TEHRAN UNIVERSITY MEDICAL JOURNAL (TUMJ)
Year:2017 | Volume:75 | Issue:9 |Papers Count:12

Stem cells are undifferentiated biological cells that can differentiate into more specialized cells and divide (through mitosis) to produce more stem cells (self-renew). In mammals، there are two broad types of stem cells: embryonic stem cells، which are isolated from the inner cell mass of blastocysts، and adult stem cells، which are found in various tissues. Mesenchymal stem cells (MSCs) are multipotent cells that are called as one of the most adult stem cells. Due to their highly proliferative potential and their suitable self-renewal capacity، these cells have provided a powerful and promising source for use in the field of regenerative medicine. Also، mesenchymal stem cells are known for their important properties involving multilineage differentiation potential، trophic factor secretion and localization along various organs and tissues. So that MSCs can differentiate into a variety of cell lineages، including: Osteoblasts (bone cells)، chondrocytes (cartilage cells)، adipocytes (fat cells)، myocytes (muscle cells)، hepatocytes (liver cells) and endothelial cells. Efficacy of differentiated MSCs to regenerate cells in the injured tissues requires the ability to maintain the differentiation toward the desired cell fate. Since MSCs represent an attractive source for autologous transplantation، cellular and molecular signaling pathways and micro-environmental changes have been studied in order to understand the role of cytokines، chemokines، and transcription factors on the differentiation of MSCs. The differentiation of MSC into a mesenchymal lineage is genetically manipulated and promoted by specific transcription factors associated with a particular cell lineage. Recent studies have explored the integration of transcription factors، including Runx2، Sox9، PPARγ ، MyoD، GATA4، and GATA6 in the differentiation of MSCs. Therefore، the overexpression of a single transcription factor in MSCs may promote trans-differentiation into specific cell lineage، which can be used for treatment of some diseases. In this review، we critically discussed and evaluated the role of transcription factors and related signaling pathways that affect the differentiation of MSCs toward adipocytes، chondrocytes، osteocytes، skeletal muscle cells، cardiomyocytes، and smooth muscle cells.

Sudden cardiac death in sport، although rare، but is a tragic event، attracting the media and public attention. Sport and exercise may act as a trigger for sudden cardiac death. Risk of sudden death in young athletes with cardiovascular disease is 2. 5 times more frequent than non-athlete individuals. More than 90% of cases of sudden death occur during or immediately after training or competition. Incidence of sudden cardiac death in any population، including athletes، is related to multiple factors such as gender، age، race، nationality، diagnostic screening methods and preventive measures for sudden cardiac death. Otherwise، incidence rate of sudden cardiac death is linked to the used definition and method of diagnosis. Different cardiovascular disorders may result in death of young athletes and hypertrophic cardiomyopathy، congenital coronary anomalies، arrhythmogenic right ventricular dysplasia and aortic rupture are among the most common causes. Marfan syndrome، dilated cardiomyopathy، viral myocarditis، Wolff-Parkinson-White (WPW) syndrome، congenital long QT syndrome، Brugada syndrome and commotio cordis are reported as other etiologies. In older athletes (more than 35 years)، ischemic coronary heart disease is responsible for majority of the cases similar to the general population. Because the outcome of sudden cardiac arrest in sports is very poor except in few cases، proper national strategies are needed to diminish the burden of sudden death in young athletes. It seems that there are two main strategies to achieve this goal: A) Primary prevention with use of purposeful pre-participation evaluation programs. This evaluation should focuss on the proper history and physical examination. Nevertheless، there is significant debate between American and European countries regarding the use of paraclinical investigations (especially ECG). American heart association does not recommend ECG as an essential part of evaluation. In contrast، European society of cardiology and international olympic committee advocate ECG for all athletes younger than 35 years. However، all evaluations should be based on national، generally accepted standards and done by well-educated experts. B) Setting evidence-based and updated protocols for early and effective cardiopulmonary resuscitation (CPR)، attendance of well equipped medical staff and early access to automated external defibrillator (AED) in all sport events and implementing CPR education in all coaching training courses.

Background: High costs of treatment and rehabilitation lead to increased tendency of researchers in complementary therapies and using the compounds which have natural origin and are cheaper. Sheep ghee، known as yellow oil، is one of the compounds used in many parts of Iran for wound healing. Considering that few studies have been performed on the effect and rate of these materials on burn wound healing، the present work is aimed to investigate the effect of ghee on burn wound healing in rats. Methods: In this experimental study which was performed in the animal lab of the Hazrat Fatemeh Hospital in Tehran، 36 adult male Sprague-Dawley rats with the relative weight of 250-300 g were selected and second-degree burn with the area of 2×4 cm was induced in them. Then، they were randomly divided into 3 groups، 12 in each. To dress the burn point in 1 to 3 groups، silver sulfadiazine cream، ghee، and Vaseline were used، respectively. The evaluation process was monitored by photography with 5 days intervals using an accurate ruler and ImageJ software، version 1. 45 (National Institutes of Health، Bethesda، Maryland، USA). On the 17th and 30th days، Tissue biopsies was performed for the epithelialization rate، degree and arrangement of collagen، and chronic and acute inflammatory cells، the sample of burn wound was sent for pathological investigation. Results: Results showed that، wound area was significantly reduced in ghee، and Vaseline groups compared with silver sulfadiazine cream on days 5th، 15th، and 25th (P= 0. 001). however، the difference between ghee and Vaseline group was not significant. In the 17-day time period، results of collagen arrangement (P= 0. 000) and epithelialization results (P= 0. 04)، acute inflammatory cells (P= 0. 001)، and fibroplasias (P= 0. 000) in 30th day were significantly better in ghee، and Vaseline groups. Conclusion: This study showed that، in contrast to the public belief in some regions in Iran، ghee could not accelerate healing of burn wound and promote histopathological indices. Therefore، they are not recommended.

Background: Renal ischemia reperfusion (RIR) injury is a common clinical syndrome that affects renal function and significantly increases morbidity and mortality. Hydrogen sulfide (H2S) is an endogenously gaseous mediator that exhibits many cytoprotective effects. Recently، studies have shown that H2S have opposite effects in different doses. Therefore، in the current study we investigated the effects of H2S at different doses on renal function after induced renal ischemia reperfusion injury model. Methods: The present study is an experimental study in animals and was conducted in Tehran University of Medical Sciences in April 2014. Male Wistar rats were assigned to five main groups (n= 6): 1) Sham، 2) Ischemia reperfusion (IR)، 3) Administration of 50 µ mol/kg Sodium hydrosulfide (NaHS)+IR، 4) Administration of 75 µ mol/kg NaHS+IR and 5) Administration of 125 µ mol/kg NaHS+IR. Sham group underwent laparotomy without cross-clamping of renal pedicles. Renal ischemia (IR) was induced in rats by both renal arteries occlusion for 55 min followed by reperfusion. Rats in the NaHS groups received intraperitoneal injections of 50، 75، or 125 µ mol/kg of NaHS 10 minutes before the onset of ischemia and immediately after the onset of reperfusion. After reperfusion، plasma was collected for functional evaluation. Results: Compared to the sham، IR animals demonstrated a significant rise in plasma creatinine and BUN levels. Rats in the low-dose NaHS treated groups (H50، H75) had improved renal function by significantly decrease of creatinine and BUN levels. However، treatment with a high-dose of NaHS increased the levels of plasma creatinine and BUN levels as compared with these indices in the IR group. Conclusion: Our study demonstrates that different doses of Sodium hydrosulfide (NaHS) can play diverse role in renal ischemia reperfusion injury. However، NaHS in the low-doses could protect the kidney from the RIR injury، in a higher dose NaHS exaggerated the renal function by increases plasma creatinine and BUN. Therefore، determining of the therapeutic doses of NaHS may be important in the protection of kidney from the RIR injury.

Background: Lichen planus is an inflammatory mucocutaneous disease which involves 0. 2‒ 4% of the population and has an unknown etiology. There is no definite treatment for the disease and current treatment modalities are palliative in nature. Although the exact cause of lichen planus is not clear، some scientists believe that free radicals and oxidative stress might have a role in causing this condition. The current study was conducted to assess the therapeutic effect of lycopene in treating erosive and atrophic oral lichen planus. Methods: Thirty patients whose disease was confirmed by a pathologist were included in the clinical trial from January to July 2016 in the Department of Oral Medicine، Faculty of Dentistry، Zahedan University of Medical Sciences. The patients were randomly divided into two groups. The first group was treated with topical corticosteroid and 15 mg of systemic lycopene daily for a month and the second group received only topical corticosteroids. We recommended that the patients use the drugs (topical corticosteroids) four times a day، avoiding taking food for one hour after applying the drugs. Pain severity was recorded by numeric rating scale before and after the treatment and disease score was recorded by Thongprasom scale before and after treatment. Data were analyzed with SPSS 18. Mann-Whitney U test was used to compare the groups. Results: In the case and control groups، pain scores before treatment were 5. 4± 1. 2 and 5. 7± 0. 9، with 3. 01± 1. 8 and 3. 2± 1. 5 after treatment، respectively. There was no significant difference between the two groups (P= 0. 6، P= 0. 4). Disease scores before treatment were 4. 1± 1 and 4± 0. 8، with 1. 7± 1. 2 and 1. 8± 1. 5 after treatment، respectively. There was no significant difference between the groups (P= 0. 7، P= 0. 8). Conclusion: In this study the use of systemic lycopene did not increase the effect of topical corticosteroid; in addition، the results showed that the systemic use of 15 mg of lycopene in addition to topical corticosteroid treatment had no significant effect on patients’ pain and disease scores in comparison to topical corticosteroids.

Background: Sonography is used for measuring the muscle morphology including length، depth، cross-sectional area، bulk and pennation angle. The supraspinatus is the most common affected muscle among the rotator cuff muscles. There is no study about the reliability of sonographic measurement of supraspinatus thickness in the positions of empty can (EC)، full can (FC) and hug up (HU) tests. The present study aims to investigate the intra-rater reliability of the measurement of sonographic thickness of supraspinatus muscle in the rest and positions of the EC، FC and HU tests. Methods: The present study was a descriptive-analytic study which was carried out in a cross-sectional method on ten healthy women aged: 22. 10± 2. 76 years without any tendon pathology. The study was carried out during four weeks (January to March in 2017). The supraspinatus thickness was scanned during rest and contracted states. The positions of measuring ultrasonic thickness of supraspinatus were as follow: position of EC test: the arm in 90-degree elevation in the scaption plane with the thumb-down، position of FC test: the arm in 90-degree elevation in the scaption plane with the thumb-up، position of HU test: the palm of hand was placed on the opposite shoulder with the elbow flexed using a 0. 5-kg weight cuff. Intra-rater reliability of ultrasonic muscle thickness measurements were examined in one day. Results: All intra-rater reliability values were equal or more than 0. 90: the value was 0. 90 (95%CI: 0. 65-0. 97) in the rest position، while for the measurement of ultrasonic thickness of the supraspinatus was 0. 96 (95%CI: 0. 87-0. 99) in the position of EC test، 0. 97 (95%CI: 0. 90-0. 99) and 0. 96 (95%CI: 0. 86-0. 99) in the positions of FC and HU tests، respectively. Conclusion: Measurement of ultrasonic thickness of supraspinatus muscle is a reliable method in the rest and positions of EC، FC and HU tests. This method can be used to compare the muscle thickness changes in the positions of the above tests.

Background: The deficiency of enzyme glucose-6-phosphate dehydrogenase (G6PD) is among the most common genetic diseases in human. The deficiency of G6PD enzyme is one of the most common encountered enzymes، affecting about 400 million people and causing a wide range of undesirable clinical complications worldwide. The performed studies have reported a variety of statements about the relationship between malaria and survival of people with defect، but these kinds of studies are limited in Iran. This study aimed to estimate the incidence of G6PD deficiency among newborns in malarious areas of Fars province. Methods: The present study was conducted ecologically and descriptively-analytically on 59745 neonates with G6PD deficiency in Fars province، Iran from April 2011 to March 2015. To determine the defect، a point fluorescence test and Kimia commercial kit (KimiaPajoohan Co.، Tehran، Iran) were used. To determine the areas with malaria، factors associated with malaria-causing cells in Fars province، including the presence of carriers، the presence of malaria، the incidence of new malaria and the presence of malaria activated sites were studied. The incidence of defect was calculated using the statistical method of estimating the annual incidence rate. ArcGIS software، version 10. 3 (ESRI، Redlands، CA، USA) was used to provide geographic mappings and distribution patterns in malarious areas. Results: The total incidence of G6PD deficiency in newborns was estimated as 15. 58 per 100 live births، including 16. 25 for boys and 14. 85 for girls. The incidence of this defect in malaria-prone areas was higher than other areas. As a region was more malaria-prone، the incidence of G6PD deficiency increased too، which was statistically significant (P= 0. 039). Conclusion: Based on the findings of this study، Fars province is among areas with high incidence of G6PD deficiency. The incidence of G6PD deficiency in malaria-prone areas of Fars province، Iran، is higher than other regions، which indicates better survival of patients against malaria in the past.

Background: Seborrheic dermatitis (SD) is a chronic dermatitis with 1-3% prevalence and even with 33-83% in immunocompromised patients. Often، because of some of predisposing factors، abnormal proliferation of Malassezia yeasts (as a normal flora) is seen in patients that lead to observation of clinical symptoms in their bodies. The aim of this study was to evaluate of Malassezia yeasts colonization rate in patients with seborrheic dermatitis that has key importance to appropriate treatment. Methods: This descriptive cross-sectional study was carried out during one-year period from January 2015 to February 2016 on 45 patients. According to the sample size formula، after visiting by a dermatologist and refer to the Medical Mycology Laboratory، Tehran University of Medical Sciences، patients were subjected to mycological examinations schedules. After recording the clinical symptoms and their specifications، sampling from all patients’ lesions was performed with sterile scalpel and a piece of scotch tape. Direct smears were prepared with 10% potassium hydroxide as a fungal clearing solution (KOH) and stained with methylene blue. The presence and rate of Malassezia yeast colonization was determined according to the standard procedures by direct microscopic examination. Results: From a total of 45 under studied patients، 66. 7% had moderate to severe colonization of Malassezia yeast. In existence of sweating and stress factors، severe colonization with significant differences was seen (P< 0. 05). In 8 cases (17. 7%)، mycelium form of yeast was observed. The highest mycelium observation was seen in existence of stress with significant differences (P< 0. 05). Conclusion: In most of patients، yeast colonization rate was more than mild status، that emphasize on the etiological role of Malassezia yeasts at least as exacerbating factor in seborrheic dermatitis. On the other hand، the role of factors such as sweating and stress in inducing of severe colonization and invasive form of Malassezia yeasts in SD was confirmed، that should be considered to be treated as well as SD in therapeutic procedure.

Background: Tetralogy of Fallot (TOF) refers to a condition in which left ventricular volume is normal or slightly less than normal. Given the differences observed in some Asian patients with TOF، the present study was conducted to investigate left heart by determining Z-scores for the mitral valve in Iranian patients with TOF. Methods: Eligible subjects in this prospective descriptive study comprised all patients with TOF presenting to Shahid Modarres Hospital in Tehran from March 2012 to March 2015 and diagnosed as the candidates for surgery. After determining the need for surgery and the therapeutic method required، the mitral valve size and Z-scores were calculated. We analyzed sex، age، body surface area (BSA)، mitral size (in 2-chamber and 4-chamber view)، mitral Z-score، other cardiac anomalies، number of surgery and previous surgery. Results: Of a total of 80 patients included in the study over 3 years، 29 (36. 3%) were male and 51 (63. 8%) were female. The mean age of the patients was 7. 15± 3. 37 years and their mitral size was found to be 10-27 mm (16. 2± 5. 99 mm) using echocardiography. Z-scores of the mitral valve were also obtained as-3. 09± 2. 11، ranging between-7. 1 SD and +1. 3 SD. 58 (72. 5%) patients have only TOF and 22 (27. 5%) with other cardiac anomalies. 45 patients were for first time underwent surgery and 22 patients for second time، 12 patients for three time and 1 for forth. Of a total of 35 patients had previous surgery، the most common were shunt 15 (42. 9%) and then tetralogy of Fallot total correction (TFTC) in 12 (34. 3%). Of a total of 80 patients، 59 (73. 8%) underwent TFTC، 17 (21. 3%) under pulmonary valve replacement and 4 (5%) shunt. Conclusion: Z-scores of the mitral valve were found to be significantly below the normal value، (i. e. 0± 2 SD)، in the study patients، suggesting the risk of hypoplastic left heart syndrome in Iranian patients with TOF، nevertheless، the type of TOF examined in these patients might have been different from those observed in other races and regions.

Background: Methotrexate (MTX) is commonly used in the hematology-oncology units and is frequently associated with adverse effects. High-dose methotrexate (HDMTX) is indicated in the treatment of acute lymphoblastic leukemia (ALL)، osteosarcoma، systemic non-Hodgkin lymphoma and primary central nervous system (CNS) lymphoma. The side effect profile of MTX varies markedly according to dose. The aim of this study was to evaluate the uses and adverse effects of HDMTX in a cancer center in north of Iran. Methods: This cross-sectional descriptive study carried out in Emam Sajjad Hospital، Ramsar، Iran from June 2016 to July 2017. Doses more than 500 mg/m2 of MTX was considered as a high-dose. Hydration status، evaluation of the renal and hepatic function، blood tests، urine pH، doses and frequencies of leucovorin administration، measurement of serum levels of MTX and side effects were evaluated. Recommendations of UpToDate 2017 were considered as standards of administration of HDMTX. Results: Forty-four courses of HDMTX were evaluated in this study. HDMTX were prescribed for lymphoma (30 cases)، ALL (8 cases) and osteosarcoma (6 cases). In all patients، hydration was done with 1340. 9± 894 normal saline plus 25 ml sodium bicarbonate 8. 4%، one to two hours before HDMTX. The solution used for dilution of MTX was 5% dextrose (1022. 7± 105. 5 ml). Urine pH was not measured in any patient. The frequency of leucovorin administration was 5. 64± 3. 03 times with doses of 17. 6± 1. 7 mg/m2 every 6 hours. Serum levels of MTX were not measured in any patient. Blood urea nitrogen and creatinine measurement was carried out before administration of HDMTX in all patients. The most common adverse effects were nausea (64. 4%)، anxiety (44%) and headache (43. 2%). Conclusion: The appropriate aspects of HDMTX usage were good hydration، urine alkalinization with bicarbonate and administration of leucovorin in patients receiving HDMTX، whereas monitoring of serum levels of MTX and administration of bicarbonate based on urinary pH were not done in any of the patients.