Iranian Journal of Medical Sciences
Volume:30 Issue: 3, Sep 2005

The natural history of ocular lesions in Behçet''s disease is toward severe loss of vision/blindness in few years, whereas cytotoxic drugs have changed the outcome. Several open labeled cohort studies showed pulse cyclophosphamide (PCP) to be the best choice. Since one third of these patients are resistant to PCP it is important to know how much improvement one can expect from the responders. To address this question, we selected patients who improved or maintained their baseline visual acuity after treatment. From a cohort of 528 patients (1056 eyes), 753 eyes were selected. At the beginning of the study PCP was given for one month as 0.75 to 1 g in perfusion, and then followed every 2 to 3 months. Prednisolone was also given as 0.5 mg/kg/daily and then tapered upon controlling inflammation. The mean±SD number of pulses was 11.5±8.5/month with follow-up of 20.6±19.8 months. Different disease activity indices such as visual acuity, posterior uveitis, retinal vasculitis, total inflammatory activity index (TIAI), total adjusted disease activity index (TADAI) were calculated at baseline and at last evaluation. The mean visual acuity improved from 2.4 to 4.4. The mean indices for posterior uveitis, retinal vasculitis, TIAI and TADAI improved from 2.2 to 1, 2.7 to 1.4, 19.3 to 9, and 27.2 to 20.5 respectively. The P value was less than 0.001 for all comparisons. Pulse cyclophosphamide is able to improve ocular lesions of Behçet''s disease; therefore it may be used as a first choice, especially in retinal vasculitis.

Viral infections such as Epstein-Barr virus and Herpes simplex virus may play a role in the pathogenesis of Behçet’s disease (BD). Interferons (INF) are natural defense mechanisms against viruses and inhibit their activities by enhancing major histocompatibility complex class I and cytokine expression. This study evaluated the efficacy of INF-α-2b on mucocutaneous lesions of BD. In this open label clinical trial, 12 patients were chosen sequentially from cases referred to the Rheumatology Unit of the Ghaem Hospital of Mashhad University of Medical Sciences, Mashhad, Iran, with inclusion criteria of active BD without central nervous system or ophthalmic involvement. They received subcutaneous injections of 3 million units of IFN-α-2b three times a week for six months. The numbers and the sizes of lesions were evaluated monthly with the objective and subjective assessments of disease activity. The average dose of interferon prescribed was 2.71 million units during six months. The numbers and sizes of oral, genital and cutaneous lesions decreased significantly with less pain and longer duration of remission. The most common side effects were flu-like symptoms and bone pain reported by 8 patients with temporary impotence in two males and local reactions as erythema and edema of the upper extremities in two patients. INF-α-2b seems to be an effective therapy for mucocutaneous lesions of Behçet’s disease.

The international study of asthma and allergies in childhood (ISAAC) is used to define the prevalence and severity of asthma in different regions. In this study we followed the performance of the ISAAC video and written questionnaires (VQ and WQ) to classify asthma in 13-14 yr-old schoolchildren.

The present study was carried out on 3540 schoolchildren 13 to 14-yrs-old using the VQ and WQ. The students were also asked to answer a separate question if they had ever been clinically diagnosed as asthmatic. The Kappa index was used to find degree of agreement between VQ and WQ regarding asthma symptoms. The sensitivity, specificity and Youden’s index of both questionnaires were also determined.

The most frequent asthma symptom was wheeze after exercise in both VQ (15%) and WQ (23%). Correlations between positive responses to the corresponding questions in the VQ and WQ were significant (P<0.001). The sensitivity of both questionnaires to the question of asthma diagnosis by physician ranged between 0.16 and 0.68. Except for wheeze limiting speech and current wheeze, the WQ had higher value of Youden’s index (0.25 - 0.46). The specificity of questions in VQ for asthma diagnosis by physician was ranged between 0.84 and 0.99.

Both WQ and VQ had low sensitivity, but WQ showed higher value of Youden’s index and the VQ exhibited good specificity. Therefore, one may consider the WQ for prevalence and VQ for relative risk studies.

Fanconi anemia (FA) is a rare, autosomal recessive (AR) and multifactorial disorder. A high prevalence of FA observed in Iran is perhaps due to the high rate of consanguineous marriages. This study investigates the extent of short stature in patients with FA, the frequency of hypothyroidism in FA and the correlation between height and hypothyroidism. Eighteen patients with FA referred to the Pediatrics Clinic of Nemazee Hospital were selected based on specific congenital and malformational symptoms and bone marrow results. These patients were evaluated for weight, height, bone age, clinical goiter and thyroid function tests. Eleven out of 18 patients (61%) had overt or compensated hypothyroidism. Short stature was found in 89% of patients with a mean height more than two standard deviation (SD) below the mean height for that age. There was no significant correlation between short stature and overt or compensated hypothyroidism. The mean height standard deviation score (SDS) of patients with normal thyroid function was also more than two SD deviation below the normal mean, revealing that short stature is an inherent feature of FA. In seven cases with goiter, only three had hypothyroidism. The mean±SD weight SDS was -1.03±0.99. The mean±SD bone age was 12±4.5 yr. According to the results of this study, our patients had a considerable prevalence of hypothyroidism and short stature was a common feature of FA. It is recommended that thyroid function test is necessary in these patients.

Leishmaniosis is a prevalent tropical parasitic disease, which is caused by Leishmania protozoa. The infection can be limited in immune-competent individuals; however, in immune-compromised individuals it could proceed to chronic and ulcerative disease. The reservoirs are carnivores, and rodents and its vectors are Phlebotomus and Lutzumia. The prevalence of different spices of Phlebotomus populations and the effects of insecticides on them are investigated in Abardejhe district located in southeast of Tehran, Iran. Tablets of aluminum phosphide (3 g) and residual formulation of methyl carbamate at concentrations of 1 and 2 g/m² were used in rodents'' burrows. Phlebotomus population was highly sensitive to both insecticides used here, and their population significantly decreased by 80% within two months after application of insecticides. The effects of methyl carbamate at concentrations used lasted two months longer than that of aluminum phosphide. Control and prevention of Leishmania infection depends on the habitat and behavior of vectors and reservoirs. Periodic insecticide spraying, using residual compound inside and outside residential areas, as well as breading places of sandflies, specially rodent’s burrows, are shown to be very effective.

Increased levels of total and lipid-associated sialic acid (TSA and LASA) have been reported in the sera of patients with benign or malignant tumors and also could be regarded as newly important clinical criteria for the diagnosis of cancer. This study has investigated the differences of TSA and LASA contents between cancer patients and healthy individuals and evaluated their correlations between TSA and LASA with some tumor markers in different types of cancer. 35 patients with histopathologically confirmed cancers and 32 healthy individuals participated in the study. Tumor markers in serum including CEA, CA15-3, CA19-9 and CA-125 were measured using ELISA. TSA and LASA were quantified using spectrophotometric methods of Erlich and Katopodis respectively and non-parametric tests were used for statistical analysis. The median (range) obtained for TSA in healthy and cancer patients were 83.6 (59.0-106.2) and 119.5 (84.7-205.8) mg/dl respectively and the difference was statistically significant (P<0.001). The corresponding values for LASA content of serum in healthy and cancer patients were 16.9 (13.3-20.7), and 31.0 (15.0-50.3) mg/dl. Statistical analysis showed significant differences in LASA content between these two groups (P<0.001). A positive correlation coefficient was obtained between TSA, LASA and different tumor markers. The significant correlation between TSA, LASA and different tumor markers in cancer patients indicated that they could be used as diagnostic criteria. However, due to their lack of specificity, they may support the presence of tumor markers in different malignancies and be helpful in relation to therapy and monitoring of patients.

The most devastating manifestations of diabetes mellitus are vascular complications. Although there are many factors involved in the pathogenesis of diabetic vasculopathy, many studies suggest a role for glucose–induced oxidative stress. Studies in animal models, have demonstrated that the administration of antioxidants restores normal endothelial functions. The study was designed to examine the possible beneficial effects of ascorbic acid, which have antioxidant properties, on vascular permeability in the duodenum of rats with streptozotocin-induced diabetes. Female adult rats were divided into two control and three diabetic groups. Diabetes was induced by a single injection of streptozotocin (55 mg/kg, ip). One control and two diabetic groups received ascorbic acid in drinking water (800 mg/kg). Diabetic groups received ascorbic acid either as therapeutic for 4 weeks, starting after the induction of diabetes or as combination therapy for 8 weeks starting 3-4 weeks before the induction of diabetes. Vascular permeability was estimated by measuring the extravasations of Evans blue dye and water content of duodenal tissue. As compared to the control group, diabetic animals significantly increased both Evans blue extravasations and water content by 202%. Ascorbic acid, used as treatment or in combination therapy, similarly restored these two variables to normal level. The findings of this study suggest that ascorbic acid might have a role in restoring some dysfunctions of experimental diabetes.

Traditionally some people employ Ocimum basilicum (Shaspram) to relieve the symptoms of dyspepsia. We therefore studied the effects of oral extract of this medicinal plant on functional dyspepsia. In a double-blind placebo-controlled clinical trial, the effect of a four-week treatment of Shaspram was evaluated on functional dyspepsia. Two hundred cases from all patients referred for dyspepsia without having any obvious pathologic signs were randomly divided into case and control groups (100 each). The hydroalcoholic extract of leaves of Shaspram was prepared and used. Patients were asked to have 30 drops of prescribed medications (placebo or the extract, equal to 1.5 gram leaves powder) daily at 30 min before lunch and dinner for four-weeks. Severity was scored for each symptom on a numbered scale and the results compared with the results of placebo group or pretreatment period. Patients in drug group responded to treatment better than patients in placebo group (P<0.001). Shaspram was more effective in female and young patients. Patients with functional dyspepsia that had dysmotility problems also responded to Shaspram better than others. Ocimum basilicum seems to relieve the symptoms of functional dyspepsia especially in female and young patients with dysmotility.

This prospective clinical study was performed to investigate the colonization of H pylori in adenoid and tonsil tissues by using the Campylobacter-like organism (CLO) test. Included in the study were 56 patients aged 3 to 43 yrs who had undergone adenoidectomy, tonsillectomy or adenotonsillectomy procedures under general anesthesia. Two-mm diameter tissue pieces of adenoid and tonsil specimens were placed in urease solution. Color changes were noted after 30 min and 24 hrs. 27 (48.2%) of the patients were shown to be H pylori positive and 29 (51.8%) were negative, regardless of the type of specimen. There was a high rate of H pylori colonization in tonsil and adenoid tissues. The cause of recurrent H pylori infections of the gastric mucosa may be the result of colonization in the adenotonsillar tissues. Prevention of H pylori colonization may reduce the recurrences of the disease.

Splenic abscess is not a common condition and actinomyces as a cause is very rarely reported. We report a case of actinomycosis of spleen in a 12 year-old boy, with a few days history of abdominal pain and fever. Past medical history was not significant. Due to sever abdominal pain and tenderness condition laparatomy was done that a small perforated area was seen on hilum of spleen, so splenectomy was done. In the histological sections typical actinomyces ball surrounded by many inflammatory cells are seen. The patient received penicillin and discharged in a good condition. This has not been previously reported in the pediatric literature

Granuloma annulare is self-limiting cutaneous condition of unknown etiology, causing necrobiotic dermal and subcutaneous papules. A number of conditions have been described in association with Granuloma annulare, including lymphoma, anemia, intestinal bleeding, seronegative arthralgia, vasculitis and autoimmune thyroiditis. This manuscript, as the first report of this combination in Iran, describes an unusual case of relapsing, concomitant anterior uveitis and biopsy proven granuloma annulare.

Chronic inflammatory demyelinating polyneuroradiculopathy (CIDP) is an immune mediated disorder characterized by progressive developing or relapsing symmetrical motor or sensory symptoms in more than one limb over a period of two months. Achalasia, as a primary esophageal motility disorder, is also characterized by increasing the tone of lower esophageal sphincter, absence or incomplete sphincter relaxation in response to swallowing, loss of esophageal peristalsis and rising intra-esophageal pressure. Herein, a case of CIDP, dysmotility-like symptoms, and achalasia is presented