ARCHIVES OF IRANIAN MEDICINE
Year:2010 | Volume:13 | Issue:6|Papers Count:23

Less than three days after submission of a manuscript to a medical journal, the author received a letter saying that his paper had been rejected. Unlike many rejection letters this one did not contain any explanation regarding the content of the manuscript or the peer reviewers’ opinions. Instead, the letter explained that there are regulations prohibiting the journal from publishing material originating from certain countries (personal communication)….

Objectives: Studies on gastric mucosal histological findings among first degree relatives (FDR) of gastric cancer (GC) patients are scarce. The aim is to evaluate the topography and the severity of gastritis among FDR of GC patients. Design: A total of 989 subjects who were FDR of GC patients, ages 40 – 65 years underwent gastroscopies. When no gross lesion was found, five specimens were evaluated according to the Sydney Classification and one for urease testing in order to determine the type of gastritis and its severity.Results: Of the 989 subjects, 107 had significant lesions, including two with GC and one with esophageal cancer. The 864 subjects who had complete morphological data taken from five gastric areas (two from the antrum and three from the corpus) comprised 419 males (mean age 48.5±7 years) and 445 females (mean age 47±6.4 years). The H. pylori rate was 76.6%. Normal mucosa was seen in 6.9%, antrum-restricted gastritis in 7.4%, antrum-predominant gastritis in 63.5% and corpus-predominant gastritis in 20% (both had >80% H. pylori infection) and corpus-restricted gastritis in 2%. More atrophy was seen in the antrum and corpus of FDR females than males. The severity did not differ between those with one or more GC patients’ relatives. Forty-nine percent of FDR had atrophy and 9.4% intestinal metaplasia (IM) in the corpus. After the age of 40, there was progression of intestinal metaplasia from 12.2 to 27.3% in the antrum and from 6.7% to 26.2% in the corpus during two decades. No high grade dysplasia was found in this mid-age population.Conclusion: Only one-fifth of FDR have H. pylori-induced corpus-predominant gastritis who are at risk for cancer and suitable for eradication. Corpus-restricted gastritis is a rare disease in this area.

Aim: To find the possible role of plasma homocysteine level as a contributing factor in venous and arterial thrombosis in patients with Behcet’s disease (BD).Methods: In a case control study, two groups of BD patients were included: 47 with thrombosis and 49 without thrombosis. All patients fulfilled the International Study Group Criteria for BD and the confirming diagnostic procedures for vascular thrombosis were either Doppler sonography or angiography. Forty-nine controls were selected by consecutive sampling among age and sex matched healthy subjects. Plasma homocysteine level was measured by ELISA in all. The clinical and laboratory characteristics of the disease were compared between the two groups of BD patients. Comparisons were done by ANOVA and Chi square tests; correlations were analyzed with Pearson test.Results: The mean plasma homocysteine level was significantly higher in BD patients (14.9±13.9 mMol/L) than in healthy controls (9.9±6.7 mMol/L), P<0.02. The difference was also signi_cant when comparing the three groups by ANOVA: BD patients with thrombosis (24.2±13.2 mMol/L), BD patients without thrombosis (5.9±7.0 mMol/L), and healthy controls (P<0.0001). We found no correlation between plasma homocysteine level and any organ involvement other than thrombosis. The mean plasma homocysteine level was lower in HLA-B51 positive BD patients (11.6±12.1 vs. 21.7±16.3 mMol/L, P<0.05), but the difference was not significant in those with thrombosis (20.9±13.2 vs. 29.5±12.7 mMol/L, P=0.18). Conclusion: Hyperhomocysteinaemia may be an independent risk factor for vascular thrombosis in patients with BD. This is the first study showing a negative correlation between HLA-B51 and plasma homocysteine level.

Background: Thrombophilia or the tendency for thrombosis has been linked to pregnancy complications, which include fetal growth restriction. The aim of the present study was to determine the association of maternal thrombophilias with unexplained fetal growth restriction.Methods: Inherited and acquired thrombophilias were checked in 34 women whose pregnancies were complicated by fetal growth restriction and 68 women with normal growth fetuses as controls, 8 – 10 weeks postpartum. Cases were matched for age, body mass index, and parity with two healthy women who had normal pregnancies during the same time period. Exclusion criteria were: maternal vascular disease, structural malformations, chromosomal abnormalities, cytomegalovirus infection, and history of drug abuse. Intrauterine growth restriction was diagnosed when the fetal weight or birth weight was below the 10th percentile for gestational age.Results: The prevalence of all thrombophilia was 55.9% in the case group compared with 10.3% in the control group (P<0.001; OR: 11; 95% CI: 3.9 – 31.1). The prevalence of thrombophilic mutations were significantly higher in the case group compared with the control group (P=0.016; OR: 14.4; 95% CI: 1.7 – 124.8). The frequency of other types of inherited or acquired thrombophilias were significantly higher in fetal growth restriction cases than controls (P<0.001; OR: 9.9; 95% CI: 3.2 – 30.9). Protein S deficiency was the most common thrombophilic defect in the fetal growth restriction group (41.1%) compared with 2.9% of controls (P<0.001). A significant difference in the frequency of multiple thrombophilias was noted between the two groups (P<0.001). All cases that had a history of fetal growth restriction during their previous pregnancies were positive for thrombophilic defects.Conclusion: Fetal growth restriction pregnancies have a higher prevalence of thrombophilias.

Background: One of the rare complications of brucellosis is mononuclear meningitis, which usually imitates systemic disease.Methods: Documents of patients with confirmed brucellar meningitis hospitalized in Sina Hospital (Western Iran) between 1988 – 2005 were collected.Results: The average age was 26.9. 64% were female and 36% were male. There were 25% confirmed cases in the spring, 21% in summer, 33% in autumn and 21% in winter.Patient complaints in order of frequency were: headache (95%), vomiting (77%), fatigue (39%), myalgia (15%), movement disorders (15%), arthralgia (13%), sleepiness (13%), and aphasia (3%). The main clinical findings were: nuchal rigidity (74%), splenomegaly (49%), fever (41%), Kernig’s (41%), and Brudzinski’s signs (39%). Lukopenia (WBC<4.5×109/L; 18%), leukocytosis (WBC>9.5×109/L; 20%), and anemia (hemoglobin level<13 g/dL in men and 12 g/dL in women) were detected in 16% of patients. The Wright agglutination test, with a titer of 1:80 to 1:1280 was present in the serum of all patients, CSF Wright test or Coombs test was positive in half of the patients. Blood, bone marrow and CSF cultures were positive in 6 out of 10 patients. Discussion: The epidemiological aspects of brucellar meningitis are similar to systemic brucellosis and, in most studies; there is no significant difference between them. The sex distribution of patients was different from most studies. Seasonal distribution of the disease did not follow seasonal distribution of systemic brucellosis; however, clinical findings or laboratory changes were similar to Turkey and other studies in Iran. A definite response, without complications and next recurrence, in this study, was achieved with co-trimoxasole plus rifampin for 45 days of therapy.

Background and Aims: The ketogenic diet is an effective medical therapy for intractable childhood epilepsy. However, it has drawbacks in that it restricts calories, fluids and protein. The Atkins diet may also induce ketosis without those restrictions. Our objective was to evaluate the efficacy of a modified Atkins diet in children with intractable childhood epilepsy. Methods: This clinical trial was conducted in 51 epileptic children aged 1-16 years with refractory seizures from Feb. 2004 to Oct. 2006. Outcome measures included seizure frequency and adverse reactions. Twenty-seven patients left the study for various reasons, leaving 24 who continued the Atkins diet for a minimum of three months. Carbohydrates were initially limited to 10 g/day and fats constituted 60% of the total energy requirement. All participants received vitamin and calcium supplementation.Results: Following three months of treatment with the Atkins diet, 16 patients (67%) had >50% decrease in seizure frequency, and 6 (25%) had >90% improvement, of whom 5 were seizure-free. Mean seizure frequency after the first, second and third months of treatment were significantly lower than at baseline (P values <0.001, 0.001 and 0.002, respectively).Conclusion: The Atkins diet can be considered as a safe and effective alternative therapy for intractable childhood epilepsy.Atkins diet was well tolerated in our patients with rare complications and it appears to demonstrate preliminary efficacy in childhood refractory epilepsy.

Background: Tumor growth depends on vascular blood supply. The novel discovery of non-endothelialized vessel-like channels in malignant tumors called vasculogenic mimicry has provided new insights about tumor behavior and also serves as a potential target for drug therapy. Although the association between vasculogenic mimicry and poor prognosis has been established in some tumors, there are only a few studies concerning prostatic carcinoma.Methods: Using a histochemical and immunohistochemical dual staining method for PAS-CD34 and special immunohistochemical staining for laminin, we studied the presence and pattern of non-endothelialized channels known as vasculogenic mimicry as well as the quantity of endothelialized vessels designated as microvessel density in usual paraffin sections of 20 low-grade and 20 high-grade prostatic adenocarcinomas by routine light microscopy.Results: We found a direct positive relationship between higher microvessel density and tumor grade (P<0.001), presence of vascular invasion (P<0.001) and percent of involved tissue (P<0.001); however, no such relationship was found with vasculogenic mimicry and only a weak correlation was noted between vasculogenic mimicry and perineurial invasion (P=0.03).  Conclusion: Unlike other cancers and despite the results of in vitro studies on prostatic adenocarcinoma, we were not able to demonstrate a significant relationship between vasculogenic mimicry channels and histologic grading as one of the most important prognostic factors; however, this may be due to an inherent limitation of prostatic tissue imposed by abundant smooth muscle fibers stained by this method. On the other hand, microvessel density scoring appears to be an important, simple, and applicable histologic tool for prostatic cancer evaluation in daily practice.

Background: Health-related quality of life measurements are necessary tools for current situation assessment of all populations. They are absolutely beneficial for evaluation of rehabilitation services which are known as major clinical sources for improving quality of life in physically impaired patients.The design and implementation of this study involved determination of the relationship between war-related physical impairments and quality of life in blind war survivors.Methods: This was a cross-sectional study of a representative population of war victims blind in both eyes who attended a day conference. SF 36 was used for quality of life assessment and demographic data was gathered by a validated questionnaire. An expert internist visited and evaluated subjects’ physical health. Results: Participants had a mean age of 43.20±8.34 years. There were 96.5% males and 3.5%females with a mean SF-36 score of 59.20±22.80. The most prevalent physical injury was shrapnel hit in the face (43.6%) and the mean time since onset of injury was 21.84±4.23 years. Quality of life had a significant relation to physical impairments (P=0.006) and the number of injuries had a significant effect on quality of life (P=0.003, f=3.788). Conclusion: Physical impairments related to war injuries significantly influenced quality of life in the study group. Participants with more impairments reported lower quality of life. Considering the physical problems that accumulate with increasing age, therefore the process of ageing would cause enhanced burden to the future of blind war survivors even though, according to the physical component scale, they have a better quality of life than lower limb amputee war survivors. Assistive devices with proper instruction on their use can help this population improve their abilities and improve their quality of life.

Purpose: The purpose of this study was to determine career preferences of medical students at the time of entering medical school compared with interns who were graduating; and to determine what factors influence the choice of a special discipline as a career.Method: A cross-sectional, questionnaire-based survey study involving freshmen and interns at Tehran University of Medical Sciences was conducted in 2006-2007. Respondents anonymously completed a specialties questionnaire developed by Feifel et al. The questionnaire was translated into Persian (Farsi) and several items were modified based on the circumstances.Results: The response rate was 91 (73%) among freshmen and 137 (77%) among interns. Forty-six freshman students (50%) and 71 interns (51.8%) indicated that they had not developed a strong decision about any particular field of medicine and needed more time. The preferred specialties among freshmen were surgery and internal medicine; whereas graduating students were more interested in “other specialties”. There was no significant difference between pediatrics, gynecology, psychiatry, and general practice among the two groups. There was a significant difference in rating when it came to “anticipated income”, “prestige” and “helping patients” of which interns were less interested compared to freshmen in these three areas. Conclusion: Approximately one-half of the medical students were unclear about their future goals. The experience of medical school may play a role in diminishing students’ interest in surgery and internal medicine as prospective careers.

Purpose: Carpal tunnel syndrome is a common peripheral entrapment neuropathy. The purpose of this study is to determine whether high resolution ultrasonography can be an alternative diagnostic method to nerve conduction study in grading the severity of carpal tunnel syndrome.Methods: A total of 164 wrists of 82 patients, bilaterally, were enrolled in the study. The cross-sectional area of the median nerve at the carpal tunnel inlet and outlet was measured in all patients with electrophysiologically confirmed carpal tunnel syndrome. All patients had nerve conduction study performed one week before ultrasonography. Then, comparisons between ultrasonography and nerve conduction study were made. The grading severity according to nerve conduction study was used as a gold standard reference.Results: The mean median nerve cross-sectional area at the tunnel inlet was11.4±1.7 mm2 for the carpal tunnel syndrome affected wrist and 5.78±0.9 mm2 for the normal wrist (P<0.001). The mean median nerve cross-sectional area at the tunnel outlet was 9.9±1.2 mm2 for the affected wrist with carpal tunnel syndrome and 4.7±0.7 mm2 for the normal wrist (P<0.001).The best cutoff value of cross-sectional area at the tunnel inlet and outlet was 8.5 mm2. The difference in cross-sectional area of the median nerve in mild, moderate and severe carpal tunnel syndrome was not statistically significant (P=0.2) neither in the carpal tunnel inlet nor outlet. Conclusion: Based on this study, cross-sectional area of median nerve ultrasonography has a diagnostic value to confirm or exclude carpal tunnel syndrome, but could not be used for grading its severity.

Background: Social phobia is a highly prevalent disorder in western countries, but is rather rare in eastern societies. Prevalence rates range from 0.5% in eastern studies and up to 16% in western studies. The present study examined the prevalence of social phobia in the Iranian general population and demographic characteristics associated with this anxiety disorder.Methods: Participants included 701 subjects from Golestan Province. Measures included the Social Phobia Inventory and a socio-demographic questionnaire. Demographic correlates of social phobia were also examined.Results: Probable social phobia was present in 10.1% of the total sample (8.6% male and 11.6% female). Sex, social support, residence, education, and job correlated with social phobia.Conclusions: Our findings corroborate those from other studies in western countries, both regarding the high prevalence of SP symptoms and its demographic correlates.

Background: Physical inactivity is one of the leading causes of major chronic disease, which contributes substantially to the global burden of disease, death and disability. This study examined physical activity in a randomly selected sample of elderly people in Tehran, Iran.Methods: A random sample of 400 elderly people aged 60 years and over was selected through multistage sampling. A multi-sectional questionnaire that contained demographic characteristics, physical activity knowledge, benefits, barriers, self efficacy, and readiness stage was used. Physical activity was measured by questions retrieved from the Physical Activity Scale for the Elderly.Results: This study showed knowledge, perceived benefits, and self-efficacy could predict physical activity stage of change (P<0.001). Sixty-two percent of participants reported laziness as the most important barrier for not engaging in physical activity. Meeting new people (74%), having fun (71.8%), and contacting friends (67.73%) were the most prevalent reasons for participating in physical activity.Conclusion: According to this study, individuals with higher knowledge, perceived benefits and self-efficacy were more likely to engage in physical activity. Furthermore, those who perceived lower barriers towards this behavior were more physically active.

Background: Considering the importance of sexual drive among teenagers, parental and societal concerns about teenagers’ sexual drives, particularly in religious communities such as Iran is of practical importance; therefore, this present research was designed to study students’ sources of sexual knowledge acquisition.Methods: This research was carried out among 2600 high school students in the cities of Tabriz, Urmia, and Ardabil in Northwest Iran. Students were selected through a multi-staged randomized sampling method in Tabriz and by the convenience method in Ardabil and Urmia. The instrument was a self-administered questionnaire, which included 19 different resources. The resources were categorized into seven main groups and the results were statistically analyzed with SPSS version 11.5 software.Results: Based on the mean score of each of the seven main groups of resources, the ranking order of the resources was as follows: 1) immediate friends and peers 2) pictures, magazines, and books 3) audiovisual (CDs, foreign movies, satellite programs, and the Internet) 4) school trainings 5) physicians, clergy, and counseling centers 6) family (parents and siblings) and 7) close family members. The differences between the resources were statistically significant (P value= 0.0001).Conclusion: Results of the present study emphasize that teenagers should be educated in different areas of sexual problems with the help of parents, schools, and official sources and centers in the society as confident sources of obtaining sexual knowledge. There is a need to prepare a codified educational curriculum in different levels in order to offer teenagers’ sexual education in the form of books or specific school credits.

Background: Early intervention improves treatment results in oral cancer. The purpose of present study was to assess the level of awareness and knowledge about oral cancer among patients referred to Mashhad Dental School. Methods: Three hundred and twenty individuals completed a 15 item written questionnaire that focused on oral cancer risk factors, signs and symptoms, epidemiology, and treatment. Statistical analyses were performed with the Kruskal-Wallis and Friedman tests (level of significance, P=0.05).Results: A total of 89.4% of patients who completed the questionnaire had a poor understanding of oral cancer, particularly with regard to etiology. Additionally, 83.8% were unaware of oral cancer risk factors. Only 8.8% knew the most likely sites for oral cancer. No relation was identified between knowledge and sex (P=0.01), or age (P=0.052) of the subjects. There was a significant correlation between the level of education and knowledge score (P<0.001). Medical students and health professionals had the highest knowledge scores (P<0.001).Conclusion: According to the results of this study, information regarding oral cancer knowledge is quite low. Therefore, it seems necessary to increase the level of public awareness with the use of various educational programs in order to reduce morbidity and mortality.

Background: Bernard Soulier Syndrome (BSS) is a hemorrhagic disorder with an autosomal recessive pattern of inheritance. We describe the demographic and clinical characteristics of Iranian patients with BSS followed in a major teaching and tertiary care hospital in Tehran, Iran.Methods: We performed a retrospective medical record review of 97 patients with BSS who received care at the Imam Khomeini Hospital between 1969 and 2001. We collected data on the family history, clinical presentation, bleeding episodes, and lab profiles of these patients.Results: Among all patients, 78 (81%) had a family history of consanguinity. The most common presenting symptom was epistaxis, seen in 62 (63.9%) patients. Peripheral blood smears demonstrated giant platelets on 67 (68.7%) of patients. Complete blood count demonstrated decreased platelets in 85 (87.4%) of patients ranging from 20,000/mL to 130,000/mL. Anemia was seen in 62 (64%) and 91 (93.8%) had prolonged bleeding time. The majority of patients (60%) had mild bleeding episodes, but 39 (40%) had at least one episode of severe bleeding in their past history.Conclusion: Our data are consistent with other reports regarding clinical presentation of BSS, but consanguinity seems to be more common.

The cerebellopontine angle is an extremely rare site for the growth of a choroid plexus papilloma. The clinicoradiological diagnosis of this tumor in the cerebellopontine angle is difficult because of its rarity in addition to a nonspecific clinical presentation and radiological features. Herein, we report the case of a 49-year-old woman with complaints of headache and features of raised intracranial pressure, whose computerized tomography (CT) and magnetic resonance imaging (MRI) were suggestive of acoustic neuroma or meningioma with hydrocephalus. Histology revealed multiple arborizing papillae with a central fibrovascular core, lined by cubo-columnar cells. The cells showed diffuse immunoreactivity for pancytokeratin, S100 protein, synaptophysin, and vimentin, as well as focal expression of glial fibrillary acidic protein, epithelial membrane antigen, and cytokeratin 7. English medical literature is also reviewed.

Hepatobiliary cystadenoma is a rare tumor which is difficult to diagnose before surgery and pathologic examination. Herein we present the case of a 32-year-old woman from an endemic area for hydatid cysts who presented with the impression of hydatid cyst of the liver, which was completely resected. Histopathologic examination revealed a mucinous hepatic cystadenoma with ovarian-like stroma. She had an uneventful postoperative course and now, after one year, she is doing well.

The above X-ray of the left hip of a 42-year-old woman with history of pain in the left buttock for six months as well as nonspeci_c complaints of chronic generalized body pain and bilateral breast discomfort (Figure 1)….

The radiography showed localized soft tissue calcification of which the possible diagnoses were: soft tissue tumor with calcified features, a metastatic calcification in the setting of abnormal calcium or phosphorus metabolism,¹ and an old infection such as a calcified granuloma. In this case there was history of injection of intramuscular calcium compound. The main diagnostic clues were in her history of intramuscular injection and radiographic finding of the hip. No specific major illness was found upon clinical evaluation. She had three intramuscular injections (30 mL total volume), of calcium gluconate (10% solution) weekly for three times in her left buttock….

In March 2009, a 79-year-old female presented with refractory anemia and excess blasts (MDS AREB-2) and was treated with cyclosporine (50 mg BID) at another hospital. In May, she was admitted to our Internal Medicine Ward for clinical and hematology surveillance….

The patient was diagnosed with Sweet syndrome (SS), or acute febrile neutrophilic dermatosis. SS is a broad spectrum condition, typically characterized by fever, neutrophilia, and cutaneous, and mucous lesions (erythematous, solid, and bullous), in addition to diffuse neutrophilic in_ltrate in the upper dermis. Genital ulcerations have been scarcely reported in SS, 2,4 which can be idiopathic, drug-induced, and associated with malignant tumors or hematologic malignancies. 1–3,5 In this patient, the diagnosis of SS was established by clinical, laboratory, and typical skin biopsy data (Figure 2) 1–3,5; and characteristically, the conspicuous lesions improved rapidly after administration of corticosteroids….

In the history of medicine, the human plague has been considered as one of the most terrifying fatal diseases that over centuries, killed millions of people. Three major pandemics took place between the 6th and 19th centuries, which profoundly impacted the world’s socioeconomic status; however, the etiologic agent of the plague remained unknown up to the end of the 19th century.During the past 400 years, Iran experienced several human plague outbreaks. In the 20th century, the outbreaks still continued mostly in the endemic area including western Iran.This paper presents a brief historical account of the human plague pandemics as well as its outbreaks in Iran, particularly during the 19th and 20th centuries….

Summary: Background: Long-QT syndromes are heritable diseases associated with prolongation of the QT interval on an electrocardiogram and a high risk of sudden cardiac death due to ventricular tachyarrhythmia. In long-QT syndrome type 1, mutations occur in the KCNQ1 gene, which encodes the repolarizing potassium channel mediating the delayed rectifier I(Ks) current….