Tehran University Medical Journal

The relationship between polymorphisms in intron 8 of vitamin D receptor gene and occult HBV infection

Kazemi Arababadi M

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Occult hepatitis B infection (OBI) is a form of hepatitis in which despite absence of detectable HBsAg, HBV-DNA is present in peripheral blood of patients. The responsible mechanisms for progression of OBI yet to be clarified, but some investigators believed that the genetics and immunological parameters are different in resistant individuals and patients. Vitamin D3 and its receptor interaction could be involved in anti-viral immune response. The aim of this study was to investigate the association between polymorphisms in intron 8 of VDR with OBI.
Methods: In this experimental study, the plasma samples of 3700 blood donors were collected and tested for HBsAg and anti-HBs by ELISA. The HBsAg negative and anti-HBc positive samples were selected and screened for HBV-DNA using PCR. HBV-DNA positive samples were assigned as OBI cases and PCR-RFLP was performed to examine the polymorphisms in intron 8 of VDR genes.
Results: Results of current study indicated that 352 (9.5%) of 3700 blood samples were HBsAg^- and anti-HBc⁺. HBV-DNA was detected in 57/352 (16.1%) of HBsAg^- and anti-HBc⁺samples. Our results showed that no significant difference was observed in Apa-1 polymorphisms of intron 8 of VDR and OBI patients.
Conclusion: Our results demonstrated that there are not any association between Apa-1 detected alleles and OBI, hence, it can be concluded that these alleles are not associated with OBI and other researchers should evaluate relation between other polymorphisms of VDR with OBI.

The effect of co-administration of morphine and L-Arginine in hippocampal CA3 area on spatial learning and memory in male rats

Pouraboli I

Background: Learning and memory are the complicated agents of central nervous system that various regions of brain can be involved in these phenomena, especially regions like hippocamp. Various agents like nitric oxide and morphine can influence learning and memory. About the effects of morphine with other components there was not clear reports so in this study the effect of co-administration of L-Arginine (precursor of nitric oxide) and morphine in hippocampal CA3 area on spatial learning and memory in male rats was investigated.
Methods: Male rats were deeply anaesthetized with ketamine and xylazine and cannula were implanted bilaterally in CA3 of hippocampus by using streotaxic technique, Then male rats were used in seven groups that received saline, L-Arginine (0/3M), L-Arginine (3μg/rat), L-NAME (0/3M), morphine (10mg/rat), L-Arginine (3μg/rat) with morphine or L-NAME with morphine for five days that they were trained in morris water maze to evaluate spatial learning and memory. There was a control group too.
Results: Our results showed that L-Arginine (3μg/rat) improved spatial learning and memory. L-NAME (inhibitor of nitric oxide) decreased spatial learning and memory in male rats. Injection of morphine also decreased spatial learning and memory in male rats. Co-administeration of L-NAME and morphine decreased learning more than morphine individually in male rats.
Conclusion: We concluded that precursor of nitric oxide improved learning and memory in male rats and inhibitor of it and morphine impaired this phenomena and coadministration of inhibitor of nitric oxide and morphine also impaired learning in rats.

Survival analysis of gastric cancer patients using Cox model: a five year study

Hajizadeh E

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Gastric cancer is the second most common cancer and known as the second cause of death due to cancers worldwide. Adenocarcinoma is the most fatal cancer in Iran and a patient with this kind of cancer, has a lower lifetime than others. In this research, the survival of patients with gastric carcinoma who were registered at Taleghani Hospital, were studied.
Methods: 291 patients with Gastric carcinoma who had received care, chemotherapy or chemoradiotherapy, at Taleghani Hospital in Tehran from 2002 to 2007 were studied as a historical cohort. Their survival rates and its relationship with 12 risk factors were assessed.
Results: Of the 291 patients with Gastric carcinoma, 70.1 percent were men and others (29.9%) were women. The mean age of men was 62.26 years and of women was 59.32 years at the time of diagnosis. Most of patients (93.91%) were advanced stage and metastasis. The Cox proportional hazards model showed that age at diagnosis, tumor stage and histology type with survival time had significant relationships (p=0.039, p=0.042 and p=0.032 respectively).
Conclusion: The five-year survival rate and median lifetime of gastric cancer patients who underwent chemotherapy or chemoradiotherapy are very low and seems that one of the important reasons for this situation is delayed diagnosis. The scheme of public education about the early warning signs of the disease and diagnosis and administration of periodic examinations is unavoidable.

Evaluation of motor control following thenar muscle fatigue using symmetrical index

Talebian S

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Muscle weakness and fatigue are two factors that cause muscle injuries. The roll of motor control is important in regulation and reduction of this effect. Repetition of motion after muscle fatigue is due to the significant role of motor control system. The aim of this study was to evaluate the quality of roll control of central nervous system following fatigue in order to answer primary questions in therapeutic exercises.
Methods: Twenty voluntary healthy subjects participated in this study. Dominant abductor policis brevis after surface electromyography (SEMG) of maximal voluntary contraction (MVC) fatigued by maximum three minutes isometric contraction in specific hand splint monitored by dynamometer until reduction of activities to 50% MVC. Before and immediately after fatigue test, 5 dynamic full range of motion in abduction direction performed without resistance and muscle activities recorded by SEMG. Three middle muscle activities selected for comparison of Symmetrical Index (SI) as specificity of motor control assessment. Fatigue indicators were percentage of reduction of MVC and median and mean frequency of power spectrum of MVC before and after fatigue test.
Results: Significant reduction of MVC (46.77%), median (13.03%) and mean (12.20%) frequency were showed (p=0.001), whereas significant increase of SI (10.76%) appeared (p=0.000), following fatigue test.
Conclusion: Fatigue reduces muscle contraction velocity, therefore median and mean frequency decrease. Also after muscle fatigue reduces of muscle proprioception sense appears, that can cause slow dynamic joint motion. Upper central control systems try to correct this situation by involving new motor units and changes of muscle timing. Synchronization of primary and new motor units plays an important role in increase of SI.

Measurement of airway related distances: virtual bronchoscopy in 140 cases

Noyan Ashraf MA

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: The insertion depth of tracheal tube differs based on sex, age, position of head and neck, type of surgery, and anatomical consideration. The aim of this study was to determine the airway related distances in Iranian patients with a non-invasive, and accurate method, the computerized reconstruction of High Resolution CT (HRCT) Virtual Bronchoscopy.
Methods: A total of 140 Iranian patients who became candidate for sinus and chest tomography, were enrolled in a cross- sectional study in Imam Khomeini Hospital Complex, Tehran, Iran, from 2006 to 2008. After reconstruction of airway related distances, Incisor- Vocal cord (IVD), Vocal cord- Carina (VCD) and Incisor- Carinal (ICD) Distances were determined.
Results: A total of 140 patients were evaluated, while 70(50%) were male. There was no statistically significant difference between age groups, sex and BMI in study patients. The measured IVD were 145.5±9.7 (males), 127.29±6.3 (females) and 136.43±12.29mm (total). For VCD, the distances were 131±13.99 (males), 122.59±11.7 (females), and 127.09±13.65mm (total). The measures for ICD in males, females, and total of patients were 277.17±16.63, 249.88±11.54, and 263.52±19.66mm respectively.
Conclusion: The insertion depth for fixation of endotracheal tube in Iranian adult patients is the same as that of anesthesia textbooks. There were no statistically significant difference between our study data and previously measured distances using invasive and less accurate methods. Virtual bronchoscopy is a noninvasive and accurate method based on reconstruction of computed tomographic images and the reconstructed images of tomography could be useful in measuring and assessment of airway anatomy.

Tricuspid valve endocarditis surgery: results of 67 patients

Torfi Y

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Surgical methods for treatment of tricuspid valve (TV) endocarditis include repair, replacement and partial or complete exicion. The aim of this study was to assess the results of these different techniques.
Methods: Sixty seven patients were enrolled in this retrospective study. This study was carried-out between April 1997 and July 2007 in Imam Khomeini hospital. Decision of methods of choice for surgery was according to intraoperative findings.
Results: The mean age was 25.52±7.35 years and 74.36% were male. The most common bacteria was Staphylococcus areus (62.30%). Most of patients (74.60%) were IV drug abuser. The most common treatment modality was TV reconstruction (56.72%) and after that was TV replacement (29.85%) and the last one was complete TV excision (13.43%). Eight patients (11.94%) needed emergent TV replacement. The morbidity rate was 28.36% and the mortality rate was 13.51%. Thirty seven patients were followed. In follow-up period it was shown that postoperative Ejection Fraction (EF) and End-Diastolic Right Ventricle Diameters (EDRVD) values did not differ from preoperative values, but Pulmonary Artery (PA) pressure and Tricuspid Regurgitation (TR) severity were significantly lower compared with preoperative values. The postoperative function class did not show any changes compared with peroperative values.
Conclusion: Considering the specific epidemiology of patients with infective endocarditis, who are suffering from TV regurgitation, in some patients, it would be better to consider replacement instead of repair. This could be due to sever deformities and diffuse damage of TV leaflets from infection in our patients.

Effect of Tactile-Kinesthetic Stimulation in weight gaining of pre-term infants hospitalized in intensive care unit

Keshavarz M

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Many studies have demonstrated that pre-term neonates gained more weight over the 10 days stimulation period. This research has been conducted to determine the effects of five days Tactile- Kinesthetic stimulation (TKS) on weight gaining of pre-term infants hospitalized in Fatemiye neonatal intensive care unit.
Methods: Fifty one babies who graduated from the NICU to the intermediate care nursery were randomly allocated into test and control groups (24 and 27 neonate respectively). TKS was provided for three 20 minute periods per day for five consecutive days to the test group, with the massages consisting of moderate pressure strokes in left and right lateral position and kinesthetic exercises consisting of flexion and extension of the limbs. They were observed for changes in physiologic parameters and weight gaining during five days stimulation in hospital.
Results: Over the five days TKS an increase in weight was seen in the test group (p=0.018, 43.1 vs 5.4). Infants in both the test and control groups were matched for mean weight before study and days in which they received antibiotics and photo therapy. Mean temperature and O² saturation had no meaningful difference, but an increase in respiratory rate (p=0.047, 32.9 vs 32.5) and heart rate (p<0.001, 148 vs 145.7) (within physiologic range) was seen in the test group during stimulation, so that no one excluded from study.
Conclusion: Tactile- Kinesthetic stimulation has no adverse effects on physiologic parameters, meanwhile has a beneficial effect on weight gaining in pre-term neonates, So touch and massage therapy which are both beneficial and cost effective could be placed in policy of care programs in nurseries in Iran.

Application of artificial neural network to predict graft survival after kidney transplantation: Reports of 22 years follow up of 316 patients in Isfahan

Ashrafi F

Background: Kidney transplantation had been evaluated in some researches in Iran mainly with clinical approach. In this research we evaluated graft survival in kidney recipients and factors impacting on survival rate. Artificial neural networks have a good ability in modeling complex relationships, so we used this ability to demonstrate a model for prediction of 5yr graft survival after kidney transplantation.
Methods: This retrospective study was done on 316 kidney transplants from 1984 through 2006 in Isfahan. Graft survival was calculated by Kaplan-meire method. Cox regression and artificial neural networks were used for constructing a model for prediction of graft survival.
Results: Body mass index (BMI) and type of transplantation (living/cadaver) had significant effects on graft survival in cox regression model. Effective variables in neural network model were recipient age, recipient BMI, type of transplantation and donor age. One year, 3 year and 5 year graft survival was 96%, 93% and 90% respectively. Suggested artificial neural network model had good accuracy (72%) with the area under the Receiver-Operating Characteristic (ROC) curve 0.736 and appropriate results in goodness of fit test (κ2=33.924). Sensitivity of model in identification of true positive situations was more than false negative situations (72% Vs 61%).
Conclusion: Graft survival in living donors was more than cadaver donors. Graft survival decreased when the BMI increased at transplantation time. In traditional statistical approach Cox regression analysis is used in survival analysis, this research shows that artificial neural networks also can be used in constructing models to predict graft survival in kidney transplantation.

A comparative study of Zinc deficiency prevalence in pregnant and non pregnant women

Haghollahi F

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Zinc is one of the elements necessary for growth and health in human. Some evidences indicate that zinc deficiency is one of real difficulties for the public health in both developed and developing countries. Since the pregnant women are more at risk of zinc deficiency, the objective of this study was to determine the rate of zinc deficiency in pregnant women in the 3 trimesters and to compare these data with that of the healthy controls.
Methods: This research was an analytic- descriptive study which was done on 677 pregnant women in 3 Trimesters and 140 non pregnant groups who referred to clinic of Tehran University. Blood sample were taken And serum zinc was assessed By Enzymatic technique.
Results: The prevalence of zinc deficiency is 16% in pregnancy and 0% in non pregnant women with a significant difference between two groups (p<0.001). Zinc deficiency had no relation to mother's age, gestational age, Iron supplementation, Parity and mothers BMI. Hemoglobin level showed a direct relation to zinc deficiency and was grossly found to be more prevalent in Hb levels less than 12 (CI: 1/36-4/26, OR=2/4).
Conclusion: Acording to the finding of presented study, zinc deficiency is more prevalent in Hb<12 inspite of iron supplementation. Iron and zinc supplements in pregnancy period seem to be more effective for Hb repair in each case.

Seroma formation after breast cancer surgery: incidence and risk factors

Jangjoo A

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Seroma formation, or the subcutaneous collection of fluid, is a common problem after surgery for the breast cancer. It may lead to wound-related complications and also can delay adjuvant therapy. The aim of this study was to investigate the effect of various clinical and therapeutic variables on seroma formation.
Methods: A prospective cross sectional study of patients who underwent surgical therapy for breast cancer was carried out. Modified radical mastectomy was performed on 67 patients (65%) and 28 patients (27.2%) underwent breast conservative surgery. Simple extended mastectomy was done for the remaining 8 patients (7.8%). Seroma formation was studied in relation to age, type of surgery, tumor size, nodal involvement, preoperative chemotherapy, surgical instrument (electrocautery or scalpel), use of pressure garment, and duration of drainage. All of the patients followed for 4 weeks after surgery.
Results: A total of 103 patients with breast cancer were studied. The mean age of the patients was 48.3 years (25-82). Seroma occurred in 27 (26.2%) patients. There was statistically significant relation between age and seroma formation after breast cancer surgery (p=0.005), while other factors studied was found to be significantly ineffective. In addition, there was not any relation between seroma formation and drain duration. However, two factors including type of the operation and level of lymphatic dissection was considerable with confidence interval up to 90%, but it was not statistically significant with confidence interval >95% (p=0.068 and 0.063 respectively).
Conclusion: These findings suggest that the age is a predicting factor for seroma formation in breast cancer patients, while other factors do not significantly affect that.

Serum homocysteine level in gestational diabetes: a prospective study

Davari Tanha F

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Increased total plasma homocysteine (Hcy) is an accepted risk factor of cardiovascular disease (CVD), stroke, preclampsia, recurrent abortion and diabetes type I and II. The aim of the current study was to assess serum homocysteine and its relation with serum folat, vitamine B12 and lipid profile in gestational diabetes mellitus and to compare these with those of pregnant women.
Methods: In a prospective controlled survey 80 pregnant women (24-28 weeks) with uncomplicated pregnancies were evaluated. They were assigned to one of two groups according to the results of 100g-OGTT. In the case group there were pregnant women with gestational diabetes mellitus according to the OGTT and in the control group women who had normal OGTT results were put. Levels of fasting glucose, homocysteine, vit B12, and folic acid, uric acid, total cholesterol, triglyceride, Low Density Lipoprotein cholesterol (LDL) and High Density Lipoprotein cholesterol (HDL) were measured in both groups.
Results: The mean level of homocysteine in GDM group was significantly higher than control group (p=0.000). The mean level of folic acid and vit B12 was significantly lower than the level in control group (p=0.001, p=0.004 respectively). Body mass index (BMI) in GDM group was higher (p=0.000) and HDL level was lower (p=0.006) than control group. There were no significant differences among the groups with respect to levels of total cholesterol and triglyceride.
Conclusion: We found that patients with gestational diabetes have higher homocysteine level than normal pregnant women. This increased level seems to be related to an abnormal OGTT. Further investigations are needed to follow up these patients in the postpartum period and later on.

Reliability and validity of Anxiety and Depression Hospital Scales (HADS): Iranian patients with anxiety and depression disorders

Seyfourian H

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Iranian researchers and scientists in the fields of psychiatry and psychology undoubtedly need to spend more time and make considerable efforts to prepare and validate Persian versions of measurements. The present study was designed to validate HADS in Iranian clinically anxious and depressed patients compared to normal population.
Methods: 261 anxious and depressed patients referred to the inpatient clinic of Rouzbeh Psychiatric Hospital, Tehran, and 261 healthy volunteers (matched for their sex) were tested using HADS, and two additional clinical tools, ie., BDI & BAI. Then the patients were interviewed by a psychiatrist or a psychologist (using DSM IV checklist) and rated for their anxiety and depression severity levels based on a 10-point scale from 1 to 10. BDI and BAI were regarded as objective device providing other external criteria to examine validity further. Moreover, to assess reliability 10% of the patients (n= 27) were randomly selected and re-tested after three days.
Results: Findings showed that all measures and their subscales proved to be valid and reliable with good internal consistencies in Iranian depressed and anxious patients. This study provides clinicians and researchers with Iranian cut-off points for HADS, BDI and BAI, to be used in their settings, to categorize the patients with different levels of psychopathology.
Conclusion: The results support the use of all the measures and subscales examined in this study in clinical and research settings. The cut-off points obtained in this study are somehow different from those presented by original authors which will be discussed from cultural point of view in this report.