TEHRAN UNIVERSITY MEDICAL JOURNAL (TUMJ)
Year:2007 | Volume:65 | Issue:12|Papers Count:19

Cervical cancer is the second most common gynecologic cancer. A steady 70% annual decline in mortality from cervical cancers has been observed since the mid 20th century after the introduction of widespread papanicolaou cytological screening. But also cervical cancer continues to be an important world health problem for women. Cervical cancer is one of the best- understood neoplasms given its well known viral cause of persistent infection with high risk human papillomavirus (HPV). To date, two manufacturers have developed HPV vaccines composed of noninfectious, recombinant HPV viral-like particles (VLPs). This article presents current advances and perspectives on HPV vaccines.The vaccine is administered by intramuscular injection, and the recommended schedule is a 3-dose series with the second and third doses administered 2 and 6 months after the first dose. The recommended age for vaccination of females is 11-12 years. Vaccine can be administered as young as age 9 years. Catch-up vaccination is recommended for females aged 13-26 years who have not been previously vaccinated. Vaccination is not a substitute for routine cervical cancer screening, and vaccinated females should have cervical cancer screening as recommended.

Background: Job stressors in managers are progressively affecting and destroying their immune systems. The relationship between hardiness, stress and immune system is important for mental health. This study was designed to determine the resources in managers against stress, resources herein designated as “hardiness” and “social support". Also in this research, the correlation between hardiness, defined collectively as feelings of challenge, commitment and control, as a resource against stress and the immune system of high school managers in Khozestan Province were studied.Methods: The study sample was comprised of 340 managers (male and female), selected by the cluster sampling method. Each subject completed the personal view survey scale and social support questionnaire. Then the individuals were divided into four groups (n= 35 in each group) of high and low hardiness and social support as follows: high hardiness / high social support, high hardiness / low social support, low hardiness / high social support and low hardiness / low social support. Subjects who suffered from disorders that affect the immune system were excluded. The number of Thelper cells (CD4), T-suppressor cytotoxic cells (CD8), natural killer cells (CD56+ CD16), complement system (C3, C4, CH50), immunoglobulin M and G (IgM and IgG), cortisol hormone, eosinophils, neutrophils and lymphocytes were measured for each subject.Results: The results revealed that, there was a significant positive correlation between hardiness and CD4, CD4/CD8, CD56, CD16, CH50, IgM and neutrophil levels. Also, there was a significant negative correlation between hardiness and CD8, cortisol and eosinophil levels. There was a significant difference between the four groups of in CD4, CD8, CD4/CD8, cortisol, C3, C4, CH50 and lymphocyte levels. Also, there was a significant positive correlation between social support and CD4, CD4/CD8, CD56, CD16, CH50, IgM, C3 and neutrophil levels.Conclusions: The results revealed that the performance of the immune system in managers with high hardiness and high social support is significantly better than that of managers with low hardiness and low social support. Furthermore, high hardiness and high social support act as resources and moderating factors against stress.

Background: Infant formula, depending on the source, contains various fatty acids, which may possess important nutritional and biological value for infants. The presence of some of these fatty acids in infant formula, however, can be harmful and toxic for the infant. In this regard, more attention has been paid to erucic acid since its accumulation in myocardial tissues may cause damage to the heart. Therefore, a limit has been set by the Codex Alimentarius for the presence of erucic acid in infant formula (less than 1% of total fatty acids). The purpose of the present study is to investigate amount of erucic acid present in three infant formulas used predominantly in Iran.Methods: Gas chromatography (GC) is a valuable method applied for the separation of fatty acids, including erucic acid, from oils and oily food. Three brands of infant formulas, namely Humana, Biomil and Multi, were analyzed by GC using a wall coated open tubular (WCOT) fused silica column and flame ionization detector (FID). Heneicosanoic acid was employed as an internal standard.Results: The findings showed that Humana and Biomil infant formula samples contained 0.06% and 0.002% erucic acid (from total fatty acids), respectively, while no erucic acid was detected in the Multi infant formula samples.Conclusion: The amount of erucic acid in the studied infant formulas was far below the Codex limit of 1% total fatty acids.

Background: Although there have been many studies on the role of mosquitoes in malarial transmission, the biology and interaction of plasmodium with its host is still not completely known. The aim of this study was primarily to follow the sporogony cycle of Plasmodium vivax in Anopheles stephensi mysorensis and then to explore the inhibitory effects of certain carbohydrates on parasitic development.Methods: In a restricted insectary, An. stephensi were fed blood containing gametocytes from donor malaria patients. The development of plasmodium was followed by dissecting the infected mosquitoes and taking a smear at different time intervals. Other groups of Anopheles were fed infected blood plus one of the following carbohydrates: N-acetyl-glucosamine, N- cetylgalactosamine, arabinose, fucose, manose, lactose or galactose.Results: Exflagellation occurred at 5 minutes after the blood meal and then ookinet was observed at 20 hours, while oocysts and sporozoites appeared in days 8 to 12. The results indicate that An. stephensi strain mysorensis has can transfer P. vivax extremely well. Furthermore, the development of P. vivax was completed in the mosquitoes that had been fed with N-acetylglucosamine, arabinose, fucose and galactose. In contrast, lactose, mannose and N-acetyl-galactosamine interrupted the life cycle of the parasite.Conclusion: The sugars lactose, mannose and N-acetyl-galactosamine have an inhibitory role in of oocyst and sporozoite development. Therefore, the results of this study can be used as basic information for inhibiting malarial transmission.

Background: Aluminum salts are common adjuvants in human and animal vaccine preparations. The two adjuvants aluminum phosphate and aluminum hydroxide show acceptable immunoadjuvant properties with many antigens. These two salts have different physicochemical characteristics that make each one suitable for certain antigens. The surface antigen of Hepatitis B (HBsAg) has several antigenic epitopes that bind to aluminum adjuvants by a ligand exchange mechanism. Although HBV vaccines using an aluminum hydroxide adjuvant are available, higher antigenicity is needed for the subgroup of people who do not respond sufficiently to the currently available vaccines.Methods: A solution of recombinant HBsAg for making different formulations of vaccines with aluminum phosphate (Adju-Phos â) and aluminum hydroxide (Alhydrogelâ) adjuvants was obtained from Darupakhsh Pharmaceutical Company. The total protein content, antigenicity, and purity of HBsAg solution were determined using BCA, ELISA, and SDS-PAGE methods, respectively. The different formulations were prepared in the lab and administered i.p. to two test groups of Balb/C mice and a third test group received the Engerix vaccine, which is currently available on the market and uses an aluminum hydroxide adjuvant. The control group of animals received the solution without antigen. After 28 days, heart blood samples were collected and serum was separated to determine the antibody titer against HBsAg using an ELISA kit.Results: This study shows that the vaccine formulated with aluminum phosphate exerted more immunogenicity than both the aluminum hydroxide laboratory formulation and the Engerix vaccines.Conclusion: Although the results of our study indicate higher immunogenic properties of the vaccine formulated with the aluminum phosphate adjuvant, complementary experiments are needed to further evaluate the biological properties with respect to effectiveness, adverse effects, product stability and finally possibility for manufacturing and distribution of this new formulation as a Hepatitis B vaccine.

Background: I Infections due to Candida spp. have increased dramatically in recent years through a rising number of predisposing factors and immunocompromised hosts. Although Candida albicans is the most prevalent and important causative agent of Candida infections, the importance of C. parapsilosis, C. tropicalis, C. krusei, C. glabrata, C. guilliermondii and C. kefyr have increased significantly as they tend to be more resistant to antifungal agents. Therefore, it is critical that infecting Candida spp. be identified and considered. Furthermore, clinical laboratories may need to expand their yeast identification capabilities in order to facilitate rapid identification of clinical yeast isolates.Methods: In a discroptive – analytic study, the patients suspected of candidiasis were sampled. Direct examination and culture was carried out for all specimens. The isolated yeast colonies were then identified using various different tests such as culture on corn mealagar tween-80, CHROMagar Candida, and assimilation test by API 20C AUX kit. Results: In the present study, 304 yeast colonies were isolated from referral patients to mycology laboratory of 304 isolated colonies 204 were identified as C. albicans and 100 were identified as non albicans candida as follow 35% C. parapsilosis, 32% C. tropicalis, 8% C. glabrata, 8% C. kefyer, 6% C. krusei, 3% C_ guilliermondii, 3% C. famata, 3% C. lusitaniae, 1% C. zeilanoides and 1% C. homicola. C. parapsilosis was the most frequent species. The result showed that clinical specimens were obtained from various infected sites of body and nail samples (59 cases) were found to be the most_frequent_among_those_specimens.Conclusion: In conclusion, our results suggest that no single phenotypic test has proven to be highly effective for definitive identification. Moreover since these organisms can vary greatly in their susceptibility to the current antifungal agent and causing significant patient management problem therefore evaluation of susceptibility of these isolates against antifungal drugs is need to be investigated.

Background: There is considerable professional debate over which technique is the best for lifting. The aim of this study is to compare three static lifting styles, the stoop, semi-squat and arm lift, using maximum isometric voluntary contraction (MIVC) as one indicator for recommending a lifting style.Methods: Thirty healthy women (mean age: 22.37 years) participated in this quasi-experimental study. They performed the tests in static postures by standing on the platform of the Lift TrackTM and pulling the dynamometer of the instrument with maximum effort in three lifting styles: the stoop, semi-squat and arm lift. The subjects warmed-up by practicing the lifts first. The mean MIVC from the two other sets of lifts were used for statistical analysis by repeated measurements and SPSS (ver.10) software.Results: There were significant differences between the MIVC of the three lifting styles in this study. The largest MIVC was for the semi-squat lift and was the least was for the arm lift (p<0.001). The MIVC of the stoop lift was larger than that of the arm lift (p<0.001).Conclusion: The largest MIVC for the semi-squat lift suggests that this style is useful for lifting objects from the floor. The differences in biomechanical and muscle pattern activity changes could explain these results. It seems that activation of the quadriceps muscles in the semi-squat lift was a main factor for producing more MIVC, so when this style is recommended for lifting, attention to the power of the quadriceps is important.

Background: Drug Utilization Evaluation (DUE) studies are performed to define, determine, and finally improve the quality of drug usage. These types of studies are especially valuable for drugs with a narrow therapeutic index or specific indication, or for expensive medications. In Iran, vancomycin is only available by prescription for methicillin-resistant staphylococcal and enterococcal infections. It is obvious that extensive and irrational use of this drug can increase bacterial resistance to this antibiotic. The goal of this study was to assess vancomycin utilization.Methods: In a descriptive cross-sectional study performed during the fall and winter of 2004, this vancomycin DUE was done in the Infectious Disease Department of Imam Khomeini Hospital in Tehran. All of the patients receiving vancomycin were enrolled in this study. The Centers for Disease Control (CDC) and American Society of Hospital Pharmacists (ASHP) protocols have been used to perform this study.Results: Of the 565 inpatients at this hospital, 39 subjects (7%) received vancomycin. Vancomycin utilization among these patients was compatible with CDC and ASHP protocols in only 28% and 35% of the patients, respectively.Conculusion: Vancomycin is predominantly administered empirically, rather than being based on the antibiogram. This may be due to the routine protocol of the ward or the physician doubting the reliability of the antibiogram.

Background: Pain control after posterolateral thoracotomy is very important for adequate respiration and to reduce pulmonary complications. Narcotic-induced respiratory depression requires different intercostal nerve block procedures with local anesthesia, such as bupivacaine, through an extrapleural catheter, paravertebral catheter and intrapleural injection in order to control pain and reduce narcotics consumption. The aim of this study is to determine the efficacy of bupivacain versus normal saline (N/S) in pain control after thoracotomy.Methods: In a single-blind clinical trial, forty patients were divided into two groups of 20 patients each. Group 1 (G.1) received a single dose (10 ml) of bupivacaine 0.5%, followed by continuous infusion of N/S (0.1 ml/kg/h) four hours after surgery. Group 2 (G.2) received a single dose (10 ml) of bupivacaine 0.5%, followed by a continuous infusion of bupivacaine (0.1 ml/kg/h) four hours after surgery. Postoperative pain was assessed every four hours for 48 hours by linear visual analog scale (VAS). If VAS> 5, then pethidine was injected at a dosage of 1 mg/kg/IM. VAS _ 3 was considered pain control.Results: TThe mean VAS at 8, 12, 16, 20 and 24 hours after surgery in G.1 was 7.6, 5.5, 6.6, 5.5 and 5.7, respectively, and in G.2 was 3.4, 3.7, 2.8, 2.1 and 1.9, respectively. There were significant differences between the two groups (for 12 hours P<0.001 and for other time points P=0.0001). During the 4-24 hour period after surgery, pain control in G.1 was 5% and in G.2 was 81%. The mean VAS at 28, 32, 36, 40, 44, and 48 hours after surgery in G.1 was 5.2, 5, 5.3, 4.4, 5.1, and 4.8, respectively, and in G.2 was 1.6, 1.8, 1.5, 1.6, 1.5 and 1.4, respectively, with a significant difference between the two groups (P<0.0001). In the first 24 hours, the mean of pethidine injection in G.1 was 3.7 and in G.2 was 0.6 (P<0.0001). In the second 24 hours, the mean pethidine injection in G.1 was 2.2 and in G.2 there was no need for pethidine (p<0.0001).Conclusion: Continuous extrapleural infusion of bupivacaine is effective in pain control and decreasing demand for narcotics after thoracotomy.

Background: Abdominal compartment syndrome (ACS) is a clinical entity that develops from progressive, acute increases in intra-abdominal pressure (IAP) and adversely affects all vital organ systems in this study, the development of intra-abdominal hypertension (IAH) and ACS in a surgical ICU population is described and examined.Methods: Over a one-year period (2004), urinary bladder pressure (UBP) was measured prospectively in all surgical patients with abdominal problems admitted to the ICU of the Imam Hospital complex. UBP of >20 cm H2O indicated IAH. ACS was defined as the development of multiple organ dysfunction including peak airway pressure (PAP) >50 cm H2O, Horowitz quotient <150 torr or urine output <0.5 ml/kg/hr in the setting of IAH. Data were gathered on all patients with IAH and ACS.Results: We evaluated some 353 patients, consisting of 165 elective laparatomies and 188 emergency cases, including 28 trauma patients. The incidence of IAH and ACS was 2 and 1 per cent (7 and 3 patients, respectively). The mean IAP of these seven patients was 29.8 cm H2O. No elevated IAP was observed after elective laparotomy (165 patients), nor in emergency cases with temporary abdominal wall closure (29 patients). APACHE II score, PAP and worst base deficit were significantly higher in patients with elevated IAP. None of the three patients with ACS underwent decompressive laparotomy. The mortality rate for patients with elevated IAP was 85%, significantly higher than the total study population.Conclusion: IAH is a rare disease of the rarity of IAH, routine measurement of IAP is necessary only in high-risk patients. Prophylactic temporary abdominal wall closure may prevent IAH and ACS in high-risk patients. Patients with elevated IAP have dismal outcomes. Critical care practitioners should become familiar with different aspects of IAH and ACS, including decompressive laparotomy.

Background: Despite recent improvement in coronary intervention, there are many controversies about its results in diabetic patients. The goal of this study is comparison of in hospital outcome of diabetics after coronary intervention with nondiabetics.Methods: In this study 115 diabetic and 115non diabetic patients who admitted for coronary intervention in our center during 1383&84 were entered in an analytic study of Cohort type. Datas about clinical, aniographic, procedural and post procedural (24hours) characteristics were entered in each patient’s form. Independent T test,chi-square and Fisher’s exact test were used for analyzing datas.Results: The Diabetic Patients were most often older men, and they had higher angina class, more co-risk factors and lower ejection fractions. Diabetic’s lesions were longer and more located in proximal portion of vessels. But success rate, major complication (death, revascularization, Q Wave MI and CVA), and minor complications (coronary/peripheral arteries complication, pulmonary edema, ischemic ECG) had no significant differences between two groups.Conclusion: Diabetes mellitus does not affect short outcomes of coronary intervention as an independent factor. So intervention could be done in these patients with considering favorable outcomes.

Background: Meningiomas are common benign tumors of the brain. Meningioma patients have optimal functional recovery after surgical removal of their tumors. Some patients experience recurrence months or years after surgical resection. In this study, we try to determine the prevalence of recurrent meningioma and the correlation between recurrence and certain factors.Methods: This retrospective descriptive-analytical study included all patients with recurrent meningioma at Shiraz University of Medical Sciences-affiliated hospitals during a 20-year period (1983 to 2003). We evaluated a series of data for each patient including age, gender, tumor volume, tumor shape, bone changes, brain edema, tumor location, histological subtypes, degree of tumor resection and duration between operation and recurrence. Finally, correlations between these factors and recurrence were investigated using SPSS software version 11.5, by the descriptive method.Results: Among the 644 patients enrolled in this study, the recurrence rate of intracranial meningioma was determined to be 9.6%. Multivariate analysis revealed a statistical correlation between edema, bone changes, tumor volume, tumor volume, tumor shape and histological subtype, but no relationship was found between age, gender and tumor location. Our study shows a statistical correlation between radiotherapy and reduced chance of recurrence. Patients with malignant and atypical meningiomas have shorter periods between surgery and recurrence than those with benign types.Conclusion: We recommend that all patients with these prognostic factors receive adjuvant therapy and closer follow-up. In consideration of the statistical correlation between the degree of tumor removal and recurrence in this study, we suggest more complete tumor resection to decrease the risk of recurrence.

Background: Postoperative shivering is a common postoperative complication. The aim of this study was to compare the effects of morphine, pethidine and fentanyl in postoperative shivering control.Methods: In this prospective, randomized, placebo-controlled, doubleblinded, clinical trial, we enrolled 72 adults scheduled for elective surgery under general anesthesia at Imam Khomeini Hospital in 2003. All the patients were anesthetized in the same manner. After transferring the patients to the post-anesthesia care unit, shivering was noted and, in patients with a shivering score of one or more, morphine (2.5 mg), pethidine (25 mg), fentanyl (25 μg) or normal saline (all with a volume of 10 ml) was randomly administered intravenously by a two-minute injection. A second shivering score was recorded 10 minutes later.Results: Pethidine and fentanyl were significantly more effective than normal saline, but there was no significant difference between normal saline and morphine groups. Pethidine was more effective than two other drugs in shivering control.Conclusions: Pethidine was significantly more effective than two other drugs. Fentanyl decreases postoperative shivering less effectively than pethidine, but morphine had no effect on postoperative shivering with an effect comparable to normal saline.