Archives of Iranian Medicine
Volume:16 Issue: 9, Sep 2013

The present study aimed to evaluate the correlation of P53 and granzyme B (GB) expression, and also the relationship between P53 expression and GB+ cell density with lymph node metastasis, histologic grade, and inflammation intensity in oral squamous cell carcinoma (OSCC). Immunohistochemical technique with P53 and GB antibodies were performed on stored paraffin blocks from 48 patients with OSCC (with lymph node metastasis n = 24; without lymph node metastasis n = 24). The density of GB expression was quantified both in invasive front (peritumoral) and within cancer nests (intratumoral). P53 positivity was seen in 13 (54.16%) cases of the nonmetastatic group and 14 cases (58.3%) in the metastatic group. A significant correlation was seen between P53 immunoexpression and histologic grade (P = 0.047), but there was no significant correlation between P53 expression with lymph node metastasis and inflammation intensity. The density of GB+ cells in the peritumoral zone correlates with a higher intratumoral GB expression (P = 0.001) and was significantly higher in the nonmetastatic group (P = 0.029). No significant correlation between GB and P53 immunoexpression, lymph node metastasis, or inflammation intensity was seen. The present study showed that the presence of a higher density of GB+ cells infiltrating the peritumoral area may have an important role against tumoral cells, prevent lymph node metastasis, and better prognosis in OSCC patients.

Oropharyngeal malignancies represent management challenges for the head and neck surgeons. Tumor resection and reconstruction with graft is the standard treatment. Split-thickness skin grafts are routinely used to cover the mucosal defects arising from resections. As amniotic membrane (AM) is used as a dressing substitute in burn, we decided to evaluate the efficacy of AM as a biologic wound dressing material for surgical defects of mucosa in the oropharyngeal region. This was a single- institution prospective study which included 50 patients with primary oropharyngeal malignancy who underwent tumor resection between March 2010 and November 2011, and were up for two to 20 months after the surgical procedure.We used amniotic membrane (AM) for dressing of the defects in the oral cavity and pharynx under general anesthesia. Efficacy of this procedure was assessed by rating of the pain and granulation tissue formation with surface epithelialization at the site of graft. The results were evaluated in the postoperative period. Forty males (80 %) and 10 females (20%) were participated, age from 20 to 80 years with a mean age of 50 ± 10.41 years. The patients underwent partial glossectomy, or floor of mouth resection according to tumor location. Complete adherence of AM to the wound was detected in all cases. Allergy either systemic or local was not reported in any of the cases. The membrane was very effective in 40 patients, and effective in 10 cases. Amniotic membrane (AM) can be used as a biologic dressing material for covering the mucosal defects in the oropharynx.

This study was planned to determine the rate, the predisposing factors, and the outcome of retinopathy of prematurity (ROP) in very low birth weight (VLBW) infants hospitalized in the neonatal intensive care unit (NICU) of a tertiary care hospital in Tehran. All VLBW neonates admitted to the NICU, from April 2007 through March 2010 were enrolled. All relevant perinatal data, including the hospital course up to the time of discharge were documented. Repeated ophthalmologic examinations were done by a single ophthalmologist to observe the progression and subsequent resolution of ROP. Out of 414 infants undergoing ophthalmologic examination, ROP was detected in 71 infants (17.14 %); 3.4 % stage I, 8.7 % stage II, and 5.1 % stage III. ROP stages IV or V were not detected. After adjustment for different variables, the following independent risk factors were identified: VLBW (P = 0.002, OR = 4.89), multiple gestation (P = 0.001, R = 3.51), resuscitation at birth (P = 0.003, OR = 3), blood transfusion more than 45 mL/kg (P = 0.02, OR = 4.91), oxygen therapy for more than five days (P = 0.009, OR = 3.11), and age more than 10 days to regain birth weight (P = 0.008, OR = 1.06).Thirty-three patients with stages II and III ROP were treated with laser therapy, all of them improved and none progressed to blindness. Our findings identify the major risk factors for ROP; skillful management of high-risk pregnancies, prevention of preterm births, appropriate neonatal care, high index of suspicion, routine screening, and prompt treatment are crucial to prevent the development and progression of ROP.

This study was performed to determine the lifetime prevalence of psychiatric disorders concomitant with attention deficit/hyperactivity disorder (ADHD) among primary school students. One thousand six hundred fifty-eight primary school students (781 females and 877 males) were selected in a cluster random manner in 2010. The first screening was performed by the Conner''s teacher rating scale revised and Teacher ADHD rating scale-IV and then the students, in whom the ADHD was diagnosed by a child and adolescent psychiatrist according to DSM-IV-TR, were evaluated by K-SADS-PL semi-structured interview to detect the psychiatric comorbidities. The prevalence of psychiatric comorbidities in ADHD subjects was 62.5%. Oppositional defiant disorder (29.4 %), specific phobia (21.9 %), and enuresis (17.5 %) were the most common co-morbidities. The most common comorbidities in ADHD -IA (inattentive type) (n = 29) were specific phobia (34.5 %), oppositional defiant disorder (20.7 %), chronic motor tic disorder (17.2 %), and enuresis (17.2 %). The most common comorbidities in ADHD-HI (hyperactive/impulsive type) (n = 15) were chronic motor tic disorder (33.3 %), oppositional defiant disorder (26.7 %), and specific phobia (26.7 %). The most common comorbidities in ADHD-C (combined type) (n = 116) were oppositional defiant (31.9 %), enuresis (19 %), and specific phobia (18.1%). The frequency of chronic vocal tic disorder was higher in ADHD-HI compared with ADHD-C (P = 0.01). The results of this study indicated that the frequency of other psychiatric comorbidities in primary school students with ADHD is high that may affect disease course and treatment. Hence, evaluation for other comorbidities in ADHD patients should be considered.

Genital wart is the most common sexually transmitted disease worldwide. Sexual risk factors and sexual behavior pattern may be different in various countries. In this study, we tried to evaluate demographic information and some sexual behaviors and risk factors in Iranian patients with genital warts. In this cross- sectional study, 250 patients with anogenital warts were evaluated. They had been referred to the Sexually Transmitted Diseases Clinic of Razi Hospital. Demographic information and sexual risk factors and pattern of sexual behaviors were recorded in the questionnaires. One hundred twenty-five men and 125 women with genital warts were evaluated. The most common age group was 20 – 30 years old; 24.8 % were single; 29.6 % had academic education; 35 (14 %) of the patients had started sexual activity before 15 years of age; 92 % reported unsafe sex; seven (2.8 %) of them were HIV infected; two cases (0.8 %) were homosexual; and seven cases (2.8 %) were bisexual. Genital her pess implex type 2 was the most common coincident sexually transmitted disease (6.4 %). Genital wart in men may be as commonas women, married and singles, and mostly involves younger people. Sexual high-risk behaviors and unsafe sex make them at risk for HIV infection. Sexual health education should be considered in high-risk groups.

Nitric oxide (NO) plays a role in almost every biologic system including regulation of energy balance and food intake. This study aimed at determining association between serum nitric oxide metabolite (NOx) levels and obesity in a population-based study. In a cross-sectional study, NOx levels were measured in 3505 adult participants. Pregnant women and those with diabetes, renal dysfunction, chronic diarrhea, and hospitalization within the past three months, subjects using antihypertensive medications or aspirin, and those with missing data were excluded. Finally, 2445 subjects (1004 men and 1441 women) were included. Women with body mass index (BMI) > 30 kg/m2 compared to those with BMI < 25 kg/m2, had significantly higher serum NOx concentrations after multivariable adjustment (B = 5.24, P = 0.002). In addition, there was a significant trend of increasing serum NOx concentrations in categories of BMI in women. Women with a waist circumference (WC) ≥ 90 cm had significantly higher serum NOx concentration even after multivariate adjustment. Women with waist-to-hip ratio (WHR) ≥ 0.90 had significantly higher serum NOx concentration; however, the association was not significant after multivariable adjustment. None of the parameters were significantly associated with NOx in men. A positive association between BMI and WC and serum NOx concentration was found in women which might be a reflection of increased NO production.

BIOMED 2 multiplex polymerase chain reaction (PCR) protocol is a widely accepted tool for evaluation of clonality in lymphoma diagnosis. Diffuse large B-cell lymphoma (DLBCL) is the most common non- Hodgkin,s lymphoma and displays a special challenge for PCR-based clonality analysis due to a high frequency of somatic hypermutation in rearranged immunoglobulin (Ig) domains. In this study, we evaluated detection of B- cell clonality in DLBCL by using Ig heavy chain (IgH) framework region 3 (FR3) primers in formalin- fixed paraffin- embedded (FFPE) tissue. FFPE samples from 100 cases diagnosed as DLBCL in the period of 2005 through 20011 were assessed in this study. Clonality of IgH (FR3) was evaluated by PCR amplification method that was optimized for FFPE tissue. The clonal detection rate was (62.8 %) with IgH (FR3) assay after modification, using filter for better DNA purification on negative cases. DNA quality in FFPE samples stored in recent five years were significantly better than older paraffin blocks (P < 0.001). Although a higher rate of clonality was observed in more recent group, it was not statistically significant. By using IgH (FR3) primers followed by one additional filter tube for better DNA purification, we could achieve a considerable rate of clonality with little adverse impact of DNA degradation.

The geographic map of cancer prevalence differs due to environmental and dietary factors in various populations. High prevalence of a number of cancers in some regions is thought to be attributed to local dietary habits. Dorema aucheri (Bilhar) is used commonly as an herbal medicine in some regions including Iran. The aim of this study was to evaluate whether Dorema aucheri has carcinogenic effects in albino mice or not. The Dorema aucheri leaves were extracted by Soxhlet method and were injected intraperitoneally and randomly into 28 healthy albino mice which were divided into seven groups. One was put aside as the non-injected control group. The second control group was chosen to be injected by a known carcinogen. Another group was injected by carcinogen and then, Bilhar extract. The left four groups were injected the extracts in a dose- dependent manner, increasingly in the range of 0.4 – 3.2mL/kg. Extract injections were repeated every 48- hour intervals for three times. Then, liver and serum samples were analyzed biochemically and pathologically. The pathologic and biochemical studies showed that the injection of plant extracts caused necrosis, inflammation of the liver tissue, cell proliferation, cholestasis, and there were significant increases in release of liver enzymes [ALP, ALT (SGPT) and AST (SGOT)] and bilirubin compared to the non-injected control group. The level of liver damage was dose dependent. Dorema aucheri has potential hepatotoxic capacities and possibly this may be related to the high prevalence of cancer in some regions of Iran.

When the spinal cord is damaged, medical procedures are vital to prevent of improvement of the lesion. Because of poor regeneration ability of central nervous tissue, the most injuries are irreversible. One of encouraging interventions for treatment of spinal cord injury is Schwann cell transplantation. However, isolation of Schwann cell for clinical interventions is complicated approach with low cells yield and purity. Thus, easily accessed sources like Adipose mesenchymal stem cells have been taken notice. Therefore, this study was planned to assess the effect of adipose stromal cell-derived Schwann cell transplantation in functional recovery after lateral hemisection in adult rats. After isolation, adipose stem cells were differentiated to Schwann cells. The differentiation was verified by immunocytochemistry and reverse transcription-polymerase chain reaction (RT-PCR). Then, we loaded the cells into collagen scaffolds with parallel aligned canals and transplanted into rats with 3mm lesions at T9 – T10 level. Motor and sensory improvement were evaluated by open field locomotor scale, narrow beam, and tail flick tests for 60 days. Subsequently, conventional histology and immunohistochemistry were performed. In vitro results revealed that mesenchymal stem cells after differentiation gained Schwann cells morphology and markers. Schwann cell-grafted group had significantly higher locomotor and sensory scores in comparison with the control and scaffold without cell groups. Histological observations showed differentiated cells have the ability to improve axonal regeneration and remyelination. Our study proved that adipose tissue- derived Schwann cells can change the rough environment of damaged spinal cord and support axon regeneration and enhance functional recovery, and possibly be helpful for people suffering from spinal cord injuries.

The Iraq-Iran war was one of the longest conflicts in the twentieth century. The aim of our research was to study a systematic review about the incidence of mortality and injuries of the war. A search strategy was designed and run in Medline, EMBASE, Scopus, and Iranian databases including Scientific Information Database (SID), IranMedex, and Magiran. Also, searching grey literature, checking references, tracking citations, hand-searching of focused journals, and websites were utilized for retrieval of related studies. All of articles which studied epidemiology of mortality or injuries of the war were included. The excluding criteria were case reports, case series, laboratory researches, and nonoriginal studies. Fourteen articles out of 1751 primary results were selected to be included in the study. During the war (1980 – 1988), 188,015 to 217,489 Iranians were killed (about 70 people per day). The mean age of mortality was 23 years. Six thousand four hundred twenty-seven (2.9%) of those who died during the war were females. One thousand five chemical warfare victims died between 1983 and 1994. From 1985 through 1998, 82 veterans had successful suicides too. At the end of war, we had 398, 587 veterans who needed follow- up. Among them, there were 52,000 chemical warfare victims. Between 1988 and 2003, 1400 people died and 2313 injured due to landmines and unexploded ordnances in five border provinces. The war caused a lot of mortalities and morbidities in our country. Now, 24 years after the war, many physically, mentally, and chemically injured victims have remained. We suggest other studies about indirect impacts of the war on societies, families, friends, and affiliates of the victims.

Placental mesenchymal dysplasia is a rare condition of the placenta and its true incidence and underlying cause has remained unknown till now due to its rarity. Its accurate diagnosis is essential, because placental mesenchymal dysplasia is usually compatible with a good fetal and maternal outcome. A precise ultrasonographic evaluation can contribute to the identification of characteristic features, particularly to discriminate it from partial hydatidiform mole, its main differential diagnosis. We report an early third-trimester pathologically- diagnosed case of placental mesenchymal dysplasia. It was complicated by fetal hydrops and death.

Foreign body ingestion is a common problem in otolaryngology. In this case report, we present a patient with fish bone ingestion with a unique route of extraction. A 50-year-old woman was presented with a complaint of odynophagia while eating fish. Rigid laryngoscopy revealed nothing except ecchymosis on the right pyriform sinus. We performed an axial neck computed tomography (CT) scan and found the fish- bone at the retropharyngeal space. After three days there was a tender bulging in the neck. We extracted the fish bone thorough a small incision on the neck. We recommend the performance of CT scan in patients with suspected hypopharyngeal and esophageal sharp foreign body impaction.

Metastatic tumor of the mandible is a rare lesion and differentiated carcinomas of the thyroid as the primary site of origin are even more uncommon. A case of late metastasis of follicular thyroid carcinoma (FTC) to the mandible is presented here. The metastasis arose 12 years after thyroidectomy. Although relatively rare, thyroid tumors metastasis to the mandible should be born in mind, as in rare cases this metastasis may be the only presentation of the original malignancy.

Laryngeal polymorphous low-grade adenocarcinoma is a rare malignant tumor with a predilection for intraoral sites. Polymorphous low-grade adenocarcinoma mostly occurs during the sixth to eighth decades of life with a female predilection. Although histopathologic evaluations enabled the definite diagnosis of this tumor, it might be mistaken with adenoid cystic carcinoma or mixed cellular tumor especially in situations when specimens with small sizes are available. We present a rare case of laryngeal polymorphous low-grade adenocarcinoma in a 55-year-old female patient.