Iranian Red Crescent Medical Journal
Volume:12 Issue: 1, 2010

Radix or nasofrontal angle has a special concern in rhinoplasty. Minimal changes in the position of nasofrontal angle can produce a different image of nasal and midfacial length in the profile view. In a patient with high radix, the profile of the forehead continues into the nose in a straight line and the nose appears too long. On the other hand, deep nasofrontal angle makes the illusion of a short nose. The ideal position of this angle has always been a matter of discussion and various methods have been introduced regarding its correction by deepening or augmenting the radix area. In this article, we first review the ideal position of nasofrontal angle and then discuss different procedures used to correct it.

Clostridium difficile-associated diarrhoea (CDAD) is associated with an increased morbidity and mortality rate in elderly population. As in one of the north London hospitals, an increase in the cases of CDAD was observed in the Elderly Ward during a three-month period, the use of antibiotics and proton pump inhibitors (PPIs) was investigated for any relationship aiming to educate population and improve clinical practice during outbreaks. In the first step (Group A) undertaken from July 2005 to September 2005, administration of antibiotics was checked in patients that developed CDAD in the Geriatric Ward. In the second evaluation (Group B) after years from January 2007 to October 2007, antibiotic prescription was rechecked identically. Similarly, the assessment was conducted when PPIs were used in patients that developed CDAD. All patients were positive for C. difficile toxin in their stools. No single group of antibiotics was associated with CDAD, but in both groups, many patients who developed CDAD were on multiple drug regimes. In the second group, a proton pump inhibitor was used by one third of patients during hospitalization. Except in one case it was not discontinued when CDAD was confirmed. Restrictive policies in antibiotic consumption may help to lower the incidence of CDAD in hospitalized elderly patients.

Human cytomegalovirus (HCMV) infection may cause severe outcomes in transplant recipients and pregnant women. Diagnosis of CMV infections by using serological detection of CMV specific antibodies varies widely due to different antigen compositions in the diagnostic tests. The aim of this study was to identify the reactive peptides of CMV for CMV-IgM and –IgG detection. The reactivity of peptides (peptide 1: amino acids 595-614 of phosphoprotein 150 (pp150), peptide2: amino acides 1024-1048 of pp150, peptide3: amino acids 798-805 of C-terminal part of glycoprotein B (gp55), peptide 4: amino acids 68-81 of N-terminal part of glycoprotein B (gp 116), and peptide 5: amino acids 29-48 of glycoprotein H) as epitopes was determined in ELISA, using renal transplant recipients’ sera (n=84) with high titers of CMV-IgM and healthy individuals’ sera (n=87) with high titers of CMV-IgG antibodies. Amino acids 595-614 and 1024-1048 of pp150 had a high reactivity (83.3% and 88.0%) with renal transplant recipients'' sera while the other peptides did not. The amino acids 68-81 of gp116 reacted with 81.6% of the healthy individuals’ sera but the other amino acids showed low reactivity with these sera. Amino acids 595-614 and 1024-1048 of pp150 and amino acids 68-81 of N-terminal part of gp 116 could be considered in recombinant protein construction for detection of CMV-IgM and -IgG antibodies.

Primary hemochromatosis is an inherited disorder. Mutation in this gene is accompanied with iron overload in the body leading to organ failure that primarily affects liver. Individuals with homozygote HFE gene mutation are prone to developing the end stage liver disease. Concomitance heterozygote HFE mutation with the other hepatic risk factors may accelerate hepatic damage, leading to cirrhosis. The aim of this study was to find out the spectrum and frequency of the HFE gene mutations in the liver transplantation (end-stage liver disease [ESLD]) candidate groups. Totally, 170 individuals were studied for HFE gene mutations including 87 ESLD patients with various etiologies from Division of Liver Transplant in Nemazee Hospital affiliated to Shiraz University of Medical Sciences. Seventy four randomly selected healthy blood donors were evaluated as the control group, and 9 hemochromatosis patients who referred to our lab for genetic analysis due to their high serum ferritin levels and clinical diagnosis were surveyed in a period of one year. HFE gene mutation was found in 57 (~33%), 14 (~9%), and 15 (~83%) chromatids of the ESLD group, control sample, and hemochromatosis patients, respectively. The allele frequency of H63D is about 0.085 among these people. The HFE mutation H63D in the ESLD is significantly higher than that of the control group (W/H63D: odds ratio 5.70, 95% CI= 2.6 – 12.55; H63D/H63D: odds ratio 6.39, 95% CI= 0.77-53.1). In compliance with our previous report, the C282Y mutation is very uncommon in the southern population. This prevalence could be due to a significant aggravating effect of H63D for liver disease in these patients and may contribute to the poor liver transplantation outcome.

Understanding genetic structure and status of genetic variation of the Fasciola hepatica populations has important implications for epidemiology and effective control of fasciolosis. The aim of the present study was to genetically characterize F. hepatica isolates from different hosts, using sequence analysis of ribosomal ITS1 and RAPD-PCR. Fifty three adult F. hepaticas were isolated from naturally infected cattle, sheep, buffalo and goat from two regions in Iran. Genomic DNA was extracted from 70% ethanol preserved flukes. RAPD-PCR with a set of arbitrary primers (UBC90 and R151) was used to estimate genetic variation within the species. Ribosomal ITS1 region of the isolates was amplified, using primers specifically designed for this study. Ten samples (4 sheep, 2 cattle, 3 buffaloes and one goat isolate) were sequenced at ITS1 and analyzed, using DNASIS and ClustalW softwares. F. hepatica ITS1 region was amplified successfully for all samples and a band of 470 bp was shown in all cases. Different isolates did not show any significant genetic variations in rDNA-ITS1 as all the sequences showed to be 100% identical. RAPD results of 52 samples, in particular those with UBC90, showed different patterns within F. hepatica isolates of each host. RAPD data for this primer showed three different patterns for each of sheep and cattle isolates and two patterns in buffalo isolates. All the 14 cattle isolates came up with an identical pattern, using primer R151. The study showed the variability of F. hepatica isolates in Iran, using RAPD markers. No intraspecies variation was seen in the Iranian F. hepatica isolates at ITS1 rRNA gene, indicating highly conserved nature of this region.

Recent studies have suggested that the decrease in the pathogenicity of E. coli is due to acquisition of resistance to some antibiotics. This study was performed to investigate four virulence factors of pap, cnf-1, sfa and hly in resistant E. coli and compare them with susceptible strains of the bacteria isolated from children with community–acquired UTI. Drug sensitivity of 96 E. coli isolates was evaluated using a disc diffusion method. The prevalence of virulence genes was determined by PCR. E. coli strains showed a high degree of sensitivity to imipenem, amikacin, nitrofurantoin and ciprofloxacin. Approximately, 80.2% of the isolates were resistant to ampicilin. Only 12.5% of the strains were susceptible to all tested antibiotics. PCR showed that cnf-1 (22.9%) was more prevalent than hly (15.6%) and among adhesion coding genes, pap (30.2%) was more prevalent than sfa (18.8%). In all strains, the expression of all virulent genes was less prevalent in most antibiotic resistant groups than in susceptible ones but not statistically significant except for genotypes of pap+-cnf+, pap+- hly+ and cnf+-hly+ with nalidixic acid. We propose that pap and cnf-1 genes in combination with hly gene constitute an uropathogenic genomic configuration which is the characteristic of the nalidixic-acid susceptible E. coli strains, causing urinary tract infection.

Morphine is a strong analgesic agent being used in acute pain but adverse effects may lead to its discontinuation before sufficient pain relief is obtained. Ketamine is an anti-nociceptive drug which blocks NMethyl- D-Aspartate receptors and can modulate acute pain. In this study, ketamine effect as an adjuvant with morphine for post-operative pain management is evaluated. In a double blind randomized clinical trial, 50 kidney donors undergoing nephrectomy and receiving morphine as analgesics were enrolled. Patients were divided into two groups receiving ketamine (ketamine group) and saline serum (placebo group). Post-operative pain was assessed by measuring cumulative morphine consumption and visual analog scale pain scores were assessed in 48 hours duration after surgery. Pain intensity and cumulative morphine consumption were lower and sedation score was higher in the ketamine group. Both groups were similar regarding the side effects. Regarding post-operative analgesia management, ketamine administration improved pain intensity and when its administration was continued for 48 hours post-operatively, there was a significant decrease in morphine consumption.

Primary prevention by vaccination to increase herd immunity remains the main thrust in the control of hepatitis B virus (HBV) infection and many countries such as Islamic Republic of Iran have incorporated HBV vaccination into their national expanded program of immunization. This study was performed to determine the vaccine efficacy of hepatitis B infection between vaccinated and non-vaccinated school-aged children. Three hundred and ninety four students aged 6 to 8 years who received the hepatitis vaccine in the infancy and 314 students aged 9 to 10 years who did not receive it in Sepidan, southern Iran were enrolled. We also determined the titer of anti HBs Ab in the vaccinated students. Two students (0.5 %) were HBV infected (positive HBC Ab) and none were a chronic carrier. Two hundred and forty nine students (63.2%) had anti HBs titer greater than 10 IU/ml. One hundred and seventeen students (30%) had anti HBs titer between 1 and 10 IU/ml and only 28 children had anti HBs titer less than 1 IU/ml. Five (1.6%) were HBV infected (positive HBc Ab) and 2 (0.6%) were chronic carriers (positive HBs Ag). The efficacy of the vaccine 6-8 years after vaccination was 67.9 %(95 CI 78-92). Our results showed that similar to other studies, vaccination could not reduce the infection rate but had a significant effect on the reduction of chronic infection and carrier state, emphasizing on the role of vaccination in the control of HBV infection in an endemic region.

Seizure is one of the possible adverse effects of tramadol hydrochloride, a synthetic, centrallyacting analgesic, prescribed for the treatment of moderate to severe pain. In this study, we describe 106 patients with tramadol induced seizures. The patients, who were referred to Nemazee Hospital, Shiraz, Iran, from March 2006 to March 2008, were examined in this cross-sectional study. All of the patients had experienced seizure(s) after ingesting tramadol. Each patient was interviewed for demographic data, history of epilepsy, family history of epilepsy, duration of tramadol use, total dose and the last dose of ingested tramadol. Neurological examinations, routine laboratory tests, electroencephalography, and brain computed tomography were performed for each patient. One hundred and six patients were studied (102 males and 4 females, mean age: 26.7±6.9 years). Among them, 92 (86.8%) had new-onset provoked seizure(s) induced by tramadol and in 14 patients (13.2%), tramadol ingestion was considered as a precipitating factor in the setting of previously-known epilepsy. Tramadol was prescribed by the physicians for alleviation of pain in 20 patients (18.9%) and abused in the remainder (86 patients, 81.1%). The dose of ingested tramadol before the seizure(s) was 50 to 1500 mg. Tramadol may provoke seizures in patients with epilepsy and also in previously healthy people even within the recommended dose ranges. Because most of the cases had occurred in young abusers, strategies to prevent tramadol addiction should be sought.

Excessive anxiety and stress can affect children’s physical and psychological health, hinder their ability to cope with surgery, encourage their negative behavior in association with health care, and may also inhibit their post-operative recovery. This study was conducted to determine the effects of pre-operative psychoeducational interventions on post-operative anxiety and pain in children undergoing Day- Case tonsillectomy. A quasi–experimental pre-post test follow up control group design was used for 199 children aged 9 to 12 years old who were admitted for Day-Case tonsillectomy unit, along with their parents during a 12-month period. In a randomized method, 100 children were divided into the experimental group receiving psychoeducational interventions, and 99 children who were assigned to the control group receiving routine information preparation. The anxiety level of children was measured using children Speilberger State Anxiety Inventory (SSAI) and the post-operative pain level of the children was assessed by using the Visual Analogue Scale (VAS). The children in the experimental group reported lower state anxiety scores in 4-time points of postoperative periods. There was no difference in children’s post-operative pain between the two groups. The study provides empirical evidence in support of the effectiveness of using psycho-educational interventions for preparation of children for surgery.

There are accumulating evidences that Human T cell Leukemia Virus type I (HTLV-I) plays a part in the development of Sjögren''s Syndrome (SS). This virus is endemic in some areas of the world. The objective of this study was to estimate the seroprevalence rates of anti-HTLV-I in SS patients in Mashhad and to determine whether any association between SS patients and HTLV-I could be observed. We recruited 21 patients with primary SS who consecutively attended our Rheumatology Clinic in Ghaem Hospital affiliated to Mashhad University of Medical Sciences in Mashhad, Northeastern Iran during May 1, 2005 to September 30, 2008. Serum samples were screened for HTLV-I, using an enzyme-linked immunosorbent assay (ELISA). To compare the seroprevalence rates of HTLV-I found in SS patients with those in the community, we used the viral infection rates calculated for the entire population of blood donors in Mashhad by Blood Transfusion Organization. All patients with SS were negative by ELISA versus HTLV-I. This study demonstrates no prevalence of positivity for HTLV-1 in SS patients in Mashhad. These data are against the role of HTLV-I in the development of SS in our region.

Honey is one of the traditional medicines used for treatment and prevention of various illnesses. This study aims to assess the in vitro antimicrobial effect of honey on Streptococcus mutans. This experimental study was conducted in Shiraz University of Medical Sciences. The Minimal Inhibitory Concentration/MIC effect of a type of commercial honey on S. mutans isolates was investigated by Agar well diffusion and broth microdilution assays. For comparison a carbohydrate solution with sugar content similar to that of natural honey was used as a control. The MIC values of honey for 88.3% of tested strains were 75% v/v that were significantly different of the MIC values of the carbohydrate solution (p<0.001) and the average inhibition zone of undiluted honey on the S. mutans isolates was 13 mm. No inhibition zone was observed for undiluted carbohydrate solution in any isolates (p<0.001). Honey (Apis mellifera) has bacteriostatic activity when tested in vitro. However, pharmacological standardization and clinical evaluation of this effect are essential before using honey as a preventive measure for dental caries.

Choristoma is a tumor-like mass consisting of tissues foreign to the site at which they are located. We report an 18 years old male presenting with persistent tonsillitis. Histological examination demonstrated the unexpected presence of a mature island of hyaline cartilage surrounded by lymphoid hyperplasia.

Cystic echinococcosis is a public health problem in endemic areas. Recurrent pneumonia is a rare complication of ruptured hydatid cysts of the lung. We report a 26-year-old lady with a recurrent right lower lobe (RLL) pneumonia. Her CXR and chest CT scan revealed involvement of RLL. In her history, it was revealed that she had undergone a surgery for liver hydatid cyst two years ago. During fiberoptic bronchoscopy (FOB) for unresolved pneumonia, we extracted the whitish-yellow bright gelatinous membrane obstructing the orifice of the posterior basal segment of RLL. A follow-up CT scan done six months later revealed clearance of RLL opacity and pleural effusion. Although treatment of pulmonary hydatid cyst by FOB is an exceptional event, our exceptional case illustrates a complete treatment without any further need for a thoracic surgical procedure which could have many complications and even morbidity.

In diaphragm injuries, especially those which are left sided, it is recommended to repair diaphragm perforation to prevent complications. However, we found two cases of diaphragm injuries including two 27 and 31 years old men who were injured with stab but they were not repaired at thoracoscopy. Both patients were haemodynically stable. Chest X-ray and CT-Scan were not in favor of diaphragm perforation in both cases. The thoracoscopic finding was a 1.5 (case 1) and 1 cm tearing on the left diaphragm on the left muscular part of the diaphragm without penetrating into the abdominal cavity and with an intact peritoneum documented by probing. Due to intact peritoneum and absence of peritoneal signs, no further thoracotomy was performed. The patients were followed for 6 months with CXR and also physical examination. They did not develop any complication on the follow-up. In conclusion, in spite of diaphragm injuries, since peritoneum was intact in both cases, neither underwent thoracotomy which is invasive. They were asymptomatic during the 6 months of the follow up.

Recently stem cell therapy has suggested novel therapeutic strategies for management of heart failure and myocardial infarction. Our aim was to show that endometrial stromal cells produce a higher overall clonogenicity with a high angiogenesis potential. In addition, they may be converted into osteoblasts, odentoblasts, chindroblasts, neuroblasts and myoblasts and can be used for cell therapy as autologous and heterologous transplantations in future studies.