Acta Medica Iranica
Volume:48 Issue: 1, Jan - Feb 2010

Diabetes Mellitus (DM) is one of the most important metabolic disease causes in many side effects. The decrease of mental abilities and even some form of dementia followed prolonged diabetes has been reported. There are evidences that show hippocampus might be the site of neural involvement in patients with dementia followed diabetes. As hippocampus received main serotonergic efferents from brain stem raphe nuclei include dorsal raphe nucleus (DRN) and median raphe nucleus (MRN), it is possible that these efferent affected by diabetes. We used adult male Wistar rat in this study. Diabetes was induced by IP injection of streptozotocin (STZ). After 2,4 and 6 months, HRP tracing were done for the efferent from DRN & MRN to CA3 of hippocampus.HRP Positive neuron of DRN & MRN and also the distribution of these cells were study by light microscopy. Statistical analysis was done by SPSS software. Microscopic study clearly showed significant decrease in HRP positive cells population in DRN & MRN after prolonged diabetes. Based on our finding, the changes in the neural connection between serotonergic nuclei and hippocampus followed diabetes might be one of the reasons for dementia in these patients.

Mouth breathing might not always result in hypoxia, but can contribute to it. The aim of the present study was to determine the effect of mouth breathing on hypoxia. Based on a pilot study, 323 patients with mouth breathing were selected. Assessment of mouth breathing was based on clinical examination and questionnaires filled out by patients and their companions. The patients were also examined for further oral findings that could be attributable to mouth breathing. Oxygen saturation of each case was measured by means of a pulse oximetry device. The level of 95% saturation was set as the limit, under which the patient was considered hypoxemic. Acquired data was analyzed for descriptive data and frequency and also by means of the Chi-square and Spearman’s correlation coefficient tests. 34.6% of the cases had normal O2 saturation. 65.4% of cases were hypoxemic (saturation level was below 95% in 42.8% and 95% in 22.6%). Most of the mouth breathing patients were male who were also more hypoxemic. A weak inverse relationship existed between the age of the patients and Oxygen saturation. Deep palatal vaults (29.4%) and gingival hyperplasia (29.2%) were the most frequent intraoral findings. Concerning the effects of hypoxia on body systems, the use of pulse oximetry in suspected mouth breathing patients could be recommended in routine oral and dental examinations.

Systemic sclerosis is a generalized disorder of connective tissue clinically characterized by thickening and fibrosis of the skin and by distinctive forms of involvement of internal organs. One of the hallmarks of systemic sclerosis is the presence of serum autoantibodies against a variety of nuclear and cytoplasmic antigens. The primary purpose of this study was to identify the autoantibodies profile in the scleroderma sera and the secondary goal was to determine the correlation and discrepancy of autoantibody profile. Autoantibody profile was determined in 118 samples stored in the Advanced Diagnostic Laboratory at the University of Calgary. 78 sera were provided from Canadian and 40 sera were provided from Ukraine. We used the following techniques to identify autoantibodies profile in scleroderma patients: 1. Antinuclear antibody (ANA) by indirect immunofluorescence on human epithelial cell substrate 2. Detection and identification of specific autoantibodies by Innolia strip assay 3. Detection and identification of specific autoantibodies against extractable nuclear antigens. 111 out of 118 patients showed positive ANA results by indirect immunofluorescence and 7 patients had negative ANA results. Anti-ENA analyses by Inolia were positive in 84 patients, while by western blotting 81 patients showed positive results. In this study, we compared the results of anti-ENA antibody by Innolia with SLR technique. A significant correlation was found between anti-SCl-70 antibodies (P=0.000) and anti- RNP antibodies (P=0.001) and JO-1 antibodies (P=0.014). Thus, we may propose that SLR and Innolia techniques could be used for the detection of autoantibody in systemic sclerosis.

Identification of acid-fast bacilli (AFB) in sputum or tissue samples is among definite diagnostic methods of tuberculosis. However, this method of diagnosis is restricted by certain limitations. Serologic diagnosis of tuberculosis (TB) has been used for a long time. The aim of this study was to determine the sensitivity and, specificity of Antigen 60 (A60) IgG, IgA, IgM test results in TB diagnosis. Mycobacterial A60-based ELISA was used to measure specific IgA, IgM and IgG antibodies in the sera of 127 adult TB patients (consisted of 74 pulmonary and 53 extra-pulmonary cases), and 95 controls (46 healthy volunteers and 49 patients with various acute or chronic diseases other than tuberculosis). Data from A60 IgG-based ELISA, chest radiography, AFB culture and pathologic evaluation for AFB were obtained. The cutoff value of A60 IgG, IgA and IgM were chosen according to a receiver operating characteristic (ROC) analysis. The sensitivity, specificity and positive likelihood ratio were determined. The mean levels of IgG, IgA and IgM were significantly higher in patients with pulmonary tuberculosis when compared with control groups. Sensitivity of IgG test was 54.3 %, while the specificity was 84.2%. The IgA test showed a sensitivity of 70.1% with a specificity of 80 %. Combination of the IgG and IgA tests showed a total sensitivity of 45.7 % and a specificity of 94.7% and the positive likelihood ratio of 8.62. Chosen cutoff values of IgG, IgA, and IgM sets were 285,265 and 0.9 ELISA units respectively. Our study results showed a good specificity (94.7%) and a reasonable positive likelihood ratio (8.62) of the test when combined IgA and IgG with new cutoff points were considered on diagnosis of tuberculosis in adult patients. Combined use of both IgG and IgA tests results allows an increased accuracy in diagnostic of tuberculosis.

Ultra rapid opioid detoxification (UROD) is one of the new methods of detoxification. This method of detoxification involves putting patients under general anesthesia and actively giving them opioid antagonists. The objective of this study was to evaluate effects of anesthesia duration in UROD on severity of withdrawal syndrome. Sixty addicted patients seeking UROD procedure assigned randomly to one of the 2hr, 4hr or 6hr anesthesia duration groups. Premedication and anesthesia procedure (induction and maintenance) were the same for three groups. Detoxification was done for all patients with 50 mg oral naltroxane (prior to induction) and 20 mg intravenous naloxane (8 mg/bolus and 12 mg/infusion). Blood pressure, heart rate and respiratory rate were automatically measured and recorded every 5 minutes. The severity of withdrawal syndrome was measured and recorded every one hour during anesthesia, 2hours post-anesthesia, and 12 and 24 hours following the induction of anesthesia according to the Wang Scale modified by Lomier (WSMBL). Patients aged 20-58 in three groups. Three cases experienced delirium after detoxification that lasted 24 hours in one. Severity of withdrawal syndrome in patients of groups 2, 4 and 6 hour were 8.7, 7.4 and 5.1 respectively during anesthesia and 12.3, 11.1 and 13.9 after 18 hours of anesthesia. Results of this study showed that, in standard settings, UROD is a safe method for detoxification and has low complications. The withdrawal symptoms during and after anesthesia are low. Shortening the duration of anesthesia has no affect on severity of withdrawal syndrome during and after anesthesia.

The aim of this study was to determine the most effective and suitable time to remove the urinary catheter (Foley) after anterior and posterior colporrhaphy surgery. Patients who experience anterior Colporrhaphy operation for genuine stress incontinency or pelvic organ prolapsed will have post operative voiding dysfunction. These patients need postoperative drainage. One of the methods preferred for this purpose is to apply Foley Catheter, but there is no particular regimen available for the exact time of catheter removal in these patients. We have tried to find out the best time to remove Foley catheter after which the repeated Foley catheter is not required or minimized. One hundred and eighty nine patients who have been undergone Colporrhaphy have been selected randomly and divided into three groups'' as 1, 2 and 4 days of catheter removal. The number of patients in each group was 62, 63 and 64 respectively. In all three groups, before removing urinary catheter, it was clamped every 4 hrs, for 3 times. After removing of Foley, the patients were guided for urination; the voiding and residual volume was measured. In the patients with an increase of residual volume, the repeated Foley requirement was increased. However, 5.6 % of the patients with residual volume of ≤ 33 percent and 23.9% of the patients with residual volume between 33 to 68 percent, and finally 64.8% of the patients with residual volume of ≥ 68% had repeated Foley insertion. When considering the number of days, 85, 65 and 35.7 percent of the patients needed repeated Foley after 1, 2, and 4 days of catheter removal respectively. Interestingly, in the third group (4 days of the catheter removal) with residual volume of ≤ 33% the repeated Foley requirement was nil, with no increase risk of urinary infection. We suggest that the best time to remove the urinary Foley catheter after anterior and posterior Colporrhaphy is the day four.

Multiple sclerosis is a chronic inflammatory disease of central nervous system.Women are more susceptible to this disease. One of the obvious clinical complaints in women with multiple sclerosis specially treated with Beta Interferones is menstrual cycle irregularity. The aim of this study was to determine the prevalence of menstrual irregularities and probable changes in blood levels of related hormones (FSH, LH, PRL, TSH, T4, T3) in 58 females with definite MS treated with beta interferones versus 58 healthy women. In comparison to the control group, the patients had higher prevalence of irregular menstruation (P=0.001), oligomenorrhea (p=0.03), abnormal amount of menstrual blood flow (P=0.001), abnormal duration of menstrual flow (P=0.01) and missed period (P=0.04). Mean LH level in patients group was higher than control group (P=0.04).Hyperprolactinemia (>25.5ng/ml) was more prevalent in patients group. There were not a significant difference in plasma levels of FSH and thyroid hormones between two groups. There were some relations between the type of Beta interferones and the subtype of menstrual irregularities in the patients. In conclusion, the results of this study emphasized the high rate of menstrual problem and changes of related plasma hormone levels in MS patients.

As introduced by different studies, dental plaque is known as a reservoir of Helicobacter Pylori (HP) and a potential source for gastric re-infection. Also, it has been demonstrated that individuals with gastric HP infection manifest a greater plaque index and a higher incidence rate for gingivitis. The goal of the present research was survey of severity and prevalence of periodontal diseases associated with gastric HP infection among patients having referred to the endoscopy wards of Imam Khomeini and Milad hospitals. In this research, 122 patients with gastric HP infection were investigated for determining 4 indices: plaque index (PI), gingival index (GI), clinical attachment loss (CAL) and pocket depth (PD), for all existing teeth, using RUT (rapid urease test). The results indicated that about 86.9% of patients had developed gingivitis of various degrees and 100% of them were afflicted with periodontitis of different degrees, and about 64.8% of patients showed a weak PI, and 61.5% had a low level of education. This low-level education seen in majority of the studied subjects, addresses a high degree of importance and influence of the oral hygiene in gastric HP infections. Hence, gastroentrologists are required to refer patients to dentists in line of preserving oral and dental health.

Regarding the high prevalence of hyperlipidaemia, which is one of the major risk factors of cardiovascular disease, and uncertain reports about the relation between periodontal disease and serum lipid profile, this study was conducted to assess this relation. The historical cohort study was conducted on 52 cases including 26 persons with chronic periodontitis as case group, and 26 healthy subjects as control group. Both groups had the same age and weight ranges, sex, and diet, without any periodontal treatment history in the past six months, underling systemic disease such as diabetes, anti-hyperlipidemic drugs or active tobacco smoking history. Low Density Lipoprotein (LDL), High Density Lipoprotein (HDL), Triglyceride (TG) and Total Cholesterol (CHOL) were measured by direct enzymatic assay. TG level was 128.4±71.1 mg/dl in control group and 165.2± 83.7 in case group indicating a significantly higher level in case group (P<0.05). In control group, 30.8 percent and in case group, 61.5 percent had abnormal serum cholesterol levels, which presents a significantly higher level in case group (P<0.03). Other serum level indices did not show any significant difference. Although it seems that patients with chronic periodontal disease are more susceptible to hyperlipidemia, it is doubtful that the former causes an increase in serum lipid levels, so we suggest studying the effects of treating chronic periodontitis on serum lipid level.

Inflammatory basis in pathopoiesis of coronary artery disease (CAD) have been demonstrated in recent decades. Elevated C-Reactive Protein (CRP) and leukocytosis were associated with an elevated risk for acute coronary syndrome (ACS). To evaluate the relationship between quantitative CRP and cardiac troponin I in conjunction with white blood cell (WBC) count and 30 days outcomes and treatment planning in patients with ACS. A concurrent inception cohort study was designed involving 200 patients as exposed and 200 patients as non exposed groups. We evaluated the relationship between baseline CRP and WBC count and cardiac troponin I, other risk factors and biomarkers, angiographic and other para-clinical tests and clinical outcomes with ACS. Higher CRP and WBC count were associated with additional coronary care unite (CCU) admission days (P = 0.002), hospitalization days (P = 0.007), arrhythmia type (P = 0.007), receiving streptokinase (P = 0.001), angiographic findings (P = 0.003), final myocardial infarction versus unstable angina (P = 0.001), date of complication (P = 0.001) and the date of cardiopulmonary resuscitation (if incident) (P = 0.015). In a multivariate Cox proportional hazard model high CRP and WBC count remained strong predictor of mortality (P = 0.028), angiography findings (three Vessel disease (3VD) and left main (LM) disease) (P = 0.001), and readmission in CCU (P = 0.002). A cardiac troponin I above 0.1 µg/lit was considered elevated. Elevated troponin level, demonstrated a significant relationship with MI incidence between two groups (P= 0.001) (89% in troponin positive group versus 11% in troponin less than 0.1 µg/lit). Inflammatory markers including, CRP and WBC count can be used to predict mortality, readmission, 3VD and LM disease in patients with ACS. In a Cox Proportional Hazard Model cardiac troponin above 0.1 µg/lit was significant predictors of MI (P = 0.003) and CPR (P = 0.044) at 30 days follow up period.

We measured the prevalence of HBV surface antigen (HBsAg) among male injection drug users (IDUs) in Detention, Tehran, Iran. A cross-sectional survey included 499 male IDUs arrested by police during a predetermined police sweep in Tehran (February, 2006). A questionnaire was filled out for each individual. Blood specimens were collected for HBsAg testing. Prevalence of HBsAg was 5.8% (95% CI 3.6-7.9). The majority of chronic HBV infections, 69.2%, were among adults age 25 to 34 years. The high prevalence of HBsAg highlights the need for special efforts to increase vaccination among adult populations at risk for HBV infection in order to reducing continuing transmission and stave off future high burden of disease.

Prostate cancer is a major cause of morbidity and mortality in Iran, yet there are few studies examining risk factors specific to the Iranian context. We conducted a case-control study to explore risk factors for prostate cancer in Mazandaran, Iran from 2005 to 2008. The cases were 137 men with clinicopathologically confirmed prostate cancer. Controls were 137 neighborhood and age match men without prostate cancer by PSA and digit examination. Analysis comprised an exploratory stage to identify potential risk factors, defined as variables associated with case status at the P < 0.20 level in conditional logistic regression. A second stage included all potential risk factors in multiple conditional logistic regression analysis, retaining those associated with prostate cancer at the P < 0.05 level. Potential risk factors for prostate cancer in exploratory analysis included family history of prostate cancer, history of other cancer, prostatitis, alcohol consumption, pipe or hookah smoking, walking to work, duration of occupational physical activity, intensity of occupational physical activity, body mass index, and older age. Multivariate analysis found intensity of occupational physical activity, prostatitis, and older age as independent predictors of increased risk for prostate cancer in this Iranian population. Our study confirms several recognized risk factors for prostate cancer, contributes evidence to the discussions of other hypothesized risk factors, and points to potentially new factors. Findings, along with confirmatory studies, can help guide efforts for early detection, treatment, and prevention for this common malignancy that is set to increase in Iran in future decades.

Persons infected with the Human Immunodeficiency Virus (HIV) are particularly susceptible to tuberculosis, either by latent infection reactivation or by a primary infection with rapid progression to active disease. This study was done to determine the frequency of tuberculosis infection among Iranian patients with HIV/AIDS. A total of 262 HIV/AIDS patients attending all three HIV/AIDS health care centers of Tehran, Iran were enrolled in this study. A detailed history and physical examination were obtained from all HIV patients suspected of having pulmonary M. tuberculosis. A positive PPD skin test was used as a diagnostic parameter for probability of TB infection. Out of 262 HIV/AIDS patients, a total of 63 (24%) were shown to have the tuberculosis infection based on a positive PPD skin test. Of the patients with positive PPD skin test, 22 (35%) had pulmonary Tuberculosis, 2 (3.2%) had extrapulmonary tuberculosis, and 39 (53%) had no evidence of M. tuberculosis infection (latent infection). Also 8 (12.7%) had history of long term residence in a foreign country, 32 (50.8%) were exposed to an index case, and 9 (14.3%) had past history of pulmonary tuberculosis, while only 33.3% had clinical manifestations of TB (active disease). There was no resistant case of tuberculosis. Our study showed that near 24% of Iranian patients with HIV/AIDS were infected with M. tuberculosis. This finding denotes the need to improve the diagnostic and preventive measures, and also prompt treatment of this type of infection in the HIV infected individuals.

We present a case of epitheloid sarcoma that was referred with a 2×3cm ulcerated lesion on the right ankle and edema of the lower leg. Foot drop of the right side was present that had caused walking difficulty. After a few months, he developed several sporthricoidal nodular lesions on the medial aspect of right thigh, inguinal lymphadenopathy, weight loss, anorexia and respiratory symptoms. Chest x-ray and HRCT showed pulmonary metastasis. Histopathological evaluation and immunohistochemical profile of both skin lesion and involved inguinal lymph node were consistent with epitheloid sarcoma. The case is interesting because as far as we know there has been no report of epitheloid sarcoma in literature presenting with foot drop and edema prior to obvious skin involvement.

Congenital undescending testis is a common anomaly of testis, but we had a rare case of ectopic testis. A 15-month-old infant was operated emergently because of left incarcerate inguinal hernia. Intraoperative exploration of hernial sac revealed two ectopic testes with one spermatic cord proximally but in the middle divided to two spermatic cords in a 8 shape. There was an important point about vas deferens as it was single proximal to the chord, but divided into two in the middle of the chord. Vessels showed a similar condition about. We released both testes and brought down both of them into scrotum. This is a rare case of ectopic testis transectopia with partially common vas and vessels.