Iranian Red Crescent Medical Journal
Volume:11 Issue: 3, 2009

Pseudomonas aeruginosa is an opportunistic pathogen causing severe, acute and chronic nosocomial infections in immunocompromised, catheterized or burn patients. Various types of virulent factors have been identified in P. aeruginosa, suggesting their contribution to the pathogenesis of the disease. The organism is generally resistant to numerous antimicrobial agents due to natural resistance in particular impermeability or mutations and acquisition of resistant determinants. Plasmid and integron have a crucial role in acquisition of mobile elements. Most treatment failures are related to inappropriate initial antibiotic therapy with insufficient coverage of multidrug resistant (MDR) pathogens, the rationale for using combinations of antibiotics to cover MDR gram-negatives. However, clinical data supporting this strategy are limited. In fact, systematic combination therapy may have contributed to the overuse of antibiotics and to the emergence of MDR microorganisms. Nevertheless, combination therapy is the best strategy to treat severe infections due to suspected MDR Pseudomonas. Optimally, therapeutic strategies should be sufficiently broad to cover relevant pathogens while minimizing the risk for emergence of antimicrobial resistance. Polymyxin E (colistin) and carbapenems are the most effective antibiotics against MDR isolates.

Pleurodesis has been a widely used treatment option for recurrent and persistent pleural effusions and air leaks. However, an ideal pleurodesing agent has not been found yet. The purpose of this study was to investigate the dose dependent effects of bioglass on pleurodesis. Fifty six male, New Zealand rabbits weighing 3000-3500 gr were used in this study. After right chest tube insertion, 35, 70, 150, and 400 mg/kg bioglass; and 70 and 400 mg/kg talc in saline solution were administered through the chest tube into the pleural cavity. One ml/kg isotonic saline solution was administered in the control group. After 4 weeks, the rabbits were sacrificed for pleurodesis evaluation. Bioglass 400 and Talc 400 had a higher pleurodesic effect than the other doses with no statistically significant difference. Local inflammation, fibrosis and particle dissemination were significantly higher in Bioglass 400 and Talc 400 than in the controls. Talc 400 caused more inflammation and more particle accumulation than those by bioglass 400. Bioglass may be a valuable pleurodesic agent. However, further studies are needed for more definitive results.

Gout is an increasingly prevalent condition worldwide, creating a heavy economic burden. Acute gout can be effectively treated with non-steroidal anti-inflammatory drugs and recurrent episodes can be prevented with the uricostatic xanthine oxidase inhibitors. This study was conducted to determine the epidemiology and clinical manifestations of 100 patients with acute or chronic gout in Imam Khomeini Hospital in Tehran, Iran. One-hundred patients with gout who referred to the Rheumatology Department were reviewed. Their demographic data, family and drug history, comorbide diseases, body mass index, symptoms and signs at the time of referral to our clinic and lab data were collected. Among patients, 84 were men and 16 women (mean age=55.8 years and mean Body Mass Index=26.1 kg/m2). Thirty three percent of the patients were smokers and 10% drank alcohol. Seventy cases had previous gout attack of whom, 56 were in the first metotarso-phalangeal joint. The mean serum uric acid was 8.5 mg/dl. In our study, the mean age and mean body mass index of the patients were similar to those in others studies. Alcohol consumption was low in our study. Hypertension was found to be a risk factor for gout.

Tranexamic acid is a synthetic antifibrinolytic drug that reduces bleeding and transfusion requirements in cardiac surgery and total knee arthroplasty. In this study, we evaluated the efficacy of the prophylactic tranexamic acid on intraoperative bleeding in patients undergoing lumbar hernial dics resection. Eighty patients in ASA class I and II were randomized into 4 groups. In group 1, anesthesia was achieved by total intravenous anaesthesia and also the administration of tranexamic acid. The other groups were group 2, anesthetized by total intravenous anaesthesia without tranexamic acid; group 3, anesthetized by halothane and the administration of tranexamic acid and group 4, anesthetized by halothane without tranexamic acid. Blood loss and surgeon''s satisfaction were registered. The amount of blood loss in group 1 was 267.1±177.3 ml; in group 2: 656±411.6 ml; in group 3: 357±307.2 ml and in group 4: 550±406.7 ml. The least bleeding was recorded in group 1 which had a significant difference with groups 2 and 4 for which tranexamic acid was not administered. Blood loss in groups 2 and 4 was more or less similar with no significant difference. The surgeon''s highest satisfaction was with group 1. No complications were recorded in the 4 groups. We concluded that administration of prophylactic tranexamic acid in patients undergoing hernial disc resection has the potential to reduce intraoperative bleeding and improving visualization of the surgical field especially when administered with total intravenous anesthesia.

During the recent decades, a lot of studies were conducted to asses the effect of electromagnetic fields on fetal developmental disorders, sterility, and a variety of neoplasms. The aim of the present study was to determine the effect of low electromagnetic field (LEMF) on the liver’s volume and the number of its megakaryocytes in NMRI mouse fetus. LEMF of 50 HZ frequency was used and 66 three month old NMRI mouse embryos were divided into 6 groups. The experimental groups were exposed to LEMF and then an embryo was randomly selected from each mother and its liver was extracted and fixed in formalin. Cell counting and volume evaluating were done by stereological methods and the data were analyzed. Although the number of liver megakaryocytes and the embryos weight in all experimental groups as compared to sham and control groups reduced but the differences were not significant. The results of this study revealed that in the pregnant mice exposed to LEMF, irrespective of the length of pregnancy, there was not a significant change in the liver volume and the number of liver''s megakaryocytes in NMRI mouse fetus.

Osteosarcoma is the most frequent highly malignant bone tumor with a peak incidence in the second decade of life. Although survival rate increased up to 60-70% within the last 10 years, the problem of unresponsiveness to chemotherapy remains. In this study, we sought to determine the prognostic significance of P-glycoprotein as a tumor marker for osteosarcoma. In a retrospective study, we correlated P-glycoprotein immunostaining with clinicopathologic and histomorphologic features of the tumor and the patient outcome in 30 cases with primary, non-metastatic, highgrade osteosarcoma who were homogeneously treated. P-glycoprotein positivity was found in 14 of 30 cases and was significantly associated with a higher incidence of adverse events and relapse rate. No relationship was found between p-glycoprotein immunostaining and clinicopathologic features such as age, sex, tumor site, histologic subtype, osteoid content, osteoid pattern, pretreatment necrosis, pleomorphism of the cells, and presence of prominent nucleoli, except for mitotic activity per 10 HPF. P-glycoprotein positivity in immunohistochemistry should be taken into consideration to identify a subgroup of osteosarcoma patients with poor outcome at the time of diagnosis. So it might be an important marker in planning innovative chemotherapeutic regimens.

One of the valuable tools for inhibiting the specific gene expression is antisense technique. To determine T cell responses, co-stimulatory molecule expression on the antigen presenting cells is important. In the present study, the effects of high affinity antisense against CD40 mRNA on the function and phenotype of DCs (dendritic cells) were investigated. The DCs were separated from the mice spleens and then cultured in vitro. By means of lipofectamine 2000, the antisense was delivered into the cells and the efficacy of transfection was estimated by flow cytometry. Also, the mRNA expression and protein synthesis were assessed by real time PCR and flow cytometry, respectively. The DCs were transfected with 6 μM antisense and 2 μl lipofectamine 2000. The percentage of CD40 expression in DCs was 38%. The results showed that CD40 expression is reduced in DCs to 22% and 24%. By annexine V and propidium iodine staining, we could evaluate the viability of the transfected cells. The inhibition of CD40 gene expression was associated with the increase in IL-4 secretion. This shifted the DCs to stimulate Th2 cytokine production from the allogenic T cells. In addition, in the MLR, the DCs without CD40 expression showed poor allostimulatory effects. This finding is valuable in the study of the costimulatory molecules of DCs. These data demonstrate that direct interference of the cell surface expression of CD40 at transcriptional level by antisense confers tolerogenecity potential of DCs. This approach is a useful tool through which DCs become tolerogenic and can be studied as a potential therapeutic option for the autoimmune diseases and allograft rejection.

Breast cancer is the most prevalent malignancy among Iranian women. Five and ten year survival is one of the indicators used for evaluation of the quality of care after surgery. In this study, we used several survival models to determine risk factors, survival times and life expectancies of different types of surgery. This study was performed on 310 patients who underwent surgery during a ten years period. Logistic regression and Cox regression models were used to analyze the factors leading to death. The Kaplan-Meier method (non-parametric) was used to estimate the survival rate. The log-rank test was used to compare survival in different groups. To compare life expectancy of different types of surgery, we used the actuarial life table method. Logistic regression showed that stage, grade, age and history of benign malignancy had significant relationship with death. Log-rank test showed that there was a significant difference between survival for patients with different stages, age and history of benign tumors. Cox regression model demonstrated that the variables of stage, grade, age and benign problems were the major risk factors. Actuarial life table model showed that the life expectancy for all patients was 10.03 years. This life expectancy in early stages of breast cancer for mastectomy and lumpectomy were 8.99 and 8.35 years, respectively, which was not significant. It can be concluded that the higher stage, grade, age and history of benign tumor were, the most important risk factors were correlated to mortality in breast cancer patients. This study showed that there was no significant difference between life expectancies of mastectomy and lumpectomy surgery.

sFasL is the soluble form of FasL inducing apoptosis by binding to Fas. Fas/sFasL could be the most important mechanisms in inflammatory conditions such as asthma by controlling inflammatory responses. This study was undertaken to determine the level of sFasL in allergic and non- allergic asthmatic patients with different stages of asthma control. Twenty asthmatic patients were enrolled and divided into controlled and uncontrolled patient groups. They were divided into 4 subgroups including controlled/allergic, controlled/non-allergic, uncontrolled/allergic and uncontrolled/non-allergic subgroups. Five normal subjects were selected as a control group. From all subjects, 3 ml of blood was obtained and sFasL and IgE serum levels were evaluated by a specific ELISA kit. sFasL in the controlled and uncontrolled patient groups did not have any significant difference; but in the uncontrolled/allergic subgroup, it was significantly lower than that in the control group and also higher in the uncontrolled/non-allergic subgroup insignificantly. In patients with acute inflammatory conditions, sFasL had an increasing effect to control inflammation observed in uncontrolled/non-allergic subgroup, but unexpectedly not in the uncontrolled/allergic subgroup. Probably in allergic patients, there are factors or mechanisms that inhibit sFasL production or expression.

Surgery has so far been used for primary treatment of pterygium; however, one of the major limitations is its high recurrence rate. This study was performed to determine the effect of bevacizumab in recurrent pterygium. Patients with recurrent pterygium were divided into two groups, receiving bevacizumab (Group 1) or normal saline (Group 2). They were evaluated for photophobia and any conjunctival congestion and were scored from 0 to 4 prior to any injection. The size of pterygium was assessed in relation to extension of pterygium on the cornea over the limbus. All patients were followed in regular 48 hour intervals weekly up to one month and then monthly up to 6 months after the injection. There were 50 patients in group 1 and 48 in group 2 and the mean age of the patients was 40.94±13.82 and 47.10±5.9 years, respectively with a male to female ratio of 1 2. The mean size of ptrygium was 52.84 in group 1 and 46.02 in group 2. In group 1, photophobia and conjunctival congestion were 59.53 and 61.27, respectively while in group 2, they were 39.16, and 37.24, respectively. In the first 48 hours, conjunctival congestion and photophobia were higher in group 1 but there was no significant difference regarding the size of pterygium. After one week, the scores were significantly lower in group 1 while the mean rank for the size of pterygium was 52.84 in group 1, and 46.02 in group 2. After 1 and 6 months, the scores were lower in group 1. Conclusion Subconjunctival injection of bevacizumab can be considered as an effective temporary treatment in the management of recurrent pterygium in those who are not a candidate for secondary operation. It can decrease conjunctival congestion and photophobia and prevent further progression even in the long term.

Breast cancer and its treatment have specific challenges for women due to changes in sexuality, femininity, body image and maternal issues which might lead to associated psychological morbidity. In the present study, our aim was to measure depression, anxiety and anger in breast cancer patients. Our study comprised 178 breast cancer patients, most of whom were diagnosed for 1 to 5 years, compared with 400 other women randomly selected from the general population referred to Shiraz medical clinics for non-therapeutic reasons. We used depression, anxiety and anger subscales of Symptom Checklist-90 Revised (SCL-90R) questionnaire. Depression and anxiety were not significantly different between the two groups and the mean scores of anger were significantly lower in breast cancer patients than those in the general population. Higher depression and anger mean scores were found among younger patients. Education and tumor size correlated significantly with anxiety. Most of our patients had been diagnosed for more than 1 year and no patient had distant metastasis. Qualitative data showed stable family condition, religious tenets and social supports which are all among the reasons for our results.

Thalassemia patients are more susceptible to hepatitis than the normal population due to the frequent blood transfusion. This study was performed to determine the immune response of children with major β-thalassemia, by measuring anti-HBS antibody following the last HBV vaccine injection. This study was carried out on all thalassemic children under the care of Iran Thalassemia Foundation (38 cases) in Birjand, receiving three standard intramuscular recombinant HBV vaccines. The children’s mean age was 9.2±4.6 years. Based on the time lapsed since their last vaccine injection, the subjects were divided into two groups of ≤5 years and >5 years. Based on the serum level of anti-HBS-antibody, the subjects were categorized as good responders (anti-HBS>100 IU/lit), low (anti-HBS=10-100 IU/lit), and non-responders (anti-HBS<10 IU/lit). The mean ranges of anti-HBS level in the above-mentioned groups were 99.7 and 43.3 IU/lit, respectively. Out of 38 individuals, 13 (34.2%) were good responders, 9 (23.7%) low and 16 (42.1%) non responders. Standard HBV vaccination in thalassemic children results in an immune response in 57.9% of subjects. Therefore, assessment of anti-HBS-antibody 5 years after the last vaccination is recommended.

Preeclampsia is an idiopathic multisystem disorder specific to human pregnancy and the puerperium and hematological abnormalities may develop in preeclamptic women. This study was designed to determine coagulation parameters in patients with severe preeclampsia in Shiraz, southern Iran. From 2002 to 2005, coagulation indices including platelet count, prothrombin time (PT), activated partial thromboplastin time (aPPT), plasma fibrinogen, and fibrin degradation products (FDP) were measured within 24 hours of admission for fifty women with severe preeclampsia and fifty normal pregnant women. The patients with coagulopathies were excluded. Abnormal coagulation indices were compared between the two groups. The mean value of platelet counts were significantly lower while the mean values of aPPT and FDP were higher in the preeclamptic patients. However, the mean values of plasma fibrinogen and PT did not show any statistical difference between these two groups. Fifty percent of the patients with severe preeclampsia showed thrombocytopenia, 10% prolonged PT, 30% prolonged PTT, 28% hypofibrinogenemia, and 32% elevated FDP. Prolonged aPTT was seen in 6% of patients with platelet counts of more than 150´103/mm3 at the admission time. However, these patients showed evidence of coagulopathies and needed to receive blood or blood products later in their hospital course. In case an abnormal platelet count or aPTT is detected in a patient with severe preeclampsia, a coagulopathic disorder should be clinically suspected.

Drop-in centers (DICs) are set up to reduce the harms of high-risk behaviors in high-risk groups especially in injecting drug users (IDUs). This study aimed to determine the prevalence of high-risk behaviors in hepatitis C virus (HCV), and human immunodeficiency virus (HIV) in IDUs seeking harm reduction services in DICs in Iran. Fifteen out of 48 centers covered by universities of medical sciences were enrolled through a systematic random sampling method. Information on demography, high-risk behaviors, and HIV and HCV infections of all IDUs (N=1531) were obtained through interview over a one month period. Among 1531 subjects analyzed, 96.1% were male, 47.8% were single, and 35.1% married. The mean age of the participants was 33±9.0 years and the most prevalent age group was 26-35 years (45%). The median durations of drug abuse and injection were 12 (ranging 1 to 43) and 5 (ranging to 37) years, respectively. 20.5% (95% CI: 17.94, 23.22) of the participants were HIV positive test cases, while the prevalence of HCV was 43.4% (95% CI: 40.17, 46.62). The median number of injections was 21 times per week for all injections and zero for injection with shared needles and syringes. 47.4% of the IDUs had sexual contact with someone other than their spouse. The proportions of unprotected homo- and heterosexual contacts among IDUs were 19.4% and 37.4%, respectively. IDUs had a high rate of unsafe sexual contact and injection related behaviors. The high prevalence of HIV and HCV infection among this group implies a high rate of transmission and exposure to the risk of serious diseases. The study showed the necessity of establishing and developing harm reduction support to the majority of IDUs, to reduce transmission and burden of HIV and hepatitis C in Iran.

In Emergency Medical Systems (EMS), decreasing the arrival time for patients is an important factor and as a result, in recent decades motorcycle ambulance (motorlance) is being used in EMS centers for missions called for in crowded, rural and arduous areas. This study was done to evaluate the impact of using motorcycles on arrival time of EMS technicians to the scene. This is a cross-sectional study based on the information of 1727 motorlance and 44426 ambulance missions in Shiraz EMS. One of these motors was settled in the arduous locations and the other in very crowded areas according to traffic statistical information. We compared the results of motorlance and ambulance missions with each other. There was a considerable decrease in referring patients to the hospital in motorlance missions, probably due to the right performance of the dispatch operators, and also the significant decreased arrival time in motorlance missions. Although we can improve the efficiency of the motorcycle ambulance through appropriate screening of age, sex, cause and time of the accident, teaching dispatch operator to select the appropriate cases for dispatching motorlances is one of the principles that should be considered. More precise information is needed to locate proper positions for motorlance missions and timely dispatching.

Sarcomas are rare forms of endometrial (uterine) cancer. We report here a 52 years old woman who was hospitalized due to abnormal uterine bleeding (menorrhagia). The patient underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy and para-iliac lymphadenectomy. The pathological result was endometrial stromal sarcoma/low grade. Meanwhile, she had an ESR of 80 mm/h. After 4 years, the patient referred with dyspnea and galactorrhea. Her serum prolactin level was more than 100 ng/ml. The lung CT-scan revealed metastatic lesions. Brain MRI with hypophysis view was normal. Thus chemotherapy with CYADIC regimen was begun for her and her ESR reached 13. Also, a decline in prolactin level occurred. After 2 years, she was hospitalized for abdominal pain and the assessments revealed progressive metastasis of the abdomen and whole body scan demonstrated the metastatic bone disease. Also, prolactin level highly increased (11102 mIu/Lit). The MRI of the brain was normal again. Serum macroprolactin was measured, revealing a negative result. The ESR reached 80 mm/h.

The following case describes a young patient with failure to thrive and new-onset diarrhea who underwent upper GI series. The findings on upper GI series revealed an enterocolic fistula. Laparatomy was performed and the persistent pathology was lymphoma.

Six cases of ameloblastoma were treated by enucleation and peripheral osteoctomy during 1992-2001. Histologically, desmoplastic reaction, epithelial cells with severe fibrous, and keratin formation in the acanthomatous follicles were seen. The disorder was in the mandible in five cases, and in the maxilla in one case. Two cases were male and four were female, and the age at surgery was between 20 to 28 years. For all cases, a uniform surgical protocol was applied. The lesions were removed primarily by enucleation with peripheral ostectomy. There was recurrence in two cases. An enbloc resection was done for the first case and a radical resection with titanium bone plate reconstruction for the second case. The patients did not have any problem, bone grafting being recommended for the first case as soon as possible. Based on our knowledge, the procedure was successful in approximately 70% of cases, but more radical surgery methods may be recommended in the initial surgery.