ARCHIVES OF IRANIAN MEDICINE
Year:2012 | Volume:15 | Issue:3|Papers Count:15

During the last few years, anthracosis and anthraco-tuberculosis have found great interest between pulmonologists of Iran and some other parts of the world as a newly emerging medical condition associated with high tuberculous burden. A recent report from World Health Organization (WHO) consider indoor air pollution from old fashion household cooking fires as the most important environmental cause of mortality and morbidity which is the etiology of at least 2 million deaths across the world each year.1 This primitive household cooking which uses biomass (dung, wood, charcoal and crop residues) results in old fashion homes filled with dense smoke, blacking walls and ceilings and sickening women and children in low income countries.The risk of these types of exposures is equal to lifelong smokers of tobacco and result in annual deaths of 872, 000 children under age 5 from acute lower respiratory infections, 1, 057, 000 adults from COPD, 36, 000 adults from lung and upper respiratory cancers.

Background: A probable concordance and association between pulmonary tuberculosis and anthracosis was observed in the published literature. We conducted this study to evaluate the clinical and radiologic characteristics of patients with bronchoscopic evidence of anthracosis as well as the prevalence of pulmonary tuberculosis in patients with anthracosis.Methods: In cluded in the study were 150 consecutive patients with evidence of anthracosis as evidenced by bronchoscopy. Pulmonary tuberculosis diagnostic work up which included bronchoalveolar lavage, sputum smears and cultures, or histologic examination of lung biopsies was performed on all patients. Patients’ clinical, pathological, and radiological findings were also recorded and analyzed.Results: A total of 88 men and 62 women, ranging in age from 42 to 92 years were included in the study. Dyspnea (38.7%) and productive cough (35.3%) were among the most common chief complaints. The abnormal bronchoscopic findings were seen most frequently in the right middle lobe bronchus. In 42 patients pulmonary tuberculosis was confirmed either bacteriologically (n=32) or histologically (n=10).CT scans of 26 patients were examined, of which the most frequent findings were consolidation and a reticular pattern. Pleural involvement was observed in 14 patients.Conclusion: Prevalence of pulmonary tuberculosis was higher among those with bronchial stenosis (P<0.05). These findings have suggested that bronchial anthracosis, especially cases of localized anthracosis, in patients with bronchial stenosis and in those without a history of smoking or occupational exposure may be caused by tuberculosis.

Background: Dietary habits play an important role in the prevention of chronic disease; however, few studies have assessed the major dietary patterns in Middle Eastern countries. This study identifies major dietary patterns among Iranian people with abnormal glucose homeostasis.Methods: This cross-sectional study was conducted at the Diabetes Research Center, Isfahan, Iran among 425 subjects with abnormal glucose homeostasis. Patients were of ages 35-55 years and had family histories of diabetes. We assessed dietary intake by the use of a food frequency questionnaire (FFQ) that contained 39 food items. General obesity was defined as a BMI ³ 30 kg/m2 and central obesity was defined as waist circumference (WC) ³ 88 in women and WC ³ 102 in men.Results: Five major dietary patterns were revealed by factor analysis: ‘western’, ‘healthy’, ‘vegetarian’, ‘high-fat dairy’, and ‘chicken and plants’. Those in the top tertile of the ‘western pattern’ had greater odds for general (OR=1.73; 95% CI=1.07 – 2.78) and central obesity (OR=2, 95% CI=1.24 – 3.22), however these associations were not significant after adjustment for confounding variables. The ‘high-fat dairy pattern’ was associated with greater odds of general obesity only after adjusting for confounding variables (OR=1.73; 95%CI=1.01– 2.96).Conclusion: The dietary pattern characterized by high intake of hydrogenated fat and sugar was shown to be positively associated with a risk of general and central obesity, however further prospective studies are required to confirm our findings.

Background: The threshold of thyroid-stimulating hormone (TSH) in current screening for congenital hypothyroidism (CH) from the heel prick test is 5mU/l. This study uses cost-effective analysis to evaluate increasing the threshold to minimize false-positive results and recall rates.Methods: Cost of screening, diagnosis and treatment, education, and care of mentally retarded patients were gathered from the Ministry of Health State Welfare Organization and Department of Education in Tehran. Screening data were obtained from 34, 007 neonates in the Central Health Laboratory of Tehran University of Medical Sciences in 2009. Sensitivity analysis and calculation of confidence interval for incremental costs and effects (gained disability adjusted life years-DALYs) and incremental cost-effectiveness ratios (ICER) were performed by Monte Carlo simulation with Ersatz software.Results: ICER for screening programs with different TSH cut-off points versus no screening was similar, and approximately -4.5±0.2 thousand US dollars per gained DALY. In the proposed cohort (10, 000 neonates), gained DALYs were 316±50 for a cutoff point of 5 mU/l, 251±40 for 10 mU/l, 146±23 for 15 mU/l, and 113±18 for a cut-off point of 20 mU/l. Sensitivity analysis showed that the model remained the same when the input parameters were changed.Conclusion: This study demonstrates that the current threshold of TSH in the national CH screening program in terms of cost-effectiveness is the most appropriate threshold. However, more studies are needed to examine new strategies and methods to reduce recall rates and related consequences such as repeated thyroid testing in neonates.

Objectives: There are relatively few systematic studies, documenting the prevalence of mucosal disorders in children and adolescents.The purpose of this study was to determine the prevalence of oral lesions in 12- to 15-year olds living in Tehran and to assess the possible relationship between the occurrence of these lesions and gender.Methods: A cross-sectional study was designed in which 1020 adolescents were participated. The sample size was based upon an expected oral lesion prevalence of 25%, a precision of 0.05 and a confidence level of 99. Epi-info version 6.0 was used for statistical analysis.Results: Two hundred eighty-six adolescents (28.0%) were diagnosed with at least one oral mucosal lesion at the time of the examination.The prevalence of any oral mucosal lesion was 29.2% among the boys and 26.9% among the girls. With the exception of melanotic macules, there were no statistically significant differences in oral mucosal lesion prevalence by gender.Conclusion: More than 28% of the adolescents were found to have at least one oral mucosal lesion. Melanotic macule was found to be proportionally more common in boys than girls.

Background: The clinical progression of mycosis fungoides (MF) often correlates with microscopic large cell transformation (LCT). It is reported that CD30 expression in the LCT of MF is associated with an absence of CXCR3 expression. This study investigates a large number of patients diagnosed with MF to determine the correlation between expression of CXCR3 and CD30 in additional sections.Methods: The study included archival skin specimens from 101 patients with MF. We analyzed these specimens by immunohistochemistry for expressions of CXCR3 and CD30.Results: The biopsy specimens showed microscopic features of low grade MF (LG-MF) in 80 cases and transformed MF (T-MF) in 21 cases. Tumor lymphocytes expressed CXCR3 in 61 out of 80 cases (76.3%) of LG-MF and in 10 out of 21 cases (47.6%) of T-MF. CD30 positivity (CD30+) was seen in 16 of 80 cases (20%) of LG-MF and 12 of 21 cases (57.1%) of T-MF. The tumor cells in 8 of the 12 CD30+ T-MF cases showed scattered expression of CXCR3.Conclusion: CXCR3 expression was associated with epidermotropic T cell tumors but was greatly absent in dermal ones. Scattered or diffuse CD30 expression in T-MF was not associated with an absence of CXCR3 expression.

Background: Zoonotic cutaneous leishmaniasis (ZCL) is a polymorphic disease that may show various clinical manifestations. Although it is suggested that the genetic variability of the parasite is one of the factors influencing clinical manifestations of leishmaniasis, no data exists regarding genetic polymorphism of Leishmania major (L. major). This study investigates the determination of genetic variations within the species of L. major isolates from different cases of ZCL in two hyper-endemic areas of Iran.Methods: A variety of nucleic acid detection methods that target both DNA and RNA have been developed. Among these, the polymerase chain reaction (PCR) method proved to be a highly sensitive and specific technique. Species identification was based on permissively primed intergenic polymorphic-polymerase chain reaction (PPIP-PCR) and restriction fragment length polymorphism analysis of amplified internal transcribed spacer (ITS-RFLP) in the ribosomal operon of L. major from clinically different forms of ZCL. The DNA products were amplified by PCR, followed by digestion of the PCR product with restriction enzymes. The profiles were visualized in agarose gel under ultraviolet (UV) light.Results: The PCR product obtained for all isolates was about 1060 bp in size. Different patterns of PPIP-PCR and ITS-RFLP in the ribosomal operon were classified as I, II, III, IV, and V. This classification was according to the number and localization of bands. Results of this research detected the genetic and clinical polymorphism of L. major, and showed that strain A was more frequent than other strains.Conclusion: The L. major causing ZCL in Isfahan, Iran is genetically a highly polymorphic species and PPIP-PCR exposed more genetic polymorphism among clinical samples in Isfahan, Iran.

Background: Gastric varices are a major cause of gastrointestinal bleeding and death in patients with portal hypertension. N-butyl-2-cyanoacrylate injection is a new method for controlling bleeding gastric varices. This study aims to investigate the prognosis and complications of cyanoacrylate therapy for bleeding gastric varices.Methods: We conducted a prospective study between May 2009 and January 2010 at our center affiliated with the Shiraz University of Medical Sciences, Shiraz, Iran. All patients with gastric variceal bleeding were enrolled in the study. N-butyl-2-cyanoacrylate injection was performed for treatment of the bleeding, and patients underwent monthly endoscopies to determine the outcomes.Results: There were 13 patients with portal hypertension and gastric variceal bleeding included in the study. Initial hemostasis was obtained in all patients but more than one injection was needed in seven patients. Two patients developed re-bleeding and two died of advanced cirrhosis and other accompanying diseases.Conclusion: No major complications were observed after treatment with N-butyl-2-cyanoacrylate. This method can be safely used in treatment of gastric variceal bleeding.

Background: Our aim was to compare different thresholds of middle cerebral artery peak systolic velocity (MCA-PSV) and amniotic fluid delta optical density (Delta-OD) with fetal hemoglobin (Hb) duringfirst and second intrauterine transfusions (IUT).Methods: We determined serial MCA-PSV and Delta-OD in 27 red blood cell alloimmunized fetuses who needed IUT. Before the second IUT, MCA-PSV was measured. The sensitivity and specificity of MCA-PSV and Delta-OD were calculated and compared with fetal hemoglobin levels.Results: From 27 fetuses, first time IUT MCA-PSV with a normal median value (MOM) cutoff of>1.29 detected 60% of the moderate and 100% of the severe anemia cases. MCA-PSV of MOM>1.5 detected none of the moderate and 93% of severe anemia cases. Delta-OD detected 50% of moderate anemic and 80% of severe anemic cases. At the second IUT, 91% of severe anemia cases were confirmed by MCA-PSV with MOM>1.5 whereas MCA-PSV with MOM>1.29 confirmed all cases. One case of moderate anemia was detected by MCA-PSV of MOM>1.29 and none were detected by MCA-PSV with MOM>1.5.Conclusion: Different thresholds of MCA-PSV have higher sensitivity and specificity for detecting moderate and severe fetal anemia compared with Delta-OD. It also has a high sensitivity at the second IUT.

Chronic inflammation plays a pivotal role in the development of colorectal cancer (CRC) in patients with inflammatory bowel disease (IBD).An orchestrated interplay of immune cells with numerous inflammatory mediators including reactive oxygen and nitrogen species, cyclooxygenase 2, and several cytokines promotes colitis-associated cancer (CAC). Recent findings have shown that inflammatory pathways not only are important in the development of CAC but are also involved in the pathogenesis of sporadic CRC. Hereby, we review the existing experimental and clinical evidence that suggest a link between inflammation and tumorigenesis in sporadic CRC.

One of the most common bacterial infections that causes ophthalmia neonatorum is Chlamydia trachomatis, (C. trachomatis). Very few studies have been performed in Iran using both cell culture and polymerase chain reaction (PCR) methods to determine the prevalence of C. trachomatis as an etiological agent of ophthalmia neonatorum. This study aimed to evaluate the prevalence of neonatal chlamydial conjunctivitis (NCC) as diagnosed by both methods in two hospitals in Tehran, Iran.From March 2008 to May 2009, out of 2253 neonates, 241 (10.7%) with clinical findings of conjunctivitis were included in this study. A total of 241 conjunctival swabs were tested by cell culture (as the gold standard test), PCR, and Giemsa staining.Cell cultures were positive for C. trachomatis in 31 (12.9%) neonates, C. trachomatis was positive in 40 (16.6%) neonates by PCR and 18 (7.5%) by Giemsa staining. The sensitivity of PCR was 100%, whereas Giemsa staining sensitivity was 58.1%.High sensitivity (100%) and specificity (95.7%) of PCR as compared to culture makes it a proper diagnostic method for the detection of C. trachomatis.

Long-term enteral feeding is vital in the management of conditions such as cerebrovascular disease or dementia. Placement of a percutaneous gastrostomy (PEG) tube is the most commonly used method for enteral feeding. It is not possible to place a PEG due to the absence of trans illumination, which is commonly encountered in patients with large hiatal hernias or organ transposition.

Although foreign body (FB) ingestion is relatively common, ingestion of a toothbrush is rare. We are reporting on a 26-year old female who had accidentally swallowed a toothbrush which was successfully removed via endoscopy using a polypectomy snare.

A previously healthy 20 year-old male presented with cough and shortness of breath for several months. He had no significant past medical history and took no medications. In the physical examination, bilateral expiratory stridor mimicking wheezing was present.His chest X-ray was normal, and the patient was placed on asthma medications. His symptoms persisted and he returned to the private facility where he was admitted and was started on intravenous antibiotics. In addition, a CT-scan of the chest and neck was performed, which showed a mass in the upper portion of his trachea (Figure 1).

Diphtheria is a contagious and life-threatening disease historically regarded as a major cause of mortality, particularly in children. Over the past centuries, frequent diphtheria outbreaks have occurred. Herein, after a quick look at the history of diphtheria throughout the world, a historical account of this lethal disease in Iran during the 19th and 20th centuries is presented.