Acta Medica Iranica
Volume:53 Issue: 6, Jun 2015

Lead poisoning is a historic universal disease. Acute or chronic lead exposure may cause reversible or even permanent damages in human beings. Environmental lead exposure is a global health concern in children. Occupational lead poisoning is still a health issue, particularly in developing countries. During the last decades, new methods and medications have been advocated for the prevention and treatment of lead poisoning. This review deals mainly with recent developments in the management of lead poisoning. Sources of lead exposure are introduced, and methods for the primary prevention of lead poisoning are discussed. Details for the screening of adults and children are also explained to serve as a practical guideline for the secondary prevention. Standard chelation therapy in different groups and up-to-date less toxic new medications for the treatment of lead poisoning are finally discussed. Our published clinical research on the therapeutic effects of garlic tablets in mild to moderate occupational lead poisoning will also be discussed.

Selective estrogen receptor modulators (SERMs) such as raloxifene have already shown beneficial effects on negative, positive and general psychopathology symptoms in postmenopausal women with schizophrenia. The purpose of the present investigation was to assess the efficacy of raloxifene as an adjuvant agent in the treatment of men with chronic schizophrenia in an 8-week double-blind and placebo-controlled trial. In a randomized, double-blind and placebo-controlled study, forty-six male patients diagnosed with schizophrenia (DSM-IV-TR), were randomized to either raloxifene (120 mg/day) or placebo in addition to risperidone (6 mg/day) for eight weeks. The assessment was performed using the positive and negative symptom scale (PANSS) at baseline, and at weeks 2, 4, 6 and 8. Extrapyramidal symptom rating scale (ESRS) at baseline, weeks 1, 2, 4, 6, 8 and Hamilton depression rating scale (HDRS) at baseline and week 8 were also used to assess extrapyramidal symptoms and depression simultaneously. Forty-two patients completed the trial. The raloxifene group showed significantly greater improvement on the negative subscale (P<0.001), the general psychopathology subscale (P=0.002) and total PANSS score (P<0.001) in comparison to the placebo group at the endpoint. There was no significant difference in the reduction of positive symptoms score between the two group (P=0.525). Extrapyramidal symptom rating scale and Hamilton depression rating scale and frequency of other adverse effects were comparable between two groups.This study indicates raloxifene as a potential adjunctive treatment strategy for chronic schizophrenia in men.

The biological effects of omega-3 and omega-6 fatty acids are determined by their mutual interactions. This interaction extremely affects various functions. Lower consumption of omega-3 during gestation leads to various disorders, even in hearing. We aimed to assess the effect of low omega-3/omega-6 ratios on auditory nerve conduction. In this experimental study, the auditory brainstem response test was performed on 24-day-old rat (n=14). The rats were divided into case (low omega-3/omega-6 ratio during gestation and lactation) and control groups. Variables such as P1, P3, and P4 absolute latency period, interpeaks (P3-P4, P1-P3, and P1-P4), and P4/P1 amplitude ratio were measured. We found an increased P4 omega-3/omega-6 ratio in the group with a low omega-3/omega-6 ratio (P<0.01). No significant difference was observed in the P1 and P3 absolute latency period between the studied groups (P>0.05). Also, no significant difference was observed between the groups with respect to the P1-P3 interpeak latency (IPL) periods (P>0.05); while the P1-P4 and P3-P4 IPLs were significantly increased in the group with a low omega-3/omega-6 ratio (P<0.05). The P4/P1 amplitude ratio significantly decreased in the group with a low omega-3/omega-6 ratio (P<0.05). Results confirmed the negative effects of low omega-3/omega-6 ratio on the auditory system and hearing.

The present study has been directed to investigate Ursodeoxycholic Acid (UDCA) effect in children, to reduce the high Liver transaminases induced by Anticonvulsant drugs (drug induced hepatitis). This idea has been driven from Cytoprotective and antioxidant properties of UDCA to be used in drug induced inflammation in Liver. Twenty two epileptic patients aged between 4mo – 3yr whom were under anticonvulsant therapy with drugs such as valperoic acid, primidone, levetiracetam, Phenobarbital or any combination of them and had shown Liver transaminases rise, after rule out of Viral-Autoimmune, Metabolic and Anatomic causes, have been prescribed UDCA in dose of 10-15 mg/kg/day, at least for 6 months. Any patient who have shown confusing factors such as genetic disorders with liver involvement or spontaneous decline in enzymes or had not treatment compliance has been excluded from the study. Transaminases range changes as well as Probable side effects of the drug have been monitored. The results indicated that UDCA is effective and well tolerable in the children with drug induced hyper transaminasemia. No side effect has been seen and recorded in this study. Based on this study and its results, we recommend UDCA as a safe and effective choice in drug induced hepatotoxicities.

Coronary artery calcium scoring (CACS) is a reasonable test for patients with the possibility of atherosclerosis. It can also be used for reclassifying the coronary artery disease (CAD) to the high-risk status by higher CACS and subsequently modifying the management of the patients.The purpose of this study was to investigate the association of CACS to the severity of coronary artery disease in the patients who were scheduled to perform coronary artery angiography (CAG) by tradition. CACS could be a simple, relatively cost-benefit, and noninvasive method for early screening of patients with obstructive coronary artery disease. In the present study, CAC scoring was evaluated by non-enhanced Multi-Detector Computed Tomography (MDCT) in a total 239 patient suffering from coronary artery disease. Of them, 223 patients were planned to undergo CAG based on clinical examination or other noninvasive diagnostic methods (such as MPI, ETT, EKG or Echo). Our results showed that 11 of 67 patients with a negative CACS (zero) had obstructive coronary artery disease derived from the results of CAG. We also found a significant correlation between high CACS (more than 400) and extensive obstructive CAD, except for the two patients who had only mild CAD. There was a linear correlation between CACS and the severity of CAD on the basis of Gensini score and the number of involved arteries (CC=0.507, PV<0.001). Despite fairly high sensitivity (86.6) of zero CAC among patients with a negative score (86%), zero CACS cannot rule out the existence of obstructive coronary artery disease. As we found, increased level of CACS (>400) might be a significant indicative of CAD in referring patients.

The ophthalmologic outcomes of diabetes were important. This research is conducted to assess the relation between diabetes and intraocular pressure changes in the patients of Avicenna Hospital, compared with healthy persons referring to the facility. With cross-sectional research, 400 persons including 200 diabetics and non-diabetics were selected on a random basis over one year in 2012. Research data were collected by examination and checklists, and then analyzed by SPSS 16 statistical software. Descriptive results were extracted, and the relation between the variables were analyzed by Chi2 test, t-test, Fisher''s exact test, Pearson''s correlation coefficient, with P. value less than 0.05 (P<0.05).In the group of diabetics, 37% and 63%were male and female respectively, while in non-diabetics group 47% and 53% were male and female. The mean age of diabetics patients were 54.17 ± 8.25 and non-diabetics 49.06 ± 7.26 years. Mean vision acuity of the right eye was 9.035 in the diabetics and 9.56 in the witness group. Mean intraocular pressure was 16.71 ± 1.96 mm/Hg in diabetics, and 12.86 ± 1.45 mm/Hg in non-diabetics, which showed a significant difference (t = 22.337, P=0.001). It is advisable that the intraocular pressure of diabetics be measured and recorded on a regular basis.

Coronary artery disease is the leading cause of death worldwide. In this study, we compared two surgical methods of left internal mammary artery (LIMA) anastomosis on left anterior descending (LAD) artery in patients with severe diffuse lesions. A total of 40 patients were included in our study and randomly assigned into two groups. In group A, after a long arteriotomy on LAD, the posterior surface of left internal mammary artery (LIMA) was opened by the same length and was anastomosed along the LAD course through normal and diseased parts. In group B instead of complete opening of LAD, a small arteriotomy was done only in areas where the wall of the vessel was nearly normal (especially the anterolateral wall), and LIMA was anastomosed to these areas in a sequential (Jump) method. The patients were then followed for post-operation results. The two groups showed equal results regarding early mortality, post-operation bleeding, and infection, pleural and pericardial effusion. There were two cases of myocardial infarction (MI) in group A with one mortality after 18 months, while no MI was reported in group B. Group B demonstrated significantly superior results regarding the rise in ejection fraction and the improvement in functional class. In this study it was demonstrated that diffuse coronary artery lesions of LAD should be preferably operated using LIMA with the sequential-jump anastomoses method and the surgeon should avoid long arteriotomy with single long anastomosis because of lower chance of long-term patency.

Epilepsy is one of the most common neurological disorders which a physician might come across in his career life. On the other hand, migraine is common disorders in society chronic headache such as migraine in epileptic patients give ride to difficulties in seizure treatment due to altering the sleeping pattern and calmness disarrangement. Therefore, early diagnosis and suitable treatment in epileptic patients is definitely inevitable, and it will help in a more desirable patients’ treatment. So we aimed to evaluate the prevalence of migraine in epileptic patients and relation between these two disorders. Number of 150 epileptic patients attended to neurology clinic of Shohadaye Tajrish Hospital and Iranian Epilepsy Association between June 2010 to May 2011 were fulfilled the questionnaire, and the data has been assessed by SPSS software. In this study, we used MS-Q (migraine screening –questionnaire) designed for early diagnosis of migraine in the general population. From all patients filling the questionnaire, the prevalence of migraine (with or without aura) was as follows: 23 persons had criteria compatible with migraine with aura; 26 patients had migraine without aura. Migraine was more common in these patients: persons with academic degrees, women, patients who were used 2 antiepileptic drugs, and patients with high BMI. In this study, we showed that migraine in epileptic patients is more prevalent than the general population. Thus, early diagnosis and efficient treatment of migraine headache in these patients is mandatory. More studies are needed for evaluation of this issue.

Vesicoureteral reflux (VUR) is one of the most important causes of urinary tract infection and renal failure in children. It is a potentially self-limited disease. The aim of this study was to evaluate the clinical course and significant factors in children with primary VUR. The medical charts of 125 infants and children (27.2 % males, 72.8% females) with all grades of primary VUR were retrospectively reviewed. Mean age at diagnosis was 22.3±22.9 months. 52% of patients had bilateral VUR. Mild reflux (Grade I, II) was the most common initial grade. 53.6% of patients achieved spontaneous resolution. 30.1% of patients had decreased renal function on initial DMSA renal scan, significantly in males and severe VUR. Reflux nephropathy occurred in 17.6% of patients, especially in renal damage and male sex. No significant association was observed between recurrent urinary tract infection with the severity of VUR, and the presence of renal damage at admission. Age at diagnosis, gender, grade, laterality, the absence of recurrent urinary tract infection and renal damage had a significant correlation between spontaneous VUR resolution. Spontaneous resolution of primary VUR occurred significantly in female patients, age ≤ 30months at diagnosis, mild-to-moderate VUR, unilateral reflux, the absence of recurrent urinary tract infection, and renal damage.

To evaluate the effect of adding neoadjuvant chemotherapy to surgery and radiation therapy for locally advanced resectable oral cavity squamous cell carcinoma, 24 patients with T3 or T4a oral cavity squamous cell carcinoma were randomly assigned to surgery alone or Docetaxel, Cisplatin, and 5-FU (TPF) induction chemotherapy followed by surgery. All patients were planned to receive chemoradiotherapy after surgery. The primary end-points were organ preservation and progression-free-survival. SPSS version 17 was used for data analysis. Median follow-up was 16 months. The median age of the patients was 62 years old (23-75 years). Man/woman ratio was 1.13. The primary site of the tumor was the tongue in most patients (48%). No significant difference was observed between pathologic characteristics of the two groups. Chemotherapy group showed 16% complete pathologic response to TPF. No significant difference in organ preservation surgery or overall survival was detected. However, the patients in the chemotherapy group had longer progression-free-survival (P=0.014). Surgery followed by chemoradiotherapy with or without TPF induction results in similar survival time. However, progression-free-survival improves with the TPF induction chemotherapy. Studies with more patents and new strategies are recommended to evaluate organ preservation improvement and long-term outcomes.

Brucellosis is the most widespread zoonotic infection in the world. The disease is endemic in countries bordering the Mediterranean Sea. It is an important re-emerging infectious disease. This disease is closely associated with the evolution of mankind as an agrarian society linked to the practice of shepherding and popularization of animal husbandry. The patients with this disease are typically present with chills, fever, asthenia and sweating. This paper describes a patient with brucellosis and skin rashes on the leg. A 41-year-old man presented with fever, ataxia, and dysarthria. He was a shepherd. The patient reported the loss of appetite, arthralgia and weight loss during previous five months. Finally, he was diagnosed with brucellosis by positive blood culture and high titer for Brucella agglutination test. The clinical manifestation of brucellosis is very broad, ranging from asymptomatic infection to serious debilitating disease. Current patient had skin rashes on his leg. Brucellosis must be considered in the differential diagnosis of acute infections, especially if there is a history of fresh milk product ingestion and living in an endemic region.

Hydatid cyst locates in the liver (70%), lungs (25%) and rarely in other body tissues. Cases with gluteal muscle localized hydatid cyst are rarely seen in literature. In this case report, a woman with hydatid cyst that was located in gluteal muscle was discussed. After the patient had been diagnosed, complete surgical excision was performed with the patient. Albendazole treatment was applied in preoperative and postoperative period to decrease local recurrence risk.