Shiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071633320080901Human Cytomegalovirus: Infections and Diagnosis12713239830ENMazyarZiyaeyanF.SabahiJournal Article20150510Human cytomegalovirus (HCMV) is a ubiquitous virus whose sole host is humans. Since HCMV can contagion from person to person through numerous ways, vast populations of humans are infected. HCMV infections can potentially have a range from asymptomatic infection in immuno-competent hosts to life-threatening diseases in organ recipients and patients with AIDS. The present article reviews the occurrence of HCMV infections and diseases in humans with different physiological and immunological status, and evaluates the existing laboratory methods for diagnosis of the diseasehttps://ijms.sums.ac.ir/article_39830_bb422e6476d2544e2123adaf9d144324.pdfShiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071633320080901Reliability of Persian Early Computed Tomography Score in Patients with Brain Infarction13313739831ENKavianGhandehariM.T.ShakeriMehdiMohammadifardA.R.EhsanbakhshMahyarMohammadifardA.R.MirgholamiJournal Article20150510Background: The one-third middle cerebral artery (1/3 MCA) method and Alberta Stroke Program Early Computed Tomography Score (ASPECTS) were used to detect significant early ischemic changes on brain computed tomography (CT) of patients with acute stroke. We designed the Persian Early CT Score (PECTS) and compared it with the above systems. Methods: The tomograms were chosen from the stroke data bank of Ghaem Hospital, Mashhad, in 2008. The inclusion criteria were the presence of MCA territory infarction and performance of CT within 6 hours after stroke onset. Axial CTs were performed on a third-generation CT scanner (Siemens, ARTX, Germany). Section thickness above posterior fossa was 10 mm (130 kV, 150 mAs). Films were made at window level 35 HU. The brain CTs were scored by four independent radiologists based on the ASPECTS, 1/3 MCA method, and PECTS. The readers were blinded to the clinical information except the symptom side. Cochrane Q and Kappa tests were used for statistical analysis. Results: Twenty four CT scans with sufficient quality were available. The difference in distribution of dichotomized ≤7 and >7 ASPECT scores between the four raters was significant; Q=13.071, df=3, P=0.04. The difference in distribution of dichotomized >1/3 and ≤1/3 MCA territory involvement between 4 raters was also significant; Q=13.5, df=3, P=0.004. Distribution of dichotomizedhttps://ijms.sums.ac.ir/article_39831_cf802e934aac875bf0190c9dec0850a0.pdfShiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071633320080901Low Dose, Short-Term Iron Supplementation in Female Blood Donors of Childbearing Age: a Randomized, Double-Masked, Placebo-Controlled Study13814339834ENS.M.MirrezaieR.ParsiS.A.TorabgahromiMehrdadAskarian0000-0003-4163-7414Journal Article20150510: Iron supplementation for blood donors is a controversial concept. However, to maintain regular blood donors, as a source of blood supply, the present paradigm is not appropriate and dose not prevent harms to blood donors. Methods: A randomized, double-masked, placebo-controlled study, was conducted by enrolling 95 female regular blood donors of childbearing age (18-49 years). The participants were selected randomly (systematic random sampling) from 300 donors who donated one unit of whole blood. These individuals were randomly assigned to receive 50 mg elemental iron or placebo once daily. Each donor was scheduled for serum ferritin determination at the beginning of the study, and 28th and 56th days after donation. Adverse effects of the treatment were evaluated on 7th, 28th and 56th days. Results: After one blood donation, mean serum ferritin concentration remained largely constant in the iron group on 28th day of the treatment, (P= 0.064) whereas it was lower in the placebo group (P= 0.001). There was no significant difference between the placebo and iron group in terms of the incidence of gastrointestinal adverse effects. Conclusion: The results of the present study indicate that short-term, low dose iron supplementation replace iron loss caused by phlebotomy, protect the female regular blood donors from iron deficiency, and assist retaining this group of donors for future donation.https://ijms.sums.ac.ir/article_39834_d603d2579c26d03759e747ccc6c12d1f.pdfShiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071633320080901CD7 Expression in Differentiating Mycosis Fungoides from Benign Cutaneous Lymphocytic Infiltrates14414939837ENF.Sari AslaniM.NaseriR.BoubA.MonabbatiJournal Article20150510Background: Diagnosis of the early phase of mycosis fungoides (MF) is sometimes difficult. Loss of CD7 expression is considered a distinguishing characteristic of MF. The aim of this study was to determine the range of CD7 expression in MF and compare the results with benign inflammatory dermatosis and equivocal cases of possible MF. Methods: During a period of 30 months, we examined 15 patients with MF, 12 patients suspicious for MF, and 15 patients with benign inflammatory dermatosis. The slides stained by H&E were reviewed by two pathologists. Immunostaining was done for CD43, CD3, CD5, CD7, and CD20 on paraffin embedded tissues. Results: All the patients in MF group showed absence of CD7 expression in epidermotropic mycosis cells. Compared with benign inflammatory dermatosis, patients with MF had significantly lower CD7 expression in the dermal infiltrate (p < 0.0001). In patients with MF, the mean CD7 was significantly lower than CD43, CD3, and CD5 (P=0.001). The mean CD7 count of parapsoriasis was significantly higher than MF (P= 0.01). The mean CD7 count of parapsoriasis was significantly lower than benign inflammatory dermatosis (P=0.016). The lowest mean CD7 counts were found in patch stage of MF. Low CD7 expression < 10 % lymphocytes had sensitivity and positive predictive values of 75% and 100% and specificity and negative predictive values of 100% and 83.3% for the diagnosis of patch stage of MF. Conclusion: Minimal expression of CD7 is a specific finding for patch stage of MF. Benign inflammatory dermatosis can also show low expression of this marker, but rarely matches that of patch stage of MF.https://ijms.sums.ac.ir/article_39837_dda675eb6f52318f00843113fe487bc0.pdfShiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071633320080901Tendon Expansion with Fascia Lata in Treatment of A-Pattern Strabismus due to Superior Oblique Overaction15015439839ENMohammad RezaTalebnejadM.H.NowroozzadehM.SharifiJournal Article20150510Background: In 1991, Wright described a superior oblique expander procedure for browns syndrome and superior overaction with good results. Originally, this procedure has been performed with silicone band expander. The aim of this study was to report the results of treatment of a series of patients with A-pattern strabismus associated with overacting superior oblique muscle using the fascia lata tendon expander technique. Methods: A total of 12 patients with bilateral overaction of the superior oblique muscle and A-pattern strabismus were treated with bilateral superior oblique lengthening with fascia lata according to the values recommended by Wright. Fascia lata was harvested through a lineal incision on the lateral aspect of the patients' thigh. Results: The follow-up was 4 to 51 months (mean, 28.8 ± 20.7 months). Mean superior oblique overaction improved from 3.5 ± 0.8 before surgery to 0.8 ± 0.9 after surgery (p <0.001). Mean A-pattern improved from 26.4 ± 8.5 PD to 1.7 ± 7 PD (p <0.001), and subjective intorsion improved from 6 ± 0.7 degree to 0.3 ± 1.1 degree (p <0.001). One patient developed overcorrection. None of the patients developed recurrence. Conclusion: The fascia lata tendon spacer is a useful procedure in the treatment of A-pattern strabismus due to superior oblique overaction. This technique may be superior to posterior tenectomy because of less incidence of superior oblique overaction recurrence; however, the operation time is longer.https://ijms.sums.ac.ir/article_39839_b5615df3c3c9b51dcb2ac5f5b7232327.pdfShiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071633320080901Impact of Bispectral Index Monitoring Versus Clinical Judgment as a Guide for Conduction of Anesthesia on Serum Cortisol Level in Co-ronary Artery Bypass Graft Surgery15515939840ENSh.ShahbaziRezaJouibarE.AllahyariA.H.ChohedriJournal Article20150510Background: Inadequate depth of anesthesia leads to release of stress hormones. Electroencephalographic monitoring by bispectral index is a guide to asses the depth of anesthesia. The aim of the present study was to measure the serum cortisol levels as an index of stress response in patients who are candidates for coronary artery bypass graft surgery in two groups of patients. Methods: Seventy-six patients who were scheduled for primary elective cardiopulmonary bypass were enrolled in a double–blind randomized study. The patients were divided into two groups. The infusion of anesthetic drugs was guided by bispectral index in group I (n=38), and by clinical judgment in group II (n=38). For all the patients the blood cortisol level was measured four times during operation. Results: Serum cortisol levels decreased during operation in both groups, reaching 67.8% of the baseline in group I and 63.2% of the baseline in group II. There were no significant differences in mean serum cortisol levels between the two groups (p <0.09). Preoperatively, the mean blood cortisol level was 19.94 mg/dl in group I and 16.89 mg/dl in group II which reached to 10.48 mg/dl in group I and 6.42 mg/dl in group II postoperatively. There was no significant difference between two groups regarding bispectral index values. Conclusions: It seems that monitoring of the patients by clinical judgment or bispectral index has equal influences on serum cortisol levels during coronary artery bypass graft surgery.https://ijms.sums.ac.ir/article_39840_b29fbaaf7d6e3770d5edad01f0a30dba.pdfShiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071633320080901The Comparison Between the Pregnancy Outcome after Easy Embryo Transfer and Difficult Embryo Transfer16016339841ENAliehTorabizadehN.MoosavifarJournal Article20150510Background: The role of embryo transfer (ET) in the success of in vitro fertilization/intra cytoplasmic sperm injection treatment is not well understood. In the present study we classified ET technique as difficult and easy types according to certain strict criteria, and compared the pregnancy outcome of the two ET types. Methods: This study was performed retrospectively on 295 infertile patients undergoing 308 embryo transfer cycles during May 2006-March 2007 in Mashhad IVF center.These cycles were divided into two groups. Group I had an easy embryo transfer (n=248) and group II had a difficult embryo transfer (n=60). The ET was considered as easy if the catheter insertion was successfully achieved without difficulty or needed slight manipulations of speculum or outer sheath of the catheter. ET was considered as difficult if slight maneuvers did not result in successful catheter insertion, tenaculum was used, or there was a need to use rigid catheters. Observation of beating fetal heart in a gestational sac of 6-7 weeks considered as positive pregnancy. Comparison of the pregnancy outcome between both groups was performed by using Student t test and Chi-square test. The results were shown as X2±SD. P value0.1). The total number of pregnancies was 55 (17.9%): 48 (19.4%) in group I and 7 (11.7%) in group II. The difference was not significant (P =0.163). Conclusion: Although the rate of positive pregnancy with easy ET was higher than difficult ET, there was no significant difference between the two groups (P =0.163). This may be due to the type of classification of easy and difficult, or fewer patients.https://ijms.sums.ac.ir/article_39841_9a417b57cba79b46e828cbdd342f0537.pdfShiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071633320080901Variation, Length and Width of Tendinous Portion of Palmaris Longus and Forearm Length and Height: Is there a link? A Cadaver Study of Adult Iranians16416839842ENMahmoodKarimi MobarakehM.Ghadi PashaM.Moaghari PoorJournal Article20150510Background: Palmaris longus (PL) is a muscle with marked variations. It is harvested as a tendon graft in many surgical proceduresin which a certain length of tendon is required. The aims of the present study were to determine the variations of this tendon in Iranian population and to find whether the length of PL tendon could be estimated by measuring the forearm length and height. Methods: We examined 128 forearms of 64 cadavers. We dissected out the tendons to measure their lengths and widths. The width of the tendon was measured at its proximal end. The forearm length and height were measured from the styloid process of the ulna to the tip of the olecranon with the forearm in neutral rotation. The height of cadavers were measured from crown to the heel in supine position. Results: The palmaris longus muscles were absent bilaterally in 5 (7.8%) and unilaterally in 14 (21.8%) cadavers. The overall prevalence of the absence of PL (unilateral or bilateral) was 29.6% (24 forearms of 19 cadavers). The mean length and width of the PL were 14.2 ± 6.3 mm and 12.8 ± 7.2 mm in males and 4.00 ± 1.9 mm and 4 ± 2.1 mm in females, respectively. The mean forearms length and cadavers' height were 29 ± 1.6 cm and 172.6 ± 9.1 cm in males and 28 ± 1.2 cm and 166.5 ± 8.9 cm in females, respectively. A significant correlation was found between the length of the tendon and forearm in both males (p <0.001) and females (p <0.001). In contrast, there was not statistically significant correlation between the forearm length and width of the tendon in either males or females (P=0.007 in males and females). Conclusions: The results of this study indicate that the length of palmaris longus tendon can be estimated based on forearm length. This estimation might be useful for surgical intervention.https://ijms.sums.ac.ir/article_39842_9c5763988a559e4bd571fea83c2a444e.pdfShiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071633320080901A Comparative Study on Using Coiled Versus Straight Swan-Neck Tenckhoff Catheters in Patients Undergoing Peritoneal Dialysis16917239832ENR.HekmatM.MojahediS.GharehJournal Article20150510The key to successful long-term peritoneal dialysis (PD) is permanent and safe access to peritoneal cavity. The two most commonly used Tenckoff catheters for PD are the straight and coiled catheters. The present study was undertaken to assess the catheter survival, catheter associated infections, and all cause mortality and to compare the straight with coiled catheters in PD. During April 1997-August 2006, 96 patients undergoing peritoneal dialysis in Ghaem Hospital, Mashhad, Iran were enrolled in this study. In 53 patients straight catheter and in 43 patients coiled catheter were used. The catheter survival, and catheter associated infections including peritonitis and exit site infection rate were compared between the two groups. The catheter survival in the two groups was in favor of coiled ones. Catheter associated peritonitis and exit site infection were more prevalent in patients with straight catheters (P=0.027 and P=0.006 respectively). Overall patient survival rate was not different between the two groups (P=0.919). There was no difference regarding tunnel infection between the two groups (P=0.673). Straight PD catheters were not associated with more overall patient morality rate but less catheter survival was noted in this group. In comparison with coiled PD catheters, peritonitis and exit site infection were seen more frequently in patients dialyzed using straight catheters. We found no difference regarding leakage episodes (P =0.562) or re-operation due to catheter malposition resulting in catheter salvage (P =0.26). Overall re-operation rate was not different between the two groups (P =0.732). Straight PD catheters were not associated with more patients' morality rate but had less catheter survival than coiled PD catheters. Peritonitis and exit site infection were found more frequently in patients dialyzed with straight catheters.https://ijms.sums.ac.ir/article_39832_a39951bcac38498a5c1597fbd19199fa.pdfShiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071633320080901Comparison of Enzyme Immunoassay, Immunochromatography, and RNA-Polyacrylamide-Gel Electrophoresis for Diagnosis of Rotavirus Infection in Children with Acute Gastroenteritis17317639835ENA.MomenzadehShahrzadModarresA.FarajiM.Motamedi RadA.Sohrabi1ShahabModarresL.AzarnoushH.MirshahabiJournal Article20150510Human rotavirus is a major etiologic agent for infantile diarrhea worldwide. It is responsible for up to 3.3 million deaths per year in children in developing countries. Various rapid and sensitive techniques have been developed to readily diagnose rotavirus gastroenteritis. In the present study, we compared the sensitivity and specificity of immunochromatography and RNA-polyacrylamide-gel electrophoresis (PAGE) methods with enzyme immunoassay (EIA) for diagnosis of group A rotavirus infection in 200 stool samples from children younger than 5 years old with acute gastroenteritis. Rotavirus was detected in 57 (28.5%) samples by EIA, 52 (26%) samples by ICG and 52 (26%) samples by RNA-PAGE. There was no significant difference between the three methods (P=0.8) nor between EIA and ICG (P=0.57) and EIA and RNA-PAGE (P=0.57). Furthermore, in comparing these methods with age variables, the present study found that the sensitivity and specificity of ICG and RNA-PAGE compared with EIA were 87.7%, 98.6% and 91.2%, and 100%, respectively (P>0.05). Results of the present study demonstrate that the sensitivity and specificity rates for ICG and RNA-PAGE were as high as EIA. It seems that all the three methods are reliable and suitable for detection of group A rotavirus infection in children affected by enteric diseases.https://ijms.sums.ac.ir/article_39835_32d1ee195964bad874563bc934a660c2.pdfShiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071633320080901Tick-Borne Relapsing Fever, a Neglected Cause of Fever in Fars Province17717939833ENGholam RezaPouladfar0000-0001-8676-4607A.AlborziB.PourabbJournal Article20150510Tick-borne relapsing fever is an endemic disease in some parts of Iran. Borellia persica, the most common cause of this disease in Iran, has a wide geographic distribution and is present in Alborz and Zagros mountain chains.Here we report a 16–year-old male patient who presented with two episodes of fever within 15 days. He had a history of few overnight stays in a cave of mountainous area in Fars province. Sites of tick bites were found on exposed areas of extremities. Spirochetes were detected in Wright-stained smears of the patient's peripheral blood. He was successfully treated with penicillin. To the best of our knowledge, there has been no reported case of tick-borne relapsing fever from Fars province in the literature during the last 28 years.Tick-borne relapsing fever should be considered in patients with recurrent fever and peripheral blood smear should be investigated for spirochetes. Further seroepidemiologic studies should be carried out to determine the prevalence of this disease in Fars province.https://ijms.sums.ac.ir/article_39833_b105799ae23b43ca74298b4889fbb6b9.pdfShiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071633320080901Free Perforation of Sigmoid Colon Secondary to Invasive Mucormycosis in a Critically Ill Patient18018239836ENRostamFarhadiehA.SalardiniJournal Article20150510Mucormycosis is a clinical entity attributed to opportunistic fungal infection of order Mucorales. This includes several pathogenic subtypes. It commonly affects the rhinocerebral sites and the immunocompromized patients with devastating results. Visceral mucormycosis is a relatively rare complication. We report the first free sigmoid colon perforation secondary to invasive mucormycosis and discuss the risk factors, methods of diagnosis, and pathogenesis of this clinical entity.https://ijms.sums.ac.ir/article_39836_62a4abd2c13619f663fdad58abf55410.pdfShiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071633320080901Periodontal Pockets as a Potential Source of Infection: a Case of Possible Odontogenic Septic Pulmonary Embolism18318639838ENSayyed GholamrezaMortazavimoghaddamJournal Article20150510Although dental foci can be sources of bacteremia and bacterial endocarditis, hematogenous spread of infection presented with septic pulmonary embolism apparently is rare. The occurrence of septic pulmonary embolism in patients with periodontal disease without suppurative thrombophlebitis of the great vessels of the neck is well documented but to our knowledge, there is no report on septic pulmonary embolism in immunocompetent patients following root canal treatment. Here in we present a 42-year-old man who referred to our hospital because of fever, left sided pleuritic chest pain, and scanty productive cough. Chest radiography and computed tomography revealed multiple nodular shadows with features characteristic of septic pulmonary embolism. His medical history revealed dental care clinic visit and root canal treatment 2 weeks earlier. In the present case, the results of extensive investigations were negative for other potential causes of septic pulmonary embolism and dental pocket was considered to be the only possible source for the disease.https://ijms.sums.ac.ir/article_39838_c3df0f37bded6ea9e5ef61864c914476.pdf