Archives of Iranian Medicine
Volume:17 Issue: 10, Oct 2014

Genetic polymorphisms in the cytochrome P450 2B6 (CYP2B6) gene could influence therapeutic outcomes of CYP2B6-metabolized drugs such as artemisinin, nevirapine (NVP), and efavirenz (EFV). The main objective of the present study was to analyze the frequency of the most common allele of CYP2B6*1 to *7 and *9 in Iranian Baluchi population and also to compare the frequencies of these polymorphisms with those reported in different ethnic groups. A total of 206 healthy, unrelated, subjects were participated in this study. CYP2B6*1, *2, *3, *4, *5, *6,*7, and *9 polymorphisms were investigated, using PCR-RFLP followed by sequencing analysis. High frequency of 516T (35.7%) was found among the studied subjects. Also, the three most frequent genotypes were CYP2B6*1/*6 (28.1%), CYP2B6*1/*1 (16%) and CYP2B6*1/*9 (14.6%). The frequency of CYP2B6*6/*6 (4.8%) was not different from Caucasian, Japanese and Chinese populations, but it was lower than West African (17%) and Papua New Guinean (43%) populations. Allele frequencies for CYP2B6 in the examined population were markedly different from those African, Caucasian, and Southeast Asian populations. CYP2B6*2, *4, *5, *6, and *7 were found in the Iranian Baluchi that may affect the response to artemisin and its derivatives. High frequency of G516T (35.7%) was detected among the examined subjects that might cause greater efavirenz plasma exposure and more central nervous system side effects. Therefore, characterization of pharmacologically relevant polymorphisms in CYP2B6 has a great potential to improve drug efficacy and reduce toxicity.

Sublingual misoprostol, used for labor induction, produces earlier and higher peak plasma concentrations of misoprostol than vaginal or rectal misoprostol. The sublingual route could be expected to be more effective and safer than the vaginal route and by avoiding a direct effect on the cervix, it might reduce the risk of uterine hyperstimulation and be safer. This study aimed to compare the efficacy of 25-µg sublingual misoprostol with 50-µg intravaginal misoprostol for cervical ripening prior to labor induction in primiparous women. In a double-blind, parallel randomized controlled equivalence trial, we recruited 131 primiparous women at 36–42 weeks of gestation requiring labor induction who referred to Alzahara hospital in Rasht, Iran. The women were randomly assigned to receive 25-µg sublingual misoprostol with vaginal placebo (n = 63) or 50-µg intravaginal misoprostol with sublingual placebo (n = 63). The dose was repeated every 4 h (maximum 4 doses). The primary outcome was the interval from the start of induction to vaginal delivery. There were no significant differences between the two groups with regard to the interval from the start of induction to vaginal delivery(13.2 ± 3.07 h in the vaginal group vs. 13.1 ± 3.46 h in the sublingual group), duration of active phase, Bishop Scores after 4h, and rate of the vaginal delivery under 12 h. Also, the rate of hyperstimulation, tachysystole, type of delivery, cause of cesarean section, Apgar scores less than 7 and admission to the NICU were similar in these two groups. The mean dose of misoprostol applied was significantly lower in the sublingual group (P = 0.001). Sublingual administration of 25-µg of misoprostol appears to be as effective as 50 µg intravaginal misoprostol for cervical ripening and labor induction.

The combination of pulsed dye laser (PDL) and topical propranolol are used with variable effectiveness for the treatment of infantile hemangiomas (IH), particularly for superficial lesions. The aim of this study was to investigate whether the therapeutic efficacy of prescribing topical propranolol along with PDL was superior to PDL therapy alone in the treatment of IH. A total of 19 patients with IH were recruited to the study. Among them, nine patients were treated with PDL, 3 sessions 4 weeks apart, and 10 patients underwent PDL treatment alongside with topical propranolol for 12 weeks. The therapeutic efficacies of each regimen were assessed by comparing photographs of skin lesions before and after the treatment based on the cessation of the lesion growth, reduction in the lesion size, and lightening of the lesion color. No side-effect was reported by the parents. Among nine patients in PDL group, only two (22%) had excellent clearance, one (11%) had good, three (30%) had weak, and three (30%) had no responses. On the other hand, among 10 patients who were treated with both the PDL and topical propranolol, five (50%) showed excellent responses and five (50%) displayed good responses. Statistical data analysis with Mann-Whitney test revealed a significant difference in the clinical response between two treatment groups. The combination of PDL and topical propranolol seem to be a safe and effective therapy, and results in better clinical responses in the treatment of IH than PDL therapy alone.

The prevalence of childhood obesity has risen greatly worldwide. However, assessment of obesity among children and adolescents is further complicated by the changes occurring in the body composition during the growth. The aim of this study is to create gender-specific percentile curves for total body fat percentage (TBFP), total body fat mass (TBFM), fat mass index (FMI), and fat free mass index (FFMI) in healthy Iranian children and adolescents. In this cross-sectional study, 472 healthy Iranian children and adolescents (234 girls and 238 boys) aged 9–18 years old participated. TBFP and TBFM were measured by Dual-Energy X-ray Absorptiometry (DEXA). Weight, height, and waist circumference (WC), pubertal stage and level of physical activity were also recorded. Mean TBFM, TBFP and FMI in girls were significantly more than boys (P < 0.001). The median TBFM in boys increased from 4.8 Kg to 7.5 Kg and in girls from 6.0 Kg to 15.6 Kg. The percentile curves of TBFP in boys were down sloping compared with that in girls (19% increase in girls and 21% decrease in boys from 9–18 years of age). We showed TBFP and FMI had a more complicated relationship with BMI depending on gender and level of BMI, but FFMI consistently increased with BMI in both genders. Also, we found that waist circumference –as a marker of metabolic syndrome-had the greatest correlation with FMI (P < 0.001) between DEXA measured parameters. CONCSLUSION: This study presents normative data for body composition in healthy Iranian children and adolescents and would be useful in adiposity assessment. Our study showed that Iranian children and adolescents had lower total body fat in all age groups and percentiles in comparison with those reported from western children.

Some hormonal and metabolic changes may stimuli normal or neoplastic thyroid cells. Thyroid tumors discovered during pregnancy present unique challenges to both the clinician and the mother. The aim of this article is to compare American Thyroid Association (ATA) guidelines to Endocrine Society guidelines for management of thyroid tumors during pregnancy. We reviewed the section of thyroid nodules and cancer of ATA and Endocrine Society guidelines which have been published recently. Both organizations have discussed and given recommendations related to maternal and fetal aspects of thyroid nodules and cancer. Each topic from either guidelines was compared together and that recommendation which was more complete included in 4 tables. There is a high degree of similarity between these two guidelines. Both organizations have discussed and given recommendations related to maternal and fetal aspects of thyroid tumors. Regarding their similarity any of these two guidelines can be used for safe and proper management of women with thyroid tumors during pregnancy. Regarding their similarity any of these two guidelines can be used by clinicians for safe and proper management of pregnant women with thyroid nodules and cancer.

Using soft-tissue composition in conventional regional dual-energy X-ray absorptiometry (DXA) scans of the spine and hip to predict whole body composition (whole-body fat mass, whole-body lean mass and trunk-fat mass) instead of a whole body DXA scan. We identified 143 adult patients who underwent DXA evaluation of the whole body. Anthropometric indices were also measured. Datasets were split randomly into two parts; the derivation set including a sample of 100 subjects, and the validation set including a sample of 43 subjects. Multiple regression analysis with the backward stepwise elimination procedure was used for the derivation set and the estimates were then compared with the actual measurements from the whole-body scans for the validation set. The Ra2 (adjusted coefficient of multiple determination) and SSE (error sum of squares) criteria were applied to compare regression models. Using multiple linear regression analyses, the best equation for predicting whole-body fat mass (Ra2= 0. 945) included gender, height, weight, waist circumference (WC), spine fat fraction and hip fat fraction; the best equation for predicting whole-body lean mass (Ra2 = 0. 970) included gender, weight, WC, spine fat fraction and hip fat fraction; and the best equation for predicting trunk-fat mass (Ra2 = 0. 944) included gender, weight, spine fat fraction and hip fat fraction. The results of this study show that regional DXA scans of the spine and hip can be used to accurately predict body composition.

Sexual function results from complex interactions of neurovascular and endocrine factors. The prevalence of sexual dysfunction varies in different countries. This study aimed to determine the prevalence of sexual dysfunction and the related factors among reproductive age women in Iran. A community-based cross-sectional descriptive study was carried out on 784 married women living in urban areas of 4 provinces of Iran. Participants were recruited using a stratified, multistage probability cluster sampling method. Female sexual function was assessed using the Female sexual function index questionnaire. Data was analyzed using Spearman and logistic regression tests. The results demonstrated 27.3% prevalence of sexual dysfunction including 0.8% severe, 20.3% moderate, and 6.3% mild sexual dysfunction. Among women with sexual dysfunction, the frequency of desire, arousal, lubrication, and orgasmic disorders were 35.6%, 39.9%, 18.9%, and 27.3%, respectively. Dyspareunia was reported by 56.1% of women. Among the participants, 15.2% were unsatisfied with their sexual life. There was a statistically significant relationship between sexual dysfunction and duration of married life, perceived attraction of spouse, overall satisfaction with routine life and the women’s ability to express their sexual desires. Sexual dysfunction is prevalent among Iranian women. A comprehensive service including counseling programs for sexual dysfunction at primary health care is highly recommended.

In vitro generation of germ cells introduces a novel approach to male infertility and provides an effective system in gene tracking studies, however many aspects of this process have remained unclear. We aimed to promote mouse embryonic stem cells (mESC) differentiation into germ cells and evaluate its effectiveness with tracking the expression of the Tsga10 during this process. mESCs were differentiated into germ cells in the presence of Retinoic Acid. Based on developmental schedule of the postnatal testis, samples were taken on the 7th, 12th, and 25th days of the culture and were subjected to expression analysis of a panel of germ cell specific genes. Expression of Tsga10 in RNA and protein levels was then analyzed. Transition from mitosis to meiosis occurred between 7th and 12th days of mESC culture and post-meiotic gene expression did not occur until the 25th day of the culture. Results showed low level of Tsga10expression in undifferentiated stem cells. During transition from meiotic to post-meiotic phase, Tsga10 expression increased in 6.6 folds. This finding is in concordance with in vivo changes during transition from pre-pubertal to pubertal stage. Localization of processed and unprocessed forms of the related protein was similar to those in vivo as well. Expression pattern of Tsga10, as a gene with critical function in spermatogenesis, is similar during in vitro and in vivo germ cell generation. The results suggest that in vitro derived germ cells could be a trusted model to study genes behavior during spermatogenesis.

As there is a significant number of Iranian immigrant and illegal refugees living in marginal areas of large cities that might induce immunization gap in these areas. The aim of this study was to provide reliable information on vaccination status of these people. A cross sectional study was conducted on children 24–47 month old who lived in the suburb areas of five large cities of Iran in 2013. Proportional cluster sampling method was used in each city and standard questionnaire of the World Health Organization applied for the purpose of data collection. The survey counts immunizations based on immunization card plus the history of vaccination according to the mother’s memory. All gathered data were analyzed using SPSS software (version 16). Overall, 4502 children (49.2% female) aged 24–47 month participated in this survey among which 88.1% were Iranian and 11.9% were Afghan or other nationalities. Totally, 4479 (99.4%, CI 95%: 99.2%–99.6%) of the children had a vaccination card while 828 (18.5%, CI 95%; 15.8%–21.1%) could not present it to the interviewers. 96.8% of children were fully immunized, 3.2% were partially immunized and 0.1% were not immunized. There was no significant difference in terms of vaccine coverage among males and females. The prevalence of partially immunization in non-Iranian children was six fold of Iranian children (11.9% vs. 2%). Immunization program is implemented appropriately with high coverage rates in suburb areas of the country. However, there is still an immunity gap in non-Iranian immigrants, which should be a health system considered as a high-risk group by the health system.

Forty-five percent of the human genome is composed of Transposable Elements (TEs); therefore, TEs have had an undisputed impact on evolution of the most evolved creature by a very simple mechanism of action. Scientists have been studying this simple mechanism of action and are currently using it to develop efficient and safe gene delivery systems especially for treatment of diseases. TEs have also been used safely in generating induced Pluripotent Stem Cells (iPSC) for regenerative medicine, which opens the door to a world of possibilities in our approach in trying to wrestle with many challenges in medicine. The PiggyBac (PB) system has yielded more success in generation of induced pluripotent stem cells in regenerative medicine, and the Sleeping Beauty (SB) has been more successful in Gene Therapy. Recent advances are indicative of more good news to come regarding the potential heights of successes achievable by the use of the TE-based systems.

Cirrhosis is the end stage of many different forms of acute and chronic liver damages. Interactions between liver and endocrine system is significant, because liver is the main organ of metabolism and catabolism of many proteins. In this study, current literature about endocrine abnormalities among patients with liver cirrhosis was reviewed. A PubMed search was performed on English literature from January 1990 onward to find human studies reporting endocrine dysfunction in liver cirrhosis. Relevant articles were included and reviewed by two expert reviewers. Data were summarized ant tabulated in separate categories for each endocrine involvement. Among 944 studies, 36 articles were eligible for review. Growth hormone resistance and low Insulin like growth factor-1 are prevalent in patients with liver cirrhosis with negative impact on prognosis. Thyroid dysfunction is mostly seen in the form of sick euthyroid syndrome. Osteoporosis is also prevalent in cirrhosis but the exact mechanism is not clear. Adrenal insufficiency is a prevalent clinical feature both in compensated and critically ill patients with cirrhosis with negative impact on patients’ outcomes. Disorders of endocrine system is prevalent in cirrhosis. These patients should be checked and treated for these disorders to achieve a stable clinical situation and prepare for liver transplantation.

We reported a typical brucellosis, which was diagnosed as hemophagocytic lymphohistiocytosis (HLH). Although some tumor markers (CEA, CYFRA21-1, NSE, CA19-9) in the patient’s serum were elevated, carcinomas were excluded by a variety of inspections including bone marrow aspirations, ultrasound examinations, and whole-body PET-CT scans. It was concluded that serum tumor markers are considered medically necessary as a screening test for brucellosis with HLH, however, detailed inspections were needed to make a final diagnosis. Moreover, combination of epidemiology investigations and laboratory inspections were helpful to determine the etiology of HLH and initiate the corresponding treatments

Tuberculosis (TB) has re-emerged in the two past decades as a major health problem worldwide. Presently, more than 2 billion people (one third of the world population) are infected with TB, of which approximately 10% will develop the clinical disease. The incidence of central nervous system (CNS) TB is related to the prevalence of TB in the community, and it is still the most common type of chronic CNS infection in developing countries. We describe a 32-year-old woman, who presented with chronic headache, followed by gaze palsy and decreased level of consciousness. The disease was diagnosed through TB PCR of the cerebrospinal fluid (CSF). Anti TB drugs and corticosteroid were started for her and she responded successfully to treatment. We conclude that TB of CNS should be considered in patients with chronic headache, particularly in endemic regions because its diagnosis may be missed.

Primary renal synovial sarcoma (PRSS) is a very rare tumor, first described by Argani, et al. The exact incidence of PRSS is not yet known. Here we present a case of PRSS diagnosed by histopathology, supplemented with immunohistochemistry.

This article presents one of the earliest clinical photographs in the history of surgery in Iran. The picture was taken around 1919 (1297 of the Iranian solar calendar) in Tabriz, Iran. The picture shows the post-operative care of surgical team of two amputees, the surgical instruments and the method of applied anesthesia. The patients were Iranian Gendarmerie soldiers who lost their limbs to frostbite. The surgeries were performed by Dr. Ali Roshdi in Gendarmerie Hospital in Tabriz. This photograph cleverly demonstrates the coconscious endeavor of the surgical team to treat and save lives of patients in about a century ago in Tabriz, Iran.