Medical Journal Of the Islamic Republic of Iran
Volume:24 Issue: 3, Autumn 2010

Multiple sclerosis (MS) is the most common autoimmune disease of central nervous system with destruction of myelin sheath mediated by auto reactive CD4+ T Lymphocytes. Because of the possible role of Epstein-Barr virus in etiology of MS and T cells immune response, the aim of this study was to evaluate anti-Epstein Barr virus antibodies as a marker of reactivity and production of TH1 and TH2 cytokines in MS patients and healthy individuals. Blood samples were taken from 68 MS patients at different stages of diseases and 20 apparently healthy individuals and plasma levels of anti- EBV nuclear antigen-1 (EBNA-1) and viral capsid antigen (VCA) antibodies determined and concentrations of IFN- [1], IL-12 and IL-4 in culture supernatants of PHA-activated peripheral blood mononuclear cells (PBMC) were measured by ELISA. The mean levels of anti EBNA-1 and VCAantibodies were significantly higher in patients compared to controls (p=0.04, p=0.001 respectively). Concentrations of IFN- [1], IL-4 & IL-12 were also significantly higher in MS patients than healthy individuals (p=0.001, p=0.005, p=0.002, respectively). Significant correlation was found between anti EBNA-1 and VCAantibodies and IL-12 production (p =0.02, r=0.27& p=0.04, r=0.25, respectively); whereas no significant correlation was found between these antibodies and production of IFN- [1] or IL-4. Due to elevated level of anti-EBV antibodies and T cell Cytokines in MS patients Rather than healthy individuals, Epstein Barr virus may play role in etiology of MS disease through activation of T cells immune response.

Mosaic form of turner syndrome that represented by two or more cell lines in an affected individual, often has limitation for detection with classical cytogenetic methods. The present study was carried out to compare the efficiency of interphase Fluorescence In Situ Hybridisation (FISH) and cytogenetic techniques in detection of mosaic form of turner syndrome. All candidate samples for turner syndrome were surveyed with both interphase FISH using DXZ1 as a chromosome X specific probe and the GTG- banding methods. The chi square test was used and a P-value of less than 0.05 was considered as being significant. Asignificant difference was observed between results obtained from the application of the two methods under study (P<0.05), indicating that the interphase FISH is favourably compares to conventional cytogenetics in detection of mosaic form of X chromosome aneuploidy, as an extended number of cells can be scored in a limited time. The results indicate that using the two techniques in parallel allow accurate differentiation between mosaicism and homogenous aneuploidy of X chromosome, and thus both numerical and structural aberrations of the X will be analyzed.

To determine the effect of oral zinc sulfate supplementation given with coamoxiclav when compared with coamoxiclav alone for treatment of otitis media with effusion (OME). The efficacy of the drug was assessed 3 and 6 weeks after administration. In a double-blind, randomized trial 4 to 14 years old children with OME who referred to ear, nose and throat clinic, were randomly assigned into two groups: 1) Zinc group: Zinc sulfate + Coamoxiclav + Pseudoephedrine + Nacl nasal drop 2) Placebo group: Placebo + Coamoxiclav + Pseudoephedrine + Nacl nasal drop. Atotal of 52 children were studied consisting zinc group 29 and placebo group 23 children. Children were examined by otoscopy and tympanometry at entry and after 3 weeks of treatment. For children who had not been cured completely after 3 weeks, treatment continued for more 3 weeks (total of 6 weeks (. At the end of the first course of treatment (3 weeks) 62.1% of children in the zinc group had clinical improvement compared with 43.5% of children in placebo group. Tympanometrically, 70.9% of children in zinc group had improvement compared with 65.5% for placebo group with no statistically significant difference. There was no significant difference between the two groups at the end of second course of treatment (6 weeks). But the response rate of zinc group was better than the placebo group (43.8% versus 12.5% clinically and 56.3% versus 40% tympanometricall). Zinc administration and cycles of treatment had no significant relationship. Although in this study oral zinc sulfate supplementation had not significant effect on treatment of OME, the response rate was better in zinc group compared to placebo group specially in longer administration. According to the findings, it seems more studies about oral zinc supplementation in the treatment of OME is needed.

Dupuytren's disease is a fibroproliferative disorder of the palmar fascia that can result in disabling contractures of the digits. When function is impeded or deformity is disabling, surgical intervention can be considered, wherein a major problem is recurrence (reported up to 74%). Although, the disease occurs predominantly in men of northern European, there are very few reports from African and Asian populations, especially from our country which may follow from the low prevalence in these areas. The purpose of this study was to examine the nature of the Dupuytren's disease and the recurrence rate after fasciectomy. A hospital-based and cohort study design was used to recruit patients. Data were gathered from the medical records and follow-up interviews with average 3 years (ranges from 1 to 8 years), from all patients who underwent fasciectomy in our hospital from 1370 to 1388. 29 patients (with 43 involved hands) have been admitted for surgical correction of Dupuytren's disease. Disease is more common (90% of cases) and appears significantly earlier in men. Right hand involves in 28% of the patients, left hand in 24% and both hands in 48%. The ring and the little fingers are involved most frequently. Association of Dupuytren's disease with the following factors was found: Manual labor in 68.97%, smoke in 31.03%, diabetes in 24.14%, alcohol in 17.24%, and epilepsy in 13.79%. The most common grade was found to be the grade II by using Tubiana's grade. Two patients with ectopic sites of the disease were found. The recurrence rate after fasciectomy in our patients is 9.38% (3 of 32 operated hands). From the recurrence risk factors, only bilateral disease involvement revealed to be significant in our patients. Manifestations, pattern and severity of the disease were nearly comparable to those observed in the published studies, except for a lower prevalence rate and lower recurrence rate in our findings which are higher in the most studies. It seems that, the reason for this difference include genetics, pathogensis and other factors which may cause the disease and are still unclear.

Patients with addictions have many acute and chronic medical illnesses, both related and unrelated to their addictions. In spite of high incidence of substance-related disabilities, substance abuse is usually underdiagnosed in general hospitals. The objective of the present study was to investigate the frequency and pattern of substance use in patients with different medical complaints. In this descriptive cross-sectional study, 1000 outpatients, aged 17 and older with various medical complaints were participated. The patients were attending neurology, ENT, nephrology, ophthalmology, cardiology, orthopedic, gastroenterology, surgical and dermatology clinics of four selected general hospitals. A 93 item clinicians-made scale, Rapid Situation Assessment of Drug Abuse in Iran, was used in this survey, and 30 items which focused on drug use were selected. 8.7% of the patients reported lifelong or recent substance use and Opium was the most used substance, reported by 65.5% of the patients. Patients of neurology, ophthalmology and orthopedic clinics showed the highest consumption. Smoking and injestion were the most frequent routes of substance used and the most reported pattern of use were 2 or 4 times a day and once a week. The current cohort of substance users were relatively young, and many had reported detectable nervous system and orthopedic complications. Further research must investigate -their outcomes in the long term.

Squamous cell carcinoma (SCC) constitutes the main oral malignancy. Parallel to better understanding of molecular and genetic patterns of tumor behavior, more precise correlation of tumor markers such as Epidermal Growth Factor (EGF) and Laminin-5 are sought to estimate macroscopic and microscopic tumor status. We conducted a cross-sectional study collecting oral SCC samples during 2006-2007 from Pathology Department of Shahid Beheshti Dental School. Mmunohistochemical staining with antibodies against EGFR and laminin-5 along with staining degree were reported by two experienced pathologist including degree of staining (low, medium, high), and pathological grading and clinical staging obtained from medical records. Forty two patient's paraffin blocks of SCC examined with mean age 58(18.72) yrs ranged between 21-88, female to male ratio of 1.33:1 was observed. The study analyses revealed a significant correlation between the expression of laminin-5 with tumor stage and grade (P< 0.001 r=0.547 and r=0.545 respectively), yet no significant correlation between expression of EGFR and tumor stage or grade (P=0.894 r=-0.018 and P=0.543 r=0.86 respectively). Considering high degree of staining and stage IV; sensitivity, specifity, positive predictive value (PPV) and negative predictive value (NPV) of 44%, 54%, 44% and 78% calculated for ERGF and 55%, 78%, 58% and 86% for laminin-5 respectively. Considering high degree of staining and grade 3; sensitivity, specifity, positive predictive value (PPV) and negative predictive value (NPV) of 57%, 57%,17% and 86% calculated for EGFR and 85%, %82, 50% and 96% for Laminin-5 respectively. We concluded that laminin-5 has a better prediction for developing higher tumor stage or grade but further research needed for identifying the precise role of EGFR.

Uncuffed endotracheal tube(ETT) were considered for children less than 8 years. Meanwhile, aspiration around ETT in patients undergoing adenotonsillectomy is concerned.We compared cuffed versus uncuffed ETT regarding respiratory complications following adenotonsillectomy. 128 children aged 2-8 yr were divided to two groups of 64 each. Uncuffed and cuffed tubes were used respectively in the uncuffed (UG) and cuffed (CG) groups. Anesthesia was routinely performed in a identical pattern in all patients. The number of attempts to reach the appropriate tube size was recorded. After extubation, the patients observed for the occurrence of cough, hypoxemia, and stridor. Less reintubation attempts were needed in the CG (p.value=0.002). In the UG, 31.3% and in the CG 10.9% had some respiratory complications (P.value=0.009). The change of the initial tube had significant effect on the occurrence of croup and stridor (P.value= 0.000). The use of cuffed tube in 2-8 yr, could lower the incidence of respiratory complications following adenotonsillectomy. It also decreases the number of intubation attempts needed to reach the appropriate tube size.

Stress urinary incontinence is a common problem in the middleaged women and can affect their quality of life. This study evaluated the effects of pelvic floor muscle exercise on quality of life outcomes in women with stress urinary incontinence. After baseline evaluation, 50 women were assigned for this clinical trial. Participants were instructed to do pelvic floor muscle exercises for 3 months and their quality of life measured before and 3 months after intervention. forty-six women completed the trial. Significant difference in the quality of life scores (P<0.0001) were noted in women with stress urinary incontinence, after 12 weeks. 12 weeks of pelvic floor muscle exercises significantly improved quality of life outcomes in women with stress urinary incontinence.

Intracranial invasion of cellular blue nevus (CBN) from the skin is extremely rare and such a condition with malignant transformation is even rarer. A case of meningeal melanoma with malignant transformation which was derived from an Ota nevus is presented in this report. A21-year-old man with a neurocutaneous syndrome since childhood was referred with headache and mild left hemiparesia. CT scan and MRI demonstrated intracranial lesions and conjunctival biopsy leads to the pathologic diagnosis of blue nevus. Thereafter his parietal lesion was operated by craniotomy with total gross excision. On histopathological examination, diagnosis of malignant melanoma was confirmed. Approximately 2 months after radiotherapy and chemotherapy, he afflicted to diplopia and blurred vision on the leftside due to enlargement of orbital and cavernous sinus lesion. Following one year follow-up, he was survived and thrived with diffuse leptomeningeal nodular enhancement in favor of melanoma dissemination. Primary intracranial melanomas are though rare, but it should be suspected especially in the presence of periorbital blue nevus or nevus of Ota. Moreover, although CBN is considered benign, scalp or periorbital CBN has the potential for intracranial invasion and malignant transformation.

Gastric cancer is the fourth most common cancer and the second leading cause of cancer death. Most cases are sporadic and only 10% of patients, show familial clustering. Among these patients, 1 to 3 % have hereditary diffuse gastric cancer (HDGC), which is autosomal-dominant and present in younger ages. Mutations in Ecadherin gene CDH1 has been identified in 30 to 50% of patients. Because endoscpoic surveillance is not effective in identifying early HDGC, gene-directed prophylactic gasterectomy is recommended for CDH1 muta-tion carriers. But in most carriers who underwent prophylactic ga-strectomy, histological examinations on the resected stomach revealed foci of diffuse gastric cancer. It shows that gasterectomy could be curative instead of prophylactic in these cases. Individuals from families with HDGC should be recommended to genetic testing and in patients that have a CDH1 gene mutation, total gasterectomy is in-dicated. We are presenting a 27 year old patient with striking history of familial gastric cancer and positive E-cadherin gene mutation who underwent prophylactic gasterectomy.

Inequalities in health are ever increasing among different communities of either affluent or disadvantaged especially in urban areas. To identify and address inequalities in health and its determinants among societies, urban health equity assessment and response tool (Urban HEART) in four 'policy domain's related to social determinants of health, has been developed by WHO Kobe Centre (WKC) and piloted in several countries. The tool was extended to six policy domains in Tehran and the number of indicators was doubled. This paper describes the concept of Urban HEART, its development, study protocol and pilot implementation in Tehran. Methods/Design: Sixty five indicators in 6 domains related to inequalities in health and social determinants of health (SDH) namely 'physical and infrastructure', 'human and social', 'economic', 'governance', 'health', and 'nutrition', were developed and approved in an international workshop held in Tehran in April 2008. Acomprehensive questionnaire with 12 sections was developed to be administered in a large population based survey in Tehran. This is the first report of urban health equity assessment and response tool (Urban HEART) project which was conducted in Tehran. Year 2010 has been devoted to 'Urbanisation and Health' by the World Health Organisation, when 1000 cities are supposed to join a global plan to raise health in the urban areas. The Urban HEART project is supposed to play an important role henceforth.