Acta Medica Iranica
Volume:51 Issue: 4, Apr 2013

Antibiotic resistance to microorganisms is one of the major problems faced in the field of wound care in burns patients. Silver nanoparticles have come up as potent antimicrobial agent and are being evaluated in diverse medical applications ranging from silver based dressings to silver coated medical devices. We aimed in present study to test the release of nanosilver from nanosilver wound dressing and compare the dermal and systemic toxicity of nanosilver dressings in a repeated dose (21 days) model. Under general anesthesia, a limited standard 2nd degree burns were provided on the back of each rat in all treatment, negative control (simple dressing) and 5% silver nitrate groups, each contained 5 male wistar rats. According to the analysis made by atomic absorption spectrometry, the wound dressings released 0.599 ± 0.083 ppm of nanosilver during first 24 hrs of study. Daily observations were recoded and wounds were covered with new dressings each 24 hrs. Burn healing was observed in nanosilver wound dressing group in shorter time periods than the control groups. In toxicity assessment, this dressing didnt cause any hematological and histopathological abnormalities in treatment group but biochemical studies showed significant rise of plasma transaminase (ALT) at the endpoint (21 days) of the study (P=0.027). Portal mononuclear lymphoid and polymorphonuclear leukocyte infiltrations in three to four adjacent foci were recognized around the central hepatic vein in treatment group. Mild hepatotoxic effects of nanosilver wound dressing in wistar rat emphasize the necessity of more studies on toxicity potentials of low dose nanosilver by dermal applications.

Nowadays, new advances in the use of cell free fetal DNA (cffDNA) in maternal plasma of pregnant women has provided the possibility of applying cffDNA in prenatal diagnosis as a non-invasive method. In contrary to the risks of invasive methods that affect both mother and fetus, applying cffDNA is proven to be highly effective with lower risk. One of the applications of prenatal diagnosis is fetal gender determination, which is important in fetuses at risk of sex-linked genetic diseases. In such cases by obtaining the basic information of the gender, necessary time management can be taken in therapeutic to significantly reduce the necessity of applying the invasive methods. Therefore in this study, the probability of detecting sequences on the human Y-chromosome in pregnant women has been evaluated to identify the gender of fetuses. Peripheral blood samples were obtained from 80 pregnant women with gestational age between 6th to 10th weeks and the fetal DNA was extracted from the plasma. Identification of SRY, DYS14 & DAZ sequences, which are not presentin the maternal genome, was performed using Real-Time PCR. All the obtained results were compared with the actual gender of the newborns to calculate the test accuracy. Considerable 97.3% sensitivity and 97.3% specificity were obtained in fetal gender determination which is significant in the first trimester of pregnancy. Only in one case, false positive result was obtained. Using non-invasive method of cffDNAs in the shortest time possible, as well as avoiding invasive tests for early determination of fetal gender, provides the opportunity of deciding and employing early treatment for fetuses at risk of genetic diseases.

Behcet´s disease (BD) is accepted as a systemic vasculitis. Vasculitis is observed predominantly on the venous system. Vessel involvement is frequently seen in males. This study was planned retrospectively evaluate demographic features, clinical features, vessel involvements in BD. Furthermore, we aimed to prospectively compare consecutively chosen patients with and without thrombosis and healthy volunteers in terms of their biochemical, immunological, coagulation parameters. One hundred fifty-two Behcet´s patients were retrospectively evaluated. Blood samples were collected from 52 consecutively chosen patients and 41 healthy subjects. Papulopustular skin lesions, eye involvement and venous lesions were detected frequent in males. In terms of evaluated parameters (biochemical parameters, coagulation parameters, C-reactive protein, erythrocyte sedimentation rate, anticardiolipin antibodies, antinuclear antibody positivity) was not found a significant difference among groups (patients without thrombosis, healthy control subjects, patients with thrombosis). We detected statistically significant difference in terms of factor V levels between patient and control group. The tendency to thrombosis in patients with BD is well known. The endothelial lesion, increased procoagulant activity, hypofibrinolysis were found to be responsible from these events. In our study, there was no significant difference in terms of coagulation parameters between the patients without and with thrombosis.

Pemphigus is a rare autoimmune blistering disease with different phenotypes. The evaluation of therapeutic interventions requires a reliable, valid and feasible to use measurement. However, there is no gold standard to measure the disease activity in clinical trials. In this study we aimed to introduce the pemphigus vulgaris activity score (PVAS) measurement and to assess the convergent validity with the experts’ opinion of disease activity. In PVAS scoring, the distribution of pemphigus vulgaris antigen expression in different anatomical regions is taking in to account with special consideration of the healing process. PVAS is a 0-18 scale, based on the extent of mucocutaneous involvement, type of lesion and the presence of Nikolsky’s sign. The sum of the scores of total number of lesions, number of different anatomic regions involvement and Nikolsky’s sign is weighted by the type of lesion. In the present study, PVAS was assessed in 50 patients diagnosed with pemphigus vulgaris by one dermatologist. Independently, five blinded experts scored all the patients through physician’s global assessment (PGA). The convergent validity with experts’ opinion was assessed. The Spearman coefficient of correlation showed the acceptable value of 0.751 (95%CI: 0.534- 0.876). PVAS is a valid, objective and simple-to-use scoring measurement. It showed a good correlation with PGA of pemphigus disease activity in Iranian patients with pemphigus vulgaris.

Diabetes mellitus (DM) is the most prevalent metabolic disease worldwide and is associated with coronary artery disease (CAD). Therefore it is very important to find a clue to diagnose the presence of CAD as early as possible in DM patients. The aim of this study was to find any correlation between microalbuminuria (MAU) and the severity of CAD in patients with DM type 2. This was a cross sectional study that included 77 DM type 2 patients with suspected CAD that all of whom were performed coronary angiography in our hospital (from 2010 to 2011). Patients were divided into two groups, the case group (group 1) that includes patients with MAU and the control group (group 2) that include patients without MAU. Severity of CAD was estimated by using Gensini score and MAU was defined as the ratio of urine albumin to urine creatinine. Of 77 patients forty three (55.8%) were female, mean ± SD of their ages was 55.8 ± 10.3 and sixteen (21%) of them had MAU. Gensini score of case group was significantly higher than control group (94.94 ± 12 versus 33.25 ± 25.4, P<0.001). The linear regression analysis revealed urinary albumin to creatinine ratio (UA/CR) as an independent predictor for the severity of CAD (P<0.001). Based on the ROC curve, 10.25 was the best albumin level cut off point for differentiating Gensini score over and below 70. Area under curve was 0.9; sensitivity and specificity were 72% and 80%, respectively (P<0.001). According to this study, in patients with DM type2, MAU is an independent predictor of severity of coronary artery stenosis and reveals a positive correlation between MAU and the Gensini score.

Longevity is a multifaceted trait in which variety of genes and environmental factors are involved. Newly, the role of vitamin D has been revived regarding its potential advantage on delaying the aging process. Vitamin D exerts its effect through vitamin D receptor (VDR). VDR-FokI is the only polymorphism which alters the VDR length. We examined the frequency of FokI genotypes in old age population as compared to young adults to determine the discerning genotype of FokI polymorphism leading to longer living. In addition, to highlight the position of FokІ polymorphism in quality of life; a cognitive function assessment was performed. 728 participants participated in this study of which 166 individuals were elderly residents of Kahrizak Charity Foundation. The rest were participants of Iranian Multicenter Osteoporosis Study (IMOS). Genomic DNA was extracted from peripheral blood and VDR genotype was detected by the polymerase chain reaction. The participants in the elderly group underwent a cognitive function assessment. Cognitive function was measured with the mini mental state examination (MMSE). Data were analyzed by SPSS 16.5. The prevalence of ff genotype showed 48% decrease in elderly population as compared to young adults (P=0.06). In addition, F allele was over-represented in the elderly group as compared to controls (P=0.05). Also, “FF” participants of elderly group had higher MMSE as compared to “ff” genotype (18.16Vs17.12). Our data suggest that single nucleotide polymorphisms (SNPs) in FokI may be possibly involved in longevity and cognitive function.

Human papilloma virus (HPV) has been suggested as an etiology of esophageal squamous cell carcinoma (SCC). The aim of this study was to investigate the prevalence of HPV infection in esophageal SCCs in our region with strict contamination control to prevent false positive results. Thirty cases of esophageal squamous cell carcinomas were chosen by simple random selection in a period of two years. PCR for target sequence of HPV L1 gene was performed on nucleic acid extracted from samples by means of GP5+/GP6+ primers. All tissue samples in both case and control groups were negative for HPV-DNA. Although the number of cases in this study was limited, the contribution of HPV in substantial number of esophageal SCCs in our region is unlikely.

It is known that neuropeptide Y which is widely distributed throughout the central nervous system is able to prevent seizures in animals. There are limited studies about the role of neuropeptide Y in febrile seizures. This study was conducted to evaluate the association between plasma neuropeptide Y level and febrile seizures in children. Seventy six patients with typical and atypical febrile seizures (each group 38 patients) and 38 sex and age matched control subjects were enrolled. The mean plasma levels of neuropeptide Y in typical and atypical febrile seizures were 90.60±28.01 and 97.34±41.27 pmol/l respectively. This value in control group was 88.94±32.66 pmol/l. There was no significant differences between groups regarding plasma neuropeptide Y level (P=0.532). Also, there was no significant difference in comparison with case groups (P=0.40). This study revealed that there is no association between plasma neuropeptide Y and febrile seizures.

Core decompression (CD) of the femoral head is one of the effective treatments of avascular necrosis (AVN), especially in the early stages of the disease. To investigate further the value of CD in treating the AVN, this study was performed on patients with symptomatic AVN with different etiologies who were treated with CD. This study was carried out on 25 patients (with the total number of 37 femoral head) who were diagnosed AVN using X-Ray and MRI. The CD treatments for these patients were started soon after the diagnosis. The results were considered as a success if there was no progression of disease confirmed by X Ray or no subsequent operation was required. Modified Ficat staging was used to record changes before and 2 years after CD treatment. Twenty five patients were participated in this study in which 68% (n=17) were female, 32% (n=8) were male, and the average of the age of the patients were 29.58±4.58. Eight of these patients had systemic lupus erythematous (SLE) (32%), 4 rheumatoid arthritis (RA) (16%), 3 with kidney transplant (12%), 1 Takayasu’s vasculitis (4%) and 1 Wegner vasculitis (4%). Eight of patients had a history of intravenous injection of Temgesic (32%). In patients using Temgesic the changes in Modified Ficat staging were significantly different before and after CD treatment (P=0.03) in comparison with other groups. And in all 8 Temgesic users AVN progressed to the stage 3 and 4 after CD treatment. This study demonstrated that CD treatment to prevent the changes in the femoral head has been more effective in patients with collagen vascular diseases and kidney transplant than patients using intravenous Temgesic. These patients, in spite of early operation, showed no benefit of CD to prevent the changes in the femoral head.

Research and planning to improve the quality of life for elderly seems to be essential, as the population of this age group has shown an increasing trend. Any chronic disease including diabetes has an impact on lifestyle of the patient. The objective of this study was to compare the quality of life between two groups of elderly diabetic patients who were residence of home as well as nursing home. A descriptive-analytical random study was conducted during 2010-2011 on two groups of 93 elderly diabetic patients, who were living in Kahrizak nursing home of Tehran (Iran), and home residents as well by interview for their demographical information and one standard questionnaire provided by world health organization. SPSS 16 was employed for data analysis. Significant differences were found in physical, psychological and social domains between two groups (P<0.05). In physical and social domains the elderly diabetic patients of nursing home had a higher mean score but in psychological domain the result was in contrast. Regarding the difference between scores in two studied groups it is necessary to study the weak points of each group individually and try to resolve the problems.

Hepatitis delta virus (HDV) infection results in more severe and even fulminant form of hepatitis B in co-infected cases. This study was designed to estimate the prevalence of anti-HDV positivity and the associated risk factors in patients with chronic hepatitis B virus infection in Zahedan (Iran). In this cross-sectional study a total of 440 consecutive patients with chronic hepatitis B virus (HBV) infection attending the Zahedan Gastroenterology and Hepatology clinics from 2008 to 2011 were included. We performed test for HDV serum marker, using commercially available enzyme-linked immunosorbent assay kit. Patients were split into two groups according to their HDV antibody status as HDV positive or negative. The collected data were coded, and the statistical analyses were conducted. Four hundred and forty patients with various forms of chronic HBV-related liver diseases enrolled in the study. 200 (45.5%) patients were carrier for HBV. 196 (44.5%) patients had chronic active hepatitis and 44 (10%) patients suffered from cirrhosis. Anti-HDV was demonstrated in 75 patients (17%). The prevalence of HDV was 7%, 16.3% and 65.9% in carriers, patients with chronic active hepatitis and cirrhosis, respectively. HDV infection is still an important public health problem in Zahedan and appears a major cause of progression of liver disease induced by HBV.

Firefighting is extremely strenuous and physically demanding work and involves ability to cope with emergency life-or-death situations. Because of the high physical demands of firefighting, successful job performance and minimizing of morbidity and mortality depends on fitness for duty. The firefighting department of Tehran does not perform periodic medical assessment for firefighters. The aim of this study was to evaluate medical fitness among firefighters in Tehran. In this cross sectional study we examined 147 firefighters. Medical and occupational history obtained by interview, then we performed physical examination, blood tests, ECG, spirometry and audiometry. Then results compared with guidelines for firefighters in the USA, Australia and the United Kingdom. Seven percent of our participants had a kind of pulmonary dysfunction and 25% had some degrees of hearing loss. A considerable percent of them had modifiable coronary heart disease risk factors. Thirteen participitants were unfit for this job that among them; ten firefighters were unfit based on vision capability, one case due to hypertention and two cases because of pulmonary dysfunction. Because of hazardouse nature of firefighting; preplacement, periodic medical evaluations and assesment of fitness for firefighters in Iran is highly recommended. Establishment of fitness criteria for firefighters in Iran is necessery to perform assigned functions safely.

Gastrointestinal (GI) cancers are a significant source of morbidity and mortality in Iran, with stomach adenocarcinoma as the most common cancer in men and the second common cancer in women. Also, some parts of Northern Iran have one of the highest incidences of esophageal cancer in the world. Multi-disciplinary organ-based joint clinics and tumor boards are a well-recognized necessity for modern treatment of cancer and are routinely utilized in developed countries, especially in major academic centres. But this concept is relatively new in developing countries, where cancer treatment centres are burdened by huge loads of patients and have to cope with a suboptimum availability of resources and facilities. Cancer Institute of Tehran University of Medical Sciences is the oldest and the only comprehensive cancer treatment centre in Iran, with a long tradition of a general tumor board for all cancers. But with the requirements of modern oncology, there has been a very welcome attention to sub-specialized organ-based tumor boards and joint clinics here in the past few years. Considering this, we started a multi-disciplinary tumor board for GI cancers in our institute in early 2010 as the first such endeavor here. We hereby review this 2-year evolving experience. The process of establishment of a GI tumor board, participations from different oncology disciplines and related specialties, the cancers presented and discussed in the 2 years of this tumor board, the general intents of treatment for the decisions made and the development of interest in this tumor board among the Tehran oncology community will be reviewed. The GI tumor board of Tehran Cancer Institute started its work in January 2010, with routine weekly sessions. A core group of 2 physicians from each surgical, radiation and medical oncology departments plus one gastroenterologist, GI pathologist and radiologist was formed, but participation from all interested physicians was encouraged. An electronic database was kept from the beginning. The number of patients presented in the tumor board increased from 4 in January 2010 to 16 in December 2011. Most patients were presented by radiation oncology department (38%) and then surgical (36%) and medical oncology (20%) departments. Physicians’ participation also grew from an average of 8 each session to 12 in the same months, with a number of cancer specialists taking part from other university hospitals in Tehran. A total number of 225 patients were presented with a treatment decision made in this 2-year period. The majority of cases were colorectal (32%), stomach (23%), and esophageal (17%) cancers. The number of pancreatic (7%) and hepatobiliary (6%) cancers were much smaller. Most decisions were for a primary treatment (surgery or radiochemotherapy) and then a neoadjuvant approach. Tehran Cancer Institute's GI tumor board is one of the first multi-disciplinary organ-based tumor boards in Iran, and as such has made a successful start, establishing itself as a recognized body for clinical decisions and consultations in GI oncology. This experience is growing and evolving, with newer presentation and discussion formats and adapted guidelines for treatment of GI cancers in Iran sought.

Old world cutaneous leishmaniasis (OWCL) usually causes a single, self-healing and uncomplicated lesion mainly on the exposed area of body. This report presents four cases of OWCL from Iran that misdiagnosed with sarcoidosis, lymphoma, and acne agminata. Two out of four patients showed a history of purplish red plaques for at least 5 years who misdiagnosed as sarcoidosis because of histological and clinical characteristics. The other one presented with flesh-colored nodules disseminated all over his skin that was misdiagnosed as lymphoma for ten years. The last patient was misdiagnosed as acne agminata due to tuberculoid reactions in examination of the lesion biopsy. All the patients responded to the treatment with meglumine antimonate.