TEHRAN UNIVERSITY MEDICAL JOURNAL (TUMJ)
Year:2008 | Volume:66 | Issue:8|Papers Count:15

Background: It is well known that erectile dysfunction is most commonly associated with diabetes, affecting 35% to 75% of men with diabetes mellitus. Several studies have been carried out to find appropriate strategies for treatment of diabetes-induced erectile dysfunction. The aim of the present study was to investigate the ability of acute administration of the endogenous cannabinoid anandamide in vitro to alter the NANC mediated relaxation of corpus cavernosum from diabetic rats and the possible role of nitric oxide in this manner.Methods: Diabetes was induced by the administration of streptozotocin for eight weeks. Corpora cavernosa were isolated in organ baths for measurement of agonist-evoked or electrical field stimulation (EFS)-evoked smooth muscle tensions.Results: The neurogenic relaxation of phenylephrine (7.5 mM) precontracted isolated corporal strips were impaired in diabetic animals. Anandamide (0.3, 1 and 3 mM) enhanced the relaxant responses to EFS in diabetic strips in a dose-dependent manner. This effect was antagonized by either the selective cannabinoid CB1 receptor antagonist AM251 (1 mM) or the selective vanilloid receptor antagonist capsazepine (3 mM). Concurrent administration of partially effective doses of L-arginine (10 mM) and anandamide (0.3 mM) exerted a synergistic improvement in EFS-induced relaxation of diabetic strips (p<0.001). The relaxant responses to the nitric oxide donor sodium nitroprusside of the subjects in the diabetic and control groups were similar.Conclusions: For the first time, we demonstrated that acute administration of an endogenous cannabinoid, alone or in combination with L-arginine could improve the NO mediated relaxation of cavernosal smooth muscle in diabetic rats and this effect was mediated by cannabinoid CB1 and vanilloid VR1 receptors within the tissue.

Background: Dimethyl sulfoxide (DMSO) has been used as a solvent for many drugs in ischemic experiments. DMSO has many biological benefits, including antioxidant, antiinflammatory, platelet aggregation inhibiting and cell membrane stabilizing effects. Moreover, some experimental studies report that DMSO has a neurprotective effect in permanent focal cerebral ischemia. Despite the effect of DMSO on the cortex, striatum injuries and motor neurological dysfunctions in transient focal cerebral ischemia are not completely clear.Methods: Thirty-six male Sprague-Dawley rats weighing 300-350 g were divided into saline- (control) and DMSO-treated groups. Under chloral hydrate anesthesia (400mg/kg, ip), transient focal cerebral ischemia was induced by 90-min middle cerebral artery occlusion (MCAO) followed by 23-h reperfusion. Rats received saline (n=11) or 2% DMSO intraperitoneally at doses of 0.01 (n=11), 0.1 (n=7) and 0.2 (n=7) ml/kg 30 min prior to induction of ischemia. Twenty-four hours after MCAO, the neurological deficit scores were ascertained. Cortical and striatal infarct volumes determined by triphenyltetrazolium chloride staining. Results: Administration of DMSO at doses of 0.1 and 0.2 ml/kg significantly reduced cortical and striatal infarct volumes (p<0.001), while rats receiving the 0.1 ml/kg dose had infarct volumes similar to those of the control group (p=0.225). Moreover, only 0.2 ml/kg doses of DMSO significantly reduce neurological motor dysfunction (p<0.001). Conclusions: Findings of this study indicate that DMSO is a potent neuroprotective agent against transient focal cerebral ischemia in rat. Moreover, our data also suggest that DMSO may be a candidate for acute stroke treatment.

Background: There is a growing interest in understanding the biological effects of timetested folk medicinal plants including the green leafy vegetables, which supply minerals and vitamins to the diet. Trigonella foenum-graecum L (fenugreek) is a dietary vegetable and there are reports concerning its antinociceptive effects in Iranian traditional medicine. Its seeds are also known for their carminative, tonic, antidiabetic, antineoplastic and restorative properties. These reports and the hypoglycemic effect of fenugreek leaf extract encouraged us to assay fenugreek aqueous extract for cytotoxicity on NIH3T3 mouse fibroblast cells.Methods: The NIH3T3 cell line was purchased from National Research Center for Genetic Engineering and Biotechnology of Iran. The cells were plated in 24-well microtiter plates with DMEM+F12 medium containing 10% fetal calf serum supplemented with 445 mg/L Lglutamine and maintained at 37°C with 5% CO2/95% air. Following a 24-hr incubation period, various concentrations (0.01-20 mg) of the extract to the culture wells. Cell viability was assessed using trypan blue and MTT assays after five days of incubation. Results: The results show that the IC50 of the fenugreek extract as calculated from the trypan blue and MTT assays were 1.25 and 2.5 mg/mL, respectively. Conclusions: Our findings, therefore, suggest that the aqueous extract of fenugreek is classified as nontoxic. This observed cytotoxicity is not specific and could be due to membrane disturbances.

Background: Multislice computed tomography (MSCT) is a noninvasive method of detecting coronary artery disease (CAD). The purpose of the present study was to investigate the accuracy of 64-slice MSCT (64-MSCT) in daily practice, without patient selection.Methods: Sixty-four consecutive suspected CAD patients underwent both 64-MSCT and quantitative coronary angiography (QCA). The CT system The mean time span between MSCT and QCA was 7.2±3.9 days. For the 64-MSCT, detection or exclusion of CAD, defined as one or more areas of >50% stenosis within major epicardial coronary arteries, the sensitivity, specificity, diagnostic accuracy, positive predictive value (PPV), and negative predictive value (NPV) were evaluated both per patient and per segment. Results: Sixty-one of the 64 coronary CT angiograms (95%) were of diagnostic image quality. QCA showed significant CAD in 64% (39/61) of the patients, with the other 36% (22/61) showing nonsignificant disease or no disease. Sensitivity, specificity, accuracy, PPV, and NPV of 64-MSCT per patient were 92%, 86%, 90%, 92% and 96%, respectively. By the per-segment analysis, 695 of 791 coronary artery segments were assessable (88%). Of these, 64-MSCT showed a sensitivity of 80%, specificity of 92%, accuracy of 90%, PPV of 65%, and NPV of 96%, respectively, in detecting CAD.Conclusions: Both per patient and per segment analyses for coronary 64-MSCT showed a higher diagnostic accuracy than QCA. This suggests 64-MSCT should primarily be used for risk stratification on a per patient basis as a noninvasive gate-keeper diagnostic method.

Background: Altitude diseases, the most frequent of which is acute mountain sickness (AMS), are among the most common and serious problems that recreational and professional mountain athletes may encounter. If left undiagnosed, they may lead to lethal consequences. In a cross sectional study, we investigate the prevalence of AMS disorder among the overnight guests of a mountain resort hotel.Methods: Overnight guests staying at Hotel Tochal (elevation 3545 m), near Tehran, Iran, in the winter of 2006 constituted the study participants. A questionnaire, including demographic data, proposed risk factors and Lake Louise score, was completed by a physician for all who had headache or other symptoms of AMS. Data from daily hotel reception records were also collected.Results: Overall, 328 persons stayed at this hotel for at least one night during the study period. Among these, 47 persons (14.3%) were admitted to the clinic for headache. According to the physician's diagnoses, only 34 guests (10.4%; 95% CI: 7.1-13.7%) were affected by AMS. The concurrent symptoms of headache and vertigo or insomnia had the highest predictive value for AMS diagnosis. Ambiguous headache had a higher predictive value than other types of headache.Conclusions: Despite the height of Tochal peak and the frequent use of high speed telecabin, it seems that the frequency of AMS is lower than that found in other studies on similar altitudes. However, more research should be done in this regard.

Background: Mitral valve prolapse is a relatively common valvular abnormality in most communities and joint hypermobility (JHM) is also seen in many healthy people as well as in certain clinical disorders, such as Marfan syndrome. The present study was designed to investigate the association between joint hypermobility and mitral valve prolapse (MVP) in an Iranian population sample.Methods: Fifty-seven patients with nonrheumatic and isolated mitral anterior leaflet prolapse (24 men and 33 women, mean age 23.5 +/-2.3) and 51 healthy subjects (20 men and 31 women, mean age 22.9+/-2.3) were studied. The presence of JHM was evaluated according to the Carter-Wilkinson & Beighton criteria. Echocardiographic examination was performed in all subjects and the correlation between the echocardiographic features of the mitral valve and the hypermobility score were investigated.Results: The frequency of JHM in patients with MVP was found to be significantly higher than that of controls (26.3% vs. 7.8%), with mean JHM scores of 3.1+/-2.2 and 1.9+/-1.7, respectively. The patients in the MVP group had significantly increased the anterior mitral leaflet thickness (AMLT, 3.4+/-0.4 mm vs. 3.0+/-0.3 mm; p<0.0005) and maximal leaflet displacement (MLD, 2.4+/-0.3 mm vs. 1.5+/-0.2 mm; p<0.0005) compared to the controls. Conclusions: We detect a statistically significant relationship between isolated MVP and joint hypermobility as well as between the severity of JHM and echocardiographic features of the mitral leaflets. These results suggest a common etiology for MVP and JHM, which should be investigated in future well-conducted studies.

Background: The relationship between coping styles and psychological adaptation during the recovery process was investigated in a sample of coronary heart disease (CHD) patients.Methods: One hundred and fifty patients from Shahid Rajaee Heart Center, Tehran, Iran, were included in this study at intake and forty five patients (27 men, 18 women) participated in the follow-up study. All participants were asked to complete the Tehran Coping Styles Scale (TCSS) and Mental Health Inventory (MHI). The Recovery Process Questionnaire (RPQ) was completed using each patient’s medical file and clinical examinations by cardiologists. Styles of coping with stress were categorized as problem focused, positive emotional-focused and negative emotional-focused. Psychological adaptation included psychological well-being and psychological distress.Results: Objective recovery status showed no significant correlation with either coping styles or psychological adaptation. Perceived recovery revealed a significant positive association with negative emotional-focused coping (p<0.05), but no significant correlation with other coping and psychological adaptation variables. Perceived recovery revealed a significant negative association with psychological distress (p<0.05), but showed no significant correlation with psychological well-being.Conclusions: Perceived recovery in CHD patients is positively influenced by negative emotional-focused coping styles. Results and implications are discussed specifically in terms of the possible reasons for the positive relationship between perceived recovery and negative emotional-focused coping.

Background: Chlamydia Trachomatis is the most common cause of trachoma and subsequently give rise to neonatal chlamydial conjunctivitis (NCC), adult ophthalmic inclusion infection, sexually transmitted diseases (STD) and pneumonia. The goal of this study was to access the incidence of chlamydia trachomatis in the normal (ophthalmic infection free) population. Methods: In a cross sectional study 250 patients referring to Farabi Eye university Hospital Tehran, Iran for non infectious ophthalmic disease in different age categories were selected and accessed for chlamydial IgM and IgG by ELISA method. Results: 250 patients (50% men and 50% women) with the mean age of 40 (ranging from one to 83 years old) were tested. IgG was detected in 11 (five females and six males) patients (4.4%) All of them had more than 31 years old. IgM was detected in 18 (13 females and 5 males) patients (7.2%). No test revealed simultaneous high IgG and IgM titre in the same patient. Conclusions: There was a low grade of chlamydial infection in our study population. So it is recommended to use serological methods for screening of ophthalmic infections in centers where no other test methods are available and in case of positive results confirmatory antigen tests to be used.

Background: Hepatitis C is a major cause of chronic liver disease and hepatocellular carcinoma. Hepatitis C infection also has extrahepatic manifestations, including cryoglobulinemia and lichen planus. Lichen planus is a relatively common mucocutaneous disorder, and, due to its chronic pattern and increased incidence of malignancy, diagnosis and treatment of this disease are very important. The aim of the present study was to investigate the prevalence of oral lichen planus in HCV-infected patients.Methods: In this cross sectional– descriptive study, the prevalence of oral lichen planus was evaluated by means of observation, clinical examination, questionnaire and evaluation of the medical records of 150 patients referred to the hepatitis clinic, gastrointentrology and infectious disease wards of Imam Khomeini Hospital and the Iran Blood Transfusion Organization, Tehran, Iran. We used a sequential method for sampling. Data were analyzed using statistical software (SPSS ver. 11) and the chi-square test.Results: From a total 150 patients, 133 were male and 17 female. Six cases (4%) had oral lichen planus. All patients with oral lichen planus were male and the buccal mucosa was the most common site.Conclusions: According to this study, the prevalence of oral lichen planus in patients afflicted with HCV is higher than in the normal population. We should pay more attention to oral lichen planus as one of the extrahepatic manifestations of hepatitis C.

Background: Although metabolic syndrome (METs) is receiving attention from physicians, data on the syndrome’s association with coronary heart disease (CHD) in the Iranian population are limited. This study was designed to determine the association of different definitions of METs and its components with CHD.Methods: Logistic regression analysis was used to analyze data from 5981 subjects aged ³30 years. METs definitions by the International Diabetes Federation (IDF), the Adult Treatment Panel (ATP III) and the WHO for CHD were used in three models: model 1 an age adjusted model, model 2 adjusted for age, smoking status, premature history of CHD and LDL-cholesterol and model 3 adjusted for the mentioned variables plus the METs components.Results: METs as delineated by all three definitions was associated with CHD in models 1 and 2. In model 2, METs was most closely associated with CHD in men, as defined by the WHO [2.3 (1.8-3)] and in women by the ATP III definition [1.6 (1.3-2)]. In model 3, METs lost its association with CHD. However, in men high fasting plasma glucose and high blood pressure plus obesity (by the WHO definition) and in women high blood pressure plus high waist circumference (by the ATP III definition), obesity and glucose domain (by the WHO definition) remained associated with CHD.Conclusions: In Iranian men and women, all three definitions of METs were associated with CHD when considering the conventional risk factors. After further adjustments for the components of METs, none of these definitions showed an association with CHD and only high blood pressure correlated with CHD in both sexes for all definitions.

Background: As an important diagnostic and therapeutic procedure for patients with intrauterine diseases, hysteroscopy permits a good view of the uterine cavity, thereby increasing diagnostic accuracy. Complications often encountered during hysteroscopy primarily concern problems with cervical dilatation and include uterine perforation, cervical tears, and the creation of false tracts. In this study, we investigate the utility of vaginal misoprostol for cervical dilatation in women undergoing hysteroscopy. Methods: This triple-blind, randomized, placebo-controlled study was carried out at Mirza Khoochak Khan Hospital, Tehran, Iran. We excluded women who were pregnant, had genital tract infection, or history of cervical trauma. We randomly assigned 80 women with abnormal uterine bleeding or intrauterine lesions to receive either 200 mg vaginal misoprostol or placebo. Ten to twelve hours prior to hysteroscopy, the placebo or misoprostol was administered to the posterior vaginal fornix. Data regarding cervical response and outcome of operative hysteroscopy, as well as complications, were analyzed. Results: The mean cervical width, as estimated by Hegar dilator, was significantly greater in the treated group (7.8±1.6mm) than that in the control group (5.6±2.2mm, p<0.001). In the misoprostol group, 28 (70%) patients required cervical dilatation, compared with 38(95%) in the placebo group (p=0.001). A significantly shorter median time of cervical dilatation to Hegar number 9 was found in the treated subjects than in the controls (60 vs. 180 seconds, p<0.001). The mean operative time was significantly shorter in the treated group (8.8±8.7 minutes) compared with that of the control group (13.1±10.1 minutes, p=0.043). Conclusions: Vaginal misoprostol before operative hysteroscopy lessens the need for cervical dilatation, facilitating hysteroscopic surgery.

Background: Proper knee function is essential for daily activity. Since almost all complex tibial plateau fractures involve soft tissue compromise, there is some controversy as to the best treatment method. Currently, progress toward indirect reduction and external fixation, such as the hybrid external fixator, with minimal complications is underway. Herein we evaluate the outcomes of complex tibial plateau function repaired with hybrid external fixation at one of the most important trauma centers in Iran.Methods: This case-series study involved the postoperative follow up (>6 months) of 20 patients with complex tibial plateau fracture repaired using hybrid external fixator at Sina Hospital from 2002-2004. We evaluated surgery complications and outcomes including soft tissue and skin necrosis, knee range of motion, degenerative joint disease, infection, neurovascular injury, union time, and knee score at final visit, among others. Results: Of the original 20 cases enrolled in this study, five dropped out. All subjects were men, with a mean age 38.6 (18-74) years. The most common injury mechanism was motor vehicle accident; mean time from trauma to surgery was 4.7 (1-15) days. Mean follow up duration was 11.6 (6-26) months. At the end of the study, 80% had good knee range of motion (>90 flexion), with knee scores of 80 or more for 60% of the subjects. Although all patients had had soft tissue injury, there was no postoperative soft tissue compromise. Two patients (11%) had postoperative infection, but ultimately recovered. Less time between trauma and surgery, less periarticular soft tissue injury, less operative manipulation of soft tissues, better articular congruency, and more stable and anatomical knee alignment are associated with better outcome and prognosis. Conclusions: This procedure reduces operative complications, especially infection and soft tissue necrosis, and requires less rest, all of which results in a stable, aligned and functional knee joint. Furthermore, adding minimal open reduction and internal fixation (ORIF) may promote even better results.

Background: Insect stings can cause local or systemic reactions that range from mild to fatal, and are among the most common causes of anaphylaxis. The major allergens of honeybee venom are phospholipase A2, hyaluronidase, acid phosphatase, allergen C and melitin. Phospholipase and melitin induce hemolysis, rhabdomyolysis and liver damage due to cell membrane breakdown, damage of the vascular endothelium and activation of the inflammatory response. Rhabdomyolysis has been implicated as the cause of acute renal failure in approximately 5-7% of cases. However, bee stings are a rare cause of rhabdomyolysis, and are usually associated with 50 or more stings. It has been reported that more than 250 bee stings are capable of causing death in humans.Case report: We report two cases of massive honeybee stings (>2000) with rhabdomyolysis, hemolysis and acute renal failure who survived with full recovery, and two cases of >500 honeybee stings who survived without significant complications.