Tehran University Medical Journal
Year:2009 | Volume:67 | Issue:6|Papers Count:11

Background: 4-Aryl-4H-chromenes are novel anticancer agents which induce apoptosis in cancer cells. These compounds were found to induce apoptosis by targeting the tubulin/microtubule system in cell proliferation process. The aim of this study was to report cyototoxic and apoptosis inducing activities of a new series of synthesized 4- aryl-4H-chromenes compounds.Methods: The in vitro cytotoxic activity of the synthesized 4-aryl-4H-chromenes was investigated against a paned of human cancer cell lines including MCF-7 (breast carcinoma), A549 (lung carcinoma), HEPG-2 (liver carcinoma), SW-480 (colon adenocarcinoma), U87-MG (glioblastoma), 1321N1 (astrocytoma), and DAOY (medulloblastoma). The percentage of growth inhibitory activity was evaluated using MTT colorimetric assay versus controls not treated with test derivatives. The data for etoposide, a well known anticancer drug, was included for comparison. For each compound, the 50% inhibitory concentration (IC50) was determined. Apoptosis inducing activity were assessed by DAPI staining. Results: Preliminary screening showed that those chromenes analogs bearing phenylisoxazole- 3-yl substitution or the derivatives containing methoxyphenyl in chromene ring exhibited cytotoxic and apoptotic inducing activity comparable with or even superior than the reference drug, etoposide. The compounds without this type of substitution have lower activity.Conclusions: Replacement of 3, 4, 5-trimethoxyphenyl group with thiazol ring in the synthesized derivatives reduced the cytotoxic activity. However, the derivatives with phenyl-isoxazole analogue showed potent cytotoxic and apoptotic inducing activity.

Background: Over the past 50 years, subtotal or supracervical hysterectomy has come to be viewed as a suboptimal procedure reserved for those rare instances in which when concern over blood loss or anatomic distortion dictates limiting the extent of dissection, the aim of this study was to compare total and subtotal laparoscopic hysterectomy. Methods: The patients who were candidates for hysterectomy with benign disease, with no contraindication for laparoscopic surgery entered the study in Arash Hospital, from March 2007 to April 2009. By simple randomization 45 patients (25 for TLH and 20 for SLH) were selected. Demographic Details and intra and post operative complications, were recorded by the staff and were compared between two groups.Results: The average time for TLH operations look significantly longer than SLH operation (148.6±29.7 minutes; 128.5±25.64 minutes, p=0.03). Although, the hemoglobin (gr/dl) drop in TLH was significantly higher than SLH (1.54 Versus 0.9, p<0.05) Blood transfusion were common in SLH (1 case Versus 3 Cases). The total length of hospital stay, was significantly shorter after SLH than TLH (3.6±1.47 day and 2.85±0.59, p=0.04). The drug requirements to control pain during hospitalization after both surgeries with analgesic injection were not significantly different, but with suppositories analgesic in SLH more than TLH. The time of return to normal activity was reported (p<0.0001) significantly shorter after SLH than TLH (13.12±18.1 and 5.04±1.79, p=0.0001). Sexual function had no significant difference between two groups but dysparunia in SLH was significantly lower than TLH (p=0.02). Cyclic bleeding and cervical prolaps, was not reported in two groups. Finally intra and post operative complications were more frequent in TLH.Conclusions: SLH is a safe and effective surgery. Our data suggest that SLH can replace TLH in selected cases.

Background: Several studies have investigated the variations in the anatomy of each segment of circle of Willis whereas a few have addressed the variations of this arterial circle as a whole. In this study the entire circle of Willis and its variations were studied in a cohort of Iranian people and compared with previous reports.Methods: Anatomical variations of the circle of Willis in 132 brains of Iranian cadavers (102 male adults and 30 fetuses and infants) were studied. The dissection process was digitally filmed for further studies. Using computer software the external diameters of the vessels were measured and the circle variations were classified. The variations of the circle as whole and segmental variations were compared with previous studies. Results: Uni-and bilateral hypoplasia of posterior communicating arteries (PcoAs) constituted the most common variation in our study which was similar to previous works. Aplasia of the anterior cerebral artery (A1) and the posterior cerebral artery (P1) were not observed. In 3.3% of fetuses and infants and 3% of adult instances both right and left posterior communicating arteries were absent. There was one case of anterior communicating artery (AcoA) aplasia in adult group.Conclusions: The anatomical variations discovered in Iranian circle of Willis in this study were not significantly different to those of more diverse populations reported in the literature. The main differences between the fetal and adult disposition are the diameter of the PcoA and the circular part of the P1.

Background: The sensitivity and specificity of body mass index (BMI) percentiles of CDC2000 standard which is used in determining obesity in Iranian children was compared with child real obesity identified by fat mass index (FMI) and obesity status in these children based on BMI and FMI was compared too.Methods: Weight, height and triceps skinfold (TSF) thickness were measured in 1800 primary school children in Sabzevar, Iran. Fat mass (estimated from TSF) and weight were divided by height squared to calculate FMI and BMI, respectively. FMI at or above the 90th percentile of age- and sex- specific data in this study was considered as criterion for real obesity, and BMI³95th and 85th<BMI<95th percentile of the CDC2000 standards were used for obesity and overweight definition, respectively. Using chisquare test, differences between the two indices in identifying obesity in children were examined.Results: Based on the CDC cut-offs, the prevalence of overweight and obesity in our children were 7.9% and 4.8%, respectively. From the real obese and non-obese children identified by the FMI, 43.3% and 0.6% were identified as obese according to BMI, respectively. In addition, the sensitivity and specificity of 90th percentile of BMI to identify children as obese were 71.1% and 98% respectively. Conclusions: The efficacy of BMI in determining childhood obesity may be less than expected and it appears that FMI in comparison with BMI, is a better indicator of obesity in children, but more studies in this area are required.

Background: Finding a reliable diagnostic method for brucellosis is the most challengeable problem. In this study we determined the optimal diagnostic cut-off point for ELISA test.Methods: We gathered 56 confirmed cases of brucellosis. Furthermore blood samples from 126 controls including 73 healthy controls and 53 without brucellosis febrile patients were collected. In all of the cases and controls ELISA Ig G and ELISA Ig M levels were measured and compared with each other by Box plot graph and the Receiver Operating Characteristic (ROC) curve. The sensitivity and specificity of ELISA Ig G and Ig M were fixed in different cut-off values and Ig G and Ig M levels yielding maximal sensitivity plus specificity were selected for determination of optimal cut-off point.Results: The nineteen patients had positive blood cultures for Brucella melitensis. The standard agglutination test results were 1/160 or more in 54 patients. The Box plot graph indicated a high degree of dispersion for Ig G and Ig M data in patients with brucellosis compared with febrile patients without brucellosis and healthy controls. We observed partial overlap for Ig M data (not for Ig G) between cases and controls. The area under ROC curve for discrimination of cases and healthy controls was more for Ig G than Ig M.Conclusions: The ELISA Ig G is more reliable test than ELISA Ig M in diagnosis of brucellosis. Using cut-off of 10 IU/ml and 50 IU/ml have the most sensitivity (92.9%) and specificity (100%) for ELISA Ig G test, respectively. 

Background: Data mining as a multidisciplinary field is rooted in the fields such as statistics, mathematics, computer science and artificial intelligence and has been gaining momentum in scientific, managerial, and executive applications in health care. Data mining can be defined as the automated extraction of valuable, practical and hidden knowledge and information from large data. Applying data mining in medical records and data is of utmost importance for health care givers and providers and brings vital and valuable outcomes. Data mining can help doctors come up with better recommendations and plans for treatment which actually in many respects have significant impact on patients’ life and satisfaction In this paper we have proposed and utilized data mining methods to extract hidden information in medical records of pelvis stone patients with ureteral stone. We have tried to design a decision support system model to be applicable for selecting type of treatment for these groups of patients. Methods: We gathered needed information from Shahid Hashemi Nejad hospital. In this research we have used decision tree as a data mining tool, for selecting suitable treatment for patients with ureteral stone. This model can predict probability of success of each treatment.Results: In this research we extracted effective attributes in selecting type of treatment for patients with ureteral stone.Conclusions: By using this model we can have eight percent improvement in number of patients who have stone free output after treating. In fact, this model has a better functionality than expert system of hospitals.

Background: Central venous catheter (CVC) related infections are important complications of cathter application. This study assessed the usefulness of mupirocin in prevention and control of these infections.Methods: In this randomized clinical trial, consecutive surgical patients requiring central venous catheter (for more than 2 days) in Amir-Alam Hospital from 2006-2008 were enrolled. Patients were divided in two groups; in “case group” patients received topical mupirocin 2% every 48 hours at the time of insertion of catheter and dressing change and for “control group” mupirocin was not used. All of the patients received chlorhexidine and enoxoparin as complementary treatments. Two groups were comparable in regard of age, sex and risk factors.Results: One hundred eighteen patients enrolled in the study (57 in case and 61 in control group) completed the study. 84 catheters in case group and 88 catheters in control group were inserted. The catheters in 90% of patients were inserted in jugularvein. At the end of study 29(16.8%) patients (16 in control versus 13 in case group) had catheter colonization (p=NS). Catheter related bloodstream infection was observed in 16(9.3%) patients (6 in case versus 10 in control group) (p=NS). Catheter related local infection was seen in 2(1.1%) patients of control versus none of mupirocin group. (p=NS).Conclusions: Mupirocin was not effective to control and prevention of bacterial colonization and catheter related infection.

Background: Cerebral palsy (CP) is a group of nonprogressive motor impairment syndromes with potentially different risk factors and causal pathways which is caused by damage in the very young brain. The etiology of CP is mostly unknown and the prevalence has not decreased in comparison to past decades, although many advances have occurred in obstetric and neonatal care. In fact, it seems that the prevalence might have even increased in term infants. The aim of this study was the evaluation of cerebral palsy risk factors in Iran to compare them with other countries.Methods: In this case-control study, all one to six years old children who were referred to a rehabilitation center from Shahid Beheshti child-health-care centers during the years 2007–2008, with documented cerebral palsy for evaluation of perinatal and neonatal risk factors were enrolled in the study, with matched controls.Results: 112 in the case and 113 in the control group were studied. The main factors associated with CP, were: preterm delivery, neonatal and postnatal seizures, Apgar score of zero to three at twentieth minute after birth, low birth weight, and multiple gestations. The majority of infants with CP were born at term and only 37.8% before 37 weeks.Conclusions: Preterm birth, hypoxic-ischemic encephalopathy and low birth weight were the independent predictors of CP in this population.

Background: Osteoarthritis is the most common form of arthritis in the world. This study presents the evidence on the prevalence of symptomatic hand osteoarthritis in urban community. To add to the evidence on the prevalence of symptomatic hand osteoarthritis in urban community.Methods: Inhabitants (age³15 yrs) in 22 randomly selected districts (Tehran) participated in a Community-Oriented Program for Control of Rheumatic Diseases (COPCORD) evaluating major rheumatic disorders, including osteoarthritis. Eventually, 10, 291 inhabitants completed a Questionnaire (75% response-rate). Trained interviewers asked participants whether they had had any pain, swelling, tenderness, or morning stiffness in the right/ left hand during previous seven days. Participants underwent a complete physical examination if they had any musculoskeletal complaint or extraarticular manifestation of rheumatic disease. Osteoarthritis was defined as presence of palpable nodules (Heberden’s/ Bouchard’s nodes, CMC1’s squaring), pain, tenderness, swelling, or a combination of them on that joint (DIP-PIP-MCP-CMC1). Clinical hand osteoarthritis was positive if at least one joint showed osteoarthritis.Results: Symptomatic hand osteoarthritis was present in 2.8% (CI; 2.3-3.4) (52.6% female, mean age; 37.1±16.3). Prevalence was higher in females (4.3% vs. 1.3%, p=0.000) and increased with age (0.1% in people <30 versus 23% in people >70, p=0.000). The most common signs in the DIP, PIP and CMC1 joints were bony enlargement, followed by tenderness and pain on movement.Conclusions: our study confirms the evidence of high prevalence of symptomatic hand osteoarthritis in an urban community. The prevalence, pattern of hand joints involvement and relationship with age and sex in this study performed in an Eastern community resemble those in Westerners, which calls for further attention by appropriate services.

Background: According to importance of post operative period, admission duration, post operative pain, and acceptable rate of complications, minimally invasive approaches with endoscope in pancreatic pseudocyst management becomes more popular, but the best choice of procedure and patient selection is currently not completely established. During past decade endoscopic procedures are become first choice in most authors’ therapeutic plans, however, open surgery remains gold standard in pancreatic pseudocyst treatment.Methods: we present here a patient with pancreatic pseudocyst unresponsive to conservative management that is intervened endoscopically before 6th week, and review current literatures to depict a schema to management navigation.Results: A 16 year old male patient presented with two episodes of acute pancreatitis with abdominal pain, nausea and vomiting. Hyperamilasemia, pancreatic ascites and a pseudocyst were found in our preliminary investigation. Despite optimal conservative management, including NPO (nil per os) and total parentral nutrition, after four weeks, clinical and para-clinical findings deteriorated. Therefore, ERCP and trans-papillary cannulation with placement of 7Fr stent was performed and led to a dramatic improvement.Conclusions: Endoscopic based approaches must be considered the first line intervention for pseudocyst management and its complications. Complexity and need for technical expertise for endoscopic therapy is rate limiting issue for this approach. Surgical intervention must be reserved for unresponsive patients to minimally invasive treatments. Further investigations need for more complex endoscopic procedures that promote the results.