Archives of Iranian Medicine
Volume:3 Issue: 2, Apr 2000

Background and Objectives-Diabetic foot is a major public health problem. None of the conventional treatments are anticipated to stimulate active wound healing. The aim of this study is to test the efficacy of topically applied autologous platelet-derived growth factors (PDGF) in active repair of chronic non-healing diabetic wounds.Methods-Seven diabetic patients with 12 skin ulcers were studied; all of them had been receiving conventional wound care without evidence of healing for an average of 15 weeks. The wounds were randomized into control and treatment groups. Seven wounds were randomized to treatment with autologous platelet extract (APE) and silver sulfadiazine, and five were subjected to controlled wound care with saline solution and silver sulfadiazine dressings for eight weeks. At the end of the eight weeks, persistent non-healing ulcers in the control group were crossed-over to the treatment group. Ulcer parameters were recorded on the first day of each week during therapy until complete epithelialization was achieved. In the control group each ulcer acted as its own control. Results-In the control group, only one ulcer achieved 50% healing in the stipulated eight-week period. However, when subjected to APE application, these ulcers healed completely; 100% healing occurred in 3.9±2.13 weeks (range 1.5-7 weeks, P<0.05). The difference between the extent of epithelialization in the treatment group at eight weeks of therapy and the control group at crossover point was highly significant (P<0.0001). The difference between healing rates with APE therapy (1.0±0.93 cm2/week) and controlled wound care (0.23±0.40 cm2/week) was highly significant (P<0.001). The overall mean 100% healing time for APE therapy was 5.41±3.05 weeks. There was no abnormal tissue formation, keloid or hypertrophic scarring.Conclusion-This study clearly shows the efficacy of topically applied autologous PDGF in the repair of chronic non-healing diabetic ulcer.

Background-It is well known that eradicating Helicobacter pylori (HP) is an essential step in curing peptic ulcer disease. Many regimens are currently available but none of them can achieve a 100% eradication rate. Furthermore, the eradication rate among Iranian patients appears to be even lower.Objective-We designed a study to determine the antimicrobial susceptibility of HP isolated from Iranian patients to the most commonly used antibiotics for HP eradication regimens.Methods-Isolates of HP were obtained from patients with dyspepsia during upper GI endoscopy. The samples were assessed for susceptibility to nitroimidazoles and clarithromycin (188 samples) and furazolidone (140) using the agar dilution method. Sixty-eight of the isolates were tested for susceptibility to amoxicillin and tetracycline using the disc diffusion procedure.Results- From 186 isolates, 69 (37.5%) were resistant to nitroimidazoles, and 27 (14.5%) to clarithromycin. Among the 140 isolates tested for susceptibility to furazolidone, 7 (5%) showed resistance. All 68 isolates tested with the disc diffusion procedure were susceptible to tetracycline but 5 (7%) exhibited resistance to amoxicillin.Conclusion- Resistance of HP to metronidazole and tinidazole is high among Iranian patients, with tetracycline and amoxicillin remaining the most efficient drugs. Furthermore, HP isolates from Iranian patients were found to be highly susceptible to furazolidone. This drug is readily available at low cost in Iran and may be a good substitute for metronidazole in HP eradicating regimens in this country.

Background-Ocular injuries caused by BB guns (civil air-powered guns) are serious and may result in total loss of vision. These injuries occur more frequently in children and young adults.Methods-A total of 16 patients with BB gun injuries were seen between September 1996 and September 1999 in Farabi hospital, Tehran University of Medical Sciences and a private eye clinic. Six patients had non-perforating eye injuries. Among 10 cases of perforating eye injuries, 2 had single and 8 had double perforations. All of perforated eyes underwent scleral buckling, lensectomy, vitrectomy and silicon injection, after a period of one to two weeks of observation or until a retinal detachment, retinal traction or posterior vitreous detachment was noted on ultrasonography.Results-Of the 16 patients with BB gun injuries, 15 (93.7%) were males and 1 (6.3%) was female with a variation of age ranging from 3 to 50 years (mean=20.6); 9 (56.2%) of them were 18 years of age or younger. All patients had a preoperative visual acuity of at least light perception. They all had a final visual acuity of hand motion or better. Ten patients achieved a score of 1/10 or better and 5 patients had scored 3/10 or above. Conclusion-This study shows that various vitreo-retinal surgical procedures can help retain vision in some cases of ocular injuries caused by BB gun pellets.

Objectives-Our aim was to find out if the peripheral blood monocytes and cultured macrophages from patients with pulmonary tuberculosis treatment failure could respond to pro-inflammatory cytokines to produce detectable nitric-oxide (NO) levels and whether the antimycobacterial activity of these NO-producing monocytes/macrophages could be correlated with the amount of nitric-oxide generated in vitro.Methods-We examined the peripheral blood monocytes of 20 healthy controls and 20 treatment-failure tuberculosis patients immediately or after culture for 7 days.Results-In vitro activation of mononuclear cells by cytokines induced the release of nitric-oxide in an amount sufficient to lead to mycobactericidal effects. Moreover, as mononuclear cells mature in culture medium, NO production also increases. This property has been demonstrated in cells removed from healthy subjects as well as from cases. Induced nitric-oxide release and mycobactericidal efficacy were found to be closely correlated in enhancement by addition of L-arginine in the culture medium or abrogation by N-monomethyl-L-arginine (NGMM arginine). The interesting and unexpected observation was that monocytes/macrophages from patients responded more efficiently as compared to healthy controls.Conclusion-Our observation suggests that human mononuclear cells from treatment failure patients are not functionally impaired, and it may be possible to suitably modulate these cells to become mycobactericidal.

Background and Objective-The " Quit and Win" contest is an international contest in which people are invited to quit smoking. This annual contest is also held in Iran and many participants who quit smoking win prizes. This study was conducted to measure the one-year post-contest abstinence rate among participants of the international "Quit and Win" contest, 1998, among Iranian adults residing in Isfahan province.Methods-This cross-sectional study was performed according to internationally agreed rules. Approximately, 7051 current smokers aged at least 18 years, residing in Isfahan province participated in this campaign along with over 200,000 participants from 48 countries worldwide. After 1 year (May 1999) a follow-up questionnaire survey was conducted on 1,100 randomly selected participants.Results-Considering the returned replies after the one-year follow-up by assessing the participant’s serum cotinine levels, the one-year quit rate was calculated to be 27.8%.Conclusion-Although these findings should be interpreted with caution, we conclude that the international "Quit and Win" contest may be considered as a convenient method with a high success rate in producing abstinence from smoking.

Background and Objective- High-dose chemotherapy with stem cell rescue has emerged as the treatment of choice for patients with refractory and relapsed non-Hodgkin’s lymphoma (NHL). To evaluate the efficacy and toxicity of a novel chemotherapy regimen with mesna, Ifosfamide novantrone and etoposide (MINE) in patients with relapsed NHL previously treated with adriamycin-based regimens.Methods-Forty-six patients with relapsed NHL were treated in this study. The median age was 42 years (range 13-65). Twenty-eight patients (60.8%) had high grade, 10 (21.7%) had low grade and the rest had intermediate grade lymphoma. The program utilized cyclic administration of ifosfamide 1.33 gm/m2 day 1-3, mesna 1.33 gm/m2 day 1-3, etoposide 100 mg/m2 day 1-3, novantrone 12 mg/m2 day 1. Cycles were repeated every 3 weeks for 6 cycles. Mean while, adequate hydration was also provided. Results-The overall response rate was 65.2% (30 patients). Complete response was achieved in 30.4% (14 patients) and a partial response in 34.8%. The median survival period was 7 months. Grade III neutropenia was seen in 10 patients (21.7%) and grade IV in 1 patient who died of treatment-related toxicity. Conclusion-MINE combination is an effective and well tolerated treatment for patients with relapsed NHL who have no chance for bone marrow transplantation.

Background-Several genera of Labiatae have anti-nociceptive properties with an efficacy similar to classical analgesic drugs.Objective-In this study, the anti-nociceptive activity of Saliva nemorosa extract was evaluated.Methods-Anti-nociceptive properties of the aerial parts of S. nemorosa were studied using hot plate and writhing tests on the aqueous decoction and ethanolic maceration extracts of the aerial parts of this plant.Results-In contrast to the ethanolic extract, intraperitoneal injection of aqueous extract showed anti-nociceptive activity in the hot-plate test which was inhibited by naloxone. In the writhing test, however, considerable anti-nociceptive activity was observed in case of both aqueous as well as ethanolic extracts. Here again, naloxone had an inhibitory effect on the anti-nociceptive properties of only the aqueous extract. Conclusion-This study shows that S. nemorosa had both central and peripheral anti-nociceptive activities that may be mediated by opioid receptors.

Background and Objective-Different properties of low-level He-Ne laser has been under investigation, one of which is its effect on blood sugar level. In the present study, the effect of low-power laser on hyperglycemia induced by isoniazid has been investigated in mice.Methods-One hundred male albino mice were divided into four groups: group 1 received intraperitoneal isoniazid, group 2 was treated with laser after isoniazid administration, group 3 was given saline and then irradiated by laser, group 4 received only saline. Laser irradiation was performed at 5 epigastric areas, 45 seconds each. This procedure was repeated twice daily for 9 days in groups 2 and 3.Results- The data indicated that intraperitoneal (IP) injection of isoniazid (100mg/kg) produces hyperglycemia in comparison to group 4. When isoniazid administration coincides with laser irradiation, the blood sugar level will not change significantly compared to the control group.Conclusion-It could be concluded that He-Ne laser is capable of reversing the isoniazid-induced hyperglycemic effect on mice liver, and might have a protective property in case of drug-induced hyperglycemia.

Background and Objectives-Poisoning due to drugs and chemicals is influenced to a large extent by the population’s socioeconomic and cultural status. The purpose of our study was to determine and present the pattern of poisoning with drugs and chemicals in 2 poisoning referral centers in Gilan province, northern Iran, and to analyze medical and social parameters involved. Methods-This retrospective cross-sectional study was performed on 1215 cases of poisoning (with drugs and chemicals) who were hospitalized in 2 poisoning referral centers, namely, Razi and 17-Shahrivar Hospitals in Rasht during a three-year period. Chi-square and a values were considered for the statistical analysis.Results-Five-hundred and twenty-six of the poisoning cases (25%) were children and 1625 cases (75%) were adults. Poisoning was most common in the 15-64 years age group and in women. In order of frequency, the three most common causes of poisoning in adults were organophosphorous compounds, rat-killers, tranquilizers and anticonvulsants, and in children they were kerosene oil, detergents, and metoclopramide. The fatality rate was 1-4%. A significant statistical relationship (p<0.05) was noted between the type of poison and patient’s age, sex, occupation, residence (village/city), cause of poisoning (intentional/ accidental) and season in which the poisoning occurred.Conclusion-It was seen that women between 15-64 years of age were more prone to suicidal poisoning with organophosphorous compounds in spring and summer and children of 1-4 years of age were more susceptible to accidental poisoning with kerosene oil and its derivatives in the spring. The fatality rate of this study was higher as compared to other cities in Iran and other industrialized countries. It is thus recommended that more preventive measures be taught to the general population.

Twenty-eight patients referred to the Iranian Cancer Institute were studied. All were diagnosed to have stage 3 or 4 epithelial ovarian cancer and had undergone total abdominal hysterectomy, bilateral salpingo-oophorectomy, and omentectomy. After 6 cycles of chemotherapy, using Docetaxel at 75 mg/m2 followed by Carboplatin at AUC-7, both given intravenously every 3 weeks, the following results were obtained: complete remission: 10/28 (35%), partial remission: 16/28 (57%), stable disease: 2/28 (7%). Second look laparotomy was performed in all 10 patients with complete remission and complete pathologic remission was found in 4(40%) cases. We conclude that Docetaxel/Carboplatin regimen at the above doses and schedule is highly active in this setting and needs to be compared in a phase 3 trial with standard Paclitaxel-based regimens.

Spontaneous non-traumatic brain hemorrhage has been investigated for clinical manifestations, possible etiologic factors, and different epidemiological indices in stroke patients hospitalized in Shafa Medical Center, Kerman from March 1998 to March 1999. In this cross-sectional prospective study, data analyses is performed using X2 and t-test. The prevalence of spontaneous brain hemorrhage is observed 15.5/100,000 in the general population and 123/100,000 in the high-risk population (above 50) respectively, in Kerman city. Approximately 85% of patients above 50 years of age had a previous history of primary hypertension, which was assumed to be the main precipitating factor. CT scan data revealed that the ganglionic region is involved in 53% of cases, and subarachnoid or ventricular hemorrhages are seen in 61% of cases.