Medical Journal Of the Islamic Republic of Iran
Volume:19 Issue: 1, Spring 2005

Very low birth weight infants (<1500 g) frequently require blood transfusions because of repeated blood sampling accompanied by anemia of prematurity. In an attempt to identify the effect of human recombinant erythropoietin to decrease the requirement for blood transfusions, erythropoietin was administered to 24 pre term infants less than 1500 g prospectively from September 1999 till December2000. Data about the characteristics of the population, the severity of diseases, and treatment with erythropoietin, clinical diagnosis, initial and subsequent hemoglobin, volume of blood loss, and the number of blood transfusions were recorded. These results were compared with data from the recorded information of 49 infants who did not receive erythropoietin during those past 2 years. There were no differences between the 2 groups with regard to the gestational age, birth weight, clinical diagnosis, severity of the illness, primary causes of admission, and initial hematologic parameters such as hemoglobin, hematocrit and reticulocytes. Erythropoietin was administered in a dose of 200 ill/kg three times weekly for 6-8 weeks accompanied with iron supplement 6 mg/ kg/day. Transfusions were administered according to protocol. There was no significant difference between the number of blood transfusion among these 2 groups (p= 0.07). However, transfusions in the erythropoietin treated group were fewer in comparison to the other group (1.9 +1-1.6 to 3.2 +/-1.1). No difference was observed between final hemoglobin and hematocrit levels among the two groups (10.3 +1- 0.9 vs. 10.4 +1- 0.7 and 33.7 +1- 2.3 vs. 32.2 +1- 2.2). Very low birth weight infants receive frequent blood transfusions but a reduction in transfusion requirements was not apparent after administration of erythropoietin and iron in preterm infants in this study. However, the lack of impact on transfusion requirements fails to support routine use of erythropoietin.

Combination therapy with interferon and ribavirin is the most effective treatment for chronic hepatitis C today. The aim of this study was to evaluate the efficacy and safety of thrice-weekly Heberon (interferon alfa-2b) in combination with ribavirin as first -line treatment of chronic hepatitis C. A total of97 treatment-naive patients received Heberon three million units thrice-weekly subcutaneously in combination with ribavirin for 12 months. Serum HCV RNA levels were measured before and during therapy and 6 months after the end of therapy. End-of-treatment and sustained virological responses was defmed as an undetectable HCV-RNA level at the end of treatment, and 6 months after treatment was completed (end of follow-up), respectively. In an intent-to-treat analysis, HCV-RNA was undetectable at the end of treatment in 49.5% of patients. At the end of follow-up, sustained virological response was 36.1 %. Combination treatment was generally well tolerated. Six patients stopped therapy because of side effects: severe cytopenia (n=4), depression (n=1), and hyperthyroidism (n= 1). Common side effects of therapy include: Flu-like syndrome (85.6%), generalized alopecia (41.2%), injection site inflammation (37.1%), mood changes (36%), anorexia (34%) and weight loss (32%). Heberon as an IFN product in combination with ribavirin for treat-ment of patients with chronic hepatitis Cis relatively safe, feasible, and potentially efficacious. It has comparable results in achieving end-of-treatment and sustained virological responses in chronic hepatitis C.

The incidence of pregnancy induced hypertension (PIH) which is one of the three main causes of maternal-neonatal morbidity and mortality is 5-7%, and prediction of this disorder is very important in maternal and neonatal health. The type of this study is analytical (comparative-prospective) and its purpose is to evaluate the isometric exercise test (lET) and roll-over test (ROT) as methods ofPIH prediction. 116 nulliparaes, with study characteristics, after filling a questionaire and physical exam, underwent ROT, and then lET after 5 minutes, between 28-32 weeks of their pregnancy. The samples are followed up regularly until24 hr after delivery in Mashad university prenatal clinics and hospitals. Statistical analysis was done by SPSS with a: 0.05. As a result, lET has a higher validity than ROT(sensitivity:78.9% vs. 47.4%, p<0.0001, specificity: 94.80 vs. 83.5%,p: 0.007,positivepredictivevalue: 75% vs. 36%,p: 0.0001, negative predictive value: 95.8% vs. 89%, p: 0.046), also validity of IETandROTtogetheris: sensitivity: 85.7%, specificity: 96.3%,PPV: 66.6% andNPV: 98.8%. The validity of lET in this study was shown to be higher than ROT, and by use of a very simple and cost -effective lET, we are able to predict PIH with the highest validity and if possible, use both tests in order to raise validity.

Schistosoma haematobium is a parasite that is carried by freshwater snails and induces gastrointestinal and urinary disease, depending on its species. In Khoozestan, one of the provinces in Iran, schistosomiasis was endemic. This study reports the results of schistosomiasis control in this region. From 1981 to 2001 nearly 650 villages and 20 cities were under surveillance for S. haematobium. More than 1.5 million urine samples were taken and positive cases were treated. From 1981 to 1990 there were 1158 positive cases; whereas, from 1991 to 2000 only 98 cases were reported and from 2000 to 2001 we could not detect any positive cases. The northwest ofKhoozestan was the most infected area. Schistosoma haematobium can be eradicated provided that anationwide health care project comprising public health education, environment decontamination, case finding, screening, and chemotherapy is designed and held meticulously.

In 1958, Silverman demonstrated that maintenance ofbody temperature reduces mortality in low birth weight infants. From the early 1990s it was already recognized that adequate environmental warmth was essential in the case of newborns. However, neonatal hypothermia continues to be a significant issue in developing countries. In order to describe the incidence and severity of hypothermia after delivery and to determine the possibility ofrelatedmortalityrisk among neonates in a tettiary nursery, we measured the body temperature on admission of 898 consecutive inborn infants after birth by a low-reading thermometer. Body temperature less than 36.5°C was designated as ''hypothermia''. In such cases the infants were re-warmed according to WHO recommendations. Their body temperature was checked and recorded every hour and their final outcome was noted. The overall incidence of hypothermia was 53.2%. 456 (i.e., 50.2% of) infants had mild hypothermia (35> T> 36.5) while 22 (2.5%) of them had moderate to severe hypothermia (T <35°C). The incidence and severity of hypothermia was found to be significantly associated with bitih weight (p= 0.000) and gestational age (p= 0.000). The duration of re-warming was also correlated with birth weight (p= 0.000). Logistic regression analysis showed that the mortality rate of hypothermic neonates is 3.64 times that of the normotherms. The risk of death was higher in the moderate to severe hypothermic groups than in the mild hypothermic infants. In our study, the incidence of hypothermia was found to be high with both the incidence and severity to be significantly associated with birth weight and gestational age. The risk of death was recognized to be higher in the hypothermic newborns than non-hypothermic ones.

Triple therapy with a proton pump inhibitor, clarithromycin and amoxicillin and quadruple therapy with a proton pump inhibitor, bismuth citrate, metronidazole and amoxicillin have been proposed in Maastricht 2000 as the optimal treatment of Helicobacter pylori infection. We aimed to compare these two regimens in Iranian pediatric patients. A randomized clinical trial in Em am Khomeini Hospital between 13 81 and 1382 was done. Patients with confirmed H. pylori infection by histology were divided in to two groups in a randomized 1: 1 scheme. Triple regimen group: Clarithromycin 15 mg/kg/d, Amoxicillin 50 mglkg/d and Omeprazole 1 mg/kg/day for 10 days. Quadruple regimen group: Omeprazole 1 mg/kg/d, Amoxicillin 50 mglkg/day, Metronidazole 20 mglkg/day and Bismuth citrate 8 mglkg for 10 days. The eradication was assessed by c-urea breath test 4 weeks after the end of treatment and byperprotocol analysis. In our study, 100 patients (50 in each group) were found and the eradication rates in the triple and quadruple group were 92% and 84% respectively (p=0.046). According to our results, we recommend triple therapy as first-line treatment in Iranian pediatric patients and quadruple therapy as a second line regimen.

Aspirin even at low dose (100 mg) can increase the risk of upper gastrointestinal bleeding. It is usual to use low dose aspirin for cardiovascular prophylaxis. We hypothesized that Helicobacter pylori eradication is as effective as omeprazole maintenance therapy for secondary prevention of bleeding in those who take low dose aspirin and are positive for Helicobacter pylori. To compare the effect of Helicobacter pylori eradication and omeprazole maintenance therapy in upper gastrointestinal bleeding sixty-two patients taking low dose aspirin for cardiovascular prophylaxis were prospectively followed for 6 months. Upper gastrointestinal bleeding was confirmed by endoscopy. Ulcers healed with 2 months treatment of 20 mg omeprazole daily. Aspirin was withheld during this 2 months. Low dose aspirin was given again after that. Thirty-one patients underwent Helicobacter pylori eradication with amoxicillin 1 g bid, metronidazole 500 mg bid, and bismuth subcitrate 240 mg bid for 2 weeks and did not receive omeprazole any more, and in thirty-one patients only omeprazole was given for 6 months. Gastrointestinal bleeding occurred in 3 patients. Two (6%) were in the eradication and one (3%) was in the omeprazole group. The difference was not statistically significant. Helicobacter pylori eradication is equivalent to omeprazole treatment in secondary prevention of upper gastrointestinal bleeding in patients who take low dose aspirin and are infected with Helicobacter pylori.

The aim of this study is to evaluate the long and short ten postoperative results after the Notaras procedure as a surgical treatment of rectal prolapse in adults. Thirty-one patients suffering from rectal prolapse who were operated with Notaras posterior mesh rectopexy in Shohada-e-Tajrish hospital between 1991- 2000 were followed up for results and complications and the results were compared with other surgical techniques for this disease. The mortality rate was zero which was ideal in comparison with other studies; short ten complications were seen in 20% of cases which had the same prevalence as other abdominal surgeries. Sexual impotence and retrograde ejaculation as long tern1 complications were seen in only one patient (3.22%).The recurrence rate was zero which stands above nearly all other procedures, also we had recuperation of fecal incontinence in all of our cases and gas incontinence in 92 % of them. The constipation rate has not increased significantly postoperatively (p= 0.8) The Notaras procedure can be used in the management of rectal prolapse with low mortality and recurrence rate but although not contraindicated, may not be appropriate for young and sexually active male patients.

The aim of this study was to standardize and assign validity and reliability of the Trauma Symptom Checklist for Children (TSCC-A). Normative data for the TSCC-A were based on 3042 students participating in a prevalence child abuse study in 19 different locations of Tehran and 140 participants who had been refered to the run-away children centers in Tehran. After the TSCC was validated on run-away and abused children, it was made available to researchers doing larger studies on a normative group. Reliability analysis of the TSCC-A scales in the normative sample demonstrated high internal consistency. The evidence for its validations (convergent, discriminant and construct validity) showed thai they were significantly acceptable. This paper presents data demonstrating the psychometric reliability and validity of the TSCC-A scales in the Iranian student population. We suggest to include the TSCC-A in a battery of relevant standardized tests.

The current practice to measure RV is either by BPG or helium dilution methods which may not be available in all clinics due to their cost. This paper outlines a method for both direct and indirect calculation of RV via PFT with acceptable sensitivity (81 %, 60%), specificity (71 %, 94%) and validity (76%, 78%) for obstructive and restrictive lung disease respectively at a much lower cost.

The aims of this study were to assay the activity of adenosine deaminase (ADA) in estrogen receptor positive (MCF-7) and negative (MDA-MB468) breast cancer cell lines. MDA-MB468 and MCF-7 breast cancer cell lines were cultured in complete medium, striped serum with and without 0.0 1~-LM diethylstilbestrol (DES), complete medium in the presence and absence of 111M tamoxifen for 20 hr. Adenosine deaminase activity was determined using the colorimetric method described by Guisti and Galanti. It was found that the activity of enzyme in estrogen receptor positive (ER+) cell line (MCF-7) was significantly higher than that of estrogen receptor negative breast cancer cell line (MDA-MB468). ADA activity in MCF-7 cells cultured in the presence of tamoxifen or charcoal-striped serum was significantly lower than that of control. Furthermore addition of diethylstilbestrol (DES) to the striped serum increased the value of ADA activity to that of control. Unlike MCF-7 cells, the activity of ADA in MDA-MB468 cells remained unchanged upon treatment with tamoxifen or striped serum. These findings suggest estrogen responsiveness of ADA expression in MCF-7 cells.

Cholesterol cleft granulomas with clusters of giant cells were noted to be a common feature of non-specific interstitial pneumonia (NSIP). This study aimed to define the cell populations involved in the granulomas. The granulomas of 16 patients with cryptogenic fibrosing alveolitis (five cases with the histological features ofNSIP, five with those ofUIP and six cases of respiratory bronchiolitis) were examined histologically and by the use of irnmuno- and lectin histochemical markers. Granulomas were discrete, compact and present only in alveolar spaces. The adjacent int~rstitium usually showed fibrous thickening although granulomas were absent. The granulomas contained central clefts surrounded by mononuclear and multinucleated giant cells, both of which were CD68 positive. The cells outside the granulomas and those lining the adjacent alveolar walls were AE 11 AE3 and CAMS. 2 positive and CD68 negative. The application of an extended lectin panel demonstrated restricted glycoprofiles for multinucleated cells, alveolar macrophages and alveolar lining cells. The glycoproflies of the first two were similar to each other, but were different from the third. The mononuclear and multinucleated cells of cholesterol cleft granulomas are derived from the macrophage-mononuclear cell lineage and express glycoproteins with a high mannose content. The alveolar lining cells are type II pneumocytes which do not contribute to the granuloma cell population.

Autosomal dominant polycystic kidney disease (ADPKD) is an inherited disorder with genetic heterogeneity. Up to three loci are involved in this disease, PKDI on chromosome 16p13.3, PKD2 on 4q21, and a third locus of unknown location. Here we report the first molecular genetic study of ADPKD and the existence oflocus heterogeneity for ADPKD in the Iranian population by performing linkage analysis on 15 affected families. Eleven families showed linkage to PKD 1 and two families showed linkage to PKD2. In two families, PKD 1 markers are common in all affected members but PKD2 markers were not informative. The results of this study demonstrate significant locus heterogeneity in autosomal dominant PKD in Iran. Analysis of clinical data confirms a milder ADPKD phenotype for PKD2 families. Our results showed relatively high heterozygosity rates and PIC values for some markers, while the most informative markers were KG8 and 16AC2.5 for PKD 1 gene and AFM224x6 for PKD2 gene.

To determine daily calcium, Vitamin D intake and serum biochemical findings of rickets in adolescent girls. A total of 414 healthy adolescent student girls aged 11-15 years were evaluated from various areas of Tehran, Iran with different socioeconomic status. A randomized, cross-sectional, prospective and descriptive study was undertaken for calculation of daily calcium, phosphorus intake and vitamin D acquirement by sunlight exposure by seven day recall record questionnaire. Serum 25-hydroxyvitamin D, parathyroid hormone, calcium, phosphorus and alkaline-phosphatase levels were measured. The serum abnormal biochemical findings of girls were divided as follows: normal or low calcium with raised alkaline phosphatase, group I; normal or low calcium with raised alkaline phosphatase, normal or raised parathyroid hormone, low 25- hydroxyvitamin D, group II; and low phosphorus and 25-hydroxyvitarnin D with raised parathyroid hormone, group III. A total of 44 (10.62%) girls of 414 had abnormal biochemical findings, of these 29 (7%) were in group I, 9 (2.17%) in group II, and 6(1.45%) in group III. The mean daily calcium intake and vitamin D acquirement by sunlight exposure and dietary intake were 360.85±350.50mg and 119.2±52.9 IU respectively. All girls had inadequate dietary calcium and vitamin D intake. All had less than 40 minutes sun exposure per day. This survey demonstrated that abnormal biochemical findings of rickets can occur even in sunny climates and are is caused by two factors, inadequate calcium intake as the major factor and vitamin D deficiency as a minor factor.

Seizure disorders are the most common neurological illnesses in infants and children. Presented is an 8 year old boy with nocturnal vomiting episodes, found to have EEG characteristics of early onset benign occipital epilepsy, better known as Panayiotopoulos syndrome.

A long pedunculated egg-shaped lipoma of the sacrum in a newborn infant, presenting as a tail, was treated surgically. Occult spinal dysraphism may be accompanied with this entity. Investigations for underlying dysraphism and its treatment are mandatory.