Iranian Journal of Medical Sciences
Volume:37 Issue: 4, Dec 2012

Echocardiography is a non-invasive diagnostic technique which provides information on cardiac morphology, function, and hemodynamics. It is the most frequently used cardiovascular diagnostic test only after electrocardiography. In less than five decades, the evolution in this technique has made it the basic part of cardiovascular medicine. Herein, the evolution of various forms of echocardiography is briefly described.

Oral lichen planus is a chronic inflammatory disease with a poorly understood etiology. The role of angiogenesis in the development of different chronic inflammatory diseases is of great concern. Vascular endothelial growth factor (VEGF) is an important regulator of angiogenesis. We aimed to evaluate the serum level of VEGF in patients with oral lichen planus compared with normal individuals and consider its clinical significance. In this case-control study, 36 serum samples from patients diagnosed with oral lichen planus admitted to the Oral Medicine Department of the School of Dentistry at Shiraz University of Medical Sciences (14 men, 22 women, mean [±SD] age: 38.8 [±6.07] years) and 23 serum samples from healthy individuals (9 men, 14 women, mean [±SD] age: 38.7 [±4.9] years) were collected. VEGF concentration was measured using the ELISA method. The Mann-Whitney test was used for statistical analysis. The serum VEGF level was significantly higher in patients with oral lichen planus compared with the healthy controls (112.97 [±63.2] vs. 66.21 [±56.2] ngr/ml, P<0.001). A similar difference was also observed between the two types of oral lichen planus, being more pronounced in the erosive form (P<0.001). Serum VEGF can be used as a useful and suitable marker to scrutinize the disease activity.

Early extubation is implemented in cardiothoracic units worldwide for its advantages such as decreased mortality, morbidity, and hospitalization costs. We conducted a retrospective study to evaluate potential factors which may affect extubation time. The records of 334 eligible patients who underwent elective coronary artery bypass grafting (CABG) in 2008 in Kowsar Hospital in Shiraz, southern Iran were evaluated to find the factors that can affect the extubation time. The patients were divided to early (equal or less than 6 hours) and late extubation groups. The patients’ demographic data and operative variables were extracted from the records. We excluded patients with difficult intubation, severe acid base disturbance, neurological problems, and cardiovascular instability; and those who used intra-aortic balloon pump, had underwent emergency operation, or had another concomitant surgery. Multiple logistic regressions comparing age, sex, number of grafts, ejection fraction, pump time, hematocrit, number of risk factors, and number of inotropic drugs, identified only age as a predictor of delayed extubation (odds ratio=1.07, CI 95%=1.04-1.10, P<0.001). Also, in both studied groups the men to women ratio was higher (P<0.05). Although in our study age was the only predictive factor for delayed extubation, a comprehensive study including preoperative, perioperative, and postoperative factors is recommended in our area.

The areas of the bed nucleus of the stria terminalis (BST) with a high density of estrogen receptors are involved in cardiovascular regulation and send axonal projections to the rostroventrolateral medulla (RVLM). We aimed to find the contribution of the RVLM to cardiovascular responses elicited by glutamate microinjection into the BST. Experiments were done in? -chloralose anesthetized ovariectomized (OVX) or OVX estrogen treated (OVX+E) female Wistar rats. Drugs were microinjected into the BST and RVLM. The average changes in mean arterial pressure (MAP) and heart rate (HR) were compared between the case and control groups using t test and with the pre-injection values using paired t test. Unilateral microinjection of glutamate (0.25 M/50 nl) into the BST decreased MAP and HR, in the OVX+E and OVX rats. These cardiovascular responses were reversibly attenuated 10 minutes after microinjection of synaptic blocker cobalt chloride (CoCl2, 5 mM/50 nl) into the ipsilateral RVLM. Re-stimulation of the BST 60 min after CoCl2 injection elicited cardiovascular responses that were not different from the control values. Ipsilateral microinjection of GABAA antagonist bicuculline (1.0 mM/50 nl) into the RVLM caused a 50% attenuation of glutamate induced depressor and bradycardic responses in both groups. Ipsilateral microinjection of GABAB antagonist, phaclophen (5.0 mM/50 nl), into the RVLM did not affect the depressor and bradycardic responses due to re-stimulation of the BST by glutamate. The RVLM sympathetic premotor neurons contain GABAA receptors that mediate in part the sympathoinhibitory responses to stimulation of the BST in the OVX animals.

In recent years use of family physicians has been determined as a start point of health system reform to achieve more productive health services. In this study we aimed to assess the cost-efficiency of the implementation of this plan in Fars province, southern Iran. This cross-sectional descriptive study was done in 2007 in 18 provincial health centers as well as 224 rural health centers in Fars province. Data were collected using forms, statistics, and available evidence and analyzed by expert opinion and ratio techniques, control of process statistics, and multi indicator decision model. Although in the family physician plan more attention is paid to patients and the level of health training, availability, and equity has improved and the best services are presented, it has not only decreased the costs, but also increased the referrals to pharmacies, laboratories, and radiology clinics and the costs of healthcare. Although the family physician plan has led to more regular service delivery, it has increased the patients’ referral to pharmacies, laboratories, and radiology centers and more referrals to family physicians. It seems that the possibility of setting regularity in health system can be gained in the following years of the family physician program mainly via planning, appropriate management and organizing correct health plans according to need assessments, and continual supervision on activities, which would happen according to current experiences in this plan.

It seems that the incidence of pertussis-like illnesses is considerably increasing despite the wide coverage of immunization with the whole cell pertussis vaccine. We aimed to investigate the occurrence of pertussis in vaccinated children by measuring anti-pertussis antibodies. In this cross-sectional study, blood samples were taken from vaccinated children aged 2, 4, 6, 12, 18, and 72 months. Anti-pertussis IgG and IgA were measured by ELISA. P<0.05 was considered significant. 725 children were enrolled in the study. Geometric mean titers for IgG that showed a slight decease after 2 months of age and increased distinctly in children aged 72 months. The frequency of the individuals whose IgG was above the determined cut-off (derived from mean+2SD) was observed in 1% of the 2, 4, and 6-month-old infants, 6% of the 12 and 18-month-olds and 12% of the 6-year -old children. Positive IgA titers were detected in 5, 9, 6, 23, 11, and 8% of children aged 2, 4, 6, 12, 18, and 72 months, respectively. Since a considerable percentage of children had high levels of anti-pertussis IgG antibodies (?2 SD), positive anti-pertussis IgA, and most importantly an increased level of anti-pertussis IgG geometric mean titer at 6 years of age, further investigations regarding the protection provided by the presently used, pertussis vaccine seems necessary.

The aim of this study was to examine the effect of crude bile on the human HepG2 and CCRF-CEM cell lines. Cells were exposed to different dilutions of bile. Antiproliferative effects were determined by the cytotoxic MTT assay. Cells undergoing apoptosis were identified by terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay. Bile administration resulted in dose-dependent cytotoxicity in both HepG2 and CCRF-CEM cell lines. Incubated cells exhibited morphologic features of apoptosis. Bile has significant cytotoxic activity in HepG2 and CCRF-CEM cancer cells via induction of apoptosis. The mechanism of apoptosis needs to be further evaluated. It may have clinical utility in the treatment of cancer after in vivo confirmation of activity.

Squamous cell carcinoma of the gallbladder is rare and constitutes only 0.5-3% of all malignancies of this organ. Most of the reported cases have had a component of adenocarcinoma. We report a 70-year-old man who presented with acute onset right upper quadrant pain. He operated on based on a presumptive diagnosis of acute cholecystitis according to clinical and ultrasonographic findings. Histopathological examination of the infiltrating mass of the gallbladder revealed well differentiated keratinized squamous cell carcinoma invading full wall thickness. Thorough evaluations revealed no other primary site for the tumor. Pure primary squamous cell carcinoma of the gallbladder is rarely reported. Clinicians and pathologists must be aware of its vague clinical presentations.

Diabetic ketoacidosis (DKA) is characterized by excessive production of organic acids leading to a low blood pH. Rarely, because of other complicating factors blood pH may be in the alkalemic range and the term diabetic ketoalkalosis has been coined to describe this condition. So far, less than 30 such cases have been reported in the literature. We report a 34-year-old woman who received methylprednisolone pulse therapy for the treatment of pancreas transplant rejection. Thereafter, she developed vomiting and abdominal pain. Her laboratory data showed high blood sugar, hypokalemia, alkalemic pH, elevated plasma anion gap, and significant ketonemia. She responded well to the treatment of DKA. It was concluded that an alkalemic pH does not rule out the presence of ongoing DKA. In suspected cases, changes in plasma anion gap and bicarbonate and the presence of ketonemia should be noted.