Acta Medica Iranica
Volume:49 Issue: 6, Jun 2011

Metopism had been observed as a genetic trait. Recent studies have brought to light that it can get as an indicator of cranial pathology. An example of this pathology has been studied by this author on an Iranian skeletal sample. The purpose of this paper is to provide basic information on the subject and thereby to create awareness among Iranian anthropologists and archaeologists of this new line of evidence as well as to pathologists.

There are some herbal plants in Iranian traditional system of medicine which are believed to be excellent remedies to alleviate the symptoms of xerostomia. The aim of the present study was to evaluate the effect of systemic administration of seven different herbal extracts on the rate of salivation in rats. The extracts of 7 herbs; Zingiber officinale Roscoe (Zingiberaceae), Citrus sinensis (L.) Osbeck (Rutaceae), Artemisia absinthium L. (Asteraceae), Cichorium intybus L. (Asteraceae), Pimpinella anisum L.(Apiaceae), Portulaca oleracea L.(Portulacaceae), Tribulus terrestris L. (Zygophyllaceae) were prepared. Nine groups of animals (including negative and positive control groups) were used and seven rats were tested in each group. After the injection of extracts, saliva volume was measured gravimetrically in four continuous seven-minute intervals. The results showed that after injection of ginger extracts salivation was significantly higher as compared to the negative control group and other herbal extracts in all of the four intervals (P<0.01). The peak action of the ginger was during the first 7-minute interval and following this, salivation decreased to some extent. The present study suggests that the extract of Zingiber offiicianle can increase the rate of salivation significantly in animal model. Further investigations on different constituents of ginger seem to be essential to identify the responsible constituent for stimulation of saliva secretion.

A major function of the enterocytes is absorption, processing, and export of dietary lipids into the lymphatic system. Pluronic L-81 is a non-ionic hydrophobic surfactant, which specifically inhibits lipid absorption in the intestine when administered in vivo. This compound is therefore an attractive probe to perturb and investigate the molecular and intracellular events in chylomicron assembly in the enterocytes. In the present study pluronic acid was administered to hamsters followed by isolation of the enterocytes and cell fractionation to investigate the effect of pluronic acid on intracellular events in lipid absorption. Four types of diet were administered to hamsters for three weeks; low-fat chow, high-fat chow and each diet with or without added pluronic acid. Sub-cellular fractions of freshly isolated enterocytes were prepared. Consistent with morphological observation, the high fat diet resulted in a three-fold increase in the triacylglycerol (TAG) content of the enterocytes and addition of pluronic acid to either the low fat or the high fat diets resulted in a ten-fold increase in cellular TAG levels. Determination of the mass of TAG and the time course of incorporation of 3H-triolein, administered by gavage, showed that the increased TAG was recovered in the microsomal (endoplasmic reticulum) fraction and the cytosol. In microsomes, increased TAG was recovered mainly in the membrane although there was a significant amount in the microsomal luminal contents. Pluronic acid therefore acts at the level of the endoplasmic reticulum and inhibits the assembly of apo-B48 with chylomicron TAG. The excess TAG is transferred to cytosolic stores.

Appendicitis is the most common surgical emergency with the incidence rate of 6-10%. Although several studies have compared the two approaches of open (OA) and laparoscopic appendectomy (LA) the technique of choice is still a matter of controversy. Considering this background we designed a study to compare OA and LA outcomes in our center. One hundred patients were included in this study performed from April 2008 to April 2009 at Shahid Sadoughi hospital, Yazd, Iran. Patients who gave informed consent were randomized to either OA or LA groups and were operated by McBurney's or laparoscopic technique, respectively. Patients received our center's routine diet, antibiotics and analgesic regimens. The patient's pain was measured by visual analogue scale (VAS) at their entrance to the recovery room and in 6-hour intervals up to 24 hours. Post-operation follow up visits were in weeks 1, 2 and 4. The data of operation time, hospital stay, intra-operation complications, time to resume normal activity, short term complications and neuralgia were collected and analysed. The average operation time was 34.48.42 min in LA and 41.78.84 in OA hand (P=0001). No intra-operative complication and no LA to OA conversion were encountered in operations. Post-operative complication rate was higher in OA group (n=10) compared to LA (n=3). The post-operative pain showed less pain in OA only at 6 and 12 hours post-operative times. Patient's mean hospital stay was 52.3219.2 and 42.9613.8 hours in LA and OA groups, respectively (P=0.003). Time to resume normal activity didnt show a significant difference between two groups (P=0.53). Only one case of neuralgia in the OA group was confronted in the follow up visits. LA has less complications and cosmetic scar with the cost of more pain. Decision between OA and LA for each patient should be made individually.

Distal junctional kyphosis (DJK) is a radiographic finding in patients that undergo spinal instrumentation and fusion, since there is an abrupt transition between fixed and mobile spinal segments.The true incidence of DJK is variable in literature and seems that has a multifactorial etiology. A consecutive series of 130 patients (mean age 15.6 years) with Adolescent Idiopathic Scoliosis who underwent posterior spinal fusion and instrumentation were evaluated by analyzing coronal and sagittal angulation and balance measurements from standing radiographs obtained pre-operatively, within 6 weeks post-operation, at two years postoperative and at the latest follow-up. There was 35 male and 95 female. The mean time of follow-up was 36 months. The incidence of DJK at latest follow-up was 6.9% (9 patients). In DJK group, distal junctional angle from pre-operative of -12.5 lordosis (-30 to 0) reached to -5.5 (P=0.015) at 6 weeks postoperation and to -1.4 (-20 to 12 ̊) (P=0.000) at 2 years follow-up,with mean of 12.1 kyphotic change (10-20 ̊). In non DJK group, distal junctional angle from pre-operative angle of -7.5 reached -8.1 at 2 years follow-up (P=0.43). The mean age of DJK group at surgery was 17 years and for non-DJK group was 15.4 years (P=0.022). Distal junctional kyphosis was less common in this study than previous reports and stabilized after two years. The magnitude of coronal cobb angles or multiplicity of coronal curves had no effect in developing DJK that may be prevented by incorporation of the first lordotic disc into the fusion construct.

Functional mitral regurgitation (MR) results from left ventricular remodeling, leaflet tethering or tenting. Coronary artery disease is one of the important causes of functional MR due to tethering. Detection of functional MR and its severity are important factors in patient prognosis. There are different methods for detection of functional MR and its severity, including anterior mitral leaflet concavity area (AMLCA). In this cross sectional study 32 patients, 19 male with three vessel disease (3VD) who were candidate for coronary artery bypass grafting (CABG) with or without mitral valve replacement were selected. The patients had functional MR in ventriculography. AMLCA was determined by long axis view of transthorasic echocardiography (TTE). In this study 32 patients with 3VD and MR were selected (15 mild, 15 moderate and 2 cases with severe MR). The mean age was 62 ± 12 years. In these patients AMLCA were 0.1- 0.43 cm2 in transthorasic echocardiography. The findings of this study showed strong association between anterior mitral leaflet concavity area and functional MR severity (r=0.89) in parasternal long axis (LAX) view of TTE. According to these findings the relation between functional MR and AMLCA was a linear relationship and increase in severity of functional MR was in concordance with increasing of anterior mitral leaflet concavity area (P=0.001). Mitral leaflet concavity area in the parasternal LAX view provides rapid and reliable recognition of functional MR due to coronary artery disease and is quantitatively related to the degree of such MR. We recommend further study with more subjects and ischemic functional MR and AMLCA.

More than eighty percent of patients with coronary heart diseases (CHD) have conventional risk factors. Prevalence of well known risk factors seems to show a different pattern in younger patients and individual above 55 years. To evaluate the pattern of conventional CHD risk factors in healthy individuals in two different age groups. A large scale population based survey of 31999 individuals from ten medical centers was designed. Screening of risk factors was performed upon these protocols: taking medical history, physical examination and blood tests of complete blood cell counts, fasting blood sugar, lipid profile, urinalysis and creatinine. Prevalence of the risk factors in healthy people aged above 55 years were: 8.1% for systolic blood pressure (SBP)>140 mmHg, 3.8% for diastolic blood pressure (DBP)>90mmHg, 13.9% for fasting blood glucose (FBS)≥126 Mg/dl, 36.9% for total cholesterol>200 Mg/dl, 19.2% for triglyceride (TG)>200 Mg/dl, 67.8% for HDL-c<40 Mg/dl, 27.2% for LDL-c>130 Mg/dl, 4.72 for TC/HDL-c ratio, 2.88 for LDL-c/HDL/c ratio and 4.24 for TG/HDL-c ratio. Prevalence of risk factors in individuals younger than 55 years were: 1.7% for SBP>140 mmHg, 1.2% for DBP>90 mmHg, 5.2% for FBS≥126 Mg/dl, 31.3% for TC>200 Mg/dl, 21.5% for TG>200 Mg/dl, 69.4% for HDL-c<40 Mg/dl, 23.2% for LDL-c>130 Mg/dl, 4.7 for TC/HDL-c ratio, 2.83 for LDL-c/HDL-c ratio and 4.43 for TG/HDL-c ratio. In univariate model of analysis: prevalence of the risk factors were significantly higher in age above 55 years than in people younger than 55 years except for hypertriglyceridemia and HDL-c<40 Mg/dl. In a multivariate model of logistic regression, pattern of following CHD risk factors remained to demonstrate a statistically significance difference between two age groups: FBS≥126 Mg/dl P=0.006, TG>200 Mg/dl P= 0.002, HDL-c<40 Mg/dl P= 0.019, education status P=0.001, sex P=0.012, and SBP>140 mmHg P=0.001. Pattern of such a CHD risk factors of FBS≥126 Mg/dl, TG>200 Mg/dl, HDL-c<40 Mg/dl, education status, sex and SBP>140 mmHg demonstrated a statistically significant difference in the age above 55 years to the healthy people younger than 55 years. These results cab be implicated to set up prediction models for stratifying individuals at higher risk of CHD.

Acute glomerulonephritis (AGN) is a type of renal disease which indicates the inflammation of glomerulus and nephrons. This study was carried on 94 children, <15 years old with the diagnosis of AGN who were admitted to Qom and Yazd's hospitals between 2000 and 2006. Data were collected using hospital records on admission, progression notes and outpatient follow up. Among 94 patients, 55.3% were male and 44.6% were female. Mean age of patients was 8.2±2.7 years old. Acute post streptococcal glomerulonephritis (APSGN) was reported in 92.5%, membranoproliferative glomerulonephritis in 4.2%, hemolytic uremic syndrome in 2.1% and IgA nephropathy in 1.06%. There was no significant differences between GN types and gender (P=0.54). Clinical manifestation included edema in 68.8%, oliguria in 36.3%, gross hematuria in 69.1%, HTN in 61.7% and anuria in 1.06%. Microscopic hematuria was detected in all patients. In the time of follow up none of patients had hypertension, 3.1% had proteinuria and 6.3% had microscopic hematuria. APSGN is the most common causes of AGN in Qom and Yazd's children. Early diagnosis and treatment of APSGN may protect children from long term morbidity and mortality and improve quality of life.

Tetanus can be only prevented by vaccination because immunity against this disease is rarely acquired, even by natural infections. To maintain long-term protective immunity against tetanus, booster immunization is essential for adolescents and adults. Most hospitalized cases and virtually all deaths occur in people over 60 years of age. The purpose of this study was to investigate the degree of protective tetanus immunity among 50 years of age and older people in Kashan city, Iran. This cross-sectional study carried out on 180 randomly individuals aged 50 years or older who were visiting a central laboratory for health examinations in 2008. Participant's serum levels of tetanus antitoxin were measured by enzyme linked immunosorbent assay. A standard questionnaire was used to collect demographic data and information about risk factors. The prevalence of protective tetanus immunity in various age groups was described and sociodemographic factors that potentially influenced the degree of tetanus immunity were analyzed. Overall, 180 persons were included. Of these, 72 (40%) had never received a toxoid booster, while 47 (26.1%) had received a booster at least once. Among all participants, 30 (16.7%) had protective tetanus antitoxin levels (≥ 0.11 IU/mL), and 34 (18.9%) had protective antitoxin levels without the need of an immediate booster ≥0.51 IU/mL. Among 86 participants aged >60 years, 6 (7%) had protective antitoxin levels ≥0.1-1 IU/mL, and 5(5.8%) had protective antitoxin levels ≥1 IU/mL. Male gender and prior receipt of toxoid booster(s) were associated with protective tetanus immunity. Tetanus antitoxin levels declined with age. It appears that most 50 years of age and older adults do not have protective levels of tetanus antitoxin because of inadequate vaccination coverage. There is a need to improve the immunity levels of this age group. It is recommended to vaccinate elderly people against tetanus.

Doubtlessly one of the major problems in Iran is drug abuse or substance abuse. The transmission of HIV/AIDS has made the problem so complicated that has created an urgent need for a campaign against this awful phenomenon. The objective of this study-that was carried out through the cross-sectional method- is considering the situation of the addict death and the related factors. The target population consists of the corpses of the addicts referred to the Legal Medicine Organization of Tehran during 2007 and 2008. The cadavers were examined in the preliminary stage. The blood, urine and the contents of the gall-bladder, stomach and viscera were collected and sent to the toxicology laboratory to examine and find narcotics metabolites and other drugs. The samples of the brain, heart, lungs, liver and kidneys were sent to the pathology laboratories. All of the extracted data were recorded and analyzed using SPSS software. It was diagnosed that 248 cases (79.7%) out of the total 311 in this study, died of substance abuse. Totally 300 cases were reported as male addicts (96.5%). The oldest and youngest addicts were 49 and 17 respectively. The most frequent drugs used were heroin and combination of heroin and opium. No meaningful difference was observed between the death cause of different groups of drug abusers. It seems that the increase in the population of the substance users is the main cause of frequency changes of the addict's deaths.

There is a growing interest of clinical and epidemiological researches in the field of functional gastrointestinal disorders in our society. Accordingly, validated and culturally adapted instruments are required for appropriate measurement of variables specially the quality of life. The aim of our study was the linguistic validation of the Irritable Bowel Syndrome-Quality of Life questionnaire (IBS-QOL) for Iranian IBS patients with Persian language. Following the standard forward-backward translation method, the IBS-QOL was translated into the Persian language and completed by 141 IBS patients. Patients also completed the IBS Symptom Severity Scale (IBS-SSS) and Hospital Anxiety and Depression Scale (HADS). One-week retest was performed on 30 randomly selected patients. Internal consistency and test-retest reliability were assessed using Cronbach's alpha and intraclass correlation coefficient (ICC), respectively. To analyze the discriminant validity, the IBS-QOL scores was correlated to the IBS-SSS and HADS scores. According to the results, reliability analyses were acceptable for all of the IBS-QOL domains (Cronbach's alpha=0.68 to 0.90 and ICCs=0.77 to 0.91). Discriminant validity was supported by the presence of correlations of the IBS-QOL scores with disease severity (r = -0.628), depression (r = -0.692), and anxiety (r = -0.711) scores; P < 0.001. These results indicate that the Persian version of the IBS-QOL is a reliable instrument with sufficient psychometric requirements to assess quality of life in Iranian IBS patients with Persian language.

Placenta increta, a rare complication of pregnancy, is associated with significant postpartum hemorrhage often requiring emergency hysterectomy. We report a case of conservative management, with a combination of parenteral methotrexate, serial ultrasound and β-hCG assessment. Serum β-hCG levels were undetectable after 8 weeks of therapy. A scan at 6 months showed complete involution of the uterus. Review of the literature discussing the diagnostic tools, clinical features, management and outcome of pregnancies with placenta increta.

We report a 27-year-old hemophilic male who was HIV positive and under Highly Active Antiretroviral Therapy (HAART) along with wart lesions. When IMOD therapy started concurrently with HAART, the skin lesions disappeared.

Presentation of an unusual case of cerebral aspergillosis in an immune competent patient who was treated successfully but symptoms and signs of a demyelinating process following initial recovery has been occurred. A 29-year-old male with focal seizure. Brain MRI revealed small multiple hemispheric and dural lesions. An open biopsy was conducted. Histological evaluation revealed hyphe-like structure in the necrotic area, within vessel walls, and lumina, suggestive aspergillus fumigatus. Furthermore, brancheal hyphae in potassium hydrxide15% and colonies on sabourud dextrose agar were observed. Based of the above findings the patient underwent anti fungal therapy. The patient recovered and continued a normal life however a follow up MRI was performed after 3 months from recovery. No significant abnormality was observed from the MRI procedure. One month later the patient developed signs and symptoms of spinal cord involvement which seemed to be the result of myelitis. A brain MR showed no abnormalities. Therefore it seemed reasonable to administer corticosteroid as a treatment for suspected active demyelinating process. During the above treatment, signs and symptoms of myelopathy disappeared and a whole spine MRI showed remarkable improvement.