Tehran University Medical Journal
Year:2019 | Volume:77 | Issue:3|Papers Count:11

Background: A professional vision at education is necessary, because of the increasing development of technical education in the field of medical education. In the conventional methods, although mastering in the field and being up-to-date is necessary, today, the faculty member must be able to design and implement a group of learning experiences for the students in order to learn and to conduct valid exams. Methods: Our study was an interventional study, conducted on obstetrics and gynecology residents of the 3rd and 4th year at Tehran University of Medical Sciences in March, 2016. The number of participants was 66. The data collection was performed by a questionnaire. The included 19 questions about the anatomy of pelvic floor. At first, the questionnaires were administered to pre-test students to assess the amount of information before and then the theoretical and practical class about the anatomy of pelvic floor were held. At the end of classes, pre-test questionnaires were returned to residents. The responses to questions before and after the training were analyzed. Results: Our study was conducted on 66 obstetrics and gynecology residents. Of the 66 subjects, 30 were in the pre-test and 66 were in the post-test. The mean score of residences in the anatomy of the pelvic floor before intervention was 5. 388± 7. 14 and after intervention was 12. 57± 2. 181 (P=0. 001). The difference in mean before and after education was significant at all levels of study. The general knowledge scores in the posttest, was significantly (P<0. 05) higher than pre-test. Conclusion: According to our findings, it can be stated that the implementation of scholarship project regarding the knowledge of obstetrics and gynecology residences by the method of theoretical and anatomical teaching of anatomy of pelvic floor increases their knowledge, consequently, increase ability of surgical procedures of the residents and reduce complications. It is recommended that other education centers use a similar method to educate obstetrics and gynecology residents.

Background: The immune-mediated responses in vascular cells may include the increased expression of endothelial adhesion molecules, leukocyte rolling and in ltration, cellular lipid dysregulation and vascular smooth muscle cells (VSMCs) differentiation. Investigating the cellular and molecular events involved in the rolling process is useful for treatment or prevention of the vessel stenosis especially in coronary arteries. MiRNAs are small and single-stranded noncoding RNAs with about 19-23 nucleotides. In this study, the role of microRNA-125 was predictably selected and experimentally investigated on the changes of expression level of adhesion molecule in endothelial cells isolated from human aorta and on the monocyte cells isolated from whole blood human with endothelial cells adhesion. The aim of this study was to determine the effect of miRNA-125 repression on cell adhesion in leukocyte rolling process to reduce or suppress artery stenosis in susceptible individuals. Methods: This experimental study was performed in Cellular-Molecular Research Center of Iran University of Medical Sciences, Tehran, Iran from July to December 2017. Normal aortic samples were prepared from subjects with brain death in Masih Daneshvari Hospital and under strictly sterile conditions, it was transferred as soon as possible. The endothelial cells were isolated from aorta of subjects with brain death using collagenase. The monocytes were isolated from whole blood. The microRNA-125 was transfected into ECs with use of polyethyleneimine (PEI). The expression level of adhesion molecule and monocyte recruitment were identified by quantitative reverse transcription polymerase chain reaction (qRT-PCR) technique and CytoSelect™ leukocyte-endothelium adhesion assay kit (Cell Biolabs, San Diego, CA, USA), respectively. Results: The results showed the microRNA-125 suppresses significantly integrin beta 2 (ITGB2) expression level (P=0. 008). In addition, the monocyte-EC adhesion was shown in the aortic miRNA-treated endothelial cells. The adhesive rate between cells reduced significantly with microRNA-125 as compared with miR-synthetic (P=0. 02). Thereby, there were the associations between the ITGB2 and miR-125a. Downregulation of ITGB2 may be reduced the adhesion of endothelial cells and moderating the process rolling. Conclusion: This study suggested that the suppression of leukocyte rolling process might be more due to the function of ITGB2. However, the functional effects of this miRNA should be directly investigated on the studied gene.

Background: Breast cancer is one of the most common diseases in women and causes more deaths rather than other cancers. The increasing trend of breast cancer in Iran makes clear the need of extensive breast cancer research in this area. Some studies showed that in the variety countries and even in the different areas in one country has different risk of breast cancer incidence and this is a reason that there is a correlation between region of life and risk of breast cancer. The purpose of this study was to determine the spatial structure associated with the incidence of breast cancer based on statistical models and identification of areas with high incidence of breast cancer in Iran. Methods: This ecological study was conducted in Kermanshah University of Medical Sciences, Iran, from February to July 2018. Data on breast cancer patients in all provinces of Iran (30 provinces) were investigated since 2004 to 2009. Risk factors in this study included fruit and vegetable consumption, physical activity, overweight or obesity, and human development index. In this study, we have used routine and spatial Poisson's generalized linear mixed models for data analysis. Results: In both routine and spatial models, direct and significant correlation was found between the incidence of breast cancer and the human development index (P<0. 05). In addition to human development index, overweight or obesity factors were also had direct and significant relationship to the incidence of breast cancer in the spatial Poisson's generalized linear mixed model (P<0. 05). In the spatial Poisson's generalized linear mixed model with correlation structure of Besag Yorg Molie (BYM), two provinces of Gilan and East Azerbaijan had the highest risk of breast cancer incidence and province of Kohgiluyeh and Boyer Ahmad had the lowest risk of breast cancer incidence. Conclusion: The results showed that the distribution of breast cancer incidence in Iran has a spatial structure. That is, the adjacent provinces have similar incidences of this disease.

Background: One of the possible mechanisms of migraine pathophysiology is neuro inflammation in which, according to previous studies, some changes happen in inflammatory factors like interleukins, adhesion molecules or acute phase reactants. Cytokines may have an essential role in the neurovascular inflammation and also in the process of pain especially in migraine patients. On the other hand, one of the mechanisms by which angiotensin converting enzyme inhibitors (ACEIs) work is anti-inflammation. The goal of this study was to evaluate the effect of enalapril as an ACEI drug, on the proinflammatory cytokines (calcitonin gene-related peptide (CGRP), tumor necrosis factor alpha (TNFα )) of migraine patients. Methods: In this randomized double blind placebo-controlled clinical trial, 40 migraine without aura patients (mean age of 34. 42± 1. 82 years) who were referred to neurology clinics of Isfahan University of Medical Sciences, Iran, between June 2011 and July 2012 were recruited. The patients were randomly divided into two groups. 21 patients were treated with 10 mg enalapril daily for two months as the intervention group and they were compared with matched placebo treated group of 19 patients. Serum samples were collected from all of the subjects and TNFα and CGRP levels were measured by means of ELISA (enzyme-linked immunosorbent assay) kits at the beginning of study (before the intervention) and after 2 months of enalapril or placebo treatment. The serum levels were compared in each group and between the groups. SPSS software, version 16 (SPSS Inc., Chicago, IL, USA) was used for statistical analysis. Results: Six males (15%) and 34 females (85%) were enrolled in this study. The mean of migraine history among the subjects was 74. 40± 7. 54 months. Patients' TNFα level decreased significantly in the case group after treatment with enalapril (P=0. 001) while there was no significant change in control group (P=0. 769). There was no significant difference in the CGRP concentrations in the intervention and control groups (P=0. 795, 0. 708 respectively). Conclusion: Enalapril may be effective in improvement of inflammatory responses of migraine patients by decreasing the inflammatory factors like TNFα .

Background: Trauma is one of the main causes of maternal mortality and morbidity in societies, which annually causes millions of deaths worldwide and imposes a high financial burden on health facilities, the purpose of this study was to determine the frequency of physical trauma and its associated factors during pregnancy. Methods: All data for this cross-sectional study were collected from medical records of pregnant women, who referred to the Mahdeeyeh Hospital in Tehran, Iran, as a result of trauma through 2015. Information related to the pregnant women with trauma was extracted from their medical records based on a researcher-made collection form. All patients who meet criteria for entering the study (based on entry and exit criteria from the study) were selected as samples. The significance level of the tests was considered as P<0. 05, the Spearman correlation coefficient tests and Chi-square were used. Results: A total of 68 people were enrolled on the basis of selected criteria, meanwhile, the mean age of subjects was 26 years and 100% had no history of abortion. In all cases the trauma was blunt and included 63% abdominal, 24% lower back, and 14% flank trauma. Abortion was reported in 3% and 8% of the cases with abdominal and lower back trauma, respectively. Also, according to the results of this study, in cases where the placental abruption (six cases) were lateral face pairs, in all of them physical trauma was also posed. It is necessary in the traumatic pregnant women referring with placental abruption symptoms and sign, due to the legal importance of doing a thorough examination and sonography, the type of placental abruption (lateral or central) is made sure and then documented in patients' files. Conclusion: Physical trauma also is common in the pregnant women and the lateral aspect placental abruption can be one of the obvious evidence for physical trauma.

Background: Cataract is one of the most common eye diseases especially in children and adolescents in two age ranges, and many of these patients need to surgery throughout life. The purpose of this study was to compare the efficacy and side effects of midazolam-ketamine and midazolam-fentanyl for sedation in adult cataract surgery. Methods: In this study, which was a case-control study, 80 patients were referred to Farabi Hospital in Tehran from November to December 2018 for cataract surgery and underwent surgery. The patients were divided into two groups (n=40). In this study the method of using midazolam-ketamine (ketamine group) was compared with the combination of midazolamfentanyl (fentanyl group). The hemodynamic variables such as blood pressure and heart rate before surgery were measured and then measured every 5 minutes during operation and were recorded. In addition to hemodynamic variables, other variables such as agitation, surgeon satisfaction, recovery nurse satisfaction, degree of oxygen saturation during surgery, and nausea and vomiting were compared between the two groups. Results: In this study, 18 patients (45%) of fentanyl group and 17 patients (42. 5%) of ketamine group were female. Patients in the two groups had similar demographic distribution before surgery. In this study about blood pressure after surgery, from 80 patients, 22 cases had blood pressure below 119. 79 mmHg, of which 3 (13. 6%) cases were in ketamine group and 19 cases (86. 4%) in fentanyl group. In general, 7. 5% of ketamine group and 47. 5% of fentanyl group had a blood pressure lower than 119. 79 mmHg. Hemodynamic changes and hypotension after sedation was more in fentanyl group. Two groups did not differ in terms of heart rate, arterial oxygen saturation during surgery, surgeon satisfaction during surgery, and postoperative nausea and vomiting. Conclusion: Administration of ketamine-midazolam versus fentanyl-midazolam in patients who underwent cataract surgery by sedation led to more stable hemodynamic variables intraoperatively and other side effects such as heart rate, oxygen saturation, surgeon satisfaction, nausea and vomiting were similar between two groups.

Background: The back extensor muscles are the main spinal supportive factors which function establishes spinal stability and erect posture of the spine. Spine deviation from the ideal alignment, like abnormal increase in the forward curvature of the thoracic spine may cause changes in the trunk muscle activity which can lead to a change in the spinal proprioception. It seems that the corrected spinal alignment as a result of an orthotic treatment course facilitates the back muscles activity and improve proprioception. The present study aimed to investigate the changes occurring in thoracic kyphosis, trunk extensor muscle strength and trunk extensor force sense after using the Spinomed orthosis in elderly people with hyperkyphosis. Methods: Twenty-six elderly people with hyperkyphosis who met the eligibility criteria participated in this preliminary study at School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran, from August to November of 2017. Subjects were randomly allocated to the experimental (wearing the orthosis with maintaining the daily physical activities) and control (maintaining daily physical activities) groups. Degree of kyphosis, absolute error of force sense and trunk extensor muscle strength were measured in all participants before and after intervention for 9 weeks. Results: Thirteen elderly people with 63. 85± 4. 63 years old in the experimental group and thirteen elderly people with 66. 92± 3. 25 years old were participated in data analysis. The results showed significant reduction in degree of kyphosis (P<0. 001) and absolute error of force sense (P=0. 001), and improvement of trunk extensor muscle strength (P=0. 021) in the experimental group. Independent t-test results showed a significant difference between experimental and control groups with better outcomes in terms of posture correction (P<0. 001) strength (P=0. 002) and force sense (P=0. 035) in the orthosis group. Conclusion: Using Spinomed orthosis for 2 months (2 hours per day) appears to have some benefit in terms of back extensor muscle strength and muscle force control. Also, Spinomed orthosis can be prescribed to improve spinal posture.

Background: Psychosocial issues and quality of life are important components at the patients diagnosed with chronic hepatitis B and C. Hepatitis is a chronic liver disease that can affect quality of life of patients. In this study, we compared the quality of life between patients with hepatitis B and C and finally presented a structural model about it. Methods: In a prospective analytic study, 86 patients with hepatitis B and 86 with hepatitis C who referred to the Rasoul-e-Akram Hospital in Tehran from April 2015 to April 2018 were compared regarding the quality of life and health-related quality of life. The clinical and radiographic data of patients were extracted from their medical records. The 36-item short-form health survey (SF-36) was used for the evaluation quality of life and health-related quality of life. The questionnaire consisted of 36 questions in eight sub-scales (physical performance, physical role, physical pain, general health, vitality, social role, emotional role, and mental health). Results: Generally, the quality of life score was significantly lower in patients with hepatitis C (34. 13± 9. 37) than patients with hepatitis B (51. 5± 10. 5) (P=0. 001). Except for the physical role and vitality, all other SF-36 subscales were significantly lower in the HCV patients group (P>0. 05). Based on the results of logistic regression, the emotional dimension of patients was reported as most important effect on the quality of life in patients [(OR=9. 15, 95% CI=(4. 11-15. 41), P=0. 001)]. Based on the results of linear analysis, hepatitis type [(B=4. 21, P=0. 001)], patient income [(B=2. 57, P=0. 001)], the level of education [(B=2. 9, P=0. 014)] and the gender of patients [(B=2. 77, P=0. 023)] were reported as most important factors affecting the quality of life of patients, respectively. There was no significant difference between age, body mass index and smoking reported in patients' quality of life (P>0. 05). Conclusion: According to the results of this study, the quality of life in patients with hepatitis C was significantly lower than the quality of life in patients with hepatitis B.

Background: Disruption of lipid metabolism threatens human life in all countries with different percentages and causes cardiovascular disease. Reducing physical activity and eliminating some of the food medications have exacerbated these complications. The aim of this study was to investigate the effect of ginger supplementation on the lipid profile and body composition of obese women following Pilates exercises. Methods: This semi-experimental study was carried out at the Medicinal Plants Research Center of Ilam University of Medical Sciences, Iran, from September to December 2012. In this study, 90 pregnant women with type 2 diabetes mellitus were randomly divided into three groups: complement, placebo and control (30 objects in each group). The exercise protocol includes a ten-week Pilates exercise. The supplement group consumed 2 grams of ginger powder daily for ten weeks. The placebo group used starch (placebo) capsules for these ten weeks. The control group did not take any supplement and did not have any activity at all. Blood samples were taken prior to physical activity and 48 hours after the end of 10 weeks Pilates training three sessions per week (30 sessions). In order to investigate intra-group changes, t-test and one-way ANOVA were used to compare the groups. Results: The results showed that after 10 weeks of using zinc supplements following Pilates exercise training in pretest and posttest, increases in HDL levels and decreased TG, LDL, Tcol, body composition and body weight in obese women. Also, consumption of 10 weeks of ginger supplement after aerobic exercise training on TG (P=0. 001), LDL (P=0. 02), Tcol (P=0. 05) and HDL (P=0. 01) in obese women in supplement and placebo groups had a significant impact. Conclusion: The results of this study showed that Pilates exercises with daily consumption of 2 grams of ginger supplement for 10 weeks caused a significant decrease in lipid profiles, body fat percentage, weight, and hip circumference.

Background: Sesame oil can be used to treat cardiovascular diseases, such as atherosclerosis, by reducing the levels of fibrinogen and factor VII. The aim of this study is to prepare a microemulsion containing sesame oil as a drug nanocarrier for improving the aqueous solubility and therapeutic effects of this vegetable oil on the reduction of the fibrinogen and factor VII levels in animal model. Methods: This experimental study was performed for microemulsion preparation and animal test at Ferdowsi University of Mashhad and Cardiovascular Research Center of Mashhad University of Medical Sciences, Mashhad, Iran, respectively, from April 2015 to January 2017. To prepare the microemulsion samples, Tween 80 and span 80 were selected as surfactant couple and surfactant ratios of 8: 1, 9: 1 and 10: 1 were determined for construction of pseudo-ternary phase diagrams. The Zealand white rabbits were categorized in three groups: receiver of base diet group, high cholesterol diet and high cholesterol diet plus microemulsion. Results: The average particle size of the samples was in the range of 16. 64± 0. 1 to 21. 16± 0. 2 nm with a uniform particle size distribution. Zeta potential was in the range of-10. 7 to 18. 4 mV, refraction index was approximately 1. 39. Electrical conductivity coefficient was in the range of 297 to 311 μ z and pH of all the samples were approximately 6. 42 for all samples. All of the microemulsion samples were physically stable and the prepared sample with 9: 1 surfactant ratio was selected to investigate the animal test due to the higher oil percentage in comparison with the other samples that be stable over 6 months. Significant decrease in the levels of fibrinogen and factor VII in the third group of rabbits was observed compared to the other groups. Conclusion: The results of this study showed the effective performance of nanostructured drug delivery systems in the form of microemulsion to improve the aqueous solubility and therapeutic effects of hydrophobic compounds such as vegetable oils.