Archives of Iranian Medicine
Volume:13 Issue: 1, Jan 2010

West Nile virus is a mosquito transmitted virus that can cause disease in humans and horses. A majority of people infected with WNV will have no symptoms or may only experience mild symptoms, such as headaches. About 20% of infected humans develop a flu-like illness characterized by fever; while in the elderly and immunocompromised West Nile virus can cause a more serious neurologic disease and may be fatal. West Nile virus infection is endemic in the Middle East. West Nile virus can also be transmitted by transfusion through infected blood components. The objective of this study is to find the West Nile virus-RNA incidence and anti-West Nile virus prevalence amongst Iranian blood donors in order to determine whether this emerging infection isa possible risk for the blood supply in Iran. Serum samples from 500 blood donors who donated blood at the Tehran Blood Transfusion Center were collected between May and October 2005. Serum samples were examined for IgM and IgG antibodies to West Nile virus using the ELISA method. The samples were tested for the presence of West Nile virus RNA by the real-time RT-polymerase chain reaction assay. All data were analyzed statistically using the Chi-Square test. All 500 donors were negative for West Nile virus-specific IgM antibody at the time of donation. No WNV RNA-positive samples were detected. The percentage of seropositivity of IgG antibodies to WNV was 5% at donation. No evidence of WNV-specific IgM antibody and WNV RNA in blood donor samples was found. In order to increase the safety of blood donation, it is essential to continue surveillance of this emerging infection in order to protect the blood supply in the future.

Current knowledge of the situation of anaesthesia in developing countries is limited. A survey of the status of education and research based on hospital records، records of the anaesthesia section، nursing records، personal observations as well as personal communication with staff، patients and hospital managers was carried out in a 1863-bed university teaching hospital located in the capital of a least developed Sub-Saharan African Country. Classification and evaluation of the data was based on the three aspects of the role of university teaching hospitals in Western countries: (I) patient care، (II) university teaching and post-graduation training، as well as (III) research activities. The section “patient care” was subdivided into anaesthesia، intensive care medicine، emergency medicine، and pain therapy. The Department of Anaesthesia at the University Teaching Hospital of Lusaka، Zambia، is organized as a subdivision of the surgical department and is not involved in emergency medicine or pain therapy. Thirteen out of seventeen operating theatres، one recovery room، and a ten bed intensive care unit are serviced by the Department of Anaesthesia. Anaesthetic equipment، medical supplies، drugs، and consumables are all in limited supply. There are limited statistics on perioperative complications and mortality. Anaesthesia at the university teaching hospital of a least developed Sub-Saharan African Country is severely short of both a workforce and resources. We have described strategies which may help to reverse this trend، the most important of which is to promote anaesthesia as an essential specialty within hospitals in developing countries.

Performing a delayed primary wound closure is often recommended in patients with gangrenous or perforated appendicitis who have undergone an appendectomy. It can result in increased pain as well as an extended hospital stay which، in turn، increases hospital costs. Delayed primary wound closure remains controversial. The general policy in our institution is to perform a primary wound closure. In this study، we have compared the incidence of wound infection in patients with simple appendicitis to those with gangrenous or perforated appendicitis whose wounds were primarily closed. This is an observational study which was carried out on 400 patients with gangrenous or perforated (50%) and simple appendicitis (50%). Both groups underwent primary wound closure. Patients were followed for wound infection for at least one month after surgery. Data including age، sex، operating time، pathologic report and wound infection were collected. A comparison between the studied groups was made using Student’s t-test for continuous variables and 2 test for categorical variables. The median age of the patients was 23 years. There were 141 (35. 2%) females and 259 (64. 8%) males. The median operating time was 30 minutes. Wound infections were observed in 15 patients (3. 7%)، including 6 cases of simple and 9 cases of gangrenous or perforated appendicitis which was not statistically significant. There was no statistically significant difference in wound infection between the simple and gangrenous or perforated appendicitis groups.

Injuries are a major health problem in developing countries. Recently, the occurrence of injuries and those related to mortality have increased dramatically in Iran. We have conducted this study to report domestic research publications in the field of trauma from 2000 to 2006 in Iran. The contents of 128 biomedical journals were analyzed. Sina Trauma Data Bank (STDB) was selected as an indicator of trauma related articles that have been published in Iranian biomedical journals. The number of trauma related articles in Iran increased during the seven year period (2000 – 2006), but the percentage of total publications was not significantly different. The mean number of authors per article was 2.7+1.3 (1 to 12) and all first authors were Iranian. Females constituted 15.4% (n=156) of first authors. Original articles were the most frequently published articles (n=871; 86.2%). Treatment of injuries and ensuing complications were the most common topics (42%) followed by war injuries (14.1%). Traffic accidents, as the leading cause of trauma death in Iran, were investigated in 27 (2.7%) articles. According to our results, it seems that more attention from researchers and health-policy makers towards trauma is necessary in our country. In addition, publishing a journal with the main theme of injury and trauma could be an effective means for increasing the proportion of trauma related articles.

Mutations in KIT and fms-like tyrosine kinase 3 genes lead to uncontrolled proliferation of leukemic cells with a poor prognosis. Since، data concerning the incidence and associations with patients characteristics vary amongst different studies، the aim of the present study is to identify and quantify the frequency of mutations in Iranian patients suffering from acute myeloid leukemia. Internal tandem duplication and D835 mutations in the fms-like tyrosine kinase 3 gene of acute myeloid leukemia patients were studied through polymerase chain reaction and polymerase chain reaction-RFLP analysis. Amplified products for a point mutation in D816 for KIT have also been identified through the polymerase chain reaction-RFLP technique. The mutations in exon 8 of KIT were detected by using the PCR and the Conformational Sensitive Gel Electrophoresis techniques، and amplified products have been confirmed by sequencing techniques. Internal tandem duplication and D835 mutations in the fms-like tyrosine kinase 3 gene occurred in 18% and 6% of AML patients، respectively. Frequencies of mutation were 1. 4% and 4. 7% in exon 8 and D816 of the KIT gene in acute myeloid leukemia patients. These results were substantially different for various subclasses of French-American-British classification. This study revealed that approximately 30% of acute myeloid leukemia patients have either KIT or fms-like tyrosine kinase 3 genetic mutations. The presence of fms-like tyrosine kinase 3 was significantly associated with M3 morphology and mutations of KIT were significantly associated with M2 and M4 subtypes

Arsenic trioxide and 1،25- (OH) 2D3 (vitamin D3) are used for the treatment oflymphocytic leukemia. However، the effects of combined treatment of these drugs are controversial. In this study، the combined effects of these drugs on the induction of apoptosis in NB4 cells were investigated using the neutral comet assay. NB4 cells were treated with various doses of arsenic trioxide (0. 1 – 3 μM) and vitamin D3 (100 – 600 nM) alone or in combination. Twenty-four hours after treatment، neutral comet assay was performed and apoptotic cells were scored under a fluorescent microscope following staining with ethidium bromide. Results show that all doses of arsenic trioxide used in this study induced apoptosis in NB4 cells. The frequency of induced apoptosis was dose dependent and significantly higher than the controls (P<0. 05 – 0. 01). In contrast، vitamin D3 at concentrations of 100 – 600 nM produced no significant effect on apoptosis induction compared to the controls. Treatment of NB4 cells with a combination of arsenic trioxide and vitamin D3 resulted in reduction of apoptosis induced by arsenic trioxide which was not dependent on the dose of vitamin D3 (P<0. 05). Results indicate that arsenic trioxide is a potent inducer of apoptosis in NB4 cells and vitamin D3 significantly decreased the sensitivity of cells to the induction of apoptosis by arsenic trioxide. These findings suggest that 1،25- (OH) 2D3 might be involved in anti-apoptotic processes via reactive oxygen species scavenging or other mechanisms not yet known.

Anencephaly is a neural tube defect incompatible with life. The aim of this prospective study was to determine the prevalence of anencephaly in Gorgan, northern Iran. Patients and During 1998 – 2005, 49,534 newborns at Dezyani hospital in Gorgan were screened for neural tube defects. Clinical and demographic data of the diagnosed cases were recorded in a pre-designed questionnaire for analysis. These data included sex, ethnicity, parental consanguinity, and residential area. The overall prevalence of neural tube defects and anencephaly were 28 and 12 per 10000 births, respectively. The prevalence of anencephaly was 11 and 12 per 10000 births in male and female newborns, respectively. Considering the parental ethnicity, the prevalence of anencephaly was 12, 16, and 7 per 10000 in Fars, Turkman, and Sistani ethnicity, respectively. The prevalence of anencephaly was 13.1/10000 in newborns with mothers aged >35 years. Consanguinity was seen in 36% of the parents. The highest rate of anencephaly occurred in 1999 (23/10000) and the least was in 2003 (2/10000). The most prevalent season for the occurrence of anencephaly was winter (16/10000). The present study indicated that the prevalence of anencephaly among Iraniannewborns in northern Iran was higher than in the European population.

Nonalcoholic steatohepatitis is a common cause of chronic liver disease. It is important to have a uniform and validated method for scoring liver histology in these patients. Therefore, we propose a modification of the Brunt system by scoring the four histologic features separately and reporting their sums as the nonalcoholic steatohepatitis activity index. A nonalcoholic steatohepatitis activity index was defined which scored the grade of disease activity between 0 and 12 according to four histologic features: steatosis, hepatocyte ballooning, portal inflammation, and lobular inflammation. Fibrosis was separately scored between 0 and 4. A total of 60 liver specimens collected from nonalcoholic steatohepatitis patients were scored by two pathologists at the time of biopsy and after three months. Liver enzyme levels were also correlated with the histologic score. The intra-rater agreement (weighted kappa) for various variables of the scoring system was between 0.59 and 0.80 for one pathologist and 0.78 to 0.95 for the other. The repeatability of the nonalcoholic steatohepatitis activity index was excellent with only 4% of the repeated measures out of the acceptable range of agreement. In addition, liver enzyme levels strongly correlated with the nonalcoholic steatohepatitis activity index. This system provides a fine graduation of liver histologic damage in nonalcoholic steatohepatitis and is well suited for use in clinical trials or natural history studies.

This report describes a rare case of secondary carpal tunnel syndrome due to a lipofibromatous hamartoma of the median nerve. Excision of the fibrofatty tissue between the nerve fascicles without risking damage to the fascicles was impossible. The transverse carpal ligament was incised and an epineurotomy was performed. Within six months, the 25-year-old female patient’s symptoms were much improved.

Heck''s disease or focal epithelial hyperplasia is a benign contagious disease caused by humanpapillomavirus types 13 or 32. It occurs with low frequency in the Iranian population. Thiscondition is characterized by the occurrence of multiple, small papules or nodules in the oralcavity, especially on the labial and buccal mucosa and tongue. In some populations, up to 39% ofchildren are affected. Conservative surgical excision of lesions may be performed for diagnostic oraesthetic purposes. The risk of recurrence after this therapy is minimal, and there seems to be nomalignant transformation potential. In the present work, we presented the clinical case of a 12-year-old Iranian girl with oral lesions that clinically and histologically correspond to Heck’s disease.

Obstructive jaundice is infrequently caused by a foreign body. We report a 42-year-old man whopresented with obstructive jaundice by an impacted shrapnel splinter in the common bile duct (CBD) 23 years after a combat injury. To our knowledge، this is the first case report of this type inIranian literature، although there are a few reports of combat related injuries in other countries. This diagnosis should be considered in the assessment of any patient with jaundice andabdominal pain who has experienced a previous combat injury.

This is the first of two articles reviewing the history of medical symbols. In this first article I have briefly reviewed the evolution of the Greek god، Asclepius، (and his Roman counterpart Aesculapius) with the single serpent entwined around a wooden rod as a symbol of western medicine and have alluded to the misplaced adoption of the Caduceus of the Greek god Hermes (and his Roman counterpart Mercury) with its double entwined serpents as an alternative symbol. In the second part of this article (to be published later)، I have made a tentative suggestion of why the Simorgh might be adopted as an Eastern or an Asian symbol for medicine.