Vitamin D supplementation in the treatment of atopic dermatitis: a clinical trial study.

BACKGROUND: The role of vitamin D in Atopic Dermatitis (AD) is ambiguous and clinical trials are needed to assess the role of vitamin D in the treatment of AD. The aim of this clinical trial study to evaluate the effect of vitamin D supplementation on patients with AD. MATERIAL AND METHODS: sixty AD patients were included in a randomized, double-blind, placebo-controlled trial study. They were randomly divided into two groups and treated for 60 days: group vitamin D (n=30), and placebo group (n=30). The two groups were as follows: Group D, 1600 IU cholecalciferol (vitamin D) and second group placebo. The severity of AD was evaluated based on SCORAD (Scoring Atopic Dermatitis) and TIS (Three Item Severity score) value by the same trained physician before and after the trial. RESULTS: According to SCORAD and TIS value index in the vitamin D group showed significant improvement in patients with mild, moderate and severe AD (P<0.05) and in patients who the intake placebo, this improvement didn't showed (P>0.05). CONCLUSION: Results mention that supplementation with oral vitamin D dramatically improved disease severity in AD patients.

Human papillomavirus detected in esophageal squamous cell carcinoma in Iran.

INTRODUCTION: Considering the different results obtained regarding the association of HPV with the development of esophageal squamous cell carcinoma (ESCC) in different populations, we aimed to determine the frequency of HPV infection and its subtypes in ESCC in Iranian patients. METHOD: A total of 100 paraffin-embedded tissue samples of ESCC diagnosed during 1991 and 2005 in the Institute of Cancer affiliated to Tehran University of Medical Sciences were selected. Seven out of 100 samples were excluded due to low quality of extracted DNA from paraffin-embedded specimens. Thus, 93 samples were included for HPV genotyping. RESULT: All samples were examined using SPF10 primers for HPV detection. HPV DNA was positive in 8 out of 93 (8.6%) ESCC specimens. Using INNO-LiPA genotyping system we detected the genotypes of 5 out of 8 HPV-positive samples. Both HPV types 16 and 6 were detected in 3 specimens; one sample was positive for HPV type 18 and 2 samples were co-infected with two HPV types. There were no statistically significant differences between HPV-positive and HPV-negative cases with regard to clinical and pathologic findings. Three samples were positive for SPF10 indicating HPV infection; however, the exact HPV type could not be clarified using INNO-LiPA genotyping . CONCLUSION: In conclusion, the present study showed that a small proportion of ESCC specimens from Iran harbor HPV16, 18 genome using a highly sensitive method. As different rates have been reported from Iran, a more widespread study with more precise definition of geographical differences could delineate the potential involvement of HPV in the development of ESCC in Iranian population.

Renal amyloidosis in a child with neutropenia.

Amyloidosis represents a heterogeneous group of disorders of protein metabolism and is characterized by deposition of fibrillar proteins in the intra- and extracellular spaces. Here, a case of generalized amyloidosis associated with neutropenia is presented. She had a medical history of multiple bacterial infections. At the age of 14 years, she developed nephrotic syndrome. An increase of antigenic stimulation during the intermittent bouts of acute infections would have been the main factor responsible for the development of secondary amyloidosis in this case. To the best of our knowledge, coexistence between neutropenic disorders and renal amyloidosis in children has not been reported till date. The purpose of this report is to present a case of secondary amyloidosis associated with neutropenia in pediatric age group, probably for the first time.

A comparative study of characteristics and risky behaviors among the Iranian opium and opium dross addicts.

BACKGROUND: Iran ranks first per capita in the use of opiates, but we have little information about possible differences regarding the 2 most commonly used illicit drugs, namely opium and its dross (residue). DESIGN: This is a cross-sectional study. SETTING: A cross-sectional study about drug abuse and drug dependence in Iran was conducted from April 2006 to August 2008 in the prisons of 28 Iranian provinces, in the treatment centers, and in the streets. PARTICIPANTS: To pursue the objectives of this research, participants included 2979 opiate addicts including opium users (n = 2636) and dross users (n = 343), who were not significantly different by gender (P = 0.269) or age (P = 0.452). MEASUREMENTS: An anonymous questionnaire was completed through an interview that gathered sociodemographic characteristics and information about some high-risk behaviors. RESULT: : By the end of the study, we concluded that dross addicts, in comparison with opium addicts, were mostly immigrants from rural areas to urban areas (P = 0.031 χ test, 95% confidence interval [CI]), mostly uneducated, illiterate, or semiliterate (P = 0.04 χ test, 95% CI), had illegal occupations (P = 0.048 χ test, 95% CI), were cigarette smokers (P < 0.000 χ test, 95% CI), and had experienced drug injections (P = 0.032 χ test, 95% CI) and drug overdose (P = 0.007 χ test, 95% CI). They also had a history of hospital admission within the preceding year because of drug overdose (P < 0.000) and a record of being arrested and jailed in the past year (P = 0.028 χ test, 95% CI). CONCLUSION: These results indicated the need for more intensive and effective care for the opioid addicts in Iran.

Accuracy of cystosonography in the diagnosis of vesicourethral reflux in children.

Vesicoureteric reflux (VUR) is found in 1% of all children and in 30%-50% of those with urinary tract infection. Furthermore, VUR in childhood is the main reason for pyelonephritis, hypertension and chronic kidney disease. Recently, a variety of procedures with low radiation have been recommended for diagnosis of VUR. Therefore, in this study, voiding urosonography (VUS) or cystosonography was performed for evaluation of VUR and for comparing it with radio nucleotide cystography (RNC). We studied 25 children admitted with initial diagnosis of VUR in our center in the year 2007. Simultaneously, RNC and VUS were performed for all the patients. VUR was detected in eight patients with the VUS procedure and in nine children with RNC. Another patient was diagnosed only by RNC, and two other patients by only VUS. The two methods were concordant in detection and exclusion of urinary reflux in 87% (P: 0.000, r: 0.728). Furthermore, the diagnosis of various grades of reflux by these two schemes were comparable (P: 0.0000, r: 0.724). Sensitivity and specifity of VUS was determined as 87% and 88%, respectively, with a 94% positive predictive value and a 77% negative predictive value. We conclude that VUS is a highly accurate, safe and inexpensive tool for the screening, diagnosis and follow-up of VUR.

Prevalence of dyslipidemia among Iranian patients with idiopathic tinnitus.

BACKGROUND: Tinnitus is a sense of sound perception in absence of an external source which can affect life quality. Different conditions may lead to tinnitus including metabolic disorders such as dyslipidemia. The aim of this study was to investigate the prevalence of dyslipidemia among Iranian patients with idiopathic tinnitus. METHODS: This was a cross-sectional study in which prevalence of dyslipidemia in fasting state and its subclasses were assessed in 1043 tinnitus patients aged 12-90 years who referred to Rasool Akram Hospital, Tehran, Iran, 2006-2009. Data was summarized by SPSS software version 17 and one sample t-test and Chi-Square test were applied to analyze the results. P less than 0.05 were considered significant. RESULTS: The most prevalent type of dyslipidemia was hypercholesterolemia with the frequency of 14.4% followed by low HDL-C with the frequency of 12.8%. Mean of total cholesterol, HDL-C, LDL-C and triglyceride levels in all patients were not greater than general population. CONCLUSIONS: Based on the results of the present study, there might be no need to check the serum lipid profile in tinnitus patients. We recommend further studies to assess both fasting and postprandial serum lipid profile in patients with idiopathic tinnitus. Simultaneous investigation of their dietary intake is also suggested.

Comparison of sexual function in females receiving haemodialysis and after renal transplantation.

The aim of this study is to compare the sexual function of kidney transplant recipients and end-stage renal disease (ESRD) patients receiving haemodialysis (HD) in female patients. In the sample population of this study, there were 72 women in the transplant group and 40 women in the HD group. To test the differences in the quantitative variables between these two groups, an independent sample Student's t-test was performed. Sexual relationship, sexual function, sexual frequency and sexual fear in the renal transplant patients are significantly better than HD patients. Sexual intercourse satisfaction was apparently higher in the kidney recipients than in the HD patients. Twenty-one patients in transplanted group described number was 6 (15%) (p = 0.03). This study indicated that female kidney transplant recipients experienced a significantly better sexual relationship compared with the ESRD patients receiving HD.

Efficacy of oral metronidazole in treatment of cutaneous and mucosal lichen planus.

INTRODUCTION: Response to different antimicrobial agents supports the infection hypothesis for lichen planus (LP). There are individual case reports describing the improvement of LP with oral metronidazole treatment in patients with concomitant intestinal amebiasis or giardiasis. There are two small studies that reported metronidazole might be effective in some patients with idiopathic LP who did not have concomitant protozoal infections of the intestinal or genital tracts. The authors performed an open trial to evaluate the effectiveness of metronidazole, as a single treatment, on different forms of LP. PATIENTS AND METHODS: A total of 49 patients, 24 male and 25 female, were selected from the dermatology outpatient clinic with a diagnosis of LP in one of its forms. Metronidazole was administered at 250 mg every eight hours daily without any concomitant therapy. Patients were examined at baseline and at days 21, 42, 63, 84 of treatment, and the follow-up period was three months. The authors used SPSS software (Version 15) for data analysis. RESULTS: A total of 20 (40.82%) skin lesions had complete response (CR) to treatment by metronidazole, 16 (32.65%) had relative healing (PR) and 13 (26.53%) did not improve (NR). The overall treatment response (CR + PR) of LP skin lesions was 73.47 percent in this study. In mucosal involvement, the overall treatment response was 66.6 percent, and finally the overall treatment response for itching was obtained in 75 percent of the cases. CONCLUSION: Based on the authors' findings, metronidazole can be an alternative therapy in treatment of LP, and is a safe agent to be considered.

Incidence and risk factors of transplant renal artery stenosis in living unrelated donor renal transplantation.

BACKGROUND: This study was designed to evaluate the incidence and risk factors of transplant renal artery stenosis (TRAS) among living donor unrelated kidney recipients. PATIENTS AND METHODS: Three hundred and sixty kidney consecutive transplant recipients were included in this retrospective cohort study. Informed written consent was obtained, only TRAS occurring three months after transplantation were considered. After five-year follow up, TRAS was established in 6.6% (24 patients) of patients. RESULTS: Mean +/- SD age of recipients was 39.8 +/- 14.9 years old (range 16-77). Upon multivariate analysis recipient age >50 (RR = 2.9, CI 95%: 1.33-2.93, p = 0.008), recipient BMI >30 (kg/m(2)) (RR: 7.97, CI 95%: 3.44-18.46, p < 0.001), retransplantation (RR = 4.88, CI 95%: 2.21-10.77, p < 0.001), cytomegalovirus (CMV) infection and delayed graft function (DGF) (RR: 4.29, CI 95%: 3.12-13.79, p = 0.01) appeared to be independently associated with TRAS. Positive CMV-antibody was more frequent in recipients with TRAS (95.83% vs. 70.8%, p = 0.04) but all of them were HCV-antibody negative. Other variables as discussed were similar between two groups. CONCLUSION: High recipient age, BMI > 30, hyper trigelyceridaemia, previous transplantation, CMV infection and DGF are shown to be risk factors for TRAS.

The efficacy of photodynamic therapy in treatment of recurrent squamous cell and basal cell carcinoma.

OBJECTIVES: A number of investigations have already been carried out to assess the effect of photodynamic therapy (PDT) on primary basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) lesions, but lack of investigations on recurrent lesions or lesions with treatment failure, prompted the authors to carry out this study. The aim of the present study was to evaluate the efficacy of photodynamic therapy on recurrent BCC and SCC lesions on head and neck skin. PATIENTS AND METHODS: A total of 30 patients, including 16 men and 14 women, were selected from patients with recurrent SCC and BCC who referred to Iran university ENT research center Rasool-e-Akram Hospital, Tehran-Iran, met the criteria and entered the study. This is a longitudinal study of 30 patients with 43 histologically verified head and neck skin tumors, candidate for photodynamic therapy. RESULTS: To cite the results obtained in this study, it is worth mention that five cases expressed disagreement with this treatment modality after the first session of illumination; the treatment was stopped because of pain or burning. In a three-month evaluation, complete treatment response rates were obtained in 72% of patients (18 cases); in SCC cases it was 71.4% (10 cases) and in BCC it was 72.7% (eight cases). The final result of complete response rate in three years of follow up, demonstrated that 16 (64%) patients out of 25 were disease-free from recurrent BCC and SCC (Table 1). In BCC cases the final three-year response rate was seven (63.6%) and in SCC cases it was nine (64.2%). Hence, there was no statistical difference between SCC and BCC cases to treatment (P = 0.34). DISCUSSION: The obtained data from the current study is supportive of the recommended treatment method of PDT as an effective, tolerable and less invasive treatment in patients with recurrent BCC and SCC carcinomas, particularly when cosmetic effects are an important consideration. However, more research is needed to establish this.

Collision tumor of meningioma and malignant astrocytoma.

The authors report a 12-year-old boy who was presented with headache, nausea, vomiting and seizure. His magnetic resonance imaging showed 2 adjacent tumors in the region of the left ventricular trigone. The pathology of tumors reported collision tumors composed of meningioma and malignant astrocytoma.

Malassezia yeast species isolated from Iranian patients with pityriasis versicolor in a prospective study.

The goal of this study was to determine the prevalence of Malassezia species in pityriasis versicolor lesions and to examine if the range of species varies with patients characteristics such as: age, sex and family history and also clinical findings such as site and number of the lesions. In a prospective study from July 2006 to July 2007, the patients with a clinical diagnosis of pityriasis versicolor (n = 166) were asked to participate in the study. A total of 116 patients had positive culture for Malassezia species: M. globosa was found in 52 (31.3%) cases, M. furfur in 34 (20.5%) cases, M. pachydermatis in 12 (7.2%) cases, M. restricta in 12 (7.2%) cases, M. slooffiae in 6 (3.6%) cases. According to our data, M. globosa is the main species causing pityriasis versicolor, M. furfur was found to be the second-most frequent species. M. sympodialis and M. obtusa were not found in any case, and in 30.2% of patient's Malassezia culture was negative.

Outcome of living donor renal allograft survival in children with focal segmental glomerulosclerosis.

FSGS is the most frequent GN that may recur in a renal allograft. Compared with adults, the impact of FSGS on graft survival appears to be more significant in children. Thus we decided to assess graft survival and complications after renal transplantation in children with FSGS. Outcome of renal transplantation in 25 children with FSGS who received a renal transplant at Labafi Nejad Hospital was studied and compared with 75 patients as a control group. The mean follow-up duration was 68.16 (s.d. = 41.93) months. Other than demographics, variables such as DGF, acute rejection, number of acute rejection episodes, and graft failure in both groups were evaluated. Acute rejection was seen in 22/25 (88%) of FSGS group, compared to 40/75 (53.3%) in the control group. This difference was statistically significant (p = 0.001). DGF was seen in 4/25 (16%) and 13/75 (17.3%) in the FSGS and control groups, respectively (p = N.S.). The mean graft survival time was 115.61 (s.e.m. = 12.56) and 155.56 (s.e.m. = 7.16) month in FSGS and control group, respectively (p = N.S.). We demonstrated that graft function and survival were not significantly different in the FSGS and control patients. However, acute rejection episodes were more common in FSGS patients but without a significant impact on graft survival.

Doxycycline plus levamisole: combination treatment for severe nodulocystic acne.

BACKGROUND: Levamisole is an agent without much potential use alone, but through immunomodulation, may synergistically improve the efficacy of other drugs like doxycycline in the treatment of acne vulgaris. OBJECTIVE: The goal of this study was to determine the efficacy of levamisole in addition to doxycycline in the treatment of patients suffering from severe nodulocystic acne. METHODS: A double-blind, randomized, placebo-controlled trial was conducted in the dermatology clinic of Rasoul-e-Akram Hospital in Tehran, Iran in 2006. Sixty patients were randomly assigned to 1 of 2 study groups. The case group was administered oral levamisole 2.5 mg/kg/wk (up to 150 mg/wk) plus doxycycline 100 mg daily and the control group was given 100 mg of oral doxycycline daily and a placebo. Patients were evaluated at baseline, and at 2-month, 4-month, and 6-month checkpoints. RESULTS: The responses to treatment were significantly higher in the case group according to the reduction in total lesions count, acne severity index; and papule/pustule and nodule/cyst count at the 2nd, 3rd, and 4th visits. CONCLUSION: Results indicated that adding oral levamisole to doxycycline is an effective treatment for severe nonresponsiveness to conventional treatments of acne vulgaris. In the patient group, levamisole was well tolerated with an acceptable safety profile. At the time of publication, this study is the first clinical trial that suggests levamisole as an effective new treatment for severe acne vulgaris.