Iranian Red Crescent Medical Journal
Year:2012 | Volume:14 | Issue:1|Papers Count:12

The history of tuberculosis (TB) traces back to antiquity. Despite significant progress of various diagnostic methods and introduction of anti-tuberculosis drugs in past decades, TB is still a major worldwide health concern which leads annually to two million deaths, especially after the emergence of multidrug-resistant Mycobacterium TB and HIV co-infection. Presented here is a brief review of conventional and new TB diagnostic laboratory methods including their advantages and disadvantages as well as common challenges in diagnosis and management of TB.

Background: Oral Lichen planus (OLP) is a chronic lesion of the oral mucosa with unknown origin. Basement membrane changes are common in OLP and may be mediated by proteases such as matrix metalloproteinase (MMPs) and mast cell chymase. The aim of our study was to evaluate the level of serum MMP-3 in OLP compared to normal individuals and assess its clinical significance.Methods: Thirty four serum samples from patients diagnosed with OLP (12 males, 22 females, age: 42.2±10.8 years) and 34 serum samples from healthy control subjects (11 males, 23 females, age: 42.5±13.3 years) were collected and MMP-3 concentration was measured by ELISA.Results: The serum MMP-3 level in OLP patients was higher (21.64±24.31 ng/ml) compared with healthy controls (16.52±23.63 ng/ml), but showed no statistically significant difference. A statistically significant difference was demonstrated between the two types of OLP, being more pronounced in the erosive/atrophic form 6).Conclusion: The different clinical appearances of OLP are associated with significant differences in MMP-3 serum level.

Background: Restless leg syndrome (RLS) is defined as an uncomfortable feeling in the limbs which is prominently sensed in legs. Dopamine system involvement is considered as the base of RLS’s etiology. Because of safety, anti-oxidant and dopaminergic promoting action of selenium, this study aims to investigate the effect of selenium on restless leg syndrome treatment.Methods: Sixty patients with primary RLS were enrolled in this clinical trial (Irct2011103015943n1). It was based on 3 periods of drug prescription with one month wash out period. As placebo, 50 and 200 mg of selenium were administered in each separated month. The diagnosis was based on criteria published by IRLSG (International RLS Study Group). The questionnaire included 10 questions while each question’s rating was between 0 and 4.Points between 1 and 10 were considered mild, 11 to 20 as moderate, 21 to 30 as severe and 31 to 40 as very severe. After end of each month of drug consumption, questionnaires were completed and each subject was asked to report the severity of disease and side effects of the drugs. At least 10 declines in scale were considered as appropriate responses.Results: Improvement (decline IRLS score>10) was significantly higher in selenium (50 and 200 mg) than placebo group.Conclusion: Selenium prescription in daily recommended dose of 50 mg instead of a dopamine agonist would be an alternative treatment in improvement of RLS symptoms.

Background: Preeclampsia is one of the most serious complications, and affecting about 3% of pregnancies. The aim of this study was to estimate the impact short duration of exposure to sperm on development of preeclampsia.Methods: The duration of sperm exposure with the biological father (cohabitation without barrier methods)<3, <6 months were evaluated among 120 primigravid women with preeclampsia and 120 women without preeclampsia in a case-control study.Results: The short duration of exposure to sperm was more common in women with preeclampsia compared with controls (29.2 versus 14.2 for <3 months, adjOR 2.6 (95% CI=1.32-5.13) and (45 versus 29.2 for<6 months, adjOR 2.4 (95% CI=1.35-4.32). Regardless of the contraceptive method, short duration of cohabitation was more common in preeclamptic group (14.2 versus 5.8 for<3 months, adjOR 3.38 (95% CI=1.28-8.92) and (29.7 versus 13.3 for<6 months, adjOR 2.64 (95% CI=1.24-5.79).Conclusion: It was concluded that short duration of exposure to sperm was more common in women with preeclampsia compared with controls.

Background: Non-syndromic cleft lip with or without cleft palate (CL/P) or cleft palate only (CPO) are orofacial clefts with multifactorial etiology. These include environmental factors and heterogeneous genetic background. Therefore, studies on different and homogenous populations can be useful in detecting related factors. The aim of the present study was to evaluate the risk factors in patients with non-syndromic cleft in Tehran, Iran.Methods: Data from 300 patients and 300 controls were collected between 2005 and 2010. Binary logistic regression analyses were used to calculate relative risk by odds ratio (OR) and %95 confidence interval.Results: Low maternal age (OR=1.06, 95% CI, 1.011-1.113), low socioeconomic status (OR=0.23, 95% CI, 0.007-0.074), maternal systemic disease (OR=0.364, 95% CI, 0.152-0.873) and passive smoking (OR=0.613, 95% CI, 0.430-0.874) increased the risk for CL/P and CPO. There was a significant difference in iron and folic acid use during pregnancy when the case and control groups were compared.Conclusion: In assessing for orofacial cleft risk, we should consider lack of folic acid supplementation use, maternal age and systemic diseases and passive smoking as risk factors.

Background: We already showed the superiority of imputation of missing data (via Multivariable Imputation via Chained Equations (MICE) method) over exclusion of them, however, the methodology of MICE is complicated.Furthermore, easier imputation methods are available. The aim of this study was to compare them in terms of model composition and performance.Methods: Three hundreds and ten breast cancer patients were recruited. Four approaches were applied to impute missing data. First we adopted an ad hoc method in which missing data for each variable was replaced by the median of observed values. Then 3 likelihood-based approaches were used. In the regression imputation, a regression model compared the variable with missing data to the rest of the variables. The regression equation was used to fill the missing data. The Expectation Maximum (E-M) algorithm was implemented in which missing data and regression parameters were estimated iteratively until convergence of regression parameters. Finally, the MICE method was applied. Models developed were compared in terms of variables significantly contributed to the multifactorial analysis, sensitivity and specificity.Results: All candidate variables significantly contributed to the MICE model. However, grade of disease lost its effect in other three models. The MICE model showed the best performance followed by E-M model.Conclusion: Among imputation methods, final models were not the same, in terms of composition and performance. Therefore, modern imputation methods are recommended to recover the information.

Background: Donor recruitment and retention are significant problems in blood collection agencies around the world. The Aim of this study was to determine the causes of lack of interest to blood donation in eligible individuals in Mashhad, Northeast of Iran.Methods: This was a descriptive study. Cases were 1130 non-donor individuals. Participants were selected from eligible individuals in different regions of Mashhad. In this study, surveys included information about age groups, gender, residence area, marriage, education, living situation and job as background variables.Result: Less than 30% of the cases had enough knowledge about blood donation. There was a significant relationship between location, age, education, occupation and social status with knowledge of blood donation, but there was not a correlation between gender and marital status.Conclusion: There are some factors which affect the decision for blood donation. There is a need to change the negative attitude by increasing the knowledge considering the individual and the social status.

Background: Blended learning as a method of learning that includes face to face learning, pure E-learning and didactic learning. This study aims to investigate the efficacy of medical education by this approach.Methods: This interventional study was performed in 130 students at different clinical levels participating in class sessions on "congenital adrenal hyperplasia and ambiguous genitalia". Sampling was done gradually during 6 months and all of them filled a pretest questionnaire and received an educational compact disk. One week later, a presence class session was held in a question and answer and problem solving method. Two to four weeks later, they filled a posttest questionnaire.Results: There was a significant correlation between pretest and posttest scores and the posttest scores were significantly more than the pretest ones. Sub-specialized residents had the most and the students had the least attitude towards blended learning approach. There was a significant correlation between the research samples accessibility to computer and their attitude and satisfaction to blended learning approach.Conclusion: Findings generally showed that the blended learning was an effective approach in making a profound learning of academic subjects.

Symptomatic spontaneous spinal epidural hematoma (SSEH) is an uncommon cause of cord compression that commonly is considered as an indication for emergent surgical decompression. We aimed to investigate a patient with a SSEH that completely resolved clinically and radiographically, without surgical treatment. The patient presented three days after the sudden onset of back pain, numbness, and weakness. Magnetic Resonance Imaging (MRI) revealed a posterior thoracolumbar epidural hematoma extending from the level of T10 to L2 with significant cord compression. Decompression was recommended but he refused surgery and was managed conservatively. One month later, weakness totally recovered and hematoma was absent on MRI.

Atherosclerotic cardiovascular diseases are the major cause of death in middle-aged and older-adults.Today, inflammation is regarded as the key pathogenic mechanism in both initiation and progression of atherosclerosis. Inflammatory markers such as high sensitive C-reactive protein (CRP) have been used to identify patients at higher risk for coronary events. The prognostic value of CRP has been established for patients with acute coronary syndrome, stable coronary artery diseases and in apparently healthy people.

Orofacial clefts are the most common congenital anomalies of the head and neck and its incidence ranges from 1/500 to 1/2000 live births, depending on populations.Etiology of these anomalies is multifactorial and includes both environmental and genetic factors. Many teratogenic agents and factors in pregnancy are claimed to cause clefting, such as maternal smoking and hypoxia and diabetes mellitus. The pivotal role of diabetes mellitus and maternal obesity on the incidence of orofacial clefts has been discussed previously.

Tuberculosis (TB) is responsible for a large portion of morbidity and mortality worldwide. According to WHO report, tuberculosis is responsible for at least 2 million deaths per year, so 90% of these occurring in developing countries.Recently, it has been shown that multidrug-resistance (MDR) and extensively drug resistant tuberculosis (XDR-TB) are the most important factors cause death in patients with tuberculosis.Drug resistance of M tuberculosis has been implicated in many etiologies such as inadequate and incomplete treatment, host genetic factors and, HIV infection. The long duration of treatment, large amount of anti-TB drugs and their gastrointestinal side effects, are the most important causes of noncompliance in patients with TB. 4 MDR-TB (when resistance to isoniazid and rifampicin appears in combination), increases the numbers of individuals who need treatment with second-line drugs worldwide.