نشریه پژوهش در پزشکی
سال سی و چهارم شماره 2 (پیاپی 134، تابستان 1389)

Corticosteroids are used for the management of allergic rhinitis. We compared the efficacy of systemic and local corticosteroid in symptom relief and serum IgE levels in patients with perennial allergic rhinitis.

A randomized experimental study design, (clinical trial) was used. 86 patients with a history of perennial allergic rhinitis were selected and randomly divided in two groups. For the first group systemic corticosteroids were given in the form of prednisolone tablet 5mg twice daily, (10mg/day), tapered every 3 days. For the second group, Beclomethasone nasal spray 50 µ g/puff was administered twice daily as two puffs in each nostril for three weeks. Rhinorrhea, nose and eye itching, sneezing, nasal obstruction and serum IgE before and after treatment, (3weeks) were evaluated and compared.

We found a significant decrease in serum IgE in both groups but the decrease was more marked with systemic corticosteroids (P<0.05). After therapy the percentage of sneezing and eye itching decreased significantly in the systemic corticosteroid group and percentage of rhinorrhea decreased significantly in the local corticosteroid group. Pre and post intervention evaluations showed improvement in all symptoms in systemic corticosteroid group and all symptoms except eye itching in local corticosteroid group.

The result of this comparative study showed that systemic corticosteroids are more efficient in improvement of sneezing and eye itching but local corticosteroids may have a better efficacy in the improvement of nasal obstruction.

Backgraound: Hypoxia is an important determinant for biological behavior of malignant solid tumors. In vitro and in vivo studies have shown that tumor hypoxia is associated with an increased likelihood of local recurrence and distant metastasis, as well as resistance to radiation therapy and certain types of chemotherapy. Studies have shown that some copper-bis thiosemicarbazones especially, Cu-ATSM accumulates avidly in hypoxic cells, but washes out rapidly from normoxic cell.

[61Cu]-diacetyl-bis (N4-methylthiosemicarbazone) ([61Cu]-ATSM) was prepared using house-made ATSM ligand and [61Cu]CuCl2 produced via the natZn(p,x)61Cu (180¼A proton irradiation, 22MeV, 3.2h) and purified by ion chromatography method. [61Cu]-ATSM was administered into normal and tumor bearing rodents up to 180 minutes followed by biodistribution and co-incidence imaging studies.

Radionuclidic control showed the presence of 67.41(4.23%), 282.96(12.2%), 373(2.15%), 511(122.9%), 656(10.77%), 1186(3.75%) keV-rays from 61Cu and showed a radionuclidic purity higher than 99%. The rest of activity was attributed to 60Cu (0.23%). [61Cu]-ATSM radiochemical purity was >99% shown by HPLC and RTLC methods. A significant difference was observed between tumor and non tumor accumulation.

The method used in this research for the production and chemical separation of 61Cu was simple and cost effective. [61Cu]-ATSM is PET radiopharmaceutical for hypoxia imaging with an intermediate half life, and our experiments on this radiopharmaceutical have shown satisfactory results, suitable for future PET studies in human.

Endometrial cancer is the most frequent cancer in the female genital system. Nowadays outpatient diagnostic procedures like pipelle and uterobrush have facilitated the diagnosis and treatment of endometrial cancer in early stages in high-risk patients. This study has been done to compare the accuracy and tissue sufficiency of biopsy by pipelle and uterobrush.

Between 2005 and 2007, 70 candidates admitted for hysterectomy in Imam Hossein Hospital entered a clinical trial study. Under local or general anesthesia, biopsies were taken by pipelle and then uterobrush or vice versa. The order of using pipelle and uterobrush was selected randomly. The samples were sent to the pathology department and examined by an expert pathologist. The results of endometrial biopsies by pipelle and uterobrush were analyzed. After that the cases were grouped (each group consisted of 35 patients) according to the order of using the pipelle and uterobrush.

The endometrial samples sufficiency from uterobrush and pipelle were 68.1% and 87.1%, respectively. The positive predictive value of pipelle was 100% and negative predictive value was 84%. These values for uterobrush were 100% and 90% respectively.

It seems that pipelle is better for obtaining sufficient size samples. However in sufficient samples, uterobrush has higher sensitivity and accuracy. Order of using pipelle and uterobrush caused no significant difference in the results.

Backgraound: Repeated suicidal attempts are common in patients with drug and chemical poisoning. This study was conducted at poisoning referral hospitals in Tehran to determine the role of different factors in repeated suicide attempts with drug and chemical agents.

In this case-control study, 19 subjects with a history of previous suicidal attempts, (cases) and 54 individuals without this history, (controls) were selected from patients admitted with drug poisoning in the poisoning referral hospitals in Tehran, from August to October 2009. We matched the two groups regarding age, gender and level of consciousness. Demographics, poisoning characteristics, past medical history and substance use history of the patients were recorded. SPSS version 16, variable bit SD indicators, qualitative variables and frequency tables for the comparison between the two groups Chi-square test were used for statistical analysis..

History of mental illness, (100%, 0.01> P), mean of number of tablets ingested (N=40), interval between drug consumption and emergency forces to reach the place (4±2.1 h), history of deliberate self poisoning (100%, P =0.001), failed resuscitation efforts in comatose patients, (51%, P =0.02) and the need for intensive care and follow-up,(37%, P=0.013) were higher in patients with a history of previous suicide attempts compared with the control group. Also, previous history of attempted suicide with drugs was associated with decreased level of consciousness, (P =0.04).

Patients with drug poisoning and a history of previous attempted suicide are at high risk for morbidity and mortality, needing special management strategies.

Although corneal graft may be rejected by the immune system of the recipient it remains as the most successful operation as compared to transplantation of other tissues. Since most patient do not reject the grafts, those who do are in the minority. This study was carried out to assess the usefulness of the cure frailty model for determining the significance of risk factors associated with the rejection of bilateral corneal transplants in patients with keratoconus.

Patients with keratoconus receiving bilateral corneal transplants were included in the study. For analysis of the time of bilateral graft rejection in the keratoconus disease we used the cure frailty model and the promotion time cure frailty and used the Cox frailty model for comparison. For estimating the parameters we used the Bayesian approach. For comparison of proposed models we used the Deviance Information Criteria (DIC).

238 individuals received corneal transplants during the study period and 22.7 percent experienced graft rejection. Mean and median of graft rejection time was 13.5±22.8 and 6.9 months respectively. Vascularization and old age were important risk factors for graft rejection. In the cure frailty model the cure rate in the patients with vascularization were 34 percent versus 75 percent without vascularization. In the time promotion cure frailty model the cure rates in cases with vascularization were 32 percent and without vascularization were 70%. The cure models that include the parameter for cure rate in the comparison to the Cox frailty model that do not have parameters for cure rate are better for data analysis.

For analysis of survival data in which selection of patients is highly selected using the cure model gives more accurate results.

Backgraound: Entamoeba histolytica antigenic markers such as Serine-Rich E. histolytica protein (SREHP) have recently been used for vaccine preparation, genetic diversity studies of Entamoeba histolytica isolates and for differentiation between E. histolytica and E. dispar species. This study was carried out with the aim of expression of a recombinant Serine Rich E. histolytica protein in the laboratory to use it in the ELISA kit.

In this study which is an exploration method, an Iranian isolate of Serine-Rich E. histolytica gene which had previously been cloned in bluescript plasmid (pBSc), was cut using BamHI restriction enzyme. After extracting and purification from gel, the SREHP gene was sub cloned into pET32a expression vector. The inserted gene was confirmed with Rosconis solution, PCR and sequencing methods. PCR was performed with the SREHP specific primers as well as pET T7 promoter primer. The cloned gene was also digested with HindIII and BamHI restriction enzymes. Recombinant plasmid was conveyed to competent cell BL21 (DE3). A colony of the plasmid including SREHP gene was cultivated and induced with IPTG. The result of expressed protein was observed on the SDS-PAGE gel. The SREHP gene was sub cloned into pET32a expression vector. A recombinant plasmid including an inserted SREHP gene was screened and confirmed with quick check method using Ruscoins solution, as well as PCR by special primers (SREHP and universal pET primer), digested with BamHI and HindIII restriction enzymes. Finally an open reading frame of 666 nucleotides from inserted SREHP gene was obtained with the sequencing method.

The recombinant protein of Serine-Rich E. histolytica in presence of IPTG was expressed in five hours and the result of expressed protein in the length of 44 KDa was observed on SDS-PAGE gel.

SREHP protein was successfully cloned and expressed in this study. However additional studies are recommended for preparation and purification of the SREHP in a large quantity and the using it for the ELISA test.

The Beijing strain of Mycobacterium tuberculosis is responsible for more than 25% of cases of Tuberculosis in the world, it has a high transmission potential and there is a significant correlation between Beijing strain and multidrug resistance. In this study we compared the presence of Phospholipase C genes in Beijing and Nonbeijing strains of Mycobacterium tuberculosis.

CTAB method was used to extract DNA from positive culture specimens from patients with pulmonary tuberculosis. Spoligotyping was used to identify Beijing from non-Beijing strains. Presence of Phospholipase C genes was ascertained by using PCR.

Of 200 specimens, 19 were Beijing strain, (9.5%) and 181 non Beijing strains, (90.5%). In Beijing strains, 16 specimens, (84.2%)were positive for plcA,17 (89.5%) were positive for plcB and 17 (89.5%) were positive for plcC genes and in non Beijing strains 17 specimens, (9.4%), were positive for plcA, 18(9.9%), for plcB and 18(9.9%) for plcC.

Majority of Beijing strains have phospholipase C genes that may be responsible for the virulence of this strain.

Approximately 20% of patients undergoing laporotomy experience chronic post-prandial abdominal pain for months after operation. Most surgeons are wary of re-operation in this condition, and opt for conservative treatment with analgesics and sedatives. This study was performed to determine the cause of this chronic abdominal pain by means of laparoscopy.

Elective laparoscopic surgery was performed on 76 patients suffering from chronic post-operative abdominal pain. They did not have any signs and/or symptoms of acute intestinal obstruction; the most common complaints were: abdominal pain in 100%, nausea in 30%, vomiting in 10%. Diagnostic laparoscopy was performed and cases with positive findings were treated by laporoscopic surgery.

In 81% of patients the cause of pain was obvious intestinal adhesions, 10% had adhesions without any correlation to patient's symptoms and the remaining 9% did not have any positive finding on diagnostic laparoscopy. Adhesiolysis, (sharp release with scissors) is the treatment of choice. 95% of those patients who underwent Adhesiolysis became pain free for a mean average of 11 months follow up (pre-operative average of pain episode was 4 time per week).

Laparoscopic diagnosis and treatment of chronic post-laparotomy pain is the gold standard method, it is minimally invasive and has good results.

Epidermolysis bullosa is an uncommon disease with a wide spectrum of severity. Here we report a patient presenting with unusual symptoms. Case Report: The patient is a 22 years old female with progressive dysphasia and odynophagia to solids and liquids and a history of spontaneously remitting blisters caused after mild trauma from her childhood till she was 13 years old. Subepidermal blisters were diagnosed as junctional type of epidermolysis bullosa by histopathology.

Physicians should have a high index of suspicion regarding epidermolysis bullosa in patients presenting with dysphagia and cutaneous blisters..