Archives of Iranian Medicine
Volume:5 Issue: 4, Oct 2002

Background – Liver failure and its complications are among the gravest diseases, and are relatively common in Iran. The only effective treatment for most of these patients is liver transplantation, which has only been available in Iran for 8 years. The aim of this study was to show that liver transplantation is feasible and affordable for patients in Iran.Methods – Records of all patients from the Liver Transplantation Unit, Nemazee Hospital, Shiraz, Iran over the past 8 years were reviewed. Clinical data were analyzed focusing on the cause of liver disease, surgical techniques adopted, post-transplantation complications, and duration of early and late survival. Results – During this period, 28 patients (19 males and nine females) received liver transplantation (mean age, 20.76 ± 12.37 yr; range, 4 – 48 yr). Twenty-one patients received organs from cadaver and seven from living-related donors. The most common cause of liver failure in adults receiving transplantation was cryptogenic cirrhosis, while the most common cause in children was biliary atresia. Early mortality (within 1 month after transplantation) including primary nonfunction of the graft occurred in seven patients. One patient died of duct syndrome 1 year after transplantation. The others were alive, healthy and active at the time of this report.Conclusion – Liver transplantation has been performed in our center for the past 8 years with acceptable results and the success rate is improving.

Objective – To assess the status of tetanus during the last 20 years in Fars Province, Iran. Methods – Analysis of the hospital records of all tetanus patients who were admitted to the two university hospitals from 1978 through 1997. Results – There were 244 cases of tetanus, the youngest was a 2-day-old male infant and the oldest was an 80-year-old man. There were 176 males and 68 females, with a male-to-female ratio of 2.5:1. Neonates numbered 94, children 24, and the remaining 126 cases were adults. The latter group included 21 postpartum cases. Conclusion – The number of detected cases per 105 population residing in Fars Province was 1.8 in 1978, 0.31 in 1987 and 0.02 in 1997, revealing a sharp decline in incidence from the late 1970s to late 1990s. This is likely due to an advancement of the knowledge of the general population, availability of a larger number of medical care facilities, particularly for pregnant women, training of a larger number of rural midwives and general practitioners, and obligatory vaccination programs for preschool children, pregnant women, soldiers and the general public over the last several years.

Background – The aim of this study was to assess the level of knowledge, attitudes and behavior of female students, aged 15 to 18 years, with regard to dysmenorrhea and menstrual hygiene, in suburban districts of Tehran.Methods – The study applied a descriptive, cross-sectional method, in which 250 students were selected at random using a cluster random sampling method. The data were collected by applying a 44-item questionnaire. The reliability of the questionnaire was checked by Chronbach-Alpha method, which showed a correlation of 90%.Results – Seventy-seven percent of the subjects claimed that they had adequate knowledge of dysmenorrhea. But only 32% of these practiced personal hygiene, such as taking a bath, and used hygienic materials (i.e. sterile pads). About 33% of the subjects, avoided any physical activity or even mild exercise during menstrual period. Over 67% of the girls reported taking palliative medicine for their menstrual pain without consulting a doctor. Fifteen percent of the subjects stated that dysmenorrhea had interfered with their daily life activities and caused them to be absent from school from between 1 to 7 days a month. The prevalence of dysmenorrhea in this study was 71%.Conclusions – The main conclusion derived in this study was the necessity of educating female students about personal hygiene associated with their menstrual period and to adopt a healthy behavior, which includes: appropriate nutrition, exercise and physical activity, personal hygiene, and appropriate use of medications based on a physician’s prescription.

Background – Low-molecular-weight heparin (LMWH) has been shown to reduce the severity of postoperative inflammatory response. We decided to evaluate the specific effect of intraoperative LMWH in reducing the severity of postoperative inflammatory response after standard extracapsular cataract extraction and posterior chamber intraocular lens implantation in cases of phacomorphic glaucoma.Methods – In a randomized, double-blind, clinical trial, 46 eyes (23 case eyes and 23 control eyes) were operated on by a single surgeon. In the first group, 5 IU/mL LMWH (Fragmin) was added to the irrigating fluid. Intraoperative and postoperative hemorrhage, degree of postoperative inflammation, fibrin and posterior synechiae formation, pigment deposits on the intraocular lens surface, visual acuity and intraocular pressure (IOP) were evaluated. The control group underwent a routine conventional surgery.Results – The mean age was 68 years (standard deviation, 8.1; range, 63 – 79 yr). No statistically significant difference in age, sex, duration of operation and hospitalization, preoperative IOP, concurrent ocular and systemic illness, or smoking was found between the cases and controls. There was a statistically significant difference between the two groups in terms of density of cell and flare in anterior chamber, fibrin formation, pigment deposition over intraocular structure, and severity of postoperative inflammation. There was also a statistically significant difference in postoperative visual acuity between cases and controls (20/50 vs 20/125, respectively; p = 0.001). The incidences of intra- and postoperative hemorrhage were similar between the two groups (p = 1.0). Conclusion – LMWH can be used safely in patients with phacomorphic glaucoma. In this study, it was positively correlated with reduced postoperative inflammation and fibrin formation, and gave rise to better visual acuity.

Background – The underlying mechanism(s) for the development of premature atherosclerosis in patients with systemic lupus erythematosus (SLE) is not precisely understood. In recent years, lipoprotein(a) [Lp(a)] has emerged as a valuable predictor as well as an independent risk factor for premature atherosclerosis. The objective of this study was to determine blood Lp(a) levels in SLE patients, and to determine whether increased levels are a contributing factor to the development of atherosclerotic complications of SLE.Methods – Serum Lp(a) levels were measured by enzyme immunoassay in 37 SLE patients, nine of their apparently healthy siblings and 35 healthy controls. Student’s t test was used for statistical comparisons. Results – Our data showed a higher frequency of enhanced Lp(a) levels (> 30 mg/dL) in SLE patients as compared with that observed in healthy controls (51.4% vs 25.7%). Analysis of lipid profiles in SLE patients also revealed significantly higher levels of triglycerides as compared with controls (165 ± 16 vs 100 ± 6 mg/dL, p = 0.001). Serum Lp(a) levels were not different between patients with or without glucocorticoids, hospitalization and disease exacerbation (p values equal to 0.9, 0.7 and 0.6, respectively. Moreover, there was no significant difference in serum Lp(a) concentration between nine SLE patients and their siblings (34 ± 11.8 vs 37.3 ± 12.8 mg/dL; p = 0.8). Conclusion – Increased Lp(a) levels are more likely to be encountered in patients with SLE than in healthy subjects. Lp(a) blood levels in SLE, as in healthy individuals, seem to represent a genetically predetermined trait.

Background – The specificity of HLA class I (HLA-A and B) alloantibodies was studied in 30 serum samples from antibody-positive, potential kidney transplant recipients who had percent panel reactive antibody values (%PRAs) of more than 5%. Methods – Antibody detection was performed using the microlymphocytotoxicity technique. In this study, the specificity of antibodies was categorized as either private epitopes or cross-reactive group (CREG) epitope clusters. A p value of less than 0.05 and χ2 values greater than 3.841 indicated a significant association between a known antigen and an unknown serum sample.Results – No specific antibody was defined in seven (23.33%) serum samples with %PRA values of less than 20%. At 88% to 100% %PRA values (7 patients, 23.33%), most of the serum reactions were positive because the patients had developed multiple antibodies against a large array of HLA antigens. Identifiable antibodies were found in 16 (53.3%) serum samples with %PRA values between 20% and 87%. Anti-CREG antibodies with or without antiprivates were identified in nine of the 16 samples (59.25%), whereas only six (37.5%) of these 16 samples contained an apparent antiprivate antibody without evidence of anti-CREG antibodies and one (6.25%) contained two different private antibodies.Conclusion – Antibody reactivity against CREG clusters was more common among patients with definable antibodies. Knowing the specificity of HLA antibodies in patients’ sera, helps to define a suitable kidney with negative cross-matching for sensitized patients, among previously HLA-typed donor banks. The records of these banks are maintained in computer programs at the IsfahanTransplantation Laboratory.

Background – An aborted suicide attempt is an event in which an individual comes close to committing suicide but does not complete the act, and thus sustains no injury. In this study, aborted suicide attempts among psychiatric inpatients in Kerman were examined.Methods – Of 650 patients who were admitted over a 6-month period to the Beheshti Psychiatric Hospital, Kerman, Iran, 400 were included in this study. They were assessed by a semistructured interview, and details of actual and aborted suicide attempts were clarified. Results – Fifty-six (14%) of the subjects had had at least one aborted suicide attempt over a six-month period prior to their admission. Aborted attempts were reported more often in subjects with a diagnosis of bipolar mood disorder, than schizophrenia and other psychotic disorders, major depressive disorder and post-traumatic stress disorder but there was no relationship between any diagnostic group and aborted suicide. The mean age ± SD of patients with aborted suicide was 30.8 ± 9.3 years, which was significantly lower than that of patients with no history of aborted suicide (34.6 ±11.2) (p < 0.008). Patients who had made an aborted attempt were nearly four times as likely to have made an actual suicide attempt than subjects with no aborted attempts. Conclusion – Patients with a history of an aborted suicide attempt are more likely to attempt suicide in the future. Psychiatrists should seek this type of behavior and take preventive steps.

Background – Chloroquine is an amine that inhibits lysosomal enzymes and is increasingly being used for increasing the rate of transfection of cells during gene transfer. Its effects on retrovirus-mediated gene transfer (transduction) are not clearly evident. Here, we studied the effects of this drug on transduction efficiency in a variety of cell lines and in hematopoietic cells.Methods – We used a GALV pseudotyped retrovirus (PG13/ MNDEGFPSN) for transduction of the cell lines Hela, 208F, K562 and HL60, and baboon column-bead selected CD34+ cells using different methods, and in the presence of different concentrations of chloroquine. Transduction was gauged by detection of cells producing green fluorescence in a flow cytometer. Results – Chloroquine (100 μmol) reduced transduction efficiency in cell lines, with some concomitant increase in propidum iodide positivity, which is an indicator of toxicity. This reduction in transduction efficiency remained in the generations of cells, even after the disappearance of conditions causing cellular toxicity. In baboon CD34+ cells, its effects were variable, but it did not increase the cellular toxicity. Increased transduction efficiency was observed in the presence of chloroquine (13.02 ± 0.5% in the absence of chloroquine versus that in the presence of 50 μmol (28.84 ± 2.71%) and 100 μmol (28.76 ± 2.12%) of chloroquine). In other experiments, chloroquine increased PI positivity of the baboon cells and decreased transduction efficiency (19.09 ± 0.61% and 17.99 ± 0.22% without chloroquine in second and third experiments, respectively). Conclusion – Although chloroquine inhibited transduction efficiency in cell lines, it had the opposite effect on baboon CD34+ cells and may actually increased transduction to these cells.

Background – Mucoid strains of Pseudomonas aeruginosa are surrounded by a capsule composed of β-1, 4 linked D-mannuronic acid and L-guluronic acid. The capsule provides a protective barrier against antimicrobial agents and the immune system, and is an important pathogen in immunocompromised hosts. In this study, we compared the activities of imipenem and ceftazidime against mucoid and non-mucoid clinical strains of P. aeruginosa.Methods – From April to September 2000, one-hundred and thirty-three P. aeruginosa cultures were isolated from hospitalized patients in Tehran. In addition to determination of the minimum inhibitory concentrations (MICs) of two antipseudomonal antibiotics, ceftazidime and imipenem, against these isolates, mucoid strains were selected by capsule staining. Mucoid phenotype was confirmed by precipitation of alginate in cold ethanol. Data were analyzed by the Chi-square method.Results – More than 70.6% of the strains were sensitive to imipenem, which inhibited most strains at an MIC of 4 μg/mL. However, more than 72.9% of strains were resistant to ceftazidime, and only concentrations of 128 μg/mL or more inhibited their growth. There was a statistically significant relationship between the presence of the alginate capsule and resistance against ceftazidime. Such a relation did not exist for imipenem.Conclusion – Considering the extensive use of ceftazidime in Iran, performing susceptibility tests, as well as determining the mucoid phenotype in strains of P. aeruginosa is strongly recommended prior to antimicrobial therapy in immunocompromised patients.

Crimean-Congo hemorrhagic fever (CCHF) is caused by Nairovirus, genus Bunyavirus in family of bunyaviridae, and is spread by the tick Hyalomma spp or via blood transfusion and contaminated blood of human and animal. CCHF virus infection was rarely reported in Iran before 1999. From January 1st 1999 to October 1st 2002 nearly 144 confirmed sporadic CCHF cases reported from many provinces of Iran. Seroepidemiological details of three cases of nosocomial CCHF that were seen in three different hospitals throughout Iran are described here. Of the three patients in this study, two died. All three patients initially presented with severe Ebola virus-like or influenza-like symptoms, making the disease difficult to diagnose in the early stage. However, petechiae and signs of bleeding distinguish CCHF from influenza, but not from Ebola which is not related to this disease and has not been reported in Iran. Leukopenia and thrombocytopenia were the most important laboratory findings. Rising IgG and IgM titers made the diagnosis certain in two of the cases. Despite the low mortality rate because of very effective treatment with ribavirin among the general population, two of the three CCHF patients died. This poor prognosis for CCHF signals the importance of early diagnosis and admission of suspicious cases to hospital

Gonadoblastoma is a rare tumor found almost exclusively in patients with an underlying gonadal disorder, and accounts for two-thirds of gonadal tumors in women with abnormal gonadal development. Three cases of gonadoblastoma are reported here. One had Swyer syndrome (pure gonadal dysgenesis) with a 46-XY karyotype, the second patient had a mixed 46-XY and 46-XO karyotype, and the third patient had male pseudohermaphrodism and a 46-XY karyotype. Patients with pure gonadoblastoma have an excellent prognosis, when bilateral excision is performed. Gonadoblastoma may be overgrown by dysgerminoma, however, there is a good prognosis. Gonadoblastoma has never been detected with metastatic lesions. The prognosis for gonadoblastoma, including cases of Swyer syndrome, is good, provided early excision is performed bilaterally.

Background – Primitive neuroectodermal tumors (PNETs) are rare neoplasms that are usually seen in children and frequently metastatize in the central nervous system. We present a case of primary intraspinal PNET.Methods – A 22-year-old woman presented with back pain and leg weakness. Magnetic resonance imaging of the spine revealed an intradural extramedullary lesion at the level of thoracic vertebra 12. Total tumor removal was performed and pathology was consistent with a PNET.Results – Within 4 weeks, there was a recurrence of symptoms with paraparesis at the original site and at the level of C1, T6, and T9. The PNET responded dramatically to radiotherapy.Conclusion – To date, only 14 cases of primary intraspinal PNET have been reported. The presented case is the second reported, in which the tumor was intradural and extramedullary. Intraspinal PNETs have a poor prognosis with reported cases surviving less than 2 years.