Iranian Journal of Medical Sciences
Volume:41 Issue: 1, jan 2016

Familial Mediterranean fever (FMF) has episodic or subclinical inflammation that may lead to a decrease in bone mineral density (BMD). The objective of this study was to assess BMD in Egyptian children with FMF on genetic basis. A cross sectional study included 45 FMF patients and 25 control children of both sexes in the age range between 3-16 years old. The patients were reclassified into two groups, namely group I(A) with 23 cases using colchicine for 1 month or less, and group I(B) with 22 cases using colchicine for more than 6 months. For both the patients and control groups, MEFV mutations were defined using molecular genetics technique and BMD was measured by DXA at the proximal femur and lumbar spines. Four frequent gene mutations were found in the patient group E148Q (35.6%), V726A (33.3%), M680I (28.9%), and M694V (2.2%). There were also four heterozygous gene mutations in 40% of the control children. Patients receiving colchicine treatment for less than 1 month had highly significant lower values of BMD at the femur and lumbar spines than the control children (P=0.007, P<0.001). Patients receiving colchicine treatment for more than 6 months had improved values of BMD at femur compared with the control, but there were still significant differences between them in lumbar spine (P=0.036). There were insignificant effect of gene mutation type on BMD and the risk of osteopenia among the patients. FMF had a significant effect on BMD. However, regular use of colchicine treatment improves this effect mainly at the femur.

Neurologic literature on therapeutic effect of subcutaneous corticosteroids in patients with migrainous chronic daily headache is scarce. The aim of this research is to assess the therapeutic effects of this management in such patients. Consecutive patients with migrainous chronic daily headache enrolled a prospective before-after therapeutic study during 2010-2013. Methylprednisolone 40 mg was divided into four subcutaneous injection doses. Two injections were administered in the right and left suboccipital area (exactly at retromastoid cervicocranial junction) and the other two injections in the lower medial frontal area (exactly at medial right and left eyebrows). A daily headache diary was filled out by the patients before and one month after the intervention. The severity of pain was classified based on a pain intensity instrument using numeric rating scale from 0-10 point scale. Paired t-test and Chi-square test were used for statistical analysis. 504 patients (378 females, 126 males) with migrainous chronic daily headache were enrolled in the study. Dramatic, significant, moderate, mild, or no improvements respectively constituted 28.6%, 33.3%, 23.8%, and 14.3% of the post treatment courses. Therapeutic effect of intervention on mean pain scores was significant; t=7.38, df=20, P=0.000. Two cases developed subcutaneous fat atrophy in frontal injection site and three cases experienced syncope during injection. Subcutaneous corticosteroids could be used as an adjunct therapy in patients with migrainous chronic daily headache.

Lumbar degenerative spondylolisthesis (LDS) is a degenerative slippage of the lumbar vertebrae. We aimed to evaluate the surgical outcome of degenerative spondylolisthesis with neural decompression, pedicular screw fixation, reduction, and posterolateral fusion. This before-after study was carried out on 45 patients (37 female and 8 male) with LDS operated from August 2008 to January 2011. The patients’ pain and disability were assessed by visual analogue scale (VAS) and Oswestry disability index (ODI) questionnaire. In surgery, we applied distraction force to facilitate slip reduction. All the intra- and postoperative complications were recorded. The paired t-test and Pearson correlation coefficient were used for statistical analysis. The mean age of patients and mean follow-up period were 58.3±3.5 years and 31.2±4.8 months, respectively. The mean slip correction rate was 52.2% with a mean correction loss of 4.8%. Preoperative VAS and ODI improved from 8.8 and 71.6 to postoperative 2.1 and 28.7, respectively. Clinical improvement was more prominent in more reduced patients, but Pearson coefficient could not find a significant correlation. Although spinal decompression with fusion and posterior instrumentation in surgical treatment of the patients with LDS result in satisfactory outcome, vertebral reduction cannot significantly enhance the clinical improvement.

Providing community-based mental health services is crucial and is an agreed plan between the Iranian Mental Health Office and the Regional Committee for the Eastern Mediterranean (affiliated with WHO). The aim of this study was to determine the effectiveness of home-visit clinical case-management services on the hospitalization rate and other clinical outcomes in patients with severe mental illness. A total of 182 patients were randomly allocated into three groups, namely, home-visit (n=60), telephone follow-up (n=61) and as-usual care (n=61) groups. Trained nurses as clinical case-managers provided home-visit services and the telephone follow-up tasks. Hospitalization rate as a measure of recurrence, as well as burden, knowledge, general health condition of caregivers with positive/negative symptoms, satisfaction, quality of life, and social skills of the consumers were assessed as the main and secondary outcomes, respectively. Most clinical variables were improved in both intervention groups compared with the control group. During the one year follow-up, the rate of rehospitalization for the telephone follow-up and as-usual groups were respectively 1.5 and 2.5 times higher than the home-visit group. Trained clinical case-managers are capable of providing continuous care services to patients with severe mental illness. The telephone follow-up services could also have beneficiary outcome for the consumers, their caregivers, and the health system network.

Human Wharton’s jelly mesenchymal stem cells (HWJMSCs) express liver-specific markers such as albumin, alpha-fetoprotein, cytokeratin-19, cytokeratin-18, and glucose-6-phosphatase. Therefore, they can be considered as a good source for cell replacement therapy for liver diseases. This study aimed to evaluate the effects of various culture systems on the hepatocyte-specific gene expression pattern of naïve HWJMSCs. HWJMSCs were characterized as MSCs by detecting the surface CD markers and capability to differentiate toward osteoblast and adipocyte. HWJMSCs were cultured in 2D collagen films and 3D collagen scaffolds for 21 days and were compared to control cultures. Real time RT-PCR was used to evaluate the expression of liver-specific genes. The HWJMSCs which were grown on non-coated culture plates expressed cytokeratin-18 and -19, alpha-fetoprotein, albumin, glucose-6-phosphatase, and claudin. The expression of the hepatic nuclear factor 4 (HNF4) was very low. The cells showed a significant increase in caludin expression when they cultured in 3D collagen scaffolds compared to the conventional monolayer culture and 2D collagen scaffold. Various culture systems did not influence on hepatocyte specific marker expression by HWJMSCs, except for claudin. The expression of claudin showed that 3D collagen scaffold provided the extracellular matrix for induction of the cells to interconnect with each other.

Morphological changes of the cells infected with rubella virus cannot be observed easily. Estimation of the size of the cultured cells can be a valuable parameter in this condition. This study was conducted to find answers to the following questions:•How much time after infection with rubella virus, the volume and surface area of the Vero cells and their nuclei get started to change?•How is it possible to apply stereological methods to estimate the volume and surface area of the cultured cells using the invariator, nucleator, and surfactor techniques? The cultured Vero cells were infected with rubella virus. The cells of the control and experimental groups were harvested at 2, 4, 8, 24, and 48 hours following the incubation period. The cells were processed and embedded in paraffin. Invariator, nucleator, and surfactor were applied to estimate the size of the Vero cells and their nuclei. The cell volume was decreased by 15-24%, 48 hours after the infection in comparison to the non-infected cells. Besides, the cell surface area was decreased by 13%, 48 hours after the infection. However, no changes were detected in the nuclei. The values of the standard deviation and coefficient of variation of the cells, estimated by invariator, were lower compared to those measured by the nucleator or surfactor. In this study, the volume and surface area of the Vero cells were reduced by rubella virus 48 hours after infection. Invariator is a more precise method compared to nucleator or surfactor.

Pulmonary tuberculosis is a common infection worldwide. In the eastern part of Iran, fluctuations in tuberculosis prevalence are seen due to the migration of people from Afghanistan. The aim of this study was to evaluate the time of bacteriologic sputum conversion after treatment and affecting factors in those whose smear does not become negative.This study was carried out on 85 smear-positive pulmonary tuberculosis patients with the mean age of 65.6±16.7 years. There were 38 male patients (44.7%), 47 urban residents (55.3%), and only 6 patients (7.1%) from Afghanistan. The mean time of sputum conversion after starting treatment was 1.99±1.06 months. The mean time of sputum conversion was significantly higher in males (P=0.046), increased bacilli density in the primary sputum sample (P<0.0001, R=0.507), and pre-existing medical illness (P=0.001).In this study, it was revealed that pre-existing illness, bacilli density in initial smear, and severe involvement of the lung on radiography, could be associated with delay in sputum smear conversion.

It is more than a decade since scientists are making use of sympathetic skin response (SSR) as a clinical and research method to evaluate sympathetic nervous system. A major portion of the efferent pathway of this response is composed of non-myelinated nerves. Thus, the latency of the response may be significantly different in normal individuals with different height and limb lengths. This study was designed to investigate the effect of these parameters on the SSR results.We measured the height and limb length of 65 normal individuals with different heights (divided into 3 groups of height ≤150 cm, 150-170 cm, and ≥170 cm). The participants had neither peripheral nor central neuropathy. They also had none of the exclusion criteria. Then, they underwent SSR testing of both palms and soles. The correlation between the height and limb length in relation to SSR parameters (latency and amplitude) was analyzed statistically by Pearson’s correlation.No significant correlation was detected between the height and limb length and the SSR amplitude. However, the results showed significant correlation between SSR latency recorded from all four sites (both palms and soles) and the height of participants. Furthermore, there was a significant correlation between SSR latency recorded from any limb and the length of that limb.Regarding the significant effect of the height and limb length on the SSR latency, both the height and limb length should be considered when interpreting the results of SSR.

Morphine withdrawal usually results in unsuccessful outcomes. Despite partial benefits from alternative substances such as methadone, its use may not lead to the desired result due to the lack of mental tranquility during the withdrawal period. In this study, by means of an animal model, morphine itself was used to manage morphine dependence. Forty mice were divided into 5 groups, in which 4 groups became dependent by increasing daily doses of morphine for 7 days (15-45 mg/kg). Afterwards, the animals received morphine for 14 days by either of the following regimens:•Once daily 45 mg/kg (positive controls)•Increasing the interval (each time 6 hours longer than the previous interval)•Irregular interval in every 36, 12 and 24 hours until the 21th day•12, 24, 36 hours decreasing doses (each time 2.5 mg/kg less than the former dosage)Negative controls received saline solution only. On day 22, total withdrawal index (TWI) was determined by injecting 3 mg/kg of naloxone. Thereafter, blood samples were taken for the measurement of cortisol and glucose levels. TWI significantly decreased in all test groups in comparison with the positive control animals (P<0.001). Cortisol levels significantly decreased when either the dosage or the administration frequencies were decreased on a regular and gradual basis (P<0.005). Blood glucose levels significantly decreased in animals that received decreasing doses of morphine (P<0.005). This study suggests that no other measures may be required in clinical practice except for changing the dosage regimen of morphine for the cessation of self-administration.

A 41-year-old man was referred with a complaint of visual loss in his left eye and his best corrected visual acuity was 20/80. Slit lamp examination showed arborizing conjunctival vessels and dry eye. Fundus examination and fluorescein angiography revealed a non-ischemic central retinal vein occlusion. Cardiovascular, rheumatologic, and hematologic work up showed no abnormal findings. An ascertained history of exposure to sulfur mustard during the Iran-Iraq war was documented in his medical history. Four sessions of intravitreal bevacizumab injections were done as needed. After two-year follow-up, visual acuity in his left eye improved to 20/25 and macular edema was resolved without any need for further interventions. We conclude that sulfur mustard gas exposure may be considered as a predisposing factor for central retinal vein occlusion, as was found in our patient (an Iranian war veteran) by excluding all yet known etiologies and predisposing factors.

Congenital adrenal hyperplasia (CAH) is a group of hereditary diseases, which are autosomal recessive. CAH occurs due to defect in one of the cortisol coding genes and often clinically presents itself with signs of androgen overproduction. In this article, we report a case of CAH and Schmid metaphyseal dysplasia. Our literature review indicated that this report is the first attempt on CYP11B1 and Schmid dysplasia in a child. The specific diagnosis of 11-β-hydroxylase deficiency can be determined using high basal levels of deoxycorticosterone and/or 11-deoxycortisol serums.

Trichobezoars are impactions of swallowed hairs in the stomach and occasionally in the intestine. They occur in emotionally disturbed, depressed, or mentally retarded patients who have trichotillomania and trichophagia. Trichobezoars are usually diagnosed on CT scan or upper GI endoscopy. They can give rise to complications like gastroduodenal ulceration, haemorrhage, perforation, peritonitis, or obstruction, with a high rate of mortality. The treatment is endoscopic, laparoscopic, or surgical removal and usually followed by psychiatric opinion. Herein, we report a case of gastric trichobezoar presenting as gastric perforation in a patient of trichotillomania and trichophagia that was accidentally found on laparotomy. As the patient was in shock on admission, relevant history of trichophagia could not be elicited. Henceforth, she was operated for perforation peritonitis. Trichobezoar was discovered intraoperatively and removed. The perforation was repaired with Graham’s omental patch. Postoperatively, history of trichophagia was corroborated with scarring alopecia of scalp.Trichobezoars is usually seen in adolescent girls, often with an underlying psychiatric or social problem. Laparotomy is the gold standard treatment. Surgical treatment should be followed by behavioral and psychiatric treatment. The patient should be vigilantly monitored for this impulsive disorder, as recurrences are common.