Acta Medica Iranica
Volume:44 Issue: 6, Nov-Dec 2006

Anandamide is an endogenous ligand for cannabinoid receptors and has endothelial protective effect against ischemic preconditioning. The purpose of this study was to investigate the effects of cannabinoids on reperfusion injury due to testicular torsion-detorsion (T/D). A total of 36 adult male Sprague-Dawley rats were divided into 6 groups. Testicular ischemia was achieved by twisting the right testes 720◦ counters clockwise for 1 hour and reperfusion was allowed for 4 hours after detorsion. In baseline (normal) group, bilateral orchiectomies performed after anesthesia. Sham operated group was served as a control group. Torsion/detorsion group underwent 1 hour testicular torsion and 4 hours of detorsion. Anandamide (cannabinoid agonist) group received pretreatment with intraperitoneally anandamide 30 min before torsion. AM251 (CB1 antagonist) group, received intraperitoneally injection of AM251 45 min before torsion. Anandamid/AM251 (An/AM) group received administrations of AM251 45 min before torsion and anandamide 30 min before torsion. The ipsilateral malondialdehyde (MDA) level in T/D group were significantly higher versus control and base line groups. Ipsilateral MDA values in anandamid group were significantly lower than T/D and An/AM groups. There were also significant decreases in catalase activity in T/D group compared with control and base line groups. These values were significantly higher in cannabinoid group versus T/D and An/AM groups. Anandamide increased ipsilateral intratesticular antioxidative markers and decreased free radicals formation during reperfusion phase after unilateral testicular torsion, which was reflected in lesser testicular MDA level. Furthermore, the effects of anandamide were mediated via cannabinoid receptors, since AM251 could abolish these effects.

Glutathione S-transferase (GST) represents the major class of detoxification enzymes from helminth parasites such as Fasciola hepatica and F. gigantica and it is a candidate for chemotherapeutic and vaccine design. Therefore, GST enzyme of Fasciola spp. could be a target for evaluation of drugs such as triclabendazole (C14H9Cl3N2OS). For this purpose, GST enzymes were purified from Fasciola spp. and sheep liver tissue by glutathione affinity chromatography using a wash-batch method and subsequently their SDS-PAGE pattern was detected. Afterward, GST specific activity levels were assayed in the whole extract and purified solutions spectrophotometrically at 30°C with reduced glutathione (GSH) and 1-chloro-2, 4-dinitrobenzen (CDNB) substrate. Finally, GST inhibition assay was investigated in the solutions by powder and bolus forms of triclabendazole. GST fraction as a 26 kDa (MW) band was obtained on sodium dodecyl sulfate- polyacrylamide gel electrophoresis (SDS-PAGE). The level of GST specific activity in purified solutions was detected 18.14 µmol/min/mg proteins for Fasciola hepatica, 35.04 for F. gigantica and 37.84 µmol/min/mg protein for liver tissue. Comparison of the effect of powder and bolus of triclabendazole in solutions revealed inhibition concentration (IC50) 8.36 and 9.05 µg/ml for Fasciola hepatica GSTs and 7.20 and 10.80 for F. gigantica GSTs and 8.65 and 9.70 µg/ml for liver tissue GSTs, respectively. These findings suggest the possibility of selective inhibition of Fasciola spp. GSTs by triclabendazole in vitro and use of these results for understanding of its effect in vivo and qualification of manufacturing bolus form of drug in comparison with original powder.

Nitroglycerin has a relaxing effect on the smooth muscles of organs including uterus. This study investigates the effect of intravenous nitroglycerin in emergency cesarean sections in which rapid and transient uterine relaxation for rapid and nontraumatic extraction of the fetus is necessary. Sixty pregnant women who were been candidates for emergency cesarean and needed rapid uterine relaxation for different reasons were selected. These subjects underwent spinal anesthesia and at the time of uterine incision, 100 micrograms of nitroglycerin was injected to them intravenously. The time lapse between nitroglycerin administration and fetal extraction, the degree of uterine relaxation, the amount of intraoperative hemorrhage, uterine tone after fetal delivery and APGAR scores of the infants were all controlled and recorded. The results showed that in 53 (88.3%) of patients the uterus was acceptably relaxed and the fetus was delivered very easily. Only in 7 patients (11.7%) uterine relaxation was not acceptable. The mean decrease in systolic and diastolic blood pressures after nitroglycerin administration compared with before injection BP was 12.96 mmHg and 7.86 mmHg, respectively. There was not any prolonged effect of the drug such as uterus relaxation tone or abnormal bleeding. Also none of the delivered infants had low APGAR scores. Besides, in patients with acceptable uterine relaxation the first and fifth minute APGAR score of infants were higher (P = 0.008 and P = 0.000), respectively. This study shows that nitroglycerin can relax uterine smooth muscles very rapidly and transiently and in emergencies it can be an appropriate alternative to other tocolytic agents with prolonged effect or onset time.

Chronic plaque-type psoriasis may be difficult to control without the use of potent systemic therapies that are accompanied by systemic toxicity. Mycophenolate mofetil is a novel agent that may be effective in the treatment of chronic plaque type psoriasis. Our purpose was to investigate of the safety and efficacy of oral mycophenolate mofetil in the treatment of chronic plaque-type psoriasis. Four patients with severe stable plaque-type psoriasis and a psoriasis area and severity index (PASI) between 7.2 and 30.4 (mean 19) were included in the study. They received oral mycophenolate mofetil 1 g twice daily for 3 months. The PASI were determined at baseline (week 0) and every two weeks thereafter. Within 4 weeks of this therapy, there was a reduction in PASI of between 52% and 68% in patients (mean PASI: 7.45). The mean PASI was 3.7 and a PASI decrease of 62.5-90% obtained after 3 month of therapy. The drug was tolerated by all the patients and severe side-effects especially hematological and liver toxicity, were not observed in any of them. Oral mycophenolate mofetil might be a safe and effective drug to treat chronic plaque type psoriasis. We think that randomized controlled trials are needed to clarify this opinion.

s study was designed reevaluate the outcome of soft wall reconstruction technique for CWD mastoidectomy and to test the validity of anteriorly–based musculoperiosteal flap attachment without oblitrating the mastoid cavity for increasing graft viability. Two methods of reconstruction were used. Soft wall reconstruction method as described previously by Smith et al, were performed on 35 patients (A), and anteriorly – based musculoperiosteal flap was attached to it in 25 patients (B). Post operative condition of meatal wall, graft failure and canal volume in two groups were documented. In 3 years follow up period no retraction pockets were documented and there was slight increase in canal volume measured by the volume of povidone iodine pouring in the canal. 17% of group A and 8% of group B had graft failure. No significant differences was seen (P > 0.05). There was no recurrent cholesteatoma in the patients on clinical examination. Soft-wall reconstruction method is a safe method for eliminating the problem of radicalized mastoid cavity, and the musculoperiosteal flap attachment had no advantage compared with soft-wall reconstruction.

Temporomandibular joint ankylosis causes limitation in mouth opening and establishes severe deformity and asymmetry in patient’s face, especially in children. Surgery is the only treatment. This study was conducted to compare the effect of two surgical approaches, gap arthropasty and interpositional gap arthroplasty, on rate of maximum interincisal opening in temporomandibular joint ankylosis. We also evaluated the relapse rate of these two surgical approaches. A total of 48 patients were enrolled in this cross-sectional experimental study. Range of mouth opening was evaluated before and during and one year after surgery. All other related information was also recorded. Mean age of the study population was 19.5  8.9 years. Of those, 21 (41%) were male and 27 (59%) were female. For 26 patients (54.2%) interpositional gap arthroplasty was accomplished and for 22 patients (45.8%) gap arthropasty was performed. Mean range of mouth opening before and after surgery was 10.3  3.9 and 33.9  5.2 in interpositional gap arthroplasty, 8.7  4.9 and 32.1  7.8 in gap arthropasty, respectively. The results showed that the range of mouth opening significantly increases after ankylosis surgery in both surgical approaches but improvement was less in interpositional gap arthroplasty. In regards to recurrence, results of interpositional gap arthroplasty were superior to gap arthropasty.

Arteriovenous fistula is considered as a prerequisite in patients with chronic renal failure undergoing hemodialysis. The purpose of this study was to compare the effectiveness and side effects if any of native vein and synthetic grafts in these patients. From April 2002 till July 2003, a total of 37 patients were referred to us for the utilization of these grafts. In 16 out of these patients we utilized native vein at the elbow joint, and in 21 patients we used polytetrafluoroethylene (PTFE) graft. In the native group, the results were better and side effects minimal and economically was in the interest of the patients. We advocate native vein as far as possible and give it a top priority.

A descriptive prospective study was undertaken to determine birth weight, length and head circumference of live births and to examine the effect of maternal age, parity and gestational age on birth sizes of the live births. A total of 459 term singleton maternal– neonate pairs were studied. The neonates had anthropometric measurements determined with in 24hours of life using standard methods. There were 247 (53.8%) males and 212 (46.2%) females. The mean birth weight was 3123.75  492.04, ranging between 1700-4550 gr. The incidence of low birth weight of the newborns was significantly higher for females (P < 0.05), younger maternal age (P = 0.007), primiparas (P = 0.001) and pre-term babies (P < 0.001). On the multivariate analysis, gestational age and sex of the newborn respectively had significant effects on birth weight, length and head circumference of the neonates controlling for the other variables. On the other hand parity and maternal age had significant effects only on the birth weight of the neonates. This study has provided information of the effects of some of maternal characteristics on the size, particularly length and head circumferences be given importance for monitoring and evaluating maternal and child health programs.

Kernicterus (bilirubin induced encephalopathy) is an uncommon disorder with tragic consequences, especially when it affects healthy term and near-term neonates. Appointment of cut off value of total serum bilirubin level that have a safe margin for early prompt treatment, as a result, prevention of kernicterus. In our study, all of icteric neonates that admitted in our center in 1 year were enrolled. From 305 neonates, 25 cases have kernicterus manifestations. These 25 neonates have not any conditions that mimic kernicterus manifestations (such as birth trauma, intra cranial hemorrhage, asphyxia). We divided neonates to 2major groups: neonates < or = 7 days and > 8 days-old. Also these cases were divided to high-risk and low-risk neonates. In this study, 220 neonates (72.1%) were ≤ 7days and 85 neonates (27.9%) were > 8 days-old. Also 109 neonates (35.7%) were or with risk factors and 196 neonates (64.3%) were or without risk factors. Risk factors were prematurity, acidosis, hemolysis, duration of hyperbilirubinemia, sepsis and respiratory distress. Cutoff value of bilirubin level for neonates ≤ 7 days was 25.15 mg/dl and for neonates > 8 days was 22.25 mg/dl that no statistically significant difference was found. Cut off value of bilirubin level for high-risk neonates was 22.35 mg/dl and for low-risk neonates was 27.95 mg/dl that statistically significant difference was found. The lower limit of bilirubin in neonates with kernicterus was 16.5 mg/dl and the upper limit was 44 mg/dl. The high-risk neonates need prompt treatment of hyperbilirubinemia at lower levels of total bilirubin compared with low-risk neonates.

This survey has been conducted to indicate the positive effects of implementing neonates continuous care patterns on their physical health as well as early diagnosis and decrease of complications in 6 weeks after delivery. This quasi-experimental study has been conducted on 118 mothers and their neonates in one maternity hospital in IRAN. Neonates were assigned in control and experimental groups. Discharge planning included mothers face to face interview, training in hospital, the determination of readiness for discharge and follow up by home visit and telephone call. Data were collected by demographic questionnaire and physical status check lists for neonates. Statistical comparison of the two groups shows that physical status of neonates was significantly better in experimental group than control group (P < 0.001). Accordingly, the implication of discharge planning by nurses could be useful in improving the neonatal physical status and decreasing their problems after birth.

Diabetic retinopathy is a common complication of type II diabetes mellitus and carries with it the threat of blindness. Accurate information regarding the incidence of diabetic retinopathy and associated risk factors is important in the prevention of its development and of the visual impairment caused by this complication. This study was designed to determine the prevalence of diabetic retinopathy in newly diagnosed patients with type II diabetes mellitus. We have also evaluated the association of diabetic retinopathy with clinical and biochemical variables. In a cross-sectional study, 152 consecutive patients with newly diagnosed type II diabetes mellitus were referred from two outpatient clinics in Tehran for ophthalmologic exam to detect retinopathy. Indirect ophthalmoscopy was performed and data regarding risk factors were extracted from routine medical records. Chi square and Mann Whitney U tests were used to analyze the data. The overall prevalence of diabetic retinopathy was 13.8 %(21 cases): three cases with microaneurysm only, 10 with mild, 5 with moderate and 2 with severe non proliferative diabetic retinopathy. Only one patient had advanced proliferative retinopathy. The prevalence of diabetic retinopathy was positively associated with age, duration of disease, fasting plasma glucose, HbA1c, and systolic blood pressure. Diabetic retinopathy is common in newly diagnosed type II diabetes mellitus patients. Ophthalmologic consultation is essential at the time of diagnosis for all patients.

Recently multiple studies have shown that elevated homocysteine levels may be associated with ophthalmic vascular disease. To investigate the role of high plasma levels of homocysteine in the patients with retinal vein occlusion, 21 patients with retinal vein occlusion (RVO) and 20 age and sex matched controls without RVO were included in this retrospective case–control study. Information regarding sex, age, blood pressure, history of diabetes, history of glaucoma were obtained from all participants. Plasma level of homocysteine was measured by high plasma liquid chromatography. Mean plasma total homocysteine level was significantly higher in patients than controls (14.17  9.91 versus 8.97  3.10 mol/L, P < 0.031). Hyperhomocysteinemia was present in 5 of the 21 patients (25%) but only one control had elevated plasma homocysteine (5%). Hyperhomocysteinemia is highly associated with retinal vein occlusion; therefore, its measurement may be useful in the management of these patients.

Abstract- The syndrome of diabetes mellitus, sensorineural deafness and megaloblastic anemia dose not result from thiamine deficiency. The previous reported patients had no sign of beriberi, had normal nutrition, and had no evidence of malabsorption. The features of this syndrome with apparent inheritance of autosomal recessive trait may define this puzzling syndrome as a true thiamine dependency state. The first Iranian patient was described by Vossough et al. in 1995. We found nine new cases with diagnostic criteria of thiamine responsive megaloblastic anemia during eight years of our study. In two patients, presentation of diabetes and anemia was concomitant. All of them were deaf with sensorineural hearing loss which was detected in infancy up to two years of age. The presence of congenital valvular heart disease was eliminated by normal echocardiography, but cardiomyopathy was discovered in two. Nonspecific amino-aciduria was discovered in three but urinary screening tests for hereditary orotic aciduria were negative. Ox-Phos biochemistry of muscle mitochondria which demonstrates severe defect in complexes I, III, IV in diabetes mellitus associated with deafness, were done but was unremarkable in our patients. Urinary methylmalonic acid and methyl malonyl carnitine by GS/MS and TMS was done in our patients and showed abnormal results in six patients. Thiamine gene, SLC 19A2, was detected in four patients.

A 3 month- old boy was admitted with recurrent severe respiratory distress and refractory to therapeutic options. Patient underwent a helical multidetector CT examination. Axial, coronal and three- dimensional imaging, revealed tracheal bronchus, stenosis, diverticulum and bronchiectasis. In this situation, CT scanning, Perfectly 3D imaging is recommend for rule out congenital tracheobronchial tree anomalies. Therefore, with proper evaluation and therapeutic options we can prevent pulmonary complications and infantile mortality.

Moebius Syndrome is a rare congenital disorder of the facial and abducens nerve. Other cranial nerves may be involved, such as V, IX and XII. Several central nervous system anomalies including hypoplastic or dysplastic brain stem, straightening of the fourth ventricle floor, focal necrosis and calcifications of cranial nerve nuclei have been reported in association with Moebius syndrome, but we report a 18 months old boy of moebius syndrome with corpus callosum agenesis that has not been reported yet.