Acta Medica Iranica
Volume:43 Issue: 2, Feb-Mar 2005

Long-term protection against hepatitis B virus (HBV) is dependent on persistence of anti-HBs antibodies and/or strong immunological memory. In this study we evaluated the persistence of anti-HBs antibodies in healthy Iranian children 5 years after primary vaccination and the response to a booster dose using recombinant hepatitis B vaccine. Totally, 81 children who had received primary course of hepatitis B vaccine at 0, 1.5 and 9 months of age were included in this study. A booster dose of hepatitis B vaccine was administered at 5 years after completion of primary vaccination program. Children were tested for anti-HBs antibody just before administration of booster dose and at 4 weeks after booster vaccination. An 81.5% seroprotection rate (anti-HBs > 10 IU/L) was observed 5 years after primary vaccination. After administration of booster dose, 100% of the children developed protective level of anti-HBs antibody and geometric mean titer rose from 206 IU/L to 1278 IU/L. These results indicate the existence of an effective immunological memory over a period of 5 years after primary vaccination with recombinant hepatitis B vaccine in healthy Iranian children.

HBME-l is an antimesothelial monoclonal antibody that recognizes an unknown antigen on microvilli of mesothelial cells. The antibody is only relatively specific for mesothelium and is used in the differential diagnosis of mesothelioma and adenocarcinoma within the context of an appropriate immuno-histochemical panel. HBME-l has also been reported to strongly and uniformly stain papillary and follicular carcinoma of the thyroid while benign disorders have been usually negative. We studied the immunoreactivity of HBME-l in 90 cases of benign and malignant thyroid lesions. We found strong positive staining in the majority of papillary carcinomas (28/31), in some of follicular carcinomas (4/6),and in a few follicular adenomas (2/17). Negative staining was found in oxyphilic cell adenoma (0/4), nodular goiter (0/13) and undifferentiated carcinoma. The results suggest that monoclonal antibody HBME-l is useful in differentiating papillary and follicular carcinoma of the thyroid from benign lesions, especially in more differentiated lesions. Strong and generalized immunoreactivity for HBME-l in a follicular lesion should raise the suspicion of malignancy, but negative staining specially in poorly differentiated lesion does not rule out malignancy.

Diabetes mellitus is a chronic disease of lifelong duration and its management requires a fundamental change in patient’s lifestyle. The aim of this study is to evaluate the efficacy of an interactive health education program on knowledge, behavior, HbA1c and health-related quality of life (HRQOL) of diabetic patients. Eighty patients were randomly selected and assigned to two groups, 40 to the intervention and 40 to the control group. All participants were followed for 4 months. At the initial visit and 4 months after education, knowledge was assessed by questionnaire, behavior assessed using an interview schedule, HbA1c measured by colorimetric method and health-related quality of life assessed by means of WHOQOL-BREF questionnaire. The intervention group showed statistically significant increase in mean of knowledge, behavior, physical and psychological health and also had a statistically significant reduction in mean of HbA1c. Control group had significant increase only in knowledge. It seems that this interactive approach is useful, worthwhile and applicable for behavior modification and improvement in HbA1c and health-related quality of life of diabetic patients.

Recombinant human erythropoietin (rh-EPO) is known to accelerate erythropoiesis in preterm infants. The purpose of this study was to compare the effectiveness of early treatment with two doses of rh-EPO (high vs. low dose) in the management of anemia of prematurity. Twenty preterm infants with hematocrit (Hct) < 30% when infant’s age was between 2 to 3 weeks after birth or Hct <25% when infant’s age was more than 3 weeks after birth, were divided randomly in two groups, each group including 10 babies. Infants in high dose group received 500 u/kg rh-EPO twice per week and the low dose group received 500 u/kg rh-EPO weekly. All infants were fed human milk supplemented with enteral iron. Hematocrit and reticulocyte counts were determined for each infant at the start of the study, 3 days after start of treatment and one week after the end of treatment. The means of gestational age in high dose and low dose groups were 31.4 ± 2.2 and 31.3±2.0 weeks, respectively. Means of birth weight in high dose and low dose groups were 1366 ± 243 and 1438±249 gr, respectively. The two groups were significantly different in reticulocyte count at 3 days after treatment (P = 0.047) and in hematocrit at the end of study (P < 0.0001). We concluded the early treatment of anemia of prematurity with high dose rh-EPO with supplemental iron significantly increases hematocrit and reticulocyte in preterm infants and reduce the need for blood transfusion in these high risk neonates.

Osteoporosis (OP) is a frequent complication of rheumatoid arthritis (RA) and longitudinal studies have documented increased rate of bone loss in RA patients. To determine the frequency of low bone mass as well as the influence of disease duration and corticosteroid use on bone mass in patients with RA, 88 patients with RA and 112 age matched controls were studied. Bone densitometry was performed by a single dual X-ray absorptiometry equipment in the lumbar spine (LS) and femoral neck (FN). The mean age of patients and controls were 52.6 and 54.6 years, respectively. The mean disease duration was 7.0 years and 79.5% of patients were taking 5.0 mg prednisolone daily for a mean period of 4.6 years. At the FN, 45% of patients had OP compared to 30.4% in the controls (P < 0.05). At the LS the frequency of OP in patients was non-significantly lower than in the controls. OP was more frequent in corticosteroids treated patients compared to non-corticosteroids treated patients both at the FN (43.5% vs 39%) and LS (26% vs 22%) but the differences were not significant. Disease duration longer than 10 years in comparison to disease duration of less than two years was associated with bone mineral density change of -10.9% at the FN (P = 0.05) and -10.4% at the LS (P not significant). The results of this study indicate that a significant proportion of patients with RA have OP at the FN and LS,and disease duration longer than 10 years is associated with a significant increase in bone loss.

Retinoblastoma is the most common primary intraocular malignancy in childhood. Enucleation remains the treatment of choice in many children because the eye can not be salvaged with any other treatment modality. In some cases after enucleation etiologies other than retinoblastoma are detected in histopathologic review (pseudoretinoblastomas). This study aims to evaluate the prevalence and etiologies of pseudoretinoblastomas in those eyes enucleated or exenterated due to clinical and radiological diagnosis of retinoblastoma in Farabi Hospital from April 1986 through February 2000. Records of all 453 patients who had sustained enucleation or exenteration due to diagnosis of retinoblastoma during these 15 years were reviewed for reports of histopathologic specimens. In those cases where the histopathologic reports were not consistent with retinoblastoma, Hematoxylin & Eosin stained slides were studied again. Histological diagnosis of retinoblastoma was confirmed in 400 cases (88.3%), and 53 cases were pseudoretinoblastomas (11.7%). This frequency was in agreement with previous studies. Most common etiologies of pseudoretinoblastomas were endophthalmitis (22.7%),phthisis bulbi, vitreous hemorrhage and retinal detachment (17% each) and coat''s disease (11.3%).

Although uncommon, traumatic optic neuropathy (TON) is an important cause of visual loss. Different therapeutic approaches including different dosages of steroids, surgical decompression of optic canal and observation alone have been suggested but there has been no conclusive evidence to establish a standard approach to this devastating cause of visual loss. To determine the effectiveness of intravenous (IV) steroids in the treatment of these patients, the medical records of patients with TON, including one bilateral case, treated with IV steroids were reviewed. Twenty-eight patients (22 males, 6 females) with mean age of 24.1 (11 to 41 years) were enrolled. All patients had received 30 mg/kg loading dose of methylprednisolone succinate followed by 5.4 mg/kg/ hour for 48 hours. Visual acuity (VA) was improved by ≥ 1 line in 8 eyes (28.6%) immediately after treatment and in 10 eyes (37%) after 3 months; however, most of them (6 and 8, respectively) were in the range of initial VA of no light perception to hand motion. After adjustment for the baseline VA, these improvements in visual acuities were not considered significant. Neither different orbital fractures, nor various extraocular muscle palsies had any significant effect on the prognosis of ultimate VA. Regarding the natural course of TON, this investigation showed that IV megadose steroids had no clear benefit on the visual outcome of patients with TON.

The prevalence of physical violence during pregnancy varies widely in different societies. To assess the incidence of self-reported physical, emotional and sexual violence in pregnancy and describe the association with maternal complication and birth outcomes, 3275 women who gave birth to live-born infants from October 2002 to November 2003 were assessed for self-reported violence in postpartum units of Obstetrics Department of Babol university of Medical Sciences. Outcome data included maternal antenatal hospitalizations, labor and delivery complications and low birth weights and preterm births. Odds ratios and 95% confidence intervals were calculated to measure the association between violence, maternal morbidity and birth outcomes. The prevalence of physical, sexual and emotional domestic violence was respectively 9.1%, 30.8% and 19.2%. Compared with those not reporting physical, sexual and emotional violence, women who did were more likely to deliver by cesarean and to have abnormal progress of labor, premature rupture of membranes, low birth weight, preterm birth and any hospitalization before delivery. Prevalence of physical, emotional or sexual violence during pregnancy was high and was associated with adverse fetal and maternal conditions. These findings support routine screening for physical, emotional and sexual violence in pregnancy and postpartum period to prevent consequences of domestic violence.

The success of oocyte donation is influenced by multiple factors. We performed a retrospective analysis to evaluate prognostic factors in oocyte donation cycles. The main outcome measurements including recipient age, donor age, estradiol level in midcycle, the day of transfer and number of transferred embryos were not different in pregnant and non pregnant groups. Endometrial pattern but not endometrial thickness was useful in predicting pregnancy outcome. Clinical pregnancy rates were not different relative to etiology of infertility. Clinical pregnancy rates in poor responders and patients with ovarian failure were 23.8% and 26.7%, respectively. Clinical pregnancy rate for zygote intrafallopian transfer (ZIFT) and rapid ZIFT was 31% vs 11.1% for uterine embryo transfer.Predictive factors for pregnancy in oocyte donation cycle were endometrial pattern and route of transfer (ZIFT and rapid ZIFT).

Biomolecular behavior of tumor cells has become attractive to investigators. p53 as an oncosuppresor gene has been core of various studies and Ki67 is a nuclear protein involved in proliferation process. Stopping of onco-suppressor function theoretically allows proliferative system to get out of any control. In this case-control study we evaluated 50 patients with non small cell lung cancer, considering the association between P53 oncoprotein and Ki67 with rate of tumoral cells differentiation. We found the concurrent move of P53 and Ki67 according to the rate of differentiation and a significant risk (odds ratio) for being poorly differentiated in samples having higher rates of these two factors. We suppose that mutant P53 protein not only may be used as an objective finding for tumor grading, but probably as a practical point of approach for determining prognosis and planning therapy for this patients.

The investigation and determination of the significance of neovascularization in the progression of soft tissue sarcoma is currently of increasing clinical importance. Microvessel density is the morphologic evidence of neoangiogenesis in the process of malignant progression of sarcomata. This brief review of the markers commonly used in clinical practice was undertaken to determine the validity of the application of these markers in the quantitation of neoangiogenesis in sarcomata. The material selection was based only on primary material from untreated cases that were part of the inhospital and consultation practices. From this investigation, one can conclude that not all markers have equal value in either the qualitative or quantitative assessment of vascularization in tumors. Laminin was found to have low sensitivity. Factor VIII was found to have extreme sensitivity but lack specificity. A combination of collagen IV, smooth muscle actin, CD34 and CD31 markers were found to represent the most reliable identificators of blood vessels in sarcomata. Morphological identification of vessels may be further supplemented by proliferation markers (e.g. PCNA, Ki67) as indicators for,not only the presence of blood vessels, but also to determine the activity of endothelial cells in blood vessel growth.

Graves’ disease is an autoimmune disorder characterized by presence of antibodies directed against thyroid stimulating hormone (TSH) receptor or nearby region. Other serological abnormalities like antibodies to double stranded DNA (ds–DNA) and antinuclear antibodies (ANA) have also been observed. We studied antibodies to ds-DNA and ANA in our patients with Graves’ disease and compared them with control group. Sera of 84 patients (29 males, 55 females) with diagnosis of Graves’ disease were prepared and level of antibodies to ds-DNA and ANA were measured and compared with 41 healthy persons (15 males, 26 females). The level of antibodies to ds-DNA and ANA in patients and control group did not show any significant difference. Our results were different from other studies in other countries. The difference may be explained by difference in our method of antibody measurement or genetic background which needs to be confirmed by HLA studies of our population.

Correlation between sacral ratio and bowel function as well as fecal continence has been well documented in patients with anorectal malformations (ARMs). One hundred and twenty children with ARMs were investigated in this study. Sacral ratio (SR) was measured from pelvic X-rays of patients. Among these, 52 patients (43%) had no pelvic X-ray and were excluded from this study. SR was measured by drawing three horizontal lines, through iliac crests (A), tip of coccyx (B) and inferior point of sacroiliac joints (C). The SR was determined by dividing the distance between lines B and C to the distance between lines A and B. In the normal and well developed children, the average ratio is ≥0.74. The SR was higher than 0.70 in 12 (17.7%) children and less than 0.69 in 56 children (82.3%). Among children with ARMs and abnormal SR, 38 cases (68%) had SR of 0.50-0.69; 12 cases (21.5%)had SR of 0.40-0.49 and 6 cases (10.5%) had SR of 0-0.39. In children with ARMs and normal SR, the fecal incontinence was observed in 2 cases (16%). In contrast, 16 cases (29%) with ARMs and abnormal SR had functional disturbance, either fecal incontinence or soiling (P < 0.12). When the patients had an absent sacrum, they had zero possibility for bowel control and frequently had major urinary problems. The sacral feature and SR appear to have a direct influence on the final functional outcome in ARMs. The abnormal SR < 0.7 correlates with poor bowel function. In patients with ARMs, sacral segment and SR are important factors in post operative bowel function disturbance.

Seizure is the most common neurologic disorder in the pediatric age. Obtaining thorough history and performing complete examination as well as electroencephalography (EEG) are very important in confirming the diagnosis and finding the cause. Epileptiform activity may be enhanced by activating procedures including sleep deprivation. In this study we performed short duration (up to 8 hours) sleep deprivation in 139 children with history of seizure but with normal or non specific awake EEG. We obtained 70% abnormality, 54% of which was of classic pattern of absence (3 Hz spike and slow wave). Most abnormal EEGs belonged to children in the age range of 5-10 yrs. It seems that short duration sleep deprivation is as useful as long duration sleep deprivation.

Normal range of joint motion is an important factor in joint examination in clinical practice which is related to factors such as age, sex and geographic region. There is no data in the literature on the range of joint motions in healthy Iranian adults. We studied joint motions in 100 healthy volunteer subjects, 49 men and 51 women, from 19 and 58 years of age. The joint mobility was examined in saggital, frontal, transversal and rotating levels (SFTR). The normal range of motion of all peripheral and axial joint was examined using the standard goniometric technique. There were no significant difference in elbow flexion, shoulder adduction, inward rotation of shoulder and inward and outward rotation of hip, in relation to the age and gender of the studied subjects. There was inverse relationship between joint motion indices and age.

Myiasis is the invasion of body tissues of humans and animals by the larvae of the Diptera or two-winged flies. There are only sporadic reports in the literature concerning human ear myiasis. A 62-year-old bedridden woman in an intensive care unit was examined because of her intense swollen and erythematous right ear. Physical examination revealed 80 live larvae (maggots) in the posterior part of right outer ear and external auditory canal. Entomological studies of the third instar larvae revealed it’s identity as Lucilia sericata. The entomological aspects, clinical and epidemiological characteristics are evaluated. In particular, we underline the rarity of myiasis because of both etiological agent and the anatomical site.

Choroid plexus papillomas are rare intracranial tumors, accounting for less than 1% of all intracranial tumors in adults. However, they are relatively more common in children and constitute 1.5 to 4% of childhood intracranial tumors. In children, choroid plexus papillomas are predominately located in the lateral ventricles, followed by the forth and third ventricles and, rarely, in the cerebellopontine angle. Bilateral choroid plexus papillomas of lateral ventricles are very rare and only afew cases have been reported. Here we report a 10 year old boy who was admitted for chronic headache and vomiting of 6 months duration. Brain imaging showed bilateral tumor in the lateral ventricles. The patient underwent surgery and histopathological study certified the diagnosis of choroid plexus papilloma.