TEHRAN UNIVERSITY MEDICAL JOURNAL (TUMJ)
Year:2013 | Volume:71 | Issue:9|Papers Count:13

Low birth weight (LBW) and preterm birth are one the most important causes of death in the world and therefore are considered as one of the major health problems. Global statistics demonstrates an increase in the prevalence of low birth weight in the developing countries. Low birth weight infants are exposed to complications such as major neurosensory impairements, cerebral palsy, cognitive and language delays, neuromotor developmental delay, blindness and hearing loss, behavioral and psychosocial disorders, learning difficulties and dysfunction in scholastic performances. The majority of infant's death and developmental disorders were due to disorders relating to prematurity and unspecified low birth weight. Infants weighing less than 2500 g, is a major determinant of both neonatal and infant mortality rates and, together with congenital anomalies (e.g., cardiac, central nervous system, and respiratory), contributes significantly to childhood morbidity. Various studies indicate that low birth weight infants are suffering from physiological and psychosocial disabilities, two to three times more than the other children. At school age, preterm and low birth weight infants have poorer physical growth, cognitive function, and school performance. These disadvantages appear to persist into adulthood and therefore have broad implications for society. Although the survival rates have increased dramatically and the incidence of morbidities has decreased, the complications are still considered to be associated with economical and social burdens. Most children with Low birth weight suffer from multiple disabilities. Therefore, they need special and consistent care. On demand of reducing the infant mortality rate, the need to decrease the complications in low birth weight and preterm infants should be considered by the policy makers in health care system. In this review article, we assessed current evidences on developmental outcomes of low birth weight and preterm newborns.

Background: Aspirin is the drug of the century, and is a multifunctional drug and one of the most prescribed drugs in the world. Aspirin is a safe drug at low doses but also it has life-threatening side effects when administered at high doses. This study investigates the effects of aspirin on renal cortical and medullary tissue in rat embryos.Methods: In this study, 30 pregnant female rats were randomly divided into 6 groups. Control group with no intervention, sham group received 2 ml distilled water (as a solvent of aspirin) received from days 8 to 20 of pregnancy, and four experimental groups received different doses of 75, 100, 200 and 300 mg/kg of aspirin by gavage. Pregnant rats were sacrificed on the twenty days of pregnancy and the fetuses were removed. Weight of the fetuses and placenta and Crown-Rump length were measured. Fetal kidneys were fixed in formalin processed, sectioned and stained with Hematoxylin- Eosin. Thickness of renal cortical and medullary tissue by using a Motic hardware and software system were measured and recorded. A significance level of 0.05 was predetermined for all statistical analyses.Results: No apparent fetal anomalies were observed in experimental groups. In addition, no significant differences were shown in the mean of fetal weight, placental weight, mean of Crown-Rump length in experimental groups 75, 200 and 300 mg/kg compared to control and sham groups. Mean fetal and placental weight in experimental group 100 significantly increased compared to control and sham groups. Mean ratio of renal cortex to renal medulla in experimental group 75, 100 and 300 were significantly decreased compared to control and sham groups (respectively P= 0.03, P= 0.013, P= 0.03).Conclusion: It seems that maternal use of aspirin during pregnancy can not cause fetal abnormalities. However, it can cause some changes in renal cortical and medullary tissue of rat embryos.

Background: Choosing the right drug with the least side effects and highest effectiveness for the control of seizures in the elderly is important. The aim of this study was compare the efficacy of lamotrigine and levetiracetam in the management of epilepsy in the elderly.Methods: This study was performed as a double-blind randomized clinical trial in patients that referred to the neurologic clinic at Sina University Hospital, Tehran, Iran in 2012. The patients over sixty years old with a diagnosis of epilepsy were selected. They had one seizure in year at least and one attack in the last 6 months. First, the patients divided to two groups; Group one were treated with lamotrigine, 25 mg per day and group two were treated with levetiracetam, 250 mg per day for 24 weeks. In the absence of drug complications, the dose was increased to the maximum dose listed in the treatment protocol. Second the patients were followed in number of attacks, abnormalities in laboratory data and side effects of drug in 2, 4, 8, 12 and 20 weeks. The collecting data of the study were analyzed using descriptive and analytical statistics methods.Results: Forty nine cases, 28 males and 21 females in lamotrigine group and 46 cases in levetiracetam group, 27 males and 19 females participated in the final analysis. Mean age of patients was 72.40±5.87 (63-85). Drug side effects were observed in 57 cases, 26 cases of lamotrigine group and 31 cases of levetiracetam group. Seizure frequency showed a declining trend in both groups but in lamotrigine group more than levetiracetam group in last week (P=0.039).Conclusion: The findings of the study showed lamotrigine and levetiracetam were effective in management of epilepsy in the elderly. Levetiracetam has a higher seizurefree effect than lamotrigine but lamotrigine is better tolerated than levetiracetam.

Background: Acquired paralysis of the diaphragm is a condition caused by trauma, surgical injuries, (lung cancer surgery, esophageal surgery, cardiac surgery, thoracic surgery), and is sometimes of an unknown etiology. It can lead to dyspnea and can affect ventilatory function and patients activity. Diaphragmatic plication is a treatment method which decreases inconsistent function of diaphragm. The aim of this study is to evaluate the outcome of diaphragmatic plication in patients with acquired unilateral non-malignant diaphragmatic paralysis.Methods: From 1991 to 2011, 20 patients with acquired unilateral diaphragmatic paralysis who underwent surgery enrolled in our study in Ghaem Hospital Mashhad University of Medical Science. Patients were evaluated in terms of age, sex, BMI, clinical symptoms, dyspnea score (DS), etiology of paralysis, diagnostic methods, respiratory function tests and complication of surgery. Some tests including dyspnea score were carried out again six months after surgery. We evaluated patients with SPSS version 11.5 and Paired t-test or nonparametric equivalent.Results: Twenty patients enrolled in our study. 14 were male and 6 were female. The mean age was 58 years and the average time interval between diagnosis to surgical treatment was 38.3 months. Acquired diaphragmatic paralysis was mostly caused by trauma (in 11 patients) and almost occurred on the left side (in 15 patients). Diagnostic methods included chest x-ray, CT scan, ultrasonography and sniff. Test prior to surgery the average FVC was 41.4±7 percent and the average FEV1 was 52.4±6 percent and after surgery they were 80.1±8.6 percent and 74.4±1 percent respectively. The average increase in FEV1 and FVC 63.4±4, 61.1±7.8. Performing surgery also leads to a noticeable improvement in dyspnea score in our study.Conclusion: In patients with acquired unilateral non-malignant diaphragm paralysis diaphragmatic plication is highly recommended due to the remarkable improvement in respiratory function tests and dyspnea score without mortality and acceptable morbidity.

Background: Various surgical procedures were described for the correction of the external genitalia in male-to-female transsexualism. In all these methods complications such as vaginal stenosis, unpleasant appearance of external genitalia and lack of consent are seen. This paper describes a method of surgery for repair of these complications and success rate of this surgery.Methods: Reconstructive surgery was performed by one surgeon in 16 patients from 2009 to 2011 in Imam Reza Hospital of Mashhad. Mean age 25.75 years of age from 21 to 31 years. Due to the condition of each patient appropriate reconstructive surgery was performed. These surgeries include: clitoroplasty, inverted U flap, labioplasty, urethroplasty, removal of excess skin and increasing depth of vagina. After the surgery, the patients admitted for complete bed rest up to 5 days. They received postoperative prophylaxis medication for anti-thromboembolic events.Results: Only 3 complications were seen in all 16 patients. One hematoma of surgery site, one infection of surgery site and a blood transfusion. Eleven patients had history of vaginoplasty using small intestine and 10 patients with penile and perineal skin. From 3 to 24 months follow up after discharge were done, no patient had a major complication in long-term follow up and were generally satisfied with their sexual intercourse.Conclusion: This study has some limitations. Follow-up of the patients was performed for about one year that longer follow-up for these patients is favorable. Also, evaluation of patients' satisfaction from their intercourse was not performed as systematically with using an standard questionnaire and by a person who is blind to the study. Using this method of restoring external genitalia in the hands of expert surgeon, aesthetic and functional result would be expected very well.

Background: Advanced glycation end-products (AGEs) came up with the recent researches regarding new biomarkers for the diagnosis of heart failure. AGEs are the end products of non-enzymatic glycation and oxidation of proteins, lipids and nucleotides during Maillard biochemical reaction. Although it has been known that AGEs have a role in the pathogenesis of chronic heart failure (CHF), information regarding its role and its pathogenetic mechanism is very limited. The aim of this study was to find any relationship between AGEs with the etiology and severity of chronic heart failure.Methods: This study is a prospective cross sectional study that enrolled 85 patients with chronic heart failure. Measurement of left ventricle ejection fraction (LVEF) was done by echocardiography. Blood samples were collected for measuring AGEs just before or after echocardiography assessment (in the same session). Measurement of AGEs was done by the enzyme-linked immunosorbent assay (ELISA) method. The relationship between AGEs with the severity of CHF and as well as the etiology of CHF were evaluated via SPSS-15.Results: Of 85 patients 48 (56.5%) patients were male and 37 (43.5%) were female; Mean±SD of their ages was 55.8±13.4 years old (ranges from 27 to 84 years). Correlation coefficient between LVEF and AGEs was 0.269 (P=0.013). Mean of AGEs in patients with and without ischemic etiology of their heart failure were 16.8±9.8mg/ml and 11.6±7.3 mg/ml, respectively. Although trend was in favor of ischemic heart failure, the difference between two groups was not statistically significant (P= 0.141).Conclusion: According to this study the rate of AGES could be helpful in the diagnosis and assessment of severity of CHF. Based on our findings, higher blood levels of AGEs in the ischemic CHF cases, also it could be concluded that in the future this marker may be used for etiologic differentiation of heart failure syndrome.

Background: Androgenetic alopecia (AGA) is the most common type of progressive balding that appears with early loss of hair, chiefly from the vertex. There has been significant relationship between AGA with coronary artery disease and related risk factors, such as hypertension in some studies. The aim of this study is to investigate the association between androgenetic alopecia with hyperlipidemia.Methods: This cross-sectional study was performed on 112 patients with vertex type AGA (in male grade 3 or higher Hamilton- Norwood scale, and in female grade 2 or higher Ludwig scale) (study group) and 115 persons age and sex matched, with normal hair status (Normal group). None of participants had diabetes mellitus, hypothyroidism, liver disease, kidney disease and none of them had history of smoking and using drugs with effect on serum lipids. They were 20-35 years old and their body mass index were 20-30. Blood samples were obtained following 12 hours fasting status and serum levels of triglyceride (TG), cholesterol, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) were determined using standard laboratory methods. Total cholesterol greater than 240 or TG greater than 200 or LDL greater than 160 or HDL less than 40 in men or HDL less than 50 in women were considered hyperlipidemia.Results: In androgenetic alopecia group 46.4% and 47% of normal group were female. Mean (±SE) of total cholesterol (172.4±3.1, 148.8±3.1, P< 0.001), TG (133.6±5.5, 88.3±4.3, P< 0.001), LDL (96.4±2.9, 84.9±2.7, P= 0.004) and HDL (54.9±2.0, 45.5±0.9, P< 0.001) in AGA patients were higher than normal group. %46.4 of patients and %52.2 of controls had hyperlipidemia. Relationship between AGA with hyperlipidemia was not significant (P>0.05).Conclusion: The findings showed that there is no relationship between AGA and hyperlipidemia. Regarding to high levels of total cholesterol, LDL and triglyceride in AGA patients, it seems that, AGA increases risk of coronary heart disease. To determine a definite association between AGA and hyperlipidemia more studies are recommended.

Background: Adipokines are peptides secreted by adipose tissue that affect whole-body energy metabolism. Exercise training exerts beneficial effects on adipose tissue. However, less is known regarding visfatin’s, IL-6 & TNF-a response to an interval acute training. Therefore, we investigated the effects of acute interval exercise on plasma visfatin, TNF-a and IL-6 levels, in healthy female rats. Furthermore, correlate between changes probably these factors were also assessed.Methods: This study was conducted experimentally. Forty five female sprague dawley rat were randomly divided into three groups: pre test (n= 15), treadmill exercise (n= 15) and sedentary controls (n= 15). The acute alternative exercise consisted of treadmill running: 3 session/ week for 8 week. The changes of plasma IL-6, TNF-a and Visfatin levels were measured by ELISA analysis. Data were analyzed using analysis of variance with measures (ANOVA) and post hoc Tukey test.Results: Acute interval treadmill exercise led to significant decreases in visfatin (P=0.036), IL-6 (P= 0.009) and TNF-a (P= 0.022) plasma levels between the groups. Also, this study no significant correlations between the changes in adipokines were observed.Conclusion: Decreased levels of TNF-α and IL-6 correlated with intensity and duration exercise. Furthermore, probably there were some factors except weight decreasing that affects on visfatin decrease. Therefore, the reduction of this factor may cause in preventing metabolic disease.

Background: Anemia at the time of birth may cause some problem like asphyxia, heart failure shock or even death in a neonate. Different etiologies can be considered for this problem. Parvovirus B19, as a viral organism, can cause hydrops fetalis and neonatal anemia and consequent complications. We present here a case of newborn infant with severe anemia who had human parvovirus B19 infection.Case Presentation: A male newborn with gestational age of 36 week was born from a mother with poor prenatal care and history of contact with domestic animal. The neonate was very pale with Apgar score 2 at 1 min and received resuscitation, mechanical ventilation and repeated blood transfusion The hemoglobin level was significantly low. Analysis was made based on the clinical presentations. According to the case history, physical and laboratory findings, neonatal severe anemia induced by parvovirus B19 infection was suggested and Laboratory work up documented his infection with parovirus B19.Conclusion: Parvovirus B19 (B19 virus) is the smallest single strand linear DNA virus in animal viruses, which is the only strain of parvovirus that is pathogenic in humans. Human parvovirus B19 may cross the placenta and result in fetal infection, morbidity and death. Parvovirus is an uncommon cause of neonatal anemia and hydrops fetalis so this etiology must be considered in differential diagnosis of anemia at birth.

Background: The anatomy of the palmar vascular arches and their variations, being one of the most challenging anatomical regions for reconstructive surgeon. Case Presentation: During a routine dissection of a male adult cadaver in dissection hall of zahedan university of medical sciences, a complex, unilateral and rare variation in the pattern of blood supply to the palm of the right hand was observed. The history of the individual and cause of the death is not known. In this cadaver there was an incomplete superficial palmar arterial arch had no contribution from the radial artery. The superficial palmar arch giving only one common palmar digital artery, that supply second interdigital space and then it terminated by giving rise to a common trunk for princeps pollicis and radialis indicis arteries. Absence of the second and third common palmar digital artery with the contiguous sides of the third and forth interdigital spaces supply by the second and third palmar metacarpal arteries from the deep palmar arch respectively. The third palmar metacarpal artery giving rise to a branch which supplies the medial side of the little finger.Conclusion: Having knowledge of the variations of vascular patterns resulting from a number of developmental errors could provide an important source of information for Anatomists, Radiologist, reconstructive and vascular surgeons.