Tehran University Medical Journal

---

This is a report of a case study on 234 patients with impetigo who referred to Razi Dermatology Hospital from April to November, 1989. Treatment was started immediately after obtaining direct smear and performing culture and antibiotic sensitivity test. The most common organism responsible for impetigo was the coagulase-positive staphylococcus (71%). In 13.7% of the cases, the coagulase-negative staphylococcus was grown on culture media, but none of the cultures showed streptococcus as the main organism. Treatment was started with oral penicillin V, oral erythromycin, benzathine penicillin G injection, oral cephalexin, and topical fuccidin. Clinical and bacteriological evaluation after 3-7 days showed that it is preferable to use oral cephalexin instead of other protocols such as oral erythromycin, which has previously been the drug of choice for impetigo. In addition, topical fuccidin with a 75% curative rate was the first drug for treatment, with the same effect as the oral cephalexin

---

The skin hyperreactivity, detected by the pathergy test, is a well known phenomenon in Behcet's disease. Two different methods were used for the pathergy test. a) A needle prick, b) An intadermal injection of normal saline. In this study 83% of Behcet's patients had a positive pathergy test. Where as 44% was of pustule type and 39% of papule type. In 26% of patients the papule formation was observed with both methods. In the control groupe 16% of subjects had a positive pathergy test. All were of papule type . Only 3% of them demonstrated a positive reaction with both methods. The sensitivity of the pathergy test, in this study, was 83% with a specificity of 84%. From these results we may conclude that a positive pathergy test of pustule type, with one of the major manifestations of Behcet's disease, (as proposed in disease). The papule type reaction, by both methods, may have the same diagnostic value as pustule type

---

Psoriasis is a chronic, inflammatory and proliferative skin disease that has a wide distribution throughout the world. The immune system plays a critical role in developing this disease. In this survey, we have studied 50 patients suffering from Psoriasis and 50 control subjects for various immunological factors, simultaneously. Anti-stratum corneum (SC) antibody was evaluated by immunofluorescent technique that showed a high significant level of it in patients (P<0.005). The titer of immunoglobulins (IgG, M, and A) measured by radial-immunodiffusion (RID) method was also higher in normal population. CIC estimated by PEG precipitating technique demonstrated high concentration in patients. TNF, a cytokine with strong performance to induce inflammation, had no significant rising amount in patient sera, but in synovial fluid in Psoriasis arthritis may have higher levels. We discuss that due to immunological findings we consider that Psoriasis is probably as an autoimmune disorder. The prevention, treatment and prognosis of the disease may follow the same procedures as other autoimmune diseases and further investigation will be helpful to achieve the above goal

---

Food allergy is affecting 6-8 percent of infants. Wheat is major source of carbohydrate and protein in the people's nutrition in all worlds and also account for one of six main food allergens in children. The goal of this study is diagnosis of wheat allergic patients and description of its importance for better recognition of this disease.
Materials and Methods: Among children with different symptoms of allergy (dermatologic - Gastro intestinal and respiratory symptoms) referred to Immunology and allergy Department of Markaz Tebbi Kodakan, during one year, 35 cases was suspected to have wheat allergy. Skin prick test and IgE specific with wheat for all of them and open food challenge test with wheat for 11 patients without history of anaphylaxy) were done. The criteria for diagnosis was based on a convincing history of anaphylaxis after ingestion of wheat or the positive result in food challenge with wheat in addition to positive skin prick test ( SPT) or specific IgE ( Eliza) with wheat.
Results: In 35 suspected cases to wheat allergy, SPT in 85/1 percent, specific IgE in 90/3 percent were positive. Food challenge test were done in 11 cases and was positive in 27/2 percent of patients. 24 patients were definitely diagnosed as wheat allergic ones. Anaphylaxis was the predominant clinical feature, accounted for 87 percent of acute symptoms which were repeated for two or more episode in 91 percent of the cases with anaphylaxis. In 50 percent of patients chronic symptoms like asthma and atopic dermatitis were also observed.
Conclusion: The mean age of symptom was compatible with time of onset of complementary foods. Therefore, were proposed exclusive breastfeeding without maternal avoidance and not to be introducing wheat in infant regimen until 12 mouth of age. Anaphylaxis was occurred, repeatedly in these patients which demonstrate, in one part, severity of the reactions in our patients and in other part the probable existence of more cases with milder reactions in whom never been referred to us .

---

Background: Food allergy is one of the most important among other allergic diseases. Although it is less prevalent in adult but in infants it’s prevalence was reported as much as 8 percent. In part, wheat is one of the six main food allergens in infant and in other part there is extensive cross reactivity between the cereals. Therefore the aim of this study is selection of the best food substitute for wheat among other cereals. Materials and Methods: 24 patients with definitive diagnosis of type one hypersensitivity reaction to wheat were entered in this study. Skin prick test and serum specific IgE (Eliza) with 6 members of cereals family (wheat, barley, oat, Rye-Rice & Corn) were performed for them and open food challenge test was also done with three more available of the cereals (corn, Rice, barley) in our food culture and so comparison between allergenicity of wheat flour and wheat bran with skin prick test were done.

Results: The Skin prick tests (SPTs) were positive in 66.7 percent for Barley, 100 percent for wheat bran and 80-100 percent for other cereals. The results of specific IgE for wheat, Barley were positive in 94.5 percent, 68 percent, 39 percent of patients respectively and the results for other cereals were positive in less than 11 percent of cases. The results of food challenge test, for barley were positive in 60 percent of cases and for Rice and Corn were negative in all cases.

Conclusion: In the base of food challenge test as the gold standard test, the best food substitute for wheat sensitive patient between other cereals, were Corn and Rice respectively. It is important to emphasis that will be needed to perform oral food challenge in hospital with complete emergency equipment before introducing any other cereals as food substitute for wheat, specially Barley.

---

Background: Cow's milk protein allergy (CMPA) is the most common food allergy during the first year of life. Strict avoidance of specific foods is the only accepted treatment for food-induced allergic reactions. This is often an unrealistic therapeutic option, since cow's milk is a basic food that is extensively used in infant formula. The recent preliminary experience of oral desensitization to cow's milk by Meglio & Patriarca seems promising. The object of this study was to investigate the desensitization of children with CMPA to cow's milk.

Methods: All the patients referred to the Allergology Department of the Children's Medical Center Hospital, Tehran from March 2004 to November 2005 suspected to have CMPA were evaluated. The patients were included in the intervention or control groups of the study. For the intervention group, Meglio's protocol was performed. We observed and examined the control group for at least 6 months. Eventually both groups were reevaluated for the symptoms and persistence of positive specific IgE for cow milk proteins.

Results: We enrolled 20 patients for oral desensitization and 13 patients were enrolled in the control group. Both groups were similar with regard to the mean age, sex and clinical symptoms. In 18 (90%) of the intervention subjects, oral desensitization with cow's milk was successfully performed. The entire protocol was completed by 14 (70%) of the intervention subjects. At the end of the six-month observation period, all the patients in the control group were still symptomatic after ingestion of cow's milk. The levels of specific IgE for cow's milk in the intervention group decreased significantly, which was not observed in the control group.

Conclusion: We successfully desensitized 90% of our CMPA patients. Considering that all the patients in the control group remained symptomatic after the period of observation and our promising results in oral desensitization with cow's milk, we can safely propose this protocol as a hopeful alternative in the treatment of CMPA. We speculate that oral desensitization to cow's milk does not alter the natural outcome of CMPA, but substantially increases the threshold dose necessary to elicit allergic symptoms.

---

Background: Plasminogen has a central role in fibrinolyrtic system can activate through various activators (PAs) to its active form plasmin and perfoem its vital function that is fibrin clot lysis. Furthermore the fibrinolyrtic system plays a major role in angiogenesis. The fibrinolyrtic system activation control cell migration and invasion. In addition to this, plasmin regulates tumor growth. Monoclonal antibodies, as biological tools, play an important role in basic researches.

Methods: In the first step the effects of antibodies on the activation of fibrinolyrtic system with PAs were evaluated with several methods including macroscopic observation, quantitative measurement of DD/E fragments by D-dimer assay and activation of plasminogen by S-2251 synthetic substrate (ELISA method), subsequently we studied the effect of antibodies on angiogenesis process in an in- vitro model.

Results: Results showed that MC2B8 that is an inhibitor of plasminogen activation in presence of plasminogen activators can inhibit angiogenesis process: A1D12 that is against N-terminal domain of Glu-plasminogen, in addition to activation of fibrinolyrtic system in presence of plasminogen activators, can activate in vitro angiogenesis process.

Conclusion: Plasmin formation is a critical step in invasion and migration of endothelial cells to form new vessels. Plasmin directly participates in angiogenesis by direct fibrin and other matrix components degradation, and indirectly by activating matrix degrading metalloproteinase and angiogenic growth factors. According to the in- vitro results, MC2B8 and A1D12 monoclonal antibodies play roles in this process in a dose dependent manner.

---

Background: Proteolytic enzymes, especially collagenases, are used for digestion of extracellular matrix, cell isolation and primary culture. Because of the problems in purification and low amount of collagenases in bacterial or animal sources, it is important to find new sources of the enzymes. So, in the present study actinidin, a plentiful protein in kiwifruit was purified and a mixture of actinidin and trypsin was applied to isolate rat aortic endothelial cells. Methods: Aortic endothelial cells were isolated using digestion solution containing different concentrations of actinidin (from 2 to 16 mg/ml) and trypsin (0.3, 0.6, 1.2 and 2.4 mg/ml) in different times (from 15 to 90 minute). Isolated cells were cultured in DMEM culture medium. Isolated cells were identified by morphological characteristics and immunocytochemical staining viability of separated cells was estimated by trypan blue exclusion test. Results: Actinidin in concentration of 10 mg/ml with trypsin in concentration of 1.2 mg/ml for one hour could isolate rat aortic endothelial cells. In this condition the viability of cells was estimated 90%. Morphological and immunocytochemical charac- teristics confirmed the isolated cells as endothelial cells. Conclusion: The results showed that the mentioned mixture of actinidin and trypsin has not considerable toxic effects on separated cells and is a novel and suitable option for isolation of rat aortic endothelial cells

---

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Skin-derived precursors (SKPs) are a type of progenitor cells extracted from mammalian dermal tissue and can be differentiate to neural and mesodermal lineage in vitro. These cells can introduce an accessible autologos source of neural precursor cells for treatment of different neurodegenerative diseases. This research was done in order to set up isolation, culture, proliferation and differentiation of human skin derived precursors (hSKPs).
Methods: Human foreskin samples were cut into smaller pieces and cultured in proliferation medium after enzymatic digestion. To induce neural differentiation, cells were cultured in neural differentiation medium after fifth passage. We used immunocytochemistry and RT-PCR for characterization of the cells. Neuron and glial cell differentiation potential was assessed by immunofloresence using specific antibodies. The experiments were carried out in triplicate.
Results: After differentiation, βΙΙΙ- tubulin and neurofilament-M positive cells were observed that are specific markers for neurons. Moreover, glial fibrillary acid protein (GFAP) and S100 positive cells were identified that are markers specifically express in glial cells. Detected neurons and glials were also confirmed by their morphologic characterizations.
Conclusion: Our results demonstrated that skin-derived precursors obtained from human foreskin can exhibit neuronal and glial differentiation potential in vitro, depending on the protocols of induction.

---

Background: Primary culture takes place following the cell isolation from tissues. Isolation and culture of melanocytes based on their roll in the protection of body against hazardous sun rays, production of skin, cornea and hair color is really important. This study was done to set isolation, culture and proliferation of melanocytes from children foreskin and adult eyelashes, and also comparison of two types of melanocyte culture medium.
Methods: Human foreskin and eyelash samples were used for melanocyte isolation and culture. After isolation of epidermis from dermis, epidermis cell suspensions were prepared by enzymatic digestion. The isolated cells were cultured in two melanocyte selective culture media. Immunocytochemistary and reverse transcription-polymerase chain reaction (RT-PCR) assays were used for confirmation of isolated and cultured melanocytes.
Results: Our results indicated that isolated melanocyte cultured in the selective medium without phorbol esters is better than the melanocytes cultured in selective medium cont-aining phorbol esters not only morphologically but also physiologically and from the aspect of cell adhesion. In addition, the results showed that isolated melanocyte from adult eyelashes are more dendritic than melanocytes isolated from children foreskin. Conversely, our results indicated that the number of cell passages in melanocyte isolat-ed from foreskin is more than melanocytes isolated from adult eyelashes.
Conclusion: Melanocytes cultured in selective medium containing convenient growth factors in absence of phorbol esters show more native physiological and adhesive properties. In addition, melanocyte isolated from younger tissues such as foreskin have better proliferative and sub-culturing properties so we suggest isolation and culture of younger tissues.

---

Background: Patients with hematologic malignancies are at risk of advanced tuberculosis. The prevalence of tuberculosis between these patients is 2.1- 2.6 percent. The cellular immune deficiency caused by hematologic malignancies and or its treatment increases the risk of tuberculosis in these patients. Multiple Myeloma is malignant proliferations of plasma cells that involves different classes of immune system. Cellular and humeral immune deficiency due to the Multiple Myeloma and drugs for its treatment results in susceptibility to unusual infections. Infections are of the important factors of morbidity and mortality in patients suffering from multiple myeloma ,but coincidence of Multiple Myeloma and tuberculosis  is rare and very little has been reported
Case presentation: In this paper a 60-year-old woman from Kermanshah, Iran who is suffering from back pain, weight loss, weakness and sweating will be introduced. Spondylitis was seen in her lumbar imaging. Her husband suffered from pulmonary tuberculosis. In diagnostic studies tuberculose spondylitis and multiple myeloma were diagnosed simultaneously.
Conclusion: Although the accompanying of Multiple Myeloma and tuberculosis is not common, but immunodeficiency caused by a hematologic malignancy as well as a history of close contact with a patient with tuberculosis resulted in tuberculosis of spine in this patient. Clinical features of abovementioned diseases are very similar. But in endemic area for tuberculosis, this disease should be considered because delay in diagnosis leads to increment in mortality and morbidities. Diagnosis of tuberculos spondylitis is based on radiologic and histologic features of the disease and on the response to treatment because the sensitivity of definitive diagnostic tests such as culture and PCR is low in extra pulmonary tuberculosis. 

---

Background: Radiotherapy can cause DNA damage in normal cells, misrepaired or unrepaired double strand breaks in DNA lead to chromosomal breaks. As a result patient experience early and late effects in normal tissue during and after radiotherapy. Cytogenetic techniques can be used as a cancer predictive assay because there is an association between chromosome abnormalities and the risk of developing cancer. Also it can assess patient's complications during the therapy. The aim of the present study was evaluation of the cytogenetic alteration in peripheral blood lymphocytes of esophageal cancer patients treated with radiotherapy. Methods: The present study is an experimental and prospective research. It was done at radiotherapy department at Omid Center in Urmia from January to December 2012. Blood samples were obtained from 15 esophageal cancer patients, before (0 Gy), during (21.6 Gy), and after radiotherapy treatment (43.2 Gy). Blood samples were cultured in RPMI-1640 complete medium containing 1% phytohaemagglutinin and incubated in a CO2 incubator. Cytochalasin-B was added to the cultures at a final concentration of 5 µg/ml. Finally, harvesting, slide making, and analysis were performed according to standard procedures. Results: This study consisted of 15 patients, including 7 men and 8 women from 55 to 84 years old (70.07±11.548). Results indicate that, in the middle of treatment the average frequency of micronuclei increased significantly compared with their concurrent pre-treatment samples (greater than four-fold). Also, an increase in chromosome damage (MN frequency) proportional increasing radiation doses at the end of treatment was observed (P=0.001). Conclusion: Increasing in the MN frequency in the second and third stages is due to radiation effects. Thus, the use of the MN technique for assessing of the side effects in patients during the therapy is very helpful. Moreover, MN assay can be used as a predictive assay for detecting individuals (patient or healthy) with intrinsic radiosensitivity.

---

Background: Spices (flavorings) are contaminated to microbial agents such as filamentous and yeast fungi during production processing. Almost these are grown and harvested in warm and humid areas of the world where the growth of a wide variety of organisms is readily supported. The aim of this study was to assess the fungal contaminations of three current spices including turmeric, black pepper and cinnamon from some supermarkets in Tehran and evaluating of their hygienic quality. Methods: In this cross- sectional study that was performed in laboratory of Medical Mycology, School of Public Health in Tehran University of Medical Sciences from December 2012 to September 2014, 165 packed spices including 55 samples from each 11 valid brands of cinnamon, turmeric and black pepper were selected from different regions of Tehran. Culture was performed on many different fungal media from 10-1 to 10-4 dilutions of their samples. The fungal colonies obtained from cultures were studied by traditional laboratory methods. On the other hand, the number of unknown possible colonies was identified by molecular methods and then all identified colonies were counted. Results: Totally, from 165 packed spices, 4317 colonies include 29 different fungal species were isolated and identified from cinnamon (1520), turmeric (1373) and black pepper (1424). The etiologic agents were mainly including Aspergillus niger (7.3%), Penicillium spp. (4.1%), Paecilomyces spp. (2.8%) and Aspergillus flavus (2.3%), respectively. Non-parametric Kruskal-wallis test indicated that there was no significant difference statistically among brands at each level. Also the present study showed P = 0.0003 among under study spices. The most contaminated spices were cinnamon, while turmeric had the lowest contamination rate. Conclusion: The obtained results of this cross-sectional study and the available proofs in community indicate that, there are the high levels of fungal contaminations in current used spices. Therefore, it is necessary to control the production units.

---

Background: Peripheral nerve injury is one of the most challenging of modern surgical problem. Recent advances in understanding the physiological and molecular pathways demonstrated the important role of growth factors in peripheral nerve regeneration. Platelet-rich plasma (PRP) is a biological product that has many growth factors. The aim of this study was to investigate the effect of PRP in the regeneration of sciatic nerve crush in the rat model.

Methods: In this experimental study that established in the animal lab of the Hazrat Fatemeh Hospital in Tehran from September to October 2013, Twenty-four healthy male Sprague-Dawley rats (200-250 g) were randomly divided into two groups. In all rats the sciatic nerve was cut and then carefully repaired by the tension free method under a light microscope. In group 1, after the repair, 0.05 µL of PRP was injected below the epineurium to the proximal and distal parts of the repaired area. In group 2 the same amount of normal saline was injected to the proximal and distal of the repaired area. After six weeks footprint analysis, neurophysiologic and histopathology evaluations were performed.

Results: Significant differences existed between the two groups footprint analysis (P= 0.001). Also the nerve conduction latency test was significantly shorter in PRP group. (1.0233 ms in PRP group and 1.7375 ms in control) (P< 0.001). The average amplitude in the first group and the second group was 7.6250 mv (control) 6.3667 mv that does not show a statistically significant difference (P= 0.093). Significant differences between the two groups in the number of axons of the proximal portion of the study was not seen (P= 0.29). The parameters included number of axons of the proximal and the distal part of axons, the diameter of the distal and proximal axons in the two groups were compared. In the two groups there was statistically significant difference between the above parameters. (P= 0.298).

Conclusion: It seems that PRP may have an important role in peripheral nerve regeneration and functional recovery after nerve laceration and repair. Further clinical evaluation recommended.

---

Angiogenesis, as the process of new vessel formation from pre-existing vessels is dependent on a delicate equilibrium between endogenous angiogenic and antiangiogenic factors. However, under pathological conditions, this tight regulation becomes lost which can result in the formation of the different diseases such as cancer. Angiogenesis is a complex process that includes many gene products that are produced by different cells. Each of the processes influenced by specific genes that their expression can be regulated by hypoxi inducible factor-1 (HIF-1). Hypoxia, the imbalance between the oxygen in need and the oxygen available, usually occurs in tumors and ischemic cardiovascular diseases. In order to overcome this challenge, tumors regulate and control the expression of genes related to angiogenesis, cell cycle and metabolism using hypoxia-inducible factor 1 (HIF-1). HIF-1 was first recognized as a transcription factor involved in hypoxia-induced erythropoietin expression. As angiogenesis pathway molecules are being described, this factor has been characterized as a key transcription regulator for these molecules. In this review article, after discussing HIF-1 structure and characterization, the role of this important factor in angiogenesis and cancer as a pathological case and finally, the clinical applications has been evaluated. Articles related to the key words of hypoxia, HIF-1 and angiogenesis were searched from valid databases such as Springer Link, google scholar, Pubmed and Sciencedirect. Then, the articles related to the role of hypoxia and HIF-1 in activation of genes that are involved in angiogenesis and cancer were searched and selected for this study. Studies show that, HIF-1 activation of genes including vascular endothelial growth factor (VEGF), angiopoietin-1 (Ang-1) and angiopoietin-2 (Ang-2), etc., induced angiogenesis in the tumor cells. Furthermore, the activation of genes such as insulin-like growth factor 2 (IGF2), transforming growth factor &alpha; (TGF-&alpha;) and MAPK and PI3K signaling pathway will also enable the survival and proliferation of tumor cells. HIF-1 by activating genes involved in angiogenesis and also activates signaling pathways associated with cell survival and proliferation plays an important role in the stability and growth of tumors. Therefore, better understanding of molecular mechanisms associated with this factor can be effective in the treatment of cancer.

---

Results: In these study 198 samples collected from patients with symptoms of vulvovaginal candidiasis, 77 vulvovaginal candidiasis cases were identified. Candida species are common in primary and recurrent cases in terms of frequency, Candida albicans (85.7%), Candida krusei (10.2%) and Candida glabrata (4.1%) were identified respectively. Total of 27 cases of recurrent vulvovaginal candidiasis, 10 cases were resistant to both clotrimazole and fluconazole (37%) was observed that the most common species are resistant to treatment were Candida albicans by (82.1%), Candida krusei (14.3%) and Candida glabrata (3.6%) respectively. Drug resistance in Candida albicans, Candida krusei and Candida glabrata causing recurrent vulvovaginal candidiasis included 69.1%, 75% and 100% respectively. Conclusion: Our findings have shown frequency of resistant non-albicans Candida species to fluconazole and clotrimazole is increasing. There is a considerable difference between Candida albicans and non-albicans species, Candida glabrata for the resistance to fluconazole and clotrimazole.

---

Results: Totally, 75 nurses were recruited from ICU-1 (N=29), ICU-2 (N=18), ICU-3 (N=19), and nephrology (N=9) departments. Type of department and occupation were the influential factors on nursing errors; also, a significant relationship was found between different work shifts and the occurrence of nurses’ errors, mostly seen in the evening work shift (P=0.037). The mean of nurses’ errors in IV drug administration was not correlated with other factors including age, work history, and the number of patients managed by each one. Also, a positive correlation was found between the number of nurses in each work shift and the number of errors (P=0.008). Conclusion: Medication errors in each stage of drug administration may lead to the hazardous clinical outcome or serious side effects such as thrombosis, infection or eventually lead to morbidity or mortality. Therefore, being aware of these errors and establishing observational policies can prevent unpleasant events related to drug administration.

---

Results: The results of this study showed no significant difference between NLR and PLR levels in both groups of patients without ocular complications and with ocular complications. But the results showed that DAS-28 was significantly lower in the group with ocular complications (P<0.0001). Conclusion: In general, the results of the present study showed that the evaluation of inflammatory factors such as platelet to lymphocyte ratio and neutrophil to lymphocyte alone could not be judged in predicting the presence or possibility of ocular involvement, and the level of these factors in patients with ocular complications was affected. Other factors, such as the number of blood cells and the condition of each patient, are included.

---

Background: Wolff-Parkinson-White syndrome is a rare but well-known disease that predisposes a person to cardiac arrhythmias. But sometimes this syndrome is accompanied by heart failure in the affected person. Several causes have been proposed for this complication including recurrent or incessant tachyarrhythmias that are frequently found in symptomatic (especially children) Wolf-Parkinson-White syndrome patients causing heart dysfunction and dilation and dilated cardiomyopathy, and also pre-excitation-related dyssynchrony leading to progressive ventricular remodeling and dilation. In this report, a patient is introduced who has improved his heart failure by radio-frequency ablation of free wall type of this syndrome.