مجله دانشکده پزشکی دانشگاه علوم پزشکی تهران
سال هفتاد و هفتم شماره 10 (پیاپی 226، دی 1398)

Behçet's disease (BD), also known as the Silk Road disease, is a multisystemic and rare inflammatory disorder primarily prevalent in populations along the Mediterranean Sea. Today, BD is defined as a crossroad between autoimmune and auto-inflammatory syndromes. Variety of syndromes including mucocutaneous manifestations such as oral and genital ulcers, papulopustular lesions and erythema nodosum as well as ocular, vascular, gastrointestinal and nervous system occur. The disease etiology has not yet been elaborated, though researchers have reported several reasons that can increase the likelihood of the disease occurrence including a genetic factor, human leukocyte antigen HLA-B51 (B51) antigen, infectious conditions such as herpes simplex virus (HSV), those involved in inflammatory and autoimmune conditions such as imbalance of various cytokines and immune cells levels as well as existence of various gene variants. Among the various immuno dysfunctions that are found in BD, patients have increased neutrophil motility and superoxide production, as well as elevated production of tumor necrosis factor (TNF)-α and decreased production of interleukin-10 (IL-10). Since vasculitis and tissue damage is usually seen with Behcet disease, unusual concentrations of chemokine and adhesion molecules can also help us understand the causes of disease. Among the functional deficiencies of the immune system, increased concentrations of neutrophils and monocytes are of importance leading to an increase in reactive oxygen species (ROS). Behcet's disease has common characteristics with some immune-mediated diseases such as systemic lupus erythematosus (SLE), psoriasis, ankylosing spondylitis, and inflammatory bowel disease (IBD), which suggests that they may share similar etiologies and genes. Genetic and epigenetic modulations have also been proposed as involved in the pathogenesis of BD. Modifications in DNA methylation have been found in BD patient monocytes and lymphocytes, leading to the adverse function of these cells. The positive replies to classical immunosuppressive agents like cyclosporine and azathioprine and participation of autoantigens at the beginning of the illness are the chief BD features that reflect the autoimmune nature of the disorder. This review article attempts to introduce the BD disease and its contributing factors with emphasis on the role of different cells and cytokines based on updated studies.

Micro-Ribonocellic Acids (miRNA) are non-coding nucleic acids that are evolutionally protected and have a length of 24-20 nucleotides. MiRNAs control the expression of genes after transcription by mRNA degradation or translation inhibition. By blocking the oncogenic miRNAs and creating the necessary and functional miRNAs (tumor suppressor), these small regulatory RNAs can have therapeutic applications in cancer. The high mortality from lung cancer highlights the fact that the majority of patients are diagnosed at an advanced stage of the disease. The use of serum biomarkers can help early detection. MiRNA is more stable than mRNA. MiRNA expression in tissue, plasma, sputum, and urine samples can be detected by fixed formulation. In addition, miRNAs are important modulators of gene expression, diagnostic markers, and prognosis. Therefore, in the present study, the expression of miR-137 in the serum of patients with lung cancer was investigated.

In this descriptive and analytical study, 100 serum samples were collected from patients referring to Masih Daneshvari Hospital in Tehran from August 2017 to May 2018. Also, individual and clinical information were collected by a questionnaire and real-time polymerase chain reaction (RT-PCR) was used for the qualitative evaluation of changes in expression of miR-137.

Data showed that there was no significant difference between the expression of miR-137 in serum samples of the first and second stages of the disease. While in the serum of patients with lung cancer who metastasized in the third and fourth stages, miR-137 expression decreased by 3.2 (P=0.42) and 6.8 times (P=0.003), respectively. Based on the results, it can be inferred that the measurement of miR-137 expression in lung cancer patients with concomitant reduction can be a sign of the progression of the disease.

Based on the results of this study, there was a significant relationship between miR-137 expression and lung cancer.

Prostate cancer has been reported as a worldwide important kind of cancer and the second most common cause of cancer-related mortality among men. Prostate-specific antigen (PSA) serum level is one of the most important markers of prostate cancer diagnosis. While PSA level helps predict the risk of prostate cancer development, researchers still looking for ways to increase the accuracy of prognostic models. To increase the specificity of PSA and decrease of unnecessary biopsies and morbidity, PSA-related parameters such as PSA doubling time (PSADT) have been used. In this study, the relationship between this factor and the severity of prostate cancer was evaluated.

In this retrospective study, the data of patients who were subjected to transrectal ultrasound-guided (TRUS) biopsy of the prostate and referred to Imam Khomeini Hospital, Tehran, between 2009 and 2017 were reviewed. We enrolled the men with at least two consecutive elevated PSA level within three months to calculate PSADT. Based on the pathology report, primary and secondary Gleason score (GS) were determined. Correspondingly, considering GS, the patients were divided into two groups with high-grade and low-grade tumor (GS<7 considered as low-grade and GS>7 considered as high-grade tumor).

Totally, 1712 cases of TRUS biopsy of the prostate were studied. Among them, 547 (32.3%) had prostate cancer, of whom 73 cases were eligible based on inclusion criteria and were consented to enroll in the study. According to the data obtained, we found a significant difference in PSADT between the two groups of patients with high-grade and low-grade malignancy (mean±SD PSADT, 9.8±14.2 vs. 16.1±14.9 respectively, P=0.004). Considering the seven months as the cut-off point for PSADT in determining malignancy, there was a significant difference between the two groups according to Fisher's exact test (P=0.01).

In our study, PSADT cut-off of 7 months provided the greatest accuracy for differentiation between low-grade and high-grade malignancy, and PSADT has acceptable accuracy for the diagnosis of high-grade tumors.

dehydration fever is a common problem during the first week of life. This study aimed to compare the characteristics of neonates with fever due to dehydration and healthy infants.

This cross-sectional study was performed on 324 neonates including 120 neonates with normal body temperature and 204 neonates with fever due to dehydration (hyperthermia) referred to Ghaem Hospital in Mashhad, Iran from 2017 to 2019, using a convenience sampling method and a researcher-made questionnaire. Infants presenting with elevated body temperature and having an axillary temperature above or equal to the rectal temperature and with no clinical or laboratory evidence of infection were considered as fever due to dehydration (case group). Infants who were referred for a routine examination or had jaundice but did not require treatment were considered as controls. Infant characteristic (neonatal age, sex, Apgar score, defecation frequency, the first defecation, breastfeeding frequency, urinary frequency, duration of feeding, birth weight, daily weight loss, daily weight loss percentage, lethargy, irritability, mucosal dryness, status fontanelles, hyperthermia, convulsion, apnea, decreased consciousness and  infant hospitalization) and maternal information (age, weight, parity, hospital stay, breast problems, mode of delivery, breastfeeding position, delayed breastfeeding, and pregnancy problems. The data were analyzed using Student’s t-test, Chi-square and SPSS software, version 20 (IBM SPSS, Armonk, NY, USA).

In dehydration fever of newborn, admission weight, frequency and duration of feeding, defecation frequency, maternal age were low, but time to first feeding were high (P<0.05). In fever of dehydration: restlessness, mucosal dryness, fontanel status, seizure, apnea, decreased consciousness, breastfeeding with traditional remedies, inappropriate breastfeeding position, lack of let-down reflex, delayed onset of lactation, breast problems and jaundice were more frequent.

Infants with fever of dehydration were more likely to weight loss, delayed in first feeding, shorter feeding times and lower duration of feeding, higher sodium, urea, creatinine, and blood glucose levels. According to the results of this study, breast problems, inappropriate breastfeeding position, absence of reflux, delayed lactation, less frequent breastfeeding, consumption of breast milk with dextrose, manna, and clay tap were risk factors for dehydration fever.

Sepsis or blood stream infection is a clinical lethal syndrome with severe systemic inflammatory response to infection, if not treated quickly, is associated with dangerous consequences and high morbidity and mortality. The traditional and conventional method for identification of sepsis is blood culture method which is so time-consuming and long that it eliminates the possibility of rapid treatment. Although, new molecular methods, due to their high sensitivity, specificity, and speed, lead to the rapid and accurate and exact detection of bacterial sepsis within only a few hours. The aim of this study was diagnosis of bacteremia in patients with suspected sepsis using amplification of 23S rRNA gene by polymerase chain reaction (PCR).

This cross-sectional study was performed in two clinical and analytical steps at Shahid Beheshti University Hospital in Kashan City, Iran, in twelve months from November 2016 to December 2017. The blood samples of two hundred and fifty-six patients with suspected sepsis admitted to Shahid Beheshti Hospital were studied by PCR method using specific primers of 23S rRNA gene of the bacteria.

The finding of molecular assays using PCR showed that of 256 blood samples that were collected from patients with clinical signs and symptoms of sepsis, 80 (30.2%) diagnosed with bacteremia. Of these patients diagnosed with sepsis, 46 out of 80 (57.5%) were male while 34 out of 80 (42.5%) were female. The most PCR positive results were obtained among patients with diabetes and bedsore as underlying diseases (21.3%). Statistical analysis showed that there was a significant correlation between results of molecular methods by PCR assays and history of antibiotic use. 

Overall, the results of the present study showed that the molecular methods such as polymerase chain reaction using universal 23S rRNA primers is an appropriated test for diagnosis of bacteremia in blood samples of patients with suspected sepsis.

Sexual issues are one of the most important aspects of human life and sexual disorders are issues that can cause some problems in any society. Paying attention to sexual problems can help to deepen the couple's relationship by reducing potential problems. It is also important to note that communication problems between couples and their interplay patterns are effective in shaping sexual behavior between couples and can be a source of sexual behavior disorders for couples. The goal of this research was to determine prevalence of sexual satisfaction of participants and some related factors.

This descriptive-analytical study was conducted on 564 married women between the ages of 18 and 55 under the cover of Zanjan University of Medical Sciences (ZUMJ), Zanjan City, Iran, among whom referring to ZUMJ educational centers from March to August 2012. A simple random sampling method was used. The data collection tool was a 14-item changes in sexual functioning questionnaire (CSFQ-14) completed by the self-efficacy method

The results of this study showed that 79.5% of women studied had some degree of sexual dissatisfaction. The study showed that with increasing age, the degree of dissatisfaction with marital relationships increased from 3.1% in the age group of 14-19 years to 38.2% in the age group of 30-39 years. Also, the rate of sexual dissatisfaction increased with the increase in education, and the highest degree of dissatisfaction was in the group with diploma education and the next stage, those with university education. The results of the study reported the highest proportion of dissatisfaction with sexual relations in the housewife group, and dissatisfaction with sexual relations increased significantly with an increasing number of years of marital life.

According to the results of this study, the prevalence of dissatisfaction especially with respect to sexual orientation among women is higher than expected, which is a threat to the individual and social health of individuals.

Aphanizomenon flos-aquae (AFA) is a type of blue-green algae and contains a source of biological compounds. These microalgae have many beneficial health effects. Recently, fucoidan, known sulfated polysaccharide component of AFA algae, has been claimed to stimulate stem-cell mobilization in animal models. Stem cells play an essential role in tissue repair process. In this study, we use excisional full thickness wound model to investigate the effectiveness of trademark AFA extract on skin wound repair process.

In this experimental study, 21 adult male Wistar rats (weighing 200-250 g) were used and under general anesthesia (intraperitoneally with a ketamine/xylazine solution), two round excisional wounds were created under sterile conditions by a 6 mm punch on the dorsum (paravertebral area) of all rats. Animals were randomly assigned into 3 groups. In groups 1 and 2 (SE-200, SE-400), StemEnhance© (StemTech Health Sciences Inc. British Columbia, Canada) were given respectively 200 or 400 mg/kg by oral gavage once daily and in group 3 (Sham), distilled water (DW) was given to all subjects. Post-wounding gavage of StemEnhance or DW started from 1st day and continued to 7th day. The wound surface area was monitored daily by digital camera and assessed by Image Tool™ software, version 3.5 (UTHSCSA, San Antonio, TX, USA). At 9th day post-wounding animals were sacrificed and repaired tissues were harvested by and assessed by a 8 mm punch. Repaired skin areas were processed for hematoxylin and eosin (H&E). Histopathological parameters of healing including inflammatory cell infiltration, angiogenesis, and fibroblast count were assessed by pathologist. Our study was conducted in the Physiology Department of Medical School, Bushehr University of Medical Sciences, Iran, from October 2016 to March 2016.

Macroscopic imaging of wound area revealed that there was statistically significant difference in wound area reduction between SE-200 group and sham group on day 6 post wounding (P=0.032). Moreover, histological findings showed that the number of neutrophils, macrophages, fibroblasts, and microvessel density decreased in both StemEnhace-treated groups. There were no significant differences between two treatment groups.

According to the obtained results it seems that the extract of Aphanizomenon flos-aquae algae positively affects wound healing process by ameliorating inflammatory response in early healing phases.

Medical malpractice is one of the most important legal issues in medicine committed more or less by physicians. The medical staff has inadequate or deficient awareness of medical errors and their importance. Therefore, this study investigated the frequency of medical malpractices/errors resulting in death in files referred to the Iranian Legal Medicine Organization.

The study population in this descriptive cross-sectional research consisted of all doctors who had been sued in Tehran's Legal Medicine Organization (Forensic Committees of Tehran Province) from the first day of July 2018 to the end of December 2018. The study was carried out in and under supervision and support of the Legal Medicine Research Center. Data were collected using a checklist of the files from Tehran's Legal Medicine Organization.

The results showed that most medical errors are of organizational types. Major medical failures occur in university-affiliated hospitals among the male technical staff aged 41-50 years with a work experience less than 6 years. Most complaints were recorded against general practitioners, general surgeons, and anesthesiologists, respectively. The smallest percentage of the complaints related to orthopedics, urologists, and ear, nose, and throat (ENT) specialists.

The results of the study indicated that most of medical failures have of an organizational nature and occur in university hospitals among male technical officials who are in the fifth decade of life with a low work experience. So, paying attention to these issues can help the better selection of technical officials. The technical authorities of the hospitals must be careful about the responsibilities given to them. In order to reduce the failure of the technical authorities of the hospitals, doctors with a high standard of service should be appointed as technical officers. These doctors ought to possess legal knowledge and be familiar with the course of complaints filed in the judiciary.

AIDS is an emerging disease, and despite the fact that it has not been recognized for the first half-century since its inception, it has been known as a century-old disaster. This disease, by proliferation in immune cells and ultimately by weakening the immune system, makes people vulnerable to diseases. Our study seeks to examine existing cases of HIV/AIDS patients in East Azerbaijan province in Iran and provides useful guidance for patient diagnosis, treatment, and care.

This is a descriptive-analytic study in which the target group includes all HIV-positive or AIDS patients identified or reported from 2004 to 2014 in Tabriz Medical Sciences or Health Centers of East Azerbaijan province. The demographic information of all patients were recorded by a researcher-made questionnaire during visiting the disease-management counseling centers. All data including transmission of the illness (including all possible ways), the diagnostic date, the onset of treatment and the date of death were collected, and then entered into the software Stata, version 11.0 (Stata Corp., College Station, TX, USA). The information were imported in the ArcGIS software, version 10.7.1 (ESRI Inc., Redlands, CA, USA), maps were created, and geographic and spatial data were analyzed.

According to the results of this study, most patients with 89.9% were male, 28.9% were under the age of 36 years, 32.3% had elementary education, and the most common way of transmission with 42.3% is through the shared infusion.

According to the results of this study, the highest prevalence of AIDS in East Azerbaijan province was observed in men under the age of 36 years and primary and lower secondary education in Tabriz and Maragheh cities.

Herpes simplex virus (HSV) encephalitis is the most common cause of sporadic encephalitis, with significant morbidity and mortality that are effectively reduced by antiviral treatment. Herpes simplex infection in pregnant women rarely results in encephalitis. The most common symptoms of a pregnant woman with herpes simplex infection are colds and skin vesicles. Herpetic encephalitis occurs during pregnancy in the third trimester in 60% of cases and with less prevalence in the second trimester. Among HSVs most, HSV-1 causes encephalitis. Early diagnosis and timely treatment are important as mortality decreases from 70% to 20-30%. This case report, reviews a pregnant woman with a diagnosis of herpes encephalitis due to seizure and consciousness disorder, which was negative in polymerase chain reaction (PCR) assay and diagnostic studies.

The patient was a 23-year-old woman with a gestational age of 29 weeks who presented with fever, headache, delirium, and cognitive impairment three days prior to admission following seizure. Early magnetic resonance imaging (MRI) showed an increase in the cortical signal in the temporal lobe and PCR assay for the detection of herpes virus was negative. Magnetic resonance venography also showed an increase in the left maxillary sinus with differential diagnosis of herpetic encephalitis. Considering the symptoms of the patient with a strong suspicion of herpes simplex encephalitis, the patient was treated with acyclovir, which was associated with improvement of clinical symptoms. Finally, normal delivery was performed after 36 weeks of gestation.

Given that herpes simplex virus encephalitis is a rare and potentially dangerous and complicated disease, it is imperative for a pregnant patient with atypical symptoms to be identified with an appropriate diagnostic and therapeutic measures.