Background: Impairment in the function of the lower urinary tract can be the cause of recurrent urinary tract infections (UTI) and vesico-ureteral reflux (VUR) in children. The purpose of our research was to evaluate the frequency of occurrence of bladder instability in children with UTI.
Methods: The research involved 133 children (11 boys, 122 girls), ranging in age from seven months to 14 years. Group A consisted of 78 children with a history of recurrent UTI, while Group B included 55 children with recurrent UTI and VUR. Urodynamic tests (cystometry) were performed on all the children.
Results: Abnormal functioning of the lower urinary tract was found in 98 children (73.1%) from Group A and 41 children (78.8%) from Group B. The most common dysfunction was detrusor-sphincter dyssynergia (DSD), which was found in 54% of all subjects, 46.2% of patients in Group A and 60% of patients in Group B (p<0.05). Unstable bladder was found in 42 (33%) children with no significant difference between the two groups. In 17 children (12.6%) DSD was accompanied by bladder instability. In both groups about 20% of the children did not present with symptoms indicative of urination dysfunction, where as 80% reported various symptoms, of which the most common were constipation and urinary urgency. In half of the children from Group A and one-fourth of the children from Group B there were several co-occurring symptoms: frequency, urgency, intermittent voiding, incontinence, dribbling and retention, and constipation.
Conclusions: The most common disturbance of lower urinary tract function in these children with recurrent UTI was DSD, which occurred more often in children with VUR.
Background: Considering the psycho-social model of diseases, the aim of this study was to evaluate the effect of psychiatric intervention on the pregnancy rate of infertile couples.
Methods: In a randomized clinical trial, 638 infertile patients referred to a university infertility clinic were evaluated. Among them, 140 couples with different levels of depression in at least one of the spouses were included in this substudy. These couples were divided randomly into two groups. The patients in the case group received 6-8 sessions of psychotherapy before starting infertility treatment and were given fluoxetine 20-60 mg per day during the same period. The control group did not receive any intervention. Three questionnaires including the Beck Depression Inventory (BDI), Holmes-Rahe stress scale and a socio-demographic questionnaire were applied for all patients. The clinical pregnancy rates of the two groups, based on sonographic detection of the gestational sac six weeks after LMP, were compared. The data were analyzed by paired-T test, T-test, χ2 and the logistic regression method.
Results: The pregnancy rate was 47.1% in the case group and 7.1% in the control group. The pregnancy rate was significantly related to the duration and cause of infertility and the level of stress in both groups (p< 0.001). The pregnancy rate was shown to be higher in couples in which the male has a secondary level of education (p< 0.001).
Conclusions: Psychiatric interventions greatly improve pregnancy rates, and it is therefore crucial to mandate psychiatric counseling in all fertility centers in order to diagnose and treat infertile patients with psychiatric disorders and help couples deal with stress.
Background: Hutchinson-Gilford Progeria Syndrome (HGPS) is a very rare genetic disorder with a frequency of 1 in 8 million live births. It is characterised by premature aging phenotype. The median age at death is 13.4 years. It is an autosomal dominat disease due to a de novo point mutation in the Lamin A gene exon 11 in the majority of cases. More than 100 cases have been reported world wide.
Case report: We describe here an exceptionally long-lived patient with HGPS, who is alive at age 36. She was referred by a cardiologist to our endocrinology clinic to be worked up for presence of a metabolic or genetic disorder before a heart surgery.
Results: Having more attention of clinicians about very rare diseases and referring the patients to geneticist are the main goals of this case report as well as describing the disease.
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Background: Varicocele
is a major cause of male infertility, but its pathophysiology is unclear.
Recent studies declare that fertile varicocele people with normal semen
analysis are also at risk of loss of infertility. The exact mechanism by which
varicocele damages spermatogenesis is still unknown. Some studies have reported
increased Reactive Oxygen Species (ROS) is a major factor in semen of men with
varicocele. The aim of this study was to investigate whether the source of
elevated ROS is intracellular or not. In addition, we studied Mitochondrial
Membrane Potential (MMP), viability, antioxidant activity, sperm count and
motility in these rats.
Methods: The study group consisted of 28 male rats
divided in four groups: control, sham, varicocele 1, varicocele 2, Experimental
varicocele was established by partial ligation of the left renal vein in last
two groups. Animals were sacrificed two and six months after surgery and
dilation of the internal spermatic veins was observed. Then, superoxide anion
production and Mitochondrial Membrane Potential were evaluated by Flow
cytometry sperm characteristics were evaluated by Flow cytometry. Sperm
superoxide anion production was assessed by the dihydroethidium and
Mitochondrial Membrane Potential with rhodamin 123.
Results: Our results showed intracellular superoxide
anion production significantly increased and Mitochondrial Membrane Potential,
viability, sperm count and motility significantly decreased in rats with
experimental left varicocele. However, there was no significant difference for
seminal plasma antioxidant activity between all groups.
Conclusions: Consequently,
our findings suggest that one of the main sources of ROS production is
intracellular and we must consider it in treatment.
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Background: Pelvic Organ Prolapse (POP) and related urinary symptoms
are frequent disorders in elderly women and their management improves life
expectancy and quality of life. Urodynamic tests applied in pathophysiologic
diagnosis and treatment of urinary disorders are not always cost effective.
This study aims to evaluate the results of Urodynamic tests in patients with
pelvic organ prolaps.
Methods: This case- control study was done using UDI-6 questionnaire during 18
months in vali-e-asr clinic of Imam Khomeini Hospital, Iran with 105 cases of POP the cases were divided into
two groups: group one (66 cases with urinary incontinency) and group two (39 without incontinency) and
assessed with urodynamic tests.
Results: Based on UDI-6, the patients of group one had more clinical symptoms (frequency, urine
leakage, urge incontinence and stress incontinence). (p<0.001). Except for first desire to
voide and normal voided volume indices, there were no significant differences in
the other urodynamic parameters in two groups. Sensitivity and specificity of
urgency leak in group one was 22 and 68/8% and in group two was 30 and 65/5% respectively. Stress leak
sensitivity and specificity in group one were 25/4% and 100% and in group two were 57/1% and 71/9% respectively.
Conclusion: In this study, considering sensitivity and specificity
of symptoms and urodynamic test for urinary incontinency assessment is advised
in patients with POP who need surgery.
Background: Vitiligo is a common acquired disorder characterized by depigmented cutaneous patches devoid of melanocytes. The disease carries a risk for ocular abnormalities. Few reports are available about the ocular findings and their possible association with the disease in patients with vitiligo in the literature.
Methods: A total of 72 patients with previously documented cutaneous vitiligo were examined for ocular findings and 50 healthy individuals were enrolled as the control group in Razi Hospital in Tehran, Iran during years 2007-2008. Demographic features including age, gender, duration of the disease, presence of any accompanying autoimmune diseases, type of vitiligo and its anatomical distribution were recorded to investigate a possible association between the disease and the ocular findings.
Results: Amongst 72 patients with vitiligo, 11 (15.3%) had ocular findings including retinal pigment epithelium hypopigmentation, posterior pole pigment changes, peripheral iris atrophy, atrophy of retinal pigment epithelium and iris hyperpigmentation. Amongst the controls, only two cases (4%) had ocular findings which consisted of iris hyperpigmentation. The relationship between ocular findings and vitiligo was statistically significant (p= 0.04). No other remarkable features, such as age, gender, age at the onset of the disease, type of vitiligo, presence of priorbital lesions or body surface area involvement by the disease, were suggestive of an association or presenting a risk factor for vitiligo.
Conclusion: Although the sample size and prevalence of ocular findings were not satisfactory enough to make a definite conclusion, we found a higher occurrence of ocular findings in patients with vitiligo than the control group.
Background: Isosorbide dinitrate has been broadly used in the treatment of various ischemic heart diseases. Isosorbide is a nitric oxide donor which increases blood flow to tumors through vasodilatation and consequently accelerates the access of chemo-drugs to them. Furthermore, this drug has inhibitory effects on angiogenesis, tumor growth and metastasis in vivo. Moreover, its ant-inflammatory effects have also been reported. In the present study we evaluated the effects of isosorbide on the proliferative activity of fibrosarcoma WEHI-164 cell line and peripheral blood mononuclear cells (PBMCs).
Methods: WEHI-164 fibrosarcoma cells and human PBMCs were cultured in complete Roswell Park Memorial Institute (RPMI) 1640 medium with 10% fetal bovine serum and 2×104 cells/mL for WEHI-164 and 2×105 cells/mL for PBMCs. The cells were then incubated at the exponential growth phase with different concentrations of isosorbide (4×10-6-1.6×10-3 M) for 24, 48 and 72 hours. Subsequently, isosorbide effects on proliferation of the cells were evaluated by trypan blue dye exclusion (TB) test and MTT assay. Statistical comparisons between groups were made by analysis of variance.
Results: The proliferative activity of WEHI-164 fibrosarcoma cells and human PBMCs treated with different concentrations of isosorbide, did not show any significant difference with untreated control cells.
Conclusion: The results of this study showed that isosorbide neither had any significant effects on the proliferative activity of fibrosarcoma WEHI-164 cells nor on human PBMCs. Our findings suggest that anti-tumoral effects of isosorbide reported by other investigators may be mediated through non-cytotoxic mechanisms.
Background: Anti-Müllerian Hormone (AMH) is secreted from granulosa cells of growing follicles and is a useful marker of ovarian reserve. Fertility in women is determined by the quality and quantity of follicle pool and ovarian follicular reserve positively correlates with AMH. In this study we aimed to determine if AMH can predict ovarian response in IVF treatments.
Methods: In this retrospective observational study undertaken in Mehr Institute during 2010 to 2011, we studied the medical records of 101 patients and recorded the concentrations of AMH, day two or three FSH, LH, basal estradiol (E2), E2 on day of HCG administration and the number of metaphase II oocytes. Having undergone ovarian hyperstimulation, the women were divided into three groups: poor responders (retrieved oocytes ?3), normal responders (retrieved oocytes 4 to 15) and high responders (retrieved oocytes ?16).
Results: Overall, 20% of patients were defined as poor responders, 71% as average responders and 10% as high responders. There were significant differences in the concentration of AMH, E2 on day of HCG administration, FSH, the number of metaphase II oocytes and age between the three groups. MII oocyte count correlated positively with AMH (r=0.487), basal E2 (r=0.275) and LH (r=0.07) but it did negatively with FSH (r=-0.26) and age (r=-0.04). The areas under curve for AMH, FSH, LH, E2 and age were 0.799, 0.32, 0.429, 0.558 and 0.304, respectively. We determined the 0.85 ng/ml AMH concentration as the cut-off point with 71% specificity and 79% sensitivity for the prediction of poor responders.
Conclusion: anti-müllerian hormone is an appropriate predicator of ovarian response following induction of ovulation.
Background: Today, a CT scan examination play an important role in disease diagnosis and thus allocates a significant dose of medical X-ray examinations. One of the important principles in the use of ionizing radiations is to observe radiation protection principles. Evaluating patient's absorbed dose and implementing the strategies for reducing dose are prior in safety issues. To achieve this purpose, sufficient studies should be performed in this regard. Therefore, patient's absorbed dose and the factors affecting have been studied in this research. This study aims to present and develop an acceptable level of absorbed dose in CT scan examinations.
Methods: Diagnostic reference dose level in the adult age group (older than 15 years) has been studied in eleven CT scan centers in Tehran. For this purpose, CT scan examinations prevalent in above-mentioned centers were chosen and Weighted Computed Tomography dose index (CTDIw) and dose length product (DLP) parameters were studied. Standard phantoms with 16 and 32 diameters of Polymethylmethacrylate (PMMA) origin have been used in the centers for CT scan calibration process. CTDIw third quartile has been considered as the diagnostic reference dose level (DRL).
Results: Rate of diagnostic reference dose in the adult age group (older than 15 years) for the head, sinus, lungs, abdomen and pelvis are 50.87, 38.27, 8.05 and 9.11 mg, respectively. Dose measurements made in this survey have been used to set up local DRLs and can be used as a template for national DRLs.
Conclusion: Value of diagnostic reference dose for the head examinations is more than the other parts and diagnostic reference dose in Tehran city in the Adult age group and the protocols compared is less than national reference dose.
Background: Ovarian sex cord-stromal tumors (SCST) account for rare ovarian malignancy. These tumors are 5-8% of all ovarian neoplasms. The most common type of sex cord ovarian tumors is granulosa cell tumor (GCT). In this study our purpose was to have a look at some of clinicopathologic aspects and treatment results of these tumors. Methods: In a retrospective study, all documents of patients with SCST was referred to tumor clinics of Ghaem and Omid Hospitals, from 1998 to 2008. The data of patients were collected and analyzed. Results: In 39 (5.9) of the 398 cases, ovarian malignancies was present in SCST. Eight Patients omitted from the study because there were not enough data for them. The commonest pathology was adult granulosa cell tumor in 25 patients (80.6%). Two patients (8.33%) had juvenile granulosa cell tumor, they were 25 and 38 years old. At time of diagnosis, 27 cases (87.1%) were in early stages (stage I). Mean age of patients was 41 years (range 16-76 years) at time of diagnosis of disease. Surgical staging of cancer was performed in 14 patients (46.7%). We did fertility sparing surgery in 12 patients (40%). Two patients were pregnant after surgery. 17 patients (54.80%) did not receive chemotherapy. Three patients (9.7%) received radiotherapy. Overall survival rates were 95% at both 2 years and 5 years. Longer survival had correlation with early stages of disease (P= 0.002). Age, conservative surgery and chemotherapy had no correlations with survival. Conclusion: The prognosis of SCST is almost good. Most of the patients were diagnosed in early stage of disease. In sex cord ovarian tumor, the only factor that have a full effect on survival, is stage of the disease. If the patients desire to preserve fertility, we can do fertility sparing surgery with minimal effect on survival.
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Background: Surgical staging is the standard treatment of ovarian cancer. Pelvic and para-aortic lymphadenectomy is the important part of the surgery. The aim of this study was to evaluate the effect of para aortic lymph node dissection in early stage of patients with ovarian cancer. Methods: This descriptive cross-sectional cohort study was performed on all stage I of ovarian cancer patients admitted in department of gynecology oncology of Ghaem Hospital, Mashhad University of Medical Sciences in November 2012 to March 2014. Every patient with clinical early stage of ovarian cancer candidate to surgical treatment selected. All cases underwent surgical staging surgery with concurrent systematic pelvic and para-aortic lymphadenectomy. In laparotomy after identification of left and right iliac artery, all lymph nodes have been properly exposed and dissected as a part of a staging laparotomy. The dissection was continued up to the nodal tissues surrounding the aorta, and inferior vena cava, until inferior mesenteric artery lymphadenectomy level. The procedure performed only by gynecologist oncologist. In addition, we assessed other parameters such as operation time, estimated blood loss, associated mortality and morbidity and vascular injuries. Finally, the effect of para aortic lymph node dissection in early stage of ovarian cancer evaluated. Results: Among a total of 57 ovarian cancer patients, 27 of them apparent stage I disease cases were selected. Surgical staging surgery with concurrent systematic pelvic and para-aortic lymphadenectomy was carried for all of them. Positive para-aortic lymph node was found only in one case. The average number removed para-aortic lymph nodes in the pelvis was 9 and in para aortic was 7, respectively. In addition, 20 minutes increase in total length of operation time was observed duo to para-aortic lymphadenectomy. Also the rate increase in intra-abdominal hemorrhage rate was estimated 60 ml. Conclusion: Lymph node dissection will produce a significant benefit in accurate and complete surgical staging. Staging surgery in addition to systematic pelvic and para aortic lymph adenoctomy in early stage ovarian cancer is preferred in gynecologic oncology centers. |
| Results: In these study 198 samples collected from patients with symptoms of vulvovaginal candidiasis, 77 vulvovaginal candidiasis cases were identified. Candida species are common in primary and recurrent cases in terms of frequency, Candida albicans (85.7%), Candida krusei (10.2%) and Candida glabrata (4.1%) were identified respectively. Total of 27 cases of recurrent vulvovaginal candidiasis, 10 cases were resistant to both clotrimazole and fluconazole (37%) was observed that the most common species are resistant to treatment were Candida albicans by (82.1%), Candida krusei (14.3%) and Candida glabrata (3.6%) respectively. Drug resistance in Candida albicans, Candida krusei and Candida glabrata causing recurrent vulvovaginal candidiasis included 69.1%, 75% and 100% respectively. Conclusion: Our findings have shown frequency of resistant non-albicans Candida species to fluconazole and clotrimazole is increasing. There is a considerable difference between Candida albicans and non-albicans species, Candida glabrata for the resistance to fluconazole and clotrimazole. |
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