مجله دانشکده پزشکی اصفهان
پیاپی 314 (هفته سوم بهمن 1393)

No comprehensive and population-based study has been so far conducted in Iran to determine the epidemiologic pattern of myocardial infarction (MI) and particularly in-hospital mortality rate and the effective factors. This study aimed to determine the epidemiologic pattern and associated risk factors. This prospective, population-based cohort study used the data of 20750 patients with MI in Iran in 2012. The in-hospital mortality rate was calculated using Cox regression. Univariate analysis of variances and multiple logistic regression were used to determine the effective factors on the patients’ mortality. The odds ratio and 95% confidence interval (CI) were reported using Stata software. 15033 patients (72.4%) were men. The mean age of the patients was 61.2 ± 13.4 years. The case fatality rate of in-hospital mortality was 12.1%. The in-hospital mortality rate was higher in women and was 6.74% (95% CI: 6.4-7%) in at-risk patients. Age of over 84 years, being female, educational level, smoking, lack of thrombolytic therapy, diabetes type 2, chest pain prior to arriving in hospital, right bundle branch block, ventricular tachycardia, percutaneous coronary intervention (PCI), lateral MIs, and ST segment elevation (STEMI) were determinants of in-hospital mortality in the patients. In view of the results obtained in this study, it seems that STEMI, lack of thrombolytic therapy, the age of over 84 years, and ventricular tachycardia have the highest impact on in-hospital mortality of the patients with MI. The results of this study are helpful in planning for monitoring and promoting healthcare and treatment for the patients.

Candidiasis is one of the most important fungal infections caused by different species of Candida. The most common etiologic agent is Candida albicans. In recent years, there are many reports about the failure treatment of patients with different clinical forms of candidiasis. Statins have been found to have antifungal activity as well as cholesterol-lowering effects. Anethum graveolens has also exhibited antifungal and anti-hyperlipidemic activities. The purpose of the present study was evaluation of antifungal activity of Anethum graveolens and atrovastatin against Candida species in comparison with fluconazole. The present study was performed on 10 previously identified Candida isolates. Minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC) results were obtained and compared using microdilution method for fluconazole, atrovastatin and Anethum graveolens extract. Of 10 Candida isolates, 5 (50%) were susceptible to fluconazole and 3 (30%) were dose-dependent. Two isolates, including Candida albicans and Candida krusei, were resistant to fluconazole. MIC range for atrovastatin was 32-128 µg/ml. In this study, our finding showed that atrovastatin has antifungal activity as the same previous reports; but, aqueous extract of Anethum graveolens showed no antifungal activity against the Candida species (Candida albicans, Candida parapsilosis, Candida krusei, Candida glabrata, and Candida kefyr).

Asthma is a chronic inflammatory disease of airways and is a multifactorial disease in which, several genes have been identified affecting occurrence and severity of the disease. T-cell immunoglobulin mucin (TIM) gene family that is expressed on T cells and its locus is located on chromosome 5 is one of these genes. A member of the TIM family, TIM-3, is selectively expressed on the surface of differentiated T helper-1 (Th1) cells. Interactions between TIM3 and galectin-9 (TIM3 ligand) regulate Th1 responses and play an important role in the development of allergic disease. Polymorphisms, that affect the structure and function of molecules, may increase the susceptibility to allergic diseases and asthma. In the present study, we assessed the association of the genotype and allele frequencies of the 4259G>T polymorphisms with asthma and the relationships among this polymorphism to IgE levels in patients with asthma. In this case-control study, we had 209 patients with asthma in case group and 200 healthy people in control group. The variant of genotypes was determined using polymerase chain reaction–restriction fragment length polymorphism (PCR-RFLP) method. The association of this polymorphism and serum immunoglobulin E was analyzed via enzyme-linked immunosorbent assay (ELISA) method. To assess the frequency of genotypes and its relationship with serum immunoglobulin E and asthma, chi-square test was used and P < 0.05 was considered significant. The genotype and allele frequency of 4259G>T polymorphism were significantly different between the patient and controls. Significant association was observed between this polymorphism and the risk of asthma. The results showed that the 4259G>T polymorphism of TIM3 gene may be associated with the susceptibility of asthma and this polymorphism may affect the performance of TIM3 binding to the ligand molecule (Galectine 9).

Current treatment strategies of psoriasis are not completely satisfactorily. By inhibiting inflammatory cytokines, nicotinamide may enhance the effects of current topical treatments. We investigated whether the combination of topical calcipotriol and nicotinamide is more effective than calcipotriol alone in treatment of psoriasis. Adult patients with mild to moderate psoriasis were randomized to receive topical calcipotriol 0.005% and nicotinamide 4% in combination or calcipotriol 0.005% alone, twice daily for 12 weeks. Patients were visited by a dermatologist at baseline and then, after the first and third months of therapy; and psoriasis severity was evaluated using the modified psoriasis area and severity index (PASI). Also, patient’s satisfaction was evaluated at the end of the trial using a 10-point rating scale. Sixty five patients (35 men) with the mean age of 36.5 ± 8.5 years completed the trial. Lesions on both sides were similar regarding baseline PASI score. At the end of the trial, PASI score was more reduced with calcipotriol + nicotinamide (83.6 ± 7.9 percent) compared to calcipotriol alone (77.8 ± 9.7 percent) (P < 0.001). Patients were also more satisfied with the improvement of lesions with calcipotriol + nicotinamide compared to calcipotriol alone (P < 0.001). Side effects included mild erythema and pruritus (4.6%) and moderate burning and sensitivity to light (3.0%). Nicotinamide can enhance the efficacy of calcipotriol when used in combination for topical psoriasis treatment, and it may be a good adjuvant to the current treatment regimens of psoriasis.

Vitiligo is a cosmetically disfiguring acquired depigmenting disorder caused by the loss of functional melanocytes in the epidermis. Various approaches used for the treatment of vitiligo can be classified as medical and surgical therapies. Non-cultured autologous melanocyte transplantation is a new and effective surgical treatment for stable vitiligo. This study aimed to evaluate the effect of the melanocyte cell suspension in Jokliks medium in the treatment of stable resistant vitiligo. Ten patients with stable vitiligo, resistant to standard treatment, underwent the treatment via melanocyte cell suspension in Jokliks medium. The repigmentation was assessed during 3 weeks, and 3 and 6 months. The mean repigmentation of 10 patients with 16 lesions was 14% in 3 weeks, 37% in 3 month and 42% in 6 month that was poor repigmentation (less than 50%). Results of this pilot study showed less than 50% repigmentation using melanocyte cell suspension in Jokliks medium, especially in light skin type patients, without using adjunct treatments like phototherapy.