مجله دانشکده پزشکی اصفهان
پیاپی 189 (هفته سوم تیر1391)

Central venous catheter is one the best and fastest ways to access the blood flow. Disadvantages of catheter insertion include early and late complications. In this study, we compared these complications in classic and tunneled methods. In a prospective study in 2008 in Alzahra Hospital (Isfahan, Iran), we compared the frequency of short-term (24-hour) and long-term (one-month) catheter-related complications in 60 hemodialysis patients. Patients were randomized into two groups. In the first group, catheters were placed via the classic method and in the second group, tunneled method was used. Finally, data was analyzed in SPSS16. The mean duration of catheter remaining was significantly higher in the tunneled group compared to the classic group (P < 0.0001). The frequency of early complications in the 2 groups showed no significant difference (P > 0.05). Similarly, the frequency of thrombosis was not significantly different between the two groups (P = 0.093). However, the frequency of infection and catheter failure in the tunneled group were less than the classic group (P < 0.0001). Tunneled catheterization is an effective and safe method for placement of vascular access in hemodialysis patients.

Thyroid transcription factor 2 (TTF2) or forkhead box E1 (FOXE1) is a polyalanine domain protein with an important role in the morphogenesis and development of thyroid gland. Mutations of TTF2 gene have been identified in neonates with congenital hypothyroidism caused by thyroid dysgenesis. In this study, the mutations of TTF2 gene were studied among these patients. In this study, the entire TTF2 gene of 50 neonates with congenital hypothyroidism due to thyroid dysgenesis who referred to Isfahan Endocrine and Metabolism Research Center (Isfahan, Iran) was studied by direct DNA sequencing. The mutations were assessed after amplification of TTF2 gene by polymerase chain reaction (PCR) method. Mutations of each exon of TTF2 gene were evaluated by the adjacent primers of the whole encoding region. We did not find any mutation in TTF2 gene. There was a serotonin polymorphism among 74% of studied patients. The length of TTF2 polyalanine tract was 14 amino acids in most patients. The findings of this study indicated the possible correlation between TTF2 polyalanine tract length polymorphism and genetic susceptibility to thyroid dysgenesis among patients with congenital hypothyroidism.

Candida is a member of normal flora of human skin and mucosa which cause a wide range of skin infections as cutaneous candidiasis. Considering the pathogenesis of acne, predisposing factors and microbial agents which involve in acne, and the pathogenicity of Candida in causing skin diseases, this study evaluated the prevalence of Candida in skin and acne lesions of patients to analyze its probable role in acne. A total number of 125 patients (70 females and 55 males) enrolled in this study. The samples were collected from inside and surface of acne lesions. Direct microscopic examination was performed with 20% potassium hydroxide (KOH) + calcofluor white (CFW). The collected samples were also cultured on Sabouraud's dextrose agar with chloramphenicol (SC). The isolated species were identified by morphologic and physiologic methods such as culture on chrome agar Candida media, germ tube test, chlamydospore forming test on cornmeal agar media, growth in 45˚c, and sugar assimilation test with HiCandida identification kit (HiMedia, Mumbai, India). Among all collected samples from inside of acne lesions, 45.6% were positive for yeast cells in direct microscopic examination. Moreover, 45 samples (36.0%), 11 cases (24.4%) from inside of acne lesions and 34 cases (75.6%) from skin surface, were positive for Candida colony growth in culture. Candida parapsilosis and Candida krusei were the most frequent isolated species from inside of acne lesions and skin surface, respectively. In 5 cases (11.1%), Candida was simultaneously found in both inside of acne lesions and skin surface samples. According to the results of our study, Candida is a normal flora of skin which can be considered in the etiology of acne. We also recommend further studies with a larger sample size and specific aims in the future.

Enhanced external counter pulsation (EECP) is used to reduce chest pain in patients with refractory angina. However, there is controversy about the effects of this method on heart failure. This study aimed to evaluate the efficacy of EECP in treatment of patients with coronary artery disease and left ventricular dysfunction.

In this cross-sectional study, 30 patients with ischemic heart disease (28 men, 55 ± 10 years old) who had a left ventricular ejection fraction (LVEF) of less than 35% were evaluated for the effects of EECP. The therapeutic protocol was 35 one-hour daily sessions which were held 5 days a week for 7 weeks. The data were analyzed using paired t-test at a significance level of P < 0.05.

Significant improvements were observed in LVEF, wall motion abnormality, fractional shortening, and left ventricular end-systolic internal dimension. Moreover, the incidence of angina pectoris significantly decreased and functional class showed significant improvement after the intervention. However, left ventricular end-diastolic internal dimension, the ratio of early diastolic mitral flow velocity/late diastolic mitral flow velocity, and the need for nitroglycerin did not improve. Meanwhile, psychological factors including depression, anxiety state, and mental and physical quality of life showed significant improvements.

In our study, EECP improved left ventricular systolic function, frequency of angina, functional class, and quality of life by decreasing anxiety and depression. Further studies about the effects of EECP in ischemic heart failure are recommended.

National newborn screening for congenital hypothyroidism (CH) was introduced in Iran in 2005.The Iranian Newborn Screening Program Center recommends a blood spot thyroid stimulating hormone (TSH) cut-off of 5 mlU/L to be used to detect CH. As the value used varies from 5 to 20 mlU/L in the world, we argued the implications of altering this threshold. In a cross-sectional study during 2006-10, blood spot TSH levels were measured in 3-5 day-old infants. Since the cut-off was 5 mlU/L, infants with TSH > 5 mlU/L were recalled for serum thyroxine (T4) and TSH tests. CH cases were confirmed by having a serum TSH > 5 mlU/L. Among the 113727 studied infants, 3224 (2.83%) had a first blood spot TSH > 5.0 mlU/L. In addition, 87.69% of the recalled infants had a TSH between 5 and 10 mlU/L. The incidence rate of hypothyroidism in neonates with filter TSH levels of 5-10 mlU/L was 4.67% (132/2827). The 99% confidence interval for the mean value of filter TSH was 16.9-25.1 in patients and 6.2-6.57 in healthy neonates. Regarding the incidence rate of hypothyroidism in neonates with filter TSH values between 5-10 mlU/L and the Newborn Screening Program guidelines which suggest rescreening for the slightly elevated TSH, it seems that repeating the filter test is sufficient, more economic, and less invasive. Besides, raising the threshold to 6.5 mlU/L will reduce a great number of false positive infants while abnormalities of thyroid function requiring treatment will not be missed with a 99% confidence.