Tehran University Medical Journal

Background: Impairment in the function of the lower urinary tract can be the cause of recurrent urinary tract infections (UTI) and vesico-ureteral reflux (VUR) in children. The purpose of our research was to evaluate the frequency of occurrence of bladder instability in children with UTI.

Methods: The research involved 133 children (11 boys, 122 girls), ranging in age from seven months to 14 years. Group A consisted of 78 children with a history of recurrent UTI, while Group B included 55 children with recurrent UTI and VUR. Urodynamic tests (cystometry) were performed on all the children.

Results: Abnormal functioning of the lower urinary tract was found in 98 children (73.1%) from Group A and 41 children (78.8%) from Group B. The most common dysfunction was detrusor-sphincter dyssynergia (DSD), which was found in 54% of all subjects, 46.2% of patients in Group A and 60% of patients in Group B (p<0.05). Unstable bladder was found in 42 (33%) children with no significant difference between the two groups. In 17 children (12.6%) DSD was accompanied by bladder instability. In both groups about 20% of the children did not present with symptoms indicative of urination dysfunction, where as 80% reported various symptoms, of which the most common were constipation and urinary urgency. In half of the children from Group A and one-fourth of the children from Group B there were several co-occurring symptoms: frequency, urgency, intermittent voiding, incontinence, dribbling and retention, and constipation.

Conclusions: The most common disturbance of lower urinary tract function in these children with recurrent UTI was DSD, which occurred more often in children with VUR.

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 !mso]> ject classid="clsid:38481807-CA0E-42D2-BF39-B33AF135CC4D" id=ieooui> Background: Atherosclerosis and the side effects thereof are a major cause of mortality and morbidity in diabetic patients. Diabetic dyslipidemia is defined by a decrease in blood levels of HDL cholesterol and increases in triglycerides and LDL cholesterol. Diabetic dyslipidemia is atherogenic, inducing cardiovascular disease in diabetic patients at a frequency that is two to three times greater than that of nondiabetics.
Methods: This study analyzes the data from the first phase of the Yazd Healthy Heart Program, a community intervention project focused on the prevention of cardiovascular disease. Using the cluster sampling method, we analyzed data from 2000 subjects from Yazd, Iran, ranging in age from 20 to 74 years. Clinical and paraclinical data were recorded by trained health providers using a questionnaire with over 700 items.
Results: The most frequent lipid disturbance was TG>150 in 67.1% of the type-II diabetic patients (p<0.000), 54.6% of whom were unaware of their TG level. The mean lipid and TG levels are significantly higher (p<0.000). Furthermore, women as a group have higher mean cholesterol, LDL-C and HDL-C levels than men (p<0.000). Additionally, diabetic patients were more obese than the nondiabetic population. (p<0.000).
Conclusion: The high prevalence of diabetes mellitus in Yazd and hypertriglyceride-mia among diabetics in this city, in addition to the lack of awareness among more than half of these patients about their illness and diagnosis, indicate an urgent need to immediately control dyslipidemia in these high-risk patients.

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Port-site metastasis following laparoscopic cholecystectomy with unsuspected gallbladder carcinoma is a serious problem. Gallbladder carcinoma is found in 1% of all biliary tract operations, in most being diagnosed only after histological examination of the gallbladder. The spread of cancer following laparoscopy appears aggressive and widespread, as noticed from re-operation for radical treatment. The pathologic findings of gallbladder were consisting of tumoral and necrotic tissue, indicating of well differentiated adenocarcinoma. Mucosa and submucosa were involved, but no evidence of invasion to muscular layer and gall bladder serosa was found (T1). In this article we present the first of an unusual case of four port site adenocarcinoma metastasis from gallbladder cancer.
Case report: A 63 year old woman underwent laparoscopic cholecystectomy for acute cholecystitis. Thirty months later, she was admitted to the hospital with a complaint of masses at the four trocar sites. A biopsy from the port sites was undertaken and led to the diagnosis of adenocarcinoma metastasis. There is no published report of all four port site metastasis of gallbladder cancer after laparoscopic cholecystectomy.

Background: Hepatitis C is a major cause of chronic liver disease and hepatocellular carcinoma. Hepatitis C infection also has extrahepatic manifestations, including cryoglobulinemia and lichen planus. Lichen planus is a relatively common mucocutaneous disorder, and, due to its chronic pattern and increased incidence of malignancy, diagnosis and treatment of this disease are very important. The aim of the present study was to investigate the prevalence of oral lichen planus in HCV-infected patients.

Methods: In this cross sectional- descriptive study, the prevalence of oral lichen planus was evaluated by means of observation, clinical examination, questionnaire and evaluation of the medical records of 150 patients referred to the hepatitis clinic, gastrointentrology and infectious disease wards of Imam Khomeini Hospital and the Iran Blood Transfusion Organization, Tehran, Iran. We used a sequential method for sampling. Data were analyzed using statistical software (SPSS ver. 11) and the chi-square test.

Results: From a total 150 patients, 133 were male and 17 female. Six cases (4%) had oral lichen planus. All patients with oral lichen planus were male and the buccal mucosa was the most common site.

Conclusions: According to this study, the prevalence of oral lichen planus in patients afflicted with HCV is higher than in the normal population. We should pay more attention to oral lichen planus as one of the extrahepatic manifestations of hepatitis C.

Background: In the patients with chronic liver disease chronic increase in serum transaminases may remain of undetermined cause despite thorough investigations. Celiac disease (non tropical sprue) has been reported as one of the causes of elevated levels of serum transaminases. The aim of this cross sectional study was to evaluate the frequency of celiac disease among patients with liver disease with chronic unexplained hypertransaminasemia.

Methods: One hundred patients with unexplained elevated liver enzymes who referred to gastroenterology and hepatology clinic of Imam Khomeini Hospital in Tehran, Iran from March 2009 to March 2010, and no cause were found for this elevation after initial clinical and paraclinical assessments and tests were enrolled in a cross sectional study. After measurement of Anti tTG IgA antibody in the serum of the patients, the biopsy of second part of duodenum were performed in cases with positive results and were assessed regarding evidences of celiac and finally the diagnosis of celiac diseas was confirmed.

Results: The mean age of patients was 39.79±16.77 and 55% of patients were male. The celiac disease was confirmed in 6% of patients (CI: 95%: 2.78- 12.48%). There were no significant differences between frequency of both sexes and means of age, ALT, and AST in the study patients.

Conclusion: In our study, the frequency of celiac disease among patients with chronic liver disease with unknown elevated liver enzymes was 6% which is near the frequency derived from other studies that has been reported.

Background: Atherosclerotic vascular disease is a major cause of morbidity and mortality in patients with end-stage renal diseases on maintenance hemodialysis. Early atherosclerotic changes of the arterial wall can be evaluated by measuring intima-media thickness (IMT), and looking for the presence and structure of plaques and parameters of vascular resistance. In this study we investigated the relationship between carotid IMT and pulsatility index (PI) or resistive index (RI) values in hemodialysis patients.

Methods: Sixty hemodialysis patients (27 females and 33 males median age 41.7 years) and 60 healthy volunteers (32 females and 28 males, median age 37.8 years) underwent ultrasonography of common carotid artery for the determination of IMT, PI and RI.

Results: Bilateral IMT was significantly higher in hemodialysis patients than in control group (P<0.001). Left carotid artery RI and PI were found to be significantly higher in hemodialysis patients than in the controls (P<0.001). Right carotid artery RI and PI had no significant statistical differences between the two groups (P=0.18 and P=0.78, respectively). There was a moderately significant negative correlation between the left carotid IMT and left RI and PI in the controls (r= -0.42, P=0.001 and r=- 0.43, P<0.001, respectively).

Conclusion: PI and RI values of the left coronary artery increased as did IMT in hemodialysis patients. Therefore, measurement of RI and PI values together with IMT are recommended for early diagnosis of atherosclerosis in hemodialysis patient.

Background: Conservative treatment needs to be tried prior to surgical treatment of knee osteoarthritis. This study was designed to evaluate the short-term effects of dextrose prolotherapy on pain relief and functional improvement in knee osteoarthritis in comparison with intra-articular hyaluronic acid injections.

Methods: In this double blind clinical trial, 100 patients, aged 40-70 years, with complaints of knee pain lasting >3 months were recruited in Akhtar hospital during the years 2010 to 2011. The patients met the criteria proposed by the American College of Rheumatology (ACR) for knee osteoarthritis. 50 patients in hyaluronic acid group received five 2 ml injections of hyaluronic acid (Synocrom Forte® 1%) weekly and 50 patients in dextrose prolotherapy group received three 2 ml bimonthly injections of 25% dextrose. The patients were evaluated before and after treatment in terms of pain and functionality using the Knee injury and Osteoarthritis Outcome Score (KOOS) self-questionnaire. The patients were followed up for 12 weeks and were examined 12 weeks after the injections by an observer unaware of group assignments. The data were recorded for statistical analysis.

Results: The mean age of the patients was 60.68.2 years. No significant differences were found between the two groups with respect to pre- and post-treatment KOOS scores. The scores showed significant improvements in all items following treatment in both groups (P<0.001).

Conclusion: It seems that intra-articular injections of 25% dextrose prolotherapy could be as effective as hyaluronic acid injections for the treatment of knee pain due to OA.

Background: Medication overuse headaches (MOH) include headaches that last more than 15 days a month and usually occur after long-term use of analgesic. Most methods of medical treatment are ineffective. In some studies, great occipital nerve block is used to treat the headaches.

Methods: This double-blind experimental study was performed in adult patients with MOH who attended Sina Hospital in Tehran from June 2009 to June 2011. Greater occipital nerve (GON) block was done in the two groups of patients by administering a combination of 3 ml of 0.5% bupivacaine and 2 ml of 5% saline or 3 ml of 0.5% bupivacaine and 80 mg of methyl prednisolone. We evaluated headache severity by Visual analog scale (VAS) and recorded days without headache. If patients were taking pain medications, preventive medications were given as usual before and after the injection. Student's t-test was performed for statistical analysis and a P<0.05 was considered significant.

Results: Overall, 13 male and 19 female patients with a mean age of 39.88±8.76 years participated in the study. The mean reduction in headache severity one hour after injection was 5.56±1.03 and 4.63±1.92 in the first and second groups, respectively. Average days without headache one month after injection were 8.75 and 4.75 days in the first and second groups, respectively. There were no significant differences between the two groups.

Conclusion: Both methods seem to be effective in medication overuse headaches treatment. This finding is important as non-responders to conventional methods will otherwise have a decreased quality of life.

Background: Thyroid cancer is the most common endocrine malignancy. Accounting for approximately 1-2% of all cancers. Thyroid cancers have been divided into four main types: papillary, follicular, medullary and anaplastic. The active form of vitamin D (1,25- (OH) 2-vitamin D3) by binding to its receptor, using genomic and non-genomic mechanisms inhibits the proliferative effect of TSH on thyroid cells. Therefore, vitamin D may have a role in regulating of thyroid gland cell proliferation. Many studies have shown anti-cancer effects of vitamin D in cancers. Polymorphisms of Vitamin D receptor can influence the prevalence to various cancers. In the present study, serum level of vitamin D and FokI, BsmI and Tru9I polymorphism of vitamin D receptor was investigated.

Methods: This case-control study was performed in the summer of 2015 in Endocrinology and Metabolism Center of Shahid Beheshti University of Medical Sciences, Tehran, Iran. Forty medullary thyroid cancer patients and 40 healthy controls were investigated. Genomic DNA of subjects was extracted with saturated salt/proteinase K and polymorphisms of vitamin D receptor gene investigated by polymerase chain reaction-sequencing. Serum level of vitamin D evaluated by ELISA technique. The results were analyzed by SPSS, ver. 20 (Chicago, IL, USA) and GraphPad Prism, ver. 5 (GraphPad, Inc., CA, USA) softwares.

Results: Genotypic and allelic abundance of FokI and BsmI polymorphisms between test and control groups have not shown significant different. In Tru9I polymorphism, Tt genotype abundance in test group were 45 percent and in control group were 17.5 percent and t allelic abundance in test group were 25 percent and in control group were 8.7 percent which this different were significant. Average serum level of vitamin D in test group was 23.32 ng/ml and in control group was 18.95 ng/ml which was statistically significant.

Conclusion: Unexpectedly, serum levels of vitamin D in test group were higher than control group. Tru9I polymorphism is significantly correlated to medullary thyroid carcinoma prevalence.

Stable molecular changes during cell division without any change in the sequence of DNA molecules is known as epigenetic. Molecular mechanisms involved in this process, including histone modifications, methylation of DNA, protein complex and RNA antisense. Cancer genome changes happen through a combination of DNA hypermethylation, long-term epigenetic silencing with heterozygosis loss and genomic regions loss. Different combinations of N-terminal’s changes cooperate with histone variants with a specific role in gene regulation. It have led to load a setting histone that determine transcription potential of a particular gene or genomic regions. DNA methylation analysis in genome region using methylation-specific digital karyotyping of normal breast tissue detect gene expression patterns and DNA specific methylation can be found in breast carcinoma too more than 100 genes in breast tumors or cell lines of breast cancer are reported hypermethylated. Important of DNA methylation on cancer has been concentrated CpG islands hypermethylation. Most of the techniques are able to identify hypermethylated areas. Often, methylated genes play important role in cell cycle regulation, apoptosis, metastasis and tissue invasion, angiogenesis and hormonal signaling. Cyclin D2 (CCND2) gene is an important regulator of cell cycle and increased of expression inhibits the transition from G1 to S cell cycle. This gene is frequently methylated in breast cancer and has been proposed as the first event. Other cell cycle regulator is p16ink4A / CDKN2A that methylated in a large number of human cancers, including breast cancer. Another regulator of the proliferation of breast cancer that methylated is tumor suppressor RAR-β cancer that has been found in lobular and ductal carcinoma. Recent studies have showed the role of epigenetic silencing in the pathogenesis of breast cancer in which tumor suppressor genes have been changed by acetylation and DNA deacetylation. Histone deacetylase inhibitors have different roles in cancer cells and could show the ways of new treatment for breast cancer. In this review, various aspects of breast cancer epigenetics and its applications in diagnosis, prediction and treatment are described.