Iranian Journal of Medical Sciences
Volume:44 Issue: 1, Jan 2019

Aloe vera is an herbaceous and perennial plant that belongs to the Liliaceae family and used for many medicinal purposes. The present study aimed to systematically review clinical trials regarding the effect of Aloe vera on the prevention and healing of skin wounds. To identify all related published studies, we searched SID, IRANDOC, Google Scholar, PubMed, MEDLINE, Scopus, Cochrane Library, and ScienceDirect databases in both the English and Persian languages from 1990 to 2016. The keywords used were Aloe vera, wound healing, and prevention. All clinical trials using Aloe vera gel, cream, or derivatives that included a control group with placebo or comparison with other treatments were included in the study. The PRISMA checklist (2009) was used to conduct the review. In total, 23 trials that met the inclusion criteria were studied. The results of the studies showed that Aloe vera has been used to prevent skin ulcers and to treat burn wounds, postoperative wounds, cracked nipples, genital herpes, psoriasis, and chronic wounds including pressure ulcers. Considering the properties of Aloe vera and its compounds, it can be used to retain skin moisture and integrity and to prevent ulcers. It seems that the application of Aloe vera, as a complementary treatment along with current methods, can improve wound healing and promote the health of society.

Common resistant-to-therapy warts pose a challenge to both clinicians and patients. Among many destructive and immunotherapeutic options, no single, fully effective treatment has been suggested yet. Many investigations, including those using intralesional antigen administrations, have demonstrated that cellular immunity plays a major role in the clearance of human papilloma virus (HPV) infection. The aim of the present study was to evaluate the effects of the intralesional injection of the measles–mumps–rubella (MMR) vaccine into resistant-to- treatment palmoplantar warts and its complications. In this single-blind, randomized, controlled clinical trial, 60 cases with resistant-to-therapy palmoplantar warts referring to the Dermatology Clinic of Bou-Ali Sina Hospital of Sari between June 2015 and 2016 were randomly assigned to 2 equal groups: the MMR Group received intralesional MMR and the Placebo Group was given saline injection. The injections were administered at 2-week intervals until complete clearance was achieved or for a maximum of 5 injections (<5 injections at 2-week intervals). The study protocol was registered in the Iranian Registry of Randomised Clinical Trials (ID: IRCT2016101027636N3), and the statistical analyses were performed using SPSS, version 17.0. The χ2 test and the F-test were used as appropriate, and a P value less than 0.05 was considered statistically significant. Complete clearance was observed in 65.2% (14⁄23) of the patients presenting with resistant-to-therapy palmoplantar warts in the MMR Group and 23.85% (5/21) in the Placebo Group (P=0.021). Recurrence was not observed in any of the completely cured patients at 6 months’ follow-up. Intralesional immunotherapy with the MMR vaccine may result in a desirable therapeutic response and can be used as an effective and safe treatment option for palmoplantar warts, particularly persistent ones.
Trial Registration Number: IRCT2016101027636N3

Health-related quality of life (HRQoL) has become a major concern in the field of children’s health research. We assessed HRQoL among Iranian children and adolescents according to the socioeconomic status (SES) of their living region. Via multistage cluster sampling from rural and urban school students aged 6 to 18 years, this nationwide study was conducted from 2011 to 2012. HRQoL was assessed using the adolescent core version of the Pediatric Quality of Life questionnaire. Through survey data analysis methods, the data were compared according to the SES of the living region, sex, and the living area. Overall, 23043 students participated in the survey (participation rate=92.2%). The mean age of the participants was 12.55±3.31 years. Boys accounted for 50.8% of the study population, and 73.4% were from urban areas. At national level, the mean of the HRQoL total score was 81.7 (95% CI: 81.3 to 82.1) with a mean of 83.5 (95% CI: 83.0 to 84.1) for the boys and 79.8 (95% CI: 79.1 to 80.5) for the girls. The highest and the lowest scores, respectively, belonged to social functioning (90.0 [95% CI: 89.7 to 90.3]) and emotional functioning (78.2 [95% CI: 77.7 to 78.7]). The highest total HRQoL score belonged to the second highest SES region of the country (mean=83.1; 95% CI: 82.5 to 83.7). The association between total HRQoL and the score of all the subscales and SES in the living area was statistically significant (P<0.001). The results of the present study showed that in the children and adolescents, SES was associated with HRQoL. Accordingly, HRQoL and the related SES differences should be considered one of the priorities in health research and health policy.

The treatment of choice for hydatidosis as an important zoonotic disease is surgery. Different agents are injected into the cyst to prevent secondary hydatidosis. To avoid the side effects of such protoscolicidal agents, considering the high protoscolicidal effects of the garlic extract, we conducted the present study on protoscolices in limited applicable times and compared the extract with some chemical agents. Sheep’s liver and lung cysts were collected. Ninety tubes were selected and divided into 3 sets (for different exposure times), each one comprising 5 groups of 6 tubes. Each tube contained 3000–4000 protoscolices. The groups were 0.5% cetrimide (as positive control), 20% hypertonic sodium chloride, 0.5% silver nitrate, 0.9% normal saline (as negative control), and the garlic chloroformic extract (200 mg/mL). The viability of the protoscolices was assessed using 0.1% eosin. The ANOVA and LSD were used to compare the mean viability of the protoscolices after exposure to the different agents at different times and concentrations. The data were analyzed using SPSS software, version 17. A P<0.05 was considered significant. Our findings showed that the protoscolicidal effects of the garlic extract at 1 (P<0.001) and 2 (P<0.001 and P=0.003) minutes of exposure were higher than those of sodium chloride and silver nitrate. At 5 minutes of exposure, there was no difference between the garlic extract and sodium chloride (P=0.36); however, the difference between these agents and silver nitrate was significant. The garlic chloroformic extract in a short exposure time had high protoscolicidal effects and could substitute other agents.

In mammalian ovaries, loss of over two-thirds of germ cells happens due to cell death. Nonetheless, the exact mechanism of cell death has yet to be determined. The present basic practical study was designed to detect 3 types of programmed cell death, namely apoptosis, autophagy, and necrosis, in murine embryonic gonadal ridges and neonatal ovaries. Twenty gonadal ridges and ovaries from female mouse embryos 13.5 days post coitum and newborn mice 1 day postnatal were collected. The TUNEL assay was performed to evaluate apoptosis. The interplay of autophagy was evaluated by immunohistochemistry for beclin-1. Necrotic cell death was analyzed by propidium iodide (PI) staining. The count and percentage of the labeled oocytes in the gonadal ridges and ovaries were evaluated and compared using the independent t test and one-way ANOVA. A P value less than 0.05 was considered statistically significant. We detected TUNEL-positive reaction in the embryonic germ cells and in the small and large oocytes of the neonatal ovaries. The germ cells and small oocytes reacted to beclin-1. PI absorption was detected in the embryonic germ cells and the large oocytes of the neonatal ovaries, but not in the small oocytes. The percentage of the TUNEL-positive and PI-labeled oocytes in the gonadal ridges was significantly higher than that in the neonatal ovaries (P<0.01 and P=0.01). In the neonatal ovaries, the percentage of the beclin-1-labeled oocytes was significantly higher than that in the embryonic phase (P<0.01). We showed that all 3 types of programmed cell death, namely apoptosis, autophagy, and necrosis, accounted for embryonic and neonatal germ-cell loss. Our observations demonstrated a potential role for necrosis, particularly in the embryonic gonadal ridge in comparison to the neonatal ovary, in mice.

There is accumulating evidence that Juglans regia L. (GRL) leaf extract has hypoglycemic and antioxidative properties. The present study aimed to investigate the protective effects of GRL leaf extract against diabetic nephropathy (DN). In total, 28 male adult Sprague-Dawley rats were used. The DN rat model was generated by intraperitoneal injection of a single 55 mg/kg dose of streptozotocin (STZ). A subset of the STZ-induced diabetic rats received intragastric administration of GRL leaf extract (200 mg/kg/day) starting 1 week (preventive group) and 4 weeks (curative group) after the onset of hyperglycemia up to the end of the 8th week, whereas other diabetic rats received only isotonic saline (diabetic group) as the same volume of GRL leaf extract. To evaluate the effects of GRL leaf extract on the diabetic nephropathy, various parameters of apoptosis and inflammation were assessed. Statistical analysis was performed using the SPSS software, version 15.0. The data were compared between the groups using the Tukey’s multiple comparison test and the analysis of the variance. P values ˂0.05 were considered statistically significant. Fasting blood sugar (FBS) levels (P=0.001) and histopathological changes in the kidney of diabetic rats attenuated after GRL leaf extract consumption. Greater caspase-3 (P=0.004), COX-2 (P=0.008), PARP (P=0.007), and iNOS (P=0.005) expression could be detected in the STZ-diabetic rats, which were significantly (P=0.009) attenuated after GRL leaf extract consumption. In addition, attenuation of lipid peroxidation in the diabetic rats was detected after GRL consumption (P=0.01). GRL leaf extract exerts preventive and curative effects against diabetic nephropathy.

Tuberculosis as a global health problem requires special attention in the contexts of prevention and control. Subunit vaccines are promising strategies to protect burdens of tuberculosis via increasing the BCG protection. The present study aimed to design a vaccine study by means of high-throughput expression and correct refolding of recombinant protein PPE17. We aimed to clone, express, and refold PPE17 protein of Mycobacterium tuberculosis in bacterial systems as a promising vaccine candidate. The PPE17 (Rv1168c) gene was PCR amplified and inserted into pET-21b(+) vector, cloned in E. coli TOP10, and finally expressed in E. coli BL21(DE3). The expressed recombinant protein was entirely found in insoluble form (inclusion bodies). The insoluble protein was denatured in 6M guanidine-HCl and refolded by descending denaturant concentration dialysis. Moreover, the recombinant protein was purified by Ni–NTA column chromatography. The changing temperature had no effects on solubilizing protein and the maximum expression was achieved at 0.5 mM concentration of isopropyl-D-thiogalactopyranoside (IPTG) induction. Bacterial expression system is a timesaving tool and refolding by descending denaturant concentration dialysis is a rapid and reliable method.

Leiomyomatosis peritonealis disseminata (LPD) is a benign disease characterized by the presence of multiple small nodules on the omentum, parietal, and visceral peritoneum. It corresponds to leiomyoma and often resembles metastases of malignant tumors; however, with favorable prognosis. Here we describe a 46-year-old woman, diagnosed with LPD, to demonstrate the etiopathogenesis of the developed leiomyomatosis following endoscopic extirpation of the uterus with the use of a power morcellator. The patient was operated for diffuse leiomyoma using a power morcellator. Six months later, during a follow-up visit, disseminated tumor nodes on the peritoneum were revealed. Histological and immunohistochemical (smooth muscle α-actin, vimentin, estrogen receptors, progesterone receptors, and Ki67) study confirmed the diagnosis of LPD. As part of the follow-up, certain regression of the tumor nodes was noted against the backdrop of the onset of menopause and the corresponding decline of estrogen levels. Currently, the prognosis is favorable and follow-up is ongoing. Such cases are rare, but the condition is particularly important due to its iatrogenic nature. It has attracted the attention of the Food and Drug Administration (FDA) because power morcellation is probably associated with the risk of spreading suspected cancerous tissue. The existing high risk of iatrogenic LPD formation indicates the need for detailed reporting of all similar clinical cases, including the established pathogenetic and pathomorphological mechanisms of this process to prevent morcellator-related complications.

Small supernumerary marker chromosomes (sSMCs), or markers, are abnormal chromosomal fragments that can be hereditary or de novo. Despite the importance of sSMCs diagnosis, de novo sSMCs are rarely detected during the prenatal diagnosis process. Usually, prenatally diagnosed de novo sSMCs cannot be correlated with a particular phenotype without knowing their chromosomal origin and content; therefore, molecular cytogenetic techniques are applied to achieve this goal. The present study aimed to characterize an sSMC in a case of Klinefelter syndrome using an in-house microsatellite analysis method and fluorescent in situ hybridization (FISH) technique. Amniotic fluid was collected from a pregnant woman who was considered to have risk factors for trisomy higher than the screening cut-off. Karyotype analysis was followed by the amplification of different microsatellite loci and FISH technique. Karyotype analysis identified a fetus with an extra X chromosome and also an sSMC with unknown identity. Further investigation of the parents showed that the sSMC is de novo. Microsatellite amplification by quantitative fluorescent PCR (QF-PCR) and FISH analysis showed that the sSMC is a derivative of chromosome 18. Eventually, the patient decided to terminate the pregnancy. Here, the first case of the coincidence of sSMC 18 in a Klinefelter fetus is reported.

Bezoars are rare conditions of mechanical intestinal occlusion. Among the various types of bezoars, phytobezoars and trichobezoars are the most common types. Symptoms are usually indistinguishable from other more common entities; therefore, it may be difficult to reach a correct diagnosis. Computed tomography (CT) scan is the preferred diagnostic method. Treatment may include surgery, lavage with Coca-Cola or hydrolytic solutions, and endoscopic mechanical or electrical disintegration. The present case report aimed to describe an uncommon symptomatic double phytobezoar (ileal and gastric), which was successfully treated surgically and endoscopically. The patient, an 83-year-old woman, was admitted to the General Hospital of Drama (Drama, Greece) after suffering from abdominal pain for 3 days. Physical examination revealed abdominal distention and pain mainly in the right quadrants. The CT scan revealed an intestinal phytobezoar which was subsequently removed surgically with a longitudinal enterotomy. On the third postoperative day, the patient presented jaundice and a new CT scan showed a second phytobezoar impacted into the duodenal bulb, which was missed during the initial diagnosis. The gastric phytobezoar was fragmented endoscopically using a polypectomy snare with high flow electric current (70-80 Watts) and its pieces were removed orally. The patient had no complications during the hospital stay and was discharged on the eighth postoperative day. Three months later, the follow-up gastroduodenoscopy and CT scan revealed no signs or symptoms of any gastrointestinal mass. The present case report is the first presentation of a double gastrointestinal phytobezoar that caused ileus and temporary jaundice. Moreover, a successful single-session mechanical-electrical fragmentation of a large gastric phytobezoar is described for the first time.

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare hematodermic myeloid malignancy that is known to be derived from plasmacytoid dendritic cells which are characterized by expression of CD4, CD56, and more specific markers such as CD123. Here, the authors present three cases of BPDCN diagnosed in the past two years and address different available diagnostic modalities such as morphology, immunohistochemistry, flow cytometry, and cytogenetics. Overall, we believe that although BPDCN is a rare diagnosis, it should not be left unchecked. Currently, available immunophenotyping markers are of great help, but the main clue to figure out the problem of BPDCN is clinicopathologic suspicion.