Iranian Red Crescent Medical Journal
Year:2009 | Volume:11 | Issue:2|Papers Count:25

While the association between Helicobacter pylori and other digestive conditions are still under the study, some authors have also investigated an expanding list of the studies on the role of H. pylori as a pathogenic determinant of some extra duodenal idiopathic diseases, such as cardiovascular, immunological, skin, liver, biliary tract, and various other disorders. Although it is still unclear how a localized infection may affect areas distant from the site of infection, it is supposed that H. pylori gastric infection may cause systemic illnesses through immune mediated mechanisms. This idea is based on the following points: (i) local inflammation can have systemic effects; (ii) gastric H. pylori infection is a chronic process that lasts for decades; (iii) persistent infection induces chronic inflammatory and immune responses that can cause lesions that are local or distant from the site of primary infection. In the past 10 years, an increasing number of studies concerning the association between H. pylori infection and extra digestive conditions have been reported. Most of these studies have documented the H. pylori infection by serology and Urease Breath Test (UBT), and rarely by PCR, and no one could isolate any H. pylori microorganism from samples, using culture method. Of course, the culture of this fastidious organism is extremely difficult; if not impossible. In this study, some of the recent papers are reviewed to find new scopes for the role of H. pylori in some kinds of extra digestive diseases.

Background: Bone marrow stem cells (BMSCs) are a rich source of stem cells and may represent a valid alternative to neural or embryonic stem cells by replacing the autologous damaged tissues in neurodegenerative diseases. In this study, we attempted to devise a protocol for the induction of BMSCs into neuroepithelial-like cells (NELCs).Methods: Rat BMSCs were isolated from the long bones of adult Sprague–Dawley rats. Their purity in the 4th passage was evaluated with fibronectin by immunocytochemistry, and the stemness marker Oct-4 was assessed by RT-PCR technique. The cells were expanded and induced in the induction stage. The BMSCs were incubated with either b-mercaptoethanol (bME) (1 mM), dimethyl sulfoxide (DMSO) (2%) or biotylated hydroxyanisol or butylated hydroxyanisol (BHA) (200 mM) in a-MEM medium without fetal bovine serum (FBS). They were washed with phosphate buffer saline (PBS) and proceeded to the 2nd phase of induction, where the induction medium was changed with a-MEM and 15% FBS containing all-trans retinoic acid (RA) (1 mM) (for 3 days). Then, the expression of the markers was assessed with GFAP, nestin and neurofilament 68 antibodies, respectively and the expression of Oct-4 and NeuroD was evaluated by RT-PCR. Results: The purity of the BMSCs at the 4th passage was more than 92%. The mRNA of Oct-4 was expressed in these cells. Induction of BMSCs by DMSO-RA could differentiate NELCs significantly more than bME-RA and BHA-RA. The transdifferentiation of NELCs was evaluated by nestin antibody and NeuroD mRNA expression; later markers expressed very low detectable level in BMSCs. But the differentiation of BMSCs into astrocytes was less in all of the experiment groups that is estimated GFAP antibody.Conclusion: The application of DMSO-RA can transdifferentiate BMSCs into NELCs in- vitro.

Background: In external radiation therapy, the percentage depth dose (PDD) is an important factor for estimating patient dose and dose distribution in target volume; therefore, its exact measurement or calculation is important. The aim of this study was to evaluate analytically the dose received by different points in water phantom and to compare it with dosimetry measurement data.Methods: To find the dose distribution throughout the tumor volume, first, the mathematical approach was performed for derivation of percentage depth dose photon beams of 6MV and 18MV Varian accelerator. Second, by dosimetry for different fields in different depths of water phantom, one can parameterize the obtained formula for percentage depth dose.Results: By comparing the mathematical and dosimetry results, the parameters of PDD-expression were computed in terms of the dimension of equivalent square field in different depths. From this formula, one can find the PDD for any fields in different depths, surface skin dose, and depth of build-up region of dose distribution, which are in agreement with empirical results with R2 >0.995, showing a good agreement with the experimental data.Conclusion: So one can measure the surface skin-dose, the depth of build-up region, and their variations in terms of square field size exactly; the measurement of these quantities have some technical problems in radiation dosimetry.

Background: The term chronic cough signifies the cough lasting for more than three weeks and is associated with different morbidities. Despite its importance, the management is often unsatisfactory. Gelatin is widely used in Iranian traditional medicine for chronic cough. This study aims to test gelatin as a possible therapy for chronic cough.Methods: One hundred patients with chronic cough without any other co-morbidities were randomly divided into two groups. The first group continued their previous antitussive medication and the second group received gelatin for 3-5 days.Results: In first group, 52% were female and 48% male (42.9±12.8 years) while these figures for the 2nd group, were 46% and 54% (41.4±14.7). Cough duration in the first group was 6.4 weeks and 6.4 weeks in the second group. In the first group, 16% reported no response to the therapy, 30% poor response, 28% fair response, 18% good response, and 8% excellent response respectively. In the second group, the figures were 4%, 20%, 32%, 38% and 6% respectively.Conclusion: Although the number of participants was not large enough to determine a statistical significance, it seems that gelatin had relieved the patients of their cough more than common antitussive medications. This study can provide the ground for further studies, especially clinical trials to evaluate the efficacy of gelatin for the treatment of chronic persistent cough.

Background: Amniotic membrane transplantation (AMT) has been considered in combination with medical treatment in progressive infective keratitis. The purpose of this study was to evaluate the efficacy of AMT as an adjunctive treatment in the management of experimental pseudomonas keratitis. Methods: Cryopreserved AMT was performed on 12 pseudomonas rabbit corneal ulcers. After one week in one group amniotic membrane transplantation combined Poostchi Eye Research Center with topical medical treatment was done (AMT group). At the end of the second week, the clinical and pathological findings were compared with those obtained from eight corneal ulcers in another group which had only been treated with topical medication (control group).Results: There was not any significant difference in clinical signs between the two groups at the end of the second week. Corneal perforation was found in three cases of the control group but in none of the cases in the AMT group. Amniotic membranes were melted in four eyes, retracted in three eyes and intact in five eyes. Pathologic examination showed no significant difference in cellular infiltration or density of organism between the two groups.Conclusion: AMT is effective in preventing corneal perforation in the early stage of experimental pseudomonas keratitis.

Background: The existing clinical trials have shown that topical corticosteroids are often effective in the management of oral inflammatory diseases. The purpose of this study was to compare the effectiveness and safety of a new mucoadhesive prednisolone tablet with that of triamcinolone acetonid paste in the management of oral lesions such as RAS-EM -pemphigus vulgaris-recurrent intraoral herpes -OLP and chemical burn.Methods: In this randomized comparative study, 60 consecutive patients with oral lesions were recruited. The patients were divided into 2 groups, one receiving topical triamcinolone acetonid 0.1% paste and the other prednisolone 5 mg mucoadhesive tablet for 2 weeks.Results: The profiles of mean lesion sizes and mean pain measures did not show any difference between the prednisolone and triamcinolone groups.Conclusion: It was found that prednisolone 5mg table is useful as triamcinolone paste in the treatment of oral inflammatory lesions with minimal side effects.

Background: Noise induced hearing loss, a permanent bilateral hearing impairment due to long term exposure to high levels of noise, represents one of the most common occupational hazards. This historical cohort study was undertaken to evaluate the auditory effects of noise and to further examine the hypothesis that a link between noise exposure and hypertension exists.Methods: The study population consisted of 140 healthy male employees from a local petrochemical industry with a history of past and present exposure to noise and 140 matched healthy unexposed individuals from the same industry (reference group). A questionnaire with 40 items concerning age, sex, weight, height, length of employment, workplace noise level, and history of hypertension was administered. Furthermore, the subjects were physically examined, their blood pressure was taken under normal resting position and all underwent audiometry testing. Similarly, sound pressure level and octave band analyzing in different stations of the workplace were carried out for every employee, and then Leq was calculated.Results: The prevalence of hearing impairment in this study was 38.5% among the exposed and 7.8% among the unexposed group and the difference was statistically significant. Similarly, the prevalence of hypertension in the exposed group was significantly higher than that in the unexposed group.Conclusions: These findings provide corroborative evidence to further substantiate the notion that exposure to noise is associated with hearing impairment. They also support the proposition that long term occupational exposure to noise appears to be a risk factor for arterial hypertension.

Background: To investigate the healing effects of vitreous body in repair of cartilage defects of the knee joint in dog as an animal model.Methods: Ten mature cross-bred female dogs weighing 20-35 kg entered our study. The right and left knees underwent a medial parapatellar incision arthrotomy. A cartilage defect was created by a six mm drill to subchondral bone in the right knee and the two borders of the fascia were fixed to the space of the joint defect. The vitreous was provided through a clear corneal incision to completely fill the joint defect. In the left knee, the cartilage defect was left untreated. The dogs were sacrificed after 3 months post-operation and the samples were studied for any sign of repair.Results: The defects of the right knee showed more signs of repair compared to the left knee after 12 weeks. Fibrous and hyaline tissues, new bone and blood vessels formation were significantly more visible in the right knee. Modified histological scoring scale in the right and left knees were 5.8 and 11, respectively.Conclusion: The results imply the promising effect of vitreous body implantation in the healing of a cartilage defect in the knee joint.

Background: The specific threshold for prostate-specific antigen and density (PSA, PSAD) to delineate which patients are at the highest risk has been controversial. The purpose of this study was to evaluate the diagnostic value of PSA and PSAD in Iranian patients with prostate cancer.Methods: Three hundred men with the serum PSA greater than 4.0 ng/ml, abnormal digital rectal examination and/or suspicious transrectal ultrasound underwent transrectal ultrasound-guided prostate biopsies. PSAD was calculated by dividing the serum PSA in ng/ml by the volume of the entire prostate in cm3. Correlation with Gleason grade of the tumor was also made. The patients were divided into three groups according to their PSA values. The receiver operator characteristic (ROC) curve was produced from the raw data on all patients.Results: One hundred and two patients showed a cancer rate of 34%. The mean PSA and PSAD of the cancer group were significantly higher than those of the non-cancer group with better performance of PSAD as confirmed by ROC curve. In patients with PSA levels between 4 and 10 ng/ml, mean PSAD values in positive and negative biopsy groups showed a significant difference while mean PSA values between these biopsy groups revealed no significant difference. The PSAD cutoff of more than 0.1 had higher sensitivity than 0.15 at the expense of increasing the number of unnecessary biopsies. Among those the patients with PSA levels above 10ng/ml, both mean PSA and PSAD values of positive and negative biopsy groups had significant differences. The sensitivity of PSAD cutoff of 0.1 was not significantly higher than 0.15 while PSAD of 0.15 showed a higher specificity. PSAD >0.15 missed cancer in 18 out of 102 patients, nearly half of those with clinically significant mid and high grade cancers.Conclusion: Overall, PSAD is a better diagnostic tool for the detection of prostate cancer than PSA, especially in patients with PSA between 4 and 10ng/ml. PSAD cutoff of 0.15 is not inclusive enough in patients with PSA levels between 4 and 10ng/ml and we propose PSAD of 0.1 as a better threshold for prostate biopsy in men with PSA at this range to detect clinically important cancers. Also, we recommend transrectal ultrasound guided biopsy in any patient with PSAD greater than 0.15 and PSA more than 4 ng/ml.

Background: Propofol (Diprivan), a modern intravenous hypnotic drug, produces a reduction in both cardiac index (CI) and mean arterial pressure (MAP) due to its sympatholytic activity. S-Ketamine (Ketanest), a potent analgesic, in contrast, causes an increase in both CI and MAP due to its sympathomimetic activity. This study was performed to compare the combination effects of propofol-ketamine and propofol-alfentanil on hemodynamic stability during induction of general anesthesia.Methods: In a prospective study, 100 patients over 60 (ASA I, II) scheduled for elective lower abdominal interventions were randomly divided into two groups. For induction of general anesthesia, after injection of midazolam, the first group (A) received alfentanil and propofol and the second group (B) received S-ketamine and propofol. Each group received atracurium as muscle relaxant. Blood pressure (BP) and heart rate (HR) were measured before and 1 and 5 minutes after induction of anesthesia.Results: The increase in HR and decrease in MAP were statistically significant in both groups 1 and 5 minutes after general anesthesia. The increase in HR and decrease in MAP were significantly more in Group A, 1 and 5 minutes after general anesthesia.Conclusion: The dose of S-ketamine administered during induction of general anesthesia may not be enough to neutralize the cardio-depressant effect of propofol. A better hemodynamic activity was observed in Group B compared to Group A due to partial neutralization of the opposing action.

Background: Although there are some studies on correlation between migraine headache and GI symptoms, they did not significantly support the correlation between migraine headache and acid peptic diseases. This case control study aimed to find such a correlation.Methods: There were 70 patients (5-15 years old) who had endoscopic documented acid peptic diseases. The frequency of migraine headache in this group and also in a group consisting of a sample of normal population (300 individuals) without any GI problem in the past year was determined by a questionnaire.Results: The frequency of migraine headache was determined in each kind of acid peptic disease in the patients, being 92.9%, 68.6%, 24.3%, 4.3%, and 4.3% among patients with gastritis, esophagitis, doudenitis, gastric ulcer, and duodenal ulcer, respectively. The frequencies of migraine headache among the normal population and acid peptic disease group were 11.3% and 22.9%, respectively. The difference was found to be statistically significant.Conclusions: Our findings showed a significant correlation between migraine headache and acid peptic diseases, especially esophagitis and gastritis. This result accords with that in some of the previous studies.

Background: Optic neuritis is a common cause of visual loss in young adults and often the first manifestation of multiple sclerosis. Recent studies have shown that treatment with intravenous methylprednisolone results in more rapid recovery of vision, but without any long term difference in visual acuity. This study was carried out to evaluate clinical characteristics of patients with optic neuritis and visual outcome after intravenous methylprednisolone treatment.Methods: In a case series study, 40 cases with optic neuritis were evaluated. Before and after treatment with methylprednisolone according to optic neuritis treatment trial, visual acuity, contrast sensitivity, color vision, streopsis and visual field were analyzed.Results: 67.5% of the patients were females. The most common age group was between 20 and 40 (60%). Blind spot enlargement and other visual field defects were also returned to relatively normal value after the treatment. Central scotoma was the most common field defect (70%) and mild Dutan defect was the most common color vision (60%) defect in this study. Visual acuity, contrast sensitivity, color vision, streopsis and visual field were significantly reduced in optic neuritis, relatively returning to the normal level after treatment.Conclusion: It seems that the assessment of other visual functions, besides visual acuity, is important in a patient with optic neuritis, because patients usually remain aware of visual deficits other than decreased visual acuity.

Background: Pain relief for labor, as an acute and severe pain, has been considered for many years. The aim of this study was to determine the effect of heat therapy on labor pain and the time of labor in primigravida women referring to the affiliated hospitals of Babol University of Medical Sciences during 2006-2007.Methods: In this study, 64 nulliparous women were randomly divided into two groups (heat therapy and routine care group). The control group received routine care in the obstetrics ward but the heat therapy group used warm bag for the low back since the cervix dilated about 3-4 cm to the end of the first stage of labor and for perinea at the second stage as well as the routine cares. The severity of pain was determined on dilatation of 3-4, 6-7 and 9-10 cm and at the end of the second stage of labor by Mc Gill pain questionnaire.Results: Comparison of the two groups showed a significant decrease in the intensity (severity) of pain in the heat therapy group in the first stage, and on dilatation of 6-7 cm and 9-10 cm, and in the second stage of labor. Also, in the heat therapy group duration of the first and third stages of labor decreased but that of the second stage of labor showed no significant difference between the two groups.Conclusion: According to the results of this study, it seems that heat affects the intensity of pain in the first and second stages of labor and shortens the first and third stages of labor.

Background: Right ventricular apical (RVA) pacing has been reported to impair diastolic and systolic function.These changes were usually studied by conventional echocardiography, while tissue-doppler imaging (TDI) has provided a new way to evaluate global and regional systolic left ventricular (LV) function and abnormal LV relaxation. We designed this study to evaluate the changes of TDI-derived indices of asynchrony after RVA pacing.Methods: We followed 41 patients with LV ejection fraction (LVEF) ³45% and LV end-diastolic dimension (LVEDD) £ 56 mm who underwent single- or dual-chamber RVA pacemaker implantation for performing pacemaker analysis and second 2-dimensional (2D) echocardiography and TDI, at least 4.2 months later. 2D measurements included LVEDD, LV end-systolic dimension (LVESD), left atrial (LA) volume and septum to lateral asynchrony, while TDI measurements were the peak velocities of myocardial shortening (Sm) and early myocardial relaxation (Em).Results: Considering the exclusion criteria, 20 patients entered the study with the mean age of 66.05 years and follow-up of 7.86 months (4.20-12.25). The reduction of Sm, Em and LVEF, and the increment of LVEDD, LVESD, septum to lat asynchrony and LA volume were statistically significant. Changes of all these parameters, however, were independent of pacing duration, frequency or mode (single- or dual- chamber).Conclusions: RVA pacing has deleterious effects on both LV systolic and diastolic parameters of not only conventional echocardiography but also TDI even in patients with normal LV function. Furthermore, LA volume increases significantly.

Background: The emergence of HIV infection and its close association with TB poses an even greater challenge to the health systems and when co-infection is present, it is the most potent risk factor for progression of the disease to an active TB. This study was performed to determine the HIV-seropositive individuals with Mycobacterial infection referring to Center for Counseling and Behavioral Modification in Shiraz, southern Iran.Methods: From January 2004 to December 2006, 459 HIV-positive individuals who referred to Center for Counseling and Behavioral Modification in Shiraz, Southern Iran were enrolled. HIV antibody tests included ELISA and western blot tests, and the tests used for M. tuberculosis infection were PPD skin test, chest x-ray, Ziehl-Neelsen technique, culture in Lowenstein-Jensen medium and pathological examination.Results: 28.5% of HIV-positive individuals had a positive PPD skin test, among whom 89.3% showed a latent tuberculosis infection and 10.7% active tuberculosis. 7.9% of HIV positive patients had active tuberculosis including pulmonary (75.8%) and extrapulmonary types (24.2%). Among the latter cases, 62.5% had TB lymphadenitis, 25% pericarditis and 12.5% TB pleuritis. 40% of those with pulmonary tuberculosis and 50% with exptrapulmonary TB had a positive PPD skin test.Conclusion: As tuberculosis is a common opportunistic infection in HIV-positive patients in Iran with a higher prevalence of extrapulmonary type and the complex clinical presentation of disease, HIV-positive patients should be regularly screened for tuberculosis. Early recognition of latent tuberculosis infection and adequate chemoprophylaxis seem to be essential too.

It has been reported that thyroid disease is common in patients with hyperparathyroidism, and vice versa. Parathyroid adenoma is the most common cause of primary hyperparathyroidism (PHPT). Hypercalcemia is an important laboratory finding in the diagnosis of hyperparathyroidism. There have been sporadic reports of the coexistence of hyperparathyroidism and non-medulary carcinoma, but the association of parathyroid adenoma and papillary carcinoma of the thyroid is not well known. This is a rare report of the coexistent occurrence of papillary carcinoma of thyroid and double adenoma of parathyroid. The case is a 52-year-old woman with a 10- year history of pain in lower extremities, with initial diagnosis of osteoporosis and no clinical improvement despite using drugs. The patient was diagnosed as a case of hyperparathyroidism, using elevated concentration of calcium and PTH and metabolic bone disease (according to the isotope bone scan). In addition to parathyroid adenomas, a firm nodule in the thyroid was detected during the surgery. Therefore, lobectomy as well as hyperparathyroidectomy was performed. In pathologic examination, parathyroid double adenoma and papillary carcinoma of the thyroid were revealed.

Ehlers-Danlos syndrome (EDS) is a rare syndrome, primarily diagnosed by clinical findings and family history. The clinical manifestations of EDS in the orofacial region consist of extra-oral and intra-oral manifestations. Its prognosis depends on the (sub) type and the proper, early diagnosis of the syndrome. The purpose of the present paper is to discuss the manifestations of this syndrome, especially its oral manifestations, and to present a case.

Wolfram syndrome is a neurodegenerative disorder usually diagnosed in childhood. The ocular manifestation of wolfram syndrome is mainly characterized by bilateral optic atrophy; however, pigmentary retinopathy has been reported in some cases. We present a case with new external ocular manifestation of wolfram syndrome not previously reported in the literature. A 22-year-old retarded man clinically diagnosed as having wolfram syndrome presented with ocular discomfort in his both eyes for a 4-year period, being aggravated recently. On examination, he was emmetrope with best corrected visual acuity of about two meter count finger in each eye. Pupillary response was sluggish but equal in both eyes. Ocular motility was normal and there was no considerable sign of nystagmus; however, there were disturbed blinking reflex, lagophthalmus, and poor bell's phenomenon. Slit lamp examination showed bilateral symmetrical saucer-like depression of the corneal surface adjacent to the limbos that is known to be deled formation. The result of Schemer test was out of the normal limit, in favor of dry eye. So, dry eye due to blinking disturbances in patients with wolfram syndrome as a neurodegenerative disorder may lead to external ocular manifestations, requiring conservative treatments.

Lemierre syndrome is an entity defined by septic thrombophlebitis of the internal jugular vein following an oropharyngeal infection, which is usually acute and complicated by metastatic infection in different organs. The usual causative organism is Fusobacterium necrophorum. On looking back at the case reports of Lemierre syndrome, we have found different sites of primary infection and also different presentations depending on the primary site and the site of involvement resulting from metastatic septic embolization. However, chronic otitis media as the primary site of infection and bloody diarrhea as the presenting symptom were very rarely presented. The case presented here was referred to Faghihi hospital of our academic medical center with bloody diarrhea. After work ups, the patient was diagnosed as a case of Lemierre syndrome on the base of chronic otitis media.

Haemangiomas are immature rests of vasofomative tissue that demonstrate angioblastic proliferation and regression, representing the most common vascular tumor of the childhood. Selecting the type of steroid, the course of administration, and the dose schedules will be guided by clinical experience. Intralesional injection of steroid is an effective treatment for hemangioma of the head and neck, with injection pressure exceeding the systemic arterial pressure routinely occur during intralesional injections steroid into capillary hemangiomas.

Hashimoto's encephalopathy is a rare complication of autoimmune thyroid disease with an estimated prevalence of 2.1/100,000. It is also known as steroid responsive encephalopathy associated with autoimmune thyroiditis, SREAT. The pathogenesis is still unknown, but the possible mechanism could be due to cerebral vasculitis with or without immune complex deposition. It is an inflammatory condition proposed by the presence of elevated TPO, elevated CSF protein,  histological feature of vasculitis of venules, and lymphocytic perivascular cuff.

Various scoring systems are used to evaluate risks of surgeries, but an appropriate scoring system for predicting the post-surgical complications should not only be simple, easy to calculate, accessible in different hospitals and centers, and proper for various operations but also it must be able to precisely assess the complications under question. The ASA scoring system developed in 1941 was reported to be an efficient system in predicting the mortality and to some extent morbidity rates in patients undergoing surgical operations.

Osteoporosis is a still a health concern with significant morbidity and mortality due to an increase of senior adults worldwide. Falls and fractures are common among frail older adults needing home health and long-term care. Although clinically bone loss and fractures in healthy premenopausal women are sporadic, more women search evaluation for osteoporosis from health care providers.

Trauma is the 5th cause of mortality of the elderly in Western countries which results in increased short and long term mortality. Post-trauma mortality is twice for every 10 years after the second decade of life. The mortality rate in elderly trauma patients was reported 15-19% which is twice as much as trauma patients with younger ages and 80% of spared trauma patients require long-term or permanent care.

Premature rupture of the fetal membranes (PROM) affects 10–20% of all pregnancies and is the main known cause of preterm delivery and neonatal and maternal morbidity and mortality. It may be related not only to physical trauma but also to biochemical processes. Vitamin C plays a role in collagen metabolism and in maintaining mechanical strength of the chorioamniotic membranes throughout gestation,  and also acts as a collagen posttranscriptional modificators.