Acta Medica Iranica
Volume:53 Issue: 11, Nov 2015

Increased nitric oxide (NO) formation is mechanistically linked to pathophysiology of the extrahepatic complications of cirrhosis. NO is formed by either enzymatic or non-enzymatic pathways. Enzymatic production is catalyzed by NO synthase (NOS) while entero-salivary circulation of nitrate and nitrite is linked to non-enzymatic formation of NO under acidic pH in the stomach. There is no data on salivary excretion of nitrate and nitrite in cirrhosis. This study was aimed to investigate salivary levels of nitrate and nitrite in a rat model of biliary cirrhosis. Cirrhosis was induced by bile duct ligation (BDL). Four weeks after the operation, submandibular ducts of anesthetized BDL and control rats were cannulated with polyethylene microtube for saliva collection. Assessment of pH, nitrite and nitrate levels was performed in our research. We also investigated NOS expression by real time RT-PCR to estimate eNOS, nNOS and iNOS mRNA levels in the submandibular glands. Salivary pH was significantly lower in BDL rats in comparison to control animals. We also observed a statistically significant increase in salivary levels of nitrite as well as nitrate in BDL rats while there was no elevation in the mRNA expression of nNOS, eNOS, and iNOS in submandibular glands of cirrhotic groups. This indicates that an increased salivary level of nitrite/nitrate is less likely to be linked to increased enzymatic production of NO in the salivary epithelium. It appears that nitrate/nitrite can be transported from the blood stream by submandibular glands and excreted into saliva as entero-salivary circulation, and this mechanism may have been exaggerated during cirrhosis.

Oxygen therapy might increase damaged tissue oxygenation, turn on the aerobic pathway, and save neurons from death and could improve clinical outcome of the patients with stroke and head trauma. Hyperbaric oxygen therapy is accompanied by some unfavorable effects. Results of normobaric oxygen therapy on clinical outcomes of patients with stroke were controversial up till now. This study was therefore designed to evaluate effects of normobaric hyperoxia on clinical outcomes of patients with severe acute stroke. A total of 52 consecutive patients with stroke who meet the inclusion criteria of the study were entered into this randomized controlled clinical trial. The patients in the case group underwent oxygen therapy with Venturi mask for first 12 hours of admission. The patients were examined for neurologic defects at the time of discharge and after six months using both Barthel and modified Rankin Scale (mRS) neurologic disability scoring systems. There was no significant sex difference between the two groups (P=0.5). There was no statistically significant difference between ischemic-hemorrhagic stroke constitutions of two groups (P=0.2). There were no significant difference in Barthel index scores of both groups at the time of discharge as well as the follow-up examination (P=0.7) According to the mRS scoring system, there was no difference between the patients of both groups at the time of admission (P= 0.8), however after treatment there was a significant difference between mRS scores of the treated group compared to the controls (P=0.04). According to the results of this study, normobaric oxygen therapy in the first 12 hours of accident could improve long time outcome of the patients with either ischemic or hemorrhagic stroke.

Patients with malignancy are at higher risk of thrombotic complications due to the hypercoagulability state. Our objective in this study was to assess the serum concentrations of Homocysteine, anti phospholipid antibodies, and anti cardiolipin in patients with benign and malignant breast tumors and study the effect of chemotherapy on the serum levels of these markers. A case control study was carried out on 100 women with malignant breast tumor and 100 age matched control with benign breast tumors.Serum concentrations of heomocystein, anti cardiolipin antibody (IgG and IgMaCL) and anti-phospholipid antibody (IgG and IgMaPL) were measured in all cases. The malignant group was followed for six months, and serum levels of abovementioned markers were measured again after surgical removal of breast tumor and chemotherapy. Current results showed a significantly higher serum concentration of Homocysteine, IgG and IgMaPL, IgG and IgM aCL in patients with malignant tumor before chemotherapy compared with benign tumor patients. We found a significant decrease in these markers after chemotherapy (P Value<0.05).We propose performing these tests (Homocysteine, IgG and IgM aPL, aCL) in patients with breast malignancy and starting prophylactic anti-thrombotic treatment in those with high serum levels of the markers. In addition, since the serum levels of the markers in patients with malignancy reduce after adjuvant therapies, we strongly recommend using adjuvant chemotherapy in these patients.

Overweight/obesity and depression are common among women especially in the elderly and can lead to unfavorable outcomes. We aimed to determine the association of overweight with depression and also to find any correlation of depression with some anthropometric indices in old women. A total of 94 depressed elderly women were compared with 99 non-depressed controls. The structured diagnostic interview based on DSM-IV were performed to diagnose depression, and Geriatric Depression Scale (GDS) was completed to rate it. Anthropometric indices were measured and compared between groups. Pearson correlation coefficients were determined for linear relations between variables. Odds Ratio of obesity and overweight in depressed subjects comparing with normal participants was 1.45 (95%CI=0.63-3.32). A significant correlation was observed between BMI and GDS score (r=0.231, P-value=0.001). Total body fat (P-value=0.001) and BMI (P-value=0.016) were significantly higher in depressed women than non-depressed women. Despite the significantly higher total body fat and BMI among old women with depression, only a weak correlation was seen between BMI and GDS score.

Lipoprotein-associated phospholipase A2 (Lp-PLA2) is produced by inflammatory cells, bound to LDL and other lipoproteins, and hydrolyzes oxidized phospholipids in LDL. Type 2 diabetes is the most common form of diabetes some investigations show the association of lipoprotein-associated phospholipase A2 mass and activity with the incidence of cardiovascular disease (CVD) in populations with high prevalences of insulin resistance and diabetes. This study is a cross-sectional descriptive and analytic study on 80 individuals with diabetes referring to the Tehran Diabetes Association. Patients divided into two groups (well-controlled and poorly controlled) based on their HbA1C. Personal information, anthropometric assessments (including height, weight, waist circumference and hip circumference) and semi-quantitative 147 items FFQ was used and vein blood samples were taken. After plasma separation, blood sample used for FBS, HbA1c and LP-PLA2 measurement. The independent sample T test was used for comparing means. Data analyses showed a significant difference between weight and WHR (waist to hip ratio) means in two studied groups, also there was a statistically significant difference in food intake (Energy, carbohydrate, protein, micronutrients percent and some of the micronutrients). FBS, HbA1C and LP-PLA2 means showed statistically significant difference (P<0/001) between two groups. This study showed LP-PLA2 is elevated in poorly-controlled patients compared to well-controlled diabetic patients, which may suggest some nutritional factors contributing to the regulation of this enzyme.

Hepatitis B (HB) disease occurs with high risk behaviors in the different communities. Aim of this study was to find out some of local customs in lifestyle that might be risk factors for transmitting this disease in order to design the educational programs and control it periodically in Chaharmahal VA Bakhtiari, Iran. This was a case-control study, carried out on patients with HB and the control group in Buldaji’s district since October 2008 to March 2011. An expert person interviewed both these groups with a valid and reliable questionnaire. The data were gathered and analyzed by descriptive statistics; Chi-square and logistic regression.A total of 85 patients with HB were enrolled in the study. Four of wrong customs were considered as predicting risk factors for transmission of hepatitis B infection in two groups; history of making shallow incisions on the auricle or leg for healing a disease or exchanging their blood in childhood [P=0.000, OR=6.130, 95%CL: 2.648-14.192], tattooing [P=0.033, OR=1.391, 95%CL: 1.028-1.882], be born at home by an untrained midwife [P=0.005, OR=3.217, 95%CL: 1.425-7.263], receiving dental services by experimental dentists [P=0.034,OR=0.218, 95%CL: 0.053-0.893]. For development of health education materials’ in our region, we focus not only on proper prevention of general risk factors of HBV transmission but also necessarily draw upon local social and cultural contexts which may spread this disease. We encourage the people to improve these customs or don’t do it to control transmission of HB.

Cyclophosphamide (CP) is a mustard alkylating agent used in the treatment of a number of neoplastic diseases and as an immunosuppressant for the prevention of xenograft rejection. There are many reports that the teratogenic effects of cyclophosphamide can be prevented by application of antioxidant drugs and stimulation of the maternal immune system. Also, there is some evidence that L-carnitine is antioxidant. Therefore, in this study, the prophylactic effect of L-carnitine on teratogenic effects of CP was evaluated. This study was performed on 31 pregnant rats divided into 5 groups. Control group received normal saline and test groups received L-carnitine (500 mg/kg), CP (15 mg/kg), CP (15 mg/kg) plus L-carnitine (250 mg/kg) and CP (15 mg/kg) plus L-carnitine (500 mg/kg) intraperitoneally at 9th day of gestation. Fetuses were collected at 20th day of gestation and after determination of weight and length; they were stained by Alizarin red-Alcian blue method. Cleft palate, spina bifida, and exencephaly incidence were 55.55%, 33.34% and 27.77% in fetuses of mice that received only CP. Cleft palate, spina bifida, exencephaly incidence were 21.42%, 4.76% and 9.52% in the group which received CP plus L-carnitine (250 mg/kg), respectively. However, cleft palate, spina bifida, and exencephaly incidence were 8%, 0% and 8% range in the group received CP plus L-carnitine (500 mg/kg), respectively. In addition, skeletal anomalies incidence including limbs, vertebrae, and sternum defects were decreased by L-carnitine. The mean of weight and length of animal's fetuses received L-carnitine were significantly greater than those received only CP. In conclusion, L-carnitine significantly decreased teratogenicity induced by CP; but this subject needs more detailed evaluation.

Several observations have addressed high rates of occupational burnout among personnel of emergency medical services (EMSs) centers. Occupational burnout influences EMS personnel's well-being and quality of life. The main objective of this study was to assess burnout and its determinants among Iranian EMS personnel. This study was carried out at all EMS centers in two provinces of Kermanshah and Hamadan located at the west of Iran. The sample consists of 260 personnel (110 in Hamadan and 150 in Kermanshah) that were consecutively entered. The information was collected by researcher attendance at their workplaces using a self-administered questionnaire. Occupational-burnout was measured using the Maslach Burnout Inventory. An average of 46.54% of personnel displayed high frequency in the subscale emotional exhaustion, 38.85% displayed high frequency in the subscale depersonalization, and only 2.69% of them displayed high frequency in the subscale incompetence/lack of personal accomplishment. Regarding the severity of burnout, severe emotional exhaustion and depersonalization were detected in an average of 25.39% and 37.69 of the personnel, respectively; while, an average of 97.31% expressed a low level of the lack of personal accomplishment. Frequency and severity of burnout were adversely affected by younger age, single status, history of smoking, lower income, higher work experience, longer shifts, and even work status of the spouse. Iranian EMSs personnel considerably suffered from emotional exhaustion and depersonalization. This should be effectively managed and improved by organizational supports, psychological consultations, and effective management aimed to improve determinants of appearing occupation-related burnout.

Irritable Bowel Syndrome (IBS) is one of the most common gastrointestinal disorders particularly affecting the quality of life (QOL). Evaluating QOL in IBS patients is a valuable method of defining a psychobiological pattern of disease. Various disease specific and general instruments are now available to measure health-related QOL (HRQOL) in IBS patients. Though, no comparison has been made between these tools especially in non-western countries. We aimed to compare QOL measures between two specific and general QOL questionnaires in a sample of Iranian IBS patients. A total of 250 IBS patients were diagnosed based on Rome III criteria (mean age 29.6 ± 9.6 years). HRQOL was assessed using disease specific quality of life for IBS (IBS-QOL) and generic World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaires. Patients also completed Speilberger`s “State/Trait Anxiety Inventory” and “Beck Depression Inventory-II” for the evaluation of anxiety and depression symptoms. The severity of symptoms was independently associated with HRQOL in patients using WHOQOL-BREF and IBS-QOL (r = -0.48 and -0.39 respectively, P < 0.001). In linear regression analysis, a strong correlation was observed between the HRQOL scores of IBS-QOL and the WHOQOL-BREF questionnaires (standard β = 0.86 (95%CI: 1.15 - 1.44), P value < 0.001). Controlling for anxiety and depression symptoms did not influence the strength of observed correlation. The WHOQOL-BREF is a psychometrically sound, rapid and convenient instrument whose HRQOL measure is as valid and accurate as the disease-specific IBS-QOL questionnaire. It seems reasonable to use the WHOQOL-BREF alongside the IBS-QOL.

Kikuchi-Fujimoto disease or histiocytic necrotizing lymphadenitis is an idiopathic, self-limiting disorder and predominantly affects young women. We report a 35-year-old female who presented with soft to firm cervical lymphadenopathy and neck pain. She had multiple enlarged cervical nodes. Examination of other systems was normal. Lymph node biopsy was performed, and the histological features, and immunohistochemistry confirmed the diagnosis. The Patient was treated with non-steroidal anti-inflammatory drugs and low-dose prednisolone. A significant decrease in the size of lymph node and relief of neck pain occurred. During four years of follow-up, the patient developed no malignant disease or systemic and autoimmune diseases such as systemic lupus erythematosus. Kikuchi-Fujimoto disease is rare, clinicians should be aware of this condition as early diagnosis of the disease will lessen concerns of the patient's family.

Crohn’s disease (CD) is rarely presented with lower GI bleeding (LGIB) which eludes the clinician. A 25-year-old lady with severe rectorrhagia was presented with no history of constipation, diarrhea or abdominal pain. Colonoscopy revealed ulcers in the rectum, sigmoid colon, and terminal ileum. Crohn’s pathologic features were detected in the terminal ileum. The bleeding was controlled via supportive care and IV corticosteroid. Recurrent LGIB was managed by prednisolone and azathioprine. The patient had an uneventful recovery. The clinicians should consider CD as a possible diagnosis in severe LGIB. Prednisolone and azathioprine efficiently control acute bleeding episodes and prevent the recurrence.

Wilms’ tumor is the most common abdominal tumor of childhood, and its cerebral metastasis is apparently very rare. The authors report an 18-month-old girl with Wilms’ tumor and brain metastasis.