Tehran University Medical Journal

---

A case with bilateral spontaneous pneumothorax was presented. Etiology, mechanism, and treatment were discussed on the review of literature. Spontaneous Pneumothorax is a clinical entity resulting from a sudden non traumatic rupture of the lung. Biach reported in 1880 that 78% of 916 patients with spontaneous pneumothorax had tuberculosis. Kjergaard emphasized 1932 the primary importance of subpleural bleb disease. Currently the clinical spectrum of spontaneous pneumothorax seems to have entered a third era with the recognition of the interstitial lung disease and AIDS as a significant etiology. Standard treatment is including: observation, thoracocentesis, tube thoracostomy. Chemical pleurodesis, bullectomy or wedge resection of lung with pleural abrasion and occasionally pleurectomy. Little information has been reported regarding the efficacy of such treatment in spontaneous pneumothorax secondary to non bleb disease

---

Background: We conducted this study To find relationship between maternal glucose challenge test (GCT) levels and fetal body weight (BW).
Materials and Methods: We analyzed five hundred women with singleton pregnancy, who had GCT at 24-28 week during pregnancy. All of them had no history of hypertension and diabetes mellitus or other medical disease before pregnancy or during previous pregnancy, and all of them had weight gain appropriate with their pre pregnancy body mass index (BMI). Also nobody had history of drug abuse or smoking. In this descriptive–analytic survey, maternal age, gravidity, BMI,GCT level ,gestational age (GA) , sex of neonate, rout of delivery , newborn weight and apgar score were evaluated .The student’s T-test and logistic regression were used for statistical analysis. We used Pearson coefficient and receiver operating characteristic (ROC) curve and chi-square test for determination GCT threshold.
Results: We found rate of small for gestational age (SGA) in newborns statistically was significant, who their maternal GCT level was ≤ 80mg/dl, P value: 0/018, specificity 89%, sensitivity 58% and confidence interval: 95% (0/162-0/545).
Conclusion: Low GCT level has association with SGA and can be used as a predictive test and may be an indication for dietary intervention.

---

Background: The Composite International Diagnostic Interview (CIDI) is a comprehensive, standardized diagnostic interview for the assessment of psychiatric disorders. There have been few studies on the validity of the CIDI. The objective of present study was to assess the validity of a Farsi translation of the complete CIDI and its psychosis/mania module in five referral clinical psychiatric settings.
Methods: Two hundred and three as well as 104 consecutive admissions were interviewed using the complete and the psychosis/mania module, respectively. Within two days of the CIDI interview, two last year residents of psychiatry or psychiatrist who were blind to the CIDI diagnosis completed the Clinical diagnostic checklists (based on DSM-IV and ICD-10 criteria) simultaneously and reached the consensus diagnosis. Data analysis was performed using SPSS 11 to determine the validity of CIDI.
Results: The sensitivity and specificity for the diagnosis of schizophrenia was 0.12 and 0.96 using DSM-IV criteria. According to ICD-10 criteria, the results were the same with 0.19% sensitivity and 0.96% specificity. The sensitivity for the diagnosis of bipolar I disorder was low (0.21 using DSM-IV criteria and 0.17% using ICD-10) and specificity, high (0.90 compared to DSM-IV and 0.89 compared to ICD-10 criteria). The results were rather similar for the psychosis/mania module of CIDI.
Conclusion: This study suggests that the Farsi translation of both the complete CIDI and the psychosis/mania module of CIDI have good specificity, but poor sensitivity for the diagnosis of schizophrenia and of bipolar I disorder.

---

Background: Preterm labor is defined as delivery before 37 weeks of gestation. Recurrence of preterm labor in future pregnancies is 6-8%. History of preterm labor is a strong risk factor for future preterm labor. Preterm labor is the leading cause of neonatal mortality in developed countries, but permanent morbidity in these premature neonates has many side effects for the newborn as well as their family members and society. For this reason we conducted a survey to identify risk factors for recurrent preterm delivery among primiparous women with previous preterm delivery.
Methods: This prospective case–control study included patients from three university hospitals, namely Imam Khomeini, Shariati and Mirza Koochakkhan Hospitals, all in Tehran, Iran. Subjects, including 539 primiparous women who delivered preterm (22–36 weeks), were divided into two groups: 47 had a second preterm delivery (study group) and 492 had first preterm delivery (control group). Exclusion criteria were induced preterm delivery due to medical indications in mother and primigravid. Data collection and analysis was performed using SPSS 10 and t-test and χ2 test were used to analyze the significance of the results.
Results: From a total of 6,537 deliveries, we found 539 cases of preterm delivery, among which 47 cases were identified as recurrent preterm delivery. The control group was composed of 492 deliveries. The recurrence of preterm delivery was 8.7%. Uterine anomaly, cardiovascular, renal and thyroid disease in mother and blood group A had a significant correlation with recurrent preterm delivery.
Conclusion: Expectant mothers with uterine anomalies, cardiovascular, renal or thyroid diseases or group A blood type should receive extra care, observation and instructions in order to limit the risk of preterm delivery and its subsequent effects.

---

Background: The aim of this survey was to evaluate the prevalence of some perinatal complications in birth weight discordance (BWD) among twin pregnancies.
Methods: In a descriptive analytical cross-sectional study, 490 twin neonates (245 twin pregnancies) born at Mirzakoochakkhan Hospital from 1999 to 2003 were evaluated. Maternal and neonatal data of each delivery were collected for BWD, gestational age, maternal age, parity, infant gender, neonatal death, neonatal septicemia, mode of delivery, hyperbilirubinemia, blood transfusion and duration of hospitalization.
Results: The average age of the mothers was 26±4.78 years, of which 51.8% were nullipara. The average gestational age was 35.02±2.73 weeks, with 15.9% before 32 weeks of gestation. The neonatal death rate was 7.8%, the majority of which involved male neonates and multiparas. The average duration of hospitalization was 6.07±4.45 days, 8.5 days for those twins with BWD≥20%, and longer (9.14 days) for neonates with mothers younger than 20 years old. Septicemia was most frequent (31.3%) in twins with BWD of 30-34%, as was hyperbilirubinemia requiring blood transfusion (25%). Hyperbilirubinemia was more common in neonates with mothers aged less than 20 years and more than 35 years..
Conclusions: BWD in twins is a predictive factor for septicemia and hyperbilirubinemia requiring transfusion. Therefore, healthcare workers and hospital wards dealing with twins with BWD should be especially ready and equipped to provide the additional care needed for these patients.

---

Background: Depressive disorders in children and adolescents are chronic and highly morbid. Few studies are carried out on antidepressant drugs for depressed youths, especially specific noradrenergic agents. Reboxetine is a selective norepinephrine reuptake inhibitor. This study was designed to evaluate the effect of reboxetine in childhood and adolescent depression.

Methods: Twenty patients of both genders, aged 7-17 years old, with major depressive or dysthymic disorders, as classified by the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), participated in an 8-week clinical trial before-after study of reboxetine. Clinical semistructured interviews, based on the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Aged Children (K-SADS), were carried out. Reboxtine was initiated at a dose of 1 mg/day and increased up to 6 mg/day. Patients were assessed for changes in: depressive symptoms using the Children's Depression Inventory (CDI) and global functioning by the Children's Global Assessment Scale (C-GAS). Side effect questionnaire was also administered.

Results: There was a significant decrease in the ineffectiveness subscale (C factor) of CDI (p=0.006). Although the CDI scores decreased by 32.69%, this change was not significant (p=0.39). No significant change in C-GAS (p=0.2) was observed. Adverse effects were relatively mild to moderate and transient. The most common adverse effects were decreased appetite and sedation.

Conclusions: Reboxetine is relatively well tolerated and improves feelings of ineffectiveness among depressed children and adolescents however it does not improve all depressive symptoms. Double-blind, placebo and active comparator controlled studies and larger sample sizes are indicated.

---

Background: Nasogastric tube (NG tube) usage was first described in 1921 by Levin. Surgeons routinely use NG tube in most esophageal resections. Considering the numerous complications caused by this tube, the uncertainty about its usefulness and the scarcity of studies conducted on the subject, particularly in esophageal cancer patients, we investigated the necessity of the NG tube in these cases.

Methods: This clinical trial was performed at the Cancer Institute of Imam Khomeini Hospital. Esophageal cancer patients were randomized into groups either with or without postoperative NG tube the latter group was also prescribed metoclopramide. Postoperative obstruction was the exclusion criteria. The operation was done by a team of surgeons using the surgical techniques of McKeown or Orringer. All patients received ranitidine, heparin and antibiotics postoperatively. All patients received postoperative chest X-ray and chest physiotherapy. The NG tube was inserted or reinserted for those with abdominal distention and/or repeated vomiting. The NG tube was pulled out after return of bowel movements. The variables recorded for each patient included the first day of flatus, the first day of defecation, the first day of bowel sound (BS) upon auscultation, duration of post-operative hospitalization, nausea and vomiting, abdominal distension, pulmonary complications, wound complications, anastomotic leakage and the need for placing/replacing the NG tube. Statistical analysis was performed using SPSS, v. 11.5.

Results: After randomization, the NG tube was inserted for 22 patients, and 18 patients had no NG tube. The incidence of anastomotic leakage was significantly higher in the NG-tube group. No significant differences between the two groups were found for other complications. The mean times until first passage of flatus, defecation and BS upon auscultation and the duration of post-operative hospitalization were not significantly different. The need for placing/replacing the NG tube was the same for both groups. There was no difference in the perioperative death rates between the two groups.

Conclusions: We conclude that the routine use of NG tubes after surgery is not recommended for all patients. NG tube should be used according to the specific needs of each patient. This protocol will protect patients from undesired complications.

---

Background: The aim of this study was to statistically evaluate the hypothesis that the presence of meconium-stained amniotic fluid is associated with postpartum maternal infection.
Methods: This prospective cohort study included 573 term pregnant women in labor, with no other medical problems, that underwent cesarean section for pregnancy termination. Women with prolonged active-phase labor, prolonged rupture of membranes, complicated cesarean section and pre-operative infections were excluded from this study.
The subjects were divided into two groups: 280 women with meconium-stained amniotic fluid (M group), and 293 women with clear amniotic fluid (C group). A comparison was done regarding postpartum fever, endometritis and wound infection between the two groups. Student's t-test and chi square test were used for data analysis, along with linear regression, with p<0.05 indicating significance.
Results: Among the 573 women, a total of 82 women (14%) had fever after cesarean 42 women from the M group, and 40 women from the C group (p= 0.3). Among the 82 women who had fever, 33 women had continuous fever, 6.5% in group M and 2.7% in group C (p<0.05, RR: 1.98, 95% CI 1.3-3.1). Among the 573 women, 4% developed endometritis 5% in group M and 2% in group C (p<0.05, RR: 2.3, 95%, CI 1.3-3.4). Similarly, among the 573 women, a total of 5 women (1%) developed wound infection, 1.7% in group M and 0.68% in group C (p=0.7).
Conclusion: Meconium-stained amniotic fluid is associated with increased postpartum infection independent of other risk factors for infection.

---

Background: Maternal zinc deficiency during pregnancy has been related to adverse pregnancy outcomes. Most studies in which pregnant women have been supplemented with zinc to examine its effects on the outcome of the pregnancy have been carried out in industrialized countries and the results have been inconclusive. It has been shown that women with gestational diabetes (GDM) have lower serum zinc levels than healthy pregnant women, and higher rates of macrosomia. Zinc is required for normal glucose metabolism, and strengthens the insulin-induced transportation of glucose into cells by its effect on the insulin signaling pathway. The purpose of this study was to assess the serum zinc levels of GDM patients and evaluate the effect of zinc supplementation.
Methods: In the first stage of this prospective controlled study, we enrolled 70 women who were 24-28 weeks pregnant at the Prenatal Care Center of Mirza Kochak Khan Hospital, Tehran, Iran. The serum zinc level of each subject was determined. In the second stage, among these 70 subjects, the diabetics receiving insulin were divided into two groups, only one of which received a zinc supplement and the other group was the control group. Birth weight of neonates and insulin dosages were recorded.
Results: The mean serum zinc level in the GDM group was lower than that of the control group (94.83 vs. 103.49mg/dl, respectively) and the mean birth weight of neonates from the GDM women who received the zinc supplement was lower than that of the control group (3849g vs. 4136g). The rate of macrosomia was lower in the zinc supplemented group (20% vs. 53%). The mean of increase of insulin after receiving the zinc supplement was lower (8.4u vs. 13.53).
Conclusion: Maternal insulin resistance is associated with the accumulation of maternal fat tissue during early stages of pregnancy and greater fetoplacental nutrient availability in later stages, when 70% of fetal growth occurs, resulting in macrosomia. In our study, zinc supplementation is associated with a reduction in the rate of fetal macrosomia among pregnant women with GDM.

---

Background: The Biophysical Profile (BPP) is a noninvasive test that predicts the presence or absence of fetal asphyxia and, ultimately, the risk of fetal death in the antenatal period. Intervention on the basis of an abnormal biophysical profile result has been reported to yield a significant reduction in prenatal mortality, and an association exists between biophysical profile scoring and a decreased cerebral palsy rate in a given population. The BPP evaluates five characteristics: fetal movement, tone, breathing, heart reactivity, and amniotic fluid (AF) volume estimation. The purpose of study was to determine whether there are different degree of acidosis at which the biophysical activity (acute marker) are affected.

Methods: In a prospective study of 140 patients undergoing cesarean section before onset of labor, the fetal biophysical profile was performed 24h before the time of cesarean and was matched with cord arterial PH that was obtained from a cord segment (10-20cm) that was double clamped after delivery of newborn. (using cord arterial PH less than 7.20 for the diagnosis of acidosis).

Results: The fetal biophysical profile was found to have a significant relationship with umbilical blood PH. The sensitivity, specificity, positive predictive value, negative predictive value of fetal biophysical profile score were: 88.9%, 88.6%, 50%, 98.1%.

Conclusion: The first manifestations of fetal acidosis are nonreactive nonstress testing and fetal breathing loss in advanced acidemia fetal movements and fetal tone are compromised. A protocol of antepartum fetal evaluation is suggested based upon the individual biophysical components rather than the score alone.

---

Normal 0 false false false EN-GB X-NONE AR-SA MicrosoftInternetExplorer4 Background: One of the major problems in the medicine is personal identification in cases of skeletal remains. The first step is determination of sex. One of the elements that recently paied more attention to it is the patella. Since the measurements are population specific, so we measured the patellas of Iranians to determine their patellas dimensions for sex prediction.
Methods: In this study three metrical characteristics of patella were measured from 67 corps between 20-64 years refered to the autopasy hall of forensic medicine center in Tehran (L.M.O). For statistical analysis of datas, the statistical product and service solution (SPSS version 16) program was used and unvariate and multivariate discriminant function analysis were performed to indicate the efficiency of each variable for sex determination.
Results: The mean of patella height in male was 4.46 cm and in female was 3.87, the mean of patella width in male was 4.60 and in female was 4.03cm and the mean of patella thickness in male was 2.25 and in female was 2.07cm. Among these measurements maximal width with average accurancy of 94% and then maximal height with 91% and finally maximal thickness with 71.6-73.1% respectively were better variables for sex determination. Also in multivariate discriminant analysis, combination of all three measurements with average accuracy of 94% was the best function for sex determination.
Conclusion: The results of this study revealed that we can determine sex with high confidence in situations such as explosions, air crashes and etc, just by using the patella measurement.

---

Normal 0 false false false EN-GB X-NONE AR-SA MicrosoftInternetExplorer4 B ackground: Preterm birth which is defined as delivery before 37 completed weeks was implicated in approximately two thirds of neonatal death. Also preterm labors are the most common cause of mortality and morbidity of infants in recent years and it costs high prices for health system. We evaluate the relationship between prepregnancy maternal body mass Index (BMI) and spontaneous and indicated preterm birth.
Methods: This study included 250 healthy pregnant women, without any risk factors of preterm birth, were classified into categories that were based on their body mass index. Association between BMI, weight gain and rout of delivery were examined. Rates of indicated and spontaneous preterm birth were compared.
Results: Obese women delivered at a more advanced gestational age. (38/34±1/66 weeks vs 37/61±2/44, p=0/006). Obese patients had significantly lower incidence of spontaneous preterm birth at < 37 weeks of gestation (16/8% vs 31/2% p=0/008). Obese women had larger infants (3354/95±596/75 vs 311.24±558/357 p=0/001), and had more frequent cesarean delivery (69/6% vs 52/8%, p=0/006). Weight gain during pregnancy is poorly correlated with prepregnancy BMI (14/41±7/93 kg vs 13/78±4/94kg, p=0/4) and preterm birth.
Conclusion: In this survey, there was adverse correlation between body mass index (BMI) before pregnancy and preterm labor less than 37 completed weeks and we suggest more study for evaluation between spontaneous and induced preterm labor mechanism and in obese and non obese women. However according to this survey obesity before pregnancy is associated with a lower rate of spontaneous preterm birth.

---

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.

---

Background: Coarctation of aorta is narrowing of proximal descending aorta. Interventional procedures such as balloon angioplasty & stent implantation has been progressively in use as alternatives for surgery in increasing number of children with diagnosis of coarctation of aorta. The aim of this study was to evaluate the use of endovascular stent in children with coarctation of aorta.

Methods: We evaluated effectiveness and safety of stenting in all patients younger than 18 years old with coarctation and re-coarctation of aorta which treated by stenting between years 2004-9 at rajaei - heart centre in Tehran, Iran.

Results: we studied 53 patients younger than 18 years old with a follow up of six months. Totally 54 stents were implanted. Mean (±SD) age of the patients was 11.6±4.2yrs. Seventeen cases (32%) were younger than 10 years old, and 36 cases (68%) were 10 years and older. Mean (±SD) weight was 39.24±18kg. 16 cases weighting less than 25kg. Peak systolic pressure gradient (SPG) decreased from 46.26±17.07 to 1.03±0.19mmHg after procedure (p<0.001). There was no significant difference (p<0.001) in the gradient before and after stenting in the patients with native coarctation (Vs re-coarctation cases), less than 25 kg and under 10 years old groups. Complications developed in 44% of cases while dominantly were minor except in two cases re-dilatation of stent was not needed during six month of follow-up of the patients.

Conclusions: Stenting of coarctation of aorta can decrease complications and can be used safely in children weighing bellow 25kg and in children below 10yrs old.

---

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Isolated pulmonary valve stenosis represents 8-10% of congenital cardiac anomalies. This study was performed to evaluate the late outcomes of Balloon Pulmonary Valvuloplasty (BPV) in children with residual infundibular stenosis.
Methods : Seventy-eight patients underwent BPV in Rajaee Heart Center in Tehran Iran, from 2008-2010. The patients were divided into two groups: with and without infundibular stenosis. The group with infundibular stenosis was subdivided into two groups: with and without propranolol administration. Gradient measurement follow-ups by Doppler echocardiography were done on the first day and 1, 3, 6 and 12 months afterwards.
Results: Thirty five (44.9%) patients were male and 43 (55.1%) were female. The mean age of participants was 4.29±3.5 years and the mean weight 16.18±8.8 kg 33 patients (43%) did not show residual infundibular stenosis but 45 (57%) did so in the evaluations. There were no significant differences between the two groups regarding age, weight, sex, kind of balloon valvuplasty, balloon to body surface area ratio and pulmonary regurgitation (PR). Propranolol was administered to 27 (60%) patients with residual stenosis for six months but 18 (40%) did not receive the medication. In both groups, the gradient significantly decreased immediately after BPV (P<0.0001). In the propranolol group a constant decrease in residual gradient was seen. There was a significant relationship between balloon to body surface area ratio (387±94mm²/m²) with moderate to severe PR (P<0.015).
Conclusion: BPV is a safe and effective procedure to treat PS. Residual infundibular gradient after BPV decreases over time and propranolol helps decrease the gradient.

---

Background: Diabetes mellitus affects numerous intracellular metabolic processes, which are reflected by changes in the concentration of some plasma constituents. Particularly, the disease may indirectly undermine some functions of the nervous system including learning and memory through altering oxidative stress status. On the other hand, probiotics can enhance the antioxidant capacity. This study was designed to evaluate the effects of probiotics on spatial memory, maze learning and indices of oxidative stress in diabetic rats.
Methods: In this experimental study, 40 male Wistar rats were randomly allocated to 4 groups (n=10 for each): Control (CO), Control probiotic (CP), Control diabetic (DC), and Diabetic probiotic (DP). The probiotic supplement, including Lactobacillus acidophilus, Lactobacillus fermentum, Bifidobacterium lactis (334 mg of each with a CFU of ~1010), was administered through drinking water every 12 hours for 8 weeks. Using morris water maze (MWM), spatial learning and memory were evaluated. Serum insulin and oxidative stress indices, including superoxide dismutase (SOD) and 8-hydroxy-2'-deoxyguanosine (8-OHdG), were measured by standard laboratory kits.
Results: Oral administration of probiotics improved impairment of spatial learning (P=0.008) and consolidated memory (P=0.01) in the rats. Moreover, probiotic treatment increased serum insulin (P<0.0001) and serum superoxide dismutase activity (P=0.007) while it decreased their blood glucose (P=0.006) and 8-OHdG (P<0.0001).
Conclusion: Probiotic supplementation reversed the serum concentrations of insulin and glucose along with an increase in antioxidant capacity in diabetic rats. It also improved spatial learning and memory in the animals. Relevancy of the metabolic changes and behavioral functions need to be further studied.

---

Background: Peptic ulcer disease is one of the most common GI disorders. Perforation has the highest mortality rate of any complication of ulcer disease, while early diagno-sis and emergency treatment save patient life.
Case presentation: This paper reports an adolescent boy admitted to the Ziaeian University Hospital. He suffered from severe abdominal pain with dyspnea had been started since past three hours. Periumbilical pain started from past 2-3 days, gradually localized to the right lower quadrant. He had anorexia without nausea and vomiting. He was tachycardic and tachypneic, but he did not have fever. On physical examination, bowel sound was hypoactive, there was generalize tenderness, guarding and rebound tender-ness focused in the right lower quadrant and suprapubic region. Laboratory finding indicated leukocytosis. Chest X-ray showed free air under diaphragm. Once the diagno-sis has been made, the patient was given analgesia and antibiotics, resuscitated with isotonic fluid, and taken to the operating room. Laparotomy was implemented through a midline incision. There was bile secretion in the peritoneal cavity. Appendix was inflamated. Cecum and ileum were normal. A small perforation, 4mm in size was detected in first portion of duodenum. Appendectomy and omental patch repair were done. Ten days later, the patient was discharged in a good state. Serologic test for helicobacter pylori was negative.
Conclusion: Stomach and duodenal perforation should be considered in patients with-out peptic ulcer disease, especially in children and adolescents with sudden and severe abdominal pain who are admitted to the hospital for other diseases. Because some patients present with peptic ulcer complications that are seemingly exacerbated by stressful life events.

---

Background: Uterine leiomyoma is one of the most common benign smooth muscle tumors occurring in 20-40% of women worldwide in their reproductive years. Recent studies revealed that estrogen plays an important role in the pathogenesis of this disease. Since glutathione S-transferase (GST) gene family are involved in the biosynthesis of estrogen, the prior probability that variants at this locus are associated with uterine leiomyoma is likely to be above the null. Therefore, this study was carried out to examine whether GSTP1 polymorphism (Ile105Val) is associated with increased risk of uterine leiomyoma in Iranian population. Methods: In this case-control study, 50 women diagnosed with uterine leiomyoma and 50 healthy controls were recruited from subjects referred to the Pasteur Institute of Iran from November 2012 to September 2013. The genomic DNA was extracted from peripheral blood leucocytes using the standard phenol-chloroform method and subsequently the GSTP1 polymorphism was genotyped using amplification refractory mutation system-polymerase chain reaction (ARMS-PCR). Logistic regression analysis was applied to estimate odds ratios and 95% confidence intervals after age adjustment using the SPSS statistical software package, version 18.0. Results: The results showed significant differences between case and control groups in terms of genotype frequency (P<0.0001). In addition, the results indicated that the presence of the valine allele significantly increased risk of uterine leiomyoma about three times more in individuals carrying the mutant allele compared to control group (Odds Ratio: 3.34 95%CI: 1.82-6.15 P<0.0001). Conclusion: To our knowledge, this is the first study performed in Iranian population assessing the association between GSTP1 Ile105Val polymorphism and risk of uterine leiomyoma. However, further extensive studies with a large number of samples from different populations and ethnicities are required to validate the results obtained in this study.

---

Background: Uterine myomas are benign tumors of the uterus and the most common solid pelvic tumors causing symptoms in approximately 25% of women in their reproductive years. However, its etiology and pathogenesis remain obscure there is increasing evidence that endometriosis is inherited as a complex genetic trait. Recent studies indicated the involvement of glutathione S-transferase M1 (GSTM1) gene in the pathogenesis of this disease and current investigations are devoted to the other members of phase II detoxification system genes such as glutathione S-transferase T1 (GSTT1). Therefore, current study was carried out to investigate the distribution of GSTM1 and GSTT1polymorphisms in Iranian population in order to estimate possible impact of null-alleles of each gene in development of this disease. Methods: In this study, 50 patients with endometriosis diagnosed by both pathology and laparoscopic findings according to the revised American Fertility Society classification of endometriosis were recruited from subjects referred to the Pasteur Institute of Iran between November 2012 to September 2013. Accordingly, controls (n=50) were subjects without any of aforementioned gynecologic conditions. The genomic DNA was extracted from peripheral blood leucocytes using the salting out method and GSTM1 and GSTT1 genotyping for gene deletions were carried out using Gap-polymerase chain re-action. Logistic regression analysis was applied to assess whether there was any significant risk increase between the case group with higher null genotypes compared to control group. The level of statistical significance was set at 0.05 and all analyses were conducted using the SPSS version 18.0 (SPSS Inc., Chicago, IL). Results: There was significant evidence that the distribution of the GSTM1 and GSTT1 genotypes differed between the patients and the controls with an allelic odds ratio (OR) of 3.56 (95%CI: 1.35-9.37, P=0.01) and 3.92 (95%CI: 1.4-10 P=0.009) respectively. Data analysis also revealed that individuals with both GSTM1 and GSTT1 null genotypes (-/-) had higher risk to develop the disease in comparison to the people with the both present (+/+) genotype (OR:19.23, P=0.007). Conclusion: The findings suggest that the GSTM1 and GSTT1 genetic polymorphisms are associated with the development of endometriosis in Iranian women which is in agreement with previous results obtained in other populations. However, the ethnic variations of polymorphisms should be evaluated in detail and differences should be incorporated into investigations of susceptibility variants for this disease.

---

Background: The major issue to address in endometriosis etiology is to identify the genetic changes in the disease and their occurrence in different populations. Uncovering these genetic changes may be important in developing potential biomarkers for early diagnosis and prognosis of endometriosis. Among all endometriosis susceptibility genes studied before, convincing association has been found with variants in the estrogen receptor alpha (ESR1) gene and this disease however, the contributions of these genetic variants in different populations and ethnic groups are not similar. Accordingly, this study was carried out to replicate the previous findings to assess whether this polymorphism is associated with endometriosis in Iranian women. Methods: A case-control study was designed to determine the possible association between ESR1-351A>G variant and occurrence of endometriosis. The study group consisted of 100 subjects diagnosed with endometriosis as case group and 100 fertile women without endometriosis as controls recruited from subjects referred to the Tehran Women’s General Hospital between January to September 2013. All subjects were genotyped for this marker using amplification refractory mutation system- polymerase chain reaction (ARMS-PCR). Association of risk allele (G) with endometriosis was as-sessed using PLINK software after age adjustment. Results: The results showed that the genotype frequencies were in Hardy-Weinberg Equilibrium (HWE) in both case (F=0.04, P:0.67) and control (F=0.02, P:0.83) groups. In addition, there were no significant differences between case and control groups in terms of genotype frequencies (P=0.17). Moreover, the results indicated that the presence of risk allele (G) did not significantly increase risk of endometriosis (OR: 1.43, 95%CI: 0.96-2.13, P=0.07). Conclusion: The results do not support the previous findings of an association between -351A>G genetic polymorphism in ESR1 gene and endometriosis. Therefore, comprehensive genetic approaches including linkage analyses and family-based tests, together with a number of replication studies with large sample size, are needed to make conclusive claims about the role of this genetic polymorphism in susceptibility to endometriosis.