Tehran University Medical Journal
Year:2005 | Volume:62 | Issue:12|Papers Count:15

Background: Human leukocyte antigen (HLA) class II molecules are encoded by genes in the human major histo compatibility complex (MHC) which is located on the short arm of chromosome 6. The three major class II loci DR, DQ and DP consist of separate A and B genes encoding ab heterodimers responsible for the presentation of peptide antigens to the T cell receptor (TCR) repertoire. The HLA class II molecules have a well-defined role in the cellular immune response. The HLA class II genes are highly polymorphic and most of the polymorphisms are localized in the second exon . The HLA class II molecules have a well-defined role in the cellular immune response and in the bone marrow and organ transplantation.Methods and Materials: To evaluate the accuracy and resolution of different molecular HLA typing methods; 7 WHO DNA samples with known HLA-DRB genotype were typed for DRB genes with PCR-SSP (Sequence specific primers), PCR-SSP-RFLP and PCR-RDB (Reverse Dot-Blot) techniques.Results: The result showed that PCR-SSP and PCR-SSP-RFLP methods were not able to identify all the alleles of the WHO DNA samples while PCR-RDB technique detected all the alleles of the WHO DNA samples with great precision.Conclusion:These results clearly indicate that gnomic typing of HLA class II by PCR-RDB is very sensitive and accurate technique in HLA typing for bone marrow and organ transplantation.

Background: The aim of our investigation is evaluation of sonography value in diagnosis of exudative pleural effusion from transudative and also diagnosis of malignant, infective and tuberculosis effusions. Beside we determine the sensitivity, specify, accuracy ,positive predictive value (PPV) and negative predictive value (NPV) of sonography for diagnosis of these conditions.Methods and Materials: In this study we followed the sonographic findings of 106 patients in Imam Khomeini hospital in Tehran .The duration of this project was one year from Aug.2002 till Aug.2003. In the cases of echogenic fluid, septation, pleural Thickening >3mm, float echogenic density and fibrin strand the diagnosis was exudate, then in the basis of existed pleural nodules, pleural thickening, winding band and homogenecity of pleural fluid we differentiated the malignant, Para - pneumonic ,empyema and tuberculosis effusion. Consequently, sono graphic findings were compared with final diagnosis regarding to clinical findings ,smear ,culture and biopsy of pleura.Results: In our investigation 61 patients were men and 45 cases were women .The range of age was between 18 till 87. In diagnosis of exudate effusion from transudate results included: sensitivity %96, specificity %100 ,accuracy %98, P.P.V %100 and N.P.V of %96 .In the cases of malignant disease ,sensitivity was 80% specificity was %96 ,accuracy was %94 PPV and NPV were %80 and %96. For the T.B effusion :sensitivity and PPV were %85, specificity and NPV were %97 and accuracy was %96. For the parapneumonic and empyema sensitivity and PPV were %77.8, specificity and NPV were %95 and accuracy was %92.4. Conclusion: Sonography is very helpful in determining the nature of pleural effusion and its application because of simple, low in price, noninvasive and bedside availability is recommended specially for very ill patients.

Background: Vitiligo is an acquired pigmenting disorder which results from destruction of melanocyte and its prevalence is about one percent among the population. This study was conducted to determine efficacy and safety of bath PUVA therapy in the treatment of vitiligo.Patients and Methods: In this step 1-clinical trial, 38 patients with vitiligo who fulfill the inclusion criteria and lack the exclusion criteria were treated with bath PUVA. The response defined as repigmentation after treatment and divided to four groups: excellent (more than 75%), good (50-75%), moderate (25-50%) and poor (less than 25%). More over the side-effect were recorded.Results: From 38 patients, 26 cases have poor response, 10 cases show moderate response, 2 cases show good response and no case shows excellent response. The average of response was 23.5%. In this study there is no meaningful relationship between age, gender and duration of disease with rate of remission but it seems number of therapeutic sessions and site of involvement have this relation with the rate of remission (P<0.005). Short-term effect after treatment are as follows: 3 cases of burn (7%), 3 cases of erythema (7%) and one case of bulla. According to the limitation in the length of treatment and follow-up, there is no comment about long-term side effects.Conclusion: Remission after treatment with bath PUVA only relates to site of involvement and number of therapeutic sessions and there is no relation with age, gender, duration of disease with the rate of remission. This fact is true about the side-effect and no relation was found between age, gender and number of therapeutic session with the rate of side-effects.

Background: Oxidative stress and lipid abnormalities are the two major risk factors for atherosclerosis in hemodialyzed patients. Vitamin E ,as an antioxidant, can reduce oxidative stress in these patients but its effects on serum lipid abnormalities are not well known. Therefore, the present study was desinged to compare the effects of vitamin E with those of nicotinic acid ,as a drug, on serum lipids and apoproteins in hypertriglyceridemic hemodialyzed patients. Material and methods: The study was a double-blind randomized clinical trial. Thirty-nine hemodialyzed patients with fasting triglyceride range of 230 to 500 mg/dl were randomly assigned to vitamin E (600mg/d) , nicotinic acid (500mg/d) and placebo groups. All patients received their supplements for 13 weeks. The blood samples were collected after a 12 to 14-hour fast at the beginning of the study and at the end of sixth and thirteenth weeks and then serum lipids and apoproteins were measured.Results: During the study, mean serum triglyceride level was significantly reduced in the vitamin E group compared to the placebo group (P<0.05).Mean serum HDL-C level was significantly increased in the nicotinic acid group when compared to the placebo group (P<0.05) but LDL-C/HDL-C ratio was significantly decreased (P<0.01). There were no significant differences among mean changes of serum total cholesterol, LDL-C , apoAI , apoB100 and Lp (a) of three groups.Conclusion: It is concluded that vitamin E is effective in reducing triglyceride concentration in hypertriglyceridemic hemodialyzed patients but it appears that combined use of vitamin E and nicotinic acid is more effective in regulating lipid abnormalities in these patients.

Background: Throughqut the world, acute diarrheal diseases are considered as one of the most common causes of death specially among children. The morbidity and mortality associated with gastrointestinal infection and also hemolytic uremic syndrome (HUS) caused by Shiga Toxin-producing E. coli (STEC) has highlighted the threat this organism pose to public health. Methods and Materials: Between April and December 2003, a total of 150 patients with significant bloody diarrhea attending four medical centers, were screened. All the stool samples were inoculated into the proper culture media according to standard methods. Strains which could not ferment the Sorbitol, were tested by latex agglutination technique using E. coli O157 monovallent antiserum. After DNA extraction from the isolated strains, the Multiplex PCR reaction for both Stx1 & Stx2 genes performed and consequently amplicons were examined by Agarose gel electrophoresis system.Results: This case study demonstrated that three cases (2%) in whole studied population were positive for the presence of STEC. Further analysis showed that in 47 cases (31.3%) other etiologic agents including Shigella and Salmonella species caused the infection.Conclusion: Although it seems that the incidence and prevalence of gastrointestinal infections caused by STEC are low in Iran, the significant complications and disorders due to STEC infection such as HUS, highlight the importance of using rapid, sensitive and specific molecular and serological diagnostic methods.

Background: One of the newest instructional strategies is cooperative learning which is classified in the social interactive family of models of teaching. Because of the Problems of traditional teaching and lecturing including rapid forgetting of learned materials, tiredness and loss of motivation in students and increased absence from classes, it appears that cooperative learning can be a good substitute for ,the traditional model. The aim of this study is to compare the traditional and cooperative teaching methods and their effect on students learning. Materials and Methods: In a quasi- experimental design, 28 students of health care management in bachelor level were randomly placed in tow groups, alternatively taught by traditional and cooperative methods.Results: The results showed that both methods were effective without significant difference in learning between the two groups.Conclusion: According to the standards of the World Federation for medical education, traditional methods of teaching can no longer compete with the increasing load of sciences and more effective methods are required. The instructors and principal stakeholders can use the results of this study to decide which method to use or combine various, methods according to the situation.

Background: Malignant pleural effusion is the second most common cause of exudative pleural effusion. For absolute diagnosis we must find malignant cells in pleural fluid or in pleural biopsy. Almost in all references cytologic evaluation of pleural fluid is more sensitive than pleural needle biopsy in the detection of malignancy but in our country it dose not seem to be the same. So this study was designed to investigate the results of cytologic examination of pleural fluid in malignant pleural effusions. Methods and Materials: During a two year period (1378-1380) all patients with exudative pleural effusion who were admitted in pulmonary department of Imam Khomeini Hospital in Tehran whose primary investigations was not conclusive were reevaluated by pleural tap & pleural needle biopsy. Cytology of pleural fluid and histology of pleural biopsy were studied in two different centers and if the results were not conclusive thoracoscopy or open biopsy was conducted.Results: Twenty-five (%51) patients were male and 24 (%49) were female .Mean age was 57.6 (17-77 Y). In 45 (%91.8) patients metastatic disease to pleura and in 4 (%8.2) patients mesothelioma was the definite diagnosis. Cytologic evaluation of fluid was positive in 29 (%59.2) of patients while pleural needle biopsy was diagnostic in 25 (%51) patients.Conclusion: The results of cytologic evaluation of pleural fluid in malignant pleural effusions in our center is similar to other studies. In order to have better results in this field more attention must be paid in the way the pleural fluid is tapped and prepared for cytologic study.

Background: Preeclampsia is characterized by hypertension development and proteinuria during pregnancy. Hypertension: disorder is a leading cause of maternal and fetal morbidity and death in worldwide. Although the pathophysiology of hypertension during pregnancy is unclear, but there is consensus that early diagnosis and aggressive treatment is warranted to prevent complicated to both fetus and mother. The changes of serum trace elements during pregnancy are paramount important to predict and good understanding the situation of patients. Methods and Materials: The aim of this case-control study was to investigate possible differences in the level of serum calcium, phosphorus and total protein in 55 healthy pregnant and 52 pregnant with hypertensive disease at 32-40 weeks of gestational age during the recent two years in Loghman hospital of Tehran.Results: The case population consisted of 22 sever preeclampsia, 15 mild preeclampsia, 8 eclampsia, and 7 chronic hypertensive. Some information such as age, blood group, parity number, , blood pressure was taken from patients by a questionnaire. The mean serum calcium concentration (mg/dl) was 9.18±0.74 in control group, 8.81±0.9 in mild preeclampsia, 7.85± 0.38 in sever preeclampsia, 7.83± 0.47 in eclampsia, 8.91± 0.3 in chronic blood pressure. The mean serum phosphorus (mg/dl) level observed, 4.27 in sever preeclampsia, 3.74 in eclampsia, 3.59 in mild eclampsia, 4.09 in chronic blood pressure, and 3.43 in control pregnant women. The mean serum total protein concentration level in sever preeclampsia and eclampsia was 5.46 and 5.04 mg/dl respectively.Conclusion: In conclusion, sever preeclampsia and eclampsia are associated with decreased level of calcium, total protein, and increased concentration of phosphorus (P<0.0001).

Introduction: Diabetic nephropathy is a serious late complication in patient with diabetes mellitus. Thus determination of microalbuminuria has become an important test for screening incipient nephropathy in diabetes and in clinical follow up studies. Material and methods: Immunoturbidimetery is a simple and rapid method, based on antigen (albumin) antibody (anti albumin). Turbidity can be measured by common photometer in laboratories and the method is sensitive enough for clinical purpose. After preparation rabbit anti human albumin, some microalbumin samples were prepared by using sensitive scale.Immunoturbidimetery method was done on these samples and the optical densities (OD) were booked and then typical references curve was drawn. Another 27 microalbumin samples were made by sensitive scale (20-200 µg/ml) and their amounts were determined by using lmmunoturbidimetery method and standard curve.Result: By using this method, sensitivity and specificity of test was %92.59 and %96.29 respectively. Several urine, samples were collected from diabetic patients. Some samples were negative in protein by using urine strip test but these samples were shown microalbumin by Immunoturbidimetery method.Conclusion: In conclusion this method is rapid, cheap and sensitive enough for clinical purpose.

Background: P53 tumor-suppressor gene which encodes a nuclear phosphoprotein that arrests cell cycle progress at G1, is one of the most frequently mutated genes in human cancers.Materials and Methods: In this study, 40 cases of Hodgkins disease (HD) which is the most common lymphoma in young adults, have been investigated for P53 gene mutations. For each case, sections of paraffin-embedded tissue blocks were cut, a light hematoxylene stain was applied, and in order to enrich our samples for a higher percentage of Reed-Sternberg (RS) cells which are thought to be the neoplastic component of HD lesions, a microdissection technique was used. We used polymerase chain reaction (PCR) amplitication technique and single strand conformational polymorphism analysis (SSCP) to study mutations within exons 5 to 8 of gene P53.Results: Six shifts were detected in five cases (12.5%), identified by SSCP (one shift in exon 5A, one in exon 5B, one in exon 6, two in exon 7 and one in exon 8). Conclusion: Since the specificity of PCR-SSCP is more than 95% for 100 to 300 bp polymerase chain reaction fragments, it is conceivable that P53 gene mutation is not a common feature in HD. However, the samples with abnormal SSCP require nucleotide sequencing studies to assess whether the abnormal migration represents a mutation or a polymorphism.

Background: The effects of positive ventilation on hepatic elimination of phenytoin with low extraction ratio characteristic have not yet been studied.Methods and Materials: In an observational prospective study, seven patients with traumatic brain injury (4 females and 3 males), old than 18 years old, GCS< 8, intubated with cute lung injury (Pao2/Fio2< 300) and without any history of hepatic (±SD) for age, CLcr and Alb were 45±58 ml/min and 3.7± 55 gm/dl. Results: The mean and range for height, weight, ideal body weight and APACHE II were 167 (160-175) cm, 64 (55-70) kg, 63 (54-73) kg and 21 (12-28) respectively. For our intubated and mechanically ventilated traumatic brain injury patients, we considered 0<PEEP≤5 H2O based on the patients pulmonary profile and attending decision. Supposing K3= 4 mg/L and Vd= 0.6 L/kg, the results were:MAP b.p.e= 108.72±10.62 mmHg, MAp2 a.p.e= 114.48±8.11 mmHg P value= 0.32 MAP= Mean arterial pressureCtrough b.p.e= 12.57±1.99 mg/l, Ctrough a.p.e= 10.42±3.63 mg/l           P value= 0.09 in the presence of MAP elevationCtrough b.p.e= 17.82±7.27 mg/l, Ctrough a.p.e= 22.95±4.43 mg/l         P value= 0.23 in thepresence of MAP reductionVmax= 6.85±0.23 mg/kg/d, Vmax a.p.e= 7.28±0.85 mg/kg/d               P value= 0.25 in thepresence of MAP elevationVmax b.p.e= 6.48±2.1 mg/kg/d, Vmax a.p.e= 6.15±1.81 mg/kg/d         P value= 0.41 in thepresence of MAP reductionConclusion: We concluded that although there is not any statistically significant correlation between mean arterial pressure (MAP) and pharmacokinetic key parameters of phenytoin following PEEP elevation (p<0.05) but clinically PEEP can cause MAP to be increased, Leading to increasing and decreasing of Vmax and Ctrough respectively and vice versa.

Background: Uncontrolled growth rate is one of the most important health problem in Iran. Fertility rate in Hormozgan province is higher than means of these rates in the country. On the other hand usage rate of low dose (LD) oral contraceptive pill and depot medroxypregestron acetate (DMPA) as contraceptive methods in this province is higher than mean of this rate in the country. The present study was conducted to determine. the knowledge of contraception in women taking LD oral contraceptive pill or DMP A who referring to Bandar Abbas health care centers.Materials and Methods: In this cross- sectional study 600 married 15-49 years old women taking LD oral contraceptive pill or DMP A as contraceptive methods were randomly selected. Face to face interviews were conducted to fill out questionnaires. Results: Both LD and QMP A users were significantly more in 20-29 years old age group than other age groups (P<0.01), most of them were housewife with low level of education. 452 (75.3%) of population under study were LD users and 148 (25.7%) were DMPA users. 42.8% of LD users and 51.5% of DMPA users had acceptable level of knowledge of contraception (P<0.001).Conclusion: The findings. suggest that there is a need to plan proper educational programs to improve contraceptive knowledge in women. Health care providers play an important role in these educational strategies.