Medical Journal of The Islamic Republic of Iran (MJIRI)

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30 cases of obstructing proximal ureteral stones at the level of L3-L5 which could not be pushed back into the pelvis and passed by a guide wire under epidural anesthesia, were removed percutaneously with the rigid ureteroscope. Multiple stones in one ureter, bilateral ureteral stones and a ureteral stone of a solitary kidney were removed successfully in one session showing the reliability and efficacy of this procedure.

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In a period of nine months, 225 strains of Gram-negative bacilli isolated from burns were identified by a variety of tests in two burn centers in Tehran. The most common species were Pseudomonas aeruginosa, Pseudomonas fluorescens, Escherichia coli, Enterobacter agglomerans, Enterobacter cloacae and Klebsiella pneumoniae. Many strains of acinetobacter spp, providencia spp, proteus spp, serratia spp, and Citrobacter freundii were also isolated. All the strains were tested for sensitivity to bacitracin, carbenicillin colistin, cephalothin, chloramphenicol, gentamicin, kanamycin, lincomycin, trimethoprim and tetracycline. The proportion of strains sensitive and resistant to different antibacterial agents varied widely with species of bacteria. Most of the strains except pseudomonas spp were sensitive to few of the antibacterial agents and posed no problem with relation to treatment. Pseudomonas spp. were 100% sensitive to polymyxin B and colistin (polymyxin E ) and 90% resistant to gentamicin and carbenicillin.

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One of the promising aspects of the immunological research on chemical war gas is to investigate the immunogenicity of some hazardous compounds such as mustard gas. Mustard gas is categorized as a "hapten" based on its physical and chemical properties. Haptenic chemicals which do not possess immunogenicity could be immunogenic experimentally when conjugated with a suitable protein carrier. To do so, mustard gas was coupled to a protein carrier and injected to an animal model (rabbit). After hyperimmunization, specific antibodies were obtained through special purification procedures and used in different immunological tests. It was observed that there are two different groups of antibody populations, one against the haptenic group and the other towards the protein carrier.

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In this study, we have investigated the proliferative response of human dermal fibroblasts isolated from normal and psoriatic individuals to different cytokines. We found that IL-1, TNF (α) and EGF are stimulatory whereas IFN « and 1 both showed inhibitory activity on fibroblast proliferation. IL-6 a more recently described cytokine, showed no detectable effects on cell proliferation. Investigating the combined effects of these mediators on fibroblasts, we found that while EG F has additive effects on IL-1 orTNF (α) activated cells, both IFNs showed suppressive activity on the cell proliferation. There was no statistical difference in proliferative response of fibroblasts isolated from normal and psoriatic individuals. The significance of these findings is discussed,

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Vitrectomy was performed on 25 eyes in 21 patients with chronic uveitis from various etiologies. Postoperative follow up averaged 22.8 months with visual improvement in 24 of 25 eyes. In this retrospective study, the techniques employed and the beneficial effect of vitrectomy alone or vitrectomy combined with cataract surgery (Iensectomy in most cases) on improving vision and decreasing the number and severity of recurrent attacks of uveitis are reviewed. Also, the indications of surgery, the effect of the surgical procedure on intraocular pressure, the prognostic factors and the management of complications are discussed.

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The relative importance of systolic (SBP) versus diastolic blood pressure (DBP) and other combinations of SBP and DBP in the prediction of stroke have been re-examined in a long term cohort study of 10,541 men and women aged 45-64 in West Scotland. During a mean follow-up of 11.6 years 1, 616 deaths occurred, among which 160 (9.9% 80 male, 80 female) were due to stroke. In a multiple logistic regression (MLR) model the predictive values of SBP, DBP, mean arterial pressure (MAP), mean arterial index (MAl) and pulse pressure (PP) were examined in relation to stroke mortality after adjustment for age, body mass index (BMI), casual blood glucose, serum cholesterol, and cigarette smoking at entry. All blood pressure measures were associated with stroke mortality in females the risk of stroke mortality was more strongly associated with DBP in males SSP and DBP have the same predictive influence on stroke mortality and the MAP and MAl have stronger associations with it than either SBP and DBP. PP is associated with the least excess risk in both genders.

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One way to confront chemical warfare in order to reduce their harmful effects, is to use the body's defense mechanisms. In order to do so firstly mustard gas (HD) was injected in an animal model in the form of an immunogen and the induced humoral immune response was investigated by two different immunological methods such as the Ouchterlony test and a new liquid phase fluoroimmunoassay. 7lt was proved that the animal model had produced specific antibodies against mustard gas which could specifically interact with the chemical gas.

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To study the zinc concentration differential in diabetic patients compared with non-diabetics and borderline subjects in a sample of two hundred individuals under investigation, we gathered information on history and duration of diabetes as well as type of treatment and diet. In addition, capillary blood glucose and serum zinc concentrations were measured.The serum zinc level was higher in diabetic patients compared to borderline and non-diabetics. The higher level of zinc in diabetic patients may be due to their change of energy source and the lower phytate and higher zinc content of their new diets which consequently reduce the effect of this substance on zinc absorption. The reason for lower levels of zinc in the borderline subjects is not presently clear and needs further investigation.

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The relative importance of systolic blood pressure (SBP) versus diastolic blood pressure (DBP) in predicting the risk of ischaemic heart disease (IHD) mortality is controversial. We have re-examined SBP compared to D BP and other combinations of SBP and D BP in predicting the risk of IHD mortality in a long-term cohort study oflO,541 men and women in the West of Scotland. During a mean follow-up of 11.6 years, 1,616 deaths occurred, among which 553 (34% 327 male, 181 female) were caused by IHD. In a multiple logistic regression (MLR) model the predictive values of SBP, DBP, mean arterial pressure (MAP), mean arterial index (MAl), and pulse pressure (PP) were examined in relation to IHD mortality after adjustment for age, body mass index (BMI), casual blood glucose, serum cholesterol and cigarette smoking at entry. All blood pressure measures were associated with IHD mortality in females the risk of IHD deaths was more strongly associated with SBP in males SBP and DBP had similar predictive strength.

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Normal full-term infants were followed by serial transcutaneous bilirubinometry over the first week of life. The pattern of physiologic jaundice in our population was similar to that shown for white infants. Mean maximum bilirubin peak was seen on day four of life and was also similar to that shown for American white infants. The incidence of non physiologic hyperbilirubinemia defined as 2 SD above the mean maximum peak was about three times that reported for white infants, but similar to that reported for orientll .' populations. Oxytocin and the type of delivery did not seem to affect this high incidence. The role of breast feeding and G6PD deficiency needs to be further defined.

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In early 1990, an outbreak of measles occurred in Kerman, (population 257, 284) Iran. Overall, 475 cases were identified and four died (case fatality ratio 5.4 per thousand). Illness was limited primarily to children below 15 years of age 166 (22.3%) were in children under five, 573 (77%) between 5-14 and six (0.8%) above 15 years of age. The age of the cases ranged from five months to 35 years. The agespecific attack rates were 3.9, 1.8,7.3 and 2.8 per 1,000 for children under I, 1-4, 5-9, and 10-14 years of age, respectively. Overall, 14 (1.9%) children with measles were hospitalized for severe complications which consisted mainly of pneumonia, otitis and gastroenteritis. Based on 745 cases with an immunization record vaccine efficacy was calculated at 88%, indicating a slight problem with the cold chain or the vaccine. The outbreak has been primarily related to low immunization coverage during the last 10 years. This outbreak again indicates the need to improve vaccine coverage with the AIK -C existing vaccine, and also the advisability of a revaccination programme at school age will need to be considered.

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Incubation of rat hepatocytes with epinephrine inhibited alanine aminotransferase (ALT) (80%) and aspartate aminotransferase (AST) (53%) activities with no effect on lactate dehydrogenase (LDH) activity. Injection of epinephrine caused a progressive increase with time in hepatic LDH activity, being 52% at 24 h. Preinjection with propranolol eliminated the hormone effect and caused further inhibition (28%) of the enzyme activity. Liver ALT activity in ephinephrine-treated animals decreased by 37% at 24 h, "_.er which it rose again to the control levels at 48 h. Propranolol raised epinephrine-induced enzyme inhibition up to 53%. Phentolamine, however, abolished the inhibitory effect. The activity of hepatic AST was not affected by epinephrine. Plasma ALT and LDH activity increased in epinephrine injected rats by 55% and 75%, respectively, but AST activity did not change. Propranolol alone stimulated serum ALT (41 %) and AST (21 %) activities. The data suggest that epinephrine exerts its effects on these enzymes through a-receptor activation and/or via the cell lesion resulting in the change of intra- and extracellular enzyme levels.

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Evaluation of a malaria screening program was carried out in two screened Afghan refugee camps in Bardsir and Rafsanjan and compared to non-screened Afghan refugees within Kerman, as well as refugees with malaria diagnosed by Communicable Disease Control (CDC) Laboratories in Kennan and Rafsanjan, by parasitological blood examinations. The study involved 456 residents of two refugee camps and random samples of 512 refugees in the Kerman Bus Tenninal and 1300 persons referred to Kerman and Rafsanjan CDC laboratories, aged from 1 to 70 years. Malaria was found in 403 (l7.H%) of the persons examined. Plasmodium vivax was identified in XS.I %, Plasmodiumfalciparum in 13.6% and mixed infection due to both of these species was found in 1.3% of the cases. The prevalence of parasitemia in screened camps was 4 times lower than non-screened active cases detected. A comparison of age-specific rates of malaria in screened and non-screened Afghan refugees indicated that screening programs are highly effective. The Afghan refugees bring high infection loads with them from outside and cause an out break of the infection, particularly in areas of [ran where malaria is under control. Therefore, malaria control in Afghan refugees in Iran should be primarily based on curative as well as preventive measures.

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By application of modern recombinant DNA technology, especially the polymerase chain reaction (PCR)/dot-blot hybridization techniques, we have investigated the molecular basis of β-thalassemia from four different regions of Iran: central, south-east, south and north. In this study, the DNA samples were isolated from patients and for the identification of the mutations, the 6 oligonucleotide probes for the mutations of IVS.1/nt. 110, .lVS.1/nt.6, IVS.1/nt.1 , nonsense codon 39, frameshift codon 8 and IVS. 2/nt.1 were selected with respect to their relative frequency in the neighbouring country, Turkey. Four mutations accounted for76.2% and of these, the most frequent was the nonsense codon 39 mutation, which accounts for 60.3% of the β-thalassemia alleles tested. The remainder, in decreasing order of frequency, wereframeshift codon 8(9.5%), lVS. 1/nt.6 (4.8%) and IVS.1/nt.11O(1.6%). No hybridization was observed with the probes corresponding to the mutations of rvS.I/nt I (0/ A) and rvS.2/nt.1 (0/ A). These results also revealed that the distributions of different types of mutations were different in the four regions. This information and the introduction to the methodology used in this study will facilitate the prenatal diagnosis of the disease in Iran.

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The prevalence and factors influencing the prevalence and severity of dysmenorrhea were studied in 768 female university students aged from 17.S to 44.2 years enrolled at the Kerman University of Medical Sciences and two teachers' training colleges. The overall prevalence of dysmenorrhea in this population was 72% 10.2% reported severe dysmenorrhea. The overall prevalence as well as the prevalence of severe dysmenorrhea decreased with age. A statistically significant association (P<0.05) was found between an early age of menarche and an increase in the severity of dysmenorrhea. There was also a statistically significant association (P<0.01) between the prevalence and severity of dysmenorrhea and marriage, and married women had significantly less dysmenorrhea (either in severity or prevalence) compared to non-married subjects. The prevalence and severity of dysmenorrhea was not affected by factors such as height, weight, body mass index, region of residence, gynecological age, regularity of menstrual cycles, or duration or amount of menstrual bleeding.

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The study was conducted to determine the prevalence of goiter and hypothyroidism in two groups of the population at various stages of social development and to determine its association with malnutrition and dietary intake. Aboriginal inhabitants (Orang Asli), a resettlement rural village (Betau Post), a traditional village in the jungle (Lanai Post) and a modern village settlement near Kuala Lumpur City (Bukit Lanjan) were selected. Three Malay villages with almost similar environments were selected for comparison. The study included house to house interviews, anthropometric, clinical and biochemical assessment of 1419 samples and estimation of iodine concentration in the drinking water of the areas studied. The World Health Organization criteria for classification of goiter were used. It was found that all Orang Asli settlements in rural areas were iodine deficient. The prevalence of goiter and hypothyroidism were higher among Orang Asli at all ages compared to Malays, and increased with remoteness of the areas (20-70% and 20- 30% respectively). Apart from iodine deficiency, a high intake of cassava and deficient intake of sea foods and protein diets were also significantly related with high prevalence of goiter. Among children, goiter was associated with the level of thyroid stimulating hormone (TSH) whereas among adults, body mass index (BM!), triiodothyronine and thyroxine levels were predictors for the presence of goiter. In conclusion, goiter and hypothyroidism were more common among Orang Asli compared to Malays, and were associated with rural location and poverty.

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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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Intraoperative radiation therapy (IORT) is a multidisciplinary approach in which residual tumors or tumor beds are directly irradiated during a surgical procedure. To evaluate its efficacy, from 1985, we conducted a prospective study including non-metastatic gastric adenocarcinoma treated by surgery, IORT (15 Grays) and postoperative external beam radiotherapy (44 Grays). Up to 1993, 51 cases of gastric adenocarcinoma (20 pN0 and 31 pN1-2) have been included in the study. Mortality and morbidity rates were not different from those of surgery alone. The overall 5 year survival rate was 59.1 %, and the pN1N2 5 year survival rate was 50.6'70. These promising results are comparable with those of Asian randomized studies which demonstrate the possible value of IORT in the treatment of gastric adenocarcinoma.

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The partition coefficients (P-values) of certain new potential, stereoselective, reversible, long-acting local anesthetics have been determined in an n-octanol/ phosphate buffer system. These are derivatives of 2-phenoxyethyldialkylamine hydrochloride, and almost all of them are readily soluble in water. Their aqueous solutions have shown different absorption maxima, and these have been used quantitatively to determine the concentration of solute in aqueous phase using the Beer-Lambert equation and the calibration curve, which has been a straight line within the test concentrations. The values of P have been calculated as the ratio of the concentration of solute in the octanol phase divided by the concentration in the aqueous phase the former value has been obtained from mass balance. The mass balance is confirmed by obtaining the absorption measurements of the organic phase. The guinea pig intradermal wheal test has been used to determine the anesthetic properties of the test agents. They have exhibited better anesthetic profiles than those of the bupivacaine standard. Moreover, they have displayed no apparent side-effects neither locally nor systemically. Although there has been no sharp general correlation between the P-values and duration of action (WT), it is observed, in many cases, that derivatives with low P-values have shorter WT than those with high P-values. Therefore, it seems that the duration of action of these compounds is not influenced only by this property, i.e. P-values, and other factors such as physicochemical, pharmacokinetic, and pharmacodynamic parameters as well as non-specific binding characteristics at adjacent tissues are also involved. Thus, the action of these new compounds is due to the molecule as a whole and not to any one particular physical or chemical property. Furthermore, these are reversible and stereoselective agents.

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Several epidemiological studies have reported that passive smoking (PS) is a public health hazard and perhaps increases the risk of heart disease. This study evaluated the relationship between female coronary heart disease and PS among married women who described themselves as non-smokers in an area of south-east Iran. Using household exposure to tobacco smoke as an estimate of PS, a hospitalbased case-control study of CHD was conducted in Kerman, Iran. We interviewed 200 married female CHD cases, aged 42-84 years (mean [standard error, SE] 60.0 [0.5]) and 400 hospital-based controls aged 42-85 (mean [SE] 60.3 [0.4]). The controls were non-CHD patients, selected from the same hospital as the cases, and matched for marital status and age (±5 years). All of the cases and controls had never smoked. Information on PS was collected for each person. The prevalence of PS at home was 39% for cases and 32.3% for controls. The corresponding prevalence rates for PS at work were 1.5% and 0.8%. Household PS increases the risk of female CHD, but this increase was not statistic all y significant. Compared to non-smokers, exposure to husband's smoking increases the risk by about 40% (odds ratio (OR) 1.40, 95% confidence interval (CI): 0.96-2.05), although no trends were observed with the number of years of exposure. The OR increases with an increase in PS (p<0.05). The odds ratio for PS at work did not suggest an increased risk. The results suggest that passive exposure to cigarette smoke may have a deleterious effect on the health of non-smokers and that married non-smoking women may be at an increased risk of developing CHD through passive exposure to their husband's cigarette smoke.