Iranian Journal of Medical Sciences
Volume:35 Issue: 1, Mar 2010

Kidney transplantation in patients with end stage renal disease is preferred to dialysis because transplantation provides a better quality of life and improved survival. However, the gap between the supply and demand for a renal allograft is widening and the waiting time is increasing. Iranian protocol, a controlled transplant program supported by the government for living unrelated donors, was initiated for solving the problem of organ shortage. Although this system might experience challenges, clearly it has advantages over other organ procurement systems primarily that thousands in need do not die while waiting for a compatible donor.In the present review I discuss the history of renal transplantation in Iran, "Iranian model" protocol, the situation of Iran’s kidney transplantation from either living or deceased donors compared with the Middle East countries, and our experiences of unrelated renal transplantation.

Knee osteoarthritis is a common degenerative joint disorder and a major cause of pain and disability. Recent studies have suggested that bisphosphonates such as alendronate may have a role in the treatment of osteoarthritis. The purpose of the present study was to investigate the potential effect of alendronate on the symptoms of knee osteoarthritis. Thirty nine patients with mild to moderate knee osteoarthritis were enrolled in a randomized، double-blind، placebo-controlled trial with parallel-group design. The patients received either placebo or alendronate pills (70mg، weekly) in a blinded fashion for six months. Symptoms of osteoarthritis were scored by Western Ontario and McMaster Universities (WOMAC) osteoarthritis index at enrollment and at weeks 4، 12، and 24. In both groups there was a significant improvement in total WOMAC score and WOMAC subscales scores of pain، stiffness، and function at 4، 12، and 24 weeks of treatment. Maximum improvement occurred at week 4. There was no statistically significant difference between the two groups regarding their total WOMAC score and its subscales at the end of weeks 4، 12، or 24 (P=0. 94). Alendronate does not reduce symptoms of mild to moderate knee osteoarthritis.

The iodine deficiency elimination program that began two decades ago resulted in Iran becoming an iodine deficiency disorders free country in the Middle East region. The present study was performed to evaluate the adequacy of iodine supplementation after 17 years of universal salt iodization in Fars province. In a cross-sectional study, 1200 schoolchildren (480 girls and 720 boys) aged 8 to10 years, were randomly selected from Fars province and evaluated in 2007. Goiter prevalence, urinary iodine excretion, and iodine content of household salts were measured and the data were compared with those obtained in 1996 and 2001. Total prevalence of goiter was 1.3% (CI: 0.53-2.47) and no grade 2 goiter was found. One-tenth of the children enrolled for goiter assessment, were randomly selected for urinary iodine measurement. The median urinary iodine in these 120 schoolchildren was 159.4 µg/L (85.6-252.3), with 14.8% having urinary iodine excretion less than 50 µg/L. 98% of households were using purified iodized salt. 70% of households had appropriate salt storage and none of the household salts contained less than 15 µg iodide. Goiter prevalence has significantly decreased in the Fars province, 17 years after universal salt iodization. The median urinary iodine of schoolchildren was adequate as that reported in 1996 and 2001, indicating a well established sustainable iodine deficiency elimination program in the province.

Previous studies have shown a prolonged blockade of nerves using bupivacaine-dexamethasone microspheres. The goal of this study was to assess the effect of subcutaneous dexamethasone added to bupivacaine on post cesarean pain. After randomization, 75 healthy parturients were allocated into three groups and received the following treatments: group A: bupivacaine 0.25% (20 ml, subcutaneously [s.c]) plus dexamethasone 16 mg (4 ml, s.c) plus normal saline (4 ml, intravenously [i.v]); group B: bupivacaine 0.25% (20 ml, s.c) plus dexamethasone 16 mg (4 ml, i.v) plus normal saline (4 ml, i.v); group C: bupivacaine 0.25% (20 ml, s.c) plus normal saline (4 ml, s.c) plus normal saline (4 ml, i.v). The visual analog scale (VAS), meperidine consumption, and time to first meperidine consumption were evaluated in the recovery room, 6, 12, 24, 48, and 72 hours postoperatively. The mean VAS in group A was less than groups B and C at 12, 24, 48 and 72 hours after surgery (A< C< B respectively). The decrease in VAS was statistically significant between groups A, B and B, C (P=0.009 and P=0.015 respectively). The mean VAS in group A was significantly less than group C at 48 and 72 hours postoperatively (P=0.020 and P=0.024 respectively). Meperidine consumption was lower in group A compared with B and C groups, however it was not statistically significant (P=0.25 and P=0.11 respectively). The addition of subcutaneous dexamethasone to bupivacaine prolonged the analgesia during 48-72 hours postoperatively. It may be an option for longer pain relief after cesarean section.

Similar to developed countries، aging is increased in India. Because of the epidemiology and demographic transition phase، chronic diseases and disabilities along with health costs are increasing day by day. As social factors and chronic diseases are the major reasons for geriatric disability، the present study was done with the following to assess and compare the socio-demographic characteristics among the disabled and non-disabled geriatric population، and to find out the association between socio-demographic and chronic diseases with functional disability among the study population. A cross-sectional study was done in a rural community of West Bengal، India. House to house visit، clinical examination، observation، and interview were done with a pre-designed، pre-tested proforma. Epi Info and SPSS software were used for statistical analysis. A total of 458 people had chronic conditions and the prevalence of disability was 17. 47%. Among the socio-demographic variables، age، female sex، marital status، literacy status، and family composition and among the chronic diseases، tuberculosis، chronic obstructive pulmonary diseases، ischemic heart disease، osteoarthritis، neuropathy، acid peptic disorder، prostatic hypertrophy، and osteoporosis were found as risk factors of disability in binary logistic regression analysis. 71. 2% of the disabilities were explained by these risk factors. The data highlighted the different risk factors associated with disability. No single measure rather multi-dimensional approach should be the model for the prevention of disability.

The tumor suppressor gene TP53 (alias p53) located on chromosome 17 is involved in various cancers. Case-control studies have shown that p53 codon 72 polymorphism modulates the prognosis and susceptibility to various malignancies. We undertook the present study to explore a possible association between mucinous and non-mucinous adenocarcinomas with different genotypes or alleles at codon 72 of TP53. The genotype distribution and allelic frequencies for p53 polymorphism was assessed in 46 and 134 specimens from patients with colorectal mucinous and non-mucinous adenocarcinomas, respectively, by using allele-specific PCR. The PCR products were 177bp for proline allele and 141bp for arginine allele. In the mucinous samples, the genotype distribution for p53 polymorphism showed 63%, 23.9%, and 13.1% for the Arg/Arg, Arg/Pro, and Pro/Pro genotypes, respectively. In the non-mucinous specimens 32.1% of the cases were Arg/Arg, 48.5% Arg/Pro, and 19.4% pro/pro. A significant difference between the two types of adenocarcinomas for the Arg 72 Arg genotype compared with (grouped) Arg 72 Arg and Pro 72 Pro genotypes was noted [OR=3.61 (1.76-7.27), P<0.001]. The arginine allele was found more often in patients with mucinous adenocarcinoma [OR=1.85 (1.07-3.19), P<0.03]. A higher portion of Dukes stage C was noted in the mucinous specimens (P<0.02) and also mucinous specimens were seen more often at advanced TNM stages (P=0.01). The Arg/Arg genotype at p53 codon 72 is more prevalent in mucinous colorectal carcinoma and the arginine allele may contribute to mucinous carcinogenesis. The proline allele was associated with higher Duke''s staging in non-mucinous adenocarcinoma.

Sepsis related-multiple organ dysfunction is associated with ileum injury. We aimed to determine the causes of ileal injury in two models of microbial sepsis resulted from infection with Aeromonas hydrophila or its endotoxin. We also evaluated the protective effect of phytic acid. Thin sections of ileum from 60 Swiss male mice in control, bacteria-infected or lipopolysaccharides (LPS) and bacteria-infected or LPS-infected co-administered with phytic acid were subjected to histopathological and TdT-mediated dUTP nick-end labeling (TUNEL) assay for apoptotic cells detection while ultra thin sections were stained with uranyl acetate and lead citrate for cytological changes examination. Also, ileum images were exposed to the image analysis software to determine some related morphometric measures. Necrosis and apoptosis were observed in ileum injury in both examined sepsis models. The ileum injury was more severe in LPS model. Phytic acid showed the ability to attenuate ileum injury in Aeromonas hydrophila and its endotoxin models of sepsis after four weeks administration where its supplementation significantly minimized the histopathological and cytological complications and morphometric alterations resulted from the injury. The protective effects of phytic acid may be caused by increased mucous secretion, decreased apoptotic index, attenuating the inflammatory and lymphocytic cells count or increasing the renewal of the crypt cells and villous epithelial cells proliferation.

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common enzyme disorder in human. The aim of this study was to determine the prevalence of G6PD deficiency among children and evaluate its association with ABO/Rh blood groups. Blood samples of 3401 asymptomatic children were analyzed and compared with 317 children who were admitted to hospital because of hemolysis resulted from G6PD deficiency. Among asymptomatic children 375 (11%) were G6PD deficient. Male to female ratio for this group was 4.2:1 and for the hemolytic group was 2.5:1 (P=0.004). Two hundred and sixty-seven (84.2%) of the patients with hemolysis were younger than 2 years, with the peak age of hemolysis between 2 and 3 years (27.7%). The overall rate of hemolysis caused by G6PD deficiency was 12.3% during the 3 consecutive months of fresh Fava bean consumption. Blood groups O+, A+, and B+ together constituted 87.1%, 87.7%, and 84% of the blood groups among normal children, asymptomatic G6PD deficient subjects, and those with G6PD deficiency related hemolysis respectively (P=0.367). Seven percent of the normal children and asymptomatic G6PD deficient subjects were Rh- vs 9.7 % of G6PD deficient children with hemolysis (P=0.16). The prevalence of G6PD deficiency among the children was 11%. Male to female ratio was greater in non- hemolytic vs hemolytic group so that the female share was higher in hemolytic group than in the other two groups (P=0.004).The distribution of ABO blood groups was similar among asymptomatic non-G6PD deficient, asymptomatic G6PD-deficient, and G6PD-deficient children with hemolysis. The distribution of Rh- types among the G6PD-deficient children with hemolysis and the other two groups was similar (9.7% vs 7%, P=0.16).

Cochlear implantation is a method used for the treatment of patients with profound hearing loss. This procedure may the accompanied by some major or minor complications. We evaluated the surgical complications of cochlear implantation in Fars province (south of Iran). A total of 150 patients with cochlear implantation were enrolled in the present study. Most of the patients were pre-lingual children and most of our devices were nucleus prosthesis. We had three device failures and four major complications, including one misplaced electrode, one case of meningitis, one case of foreign body reaction to suture and one case with extensive hematoma. These complications were managed successfully by surgical intervention or re-implantation. Facial nerve damage or wound breakdown was not seen. Minor complications including small hematoma, edema, stitch infection and dizziness were found in 15 cases, which were managed medically. In our center, the rate of minor complications was comparable to other centers in the world. But the rate of major surgical complications was lower than other centers.

During adolescence, there is a tendency to sleep late and sleep less because of altered psychosocial and life-style changes. Recent studies have demonstrated the link between sleeping less and gaining weight in children, adolescents, and adults. We studied the effect of late sleeping and sleeping less on body mass index (BMI) in medical college freshmen. All participants were adolescents (104 male and 38 female adolescents, mean age 17.77±0.79 years). After obtaining informed consent, they filled out a questionnaire about their sleeping habits. Height and weight were measured after a brief history taking and clinical examination. BMI increased significantly with decrease in total sleep duration and with delayed bedtime. Late sleeping individuals (after midnight) had significantly less sleep duration (6.78 hours v 7.74 hours, P<0.001), more day time sleepiness (85.2% v 69.3%, P=0.033) and more gap between dinner time and going to sleep (234.16 min v 155.45 min, P<0.001). Increased BMI in late sleepers may be explained by low physical activity during the day caused by excess sleepiness and increased calorie intake with a gap of 5-6 hours between dinner and sleep. Sleep habits of late sleeping and sleeping less contribute to increase BMI in adolescents.

Acute neutrophilic dermatosis, first described in 1964 by Robert Douglas Sweet, is characterized by sudden onset fever, neutrophilic leukocytosis, and well demarcated erythematous papules, nodules, and plaques with dense neutrophilic infiltrates on histologic evaluation.Here is a report of a 7-year-old girl who presented with high grade fever, and discrete erythematous papular skin eruptions, which gradually increased in number and involved the face, trunk, extremities, palms, soles, hard palate, and palatal tonsils. The skin eruptions evolved to pustules and after coalescing caused large crusted plaques, with mild tenderness but without any pruritus. White blood cells were 36900/ml with 92% neutrophils. Skin biopsy test was compatible with acute febrile neutrophilic dermatosis, so prednisolone (1 mg/kg/day) was started that led to a rapid defervescence and significant improvement of dermatosis. After a few days, the patient presented with fever and arthritis of right elbow, both ankles, and wrists, so she was re-admitted. She also developed bloody diarrhea during the hospital stay. Colonoscopy and intestinal biopsy were performed, which confirmed the diagnosis of ulcerative colitis. Prednisolone, sulfasalazine, and naproxen were prescribed. The fever and diarrhea stopped after a few days and joint swelling decreased. She was discharged 2 weeks after the admission with a rather good general condition. Inflammatory bowel disease can be one of the several conditions accompanying sweet syndrome.

Thoracobiliary fistula is a rare complication of hydatid cyst disease of the liver especially in calcified form. Given the rarity and high mortality of such fistula, it is not surprising that there is no consensus about surgical treatment of this condition. In the present paper we report two cases of thoracobiliary fistula of complicated calcified hydatid cyst of the liver. A 64-year-old man with cough and biliary sputum and a 66-year-old man with cough and right biliary pleural effusion (pleurobiliary fistula). The patients underwent left hepatectomy with cholecystectomy and T-tube choledochal drainage in one patient and successful decortication of the lung, and cystectomy with excision of calcified pericystectomy of the liver in another patient. Pathologic examinations revealed calcified hydatid cysts of the liver. Because of poor prognosis of thoracobiliary fistula, radical surgical intervention is recommended.

Arterial thrombosis associated with ulcerative colitis usually occurs in the postoperative period with a good response to anticoagulant therapy and embolectomy. Our patient was a 14-year-old girl with ulcerative colitis who presented with bilateral pulsless extremities, which did not respond to medical treatment and embolectomy. Subsequent colectomy did not save her limbs. The repeated thrombosis caused gangrene of extremities in the below knee region leading to bilateral amputation. Thrombosis can be the first presentation of ulcerative colitis.