Journal of Research in Medical Sciences
Volume:17 Issue: 5, May 2012

Considering that thyroid nodules and thyroid cancer occur more frequently in people exposed chronically to radiation, the aim of this study was to evaluate the prevalence of thyroid nodules in a population occupationally exposed to radiation, in the hospitals of Isfahan. In this case control study the prevalence of thyroid nodules in radiation exposed workers was determined by ultrasonography which was performed by a radiologist. The results were compared with the results of another study among the adult population of Isfahan city which were selected by Cluster – random sampling method. The two studied groups were matched according to sex and age. The studied population in case and control groups was 124 and 471 respectively. The prevalence of thyroid nodule in the case and control groups was 22.6% and 24.6% respectively (p > 0.05). Thyroid nodule was more prevalent in females in the control group but there was no difference between the females and males of the case group (p > 0.05).The number of thyroid nodules (single or multiple) and calcification were not different for the two groups (p > 0.05). Moreover, the echo pattern of thyroid nodules for hypoechogenicity was not different in the two groups (p > 0.05). In our study, there was no correlation between occupational chronic exposure to a low dose of radiation and the risk of developing thyroid nodules. Further studies with a larger sample size and the consideration of different doses of radiation, in accordance with the iodine status and thyroid function are necessary.

Atherosclerosis is the leading cause of death in hemodialysis patients. These patients are also highly prone to L-carnitine deficiency due to kidney disease. In this clinical trial, we investigated the effect of oral L-carnitine on the endothelial function of these patients. We studied 31 adult chronic hemodialysis patients in our center and divided them into two groups, a group of 20 patients who received 1500 mg/dialysis interval (every other day) oral L-carnitine and a control group of 11 patients who received placebo for one month. Ultrasonographic measurement of flow mediated dilation and carotid intima media thickness were performed before and after one month of L-carnitine and Placebo therapy. This study showed that after one month of L-carnitine or placebo therapy there was no significant improvement in flow mediated dilation (p = 0.80, p=0.59 respectively) or decrease in carotid intima media thickness (p = 0.12, p = 0.50 respectively). Our study revealed that one month oral L-carnitine therapy does not improve endothelial function in hemodialysis patients. Long term studies with a large sample size using intravenous form and higher doses of the drug are required to clarify the questionable role of L-Carnitine in hemodialysis patients.

Patients with Rheumatoid arthritis may resistant to conventional treatment with DMARDs and biologic therapy is costly and may be inconvenient for many of patients. Pamidronate is a potent bisphosphonates with the capacity of modifying the biological activity of the immune system cells, thus it may be used as an anti-inflammatory agent in patients with inflammatory joint diseases. To assess the effectiveness of Pamidronate in the management of Rheumatoid arthritis, we chose thirty eight patients with rheumatoid arthritis to take part in a pilot study to receive a combination of pamidronte and conventional treatment with prednisolon and Disease Modifying Anti Rheumatic Drugs. These patients received 60 mg of pamidronate in 3 consecutive months and for six more months since the first infusion. The Mean Visual Analogue Score (VAS) and Mean Disease Activity Score(DAS28) were steady until one month after the third infusion but showed no improvement in the next three months after the last infusion of the drug. All except one patient reported a decrease in pain in response to three consecutive pulses of pamidronate and most had improvements in the laboratory and clinical indices that were assessed. The drug was tolerated well by our patients. Pamidronate infusions had a beneficial effect on various clinical and laboratory parameters of patients, but alleviation of symptoms were temporary (more than 6 months) This treatment can be an option for difficult cases of rheumatoid arthritis with severe pain and osteoporosis.

The goal of this study was to evaluate the results of the expression of p16INK4a in normal uterine cervical epithelium, low-grade cervical intraepithelial neoplasia, (CIN) high-grade CIN, squamous cell carcinoma (SCC), and adenocarcinoma of the cervix, in order to help draw a distinction between low risk and high risk patients with cervical lesions. P16INK4a expression was evaluated by immunohistochemistry in 78 paraffin-embedded tissue samples including 39 normal cervical tissues, 11 low-grade CINs, 11 high-grade CINs, 22 cervical SCCs and 8 cervical adenocarcinomas. Two parameters in immunohistochemical p16 expression were evaluated: percentage of p16-positive cells, and reaction intensity. The p16INK4a expression rate was 81.8% in low-grade CINs, 91% in high-grade CINs, 90% in SCCs and 75% in cervical adenocarcinomas. 10% of normal cervical samples expressed p16. Moreover, there is a significant relationship between the histological diagnoses and percentage of positive cells and reaction intensity of p16 (p < 0.005). The intensity of the reaction is the best parameter to evaluate the positivity of p16. Over-expression of the p16INK4a is typical for dysplastic and neoplastic epithelia of the uterine cervix. However, p16INK4a-negative CINs and carcinomas do exist. Although negative p16INK4a expression does not definitely exclude the patient with cervical lesion from the high-risk group, immunohistochemical study for p16INK4a may be used as a supplementary test for an early diagnosis of cervical cancers.

Atherosclerosis is a complex disease that is associated with a variety of etiologic factors such as hyperlipidemia and inflammation. aloe vera (Liliaceae family) has been used traditionally as an anti-inflammatory drug. The aims of this survey were to define the beneficial effects of aloe vera leaf gel on some of the atherosclerosis risk factors, and the fatty streak formation in hypercholesterolemic rabbits. 32 white male rabbits were randomly divided into four experimental groups (n = 8, each). During the study, the animals had a standard diet (control group), high cholesterol diet (HC group), high cholesterol diet with aloe vera leaf gel (3.2%v/v) (HC+ aloe group) and aloe vera leaf gel (Aloe group) for 30 days. Fasting blood samples were collected from all animals at the beginning and at the end of the study. Then their total cholesterol (TC), fasting blood sugar (FBS), triglyceride (TG) and CRP were measured before and after the experimental period. By the end of the study, the aortas were removed and investigated for atherosclerosis plaque formation. Significant differences were observed in the TC and CRP levels of the high-cholesterol diet with aloe vera and the high-cholesterol diet alone (p < 0.05). The formation of fatty streaks in the aorta was also significantly lower in the same animals under the influence of dietary aloe vera(p < 0.05). The control and aloe group did not show any evidence of atherosclerosis. No significant difference was found between the TG and FBS groups. The data suggests that aloe vera is effective in preventing the development of fatty streak; it may reduce the development of atherosclerosis through the modification of risk factors. However, further studies are needed to understand the mechanisms whereby this plant exerts its anti-atherosclerotic effects.

Hypertension and obesity are risk factors of cardiovascular disease. The association between C-reactive protein, homocysteine, microalbuminuria and cardiovascular risk have been debated for decades. Resistin is a newly discovered adipocyte derived cytokine. In the current study we planned to investigate the relation of resistin to these probable cardiovascular risk factors and obesity in hypertensive patients. The study population consisted of 42 non-obese and 42 obese hypertensive females. After making comparisons between C-reactive protein, homocysteine, microalbuminuria and resistin in the two groups, we also sought correlations between all parameters in non-obese and obese groups. In our obese hypertensive group resistin levels were higher than in the non-obese hypertensive group (p < 0.001), but we did not find any difference in other parameters. We found a positive correlation between resistin and C-reactive protein in both non-obese and obese hypertensive groups (in non-obese hypertensives p < 0.05 and in obese hypertensives p < 0.001). We showed that in female obese hypertensive patients resistin levels were higher than in the non-obese patients. We also think that resistin may be associated with C-reactive protein levels but not with homocysteine or microalbuminuria in both non-obese and obese hypertensive patients.

Given the high prevalence of consanguineous marriages in rural and urban areas of Iran, the aim of this study was to identify its role in increasing fetal and infant deaths. This was a cross-sectional study in which 494 mothers with more than one exceptional child (mentally retarded and physically-dynamically disabled) or with normal children were selected based on multi-stage random sampling method. Data was gathered using the features of parents with more than one exceptional child questionnaire. The validity and reliability of this questionnaire was acceptable. Hierarchical log-linear method was used for statistical analysis. Consanguineous marriage significantly increased the number of births of exceptional children. Moreover, there was a significant relation between the history of fetal/infant death and belonging to the group. There was a significant relation between consanguineous marriage and the history of fetal/infant death which means consanguineous marriage increased the prevalence of fetal/infant death in parents with exceptional children rather than in parents with normal children. The rate of fetal/infant death in exceptional births of consanguineous marriages was higher than that of non-consanguineous marriages.

Malignant melanoma is the most invasive cutaneous tumor, and it is still associated with an incredibly high mortality rate. The most reliable histological factors associated with melanoma prognosis are tumor thickness, which is measured with the Breslow index, and invasion depth, which is measured by the Clark level. The murine double minute 2 (MDM2) gene inhibits P53-dependent apoptosis. An increase in MDM2 expression has been found in many tumors. This study aimed to investigate MDM2 expression in malignant melanoma and its correlation with tumor thickness and invasion level. This study assessed paraffin blocks from 43 randomly selected patients with primary cutaneous melanoma referred to the main university pathology center. The MDM2 expression rate was assessed via immunohistochemical techniques, and hematoxylin and eosin (H&E) staining were used to determine tumor thickness and invasion level. Correlation analysis for tumor thickness and invasion and MDM2 expression were performed using SPSS software. The mean patient age was 61.2 ± 15 years; 55.8% of patients were men and 44.2% women. The rate of MDM2 positivity was 28.9%. There was a direct relationship between MDM2 expression and tumor thickness (r = 0.425, p = 0.002) and a weak relationship between MDM2 expression and invasion level (r = 0.343, p = 0.01). Despite the low MDM2 expression rate observed in this study, a direct relationship between MDM2 positivity and tumor thickness and invasion level was identified, suggesting a potential new predictive prognostic factor.

Infertility is a condition associated with multiple etiologies. Sperm nuclear chromatin decondensation is one of the important events that occur during fertilization. Abnormal spermatogenesis leads to improper protamine package and chromatin condensation. The aim of the study was to analyze and understand the levels of fertilization capacity and nuclear stability of the spermatozoa in different infertile subgroups. A total of 65 infertile males and 24 fertile males were employed in the study. Infertile subjects were classified into different groups according to the World Health Organization (WHO) protocol. In this study, in vitro nuclear chromatin decondensation status was assessed in different subgroups of infertile males. The obtained data was then statistically analyzed. Decreased sperm chromatin decondensation was observed in different infertile subgroups compared to the control group (p < 0.05). Spermatozoa with swollen head indicated a positive response and unswollen head indicated a negative response. This study asserts that abnormal nuclear decondensation is a potential factor that diminishes the fertilizing capacity of the sperms among different subgroups of infertile males.

Vascular anastomosis is considered as a difficult surgical procedure. Although different alternative methods have been tried to tackle these difficulties, none were found to be successful. Commercial fibrin glue has recently been used for vascular anastomosis. However, it did not gain popularity due to some limitations such as low tensile strength, rapid removal by the immune system, and risk of transmission of blood-borne viral infections. In this article, we presented a novel method for producing single-donor human fibrin glue and determined its success rate for vascular anastomosis in an animal model. In this study, 3 mL of single-donor fibrin sealant was prepared from 150 mL of whole blood containing 50-70 mg/mL of fibrinogen. The study was performed on 10 dogs and 5 cats. After transection of the carotid artery, both ends were anastomosed by means of 3-4 sutures (Prolene 8-0). The suture line was then sealed with one layer of the new fibrin sealant. After 3-8 weeks, the site of anastomosis was evaluated angiographically and morphologically for healing and possible complications such as thrombosis or aneurysm. In evaluations 3 weeks after the surgery, all arterial anastomoses were patent in dogs, but some degree of subintimal hyperplasia was noted. After 8 weeks, all anastomoses were patent and the degree of subintimal hyperplasia was decreased. In cats on the other hand, after 4 weeks, all anastomoses were patent and subintimal hyperplasia was absent. Single-donor fibrin glue was a quite reliable and practical alternative to minimize suturing and therefore operative time in our animal model. This sealant can easily be obtained from the patient''s whole blood. Its application in humans would require further studies.

The progression rate of liver fibrosis is variable among patients with hepatitis C virus (HCV) infection. It is affected by environmental and genetic factors. We determined the association between ABO blood groups and the severity of liver fibrosis in HCV patients. This cross-sectional study was conducted on adult patients with chronic HCV infection who referred to university clinics in Isfahan, Iran in 2009-10. Patients with positive hepatitis B surface antigen (HBS Ag), human immunodeficiency virus antibody (HIV Ab), or other liver disorders, as well as those who had received anti-HCV treatments were not included. Blood type was determined and liver biopsy was obtained from all patients. The severity of hepatic fibrosis was graded from F0 to F4 based on METAVIR system. Non-O blood groups were present in 53.8%, 72.3%, 75%, 87.5%, and 90.4% of the patients with F0-F4 grades of liver fibrosis, respectively (p = 0.019). There was no relationship between the severity of hepatic fibrosis and age or gender. In ordinal regression analysis, only the viral load (p = 0.028) and non-O blood group (p = 0.001) were associated with the severity of hepatic fibrosis. Non-O blood group is a genetic risk factor for progression of liver fibrosis in patients with HCV infection. It can play an important role in determining the prognosis and appropriate treatment among these patients. The association between blood group and liver fibrosis is probably due to the increased risk of venous thrombosis. Such relation can be the goal of preventive/treatment strategies.

Methamphetamine (MA) is the most popular recreational drug. According to potential neurotoxicity of this agent, it can cause deleterious effects in neural differentiation of the embryo, if used during the child bearing period. In recent decades, undifferentiated pluripotent embryo-derived stem cell lines, resembling early embryonic stages, have been used to analyze the toxic effects of components in vitro. Thus, this study aims at assessing toxic effects of MA on embryonic stem cell (ESC)-derived neuronal cells during differentiation in a pharmacological model. Royan ESC line was used throughout this study. The effect of MA on neural differentiation was assessed during two periods, group 1: MA (10, 100, 200,500, 750, 1000 µM concentrations) was added during EB formation, group 2: MA (10, 50, 70, 100, 200, 500 µM concentrations) was added after the generation of neural precursors. Then cells were evaluated for neuronal markers by immunocytochemistry and RT-PCR. One way ANOVA followed by the post hoc test was used to analyze data. The declining in the outgrowth of dendrites was observed in neural morphology in a dose dependent manner. The ID50 (Inhibition of neuronal differentiation) of groups 1 and 2 were 130 and 400 µM, respectively. By using RT-PCR, in comparison with MAP2, no significant change was observed in the nestin expression. Our data about neuronal toxicity were consistent with in vivo and in vitro studies. Therefore, we concluded that ESCs can be used as an efficient model to assess the toxicity of drugs.

Intra operative cytology (IC), including touch imprint (TI) and crash preparations (CP), has been demonstrated to be a diagnostic tool for many organs but its validity and reliability for the diagnosis of thyroid nodules remain controversial. In this study we evaluated the diagnostic value of frozen section, touch imprint, crash preparation, the combination of touch imprint and crash preparation, and the combination of frozen section, touch imprint and crash preparation. 55 intra operative specimens from patients with thyroid nodules who underwent thyroidectomy were evaluated at Alzahra and vali-Asr hospital laboratories. For all of the patients frozen section (FS), touch imprint (TI) and crash preparation (CP) was obtained and reviewed by two pathologists at the same time. Serial (TI and CP) and (FS, TI and CP) were reviewed by the same pathologists. Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio and accuracy were calculated according to the permanent section of the gold standard test. in our study sensitivity, specificity and accuracy of FS was 100%, 97.6% and 98.1% respectively; for TI they were 78.6%, 95% and 92.4% respectively; for CP they were 78.6%, 92.7% and 89.9% respectively; for serial TI and CP they were 85.7%, 92.7% and 90.9% respectively; and for the combination of FS and TI and CP they were 100%, 97.6% and 98.18% respectively. Intra operative cytology (including TI and CP) seems to be a useful, valuable and inexpensive method in clinics which do not have the necessary equipment for frozen sections. Intra operative cytology combined with FS increased the overall accuracy of the diagnosis. Further studies are needed to validate the obtained results of this study.

HIV is a multidimensional problem. Therefore, prioritization of research topics in this field is a serious challenge. We decided to prioritize the major areas of research on HIV/AIDS in Iran. In a brain-storming session with the main national and provincial stakeholders and experts from different relevant fields, the direct and indirect dimensions of HIV/AIDS and its related research issues were explored. Afterward, using the Delphi method, we sent questionnaires to 20 experts (13 respondents) from different sectors. In this electronic based questioner, we requested experts to evaluate main topics and their subtopics. The ranges of scores were between 0 and 100. The score of priorities of main themes were preventive activities (43.2), large scale planning (25.4), the estimation of the HIV/AIDS burden (20.9), and basic scientific research (10.5). The most important priority in each main theme was education particularly in high risk groups (52.5), developing the national strategy to address the epidemic (31.8), estimation of the incidence and prevalence among high-risk groups (59.5) and developing new preventive methods (66.7), respectively. The most important priorities of researches on HIV/AIDS were preventive activities and developing national strategy. As high risk groups are the most involved people in the epidemic, and they are also the most hard-to-reach sub-populations, a national well designated comprehensive strategy is essential. However, we believe with a very specific and directed scheme, special attention to research in basic sciences is necessary, at least in limited number of institutes.

Extranodal lymphoma may arise anywhere outside lymph nodes mostly in the gastrointestinal (GI) tract as non-Hodgkin''s disease. We reviewed the clinicopathological features and treatment results of patients with primary GI lymphoma. A total number of 30 cases with primary GI lymphoma were included in this study. Patients referred to the Radiation Oncology Department of Omid Hospital (Mashhad, Iran) during a 5-year period (2006-11). Clinical, paraclinical, and radiological data was collected from medical records of the patients. Out of the 30 patients with primary GI lymphoma in the study, 12 were female (40%) and 18 were male (60%) (male to female ratio: 3/2). B symptoms were present in 27 patients (90%). Antidiuretic hormone (LDH) levels were elevated in 9 patients (32.1%). The most common primary site was stomach in 14 cases (46.7%). Other common sites included small intestine and colon each in 8 patients (26.7%). All patients had histopathologically proven non-Hodgkin''s lymphoma. The most common histologic subtype was diffuse large B-cell lymphoma (DLBL) in 16 patients (53.3%). In addition, 28 patients (93.3%) received chemotherapy with cyclophosphamide, vincristine, doxorubicin, prednisolone (CHOP regimen). The median course of chemotherapy was 6 cources. Moreover, 8 patients (26.7%) received radiotherapy with cobalt 60. The median follow-up time was 26 months. The overall 5-year survival rate was 53% and the median survival time was 60 months. Primary GI lymphoma is commonly seen in stomach and small intestine and mostly is DLBCL or mucosa-associated lymphoid tissue (MALT) lymphoma.

Fetus in fetu is a rare congenital anomaly in which malformed fetus grows within the body of its twin. It is almost always detected as an abdominal mass in infancy. It is a parasitic twin of a diamniotic, monozygotic twin. It should be differentiated from teratoma which has no axial arrangement and has got definite malignant potential. Herein, we present a case of a two-month old female infant and review the literature. Although fetus in fetu is a rare condition, correct diagnosis using imaging can be made before surgery. It should be considered as a differential diagnosis for lump abdomen especially in infants. Complete excision is curative.

Tongue squamous cell carcinoma is a very rare disease in children with only a few cases reported in the literature. A case of 15 year old female tongue squamous cell carcinoma (SCC) with review of reported cases is presented.Pediatricians and family physicians should also be aware of the possibility of this disease entity occurring at an earlier age to decrease delay in diagnosis and initiation of treatment.

Dear Editor, We read an article entitled «Synchronous bilateral adrenalectomy by midline incision: A reliable method for treatment of hypercortisolism» by Tabatabaee et al. [1] with interest. We congratulate the authors for their good surgical outcomes. However, we would like to clarify a few points about simultaneous bilateral laparoscopic adrenalectomy (SBLA) for patients with medically uncontrollable Cushing''s syndrome. Laparoscopic adrenalectomy (LA) has significantly reduced the morbidity classically associated with open adrenalectomy. It is now the standard treatment of choice for most benign adrenal tumors, including unilateral Cushing''s adenoma. [2] Even though the authors cited the complication rates of 9. 5-12% during unilateral or SBLA, their references were from the earlier series. [1] In fact, those major complications were infrequently encountered in the experiences of ours and others, [2-5] with the mean conversion rate of only 0 [4] -4. 7% [3] during SBLA. In contrast, decreased blood loss, less postoperative pain, earlier resumption of oral feeding, and shorter hospital stays were achieved in patients undergoing either unilateral LA or SBLA. [3-5] We believe SBLA is technically feasible and safe under experienced hands.

Dear Editor, Most Indians tend to have strong religious affiliations. Traditionally, medicine and religion are inseparable, and religious priests are considered to be healers of body and soul. Ayurveda, an Indian system of traditional medicine, makes use of herbal medicines and prayers to heal the person as a whole. The practice of medicine is considered a sacred activity in which God is the ultimate authority on knowledge about life and death. [1] A similar role was assigned to religion in Western societies in the past. With advances in scientific knowledge around the 17th century, religion fell out of favor as it was considered «unscientific». This led to a division of roles between religious leaders for healing the soul and physicians for healing the body. Interest in spirituality developed, as an alternative to rigid religion, which is considered a sign of social progress. Religiosity and spirituality have the common objective of reaching the «higher power», or God, or something that is «sacred». Spirituality is viewed as an individual quest while religiosity is a group phenomenon with other objectives such as developing an identity, and providing social support and feelings of security. [2] The World Health Organization (WHO) has recognized spirituality as an important factor influencing health. Many Western medical universities have included spirituality in their training programs. One deficiency of these programs is that they are not uniform, and most of them do not evaluate their own effectiveness. [3] It is inherently difficult to teach and assess spirituality because it is a personal quest which students pursue at different speeds.

Dear editor of theJournal of Research in Medical Sciences (JRMS) In the midwifery profession, measuring pelvic and cervical dilatation is essential for making decisions, especially when the mother is in labor phase. For this reason, several studies have been conducted in pelvimetry. [1-4] Measurement of the cervix and judgments about pelvic dimensions are performed by the midwife''s fingers. However, as finger size and how to measure the distance between the fingers differ from person to person, it is important to develop a method with similar results for everyone. A reliable and convenient tool would thus be advantageous for different fields of medical sciences. The «midwifery ruler» is used to produce homogenous measurements by different obstetricians and midwives. It is a ruler with three blades. Two of them (blades A and B) join together and make a cross. The ends of these two blades are connected to another blade (C). Blade C is mobile and is scaled with centimeters. After entering the ruler into the vagina, the blade edges are placed near the edges of the cervix, the edges are rounded to avoid injury and perforation in vaginal tissue and amniotic membranes. The cervical dilatation is measured by opening the blades. It is also possible to estimate the diameter of the mid-pelvis with the same method. As a third application, this tool can measure diagonal diameter by completely sticking blades A and B and placing one end near promontory of sacra bone while the other end is placed in pubic bone angle. The distance can then be measured by observing the scaled surface. The ruler can be made of durable and sterilized metal or compact plastic (for disposable products). The midwifery ruler has been registered at Invention Registry of Islamic Republic of Iran (No. 389030679) in 2010.