Archives of Iranian Medicine
Volume:6 Issue: 1, Jan 2003

Background – The spread of human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) continues at an alarming rate worldwide. This pandemic has created a dramatic, often devastating, impact on many countries including Iran. Due to the similar route of transmission of HIV, HBV and HCV, intravenous drug abusers are considered one of the leading high-risk groups. The aim of this study was to determine the prevalence rate of these viruses and associated risk factors among intravenous drug addicts in Zanjan prisoners.Methods – This was a cross-sectional investigation conducted in 2001. The study population included 346 drug addict prisoners in Zanjan. Data were collected through interview and blood testing for HIV, HBV and HCV. All blood samples were examined using enzyme-linked immunosorbent assay. Samples positive for HIV were confirmed using Western blot. Results – The prevalence of HIV infection was 1.2%, HBV 3.8% and HCV 47.7%. Intravenous injection, homosexuality and tattooing were, statistically, significantly associated with HIV-, HBV- and HCV-positivity, separately and cumulatively. Conclusion – Taking into account the similarities that exist among the routes of transmission of these viruses and the high rate of infection with HCV in the population studied, it can be predicted that the rate of infection with HBV and HIV will tend to increase. Accordingly, preventive and health education programs are essential.

Background – HIV infection is found worldwide and the number of cases is increasing rapidly, particularly in developing countries. In recent years, the rate of HIV infection seems to be increasing in Iran, particularly due to the increased number of intravenous (IV) drug abusers who are infected in prisons and rehabilitation centers. Methods – From September 1998 to April 2000, we reviewed 44 HIV-positive patients who presented to Masih Daneshvari Hospital, Tehran, Iran. Epidemiological factors, immunological status, associated infections and complications were evaluated. Results – Of 44 patients, 4 (10%) were females and 40 (90%) were males. The mean age was 38 years. The most frequent route of infection was IV drug abuse (75%), followed by heterosexual activity (16%) and blood transfusion (9%). Flow cytometric tests in 39 patients revealed that 16 had lymphocyte CD4+ counts less than 500 cells/μL. The purified protein derivative test was positive in 10 of 30 cases (33%). Eight of 39 (21%) patients had hepatitis B surface antigen (HBsAg) and 17 of 39 (44%) had hepatitis B surface antibody (HBsAb); none of these patients had been vaccinated against hepatitis B virus (HBV). Twenty-nine of 39 (81%) cases were positive for antibodies to hepatitis C virus (anti-HCV). Five patients had clinical tuberculosis. Four (9%) patients died.Conclusion – Our results help to set priorities and to rationalize the availability of prevention and treatment programs in our country, particularly, among IV drug abusers. Multidisciplinary and multilevel approaches, both by government and private health care providers, will have a positive impact on HIV status in Iran.

Background – Hepatitis B virus is one of the most common causes of chronic liver disease, cirrhosis and liver carcinoma, and prophylaxis with vaccination is of utmost importance. The present study was conducted to compare the effectiveness of intradermal and intramuscular injection of hepatitis B vaccine.Methods – Two-hundred female high school students entered this double-blind randomized clinical trial performed in Kashan (a city in the center of Iran) in 1996–97. A 5-mL blood sample was obtained and checked for hepatitis B surface antigen (HBsAg) and antibodies to the HBsAg (HBsAb) using an enzyme-linked immunosorbent assay (ELISA). Subjects were allocated to one of three age groups and randomly assigned to receive intramuscular (control; 1 mL recombinant hepatitis B vaccine) or intradermal (case) vaccine (0.1 mL recombinant hepatitis B vaccine) in the deltoid region at months 0, 1, and 6. Three weeks after the last vaccination, the HBsAb level was measured by ELISA.Results – Intramuscular injection resulted in 97.6% positive, 1.2% mild, and 1.2% negative responses, respectively, whereas intradermal injection resulted in 93.7% positive, 2.1% mild, and 4.2% negative responses, respectively. This difference was not statistically significant (p = 0.23).Conclusion – Due to a very small difference in the effectiveness of the two injection methods and the cost-effectiveness of the intradermal injection, intradermal injection could be safely substituted for intramuscular injection.

Background and Objective – Recurrent herpes simplex is one of the most common infections in humans, but there is not yet an effective treatment to prevent recurrence. Topical zinc sulfate 0.5% to 20% was recently used to reduce recurrence of the infection, but the high concentrations caused severe irritation. In this study, the efficacy of topically administered zinc sulfate in reducing the frequency of herpes simplex attacks was assessed.Methods – Sixty-four patients with recurrent herpes simplex referred to educational dermatology centers in Isfahan during 1999 – 2000 were enrolled in a double-blind clinical trial. Patients were randomized to treatment with topical zinc sulfate 0.05% or 0.025% or placebo for 6 months. No other drugs were permitted during the study. Patients were followed for possible side effects. Data analysis was performed using χ2 (Chi-squared) and SPSS software.Results – There was a statistically significant reduction (60% reduction from pre-treatment number of attacks) in the group receiving zinc sulfate 0.05% (p < 0.01) compared with the groups receiving zinc sulfate 0.025% (25% reduction) and placebo (16% reduction). There was no significant difference between the frequency of recurrence in patients receiving placebo or 0.025% zinc sulfate at the end of 4 months of follow-up. After 6 months, the recurrence rate in patients treated with zinc sulfate 0.05% was much lower than that in the other two groups.Conclusion – Topical zinc sulfate 0.05% was an effective therapeutic modality against recurrent herpes simplex compared with either a lower concentration or placebo.

Background – The etiology of most primary immunodeficiency disorders is unknown, though a variety of genetic imbalances have been reported to be implicated. The histocompatibility locus antigen (HLA) genes and antigens play a decisive role in immune regulation. Therefore, lower or higher representation of some HLA alleles may contribute to the presentation of some immunodeficiency conditions. One important human immunodeficiency that has recently been shown to be associated with particular HLA antigens is common variable immunodeficiency (CVID). We investigated for the first time the association between HLA antigens and this condition in Iranian patients.Methods – Epstein-Barr virus (EBV)-transformed B-cell lines established from 16 patients with CVID and 85 healthy controls were screened using the microlymphocytotoxicity method, with a panel of anti-HLA antisera. The statistical of differences was determined using Chi-squere test with Yate’s correction.Results – Expression of HLA-A2 (p < 0.02) and A33 (p < 0.001) was significantly increased in patients compared to controls. A significant negative association was also evident for DR2 (p < 0.05), DR7 (p < 0.001), DR52 (p < 0.05), and DQ2 (p < 0.05) alleles.Conclusion – Our study demonstrated a significantly greater representation of HLA-A2 and A33 and lower frequencies of HLA-DR2, DR7, DR52, and DQ2 in patients compared to controls. This may suggest involvement of the HLA complex in the presentation of CVID in the Iranian population.

Background – Histocompatibility locus antigen (HLA) class I typing by serology is the most common method in the routine clinical setting. With DNA sequence information available for alleles of the HLA system and the development of molecular biological techniques, it is possible to tissue type for allelic differences in HLA genes. Methods – In this study, serological HLA-A, -B and -C typing results were compared to typing results obtained using sequence-specific primers in the polymerase chain reaction (PCR-SSP). HLA-A, -B and -C typing was performed on a random Iranian population consisting of 40 healthy individuals. Results – There were 16 blank antigens (antigen not detected) on serological testing, 9 in the A locus and 7 in the B locus. PCR-SSP allowed assignment of 2 of the 9 blanks in the A locus and 3 of the 7 blanks in the B locus. In this study, there was a 31% difference in the two typing methods. Conclusion – DNA typing is necessary, particularly in individuals with uncommon alleles and immunosuppression.

Background and Objective – Visceral leishmaniasis is endemic in northwest and southern Iran and is found sporadically in other parts of the country. It manifests as the Mediterranean type of kala-azar, which mainly affects children. Early diagnosis and prompt treatment of the disease could prevent its high mortality. We evaluated the rapid "Dipstick rK39" test in diagnosis and serological survey of the disease in human as well as in dogs, and compared it either with the direct agglutination test (DAT) or enzyme-linked immunosorbent assay (ELISA).Methods – "Dipstick rK39" kits were used for diagnosis in suspected and confirmed kala-azar patients and for case finding among children in the endemic area of Meshkin-Shahr, Ardebil Province, in northwest Iran. The kits were also used to diagnose visceral leishmaniasis in dogs experimentally infected with Leishmania infantum as well as in dogs with clinical symptoms of infection in endemic areas. Results were evaluated based either on results with DAT, ELISA or, in a few cases, microscopic diagnosis.Results – The rapid "Dipstick rK39" test was sufficiently sensitive and quite specific in diagnosis of visceral leishmaniasis in human as well as in dog.Conclusion – The "Dipstick rK39" test is rapid and noninvasive. It does not require much expertise or elaborate equipment and it can be used for diagnosis of visceral leishmaniasis in remote endemic areas.

Background and Objective – It is generally believed in our community that unripe grape juice (verjuice) has a lipid-lowering effect. There is no published data on the lipid-lowering effect of verjuice, so this study sought to test this hypothesis.Methods – In a prospective crossover study, 97 persons with primary hyperlipidemia were enrolled. Group A (n = 47) received 80 mL verjuice daily at lunchtime for the first two months of the study and group B (n = 50) received the same amount for the last two months of the study. The total duration of the study was four months. The serum lipid profiles were measured at the beginning and two and four months after starting the trial. Results were analyzed by paired-samples t-test.Results – The mean ± standard deviation levels of triglyceride, total cholesterol, low-density (LDL) and high-density (HDL) lipoprotein cholesterol were measured. The p value for all pairs was more than 0.05, indicating that verjuice has no lipid-lowering effect.Conclusion – Our study revealed that unripe grape juice has no lipid-lowering effect, but its antioxidant effect on LDL cholesterol should be studied.

Background and Objective – Hepatotoxicity associated with the hypoglycemic effects of an aqueous extract of Teucrium polium was previously described. In this investigation, the effects of the extract on oral glucose tolerance test, regeneration of pancreatic islets and hepatic glucokinase activity of streptozocin-induced diabetic rats were studied.Methods – An aqueous extract of T. polium was fed by gavage tube to healthy and streptozocin-induced diabetic rats for several days. Oral glucose tolerance, number of pancreatic islets and hepatic glucokinase activity were measured using standard methods and compared between diabetic and healthy rats. Results – In diabetic animals, the aqueous extract caused a significant reduction (p < 0.001) in the level of serum glucose during oral glucose tolerance tests. The number of pancreatic islets per unit area significantly increased (p < 0.01) and glucokinase activity was significantly elevated (p < 0.01) in diabetic animals treated with the extract. Conclusion – Although aqueous extract of T. polium contains some hepatotoxic compounds, it also contains components that are beneficial in the treatment of streptozocin-induced diabetes.

Background – Acarbose is known to lower blood glucose concentration by functioning as an α-glucosidase inhibitor in the intestine. It is also suggested that acarbose may directly arrest the intestinal absorption of hexoses. The purpose of the present study was to further elucidate the normal intestinal absorption of hexoses and the effect of acarbose on the rate of intestinal absorption of monosaccharides in normal and streptozocin-induced diabetic rats. Methods – Segments of small intestine, as everted sacs, from normal and diabetic rats were incubated in solutions of various concentrations of monosaccharides, with and without acarbose, at 37ºC for 90 min and the sugar concentration was measured before and after incubation. Student’s t-test with p < 0.05 was used to compare the mean ± standard error of the mean values for intestinal absorption rates of various sugars in different groups of rats. Results – The optimum effective dose of most sugars for intestinal absorption was 100 mg/dL and the best inhibitory dose of acarbose was 1 mg/mL. The rate of intestinal absorption of glucose and galactose in the presence of acarbose was significantly reduced in both normal and diabetic rats, while fructose and sucrose absorption was not affected significantly by acarbose in diabetic rats. Mannose absorption was not affected significantly by acarbose. Conclusion – Acarbose directly arrested the intestinal absorption of most hexoses at different rates, probably due to different mechanisms involved in the intestinal absorption of monosaccharides.

Background and Objective – Captopril is a widely used antihypertensive drug and is formulated by several pharmaceutical companies in Iran. This study was conducted to compare the bioavailability of two captopril formulations with reference products of the same strength in healthy volunteers.Methods – The relative bioavailability of captopril was determined in two single-blind, single dose, randomized, crossover, two-phase studies. The relative bioavailability of the test product (first study: generic captopril 25 mg tablets; second study: generic captopril 50 mg tablets) with respect to the reference product (first study: Capoten® 25 mg tablets; second study: Capoten® 50 mg tablets, Bristol-Myers Squibb) was determined. Twelve healthy volunteers in two groups took part in these studies and took either the test or reference tablets in the first phase and received the other tablet in the second phase of each study. Results – In the first study, the mean values for the variable peak plasma concentration (Cmax) were 459.8 ng/mL for the reference and 466.6 ng/mL for the test product. The mean values for the variable area under the curve (AUC0-t) were 1392.5 ng.hr/mL and 1403.2 ng.hr/mL for the reference and test product, respectively. In the second study, the mean values for the variable Cmax were 535.5 ng/mL for the reference and 517.2 ng/mL for the test product. The mean values for the variable AUC0-t were 1518.8 ng.hr/mL and 1444.5 ng.hr/mL for the reference and test product, respectively. The 90% confidence intervals for the test/reference mean ratios of Cmax and AUC0-t were between 0.90 and 1.19, which is within the conventional bioequivalence range of 80 – 125%. Conclusion – The test products were bioequivalent to the reference (Capoten®) in terms of the rate and extent of absorption of captopril in both 25 mg and 50 mg strengths.

The intestine contains the largest interface between man and his environment; thus, the intestinal barrier could be a key factor in health and disease states. This barrier is a highly selective gatekeeper that permits the passage of nutrients and prevents the penetration of harmful bacterial products and dietary antigens. The intestinal barrier is composed of immunological and nonimmunological compartments and the latter part is made up of multilayered structural and functional components. The intestinal epithelium and its paracellular tight junctions appear to be the key for integrity of this barrier. The cytoskeletal assembly is essential for maintaining epithelial structure, transport, and functional integrity, but is also pivotal for integrity of the paracellular pathway, especially the tight junction complex. Actin and microtubules are two cytoskeletal filaments that play key roles in regulation and maintenance of the intestinal barrier. Various noxious agents such as ethanol and/or oxidants can induce cytoskeletal damage and disruption of barrier integrity. The injurious effects of these compounds are mediated through upregulation and activation of inducible nitric oxide synthase (iNOS) and the resultant NO overproduction and nitration and oxidation of actin and tubulin. Oxidized cytoskeletal proteins result in depolymerization of cytoskeletal filaments, cytoskeletal disassembly and disarray and eventually disruption of barrier function. The disrupted barrier can initiate or perpetuate an inflammatory cascade that will result in intestinal mucosal injury and inflammatory bowel disease flare-up. There are several lines of repair/defense that help to brake this inflammatory cascade, reestablish barrier integrity and thus limit or terminate mucosal injury. One of these lines of defense is mediated through protecting factors such as epidermal growth factor, which prevents ethanol-induced and oxidative damage to the gastrointestinal epithelium.

The complete or partial spontaneous disappearance of a cerebral arteriovenous malformation is rare. Spontaneous thrombosis in large arteriovenous malformations has been reported in only two cases. We report the case of a large arteriovenous malformation in a 17-year-old man, that thrombosed spontaneously after minor surgical manipulation and review the literature and some possible mechanisms for spontaneous thrombosis of arteriovenous malformation.