Tehran University Medical Journal

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In view of the rapid expansion of contact lens amongst the users, new dimensions have been added to the domain of ophthalmology: Giant papillay conjunctivitis, a disease caused by different kinds of contact lens, appears weeks or months after they are used, although some patients are struck years later. The predominant symptoms are increased awareness of lenses, ocular itching, blurred vision and excessive lens movement. The predominant signs are the formation of papillae, the presence of excessive mucus, and contact lens coatings. The syndrome occurs mostly with the soft lens and is more intense. Other independent studies show that the rate of prevalence of the disease with soft lenses and hard lenses is 10% and 5% respectively. The study comprised 550 soft lenses and 150 hard lenses. The diagnosis of the disease was based on the symptoms and signs of the disease. Eleven percent of the patients using soft lens and 4% of the patients using hard lens had the disease at some stage. Almost all of the patients were using dirty and low grade lenses. The therapy protocol of the disease consisted of changing the polymer type of the lens and administering cromolyn 4% drop. In cases that the therapy was unsuccessful, a temporary suspension of the lens and administration of cromolyn 4% was recommended before using the new lens.

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In 100 healthy, adult and female mice weighing about 20 to 25 g each, paris of full thickness and nearly symmetrical cutaneous wounds, 100±15 mm² each were created in dorsolumbar region. Mice were divided into 3 groups randomly, group 1 (Right wound exposure), group 2 (Left wound exposure) and group 3 (Control). Wounds were exposed to laser He-Ne (632.8 were length and 16 mw constant power) for 10 days, 250 seconds each day. The control group mice were in equal situation except for the exposure wound were measured in size once every 2 days. Also biopsies were made from a clear number of cases once every 3 days from microscopic evaluation of wound healing stages. The difference in wound healing between the test groups and controls was significant as confirmed by statistical methods (E.g. one way ANOVA and SCHEFFE) with (?=0.05) and proved by microscopic findings. This experiment were made in "Blind" form. There was no significant difference in wound healing between 2 sides in test groups, this strengthens the idea that laser therapy causes the release of systemic wound healing factors

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Botulinum toxin produced by Clostridium butolinum in one of the most fatal toxins known. Botulism is the name given to condition produced by this toxin. In recent years the diluted form of this toxin has been produced in injection form and used for treatment of hemifacial spasm and blepharospasm. This toxin blocks neuromuscular junction and inhibits acetylcholine release. In this article we reported 36 patients suffering from hemifacial & blepharospasm treated by injections of botulinum A toxin. 85 to 90 percent of patients responded well. The common complications of this drug were ptosis, hemifacial paresis, burning of the mouth and discoloration of the injection site. Generally speaking the patients preferred this toxin to taking oral medications which were less effective.

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L-fucose (6.deoxy. L.galactose) is the only monosacharide which is placed in non reducting position of glycoproteins structure in L-deoxy form. L-fucosidase and fucosy 1 transferase directly take part in the elevation or decrease of sorum L-fucose levels. Tumors may directly induce enzymes that release L-fucose from glycoproteins formed in the neoplastic tissue, or the glycoproteins may be released indirectly as a result of body-defense metabolic secretion of glycoproteins and their filtration in glomeruls, and has a close correlation with glomerular filtration rate (GFR). In this study we compared urinary L-fucose of 30 known cases of cancer versus 40 healthy people. Fifteen patients had Gastrointestinal (GI) cancer and 15 patients Gyneclologic (Gyn) cancer. There was significant difference between urinary L-fucose of patients with GI cancer and controls (P<0.01), and also we saw the same result (P<0.01) in Gyn patients in comparison with controls. Significant elevations of urinary L-fucose, in GI and GY cancers may lead us in the way to further evaluation of its relationship with L-fucose levels to make its early diagnosis and better prognosis in susceptible individuals and those at a high risk of developing cancer, possible.

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Twenty cases of isolated optic neuritis (15 female, 5 male) were studied and followed for several months to years after the initial attack. The mean age of patients was 23 years (range: 15-29 years). The most frequent clinical manifestations were decreased visual acuity and blurred vision. A complete neurological examination was performed. In 15 cases (75%) the initial brain MRI was abnormal. In fourteen cases, other signs of multiple sclerosis presented in one month to eight years following the initial attack of optic neuritis eleven of the latter cases had an abnormal initial MRI. Acute optic neuritis can be considered a presenting feature of multiple sclerosis, particulary in the presence of an abnormal brain MRI.

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The chief aim of this research is intended to study the planning and performance of the health and treatment units of the Social Security Organization about the illnesses that may occur in connection with occupations. We believe, however, that healthy skilled work force are the nmost important factors for the development and progress of a country. Therefore, illnesses and disabilities from chemical, physical, biological, psychological and ergonomic can be drasticly eliminated in order to ensure the safety standards of the work force. Five occupational medicine centers in Tehran, have undergone 35199 tests for pre-employment medical examinations. The results were fit, conditionally fit, and unfit that were introduced to employers, during August 1996 and July 1997. Periodical examinations, visits of workshops and factories, presentation of health care in 200 dispensaries has helped recognizing professional diseases. The results work of committee of medical assistant, showed 56 cases of disabilities due to occupation. Professional causes, 16.07% of the above disabilities are from mechanical and, 16.07% from transportation. Hands amputation 50%, injuries of waist 19.65%, feet 10.71% and head 7.14% had responsibility for invalidity due to occupations. Other results of this research like time distribution, causes of invalidity have been presented.

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Tumor angiogenesis shown by Microvessel Count (MVC) or Microvessel Density (MVD), is assessed by several studies as prognostic factor in some types of tumors, and also in colorectal carcinoma. This article is payed to correlation between clincopathologic factors and tumor angiogenesis. In this study, immunohistochemical techniques are used for vascular evaluation in specimens from twenty-nine colorectal carcinoma, and stained for Factor VIII-Related Antigen (F8RA) by using monoclonal antibody. Uni and multivariate analysis disclosed that total MVC was higher in tumor [76.3±33 (×100=2.5 mm²/field) and 29.8±11 (×200=0.785 mm²/field)] than in normal tissue [37.7±15.8 (×100) and 17.6±7.8 (×200)], (P=0.022, P=0.000009). Microvessel quantification was significantly higher in stage D (115±36.6, ×100 and 26.7±6.4, ×200, P=0.002 and P=0.04). In this study MVD has correlation with vascular invasion (P=0.024, ×100 and P=0.007, ×200), the mean tumor vessel count although was increased with clinicophatologic findings such as age<60 years, male, right colon involvement, infiltrating type, mucinous carcinoma, transmural penetration, grade III, lymphatic and perineural invasion, but was not statistically significant. Lymph node and hematogenous metastasis and size of tumor also, was not important. As a conclusion, MVD was increased in tumor and has shown correlation with metastasis, and vascular invasion. Resulting angiogenesis increase risk of metastasis.

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Background: Migraine is a chronic hereditary and relapsing headache. With regard to the prevalence of this ancient disease and its economic complications in country, in this study , nocturnal serum melatonin of migraine patients and control subjects have been evaluated and compared by ELISA kit.

Materials and Methods: Fifty migraine patients (mostly women) were compared to a control group (mostly men) matched according to age. Results: Statistical analysis revealed a decrease in nocturnal serum melatonin levels for migraine patients (32.9 28.4) compared to the control one (75.6 56.8). With using of t-test by ELISA kit showed significant difference (p=0.0064).

Conclusion: With regard to this, the pineal gland has the main role in the synchronization of the organism with the environmental conditions and migrainous headaches.

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Background: Stomatitis, the inflammation of the mucous lining of any of the oral structures, is a frequent side-effect of anticancer drugs due to excess uric acid production. Strict oral hygiene and the application of an appropriate mouthwash has been reported to relieve pain and improve patient quality of life. Allopurinol is a drug used to treat conditions caused by excess uric acid. The aim of this study to evaluate the effectiveness of prophylactic use of allopurinol mouthwash for stomatitis in patients undergoing chemotherapy.
Methods: In this quasi-experimental study, 42 patients were randomly assigned to either a study group or a control group. In the study group (28 patients), patients used 5 mg/ml allopurinol mouthwash in hydroxyl propyl methyl cellulose. The control group (14 patients) used water instead of the mouthwash. Treatment was administered for 16 days.
Results: Data collected during the daily follow-up of the patients' oral mucosa showed that allopurinol mouthwash decreased the severity, pain and duration of stomatitis.
Conclusion: Preventing stomatitis in patients receiving chemotherapy improves the health of the patient and compliance with treatment. Based on our findings, allopurinol mouthwash should be used for all chemotherapy patients for the prevention of stomatitis. This nursing intervention can also improve the patient's nutritional state and level of satisfaction.

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Background: In kidney transplantation decision about the proper kidney donation is different between surgeons, but simple vasculature anatomy and a kidney without abnormalities are the most important reasons of choosing a kidney. Therefore    complete assessment of renal vessels of a live donor with noninvasive techniques is a necessity for nephrectomy. For delineation of the kidney vasculature anomalies and urinary system abnormalities, Multi-Detector CT seems to be excellent method for evaluation.
Methods: In this study 59 live donors were assessed with Multi-Detector CT Angiography. After injection of contrast media, we acquired images with 0.6 mm slice thickness. Processing and three dimentional reconstructions were done and the accessory arteries, early branching of main renal artery, the number of main renal vessels and the ureters were assessed. Findings were compared with the nephrectomy results.
Results: In Multi-Detector CT Angiography the prevalence of accessory renal artery was 3/4% with 98% accuracy, early branching of main renal artery was 8/4% with 100% accuracy. Multiplicity of renal veins was seen in 8/4% of donors with 98% accuracy. Duplicated ureter was not seen in any of the donors.

Conclusions: The accuracy of CT Angiography is 95% for depicting accessory renal artery and multiple renal artery and 100% for early branching. These results were comparable with findings in conventional angiography. Studies showed this method  more valuable than M.R. Angiography and digital subtraction angiography. It is less invasive and can be named as the gold standard method in the diagnosis of anomalies of vessels & collecting system in live donors. 

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Background : Open fractures are associated with an increased risk of infection and healing complications. Management of open fractures is based on the following principles: assessment of the patient, classification of the injury, antibiotic therapy, debridement and wound management, Fracture stabilization, early bonegrafting, and supplemental procedures to achieve healing.
Methods : In a case- control retrospective study we evaluated 33 patients with open tibial fracture (type two gustillo) who were admitted in sina General hospital in Tehran, Iran during years 1999-2009 and were treated uniformly with external fixation as primary treatment in our center as case group and the other 33 patients with the same method and another 33 patients who had not been infected as control group. W e compared the folders of case and control groups retrospectively. 
Results : There was no statisticant difference between two groups in mean age, gender, the mechanism of trauma and body mass index (p >0.05 ), while statistically significant difference between them in smoking habitus, blood transfusion, first debridment time, diabet mellitus, femoral shaft fracture (p <0.05 ).
Conclusions: Accompanying femoral fracture is the sign of high energy trauma and it is logical that it is an important risk factor for infection. In our study the time of the first debridment stablished as a significant factor influencing the infection rate in tibial open fracture. In some studies smoking had been recognized as a significant factor influencing in tibial bone open fracture our study reveals the same.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Cystic fibrosis is a monogenic recessive disorder founds predominantly in caucasian population causes exocrine glands function defect. This disease arises from mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. Because of heterogeneity of the mutations in CFTR gene, phenotypic symptoms in this disease are very variable. In this study we consider poly T polymorphism (T₅, T₇, T₉) in the intron 8 of CFTR gene in normal individuals and cystic fibrosis patients in mazandaran province.
Methods: Forty cases of cystic fibrosis patients and 40 normal individuals were screened for poly T polymorphism in intron 8 of CFTR gene using Reverse Dot Blot method.
Results: T₇ allele is the most prevalent in normal individuals and CF patients and it's abundance is approximately 75%. T₉ and T₅ represent approximately 20% and 5% of normal or mutant alleles respectively. T₇/T₇ genotypes in normal individuals and CF patients are the most prevalent with 72.5% and 60% prevalence rate, respectively. T₅/T₉ and T₅/T₅ genotypes were not found. 22.5% of normal individuals and 30% of CF patients had heterozygote genotypes.
Conclusion: The abundance of T₅, T₇, T₉ alleles and the presence of 22.5-30% heterozygote genotypes in normal individuals and CF patients indicates that poly T polymorphism in intron 8 of CFTR gene can be used as a marker for detection of normal and mutant alleles in prenatal diagnosis or can be used in carrier assessment in families with previous history of the disease.

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Background: Exogenous natural and synthetic surfactants is a rescue treatment for respiratory distress syndrome (RDS). The goals of the study were to compare the clinical response and side-effects of two frequently used surfactants, poractant alfa (Curosurf) and beractant (Survanta), for the treatment of respiratory distress syndrome in preterm infants.

Methods: This clinical trial study was performed during a two-year period in the Neonatal Intensive Care Unit of Ghaem Hospital in Mashhad, Iran. Sample size calculated by a 95% confidence and power of 80, included 104 premature neonates, 74 in survanta and 30 in curosurf groups. The level of statistical significance was considered to be < 0.05.

Results: There were no statistically significant differences between the infants treated by survanta or cursurf groups regarding their mean gestational age (30.58 Vs. 29.00 weeks) and birth weight (1388 Vs. 1330 g), (p=0.3) There were also no significant differences between the two groups regarding incidences of broncho- pulmonary dysplasia (BPD) (40.5% Vs. 40%), intraventricular hemorrhage (IVH) grades III/IV (13.5% Vs. 13.3%), pneumothorax (both 20%), patent ductus arteriosus (PDA) (28/3% Vs. 20%) or death (28% Vs. 26.6%) on the 28th day postpartum.

Conclusion: This study showed that survanta and curosurf had similar therapeutic effects in the treatment of neonatal respiratory distress syndrome.

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Background: ATP-binding cassette transporter A1 (ABCA1) is a key mediator of cholesterol efflux to apoA-I in lipid-laden macrophages, the first step of reverse cholesterol transport (RCT) in vivo and a critical step in preventing atherosclerosis. Enhanced ABCA1 expression may inhibit foam cell formation and consequently reduce atherogenic risk. On the other hand, garlic, Allium sativum, and garlic extracts have been demonstrated to have potential cardiovascular benefits. Moreover, garlic has direct antiatherogenic and antiathersclerotic effects on artery walls. The aim of this study was to evaluate the effects of alcoholic garlic extract on the expression of ABCA1 in macrophages. Methods: Cell viability assay was used in order to detect the cytotoxic dose of alcoholic garlic extract on macrophages. Real-time PCR and Western blotting were performed to study the effects of alcoholic garlic extract on the expression of ABCA1. Macrophage cells were treated by different concentrations of alcoholic garlic extract for 48 h. The total RNA of the treated macrophages were extracted and analyzed by real-time PCR. ABCA1 protein expression was also analyzed using the Western blotting technique. Results: Alcoholic garlic extract increased the ABCA1 mRNA (20-23%) and protein expression (18-37%) in THP-1 macrophage cells compared with the controls (untreated cells). Conclusion: The results of this study are suggestive of the potential effects of alcoholic garlic extract in increasing ABCA1 expression in macrophages, the possibility of promoting reverse cholesterol efflux in macrophages and preventing atherosclerosis

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Too many studies are in the process of determining the probable role of immune system in the etiopathogenesis of nasal polyposis. This study was designed to identify the probable participation of Th1, Th2 lymphocytes in the induction and progression of nasal polyposis.
Methods:  Seventy-five patients, 42 male and 33 female, with nasal polyposis were examined for total serum IgE, specific serum IgE and reaction to skin test for differentiating allergic from non-allergic participants in Rasoul Akram Hospital during 2010. To determine the possible correlation of allergic reactions in the upper respiratory tract and nasal polyposis, cytokine gene expression was evaluated on the extracted RNA by RT-PCR. The data were analyzed by using c², independent t-test, correlation and Receiver operating characteristic (ROC) curve.
Results:  The mean age of participants was 38 years (18-81 years). IFN-γ and IL-4 gene expressions were more prevalent in allergic than non-allergic individuals (IFN-γ: 39.5% vs. 14.2%, P=0.3 and IL-4: 44.7% vs. 18.9%, P=0.02, respectively). IL-10 and IL-12 (P35 and P40 fractions) genes were not significantly different between the two groups. IL-10 and IL-12 (P35, P40) genes did not differ significantly either.
Conclusion: This research suggests that overproduction of cytokines and an imbalance of Th1 and Th2 cell production may play an important role in the pathophysiology of allergic or non-allergic nasal polyp formation. Thus, although nasal polyposis is a multifactorial disease with several different etiological factors, chronic persistent inflammation is undoubtedly a major factor irrespective of the etiology.

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Background: The characteristic of stem cells in self renewal and differentiation to different types of cells has stimulated the interests for using stem cells as a starting material for generating insulin secreting cells. We've evaluated the differentiation potential of Programmable cells of monocytic origin (PCMOs) into insulin producing cells effected from the growth factors and fibroblasts conditioned media (FCM).

Methods: Peripheral blood monocytes of rat were cultured for 6 days in RPMI with 15% FBS, β- mercaptoethanol, MCSF and interleukin-3. Then, these cells were incubated in differentiation media with HGF, EGF, Nicotinamide, 15% fibroblasts conditioned media and glucose for 15days. Morphological differences of cells were studied by invert microscope. In several stages, the amounts of insulin in supernatant of cells were measured by radioimmunoassay kit. Also productions of insulin from differentiated cells were studied with DTZ special staining.

Results: In response to MCSF and IL-3, monocytes dedifferentiated. These programmable cells of monocytic origin (PCMOs) were capable of differentiating into insulin producing cells in differentiation media. The morphology of differentiated cells was similar to Beta cells and the amount of insulin in supernatant of differentiated cells was much higher than PCMOs (P<0.05).

Conclusion: HGF, EGF, Nicotinamide and fibroblasts conditioned media are differentiation factors of PCMOs into insulin producing cells. According to the results insulin producing cells can be differentiated from programmable cells of monocytic origin in presence of fibroblasts conditioned media.

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Background: Cystic fibrosis (CF) is a multiorgan autosomal recessive disorder. As CF is highly heterogeneous in Iran and many mutations have a low frequency, routine molecular diagnostic methods are not very efficient. The use of highly polymorphic intragenic markers not only can facilitate phenotype prediction in prenatal diagnosis by gene tracking, but also can lead to the demonstration of possible associations between haplotypes and specific mutations. We determined IVS8 polyT and M470V polymorphisms in exon 10 of CFTR gene in this case-control study.

Methods: Polymorphisms of IVS8 polyT in 53 patients with CF were referred to Amirkola children's Hospital of Babol University of Medical Sciences, 2007 to 2011 and 49 fertile healthy individuals were determined by reverse dot blot method. M470V polymorphism was analyzed by PCR-RFLP.

Results: In IVS8 polyT study, T7 was the most frequent allele in healthy individuals than patients with CF (respectively, 82.8% Vs. 77.2%). T9 was more abundant in patients with CF than normal individuals (respectively, 21.7% Vs. 7.4%, P=0.005). T9/T9 genotype was more frequent in patients than healthy individuals (respectively, 15.1% and 2%, P=0.032). Study for M470V polymorphism showed that M/V was the most common genotype in normal individuals and patients with CF (respectively, 49% and 40.4%). M-T9 haplotype was highly associated with the disease in both patients with CF and normal individuals (respectively, 19.1% and 2.4%, (P<0.001)

Conclusion: The allelic distribution and heterozygosity results suggest that both M470V and IVS8 polyT can be helpful in the prenatal diagnosis of CF in Northern Iranians with a positive family history of the disease.

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Background: Ischemia/reperfusion induced acute renal failure causes excretory functional disorders of nephrons. Ischemia/reperfusion injury is accompanied by generation of reactive oxygen species that leads to dysfunction, injury, and death of renal cells. Antioxidants of plant origin minimize the harmful effects of reactive oxygen species. The aim of this study was to determine the possible therapeutic potentials of Rosa canina L. in preventing renal functional disturbances during the post-ischemic reperfusion period.

Methods: In this experimental study undertaken for evaluating renal excretory function in 30 male Wistar rats, renal ischemia was induced by occluding both renal arteries for 45 min, followed by 24 h of reperfusion. The rats received 2 ml of tap water or a hydroalcoholic extract of Rosa canina (500 mg/kg) orally for 7 days before induction of ischemia. In plasma samples, creatinine and urea nitrogen levels were measured, and in renal tissue samples, red blood cells were counted. The data were analyzed using ANOVA and Duncan tests.

Results: Renal ischemia for 45 minutes increased plasma levels of creatinine (P<0.001) and nitrogen urea (P<0.01) while reducing red blood cell counts in renal glomeruli (P<0.001). Rosa canina administration diminished the increase in creatinine (P<0.001) and nitrogen urea concentrations (P<0.01), and prevented reductions in red blood cell counts in renal glomeruli (P<0.001).

Conclusion: Rosa canina seems to be useful as a preventive agent against renal damages induced by ischemia/reperfusion injuries in rats.

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Background: Staphylococcus aureus secretes numerous superantigenes which trigger the inflammatory mechanisms of sinus mucosa and cause chronic rhino-sinusitis. This study was designed to evaluate the role of staphylococcus aureus superantigens in polyp tissues of patients with chronic rhino-sinusitis in comparison with a control group.
Methods: Polyp tissue samples of 28 patients and mucosal specimens of 19 healthy individuals were evaluated for staphylococcus aureus bacterium superantigens, exotoxins A, B, C and D and TSST-1 with RT-PCR and ELISA methods Rasoul Akram Hospital during 2 years.
Results: Polymerase chain reaction (PCR) results revealed that 88.2% of the patients and 45.5% of the controls had at least one type of superantigen (P=0.03). Evaluation of superantigens using ELISA method showed presence of at least one type of superantigen in the nasal samples of all patients and in 35.3% of the controls (P<0.001).
Conclusion: A relationship between staphylococcal superantigens and nasal polyps is concluded from this study which indicates the probable role of these superantigens in the pathogenesis of nasal polyposis.

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Background: Ventilator associated pneumonia (VAP) is one of the serious complications of ventilatory support, occurring in ICUs. The aim of this study was to determine various risk factors associated with the acquisition of Acinetobacter infection and its antimicrobial susceptibility pattern.
Methods: This cross-sectional study was performed in the ICUs of Rasoul-e-Akram Hospital in Tehran, Iran during the year 2011. A total of 51 endobronchial aspirates from intubated patients who had been clinically diagnosed to have VAP were studied bacteriologically. The in vitro susceptibility was determined by disk-diffusion and broth microdilution MIC methods.
Results: Out of 51 patients with VAP, 35 (66.66%) had positive cultures for Acineto-bacter species. In vitro susceptibility test revealed that a high percentage of isolates were resistant to imipenem, piperacillin-tazobactam, third generation cephalosporines, and aminoglycosides.
Conclusion: The antimicrobial resistance of gram negative bacteria, particularly Acine-tobacter species, is increasing and preventive measures need to be taken as a matter of urgency.