Decreased salivary beta-defensin 2 in children with asthma after treatment with corticosteroid inhaler.

PURPOSE: Asthma is the most common chronic disorder in childhood. Inhaled corticosteroid therapy is currently the most effective treatment for Asthma. The oral cavity complications related to this treatment may be in terms of the changes in the innate immune system of mouth. Salivary defensin has many immunomodulatory properties. The expression of beta-defensin 2 was measured before and after inhaled corticosteroid treatment in children with asthma to determine the potential impact of corticosteroids on defensin expression. METHODS: The present study was a cohort study conducted on the patients referred to Children's Medical Center for whom a diagnosis of Asthma was confirmed, and inhaled corticosteroid therapy was prescribed. Saliva was sampled once at the stage of diagnosis and before receiving any treatment. Another salivary sample was collected 4 weeks after receiving corticosteroids. ELISA was performed to assess beta-defensin 2. RESULTS: The beta-defensin 2 salivary level after inhaled corticosteroid therapy was significantly lower than before treatment. There is no significant difference in the salivary flow rate before and after treatment. CONCLUSIONS: Considering the limitations of the present study, the following conclusions can be made salivary beta-defensin 2 is decreased in children with asthma after treatment with a corticosteroid inhaler. Regular dental and oral soft tissue examinations in Asthmatic children under corticosteroid therapy could be suggested.

Customized birthweight standard for an Iranian population.

OBJECTIVE: To produce a customized birthweight standard for Iran. METHOD: Retrospective study of a pregnancy database collected from five hospitals across Iran. The cohort consisted of 4994 consecutive term births with complete data, delivered between July 2013 and November 2014. Coefficients were derived using a backwards stepwise multiple regression technique. RESULTS: Maternal height, weight in early pregnancy and parity as well as the baby's sex were identified as significant physiological variables affecting birthweight. Paternal height and weight were also significant although weaker factors. The expected 280-day birthweight, free from pathological influences, of a standard size mother (height 163 cm, weight 64 kg) in her first pregnancy was 3390 g. Pathological factors found to affect birthweight in this cohort included village housing, anemia, preexisting and gestational diabetes and preeclampsia. CONCLUSION: The analysis confirmed the main physiological variables that affect birthweight in other countries and shows paternal factors also to be significant variables. Development of a country-specific customized birthweight standard will aid clinicians in Iran to distinguish between fetuses that are either constitutionally or pathologically small, thereby avoiding unnecessary interventions, and improving identification of at-risk pregnancies and perinatal outcome.

Does the BCG vaccine have different effects on strains of tuberculosis?

Several explanations have been suggested concerning the variety in bacille Calmette-Guerin (BCG) vaccine efficacy on strains of Mycobacterium tuberculosis (Mtb). This study aimed to compare the effect of BCG vaccination history in the prevention of the occurrence of Mtb-Beijing and non-Beijing strains. In this cross-sectional study, 64 patients with pulmonary tuberculosis (TB) were recruited from the Iranian border provinces (North West and West). Isolates were subjected to restriction fragment length polymorphism (RFLP) analysis, using the insertion sequence IS6110 as a probe (IS6110 RFLP) and drug susceptibility testing using the proportion method. Samples were analyzed with Gel Compare II 6.6 and spss version 18. The mean age [standard deviation (SD)] of the patients was 54·4 (SD = 17·0). Overall, 49 cases (76·56%) had no BCG vaccination scar. The prevalence of Beijing strains was 9·38% and drug resistance proportion among the isolates was 14·1% (nine cases). There was a significant relationship between Beijing strains and tuberculosis (TB)-drug resistance in isolates (χ2  = 26·29, P < 0·001). There was also a strong association between vaccination history and Beijing strains (χ2  = 13·23, P = 0·002). Also, a statistical relationship was observed between Beijing strains and drug-resistant TB among patients with a history of vaccination (χ2  = 7·47, P = 0·002). This association was not maintained in the unvaccinated group (P = 0·102). These findings confirm the claim that the vaccine has different effects on different subspecies of tuberculosis. The cause of the high probability of drug resistance in patients with Beijing-TB and vaccination history requires further investigation with a higher sample size.

Evaluation of patients with primary immunodeficiency associated with Bacille Calmette-Guerin (BCG)-vaccine-derived complications

BACKGROUND: Bacille Calmette-Guerin (BCG) vaccination has a great impact on the prevention of severe complications of tuberculosis. However, in patients with primary immunodeficiencies (PID), it can lead to severe complications such as severe combined immunodeficiency, chronic granulomatous disease, and Mendelian susceptibility to mycobacterial disease. This study highlights the demographics, clinical complications and laboratory parameters among PID patients associated with BCG vaccination side effects. METHODS: One hundred and thirty-seven PID patients with BCGosis were evaluated in this study, based on the complications following BCG vaccination. RESULTS: The mean age of the patients with BCG complications at the time of the first visit was five years. The within-group comparison of patients showed a highly significant incidence of pneumonia and hepatomegaly in severe combined immunodeficiency patients. Furthermore, the immunologic data showed an increase in the overall rates of lymphocytes such as CD3+, CD4+ and CD8 + T cells in Mendelian susceptibility to mycobacterial disease patients. The level of immunoglobulins has also increased in chronic granulomatous disease patients. CONCLUSION: The high rate of undiagnosed PIDs predisposes individuals to a high risk of severe side effects as a result of BCG vaccination, as well as infants that are less than one month of age. Therefore, there is a need for early screening and diagnosis of PIDs before exposing unknown PID status patients to BCG vaccination. The benefits of screening and early diagnosis of PID cannot be overemphasized, especially in patients with a previous family history of immunodeficiency

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Evaluation of patients with primary immunodeficiency associated with Bacille Calmette-Guerin (BCG)-vaccine-derived complications.

BACKGROUND: Bacille Calmette-Guerin (BCG) vaccination has a great impact on the prevention of severe complications of tuberculosis. However, in patients with primary immunodeficiencies (PID), it can lead to severe complications such as severe combined immunodeficiency, chronic granulomatous disease, and Mendelian susceptibility to mycobacterial disease. This study highlights the demographics, clinical complications and laboratory parameters among PID patients associated with BCG vaccination side effects. METHODS: One hundred and thirty-seven PID patients with BCGosis were evaluated in this study, based on the complications following BCG vaccination. RESULTS: The mean age of the patients with BCG complications at the time of the first visit was five years. The within-group comparison of patients showed a highly significant incidence of pneumonia and hepatomegaly in severe combined immunodeficiency patients. Furthermore, the immunologic data showed an increase in the overall rates of lymphocytes such as CD3+, CD4+ and CD8 + T cells in Mendelian susceptibility to mycobacterial disease patients. The level of immunoglobulins has also increased in chronic granulomatous disease patients. CONCLUSION: The high rate of undiagnosed PIDs predisposes individuals to a high risk of severe side effects as a result of BCG vaccination, as well as infants that are less than one month of age. Therefore, there is a need for early screening and diagnosis of PIDs before exposing unknown PID status patients to BCG vaccination. The benefits of screening and early diagnosis of PID cannot be overemphasized, especially in patients with a previous family history of immunodeficiency.

Association between small for gestational age and low birth weight with attention deficit and impaired executive functions in 3-6 years old children.

BACKGROUND: Behavioral disorders and attention deficit hyperactivity disorder (ADHD) symptoms are frequently reported among children with history of small body size at birth and disproportionate intrauterine growth retardation. The current study aimed to investigate some factors like executive functions and attention deficit in children with history of Small for gestational age (SGA) and/or Low Birth Weight (LBW) at birth. METHODS: A historical cohort study was done and 3-6 years old preschool children (with past history of SGA/LBW) from some kindergartens and health centers were selected. Control group was randomly selected among children with history of normal birth weight and appropriate for gestational age at birth. All children were interviewed by an expert psychologist. Variables related to their attention, development, and executive functions were assessed by ASQ, Conner's, and Wisconsin Card Sorting Test. Completed questionnaires related Attention deficit and indexes of executive functions were evaluated between children in case groups and their counterparts in controls. RESULTS: Based on inclusion criteria, 229 preschool children entered the study. With regard to size for gestational age, 124 cases were categorized in the SGA/LBW group and the rest were assigned in the appropriate for gestational age (AGA) group. In the case group, NPE and Percent Perseverative Errors (PPE) scores were significantly lower than normal birth weight group (p = .0001, p = .015). Scores related B item of Conner's was significantly different between cases and their controls (p = .039, p = .035). CONCLUSIONS: Our results indicated that children with past history of some risks at birth may suffer from complications related attention and executive functions in their childhood. Recommendations for further research are strongly suggested.

Intracardiac electrogram envelope detection during atrial fibrillation using fast orthogonal search.

The performance of any intracardiac electrogram processing method is limited by the accuracy of its activation detection approach. The most common activation detection approaches in the literature aim to find the highest peak in the activation envelope disregarding the start and end points. However, the duration of the activation can be used to extract useful information such as wave collisions. In this work, we propose a novel orthogonal based approach for fast and accurate estimation of the start and end of the activations (activation envelope) in intracardiac recordings during atrial fibrillation. Wavelet decomposition of the signals was used to create a pool of basis functions for the proposed modeling method. The database included 24 recordings of approximate length of 6s obtained from atrial endocardium of 5 patients who underwent catheter ablation therapy. The start and end of activations in each electrogram was manually annotated by an expert electrophysiologist and the annotations were used as a gold standard to calculate the performance of our envelope detection method. The results show promising performance and excellent robustness to training data for our proposed method with respect to envelope estimation error.

Evaluation of serum hepcidin and iron levels in patients with PCOS: a case-control study.

PURPOSE: Polycystic ovary syndrome (PCOS) is the most common cause of chronic anovulation with a prevalence of 5-10% in women of reproductive age. The etiology of this disease is not well known, and hepcidin is one of the factors affecting the pathogenesis of the disease. The aim of this study was to evaluate plasma levels of hepcidin in patients with PCOS and its correlation with serum iron level. METHODS: In this case-control study, plasma levels of hepcidin, IL-6, and ferritin using ELISA method and serum iron levels using a spectrophotometric method were tested on 56 women with PCOS (case group) and 41 healthy subjects (control group). The results were analyzed using t test, General Linear Model, Binary logistic regression, and linear regression tests. RESULTS: The mean hepcidin levels were 1.97 ± 0.53 and 2.40 ± 0.25 pg/ml in the case and control groups, respectively. The t-test results showed significant difference between the two groups (p = 0.0001). The mean serum iron levels were 72.89 ± 28.97 and 70.62 ± 31.18 g/dl in the case and control groups, respectively. The t test analysis indicated no significant difference between the two groups. The serum ferritin and iron levels had no significant relation with serum hepcidin level in two groups. CONCLUSION: Despite the differences in the serum levels of hepcidin between the two groups, no significant relation was observed between serum iron levels and hepcidin level in this group of patients. This implies the need for more comprehensive studies on gene expression in hepcidin and iron pathways using real-time and Western techniques to investigate more precisely serum hepcidin level and its relationship with the factors mentioned.

Clinical efficacy analysis of preoperative neoadjuvant chemotherapy with high-dose dense paclitaxel plus cisplatin in Stages IB2, IIA2, IIB cervical cancer in Iran.

PURPOSE OF INVESTIGATION: In Iran, the authors use neoadjuvant chemotherapy (NACT) prior to surgery in cervical cancer due to limited access to the radiotherapy and very prolonged waiting time in accession to radiotherapy. The study was done to analyze the efficacy of the NACT with high dose-dense paclitaxel and cisplatin before radical surgery on cure rate, survival rate, and the progression of free survival rate of bulky tumor of cervical cancer in Stages 1B2, IId A2, and IIB. MATERIALS AND METHODS: Fifty-two patients with cervical cancer in Stages Ib2, IIA2, and IIB were selected, and responding patients to chemotherapy were scheduled to undergo radical hysterectomy and bilateral pelvic lymphadenectomy with or without para-aortic lymphadenectomy. RESULTS: Fifty out of 52 patients with a median age of 50 years were evaluable for clinical response. Thirty-two patients (64%) responded to the NACT including six (12%) with a complete clinical response. There was no statistical relationship between clinical response, tumor stage and size, and parametrical involvement, however, patients with higher grade of tumor, adenocarcinoma or tumor in upper 2/3 of vagina showed a higher probability of no response to chemotherapy. Downstaging after NACT in all stages was statistically significant regarding pathologic findings and clinical response (p = 0.002). Five-year survival was 88% and factors affecting survival and disease-free survival were pathological response and tumor site based on cox-regression analysis. Overall recurrence rate was 20% and tumor size was the only significant relevant factor for recurrence (p = 0.017). CONCLUSION: Combined regimen of chemotherapy in locally advanced cervical cancer proved to be valuable and efficacious without any late complications.

Evaluation of risk factors for retinopathy in preterm infant: a case-control study in a referral hospital in Iran.

AIM: Aim of the study was to detect possible risk factors for retinopathy of prematurity (ROP), as a leading cause of treatable childhood blindness, among premature neonates. METHODS: In this retrospective study, 60 premature neonates with ROP and 60 premature infants without ROP were entered and compared. Variables such as gestational age, birth weight, oxygen therapy, phototherapy, and so on were gathered and compared between the two groups. RESULTS: Significant statistical differences were seen regarding gestational age (29.3±3.1 weeks in the ROP group vs. 31.9±2.2 in control group) and first-minute apgar score (6.55±1.7 in the ROP group vs. 7.06±2.3 in the control group). Regarding comparisons made in terms of therapeutic interventions made, only oxygen therapy and phototherapy showed significant differences between the two groups which were higher in the ROP group. CONCLUSION: Gestational age (lower in the ROP group), first-minute Apgar score (lower mean score in the ROP group), birth weight, phototherapy, and oxygen therapy were factors discovered to affect the occurrence of ROP among premature infants. Higher birth weight and more advanced gestational age were protective factors for ROP. Oxygen therapy and multiple birth are ROP risk factors and these can be used for prediction of ROP occurrence.

Computationally efficient method for localizing the spiral rotor source using synthetic intracardiac electrograms during atrial fibrillation.

Atrial fibrillation (AF), the most common sustained cardiac arrhythmia, is an extremely costly public health problem. Catheter-based ablation is a common minimally invasive procedure to treat AF. Contemporary mapping methods are highly dependent on the accuracy of anatomic localization of rotor sources within the atria. In this paper, using simulated atrial intracardiac electrograms (IEGMs) during AF, we propose a computationally efficient method for localizing the tip of the electrical rotor with an Archimedean/arithmetic spiral wavefront. The proposed method deploys the locations of electrodes of a catheter and their IEGMs activation times to estimate the unknown parameters of the spiral wavefront including its tip location. The proposed method is able to localize the spiral as soon as the wave hits three electrodes of the catheter. Our simulation results show that the method can efficiently localize the spiral wavefront that rotates either clockwise or counterclockwise.

Role of appropriate surgery in survival of patients with epithelial ovarian cancer.

OBJECTIVE: Management of epithelial ovarian cancer (EOC) patients is largely based on appropriate surgery. The principle treatment of early stage is competence of surgical staging surgery and surgical management of all patients with advance EOC is approach in a similar manner with cytoreduction surgery. We decided to evaluate the impact of appropriate surgery as a scale on 2 and 5-year survival in EOC patients. METHODS: In a descriptive analytic study a total 186 patients were divided into 62 with early stage of EOC equivocal FIGO stage I and 124 with advanced disease at Vali-e-Asr Hospital affiliated with Tehran University of Medical Science, Iran, from 1998 to 2008. Two and 5-year disease free survival (DFS) and overall survival rates were determined and compared between the two groups using chi-squared test' Kaplan Meier and Cox regression. RESULTS: Five-year DFS in patients with early stage of disease was 85% for the surgical staging group and 38% for non-surgical staging group (P = 0.037). Two-year DFS and overall survival did not differ between the groups. Also 5-year survival rates in subjects with surgical staging surgery were 42% and 40% for non staging group. For patients assigned to advanced disease group, 5-year DFS in subjects with cytoreductive surgery was 73% and the figure for the remainder was 58%. Five-year overall survival rate in cytoreductive surgery group was 43% in comparison to 38% in the second group. CONCLUSION: Maximal effort for appropriate surgery appears to be a corner stone for optimal survival.

Effect of metformin on miscarriage in pregnant patients with polycystic ovary syndrome / Efecto de la metmorfina sobre los abortos espontáneos de pacientes embarazadas que presentan el síndrome de ovario poliquístico

BACKGROUND: This study was performed with the aim of evaluating the effect of metformin in reducing miscarriage when continued until the end of the first trimester of pregnancy in patients with polycystic ovary syndrome (pCOS) and infertility. SUBJECTS AND METHOD: From January 2004 to December 2005, a total of 75 pregnant women with PCOS were studied in three different groups. In Group A, metformin administration (500 mg three times daily (TDS)) was stopped immediately after diagnosis of pregnancy (5-6 weeks gestation), in Group B, metformin was administered until the end of 8 weeks gestation and in Group C until the end of 12 weeks gestation. The results of this study were then assessed using chi-square McNemar's, ANOVA Kruskal Wallis and logistic regression tests. RESULTS: There was a significant statistical difference between previous and current miscarriage in the current pregnancy with a decline in Group B from 40% to 8% and in group C from 32% to 4%. In spite of the reduced rate of miscarriage seen in Group A, from 20% to 4%, this difference was not statistically significant. Fetal anomalies were absent in all three groups. CONCLUSION: According to the current findings, it seems that continuing metformin during the first trimester of pregnancy has beneficial effects in patients with PCOS.

ANTECEDENTES: Este estudio fue realizado con el propósito de evaluar el efecto de la metmorfina en la reducción de abortos espontáneos cuando se la continúa hasta el final del primer trimestre de embarazo, en pacientes con síndrome de ovario poliquístico (SOPQ) e infertilidad. SUJETOS Y MÉTODO: De enero 2004 a diciembre 2005, fueron estudiadas en tres grupos diferentes, un total de 75 mujeres embarazadas que presentaban SOPQ. En el grupo A, la administración de metmorfina (TDS) 500 mg tres veces al día se detuvo inmediatamente después del diagnóstico del embarazo (5 - 6 semanas de gestación); en el grupo B, se administró la metmorfina hasta el final de las 8 semanas de gestación, y en el grupo C hasta el final de las 12 semanas de gestación. Los resultados de esta estudio fueron entonces evaluados usando chi-cuadrado McNemar's, ANOVA Kruskal Wallis y teste de regresión logística. RESULTADOS: Hubo una diferencia estadística significativa entre los abortos espontáneos previos y los corrientes en los embarazos corrientes, con una disminución del 40% al 8% en el grupo B, y del 32% al 4% en el Grupo C. A pesar de la reducción de la tasa de abortos espontáneos observada en el grupo A, del 20% al 4%, la diferencia no fue estadísticamente significativa. Las anomalías fetales estuvieron ausentes en los tres grupos. CONCLUSIÓN: De acuerdo con los hallazgos actuales, parece que la continuación de la metmorfina durante el primer trimestre del embarazo, tiene efectos beneficiosos en los pacientes con SOPQ.

Effect of metformin on miscarriage in pregnant patients with polycystic ovary syndrome.

BACKGROUND: This study was performed with the aim of evaluating the effect of metformin in reducing miscarriage when continued until the end of the first trimester of pregnancy in patients with polycystic ovary syndrome (PCOS) and infertility. SUBJECTS AND METHOD: From January 2004 to December 2005, a total of 75 pregnant women with PCOS were studied in three different groups. In Group A, metformin administration (500 mg three times daily (TDS)) was stopped immediately after diagnosis of pregnancy (5-6 weeks gestation), in Group B, metformin was administered until the end of 8 weeks gestation and in Group C until the end of 12 weeks gestation. The results of this study were then assessed using chi-square McNemar's, ANOVA Kruskal Wallis and logistic regression tests. RESULTS: There was a significant statistical difference between previous and current miscarriage in the current pregnancy with a decline in Group B from 40% to 8% and in group C from 32% to 4%. In spite of the reduced rate of miscarriage seen in Group A, from 20% to 4%, this difference was not statistically significant. Fetal anomalies were absent in all three groups. CONCLUSION: According to the current findings, it seems that continuing metformin during the first trimester of pregnancy has beneficial effects in patients with PCOS.

Radiation effects on the intima-media thickness of the common carotid artery in post-radiotherapy patients with head and neck malignancy.

BACKGROUND: Post-radiation large vessel injury has not received as much attention as microvascular irradiation injury. A few studies have shown that common carotid intima-media thickness (IMT) is increased after radiotherapy to the head and neck. However, in most of these studies, the irradiated subjects also had other major risk factors for atherosclerosis. In this study, irradiated subjects with major risk factors such as hypertension, diabetes, history of previous cerebrovascular accident and connective tissue disorder were excluded. OBJECTIVE: To show in a cross-sectional study if radiotherapy to the carotid area has any effect on the IMT of the common carotid artery. SUBJECTS AND METHODS: 13 patients with head and neck malignancies who had completed radiotherapy to the carotid region at least 1 year previously underwent ultrasound of the carotid artery. IMT measurements were compared with those of 13 healthy controls, matched for age, sex and race, with no history of radiotherapy. RESULTS: The irradiated subjects had significantly larger IMT measurements (mean 0.74 mm) than the non-irradiated subjects (mean 0.46 mm). The difference was significant (p<0.001) with a confidence interval of 95%. CONCLUSIONS: This study shows that there is a measurable, significant (p<0.001) increase in IMT of the common carotid artery after radiotherapy for head and neck malignancy compared with non-irradiated matched controls. This knowledge is important for risk-benefit assessment of prophylactic or therapeutic neck irradiation. Increased awareness of this complication should provide an opportunity to intervene and prevent future cerebrovascular accidents in the majority of such patients.

Rubella serology in pregnant women attending health centres of Tehran University of Medical Sciences.

This study was performed in 2003-05 to determine the serological status of a sample of pregnant women as a preliminary study for the rubella vaccination programme. Out of 965 pregnant women attending health centres affiliated to Tehran University of Medical Sciences for prenatal care, the estimated rubella immunity rate was 91.1% (95% CI: 89.3%-92.9%) and the nonimmunity rate was 8.9% (95% CI: 7.1%-10.7%). The rubella immunity rate differed in different areas of Tehran but not significantly so. However, there was a significant difference in the level of rubella immunity by the number of persons per household and by age, but no significant relationship with economic status, occupation or level of education.

Prevalence of induced abortion and associated complications in women attending hospitals in Isfahan.

A high proportion of maternal deaths are caused by abortion, especially induced abortion. This cross-sectional study determined the prevalence of illegally-induced abortion prior to admittance and its associated risk factors in 8 maternity hospitals in Isfahan, Islamic Republic of Iran, during 2003-04. In confidential interviews with 417 women who attended the hospitals with abortion, 50 (12.0%) reported that it was illegally induced. These abortions had a significant correlation with fever, septic shock and septic abortion. Of all pregnancies, 35.0% were unwanted, and 27.1% of these were illegally-terminated by induced abortions. Unwanted pregnancy was one of the most important risk factors for induced abortion (OR = 8.84, 95% CI: 4.36-17.92).