Tehran University Medical Journal
Year:2007 | Volume:65 | Issue:9|Papers Count:19

Background: Leukemia inhibitory factor (LIF) is a group of secreted glycoproteins with molecular weights ranging from 38-67 kD, resulting from differential protein glycosylation. LIF is constitutively expressed at high levels in the human fallopian tube epithelium and has an important role in the motility and vitality of sperm. In the present study, the effect of human recombinant LIF on human sperm motility and survival in vitro was investigated.Methods: Normal spermatozoa of 30 fertile men were collected and after preparation were incubated in Ham’s F10+FCS 10% medium, containing various concentrations (0, 3, 5, 10, and 50 ng/ml) of LIF at 37oC under 5% CO2 for 6, 24 and 48 hours. Sperm motion characteristics were measured using a Makler chamber. Sperm survival was determined using the hypoosmotic swelling test. Collected data were analyzed by one-way ANOVA and LSD test using SPSS version 11. The difference in values were considered significant when p<0.05.Results: Sperm motility was significantly higher after 24 h exposure to 5-10 ng/ml LIF (p<0.05). The survival rate of sperm was significantly prolonged when exposed to 50 ng/ml LIF (p<0.05). Nonprogressive motility and survival rate of sperm were significantly higher after 48 h exposure to 50 ng/ml and 10-50 ng/ml LIF, respectively (p<0.05). There was no significant difference in progressive sperm motility during the 48 h exposure of sperm to the various concentrations of LIF.Conclusion: According to our results, the effect of LIF on sperm motility and survival were dependent on the dose of LIF supplementation and the length of incubation.

Background: Nonlethal genetic damage is the basis for carcinogenesis. As various gene aberrations accumulate, malignant tumors are formed, regardless of whether the genetic damage is subtle or large enough to be distinguished in a karyotype. The study of chromosomal changes in tumor cells is important in the identification of oncogenes and tumor suppressor genes by molecular cloning of genes in the vicinity of chromosomal aberrations. Furthermore, some specific aberrations can be of great diagnostic and prognostic value. Comparative genomic hybridization (CGH) is used to screen the entire genome for the detection and/or location chromosomal copy number changes.Methods: In this study, frozen sections of 20 primary breast tumors diagnosed as invasive ductal carcinoma from the Cancer Institute of Imam Khomeini Hospital, Tehran, Iran, were studied by CGH to detect chromosomal aberrations. We compared histopathological and immunohistochemical findings.Results: Hybridization in four of the cases was not optimal for CGH analysis and they were excluded from the study. DNA copy number changes were detected in 12 (75%) of the remaining 16 cases. Twenty-one instances of chromosomal aberrations were detected in total, including: +1q, +17q, +8q, +20q, -13q, -11q, -22q, -1p, -16q, -8p. The most frequent were +1q, +17q, +8q, -13q, similar to other studies. In three cases, we detected -13q, which is associated with axillary lymph node metastasis and was reported in one previous study. The mean numbers of chromosomal aberrations per tumor in metastatic and nonmetastatic tumors was 1.5 and 1, respectively. No other association between detected chromosomal aberrations and histopathological and immunohistochemical findings were seen.Conclusion: Since intermediately to widely invasive carcinomas are more likely to have chromosomal aberrations, CGH can be a valuable prognostic tool. Furthermore, CGH can be used to detect targeting molecules within novel amplifications which holds the potential for a new therapeutic approach for intractable cancer.

Background: Despite major diagnostic and industrial progresses in the technology and use of Ionizing radiations, they have been found to be harmful to the health of the radiology and nuclear medicine staffs. Since Ionizing radiations have the potential to produce free radicals, therefore, it is likely that the total plasma level of anti-oxidant in medical and nuclear medicine staffs could be reduced.Methods: In this case-control study the relationship of total anti oxidant level of plasma and the function of immune cells such as lymphocyte proliferating response using MTT method, Neutrophil chemotaxi, Intensity of respiratory burst (NBT) and evaluation of IL-2 and IL-4 (ELISA) were investigated. 101 samples were collected for this study and they were assigned as two groups: 61 samples cases from radiology and nuclear medicine staffs of Tehran University Of Medical Science hospitals (Shariaty, Imam Khomeyni, Ghalb-e-Tehran) were assigned as the exposed group, whereas, 40 samples from Pediatric, Orthopedic, Infirmary and Emergencies wards were assigned as control group. Using heparinized syringes, 8 to 10 ml of blood samples were collected from each person with age between 25 to 50, averaging 36.4±7.2, and several assays including Anti Oxidant Capacity of Total Plasma (FRAP Method), T cell proliferative response to PHA mitogen (MTT Method), Chemotaxi of neutrophils and Magnitude of respiratory burst were carried out on these samples. The results were analyzed using spirman correlation analysis.Results: The results showed that exposure to ionizing radiation chronically with low dosed had no effect on chemotaxis of neutorophils and intensity of respiratory burst, but could have effect on lymphocyte function specially in cytokines secretion like IL-2 which are essential in the immune responses.Conclusion: This study indicates that long term low dose ionizing radiation may have effect in some parts of the immune function.

Background: Fanconi anemia (FA) is a rare autosomal recessive disorder characterized by short stature, skeletal anomalies, increased incidence of solid tumors and leukemia, and bone marrow failure (aplastic anemia). FA has been reported in all races and ethnic groups and affects men and women in an equal proportion. The frequency of FA has been estimated at approximately 1 per 360,000 live births. In some populations, including Ashkenazi Jews, Turks, Saudi Arabians and Iranians, this frequency appears to be higher, probably as a result of the founder effect and consanguineous marriage. Because of extensive genetic and clinical heterogeneity (the age of onset, clinical manifestations and survival), diagnosis of FA on the basis of clinical data alone is unreliable and its molecular diagnosis is difficult. The diagnosis of FA exploits the hypersensitivity of FA lymphocytes and fibroblasts to bifunctional alkylating agents such as mitomycin C (MMC), diepoxybutane (DEB) and nitrogen mustard and differentiates it from idiopathic aplastic anemia. In this study, in addition to the patients’ clinical profiles, a cytogenetic test using MMC was implemented for an accurate diagnosis of Fanconi anemia.Methods: In this study, the lymphocytes of 20 patients referred for FA, and those of their normal sex-matched controls, were treated with three different concentrations of mitomycin C (20, 30, 40 ng/ml). Slides were prepared and solid stained. In order to determine the number and kind of chromosome abnormalities, 50 metaphase spreads from each culture were analyzed. Clinical information was obtained from patient files.Results: Five patients manifested increased chromosome breakage with MMC, confirming the FA diagnosis. Two different concentrations of MMC (30, 40 ng/ml) were most effective.Conclusion: The chromosomal breakage test is important for the accurate diagnosis of Fanconi anemia. DNA crosslinking agents used to treat idiopathic a plastic anemia may be lethal for patients with FA. Thus, aplastic anemia patients with unknown etiology, infants with congenital abnormalities involved in FA and siblings of FA patients should also be cytogenetically tested.

Background: The major responsibility of an anesthesiologist is to provide adequate respiration for the patient. The most vital element in providing functional respiration is the airway. No anesthetic is safe unless diligent efforts are devoted to maintaining an intact functional airway. Difficult intubation had been classified into four grades, according to the view obtainable at laryngoscopy by Cormack and Lehane in 1984. This grading system has been in use to evaluate and manage those patients with difficult airway by anesthesiologists. In clinical state, grades III and IV are quite rare, so the need for a modified Cormack and Lehane grading system was felt. The use of a modified Cormack-Lehane scoring system of laryngoscopic views during direct laryngoscopy, was previously examined in the Western population. Koh and his co-workers had examined this modified Cormack and Lehane grading system in Asian population in a study in Singapore General Hospital. The aim of this study was to investigate this scoring system in Iranian patients.Methods: In a cross sectional study, a modified version of the Cormack and Lehane grading system was evaluated in 300 patients requiring tracheal intubation. In the modified system, grade II (only part of the glottis is visible) was divided into IIa (part of the cords is visible) and IIb (only the arytenoids or the very posterior origin of the cords are visible). Difficult intubation was defined as requiring more than one laryngoscopy or the use of special equipments.Results: Sixty eight patients (22.7%) were scored as grade IIa and 32 (7.7%) as grade IIb. The prevalence of difficult intubation in grade IIb was significantly higher than patients in group IIa (47.8% vs. 2.9% respectively, Fisher's exact test, p= 0.001)Conclusion: The modified grading system provides more information than the original Cormack and Lehane system.

Background: Abdominal hysterectomy is one of the therapeutic options in treatment of gynecologic diseases. The most common methods are total and subtotal abdominal hysterectomy. The effect of hysterectomy on sexuality is not fully understood and, until recently, total and subtotal abdominal hysterectomies have been compared only in observational studies. In this study, we compare total vs. subtotal abdominal hysterectomy in terms of surgical complications and postoperative sexual function of patients.Methods: In a single-blinded randomized clinical trial, we enrolled 25 patients who underwent subtotal abdominal hysterectomy (STAH), and 25 patients who underwent total abdominal hysterectomy (TAH). All patients were followed for 24 months after surgery. Three, six, 12 and 24 months after the procedures, all variables were compared between these two groups.Results: The duration of operation (p=0.007), volume of bleeding (p=0.0007) and duration of hospital stay after surgery (p=0.03) were less in the STAH group than the TAH group. No complications were experienced during the operation, nor excessive post-operative pain or infection for either group. No significant differences were seen between the two groups with regard to dyspareunia, sexual satisfaction of the patients and their partners were. Spot bleeding in the STAH group was significantly more frequent than in the TAH group.Conclusion: TAH and STAH do not have significantly different outcomes with regard to sexual satisfaction and function and surgical complications.

Background: Acupuncture is one of the most effective methods of alleviating pain in different situations including chronic and acute pain management. The aim of this study was to evaluate the effectiveness of acupuncture in the reduction of post-operative pain after hernia repair.Methods: In this placebo-controlled, double-blinded clinical trial, we enrolled 60 male patients aged 30 to 60 years old with an ASA physical status of I or II undergoing elective inguinal hernia repair under general anesthesia in Imam Khomeini Hospital, Tehran, Iran. All patients experienced standard anesthetic and surgical procedures. After completion of the operation and while the patients were still under general anesthesia, they were randomly assigned to two groups: acupuncture (with stimulation of GV2, GV4 and SP6 points with sterile acupuncture needles), and control (with sham acupuncture stimulation). After termination of anesthesia, during the first six hours, the pain intensity was evaluated hourly. Pethidine (25 mg) was administered for the patients when necessary. Pain intensity and pethidine use were recorded and compared between the two groups.Results: The mean age of two groups did not differ. Pain intensity was significantly lower in the acupuncture group between the second and fifth postoperative hours. Moreover, pethidine use was significantly lower in the acupuncture group versus the control group during the first six hours after surgery (12.07±7.5 mg vs. 12.91±6.5 mg, respectively; p=0.0001).Conclusion: The application of acupuncture in patients is associated with a marked decrease in pain after inguinal hernia repair and does not have any serious complications. Acupuncture is strongly recommended for all post-operative patients.

Background: Attention Deficit Hyperactivity Disorder (ADHD) is a common psychiatric disorder among children and adolescents. This disorder causes difficulties in academic, behavioral, emotional, social and family performance. Stimulants show robust efficacy and a good safety profile in children with this disorder, but a significant percent of ADHD children do not respond adequately or cannot tolerate the associated adverse effects with stimulants. Such difficulties highlight the need for alternative safe and effective medications in the treatment of this disorder. This open-label study assessed the effectiveness of reboxetine, a selective norepinephrine reuptake inhibitor, in children and adolescents with attention deficit hyperactivity disorder (ADHD).Methods: Fifteen child and adolescent outpatients, aged 7 to 16 (Mean± SD=9.72±2.71) years, diagnosed with ADHD were enrolled in a six open-label study with reboxetine 4-6 mg/d. The principal measure of the outcome was the teacher and parent Attention Deficit Hyperactive Disorder Rating Scale (ADHD Rating Scale). Patients were assessed by a child psychiatrist at baseline, 2, 4 and 6 weeks of the medication started. Side effects questionnaire was used to detect side effects of reboxetine. Repeated measures Analysis of variance (ANOVA) was done for comparison of Teacher and Parent ADHD Rating Scale scores during the intervention.Results: Twelve of 15 (80%) participants completed the treatment protocol. A significant decrease in ADHD symptoms on teacher (p=0.04) and parent (p=0.003) ADHD rating scale was noted. Adverse effects were mild to moderate in severity. The most common adverse effects were drowsiness/sedation and appetite decrease.Conclusion: The results of the current study suggest the effectiveness of reboxetine in the treatment of ADHD in children and adolescents. Double-blind, placebo-controlled studies and larger sample size with long duration of intervention are indicated to rigorously test the efficacy of reboxetine in ADHD. It is important that future studies complete our knowledge about safety and side effects of reboxetine.

Background: The knee is the most commonly injured joint. The internal components of the knee include the meniscuses, the anterior cruciate ligament (ACL) and posterior cruciate ligaments (PCL). Magnetic resonance imaging (MRI) is now used widely because of its high accuracy and noninvasiveness. Our objective was to diagnose internal knee component injuries by MRI and compare its diagnostic value with that of arthroscopic surgery.Methods: This process research study was carried out between May 2004 and September 2006 on 90 randomly selected patients admitted to the orthopedic ward of Baghiatollah Hospital, Tehran, Iran. Each patient had arthroscopic surgery after undergoing MRI by an expert radiologist.Results: Out of 90 patients, 81 were male and nine were female. The mean age was 31.6 years (range: 17-71). Among patients with normal ACL as shown by MRI, 42.4% were shown by arthroscopy to have a ruptured ACL. The sensitivity and specificity of MRI in ACL abnormalities were 73% and 77%, respectively. Only 1.3% of the patients with normal PCL by MRI showed PCL rupture upon arthroscopic examination. The evaluation of the lateral meniscus by MRI had a sensitivity and specificity of 40% and 94%, respectively. Likewise, in the medial meniscus, sensitivity and specificity by MRI was 70% and 98%, respectively.Conclusion: According to our study, considerable differences exist between MRI reports and arthroscopic findings in the diagnosis of internal knee injuries. We therefore conclude that sole reliance on MRI reports is not reasonable for making treatment decisions and MRI should be used as just one of the diagnostic tools, in conjunction with other methods, such as physical examination and arthroscopy.

Background: The misdiagnosis of urinary tract infection (UTI) may lead to kidney deficiency and even pyelonephritis. Since different species may cause this disease, urine culture (UC) and antibiogram of the isolated species should be performed and results compared to urine analysis (UA) parameters to obtain the best diagnosis.Methods: The urine specimens from 1509 patients (1195 women and 314 men) were processed for UA, UC and antibiogram. First of all, the sterile urine samples were cultured using differential media, including EMB and blood agar. After 24 hr incubation, the colonies were identified and differentiated by biochemical tests. Antibiograms for all isolated species were determined using Muller Hinton agar. All results obtained from this survey were analyzed using SPSS software.Results: Of the 1509 samples, 986 (65.3%) were positive for pathogenic bacteria, 170 (17.2%) of which were from men and 816 (82.8%) from women. E. coli was the most prevalent with 591 cases (58.7%), followed by Enterobacter 115 (11.4%) and Klebsiella 88 (8.8%). Data analysis revealed that the correlations between the WBC, RBC, nitrite, crystal, and protein were significantly higher in culture-positive samples. Of the antibiotics tested, isolated species were most sensitive to amikacin and most resistant to ampicillin.Conclusion: The present study revealed a correlation between pyuria and bacteruria; however, it should be noted that the clinical signs and the presence of WBC in urine could not be used to confirm the UTI. In addition, since different bacterial species are able to cause UTI, in order to administer proper treatment while controlling improper use of antibiotics, thorough testing, including UA and UC together with antibiogram, is strongly recommended.

Background: Health care workers (HCWs) are at substantial risk of acquiring bloodborne pathogen infections through contact with blood and other potentially infectious materials. The main objectives of this study were to determine the epidemiological characteristics of occupational exposure to blood/body fluids, related risk factors of such exposure, and hepatitis B vaccination status among HCWs.Methods: This cross-sectional study was conducted from December 2004 to June 2005 at three university hospitals in Tehran, Iran. Using a structured interview, we questioned HCWs who had the potential for high-risk exposure during the year preceding the study.Results: With a total number of 467 exposures (52.9%) and an annual rate of 0.5 exposures per HCW, 391 (43%) of the 900 HCWs had at least one occupational exposure to blood and other infected fluids during the previous year. The highest rate of occupational exposure was found among nurses (26%) and the housekeeping staff (20%). These exposures most commonly occurred in the medical and emergency wards (23% and 21%, respectively). The rate of exposure in HCWs with less than five years of experience was 54%. Percutaneous injury was reported in 280 participants (59%). The history of hepatitis B vaccination was positive in 85.93% of the exposed HCWs. Sixty-one percent had used gloves at the time of exposure. Hand washing was reported in 91.4% and consultation with an infectious disease specialist in 29.4%. There were 72 exposures to HIV, HBV and HCV; exposure to HBV was the most common. In 237 of the enrolled cases, the source was unknown. Job type, years of experience and hospital ward were the risk factors for exposure.Conclusion: Education, protective barriers and vaccination are important in the prevention of viral transmission among HCWs.

Background: Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system resulting from demyelination and axonal loss. Although treatment of MS has progressed, patients continue to have attacks and treatment for such episodes remains a subject of ongoing study. The object of this study is to determine the effect of intravenous methylprednisolone (IVMP) on the degree of disability in MS patients.Methods: This cross-sectional study involved 63 patients with a definite diagnosis of MS, based on the MacDonald criteria, at the Iranian Center for Neurological Research at Imam Khomeini Hospital, Tehran, Iran, from March 2004 through March 2005. After obtaining informed consent, investigators gathered data including each patient's age, gender, pyramidal activity status, cortical, cerebellar and brain stem activity status, sensory signals in the extremities, including vibration, touch, pain, position, visual status, as well as bladder and intestinal activity, and Expanded Disability Status Scale (EDSS) score. SPSS version 11 was used for data analysis.Results: A five-day regimen of IVMP (5g) significantly reduced the immediate posttreatment score from 4.595 to 3.635, which represents a 96% improvement in the EDSS. The greatest change in functional system disability was seen in the pyramidal system with a mean score of 1.13. After treatment, the rate of disability reduction in the sensory system, cerebellum, vision, bladder and intestinal activity was 0.57, 0.49, 0.46, 0.4, and 0.38, respectively. Patients who had experienced fewer relapses responded better to treatment. There was no statistically significant relationship between patient age and the level of response to treatment. However, the rate of disability reduction after treatment was greater in males than females (p=0.05).Conclusion: These results show that IVMP treatment induces an immediate posttreatment effect that could partly account for clinical and radiological improvement in MS patients. However, further study is required to determine the possible long-term, or even intermediate-term, effects of methylprednisolone treatment on the course of this disease.

Background: Stomatitis, the inflammation of the mucous lining of any of the oral structures, is a frequent side-effect of anticancer drugs due to excess uric acid production. Strict oral hygiene and the application of an appropriate mouthwash has been reported to relieve pain and improve patient quality of life. Allopurinol is a drug used to treat conditions caused by excess uric acid. The aim of this study to evaluate the effectiveness of prophylactic use of allopurinol mouthwash for stomatitis in patients undergoing chemotherapy.Methods: In this quasi-experimental study, 42 patients were randomly assigned to either a study group or a control group. In the study group (28 patients), patients used 5 mg/ml allopurinol mouthwash in hydroxyl propyl methyl cellulose. The control group (14 patients) used water instead of the mouthwash. Treatment was administered for 16 days.Results: Data collected during the daily follow-up of the patients’ oral mucosa showed that allopurinol mouthwash decreased the severity, pain and duration of stomatitis.Conclusion: Preventing stomatitis in patients receiving chemotherapy improves the health of the patient and compliance with treatment. Based on our findings, allopurinol mouthwash should be used for all chemotherapy patients for the prevention of stomatitis. This nursing intervention can also improve the patient’s nutritional state and level of satisfaction.

Background: Hutchinson-Gilford Progeria Syndrome (HGPS) is a very rare genetic disorder with a frequency of 1 in 8 million live births. It is characterised by premature aging phenotype. The median age at death is 13.4 years. It is an autosomal dominat disease due to a de novo point mutation in the Lamin A gene exon 11 in the majority of cases. More than 100 cases have been reported world wide.Case report: We describe here an exceptionally long-lived patient with HGPS, who is alive at age 36. She was referred by a cardiologist to our endocrinology clinic to be worked up for presence of a metabolic or genetic disorder before a heart surgery.Results: Having more attention of clinicians about very rare diseases and referring the patients to geneticist are the main goals of this case report as well as describing the disease.