Comparative expression profile of orphan receptor tyrosine kinase ROR1 in Iranian patients with lymphoid and myeloid leukemias

It has recently been shown that ROR1, a member of the receptor tyrosine kinase family, is overexpressed in leukemic B cells of Chronic Lymphocytic Leukemia [CLL] and a subset of Acute Lymphoblastic Leukemia [ALL]. In this comparative study the expression profile of ROR1 mRNA was investigated in Iranian patients with CLL and Acute Myelogenous Leukemia [AML] and the results were compared with those previously reported in our Iranian ALL patients. RT-PCR was performed on bone marrow and/or peripheral blood samples of 84 CLL and 12 AML patients. CLL samples were classified into immunoglobulin heavy chain variable region [IGHV] gene mutated [n=55] and unmutated [n=29] and also indolent [n=42] and progressive [n=39] subtypes. ROR1 expression was identified in 94% of our CLL patients, but none of the AML patients expressed ROR1. No significant differences were observed between different CLL subtypes for ROR1 expression. Taken together the present data and our previous results on ROR1 expression in ALL, our findings propose ROR1 as a tumor-associated antigen overexpressed in a large proportion of lymphoid [CLL and ALL], but not myeloid [AML] leukemias. Expression of ROR1 seems to be associated to lineage and differentiation stages of leukemic cells with a potential implication for immunotherapy

Evolutionary dynamics of Helicobacter pylori cagA and vacA genes in Iran and their association with clinical outcomes

There is a relationship between specific genotypes of Helicobacter pylori cagA and vacA genes and the increased risk of peptic ulcer diseases and gastric cancer. These genes also possess strong patterns of geographical differentiation. The present study aims to determine the patterns of variation of the virulence genes in Iran and their association with clinical status. Sequence fragments for cagAand vacA were obtained from a total of 147 H. pylori isolates from diverse geographical and ethnic sources within Iran. We used phylogenetic methods to determine the patterns of allelic diversity, and the relationship between evolutionary lineages and clinical status. Phylogenetic analyses of Iranian cagA gene disclosed four lineages, whereas the vacA gene had two distinct lineages. The cagA lineage II showed extensive genetic diversity compared with lineage I. cagA lineages III and IV disclosed mixed ancestries with recombinant nucleotides that originated from lineages I and H Iranian strains with vac A lineage II genotype were significantly cagA+ [> 90%, p = 0.0] and correlated with a higher rate of peptic ulcers in infected individuals [p =0.003]. Most strains in the cagA lineage I showed a vacA lineage II genotype [p = 0.003] and significantly correlated with an increased risk of peptic ulcers in infected individuals [p = 0.022]. Strains with cagA lineage III genotype significantly correlated with gastritis [p = 0.0]. The increased level of allelic diversity in the virulence genes shows strong evolutionary dynamics, resulting in the emergence of new clonal genealogies of the cagA gene within Iran. Particular lineages of the Iranian cagA and vac A genes correlate with peptic ulcer diseases

[Epidemiology of helicobacter pylori infection in Kurdistan Province, 2006]

It is estimated that more than half of the world population are infected with H-pylori. Therefore, this infection maybe regarded the most common infection in human being. The organism may be unique among bacterial pathogens in provoking a wide range of sequelae. The aim of this study was to determine the prevalence rate of H-pylori infection in Kurdistan Province in the west of Iran, in 2006. In this cross sectional study, the sample size included 1503 people, older than 10 years of age, who were selected randomly out of Kurdistan resident population. Samples were tested by use of ELISA method for detection of H-pylori IgG antibody using kits of Trinity Biptech capita H.pylori IgG. Data were introduced into SPSS software and analyzed by means of Correlation analysis, t-test, and X[2] test. Blood specimens from 1503 subjects were collected. 866 [57.6%] patients were female and 637 [42.4%] were male. 802 [53.35] patients were living in urban and 70 [46.64%] patients in rural areas. The mean age of subjects was 32.15 [SD=14.91] years, with age range of 10 to 100 years. The prevalence of H-pylori infection was 36.5 percent. According to the results of this study the prevalence of Helicobacter pylori infection in our subjects is relatively low which must be considered in clinical evaluation

[Evaluation of the pre-emptive effect of acetaminophen codeine on the pain after liver biopsy]

Liver biopsy is one of the most important diagnostic procedures for liver diseases. Pain is the most common complication of liver biopsy and it can lead to clear morbidity. Finding a way to reduce pain of liver biopsy its complication is very important for investigators. There are limited studies on evaluation of pre-emptive effect of acetaminophen on liver biopsy. The aim of this study was to investigate pre-emptive effect of Acetaminophen codeine on the pain of liver biopsy during the first 24 hours after biopsy. This was a double blind randomized clinical trail study from Oct 2007 to Oct 2008 in gastroenterology and liver disease unit of Tohid hospital in Sanandaj. Sample size included all the patients who were candidate for liver biopsy. Forty four patients [23 in experimental group and 21 in placebo group] were enrolled into the study on the basis of randomized blocking method. Exclusion criteria included any contraindication for liver biopsy or need of penetration of needle for two or more times for biopsy. Visual analogue scale [VAS] was used to assess pain after liver biopsy, 0,1,3,6 and 24 hours after biopsy. This study was conducted after approval of Ethical review Committee of Kurdistan University of medical Sciences and obtaining the informed written consent from the patients. The patients received acetaminophen codeine or placebo one hour before biopsy. Data were analyzed by means of Chi square, t-test, analysis of variances, and nonparametric tests. The mean value of the pains intensity in zero, one, three, six, and twenty four hours after biopsy in experimental group was higher than that of placebo group but there was no significant differences between two groups [P>0.05]. Intensity of the pain after liver biopsy in females was higher than in males in the two groups but there was no significant differences between two groups [P>0.05]. Comparison of the results of the present study with those of other studies shows that acetaminophen codeine is not effective in reducing the pain of biopsy. Further clinical trail studies for determination of the effect of other analgesics drugs are recommended in the future

Humoral immune system alterations in silica exposed workers

Crystalline silica may act as an immune adjuvant to increase inflammation and antibody production. The highest exposures to silica are known to occur in the dusty trades industries such as stone- cutting. We undertook this population based study to examine the association between occupational silica exposure and humoral immune system. In this historical cohort study, 47 workers from 10 stone-cutting factories in Rey City, south of Tehran, Iran that had more than 10 years exposure to silica were included in case group and 45 individual without any exposure to silica were selected for control group. We measured serum immunoglobulins [IgM, IgG, and IgA] of participants with ELISA method and compared the results between exposed workers and control groups. The mean concentrations of two immunoglobulines [IgG, IgA] and IgM in case group in comparison with control group were higher and lower respectively but both were in normal range. IgA concentration between two groups was statistically significant [P< 0.05]. Crystalline silica exposure may promote the humoral immune system in some individuals. Additional research is recommended in other population, using study design that minimize potential selection bias and maximize the quality of exposure assessment

[Correlation between serum level of endothelin I, portal hypertension and hepatopulmonary syndrome among cirrhotic patients]

Increased Endothelin I [ETI] activity may contribute to the complications of cirrhosis and portal hypertension. The main aim of this study was to determine the role of Endothelin I in cirrhotic patient with portal hypertention and hepatopulmonary syndrome. Fifty patients with biopsy proven cirrhosis and 50 normal healthy controls were selected for study. After getting informed consent, two dimensional echocardiography, chest x-ray and pulmonary function test have been done for all cirrhotic patients. Patients with cardiac and pulmonary disease history were excluded from the study and the cirrhotic patients who had proved to have intra-pulmonary vascular dilatation in their contrast echocardiogram were classified as the positive HPS. A total of 100 subject [60 males and 40 females in both case and control group] enrolled in the study. Among cirrhotic patients, 10 subjects with clinical and 7 subjects with sub clinical HPS were detected. The most common etiology of cirrhosis was HBV. Hepatopulmonary syndrome was significantly higher in class C [P=0.007]. There was no significant difference between plasma ETI level in both clinical and subclinical HPS compared to other cirrhotic patients. ET I levels in cirrhotic patients [2.29 pg/ml] were significantly higher in cirrhotic patients compared to that of normal healthy controls [0.85 pg/ml] [P = 0.038]. The effects of HPS on cirrhotic patient's survival are unclear. As to other studies, we found significant increase in plasma Et I level in cirrhotic patients rather that normal subjects, but in contrast to previous study we found no relation between Et I level and HPS. Only further studies with further numbers of cirrhosis-caused HPS patients may bridge up the gap between scientific effort and credibility in this field

Immunophenotypic subtyping of leukemic cells from Iranian patients with acute lymphoblastic leukaemia: association to disease outcome

Immunophenotypic characterization of the leukemic cells has been widely used as a tool for diagnosis, classification, stratification and prognosis of leukaemia. To investigate the immunophenotypic subtype profiles of Iranian patients with acute lymphoblastic leukemia [ALL] and its association to disease outcome. In this study, a total of 60 Iranian patients with ALL were immunophenotyped by flow cytometry using a panel of monoclonal antibodies specific for CD2, CD3, CD5, CD10, CD13, CD14, CD19, CD20, CD33, CD34, CD45, HLA-DR and TdT molecules. The samples were initially categorized into T-ALL [n=9], B-ALL [n=50] and mixed lineage [n=1] based on the expression patterns of CD3 and CD19 molecules. B-ALL patients could further be classified into four subtypes, including Pro-B [n=7, 11.7%], Pre-B I [n=28, 46.7%], Pre-B II [n=13, 21.7%] and immature/mature B cells [n=2, 3.3%] on the basis of expression of CD10, CD19, CD20, HLA-DR and TdT. Clinical manifestations and laboratory findings of the patients did not reveal association with immunophenotypic sub-types of ALL, with the exception of mediastinal mass and WBC count at the time of diagnosis which were found to be significantly higher in patients with T-ALL compared with B-ALL [p=0.001 and 0.014], respectively. Our results indicate that overall the immunophenotypic profile of Iranian ALL patients is similar to previous reports and it might be used for monitoring of minimal residual disease and prognosis

[Alterations of hepatic enzymes in industrial painters exposed to organic solvents in Tehran]

Organic solvents are widely used in different industries and occupations. They have a central role in production and use of paints. This study was carried out to evaluate the hepatic damage due to solvent exposure. In this cross-sectional study 62 painters were selected as cases with at least one year exposure to solvents and 54 employees as controls with no exposure. Demographic and clinical information collected via questionnaire and physical examination and the results of liver function tests, [ALT, AST, ALP], were compared in the two groups. The mean levels of ALT, AST, and ALP were not significantly different between cases and controls; however the mean levels of ALT and AST in individuals with high exposure were significantly more elevated than in persons with low exposures, [subgroups of cases]. We concluded that routine hepatic enzyme tests are not suitable for early detection of hepatic damage in workers exposed to solvents and the use of more sensitive tests should be considered

[Anesthetic gases and spontaneous abortion: a historical cohort study]

There are different opinions about the relationship between spontaneous abortion and women's occupational exposure to anesthetic gases. This study and other similar studies about women's occupational exposure seems necessary as more than 50 percent of women experience pregnancy during their working life. The aim of our study was to determine the association between rate of spontaneous abortion and maternal occupational exposure to anesthetic gases. Our study was a historical cohort. Two groups of married women were studied: exposed group [women who worked in operating rooms] and unexposed group [women who worked in emergency department, ICU or CCU]. Data was collected through questionnaire and interview, and exclusion and inclusion criteria were applied. Pregnant personnel were followed till the end of 20[th] week of pregnancy. Data was analyzed using SPSS 11.5 software with frequency distribution tables, cross-tabulation tables, chisquared test, and t-test, and p<0.05 was set as significance. Findings: Spontaneous abortion rate in the exposed group was 15.7% and in the unexposed group was 13.4%. Chi-squared test showed no significant difference [p=0.529]. Odds ratio was 1.196 with a confidence interval of 0.685-2.090. Our study did not find a significant relationship between spontaneous abortion and occupational exposure to anesthetic gases, but avoidance of unreasonable exposure is rational using scavenging systems

Survey of normal indices of pulmonary function test by use of spirometry in the people of Kurdistan province

In the last three decades, spirometry has become one of the main diagnostic tools in pulmonology. But different nomograms in different references has brought about challenges. The aim of this study was to obtain normal ranges of spirometry parameters in the people living in Kurdistan province. This was a discriptive study, and included all 15 to 64 years old people of Kurdistan province. Sampling method was random and sample size encompassed 1589 people. Weight, height and demographic data of the subjects were recorded in check lists. Then spirometry was performed under standard conditions. Data were analyzed with SPSS soft ware using descriptive statistics including frequency, mean and standard deviation. The results of this study showed that the mean value for forced vital capacity [FVC] was 3.6 liters [CI=0.96%]; 4.33 Lit for men [CI=0.89%], and 3 Lit for women [CI=0.46%]. The mean FEV[1] values were 3.74 [CI=0.82] and 2.61[CI=0.53] for men and women respectively. According to the results of this study, it seems that the values for FEV[1] are as the same as those of other references, -but the values for FVC are lower. Therefore the normal ratio of FEV[1]/FVC increases, and should be considered while interpreting spirometry results

An unusual form of silicosis in a stone-cutter

Silicon dioxide or silica is the earth's most abundant mineral. The primary pulmonary illness attributable to silica exposure is silicosis, which is observed in three forms: classic, accelerated and acute. A case of silicosis is presented in this article who has been working in a stone-cutting plant. He had suffered from symptoms of silicosis one year after employment in this plant [acute form], but his radiologic findings were compatible with accelerated or chronic silicosis. One of the important occupational diseases is silicosis, which is not treatable but is preventable. However, because of lack of appropriate engineering controls or personal protective devices in some workplaces we observe cases of silicosis yet

[Comparison between analgestic effects of Sufentanil and intraarticular injection Sufentanil and Sufentanil Plus Methylprednisolone after arthroscpic knee surgery]

Many different methods have been used in an effort to provide adequate analgesia after knee surgery. The goal of this study was comparison analgesic effect of. In a double-blind clinical trial study, 96 ASA physical status I-II patients ranging 20-45 years undergoing knee arthroscopic meniscectomy. Patients were allocated to groups receiving I.V sufentanil, intraarticular sufentanil 10 micro g, or Sufentanil 10 micro g plus Methylprednisolone 40 mg at the end of arthroscopy during general anesthesia. Postoperatively, pain levels at rest and during movement [i.e., active flexion of the knee] were measured by a visual analog scale. Supplementary analgesia-Acetaminophen codein orally-was given at patient request. Statistical analysis was performed by the Mann-Whitnery U-test, Wilcoxon's test and the X[2] test as appropriate. All data are presented as mean +/- SD. With regard to demographic data, duration of anesthesia and tourniquet time, significant difference were not observed among groups A, B and C. Postoperatively, pain score during rest and movement were significantly higher in the I.V group than in the other groups [P< 0.05] and the difference between the B and C groups was also significant [P< 0.05]. Postoperatively, supplementary analgesic consumption was significantly decreased in the intraarticular Sufentanil and Sufentanil plus Methylprednisolone groups [P< 0.05], and the difference between the B and C groups was also significant [P< 0.05]. Intraarticular administration of Sufentanil alone and combination of Sufentanil and Methylprednisolone after knee meniscectomy are effective, reliable, and well-tolerated analgesic techniques. Sufentanil pluse Methyl-prednisolone reduced pain and use of supplementary analgesics effectively

[Safety and efficacy of stenting in malignant esophageal obstruction: a prospective study]

Palliative procedures in esophageal cancer to restore swallowing are preferable to- major surgery in most cases. The aim of this prospective study was to provide further information on treatment techniques, complications, and survival in the patients with malignant esophageal obstruction undergoing endoscopic palliative therapy using Self-Expanding Metal Stents [SEMS]. Patients with obstruction of the esophagus secondary to carcinoma who referred for stenting with SEMS between October 2004 and July 2005 were studied. In all cases the tumor was considered non-respectable and the stage of the disease was III or IV. All patients had aphagia or severe dysphagia to liquids and saliva, due to which, stenting was indicated. A follow-up in 1-11 months was taken, with physical and laboratory examinations. Symptom relief, survival rate, and complications were analyzed using Wilcoxon signed ranks test and student t-test by SPSS software version 10.0. Results were considered statistically significant for p<0.05. Between October 2004 and July 2005 twenty two stents were placed under fluoroscopic guidance in 19 patients [13 males and 6 females with mean age of 65.5+/-12.6 years] with the obstruction of the esophagus secondary to carcinoma. Technical success rate was 100%. The dysphagia score improved significantly in a month after stenting [p=0.001]. During this time period, appetite score of the patients was not improved significantly [p=0.070]. Major immediate complications including severe pain occurred in two patients [10.5%]. Eight [42.1%] patients died. The survival rate was 68.4%, 63.2% and 57.9% for 3, 6 and 9 months, respectively. Our results suggest that self-expandable metallic stent placement is a simple, quick, safe and efficient method to palliate esophageal carcinoma obstruction and its implantation will efficiently palliate dysphagia. The major problem of these patients, however, seems to be loss of appetite due to the underlying disease

[Comparing helicobacter pylori infection between dentistry and pharmacy students in Tehran]

The route of person-to-person transmission of helicobacter pylori may be either fecal-oral or oral-oral, because the bacterium is found in both dental plaque and feces. We assessed the prevalence of H. pylori, which reflects present or past infection in dental students exposed occupationally to dental plaque. We examined the sera of 68 dental students and residents [24 residents and 44 students] and 69 age-matched controls by using quantitative ELISA for antibodies of lgG class to H. pylori. The proportion of dental group seropositive for H. pylori was [39 of 68] 57.4%, the proportion of control group seropositive for H. pylori was [40 of 69] 58%. There was no significant difference between groups. We conclude that dental practice in dental students does not increase the risk of H.pylori infection

Safety and efficacy of interferon alfa for the treatment of chronic hepatitis C infected subjects with transfusion dependent thalassemia in Iran

Up to 30% of Iranian adult multi-transfused thalassemic patients are infected with hepatitis C virus [HCV] which can intensify the progression of liver disease caused by iron overload in this group of patients. Our aim was to assess the biochemical and virological response of interferon alfa [INF-alpha] and its safety in thalassemic patients with chronic HCV infection. This trial was a single center, open label, single treatment prospective study of INF-alpha[Heberon alfa R, 3 MU, every other day] for a period of 12 months. 29 subjects, 13 to 56 years old [mean +/- SD: 25.1 +/- 10.4 years], whose serum HCV-RNA was positive and mean AlT remained greater than 1.5 times upper limit of normal in the last 6 months before the study were enrolled. A percutaneous liver biopsy was performed before treatment and all patients underwent monthly assessment for adverse events and monitoring of serum ALT. Qualitative serum HCV -RNA was obtained in months 3 and 6 and at the end of therapy. Pretreatment liver biopsy showed mild fibrosis in 33.3%, moderate fibrosis in 56.7% and cirrhosis in 10% of patients. Siderosis was severe in 14 patients [46.7%]. Two nonsplenectomized patients discontinued INF because of mild cytopenia, which resolved in less than one week after interruption of therapy. The following were some of the important adverse events observed during the study period: Flu syndrome in 29[100%], chills or fever>39°C in 14[48%], local pain in 14[48%], transient gastrointestinal symptoms in 13[44%], weakness in 5[17%], local induration in 3[10%] and edema in 2[7%] of the patients. By the end of 12 months of therapy, 15 patients out of 27 [55.6%] had a normal ALT and negative HCV -RNA [complete end-treatment response], they were followed up for a mean duration of 10.5 months [range: 6 to 22 months] and in 8 of them [53.3%] the condition relapsed [abnormal ALT with positive PCR]. Viral clearance was a delayed event in our patients [29% by the end of month 3 and 63% by month 7] but ALT normalization occurred in 94% of responders by the end of month 3. Our experience indicates that the cure of HCV -related liver disease in thalassemic patients is not an unrealistic aim and may be achieved with a safe and inexpensive INF preparation [Heberon Alfa R] in a sizeable portion of cases. As opposed to non-thalassemic patients, in whom most viral responses happen in the first 3 months of therapy, in this group of thalassemic patients we found that maximum virologic response happened between 3 to 6 months of therapy. Although INF-alpha is an effective drug for initial treatment in thalassemic patients infected with HCV, its efficacy with the above dose and duration, for maintaining long term remission is under question