Tehran University Medical Journal

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Background: Psychosocial stressors and the quality of the support system are important factors in attempted suicide. This research has studied these stressors and the condition of the support system in suicide attempt cases in Karaj, Iran. Methods: This is a part of the Iranian section of the widest multisite study on suicide prevention (SUPRE-MISS) proposed and directed by the WHO in eight countries, including Iran. Here we present data obtained from 632 suicide attempters presenting in emergency centers over a period of ten months.
Results: According to the time lapse from the stressor to the suicide attempt, proximal stressors are considered to be precipitating while distal stressors are considered to be perpetuating factors. Although, family conflicts were found to increase the risk of suicide one year after the conflict, conflicts with family (25%) and spouse (35%) were the most frequent stressors one month before the attempt, acting as proximal factors. Conflict with spouse was more prominent for people who had been married less than seven years. Conflict with family was the most important stressors for 15-25 year-old attempters. Though it is not clear which areas of conflict are more crucial in a suicide attempt, especially considering gender differences, educational and financial problems were more prominent one year before the suicide attempt. The support system was more crucial for female attempters: Although they received more practical support than males, females complained more of deficiencies in support.
Conclusions: The roles of different psychological stressors in attempted suicide vary according to the time lapse from the stressor until the suicide. Family and marital conflicts can be precipitating and perpetuating factors, while educational and financial problems appear to be perpetuating factors. Family is considered to be an important support system for a great number of attempted suicide cases, especially since it offers practical support. Support systems are crucial in preventive programs for suicide, especially among women.

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Background: Plant-origin foods are among the most important sources of food allergic reactions. An increase in the incidence of sesame seed allergy among children and adults has been reported in recent years. The aim of this preliminary study was to investigate the prevalence, importance and clinical manifestations of sesame allergy among Iranian patients.

Methods: In a cross-sectional survey, 250 patients with suspected IgE-mediated food allergies completed a questionnaire and underwent skin prick tests with sesame extract as well as cross-reacting foods (walnut, soya and peanut). Total IgE and sesame-specific IgE levels were measured. Patients with positive skin test reactions and/or IgE specific for sesame without clinical symptoms were considered sensitive to sesame. The patients who also had clinical symptoms with sesame consumption were diagnosed as allergic to sesame.

Results: Of the 250 patients enrolled in this study, 129 were male and 121 female, with a mean age of 11.7 years. The most common food allergens were cow's milk, egg, curry, tomato and sesame. Sesame sensitivity was found in 35 patients (14.1%). Only five patients (2%) had sesame allergy. Sesame-sensitive patients had a significantly higher frequency of positive prick test to cross-reacting foods when compared to non-sensitized patients (p=0.00). The type of symptom was independent of gender and age of the patients, but urticaria and dermatitis-eczema were significantly more frequent in sensitized patients (p=0.008).

Conclusions: This is the first study addressing the prevalence of sesame seed allergy in Iranian population. We found sesame to be a common and important cause of food allergy. The panel of foods recommended for use in diagnostic allergy tests should be adjusted.

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Background: The Temperament and Character Inventory (TCI) efficiently diagnoses personality disorders, differentiating the individual subtypes. This research aimed to evaluate personality dimensions using the Cloninger TCI (TCI-125) in a group of people with borderline personality disorders at Ruzbeh Hospital, Tehran, Iran.

Methods: In this descriptive cross-sectional study, 27 borderline personality patients were evaluated with a clinical interview based on the Diagnostic and Statistical Manual of Mental Disorders fourth edition text revision (DSM-ІV-TR) and Structured Clinical Interview for DSM-ІV Axis IІ (SCIDII). Depression and anxiety scores of patients were assessed using the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) questionnaires. Dimensions of temperament and character traits were assessed using the TCI-125. The findings were compared with parameters of the normal Iranian population.

Results: Results showed higher scores for novelty seeking and harm avoidance and lower scores for self directedness, self transcendence and cooperativeness in borderline personality disorder patients.

Conclusion: The results of the Cloninger TCI in this study showed higher scores for novelty seeking and harm avoidance and lower scores for self directedness than those of the normal Iranian population. Scores for reward dependence fell within the range of the normal population. Lower scores for character factors, such as self directedness, cooperativeness and self transcendence, are usually associated with cluster B personality traits. Higher scores for novelty seeking and harm avoidance are usually characteristic of borderline personality disorder patients. In this study, there is the possibility that the small sample size or other factors, such as medication or substance abuse, might affect the study, resulting in normal scores for reward dependence.

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Background: Several studies have investigated the variations in the anatomy of each segment of circle of Willis whereas a few have addressed the variations of this arterial circle as a whole. In this study the entire circle of Willis and its variations were studied in a cohort of Iranian people and compared with previous reports.
Methods: Anatomical variations of the circle of Willis in 132 brains of Iranian cadavers (102 male adults and 30 fetuses and infants) were studied. The dissection process was digitally filmed for further studies. Using computer software the external diameters of the vessels were measured and the circle variations were classified. The variations of the circle as a whole and segmental variations were compared with previous studies.
Results: Uni-and bilateral hypoplasia of posterior communicating arteries (PcoAs) constituted the most common variation in our study which was similar to previous works. Aplasia of the anterior cerebral artery (A1) and the posterior cerebral artery (P1) were not observed. In 3.3% of fetuses and infants and 3% of adult instances both right and left posterior communicating arteries were absent. There was one case of anterior communicating artery (AcoA) aplasia in adult group.
Conclusions: The anatomical variations discovered in Iranian circle of Willis in this study were not significantly different to those of more diverse populations reported in the literature. The main differences between the fetal and adult disposition are the diameter of the PcoA and the circular part of the P1.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Allergic rhinitis is a common disorder with great morbidity. Its prevalence has increased during recent years, therefore attracting attentions to its mechanisms. Type 2 cytokines play a major role in allergies. It has been proposed that Natural killer (NK) cells may be able to produce type 2 cytokines. This study was done to evaluate NK cells number and subtypes in patients with allergic rhinitis, comparing healthy subjects.
Methods: In a case control study, patients with allergic rhinitis were compared to healthy non-atopic subjects. Allergic rhinitis was diagnosed according to ARIA guidelines. NK cells quantity was studied by staining of peripheral blood mono nuclear cells with anti-CD16-FITC and anti-CD56-PE and evaluated by two color flowcytometry. Intracellular cytokines were evaluated by tri-color flowcytometry. NK cells were separated by magnetic beads, and cultured for 72 hours. Secretion of IL-4, IL-5, IL-10, IL-13, and IFN-γ was measured by ELISA, in stimulated and unstimulated conditions.
Results: Patients had more CD16+ CD56+ NK cells than control group. IL-4+ NK cells were significantly higher in patients (p<0.001), but the number of IFN-γ+ NK cells was not different. Cytokine secretion of NK cells was similar in case and control groups. Although IL-13 level after stimulation seemed higher in patients, the difference was not significant.
Conclusion: NK cells number is increased in patients with allergic rhinitis and a considerable number of them produce IL-4.

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Background: Streptococcus pneumoniae is a common cause of respiratory infection. Pneumococcal upper respiratory tract infection (URTI) in children is seldom bacteremic. Determination the prevalence of S.pneumoniae infections in children with URTI using rapid urinary antigen test (BINAX now) and titration of serum pneumolysin antibody (added to conventional culture) was the object of this study.
Methods: A cross sectional, case-control study done in ENT & pediatric departments of Rasoul Hospital in Tehran, Iran, (2008 -2010) upon 133 cases with upper respiratory tract infection (otitis media, sinusitis and tracheitis). The nosocomial infection omitted in first step. 60 remaining cases followed for S.pneumoniae infection by culture and rapid urinary antigen test (Binax Now). Serum pneumolysin antibody titers compared between 45 cases and 66 controls.
Results: Positive culture (S.pneumoniae, H.influenza) obtained in 4/60 URTI cases. Positive urinary S.pneumoniae antigen detected in 50% (30/60) of cases and 6% (4/66) of controls (p=0.01). The pneumolysin antibody level with cut-off level 525pg/ml was higher in URTI cases than controls (982±441 Vs. 525±42, p<0.0001). Area under the ROC curve for pneumolysin antibody was 0.923 (95%CI 0.86-0.97, p<0.0001) and had 87% sensitivity and 82% specificity for differentiation between cases and controls.
Conclusions: The high pneumolysin antibody level in cases with URTI strongly indicates the pneumococcal infection. Pneumolysin antibody level even in little amounts (525pg/ml) with 87% sensitivity and 82% specificity is a suitable test for diagnosis of pneumococcal infection in children with URTI, but this test should be added to conventional culture (gold standard) and rapid urinary antigen test.

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Background: Tubal sterilization is the permanent and effective contraception method. This can be performed at any time, but at least half are performed in conjunction with cesarean or vaginal delivery and are termed puerperal. The most complication after tubal ligation is ectopic pregnancy. Ectopic pregnancy is the leading cause of maternal death in first trimester.
Case presentation: We present a 33 years old woman gravida5, para4, all normal vaginal delivery, presented with complaints of delayed menstrual period, pelvic pain and spotting. She underwent tubal ligation for two times. For the first time she had puerperal Pomeroy tubal sterilization after third child delivery. Intra uterine pregnancy occurred three years later. One day after vaginal delivery of fourth child, she underwent post partum tubal ligation with the Parkland method. Tubal pregnancy occurred nine months later. Physical examination identified acute abdomen. Pelvic ultrasound showed no gestational sac in uterine cavity. The sac with fetal pole was in right adnexa. Beta-HCG was 2840mIU/ml. She underwent laparotomy. Surgical management included salpingectomy with cornual resection in both sides. The surgery identified Ectopic pregnancy.
Conclusion: Any symptoms of pregnancy in a woman after tubal ligation must be investigated an ectopic pregnancy should be excluded. Ectopic pregnancy must be considered, in any woman with lower abdominal pain, missed period and vaginal bleed-ing. Conception after tubal sterilization can be explained by fistula formation and re-canalization of fallopian tube.

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Background: Cerebral venous thrombosis (CVT) is uncommon after cesarean section. Although it can be a leading cause of maternal mortality. CVT may occur during pregnancy because of hypercoagulable states such as preeclampsia, thrombophilias, antiphospholipid antibody syndrome and sepsis.
Case presentation: A 31 years old woman G2 Ab1 at 37 weeks gestational age with  premature rupture of membrane underwent cesarean section because breech presentation and preeclampsia. Spinal anesthesia was done for emergent cesarean section. On the second day after cesarean section, she developed headache, vomiting, focal neurologic deficits, paresthesia, blurred vision. Brain magnetic resonance imaging (MRI) showed thrombosis in anterior half of superior sagittal sinus. Treatment consisted of anticoagulation. 
Conclusion: Thrombophilias, pregnancy-related hypertension and cesarean section are the predisposing factors for thromboembolism. Unfractionated heparin and low molecular weight heparin (LMWs) are effective drugs for thromboprophylaxis. It is vital to prevent venous thrombosis to reduce mortality during both intrapartum and postpartum periods. Consideration of cerebral venous thrombosis in similar cases is recommended.

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Background: Velopharyngeal insufficiency causes hypernasal vocal quality and can also result in audible nasal air emission and difficulty in producing pressure consonants. The resulting speech is often socially unacceptable and can be difficult to understand. Platelet-rich plasma is an autologous derivative of whole blood. Today, the importance of clinical use of Platelet-rich plasma in the plastic surgery is considered. This study was designed to evaluate the effectiveness of combined Platelet-rich plasma and fat injection in the treatment of velopharyngeal insufficiency.

Methods: In this prospective clinicaltrial study, of 15 patients including 9 males and 6 females and aged 15-20 years with mild/ moderate velopharyngeal insufficiency who were injected with 5 mL of combined Platelet-rich plasma (1 mL) and fat (4 mL) in the front volume in the posterior pharyngeal wall in the pre-vertebral fascia under sedation. Speech samples were recorded by nasoendoscopy before the injection, and at 6 weeks and 6 months after the injection. Assessment of pathologic speech was done by speech therapist.

Results: Velar displacement showed significantly increased at 6 weeks after the injection (P=0.049). Velopharyngeal gap disappeared in 60% of patients at 6 weeks after the injection (P=0.019). Lateral pharyngeal wall movement showed significantly increased in 73.3% of the patients at 6 months after the injection (P=0.04). After the treatment, aerodynamic assessment showed significantly decreased in nasal air escape during phonation and repeat the words (P<0.05). Assessment speech therapist showed significantly improve quality of phonation in these patients (P<0.05).

Conclusion: It seems that, combined Platelet-rich plasma and fat injection lead to improve voice resonance and reduce nasal air escape in all treated cases. It can be a promising alternative to major procedures, such as velopharyngoplasties, for the treatment of mild/ moderate velopharyngeal insufficiency.

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Background: Surgery is one of the best choices for the treatment of hydatidosis. The use of effective scolicidal agents during surgery for hydatid cyst is essential to prevent the secondary infection. Up to now no effective and safe agent has been identified for this purpose. Berberis vulgaris called “Zereshk” in Persian has been traditionally used as herbal remedy for the treatment of complaints and it is widely cultivated in Iran. Many studies have shown that it has antibacterial, antifungal and antiparasitic effect. Methods: In this study the scolicidal effect of Berberis vulgaris aqueous and hydro-alcohol extract for different concentrations (for aqueous: 0.5, 1, 2 and 4 mg/ml and for hydro-alcohol: 0.25, 0.5, 1 and 2 mg/ml) at different exposure times (5, 15 and 30 minutes) was evaluated. For this purpose, we obtained liver hydatid-cysts from a slaughter house. Viability of protoscolices was assessed by 0.1% eosin staining. Normal saline and hypertonic saline were used as negative and positive controls respectively. Results: All the different concentrations of Berberis vulgaris aqueous and hydro-alcoholic extracts had scolicidal effect. An aqueous extract with 4mg/ml concentration acted as positive control and we observed to lead to the death of 100% of protoscolices in the first 5 minutes. The least scolicidal effect (12.3%) was observed in an aqueous extract with 0.5 mg/ml concentration.The scolicidal activity of hydro-alcoholic extract with concentration of 2 mg/ml was 100% after 5 min of application, which was the same as positive control group. We noticed a significant increase in protoscolicidal activity with an increase in concentration in the two extracts of Berberis vulgaris (P<0.001). Conclusion: It is important to mention that all the concentration levels and exposure times applied in this experiment are relatively low, since scolitical activity in both of the extracts is at its highest in this low spectrum. For further experiments, we suggest that the stability of cyst fluid in both of the extracts should be assessed. Therefore, after In vivo examination and additional experiments, it may be used as a suitable and effec-tive scolicidal in surgery.

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Background: Radiotherapy has been used to treat many types of cancers over the past years. Radiotherapy generates side effects on normal tissues. Radiosensitizer products provide decrease in tumor proliferation and reduce radiation dose in radiotherapy. Docosahexaenoic Acid (DHA) as an omega-3 polyunsaturated fatty acid has anti-proliferative effects on malignant cells. In this study, the effects of DHA accompanied by ionizing radiation on growth rate and survival fraction of HT29 colorectal cancer cells were evaluated. Methods: The present study was performed at the Institute of Biotechnology, affiliated to Urmia University, Urmia, Iran in the year 2013. In this laboratory experiment, ma-lignant cells were cultured in RPMI-1640 supplemented with 10% fetal bovine serum. HT-29 cells were cultured at 5105 cells/well into 6-well culture plates for overnight. Thereafter, the cells were pretreated with either 50 or 100 µM DHA for 4 hours and malignant cells were irradiated with either dose of 2 or 10 Gy. Cell viability was evalu-ated by trypan blue staining after 48 hours. Moreover, malignant cells were pretreated with either 50 or 100 µM DHA for 48 hours and irradiated with dose of 2 to 10 Gy. Thereafter, survival rate was evaluated by 3-(4,5-Dimethylthiazol-2-Yl)-2,5-Diphenyltetrazolium Bromide (MTT) assay after 6 days. Results: Cell viabilities were found to be 59.8% and 17.5% for 50 µM DHA in combi-nation with doses of 2 and 10 Gy respectively. Using 100 µM DHA diminished cell vi-ability up to 47% and 13.9% following doses of 2 and 10 Gy respectively. Treatment of cells with DHA accompanied by increasing doses of γ-rays significantly diminished survival rate. In treated cells with 50 and 100 µM DHA, survival rate were measured to be 79.1%, 57.6%, 42.8%, 40.5%, 34% and 55.8%, 43.7%, 33.6%, 27.9%, 23.5% for doses of 2, 4, 6, 8 and 10 Gy respectively. Conclusion: Our study indicates that DHA decreases colorectal cancer cells prolifera-tion and could provide a new radiosensitizer drug to enhance the efficacy of colorectal cancer radiotherapy.

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Background: In patients who undergoing PCI, association between right ventricular function and outcome of the procedure remained unclear. The present study aimed to determine association between echocardiography findings of systolic right ventricular function and functional status of patients following PCI. Methods: In a cross-sectional study conducted at Imam Ali hospital and heart center in Kermanshah, Iran in 2013, 40 patients with history of inferior wall myocardial infarction (Inf MI) according to previous electrocardiography (ECG) in past hospitalization for MI who were candidate for percutaneous coronary intervention (PCI) on right coronary artery (RCA) and had left ventricle ejection fraction (LVEF) less than 40% were included. The subjects underwent echocardiography on admission to assess echocardiography indices of systolic right ventricular function including tricuspid annular plane systolic excursion (TAPSE), tricuspid annular systolic velocity (TASV), Tei-index (Myocardial performance index), and RV fractional area (RVFA) change that was repeated one month later. Baseline functional status was assessed based on the New York Heart Association functional classification score (NYHA score) that divided to 4 grades. Results: NYHA score improved following PCI procedure (from 2.20±0.46 to 1.10±0.30, P<0.001). The mean score of TAPSE significantly increased from 18.68±2.12 to 20.40±2.11 (P<0.001). The mean of TASV also increased from 13.28±1.52 to 14.85±1.90 (P<0.001). Also, Tei-index was improved from 0.52±0.05 to 0.47±0.03 (P<0.001). Moreover, RVFA was significantly increased after PCI (from 35.02±2.40 to 38.25±2.57, P<0.001). There was no significant relationship between the changes in NYHA score and each of right ventricular systolic function indices. Conclusion: Although right ventricular systolic function considerably improved fol-lowing PCI procedure, but the changes in this improvement is not associated with the improvement of function class after the procedure.

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Background: A variety of endocrine disorders can complicate pregnancy. Diabetes insipidus although uncommon, may have devastating effect on pregnancy outcome, if unrecognized and untreated. The etiology of diabetes insipidus is often unknown, many cases are likely autoimmune, with lymphocytic infiltration of the posterior pituitary gland. Massive polyuria, caused by failure of the renal tubular concentrating mechanism, and dilute urine, with a specific gravity 1.005, are characteristic of diabetes insipidus. The diagnosis of diabetes insipidus relies on the finding of continued polyuria and relative urinary hyposmolarity when water is restricted. Most women require increased doses Desmopressin Acetate during pregnancy because of an increased metabolic clearance rate stimulated by placental Vasopressinase. By this same mechanism, subclinical diabetes insipidus may become symptomatic during pregnancy. Transient diabetes insipidus is associated with acute fatty liver and HELLP syndrome as well as twin gestation. Increased placental Vasopressinase activity, along with insufficient liver degradation in HELLP syndrome and acute fatty liver, may unmask this condition. Diabetes insipidus in pregnancy is rare. The disease results from inadequate or absent antidiuretic hormone (vasopressin) production by the posterior pituitary gland. The increased glomerular filtration rate seen in pregnancy may increase the requirement for antidiuretic hormone. Case presentation: We present a 39 years old woman, gravida3 para3, was admitted to Akbarabadi Teaching Hospital in september 2013. She was admitted due to polyuria, malaise, thirst with slight fever, six days after normal vaginal delivery. The urine volume was 8 lit/day and the specific gravity (S.G.) of the urine was 1.010. The urine osmolarity was lower than the plasma osmolarity. Electrolyte serum examination showed hypernatremia. The patient received 5 µg/day of synthetic vasopressin, in the form of l- deamino-8-Darginine vasopressin (DDAVP). This drug was given as intranasal spray in doses 0.25 mg twice daily. Plasma electrolytes and fluid status monitored carefully with initiation of therapy. DDAVP was used because it was not degraded by vasopressinase. Treatment was continuing, when the symptoms of central diabetes insipidus resolve and urinary concentrating ability was preferred. Maximum urinary osmolality over the next 11 hours was assessed, 730 mosm/kg was considered normal. Conclusion: Close attention to electrolyte and fluid balance is important in the postpartum period. The symptoms of transient vasopressin-resistant diabetes insipidus resolve in few days to a few weeks after vaginal delivery or when hepatic function returns to normal.

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Background: Bispectral Index (BIS) may be used in traumatic brain injured patients with different anatomical sites of injury to evaluate the level of consciousness. The objective of this study is to evaluate the relation between type of brain injury and the presence or absence of frontal lobe damage based on brain CT-scan with BIS monitoring in intubated acute head trauma patients admitted to the intensive care unit (ICU). Methods: Participants of this cross-sectional study consisted of 30 intubated head trauma patients over the age of 15 years old, without any known history of visual or hearing impairments, neurologic disorders, mental retardation, or frontal skin laceration, who were admitted to the ICU in Rasool Akram University Hospital, Tehran. Patients who needed muscle relaxant administration, or those who showed instability of vital signs, hypoxemia, disorders of the blood biochemistry, or blood gases, liver or kidney failure, convulsion or hypoxic encephalopathy during the study were excluded. In the first three days of admission, each patient underwent monitoring of BIS every sixty minutes for just six hours a day. All the hypnotic drugs were discontinued six hours prior to the start of monitoring and fentanyl was the only opioid, which was administered if an analgesic was required. Statistical analysis were used to evaluate the data and p-value less than 0.05 was considered statistically significant. Results: Mean age of all patients was 43.6 years with a Standard Deviation (SD) of 18.96. Presence or absence of frontal lobe injury, had no statistically significant correlations with mean BIS in each three days of study and the mean BIS total. However, mean BIS in the second and third days had statistically significant differences in different types of cranial lesions (contusion, subdural hemorrhage, subarachnoid hemorrhage, etc) which usually have different prognoses. Conclusion: Different kinds of acute traumatic cranial lesions with different prognosis may have different values in BIS monitoring. Presence or absence of frontal lobe injury, had no statistically significant correlations with BIS values.

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Background: Varicocele is recognized as the most common cause of male factor infertility and is found in 15% of the general population. This prevalence increases to 35% in men presenting with primary infertility and between 70 to 80% in men presenting with secondary infertility. The effect of varicocele on Leydig cell function and testosterone production has been always a question. In this study we examined the effect of varicocelectomy on serum testosterone. Methods: This research protocol was approved by the institutional review board at Royan Institute in infertility department and also this study has been done in Royan Institute (Tehran, Iran) during one year since September 2012 till October 2013. In this cross-sectional study, Serum levels of total testosterone in 79 men with clinical varicocele and in 70 fertile men who served as a control group were compared. Men aged 23–46 years with clinically palpable varicoceles as determined by physical examination were studied. Three to 6 months, testosterone levels were measured again after varicocelectomy, then testosterone levels were compared before and after varicocelectomy. Results: The mean of serum testosterone levels before surgery in infertile men with varicocele and fertile men were 590(230) vs. 583(237) ng/dl respectively. No statistically significant changes were noted in serum testosterone levels for any groups. Three month after varicocelectomy mean serum testosterone levels were significantly increased in infertile men with varicocele compared with preoperative levels from 590 (230) to 663 (242) ng/dl (P=0.009). Also the testis volume of patients were examined, which were divided into two groups included the men with testis volume less than 16 ml (<16) and more than 16 ml (≥16). Conclusion: In infertile men affected with clinical varicocele, varicocelectomy seems to have caused positive impact on the level of serum testosterone increase. It is thought that positive effect is probably caused by improvement of the Leydig cell functions which induce the increase of serum testosterone level.

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Background: After primary infection, the number of CD4 T-cells decreases with disease progress. The patient’s immunological status could inform by The CD4 T-cell counts over the time. The main purpose of this study is to assess the trend of CD4 cell count in HIV+ patient that received Antiretroviral Therapy (ART) by using a multistate Markov model to estimate transition intensities and transition probabilities among various states.

Methods: A total of 122 HIV+ patients were included in this cohort study who are undergoing Antiretroviral Therapy treatment in the Iran AIDS center in Imam Khomeini Hospital in Tehran that inter during March 1995 to January 2005 and then fallow up to October 2014. All adults with at least two follow-up visits in addition to their pre-ART treatment were considered to be eligible for inclusion in the study. Continuous-time Markov processes are used to describe the evolution of a disease over different states. The mean sojourn time for each state was estimated by multi state Markov model.

Results: Sample included 22 (18%) female with a mean age of 43.32 (standard deviation 8.33) years and 100 (82%) male with a mean age of 45.28 (standard deviation 8.34) year. Age was divided in to two categories, 40 years old and lower than that 66 (54.1) patents and persons older than 40 years old 56 (45.9) patents. A total of 122 patients were included. 29 patients died during follow-up. One year transition probability for staying in state 1 of CD4 cell count was 51%. This probability for six year was 33%. The mean sojourn time for sate 4 was 21 month. The hazard ratio of transition from state 3 to state 4 was 4.4 in men related to women.

Conclusion: The use of antiretroviral therapy in the treatment of HIV infected persons reduce viral replication and increase in CD4 T lymphocyte count, and delay the progression of disease. This paper is shown the progression of this trend.

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Background: Polycystic ovary syndrome (PCOS) is a common complex condition. Evidences from studies on women with PCOS and rat PCO model suggest that the sympathetic regulatory drive to the ovary may be unbalanced (hyperactivity). Findings that support the involvement of sympathetic nervous system in the pathophysiology of PCOS are that the catecholaminergic nerve fibers in the polycystic ovaries of women with PCOS are denser than in normal ovaries. The purpose of this study was reduction of this hyperactivity.

Methods: This study was clinical trial and was performed in Reproductive Health Research Center, Tehran University of Medical Sciences, Iran, during January 2013 to 2015. A total of 61 women between aged 20-40 years and BMI under 28 kg/m2, who were previously diagnosed with PCOS were assessed. The diagnosis of PCOS was made according to joint criteria of the European Society of Human Reproduction and Embryology and the American Society of Reproductive Medicine (ESHRE/ASRM). The study objectives were explained to the patients before they entered the study, and an informed consent was obtained from all. They were divided into three groups as follows: (i) two study group (n=39) and (ii) control group (n=22). For evaluating effects of alpha-2 inhibitors (Clonidine and Yohimbine) by Eliza, the following variables were evaluated before and after drug therapy: serum cortisol adrenaline (A) noradrenalin (NA) beta-endorphin (&beta-End) insulin as well as sex hormones including FSH, LH and Estradiol.

Results: Our results showed that, Clonidine as central anti-adrenergic drug causes 61% of all pregnancies in the study group. This is high percentage of the pregnancy rate compared with yohimbine (P< 0.001). Yohimbine (Indol alkaloid) as alpha-2 adenoceptor antagonist increases follicular development in this disease. This follicle growth is higher than clonidine (P< 0.01).

Conclusion: Our findings showed that increasing the pregnancy rate and follicular development represent the strategic role of sympathetic nervous system (SNS) in polycystic ovary syndrome and) SNS may thus offer a novel biological and pharmacological target in treatment of PCOS.

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Background: Over the last two decades invasive candidiasis has become an increasing problem in neonatal intensive care units (NICUs). Colonization of skin and mucous membranes with Candida spp. is important factor in the pathogenesis of neonatal infection and several colonized sites are major risk factors evoking higher frequencies of progression to invasive candidiasis. The aim of this study was to detect Candida colonization in NICU patients.

Methods: This cross-sectional study was conducted on 93 neonates in NICUs at Imam Khomeini and Children Medical Center Hospitals in Tehran. Cutaneous and mucous membrane samples obtained at first, third, and seventh days of patients’ stay in NICUs during nine months from August 2013 to May 2014. The samples were primarily cultured on CHROMagar Candida medium. The cultured media were incubated at 35°C for 48h and evaluated based on colony color produced on CHROMagar Candida. In addition, isolated colonies were cultured on Corn Meal Agar medium supplemented with tween 80 for identification of Candida spp. based on their morphology. Finally, polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method was performed for definite identification of isolated species.

Results: Colonization by Candida spp. was occurred in 20.43% of neonates. Fifteen and four patients colonized with one and two different Candida spp., respectively. Isolated Candida spp. identified as; C. parapsilosis (n: 10), C. albicans (n: 7), C. tropicalis (n: 3), C. guilliermondii (n: 2), and C. krusei (n: 1). In present study non-albicans Candia species were dominant (69.56%) and C. parapsilosis was the most frequent isolate (43.47%). Using Fisher's exact test, the correlation between fungal colonization with low birth weight, low gestational age, and duration of hospital stay was found to be statistically significant (P=0.003).

Conclusion: The results of this study imply to the candida species colonization of neonates. Neonates in NICU are at the highest risk for severe infection with Candida parapsilosis. Therefore, isolation of C. parapsilosis as the most common species (43.47%) in present study was noteworthy.

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Background: Spermatogenesis is a complex and highly organized process of proliferation and differentiation of spermatogonial stem cells. Spermatogonial stem cells (SSCs) as a unique stem cell have the potential to self-renewal, differentiation and transmit genetic information to the next generation and play a vital role in maintaining fertility. Sertoli cells as the only somatic cells within the seminiferous epithelium play central roles in the formation of niche and balance between self-renewal and differentiation by secrete many growth factors. Given the importance and widespread use of SSCs, particularly in the treatment of infertility, the aim of this study was to create an optimal environment for the proliferation of SSCs. So we decided to study of undifferentiated (ID4) and differentiated (c-Kit) gene expression in SSCs followed by co-culture with Sertoli cells for a one-month.

Methods: This experimental study was conducted from November 2013 to December 2014 in Department of Anatomy, School of Medicine, Tehran University of Medical Sciences, on immature NMRI mouse (6-3 days old). Initially, Sertoli cells and SSCs were isolated from neonates mouse testes during the two-step enzymatic digestion characteristics Sertoli cells with vimentin marker and SSCs with promyelocytic leukemia zinc-finger (PLZF) marker were confirmed. Then SSCs were cultured in two groups: co-culture with Sertoli and without co-culture (control). Undifferentiated (ID4) and differentiation (c-Kit) gene expression were evaluated by Real-time PCR technique.

Results: Spermatogonial stem cells purity was obtained 66.91% by flow cytometry. The relative expression levels of gene ID4 in co-culture group at the end of each week, compared to the control group showed a significant increase (P<0.05). While the expression of this gene significantly decreased in each group over time (P<0.05). The results of the comparison of the relative expression of c-Kit gene in co-culture group are indicated significant decrease than the control group at the end of each week (P<0.05). In addition, this gene expression was showed significant increase in each group individually over time (P<0.05) ID4 gene expression showed a significant (P<0.05) increase toward the control group, while in the expression of c-Kit was observed a significant (P<0.05) decrease compared with the control group at the end of each week.

Conclusion: According to the results of this study, co-culture with Sertoli cells maintains SSCs in the prolifration stage for long-term, so can be used to optimize the culture medium at the clinic.

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Background: It is reported that high frequency of chromosomal aberrations in peripheral blood lymphocytes of individuals is a marker of cancer predisposition. The aim of this study was to investigate the in vitro frequency of chromosomal damage in lymphocytes of patients with head and neck cancer against gamma irradiation compared with those in healthy individuals.

Methods: In a case and control study, peripheral blood lymphocytes of 101 patients with head and neck cancer were collected before the onset of radiotherapy. Lymphocytes of 40 healthy individuals were also collected as controls. Head and neck cancer patients and the control group were consecutively recruited between April 2012 and February 2015 from Clinics of Cancer Institute, Imam Khomeini Hospital, Tehran, Iran. Lymphocytes of patients or control group were cultured and exposed to gamma radiation in G2- and G0- phase of the cell cycle. The induced chromosomal aberrations such as chromosome and chromatid breakages, chromosome and chromatid gaps, chromatid exchanges and micronuclei were scored in one-hundred metaphase cells of each individual. The mean of each chromosomal aberration was compared in patient and control groups. Early and late tissue reactions were scored during radiotherapy treatment or thereafter.

Results: There was no significant difference in demographic characterization between the two study groups. The frequency of radiation- induced G2 aberrations in lymphocytes of patients was significantly higher than in those of healthy donors (P= 0.001 for chromosomal breaks). The frequency of radiation-induced micronuclei in G0 assay was also higher in patients than in those in controls (P= 0.05). The results also indicate that there is no correlation between the two assays. No significant correlation was also observed between aberration frequencies in lymphocytes and the degree of both early and late normal tissue reactions.

Conclusion: The results indicate that the in vitro chromosomal radiosensitivity of peripheral blood lymphocytes of patients with head and neck cancer against gamma irradiation was significantly higher than that in healthy individuals.