Journal of Shahid Sadoughi University of Medical Sciences
Year:2006 | Volume:14 | Issue:1|Papers Count:17

Introduction: Hemodialysis patients often develop resistance to recombinant human erythropoietin due to functional Iron Deficiency. In these patients iron therapy can be hazardous leading to hemosiderosis. Recent studies have suggested that intravenous ascorbic acid may be able to improve this hyporeponsiveness. The aim of this study was to evaluate the effect of intravenous ascorbic acid on functional iron deficiency and whether it results in better correction of anemia or not. Methods: Forty hemodialysis patients with serum ferritin >300 ug/l, hemoglobin less than 10 gm/dl, and transferrin saturation less than 20% were selected. The reticulocyte index and KT/V was also calculated. Patients were later administered 500 mg intravenous ascorbic acid three times a week for three months. At the end of study, serum ferritin, transferrin saturation, hemoglobin, reticulocyte index and KT/V were rechecked and compared with the base line values by before and after method. Results: Serum ferritin decreased significantly (median base line ferritin 480.45 ug/dl as compared to final ferritin level of 363.78 (P=0.0001), whereas there was a significant rise in hemoglobin concentration (median baseline hemoglobin 8.92 gm/dl compared to 9.88 gm/dl (P=0.0001). Transferrin saturation was also significantly raised (median baseline transferrin saturation 17.35% as compared to final level of 25.12% (P= 0.0001). KT/V before and after treatment with ascorbic acid had no significant change (P =0.396). Finally, the rate of decrease in serum ferritin and increase in hemoglobin according to age and duration of dialysis was studied. The effect of ascorbic acid was found to be significantly greater in older patients and those with longer duration of dialysis (P<0.05); but there was no significant relationship between transferrin saturation increase and age or duration of dialysis. Conclusion: Intravenous ascorbic acid may partially correct functional iron deficiency, although anemia is not totally corrected.

Introduction: Motor vehicular accidents are one of the leading causes of death in young men and severe complications in all age groups. This study was carried out to evaluate eye injuries secondary to motor vehicular accidents that have a high rate of occurrence in Yazd province Methods: This descriptive, cross- sectional study was conducted through case series method. Simple sampling, i.e. census from the under study population was performed to complete the sample number. The study was carried out in 1383 on 126 motorcycle accident cases with eye injuries referred to the Kalantari Emergency Department. Data collected from questionnaires was analyzed by SPSS software using chi- square, Fisher and Variance analysis statistical tests. Results: Of the 126 cases, 124 (98.4%) were male and 2 (1.6%) were female. The mean age of the patients was 27.4 (SD=13.7) ranging between 5 months and 81 years. The highest rate of accidents was between cars and motor cycles; 83 cases (65.9%) and most of them (76.2%) were in the city. The most frequent eye injury was sub conjunctival hemorrhage in 112 cases (44.4%) followed by eyelids injury [Right side 64 cases (50.8%) and left side in 55 cases (43.6%)], orbital injury in 57 cases (22.6%) of which 39 cases (68.4%) had periorbital hematoma and 18 cases (31.6%) had an orbital fracture, 20 cases (7.9%) had ocular movement limitation and lacrimal drainage system injury was seen in 13 cases (5.2%). Those with helmets had more mandibular fractures (p=0.0001). Conclusion: The victims of motor vehicular accidents in our study were young men. The most frequent eye injuries were sub conjunctival hemorrhage, eyelid, orbital and lacrimal system injuries.

Introduction: Lymphomas as a group rank seventh as the most leading cause of death in cancers. Stomach is the most common extra nodal site of primary lymphomas. On the other hand, new information demonstrates that MALT lymphoma responds to Helicobacter antibiotic therapy. We therefore decided to determine the frequency of distribution of Helicobacter Pylori infection in primary gastric lymphoma cases at the pathology centers of Yazd and determine the relationship of Helicobacter Pylori infection with sex, age and chief complaint of these patients. Methods: This was a case series and cross- sectional study and population included patients referring to pathology centers of Yazd for whom diagnosis of primary gastric lymphoma had been suggested. Required data was accumulated with assessment of pathology reports and hospital folders of patients. Also, tissue blocks of studied patients were evaluated for presence or absence of Helicobacter Pylori. After completing the questionnaire, data was analyzed statistically using SPSS 13, ANOVA and Fisher's Exact tests. Results: 28 patients were included in this study. Prevalence of Helicobacter Pylori infection in the study group was 43.5% and more in female patients and patients aged above 45 years. Helicobacter Pylori infection was more in patients who had dyspepsia as their chief complaint and those with ulcer on endoscopy. Also, the frequency was more in high grade lymphoma cases. Conclusion: In this study we didn’t achieve a statistically significant correlation between primary gastric lymphoma and Helicobacter Pylori infection. We suggest further studies with larger number of cases to determine the prevalence of various grades of lymphoma and their relationship with Helicobacter Pylori in other provinces with conditions similar to Yazd.

Introduction: Cancer research is one of the essential activities for its control and treatment. Hospital based cancer registry system is an information system designed to collect, organize and analyze data on cancer. The objective of the present study was to compare hospital based cancer registry system in Iran with that in the USA. Methods: This research was a comparative study. Studied population included all the health care centers o Tehran, Shaheed Beheshti and Iran medical sciences universities having a pathology laboratory. Results: The findings indicate that “Pars” software program is mainly used in pathology, while “ADS- 9” program in medical record departments of the hospitals .Furthermore, requested information about cancer cases was mostly by researchers and students and the least by the hospital heads, cancer committees and physicians councils. 4- 8% of cancer information from the pathology departments was demanded by hospital managers, pathology committees, physicians, researchers and students. 60% of cancer information from “medical record departments” was reported to the drug and care deputy of the medical sciences universities to which the hospitals were affiliated. 56% of cancer information from the pathology departments was reported to the health centers outside the hospitals. Conclusion: The hospital based cancer registry system in Iran is imperfect and limited in scope as compared to the registry system in the U.S. The cancer registry in Iran only records demographic information of patients and the type of tumors. Learning from the hospital based cancer registry of the U.S.A can help to improve the hospital cancer registry based system in Iran.

Introduction: Drug resistant Staphylococci are the most important agents of nosocomial infections. In this survey, effect of different antibiotics on these bacteria and their drug resistance was investigated. Methods: The study included 500 strains of Staphylococci. Minimum Inhibitory Concentrations of all antibiotics was determined by the broth macro dilution technique and standard methods from the National Committee for Clinical Laboratory Standards. Result: Oxacillin resistance of S. aureus was 14.2% and that of coagulase- negative staphylococci was 53.4%. The activity of different antibiotics is presented in detail. Conclusion: Surveillance of strains resistant to methicillin is necessary.

Introduction: The respiratory system is both a route of entry and exit for toxins and injurious agents, as well as being a target for chemical substances and pathogens. Therefore, an understanding of the structure and function of the migratory cell populations of pulmonary tissues including alveolar macrophages is central in a number of important disease processes. This study aimed to identify and specify the glycotypes of alveolar macrophages in fibrotic lung disorders. Methods: Sections of paraffin- embedded tissue from 40 cases in both normal human lung and fibrotic lung disorders were studied by immunohistology and by lectin histochemistry with a panel of 27 biotinylated lectins. Results: The findings of this study showed that ten lectins (AHA, PTL- II, AAA, , LTA, UEA-I, BSA- 1B4, VVA, SBA, DBA, PTL-I) did not bind to the alveolar macrophages in any of the cases, whereas 17 lectins (GNA, NPA, HHA, l-PHA, e- PHA, LCA, PSA, Con A, LEA, PAA, s- WGA, ECA, MPA, HPA, WFA, SNA, MAA) bound from moderately to strongly. In contrast, in fibrotic lung disorders some glycans were somewhat more marked or changed. Conclusion: Glycans terminating in β- galactose, terminal Gal β1, 3 GalNAc and subsets of GalNAc also appeared in alveolar macrophages of fibrotic lung disorders. L- fucosylated and terminal α-linked galactosyl glycans were also detected in diseases states. Subsets of N- glycans were either changed minimally or not at all.

Introduction: Type I diabetes mellitus is caused by autoimmune destruction of the insulin-producing- cells. A new potential method for curing the disease is transplantation of differentiated insulin- secreting cells from human embryonic stem cells. Methods: Human embryonic stem cell lines (Royan H1) were used to produce embryoid bodies. Differentiation carried out by growth factor- mediated selection of nestin positive cells. In final stage, these cells were expanded in the presence of bFGF, followed by addition of nicotinamide to promote differentiation of insulin- secreting cells. Cells were assayed by immunocytochemistry, RT- PCR, insulin secreting assay with Radio- immuno assay kit and Transmission Electron Microscopy. The cells were transplanted into immunosuppressed mice. Results: Analysis of differentiation cells immunocytochemistry showed that these cells were insulin, glucagon, somatostatin and pancreatic polypeptide positive. RT- PCR reaction demonstrated the expression of pancreatic endocrine genes. Differentiation cells secreted insulin in response to glucose, but no significance difference in insulin concentration was observed with an increase in concentration of glucose. The implanted cells were vascularized and remained immunoreactive with insulin and glucagon. Transmission Electron microscopy of differentiate cells showed Golgi complexes, rough endoplasmic reticulum and a few granules but no true_ granules. Conclusion: The data showed that human embryonic stem cells can produce insulin secreting cells. However, more studies are needed to generate true beta cells

Introduction: Recent investigations have detected the presence of significant levels of heavy metals (chromium, lead and cadmium) in toys and other PVC products manufactured for children. In some countries, addition of compounds containing toxic metals to toys are limited or prohibited. Methods: To evaluate the safety of some of the plastic toys in the city of Isfahan with respect to toxic trace metals, pb, cr and cd, 75 samples of three types of toys were collected from the toy shop’s and were digested with acid with the two methods ISIRI and ASTM. The heavy metals were determined using atomic absorption spectrophotometer. Variance analysis and T- test were used for data analysis. Results: The result of the study showed that the products tested contained lead, chromium and cadmium and the highest and lowest concentration were related to Pb and Cd, respectively. The statistical analysis of the samples showed that there are no significant differences between ASTM and ISIRI digestion methods. The study revealed that none of the heavy metals in the toy samples exceeded the recommended standard levels. Highest average concentration of Pb and Cd were related to toys with green color and the highest Cr concentration was related to yellow toys in this study. Conclusion: Extensive studies are required to evaluate the quality of the toys being used by children and the toxic trace elements should be eliminated from the plastic materials used for making toys.

Acanthamoeba keratitis is a vision - threatening infection and the most important risk factors are contact lenses Characteristic symptoms include disproportionately severe ocular pain, epithelial ulcer, ring stromal infiltrate and resistance to antimicrobial treatment. The aim is to report the first cases of Acanthamoeba keratitis in Yazd in a retrospective study confirmed on histopathological and confocal microscopy. All of our patients used soft contact lenses and were women. The age range was between 20-29 years. One eye was misdiagnosed as herpes simplex keratitis and two were misdiagnosed as bacterial keratitis. A delayed visit as well as a late diagnosis led to the advanced stage of eye disease. Improvement in visual acuity following medical therapy was seen in two patients and one patient needed urgent keratoplasty for corneal necrosis. A prompt clinical and laboratory diagnosis along with treatment with propamidine- isentionate resulted in significant improvement of eye condition Failure to disinfect contact lenses and introduction of tap water rinsing of storage cases were associated with increased risk of Acanthamoeba infection. Penetrating keratoplasty is an effective treatment for medically unresponsive acanthamoeba keratitis. Confocal microscopy is the most effective and a fast diagnostic tool because it ensures the detection of acanthamebic cysts and trophozoids in corneal stroma.

Extramedullary plasmacytomas are plasma cell tumors that arise outside the bone marrow. They are most often located in the head and neck. Extramedullary plasmacytomas account for approximately 3 percent of plasma cell malignancies. The diagnosis of an extramedullary plasmacytoma depends upon the demonstration of a monoclonal plasma cell tumor at an extramedullary site with no evidence of multiple myeloma based upon bone marrow examination and roentgenographic studies, absence of an M- protein in serum and/ or urine, and no related organ or tissue impairment. These tumors are highly responsive to local radiation therapy and rarely progress or recur. A 77 year old man referred for gradual enlargement of scrotum in April, 2004. He had no fever, weight loss or loss of appetite during the period. No tenderness, warmth or erythem of scrotum was observed on physical examination. No lymphadenopathy was detected. Later he had temporary relief because of antibiotic therapy. 7 months later, he referred again following the aggravation of his symptom. Ultrasonography of his scrotum was done and enlargement in the left testis was reported. Lab data including CBC, diff, ESR, AFP were normal but βHCG titer was reported higher than normal. He underwent radical orchiectomy and the specimen was sent for pathological study. Spermatocytic seminoma and plasmacytoma were suspected, but plasmacytoma was reported after the IHC. In order to rule out multiple myeloma, whole body bone scanning with sestamibi and urine Bence Jones protein were examined, all of which were negative. In bone marrow aspiration, the cellularity was normal and no pathologic lesion was reported. Considering clinical and paraclinical evidences, the diagnosis was extramedullary plasmacytoma.

Introduction: Aphallia is a very rare urogenital anomaly with incidence rate of 1 in 30,000,000. It usually coexists with other anomalies such as cardiovascular anomalies which are incompatible with normal life, and therefore infants are delivered stillbirth or live for a very short period of time. Methods: We present an 18 months old boy with aphallia associated with congenital urethrorectal fistula, bladder and urethral stones. All stones were removed endourologically, recto- urethral fistula was repaired and perincal urethrostomy was performed. Results: The stones were composed of calcium phosphate colonized by klebiella pneumonia and proteus mirabilis. Urethrorectal fistula repairment was confirmed by cystography. Patient was discharged without a urinary catheter. Conclusion: In developed countries, management of such patients is to raise them as females. However, we must consider socio- cultural conditions, parents preference and patients tendency in management of aphallia.

Acanthosis nigricans (AN), Tripe palm (TP) and sign of lesser trelat (LT) are rare dermatoses which are often seen with malignant conditions. Acanthosis nigricans occurs both on the skin and mucus membranes as velvety hyper pigmented lesions in the flexors and around the neck, or papillomatous and verrucous lesions on the lips and buccal mucosa. These para neoplastic dermatoses are generally linked with intra- abdominal malignancies, especially gastric adenocarcinomas and improvement of the associated dermatoses after treatment of the malignancy has been frequently observed, although it has also been observed with other malignancies. We report the case of a 44 year old woman who initially came to be treated for her mucocutaneous lesions, and with diagnosis of malignant AN was further studied for the initial malignancy and finally, her main malignancy was determined as carcinoid tumor.