Archives of Iranian Medicine
Volume:14 Issue: 4, Jul 2011

This study compared histological and immunohistochemical changes of cutaneous leishmaniasis treated with meglumine antimoniate, imiquimod, and the combination of both therapies. Single blind clinicopathological studies of fifteen patients with old world cutaneous leishmaniasis in Kerman, Iran were included. A total of four patients received a combination of imiquimod (5% cream) and intra-lesional meglumine antimoniate weekly for four weeks. Monotherapy with imiquimod was given to seven patients and four patients were treated with meglumine antimoniate intralesionally. Histological confirmation was performed before and during therapy. Semi-quantitative histological parameters such as numbers of mixed inflammatory cells (cells/mm2) and percentages of Langerhans cells (CD1a+), T-cells (CD3+), B-cells (CD20+), and macrophages (CD68+) were calculated immunohistochemically in the dermis and adjacent epidermis. Topical imiquimod significantly reduced mean histiocytic cellular aggregation size (P<0.05). Meglumine antimoniate reduced parasite load and infected activated histiocytes in the dermis (P<0.05). Meglumine antimoniate therapy decreased epidermal CD3+ lymphocytes but increased them in the dermis, within the granulomas (P<0.05). During topical application of imiquimod a depletion of CD1a+ dendritic cells in the epidermis (P<0.05) and slight predominance of dendritic cells in the dermis were observed. Combined therapy and imiquimod monotherapy decreased CD68+ macrophages in the dermis (P<0.05). Meglumine antimoniate decreases parasite load with considerable effect on up-regulation of T-cells, which demonstrates that meglumine antimoniate works as parasitocidal and immunomodulator, which could be a first line of treatment. Imiquimod, as an immunomodulator, accentuates the host immune response and reduces granuloma size which could be effective immunomodulator for combination therapy. Monotherapy of imiquimod is less effective than the two other regimens in decreasing parasite load, inflammation and congestion at the inoculated site.

Orthotropic liver transplantation (OLT) is the final procedure of both end stage and metabolic liver diseases. Hepatocyte transplantation is an alternative for OLT, but the sources of hepatocytes are limited. Bone marrow mesenchymal stem cells (BM-MSCs) can differentiate into hepatocyte-like cells and are a potential alternative source for hepatocytes. We aimed to investigate the differentiation potential of BM-MSCs into hepatocyte-like cells. Human BM-MSCs from a healthy donor were cultured and differentiated into hepatocyte-like cells. We investigated the expression of hepatocyte-specific markers in MSC-derived hepatocyte-like cells (MSC-HLCs) and evaluated their functionality using metabolic assays. MSC-HLCs expressed hepatocyte-specific markers at both mRNA and protein levels. In addition, the cells had the ability to uptake low density lipoprotein (LDL), clear ammonia, secrete albumin, and store glycogen. MSC-HLCs were transplanted into a familial hypercholesteromia patient. Human MSCs can be differentiated into partially functional hepatocyte-like cells. Thus, they could be a potential source for cell therapy in liver disorders.

This study determined the importance of including tests for refractive errors in vision screening. In this cross-sectional study, we performed a random cluster sampling of schoolchildren in the city of Dezful, Iran. After sampling and obtaining informed written consents from their parents, children underwent examinations at the school sites. Students underwent tests of visual acuity, cover tests and cycloplegic refractions. Elementary and middle school students who had a visual acuity of 20/20 or better in both eyes were included in the study. From 3673 elementary and middle school students, 2957 (80.5%) had 20/20 vision or better. Of these, 16.1% [95% confidence interval (CI): 14.8 – 17.4] were ametropic, 0.4% had myopia and 10.1% had hyperopia. Mean sphere in those with hyperopia was +2.6±0.7 (range: +2.0 to +7.28) diopter (D). Astigmatism was detected in 6.6% and the mean cylinder was -0.9 (range: -0.75 to -3.25) D. The rate of anisometropia was 1.5% (95% CI: 0.8 – 2.0). Screening results of 20/20 vision for schoolchildren does not necessarily indicate normal eye status because hyperopia and astigmatism may still be sources of visual discomfort. To identify these cases and increase the sensitivity of screening tests, measurement of refractive errors by cycloplegic refraction tests might be included in vision screening.

Hepatitis B virus initiates a complicated cascade process leading to chronic hepatitis B, cirrhosis, and hepatocellular carcinoma. In inflammatory situations, myeloperoxidase is released in plasma and binds to apolipoprotein A-1 in high-density lipoproteins. This study aims to evaluate the level of plasma myeloperoxidase as well as the pattern of plasma proteins in patients with chronic hepatitis B. Included in this study were 30 male subjects: 19 chronic hepatitis B patients, 6 HBV-related cirrhotic patients, and 5 healthy controls. Plasma myeloperoxidase was measured using enzyme-linked immunosorbent assay. Proteomic analysis of plasma proteins was performed by two-dimensional gel electrophoresis (2-DE) and mass spectrometry. One way ANOVA was used for data analysis. Mean plasma myeloperoxidase levels were higher in patients with liver cirrhosis (65.5±12.5; P=0.007) and chronic hepatitis B (53.7±10.6; P=0.18) when compared with healthy subjects (45±7.6). Moreover, a positive correlation was found between plasma myeloperoxidase levels and hepatic fibrosis stage (r=0.53, P=0.002; r=0.63, P=0.000). Proteomic analysis showed an altered plasma protein pattern in progressive hepatitis B and down-regulation of the major apolipoprotein A-1 along with the appearance of a variety of spots noted to be apolipoprotein A-1isoforms with different molecular masses. In this study, progressive liver injury due to HBV infection correlated with higher plasma myeloperoxidase and an altered plasma apolipoprotein A-1pattern.

Manifestations of dyslexia depend on language systems and scripts. This study explored the prevalence and clinical features of developmental dyslexia among monolingual Persian students and provided insights on mechanisms involved in reading Persian. To measure reading ability we developed a new instrument, Analysis of Persian Reading Ability, which had acceptable validity and reliability. A total of 1562 children aged 6 ½ – 14 were randomly selected from a population of 109696 primary school students in the city of Qom, Iran. Using a variety of statistical and clinical criteria, 82 (5.2%) of the sample were classified as dyslexics. A detailed analysis of reading errors revealed eight types of errors related to three categories. The most frequent category in both dyslexic and the matched control group was phonological, followed by pragmatic and visual errors. The observed prevalence rate of dyslexia and reading error categories would suggest that Persian in vowel-free format is an opaque language and predominant use of a sub-lexical strategy is involved when reading Persian.

Abdominal colic, constipation and delay in gastric emptying are symptoms of lead poisoning, but there is scant information about the effect of lead on gastric motility. In the present study, we investigated the effect of lead acetate on gastric motility in rats. Animals were divided into nine groups (n=8); four groups were exposed to lead acetate solution (1%) for 1, 2, 3, and 4 weeks (Pb1, Pb2, Pb3, and Pb4 groups, respectively). Sodium acetate solution was given to another four groups for 1, 2, 3, and 4 weeks (Na1, Na2, Na3, and Na4 groups, respectively) and the control group had free access to tap water. Gastric motility was measured in the basal and acetylcholine (Ach)-stimulated states using a physiograph instrument. Nitric oxide metabolite of gastric tissue was determined by Griess micro-assay. There were no significant differences between basal and Ach-stimulated gastric motility in Pb1, Pb2, Na1, and Na2 groups. However, it was significantly greater in Pb3 and Pb4 groups when compared with Na3 and Na4 groups in both basal and Ach-stimulated states (P<0.05). In addition, nitric oxide metabolite of gastric tissue was more in all Pb groups in comparison with their Na counterparts (P<0.05). We found that lead exposure could affect gastric motility via the nitric oxide pathway

The limitations of antipsychotics for treatment of schizophrenia have led to investigation of the usefulness of pharmacological augmentation strategies. Clinical studies have provided evidence for glutamate abnormalities in schizophrenia. Topiramate is an anticonvulsant drug with alpha-amino-3-hydroxy-5-methylisoxazole-4-propionic acid receptor antagonist properties; therefore, the objective of the present study was to explore the therapeutic efficacy of topiramate as an adjunctive medication in schizophrenia. A 17 week, double-blind, placebo-controlled clinical trial was performed on 80 patients (25 – 65 years) from 2005 – 2007. All were hospitalized in Mashhad psychiatric hospitals with chronic DSM-IV-TR-diagnosed schizophrenia. All participants received up to 300 mg/day of clozapine. In addition, participants randomly received either topiramate (200 – 300 mg/day) or placebo gradually added to their ongoing treatment. Efficacy of medication was measured by administering Positive and Negative Syndrome Scale at baseline and weeks 4, 8, 12, and 17. During the study, 5 patients from the placebo group and 12 participants from topiramate group were excluded. Clozapine and topiramate group showed significant decreases in all three subscales of PANSS values from baseline, with the maximum efficacy in week 12. However, after tapering topiramate, the general psychopathology sign was the only subscale that showed a significant difference. The clozapine and placebo group showed a significant decrease in all three subscales of PANSS values compared to baseline. The significant efficacy for all subscales was obtained at the end point. No significant differences in PANSS scores from baseline to end point were noted between case and control groups. Augmentation of clozapine and topiramate did not significantly decline patterns in any of the three subscales of PANSS compared to the clozapine and placebo group.

Neovascularization is an important factor for predicting tumor behavior. Evidence suggests that endoglin (CD105) is a powerful marker of neovascularization and determination of microvessel density in several malignancies, and can be used as an agent to predict lymph node metastasis. However, it is controversial, particularly in head and neck squamous cell carcinoma.We studied CD105-MVD in tongue squamous cell carcinoma and evaluated its correlation with lymph node metastasis in relation to sex, age, and histopathologic grade. This study analyzed a total of 40 cases of tongue squamous cell carcinoma by dividing patients into two groups, a) with metastatic lymph nodes (N+) and b) without metastatic lymph nodes (N-). By CD105 immunostaining, microvessel density was determined in three different areas (intratumoral, invasive front and adjacent normal tissue) of all cases. Statistically, we evaluated the relation between microvessel density and lymph node involvement, in addition to other clinicopathologic factors by using the Kolmogorov-Smirnov test, t-test, and other analyses. CD105-MVD in the invasive front (P≤0.001) and intratumoral (P≤0.006) areas of the N+ group was significantly higher than in the N-group. In addition, there was a correlation between CD105-MVD and differentiation in the invasive front area (P≤ 0.013) No relation existed between CD105-MVD and other clinicopathologic features. CD105-MVD, as a prognostic factor, may be helpful for determining the possibility of lymph node metastasis of primary SCC of the tongue.

In recent decades there has been increasing focus on developing and localizing quality of life (QOL) instruments in different societies. In this study, we aim to translate WHO’s Quality of Life WHOQOL-100 questionnaire into the Persian language and assess the validity and reliability of the translated version. We used a forward-backward procedure to translate the questionnaire. A pilot sample of 60 university students was recruited to assess the repeatability and construct validity of the instrument. To assess the construct validity, 60 university students filled out both the WHOQOL-100 and WHOQOL-BREF questionnaires. Then, 500 healthy and 500 disabled individuals were randomly selected using a multi-stage sampling technique. The internal consistency of the Persian version of the WHOQOL-100 was evaluated using Cronbach’s alpha in the sample. In addition, a multiple linear regression model was utilized for assessing the discriminant validity of this instrument, adjusting for different confounders. Test-retest analysis of data from the pilot sample showed that the Persian version of the WHOQOL-100 has acceptable repeatability (ICCs for all six domains were higher than 0.7). In addition, computation of the correlation between the domains of WHOQOL-100 and WHOQOL-BREF showed satisfactory construct validity. Analyzing the data from 500 healthy and 500 disabled persons revealed that all domains of WHOQOL-100 met the minimum level of acceptable internal consistency. Multiple regression results showed acceptable discriminant validity for all domains of the Persian version, except for the spiritual domain. In general, the Persian version of the WHOQOL-100 had satisfactory reliability and validity for assessing QOL of Iranian people. However, we recommend further research for challenging the problem of the spiritual domain.

Hepatic granuloma is reported in 2 – 15% of liver biopsy specimens. It is relatively easy for the pathologist to diagnose, but sometimes arriving at a specific etiology is quite difficult. Until now, there are few published studies about the etiology of hepatic granuloma in Iran. In this study, we attempt to determine the causes of hepatic granuloma from one of the largest referral centers in this country. In a retrospective study over 12 years, a hepatopathologist reviewed all liver biopsies with granuloma. The medical records, including clinical findings, autoantibodies, viral markers, imaging studies, drug histories, and all other specialized tests, such as molecular studies, were reviewed to reach a definite diagnosis. During 12 years, there were 72 cases diagnosed with liver granuloma. The most common cause of hepatic granuloma was infectious, with Mycobacterium tuberculosis (52.8%). The second most common cause was visceral leishmaniasis in 8.3% of biopsies. Other less common causes were fungal infections, visceral larva migrans, primary biliary cirrhosis, and hepatitis C, each in 4.2% of cases. Autoimmune hepatitis was diagnosed in 2.8% of patients. Lymphoma, drug induced, disseminated BCGitis, CMV infection, foreign body reaction and sarcoidosis, were each found in 1.4% of the liver biopsies. After all investigations, there were 12.5% idiopathic hepatic granulomas. According to this study, the most common cause of hepatic granuloma in Iran is tuberculosis. This finding is completely different from western countries and very similar to the results of countries such as Saudi Arabia.

Postoperative cerebellar hemorrhage or remote cerebellar hemorrhage is a rare complication occurring after supratentorial and spinal surgery. Although the mechanism remains unclear, previous reports implicate over drainage of cerebrospinal fluid as the predominant cause. We report a patient who underwent craniotomy for removal of meningioma. The hemorrhage manifested a few days postoperatively as a headache and transient loss of consciousness. Our patient recovered without further intervention with no major neurologic deficit. Early detection and awareness of this complication may help to avoid unnecessary measures.

Primary glomus tumors are extremely rare in the liver. To this date, only two cases of primary glomus tumors of the liver have been reported in the literature. This report is the third case of this specified tumor. The patient was a 50 year-old Iranian woman who presented with a history of epigastric pain and nausea. Abdominal computed tomography (CT) scan showed a huge hepatic mass that replaced the entire left lobe. Surgical biopsy showed that the specimen consisted of a vascular network confined by the proliferation of epithelioid cells with round-to-oval nuclei and eosinophilic cytoplasms. The cells expressed diffuse reactivity for vimentin, smooth muscle actin and CD34, whereas no reactivity was observed with carcinoembryonic antigen, synaptophysin, chromogranin, cytokeratin, and human melanoma black 45. We conclude that glomus tumors must be considered in the differential diagnosis of hepatic masses, with immunohistochemical staining for smooth muscle actin being a useful method to prove the diagnosis.

Disseminated Mycobacterium tuberculosis with involvement of liver, spleen, and bone marrow is a nonspecific and rare complication in human immunodeficiency virus (HIV) infected infants. Here, we report a six month old girl with fever, recurrent infections, bilateral axilary lymphadenitis, hepatomegaly, huge splenomegaly, and failure to thrive per the Center for Disease Control category of C for AIDS. The infant and her mother had positive enzyme immunoassay (EIA) and Western blot. HIV DNA PCR test of the infant was positive with subtype A (A1) in genotyping. A positive bone marrow aspirate staining for acid fast bacilli and PCR test on culture revealed Mycobacterium tuberculosis.