Tehran University Medical Journal

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Background: Patients with endometrial or ovarian cancer have an increased risk for breast or colon cancer. The aim of this study was to assess the individual and age-related characteristics of patients with a combination of these malignancies.

Methods: In this retrospective descriptive study, we reviewed the medical records of 100 patients admitted for endometrial or ovarian cancer in Rasol Akram, Akbarabadi and Firozgar educational Hospitals in Tehran, Iran, during 2010- 2011. Colon polyps were evaluated by immunohistochemistry assay.

Results: The mean age, weight and BMI of the patients were 50.21, 65.9 and 26.07, respectively. Among 100 cases participating in this study, five (5%) patients had colon polyps. All the five cases with colon polyp had positive familial histories of ovarian cancer.

Conclusion: With considering the low prevalence of colorectal polyps among women with ovarian and endometrial cancers, patient's follow-up for screening test is not recommended.

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Background: Medication overuse headaches (MOH) include headaches that last more than 15 days a month and usually occur after long-term use of analgesic. Most methods of medical treatment are ineffective. In some studies, great occipital nerve block is used to treat the headaches.

Methods: This double-blind experimental study was performed in adult patients with MOH who attended Sina Hospital in Tehran from June 2009 to June 2011. Greater occipital nerve (GON) block was done in the two groups of patients by administering a combination of 3 ml of 0.5% bupivacaine and 2 ml of 5% saline or 3 ml of 0.5% bupivacaine and 80 mg of methyl prednisolone. We evaluated headache severity by Visual analog scale (VAS) and recorded days without headache. If patients were taking pain medications, preventive medications were given as usual before and after the injection. Student's t-test was performed for statistical analysis and a P<0.05 was considered significant.

Results: Overall, 13 male and 19 female patients with a mean age of 39.88±8.76 years participated in the study. The mean reduction in headache severity one hour after injection was 5.56±1.03 and 4.63±1.92 in the first and second groups, respectively. Average days without headache one month after injection were 8.75 and 4.75 days in the first and second groups, respectively. There were no significant differences between the two groups.

Conclusion: Both methods seem to be effective in medication overuse headaches treatment. This finding is important as non-responders to conventional methods will otherwise have a decreased quality of life.

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Background: Percutaneous endoscopic gastrostomy (PEG) is one of the ways to non-oral feeding in patients with dysphagia caused by conditions such as stroke, oropharyngeal malignancy and motor neuron disease. The aim of study was assessment of early outcome of PEG in hospitalized patients according to clinical situation and underlying disease.
Methods: This study was cross- sectional and prospective. Sixty five patients were included with PEG from April 2011 to July 2012, at Sina University Hospital, Tehran, Iran. Tube function, feeding, and patients' symptoms were assessed and patients were followed six month at least to one year after procedure .The follow up of patients were stopped if the patient died or removal of tube.
Results: Sixty five patients (33 men, 32 women) enrolled in this study. The mean age of patients was 57.45±16.83 years (19-94 years). Head trauma and postoperative thoracic surgery were in 15 (23.1%) and 4 (6.2%) cases. 36 of patients (55.39%) had no symptoms. The complications include lickage (11 cases), stenosis (9 cases), cellulitis (7 cases), and PEG separation (2 cases). A total of 29 patients were complicated and 21 patients (72%) of them complicated 2 -5 months after PEG. No statistical significant differences between two sexes in PEG complication. 27 patients (41%) died that have no relation to complications of PEG.
Conclusion: Finally, the study showed the PEG is a safe method to enteral nutrition. The advantages of this method include its simplicity, no need to general anesthesia and low rate of complications especially in inpatient under the supervision of medical staff. Therefore it can be used as a favorable method.

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Background: Severe spondylolisthesis is related to high degenerative changes in verte-bral spine. Degenerative spondylolisthesis often is seen with high-sacral slope. This study was conducted to investigate the relationship between high degenerative spondyl-olisthesis and sacral slope.
Methods: A cross-sectional prospective study was done in patients with low back pain in Shafa Yahyaian and Sina University Hospitals in Tehran, in 18 months (April 2010- October 2011). Intermittent or continuous low back pain for three months and history of two disable low back pain attacks since one year ago were inclusion criteria. Pregnant patients were excluded. Lumbar vertebra displacement to vertebra body size ratio was calculated in dynamic mode. The ratio higher than 8% was considered as a lumbar instability. Rotation angle more than 11 ° was considered abnormal.
Results: In this study, 52 patients (30 men, 22 women) with 38.35±9.49 years old were enrolled. Mean body mass index was 23.01±4.59kg/m2. Thirty cases had abnormal verte-bral displacement. Angulation of the disc space more than 11 degrees was seen in 20 patients. No statistically significant difference in pelvic index between normal and abn-ormal lumbar vertebra displacement (P=0.443). The mean pelvic index in normal and abnormal angulation groups were 55.97° and 53.58°, respectively the difference was not statistically significant (P=0.556).
Conclusion: The results of the study showed disc degeneration had no association with sacral slope. High sacral slope can intensify spondylolisthesis but does not affect the incidence of degenerative spondylolisthesis. Additional research is required to find the other causes of degenerative spondylolisthesis.

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Background: Serum estradiol level is a controversial prognostic factor in the outcome of labial adhesion. The aim of this study was to evaluate serum estradiol levels and topical estrogen response in patients with labial adhesion.
Methods: A prospective interventional study was conducted among girls with labial adhesion that referred to Pediatrics clinic in Taleghani University Hospital, Gorgan city, Iran in 2011. One hundred patients entered the study. The diagnosis was conducted by clinical examination of vestibule area. Inclusion criteria were, three months to eight years old prepuberty girls, no ambiguous genitalia, lack of vulvovaginitis symptoms, labial adhesion more than twenty five percent, no history of previous topical estrogen treatment since two weeks ago and previous incomplete treatment. The patients who did not use proper amount and duration of drug and also with adverse drug reactions during treatment period were excluded from the study.
Results: The maximum frequency of labial adhesion was in the group of less than one year old. The minimum frequency of labial adhesion was in the 7-8 years old group. Eighty six patients had complete or partial remission. No evidence of an improvement was observed in fourteen children. Severity of adhesions did not worsen in our patients. Serum estradiol levels were lower in patients who had a positive response to treatment. There were significant differences in serum estradiol levels between full or relative improvement with no improvement groups (P=0.044).
Conclusion: Findings of this study showed that the labial adhesion patients with low serum estradiol level had better treatment response after using topical estrogen.

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Background: Choosing the right drug with the least side effects and highest effectiveness for the control of seizures in the elderly is important. The aim of this study was compare the efficacy of lamotrigine and levetiracetam in the management of epilepsy in the elderly.
Methods: This study was performed as a double-blind randomized clinical trial in patients that referred to the neurologic clinic at Sina University Hospital, Tehran, Iran in 2012. The patients over sixty years old with a diagnosis of epilepsy were selected. They had one seizure in year at least and one attack in the last 6 months. First, the patients divided to two groups Group one were treated with lamotrigine, 25 mg per day and group two were treated with levetiracetam, 250 mg per day for 24 weeks. In the absence of drug complications, the dose was increased to the maximum dose listed in the treatment protocol. Second the patients were followed in number of attacks, abnormalities in laboratory data and side effects of drug in 2, 4, 8, 12 and 20 weeks. The collecting data of the study were analyzed using descriptive and analytical statistics methods.
Results: Forty nine cases, 28 males and 21 females in lamotrigine group and 46 cases in levetiracetam group, 27 males and 19 females participated in the final analysis. Mean age of patients was 72.40±5.87 (63-85). Drug side effects were observed in 57 cases, 26 cases of lamotrigine group and 31 cases of levetiracetam group. Seizure frequency showed a declining trend in both groups but in lamotrigine group more than levetiracetam group in last week (P= 0.039).
Conclusion: The findings of the study showed lamotrigine and levetiracetam were effective in management of epilepsy in the elderly. Levetiracetam has a higher seizure-free effect than lamotrigine but lamotrigine is better tolerated than levetiracetam.

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Background: Gastrointestinal stromal tumors are gastrointestinal tract mesenchymal tumors with gene mutations. The most common site of gastrointestinal stromal tumors is in stomach (40-60%) and small intestine (30-40%), and rare cases about 3-5% of them occur in the duodenum. Case presentation: The patient is a forty six years old man. He complained of frequent colic pain in left upper quadrant of abdomen for two months before admitting to the hospital. The pain resolved spontaneously after a few hours. This situation almost has been repeated every week. The patient had severe repeated melena and faint for two weeks. As soon as the patient was entered the Sina Hospital in 2012, supportive care was started. Then upper gastrointestinal endoscopy was performed for him and the bleeding point was detected. Also abdominal and pelvic computed tomography with oral and intravenous contrast was done. Finally the patient was operated on tumor diagnosis in duodenal area according to classic Whipple procedure. Conclusion: Gastrointestinal bleeding is the most common symptom of gastrointestinal stromal tumors. The bleeding is minimal and chronic. It will be progress to sudden and severe bleeding. Diagnosis is done by upper gastrointestinal endoscopy and biopsy. The large tumors with high mitotic

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Background: Many drugs have been abused by patients for headache management. Celecoxib has not been abuse widely as a pain relief drug for headache. The aim of this study was comparison between celecoxib and prednisolone in bridge stage therapy following medication overuse headache. Methods: A double-blind randomized clinical trial was done in patients admitted to a private headache clinic in Tehran, Iran at 2012. Patients were selected with 18- 65 years old and 15 days headache per month at least. Prednisone was administered as a 75 mg/day, 50 mg/day, 30 mg/day, 25 mg/day and 10 mg/day dose, in 3 days interval. Celecoxib was administered as a 100mg dose three times per day (first 5 days), twice per day (second 5 days) and one time per day (third 5 days). Headache time, headache intensity, headache duration, analgesic consumption due to severe headache and drug side effects was assessed. We used the visual analog scale to determine the severity of the pain. Results: One hundred and three patients were enrolled in two groups: celecoxib (53 cases) and prednisolone (50 cases). Twenty and one men and eighty and one women with a mean age of 33.62±9.65 years participated in the study. The maximum fre-quency for headache time in the celecoxib group was 1-4 hours (19 cases) and more than four hours (19 cases). In the prednisolone group the maximum frequency for headache time was more than 4 hours (28 cases) (P=0.149). The frequency of side effects of prednisolone and celecoxib groups were 42% and 18.9%, respectively (Relative Risk=2.2, P=0.011). The most common side effects in both groups were weakness and lethargy. Conclusion: Considering the positive effect of both drugs in reducing patients' head-ache during withdrawal, celecoxib compared with prednisolone has better efficacy and fewer side effects.

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Background: Identify the causes of complaints and contributing factors may reduce medical litigation. The aim of this study was to assess the cases of complaints in the field of psychiatric. Methods: This study was done in retrospective cross-sectional study method. We inves-tigated 27 cases of medical malpractice in the field of psychiatry that registered in higher disciplinary board of the Medical Council of Iran, from 2001 to 2010. We calcu-lated the absolute and relative frequency of variables after collecting all data and calculated the difference between malpractice and exculpation cases based on physicians profile by Pearson's chi-squared test and Fisher’s exact test. P< 0.05 was considered as statistically significant difference. Results: The 24 people who died and their families protested against psychiatrist were enrolled in this study. Demographic information and other characteristics of the cases were collected. All participants had been men. Seventeen of 24 cases (70.84%) were in 30-50 year old group and seven of 24 cases (29.16%) were in > 50 year old group. The most common types of negligence were related to disregarding of governmental provi-sions (40%). The age, expertise and place of medical activities were variables that dif-ferent significantly between negligence and non-negligence groups (P< 0.05). The re-sults of the study showed eight cases of 24 cases (33%) in the lower board, nine cases of 24 cases (37.5%) in the appeals board and eight cases of 24 cases (33%) in the higher disciplinary board were acquitted. Conclusion: Based on the study findings, it appears that age, expertise and activity place are factors that can be effective in reducing malpractice in psychiatry.

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Background: Lack of precise diagnostic criteria and sufficient findings in support of biopsy sampling during upper gastrointestinal endoscopy is one of the special challenge in endoscopy assessment in Barrett's esophagus. The aim of this study was to evaluate the mucosa in the distal esophagus tissues through a biopsy during upper gastrointesti- nal endoscopy in gastroesophogeal reflux disease patients whose symptoms don't im- prove or only partially resolve with treatment. Methods: A cross-sectional study was done in patients with gastroesophogeal reflux disease medically resistant to treatment. The patients were assessed by gastroenterology department in Sina Hospital, Tehran, Iran, since September 2012 to September 2013. Patients with coagulopathy, esophageal varicose, esophageal cancer, earlier detection of developing Barrett's esophagus, history of irritable bowel syndrome, psychological dis- orders and using of nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, were excluded. Esophageal squamous epithelium and cylindrical tissue of stomach was carefully checked by endoscope. Then 2 to 4 biopsy of the Z-line above the gastroe- sophageal mucosa were obtained. Results: One hundred and fifty three patients included 78 men (51%) and 75 females (49%) with a mean age of 47.92±17.57 years participated in the study. The mean of body mass index of patients was 25.05±4.17 kg/m2 and body mass index in 45.8 % of the patients more than 230 kg/m2. Biopsy specimens were taken in 31 cases were not enough for histological examination. In other patients, 25 cases (20.5%) were normal and 97 cases (79.5%) had the following pathological diagnosis: mild esophagitis (49 cases 40.2%), moderate esophagitis (24 cases 19.7%), severe esophagitis (14 cases 11.5%), Barrett's esophagus (8 cases, 6.5%), fungal esophagitis (1 cases, 0.8%), and eosinophilic esophagitis (1 cases 0.8%). 117 patients (76.5%) had H. pylori infection. Sensitivity and specifity of endoscopy for detection of Barrett's esophagus during upper gastrointestinal endoscopy were 100% and 84.13% (CI 95%:78.53-89.09%), respec- tively. Conclusion: Our data showed that doing of accurate and adequate biopsy samples from lesions in upper GI endoscopy can be helpful in the diagnosis of Barrett's esophagus

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Background: Short-stem prosthesis for total hip arthroplasty (THA) have been designed to overcome the weakness of standard-stem prostheses and improve surgical outcomes. The aim of this study was to compare short-stem with standard-stem prosthesis outcomes. Methods: This study was performed as a randomized clinical trial. Subjects were selected among patients referred to Sina University Hospital, Tehran, Iran from April 2010 to 2012. THA were performed with short-stem or standard-stem prostheses after obtaining written informed consent from patients. Balanced block randomization method was used to get a random sample in each group. Clinical outcomes were evaluated based on Harris Hip Score (HHS). Patients were followed up for at least one year. All patients were examined at 2 weeks, 6 weeks, 3 months, 6 months and one year after surgery. In each visit, Control X-ray was obtained and bone and prosthetic position were assessed. Also, the symptoms such as infection, pain, claudication, ability to climb stairs, using crutches and weight bearing were rechecked. Student t-test was used to compare outcomes in the two groups. Results: A total of eighty four THA were studied. 13 patients were lost to follow-up or had infection and failure. One patient died with the prosthesis in situ from causes not related to the surgery. Therefore, a total of 70 patients were analyzed. Of these, 34 and 36 hips underwent small stem and standard stem THA, respectively. The mean age of the patients at the time of operation was 61.1±8.68 years (range, 48-86 years). Most common reasons for arthroplasty were osteoarthritis, avascular necrosis and dysplasia of hip. There were significant differences between the two study groups in bleeding during surgery (P=0.001). There were no significant differences among the study groups in HHS except for 6th week and 3th month (P=0.000). Conclusion: The use of short-stem prosthesis can improve the performance of patients in short-term but no significant difference with standard-stem prosthesis in long- term.

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Background: Helicobacter pylori is a gram negative microaerophilic spiral bacilli, which causes duodenal and gastric ulceration. Also this organism cause distal gastric adenocarcinoma and primary gastric lymphoma. The most important Helicobacter pylorus virulence factor is cytotoxin associated gene A (cagA) Pathogenicity Island that cause secretion of antibody by stimulation of immune system. Measurement of the serum antibody can be used to diagnosis strain of Helicobacter pylorus that causes peptic ulcer disease (PUD). Serological discrimination between strain types would reduce the need to emergent endoscopic studies. The aim of this study was comparison of serum anti-CagA antibodies of patients with peptic ulcer disease and patients with Non-ulcer dyspepsia. Methods: This case-control study was carried out from october 2011 to october 2012, in 130 patients who complained of dyspepsia more than six months and referred to gastroenterology and endoscopic ward of Firoozgar Hospital, Iran University of Medical Sciences, Tehran. Serum sample obtained from all patients. Anti-CagA antibodies levels were measured in serum samples using ELISA technique. Patients with peptic ulcers as cases and patients without peptic ulcer in endoscopy study were considered as controls. Results: One hundred thirty patients were enrolled in the study and equally two groups (65 patients in case group and 65 patients in control group). Fifty nine subjects of case group (90.76%) and 37 subjects of control group (56.92%) had positive serum anti-CagA antibody (P= 0.003). Sixty one percent of anti-CagA antibodies positive patients and 17.6% of anti-CagA antibodies negative patients had peptic ulcer (P= 0.003). (Odds ratio= 7.4 95%CI: 2.8-19.7 P= 0.003). Conclusion: The detection of CagA antibodies as an additional and noninvasive test in association with determination of serum anti-CagA antibodies, could help better detection of risk factors of peptic ulcer disease. Also it can reduce the emergency endoscopy process. We can use this technique in patients with dyspepsia who had no warning signs or malignant disease and not taking a nonsteroidal anti-inflammatory drugs in primary care of clinical practices.

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Background: One of the toxins accumulated in the body of hemodialysis patients is beta-2 microglobulin which is caused and increased by various factors. The one of this factors that can affect beta-2 macroglobulin is of membrane type that using in hemodialysis. In the present study, we examined the impact of C-reactive protein (CRP) as an inflammatory factor on beta-2 microglobulin in high-flux membrane hemodialysis patients. Methods: This cross-sectional study was done in 44 hemodialysis patients that have been dialyzed in two academic centers Sina and Amir Alam Hospitals, Tehran, Iran from 2013 to 2014. The patients were hemodialyzed via fistula or permanent catheters three times a week for 4 hours for more than three months. Patients with known infectious disease, hemodialysis with low-flux membrane and dialysis less than three times a week were excluded. All patients were hemodialyzed using Fresenius biocompatible high-flux membrane (FX 100, Fresenius, Massachusetts, USA). Arterial blood sampling was performed. beta-2 microglobulin, CRP, BUN and creatinine tests were conducted for all patients. Results: Forty-four patients among the chronic hemodialysis patients were selected for final analysis. 20 males (44.5%) and 24 females (54.5%) were included in this study. The frequencies of underlying disease in patients participating in the study were as follows: hypertension, 23 cases (52.3%) diabetes mellitus, 11 cases (25%) hypertension and diabetes mellitus, 2 cases (4.5%) obstructive disorder, 2 cases (4.5%). In 23 patients (52.3%), beta-2 macroglobulin was >12 mg/l and in 21 (47.7%), it was <12 mg/l. 29 cases (65.9%) had CRP values less than or equal 6 mg/l. However, there was no significant differences between beta-2 microglobulin and CRP levels (P= 0.460). Also regression analysis of data showed no relationship between beta-2 microglobulin and CRP levels (r= -047, P= 0.763). Conclusion: Although it seems that inflammatory factors can be effective in increasing beta-2 microglobulin, the present study did not find such a relationship between CRP and beta-2 microglobulin.

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Background: Personal characteristics such as gender, ethnicity, disability, age, goals and personal expectations and academic variables such as the number of classes and grades are among the factors that could have an important role in the development of student satisfaction. Besides these factors, the relationship between emotional intelligence (EI) and academic satisfaction has received little attention. Methods: This descriptive cross-sectional study was done in Tehran University of Medical Sciences, Tehran, 2013. Cluster sampling was applied in this study. First, faculties randomly selected from Tehran University of Medical Sciences then randomly selected classes from the faculties. Self-report and Barr-On's emotional Intelligence questionnaires were used to collect data and measuring the variables of educational satisfaction. Questionnaires were completed by students. Overall reliability test using Cronbach's alpha coefficient was 0.73. The cut-off point of questionnaires was considered 70. This means that scores below 70 points showed the low level of satisfaction and scores more than 70 points were considered as a high level of satisfaction. Results: One hundred sixty eight students participated in the study. Average emotional intelligence was 3.25±0.45, the scale of consciousness 3.44±0.59, the self-control scale 3.90±0.59, scale spontaneous 3.17±0.46, Social skills 3.30±0.59, social consciousness 3.24±0.67, satisfactory academic 96.55±14.66 respectively. There was a significant relationship between self-consciousness and educational satisfaction (P=0.002) but self-control variable did not significantly correlated with educational satisfaction (P=0.249). The results showed that emotional intelligence on academic satisfaction can be explained. A change in the variance in one unit emotional intelligence was as much as five unit of the variance student satisfaction in based on standardized beta coefficient. There is a positive and direct relationship between them. Conclusion: The promotion of education satisfaction will increase indirectly possibility of job satisfaction in students in the future. Our results showed self-awareness and motivation skills in students increase their educational satisfaction.

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Background: Tramadol is a synthetic drug which is prescribed in moderate and severe pain. Tramadol overdose can induce severe complications such as consciousness impairment and convulsions. This study was done to determine the convulsions incidence after tramadol use until one week after hospital discharge. Methods: This prospective study was done in tramadol overdose patients without uncontrolled epilepsy and head injury history. All cases admitted in Loghman and Rasol Akram Hospitals, Tehran, Iran from 1, April 2011 to 1, April 2012 were included and observed for at least 12 hours. Time interval between tramadol intake and first seizure were record. Then, patients with second drug-induced seizure were recognized and log time between the first and second seizure was analyzed. The patients were transferred to the intensive care unit (ICU) if clinical worsening status observed. One week after hospital discharge, telephone follow-up was conducted. Results: A total of 150 patients with a history of tramadol induced seizures (141 men, 9 women, age: 23.23±5.94 years) were enrolled in this study. Convulsion was seen in 104 patients (69.3%). In 8 out of 104 patients (7.6%) two or more convulsion was seen. Time interval between tramadol use and the onset of the first and second seizure were 0.93±0.17 and 2.5±0.75 hours, respectively. Tramadol induced seizures are more likely to occur in males and patients with a history of drug abuse. Finally, one hundred forty nine patients (99.3%) were discharged with good condition and the only one patient died from tramadol overdose. Conclusion: The results of the study showed tramadol induced seizure most frequently occurred within the first 4 hours of tramadol intake. The chance of experiencing a second seizure exists in the susceptible population. Thus, 4 hours after drug intake is the best time for patients to be hospital discharged.

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Background: High-resolution manometer (HRM) of the esophagus has become the main diagnostic test in the evaluation of esophageal motility disorders. The development of high-resolution manometry catheters and software displays of manometry recordings in color-coded pressure plots have changed the diagnostic assessment of esophageal disease. The first step of the Chicago classification described abnormal esophagogastric junction deglutitive relaxation. The latest classification system, proposed by Pandolfino et al, includes contraction patterns and peristalsis integrity based on integrated relaxation pressure 4 (IRP4). It can be discriminating the achalasia from non-achalasia esophageal motility disorders. The aim of this study was to assessment of clinical findings in non-achalasia esophageal motility disorders based on the most recent Chicago classification.

Methods: We conducted a prospective cross-sectional study of 963 patients that had been referred to manometry department of Gastrointestinal and Liver Research Center, Firozgar Hospital, Tehran, Iran, from April, 2012 to April, 2015. They had upper GI disorder (Dysphasia, non-cardiac chest pain, regurgitation, heartburn, vomiting and asthma) and weight loss. Data were collected from clinical examinations as well as patient questionnaires. Manometry, water-perfused, was done for all patients. Manometry criteria of the patients who had integrated relaxation pressure 4 (IRP4) ≤ 15 mmHg were studied.

Results: Our finding showed that the non-achalasia esophageal motility disorders (58%) was more common than the achalasia (18.2%). Heartburn (68.5%), regurgitation (65.4%) and non-cardiac chest pain (60.6%) were the most common clinical symptoms. Although, vomiting (91.7%) and weight loss (63%) were the most common symptoms in referring patients but did not discriminate this disorders from each other’s. Borderline motor function (67.2%) was the most common, absent peristalsis (97%) and the hyper-contractile esophagus were rarest in the non- achalasia esophageal motility disorders.

Conclusion: However, achalasia is a treatable esophageal motility disorder but non-achalasia esophageal motility disorders were more common. Thus, manometrial study is an imperative tool for proper diagnosis and treatment of these patients, especially in gastro-esophageal reflux disease. Clinical finding could not accurately diagnosis between different types of non-achalasia esophageal motility disorders from each other’s.

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Background: Nonalcoholic fatty liver disease (NAFLD) includes steatosis, nonalcoholic steatohepatitis, fibrosis and liver cirrhosis. The oxidative stress enzymes are the diagnostic markers to prediction of histologic status of liver in nonalcoholic steatohepatitis disease. The aim of the study was to assessment of relationship between serum Zinc (Zn) levels with pathologic manifestation in patients with nonalcoholic steatohepatitis.

Methods: This cohort study was done in patients with nonalcoholic steatohepatitis that had been visited in gastrointestinal clinic of Sina Hospital, Tehran, Iran from April, 2014 to April, 2015. Control group included the patients with no clinical manifestation of nonalcoholic steatohepatitis and normal liver ultrasonography, lab test and liver biopsy. Serum Zn level was measured with atomic absorption spectroscopy. Normal Serum level of Zn was considered 10.7-22.9 µmol/L (70-150 µg/dL) and less than 7 µg/dL was considered as Zn deficiency. Pathological findings were grading according to NAFLD activity score.

Results: One hundred twenty patients were selected for the study in two equal groups. Six and 26 patients were excluded in case and control groups, respectively due to no consent to lab test. Finally, 54 patients (35 male/19 female) and 34 patients (22 male/12 female) in control group were participated in data analysis. The mean age on case and control group was 37.02±9.82 year and 33.24±12.01 year, respectively (P= 0.111). Zn level in case and control groups were 90.82±13.69 and 88.82±13.10, respectively. There were no statistically significant differences between two group in serum Zn level (P= 0.50). Also, there were no statistically significant differences between pathological grading in case group participants (steatosis: P= 0.640; Lobular inflammation: P= 0.882; fibrosis: P= 0.531).

Conclusion: The finding of the study showed no significant association between serum zinc level and hepatic steatosis, lobular inflammation and fibrosis of the liver in nonalcoholic steatohepatitis.

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Stable molecular changes during cell division without any change in the sequence of DNA molecules is known as epigenetic. Molecular mechanisms involved in this process, including histone modifications, methylation of DNA, protein complex and RNA antisense. Cancer genome changes happen through a combination of DNA hypermethylation, long-term epigenetic silencing with heterozygosis loss and genomic regions loss. Different combinations of N-terminal’s changes cooperate with histone variants with a specific role in gene regulation. It have led to load a setting histone that determine transcription potential of a particular gene or genomic regions. DNA methylation analysis in genome region using methylation-specific digital karyotyping of normal breast tissue detect gene expression patterns and DNA specific methylation can be found in breast carcinoma too more than 100 genes in breast tumors or cell lines of breast cancer are reported hypermethylated. Important of DNA methylation on cancer has been concentrated CpG islands hypermethylation. Most of the techniques are able to identify hypermethylated areas. Often, methylated genes play important role in cell cycle regulation, apoptosis, metastasis and tissue invasion, angiogenesis and hormonal signaling. Cyclin D2 (CCND2) gene is an important regulator of cell cycle and increased of expression inhibits the transition from G1 to S cell cycle. This gene is frequently methylated in breast cancer and has been proposed as the first event. Other cell cycle regulator is p16ink4A / CDKN2A that methylated in a large number of human cancers, including breast cancer. Another regulator of the proliferation of breast cancer that methylated is tumor suppressor RAR-β cancer that has been found in lobular and ductal carcinoma. Recent studies have showed the role of epigenetic silencing in the pathogenesis of breast cancer in which tumor suppressor genes have been changed by acetylation and DNA deacetylation. Histone deacetylase inhibitors have different roles in cancer cells and could show the ways of new treatment for breast cancer. In this review, various aspects of breast cancer epigenetics and its applications in diagnosis, prediction and treatment are described.

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Background: The Micronuclei has been discussed as an indicator of chromosomal damage in radiotherapy. This study aimed to investigate the changes of micronuclei in peripheral blood lymphocytes of patients with of the gastrointestinal cancers pre- and post-chemo-radiation.

Methods: This cross-sectional study was conducted in patients with gastrointestinal cancers who referred to oncology ward of Rasool Akram Hospital in Tehran from January to March, 2016. After obtaining informed consent from all patients, 3 cc of peripheral blood samples was obtained for cytogenetic assessment in two stages, before treatment and 4 weeks after treatment. The frequency of micronuclei was examined per 1,000 lymphocytes with two nuclei.

Results: Sixty-one patients were evaluated and 11 patients were excluded at the end of study. Fifty patients (34 males, 16 females) with a 59.74±13.34 years old were evaluated. 24 (48%) and 26 patients (52%) were in the less than 60 years’ age group and more than one, respectively. 37 cases (74%) with gastric cancer and 13 cases (26%) with esophageal cancer enrolled in the study. The significant differences were meaningful pre- and post-treatment (44.88 vs. 364.4 /1000 cells) (P=0.005). Also, there were no significant differences of the mean number of micronuclei between pre- and post-treatment according the type of cancer, sex and age groups. Further analysis according by age, sex and cancer of the esophagus or stomach showed no statistically significant differences between the groups in micronuclei number. In other words, chemotherapy and radiation in patients, regardless of age, sex and type of gastrointestinal cancer is very significant impact on the micronuclei production in peripheral blood of patients.

Conclusion: The number of micronuclei in peripheral blood increased significantly in patients with gastrointestinal tract cancer (esophagus and stomach) under the chemo-radiation therapy. It seems that this increase was not correlated with age, sex and type of cancer (stomach or esophagus).

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