TEHRAN UNIVERSITY MEDICAL JOURNAL (TUMJ)
Year:2018 | Volume:75 | Issue:11 |Papers Count:16

Cancer is the major cause of death in the world and the rate of mortality is higher in developed countries. Therefore, lifestyle could be effective in promoting the cancer. The pancreatic tumors, are 8th cause of mortality due to cancer, which have several types, among them ductal adenocarcinoma is the most common and includes 85% of cases. Since, it is almost impossible to diagnosis the tumor in early stages of the disease, it contributes to high rates of mortality, although if it diagnosis in early stage and the surgery performed for them only 10-20% of patients will be survived. Metastasis occurs when the tumor is smaller than 2 cm in size and because the pancreas is located in the depth of abdomen, typically, it happens after tumor is spread to other organs. A combination of medical imaging, blood tests, and examination of tissue samples are usually made for diagnosis and based on the cancer stage, surgery, radiotherapy and chemotherapy are chosen as treatment options. Some rare genetic variations can cause pancreatic cancer and about 5-10% of cases are linked to inherited genes. However, major risk factors are including age, obesity, tobacco smoking and diabetes. Smoking counts for about 25% of cases, and the diabetes is the main symptoms of pancreatic cancer, which observed in about 80% of cases. But, it is still unclear whether diabetes is a predisposing factor in pancreatic cancer, or the outcome of tumor progression. Recent studies have shown that, diabetes is unique in pancreatic cancer which is not related to common types. Currently, CA 19-9 is the only reliable tumor marker for pancreatic cancer that its frequency also increases in non-bad conditions, such as pancreatitis and obstructive jaundice, so is not sensitive and specific enough for diagnosis of this cancer. Due to researches continue to find more specific markers. In this review the etiology of pancreatic cancer, diabetes associated with this type of cancer and significant biomarkers for diagnosis will be considered.

Before the recent outbreaks of Zika virus, few people have ever heard of its name. Even virologists had paid little attention to this member of the Flaviviridae family. Hence, up to January 2016, only 269 articles about Zika virus had been indexed in PubMed compared to the 9187 articles related to dengue virus. However, declaration of the World health organization (WHO) about the global Zika virus spreading, which has been associated with birth defects and some neurological problems, diverted more attention to this forgotten virus. Afterwards, the virus hit the headlines and became a research interest. Since then, up to 9 August 2017, the number of Zika related articles indexed in PubMed reached to 3214. Zika virus is a re-emerging arbovirus. The First detection of Zika virus was in Uganda in 1947. It belongs to the Flavivirus genus in the Flaviviridae family. Zika can typically cause a mild and self-limiting disease in a healthy person. However, in pregnant women, it might cause birth defects and occasionally it can be associated with peripheral neuropathy such as Guillain-Barre syndrome. Although many research have been conducted to find out the casual link between this virus and these disorders but this relationship is still dim and controversial. Considering its recent epidemics in 2015 and 2016 the geographical distribution of Zika virus seems to expand all over the world progressively. Interaction between virus and vector is dynamic. Variety of competent vectors and adaptability of virus to new arthropod vectors are the two major factors for this process. According to the last report published by WHO, 84 countries/territories in five continents have reported the circulation of Zika virus in their area. In the recent outbreak, WHO regional office in our region (EMRO) have reported no case of Zika virus transmission from this region. Nonetheless, because specific and competent vectors exist in some countries, this region has a potential of epidemic risk. Until now we have neither autochthonous nor imported case of Zika virus in our country but we should prepare for any unexpected situation. In this review, we will discuss new findings about the history, virological features, vectors, transmission routes and epidemiological aspects as well as laboratory diagnosis of Zika virus. In addition, the epidemiology of this virus in Iran will be discussed.

Background: Burns is a major health problem due to severe side effects and limited financial resources. Some herbs are cheap and available, such as Arnebia euchroma can be effective treatment of burn wounds and reduce recovery time. The aim of this study was to evaluate the effect of Arnebia euchroma ointment on healing of deep second-degree burn wound in rats. Methods: This experimental study was conducted in animal laboratory of Hazrat Fatemeh Hospital in 2015, Tehran. In this study 24 male Sprague-Dawley rats weighing approximately 300 to 350 g were selected. After general anesthesia, back of each rat was shaved with clipping device. Then second-degree burn with the area of 2×4 cm was induced on them. Rats were randomly divided into 2 groups, 12 in each. The surface of the wound in the first group was covered with Arnebia euchroma ointment and in the second group with Vaseline. Dressing was done daily until complete recovery and the wound healing process was monitored by photographing every five days. On day 20, the samples were sent for pathological evaluation of the amount of collagen and inflammatory cells. Results: Results showed that, during days from 5 to 15 the extent of the wounds reduced in both groups (P= 0. 000). The reduction of wound size was significantly higher in Vaseline group compared to Arnebia euchroma ointment group (P= 0. 040). The results of the pathological examination showed no significant difference in the amount of collagen and inflammatory cells in the two groups. Conclusion: It seems Arnebia euchroma ointment to some extent reduced the extent of the wound especially in superficial burns compared to other dressings. However, it is better to conduct more similar studies with a larger sample size and different method and change in timing of dressing.

Background: The prevalence of diabetes mellitus due to existence of various factors is growing rapidly. The insulin resistance phenomenon is one of the main underlying causes of this disease, due to various reasons such as a decrease in serum levels of vitamin D3. In this study, we evaluated the relationship between plasma level of vitamin D3 and some other main plasma factors. Methods: This clinical trial study carried out on type 2 diabetes mellitus subjects who referred to diabetes clinic of Baqiyatallah Hospital in Tehran city during June to September 2016. First demographic data of all patients were collected. Then the blood samples for evaluation of blood glucose, HbA1c, triglyceride, cholesterol, HDL, LDL and vitamin D3 were obtained. Based on plasma level of vitamin D3, diabetic subjects were divided into two separate treatment groups (with and without vitamin D3 deficiency) and then above-mentioned factors were compared between these two groups. Afterward, in group with vitamin D3 deficiency, treatment by vitamin D3 triggered (50000 unit per week for eight weeks orally) until plasma level of vitamin D3 reached above 30 ng/mL. Then, treatment continued by vitamin D3 (50000 Unit per week orally) and calcium (1. 5 g/day PO) until 60 days. Finally, the patients were evaluated about fasting blood glucose, HbA1c, HDL, LDL and blood pressure. Results: In total, 187 subjects (99 men and 88 women) were evaluated in this study. Total hypovitaminose incidence was 0. 65% which was higher in subjects with higher body mass index (BMI). Serum content of vitamin D3 and calcium, significantly changed the values of fasting blood sugar (FBS), HbA1c, HDL and TG, but has no significant effects on other factors. Conclusion: Our results clearly revealed that hypovitaminose vitamin D3 is one of the main factors that can leading to rise in plasma glucose and dyslipidemia occurrence. Also, our data are demonstrated that treatment by vitamin D3 and calcium can modify fasting blood glucose and dyslipidemia in type 2 diabetes mellitus subjects.

Background: In three-dimensional conformal radiation therapy (3D-CRT), contrast-enhanced CT (CECT) image is commonly used to assist radiation oncologists in diagnosing regions of interest, so that normal and target tissues can be better delineated. CECT causes the temporary increase in the CT number and the corresponding electron density (ρ e). Administrated contrast agents (CA) during CT simulation and altering the ρ e of structures can be effective on radiation calculations and dose-volume histograms (DVHs) in radiotherapy treatment planning. Therefore, present study was designed and performed to determine the influence of the administrated CA on DVHs. Methods: Current study performed as a self-controlled clinical trial study with before/after method at Imam Reza Hospital, Kermanshah City, during the period from June 2015 till August 2016. Ten patients with pelvic cancer included in this study through simple sampling. Cases with prior reactions to CA, diabetes, renal diseases, and asthma were excluded. Two sets of CT-scans were taken for each patient in the same position and coordinates. Primary study sets contained pre-contrast images and secondary study sets were performed post-contrast. Both sets of CT images were transferred to the treatment planning system (ISOgray® software, Version 4. 1. 3. 23 L, DOSIsoft® , Cachan, France). All treatment plans were generated on pre-contrast and subsequently copied to the post-contrast CT. Quantitative calculations were performed in treatment planning including the difference in ρ e before and after CA administration. Results: The prostate (1. 27%), the bladder (0. 62-0. 79%) and the rectum (0. 43-0. 56%) showed the largest changes in average ρ e increase. The results confirm the expected relationship of increasing attenuation, CT number, and ρ e with increased tissue density due to the CA. However, the DVHs showed insignificant difference between pre-and post-contrast CTs for 18 MV photon beam. Conclusion: The results showed statistical insignificant difference between with and without CA CTs treatment plan in pelvic field for targets and OARs. These results may serve as a reference to justify the use of CECT data sets for 3D-CRT planning of pelvic region cancers using DosiSoft ISOgray system.

Background: Hepatitis A is one of the most common viral infections in the world. In children, the manifestations of infection are usually milder but in adults they are more severe. The risk of acute hepatic failure increases when the infection occurred in the older ages. The aim of the study was to evaluate of serum hepatitis A antibodies in children. Methods: This cross-sectional study was performed on two hundred children (two groups of hundred individuals each) aged 6 months to 10 years old hospitalized in the emergency department of Taleghani Hospital (Gorgan city) from May to July 2016. The first group aged 6 months to 3 years and the second group 3 to 10 years old. After obtaining the parental consent, 3 ml of blood sample were taken to determine immunoglobulin M (IgM) against HAV using commercial ELISA kits (Dia. Pro Diagnostic, Milano, Italy) and the children’ s’ demographic data were recorded. Results: The study was conducted on two hundred children. Of these patients 127 (63. 5 percent) were boys and 73 (36. 5 percent) girls. Overall, 11 percent [twenty-two patients including eight (8 percent) in the first group and Thirteen (13 percent) in the second group] were serologically positive for hepatitis A. There was no significant difference between the groups in terms of age and sex. (P= 0. 239) and (P= 0. 535). Only 11 percent of children under 10 years old were infected by hepatitis A and 89 percent of children had no history of contact or infection. Conclusion: Based on this study, the incidence of hepatitis A infection was about 11% in children under 10 years old, which indicates a reduction in exposure with this virus. It may seem reasonable based on health policy but the adverse effect of this trend is later probability of contacts with Hepatitis A patients and occurrence of HAV in older ages. Therefore, we can conclude that HAV infection has been shifted to older ages.

Background: Infertility is clinically defined as failure of a couple to conceive after one year of regular sexual intercourse and occurs in both males and females for various reasons. About half of the infertility causes is due to male factors such as azoospermia and the lack of sperm in the ejaculate. Azoosperima is divided into two types: Non-obstructive azoospermia (NOA) and obstructive azoospermia (OA). NOA is a type of male infertility caused by spermatogenesis defects. Therefore, investigating the factors involved in spermatogenesis, including hormones and genes, is one of the important aspects in understanding the mechanism of infertility in men. To this end, we aimed to investigate the expression of the clusterin gene expression and LH, FSH and testosterone hormone levels in the testicular tissue and blood of NOA patients, respectively. Methods: The study population included 42 NOA infertile men referred to Royan Institute, Tehran, Iran in June 2016 to February 2017. Their blood samples were collected and testosterone, LH and FSH hormones were measured by ELISA. Afterwards, based on the biopsy results the patients were categorized into TESE+ (positive sperm retrieval) and TESE-groups. The genomic RNA was extracted from testicular tissue samples obtained from TESE surgery. After converting to cDNA, the clusterin gene expression was investigated by Real-time PCR technique. The achieved data was analyzed using SPSS software, version 18 (Armonk, NY, USA). Results: According to Real-time PCR results, the expression level of clusterin gene in TESE+ group was significantly higher than TESE-group (P= 0. 035). The mean of FSH and LH hormone levels in the TESE+ group was relatively lower than the TESE-group (P= 0. 07 and P= 0. 08), but there was no significant difference in the mean of testosterone hormone levels between the two groups (P= 0. 66). Conclusion: Based on the results of this study, the clusterin gene can have a role in spermatogenesis and by evaluating FSH and LH hormones in a larger non-obstructive azoospermic patient’ s population significant statistical results can be achieved.

Background: Hepatitis E virus (HEV) is from Hepeviridae family and genus Hepevirus. This virus is in 4 genotypes. These 4 genotypes are classified in 2 classes. In first class there are genotypes 1 and 2 which are specific for human. Genotypes 1 and 2 are not developed to chronic hepatitis is spite to genotypes 3 and 4 which may develop to chronic hepatitis in immunocompromised patients. It should say that in middle east genotypes 3 and 4 are not frequent. One of the immunodeficiency syndrome is human immunodeficiency virus (HIV) infection in which in the late phases of the disease the power of the immunity will be severely decreased in the patients. Therefore, in patients with HIV infection, HEV (specially genotypes 3 and 4) may be a problem and it may progress to a chronic viral hepatitis which may lead to liver failure. Therefore, it may need treatment and prophylactic strategies in some areas. The aim of this study was to evaluate the frequency of HEV infection in HIV patients by molecular assay. Methods: This descriptive, cross-sectional study was conducted on 111 random selected, known HIV infection patients in 2016 in Isfahan, Iran. This study was done under supervision of Immunodeficiency Research Center of Isfahan University of Medical Sciences. The criteria for enrolling in the study, was positivity of HIV infection, and samples were selected from all known HIV infected patients in Isfahan. After blood sampling from the selected patients, HEV RNA was surveyed by RealStar® HEV RT-PCR Kit 1. 0 (Altona Diagnostics, Hamburg, Germany). At the end, after isolation of HEV RNA, the cDNA was prepared and evaluated. Results: Patients were between 5 to 68 years old and mean of the patients age was 38. 5± 11. 5 years. 75 (67. 6%) and 36 (32. 4%) of the patients were men and women respectively. Mean count of the CD4 cells in these patients was 317. 2± 187. 8. HBsAg and HCVAb was positive in 6 (5. 4%) and 39 (35. 1%) of them. No one of the studied patients were positive for HEV infection. Conclusion: On the results of this study, there is no chance for having hepatitis E infection in Iranian HIV patients. Therefore, it seems that, hepatitis E is not an important problem in this group of patients in Iran.

Background: One of the important effects of kangaroo mother care (KMC) in preterm baby is improvement in weight gain and so shortening in hospitalization, but it is not clear that how long of kangaroo mother care is effective in weight gain. The aim of this study was to determine the least effective duration of kangaroo mother care in weight gain in very low birth weights. Methods: Preterm babies with birth weight less than 1500 gr, without chronic cardiopulmonary disease, congenital anomaly and other medical problem when receiving to 140 ml/kg/d enteral feeding enrolled the study. KMC was started when the baby has been stabled, on the mother’ s appetency and ability at bedside. The mean daily weight gain in KMC period was compared with expected that (15 mg/kg/d) for the same baby. The babies with KMC≥ 7 days were divided in three groups on the basis of mean daily KMC duration (< 30 min, 30-60 min and> 60). Statistical study performed by using SPSS software, version 22 (IBM SPSS, Armonk, NY, USA) and P values of less than 0. 05 were considered to be significant. Results: In this study, 103 preterm baby (47 boys, 56 girls) less than 1500 gr were enrolled, with mean birth weight 1107. 85± 190. 87 gr. Mean weight gain of boys in KMC period and expected that were 324. 78± 162. 66 gr Vs. 127. 46± 54. 66 gr (P< 0. 001). In eighty-seven babies who received KMC (7-40 days) mean daily weight gain was 26. 69± 15. 55 gr (P< 0. 001). Mean weight gain in KMC period for group with< 30 min (n=19), 402. 63± 126. 29 gr Vs. 167. 21± 74. 20 (P< 0. 001), group with 30-60 min (n=54) were 338. 79± 182. 60 gr Vs. 220. 36± 66. 98 (P< 0. 001) and group with 60< (n=14) 352. 14± 236. 02 gr Vs. 259. 96± 112. 23 (P= 0. 09). Conclusion: On the basis of this study KMC less than 1 hour per day is effective in weight gain of very low birth weight preterm babies.

Background: 2-phenylethanol is a colorless and aromatic compound with antimicrobial effects which is used extensively in perfumes and cosmetics, as well as in the food industry. Chronic vulvovaginal candidiasis is a vulvovaginal inflammation which is caused by Candida spp. Resistance to clotrimazole which is one of the most common drugs in the treatment of this disease was reported in many patients. In order to improve the treatment, the effect of 2-phenyl ethanol was investigated in combination with clotrimazole on Candida species isolated from chronic vulvovaginal candidiasis. Methods: This interventional study was performed in Iran University of Medical Sciences from February, 2016 until December, 2016 on Candida species isolated from women with chronic candidial vulvovaginitis who had been referred to Lolagar Hospital of Tehran. All specimens were examined by direct microscopy, culturing on Candida CHROMagar medium (to primary identification), sabouraud dextrose agar medium) to preservation the isolates) and determining the internal transcribed spacer (ITS) sequence (in order to final determination of Candida species). Then clotrimazole and 2-phenyl ethanol alone and in combination, was examined on isolated species, according to Clinical and Laboratory Standards Institute (CLSI) M27-A3 protocol (micro-broth dilution method). Finally, findings were analyzed. Results: From 40 detected strains of Candida species in this study, 95% were Candida albicans and 5% were Candida africana. The mean minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC) of clotrimazole were 24. 73± 28. 87 µ g/ml and 30. 18± 33. 004 µ g/ml, respectively and the mean MIC and MFC of 2-phenylethanol were 2580± 932. 38 µ g/ml and 3200± 1403. 29 µ g/ml, respectively. The MIC50 and MIC90 of clotrimazole were 16 and 64 µ g/ml, respectively. The MIC50 and MIC90 of 2-phenylethanol were both 3200 µ g/ml. Most of the isolates were resistant to clotrimazole (82. 5%). In combination test, the mean MIC of 2-phenylethanol and clotrimazole alone were 3200± 0 µ g/ml and 56± 40. 16 µ g/ml, respectively. The fractional inhibitory concentration index (FICI) range was 0. 14-0. 37. Also, there was a significant difference between clotrimazole MIC values alone and in combination (P= 0. 021). Conclusion: The synergistic effect was observed in combination of clotrimazole and 2-phenylethanol.