Journal of Isfahan Medical School
Year:2009 | Volume:27 | Issue:97|Papers Count:8

Background: Increased dietary consumption of the n-3 polyunsaturated fatty acids (PUFA) eicosapetaenoic acid (20: 5n-3; EPA) and docosahexaenoic acid (22: 6n-6; DHA) is associated with their incorporation into circulating phospholipid and increased production of lipid peroxide metabolites. The relationship between peripheral blood mononuclear cell (PBMC) function, n-3 PUFA intake and antioxidant cosupplementation is poorly defined in rheumatoid arthritis (RA) patients. This study was designed to evaluate tumor necrosis factor-a (TNF-a) and interleukin (IL) 6 production by PBMC in RA. Methods: Fifty-five patients (50 female, 5 male; mean age = 47 ± 11 years) were investigated in three groups in a randomized double-blind clinical trial. Patients were randomly assigned to one of these three groups: group 1 (G1) was received placebo (MCT oil, 2 g/d plus vitamin E placebo), the second group (G2) was received n-3 fatty acids (1.2 g/d; EPA/DHA plus vitamin E placebo), and the third group (G3) was received n-3 fatty acids (1.2 g/d; EPA/DHA) plus 100 IU/d vitamin E. Medication dose was intact during the study. Data were compared between groups using analysis of variance (ANOVA).Findings: Fish oil n-3 fatty acids supplementation of diet decreased production of TNF-a (P = 0.007) by stimulated PBMC in G2 and G3 in relation to G1. Also G3 in relation to G2 and G1 showed significant decrease with respect to malonaldehyde (MDA) (P = 0.005).Conclusion: Consumption of omega-3 fatty acids with vitamin E not only decreased production of inflammatory parameters but also decreased lipid per-oxidation in RA patients.

Background: Adolescent idiopathic scoliosis is the most common form of scoliosis. However, there is a little information exists about the patient satisfaction who underwent the surgery of adolescent idiopathic scoliosis. Most of the surgeons rely on the radiographic parameters as an index of successful outcome of surgery. This study was designed to evaluate the patient’s satisfaction after the surgery of adolescent idiopathic scoliosis. Methods: A cross sectional study using SRS 30 questionnaire was performed to prospectively assess the outcome of surgically treated patients with adolescent idiopathic scoliosis. Data were collected before surgery and 24 months after surgery. Findings: A total of 43 patients were included in our study. The mean satisfaction score was 2.7± 0.3 before the operation and 4.2±0.2 after the surgery (P< 0.01). General self image, psychiatric state and function and activity level, showed the significant improvement after the surgery (P < 0.01). Conclusion: Pain was not a major complaint in our patients. Overall 95 percent of the patients were highly satisfied and 5 percent were partially satisfied. Surgery will improve outcome in adolescent idiopathic scoliosis patients and it could improve patient satisfaction and well being in addition to the deformity correction.

Background: Current evidences suggest that the change in cytokine level by induction of angiogenesis may play a key role in the development of lung fibrosis. It seems, thalidomide by the destruction of endothelial cells and changing TNF-a level could be help full in antiangiogenic therapies. The present study examined the effect of thalidomide on bleomycin-induced lung fibrosis in rats.Methods: 18 rats were divided into three groups: (group 1) negative control group, which received normal saline intratracheally, (group 2) positive control group in which bleomycin was intratracheally injected, (3) intervention group which recieved thalidomide and bleomycine.Findings: Lung tissue was extracted after one month of treatment. Collagen content (as fibrosis index) and angiogenesis were indicated by Woessner method and Von Wilbrand staining, respectively. Total Lung Capacity index, was determined by MATLAB software.Collagen content had significant difference between positive and negative control groups, but there was no difference between positive control and experimental group. There was no significant difference between groups for angiogenesis and Total Lung Capacity index. Thalidomide had no effect on bleomycin induced pulmonary fibrosis.Conclusion: Otherwise, the findings of the study provide this evidence that thalidomide may induce pulmonary injury that is pathologically looks like IPF. So, more studies with some other angiostatic drugs and different doses are needed.

Background: Cartilage is a tissue with a low potency of self-repairing. One of the methods in increasing of regeneration and metabolism in cartilge, is stimulating physicochemical parameters on cell-polymer systems, as cartilage based cells. The cell–polymer system can be used to identify and control various biochemical and physical factors expected to influence cell function and tissue growth. Methods: Two physicochemical parameters, oxygen tension and pH, was changed to measure the lactate and rate of lactate production after 1, 2 and 3 days culture and GAG (glycosaminoglycan) production after 3, 7 and 14 days culture of chondrocytes on DegraPol®, as a biodegradable polyurethane scaffold (BPUS), and alginate scaffolds. The results finally were compared on both scaffolds. Findings: Physicochemical parameters like oxygen tension and pH could change cell metabolism. In fact, the physicochemical parameters could affect lactate production and GAG content of chondrocyte cells and it does not depend on the type of scaffold. The best condition of the articular chondrocytes metabolism was for 5% O2 and pH = 7.4 (P < 0.001). The comparison between BPUS and alginate scaffold is showing that the results are better for alginate beads (P < 0.001). Conclusion: Oxygen and pH alterations could change the cell volume that cause changing of normal mechanism of transferring ions and other digesting solutes into the cells. Therefore, optimization of oxygen tension and pH could optimize glycolysis process in cartilage. Also, hydrophilicity of alginate causes better cell distribution and nutrition than BPUS.

Background: Esophageal resection is the standard treatment for resectable esophageal cancer and some of the benign esophageal lesions. The most important cause of mortality and morbidity after Esophageal resection is the development of pulmonary complications. This study was performed to determine respiratory complications after the ER and associated risk factors. Methods: In this descriptive–analytic prospective study all patients who underwent transhiatal esophagectomy for esophageal cancer in AL-Zahra hospital in Isfahan from 2006 to 2007 to were entered to the study. All data were gathered through multiple variables questionnaire. During 12 months of follow–up after orringer procedure, respiratory complications including: pneumonia, pulmonary atalectasia, empyema or plural effusion, pulmonary emboli and chylothorax were determined. The frequency of risk factors in these patients was compared with those patients without any respiratory complications (P < 0.05). Findings: Pulmonary complications occurred in 18 (26.5%) of 61 patients. Serum albumin level less than 3.5 gr/dl, weight loss more than 20%, leak of the anastomosis, FEV1 < 2 lit and the time of mediastinal manipulation, were higher in the patients with pulmonary complications (P < 0.05). Conclusion: It seems the cardiopulmonary rehabilitation, improvement in nutritional status (weight loss, serum albumin) and reducing the time of mediastinal manipulation are the main strategies which reduce the pulmonary complications after ER.

Background: Methamphetamine (MAMP) is a central nervous system stimulant that is increasingly abused by teenagers and young adults. The MAMP effects on the male reproductive system are not clear. In this experimental study, we evaluated the effects of single injection of three different doses of MAMP on the proliferation and apoptosis of the sperm germ cells in the mature rat.Methods: A single dose of MAMP in different doses (1, 5 or 15 mg/kg) or normal saline was administered intraperitoneally in four groups of mature male rats. The right and left tissue sections were immunostained with immunohistochemical methods for proliferation and apoptosis, respectively. Indexes were calculated for proliferating and apoptotic cells. Findings: Cell proliferation decreased significantly in the group which treated with the highest dose. The ratio of proliferation to apoptosis decreased significantly in two groups with the highest doses. Conversely, apoptosis occurrence was increased in these groups. In the control group, more than 95% of spermatogonia were proliferating cells; however, 15mg/kg of MAMP caused an 85% reduction in the number of proliferating spermatogonia. On the contrary, the number of apoptotic cells at least doubled in some tubules of these groups. There were significant differences between the lower dose group and the higher doses groups. Therefore, the observed differences were relatively dose-dependent.Conclusion: This study revealed that one exposure to MAMP particularly at the high dose can change the proliferation/apoptosis ratio of spermatogonia in rat testis. Therefore, this would adversely affect the normal spermatogenesis process and could lead to disturbances in male fertility.

Background: Considering the heterogenicity of polycystic ovary syndrome (PCOS), the diagnosis is difficult. The aim of present study was to compare ovarian morphology, pattern of menstrual cycles and testosterone level in obese and non obese polycystic ovary syndromepatients. Methods: Clinical characteristics, hormonal profile and ovarian morphology were evaluated in 54 women with polycystic ovary syndrome, aged 21-48 years. They were devided in 2 groups regarding Body Mass Index; obese (BMI ³ 25) and nonobese (BMI < 25). Fidings were statistically analyzed.Findings: Mean BMI was 28.5 ± 3.2 in obese group and 21 ± 2.6 kg/m2 in nonobese group. Menstrual cycles were regular in 11 patients (20.4%) and irregular in 43 patients (79.6%). BMI was 23.6 ± 3.6 in patients with regular cycles and 25 ± 5 in those with irregular cycles (P = 0.36). Mean testosterone level was 7.1±1.7 in obese and 5.6 ± 2.9 ng/ml in nonobese group (P = 0.69). In obese group, ovarian morphology was normal in only 8 patients (29.6%) and abnormal in 19 patients (70.4%) (P = 0.039) and in nonobese group 12 patients (44.4%) had normal morphology and 15 patients (55/6%) had abnormal morphology. (P = 0.039). Conclusion: Our study suggests that there is significant correlation between BMI and ovarian morphology but there is no significant difference between BMI and menstrual cycle or BMI and testosterone level. Thus both obese and nonobse PCOS patients show different presentations and it is necessary to do more studies to compare clinical features of PCOS in obese and nonobese patients for early diagnosis and management.

Background: Primary amyloidosis is the most common form of systemic Amyloidosis. Amyloidosis is the results of fibril formation due to plasma cell dyscrasia or rarely monoclonal gammopathy of uncertain significance (MGUS). Clinical manifestations are proteinuria, cardiomyopathy, peripheral neuropathy, large tongue and shoulder fat pad enlargement and hepatosplenomegaly. Case Report: The presented patient is a 42-year old woman with clinical features of a dull epigastric and left upper abdominal pain from one year ago. Her family history and past medical history was normal except for an exertional dyspnea. In the physical examination, paleness, large tongue with indentations around it and hepatosplenomegaly were obvious, during admission, she had rectorrhagia, polipectomy led to severe hemorrhage. Echocardiography performed and revealed the typical sign of sparkling pattern with restrictive cardiomyopathy. In bone marrow evaluation plasma cells were 8%. Serum protein electrophoresis showed that monoclonal gammopathy near 2 grams in weights and all data confirm monoclonal gammopathy of uncertain significance. Duodenal biopsy verified an amyloid deposition which was confirmed by Congo red coloration. There were no data to support secondary amyloidosis in our wide investigation and patient was treated with the diagnosis of primary amyloidosis due to monoclonal gammopathy of uncertain significance. Conclusion: Primary amyloidosis secondary to monoclonal gammopathy of uncertain significance is a rare disease which should be mentioned in chronic multiorgan disorders.