Tehran University Medical Journal

---

Background: As an important diagnostic and therapeutic procedure for patients with intrauterine diseases, hysteroscopy permits a good view of the uterine cavity, thereby increasing diagnostic accuracy. Complications often encountered during hysteroscopy primarily concern problems with cervical dilatation and include uterine perforation, cervical tears, and the creation of false tracts. In this study, we investigate the utility of vaginal misoprostol for cervical dilatation in women undergoing hysteroscopy.

Methods: This triple-blind, randomized, placebo-controlled study was carried out at Mirza Khoochak Khan Hospital, Tehran, Iran. We excluded women who were pregnant, had genital tract infection, or history of cervical trauma. We randomly assigned 80 women with abnormal uterine bleeding or intrauterine lesions to receive either 200 μg vaginal misoprostol or placebo. Ten to twelve hours prior to hysteroscopy, the placebo or misoprostol was administered to the posterior vaginal fornix. Data regarding cervical response and outcome of operative hysteroscopy, as well as complications, were analyzed.

Results: The mean cervical width, as estimated by Hegar dilator, was significantly greater in the treated group (7.8±1.6mm) than that in the control group (5.6±2.2mm, p<0.001). In the misoprostol group, 28 (70%) patients required cervical dilatation, compared with 38(95%) in the placebo group (p=0.001). A significantly shorter median time of cervical dilatation to Hegar number 9 was found in the treated subjects than in the controls (60 vs. 180 seconds, p<0.001). The mean operative time was significantly shorter in the treated group (8.8±8.7 minutes) compared with that of the control group (13.1±10.1 minutes, p=0.043).

Conclusions: Vaginal misoprostol before operative hysteroscopy lessens the need for cervical dilatation, facilitating hysteroscopic surgery.

---

The response of living tissues to the surgical trauma is associated with varying degrees of tissue repair and involves two distinct processes including replacement and regeneration. Replacement results in scar tissue formation instead of restoration of the normal architecture. However, regeneration leads to restoration of the original architecture leaving no sign of injury. Anti-proliferative agents are used to inhibit tissue responses to surgical trauma. Among them mitomycin- C and 5- FU had gained increasing applications in ophthalmic surgeries, including filtering glaucoma surgeries, laser vision correction with excimer laser by ablative surface refractive surgery, reconstructive surgeries for ocular surface disorders and removal of neoplastic tissues and secondary operations on nasolacrimal ducts. In this review article, the various aspects of applications of these agents including their mechanism of action, function, mode of application and complications in different ophthalmology fields are discussed.

---

Background: Alopecia areata, a non-cicatricial form of hair loss, is believed to be an immunologic response that targets hair follicles. Genetic background is important in the pathogenesis of this disorder, although some evidence point to the role of melanocytic antigens. There are some reports on the relationship between alopecia areata and celiac disease. The aim of the present study was to identify antigliadin antibodies in patients with alopecia areata.
Methods: Fifty patients, aged 2.5-50 years, with alopecia areata presenting to the dermatology clinic of Razi Educational Hospital in Tehran, Iran, and fifty healthy individuals, aged 5-48 were matched and enrolled in the study. After signing an informed consent form, blood samples (10 ml clotted blood) were obtained from the participants and sent to referral laboratory for the presence of antigliadin IgA and IgG antibodies. Concentrations of antibodies were measured by ELISA through a full automatic ELISA reader.The data were analyzed statistically.
Results: The study included 29(58%) male and 21(42%) female patients with a mean age of 24.6 years. The control group included 29(58%) male and 21(42%) female individuals with a mean age of 24 years. In the case group, 9(18%) patients were positive for antigliadin antibody, while only one (2%) individual was positive for the antibody in the control group (p<0.001). No other differences were of statistical significance.
Conclusions: Regarding the higher prevalence of antigliadin antibodies in patients with alopecia areata, it would be wise to screen the patients for celiac disease.

---

800x600 Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Psoriasis is a chronic, inflammatory disease of the skin. Recently, nicotinic cholinergic receptors have been demonstrated on keratinocytes, stimulating calcium influx and accelerating cell differentiation. Therefore, smoking and nicotine seem to influence inflammatory processes in psoriatic skin. The aim of this study was to determine the frequency of cigarette smoking as an independent risk factor in patients with psoriasis who attended the department of dermatology at Razi Hospital in Rasht during the years 2008 and 2009.
Methods : In this descriptive-inferential study, we recruited 96 patients with psoriasis vulgaris and 96 individuals as the controls. The participants were adjusted for sex, age and body mass index. The collected data related to smoking status, duration of smoking habit, smoking intensity, pack-year smoking history, and passively exposure to smoking were documented in a researcher-devised questionnaire. Subsequently, the data were analyzed by descriptive and inferential statistics such as χ², t-test and Mann-Whitney U test by SPSS software.
Results : The smoking rate was 33.3% in the patients and 19.4% in the controls. Pack-year history, regarded as the intensity and duration (years) of smoking, significantly increased the risk of psoriasis vulgaris (P<0.05, OR=2.07, 95% CI=1.17-3.68). Being a passive smoker did not make significant differences between the cases and the controls.
Conclusion: Our study demonstrated that psoriasis vulgaris had a relationship with duration and intensity of cigarette smoking and revealed the importance of smoking cessation, particularly among patients with psoriasis.

---

Background: Body dysmorphic disorder (BDD) is characterized by a preoccupation with an imagined defect in ones appearance or an exaggeration of a slight physical anomaly. Any part of the appearance may be the focuse of BDD patients. Thus preoccupation with appearance leads to significant damages of social and job functioning. The aim of this study is to determine the prevalence of BDD in patients referred to cosmetic clinic of Razi hospital.
Methods: Patients visiting cosmetic clinic of Razi hospital were selected if they agreed to participate in the study. They were evaluated by Yale brown obsessive compulsive scale modified for body dysmorphic disorder (YBOCS-BDD) as well as questionnaires containing demographic characteristics of patients including gender, educational status, marital status, history of reference to psychiatrist or psychologist, other medication, history of cosmetic surgery and rate of satisfaction of cosmetic surgery. YBOCS-BDD questionnaires then processed by educated specialist to determine BDD score of patie-nts. Demographic questionnaires, also analysed to evaluate epidemiologic properties of patients visiting cosmetic clinic of Razi hospital.
Results: The prevalence of BDD in current sample was 33.3%. 70.7% of BDD patients were female while 29.3% were male. The commonest age range was 21-50 years (82.8%). 65.5% were educated to level of diploma or lower, while 34.5% had academic degrees. 51.7% were married. 20.7% had history of reference to psychiatrist or psycholo-gist. 17/2% had history of cosmetic surgery with satisfaction ranging from unsatisfied (20%) to relative satisfaction (80%). None were fully satisfied.
Conclusion: BDD had high prevalence in patients visiting cosmetic clinic of Razi skin hospital. This high rate of prevalence show the necessity of diagnosis of BDD in skin patients and it is critical for them to refer to psychiatrists or psychologists.

---

Background: Alopecia areata (AA) is a common cause of noncicatricial alopecia that occurs as a patchy, confluent or diffuse pattern. Exact etiologic factor of AA not yet recognized. Among many hypothesis, relationship between AA and autoimmune disease, especially thyroid disorders, was more interesting. The objective of this study was to determine the prevalence of thyroid test disorders in the patients with alopecia totalis and universalis in comparison with normal population.
Methods: We analyzed medical records of 100 patients, including 44 male and 56 female in Tehran Razi Hospital from 1388 to 1389. The mean age was 24.1 years. Patients having totalis and universalis form of AA considered as case group while 100 normal person (42 male and 58 female with mean age of 26.1) who had not any form of AA considered as control group. Both groups had not any sign of thyroid disease at clinical examination according to their available medical records. Collected data were analyzed statistically in SPSS software 17th version.
Results: In the majority of patients (54%) the disease was manifested in the first two decades of life. History of atopia was seen in 9.8% of patient. Presence of the similar disease in first-degree family members was seen in 14.3% of patients. Abnormal T3, T4 and TSH were significantly higher in case group. Abnormal T3 uptake was higher in case group but not statistically significant.
Conclusion: Paraclinical thyroid disorders were significantly higher in the alopecia areata patients than in normal population. There was no significant association between the age, sex and duration of disease and presence thyroid dysfunction.

---

Background: Intense Pulsed Light (IPL) technology is one of our new measures in treating dermatologic disorders including undesirable skin pigmentation. In contrast with lentigines and freckling of the skin, few reports about nevus spilus treatment using intense pulsed light have been published. The aim of current study was to evaluate efficacy and safety of nevus spilus treatment with an intense pulsed light device (Palomar Max-G IPL). Methods: Patients with diagnosed nevus spilus confirmed via histopathology, were treated by an intense pulsed light source using parameters according to the skin type and location of lesions in one to three consecutive treatment sessions at 14-21 day intervals for three month. Palomar Max-G ® IPL hand piece is optimized for pigmented skin lesions and we used no additional filter. After each session, Photographs were taken from lesions with 10 mega pixel camera. Two months after finishing the treatment, the effect was evaluated base on close-up photographs. Results: Fourteen female patients were included. Significant improvement (76-100%) in one patient, good improvement (51-75%) in eight patients and fair to poor improvement (0-25%) in five patients were achieved. The commonest side effect of treatment was transient erythema resolved after six to eight hours. No permanent complication was reported. Younger patients and patients with shorter duration of lesion had better response to treatment however the differences were not statistically significant. Only one recurrence has been seen. No significant relationship between age, gender, anatomical site of lesions and skin type with response rate was found. Conclusion: Intense pulsed light is seemed an effective and safe treatment for nevus spilus Treatment however randomized control trials with longer follow-up periods are required to evaluate the efficacy and safety.

---

Background: Mycosis fungoides (MF) is the commonest T-Cell lymphoma (CTCL) involving skin and its appendages to variable degrees. Nail involvement is one of multiple dermatologic manifestation of this disorder and could have negative impact on psychological status of patients and producing therapeutic challenge to physician. We aimed to evaluate prevalence and subtypes of nail involvement in MF patients attending dermatology clinic, Razi Hospital in Tehran, Iran. Methods: All patients having MF confirmed via histopathology, visiting Razi Hospital Dermatology Clinic, Phototherapy and follow-up on inpatient wards from 2010 to 2011, were included. Patients examined by dermatologist researcher focusing on nail changes and all detected nail changes including onycholysis, longitudinal ridges and 11 more other changes, recorded in appropriated questionnaires. Treatment regimen prescribed to the patients also recorded as well as clinical CTCL staging. Results: A total of 60 patients, including 28 (46.7%) males and 32 (53.3%) females entered the study. 18 patients (12 males and 6 females) had different nail changes including longitudinal ridging, leukonychia, pitting and nine more morphological changes in decrescendo order. Ten patients had smoking history including four patients with nail changes. The commonest used treatment was local bath Psoralen and UVA light therapy (PUVA). Overall nail involvement in our study was approximately 30%. There was no significant relationship between prevalence of nail changes, demographic and clinical specification of underlying CTCL disorder especially tumor stage. Also, no significant relationship between prevalence and type of nail involvement with prescribed therapeutic regimen was found. Conclusion: We found about 30% prevalence that is a little higher than previously shown. It seems that nail changes in CTCL have no relationship to CTCL staging or other specifications including demographic specifications.

---

Eyes and the vision system allow the human being to receive information from the environment to the extent that 90% of the man’s information is acquired through observation, thus health and correct function of this organ have always been important. Diseases threatening vision such as Acute Macular Degeneration and Diabetic Retinopathy deprive millions of people of seeing every year while access to proper cures can prevent many ocular damages. Despite scientific progress in the medical fields over the recent decades there still exist many challenges in the field of ophthalmology and ocular diseases. As for ocular treatments, major challenges stem from pharmaceutical weaknesses, in other words in spite of access to the suitable drugs for ocular complications we have not yet succeeded to achieve an appropriate method to apply these drugs. By appropriate application of drugs we may deliver the active pharmaceutical ingredient to the target organ with the least side-effect, the most benefit and the highest level of patient compliance. Incapability of effective delivery of drug to the eye arises from the special physiology and anatomy of this organ. The static barriers such as Blood-Aqueous and Blood-Retinal and dynamic barriers such as conjunctival blood circulation and lymphatic clearance will reduce the bioavailability of ocular drugs. Overcoming the above-mentioned weaknesses requires a complete knowledge of the eye characteristics as well as acquaintance with novel drug delivery system. When speaking of drug delivery system (DDS) it means employing a two-part structure consist of active pharmaceutical ingredient (API) and carrier that in fact characteristics of formulated DDS will determine by the carrier. We may hope that by applying and designing modern pharmaceutical systems that mainly take advantage of nanoparticles we would be able to overcome many challenges of ocular drug delivery. The present study is aimed at reviewing the eye structure, challenges faced by ocular drug delivery, familiarity with nanotechnology and approaches of this science in the area of ophthalmology as well as mechanisms of designing a local system for effective drug delivery to the eye tissue.

---

Background: As far as the role and amount of Transferrin receptor 2 (TFR2), which is the transferrin receptor gene, studies have been conducted, some of which confirming its relationship with gastric adenocarcinoma. The idea behind this study was to examine changes in the TFR2 gene expression in the tumor cells of gastric adenocarcinoma and comparing with gene expression in the normal tissue adjoining the tumor.

Methods: This case-control study was conducted at the Pathology Section of Cancer Institute of Imam Khomeini University Hospital in Tehran from September 2015 to September 2016. In this study, 30 fresh samples from tumor tissues of patients diagnosed with gastric adenocarcinoma, 30 fresh samples of normal tissue adjoining the tumor and 30 samples of frozen plasma from the same patients were taken. The patients' plasma was examined in terms of existence of helicobacter pylori antibody by enzyme linked immunosorbent assays (ELISA) method and TFR2 gene expression in the tumor tissue and the adjoining normal tissue by applying real-time polymerase chain reaction (Real-Time PCR).

Results: Gene expression (by applying real time polymerase chain reaction) in the tumor tissue was meaningfully higher than in the normal tissue (P= 0.125). The TFR2 expression in patients with stomach cancer, who were at the same time infected with helicobacter pylori, indicated that the gene expression had increased in those with this contamination (P= 0.077). Examining the relationship between this gene expression and the stage of disease showed that the TFR2 gene expression increased significantly in the more advanced stages of the disease (P= 0.396).

Conclusion: The TFR2 gene expression increases in the stomach's tumor tissue. This gene expression is higher in people infected with helicobacter pylori or in those at an advanced stage of the disease. These findings may confirm the direct relationship between gene expression and the occurrence or metastasis of gastric adenocarcinoma.

---

Results: In contrast to the direct method, the final product obtained by combined ion-exchange chromatography had a good purity by the average of about 95% and the amount of polymer was estimated to be less than 5% by HPLC analysis (P<0.05). Conclusion: By diluting the plasma and subsequently reducing the ionic strength, albumin can be separated from human plasma with a high degree of purity only by two steps of ion-exchange chromatography.

---

The recording of electrophysiological activities of brain neurons in the last half-century has been considered as one of the effective tools for the development of neuroscience. One of the techniques for recording the activity of nerve cells is the multi-electrode arrays (MEAs). Microelectrode arrays (MEAs) are usually employed to record electrical signals from electrogenic cells like neurons or cardiomyocytes. MEAs consist of an array of planar or three-dimensional electrodes that act as electrical interfaces and record cellular signals or stimulate cells. These platforms can be used in different applications including neuroscience studies, prostheses and rehabilitation, deep brain stimulation (DBS), cardiac pacemakers, retinal and cochlear implants, or for brain-computer interfaces (BCI) in general. Multi-electrode arrays are known as long-term recording and non-invasive devices. The MEA structure includes arrays of electrodes with micrometer and nanometer dimensions which are designed to stimulate and record the electrical activity of cells, and are fabricated using micromachining technologies. MEAs should be biocompatible to serve as a substrate for cell growth. On the other hand, they must have low impedance to be able to provide a high signal-to-noise ratio, and small size to offer a suitable spatial resolution for recording. MEAs are usually fabricated on glass substrates patterned with high-conductivity metals such as gold, iridium or platinum, which are insulated with a biocompatible layer. Despite fast progress, current multi-electrode arrays for neural applications still face limitations such as low signal-to-noise ratio and spatial resolution. To achieve better spatial resolution and lower noise levels and therefore more accurate signal, it is necessary to develop arrays with smaller sizes and lower impedance. Meanwhile, many nanostructures such as graphene, carbon nanotubes, gold nanoparticles, and also conductive polymers have become attractive candidates for this application due to their interesting properties. In this paper, the technology of multi-electrode arrays, how it works and its various parts are introduced, and finally, the challenges and developments in this field are investigated. Multi-electrode array technology is used for neuroscience research, neural network analysis, drug effects screening, and neural prosthesis studies.

---