Acta Medica Iranica
Volume:46 Issue: 4, July Aug 2008

Diabetes mellitus is a multifactorial disease. It has recently been shown that an insertion (I)/deletion (D) polymorphism exists in the angiotensin-converting enzyme (ACE) gene that can affect the serum ACE level. There are three genotypes: DD, DI, and II, with the ACE level being highest in DD, intermediate in DI, and lowest in II. In the present investigation, 170 patients with type 2 diabetes mellitus (T2DM) and 144 control subjects were studied. The ACE I/D polymorphism was determined by polymerase chain reaction (PCR) utilizing specific primers. ACE activity was determined spectrophotometrically. Distribution of ACE gene (I/D) polymorphism and allele frequencies in patients with T2DM were significantly different from those in control (P < 0.001); D allele frequency was 51% in T2DM vs. 48% in controls. The level of ACE activity was significantly higher in the DD genotype (91.1 ± 23.18) than those in ID (60.6 ± 22.8) and in II genotypes (36.8 ± 6.9). There was a significant difference in genotype distribution between the two groups (P < 0.001). New normal ranges of serum ACE level were determined for each genotype. Moreover, we found test sensitivity to be 62.3%. Serum ACE activity was significantly associated with ACE (I/D) gene polymorphism.

The dysesthesia and paresthesia that occurs in laboratory rats after spinal cord injury (SCI) results in autophagia. This self-destructive behavior interferes with functional assessments in designed studies and jeopardizes the health of the injured rat. In this study, we evaluated role of saturated picric acid in the prevention of autophagia and self-mutilation. All rats were anesthetized with an intraperitoneal injection of a mixture of ketamine (100 mg/kg) and xylazine (10 mg/kg) for the SCI procedures. In the first 39 rats, no solution applied to the hind limbs, but in the next 26 cases, we smeared the saturated picric acid on the tail, lower extremities, pelvic, and abdomen of the rats immediately after SCI. In the rats without picric acid, 23 rats died following autophagia, but in the 26 rats with picric acid, there was no autophagia (P < 0.001). Picric acid side effects in skin and gastrointestinal signs such as irritation, redness and diarrhea were not seen in any rat. Saturated picric acid is a topical solution that if used appropriately and carefully, might be safe and effectively prevents autophagia and self-mutilation. When the solution is applied to the lower abdomen and limbs, we presume that its bitterness effectively prevents the rat from licking and biting the limb.

Pain, particularly after surgery, can create a variety of side effects including delay in wound healing. Different drugs such as pethidine and non-steroidal anti-inflammatory drugs are used for relieving patient''s pain after surgery. The purpose of this research was to compare effect of pethidine vs. diclofenac (D) suppository in relief of pain after laminectomy. A total of 100 patients who underwent laminectomy entered this study. They were divided into pethidine and diclofenac groups. The patients'' pain score was measured with visual analog scale (VAS) method. The mean pain score 24 hours after surgery was 2.8 ± 2.0 in pethidine group and 4.46 ± 2.30 in diclofenac group. There was a significant statistical difference between pain score after surgery in two groups (P < 0.05). Nausea was the most common side effect observed in pethidine group (20%) and epigastric pain was the most common one in diclofenac group (18%). There wasn''t any statistical significant difference between side effects in these two groups. It seems that pethidine injection is more effective than diclofenac suppository in relieving pain after laminectomy.

Parapneunomonic effusion is a common accompaniment of bacterial pneumonia and mostly is resolved with medical management. We studied the etiology and possible underlying causes of complicated parapneumonic effusion and timing of pulmonary decortication. A descriptive study on 34 patients with postpneumonic empyema which required decortication carried out. Post surgical and post traumatic empyema were excluded. Patients'' age ranged from 20 to 75 with a mean of 46 years. The most common clinical findings were fever (90%), pleural dull pain (80%), productive cough (73%) and dyspnea (70%). PPD test was negative in all patients. In 78%, white cell count was normal; in remainder it was more than 10.000. Bacteriological findings were negative and acid fast basili were not detected. All patients underwent posterolateral thoracotomy and decortication and completely expansible lung was achieved. Tissue diagnosis after decorticating showed tuberculosis in 8(24%) patients and necrotic tissue in remainder. Average medical management time and postoperative hospital stay were 38 ± 2 and 6.7 ± 2 days, respectively. Morbidity rates were acceptable and there was one late ortality. No recurrent was happened. In parapneumonic effusions not responding to standard treatment, tuberculosis must be considered, especially in addicted persons, positive family history and ESR >100. In complicated parapneumonic effusion, early thoracotomy and full decortication is recommend because it is diagnostic, allows control of infection, releases the pulmonary entrapment, early discharge from hospital, need not further antibiotic administration and is cost benefit.

The most common cause of failure during the first trimester after trabeculectomy is encapsulated bleb and needling bleb revision is a less invasive method in the management of refractory cases. The purpose of this study is to determine the efficacy and safety of mitomycin-C (MMC) augmented bleb revision of failed filtration surgery. This study is a before-after (paired) observation. 33 patients with failed trabeculectomy because of bleb encapsulation, whose intraocular pressure (IOP) was not reduced under 21 mmHg despite of medications and digital massage, underwent needling bleb revision and subconjunctival injection of 0.1 ml MMC (0.4 mg/ml).The mean follow-up time was 9.24 ± 5.27 months (1-20 months). Statistical analysis of the data included the paired two-tailed Student''s t test for preoperative and postoperative IOP and number of medications. 36 needling procedures (mean, 1.09 ± 0.21 revisions per eye) were performed on 33 eyes. Patients were between 10-80 years old (mean, 45.67 ± 22.41 years) and mean follow-up was 9.24 ± 5.27 months. IOP decreased from 29.06 ± 5.03 mmHg to 18.21 ± 6.76 mmHg at last follow-up (P= 0.000). Antiglaucoma medications decreased from 2.18 ± 0.58 to 1.36 ± 0.29 at last follow-up (P= 0.000).Overall, 6 (18.2%) of 33 cases achieved a complete success and 20 (60.6%) of cases achieved a qualified success. The complications of this procedure were subconjunctival hemorrhage (17 cases), hyphema (5 cases) and conjunctival button hole (2 cases). Needling bleb revision with mitomycin-C appears to be an effective and relatively safe way to revive failed filtration surgery.

Postoperative low cardiac output states are a major cause of postoperative mortality in infants and children following corrective cardiac surgery or congenital heart defects. Whole body hypothermia has been used since 2001 in the management of these low output states when they are refractory to conventional modes of therapy. From December 2001 to April 2006, 25 cases were included in this study. The median (range) age of patients was 36.6 months (1 mo-19 y) with a median weight of 12.2 kg (3.5-44 kg). Following cooling, there was a decrease in heart rate (P< 0.001), an increase in mean arterial pressure (P< 0.001) and a decrease in mean arterial pressure (P< 0.001). Significant increases in pH and urine output were also noticed, the increase in urine output being greater in the surviving group (P= 0.02). A decrease in platelet count was occurred (P< 0.001) but WBC count remained unchanged (P= 0.18). Fifteen of 25 patients survived to leave hospital. Induced hypothermia does not appear to be associated with any complications and after the failure of all conventional treatments, it seems likely that the technique may have been beneficial to outcome in some patients.

Several studies have assessed association between Helicobacter pylori infection and thrombotic ischemic stroke. This study was designed to investigate the association between this organism and ischemic strokes. Antibody against H. pylori (Hp IgG) was measured in 81 patients with stroke and 43 subjects without stroke. Hp IgG titer more than 20u/ml was defined as positive. 67.4% of control subjects and 70.4% of cases were Hp IgG seropositive (P = 0.838). The means of serum Hp IgG titers in control subjects and cases were 51.1859 u/ml and 50.1641 u/ml, respectively (P = 0.927). The difference between these 2 groups was not significant statistically. There wasn''t any significant difference in seropositivity of Hp IgG between case and control subjects in men and women. H. pylori IgG titer hasn''t a predictive role for thrombotic ischemic stroke.

A number of studies have examined the role of aerobic exercise and evidence suggests this may be an effective therapy for premenstrual syndrome (PMS). The aim of this study was to assess the PMS symptoms between swimmer and non-swimmer female students. Two hundred eighty subjects were studied. One hundred forty subjects were swimmers, while 140 were normal sedentary controls. Duration of swimming per week, and the length of exercise were asked from the case group. The predominant symptom of PMS was determined. PMS occurred in 36.2% and 22.8% of non-swimmers and swimmers, respectively (P = 0.00). The prevalence of premenstrual symptoms differ in the two group studied. There was no complaint about items asked in 35 (25%) and 13 (9.9%) of swimmers and non-swimmers, respectively (P = 0.000). In 11 (7.9%) swimmers, there was a problem in more than 50% of items asked, whereas 48 (17.1 %) non-swimmers had complaints in this range (P = 0.00). The prevalence of feeling more irritable, tend to eat more than usual or at irregular hours, easily distracted, restless behavior noticeable by others, feeling more angry, physical symptoms, change in mood without obvious reason, significant swelling in breasts, ankles, and abdomen, marked change in sexual desire, avoiding some social commitments, and decreasing desire to have communication with males were significantly lower in swimmers. Aerobic exercise has been found in epidemiologic studies to be associated with fewer reported premenstrual symptoms. Swimming is one of aerobic exercises which can be used in relation to this issue.

The scientific literature regarding threatened abortion is relatively limited on the subject of outcomes and viability at term. To investigate prospectively the risk of adverse pregnancy outcome in women presenting with first-trimester threatened miscarriage, a prospective case control study was performed on 600 subjects, 150 women presenting with bleeding in the first trimester and 450 asymptomatic age-matched controls. Main outcome measures included gestational age and weight at delivery as well as incidence of adverse pregnancy outcome such as preterm labor, preterm prelabor rupture of membranes (PPROM), placental abruption, and low birth weight (LBW). The first-trimester miscarriage rate in the threatened miscarriage group was 42.7%. Compared with controls, women presenting with threatened miscarriage were more likely to deliver prematurely, 14.7% compared with 52.9%, respectively (relative risk 3.6, 95% confidence interval [CI] 2.4-4.8). They were also more likely to have PPROM, 6.4% compared with 27.5%, respectively (relative risk 4.2, 95% CI 2.6-6.9) and placental abruption, 5.7% compared with 1.5% respectively (relative risk 3.6, 95% CI 1.2-11.3), and LBW, 14.9% compared with 7.1% respectively (relative risk 2.1, 95% CI 1.1-3.8), low lying placenta 1.1% compared with 18.2% respectively, birth weight 2866 ± 523.3 g compared with 312.45± 591.4 respectively, gestational age 35.71 ± 4.3 compared with 38.07 ± 3.2 respectively. First-trimester vaginal bleeding is an independent risk factor for adverse obstetric outcome and this risk factor should be taken into consideration when deciding upon antenatal surveillance and management of their pregnancies.

Breast cancer is the most common cancer occurring among women. The mortality rate of breast cancer can be reduced by regular breast cancer screening program. This study was carried out to identify the knowledge and practice of women about breast cancer screening in Zahedan, southeast of Iran. In this cross- sectional study, 384 women were selected as an improbability sample of women referring to Qouds maternity hospital. Knowledge and practice of them about breast cancer screening were investigated through face-to-face interview based on a purposed questionnaire, and data were analyzed using descriptive and analytical statistics. Only 8.3% of women were aware of breast cancer screening methods. About breast self-examination 21.6%, and about mammography 3.4% had good knowledge. Overall knowledge of breast cancer screening was insufficient in 67.4%. There was statistically significant relationship between knowledge of breast cancer screening and level of education, history of individual breast disease, and history of breast cancer in their families (P < 0.001). There was statistically significant and inverse relationship between knowledge of how to examine the breasts and knowledge about mammography with age (P < 0.001). Practices of women in Zahedan about Breast cancer screening were very low. Only 4.5% of women performed breast self examination (BSE), on a regular basis, 4.1% had ever had a clinical breast examination (CBE), and %1.3 had a mammography throughout their life. Our findings suggest that knowledge and practice about breast cancer screening was relatively in a weak level and it needs to be improved.

Acute renal failure (ARF) following cardiac surgery occurs in 1 to 10% of patients. Patients who develop ARF have higher rates of mortality. This study was undertaken to estimate the role of perioperative variables in predicting of post cardiac surgery ARF. We studied a cohort of 398 adult patients who underwent cardiac surgery at our institution from February 2004 to February 2006. Adult patients who were scheduled for cardiac valvular surgery, coronary artery bypass grafting (CABG) or both, with or without cardiopulmonary bypass (CPB) were included. Exclusion criteria were death within two days of operation (n= 8), incomplete patient data, and preexisting renal dysfunction and dialysis requirement or a baseline serum creatinine > 4 mg/dl. Age, sex, left ventricular ejection fraction, diabetes, preoperative, presence of proteinuria (on dipstick), type of surgery, use of CPB and duration of surgery were recorded. A logistic regression analysis was performed to assess independent contribution of variables in the risk of ARF. A binary logistic regression revealed age was an independent predictor of ARF (P < 0.05). When both all variables were included in a multinominal logistic regression model, preoperative proteinuria independently predicted ARF (Odds ratio= 3.91, 95% CI: 1.55-9.91, P = 0.004). Our results revealed that special considerations should be given to elderly and patients with proteinuria when managing post cardiac surgery ARF.

During last decades many researchers have focused on the conditions associated with Bell''s palsy including diabetes mellitus, hypertension, and viral infections. This study was performed to evaluate correlation of diabetes mellitus and Bell''s palsy and some relevant features not discussed in the literature in an Iranian population. The presence of diabetes mellitus was evaluated in a total number of 275 subjects (75 patients with Bell''s palsy and 200 control subjects). Diabetes mellitus was noted in 10 (13.3%) patients with Bell''s palsy among which 6 case were diagnosed as new cases of diabetes. Previous history of Bell''s palsy was present in 10.67% of the subjects with Bell''s palsy. Symptoms of other cranial nerves revealed higher figures in Bell''s palsy patients with underlying diabetes. Such studies in developing countries may reveal some unknown features of the disease. This study confirms the correlation of diabetes mellitus and Bell''s palsy for the first time in an Iranian population. The results also suggest that diabetic patients with Bell''s palsy suffer from more cranial nerve symptoms. We offer screening tests of diabetes as a routine process in the management of Bell''s palsy especially in developing countries.

There are some reports of decreased serum levels of 25(OH)D in the subjects with impaired glucose tolerance and type 2 diabetes mellitus (T2DM). To assess vitamin D status of the Iranian diabetics, a pilot study was conducted on 90 subjects with either type 1 diabetes mellitus (T1DM) (n= 30), T2DM (n= 30), or apparently healthy subjects (n= 30) during fall and winter of 2005. Serum samples were analyzed for 25-hydroxycholecalciferol using three different high-performance liquid chromatography (HPLC), competitive protein-binding assay (CPBA) and radioimmunoassay (RIA). In this study serum levels of 25(OH)D were categorized as follows: sufficient ≥ 37 nmol/L; 25 nmol/L ≤ mild deficiency < 37 nmol/L; 12.5 nmol/L ≤ moderate deficiency < 25 nmol/L; severe deficiency < 12.5 nmol/L. Results showed that the occurrence of vitamin D insufficiency was almost the same in patients with T1DM and healthy controls. Mean serum level of 25(OH)D in patients with T2DM was significantly higher than in T1DM, as judged by HPLC (58.2 ± 8.5 vs. 35 ± 5 nmol/L, Mann Whitney U-Wilcoxon, P= 0.024). Moreover, both CPBA and RIA showed some over-estimation of serum 25(OH)D, compared to HPLC. Our findings suggest that, at least in the cold seasons, vitamin D status of the healthy subjects may not be higher than that of T1DM patients.

Primary localized amyloidosis of eyelid is a localized type of amyloidosis without evidence of systemic involvement. We report a 75-year-old man suffering of unilateral (left) ptosis due to upper eyelid mass with bony consistency. Eye examination revealed upper lid mass attached to tarsus. No ocular infection or inflammation was found. Pathologist reported diffuse distribution of eosinophilic homogenous deposits of stroma that show apple green birefringence by polarized light compatible with amyloidosis. Primary localized amyloidosis may appear as a bony tumoral mass. It is important to consider secondary localized and systemic amyloidosis in differential diagnosis of the disease.

Neurofibromatosis is a benign neurogenic tumor, originatig from Schwann cells of the nerve sheath. This tumor forms a round, white mass on the course of the involved nerve. It occurs sporadically or in association with von Recklinghausen''s disease. Laryngeal involvement is a rare occasion that affects women more than men (F/M ratio 3:2). The most common symptoms are hoarseness, dyspnea and dysphagia. The most common sites of origin are arytenoids and aryepiglottic folds. Because of benign nature of this tumor, conservative surgery is recommended as the management of choice. Only few cases of laryngeal involvement have been reported in literatures and this article presents two cases of laryngeal neurofibroma with brief review of literatures. Both cases had submucosal, non-ulcerated, endolaryngeal mass with signs and symptoms of airway compromise. In both cases surgical approach was endolaryngeal conservative surgery with CO2 laser.

Familial Mediterranean fever (FMF) is a relatively rare disorder, characterized by recurrent self-limited attacks of fever and polyserositis. Diagnosis is made by clinical features, gene identification on chromosome 16 and clinical response to specific treatment. Different types of vasculitis have been reported in FMF. Henoch-Schönlein purpura (HSP) is one of them, usually with a benign clinical course. Repeated attacks of HSP have been rarely reported in FMF. This is the report of a 7-year-old girl who presented initially with recurrent fever and abdominal pain. After the primary diagnosis of FMF and appropriate treatment, she experienced two documented repeated attacks of HSP with severe renal involvement (crescentric glomerulonephritis) and protracted abdominal pain in the second one. Glomerulonephritis was controlled by methyl-prednisolone pulse therapy plus oral corticosteroid and azathioprine, but abdominal pain was resistant to steroids and revealed completely by intravenous immunoglobuline (IVIg) administration. In conclusion, it is suggested to consider the recurrence of HSP in cases with FMF to prevent irreversible renal complications. IVIg seems to be a good choice for the management of intractable abdominal pain of HSP.