Acta Medica Iranica
Volume:45 Issue: 2, Feb Mar 2007

Valproic acid (VPA) is one of the mostly used antiepileptic drugs that may have some side effects so, it is highly recommended to evaluate its serum concentrations. The aim of this study was to develop a simple, fast and economic method using gas-chromatography equipped with flame ionization detector (GC/FID) and VPA analysis. To do this, 200 µl of serum was mixed with an aliquot of caproic acid (200 µL, methanolic solution) as internal standard and extracted by stepwise addition of hydrochloric acid and chloroform with slight agitation between each step. After centrifugation, 1.0 µl of the bottom layer was injected into a wide-bore nonpolar capillary column. Injectable samples for analysis of unbonded VPA were prepared by ultra filtration followed by solid phase extraction (SPE). Caproic acid and VPA were eluted after 1.5 min and 3.0 min, respectively (total GC run time about 3.2 minutes). This GC/FID method was linear over a range of 2.5-6400 µg/ml with the mean recovery of 92%. The intra- and inter-assay precision in the range of 25-100 µg/ml was 1.50-, 2.95, and 2.35- 3.22%, respectively. The simplicity of sample preparation with no derivatization, short run-time and high sensitivity sufficient to detect low concentrations of the drug makes this method suitable for research as well as routine use.

Herbal extracts have been successfully used in dentistry as tooth cleaning and antimicrobial plaque agents. The aim of this study was to evaluate the clinical effects of a dental gel containing barberry extracts (from Berberis vulgaris) on gingivitis and microbial plaque control. A double blind clinical trial study was conducted in a dormitory on 45 boys aged 11-12 years having the same socioeconomic conditions. These students were divided into 3 groups; the first group (25 students) using barberry gel, and the second group (10 students) using placebo gel without active ingredient. To compare the activity of our gel with an active antiplaque, a third group of 10 students using Colgate® antiplaque toothpaste was also considered. At the beginning all subjects were examined for plaque index (PI) and gingival index (GI). These tests were re-evaluated after 21 days of using the above mentioned dentifrices. The results showed that barberry gel has reduced the PI for about 56%. This reduction was 18.5% for placebo and 44% for Colgate® antiplaque groups. Considering means of PI (PI) and GI (GI) of different groups, there was significant difference between barberry and placebo gel’s groups and between placebo and Colgate® groups, but the difference between barberry and Colgate® groups was not significant. This study indicates that the barberry dental gel effectively controls microbial plaque and gingivitis in the school aged children; therefore, the use of barberry dental gel is strongly recommended.

The molecular basis of metastatic potential of human breast carcinoma cells can be useful information to determine the practical implications in the diagnosis, determining prognosis and treatment of breast cancer. The aim of this study was to identify predictors of aggressive biological behavior and metastatic potential in breast carcinoma among a number of intrinsic biomarkers of tumor cells. We used routine formalin fixed, paraffin embedded tumor samples; sections were stained immunohistochemically to determine the expression of estrogen receptor (ER), progesterone receptor (PR), HER2/neu, Ki67, p53 and cathepsin D in 66 breast carcinoma patients. The result of the quantitative immunohistochemical assays were correlated with clinical and histological data such as patient age, tumor size, axillary lymph node status, tumor grade, the therapeutic regimens and survival rates. Univariate analysis revealed a statistically significant relation between tumor size and overexpression of p53, and between tumor grade and PR status, p53 status and Ki67. In multivariate analysis the independent factors predicting for tumor grade were Ki67 and PR status. Among patients with ER expression, negative p53 or Ki67 status, tumors with lower grades and negative axillary lymph nodes (or < 4 involved lymph nodes), there was a higher survival rate (either disease free or overall); however, relationship was not statistically significant, most probably due to the low number of studied patients. In conclusion, Ki67 was an independent factor to predict tumor grade in our study; the use of this proliferation activity marker in routine approach to patients with breast cancer is recommended, at least to evaluate the accuracy of tumor grading by mitotic count.

Abstract: Intrauterine insemination (IUI) has been widely used for the treatment of infertility. Several prognostic factors for IUI outcome have been proposed, including the endometrial thickness and follicle numbers, etiology and duration of infertility and morphology, type and motility of sperms. A total of 463 IUI cycles in which clomiphene citrate and/or human menopausal gonadotrophin (HMG) were used for ovarian stimulation analyzed retrospectively to identify prognostic factors regarding treatment outcome. The overall pregnancy rate was 13% per cycle. Logistic regression analyses were done on 14 sets of data, including age, Duration of infertility, Type of infertility, The etiology of infertility, Sperm count, Sperm motility before and after processing, The method of ovarian stimulation, Endometrial thickness, Type of catheter, Use of tenaculum, Season of IUI performing, The number of dominant follicle and cycle number. Logistic regression analysis revealed two predictive variables as regards pregnancy: number of the dominant follicles (P = 0.003) and the thickness of endometrium (P = 0.001). The odds ratios for number of the dominant follicles and thickness of endometrium were 1.41 and 1.78 respectively. The results indicate that controlled ovarian hyperstimulation (COH) and IUI achieves the best results with increased number of preovulatory follicles and endometrial thickness.

Pulmonary metastases occur in 30% of all oncology patients. Surgical resection of lung metastases is a widely accepted procedure but long-term results are disappointing with a 5-year survival rate of 20-40% and the results vary with the histologic type of the primary tumor. Due to unavailability of any study regarding pulmonary metastasectomy in Iran and emergence of new treatment modalities, reassessment of our current practices is essential. We performed a retrospective study of 60 cases of pulmonary metastasectomy during a 5-year period in one of the major thoracic surgery centers in Tehran (Imam Khomeini Hospital). Bilateral metastases were present in 23% of cases, number of metastases in each patient ranged from 1-12. Average disease-free interval was 12 months, pneumonectomy rate was 21.7% mostly as a second or third attempt and finally, recurrence or death following initial metastasectomy occurred in 12-18 months in most patients. These results confirm that surgery remains unsuccessful in obtaining long-term survival or cure in most patients with pulmonary metastases and treatment strategies other than surgery, such as radiofrequency ablation are needed to avoid performing multiple operations in these patients and improving their quality of life.

Myocardial bridging with systolic compression of the left anterior descending coronary artery (LAD) may be associated with myocardial ischemia. In symptomatic myocardial bridging unresponsive to medical treatment, surgical unroofing of the left LAD can be performed. Little information is available about the long-term prognosis of patients with this coronary anomaly after the surgical unroofing, so we decided to evaluate the result of this operation. A total of 26 patients underwent surgical unroofing of myocardial bridging. Patients had a myocardial bridge of at least 3 cm in length in the middle of LAD and with more than 70% compression during systole. Unroofing was performed with cardiopulmonary bypass in 16 and with off pump technique in 10 patients. In 6 patients repeat angiographies for control of myotomy were done. In one of them a nonsignificant 20% narrowing was seen. Postoperative scintigraphic and angiographic studies demonstrated restoration of coronary flow and myocardial perfusion without residual myocardial bridges under beta-stimulation in 24 patients. Two patients had residual narrowing. With off pump technique, 1 patient had perforation of the right ventricle and 1 patient underwent reoperation because of incomplete unroofing during the first operation. None of the patients with cardiopulmonary bypass technique had residual chest pain or other complications. Surgical unroofing of myocardial bridging with the aid of cardiopulmonary bypass is a safe and easy procedure with low operative risk and with excellent functional results.

Because of significant reduction of rupture rate and increase in the patient’s life expectancy, elective surgical treatment in patients with abdominal aortic aneurysm has been widely accepted. The present article aims at assessing the postoperative complications and mortality rate in patients who had been submitted to elective surgery for abdominal aortic aneurysms. This is a retrospective study, carried out on 126 consecutive patients who were operated on within a 10 years period, from 1993 to 2002. Variables included demographic data, clinical features, operation notes and postoperative outcome which were analyzed according to standard health system research. During 30 days after surgery, mortality rate was 8.4%. Mortality rate in patients older then 75 years of age was 12.5%. There was no specific correlation between associated disease and risk factors with mortality. Surgical complications were observed in 35 (29.6%) patients: 19 cases (15.2%) showed only one complication, 8 cases (6.7%) had two complications and another 8 (6.7%) had more than two complications. The most common complication was bronchopneumonia, which occurred in 10 (8.4%) patients. Results of this study suggest that there is a significant correlation between elective surgery and decreased complications of abdominal aortic aneurysm, offering a low rate of mortality and complication and a long life expectancy for the patients.

The standard approach to management of high imperforate anus is colostomy in the newborn period followed by posterior saggital anorectoplasty (PSARP) at 6 to 12 months of age. The purpose of this study was to determine whether a one-stage repair by primary PSARP in the newborn period could be performed without clear determent to the patient’s functional result. Totally 30 newborns with high imperforate anus who underwent primary PSARP without colostomy were studied retrospectively. All cases were studied by sonography, echocardiography, lower vertebra X-ray and finally routine blood and urine laboratory tests. Incontinence was defined as fecal soiling at least twice a day, and patients requiring more than office dilatation were described to have stricture formation. All patients recovered well and were followed for periods ranging from 1.5 to 10 years. There were 3 cases of postoperative wound infection, but no anastomotic dehiscence, stricture formation and fistula recurrence were seen. In cases of constipation and fecal incontinence there were associated anomalies such as sacral dysplasia, kidney dysplasia, ventricular septal defect and vesicoureteral reflux. There were no complications in other cases. The most important factor is patient selection, and one-stage PSARP spares the patient the morbidity of additional surgeries in the standard multistage approach for high imperforate anus. These preliminary results suggest that one-stage PSARP is a safe and viable approach to the management of high imperforate anus without clear determent to future bowel function.

Many xenobiotic and natural compounds such as testosterone have been used and sometime misused to improve the growth of cattle and other livestock animals. In order to control the testosterone hormone residues in meat and to ensure the safety of Iranian consumers, a monitoring system must be put in place to address the concerns. The present study was undertaken to detect and quantify the levels of testosterone residue in the market meat. Cattle meat samples were collected randomly from the market in Tehran. A total of 120 samples of cattle meat were analyzed for the level of testosterone by Enzyme-linked immuno sorbent assay (ELISA) method. The average experimental value of testosterone in cattle meat was 810.9 ng/kg. The average value of cattle meat testosterone was significantly upper than FDA (Food and Drug Administration) allowable level but was in agreement with the values proposed by JESFA (Joint Expert Committee on Food Additives). So it seems that the present status of this anabolic hormone in market meat is not at risk but there is need to routinely monitor this chemical as a food quality control measure.

Early diagnosis of bacteremia and its complications is the most important part of care and management of the febrile patients. However, a majority of patients who appear to be clinically septic have negative blood culture. The use of polymerase chain reaction (PCR) techniques has allowed identifying the pathogenic organisms rapidly and accurately. The objective of this study was to investigate the prevalence of bacteremia in febrile pediatric patients, comparing universal PCR and conventional blood culture. One hundred febrile children (45 males, 55 females) with suspected septicemia were evaluated. A total of 100 paired blood samples were collected from children to analyze for bacterial detection using universal PCR and culture. Twelve patients were blood culture positive. The most common pathogens isolated from blood culture were Staphylococcus aureus, coagulase negative staphylococci (CoNS) and Pseudomonas aeruginosa. The PCR were positive in 19 patients. The comparison revealed sensitively, specificity and accuracy of 91.67, 90.91 and 91%, respectively, for PCR. The present study shows that the use of PCR is more sensitive than the use of conventional blood techniques for the detection of bacterium pathogens based on patients’ clinical context.

Cognitive impairment may be a common even at the onset of multiple sclerosis (MS). In this case-control study, we tried to find out the probable relationship between homocysteine levels and cerebral atrophy or cognitive impairment in patients with multiple sclerosis. One hundred fifty six patients who had MS according to McDonald diagnostic criteria were included in this study. Patients’ age, gender, and educational level, MS duration and clinical type, disability, cognitive function state based on minimental state examination (MMSE), presence of hyperhomocysteinemia, and brain atrophy were evaluated. There was no statistically significant relationship between hyperhomocysteinemia and cognitive status. Total homocysteine levels had a significant correlation with MMSE score only in those patients with elementary level of education. Also total homocysteine levels and overall cerebral atrophy did not indicate significant relationship according to those independent variables mentioned above except in the patients with EDSS less than 6. When intercaudate ratio > 0.10 was applied as a criterion for cerebral atrophy, we found that hyperhomocysteinemia related significantly to intercaudate ratio > 0.10 in females, aged between 21 and 30 years, MS duration ≤ 5 years, primary progressive MS and relapsing-remitting MS clinical types, EDSS ≤ 3 and elementary level of education. We suggest applying MMSE only for the first step of cognitive function survey. In the next steps, much more exact test must be used (e.g. MSNQ). Also we can not suggest measuring plasma homocysteine level as criterion for monitoring the cognitive function in patients with MS.

Brucellosis is a major health problem in many parts of the world, particularly in the Mediterranean and Middle East. Very few data on the frequency and diversity of haematological abnormalities occurring in brucellosis have been reported. In the present study 85 patients with brucellosis in Imam Khomeini Hospital during 1997-2002 were investigated retrospectively to determine the haematological changes during the active course of this infection. Inclusion criteria included a compatible clinical picture with either a positive blood culture or bone marrow culture for brucella organism or a brucella antibody titre of 1/80 (Wright agglutination test), and 2ME (2-mercaptoethanol) of 1/40 or coomb’s Wright with any titre. Anemia was detected in 43.5% patients, leukopenia in 13.6%, thrombocytopenia in 12.5% and pancytopenia in 2.4% of patients. Unusual complications were detected in two patients, one with mouth bleedings, the other with purpuric skin lesions of the lower extremities, both patients had endocarditis. As brucellosis is common in our region it may be considered in patients whose blood picture reveals haemolytic anemia, leukopenia, thrombocytopenia or pancytopenia, particularly when the disease is epidemiologically suspected.

Excessive daytime sleepiness (EDS) denotes a propensity to doze off or fall asleep unintentionally during the day, particularly in passive situations. There is cumulative evidence pointing to an association between sleepiness and probability of involvement in motor vehicle crashes. This study was designed to determine the prevalence of sleepiness in a group of Iranian lorry drivers and its association with accidents. A cross-sectional study was carried out in lorry drivers of Tehran goods transportation terminal in 2005. This study used a questionnaire and the Epworth Sleepiness Scale (ESS). The questionnaire included questions regarding demographic features, professional data, sleep habits and excessive daytime sleepiness. A total of 386 male drivers, aged 43.23 ± 9.72 years were included in the study. ESS was higher than 10 points in 9.1% of the interviewees; 50.8% never have driven drowsy, although 36% rarely, 7.3% half of the times, 4.9% almost always and 1% always have driven drowsy. Logistic regression analysis indicated that EDS, age and job satisfaction were associated with an increased risk of accidents. Sleepiness is a prevailing symptom in lorry drivers and is probably related to accidents.

Abstract: Urinary tract infection (UTI) is a common bacterial illness in children. Knowledge of the antimicrobial resistance patterns of common uropathogens in children according to local epidemiology is essential for providing clinically appropriate, cost effective therapy for UTI. The aim of this study was to determine the distribution of urinary tract infections in a referral hospital, Children’s Medical Center, and determination of in vitro susceptibility of these organisms to antimicrobial agents. Of the 1231 bacterial isolates the most frequent isolates were Escherichia coli (38.66%), Klebsiella spp. (22.25%), Coagulase-negative staphylococci (10.1%), Pseudomonas spp. (8.7%), enterococci (8.28%), Enterobacter spp. (4.1%), staphylococcus aureus (3.24%), and proteus mirabilis (2.9%). Among Enterobacteriaceae, 79.80% of E. coli were amikacin-sensitive. Of Gram-positive cocci, 66.66% of staphylococcus aureus were vancomycin-sensitive. Our data show the original distribution of uropathogens from UTIs in children referred to Children’s Medical Center in Tehran and the emergence of multidrug resistant strains.

Silicon dioxide or silica is the earth’s most abundant mineral. The primary pulmonary illness attributable to silica exposure is silicosis, which is observed in three forms: classic, accelerated and acute. A case of silicosis is presented in this article who has been working in a stone-cutting plant. He had suffered from symptoms of silicosis one year after employment in this plant (acute form), but his radiologic findings were compatible with accelerated or chronic silicosis. One of the important occupational diseases is silicosis, which is not treatable but is preventable. However, because of lack of appropriate engineering controls or personal protective devices in some workplaces we observe cases of silicosis yet.

Acute fatty liver of pregnancy (AFLP) is a rare entity and a potentially fatal disorder. It is reported to be more common in multiple than singleton pregnancies. Sometimes it coincides with preeclampsia but the exact etiology is not yet understood. A 31-year-old G2 P1 patient admitted at 33 weeks of pregnancy with signs and symptoms of jaundice, gastroenteritis, hypertension, malaise, urinary incontinence and preterm contractions. She had history of idiopathic hypothalamic amenorrhea and by a recent trial with gonadotropins, she had got triplet gestation. After admission her general condition deteriorated. She underwent Cesarean section at once and all fetuses survived. She had severe postpartum hemorrhage. The results of laboratory tests indicated coagulopathy and liver function abnormalities. The AFLP was diagnosed on the third day of hospital stay. She was discharged one week later. Again she returned with complaint of severe sustained headache. Computed tomography showed subdural hemorrhage and drainage of hematoma was performed immediately. Finally the patient recovered from all of these critical conditions. This is the first report of AFLP in a patient with history of idiopathic hypothalamic amenorrhea. AFLP should be suspected in every pregnant patient with preeclampsia and gastroenteritis symptoms in the third trimester of pregnancy.