Tehran University Medical Journal
Year:2009 | Volume:66 | Issue:10|Papers Count:20

Background: Tumor cells need food and oxygen supply for growth and division. Therefore one of the most promising areas of cancer therapy focuses on using agents that inhibit tumor angiogenesis. Inhibition of angiogenesis prevents cell growth, division and metastasis. Previous studies showed that plasminogen related Protein-B has an anti-tumor activity in mice. This protein has a high level of homology with preactivation Peptide (PAP) of human plasminogen. According to this high homology, antiangiogeneic activity of PAP was investigated in an in vitro angiogenesis model. Methods: PAP encoding region of human plasminogen gene was isolated by Polymerase Chain Reaction and cloned in pGEX-2T vector. This plasmid was expressed in Escherichia coli as a fusion protein (GST-PAP). GST-PAP was expressed as inclusion body and purified by affinity chromatography on GSH-sepharose resin after refolding. antiangiogenic effects of purified protein were surveyed with Matrigel assay.Results: The GST-PAP was expressed and purified and its accuracy was confirmed by SDS-PAGE analysis and immunoblotting. Microscopic studies showed that GST-PAP inhibited angiogenesis in Matrigel system which is shown by shrinking the length of capillary like structures and a decrease in the number of tubule. While applying concentarations of 25mg/ml of GST-PAP and concentrations above that, antiangiogenic activity of GST-PAP was significant comparing to the controls.Conclusion: Finding shows that GST-PAP can inhibit network formation in Matrigel system. This findings support the theory that PAP is a potent angiogenesis inhibitor.

Background: Respiratory distress syndrome remains a common cause of neonatal morbidity and mortality. Consequently fetal lung maturity (FLM) testing plays an important role in establishing obstetrics management strategies.Methods: This prospective study was performed on 80 pregnant women (between 28 to 40 weeks of gestation) and their neonates. Respiratory Distress Syndrome (RDS) had been diagnosed with presence of physical sign (grunting, retraction of intercostals muscles and thacypnea) and O2 requirement over the 24 hours and X -ray signs. The respiratory status of each newborn was evaluated standard clinical and radiographic criteria were used to diagnose RDS. The ability of amniotic fluid optical density (OD 650) was evaluated by calculating the sensitivity and specificity of each value. Results: Twenty (25%) infants developed RDS. OD 650nm more than 28% ratio predicted pulmonary maturity. Nineteen out of 20 RDS cases had been predicted correctly. The mean of weight of this neonates was 2043±511.68 and mean of gestational age was 32.3±20.43 weeks and mean of OD 650 was 0.134. The negative predictive value of OD 650nm> 0.28 ratio was 97% and positive predictive value was 51% and the sensitivity for prediction of RDS was 95% and specificity was 70%. Conclusions: measuring optical absorbance of amniotic fluid (OD 650) is a rapid simple and inexpensive procedure that compares favorably with other methods of fetal maturity assessment.

Background: Because of importance and extensive use of textile in clinical setting especially as bandage, so outbreak of nosocomial infections due to Bacteria resistance; nanobiotechnological advances in recent decade, achieved methods for fabrication antimicrobial effect in fibers that can satisfied the needs of patients in the wake of health and hygiene.Methods: The antimicrobial effect of special type of fibers produced in Isfahan Poly Acryl Plant on one resistant strain of Pseudomonas aeruginosa isolated from 54 wound samples of patients in Isabn e Maryam hospital and P.aeruginosa (PTCC1024) was studied by using shake flask method. In order to compare the effect of pure antimicrobial agent of the fiber with that of gentamicin, the minimal inhibitory concentration of these agents was tested on strains. The effect of the interaction of these two antimicrobial agents and their fractional inhibitory concentration on chosen strains was studied using checkerboard method.Results: The results show inefficient effect by antimicrobial fiber on P.aeruginosa strains after 24 hrs. But despite the high level MIC of gentamicin on these bacteria (1-3 mg/ml), the MIC of pure antimicrobial agent of fiber at a level of 10-3 ml/ml caused growth inhibition. The interaction of these antibacterial agents on the P.aeruginosa isolated from wound was evaluated as synergism.Conclusions: According to this study the antimicrobial effect of the fiber on growth inhibition of P.aeruginosa strains is negative (despite of significant effect by pure antimicrobial agent used in produced the antimicrobial fiber on examined strains).

Background: Many studies have shown that about 45-65% of multiple sclerosis (M.S) patients suffer from cognitive impairments. Semantic memory as one of the subcategories of cognition is quite important for effective communication. In the present study, category-semantic memory was studied in order to evaluate the semantic memory organization in normal individuals and MS patients.Methods: Ninety voluntaries participated in this study. Participants comprise of 45 MS patients and 45 normal individuals. All participants were matched in terms of age, sex and education. Variables such as the reaction time and the number of correct responses for retrieval (recognition) of natural (animal and fruit) and artifact (object) words were measured in both groups by presentation software. Data analyzed by t-paired and One- Way ANOVA tests. Ethical committee of Tehran University of Medical sciences approved the study.Results: The results of current study showed significant differences in reaction time and correct responses of artifact and natural categories between the MS and normal individuals (p<0.05). Furthermore, there was significant difference between reaction time and number of correct responses to natural and artifact categories in each group (p<0.05).Conclusions: This study showed that the organization of semantic categorization as natural and artifact categories is still preserved in multiple sclerosis patients. However, the processing of semantic categorization was different in term of reaction time and number of correct responses between MS patients and normal subjects and the processing of semantic-memory is slower than normal individuals.

Background: To evaluate the association between age, sex, BMI, waist/hip ratio, smoking, religion, ethnicity, education and knee osteoarthritis.Methods: Eligible subjects were randomly included from participants of Tehran COPCORD study, of whom 480 subjects with knee osteoarthritis were compared to 490 subjects without (case-control study). Using a questionnaire developed by COPCORD group (Asia & Oceania), we enquired about the risk factors of knee osteoarthritis i.e. age, sex, BMI, Waist/Hip ratio, religion, ethnicity, education and smoking. Knee osteoarthritis was defined using ACR criteria. Each knee was unit of analysis using GEE technique to evaluate these associations.Results: Age (OR; 1.096; CI95%: 1.091-1.1; P: 0.00) and sex (OR; 2.85; CI95%: 2.49-3.28; P: 0.00) showed significant association with knee osteoarthritis. Overweight (OR; 1.81; CI95%: 1.28-2.55; P: 0.00) and obesity (OR; 3.3; CI95%: 2.34-4.66; P: 0.00) both showed higher risk for knee osteoarthritis. The association between waist/hip ratio and knee osteoarthritis showed an OR of 5.28, CI95%: 0.89-31.44; P: 0.07. However, this association was only borderline significant. People with different religion or ethnicity and smokers had no extra risks for knee osteoarthritis. Higher education is a protective factor for knee osteoarthritis as people who had university education compared topeople with no/primary education showed a lower risk for knee osteoarthritis (OR; 0.54; CI95%: 0.38-0.78; P: 0.00).Conclusions: Our study confirmed that elderly, females, overweight and obese people are at higher risk to develop knee osteoarthritis as found in western societies. Higher education is a protective factor against knee osteoarthritis. Ethnicity, religion and smoking showed no extra risk of knee osteoarthritis.

Background: Pin loosening and infection in skeletal traction are important problems in orthopedic surgery and methods which are usually used to manage these problems, are costly and sometimes complicated. In this study, the efficacy of using cast support in infection and loosening of proximal tibial pin was investigated.Methods: In a randomized clinical trial, 60 patients referring to Rasul-e- Akram hospital from 1383 to 1384, who needed to have proximal tibial pin for at least one month, were studied. All patients were treated with oral antibiotic until 24 hours after pin insertion. Depending on using cast support or not, they were randomly categorized into two groups (30, 30). The rate of pin loosening and infection between these two groups were compared.Results: In the group without cast support infection rate was about %26.7 while this rate was %13.3 in the group with cast support, which means no significant difference (.33). In addition, although the rate of loosening in the group without cast support was more than the other group, it had no statistical meaning. (%20 compared with %10, p= 0.47).Conclusions: Cast support doesn’t affect the rate of pin loosening and pin site infection. However, considering correct technique for pin insertion including prevention of thermal injury and local hematoma is very important. Therefore, the use of cast support is an optional choice up to surgeons’ preference.

Background: In recent years, many ill cases with cytomegalovirus reactivation in nonimmuno compromised persons reported. Goal of study: to determine the CMV infection in cerebrospinal fluid of aseptic meningoencephalitis children hospitalized in Rasul & Mofid hospital (2005-2007).Methods: In a cross sectional study 132 cases selected with simple sampling. CMVDNA in their Cerebro spinal fluids searched by qualitative PCR.Results: The age range of the study patients was 5 month- 13 years, median age= 2±3.7 years; 87(65.9%) male and 45 (34.1%) was female. The presenting signs and symptoms were convulsion 77(69.4%); meningitis 25 (18.8%), loss of consciousness 47(37%); neurologic defects 15.9%. DNA extrated in 11 cases. Mycoplasma- DNA in 2cases; DNA-CMV detected 2(1.5%). Positive DNA HSV found in 7(15.3%) of patients. DNAHSV type- 15.3% (7/132) cases. An infant 5 month age with developmental delay, microcephaly and recurrent convulsions. A 1 year girl with brain atrophy and progressive hydrocephaly with intracranial shunt.Conclusions: Differentiation between herpes meningoencephalitis and other encephalopathy based on clinical signs in children is too difficult. CMV (1.5%) has lower rate than herpes simplex type-1 (5.7%). In addition to CMV and HSV1 all of herpes family viruses (varicella, herpes 6, 7, Epstein barr virus) could have role in children with meningoencephalitis. In recent years a sensitive, rapid, simple diagnostic test "Single tube Multiplex PCR" in cerebro spinal fluid recommend. Rapid diagnosis and faster treatment is necessary for decreasing mortality and morbidity in all of herpes meningoencephalitis cases.

Background: The use of synchronized intermittent mandatory ventilation (SIMV) and pressure support ventilation (PSV) have been used for older children and adults. The purpose of this study was to compare PSV and SIMV modes in weaning from mechanical ventilation in neonate with respiratory failure.Methods: A randomized clinical trial study carried out in NICU ward of Valiasr hospital Imam Khomeini Hospital complex, Tehran, Iran. Thirty neonates enrolled in two groups of 15. At the weaning time they randomly assigned to SIMV or PSV. They compared for tidal volume (VT), peak inspiratory pressure (PIP), incidence of pneumothorax, weaning failure and duration of weaning. For two groups to be homogeneous, maternal disease during pregnancy were also considered. Results: In this study, VT, PIP, incidence of pneumothorax and weaning failure did not differ between groups; duration of ventilation of the two methods (hours) and duration of hospitalization (days) were separately calculated. The only meaningful difference in two groups was due to weaning duration. The neonates weaned by PSV mode experienced shorter weaning time. (6.05 hours). The weaning time in SIMV mode was longer (45 hours) (P=0.006). There were no other meaningful differences between the two groups.Conclusions: According to the results of this study there were no advantage using PSV over SIMV except that the weaning time were shorter in PSV. This decrease in weaning time causes less dependence of the neonate to the ventilator and as a result secures them from complications.

Background: Acute pyelonephritis may lead to permanent renal scarring. The standard recommendation for treatment of febrile children with urinary tract infection (UTI) is hospitalization for intravenous antibiotics. The purpose of this study was to compare the efficacy of outpatient intravenous ceftriaxone and cefixime versus inpatient of the same regimen for children with febrile UTI.Methods: In a randomized clinical trial, we compared the efficacy of administration two days intravenous ceftriaxone followed by an oral cefixime for eight days (as outpatient group) versus four days intravenous ceftriaxone followed by an oral cefixime for six days (as inpatient group), in 203 children (99 cases in outpatient group and 104 cases in inpatient group) 3 months to 15 years of age with febrile UTI, in terms of shortterm clinical outcomes (sterilization of the urine and defeverescence) and long-term morbidity (incidence of reinfection and renal scarring documented by DMSA scintigraphy.Results: Repeat urine cultures were sterile within 48 hours in all children, mean time to defeverescence was 27.58 (SD=±12.62) and 31.44 (SD=±17.06) hours for children in outpatient and inpatient groups, respectively (P=0.067). Reinfection occurred in 9.1% of outpatient and 13.4% of inpatient group (P=0.326). Renal scarring developed in 11% of children of outpatient and 7.6% of children of inpatient group (P=0.884). There was no significant difference between the two groups in respect of renal scarring.Conclusions: Outpatient ceftriaxone for two days followed by cefixime to complete a 10 days course can be recommended as a safe and effective treatment for children with febrile UTI.

Background: Pain associated with IV injection of propofol is seen in 28 to 90% of patients. A number of techniques have been tried to minimize propofol-induced pain, with variable results. We compared the efficacy of pretreatment with ephedrine and lidocaine for the prevention of propofol-induced pain.Methods: One hundred and twenty adult patients, ASA physical status I-II, undergoing elective surgery were randomly assigned into six groups (20 each). Normal saline group received normal saline, lidocaine group received lidocaine 2% (40 mg), and ephedrine (E 30) group received 30 mg/kg ephedrine, ephedrine (E 70) group received 70 mg/kg ephedrine, ephedrine (E 100) group received 100 mg/kg ephedrine, ephedrine (E 150) group received 150 mg/kg ephedrine. All pretreatment drugs were made in two mL. Pain was assessed by a 100-point scale of visual analogue (VAS) (0= no pain, 100= the most severe pain) and (VRS) verbal rating scale at the time of propofol injection. Noninvasive mean arterial blood pressure (MAP) and HR were recorded before induction, just before intubation, and 1, 2, and 3 min after intubation, respectively.Results: The mean of pain scorel during propofol injection was significantly more in Normal Saline group compared to lidocaine and ephedrine (E30, E70, E100, E150) groups but there was no significant difference between lidocaine and ephedrine (E30, E70, E100, E150) groups (80.9vs 59.6 and 56.2, 51.05, 52.8, 57.45) Kruskal- wallis P=0.009. The incidence of pain was also significantly more in Normal Saline group compared to lidocaine group and ephedrine’s groups but there was no significant difference between lidocaine and different dose levels of ephedrine. A small dose of ephedrine (30 and 70 mg/kg) could prevent propofol induced pain before intubation and did not produce significant hemodynamic changes compared with the other groups after intubation. Conclusions: Pretreatment with ephedrine (specially low dose) effectively attenuated pain intensity, and frequency with propofol injection without undesired complications.

Background: Preeclampsia is a disorder of pregnancy with increased maternal and perinatal morbidity and mortality. An imbalance between free radical induced lipid peroxidation and antioxidant system has been suggested as possible pathogenesis of preeclapsia. It has been shown correlation of some serum antioxidant agents (for example ceruloplasmin) with preeclampsia and its severity. The purpose of this study was to evaluate of this correlation.Methods: In a analytic case-control study, in clinic and delivery unit of Mirza Koochak Khan university hospital, Tehran, we evaluated 90 pregnant women of 19-38 years old with gestational age higher than 20 weeks in two groups, case (preeclampsia) and control (healty mother). Case group was devided into two groups; mild preeclampsia (n=30) and severe preeclampsia (n=30). Patients with preeclampsia (n=60) had either early (n=41) or late preeclampsia (n=19). Control group included 30 normotensive pregnant women. Serum Ceruroplasmin level was measured. Then relationship between this factor and preeclampsia was studied.Results: The mean level of serum ceruloplasmin in women with severe preeclampsia (390.83mg/dl) and mild preeclampsia (319.43mg/dl) was higher than control group (212.7mg/dl). Likewise it was significantly higher in severe preeclampsia than mild (P<0.001) and higher in early (373.28mg/dl) than late preeclampsi (298.34 mg/dl) (P<0.01).Conclusions: Our data suggest that serum ceruroplasmin level may predict preeclampsia occurrance and its severity. Likewise antioxidant theryapy before the onset of preeclampsia in an attempt to decrease its frequency should be considered.

Background: Chronic Pelvic Pain (CPP), a common health problem in women, characterized by lower abdominal pain that has lasted at least for six months. Although, it’s annual prevalence estimated 3.8 to 49%, there is no data in Iranian society. This study was aimed at gathering comprehensive and reliable data regarding the prevalence of CPP in female employees at two university hospitals in Tehran in 2006-2007.Methods: A cross-Sectional study was conducted to determine the CPP prevalence on 303 volunteer females aged 19-63(34.7±9.2) years, working in two university hospitals, Tehran. A designed questionnaire with four parts containing questions regarding demographic information, gynecological, urinary and gastrointestinal symptoms was used. The ethical committee of the Shaheed Beheshti Medical University approved the study.Results: The prevalence of present pelvic pain unrelated to menstrual cycle was 22.3% and totally 10.2% subjects suffered from CPP during the last 6-12 months. Our data showed a significant difference in prevalence of CPP between women with and without vaginal delivery (37% VS. 24 P=0.036%). There was a significant relationship between incomplete and hard defecation and occurrence of CPP (p<0.001). The prevalence of LBP & PPD in women with CPP was higher than women with no CPP (p<0.001).Conclusions: Regarding to the prevalence of CPP and its relationship with gynecological, urinary, musculoskeletal and gastrointestinal factors, we emphasize on a multidisciplinary approach for management of CPP, also recommend performing further community-based epidemiological studies.

Background: Chronic pancreatitis is a progressive fibrosis of the pancreas that leads to loss of endocrine and exocrine function of pancreas. The most common symptom is intractable pain. Which adversely effects quality of life, remains the most common indication for surgery in patients with chronic pancreatitis.Case report: Three patients underwent operations for chronic pancreatitis at the Ghaem hospital, Mashhad University of Medical Sciences Mashhad, Iran. Indication for operation in all cases was intractable abdominal pain. In all of the three patients complete relief of symptoms was obtained. There was no morbidity and mortality. In one patient exocrine function of pancreas and malabsorpation resolved after surgery. Conclusions: Although chronic pancreatitis is uncommon, but in persistent abdominal pain surgery should be considered. Surgery for patients with chronic pancreatitis can be performed safely with minimal morbidity and effective in control of pain and malabsorption.

Background: Acute hepatitis is upon serious complications of halothane usage, can be associated with 50% mortality in severe cases. Use of halothane as inhalational anesthetic or use of it for maintenance of anesthesia is restricted/ prohibited in USA and most European countries. The occurrence of icterus and elevated liver enzymes after halothane anesthesia may be due to the drug induced hepatitis.Case report: we report a 28 year old woman with acute hepatitis after cesarean section under halothane anesthesia, fortunately discharged to home 40 days after that. Other causes of hepatitis became role out in the patient.Results: The usage of halothane should be restricted/ prohibited in our country because of its potentially serious and fatal complications and so existence of more safe but expensive alternatives.