Archives of Iranian Medicine
Volume:15 Issue: 8, Aug 2012

This study ascertained the effects of soy, in the forms of textured soy protein (TSP) and soy nuts, on lipid profiles, apolipoproteins, inflammatory and prothrombotic markers, and blood pressure in elderly women diagnosed with metabolic syndrome (MetS). This was a 12-week parallel, randomized, controlled trial conducted in rural health centers of Babol, Iran. Participants were 75 women, ages 60–70 years, who were diagnosed with MetS. Subjects were randomized to one of the following 3 groups: i) soy nut (35g/d), ii) TSP (35g/d), and iii) control. Blood biochemical markers measured at baseline and at the end of the study included: triglycerides (TG), cholesterol, HDL-C, LDL-C, VLDL-C, ApoB100, ApoAI, C-reactive protein (CRP), and fibrinogen. Soy nuts significantly improved LDL-C, VLDL-C, and ApoB100levels (P < 0.05), while fewer, significant improvements were observed in these variables in the TSP group compared to mean changes from baseline (P < 0.001). Similar results were found for ApoAI in the treatment groups (P < 0.01). Serum total cholesterol (TC) decreased significantly in the treatment groups compared with the control group (P < 0.005). Differences from the control group in terms of TG, HDL-C, fibrinogen, CRP, and blood pressure were not significant. Both forms of soy improved lipid profiles. The group that consumed soy nuts had greater improvement than the TSP group. Therefore, moderate daily intake of soy may be a safe, inexpensive, and practical method to improve the risk of cardiovascular disease (CVD) and reduce the need for medical treatment.

In cases of isolated vertigo, physicians are unable to definitely distinguish between central or peripheral vertigo by history and physical examination. Some central causes of isolated vertigo such as cerebellar stroke can be life-threatening and require intervention. Brain infarction can be detected shortly after the onset of clinical symptoms by using diffusion-weighted MRI (DWI). We have conducted this study to perform DWI on isolated vertigo patients with a higher probability of brain infarction. We enrolled 55 consecutive patients with isolated vertigo who had at least one cardiovascular risk factor. A questionnaire that consisted of cardiovascular risk factors was completed and DWI performed for each patient. We analyzed the association of cardiovascular risk factors with infarction as identified by DWI.Using DWI, 5 (9.1%) patients had an acute ischemic stroke. Among cardiovascular risk factors, analysis showed a significant relationship between diabetes mellitus (DM) and infarction. Isolated vertigo may occur due to the occlusion of a small artery in the area of brain circulated by the posterior inferior cerebellar artery. According to our results, DWI may be used in diabetic patients with isolated vertigo to locate a probable infarction.

The present study aimed to evaluate the effects of low dose zinc (Zn) supplementation on biochemical markers and underlying disease status in non-alcoholic cirrhotic patients. We enrolled 60 cirrhotic patients in a double-blind, placebo-controlled, randomized clinical trial. All patients in the interventional group (n = 30) received long-term, low dose Zn supplementation (50 mg elemental Zn sulfate daily). The control group (n = 30) received placebo (starch). Child-Pugh scores and biochemical markers were assessed for both interventional and control groups at the first day and the end of the 90th day of the interventional period. A per-protocol analysis was performed after excluding all participants who did not receive or complete the randomized intervention. The mean differences of quantitative variables between and within groups were evaluated by independent samples t-test and paired-samples t-test, respectively. SPSS version 13.00 was used for statistical analysis. In the initial evaluation, 16 (53.30%) patients from the interventional group had a Child-Pugh score of 5–8 and 14 (46. 70%) had a score of 9–12. In the control group 18 (60.00%) had a Child-Pugh score of 5–8 and 12 (40.00%) scored 9–12. After three months the mean Child-Pugh score in the interventional group showed a significant improvement (from 6.56 ± 0.21 to 5.72 ± 0.22, P = 0.001) whereas in the control group despite no significant decline, the mean Child-Pugh score increased slightly (from 6.25 ± 0.27 to 6.67 ± 0.31, P = 0.14). Zn supplementation significantly decreased copper (Cu; P = 0.01) and creatinine (Cr; P < 0.0001) levels. In this study, we determined that low dose Zn supplementation could prevent deterioration of clinical status of cirrhosis and prevent excess Cu accumulation in non-alcoholic cirrhotic patients. Zn supplementation produces metabolic effects and trends towards improvements in liver function, hepatic encephalopathy, and nutritional status.

There is no general agreement as to which treatment is best for hyperthyroidism. The objective of this study is to investigate the effectiveness of continuous methimazole (MMI) treatment and to compare the results of neuropsychological testing in patients receiving long-term continuous MMI to those on replacement thyroxine following radioiodine-induced (RAI) hypothyroidism.We enrolled 239 patients with diffuse toxic goiter who had recurrences of hyperthyroidism. Of these, 104 patients were randomized into two groups, MMI and treatment with thyroxine following RAI hypothyroidism. The remaining 135 patients voluntarily enrolled into either of the two groups. From all patients, 59 MMI-treated patients and 73 patients in the RAI group completed follow up. Thyroid function tests, serum lipids and lipoproteins, echocardiography, bone mineral density (BMD) and seven neuropsychology tests were performed at the final visit. In the RAI group compared to the MMI-treated group during a mean of 14 years follow up, there were more incidences of elevated TSH [> 5 mU/L; adjusted relative risk (RR) 1.23; 95% confidence interval (CI) 1.04–1.47), increased triglycerides (> 150 mg/dL; RR 2.20; 95% CI 1.34–3.62), HDL-C (< 40 mg/dL; RR 3.46; 95% CI 1.40 – 8.53), and early diastolic annular velocity (< 12.2 cm; RR 3.91; 95% CI 1.42–10.74), in addition to a decreased early diastolic to annular velocity ratio (< 6.7; RR 7.14; 95% CI 1.38–34.48). The MMI group scored better in neuropsychology tests that included mood, direction, logical memory, repeated numbers, and intelligence quotient (IQ). Long-term MMI treatment was superior to RAI therapy in patients with diffuse toxic goiter when mood, cognition, cardiac function and occurrence of thyroid dysfunction were compared.

This report studies the clinical features of Behçet disease (BD) in children and compares our results with other international studies.We retrospectively reviewed patient data that included the clinical picture, HLA typing, and treatment in BD cases.This study reviewed data from a total of nine children with BD. Median age at presentation was seven years, with a male to female ratio of 2:1. There was one patient who had Down’s syndrome. Oral ulcers were present in all children, while genital ulcers were present in only 66% of cases. Skin manifestation was seen in 88% and uveitis in 55%. There was evidence of gastrointestinal (55%), neurological (55%), and musculoskeletal manifestations (77%). HLA B5 was positive in 66% of cases and 55% had positive family histories. Apart from gastrointestinal symptoms, our results were comparable with other studies.Awareness of BD symptoms in the pediatric age group is crucial for early diagnosis and treatment. The coexistence of BD and Down’s syndrome needs further genetic study, which may link these two major disorders.

The numbers of thyroid surgeries have been increasing recently. Robot-assisted thyroidectomy allows for a better cosmetic outcome in comparison with conventional open thyroidectomy. We performed two robot-assisted endoscopic thyroidectomies by a gasless unilateral axillo-breast approach using the da Vinci surgical robot system. We performed right thyroid lobectomies in both patients. The pathologic reports were: micropapillary carcinoma without extracapsular invasion in patient 1 and a benign cyst in patient 2. The operation times were 165 minutes in patient 1 and 110 minutes in patient 2. No postoperative complications occurred. Regarding our early experience, robotic thyroidectomy using the gasless axillo-breast approach is a safe, feasible, and cosmetically good procedure.

Neurobrucellosis (NB) is a rare, but important complication of brucellosis. The clinical features vary greatly and, in general, tend to be chronic. Many laboratory procedures are usually employed in the diagnosis of NB. Even though the culture method is the gold standard, growth rate is low and time consuming. Thus the rate of sequelae and mortality increase in case of a delay in treatment. Therefore it is necessary to perform serological tests in both serum and cerebrospinal fluid (CSF) in suspected patients. In this study we aim to evaluate clinical features, diagnosis, and treatment of patients with NB.We enrolled 17 patients diagnosed with NB. Clinical features, cultures, serological tests, additional laboratory findings, and CSF analyses were recorded for all patients.There were 14 female and 3 male patients. Ten patients presented with neuropsychiatric symptoms and signs (aphasia, diplopia, hemiparesis, facial paralysis, tremor, ataxia, depression, personality disorder, and hallucinations). Serum standard agglutination test (SAT) was negative in 4 (23.5%) patients and serum Coombs’ test was negative in 2 (11.7%). CSF SAT was negative in 4 (23.5%) patients and CSF Coombs was negative in 3 (17.6%) patients. B. melitensis grew in the blood of 6 (35.2%) patients and in the CSF of 3 (17.6%). Treatment protocol for 11 patients consisted of ceftriaxone, rifampicin, and doxycyline for a period of four weeks, followed by rifampicin and doxycyline for an additional four weeks. The remaining patients were given different treatment combinations. One patient died, mild sequelae was present in another patient and the remaining patients recovered without any sequelae.NB should be considered in the differential diagnosis of neurological and psychiatric cases that are encountered in endemic areas for brucellosis. In order to prevent overlooking this diagnosis, Coombs’ test should be performed in both CSF and serum.

Osteoarthritis (OA) is the most common form of arthritis seen clinically. Current treatments for OA are limited to decreasing associated pain, maintaining or improving joint function, and minimizing disability. However, these treatments have no effect on the regeneration of hyaline cartilage. Since mesenchymal stem cells (MSCs) have been described as promising cell sources for cartilage repair, the present study was designed to examine whether intra-articular injection of scaffold-free adipose-derived stem cells (ASCs) obtained from subcutaneous adipose tissue could restore the matrix of arthritic knee joints in mature animals. OA was induced in adult white New Zealand rabbits by unilateral anterior cruciate ligament transection (ACLT); the contralateral knee was considered the sham-operated group. At 12 weeks following surgery, the ASCs treated group was injected intra-articularly with a single dose of 1 × 106 cells suspended in 1 mL of medium. The control group received 1 mL of medium without cells and the sham-operated group received no treatment. All rabbits were sacrificed at 16 and 20 weeks after surgery. OA progression was evaluated radiologically, grossly, and histologically using hematoxylin and eosin, Safranin-O, and toluidine blue staining.At 12 weeks after surgery all knees subjected to ACLT showed radiological signs of OA. The findings showed significant differences in the quality of cartilage between ASCs-injected group compared to control group, particularly at 20 weeks after surgery.This study suggests that ASCs obtained from subcutaneous adipose tissue could be a viable approach for treating OA.

This study aimed to define the nasopharyngeal carrier rates, serotype distribution, and antimicrobial resistance patterns of Streptococcus pneumoniae in healthy children less than ten years-old in Tehran. This was a cross-sectional study conducted from November 2008 until January 2009. Nasopharyngeal specimens were collected by trained investigators from 1300 healthy children recruited from 20 randomly selected day care centers and 50 elementary schools in Tehran and inoculated into blood agar. Positive cultures that grew alpha-hemolytic colonies were gram-stained and serotypes of the isolates identified by the Quellung reaction. All isolated pneumococci were tested for sensitivity to different antibiotics by the disc diffusion method. The carrier rate for Streptococcus pneumoniae was 44.1%. Serotypes 19, 6, 14, 17, 20, 23, and 21 were most common, found in decreasing order from 11.9% to 6.1%. Only 38.56% of isolates belonged to strains covered by the heptavalent pneumococcal vaccine. Most (69.4%) were resistant to one or more antimicrobial agents: tetracycline (69.85%), clarithromycin (57.2%), azithromycin (54.9%), co-trimoxazole (11.8%), penicillin (9.2%), and vancomycin (1.5%). All isolates were sensitive to rifampin and meropenem. This study has revealed the nasopharyngeal carrier rate, serotype distribution and antibiotic sensitivities of Streptococcus pneumoniae strains in children from Tehran. Our findings may have implications on the type and efficacy of pneumococcal conjugate vaccines that should be used for prevention of pneumococcal invasive disease in Iranian children.

Systematic reviews favor a better body image and sexual activity in patients who have undergone conservative breast surgery (BCS) compared to modified radical mastectomy (MRM). In those patients with the same survival, MRM remains the surgical choice among both surgeons and patients in Iran as well as in many other countries. This cross-sectional study focuses on health-related quality of life in early stage breast cancer patients following BCS and MRM. From all post-op patients who referred to the Motahari Clinic, Shiraz, Iran, we used a convenient sampling method to select 160 MRM patients and 127 who underwent BCS. Translated copies of the EORTC QLQ-C30 (version 3) and the EORTC QLQ-BR23 questionnaires, in addition to a third questionnaire which was customized and prepared for this study, were completed by the patients under our supervision The two groups were compared by a multivariate method (Hotelling’s trace test) after controlling for variables with unequal values such as disease stage, hormonal and radiotherapy treatments, and patients’ role in the choice of surgery. We noted a significant difference (P < 0.001) attributed to a significantly better BI in the BCS group (average: 78.49 ± 23.14) compared to the MRM group (average: 60.71 ± 23.14). We concluded that in terms of body image, BCS has a better impact on health-related quality of life.

This article discusses the importance, definition, and types of confounders in epidemiology. Methods to identify and address confounding are discussed, as well as their strengths and limitations. The article also describes the difference among confounders, mediators, and effect modifiers

Solitary bone plasmacytoma (SPB) can progress to generalized myeloma if not treated early. The elderly population is increasing and delays in diagnosis of plasma cell malignancies are frequent among them. Hyperglobulinemia of multiple myeloma (MM) plays a role in hyperviscosity syndrome (HVS).A 65-year-old woman with hypertension and diabetes mellitus was admitted due to loss of appetite, muscle weakness, breathlessness and discrete expectoration, without fever. Chest X-ray showed an abnormal shadow projection on the right lung field, while computed tomography (CT) revealed an osteolytic mass at the sixth rib. There were more than 50% of plasma cells in the bone marrow samples and high IgA levels according to serum electrophoresis. Rib plasmacytoma and overt IgA-producing myeloma with HVS were diagnosed, but treatment was unsuccessful. Case studies may enhance the awareness about this ominous condition, which may develop unnoticed, particularly in elderly patients with renal insufficiency, and can pose difficulties with diagnosis in primary care settings.

Endobronchial metastases of extrapulmonary malignant tumors are rarely encountered. Herein, we have reported two cases of endobronchial metastases from nonpulmonary tumors. The first case was a 32-year-old female patient who underwent surgery for a sclerosing epitheloid fibrosarcoma in her left thigh in 2007. Metastatic bilateral parenchymal nodules in her lungs were seen on thorax CT. Bronchoscopy revealed a mass plugging, particularly in the openings of the anterior and lateral basal segments of the left lower lung lobe. Pathological examination of the biopsies was interpreted as fibrosarcoma metastasis. The second case was a 49-year-old male patient who complained of cough, weight loss, excessive sweating, and fatigue. A 7×8 cm, irregular limited soft tissue density in the right middle lobe of the lung that showed air bronchogram and cystic regions was detected on thorax CT. Bronchoscopy was performed. Pathological examination of the bronchoscopic materials taken from the mass that had obstructed the entrance of the middle lobe revealed a large B cell diffuse lymphoma.