Tehran University Medical Journal
Year:2018 | Volume:76 | Issue:7|Papers Count:10

Head injury is one of the most important types of injury and is responsible for most of the deaths due to trauma. Low-income and middle-income countries face with more risk factors, but they still lack adequate health-care capacity to deal with complications. Trauma literally means the damage and injury, and head injury was defined as physical damage to the brain or skull caused by external forces. Head trauma is an important event. Anyone can fall including toddlers, adults and elders. There are several mechanisms for head injury, including motor vehicle accidents, falls, assault and violence. After the motor vehicle accidents, fall is the second most important cause of head injury. Deaths from falling in countries with lower socioeconomic conditions are higher. To collect the information for this study, the PubMed, Scopus and Google Scholar databases were used. Sixty-four related articles were reviewed from 1980 to 2018. The keywords including "head injury", "head trauma", "brain damage", "fall mechanism", "Iran" and "epidemiology" were used to search the articles. According to the findings of this review fall is the second most common head injury mechanism in Iran. The fall mechanism is more common in the age group of young children and elderly. Also, the incidence of fall mechanism is more in males with head injury than women. In most other countries in the world, fall is the first and the second head injury mechanism. Also, falling from lower altitudes is a more common mechanism than a fall from higher altitude in injury to the head. Falling from lower level is a more common mechanism than fall from higher level in head injuries. In addition, the outbreak of the fall mechanism in children and the elderly with head injuries is more. Despite the efforts that have been made in the past years to determine the pattern of epidemiology of head trauma and its results in Iran, there is not enough information on fall-related head injury. Considering that the head traumatic injury is one of the most common and most dangerous outcomes of fall, the purpose of this review study is to investigate epidemiologic fallrelated head injury.

Background: Multiple sclerosis is the most common autoimmune demyelinating disease of the central nervous system (CNS). Interleukin-33 (IL-33) is a cytokine with both pro-inflammatory and anti-inflammatory activities that implicated in the pathogenesis of some autoimmune diseases. The aim of this study was to determine single nucleotide polymorphism (SNP) of IL-33, rs1929992, in patient’ s gene with multiple sclerosis (MS) and investigation of this polymorphism with susceptibility to MS. Methods: In this case-control study, peripheral blood samples were collected from 140 MS patients (patients in the Afzalipur Hospital in Kerman) and blood sample of 140 healthy subjects (people referred to the Blood Transfusion Organization) as a control group from March 2016 to January 2018. SNP at rs1929992 was determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Results: There was significant difference between healthy control group and patient with multiple sclerosis in the frequency of genotypes. The frequency of AA genotype at rs1929992 was significantly higher in the MS group in comparison with healthy control subjects (P= 0. 0001), whereas frequency of AG genotype was significantly higher in the control group as compared with MS group (P= 0. 02). There was no significant difference between the MS patients and healthy control group in GG genotype. Moreover, the frequencies of AA genotype at SNP rs1929992 were significantly higher in patients with secondary progressive MS (SP-MS) and primary progressive MS (PP-MS) as compared with control group (P= 0. 03). However, the frequencies of AG genotype was significantly lower in patients with relapsing-remitting MS (RRMS) in comparison to the healthy group (P= 0. 01). In patients with RR-MS, PP-MS and SP-MS patterns, the frequencies of A allele was significantly higher than that in control group (P= 0. 03, P= 0. 01, P= 0. 001). In patients with RR-MS, PP-MS and SP-MS pattern, the frequency of G allele was significantly lower than control group (P= 0. 03, P= 0. 01, P= 0. 001). Conclusion: The results of this study suggest that the SNP rs1929992 in IL-33 gene, may be associated with different pattern of MS susceptibility.

Background: Regarding the increased risk of developing type 2 diabetes in pre-diabetic people, identifying pre-diabetes and determining of its risk factors seems so necessary. In this study, it is aimed to compare ordinary logistic regression and robust logistic regression models in modeling pre-diabetes risk factors. Methods: This is a cross-sectional study and conducted on 6460 people, over 30 years old, who have participated in the screening of diabetes plan in Mashhad city that it was done by Mashhad University of Medical Sciences from October to December 2010. According to the fasting blood sugar criteria, 5414 individuals were identified as healthy and 1046 individuals were identified as pre-diabetic. Age, gender, body mass index, systolic blood pressure, diastolic blood pressure and waist-to-hip ratio were measured for every participant. The data was entered into the Microsoft Excel 2013 (Microsoft Corp., Redmond, WA, USA) and then analysis of the data was done in R Project for Statistical Computing, Version R 3. 1. 2 (www. r-project. org). Ordinary logistic regression model was fitted on the data. The outliers were identified. Then Mallow, WBY and BY robust logistic regression models were fitted on the data. And then, the robust models were compared with each other and with ordinary logistic regression model according to goodness of fit and prediction ability using Pearson's chi-square and area under the receiver operating characteristic (ROC) curve respectively. Results: Among the variables that were included in the ordinary logistic regression model and three robust logistic models, age, body mass index and systolic blood pressure were statistically significant (P< 0. 01) but waist-to-hip ratio was not statistically significant (P> 0. 1). There were 552 outliers with misclassification error in the ordinary logistic regression model. Pearson's chi-square value and area under the ROC curve value in the Mallow model were almost the same as for ordinary logistic regression model. But it was relatively higher in BY and WBY models. Conclusion: Based on results of this study age, overweight and hypertension are risk factors of prediabetes. Also, WBY and BY models were better than ordinary logistic regression model, according to goodness of fit criteria and prediction ability.

Background: Metabolic syndrome (MetS) is characterized by a combination of cardiometabolic risk factors. Given that genetic factors have been shown to contribute to individual susceptibility to MetS, the identification of genetic markers for disease risk is essential. Recent studies revealed that rs780094 and rs1260326 of glucokinase regulatory gene (GCKR) are associated with serum triglycerides, plasma glucose levels and metabolic syndrome. The aim of this study was to investigate associations of GCKR gene variants with metabolic syndrome and its components. Methods: This case-control study was conducted from April to August 2017. In this study, 8710 adults (3522 males and 5188 females), over 19 years, were randomly selected from the Tehran Lipid and Glucose Study (TLGS) population. Based on joint interim statement (JIS) criteria, the subjects were divided into two groups: case and control. Genotyping was performed by HumanOmniExpress-24 v1. 0 BeadChips (Illumina, San Diego, CA, USA). Results: Allele frequencies were in conformity with Hardy-Weinberg equilibrium. Comparisons of allele frequencies by the Chi-square test revealed that frequencies of TT genotype of both polymorphisms were significantly higher among patient group than healthy group. Logistic regression analysis with adjustment for age, gender and CRP revealed that the GCKR polymorphisms (rs1260326: odds ratio 2. 7, 95% CI 1. 6-4. 6, rs780094: odds ratio 2. 5, 95% CI 1. 5-4. 2) were significantly associated with MetS. Frequency of TT genotype was more in persons who had C-reactive protein (CRP) levels above 3 mg/l. The minor T allele of both polymorphisms was significantly associated with increases in the blood serum concentration triglyceride and to a decrease in fasting plasma glucose levels. Conclusion: The results of our study indicated that, rs780094 and rs1260326 common polymorphisms of the GCKR gene were associated with serum triglycerides levels, fasting plasma glucose levels, and metabolic syndrome in a sample of the Tehranian population (TLGS), as it was already confirmed the inverse effect of this polymorphisms on triglycerides and glucose levels in previous studies.

Background: Glioma is one of the most common and deadliest primary malignant tumors in the brain. A large part of the gene expression products are non-coding protein RNA. LncRNA THRIL gene is an antisense LncRNA and one of the most important mediators of the NF-KB signaling pathway, that express in many tissues of the body, including the central nerve system (CNS). The aim of the present study was to investigate the alternation in the expression of LncRNA THRIL gene in cells of the adenocarcinoma glioblastoma T98G cell line, under treatment with temozolomide chemotherapy drug. Methods: This case-control study was conducted in Research Center of Islamic Azad University of Zanjan, Iran, from April to September 2017. Cells of T98G cell line was treated with various doses of temozolomide chemotherapy drug (25-50-100 μ M) and at different times (72-48-48 hours), Respectively RNA extraction and cDNA synthesis were performed. Then LncRNA THRIL gene expression was studied by real-time PCR method and the results were analyzed by relative quantitative and livak methods. Results: The THRIL gene expression in 24 hours’ time with 25 and 100 μ M doses (P< 0. 001) had significant decreased expression and 50 μ M dose had non-significant increase. It had significant increase in 48 hours time with 50 μ M dose (P< 0. 001), except 25 μ M (P< 0. 001) and 100 μ M (P< 0. 001) doses had significant decreased expression. It had significant increase during 72 hours time with 50 μ M dose (P< 0. 001), in contrast 25 μ M (P> 0. 001) and 100 μ M (P< 0. 001) concentrations of temozolomide chemotherapy drug demonstrated decreased expression of the LncRNA THRIL gene (P< 0. 001). Conclusion: As a result, the THRIL gene expression alterations after cancer cells treatment by temozolomide chemotherapy drug depends on the time and dose of the drug and the 48 hours treatment time with 50 μ M dose (P< 0. 001) had the highest effect on cancer cells of the T98G cell line, due to the expression of the THRIL gene.

Background: Each toxic agent results in unique presentations, depending on what neurophysiological changes occur following exposure. Scientific understanding of lead toxicity in the organ systems and at low levels of exposure continues to evolve. However, effects of lead poisoning on the thyroid gland function are controversial. In this descriptive study, changes in thyroid hormones in patients with lead poisoning were compared with patients with opioid addiction and healthy individual who were matched for age and sex. Methods: In this descriptive study, which was conducted from March 2016 to February 2017 in Loghman Hakim Hospital in Tehran, ninety patients were evaluated using convenient sampling method for lead and thyroid hormones levels. The levels of lead and thyroid hormones were evaluated using standard laboratory method, in thirty male patients with lead poisoning, thirty male patients with opioid addiction referring to addiction treatment center and thirty healthy male referring to a blood donation center who were matched for age. Thyroid function parameters in patients with lead toxicity were compared with those of control groups. Results: The lead level in the lead toxicity group was 57. 5± 23. 5 μ g/dl, in the first control group with opium addiction 7. 8± 3. 8 μ g/dl and in the healthy male referring to a blood donation center, 5. 9± 9 μ g/dl. Thyroid stimulating hormone (TSH) was significantly lower in patients with lead poisoning (0. 2± 0. 01 Milli-International Units Per Liter (mIU/L) than in the patients with opioid addiction (2. 4± 1/05 mIU/L) and healthy male referring to a blood donation center (2. 3± 0. 01 mIU/L) (P= 0. 04), and thyroxine hormone (T4) was significantly higher in patients with lead poisoning (17. 8± 2. 6 μ g/dl) than in the patients with opioid addiction (8. 8± 1/9 μ g/dl) and healthy male referring to a blood donation center (7. 4± 3. 5 μ g/dl) (P= 0. 02). Conclusion: Lead toxicity has an effect on thyroid function and it reduces thyroid stimulating hormone and increases thyroxin levels. Clinicians should be aware of the potential hazardous effects of lead on the thyroid and mechanisms through which lead causes these effects on thyroid function need to be elucidated.

Background: A significant increase in cesarean section in worldwide is known as one of the health system problems. The WHO has estimated that cesarean section in recent years has been 10% in all countries. Despite the increasing popularity of cesarean section, the literature lacks insights about factors affecting the selection of this delivery method. In this vein, this study investigates the factors affecting the choice of cesareansection from the perspective of pregnant women. Methods: The sample of this descriptive and analytical study is 200 pregnant women selected using simple random sampling method in Kosar Hospital in Qazvin Province, Iran. The survey questionnaire was used for data collection from March to September of 2017. In order to evaluate the validity and reliability of the research, expert’ s opinion and Cronbach alpha coefficient have been used. The questionnaire included scales designed to measure effective factor. Statistical package for social science software (SPSS) version 22 (SPSS Inc., Chicago, IL, USA) were used to analyses the data. T-test and ANOVA were used to compare groups. Results: The results of prioritizing the items in terms of psychological factors showed that the statements “ I am afraid of the pain of normal labor” and “ I feel higher stress and anxiety with natural labor were the first priorities” . There was no significant difference between pregnant women who had previous experience and those who did not have a delivery experience. The results of the mean comparison test showed no significant difference between the attitudes of women with previous delivery experience and women who did not have a delivery experience. There were only differences between socio-cultural factors (P= 0. 004), factors related to delivery conditions (P= 0. 001), consequences of delivery (P= 0. 017) among pregnant women with different levels of training. Conclusion: The results of this study revealed that there is a difference between the attitudes of pregnant women and different levels of education, so pre-pregnancy training should be provided to pregnant women.

Background: Hospital bed capacity is one of problems in intensive care unit during at the time of crisis, emergencies and disasters. At this regard, it seems reverse triage can resolve this issue by using predictive score systems. This study was purposed to develop a reverse triage system in intensive care unit using APACHE II scoring system for crisis, emergencies and disasters situations. Methods: This study was performed by a prospective longitudinal design that lasted from March 2016 to February 2017. Research population were 420 internal patients that were admitted in intensive care units of Imam Reza Hospital in Mashhad, Iran. Data were collected and documented for each patient by demographic questionnaire and APACHE II scoring system daily until discharging time from intensive care units. The patient’ s status after discharge from the intensive care unit was used as a criterion for statistical tests. Results: APACHE II mean score in first day of admission was 18. 9± 16. 20. Risk ratio of patients’ discharging from intensive care unit was 1. 034. The patients were placed in four levels of inverse triage according to mortality rate and risk ratio. The scores of four levels were including: 0-10 (first level and green color), 11-16 (second level and yellow color), 27-71 (third level and black color) and 17-26 (fourth level and red color). Conclusion: The Apache II system can be used as a tool for reverse triage in intensive care units during at the time of crisis, emergencies and disasters. When using this system for reverse triage, patients at the first to third levels can be discharged from intensive care unit. However, patients on the fourth level should not be discharged from intensive care units under any circumstances.

Background: It is important to use reliable, valid, and responsive instruments to assess the treatment outcomes. The functional rating index (FRI) is a patient reported outcome measure to assess the pain and function in patients with neck and low back pain. The FRI has been translated and culturally adapted into Persian language. The purpose of this study was to investigate the responsiveness of Persian functional rating index in patients with chronic non-specific neck pain (CNSNP). Methods: The adult patients with CNSNP recruited from Shariati Hospital in Tehran and filled the Persian functional rating index (PFRI), Persian neck disability index (PNDI), and pain numerical rating scale (NRS) before and after 10 physiotherapy sessions, from March to July 2017. The patients completed the global rating change scale after treatment. For statistical analyses, the effect size (ES), standardized response mean (SRM), Guyatt response index (GRI) were used. The Spearman or Pearson test was used for correlation analyses. The area under the receiver operating curve (ROC) and minimal clinically important difference (MCID) were calculated. Results: In this study, 30 patients (female 17) with a mean of age 45. 6 years [standard deviation (SD) 13. 8] participated. The mean duration of neck pain was 14. 7 months (SD 12. 8). Significant strong and moderate correlations were identified between PFRI with PNDI and GRC scores (r= 0. 78 and r= 0. 69). The respective ES and SRM values were 0. 73 and 0. 78 for PFRI. The GRI was 5. 58. The AUC was 0. 89 (P= 0. 001). MCID was 11. 7%. Conclusion: This study confirms that the Persian functional rating index is responsive for assessing disability in Persian speaking patients with chronic non-specific neck pain.

Background: Breast cancer is a common malignancy in which early breast cancer detection by the help of imaging can improve the treatment outcome. Thermography utilizes infrared beams which are fast, non-invasive, and non-contact and the output created images by this technique are flexible and useful to monitor the temperature of the human body. Case presentation: Our patient is a 25-year-old woman who was referred to Tehran's Imam Khomeini Hospital, Tehran University of Medical Sciences, in October 2014 and June 2017 to perform clinical examinations of breast cancer at the Invasive and New Radiology Research Center of Tehran. The results of the sonography for the left breast and bilateral axillary regions and sonography guided biopsy from the left axillary region indicated that: it was consistent with the tangential prominence at 11-12 O’ clock in the left breast tissue and echo gene was found without any suspected findings. Then, using the non-contact infrared imaging camera VisIR 640 (Thermoteknix Systems Ltd, Cambridge, UK), the feasibility of thermography method in the patient's follow-up was investigated. Conclusion: Thermography can be used to detect abnormal areas in the breast tissue that may have cystic origin. The results indicated that the accuracy of the identification and matching of patient cysts in mammography and ultrasonography with the results of thermography in both periods of October 2014 and June 2017. Considering the results, it is noteworthy that the diagnostic clock of the breast cysts in the patient is consistent with the results of the clinical trials with the thermography. Moreover, in a 2 years intervals, the status of thermal morphology status of the cystic region did not considerably change which showed a relatively stable status.