Acta Medica Iranica
Volume:47 Issue: 5, Sep-Oct 2009

During antigen capture and processing، mature dendritic cells (DC) express large amounts of peptide-MHC complexes and accessory molecules on their surface. We investigated the role of IFN-β in induction HLA-G expression on the monocyte derived DC and cytokine profile in diabetes type 1. We accomplished secretary pattern and total cytokine production of the Th1 cytokine (IL-2، γIFN) and Th2 cytokines (IL-4، IL-10) before and after mixed leukocyte reaction (MLR) of 30 diabetic patients and 30 normal subjects. In this study a significant increase of IL-10 and γIFN reduction after IFN-β Therapy in culture in presence of HLA-G bearing DC as compared to control were seen. It is seen that dendritic cell causes IL-10 production of T cell in vitro that reduce T cell activation from diabetes patients and normal subjects resulted to the production and expression of HLA-G on these cells from both groups. Using mixed leukocyte reaction، it was found that IFN-β-treated dendritic cell mediated the inhibition of autologous T cell activation via IL-10 production and level of HLA-G on dendritic cell may be correlated to disease activity in diabetes patients and it could also serve as a useful marker for disease progress and treatment.

Accumulating evidence suggest that in patients with diabetes mellitus, increased rate of lipoprotein oxidation and oxidative stress have important role in diabetic angiopathy, including nephropathy. To evaluate the association of oxidized low- density lipoprotein (ox-LDL) with the development of diabetic nephropathy, plasma level of ox-LDL were measured in 70 diabetic patients with macro and 63 patients with normoalbuminuria. The plasma oxidized- LDL level in patients with macroalbuminuria was higher than those in normoalbuminuric group, (85.72 ± 32.92 mu/L versus 75.07 ± 26.46 u/L, P= 0.041). hemoglobin A1C (HbA1C) levels were similar in diabetic patients with macro (9.0 ± 1.80%) and normoalbuminuria (8.52 ± 1.7%, P= 0.098). There was no significant correlation between the ox-LDL and HbA1C level. The significantly elevated plasma oxidized- LDL in patients with macroalbuminuria suggests that ox-LDL may play an important role in the progression of diabetic nephropathy.

As the most common male sexual disorder premature ejaculation (PE), also referred to as early ejaculation (EE) or rapid ejaculation (RE), affects 30%-40% of sexually active men. Despite the limited number of available studies comparing the efficacy of selective serotonin re-uptake inhibitors (SSRI) they have been thought to have beneficial effects for the treatment of patients with PE. In the present study, we assessed the efficacy of on-demand use of citalopram, in the treatment of premature ejaculation. A randomized double blind study of fixed dose on-demand use of citalopram was performed in Roozbeh Psychiatry Hospital, Tehran University of Medical Sciences. The sample was consisted of 80 married patients diagnosed with PE according to Diagnostic and Statistical Manual of Mental Disorders. The patients were randomly assigned to two groups: group 1 consisting of 42 patients received 20mg citalopram, and group 2 consisting of 38 patients received placebo four hours before intercourse for a 4-week treatment course. The effects of drug on the ejaculatory function in each group were assessed by the intravaginal ejaculation latency time (IELT), and the Chinese Index of Premature Ejaculation (CIPE) before and at the end of treatment course. The mean IELT increased from 66.78±36.94 to 80.85±43.05 seconds in group 1 and from 63.44±33.16 to 65.71±34.26 seconds in group 2 (P = 0.000). Mean CIPE score increased 1.14±1.04 and 0.52±0.50 in group 1 and 2 respectively (P = 0.002). The patients treated with on demand citalopram showed significantly greater improvement in IELT and CIPE score compared to the patients receiving placebo. It seems that citalopram may be an effective treatment of premature ejaculation with on-demand usage. However further studies are warranted.

Staphylococcus aureus is a major human pathogen producing different types of toxins. Enterotoxin A (SEA) is the most common type among clinical and food-related strains. The aim of the present study was to examine the prevalence of sea in clinical isolates of S. aureus. Moreover, the correlation between sea producing strains and type of infection as well as resistance to antibiotics is also considered. 128 S. aureus isolates randomly collected from different clinical samples in Tehran University Hospitals from February 2008 to June 2008. Patients’ information including sex, infection type and the hospital where samples come from were recorded. The sea gene was observed among 60 (46.9%) of clinical isolates. There was a significant correlation between prevalence of sea gene and type of infection (P = 0.01). Furthermore, significant correlation was detected between the presence of sea gene and resistance to the most of antibiotics used in this study. The significant relationship between the type of infection and S. aureus isolates carrying sea indicates the interaction quality of the S. aureus pathogen and the host as well as the pathogenic role of S. aureus.

Communication, cognition, language, and speech are interrelated and develop together. It should come as no surprise to us that the key to intervention with deaf children is to establish, as early as possible, a functional communication system for the child and the parents. Early intervention programs need to be multidisciplinary, technologically sound and most important, it should take cognizance of the specific context (community, country) in which the child and family function. The main aim of this study was to obtain oral communication development regarding current status of the intervention (aural habilitation and speech therapy)for children with severe to profound hearing impairment in Iran. A prospective longitudinal study was undertaken on a consecutive group of children with severe to profound deafness. Nine severe to profound hearing-impaired children out of the primer 42 cases, who were detected below two years old, had been selected in the previous study to receive aural habilitation. The average of their speech intelligibility scores was near 70% at age 6, which was accounted as poor oral communication and only two of them were able to communicate by spoken language. An integrated intervention services continued again for one year and their oral communication skill was assessed by their speech intelligibility. The intelligibility test of children was recorded on audio-tape, when they read 10 questions such as where is your home. This can be answered only in one word. Each tape was presented to10 normal hearing listeners, and their task was to write down, the answers in Persian orthography. At the beginning (at age 6) the average speech intelligibility score of these children was 72% and only two of them had score of 90% and 100%. At age 7, all of the severe groups were over 90%, and only two profound ones achieved the score of 48% and 62%. All of severe groups develop oral communication, but profound ones had a semi-intelligible speech and used Total communication. Oral communication development in severe to profound hearing impaired children is achievable in Iran, but needs integrated public services on aural habilitation and speech therapy. By providing such services, a considerable number of hearing impaired children would have a favorable chance to take part in regular schools and benefit from equivalent social development with normal hearing peers.

Important aspect of sperm function such as motility and capacitation appear to be mediated at least partially though hyaloronic acid (HA). Present study investigated effects of different doses of HA on sperm motility and vitality in human. Sperm was obtained from 20 male from IVF clinic in Imam Khomeini Hospital. Sperm motility and vitality in human semen was analyzed according to WHO criteria before and 4 hours after treatment with different doses of HA (0.750, 1000 and 1250 µg/ml). The results showed that in 1000 µg/ml the percent of stage 3 and 4 increased compare to control group. Percent of stage 1 and 2 decreased in group with 1000 µg/ml HA, there was an increase in the percentage of stage 3 and 4 and decrease in percentage of stage 1 and 2 compare to control. In the group treated with 1250 µg/ml stage 1 and 2 increased while stage 3 and 4 decreased. Vitality in all groups decreased except of the group treated with 1000 µg/ml HA. The group with 1250 µg/ml showed significantly decrease in vitality compare to fresh group (P < 0.05). The present study showed that the effects of HA on sperm motility and vitality is dose dependant and 1000 µg/ml HA had the effective role on sperm parameters.

Currently cancer is considered as one of the main factors of mortality globally. Many chemicals in our environment can cause genetic mutations and are potentially responsible for millions of cancer-related deaths. Nowadays the scientists are looking for food materials which can potenthially prevent the cancer occurrence. The purpose of this research is to examine antimutagenicity and anticancer effect of Citrus Medica fruit juice.In present study human astrocytoma cancer cells were cultured in DMEM (Gibco),supplemented with 10% fetal calf serum,peniciline-streptomycin,L-glutamine and incubated at 37 ºC for 2 days.In addition cancer cell line were treated by half-ripe and ripe Citrus Medica fruit juice and cellular vital capacity was determined by MTT. The Citrus Medica fruit juice was subsequenthy evaluated in terms of antimutagenicity and anticancer properties by a standard reverse mutation assay (Ames Test). This was performed with histidine auxotroph strain of Salmonella typhimurium (TA100). Thus, it requires histidine from a foreign supply to ensure its growth.The aforementioned strain gives rise to reverted colonies when expose to carcinogen substance (Sodium Azide). During MTT, human astrocytoma cell line revealed to have a meaningful cell death when compared with controls (P<0.01). In Ames Test the fruit juice prevented the reverted mutations and the hindrance percent of half-ripe Citrus Medica was 71.7% and ripe Citrus Medica was 34.4% in antimutagenicity test and this value in anticancer test was 83.3% and 50% in half-ripe Citrus Medica and ripe Citrus Medica respectively.This is the first study that have revealed antimutagenicity and anticancer effect of Citrus Medica fruit juice and the effects were higher in half-ripe Citrus Medica in comparison to the riprned one.

Glucose 6-phosphate dehydrogenase (G6PD) deficiency is an enzyme deficiency of the red blood cells and the most important disease of hexose monophosphate pathway. The role of hemolysis in the pathophysiology of neonatal jaundice due to G6PD deficiency is in contencious. Our aim is to study the role of hemolysis in neonatal jaundice associated with G6PD deficiency. This prospective descriptive study has been done on 244 neonates who were admitted with the symptoms and signs of icter to the Ali-Asghar Children Hospital, affiliated to Iran University of Medical Sciences, Tehran, Iran, during April 2006 to April 2007. Two groups of the babies, G6PD-defcient with neonatal jaundice and G6PD-normal with neonatal jaundice, were compared based on the parameters related to hemolysis such as hemoglobin, reticulocyte count and bilirubin level. The criteria of hemolysis in our study were reticulocyte count more than >5% and hemoglobin less than <14 mg/dl. Our data have shown that 14 (5.7%) of 244 neonates with the chief complain of icter suffered G6PD-deficiency with high male to female ratio (3.6 to 1). The mean hemoglobin levels and reticulocyte counts (16.72 vs. 16.97 and %2.48 vs. %2.79 respectively) did not differ significantly between both groups (P>0.05). The present study indicate, G6PD- deficiency as a major cause of neonatal jaundice and hemolysis is not a main determinant of neonatal jaundice in G6PD-deficient babies and most of them have non hemolytic jaundice.

Procalcitonin (PCT) is a precursor peptide for the hormone calcitonin and is frequently increased in overt sepsis. The aim of this study was to test diagnostic accuracy of procalcitonin among patients with positive systemic inflammatory response syndrome (SIRS) in identifying sepsis. In this cross sectional study, from 563 patients with positive SIRS admitted through the emergency department of a university hospital, we included 120 patients. Procalcitonin was measured semi-quantitatively. Two groups of patients (with and without infection) were defined based on clinical, laboratory and bacteriologic findings throughout the admission course; the serum PCT levels were compared between the two groups. Seventy two (60%) patients were male and 48 (40%) were female, and the mean age was 49.1 ± 20.2 years. Final diagnosis was infection in 71 patients (59.2%) and 49 (40.8%) had non-infectious SIRS. When considering PCT > 0.5 μg/L as the cut-off point, PCT had a sensitivity of 88.7%, a specificity of 77.6%, a positive predictive value of 85.1% and a negative predictive value of 82.6%. Serum level of procalcitonin in infectious group was significantly higher than in non-infectious group (P < 0.0001). PCT level was a predictor of mortality in patients with infectious SIRS. (P = 0.01) In summary, PCT is a useful marker for differentiating sepsis from other cause of SIRS. With change in the cut-off value of PCT in any situation its application can be maximized. Procalcitonin can also be a good marker for predicting outcome in patients with infection.

Pseudo-aneurysm of the femoral artery is the most common arterial complication in drug injecting abusers. Scholars in vascular surgery have published debating statements regarding techniques of successful surgical management during last two decades. We present the results of simple arterial ligation in a series of 32 patients presenting with infected femoral pseudo-aneurysm. Most of the patients were males (89%). Young persons in the age group of 15-44 years were mostly affected. Site of lesion included common femoral artery in 65%, superficial femoral artery 28% and at bifurcation 6.2%. celulitis in 14 (53%), abscess & celulitis in 6 (19%), necrosing fasciitis in 2 (6.2%) and vascular abscess in 7 (22%) cases were the forms of associated local infection. There was no hemorrhage, vascular thrombosis, amputation, or mortality. Claudicating were the only complications identified in 2 patients with Tripe ligation. Ligation is the optimal management for infected pseudo-aneurysms because it is easy, cost-effective, and safe. Early reconstruction is not recommended, since there is an extended infection in the location of the pseudo-aneurysm.

Surgery on the skeleton frequently requires harvesting of autogenous bone graft from the pelvis, but this procedure often is complicated by problems. The purpose of this retrospective, comparative descriptive study was to compare the efficacy of metal-derived bioactive glass (Novabone) versus autogenous iliac crest bone graft in adolescent idiopathic scoliosis surgery. The study was carried out on forty cases (aged 14-20 years) with 55 total curves fused for AIS. Posterior spinal fusion was performed using local bone grafts combined with autogenous iliac crest bone graft in 20 patients (group 1), and combined with Novabone in another twenty ones (group 2). The patients were observed for a minimum of 24 months after surgery, with a mean postoperative observation time of 34.7 months. The results were assessed clinically and radiologically. In group 1, average preoperative curve was 66° with immediate correction to 24.2° (59.7%) and final follow-up of 27.4° (54.3%), but in group 2 the calculated numbers included 63.8°, 25.8° (59.6%) and 28.4° (55.5 %) respectively. There were 5 indeterminate fusions (3 cases in group 1 and 2 in the other group), 1 acute infection, and 1 hook dislodgement in the synthetic group. These results justify and favor the use of bone substitutes for instrumented posterior spinal fusion in AIS. Potentially hazardous harvesting of pelvic bone is no longer necessary for such operations.

The development and widespread use of a prophylactic vaccine significantly reduced the incidence of poliomyelitis. At present we more commonly encounter with poliomyelitis sequelae especially in developing countries. We evaluate the results of a modified innominate osteotomy for leg length discrepancy in poliomyelitis. Instead of triangular bone graft as in Salter’s innominate osteotomy, a trapezoidal bone graft from the ilium is inserted in the site of osteotomy after gradual distraction of the limb. 25 patients (9 males and 16 females) with mean age of 25 years (17-37 years) were treated by this method. All of them had poliomyelitis with limb shortening. At a mean follow-up of 7 years (3 months to 17 years) an average of 3 cm (2.5-3.5) was achieved. Complication was seen in three patients including injury to the lateral cutaneouns nerve of thigh and displacement of osteotomy in two patients. except in one all of the patients satisfied with the operation. We believe this method is safe, effective and cost-benefit for treating of moderate shortening of the lower limb in poliomyelitis.

Injuries, especially traffic accidents are so important causes of death, disability, hospital expenses, economic damages to the society which World Health Organization selected them as the main subjects for investigation and research. We have done an epidemiologic study about trauma in Guilan, a province in north of Iran. This is a descriptive study carried out on patients with traumatic injuries, admitted in Poursina Teaching Hospital, during September 2005 to July 2006. Data were collected prospectively using a data collection form including demographic information, mechanism of trauma, anatomical site of injuries, according to AIS90 and severity of head trauma according to glasgow coma scale (GCS). Data were processed by SPSS 11.5 and are shown in tables and figures. Overall 3598 patients admitted. Mean age was 31.85 ± 17.76 years with male to female ratio about 3.5:1. Most of patients were 25-44 years old (33.9%). Traffic accidents were the leading cause of injuries (73.84%) and then fall (15.7%). Motorcycle was the most common mode of transport in our patients (47.07%) after that car (24.3%). Occurrence of traffic accidents increased through evening. Forty six percent of patients transported to hospital by people or came themselves (46.42%). Head and neck were the most common injured part of body (82.4 %,) however about in 81.66% of patients were mild and then limb and pelvis (34.7%). Finally about 2.8% of them died. A trauma especially traffic accidents are an important public health issue in Guilan, we recommend conducting other studies focusing on risk factors in details, and considering injury prevention in local decision making.

Computed tomography (CT) is now the primary diagnostic method for head trauma because of its ability to demonstrate the nature, extent, sites, and multiplicity of brain injuries. Although there have been numerous reports on the CT findings of most types of intracranial injury, the findings in brainstem injury have not been well described. This study aimed at comparing the autopsy findings of brainstem in head trauma in comparison with CT scan results. Two hundred patients with head trauma, who expired after a period of time of hospitalization, were assessed in a diagnostic value study. Brain stem involvement was determined by autopsy as well as CT scanning of the brain during their hospitalization. The results of the two methods were compared with each other, emphasizing on the type and location of probable lesions in the brain stem. Considering the autopsy as the method of the choice, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of CT scan in brain stem lesions of patients with head trauma were calculated. The effect of primary cause of head trauma, survival time and Glasgow Coma Scale (GCS) were evaluated, as well. Brain stem lesions were detected in 39 (19.5%) patients in autopsy. However, CT scan revealed brain stem lesions in 23(11.5%) cases. The sensitivity, specificity, PPV and NPV of CT scan was 59%, 100%, 100% and 91% respectively. The most common lesions of the brain stem region were as contusion of pons (8.5%), medulla (5%) and midbrain (4.5%). There were 6 (3%) cases of ponto-medullary junction tearing and 1 (0.5%) case of cervico-medullary junction tearing. CT scan is a specific method of evaluating patients with probable brain stem injuries after head trauma, but low sensitivity limits its efficacy. Our results are in conformity with the reports in the literature.

This is a case of a patient with bowel obstruction, imaging studies were suggestive for pneumatosis intestinalis. Clinically diagnosed as adhesion band and pnematosis intestinalis. She underwent laparatomy, enterolysis, obstructionolysis and enterorrhaphy. The patient developed respiratory distress and expired after 2 days. At autopsy we found gray-brown discoloration in the wall of some part of small bowel and flattening of mucus membrane. Grossly multiple gas-filled cysts were seen at the serosal surface. Microscopic evaluation of small intestine wall showed multiple cysts located in submucosal and serosal layers.

Metastatic tumors in the nose and paranasal sinuses are infrequent. The origin of this metastatic tumors are often renal cell carcinoma. We present one case of metastatic renal cell carcinoma to the nose and paranasal sinuses, 4 years after initial nephrectomy and diagnosis of stage T1N0M0 clear cell carcinoma. The patient complained of nasal obstruction and recurrent epistaxis who was treated with endoscopic sinus surgery and was successfully palliated after one year.

Primary Sjorgen syndrome is one of the commonest autoimmune diseases with characteristic of involvement of lachrymal and salivary glands, but other organ involvements as peripheral and central nervous system are also possible. The reported case is a 23 year old lady presented with progressive sensory ataxia and weakness of four limbs, bilateral sensory hearing loss and cognitive impairment with minimental score equal to 15/30 since one year prior to admission with associated bilateral central corneal opacity, dry mouth and dry eyes. Electro physiologic studies showed sensory motor axonal polyneuropathy. A biopsy of sural nerve and salivary glands of lower lip showed lymphocytic infiltration. Serologic evidence showed positive Anti Ro (SS-B), negative HCV and HIV antibody, thereafter the diagnosis was confirmed and according to this diagnosis she received high dose of intravenous methyl prednisolon then both hearing loss and cognitive impairment improved partially (minimental score 21/30). At last, she underwent plasmapheresis and her sensory ataxia improved greatly.

A woman presenting with severe right lower quadrant (RLQ) abdominal pain is presented here. She was evaluated for all usual cause of such pain. Laboratory tests and abdominal and pelvic sonography was normal. MRI revealed L1-L2 disc herniation.

Liposarcoma is a mesenchymal malignant tumor and is the second-most common soft tissue sarcoma in adults. Primary peritoneal liposarcoma is very rare. We report a case of abdominal liposarcoma originating from peritoneum in 57-year old woman, presenting with hugeness of abdomen. The symptoms had been begun from one month ago without any pain, discomfort or gastrointestinal symptoms. In physical examination a large mass with approximate size of 30×35 cm and firm density was found in left lower part of abdomen. The patient underwent laparotomy. The pathologic diagnosis was well differentiated liposarcoma. After 5 months of treatment the patient is well and no problem, complication or recurrence has been reported.