Archives of Iranian Medicine
Volume:18 Issue: 9, Sep 2015

Chronic infection with the hepatitis B virus and obesity may both contribute synergistically to liver disease, although relatively few studies have investigated this hypothesis. Therefore, in this study, we evaluated the relationship between central obesity and the liver stiffness in the Golestan Hepatitis B cohort study (GHBCS). Our study included 304 chronic hepatitis B (CHB) patients enrolled from GHBCS. Liver stiffness measurement (LSM) and laboratory tests were performed after a follow-up of 4 years (2012). The hepatitis B viral load was measured at the baseline and follow-up using the real-time PCR method. Waist circumference ≥ 102 cm in men and ≥ 89 cm in women (central obesity) was considered to be abnormal. Advanced liver stiffness (ALS) was defined as LSM ≥ 8 KPa. Statistical analysis was performed using SPSS-V17. Logistic regression was used to test predictors of advanced liver stiffness (LSM ≥ 8 KPa). Linear regression was used to test the predictive value of variables in ALT (as a continuous variable). P-value of less than 0.05 was considered statistically significant. Among these CHB patients, 19 (7.4%) cases with a mean (±SD) age of 49.5 (±6.3) developed ALS after 4 years of follow-up. Multivariate analysis showed a significant predictive role of central obesity and viral load in ALS. Central obesity is related to the liver stiffness in chronic hepatitis B patients.

Bladder cancer (BC) is the most common genitourinary system malignancy in humans. Consumption of opium and its derivatives, maybe a risk factor possibly in Iran. The aim of this study was to investigate the relationship between consumption of opium and its derivatives and the incidence of BC. In an individually matched case-control study in Shiraz (located in the south of Iran), 198 patients with BC and 396 healthy individuals (matched in age, sex and residence (urban/rural)) were investigated. Data about consumption of opium and its derivatives, tobacco, alcohol and diet were collected using a structured valid and reliable questionnaire. Crude and adjusted odds ratios (ORs) were computed using conditional logistic regression models. Opium consumption was associated with an increased risk of BC with an adjusted OR = 3.9 (95% CI: 1.2 – 12.0). Moreover, a considerable dose-response relationship was observed between the opium consumption and its derivatives and the incidence of BC; comparing to no users, the odds ratios of low and high consumptions were 3.3 (95% CI: 0.5 – 23.1) and 4.9 (95% CI: 1.1 – 21.9) respectively. Opium consumption can be a potential strong risk factor for BC in Iran.

Recently, it has been questioned whether insulin resistance is associated with thyroid nodules. The aim of this study was to examine insulin resistance prevalence in a case–control study of patients with benign thyroid nodules in an iodine-sufficient area. This was a single-center, case–control study on euthyroid patients with benign nodular diseases. Thirty newly diagnosed patients with benign thyroid nodules according to fine needle aspiration cytology were investigated for insulin resistance. As a control group, 30 euthyroid control subjects with normal thyroid sonography without nodule were recruited from the general population. The participants were matched in pairs by age, gender, and body mass index. The diagnosis of insulin resistance was made when the homeostasis model assessment of insulin resistance (HOMA-IR) index was more than 2.5. The mean of HOMA-IR value was significantly higher in patients compared to controls (1.32 ± 0.65 vs, 0.76 ± 0.36, P-value < 0.001). Insulin resistance was seen in two subjects with thyroid nodules (6.7%), but none in the control group. There was a positive significant correlation between HOMA-IR and thyroid nodule size (r-value: +0.38, P < 0.03). Patients with thyroid nodules have higher HOMA-IR value. There is an association between insulin resistance and benign thyroid nodules. More investigations are required to define the role of this factor in thyroid nodule formation.

We assessed the outcome of high-dose methotrexate (HD-MTX) chemotherapy with or without radiotherapy (RT) in primary central nervous system lymphoma (PCNSL) patients. Fifty-one HIV-negative patients with an average age of 50.3 years were treated with chemotherapy regimen included 2500 mg/m2 MTX with Leucovorin rescue and 1.4mg/m2 vincristine (day two), which was administered every other week for 6 weeks. Only the patients who were younger than 60 years received RT. All patients received two cycles of 3000 mg/m2 cytarabine at the end of the treatment for two successive days. Diffuse large B-cell lymphoma was the most common histologic subtype (90.2%), and twenty-six (51.0%) patients had multiple brain lesions. The median survival of patients who were younger than 60 years was 37 months. For patients who were older than 60 years, the median survival was 20 months. The median survival of men and women were 30 and 34 months, respectively. There was no significant difference in survival of patients in terms of age and sex. Overall, sixteen patients (31%) out of fifty-one patients died, five of them were older than 60 years and eleven were younger than 60 years. Twenty-five (49%) of all patients experienced relapse, and 10 (40%) of them died after rechemotherapy. The base of our chemotherapy regimen was HD-MTX as the regular doses of MTX cannot penetrate the blood brain barrier (BBB). Our results indicated that the combination of HD-MTX with RT may not influence the outcome of PCNSL; thus, RT cannot be the first line therapy.

To obtain information related to the knowledge and clinical practice of general practitioners (GPs) in management of people with type 2 diabetes, and to explore the impact of formal continuous medical education (CME) programs. A total of 1104 GPs participated in a cross sectional survey related to diabetes management considering ADA/EASD consensus 2011 focused on demographic and background characteristics, diabetes related knowledge, and patient care. Fisher’s Exact and Chi-square tests were used in the analysis of contingency tables. The majority of the participants (83.9%) worked in large cities and 39.8% had taken part in CME programs in diabetes management. Overall, 52% of the GPs knew the treatment goal for HbA1c. The rate was slightly higher for those taken part in CME (P = 0.003). Considering patient care, slightly more than half of the participants answered correctly to the questions on duration and distribution of physical activity, with no difference by taking part in CME programs. On average, 41.5% of the physicians selected metformin as the first OGLD for treatment of type 2 diabetes, and only 27.9% stated that they add basal insulin to OGLD if treatment failed. The results of this study provide the evidence that the knowledge and clinical practice of Iranian GPs in management of type 2 diabetes were not satisfactory. Furthermore, traditional CME programs in diabetes management were not effective in changing the GPs’ clinical practice. Consequently, designing and implementing more effective strategies are necessary for improving patient health related outcomes.

In recent years the increasing use of nanoparticles has led researchers to study their effects on biological systems. The most important effects of nanoparticles on cells are their ability to induce or suppress production of reactive oxygen species (ROS). Changes in reactive oxygen species play an important role in various developmental processes, including proliferation and differentiation in several diseases such as Parkinson. The aim of this study was to investigate the effect of iron oxide nanoparticle with dimensions of less than 20 nanometers on the viability and neuronal differentiation of mouse embryonic stem cell (Royan B1). To assess the effects of Fe2O3 nanoparticles on neuronal differentiation of Royan B1 cells, embryoid bodies were divided into eight groups receiving different amounts of nanoparticle (10, 20, 30 μg/mL) for 12 hours, retinoic acid (1 μM), and both. Differentiation was examined under phase contrast microscope and using immunocytochemistry. Data analysis showed that cell death was increased by a time and concentration manner and there was a direct relevance between iron oxide amount and H2O2 level in cells. Statistical analysis of embryoid bodies showed that neural differentiation of mouse embryonic stem cells in groups that received nanoparticles were significantly lower than other groups and their viability were considerably reduced. According to the findings of this study it can be concluded that iron oxide nanoparticles reduce retinoic acid-neuronal differentiation in mouse embryonic stem cells and it seems that the main mechanism involved in the reduction of viability and neural differentiation was enhanced levels of ROS within the cells.

Anxiety is an unpleasant physiological state in which an overreaction to a situation occurs. It has been suggested that different brain regions are involved in the modulation and expression of anxiety, including the amygdala, hippocampus, and frontal cortex. Dysfunction of neurotransmitters and their receptorscan lead to many mood disorders like anxiety. There are evidences that dopamine plays an important role in anxiety modulation in different parts of the brain. Some evidence has shown that the mesolimbic, mesocortical and nigrostriatal dopaminergic system are involved in anxiety. Both dopamine D1 and D2 receptor mechanisms are important in mediating anxiety.The activity of dopaminergic system is modulated by several neurotransmitters, including glutamatergic neurons from the medial prefrontal cortex (mPFC), GABAergic fibers from the nucleus accumbens (NAc) as well as the ventral pallidum and cholinergic fibers from the pedunculopontine nucleus and the laterodorsal tegmental nucleus. Thus, changes in the glutamatergic, and GABAergic, as well as mediated transmission in the mesolimbic, mesocortical and nigrostriatal dopaminergic system may influence anxiety-like behavior.

Rotaviruses (RVs), a member of Reoviridae family, are a major cause of severe diarrhea in children < 5 years of age worldwide, infecting mainly the gastrointestinal tract although recent findings have shown extraintestinal spread of RV infections. The RV is known to cause systemic infection in children with acute gastroenteritis (AGE). The systemic RV infection may lead to the virus reaching extraintestinal organs, therefore developing clinical symptoms. RV RNA, antigen, and infectious particles have been found in serum, cerebrospinal fluid (CSF) and extraintestinal tissues in children with acute gastroenteritis (AGE). According to previous studies on molecular genotyping of RV, no specific association has been yet found between antigenemia and RV G genotype. However, nucleotide changes and genotype discordance in RVs have been detected in paired stool and serum samples. In children, who show the evidence of antigenemia, RV genome is detectable in extraintestinal organs. Although, clinical significance of the laboratory findings remains to be determined.

Cystoid macular edema is rarely observed secondary to paclitaxel treatment. A 55-year-old female patient was applied five cures of paclitaxel and carboplatin chemotherapy after being diagnosed with metastatic ovarian cancer. The patient had a normal bilateral vision prior to the chemotherapy treatments. After the fifth cure, the patient complained of bilateral vision loss, which was more severe in the left eye. Ophthalmologic examination revealed that right eye vision was 4/10 blurred without glasses and 7/10 blurred with glasses, left eye vision was 1/10 blurred without glasses and 4/10 blurred with glasses. Pathology was not detected during the biomicroscopic examination. Fundus examination of the patient revealed pigment epithelium irregularity, which was found to be less in the right eye, and it was found a decrease in foveal cavity. For fundus examination, the patient underwent fundus fluorescein angiography (FFA) and optical coherence tomography (OCT). FFA revealed fluorescein leakage and cystoid appearance particularly more apparent in the left eye. Thickening in the macula and cystoid space was observed particularly more in the left eye in the OCT measurement. In conclusion, we presented our case as a rarely observed cystoid macular edema secondary to paclitaxel treatment.

The most common location of the leiomyoma is uterus, small bowel and the esophagus, however they can occur in any organ. Intraparenchimal leiomyomas of the breast are very rare and only 30 cases were reported in the literature. These histologically benign tumors, may mimic malignancies and therefore may present a diagnostic challenge. Here, we present two new cases. The first case was a 50-year-old woman presented with a 4 cm firm mass in her right breast with discrete localized skin thickening/retraction. The second case was a 35-year-old woman presented with a painless palpable lump in the lower outer quadrant of her right breast. Physical examination, mammography and ultrasound as well as surgical excision were performed in both cases. According to histologic examination and immunohistochemical analysis, a diagnosis of smooth muscle tumor of the breast was made. These tumors clinically and radiologically mimic other breast lesions. Neither imaging studies nor palpation allow distinction between benign and malignant tumors.

Brainstem involvement is a characteristic feature and accounts for the high mortality associated with listeriosis especially in immunosuppressed patients. We report two cases of rhombencephalitis infection by Listeria monocytogenes in a 65 and 63-year-old men with diabetes. They were referred to a neurologist due to fever and drowsiness after 3 weeks. The 65-year-old man had vertigo, diplopia, ataxia, bidirectional nystagmus and the 63-year-old man complained of perioral numbness, dysphagia and dysartheria. Treatment with ampicillin (12 g/day) was started empirically and modified when the culture results were available. The CSF cultures were positive to Listeria monocytogenes and brain MRI findings were suggestive of rhomboencephalitis. Despite delays in treatment, they had a complete clinical recovery with resolution of MRI abnormalities. In contrast to our results, in most reports, a bi-phasic illness has 
been described and late treatment was associated with unfavorable courses or long lasting sequelae.

Cases with foreign bodies in the bladder are rarely seen. According to literature, it has been reported that foreign bodies were removed from the bladder. The etiology of these cases are iatrogenic causes, migration from adjacent organs, tissues and self-insertion. In this case report, we presented a 22-year-old female who was admitted to the emergency room with vaginal bleeding, and groin pain. The foreign body was removed from the urinary bladder.

Nezami Aruzi prepared Čahār Maqāla (Four Discourses) as a guide and admonishment for the rulers and kings. The fourth discourse of Čahār Maqāla with 12 anecdotes is devoted to the science of medicine and the characteristics of the physicians. The discourse presents the name of the eminent scientists, physicians, as well as Farsi and Arabic medical books that had professional acceptance in the medieval in Persia. The author has described how medicine was studied in the medieval in Persia and has presented notes on the physiology of the nervous system, pulse, uroscopy, fever, spiritual affairs and medical ethics. The current essay is a brief review of the medical subjects in Čahār Maqāla.