ARCHIVES OF IRANIAN MEDICINE
Year:2015 | Volume:18 | Issue:4|Papers Count:13

Chronic kidney disease (CKD) is a global problem with psycho- socio-economic consequences. In end stage renal disease, step-wise replacement therapy should be initiated, including hemodialysis (in center/home), peritoneal dialysis and kidney transplantation. Patient’s information and education alongside a team of healthcare professionals are key points for appropriate management. The level of patient engagement for self-management depends on education, facility, cultural factors and government policy.

INTRODUCTION: Successful isolation of Mesenchymal stem cells from waste tissues might be extremely promising for developing stem cell-based therapies. This study aimed to explore whether cells retrieved from teeth extracted due to advanced periodontal disease present Mesenchymal stem cell-like properties.METHODS: Pulp cells were isolated from 15 intact molars and 15 teeth with advanced periodontal disease. Cell proliferation and markers of Mesenchymal stem cells were evaluated.RESULTS: Based on the RT-PCR and agarose gel electrophoresis, nucleostemin, Oct-4 and jmj2c, but not Nanog, were expressed in undifferentiated Mesenchymal stem cells of both groups. Interestingly, diseased pulp exhibited higher gene expressions although it was not statistically significant. The average percentage of BrdU positive cells in the diseased group (84.4%, n=5) was significantly higher than that of the control group (65.4%, n=5) (t-test, P=0.001).CONCLUSION: Our results indicate the successful isolation of Mesenchymal stem cells from the pulp tissue of hopeless periodontally involved teeth.

INTRODUCTION: Epithelial-myoepithelial carcinoma is a low-grade malignant salivary gland neoplasm with a biphasic cell population that encompasses around 1% of all salivary neoplasms.METHOD: We present different cases of epithelial-myoepithelial carcinoma, with special emphasis on histopathology, differential diagnosis, relevant prognostic factors and follow-up.RESULT: This study included 8 patients who were diagnosed with epithelial-myoepithelial carcinoma and treated surgically including a follow-up period of at least 19 months.CONCLUSION: Clinical and histopathological characteristics of these rare tumors are extremely valuable for accurate diagnosis and further therapy planning.

BACKGROUND AND AIM: Rabies is a widespread neurological zoonotic disease causing significant mortality rates, especially in developing countries. Although a vaccine for rabies is available, its production and scheduling are costly in such countries. Advances in recombinant DNA technology have made it a good candidate for an affordable vaccine. Among the proteins of rabies virus, the Glycoprotein (RVG) has been the major target for new vaccine development which plays the principalrole in providing complete protection against RV challenge. The aim of this study is to produce recombinant RVG which could be a DNA vaccine candidate and to evaluate the efficiency of this construct in a prime-boost vaccination regimen, compared to commercial vaccine.METHODS: Cloning to pcDNA3.1 (+) and expression of rabies virus glycoprotein gene in BSR cell line were performed followed by SDS-PAGE and Western blot analysis of the expressed glycoprotein. The resulting genetic construct was used as a DNA vaccine by injecting 80 mg of the plasmid to MNRI mice twice. Prime-Boost vaccination strategy was performed using 80 mg plasmid construct as prime dose and the second dose of an inactivated rabies virus vaccine. Production of rabies virus neutralizing antibody (RVNA) titers of the serum samples were determined by RFFIT.RESULTS: In comparisons between heterologous prime-boost vaccination strategy and DNA vaccinations, the potency of group D that received Prime-Boost vaccine with the second dose of pcDNA3.1 (+)-Gp was enhanced significantly compared to the group C which had received pcDNA3.1 (+)-Gp as first injection.CONCLUSION: In this study, RVGP expressing construct was used in a comparative approach between Prime-Boost vaccination strategy and DNA vaccination and compared with the standard method of rabies vaccination. It was concluded that this strategy could lead to induction of acceptable humoral immunity.

BACKGROUND: Adverse cutaneous drug reactions (ACDRs) are caused by a wide variety of agents. The aim was to study the incidence and clinico-demographic profile of ACDRs to identify any potential risk factors and compare the results with other studies.METHODS: A cross-sectional observational study was conducted over a period of one year from October 2012 to October 2013 in the outpatient department (OPD) of a tertiary care teaching hospital of the Kashmir valley in India and various ACDRs were recorded.RESULTS: The incidence of ACDRs was 0.16%. The mean age of patients was 39.36±16.77 years. The male: female ratio was 0.97:1. The most frequently reported cutaneous reactions were with antimicrobials (57.33%) followed by NSAIDs (21.33%) and antiepileptic drugs (17.33%). Less common groups involved were steroids, antipsychotics and bisphosphonates (1.33% each). Fixed drug eruptions (FDEs) were the commonest (45.33%) followed by maculopapular (17.33%), photoallergic (8%), erythema multiforme (6.66%), Stevens-Johnson syndrome (5.33%) and lichenoid eruptions (4%). Less common patterns were urticaria, Drug Reaction with Eosinophilia and systemic symptoms (DRESS syndrome) and acneform eruptions (2.66% each) followed by angioedema, acute generalized exanthematous pustulosis (AGEP), exfoliative dermatitis and toxic epidermal necrolysis (1.33% each).CONCLUSION: Physicians should have adequate knowledge of adverse drug reactions, especially of newer drugs which are increasing every year in order to minimize such events.

BACKGROUND: Previous Saudi studies have shown the psychiatric comorbidity among adolescent girls. This article was done to assess the prevalence and comorbidity of psychiatric disorders among secondary school girls in Taif area.METHODS: A cross-sectional multistage cluster-sampling methodology was carried out on 1024 secondary school female students. Psychometric evaluation of students was carried out using the Beck depression inventory, Castello and Comery Anxiety scale and Obsessive-compulsive disorder scale.RESULTS: Out of the 1024 participants, 42.9%, 54.9%, and 23.1% had significant depression, anxiety and obsessive compulsive symptoms, respectively. In addition, 64.7% of them had symptoms of the three studied disorders. A highly significant positive correlation was found between depression score and both anxiety and OC symptoms scores and between anxiety score and OC symptoms score.CONCLUSIONS: There is a need for a national intervention program for promotion of adolescent mental health. The program should include screening of students using the psychometric scales.

Chronic kidney disease (CKD) and the resultant end stage renal disease (ESRD) are associated with significant mortality, morbidity, and cost for the individual patient and society. CKD is among the major contributors to years of life lost (YLL) due to premature mortality. Also, while the disability adjusted life years (DALY) for many conditions decreased between 1990 and 2010, the DALY for CKD has increased by 69%. In addition to the physical disability, CKD is associated with high prevalence (27.9%) of major depressive episodes, associated with limitations of employment, and a significant negative effect on quality of life (QOL). A major determinant of QOL is satisfaction with treatment choice. There is consensus among investigators that patients who are actively engaged in their own care experience improved health outcomes. The shared decision making (SDM) approach allows patients and providers the opportunity to work in partnership to make decisions that are congruent with the patient's values, preferences, and distinct situations. SDM has been associated with improved outcomes among patients with various chronic disease states. Mentoring, particularly by trained peers, has been used as an approach to enhance SDM in several chronic conditions, including cancer and cardiovascular disease. In this review, we will focus on care of patients with CKD as a model for the study of the impact of peer mentoring on SDM and choice of treatment for ESRD.

Celiac disease (CD) is an immune disorder that is associated with gluten sensitivity in people who are genetically predisposed. In celiac disease, food containing gluten mounts inflammatory response that results in villous atrophy in small bowel and increased permeability. This disorder is not only related to complications in the small bowel, but also has association with manifestations outside the GI tract. Small bowel mucosal immunity, exposed to infectious agents, is affected by CD; therefore, it is likely that patients with untreated celiac disease are more susceptible to infectious diseases. It is possible that sensitivity to gluten increases in patients infected with infectious diseases, and consequently infection may trigger CD in susceptible individuals. It is likely that, due to reduced immunity following the loss of intestinal villi, viral, bacterial, and parasitic infections develop faster in celiac disease patients and systemic complication occur more frequently. In addition, increased permeability, changing the microbiota following the chronic inflammation of the small intestine and abnormal immunological reactions are associated with celiac disease. PubMed, Medline, Google scholar, SID, and Magiran were searched for full text articles published between 1999 and 2014 in Persian and English. The associated keywords were used, and papers, which described particularly the impact of infectious agents on celiac disease, were selected. In this review, we have focused on the role of infectious agents and gut microbiota in the pathogenesis of celiac disease.

Transitional cell carcinoma of urinary bladder (TCCB) is an extreme rare entity in childhood. We aim to report our experience in treating this tumor.From 1980 to 2013, four patients (4 males, aged 11, 14, 15, and 17 years) were referred to our center with TCCB. The clinicopathological features, means of treatment, and prognostic outcomes were reviewed from the medical records.Of all the four patients, three presented with gross hematuria, whereas the other patient presented with dysuria. All patients were treated with transurethral resection alone, but one patient underwent postoperative multiple intravesical instillation of hydroxycamptothecin. Postoperative histological studies showed low-grade papillary urothelial carcinoma for all patients. No evidence of recurrence has been observed during the follow up.In childhood, TCCB which carries an excellent prognosis is low-grade and non-invasive. The general principle of therapy is transurethral resection. Bladder ultrasound is an efficient tool in the screening protocol, especially for low-grade TCCB patients.

Nevus sebaceous (NS), also known as organoid nevus, is a congenital skin hamartoma involving pilosebaceous follicle, epidermis and adnexal structures, which usually occurs in the head and neck region. During the first stage, which is seen in infancy and childhood, the lesion remains static, but can subsequently grow during puberty to become more evident and verrucous or nodular. Depending on the location and extent, nevus sebaceous causes only a cosmetic problem during childhood; however, the development of benign and malignant neoplasms on the lesion is the most severe complication during adulthood. The association between nevus sebaceous and various benign and malignant cutaneous neoplasms is well documented. Basal cell carcinoma (BCC) is the most common malignant lesion, and syringocystadenoma papilliferum (SP) is the most common benign tumor associated with nevus sebaceous. Development of squamous cell carcinoma within NS is very rare. The literature contains only a few reports of simultaneous multiple malignant tumors developing on nevus sebaceous. We present a review of the literature and report the case of a 42-year-old female patient with two squamous-cell carcinomas (SCC) simultaneously within a single NS.

Aphallia or penile agenesis is an extremely rare congenital anomaly with an estimated incidence rate of 1 in 10 to 30 million births. We report a rare case of aphallia with right kidney hypoplasia and left kidney dysplasia in a 10-day old Iranian-Azeri male. The patient had creatinine rise and renal failure due to dysplastic left kidney and hypoplastic right kidney and expired on fifth day of admission. There were only six cases of renal malformation associated with aphallia in the literature review. Three of the cases were complicated by Potter sequence and one of them was accompanied by chronic renal failure. Our case had a unique presentation because of bilateral renal malformation and subsequent renal failure without the Potter sequence.

Primitive neuroectodermal tumors are fairly rare in uterus. A case of uterine body primitive neuroectodermal tumor in a 32-year-old Iranian woman is presented. The patient was admitted with abdominal pain and fever and underwent emergency exploratory surgery with total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node dissection. Posterior wall of the uterus was necrotic and ruptured and a huge tumor disrupted the uterine body. The tumor was strongly positive for CD99, NSE, and chromogranin; No reaction was seen for CD10, CD45 and myogenin. To the best of our knowledge, this is the first report of an uterine body primitive neuroectodermal tumor and the second report of uterine primitive neuroectodermal tumor from Iran.

During the Sassanid Empire in Persia (226-652 AD), there was a renaissance of humanistic sciences, including medicine, in the city of Gondi-Shapur. When the Islamic center of power moved to Baghdad in about 750 AD, physicians of Gondi-Shapur, including the dean of the medical school (a Nestorian Christian), gradually moved to Baghdad constructing hospitals and medical schools. Aided by the Persian and Nestorian Christians, the Islamic civilization ushered in what is considered to be the Golden Age of Islam from the 8th to 13th century AD. During this period, there were remarkable achievements in humanistic sciences including medicine by many physicians/authors whose medical textbooks were used for centuries in burgeoning medical schools in Europe. The medical texts written during the Golden Age of Islamic Medicine contain sections and chapters about the clinical conditions, diseases and medical care of children. It was during this era that the first treatise was written on the diseases of children and their care. This essay will describe, in brief, the writings about the conditions and diseases of children and their medical care, by three prominent Persian physicians of the Golden Age of Islamic Medicine: 1) Abubakr Muhammad Ibn Zakaria Razi, Rhazes (865-925 AD); 2) Ali ibn-al-Abbas al-Majusi or Haly Abbas (949–994 AD); and 3) Abu Ali al-Husayn ibn Abd Allah ibn Sina or Avicenna (980–1037 AD).