Archives of Iranian Medicine
Volume:17 Issue: 7, Jul 2014

Irritable bowel syndrome (IBS) is a common disorder in Iran with challenging treatment. Although trials have suggested that probiotics alleviate the complaints of patients with minimal side effects, they have not been investigated in Iranian adults. In a randomized double-blind study, 108 eligible IBS patients (Rome III Criteria) aged 20 – 70 years who referred consecutively to a clinical center in Tehran with abdominal bloating from 2010 to 2012 received a combination probiotics or placebo twice daily for 4 weeks. The objective was to evaluate the efficacy and safety of a multi-strain probiotics combination. One week prior to and throughout the treatment, the participants recorded their abdominal symptoms on a daily basis, using visual analogue scale and reported satisfactory relief of general symptoms at the end of each week. Adverse events were evaluated by self-reporting and physical examination. Continuous variables were analyzed by independent t-test and chi-square was used for binomials. The baseline characteristics were balanced (60% female, mean age 36.7 ± 11.5). A total of 97 (51 intervention, 46 control) completed the treatment. Intention to treat analysis was done on 108 allocated subjects. 85% of the probiotic group reported satisfactory relief of general symptoms compared with 47% in the control group (P < 0.01). A reduction in abdominal bloating and pain with probiotic was superior to placebo [-13.0 vs. -3.7 (P < 0.01), -8.2 vs. -2.1 (P = 0.02), respectively]. No severe adverse drug reaction was seen in either group. A 4-week period of treatment with the combination probiotics twice daily was safe, well tolerated, and effective in our patients. Further investigation is recommended for other subgroups of IBS.

Intellectual Disabilities (ID), defined as a state of developmental deficit, result in significant limitation of intellect and poor adaptation behavior. A number of genetic factors can result in ID, such as chromosomal abnormalities, copy number variation, and single gene defect. Karyotyping is the routine method for detecting chromosomal abnormalities in patients with ID. More recently, the Multiplex Ligation-dependent Probe Amplification (MLPA) method has been applied for detecting microdeletion/duplication in patients with dysmorphism and ID. A total of 100 patients with dysmorphism and ID have been referred to us since 2011. All patients were first evaluated clinically and a number of these individuals had normal karyotypes. We investigated duplications and deletions for 21 different microdeletion syndromes using MLPA kit (MRC-Holland). We were able to identify aberrations in 12 (12%) patients clinically ascertained as follows: 5 Williams syndromes, 3 Miller- Dieker syndromes, 1 Sotos syndrome, 1 Angelman Syndrome, 1 Di-George syndrome and one patient with an abnormal 4p chromosomal region. Our MLPA results indicate a high degree of concordance between the clinical data and the genotype. We suggest MLPA as the first screening method for children suffering from MR with normal karyotypes. In those cases where clinical findings were not compatible with the microdeletion syndrome identified by MLPA investigation, further studies such as FISH and aCGH were performed.

In this study, a new alpha globin gene mutation on the α2-globin gene is reported. This mutation resulted in a Lys > stop codon substitution at position 127 which was detected in four individuals (three males and one female). DNA sequencing revealed this mutation in unrelated persons in Khuzestan province, Southwestern Iran of Lor ethnicity. This mutation caused no severe hematological abnormalities in the carriers. From the nature of substituted residues in α2-globin, it is widely expected that this mutation leads to unstable and truncated protein and should be detected in couples at risk for α-thalassemia.

So far, a variety of prevalence rates have been reported for the metabolic syndrome (MetS) according to several definitions. The aim of this study was to assess the prevalence of MetS in Iran according to two definitions and compare the characteristics of the subjects who met the MetS criteria according to the different definitions. Participants were recruited from family registries of public health centers. After obtaining demographic and clinical data, the subjects underwent anthropometric measurements and laboratory evaluations. MetS was defined according to the NCEP-ATPIII and IDF criteria. The subjects were then categorized into 3 groups: 1.Healthy non-MetS subjects based on either definition, 2.Individuals with MetS according to only one of the definitions, and 3.Individuals who met both NCEP-ATPIII and IDF criteria for MetS. Totally, 5826 subjects in Amol and 2243 subjects in Zahedan were enrolled in the study. The weighted prevalence of MetS according to the NCEP-ATPIII and IDF criteria was 27.8% and 26.9% in Amol and 12% and 11.8% in Zahedan, respectively. Overall, 18.9% of the subjects fulfilled both criteria for MetS. However, a considerable proportion (8.5%) met the MetS criteria according to only one definition but not both. MetS is increasingly prevalent in Iran as well as other parts of the world. Due to non-uniform definitions of MetS, some of the subjects who meet MetS according to one set of criteria might be considered healthy according to another definition and consequently would not receive the preventive health services.

Chorionic Villous Sampling (CVS) is a diagnostic method for determining genetic disorders. The present study aimed to determine the negative predictive value of the CVS in the diagnosis of major thalassemia in genetic laboratory of Dastgheib Hospital, Shiraz, Iran. The present research was an evaluation diagnostic test conducted on 372 records of embryos examined through CVS in the genetic lab in 2010 and definitely diagnosed by electrophoresis after birth in 2012. The sensitivity and positive predictive value of the test were assessed for minor thalassemia. The negative predictive value and the specificity of this test were determined, as well. A total of 3 embryos (0.8%) were aborted due to testing. In this study, the sensitivity and specificity were 94.8% and 80.4%, respectively. Also, the negative predictive values for diagnosis of major and minor thalassemia were 100% and 89.2%, respectively. No relationships were found between the gestational age and the test results. The results of this study showed that CVS genetic testing in genetic laboratory of Dastgheib Hospital was valid and had a high diagnostic value. Thus, minor couples can undergo this test with relative safety in order to prevent major thalassemia.

Propofol (2, 6-diisopropylphenol) is a widely used intravenous sedative-hypnotic agent for both induction/maintenance of anesthesia and sedation of critically ill patients. The present study aimed to evaluate oxidative stress biomarkers in individuals undergoing surgery with propofol and ketamine at doses used to induce anesthesia. The plasma oxidative stress biomarkers such as total antioxidant capacity (TAC), lipid peroxidation (LPO), total thiol molecules (TTM) and antioxidant enzymes activity such as glutathione peroxidase (GPx), superoxidedismutase (SOD) and catalase (CAT) were studied in blood samples obtained from 40 patients with propofol, and compared to samples from 40 patients with ketamine aged 11 – 50 years. The results showed that the ketamine group had significantly higher blood LPO level, GPx and SOD activity while having lower blood TAC and TTM concentrations in comparison to the propofol group. In conclusion, our findings showed that propofol has antioxidant effects in human. Further studies need to be conducted to demonstrate the exact mechanism of oxidative stress caused by anesthesia in surgery patients.

Maize is a member of the Poaceae family, capable of producing large amounts of pollen grains which may constitute important allergens in spring and summer. The aim of this study was to determine the protein content of maize pollen and its allergenicity in guinea pigs. The morphology of maize pollens was determined using light microscopy and scanning electron microscopy. The size of separated proteins was obtained by SDS-PAGE. A group of animals were immunized with maize pollen extract and the others were kept as control. After 40 days, the skin prick test was done in animals after blood sampling for counting the eosinophils. The allergenisity of proteins was identified by immunoblotting of transferred bonds using sera from sensitized guinea pigs. Pollen grains showed a spherical, monoporate structure with the scabrate exine surface. The SDS-PAGE indicated a major band of about 50kD.We also showed increase in flare and wheal diameter following skin prick test in sensitized guinea pigs along with an elevated number of eosinophils. The presence of group 13 allergen (Zea m13) with molecular weight of ~ 50kD was found in immunoblotting results. This study showed one protein in maize pollen extract that could be considered as an allergen belonging to group 13 of allergen categories. However, further investigations should be scheduled for precise analysis of the proteins. This allergen can be used for diagnostic or therapeutic purposes (vaccination approaches) in allergic asthma patients.

A slightly lower rate of atherosclerosis in some tropical regions such as the Nile delta in Egypt, Saudi Arabia, Yemen and sub-Sahara Africa is associated with evidences of increased helminthic co-infection. Attempts to eradicate helminthic infections led to the shift of immune balance toward T helper 1 cells and their related cytokines. This shift is parallel with atherogenesis and its related complications. Atherosclerosis is a degenerative man-made disease which begins in early life. Thus, preventive strategies should begin at the same time. As an example to follow, living with old friends, adaption of a more nature-friendly lifestyle and «fine immune-modulation» plans from early childhood, like Egyptians, seems a good option. Finally, a proper intentional balance between T helper 1 and 2 cells should be defended and constructed environmentally in the manner compatible with modern hygiene using a soft application of old hygiene. This needs robust understanding of atheroprotective habits in regions with lower burden of atherosclerosis.

This study attempted to identify the role of combined conventional and novel echocardiographic techniques in evaluation of left atrial (LA) function to predict the postoperative AF (POAF). In this cross-sectional study, subjects with sinus rhythm who were candidates for CABG were enrolled. Preoperative LA function was evaluated by conventional echocardiography and 2-dimensional strain imaging based-velocity vector imaging (VVI). VVI-derived systolic peak positive, early and late diastolic strain rate were measured. Using tissue Doppler study, systolic peak velocities (Sm), early diastole (Em), atrial systole (Am) and AEMi were also measured. The patients were observed during their hospital stay. The primary endpoint of the study was postoperative AF lasting > 5minutes. POAF occurred in 12.7% of patients. Age, LA volume index (LAVI), LA area, LA empting fraction (LAeF) and cardiopulmonary bypass time were found to be the independent predictors of POAF. TDI-derived velocities were similar in study groups. LA systolic strain rate (SRs) and early diastolic strain rate were impaired in patients with no significant difference between those who developed POAF and those who did not. Conventional echocardiography could be used as a feasible method for evaluating subclinical atrial dysfunction in patients undergoing CABG and the use of VVI- based 2-dimensional strain imaging may need further studies.

Hospitalized patients constitute the main fraction of users in any health system. Financial burden of reimbursement for received services and cares by these users is sometimes unbearable and may lead to catastrophic medical payments. So, designing and implementing effective health prepayments schemes appear to be an effective governmental intervention to reduce catastrophic medical payments and protect households against it. We aimed to calculate the proportion of hospitalized patients exposed to catastrophic medical payments, its determinant factors and its distribution. MATHERIALS AND We conducted a cross sectional study with 400 samples in five hospitals affiliated with Tehran University of Medical Sciences (TUMS). A self-administered questionnaire was distributed among respondents. Data were analyzed by logistic regression and χ2 statistics. Also, we drew the Lorenz curve and calculated the Gini coefficient in order to present the distribution of catastrophic medical payments burden on different income levels. About 15.05% of patients were exposed to catastrophic medical payments. Also, we found that the educational level of the patient’s family head, the sex of the patient’s family head, hospitalization day numbers, having made any out of hospital payments linked with the same admission and households annual income levels; were linked with a higher likelihood of exposure to catastrophic medical payments. Also, the Gini coefficient is about 0.8 for catastrophic medical payments distribution. There is a high level of catastrophic medical payments in hospitalized patients. The weakness of economic status of households and the not well designed prepayments schemes on the other hand may lead to this. This paper illustrated a clear picture for catastrophic medical payments at hospital level and suggests applicable notes to Iranian health policymakers and planners.

Gastric cancer is a heterogeneous disorder; genetic factors, H. pylori infection and various environmental factors contribute to its development. Advanced atrophic corpus-predominant gastritis provides the histological base for its genesis. Low socio-economic status and poor hygienic conditions, smoking habits, heavy alcohol consumption, high salt and low intake of vegetables and fruits are important external factors for the occurrence of gastric cancer. For its prevention, the eradication of H. pylori infection at an early age is mandatory for subjects at high risk or those living in areas with high prevalence of gastric cancer. Given that an increased serum level of Pepsinogen II is a good biomarker for the presence of gastritis, it seems reasonable to screen all infected subjects at risk of gastric cancer with increased serum pepsinogen II at an early age (at around 30 years) to eradicate H. pylori. An endoscopy should be performed for subjects at an older age (40 years and older), when increased serum pepsinogen II level is associated with decreased serum pepsinogen I and pepsinogen I to II ratio.

A 3-month old girl with monosomy for distal part of the short arm of chromosome 3 is described. Physical examination showed growth retardation, microcephaly, ptosis, micrognathia, low set ears, broad nasal bridge, Simian crease, long philtrum, thin lips and hypertelorism. The patient’s clinical phenotype largely resembled that of 3p- syndrome but her karyotype was more complicated than just losing the telomeric portion (3p-25.3) of the short arm of one of her chromosomes 3. Her karyotype was 46, XX, t(2;18) (p12;q12.1), del(3) (p23p26), t(3; 9; 15; 20) (q13; p23;q12; p12). Her parents showed a normal karyotype pattern.

Myiasis is the invasion of larvae to human or animal live tissues by flies belonging to the order Diptera and families like Calliphoridae, Sarcophagidae, Oesteridae, etc. Although rare, nosocomial myiasis must be noted carefully, especially in case of hospitalized patients. A 63-year old man admitted to an ICU ward in Mashhad is investigated and presented in this research. On the 35th day of hospitalization, about 100 larvae 6-7mm in length, yellow to cream and fusiform were observed around the tracheotomy site. They were identified as second instar larvae of Lucilia genus of the family Calliphoridae based on morphological characters of the larvae. However, for exact identification of the species, the emerging adults must also be tested. According to the standard key of adult flies, they were identified as Lucilia sericata.

Plasma cell tumors of the skull base are rare in neurosurgical practice. True solitary osseous plasmacytoma of the skull base without development of multiple myeloma is extremely rare. We report a case of typical Gradenigo’s syndrome, including left abducens nerve palsy, left facial pain and paresthesia in V1 and V2 distribution of trigeminal nerve caused by solitary osseous plasmacytoma of the left petrous apex. The patient was a 46-year-old man who presented with diplopia for two days. Magnetic resonance imaging (MRI) of the brain showed a hyperintense mass on T1-weighted images and slightly hypointense mass on T2-weighted images in the left petrous apex and left parasellar area. Through a left subtemporal middle fossa approach, subtotal resection of the lesion was performed. Histopathological examination of the lesion revealed plasmacytoma. The patient received 54 Gy radiation for the local tumor. Four months after radiation, the abducens palsy improved. Four years after treatment, the patient remained well with no symptoms or signs of local recurrence or progression to multiple myeloma.