Archives of Iranian Medicine
Volume:2 Issue: 2, Apr 1999

Background/Objective-Malaria is still an significant heath problem for many countries, which has even worsened with the emergence of drug-resistant strains of the parasite.Purpose-To evaluate the susceptibility of P. falciparum and P. vivax to anti-malarial drugs.Setting-Malaria out-patient clinics in Bandar-Abbass (Hormozgan Province) and Iran-Shahr (Sistan-Baluchestan Province), south-eastern Iran.Methods-From 1990 to 1993, 808 and from 1994 to 1996, 493 falciparum malaria patients were treated with chloroquine (CHL) and followed up with an extended in vivo test. During 1994-96, to assess the susceptibility of P. vivax to CHL, 493 vivax malaria patients were treated with CHL (25 mg/kg over 3 days) and primaquine (0.75 mg/kg/w for 8 weeks) and examined by extended in vivo testResults-During the first phase of our study (1990-93), 593 falciparum cases (73.4%) were resistant at RI (45.5%), RII (16.7%) and RIII (11.2%) levels. Of 88 CHL-resistant patients treated with sulfadoxine-pyrimethamine (SDX/PYR), 12 cases (13.6%) were also resistant to SDX/PYR at RI (6.8%) and RII (6.8%) levels. In the in vitro test, using WHO kits and methods, 1,011 blood samples were collected from falciparum malaria patients and examined against chloroquine, amodiaquine, sulfadoxine/pyrimethamine, mefloquine and quinine. Among 508 cases in whom the growth of the parasite was successful, the resistance rates to the above drugs were 33.4%, 15.2%, 17.9%, 2.2% and 0.0%, respectively. In the second phase of the study (1993-96), 297 cases (60.2%) were resistant to CHL at RI (46.9%), RII (10.5%) and RIII (2.8%) levels. In P. vivax all cases were sensitive and the mean of parasite clearance time (MPCT) was 1.95 days in Sistan-Baluchestan and 2.81 days in Hormozgan.Conclusion-Our study showed a decrease in the resistance rate and levels of P. falciparum and sensitivity of P. vivax to CHL during 1994-96 in the studied areas.

Background-A worldwide high incidence of breast cancer (BC) has promoted essential investigational efforts in the fields of clinics and genetics. A positive family history of BC is the strongest epidemiologic risk factor which could provide early detection and preventive measures.Objective-To establish an informative bank allowing rapid detection, prevention and positive counseling and management strategies for BC-prone pedigrees.Methods-DNA samples were extracted from peripheral blood of 12 primary BC patients and the Polymerase Chain Reaction (PCR) and non-radioactive Single Strand Conformation Polymorphism (SSCP) were performed. The electrophoretic gels were stained with silver nitrate and the variant bands were assumed a result of mutation for BRCA1-gene, including exon 5,11A, and 11B.Results-The family history of 4 and 2 BC-cases was found in 42% (5/12) and 58% (7/12) of pedigrees respectively, of those an affected BC-praband revealed to carry a mutation in exon 11B.Conclusion- A genetics-clinical strategy as a powerful diagnostic tool to prevent breast cancer in patients and their relatives with high risk pedigrees.

Objective-The majority of methods of ICP monitoring are invasive and therefore not applicable in many situations. In an attempt to overcome this problem we tested changes in scalp blood flow (SBF), measured by non-invasive laser Doppler technique, as an indicator of changes in ICP. Methods-In six rabbits anesthetized with Hypnorm (IM) and diazepam (IP), ICP was manipulated by alterations in the height of a saline container connected to the subdural space through a cannula. Arterial blood pressure was monitored by connecting the femoral artery cannula to a blood pressure tranducer and a physiograph.Results-An inverse relationship was found between changes of ICP and SBF. Overall, the SBF was reduced from 139±9 to 71±5.8 arbitrary units (P<0.001, t-test) when ICP was changed from a baseline value of 2.3±0.65 to 19.8±0.75 mm Hg(P<0.001) in 108 experiments. The correlation coefficient between these two was found to be -0.839. At the same time, the mean arterial pressure was changed from a baseline value of 94.6±5.5 to 107.6±7.4 mm Hg.Conclusion-Based on the results of this study, the SBF measurement may be used as an indicator of ICP, if a similar relationship is obtained in human studies. Laser Doppler technique is a safe and clinically applicable method of blood flow monitoring in this relation.

Background/Objective-Despite the lower rates of drug poisoning reported in Iran, a traditional depilatory agent has been increasingly used as a means of suicide in this country. Due to the unique composition of this depilatory agent, poisoned patients suffer both corrosive injuries of the upper digestive tract and the systemic effects of acute arsenic poisoning. In most cases, the poison cannot be evacuated from the stomach by conventional means.Purpose-In this case series report, we present the clinical characteristics and results of the surgical management of patients poisoned by this corrosive arsenic-based depilatory agent (CABD).Setting-A consecutive sample of 30 patients referred to the Loghman Hakim Hospital General Surgery Service for surgical removal of the CABD mass was prospectively studied in 1993.Methods-Following initial workup, a laparotomy was performed in each case. The poisonous CABD mass was manually removed and scrubbed off the gastric mucosa, and gangrenous tissue was resected.Results-Although CABD poisoning constituted only 1.04% of drug poisonings referred to Loghman Hospital during the study period, it had a high case-fatality rate (36.7%), Twenty-five cases (83.3%) were suicidal poisonings. Patients were typically males in their fourth, fifth or sixth decade.Conclusion-CABD poisoning is associated with greater mortality if ingested as a liquid solution, since gastrointestinal absorption of this form is much more rapid compared to CABD paste or powder. Prompt surgical management of patients with CABD poisoning is of the utmost importance in preventing mortality due to the ensuring corrosive injuries and arsenic poisoning.

Background/Objective-Facial port-wine stain may be associated with ocular anomalies and cause significant visual morbidity.Purpose-The aim of the study was to determine the frequency of ocular lesions of port-wine stain of the face in our patients.Methods-Of patients referred to the Plastic Surgery Services of the Razi Hospital of Tehran University of Medical Sciences, from 1988 to 1997, clinical and radiologic studies of 271 patients were evaluated.Results-The author presents ophthalmic findings in 271 cases of facial port-wine stain, including glaucoma and vascular abnormalities of the conjunctiva, episclera, choroid and retina. Of the 271 cases, 27(9.9%) had leptomeningeal angiomatosis (LA), 13(4.8%) had glaucoma (which was bilateral in 5 patients), nine (3.3%) had LA and glaucoma and 10(3.6%) had choroidal hemangioma, which was bilateral in 3 patients and 41(15.1%) had conjunctival or episcleral hemangioma. Other ocular manifestations (iris heterochromia, retinal detachment and retinal vascular tortuosity) were also observed. The ages of the patients when seen varied from 6 to 55 years (mean=24.4). Seventy-nine patients (29.1%) were male and 192(70.8%) female.Conclusion-The study shows that only patients with lesions located in the ophthalmic cutaneous area should be evaluated prospectively for neuro-ocular abnormalities.

Background-Histologic grading has been used as a prognostic factor and for clinical behavior evaluation of oral squamous cell carcinoma (SCC) for the past several decades. At the same time, the prognostic value of different grading classifications remains controversial.Methods-A retrospective study of 48 cases of tongue SCC was undertaken to compare different grading systems and their relation to lymph node metastasis. Surgical specimens of 22 non-metastasizing tumors were compared with 26 tumors which had metastasized. Each case was graded according to: Broders'' classification in the whole thickness of tumor as well as deep invasive margins, multifactorial grading system (Anneroth et al. 1987), the Bryne et al. system (1989), and the new invasive margins grading method modified by Bryne et al. (1992).Results-New malignancy grading based on the deep invasive margins showed significant relation with lymph node metastasis (p=0.03). Other grading methods failed to show any relation with metastasis.Conclusion-Grading of the deep invasive margins in appropriate biopsy specimens would be of great value in predicting lymph node metastasis and treatment results of tongue SCC. Prospective studies with adequate follow ups are needed in order to obtain better evaluation of the role of this system in prognosis and survival.

Background/Objective-Antibiotic resistance of Staphylococcus aureus, now frequently encountered in hospitals, results in an increase in the costs and problems of the treatment of infections caused by this organism. Little information is available regarding an antibiotic resistance survey of S. aureus in Iran. This study incorporates testing the susceptibility in 40 hospital isolates of S. aureus and determination of the plasmid pattern of each isolate in relation to ß-lactamase enzyme.Methods-Forty strains of S. aureus were isolated from patients hospitalized in different hospitals in Kerman, Iran. The sensitivity of the isolates were measured by disc diffusion break-point assay, and the minimum inhibitory concentration (MIC) of each antibiotic was determined by broth micro-dilution method. The existence of the plasmid and ß-lactamase enzyme among the isolates was also evaluated.Results-The hospital isolates of S. aureus showed different patterns of antibiotic resistance. Organisms were highly resistant to penicillins, though 57% exhibited MIC greater than 32 m g/ml to the third generation of cephalosporins. These strains were also ß-lactamase-producers and carried at least one plasmid. When cells were exposed to curing agent ethidium bromide, the production of the ß-lactamase was lost.Conclusion-Our data indicate that S. aureus strains isolated from hospitals in Kerman are relatively resistant to commonly-used antibiotics, and plasmid-mediated antibiotic resistance in relation to ß-lactamase is common among the isolated strains.

Background/Objective-Decubitus ulcer is an important medico-surgical problem. Medical therapies mostly lead to failure and many patients with decubitus ulcer will ultimately need reconstructive surgery after long morbidity. The aim of our study was to evaluate the effectiveness of autologous platelet-derived growth factor in the healing of these ulcers when compared to conventional therapies.Methods-This study was a randomized control-designed therapeutic clinical trial. Fifteen patients with twenty decubitus ulcers were randomly assigned to treatment and control groups. Eleven wounds were randomized to treatment groups and received general wound care, dressing and PDGF, and nine were subjected to controlled wound care with the same general management and dressing for two weeks. Ulcer parameters were recorded on the first day and then every three days for two weeks. These parameters were compared in the two groups and data-analyzed by student t-test, Kolmogorov-Smirnov goodness of fit test (K-S), Fisher exact test and analysis of variance (ANOVA). P values less than 0.05 were considered statistically significant.Results-In the treatment group, four patients had complete healing and in others there was reduction in the size of the ulcer. The reduction in the wound area among treatment and control groups was 3.90±2.42 and -1.44±2.24 cm2 respectively (p=0.001). Reduction in the wound depth in the treatment group compared to the control group was 3.45±2.54 and –2.22±3.76 mm respectively (p=0.001). A seventy percent reduction in the wound area in the treatment group compared to the same change in the control group was 70.80±29.81% and 29.53±49.29% respectively (p=0.001), and a seventy percent reduction in wound depth in the treatment group compared to this change in control group was 70.83±30.56% and –47.68±72.68% (p=0.001). Conclusion-We conclude that topically applied autologous platelet-derived growth factor better promotes wound healing in patients with decubitus ulcers compared to those who receive conventional therapy, and renal failure and sepsis do not suppress the wound healing process in treated patients.

A 38-year-old man with bilateral retinal detachment was referred to the Dermatology Clinic because of skin discoloration. The patient also suffered from forehead leukoderma on the right side with an ipsilateral white forelock and poliosis of both eyebrows and eyelashes. Hypoacusis was the most recent symptom. Thus, a diagnosis of Alezzandrini syndrome(AS) with poliosis of the forelock on the right side associated with ipsilateral eyebrow and eyelashes was made. Retinal detachment was the prodromal sign which appeared on the right and left sides consecutively and is a rare finding in this syndrome.

Drash syndrome is an extremely rare condition and comprises the association of Wilms'' tumor, male pseudohermaphroditism and degenerative glumerulopathy and presents in early childhood. It has been suggested that inactivation or a dominant negative mutation of the tumor suppressor gene WT1, residing on the short arm of chromosome 11 (11p13) is the primary event causing this syndrome. Herein, we report a case of Drash syndrome in a 32-month-old child whose parents were first cousins, suggesting an autosomal hereditary pattern of the condition.

Kleine-Levin syndrome (KLS) is an uncommon psychiatric entity in children and adolescents which may present with non-specific and puzzling symptoms. Three cases of KLS in adolescent females are presented and clinical features and probable pathophysiological mechanisms discussed.