Journal of Research in Medical Sciences
Volume:16 Issue: 7, July 2011

Although a variety of strategies have been employed for managing articular cartilage defects in the knee, overall outcomes have not been satisfactory. An alternative option may be autologous chondrocyte transplantation (ACT). However, as this method is still under investigation, here we assessed the efficacy of ACT for human knee defect cartilage repair. In a randomized clinical trial study, eleven patients (mean age 31.09 years) were enrolled in the study with full thickness cartilage defects in the knee. Arthroscopically, healthy cartilage was obtained, chondrocytes expanded for 2-3 weeks and ACT performed. Clinical status was evaluated before ACT, 6 and 12 months after ACT using the Brittberg-Peterson functional assessment and modified Cincinnati rating score. Magnetic resonance imaging (MRI) findings were evaluated based on the scoring systems used by Sally Roberts and by Henderson. Modified Cincinnati rating indicated significant improvement of clinical score before ACT compared to 6 (p < 0.001) and 12 (p < 0.001) months after ACT (from 2.73 before ACT to 7.27, 8.36 and 9.5 at 6, 12, and 48 months after ACT, respectively). Brittberg-Peterson functional assessment indicated a decline from 79.27 to 25.82 and 19.27 at 6 and 12 months post ACT. Further, statistical test demonstrated significant differences 6, 12 and 48 months post ACT (p = 0.007). Evaluation of MRI revealed a score of 6.5 for Henderson criteria and a score of 2.5 for Robert criteria. Our study demonstrated that ACT of the knee provides an excellent treatment for full thickness cartilage defects with outstanding clinical and radiological outcomes.

Evidence exists for reciprocal effects of insulin and desacyl-ghrelin (DAG) concentration, but the association between different fatty acid saturation in high fat diet (HFD) and these hormones remain to be established. To evaluate the impact of different sources of dietary fat and the level of fatty acid saturation on plasma insulin and DAG levels and also the association of DAG with insulin action this study was carried out. Male weaning Wistar rats were randomly divided into four groups of HFDs, high fat butter (HF-B), high fat soy (HF-S), high fat olive (HF-O), high fat fish (HF-F), and a group of standard diet (SD). Blood samples were collected after 8 weeks and after they were fasted for 24 h. Body weight, food intake, plasma glucose, insulin, DAG and insulin resistance (HOMA-IR) were measured. Plasma insulin levels at fed and fasted status, were significantly higher in rats on HF-B compared to those on SD, HF-F and HF-O diets (P < 0.05). Insulin concentration in rats on HF-S was also higher than those on SD, HF-F and HF-O diets (P < 0.05), in the feeding status. Insulin resistance was significantly higher in rats on HF-B, compared to those on SD, HF-F and HF-O (P < 0.05). Rats that were fed with HF-B diet had lower fasting plasma DAG levels than the SD, HF-F and HF-O groups (P < 0.05); furthermore, the HF-F group had significantly higher DAG level than the HF-S groups (P < 0.05). Fish and olive oils may hence contribute to lower insulin level and HOMA-IR by increasing DAG concentration and may have more health benefits than other fat sources in diets.

A novel version of the Modified Child Dental Anxiety Scale (MCDAS) was developed by addition of faces rating scale to the original numeric form. The aim of this prospective descriptive study was to perform a transcultural adaptation and reliability analysis of the Iranian version of Faces version of Modified Child Dental Anxiety Scale (MCDASf) and the Dental Subscale of the Children’s Fear Survey Schedule (CFSS-DS). To determine the test–retest reliability, 200 school-children aged 8–12 years completed the MCDASf and the CFSS-DS on two separate occasions, 2 weeks apart. To determine the criterion validity, all participants completed two questionnaires at the same sitting. The translated instrument was tested for internal consistency by Cronbach’s alpha, inter-item, and item-total correlation coefficients. Correlation between the MCDASf and CFSS-DS mean scores and age were calculated using the Pearson correlation coefficient. The intraclass correlation coefficients ranged from 0.158 to 0.658 (p < 0.01) for the individual items of the MCDASf between the first and the second assessments and also, ranged from 0.350 to 0.677 (p < 0.01) for CFSS-DS. The internal consistencies (Cronbach's alpha) were 0.85 and 0.92 for the MCDASf and CFSS-DS, respectively. The correlation between the MCDASf and CFSS-DS was 0.73 (p < 0.001). The MCDASf and the CFSS-DS scores at the first administration were significantly greater than those of the second. The MCDASf is a reliable measure of dental anxiety in Iranian children aged 8–12 years, suggestive of good reliability and validity.

Diabetes mellitus is a heterogeneous metabolic disorder characterized by hyperglycemia. Studies showed paraoxonase activity, and vitamin C and A levels are decreased in diabetes. The effect of omega-3 fatty acids on serum paraoxonase activity and vitamins A, E, C in patients with type 2 diabetes is not fully understood. This study aimed to determine the effect of omega-3 fatty acids on paraoxonase activity, vitamins C, A and E levels in type 2 diabetic patients. In a double-blind, placebo controlled trial, 80 type 2 diabetic patients were randomly enrolled into the study. Study subjects received daily 2714 mg of omega-3 fatty acids or placebo for 8 weeks. Ten milliliter fasting blood was collected before and after treatments. Serum paraoxonase activity and vitamin C levels were measured by spectrophotometry. Vitamin A and vitamin E were measured using high performance liquid chromatography. Nutrient intake was estimated using 24-hours dietary recall questionnaire (for 2 days) before and after treatments. Dietary data were analyzed using FPII. To compare the means of variables between the two groups, independent t-test was employed. Differences between variables before and after interventions were calculated using paired t-test. Serum levels of paraoxonase activity were significantly increased after omega-3 intake (126.47 IU/ml vs. 180.13 IU/ml). However, omega-3 intake caused no significant change in serum vitamin A, C, and E. Supplementation of omega-3 fatty acids was found to increase paraoxonase activity in diabetic patients.

The aim of this study was to evaluate epidemiological relationship between chronic obstructive pulmonary disease and sleep apnea syndrome in a sample of Persian population. As a part of a population-based cross-sectional study, 3900 randomly selected individuals aged 15 years or older were invited to take part in the survey; 3770 individuals (96.6%) agreed to fill out the respiratory and sleep questionnaire. Those subjects suspected to have either chronic obstructive pulmonary disease and/or obstructive sleep apnea underwent spirometry and polysomnography test if indicated. Spirometric measurements were performed on 420 invited responders. Polysomnography measurements were performed on 25 of the responders. Prevalence rates for sleep apnea, chronic obstructive pulmonary disease and current asthma were 4.98%, 5.7% and 3.1%, respectively. Logistic regression showed independent associations between sleep apnea and chronic obstructive pulmonary disease. There was no significant independent association between sleep apnea symptoms and current asthma and wheeze ever. These observations indicated relationship between chronic obstructive pulmonary disease and obstructive sleep apnea. These observations indicated the necessity of further studies to explain the possible common pathogenic mechanisms involved in two disease entities.

Tinnitus is a sense of sound perception in absence of an external source which can affect life quality. Different conditions may lead to tinnitus including metabolic disorders such as dyslipidemia. The aim of this study was to investigate the prevalence of dyslipidemia among Iranian patients with idiopathic tinnitus. This was a cross-sectional study in which prevalence of dyslipidemia in fasting state and its subclasses were assessed in 1043 tinnitus patients aged 12-90 years who referred to Rasool Akram Hospital, Tehran, Iran, 2006-2009. Data was summarized by SPSS software version 17 and one sample t-test and chi-Square test were applied to analyze the results. P less than 0.05 were considered significant. The most prevalent type of dyslipidemia was hypercholesterolemia with the frequency of 14.4% followed by low HDL-C with the frequency of 12.8%. Mean of total cholesterol, HDL-C, LDL-C and triglyceride levels in all patients were not greater than general population. Based on the results of the present study, there might be no need to check the serum lipid profile in tinnitus patients. We recommend further studies to assess both fasting and postprandial serum lipid profile in patients with idiopathic tinnitus. Simultaneous investigation of their dietary intake is also suggested.

The present study sought to 1) investigate the degrees of correlations between different disease activity scores (DASs) and health-related quality of life (HRQoL), and 2) determine if DASs correlate with either physical or mental HRQoL. Eighty patients with rheumatoid arthritis (RA) were assessed for different DASs, measured with erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP), namely DAS4-ESR, DAS-3 ESR, DAS4-CRP, DAS3-CRP, DAS4-28 ESR, DAS3-28 ESR, DAS4-28 CRP, and DAS3-28 CRP, and Simplified Disease Activity Indexes namely SDAI-ESR, and SDAI-CRP. Physical and mental HRQoL were measured using the SF-36. The Pearson correlation test was employed to examine the correlations between HRQoL and different DAS indices. PASS 2000 (Power Analysis and Sample Size) software was utilized to find significant differences between the correlations. SF-36 total score showed a significant inverse correlation with the DAS4-ESR, DAS-3 ESR, DAS4-CRP, DAS3-CRP, DAS4-28 ESR, DAS3-28 ESR, DAS4-28 CRP, and DAS3-28 CRP, with correlation coefficients of -0.320, -0.314, -0.330, -0.323, -0.327, -0.318, -0.360 and -0.348, respectively (p < 0.01 for all). The correlation coefficients between different DAS indices and the HRQoL score were not significantly different. In addition, all DASs showed significant correlations with physical HRQoL, but not with mental HRQoL. Among patients with RA, disease severity indices are associated with physical, but not mental HRQoL. However this study failed to show any differences between various DASs in their clinical use.

Foot ulcers and infections are the major sources of morbidity in individuals with diabetes mellitus.This study aimed to evaluate the efficacy of topical Royal Jelly (a worker honey bee product) on healing diabetic foot ulcers. Diabetic patients with foot ulcers that were referred to our clinic at Khorshid Hospital, Isfahan, Iran; were evaluated three times a week and treated according to standard treatments consisted of offloading, infection control, vascular improvement and debridement if required. In addition, all ulcers were measured and then topical sterile 5% Royal Jelly was applied on the total surface area of the wounds. Eventually, they were covered with sterile dressings. Each patient was followed for a period of three months or until the complete healing. A total of eight patients were enrolled in this study. Of these, two had two ulcers and, therefore, ten ulcers were evaluated. Two ulcers were excluded. Seven of the remained eight ulcers healed. Mean duration of complete healing was 41 days. One ulcer did not completely heal but improved to 40% smaller in length, 32% in width and 28% in depth. The mean length, width and depth reduction rates were 0.35 mm/day, 0.28 mm/day and 0.11 mm/day, respectively. Royal Jelly dressing may be an effective method for treating diabetic foot ulcers besides standard treatments.

Hemodynamic deterioration is a common postoperative problem. Intravenous nitroglycerin (NTG) is used for prevention of this complication. Nitroglycerin has different doses and is primarily a vasodilator. Applying different doses of intravenous NTG can induce different effects on post-operative cardiac instability, so we aimed to investigate whether there was a difference need for administration of inotrope drugs in patients undergoing CABG as indicators of cardiac instability. Sixty seven consecutive patients enrolled in this double-blind clinical trial performed in Shahid Rajaee hospital, Shahid Beheshti University of Medical Science, Tehran, Iran. The decrease in blood pressure and the need for administration of epinephrine was more prevalent in warming up period in all three groups. No need for administration of epinephrine was detected before and during anesthesia in groups receiving 100 and 150 µg/min intravenous nitroglycerin, but 6.6 percent (1 patient) of patients receiving 50 µg/min epinephrine, demonstrated a decrease in blood pressure which necessitated the use of epinephrine. It seemed that application of different doses of intravenous nitroglycerin did not exert a significant influence on cardiac instability and the need for use of inotrope drugs.

Post-transplant infection with polyoma viruses (BK and JC viruses) is an important cause of graft loss and nephropathy. The objective of this study was to compare the frequency of BK and JC viruria in renal transplant recipients with and without graft dysfunction. In a case-control study, we selected 60 kidney transplant patients with and without graft dysfunction in the first two years after transplantation. Each group consisted of 30 patients evaluated for basic demographic and laboratory characteristics. First morning urine samples were sent for BK and JC virus detection with QIAamp DNA Mini Kit and real-time polymerase PCR. Chi-square test with Yates’ correction, Student t-test and Mann-Whitney U test were used as indicated. P value of less than 0.05 was regarded as statistically significant. Both groups were similar in age, gender, and time after transplant and pretransplant dialysis. In both groups, seven patients (23.3%) were JC virus positive whereas in case group 14 patients (46.7%) and in control group 9 patients (30%) were BK virus positive. There were no statistical significant difference between case and control groups for both JC and BK virus infection rate. We concluded that JC and BK virus infection is very prevalent in the first 2 years after transplant and might be monitored appropriately.

Chronic tension-type headache (CTTH) is recognized as the most common type of headache and can be further defined as either episodic or chronic. Regarding the chronic nature of CTTH and intolerance or side effects of drugs that are used for treatment, other methods of treatment such as Transcutaneous Electrical Nerve Stimulation (TENS) has been used as a convenient and available method for treatment and prevention of CTTH. In the current study, we evaluated the efficacy of the imipramine versus TENS in the prevention of the CTTH as a prospective clinical trial. In this study, 138 patients with confirmed CTTH were randomized to be treated either with imipramine or TENS method. Sixty nine patients were treated with TENS and 69 cases were regarded as controls and were treated with imipramine. In the Imipramine group, treatment was performed by imipramine tablet, 25mg, twice daily. In the TENS group, patients were treated thrice weekly for ten weeks, each lasting 15 minutes in temporal and occipital regions. Three months after treatment, both the TENS and imipramine significantly reduced the severity of tension headache (p < 0.05). However, imipramine was significantly more effective than TENS in reduction of the headache severity (p < 0.05). It appears that TENS method may be a good alternative method for patients suffering from CTTH. To better evaluate the efficacy of this method in the prevention and treatment of CTTH, more studies are recommended.

Cancer is one of the leading causes of mortality and morbidity worldwide. The incidence of cancer has increased markedly in recent decades in most countries. Studies have shown that diseases such as cancer affect the individual's quality of life. The sample of study consisted of 384 patients selected through non-random convenient sampling procedure from three general hospitals and outpatient clinics in Isfahan and Tehran. The measures used in the study included a demographic questionnaire, the Iranian version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), the Cancer Coping Questionnaire, and the Religious Attitude Questionnaire. The results revealed significant correlation between patient's scores on the total scale of the Cancer Coping Questionnaire and their scores on the Global health status/Quality of Life. Significant correlations were also found between patient's scores on the Religious Attitude Questionnaire and various scales of the Quality of Life Questionnaire. However, no significant correlations were found between Cancer Coping and Religious Attitude measures in any type of cancer except for the prostate cancer. Religious attitude was a significant and important factor in coping with cancer. In addition, patient's quality of life correlated significantly with religious attitude as well as cancer coping measures. However, the results did not show any significant relationship between religious attitude and cancer coping measures except in patients with prostate cancer. The findings of this study are consistent with other studies that have shown significant correlations between religiosity and spirituality and quality of life in patients with life threatening diseases.

The distinction between basal cell carcinoma (BCC) and trichoepithelioma (TE) may be very difficult in some cases because of the close similarities of these two lesions clinically and histopathologically. The purpose of this study is to investigate the usefulness of CD10 in distinguishing BCC and TE. The immunohistochemical expression of CD10 was evaluated in an archived group of 30 BCCs and 12 TEs in a retrospective cross sectional study. The localization of anti-CD10 to the tumoral and/or stromal cells was determined in each case and was compared between these two tumors using Fisher's Exact Test. In BCC cases, the expression of CD10 was noted in tumoral cells in 26 cases (83.2%). Of these, 3 cases showed positivity of the stromal and basaloid cells, two cases demonstrated stromal expression alone and two BCCs were not immunoreactive. On the other hand, 10 out of 12 (83.3%) TEs showed positive stromal immunoreactivity. Of these, one case also showed positivity of the basaloid cells. One TE demonstrated epithelial expression alone and one TE was not immunoreactive. The pattern of staining of basaloid cells and stromal cells in BCC and trichoepithelioma was statistically different (p < 0.001). We conclude that CD10 is a useful marker in the differential diagnosis of BCC versus TE.

This study was carried out to analyze the relationship between clinical factors and velopharyngeal closure (VPC) in cleft palate patients. Chi-square test was used to compare the postoperative velopharyngeal closure rate. Logistic regression model was used to analyze independent variables associated with velopharyngeal closure. Difference of postoperative VPC rate in different cleft types, operative ages and surgical techniques was significant (P=0.000). Results of logistic regression analysis suggested that when operative age was beyond deciduous dentition stage, or cleft palate type was complete, or just had undergone a simple palatoplasty without levator, patients would suffer a higher velopharyngeal insufficiency rate after primary palatal repair. Cleft type, operative age and surgical technique were the contributing factors influencing VPC rate after primary palatal repair of cleft palate patients.

We studied the antioxidant effects of fresh juice and peel extract of Citrus aurantifolia (Christm). Low density lipoprotein (LDL) was separated from one hypercholesterolemic human serum by modified Bronzert and Brewer procedure. Oxidation of LDL was measured at 234 nm against 0, 5, 10, 20, 25, 30 and 40 μl of fresh lime juice and 0, 5, 10, 15 and 20 μl of peel polyphenolic extract solution in DMSO. 5 μl of lime juice didnt change LDL oxidation. 10 μl of juice inhibited LDL oxidation, and with increasing the juice concentration, LDL was oxidized faster. The higher concentrations of peel extract prevented LDL oxidation better than the lower ones. Both juice and peel demonstrated antioxidant properties, but the excessive consumption of lime juice seems not to be beneficial. Regarding the intensity and type of flavonoids, lime juice and peel may show different effects.

Natural disasters are tragic incidents originating from atmospheric, geologic and hydrologic changes. In recent decades, millions of people have been killed by natural disasters, resulting in economic damages. Natural and complex disasters dramatically increase the mortality and morbidity due to communicable diseases. The major causes of communicable disease in disasters are categorized into four sections: Infections due to contaminated food and water, respiratory infections, vector and insect-borne diseases, and infections due to wounds and injuries. With appropriate intervention, high morbidity and mortality resulting from communicable diseases can be avoided to a great deal. This review article tries to provide the best recommendations for planning and preparing to prevent communicable disease after disaster in two phases: before disaster and after disaster.

Primary malignant fibrous histiocytoma (MFH) of the spleen is extremely rare. Since the first description of primary splenic MFH reported by Govoni et al in 1982, to the best of our knowledge, only 13 cases of MFH of the spleen have been reported in the English language literature in Medline. We herein report a rare case of primary splenic MFH accompanying with hepatic cyst in a 48-year-old Chinese female who treated successfully by laparoscopic splenectomy and fenestration, which has not yet been reported in the literature. Compared with the 13 previously cases of MFH of the spleen, our case is the first case accompanied with other disease, and also the first case treated successfully by laparoscopic splenectomy. A literature review of MFH of the spleen previously reported in the English language literature in Medline is also provided.

We describe a case of intracranial malignant fibrous histiocytoma which had infiltrated pons, cerebellum and basal surface of left temporal lobe without any visible mass. The patient presented with a sudden loss of consciousness and vomiting. Clinical findings, laboratory tests, imaging and examination of the cerebrospinal fluid tended to establish the diagnosis of an infectious condition than a malignancy. Without any response to the antibiotics and with a progressive deterioration of neurologic and mental condition, the patient died after 20 days. In the autopsy, histological and immunohistochemical study of the brain revealed the diagnosis of malignant fibrous histiocytoma (MFH).

interestedly read the published article by Kalantari et al. in your journal recently.1 Hepatitis C virus (HCV) infection is one of the main causes of liver disease in Iran.2, 3 The standard therapy with alpha interferon and ribavirin can eradicate the virus in about 50% of patients.4 Therefore, it necessitates studying other HCV infection treatment drugs.There are some reports about safety and efficacy of herbal medicine in chronic liver disease management.5, 6 The most known herbal medicine is Silybum marianum (milk thistle) which is reported to be safe with no serious adverse effects.5 First of all, I would like to mention that insulin resistance has an important role in nonalcoholic fatty liver disease and HCV infection.7 Considering the proposed role of oxidative stress in pathogenesis of liver disease, using antioxidants, such as silymarin, has been reported to be effective in treatment of different types of liver disease, especially nonalcoholic fatty liver disease.8-10

Many thanks for providing us with the opportunity to discuss our article entitled: Effects of silybum marianum on patients with chronic hepatitis C virus (HCV).1 We were glad to receive Dr.Alavian's comment entitled “Herbal medicine and liver disease, for any conclusion we need more studies”. HCV is a major cause of liver-related morbidity and mortality.2 Ribavirin plus interferon combination therapy is presently considered as an optimal treatment for patients with chronic hepatitis C, but the recommended treatment regimen is concerned with considerable expense, adverse effects and poor efficacy in some patients. Although the popularity of silymarin has been increased in people with liver diseases,3,4 a few evidences with controversial results exist regarding the effect of silymarin on chronic HCV infection.