Acta Medica Iranica
Volume:52 Issue: 1, Jan 2014

Gum tragacanth is a natural complex mixture of polysaccharides and alkaline minerals extracted from species of Astragalus plant, which is found widely in arid regions of the Middle East. In a pilot experimental study we examined the effects of its topical application on wound healing in ten albino adult male rats. Two similar parasagittal elliptical full-thickness wounds (control vs. test samples) were created on the dorsum of each animal. Test group samples were fully covered by a thin layer of gum tragacanth daily. The extent of wound healing was evaluated by planimetric analysis on multiple occasions during the 10-day study period. On the 7th day of the study, the percent of wound closure was significantly higher in gum tragacanth-treated specimens compared to the control samples (87%±2% vs. 70%±4%, P<0.001). The majority of wounds in the test group were completely closed by the 10th day of the study. The difference in wound healing index measured by histological examination on day 10 of the study was also statistically meaningful between the two groups (0.624±0.097 vs. 0.255±0.063, P<0.05). The results of this study clearly showed the useful effects of topical application of gum tragacanth in acceleration of skin wound contraction and healing. More studies are encouraged to identify the implicating agents and precisely understand the mechanism by which they exert their wound healing effects.

Efg1 transcription factor is believed to be the main regulator of hyphal formation under many different conditions. In addition, it is responsible for positive regulation of the expression of several hyphal-specific genes. SAP5, which encodes secreted aspartic proteinase, is one of the mentioned genes and is crucial for pathogenicity properties. In the present work we have established the experimental conditions for the use of siRNA in the diploid yeast Candida albicans in order to knock-down the EFG1 gene expression as well as the Efg1-dependent gene, SAP5. The 19-nucleotide siRNA was designed according to cDNA sequence of EFG1 gene in C. albicans and modified-PEG/LiAc method was applied for yeast transfection. To quantify the level of both EFG1 and SAP5 gene expression, the cognate mRNAs were measured in C. albicans by quantitative real-time RT-PCR and data was consequently analyzed by use of REST® software. Images taken by fluorescent microscopy method indicated the effectiveness of transfection. According to REST® software data analysis, expression of EFG1 gene decreased about 2.5-fold using 500 nM of siRNA. A 7-fold decrease in EFG1 gene expression was observed when applying 1 µM of siRNA (P<0.05). Consequently, the expression of SAP5 was significantly down-regulated both in yeast treated with 500 and 1000 nM of siRNA (P<0.05). In conclusion, post-transcriptional gene silencing (PTGS) is likely to be considered as a promising approach to discover new gene targets so as to design fungal-specific antifungal agents, and it is strongly possible that we are taking the right way to battle with C. albicans-associated infections.

N-terminal pro β-type natriuretic peptide (NT-proBNP) is a valuable marker for monitoring the response to treatment in patients with heart failure. Based on the clinically observed improvement of heart failure symptoms early after cardiac resynchronization therapy (CRT), we sought to investigate whether CRT induce any significant reduction in the plasma level of NT-proBNP in three days after implantation and whether it is correlated with patients’ response at six months. In this prospective study, 21 consecutive patients with severe heart failure (New York Heart Association class 3.19±0.40) who underwent CRT were enrolled. Being alive, no hospitalization due to decompensated heart failure, and improvement of at least one NYHA functional class at six months were classified as clinical responsiveness. The plasma level of NT-proBNP was measured before, three days, and six months after CRT. Clinical evaluation, echocardiographic study, and six-minute walking test were performed before and six months after the procedure. At six months’ follow-up, 16 (76.2%) patients were responders. The plasma level of NT-proBNP at three days after CRT increased almost equally in both responder and non-responder groups of patients (∆NT-proBNP was 40.94±135.74 vs. 54.80±88.98); however, at six months’ follow-up, the NT-proBNP changes statistically differed across the two groups of patients (P=0.005). According to our findings, NT-proBNP percent deviation from baseline to three days after CRT appears to be not correlated with the patients’ clinical response after six months, which was incongruent to the patients'' clinical improvement after CRT.

Given the importance of patient’s rights in healthcare, special attention has been given to the concept of patient’s rights by the Ministry of Health and Medical Education in Iran. Iranian patient’s rights charter has been compiled with a novel and comprehensive approach. This charter aims to elucidate rights of recipients of health services as well as observing ethical standards in medicine. This paper presents the Iranian patient’s rights charter. Based on a study done from 2007 to 2009, the charter has been finalized through an extensive consultation involving all stakeholders, patients, physicians, nurses, lawyers, patient associations and health policy makers. The developed charter was adopted by the Ministry of Health in December 2009. Iranian patient''s rights charter has been formulated in the framework of 5 chapters and 37 articles including vision and an explanatory note. The five chapters concern right to receiving appropriate services, right to access desired and enough information, right to choose and decide freely about receiving healthcare, right to privacy and confidentiality, and finally right to access an efficient system of dealing with complaints which have been explained in 14, 9, 7, 4 and 3 articles, respectively. The paper concludes that, adopting the patient''s rights charter is a valuable measure to meet patient’s rights; however, a serious challenge is how to implement and acculturate observing patient’s rights in practice in our healthcare system in Iran.

Body weight is influenced by both food intake and energy expenditure. Acylated ghrelin enhances appetite, and its circulating level is suppressed by Growth Hormone. Data on the acylated ghrelin responses to exercise of different intensities in obese individuals are currently not available. This study examined the effects of an intermittent exercise protocol on acylated ghrelin levels and hunger ratings in obese people. Nine inactive male ran on the treadmill at 0900 with progressive intensities of 50, 60, 70, and 80% of VO2max for 10, 10, 5, and 2 min respectively. Blood samples were collected before the exercise at 0845 (-15 min as the resting values), after each workload (10, 23, 31, and 36 min during exercise), and at 30, 60, and 120 min thereafter. The control trial was conducted under identical conditions with the exception of exercise. Compared to the baseline, both acylated ghrelin levels and hunger ratings were suppressed at 70% of VO2max during exercise (17.74 vs. 9.80 pmol/L and 4.84 vs. 2.96 unit respectively) and remained significantly lower than the control trial 2 h after the cessation of exercise (13.95 vs. 20.32 pmol/L and 3.33 vs. 6.04 unit, respectively). Growth Hormone increased during the exercise period and peaked at 80% of VO2max. These findings indicate that acylated ghrelin concentrations and hunger ratings are suppressed during exercise and two hours thereafter in obese individuals, and it is possible that Growth Hormone caused the suppression of acylated ghrelin.

The aim of this study was to determine the incidence and causes of fever as a major problem contributing to transplantation related mortality among patients undergoing hematopoietic stem cell transplantation (HSCT) and evaluation of antibiotic use, according to reliable guidelines.We retrospectively reviewed hospital records of 195 adult patients who underwent HSCT between 2009-2011 at hematology-oncology and bone marrow transplantation research center. Baseline information and also data related to fever and neutropenia, patient’s outcomes, duration of hospitalization and antibiotic use pattern were documented.A total of 195 patients were analyzed and a total of 268 febrile episodes in 180 patients were recorded (mean 1.5 episodes per patient). About 222 episodes (82%) were associated with neutropenia which one-fourth of them were without any documented infection sources. Microbiologic documents showed that the relative frequencies of gram positive and gram negative bacteria were 62.5% and 37.5%, respectively. The hospital stay duration was directly related to the numbers of fever episodes (P<0.0001).The rate of febrile episodes in autologous stem cell transplantation was significantly higher compared to allogeneic type (P<0.05).It is necessary to determine not only the local profile of microbiologic pattern, but also antibiotic sensitivities in febrile neutropenic patients following hematopoietic stem cell transplantation, and reassess response to antibiotic treatment to establish any necessity for modifications to treatment guidelines in order to prevent any fatal complications from infection.

Lumbar puncture (LP) is a procedure for obtaining spinal fluid from spinal meningeal spaces this can be done as a diagnostic or therapeutic procedure which can result in to a typical positional headache named as post lumbar puncture headache. This can cause a lot of discomforts for patients and makes fear from the procedure. This study designed to evaluate the effect of resting position after LP on post lumbar puncture headache (PLPH). Patients who had a diagnostic lumbar puncture were divided randomly in two groups. Group A patients had one hour rest in the supine position while group B patients had one hour rest in the prone position. Both groups followed for appearance of symptoms of PLPH for 5 days. 119 patients completed the study, 57 (48%) male patients and 62 (52%) female. PLPH totally appeared in 38 (31.9%) patients. In the group A PLPH was present in 20 patients whereas in group B it was present in 18 patients. Statistical analysis showed no significant differences between two groups (P>0.07). Position of rest after LP has no significant effect on reducing post lumbar puncture headache and there is no need to emphasize on position of rest after LP.

This study was designed to determine the prevalence of bipolar disorder in women with polycystic ovarian syndrome (PCO). One hundred and ten women with definite diagnosis of PCO and one hundred and ten age-matched infertile women due to other reasons except for PCO were enrolled in this case-control study. Ten ml fasting venous blood sample obtained to measure fasting glucose، LH and FSH. Height، weight and waist-to-hip ratio (WHR) were also recorded by an expert technician. A psychiatrist examined all 220 cases in order to determine the prevalence of depression and bipolarity. Mean age of each group participants were not significantly different while FBS، LH and LH/FSH levels were significantly higher in PCO patients. Eighty eight case were depressed in PCO group while 96 were depressed in control group (P=0. 03). Bipolar disorder were higher in PCO group in comparison with controls (8 vs. 0، P=0. 004). Psychiatric disorders should be considered in PCO women.

This study examines the association of father’s and mother’s age with the severity of inattention and hyperactivity/impulsivity. Participants are 470 children with attention deficit hyperactivity disorder (ADHD) diagnosed according to DSM-IV diagnostic criteria. Moreover, parents reported the severity of ADHD symptoms through completing ADHD checklist. Mother’s and father’s age was associated with the score of hyperactivity/impulsivity. Lower father’s age and advanced maternal age are associated with higher severity of hyperactivity/impulsivity in children and adolescents with ADHD. None of mothers’ and fathers’ age is associated with ADHD inattentiveness severity in children. Maternal and paternal education levels are not associated with ADHD severity. Older mothers and younger fathers have ADHD children with higher hyperactivity/impulsivity severity. It should be investigated whether the father’s and mother’s age are risk factors for ADHD.

The study was aimed to investigate the diagnostic differences between male and female patients in pulmonary tuberculosis in a tertiary 660 bedded Educational Respiratory Medicine Hospital, Istanbul, Turkey. A retrospective study was conducted with the new diagnosed, 50 men and 50 female pulmonary tuberculous patients. Age, symptoms, personal history, radiologic and sputum smear findings were collected from their files. 44 male and 42 female patients were enrolled to the study. Male patients tended to be older, smoke more, get alcohol more, lose weight more and have sputum smear positivity more than the female patients. Neither the time of diagnosis nor the radiologic appereance differed statistically. The radiologic appereance, not the clinic symptoms help to diagnose tuberclosis in female patients; especially in those with no weight loss and sputum smear negativity.

It is obvious that lead intake is of concern not for its beneficial/essential effects on metabolism, but rather for its toxic actions, which can be especially damaging to children. The objective of this study was to analyze the concentration of lead in milk of mothers during prolonged lactation. Milk samples from 43 mothers were collected at 2 months postpartum. Lead was analyzed using atomic absorption spectrophotometer. The value of lead in human milk was 23.66±22.43 μg/l. Lead concentration in human milk of mothers was higher than other countries and no significant relationship was found between levels of human milk lead and mother''s education, age, parity, height and weight. The concentrations of lead in the milk samples were high, which makes a major public health hazard for the inhabitants, especially neonatal and children, of the industrial locations.

Buerger''s disease or thromboangiitis obliterans (TAO) seems to be common in IR Iran, The present study aimed to evaluate an Iranian population with Buerger''s disease in order to suggest a diagnostic criterion for Buerger''s disease based on the most frequent findings and to compare it with Papa diagnostic criteria. In a cross-sectional study, all patients with resting limb pain, limb ischemic ulcers, intermittent claudication and limb ischemia who referred to the Vascular Clinic of Sina Hospital during 2009-2011 were evaluated. The patients were allocated to Buerger’s and non-Buerger’s groups; Evaluating 122 patients (61 in each group), according to the model each clinical manifestations and risk factors in the patients with Buerger''s disease obtained a score. Absent pulsation, abnormal distal Doppler sonography and ischemic ulcer were respectively present in 58 (95.1%), 58 (95.1%) and 49 (80.3%) individuals with Buerger''s disease. Multivariate linear regression analysis and multivariate logistic regression analysis were used for modeling. Considering the model finding findings, diagnostic criteria including age, sex, smoking, Raynaud''s phenomenon, abnormal proximal Doppler, diabetes mellitus and hyperlipidemia were suggested (R2=0.582); the sensitivity and specificity of the criteria was respectively 95.1% and 78.7%. Compared with Papa criteria, Kappa coefficient was measured at 0.66 with a P-value<0.001. It seems that the recommended criteria have an acceptable accuracy in diagnosing Buerger''s disease, especially in the Iranian population; however, it is necessary to conduct more studies with larger sample sizes to evaluate the criteria, especially in other populations.

The Obsessive Beliefs Questionnaire-44 (OBQ-44), a self-report measure, was developed by the Obsessive Compulsive Cognitions Working Group (OCCWG) to assess beliefs considered relevant in the etiology and maintenance of obsessions and compulsions. The purpose of this study was to evaluate the psychometric properties of the Persian language version of the Obsessive Beliefs Questionnaire (POBQ-44). A sample of 222 medical students from an Iranian university was used to assess the reliability and validity of the POBQ-44. The results indicated five factors: 1) general, 2) perfectionism, certainty, 3) responsibility and threat estimation, 4) importance and control of thoughts, 5) complete performance. Each of these factors was found to have adequate test-retest and internal consistency reliability. Each of the factors was associated with O-C symptoms. In addition, adequate convergent validity was found with a measure of obsessive compulsive symptoms, and discriminate validity was found with measures of depression and anxiety.

Inappropriate use of drugs is a widespread problem with serious consequences such as increased adverse drug reaction and antimicrobial resistance. Proper interventions would have important financial and public health benefits. Several studies have been performed about Rational Drug Use (RUD) in Iran. To provide a picture of researches were done about RUD and highlight the existing gaps in practice in Iran, a systematic search was conducted by reviewing all papers (English and Persian) found by searching keywords in Pubmed, Web of Science, Google Scholar, CINAHL, Proquest, International Pharmaceutical Abstract (IPA), SID, Iran Medex and MagIran. Retrieved articles were extracted in Access form and exported to Excel for further analysis. After excluding duplicate and irrelevant articles, 466 related articles were remained. Number of publications increased dramatically after 2001. About 73% of studies were cross-sectional. Evaluation of prescribing pattern (15%), self-medication (11.3%) and adverse drug reaction (9.1%) were among the top topics which were studied. Despite an increasing trend in RUD publications in Iran, still large gaps remain to be investigated. Knowing the existing gaps is crucial for policy makers to make investments to solve the problems.

Decreased level of consciousness in neonates may result from different etiologies, including rare metabolic and hormonal disorder due to anterior pituitary insufficiency. In this case report, a five-day-old newborn boy was referred to the neonatal intensive care unit of Mustafa Khomeini hospital of Ilam, Iran. He had an open anterior fontanel with no history of prenatal and familial diseases. Clinical examination showed decreased level of consciousness so that this patient responded only to painful stimuli. Furthermore, unconsciousness, hyperbilirubinemia, and hypotonia were fully evident. Given the clinical findings and decreased level of consciousness, hormonal diagnostic tests and brain CT scan were performed for any evidence of hypopituitarism. Clinical and experimental findings were consistent with the generalized edema and pituitary insufficiency secondary to central hypothyroidism and cortisol deficiency. Based on the findings, the neonate was put on the hormonal replacement therapy and, as the result, all of the abnormal clinical symptoms disappeared. In conclusion, fatal neonatal diseases may be mistaken with unimportant clinical findings at the first examination. Therefore, comprehensive attention to all potential causes of such symptoms in the neonates should be given for early diagnosis and treatment, and to prevent any fatal and irreversible complications.

The Yunis-Varón syndrome represents a rare autosomal recessive syndrome of easy recognition characterized by defective growth of the cranial bone along with complete or partial absence of the clavicles (cleidocranial dysplasia), absence of thumbs and halluces, distal aphalangia, ectodermal anomalies, growth retardation and poor outcome. The molecular genetic basis is unknown. Here, we report an 8 months old girl with Yunis-Varón syndrome, born to a consanguineously married, with normal parents. She had micrognathia, wide fontanels, prominent eyes, poor sucking, congenital heart diseases, asymmetric face, ambiguous genitalia, reduction anomaly in right hand including thumb, and hypo plastic distal phalanges of 3th fingers, and hypo plastic clavicles. She has glaucoma and lenses opacity. There is another similar case in her family. Karyotype is normal. She is the first Iranian known case of Yunis-Varón syndrome.

Ectopic decidualization with gross involvement of the peritoneum is one of the rare findings in pregnant women particularly when ectopic decidualization disseminated as an asymptomatic intra-abdominal nodule. We present here a case of an ectopic decidualization in a 33-year-old pregnant woman with symptoms of irritable bowel syndrome during pregnancy.