TEHRAN UNIVERSITY MEDICAL JOURNAL (TUMJ)
Year:2010 | Volume:68 | Issue:5|Papers Count:11

Background: Postpartum depression is a mood disorder that has harmful effects on mothers, infants, family and relationships. Acute decrease of progesterone after delivery has been proposed as a cause for postpartum depression. This hormone can affect neurotransmitters’ function. Zinc (Zn) and magnesium (Mg) as trace elements exert their antidepressant effects through neurotransmitter pathways. On the other hand, thiamin (Vit B1) deficiency leads to depression in animal models. The aim of this study was to evaluate effects of combination of zinc, magnesium and thiamine on postpartum depression and role of nitrergic system.Methods: One hundred ten female mice in five groups were used. Postpartum depression was conducted using progesterone injections. Combinations of Zinc chloride, magnesium chloride and thiamine HCL were administered 30 minutes before open field and forced swimming test (FST). In order to investigate role of nitrergic system, L-arginine and LNAME were administered.Results: All treatment groups spent less immobility time than the control group (p<0.05). Combined administration of Zn+ Mg+ Vit B1 caused the most reduction in immobility time. Administration of L-NAME in Zn+ Mg+ Vit B1 group caused reduction in immobility time while administration ofL-arginine caused increase in immobility time in the same group.Conclusion: Zinc, magnesium and thiamine can improve depressive symptoms by nitrergic pathway. These elements as supplement compounds could be alternatives for antidepressants in postpartum period.

Background: Scorpion envenomation is considered as one of the Public Health problems in some countries in the world including Iran. Annually, approximately 30, 000scorpion stings happen in Iran from which 12% belongs to Hemiscorpius lepturus (special small closely spaced, bead-shaped jointed tail, similar in the shape to a cows tail, and is locally called ‘‘gaodim’’ (Gao, cow; dim, tail)) with95% mortality. The main treatment is antiserum therapy which is produced in horse and is the only way to neutralize the venom. Due to the anaphylactic shock of the horse antiserum in some of the stung patients other source of antiserum is recommended. In this study the ability of produced camel antiserum in neutralizing the scorpion venom of Hemiscorpius lepturuswas performed in Balb/c model.Methods: Camel is an animal model that genetically is compatible with human genome utilized in this research to produce antiserum against scorpion venom. Two camels were used for immunization with the venom of Hemiscorpius lepturus. ELISA method was used to confirm the immunity. Antiserum was produced and used for neutralizing test. The precipitated antiserum with saturated ammonium sulfate (SAS) was also used to perform the neutralizing test in mice.Results: The results indicated that the amount of 200 ml of antiserum and 400 ml of SAS antiserum were able to neutralize the amount of1 LD100 of the venom and the survived the mice from death.Conclusion: The result indicated that camel antiserum against scorpion venom is capable to neutralize the crude venom in mice model. Due to the safety of camel serum in human, it is suggested that the produced antiserum in camel can be substitute with the traditional horse antiserum in scorpion stung patients.

Background: M. pneumonia infection in children is usual and diagnosis of its neurologic complications for rapid treatment is very important. To compare the CSF M. pneumonia antibody level between febrile children with acute neurologic signs (Menigoencephalitis, Guillan Barre Syndrome(GBS), Transverse myelitis, Ataxia and so on) with unaffected ones.Methods: A cross sectional/ case control study in pediatric wards of Rasoul-e-Akram & Mofid hospitals (2007-2009) was done. The amount of Specific M. pneumoniae IgG (ELISA)antibody level determined in CSF of 55 cases and in 10 controls. Chi square values (CI 95%, p<0.05) calculated for all categorical variables. Sensitivity; specificity; Positive Predictive Value (PPV); Negative Predictive Value (NPV) of CSF antibody level determined by using the Area under the ROC Curve.Results: Cases (n=55) aged between five month to 13 years with mean age of 3.84±3.43 years. Area Under Curve (AUC) in ROC was 0.876 (%95 CI, 0.78- 0.96; p<0.0001). Cut off level for antibody was0.0025 with 73% sensitivity; 90% specificity; 100% PPV; 28.8% NPV. CSF antibody level had significant difference between cases and controls [0.08±0.26 Versus 0.001±0.001; p: 0.02]; It had poor agreement between cases and controls (Kappa=0.27). Lowest amount seen in cases with aseptic meningitis; highest amount observed in cases with GBS and cases with focal neurologic signs.Conclusion: The presence of very low amount (0.0025) of M. pneumoniae antibody in CSF of febrile children with acute neurologic signs had 70% sensitivity and 90% specificity; 100% PPV; but had low (28.8%) NPV. M. pneumoniae would be a rare cause in cases with aseptic meningitis. Finding the M. pneumoniae -DNAs in CSF are not so frequent(2%) but in high suspicious cases adding this test to determining the CSF antibody level might be helpful.

Background: Preeclampsia, a specific syndrome in pregnancy, may summits mortality or morbidity in mother and fetus. Diagnostic methods are based on 24 hours urine protein measures which may be tedious, thus it is desirable to apply a faster and more applicable method for this goal. In this study we evaluate measurement of 8-hours urine protein in order to estimate 24-hours urine protein measure.Methods: Fifty pregnant women were entered in a cross sectional study in Vali-e-asr hospital located in Tehran- Iran, during 2008-2009. A urine sample was given after 8-hours and urine volume as well as protein levels were calculated and compared with the same values of 24-hours urine measures. Other necessary data was obtained by history taking and physical examination as well as using patient's medical records.Results: Mean of age was 27.5±5.4 years and mean of gestational age was 30.5±4 weeks. Mean of urine protein in8 and 24 hours urine protein were 79±119 and 532±1218 mg respectively. Sensitivity, specificity, positive predictive value and negative predictive value of8 hours urine protein were 61%, 98%, 88% and 90% respectively, in order to diagnosis of 24 hours urine protein to consider cut off point 105 mg for 8 hours urine protein. Mean protein levels were significantly higher in group with proteinuria ≥300 mg/24h in these two types of urine samples (p<0.001).Conclusion: Sensitivity of 8-hours urine protein is low but its specificity is suitable for normal mothers. We offer measuring of 8-hours urine protein as a valuable method for diagnosis of preeclampsia.

Background: Estimation of Left Ventricular End Diastolic Pressure (LVEDP) among patients with Mitral Stenosis (MS) helps to diagnose diastolic dysfunction and to explain their symptoms. However, Conventional Doppler measurements have limitation in predicting of LVED P. This study sought to establish whether the correlation between measurements derived from Tissue Doppler echocardiography and LVED Premains valid in the setting of severe mitral stenosis.Methods: Thirty three patients with moderate to severe MS who had indication for left heart catheterization enrolled during1387-88 in Imam Khomeini Hospital in Tehran, Iran. The mean diastolic transmitral pressure gradient and mitral valve area (MVA) were calculated, and Two-dimensional, M-mode, color Doppler and tissue Doppler Imaging indices such as: early diastolic mitral inflow velocity (E), annular early diastolic velocity (Ea), E/A ratio, Isovolemic relaxation time (IVRT), Pulmonary Vein systolic and diastolic flow velocities, Velocity Propagation, LA size, TE-Ea, Tei Index were obtained in maximum three hours before cardiac catheterization. The echocardiography analysis was performed offline without knowledge of hemodynamic data Linear correlation and multiple linear regression were used for analysis. p<0.05 was considered significant.Results: In univariate analysis, E/Ea was associated with LVEDP significantly (p=0.04, r=0.38). There was also a significant correlation between TE-Ea and LVDP (p=0.01, r=-0.44). In multiple linear regression Tei Index (b=0.4, p<0.02), and TE-Ea (b=0.5, p=0.02) were showed as independent predictors of LVEDP (R2=49%).Conclusion: Although we observed a moderate correlation between Doppler measurements and  LVEDP in patients with severe MS, more similar studies are required.

Background: There are multiple diagnostic methods for evaluation of patients with low back pain with a radicular pattern, each one has it’s own accuracy and diagnostic ability and so comparing them with each other would help the clinicians to find the best diagnostic method. The main objective of our study was to compare the diagnostic accommodation of electromyography (EMG) and Magnetic Resonance Imaging (MRI) findings in patients with low back pain and radiculopathy.Methods: In this descriptive cross-sectional study, 101 patients with low back pain and radiculopathy attending to Sina Hospital in Tehran, Iran from 2007 to 2009 that had indication for both EMG and MRI were evaluated for their demographic characteristics and disease-related factors.Results: Totally, 90 out of 101 patients (89%) had abnormal EMG findings and 94 out of 101 subjects (93%) had abnormal MRI results. The concordance rate was 88% (89 patients) with no significant difference (p>0.05). The sensitivity and specificity of MRI were95.6% and 27.3%, respectively, and the sensitivity and specificity of EMG were 91.5%and 60%, respectively.Conclusion: According to the results of this study and in comparison with other studies it may be concluded that MRI and EMG are both accurate and use of them in a concomitant manner would result in increased diagnostic ability in patients with low back pain and radiculopathy.

Background: The Bispectral Index (BIS) is an EEG-derived value that measures the sedative and hypnotic component of the anesthetic state. The effects of age on the bispectral index have not been well documented. The objective of the present study was to determine the influence of age on hypnotic requirement and bispectral index in awake and in patients with sedation induced by midazolam.Methods: Eighty patients were enrolled in this prospective observational study. The patients in study group were aged more than70 years, and the age in control group ranged20-40 years. Baseline recording of BIS was taken in awake patients in two groups for few minutes. Five minutes after administration of0.02 mg/kg IV midazolam the BIS value also was taken and recorded.Results: In the study group, patients had a mean base BIS 94±3 compared with 97.3±1 in the control group (p<0.0001). Five minutes after administration of 0.02 mg/kg midazolam the value were 80.9±6 and 90.4±3 respectively (p<0.0001).Conclusion: When BIS is used as a monitor of hypnosis in the elderly, we recommend that a baseline recording be taken before induction for a few minutes to alert the anesthesia provider to the possibility of low initial values. Further studies are needed to verify if the recommended range of50-60 of BIS during clinical anesthesia is also adequate in the elderly with low initial baseline BIS or if this range needs adjusting in view of reduced initial BIS value.

Background: Systemic Lupus Erythematosus (SLE) is a prototypic autoimmune disease with diverse clinical manifestations in association with autoantibodies to components of the cell nucleus. SLE as a chronic autoimmune disease has a worldwide distribution. There is a wide variation in the natural history of SLE among different ethnic and geographic groups. Our SLE registry is one of the largest series in Asia-Pacific region. The aim of this study was to show the manifestations of SLE in Iranian patients.Methods: This study is on clinical and Para clinical manifestations of SLE according to the database of the Rheumatology Research Center (RRC), Tehran University of Medical Sciences as a major referral center for rheumatic disease in Iran during the period of1976 to 2009.Results: A total of 2143 SLE patients were studied. The female to the male ratio was 8.8: 1and the mean age at the presentation was 24.2±10 Years. Prevalence of clinical manifestations included: musculoskeletal, cutaneous, renal, neuropsychiatric, pulmonary, cardiac and hematologic were 85.2%, 83.1%, 66.6%, 24%, 22.3%, 17.5% and 67.1%respectively. There were seen positive FANA in 78.3% and anti-DNA in 70% of patients. Overlap syndrome and positive family history with other autoimmune diseases were detected in14.9% and 3.4% of patients respectively.Conclusion: The prevalence of some manifestations (such as cutaneous and renal involvement) in our patients were similar to those of nearby countries (with similar climate), while other manifestations (such as hematologic and joint involvement) were similar to the European countries (with similar ethnicity). Genetic and/or climatic factors may lead to different presentations of lupus.

Background: Central venous catheters are useful instruments in monitoring of critical patients and are important roots for total parentral nutrition. The catheters are widely used in general wards and intensive care units. Their use may be associated with serious and rare complications.Case presentation: We reported a 24 years old woman that admitted to Ghaem hospital Mashhad University of Medical Science, in Mashhad, Iran, because of penetrating chest wall injury and surgical exploration indicated due to massive hemorrhage. Central vein (right jugular vein) was canulated for resuscitation and monitoring. Superior vena cava was injured after canulation and presented with delay massive mediastinal hematoma.Conclusion: We aim to introduce this rare complication and its management. This management could be conservative or surgical intervention according to severity of the vein damage.