Acta Medica Iranica
Volume:49 Issue: 3, Mar 2011

Keloids are aesthetically disfiguring and severely disabling. The optimal treatment remains undefined. This clinical study, evaluate the efficacy and side effects of combined topical silicone and 5-Fluorouracil on the prevention of keloids. In this double blind randomized clinical trial, fifty patients with keloids were randomly allocated in two groups. The control group were treated by perilesional surgical excision of keloids combined with topical silicone and the trial group were treated with adjuvant treatment of intralesional 5-Fluorouracil. All patients were examined and assessment was done by an independent observer. the data collected were analyzed by SPSS statistical software with using tables and χ square tests. 75% of the cases in the trial group were keloid free 21% have keloid partially improvement and 4% have keloid recurrence, compared to patients in the control group respectively: 43%, 35% and 22%, findings suggest that efficacy of 5- Fluorouracil combined with topical silicone used for the prevention of keloid is comparable to other modality. The lack of any serious side effects and the evidence of recurrence at one year of follow-up make this an effective tool for the prevention of keloids.

Adhesions after endoscopic sinus surgery (ESS) are a potential cause of surgical failure. Mitomycin-C (MMC) is recently proposed as a solution for these adhesions. This study was performed to investigate the effect of Mitomycin C in reducing scar formation and adhesion in the nasal mucosa after endoscopic nasal surgery. This double blind randomized clinical trial study was performed on 37 patients with bilateral chronic rhinosinusitis. At the end of ESS, randomly impregnated mesh with MMC was placed in one side and another mesh impregnated with saline in the opposite side for 5 minutes. Patients were followed at least for three months, and the results of diagnostic endoscopy were recorded. Post operative adhesion occurred in 12 (32.4%) patients (2 bilateral/10 unilateral). Among total of 14 adhesions, 4 (10.8%) were in the MMC side and 10 (27%) in the control side. This differences was close to statistically significant (P=0.058). MMC may reduce adhesions after ESS, but further studies with different doses, sample size and frequent use of topical MMC is recommended.

Cutaneous leishmaniasis (CL) is an endemic disease in some parts of Iran and it has high morbidity in some areas of the country. The disease is detected by parasitological examinations including direct microscopic and culture tests. This comparative study aimed to evaluate the relationship between positivity of the leishmanin skin test (LST), microscopically examination and clinical forms of CL for the diagnosis of human cutaneous leishmaniasis. This study was performed on 66 patients suspected to cutaneous leishmaniasis. CL cases evaluated by both microscopical examination and leishmanin skin test. In this study, 1 ml of leishmanin fluid (lot no 121/1, produced in Pasteur institute of Iran) was injected intradermally in forearms of all patients and indurations were measured after 72hours. Induration of 5 mm and higher was considered as positive results. The collected data were statistically analyzed using the SPSS version 13.5. From 66 CL patients who were evaluated in this study, 30 (45.5%) of them had positive microscopically results while 28(42/4%) of them had showed positive leishmanin skin test (≥5mm diameter). From 36 (54.5%) patients who had negative microscopical examination, only 6(16/6%) of them had positive leishmanin skin test. The agreement between two tests was 87.9 % by kappa analysis (p< 0.01). In attention to the results of this study, it seems the LST would be used as an alternative diagnosis method when there is a strong clinical doubt to cutaneous leishmaniasis even there is no parasite in direct smear.

This study determines the value of linkage analysis using six RFLP markers for carrier detection and prenatal diagnosis in familial DMD/BMD cases and their family members for the first time in the Iranian population. We studied the dystrophin gene in 33 unrelated patients with clinical diagnosis of DMD or BMD. Subsequently, we determined the rate of heterozygosity for six intragenic RFLP markers in the mothers of patients with dystrophin gene deletions. Finally, we studied the efficiency of linkage analysis by using RFLP markers for carrier status detection of DMD/BMD. In 63.6% of the patients we found one or more deletions. The most common heterozygous RFLP marker with 57.1% heterozygosity was pERT87.15Taq1. More than 80% of mothers in two groups of familial or non-familial cases had at least two heterozygous markers. Family linkage analysis was informative in more than 80% of the cases, allowing for accurate carrier detection. We found that linkage analysis using these six RFLP markers for carrier detection and prenatal diagnosis is a rapid, easy, reliable, and inexpensive method, suitable for most routine diagnostic services. The heterozygosity frequency of these markers is high enough in the Iranian population to allow carrier detection and prenatal diagnosis of DMD/BMD in more than 80% of familial cases in Iran.

Cerebrovascular accidents rank first in the frequency and importance among all neurological disease. Although a number of studies had shown increased level of the high sensitive C-reactive protein (hs-CRP) in patients with ischemic stroke, the association of increased hs-CRP with various type of stroke especially the assessment hs-CRP level in ischemic and hemorrhagic stroke have not been investigated. In the present study, we assessed the concentration of hs-CRP in patients with documented ischemic and hemorrhagic stroke in the first 24 hours of the onset of symptoms. Thirty-two patients with Ischemic and hemorrhagic stroke were evaluated at neurology department of Poursina Hospital. The presence of baseline vascular risk factors, including hypertension, diabetes mellitus, hypercholesterolemia, obesity, and smoking, was determined. The blood samples were then collected and routine hematology and biochemistry tests were done. hs-CRP levels were determined using a highly sensitive immunonephelometric method. In this cross sectional study, the age of patient varied from 45-85 years (Mean 70.9 9.4). Serum level of hs-CRP in Ischemic patients were 18.92 11.28 and in hemorrhagic group was 2.65 1.7. This relationship was statistically significant (P<0.0001). It might be concluded that hs-CRP might be considered as a usefully adjunct method for the initial diagnosis of the type of stroke.

Illiteracy in studies on quality of life (QOL) and self-efficacy (SE) of diabetic patients has been ignored. Illiteracy and diabetes have high rates in developing countries. The aim of this study was to identify the effect of literacy level on health outcomes. To achieve this, we studied health outcomes such as SE, self-management behaviors and Health-Related Quality of Life (HRQOL) in diabetic patients. A cross-sectional study was carried out in an Iranian urban federally-funded diabetes clinic (with 1400 diabetes patients) in Bandar Abbas, a city located in south of Iran. 256 Non Insulin Dependent Diabetic Mellitus patients were chosen during June, July and August 2007. Patients were grouped as illiterates, low-literates and literates. SE and QOL were measured by standard questionnaires. HbA1C was measured by calorimetric method. Data was collected with interview. Data analysis was carried out with one way ANOVA Post Hoc, and bivariate analysis method. Literacy level among the three groups from the view points of age, physical domain, psychological domain, environmental domain and SE were significant. There was no significant difference for the level of HbA1C among three groups. Literacy level does not have any effects on glycemic control. There is a strong relationship between self-efficacy and QOL domains.

Previous studies on etiology of squamous cell carcinoma (SCC) of the tongue have reported results with respect to long term exposure to cigarette smoking and alcohol abuse. The aim of this study was to investigate risk factors for SCC of the tongue in a set of patients with minimum exposure to cigarette smoking and alcohol. Sixty four cases with diagnosis of oral tongue SCC were reviewed in this study. The patients underwent surgical management at the educational and therapeutic centers, Imam and Buali Hospitals (Hamedan, Iran) between the dates of January 1990 and December 2006. Eighty five percent of patients were older than 40 years of age. Most of patients had poor oral hygiene, dental decay and halitosis. It appears that poor oral hygiene and nutritional deficiency can be considered as risk factors for the SCC of the tongue in west of Iran.

Animal related injuries as most common causes of human morbidity have different pattern by geographical zones. We aimed to explore the main descriptive epidemiology of animal-related injuries in both rural and urban areas in Iran. Between 2000 and 2004, we collected the data of all the cases of animal related trauma hospitalized for more than 24 hours in eight cities (Tehran, Mashhad, Ahwaz, Shiraz, Tabriz, Qom, Kermanshah, and Babol). Further evaluations were conducted on 17753 eligible subjects. Of 17753 traumatic patients, 40 subjects (0.2%), had animal-related injuries. The highest rate was seen in Tabriz with 11 cases. Upper and lower extremities were the most frequent sites of trauma and they were injured in 13 and 11 cases respectively. Dog bite and cow-related injuries were responsible for 40% and 32.5% of injuries respectively. Amputation of the phalanx was done in 2 cases due to dog bite and bull gore occurred. One thoracotomy, one laparatomy and one craniotomy were done. One patient needed fasciatomy due to snake bite. Educating the patients could decrease the incidence of morbidity of these injuries.

Patellofemoral pain syndrome (PFPS) is the most common overuse syndrome in athletes. It is one of the causes of anterior knee pain in athletic population who come to the sports medicine clinic. Patellofemoral pain is more common among female athletes especially adolescents and young adults. Symptoms include: persistent pain behind the patella or peripatella. Pain increases on ascending and descending stairs and squatting and prolonged sitting. The aim of this study was to evaluate the prevalence of PFPS in Iranian female athletes. 418 female athletes aged 15-35 years were examined in five sports: Soccer (190), volleyball (103), running (42), fencing (45) and rock climbing (38). The athletes who had non- traumatic onset anterior knee pain of at least 3 months that increased in descending and ascending stairs and squatting, had no other causes of anterior knee pain such as ligament instability, bursitis, meniscal injury, tendonitis and arthritis and no history of knee surgery during the one past year were diagnosed as PFPS. 26/190 (13.68 %) soccer players, 21/103(20.38 %) volleyball players, 7/42 (16.66 %) runners, 6/45(13.33 %) fencers and 10/38 (26.31%) rock climbers had patellofemoral pain. Among the 418 female athletes who were evaluated 70 had PFPS. Rock climbers were the most common athletes with PFPS followed by volleyball players and runners.

Height measurement is an important part of nutritional assessment especially in children. However, in such cases as hospitalized or certain kinds of malformations or disabilities, height cannot be measured accurately. We aimed to determine appropriate height predictors in Iranian healthy children for further use in disabled and/or hospitalized children. A total of 730 apparently healthy children aged 7-11 years old from both sexes from Tehran, Meshed and Rasht were enrolled in a cross sectional study. Height, demispan (DS), halfspan (HS), arm length (AL) and tibia length (TL) were all measured using a measuring tape. Linear regression models were established between height, DS, HS, AL and TL. For boys AL (R2=0.783) and TL (R2=0.837) and for girls AL (R2=0.720), TL (R2=0.765), HS (R2=0.771) and age (R2=0.775), respectively, entered the linear regression model. When height predictors were evaluated individually for each city, only in Tehran DS also entered the regression model. Concordance of different percentiles of height estimates based on AL with those of actual height proposed this measure as a reliable height proxy for this age group in clinical as well as field practice.

This study determined the clinical effect of subconjunctival administration of bevacizumab in patients with primary and recurrent pterygium. The study was an off-label, single-dosing, interventional case series involving 22 patients with primary and recurrent pterygium. They received subconjunctival bevacizumab (0.2cc). Pterygium vascularity and thickness was graded. The size of the pterygium (measured by surface area in cm2) was recorded from baseline to 12 weeks, after injection. Treatment-related complications and adverse events were reported. The main outcome of measurements was the change in size, vascularity, thickness, color intensity. There were 15 males (68.2%) and 7 females (31.8%) of 22 patients with a mean age of 45.5 years (SD 11.68 years). One cases didnt cooperate, and excluded. There was a significant difference in the mean surface area of pterygium at different intervals (P < 0.05) and the size of pterygium was reduced. On comparison of the mean pterygium size, there was no significant difference between men and women (P >0.05). There was a significant reduction in the mean pterygium size of patients younger than 45 years in comparison to those older than 45 years after three month (P =0.037), but after 6 months, this difference was not significant (P = 0.338). Average changes in pterygium size for both eyes were not different. The reduction of color intensity in both eyes was significant (P =0.031). Subconjuctival bevacizumab injection is useful in management of patients with primary and recurrent pterygium without significant local or systemic adverse effects.

Asthma is the most common chronic disorder of school-age children and youth, with rising prevalence in all over the world. By attention to the geographic area there is considerable difference in the prevalence of asthma. The International Study of Asthma and Allergies in Childhood (ISAAC), was founded to maximize the value of epidemiological research into asthma and allergic disease by establishing a standardized methodology and facilitating international collaboration. To determine the prevalence of asthma and related symptoms in Kermanshah (a city in west of IRAN) schoolchildren and also identifying the related variables that increased asthma risk using the ISAAC protocols. This descriptive analytic study was done by the ISAAC written questionnaire and additional questions about family number, demographic and socio-economic characteristics of two groups of first and second grade of primary and guidance schools (6-7 y, 13-14 y). Suggested sample size were applied and selected randomly. Results were analyzed by SPSS soft ware by 95% confidence interval. The ISAAC-written questionnaire was completed by a total of 6236 (48.7% were 6-7 and 51/3% were 13-14 years old) schoolchildren. 50.4% of students were girls and 49/6% were boys. The prevalence of diseases and symptoms were as follows: 20.6% had ever wheezing (27.4% in 13-14 years old and 13.4% in 6-7 years old children and it was 21.6% in girls and 19.5% in boys). Among which the estimated mean national 12-month prevalence of wheeze (current wheeze), speech limiting wheeze, exercise wheeze, night cough and physician diagnosed asthma (ever asthma) were respectively 30.1%, 5.4%, 9.4%, 7.3% and 3.3% for the 6-7 year age group and 44.2%, 13.5%, 28.9%, 17.4% and 2.1% for the 13-14 year age group. Current wheeze was higher in Childs and adolescents with family history of smoking and in higher family number. Comparing with regional study the results of this epidemiological survey of asthma in Kermanshah indicate that asthma is more common here, more prevalent in girls than boys and is higher in 13-14 years old than 6-7 years old but sever asthma is much less common. The results may be due to better diagnosis and better control of disease.

Retinoblastoma is the most common intraocular neoplasm in children. Glial tumor of the retina and optic nerve head are considered to be congenital and are therefore classified as hamartomas. Concurrent occurrence of these tumors in one eye is uncommon and by reviewing the studies, a few cases have been reported. We report a 9 years old boy with eye enucleation and concurrent occurrence of retinoblastoma and astrocytoma in one eye as two separate and different masses. Although retinoblastoma and astrocytoma are two distinct tumors and their concurrent occurrence in one eye is rare, concurrent occurrence of these tumors may suggest differentiation of these two tumors from a neuroectodermal primary cell.

Descriptive case report of a 42-year old woman with coetaneous vasculitis, and severe abdominal pain, which was led to diagnostic laparotomy. These presentations are probably as a side effect of Methocarbamol injection. This is the first report according to our literature search (PubMed, google scholar, ISI web of knowledge, ProQuest, MD consult, Science Direct, SCOPUS) about Methocarbamol related vasculitis from 1966 since now. Vasculitis is not a known side effect of Methocarbamol. This case indicates, likely the potential for development of vasculitis with this medication.