Acta Medica Iranica
Volume:49 Issue: 11, Nov 2011

Intravenous hydralazine is a commonly administered arteriolar vasodilator that is effective for hypertensive emergencies associated with pregnancy. Oral nifedipine is an alternative in management of these patients. In this study the efficacy of nifedipine and hydralazine in pregnancy was compared in a group of Iranian patients. Fifty hypertensive pregnant women were enrolled in the study. A randomized clinical trial was performed, in which patients in two groups received intravenus hydralazine or oral nifedipine to achieve target blood pressure reduction. The primary outcomes measured were the time and doses required for desired blood pressure achievement. Secondary measures included urinary output and maternal and neonatal side effects. The time required for reduction in systolic and diastolic blood pressure was shorter for oral nifedipine group (24.0±10.0 min) than intravenus Hydralazine group (34.8±18.8 min) (P≤0.016). Less frequent doses were required with oral nifedipine (1.2±0.5) compared to intravenus hydralazine (2.1±1.0) (P≤0.0005). There were no episodes of hypotension after hydralazine and one after nifedipine. Nifedipine and hydralazine are safe and effective antihypertensive drugs, showing a controlled and comparable blood pressure reduction in women with hypertensive emergencies in pregnancy. Both drugs reduce episodes of persistent severe hypertension. Considering pharmacokinetic properties of nifedipine such as rapid onset and long duration of action, the good oral bioavailability and less frequent side effects, it looks more preferable in hypertension emergencies of pregnancy than hydralazine.

Squamous-cell carcinoma (SCC) of the eye conjunctiva is a rare tumor. Its link with immune impairment suggests that infectious agents such as human papillomavirus (HPV) may be involved in the etiology of SCC. We conducted a case-control study on 50 SCC cases (mean age: 65.2) and 50 age frequency-matched control patients with lesion-free, normal conjunctival biopsies (mean age: 63.8) obtained from the cancer registry archive at Pathology Department of Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran, where SCC has become the most common conjunctival malignancy. MY/GP nested PCR was performed for HPV detection and E6/E7 consensus primers in combination of type specific primers were used in another nested PCR series for HPV typing. HPV DNA was detected in 46 of 50 samples of squamous cell carcinoma and none of the normal biopsies by nested PCR using primer sets of the HPV consensus L1 region (MY/GP). Subsequently, specimens from the 46 positive cases were subjected to specific PCR. Although 630bp amplicon was produced in 44 of 46 samples (E6/E7 primers), none of the specific HPV PCR reactions for HPV DNA type 16, 18, 31 or 33 resulted in the detection of HPV DNA in the 44 SCC specimens of the conjunctiva. Current results confirm the role of HPV in the etiology of conjunctival SCC. The absence of HPV 16, 18, 31 and 33 in conjunctival SCC in this study raise doubts about the role of genital types of HPV in conjunctival carcinomas.

This study aimed to assess the relationship between the serum levels of anti-mullerian hormone (AMH) and other hormonal markers and results of assisted reproductive techniques (ART) in polycystic ovary syndrome (PCOS) patients. This cohort study was conducted on 60 PCOS patients who were candidates for assisted reproductive techniques. In all patients the serum levels of AMH, follicle stimulating hormone (FSH) and luteinizing hormone (LH), estradiol (E2), free testosterone (fT), testosterone (T) and inhibin B were measured in the 3rd day of menstrual cycle. The relationship between serum level of measured hormonal markers with retrieved oocytes, mature oocytes, the number of transferred fetus and pregnancy rate were assessed. The cut-off value for the serum level of AMH and retrieved oocytes were determined. There was a significant direct correlation between the serum mullerian inhibiting substance (MIS) level with number of total picked up oocytes (r=0.412), mature oocytes (r=0.472) and embryo transfer (r=0.291). There was a linear and significant correlation between inhibin B and fertilization (r=0.283) Cut-off point for AMH level according to presence or absence of pregnancy was 4.8 ng/ml and it was not statistically significant (P=0.655). Area under curve (AUC) was 0.543. Cut-off point for MIS according to picked up oocytes was 2.7 ng/ml with area under the curve (ROC curve) of 0.724 (CI= 0.591-0.831) (P=0.002). Patients with PCOS who had AMH more than 2.7 ng/ml, the number of retrieved oocytes (6 or more) was higher than MIS/AMH <2.7 ng/ml (P=0.002). As a marker of ovarian responsiveness to controlled ovarian hyperstimulation (COH) and despite a small sample size of our study, it is revealed that pretreatment MIS/AMH is highly associated with the number of mature oocytes retrieved during COH in PCOS women.

There is some evidence indicating the role of Helicobacter pylori infection in pathogenesis of extragastrointestinal diseases including skin, vascular, and autoimmune disorders, as well as some respiratory diseases. The aim of this study was to investigate the association between H. pylori and chronic obstructive pulmonary disease (COPD). In a case-control study, 90 patients with COPD and 90 age- and sex- matched control subjects were included. Serum samples were tested for anti-H. pylori and anti-CagA IgG by ELISA. A physician completed a questionnaire including demographic characteristics, habitual history, and spirometric findings for each patient. Of 90 patients with COPD 66 (51%) had mild, 31 (34.4%) moderate, and 13 (14.4%) sever disease. There was no significant association between H. pylori IgG seropositivity and COPD. Serum levels of anti-CagA IgG were significantly higher in patients with COPD than in the control subjects (P < 0.001). No association was observed between H. pylori infection and severity of COPD. The results suggest that there is an association between CagA-positive H. pylori infections and COPD. Further studies should be planned to investigate the potential pathogenic mechanisms that might underlie these associations.

Aim of our study was to investigate the effects of exposure to industrial noise on serum lipid profile among workers who are exposed to noise at work. In a historical cohort study, we recruited 154 and 146 male workers as high and low level noise exposure groups respectively. We defined workers with at least one year exposure to noise level more than 90 dB as high exposure group, and those with exposure to less than 80 dB as low exposure group. Afterwards, in the fasting blood specimens of participants we measured serum Triglyceride (TG), total Cholesterol (TC), high and low density lipoprotein (HDL and LDL). Mean of TG, TC, HDL and LDL for low exposure group were 148, 189, 38 and 103 mg/dl and for high exposure group were 237, 189, 37 and 104 mg/dl respectively. Mean serum TG between two groups was different. Even after adjustment for age, BMI, smoking and work hours per week, serum TG among high exposure group was 89 mg/dl higher than low exposure group and this difference was statistically significant (P=0.00). There was no significant difference between two groups in TC, LDL and HDL levels. This study did not find a statistically significant relationship between exposure to noise and serum TC, LDL and HDL, but TG in two groups was different and this difference was statistically significant.

Pattern of the coronary artery disease (CAD) risk factors across body mass index (BMI) categories remains uncertain. There is a different threshold of obesity for increasing cardiovascular hazard across populations, accordingly recognition and management of obesity and overweight can guide better control of CAD epidemic in the national level. To determine the discrepancy in the prevalence of CAD risk factors across five BMI categories. A population based survey of 28566 participants recruited to medical screening of taxi drivres in Tehran (MSTDT) was designed. According to a standardized protocol data on CAD risk factors were obtained by taking medical history, examination and laboratory tests. After adjustment for age, sex, literacy, smoking, systolic blood pressure (SBP), fasting blood sugar (FBS), and LDL-C/HDL-C ratio, these CAD risk factors of diastolic blood pressure (DBP)>90 mmHg, hypertriglyceridemia, high triglyceride/ HDL-C ratio, hypercholesterolemia, and high cholesterol/HDL-C ratio were increased significantly across five incremental categories of BMI. Prevalence of DBP> 90 mmHg, hypertriglyceridemia, hyper cholesterolemia and ratios of cholesterol/ HDL-C and TG/HDL-C increased considerably across five groups of BMI. This pattern is different from previous research and our results endorsed more features of pattern of CAD risk factors across BMI categories.

Despite an increasing prevalence of obesity and hypertension in young age, there is limited information on the contribution of body mass index (BMI) to blood pressure (BP) in these populations, especially in developing countries. This study examines the association between BMI and BP in four populations of school age children across southern region of Islamic republic of Iran.

Elongation and calcification of the stylohyoid apparatus is probably related to Eagle's syndrome and may cause such symptoms as facial pain and dysphagia in patients. In the present study, the relationship between serum calcium level and stylohyoid apparatus length was studied in adults referring to the dental college of Yazd. This was a cross-sectional descriptive study on 50 adult patients above 20 years old (28 men, and 22 women) referring to the radiology ward of the dental college. The stylohyoid ligaments were measured from the base of the skull to the bony tip of each appendix by panoramic radiograph. Mineralization of the ligaments more than 30 mm on the panoramic radiographs was considered abnormal. The serum calcium level of all patients was then measured. Data were analyzed by t-test and Pearson's correlation analysis. Mean length of the stylohyoid apparatus was 27.36 ± 9.10 mm and was not related to age and sex. An elongation rate of 26% was obtained. The mean serum calcium level was 9.39 ± 0.57 mg/dl and there was not a statistically significant difference in serum calcium level between various age groups and genders. There was no relationship between the length of the stylohyoid apparatus of each side and serum calcium concentrations in different age groups. It appears that the length of the stylohyoid apparatus is not related to serum calcium level within our patient population.

Welding is a process in which two or more metals are attached by the use of heat and, in some cases, pressure. Direct exposure and inhalation of welding fumes causes acute and chronic side effects in humans. Kidney damage is one of these important side effects. β2 microglobulin is an 11.8 kilodalton protein and levels increase in the case of some inflammatory and viral diseases, or kidney malfunction and autoimmune diseases. In this study measurements of β2 microglobulin were used as a criterion for assessing effects on the kidneys of workers exposed to welding fumes. The study population were electric arc welders in an industrial plant in Tehran, Iran. For control we selected workers who did not have any exposure to welding fumes. Both groups were selected on the basis of a questionnaire and the consideration of criteria for inclusion and exclusion. In the end 50 cases and 50 controls were chosen. A urine sample was collected from all participants and urinary pH was set to between 6-8 using NaOH (1M). Sample transportation to the laboratory complied with the related standards. The samples were assessed using the ORG 5BM kit. For quantitative assessment of β2 microglobulin we used the Enzyme-linked Immunosorbent Assay (ELISA) method. The ages of the welders ranged from 21 to 48 years (mean=30.5±5.9 yrs) and of controls from 23 to 56 years (mean=31.8±5.9 yrs). Mean employment duration was 7.86±5.01years (range 2 to 27 years) for welders. Mean β2 microglobulin level was 0.10±0.096 μg/ml in welders and 0.11±0.06 in controls. This difference was not statistically significant (P=0.381). In conclusion we dont find that exposure to electric arc welding fumes cause a significant change in urinary β2 microglobulin compared to the control group.

Integration is an important educational strategy in medical education. Considering this idea, the goal of the present study was to design and implementation of longitudinal and vertical integrated education of anatomy, physiology, pharmacology, neurology and neuropsychiatry subjects of brain's basal ganglia by a multidisciplinary team. Kern's approach to curriculum development was used. Participants were 20 medical students at basic science level who contribute in a 10 stations of pre-test exam at Medical School's Skill Lab. After the implementation of the module by a multidisciplinary team, post-test were done. A structured questionnaire was designed to assess student opinions about adequacy, usefulness of the module using a Likert scale with 5 categories ranging from "completely agreement" to "completely disagreement". The result of pre and post-test were also compared. Twenty questionnaires were completed, giving a 77.63% satisfaction rate. Seventy-five percent of students found it useful and appropriate at basic science level. About fifty percent of students suggested the implementation of this module for other medical students. The score of post-test was significantly (14.52±0.47 vs 6.32±0.62, P<0.05) higher than pre-test results. The viewpoints of medical students were positive and they value the module highly. Since it is not easy to change the style we teach, these results suggest necessitate of supporting the faculty member's participation in these modules.

Malignant tumors of pancreas are usually primary neoplasms and pancreatic metastases are rare findings. We are reporting a case of squamous cell carcinoma (SCC) of the esophagus with pancreatic metastasis. A 59-year old woman was admitted with chief complaint of abdominal pain and mass. She was a known case of esophageal SCC since 4 years before when she had undergone transthoracic esophagectomy and cervical esophago-gastrostomy. In order to evaluate recent abdominal mass, CT scan was done which revealed septated cystic lesion in the body and the tail of the pancreas. Palliative resection of the tumor was performed and its histological study showed SCC compatible with her previously diagnosed esophageal cancer.

We present a 24-year-old female referred with non-healing wound of a few days duration on anterior aspect of her right foreleg. Biopsy of the wound was reported to be pyoderma gangrenosum on pathologic report. Further work up of the patient for high grade fever and occasional leukopenias revealed the diagnosis of cyclic neutropenia. Treatment with granulocyte colony-stimulating factor (G-CSF) resulted in patient's neutrophil counts correction and dramatic improvement in healing of her lower extremity wound.

Superior mesenteric artery (SMA) aneurysm is a rare disease. In this case report, we present a 32 years old woman who was admitted to our hospital with chronic abdominal pain. SMA aneurysm was diagnosed after radiological evaluation. The patient underwent ligation of the superior mesenteric artery aneurysm and remained well 12 months after the surgery.