TEHRAN UNIVERSITY MEDICAL JOURNAL (TUMJ)
Year:2008 | Volume:66 | Issue:7|Papers Count:20

There are limited published investigations about adherence to antiretroviral and its determinants. Many determinants influence on adherence to therapy. The effects of some determinants on adherence are controversial. More studies are needed to be fulfilled about adherence and its determinants to compile strategies. Key to the success of antiretroviral therapies is the ability and willingness of HIV-positive individuals to adhere to antiretroviral regimens. There are different definitions for full adherence. In the most studies, adherence is defined as taking ³95% of prescribed medication.Adherence rate needs to be >95% to prevent virologic failure and for complete suppression.The consequences of poor adherence include not only diminished benefits for the patient, but also the public health threat of the emergence of multidrug-resistant viruses, as these resistant strains can then be transmitted from a patient to their contacts. Evaluating adherence has proven to be difficult and there is no gold standard for evaluating adherence to medication. Adherence is assessed in various ways. The most studies evaluate adherence to treatment by using patient’s self report and the pill count method but these are methods known to overestimate adherence. Some determinants are associated with adherence include: age, gender, addiction specially injection drug users, alcohol consumption, depression, social support, level of education, work situation, adverse antiretroviral effects, pregnancy, type of antiretroviral drug regimen, number of pills and daily doses received, severe traumas, social and psychological factors, and relationship between clinician and patient.

Background: Paraquat is an herbicide produced and used prevalently worldwide.Studies have shown that lung fibrosis induced by paraquat can be prevented or delayed by certain antioxidants, iron chelating agents, melatonin, and, recently, blood pressure lowering drugs such as captopril.Methods: The protective effects of captopril on paraquat toxicity were studied using RT-PCR and immunohistochemistry to determine the gene and protein expression of p53 and Bcl-2 in lung tissue samples from rats treated with captopril before and after exposure to paraquat.Results: We found no significant difference in the gene and protein expression of p53 in different tissue samples, except for mRNA levels in the lung tissue of captopriltreated rats. However, the protein expression of Bcl-2 is greater in tissue from rats exposed to paraquat alone and paraquat together with pre- and posttreatment with captopril compared to tissue from untreated control rats and from those treated with captopril alone, which can be due to inflammatory responses of lung tissue. By RTPCR, we were unable to detect Bcl-2 in lung tissue samples.Conclusion: These results show that paraquat does not induce significant DNA damage; therefore, the gene and protein expression of p53 was not changed. Paraquat does induce lung tissue inflammation, which in turn increases Bcl-2 protein expression.Finally, captopril had no significant effect on the lung tissue toxicity induced by paraquat. Considering these results and the cellular interactions in lung tissue, we suggest that complementary assays and in-vitro cell culture experiments be performed to further elucidate the molecular events underlying paraquat lung toxicity.

Background: Glycoconjugates are a class of cell surface glycoproteins, the terminal sugars of which are important indicators of neoplasia and the aberrant biological behavior of cancer cells. Lectins are a class of plant or animal glycoproteins that specifically bind to the terminal sugars of glycoconjugates. The aim of the present study is to identify the presence of L-fucose in cell surface glycoconjugates and extracellular matrix glycoconjugates of cancer cells of different grades of colonic adenocarcinoma.Methods: Paraffin blocks of colonic adenocarcinoma tissue from 30 patients were collected from the Pathology Department of Khatam Al Anbia Hospital in Zahedan, Iran. Sections, 5-7 mm thick, were prepared and stained using hematoxylin and eosin.Sections were graded histopathologically and then stained using the lectin Ulex europaeus agglutinin (UEA, 10 mm/mL), which binds specifically to L-fucose, and Alcian blue (pH=2.5). Sections were graded blindly according to lectin staining intensity on a scale of 0-3. Collected data were analyzed using Kruskall-Wallis and Mann Whitney nonparametric tests with SPSS.Results: Our results show that there is a significant difference in the staining intensity for L-fucose between tumoral cells of different grades of colon carcinoma (p<0.001).Results show that the degree of UEA lectin binding to cancer cells is lower in the cytoplasm and nucleus and higher in the extracellular matrix in tumors, with the degree increasing with histopathological grade. Furthermore, staining intensity differs in different portions of cancer cells.Conclusions: The increased staining intensity of L-fucose in the extracellular matrix of colon carcinoma is a reflection of the aberrant protein glycosylation pathway in neoplasia.

Background: Chronic peritoneal dialysis is a safe method for the treatment of endstage renal failure. Worldwide, patients on chronic peritoneal dialysis constititute approximately 15% of the total number of patients on dialysis. In Iran, very few people have access to chronic peritoneal dialysis, which is targeted by the Ministry of Health.This lack of access is primarily due to the high occurrence of mechanical complications. Improving catheterization procedures is an important way to extend the use of peritoneal dialysis in Iran. Thus, a prospective study was implemented to evaluate the outcome of a new laparoscopic technique for the insertion of peritoneal dialysis catheters under local anesthesia.Methods: A total of 115 catheters (two-cuff, swan-necked, coiled) were inserted into the peritoneal cavity of 109 patients with end-stage chronic renal failure during a 16- month period. The method of insertion was a two-port laparoscopic technique with local anesthesia and sedation. All patients were followed for 12 to 28 months. We prospectively evaluated mechanical and infectious complications and survival rates of the catheters.Results: The average age of the patients was 51.5 years (range: 15-84 years); 54.8% of these patients were female. The overall one-year and two-year catheter survival rates using this approach were 88% and 73%, respectively. Event-free catheter survival was 35%. The most common infectious and mechanical complications were peritonitis in 52 cases (45.2%) and temporary dialysate leakage in 10 cases (8.7%) respectively.Conclusion: Laparoscopic insertion of peritoneal dialysis catheter with local anesthesia is a safe and simple procedure, giving reasonable rates of catheter survival and complications.

Background: Approximately 2-15% of the global population suffers from migraine headaches. Since acupuncture is one of the treatments for this disorder, the aim of the present study was to assess the effectiveness of this modality on patients with migraine.Methods: In this experimental interventional study, we enrolled 180 patients with migraine headache attacks at a documented frequency of at least 2 attacks during last 6 months. For all patients, the number, duration and intensity of the headaches were recorded before treatment. To treat the patients, the point with maximal pain was first determined and the meridian was distinguished. Then, the related acupoints were found and stimulated by percutaneous electrical acupuncture for several minutes. The procedure was repeated once per week for six weeks. After completion of all treatment sessions, the patients were visited and questioned about the number, duration and the intensity of headaches.Results: The mean of number of attacks (9.55±8.26 vs. 3.50±6.77, p=0.001), the mean duration of each attack (9.11±6.59 vs. 3.33±3.65, p=0.001) and the intensity of the attacks (1.83±0.38 vs. 0.61±0.78, p=0.001) were significantly lower after treatment.Conclusion: Application of acupuncture in patients with migraine headaches is associated with a significant decrease in the mean number, duration and intensity of attacks. Thus, this method of treatment is strongly recommended for migraine headache.

Background: Ovarian cancer is the leading cause of death among all gynecologic cancers in developed countries. The standard treatment for advanced ovarian cancer consists of cytoreductive surgery associated with a platinum/paclitaxel-based chemotherapy. Over than 50% of patients with advanced ovarian cancer will develop recurrent disease. For those patients who have recurrence of disease at least six months after initial therapy, the paclitaxel- platinum combination has been shown to be a superior treatment to platinum monotherapy. However, many patients develop clinically relevant neurotoxicity, frequently resulting in treatment discontinuation. The efficacy and safety of an alternative regimen that dose not show significant neurotoxicity were evaluated by comparing gemcitabin- carboplatin with carboplatin in platinum sensitive recurrent ovarian cancer patients in a Gynecologic Cancer InterGroup trial in Canada and European Organization for research and treatment of Cancer Gynecological Cancer Group. But this study was not done in Iran.Methods: We performed a study with escalating doses of gemcitabin combined with carboplatin in 21 patients. All patients who were treated in Vali-Asr hospital between 2003- 2005 evaluated. Gemcitabin with dose of 800mg/m2 was given on days 1, 8 and 15 followed by one week rest period for a 28 day cycle. Combine with carboplatin with AUC 4 given on day 2. All patients with surgically resected, histologically confirmed epithelial ovarian cancer and who had failed first- line platinum chemotherapy were allocated to this study.Results: Median age was 49 years (range 23-78 years). Median follow-up was six months (range 4-22). Total of 87 cycles of chemotherapy were administered with median number of four (range 2-6 cycles). Thrombocytopenia (grade I) and leucopenia (grade I) were seen in 4.75% and 9.52% of patients.Conclusion: Gemcitabin and carboplatin Combination was tolerated in patients with recurrence of ovarian cancer.

Background: Cyclosporine is one of the main immunosuppressors used for renal transplant recipients, and is given to prevent transplant rejection. Although the drug increases the survival of patients and grafted organs, it has some side effects independent of its effect on the immune system that are usually ignored. In this study, we evaluate the effect of cyclosporine on serum Mg levels and metabolic side effects in renal graft patients.Methods: In this study, we followed 157 renal transplant recipients (62 females and 95 males) who were being treated with cyclosporine at a private clinic to prevent transplant rejection. The patients were first physically examined and then blood samples were obtained in order to measure levels of cyclosporine, Mg, creatinine, fasting blood sugar, lipids, calcium, phosphorus, and uric acid levels. We then analyzed the data for correlations between serum Mg levels, cyclosporine and other metabolic complications.Results: The mean levels of Mg and cyclosporine were 196±0.31 mg/dl and 371±192 mg/dl, respectively. Hypomagnesemia was detected in 16 patients (10.2%).There was a significant negative correlation (p<0.05) between levels of Mg and cyclosporine levels (r=-0.53), serum creatinine (r=-0.61), plasma LDL (r=-0.3), fasting blood sugar (r=-0.60) and uric acid (r=-0.36), and no correlation (p>0.05) between levels of Mg and calcium (r=0.2), phosphorus (r=-0.01), triglycerides (r=0.06) and HDL (r=-0.08). Mean levels of cyclosporine, creatinine, LDL, fasting blood sugar and uric acid in patients with hypomagnesemia were significantly different from those patients with normal serum Mg levels (p<0.05). There was no significant difference between the two groups with regard to mean total cholesterol, HDL, calcium and phosphorus (p>0.05).Conclusion: According to the results of this and previous studies, there is a significant correlation between cyclosporine levels and hypomagnesemia as well as other biomedical complications secondary to hypomagnesemia. Therefore, we recommend routine serum Mg determination and greater attention to hypomagnesemic patients to prevent further complications.

Background: The preferred modality of dialysis is a controversial issue in nephrology.In this study we compare some demographic and epidemiological characteristics of hemodialysis and peritoneal dialysis patients in an attempt to analyze this issue.Methods: The results of the research protocol “A survey of the epidemiological characteristics of chronic dialyzed patients in Khorassan province”, was used to compare some demographic and epidemiological aspects of chronic hemodialysis and peritoneal dialysis patients in search of any statistically significant difference.Results: A total of 836 chronic dialysis patients entered this study, 802 (95.9%) of which were under chronic hemodialysis, and 34 (4.1%) patients were undergoing peritoneal dialysis, with 339 (42.3%) and 12 (35.3%) being female, respectively. The mean age for each group was 47.57 and 46.75 years, respectively. The causes of endstage renal disease in hemodialzed patients were most commonly hypertension (32.2%), followed by diabetes mellitus (22.3%), unknown causes (19.6%) and chronic glomerulonephritis (10.2%). In the peritoneal dialysis group, chronic glomerulonephritis (32.4%) was the most common reason for dialysis, followed by diabetes mellitus (26.5%) and unknown causes (11.8%). The mean serum hemoglobin creatinine, calcium, and phosphorus levels for hemodialysis patients were 10.42, 8.5, 8.93, and 6.03 mg/dL, respectively, and those for peritoneal dialysis patients were 11.28, 8.52, 9.41 and 5.40 mg/dL. There were no statistical differences between the median age, sexual distribution and mean levels of Hgb, Ca, phosphorus, creatinine, HCV antibody and HbsAg of the hemodialysis patients and those of the peritoneal dialysis patients.Conclusions: The results of our study show that hemodialysis and peritoneal dialysis are similarly effective treatments.

Background: Chlamydia trachomatis is a common and curable STI that may be symptomatic or asymptomatic. The few studies on C. trachomatis among Iranian women have had, for the most part, small sample sizes and are therefore unsuitable for epidemiological deductions. The aim of this study was to estimate the prevalence of urogenital C. trachomatis infections by PCR on urine samples of married women in their fertile years in order to determine the need for a C. trachomatis screening program for asymptomatic women in Iran.Methods: This descriptive-analytical and cross-sectional study was performed on 991 married women. The research material consisted of questionnaires and urine samples, which were transported daily to Avesina Research Institute, Tehran, Iran, to extract their DNA and prepare them for PCR tests. The gathered data were analyzed by SPSS, version 13, and evaluated statistically by t-test, chi-square test, Fisher’s exact test and logistic regression, considering p<0.05 as significant.Results: Of all the subjects, 127 (12.8%) were positive by PCR for C. trachomatis. The mean age of the participants was 28.88± 6.19 years. Infection was more prevalent among those with lower levels of education, who were employed and not pregnant.This infection was more prevalent among those who were using contraception, especially condoms. Reproductive history revealed that infection was more prevalent among participants with a history of vaginal discharge, pelvic pain, infertility and low birth-weight infants, and less prevalent among those with a history of abortion, preterm delivery and ectopic pregnancy. However, these patterns were not statistically significant.Conclusion: In populations with C. trachomatis prevalences higher than 4%, screening programs are recommended. Thus, Chlamydia screening should be part of the health care program in Iran to reduce the burden of this disease.

Background: Atherosclerosis and the side effects thereof are a major cause of mortality and morbidity in diabetic patients. Diabetic dyslipidemia is defined by a decrease in blood levels of HDL cholesterol and increases in triglycerides and LDL cholesterol. Diabetic dyslipidemia is atherogenic, inducing cardiovascular disease in diabetic patients at a frequency that is two to three times greater than that of nondiabetics.Methods: This study analyzes the data from the first phase of the Yazd Healthy Heart Program, a community intervention project focused on the prevention of cardiovascular disease. Using the cluster sampling method, we analyzed data from 2000 subjects from Yazd, Iran, ranging in age from 20 to 74 years. Clinical and paraclinical data were recorded by trained health providers using a questionnaire with over 700 items.Results: The most frequent lipid disturbance was TG>150 in 67.1% of the type-II diabetic patients (p<0.000), 54.6% of whom were unaware of their TG level. The mean lipid and TG levels are significantly higher (p<0.000). Furthermore, women as a group have higher mean cholesterol, LDL-C and HDL-C levels than men (p<0.000).Additionally, diabetic patients were more obese than the nondiabetic population (p<0.000).Conclusion: The high prevalence of diabetes mellitus in Yazd and hypertriglyceridemia among diabetics in this city, in addition to the lack of awareness among more than half of these patients about their illness and diagnosis, indicate an urgent need to immediately control dyslipidemia in these high-risk patients.

Background: Infertility influences various aspects of a woman’s personality and psyche, and affects her functions within her family and occupation, as well as her ability to communicate. Studies have shown that infertility is associated with depression, stress, anxiety, dissatisfaction with life and other psychological problems.The purpose of the present study was to compare the dimensions of neuroticism and androgyny in fertile, infertile and postmenopausal women.Methods: This study included of 180 fertile, infertile and postmenopausal women (60 in each group) selected from inpatients at Imam Khomeini and Mirza Koochak Khan Hospitals, Tehran, Iran, during 2004. Data were collected using the NEO Personality Inventory Neuroticism Scale and Bem Sex-Role Inventory and analyzed using the oneway ANOVA technique.Results: LSD test results show that mean neuroticism scores were significantly different between the three groups, with scores following the trend: infertile women > postmenopausal women > fertile women. The mean androgyny scores were also significantly different between the three groups, following the trend: infertile women < postmenopausal women < fertile women (p<0.01).Conclusion: The results of this research are congruent with findings from other studies. These results may be useful for infertility counseling and therapy.

Background: A high percentage of the patients at ENT or plastic surgery clinics have ENT abnormalities, either congenital or those developing later in life. Some are life threatening, while others cause disability and esthetic problems, with profound consequences for the affected child and the family. In addition, ENT abnormalities usually place stress on interpersonal relationships, causing social isolation, unhappiness and depression. The majority of these abnormalities is genetic and follows autosomal recessive pattern of inheritance. Geneticists believe that there is a higher frequency of autosomal recessive disorders among the offspring of consanguineous parents. The aim of this study was to find the frequency of ENT abnormalities among children born of consanguineous parents.Methods: We studied 3503 files (pedigrees) of patients referred for genetic counseling at the Department of Genetics at Imam Khomeini Hospital, Tehran, Iran, from 1999 to 2000. We studied these cases according to degree of parental consanguinity, patterns of inheritance and gender using SPSS v.15.Results: Of all 3503 files, 206 had ENT abnormalities, of which 157 had consanguineous marriages. Among these 157 pedigrees, 496 cases had consanguineous parents.Out of the 496 cases, the four most frequent ENT abnormalities were: 115 cases (23.2%) of deafness, 53 cases (10.7%) of hearing loss, 12 cases (2.4%) of cleft lip and palate, and 5 cases (1%) of cleft palate.Conclusion: This high frequency of ENT abnormalities indicates that consanguineous marriage should be discouraged by Iranian policy makers in order to reduce the burden of these disorders on society. Further research into the cultural problems that encourage consanguineous marriage and ways of resolving these problems is recommended.

Background: Lead poisoning could be associated with gastrointestinal renal, hematologic complications and neurologic deficit.Case report: The patient was an opium addict, forty one years old male, to hospital admitted with gastrointestinal signs, constipation, abdominal pain, severe weakness of upper and lower limbs without any sensory impairment and with anemia, leukocytosis, and slightly increased liver function tests. Serum level of lead was more than 200mg/dl.After treatment with dimercaprol (BAL), CaNa2EDTA for two five days sessions that followed with oral succimer for three days, signs and symptoms relieved, all laboratory tests became normal and blood level of lead reduced but the patient was discharged with quadriplegia. There was no fecal or urinary incontinence.Conclusions: Because of irreversibility and severity of lead related neuronal injury, we should suspect to lead poisoning in each patient with neuronal involvement and concurrent GI and hematologic signs.

Background: Port-site metastasis following laparoscopic cholecystectomy with unsuspected gallbladder carcinoma is a serious problem. Gallbladder carcinoma is found in 1% of all biliary tract operations, in most being diagnosed only after histological examination of the gallbladder. The spread of cancer following laparoscopy appears aggressive and widespread, as noticed from re-operation for radical treatment. The pathologic findings of gallbladder were consisting of tumoral and necrotic tissue, indicating of well differentiated adenocarcinoma. Mucosa and submucosa were involved, but no evidence of invasion to muscular layer and gall bladder serosa was found (T1). In this article we present the first of an unusual case of four port site adenocarcinoma metastasis from gallbladder cancer.Case report: A 63 year old woman underwent laparoscopic cholecystectomy for acute cholecystitis. Thirty months later, she was admitted to the hospital with a complaint of masses at the four trocar sites. A biopsy from the port sites was undertaken and led to the diagnosis of adenocarcinoma metastasis. There is no published report of all four port site metastasis of gallbladder cancer after laparoscopic cholecystectomy.