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F Farahmand, K Shiasi Arani,
Volume 59, Issue 6 (11-2001)
Volume 59, Issue 6 (11-2001)
Abstract
Chronic Liver diseases in children is the result of many different diseases including: metabolic, genetic, infectious, toxic and idiopathic causes. This was a case series study on 133 infants and children with age range 6 month to 12 years old, who presented clinically with manifestation of chronic liver disease and were admitted to Children Hospital Medical Center from year 1999 to 2000. In this study, 32 (24.5 percent) patients had autoimmune chronic hepatitis, 15 (11.3 percent) Glycogen storage diseases, 12 (9 percent) extrahepatic biliary atresia, 11 (8.2 percent) willson disease, 10 (7.5 percent) cryptogenic cirrhosis, 6 (4.5 percent) chronic hepatitis C, 5 (3.8 percen) chronic hepatitic B, 5 (3.8 percent) galactosemia 3 (2.25 percent) congenital hepatic fibrosis, 3 (3.8 percent) histiocytosis X, 3 (2.25 percent) sclerosing cholangitis, 2 (1.5 percent) byler’s disease 2 (1.5 percent) primary tuberculosis, 1 (0.75 percent) choledocalcyst, 1 (0.75 percent) Alagyle syndrome. According to our data, chronic liver disease should be considered in infants and children. In our study, the most common causes are found to be: metabolic and genetic diseases (37.5 percent), chronic autoimmune hepatitis (24 percent) and biliary disorders (14 percent), that encompass 86 percent of the patients.
Ahmadinejad Z, Rasoiili Nejad M, Mahmoudi M, Rezaei N,
Volume 61, Issue 2 (5-2003)
Volume 61, Issue 2 (5-2003)
Abstract
Brucellosis is a zoonotic disease of worldwide distribution. Despite its control in many developing countries the disease remains endemic in Iran. The symptoms, signs and laboratory results are variable and nonspecific. This case series study was conducted to determine the liver complications of Brucellosis in Iran
Materials and Methods: We studied 188 patients (108 males and 80 females) with Brucellosis, fulfilled the diagnostic criteria, aged 1-79 years (mean 34.8 years) were registered in Imam Khomeini Hospital, a referral center in Tehran, during the six years (1995-2001).
Results: Thirty-four of 188 cases (18.08 percent) had elevated liver enzyme (elevated SGOT only, 6 patients elevated SGPT only 1 patient elevation of both transaminases, 27 patients). The prominent symptoms included anorexia (74 cases), weight loss (62 cases), right upper quadrant pain (32 cases), epigastric pain (25 cases) and nausea and vomiting (23 cases). Among the gastrointestinal signs were found in these patients, hepatomegaly was seen in 28 patients. Jaundice and ascitis were present in only 7 and 3 patients, respectively. Other laboratory results showed elevated alkaline phosphatase in 28 cases and abnormal bilirubin in 10 cases. Fifty-seven patients had a focal illness, representing 30.32 percent of all patients. Osteoarticular complications were the most frequent focal forms, being present in 34 cases. Twelve male patients had genitourinary Brucellosis, representing 10.53 percent of focal forms. Also, 5 patients had neurologic complications.
Conclusion: In conclusion liver involvement is frequent in Brucellosis, although the rate of this complication in our study was lower than other studies. So, in patients with evidence of overt clinical or laboratory findings compatible with liver disturbance etiologies other than brucellosis should be considered in Iran.
O Taziki, M Lesanpezeshki , R Abolghasemi,
Volume 64, Issue 1 (3-2006)
Volume 64, Issue 1 (3-2006)
Abstract
Background and Aim: What constitutes adequate dialysis has been debated in the nephrology literature over the past years. We believed that short and infrequent dialysis session contributed to poor outcome. This result provides additional evidence that (KT/V) in a flawed concept upon which to based the dose dialysis in general. Base on published evidence from many source we proposed a new index of adequacy of hemodialysis to be called hemodialysis product (HDP).
Materials and Methods: The prospective study was performed on 100 dialysis patient in the Imam hospital dialysis ward in Tehran during 2002. delivered (KT/V) and (HDP) achieved for any patient separated. Results: 100 patients including 44 female and 56 male were studied. Result has shown (KT/V) d≥ 1 in 43% and (KT/V) d< 1 in 57%. HDP in patient with (KT/V) d > 1 were ≥ 36. HDP in patient with (KT/V) d < 1 were < 36. Correlation between (KT/V) d and albumin was significant (p< 0.03, Albumin ≥ 4 mg/dl). Correlation between (KT/V) d and cholesterol, hemoglobin, creatinine were not significant. Correlation between (KT/V) d and HDP was significant (p< 0.001).
Conclusion: Finding above has shown that higher weekly delivered (KT/V) correlate with dialysis result increase hemodialysis product (HDP). More frequent and session dialysis results increase in HDP, provide better weekly (KT/V) d with normal albumin (show good caloric and protein intake).
A. Garshasbi, N. Fallah,
Volume 64, Issue 4 (7-2006)
Volume 64, Issue 4 (7-2006)
Abstract
Background: The aim of the study was to investigate associations between maternal characteristics, with emphasis on hematological status, and risk of low birth weight and preterm delivery among pregnant women
Methods: In a cohort study, 1,500 pregnant women attending Hazrat Zaynab Hospital for prenatal care and delivery in the period 2000-2001, without any risk factors for preterm delivery and low birth weight were included. Maternal characteristics including hematocrit values were recorded at the first antenatal visit. Main outcome measures included birth weight and gestation at delivery. Linear and logistic regression models were used to analyze data.
Results: Severe anemia (hematocrit< 24%) was associated with a significantly increased risk of low birth weight (<2500 g) and preterm delivery (< 37 weeks gestation). High hematocrit values (> 40%) did not increase the risk of low birth weight and preterm delivery. Teenagers, women with short height or low body mass index had significantly higher risk of delivering low birth weight infants.
Conclusion.: Severe maternal anemia, particularly in the first trimester, was significantly associated with adverse pregnancy outcome. Low maternal age, height or body mass index also increased the risk of low birth weight. Improved nutritional status of young women could contribute to improved health among their infant.
Borna H, Borna S, Rafati Sh, Haji Ebrahim Tehrani F,
Volume 64, Issue 8 (8-2006)
Volume 64, Issue 8 (8-2006)
Abstract
Background: A variable hematological value without clinical sign of sepsis or hematological disorder is often observed in newborns. The purpose of this study was to investigate hematological measurements in umbilical cord vein of newborns delivered spontaneously or by cesarean section.
Methods: We studied 150 pregnant women who delivered term normal infants. The patients were divided into two groups according to the route of delivery: vaginal (n=75) and cesarean section (n=75). Immediately after delivery, umbilical cord blood samples were collected. Any possible relationship between mode of delivery, gestational age, gravidity, parity, sex, weight of the new born infant, and the duration of different phase of labor with the hematological parameters was investigated.
Results: We observed a significant increase in all hematologic parameters including hemoglobin and hematocrit levels and WBC, platelet and RBC counts in newborns delivered spontaneously (p<0.001). The lymphocyte counts were similar in two groups. Male infants and newborns with higher gestational age showed a higher hemoglobin and hematocrit levels. Increased parity and gravidity correlated with a decrease in all hematological values of umbilical vein blood except of lymphocyte count (p<0.001). Prolonged duration of first and second stage was associated with higher mean leukocyte, neutrophil, platelet, hemoglobin and hematocrit values.
Conclusion: The mode of delivery, gestational age, parity, gravidity, sex and weight of newborn, and the duration of first and second stage of labor can influence on hematological parameters of umbilical cord blood.
Term delivery following successful treatment of choriocarcinoma with brain metastases, a case report
Behnamfar F, Hamedi B, Ramezanzadeh F, Behtash N,
Volume 64, Issue 9 (9-2006)
Volume 64, Issue 9 (9-2006)
Abstract
Background: Cerebral metastases from choriocarcinoma are poor prognostic indicator of outcome in both the World Health Organization and FIGO classification systems. Although gestational trophoblastic neoplasia has become the most curable gynecological malignancy, failure rate among “high-risk” patients is still high despite the use of aggressive multidrug regimens.
case: A 27 year old woman (G4P2Ab1) presented with hemiplegia due to brain metastases of choriocarcinoma one year after spontaneous abortion. She underwent craniotomy and was treated with nine courses of multiple agent etoposide, methotrexate, actinomycin-etoposide and cisplatinum (EMA-EP) regimen combined with whole brain irradiation. She delivered a term healthy child two years after termination of treatment. Conclusion: Multiagent EMA-EP chemotherapy and whole brain irradiation with craniotomy in selected patients preserves fertility and may improve a patient overall prognosis. Methods: In a descriptive study from February to April 2005, two hundred sixty six consecutive pregnant women referring to a university hospital were asked to answer a questionnaire containing questions their sexual status and some demographic data. In 122 cases the answers of the spouses was collected also. The answers were compared in divided groups according to age range, duration of marriage, parity and educational status.
Results: Fifty five percent of men and fifty eight percent of women had a negative attitude about sexual relations during pregnancy, and 60% of men and 75% of women presented incorrect knowledge about sexuality during pregnancy. Main reasons for decreased sexual relations in pregnancy were mentioned to be dysparaunia, and the fear of trauma to the baby, abortion, membrane rapture, preterm labor and infection.
Conclusion: As couples’ knowledge and attitudes about sexuality affect their general sexual behavior during pregnancy it is crucial to provide proper consultation regarding sexual relations in prenatal care services.
Davari Tanha F, Valadan M, Kaveh M, Bagherzadeh S, Hasanzade M,
Volume 65, Issue 2 (3-2008)
Volume 65, Issue 2 (3-2008)
Abstract
Background: Preterm labor is defined as delivery before 37 weeks of gestation. Recurrence of preterm labor in future pregnancies is 6-8%. History of preterm labor is a strong risk factor for future preterm labor. Preterm labor is the leading cause of neonatal mortality in developed countries, but permanent morbidity in these premature neonates has many side effects for the newborn as well as their family members and society. For this reason we conducted a survey to identify risk factors for recurrent preterm delivery among primiparous women with previous preterm delivery.
Methods: This prospective case–control study included patients from three university hospitals, namely Imam Khomeini, Shariati and Mirza Koochakkhan Hospitals, all in Tehran, Iran. Subjects, including 539 primiparous women who delivered preterm (22–36 weeks), were divided into two groups: 47 had a second preterm delivery (study group) and 492 had first preterm delivery (control group). Exclusion criteria were induced preterm delivery due to medical indications in mother and primigravid. Data collection and analysis was performed using SPSS 10 and t-test and χ2 test were used to analyze the significance of the results.
Results: From a total of 6,537 deliveries, we found 539 cases of preterm delivery, among which 47 cases were identified as recurrent preterm delivery. The control group was composed of 492 deliveries. The recurrence of preterm delivery was 8.7%. Uterine anomaly, cardiovascular, renal and thyroid disease in mother and blood group A had a significant correlation with recurrent preterm delivery.
Conclusion: Expectant mothers with uterine anomalies, cardiovascular, renal or thyroid diseases or group A blood type should receive extra care, observation and instructions in order to limit the risk of preterm delivery and its subsequent effects.
Farahmand F, Khatami Gh, Mehrabi V.a, Mahjoob F, Ezadyar M, Mehdizadeh M,
Volume 65, Issue 2 (3-2008)
Volume 65, Issue 2 (3-2008)
Abstract
Background: The aim of this study was to review the frequency, histopathology and outcome in children with tumors of the liver.
Methods: Included in this retrospective/descriptive study were 30 children treated for liver tumors from 1375-1384 (ca. 1996-2005), at Children’s Hospital Medical Center, Tehran, Iran. We included the clinical, radiologic, and pathologic data of our patients, focusing on the frequency, etiology and outcome.
Results: Patient ages ranged from three months to 12 years (median 3.8 years), with 18 males (60%) and 12 females (40%). Of these, 17 patients had hepatoblastoma (55.66%), including 13 males and four females, with an age range of six months to five years. Four cases (13.33%) had neuroblastoma. Hepatocellular carcinoma (HCC) was found in three cases (10%), all of whom were carriers of hepatitis B. Two cases (6.66%) were diagnosed with mesenchymal hamartoma, two cases (6.66%) with hemangioendothelioma and two cases (6.66%) with rhabdomyosarcoma and leiomyosarcoma of the biliary tract. Abdominal swelling and hepatomegaly were seen in all of patients. Jaundice was observed in two cases. Serum alpha-fetoprotein levels greater than 500 ng/ml were seen in 17 cases (56.66%). All patients were receiving specific treatment. The three-year survival rate was 65% for hepatoblastoma and 2% for HCC
Conclusion: With the introduction of specific treatment, the survival rate for children with tumors of the liver has significantly increased. Further improvement can be achieved using diagnostic biopsy for hepatoblastoma, although it may result in complications, and preoperative chemotherapy followed by complete surgical excision (per International Society of Pediatric Oncology guidelines), yielding an outstanding survival rate of 80%.
Hantoushzadeh S, Shariat M, Rahimi Foroushani A, Ramezanzadeh F, Masoumi M,
Volume 66, Issue 12 (3-2009)
Volume 66, Issue 12 (3-2009)
Abstract
Background: The perception of impairment of sexual function after childbirth in vaginal delivery (as a complication) makes pregnant women to request elective cesarean section. But this conception is more related to culture. Therefore we studied women's sexual health after childbirth to assess whether women who underwent cesarean section experienced better sexual health in the postnatal period than women with vaginal births.
Methods: A cohort study was conducted on 303 primiparous women who had delivered vaginaly and 315 primiparous delivered by elective cesarean section in seven private hospitals in Tehran, employing data of demographic characteristics like age, education, BMI, obstetric history (weight gain in pregnancy, history of pelvic pain and vaginal discharge), stress incontinence history (prepregnancy and during pregnancy) and effect of delivery on sexual satisfaction in several follow-ups until 12 months after delivery.
Results: Sexual satisfaction after delivery in vaginal group was significantly more than cesarean group. (76% vs 60%, p<0.0001). There was no relation between pelvic pain & delivery type (in several follow- up).
Conclusions: Instead of social conception of have more sexual satisfaction after cesarean delivery, outcomes from this study provide no basis for advocating cesarean section as a way to protect women's sexual function after childbirth. Therefore Request of cesarean section by mother for having more sexual satisfaction after childbirth is not logic.
Mohammadinia Ar, Bakhtavar K, Ebrahimi-Daryani N, Habibollahi P, Keramati Mr, Fereshtehnejad Sm,
Volume 67, Issue 2 (5-2009)
Volume 67, Issue 2 (5-2009)
Abstract
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Methods: Sixty patients with various degrees of
fatty infiltration on liver biopsy and twenty normal subjects without any sign
of hepatic fat infiltration in ultrasonography examined using standard colour
and spectral doppler sonography. The waveforms of Hepatic Vein were classified
into three groups: regular triphasic waveform, biphasic waveform without a
reverse flow, and monophasic or flat waveform. The hepatic artery resistance
index was calculated as the mean of three different measurements.
Results: The mean BMI in Nonalcoholic fatty liver disease group and normal subjects was 26.9(SD=3.3) and 22.4(SD=1.7) Kg/m2, respectively with a
range of 22
up to 44 Kg/m2. Abnormal Hepatic Vein
waveforms (biphasic and monophasic) were found more frequently in doppler
sonography (p<0.001)
in patients with Nonalcoholic fatty liver disease (12 biphasic and 17 monophasic) compared to normal subjects. Hepatic artery resistance
index was significantly lower in Nonalcoholic fatty liver disease patients [0.7(SD=0.1)] compared to normal
ones [0.8(SD=0.0)]
(p<0.001).
Conclusions: The incidence of abnormal hepatic vein waveforms is significantly higher in
patients with fatty infiltration compared to those who had no abnormality in
liver ultrasonography and these patients had a significant lower hepatic artery
resistance index. supportFields]> ADDIN EN.CITE ADDIN EN.CITE.DATA
Kadkhodaee M, Golab F, Zahmatkesh M, Ghaznavi R, Hedayati M, Arab Ha, Soleimani M,
Volume 67, Issue 7 (10-2009)
Volume 67, Issue 7 (10-2009)
Abstract
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Background: The effect of ischemia/reperfusion (I/R) injury on kidney has
been under investigation for many years. But the changes in liver function and
oxidative stress status in renal I/R injury is not well known. Recent studies
suggest a crosstalk between liver and kidneys. The aim of the present study was
to assess liver changes after induction of various degrees of renal I/R injury.
Methods: This is an
experimental study conducted on 20
male rats that were obtained from animal house of Physiology Department. Twenty
male rats were subjected to either sham operation or ischemia (30, 45 and 60 min) followed by 60 min reperfusion
periods. Blood samples were drawn post-operatively and plasma creatinine, BUN, ALT and AST were measured.
Hepatic glutathione (GSH) and FRAP (ferric reducing antioxidant power) levels and the concentration
of IL-10 and tumor necrosis
factor (TNF) -alpha were
evaluated.
Results: Both 45 and 60 min ischemia
followed by 1h reperfusion periods
resulted in significant increases in plasma creatinine (11.1±1.7mg/dl and 1.24±0.07mg/dl vs 0.55±0.15mg/dl, p<0.05) and BUN (34±3.85mg/dl and 35.0±2.81mg/dl vs 23.75±1.1mg/dl, p<0.05). These rats
showed a significant decrease in liver GSH as well as significant increase in TNF-a & IL-10 concentrations.
Conclusion: Renal ischemia causes
changes in liver function and oxidative stress status. A minimum of 45 min ischemia is needed to
study the effects of renal injury on liver as a remote affected organ.
Sadeghi R, Rabiee M, Saderi H, Jafari M,
Volume 69, Issue 1 (4-2011)
Volume 69, Issue 1 (4-2011)
Abstract
Background: Many studies have shown that periodontal pathogens are emerging as a risk factor for preterm delivery and low birth weight, but there are few studies about the relationship between other oral bacteria and pregnancy outcomes. The aim of the present study was to determine the relationship between salivary bacteria and pregnancy outcomes. Methods: This cohort study was performed on 300 pregnant women who were recruited from the prenatal clinic of Zeynab Hospital in Tehran during 2009-2010. The patients’ demographic and pregnancy data were recorded. Using samplers, saliva samples were collected about one hour after breakfast. Microbial evaluation was performed by counting the bacteria based on their shape and the Gram reaction. The studied bacteria were composed of gram-positive and negative cocci, gram-positive and negative bacilli, spirilla, spirochetes, yeasts, fusiform bacteria and actinomycetes. Results: The data on the bacteriological profile and pregnancy outcome of 243 out of the 300 eligible participants of the study were completed. Five cases (2%) had intra uterine fetal death (IUFD) while 238 (98%) delivered live infants. There was a significant statistical relationship between the mean of gram-negative cocci and IUFD (P=0.04). 10 cases (4.1%) of 243, experienced adverse delivery outcomes and 233 cases (95%) had normal delivery. The adverse pregnancy outcomes had a significant relationship with the presence of spirochetes in saliva (P<0.05) but this relationship was not true for the other bacteria. Conclusion: Some oral bacteria may pose a risk for premature deliveries and low birth weights.
Ostadhadi S, Bakhtiarian A, Azizi Y, Nikoui V,
Volume 71, Issue 1 (4-2013)
Volume 71, Issue 1 (4-2013)
Abstract
Background: Nowadays, nanomaterials are used in daily life extensively. One of the most common of these materials is nano titanium dioxide (TiO2) which is used to purify the air and also sunscreens, shampoos and other hygienic products. Although nano-particles are useful, can also have potential hazards. The aim of this study is to evaluate the effects of TiO2 on lung tissue in rabbits.
Methods: We divided 18 male rabbits into three groups randomly. The first group recei-ved 50 µl of TiO2 with dose of 50 mg/kg by intratracheal instillation. The second group received 50 µl of TiO2 with dose of 100 mg/kg and the third group received 50 µl of nor-mal saline by the same route. Chest X-rays were taken from all rabbits before injection and on days of 10, 17 and 24 after injection. Twenty four days after injection, rabbits anesthetized and histopathological assays, blood samples and biochemical factors were evaluated.
Results: Radiographic assays showed a progressive pulmonary fibrosis in rabbits recei-ved TiO2 rather than the control group and this lesion developed to maximum at 24th day of the experiment. We also showed pulmonary emphysema and inflammation in histo-pathologycal study of groups treated with TiO2. Moreover, we observed a significant increase in the amount of liver enzymes, white blood cells and hematocrit in TiO2 treat-ed groups compared to control group (P≤0.05). There were no significant differences between plasma levels of creatinine in different groups (P>0.05).
Conclusion: Results showed that nanotitanium dioxide particles can lead to pulmonary fibrosis and inflammation and also increasing liver enzymes and inflammatory cells.
Narmin Ghaderi , Khosro Esazadeh , Alireza Shoae Hasani,
Volume 71, Issue 11 (2-2014)
Volume 71, Issue 11 (2-2014)
Abstract
Background: Apoptin is a protein from chicken anemia virus that could induce apoptosis specifically in the cancer cells but it has not any effect in the normal cells. Phage therapy is a novel field of cancer therapy and phage nanobioparticles (NBPs) such as λ phage could be modified to deliver and express genetic cassettes into eukaryotic cells safely in contrast with animal viruses. The bacteriophages like Lambda could be manipulated to deliver genetic cassettes into eukaryotic cells and express the gene safely. We developed the safe way for the expression of Apoptin gene via Lambda bacteriophage in the human tumors. Methods: At first the Apoptin clone was produced and then transferred into ZAP-CMV plasmid through BamH-I and HinD-III restriction sites. Then this construct inserted into the Lambda phage in the Escherichia coli host cell. The expression of Apoptin in the recombinant construct was evaluated via RT-PCR and Western Blot analysis. The anti tumor function of expressed protein was measured in the BT-474 cells that was hosted by nude mice. Results: Transfection of breast carcinoma cells by Lambda bacteriophage containing λZAP-Apoptin-CMV was inhibited the tumor growth significantly but did not any effect on normal cells. The expression of this protein was very high in tumor cells and prevented the death of tumor bearing nude mice. The penetration and spreading of Apoptin construct by bacteriophage Lambda was significantly high but the Apoptin plasmid had very little expression in BT-474 cell, directly. Transfection with NBPs carrying λZAP-CMV-Apoptin significantly inhibited growth of all the breast carcinoma cell lines in vitro, but had no effect on normal cells. Conclusion: Utilization of recombinant Lambda bacteriophage as a safe expression vector has been confirmed. Apoptin was induced apoptosis specifically in the tumors in vivo. Use of such construct is a very safe way to treat cancer in human. The results presented here reveal important features of λ nanobioparticles to serve as safe delivery and expression platform for human cancer therapy.
Gholamreza Rezamand , Mojdeh Ghabaee , Naser Ebrahimi Daryani , Hoda Ghadami ,
Volume 72, Issue 1 (4-2014)
Volume 72, Issue 1 (4-2014)
Abstract
Background: Nonalcoholic Fatty Liver Disease (NAFLD) is one of the most wide-spread human diseases that can impair liver function and sometimes progresses to cir-rhosis. Recently NAFLD has been identified as an independent risk factor for cardio-vascular disease. The aim of this study was to investigate the correlation of fatty liver disease and its sonographic severity on the resistance of the intracranial arteries. Methods: This study was a cross-sectional study of 55 patients referred from Gastroen-trology clinic with diagnosis of NAFLD to Sonodoppler department of Iranian Center of Neurological Research. Pulsaltile index as a Hemodynamic parameter of Middle Cerebral (MCA) and basilar Arteries of NAFLD Patients was measured by Trans Cra-nial Doppler (TCD) sonography and the measurements were compared with normal values. Also the association of these indices with serum liver enzymes and sonographic grading of liver involvement was assessed. The analysis was done by SPSS 16. Fre-quency distribution, mean and standard deviation were used in descriptive analysis and statistical test 2 to compare qualitative variables. Results: Pulsatile Index (PI) were normal (MCA, P= 0.166, Basilar, P= 0.053) and there was no significant difference with relation to severity of fatty liver based on so-nography findings (P= 0.789), but serum liver enzyme levels were inversely correlated with basilar artery PI (P= 0.014). Conclusion: Considering the increase of cerebral arteries PI in advanced liver disease, absence of increase in vascular PI of patients in the present study could be attributed to the short duration of disease from diagnosis to perform TCD, lack of advanced liver involvement (absence of liver dysfunction) and the response effect to treatment before the TCD. Therefore, to assess vascular changes over time, repeating the TCD with assess other parameters such as Fibroscan and K18 factor that has more compatibility of liver function, could help to understand the pathophysiology of liver diseases and its effect on vascular resistance.
Farideh Keypour , Ilana Naghi ,
Volume 72, Issue 4 (7-2014)
Volume 72, Issue 4 (7-2014)
Abstract
Background: A variety of endocrine disorders can complicate pregnancy. Diabetes insipidus although uncommon, may have devastating effect on pregnancy outcome, if unrecognized and untreated. The etiology of diabetes insipidus is often unknown, many cases are likely autoimmune, with lymphocytic infiltration of the posterior pituitary gland. Massive polyuria, caused by failure of the renal tubular concentrating mechanism, and dilute urine, with a specific gravity 1.005, are characteristic of diabetes insipidus. The diagnosis of diabetes insipidus relies on the finding of continued polyuria and relative urinary hyposmolarity when water is restricted. Most women require increased doses Desmopressin Acetate during pregnancy because of an increased metabolic clearance rate stimulated by placental Vasopressinase. By this same mechanism, subclinical diabetes insipidus may become symptomatic during pregnancy. Transient diabetes insipidus is associated with acute fatty liver and HELLP syndrome as well as twin gestation. Increased placental Vasopressinase activity, along with insufficient liver degradation in HELLP syndrome and acute fatty liver, may unmask this condition. Diabetes insipidus in pregnancy is rare. The disease results from inadequate or absent antidiuretic hormone (vasopressin) production by the posterior pituitary gland. The increased glomerular filtration rate seen in pregnancy may increase the requirement for antidiuretic hormone. Case presentation: We present a 39 years old woman, gravida3 para3, was admitted to Akbarabadi Teaching Hospital in september 2013. She was admitted due to polyuria, malaise, thirst with slight fever, six days after normal vaginal delivery. The urine volume was 8 lit/day and the specific gravity (S.G.) of the urine was 1.010. The urine osmolarity was lower than the plasma osmolarity. Electrolyte serum examination showed hypernatremia. The patient received 5 µg/day of synthetic vasopressin, in the form of l- deamino-8-Darginine vasopressin (DDAVP). This drug was given as intranasal spray in doses 0.25 mg twice daily. Plasma electrolytes and fluid status monitored carefully with initiation of therapy. DDAVP was used because it was not degraded by vasopressinase. Treatment was continuing, when the symptoms of central diabetes insipidus resolve and urinary concentrating ability was preferred. Maximum urinary osmolality over the next 11 hours was assessed, 730 mosm/kg was considered normal. Conclusion: Close attention to electrolyte and fluid balance is important in the postpartum period. The symptoms of transient vasopressin-resistant diabetes insipidus resolve in few days to a few weeks after vaginal delivery or when hepatic function returns to normal.
Saeed Nouri , Mohammad Reza Sharif ,
Volume 72, Issue 7 (10-2014)
Volume 72, Issue 7 (10-2014)
Abstract
Background: Controlling parenchymal hemorrhage especially in liver parenchyma, despite all the progress in surgical science, is still one of the challenges surgeons face saving patients’ lives and there is a research challenge among researchers in this field to introduce a more effective method. This study attempts to determine the haemostatic effect of aluminum chloride and compare it with that of the standard method (simple suturing technique) in controlling bleeding from liver parenchymal tissue. Methods: This is an experimental study. In this animal model study 60 male Wistar rats were randomly allocated into six groups and each of which contains 10 mouse. An incision, two centimeters (cm) long and half a cm deep, was made on each rat’s liver and the hemostasis time was measured once using aluminum chloride with different concentrations (5%, 10%, 15%, 25%, and 50%) and then using the control method (i.e. controlling bleeding by simple suturing). The liver tissue was examined for pathological changes. Finally, the obtained data were entered into SPSS software and analyzed using Kruskal- wallis test, Mann- Whitney, Kolmogorov- Smirnov test. Results: The mean time to hemostasis in groups of aluminum chloride concentration of 50%, 25%, 15%, 10% and 5% were respectively, 8.90, 13.10, 23.30, 30.30 and 37.8 seconds, also in the control group (suture) mean time of hemostasis was 60/81 seconds. The haemostatic times of different concentrations of aluminum chloride were significantly less than that of the control group (P< 0.001). There was a statistically significant difference between every two haemostatic times (P< 0.001). The pathologic examination showed the highest frequency of low grade inflammation based on the defined pathological grading. Conclusion: Aluminum chloride compare to the control method (i.e. controlling liver bleeding by simple suturing) needs less time to control liver bleeding. Aluminum chloride is an effective agent in controlling liver hemorrhage in an animal model.
Razieh Mohamad Jafari, Mehrnaz Taghvai Maasomi , Mahin Najafian , Najmie Saadati ,
Volume 72, Issue 7 (10-2014)
Volume 72, Issue 7 (10-2014)
Abstract
Background: Previous investigations have shown that pregnancy-associated plasma protein-A (PAPP-A) levels are associated with adverse pregnancy outcomes including intrauterine growth restriction (IUGR) fetuses as well as preterm delivery. The aim of this study was to determine the rate of preterm delivery in women with low PAPP-A and at intermediate risk for chromosomal abnormalities in the first trimester screening. Methods: A total of 137 women who underwent Down syndrome screening between 11 to 14 weeks of gestation were studied from September 2011 to September 2013 at Perinatal Care Clinic, Imam Khomeini Hospital, Ahvaz, Iran. From those, 52 patients had low PAPP-A. Inclusion criteria were singleton pregnancies, at 11 to 14 weeks of gestation, at intermediate risk for Down syndrome (risk in 1:101 to 1:1000). The intermediate risk was estimated based on maternal parameters, maternal serum markers (PAPP-A and β-hcG), and nuchal translucency (NT) using fetal medicine foundation (FMF), UK) software. The power of the study was 90%. The sample size was estimated based on prevalence of preterm delivery in pregnancies with low PAPP-A in the first trimester screening. Patients were followed-up until delivery to observe pregnancy outcomes. We evaluated the variables such as level of PAPP-A, outcomes of delivery, age, β-hCG, and gestational age. Results: Among 137 normotensive pregnant women at intermediate risk for Down syndrome, 52 cases (38%) had low PAPP-A (<0.4 MoM). Of 52, 14 cases (27%) had preterm delivery. None of our patients had pregnancy related or non related diabetes, preeclampsia, or chromosomal anomalies. 45 cases (86%) from 52 patients were equal or less than 35 years, while 7 patients were more than 35 years. Among 52 followed-up patients, 48 patients (92.4%) were at low-intermediate risk (risk in 1:251 to 1:1000), and 4 cases (7.6%) were at high-intermediate risk (risk in 1:101 to 1:250). Conclusion: We found high frequency of preterm delivery in pregnant women with low PAPP-A level at the first trimester screening. Hence, this group of patients needs special and early preventive management. Furthermore, we suggest that future researches to be conducted with larger sample size and also cervix length measurement to be included.
Sariyeh Golmahammadlou, Tayebeh Karjooyan , Shahryar Sane , Sima Oshnouei , Sarvin Pashapoor ,
Volume 72, Issue 7 (10-2014)
Volume 72, Issue 7 (10-2014)
Abstract
Background: Spontaneous hepatic rupture is a rare condition during pregnancy. Pregnant women with Hemolysis, Elevated Liver enzymes and Low Platelete count (HELLP) syndrome are more susceptible to hepatic rupture. It can occur per 40000 to 250000 pregnancies with high mortality and morbidity. There is no agreement on the best approach to this severe pregnancy complication. This is the case report of a spontaneous hepatic rupture associated with HELLP syndrome during pregnancy which occurred for the first time in the West Azerbaijan Province, Iran. Case Presentation: A 33 years old lady gravida 6, 3 intrauterine fetal deaths, 2 neonatal deaths at 30th weeks of gestation was admitted for preeclampsia. On admission, she had thrombocytopenia and elevated liver enzyme. Cesarean section was performed due to fetal distress and a preterm fetus was born. Inspection of the abdomen revealed a large hematoma in the right liver lobe associated with rupture of the capsule. Liver packing was performed by general surgeon and the abdomen was closed without repairing of fascia. In the 2nd day after operation, the patient was oriented but the abdomen reopened because of very low blood pressure. There was no severe liver hemorrhage so the liver was packed again with many surgicels. She developed acute kidney and liver failure, pleural effusion and a major coagulopathy post-operatively. Three weeks after surgery the abdomen was reopened for dehiscence and fascia was closed. The patient discharged after 40 days. Conclusion: Spontaneous liver rupture associated with HELLP syndrome is a rare and life-threatening complication of pregnancy. Unruptured liver hematoma is also a rare condition during pregnancy with a very difficult diagnosis. Using clinical diagnostic tests such as CT scan or MRI would be helpful to improve clinical outcomes.
Mehrdad Mohammadpour , Mohammad Saleh Sadeghi ,
Volume 72, Issue 10 (1-2015)
Volume 72, Issue 10 (1-2015)
Abstract
Eyes and the vision system allow the human being to receive information from the environment to the extent that 90% of the man’s information is acquired through observation, thus health and correct function of this organ have always been important. Diseases threatening vision such as Acute Macular Degeneration and Diabetic Retinopathy deprive millions of people of seeing every year while access to proper cures can prevent many ocular damages. Despite scientific progress in the medical fields over the recent decades there still exist many challenges in the field of ophthalmology and ocular diseases. As for ocular treatments, major challenges stem from pharmaceutical weaknesses, in other words in spite of access to the suitable drugs for ocular complications we have not yet succeeded to achieve an appropriate method to apply these drugs. By appropriate application of drugs we may deliver the active pharmaceutical ingredient to the target organ with the least side-effect, the most benefit and the highest level of patient compliance. Incapability of effective delivery of drug to the eye arises from the special physiology and anatomy of this organ. The static barriers such as Blood-Aqueous and Blood-Retinal and dynamic barriers such as conjunctival blood circulation and lymphatic clearance will reduce the bioavailability of ocular drugs. Overcoming the above-mentioned weaknesses requires a complete knowledge of the eye characteristics as well as acquaintance with novel drug delivery system. When speaking of drug delivery system (DDS) it means employing a two-part structure consist of active pharmaceutical ingredient (API) and carrier that in fact characteristics of formulated DDS will determine by the carrier. We may hope that by applying and designing modern pharmaceutical systems that mainly take advantage of nanoparticles we would be able to overcome many challenges of ocular drug delivery. The present study is aimed at reviewing the eye structure, challenges faced by ocular drug delivery, familiarity with nanotechnology and approaches of this science in the area of ophthalmology as well as mechanisms of designing a local system for effective drug delivery to the eye tissue.
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