Archives of Iranian Medicine
Volume:16 Issue: 8, Aug 2013

Brucellosis is an anthropozoonotic disease with heterogeneous clinical presentations. This study aims to investigate the peripheral nervous system (PNS) involvement in brucellosis. A total of 57 patients with brucellosis, and 42 age- and gender-matched healthy subjects were enrolled into the study. We performed motor conduction studies that included bilateral median, ulnar, tibial and peroneal nerves, and sensory nerve investigations from bilateral median, ulnar, radial, sural and medial plantar nerves. Among patients with brucellosis, 21 had neuropathic symptoms. Of these, 9 had abnormalities in nerve conduction studies. The electromyographic testing revealed abnormalities in 2 patients without neuropathic symptoms. Overall, 11 patients (4 males, 7 females) with brucellosis (19.3%) had polyneuropathy (PNP). The mean age of patients with PNP was 52.63 ± 19.06 years, being significantly higher than those without PNP (P = 0.006). The mean duration of brucellosis was also longer in patients with PNP, but not significant. The mean distal latency (DL) and nerve conduction velocity (NCV) values were almost always longer in patients with brucellosis than controls, though not statistically significant. Our results showed that brucellosis causes clinical or subclinical peripheral PNP, and should therefore be considered as a cause of PNP, especially in endemic regions.

Proton pump inhibitors (PPIs) are the most effective agents available for reducing acid secretion. They are used for medical treatment of various acid-related disorders. PPIs are used extensively and for extended periods of time in gastroesophageal reflux disease (GERD). A troublesome issue regarding maintenance therapy has been the propensity of PPI-treated patients to develop chronic atrophic gastritis while on therapy that could theoretically lead to an increased incidence of gastric cancer. In addition, animal studies have raised concern for development of enterochromaffin-like cell hyperplasia and carcinoid tumors in the stomachs of mice receiving high dose PPIs. Current literature does not provide a clear-cut conclusion on the subject and the reports are sometimes contradictory. Therefore, this study is a systematic review of the available literature to address the safety of long-term PPI use and its relation to the development of malignant/premalignant gastric lesions. A literature search of biomedical databases was performed. The reference lists of retrieved articles were reviewed to further identify relevant trials. We hand-searched the abstracts of the American Digestive Disease Week (DDW) and the United European Gastroenterology Week (UEGW) from 1995 to 2013. Only randomized clinical trials (RCTs) that used PPIs as the primary treatment for at least six month versus no treatment, placebo, antacid or anti-reflux surgery (ARS) were included. Two reviewers independently extracted the data. Discrepancies in the interpretation were resolved by consensus. All analyses of outcomes were based on the intention-to-treat principle. We performed statistical analysis using Review Manager software. The effect measure of choice was relative risk (RR) for dichotomous data. Six RCTs with a total of 785 patients met the inclusion criteria. Two multicenter RCTs compared Esomeprazole with placebo. One RCT compared omeprazole with ARS. Two RCTs compared omeprazole with ranitidine and one RCT compared lansoprazole with ranitidine. Four of the included RCTs had moderate risk of bias and two had low risk of bias. The number of patients with increased corporal atrophy score, intestinal metaplasia score and chronic antral inflammation did not statistically differ between the PPI maintenance group and controls. Similar results were found when ECL-cell hyperplasia was assessed between the groups. Maintenance PPIs did not have an association with increased gastric atrophic changes or ECL-cell hyperplasia for at least three years in RCTs.

The current WHO classification of hematologic malignancies defines distinct entities of myeloid disorders based on the presence of recurrent cytogenetic abnormalities. Diagnostic clonal chromosomal abnormalities provide important prognostic information and are among the most important factors in predicting initial response to chemotherapy, duration of remission and overall survival. This study analyzed chromosomal abnormalities in bone marrow aspirates of 50 children diagnosed with acute myeloid leuckemia (AML). The culture success rate was 94%, clonal chromosomal abnormalities constituted 62% and recurrent chromosomal abnormalities were 56%. In the favorable prognostic category, there were 51.6% of cases with t(8;21)(q22;q22), 16.1% had t(15;17)(q22;q21), and a total of 12.9% had chromosome 16 rearrangement. The adverse risk category showed a low frequency of t(9;11)(p22;q13); t(1;22)(p13;q13); inv(3)(q21q26); add 4(q35) and ring chromosome. According to fluorescent in situ hybridization (FISH) results in 16 cytogenetically normal patients, there were no CBFβ/MYH11 fusion genes observed in chromosome 16 rearrangements. Larger studies of this kind may provide more information about chromosome 16 rearrangements in cytogenetically normal patients. The present analysis suggests that both age and cytogenetics are important strategies for risk stratification (outcome). Additional laboratory parameters should also be considered in childhood AML.Keywords:

Esophageal squamous cell carcinoma (ESCC) is the second-most frequently diagnosed cancer in Northeast Iran, often diagnosed in advanced stages. No standard early diagnostic guideline has been proposed to date and current therapeutic modalities are not effective. Detection of tumor-specific biomarkers, which is the goal of this study, could prove useful in the diagnosis of ESCC. To better understand the gene expression profile of ESCC, we analyzed tumor samples and corresponding adjacent normal tissue from ESCC patients by Chemiluminescent Human Cancer GEArrays. Candidate genes were verified by real-time PCR. Out of 440 cancer-related genes included in the array, 71 were overexpressed compared to normal tissue, with significant differences in 11 genes. There were 108 genes underexpressed, with significant differences in 5 genes. Until now, the AP2M1, FTL, UBE2L6, HLA-C, and HSPA8 overexpressed genes and XRCC5, TP53I3 and RAP1A underexpressed genes were not reported in ESCC. We chose the MMP2, HLA-G, and XRCC5 markers from 58 Iranian ESCC patients to verify the expression validity by real-time PCR. The microarray results were confirmed with two-tailed significance levels of P = 0.003 (MMP2), P = 0.000 (HLA-G) and P = 0.002(XRCC5). Analysis performed for the candidate genes using GNCpro online software highlighted two pathways, an immuno-modulatory response and DNA replication and repair. We successfully performed and validated Chemiluminescent GEArray gene expression profiling in ESCC. Several biomarkers that might be related to tumorigenesis in ESCC were identified. Immuno-modulatory and DNA repair pathways could be used as targets to locate specific diagnostic, prognostic, and therapeutic biomarkers for ESCC.

Kala-azar is a multisystem infection of the reticuloendothelial system. Various hematologic abnormalities have been described in kala-azar including hemophagocytic syndrome (HPS). We reviewed bone marrow aspirate smears from 18 documented cases of kala-azar complicated by HPS. The bone marrow smears were hypercellular with erythroid hyperplasia. Megaloblastic changes, foamy macrophages, activated macrophages with cytoplasmic vacuoles and elongated cytoplasmic process, intra- and extracellular amastigotes, cytoplasmic fragments (blue bodies), plasma cells with inclusions and hemophagocytic cells were seen. Leishman bodies (amastigotes) were also found in some hemophagocytic cells. Kala-azar should be considered as an etiology of HPS, particularly in endemic areas.

Leishmaniasis is a zoonotic infection caused by a protozoa belonging to the genus Leishmania. Its clinical manifestations range from a self-healing cutaneous leishmaniasis (CL) to lethal visceral leishmaniasis. We aim to examine the quality of life of patients with CL in Kerman, Iran. In this cross-sectional study we evaluated 124 patients with CL. The Dermatology Life Quality Index (DLQI) questionnaire was used for measuring quality of life. Data on demographics and characteristics of the lesions also were collected. Mann-Whitney U-test and Kruskal-Wallis were used for data analyses. The mean DLQI score was 5.87 ± 5.96. We observed the highest effect in the symptoms and feelings domains; the lowest effect was seen in the treatment domain of the DLQI. There was no significant difference in DLQI scores between men and women. Patients with ulcerated lesions had lower quality of life (P < 0.05). CL significantly affects the quality of life of patients. Further studies are suggested to examine the effect of its treatment on the quality of life in these patients.

A damaged orthopedic implant in the body can cause problems for the patient and disrupt the therapeutic process. This study investigates various factors for orthopedic implant failures in patients with traumatic lower limb fractures who referred to a trauma center in Mashhad, Iran. This was a prospective study of 23 patients referred to Kamyab University Hospital with failed orthopedic implants in 2009. We included any patient with an orthopedic device previously implanted secondary to a traumatic lower limb fracture who later presented to Kamyab University Hospital because of a failed implant.For all patients, a thorough history was taken and the necessary investigations that included radiographic studies were performed. We investigated the quality of the failed devices by chemical analysis, metal hardness testing and metallography. The results were statistically analyzed. The mean age of the patients was 33 ± 19 years. There were 19 (82.5%) male and 4 (17.4%) female patients. In 14 (60.9%) cases, there were failed femoral implants and 9 (39.1%) cases had failed implants for tibial fractures. We compared the implants against ASTM standards. According to chemical analysis, all internally produced devices and one of the leading international brands were within the expected standard. However, in 3 cases chemical analysis showed a deviation from the standards. These were manufactured by “miscellaneous” companies. In one (4.3%) case the device failure was iatrogenic, in 14 (60.9%) it was due to faulty implants and in 8 (34.8%) cases, the patients were non-compliant with instructions. Hardness testing was satisfactory in all cases and metallographic studies showed good quality for the leading international brands, satisfactory quality for the internally produced devices and poor quality for the miscellaneous devices. The implants classified as miscellaneous were of poor quality. Thus, we cannot recommend their use in orthopedic surgeries. We recommend using credible, known brands.

Most people want to know how they can improve their health by implementation of a proper diet. Therefore nutritional epidemiology studies, which correlate the intake of specific nutrients, food items, or dietary patterns with health outcomes, receive substantial interest in the media. However, the results of many nutritional epidemiology studies have not been replicated in subsequent studies. This paper reviews the primary methodological problems in nutritional epidemiology that result in lack of replicability and inconsistency across studies. The problematic methodological issues include substantial measurement error, confounding, the variable effects of food items, variable reference groups, interactions, and multiple testing.

Hepatitis B surface antigen (HBsAg) screening is an important procedure to determine the prevalence of hepatitis B (HBV) in a community. However, it is difficult, time consuming and expensive. In this study we aim to investigate the efficacy and usefulness of fingerprint blood impregnated paper in HBsAg screening. To our knowledge, blood impregnated paper is a practical, useful method for HBsAg screening in the community.

Cholethorax or bilious effusion in the thorax, is a rare condition in which bile passes into the pleural space from the abdominal cavity, necessitating urgent treatment. In this article, we present a case of cholethorax as a complication of laparoscopic cholecystectomy (LC). The patient underwent a LC due to the presence of a gallbladder polyp. The clip attached to the Hartman opened, and the abdominal cavity became contaminated with biliary fluid. Postoperatively, the patient experienced severe right upper quadrant pain and dyspnea. Both the posteroanterior (PA) chest radiography and thoracic computed tomography (CT) were remarkable for marked effusion in the right hemithorax. The patient underwent thoracentesis which resulted in the removal of 250 cc bilious pleural effusion. The bilirubin level of the pleural fluid was 9.1 mg/dL. Following thoracentesis, the patient experienced significant improvement in dyspnea and pain. The patient was discharged without any complications on the seventh day postoperatively. Cholethorax may occur as a result of diaphragmatic injuries secondary to a laparoscopic instrument and can be successfully treated by a thoracentesis.

We describe the case of a man incidentally found to have a pseudoaneurysm of the ascending aorta at the site of a previously (12 years ago) implanted metallic prosthetic aortic valve. Transthoracic echocardiography and computed tomography images demonstrate the pseudoaneurysm. The patient has undergone surgical repair with a good result.