[Hepatitis B virus x protein coding sequence variation in chronically infected patient]

Background and Objective: Chronic infection with Hepatitis B virus [HBV] is one of the main causes of cirrhosis and hepatocellular carcinoma [HCC]

The pathogenicity of the virus is determined by the multi-functional protein x [HBx]. Changing the sequence of the gene encoding this protein causes the regulation of transcription and pathogenicity factors. This study was done to analyze the genetic dynamics of the HBx coding gene in a person with chronic HBV

Methods: In this descriptive laboratory study, an infected person with chronic hepatitis B virus infection was first amplified and cloned into complete sequence of HBx encoder. Then, the reference sequences of genotypes, serotypes and different virus subtypes of the GenBank database were matched by CLC Sequence Viewer software. The comparative result was used to plot the phylogenic tree by T-rex server and population genetic analysis using DnaSP software. Natural selection at the nucleotide and protein level was performed by the Tajima's D test

Results: No known mutation at the level of the protein was found in the chronic sequence of the HBx encoder. The results of natural selection indicated neutral mutations in the HBx gene. The phylogenetic results showed that the HBx encoding sequences in the chronic infected individual had a genetic affinity with genotype D and ayw2 subtype

Conclusion: Neutrality polymorphism takes place in HBx coding region. Also, the phylogenetic results of the present study are consistent with the previous findings of Golestan province and Iran which have reported the prevalence of genotype D and subspecies ayw2

[ efficacy of carbon dioxide laser in the treatment of chronic and lupoid cutaneous Leishmaniasis in Kerman city: a randomized clinical trial]

Lupoid [LL] and chronic leishmaniais [CCL] are variants of cutaneous leishmaniasis [CL] which are resistant to various treatments. The diseases are endemic in some developing countries such as Iran. A Variety of drugs with different effects have been suggested in recent decades. Carbon deoxide laser has been recently applied in the treatment of different dermatological diseases. The aim of this study was to compare the efficacy of CO[2] laser compared to systemic Glucantime plus Allopurionl in the treatment of LL and CCL. A total of 50 patients with 86 LL or CCL lesions were participated in this study. They were divided into the two groups; the first group was treated with CO[2] laser for one session and the second group was treated with Glucantime [50 mg/kg IM for 21 days] plus Allopurionl [20mg/kg for 30 days]. All patients were followed at weeks 4[th], 8[th], 48[th] and 72[nd] and the results were compared. At week 4, the cure rate of complete improvement of two treatment groups was not statistically different [P=0.609]. By week 8, the cure rate slightly decreased [P=0.417]. The decreasing trend continued until weeks 48[th] and 72[nd] [P=0.289 and P=0.095, respectively]. Finally, 16 patients of laser group and 22 patients of the other group were cured, but statistically no significant difference was observed between the two groups [P=0.095]. Carbon deoxide laser therapy could be used in patients with hypersensitivity to pentavalent antimoniate or those with serious systemic diseases

Prevalence of left ventricular diastolic asynchrony in patient with systolic heart failure

To study the occurence of left ventricular [LV] diastolic asynchrony in patients with systolic heart failure [HP] and its relationship to diastolic function regardless of QRS duration. Recent work has demonstrated that intraventricular asynchrony is a common finding in patients with systolic heart failure. Little attention has been paid to diastolic asynchrony in patients with systolic heart failure. We have therefore decided to determine the extent to whuch patients with systolic heart failure have evidence of diastolic asynchrony and wheather or not diastolic asynchrony is correlated with diastolic dycfunction. Tissue Doppler echocardiography was performed in 50 HF patients [LV EF=23 +/- 8%]. Diastolic and systolic asynchrony was determined by tissue synchronization imaging using a 6 basal, 6 mid-segmental model. Systolic and diastolic asynchrony were assessed by the maximal difference in time to peak systolic and early diastolic velocities between any two of 12 LV segments, and the standard deviation of time to peak systolic and early diastolic velocities of the 12 LV segments. The mean +/- SD maximal difference in time to peak systolic velocity [controls: 17.2 +/- 9.6 ms versus narrow QRS: 66.7 +/- 38.0 ms versus wide QRS: 76.5 +/- 34.6 ms, both P<0.05 versus controls] and in standard deviation of time to peak systolic velocity of 12 LV segments [controls: 15 +/- 6.1 ms versus narrow QRS: 25.9 +/- 15.3 ms versus wide QRS: 28.6 +/- 14.4ms, both P<0.05 versus controls] was prolonged in both the narrow and wide QRS groups compared with normal controls. Similarly, the maximal difference in time to peak diastolic velocity [controls: 39 +/- 16.8 ms versus narrow QRS: 73.1 +/- 58ms versus wide QRS: 108.5 +/- 168 ms, both P<0.05 versus controls] and in standard deviation of time to peak early diastolic velocity of 12 LV segments [controls: 15.3 +/- 5.8ms versus narrow QRS: 25.1 +/- .13.8ms versus wide QRS: 25.5 +/- 14.9ms, both P<0.05 versus controls] was prolonged in both the narrow and wide QRS groups. The respective prevalence of systolic and diastolic asynchrony was 31.4% and 20%, in the narrow QRS group, and 40% and 28.6%, in the wide QRS group respectively.Stepwise multiple regression analysis showed that low ejection fraction and low mitral annular early diastolic velocity were independent predictors of both systolic and diastolic asynchrony. QRS complex duration was found to correlate only with diastolic asynchrony. LV systolic and diastolic mechanical asynchrony is common in patients with HF regardless of QRS duration. Selection for cardiac resynchronization treatment should also be based on information about systolic and diastolic synchronicity

Comparison of transesophageal echocardiographic assessment of right and left atrial appendage functions

To define right atrial appendage functional parameters and comparing them with those of left atrial appendage. A consecutive series of 154 patients [76 males and 78 females] with mean age of 42 years were referred for transesophageal echocardiography. Ejection and filling velocities of right and left atrial appendages were measured at 120 and 70 degrees respectively. The left and right ventricles size and function, right atrial size, tricuspid regurgitation severity, and pulmonary artery systolic pressure were prospectively measured and calculated during transthoracic echocardiography. Mean right and left atrial appendages velocities were 42 +/- 18 cm/s and 50 +/- 26 cm/s respectively [PV<0.001]. Statistically significant positive association [PV<0.001] was found between right atrial appendage velocity and right ventricle ejection fraction and statistically negative relationship was observed between right atrial appendage velocity and smoke pattern [PV<0.001]. Also, the results suggested marginally significant associations between right atrial appendage velocity and right atrium size [PV = 0.05] and pulmonary artery systolic pressure [PV = 0.07]. It was also found that right atrial appendage measures were relatively independent on right ventricle size and tricuspid regurgitation severity. Our study showed right atrial appendage measures were relatively dependent on right ventricle function, right atrium size and pulmonary artery systolic pressure and relatively independent on right ventricle size and tricuspid regurgitation severity. In patients with right atrium smoky pattern right atrial appendage velocity was significantly reduced

Correlation of right ventricular DP/DT with functional capacity and RV function in patients with mitral stenosis

Evaluation of right ventricular [RV] contractility and systolic function in patients with right sided heart disease is an essential component of clinical management. The aim of this study was to assess RV systolic function by qualitative and quantitative methods and compare it to rate of ventricular pressure change during the isovolumic contraction period [dP/dt] as RV contractility index in patients with rheumatic mitral stenosis. In 56 consecutive patients with moderate to severe mitral stenosis, RV systolic function, RV dP/dt and dP/dt/Pmax, were calculated and compared. There was significant correlation between RV dP/dt and RV function [P < 0.001] and between RV dP/dt and New York Heart Association [NYHA] functional capacity [P < .001]. The mean of dP/dt was decreased with increasing severity of RV dysfunction [mean dP/dt was 648 +/- 159 for normal RV function, 592 +/- 126 for mild RV dysfunction, 319 +/- 146 for moderate RV dysfunction and 166 +/- 150 for severe RV dysfunction] Severity of tricuspid regurgitation and pulmonary hypertension had no significant effect on RV dP/dt and RV function. RV dP/dt/Pmax had also significant relationship with RV function and functional capacity [P < 0.001]. Measurements of dP/dt and dP/dt/Pmax, are practical methods for estimating RV contractility and results have a good correlation with RV systolic function and functional capacity

Open lung biopsy with local anesthesia

Open lung biopsy may be required in the patients with parenchymal lung disease who do not have a clearly defined diagnosis. There is no doubt thoracotomy with general anesthesia is preferable to local anesthesia; but it is associated with high risks in the severally ill patients. The aim of this study is to review our experience and compare the efficacy and complications of using local anesthesia versus general anesthesia for open lung biopsies in high risk patients. From January 2002 to September 2004, Twenty five patients [18 males, 7 females] underwent open lung biopsy using minithoracotomy in the Baqiyatallah hospital in Tehran. 14 [56%] of them had open lung biopsy using general anesthesia [GA] and 11 [44%] selected for this procedure with local anesthesia [LA], all of LA group were excluded from GA because of their poor condition. we reviewed effectiveness of LA for minithoracotomy and also compared the safety, accuracy and various complications of this procedure between the two methods of anesthesia. The mean age in the first [GA] group was 42.5 [ +/- 14.7] years and in the second [LA] group was 49.6 [ +/- 12.2] years [NS]. The average length of hospital stay, postoperative air leak, and the diagnostic accuracy was not significantly different between the two groups. There was one operative-related mortality in the second group [NS]. In selected patients with diffuse lung disease or peripheral lesions Local anesthesia is an acceptable substitute to general anesthesia for minithoracotomy to obtain adequate lung tissue for accurate diagnosis

[ efficacy of horse collagen[Antema] in hemostasis of bleeding due to dental procedures, pilonidal sinus surgery, hemorrhoidectomy and laminectomy]

Hemostasis and control of bleeding are important principles in surgery. Control of bleeding with normal procedures such as cauterization and ligation is sometimes hard and even impossible. Considering different effects of collagen including hemostasis acceleration, complete absorption, tissue repair, and flexibility and appropriate traction, it can help maintain hemostasis. In a randomized controlled clinical trial, 92 cases and 91 controls were compared. Horse collagen [Antema] was used in cases while routine procedures were implemented in controls. Patients were evaluated in 4 groups involving dental procedures, pilonidal sinus open surgery, hemorrhoidectomy, and laminectomy. Statistical indices such as mean, standard error, and statistical tests such as t-test and chi-square were used in the analysis. Mean age was 29.48 +/- 1.29 in the cases and 33.2 + 1.5 in the control group. Seventy four [36 cases, 38 controls] undergoing dental procedures, 61[31 cases, 30 controls] pilonidal sinus open surgeries, 31[18 cases, 18 controls] hemorrhoidectomies, and 12[7 cases, 5 control] laminectomies were investigated. Despite higher severity of bleeding in cases [p=0.011, r=0.247], the time of bleeding control [p<0.001] and the time of complete hemostasis[p<0.001] were lower in cases than in the control group. Antema is effective in hemostasis and it may be used as an adjunct material in hemostasis

Association of variable number of tandem repeats in endothelial nitric oxide synthase gene with coronary artery disease

Endo-derived nitric oxide [NO] is synthesized from L-arginine by endothelium nitric oxide synthase [eNOS]. Since reduced NO synthesis has been implicated in the development of coronary atherosclerosis; we hypothesized that polymorphisms of NOS gene might be associated with increased susceptibility to this disorder and coronary artery disease [CAD]. We studied the 27 base pair tandem repeat polymorphism in intron4 of the endothelial nitric oxide synthase [eNOS] gene in 141 unrelated CAD patients with positive coronary angiograms in Shahid Rajaee Heart Hospital and 159 age matched control subjects without a history of symptomatic CAD. The study protocol was approved by the Iran University of Medical Sciences Ethics Committee. The eNOS gene intron4a/b VNTR polymorphism was analyzed by polymerase chain reaction. The plasma lipids levels and other risk factors were also determined. The genotype frequencies for eNOS4b/b, eNOS4a/b and eNOS4a/a were 68.8, 29.1 and 2.1% in CAD subjects, and 81, 18.4 and 0.6% in control subjects, respectively. The genotype frequencies differed significantly between the two groups [X[2]=6.38 P=0.041]. The frequency of the allele was 16.7% in CAD subjects and 9.8% in control subjects and was significantly higher in the patients [X[2]=6.18 P=0.013, odds ratio=1.84]. Plasma lipids, except HDL-C were also remarkablely increased in CAD group

Value of fine needle aspiration in diagnosis of palpable breast masses

Fine needle aspiration [FNA] as a cytological method for the evaluation of breast masses was first performed in 1930, and of present is used as a routine method for the evaluation of breast masses. Aspiration via fine needle as a diagnostic tool is easy, accessible and relatively non - invasive. The purpose of this study was to determine the diagnostic value of this method and its comparison with open biopsy in determining the nature of breast masses. This prospective study included 62 females with palpable breast masses who were candidates for breast biopsy. Mean age was 43.7 +/- 14.3 years [16-68 years]. All patients had palpable breast masses and underwent FNA prior to conventional open breast biopsy Excised tissues and FNA samples were studied by a pathologist who was blinded to the patient's name and her medical history. According to histopathological exam, there were 40 [64.5%] benign and 22 [35.5%] malignant. Incidence of malignancy was higher in the larger masses. When FNA reports were compared with final histopathology reports, there was one false negative and one false positive report. Positive predictive value [PPV] and negative predictive value [NPV] were 95.5% and 96.7% respectively. This study demonstrates that FNA is safe and accurate diagnostic procedure in evaluation and diagnosis of breast masses. We recommend it to be used as the initial diagnostic test for all palpable breast masses. To avoid any misdiagnosis, open biopsy should be performed when needle aspiration is negative or the masses are clinically suspicious for malignancy