Tehran University Medical Journal

Therapeutic potential of cell therapy in the repair of hair cells and spiral ganglion neurons: review article

Ali Asghar Peyvandi

The mammalian cochlea is a highly complex structure which contains several cells, including sensory receptor or hair cells. The main function of the cochlear hair cells is to convert the mechanical vibrations of the sound into electrical signals, then these signals travel to the brain along the auditory nerve. Auditory hair cells in some amphibians, reptiles, fish, and birds can regenerate or replace by new cells, but irreversible damage to the mammalian hair cells are not being replaced through differentiation of the internal epithelial cells in the inner ear. Indeed, mammalian auditory hair cells do not spontaneously repair or regenerate after development. Sometimes, functions of damaged hair cells may be restored, but in most cases, there is no such possibility and permanent hearing loss occurs. Several factors such as chronic ear infections, genetic disorders, drug abuse, acoustic trauma and aging can damage the cochlea, resulting in permanent hearing loss. More than 250 million people in the world have disabling hearing impairment. Deafness is caused by damage to sensory hair cells or spiral ganglion neurons. Although hearing aids and cochlear implants were used for improvement of hearing loss, but they do not restore normal hearing. In addition, application of new biological approaches to induce auditory hair cell regeneration provides more comprehensive treatment for hearing loss. Cell therapy is considered a promising way in the treatment of several diseases such as Parkinson, diabetes and cardiac diseases. According to recent research, cell therapy can be useful in hair cell regeneration. Cell therapy is effective in hearing loss when stem cell differentiates into hair cells with appropriate morphology, electrical activity and capacity for suitable innervations with inner ear tissues. In fact, stem cell-derived neurons need to project neural processes toward the sensory hair cells and the cochlear nucleus neurons. In this regard, studies focus on methods in which hair cells can be provided from exogenous and endogenous stem cells. Here, we review cell therapy approaches in repair damaged cochlear hair cells, as well as imitations and problems of its clinical application.

Survey of Iranian gastroenterology and hepatology scientific productions in Web of Science database from 1983 to 2017

Fatemeh Karami Robati

Background: One of the most important criteria of the development of countries at the national and international levels is the survey of scientific productions indexed in authentic databases. This study aimed to analyze the scientific productions by Iranian researchers on gastroenterology and hepatology in the Web of Science (WOS) database.
Methods: This applied study used a scientometric approach to review the scientific productions by Iranian researchers on gastroenterology and hepatology in the WOS database. Therefore, the total number of scientific documents related to the category of gastroenterology and hepatology, Iran, and other countries were recovered. The time frame was until the end of 2017. Data were collected in April 2018. This research was conducted at the Clinical Research Unit in Afzalipour Medical Center in Kerman, Iran.
Results: The results showed that during 1983 to 2017, the total number of 2180 scientific productions (0.31%) on gastroenterology and hepatology were published in Iran, ranking the country 34th in the world. Compound annual growth rate (CAGR) in Iranian scientific publications was 9.5%. The «Tehran University of Medical Sciences» was identified as the most productive center in gastroenterology and hepatology field with a contribution rate of 35.69%. The results also showed that the most international collaboration of Iranian researchers on gastroenterology and hepatology field was with the United States of America (USA) scientific centers (5.82%). Most articles in the field of gastroenterology and hepatology (26.69%) were published in the «Hepatitis Monthly» journal. Most scientific productions in this field were related to the microbiology. The majority of scientific productions on gastroenterology and hepatology field were published in the form of article. Most scientific productions by Iranian researchers on gastroenterology and hepatology in the Web of Science (WOS) database were in English language.
Conclusion: Results showed that although compound annual growth rate (CAGR) in Iranian gastroenterology and hepatology publications was high rather than gastroenterology and hepatology scientific productions CAGR in the world, it’s not satisfying. Most articles have published in journals with low impact factor. Therefore, we should resolve the problems and increase the scientific level of researches.

Factors affecting axillary lymph node involvement in patients with breast cancer

Maryam Zakerihamidi

Background: Breast cancer is the most commonly diagnosed and the leading cause of cancer death among females worldwide. The rate of breast cancer incidence among Iranian women is 17% of all cancers, it has been ranked first in Iran. This study aimed to investigate the factors affecting axillary lymph node involvement in female patients with breast cancer.
Methods: A cross-sectional study was conducted on 167 patients with breast cancer diagnosed between March 2012 and March 2015 at Shahid Beheshti of Babol, Shahid Rajaei of Tonekabon and Imam Sajad of Ramsar hospitals. A researcher-made questionnaire was used to collect information on the patients and pathology report of tumor and lymph nodes was completed.
Results: The rate of axillary lymph node involvement was observed in 117 patients (70.1%). Mean age was 49.64±11.62 years in the patients with breast cancer. The highest frequency of lymph node involvement was observed in the 40-49 age group (24%). The average size of tumor was 3.39 cm and the majority of patients had a tumor 2-5 cm (T2) but the most involvement was related to T3 (>5cm). The most common type of cancer and grading were invasive ductal carcinoma (93.4%) and tumor grade 2 (52.1%), respectively. Most lymph node involvement was observed in invasive ductal carcinoma and 85.1% of patients had tumor degree 3. 22.2% of patients with vessels involvement had axillary lymph node involvement. 63% of patients’ tumors had receptors of estrogen and progesterone. A statistically significant association was observed between axillary lymph node involvement and tumor size (P=0.031), tumor type (P=0.007), tumor grade (P=0.011), estrogen receptor (P=0.008) and progesterone receptor (P=0.038).
Conclusion: There was a statistically significant association between axillary lymph node involvement and tumor size, type and grade, estrogen and progesterone receptor status, but there was no statistically significant association between axillary lymph node involvement and age and estrogen as well as progesterone receptor status.

Efficacy and complications of oral ibuprofen and intravenous acetaminophen in closure of patent ductus arteriosus of preterm neonates

Semira Mehralizadeh

Background: Previous studies have considered patent ductus arteriosus (PDA) a common finding in premature infants, leading to complications such as intracranial hemorrhage, necrotizing enterocolitis and pulmonary dysplasia. The aim of this study was to assess and compare the efficacy of oral ibuprofen and intravenous acetaminophen in the closure of arterial duct in premature newborns. We also evaluated the complications of each drug.
Methods: A cross-sectional and analytical study was conducted at Amiralmomenin Hospital, Semnan City in Iran from April 2012 to December 2017. Subjects were selected through convenient sampling and consisted of all premature infants with patent arterial duct. All of the infants with the diagnosis of PDA were treated with either intravenous acetaminophen or oral ibuprofen. Cardiac echocardiographic findings were assessed in two study groups before and after each treatment course. The complications associated with the two treatment approaches were evaluated in two groups after treatment of each drug.
Results: In general, twenty-four neonates (62.5% females) with the average gestational age of 31.46±3.43 weeks were studied. There was no significant difference in the echocardiographic characteristics in the two treatment groups at the pre and post-treatment periods as well as the side effects of the medications. The average number of treatment cycles in newborns treated with oral ibuprofen (1.06±0.25) was not significantly different compared to those with intravenous acetaminophen (1.25±0.46) (P=0.190). There was no significant difference concerning closure status of the arterial duct in the two treatment groups at the end of the first period (P=0.112) as well as after the second period of treatment (P=0.386).
Conclusion: Our study indicated similar efficacy of oral ibuprofen and intravenous acetaminophen in the closure of the arterial duct. The incidence of complications was not significantly different between the two groups. The results of this study suggest the use of intravenous acetaminophen as a suitable drug for PDA closure, particularly in cases of ibuprofen contraindications.

The survey on the amount of scientific productions in the field of obstetrics and gynecology before and after the health reform plan, based on the Web of Science database: a sciento-metrics study

Mousa Bamir

Background: The position of each subject area in scientific production can indicate the ability of the scientific performance of that subject field. Since obstetrics and gynecology is one of the most important clinical sciences discipline of medical science, this study aimed to evaluate the scientific production in the field of obstetrics and gynecology before and after the Iran health reform plan.
Methods: This study is a scientometrics, time interval in the study was from 2008 to 2017 on Iranian articles based on the indexes of the number of documents, the number of citations received, the number of citations to each article, and the H-index of obstetrics and gynecology field based on the Web of Science database. It Indicators investigated, was extracted separately from the analysis section of the database.
Results: The average citation per article, the number of documents and the number of citations in the 5 years before the health reform plan respectively in the field of obstetrics and gynecology equal to 10.44, 196.6, 1750.6 and after the implementation of the health reform plan, equal to 3.89, 282.6, 1031.4. Also, the level of international collaboration before and after the project is 13.06 and 13.25, respectively. Also in the field of gynecology and obstetrics, Ramezani Tehrani, with 1.91% of all articles was the most reproductive writer, and Tehran University of Medical Sciences, with the highest scientific productions in the field of obstetrics and gynecology by 23.77% of all productions. Finally, the field of obstetrics and gynecology had the highest share of scientific production by 66.88%.
Conclusion: The findings showed that the scientific production of obstetrics and gynecology, in terms of quantity (number of documents), after the health reform plan, has been growing, but the quality (citation, H-index) is decreasing. Also, international collaboration has grown after the health reform plan. The findings also showed that before and after the health reform plan, the most cooperation was with the United States and the rate has been lower with Asian countries.

Comparison of supraspinatus sonographic thickness in empty can, full can and hug up testing positions in healthy women

Mehri Ghasemi

Background: Rotator cuff injuries are the most common causes of shoulder pain and supraspinatus muscle is usually involved. Clinical tests are available and inexpensive tools for assessment of shoulder dysfunctions. The empty can (EC) and full can (FC) tests are considered as shoulder gold standard tests. Recently, hug up (HU) test has been developed to assess the supraspinatus. So far, no ultrasonographic study has compared supraspinatus muscle thickness in these testing positions. The present study aimed to compare the supraspinatus muscle thickness in the hug up testing position with the full can and empty can testing positions in young and healthy women.
Methods: Forty healthy women (mean age 21.62±2.4 years) participated in this cross-sectional-comparative study from April to June 2018 in the Biomechanic Laboratory of Rehabilitation School, Shahid Beheshti University of Medical Sciences in Tehran, Iran. The supraspinatus muscle thickness was scanned during rest and contracted states with a 0.5 Kg weight cuff. For contracted states, (A) EC testing position: the arm was at 90º abduction in the scaption plane with the thumb-down, (B) FC testing position: the arm was maintained at 90º abduction in the scaption plane with the thumb-up, (C) HU testing position: the palm of hand was placed on the opposite shoulder with the elbow flexed.
Results: The Bonferroni test showed significant differences (P<0.001) between the muscle thickness in the rest and the testing positions. The muscle thickness in the empty can testing position was significantly less than the full can testing position (P=0.001), no significant difference was found between the muscle thickness in the hug up testing position compared to the full can and empty can testing positions.
Conclusion: All of the empty can, full can and hug up testing positions demonstrated increased mean muscle thickness when compared to the rest position and the greatest muscle thickness was in the full can testing position. It seems that supraspinatus muscle thickness in hug up testing position is similar with empty can and full can testing positions.

Fluoroscopic analysis of anterior tibial translation during eccentric and concentric phase of knee rehabilitation exercises in men with anterior cruciate ligament injury

Fateme Esfandiarpour

Background: The amount of anterior tibial translation during rehabilitation exercises is a key factor in organizing exercise regimen after anterior cruciate ligament injury. Excessive anterior tibial translation could increase the magnitude of tension imposed on injured and reconstructed anterior cruciate ligament knees. Forward lunge and open-kinetic knee extension exercises are commonly used in anterior cruciate ligament rehabilitation. However, there is insufficient data about the amount of anterior tibial translation in the eccentric and concentric phases of these exercises. This study compared the amount of anterior tibial translation in the eccentric and concentric phase of the lunge and seated knee extension in anterior cruciate ligament deficient and intact knees.
Methods: Using a non-probability sampling method, 14 men with unilateral anterior cruciate ligament rupture were selected for participation in this cross-sectional study. Participants were recruited from the university’s physiotherapy clinics. A uni-plane fluoroscope was used to image the knee joint while participants performed the forward lunge and open-kinetic knee extension exercises with the intact and injured legs in random order. Fluoroscopy imaging was performed in the radiology center at Sina Hospital, Tehran, Iran, from September 2013 to February 2014. Two factorial mixed ANOVA was used to analyze the data.
Results: There were no significant differences in the anterior tibial translation between the limbs and contraction phases during the lunge exercise. During open-kinetic knee extension, the anterior tibial translation in anterior cruciate ligament deficient knees was significantly more than that of healthy knees at 0⁰ (P=0.007). The anterior tibial translation in the eccentric phase of open-kinetic knee extension at flexion angles of 0⁰ (P=0.049) and 15⁰ (P=0.024) was significantly greater than that in the concentric phase.
Conclusion: In the lunge exercise, the amount of anterior tibial translation was similar between the eccentric and concentric phases and the intact and anterior cruciate ligament deficient knees, however, during open-kinetic knee extension exercise, in the eccentric phase was greater than that in concentric, and in the intact knees was greater than that in the intact knees, at 0-15⁰ angles.

The relationship between shift work and metabolic syndrome: a prospective cohort study

Mohammad Gholami-Fesharaki

Background: Metabolic syndromes have been identified as a major risk factor for people with cardiovascular disease. Metabolic syndromes are defined as a range of conditions including waist-fat, abdominal obesity, high blood pressure, diabetes, high triglycerides, and HDL. Considering the importance of controlling metabolic syndrome, the research study subject with the mentioned aim is so important in the world and Iran. One of the affecting factors that have reported contradictory results in the previous study are shift work. Therefore, this prospective cohort study was conducted to investigate the relationship between metabolic shift syndromes on labor men.
Methods: This five-year prospective cohort study has been conducted in randomly selected workers (using random cluster sampling) who work in Esfahan’s Mobarakeh Steel Company (the largest steel company in Iran country that located in Mobarkeh city in Isfahan province, Iran) from April 2011 March 2015. In this study shiftwork and metabolic syndromes considered as an independent and dependent variable respectively. In addition, age, education and work experience considered as a controlling variable. In this study, routinely rotating (ROR) and weekly rotating (WRO) shifts were scheduled with a clockwise rotation plan (two mornings, two evenings, two night and two days off for ROR and three morning shifts, three evening shifts, and one day off every two weeks, Fridays always off for WRO shifts). The morning, evening, and night shifts began at 7 AM, 3 PM, and 11 PM, respectively. Day workers (DW) worked from 7 AM to 3 PM on weekdays and had Thursdays and Fridays off.
Results: The study sample included 1321 male workers (mean age=43). Among these subjects, 528 (40%), 155 (12%) and 638 (48%) were day workers, WRO shift workers, and ROR. The 5-year odds ratio (OR) of metabolic syndrome in the ROR shift worker compared to the DW was OR=1.93, P-value=0.044 and for a WRO shift with OR=1.26, P=0.64.
Conclusion: Considering the result of this study increased risk of metabolic syndrome in ROR shift worker rather than DW has been approved but such increase in WRO shift rather day worker had not to be approved.

A study of clinical manifestations of patients with cavernous malformation

Sajjad Daneshyar

Background: Venous anomalies are the most common vascular malformation of the central nervous system in adult, it can form anywhere in the body, but are most likely to cause symptoms when they grow in the brain or spinal cord. Common symptoms include headaches or seizures. Experiencing symptoms depend on where the lesions grow and how many of the lesions are present. Most of the time, these formations cause no problems. In some people, knowing the clinical signs and possible future complications in the disease can help to treat the disease and diagnose it.
Methods: In this Prospective cohort study, 41 patients with cavernous malformation who were diagnosed by neurologist referred to Sina Hospital in Hamedan City, Iran, from 2016 to 2017 were studied. Patients' information about their referrals during the follow-up period were collected and the results were reported.
Results: This study was conducted on 20 (48.79%) females and 21 (51.21%) males with the mean ages of 50±2 years. The most common manifestation of disease was seizure in 20 patients (48.78%). Most of these lesions were found in parietal lobe in 11 cases (26.82%) and then in the frontal lobe with 8 cases (19.51%). In terms of complications during follow-ups, 16 patients (39.2%) were uncomplicated, 16 patients had 48 episodes of seizure, seven patients had nine episodes of hemorrhage, two patients with hemiparesis, one patient with headache and one patient with sixth cranial nerve paralysis. According to the associated disease and risk factors, nine patients (26.82%) had high blood pressure, five patients (12.19%) had meningioma and three patients (7.31%) had diabetes. Seven patients (17.07%) had a positive family history that symptoms and complications in this patients are higher than the rest of patients.
Conclusion: In this study, most of the cases are sporadic and the most common symptom was seizure. The most common symptom in supratentorial lesions were seizure whereas in multiple and infratentorial lesions were bleeding. Five patients were involved with meningioma which could be considered in more studies with more patients in future.

Presentation of a case with perineal and bartholin gland inflammations as an initial manifestation of acute myeloid leukemia: case report

Setare Nassiri

Background: Acute myeloid leukemia (AML) is a malignant hematological disorder which has numerous manifestations at the initial step such as infections and hemorrhagic signs. This is the first report in which the diagnosis of AML was made after managing of Bartholin gland site swelling and pain as the chief complaint of a patient.
Case presentation: Herein, we present a young girl who was referred to us in our tertiary level hospital, Firoozgar Hospital, Tehran, Iran, in october, 2017 just with pain and swelling of the left Bartholin gland. At first, it was suspected to be a cyst or abscess of Bartholin gland, she did not have any history or symptoms of infection on comprehensive physical examinations such as pneumonia, meningitis, Nevertheless, the ultimate diagnosis of AML was made after generalized and precise systemic examination and laboratory findings were done. According to the guidelines for the treatment of AML, systemic chemotherapy with multiple drugs was given immediately but unfortunately, she died due to severe septicemia which was resistant to broad-spectrum antibiotics and disseminated intravascular coagulation.
Conclusion: Based on our searching, this is the first case. Because we expected other more common symptoms of acute lukemia, systematic and precise generalized examination must be performed gently in all of the patients even in women just with genital symptoms as their chief compliant for instance, pain and swelling of Bartholin gland. Finally, not focusing just on the perineal site and detailed examination for all parts of the body may reveal an accurate diagnosis of the main underlying disease.

Health strengthening plan, a supplement to Iran health transformation plan: letter to the editor

Ali Mohammad Mosadeghrad

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