Tehran University Medical Journal

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Mycosis Fungoides (MF) is a cutaneous T-cell lymphoma (2,5). Alopecia is rarely seen in this disease, and the reported cases are in the form of follicular mucinosis (1,2,4). In this case report a patient is presented whose lesions all showed alopecia without mucinosis. Furthermore there was a patch of alopecia without any epidermal changes, which was clinicaly identical with alopecia areata, and histologically identical with MF. After six months of treatment there is regrowth of almost normal hair on all of the lesions

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During one year survey, 77 psoriatic patients were hospitalized in the dermatology department of Razi Hospital. This comprised 19% of admitted patients in this period. 29% (n=22) of psoriatic patients had previous history of hospitalization. On admission, the mean age of patients was 32.8 years, the mean and peak age of disease onset were 26.46 and between 11-20 years, respectively. 14% (n=10) of the patients had a family history of psoriasis and 70% (n=7) of those with a positive family history had their age of onset under 20 years. Involvement of different regions was as follows: Scalp: 88% (n=68), nails: 53% (n=41) and joints (arthritis): 10% (n=8). Psoriasis was associated with scrotal tongue in 19% (n=13) and with geographic tongue in 10% (n=8) of patients. Regarding the medical treatment, the drugs which were used most frequently were tigason in 34% (n=41) and ditranol in 22% (n=26) of the cases. The mean duration of hospitalization was 39.29 days and most patients were discharged from the hospital in a good condition without any serious complication. During this period 9% of patients had a relapse of their disease.

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Tuberculos Gumma is one of the various clinical manifestations of cutaneous TB that is characterized by non tender, undolent subcutaneous nodules which progressively involve the skin and take the appearance of an ulcer. In this article, we present two young patients, affected with tuberculos gumma. One of them, presented with multiple abcesses on the face and extremities, associated with pulmonary involvement and arthritis of the left wrist. The other one had just one subcutaneous nodule on the face, with positive familial history of pulmonary TB and tuberculos lymphadenitis in her two brothers. Both patients were cured with anti TB treatments

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Epidermolysis bullosa (EB) is the term applied to a group of disorders whose common primary feature is the formation of blisters following trivial trauma. Hereditary EB comprises 3 major classes: simplex, junctional and dystrophic, and includes more than 23 phenotypes. The albopapuloid pasini variant of dominant dystrophic EB is characterized by a distinctive clinical appearance. In this article, we report this disease in three members of a family (father and two sons).

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Kindler syndrome is characterized by acral blister formation in infancy and childhood, poikiloderma and cutaneous atrophy. Undoubtedly, similarities of the clinical features exist between Kindler syndrome and Epidermolysis bullosa simplex with mottled pigmentation. In this article, we report 3 patients with Kindler syndrome. Until the Bullous component of Kindler syndrome is more completely understood, we believe that this disorder should continue to be classified as a separate disease.

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Superficial mycosis of the skin is one of the most prevalent human infections. Within these infections, tinea pedis and tinea cruris have been studied. Different aetiologic causes play role in these infections which the most important of them are Trichophyton rubrum, Trichophyton Mentagrophyte and Epidermophyton floccosum. Prevalence arrangement of these causes are defferent in societies. This study is a case series study which in the course of this period 42 affected patients 0 tinea pedis and 40 affected patients to tinea cruris have been studied. From patients with doubtfull clinical lesion, whom have reffered to Razi Hospital within the first six months of the year 77, smear and culture were provided and in the meanwhile for consideration of possible association of Dermatophytoses in these two location in cases of clinical doubt to tinea pedis among the affected patients to tinea cruris, smear and culture wase made and it wase observed that 40 of affected patients to tinea cruris, 4 patients simultaneously have tinea pedis (10%). In this study also, risk factors of tinea pedis and tinea cruris have been studied. Etiologic causes in tinea pedis in this study with respect to arrangment are: T.Ment, T.rubrum and then Epid.floccosum and the causes of thinea cruris with respect to arrangment are: Epid.floccosum, T.rubrum and then T.Ment. In this study foot and groin Etiologic factors have been considered, it was observed that the pattern of their etiologic causes in Iran with respect to other countries are different.

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Background: This study investigated reliability and validity of the Persian version of Impact of Event Scale-Revised (IES-R) in a sample of people from Bam after the 2003 earthquake.

Methods: The study was performed in 272 people, 4 months after Bam earthquake. For evaluating internal consistency we used α chronbach and for test-retest reliability (after 3 weeks) we used Pearson correlation coefficient. For assessing convergent validity, 50 samples completed GHQ 28(General Health Questionnaire 28) in addition to IES-R.

Results: The Persian version of IES-R has good internal consistency (α chronbach=0.67-0.87) and test-retest reliability (r=0.8-0.98 , P<0.001) and also good convergent validity. Finally, factor analysis was conducted and 3 -factor solution which explained 41.6% of the variance, was retained.

 Conclusion: In spite of good internal consistency, test-retest reliability and convergent validity regarding the result of factor analysis, there is necessity for changing some items corresponding to the Iranian culture.

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Background: Depressive disorders in children and adolescents are chronic and highly morbid. Few studies are carried out on antidepressant drugs for depressed youths, especially specific noradrenergic agents. Reboxetine is a selective norepinephrine reuptake inhibitor. This study was designed to evaluate the effect of reboxetine in childhood and adolescent depression.

Methods: Twenty patients of both genders, aged 7-17 years old, with major depressive or dysthymic disorders, as classified by the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), participated in an 8-week clinical trial before-after study of reboxetine. Clinical semistructured interviews, based on the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Aged Children (K-SADS), were carried out. Reboxtine was initiated at a dose of 1 mg/day and increased up to 6 mg/day. Patients were assessed for changes in: depressive symptoms using the Children's Depression Inventory (CDI) and global functioning by the Children's Global Assessment Scale (C-GAS). Side effect questionnaire was also administered.

Results: There was a significant decrease in the ineffectiveness subscale (C factor) of CDI (p=0.006). Although the CDI scores decreased by 32.69%, this change was not significant (p=0.39). No significant change in C-GAS (p=0.2) was observed. Adverse effects were relatively mild to moderate and transient. The most common adverse effects were decreased appetite and sedation.

Conclusions: Reboxetine is relatively well tolerated and improves feelings of ineffectiveness among depressed children and adolescents however it does not improve all depressive symptoms. Double-blind, placebo and active comparator controlled studies and larger sample sizes are indicated.

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Background: Attention Deficit Hyperactivity Disorder (ADHD) is a common psychiatric disorder among children and adolescents. This disorder causes difficulties in academic, behavioral, emotional, social and family performance. Stimulants show robust efficacy and a good safety profile in children with this disorder, but a significant percent of ADHD children do not respond adequately or cannot tolerate the associated adverse effects with stimulants. Such difficulties highlight the need for alternative safe and effective medications in the treatment of this disorder. This open-label study assessed the effectiveness of reboxetine, a selective norepinephrine reuptake inhibitor, in children and adolescents with attention deficit hyperactivity disorder (ADHD).
Methods: Fifteen child and adolescent outpatients, aged 7 to 16 (Mean± SD=9.72±2.71) years, diagnosed with ADHD were enrolled in a six open-label study with reboxetine 4-6 mg/d. The principal measure of the outcome was the teacher and parent Attention Deficit Hyperactive Disorder Rating Scale (ADHD Rating Scale). Patients were assessed by a child psychiatrist at baseline, 2, 4 and 6 weeks of the medication started. Side effects questionnaire was used to detect side effects of reboxetine. Repeated measures Analysis of variance (ANOVA) was done for comparison of Teacher and Parent ADHD Rating Scale scores during the intervention.
Results: Twelve of 15 (80%) participants completed the treatment protocol. A significant decrease in ADHD symptoms on teacher (p=0.04) and parent (p=0.003) ADHD rating scale was noted. Adverse effects were mild to moderate in severity. The most common adverse effects were drowsiness/sedation and appetite decrease.
Conclusion: The results of the current study suggest the effectiveness of reboxetine in the treatment of ADHD in children and adolescents. Double-blind, placebo-controlled studies and larger sample size with long duration of intervention are indicated to rigorously test the efficacy of reboxetine in ADHD. It is important that future studies complete our knowledge about safety and side effects of reboxetine.

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Background: Diabetes mellitus is a common endocrine disorder with increasing prevalence. Diabetic foot is a costly and serious chronic complication of diabetes mellitus that if it does not controlled will cause severe morbidities in patients with diabetes mellitus. Based on the study of center of management and prevention of diseases about 230 milliard Rials were expended for direct costs of diabetes annually and instruction of patients about protection of foots in some countries, decrease rate of amputation between 44 to 85% and infact instruction of diabetic patients is the base of treatment and prevention of complications of diabetes mellitus.
Methods: In a cross sectional study with attention to one of important causes of refer of diabetic patients to hospitals diabetic ulcers of foots, we discuss about risk factors and ways of treatment and prevention of them. The study done on patients admitted in endocrinology unit of Imam Khomeini hospital. For analysis we used SPSS 11.5 program. Although the costs for patients are calculated.
Results: In this study from 245 patients that admitted because of diabetic foot (63.26% male and 36.73% female), 74 patients have done amputation. From these 74 patients (30.2%), 65.67% were male and 24.32% were female. Age average was 58.24+12.29 years And the mean duration of DM was 10.56+8.32 years and the past history of diabetic foot was present in 45.95% of them. Past history of smoking was present in 66.21% of patients.
Conclusion: From 245 patients from 1996 to 2001 that admitted because of diabetic foot, 155 patients (63.26%) were male and 90 patients (36.73%) were female. From this numbers the most of them were in 60-70 years old and the least were 20-30 years old. Gender of most of them was male. For treatment of this complication a lot of costs were necessary and instruction of patients decrease this complications.

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Background: Mongolian spots are the most frequently encountered pigmented lesions in newborns. The patches appear at birth or shortly there after, rarely later the MS in term newborns in always present at birth. The shape of MS was commonly either irregular or indefinite, with its borders gradually blending with the surrounding skin. The color most frequently observed in all ethnic groups was blue- green. For the Negro population the color was commonly greenish– blue the next most common color in the total population was blue- gray. Brown coloration in the form of brown specks on a back ground of blue was present in ten percent Negro Newborns. The most common location is the sacragluteal region, which frequently is the only part affected. MS occasionally are found in the extremities in those cases with extensive involvement, particularly in the shoulders. The presence of MS in the head or neck has been called aberrant Mongolian spot. The macula has been variously described as irregularly round, oval, roughly triangular, heart shaped, resembling a tennis racket, and angular. The size may vary from a dot of a few millimeters to six or more centimeters in diameter the mark of ten disappears during the first or second year of life. Those marks distant from the sacral region are said to be more apt to persist than the typical sacral one and the buttocks was the site of predilection. Its incidence varies from over 80% in Asians (Mongolian and Chinese) to 10% of white infants. Only a limited number of studies were carried out in Iran. Our objective was to study Mongolian spots incidence and common locations in newborns at Shariati hospital.
Methods: During 2004-06, 2305 consecutive newborns were examined at Shariati hospital. Diagnosis of Mongolian spot was based on clinical impression with Pediatricians.
Results: Mongolian spot was observed in 11.4% neonates. The most frequent site of involvement is the sacral, followed by the gluteal area. Mongolian spot did not show a significant relationship to sex, gestational age, mother’s age groups and delivery type (p>0.05) but the relationship between Mongolian spot and birth weight groups was significant (p<0.05).
Conclusion: Incidence of mongolian spots in our patients was simila

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 There are limited published investigations about adherence to antiretroviral and its determinants. Many determinants influence on adherence to therapy. The effects of some determinants on adherence are controversial. More studies are needed to be fulfilled about adherence and its determinants to compile strategies. Key to the success of antiretroviral therapies is the ability and willingness of HIV-positive individuals to adhere to antiretroviral regimens. There are different definitions for full adherence. In the most studies, adherence is defined as taking ≥95% of prescribed medication. Adherence rate needs to be >95% to prevent virologic failure and for complete supper-ssion. The consequences of poor adherence include not only diminished benefits for the patient, but also the public health threat of the emergence of multidrug-resistant viruses, as these resistant strains can then be transmitted from a patient to their contacts. Evaluating adherence has proven to be difficult and there is no gold standard for evaluating adherence to medication. Adherence is assessed in various ways. The most studies evaluate adherence to treatment by using patient's self report and the pill count method but these are methods known to overestimate adherence. Some determinants are associated with adherence include: age, gender, addiction specially injection drug users, alcohol consumption, depression, social support, level of education, work situation, adverse antiretroviral effects, pregnancy, type of antiretroviral drug regimen, number of pills and daily doses received, severe traumas, social and psychological factors, and relationship between clinician and patient.0

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Background: Pain associated with IV injection of propofol is seen in 28 to 90% of patients. A number of techniques have been tried to minimize propofol-induced pain, with variable results. We compared the efficacy of pretreatment with ephedrine and lidocaine for the prevention of propofol-induced pain.

Methods: One hundred and twenty adult patients, ASA physical status I-II, undergoing elective surgery were randomly assigned into six groups (20 each). Normal saline group received normal saline, lidocaine group received lidocaine 2% (40 mg), and ephedrine (E 30) group received 30 µg/kg ephedrine, ephedrine (E 70) group received 70 µg/kg ephedrine, ephedrine (E 100) group received 100 µg/kg ephedrine, ephedrine (E 150) group received 150 µg/kg ephedrine. All pretreatment drugs were made in two mL. Pain was assessed by a 100-point scale of visual analogue (VAS) (0= no pain, 100= the most severe pain) and (VRS) verbal rating scale at the time of propofol injection. Noninvasive mean arterial blood pressure (MAP) and HR were recorded before induction, just before intubation, and 1, 2, and 3 min after intubation, respectively.

Results: The mean of pain scorel during propofol injection was significantly more in Normal Saline group compared to lidocaine and ephedrine (E30, E70, E100, E150) groups but there was no significant difference between lidocaine and ephedrine (E30, E70, E100, E150) groups (80.9vs 59.6 and 56.2, 51.05, 52.8, 57.45) Kruskal- wallis P=0.009. The incidence of pain was also significantly more in Normal Saline group compared to lidocaine group and ephedrine's groups but there was no significant difference between lidocaine and different dose levels of ephedrine. A small dose of ephedrine (30 and 70 µg/kg) could prevent propofol induced pain before intubation and did not produce significant hemodynamic changes compared with the other groups after intubation.

Conclusions: Pretreatment with ephedrine (specially low dose) effectively attenuated pain intensity, and frequency with propofol injection without undesired complications.

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Normal 0 false false false EN-GB X-NONE AR-SA MicrosoftInternetExplorer4 Background: The ability of a specific test to predict a difficult intubation is decreased by the variability of definitions of difficult intubation/laryngoscopy. The Mallampati classification system is a widely utilized approach for evaluating patients in the preoperative setting. Zero class of Mallampati is a new class of airway view that to add to the four modified Mallampati classes. This study estimates the incidence of class zero airway and determines the ability of Mallampati score, age and sex on the prediction of the larangoscopy grade.
Methods: This is a cross sectional study in which 376 patients aged 7-18 years and A.S.A physical status I or II were enrolled. They were scheduled for surgery under general anesthesia All the airway assessments were done in the sitting position, with the patient's head in neutral position, mouth fully open, tongue fully extended and without phonation. After induction of general anesthesia, laryngoscopy grade was assessed in sniffing position using the Cormak & Lehame grading scale.
Results: Class zero airways occurred in 0.3% of patients, and the patients with class zero airway had a grade I laryngoscopy. 49.5% of patient had class I, 37.2% class II, 13% of patient had class III and there found no patient with class IV airway. Grade II and III laryngoscopy were more frequent in females than in males but this correlation was not statistically significant. 
Conclusions: Assessment of airway by Mallampati scoring system and attention to the age can be an important factor in the prediction of high laryngoscopy grade.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Pelvic Organ Prolapse (POP) and related urinary symptoms are frequent disorders in elderly women and their management improves life expectancy and quality of life. Urodynamic tests applied in pathophysiologic diagnosis and treatment of urinary disorders are not always cost effective. This study aims to evaluate the results of Urodynamic tests in patients with pelvic organ prolaps.
Methods: This case- control study was done using UDI-6 questionnaire during 18 months in vali-e-asr clinic of Imam Khomeini Hospital, Iran with 105 cases of POP the cases were divided into two groups: group one (66 cases with urinary incontinency) and group two (39 without incontinency) and assessed with urodynamic tests.
Results: Based on UDI-6, the patients of group one had more clinical symptoms (frequency, urine leakage, urge incontinence and stress incontinence). (p<0.001). Except for first desire to voide and normal voided volume indices, there were no significant differences in the other urodynamic parameters in two groups. Sensitivity and specificity of urgency leak in group one was 22 and 68/8% and in group two was 30 and 65/5% respectively. Stress leak sensitivity and specificity in group one were 25/4% and 100% and in group two were 57/1% and 71/9% respectively.
Conclusion: In this study, considering sensitivity and specificity of symptoms and urodynamic test for urinary incontinency assessment is advised in patients with POP who need surgery.

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No abstract###

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Diabetes is a metabolic disorder affecting the whole body systems including the female reproductive organs. Moreover, diabetes is an important cause of infertility. Metformin is commonly used to control hyperglycemia in patients with diabetes. This study was done to evaluate the ultrastructural changes of ovarian follicles in diabetic rats and their response to metformin.
Methods: Thirty-six adult Sprague-Dawley female rats (170-210 g) were studied in three groups (Control, diabetic and metformin-treated rats). In the second and third groups, diabetes was induced by injection of streptozotocin (45 mg/kg). The rats in the third group were later treated by metformin monohydrochloride (100 mg/kg). At the end of the experiment, rats were sacrificed and their right ovaries were observed under transmission electron microscope. Quantitative data were analyzed by student t-test in SAS software.
Results: In comparison with the control group, significant decreases in zona pellucida thickness and the mean number of microvilli were observed (respectively, P<0.01 and P<0.001) in diabetic rats. Significant decreases in zona pellucida thickness were also observed in metformin-treated rats (P<0.05) but changes in the number of microvilli were non-significant. The number of organelles in oocyte cytoplasm was higher and they were natural or natural-looking in metformin-treated rats versus the diabetic ones. Reduction in the number of mitochondria and their ballooning cristae were of the most noticeable changes in diabetic rats.
Conclusion: Diabetes decreases the number of microvilli and oocyte organelles and diminishes zona pellucida thickness leading to structural changes in the organelles but metformin could improve the aforesaid conditions.

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Background: Recent studies have demonstrated an essential role for IL-17 in the pathogenesis of experimental autoimmune encephalomyelitis (EAE). Furthermore, it has been shown that FoxP3+Treg cells play an important role in the suppression of autoinflammatory reactions. Although, previous studies have determined the immunomodulatory potentials of all-trans-retinoic acid (ATRA), but these immunomodulations have been mostly justified by alteration in Th1/Th2 cytokines. The present study was carried out to investigate the therapeutic effects of ATRA on EAE and its effects on T-helper cells responses.

Methods: EAE was induced by MOG35-55 peptide and complete Freund's adjuvant in female C57BL/6 mice. The mice were allocated to two therapeutic groups (n=7 per group). Treatment with ATRA (500 μg/mouse every other day) was initiated in treatment group on day 12 when they developed a disability score. EAE controls received vehicle alone with the same schedule. Signs of disease were recorded daily until day 33 when the mice were sacrificed. Splenocytes were tested for proliferation by MTT test, cytokine production by ELISA and FoxP3+Treg cell frequency by flowcytometry.

Results: ATRA significantly reduced the clinical signs of established EAE. Aside from decreasing lymphocytic proliferation (P<0.05), ATRA significantly inhibited the production of pro-inflammatory IL-17 (P<0.005) as well as IFN-γ (P<0.0005) upon antigen-specific restimulation of splenocytes. FoxP3+Treg cell frequency and IL-10 levels were not altered significantly. However, IFN-γ to IL-10 and IL-17 to IL-10 ratios decreased significantly (P<0.0005).

Conclusion: Parallel to reducing autoreactive lymphocyte proliferation and cytokine production in favor of pro-inflammatory cytokines, all-trans-retinoic acid ameliorated established experimental autoimmune encephalomyelitis.

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Background: True umbilical cord knot is one of the abnormalities of the umbilical cord. Active fetal movements create cord knotting. True umbilical cord knots are rare but may be associated with fetal distress and stillbirth. True umbilical cord knots are capable of impeding blood flow to the fetus.
Case presentation: A 26-year old primigravid woman was first treated for genital herpes simplex virus (HSV type 2) at 36 weeks of gestational age. She received oral acyclovir (400 mg three times daily for 10 days). At the gestational age of 38 weeks and 5 days, fetal activity decreased and NST was nonreactive. She was delivered by cesarean section and a true umbilical cord knot was found. Four years later, in her second pregnancy, another true knot was seen.
Conclusion: Excessively long umbilical cords are more likely to be associated with true knots. Genetics has an important role in determining cord length and occurrence of true knots.

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Background: Stretching exercises and massage therapy are both suggested for pain relief in fibromyalgia syndrome. Previous studies have not proved their superiority over each other. This study compared the therapeutic effects of friction massage, stretching exercises, and analgesics on pain relief in patients with fibromyalgia syndrome.
Methods: We evaluated 129 female patients with the diagnosis of primary fibromyalgia visited at the physical medicine clinics of Baqiyatallah Hospital in Tehran, Iran during 2010- 2011. Patients were randomly divided into three groups: the first group received 400 mg ibuprofen P.O. (3 times per day) and 25 mg nortriptyline (daily) P.O. as analgesic, the second group was treated by friction massage and the third group performed stretching exercises. Patients were assessed three times (initially, after one and four weeks) by visual analogue scale (VAS).
Results: The mean age of participants was 60.46 years. The mean age in each treatment group was 46.66 years in medication group, 46.73 years in stretching group and 46.65 years in friction massage group. Changes in VAS score over 4 weeks were 2.4, 3.1 and 1.9, in the first, second, and third groups, respectively. The changes in VAS were significantly different in the first and second groups rather than the controls (P<0.05).
Conclusion: The effect of stretch exercise on pain relief was similar to analgesics, but it was more effective than friction massage. Moreover, the therapeutic effect of stretching exercise on pain relief upon four weeks was more permanent than friction massage but it was similar to analgesics.