Archives of Iranian Medicine
Volume:4 Issue: 1, Jan 2001

Background-Paucity of information about primary drug resistance in this region and the necessity of obtaining information due to worldwide emergence of multidrug resistance tuberculosis (MDR-TB) prompted this study.Methods-A total of 165 specimens from cases with pulmonary tuberculosis were selected in 3 consecutive years by the non-probable convenience method. This sample included about 1/3 of all sputum/washing-positive pulmonary tuberculosis (TB) cases. Direct microscopy we used according to the "International Union against Tuberculosis and Lung Disease" (IUATLD) guideline; for culture, isolation and sensitivity test we applied the WHO guideline in order to compare our results with those of national and international studies on primary drug resistance. Relapse cases or patients with previous history of anti-TB treatment and mycobacteria other than Mycobacterium tuberculosis (including Mycobacterium bovis) were excluded from the study by careful enquiry of records and laboratory data.Results-Seventeen cases were excluded from the study and the remaining 148 had the clinical and laboratory criteria of primary drug resistance. Mean age of the patients was 44.01±18.23 and 56% were males. All patients had clinicoradiological findings of pulmonary tuberculosis. Single primary drug resistance to isoniazid (INH) and streptomycin (SM) were 4.05 % and 8.78 % and total primary resistance were 7.43% and 12.83 % respectively. Combined resistance to INH+SM was seen in 3.38% of cases, and no resistance was detected to rifampin (RMP) and ethambutol (ETB) amongst new patients affected by Mycobacterium tuberculosis. Resistance to RMP and ETB was noticed only in patients with a previous history of anti-TB therapy (secondary resistance) or in patients with non-tuberculous mycobacteria. Conclusion-In this study which was conducted on patients with pulmonary TB, the highest primary resistance was towards SM and INH alone or to both of these drugs. There was no primary resistance to RMP or ETB, and hence the possibility of MDR-TB is negligible in our region.

Background and objective- Estimation of the colonic transit time (CTT) or the transit time of various bowel segments helps in the pathological diagnosis of constipation and in determining the required treatment. The aim of this study was to recognize the mechanism and type of passage of feces in various segments of the large bowel among patients who attended different GI clinics with constipation.Methods-Among the patients with chronic constipation and no signs of organic or endocrine disease, the time taken for evacuation of the colon (CTT) was estimated by the ingestion of ten radio-opaque markers, each 1-3 mm in length, for 6 consecutive days after which a plain abdominal X- ray was taken on the seventh day. A comparison was then made between the time required for evacuation of the markers from the colon and the patient’s age, sex, frequency of defecation, severity and pressure at the time of defecation.Results-A total of 64 patients (28 male and 36 female) with a mean age of 37.3 years and a range of 13-76 years were included in the study. The frequency of defecation was less than once a week, once a week and twice a week in 7, 41 and 16 patients, respectively. Moreover, 26 patients had no pressure on defecation. Among the 64 persons under study, 37 had abnormal colonic transit time (over 34 hours). The remaining 27 patients who complained of severe constipation were found to have a normal transit time. The duration of abnormal defecation was unrelated to sex, chronicity of the disease or pressure on defecation. Delayed bowel evacuation in the right colon, left colon and rectosigmoid was found in 8, 26 and 15 patients, respectively. Conclusion-The estimation of bowel evacuation time using radio-opaque markers can be very helpful in determining the mechanism, pathophysiology and treatment of constipation. In addition, it is a helpful method in the recognition of false cases in patients who complain of severe constipation but who have a normal bowel transit time. Thus it is possible to use suitable treatment according to the motility disorder of the different areas of the bowel.

Background-Pasteurization is now available to treat products derived from plasma to inactivate transfusion-transmitted enveloped and non-enveloped viruses.Objective-This study was performed to assess the capacity and efficacy of virus inactivation by pasteurization in human coagulation factor VII concentrate with two model viruses including poliovirus type 1 (non-enveloped) and herpes simplex virus type 1 (enveloped).Methods-The viruses were added to the stabilized factor VII (70% sucrose, 20% glycine) and pasteurized for 10 h at 60° C. Viral infectivity was tested in vitro on cell culture (Vero) using standard microtitration assays and the virus titer was expressed as log10 TCID50/ml.Results-On completion of the pasteurization procedure, 6.3 log of poliovirus type 1 and 5.8 log of HSV-1 were inactivated. Recovery of factor VII activity using sucrose/glycine as stabilizer was 80%. Other stabilizers showed lower recovery of factor VII and were less suitable.Conclusion-Viral inactivation by pasteurization procedures destroys both enveloped and non-enveloped viruses and can be applied to production of factor VII from plasma with relatively good recovery and can improve the safety of replacement therapy in hemophilia patients with inhibitors.

Background-Malaria is a main parasitic disease with high morbidity and mortality in the world. Rapid diagnosis and prompt treatment are the basic technical elements for the management and control of the disease. During the recent years rapid immunochromatography tests have been applied in diagnosis of specific antigens of human Plasmodia. Objective-The main objective of this study is the evaluation of immunochromatographic test for P. falciparum "ICT Malaria Pf" in the detection of parasitemia in falciparum malaria infection and also in the in vivo drug susceptibility test.Methods-Dipstick kits "ICT Malaria Pf" were applied in the diagnosis and in vivo assessment of the response of P. falciparum to chloroquine in patients with malaria in Bandar-Abbas, southeast Iran. The results of all tests were compared and evaluated with those of microscopic examination (ME) and parasite count in the stained thick blood smears.Results-ICT Malaria Pf was highly specific (reaching 100%) and sensitive (93%) in detection of P. falciparum parasitemia and also quite helpful in the in-vivo assessment of the response of the parasite to chloroquine.Conclusion- At present for the diagnosis of malaria in endemic countries, the dipstick kits are rather expensive. Nevertheless, it is very helpful in centers where the necessary facilities for ME are not accessible for the prompt diagnosis of falciparum infection.

Background-The mucoid strains of Pseudomonas aeruginosa produce a hyperviscous capsule, which has several roles in pathogenesis. In this study, the in vitro microscopic effects of sub-inhibitory concentrations of gentamicin on capsule production by mucoid Pseudomonas aeruginosa were investigated.Methods-The production of a capsule by the mucoid Pseudomonas aeruginosa cells cultured on agar media in the presence of sub-inhibitory concentrations of gentamicin was observed by light and electron microscopy. Results- Capsule production was reduced by 0.5 and 0.25 minimum inhibitory concentrations. The results showed a reduction in capsular size in the presence of sub-inhibitory concentrations of gentamicin. The size of the capsule in the presence of 0.5 MIC gentamicin was less than its size in 0.25 MIC gentamicin.Conclusion-The results confirm that the production of alginate was reduced and consequently, P. aeruginosa infections might be prevented by sub-inhibitory concentrations of gentamicin.

Background-Atherosclerosis is one of the most prevalent diseases in developed countries and is becoming an area of increasing concern in other parts of the world. Trace elements, which play a vital role in health and disease, have been the subject of several investigations concerning their role in the etiology of coronary heart disease in the recent years.Objective- In order to compare the status of serum zinc, copper, chromium and nickel as well as levels of TG, TC, LDL and HDL-C in male and female patients with atherosclerosis with normal controls, this study was performed.Methods-Serum levels of the above mentioned elements in sixty patients with angiography proven stenosis of more than 50% in the four major coronary arteries were obtained. The levels were compared with those of 30 normal controls.Results-Total mean level of serum Zn for the patients was significantly lower than that of controls (p=0.016) and a significant difference was observed in male patients as compared to male controls (p=0.006). This difference was also observed in the female study group (p<0.001). Total mean Cu was significantly higher in patients (p=0.004), and this difference was reflected in both males and females (p<0.01 and p<0.001 respectively). There was no significant difference in the levels of Ni between patients and controls (p>0.05), even though the mean level was found to be higher in patients. This result was also found to differ according to sex. Analysis of Cr revealed lower levels in the patient group as compared to controls but again this difference was not significantly different (p>0.05). TG, TC and LDL-C were elevated in patients and HDL-C was lower in our patients, but not significantly (p>0.05).Conclusion-Deficiency or suboptimal levels of micronutriants may play a role in the development of atherosclerosis.

Background-HTLV is a lymphotropic virus which can contribute to carcinogenesis in adult T-cell leukemia. The prevalence of this virus in Northeastern Iran has led us to investigate more accurately its serologic prevalence.Methods-A total of 229,037 blood donors were studied during a 4-year period by using Micro-ELISA and Western Blot (WB) assays. Positive results in both tests were considered and Cases with ambiguous results were checked by PCR.Results-Among all the blood donors under study, 2,634 cases were HTLV positive. The elimination of repeated donation resulted in the identification of 2,167 blood donors who actually carried the virus in their blood. The male to female ratio was 3:1 and the total prevalence of this virus was found to be 1.16% [CI 95%=1.11%-1.21%].Discussion-As one fifth of cases infected with this virus had donated blood more than once in this study, it would be better if a system was implemented to recognize these subjects and to prevent them from further donations. All blood donations must be accurately studied for the presence of HTLV.

Munchausen syndrome by proxy (MSBP) bottom-list diagnosed in medical settings, imposes a large burden and is a matter of concern to public health. It has the ill reputation of being unamenable to treatment. Authors describe a case from Iran suffering from both MSBP and Munchausen syndrome (MS) at the same time. A form of nonpharmacologic intervention specifically tailored for MS was found promising and there was no relapse in a two year follow up.