Iranian Red Crescent Medical Journal
Volume:14 Issue: 1, Jul 2012

The history of tuberculosis (TB) traces back to antiquity. Despite significant progress of various diagnostic methods and introduction of anti-tuberculosis drugs in past decades, TB is still a major worldwide health concern which leads annually to two million deaths, especially after the emergence of multidrug-resistant Mycobacterium TB and HIV co-infection. Presented here is a brief review of conventional and new TB diagnostic laboratory methods including their advantages and disadvantages as well as common challenges in diagnosis and management of TB..

Oral Lichen planus (OLP) is a chronic lesion of the oral mucosa with unknown origin. Basement membrane changes are common in OLP and may be mediated by proteases such as matrix metalloproteinase (MMPs) and mast cell chymase. The aim of our study was to evaluate the level of serum MMP-3 in OLP compared to normal individuals and assess its clinical significance.. Thirty four serum samples from patients diagnosed with OLP (12 males, 22 females, age: 42.2±10.8 years) and 34 serum samples from healthy control subjects (11 males, 23 females, age: 42.5±13.3 years) were collected and MMP-3 concentration was measured by ELISA.. The serum MMP-3 level in OLP patients was higher (21.64±24.31 ng/ml) compared with healthy controls (16.52±23.63 ng/ml), but showed no statistically significant difference. A statistically significant difference was demonstrated between the two types of OLP, being more pronounced in the erosive/atrophic form 6).. The different clinical appearances of OLP are associated with significant differences in MMP-3 serum level..

Restless leg syndrome (RLS) is defined as an uncomfortable feeling in the limbs which is prominently sensed in legs. Dopamine system involvement is considered as the base of RLS’s etiology. Because of safety, anti-oxidant and dopaminergic promoting action of selenium, this study aims to investigate the effect of selenium on restless leg syndrome treatment.. Sixty patients with primary RLS were enrolled in this clinical trial (Irct2011103015943n1). It was based on 3 periods of drug prescription with one month wash out period. As placebo, 50 and 200 µg of selenium were administered in each separated month. The diagnosis was based on criteria published by IRLSG (International RLS Study Group). The questionnaire included 10 questions while each question’s rating was between 0 and 4. Points between 1 and 10 were considered mild, 11 to 20 as moderate, 21 to 30 as severe and 31 to 40 as very severe. After end of each month of drug consumption, questionnaires were completed and each subject was asked to report the severity of disease and side effects of the drugs. At least 10 declines in scale were considered as appropriate responses.. Improvement (decline IRLS score >10) was significantly higher in selenium (50 and 200 µg) than placebo group.. Selenium prescription in daily recommended dose of 50 µg instead of a dopamine agonist would be an alternative treatment in improvement of RLS symptoms..

Preeclampsia is one of the most serious complications, and affecting about 3% of pregnancies. The aim of this study was to estimate the impact short duration of exposure to sperm on development of preeclampsia.. The duration of sperm exposure with the biological father (cohabitation without barrier methods) <3, <6 months were evaluated among 120 primigravid women with preeclampsia and 120 women without preeclampsia in a case-control study.. The short duration of exposure to sperm was more common in women with preeclampsia compared with controls (29.2 versus 14.2 for <3 months, adjOR 2.6 (95% CI=1.32-5.13) and (45 versus 29.2 for <6 months, adjOR 2.4 (95% CI=1.35-4.32). Regardless of the contraceptive method, short duration of cohabitation was more common in preeclamptic group (14.2 versus 5.8 for <3 months, adjOR 3.38 (95% CI=1.28-8.92) and (29.7 versus 13.3 for <6 months, adjOR 2.64(95% CI=1.24-5.79).. It was concluded that short duration of exposure to sperm was more common in women with preeclampsia compared with controls..

Non-syndromic cleft lip with or without cleft palate (CL/P) or cleft palate only (CPO) are orofacial clefts with multifactorial etiology. These include environmental factors and heterogeneous genetic background. Therefore, studies on different and homogenous populations can be useful in detecting related factors. The aim of the present study was to evaluate the risk factors in patients with non-syndromic cleft in Tehran, Iran.. Data from 300 patients and 300 controls were collected between 2005 and 2010. Binary logistic regression analyses were used to calculate relative risk by odds ratio (OR) and %95 confidence interval.. Low maternal age (OR=1.06, 95% CI, 1.011-1.113), low socioeconomic status (OR=0.23, 95% CI, 0.007-0.074), maternal systemic disease (OR=0.364; 95% CI, 0.152-0.873) and passive smoking (OR=0.613, 95% CI, 0.430-0.874) increased the risk for CL/P and CPO. There was a significant difference in iron and folic acid use during pregnancy when the case and control groups were compared.. In assessing for orofacial cleft risk, we should consider lack of folic acid supplementation use, maternal age and systemic diseases and passive smoking as risk factors..

We already showed the superiority of imputation of missing data (via Multivariable Imputation via Chained Equations (MICE) method) over exclusion of them; however, the methodology of MICE is complicated. Furthermore, easier imputation methods are available. The aim of this study was to compare them in terms of model composition and performance.. Three hundreds and ten breast cancer patients were recruited. Four approaches were applied to impute missing data. First we adopted an ad hoc method in which missing data for each variable was replaced by the median of observed values. Then 3 likelihood-based approaches were used. In the regression imputation, a regression model compared the variable with missing data to the rest of the variables. The regression equation was used to fill the missing data. The Expectation Maximum (E-M) algorithm was implemented in which missing data and regression parameters were estimated iteratively until convergence of regression parameters. Finally, the MICE method was applied. Models developed were compared in terms of variables significantly contributed to the multifactorial analysis, sensitivity and specificity... All candidate variables significantly contributed to the MICE model. However, grade of disease lost its effect in other three models. The MICE model showed the best performance followed by E-M model.. Among imputation methods, final models were not the same, in terms of composition and performance. Therefore, modern imputation methods are recommended to recover the information..

Donor recruitment and retention are significant problems in blood collection agencies around the world. The Aim of this study was to determine the causes of lack of interest to blood donation in eligible individuals in Mashhad, Northeast of Iran.. This was a descriptive study. Cases were 1130 non-donor individuals. Participants were selected from eligible individuals in different regions of Mashhad. In this study, surveys included information about age groups, gender, residence area, marriage, education; living situation and job as background variables.. Less than 30% of the cases had enough knowledge about blood donation. There was a significant relationship between location, age, education, occupation and social status with knowledge of blood donation, but there was not a correlation between gender and marital status.. There are some factors which affect the decision for blood donation. There is a need to change the negative attitude by increasing the knowledge considering the individual and the social status..

Blended learning as a method of learning that includes face to face learning, pure E-learning and didactic learning. This study aims to investigate the efficacy of medical education by this approach.. This interventional study was performed in 130 students at different clinical levels participating in class sessions on “congenital adrenal hyperplasia and ambiguous genitalia”. Sampling was done gradually during 6 months and all of them filled a pretest questionnaire and received an educational compact disk. One week later, a presence class session was held in a question and answer and problem solving method. Two to four weeks later, they filled a posttest questionnaire.. There was a significant correlation between pretest and posttest scores and the posttest scores were significantly more than the pretest ones. Sub-specialized residents had the most and the students had the least attitude towards blended learning approach. There was a significant correlation between the research sample's accessibility to computer and their attitude and satisfaction to blended learning approach.. Findings generally showed that the blended learning was an effective approach in making a profound learning of academic subjects..

Symptomatic spontaneous spinal epidural hematoma(SSEH) is an uncommon cause of cord compression that commonly is considered as an indication for emergent surgical decompression. We aimed to investigate a patient with a SSEH that completely resolved clinically and radiographically, without surgical treatment. The patient presented three days after the sudden onset of back pain, numbness, and weakness. Magnetic Resonance Imaging (MRI) revealed a posterior thoracolumbar epidural hematoma extending from the level of T10 to L2 with significant cord compression. Decompression was recommended but he refused surgery and was managed conservatively. One month later, weakness totally recovered and hematoma was absent on MRI.

Atherosclerotic cardiovascular diseases are the major cause of death in middle-aged and older-adults.1,2 Today, inflammation is regarded as the key pathogenic mechanism in both initiation and progression of atherosclerosis.3 Inflammatory markers such as high sensitive C-reactive protein (CRP) have been used to identify patients at higher risk for coronary events. The prognostic value of CRP has been established for patients with acute coronary syndrome, stable coronary artery diseases4 and in apparently healthy people.5,6.Comprehensive cardiac rehabilitation is probably the most effective approach for cardiovascular reduction and long-term care of cardiac patients as well as subjects with multiple coronary risk factors.7,8 Secondary prevention, through cardiac rehabilitation program is now regarded as an essential component of contemporary management of patients with various presentations of coronary disease.9.There are some evidences that protective effects of cardiac rehabilitation may in part be related to lowering of inflammation. The goal of this prospective study was to assess the effect of cardiac rehabilitation on high sensitive CRP as a marker of increased risk of coronary artery disease..The subjects were randomly selected from patients with recent anterior wall myocardial infarction referring to Alzahra Cardiac Rehabilitation Center in Shiraz from May to December 2007. Inclusion criteria were males and females aged 30-75 years with anterior wall MI in past 1 month. Patients were divided into two groups. Group A consisted of 30 participants who received cardiac rehabilitation and group B consisting of 26 participants which did not receive any cardiac rehabilitation program. CRP levels were assessed before starting the program and eight weeks later. We used CRP Quantitative Diagnostic Kit for serum and plasma-Photometry technique. The data were analyzed by Wilcoxon Signed Rank and Mann-Whitney tests..The cardiac rehabilitation program included 8 weeks of exercise training, education and behavior modification therapy 3 times per week. The exercise training included arm and leg ergometry and treadmills. Behavioral modifications were smoking cessation, healthy nutrition, hypertension control, etc..The average age of patients was 62.7 years old. At enrollment, 66% (n=20) of participants in cardiac rehabilitation (group A) had CRP levels in the intermediate and high-risk range of >1 mg/dl and after completion of cardiac rehabilitation only 27% (n= 5) of patients had elevated CRP levels (p=0.0009). In the group B, 73% (n=19) of participants had CRP levels >1 mg/dl and after eight weeks, 53% (n=14) of them had CRP levels >1 mg/dl (p=0.50)..A higher CRP level was observed in patients <65 years of age participating in cardiac rehabilitation compared to those >65 years, but both age groups demonstrated significant improvements in CRP post-cardiac rehabilitation. This study showed a significant decrease in CRP levels in patients with cardiac disease after participation in cardiac rehabilitation program. The findings showed that cardiac rehabilitation decreased vascular inflammation accompanying improvement in risk factors..Regardless of gender, there was a significant decrease in CPR at the completion of cardiac rehabilitation. The decrease in inflammation along with previously described benefits of cardiac rehabilitation supports the recommendations of American Heart Association and American Association of Cardiovascular and Pulmonary Rehabilitation that participation in cardiac rehabilitation should be a part of comprehensive care of cardiac patients..The findings in our study had two important clinical implications. First, the potential independent effect of cardiac rehabilitation in lowering CRP levels was demonstrated which is independent from weight in our study. The non-pharmacologic mechanism for this observation may be due to dietary modifications, weight management and exercise components of the program. Secondly, the decrease in vascular inflammation associated with cardiac rehabilitation is evident regardless of gender, age and metabolic syndrome..

Editor,.Orofacial clefts are the most common congenital anomalies of the head and neck and its incidence ranges from 1/500 to 1/2000 live births, depending on populations.1 Etiology of these anomalies is multifactorial and includes both environmental and genetic factors. Many teratogenic agents and factors in pregnancy are claimed to cause clefting, such as maternal smoking and hypoxia2 and diabetes mellitus.3,4 The pivotal role of diabetes mellitus and maternal obesity on the incidence of orofacial clefts has been discussed previously.5.Adiponectin is 244-amino acid collagen-like polypeptide that is secreted by adipocytes and acts as an anti-inflammatory hormone and insulin sensitizer.6 Adiponectin exists in at least two forms, low molecular weight oligomer that is hexamers (two trimers) and high molecular weight oligomer consisting of four to six tirmers.7 Plasma concentration of this polypeptide in human blood ranges from 3 to 30 µg/ml and accounts for 0.05% of total plasma protein.8.Findings from animal studies and metabolic studies in human suggests that adiponectin has different properties, such as suppression of hepatic gluconeogenesis, stimulation of fatty acid oxidation in the liver, glucose uptake in skeletal muscle and stimulation of insulin secretion.8,9 According to most of the studies in different populations, higher adiponectin level is associated with a lower risk of diabetes10 and low plasma level of adiponectin is associated with increased insulin resistance both in children and adults.11.As we know, diabetes mellitus is one of the major risk factors of orofacial clefts.3 So it is suggested that lower adiponectin levels in diabetic pregnant women takes part as a risk factor for orofacial clefts. This hypothesis could be assessed by screening pregnant women with diabetes mellitus for serum adiponectin level, and then investigating the incidence of cleft lip and/or palate in their children in comparison to control group..According to our knowledge, diabetes mellitus is one of the important risk factors of orofacial clefts.3 Adiponectin is secreted by adipocytes and increases insulin sensitivity. Higher levels of adiponectin are associated with lower risk of diabetes mellitus and the dose-response relation is consistent. If the association between adiponectin level and orofacial clefts in pregnant mothers can be verified, then one of the major risk factors of orofacial clefts could be achieved. These evidences suggest adiponectin level can be used as a screening marker for early diagnosis of obesity related abnormalities..

Tuberculosis (TB) is responsible for a large portion of morbidity and mortality worldwide. According to WHO report, tuberculosis is responsible for at least 2 million deaths per year, so 90% of these occurring in developing countries.1,2 Recently, it has been shown that multidrug-resistance (MDR) and extensively drug-resistant tuberculosis (XDR-TB) are the most important factors cause death in patients with tuberculosis.3,4 Drug resistance of M tuberculosis has been implicated in many etiologies such as inadequate and incomplete treatment, host genetic factors and, HIV infection.5-8 The long duration of treatment, large amount of anti-TB drugs and their gastrointestinal side effects, are the most important causes of noncompliance in patients with TB.4 MDR-TB (when resistance to isoniazid and rifampicin appears in combination), increases the numbers of individuals who need treatment with second-line drugs worldwide.9,10 After developments of MDR-TB, the development of resistance to second line drugs was another problem.5 XDR-TB is a form of TB caused by bacteria that are resistant to the most effective anti-TB drugs. XDR explained by resistance to both rifampin and isoniazid, as well as to fluoroquinolones plus an injectable agent and Pre–XDR TB isolates are multidrug resistant bacilli which are resistant to either a fluoroquinolone or an injectable agent, but not both.11 Some believe that XDR-TB strains have emerged from the mismanagement of multidrug-resistant TB and once created, can spread from one person to another.7,12 TB and drug resistant tuberculosis is also a serious public health problem in Iran as other developing countries. According to the World Health Organization, the estimated incidence rate of TB in Iran is 28 cases per 100,000 population.2,6 In a report from Southest of Iran,among patients with PTB in Zahedan, where the incidence rate of TB is higher than other regions of Iran,16% of patients with PTB had MDR TB.9 XDR-TB is higher in patients with MDR-TB and mortality in XDR-TB is higher than MDR-TB.7 Recent report in Iran showed that 5.3% of patients with PTB had MDR-TB and of these patients, 10.9% had XDR-TB.7 Since, there were few reports about MDR-TB and no any data about the prevalence of XDR-TB in Zahedan, we decided to evaluate them..From January 2007 to January 2008, we evaluated all patients with a positive sputum culture who referred to our hospital (Research Center for Infectious Diseases and Tropical Medicine). First, all patients who had clinical signs and symptoms suggestive of PTB were enrolled. These patients were asked to participate in our study. If they accepted, they underwent testing including Ziehl-Neelsen staining and culture. Patients who subsequently were culture-negative for Mycobacterium tuberculosis were withdrawn from the study. Then, we analyzed all culture-positive cases of Mycobacterium tuberculosis infection referred to our TB center. Primary isolation and culture of Mycobacterium isolates, after NaOH-N-acetylcysteine was done in conformity with standard solid-culture procedures.13 All isolates were identified as M. tuberculosis complex with use of standard biochemical tests, including niacin activity, production of catalase and nitrate reduction, as well as the registration of pigment production and growth rate. Drug susceptibility testing against isoniazid and rifampicin was done by the proportional method on Lo¨wenstein-Jensen media at a concentration of 0.1 and 0.001 mg/mL.14 Drug-susceptibility testing against second-line drugs (amikacin, kanamycin, capreomycin, ciprofloxacin, levofloxain) was carried out using 2 critical proportions of 0.1 and 0.001. All of these drugs were purchased from glaxo Chemical. Clinical and Epidemiological Information collected from patients with confirmed cases of TB by trained technicians using standard questionnaires. Information obtained on sex, age, previous history of TB, present address, and associated medical data such as chest radiograph findings and presence of HIV infection. Patients also required to have drug-susceptibility test results that showed resistance to isoniazid and rifampin (as MDR-TB), as well as chest radiograph findings and clinical signs and symptoms that were compatible with PTB. Statistical analysis was performed using SPSS, version 11. Data were analyzed by Chi-Square test and p<0.05 was considered significant..This prospective study was conducted using a total of eighty eight patients (40% male, 60% female) with positive sputum culture for M. tuberculosis complex. The patients aged between 15 and 94 years. 90% of patients were Iranian and 10% wer Afghan. 12.2% of our patients had MDR-TB (3 females; 6 males) and one subject with pre-XDR-TB (resistant to capreomycin) identified. No case had XDR-TB. 8% of culture positive patients had a negative sputum smear and two cases had HIV infection. Ten patients (8.8%) had a past history of treatment for tuberculosis. Among previously treated patients, 44% had MDR-TB. Among patients who had received a new diagnosis, 10% had MDR-TB..Our results showed that 12.2% of our patients had MDR-TB. One patient with pre- XDR-TB (capreomycin resistanse) identified; and there was no case of XDR-TB. Tuberculosis is a serious public health problem in Iran as other developing countries and MDR-TB is a very important and serious health problem among patients with tuberculosis.9,10 Extensively drug-resistant tuberculosis has also recently emerged as a global health problem, threatening the success of TB control programs in the world.7,15,16 There are many reports which show MDR and XDR-TB are increasing worldwide. Recent studies in Iran also showed that both MDR and XDR-TB were increasing especially among patients treated within inappropriate regimens or when patients became selectively non-compliant by not taking all of the 3 or 4 drugs.4,9,10 Masjedi et al. reported results of susceptibility to first-line drugs performed for 1284 Mycobacterium tuberculosis isolates who were referred to the National Research Institute of Tuberculosis and Lung Diseases (Tehran, Iran) for treatment and diagnosis from 2003 to 2005. Subsequently, the strains which were identified as multidrug-resistant M. tuberculosis (113 isolates) were subjected to susceptibility testing for second line drugs. A total of 12 (10.9%) of 113 multidrug-resistant M. tuberculosis strains were XDR M. tuberculosis.7 Shamimi and his colleagues reported 2% of 548 patients had MDR-TB.17 Another study in Southeast Iran by Naserpour and colleages showed that 16% of patients with PTB had MDR-TB.8 There was no any XDR-TB among patients in these two recent studies. A global survey in reference laboratories for TB isolates during 2000–2004 identified XDR-TB in 17 countries and estimated that10% of the sampled multidrug-resistant (MDR) TB strains were XDR.18 A study in California during 1993–2006, identified 18 XDR-TB cases who had poor outcomes. None of the patients in California with XDR-TB had AIDS.19.In conclusion, 12.2% of patients had MDR-TB. There was no patient with XDR-TB in our study. We recommend drug-susceptibility testing on the first-line drugs in any patient with tuberculosis in the beginning of treatment.