Iranian Red Crescent Medical Journal
Volume:14 Issue: 10, Oct 2012

The aim of this study is to determine the level of serum cytokeratin19 fragment (cyfra21-1) in patients with benign or malignant pleural effusion and evaluation the sensitivity and specificity of this tumor marker.Method & Material: We prospectively evaluated 98 patients (39 malignant, 54 benign and the results were inconclusive in 5) with pleural effusion. The diagnosis of malignant pleural effusion was defined by cytological or histological results. We used serum cyfra21-1 criteria from literature of Roch company. Level of the marker was determined using electrochemiluminescence. There was statistically significant difference between mean of serum cyfra21-1 levels of benign (3.9±7.6) and malignant(19.5± 30) pleural effusion (p=0.01). In addition the sensitivity, specificity, positive predictive value and negative predictive value of serum cyfra21-1 at the cut off point of 3.3 ng/ml, was 84%, 61%, 61% and 84 % respectively. Serum cyfra21-1 is useful as a measure in differentiating malignant from benign pleural effusion.

Calcium infusion is used as a pre-treatment before calcium channel blockers to prevent hypotension. Occasional cardioversion with calcium gluconate infusion is seen in patients with paroxysmal supraventricular tachycardia. Several mechanisms have been suggested for mechanism. Herein we report a case presenting with atrial fibrillation but cardioverted with calcium gluconate infusion, which is unreported in the literature before.

Disorders of the palatal uvula is one of the least highlighted areas of medical literature, inspite the fact that uvula is a key organ in functions like speech, deglutition and mastication. The aim of this paper is to present a series of cases of wide range of uvular deformities ranging from bifid uvula to absence of uvula.

Disasters may lead to ethical challenges that are different from usual medical practices. In addition, disaster situations are related with public health ethics more than medical ethics, and accordingly may require stronger effort to achieve a balance between individual and collective rights. This paper aims to review some ethical dilemmas that arise in disasters and mainly focuses on health services. Disasters vary considerably with respect to their time, place and extent; therefore, ethical questions may not always have `one-size-fits-all` answers. On the other hand, embedding ethical values and principles in every aspect of health-care is of vital importance. Reviewing legal and organizational regulations, developing health-care related guidelines, and disaster recovery plans, establishing on-call ethics committees as well as adequate in-service training of health-care workers for ethical competence are among the most critical steps. It is only by making efforts before disasters, that ethical challenges can be minimized in disaster responses.

Ability of athletes in speed or endurance contests somehow is determined by inherited muscle fiber types. One of the important genes involved in sport genetics is ACTN3 that is located on chromosome 11q13-q14 and encodes α-actinin-3, which belongs to highly conserved family of α-actinin proteins. Genetic analysis of α-actinin-3 gene has showed a polymorphism R577X (rs1815739), which results in premature stop codon and leads to non functional α-actnin-3 protein. ACTN3 genotype can contribute to the performance in elite and endurance activities. R577X polymorphism replaces arginine by stop codon. Individuals homozygous for R577 have full copy of α-actinin-3 and elite and power sprint athletes show significantly higher frequency of 577R allele. In the other hand, some studies represented that X allele have high level of frequency in endurance athletes. However, this data remains controversial Since there is no information about the frequency of ACTN3 genotype in our population therefore as the first step it is essential to determine the genetic background of Iranian population.. The objective of this study was to genotype normal Iranian individuals to determine the prevalence of each allele in our population. We used PCR-RFLP method for genotyping 210 normal individuals. Total of 210 Iranian normal individuals for distribution of R577X and R alleles were genotyped. The different genotypes were as follow; 24% RR (50/210), 65%RX (136/210) and 11%XX (24/210), with allelic distribution of 0.56 and 0.44 for 577R and 577X alleles of ACTN3. This allelic distribution for Iranian's is more close to Caucasian population, which is concurrent with the route of ancient human's migration from Iran Plateau toward Europe. Our results showed no different patterns of allelic distribution among female and males, which was the same in other studies too, although some differences has been reported in the studies on athletes population.

Influenza can causes morbidity and mortality that are greatly enhanced in patients with underlying chronic diseases such as Cirrhotic patients. This study was performed to assess the immunogenicity of Influenza vaccination in patients with cirrhosis and inactive carriers of Hepatitis B virus infection. In this clinical study 93 enrolled subjects divided into 3 groups: Cirrhotic (N=28), Inactive carriers of Hepatitis B (N=31) and subjects (N=34). All the participants were vaccinated by Influenza vaccine (Influvac®). Serum samples were taken before and 4 weeks after vaccination and the Humoral Immunogenicity was assessed by the Hemagglutination iInhibition (HI) test. Four weeks after vaccination, seroconversion rates of vaccine strains ranged between 71.4% and 100% in Group 1, 70.6% and 94.1% in Group 2, and 58.1% and 80.7% in Group 3. No significant differences were seen in the rates of Seroconversion and antibody Geometric Mean Titers (GMTs) against Influenza A (H1N1 and H3N2) vaccine components in the three groups (P>0.05).The rates of Seroconversion and antibody GMTs against Influenza B vaccine component were significantly higher in Cirrhotic and inactive carriers of Hepatitis B than healthy subjects (P<0.005). No significant (P>0.05) differences in the rates of Seroprotection were observed within the three groups. Antibody GMTs against all three strains of Influenza vaccine increased significantly (P<0.001) after vaccination in three groups. Influenza vaccination is effective in Cirrhotic patients and inactive carriers of Hepatitis B as well as healthy individuals. It means that vaccination should be considered in such patients in order to reduce the morbidity and mortality of Influenza.

To evaluate the effectiveness of acupuncture and compare it with fluoxetine in treatment of fibromyalgia syndrome (FMS). We conducted a prospective, randomized clinical trial. Fifteen patients were treated with acupuncture and compared with a control group (n=15) of patients who received fluoxetine. Visual analogue scale, Fibromyalgia Impact Questionnaire (FIQ) and determined number of tender points were used as outcome measurements. After four weeks, the acupuncture group was significantly better than the control group in the number of tender points. Total fibromyalgia symptoms were significantly improved in the acupuncture group compared with the control group during the study period (P= 0.01). The largest difference in mean FIQ total scores was observed at 4 weeks (42.2 VS. 34.8 in the control and acupuncture groups, respectively; P= 0.007). At the end of one year of the follow up, patients who received acupuncture were significantly better than the control group in all measures. Fatigue and anxiety were the most significantly improved symptoms during the follow up period. Acupuncture significantly improved pain and symptoms of fibromyalgia. Also, we found that acupuncture did not have any side effect and was tolerable.

Acetaminophen exposure might be associated with increasing risk of asthma prevalence and other atopic disorders over recent decades. The present study aimed to investigate the association between acetaminophen exposure and the risk of developing childhood asthma. A case - control study was undertaken between March and September 2010 in Urmia district north west of Iran. Subjects were children aged between 2 - 8 years old. Cases were asthmatic children diagnosed based on GINA criteria (n=207) and controls were children without asthma symptoms (n=414) using 1:2 sampling method. Cases and controls were matched for age and gender. Clinical data including Acetaminophen exposure was collected by a questionnaire which completed by interviewing with parents/ guardians. Using Acetaminophen during the first year of life had no any effect on the risk of asthma (p=0.19), but amongst 2-8 years old children, this association was observed (p<0.001). There was also a doseresponseassociation between Acetaminophen consumption and risk of asthma (OR: 3.8; 95% CI; 2.15 6.59 for once per 2 to 3 month and OR: 4.2; 2.50 - 7.3 for at least one per month). Using Acetaminophen increases risk of asthma among 2 - 8 years old children. However stronger evidences are required to design evidence-based guidelines to reduce acetaminophen consumption following post - vaccination and other febrile disorders.

Outer hair cell's (OHCs') dysfunctions as the extent of temporary and permanent threshold shifts (TTS and PTS) and cochlear damage were assessed in rabbits exposed to continuous noise. Twelve New Zealand white rabbits were studied in noise (N) (n=6; exposed to continuous noise; 95 dB SPL, 500-8000 Hz for 8 h per day during 5 consecutive days) and control (C) (n=6; not exposed to noise). OHC's functions were assessed by distortion product otoacoustic emission (DPOAE) level (Ldp) measurements in different periods and comparing TTS and PTS. Animals were anaesthetized by CO2; cochleae were extracted, fixed in 10% formaldehyde for 48 hours, decalcified by 10% nitric acid for 24 hours, and dehydrated, embedded, sectioned 5 µm thickness and stained by Hematoxylin and Eosin for light microscopy. The most and least Ldp or TTS or PTS were related to 5888.50 Hz and 588.00 Hz respectively in noise subjected rabbits (P<0.05). TTS and PTS were decreased up to 17.79 dB and to 16.01 dB respectively. TTS were more than PTS over all test frequencies, especially at 5888.50 Hz (P<0.05). Ldp or TTS or PTS were found to be equal across ears (P>0.05). Severely vacuolated OHCs, pyknotic IHCs, swollen SC, and slightly thickened BM were found. Continuous noise extensively led to OHC's dysfunctions as decreased Ldp (both TTS and PTS) and highly damage to cochlea.

Treatment of Helicobacter pylori (H. pylori) as a major cause of gastric diseases is of utmost concern.We aimed to assess efficacy of triple therapy (amoxicillin, clarithromycin and pantoprazole) plus probiotic yogurt (PY) on eradication of H.pylori. Total 102 H. pylori positive patients were divided to 3 groups equally and randomly. For treatment of each group Amoxicillin, clarithromycin and pantoprazole were used. Group A had additional PY, Group B ordinary low fat yogurt and Group C just had triple therapy in their regimen as well. These groups were compared regarding treatment success.. Total number of 88 patients finished the treatment course. The most common experienced side effects were dysgeusia in groups A and B (25.8% and 32.3%, respectively), and dysgeusia with diarrhea and abdominal pain (30.8%) in group C. Eradication rate was, respectively, 61.3%, 64.5% and 71.3% in group A, B and C of which difference was not statistically significant (P> 0.05). However, the difference between 3 groups in regard to education level was statistically significant (P=0.005). PY enriched triple therapy has decreased side effects of antibiotics consumption; however, this has no impact on eradication of Hpylori. PY and triple therapy can be used concomitantly to increase the patient tolerance.

Plasmablastic lymphoma (PBL) is a relatively new entity, classified by WHO as a rare variant of diffuse large B cell lymphoma. The present case report introduces a 17 year old girl with chronic diarrhea, abdominal pain, intra-abdominal venous thromboses, ascites, mesenteric lymphadenopathies and small intestinal polyposis, the pathologic and immunohistochemistric examinations of the polypoid lesions were in favor of PBL. Numerous cases of PBL have been reported, but to our knowledge, this is the first report of PBL presenting as small intestinal polyposis.Among lymphomas, only mantle cell lymphoma and follicular cell lymphoma have been previously reported to cause intestinal polyposis. This report introduces Plasmablastic lymphoma, a rare variant of diffuse large B cell lymphoma, as a possible cause of small intestinal polyposis.

Vancomycin-resistant enterococci (VRE) recently have emerged as a nosocomial pathogen among dialysis patients. This study aims to appraise the prevalence, incidence density and risk factors for VRE colonization among these patients. In this prospective study, 782 stool or rectal swab specimens were collected from 250 chronic hemodialysis patients with an interval of at least one month. To identify the risk factors of VRE colonization, demographic and health data of VRE+ and VRE- patients were compared. VRE colonization was detected in 55 (22%) patients during study. Incidence density of one case per 79.6 patient-month of follow up was estimated.The only significant difference between the data collected from VRE+ and VRE- patients was observed in antibiotic consumption (P<0.001). VRE colonization is relatively high and rapidly spreading among chronic dialysis patients. It is strongly associated with recently antibiotic consumption.