Flow cytometric dna analysis and histopathologic re-evaluation of paraffin embedded samples from hydatidiform moles and hydropic abortions

Distinction of hydatidiform moles [HMs] from non-molar abortions and sub-classification of HMs are important for clinical practice; yet, diagnosis based solely on morphology is affected by interobserver variability. The objective of this study was to determine the role of DNA flow cytometry in distinguishing molar from non-molar pregnancies. This retrospective study was conducted at the Department of Pathology, Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran, between 2006 and 2010. DNA ploidy analysis and histopathologic re-evaluation were performed on paraffin-embedded tissue from 36 [17 complete and 19 partial] molar and 24 hydropic abortus [HA] cases which were previously diagnosed based on histomor-phologic study. Of the 17 cases initially diagnosed as complete HM [CHM], 9 were dip-loid, 2 were triploid, 5 were tetraploid and 1 was aneuploid. Of the 19 initial partial HMs [PHMs], 2, 8, 1 and 8 cases were diploid, triploid, tetraploid and aneuploid, respectively. In the initial HA category [n=24], 14 diploid, 1 triploid, 5 tetraploid, and 4 aneuploid cases existed. Following flow cytometry and histopathologic re-evaluation, 1 case with previous diagnosis of HA was reclassified as PHM, 2 initial PHMs were reclassified as CHM and 2 initial CHMs were categorized as PHM. The results show that correct diagnosis of PMH is the main challenge in histological diagnosis of gestational trophoblastic disease [GTD]. DNA flow cytometric analysis could be an informative supplement to the histological interpretation of molar and hydropic placentas

[Streptococcus super antigen in polyp tissue of patients with nasal polyposis and chronic rhinosinusitis in comparison to normal population]

Nasal polyp [NP] is a benign mucosal mass located in both sinuses and nares which is mostly seen in association with cystic fibrosis, asthma or oversensitivity to aspirin. The prominent histological feature of NP is inflammatory cell infiltration with eosinophil predominance. Superantigens role in causing NP complications is already proven. Superantigens, which are mostly originated from Streptococci and Staphylococci, activate T cells strongly and increase the process of production and release of cytokines, and secretion of IgE from B cells, which in turn directly affects proinflammatory cells such as eosinophils, both in their tissues infiltration and functions. The samples are collected from patients referring to ENT clinic in Rasoul Akram training Hospital in Tehran after thorough clinical and paraclinical examinations. For control group the samples collected from patients undergoing rhinoplasty. All the samples kept frozen and sent to immunology lab. The DNA of the excised tissues extracted and amplified by using the superantigens specific primers and PCR product detected by gel electrophoresis. The date analyzed by using mean and SD and CHI[2] analytical tools. Fifteen healthy individuals, 25 patients with rhinosinusitis and 24 with polyposis entered this trial. Group A Streptococcus toxin detection was significantly more frequent in those with nasal polyp and rhinosinusitis compared to healthy individuals [P=0.001 and 0.005, respectively], but the results were almost the same for those with nasal polyp and rhinosinusitis [P=0.4]. Streptococci may play an important role in induction or clinical exacerbation of polyposis and group A Streptococcus pyogenes exotoxin [SPEs] with superantigenic effects may have a crucial role in etiology and pathogenesis of polyps with or without rhinosinusitis. It is postulated that, T cells polyclonal activation by SPEs may cause recruitment of inflammatory cells in nasal mucosa. These inflammatory cells include IgE producing B cells leading to allergic and inflammatory reactions in NP.

Tinnitus: an epidemiologic study in Iranian population

A wide range of population, 4% to 30%, suffers from tinnitus that is defined as perception of sound without apparent acoustic stimulus. We conducted the present study to determine the prevalence of tinnitus in Iranian population; Tehran province. This cross-sectional study was conducted from January 2009 to December 2009, recruiting 3207 individuals [age range, 7-98] who were residing in Tehran province, Iran. Participants were asked to fill two questionnaires; the validated Persian version of Tinnitus Questionnaire [TQ] and another one that was specifically designed for this study. Prevalence of tinnitus and its association factors were evaluated. 3207 participants enrolled into our study comprising 1429 [44.7%] male and 1765 [55.3%] female with mean age of 55.01 +/- 17.85. Of total of 3207 participants, 146 [4.6%] had tinnitus consisting of 80 male [54.8%] and 66 [45.2%] female participants. It showed a rising trend with increasing age that was especially significant after the sixth decade of life [P=0.001]. The analysis showed mean TQ global score of 35.96 +/- 25.52 that was significantly different between male and female participants [P=0.051] and had no significant correlation with increasing age [Spearman's r=0.1, P=0.10]. The tinnitus intensity was moderate to very severe in 95 [56.1%] of the participants. Its severity level was not significantly different between men and women [P=0.09]. Tinnitus intensity had no significant association with increasing age [Spearman's r=0.1, P=0.31]. Patients with higher TQ global score had higher tinnitus intensities [P=0.001]. The annoyance level was significantly different between men and women [P=0.04] and its impact on the participants daily routine functions were significantly higher in men [P=0.003]. Given the results of the study, demonstrating that prevalence of tinnitus in Iranian population [Tehran province] was lower than the other countries and had a direct correlation with increasing age only after the sixth decade. TQ global score had significant correlation with tinnitus intensity, annoyance and impact on the participants' daily routine functions. However, none of the above had correlation with increasing age. Tinnitus TQ global score and intensity were not different between men and women; however annoyance of tinnitus and its impact on participants' daily routine functions were significantly higher in men

Searching Mycoplasma pneumonia by serology and PCR in children with adenoid hypertrophy and rhinosinusitis: a case control study, Tehran, Iran

Chronic infection in childhood is a leading cause of adeno-tonsillectomy. The aim of this study was to determine the role of M. pneumoniae in children with rhino sinusitis and adenoid hypertrophy. This case - control study was carried out in the pediatric and ENT wards of Hazrat Rasul Hospital, Tehran, Iran [2007-2009]. In this trial, we investigated 40 cases with adenoid surgery and 32 controls.We looked for M pneumoniae -DNA [PCR] in adenoid tissues resected from cases and 31 nasopharyngeal swabs in controls and IgM and IgG antibodies [ELISA] were compared between the 2 groups, P < 0.05 was considered to show a significant value. Positive PCR results were observed in 35% of cases and none of controls, positive-IgG was seen in 20% of cases and 6.4% of controls [P = 0.71] which was higher in older cases [6 vs. 4 years, p < 0.05]. Positive -IgM was seen in 10% of cases vs. 9.7% of controls, [P = 0.74]; without any difference for age [6.2/ 5.3 years, p = 0.1]. A positive PCR result was not related to positive IgG [p = 0.014], but to a positive IgM [p = 0.1]. M. pneumoniae infection was found serologically [IgM and IgG] in 10% and 20% of cases, respectively. These numbers along with positive PCR in adenoid tissue of cases [30%] indicates the prominent role for M pneumoniae in adenoid hypertrophy. We concluded that children in Iran will have been infected with M pneumoniae and would have obtained immunity between the ages of 6 and 8. Adenoid tissue might act as a reservoir for M. pneumoniae and cause rhino sinusitis concomitant with adenoid hypertrophy in infected children. Theoretically, suitable M pneumoniae eradicating antibiotics before adenoid surgery [with rhino sinusitis or chronic ear infection] might be helpful treatment, but it needs future RCT studies to be proven

Surgeon satisfaction during endoscopic management of cerebrospinal fluid rhinorrhea: a comparison between propofol-remifentanil and isoflurane-remifentanil anesthesia

Surgeon's depend to a large degree on the amount of blood loss and a clear view of the surgical field, when conducting endoscopic procedures in order to achieve satisfactory outcomes. The anesthesiologist's choice of method for the induction and maintenance of anesthesia plays a major role in achieving this goal. This study was performed in order to compare the two most well-known methods in this regard; total intravenous anesthesia [TIVA] and venous inhalational mixed anesthesia [VIMA]. This study included the endoscopic management of 89 patients with cerebrospinal leakage [CSF leakage] covering a period of nine years [1999-2008] for whom a subarachnoid injection of fluorescein was first administered, and afterwards they were maintained under general anesthesia using two distinct methods; propofol-remifentanil versus isoflurane-remifentanil [inhalational or intravenous]. During the operation, hemodynamic indices, blood loss, and surgeon's satisfaction, were assessed and compared between the two groups. Endoscopic management and autografts were successful in repairing anterior skull defects in 90% of cases. Regarding the surgeon's satisfaction level, and hemodynamic stability no significant difference between the two groups was observed [P > 0.01]. Both isoflurane and propofol in combination with remifentanil afford optimal surgical conditions with regard to hemodynamic parameters and the satisfaction of the surgeon with the surgical field

anticipation and inheritance pattern of c.487 A>G mutation in the GJB2 gene

Mutations in the GJB2 gene are the most common causes of hereditary hearing loss. This study reveals some facts about the inheritance pattern of M163V in the GJB2 gene. This study was performed on two different families with non-syndromic hearing loss. We screened the GJB2 coding region with direct sequencing. There was a substitution of A to G in exon 2 at nucleotide 487 [M163V]. This mutation was heterozygous in fathers and children while mothers were normal. Fathers of both families showed late onset hearing impairment, but there was early onset hearing loss in the children, which was more severe compared to the fathers. M163V has been reported as an unknown heterozygous mutation that leads to failure of the homotypic junctional channel formation. Another mutation in this codon is M163L, with an autosomal dominant inheritance, which impairs trafficking through the plasma membrane, resulting in cell death. Assessment of the familial pedigree has revealed anticipation in phenotype and autosomal dominant inheritance. These data in addition to the high conservation of methionine residue in mammalian species suggest that M163V is inherited with an autosomal dominant pattern. Therefore, the risk of inheritance will increase. Genetic counselors and otologists should prioritize the evaluation and prevention of this disorder in patients

[Superantigens in polyp tissue of patients with chronic rhino-sinusitis, a comparative study: a brief report]

Staphylococcus aureus secretes numerous superantigenes which trigger the inflammatory mechanisms of sinus mucosa and cause chronic rhino-sinusitis. This study was designed to evaluate the role of staphylococcus aureus superantigens in polyp tissues of patients with chronic rhino-sinusitis in comparison with a control group. Polyp tissue samples of 28 patients and mucosal specimens of 19 healthy individuals were evaluated for staphylococcus aureus bacterium superantigens, exotoxins A, B, C and D and TSST-1 with RT-PCR and ELISA methods Rasoul Akram Hospital during 2 years. Polymerase chain reaction [PCR] results revealed that 88.2% of the patients and 45.5% of the controls had at least one type of superantigen [P=0.03]. Evaluation of superantigens using ELISA method showed presence of at least one type of superantigen in the nasal samples of all patients and in 35.3% of the controls [P < 0.001]. A relationship between staphylococcal superantigens and nasal polyps is concluded from this study which indicates the probable role of these superantigens in the pathogenesis of nasal polyposis

Subjective sleep quality in urban population

Sleep disturbances are common among adult populations and can have a significant effect on daytime activities. The aim of this study is to determine the prevalence of sleep problems and subjective sleep quality in the adult population of Tehran, Iran. From an urban community of Tehran, a random sample of 3400 adult men and women were selected by a cross-sectional design. Using the Persian version of the Pittsburgh Sleep Quality Index [PSQI], subjects were interviewed face-to-face. There were 3114 completed questionnaires returned and analyzed. The mean age of the subjects was 43.57 [ +/- SD 17.5] years. Overall 37% [95% CI: 35-39] of the population were categorized as poor sleepers. The PSQI > 5 showed 27% were males versus 35% among females. The global PSQI scores ranged from 4.20 +/- 2.67 to 5.60 +/- 3.74 for males and 5.03 +/- 3.00 to 7.97 +/- 4.31 for females by age groups. The difference across age groups for global PSQI score was significant in females [P < 0.01]. The prevalence rate of sleep complaints in this population-based study was high. Females, older adults, widows and separated couple were the most important risk factors for sleep disturbances

Profile of Iranian GJB2 mutations in young population with novel mutation

Despite the enormous heterogeneity of genetic hearing loss, most non-syndromic hearing losses are caused by mutations in the GJB2 gene. We aimed to characterize the mutation profiles of 100 Iranian deaf patients that were under 10 years old. Patients were tested with direct sequencing of entire coding region of the GJB2 gene. Eight known mutations plus one novel [358delGAG] were found in 25% of study group. The 35delG mutation [64%] constituted the majority of GJB2 mutations. Role of GJB2 mutation in Iranian young deaf population is more prominent than previous study that can be a result of higher consanguine marriage in population. But our result shows that there is only 25% non-syndromic hearing loss due to high frequency of consanguine marriage in Iranian population. Identification of other genes involved in genetic deafness will help us understand the fundamental mechanisms of normal hearing, both in early diagnosis and therapy

Effectiveness of adenoidectomy on tympanostomy tubes retention duration

The children with middle ear effusion need repeated re-tympanostomies. Adenoidectomy is an effective surgical intervention in the management of chronic otitis media with effusion in conjunction with insertion of tympanostomy tubes [TTs]. To find out whether TTs in different positions decrease the rate of re-tympanostomies study was done. The present study retrospectively evaluated the effectiveness of adenoidectomy on retention of Shepard TTs in antero-inferior quadrant [AIQ] and postero-inferior quadrant [PIQ] with chronic, persistent or recurrent otitis media. Eighty-five children [one-hundred and seventy ears] underwent bilateral myringotomy and TTs placement with and without adenoidectomy with informed consent. According to the TTs retention duration rate, there was a significant difference between adenoidectomy and non-adenoidectomy groups in AIQ. It was concluded that TTs placement in the AIQ in conjunction with adenoidectomy showed better improvement and prolonged ventilation. This study suggests that adenoidectomy is an effective surgical intervention in the management of otitis media especially when it is performed in conjunction with insertion of TTs. This significantly decreases tube extrusion rate especially in an AIQ, which might be due to improving eustachian tube function that consequently reduces repeated otitis media

[ comparison of TH1 and TH2 cytokines gene expression in allergic and non-allergic patients with nasal polyps by PCR]

Too many studies are in the process of determining the probable role of immune system in the etiopathogenesis of nasal polyposis. This study was designed to identify the probable participation of Th1, Th2 lymphocytes in the induction and progression of nasal polyposis. Seventy-five patients, 42 male and 33 female, with nasal polyposis were examined for total serum IgE, specific serum IgE and reaction to skin test for differentiating allergic from non-allergic participants in Rasoul Akram Hospital during 2010. To determine the possible correlation of allergic reactions in the upper respiratory tract and nasal polyposis, cytokine gene expression was evaluated on the extracted RNA by RT-PCR. The data were analyzed by using c2, independent t-test, correlation and Receiver operating characteristic [ROC] curve. The mean age of participants was 38 years [18-81 years]. IFN-gamma and IL-4 gene expressions were more prevalent in allergic than non-allergic individuals [IFN-gamma: 39.5% vs. 14.2%, P=0.3 and IL-4: 44.7% vs. 18.9%, P=0.02, respectively]. IL-10 and IL-12 [P35 and P40 fractions] genes were not significantly different between the two groups. IL-10 and IL-12 [P35, P40] genes did not differ significantly either. This research suggests that overproduction of cytokines and an imbalance of Th1 and Th2 cell production may play an important role in the pathophysiology of allergic or non-allergic nasal polyp formation. Thus, although nasal polyposis is a multifactorial disease with several different etiological factors, chronic persistent inflammation is undoubtedly a major factor irrespective of the etiology

LMA CTrach, a new approach for endotracheal intubation: a pilot study in 100 patients undergoing elective surgery

The LMA CTrach system is a new device for airway management and endotracheal intubation under direct vision in both anticipated and unexpected difficult intubation situations. We used this system in 100 patients undergoing general anesthesia for different types of elective surgeries. After randomly selecting the patients for intubation with this new device, the airway characteristics, height, weight, dental overbite and thyromental distance were all evaluated before induction. Our goal was to explore primarily the success rate of intubation with LMA CTrach. We were able to insert LMA CTrach and provide optimal ventilation in all 100 patients. Nonetheless, successful tracheal intubation was performed in 95 patients. Among our patients, 2 had Mallampati grade IV airways with short necks, body mass index [BMI] > 30, and without the capability to bite their upper lips. Amazingly both patients were intubated with this method, proving a device as an assuring approach in cases of difficulty with ventilation and intubation. Of all patients, 44 were females and 56 males. The mean age was 34 +/- 2 years. BMI measured for all patients was 20-25 except for two cases who had BMI > 30. Since the LMA CTrach provided us with direct view of the larynx and vocal cords during intubation even in difficult cases, it can be assumed that this device is a precious aid as equal as fiberoptic bronchoscopy for the anesthesiologists

[Effectiveness of low level laser irradiation on tinnitus and parameters of electrocochleography and distortion product otoacoustic emissions]

Tinnitus is the consciousness of sound that arises in the ear or head without any external sound origin. The efficacies of transmeatal low-level laser irradiation for tinnitus treatment were reported before. The aim of this study was to evaluate the effectiveness of low level laser therapy on tinnitus and ECochG and DPOAEs parameters. The study design was prospective, quasi experimental. This investigation conducted on 16 ears [10 patients] with disabling tinnitus. All patients underwent ENT examination, complete audiological evaluation, tinnitus study, ECochG and DPOAEs, and finally completing tinnitus data sheet. The results were compared before and after irradiation. Means of tinnitus loudness [LMT] and CAP amplitudes were significant different before and after irradiation [p<0.005]. There was no any other significant difference before and after low level laser irradiation in subjective loudness, pitch matching annoyance grade of tinnitus and DPOAEs and other ECochG parameters. Transmeatal low-power laser irradiation with 200 mW seems not to be effective for treatment of tinnitus. This paper is the research brief report. In clinical point of view, this study should be repeated with a greater sample size although our results were statistically important

Infection in childhood sensory hearing loss

To evaluate the possible role of infectious agents on the occurrence of idiopathic sensorineural hearing loss [SNHL] in children. This case control study was carried out at Rasul Hospital in Tehran, Iran from 2002-2003. We compared specific serum antibodies [IgG, IgM] measured by enzyme linked immunosorbent assay in 95 sensory hearing loss cases and 63 controls. Acute infections [IgM] detected in cases included: cytomegalovirus [CMV] 34.6%, toxoplasma 11.5%, mumps 8.7%, rubella 5.3%, and herpes simplex 5.3%. Previous infections [IgG] detected in cases included CMV 72%, herpes 6.6%, toxoplasma 26%, mumps 23.3%, and rubella 17.2%. Acute CMV and toxoplasma infections were more frequent in cases. Previous CMV, toxoplasma, rubella, and herpes infections were higher in controls. There was no significant difference for acute mumps, rubella, and herpes infections between cases and controls. These data are compatible with infectious agents having a significant role in the studied idiopathic SNHL cases, but association does not prove causation. We recommend specific drugs for confirmed active infections [CMV, toxoplasma, herpes] in idiopathic SNHL infants diagnosed before their first birthday. Mumps and rubella induced SNHL are preventable with routine vaccination

[Auditory neuropathy: Findings of behavioral physiological and neurophysiological tests]

Auditory neuropathy [AN] can be diagnosed by abnormal auditory brainstem response [ABR], in the presence of normal cochlear microphonic [CM] and otoacoustic emissions [OAEs]. The aim of this study was to investigate the ABR and other electrodiagnostic test results of 6 patients suspicious to AN with problems in speech recognition. This cross sectional study was conducted on 6 AN patients with different ages evaluated by pure tone audiometry, speech discrimination score [SDS], immittance audiometry. ElectroCochleoGraphy, ABR, middle latency response [MLR], Late latency response [LLR], and OAEs. Behavioral pure tone audiometric tests showed moderate to profound hearing loss. SDS was so poor which is not in accordance with pure tone thresholds. All patients had normal tympanogram but absent acoustic reflexes. CMs and OAEs were within normal limits. There was no contra lateral suppression of OAEs. None of cases had normal ABR or MLR although LLR was recorded in 4. All patients in this study are typical cases of auditory neuropathy. Despite having abnormal input, LLR remains normal that indicates differences in auditory evoked potentials related to required neural synchrony. These findings show that auditory cortex may play a role in regulating presentation of deficient signals along auditory pathways in primary steps

Bacterial etiologies and antibiotic resistance in sinusitis: a study of 264 cases

Although inflammatory processes involving facial sinuses rarely develop during childhood, these antrums due to their anatomic situations are exposed to a variety of biologic and nonbiologic agents after birth. Many types of bacteria are able to initiate inflammatory responses in these antrums. Since effective management of these patients rests upon demonstration of a specific pathogen and testing the organism [s] for sensitivity to a variety of antimicrobial agents and due to the fact that there are distinct epidemiological features in certain regions with respect to the etiologies, we have randomly selected 264 patients with sinusitis from several Tehran hospitals in order to estimate the frequency with which various organisms may cause the condition and to evaluate antibiotic potency and efficacy in eradicating the condition. In 62.12 percent of cases the causative organisms could be cultured, in 32.3% of which more than one genus of bactria were isolated. The most common bacterium in this setting was Staphylococcus aureus followed in order by pneumococcus, enterobacteriaceae, haemophilus, pseudomonas and branhamella. The sensitivity of these organisms to various antibiotics [suitable in each case] were studied as well