with chronic HBV infection and persistently normal alanine aminotransferase levels are sparse. We aimed to investigate the histological activity and HBV DNA levels in these patients.Methods: There were 132 patients with HBeAg negative chronic HBV infection and persistently normal alanine aminotransferase levels that were included prospectively. Data were dichotomized according to the median levels. Associations of histology with HBV DNA and other variables were assessed.Results: A total of 80 patients were male. The median age was 36 years. The median baseline HBV DNA was 2.9Log10 IU/mL. There were 50 cases (38%) with a total score ³5, 53 cases (40.2%) had grade ³4 and 40 cases (30.3%) had stage ³2. A baseline HBV DNA <2000 IU/mL was seen in 24 cases (48%) of those with total score ³5, 28 cases (53%) of those with grade ³4 and 9 cases (22.5%) with stage ³2. Multivariate analysis of baseline HBV DNA above the median level significantly predicted the total score, grade and stage with an adjusted odds ratio of 5.43, 3.47, and 4.23, respectively when compared to below median values. A second liver biopsy was performed in 61 patients. The median time interval between the two biopsies was 40 months. Total scores of 23 cases (38%) progressed by ³2 scores and the HBV DNA of 18 cases (22.5%) increased by ³1 Log10 IU when compared to baseline values.Conclusions: HBeAg negative chronic HBV infection with persistently normal alanine aminotransferase is not a silent disease. Active liver disease may be seen in such patients with viral loads less than 2000 IU/mL.

Background: The purpose of this study was to report age-specific incidence rates of histopathological subtypes of ovarian cancer in Iran.Methods: Data published by the pathology-based Cancer Registry, Iranian Ministry of Health and Medical Education for the year 2004, was utilized. This study included 793 new ovarian cancer cases which were analyzed by SPSS software (version 13).Results: There were 45 different histologies reported in 793 new cases which were categorized into ten major groups. Epithelial tumors displayed the highest age specific incidence rate, followed by germ cell tumors. Serous epithelial tumors were the most common in the epithelial group.Conclusion: The age-specific incidence rate of ovarian cancer varies based on histolo

Background: Repeated administration of certain drugs could result in an enhancement of the behavioral effects of those drugs. In the present study, the effect of repeated administration of histamine on amnesia induced by post-training administration of the drug was examined. Methods: A single trial step-down inhibitory (passive) avoidance task was used for memory assessment in male NMRI mice.Results: The results showed that post-training administration of different doses of histamine (5, 10, and 20mg/mouse, i.c.v.) decreased the step-down latency on the test day. Repeated pretreatment of histamine (10 and 20mg/mouse) for three days followed by five days of no drug treatment prevented amnesia due to post-training histamine (20mg/mouse). In contrast, repeated administration of histamine H1 receptor antagonist, pyrilamine (5, 10, and 20 mg/kg) or histamine H2 receptor antagonist, ranitidine (12.5 and 25mg/kg) 10 minutes prior to histamine injections, decreased the effect of repeated histamine administration. Moreover, a similar pattern was seen in animals which received dopamine D1 receptor antagonist, SCH 23390 (0.025, 0.5, and 1mg/kg) or dopamine D2 receptor antagonist, sulpiride (0.2, 1, and 5mg/kg) 10 minutes prior to histamine injections during the repeated pretreatment.Conclusion: The results indicated that both the histamine and dopamine receptor mechanisms may be involved in the effects of repeated pretreatment of histamine on drug induced amnesia.

Background: The Bipolar Depression Rating Scale is an instrument to measure depression severity in patients diagnosed with bipolar disorder. This study has reevaluated the psychometric values of the Bipolar Depression Rating Scale through assessing an Iranian sample of patients with bipolar depression.Methods: A total of 60 patients (36 males and 24 females) with bipolar depression referred to four medical centers in Tehran, Iran were interviewed with the Structured Clinical Interview for DSM-IV axis I Disorders, Young Mania Rating Scale, center for Epidemiological Studies Depression Scale, and the Bipolar Depression Rating Scale. Internal consistency and inter-rater reliability of the Bipolar Depression Rating Scale, and Pearson’s correlation coefficient between the Bipolar Depression Rating Scale and Young Mania Rating Scale/Center for Epidemiological Studies Depression Scale were calculated.Results: The Cronbach’s alpha coefficient was 0.81. The Pearson’s correlation coefficients of the Bipolar Depression Rating Scale with the Center for Epidemiological Studies Depression Scale and Young Mania Rating Scale were 0.73 and -0.82, respectively. The correlation coefficients between the two raters for the total score of the Bipolar Depression Rating Scale according to the Pearson’s correlation and intraclass correlation tests were 0.83 and 0.89, respectively.Conclusion: The Bipolar Depression Rating Scale is a reliable and valid instrument to use in studies on Iranian clinical patients with bipolar depression.

Background: Neural correlates of single word reading with the use of a functional MRI (fMRI) scan have been widely studied in different languages. These study patterns of cortical activation differ in different languages. In this report we used a similar technique to study cortical activation when reading single Persian words.Methods: The subjects were comprised of nine healthy right-handed bilingual individuals who performed three consecutive fMRI paradigms. Results: Our study showed activation of the inferior frontal gyrus (IFG) when single Persian words were read. These results revealed that the pattern of brain activation during word production in Persian has a similar topography to that of English equivalents. Conclusion: The paradigms selectively activate word production areas and are useful in neurological assessment of the Persian population.

Background: The use of acute hospital beds is an issue of concern both to policy-makers and practitioners. In most countries attempts are underway to improve efficiency in this sector. Methods: One of the most widely used instruments for assessing inappropriate hospital use is the Appropriateness Evaluation Protocol, which consists of a set of standards based on objective criteria relating the condition of the patient to the clinical services received. The aim of this study was to measure inappropriateness of admission and inpatient stays at four major hospitals in Shiraz, Iran.Results: The results showed that 22% of the total admissions in four hospitals were rated as inappropriate. The most as well as the least inappropriate admissions were found in both teaching university affiliated hospitals. Our data has shown that a total of 29.6% (average 6.40%) of the hospital stays in the study population were judged to be inappropriate. The result of the Least Significant Difference Test indicated a significant association between the mean days of inappropriate stay and turn of admission in all hospitals. In the four hospitals, a significant association was observed between the inappropriateness of hospital stay, costs, and length of stay.Conclusion: Considering the findings of this study, in addition to other studies in Iran and other countries, we can conclude that the factors involving inappropriate admission of patients to hospitals are mostly similar. In order to solve this problem we can use strategies such as: improving the performance of the referral system, using standard criteria for an appropriate evaluation protocol by the medical staff, and extending outpatient diagnostic services to reduce inappropriate hospitalization.

Background: The incidence of esophageal squamous cell carcinoma (ESCC) is very high in northeastern Iran. However, the genetic predisposing factors to ESCC in this region have not been clearly defined. The P21 (waf1/cip1) gene is involved in the arrest of cellular growth, as induced by the p53 tumor suppressor gene. Two polymorphisms of p21 gene in codon 31 (p21 C98A, dbSNP rs1801270) and the 3'UTR (p21 C70T, dbSNP rs1059234) ma-y affect protein expression and play a role in cancer susceptibility. The present study aimed to investigate the association of p21 polymorphisms in codon 31 and the 3'UTR, and cigarette smoking on the risk of ESCC in northeastern Iran.Methods: A case-control study was carried out to detect the p21 polymorphism in the 3’UTR and codon 31 of samples from 126 ESCC cases and 100 controls from 2006 to 2007. There were no significant differences of age and sex between cases and controls. Genotyping of p21 polymorphisms were determined with the PCR-RFLP method. Conditional logistic regression was used to adjust for potential confounders.Results: None of the p21 genotypes were significantly associated with risk of ESCC, even after adjusting for age and gender (P=0.52, OR=1.24; 95% CI: 0.63-2.42). However, the presence of these polymorphisms in combination with cigarette smoking had a synergistic interaction in ESCC carcinogenesis in northeastern Iran (P=0.02, OR=8.38; 95% CI: 1.03-67.93).Conclusions: Our data suggests that these two p21 polymorphisms, both alone and in combination, are not genetic susceptibility biomarkers for ESCC. However, their interaction with cigarette smoking may influence the susceptibility to ESCC development in northeastern Iran.

How well we can identify individuals at risk for mortality and morbidity using a simple measurement. Obviously obesity is a growing threat to heath worldwide and anthropometric indicators are good means to screen and identify high-risk people. It has been reported that compared to Body Mass Index (BMI), indices of central obesity are better discriminators for cardiovascular risk factors.

Fibrous dysplasia is a benign bone lesion of unknown etiology. Bone involvement usually is solitary (monostotic). Multiple forms (polyostotic) associated with extra skeletal symptoms, particularly cutaneous pigmentation, endocrine dysfunction and precocious puberty is called McCune–Albright syndrome (MAS). We report the case of a 40-year-old man who presented with left mandibular body expansion and intermittent suppuration from the skin sinus tract formation since he was 18 years old. He had skeletal deformities, limping, and multiple skin pigmentation. X-ray revealed multiple fractures and radiolucent lesions in numerous bones. Laboratory analysis showed an increased serum alkaline phosphatase. Precocious puberty was determined upon taking the patient’s history. The patient’s height was 148 cm. Microscopic findings of the mandibular lesion, clinical presentation and X-ray findings were strongly diagnostic for MAS.

The sternoclavicular joint is an unusual site for bacterial infection. In this case, we describe a 25-year-old man who presented to the emergency department with fever, chills, limited range of motion in the right upper limb along with complaints of severe pain and tenderness in the right upper chest wall and shoulder. He was admitted to the hospital for further evaluation. This patient admitted to a history of injecting heroin use during the previous three months. The diagnosis of septic arthritis of the right sternoclavicular joint was confirmed by blood culture and MRI of the sternoclavicular joint. This case is, to the best of our knowledge, the 25th recorded staphylococcal septic sternoclavicular arthritis. He received appropriate intravenous antibiotic therapy and subsequently was discharged two weeks later with complete clinical and laboratory recovery.

Trigger finger is a common disease which particularly occurs in middle-aged women. We present a rare case of a male musician with six trigger fingers (five in the left hand and one in the right hand). Mostly these fingers had been used for playing the guitar.The patient had previously been treated with local steroid injections in his fingers, however no response was seen. Therefore, we performed a surgical procedure. Four weeks after surgery, the patient could play the guitar without discomfort in his hands.

A 54-year-old male smoker presented with complaints of generalized bone and muscle pain. His pain was aggravated over time to the extent that he became unable to walk and developed paraparesis. Upon physical examination, a tumor was not located; however, generalized bony tenderness with decreased muscle strength, predominantly in the lower extremities was noted. On lung examination, bilateral scattered wheezing was heard.

In part one of this article I reviewed the history of Asclepius and the Caduceus of Hermes as medical symbols and made a tentative suggestion of using the mythical bird Simurgh as an Iranian symbol of medicine. In this, the second part, I shall describe the evolution of the myth of the Simurgh and discuss the medical relevance of this bird in Iranian history.

Approximately ninety two years ago, the worst influenza pandemic or “Spanish flu” occurred in 1918, at the end of the First World War (WWI, 1914-1918) which resulted in the deaths of millions of people worldwide. The death toll exceeded the total number of victims of WWI.The 1918 Spanish flu was a deadly, major global event that affected many countries, including Iran. In Iran, it was accompanied by a high mortality rate estimated to be more than one million. However, detailed information on the impact of this outbreak in Iran is scarce.The present paper describes a brief history of the influenza pandemics in the world as well as the spread of the 1918 Spanish flu to Iran.