فصلنامه علوم پزشکی دانشگاه آزاد اسلامی
سال پانزدهم شماره 2 (پیاپی 40، تابستان 1384)

Medical plants entail numerous therapeutic capabilities due to their antimicrobial activities. During the present study, the antimicrobial activity of aqueous and methanol extracts of Heracoleum Persicum was determined in vitro. We have gathered the aforementioned plant from heights of Ashkour near Tonkabon. The antimicrobial activity of aqueous and methanol extracts was determined against 14 bacterial and 2 fungal specimens according to the disc diffusion, MIC (minimal inhibitory concentration), and MBC (maximum bactericidal concentration). The aqueous extract of Heracoleum Persicum failed to show antimicrobial activity, however, the methanol extract was effective against bacillus, streptococcous, enterococcous and nocardia. The methanol extract of Heracoleum Persicum has antibacterial activity. Further studies are strongly recommended to find out the possible therapeutic capability of this plant in infectious diseases.

In some countries, wild polioviruses have been isolated from environment despite the absence of viruses being recovered from clinical cases, therefore to confirm of final Polio eradication, WHO has recommended environmental surveillance using sewage specimens and surface water. During the present study, in order to assure the polio eradication in Iran, Sistan-Balouchestan province was chosen as the target area. During a 12-month period, 86 specimens from 2 sewage disposal systems and 5 hospitals, as well as surface water from several rural areas were collected by Grab Sampling and tested for polioviruses using direct and concentrated specimens with 2 concentration Pellet and Two-phase. Then the isolated viruses were serotyped by microneutralization method and differentiated intratypically by ELISA and probe hybridization techniques. Of all studied specimens, 18 (20.9%) were identified as poliovirus, none of which were wild virus fortunately. Among these, 2 (2.3%), 8 (9.3%) and 13 (15.1%) were isolated from direct specimens, Pellet and Two-phase concentrated specimens, respectively. The most frequent viruses were Polio 2 (72.2%) and Polio 3 (27.8%). Results have revealed the efficacy of immunization coverage in Iran. Meanwhile, sufficient surveillance programs have been observed during the recent years.

Over 500,000 women die each year from pregnancy-related complications among whom, 13% are due to unsafe abortion. This study was conducted to compare the side effects of TCu380A and CuSafe300 IUDs including bleeding, pain, and infection during a 6-month period in Karaj health centers in 2003. It was a randomized single–blind clinical trial, during which 270 candidates applied for IUD were randomly placed in two groups of IUD TCu380A and CuSafe300. Having inserted the IUD, its location was controlled by sonography. The side effects were recorded in the following 1,2,3,6 months. Bleeding was more commonly occurred during the first month of implantation in both groups, however, at the 1st,2nd and 6th month, bleeding was significantly lower in CuSafe300 group. Meanwhile, pain was more frequently happened during the first month in both groups while at all intervals CuSafe300 users were complained of pain and infection significantly less than the other group. The 6th month was complicated more commonly with infection among all subjects. Although the CuSafe300 IUD is more expensive than TCu380A, females who have encountered problems while using TCu380A IUD are strongly recommended to insert CuSafe300.

The association between adenomatous polyps and malignancy has an important role in patient screening and follow up after polypectomy. Due to less attraction towards the segmental resection, colonoscopic evaluation of malignancy has found its utmost importance role. Polyp size and morphology have dictated the potential of malignancy in prior studies, however, in recent decade some authorities have paid further attention to dysplasia. During the present study, besides the aforementioned criteria, especial attention was paid to involved region of the colon. Between June 2001 and March 2004, the distribution of 130 adenomatous polyps was compared with synchronous invasive or in situ cancer. Patients were excluded from analysis if they had been previously familial adenomatous polyposis (FAP) or inflammatory bowel disease (IBD). Factors such as age, gender, location of the lesion, size of polyp, histological subtype of adenoma on biopsy, degree of dysplasia, synchronous cancer, color of polyp, and number of polyps were included in the data collection. Multivariate logistic regression test was used to evaluate the association between malignancy and various clinical variables. It revealed histological subtype (OR=16.4, 95%CI: 4.8-86.3), high grade of dysplasia (OR=12.9, 95%CI: 4.5-37.9) and size. 1cm (OR=3.7, 95%CI: 1.9-14.1) to be independent predictor of malignancy. However, location of the lesion (OR=5.9, 95%CI: 1.9-36.9) was an independent risk factor for high-grade dysplasia. Our study recommends to strict follow-up for 3 years intervalafter polypectomy for distal polyps to speleinc flexure, which are greater than 1 cm with villous component.

Transient low back pain is a common complaint following spinal anesthesia. Pregnancy and delivery may also contribute to low back pain due to hormonal and mechanical alterations. The present study was achieved to determine the frequency of low back pain following the caesarean section with spinal anesthesia. Meanwhile, other factors including age, weight, parity, needle thickness and number of attempts were investigated. For this analytic-descriptive study, all pregnant women referring for caesarean section (with spinal anesthesia) to Javaheri Hospital during the first two seasons in 2004 were included. Low back pain was inquired 6 weeks following the operation. Among 200 studied cases, 83 (46.5%) reported low back pain after caesarean section. Age, weight, parity and the type of the needle were significantly associated with low back pain, while number of attempts did not correlate with low back pain. Low back pain is a common complication of spinal anesthesia. Obesity, older age and frequent parity may increase the possibility of this complaint following the operation, whereas narrower needles may be associated with decreased frequency.

Totally, 3-5% of neonates have detectable congenital anomalies. Congenital anomalies are important causes of neonatal morbidity and mortality. With decreasing incidence of fatal infectious diseases, congenital anomalies would be one of the main causes of infants mortality in future. This study has performed to determine the prevalence of congenital anomalies in 1000 live-born neonates at Javaheri Hospital in Tehran during a 6-month period in 2004. For this cross sectional study, 1000 live-born neonates were selected. Neonates with major and minor anomalies were identified by reviewing their medical records. Finally, data analysis was achieved by SPSS software. Congenital anomalies were identified in 52 of 1000 live-born neonates, mostly among male neonates. Undescended testis was by far the most common congenital anomaly. According to the involved system, there was orderly the anomalies of musculoskeletal system, urogenital, cardiovascular, CNS and GI tract. Calcaneovalgus (musculoskeletal anomaly) and undescended testis and hypospadiasis (urogenital anomalies) were found more frequently than others. Some of the congenital anomalies are not recognized at birth and may occur later in life, thus, the aforementioned prevalence rate is underestimated. Attention to preconception care, prenatal care and genetic counseling for high risk parents have important role in prevention of congenital anomalies.

Beta-thalassemia is an autosomal recessive disorder that most commonly caused by point mutations in the beta-globin gene. IVS-I-5 and IVS-I-110 are the most frequent mutations found among Iranians comprising 12% of all mutations. In this study, we develop the implementation of the reverse Dot-Blot (RDB) hybridization technique as a rapid and simple method for the detection of the two common mutations in the beta-globin gene. Total genomic DNA was extracted and PCR with specific primer (forward and reverse primer) was performed on region of beta-globin gene consisting the two mutations. Labeled dNTPs with DIG-II-dUTP were used in PCR mixture therefore PCR product contained DIG labeling formed. The oligonucleotide probe was immobilized onto a Biodyne C nylon membrane via activation membrane. The strips were hybridized with 10 microliters of denatured PCR product labeled to DIG at 42°C for 60 minutes. After blocking strip with the blocking buffer, the strip exposed to 5 unit anti-DIG antibody conjugates with alkaline phosphatase for 30 minutes at room temperature. The color detection was performed with nitroblue tetrazolium salt (NBT/BCIP) substrate for 120 minutes. The presence of a particular DNA sequence was detected by the appearance of a dot on the membrane. Normal individuals (N/N) showed dots with each wild-type sequence but not with any mutant probe. Heterozygotic individuals showed the appearance of a single mutation dot in addition to all the normal dots and homozygous individuals revealed dots with each mutant probe but not with any wild-type sequence. we described a rapid and simple strategy to detect beta-thalassemia mutations based on PCR followed by reverse Dot-Blot hybridization.

There are no data on the frequency and biochemical expression of the hemochromatosis associated mutations, C282Y and H63D, in Iranian adult population. This is the first study among Iranians that may advocate a screening program. We investigated the frequency of the C282Y/H63D HFE gene mutations in a group of 1029 randomly selected Iranian blood donors as well as transferrin saturation (TS), serum iron and serum ferritin levels. DNA extraction with salting-out method was performed on blood samples and the analysis of HFE gene mutations was performed by PCR amplification followed by digestion with RsaI and BclI restriction enzymes. The mean age of donors was 40±11 years and 92.7% were male. No homozygosity was detected for the C282Y mutation. Heterozygosity for the C282Y mutation was 0.2%, while homozygosity and heterozygosity for the H63D mutation were 1.6% and 19.6%, respectively. There was no compound heterozygote for the C282Y/H63D mutation. These data resulted in allele frequencies of 0.1% and 11.3% for C282Y and H63D mutations, respectively. Serum iron and TS were not influenced by the type of C282Y and H63D mutation. There was no difference in ferritin levels according to type of HFE mutations among blood donors. This study shows low allele frequency for C282Y and H63D mutations in Iran. These results also suggest that there is not any association between HFE gene mutations and iron, TS and ferritin level among Iranian population. The genetic screening for the HFE gene mutation in Iran is not recommended until the true prevalence of other mutations in all hemochromatosis genes could be established.

May-Hegglin anomaly (MHA) is a rare autosomal disorder which is characterized by triad of thrombocytopenia, giant platelets and Dohle like inclusion bodies in granulocytes. This is the first report of MHA and its mutation from Iran. The specimen of two patients (father 51 and son 15 y/o) collected with EDTA and tri-sodium citrate anticoagulants. CBC and peripheral blood smear studied by automatic cell counter and microscopic examination, respectively. Direct sequencing of extracted DNA of certain exons of MYH9 gene was performed. Both patients had demonstrated the diagnostic triad of MHA. Mutations showed homozygous and heterozygous pattern in the father and the son, respectively. This is the first report of MHA from Iran. The mutation of both patients was E1841K which is the most common type among MYH9 mutations in MHA. The most interesting finding was the homozygous mutation that did not entail any clinical severity.

Infectious endocarditis (IE) is caused by a variety of microbial agents and poses severe complications such as embolic and septic events. This condition is aggravated among elderly patients and is associated with a high morbidity rate. Recent advances in diagnostic modalities, especially transesophageal echocardiography (TEE) have revolutionalized early diagnosis, prediction of emboli, treatment and evaluating the outcomes of interventions. In this article, we explain our experience with 4 cases of infectious endocarditis. Having had the clinical suspicions to IE, patient underwentroutine diagnostic procedures including transthoracic echocadiography (TTE) and blood culture. Surprisingly, TTE was negative for all patients however, the clinical symptoms and the presence of complications were favoring IE, therefore, all were subjected for TEE. TEE confirmed the diagnosis of IE in all 4 cases. There were mitral valve vegetations measured 0.5-3cm in three cases, whereas the other one presented with aortic valve vegetation measured 1cm. Three patients had blood culture positive for staphylococcus aureus and one patient with aortic valve vegetations had enterococcus positive blood culture. All patients had developed various complications and one had splinter hemorrhage. Two patients underwent surgical valvuloplasty, however, one of them was re-operated for splenectomy due to splenic abscess. All patients received an appropriate antibiotic regimen including vancomycine and cefteriaxon and were discharged in satisfactory state. Patients were routinely admitted for follow up TEE, while none developed symptoms or complications compatible with IE. Our results revealed that TEE is significantly superior to TTE for diagnosis and follow up of IE.