Radiologic assessment and frequency of idiopathic osteosclerosis of jawbones: an interpopulation comparison.

BACKGROUND: Idiopathic osteosclerosis is a localized growth of compact bone with an unknown cause. This asymptomatic lesion is an insignificant finding and as such requires no treatment. It should be distinguished from other types of osteosclerosis created by inflammatory processes and systemic diseases. PURPOSE: To determine the prevalence and distribution of idiopathic osteosclerosis in the jawbones in Iran and to compare this prevalence and distribution with other populations. MATERIAL AND METHODS: This cross-sectional descriptive study was performed in the Dental School of Shahid Beheshti University of Medical Sciences, Tehran, between 2010 and 2011. Data were collected from the files of patients who underwent panoramic radiography for dental treatment. Location, shape, and relation between idiopathic osteosclerosis and the tooth as well as the resorption of the tooth involved were evaluated. Lesion distribution regarding age, gender, localization, shape, dental relationship, and root resorption was assessed using the chi-squared test. RESULTS: In total, 787 panoramic radiographs of 456 women and 331 men were assessed. Idiopathic osteosclerosis was detected in 75 (9.5%) patients. The prevalence of idiopathic osteosclerosis was significantly higher in the women (11.8% vs. 6.3%; P < 0.01). The mean age of the patients with idiopathic osteosclerosis was 31.9 ± 17.9 years and 30.8 ± 13.3 years in the patients without idiopathic osteosclerosis. The distribution of idiopathic osteosclerosis in the mandible (97.3%), mostly in the premolar region, was significantly higher than that in the maxilla (2.7%). CONCLUSION: Our results showed high frequencies of idiopathic osteosclerosis in Iran in comparison to some other countries.

Physical inactivity is correlated with levels of quantitative C-reactive protein in serum, independent of obesity: results of the national surveillance of risk factors of non-communicable diseases in Iran.

Increased C-reactive protein (CRP) levels are associated with coronary heart disease, stroke, and mortality. Physical activity prevents cardiovascular disorders, which can be partly mediated through reducing inflammation, including serum CRP levels. The association of different intensities of physical activity, sedentary behaviours, and C-reactive protein (CRP) levels in serum was examined after adjustment for markers of adiposity, including waist-circumference and body mass index (BMI), in a large population-based study. Using data of the SuRFNCD-2007 study, a large national representative population-based study in Iran, the relationship between quantitative CRP concentrations in serum and physical activity was examined in a sample of 3,001 Iranian adults. The global physical activity questionnaire (GPAQ) was used for evaluating the duration and intensity of physical activity. Total physical activity (TPA) was calculated using metabolic equivalents for the intensity of physical activity. Quantitative CRP concentrations in serum were measured with high-sensitivity enzyme immunoassay. The CRP levels in serum significantly correlated with TPA (r=-0.103, p=0.021 in men and r=-0.114, p=0.017 in women), duration of vigorous-intensity activity (r=-0.122, p=0.019 in men and r=-0.109, p=0.026 in women), duration of moderate-intensity activity (r=-0.107, p=0.031 in men and r=-0.118, p=0.020 in women), and duration of sedentary behaviours (r=0.092, p=0.029 in men and r=0.101, p=0.022 in women) after multiple adjustments for age, area of residence, BMI, waist-circumference, smoking, and diabetes mellitus. Physical activity (of both moderate and vigorous intensity) is inversely associated with the quantitative CRP levels in serum, independent of diabetes and body adiposity.

The role of pre-participation cardiac evaluation in the management of an athlete with premature ventricular contraction-induced cardiomyopathy: a case report.

Background: Premature ventricular contractions (PVCs) are commonly observed during pre-participation cardiac screening in elite athletes. There is an ongoing debate about the clinical significance of PVCs in athletes and whether burden, morphology, or both should be used to differentiate benign PVCs from PVCs suggestive of cardiac disease. Case summary: A 28-year-old male athlete was evaluated as part of the pre-participation screening programme. He was asymptomatic, without specific cardiac signs and symptoms. A 12-lead electrocardiogram showed bigeminy PVCs with infundibular morphology and left ventricular outflow tract origin. Left ventricular dilatation and systolic dysfunction without valvular lesions was detected on echocardiography. Cardiac magnetic resonance imaging showed biventricular dilatation and dysfunction without evidence of myocardial fibrosis or fatty infiltration. A 48 h Holter monitoring showed 75191 PVCs (35% of total beats). Radiofrequency ablation was performed, and post-ablation assessments showed no PVCs with normalized ventricular function and dimension. Discussion: This case demonstrated that a high PVC burden of common morphology does not also represent a benign finding and requires a comprehensive evaluation to rule out any pathological condition. Furthermore, the present case highlights the critical role of pre-participation cardiac evaluation in identifying cardiac disease in asymptomatic athletes.

Evaluation of periostin levels in gingival crevicular fluid in association between coronary heart disease and chronic periodontitis.

BACKGROUND: Periostin is a protein, which is essential for periodontal tissue integrity, development and maturity. The aim of this study was to evaluate the role of gingival crevicular fluid (GCF) periostin levels in the association between coronary heart disease (CHD) and chronic periodontitis (CP). MATERIALS AND METHODS: This matched case-control study was conducted on 116 participants. The participants were matched for age, gender, and body mass index and divided into four groups as follows: (1) 29 patients with CHD and sever CP (CHD-CP), (2) 29 patients with CHD and without CP (CHD-H), (3) 29 patients without CHD and with sever CP (H-CP), and (4) 29 healthy participants (H-H). The GCF periostin was collected and evaluated using the enzyme-linked immunosorbent assay (ELASA). Finally, the data were analyzed by analysis of variance using the stata software. Significance was assigned at P < 0.05. RESULTS: The results showed that there was a significant difference in the GCF periostin levels in the four groups (P < 0.05). Moreover, according to the results of the Bonferroni's test, differences in the mean periostin levels were significant (P < 0.001) between CHD-CP and CHD-H, CHD-CP and H-CP, CHD-CP and H-H, CHD-H and H-H, and also between H-CP and H-H. CONCLUSION: The periostin levels reduced in the CHD patients, especially in the CHD-CP group. The findings reveal a probable role of periostin in the association between CHD and CP.

Graves' ophthalmopathy and gene polymorphisms in interleukin-1alpha, interleukin-1beta, interleukin-1 receptor and interleukin-1 receptor antagonist.

PURPOSE: Interleukin-1 (IL-1) is known to have an important role in pathogenesis of Graves' ophthalmopathy (GO). Polymorphisms in IL-1 gene have been associated with autoimmune reactions. This study aimed to investigate the association of GO with single-nucleotide polymorphisms (SNPs) in the IL-1 family (IL-1alpha, IL-1beta, IL-1 receptor [IL-1R] and IL-1 receptor antagonist [IL-1RA]). METHODS: A total of 57 patients of Graves' disease without GO, 50 patients with GO and 140 healthy controls were enrolled. Patients were recruited consecutively from the outpatient endocrine clinic of a large university general hospital. Cytokine typing was performed by the polymerase chain reaction with sequence-specific primers assay. The allele and genotype frequencies of the following polymorphisms were determined: IL-1alpha (-889C/T), IL-1beta (-511C/T), IL-1beta (+3962C/T), IL-1R (Pst-1 1970C/T) and IL-1RA (Mspa-1 11100C/T). Genotype distributions among patients were in Hardy-Weinberg equilibrium for all polymorphisms. RESULTS: Among the five SNPs studied, the frequencies of the T allele and the TT genotype of IL-1alpha (-889C/T) were significantly higher among patients with GO than those without GO (odds ratio [OR] = 2.16, 95% confidence interval [CI] = 1.25-3.74; P = 0.006 and 5.67, 95% CI = 1.66-49.34; P = 0.005, respectively). For IL-1RA (Mspa-1 11100C/T), the frequencies of the C allele and the CC genotype were significantly higher among patients with GO (OR = 2.31, 95% CI = 1.34-4.00; P = 0.004 and 6.73 95% CI = 1.94-23.36; P = 0.004, respectively; P < 0.01). No significant association was found for other SNPs. CONCLUSION: This is the first study to show a positive correlation between polymorphisms in the IL-1alpha and IL-1RA genes and susceptibility to GO. These findings promote further research into genetic correlates of GO.

Fistula formation between the right and left main bronchus caused by endobronchial tuberculosis.

The prevalence of endobronchial tuberculosis (EBTB) in patients with active tuberculosis is about 10% to 40%. The most common complication of EBTB is bronchial stenosis. Fistula formation by pulmonary tuberculosis is a very rare complication and is most commonly bronchopleural. The authors present a 53-year-old woman presented with chronic cough and abnormality in chest computed tomography scan. According to chest computed tomography scan finding, bronchoscopic study was done and bronchial lavage was obtained. Bronchial lavage was positive for acid fast bacilli. Bronchoscopy showed fistula formation between the right and left main bronchus, a rare manifestation of EBTB. The patient was treated with antituberculosis therapy, and her symptoms improved and radiological findings showed regression of pulmonary lesions.

Oxidized low-density lipoprotein is negatively correlated with lecithin-cholesterol acyltransferase activity in type 2 diabetes mellitus.

INTRODUCTION: It is now believed that the oxidative modification of plasma lipoproteins enhance their atherogenicity in patients with type 2 diabetes. Because a variety of highly reactive lipid peroxidation products can transfer from oxidized low-density lipoprotein (ox-LDL) to high-density lipoprotein -cholesterol, the authors evaluated the association between ox-LDL and lecithin-cholesterol acyltransferase (LCAT) activity, a key enzyme in reverse cholesterol transport and HDL remodeling. METHODS: A total of 45 patients with diabetes and 45 age-, sex- and body mass index-matched healthy adult volunteers were enrolled. Fasting blood samples were obtained, and plasma glucose, lipid profile, creatinine, insulin, ox-LDL and LCAT activity were measured. Homeostasis model assessment of insulin resistance was also calculated. RESULTS: Patients with diabetes, compared with healthy participants, had a significantly higher ox-LDL (17.16 ± 3.75 U/L versus 7.93 ± 1.92 U/L, P < 0.001) and lower LCAT activity (73.7 ± 9.1 µmol/L/hr versus 88.7 ± 4.5 µmol/L/hr, P < 0.001). The higher level of LCAT activity completely disappeared after adjustment for ox-LDL. LCAT activity had a significant (P < 0.001) inverse correlation with ox-LDL (r = -0.77) in patients with diabetes and healthy participants (r = -0.75). CONCLUSION: LCAT activity is significantly decreased in type 2 diabetes. The lower LCAT activity in type 2 diabetes might be through ox-LDL mechanism. Ox-LDL may adversely affect high-density lipoprotein -cholesterol metabolism by reducing LCAT activity.

Graves' disease and gene polymorphism of TNF-α, IL-2, IL-6, IL-12, and IFN-γ.

The role of genetic factors in the pathogenesis of Graves' disease (GD) is not clear. The purpose of this study was to investigate the association between single nucleotide polymorphisms in pro-inflammatory cytokine genes and GD in Iranian patients. A case-control hospital-based study was carried out on 107 GD patients and 140 healthy controls. Cytokine typing was performed by polymerase chain reaction with sequence-specific primers (PCR-SSP) assay. The allele and genotype frequencies of the following cytokine genes were determined: TNF-α (-308A/G, -238A/G), IL-2 (-330T/G, +166G/T), IL-6 (-174C/G, A/G nt565), IL-12 (-1188A/C), and IFN-γ (UTR 5644A/T). The following alleles and genotypes were significantly overrepresented in patients: TNF-α -308A allele (P < 0.01) and AA genotype (P < 0.05), IL-2 -330G allele (P < 0.01) and GG genotype (P < 0.01), IL-6 -174C allele (P < 0.01) and CC genotype (P < 0.01), IL-12 -1188C allele (P < 0.01) and CC genotype (P < 0.01), IFN-γ UTR5644T allele (P < 0.01) and TT genotype (P < 0.01). In conclusion, this is the first study to show a significant association between GD and IL-2 -330G, IL-12 -1188C, and IFN-γ UTR 5644T alleles. Our results support the hypothesis that polymorphism in pro-inflammatory cytokines might be involved in predisposition to GD.

Genetic susceptibility to Graves' ophthalmopathy: The role of polymorphisms in anti-inflammatory cytokine genes.

BACKGROUND: Various polymorphisms occur in cytokine genes involved in inflammatory processes in Graves' ophthalmopathy (GO). Anti-inflammatory cytokines such as transforming growth factor- ß (TGF-ß), interleukin-10 (IL-10) and interleukin-4 (IL-4) are among those believed to be involved in the disease process. In this study, we investigated the association between 8 polymorphisms within the mentioned cytokines and GO. METHODS: The following polymorphisms were studied in 50 patients with GO, 57 Graves' patients without GO and 140 healthy individuals using polymerase chain reaction with sequence-specific primers: TGF-ß (+869C/T, +915G/C), IL-10 (-1082A/G, -819C/T, -592C/A) and IL-4 (-1098T/G, -590T/C, -33C/T). A corrected p value less than 0.05 was considered statistically significant. RESULTS: The TGF-ß +915C allele (Odds Ratio [OR] = 2.20) and CC genotype (OR = 7.50) as well as +869C allele (OR = 2.21) showed significant correlations with GO. Regarding IL-4 polymorphisms, the -1098G allele (OR = 2.09) and GG genotype (OR = 7.49), and the -33T allele (OR = 2.05) and TT genotype (OR = 4.00) were significantly associated with GO. The IL-10 -819TT genotype (OR = 5.00) was significantly correlated with GO. CONCLUSION: This is the first study to show that polymorphisms in anti-inflammatory cytokine genes are associated with susceptibility to GO.

Gene polymorphisms of interleukin-4, interleukin-10 and transforming growth factor-beta in Graves' disease.

Among genetic factors that may contribute to the development and progression of Graves' disease (GD) and its complications are polymorphisms in the genes encoding cytokines. The association between GD and the following polymorphisms in anti-inflammatory cytokines was studied in 107 patients with GD and 140 healthy controls: IL-4 (-1098T/G, -590T/C, -33C/T), IL-10 (-1082A/G, -819C/T, -592C/A) and TGF-beta (+869T/C, +915G/C). The following alleles and genotypes were significantly (P < 0.01 after correction for multiple testing) more frequent among patients: the IL-4 -1098G allele and GG genotype (OR = 3.12 and 105.00, respectively), IL-4 -33T allele and TT genotype (OR = 2.52 and 118.83, respectively), IL-10 -1082G allele and GG genotype (OR = 2.16 and 6.40, respectively), IL-10 -819T allele, TC and TT genotype (OR = 2.60, 3.68 and 6.76, respectively), IL-10 -592A allele, AC and AA genotype (OR = 2.41, 2.89 and 5.68, respectively), TGF-beta +869C allele and CC genotype (OR = 2.24 and 6.21, respectively), and TGF-beta +915C allele, CG and CC genotype (OR = 7.81, 11.80 and 20.40, respectively). The only allele and genotype with a lower frequency in patients were IL-4 -590T allele and TC genotype (OR = 0.47 and 0.08, respectively; P < 0.01). In conclusion, this study highlighted the importance of anti-inflammatory cytokine gene polymorphisms in susceptibility to GD.

Association of serum leptin levels with homeostasis model assessment-estimated insulin resistance and metabolic syndrome: the key role of central obesity.

BACKGROUND: Leptin is correlated with several features of metabolic syndrome; however, possible confounders (eg, obesity) of this association are not known. This study evaluated the relationship between leptin, metabolic syndrome, and insulin resistance in an Iranian population and further investigated whether this relationship is confounded by obesity or central obesity. METHODS: A total of 387 participants (18-65 years old) who referred to a large university general hospital for routine health examinations were categorized into 2 groups with (n = 130) and without (n = 257) metabolic syndrome. Fasting plasma glucose, insulin, lipids, and leptin levels were measured and the homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. Metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria. RESULTS: Age- and sex-adjusted leptin levels were significantly higher in patients with than those without metabolic syndrome (29.62 +/- 1.67 vs. 18.50 +/- 1.21 ng/mL, P < 0.001). After adjustment for age, sex, and body mass index (BMI), leptin values were significantly correlated with HOMA-IR (P < 0.001), metabolic syndrome, and its components (P < 0.05). After adjustment for waist circumference, however, these associations were no longer statistically significant. CONCLUSIONS: We demonstrated that high leptin levels are associated with insulin resistance and metabolic syndrome independent of BMI but these associations are significantly mediated through the effects of central obesity.

Pretibial myxedema is associated with polymorphism in exon 1 of CTLA-4 gene in patients with Graves' ophthalmopathy.

Cytotoxic T-lymphocyte associated antigen-4 (CTLA-4) is a well-known molecule that regulates T cell activity, with polymorphisms at different regions of this gene having been associated with autoimmune conditions. Pretibial myxedema (PTM), also called Graves' dermopathy, is an autoimmune extrathyroidal manifestation of Graves' disease. We opted to investigate the relationship between three single nucleotide polymorphisms of the CTLA-4 gene (+49A/G, and -318C/T and -1147C/T) and PTM in Iranian patients with Graves' ophthalmopathy (GO). A total of 105 unrelated Iranian patients with GO from the outpatient endocrine clinic of a large university general hospital as well as 103 healthy controls were studied. The genomic DNA was extracted from venous blood samples by a salting out method, and the polymorphisms at +49, -318 and -1147 positions of the CTLA-4 gene were determined using the polymerase chain reaction-restriction fragment length polymorphism method. The GG genotype (OR = 6.000, 95% CI = 1.805-19.940, P = 0.005) and the G allele (OR = 2.653, 95% CI = 1.314-5.357, P = 0.009) at position +49 were significantly associated with PTM in the patient group. The same genotype and allele were also significantly more common among patients (with or without PTM) than controls. No significant association was found for the other two polymorphisms. In conclusion, the +49G allele is associated with increased risk of PTM in patients with GO. Studies with larger sample sizes are needed to confirm the results of the present study.

Association of CTLA-4 gene polymorphism with Graves' disease and ophthalmopathy in Iranian patients.

BACKGROUND: The cytotoxic T lymphocyte associated antigen-4 (CTLA-4) gene, is one of the candidate genes for susceptibility to Graves' disease. This study aimed to investigate the association of Graves' disease and Graves' ophthalmopathy with polymorphisms at position +49 in exon 1 and positions -318 and -1147 in the promoter region of CTLA-4 gene in Iranian patients. METHODS: A total of 205 unrelated Iranian patients with Graves' disease who were referred to the outpatient endocrine clinic of a large university general hospital and 103 sex-matched healthy controls were included in this study. Venous blood was obtained, genomic DNA was extracted by a salting out method, and the polymorphisms at positions +49, -318 and -1147 of the CTLA-4 gene were determined using the PCR-restriction fragment length polymorphism method (PCR-RFLP). Genotype and allele frequencies were determined. RESULTS: The frequency of the G allele at position +49 was significantly higher in patients with Graves' disease than in the control group (27.1% vs. 15.1%, OR=2.096, 95%CI=1.350-3.253 and p<0.01). Significant trends were not seen for the other two polymorphisms studied. In patients with ophthalmopathy, the frequency of the G allele at position +49 was higher than in those without ophthalmopathy (33.8% vs. 20.0%, OR=2.043, 95%CI=1.304-3.202 and p<0.01). CONCLUSION: The results of this study suggest that the G allele at position +49 in exon1 of the CTLA-4 gene is associated with Graves' disease and Graves' ophthalmopathy in Iranian patients.

Involvement of amlodipine, diazoxide, and glibenclamide in development of morphine tolerance in mice.

In this study, the effects of the calcium channel blocker (amlodipine), potassium channel opener (diazoxide), and potassium channel blocker (glibenclamide) on the development of morphine-induced tolerance in the formalin test was investigated. During development of tolerance to morphine, intraperitoneal (i.p.) administration of different doses of amlodipine (5, 7.5 and 10 mg/kg) or diazoxide (1, 5 and 10 mg/kg) in combination with morphine (20 and 30 mg/kg) increased tolerance in the first and second phase of the test. However, glibenclamide (2.5, 5, and 10 mg/kg) decreased morphine tolerance in the second phase of formalin test. It is concluded that calcium and potassium channel mechanisms may be involved in the morphine tolerance.

Metabolic syndrome and insulin resistance significantly correlate with body mass index.

BACKGROUND: Metabolic syndrome (MetS) is a cluster of metabolic risk factors for cardiovascular disease. This study aimed to compare the prevalence of MetS and its components in different degrees of obesity in Iranian subjects. METHODS: A total of 2309 adults were divided into four groups according to their body mass index (BMI): 1511 subjects were non-obese (BMI <30 kg/m(2)); 535 were moderately obese (BMI > or =30-<35); 176 were severely obese (BMI > or =35-<40) and 87 were morbidly obese (BMI > or =40). Fasting blood samples were obtained and plasma glucose, lipids, insulin and HbA1c were measured. The homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. The prevalence of MetS, according to the definitions of the International Diabetes Federation (IDF) and National Cholesterol Education Program Adult Treatment Panel III (ATPIII), was compared across increasing grades of BMI. RESULTS: Prevalence of MetS gradually rose with increasing grades of obesity (p<0.001), from 31.9% in the non-obese to 69.0% in the morbidly obese according to the IDF criteria and from 31.2% to 62.1% according to the ATPIII criteria. After controlling for age and sex, one grade increase in the BMI category was associated with 2.5-3 times higher risk of MetS depending on the definition used. In addition, HOMA-IR was significantly correlated with BMI in all subjects (r=0.343, p<0.001) and in moderately (r=0.184, p<0.01), severely (r=0.147, p<0.01) and morbidly (r=0.101, p<0.05) obese participants separately. CONCLUSIONS: MetS and its components, including high blood pressure, central obesity, hyperglycemia, IR, hypertriglyceridemia and low high-density lipoprotein-cholesterol increase in parallel with increasing obesity grades.