Acta Medica Iranica
Volume:47 Issue: 4, July Aug 2009

Glucocorticoid steroids are widely used as anti-inflammatory and immunosuppressive medications and are well known to induce osteoporosis. In Present study 24 rats were randomly divided into four groups (n=6): Group A (control), Group B (sham)that was treated only by normal saline for 1 month.Group C that was treated by methylprednisolone acetate alone (0.2 mg/kg) for 1 month. Group D that was treated by methylprednisolone acetate (0.2 mg/kg) and oral calcium supplementation (15 mg/kg) for 1 month. Changes in concentration of bone metabolic markers such as osteocalcine, acid phosphatase and calcium were evaluated before and after treatment. Bone mineral density (BMD) of lumbar vertebrae was also measured by dual energy X ray absorptiometry (DEXA). The results showed that concentration mean of serum acid phosphatase was increased significantly (P < 0.05) in C and D groups in compared to A and B groups. The concentration mean of serum osteocalcine in group C was decreased significantly (P < 0.05) in comparison to A and B groups but increased significantly in the group D in comparison to group C. The concentration mean of serum calcium was decreased significantly (P < 0.05) in C and D groups in compared to A and B groups. The bone mineral density (g/cm2) was decreased significantly (P < 0.05) in group C in compared to A and B groups. This increased significantly in group D in compared to group C. These results are compatible with the view that low doses of methylprednisolone acetate decreases bone formation and increase bone resorption in the lumbar vertebrae of rats. Calcium administration decreased effects of methylprednisolone.

Macular or maculopapular skin reactions are frequent events in skin allergies as well as in viral infections. Clinically, the differentiation may be difficult in the absence of a clear relationship with drug intake or in the failure to detect measles virus-specific antibodies. Studies on drug-specific T cell lines and T cell clones isolated from skin-allergy patients have suggested that these cells may represent a significant source of IL-4 and IL-5. On the other hand, viral infections are frequently associated with elevated IFN-γ levels. Determination of serum cytokine levels helps to differentiate between skin allergies and virally induced skin eruptions. Forty patients suffering from skin allergy and 40 patients with measles infection entered the study. Serum IL-4, IL-5 and IFN-γ levels were determined by ELISA assay for skin-allergy and measles patients. In 37/40 patients with skin allergy, IL-4 was elevated and in 6/40 patients with skin allergy IFN-γ was measurable. In 29/40 patients with measles infection, IFN-γ serum levels were elevated and 32/40 patients with measles had elevated IL-4 levels. IL-5 was increased in 32/40 patients with measles infection and in 34/40 patients with skin allergy. These data underline the distinct pathogenesis of these morphologically similar exanthemas and suggest that a combined analysis of IL-4, IL-5, and IFN-γ might help differentiate skin eruptions.

The microdose GnRH agonist (GnRH-a) flare protocol may have a particular value for previously poor responders in whom it has been observed to stimulate dramatic increases in serum FSH. The Purpose of this study was to determine the effects of microdose GnRH-a in poor responders. This is a clinical trial with before and after design. This study was done in Research and Clinical Center for Infertility (Shahid Sadoughi University, Yazd, Iran) and Madar Hospital, Yazd, Iran. In this study, 61 poor responders volunteered for in vitro fertilization (IVF) or intracytoplacmic sperm injection (ICSI). The volunteers were divided into two age groups (group A, 20 - 34; group B, 35 - 40) and received low dose oral contraceptive pills for 21 days, then 40µg of subcutaneous buserelin 2 times/day from day 3 of the cycle and human menopausal gonadotropin (hMG) 3 ampoules/day from day 5. Main Outcome measures were number of follicles, oocytes and embryos, and pregnancy rate (PR). These measures were then compared with those of the previous cycle. There were significant differences in all parameters (P < 0.05). Pregnancy occurred in 3 women (5%). There was no significant difference in number of follicles, oocytes and embryo between two age groups (P > 0.05). Use of microdose GnRH-a plus HMG for controlled ovarian hyperstimulation in IVF or ICSI cycles can lead to formation of more follicles, oocyte and embryo in poor responders.

Strenuous aerobic exercise is associated with oxidative stress and tissue damage. Therefore, we have investigated the effects of exercise and eicosapentaenoic acid supplementation, with or without vitamin E, on the plasma levels of vitamin C, E and A, IL-6, and glutathione peroxidase activity in basketball players. Thirty four male basketball players, enrolled in the study. Subjects received 2g EPA and/or 400 IU vitamin E or placebo depending on their groups. For 6 weeks, eight subjects took a daily EPA sup-plement together with vitamin E (group 1), nine received an EPA supplement together with placebo (group 2), nine were administered placebo along with vitamin E (group 3), and finally, eight subjects received placebo alone (group 4). As compared with group 4 (placebo), there were significant increases in vitamins C, E, and A in groups 1 and 3, but significant decreases in these parameters in group2 (P < 0.01). In addition, there were significant decreases in IL-6 in groups 1 and 3 (P < 0.01), whereas there were significant increases in glutathione peroxidase in groups1 and 3 (P < 0.01).There were significant differences in vitamin C between groups 3 and 4 (P < 0.05), and in vitamin E between groups 1 and 2, and groups 2 and 3 (P < 0.01), and in vitamin A between groups 1 and 2 (P < 0.05), and groups 1 and 4, 2 and 3, and 3 and 4 (P < 0.01), and in IL-6 between groups1 and 2 (P < 0.05), groups 1 and 3 (P < 0.01), 2 and 3 (P < 0.01), 2 and 4 (P < 0.01), and 3 and 4 (P < 0.05).

Asparaginase is one of the most important agents in the treatment of ALL. However, it has some side effects including dislipidemia, hyperglycemia, coagulopathy and hepatotoxicity. We studied its side ef-fects on our patients. The effects of L-asparaginase were assessed on 25 new ALL patients (case group) and 25 patients with known ALL who had completed their treatment before. Sixty two percent of cases were male and remainder was female. The mean age of patients was 7.2 ± 3.8 years. In our patients, there was a rise in triglycerides (TG) was seen following L- asparaginase administration (P = 0.02). Also, PT prolongation (P = 0.02) and hypoalbominemia (P = 0.002) were detected which could PT prolongation and hypoalbuminemia may be seen with L-asparaginase therapy that can be prevented with transfusion of FFP. Hypertriglyceridemia is often asymptomatic with no need for therapy.

World Health organization (WHO) has reported that out of more than 10,000 of 250,000 tuberculosis afflicted children die annually. Pulmonary tuberculosis is a research priority in our country, and diagnos-ing this disease especially in children who are known as the major transmitter of the disease is rather difficult. As a result, it was decided to conduct an overall assessment on this age group in order to determine the importance of the findings of chest radiography and skin test in diagnosing the disease. The present descriptive study was carried out based on the findings of a health plan in Fasa, a Iranian town, during 1995 and 1996, on 2 groups: first-grade students of Fasa elementary schools. Among 2263 students, 102 (4.5%) cases had a positive skin test. According to the radiographic findings, tuberculosis was reported in seven (6.9%) of them. The diagnosis of tuberculosis is more difficult in children; this is because taking sputum samples for laboratory examination is rather difficult especially in children lower than 10 years. In this group, diagnosis is made based on the symptoms like cough, weight loss, history of contact with a TB patient and other diagnostic procedures including chest radiographies and skin test.

Cancer patient receive various cytotoxic drugs in association with antiemetic drugs such as 5HT3 receptor antagonists as their chemotherapy regimen. 5HT3 receptor antagonists have been reported to produce changes in ECG parameter. There are only a few studies about cardiovascular events of these drugs in patient receiving potentially cardiotoxic chemotherapies. The subject of this study is to evaluate ECG changes after administration of chemotherapeutic agents and granisetron (the most commonly used 5HT3 antagonist in Iran) in adults with cancer. For this clinical trial study, all cancer patients referred to department of radiation oncology of Imam Hossein Hospital since August 2005 to March 2006 were evaluated if they had inclusion criteria. Granisetron (3 mg) was infused intravenously over 30 seconds just a few minutes before chemotherapeutic agent administration. The 12-lead ECG recording was obtained before and 90 minutes after infusion of granisetron. One cardiologist determined PR, QRS, QTc intervals and heart rate of all ECGs. During the study period 54 patients fulfilled our criteria. With paired t-test, the PR and QTc intervals, but not QRS interval showed statistically significant prolongation after drug infusion (P < 0.0001), and heart rate showed statistically significant decrease (P < 0.0001). The ECG findings of chemotherapeutic agents and granisetron administration were prolongation of PR and QTc intervals and decrease of heart rate (P < 0.0001). Although these changes did not cause clinical signs, with keeping in mind that there may be possible drug-drug interactions and preexisting cardiac comorbidities in cancer patient, it seems reasonable and necessary to consider physical condition specifically cardiac condition and drug usage of each patient, while designing chemotherapy regimen and supportive drugs.

The aim of this study was to investigate C-reactive protein (CRP) level in preeclampsia (PE) and its association with the severity of the disease. This cross-sectional study included 43 women with mild PE, 43 women with severe PE, and 43 healthy pregnant. They were selected in the third trimester of pregnancy in the Afzalipour Hospital, Kerman, Iran, from March 2006 to March 2007. Mean diastolic pressure and level of proteinuria were used as indicators of the severity of the disease. The results were analyzed by t-test and spearman''s rank correlation coefficient. Hemoglobin, aspartate and alanine transaminase, creatinine and urine protein excretion, serum CRP, and alkaline phosphatase were higher in women with PE. There were significant correlations between serum CRP levels and diastolic blood pressure (r = 0.5, P = 0), urinary protein excretion (r = 0.5, P = 0), creatinine (r = 0.2, P = 0.003), spartate transaminase (r = 0.3, P = 0), alanine transaminase (r = 0.2, P = 0.006), and Hemoglobin (r = 0.2, P = 0.001). There were a negative correlation between serum CRP and weight of the new born (r = -0.09, P = 0.01) and gestational age in the time of delivery (r = -0.07, P = 0). We showed higher levels of CRP in women with PE. Elevated serum levels of CRP in PE women are, thus, correlated with severity of disease.

There has been a highly significant increase in the number of patients with malignant mediastinal tumors in the last four decades. Since these lesions are infrequently encountered and there are very few reports in Iran concerning this issue, we performed this study to review our institutional experience of medias-tinal masses and to compare differences in the clinical spectrum between our study population and other patients studied by various reports. This was a retrospective, descriptive and cross sectional study conducted on 105 patients with mediastinal masses who underwent surgical resection over a 5-year period from 1999 to 2003 in three major hospitals in Tehran. A total of 105 patients with mediastinal masses including 65 males (62%) and 40 females (38%) with a mean age of 34 years (range,2-80 years) who had undergone surgery entered the study. Most mediastinal tumors (47%) were identified in the third and fifth decades of life and the most common malignancy during the first four decades of life was malignant lymphoma. Considering the location of mediastinal masses,the anterior mediastinum was the most common site (65%) followed by paravertebral sulci (21%) and visceral mediastinum (14%).The highest rate of malignancy was observed in visceral mediastinum (73% malignancy rate). Histopathologic evaluation of resected masses revealed twenty two types of tumors of which sixty percent were malignant. Nonspecific symptoms such as dyspnea (41%) and cough (40%) constituted the most presenting complaints. Twelve percent of patients were completely asymptomatic. The most common complication observed in this series of mediastinal masses was Superior Vena Cava (SVC) syndrome. There was no postoperative complication. Crude mortality rate of the whole series was 16%. The prevalence of tumors in our series varied from some previously published reports. We demonstrated definite differences in histologic distribution, age range, malignancy rate and diagnostic methods of mediastinal tumors between our study population and other reported cases which should be considered in the evaluation and planning of therapeutic modalities for mediastinal masses encountered in our current practice.

South Asian countries have a high prevalence of coronary heart disease (CAD) in line with their economic development. In these countries, we find nearly one quarter of the total world population in the process of nutritional transition, from poverty to affluence due to rapid economic development. India; in particular, with a population of over one billion has a high burden of CAD. To evaluate the role of socio-economic and demographic variables on the coronary artery disease. A hospital based case-control study was conducted to investigate the role of social related risk factors on coronary artery disease (CAD) in an urban area of East Delhi from April 2002 to December 2004. To obtain more validate comparisons, a control group also was selected from community of East Delhi. The tools of enquiry were a pre-tested and pre-coded questionnaire, physical examination and laboratory testes. A confidence level of 95% and study power of 80% were considered for the interpretation of possible significant findings. Sexwise stratified analysis was separately done for male and female subjects. Comparison of male cases with their counterparts in both control groups indicated that the majority of them had significantly a college education, higher monthly income, semi or full professional occupations and were living in families with size of more than 9. The similar results was found for female cases as that majority of them as compare to females in both control groups were literate, employed and belonging to families with income levels of more than RS.8000. In addition, belonging to religion other than Hindus was another significant variable that was accounted for as risk for getting CAD. Our findings indicate that both male and female cases belonging to high socio-economic classes had higher chance for getting CAD as compare to their counterparte.

Erectile dysfunction (ED) is an important impediment to quality of life. Diabetes mellitus is one of the most common causes of ED. However, it has been one of the most neglected complications of diabetes mellitus. Our objective was to study the prevalence of ED and its risk factors in Iranian diabetic men. During 2002-2004, 700 diabetic men aged 20-69 years were interviewed to report on their experience of ED as defined in the National Institutes of Health Consensus Conference 1993. ED was found in 246 (35.1%) of this population. Prevalence of ED was increased with age from 9.7% in men aged 20-39 years to 43.4% in those aged over 60 years (P < 0.001). Men with type I diabetes reported ED less frequently than did men with type II diabetes (P = 0.037). In comparison with patients with reported diabetes lasting ≤ 5 years (25.4%), the prevalence of ED was less than in those with diabetes of 6-11 years (34.3%) and of 12-30 years (43.5%, P < 0.001). ED increased significantly in those who had poor glycemic control. Prevalence of ED in patients with good, fair and poor glycemic control was 28.4%, 39.9% and 44.4% respectively (P = 0.004). Type of treatment (diet alone, oral agents, insulin and insulin plus oral agents) had significant association with ED and its severity (P < 0.001). ED is common in Iranian diabetic men but its prevalence can be reduced with good glycemic control.

This study was carried out to find the extent of staphylococcal carriages including Methicillin resistant Staphylococcus aureus MRSA in employee''s of teaching university hospitals in Yazd. Nasal swabs of 742 employees in four different medical teaching hospitals in Yazd were collected, and tested for detection of staphylococci strains. Out of 742 employees, 94 (12.7%) were carrier of staphylococcus aurus and 57 (11.38%) for methicillin resistant Staphylococcus aureus (MRSA) respectively. Prevalence of Staphylococci aureus and MRSA in individual hospitals and wards were different. In general the highest carriers were personnel of dialysis ward and the lowest pediatrics wards. Resistance rate of MRSA against Ciprofloxacin, Vancomycin, and Rifampin were found to be as 28.1%, 10.5% and 35.1% respectively.

In July 2003, the Bellagio Study Group on Child Survival estimated that the lives of 6 million children could be saved each year if 23 proven interventions were universally available in the 42 countries re-sponsible for 90% of child deaths in 2000. The aim of this study was to determine frequency of important causes of mortality among under-5 year old children in hospitals, Tehran, Iran. Information about Mortality data of under-5 year old children from 16 hospitals in the West of Tehran was collected. The study period was conducted from 1 October 2005 to 30 March 2006. Educated health personnel in each hospital interviewed parents of children who died in hospital and filled out a checklist. 142 under-5 year old children died over the course of study, of whom, 118 (83%) were neonates (under 28 days-old), 53.5% had low birth weights (< 2500 Kg), 62 (43%) were girls and 80 (57%) boys. The most common cause of under-5 year death was due to certain conditions originating in the perinatal period (ICD-10: P00-P96) (68%). Congenital abnormalities (12%) and pneumonia (5%) were the second and third most common causes respectively. Among 28-day to one-year old children, the leading cause of death was pneumonia (27.3%), while for children being 1 to 5 years of age, this included pneumonia and chronic hepatitis (about 30%). Overall, the most common causes of death were disorders related to short gestation and low birth weight. Therefore, achievement of the millennium development goal of reducing child mortality by two-thirds from 1990 rate will depend on renewed efforts to prevent and control low birth weight, preterm delivery, pneumonia, and infectious diseases in our setting.

This study investigated the antibacterial resistance among enterococci isolated in Tehran hospitals. A total of 277 Enterococcus faecalis, 123 Enterococcus faecium and 13 isolates of other enterococcal strains were collected from 1 March 2002 to 15 April 2004 from three teaching hospitals of Tehran University of Medical Sciences. The minimum inhibitory concentrations (MIC) of tested antibiotics were determined by agar dilution method. Susceptible and resistant isolates were defined according to the species-related MIC breakpoints of the Clinical and Laboratory Standards Institute (CLSI) guidelines. Sixty- three percent of isolates were resistant to rifampicin (MIC90 64 µg/ml), 44% to ciprofloxacin (MIC90 16≤ µg/ml), 43% to erythromycin (MIC90 512 µg/ml), 32% to cefazolin (MIC90 256≤ µg/ml), 25% to penicillin (MIC90 32 µg/ml), 21% to ampicillin (MIC90 128≤ µg/ml), 8% to vancomycin (MIC90 ≤ 8 µg/ml), and 8% to teicoplanin (MIC90 16≤ µg/ml). All of the vancomycin-resistant strains carried the vanA phenotype and genotype. High level resistance to gentamicin and streptomycin were found in 52% and 83% of the isolates, respectively. The results indicated that a significant percentage of isolates are resistance to different antibiotics, pointing out the need for control strategies to avoid dissemination of resistant isolates and for continuous surveillance for the detection of emerging resistance traits.

Bacterial resistance to antibiotics is a serious problem and is increasing in prevalence world-wide at an alarming rate. The antimicrobial susceptibility patterns of 1897 gram-positive bacterial Isolates were evaluated. The minimum inhibitory concentration (MIC) of isolates which comprised Staphylococcus aureus (927 isolates), coagulase-negative staphylococci (CNS; 425 isolates), Enterococcus faecalis (320 isolates), Enterococcus faecium (157 isolates), and pneumococci (50 isolates) collected from 3 teaching hospitals in Tehran were determined by agar dilution method according to Clinical and Laboratory Standards Institute (CLSI) guidelines. The presence of mecA gene was investigated in methicillin-resistant staphylococci by PCR method and vanA and vanB genes were targeted in enterococcal isolates by Multiplex PCR method. The resistance rate to methicillin among S. aureus and CNS isolates were 33% and 49%, respectively. All S. aureus isolates were susceptible to vancomycin. The lowest rate of resistance in all S. aureus isolates was found for rifampicin (<4%). The vancomycin resistance rate in enterococci isolates was 11% which was more frequent among E. faecium (19%) than E. faecalis (4%), all resistant isolates carrying vanA. High-level resistance to gentamicin and streptomycin, were detected in 47% and 87% of enterococcal isolates respectively. The rate of penicillin resistance in pneumococci was 3% and about 27% of isolates had reduced susceptibility to penicillin. The prevalence of erythromycin resistant among pneumococci was 58%. All pneumococcal isolates were susceptible to ceftriaxone, rifampicin and vancomycin. Our data highlight the importance of access to updated bacterial susceptibility data regarding commonly prescribed agents for clinicians in Iran.

Lymphocytic infiltration of Jessner-Kanof is a chronic, benign T cell infiltration disorder of exposed skin with unknown etiology. In some instances, these lesions are induced or aggravated by light exposure. In this case report, we are going to describe an interesting occupationally related skin disease, Jessner''s disease, after several years working with computer. On the basis of literature review, a similar case regarding to association between Jessner''s syndrome and exposure to computer monitor has not yet been describe. Interpreting our case regarding to previous reports about induction or aggravation of Jessner''s disease by light exposure, we can conclude that there may be an association between exposure to radiation reflection from computer monitor and in this facial skin problem, as when patient was away from work her condition got better and when she came back, her condition got worse

Occurrence of cutaneous metastasis of gastrointestinal cancer is uncommon, with a reported frequency of less than 5 percent.They can occur as the first sign of disease recurrence in a treated patient or as a sign of terminal disseminated cancer or rarely as the first manifestation of an occult malignancy. The cases reported here represent three different manifestation of cutaneous metastasis of gastrointestinal cancers.