Acta Medica Iranica
Volume:49 Issue: 12, Dec 2011

Stachys lavandulifolia is used as the herbal tea and its wide and potent medical effects have been reported for the extract in animal studies. This study aimed to find the safety profile of the extract to find the appropriate doses for further human studies. The aerial parts of the plant were air-dried and the hydroalcoholic extract was obtained and concentrated by percolation method with 140 mg/ml concentration. To assess the toxicity profile of this extract, 60 female mice (30 cases, 30 controls, 24.8 ±2.1 g, 4-6 weeks) were administered the extract by oral gavages in acute (24 hrs), subacute (14 days) and subchronic (45 days) models. All clinical, hematological, biochemical and histopathological changes were assessed in appropriate midpoints and endpoints and compared with control group. Doses up to 140 mg⁄kg were recognized as maximum tolerated dose in subchronic model. Abnormal changes in kidney and liver weight in treatment groups as well as the significant elevation of biochemical parameters in 45 days study has suggested the possible hepatic and renal toxicity potentials of this extract with doses upper than 140mg⁄kg. Doses up 70 mg⁄kg could be considered as no observable adverse effect level (NOAEL) and could be used in further clinical trials on the possible therapeutic effects of this plant.

Breast cancer is the most common cause of cancer-related death in female, after lung cancer. Angiogenesis is essential for tumor growth and metastasis; therefore, antiangiogenesis strategies for treatment of cancer are currently an issue of interest. The role of vascular endothelial growth factor that assumed to be most potent angiogenesis factor is ambiguous in breast cancer. This study described the correlation between vascular endothelial growth factor expression and tumor grade, to define the breast cancer patients who responder to anti-vascular endothelial growth factor therapy. In this research, 200 cases of histological proved invasive ductal breast carcinomas analyzed for vascular endothelial growth factor expression by immunohistochemical staining via cross-sectional descriptive study. Vascular endothelial growth factor expressed in 72.54% of the breast cancers. The VEGF was more detectable in grade I (78.5%) than grade II (77.4%) and grade III (56.2%). There is a significant correlation between tumor grade and VEGF expression (P<0.05). According to this study, VEGF often expressed in invasive ductal breast carcinomas and inversely correlated with tumor grade. Anti-vascular endothelial growth factor postulated more convenience for tumor progression suppression in low grade tumor than high grade tumor.

Vitamin D is an essential hormone for growth and development of bones in children. There is a lot of evidence for deficiency of this vitamin in Middle East females. This study conduct to find a way to combat deficiency in girls during rapid growth phase of puberty in academic year. One hundred and two Middle School girls who had not consumed any vitamins supplement have been participated in this randomized clinical trial. They allocated randomly in two case groups who received 50,000 or 100,000 IU vitamin D3 in October and three months later in January or in control group who received vitamin E. At the end of winter blood samples for 25-hydroxyvitamin D were checked. The mean of 25-hydroxyvitamin D were 5.5±1.5 ng/ml, 15.2±6 ng/ml, 23.0±6.8 ng/ml in control, 50,000 and 100,000 IU vitamin D groups respectively (P<0.05). Neither dosage of vitamin D could raise 25-hydroxyvitamin D above 20 ng/ml in all cases. However, none of the students in 100,000 IU of vitamin D3 had severe deficiency in winter. Headache, dizziness, and weakness were the most common complain after vitamin D consumption, but no difference between groups detected (P>0.05). Urine calcium/creatinin ratio was equal in case and control groups (P>0.05). 100,000 IU of vitamin D3 every three months (equal to 800IU/day) can raise 25-hydroxyvitamin D above 12 ng/ml in all cases but for area with high prevalence of sever deficiency, dosage more than 100,000 IU every three months or shorter interval recommended to achieve optimal level.

Cumulative embryo score (CES) is one of the many embryo scoring methods which have been developed to help clinicians to transfer high quality embryos and predict pregnancy rate in assisted reproductive techniques (ART) cycles. Regarding the existing difference in CES calculation this study was done to compare two methods in order to determine the more practical and preferable one. In a retrospective, cross sectional descriptive analytical study, a total of 508 ART cycles in infertile patients treated from November 2002 until March 2004, were evaluated using two methods of CES calculation in embryonic scoring to predict ART outcome. According to one method, CES was obtained by adding the individual scores of all transferred embryos. Whereas in the other reference method, CES was calculated by the sum of each embryo score multiplied by its number of blastomeres on the day of transfer. The mean score of transferred embryos (MSTE) was referred to CES divided by the total number of embryos transferred in either method. A total of 109 clinical pregnancies (pregnancy rate 21.5%) including 96 singletons, 10 twins and triplets occurred in the 508 ART cycles. The pregnancy rate was strongly correlated to CES & MSTE. According to one method, CES was 12.6±6.4 in pregnant versus 9.2±5.8 in non-pregnant group (P<0.0001). According to the other one, in the pregnant group CES was 86.7±48 versus 68.7±55 in the non-pregnant group (P<0.002). Both methods showed a significant difference. Regarding MSTE, using the first method, in the pregnant group it was 3±0.6 versus 2.8±0.7 in the non-pregnant group (P<0.011) whereas with the other approach it was 21.3±8.6 in the pregnant group versus 19.9±9.07 in non-pregnant (P<0.152) showing that the first method can also predict pregnancy outcome with MSTE. Considering that both MSTE and CES in the first method can significantly predict outcome in ART cycles, it seems this method is preferable and more useful in practice. Moreover, sometimes due to continuous division, on the third post oocyte retrieval day the blastomere number cannot be counted precisely which can be misleading if taken into account according to the method introduced by Steer.

The previous large retrospective studies demonstrated that treatment with Statins reduces both the incidence of prostate cancer by 50% and serum Prostate Specific Antigen (PSA) level up to 40%. However the main problem in those studies was the absence of control groups of men with hypercholesterolemia without Statin treatment. We performed a small prospective controlled clinical trial to assess the influence of the treatment with Atorvastatin on serum PSA in men with hypercholesterolemia referred to our educational and treatment center from October 2007 to March 2008. In this study, among the newly diagnosed males with hypercholesterolemia (LDL > 130 mg/dl), 40 patients with LDL more than 190 mg/dl were selected as a case group and were treated with Atorvastatin (20 mg/day). Among the same population and in the same period, another 40 patients with LDL between 130 and 190 mg/dl were selected as first control group and were treated only with low fat diet. Another 40 patients with normal serum cholesterol and without any treatment were selected as second control group. The lipid profile and serum PSA level of patients of all groups were tested at the first and third months after the therapy. After completion of data, the mean serum lipids and PSA level were measured in both visits and compared with each other by paired t-test. Also the mean PSA change in two visits between three groups was compared by ANOVA and Tukey HSD test. There was not any significant difference in mean baseline PSA between hypercholesterolemic and normocholesterolemic patients (P=0.547). In case group, mean PSA and LDL was reduced by 14.1% (P=0.0001) and 30% (P=0.0001) respectively by second visit. In first control group, mean PSA was not changed significantly (P=0.337), whereas mean LDL in this group was reduced by 9.6% (P= 0.0001). Similarly in the second control group mean PSA was not changed significantly (P=0.309) by second visit. In addition, mean change of PSA in case group was compared with first and second control groups that was significantly different (P=0.0001) whereas mean change of PSA between two control groups was not significantly different (P=0.615). The results of this study showed that: 1) Short term treatment with Atorvastatin can reduce serum PSA level, and 2) This reduction is more likely to be due to direct effect and is not related to lowering serum cholesterol levels. Thus, if results of this study are confirmed by large prospective randomized clinical trials with longer follow up period, it will be possible that Atorvastatin could be used in long term as a safe chemoprophylactic agent against prostate cancer in high risk patients.

Failure to thrive (FTT) is a perplexing disorder commonly seen by primary care physicians. Identification of FTT and an assessment of severity of the undernutrition are important to identify children at risk, and to provide appropriate intervention for preventing malnutrition and developing sequela. One of different anthropometric methods for categorizing undernutrition in childhood is Waterlow and Gomez classifications. Unfortunately, these classifications are not an easy task for the practitioners due to its difficult calculations. In this paper, Waterlow and Gomez classifications have been shown on the Standard Growth Charts (WHO 2006). Using these curves, the practitioners can determine severity of FTT by plotting weight, height and age of the patients without any calculations.

The purpose of this study was to assess the possible correlation between Brucella and HIV infections. Iran is a country where HIV infection is expanding and Brucellosis is prevalent. In the present study, 184 HIV infected patients were assigned and for all of them HIV infection was confirmed by western blot test. In order to identify the prevalence rate of Brucella infection and systemic brucellosis in these subjects, sera samples were obtained and Brucella specific serological tests were performed to reveal antibody titers. Detailed history was taken and physical examination was carried out for all of patients. 11 (6%) subjects had high titers but only 3 of them were symptomatic. Most of these subjects were injection drug user (IDU) men and one was a rural woman. Considering both prevalence rates of Brucella infection (3%) and symptomatic brucellosis (0.1%) in Iran, our HIV positive patients show higher rates of Brucella infection and systemic brucellosis. Preserved cellular immunity of participants and retention of granulocytes activity may explain this poor association; whereas other explanations such as immunological state difference and non-overlapping geographical distribution of the 2 pathogens have been mentioned by various authors.

Squamous cell carcinoma (SCC) is the second most common type of skin cancer with potential risks for metastasis and recurrence if left untreated or incompletely excised. This case series study was designed to determine the frequency of incompletely excised SCCs and the related risk factors. A total of 273 SCCs (253 patients) excised in Razi dermatology hospital of Tehran from 2006-2008, were evaluated and were analyzed by Chi-square or t-test. The incidence of incomplete excision was 17.58 % and deep margin involvement was observed in 73% of lesions. Risk factors associated with incomplete excision of SCCs were being female, location of the tumors (in particular the lesions on lateral canthus, upper lip, foot, forehead, cheek, neck, nose and ear), large lesions and grafting method of repair. There was no statistically significant difference for the age, degree of histological differentiation, childhood history of radiotherapy for tinea capitis and the type of anesthesia. More care should be taken for high risk SCCs as complete excision avoids potential risk of recurrence and metastasis.

Patients with Solitary Rectal Ulcer Syndrome (SRUS) come to a physician with passage of mucus and bloody liquid within defecation. The treatment for SRUS is depended to the severity of symptoms and the existance of rectal prolapse. This study is a report of the assessing of rectopexy as surgical modalities for 62 medical treatment resistant SRUS patients who were referred to the gastrointestinal department of Shahid Sadoughi Medical University and Mojibian hospital. The present non-randomized clinical trial was carried out in 62 SRUS patients from 1991 till 2005. In these patients SRUS was confirmed by histology. They were symptomatic after conservative therapy and referred for surgical intervention. All of them had been undergone abdominal rectopexy by two laparoscopic surgeons. In our study, rectal bleeding and history of digitalization had the highest and lowest frequency of symptoms and signs in our cases respectively. Abdominal rectopexy was done in 39 cases and complete recovery in our cases was 69.23%. Complete recovery rate in cases with dysplasia (63.8%) was significantly higher than cases without that (P=0.04). Complete recovery rate in cases that had finger defecation (85%) was significantly higher than cases without that (50%) (P=0.03). Laparoscopic rectopexy is one of the main surgical techniques for treatment of SRUS. This technique can present complete recovery for SRUS patients. Some of them include topical medications, behavior modification supplemented by fiber and biofeedback and surgery were more available and studied. But it seems that education of SRUS patient conservative treatment remain cornerstone in the SRUS management.

One of the main problems of the drug abusers is drug related attention bias, which causes craving, and as a result drive the drug abusers to take narcotics. Methadone is used as a maintenance treatment for drug abusers. The purpose of this study is evaluation of the effect of Methadone maintenance therapy (MMT) on selective attention and drug related attention bias. This study investigated drug cue-related attention bias and selective attention in 16 methadone-maintained patients before and 45 days after methadone therapy period. Stroop color-word test and addiction Stroop test were used as measurement methods. Results show less reaction time and higher accuracy in Color-Word Stroop Test after MMT and less delay for addict related word in addiction Stroop test. It is concluded that methadone can improve selective attention capability and reduce drug related attention bias.

Calcium metabolic disorders, such as hypercalcemia is a potentially life-threatening disorder especially when coupled with an already compromised condition. The aim of this study was to determine the prevalence of metabolic calcium disorders in childhood cancers of patients admitted to the pediatric ward of Vali-Asr Hospital from the year 2001-2008. The study was carried out by reviewing hospital records of these patients from the hospital archives. Range of age was between 1 and 18 years. Inclusion criteria for the study population were the presence of total serum calcium evaluated at least once; and for the hypercalcemia subgroup, at least two occasions of elevated calcium levels. The prevalence of hypercalcemia and other metabolic abnormalities of phosphorus, alkaline phosphatase, urea and creatinine; the prevalence of parameters such as age, gender, type and duration of cancer were determined within these groups. Median of elevated calcium levels was also determined to classify hypercalcemia into moderate and severe hypercalcemia. Median was 11.7 mg/dl, therefore, severe hypercalcemia was ≥11.7mg/dl and moderate hypercalcemia, a range between the upper limit of normal, 10.8 and 10.2 mg/dl for the child and adolescent respectively, and 11.7 mg/dl. Relationship between hypercalcemia and the other metabolic disorders and parameters were analyzed by the SPSS V.17 program. The population of study consisted of 148 cases. Hypercalcemia was found in 8 (5.4%) patients. Half of the cases were associated with severe hypercalcemia and acute lymphoblastic leukemia (ALL). Out of 148 cases, there were 92 (62%) boys and 56 (38%) girls. Mean and median ages were 10.9 and 11 years respectively. Mean duration of cancer was 12.8 and median 6 months. There were 57 (38.5%) cases of leukemia and 91 (61.5%) cases of solid tumors. The most common cancers were ALL, 44 cases (29.7%) followed by brain tumors, 19 cases (12.8%); non-Hodgkin''s lymphoma, 16 cases (10.8%); 13 cases of acute myeloid leukemia (AML) (8.8%); 13 cases of Ewing sarcoma (8.8%); osteosarcoma, 9 cases (6.1%); Hodgkin''s lymphoma, 6 cases (4.1%); others, 19.1%. There was no significant difference between hypercalcemia and the metabolic disorders and parameters. Metabolic calcium disorder, especially hypercalcemia, is not a rare finding in pediatric cancers. ALL, the commonest pediatric cancer, is most often associated with this disorder.

The surface electrocardiogram (ECG) has been used as a useful method for detection of metabolic disturbances for a long time. However, it may be difficult to distinguish the exact disturbance when more than one metabolic abnormality exists in a patient simultaneously. Although, "classic" ECG characterizations of common electrolyte disturbances are well described, multiple concurrent electrolyte disturbances may lead to ECG abnormalities that may not be easily detectable. This ECG concerns a 60-year-old male presented with general fatigue, weakness, epigastric pain, anorexia, nausea and extreme hypercalcemia (serum total and ionized calcium levels 20.5 mg/dL and 12.02 mg/dl, respectively), hypokalemia and hypomagnesemia associated with elevated parathyroid hormone (1160 pg/ml) and normal serum vitamin D level (97 ng/ml). This rare manifestation of primary hyperparathyroidism has been named hyperparathyroid crisis in the literature. Hyperparathyroid crisis is an emergency form of multiple electrolyte abnormalities that manifest as a life-threatening hypercalcemia and simultaneous hypokalemia and hypomagnesemia; these two later are believed to be caused by diuretic effect of calcium on the renal tubules. The unique pattern of ECG in our patient first was misdiagnosed as prominent T waves with prolongation of the QT corrected (QTc) interval, which has been reported several times in patients with hyperparathyroidism crisis, compatible with our patient. But more investigation revealed that, the QTc interval not only is not prolonged, it is shortened as it is expected from the effect of hypercalcemia on electrocardiogram. The exact pattern of the patient`s ECG (figure 1) can be interpreted as it follows: (1) Flattening of the T wave, (2) a prominent U wave, (3) prolongation of the descending limb of the T wave such that it overlapped with the next U wave (4) virtual absence of ST segment and (5) shortening of the QT corrected interval. In conclusion, it should be emphasized when the T and U waves are separated by a very short segment they can mimic the appearance of a prolonged QT interval. However, more investigation can demonstrate the exact electrocardiographic pattern especially in multiple electrolyte disturbances, when "classic" ECG patterns are not expectable.

This case is a rare aspect of inguinal hernia. The patient was admitted with a 10-day pain of right groin and a past history of an inguinal hernia which was irreducible at the time of admission. In the operating room, the hernia sac was opened which included a perforated and gangrenous appendix that is called Amyand‘s hernia. The patient underwent appendectomy and herniorrhaphy at the same operation.