TEHRAN UNIVERSITY MEDICAL JOURNAL (TUMJ)
Year:2007 | Volume:65 | Issue:8|Papers Count:23

Background: The extracellular matrix is a complex three-dimensional network of proteins and glycosaminoglycans, which have important roles in cellular physiology and cell-cell and cell-extracellular matrix interactions. Any changes in the extracellular matrix of tumors may be implicated in cellular transformation and metastasis. The aim of the present study was to identify changes in the hyaluronic acid of the stroma of colonic carcinoma.Methods: Paraffin blocks of 30 patients with colon carcinoma (10 patients at each histological grade) were chosen from the pathology file of Khatam-Al-Anbia Hospital in Zahedan, Iran. Tissue sections (5-6 micrometers thick) were stained with hematoxylineosin and the alcian blue critical electrolyte concentration histochemical technique at pH=5.8. The intensity of the staining in each section was graded as 1, 2 or 3, referring to low, moderate or severe staining reactivities, respectively. Statistical data was analyzed with nonparametric tests by SPSS (ver. 10) and histopathological reports were prepared.Results: The results of this study showed that there is a good correlation between histopathological grading and staining intensity of tumoral stroma for hyaluronic acid (p<0.005). Analysis using the Mann Whitney test revealed significant differences between staining grades 1 and 3 and grades 2 and 3 (p<0.005 and p<0.002, respectively), although there was no significant difference between staining grades 1 and 2 for hyaluronic acid.Conclusions: The difference in staining intensity of the stroma in colon carcinoma is a result of different amounts of hyaluronic acid in stroma, indicating that increased levels of hyaluronic acid are associated with the invasion and metastasis of neoplastic cells.

Background: Anopheles superpictus is one of the main malaria vectors in Iran. The mosquitoes of this species are found throughout the Iranian plateau up to 2000 meters above sea level in the Alborz Mountains, south of the Zagros Mountains, and in the plains near the Caspian Sea and Persian Gulf. It has been reported that different geographical populations of An. superpictus play different roles in malaria transmission. Based on the presence or absence of a black spot/band on the apical segment of the female maxillary palpi, two morphological forms have been reported in this species. This work has been conducted to study other morphological features as well as the genetic structure of these two forms of An. superpictus in Iran. Methods: The different morphological characteristics of 35 different populations were observed and recorded. An 887 bp portion of the mitochondrial DNA (mtDNA) cytochrome oxidase subunit I (COI) was amplified and assayed by restriction fragment length polymorphism (RFLP) using 18 enzymes and PCR-direct sequencing techniques.Results: Among the morphological characteristics studied, there are significant differences between the two forms with regard to the length of the palp light band (p<0.01), wing length (p<0.5), and the distance from the branching point of the II/IV veins to the tip of the wing (p<0.05). Results also revealed that these two forms are sympatric in most localities of Iran. RFLP analysis and sequences of about 710 bp of the gene showed that there was great variation between and/or within the populations, but these variations were not associated with the morphological forms.Conclusion: This is the first comprehensive study on the morphological and molecular characteristics of An. superpictus in the literature. To determine the role of these morphological forms or genetic haplotypes in malaria transmission, further molecular, cytological, morphological, and epidemiological studies are necessary.

Background: Several randomized controlled trials have demonstrated the safety and efficacy of drug eluting stents (DES) in selected groups of patients with less complicated diabetes. We conducted this study to determine how an unselected group of diabetic patients in Iran fare following DES implantation.Methods: Data were collected on 147 consecutive diabetic patients who underwent percutaneous coronary intervention (PCI) with the implantation of at least one DES at the Tehran Heart Center from June 2003 to September 2005. Clinical follow-up was performed by timely scheduled visits at one, four and nine months following DES implantation. Nine months of follow-up was completed for 94.5% of the patients. The primary endpoint was the occurrence of major adverse cardiac events (MACE), which include cardiac death, myocardial infarction and target vessel revascularization (TVR). In-hospital complications were the secondary endpoint.Results: A total of 158 coronary artery lesions were treated with DES in 147 diabetic patients (mean age = 56.4±8.92 years, 57.1% were men). During the nine-month follow up, MACE occurred in 3.4% of patients, with a myocardial infarction rate of 1.4% and TVR rate of 1.4%. Considering one patient who underwent TVR due to acute stent thrombosis following angioplasty (during hospitalization) the total number of TVR reached 3 (2%). Only one patient (0.7%) died of cardiac death, which occurred after the procedure and before discharge. In-hospital complications occurred in six patients (4.1%); five patients suffered from myocardial infarction. Conclusions: PCI with DES seems to be safe and effective in diabetic patients. However, more studies with larger study populations and longer follow-up are required to confirm this issue.

Background: Congenital scoliosis is a developmental disorder defined as a lateral curvature of the spine. Its progressive trend and complications, such as cosmetic problems, pain and pulmonary symptoms, have put scoliosis as an important skeletal deformity that should be corrected. One of the currently accepted methods of treatment is posterior spinal fusion (PSF) that may be performed with or without instrumentation. However, the use of implants in conjunction with PSF in congenital spine deformity has been debated over the past three decades primarily because of increased risk of neurological deficit and implant displacement. The aim of this study was to compare short-term and long-term outcomes of spinal fusion with and without posterior instrumentation in congenital scoliosis.Methods: In this historical cohort study, 41 patients with congenital scoliosis were recruited. All patients underwent PSF surgery between 1977 and 1996. They were divided into two groups according to the use of instrumentation: 22 congenital scoliotic patients who were treated by PSF without any instrumentation (group A), and 19 instrumented PSF patients (group B). Instrumentation was mostly performed using the Harrington rod. The major curve angle was measured before surgery, two weeks and one year after PSF surgery and at the end of the follow-up period.Results: The mean baseline curve angles were 66.3o and 69.1o in groups A and B, respectively. The mean Cobb angles one year after PSF were 43.1o and 38.4o in groups A and B, respectively. The mean follow-up period was 8 years (SD=3) and, at the end of this period, the final Cobb angles were 47.3o and 39.4o in groups A and B, respectively. Therefore, the final angle correction was 28.7% in patients without instrumentation and 43% in patients with instrumentation. The mean loss of correction was 5.5% and 4.3% in groups A and B, respectively. The final curve angles was significantly more corrected for those patients in whom instrumentation was used than those without instrumentation (p<0.05).Conclusion: The treatment of congenital scoliosis can be very challenging despite the benefits of modern surgeries and instrumentation methods. The results of our study demonstrate that the application of an implant with PSF surgery may lead to increased improvement of the scoliotic curvature in the short-term and long-term periods, as well as a decrease in the loss of correction and the rate of reoperation. In addition, the low incidence of complications in our study indicates the safety of the posterior instrumentation for the treatment of congenital scoliosis.

Background: In rhinoplasty, periorbital edema and ecchymosis is due to soft tissue trauma and small vessel injury with subsequent exudation and bleeding. The main purpose of this study is to determine the effect of dexamethasone in reducing periorbital edema and ecchymosis and intraoperative bleeding in rhinoplasty patients.Methods: This double-blind study included 90 patients who underwent rhinoplasty from October 2004 to March 2005. In group A, 8 mg of intravenous dexamethasone was administered only preoperatively. In group B, 8 mg of dexamethasone was administered preoperatively and continued every 8 hours postoperatively. Group C, the control group, received no dexamethasone.Results: The degree of upper lid edema in groups A and B was significantly less than that of group C. During the first and second day the severity of upper lid edema in group B was less than that of group A, but the difference was not significant. The degree of lower lid edema during the first and second days in groups A and B was significantly less than that of group C, although it was identical in all groups during the fifth and seventh days. The degree of upper lid ecchymosis during the first and fifth days in group C was significantly more than that of groups A and B, but it was similar on the seventh day in all groups. The degree of lower lid ecchymosis on the first day in groups A and B was significantly less than that of group C; however, it was similar in all groups during the second, fifth and seventh days. The volume of intraoperative bleeding in the three groups was similar. The mean period of recovery (12 days) was comparable in all groups.Conclusions: Dexamethasone administration leads to the reduction of upper lid edema, ecchymosis and lower lid edema during the first and second postoperative days, and reduction of lower lid ecchymosis on the first postoperative day.

Background: The use of serial quantitative beta-human chorionic gonadotropin (β–HCG) with transvaginal ultrasound to enhance early diagnosis of ectopic pregnancy (EP) improves options for conservative treatment with methotrexate (MTX). The aim of this study was to evaluate the outcome of unruptured EP treated with a single dose of intramuscular MTX injection.Methods: This clinical trial included 41 EP patients with specific inclusion criteria for medical treatment. For each patient, MTX (50 mg/ml) was administered intramuscularly and a repeat dose was given if the weekly decrease in the level of β–HCG was less than 15%. The therapy was considered successful if the level of β–HCG fell below 10 mIU/cc without surgical intervention.Results: Overall, 78% of the patients were successfully treated, among whom 18.7% received second doses of MTX. Of the patients who were successfully treated, 60% presented with vaginal bleeding without pelvic pain; however, of those patients in whom the treatment failed, 88% presented with pelvic pain together with vaginal bleeding. Furthermore, the presence of free peritoneal fluid on vaginal ultrasound was a significant predictor of treatment failure (p<0.005). There was no relation between the women’s age, gravidity or parity, the size of the conceptus, gestational age, pretreatment serum β–HCG titer, endometrial thickness on vaginal ultrasound and the efficacy of treatment.Conclusions: With a reasonably high success rate, we found systemic single-dose MTX treatment to be a safe, conservative therapy for EP. However, when free peritoneal fluid is noted upon transvaginal ultrasound or when the patient presents with pain, the threshold for surgical intervention may be lower.

Background: Depressive disorders in children and adolescents are chronic and highly morbid. Few studies are carried out on antidepressant drugs for depressed youths, especially specific noradrenergic agents. Reboxetine is a selective norepinephrine reuptake inhibitor. This study was designed to evaluate the effect of reboxetine in childhood and adolescent depression.Methods: Twenty patients of both genders, aged 7-17 years old, with major depressive or dysthymic disorders, as classified by the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), participated in an 8-week clinical trial before-after study of reboxetine. Clinical semistructured interviews, based on the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Aged Children (K-SADS), were carried out. Reboxtine was initiated at a dose of 1 mg/day and increased up to 6 mg/day. Patients were assessed for changes in: depressive symptoms using the Children’s Depression Inventory (CDI) and global functioning by the Children’s Global Assessment Scale (C-GAS). Side effect questionnaire was also administered.Results: There was a significant decrease in the ineffectiveness subscale (C factor) of CDI (p=0.006). Although the CDI scores decreased by 32.69%, this change was not significant (p=0.39). No significant change in C-GAS (p=0.2) was observed. Adverse effects were relatively mild to moderate and transient. The most common adverse effects were decreased appetite and sedation.Conclusions: Reboxetine is relatively well tolerated and improves feelings of ineffectiveness among depressed children and adolescents; however it does not improve all depressive symptoms. Double-blind, placebo and active comparator controlled studies and larger sample sizes are indicated.

Background: Hyperhomocysteinemia is an independent risk factor for cardiovascular diseases. The frequency of hyperhomocysteinemia is higher in hemodialysis (HD) patients than the general population. The objective of this study is to assess the efficacy of high-dose folic acid supplementation with and without vitamin B12 on lowering plasma total homocysteine (tHcy) concentrations in HD patients.Methods: Thirty-six HD patients at Imam Hossein Hospital, Tehran, Iran, who had been given folic acid supplements (5 mg/d) for at least 3 months before, were enrolled in this clinical trial. Subjects were also checked for other inclusion and exclusion criteria. The subjects were divided randomly into four groups and underwent two months of supplementation as follows: 5 mg/d oral folic acid + placebo in group one, 5 mg/d oral folic acid + vitamin B12 (1 mg/d orally) in group two, 15 mg/d oral folic acid + placebo in group three and 15 mg/d oral folic acid + vitamin B12 (1 mg/d orally) in group four. Concentrations of plasma tHcy and serum folic acid and vitamin B12 were measured at baseline and after the supplementation period. Dietary intake of patients was also determined during the supplementation period.Results: Of the folic acid supplemented patients, 27.8% had normal levels of tHcy at baseline and 72.2% had hyperhomocysteinemia. After the supplementation period, plasma tHcy increased by 1.35% in group one and decreased by 6.99%, 14.54% and 30.09% in groups two, three and four respectively. Changes in plasma tHcy and serum vitamin B12 were only significant in group four; however, no significant changes were seen for serum folic acid. The percentage of subjects reaching normal levels of plasma tHcy was 5.6 fold higher in group four than in the reference group.Conclusions: Supplementation with 15 mg/d folic acid together with 1 mg/d oral vitamin B12 is more effective in reducing tHcy levels in HD patients.

Background: Considering the psycho-social model of diseases, the aim of this study was to evaluate the effect of psychiatric intervention on the pregnancy rate of infertile couples.Methods: In a randomized clinical trial, 638 infertile patients referred to a university infertility clinic were evaluated. Among them, 140 couples with different levels of depression in at least one of the spouses were included in this substudy. These couples were divided randomly into two groups. The patients in the case group received 6-8 sessions of psychotherapy before starting infertility treatment and were given fluoxetine 20-60 mg per day during the same period. The control group did not receive any intervention. Three questionnaires including the Beck Depression Inventory (BDI), Holmes-Rahe stress scale and a socio-demographic questionnaire were applied for all patients. The clinical pregnancy rates of the two groups, based on sonographic detection of the gestational sac six weeks after LMP, were compared. The data were analyzed by paired-T test, T-test,  c2 and the logistic regression method.Results: The pregnancy rate was 47.1% in the case group and 7.1% in the control group. The pregnancy rate was significantly related to the duration and cause of infertility and the level of stress in both groups (p< 0.001). The pregnancy rate was shown to be higher in couples in which the male has a secondary level of education (p< 0.001).Conclusions: Psychiatric interventions greatly improve pregnancy rates, and it is therefore crucial to mandate psychiatric counseling in all fertility centers in order to diagnose and treat infertile patients with psychiatric disorders and help couples deal with stress.

Background: Bacillus cereus spores distribute widely in nature and can be isolated from different kinds of foods. This bacterium can produce diarrhea and emetic enterotoxins and syndromes. As infants are known to be more susceptible to B. cereus infection due to their incomplete intestinal flora and fast growth of this bacterium during consumption, it is very important to investigate the presence of B. cereus in infant formula and possible pathogenicity of this microorganism in infants.Methods: In this study, 60 samples of infant formula were examined for the presence of B. cereus. From a 1/10 dilution of each sample, a total amount of 1 ml was inoculated onto four phenol red agar plates containing mannitol, egg yolk emulsion and polymyxin B sulfate. The plates were incubated at 30oC for 24 hours. Confirmation tests were then performed on suspected colonies.Results: Among the 60 samples, 11 samples had more than 10 cfu/g, four of which contained more than 102 cfu/g. The other 49 samples showed less than 10 cfu/g of B. cereus.Conclusions: We suggest that for infant formula the maximum microbial limit be reduced to less than 10 cfu/g to control B. cereus contamination and to prevent infection in infants. For this purpose, infant formula should be tested by the method and confirmation tests used in this study. In addition, susceptibility to penicillin, b-hemolysis and growth rate at 45oC could also be performed.

Background: Hepatitis type C virus (HCV) is one of the important threatened infectious blood born viruses in different populations. More than 300 million people were suffered form different HCV clinical complications all around the world. It is estimated that only 20% of HCV infected individuals will recover from this viral infection, while the rest become chronically infected. The majority of chronically infected individuals never exhibit symptoms, but approximately 10-/30% of these patients will eventually develop severe liver complications. In this research the prevalence of HCV Ab and the role of some demographic data in HCV incidence and clinical outcomes were determined.Methods: In this retrospective study 11472 blood samples from, Iranian blood donors, Shahrekord city were collected for one year. The frequency of HCV Ab was analyzed with a third generation EIA method. The statistical relationships of different possible risk factors of HCV infection were analyzed by Instat software.Results: The HCV Ab was diagnosed in 69 of 11472 (0.6%) serum samples. Significant correlations were detected between the history of HCV infection with marriage, tattooing, and doubtful sexual contact. Significant relationships were not defined between HCV infection with age, history of liver disease, and record of travel to abroad.Conclusions: Significant relationships were find between HCV infection with marital status, history of tattooing and sexual contact, but significant correlations were not find between HCV infections with sex, history of liver disease and traveling to other countries.

Background: Lead poisoning has proven to be one of the most important environmental health problems among developing countries with both direct and indirect effects on human life. Lead is known to cross the blood-brain barrier and placenta, and accumulates in soft and hard tissues. Lead can be excreted in urine, stool, milk, sweat, nails and saliva. During pregnancy and lactation, lead is released from bones into the blood along with Ca2+. The toxic effects of lead on various human tissues have been studied extensively, but few studies have addressed its impact on fetal development during pregnancy. Blood levels of lead are higher in people living in lead-polluted regions. It has been reported that Tehran (central and southern parts) is the most problematic city in terms of lead poisoning.Methods: From 86 sets of mothers and newborns in a non-polluted area of rural Rasht, Iran, we examined specimens of maternal blood, cord blood and colostrum (86×3=258) and specimens from 85 sets of mothers and newborns in a polluted area of Tehran, Iran (85×3=255) for lead levels using atomic absorption spectrophotometry (AAS) and analyzed the results by t-test, SPSS, and linear regression.Results: The mean blood lead concentrations of mothers, cord blood of newborns and colostrum were 7.6±4.1, 5.9±3 and 4.2±2.5 mg/dl, respectively, in the non-polluted area and 9.1±8.4, 6.5±5.2 and 5.8±5.5 mg/dl, respectively, in the polluted area. The mean weights of the newborns in non-polluted and polluted areas were 3.2±0.5 kg and 3.2±4.5 kg, respectively.Conclusions: Our data revealed an association between mean concentrations in blood lead of mothers and newborns and between mean concentrations of colostrum lead and newborn blood lead in both areas (p=0.01). There was no association between mean blood lead concentration of mothers with the weight of their newborns (p=0.89).

Background: As future health care providers, medical students should be aware of the relationship between health and physical fitness, giving them an advantage toward attaining proper physical fitness. The exercise and fitness habits of first-year medical students in Iran are not known. This study examines the relationship between the body mass index (BMI) of an unselected group of first-year medical students and their personal physical fitness.Methods: In this cross-sectional study, 513 first-year medical students were evaluated. BMI, skin folds (triceps, biceps, suprailiac and subscapular) and physical fitness were assessed in all students. Fitness was evaluated by the Eurofit test, which included body composition, cardiovascular endurance, flexibility, muscular endurance, muscular strength, power, balance and agility. The software SPSS (version 11) and Pearson’s correlation were used for statistical analysis.Results: The group surveyed was 67.8% female and 32.2% male, and 97.2% were entering medical school in 2004. The mean weight of the students was 60.1 kg, mean height was 163.9 cm and the mean BMI was 22.3 kg/m2. Underweight status (BMI<20) was observed in 27.1% of the subjects, 16.1% were overweight (25<BMI≤30) and 3.7% were obese (BMI>30). Overweight and obesity in males was higher than in females. The total physical fitness score in female students was better than that of male students. We found a negative correlation between physical fitness and weight, BMI, body fat and wrist to hip ratio in both genders. In addition, a positive correlation exits between hip circumference and physical fitness in both groups.Conclusions: This study suggests that academically competitive premedical students may not be involved in physical activity. Medical students should be encouraged to maintain a good BMI and perform physical exercise.

Background: Plant-origin foods are among the most important sources of food allergic reactions. An increase in the incidence of sesame seed allergy among children and adults has been reported in recent years. The aim of this preliminary study was to investigate the prevalence, importance and clinical manifestations of sesame allergy among Iranian patients.Methods: In a cross-sectional survey, 250 patients with suspected IgE-mediated food allergies completed a questionnaire and underwent skin prick tests with sesame extract as well as cross-reacting foods (walnut, soya and peanut). Total IgE and sesame-specific IgE levels were measured. Patients with positive skin test reactions and/or IgE specific for sesame without clinical symptoms were considered sensitive to sesame. The patients who also had clinical symptoms with sesame consumption were diagnosed as allergic to sesame.Results: Of the 250 patients enrolled in this study, 129 were male and 121 female, with a mean age of 11.7 years. The most common food allergens were cow’s milk, egg, curry, tomato and sesame. Sesame sensitivity was found in 35 patients (14.1%). Only five patients (2%) had sesame allergy. Sesame-sensitive patients had a significantly higher frequency of positive prick test to cross-reacting foods when compared to non-sensitized patients (p=0.00). The type of symptom was independent of gender and age of the patients, but urticaria and dermatitis-eczema were significantly more frequent in sensitized patients (p=0.008).Conclusions: This is the first study addressing the prevalence of sesame seed allergy in Iranian population. We found sesame to be a common and important cause of food allergy. The panel of foods recommended for use in diagnostic allergy tests should be adjusted.

Background: Immediate treatment when an esophageal foreign body is suspected is critical because of the possibility of serious complications. The presence of foreign bodies in the esophagus usually occurs accidentally in children and mentally retarded adults. A greater risk of perforation of the esophagus, development of a mediastinal, as well as airway compromise is present when a foreign body is lodged longer than 24 hours. Furthermore, this condition results in complications, such as hemorrhage or esophageal fistula, when treatment is delayed. We herein report a case of esophageothyroidal artery fistula, a rare complication resulting from the delayed removal of an esophageal foreign body. Patient presentation: A 34 year-old female who had swallowed her dental prosthesis one week previously was referred for severe gastrointestinal bleeding. Surgery to remove the foreign body was performed. To determine the cause of continued bleeding after the endoscopy and angiography, we performed a neck exploration, which revealed hemorrhage from a fistula between thyroid vessels and the esophagus. After surgical resection of the fistula, the patient was discharged from the hospital in good condition and has had no related problems for six months.Conclusions: Considering the complications resulting from the delay of the removal of foreign bodies from the esophagus, these objects should be removed as soon as possible.