relationship between dietary intakes of amino acids and bone mineral density among individuals with spinal cord injury

Objectives: The effect of dietary protein intake on bone mineral density [BMD] has not been explained in patients with spinal cord injury [SCI]. In this study, we looked at the relationship between BMD and higher protein intake in patients with SCI while controlling for possible confounders

Methods: Patients with SCI, who were referred to the Brain and Spinal Cord Injury Research Center between November 2010 and April 2012, were included in the study. In total, the dietary intakes of 103 patients were assessed by 24-hour dietary recall interviews. We used dual-energy X-ray absorptiometry to measure BMD in the femoral neck, trochanter, intertrochanteric zone, hip, and lumbar vertebras

Results: Eighty-six men and 17 women participated in this study. Protein intake was negatively associated with the BMD of lumbar vertebrae [p = 0.001, r = -0.37 for T-score and p = 0.030, r = -0.24 for Z-score]. The BMD of lumbar vertebrae were negatively associated with intake of tryptophan, isoleucine, lysine, cysteine, and tyrosine [p = 0.007, 0.005, 0.009, 0.008, and 0.008 for T-score, respectively]. Higher intakes of threonine, leucine, methionine, phenylalanine, valine, and histidine were related to a lower BMD of lumbar vertebrae [p = 0.006, 0.010, 0.009, 0.010, 0.009, and 0.008 respectively for T-scores]

Conclusions: We found that high protein intake led to a lower BMD of lumbar vertebrae in patients with SCI after controlling for confounders including demographic and injury-related characteristics and calcium intake. No relationship between higher amino acids intake and BMD of the femur and hip was detected. Intake of alanine, arginine, and aspartic acid were not related to BMD

[Evaluation of the mean percentages of the peripheral blood gamma delta t lymphocytes in the healthy subjects and celiac patients in Isfahan]

An elevation in the mean percentages of the gamma delta T lymphocytes per total T cells in the epithelium of the small intestine has a diagnostic value for celiac disease. This study aimed to measure the percentages of the peripheral blood gamma delta T lymphocytes in the adults' celiac disease and healthy controls.In this case-control study the absolute numbers of the peripheral blood lymphocytes obtained from the controls [n = 21] and celiac patients [n=15] were studied, Using a cell counter. The proportions of the gamma-delta T lymphocytes were evaluated by the flow cytometer method. The results showed that there was not significant I difference in the percentages of the gamma-delta T lymphocytes between celiac patients and healthy individuals. [p value= 0.84] Collectively, the data show that the percentages of the peripheral blood gamma delta T lymphocytes could not be helpful for celiac disease diagnosis

Phenotypical characterization of the peripheral blood T cells in patients with celiac disease: does it differentiate suspicious celiac disease cases?

The present study aimed to study the immunological changes seen in the intestinal epithelium of the celiac patients could also be detected in the peripheral blood lymphocyte populations. Celiac disease [CD] is a small bowel enteropathy caused by permanent wheat gluten intolerance. One of the earliest signs of CD is an increase in the numbers of the intestinal intraepithelial lymphocytes [iIEL]. In this case-control study, totally 13 untreated subjects with acceptable criteria for CD without any complication and 16 healthy subjects without any positive criteria for CD were selected. Peripheral blood T cells were analyzed by two-color flow cytometry in both groups. The mean age of patients was 33.6 +/- 3.4 years and two patients had Marsh IIIB, five patients had Marsh IIIA and six patients had Marsh II histology class. The mean percentages of the gamma delta]TCR[+] T cells in the patients were significantly higher than the controls [p=0.015]. However, the mean percentages of the [alpha beta]TCR[+] T cells were significantly lower in the untreated patients than the controls [p=0.025]. There were no significant difference between the mean percentages of lymphocytes expressing the CD3, CD4 and CD8 molecules in the patients and the controls. The change in the percentages of the peripheral blood T cells expressing the [gamma delta]TCR and [alpha beta]TCR in the celiac patients could be used in conjunction with the other serological markers to identify new CD cases

Immunohistochemical analysis of mismatch repair proteins in iranian colorectal cancer patients at risk for Lynch syndrome

Hereditary non-polyposis colorectal cancer [HNPCC] is a common hereditary cancer predisposing syndrome has molecular and clinicopathological features still have remained ambiguous within Iranian populations. We discuss in this article some molecular and clinicopathological features of the condition. The study was a descriptive retrospective and designed on 1659 colorectal cancer [CRC] patients were screened based on early-onset disease and Amsterdam II criteria during 14 years [2000-2013]. Immunohistochemistry [IHC] staining was set up to detect expression of mismatch repair [MMR] genes on paraffin-embedded tissue sections of 31 HNPCC-CRC tumors. SPSS 19 software was used to analyze the data. IHC-MMR staining was absent in 7/31 individuals [22.6%] of which 4 cases showed IHC-Absent [IHC-A] in both MSH2 and MSH6 [57.1%], in 2 cases both MLH1 and PMS2 had negative staining [28.6%], and just in one case, MSH6 was defective [14.3%]. The frequency of CRC among IHC-A and IHC-Present [IHC-P] families was 67.5% and 27.9%, respectively. Also the most frequent extracolonic cancers in IHC-A group were: stomach [10%], small bowel [5%], and prostate [5%]; and in IHC-P group: stomach [18.4%], lung [10.9%], and breast [7.5%]. Average age of IHC-A individuals at diagnosis was 38.0 versus 45.3 years in IHC-P individuals. Overall, 20.8% and 57.1% of our index CRCs were localized proximal to the splenic flexure in IHC-P and IHC-A groups, respectively. Given the lack of enough information about molecular aspects of hereditary cancer syndromes like HNPCC in Iran, more evaluations are necessary on larger samples using complementary techniques such as MSI-testing and mutation analyses

Sono-elastography for differentiating benign and malignant cervical lymph nodes: a systematic review and meta-analysis

We did this systematic review to determine diagnostic accuracy of sono-elastography in evaluating cervical lymph nodes [LNs]. A highly sensitive search for sono-elastography and LNs was performed in MEDLINE, Cochrane Library, ACP Journal Club, EMBASE, Health Technology assessment, and ISI web of knowledge for studies published prior to December 2012. SPSS version 18 [SPSS Inc., Chicago, IL, USA] used for descriptive analysis and meta-disk version 1.4 applied for meta-analysis. Forest plots for pooled estimates and summery of receiver operating characteristic plots for different cut-offs were produced. The literature and manual search yielded 69 articles, of which 10 were eligible to include. A total of 578 individuals with a total number of 936 cervical LNs was evaluated [502 malignant and 434 benign]. The summary sensitivity of the scoring and strain ratio [SR] measurements for the differentiation of benign and malignant LNs were 0.76 [95% CI: 0.71-0.8] and 0.83 [95% CI: 0.78-0.87]. The summary specificities were 0.8 [95% confidence interval [CI]: 0.75-0.84] and 0.84 [95% CI: 0.79-0.88], respectively. Area under the curve for scoring system was 0.86 [standard error [SE] = 0.03] and 0.95 [SE = 0.02] for SR measurement. Sono-elastograohy has high accuracy in differentiating benign and malignant cervical LNs

Human autologous serum as a substitute for fetal bovine serum in human schwann cell culture

Nowadays, cell -based and tissue engineered products have opened new horizons in treatment of incurable nervous system disorders. The number of studies on the role of Schwann cells [SC] in treating nervous disorders is higher than other cell types. Different protocols have been suggested for isolation and expansion of SC which most of them have used multiple growth factors, mitogens and fetal bovine sera [FBS] in culture medium. Because of potential hazards of animal-derived reagents, this study was designed to evaluate the effect of replacing FBS with human autologous serum [HAS] on SC's yield and culture parameters. Samples from 10 peripheral nerve biopsies were retrieved and processed under aseptic condition. The isolated cells cultured in FBS [1st group] or autologous serum [2nd group]. After primary culture the cells were seeded at 10000 cell/cm[2] in a 12 wells cell culture plate for each group. At 100% confluency, the cell culture parameters [count, viability, purity and culture duration] of 2 groups were compared using paired t-test. The average donors' age was 35.80 [SD=13.35] and except for 1 sample the others cultured successfully. In first group, the averages of cell purity, viability and culture duration were 97% [SD=1.32], 97/33% [SD=1.22] and 11.77 [SD=2.58] days respectively. This parameters were 97.33% [SD=1.00], 97.55% [SD=1.33] and 10.33 days [SD=1.65] in second group. The difference of cell count, purity and viability were not significant between 2 groups [P>0.05]. The cells of second group reached to 100% confluency in shorter period of time [P=0.03]. The results of this study showed that autologous serum can be a good substitute for FBS in human SC culture. This can reduce the costs and improve the safety of cell product for clinical application

Functional outcome of flexor tendon repair of the hand at zone 5 and post operative early mobilization of the fingers

There are few reports on outcome following flexor tendon repair of the hand in zone 5. We hypothesized that early mobilization of the fingers is possible if the suture site of repaired tendon is strong enough. The aim of this study was to assess the results of flexor tendon repair in this zone using modified Kessler method reinforced by peripheral running suture and a post operative early active and passive mobilization of the fingers. This prospective study was carried out between April 2006 and Feb 2010, and 171 digits flexor tendons cut in 42 patients were repaired by modified Kessler technique reinforced by running peripheral suture. Early active mobilization and gentle passive motion of the fingers was allowed in a dorsal wrist splint the day after surgery. Wrist Immobilization was performed for one month. Function of the tendons was assessed by Buck-Gramcko score at nine month follow up. Mean age of the patients was 25.4 years [range 17-46 y]. Twenty nine flexor policis longus, 77 flexor digitorum superficialis and 65 flexor digitorum profundus tendons of digits were repaired. Middle and index fingers were most commonly involved. Median and ulnar nerve repair was done in 17 and 12 cases respectively. Good to excellent results were seen in of 79.34% of FPL and 74.65% of other finger flexors. One case of FPL rupture was seen. Tenolysis of FDS was performed in one case. Recovery in thenar muscle function was good, fair and poor in 5, 2 and 10 cases after median nerve repair, while all 12 patients with ulnar nerve lesion showed some degrees of clawing of 4[th] and 5[th] fingers. Most patients following flexor tendon repair at zone 5 obtained good results. Early motion of the fingers seems to improve outcome in these patients. Concomitant nerve cut in particular of ulnar nerve were associated with a high rate of poor results

Recurrent acute pancreatitis and cholangitis in a patient with autosomal dominant polycystic kidney disease

Autosomal dominant polycystic kidney disease [ADPKD] is an inherited disorder associated with multiple cyst formation in the different organs. Development of pancreatic cyst in ADPKD is often asymptomatic and is associated with no complication. A 38-year-old man with ADPKD was presented with six episodes of acute pancreatitis and two episodes of cholangitis in a period of 12 months. Various imaging studies revealed multiple renal, hepatic and pancreatic cysts, mild ectasia of pancreatic duct, dilation of biliary system and absence of biliary stone. He was managed with conservative treatment for each attack. ADPKD should be considered as a potential risk factor for recurrent acute and/ or chronic pancreatitis and cholangitis

Should we look for celiac disease among all patients with liver function test abnormalities?

Celiac disease [CD] has been found in up to 10% of the patients presenting with unexplained abnormal liver function tests [LFT]. As there is no precise data from our country in this regard, we investigated the prevalence of CD in patients presenting with abnormal LFT. From 2003 to 2008, we measured IgA anti-tissue transglutaminase [t-TG] antibody [with ELISA technique] within the first-level screening steps for all patients presenting with abnormal LFT to three outpatient gastroenterology clinics in Isfahan, IRAN. All subjects with an IgA anti-tTG antibody value of>10 ?/ml [seropositive] were undergone upper gastrointestinal endoscopy and duodenal biopsy. Histopathological changes were assessed according to the Marsh classification. CD was defined as being seropositive with Marsh I or above in histopathology and having a good response to gluten free diet [GFD]. During the study, 224 patients were evaluated, out of which, 10 patients [4.4%] were seropositive for CD. Duodenal biopsies were performed in eight patients and revealed six [2.7%] cases of Marsh I or above [four Marsh IIIA, two Marsh I], all of them had good response to GFD. The overall prevalence of CD among patients with hypertransaminasemia, autoimmune hepatitis, and cryptogenic cirrhosis was determined as 10.7% [3/28], 3.4% [2/59], and 5.3% [1/19], respectively. Serological screening with IgA anti-tTG antibody test should be routinely performed in patients presenting with abnormal LFT and especially those with chronic liver diseases including hypertransaminasemia, autoimmune hepatitis, and cryptogenic cirrhosis

Attitude toward plagiarism among Iranian medical faculty members

The goal of this study was to assess attitude towards plagiarism in faculty members of Medical School at Tehran University of Medical Sciences. One hundred and twenty medical faculty members of Tehran University of Medical Sciences were enrolled in this cross-sectional study. They were asked to answer to valid and reliable Persian version of attitude towards plagiarism questionnaire. Attitude toward plagiarism, positive attitude toward self-plagiarism and plagiarism acceptance were assessed. Eighty seven filled-up questionnaires were collected. Mean total number of correct answers was 11.6 +/- 3.1. Mean number of correct answers to questions evaluating self-plagiarism was 1.7 +/- 0.4 and mean number of correct answers to questions evaluating plagiarism acceptance was 1.4 +/- 0.2. There was no significant correlation between plagiarism acceptance and self-plagiarism [r=0.17, P=0.1]. It is essential to provide materials [such as workshops, leaflets and mandatory courses] to make Iranian medical faculty members familiar with medical research ethics issues such as plagiarism

Is routine duodenal biopsy necessary for the detection of celiac disease in patients presenting with iron deficiency anemia?

Iron deficiency anemia [IDA] is one of the well recognized presentations of celiac disease [CD]. According to the lack of data from our population in this regard, we determined the prevalence of CD in patients presenting with IDA to see if it is worthwhile to do a precise screening for CD in such patients. This cross-sectional study was conducted on patients referred with IDA to Poursina Hakim Gastroenterology Clinic, Isfahan [IRAN]. All included patients underwent upper gastrointestinal endoscopy and duodenal biopsy. Histopathological changes were assessed according to the Marsh classification. Also, patients were evaluated for IgA anti-tissue transglutaminase [t-TG] antibody with enzyme-linked immunosorbent assay [ELISA] technique. CD was defined as having Marsh II or above histopathology or being seropositive with Marsh I histopathology and having a good response to gluten free diet [GFD]. During the study, 130 patients with the mean age of 35.5 +/- 13.7 [67.7% female [20.4% post-menopausal]] were undergone seropathological studies. According to histopathological study and a clinical response to GFD, 13 patients [10%] were ultimately diagnosed with CD. Nine patients [6.9%] were seropositive, from which, five patients [3.8%] were ultimately diagnosed as CD cases. IgA anti-tTG became negative in all of these patients after six months of GFD. CD should be considered in any adult patient presenting with unexplained IDA, even if not accompanied with gastrointestinal symptoms. Routine duodenal biopsy performed during diagnostic upper gastrointestinal endoscopy is worthwhile in order to investigate for CD as an underlying cause of IDA in adult patients

Linguistic validation of the irritable bowel syndrome-quality of life questionnaire for Iranian patients

There is a growing interest of clinical and epidemiological researches in the field of functional gastrointestinal disorders in our society. Accordingly, validated and culturally adapted instruments are required for appropriate measurement of variables specially the quality of life. The aim of our study was the linguistic validation of the Irritable Bowel Syndrome-Quality of Life questionnaire [IBS-QOL] for Iranian IBS patients with Persian language. Following the standard forward-backward translation method, the IBSQOL was translated into the Persian language and completed by 141 IBS patients. Patients also completed the IBS Symptom Severity Scale [IBS-SSS] and Hospital Anxiety and Depression Scale [HADS]. One-week retest was performed on 30 randomly selected patients. Internal consistency and test-retest reliability were assessed using Cronbach's alpha and intraclass correlation coefficient [ICC], respectively. To analyze the discriminant validity, the IBS-QOL scores was correlated to the IBS-SSS and HADS scores. According to the results, reliability analyses were acceptable for all of the IBS-QOL domains [Cronbach's alpha=0.68 to 0.90 and ICCs=0.77 to 0.91]. Discriminant validity was supported by the presence of correlations of the IBS-QOL scores with disease severity [r=-0.628], depression [r=-0.692], and anxiety [r=-0.711] scores; P<0.001. These results indicate that the Persian version of the IBS-QOL is a reliable instrument with sufficient psychometric requirements to assess quality of life in Iranian IBS patients with Persian language

[Cost-effectiveness of homograft heart valve replacement surgery: an introductory study]

The clinical effectiveness of heart valve replacement surgery has been well documented. Mechanical and homograft valves are used routinely for replacement of damaged heart valves. Homograft valves are produced in our country but we import the mechanical valves. To our knowledge the cost-effectiveness of homograft valve has not been assessed. The objective of the present study was to compare the cost-effectiveness of homograft valve replacement with mechanical valve replacement surgery. Samples were selected from 200 patients that underwent homograft and mechanical heart valve replacement surgery in Imam-Khomeini hospital [2000 - 2005]. In each group we enrolled 30 patients. Quality of life was measured using the SF-36 health survey and efficacy was measured in QALYs. For each group we calculated the price of heart valve and hospitalization charges. Finally the cost-effectiveness of each treatment modalities were summarized as costs per QALYs gained. Forty males and 20 females participated in the study. The mean score of quality of life was 66.06 [SD= 9.22] in homograft group and 57.85 [SD= 11.30] in mechanical group [P< 0.05]. The mean QALYs gained in homograft group was 0.67 more than mechanical group. The incremental cost-effectiveness ratio [ICER] revealed a cost savings of 9,604,440 IRRials for each quality-adjusted life year gained in homograft group. Despite limitation of this introductory study, we concluded that homograft valve replacement was more effective and less expensive than mechanical valve. These findings can encourage healthcare managers and policy makers to support the production of homograft valves and allocate more recourse for developing such activities

[Electronic learning in medical education]

Medical education in Iran consists of undergraduate, postgraduate and continuing medical education [CME], like most other countries. Experts in medical education, in various meetings, recommended strategies to implement fundamental changes and improve medical education to alleviate current defects in medical education. One of the most important suggestions was to develop information technology in the field of medical education. Nowadays, most colleges in developed countries use online systems for communication with students, and also most courses are presented as online. These changes have been occurred in Iran, and medical schools of Iran have implemented electronic learning [E-learning] in their strategic planning. Efforts have been made in some universities to implement E-learning in CME courses. This may advance E-learning in medical education, especially in basic sciences. In this study, more than 50 international articles, 10 domestic articles and 80 websites related with E-learning in medical education were evaluated. Our findings showed that E-learning has been a routine program in world medical universities. Some Universities, such as North American Universities, have implemented E-learning in the education of all courses of basic sciences. Some Iranian Universities have set up CME programs in this topic, and have presented some courses as E-learning

Autologous in vitro expanded mesenchymal stem cell therapy for human old myocardial infarction

Stem cell transplantation after myocardial infarction has been claimed to restore cardiac function. Mesenchymal stem cells attract a lot of attention because of the feasibility of in vivo and ex vivo differentiation to cardiomyocytes and endothelial cells as well as their trophic effect on tissue repair. In this study, we investigated the efficacy of autologous bone marrow derived mesenchymal stem cells in improving heart function in patients with old myocardial infarction. Eight patients with old myocardial infarction and proper inclusion criteria were injected with mesenchymal stem cells at the time of coronary artery bypass grafting or percutaneous coronary intervention [test group] and compared with eight matched patients who received the same treatment without mesenchymal stem cell injection [control group]. Evaluation of heart function was done by echocardiography plus single-photon emission computed tomography before and six months after the procedure. Serial clinical examination was performed every month through New York Heart Association class. The mean New York Heart Association class and single-photon emission computed tomography scan results decreased significantly in the test group [P=0.000 and 0.002, respectively] and in the control group [P=0.049 and 0.007, respectively] after the procedure at six months follow-up. Left ventricular ejection fraction increased significantly in the test group [P< 0.005] but not in the control group. In comparison between the test and control groups the results of New York Heart Association class assessment and single-photon emission computed tomography demonstrated significant improvement in the test group [P=0.005 and 0.013, respectively]. There were no significant differences between the baseline variables in the two groups. In conclusion transplantation of ex vivo expanded bone marrow derived mesenchymal stem cell in patients with old myocardial infarction is a safe and feasible procedure. These cells improve the cardiac fimction without serious adverse effects

Subfascial endoscopic perforator vein surgery: the first report from Iran

Chronic venous stasis ulcers of the leg are still a challenge in vascular surgery. Innovation of new surgical techniques using endoscopic instruments have ushered in a new era with less complications and better results. This study was designed to evaluate the safety and long-term outcomes of this technique for the first time in Iran. Subfascial endoscopic perforator vein surgery was performed on 10 legs in 8 patients who had signs of chronic venous insufficiency [between September 2001 and September 2003]. Patients were followed up for a mean of period 12.5 months. The operations were performed successfully in all patients. No serious complications occurred intraoperatively. There was no mortality or significant morbidity. Complete healing of skin ulcers was observed in 5 active and 2 healed ulcers in less than 12 weeks. There were 2 recurrences after 4 and 27 months, respectively. Subfascial endoscopic perforator surgery is a safe procedure for the treatment of venous stasis ulcers. Rapid ulcer healing can be expected in selected patients