ARCHIVES OF IRANIAN MEDICINE
Year:2018 | Volume:21 | Issue:5|Papers Count:7

Background: Gene expression profiling of breast cancer has demonstrated the importance of stromal response in determining the prognosis of invasive breast cancer. The host response to breast cancer is of increasing interest to pathologists and may be a future focus for novel pharmacological treatments. Methods: This study describes the pattern of distribution of stromal myofibroblasts using immunostains for CD10 and smooth muscle actin (SMA) in 50 primary breast cancers and their matched nodal metastases (68. 6% nodes positive and 31. 4% nodes negative). The stroma within the tumor (intratumoral) and at the advancing tumor edge (peri-tumoral) was studied in both primary and nodal sites. A simple quantitative scoring system was employed for both immunostains. The correlation between expression of these markers by stromal cells and standard pathological prognostic factors of stage, grade, hormone receptor and Her-2 status was analysed. Results: SMA-positive stromal cells were more abundant in peri-tumoral stroma compared with intratumoral stroma in both primary and metastatic lesions. SMA expression in the lymph node metastases showed a significant correlation with tumor stage. SMA expression in peri-tumoral stroma correlated with Her-2 status. Conclusion: The results of this study suggest that myofibroblasts, particularly those expressing SMA, might potentiate the progression of the carcinomatous process especially in nodal metastases. Thus these cells may be a potential therapeutic target.

Background: Coexistence of bacteria and yeast in a myriad of microbial communities is indicative of their intimate relationship, which could be the intracellular existence of bacteria inside yeast. In this study, the intracellular existence of bacteria inside yeast and bacterial release from amphotericin B-treated yeasts was examined using polymerase chain reaction (PCR) and microscopy. Methods: Released bacteria, B1 from Y1 (a gastric yeast) and B2 from Y2 (an oral yeast) were identified as Staphylococcus hominis and Staphylococcus haemolyticus by biochemical tests as well as amplification of Staph-specific tuf and 16S rRNA genes. PCR products were sequenced and matched with Staphylococcus published sequences in GenBank. PCR was also used for amplification of Staph-tuf and Helicobacter pylori-16S rRNA genes from DNAs of 50 yeasts (20 oral, 20 gastric and 10 fecal). Microscopy was used for observing bacterium-like bodies (BLBs) inside the yeasts vacuole. Results: Thirty-two yeasts (64%) carried Staph-tuf gene, 20 yeasts (40%) carried H. pylori 16S rRNA gene, 14 yeasts (28%) carried both genes, 12 yeasts (24%) carried neither, 6 yeasts (12%) carried only H. pylori 16S rRNA gene, and 18 yeasts (36%) carried only tuf gene. Amplified products of tuf (370 bp) and 16S rRNA (756 bp) genes from B1 and Y1, and B2 and Y2 showed high similarity to S. hominis and S. hemolyticus, respectively. Microscopic observations showed BLBs inside the yeasts vacuoles, which could be related to the released bacteria. These BLBs were alive and could be observed in successive generations of yeasts. Conclusion: Amplification of Staphylococcus-and H. pylori-specific genes from yeasts showed that the intracellular BLBs could belong to Staphylococcus species and H. pylori. Release of culturable staphylococci from 2/50 (4%) yeasts showed that not all yeasts release bacteria, and bacterial release takes place under unknown conditions. However, it could be triggered by amphotericin B or hydrolytic enzymes. Coexistence of staphylococci and H. pylori genes could represent a mixed endosymbiotic bacterial population in Fungi such as yeast. By selecting certain bacterial associates, the diversity of microbial communities could be determined. These selected bacteria could have an intracellular origin, being released under certain conditions.

Background: Health systems have a set of limited resources for meeting the needs of communities. Health priority setting based on criteria and values is inevitable in such situation. This paper aims to identify the social values that are considered in Iranian health system. Methods: This qualitative study was conducted in 3 steps including collecting national documents and literature review, interviewing key informants, and a 2 round Delphi. Interviews and documents were analyzed through thematic framework analysis. Statistical guidance was applied for determining consensus cut-off in Delphi technique. Results: Five social values including freedom of choice, equity, solidarity, severity of disease(s), and burden of disease(s) were considered more important than other values in the health priority setting decisions. Moreover, 2 non-value based factors including conflict of interest and lobbying had a high effect on decision making. Conclusion: Most health policy makers decide based on Egalitarian school, but restriction of resources in the country decreases the outcome. Moreover, personal judgments and preferences sometimes affect their decisions. It seems that developing a value-based framework and making it as a national guidance could have affirmative effect on health administers decisions.

Background: Pertussis caused by Bordetella pertussis is a vaccine-preventable disease causing whooping cough in humans of all ages. This study reports infection rate of pertussis in Palestine between the years 2004-2008 from archived nasopharyngeal samples collected from clinically-suspected cases. Methods: A convenience archived DNA samples collected from 267 clinically-suspected pertussis cases were investigated for B. pertussis. Laboratory diagnosis was done by examining all DNA samples using polymerase chain reaction (PCR). Results: Approximately 49% (130/267) were confirmed by PCR. A pertussis peak was shown to occur in 2008 with 77% (100/130) of PCR-confirmed cases isolated in that year. PCR-confirmed cases existed in all Palestinian districts with highest rate in Ramallah, Bethlehem, Jenin and Al-Khalil. Half of the PCR-confirmed cases (68/130) were less than 2 months old. The positivity rate among who had three doses of vaccine (at 2, 4 and 6 months) was 38%, and became 50% with the fourth dose at 12 months. Conclusion: The prevalence of pertussis was found to be significantly high among infants less than 2 months old. Active pertussis surveillance using rapid PCR assays is essential, as it is helpful in prompt diagnosis and treatment of patients with pertussis.

Background: Recent evidence from prospective cohort studies show a relationship between consumption of dairy foods and cardiovascular diseases (CVDs) and type 2 diabetes mellitus (T2DM). This association highlights the importance of dairy foods consumption in prevention of these diseases and also reduction of associated healthcare costs. The aim of this study was to estimate avoidable healthcare costs of CVD and T2D through adequate dairy foods consumption in Iran. Methods: This was a multistage modelling study. We conducted a systematic literature review in PubMed and EMBASE to identify any association between incidence of CVD and T2DM and dairy foods intake, and also associated relative risks. We obtained age-and sex-specific dairy foods consumption level and healthcare expenditures from national surveys and studies. Patient level simulation Markov models were constructed to predict the disease incidence, patient population size and associated healthcare costs for current and optimal dairy foods consumption at different time horizons (1, 5, 10 and 20 years). All parameters including costs and transition probabilities were defined as statistical distributions in the models, and all analyses were conducted by accounting for first and second order uncertainty. Results: The systematic review results indicated that dairy foods consumption was inversely associated with incidence of T2DM, coronary heart disease (CHD) and stroke. We estimated that the introduction of a diet containing 3 servings of dairy foods per day may produce a $0. 43 saving in annual per capita healthcare costs in Iran in the first year due to saving in cost of CVD and T2DM treatment. The estimated savings in per capita healthcare costs were $8. 42, $39. 97 and $190. 25 in 5, 10 and 20-years’ time, respectively. Corresponding total aggregated avoidable costs for the entire Iranian population within the study time horizons were $33. 83, $661. 31, $3, 138. 21 and $14, 934. 63 million, respectively. Conclusion: Our analysis demonstrated that increasing dairy foods consumption to recommended levels would be associated with reductions in healthcare costs. Further randomized trial studies are required to investigate the effect of dairy foods intake on cost of CVD and T2DM in the population.

A 55-year-old previously healthy man was admitted with a diagnosis of pneumonia, and successfully managed with intravenous antibiotics. ...

Chickenpox, an infection of childhood with vesicular skin rash, is caused by varicella-zoster virus (VZV). Although the infection is rare in adults, it can cause serious complications Varicella pneumonia is the most encountered complication. In this report, a VZV pneumonia case in a previously healthy adult is presented. The patient was treated with early intravenous acyclovir and both clinical and radiographic recovery has been observed.