Tehran University Medical Journal
Year:2009 | Volume:67 | Issue:3|Papers Count:12

Background: Hepatitis B vaccination has been included in routine immunization of all individuals according to WHO recommendations since 1991. Despite successful coverage, 3-5% of recipients fail to mount a desirable protection level of Ab. Vaccine failure results from: emergence of mutation, immune failure of individuals, decrease in vaccine potency, and etc. The quality of Hepatitis B vaccine should be evaluated by a reliable method.Methods: The amount of vaccine antigen was measured through the in vitro assay of Hepatitis B vaccines which consists of multiple dilutions of the reference material and samples. The preparations were evaluated by Elisa to determine the amount of HBsAg. The data were analyzed by parallel-line analysis software. The in vivo assay was performed by inoculating multiple doses of the reference and sample preparations in Balb/c mice. A control group was also inoculated with vaccine matrix. Four weeks later, the mice sera were evaluated to determine the presence of antibodies against Hepatitis B by Elisa method. The data were analyzed by Probit analysis software.Results: Both methods were set up in our laboratory by which different batches of Hepatitis B vaccine were evaluated. It was observed that In vivo and In vitro methods provide comparable results. Therefore we can use the in vitro method for routine testing of HB vaccine quality control.Conclusion: In vitro method can be used in place of In vivo method because of its time and cost-effectiveness. Moreover, since no animals are used in in vitro method, it complies well with the 3R concept (Reduction, Refinement, and Replacement of animal testing) and the current tendency to use alternative method.

Background: Leishmaniasis is a parasitic infectious disease which causes skin sores. There is no effective laboratory screening tests for leishmaniasis. Some diagnostic techniques exist that allow parasite detection and species identification by special culture and microscopy, biochemical (Isoenzymes), immunologic (immunoassays), and molecular (PCR) approaches. Specific major objectives of this study was to genotyping of Leishmania species in Bam and Shiraz city.Methods: A total of 83 samples of Leishmania were collected from patients clinically suspected of cutaneous leishmaniasis. The geographic distributions of the samples were 55samples from Bam and 28 from Shiraz city. For this propose samples of skin and bloods were blotted on filter paper. Genomic DNA extracted with a Genomic DNA extraction kit (AccuPrep, BIONEER). Aliquots of extracted DNA were kept at -20oC. region of ITS1 amplified with the published Leishmania -specific primers.15–20mL of these amplicons, containing the amplifiedITS1 region, was digested for 2h with Hae III.Results: All 55 samples from Bam were considered as L. tropica and the positive samples from Shiraz considered asL. tropica and just one sample was L. major which was belonged to a patient had previously traveled to Isfahan and Khuzestan.Conclusion: In the current study a PCR technique was employed for amplification of Leishmania DNA directly in biological materials. Characterization of genus of Leishmania using RFLP-PCR method is too sensitive and too rapid, and there is no need for culturing the parasite for diagnosis.

Background: Tuberculosis is an important cause of death in some countries. The world health organization estimates that if stronger measures are not taken up to control the prevalence of this disease, from2000 to 2020 a billion people will be infected by the bacterium. According to time consuming of common detection methods of Mycobacterium tuberculosis such as culture, it is necessary to evaluate a rapid detection tests such as PCR. Rapid diagnosis of tuberculosis may have profound effects in patients’care According to importance of rapid detection and treatment of tuberculosis and for determine of sensitivity, specificity, positive predictive value and negative predictive value of PCR by using IS6110 this study was done in Kashan university of medical science.Methods: A total of 248 sputum samples from patients suspected of mycobacterial diseases were studied. DNA was extracted by boiling method. IS6110 PCR method by a specific pair of primers designed to amplify123bp and 245bp sequences of the insertion sequence, 6110, in the M. tuberculosis genome was used to analyze sputum samples.Results: 32 out of 248 (12.9%) of samples had positive culture. PCR yielded a sensitivity of93.8 % and specificity of 99.1% for the diagnosis of TB patients with TB confirmed by culture. There were two out of32 (6.3%) PCR-positive cases among the patients with non-TB disease.Conclusion: The findings of the present study indicate that Multiplex PCR may provide a faster method of detecting tuberculosis, thus enhancing diagnostic procedures and we conclude that the performance of anIS6110 PCR assay is valuable in the rapid diagnosis of tuberculosis.

Background: Malaria is an important parasitic vector-borne disease with considerable infectivity and world-wide distribution. Since prevalence of chloroquine resistance in Plasmodium falciparum at the malarious areas such as Iran and reliable reports from many countries indicating emergence of chloroquine- resistant strains of P.vivax, this study was conducted to monitor the current response of vivax and falciparum plasmodia to chloroquine in Bandar-Abbas district, a malarious area in Iran.Methods: The study was conducted at the Bandar-Abbas district in Hormozgan province, Iran. 123 patients were enrolled and considered. The patients were treated with a standard3-day regimen of chloroquine and were followed-up clinically and parasitologically. The results were interpreted as mean parasite clearance time (MPCT) in P.vivax and early treatment failure (ETF), late treatment failure (LTF) and adequate clinical and parasitological response(ACPR) in P. falciparum.Results: The patients with vivax malaria were responded to the regimen of chloroquine within24-216 hours. Most cases of the parasite clearance time occurred at 48 hours (50.40%), and less of them at 120, 168, 192 and 216 hours with 0.81% for each of them. MPCT in this study was calculated as 61.07 (±26/47) hours for all of the patients.33.33% and66.66% of the patients with falciparum malaria were found at ACPR and LTF groups, respectively.Conclusion: This study confirms the efficacy of chloroquine on P.vivax. The extended parasite clearance time in a number of patients may be an early sign for reduced susceptibility of P.vivax to chloroquine in the studied areas. Most of the patients with falciparum malaria (66.66%) considered in this study did not respond to the regimen of chloroquine because of chloroquine- resistance in P.falciparum at the area.

Background: Cancer prevention besides detection and treatment has a very important role in control of cancer disease. Since some chemical compounds that are used in laboratories, especially in pathology laboratory are potentially mutagens, lab assistance that are working with chemical as Benzene, Xylazine and Formaldehyde for long period of time may be exposed to overload of these carcinogens. Therefore, it is necessary to use an indicator for detecting these occupational exposures. Ames test has been recommended in biomonitoring of environment that has high risk carcinogenicity characteristic.Methods: A total of fifty seven urine samples of forensic medicine laboratory personnel’s were extracted by C18 column and then tested by TA100 and TA98 standard strains of Ames assay. Each sample was analyzed with and without activator to detect mutagen and promutagen materials.Results: Levels of mutagenicity were found by TA98 strain without activator in one case as well as with activator in two cases of urine sample of pathology laboratory personnel’s. These cases were working in laboratory for long time in all of the workdays.Canclusion: Personnel’s working in pathology laboratories may have greater risk of cancer and should be take care from these occupational exposures.

Background: One of the major problems in the medicine is personal identification in cases of skeletal remains. The first step is determination of sex. One of the elements that recently paied more attention to it is the patella. Since the measurements are population specific, so we measured the patellas of Iranians to determine their patellas dimensions for sex prediction.Methods: In this study three metrical characteristics of patella were measured from 67 corps between 20-64 years refered to the autopasy hall of forensic medicine center in Tehran (L.M.O). For statistical analysis of datas, the statistical product and service solution (SPSS version 16) program was used and unvariate and multivariate discriminant function analysis were performed to indicate the efficiency of each variable for sex determination.Results: The mean of patella height in male was 4.46 cm and in female was 3.87, the mean of patella width in male was 4.60 and in female was 4.03cm and the mean of patella thickness in male was2.25 and in female was 2.07cm. Among these measurements maximal width with average accurancy of 94% and then maximal height with 91% and finally maximal thickness with 71.6-73.1% respectively were better variables for sex determination. Also in multivariate discriminant analysis, combination of all three measurements with average accuracy of 94% was the best function for sex determination.Conclusion: The results of this study revealed that we can determine sex with high confidence in situations such as explosions, air crashes and etc, just by using the patella measurement.

Background: Transthoracic needle biopsy is a well established method for obtaining pathologic diagnosis in the lung mass that performed after a previous negative bronocoscopy. The goal of this study is evaluation of the safety and accuracy of ultrasonographic guided transthoracic needle biopsy for diagnosing peripheral lung mass.Methods: In a descriptive and prospective study from September 2005, 30 patients with peripheral lung mass with greater than3cm in diameter and less than 5cm distance through the chest wall, underwent ultrasonographic guided transthoracic needle biopsy and it’s diagnostic accuracy and complications were analyzed.Results: The male to female ratio was two to one, the average age of the patients was 61.2 years and 60% of the lesions were located in right side. Adequate biopsy specimens were obtained in all patients, but transthoracic needle biopsy was diagnostic in 86.6% and 13.3% patients because doubtful diagnosis, who underwent thoracotomy for definitive diagnosis. From these four (13%) patient who needed thoracotomy definitive diagnosis were organized embolism, granulomatouse tuberculosis, bronchoalveolar carcinoma, and metastatic adenocarsinoma. Pathological diagnosis were malignant lesion in83.3% that squamouse cell carcinoma and adenocarcinoma were the most common malignancies and benign lesions were found in16.6% that granulomatouse tuberculosis was the most common lesion. Complications were observed in13.3% that included pneumothorax (6.6%) and hemoptysis (6.6%) that managed medically. No cases of mortality were observed.Conclusion: Transthoracic needle biopsy with ultrasonographic guide due to appropriale diagnostic accuracy and low complication rate with low cost and availability is recommended for the diagnosis of peripheral lung mass.

Background: Trauma is the 2nd cause of mortality in Iran, after cardiovascular diseases. In traumatic patients, head and neck and face skeletal fracture is common. The most common facial fracture is mandible fracture and the least common is frontal fracture. Complications due to orbital fracture are more devasting than the other fractures in face.Methods: These descriptive cross sectional studies are designed on 92 patients with orbital fractures in a referral educational trauma center, Imam Khomeini hospital, Tehran, Iran. Sample size was the patients who referred to this hospital with orbital fracture during the ten years period (1986-2000).Results: In this study 74 patients were male and 18 patients were female. Mean age of patients was 30 years. The most common cause of orbital fracture was motor vehicle accident which was seen in 38 patients.46 patients had fracture in left orbit and 44 patients in right. Isolated orbital fracture was seen in 38 patients and 54 patients had concomitant trauma and fracture in the other organs. Management of orbital fracture was reduction of displaced bone fragment and fixation for osteosynthesis. The most common methods for osteosynthesis was fixation with miniplate which used in 53 patients and then reconstruction of orbital floor and roof with autologus bone graft. The most common complications due to orbital fracture was related to eyes that were seen in 20 patients.Conclusion: Face fractures are a piece of all problems in multiple trauma patients as the tip of iceberg. Concomitant injuries are the concealed part of this iceberg. Early detection of orbital fracture and immediate treatment that prevent the future complications and deformities due to orbital fractures.

Background: Bispectral index (BIS index) shows the depth of anesthesia. The effects of drugs on BIS and amnesia are different. This study was performed to evaluate the association between two different sedative regimens on BIS and amnesia.Methods: In this clinical trial, 60 patients who needed elective orthopedic surgery under regional anesthesia with intravenous sedation were elected. Patients divided in two equal groups based on sedation protocol by block randomization method: midazolam plus fentanyl group (MF group) or propofol group (P group). Dose of sedative drugs were adjusted according to clinical findings of sedation. Depth of sedation in all patients, preserved in four based on modified Ramsey Sedation Score. Patients questioned about spontaneous recall after full awakening in recovery room. Recall of any event during operation considered as failed amnesia. Correlation of BIS index with recall was measured in two different groups separately.Results: The frequency of recall was 2 (6.7%) in P group and 10 (33.3%) in MF group (p=0.01). The mean ± SD of BIS in P group was 76±5 (68-91) and in MF group was 93.4±5 (77-98) (p<0.001). The difference of BIS in patients without amnesia (p=0.019) and with amnesia (p<0.001) in two groups were significant, respectively. No delay in recovery was observed.Conclusion: Although the Modified Ramsey Sedation Score and clinical sedation indices were the same, but BIS in patients varied in a wide range. Hypnotic drug was a main determinant of BIS score and amnesia.

Background: The abdominal sacrocolpopexy is the gold standard method of vaginal prolapse correction and posterior intra- vaginal slingplasty (posterior IVS) is a newer procedure with minimal invasion. This study is going to compare the effectiveness and complications of these two surgical methods.Methods: In this study, 51 patients with prolapse admitted to vali-e-asr Hospital of Tehran University of medical science were evaluated during years2001-2004.26 patients were operated by posterior IVS method (the first group) and 25 of them had undertaken sacrocolpo-pexy (the second group). Data were primarily gathered from patients' folder and further complimentary information were achieved by two years follow-up and inviting patients to interview or exam.Results: Eighty percent of women with abdominal sacrocolpopexy were cured compared to96.2 percent with posterior IVS. Surgery complications was reported in one patient(4%) of second group while none of patients in first group experience this and the difference was not statistically meaningful. Short-term post surgical complications (hemorrhage-perforation fever and abdominal distention) were also negative in first group (posterior intra vaginal slingplasty) but these problems such as fever and abdominal distention were positive in36% of second group (abdominal sacrocolpopexy) which was evidently statistically meaningful (p=0.001). Long- term post surgical complication (tape and mesh disfunction) were seen in7.7% of first group while none of second group patients showed these complications.Conclusion: According to shorter operating time, lower complications and efficient response to therapy in posterior IVS method, it can be an alternative in prolapse surgery it is preferred in elderly patients with medical problems.

Background: Preterm birth which is defined as delivery before 37 completed weeks was implicated in approximately two thirds of neonatal death. Also preterm labors are the most common cause of mortality and morbidity of infants in recent years and it costs high prices for health system. We evaluate the relationship between prepregnancy maternal body mass Index (BMI) and spontaneous and indicated preterm birth.Methods: This study included 250 healthy pregnant women, without any risk factors of preterm birth, were classified into categories that were based on their body mass index. Association between BMI, weight gain and rout of delivery were examined. Rates of indicated and spontaneous preterm birth were compared.Results: Obese women delivered at a more advanced gestational age. (38/34±1/66 weeks vs37/61±2/44, p=0/006). Obese patients had significantly lower incidence of spontaneous preterm birth at<37 weeks of gestation (16/8% vs 31/2% p=0/008). Obese women had larger infants (3354/95±596/75 vs 311.24±558/357 p=0/001), and had more frequent cesarean delivery (69/6% vs 52/8%, p=0/006). Weight gain during pregnancy is poorly correlated with prepregnancy BMI (14/41±7/93 kg vs 13/78±4/94kg, p=0/4) and preterm birth.Conclusion: In this survey, there was adverse correlation between body mass index (BMI)before pregnancy and preterm labor less than 37 completed weeks and we suggest more study for evaluation between spontaneous and induced preterm labor mechanism and in obese and non obese women. However according to this survey obesity before pregnancy is associated with a lower rate of spontaneous preterm birth.

Background: Acardiac twin is a rare complication affecting monozygotic twins and is related to the twin reversed atrial perfusion sequence(TRAP). The TRAP sequence involves a pump twin perfusing a recipient twin through vascular anastomosis. Here, we report two cases with different presentations of acardiac twin.Case report: The first acardiac twin was composed of a healthy fetus and a fetus with proximal of trunk, pelvic and lower limbs without head, neck and arms (acardia acephalus- classic form). The pregnancy was followed with ultrasonography and pregnancy terminated at29 weeks, because there was abnormal doppler of ductus venosus and non-reassuring NST in pump twin. The second acardiac twin first time was diagnosed at a rotine ultrasonography at 26 weeks gestation as a healthy fetus and an acardia fetus with a hypoplastic lower limb and intestine like organ (amorphic mass). The pregnancy following, normal infant was born with a sac with some loops of the intestine at term. Each two cases were diagnosed at26 week and each was delivered healthy pump twin.Conclusion: Acardiac twin has different presentation and here we presented two end of acardia twin presentation with different management and outcome.