Medical Journal of The Islamic Republic of Iran (MJIRI)

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In vivo and in vitro assessments of the response of P. falciparum to chloroquine using WHO standard kits and techniques were carried out in I ran Shahr, Sistan and Baluchestan province of Iran in 1985. In the in vivo assessment, 24 malaria patients treated with chloroquine (25mg/kg over three days) were followed up for one to four weeks. The mean parasite clearance time was 4.3 days and in two cases, recrudescence occurred on the 20th and 22nd day. In the micro in vitro test, from among 87 samples, the growth of the parasites was satisfactory in 11 cases (12.6%) and the development of the parasites continued in the presence of higher doses of chloroquine (1.14 to 6.4 micromol/l blood). In the macro in vitro test, from 28 successful tests, the growth of the parasites continued in the presence of higher doses of chloroquine (1.25 to 3 micromol/l blood) in eight cases (28.5%). The present study showed resistance of P. falciparum to chloroquine in Iran Shahr area, southeastern Iran, and confirmed the results of the preliminary studies carried out in this area in 1983.

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We describe a simple, economical procedure for the emergency determination of serum acetaminophen levels. Prior to color development, free unconjugated acetaminophen was separated from other endogenous compounds containing phenol groups by extracting the acetaminophen into ethyl acetate and hydrolyzed to p-aminophenol by treatment with ho􀁗 acid. A blue color, which can be measured at 635 nm is formed by the addition of 2,5-dimethylphenol (p-xylenol) and sodium periodate, based on the reaction of a primary aromatic amine and a phenolic hydroxyl reagent (Figure 1). This method is linear from 25-600 mg/L. The intra-run precision had day-to-day coefficient variation of between 4.8 and 7.0. The method was correlated with established nitration method of Glynn and Kendal (1975) and the colorimetric method of Liu and Oka (1980) with the correlation coefficient of 0.97 and 0.98 respectively.

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The glucosinolate autolysis products of crushed seeds of DesclIrainia sophia L. (khakeshi) and Brassica napus L. (shelghem) were administered orally to rats in doses representing 8,16 and 32 gm seeds/kg body weight/day at intervals of 10, 20 and sometimes 30 days. Serum T3 and T4 concentrations were reduced in 10 day•autolysate treated animals in a similar fashion to that found with methimazole. The antithyroid effect persisted until day 20, but was weaker than that seen with methimazole. By day 30, serum T3 and T4 concentrations returned to normal in plant treated animals.

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Alkaloids of the aerial parts of chelidonium were extracted in the salt form, and their aqueous solutions were prepared in different concentrations. Rat hepatocytes were obtained by liver perfusion. The alkaloidal solutions were added to suspensions of hepatocytes in petri dishes and the mixtures were incubated. Two types of controls have been used in one type. no alkaloidal extract was added to the media, and in the other, alkaloidal extract of datura which has no cytotoxic activity was added to the hepatocytes. Intracellular LOH activity as well as the activity of leaked LOH into the media, the glucose uptake by the cells, and the glycogen contents of the cells were determined after incubation. The results indicate that 0.05 ml of the alkaloidal solution of chelidonium has no detectable effect on LOH activity during a 240 minute incubation period. With n.1 ml doses, detectable changes were observed only after 240 minutes of incubation. When 0.2 ml doses were used, the intracellular LOH activity was lowered by 3.23,n.71) and 30.XI) percent after nO,120 and 240 minutes of incubation respectively, as compared with the controls. The activity of leaked LOH into the media duration of incubation was increased. Determination of glucose in different media showed that the uptake of this sugar by the hepatocytes incubated with chelidonium decreased as the dose and incubation periods increased. On the other hand, as the glycogen content of the hepatocytes incubated with chelidonium was the same as that of the controls, we believe that the hepatocytes lost their viability in the presence of chelidonium-derived cytotoxic alkaloids.

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The hydroalcoholic extracts of dried ligulate florets of Calendula officinalis L., dried leaves of Plantago major L., and dried aerial parts of Vinca major L. were prepared and used as the main active ingredients of two types of anti-anorectal disease ointments and suppositories. Benzocaine was used in one of the formulations, while a mixture of belladonna dry extract and ephedrine sulfate was used in the other. The effects of both prepared formulations were investigated in patients suffering from anorectal diseases, using relevant placebos for comparison. The results indicated that the prepared drugs were significantly effective in the treatment of anorectal diseases. Formulations containing benzocaine proved to be more effective in patients suffering from hemorrhoids, while formulations containing belladonna dry extract and ephedrine sulfate were more effective in anal fissure and proctitis.

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The hydroalcoholic extracts of dried ligulate florets of Calendula officinalis L., dried leaves of Plantago major L., and dried aerial parts of Vinca major L. were prepared and used as the main active ingredients of two types of anti-anorectal disease ointments and suppositories. Benzocaine was used in one of the formulations, while a mixture of belladonna dry extract and ephedrine sulfate was used in the other. The effects of both prepared formulations were investigated in patients suffering from anorectal diseases, using relevant placebos for comparison. The results indicated that the prepared drugs were significantly effective in the treatment of anorectal diseases. Formulations containing benzocaine proved to be more effective in patients suffering from hemorrhoids, while formulations containing belladonna dry extract and ephedrine sulfate were more effective in anal fissure and proctitis.

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Between April 5, 1988 and Sept. 3, 1992, 204 cases of kidney transplantation were performed using modified Licht's implantation technique and from Sept. 4, 1992 to Sept. 3, 1993, 57 cases were done with Barry's method. Age ranged from 11 to 60 years and in both groups had nearly similar distribution. Kidneys were provided from live donors. Immunosuppressive therapy was similar in all patients and included cyclosporin A, azathioprine and corticosteroids.I-3 After transplantation, all patients were followed and meticulous attention was paid to determining the occurrence of possible urologic complications. Sonography, LV.V. and/or radioisotope scanning was performed as indicated. In this study, 15 patients (7 % ) in the Licht group and one patient (2%) in the Barry group developed urological complications.

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The use of bovine amnion in the urinary tract for reconstructive purposes following ablative surgery in cases of trauma, cancer or infection is now a common practice in urological surgery. To evaluate urinary bladder reconstruction with bovine amniotic membrane (BAM), ten healthy mongrel dogs of either sex weighing 10-40 kg were used. The animals were randomly divided into two groups of five animals each. A piece of the cranial wall of the bladder 5 cm in diameter was resected and replaced with fresh and formalin-preserved BAM respectively. The graft compatibility was evaluated on the basis of clinical, biochemical ultrasonographical, radiological and histopathological changes. Clinically all of the dogs were dull and depressed with blood tinged urine for the first few post-operative days. The biochemical parameters didn't show any significant changes in BUN and creatinine. Ultrasonographic findings consisted of floating masses in the bladder lumen (40%), chronic cystitis (10%), bladder adhesion with adjacent tissues (90%) and radiological findings were lack of normal distension of the graft site (100%) and filling defect (30%). No inflammatory responses and leakage were observed. The regeneration of uroepithelium, and proliferation of granulation tissue, infiltration of lymphoid cells, degenerative changes at the junction of the bladder and graft and heterotopic bone formation were observed. Keeping in view the compatibility of the fresh and preserved BAM, this study showed that it can act as a scaffold for repairing urinary bladder defects in dogs.

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Bacterial and viral triggers are suspected agents in the initial etiology of autoimmune diseases. There are some studies on the etiology of autoimmune disorders which have focused on streptococcal infection and a possible relation with microbial heat shock proteins (hsp) which show significant homology with human heat shock proteins. In addition, some serotypes of streptococci cross-react with human hsp, namely 65kD hsp. Therefore, we have examined isotype specific antibody responses to streptokinase, the antigen released during infection with the common bacterium streptococcus, together with IgG responses to mycobacterium heat shock protein 65 (mhsp 65), a possible superantigen for autoimmune diseases. The levels of these antibodies were examined in patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), thyroiditis and Henoch Schonlein purpura (HSP) and a group of normal controls. Patients with RA showed a statistically significant elevation in levels oflgM anti-streptokinase antibodies compared to the control group (p<0.001). In Henoch Schonlein purpura patients, the levels of lgG and neutralising anti-streptokinase antibodies correlated with the levels of IgG anti-mhsp 65 (r= 0.56, p<0.09 and r= 0.57, p<0.08, respectively). According to these findings, we suggest that streptococcal infections may have an important role in the pathogenesis of rheumatoid arthritis and Henoch Schonlein purpura.

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This case is a 19-year-old soldier who suffered a combined elbow dislocation and posterior Monteggia fracture and dislocation (type II). The ulna fracture was managed by ORIF. The elbow dislocation was managed by closed reduction and immobilization in 900 flexion. The posteriorly dislocated radial head was kept reduced by a transarticular pin. After 6 months elbow and forearm motion was restricted and X-ray revealed heterotopic ossification around the radial head. In further follow up there was no improvement in his range of motion. Treatment of these combined elbow injuries remains challenging.

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In this prospective descriptive study, all patients with acute lower limb ischemia who presented to Shohada Tajrish Hospital (STH) between July 200 1 and July 2003 were analyzed and followed for 6 months. The total population of 109 patients, with no significant difference in sexual distribution had a mean age of 64± 16 years. 23% had AF and 31 % had a history of MI, 'but in the ECG of 30%, no pathologic finding had been detected. Pain and coolness were the two most prevalent symptoms. Only onethird of the patients.had normal sensory and motor examination in their limb and the rest had different degrees of impairment. More than 70% of the patients arrived here after 12 hours from the onset of the symptoms. Fasciotomy was done in 29%, and amputation in 23.5%. The mortality rate was 12.2%. Surgical site infection occurred in 11 % and] 4.1 % underwent re-embolectomy. There was no pseudoaneurysms. The time interval from the onset, sensory and motor findings, and calf tenderness affected the prognosis. Prognosis was better in smokers. The iatrogenic group which consisted of 13.7% of our patient population had the best prognosis (no mortality or morbidity). 4% of the patients who had first undergone embolectomy in other centers, all lost their limbs. In cases of late embolectomies, venotomy and heparin flush has lowered the amputation level without increasing mortality. Early referral by a cardiologist, receiving heparin rapidly and smoking are among the factors which improve prognosis.

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Embolectomy has long been the gold standard for treating limbs acutely threatened by arterial occlusion. Delayed embolectomy has not been investigated adequately due to the belief that accompanying mortality and morbidity render the case futile. Following our previous experience with late arterial repair for leg or knee salvage I we applied the same principle to limbs threatened with prolonged ischemia as a result of missed emboli. In this study the response of patients with delayed embolectomy in a 2-year interval is evaluated. All of the patients who presented to Shohada Tajrish Medical Center, Tehran, Iran between 2001 to 2003 with prolonged ischemia of the lower limb (more than 12 hours) were selected for this study. All underwent embolectomy and prior to reinstitution of blood to the ischemic leg, all those with calf rigor underwent simultaneous venotomy and irrigation of the arterial tree with heparinized solution and were studied accordingly. Of the total 76 patients 20% had muscle rigor on admission who underwent simultaneous venotomy and irrigation. The limb was salvaged in 45% of patients with above knee sensory deficit and 40% of those with above knee motor deficit. The salvage rates of the limb for below knee sensory and motor deficits were 79% and 85% respectively. We were able to save the knee in 20% of our patients. The short term m011ality rate in the whole was 9.2%. We had only one operative mortality in this high risk group of patients & our figures are lower than those reported in the literature, while at the same time we were able to salvage their limbs or knees.

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Regarding the increasing numbers of IV drug addicts, the incidence of infected pseudoaneurysm is increasing. So far, different therapeutic strategies have been tried, but each method has its own drawbacks. Therefore, discovering an appropriate therapeutic method is necessary. 65 patients with infected pseudoaneurysm due to drug injection referred to Shohada Medical Center from Feb 1994 till Oct 2003 were chosen. After obtaining proximal control of the external iliac artery, femoral artery ligation was performed in all patients. The patients were observed for signs and symptoms of ischemia. After primary ligation of the involved artery, acute ischemia occurred in only 6 patients who later underwent extra-anatomical bypass. Only 3 patients underwent amputation. One of them was performed after extra-anatomical bypass and two cases after arterial ligation, as ischemia and gangrene had been present on admission. During patient follow up (minimum 3 months, maximum 3 years and average 12 months), 8 cases of slight claudication (9.3 % ) and 3 cases of severe claudication were reported and the rest have been symptom-free. Various treatments have been used for infected pseudoaneurysm, but none of them are faultless. According to infection of the site and existence of extensive necrosis and inflammatory tissue, anatomical and even non-anatomical bypasses are almost improbable. The results of this study indicate that arterial ligation could be the fIrst and probably the best choice of treatment in such patients with less cost and also without mentionable morbidity or mortality. This procedure must be performed in a vascular surgery center to perform vascular bypass if needed.

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 ABSTRACT

 Background: In 1958, Silverman demonstrated that maintenance ofbody temperature reduces mortality in low birth weight infants. From the early 1990s it was already recognized that adequate environmental warmth was essential in the case of newborns. However, neonatal hypothermia continues to be a significant issue in developing countries.

 Methods: In order to describe the incidence and severity of hypothermia after delivery and to determine the possibility ofrelatedmortalityrisk among neonates in a tettiary nursery, we measured the body temperature on admission of 898 consecutive inborn infants after birth by a low-reading thermometer. Body temperature less than 36.5°C was designated as 'hypothermia' . In such cases the infants were re-warmed according to WHO recommendations. Their body temperature was checked and recorded every hour and their final outcome was noted.

 Results: The overall incidence of hypothermia was 53.2%. 456 (i.e., 50.2% of) infants had mild hypothermia (35> T> 36.5) while 22 (2.5%) of them had moderate to severe hypothermia (T <35°C). The incidence and severity of hypothermia was found to be significantly associated with bitih weight (p= 0.000) and gestational age (p= 0.000). The duration of re-warming was also correlated with birth weight (p= 0.000). Logistic regression analysis showed that the mortality rate of hypothermic neonates is 3.64 times that of the normotherms. The risk of death was higher in the moderate to severe hypothermic groups than in the mild hypothermic infants.

 Conclusion: In our study, the incidence of hypothermia was found to be high with both the incidence and severity to be significantly associated with birth weight and gestational age. The risk of death was recognized to be higher in the hypothermic newborns than non-hypothermic ones.

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Background: The aim of this study is to evaluate the long and short ten postoperative results after the Notaras procedure as a surgical treatment of rectal prolapse in adults. Methods: Thirty-one patients suffering from rectal prolapse who were operated with Notaras posterior mesh rectopexy in Shohada-e-Tajrish hospital between 1991- 2000 were followed up for results and complications and the results were compared with other surgical techniques for this disease. Results: The mortality rate was zero which was ideal in comparison with other studies short ten complications were seen in 20% of cases which had the same prevalence as other abdominal surgeries. Sexual impotence and retrograde ejaculation as long tern1 complications were seen in only one patient (3.22% ).The recurrence rate was zero which stands above nearly all other procedures, also we had recuperation of fecal incontinence in all of our cases and gas incontinence in 92 % of them. The constipation rate has not increased significantly postoperatively (p= 0.8) Conclusion: The Notaras procedure can be used in the management of rectal prolapse with low mortality and recurrence rate but although not contraindicated, may not be appropriate for young and sexually active male patients.

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Gastric liposarcoma is very rare such that only a few cases have been reported to date. We present a case of a 62 - year - old diabetic man who presented with epigastric pain, vomiting, constipation and melena. The physical examination was unremarkable. By computed tomography (CT), a large mass with low attenuation value was seen in the left abdominal cavity. Histologic examination of a gastric biopsy was nondiagnostic. The patient underwent subtotal gastrectomy. On microscopic examination, the tumor showed features of a benign lipoma but with a distinctive capillary network and dense fibrotic areas. In immunohistochemial staining, positive S 100 and negative CD 117 reactions were seen, and less than 1 % Ki67 positive cells could be found. These findings suggested a highly differentiated gastric liposarcoma.

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 Abstract

 Background: The cosmetic result of the surgical scar has long been considered by surgeons as an important factor for patient satisfaction. On the other hand, there has been an old teaching that perfect closure of contaminated wounds increases the rate of infection. We decided to look into this matter and see if this is a fact or a myth.

 Methods: In this prospective randomized study conducted on 200 patients with suppurative or gangrenous appendicitis, we closed the wounds with a cosmetic subcuticular suture of 4/0 nylon in 100 patients and in the other 100 patients the wound was approximated loosely with a few stitches of 3/0 nylon in vertical mattress fashion during a 14-month period.

 Results: There was no significant difference in the rate of wound infection between these two groups.

 Conclusions: This study shows that perfect closure of the wound with subcuticular closure, which gives a very good cosmetic result in comparison with traditional loose closure, does not increase the rate of wound infection.

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 Abstract

 Background: There are a large number of patients with penetrating abdominal trauma who have normal vital signs and negative abdominal examination when referred to trauma centers. Agreat deal of controversy exists between authorities about screening these patients for emergency explorative laparotomy. Many references have reported more than 90% sensitivity for DPL as a diagnostic method to determine whether intraabdominal injuries were present and emergent laparotomy is indicated or not. This study is for reassignment of this sensitivity according to our own evidence.

 Methods: All of the patients with abdominal stab wounds and normal vital signs plus negative abdominal examination who were referred to Shohada-e-Tajrish hospital between March 2004 to December 2005, underwent local wound exploration and those confirmed to have peritoneal penetration, underwent emergency laparotomy. In the operating room and prior to surgery, under general anesthesia, DPL was performed. Then DPL results were compared with laparotomy findings and DPL sensitivity was assigned.

 Results: Of the total number of 34 patients, 8 had a positive DPL and positive laparotomy 2 had a positive DPL and negative laparotomy 8 had negative DPL and positive laparotomy, and 16 patients had negative DPL and negative laparotomy.

 Conclusion: According to our study, DPL sensitivity is much less than mentioned in trauma texts (approximately 50%). So, it is not a valuable tool to discriminate between operative and conservative approaches in penetrating abdominal trauma. We suggest more sensitive modalities. Laparotomy is the most sensitive approach but at the price of a high negative laparotomy rate.

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  Abstract

  Background : Leukemia is one of the mostcommon cancers in children, comprising more than a third of all

  childhood cancers. Newly affected patients in USA are estimated as 10100cases, and if these cases are diagnosed late or proper treatment is not applied, then it can be mortal. Because rapid and proper diagnosis of leukemia based on clinical or medicinal findings (without biopsy) is impossible, we decided to apply artificial neural network for rapid leukemia diagnosis. For this aim we used clinical and medical parameters taken from 131 patients of Sina hospital of Hamadan.

  Methods : We carried out independent sample T-test with SPSS software for 38 parameters. With regard to

  the results of this analysis we selected 8 parameters that had lowest sig for ANN analysis (among parameters, whose sig were less than 0.05). Selected parameters of 131 patients were applied for training network with Levenberg-Marquardt learning algorithm, with learning rate of 0.1.

  Results : Performance of learning was 0.094. The Relationship between the output of trained network for test data and real results of test data was high and the area under ROC curve was 0.967.

  Conclusions : With these results we can conclude that training process was done successfully and accurately. Therefore we can use artificial neural network for rapid and reliable leukemia recognition.

 

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  Background: Heavy exercise cause muscle damage associated with production of inflammatory agents. The purpose of present study was to determine the effect of acute and 14-day Coenzyme Q10 supplementation on inflammatory, blood lactate and muscle damage in male middle-distance runners.

  Methods : Eighteen male middle-distance runners in a randomized and quasi experimental study were allocated into two equal groups: supplement group (n=9, Coenzyme Q10: 5mg/kg/day) and placebo group (n=9, Dextrose: 5mg/kg/day). After acute (1day) and 14-day supplementation, all subjects were participated in a training like running (competitive 3000 meters). Blood samples were obtained in the four phases: one hour before and 18-24 hours after two running protocols. Lactate, serum interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), C-reactive protein (CRP) and creatine kinase (CK) were analyzed. Repeated ANOVA and Bonferunias a post hoc tests were used to determine the changes in four stages. Differences between groups were determined by t-test.

  Results : The results showed that acute and short-term Coenzyme Q10 supplementation had not significant effect on basal parameters. The acute coenzyme Q10 supplementation attenuated only the exercise-induced increase in response of the plasma CRP. The short-term (14-day) coenzyme Q10 supplementation attenuated the exercise-induced increase in response of the lactate, serum interleukin-6, tumor necrosis factor-alpha, and CRP in male middle-distance runners. However, the acute and short-term coenzyme Q10 supplementation had not any significant effect on the exercise-induced increase response of total serum creatine kinase.

  Conclusion : Based on the present results, it can be concluded that the 14-day coenzyme Q10 supplementation (5mg.kg-1.day-1) is more effective than the acute supplementation to overcome the exercise-induced adverse responses in some oxidative, inflammatory and biochemical parameters. Therefore, short-term coenzyme Q10 supplementation is recommended to reduce exercise-induced adverse consequences.