Tehran University Medical Journal

Background: Necrotizing soft tissue infections are one of the most dreaded infections in human and result in a very high rate of mortality. The treatment of these infections must be very aggressive and consists of radical debridement of all necrotic tissue accompanied by appropriate antibiotics.

Materials and Methods: This study was undertaken to assess the mortality rate, the time from diagnosis to cure, and some of the parameters which may affect mortality in our patients. In this descriptive, retrospective study first files from patients attended by necrotizing soft tissue infections including Fournier's gangrene or disease, gas gangrene, hemolytic streptococcal infections, myonecrosis, necrotizing fascitis and related subjects in Sina and Amir-Alam hospitals from 1989 to 1999 were studied. Data were extracted and analyzed by SPSS.

Results: The total number of cases was 36. The median age was 47.69 years. Seven of the patients were female. The median time from onset to cure was 10 days. The most common site affected was the perineum and the most common etiology was perianal abscess. Diabetes mellitus was the underlying disease mostly observed. Half of the patients had received inappropriate treatments. In this group mortality was higher.

Conclusion: It is crucial that general practitioners be acquainted with the diagnosis of necrotizing soft tissue infections so that patients are referred immediately to surgical centers. In our referral center the mortality was acceptable but it can be lowered further. The sex, sites of infection, underlying disease and etiologies in our patients were similar to patient in other countries except for alcoholism. It appears that data in foreign texts can be attributed to Iranian patients.

Methods: The excretory-secretory and somatic antigens of two species were prepared from adult flukes collected from the bile ducts of sheep and stored at -20^oC. For the preparation of the antisera, the antigens were injected to laboratory-bred rabbits. Each rabbit received five injections at intervals of seven days, starting with 0.5 ml and ending with 2.5 ml. Ten days after the last injection, the rabbits were bled, and serum samples separated and stored at -20^oC. The reaction between homologous and heterologous antigens and antisera was tested by ELISA and optical densities were recorded.

Results: Excretory- secretory and somatic antigens of each species showed a strong positive reaction with the antisera of the other species. In a homologous combination of antigens and antisera, a stronger reaction was observed compared to the heterologous combination, therefore many antigenic materials of both species are the same.

Conclusion: The differences of these crude antigenic materials of F. hepatica and F. gigantica are insufficient to prevent cross reaction of two species by ELISA. Further investigations are recommended for the identification, detection and purification of antigenic material of each species to improve the specificity of this assay.

Background: Pre-diabetes is a high risk condition for developing type 2 diabetes mellitus and cardiovascular disease. The target of this study is evaluation of incidence rate of pre-diabetes and its risk factors in a long- term follow up in the Tehran Lipid and Glucose Study.

Methods: The Tehran Lipid and Glucose Study is a prospective study being accomplished on a characteristic sample of the Tehranian residents at District 13, targeted determining the prevalence and incidence of non-communicable diseases and their risk factors. Four phases of the study have been implemented, including three-year periods from 1999 to 2011. From an overall of 12808, twenty years old and older people at baseline, after excluding participants who did not have the necessary conditions, analyses were accompanied on a 2597 male and 3282 female to estimate pre-diabetes incidence and detect their risk factors.

Results: In men with incident pre-diabetes, age, fasting plasma glucose, 2-hour post-challenge plasma glucose and body mass index in addition to a positive family history of diabetes and <12 years of education were associated to a developed risk of rising pre-diabetes, but intervention and being single had a significant caring effect.

In women with pre-diabetes, 2-hour post-challenge plasma glucose, triglycerides to high density lipoprotein-cholesterol ratio, waist-to-height ratio, fasting plasma glucose and a helpful family history of diabetes increased risk of pre-diabetes, however being divorced/widowed had a slighter risk. Potential risk factors for evolving combined impaired fasting glucose and impaired glucose tolerance were higher fasting plasma glucose, 2-hour post-challenge plasma glucose, body mass index and triglycerides to high density lipoprotein-cholesterol ratio, but bigger hip circumference had a caring effect.

Pre-diabetes incidence rate was computed 46.1 per 1000 person-years in men and 36.8 per 1000 person-years in women.

Conclusion: The study showed that the incidence of diabetes and its variants in the Iranian people is high.

Background: Systemic sclerosis (SSc) is an autoimmune rheumatic connective tissue disease. In normal wound healing process, fibroblasts are activated, proliferated and involved in tissue repair, and then removed by apoptosis. In systemic sclerosis, patient’s fibrosis occurs when fibroblasts become resistant to apoptosis and secrete a large amount of collagen and other extracellular matrixes. As the primary causes the disease are very complex and often unknown, it is necessary to consider or target the secondary causes of disease, such as the unresponsiveness of activated fibroblasts to apoptosis as the major factor in the creation and deployment of illness. In this study, we examined the expression levels of two key pro-apoptotic genes, Fas and Apaf-1, which are respectively involved in external and internal pathway of apoptosis.

Methods: In a case-control study skin biopsy samples were obtained from 19 patients with diffuse SSc, and 16 healthy controls. Dermal fibroblasts were cultured and total RNA was isolated from cell populations using High Pure RNA Isolation Kit (Roche Applied Science, Mannheim, Germany), followed by cDNA synthesis using RevertAid First Strand cDNA Synthesis Kit (Thermo Fisher Scientific Inc., Massachusetts, USA). Real-time PCR was performed using SYBRGreen gene expression master mix (Takara Shuzo, Co., Ltd, Shiga, Japan) and specific primers for Fas and Apaf-1. Real-time data were analyzed using the (2^-ΔCT)×1000 method. Statistical analysis was accomplished by using the SPSS software, v22 (IBM, Armonk, NY, USA). The P value less than 0.05 were recognized as a significant threshold. All data are represented as the mean ± SEM.

Results: Our results showed no significant difference in Fas (P=0.8) and Apaf-1 (P=0.17) mRNA expression levels between skin fibroblasts of systemic sclerosis patients and healthy controls.

Conclusion: In this study we observed no significant change in Apaf-1 and Fas mRNA levels in systemic sclerosis fibroblasts compared to control group. Hence, Apaf-1 and Fas are not transcriptionally activated in SSc fibroblasts. Further studies need to take place on protein levels and function of these proteins to confirm the mRNA transcription results.