Tehran University Medical Journal

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In the present study, we investigated total cell protein patterns of ten isolates of Epidermophyton Floccosum Var.pigmented by SDS-PAGE on 10% polyacrylamide resolving gels. Densitometric analysis of the gels allowed to detect more than 31 clearly detectable mycelial protein bands with molecular weights in the range of 12 to 98 KD proteins of 12.5, 13.5, 14.4, 16, 18.4, 19.7, 20.1, 23.5, 26, 27, 29, 30, 32.5, 34, 35.5, 37, 39.5, 40.5, 43, 47.5, 50, 63, 68, 75, 79, 82.5, 74.5, 90, 94, 96, 97-5 KD were present but their frequencies varied among the isolates. Protein bands of 18.4, 19.7, 20.1, 27, 29, 34, 37, 43, 47.5, 50, 63, 79, 94, KD were stronger and common among the isolates and could be specific to recognize genus differences. Protein analysis by SDS-PAGE could be considered an useful technique in identifying differences among the dermatophyte isolates.

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The well-known fluorimetric method for histamine measurement which is one of the common methods in diagnostic laboratories was modified to accelerate and facilitate measurement of serum histamine levels and decrease the costs and restrictions. The modified method needs only 1 ml of whole blood (or serum) instead of about 10 ml in original method which is difficult almost or impossible specially for children. In addition, very small amounts of the expensive materials are needed and the samples are saved for about 15 days in -20°C which makes no significant changes. Because in most cases, sample can not be read at sampling day, the saving possibility is an advantage for improved method.

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Food allergy is affecting 6-8 percent of infants. Wheat is major source of carbohydrate and protein in the people's nutrition in all worlds and also account for one of six main food allergens in children. The goal of this study is diagnosis of wheat allergic patients and description of its importance for better recognition of this disease.
Materials and Methods: Among children with different symptoms of allergy (dermatologic - Gastro intestinal and respiratory symptoms) referred to Immunology and allergy Department of Markaz Tebbi Kodakan, during one year, 35 cases was suspected to have wheat allergy. Skin prick test and IgE specific with wheat for all of them and open food challenge test with wheat for 11 patients without history of anaphylaxy) were done. The criteria for diagnosis was based on a convincing history of anaphylaxis after ingestion of wheat or the positive result in food challenge with wheat in addition to positive skin prick test ( SPT) or specific IgE ( Eliza) with wheat.
Results: In 35 suspected cases to wheat allergy, SPT in 85/1 percent, specific IgE in 90/3 percent were positive. Food challenge test were done in 11 cases and was positive in 27/2 percent of patients. 24 patients were definitely diagnosed as wheat allergic ones. Anaphylaxis was the predominant clinical feature, accounted for 87 percent of acute symptoms which were repeated for two or more episode in 91 percent of the cases with anaphylaxis. In 50 percent of patients chronic symptoms like asthma and atopic dermatitis were also observed.
Conclusion: The mean age of symptom was compatible with time of onset of complementary foods. Therefore, were proposed exclusive breastfeeding without maternal avoidance and not to be introducing wheat in infant regimen until 12 mouth of age. Anaphylaxis was occurred, repeatedly in these patients which demonstrate, in one part, severity of the reactions in our patients and in other part the probable existence of more cases with milder reactions in whom never been referred to us .

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Background: Food allergy is one of the most important among other allergic diseases. Although it is less prevalent in adult but in infants it’s prevalence was reported as much as 8 percent. In part, wheat is one of the six main food allergens in infant and in other part there is extensive cross reactivity between the cereals. Therefore the aim of this study is selection of the best food substitute for wheat among other cereals. Materials and Methods: 24 patients with definitive diagnosis of type one hypersensitivity reaction to wheat were entered in this study. Skin prick test and serum specific IgE (Eliza) with 6 members of cereals family (wheat, barley, oat, Rye-Rice & Corn) were performed for them and open food challenge test was also done with three more available of the cereals (corn, Rice, barley) in our food culture and so comparison between allergenicity of wheat flour and wheat bran with skin prick test were done.

Results: The Skin prick tests (SPTs) were positive in 66.7 percent for Barley, 100 percent for wheat bran and 80-100 percent for other cereals. The results of specific IgE for wheat, Barley were positive in 94.5 percent, 68 percent, 39 percent of patients respectively and the results for other cereals were positive in less than 11 percent of cases. The results of food challenge test, for barley were positive in 60 percent of cases and for Rice and Corn were negative in all cases.

Conclusion: In the base of food challenge test as the gold standard test, the best food substitute for wheat sensitive patient between other cereals, were Corn and Rice respectively. It is important to emphasis that will be needed to perform oral food challenge in hospital with complete emergency equipment before introducing any other cereals as food substitute for wheat, specially Barley.

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Background: Using the systemic opioids in pain relief has been known during the history. Several evidences indicate that exogenous opioids such as morphine can produce anti-nociceptive effects by interacting with local opioid receptors in peripheral inflamed tissues in addition to analgesic effects of morphine, less clear is potential anti-inflammatory effects of it.

Materials and Methods: In the present study we examined effects of intra-peritoneal (i.p.) injection of morphine (7 mg/kg) on carrageenan (0.05 ml, 3% W/V in saline) induced paw edema in mice.

Results: Carrageenan induced paw edema were measured by mercury plethysmometer and was maximal at hour 3 and pretreatment with morphine could reduce the edema significantly. At the same time the serum levels of interleukin-1 alpha (IL-1α) were increased. Pretreatment with naloxone (2&10 mg/kg, i.p.) at 45 min before and 165 min after carrageenan, respectively, blocked the effects of morphine sulfate on edema in each groups. Pretreatment with naloxone abolished morphine anti-inflammatory while decreased IL-1α serum levels, significantly. Although, administration of anti mouse IL-1α (7, 14 & 28 µg/mice, i.p.) abolished morphine anti-inflammatory effects.

Conclusion: These findings showed that increase in serum levels of IL-1α play important roles in anti-inflammatory effect of morphine. The results indicated that morphine exert significant anti-inflammatory activity. Presumably, the anti-inflammatory action of morphine may be due to change on the cytokine production and/or release by host immune system.

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Radioiodine therapy is the safest, simplest, least expensive and most effective method for treatment of Graves' disease. Due to difficulties in previous methods for dose determination, fixed dose method of 1-131 is now considered the best practical method for 1-131 therapy in Graves' disease, but there is no consensus on the dose. We compared two routinely recommended fixed doses of 5 and 10 mCi for this purpose.
Materials and Methods In this clinical trial, 59 patients with Graves' disease referred for radioiodine therapy were randomized into two groups, one group was treated with 5 mCi of 1-131 and the other with 10 mCi. All patients were followed for two years, with 6-month intervals.
Results: Totally, among 59 patients treated with 1-131, 20 (33.9%) patients became euthyroid and 19(32.2%) became hypothyroid, while failed therapy (no response or relapse) was noticed in 20 patients (33.9%). In the group treated by 5 mCi (33 patients), 10(30.3%) were euthyroid, 6(18.2%) were hypothyroid (overall cure of ^8.5%), while 17(51.5%) remained hyperthyroid by the end of the follow-up period. From the 26 patients treated with 10 mCi, the euthyroid and hypothyroid states were observed in 10(38.5%) and 13(50%)patients, respectively (overall cure rate of 88.5%), and hyperthyroid state in 3(11.5%). No relationship was noted between the outcome and age, sex, size of the thyroid gland and thyroid uptake, but the relationship between the disease outcome and the amount of administered radioiodine was significant (P<0.003). Although the incidence rate of early hypothyroidism (by the end of 2 years) in the group treated with 5 mCi is less than those treated with 10 mCi, the incidence of failed therapy is higher in the former group. In addition, it is known that long-term hypothyroidism prevalence is not significantly different by using different doses of I-131. On the other hand, if the initial dose is so little to cure, cost and time for perfect treatment, number of office visits and morbidity due to untreated hyperthyroidism are markedly increased.
Conclusion: Regarding lower rate of failed therapy with 10 mCi, and as there is no significant difference in late hypothyroidism between low doses and high doses of I-131, we concluded that 10 mci is the optimal fixed dose for treatment of Graves' disease.

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Background: Mental health of prisoners, as a high risk group, is of considerable importance. Unfortunately limited data is currently available about psychiatric morbidity of this group in Iran. This study was designed to determine the prevalence of axis I disorders in prisoners and their correlation with the type of offense.

Methods: Using stratified random sampling 351 prisoners from five offense categories (54 from financial, 71 from violent, 74 from nonviolent, 72 from drug related and 80 from immoral acts subgroup) were recruited into the study, and examined by Structured Clinical Interview for DSM-IV.

Results: Eighty- eight percent of the prisoners had experienced at least one axis I disorder throughout their lives, and 46.9% met the criteria for current disorders. Substance related (78%) and mood disorders (48.7%) were the most prevalent of lifetime disorders. However, mood (30.7%) and adjustment (12.6%) disorders had the highest amounts in current diagnoses. The total number of disorders was lowest in the financial subgroup. The drug related subgroup had lower rate of anxiety and higher rate of substance related disorders.

Conclusion: Compared to western studies, the prevalence of axis I disorders in this study is among the highest. The fact that about half of all prisoners at the time of study suffered from at least one axis I disorder shows the emergent need of this group for more mental health care and services.

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Background: Cow's milk protein allergy (CMPA) is the most common food allergy during the first year of life. Strict avoidance of specific foods is the only accepted treatment for food-induced allergic reactions. This is often an unrealistic therapeutic option, since cow's milk is a basic food that is extensively used in infant formula. The recent preliminary experience of oral desensitization to cow's milk by Meglio & Patriarca seems promising. The object of this study was to investigate the desensitization of children with CMPA to cow's milk.

Methods: All the patients referred to the Allergology Department of the Children's Medical Center Hospital, Tehran from March 2004 to November 2005 suspected to have CMPA were evaluated. The patients were included in the intervention or control groups of the study. For the intervention group, Meglio's protocol was performed. We observed and examined the control group for at least 6 months. Eventually both groups were reevaluated for the symptoms and persistence of positive specific IgE for cow milk proteins.

Results: We enrolled 20 patients for oral desensitization and 13 patients were enrolled in the control group. Both groups were similar with regard to the mean age, sex and clinical symptoms. In 18 (90%) of the intervention subjects, oral desensitization with cow's milk was successfully performed. The entire protocol was completed by 14 (70%) of the intervention subjects. At the end of the six-month observation period, all the patients in the control group were still symptomatic after ingestion of cow's milk. The levels of specific IgE for cow's milk in the intervention group decreased significantly, which was not observed in the control group.

Conclusion: We successfully desensitized 90% of our CMPA patients. Considering that all the patients in the control group remained symptomatic after the period of observation and our promising results in oral desensitization with cow's milk, we can safely propose this protocol as a hopeful alternative in the treatment of CMPA. We speculate that oral desensitization to cow's milk does not alter the natural outcome of CMPA, but substantially increases the threshold dose necessary to elicit allergic symptoms.

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Background: Plant-origin foods are among the most important sources of food allergic reactions. An increase in the incidence of sesame seed allergy among children and adults has been reported in recent years. The aim of this preliminary study was to investigate the prevalence, importance and clinical manifestations of sesame allergy among Iranian patients.

Methods: In a cross-sectional survey, 250 patients with suspected IgE-mediated food allergies completed a questionnaire and underwent skin prick tests with sesame extract as well as cross-reacting foods (walnut, soya and peanut). Total IgE and sesame-specific IgE levels were measured. Patients with positive skin test reactions and/or IgE specific for sesame without clinical symptoms were considered sensitive to sesame. The patients who also had clinical symptoms with sesame consumption were diagnosed as allergic to sesame.

Results: Of the 250 patients enrolled in this study, 129 were male and 121 female, with a mean age of 11.7 years. The most common food allergens were cow's milk, egg, curry, tomato and sesame. Sesame sensitivity was found in 35 patients (14.1%). Only five patients (2%) had sesame allergy. Sesame-sensitive patients had a significantly higher frequency of positive prick test to cross-reacting foods when compared to non-sensitized patients (p=0.00). The type of symptom was independent of gender and age of the patients, but urticaria and dermatitis-eczema were significantly more frequent in sensitized patients (p=0.008).

Conclusions: This is the first study addressing the prevalence of sesame seed allergy in Iranian population. We found sesame to be a common and important cause of food allergy. The panel of foods recommended for use in diagnostic allergy tests should be adjusted.

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Background: In the treatment of bronchial asthma, the identification, isolation, and elimination of causative allergens is the most effective part of treatment. With the recent diversification within the pet industry, pet owner exposure to many unknown antigens is on the rise. The results of population studies have been contradictory and some epidemiological studies have failed to confirm this, some indicating that keeping pets might actually reduce the risk of sensitization and asthma. The purpose of this study was to determine the association between pet ownership and asthma.

Methods: This case-control study included 300 asthmatic participants referred to the Children's Medical Center over a two-year period. Participants were asked to fill out a questionnaire regarding pet ownership, pet gender and puberty, the place it was kept, how long the pet was kept and the reason for keeping the pet. The same questions were asked from 300 age- and gender-matched nonasthmatic individuals as the control group. Statistical analysis was performed to calculate odds ratios (OR) of asthma morbidity in individuals who kept pets.

Results: The OR for asthma morbidity in patients who kept pets was 2.59 (CI=1.60-4.21 and p>0.001). Financial aim was the most common reason for keeping a pet and most pets were mature and kept outdoors. No significant correlations for pet genders were observed.

Conclusion: This survey provides evidence that pet ownership is an important risk factor for asthma, therefore we suggest that individuals at risk for asthma (atopic individuals) must avoid contact with pets. However, more research in this field in Iran is necessary.

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Background: Hepatitis B vaccination has been included in routine immunization of all individuals according to WHO recommendations since 1991. Despite successful coverage, 3-5% of recipients fail to mount a desirable protection level of Ab. Vaccine failure results from: emergence of mutation, immune failure of individuals, decrease in vaccine potency, and etc. The quality of Hepatitis B vaccine should be evaluated by a reliable method.

Methods: The amount of vaccine antigen was measured through the in vitro assay of Hepatitis B vaccines which consists of multiple dilutions of the reference material and samples. The preparations were evaluated by Elisa to determine the amount of HBsAg. The data were analyzed by parallel-line analysis software. The in vivo assay was performed by inoculating multiple doses of the reference and sample preparations in Balb/c mice. A control group was also inoculated with vaccine matrix. Four weeks later, the mice sera were evaluated to determine the presence of antibodies against Hepatitis B by Elisa method. The data were analyzed by Probit analysis software.

Results: Both methods were set up in our laboratory by which different batches of Hepatitis B vaccine were evaluated. It was observed that In vivo and In vitro methods provide comparable results. Therefore we can use the in vitro method for routine testing of HB vaccine quality control.
Conclusion: In vitro method can be used in place of In vivo method because of its time and cost-effectiveness. Moreover, since no animals are used in in vitro method, it complies well with the 3R concept (Reduction, Refinement, and Replacement of animal testing) and the current tendency to use alternative method.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Asthma prevalence has increased in developed and developing countries in several last decades. Although cigarette smoking is an identified risk factor for many diseases such as coronary Heart disease and chronic obstructive lung disease, its effect on asthma is controversial. The aim of this study was to determine the odds ratio and its confidence interval for asthma morbidity among children referred to the Immunology and Allergy department of children medical center according to their parents' smoking and daily cigarette consumption.
Methods: A case-control study was conducted during two years period on the asthmatic patients who referred to Immunology and Allergy department of children medical center. Demographic information and parents' smoking and daily cigarette consumption assessed by a questionnaire. Healthy children with same age and sex were entered to the study as the control group. Statistical analysis was performed to calculate odds ratio.
Results: Among 215 patients who entered the study 63 patients were exposed the cigarette smoke. Odds ratio for asthma morbidity among children whose parents smoke more than five cigarettes per day in comparison with whose smoke less than five or do not smoke was 2.38 (p<0.01).
Conclusion: Parent's cigarette smoking is a risk factor for childhood asthma and could increase the risk of asthma to 2.38 folds in children whose parents smoke more than five cigarettes. Increasing in parents' knowledge level that probably relate to their education results in cigarette consumption decline.

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Background: The hypersensitivity to cow’s milk allergens is the most common allergies in children at the first year of life. The specific IgE evaluation is one of the important methods in diagnosis of allergic disease. The aim of this study was development of a sensitive and credible procedure for detection of cow’s milk allergens specific IgE. Methods: The allergen discs were prepared by coating of allergens on nitrocellulose paper. After incubation of allergen discs with patients serum, anti-human IgE conjugated were used. In following optimization of any step of ELISAs test, a complete kit was designed. Efficiency of designed kits were evaluated by determination of specific IgE in normal (n= 29) and patient (n= 153) children serum samples and compared with commercial kits. Results: The specific IgE against three allergrns involving casein, -lactalbumin and - lactoglobulin were measured on normal and patient children serum with designed and commercial ELISA kits. Results were demonstrated specificity of 93%, 89.7% & 82.8% and sensitivity of 86.3%, 81.3% & 89.6% respectively for casein, -lactalbumin and - lactoglobulin specific kits and these results were similar and comparable with commercial kits. Conclusion: The Designed kits in comparison with the commercial kits were showed equivalent sensitivity and specificity. The designed kit stability was ultimately one month, probably due to don’t using of stabilizers for prepared allergen discs. We suggest these kits for commercial product in Iran and we hope be helpful for easier accesses for Cow’s milk allergy diagnosis and extend that for other allergens.

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Background: Asthma is a major health condition in Iran. This randomized clinical trial was aimed for the comparison of the effects of two exercise protocols (aerobic and aerobic-strength) on the pulmonary indices and quality of life of asthmatic patients.

Methods: The study was conducted in pulmonary ward of Dr Shariati Hospital in Tehran, and Research Center of Exercise Medicine of Tehran in 2009. Fifty six asthmatic patients were selected and after two weeks of education, their spirometric parameters were recorded and the St George's respiratory questionnaire was completed. Then patients were randomly assigned to two groups of A and B. For ten weeks group A did the aerobic-strength exercises and group B did only the aerobic ones at home. At the end, again their spirometric parameters were recorded and the questionnaire was completed. Finally 42 patients completed the study.

Results: After the intervention, FEV1 and FVC but not FEV1/FVC increased in group A. There were no changes in these parameters in group B. In addition, post-intervention FEV1 and FVC were significantly higher in group A than group B. All scores of St George's respiratory questionnaire were significantly improved in both groups but they were not different between them.

Conclusions: Our findings showed that regular aerobic exercises, individually or concomitant with strength exercises, could improve vital signs and quality of life of mild to moderate asthmatic patients. However, only aerobic exercises with strength ones improve spirometric parameters. Therefore, a combination of both aerobic and strength exercises could be considered in treatment protocols of asthmatic patients.

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Background: Because bronchial hyper responsiveness (BHR) has been shown to be a risk factor for asthma and lung function decline, interest has focused on diagnosing BHR. The aim of our study was to measure the association between airway caliber relative to lung size expressed as the ratio between forced expiratory flow, mid expiratory phase, divided by forced vital capacity (FEF25-75/FVC) and BHR measured by methacholine challenge test (MCT) to obtain a cutoff for this ratio and positive MCT.
Methods: We carried out a cross- sectional study on general Iranian population in 376 subjects aged 7-73 years who were referred to Shariati hospital in Tehran, Iran in an outpatient setting. There were 190 male (50.5%) and 186 female (49.5%) subjects. They had chronic respiratory symptoms such as cough and dyspnea. The physical examination was normal. Baseline spirometry was normal or equivocal. MCT was done for all subjects over a two year period (2009- 2010). Positive MCT was defined by PC 20≤4mg/ml.
Results: The methacholine challenge test was positive in 191 (50.8%) and negative in 185 (49.2%) patients. The mean of FEF25-75/FVC in positive MCT was 0.86±0.27 Vs. 0.91±0.28 in the negative ones (p=0.070). The sensitivity and specificity of FEF25-75/FVC for prediction of MCT results were 57.1% and 60.2% based on cutoff point of 0.85 in all patients, and 87.5% and 70.7% based on cut off point of 1 in allergic patients, respectively.
Conclusion: The FEF25-75/FVC appears to be a useful predictive ratio in allergic patients but not in general population.

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Background: Asthma is a life-threatening disease that can cause death due to bronchospasm. In addition to clinical symptoms such as wheezing, acute paroxysmal dyspnea, chronic cough after exposure to cold air or cough after exercise, spirometry is also necessary for the diagnosis of asthma. The association between respiratory symptoms and a positive methacholine challenge test (MCT) is still controversial. The aim of this study was to determine the association between methacholine test results and respiratory symptoms and allergy.

Methods: One hundred and forty-six patients with respiratory symptoms and normal baseline pulmonary function tests were enrolled in this cross-sectional study. The participants were divided into two groups according to their positive or negative response to MCT. The association between MCT and the clinical symptoms and allergy was later evaluated statistically.

Results: Out of 146 participants of the study 59 (40.4%) were female and 87 (59.6%) were male. The mean age of the participants was 33.8±13.8 years. Sixty-one patients (41.8%) had positive results for the test. There was an association between a history of allergy, wheezing and age with positive MCT results. The other clinical signs had no association with the test.

Conclusion: Methacholine challenge test is the best diagnostic test for ruling out asthma in patients with normal pulmonary function tests in whom we cannot definitely rule out asthma based solely on clinical symptoms. Nevertheless, in adults with a history of allergy, wheezing and also in patients below 30, the probability for a positive MCT is high.

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Background: ATP-binding cassette transporter A1 (ABCA1) is a key mediator of cholesterol efflux to apoA-I in lipid-laden macrophages, the first step of reverse cholesterol transport (RCT) in vivo and a critical step in preventing atherosclerosis. Enhanced ABCA1 expression may inhibit foam cell formation and consequently reduce atherogenic risk. On the other hand, garlic, Allium sativum, and garlic extracts have been demonstrated to have potential cardiovascular benefits. Moreover, garlic has direct antiatherogenic and antiathersclerotic effects on artery walls. The aim of this study was to evaluate the effects of alcoholic garlic extract on the expression of ABCA1 in macrophages. Methods: Cell viability assay was used in order to detect the cytotoxic dose of alcoholic garlic extract on macrophages. Real-time PCR and Western blotting were performed to study the effects of alcoholic garlic extract on the expression of ABCA1. Macrophage cells were treated by different concentrations of alcoholic garlic extract for 48 h. The total RNA of the treated macrophages were extracted and analyzed by real-time PCR. ABCA1 protein expression was also analyzed using the Western blotting technique. Results: Alcoholic garlic extract increased the ABCA1 mRNA (20-23%) and protein expression (18-37%) in THP-1 macrophage cells compared with the controls (untreated cells). Conclusion: The results of this study are suggestive of the potential effects of alcoholic garlic extract in increasing ABCA1 expression in macrophages, the possibility of promoting reverse cholesterol efflux in macrophages and preventing atherosclerosis

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Background: Finding an acute brain lesion by diffusion-weighted (DW) MRI upon an episode of transient ischemic attack (TIA) is a predictor of imminent stroke in the near future. Therefore, exploring risk factors associated with lesions in DW-MRI of the brain is important in adopting an approach to TIA management. In the current study, we tried to determine the risk factors associated with lesions in DW-MRI of the brain in patients experiencing TIA episodes.
Methods: Fifty patients with TIA were recruited consecutively in Sina Hospital, Tehran, Iran, over a 6-month period between July 2008 and January 2009. All of the patients underwent a complete neurological examination and laboratory tests. Brain DW-MRIs were performed for all the patients within 72 hours of a TIA episode.
Results: DW-MRI revealed an acute lesion in 16% of the participants. There was a significant correlation between presence of an acute lesion in DW-MRI and TIA duration, history of diabetes mellitus and presence of unilateral facial palsy (P=0.0003, P=0.02 and P=0.008, respectively). Other variables such as age, hypertension, hyperlipidemia, past history of TIA, headache, vertigo, and sensory or visual disturbances had no significant relation with the presence of an acute lesion in DW-MRI.
Conclusion: Duration of TIA, presence of diabetes mellitus and unilateral facial palsy are risk factors for an acute lesion in DW-MRI, meaning that patients with such risk factors are at risk for stroke in the near future.

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Background: Dyskeratosis Congenita (DC) is a rare inherited disease with an incidence of approximately one case per million population. The disease is characterized by a classic triad: nail changes, color reticulated skin and oral leukoplakia. In these patients, premature death is often associated with bone marrow failure, infections, pulmonary complications, or malignancy. Three patterns of inheritance for dyskeratosis congenita have been reports, X-linked recessive trait, autosomal dominant and recessive trait. The present study is a case report of an adoloscent patient with dyskeratosis congenita. Case presentation: The patient is a 16 year old boy living in Arak without history of any illness was referred with fever, chills, malaise and admitted to Vali-e-Asr Hospital with initial diagnosis of sepsis. The patient was treated with broad-spectrum antibiotics. In tests, showed pancytopenia. Bone marrow biopsy was performed. Blood and urine culture were negative, rheumatologic lab test and other tests were normal. Ultrsonography of abdomen and pelvis showed splenomegaly. In physical examination, diffuse hypopigmented lesions on the trunk and extermities, nails dystrophy and oral mucosal leukoplakia were observed. Skin biopsy was consistent with DC. Conclusion: The skin and oral mucosal lesions have an impact role in the diagnosis of systemic disease. Early diagnosis and treatment of patients with DC are important in improving clinical outcomes.

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Background: Many drugs have been abused by patients for headache management. Celecoxib has not been abuse widely as a pain relief drug for headache. The aim of this study was comparison between celecoxib and prednisolone in bridge stage therapy following medication overuse headache. Methods: A double-blind randomized clinical trial was done in patients admitted to a private headache clinic in Tehran, Iran at 2012. Patients were selected with 18- 65 years old and 15 days headache per month at least. Prednisone was administered as a 75 mg/day, 50 mg/day, 30 mg/day, 25 mg/day and 10 mg/day dose, in 3 days interval. Celecoxib was administered as a 100mg dose three times per day (first 5 days), twice per day (second 5 days) and one time per day (third 5 days). Headache time, headache intensity, headache duration, analgesic consumption due to severe headache and drug side effects was assessed. We used the visual analog scale to determine the severity of the pain. Results: One hundred and three patients were enrolled in two groups: celecoxib (53 cases) and prednisolone (50 cases). Twenty and one men and eighty and one women with a mean age of 33.62±9.65 years participated in the study. The maximum fre-quency for headache time in the celecoxib group was 1-4 hours (19 cases) and more than four hours (19 cases). In the prednisolone group the maximum frequency for headache time was more than 4 hours (28 cases) (P=0.149). The frequency of side effects of prednisolone and celecoxib groups were 42% and 18.9%, respectively (Relative Risk=2.2, P=0.011). The most common side effects in both groups were weakness and lethargy. Conclusion: Considering the positive effect of both drugs in reducing patients' head-ache during withdrawal, celecoxib compared with prednisolone has better efficacy and fewer side effects.