Acta Medica Iranica
Volume:52 Issue: 8, Aug 2014

Occult Hepatitis B (OHB), or persistent hepatitis B virus (HBV) viremia in surface-antigen-HBsAg-negative patients, has been recognized as a medical concern during the last decade. The exact magnitude, pathogenesis and clinical relevance of OHB are unclear. This review organizes the published data on OHB and presents an overview of the current hypotheses on OHB’s pathogenesis and clinical relevance.Many explanations have been offered for the pathogenesis of OHB, ranging from the inability of standard immunoassays to diagnose OHB to the involvement of the versatile virus–host factorsAlso, special care should be taken regarding the diagnosis of OBH. It seems that both shared viral-host factors are involved in the pathogenesis of OBH. Further molecular studies on cohort patients group need to explore such association.

Compelling evidence suggests that the oxidative stress plays a key role in the pathophysiology of cardiovascular disease (CVD). Superoxide dismutase (SOD) enzymes play a major role in detoxification of reactive oxygen species and protection against oxidative stress. We examined the possible association between a 50-bp insertion/deletion in the SOD1 promoter 1684-bp upstream of the SOD1 ATG with CVD in an Iranian population. A total of 400 individuals including 200 CVD patients and 200 healthy subjects from the same ethnic background as the control group were participated in this study. Genomic DNA from all subjects was screened for the 50-bp SOD1 promoter deletion using a polymerase chain reaction (PCR) assay. Our finding showed an association between SOD1 DEL/DEL (9% vs. 2.5%) and INS/DEL genotypes and risk of CVD and these genotypes increased the susceptibility to CVD (OR=2.096, 95% CI: 1.336-3.286, P= 0.001 for the INS/DEL genotype; OR=4.811, 95% CI: 1.734-13.346, P= 0.003 for the DEL/DEL genotype). Additionally, the DEL allele of the SOD1 variation was found to be more prevalent in the CVD patients with the frequency of 26.3% and 13.5% in cases and controls, respectively, and this difference reached statistical significance (OR=2.281, 95% CI: 1.586-3.279, P= 0.001). The analysis of SOD1 genotypes according to patients’ characteristics revealed that the SOD1 Ins/del and Del/Del genotypes were more prevalent in CVD patients with a history of CVD or hypertension or DM (P<0.05), whereas the majority of Ins/Ins genotype carriers had no history of these diseases. Overall, our results demonstrated that SOD1 50-bp Del/Del and Ins/Del genotypes, as well as Del, allele, were associated with an increased risk of CVD.

Administration of endotracheal surfactant is potentially the main treatment for neonates suffering from RDS (Respiratory Distress Syndrome), which is followed by mechanical ventilation. Late and severe complications may develop as a consequence of using mechanical ventilation. In this study, conventional methods for treatment of RDS are compared with surfactant administration, use of mechanical ventilation for a brief period and NCPAP (Nasal Continuous Positive Airway Pressure), (INSURE method ((Intubation, Surfactant administration and extubation)). A randomized clinical trial study was performed, including all newborn infants with diagnosed RDS and a gestational age of 35 weeks or less, who were admitted in NICU of Valiasr hospital. The patients were then divided randomly into two CMV (Conventional Mechanical Ventilation) and INSURE groups. Surfactant administration and consequent long-term mechanical ventilation were done in the first group (CMV group). In the second group (INSURE group), surfactant was administered followed by a short-term period of mechanical ventilation. The infants were then extubated, and NCPAP was embedded. The comparison included crucial duration of mechanical ventilation and oxygen therapy, IVH (Intraventricular Hemorrhage), PDA (Patent Ductus Arteriosus), air-leak syndromes, BPD (Broncho-Pulmonary Dysplasia) and mortality rate. The need for mechanical ventilation in 5th day of admission was 43% decreased (P=0.005) in INSURE group in comparison to CMV group. A decline (P=0.01) in the incidence of IVH and PDA was also achieved. Pneumothorax, chronic pulmonary disease and mortality rates, were not significantly different among two groups. (P=0.25, P=0.14, P=0.25, respectively). This study indicated that INSURE method in the treatment of RDS decreases the need for mechanical ventilation and oxygen-therapy in preterm neonates. Moreover, relevant complications as IVH and PDA were observed to be reduced. Thus, it seems rationale to perform this method as the initial treatment for neonates with mild to moderate RDS.

Vitiligo Vulgaris is a pigment disorder as the lack of skin pigmentation which its most prevalent cause is autoimmune. Vitamin D has various effects on the natural and acquired immune of the body because of its effectiveness on the T cells and B cells, macrophages and dendritic cells.The object of this study was assessment of the Vitamin D in patients with vitiligo vulgaris in dermatologic clinics in Qazvin in 2012. The 100 patients with Vitiligo were studied through a cross-sectional study. The required data were collectedby the questionnaire (age, gender, job, family background, consumption of the dairies and vitamin D supplements), examination (type of skin) and para clinical test (measurement of the serum 25-hydroxyvitamin D level). The 42 (42%) and 58 (58%) people of the population under study were respectively male and female. The mean age of the population under study was 28.7±1.17. The mean serum of 25-hydroxyvitamin D level was 42±24.14 which had a significance difference with a normal level (p<0.04). The mean serum 25-hydroxyvitamin D level among patients with Vitiligo had a significance difference with a normal level.

Lack of scientific and confirmed researches and expert knowledge about evaluation systems for clinical governance development in Iran have made studies on different Evaluation Systemsfor Clinical Governance Development anecessity. These studies must provide applied strategies to design criteria of implementing Clinical Governance for Hospital's Accreditation. This is a descriptive and comparative study on Development of Clinical Governance Models all over the world. Data have been gathered by reviewing related articles. Models have been studied in Comprehensive Review Method. The evaluated Models of Clinical Governance Development were Australian, NHS, SPOCK and OPTIGOV. The Final aspects extracted from these models were Responsiveness, Policies and Strategies, Organizational Structure, Allocating Resources, Education and Occupational Development, Performance Evaluation, External Evaluation, Patient Oriented Approach, Risk Management, Personnel's Participation, Information Technology, Human Resources, Research and Development, Evidence Based Medicine, Clinical Audit, Health Technology Assessment and Quality. These results are applicable for completing the present criteria which evaluating Clinical Governance Application and provide practical framework to evaluate country's Hospital on the basis of Clinical Governance Elements.

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. It accounts 90% of all entrapment neuropathies all over the world. Ultrasound is a non-invasive, cost effective and available para-clinical method which could be applied for CTS diagnosis. Cross-sectional area of the median nerve at the level of the inlet is considered as a diagnostic criterion in CTS cases. In this study, thirty-eight patients with electrophysiologically confirmed idiopathic CTS and 22 healthy controls were enrolled. Seventy-one affected nerves and 42 unaffected nerves were evaluated within 14 days after electrophysiological examination. The largest cross-sectional area (CSA) was measured at the level of the carpal tunnel inlet and the maximum nerve perimeter was also recorded by means of the software. Mean CSA and perimeter were 14.02 ± 4.5 mm2 and 1.7±0.28m in all patients and 8.2±2.1 mm2, 1.3±0.19 m in controls (P<0.001, P<0.001). Mean CSA and Perimeter were significantly different between patient’s groups and control. The best cut off point for CSA of the tunnel inlet was 10.5 mm2 with sensitivity and specificity of 80% and 76% (AUC (Area under the Curve) = 0.9, P<0.001). The best cut off point for inlet perimeter was 1.44 m with sensitivity and specificity of 85% and 77 % (AUC=0.87, P<0.001). Our findings showed that median nerve CSA at carpal tunnel inlet could be used as the diagnostic criteria for CTS.

Hypoglycemia is considered as a serious risk factor in neonates. In the majority of cases, it occurs with no clinical symptoms. Accordingly, early diagnosis is extremely imperative, which can also lead to less morbidity and mortality. The aim of this study was to assess the importance of screening blood glucose using glucometer (known as a quick and cost-effective diagnostic test) in comparison with laboratory method. A total of 219 neonates at risk of hypoglycemia were included in this study. Blood glucose was measured by glucometer and laboratory. In addition glucose level of capillary blood was measured by glucometer at the same time. Sensitivity and specificity of capillary blood glucose measurement by glucometer were 83.5%, 97.5% respectively (ppv=80%), (npv=98%). Capillary blood glucose measured by glucometer has an acceptable sensitivity and specificity in measurement of neonatal blood glucose. Therefore measurement by glucometer is recommended as a proper diagnostic test.

Nasal mucosa has an extraordinary nerve supply with unique geometry that encompasses complex physiology. Among these, side-specific predilections to the respiratory and autonomic centers are the interesting issues that have been raised about the consequences of the nasal irritations. The aim of the study was an evaluation of how intranasal stimulation influences lung mechanics and determines whether unilateral stimulation produces side-specific partitioning responses. Tracheotomized-paralyzed rats received unilateral air-puff stimulation. Inspiratory pressure- volume (P-V) curve was obtained. Low frequency forced oscillation technique (FOT) was used to detect changes in central and peripheral airways. Mean airway pressure significantly increased to >10 cmH2O in the presence of 5cmH2O of positive end-expiratory pressure. Elastance was significantly changed, and significant higher airway resistance (Raw) and lower reactance (Xrs) were noticed in peripheral airways following different side of stimulation. Calculated inspiratory P-V curve showed significant deviations in transitional, rising and maximal pressures following stimulations. Transitional left-side shifting was observed following right side stimulation, whereas left side stimulation shifted the curve to the right. May be altered respiratory mechanics is the consequences of bimodal pressure-volume relationships observed in central and peripheral airways following nasal stimulation.

Moving toward establishing more student center educational environment to meet the ever-changing learning expectations in a challenging climate like emergency department for under graduates is an intimidating task. In our newly founded academic emergency department, every step toward scoring as a dynamic and modern educational environment for both undergraduates and postgraduates would be a great success. The last 18 months of undergraduate medical education in Iran is considered as an internship. Interns have two months mandatory emergency department rotation during that period. This study has design to evaluate the medical students’ conception about the educational environment using the Dundee Ready Education Environment Measure (DREEM) questionnaire. 156 undergraduate interns during their two months emergency medicine rotation from October 2009 to March 2010 enrolled into a cross sectional observational study to anonymously fill up the DREEM questionnaire on the last week of the course. The overall mean score of DREEM questionnaire was 134.79 out of 200 for the emergency department. The mean scores are 135.37 in female (n=87) group and 131.56 in male (n=69) group. There was not any significant difference between two genders (P>0.05). A score of 134.79 is compatible with the modern universities. Scores of 100 or less indicate serious problems and scores above 170 is compatible with ultimate student centered and modern educational environment. Such an achievement in the start of the new installed Emergency Medicine program is admirable, hence great effort must be put to pinpoint problems and fix them. DREEM questionnaire helped us moving toward a more student center environment in the emergency department.

Mutations in the Connexin 26 (Cx26) gene are a common cause of hereditary hearing loss in different populations. In the present study, an Iranian patient with bilateral hearing loss underwent molecular analysis for the causative mutation. DNA studies were performed for the Cx26 gene by PCR and sequencing methods. We describe a novel compound heterozygous mutation (35delG, 363delC) in the Cx26 gene that is strongly associated with congenital non-syndromic hearing loss (NSHL).

Atrial dissociation is characterized by different types of P waves captured in an electrocardiogram, usually seen in critically ill or post-cardiac transplantation patients. Our case demonstrates a 55-year-old man, presenting with chestpain (unstable angina) in the emergency department with transient double-P waves; representing the phenomenon. Our case did not have any of the suggested causes or any known cardiac problems; therefore, with ruling out other differential diagnosis, researches must be done to find another explanation, if repeated.

Synovial hemangioma is a rare benign malformation of the synovium. It presents frequently in the knee with pain, tenderness, intermittent swelling and recurrent hemarthrosis. MRI can be helpful in diagnosis of synovial hemangioma. In this paper, we present a 45-year-old lady with chronic symptoms and obscure clinical symptoms for 35 years which finally diagnosed and managed arthroscopically as synovial hemangioma of the knee. The patient`s complaints resolved efficiently with no recurrence after one year.

Epidermal nevus syndrome is a rare congenital disorder, characterized by epidermal nevi and multiple organ involvement. Multicystic kidney disease has been very rarely reported in this syndrome. Here is the report of a boy presented with multiple epidermal nevi, cardiac anomaly, seizure attack, hemi hypertrophy, and multicystic dysplastic kidney complicated with Wilms'' tumor. According to this association, it is suggested to search for dysplastic kidney disease in patients with neurocutaneous disorders.