Lamivudine resistance in Iranian chronic hepatitis B patients

Background and objectives: Lamivudine therapy for chronic hepatitis B (CHB) is associated with resistance. This study aimed to analyze the response, the incidence of LAM resistance, and different viral mutational patterns of Lamivudine therapy. Study design: CHB patients (n=31) who had not previously received interferon or a nucleoside analogue, received Lamivudine once daily for a minimum of E12 months and followed. All patients were tested for presence of mutation in YMDD motif of viral polymerase gene at the end of the first year of treatment, and if indicated in rising alanine aminotransferase (ALT) or HBVDNA titer. Polymerase chain reaction along with restriction fragment length polymorphism (PCR-RFLP) method was used to detect mutations in YMDD motif. Results: The mean age of patients was 45.2 (SD 13.5) years. The mean follow-up period of patients was 45.5 (21.9) months. Seventeen patients (54.8) had mutations, and 45.2 of subjects were sensitive to LAM. Mean time of mutation detection after treatment was 45.5 (SD 25.3) months. The distribution of YMDD status was: 32.3 YIDD, 3.2 YSDD, 12.9 YVDD, and 6.5 YVDD/ YIDD. The mean age, pretreatment HBeAg negativity, and high HBVDNA titer at time of mutation had significant statistical association with occurrence of YMDD mutants (PV= 0.009, 0.032, 0.049), respectively. Conclusions: Lamivudine-resistant mutation is common in CHB patients. Regarding different mutant strains as identified in this study, is necessary for develop more useful treatment strategies, especially in patients without YMDD mutation and high HBVDNA titer, analysis for possible new mutants should be performed. Copyright © 2010, Shiraz E Medical Journal. All rights reserved

Swedish massage and abnormal reflexes of children with spastic cerebral palsy

Objectives: Massage therapy is one of the most widely used complementary and alternative medicine therapies for children. This study was conducted to determine the effect of wedish massage on abnormal reflexes in children with spastic cerebral palsy (CP). Material and Methods: This study was a single blind clinical trial conducted on forty children with spastic CP who were recruited from clinics of the University of Social Welfare & Rehabilitation Sciences. They were randomly assigned to intervention and control groups. The routine occupational therapy (OT) techniques were performed during a 3 month-period in both groups. The intervention group also received Swedish massage for 30 minutes before every OT session. Primary, spinal, brain stem, midbrain, cortical and automatic reflexes were evaluated at the beginning of the study and 3 months later. The data analysis was done by parametric and nonparametric tests. Results: Finally, thirteen subjects in the intervention group and 14 subjects in the control group were remained and studied. The average ages in the intervention and control groups were 49.5 and 42.1 months respectively. There were no statistically significant differences in abnormal reflexes in the intervention group in comparison to the control (P > 0.05). Conclusion: Adding Swedish massage to traditional OT techniques had no significant effects on abnormal reflexes in children with spastic cerebral palsy. Evidently more research is required in order to completely reject the effects of Swedish massage on abnormal reflexes of children with CP

Clinical characteristics, management and 1-year outcomes of patients with acute coronary syndrome in Iran: The Iranian Project for Assessment of Coronary Events 2 (IPACE2)

Objectives: To assess contemporary data on characteristics, management and 1-year postdischarge outcomes in Iranian patients hospitalised with acute coronary syndrome (ACS). Setting: 11 tertiary care hospitals in 5 major cities in the Islamic Republic of Iran. Participants: Patients aged �20 and �80 years discharged alive with confirmed diagnosis of ACS including ST-segment elevation myocardial infarction (STEMI), non-STEMI (NSTEMI) and high-risk unstable angina (HR-UA). Primary and secondary outcome measures: Patients were followed up regarding the use of medications and the end points of the study at 1 month and 1 year after discharge. The primary end point of the study was 1-year postdischarge major adverse cardiac and cerebrovascular events (MACCEs), defined as mortality (cardiac and non-cardiac), ACS and cerebrovascular attack (stroke and/or transient ischaemic attack). The secondary end points were hospital admission because of congestive heart failure, revascularisation by coronary artery bypass grafting surgery or percutaneous coronary intervention (PCI), and major and minor bleeds. Results: A total of 1799 patients (25.7 STEMI and 74.3 HR-UA/NSTEMI) discharged alive with confirmed diagnosis of ACS were included in the final analysis. During hospitalisation, the majority of the patients received aspirin (98.6), clopidogrel (91.8), anticoagulants (93.4), statins (94.3) and β-blockers (89.3). Reperfusion therapy was performed in 62.6 of patients with STEMI (46.3 thrombolytic therapy and 17.3 primary PCI). The mean door-to-balloon and door-to-needle times were 82.9 and 45.6 min, respectively. In our study, 64.7 and 79.5 of the patients in HR-UA/NSTEMI and STEMI groups, respectively, underwent coronary angiography. During the 12 months after discharge, MACCEs occurred in 15.0 of all patients. Conclusions: Our study showed that the composition of Iranian patients with ACS regarding the type of ACS is similar to that in developed European countries and is unlike that in developing countries of the Middle East and Africa. We found that our patients with ACS are treated with high levels of adherence to guideline-recommended in-hospital medications

Epidemic assessment of bacterial agents in osteomyelitis and their antibiotic resistance pattern determination

The aim of the present study was to determine the causative agents of osteomyelitis and specifying their antibiotic resistance pattern in patients referred to pediatrics ward of Imam Khomeini Hospital. This study has been performed in Tehran during January to December 2006. In this study, Synovial fluid was taken from 90 patients who referred to pediatrics ward of Imam Khomeini. Samples were examined by direct test, culture and biochemical tests. In next step, antibiogram by disk diffusion method (Kirby-Bauer Test) was established on each positive sample and finally, the results were analyzed. Of 90 examined samples, 27 bacterial cases were isolated; Staphylococcus aureus with 55.9 was the most epidemic agent and Klebsiella sp., coagulase negative Staphylococci, Streptococcus pneumoniae and Enterobacter sp. were the next common agents, respectively. However, it was revealed that more than 40 Staphylococcus aureus are sensitivity to Vacomycin, Gentamicin, Sulfamethoxazole and Erythromycin and most of gram negative Rods isolated of were sensitivity to Amikacin, Ampicillin and Cephalothin (50-100). The most of bacteria (Staphylococcus aureus, coagulase negative Staphylococci, Streptococcus pneumoniae and Enterobacter sp.) were sensitive to Vancomycin, gentamicin and Cephalothin. Similar to previous results, it was proved either in our study that Staphylococcus aureus is the main agent of osteomyelitis and gram negative bacteria with coagulase negative Staphylococci and Streptococci are other agents. Also, it was observed that the most isolated bacteria had high antibiotic resistance to common drugs. © 2008 Asian Network for Scientific Information

Alterations in early auditory evoked potentials and brainstem transmission time associated with tinnitus residual inhibition induced by auditory electrical stimulation

Introduction: Residual inhibition (RI) is the temporary inhibition of tinnitus by use of masking stimuli when the device is turned off. Objective: The main aim of this study was to evaluate the effects of RI induced by auditory electrical stimulation (AES) in the primary auditory pathways using early auditory-evoked potentials (AEPs) in subjective idiopathic tinnitus (SIT) subjects. Materials and Methods: A randomized placebo-controlled study was conducted on forty-four tinnitus subjects. All enrolled subjects based on the responses to AES, were divided into two groups of RI and Non-RI (NRI). The results of the electrocochleography (ECochG), auditory brain stem response (ABR) and brain stem transmission time (BTT) were determined and compared pre- and post-AES in the studied groups. Results: The mean differences in the compound action potential (CAP) amplitudes and III/V and I/V amplitude ratios were significantly different between the RI, NRI and PES controls. BTT was significantly decreased associated with RI. Conclusion: The observed changes in AEP associated with RI suggested some peripheral and central auditory alterations. Synchronized discharges of the auditory nerve fibers and inhibition of the abnormal activity of the cochlear nerve by AES may play important roles associated with RI. Further comprehensive studies are required to determine the mechanisms of RI more precisely

Diagnostically Challenging Epithelial Odontogenic Tumors: A Selective Review of 7 Jawbone Lesions

Considerable variation in the clinicopathologic presentation of epithelial odontogenic tumors can sometimes be confusing and increase the chance of misdiagnosis. Seven diagnostically challenging jawbone lesions are described. There were 2 cases of mistaken identity in our ameloblastoma file. One unicystic type, initially diagnosed and treated as a lateral periodontal cyst, showed destructive recurrence 6 years postoperatively. The other globulomaxillary lesion was managed under the erroneous diagnosis of adenomatoid odontogenic tumor and recurred 4 times over an 11-year period. This tumor was found in retrospect to be consistent with an adenoid ameloblastoma with dentinoid. The diagnosis of cystic squamous odontogenic tumor (SOT) occurring as a radicular lesion of an impacted lower third molar was one of exclusion. Of two unsuspected keratocystic odontogenic tumors, one depicted deceptive features of pericoronitis, while the other case has long been in our files with the diagnosis of globulomaxillary SOT. Two cases of primary intraosseous squamous cell carcinoma appeared benign clinically and exhibited unexpected findings; an impacted third molar began to erupt in association with the growth of carcinoma and another periradicular carcinoma showed dentinoid formation. Cases selectively reviewed in this article present challenging problems which require clinical and radiographic correlation to avoid potential diagnostic pitfalls

DIAGNOSTIC VALUE OF SILVER-STAINED NUCLEOLAR ORGANIZER REGIONS IN OSTEOSARCOMA, FIBROUS DYSPLASIA AND OSSIFYING FIBROMA OF THE JAWS

It is sometimes difficult to recognize a jaw lesion as osteosarcoma, ossifying fibroma or ‎fibrous dysplasia in routine hematoxylin and ‎eosin staining and a more accurate technique is needed to differentiate these ‎lesions. ‎Many studies have shown the potential usefulness of silver-stained nucleolar organizer region (AgNOR) parameters for the diagnosis of various neoplasms. This study was carried out on 42 archival biopsy specimens of jaw lesions including 14 fibrous dysplasias, 14 ossifying fibromas and 14 ‎osteosarcomas (10 well differentiated and 4 poorly differentiated). Number of AgNORs was evaluated on formalin-fixed, paraffin embedded sections. The mean AgNOR counts showed significant differences between these lesions. The mean counts of AgNORs were 6 for poorly ‎differentiated osteosarcoma. By considering a cutoff point of 1.81-2.5 for well differentiated osteosarcoma and 1-1.8 ‎for ossifying fibroma, well differentiated osteosarcoma can be differentiated from ossifying fibroma with a sensitivity of ‎90% and a specificity of 64.3%. The area under the ROC curve was 0.84. ‎The results in this study indicate that AgNOR staining is a useful technique for differential diagnosis of osteosarcoma, ossifying fibroma and fibrous dysplasia of jaws when it is difficult to recognize these lesions in routine hematoxylin and ‎eosin staining

The outcome of requests for empty CCU beds by the hospital from medical emergency headquarters Tehran (Year 2000)

Introduction: Inter-hospital transport constitutes one of the important parts of the emergency system in every country. Materials and methods: To determine the outcome of requested CCU beds from the medical emergency headquarters in year 2000 by the hospitals affiliated to Tehran university of medical sciences, we have reviewed retrospectively 2688 clinical files of patients for whom a request for an empty CCU bed in other hospitals had been sent to the medical emergency headquarters. The main measure was the success rate of being admitted to CCU in other hospitals. Results: On the whole 68.5 percent of requests were followed by a CCU admission to other hospitals. Using logistic regression method, variables including season of the year, shift diagnosis of the patient and the original hospital were shown to be related with the success rate. Conclusion: Increasing the number of available CCU beds and providing the centers with the necessary equipment is of high priority in hospitals located in city of Tehran

Low-dose dobutamine stress echocardiography cannot predict mitral regurgitation reversibility after coronary artery bypass grafting

Background: The ideal management of ischemic mitral regurgitation (MR) remains a clinical dilemma because of the suboptimal available therapeutic options. Recently, new concepts have emerged, pointing to the benefits of a patient selection approach when debating the management of moderate ischemic MR. We investigated the predictability of low-dose dobutamine stress echocardiography (DSE) in selecting candidates for CABG with moderate MR for valve repair. Methods: From November 2002 to May 2010, 110 candidates for first-time CABG, who were admitted to the cardiac surgery department in Day General Hospital (Tehran, Iran), were enrolled in the present cross-sectional study. DSE was performed for each case before CABG. Those with positive findings underwent CABG alone and those with negative results underwent concomitant CABG and mitral valve repair. The patients were followed up for a minimum of 60 months. Results: Of the 110 patients, 47 (42.72) had positive test results and underwent CABG alone and 63 (57.28) had negative DSE results and underwent concomitant CABG and mitral valve repair. The MR degree had decreased from 2.8 ± 0.3 preoperatively to 1.46 ± 0.6 early during the hospital stay and 1.9 ± 0.7 during late follow-up in the CABG group. It had decreased from 2.84 ± 0.4 preoperatively to 0.93 ± 0.65 postoperatively but then increased to 1.41 ± 0.9 during late follow-up, for a significant decrease in the combined group (P < .05). Conclusions: Despite its utility in selecting CABG patients with moderate ischemic MR for valve repair from a short-term perspective, the use of DSE cannot predict the long-term outcomes of these patients. © 2014 The American Association for Thoracic Surgery