Acta Medica Iranica
Volume:46 Issue: 6, Nov-Dec 2008

Osteoporosis is a metabolic disease characterized by reduction in bone density and susceptibility to deformity and fracture. Some studies show that osteoblasts can create inter-cellular free radicals that lead to cellular death. Superoxide dismutase (SOD) plays an essential role in cell defense against reactive oxygen metabolites. The purpose of this study was to measure the plasma SOD activities in Iranian women with osteoporosis compared to the control group. SOD activity was measured spectrophotometrically at 540 nm in 192 women. Plasma activity of SOD (mean ± SD) was 1.72 ± 0.79 mg protein in the control group, 2.05 ± 0.87 mg protein in patients as a whole [(mild osteopenia + severe osteopenia and osteoporosis) (T-score < -1)] and 2.32 ± 0.91 mg protein in patients with severe osteopenia and osteoporosis (T-score < -1.7). In this study, that plasma activity of SOD was significantly higher in patients than in controls. Furthermore, this difference was more prominent between the controls and patients with severe disease (T-score < -1.7) than patients as a whole. T-score of femur adjusted for age and body mass index (BMI) showed negative significant correlation with plasma activity of SOD.

Pedicle screws provide rigid fixation for instabilities in the lumbar and lumbosacral spine. Anatomical consideration and potential risk of neurologic complications are the reasons to hesitate using pedicle screws in the thoracic spine. Twenty moulages similar to human vertebrae were instrumented with Cotrel-Dubousset (CD) system pedicle screw by intratransverse process, extrapedicular and intrapedicular methods and pullout strength was measured. There was statistically significant difference between three techniques. By increasing the length of screw in any method, pullout strength increased. Average pullout strength in extrapedicular technique was less than two other techniques in dynamic state. The strongest technique for screw placement was intratransverse process technique. It seems that intratransverse process technique is safe for posterior fixation of spine.

Previous studies have suggested that ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, provides a pre-emptive analgesic effect and pre-emptive analgesia improves postoperative pain management. The aim of this study was to determine the effict of pre-incisional vs. post-incisional intravenous low dose of racemic ketamine in postoperative pain in children undergoing inguinal hernia repair. Seventy-five children aged 1-6 years who were scheduled for inguinal herniorrhaphy were included in a prospective, double-blind randomized controlled trial. Patients were randomly allocated to three groups (pre-incisional, post-incisional and control). Patients in pre-incisional group received an intravenous bolus of racemic ketamine (0.25 mg/kg) before surgical incision and patients in post-incisional group received the same dose of racemic ketamine after surgical incision. Children of control group received intravenous boluses of normal saline. In post anesthesia care unit and pediatric surgical ward, the degree of pain and sedation, additional analgesic requirements and side effects were evaluated. There were no differences between groups with respect to demographic and hemodynamic parameters. Pain and sedation scores were not statistically different between groups during 24 h study. In addition, there was no significant difference among groups in number of supplementary analgesic requirements and postoperative nausea and vomiting in the first 24 h. No other side effects were reported during the study period. We found that low dose racemic ketamine administered prior to surgical incision has no pre-emptive effect on post-operative pain and supplementary analgesic requirement during the first 24 h after herniorrhaphy in pediatric patients.

Vasectomy is one of the extensively used methods of contraception in family planning programs. Antisperm antibodies (ASA) develop after vasectomy which can result in auto-immune male infertility. The precise sperm antigens involved in the autoimmune response are still poorly defined, therefore we determined the circulating ASA and identified relevant sperm antigens based on localization of binding sites of ASA to sperm cell antigens, using a rapid, inexpensive and clinically relevant assay in vasectomized men. Results showed that 2.5% of men had ASA at the time of vasectomy, whereas 53.5% of the study population subsequently developed ASA. The numbers of men with circulating ASA increased significantly for the first three months after vasectomy. These antibodies were distinguishable into three groups based on their bindings to different sites of sperm cell antigens including against acrosome and tail in 67.56% and 10.8%, respectively; 21.6% of subjects had antibody to the other parts of the sperm cell antigens. The results of this study are discussed in terms of an autoimmune response against sperm antigens and development of ASA

ndometrial vasculature has been shown to play an important role in the early endometrial response to the implanting blastocyst, and vascular changes may contribute to uterine receptivity. The aim of this study was to investigate the role of endometrial and subendometrial vascularity and thickness in uterine receptivity in infertile women treated with assisted reproductive technologies (ART). A total of 175 women were recruited from our ART program from June 2005 to May 2006. In the first stage, down regulation was done using GnRH-a and then ovarian hyperstimulation was initiated with human menopausal gonadotrophin and in vitro fertilization (IVF) procedures were performed. Then, the endometrial-subendometrial blood flow distribution pattern was determined by color Doppler ultrasonography and its characteristics were compared between pregnant (n = 56) and non-pregnant (n = 119) women. Zones 1, 2 and 3 of vascular penetration were found in 15.4%, 22.3%, and 62.3% of patients, respectively. The number of implanted embryos was 62 and implantation rate was 11.61%. There was no significant association between implantation rate and endometrial thickness or zone of vascular penetration. Among all women, fertility occurred in 56 (32.2%) women. Zone 1 of vascular penetration was found in 10.71% and 10.08% (P = 0.898), zone 2 in 16.07% and 13.44% (P = 0.643), and zone 3 in 41.07% and 41.17% (P = 0.989) of pregnant and non-pregnant groups, respectively. Endometrial-subendometrial blood flow (according the findings of Doppler ultrasonography) in women undergoing ART could not predict endometrial receptivity and IVF outcome.

Placenta plays a vital role in normal fetal development and failure of placenta to gain weight and insufficiency of its function can result in fetal disorders. We performed this study to determine placental weight and factors associated with low weight placentas. In a longitudinal cross-sectional study, women with single pregnancy, and gestational age between 37-42 weeks were studied. The subjects were categorized in high (> 750 g), normal (330-750 g), and low placental weights (< 330 g). The placental weight, birth weight, maternal age, gestational age, parity, pre-eclampsia, history of maternal diabetes, delivery approaches, infants'' gender; and Apgar score in 5th minutes after delivery were examined. One thousand-eighty eight pregnant women were included in the study. The mean and standard deviation for maternal ages and gestational ages at deliveries were 25.35 ± 5.6 and 247.51 ± 9.56 days, respectively. The mean and standard deviation of neonates'' weights at birth and placental weights were 3214.28 ± 529 and 529.72 ± 113 g, respectively. The prevalences of low and high placental weights were 2% and 2.8%, respectively. There were statistically significant relationships between placental weight and birth weight, fetal distress, Apgar score, maternal diabetes, pre-eclampsia and approaches of deliveries (α = 0.05). Our findings indicate that placental weight can be associated with important variables influencing some maternal and neonatal outcomes and placental weight lower than 330 g can be a warning sign. Careful attention to placenta growth during pregnancy, for example by ultrasonography, can guide physicians to assess neonatal health.

There are numerous, often contradictory reports on the effect of growth hormone (GH) therapy on thyroid function. These reports prompted us to evaluate the impact of GH therapy on thyroid function in previously euthyroid children with GH deficiency. Twenty five clinically and biochemically euthyroid children with GH deficiency were studied. A thyroid profile (T4, Free T4, T3 and TSH) was performed at baseline and 3, 6 and 12 months after GH therapy in 21 children with idiopathic growth hormone deficiency (group A) and 4 children with organic GH deficiency (group B). We observed a significant reduction in serum T4 and free T4 concentrations during GH therapy in both groups (P < 0.01). No patient in group A had free T4 levels fell into the hypothyroid range, while in one of four patients in group B, free T4 value fell into the hypothyroid range during GH therapy. In both groups, no significant variation in serum TSH and T3 was recorded at any time. Our data suggest that GH therapy can introduce changes in thyroid function and so confirm the need of a careful monitoring of thyroid function in particular in children with organic GH deficiency during long-term GH therapy.

Febrile seizure is the most common type of seizure in children and a variety of causes are considered to be responsible for it. There are some reports that zinc may have a role in febrile seizure. The aim of this study was to compare the serum zinc level in children with and without febrile seizure. In this case-control study, 52 children with febrile seizure compared with 52 healthy children based on serum zinc level. Both groups were matched for age, sex, weight, height, and head circumference. The age range of children was 9 months to 5 years. Serum zinc level was measured using flame atomic absorption spectrophotometry. Of 52 children in case group, 30 (57.7%) were male and 22 (42.3%) female and among the control group, there was 31 (59.9%) males and 21 (40.4%) females. The mean age of children in case group was 27.13 ± 15.72 and in control group 28.49 ± 16.5 months. The mean zinc level in case group was 62.84 ± 18.40 mg/dl and in control group 85.70 ± 16.76 (P < 0.05). This study revealed that the serum zinc level in children afflicted with their first febrile seizure is lower than in healthy children and the difference is statistically significant. It seems that the zinc deficiency may play a role in febrile seizure.

Among the causes of headache, cerebral venous and/or dural sinus thrombosis (CVT) is an important challenge because of its variable clinical presentation, having negative brain CT in up to 30% of cases and unavailability of MRI in some situations. On the other hand as D-Dimer (DD) test has been reported to be a sensitive test for the exclusion of venous thromboembolism, we sought whether it could be useful in the diagnosis of cerebral venous thrombosis. A prospective study of 104 consecutive patients with headache or unusual ischemic stroke (infarction in brain CT, but not compatible with any brunch of cerebral arteries), suggesting CVT was conducted between 2003 and 2005. D-Dimer test determined for all patients in the emergency ward before MRI or MRV was performed. Titers above 500 ng/ml were regarded as positive test. From a total 104 patients, 21 cases (20.2%) were confirmed (by MRI and/or MRV) to have CVT, 20/21 (95.7%) of whom had positive DD test. In the remainder 83 (without CVT) it was only positive in 16.8% (14/83), which was statistically meaningful (P < 0.001). Specificity, sensitivity, negative and positive predictive values of DD test were 83.1, 95.2, 98.6 and 58.8%, respectively, so application of this test would be useful in the diagnosis of CVT and values below 500 ng/ml make acute thrombosis unlikely.

Psoriasis is a chronic, non-contagious skin condition characterized by inflamed and scaly lesions of skin. Whilst the pathogenesis of psoriasis is not known, psychological stress has been implicated as a potential trigger in the onset and exacerbation of the condition. Psychiatric and psychological factors play an important role in at least 30% of dermatologic disorder and pathophysiologic link between psychological stress (PS) and disease expression remains unclear. Recent studies demonstrated PS-induced alterations in permeability barrier homeostasis, mediated by increased endogenous glucocorticoids. As activation of the hypothalamic pituitary adrenal axis (HPA) is critical to a successful stress response, we investigated this in patients with psoriasis. This study was performed on 55 patients (40 females and 15 males) visited our clinic for treatment of psoriasis in pharmacology department. We measured the rate of activation of HPA by hormonal changes. These patients displayed higher fasting blood sugar (FBS), epinephrine (Ep), adrenocorticotropin hormone (ACTH), aldosterone, prolactin, growth hormone and estradiol hormones value but diminished cortisol and corticotropin releasing factor (CRF). These results show that HPA and psychoneuroendocrine hormones have a significant role in psoriasis

Brucellosis is not uncommon in children in endemic areas. We described clinical and laboratory features and therapeutic regimens for brucellosis in children under 14 who admitted in the Pediatric Medical Center Hospital, Tehran, Iran from March 1988 until February 2001. The male: female ratio was 2:1. Family history of brucellosis and consumption of un-pasteurized milk and dairy products was positive in 20.4% and 65.9%, respectively. The common clinical findings were arthritis (79.5%), fever (77.4%), anorexia (61.4%), sweating (52.3%), splenomegaly (43.2%), hepatomegaly (34.1%) and lymphadenopathy (13.65). Anemia, leukopenia and thrombocytopenia were recorded in 56.8%, 31.8% and 9.1%, respectively. Out of all patients, seropositivity rate for brucellosis was found in 97.7% using serum agglutination test. Culture of blood and bone marrow specimen were positive in 30% and 50% of samples obtained, respectively. Rifampin and co-trimoxazole were the most commonly used combination in 68.1%. The overall relapse rate was 13.6%. Arthritis and fever were the most common clinical findings of brucellosis. Wright test is a very sensitive method to detect brucella infection. Public education and control measures should be applied to prevent the zoonotic and human brucellosis.

Residual ventricular septal defects (VSD) are major complications after cardiac surgery. We studied the incidence of this complication, risk factors for its occurrence and short-term follow-up in 179 pediatric patients that underwent surgical closure of VSD from April 2003 until May 2004. All data were gathered retrospectively except measurements of shunt ratio. Studied risk factors included age, sex, weight, height, ejection fraction, VSD size, presence of pulmonary stenosis (PS), responsible surgeon, use of patch material for closing VSD, mean degree of hypothermia, cardiopulmonary bypass and aortic cross-clamp times, hemorrhage, documented infection, and surgical approach for defect closure. The incidence of all residual VSDs was 56% and significant ones (i.e. with Qp/Qs > 1.5) 22%. The only statistically significant risk factors were higher age, weigh and height of the patients. There was notable but statistically insignificant differences in residual shunt incidence among the patients of different surgeons and with the use of different patch materials. During the median follow-up period of 9.5 months, 35% of the residual defects were closed spontaneously. Six patients underwent catheterization, three of which were candidates of residual VSD closure. As residual VSD is a hemodynamically and psychologically important complication, we recommend VSD closure at lower age and the use of intraoperative epicardial or transesophageal echocardiography to minimize its occurrence.

Various scoring systems have been devised to aid diagnosis of acute appendicitis. The main objective of this study was finding the accuracy of modified Alvarado score in prediction of acute appendicitis. The registries of cases with appendectomy, who had been admitted to a referral medical center in the capital of Iran from February 2000 to March 2004, were studied. Sensitivity and specificity of modified Alvarado scoring and clinical diagnostic system used in our center were calculated. ROC curve analysis demonstrated increasing chance of acute appendicitis by increasing of the modified Alvarado score (P = 0.001), but it was neither sensitive nor specific (sensitivity, 55%; specificity, 59%). Diagnosis based on surgeons'' decision was more sensitive than Alvarado scoring (sensitivity 93-95% in different age groups). Diagnosis of acute appendicitis based on surgeons'' decision is more helpful than modified Alvarado score.

There is some data in the literature on the association of HLA-B5 and some manifestations of Behçet''s disease (BD), especially ocular lesions. We studied 433 patients to see if there was any relationship between B51 and the manifestations of the disease. Clinical manifestations of BD were compared in patients having HLA-B51 (155 patients) and those lacking HLA-B51 (278 patients). Oral aphthosis, genital aphthosis, skin manifestations, joint manifestations, gastrointestinal manifestations, phlebitis and neurological manifestations showed no significant difference in patients with and without HLA-B51. Ophthalmologic manifestations were seen in 52% of patients having B51 and in 42% of patients lacking it (χ2: 4.451, P = 0.035). Considering different lesions of ocular manifestations separately, no significant difference was found regarding the presence or absence of B51. Pathergy phenomenon was detected in 55% of B51 positive patients and in 45% of B51 negative patients (χ2: 4.111, P = 0.043). It seems that HLA-B51 may play a role in the pathogenesis of Behçet''s disease, but cannot be used as predictive value for the occurrence of organ involvement, except for the eye.

The economic burden of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is far greater than its direct medical costs. This study estimated annual indirect costs of the HIV/AIDS epidemic in Islamic Republic of Iran in 2006-2007 from societal perspective. A patient cost diary in sets of six booklets covering a total of 6 months (from October 2006 and fallowed until March 2007) was developed in order to estimate total indirect resource use. Service costs for HIV-infected individuals were indexed to 2006-2007 prices. Annual indirect costs, consisting of the costs of informal services, lost economic productivity, and other non-medical expenses such as transportation expenditures due to HIV/AIDS illness and treatment were included. Lost production was valued using Human Capital Approach. This study included sixty known and detected HIV positive persons and patients younger than retirement age who had record in HIV Consultant Center of Imam Khomeini Hospital. Annual patient-based indirect costs of HIV/AIDS were US $ 616.00 (95% confidence interval [CI]: 401.49-830.43), and indirect costs of HIV/AIDS for each person were nearly sixty percent of direct costs in the same year. Also, annual population-based indirect costs of HIV/AIDS in detected cases were US $ 8,440,000 (95% CI: 5,501,000-11,379,000) and in total estimated cases were US $ 40,653,000 (95% CI: 26,498,000-54,809,000). As indirect costs have significant portion in total costs of disease, both direct and indirect costs, when obtainable, should be used to assess the economic consequences of HIV infection and treatment interventions.

Toxic reactions to local anesthetics may occur due to over dose, accidental intravenous injections or rapid systemic uptake of the drugs. But there have been few reports on toxicity due to displacement of epidural catheters after an initial correct insertion and performance of a test dose. Here we present a case of local anesthetics toxicity due to possible displacement of the epidural catheter during APR (Ant-post Colporrhaphy) surgery. The patient''s level of consciousness decreased at the end of surgery. She demonstrated CNS and cardiovascular toxicity due to local anesthetics. Consequently the patient was intubated and transferred to ICU, where she received mechanical ventilation along with other supportive treatments such as inotropic and antiepileptic drugs. We concluded that supportive therapy is the treatment of choice for such cases.

Tuberculosis (TB) still represents a major public health problem worldwide. The primary form of disease is most often localized to the lung. In a minority of patients, progressive pulmonary disease spreads to other organ systems through self inoculation via infected sputum, blood and lymphatic system, establishing the secondary form of tuberculosis. We present a patient that was referred to us with complaint of ulcerative mouth lesions from 3 months ago. In physical examination multiple erythematous and irregularly ulcerative lesions affecting soft palate area, uvula and anterior tonsillar pillar was noted bilaterally. Punch biopsy was done from several points that revealed chronic granulomatous inflammation. Ziehl-Nielsen staining of cultured specimen demonstrated acid-fast bacilli. Chest X-ray showed apical pulmonary involvement, suggesting tuberculosis infection. Patient was treated with anti-tuberculosis 4 drugs regimen. In the one year follow-up period after complete treatment; patient didn''t have any evidence of disease. Oral and oropharyngeal TB lesions are uncommon, it is estimated that only 0.05-5% of total TB cases may present with oral manifestations, but should be an important consideration in the differential diagnosis of lesions that appear in the oral cavity and oropharynx. The secondary form is more frequent and involves mainly the tongue but involvement of pharynx is quite rare condition. Although tuberculosis of oropharynx is relatively rare, with the increasing incidence of tuberculosis, it must be considered in the differential diagnosis of atypical ulcerative lesions of the mouth and oropharynx.