Archives of Iranian Medicine
Volume:13 Issue: 5, sep 2010

The main aim of our study was to investigate the influence of calcification on the accuracy of 64-slice computed tomography for identification of significant coronary artery disease. A contrast-enhanced 64-slice computed tomography was performed prior to invasive coronary angiography in 168 consecutive patients with suspected coronary artery disease. All coronary segments 1.5 mm or larger in diameter were evaluated for the presence or absence of significant coronary artery stenosis, defined as a diameter reduction of >50%. The patients were also ranked by total calcium score which was expressed in Agatston units and the impacts of calcification on diagnostic accuracy of 64-slice computed tomography were assessed. Results were compared with quantitative coronary angiography as the standard of reference. The overall sensitivity, specificity, positive predictive value, and negative predictive value of 64-slice computed tomography for detection of significant stenosis were: by segments, 95%, 98%, 91%, and 99%, respectively; by patient, 98%, 97%, 96%, and 99%, respectively; and by artery, 94%, 93%, 91%, and 95%, respectively. In mild and moderate calcium scores (0 – 418 Agatston units), the sensitivity was 100%, specificity was 93%, positive predictive value was 97% and negative predictive value was 100%. Severe calcification (>419 Agatston units) reduced the sensitivity, specificity, positive, and negative predictive values of multi-slice computed tomography to 89%, 60%, 89%, and 60%, respectively. Our study revealed that the 64-slice computed tomography is a highly accurate diagnostic modality for detecting hemodynamically significant coronary stenosis; however, severe calcification is considered as a shortcoming which limits the routine application of multi-slice computed tomography in daily practice.

A functional polymorphism in the uncoupling protein 2 (UCP2) gene promoter has been associated with obesity and type 2 diabetes (T2D) in some populations. The impact of UCP2 polymorphisms on diabetes and obesity is still under debate. Contradictory results have been reported in different populations world-wide. To clarify the contribution of the UCP2 gene -866 G/A polymorphism in the Iranian population, we studied its association with obesity and T2D. A total of 225 unrelated subjects were studied: 75 T2D patients without obesity, 75 obese patients without diabetes and 75 control subjects. The UCP2 -866 G/A polymorphism was determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). In the normal Iranian population, GG polymorphism was significantly associated with an increased HDL-C level (P=0.027). G/A polymorphism was not associated with obesity and T2D in our study population, but the odds ratio (OR) between GG and G/A polymorphism was 0.61 with a confidence interval (CI) range of 0.34 – 1.08 in obese patients. Subjects with AA genotypes in all of the studied groups showed a lower body mass index (BMI) than subjects with the GG genotype. Although the data in our study population is not statistically significant, the A allele in the UCP2 gene promoter seems to be protective against obesity. This may suggest the possibility of UCP2 as a target molecule for studies on the etiology and treatment of obesity.

Dietary factors seem to play a major role in esophageal carcinogenesis in Golestan Province, a high-incidence area for esophageal cancer in northern Iran. The current study was conducted to evaluate previous reports on severe deficiency of vitamin intake in Golestan. Using a food frequency questionnaire, food intake data were collected from 30,463 healthy participants in the Golestan Cohort Study. Intake of selected nutrients was compared with recommended daily allowance and lowest threshold intake values. Vitamin A intake in the majority of participants was lower than recommended values. The proportion of participants with intakes lower than lowest threshold intake was as follows: urban men, 20%; urban women, 31%; rural men, 48%; and rural women, 64%. The pattern of vitamin C deficiency was similar to that of vitamin A, however, vitamin C deficiency was less common. Daily intake of vitamin C lower than the LTI was as follows: urban men, 6%; urban women, 9%; rural men, 13%; and rural women, 19%. On the other hand, protein intake in the majority of the general population in Golestan was higher than recommended values. Severe deficiency in vitamin intake among women and rural dwellers may partly explain the high incidence of EC among inhabitants in rural areas and the male:female ratio that is approximately 1 in Golestan; while EC is much more common in men in many low-incidence areas.

Although several studies have been performed to evaluate the personality differences amongst smokers with different dependency levels, they do not use constant criteria for patients selection. The inconsistencies between some of these findings suggest the need for using solid criteria such as the modified Fagerström Tolerance Questionnaire (mFTQ) score to evaluate the relation between personality traits and impulsivity differences and the severity of nicotine dependency. In this study, 22 heavily dependent, 37 lightly dependent and 30 non- smokers were recruited using the mFTQ score, a widely used test of nicotine dependence. All participants completed the Beck Depression Inventory, Cattle Anxiety Scale, Temperament, and Character Inventory and three other personality questionnaires intended to measure impulsivity: the Barratt’s Impulsiveness Scale, Eysenck Impulsiveness Questionnaire, and Zuckerman’s Sensation Seeking Scale. Participants also had to perform a behavioral choice task, the Delay Discounting Choice, which is designed to assess impulsivity. Although heavily dependent smokers scored higher than non-smokers and lightly dependents on the Beck depression Inventory and most of the impulsivity subscales; lightly dependent smokers scored higher than non-smokers only on a few subscales of the impulsivity scores. The mFTQ scores correlated significantly with many scores of the impulsivity subscales. These results would be helpful to design more specific questionnaires for the psychological assessment of smokers according to nicotine dependence level and to adopt more etiologic oriented treatment approaches in the future.

There are different clinical responses to omeprazole treatment in Iranian patients with gastroesophageal reflux disease. Omeprazole is metabolized in the liver by the cytochrome p450 2c19 (CYP2C19) enzyme. Two common polymorphisms of the CYP2C19 gene affect CYP2C19 enzyme activity. We investigated the effect of CYP2C19 gene polymorphisms on the clinical response to treatment with omeprazole in Iranian patients with erosive reflux esophagitis. Eighty-two Iranian patients with reflux esophagitis were enrolled in the study and underwent treatment with omeprazole at 40 mg daily for 4 weeks. A 2 mL sample of venous blood was obtained from each subject. CYP2C19 genetic polymorphisms were detected using the PCR-RFLP method. The patients were grouped into homo-extensive metabolizers and hetero-extensive metabolizers based on their CYP2C19 polymorphism. The grade of esophagitis was determined via endoscopy. The symptoms score was assessed at the beginning of treatment. Our results showed that the rate of complete clinical response to treatment with omeprazole was 95% in the hetero-extensive metabolizers group, which was higher than in the homo-extensive metabolizers group (P<0.001). CYP2C19 polymorphism influences the therapeutic efficacy of omeprazole in the treatment of Iranian patients with erosive reflux esophagitis. The clinical response and endoscopic healing of esophagitis are both affected by CYP2C19 genotype condition.

On June 16 and 17, 2007, the medical clinic of a prison in Isfahan, Iran received multiple reports of gastrointestinal illness among prisoners. A cross-sectional study was therefore undertaken to determine the extent, causative agent and possible source of the outbreak. A case-patient was defined and patient information was collected with a standardized questionnaire. Stool samples were collected from the patients and restaurant employees, and analyzed for the presence of enteric bacteria by routine bacteriological methods. Shigella isolates were identified and serotyped by commercially available antisera. The relationship between the strains was determined using antimicrobial drug resistance pattern analysis and enterobacterial repetitive intergenic consensus polymerase chain reaction (ERIC-PCR). Seven hundred one inmates experienced gastrointestinal illness and severe diarrhea. The attack rate was 14.02%. Rectal swabs and stool cultures recovered from patients tested positive for Shigella flexneri serotype 3a. All tested isolates had a similar antibiotic resistance and ERIC-PCR pattern. Our findings demonstrated that raw vegetables were more likely to be the causative agent of this outbreak. The results indicated that a single clone of S. flexneri was responsible for this outbreak. Although we could not trace the exact origin of the organism, the consumption of raw vegetables one day prior to the onset of illness was strongly associated with an increased risk of S. flexneri infection. This study emphasizes the need for accurate monitoring and surveillance of food and vegetables consumed in prisons.

Post-transplantation lymphoproliferative disorders (PTLD) are a spectrum of diseases defined as polyclonal or monoclonal proliferations of lymphocytes which occur after solid organ transplants. In this study, we report our first experiences with PTLD following liver transplantation in Iran.Patients and We retrospectively analyzed five cases of PTLD which followed liver transplantation among more than 550 liver transplants in our center. Of these, three were pediatric cases and two were adults. The underlying causes were tyrosinemia, autoimmune hepatitis, and progressive familial intrahepatic cholestasis (PFIC) in the three pediatric cases. HCV hepatitis was the primary cause for cirrhosis in one of the adults and the other adult was labeled as cryptogenic cirrhosis.All cases, except for one, developed PTLD during the first year following liver transplantation. Patients were diagnosed as PTLD, B-cell, MALT and Hodgkin-like (according to the WHO classification of PTLD). The three pediatric patients died despite discontinuation of immunosuppressive drugs and chemotherapy. Fortunately both adult patients, until now, are still alive. The incidence of PTLD in our center is lower than previous reports from other centers (0.9%), with a 60% mortality rate and worse prognosis in the pediatric age group.

This study was conducted to evaluate the hematological effects of umbilical cord clamp timing and delivery type in term infants 48 hours after birth in Imam Hossein Hospital, Tehran, Iran. From Oct 2007 – March 2008, 100 mother-infant eligible pairs were selected and divided by cord clamp timing (≤15 s and >15 s) for hematologic value determination between the two groups. Data analysis was performed with SPSS for Windows statistical package (version 13). Maternal hematological status was assessed upon admission to the delivery room. A total of 100 mother-infant pairs were divided into two groups: delayed cord clamp time within 15 s (n=70) or early cord clamp time [15 s after delivery (n=30)]. The groups had similar demographic and biomedical characteristics at baseline. Forty-eight hours after delivery the mean infant hemoglobin (Hgb; 16.08 gm/dL vs. 14.5 gm/dL; P<0.001) and hematocrit (Hct 47.6 vs. 42.8; P<0.001) levels were significantly higher in the delayed clamping group. There was no significant difference in ferritin levels (214.7 vs. 173.6 ng/dL; P=0.08). Fifty infants were born vaginally and 50 were delivered by cesarean section. Infants delivered vaginally had significantly more delayed cord clamp times (>15 s; P<0.001). Delaying cord clamping increases the red cell mass in term infants. It is a safe, simple and low cost delivery procedure that should be incorporated in integrated programs that are aimed at reducing iron deficiency anemia in infants in developing countries. Vaginal delivery facilitates this action.

Mycosis fungoides is the most common type of cutaneous malignant T cell lymphoma which primarily affects skin. However, extracutaneous manifestation may occur in advanced stages, mostly observed in postmortum studies. We present a case of mycosis fungoides that disseminated to the true vocal cord of a 48 year-old African American man who presented with hoarseness. Only two cases that have also demonstrated a rare involvement of the true vocal cord have been reported in the English literature. In both cases, mycosis fungoides infiltration of the true vocal cord was seen postmortem, along with visceral dissemination of mycosis fungoides. We herein describe a single extracutaneous manifestation of mycosis fungoides in the true vocal cord of a living patient with a 21-year diagnosis of mycosis fungoides. Vocal cord involvement by mycosis fungoides must be considered as one of the differential diagnoses in any mycosis fungoides patients who complain of persistent hoarseness. Awareness of this entity is clinically important due to the necessity of a different management.

Anthrax is an ancient disease of animals and men, caused by Bacillus anthracis. The diagnosis of cutaneous infection is relatively easy, but other clinical forms might escape recognition. We present two rare and fatal forms of anthrax: meningeal in a 33-year-old male shepherd and intestinal in a 4-year-old boy. The former was admitted to the hospital with complaints of headache, vomiting, fever, and decreased level of consciousness. The latter presented with abdominal pain and distension, vomiting, and fever. Both cases were proven by animal inoculation.

We report a case of combined subcutaneous, intrathoracic, and abdominal splenosis who presented with attacks of flushing, tachycardia and vague abdominal pain. The patient’s past medical history included a splenectomy due to abdominal trauma and years later, a lung lobectomy due to recurrent pneumonia. An enhancing solid mass adjacent to the upper pole of the left kidney and nodular pleural based lesions in the left hemi-thorax along with nodular lesions in subcutaneous tissue of the left chest wall suggested possible adrenal malignancy with multiple metastases. Histopathologic examination demonstrated benign lesions of ectopic splenic tissue.

A 67-year-old myopic man presented to the Ophthalmology Department of a teaching hospital in the mountainous state of Sikkim with complaints of red eye, ocular discomfort, and sensation of something moving in his right eye that lead to occasional visual blurring from the previous four days. His symptoms started after washing his face in a stream. Clinical diagnosis was a leech in the limbus of the right eye at the 12 o’clock position. Ocular leech infestation should be considered in a patient with a history of swimming or face washing in streams and lakes. Herein we report a case of ocular leech infestation that presented as red eye with intermittent blurring of vision in the affected eye, and discuss the differential diagnosis and clinical significance.

Many nations are indebted to Avicenna (Ibn-Sina) for their scientific progressions and civilization. Many countries in the Middle East, Africa, and Europe have honored Avicenna, the great Persian scientist, by depicting his vignette on their postage stamps. The symbolic value of Avicenna has been chosen to commemorate scientific occasions, achievements and anniversaries, which represents the ultimate performance of conscious honoring.