Archives of Iranian Medicine
Volume:11 Issue: 1, Jan 2008

Angiotensin-converting enzyme insertion/deletion polymorphism has been shown to be associated with diabetes, hypertension, coronary artery diseases, and diabetic nephropathy. The objective of this study was to investigate whether angiotensin-converting enzyme gene insertion/deletion polymorphism is associated with metabolic syndrome in Iranians with type 2 diabetes mellitus. A total of 170 patients with type 2 diabetes mellitus and 91 control subjects were studied. The angiotensin-converting enzyme insertion/deletion polymorphism was determined by polymerase chain reaction (PCR) utilizing specific primers. The definition and criteria of metabolic syndrome used in this study matched that proposed in 1998 World Health Organization classification. Of 170 patients studied, 119 (70%) fulfilled the criteria for metabolic syndrome. The prevalence of angiotensin-converting enzyme genotype in the control subjects with DD, ID, and II genotype was 13.2%, 47.3%, and 39.5%, respectively. In patients with metabolic syndrome, the prevalence was 26.9%, 56.3%, and 16.8%, respectively; in patients without metabolic syndrome, it was 21.6%, 62.7%, and 15.7%, respectively. The angiotensin-converting enzyme insertion/deletion polymorphism was not significantly associated with presence of metabolic syndrome in patients with type 2 diabetes (P=0.711). The frequency of DD genotype in the metabolic syndrome group (26.9%) was higher than that (21.6%) in those without metabolic syndrome (P=0.447) and the control group (13.2%, P=0.02). The frequency of D allele in metabolic syndrome patients was 55.1% as compared to those patients without metabolic syndrome (52.9%, P=0.72) and the control subjects (36.8%, P<0.001). It seems that the DD genotype and/or D allele of angiotensin-converting enzyme gene may increase the risk for developing type 2 diabetes mellitus, but not metabolic syndrome

Metabolic syndrome not only is a serious problem for adults, but is also afflicting an increasing number of children and adolescents. This syndrome is a risk factor for type 2 diabetes mellitus and cardiovascular diseases. The aim of this study was to estimate the prevalence of metabolic syndrome in a sample of Iranian adolescents. A total of 554 overweight adolescents (aged 11 – 17 years) participated in a community-based cross sectional survey. Anthropometric examinations including height, weight, body mass index, and blood pressure were assessed. A fasting blood sample was taken for measurement of glucose and lipid profile. Metabolic syndrome was determined by the definition released by the National Cholesterol Education Program Adult Treatment Panel III, which was modified for age. The overall prevalence of metabolic syndrome was 26.6%. There was no gender difference in the distribution of metabolic syndrome. When stratified by body mass index, 22.5% were overweight (BMI≥95th percentile) besides having the criteria for metabolic syndrome, while the remaining 4.1% of the adolescents were at risk for overweight (BMI between 85th and 95th percentile) together with metabolic syndrome. Hypertriglyceridemia was the most common and high-density lipoprotein was the least common constituent of metabolic syndrome. This study suggests a high prevalence of metabolic syndrome among overweight Iranian adolescents. This poses a serious threat to the current and future health of Iranian youth.

Endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy has become widely available for the treatment of pancreatobiliary diseases; however, it has mortality and complications. The aim of this study was to compare the success rates and complications of two different methods of common bile duct cannulation. From June 2003 though February 2004, patients who were candidates for endoscopic retrograde cholangiopancreatography and/or endoscopic sphincterotomy were randomly divided into two groups: standard cannulation (group A) and suprapapillary needle-knife fistulotomy (group B). Postendoscopic retrograde cholangiopancreatography pancreatitis, cholangitis, bleeding, and perforation were evaluated. Two hundred and eighteen cases (86 males and 132 females with a mean±SD age of 56.2±17.5 years) were enrolled in this study. Group A, contained 112 patients and group B included 106 patients. In group A, the final cannulation success was achieved in 100 patients (89.3%). Cannulation was successful in 88 patients (83.0%) in group B. Difficulty in cannulation occurred more frequently in group A (25.5% vs. 2.6%, P=0.002). There were two patients in group B and three patients in group A who developed pancreatitis after endoscopic retrograde cholangiopancreatography. Perforation occurred in one patient in group B, which was improved with medical support. Bleeding and cholangitis were not occurred in any of the groups. The overall complication rate was 3/112 in group A and 3/106 in group B. Needle-knife fistulotomy is safe and can be applied as an effective alternative to standard technique for common bile duct cannulation in expert hands.

Neurobrucellosis is an uncommon complication of brucellosis. The clinical features of neurobrucellosis vary greatly and, in general, tend to be chronic. Many of the laboratory procedures usually employed in the diagnosis of brucellosis frequently give negative results. For these reasons, and because brucellosis is a disease, which is both treatable and curable, the degree of suspicion must be high, especially in endemic areas, so that an early diagnosis can be made to allow suitable treatment to be established. A retrospective analysis of 31 cases of neurobrucellosis was carried out. Meningitis and meningoencephalitis were the most common form of neurobrucellosis in our patients. The most commonly-used antibiotics were combinations of rifampin, doxycycline, and trimethoprim-sulfamethoxazole. The differential diagnosis of neurobrucellosis is wide. However, the disease should be ruled out in all patients who develop unexplained neurological symptoms, especially in those who live in endemic areas

Cystic craniopharyngiomas are the most frequent intracranial neoplasm of nonglial origin in children. Follow-up data were analyzed to assess the value of intracavitary irradiation with stereotactically applied 32P radioisotopes for the treatment of patients with craniopharyngioma cysts admitted to Shohada Tajrish Hospital, Tehran, Iran, between 1998 and 2005. Patients with predominantly cystic craniopharyngiomas, who underwent stereotactic intracavitary irradiation, were followed for tumor response and complications. Beta-emitting 32P isotopes were injected into cysts using a computed tomography-guided and computer-assisted three-dimensional stereotactic treatment planning and application system. The cumulative dose to the inner surface of the cyst wall was 250 Gy. Twenty-two (12 females and 10 males) patients with a mean±SD age of 14.0±6.6 (range: six to 35) years were studied. The tumor response rate gained with 32P-labeled chromic phosphate was 73% (16 of 22 cysts). The mean±SD survival after intracavitary irradiation was 25.4±6.8 (95% CI: 12.0 – 38.7) months. Intracavitary irradiation using 32P is highly effective in the treatment of cystic craniopharyngiomas. In patients with solitary cyst treated exclusively with this method, it has been the only necessary therapy over a long period. It seems reasonable to recommend intracavitary irradiation as the initial treatment for selected patients and as palliative therapy in those with recurrence

Monitoring the engraftment of donor cells after allogeneic stem cell transplantation is important for the early diagnosis of graft failure or relapse of disease. The objective of the present study was to evaluate the application of the amelogenin gene for the assessment of chimerism in samples of patients who had received a sex-mismatched stem cell transplantation. A polymerase chain reaction technique was developed using a set of amelogenin gene primers alone and/or in combination with short tandem repeats primers and was preformed on blood and/or bone marrow aspiration samples of 30 recipient patients after transplantation. The technique was then set up as a routine procedure, from September 2000 through April 2006, more than 1400 samples taken from 300 stem cell transplantation patients suffering from different types of leukemia and nonmalignant hematologic disorders were evaluated for detection of chimerism after transplantation. The sensitivity of the test was as low as 1 – 2%. The ratio of X/Y fragments was as the mixed chimerism. In 90% of the patients, amelogenin marker was as informative as short tandem repeats markers, as confirmed by the clinical outcome. In 5% of the patients, when there was no pre- bone marrow transplantation sample from either donor or recipient, the applicability of this assay became crucial to our treating physicians. The application of the amelogenin marker alone or in combination with the short tandem repeats system can be used for relative quantitative analysis of mixed chimerism and for observing kinetics of engraftment in patients who have sex-mismatched bone marrow transplantation. Amelogenin polymerase chain reaction analysis showed an excellent correlation with the short tandem repeats-polymerase chain reaction results.

The link between dietary fat and coronary heart disease has attracted much attention since the effect of long‑chain fatty acids on gene transcription has been established. The aim of this study was to investigate the effects of long‑chain fatty acids and clofibrate on mRNA levels of specific lipid metabolism‑related genes and to determine their effects on global transcriptome levels in a cardiovascular cell-line. After culturing P19CL6 cells with long‑chain fatty acids or clofibrate, the expression levels of heart-type fatty-acid binding protein and peroxisome proliferators-activated receptors (PPARa,b,g) were determined by reverse transcriptase-polymerase chain reaction. Additionally, global transcriptome profiles were compared using microarray analysis. Long‑chain fatty acids significantly increased the abundance of PPARa and PPARg. Moreover, microarray analysis showed that the effects of linoleic and a‑linolenic acids, and clofibrate were similar but differed from those of palmitic and oleic acids. These findings show that cellular responses to polyunsaturated fatty acids differ from those observed with saturated and monounsaturated fatty acids.

Management of the infected femoral artery pseudoaneurysm has remained controversial. Although common femoral artery ligation and local debridement is an acceptable approach, some patients need revascularization for the treatment of leg ischemia or intermittent claudication. In this study, we report obturator bypass as an alternative technique that has been done at Sina Hospital, Tehran, Iran during a 10-year period. This was a retrospective study and the data were obtained from the patients’ medical records. Ten obturator bypasses were done on nine patients. Two cases had previous history of ligation of the femoral artery branches. One death and two forefoot amputations occurred. Femoral artery ligation has been suggested as the treatment of choice for the management of infected femoral artery pseudoaneurysms. Among the extra-anatomic bypasses, the obturator bypass is an acceptable alternative with favorable results.

This study was conducted to determine if serum inhibin B concentration can predict spermatogenesis in azoospermic infertile men. This cross-sectional study included 70 patients with male-factor infertility referred to Alvand and Vali-e-Asr Infertility Centers, Tehran, Iran. All patients had azoospermia. Standard evaluation consisted of history and physical examination with extreme attention to sexual history and testis examination including testis size, consistency, and presence of varicocele. Laboratory evaluation done for all cases consisted of FSH, testosterone, LH, prolactin, and inhibin B. Testis biopsy was performed in all cases with acceptable testis volume and FSH. The mean inhibin B level was compared in groups with positive and negative sperm retrieval. The mean±SEM age of 70 azoospermic patients was 32.1±6.2 (range: 20 – 50) years. All couples had primary infertility with a mean±SEM duration of infertility of 74.3±7.7 months. The mean±SEM testicular volume was 10.14±0.75 mL. The mean±SEM FSH and LH levels were 17.55±1.68, and 11.33±0.99 mIU/mL, respectively. The mean±SEM serum prolactin and testosterone levels were 308.77±17.35 and 5.45±0.91 ng/dL, respectively. The mean±SEM serum inhibin B concentration was 138.23±28.58 (range: 15 – 1500) pg/mL. Sperm was not retrieved in 82% of the patients; in 13% of the cases, biopsy revealed spermatogenesis. The mean±SEM serum FSH level of positive and negative groups was 9.78±2.13 and 22.56±2.46 mIU/mL, respectively (P<0.05). The mean serum LH, prolactin, and testosterone levels were not statistically different between the two groups. The mean±SEM serum inhibin B was 129±45.46, and 158.93±47.24 pg/mL in positive and negative groups, respectively (P>0.05). Inhibin B concentration is not an appropriate predicting factor for testicular spermatogenesis.

Insufficient dietary intake of chromium as an essential nutrient leads to signs and symptoms that are similar to those observed for diabetes and cardiovascular diseases. We postulate that in healthy individuals, urinary chromium excretion following a high glycemic index diet is higher than after a low glycemic index diet. A sequential randomized controlled cross-over study was carried out at the Metabolic Unit of Nutrition Department of King’s College London. Sixteen healthy individuals aged 18 – 60 years were recruited from 26 volunteers. A low or high glycemic index diet (as the main meals/day) was given to the volunteers over six days. Fasting blood glucose and insulin changes were determined and 24-hr urine samples were collected to measure chromium excretion before intervention and every second day within each treatment with a one wash-out period using Dynamic Reaction Cell Inductively Coupled Plasma Mass Spectrometer. During the six-day diet study, there were no significant differences in 24-hr urinary chromium losses between the two groups following the low glycemic index (0.58 ± 0.08µg/24 hr) and high glycemic index diets (0.48 ± 0.06µg/24 hr). However, during day six there was a trend towards greater loss of chromium after the high glycemic index diet (0.73 ± 0.1 µg/24 hr) in comparison with the low glycemic index diet (0.54 ± 0.07 µg/24 hr). Evidence that urinary chromium loses following the high glycemic index diets have not been clearly demonstrated in normal subjects. These results suggest that chromium excretion may need to be observed for longer than six days to address this question.

Organophosphorus compounds have been used as pesticides and as chemical warfare nerve agents. The mechanism of toxicity of organophosphorus compounds is the inhibition of acetylcholinesterase, which results in accumulation of acetylcholine and the continued stimulation of acetylcholine receptors. Therefore, they are also called anticholinesterase agents.Organophosphrus pesticides have largely been used worldwide, and poisoning by these agents, particularly in developing countries, is a serious health problem. Organophosphorus nerve agents were used by Iraqi army against Iranian combatants and even civilian population in 1983 – 1988. They were also used for chemical terrorism in Japan in 1994 – 1995. Their use is still a constant threat to the population. Therefore, medical and health professionals should be aware and learn more about the toxicology and proper management of organophosphorus poisoning.Determination of acetylcholinesterase and butyrylcholinesterase activity in blood remains a mainstay for the fast initial screening of organophosphorus compounds but lacks sensitivity and specificity. Quantitative analysis of organophosphorus compounds and their degradation products in plasma and urine by mass spectrometric methods may prove exposure but is expensive and is limited to specialized laboratories. However, history of exposure to organophosphorous compounds and clinical manifestations of a cholinergic syndrome are sufficient for management of the affected patients.The standard management of poisoning with organophosphorous compounds consists of decontamination, and injection of atropine sulfate with an oxime. Recent advances on treatment of organophosphorus pesticides poisoning revealed that blood alkalinization with sodium bicarbonate and also magnesium sulfate as adjunctive therapies are promising. Patients who receive prompt proper treatment usually recover from acute toxicity but may suffer from neurologic complications.

The exact etiology of alopecia areata is still unknown, and no completely effective treatment has been established. The use of oral steroids for treating this disorder is controversial and may have potential side effects. Relapses are also common upon withdrawal of the medication. The objective of this study was to evaluate the therapeutic and side effects of pulse-therapy with methylprednisolone combined with oral cyclosporine in severe alopecia areata, defined as alopecia totalis and universalis. Six patients with alopecia totalis and 12 patients with alopecia universalis were referred to our center. The patients were treated with monthly intravenous methylprednisolone in doses of 500 mg for three days and oral cyclosporine (2.5 mg/kg/day) for five to eight months. Responses were categorized as: "adequate” (i.e., hair regrowth on ≥70% of the affected area) and "inadequate" (i.e., hair regrowth on <70% of the affected area). Adequate response was observed in six (33%) patients: three with alopecia totalis and 3 with alopecia universalis. Responses were better in patients with alopecia totalis, age >20 years, negative history of atopy, negative family history of alopecia areata, presence of nail pitting, and pruritus in the affected area. No cases of relapses and no severe side effects were observed.Patients with severe and resistant alopecia areata, if properly selected, may benefit from intravenous methylprednisolone pulse-therapy plus oral cyclosporine.

Herein, we reviewed the pattern and mechanisms of injuries resulting from bicycle accidents in Tehran. During one year of trauma registry in six general hospitals, 8,000 trauma patients who had sustained injuries within a week before admission and hospitalized for more than 24 hours were studied. Bicycle injuries comprised 2.1% (n=170) of all cases admitted during the studied period. Males were injured more often than females (M:F ratio=8:1). Seventy-seven point one percent of the patients were younger than 20 years. None of the patients had used helmets while being injured. A considerable proportion of accidents occurred between 6 and 8 PM. The most common season of bicycle accidents were summer (55.2%) and spring (24.8%). Seventy-six (44.7%) patients sustained injuries in collision with other vehicles (cars, motorcycles, etc). Four patients died of severe head injuries. Thirteen (8.1%) patients had injury severity score of >16 (severe injury). The mean duration of hospital stay was 5.2 (range: 1 – 52) days.Due to the fatal nature of head injuries and high incidence of fall/overturn injuries among bicycle riders, helmets should be worn by all riders, particularly young children. In addition, allocating a separate cycle path may reduce severe bicycle injuries.

Atrial myxoma as a rare benign heart tumor can cause acute coronary syndrome via coronary embolization. In this report, we present a 54-year-old woman who presented with acute inferior myocardial infarction. In further evaluation a 2.5×3×4 cm mass was found in the left atrium. The mass was excised surgically and its pathology was compatible with myxoma. After resection, the patient was discharged with a favorable outcome.

Acute hemorrhagic edema of infancy is a distinctive, cutaneous small vessel leuko­cyto­clastic vasculitis of young children with dramatic characteristic skin findings. It is characterized by low- grade fever, erythematous edema, and purpuric lesions mainly on the face and extremities. Visceral involvement is uncommon, and spontaneous recovery usually occurs within one to three weeks without sequelae. The main differential diagnosis is Henoch-Schönlein purpura. We report this case to highlight the condition and emphasize its benign nature.We describe a classic case of acute hemorrhagic edema of infancy, and comment on the clinical features, pathology, treatment, and prognosis. The disease has spontaneous recovery without sequelae.

Concurrent lesions in the brain and spinal cord, which can produce similar symptoms are truly confusing situations. Herein, we report on a 56-year-old woman who suffered from an intermittent radicular pain and paresthesia in her right upper limb and mild headache. Imaging showed a cervical vertebral disc herniation and a small round tumor of the somatosensory cortex with clear border, considered as a little meningioma, which could be followed. To deal with these two concurrent lesions, we faced a challenging condition.

Adenoid ameloblastoma with dentinoid is a rare odontogenic tumor showing histopathologic features similar to ameloblastoma and adenomatoid odontogenic tumor along with hard tissue formation. In this report, a 19-year-old female with a maxillary tumor, microscopically consistent with previously reported cases of adenoid ameloblastoma with dentinoid is presented