TEHRAN UNIVERSITY MEDICAL JOURNAL (TUMJ)
Year:2008 | Volume:65 | Issue:11|Papers Count:18

Background: Fasciolosis is a worldwide disease with major economic and public health consequences. Early detection of the infection is important for the prevention and control of the disease. ELISA allows for early detection of fasciolosis in man and animals. Fasciolosis is caused by Fasciola hepatica and F. gigantica in man and domestic animals respectively. These two species have many similar morphological characteristics. In this study, the crude antigens of these two species are investigated by ELISA test. Methods: The excretory-secretory and somatic antigens of two species were prepared from adult flukes collected from the bile ducts of sheep and stored at -20oc. For the preparation of the antisera, the antigens were injected to laboratory-bred rabbits. Each rabbit received five injections at intervals of seven days, starting with 0.5 ml and ending with 2.5 ml. Ten days after the last injection, the rabbits were bled, and serum samples separated and stored at -20oc. The reaction between homologous and heterologous antigens and antisera was tested by ELISA and optical densities were recorded. Results: Excretory- secretory and somatic antigens of each species showed a strong positive reaction with the antisera of the other species. In a homologous combination of antigens and antisera, a stronger reaction was observed compared to the heterologous combination, therefore many antigenic materials of both species are the same.Conclusion: The differences of these crude antigenic materials of F. hepatica and F. gigantica are insufficient to prevent cross reaction of two species by ELISA. Further investigations are recommended for the identification, detection and purification of antigenic material of each species to improve the specificity of this assay.

Background: Tuberculosis is still one of the most important causes of mortality and morbidity in many countries and is the second only to human immunodeficiency virus as a cause of death worldwide resulting from a single infectious agent. In 1993, the World Health Organization declared tuberculosis a global public health emergency. Conventional methods for the diagnosis of Mycobacterium tuberculosis (MTB) infections are time consuming, as MTB culture requires 3-8 weeks for growth. To determine the sensitivity of polymerase chain reaction (PCR) in peripheral blood mononuclear cells (PBMC), we have evaluated Mycobacterium tuberculosis DNA in peripheral blood samples with PCR technique in adults with new cases of pulmonary and extra-pulmonary tuberculosis. Setting: Department of Infectious disease of Imam Khomeini Hospital, 2004- 2005, Tehran, Iran. Methods: In this cross-sectional study, we evaluated MTB DNA extracted from 3ml citrated peripheral blood samples from 95 adults with new cases of pulmonary and extra pulmonary tuberculosis. DNA extraction was performed using a commercial PCR kit with IS1081 primers. For prevention of cross contamination and reduction of false positives, all steps were performed under laminar hood. Results: The 95 patients, 59 of whom were male, had a mean age 44.44 years (SD±20.26); 69 cases had pulmonary and 26 had extra-pulmonary tuberculosis. PCR was positive in 32 (33.7%) patients and negative in 63 (66.3%) cases. The overall sensitivity and accuracy of the PCR assay was 44.1% for pulmonary, 19.2% for extra-pulmonary and 10% for disseminated tuberculosis, respectively.Conclusion: The low sensitivity of the IS1081 primer MTB-PCR assay on PBMC may pose problems for the rapid diagnosis of tuberculosis. However, further studies are needed to confirm this technique as an alternative test for the diagnosis of tuberculosis.

Background: Rheumatoid factor (RF) is an IgM antibody against the Fe portion of IgG, which together form an immune complex. RF is an important criterion in the diagnosis of early-stage rheumatoid arthritis (RA) and prognosis of RA pathogenesis, as higher levels of RF indicate a higher possibility of more damage. Although 2/3 to 3/4 of patients that undergo ordinary standard tests and have final clinical diagnosis are also positive for RF, a 70-90% prevalence of RF among RA patients can be achieved, depending on the method of detection and the target antibody, IgG or IgM. In this study, we measured the frequency of IgG and IgM RF isotypes using the ELISA and latex agglutination methods and compare these results with those of a hospital control group, tested using standard methods, in order to determine the best method for the measurement of RF. Methods: Of the patients referred to the Rheumatology Clinic of Imam Khomeini Hospital during 2005-2006, one hundred randomly selected rheumatoid arthritis patients, 75 females and 25 males, with classical or definite rheumatoid arthritis (defined by the criteria of the American College of Rheumatology), with a short disease duration of 12-24 months, underwent testing for RF using the latex method for IgM and ELISA for IgM-IgG. The healthy control group (75 females and 25 males) were tested for RF using the ELISA method for IgM-IgG. The variables were compared using the Pearson's chi-square test. Results: We found that the measurement of RF among RA patients using did not differ significantly between the two methods. The immune complex in RA is mainly IgM. The positive IgM results in RF patients using two similar methods showed a significant relationship by Pearson's correlation co-efficient (r=0.60, p<0.001). In addition, comparison of the IgM and IgG RF by ELISA showed a weak correlation with low significance (r=0.10, p<0.001). In sum, this study showed a significant difference (r=0.24, p<0.001) between the IgM in RA patients and that in healthy people, who had no IgM or IgG RF.Conclusion: Approximately 75% of confirmed RA cases had the IgM RF; however, we found little advantage in 'using the one method over the other, nor was the measurement of IgG more useful than IgM as diagnostic criteria.

Background: Oocyte donation and assisted reproductive technology (ART) give women with ovarian failure, advanced reproductive age, inheritable disorders or recurrent implantation failure, the ability to conceive. The success of oocyte donation is reportedly influenced by multiple parameters of the oocyte donor and recipient. The objective of this study was to evaluate the donor and recipient variables affecting the outcome of oocyte donation. Methods: In this retrospective study, we analyzed 51oocyte donation cycles of 45 women in an in vitro fertilization clinic. Data collected included age, body mass index, endometrial thickness, cycling and gravidity of recipients and the age of donors. Results: The clinical pregnancy rate was 40%per recipient and 35%per cycle resulting in 9 singleton, 7 twin and 2 triplet gestations. Embryo implantation rate was 27%. Oocyte fertilization rates among patients who had become impregnated and those who had not were 75% and 79%, respectively of 18pregnancies, 15culminated in a live birth (33% live birth rate). There was no significant relationship between incidence of pregnancy and mean age, BMI, gravidity, cyclicity of recipients and age of donors. There was a significant difference between the endometrial thickness of patients who became pregnant and those who did not (p=0.048). The number of transferred embryos was positively associated with pregnancy (p=0.006).Conclusion: The factor that most reliably predicts the outcome of oocyte donation cycles is oocyte recipient endometrial thickness. Donor age from 20-34years dose not affect clinical pregnancy rates. Donors in their early 30's are considered to be the best candidates for oocyte donation.

Background: Approximately 5-10%of epileptic patients do not respond to antiepileptic drugs. Adenosine has an inhibitory effect on the nervous system and its metabolism is prevented as a side effect of allopurinol, a xanthine oxidase inhibitor. The current study evaluates the efficacy of allopurinol in intractable epilepsy. Methods: In this double-blind case-control clinical trial, of the 38 epileptics with intractable seizures, 18 received 300 mg allopurinol daily and 20 received a placebo as adjuvant treatment to their previous antiepileptic drugs. The patients were first examined two weeks after initiation of the treatment and then monthly for a total of six months, during which they were evaluated for seizure control and possible side effects.Result: Of the 38 participants, 32 patients completed the study. There were significant differences between the two groups in terms of reduction in the total number of seizures over the entire six-month trial. A seizure reduction of 30% observed in 66% of the patients, 50%in 55%, and 60%in 44% of the cases in the allopurinol group was achieved after two months and persisted throughout the study. Furthermore, a significant difference in seizure duration was found between the two groups in month four of the trial. In the allopurinol group, two patients had transient rashes, two patients had mild nausea, and two experienced dizziness; however, only one patient discontinued the drug due to dizziness. In the placebo group, one patient had rash and one had nausea. In addition, no significant hematological or hepatic changes were found during the trial in either group.Conclusions: The results suggest that allopurinol is a safe and effective adjuvant agent in refractory epilepsy. Based on this study, we suggest that purine metabolic pathways and the specific use of allopurinol should be further investigated for the treatment of refractory epilepsy.

Background: Post-menopausal hemorrhage is one of the most common complains in gynecologic clinics. More than 60%of these cases have abnormal findings in diagnostic work ups. There is contraversy about the best diagnostic method for evaluating postmenopausal hemorrhage. The aim of this study was to evaluate the results of Trans-Vaginal Ultrasonography and compare its result to ones derived from direct endometrial biopsy and Hysteroscopy findings.Methods: In a cross-sectional study, menopausal women who attended the outpatient clinic of Arash Hospital, Tehran University of medical Sciences, from April 2005 to March 2006 with the complain of hemorrhage were evaluated. In all of these patients, after getting informed consent, Trans-Vaginal Ultrasonography, Dilatation and Curettage and Hysteroscopy were performed.Results: The total number of 90 women was recruited to the study with the age range of 41-80years. The mean age of participants was 53.84±6 years and 4.3±5.1 years had passed from their menopause. The mean thickness of endometrium, measured by Trans .Vaginal ultrasonography was 6.25±3.7 millimeter. In the biopsy derived specimens, the most finding pathological presentation was atrophy (48.9%) and the Proliferative endometrium had the second prevalence (36.7%). Atrophy (44.4%) and Proliferative endometrium (33.3%) were the most prevalent finding in Hysteroscopy. There was a significant difference in endometrial thickness between groups of different pathological findings. A significant difference in endometrial thickness was also seen between groups with different Hysteroscopic finding. By grouping the data according to endometrial thickness, it became evident that endometrial thickness can predict the outcome of endometrial biopsy and Hysteroscopic finding efficiently. We used ROC curves to find the best grouping threshold for endometrial thickness to achieve the best sensitivity and specificity.Conclusion: Measuring the endometrial thickness by Trans-Vaginal Ultrasonography is an appropriate non-invasive test for screening post-menopausal hemorrhage.

Background: It is well known that, at the time of the initial presentation of patients with non-small cell lung cancer, N-status is very important in accurate staging and avoiding inappropriate surgical procedures. Also, if mediastinal lymph node metastasis (N2) of non-small cell lung cancer (stage IIIA) is present, neoadjuvant (preoperative) chemoradiotherapy is indicated; therefore a quick and accurate N-status determination is critical before thoracotomy. We compared the usefulness and accuracy of touch imprint and frozen section analysis for this purpose. Methods: During 2006, fifty eight mediastinal lymph node specimens from 27 patients with lung cancer were excised. After touch imprint preparation, half of each lymph node was sent for frozen section and finally permanent histology. Results: Frozen section and touch imprint had only one and two false negative results, respectively, but neither had false positive reports. The sensitivity, specificity and accuracy of the frozen section evaluation was 95.5%,100%and 98.2%,respectively, and those of touch imprint were, 90.9%,100%and 96.4%.The differences in the sensitivity, specificity and accuracy between the two methods were not significant (p>0.05). Conclusion: Frozen section and touch imprint have similarly high accuracies for detecting mediastinal lymph node metastasis in lung cancer. However, since the touch imprint method is more rapid and simple, it maybe method of choice.

Background: Hyperhydrosis, excessive sweating, can profoundly affect the quality of life of the patient, with severe impairment of daily activities, social relationships and occupational activities. The purpose of this study was to evaluate the outcome of thoracoscopic sympathectomy in patients with palmar hyperhydrosis. Methods: In a clinical trial at Imam Khomeini, Milad and Velenjak Hospitals from 2003 to 2006, 33 patients older than five years of age with palmar hyperhydrosis underwent thoracoscopic sympathectomy of T2 and T3 ganglions. The variables regarding operation duration, length of hospital stay and early post-op complications were recorded. In addition, the quality of life of the patients was evaluated using the DLQI questionnaire, while the satisfaction of the patients was evaluated using the visual analogue scale before, immediately after and six months after the operation. Results: The mean age of the patients was 23 years and 63.6% of our patients were female. The sites of hyperhydrosis wereh and, foot and armpit in 72.7%of the patients. In 90.91% of the cases, disease onset occurred during childhood and 78.79%of the patients had a family history of hyperhydrosis. Hyperhydrosis impaired function and had social, interpersonal and emotional effects in 72.7% of the cases. The mean duration of the operation was 40.3 minutes and the mean hospital stay was 1.45days. The most common early post-op complications were atelectasis (7.57%),short-term pulmonary complications (3.03%)and pleural effusion (3.03%).Compensatory hyperhydrosis occurred in 60%of the cases, while 18.75%experienced gustatory sweating. Palms were reported to be totally dry immediately after and six months after the operation in 81.82%of the cases, while 18.18% reported acceptable levels of perspiration. The mean level of satisfaction immediately after and six months after the procedure was 0.81. All patients felt improvement in all aspects of their lives immediately after and six months after the operation. In terms of quality of life, the mean of DLQI score was significantly lower immediately after and six months after operation (18.78±501 vs. 1.60±0.81 and 1.64±1), indicating that symptoms had less effect on the patients' lives. All patients were willing to re-experience the operation if necessary. Conclusion: Thoracoscopic sympathectomy is an effective and safe therapeutic modality for palmar hyperhydrosis with a great rate of success and a slight chance of complications. This operation results in a remarkable improvement in various aspects of the patients' lives. Willingness to re-experience the operation indicates the high degree of satisfaction.

Background: Remifentanil is known to produce side-effects of hypotension and bradycardia. In this study, we examine the effect of low-dose ketamine infusion on the heart rate and blood pressure of patients anesthetized with remifentanil. Methods: In a randomized clinical trial, 54 patients aged 20-50 years old, with ASA physical status I, were studied in two groups (n=27), Ketamine- Remifentanil (K-R group) and Placebo- Remifentanil (P-R group). Exclusion criteria were ASA physical status >1, gastroesophageal reflux, tachycardia, bradycardia, systemic diseases, use of antihypertensive drugs, difficult intubations, risk of aspiration and contraindications of ketamine. Remifentanil was started at a rate of 0.5 mg.kg-1. min-1 and anesthesia was induced with thiopental sodium 2 mg.kg-1.Maintenance of anesthesia included halothane and nitrous oxide/oxygen mixture. Remifentanil infusion was continued in both groups at a rate of 0.5 /lg.kg-1.min-l.In the K-Rgroup, ketamine was started with an infusion rate of 10 mg.kg-1. min-1, 10 minutes after intubation, while in the P-R group, normal saline was started with the same dose of remifentanil. Heart rate, systolic, diastolic and mean arterial blood pressure were measured and compared at 1, 3, 5, 10, 15, 20, 25 and 30 minutes. Results: No significant differences were found between basic patient characteristics of mean of age, sex, weight, systolic, diastolic and mean arterial blood pressure and heart rate (p>0.2)in the two groups. However, the rate of systolic, diastolic and mean arterial blood pressure changes in the P-R group was significantly greater than that of the K-R group (p<0.006). Heart rate changes were similar between the two groups (p=0.6). Incident of severe hypotension (a decrease of more than 25%of the basic value) was less in the K-R group than that of the P-R group (11%vs. 89%; p=0.000). Conclusion: Low-dose ketamine infusion modulates the effect of remifentanil-induced hypotension and provides better hemodynamic stability during general anesthesia.

Background: To eradicate a problem such as drug abuse, we need thorough knowledge of the problem and its epidemiological aspects. In response to increasing ecstasy abuse among youth, as noted by the increase in related health issues at emergency clinics, we performed this epidemiologic study on ecstasy use in Tehran. Methods: In this cross-sectional study, including 1,903 youth aged 15-25 years, at different coffee shops in Tehran, Iran, subjects filled out questionnaires to evaluate the prevalence of ecstasy use with regard to gender, age, family income, level of education, psychological state (Beck test), acute complications of ecstasy use, as well as manner and place of ecstasy use and reason for repeated ecstasy use. Information was gathered from September 2004 to January 2005, using simple nonprobable sampling. Results: The prevalence of ecstasy abuse among our study population was 18.5%, which meaningfully correlated with gender (male), education level (undergraduate degree), family income (high), drug abuse and Beck test score (high). The mean age of ecstasy abusers was 21.3 years (SD: 2.65), which wasn't statistically different than the study population as a whole and the portion that did not use ecstasy. Tablet was the most common form of ecstasy usage (97.1%). In this study population, 91.4% had heard of the ecstasy name, and 83.7% were familiar with its use. The most common site of usage was in parties (85.7%) and in group forms (84%). Of all the users, 30%stated the reason for repeat ecstasy use was their friends' insistence, 38.8%expressed emotional need, 37.7% had no reason, whereas 6.6% felt a physical need and 1.7% repeatedly used ecstasy to prevent withdrawal symptoms.Conclusion: Some studies have reported that drug abusing friends are the basic cause of drug abuse. In this study, the ecstasy users admitted that the influence of friends and emotional need were the causes of their repeat use. Remarkably, these subjects report withdrawal symptoms with ecstasy use. Most importantly, families have to consider the relationships and emotional needs of their children. The statistical difference between Beck test scores between ecstasy users and the non-users placed them in two clinically different psychological groups. The ecstasy users were in groups that definitely needed psychological consultation and non-users were in the slightly depressed group. These psychological aspect of drug abuse expressed here is an alarm.

Background: Carcinoma of the uterine cervix is the sixth most common malignant neoplasm in women. Early stage diagnosis of uterine cervix carcinoma increases the cure rate of disease. Radiotherapy, with or without concurrent chemotherapy, is one of the most effective treatment modality in cervical carcinoma. After radiotherapy, accurate and regular follow-up results in early diagnosis and effective treatment of recurrence. The aim of this study is the assessment of the pathologic characteristics, setting and indications for postoperative radiotherapy and outcome of patients at the last follow-up. Methods: In this retrospective study, we evaluated 346 cases of cervical carcinoma had received radiotherapy in radiation oncology department of the Cancer Institute of Imam Khomeini Hospital, Tehran, Iran, from 1995 to 2001. Results: The age of the study group ranged from 26 to 78 years (mean=50.5, SD=11).Of these patients, 30.4% were in the early stage and 69.6% had advanced stage disease. Squamous cell carcinoma comprised 92.2% of the cases and 6.4% adenocarcinoma. Radical radiotherapy was the most frequent radiotherapy setting and adjuvant radiotherapy (post-op) was the second. A considerable number of patients did not come back for follow-up, and 43.7% were followed for a short time.Conclusion: Accurate presurgical clinical staging and surgical treatment by an expert gynecologic oncologist can reduce expose the patients to risks of two modality treatments (surgery and radiotherapy). According to our results, patients do not pay enough attention to disease follow-up. An acceptable training plan with emphasis on regular follow-up, is recommended.

Background: Helicobacter pylori (Hp) infection often occurs in childhood and adolescence, with the frequency increasing with age. Hp infection is associated with insufficient hygiene, overcrowding and low socioeconomic status. Although declining in developed countries, children in the developing countries continue to have a high prevalence of Hp infection. As the association of Hp infection with chronic abdominal pain is not ubiquitously accepted, in this study we investigate the significance of endoscopic finding associated with Hp infection in children with abdominal tenderness. Methods: This cross-sectional study included 1,665healthy children, aged 6 to 12 years, in whom Hp infection was evaluated using the IgG anti-H pylori test. Hp-positive children with epigastric tenderness underwent upper gastrointestinal (GI) endoscopy. Urease activity of gastric mucosal biopsies was measured. The presence and density of Hp organisms, the presence of follicular gastritis, and the nature of inflammation and gastritis activity were assessed by histologic examination. Results: Of 1665children, 429 (26%) subjects (51% girls, 49%boys) were seropositive for H pylori. There was a significant association between Hp infection and older age (p<0.001) and male/female ratio (p<0.05). Epigastric tenderness was detected in 39 children (1%), 29 of whom underwent upper GI endoscopy. Nodular gastritis with antral erythema was the most common endoscopic finding (26/29; 89.7%). Histological findings revealed that, in all cases with endoscopic nodularity, lymphoid follicles were present. Bacterial density was low in 13 (44.8%), moderate in 14 (48.2%) and high in 2 (7%) subjects. Conclusion: The findings of the present study demonstrated that antral nodularity is the most common feature in children with Hp infection and epigastric tenderness was significantly associated with histological findings of lymphoid follicles.

Background: Major clinical manifestations of antiphospholipid syndrome (APS) in the central nervous system are generally arterial thrombotic events and a number of non thrombotic neurologic syndromes. Antiphospholipid antibodies (APAs) are one of the important risk factors for cerebrovascular accidents (CVA). The aim of present study was to assess the relationship between APA titers and CVA in this clinically important age group. Methods: This case-control study was carried out on patients under 50 years old who had CVA (stroke or transient ischemic attack) in Shahid Sadoughi Hospital in Yazd (central Iran) from Dec 2003 until March 2005. In this study, 61 patients with CVA were compared with 68 age- and gender-matched control subjects. Lupus anticoagulant assay results and APA titers were assessed in both groups. Results: The mean value of IgM APA titers in patients with cerebrovascular accidents was 6.492 MPL (IgM antiphospholipid units) and 1.846 MPL in the control group. The difference between the two groups was significant (p-value: 0.000). In 12 (20%) of the patients with cerebrovascular accidents, IgM titers were higher than 10 MPL, one of whom had an IgM titer higher than 40 MPL. The mean value of IgG titers in the case group was 5.50 GPL (IgG antiphospholipid units) and 3.51 GPL in the control group. The difference between the two groups was significant (p-value: 0.012). Thirteen (21%) patients with cerebrovascular accidents had IgG titers higher than 10 GPL. The difference between the LA assay results was not significant between the two groups (p-value: 0.311). Conclusion: The present study showed a positive relationship between APL (IgM and IgG) titers and CVA in patients under 50 years old.

Background: surgical site infection is one of the most common post operative complications alongside with sepsis, cardiovascular, pulmonary and thromboembolic complications. The development of surgical site infection is related to three factors: the degree of microbial contamination of the wound during surgery, the duration of the procedure, and host factors such as diabetes, malnutrition, obesity, immune suppression, and a number of other underlying disease states. The purpose of this study was to evaluate the effects of topical cephazolin in controlling infection of the site of surgery after non-laparoscopic cholecystecomy. Methods: One hundred and two of patients referred to the outpatient clinic of Imam Khomeini Hospital from fall 2005 to fall 2006 non- laparoscopic cholecystectomy enrolled in a randomized clinical trial. All patients underwent the same procedure of anesthesia and surgery and they were randomly assigned into two groups of cases with irrigation of the site of surgery with 19 of topical Cephazolin prior to the termination of the operation- and controls. Cephazolin is a first generation cephalosporin which binds penicillin binding protein and is a potent cell wall synthesis inhibitor. The patients were followed up for six weeks for symptoms and signs of infection including discharge of the wound; and presence of pain, warmness, swelling and erythema of the wound. Results: There were no significant differences between two study groups regarding mean age, duration of operation, and sex. There was no significant difference in the incidence of infection of the site of surgery (11.8% in both groups with p=0.99) between two groups.Conclusion: Analyzing the collected data confirms that prophylactic use of topical cephazolin was unable to decrease the risk of infection of the site of surgery in patients undergoing non- laparascopic cheolecystectomy.