[Mutations of cystic fibrosis transmembrane conductance regulator gene in patients with Mayer rokitansky Kuster Hauser syndrome]

Mayer Rokitansky Kuster Hauser [MRKH] syndrome is characterized by Mullerian duct aplasia in an XX individual with female phenotype presenting primary amenorrhea at adolescence. This study was done to determine the mutations of cystic fibrosis transmembrane conductance regulator [CFTR] gene including deltaF508, G542X, N1303K, W1282X in patients with MRKH syndrome. This case-control study was performed on 25 females with MRKH syndrome and 25 healthy females. Blood sample was taken from each subject. DNA genomic was isolated by standard methods and common mutations of CFTR gene analyzed by ARMS-PCR. deltaF508 gene was found in 3 in case and one individual in control group. G542X, N1303K and W1282X gene was not detected. deltaF508 gene was found in 12% of patients with MRKH syndrome

Problems of health insurance systems and the need for implementation of a reform approach

Heann care has always been considered as one of the basic needs of human communities. Health insurance is the best choice for establishing social justice in health care settings. Preliminary studies on insurance systems in Iran show that these systems suffer from serious problems. This study was an attempt to identify system problems and review the necessity for adopting a reform in health insurance systems of Iran. In this descriptive and exploratory study a questionnaire was used to collect data by reviewing reliable sources and referring to health insurance organizations and Medical Universities. The population included 24 university subject specialist informants and managers of health insurance organizations. The data were analyzed by SPSS software. The validity and reliability of the questionnaire were measured by content validity and test-retest method [r=0.84]. The main challenges of health insurance systems were related to the process of integration of health insurance systems. These problems can be classified as dimensions of policy making, rules and regulations, organizational structures and funding. Reforming health care and insurance systems stems from both health decision making and strategies. It seems that the creation of a coordinated information infrastructure is the main challenge for the integration and ultimately the reform of health insurance systems in Iran

Correlation between lipid-lowering and bone-protective effects of eicosapentaenoic acid in rats with steroid induced bone loss

This study was conducted to investigate the correlation between lipid-lowering and bone-protective effects of eicosapentaenoic acid on steroid-induced bone changes in rats. Twenty-one male 10-week-old Wistar rats were divided into 3 groups [n = 7 each] and treated with 0.9% NaCl SC [group 1] or methylprednisolone 7 mg/kg SC once a week [group 2] or methylprednisolone 7 mg/kg SC once a week + eicosapentaenoic acid 160 mg/kg, PO daily [group 3], for 6 weeks. At the end of the experiment, serum total cholesterol and triglycerides concentrations were determined using enzymatic colorimetric assays and bone histomorphometric analyses were performed on cancellous bone of femoral epiphysis and metaphysis using a photomicroscope and a digital camera. Histomorphometric parameters demonstrated a significant bone loss due to methylprednisolone administration, which was partly restored by eicosapentaenoic acid. A strong inverse correlation was observed between the serum total cholesterol concentration and epiphyseal trabecular width and metaphyseal trabecular osteoid width [R = -0.82, P = 0.04 and R = -0.86, P = 0.01, respectively]. Serum triglycerides concentration was also strongly and inversely correlated with the above mentioned parameters [R = -0.88, P = 0.02 for epiphyseal trabecular width and R = -0.81, P = 0.02 for metaphyseal trabecular osteoid width]. The correlation between the lipid-lowering and bone-protective effects of eicosapentaenoic acid may be helpful in the clarification of its effects on bone and lipid metabolism

Alterations of triglyceride and cholesterol in response to Aloe vera gel extract in HepG2 cells and hyperlipidemic guinea pigs

Aloe vera is well-known for its pharmacological and nutritional properties. The aim of the present study was to determine the effect of A. vera gel extracts on the secretion and cell content of triglyceride [TG] and cholesterol [TC] in HepG2 cells and their short-term effects on the dietary hyperlipidemic guinea pig model. The effects of increasing concentrations of A. vera crude gel and its alcoholic and hydro-extract were compared to HepG2 cells in both basal and TG induced conditions with 20 mM glucose for 24 h. In addition, 24 male guinea pigs were randomly separated into six experimental groups as follows: control, hyperlipidemic control, levostatin control and A. vera receiving groups [fed with lipid-rich diet supplemented with A. vera crude gel, alcoholic or hydro-extracts of A. vera gel]. Treatments were carried out for 10 d TG and TC levels were measured in both collected fluid [sera and media] and extracted tissue [HepG2 and liver]. Although basal and stimulated conditions of crude gel and its hydro-extract decreased the secretion and cell content of TG, compared to the control [p<0.05]. This pattern was not seen with the alcoholic extract. Furthermore, A. vera did not have any effect on the serum or liver contents of TG or TC. Our results suggest that A. vera could be a beneficial supplement to modulate the levels of TG and TC. However, it does not appear to be a short-term lipid modulator for hyperlipidemia

Effects of Fig tree [Ficus carica] leaf extracts on serum and liver cholesterol levels in hyperlipidemic rats

The effects of three Ficus carica leaf extracts on the total cholesterol levels [TC] of serum and liver were investigated in experimentally-induced nutritional hyperlipidemic rats. In nine treatment groups [n=5 each group], hyperlipidemic rats were treated daily with hydromethanolic [total] extract [2.5, 5, 10 mg/kg, intraperitoneal [ip]] and its aqueous fractions, namely fraction A [10, 50,250 mg/kg, ip] and fraction B [10, 50,250 mg/kg, ip] for eight days. In negative and positive control groups, animals received normal and hyperlipidemic diets with ip injections of normal saline, respectively. The lipid-lowering effect of total extract on liver cholesterol was more pronounced than that of serum. Fraction A caused a significant dose-dependent decrease in cholesterol levels in both the serum and the liver [p<0.05]. Fraction A at dosages of 10, 50 and 250 mg/kg lowered the TC in serum from 1.40 +/- 0.26 mmol/L [mean +/- standard deviation; untreated hyperlipidemic group] to 1.06 +/- 0.14, 1.04 +/- 0.07 and 0.90 +/- 0.08 mmol/L, respectively. At 50 and 250 mg/kg, it lowered the TC in liver significantly from 59.86 +/- 10.35 mg/g [untreated] to 42.61 +/- 12.08 and 37.16 +/- 5.59 mg/g, respectively. Fraction B lowered the level of TC in the serum and liver, but the results of this treatment were conflicting. Phytochemical screening showed that total extract had moderate levels of flavonoids and a large amount of tannins, which may account for the observed effects on decreasing TC levels. In conclusion, Ficus carica leaf extracts have been shown to decrease liver and serum TC levels in hyperlipidemic rats

[Cecal volvulus [two cases]]

Cecal Volvulus is an acute surgical emergency. In this condition cecum, terminal ileum and ascending colon on its mesenteric anticlock wise direction from 180 to 360 degrees. The cecal volvulus is caused by a congenital lack of fixation of cecum to retroperitoneum. The usual presentation consists of severe colicky abdominal pain with asymmetric abdominal distension. In this article two cases of cecal volvulus are defined. The first case was a 74 year-old female with sudden abdominal pain and severe abdominal distension subsequent 3 days patient often refers with sever colicky pain and asymmetric abdominal distention. After plain abdominal x-ray and abdominal CT scan, right hemicolectomy was performed. The second case was a 70 year- old female who subsequent 4 days without defecation was affected abdominal pain and distension. Supine and erect abdominal x-ray showed colon hyperairation and air-fluid levels. The gangrenous colon was resected etiology of bowel. Despite of other of obstruction or sigmoid volvulus that sometimes can be treated medically, the treatment of cecal volvulus is always surgery and consisted of cecum and ascending colon resection

case report of primary localized amyloidosis of eyelid with extensive calcification and ossification, clinically presenting as a bone tumor

Primary localized amyloidosis of eyelid is a localized type of amyloidosis without evidence of systemic involvement. We report a 75-year-old man suffering of unilateral [left] ptosis due to upper eyelid mass with bony consistency. Eye examination revealed upper lid mass attached to tarsus. No ocular infection or inflammation was found. Pathologist reported diffuse distribution of eosinophilic homogenous deposits of stroma that show apple green birefringence by polarized light compatible with amyloidosis. Primary localized amyloidosis may appear as a bony tumoral mass. It is important to consider secondary localized and systemic amyloidosis in differential diagnosis of the disease

[Immunohistochemical study of inflammatory pseudotumors of the orbit at Farabi hospital, Tehran, Iran]

To verify the myofibroblastic origin of spindle cells by immunohistochemistry in idiopathic inflammatory pseudotumor [IPT] of the orbit. We reviewed a series of 32 orbital IPTs for expression smooth muscle actin [SMA], Vimentin, Desmin and anaplastic lymphokinase [ALK]. The study was performed on histologic samples of 33 patients with a diagnosis of orbital IPT. The lesions expressed SMA in 51.7%, Vimentin in 72.0% and Desmin in 17.2%. All lesions were negative for ALK. Reactivity for SMA in spindle cells may indicate their myofibroblastic origin. The absence of ALK expression in all cases strongly suggests that these lesions, although histologically similar, are biologically distinct from their soft tissue counterparts. IPTs which are negative for ALK may be characterized by one or more chromosomal aberration involving regions other than 2p23

[ rare case of double myocardial bridges of the left anterior descending artery]

Myocardial bridge is a benign congenital anomaly in which a segment of major epicardial coronary arteries descends into the myocardium for a variable distance. Myocardial bridge is most often single and located in the middle part of the left anterior descending artery. The presence of more than one myocardial bridge in coronary arteries is very rare. We present a patient with more than one myocardial bridge in the left anterior descending artery. The case was a 55- year old man, referred to our clinic with the complaint of atypical chest pain. In the radionucloid study a reversible ischemia in the anterior wall was found. For this abnormal finding, he underwent a coronary angiography and it showed two myocardial bridges in the mid and end segments of the left anterior descending artery. Since myocardial bridge is usually single, the present case with two consecutive myocardial bridges in one artery can be presented as a very rare case report

Enucleation in a patient with neurofibromatosis type 1 with buphthalmos and ocular deformity

In infants with neurofibromatosis type 1, plexiform neurofibroma with altering anterior segment outflow system may result in raised intraocular pressure. Here we report a case of buphthalmos with neurofibromatosis [NF-1] who suffered with blindness suffered enucleation. Physical examination and histopathology were performed. Physical examination revealed Buphthalmos and vascularized cornea with lower lid ectropion and orbital deformity. Histopathologic findings showed plexiform neurofibroma in orbital tissue with scleral wall involvement. And hamartomatous proliferation in choroid and cilliary bodies with melanocytic elements. Few NF-1 cases with buphthalmos have been reported. But cases with complicationg buphthalmos [retinal detachment and optic nerve atrophy] suffering enucleation are very rare

[Normal conjunctival flora in newborns and infants]

To determine the normal conjunctival flora in neonates and infants. Conjunctival specimens were obtained from both eyes of 43 newborns delivered by cesarean section [C/S] and 53 newborns delivered by normal vaginal delivery [NVD] as well as 54 healthy infants in two maternity and pediatric hospitals. The specimens were cultured aerobically, anaerobically and for fungi. Among C/S delivered newborns 51% were culture positive for Staphylococcus epidermidis as the most common isolate [72.4%] followed by corynebacterium species. [10.3%]. Among NVD newborns 73.5% were culture positive. The most common isolates were S. epidermidis [26.5%] and Streptococcus viridans [17%]. Significantly greater isolates of anaerobic bacteria were observed in NVD newborns compared to C/S delivered newborns as follows: Lactobacillus [9.5%], Propionibacterium acnes [7.8%] and Fusobacterium [1.5%]. Among healthy infants 48% were culture positive. The most common isolates were S. epidermidis [55%] and P. acnes [10.5%]. There were no significant differences in normal conjunctival flora between healthy infants and C/S newborns, but significant differences were observed between infants and C/S newborns versus NVD newborns in certain vaginal tract related isolates such as Lactobacillus and Streptococcus species. Due to the higher incidence of anaerobic bacteria in NVD newborns, these organisms may be considered as presumptive causes in ophthalmia neonatarum

[ role of six sigma on the quality improvement in health care organizations]

Health care organizations, because of their special nature of medical services, impossibility of assessment by customers, and increasing of patient and customer expectation, have to apply different management approach. In recent decade Six Sigma has been considered as systematic and powerful to improve service quality and cost saving. Six Sigma is a statistical and systematic approach that tends to define the process performance defects and decrease the errors of clinical and business processes that are done with long time, high cost and poor outcome. The aim of this paper was to investigate the role of Six Sigma on the improvement of quality services in health care organizations using library and internet resources and descriptive and analytical method. Empirical findings in different countries that have through implemented Six Sigma in health care organizations have improved the time cycle and patient cycle in emergency room, operating room, radiology and laboratory services, supportive management, antibiotics management improvement in scheduling hospital staff activities, medical errors and cost saving. Also, good infrastructure and continual training is a necessity to six sigma implementation. Six Sigma methodology provides a systematic approach to business processes improvement based on customer demand and actual analysis in carrying out processes in any organization. There is a major difference between Six Sigma and other approaches and that is why it is being used in health care organizations. Nevertheless the different methods used to implement whatever approach the basic ground to embrace the culture quality should exist in the organization. Also quality improvement is a continual process which derives the cooperation of all working teams and the use of appropriate means and methods in solving individual problem. Although, the use of any method needs to preparation and adaptation of quality culture in organizations. Also quality improvement is continual process that needs to cooperate and interact work teams and use of suitable tools and methods for any problem

[Ischemic and reperfusion injury of adult rat sciatic nerve]

Ischemia plays a major role in development of pathological changes in various neuropathies. Reperfusion amplifies physiological and pathological abnormalities in ischemic nerves. In this research, we studied ischemic-reperfusion [IR] injury of sciatic nerve up to 14 days of reperfusion. IR was produced by ligation and release of nooses around supplying vessels to the sciatic nerve. 30 rats were assigned into 5 groups of 6. Group 1 [control] did not undergo IR while the 4 remaining groups after three hours of complete hind leg ischemia underwent reperfusion within 0hr, 3hrs, 7 days and 14 days. Pathologically, two phases were identifiable. During phase 1 [0-3 hrs] fiber degeneration and endoneurial edema were observed. During phase 2 [7 days and, 14 days] prominent fiber degeneration and prominent endoneurial edema were observed. Loss of function occurred in more than 75% of the rats with ischemia alone, in comparison with the control group the maximum reduction in activities was observed amongst the group of rats reperfused within 3 hours. IR injury depends on duration of reperfusion. Microvascular events during reperfusion may enhance the nerve fiber damage following the ischemia period

[Histopathological and immunohistochemical evaluation of orbital spindle cell tumors]

To assess the histopathological and immunohistochemical features of orbital spindle cell tumors. A descriptive, retrospective study was performed on 63 pathology reports on all types of orbital spindle cell tumors at the pathology department of Farabi hospital between 1995 and 2005. Immunohistochemistry studies for different markers, such as smooth muscle actin, Desmin, S100 protein, CD31, Factor VIII, CD 68 and CD34, were carried out in cases with indeterminate origin on routine histopathologic study to achieve a definitive diagnosis. Our study included 63 cases with average of 30 years including 62% female and 38% male subjects. The leading types of orbital spindle cell tumor in our study in order of frequency included: benign nerve sheath tumors [46.0], rhabdomyosarcoma [11.1%], hemangiopericytoma [7.9%], fibrous dysplasia [7.9%], ossifying fibroma [4.8%], fibrous histiocytoma [3.2%], and other types [19.1%]. From 29 cases with benign nerve sheath tumor, 16 cases [25.4%] were neurofibroma and 13 cases [20.6%] were schwannoma. The orbital tumors were benign in 74.7% and malignant in 25.3%. The most common type of orbital spindle cell tumor in this study was benign nerve sheath tumor. Immunohistochemical studies for different markers are required for definitive diagnosis of cases with indeterminate origin on routine histopathological study

Two case reports of emphysematous cystitis in two diabetic patients with related literature review

Emphysematous cystitis is a rare form of acute infection of the bladder is which most cases are seen in diabetic patients. Most infections are due to E.coli and Klebsiella species. Predisposing factors are diabetes mellitus, recurrent urinary tract infections, bladder outlet obstruction and neurogenic bladder. CT-scan is the most sensitive method of diagnosis that detects air whithin intramular of bladder that is pathogonomonic of the disease. In this case report we reported two cases of emphysematous cystitis. The first case was a 73 years old diabetic woman who was admitted due to acute renal failure after cholecystectomy. During hospitalization, after remission of renal function, she developed fever, abdominal pain, hematuria and progressive abdominal distention. In physical examination she had generalized abdominal tenderness with dominance in the lower abdomen without rebound tenderness which with observation of air in intramural bladder by CT-scan, diagnosis of emphysematous cystitis was confirmed and the patient was treated and improved. The second case was a 37 years old diabetic woman. She was refered to the hospital because of nausea, recurrent vomiting and abdominal pain. In physical examination she had severe hypotention, generalized abdominal tenderness that was dominant in the lower abdomen and abdominal mass in suprapubic area. Suspicious to emphysematous cystitis, pelvic CT-scan was ordered. By observation of air in intramural bladder, emphysematous cystitis was confirmed. Patient was treated with antibiotic, insertion of fouly catheter and was improved. Undiagnosing or delaying in initiating appropriate treatment can lead to peritonitis secondary to intraperitoneal perforation of the bladder, septisemia and ultimately death of the patient. Timely diagnosis and aggressive therapy are important for the survival of these patients

case report of well differentiated chondrosarcoma of thyroid gland

We report a 75 year old man who presented with a cervical mass, dysphagia and hoarseness, CT - scan of neck showed a large cold nodule in the right lobe of thyroid gland, which was followed by surgical excision and its histopathologic exam revealed well-differentiated chondrosarcoma