Tehran University Medical Journal

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Background: Nucleus accumbens (NAc) and prefrontal cortex (PFC) dopaminergic and glutamatergic systems are involved in regulating of locomotor activity behaviors. This study has investigated the interaction of NAc shell dopaminergic system and prelimbic glutamatergic systems in regulating locomotor activity and related parameters.
Methods: The aim of this study was the effect the drugs injection interaction in the brain of male Wistar rats on locomotor activity and related parameters, in the order of this purpose, open field apparatus that automatically recorded locomotor activity was employed. Unilateral intra-cerebral injection of drugs was done.
Results: Unilateral intra-prelimbic injection of D-AP7 (N-methyl-D-aspartic acid= NMDA receptor antagonist 0.25, 0.5 and 1μg/μl) did not alter locomotor activity behaviors. However, infusion of NMDA (0.9μg/μl) in this region increased locomotor activity (P<0.01), whereas decreased rearing (P<0.01) and grooming (P<0.01) which was blocked by D-AP7 (0.25μg/μl) (P<0.01). Moreover, unilateral infusion of SCH23390 (dopamine D1 receptor antagonist 0.25, 0.5 and 1μg/μl) into the left NAc shell did not alter locomotor activity. However, injection of SKF38393 (dopamine D1 receptor agonist 4μg/μl) into the left NAc shell increased locomotor activity (P<0.05) which was blocked by SCH23390 (0.25μg/μl) (P<0.01). Furthermore, the subthreshold dose infusion of SCH23390 (0.25μg/μl) into the left NAc shell reduced the effect of intra- prelimbic NMDA on locomotor activity (P<0.01). In addition, intra-NAc shell administration of the subthreshold dose of SKF38393 (1μg/μl) potentiated the middle dose (P<0.05), whereas decreased the higher dose of intra-left prelimbic NMDA response (P<0.05) on locomotor activity.
Conclusion: The results suggested a modulatory effect of the NAc shell dopaminergic system on increased locomotor activity by activating glutamate system in prelimbic.

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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. 

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Background: Recent studies have suggested that impaired fetal growth are indicators that may be present in the first trimester. The aim of this study was to investigate the relationship between crown-rump length (CRL) and pregnancy associated plasma protein-A (PAPP-A) measurements in first trimester for low birth weight (LBW).
Methods: This prospective cohort study were on 120 pregnant women in first pregnan-cy trimester, in Women's Hospital Mirza Kochak Khan in 2011-2012. Gestational age according to crown-rump length and gestational age according to last menstrual period (LMP), neonatal weight, small for gestational age, pregnancy associated plasma protein-A and low birth weight were recorded. Main outcome measures was weight and gestational age at birth. Statistical tests used included descriptive statistics, t-test, χ² and all tests were two-tailed and differences with P<0.05 were considered to be statistically significant.
Results: Our findings showed that a total of 120 cases were included CRL Z-score and log 10 (MOM PAPP-A) were positively correlated with fetal birth weight. The mean Crown-rump length Z-score was significantly can be reduced in LBW in first trimester pregnancy. (P<0.001) Mean PAPP-A in low birth weight was (0.4±0.11 MOM), but in normal weight infants was (1.04±0.7 MOM). (P=0.011) also mean PAPP-A in pregnant women with SGA infants is significantly less than other pregnant women (0.5±0.2 versus 1.1±0.7) (P<0.001).
Conclusion: Our data suggest that crown-rump length and maternal levels of PAPP-A measured during the first trimester are independent factors that influence fetal birth weight. But their predictive powers are not sufficiently good for them to be used alone for low birth weight screening.

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Background: On of the most common gasterointrestinal disease is gallstone disease and it`s prevalence is 11%-36%in autopsies. If gallstone leads to symptoms and side effect cholecystectomy will be inevitable. Gastric infection due to H.P will cause several symptoms of which dyspepsia and epigastric pain are outstanding .Gall stones also usually causes epigastric and/or right upper quadrant pain. Pain in other abdominal quadrant is less common. In this study we investigated the coincidence of gall stone and gastro intestinal H.P regarding the common symptom, between these two conditions to prevent unnecessary operation.
Methods: The cases were adopted from cholecystectomy candidates due to gall stone disease (proved by ultrasonography). The control group were normal people who proved to be gall stone free ultrasonographicly. Serum IgG anti H.P was checked and compared between the two groups.
Results: Seventy percent of patients entered into the study which consisted of 35 case and 35 controls. The two groups were not significantly different in age and gender. There were 22 (68.8%) and 10 (31.2%) H.P positive cases in case and control groups respectively. Thirteen (34.2%) and 25 (65.8%) cases were H.P negative in case and control groups respectively. Comparing these results will reveal a statistically significant difference (P=0.004).
Conclusion: The relationship between gastric H.P and gall stone in this study supports the role of H.P in gall stone formation. According to our results and the common symptoms of two conditions specially in atypic biliary colic, it seems that in many cases gastrointestinal H.P causes the pain. Prospective studies are recommended.

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Background: It is rare to find squamous metaplasia in the thyroid gland. Its existence is usually seen in association with a pathological lesion such as mucoepidermoid carcinoma, squamous cell carcinoma and diffuse sclerosing variant of papillary thyroid carcinoma. In most cases the squamous cells are few in number and squamous metaplasia is focal and small in size. Extensive squamous metaplasia of the thyroid gland is a very rare finding.
Case Presentation: We report a case of massive squamous metaplasia in Hashimoto thyroiditis in a 53 year-old- male with a four year history of hypothyroidism. Also seen in the history is impaired thyroid function tests of low T3 and T4 levels with rise in TSH. The patient currently presented with neck discomfort and a somewhat firm nodular neck mass. Ultrasonography revealed heterogeneous nodular enlargement of both thyroid lobes and a calcified nodule of the left lobe. Fine needle aspiration of the thyroid nodule was performed which reported findings suspicious for malignancy. Based on these findings the patient underwent total thyroidectomy.
Conclusion: In this article we address the causes and sources of massive squamous metaplasia in the thyroid gland. We also discuss the histopathologic differential diagnostic lesions which could be the cause of potential pitfalls encountered in the interpretation of the cytopathology and histopathology of such lesions arising in this gland.

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Background: Polycystic ovarian syndrome (PCOS) is the most common endocrinological disorders that affect approximately 5-7% of women in reproductive age. There is not any consensus about the efficient in vitro fertilization (IVF) protocol for patients with PCOS. The aim of the present study was to compare the half and one-third dose depot gonadotropin-releasing hormone (GnRH) agonist protocols versus the GnRH antagonist protocol in PCOS patients.
Methods: In the present study, we retrospectively evaluated 119 infertile women with PCOS. The patients entered in the study in accordance with Rotterdam criteria. According to GnRH analogue used for pituitary suppression, patients were divided into three groups: half and one-third dose depot GnRH agonist protocols and GnRH antagonist protocol. In GnRH agonist protocol, half or one-third dose depot Decapeptyl (1.875 mg, 1.25 mg) was injected on 21st day of previous cycle. In GnRH antagonist cycles, cetrotide 0.25 mg were administered daily when the leading follicles reached 14 mm. All basal and controlled ovarian hyperstimulation (COH) characteristics were analyzed.
Results: Basal characteristics including: age, FBS, prolactin, hirsutism, length of menstrual cycle were similar between 3 groups. Statically significant decreases in days of stimulation, number of gonadotrophin ampoules and metaphase II (MII) oocytes were found in GnRH antagonist protocol (P<0.001, P<0.001 and P=0.045), while the decrease in biochemical pregnancy (P=0.083) and live birth rate (P=0.169) wasn't significant. Number of embryos transferred were similar in the half and one-third dose depot GnRH agonist and GnRH antagonist cycles (P=0.881). The incidence of OHSS weren't significantly different between 3 groups (5%, 4.9% and 12.8%, P=0.308).
Conclusion: Our study suggest that one-third dose depot GnRH agonist protocol could be a suitable choice for treatment of PCOS because of lower incidence of ovarian hyperstimulation syndrome (OHSS) as compared with half dose depot GnRH agonist and higher pregnancy rate as compared with GnRH antagonist.

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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: Surgeons and anesthesiologists working in orthopedic operating theatres are exposed to significant noise pollution due to the use of powered instruments. This may carry a risk of noise-induced hearing loss. The present study was designed to quantify the noise pollution experienced by anesthesiologists at Imam Khomeini Hospital which is one of the largest Iranian hospitals. Methods: Prior to beginning of any operation a sound level meter was worn by the anesthesiologist at the level of chest pocket. Basal sound level was recorded. All changes in the sound level of 25 operation rooms and two related pass ways were recorded and the mean sound level along with maximum sound level were noted. These data were analyzed by SPSS version 17. For comparing the mean values, the One way ANOVA and Post-Hoc analysis was used. Noise exposures were compared with occupational health guidelines. Results: Our comparative data showed that orthopedic operation room had the highest level of noise, indicating that orthopedic operation room is significantly suffered by the most types of noise with the P value of 0.002. This is contrast to the sound levels at the other operation rooms which were at same range and were not significantly different. Comparison of the maximum sound level between these 27 places showed that orthopedic and one of general surgery room had top two maximum sound levels. Conclusion: Overall total noise dose during all types of surgeries was measured as twice of permitted dose and also orthopedic and general operation rooms experience brief periods of noise exposure in excess.

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Background: Primary cardiac tumors are rare tumors which should be operated urgently. In this study, cardiac myxoma have been evaluated from diagnosis until dis-charge in a 10 years period and then results including presenting symptoms, approach to the patients were compared with similar study in this center a decade ago. Methods: Patients who underwent operation for myxoma from year 2003 until 2013 in the Shahid Modarres Hospital were included in this study. Results: Eighteen patients included in the study, 11 female and seven male. Patients’ ages were in the range of 13 to 76 years (mean 53 years). Mean time from diagnosis to operation was 5.8 days and mean time from surgery to discharge was 8.6±6.1 days. Most common presenting symptoms were first clinical presentation in four patients. In all patents echocardiography was the main diagnostic modality. In addition to trans thoracic echocardiography (TTE), in five patients TEE was used and in 13 patients coronary angiography was used to rule out concomitant coronary artery disease. 94.4% of all tumors (17 cases) were primary cardiac tumors and only one tumor (5.6%) was recurrent. In 16 patients (88.9%) tumor were found in the Left Atrium (L.A) and in one case, tumor was found in both atria and in another case, tumor was in the ventricle. After tumor excision, atrial septum was repaired primarily in seven cases (38.9%) and with pericardial patch in 9 cases. One patient underwent concomitant coronary artery bypass graft (CABG) and another patient underwent concomitant pulmonary valve repair. 14 patients (77.8%) discharged from hospital without any post operative complication. Heart block occurred in one patient and cerebral emboli with secondary cerebrovascular accident (CVA) developed in two patients. One patient died (5.6%). Conclusion: Comparing results from two similar studies in two consecutive decades revealed that mean time from diagnosis to operation obviously was reduced but ad-vances in diagnostic modalities were unable to change clinical presentation or reduce age of tumor diagnosis or complications or size.

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Background: With introduction of intracytoplasmic sperm injection with testicular sperm extraction or precutaneouse epididymal sperm aspiration, effective treatment was provided for azoospermic men. The aim of present study was to compare clinical outcome following intracytoplasmic sperm injection using extracted testicular/epididymal sperm or ejaculated severe oligoasthenoteratozoospermic sperm. Methods: After retrospective evaluation of more than four hundred medical records of patients undergoing intracytoplasmic sperm injection Mehr medical institute (between 2011-2012), 45 cycles with severe eligoasthenoteratozoospermia and 34 cycles with azoospermia were included. Patients were treated with gonadotropin releasing hormone agonist. The clinical characteristics and intracytoplasmic sperm injection outcome such as the rate of fertilization, implantation and clinical pregnancy were compared between the two groups. Results were presented as mean±standard deviation and number (percent). Differences between variables were analyzed using student's t test and the chi-square test was used to examine differences between categorical variables. P value less than 0.05 were considered as statistically significant. Results: Mean of female age (29±4.9 vs. 30.2±5.8), body mass index (26.9±5.3 vs. 26.9±3.8), estradiol level on human chorionic gonadotropin administration day (1375.6±843.9 vs. 1181.8±673.1), total number of retrieved oocytes (9.7±5.3 vs. 9.2±5.9) and metaphase II oocytes (7.7±5.1 vs. 7.5±5.4) were similar between the two groups. Of 436 and 313 retrieved oocytes, respectively 232 and 163 oocytes were ferti-lized in oligoasthenoteratozoospermic and azoospermic groups (53.2% vs. 52.1%, P=0.214). There were not statistical differences between groups in number of trans-ferred top quality embryos (1.5±1.2 vs. 1±1.2, P=0.09), implantation rate (22.7% vs. 16.9%, P=0.238) and clinical pregnancy rate (21 (47.7%) vs. 11 (35.4%), P=0.199). Conclusion: Intracytoplasmic sperm injection with precutaneouse epididymal sperm aspiration and testicular sperm extraction are effective methods to treat azoospermic men and its clinical outcome were comparable to ejaculated sever oligoasthenoterato-zoospermic cycles. It can be concluded that the influence of sperm quality and origin on intracytoplasmic sperm injection outcome are the same.

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Background: Several risk factors like prematurity, hyperoxia, hyperglycemia, duration of mechanical ventilation and supplemental oxygen use have been attributed to the occurrence of retinopathy of prematurity (ROP) in low birth weight infants. Clinical Risk Index for Babies (CRIB) score have been used to assess the severity of the newborn's disease and neonatal mortality. The relation between the CRIB score and the incidence of retinopathy of prematurity is less assessed. This study was carried out to determine the relation between the CRIB score and retinopathy of prematurity in preterm infants. Methods: In a cross-sectional study all preterm infants admitted to NICU from March 2009 to November 2012, with a birth weight less than 1500 grams and gestational age less than 28 weeks and other premature infants with birth weight 1500 to 2000 grams and gestational age 29 to 34 weeks with an unstable clinical condition, were included. The CRIB score was recorded in firs 12 hours of admission to the NICU. Ophthalmologic examination was done by a retinologist unaware of CRIB score. ROP classification was done according to the international classification of ROP. The CRIB score compared with presence or non-presence of ROP and its stage, progression or regression of disease. A P-value less than 0.05 are considered significant. Results: One hundred and eighty (70%) neonates out of 256 neonates developed ROP. In 124 (68.88%) neonates it resolved spontaneously on serial ophthalmologic examination, but fifty-six (31.11%) neonates were required treatment for ROP which 42 (75%) received Avastin and 14 (25%) neonates treated with Laser. The Mean±SD for CRIB score in ROP group was 4.79±2.74 and in a group without ROP it was 3.78±2.00 (P=0.004). No correlation was found between the severity of ROP and CRIB score (P=0.152). Conclusion: The CRIB score can predict the occurrence of ROP, but can't predict its severity and progression or regression.

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Background: Uterine leiomyoma is one of the most common benign smooth muscle tumors occurring in 20-40% of women worldwide in their reproductive years. Recent studies revealed that estrogen plays an important role in the pathogenesis of this disease. Since glutathione S-transferase (GST) gene family are involved in the biosynthesis of estrogen, the prior probability that variants at this locus are associated with uterine leiomyoma is likely to be above the null. Therefore, this study was carried out to examine whether GSTP1 polymorphism (Ile105Val) is associated with increased risk of uterine leiomyoma in Iranian population. Methods: In this case-control study, 50 women diagnosed with uterine leiomyoma and 50 healthy controls were recruited from subjects referred to the Pasteur Institute of Iran from November 2012 to September 2013. The genomic DNA was extracted from peripheral blood leucocytes using the standard phenol-chloroform method and subsequently the GSTP1 polymorphism was genotyped using amplification refractory mutation system-polymerase chain reaction (ARMS-PCR). Logistic regression analysis was applied to estimate odds ratios and 95% confidence intervals after age adjustment using the SPSS statistical software package, version 18.0. Results: The results showed significant differences between case and control groups in terms of genotype frequency (P<0.0001). In addition, the results indicated that the presence of the valine allele significantly increased risk of uterine leiomyoma about three times more in individuals carrying the mutant allele compared to control group (Odds Ratio: 3.34 95%CI: 1.82-6.15 P<0.0001). Conclusion: To our knowledge, this is the first study performed in Iranian population assessing the association between GSTP1 Ile105Val polymorphism and risk of uterine leiomyoma. However, further extensive studies with a large number of samples from different populations and ethnicities are required to validate the results obtained in this study.

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Background: Assessment of the serum lead’s concentration in the newborn immediately after birth can be effective for the detection of lead poisoning in the early stages and prevent of developmental disorders and neuropsychiatric behaviors. This study aimed to assess the serum lead levels of cord blood in some of the hospitalized newborns. Methods: This cross-sectional analytic study conducted in the newborns ward of two hospitals (Rasoul Akram and Akbar Abadi) From December 2011 to October 2012 in Tehran, Iran. After non-probability sampling, 60 newborns in the first days after birth, underwent the cord blood sampling and the cord blood lead levels were measured by atomic absorption spectrophotometer. Then all of data were collected and analyzed. The serum lead concentration greater than 5 μg/dl was considered valuable. Results: In total, 61.4% of samples were boys. The mean (±SD) of gestational age was 37.4±2.64 weeks and mean (±SD) of birth weight was 2701±642.8g. The mean (±SD) of maternal age was 29.20±6.73 years. 70% of mothers were urban. 13% of mothers had a history of drug use, and 5% were current smokers. The mean (±SD) of the serum lead level of cord blood was 2.97±2.24 μg/dl. This level was not associated with fetal gender, place of residence, drug history and current smoking. This level in the 16.7% of samples was greater than 5 μg/dl (high risk cases). High risk level was associated with maternal age, weight and fetal age (P=0.02, P=0.004, P=0.03), but this level was not associated with fetal gender, place of residence, drug history and current smoking. Conclusion: Serum lead level of cord blood was relatively higher than other studies, although the prevalence of the high risk newborns (serum blood lead levels greater than 5 μg/dl) was low. Further research has recommended assessing the serum lead level in other newborns in the different areas to identify risk factors of neuromotor outcome in infants to prevent.

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Background: Uterine myomas are benign tumors of the uterus and the most common solid pelvic tumors causing symptoms in approximately 25% of women in their reproductive years. However, its etiology and pathogenesis remain obscure there is increasing evidence that endometriosis is inherited as a complex genetic trait. Recent studies indicated the involvement of glutathione S-transferase M1 (GSTM1) gene in the pathogenesis of this disease and current investigations are devoted to the other members of phase II detoxification system genes such as glutathione S-transferase T1 (GSTT1). Therefore, current study was carried out to investigate the distribution of GSTM1 and GSTT1polymorphisms in Iranian population in order to estimate possible impact of null-alleles of each gene in development of this disease. Methods: In this study, 50 patients with endometriosis diagnosed by both pathology and laparoscopic findings according to the revised American Fertility Society classification of endometriosis were recruited from subjects referred to the Pasteur Institute of Iran between November 2012 to September 2013. Accordingly, controls (n=50) were subjects without any of aforementioned gynecologic conditions. The genomic DNA was extracted from peripheral blood leucocytes using the salting out method and GSTM1 and GSTT1 genotyping for gene deletions were carried out using Gap-polymerase chain re-action. Logistic regression analysis was applied to assess whether there was any significant risk increase between the case group with higher null genotypes compared to control group. The level of statistical significance was set at 0.05 and all analyses were conducted using the SPSS version 18.0 (SPSS Inc., Chicago, IL). Results: There was significant evidence that the distribution of the GSTM1 and GSTT1 genotypes differed between the patients and the controls with an allelic odds ratio (OR) of 3.56 (95%CI: 1.35-9.37, P=0.01) and 3.92 (95%CI: 1.4-10 P=0.009) respectively. Data analysis also revealed that individuals with both GSTM1 and GSTT1 null genotypes (-/-) had higher risk to develop the disease in comparison to the people with the both present (+/+) genotype (OR:19.23, P=0.007). Conclusion: The findings suggest that the GSTM1 and GSTT1 genetic polymorphisms are associated with the development of endometriosis in Iranian women which is in agreement with previous results obtained in other populations. However, the ethnic variations of polymorphisms should be evaluated in detail and differences should be incorporated into investigations of susceptibility variants for this disease.

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Background: The major issue to address in endometriosis etiology is to identify the genetic changes in the disease and their occurrence in different populations. Uncovering these genetic changes may be important in developing potential biomarkers for early diagnosis and prognosis of endometriosis. Among all endometriosis susceptibility genes studied before, convincing association has been found with variants in the estrogen receptor alpha (ESR1) gene and this disease however, the contributions of these genetic variants in different populations and ethnic groups are not similar. Accordingly, this study was carried out to replicate the previous findings to assess whether this polymorphism is associated with endometriosis in Iranian women. Methods: A case-control study was designed to determine the possible association between ESR1-351A>G variant and occurrence of endometriosis. The study group consisted of 100 subjects diagnosed with endometriosis as case group and 100 fertile women without endometriosis as controls recruited from subjects referred to the Tehran Women’s General Hospital between January to September 2013. All subjects were genotyped for this marker using amplification refractory mutation system- polymerase chain reaction (ARMS-PCR). Association of risk allele (G) with endometriosis was as-sessed using PLINK software after age adjustment. Results: The results showed that the genotype frequencies were in Hardy-Weinberg Equilibrium (HWE) in both case (F=0.04, P:0.67) and control (F=0.02, P:0.83) groups. In addition, there were no significant differences between case and control groups in terms of genotype frequencies (P=0.17). Moreover, the results indicated that the presence of risk allele (G) did not significantly increase risk of endometriosis (OR: 1.43, 95%CI: 0.96-2.13, P=0.07). Conclusion: The results do not support the previous findings of an association between -351A>G genetic polymorphism in ESR1 gene and endometriosis. Therefore, comprehensive genetic approaches including linkage analyses and family-based tests, together with a number of replication studies with large sample size, are needed to make conclusive claims about the role of this genetic polymorphism in susceptibility to endometriosis.

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Background: Helicobacter pylori (H. pylori) cause various diseases especially gastrointestinal disorders. Clinical diagnosis of H. pylori infection can be done in different ways, and new diagnostic methods are under study .This study aimed to assess the levels of interleukin (IL) 6, 17 and 23 in the middle ear effusion of patients with otitis media, and the association between these levels with H. pylori infection. Methods: This cross-sectional study conducted in 40 patients who nominated for ventilation tube (VT) placement due to otitis media with effusion, and admitted to ear, nose, and throat (ENT) clinics of Tehran University of Medical Sciences from March 2012 to August 2013. All of patients underwent myringotomy with VT insertion, and then aspirated effusion sample was tested. H. pylori infection diagnosed by polymerase chain reaction (PCR) and bacterial culture. The concentration of IL-6, IL-17 and IL-23 measured by enzyme-linked immunosorbent assay (ELISA). The levels of each interleukins were compared between the two positive and negative PCR groups. Results: In all of samples, PCR test result was positive in 22.5%. The mean and standard deviation of IL-6 level was 10.11±2.95, IL-17 was 5.89±0.91 and IL-23 was 4.07±1.34. The mean±standard deviation (SD) of IL-6 level in patients with a positive PCR (H. pylori) was 22.29±6.40 and in patients with a negative PCR was 6.16±3.88 that difference was significant (P=0.01). The mean±SD of IL-17 level in patients with a positive PCR was 6.16±1.29 and in patients with a negative PCR was 5.81±1.13 that difference was not significant (P=0.42). The mean±SD of IL-23 level in patients with a positive PCR was 6.15±3.77 and in patients with a negative PCR was 3.42±1.33 that difference was not significant (P=0.27). Conclusion: According to finding, association between H. pylori infection and increased levels of IL-6 in the middle ear effusion was approved. It is recommended to conduct researches aimed to identify other cytokines as inflammatory markers.

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Background: There are many genetic and non-hereditary risk factors that are known to causes venous thromboembolic (VTE) disorders, Cardiovascular diseases and types of cancer. One of these is the Prothrombin G20210A mutation. Prothrombin mutation (guanine to adenine G→A) at nucleotide position 20210, which is present in the 3′ untranslated region of the prothrombin gene. Prothrombin G20210A mutation is present outside the coding region for prothrombin, and hence it does not affect the actual structure of the prothrombin molecule and it does not affect its function as a strong clotting factor when activated into thrombin. However, several studies have shown that, G20210A heterozygosity was associated with a threefold increased risk for VTE. Moreover, the association of PTH G20210A polymorphisms with cancer has been reported. The present study was designed to determine the frequency of PTH G20210A polymorphism in Southern Iran. Methods: In this cross-sectional study, 140 healthy women were from Southern Iran recruited among participants in Namazi Hospital, Shiraz, Iran, from March 2013 to February 2014. A total of 5 ml of peripheral blood was taken from individuals then Genomic DNA was extracted using blood DNA kit (Ron’s Blood and Cell DNA Mini Kit, BioRon, Germany). The amplification refractory mutation system- polymerase chain reaction (ARMS-PCR) method was used for the detection of PTH G20210A single nucleotide polymorphism in each subject. Results: The frequencies of the GG and GA genotypes were as 97.9%, 2.1% respectively. The frequency of G allele was and the frequency of A allele was 1.1%. Conclusion: Results of the present study might be important in understanding the distribution of PTH G20210A polymorphism in the Southern Iran. Minor allele frequency in this population is higher than in the Iranian and European population but similar to the prevalence in the Western Iran, Iranian Jews, American, Irish, Tunisian and Bahraini population.

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Background: Prostate-Specific Antigen (PSA), also known as gamma-seminoprotein or kallikrein-3 (KLK3), is the best marker for early diagnosis of prostate cancer. Since age and race are affecting PSA levels, determining age-specific reference ranges of PSA in every community is necessary for increasing the efficiency rate of PSA. The aim of the present study was to evaluate the normal distribution of total prostate-specific antigen (TPSA) and free prostate-specific antigen (FPSA) and determine age-specific reference ranges of PSA in Iranian men. Methods: In this cross-sectional study, 1200 normal men with the age range of 50 to 79 referred to Shahid Rajaie Hospital, Qazvin Province in Iran, from 2011 to 2013. After excluding patients with prostate cancer and urinary tract infection, 1020 men were included in this study. Then, their blood samples were collected and after the extraction of serum from blood, serum levels of FPSA and TPSA were measured using commercial kits the reference range of PSA was specified for each age group and compared with reference ranges of other populations. Results: The mean age of the patients was 61.03±7.5 years and the mean values of FPSA and TPSA were 0.47±0.6 ng/ml and 1.56±2.05 ng/ml, respectively. PSA serum levels (95th percentile range) in 50 to 59, 60 to 69 and 70 to 79-year age groups were 0-3.6 ng/ml, 0-5.7 ng/ml and 0-6.8 ng/ml, respectively. TPSA (r= 0.2, P< 0.001) and FPSA (r= 0.22, P< 0.001) were significantly associated with age. In addition, a significant relationship was found between TPSA serum levels and alcohol consumption (P= 0.017), smoking (P< 0.001) and family history of prostate cancer (P= 0.014). Conclusion: Findings of the present study showed that PSA levels are correlated with age. It was also revealed that the PSA age-specific reference range obtained in this study is different from other races and is specific to Iranian men. Therefore, age-specific reference ranges of PSA obtained in the present study can increase PSA test sensitivity and specificity by reducing unnecessary diagnostic procedures and early detection of prostate cancer in Iranian men.

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Despite the valuable results achieved in identification of genes and genetic changes associated with type 2 diabetes (T2D), lack of consistency and reproducibility of these results in different populations is one of the challenges lie ahead in introduction of T2D candidate genes. Therefore, the present review article aimed to provide an overview of the most important genes and genetic variations associated with development of T2D based on a systematic search in well-known genetic databases. For this purpose, the National Center for Biotechnology Information, Database of Genotypes and Phenotypes (NCBI dbGaP) and Human Genome Epidemiology Network (HuGENet) database were searched to find the most important genes associated with T2D. In addition, a gray literature search was conducted to collect any available information released by laboratories offering genetic tests such as deCODE genetics and 23andMe. Candidate genes were selected among the results of all databases based on the highest level of similarity. Subsequently, without any time restriction, PubMed, Scopus and Google scholar databases were searched using relevant Medical Subject Headings (MeSH) terms to access related articles. The relevant articles were screened to make a conclusion about the genes and genetic variations associated with T2D. The results revealed that four selected candidate genes, in order of importance, were TCF7L2, CDKAL1, KCNJ11, and FTO. The most significant single nucleotide polymorphism (SNP) associated with T2D in the TCF7L2 gene was rs7903146 however, the results showed a wide range of variation from slight association in the Amish (P= 5.0×10^-2) to strong association in European descent populations (P= 2.0×10^-51). Then, rs10440833 mapping to the intronic region of the CDKAL1 gene showed significant association with T2D (P= 2.0×10^-22). In the KCNJ11 gene, a missense variation (rs5215) in exon one was found to have the highest association with T2D compared with other SNPs discovered in this gene (P= 5.0×10^-11). Finally, rs8050136 located in the first intron of the FTO gene had the strongest association with T2D (P= 2.0×10^-17). On the basis of these results, it can be concluded that the current study can be introduced as a model for achieving well-documented results among spectrum of information available in genetic databases based on a systematic search strategy. The candidate genes and genetic variations presented in this review article might be applied for early diagnosis, prevention, and treatment of T2D.

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Background: Bacterial pneumonia is one of the most common causes of morbidity and mortality, and accurate diagnosis and treatment of the pneumonia causative agent, especially in polybacterial cases, is difficult and much appreciated. The aim of this study was to determine the causative agents and antimicrobial susceptibility of polybacterial pneumonia in patients with lower respiratory tract infections.Methods: In this retrospective cross-sectional study, 167 cases with symptoms of lower respiratory tract infection (LRTI), admitted since March 2010 to March 2013 to Baqiyatallah Hospital, Tehran, were studied. Bronchoalveolar lavage (BAL) samples have been obtained from all these patients and have been investigated for the presence of bacterial causative agent, presence of polybacterial pattern of the infection, and the pattern of antimicrobial susceptibility testing by disc diffusion method. Also, the samples have been studied for the presence of Mycobacterium tuberculosis through culture of specific media, separately.Results: From 167 patients (62 women and 105 men), 90 cases were positive for the presence of bacterial pathogens while 77 cases were negative by culture. The incidence of bacterial pneumonia was not statistically different between men and women. Totally 117 bacterial isolates were obtained belonging to 15 different bacterial species. Mycobacterium tuberculosis (25%), Pseudomonas aeruginosa (15%) and Staphylococcus aureus (14%) were the most frequent pathogens identified. 72 percent of pneumonic cases were monobacterial infections and the others were polybacterial infections (23% two-bacterial, and 5% three-bacteria). The highest antibiotic resistance rate was seen for amoxicillin and the lowest one was seen for vancomycin.Conclusion: This study found that the prevalence of bacterial pneumonia increases with age, and also is caused by different etiologic agents. A high percentage of negative cases may be due to fastidious bacteria, viral agents, and previous antibiotic therapy. Due to high levels of resistance to antimicrobial agents, accurate diagnosis and susceptibility testing of pneumonic patients is essential.