Iranian Journal of Medical Sciences
Volume:35 Issue: 4, Dec 2010

Sulfur mustard is one of the major potent chemical warfare agents. It was widely used against not only military personnel but also civilian people of Iran during the last years (1984–1988) of the Iraq–Iran war. A number of studies were performed regarding the acute and long-term consequences of sulfur mustard on respiratory system. Currently, many aspects of leading respiratory disorder that was prescribed as “mustard lung” have been revealed. However, there is growing concern about pathophysiological mechanisms behind the mustard lung. Herein available published materials about mustard lung are summarized, and it has been tried to highlight practical points relevant to the diagnosis and treatment of the disease.

Tibolone is frequently used as a hormone-like alternative to traditional HRT. Therefore, it is valuable to compare the effects of tibolone and HRT on cardiovascular diseases risk factors. A total of 156 healthy non-surgical postmenopausal women were included in an open randomized study. They were assigned to receive daily 2.5 mg tibolone plus one Cal+D (500 mg calcium and 200 IU vitamin D) tablet (n=52), 0.625 mg conjugated equine estrogen and 2.5 mg medroxy progesterone (CEE/MPA) plus one Cal+D tablet (n=52), or one Cal+D tablet (n=52). The latter group was used as control. The women were followed for six months. The body mass index (BMI), blood pressure (BP), serum levels of high density lipoprotein (HDL), low-density lipoprotein (LDL), and triglyceride (TG), C reactive protein (CRP), sex hormone binding globulin (SHBG), free testosterone index (FTI), and free estradiol index (FEI) were determined before and after the interventions. Compared to baseline values, BMI, BP, CRP, SHBG, HDL, FTI, and FEI were significantly different after the treatments in the tibolone and CEE/MPA receiving groups (P<0.05), but not in the control group. Moreover, serum LDL and TG levels changed significantly after the treatments in all the three groups (P<0.01). There were significant differences between the tibolone and CEE/MPA groups in terms of CRP, LDL, HDL, TG, SHBG, FTI, FEI and BP (P<0.01). Tibolone may be considered an alternative to conventional HRT in postmenopausal women. However, clinical recommendations regarding the effects of tibolone on cardiovascular outcome needs further studies.

Acquired immunodeficiency may impose considerable consequences on patients’ family behaviors toward them. The objective of the present study was to investigate whether a counseling program at Behavioral Counseling Center in the city of Shiraz, Iran could change the attitude, knowledge and behavior of patient's family members. 125 HIV/AIDS patients’ family members were interviewed, using a valid and reliable questionnaire before and after performing counseling sessions at Behavioral Counseling Center. The findings were analyzed using nonparametric tests. The age of the participants was 40±13 years. Sixty five percent were female, 63% married and 79% educated. Forty four percent of participants had spousal relationships with their patients. Their knowledge about the main routes of HIV transmission were 9.76 ± 2.59 and10.64±0.88 before and after counseling, respectively (P=0.028). Supportive behaviors of families toward their patients reached to 79% after counseling compared with 44 % before that (P=0.004). Belief to isolate the patients and the practice of this approach at home dropped from 71% to 15% and from 29% to 7% after counseling, respectively (P<0.05). In 30% of participants fear of getting HIV from patients was not changed by counseling, and 24% of patients’ spouses did report to avoid protected sex with their HIV infected husbands even after taking part in the counseling program (P>0.05). Ongoing counseling for HIV/AIDS patients’ families at Behavioral Counseling Center of Shiraz did advance their knowledge about AIDS and improved their attitude and behavior toward their patients However, the counseling program did not show remarkable success in some aspects such as the removal of fear about HIV spread in the family or the change of the patients’ wives attitude to have protected sex with their HIV infected husbands.

Neonatal sepsis is a major cause of mortality and morbidity, especially in developing countries. The goal of the present study was to determine the bacterial etiology and antibiotic sensitivity patterns of neonatal sepsis. This cross sectional study was conducted on 208 neonates admitted with clinically suspected sepsis over a period of 30 months. Sepsis was divided into early onset sepsis (EOS, ≤5 days of age) and late onset sepsis (LOS, >5 days of age). The two groups were further divided into proven (culture positive ± abnormal markers) and probable (culture negative + abnormal markers) subgroups. Blood culture was performed using Bactec. Of 208 cases, 90 had neonatal sepsis consisting of 38 (26 proven) presented as EOS and 52 (42 proven) as LOS. In the EOS, Escherichia coli (E. coli) was the most common organism followed by klebsiella spp, Staphylococcus aureus (S. aureus). As for LOS, Coagulase-negative staphylococci (CONS) were the most common organism followed by Enterococcus spp, S. aureus. The antibiogram on the isolated E. coli and klebsiella spp revealed a greater combined sensitivity to cefotaxime. Coagulase-negative staphylococci and S. aureus had 100% and Enterococcus spp 90% sensitivity to vancomycin. Escherichia coli and CONS were the most common organisms causing EOS and LOS, respectively. Since the antibiotic sensitivity patterns of these organisms are changed, it seems necessary to conduct bacterial etiology studies and to determine antibiotic sensitivity patterns periodically in order to promote the empirical therapy.

Tibolone is frequently used as a hormone-like alternative to traditional HRT. Therefore, it is valuable to compare the effects of tibolone and HRT on cardiovascular diseases risk factors. A total of 156 healthy non-surgical postmenopausal women were included in an open randomized study. They were assigned to receive daily 2.5 mg tibolone plus one Cal+D (500 mg calcium and 200 IU vitamin D) tablet (n=52), 0.625 mg conjugated equine estrogen and 2.5 mg medroxy progesterone (CEE/MPA) plus one Cal+D tablet (n=52), or one Cal+D tablet (n=52). The latter group was used as control. The women were followed for six months. The body mass index (BMI), blood pressure (BP), serum levels of high density lipoprotein (HDL), low-density lipoprotein (LDL), and triglyceride (TG), C reactive protein (CRP), sex hormone binding globulin (SHBG), free testosterone index (FTI), and free estradiol index (FEI) were determined before and after the interventions. Compared to baseline values, BMI, BP, CRP, SHBG, HDL, FTI, and FEI were significantly different after the treatments in the tibolone and CEE/MPA receiving groups (P<0.05), but not in the control group. Moreover, serum LDL and TG levels changed significantly after the treatments in all the three groups (P<0.01). There were significant differences between the tibolone and CEE/MPA groups in terms of CRP, LDL, HDL, TG, SHBG, FTI, FEI and BP (P<0.01). Tibolone may be considered an alternative to conventional HRT in postmenopausal women. However, clinical recommendations regarding the effects of tibolone on cardiovascular outcome needs further studies.

Central post-stroke pain (CPSP) is a distressing pain syndrome, sometimes become refractory to the conventional pain managements. Anticonvulsants have been used to alleviate different central pains. Lamotrigine is a novel anticonvulsant and its proper dosage and its efficacy have not been well studied yet. The aim of this study was to evaluate the effect of 100 mg lamotrigine on refractory form of CPSP. The medical files of 17 patients with CPSP who had not responded to the other drugs and were treated with lamotrigine were studied. Using Brief Pain Inventory, pain, sleep and mood were assessed before, and after 8 and 24 weeks of treatment. After 24 weeks, 70.5 % of the patients responded to lamotrigine, and there was an improvement of 2.41 in the mean score of average pain (P=0.001). Lamotrigine 100 mg daily was effective in the treatment of refractory CPSP, and might be prescribed before planning for more aggressive surgical managements.

One of the major paths for drug development is the study of bioactivities of natural products. Therefore, the aim of this study was to compare the cytotoxic effects of aqueous extract of whole Cuscuta chinensis Lam., which is a traditional medicinal herb commonly used in Iran and other oriental countries, on the human caucasian acute lymphoblastic leukemia (CCRF-CEM) and another human lymphocyte, Jurkat (JM) cell lines. In vitro cytotoxic screening with various concentrations (0, 0.1, 1, 10, 25 and 50 µg/ml) of the extract was performed using microscope and methyl tetrazolium bromide test (MTT). The minimum effective concentration of the plant extract was 1 µg/ml, and increasing the dose to 10 µg/ml induced increasingly stronger effects. The inhibitory concentration 50% (IC50) of the extract against CCRF was about 3 µg/ml in 24 hours and 2.5 µg/ml in 48 hrs. In contrast, the extract did not have cytotoxic effect for the JM cells at these doses. The findings of the present study suggest that C. chinensis is toxic against CCRF-CEM and JM tumor cells. Whether or not such effects can be employed for the treatment of such tumors must await future studies.

Adverse outcome of pregnancy is a potentially dangerous complication of conception and affects 15-20% of pregnancies. According to recent studies increased level of blood antiphospholipids antibodies, if accompanied by predisposing factors, can be an adverse event in human pregnancy. The aim of the present study was to compare the maternal serum levels of anticardiolipin and antiphosphatidyl serine, and partial thromboplastin time between patients with adverse outcome of pregnancy and matched subjects with normal pregnancy. Serum levels of anticardiolipin and antiphosphatidyl serine and activated partial thromboplastin time were measured in 150 women with adverse pregnancy outcome and 150 matched women with normal pregnancy after a gestational age of 10 weeks. Data on maternal age, age of pregnancy, serum levels of anticardiolipin and antiphosphatidyl serine, and activated partial thromboplastin time were collected and compared by Student’s t or χ 2 tests. The age of mothers in the two groups were 25.86±5.90 and 27.09±5.63 years (P=0.67), and the age of pregnancies were 29.34±5.12 and 28.17±7.03 (P=0.1) weeks in the control and patient groups, respectively. Positive levels of serum anticardiolipin and antiphosphatidyl serine antibodies, and activated partial thromboplastin time for the control and patient groups were 14.3% versus 85.7% (P=0.002), 15.2 % versus 84.8 % (P=0.003), and 23.1 % versus 76.9% (P=0.001), respectively. The findings suggest that positive levels of serum antiphospholipids are associated with adverse outcome of pregnancy in the study population.

Uretero-Pelvic Junction Obstruction (UPJO) is a common congenital anomaly that may need pyeloplasty to prevent renal function deterioration. The purpose of this study was to describe a modified use of jj stent catheter in pyeloplasty for infant with UPJO. A series of 12 children, between 3 and 10 months, underwent stenting open pyeloplasty. In each patient a 6 French Foley catheter was placed within the bladder. One ml sterile methylene blue was instilled into the catheter, which was clamped during the operation time. During a dismembered pyeloplasty, a small (3F) double j stent was placed through the flank into renal pelvis, passing the flank skin, muscles and entering via lower pole posteriorly to pass the anastomosis and entering the ureter and urinary bladder, confirmed by observing methylene blue within the wound. The external end of the jj catheter was doubled up and sutured to the flank skin and then removed 4 weeks later. No procedure related complication(s) such as extravasation, infection, and stent displacement was seen. The duration of follow up was 6 months to 3 years. This method of stenting pyeloplasty is easily tolerated and causes no need for endoscopic removal of the catheter. It is an invaluable technique of pyeloplasty with stenting in very small children, and needs no external appliance.

Glucose-6-Phosphate dehydrogenase (G6PD) deficiency is a common enzyme deficiency in the world. It's Prevalence in Iran is about 12% in male & about 1% in female. The present study did examine the relation between the development of preeclampsia and G6PD deficiency. It was investigated whether or not the risk of preeclampsia in G6PD deficient women is higher than that in normal pregnant women.A total of 400 pregnant patients with an age range of 20-34 years were selected in the cities of Shiraz and Jahrom, Iran, They were on 24 weeks inside their first or second pregnancy. There were 4 cases of G6PD deficiency in preeclamtic women compared to two cases in normal pregnant women. (OR=2.02, CI: 0.37-11.02). Although the relation between G6PD deficiency and preeclamsia did not reach statistical significance, the higher incidence of the deficiency in preecclamtic women might suggest that the test for G6PD deficiency might be used as a screening tool for preeclamsia.

Antepartum mastitis is a rare condition, whereas postpartum or lactation mastitis is a common problem. This report introduces a case of complicated bilateral antepartum mastitis, which was treated successfully by drain insertion and antibiotic therapy. The patient was a 23-year-old woman in the 23rd week of her first pregnancy. Her chief complaint was progressive swelling, redness and radicular pain in both breasts, which had been started gradually from the 18th week of pregnancy. The patient was admitted to hospital, and received oral and intravenous antibiotics empirically, which was not effective. The patient was treated by drainage and oral antibiotic therapy. Based on the approaches employed and the outcomes achieved it is suggested that early surgical insertion in the presence of fluid collection in antepartum mastitis will shorten hospitalization and course of intravenous antibiotic therapy.

Multiple myeloma is a monoclonal malignant proliferation of plasma cells. The disease is more frequent in men, and the average age of patients at the time of diagnosis of the disease is about 60 years. Solitary myeloma may be the first manifestation of the disseminated form of multiple myeloma, which is characterized by multiple skeletal lesions, general metabolic alterations, impairment of renal function and eventually death.The findings in regards to the present case suggest that oral manifestations may be the first sign of multiple myeloma. This might highlight the important role that a dentist can have in the early diagnosis of the disease.

Although uncommon, different kinds of foreign bodies, most of which metallic, have been reported to enter the appendix. The present report describes a case with a metallic foreign body-induced appendicitis, and makes suggestion in regards to the diagnosis and management of the problem. A metallic foreign body was accidentally observed in the right lower quadrant region in an abdominal X-ray taken after blunt trauma in a 6-year-old boy. After 4 months of persistent presence of foreign body not related to trauma, the patient was apparently asymptomatic, and there was a mild to moderate Mc-Burney tenderness. Exploration revealed the presence of an air-rifle buckshot in the proximal part of the appendix causing appendicitis due to luminal obstruction. Histopathologic study of the appendix revealed inflammation and serositis.

Spontaneous perforation of the sigmoid colon or rectom is defined as a sudden perforation of the colon in the absence of diseases such as tumors, diverticulosis or external injury. It is a very rare finding, and if neglected, results in severe peritonitis and high mortality. The causes of this rare condition are numerous, and in this case it might be due to the chronic constipation induced by an anticholinergic antipsychotic.