فهرست مطالب

Medical Sciences - Volume:42 Issue: 4, Jul 2017

Iranian Journal of Medical Sciences
Volume:42 Issue: 4, Jul 2017

  • تاریخ انتشار: 1396/04/25
  • تعداد عناوین: 14
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  • Samira Alinejad, Nasim Zamani, Mohammad Abdollahi, Omid Mehrpour Pages 327-346
    Poisoning is a frequent cause of referral to medical emergencies and a major health problem around the world, especially in developing countries. We aimed to review the epidemiology and pattern of adult poisoning in Iran in order to facilitate the early diagnosis and management of poisoning. The pattern of poisoning is different in various parts of Iran. Pharmaceutical compounds were the most common cause of poisoning in most parts of Iran. Pesticide-related toxicities were more common in northern agricultural regions, whereas bites and stings were seen more commonly in southern Iran. Carbon monoxide poisoning was common in cities with many motor vehicles such as Tehran and in colder climates such as in northern and western regions due to inadequately vented gas appliances such as stoves and heaters. Majoon Birjandi (containing cannabis) is a unique substance used in eastern Iran. Poisoning by opioids, tramadol, and pesticides (organophosphate and aluminum phosphide) has remained a common hazard in Iran. Poisoning-associated morbidity and mortality rates vary by region and have changed over time due to the introduction of new drugs and chemicals. Early diagnosis and proper treatment may be lifesaving; thus, understanding the general pattern of poisoning in different regions is important.
    Keywords: Epidemiology, Iran, Medicine, Pesticides, Poisoning, Stings, Toxicity
  • Sayyed Ehtesham Hussain Naqvi, Atia Zaka-Ur-Rab, Najmul Islam, Eram Ali Pages 347-353
    Background
    Inflammatory response following surgical trauma has long been a matter of study. Results, however, have been varied. We sought to assess changes in the levels of proinflammatory and anti-inflammatory cytokines in patients undergoing laparoscopic and open cholecystectomy and their impact on the clinical outcome of patients concerning the postoperative pain score.
    Methods
    The study involved 90 cholecystectomies (55 laparoscopic and 35 open) for chronic cholecystitis. Blood samples were collected 2 hours preoperatively and at 4 and 24 hours post surgery. Sera were evaluated for the levels of interleukin-1β, interleukin-10, and tumor necrosis factor-alpha. The independent sample t-test was used to compare the means of a variable between the 2 groups. Statistical analysis was done using SPSS, version 17.
    Results
    The rise in the levels of interleukin-1β, interleukin-10, and tumor necrosis factor-alpha was significantly more in the open cholecystectomy group at 4 hours (P
    Conclusion
    Both laparoscopic and open cholecystectomy procedures altered the inflammatory milieu of our patients in the postoperative period. Inflammation caused by the laparoscopic procedure was significantly less. More research is needed to target specific inflammatory and anti-inflammatory cytokines to reduce surgical stress and improve patient outcomes.
    Keywords: Cholecystectomy, Laparoscopic, Open cholecystectomy, Inflammatory response interleukins, Tumor necrosis factor
  • Robabeh Soleimani, Maryam Kousha, Homa Zarrabi, Seyede Mahnaz Tavafzadeh-Haghi, Mir Mohammad Jalali Pages 354-361
    Background
    Children with attention deficit hyperactivity disorder/developmental coordination disorder (ADHD/DCD) suffer from problems associated with gross and fine motor skills. There is no effective pharmacological therapy for such patients. We aimed to assess the impact of methylphenidate (MPH) on motor performance of children with ADHD/DCD.
    Methods
    In this double-blind placebo-controlled, 17 children (12 boys) with ADHD/DCD with a mean age of 7 years 6 months were recruited in Shafa Hospital, Rasht, Iran. The response was defined as ≥25% reduction in the total score of ADHD rating scale-IV from the baseline. Sixteen boys entered phase 2 of the study in which the impact of MPH on motor function was determined through a crossover randomized clinical trial. Eligible individuals were scheduled for baseline and two assessment visits after a one-week period of intervention. We used the short form of Bruininks-Oseretsky test (BOT-2) to identify the disability of motor function. Children were randomly assigned to receive MPH or inert ingredients (placebo). In the second period, medication (MPH/placebo) was crossed over. The effects of MPH were analyzed using χ2 test for related samples to compare the performance during baseline, placebo, and MPH trials. The results were analyzed using the SPSS software version 16.0.
    Results
    The mean minimal effective dose of MPH per day was 17.3 mg (0.85 mg/kg). Children with higher ADHD rating scale had a significantly lower standard score in BOT-2 (P=0.03). Following MPH intake, 26.6% of the children showed clinically significant improvement in motor function. However, the improvement was not statistically different between the MPH and placebo.
    Conclusion
    Although MPH improved ADHD symptoms, problems with motor performance still remained. Further work is required to determine the probable effects of MPH in a higher dosage or in different subtypes of ADHD.
    Keywords: Methylphenidate, Psychomotor performance, Attention deficit disorder with hyperactivity, Motor skills
  • Setareh Akhavan, Parvaneh Lak, Fatemeh Rahimi-Sharbaf, Seyed Rahim Mohammadi, Mahboobeh Shirazi Pages 362-368
    Background
    The admission test (AT) has been carried out for many years, but there are still debates about the prognostic value of the test. Therefore, we aimed to examine the value of the AT in predicting the adverse outcome in neonates.
    Methods
    In this cross-sectional study, 425 pregnant women with normal vaginal delivery were studied between2009 and 2014at Vali-e-Asr Hospital. Based on the results, the women were divided into 2groups of normal and abnormal ATs. All the patients were followed up until the birth of their baby, when the status of mother and neonate was determined. The main outcomes of the study were cesarean rate, neonatal intensive care unit (NICU) admission, fetus demise, neonatal acidosis, and Apgar score. The independent t-test, chi-square test, Fisher exact test, and logistic regression were used for statistical analysis. The data were analyzed using SPSS (version 17).
    Results
    Of 425 pregnant women studied, 142 (33.4%) had abnormal ATs with a mean age of 29 (±4.5) years. Multivariate analysis showed that an abnormal AT was able to predict the incidence of cesarean section, intrauterine growth restriction, turned cord, and Apgar
    Conclusion
    The AT was shown to be a useful screening test with risk factors such as oligohydramnios, bloody amniotic fluid, meconium amniotic fluid, intrauterine growth restriction, and turned cord. Additionally, the test was also able to predict NICU admission and the need for cesarean section, but it could not predict the occurrence of neonatal death.
    Keywords: Infant, Outcome, Admission test, Electronic fetal monitoring, Cardiotocography
  • Arman Seri, Marjan Khorsand, Zahra Rezaei, Azadeh Hamedi, Mohammad Ali Takhshid Pages 369-376
    Background
    Glucose-induced protein glycation has been implicated in the progression of diabetic complications and age-related diseases. The anti-glycation potential of polyphenol-rich plant extracts has been shown previously. Bunium Persicum has been demonstrated to possess a high level of polyphenols. The aim of current in vitro study was to determine the possible inhibitory effect of Bunium Persicum hydroalcoholic extract (BPE) on glucose-induced bovine serum albumin (BSA) glycation, oxidation, and aggregation.
    Methods
    Folin-Ciocalteu assay was used to measure the content of total phenolic compounds of BPE. To test the in vitro effect of BPE on the formation of glycated BSA, thiol group oxidation, and protein aggregation of BSA, various concentrations of BPE were incubated with BSA and glucose at 37 °C for 72 hr. Glycation, thiol group oxidation, and aggregation of BSA were then measured using thiobarbituric acid, 2, 4-dinitrophenylhydrazine, and Congo red colorimetric methods, respectively. Data were analyzed using the SPSS software (version 16.0). One-way ANOVA followed by Tukey’s post hoc test was used to compare group means. P
    Results
    The results demonstrated that the content of total phenolics of BPE was 122.41 mg gallic acid equivalents per gram dried extract. BPE (10, 15, and 30 μg/ml) significantly inhibited the formation of GA in a concentration-dependent manner. BPE also significantly decreased the levels of thiol group oxidation and BSA aggregation.
    Conclusion
    The results showed that BPE has anti-glycation and antioxidant properties and might have therapeutic potentials in the prevention of glycation-mediated diabetic complications.
    Keywords: Glucose, Glycation, Serum albumin, Bovine, Bunium persicum, Apiaceae
  • Pariya Ahmadi Balootaki, Mansour Amin, Farkhondeh Haghparasti, Farokh Rokhbakhsh-Zamin Pages 377-383
    Background
    Erysipelothrix rhusiopathiae (E. rhusiopathiae) is generally transmitted into the gastrointestinal tract of animals by the intake of contaminated food or water and causes great economic loss in agriculture worldwide. Some of the Erysipelothrix spp. are the causative agents of erysipeloid, which is an occupational infection in humans. The aim of the present study was to isolate E. rhusiopathiae from animals as well as the hands of the butchers working in Ahvaz, Iran, and to determine their susceptibility to antibiotics.
    Methods
    Totally, 150 samples were taken from slaughterhouse workers, fishermen, and livers and hearts of sheep and calves by the swabbing method. Phenotypical methods and polymerase chain reaction (PCR) were used for the isolation and identification of E. rhusiopathiae. The isolates were tested for their susceptibility to commonly used antimicrobial agents using the disk diffusion protocol described by the Clinical and Laboratory Standards Institute.
    Results
    Out of the 150 samples examined via phenotypical and biochemical tests, 16 samples were positive as putative Erysipelothrix spp. twelve cases out of the 16 putative Erysipelothrix spp. were confirmed by PCR. The tested isolates were highly sensitive to the antibiotics used. The results of the sensitivity and specificity of PCR revealed that the sensitivity and specificity of indirect PCR were higher than those of direct PCR.
    Conclusion
    E. rhusiopathiae is widely distributed on seafood and presents as a commensal pathogen in nature and animals. Infection with this microorganism should be emphasized because it is a rare organism causing severe infections such as infectious endocarditis and polyarthritis following localized infections.
    Keywords: Erysipelothrix rhusiopathiae, Erysipeloid, Occupational diseases, Polymerase chain reaction
  • Imam Subadi, Boya Nugraha, Hening Laswati, Harjanto Josomuljono Pages 384-391
    Background
    Wet cupping therapy is a complementary therapy in pain management. The mechanism of this therapy, however, needs further elucidation. Cells injured by wet cupping therapy seem to stimulate the expression of heat shock protein 70 (HSP70). Its benefit in pain reduction could be mediated by the expression of ß-endorphin. This study aimed at determining the correlation between HSP70 and ß-endorphin after wet cupping therapy.
    Methods
    Sixteen male Wistar rats were divided into control (CG; n=8) and treatment (TG; n=8) groups. The rats in both groups were injected with complete Freund’s adjuvant (CFA) at the footpad. In the TG, wet cupping therapy was done at the left and right paralumbar regions 48 hours after the CFA injection. Twenty-four hours after therapy, the hot plate test was done to assess pain threshold. Thereafter, immunohistochemistry from the skin subjected to wet cupping therapy was conducted for HSP70 and ß-endorphin.
    Results
    The expression of HSP70 was significantly higher in the keratinocytes of the TG (20.25±3.53; P
    Conclusions
    The benefit of wet cupping therapy in terms of pain reduction in rats could be mediated by the expression of HSP70 and ß-endorphin.
    Keywords: Pain, Rat, HSP70 heat-shock proteins, ß-endorphin, Complementary therapies
  • Mansoureh Kazemi, Mohammad Reza Fayyazi-Bordbar, Nasser Mahdavi-Shahri Pages 392-396
    Autism is a neurodevelopmental disorder originating from early childhood; nevertheless, its diagnosis is in older ages. In addition to heredity, environmental factors are also of great significance in the etiology of the disease. Dermatoglyphic patterns, albeit varied, remain stable for a lifetime and yield a large number of patterns upon examination. Studies have shown a significant association between dermatoglyphics and some diseases, especially genetic ones. We compared fingerprints between patients with autism and normal individuals in a Fars population living in Khorasan-Razavi Province, Iran, in 2015. The right and left hand fingerprints of 104 autistic individuals (case group; age range=5–15 y) were collected using a fingerprint scanner. The same process was performed for 102 healthy individuals, in the age range of 6 to 25 years. All dermatoglyphic patterns and ridge counts were determined. The data were analyzed using the Mann–Whitney nonparametric test and binomial distribution. There was a significant difference in the distribution of the dermatoglyphic patterns on the right and left thumbs and the index fingers between the case and control groups (P
    Keywords: Autistic disorder, Dermatoglyphics, Fingerprint, Child, Risk
  • Iskender Kara, Fatma Yildirim, Esra Kayacan, Burcu BilaloĞ, Lu, Melda Turkoglu, GÜlbin Aygencel Pages 397-403
    Our study evaluated the differences between early and late hemodialysis (HD) initiation in the intensive care unit (ICU) according to the RIFLE (Risk, Injury, Failure, Loss, and End-stage renal failure) and AKIN (Acute Kidney Injury Network) classifications. On the assumption that early initiation of HD in critical patients according to the RIFLE and AKIN criteria decreases mortality, we retrospectively evaluated the medical records of 68 patients in our medical ICU and divided the patients into 2 groups: those undergoing HD in no risk, risk, or injury stage according to RIFLE and in stage 0, I, or II according to AKIN were defined as early HD and those in failure stage according to RIFLE and in stage III according to AKIN were defined as late HD. The median age of the patients was 66.5 years, and 56.5% were male. HD was started in 25% and 39.7% of the patients in the early stage in the RIFLE and AKIN classification, respectively. According to RIFLE, HD was started in 61.5% of the surviving patients in the early stage; this rate was 16.4% in the deceased patients (P=0.001). HD was commenced in 69.2% of the surviving patients in AKIN stages 0, I, and II and in 32.7% of the deceased patients (P=0.026). Sepsis (61.5% vs. 94.5%; P=0.001) and mechanical ventilation (30.8% vs. 87.3%; P
    Keywords: Acute kidney injury, Intensive care units, Renal dialysis
  • Sara Mirzaeian, Sedigheh Ayati, Asieh Maleki Pages 404-406
    The prevalence of bilateral sudden sensorineural hearing loss (SSNHL) is less than 5% and the etiology of most cases is unknown. Due to many structural and functional similarities between the kidney and inner ear, many conditions, diseases, and drugs have both renal and cochlear effects and toxicities. There are several reports of SSNHL in patients with CRF, uraemic patient, hemodialysis treatment, and ARF. Here, we report a rare manifestation of SSNHL following severe postpartum hemorrhage that has simultaneous renal failure and cochlear impairment. The patient was a 22-year-old primigravida woman with term pregnancy who after delivery and episiotomy hematoma and postpartum hemorrhage subsequently suffered from kidney failure, oliguria, and SSNHL that occurred after 3 days of delivery. In conditions such as severe postpartum bleeding leading to acute renal involvement, the possibility of simultaneous involvement of cochlea due to hypoxia or received drugs should be considered.
    Keywords: Sensorineural hearing loss, Renal insufficiency, Postpartum period
  • Babyamma Raghavan Varun, Nettiyat Oommen Varghese, Trivandrum Thanappan Sivakumar, Anna Palliath Joseph Pages 407-411
    Lymphomas are solid malignant tumors having a wide spectrum of clinical and pathological features. Non-Hodgkin’s lymphoma (NHL) is a subtype of lymphoma with two-thirds of the cases presenting as lymph node enlargement. The remaining one third of NHL cases has been reported in the extranodal sites, including the gastro intestinal tract, Waldeyer’s ring, bone, skin, and brain. Intraoral non-Hodgkin’s lymphoma is uncommon and may affect either the jaw bones or occur within the soft tissues of the oral cavity. Here we report a case of non-Hodgkin’s lymphoma in a 65-year-old male patient who presented with a growth from the extraction socket. Non-Hodgkin’s lymphoma presenting as a growth from the extraction socket is unusual. An orthopantamograph (OPG) was taken which revealed a diffuse radiolucent defect in relation to the extraction socket of the left lower molar region. Routine hemogram, urine analysis, and chest radiograph were normal. Incisional biopsy was performed and the tissue was subjected to histopathological examination. Histopathological and immunohistochemical analysis confirmed the diagnosis of B-cell lymphoma. The patient was referred to a regional cancer institute for further management, where chemotherapy was planned. However, prior to chemotherapy, the patient was diagnosed with brain metastasis and he expired in hospital within one month.
    Keywords: Lymphoma, Non-Hodgkin, Extranodal, Mouth
  • Ladan Haghighi, Mansooreh Shaabani Zanjani, Zahra Najmi, Neda Hashemi Pages 412-415
    A 37-year-old woman underwent surgery to remove bilateral vulvar masses. The masses were firm, non-tender, and immobile. Pathologic finding was a well-delineated creamy grayish mass with a homogenous grayish solid surface and mild edema, chronic inflammatory infiltration, and focal dilation of the ducts with squamous metaplasia. The diagnosis was hyperplastic and hypertrophied Bartholin’s gland. Hyperplasia is a rare etiology for an enlarged Bartholin’s gland. Clinical presentation of Bartholin’s gland nodular hyperplasia is rather specific, although inflammatory lesion is the most common cause of swelling of the Bartholin’s gland in all age groups. Bartholin’s hyperplasia should be considered in cases with a solid mass. Total surgical excision is required for diagnosis. Only a few cases of Bartholin’s gland hyperplasia have been reported in the literature. Our patient has been receiving regular follow-up examination and there is no evidence of dyspareunia, perineal pain, and recurrent disease 12 months after surgery.
    Keywords: Bartholin's gland, Hyperplasia, Lymphadenitis
  • Binoy Shankar, Euden Bhutia, Dinesh Kumar, Sunil Kishore, Shakti Pad Das Pages 416-419
    Holt-Oram syndrome is an autosomal dominant disorder, characterised by skeletal abnormalities of the upper limb associated with congenital heart defect, mainly atrial and ventricular septal defects. Skeletal defects exclusively affect the upper limbs in the preaxial radial ray distribution and are bilateral and asymmetrical. They range from clinodactyly, absent or digitalised thumb, hypoplastic or absent radii, and first metacarpal to hypoplastic ulna and carpal bone anomalies. Cardiac involvement ranges from asymptomatic conduction disturbances to multiple structural defects. Structural defects are seen in 75% of the cases and include both atrial and ventricular septal defect. More complex cardiac lesions such as Tetrology of Fallot, endocardial cushion defects, double outlet right ventricle, and total anomalous pulmonary venous return are observed uncommonly. An aneurysm of the interatrium septum is an infrequent finding in infants. It has been speculated that atrial septal aneurysm (ASA) is a direct source of thrombus formation. Paradoxical embolism of venous thrombi across a right to left shunt is possibly responsible for the cryptogenic stroke in a patient with ASA. However, coagulopathy associated with cyanotic congenital heart defect may also be contributory. Our patient had a rare association of complex cardiac lesion (tricuspid atresia, pulmonary stenosis, atrial septal aneurysm) with cardiac conductive defects and left parietal infarct along with the usual skeletal abnormalities.
    Keywords: Holt-Oram syndrome, Congenital heart disease, Tricuspid atresia
  • Parisa Zarei-Shargh, Atieh Mehdizadeh-Hakkak, Mohammad Bagherniya, Lida Jarahi, Zohreh Mousavi, Mohammad Safarian Pages 420-421