Atomic force microscopy (AFM) is a three-dimensional topographic technique with a high atomic resolution to measure surface roughness. AFM is a kind of scanning probe microscope, and its near-field technique is based on the interaction between a sharp tip and the atoms of the sample surface. There are several methods and many ways to modify the tip of the AFM to investigate surface properties, including measuring friction, adhesion forces and viscoelastic properties as well as determining the Young modulus and imaging magnetic or electrostatic properties. The AFM technique can analyze any kind of samples such as polymers, adsorbed molecules, films or fibers, and powders in the air whether in a controlled atmosphere or in a liquid medium. In the past decade, the AFM has emerged as a powerful tool to obtain the nanostructural details and biomechanical properties of biological samples, including biomolecules and cells. The AFM applications, techniques, and -in particular- its ability to measure forces, are not still familiar to most clinicians. This paper reviews the literature on the main principles of the AFM modality and highlights the advantages of this technique in biology, medicine, and- especially- dentistry. This literature review was performed through E-resources, including Science Direct, PubMed, Blackwell Synergy, Embase, Elsevier, and Scholar Google for the references published between 1985 and 2010.
Atomic force microscopy; Scanning tunneling microscopy; Scanning probe microscopy; Dental; Biological
Background: Various regions in Iran, especially the Khuzestan Province, have been covered by dust and dirt during the past two years due to environmental changes in the Middle East. We sought to evaluate the effect of these pollutants on the coagulant factors of people residing in Abadan and Khoramshahr, two major cities of Khuzestan Province.
Methods: One hundred twenty-nine healthy individuals were enrolled into this study, and their prothrombin time as well as fibrinogen, platelet, and Factor VIII levels were measured before and after climate changes.
Results: After climate changes, the mean prothrombin time decreased, while the fibrinogen, platelet, and Factor VIII levels rose.
Conclusion: The results of this study suggest that the pollutants deployed in the Middle East can affect prothrombin time as well as fibrinogen, platelet, and Factor VII levels considerably and increase coagulant state. The pollutants can, consequently, increase the risk of cardiovascular diseases. It seems that cooperation at government levels between Iran and its neighboring countries is required to reverse desertification and avoid inaccurate usage of subterranean water resources so as to lessen air pollution.
Air pollution; Prothrombin time; Middle East
Background: For all the reports on the association between seasons and coronary artery disease, there is a paucity of information on the possible effects of seasonal variations on the outcome of patients after coronary artery bypass grafting surgery (CABG). The aim of this study was to assess the short-term outcome of post-CABG patients in the four different seasons to find any correlation between seasonal variations and the outcome of such patients.
Methods: Data on patients who underwent cardiac surgery between 2007 and 2009 were analyzed. In-hospital mortality, length of Intensive Care Unit (ICU) stay, and length of hospital stay in the four different seasons were considered as outcome measures. The EuroSCORE was calculated for all the patients, and the Kruskal-Wallis, Mann-Whitney, Student t, and chi square tests were used as appropriate.
Results: Of a total of 402 patients, who underwent CABG during the mentioned period, 292 patients were male (M/F ratio=2.65). There were no differences in terms of mean age, sex ratio, and mean EuroSCORE of the patients between the seasons. The mean length of ICU stay was significantly more in the spring than that of the other seasons (P<0.001), while the difference between the four seasons regarding the mean length of hospital stay did not constitute statistical significance (P=0.22). No effect of seasonal variations was found for the lengths of ICU and hospital stay in the presence of the EuroSCORE after multiple logistic regression analysis (P=0.278, 0.431).
Conclusion: Psychological mood changes caused by regional cultural differences rather than environmental factors should be considered in the optimal management of patients after CABG.
Coronary artery bypass graft; Seasonal variations; Iran
Background: To assess the therapeutic effects of oral zinc supplementation on acute watery diarrhea of children with moderate dehydration.
Methods: All 9-month to 5-year-old children who were admitted with acute watery diarrhea and moderate dehydration to the Children Ward of Motahari Hospital, Urmia, Iran in 2008 were recruited. After the application of the inclusion and exclusion criteria, the patients were randomly allocated to two groups: one group to receive zinc plus oral rehydration solution (ORS) and the other one to receive ORS plus placebo. All the patients were rehydrated using ORS and then receiving ORS for ongoing loss (10 ml/kg after every defecation). Additionally, the patients in the intervention group received zinc syrup (1 mg/kg/day) divided into two doses. A detailed questionnaire was filled daily for each patient by trained pediatrics residents; it contained required demographic characteristics, nutrition and hydration status, and disease progression. The primary outcome (frequency and consistency of diarrhea) and the secondary outcomes (duration of hospitalization and change in patients’ weight) were compared between the two groups.
Results: The mean diarrhea frequency (4.5±2.3 vs. 5.3±2.1; P=0.004) was lower in the group receiving zinc +ORS; however, the average weight was relatively similar between the two groups (10.5±3.1 vs. 10.1±2.3; P=0.14). The qualitative assessment of stool consistency also confirmed earlier improvement in the treatment group in the first three days of hospitalization (P <0.05). The mean duration of hospitalization was significantly lower in the patients receiving zinc supplements (2.5±0.7 vs. 3.3±0.8 days; P=0.001).
Conclusion: Our results imply the beneficial effects of therapeutic zinc supplementation on disease duration and severity in patients with acute diarrhea and moderate dehydration in Iran.
Trial Registration Number: IRCT201201241580N2
Zinc; Diarrhea; Dehydration; Children; Acute gastroenteritis
Background: In addition to the well-defined histological criteria for squamous cell carcinoma (SCC) and basal cell carcinoma (BCC), immunohistochemical techniques can be used in difficult cases for their differentiation. As differential diagnosis between trichoepithelioma (TE) and BCC is sometimes difficult for the clinician and the pathologist, CD10 may be a useful marker for definite diagnosis. We aimed to evaluate the usefulness of this marker in the differentiation between SCC and BCC and also in the differentiation between BCC and TE.
Methods: Fifty-five BCC cases, 50 SCC cases, and 20 cases of benign adnexal tumor with follicular differentiation were retrieved from the archives of the pathology departments of hospitals affiliated with Shiraz University of Medical Sciences. Immunohistochemistry for CD10 was performed on the sections obtained from formalin-fixed, paraffin-embedded blocks. CD10 immunoreactivity in the stroma and/or tumor cells was determined as follows: negative (0); 1+(10-50% positive cells); and 2+(>50% positive cells).
Results: Comparison of CD10 expression between the BCC and SCC groups showed a significant difference (P<0.001) in each of the tumor and stromal cells. Comparison of CD10 expression between the BCC and TE groups demonstrated a significant difference in both the tumor and stromal cells (P<0.001). There was no significant difference in CD10 expression between the stromal and tumor cells of the BCC subtypes.
Conclusion: CD10 is a useful adjunct marker in distinguishing TE from BCC. CD10 is suggested to be one of the useful immunohistochemical markers to differentiate BCC from SCC.
Squamous cell carcinoma; Basal cell carcinoma; Trichoepithelioma
Background: The glycoconjugate content of sperms indicates their physiological and fertility properties. Lectin reactivity is indicative of intact, capacitated, and acrosome-reacted sperms. In the epididymis, sperms experience maturation, glycoconjugate modification, and simultaneously, higher L-carnitine (LC) concentrations. The aim of this project was to evaluate the effects of LC and Pentoxifylline (PF) on the integrity, capacitation, and acrosomal reaction of sperms by studying their lectin reactivity.
Methods: Mouse testicular sperm samples were divided into three parts. Each sample was added Ham’s F10 (control) or media containing 1.76 mM LC or PF. At 30 and 90 minutes after incubation, sperm motility was assessed. Peanut agglutinin (PNA), wheat germ agglutinin (WGA), and Concanavalin A (Con A) were used to detect non-acrosome-reacted, non-capacitated, and acrosome-reacted sperms, respectively and the frequency was evaluated by flow cytometry. Statistical analysis was performed using the ANOVA.
Results: Sperm motility increased after 30 and 90 minutes of incubation in the LC- and PF-treated cultures (P=0.001). LC administration created a significant increase in the percentage of the non-acrosome-reacted sperms compared to the control sperms after 30 and 90 minutes (P=0.02 and P=0.03, respectively). The frequency of the non-capacitated sperms in the LC-treated group increased compared to the control sperms after 30 minutes significantly (P=0.01).
Conclusion: Although the administration of LC and PF enhanced sperm motility, LC also impacted glycoconjugates on the sperm surface. Glycoconjugates are involved in the interaction between the sperm and the zona pellucida and subsequently fertilization, thereby probably influencing the male fertility state.
Glycoconjugates; Spermatozoa; Lectin; L-carnitine; Pentoxifylline
Background: There have been some reports about the possible N-methyl-D-aspartate (NMDA) antagonist activity of Guaifenesin. As drugs with a similar structure to Guaifenesin (i.e. Felbamate) and those with NMDA antagonist activity have been clinically used as anticonvulsants, the aim of this study was to determine whether Guaifenesin has an anticonvulsant effect in an animal model of seizure.
Methods: Anticonvulsant effect of Guaifenesin was assessed via Pentylenetetrazol (PTZ)-induced convulsion. Male albino mice received Guaifenesin (100, 200, 300, or 400 mg/kg; n=8-10) or 0.25% Tween (vehicle) intraperitoneally 30 minutes before the injection of PTZ (95 mg/kg). Diazepam (3 mg/kg; n=8) was used as a reference drug. The latency time before the onset of myoclonic, clonic, and tonic-clonic convulsions, percentage of animals exhibiting convulsion, and percentage of mortality were recorded. In addition, the effect of Guaifenesin on neuromuscular coordination was assessed using the Rotarod.
Results: Guaifenesin at all the studied doses significantly increased the latency to myoclonic and clonic convulsions in a dose-dependent manner. In addition, Guaifenesin at the dose of 300 mg/kg increased the latency to tonic-clonic seizure. The ED50s of Guaifenesin for protection against PTZ-induced clonic and tonic-clonic seizures and death were 744.88 (360-1540), 256 (178-363), and 328 (262-411) mg/kg, respectively. Guaifenesin at all the investigated doses significantly reduced neuromuscular coordination, compared to the vehicle-treated group.
Conclusion: These results suggest that Guaifenesin possesses muscle relaxant and anticonvulsant properties and may have a potential clinical use in absence seizure.
Guaifenesin; Anticonvulsant; Pentylenetetrazol
The gold standard to assess jaundice in neonates is the serum bilirubin measurement. Blood sampling for the determination of total serum bilirubin (TSB) is painful for newborns and stressful for parents. The Bilicheck®, a new transcutaneous bilirubinometer, is considered as a more accurate measurement of bilirubin compared to the previous bilirubinometers courtesy of its advanced technology. The objective of this study was to evaluate the correlation between transcutaneous bilirubin (TcB) measurements using the Bilicheck® device and TSB in some Iranian neonates and to determine the most reliable cut-off value with the highest sensitivity and desirable specificity for bilirubin measured by the Bilicheck® on the forehead. This prospective observational study was conducted in 2011 on 560 healthy neonates with jaundice. TcB was measured using the Bilicheck® (Respironic, USA) within 30 minutes of TSB measurement via direct spectrophotometry. The results were assessed by simple linear regression analysis and receiver operative characteristic curve. There was good a correlation between TcB and TSB (r=0.969, r2=0.94), and this was not affected by sex, gestational age, postnatal age, and birth weight. TSB can be calculated through the measurement of TcB and use of the linear regression equation: TSB=-0.99+1.06TcB. Sensitivity and specificity of the Bilicheck® at the most reliable cut-off value (15 mg/dl) were 96.6% and 99%, respectively. The findings of the present study indicate that the Bilicheck® is a non-invasive, simple, easy, and reliable method for bilirubin measurement in neonatal jaundice, especially in neonates with bilirubin levels ≤15 mg/dl.
Neonatal jaundice; Hyperbilirubinemia; Transcutaneous
We encountered a 55-year-old man, who presented with an orifice in the suprapubic region, through which fecal material was discharged. On physical examination, the patient was unstable. After resuscitation, thorough evaluation, and laboratory and imaging investigations, he underwent an exploratory laparotomy. The ileum was entrapped at the deep inguinal ring, and there was some pus in the pelvic cavity. The purulent material was cleaned, and anastomosis was done after the resection of the defective ileal segment. In view of the rarity of this presentation and the paucity of published articles, this case is reported here.
Inguinal ring; Hernia; Cellulitis
Reactive airway dysfunction syndrome (RADS) is a type of non-immunologically mediated asthma-like disease. It usually occurs after a massive exposure to an irritating substance in the atmosphere in the form of smoke, fumes, gases, and vapor. Unlike bronchial asthma, there is no latency to the symptoms seen in RADS. A number of agents are known to cause RADS, but tile dust, as an etiological agent, has not been previously reported. We report a 45-year-old male laborer, who presented with an acute onset of cough, chest tightness, breathlessness, and audible wheeze after his first time exposure to porcelain tile dust within 5 hours of exposure. Lab tests, including, chest X-ray, electrocardiogram, air blood gas analysis, and serum IgE, were unremarkable. Spirometry showed a mild obstruction [forced expiratory volume in 1 second (FEV1)=72% of predicted], while the bronchodilator reversibility test was significant(14% increase in FEV1 above the baseline).Bronchial biopsy revealed a chronic inflammatory reaction with lymphocytic and plasma cell infiltration and more importantly a striking absence of eosinophils. To the best of our knowledge, this is the first reported case of RADS as a result of exposure to tile dust (porcelain ceramics).
Porcelain; Dust; RADS
The prevalence of inflammatory bowel diseases (IBDs) is set to stabilize in Western Europe and North America, as opposed to its increasing trend in developing countries in Asia. The epidemiology of IBDs in areas where the incidence and prevalence are relatively low provides an opportunity for researchers to determine the unknown aspects of them. In this review article, the PubMed and MEDLINE databases were searched from 1970 to 2012 and the epidemiological aspects assessed in Iranian articles were compared with identical subjects in other Asian countries. During this period, there were 21 documented articles on IBD epidemiology in Iran and 52 in Asia. According to the present review, CTLA-gene polymorphism and male/female ratio in ulcerative colitis (UC), incidence of extra-intestinal manifestations, extent of intestinal involvement, and family history in both UC and Crohn’s disease (CD) seemed to be different between Asia and Iran. In contrast, the incidence of primary sclerosing cholangitis in IBD patients and association between NO2/CARD15 mutation and CD as C3435-T allele and UC were nearly the same. The rate of IBD has increased significantly in Iran, as has that of other Asian countries during the last decade. A thorough, well-designed, population-based, multi-regional epidemiologic study seems mandatory due to the substantial demographic and characteristic variability in IBD patients in our region.
Inflammatory bowel disease; Epidemiology; Prevalence; Iran
Background: Intravenous Valproate (IVVP) has been used in the treatment of migraine in some studies; however, it is far better known in the management of status epilepticus.
Methods: Consecutive patients with migraine in our Headache Clinic were enrolled in this prospective, randomized clinical trial in 2011. The patients were randomized into two therapeutic groups, one receiving 900 mg IVVP (Orifil) and the other 16 mg IV Dexamethasone (IVDEX) diluted in 150 CC normal saline and infused for 10 minutes. Worst severity of pain before treatment and least severity at 3 hours after the infusion using a 0-10 point numeric rating scale were recorded. An interview with the patient was performed 72 hours after treatment to detect a possible relapse of headache.
Results: Thirty-one migraine status patients, comprising 28 women and 3 men at a mean±SD age of 33.355±12.373 SD, were investigated. Differences in the therapeutic effects of IVVP (Orifil) and IVDEX on pain score were not significant between the two groups (t=0.933, df=29; P=0.358). Relapse of headache occurred in 68.42% of the IVVP (Orifil) group and 66.67% of the IVDEX group. Distribution of relapse was not significantly different between the two therapeutic groups of patients (P=0.870).
Conclusion: IVVP (Orifil) was similar in efficacy to IVDEX as abortive therapy in patients with migraine status. IVVP (Orifil) appears to offer a safe and well-tolerated abortive treatment.
Trial Registration Number: IRCT13891146234N2
Valproic acid; Dexamethasone; Migraine disorders
Background: Geographical distribution of zoonotic cutaneous leishmaniasis (ZCL) has continuously been extended in recent years in Iran. The Beiza District is one of the newly-emerged endemic foci of ZCL in southern Iran. The main aim of the present study was to detect the vector(s) of ZCL in this area.
Methods: To detect the fauna and vectors of ZCL in this district, sand flies were caught using sticky papers. Seventy randomly selected female sand flies out of 730 were molecularly investigated for Leishmania infection using species-specific nested polymerase chain reaction (PCR) assay between April and October 2010.
Results: A total of 2543 sand flies were caught. The fauna was identified as 10 species (five Phlebotomus spp. and five Sergentomyia spp.). Phlebotomus papatasi was the most dominant species both indoors and outdoors (37.55% and 16.35 %, respectively). L. major was detected in 5 out of 48 investigated Phlebotomus
papatasi (10.41%). Sequence-based characterization was carried out to confirm the PCR findings. The positive samples were shown to have 75-88% similarity with L. major sequences in GenBank.
Conclusion: According to the findings of the present study, similar to the other foci of ZCL in Iran, P. papatasi is the proven and primary vector of CL. This study could be drawn upon for future strategy planning in this newly emerged endemic focus.
Leishmaniasis; PCR; Sand flies; Phlebotomus papatasi; Leishmania major; Iran
Background: It was hypothesized that the use of Pentoxifylline would increase arterial O2 saturation and increase exercise tolerance in patients with Chronic Obstructive Pulmonary Disease (COPD).
Methods: We tested this hypothesis in 23 patients with COPD and pulmonary hypertension. Patients were randomized to receive Pentoxifylline or placebo, each for a 12-week period, in a prospective, double-blind study to assess the effects of Pentoxifylline on oxygen saturation and exercise tolerance via pulse oximetry and the 6-Minute Walk Test (6MWT).
Results: At the end of the 12 weeks, the six-minute walk distance rose from 351.9±65 meters to 393±67 meters in the Pentoxifylline group (10 patients) and increased from 328±79 meters to 353±66 meters in the placebo group (10 patients) (P=0.142). Resting oxygen saturation by pulse oximetry changed from 87±4% to 85±14% in the Pentoxifylline group and from 88±3% to 88±2% in the placebo group (P=0.676). There were no significant changes in dyspnea severity index and heart rate before and after the 6MWT.
Conclusion: Pentoxifylline does not seem to improve exercise capacity and dyspnea in patients with severe and very severe COPD.
COPD; Oxygenation; Pentoxifylline
Background: We sought to determine the clinical characteristics of pediatric esophagitis in southern Iran.
Methods: This cross-sectional study was conducted over a 4-year period, from 2005 to 2009, in Nemazee Hospital, a tertiary healthcare center in Shiraz, southern Iran. We consecutively included all pediatric patients (<18 years) who underwent endoscopy in our center and had pathology-confirmed diagnosis of esophagitis. Data regarding the patients’ demographic characteristics, comorbidities, and clinical findings were recorded using a questionnaire. All the patients underwent upper gastrointestinal endoscopy and biopsy of the esophagus, and the findings were recorded in the questionnaire.
Results: We studied 125 children, comprising 61 (48.8%) girls and 64 (51.2%) boys at a mean age of 6.6±5.5 years. Repeated vomiting was the prominent symptom in our series, with it being reported by 75 (60%) patients, followed by fever in 35 (28%). Erythema (33.6%), esophageal ulcer (11.2%), and whitish patch (8.0%) were the most common endoscopic findings, while reflux esophagitis (32.8%), chronic (6.4%) and acute esophagitis (5.6%), and candida esophagitis (5.6%) were the most common histological diagnoses. Only one (0.8%) patient was diagnosed as having eosinophilic esophagitis, aspergillosis, and graft-versus-host disease.
Conclusion: Reflux was the most common cause of esophagitis in the pediatric population of southern Iran. Contrary to previous reports, the prevalence of eosinophilic esophagitis was far less than that estimated, while the prevalence of opportunistic infections was higher secondary to post-liver transplantation immunosuppression.
Esophagitis; Pediatrics; Reflux esophagitis; Eosinophilic esophagitis; Iran
Background: Movement dysfunction may be expressed in terms of symptoms experienced in non-physiological postures, and head-down crooked kneeling (HDCK) is a posture frequently assumed by Muslims during prayer activities. The purpose of this study was to investigate the cardiovascular responses in the HDCK posture.
Methods: Seventy healthy volunteers, comprising 35 males and 35 females, participated in the study. Cardiovascular parameters of blood pressure and pulse rate of the participants were measured in rested sitting position and then at one and three minutes into the HDCK posture. Two-way ANOVA was used to determine the differences between cardiovascular responses at rest and in the HDCK posture, and the Student t test was utilized to determine gender difference in cardiovascular responses at rest and at one and three minutes into the HDCK posture.
Results: The study showed a significant decrease in systolic and diastolic blood pressures at one minute into the HDCK posture and an increase in pulse rate at one and three minutes into the HDCK posture, as compared to the resting values. Rate pressure product also rose at one minute into the HDCK posture, whereas pulse pressure increased at one and three minutes into the HDCK posture, as compared with the resting values. However, no significant change was observed in the mean arterial pressure values.
Conclusion: The findings from this study suggest that no adverse cardiovascular event can be expected to occur for the normal duration of this posture during Muslim prayer activities.
Cardiovascular system; Head-down; Muslim; Prayers
Background: Despite the medical discoveries of different medicines and advanced ways of treatment, statistics have shown that the number of patients is increasing. This may be due to chemical drugs used in healthcare, agriculture, and diets. This soaring demand in medicines urges us to look for natural sources such as aromatic plants and essential oils, which are rich in efficient compounds.
Methods: Extraction of essential oils was performed using a Clevenger-type apparatus. Identification was achieved using the GC-FID technique. Confirmation was made using the GC-MS technique, and isolation was done using a preparative HPLC, equipped with an aliquots collector. The microdilution broth susceptibility assay was utilized to determine minimum inhibitory concentrations (MICs).
Results: Our in vitro study demonstrated the antibacterial activity of the Thymus syriacus Boiss essential oil and its components against the tested isolates at levels between 0.375 and 50 µl/ml. The main components of the T. syriacus essential oil were carvacrol, γ-terpinene, and ß–caryophyllene. MIC90 values for the T. syriacus essential oil against the gram-negative organisms varied between 3.125 and 12.5 µl/ml. The most effective components against the gram-negative bacteria were thymol, carvacrol, dihydro-carvon, and linalool respectively.
Conclusions: The T. syriacus essential oil and some of its components exhibited very good inhibitory effects against Syrian gram-negative isolates.
Essential oils; Gram-negative bacteria; Minimum inhibitory concentration
Polycystic ovary syndrome (PCOS) has been suggested to be linked with autoimmune processes. Laparoscopic ovarian electrocauterization has the potency to stimulate more autoimmune reactions in PCOS patients. In the present study, we considered anti-nuclear antibodies (ANAs) as the hallmark of autoimmune reactions, and investigated the serum level of these antibodies in 35 patients with PCOS (21-38 years old) pre and one-month after electrocauterization, and in 35 fertile healthy women (25-35 years old) as the control group. Serum levels of ANAs, as well as ANA subtyping, were investigated using the Enzyme-Linked Immunosorbent Assay (ELISA). While 3 out of the 35 patients (8.6%) were positive for ANAs before electrocauterization, none of the controls was positive. The number of ANA-positive cases increased following electrocauterization (3 out of 35 [8.6%] before vs. 10 out of 35 [28.6%] after the procedure). The main ANA subtype in the positive samples was SS-A. The higher ANA level among the PCOS patients suggests association of the disease with autoimmune reactions. Laparoscopic ovarian electrocauterization seems to increase the number of positive-ANA patients.
Anti-nuclear autoantibodie; Polycystic ovary syndrome; Laparoscopic ovarian
The Witkop syndrome is a rare autosomal dominant disorder characterized by the absence of several teeth and abnormalities of the nails. This is the first report of a rare genetic tooth and nail syndrome diagnosed in a 2.5-year-old boy with early exfoliation of the primary canine, absence of the primary incisors, and nail dysplasia. A homozygous mutation was identified in 3’-UTR of MSX1 gene in the proband. The parents of the patient had no dental and nail anomalies.
Witkop syndrome; MSX1; Nail dysplasia
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe adverse cutaneous reactions to drugs. We describe the case of a 19 year old patient with SJS/TEN overlap syndrome, who developed severe interstitial pneumonia after she had received antiepileptic drugs. A cytomegalovirus infection was diagnosed by Real Time Polymerase Chain Reaction (RT-PCR) detection on Bronchoalveolar lavage. Based on observations on biological data, temporal relationship, and clinical features, it could be inferred that the reactivation of cytomegalovirus with viral replication can predispose a person to TEN-SJS. We discuss here, in the light of the current literature, the probable association between drug-induced SJS-TEN and fulminant reactivation of cytomegalovirus.
Stevens-Johnson syndrome; Toxic epidermal necrolysis; Cytomegalovirus; Pneumonia
Deficiency of vitamin B12 and/or folic acid as a cause of pyrexia, though known, is rarely reported in literature. We aimed to report a case in a 51 year old woman, who presented with fever and pancytopenia and was diagnosed to have megaloblastic anemia secondary to vitamin B12 and folate deficiency. The pyrexia subsided following the intramuscular injection of vitamin B12 and oral folic acid administration. All the other infective, inflammatory/autoimmune, endocrine causes of pyrexia were excluded by appropriate investigations. Therefore, we suggest that all physicians be aware of megaloblastic anemia as a treatable cause of pyrexia in order to avoid unnecessary costly investigations and antibiotic usage.
Megaloblastic anemia; Pyrexia; Vitamin B12; Folic acid
Echocardiography is a non-invasive diagnostic technique which provides information on cardiac morphology, function, and hemodynamics. It is the most frequently used cardiovascular diagnostic test only after electrocardiography. In less than five decades, the evolution in this technique has made it the basic part of cardiovascular medicine. Herein, the evolution of various forms of echocardiography is briefly described.
Echocardiography; Cardiac imaging; Evolution
Background: Oral lichen planus is a chronic inflammatory disease with a poorly understood etiology. The role of angiogenesis in the development of different chronic inflammatory diseases is of great concern. Vascular endothelial growth factor (VEGF) is an important regulator of angiogenesis. We aimed to evaluate the serum level of VEGF in patients with oral lichen planus compared with normal individuals and consider its clinical significance.
Methods: In this case-control study, 36 serum samples from patients diagnosed with oral lichen planus admitted to the Oral Medicine Department of the School of Dentistry at Shiraz University of Medical Sciences (14 men, 22 women, mean [±SD] age: 38.8 [±6.07] years) and 23 serum samples from healthy individuals (9 men, 14 women, mean [±SD] age: 38.7 [±4.9] years) were collected. VEGF concentration was measured using the ELISA method. The Mann-Whitney test was used for statistical analysis.
Results: The serum VEGF level was significantly higher in patients with oral lichen planus compared with the healthy controls (112.97 [±63.2] vs. 66.21 [±56.2] ngr/ml, P<0.001). A similar difference was also observed between the two types of oral lichen planus, being more pronounced in the erosive form (P<0.001).
Conclusion: Serum VEGF can be used as a useful and suitable marker to scrutinize the disease activity.
Oral lichen planus; Vascular endothelial growth factor; Serum