JOURNAL OF RESEARCH IN MEDICAL SCIENCES (JRMS)
Year:2007 | Volume:12 | Issue:4|Papers Count:12

Since the beginning of the open-access movement in 2003, many scholarly publishers have turned to this new model of knowledge distribution. The rationale that publicly funded works must be publicly available to anyone who needs that information seems indisputable. This is particularly necessary as Arthur Amman, the president of Global Strategies for HIV Prevention, pointed out the case of South Africa’s access to medical information. He concludes that the restricted model of access to vital knowledge (e.g. medicine) potentially is associated with increased morbidity: “I recently met a physician from Southern Africa, engaged in prenatal HIV prevention, whose primary access to information was abstracts posted on the Internet. Based on a single abstract, they had altered their prenatal HIV prevention program from an effective therapy to one with lesser efficiency.

BACKGROUND: The cerebrovascular diseases rank first in frequency and importance among all the neurological diseases of adult life. It is important to understand the risk factors associated with stroke subtypes in order to improve primary and secondary preventative strategies. There is currently no information on the relationship of these stroke subtypes with cerebrovascular risk factors. Clinicians have tended to view strokes occurring in the anterior circulation (AC) and the posterior circulation (PC) as separate entities because the most common ischemic strokes occur in the AC, while strokes occurring in the PC are the most severe. Furthermore, AC and PC strokes have different underlying pathogenesis, natural histories and potential responsiveness to interventions such as anticoagulation and risk factors. We sought to explore differences between AC and PC strokes concerning their risk factors.METHODS: In this prospective descriptive study, we evaluated 250 patients; 125 had AC involvement and 125 had PC involvement, and were referred to Alzahra and Noor University Hospitals and private clinics between January 2000 and December 2004. Strokes in AC and PC were diagnosed by clinical and neuroimaging findings including brain CT Scanning and MRI. Pre-stroke cerebrovascular risk factors for each patient recorded from previous and present evaluations included hypertension, diabetes mellitus, hyperlipidemia and smoking.RESULTS: The average age of patients with AC stroke was 73±19.15 and the average age of patients with PC stroke was 70±19.7. Of 125 patients with AC stroke, 57 (45.6%) were male and 68 (54.4%) were female. Of 125 patients with PC stroke, 54 (43.2%) were male and 71 (56.8%) were female. The prevalence of hypertension as a major risk factor of stroke was higher in patients with PC stroke in comparison to patients with AC stroke (60 % vs. 40.8%) and the odds ratio for PC stroke was 2.8 (95% CI; 1.27–3.73). The prevalence of smoking in patients with PC stroke was higher than in those with AC stroke (32.8% vs. 15.2%) and this difference was statistically significant (P=0.001).CONCLUSIONS: The prevalence of hypertension as a major risk factor of stroke was higher in patients with PC strokes. However, there was no increased prevalence of stroke associated with diabetes mellitus between AC and PC strokes. Our results also showed that hyperlipidemia was a risk factor for AC and PC strokes and the prevalence was equal in both types, while the prevalence of smoking in PC strokes was higher compared to AC strokes.

BACKGROUND: Several studies have suggested an association between Chlamydia pneumonia infection and atherosclerosis. This study was designed to investigate the association between this organism and atherosclerotic plaque formation in right and left common carotid arteries (CCAs) and extracranial portions of internal carotid arteries (ICAs). METHODS: Antibodies to Chlamydia pneumoniae (IgA and IgG) were measured and compared in 42 patients who had plaque in at least one CCA or ICA (detected by duplex ultrasound) and 82 patients without any plaque in these arteries. Cp.IgG and Cp.IgA titers over 1.10 ISR were defined to be positive. RESULTS: We found that 6.1% of control subjects and 16.7% of cases were Cp.IgA seropositive. The difference between these two groups was prominent but was not statistically significant (P=0.104). 4.2% of females without atherosclerotic plaque and 31.6% of females with plaque were Cp.IgA seropositive. This difference is statistically significant (P=0.005). There was no significant difference in seropositivity of Cp.IgG between case and control subjects or in male and female groups with or without plaque. CONCLUSIONS: Cp.IgA is a predictor of atherosclerosis in women, but Cp.IgG has no predictive value for plaque formation in either gender.

BACKGROUND: Considering reports on the associations of symptoms of anxiety disorders with multiple sclerosis (MS), this study aimed to 1) further evaluate various anxiety disorders systematically presenting in patients with MS and 2) compare the results with a control group.METHODS: To assess anxiety disorders in patients with MS in a case-control study, 85 registered patients in the Iranian Multiple Sclerosis Society (IMSS) were randomly selected according to the inclusion criteria. A group of healthy individuals whose age and gender were matched with the case group were also selected. Both groups underwent a clinical interview based on DSM-IV diagnostic criteria. RESULTS: Frequency of diagnosis of all anxiety disorders in the two groups was 22.4% and 7.1%, respectively, indicating a statistically significant difference. Frequency of obsessive-compulsive disorder (OCD) was significantly higher in the case group (P<0.05). Relation of university education with the diagnosis of generalized anxiety disorder was significant too (P<0.05).CONCLUSIONS: OCD in patients with MS was more frequently observed than in the control group.

BACKGROUND: There is controversy about the efficacy of amantadine in the treatment of chronic hepatitis C. In this study, we evaluated the efficacy of triple therapy with interferon-alpha, ribavirin and amantadine in the treatment of nave patients with chronic hepatitis C. METHODS: Forty-eight patients with genotype 3 chronic hepatitis C received a three- drug regimen: interferon alpha-2b, 3 million units, three times a week, ribavirin 1000–1200 mg based on body weight, daily, in divided doses, and amantadine 100 mg twice daily, for six months. End of treatment response (ETR), sustained virologic response (SVR), biochemical response and histologic improvement were evaluated. RESULTS: Forty-eight patients, 41 male and 7 female, with a mean age of 37.42±16.2 years, were enrolled in the study. During treatment, four patients were excluded from the study due to severe thrombocytopenia, major depression and incompliance. End of treatment response was seen in 38 (86.36%) patients. Among these patients, 34 (77.27%) had sustained virologic response 6 months after the end of treatment and 40 (91%) had improvement in serum level of liver enzyme. Among patients who had response to treatment, liver biopsy was performed for 33 at the end of treatment and 31 patients had histologic improvement. Five non-responsive patients underwent liver biopsy at the end of treatment, and 2 of them had histologic improvement. No major side effects due to amantadine occurred in our patients. CONCLUSIONS: Triple therapy with interferon-alpha-2b, ribavirin and amantadine is a safe and effective regimen in the treatment of chronic hepatitis C.

BACKGROUND: The treatment of comminuted fractures in long bones has continued to be a problem in orthopedic surgery. Recently, fixation without exploration of the fracture site, known as "biologic fixation”, has been introduced. This study was performed to assess the results and complications of this method for the treatment of comminuted fractures of the tibia and femur. METHODS: The study included 41 patients with comminuted fractures of the tibia and femur treated with biologic plating from 2003 to 2006 (25 femur fractures and 16 tibial fractures). After biological fixation joint motion was started but weight bearing was avoided until radiographic evidence of union was shown. RESULTS: The mean time of union in the tibial fractures was 19±2 weeks and 17±2 weeks for the femur fractures. All patients had fracture union without any infection, non-union or implant failure. In one patient with a femur fracture there was a 10o internal rotation deformity. Two of the femoral fractures had shortening of 1 cm, and one patient had shortening of about 2 cm. Compared to similar studies, all results were statistically significant (P<0.05). CONCLUSIONS: The biologic plating method is a safe, simple and effective method of fixation for comminuted fractures of long bones. It has a high rate of union with minimal complications.

BACKGROUND: Chamomile is a beneficial herbal drug that is used as an anti-inflammatory, sedative and anti-allergic agent. The mechanism of action of matricaria recutita (MR), a specious of chamomile, in nociception in male and female animals is not fully understood. In this study, the sedative effect of a species of chamomile, MR, on acute pain was investigated in both male and female adult mice in the presence and absence of sex hormones. METHODS: Male and female NMRI mice weighing 28±3 grams were used. Animals of each sex were divided into intact and gonadectomized groups. Intact group received saline or MR extract (10, 30, 50 mg/kg, intraperitoneally). Gonadectomized group contained two subgroups: a) group that received saline or MR hydro alcoholic extract (50 mg/kg, I.P.), and b) group that received sex hormones (testosterone in male mice and estradiol benzoate and progesterone in female mice), both with and without MR extract (50mg/kg, IP). The analgesia times in all groups were evaluated by hot plate test. RESULTS: MR increased analgesia time both in intact and gonadectomized male and female mice, but had no effect in the presence of pharmacological doses of testosterone (2 mg/kg, subcutaneous) in male mice, and estradiol benzoate mg/kg, SC) and progesterone (0.5 mg/kg, SC) in female mice. CONCLUSIONS: It seems that MR can induce a pain-relieving effect with and without physiological doses of sex hormones in male and female mice, but sex hormones probably interact with its analgesic effect in their pharmacological doses.

BACKGROUND: Preeclampsia is one of the three leading causes of maternal mortality. Studies have suggested that the incidence of preeclampsia may be partially dependent on the month or season of delivery. This study was conducted to evaluate whether seasonal variation has any effect on the incidence of eclampsia or preeclampsia.METHODS: From 1999 to 2001, a cross-sectional study in Alzahra Hospital was performed using all deliveries with gestational age more than 20 weeks. Variables of maternal age, parity, occurrence of preeclampsia and eclampsia, and season were evaluated and analyzed by chi-square test in SPSS 10.RESULTS: During the period of the study, there were 12,142 deliveries at Alzahra Hospital in Rasht. There were 2,579 (21.3%) deliveries in spring, 2,696 (22.2%) in summer, 3,645 (30%) in autumn, and 3,222 (26.5%) in winter. There was no statistically significant relationship between the age, parity and season. Hypertensive disorder was reported in 609 pregnancies (5%), with 11,533 (95%) having no hypertensive disorder. Data showed that 397 patients (3.3%) had preeclampsia and eclampsia. The highest rate of preeclampsia was in spring (3.6%), and the lowest rate was in summer (3%), but it revealed no statistical difference in the incidence of preeclampsia with season.CONCLUSIONS: We found no correlation between preeclampsia or eclampsia and season. It may be due to relative similarities between seasons in North of Iran. For example, there are relative similarities between spring and summer, and between autumn and winter.

Lungs possess dynamic and complex coagulation-thrombolytic and inflammatory sets of innate reactive responses, which generate changes that cause a dramatic alteration in its parenchyma. Clinically, since its steps are reciprocally inter-connected, the pulmonary embolic injury is very complex to describe as one exclusive progression. For example, each step in a coagulation-fibrinolytic-inflammation-integrated pathway produces more side-steps, which later plays an important role in a specific lung damage description. In this clinical review, the enzyme thrombin, an ontogenetically very old and key blood coagulation serine protease is centrally placed as a mediator, activator and up-regulator of postpulmonary embolic damage to reveal its enormous flexibility in post-pulmonary embolism damage and its reparative processes. Additionally, some beneficial aspects of its control throughout its inhibition are discussed. ABBREVIATIONS: ADP adenosine 5 diphosphate; APC activated protein C; APTT activated partial thromboplastin time; ASA Acetylsalicylic acid; AT III antithrombin; C-1INH C-1Inhibitor; EC endothelial cells; eNOS endothelial nitric oxide synthase; EPCR endothelial protein C receptor; FDP’s fibrin degradation products; fibrin stabilization factor FSF; FM Fibrin monomer; GAG Glycosaminoglycans; GP glycoprotein; HC II Heparin cofactor II; HIT heparin induced thrombocytopenia; HMWK High Molecular Weight Kininogen; LDUH low dose unfractionated heparin; LMWH low molecular weight heparin (s); LV left ventricle; MAP mean arterial pressure; MLCK myosin light chain kinase; NO nitric oxide; PA pulmonary artery; PARs Proteinase (or protease)-activated receptors; PC protein C; PAI-1 plasminogen activator inhibitor; PE pulmonary embolism; PF 4 platelet factor 4; PLA-2 phospholipase A 2; PN-1 Protease Nexin; PT prothrombin time; RBC red blood cell; RV right ventricle; SMC’S’ s vascular smooth muscle cells; t-Pa tissue plasminogen activator; TAFI thrombin activatable fibrinolysis inhibitor; TF tissue factor (factor III); TFPI Tissue factor pathway inhibitor; TM Thrombomodulin; TNF tumor necrosis factor; TXA 2 thromboxane A2; VEGF vascular endothelial growth factor; vWf von Willebrand factor.

Aggressive angiomyxoma is a rare soft tissue neoplasm that usually arises within the perineum. It often occurs as a vulvar mass and clinically simulates a Bartholin's gland cyst. Most patients are in the second or third decade of life, but some cases have also been reported in children. This is the report of a 21 year old woman with 4.5×3×1.5 cm mass in right labia major. The patient underwent wide local excision surgical treatment. Histological examination showed high vascular myxoid tumor containing spindle cells. Immunohistochemical study of cells showed positive reaction to estrogen and progesterone and negative reaction to S100, SMA and desmin. Treatment with a gonadotropin-releasing hormone agonist was administered to deal with residual tumor and prevent local recurrence for 6 months.

A patient with multiple subcutaneous mobile lesions limited to forearms is presented. Pathologic review of the biopsy confirmed the diagnosis.

We would like to report a rare case of sporadic Creutzfeldt-Jacob disease in Isfahan, Iran. A 61-year-old man without familial or personal history of neurologic disease or hormone treatment presented initially with problems of comprehension and psychomotor condition. On admission to the neurology department, in Kashani hospital, Isfahan, about three months after the first symptoms, neuropsychological examination showed drowsiness, apathetic affect, decreased speech output, visual hallucination, negative attitude, concrete thinking, and impaired judgment. Neurologic examination showed augmentation of muscle tone (rigidity), spontaneous myoclonus involving entire body, impaired pursuit gaze, asterixis and ataxic gait.