Tehran University Medical Journal

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Background: Lead poisoning has proven to be one of the most important environmental health problems among developing countries with both direct and indirect effects on human life. Lead is known to cross the blood-brain barrier and placenta, and accumulates in soft and hard tissues. Lead can be excreted in urine, stool, milk, sweat, nails and saliva. During pregnancy and lactation, lead is released from bones into the blood along with Ca²⁺. The toxic effects of lead on various human tissues have been studied extensively, but few studies have addressed its impact on fetal development during pregnancy. Blood levels of lead are higher in people living in lead-polluted regions. It has been reported that Tehran (central and southern parts) is the most problematic city in terms of lead poisoning.

Methods: From 86 sets of mothers and newborns in a non-polluted area of rural Rasht, Iran, we examined specimens of maternal blood, cord blood and colostrum (86×3=258) and specimens from 85 sets of mothers and newborns in a polluted area of Tehran, Iran (85×3=255) for lead levels using atomic absorption spectrophotometry (AAS) and analyzed the results by t-test, SPSS, and linear regression.

Results: The mean blood lead concentrations of mothers, cord blood of newborns and colostrum were 7.6±4.1, 5.9±3 and 4.2±2.5 μg/dl, respectively, in the non-polluted area and 9.1±8.4, 6.5±5.2 and 5.8±5.5 μg/dl, respectively, in the polluted area. The mean weights of the newborns in non-polluted and polluted areas were 3.2±0.5 kg and 3.2±4.5 kg, respectively.

Conclusions: Our data revealed an association between mean concentrations in blood lead of mothers and newborns and between mean concentrations of colostrum lead and newborn blood lead in both areas (p=0.01). There was no association between mean blood lead concentration of mothers with the weight of their newborns (p=0.89).

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Background: Thymidine phosphorylase (TP) catalyses the conversion of thymidine into thymine. Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is an autosomal recessive disease which is caused by mutations in the nuclear gene encoding TP, bringing about severe impairment of TP-enzyme specific activity and accumulation of thymidine in plasma. The clinical manifestations of MNGIE are recognizable and homogenous, but not in the early stages of the disease. In patients who are suspected of having MNGIE, determination of TP-specific activity in leukocytes and thymidine levels in plasma are diagnostic. The methods that are usually used for the measurement of TP activity and plasma thymidine are not rapid or accurate enough and lack sensitivity.

Methods: The specific activity of TP was measured by RP-HPLC in leukocytes of both the controls and the patients exhibiting clinical features suggestive of MNGIE. Moreover, plasma thymidine was assessed by the same method.

Results: The patients had detectable plasma thymidine (>3 µmol/L) but it was undetectable in the healthy controls. The patients' TP-specific activity decreased to less than 5% relative to the controls (14±4 nmol/h/mg vs. 525±165 nmol/h/mg, P<0.05). A diagnostic algorithm for the definitive diagnosis of MNGIE is suggestible based on the results of this study which relies on the measurement of plasma thymidine, TP-specific activity in leukocytes, or both.

Conclusion: In this study, we set up a sensitive and rapid assay for the evaluation of TP-specific activity by using RP-HPLC in Iran. In addition, we established reference values for TP-specific activity and plasma thymidine in the Iranian patients.

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Background: With introduction of intracytoplasmic sperm injection with testicular sperm extraction or precutaneouse epididymal sperm aspiration, effective treatment was provided for azoospermic men. The aim of present study was to compare clinical outcome following intracytoplasmic sperm injection using extracted testicular/epididymal sperm or ejaculated severe oligoasthenoteratozoospermic sperm. Methods: After retrospective evaluation of more than four hundred medical records of patients undergoing intracytoplasmic sperm injection Mehr medical institute (between 2011-2012), 45 cycles with severe eligoasthenoteratozoospermia and 34 cycles with azoospermia were included. Patients were treated with gonadotropin releasing hormone agonist. The clinical characteristics and intracytoplasmic sperm injection outcome such as the rate of fertilization, implantation and clinical pregnancy were compared between the two groups. Results were presented as mean±standard deviation and number (percent). Differences between variables were analyzed using student's t test and the chi-square test was used to examine differences between categorical variables. P value less than 0.05 were considered as statistically significant. Results: Mean of female age (29±4.9 vs. 30.2±5.8), body mass index (26.9±5.3 vs. 26.9±3.8), estradiol level on human chorionic gonadotropin administration day (1375.6±843.9 vs. 1181.8±673.1), total number of retrieved oocytes (9.7±5.3 vs. 9.2±5.9) and metaphase II oocytes (7.7±5.1 vs. 7.5±5.4) were similar between the two groups. Of 436 and 313 retrieved oocytes, respectively 232 and 163 oocytes were ferti-lized in oligoasthenoteratozoospermic and azoospermic groups (53.2% vs. 52.1%, P=0.214). There were not statistical differences between groups in number of trans-ferred top quality embryos (1.5±1.2 vs. 1±1.2, P=0.09), implantation rate (22.7% vs. 16.9%, P=0.238) and clinical pregnancy rate (21 (47.7%) vs. 11 (35.4%), P=0.199). Conclusion: Intracytoplasmic sperm injection with precutaneouse epididymal sperm aspiration and testicular sperm extraction are effective methods to treat azoospermic men and its clinical outcome were comparable to ejaculated sever oligoasthenoterato-zoospermic cycles. It can be concluded that the influence of sperm quality and origin on intracytoplasmic sperm injection outcome are the same.

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Background: Morbid obesity is associated with a some of significant comorbidities. Early and uneventful postoperative recovery of obese patients remains a challenge for anesthesiologists. It seems Bispecteral Index (BIS) monitoring may reduce drug usage and hasten recovery time in inhalation anesthesia. The aim of this study was to investigate the effect of BIS monitoring on intraoperative isoflurane utilization and the early recovery profile. Methods: Fifty morbidly obese adult patients (Body Mass Index (BMI) of 35 kg/m2 or grater) undergoing elective laparoscopic cholecystectomy in Urmia Imam Khomeini Hospital were enrolled in this prospective, Cohort and single blind study. Duration of this study was six months between April to September 2012. Patients were randomly divided two groups (25 patients per group). In the first phase of the study, patients were anesthetized without the use of BIS monitoring and isoflurane being administered according to standard clinical practice (this group formed the control group). In a second phase, with use of BIS monitoring isoflurane was titrated to maintain a BIS value between 40 and 60 during surgery, and then 60-70 during 15 min before the end of surgery (this group formed the BIS group). Isoflurane consumption and recovery time were compared between two groups. Results: All patients completed the study. No differences were noted between demographic data. The isoflurane consumption in the BIS group was 30-35% lower than in the control group (P< 0.001). The time to awakening and duration of extubation in the BIS group were significantly less than the control group (P< 0.001). Furthermore, analgesic consumption in the recovery room and sedation score during postoperative phase were similar between the groups. Significant differences were noted in recovery time between two groups (P< 0.001). Conclusion: The addition of Bispectral index monitoring to standard monitoring reduced isoflurane usage. We found use of BIS hastened recovery time after isoflurane anesthesia.

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Results: The data showed enhanced level of the expression of AXIN2 gene in the colonic polyps in comparison to the normal tissues (RQ>2), which was significantly upper in adenoma polyps compared to the hyperplastic group (P=0.015). Also, unlike the rectum, the AXIN2 gene activity in colon area was higher than normal tissue.