Acta Medica Iranica
Volume:48 Issue: 3, May -June 2010

Application of therapeutic gene transfer in the treatment of genetic diseases is a notable progress but there are some disadvantages and limitations in it. The process of overcoming these barriers is a drastic change in gene delivery. Recently, calcium phosphate nanoparticles alone, or in combination with viral and nonviral vectors, were found to have a positive effect on gene transfer especially when incorporated in the colloidal particulate systems. This review elaborates on various successful methods of using calcium phosphate nanoparticles in gene delivery, which are considered an advancing approach to gene delivery.

Meningiomas are slow-growing neoplasms which recur locally, their morphologic grading is simple but do not always correlate with patient outcome. The aim of present study is to evaluate the status of progesterone receptor (PR) and proliferation marker Ki67 in various grades of meningioma in a group of Iranian patients. 78 cases of meningioma were selected from the file of a hospital university. All archival H&E stained sections were reviewed and regraded according to WHO criteria. Immunohistochemical analysis for PR and Ki67 was performed on formalin- fixed, paraffin- embedded samples. PR status considered positive if > 10% of tumor cell''s nuclei were strongly immunoreactive, or if > 50% of nuclei were stained with medium intensity. The Ki67 labeling index (LI) is defined as the percentage area with strongest immunostaining. PR were positive in 61/63(96.8%) of grade I tumors,2/10(20%) of grade II,and 0/5(0%) of grade III tumors.Ki67 LI was %2.98±2.27 in grade I tumors, %9.30±5.79 in grade II tumors and %34.00±5.47 in grade III tumors. For both markers, differences between grade I,II and III tumors were significant(P<0.001).There was a reverse relationship between mean of Ki67 LI and PR status,with increasing grade of tumor. Evaluation of PR status and Ki67 LI together with conventional histologic evaluation can help in providing more information about the biologic behaviour of meningiomas,especially for those that histological grading is not straightforward.

A multimodal approach to postcesarean pain management may enhance analgesia and reduce side effects after surgery. We investigated postoperative pain in a double-blinded, randomized, single-dose comparison of the monoaminergic and µ-opioid agonist tramadol, 100 mg (Group T) and piroxicam 20 mg (Group P) given IM alone- single dose in 150 patients who had elective cesarean delivery. All patients were assessed at 0, 6, 12 and 24 hours post operation for pain degree (by Visual Analogue Score: VAS 1-10), nausea and vomiting. Pain degree was classified as: Painless: 0, Mild: 1-4, Moderate: 5-8, Severe: 9-10. There was no significant difference between the efficacy of tramadol and piroxicam injections (P>0.05). Pain intensity decreased markedly over time in both groups. Mean±SEM pain degrees were as follows: P=7.7±0.5, T=8.2±0.8 after 0 hours; P=5.4±0.6, T=6.1±0.5 after 6 hours; P=3.3±0.4, T=3.4±0.7 after 12 hours; P=1.1±0.4, T=1.3±0.5 after 24 hours of surgery. Side effects were similarly minimal with all treatments. It might be concluded that i.m. injections of 20 mg piroxicam (single dose therapy) could relieve postoperative pain after cesarean section as well as tramadol and it could reduce opioid analgesic requirements with less adverse side effects during the first postoperative 24 h.

Spasticity is one of the common complications in upper motor neuron lesions and without appropriate treatment it causes disturbances in movement pattern. Assessments of patients are effective in patient`s management. Modified Ashworth scale (MAS) is one of the criteria in qualitative assessment of spasticity, and there are lots of controversies about its validity. The purpose of this study is to compare MAS with electrophysiological indices of spasticity. The spasticity of upper limb muscles in patients with hemiplegic cerebral palsy are measured and recorded by MAS. Then electrophysiological indices of Hoffmann reflex (H reflex) and ratio of maximum range of action potential of combined movement of flexor carpi radialis (FCR) for upper limb and soleus for lower limb were estimated. Data of 11 patients with age range 4 to 6 were analyzed. There is no significant correlation between degree of spasticity and electrophysiological indices.

The present study was undertaken to compare the in hospital results of coronary artery bypass graft (CABG) with (on pump) or without (off pump) cardiopulmonary bypass (CPB). Data were collected on all first-time isolated CABGs with saphenous vein and/or artery grafts at Shahid Madani Hospital in Tabriz-Iran، between 2006 and 2009. Age and clinical profile were marched between on pump and off pump group patients. Patients with concomitant cardiac operations or beating pump technique were excluded from the study. The study included 994 patients; CABG with CPB (ONCABG) was done in 578 (58%) and CABG without CPB (OPCABG) in 416 (42%). For pump and off pump group respectively، mortality rate was 2/3%، and 0. 2%، the number of grafts was2/92 ± 0. 82 and 2/12 ±o. 73 and the use of intra aortic balloon-pump (IABP) was1. 5% and5. 4%. Post operative ejection fraction (EF) was improved in off pump group (47. 9±0. 6) versus on pump group (44. 53±1. 5) and the latter group had more post operative atrial fibrillation، Stroke، acute renal failure، bleeding rate and blood products transfusion، prolonged intubation time but was not statistically significance. Meanwhile Hospitalization time and use of inotrops was less in comparison with former patients group. Off pump CABG was a safe method in our series. Patients with comparable risk profiles have similar prevalence''s of selected complications after ONCABG and OPCABG، though some clinical and hemodynamic results are better with off pump technique.

Although systolic dysfunction is revealed as a prognostic factor in cardiac surgery, the role of diastolic dysfunction as a predictive factor is less evaluated. In this retrospective study from 872 patients that underwent isolated coronary artery bypass graft(Jan 2008-Feb 2009),388 patients had normal left ventricular ejection fraction (>50%). These are divided in two groups, Group 1: 361 patients without diastolic dysfunction (impaired relaxation) and Group 2: 27 patients with diastolic dysfunction (impaired relaxation). Mean age in group 1 was 57.72 year and in group 2 was 61.16 year (P =0.07). Risk factors such as diabetes mellitus, hypertention and dyslipidemia were similar. Although overall complication rate was higher in group 2(11.1% vs 2.8% P value 0.05),but when each complication was studied individually no significant statistical difference was found. Also no significant statistical difference was found in mortality (2.2% in group 1 vs 7.4% in group 2 P =0.1). In conclusion, from clinical standpoint diastolic dysfunction can be an important factor in assessing surgical outcome in patients whom underwent coronary artery bypass grafting.

Chorionic villus sampling (CVS) is a new method and its true risk of fetal loss and complications is not still clearly determined. The objective of this study was to review the clinical pregnancy outcome of transabdominal CVS (TA-CVS) performed on women with minor beta thalassemia. TA-CVS performed on 300 women with a singleton pregnancy and we could follow 213 women until delivery. Data regarding induced legal abortion, spontaneous abortion, vaginal leakage, Vaginal bleeding and deformity of extremities (limb reduction) were obtained by questionnaire in five years. All CVS were performed by one operator. The mean gestation at time of CVS was 82.4±11.3 days. 79.2% of the procedures were made between 10-13 completed weeks and in other women (20.7%) TA-CVS was performed at 13-16 weeks. The majority (86.9%) required only one puncture. There were 47 pregnancy terminations because of fetal major beta thalassemia diagnosis (18 %). The rate of spontaneous abortion in our study was over ally (1.4%) and in two patients vaginal bleeding was noticed. We didn''t find any vaginal leakage and limb reduction in our survey. TA-CVS is an accurate and safe procedure in experienced hands. It should be considered as one of the safe available procedures for women who require prenatal genetic diagnosis and wish to receive earlier diagnostic information for probable termination of pregnancy.

Color -blindness is the inability to perceive differences between some color that other people can distinguish. Using a literature search, the results indicate the prevalence of color vision deficiency in the medical profession and its on medical skills. Medical laboratory technicians and technologists employees should also screen for color blindness. This research aimed to study color blindness prevalence among Hospitals'' Clinical Laboratories'' Employees and Students in Tehran University of Medical Sciences (TUMS). A cross- sectional descriptive and analytical study was conducted among 633 TUMS Clinical Laboratory Sciences'' Students and Hospitals'' Clinical Laboratories'' Employees to detect color - blindness problems by Ishihara Test. The tests were first screened with certain pictures, then compared to the Ishihara criteria to be possible color defective were tested further with other plates to determine color - blindness defects. The data was saved using with SPSS software and analyzed by statistical methods. This is the first study to determine the prevalence of color - blindness in Clinical Laboratory Sciences'' Students and Employees. 2.4% of TUMS Medical Laboratory Sciences Students and Hospitals'' Clinical Laboratories'' Employees are color- blind. There is significant correlation between color - blindness and sex and age. But the results showed that there is not significant correlation between color -blindness defect and exposure to chemical agents, type of job, trauma and surgery history, history of familial defect and race. It would be a wide range of difficulties by color blinded students and employees in their practice of laboratory diagnosis and techniques with a potentially of errors. We suggest color blindness as a medical conditions should restrict employment choices for medical laboratory technicians and technologists job in Iran.

There are increasing reports of emergence of multiple drug resistant (MDR) Acinetobacter spp in the world; however there are a few reports in our country. 145 A. baumannii isolates from distinct wards and Children''s Medical Center (CMC) in Tehran were studied in order to find the profile of antibiotic resistance among them. 40. 6% (59/145) of A. baumannii isolates were identified as MDR. Overall susceptibility rates to cotrimoxazole، chloramphenicole and ciprofloxacin were 23. 4%، 16. 9% and 20. 1%، respectively. Frequency susceptibility rates to amikacin، kanamycin، gentamycin and tobramycin decreased gradually from 81. 2%، 50%، 50% and 62. 5% in 2002 to 25%، 15. 6%، 28. 1% and 25% in 2007 respectively. Overall susceptibility rates to cephalosporines cephalotin، ceftazidime، cefteriaxon، ceftizoxime and cefixime were 9. 3%، 14. 7%، 16. 2%، 15. 9% and 18%، respectively. Susceptibility to carbapenems was assessed only in 2007. The susceptibility rates of Imipenem and meropenem were shown to be 50% and 46. 8%، respectively. Our data indicates that MDR A. baumannii strains are spreading and carbapenem resistance is becoming more common in Iran. Our findings also highlight the importance of clinicians'' access to updated susceptibility data regarding A. baumannii in developing countries such as Iran.

Hepatitis A is acute and usually self - limiting disease، but sometimes it can be dangerous such as in immunosuppressed patients. Purpose of this study is to investigate the prevalence of hepatitis A serology in HIV/AIDS Patients. 247 HIV positive patients from March 2005 to September 2006 were entered in this study. Participants completed questionnaires to elicit demographic، drug and sex risk information، and were tested for hepatitis A. They were all referred to Counseling center for behavioral diseases in Imam Khomeini Hospital. Cases were chosen from volunteers with no history of jaundice or acute hepatitis. Data were analyzed by SPSS version 13 and results were compared between seropositive and seronegative groups using T test and chi square. Statistical significance was accepted at a level of P<0. 05. 200 (80. 98%) were male and 47 (19. 02) were female. The mean age was 369. 3. 238 (96. 3%) of patients were seropositive. One hundred percent and 96% who were born in rural and urban areas were seropositive، respectively. Also، 85. 7% and 96. 6% who reside in rural and urban areas were seropositive، respectively. Iran is an endemic country for hepatitis A in which most people has asymptomatic infectious during childhood. According to high prevalence of hepatitis A positive serology in HIV/AIDS patients، routine vaccination seems to be unnecessary. But special sub populations like HIV infected infants should be evaluated more precisely and different approaches may be needed for them.

Autoimmune polyglandular syndrome (APS) type 2 is characterized by the presence of Addison''s disease, in association with autoimmune thyroid disease and/or type 1 diabetes mellitus. APS type 2 occurs most often in middle aged females and is rare in children. Here an 11 year old boy is reported with Addison''s disease who developed symptom''s of diabetes mellitus, goiter, malabsorption, macrocytic anemia and keratitis. APS type 2 occurs most often in middle aged females and is quite rare in children but one should think to autoimmune poly glandular syndrome type II in patient at any age especially in patients with Addison''s disease.

A case who was suffering from abdominal pain and chronic diarrhea refered to Isfahan Health Training and Research Center، Institute of Public Health. Current treatments for chronic diarrhea incloding a traial of gluten fre diet were performed but these were not effective because he was infected by Dicrocoelium dentriticum. Then he was cured with parasitic treatment.

Mycotic pseudoaneurysm of the ascending aorta is rare in patients undergoing coronary artery bypass graft (CABG) and usually caused by staphylococcus aureus. We describe a patient with a mycotic pseudoaneurysm of the ascending aorta at the proximal vein graft anastomosis site after CABG. Culture from the sinus tract of the sternum and from the aneurysm sac was Klebsiella pneumoniae. Surgical technique was patch repair of aorta under hypothermic circulatory arrest. He is asymptomatic at 24 months follow-up.