Journal of Isfahan Medical School
Year:2005 | Volume:23 | Issue:76|Papers Count:15

Thalassemia, an autosomal recessive disorder, is one of the most prevalent single-gene disorders in Iran. There is no definite and easily available treatment for this disease; hence preventive measures using prenatal diagnosis (PND) constitutes the most effective way of controlling the disease. PND is usually performed in the first trimester using fetal tissue made available through CVS. Due to the heterogeneous genetic background of the Iranian population, a wide spectrum of mutations can be expected in thalassemic patients. Thus, a decision was made to study the prevalence of 8 important Mediterranean mutations using a PCR-based method (ARMS) in Isfahan Province.The most prevalent mutation was CD36/37 (-T) with a frequency of 17.5%, and the lowest was CD16 (-C) with a frequency of 1%. CD5 (-CT) was not detected in anyone of the cases. The prevalence of other mutations was as follows: CD8 (-AA) 8.3%, CD39 (C→T) 39%, IVSI-6 (T→C) 2.9%, CD44 (-C) 4.4% and IVSI-3' end-25bp 2%.The mutation CD36/37 (-T) had the highest frequency among the 8 thalassemia mutations studied. Previous studies on thalassemic patients in Isfahan have never reported this mutation as a prevalent thalassemia mutation in this region Isfahan. The results of this study, together with previous studies are useful in gradually building a reliable provincial thalassemia mutation spectrum which will definitely help prenatal diagnosis and thalassemia control in the country.

Introduction: Cystic hydatidosis is recognized as one of world's zoonosis. This is caused by an infection with the metacestode stage of Echinococcus granulosus parasite. Diagnosis is important from both healthy and economical point of view. Therefore, in this study titer of specific immunoglobulin (IgE, IgG) in cyctic echinococcusis patients was evaluated.Methods: Blood samples were taken from 43 hydatidosis patients who were under operation. The Immunofluorescence antibody test (I.F.A.T) was performed with frozen section of protoscolices for the titer of specific antibodies (IgE, IgG) titer.Results: An increase in the serum of IgG and IgE were seen. The titer of specific IgE was higher than IgG. Results also indicated that specific antibodies titer were higher in patients with liver cysts in comparison with lungs cysts. Discussion: The measurement of specific immunoglobulin (IgE, IgG) with IFA technique is an useful method for the diagnosis of hydatidosis. High level of IgE as compared to IgG can help more in terms of diagnosis and follow up.

Introduction: Leishmania major is the causative agent of zoonotic cutaneous leishmaniasis (ZCL), affecting millions of people worldwide. About ten percent of the world's population is at risk and two million new cases are reported annually. This disease is endemic in some parts of Iran and is also a major health problem in this country. LACK protein "among the vaccine candidate proteins of Leishmania" has considerable importance because of its role in regulating the immune responses against this disease.Materials and methods: In this study and for the first time, the LACK gene of the Iranian strain of Leishmania major was cloned and sequenced. A pair of primers was designed based on the LACK gene sequence in the gene bank, then the LACK gene of Leishmania major was PCR amplified using the Taq polymerase enzyme. The amplified LACK gene was ligated into the pTZ57R plasmid and transformed into the E. coli Xllblue. The transformed clone was cultured under the appropriate conditions, and the obtained colonies were screened using the different restriction enzymes. After verification by restriction digestion, one of the recombinant plasmids was sequenced using the automated DNA sequencing method.Results: Comparison between the LACK gene sequence from the Iranian strain of Leishmania major and the LACK gene of Leishmania major in the gene bank (Accession number U27568) showed a %99 homology. The amplified LACK sequence contained 939 bp, hence encoding a protein encompassing 313 amino acids.Discussion: Complete homology among the LACK gene sequence of the Iranian strain of Leishmania major and the LACK gene sequence of other Leishmania major strains and Leishmania genera is in agreement with other studies which have indicated that the LACK gene sequence is conserved among different Leishmania genera. Therefore it can be concluded that the results from the LACK gene of different Leishmania genera can be extended to each other. It is feasible to cut out the LACK sequence from pTZ57R-LACK clone and sub clone it into an appropriate plasmid for the expression and production of the LACK protein. Additionally it would be possible to produce mutations or knocking out a part of this gene to modify the pathogenesis of Leishmania.

Introduction: About 75% of all cases of diabetes type 2 die because of coronary artery diseases. The basic pathogenesis of this disease in vascular complications is endothelial cell dysfunction. One of the risk factors of this pathophysiology is homocysteine; a metabolite of diary methionine Hyperhomocysteinemia leads to a higher risk of ischemic myocardial injury in acute coronary syndromes. Otherwise, hyperhomocysteinemia occurs after acute myocardial infarction (AMI). Folic acid effectively lowers the serum homocysteine level. Thus the authors arranged a study to compare the efficacy of folic acid on serum homocysteine level, ejection fraction and mortality of diabetic patients with recent AMI in a 6-months period.Materials and methods: After selecting 60 diabetic cases (type 2) with AMI who referred to Noor Hospital in Isfahan, subjects were randomly divided into case and control groups, both undergoing the same medical therapy. Serum homocysteine level and ejection fraction were measured in all of the subjects. Patients in the case group were prescribed 1 mg folic acid tablets, daily for a minimum period of 6 months, in addition to medications prescribed for patients in the control group. After 6 months, all patients were called for measurement of serum homocysteine level and ejection fraction. Mortality rate in each group was evaluated and the data pertaining to each group were analyzed using T-test.Results: Six-month mortality rate was compared between the two groups. Two patients from the case group (6.7% of the case group) and 4 patients from the control group (13.3% of the control group) died. Despite no statistically significant difference between the two groups, mortality rate in the control group was twice as high. In the case group, we found a significantly decreased serum homocysteine level (19.42±7.72 µmol/liter at the beginning of the study and 12.57±4.839 µmol/liter after 6 months) (P<0.001). Analysis of data in the control group showed a significant increase in serum homocysteine level (19.98±10.75 µmol/liter at the beginning of the study and 21.39±10.58 µmol/liter after 6 months) (P=0.033). Mean differences of serum homocysteine in the case and control groups were -6.75±3.88 and 1.67±3.86 µmol/liter, respectively; the difference in serum homocysteine level between the two groups 6 months after AMI was highly significant (P<0.001). Comparison of change in ejection fraction between the two groups revealed no statistical significance (P=0.26). However, the rise in ejection fraction within each of the two groups (EF2-1) was significant (P<0.001 in the case group and P=0.016 in the control group).Conclusion: Although we could not demonstrate the efficacy of folic acid in improving left heart function and reducing mortality rate, we revealed that folic acid lowered serum homocysteine level, which is a risk factor for endothelial dysfunction. Thus, we recommend routine use of folic acid in diabetic patients with recent AMI. A long-term follow up involving a greater number of subjects is warranted to determine the effect of folic acid on mortality rate.

Introduction: The harmful effect of Pringle maneuver on hepatocytes is time-related and the most useful method of evaluating these effects is the liver function test. In this study, changes in the liver function test results following transient ligation of hepatoduodenal ligament of rabbit were evaluated.Materials and methods: In this experimental study, 20 rabbits were studied in four equal groups. In each animal, hepatoduodenal ligament was ligated for 30 minutes (group A), 45 minutes (group B), 60 minutes (group C) and 75 minutes (group D). Under general anesthesia liver biopsy was taken after performing the maneuver and levels of serum SGOT and SCPT were measured on the first, third, fifth and seventh post-operative days.Results: SGOT on the first post operative day was 806±494.6 U/L in group A, 656.5±337.6 U/L in group B, 1559.6±270.6 U/L in group C, and 1637.5±880.34 U/L in group D. The rise in SGOT was significant compared to preoperative levels (P<0.05).SGOT on the third post-operative day was 202.75±80.9 U/L in group A, 195.7±74.8 U/L in group B, 223.3±77.3 U/L in group C and 238.5±30.4 U/L in group C. This decrease in SGOT level is significant compared to the first post-operative day (P<0.05). The SGPT on the first post-operative day was 756.2±522.5 U/L in group A, 834.5±262.02 U/L in group B, 1200±239.5 U/L in group C and 2288±143.6 U/L in group D. The rise in SGPT was significant compared to preoperative levels (P<0.05). The SGPT on the 3rd post-operative day was 280±221 U/L in group A, 270±77.5 U/L in group B, 289.3±164.4 U/L in group C, and 489±122.5 U/L in group D. The decrease in SGPT level was significant compared to the first post-operative day (P<0.05).Discussion: Closure of hepatoduodenal ligament for 45 minutes is safe and closure of hepatoduodenal ligament for more than one hour leads to severe increase in hepatic enzymes and high mortality.

Introduction: Coronary artery disease is the most common entity in cardiovascular medicine. There are different modalities for treatment: drug therapy and revascularization (PCI: Percutaneous Coronary Intervention & CABG: Coronary Artery Bypass). But quite a few patients experience intractable and disabling angina from the beginning due to inappropriate coronary anatomy or even after using therapeutic methods (full medical therapy, PCI, CABG). In such cases EECP (Enhanced External Counterpulsation), as an alternative and noninvasive therapy can decrease angina episodes and improve the quality of life.Materials and methods: Forty-four patients were included in this study. All had intractable angina despite full medical therapy and were not appropriate candidates for PCI & CABG, and this problem had notable effect on their life and work. EECP was done in 35 sessions (one hour daily) for all patients in Chamran Hospital-Isfahan. Exercise treadmill test was done before and after completion of the treatment course.Results: Treatment with EECP significantly increased exercise test time in this study. Mean exercise test time before and after completion of treatment was 192.65 and 341.38, respectively. After data analysis, a significant improvement was observed in exercise test time (P<0.001).Discussion: EECP in patients with refractory angina pectoris significantly increased exercise test time and consequently improved the patients' quality of life.

Introduction: The first step in planning for every disease control program is a precise epidemiologic study. This study was conducted to elucidate the prevalence of asthma and its related symptoms (rhinitis, conjunctivitis and eczema) in 6-7 and 13-14 years old children of Tehran during the years 2000-2001, as the third phase of the International study of Asthma and Allergies in childhood (ISAAC).Methods: This descriptive questionnaire-based study was performed on a total of 6127 students from 72 schools in Tehran Province selected by simple random sampling out of a total of 12 clusters of 22 municipality regions. All of the first-graders, as well as students from 7-8 grades were enrolled in the study.Results: A total of 6140 students consisting of 3015 6-7-year-old and 3125 13-14-year-old students were included in the study. Results showed that 11.4% of 6-7-year-old and 33.7% of 13-14-year-old students had positive symptoms of rhinitis including sneeze, rhinorrhea and nasal congestion, 8.9% and 25.1% of which had recently become symptomatic. Conjunctivitis symptoms were reported by 22% of 6-7-years-old and.13.5% of 13-14-year-old students within 12 months. Incidence of symptoms was highest during January through March and lowest during July through September. Severity of symptoms in 5.6% of 6-7-year-old and 15.5% of 13-14-year-old students had resulted in limitation of physical activity.Discussion: Prevalence of allergic rhinitis symptoms was much higher in the 13-14 year-old group of students, a result that has not changed dramatically since the first phase of the study. Further studies are warranted to identify the cause (s) of such a high prevalence.

Introduction: Numerous studies have indicated the superiority of enteral nutrition compared to parenteral nutrition. The frequency of enteral nutrition-related gastrointestinal complications in critically ill patients is high. Enteral nutrition (gavage) has complications such as diarrhea, nausea, vomiting and gavage intolerance (the residual volume of that which is aspirated from stomach is greater than 50% of the volume that is infused), which may cause fluid and electrolyte imbalance. The goal of this study was to compare the above complications between bolus, intermittent and continuous methods of gavage in surgical intensive care unit (SICU) patients.Materials and methods: After approval of the proposal by the Ethics Committee and obtaining the patients' informed consent, this clinical trial was conducted on 63 SICU patients. Patients were randomly divided into three groups. The methods of gavage used in the three groups were bolus, intermittent and continuous. Data collection was conducted using a checklist on the gavage method and complication data. Statistical analysis was performed with ANOVA and Pearson correlation coefficient was determined.Results: The study showed that the incidence of diarrhea, nausea, and vomiting was not significantly different between the three groups. This study shows that the incidence of diarrhea, nausea and vomiting was not significant between the three groups. Mean+SD durations of gavage tolerance in bolus, intermittent and continuous groups were 13.71+2.19, 13.95+1.35, and 14.85+0.47, respectively. The tolerance of gavage was significantly higher in the continuous groups compared to the bolus group (P<0.05).Conclusions: This study showed that the continuous method of gavage in SICU patients is better tolerated than the bolus method.

Introduction: Reports on the effects of contraceptive method on pathologic evidence provided by Pap smear test have been varied. A few studies have reported that the type of contraception pills or devices is the predisposing risk factor for precancerous changes in cervix. The aim of this study was to evaluate the prevalence of abnormal findings in Pap smear tests which were related to contraceptive methods and devices, in women in Isfahan.Methods: In a cross-sectional study, 500 women using one of the contraceptive methods for at least 1 year were selected. Pap smear test was administered for all of the subjects. The results of Pap smear test in relation to the contraceptive method were analyzed.Results: Overall, 333 (66.6%) women had abnormal pap smear test results, of which 214 (42.8%) were nonspecific, and 119 (23.8%) were specific findings. There was no significant difference between the relative prevalence of various pathologic findings in Pap smear test, as relates to the method of contraception.Discussion: Our results demonstrated that there is no relationship between the method of contraception and cytological abnormalities observed in Pap smear test. In view of other studies, other factors such as human papilloma virus, chlamydia trachomatis, HIV infection, cigarette smoking and age should be considered as predisposing factors for precancerous changes of cervix. The contraceptive method and devices probably have no role in pathologic effects observed in Pap smear test.

Introduction: Diabetes is associated with a high rate of mortality and morbidity. Diabetes Autonomic Neuropath (DAN) is manifested by sympathetic and parasympathetic system dysfunction in multiple organs (cardiovascular, gastrointestinal, genitourinary ...) Methods: DAN is a serious complication of diabetes mellitus. A total of 96 type-2 diabetes mellitus patients aged 25-85 years visiting the Health Centers affiliated with Isfahan University of Medical Sciences in 2003-2004 were studied. EWING battery triple tests (deep inspiration-valsalva, lying-to-standing) were conducted to evaluate the subjects for cardiac autonomic neuropathy.Results: Cardiac autonomic neuropathy was seen in 68 patients (70.8%). Abnormal valsalva test was seen in 64 patients (66.7%). Abnormal E/I ratio test was seen in 45 patients (46.9%). Abnormal lying-to-standing test was seen in 5 patients (5.2%). Based on the severity of cardiac autonomic neuropathy, the subjects were categorized as Mild CAN (24 patients, 25 %), Moderate CAN (42 patients, 43.8%), and Sever CAN (2 patients, 2.1%). There was no correlation between cardiac autonomic neuropathy and chronic diabetic complications in this study.Discussion: A high prevalence of CAN was found in type-2 DM patients, which was higher than others diabetic complications. These abnormalities may be distinguishable in the early stages of neuropathy.

Introduction: Iodine deficiency disorders (IDD) are a worldwide health problem and have been known as a major public health problem in Iran for many years. Isfahan is among the areas with a high rate of goiter according to studies before the intervention. The IDD Control and Monitoring Program in Iran, which includes production and distribution of iodized salt has been underway since 1989.Methods: This survey was conducted to monitor the national IDD program in 2001. This was a cross-sectional survey. 1200 schoolchildren (sex ratio=1) were randomly selected. Goiter was assessed by palpation and graded according to WHO/UNICEF/ICCIDD classification. Urinary iodine was measured in one-tenth of the population.Results: Total Goiter rate was 5.5% in Isfahan (F:5%, M:5.9%). Median urinary iodine was 11.9µg/dl. In 62% of the population urinary iodine level was over 10 µg/dl and urinary iodine level lower than 5µg/dl was found in 10% of the population. Urinary iodine levels below 2µg/dl were not detected in any of the children. No significant difference was found in the prevalence of goiter and urinary iodine level between boys and girls, or between urban and rural regions.Discussion: The findings reveal significant reduction in the of prevalence of goiter compared with 1996 and show that after 11 years of salt iodization, Isfahan has met standards approved by WHO and can be considered to be IDD free.

Introduction: Unstable angina pectoris may lead to acute myocardial infarction. Since lipid peroxidation is thought to be causally related to chronic and acute events in atherosclerosis and coronary artery disease, we measured lipid peroxidation products in 90 patients with coronary artery disease and compared them to a matched control group.Methods: 30 patients with stable angina pectoris (SA), 30 patients with unstable angina pectoris (USA) and 30 patients with acute myocardial infarction (AMI) according to the World Health Organization criteria were selected and compared to 30 clinically healthy individuals. In addition to creatine phosphokinase (CPK) and its isoenzyme (CPK-MB) analysis, malondialdehydes (MDA) as thiobarbituric acid reactive substances (TBARS) and conjugated dienes were measured.Results: Patients had significantly higher CPK, CPK-MB, MDA and conjugated diene values than controls (P<0.001). When patients were divided into groups with SA, USA and AMI respectively, MDA were significantly higher in patients with USA and AMI as compared with the control group (P=0.001, P= 0.04, respectively). Also, there were significantly higher values in patients with USA, as compared with SA (P=0.03). Significantly higher values were obtained in patients with USA as compared with AMI patients (P=0.04). Similar results were obtained when patients were compared with controls using conjugated diene with few differences, lower P-value and also a significant difference between conjugated diene values was obtained in patients with AMI and SA (P<0.04). Plasma levels of MDA and conjugated dienes were not associated with increased levels of total CPK and CK-MB and were not associated with age, cholesterol or triglyceride levels.Discussion: It is concluded that lipid peroxidation parameters are increased in patients with USA and AMI which can differentiate SA from USA patients.

Usually extubation is a safe and routine procedure in intensive care unit. However it can be occasionally associated with potentially life threatening candition due to laryngeal edema and stridor, and finally it necessitates reintubation and rarely tracheostomy.In this case, a Patient with severe Postextubation stridor is introduced that reintubation was failed and at last emergency tracheostomy was performed.With regard of importance of subject, present methods for diagnosis of postextubation stridor (cough-test and cuff- leak test) before extubation and treatment of this complication are discussed.