Tehran University Medical Journal

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Diabetic nephropathy is common in Mazandaran and a significant number of patients under chornic hemodialysis are diabetics. The present study was designed to study the prevalence and predisposing factors of diabetic nephropathy (DN) in Mazandaran. Methods: During a 20 months period from June 1993 through December 1994, 490 (350 female, 140 male) cases of non-insulin dependent diabetes mellitus (NIDDM) were diagnosed according to the criteria of National Diabetes Data Group. DN was diagnosed in 18 (11 male, 7 female) patients with proteinuria of 500 mg or more in a 24-hour urinary sample in at least two separate occasions, and excluding other causes of nephropathy. Results: 3.7 percent of all NIDDM patients had DN, 15+5 years after onset of diabetes. Male patients have higher prevalence of DN (7.8%) than female (2%). Onset of diabetes before 50 years age in male is a risk factor for DN (9.5%) as compared after 50 (4.5%) (P=0.01), in female the prevalence of DN before and after 50 is, 1 and 3.4 percent respectively (P=NS). Conclusions: In Mazandaran DN is not uncommon, it is more common in male patients than female. The age of onset, duration of diabetes and maleness are predisposing factors for DN.

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Ingestion of fish oil fatty acids (omega - 3 fatty acids ) inhibits the formation of arachidonic acid - derived cytokines and leads to production of compounds with diminished biological activity. Beneficial effects of dietary supplementation with fish oil in rheumatoid arthritis have been shown in many controlled trials.
Methods : 43 patients with active rheumatoid arthritis entered in a prospective, double-blind, placebo-controlled clinical trial to recieve either lOgr fish oil daily (treatment group) or corn oil (placebo group). Baseline drugs and usual diet were continued without any changes. Disease variables were evaluated at baseline and after completion of study period.
The changes in disease variables were compared by paired t-tesl in each group. Comparison of the two groups was done by t-test. Functional capacity was compared by Wilcoxon ranks test.
Results : 19 patients in treatment group and 20 patients in placebo group completed the study which lasted eight weeks . In the treatment group, joint pain index decreased from 30±11 at baseline, to 18±11 at the end of study period (P < 0.01). Joint swelling index decreased from 8 ± 4 to 2 ± 4, (P< 0.01), morning stiffness from 87 ± 41 to 24±16 minutes (P < 0.01). In the placebo group the above variable changes were from 19±14 to 25±14 8±8 to 7±6 and 80±71 to 76±75 minutes respectively, which were not significant . The differences between the treatment and placebo groups were significant in joint swelling index (P < 0.05), morning stiffness (P<0.01) and functioal capacity (p< 0.005), the differences in joint pain index and grip strenght did not quite achieve statstical significance. During study period there were no adverese effects with fish oil consumption.
Conclusion : Fish oil supplemention has anti-inflamatory effects in rheumatoid arthritis. Further studies are needed to recommend its long - term usage concomittant with other drugs in all patients

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As fever is a sign of infection and also an unpleasant and unfavorable feeling for patients it is urgent to be treated as soon as possible. The treatment can be difficult because of critical situation. This paper is intended to propose a management program according to 6 months follow up in our (ICU). Results were considerable in decreasing about 60% mortality and morbidity.

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There are now several tests available that can assess fetal status. A series of 164 cases of high risk pregnancies were studied in order to assess predictive value of a nonstress test. The majority (36%) of patients complained about postdate pregnancy. A nonreactive test was identified in 24 of the patients (14.6%). Fetal distress, low Apgar score in 1 and 10 minutes after birth and mean of Apgar score in 5 minutes, cesarean section due to fetal distress, congenital anomalies, need of neonatal care, IUGR, abnormal presentation and perinatal death were much more common in the group of pregnancies with a nonreactive NST than in the group with reactive test. The difference was statistically significant. A reactive test was found to be a good predictor of the healthy fetus. Negative predictive value and specifity of the test were found 80% and 91.9%, respectively. The nonreactive test could identify a population at risk but it was not helpful as a stand alone modality in decision making, because of the low sensitivity and positive predictive value rates (33.3% and 58%).

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To determine the complications of gold sodium thiomalate therapy in rheumatoid arthritis (RA), 32 patients with active RA (27 female, 5 male) treated for a mean period of 28 ? 14 weeks were studied. From these patients, 62.5 (46-79) percent showed at least one drug reaction. Pruritus was the most common complication occurred in 59 (42-76) percents, and was accompanied by skin rush in 37 (15-57) percents of cases. Renal, mucosal and post-injection complication developed, each in 16 (3-29) and percents of patients. Hematologic and pulmonary reaction occurred in 12.5 (1-24) and 9 (1-19) percents of cases respectively. Drug reaction resulted to discontinuation of gold therapy in 19 (5-32) percents of patients. Majority of drug reactions occurred during the first 15 weeks of therapy. In comparison to reports coming from other studies, drug reactions in Iranian patients were more frequent but less severe.

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Population growth has been one of the main anxieties of different countries planners so far. Background and purpose growth of population has always had various impacts on society in economical, social, health and even political fields and its cure is controlling population growth. In order to study the efficient factors upon unwanted children, 1527 married women in Tehran have been randomly selected and data from questionnaire was selected. In this study, effective factors such as couple's education level, couple's occupation, number of children, age of marriage, age of last pregnancy, having stillbirth, breast feeding period in last born and effect of sex of infant in family planning upon unwanted children have been studied. Results show that some factors like husband's age, number of children, age of first marriage, age of last pregnancy, husband occupation, having stillbirth, breast feeding period and effect of infant's sex in family planning increase the chance of unwanted children and some criteria like women age, woman's education, fist pregnancy age, woman occupation, decrease the chance of unwanted children. According to logistic regression model, women age is one of the most important effective factors and one year increment in woman's age increase the chance of unwanted child 0.89 more times. Other factors is the number of children that in return for increasing one child to family, the chance of un wanting become 116.8 more times. It seems families don't have enough knowledge about family planning measures and their usage. Breast feeding period in wives who have fed their last children for more than six months, is another important factor which increases the chance of unwanted child to 1.02 more times than woman who have fed their last children for less than six months.

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Background: Stereologic methods are used to obtain quantitative information about three dimensional structures from histologic sections. The aim of present study was using new and unbiased stereological techniques to investigated changes in volume and number of glomeruli after chronic lead acetate intoxication. Lead is one of the heavy metals that have adverse effects on renal function. Its effects can involve both renal tubules as well as glomeruli. So many studies based on observation and qualitative reports. Some of which report changes in volume and number of glomeruli.

Materials and Methods: Male Wistar rats were randomly divided to four groups (n=9). During a period of 8 weeks, the treatment groups were given 0.5 percent and 1 percent lead acetate in drinking water and the control and sham control were given distilled water and 0.4 percent acetic acid solution respectively. Stereological analysis based on Cavalierie's principle was performed to determine the reference volume (VRefrence), the fraction volume of glomeruli (VVGlom) and total glomerular volume (VTGlom). Furthermore, for estimating the numerical density (NVGlom) and total number of glomeruli (NTGlom), the physical dissector was utilized.

Results: Results showed that the number of glomeruli in treatment group which received 1 percent lead acetate in drinking water decreased significantly (P<0.05), but no changes occurred in 0.5 percent group (P>0.05). On the other hand glomerular total volume in both 0.5 percent and 1 percent groups increased significantly in comparison to control and sham control groups (P=0.000).

Conclusion: This experiment is in agreement with other qualitative reports by using unbiased method of stereological methods and showed changes in volume and number of glomeruli following lead acetate intoxication.

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Background: Cephalometry is one of the important branches of anthropometry that has wide uses in identification, forensic medicine, plastic surgery, orthodontics, archeology and determining the origins of races. This research was investigated to determine the head and face phenotypes among one-day newborn boys in two aborigines of Sistani and Baluchi who were resident in Zahedan.

Materials and Methods: The investigation is based on cross-sectional analytical descriptions of 420 newborn aborigine boys (216 Sistani & 204 Baluchi), who were clinically healthy, in Quds hospital in summer 1381, in Zahedan. In this study cephalic and prosopic indices were determined by classical cephalometric.

Results: The mean and the standard deviations of cephalic index were 83.67±4.80 and 83.64±4.77 and prosopic index 86.79±5.87 and 86.53±6.76 for Sistani and Baluchi subjects respectively. Based on the cephalic index, the dominant head types in sistani group were hyperbrachycephalic (37%) and brachycephalic (37%). In Blachui group, the hyperbrachycephalic (37.3%) and brachycephalic (35.3%) type were the dominant one. Furthermore, according to the prosopic index. The dominant face type among sistanis was euryprosopic type (42.6%). In Baluchi group, the dominant face type was also euryprosopic (39.2%).

Conclusion: This research showed no statistically significant differences in terms of head and face type indices between two aborigines of Zahedan. Based on this cross-sectional study, it seems that there is similarities between the aforementioned groups

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Background: This investigation was conducted in order to study angiographic findings in patients with cerebral aneurysm.

Materials and Methods: The study conducted on 136 cases of ruptured cerebral aneurysms between 1995-2000 confirmed by means of 4-vessel cerebral angiography to get an insight to racial, geographic and environmental factors predisposing to the occurrence of subarachnoid hemorrhage and aneurysm formation. Results: The data analysis revealed the following

Results: 58% of the population comprised of male and 42% female with a mean age of 46 years. 89% of the aneurysms were found in the anterior circulation and 11% occurred in the posterior cerebral circulation. The most common site in both the sexes was the anterior communicating artery. 9.6% of the patients displayed two separate aneurysms. 5.2% of the aneurysms were found to be giant aneurysms and 3% of the patients had fusiform aneurysms.

Conclusion: The low average age, a predilection in male population and the prevalence of aneurysms at carotid and middle cerebral artery bifurcation and the distal branches of anterior cerebral artery and a higher incidence of anterior communicating artery in women were the findings observed in this study.

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Background: It was believed that Inhabitant of Islamshahr avoid referring to their health centers and health posts to receive bargain medical services. In search for the rate and causes of such neglect, this study was formed.

Materials and Methods: In a cross-sectional study from all urban centers and health posts under the supervision of Islamshahr health network, 712 files were selected randomly.

Results: Investigating the selected files it revealed that 25% were complete, 51% were defective and 24% were blank. In other words, only 25% of the files were complete and 75% of the files showed lack of full participation in primary care services. In the process of evaluation of each separate service unit, more defective files were found in family planning and oral health programs. But in the prenatal care and growth observation units, the number of complete files was a little higher than the number of defective ones. This is probably justifiable de to free vaccination of children and pregnant women, which causes the customer to refer to the mentioned units. In search for the causes of this lack of participation, 533 defective files were selected and those families were interviewed through some questionnaires.

Conclusion: In family planning and growth observation and prenatal care, the interviewees believed that there was no need for them to seek such services. This in turn shows their lack of knowledge about the necessity of these cares. In case of oral health, lack of such unite in the health center was mentioned as the reason. More details are discussed in the article.

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Our understanding of the pathogenesis of endocrine disorders increase rapidly by genetic studies at the molecular level. Common endocrine disorders such as diabetes mellitus, obesity, osteoporosis, dyslipidemia and cancer follow the multifactorial model in the genetic aspect. This review tries to clarify the approach in molecular studies of such diseases for clinicians in different specialties. How to evaluate a possible association between a single nucleotide polymorphism and an endocrinopathy or its complication is the main concern of this review. Two approaches for gene mapping will be discussed as well as main challenges regarding each approach. All such genetic studies ideally include some test of the association between genome sequence variation and the phenotype of interest such as the trait itself, the presence of a given complication, or measures of some endocrinopathy-related intermediate trait. Despite different advances in this analysis, there are major concerns regarding the overall performance and robustness of genetic association studies. By using powerful new high-throughput methods, further insights to molecular basis of such endocrine disorders can be expected. Close correlation between geneticists and clinicians can effectively bridge between basic sciences and clinical investigations.

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Background: Sexual function in women may be affected by their menstrual cycle. Lack of sexual drive is a deficiency or absence of sexual fantasies and desire for sexual activity. This study aims at determining the changes in sexual desire during the menstrual cycle and those associated with premenstrual syndrome (PMS) and evaluates sexual desire during the menstrual cycle and the associated changes with PMS.

Methods: The sample for this cross-sectional study includes 150 women employed in factories in Tehran. The instruments for data collection were questionnaires and journals of premenstrual experiences.

Results: Analysis of the data showed that the mean age of the subjects was 31 years )standard deviation = 8.46(. The most frequent decrease in sexual desire was during the week prior to the start of menstrual bleeding (27.3%) and the least frequent was from the end of bleeding to one week before the next period of menstrual bleeding (5.3%). In 24.7% of the cases, an increase in sexual desire occurred during the middle of the menstrual cycle and 27.3% during the course of menstrual bleeding. Moreover, 10.7% of the subjects had an increase in sexual desire during the week before bleeding. Furthermore, a positive correlation was found between changes in sexual desire and PMS (p<0.001). In addition, a positive correlation was found between changes in sexual desire and breast tenderness, joint and muscle pain.

Conclusions: The sexual desire of women, with or without PMS, changes during the menstrual cycle. The greatest decrease in sexual desire occurs during the first week before menstrual bleeding in women with PMS. Such information can greatly help toward understanding and treatment in sexual therapy for couples.

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Background: Leukemia is one of the most common pediatric malignancies. T-cell Acute Lymphoblastic Leukemia (T-ALL) accounts for 15% of hematopoetic cancers. It has been well understood that identification of genetic alterations associated with leukemias is very critical. The molecular genetic techniques have promoted the identification of leukemia-associated genetic changes that may characterize the most accurate predictors of clinical outcome. These considerations reinforce the requirement for rapid identification of the abnormalities.

Methods: Multiplex RT-PCR, a highly sensitive and specific method applied to screen simultaneously three most frequent transcription factors, TLX1/HOX11, TLX3/HOX11L2 and TAL1/SCL which are associated with T-cell Acute Lymphoblastic Leukemia (T-ALL).

Results: We describe here our efforts to establish a multiplex RT-PCR analysis system that facilitates the detection of HPB-ALL and K562 cell lines, respectively.

Conclusion: The multiplex RT-PCR technique is a sensitive, valuable and cost-effective diagnostic tool which could improve our ability to accurately and rapidly risk-stratification of patients with childhood T-ALL. In order to perform multiplex RT-PCR technique researchers do not need bone marrow samples and they can employ this method using peripheral blood samples. Therefore, the status of treatment could be followed by assessment of the level of mRNA expression of oncogenic transcriptional factor using peripheral blood sample. Use of this procedure not only provides the best results in short term for specialist, but also clinicians could have opportunities to choose suitable treatment strategies with decrement of drug side effects.

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Background: Estimation of Left Ventricular End Diastolic Pressure (LVEDP) among patients with Mitral Stenosis (MS) helps to diagnose diastolic dysfunction and to explain their symptoms. However, Conventional Doppler measurements have limitation in predicting of LVEDP. This study sought to establish whether the correlation between measurements derived from Tissue Doppler echocardiography and LVEDP remains valid in the setting of severe mitral stenosis.

Methods: Thirty three patients with moderate to severe MS who had indication for left heart catheterization enrolled during 1387-88 in Imam Khomeini Hospital in Tehran, Iran. The mean diastolic transmitral pressure gradient and mitral valve area (MVA) were calculated, and Two-dimensional, M-mode, color Doppler and tissue Doppler Imaging indices such as: early diastolic mitral inflow velocity (E), annular early diastolic velocity (Ea), E/A ratio, Isovolemic relaxation time (IVRT), Pulmonary Vein systolic and diastolic flow velocities, Velocity Propagation, LA size, TE-Ea, Tei Index were obtained in maximum three hours before cardiac catheterization. The echocardiography analysis was performed offline without knowledge of hemodynamic data Linear correlation and multiple linear regression were used for analysis. p< 0.05 was considered significant.

Results: In univariate analysis, E/Ea was associated with LVEDP significantly (p = 0.04, r = 0.38). There was also a significant correlation between TE-Ea and LVDP (p = 0.01, r = -0.44). In multiple linear regression Tei Index (ß = 0.4, p< 0.02), and TE-Ea (ß = 0.5, p = 0.02) were showed as independent predictors of LVEDP (R2 = 49%).

Conclusion: Although we observed a moderate correlation between Doppler measurements and LVEDP in patients with severe MS, more similar studies are required.

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Background: An increased risk for invasive infections with encapsulated bacteria such as Streptococcus pneumoniae has been described in patients with chronic kidney disease (CKD) or in those on dialysis. The aim of this study was to evaluate the antibody response to pneumococcal capsular polysaccharide vaccine in CKD patients. Methods: Sixty-six patients with CKD and 40 healthy individuals were vaccinated with pneumococcal polysaccharide vaccine. The serum antibody response (IgG and IgG2) to the Pneumovax antigens was determined by enzyme-linked immunosorbent assay (ELISA) prior to and four weeks after vaccination. Results: Out of 66 vaccinated patients with CKD, 14 were found to be hyporesponsive to the vaccine (Group 1). Patients with normal specific antibody response were regarded as respondents and were assigned to Group 2 (n=52). The mean post-vaccination IgG titer to the pneumococcal antigens in Group 1 was significantly lower than those in Group 2 (P=0.012 for IgG and P=0.02 for IgG2). The increased anti-pneumococcal IgG titer was significantly lower in patients in Group 1 versus Group 2 (P=0.001) or the healthy control group (P=0.005). During the follow-up period of patients, patients in Group 1 developed higher episodes of pneumococcal infections than those in Group 2 (P=0.007). Conclusion: A substantial proportion of patients with chronic kidney disease fail to mount an adequate antibody response to pneumococcal antigens and remain at significant risk for such infections. These patients should be offered other prophylactic measures to protect them against invasive pneumococcal diseases.

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800x600 Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Recurrent miscarriage is defined as the loss of three or more pregnancies. Recurrent Pregnancy Loss (RPL) is traditionally investigated after three or more consecutive losses. Although some believe that the investigation must be launched after two miscarriages, there is not enough compelling evidence to draw conclusion.
Methods : In this cross-sectional study, we studied 58 women with two or more consecutive abortions (37 women with two and 21 women with three or more miscarriages) from 2005 to 2009. The following risk factors were analyzed and compared between the two groups: endocrine dysfunctions, genetic abnormalities, uterine anomalies, infections, thrombophilia, polycystic ovary syndrome, autoimmune disorders, sperm characteristics, and advanced maternal age.
Results : We did not find any known factor for pregnancy losses in 18 (31.03%) patients but in the rest, the most common cause of Recurrent pregnancy loss was endocrine disorders (41.4%). The other causes were uterine abnormalities (12.1%), infections (12.1%), maternal age more than 35 years (12.1%), thrombophilia (8.6%), abnormal semen analysis (8.6%), genetic defects (6.9%) and autoimmune disorders (1.7%). There were no significant differences between the two groups in regards with the causes of abortion except uterine abnormality (P=0.039) which was more frequent in women with three or more three miscarriages (23.8%) relative to women with two abortions (5.4%).
Conclusion: There were no significant differences between women with two or women with three or more three abortions in regards with the causes of abortion except uterine anomalies. Therefore, it seems quite reasonable and perhaps beneficial to start the investigation in patients with two abortions.

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Background: In recent years, consumption of whole-blood for the treatment of patients has decreased but use of biological plasma-derived medicines such as albumin, immunoglobulin and coagulation factors have increased instead. Paying attention to albumin molecular structure is important for its isolation from human plasma. Albumin is a single-chain protein consisting of about 585 amino acids and a molecular weight of 66500 Daltons. Albumin is a stable molecule and it is spherical in shape. There are different methods for human albumin preparation. Considering the large consumption of this biological drug in clinical settings, methods with fewer steps in production line are of big advantage in saving time and manufacturing more products.

Methods: In this project, we prepared human albumin using hollow fiber cartridges in order to omit the rework on fraction V+VI. Human albumin is usually produced by the application of cold ethanol method, where albumin is obtained from fraction V by doing a rework on fraction V+VI to separate fraction V.

Results: In the current work, human albumin was prepared from fraction V+VI by the help of hollow fiber cartridges. With a concentration of 20%, the obtained albumin had 96.5% of monomer and 3.5% of polymer and polymer aggregate.

Conclusion: Comparing the obtained human albumin with a number of commercial human albumin samples by the use of SDS-page, the results were satisfactory regarding the 3.5 percent polymer and aggregate rate for the prepared albumin.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: The current treatment of IBS is often unsatisfactory and frustrating. Several controlled trials have demonstrated benefits of tricyclic antidepressants for irritable bowel syndrome, especially when pain is a prominent symptom but the efficacy of antidepressants in irritable bowel syndrome is controversial. The aim of this study was to compare the effect of doxepin and nortriptyline on diarrhea-predominant irritable bowel syndrome.
Methods: Seventy-five patients with IBS according to Rome III criteria were treated for two months. The patients were randomly assigned to one of three groups treated with doxepin, nortriptyline or placebo. Subjects were assessed clinically one month and two months after treatment. The symptoms and adverse effects of the drugs were recorded in the questionnaire. The total score was considered as the number of the symptoms for each patient, which ranged between zero and six.
Results: Improvements in abdominal pain and bloating in the doxepin group were significantly higher than the nortriptyline or the placebo groups (P=0.001 and P=0.012, respectively). However, improvement in diarrhea in patients on nortriptyline was significantly higher than the other groups (P=0.018). The average improvement of symptoms in the patients after two months of treatment in doxepin, nortriptyline and placebo groups, respectively were 2.56, 2 and 0.6 (P<0.05).
Conclusion: Both doxepin and nortriptyline are effective for the treatment of diarrhea-predominant irritable bowel syndrome in a period of two months but doxepin seems to be more efficacious than nortriptyline in this regard. However, larger comparative trials are suggested.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Abnormal iron homeostasis such as iron deficiency or iron excess is associated with the pathogenesis of many chronic diseases including diabetes and cardiovascular disease (CVD). Iron may stimulate the progression of atherosclerosis by increasing the oxidative stress. Changes in carotid intima-media thickness (CIMT) have been validated as a vascular indicator of atherosclerosis progression. The purpose of this study was to apply CIMT to investigate the association between iron status and the initial stages of atherosclerosis.
Methods: 140 healthy premenopausal women aged 18 to 50 years who had no chronic or acute disease were selected randomly from one of the Tabriz university sub specialized clinics. Blood samples were taken to assay iron status parameters. CIMT was measured noninvasively by ultrasonography. Based on CIMT results, the subjects were classified as "healthy" (CIMT ≤0.8 mm) or "at risk" (CIMT >0.8 mm). Student's t-test was used to determine the mean differences between the two groups.
Results: The mean±SD age of the participants was 32.76±8.1 years. The mean iron, ferritin, hematocrit and mean corpuscular volume (MCV) were significantly higher and the total iron binding capacity (TIBC) was lower (P<0.05) among the "at risk" group. However, there was no significant differences in red blood cell count or hemoglobin levels between the two groups (P>0.05).
Conclusion: Results of this study showed a relative correlation between iron status parameters and CIMT as the initial indicator of CVD. Regarding the contradictions found in the literature, more research is needed to clarify the situation.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Nocardiosis is a rare and potentially life-threatening infection caused by several species of the Nocardia genus. The objective of this study was to develop and evaluate a rapid and new method to clinically identify relevant Nocardia species. Rapid and accurate diagnosis of Nocardia species is essential for the treatment of severe infections and prevention of cerebral abscess.
Methods:  One hundred and eighty patients, 103 (57.22%) male and 77 (42.78%) female, with severe symptomatic pulmonary infection were studied in the course of a 12-month period in Dr. Shariati Teaching Hospital affiliated to Tehran University of Medical Sciences in 2010. The specimens were cultured and identified using microbiological and biochemical tests. Polymerase chain reaction (PCR) was used to directly identify the organism in the broncoalveolar lavage samples collected from the patients. NG1 and NG2 primers were used to amplify a Nocardia genus-specific 598-bp fragment of 16S rRNA.
Results:  Nineteen samples (10.56%) were positive with PCR and 5 samples (2.78%) with conventional methods. All samples with positive cultures were also positive by PCR.
Conclusion: The results of this study showed that PCR has a high sensitivity and accuracy for the detection of Nocardia compared with culture and biochemical tests. Considering the rapidity, precision, high sensitivity and specificity of molecular techniques, use of these techniques is suggested in conjunction with conventional methods for the detection of Nocardia phenotypes in clinical laboratories and research centers.