Tehran University Medical Journal

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Background: Surgery is one of the best choices for the treatment of hydatidosis. The use of effective scolicidal agents during surgery for hydatid cyst is essential to prevent the secondary infection. Up to now no effective and safe agent has been identified for this purpose. Berberis vulgaris called “Zereshk” in Persian has been traditionally used as herbal remedy for the treatment of complaints and it is widely cultivated in Iran. Many studies have shown that it has antibacterial, antifungal and antiparasitic effect. Methods: In this study the scolicidal effect of Berberis vulgaris aqueous and hydro-alcohol extract for different concentrations (for aqueous: 0.5, 1, 2 and 4 mg/ml and for hydro-alcohol: 0.25, 0.5, 1 and 2 mg/ml) at different exposure times (5, 15 and 30 minutes) was evaluated. For this purpose, we obtained liver hydatid-cysts from a slaughter house. Viability of protoscolices was assessed by 0.1% eosin staining. Normal saline and hypertonic saline were used as negative and positive controls respectively. Results: All the different concentrations of Berberis vulgaris aqueous and hydro-alcoholic extracts had scolicidal effect. An aqueous extract with 4mg/ml concentration acted as positive control and we observed to lead to the death of 100% of protoscolices in the first 5 minutes. The least scolicidal effect (12.3%) was observed in an aqueous extract with 0.5 mg/ml concentration.The scolicidal activity of hydro-alcoholic extract with concentration of 2 mg/ml was 100% after 5 min of application, which was the same as positive control group. We noticed a significant increase in protoscolicidal activity with an increase in concentration in the two extracts of Berberis vulgaris (P<0.001). Conclusion: It is important to mention that all the concentration levels and exposure times applied in this experiment are relatively low, since scolitical activity in both of the extracts is at its highest in this low spectrum. For further experiments, we suggest that the stability of cyst fluid in both of the extracts should be assessed. Therefore, after In vivo examination and additional experiments, it may be used as a suitable and effec-tive scolicidal in surgery.

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Background: Radiotherapy has been used to treat many types of cancers over the past years. Radiotherapy generates side effects on normal tissues. Radiosensitizer products provide decrease in tumor proliferation and reduce radiation dose in radiotherapy. Docosahexaenoic Acid (DHA) as an omega-3 polyunsaturated fatty acid has anti-proliferative effects on malignant cells. In this study, the effects of DHA accompanied by ionizing radiation on growth rate and survival fraction of HT29 colorectal cancer cells were evaluated. Methods: The present study was performed at the Institute of Biotechnology, affiliated to Urmia University, Urmia, Iran in the year 2013. In this laboratory experiment, ma-lignant cells were cultured in RPMI-1640 supplemented with 10% fetal bovine serum. HT-29 cells were cultured at 5105 cells/well into 6-well culture plates for overnight. Thereafter, the cells were pretreated with either 50 or 100 µM DHA for 4 hours and malignant cells were irradiated with either dose of 2 or 10 Gy. Cell viability was evalu-ated by trypan blue staining after 48 hours. Moreover, malignant cells were pretreated with either 50 or 100 µM DHA for 48 hours and irradiated with dose of 2 to 10 Gy. Thereafter, survival rate was evaluated by 3-(4,5-Dimethylthiazol-2-Yl)-2,5-Diphenyltetrazolium Bromide (MTT) assay after 6 days. Results: Cell viabilities were found to be 59.8% and 17.5% for 50 µM DHA in combi-nation with doses of 2 and 10 Gy respectively. Using 100 µM DHA diminished cell vi-ability up to 47% and 13.9% following doses of 2 and 10 Gy respectively. Treatment of cells with DHA accompanied by increasing doses of γ-rays significantly diminished survival rate. In treated cells with 50 and 100 µM DHA, survival rate were measured to be 79.1%, 57.6%, 42.8%, 40.5%, 34% and 55.8%, 43.7%, 33.6%, 27.9%, 23.5% for doses of 2, 4, 6, 8 and 10 Gy respectively. Conclusion: Our study indicates that DHA decreases colorectal cancer cells prolifera-tion and could provide a new radiosensitizer drug to enhance the efficacy of colorectal cancer radiotherapy.

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Background: In patients who undergoing PCI, association between right ventricular function and outcome of the procedure remained unclear. The present study aimed to determine association between echocardiography findings of systolic right ventricular function and functional status of patients following PCI. Methods: In a cross-sectional study conducted at Imam Ali hospital and heart center in Kermanshah, Iran in 2013, 40 patients with history of inferior wall myocardial infarction (Inf MI) according to previous electrocardiography (ECG) in past hospitalization for MI who were candidate for percutaneous coronary intervention (PCI) on right coronary artery (RCA) and had left ventricle ejection fraction (LVEF) less than 40% were included. The subjects underwent echocardiography on admission to assess echocardiography indices of systolic right ventricular function including tricuspid annular plane systolic excursion (TAPSE), tricuspid annular systolic velocity (TASV), Tei-index (Myocardial performance index), and RV fractional area (RVFA) change that was repeated one month later. Baseline functional status was assessed based on the New York Heart Association functional classification score (NYHA score) that divided to 4 grades. Results: NYHA score improved following PCI procedure (from 2.20±0.46 to 1.10±0.30, P<0.001). The mean score of TAPSE significantly increased from 18.68±2.12 to 20.40±2.11 (P<0.001). The mean of TASV also increased from 13.28±1.52 to 14.85±1.90 (P<0.001). Also, Tei-index was improved from 0.52±0.05 to 0.47±0.03 (P<0.001). Moreover, RVFA was significantly increased after PCI (from 35.02±2.40 to 38.25±2.57, P<0.001). There was no significant relationship between the changes in NYHA score and each of right ventricular systolic function indices. Conclusion: Although right ventricular systolic function considerably improved fol-lowing PCI procedure, but the changes in this improvement is not associated with the improvement of function class after the procedure.

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Background: A variety of endocrine disorders can complicate pregnancy. Diabetes insipidus although uncommon, may have devastating effect on pregnancy outcome, if unrecognized and untreated. The etiology of diabetes insipidus is often unknown, many cases are likely autoimmune, with lymphocytic infiltration of the posterior pituitary gland. Massive polyuria, caused by failure of the renal tubular concentrating mechanism, and dilute urine, with a specific gravity 1.005, are characteristic of diabetes insipidus. The diagnosis of diabetes insipidus relies on the finding of continued polyuria and relative urinary hyposmolarity when water is restricted. Most women require increased doses Desmopressin Acetate during pregnancy because of an increased metabolic clearance rate stimulated by placental Vasopressinase. By this same mechanism, subclinical diabetes insipidus may become symptomatic during pregnancy. Transient diabetes insipidus is associated with acute fatty liver and HELLP syndrome as well as twin gestation. Increased placental Vasopressinase activity, along with insufficient liver degradation in HELLP syndrome and acute fatty liver, may unmask this condition. Diabetes insipidus in pregnancy is rare. The disease results from inadequate or absent antidiuretic hormone (vasopressin) production by the posterior pituitary gland. The increased glomerular filtration rate seen in pregnancy may increase the requirement for antidiuretic hormone. Case presentation: We present a 39 years old woman, gravida3 para3, was admitted to Akbarabadi Teaching Hospital in september 2013. She was admitted due to polyuria, malaise, thirst with slight fever, six days after normal vaginal delivery. The urine volume was 8 lit/day and the specific gravity (S.G.) of the urine was 1.010. The urine osmolarity was lower than the plasma osmolarity. Electrolyte serum examination showed hypernatremia. The patient received 5 µg/day of synthetic vasopressin, in the form of l- deamino-8-Darginine vasopressin (DDAVP). This drug was given as intranasal spray in doses 0.25 mg twice daily. Plasma electrolytes and fluid status monitored carefully with initiation of therapy. DDAVP was used because it was not degraded by vasopressinase. Treatment was continuing, when the symptoms of central diabetes insipidus resolve and urinary concentrating ability was preferred. Maximum urinary osmolality over the next 11 hours was assessed, 730 mosm/kg was considered normal. Conclusion: Close attention to electrolyte and fluid balance is important in the postpartum period. The symptoms of transient vasopressin-resistant diabetes insipidus resolve in few days to a few weeks after vaginal delivery or when hepatic function returns to normal.

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Background: Bispectral Index (BIS) may be used in traumatic brain injured patients with different anatomical sites of injury to evaluate the level of consciousness. The objective of this study is to evaluate the relation between type of brain injury and the presence or absence of frontal lobe damage based on brain CT-scan with BIS monitoring in intubated acute head trauma patients admitted to the intensive care unit (ICU). Methods: Participants of this cross-sectional study consisted of 30 intubated head trauma patients over the age of 15 years old, without any known history of visual or hearing impairments, neurologic disorders, mental retardation, or frontal skin laceration, who were admitted to the ICU in Rasool Akram University Hospital, Tehran. Patients who needed muscle relaxant administration, or those who showed instability of vital signs, hypoxemia, disorders of the blood biochemistry, or blood gases, liver or kidney failure, convulsion or hypoxic encephalopathy during the study were excluded. In the first three days of admission, each patient underwent monitoring of BIS every sixty minutes for just six hours a day. All the hypnotic drugs were discontinued six hours prior to the start of monitoring and fentanyl was the only opioid, which was administered if an analgesic was required. Statistical analysis were used to evaluate the data and p-value less than 0.05 was considered statistically significant. Results: Mean age of all patients was 43.6 years with a Standard Deviation (SD) of 18.96. Presence or absence of frontal lobe injury, had no statistically significant correlations with mean BIS in each three days of study and the mean BIS total. However, mean BIS in the second and third days had statistically significant differences in different types of cranial lesions (contusion, subdural hemorrhage, subarachnoid hemorrhage, etc) which usually have different prognoses. Conclusion: Different kinds of acute traumatic cranial lesions with different prognosis may have different values in BIS monitoring. Presence or absence of frontal lobe injury, had no statistically significant correlations with BIS values.

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Background: Varicocele is recognized as the most common cause of male factor infertility and is found in 15% of the general population. This prevalence increases to 35% in men presenting with primary infertility and between 70 to 80% in men presenting with secondary infertility. The effect of varicocele on Leydig cell function and testosterone production has been always a question. In this study we examined the effect of varicocelectomy on serum testosterone. Methods: This research protocol was approved by the institutional review board at Royan Institute in infertility department and also this study has been done in Royan Institute (Tehran, Iran) during one year since September 2012 till October 2013. In this cross-sectional study, Serum levels of total testosterone in 79 men with clinical varicocele and in 70 fertile men who served as a control group were compared. Men aged 23–46 years with clinically palpable varicoceles as determined by physical examination were studied. Three to 6 months, testosterone levels were measured again after varicocelectomy, then testosterone levels were compared before and after varicocelectomy. Results: The mean of serum testosterone levels before surgery in infertile men with varicocele and fertile men were 590(230) vs. 583(237) ng/dl respectively. No statistically significant changes were noted in serum testosterone levels for any groups. Three month after varicocelectomy mean serum testosterone levels were significantly increased in infertile men with varicocele compared with preoperative levels from 590 (230) to 663 (242) ng/dl (P=0.009). Also the testis volume of patients were examined, which were divided into two groups included the men with testis volume less than 16 ml (<16) and more than 16 ml (≥16). Conclusion: In infertile men affected with clinical varicocele, varicocelectomy seems to have caused positive impact on the level of serum testosterone increase. It is thought that positive effect is probably caused by improvement of the Leydig cell functions which induce the increase of serum testosterone level.

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Background: After primary infection, the number of CD4 T-cells decreases with disease progress. The patient’s immunological status could inform by The CD4 T-cell counts over the time. The main purpose of this study is to assess the trend of CD4 cell count in HIV+ patient that received Antiretroviral Therapy (ART) by using a multistate Markov model to estimate transition intensities and transition probabilities among various states.

Methods: A total of 122 HIV+ patients were included in this cohort study who are undergoing Antiretroviral Therapy treatment in the Iran AIDS center in Imam Khomeini Hospital in Tehran that inter during March 1995 to January 2005 and then fallow up to October 2014. All adults with at least two follow-up visits in addition to their pre-ART treatment were considered to be eligible for inclusion in the study. Continuous-time Markov processes are used to describe the evolution of a disease over different states. The mean sojourn time for each state was estimated by multi state Markov model.

Results: Sample included 22 (18%) female with a mean age of 43.32 (standard deviation 8.33) years and 100 (82%) male with a mean age of 45.28 (standard deviation 8.34) year. Age was divided in to two categories, 40 years old and lower than that 66 (54.1) patents and persons older than 40 years old 56 (45.9) patents. A total of 122 patients were included. 29 patients died during follow-up. One year transition probability for staying in state 1 of CD4 cell count was 51%. This probability for six year was 33%. The mean sojourn time for sate 4 was 21 month. The hazard ratio of transition from state 3 to state 4 was 4.4 in men related to women.

Conclusion: The use of antiretroviral therapy in the treatment of HIV infected persons reduce viral replication and increase in CD4 T lymphocyte count, and delay the progression of disease. This paper is shown the progression of this trend.

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Background: Polycystic ovary syndrome (PCOS) is a common complex condition. Evidences from studies on women with PCOS and rat PCO model suggest that the sympathetic regulatory drive to the ovary may be unbalanced (hyperactivity). Findings that support the involvement of sympathetic nervous system in the pathophysiology of PCOS are that the catecholaminergic nerve fibers in the polycystic ovaries of women with PCOS are denser than in normal ovaries. The purpose of this study was reduction of this hyperactivity.

Methods: This study was clinical trial and was performed in Reproductive Health Research Center, Tehran University of Medical Sciences, Iran, during January 2013 to 2015. A total of 61 women between aged 20-40 years and BMI under 28 kg/m2, who were previously diagnosed with PCOS were assessed. The diagnosis of PCOS was made according to joint criteria of the European Society of Human Reproduction and Embryology and the American Society of Reproductive Medicine (ESHRE/ASRM). The study objectives were explained to the patients before they entered the study, and an informed consent was obtained from all. They were divided into three groups as follows: (i) two study group (n=39) and (ii) control group (n=22). For evaluating effects of alpha-2 inhibitors (Clonidine and Yohimbine) by Eliza, the following variables were evaluated before and after drug therapy: serum cortisol adrenaline (A) noradrenalin (NA) beta-endorphin (&beta-End) insulin as well as sex hormones including FSH, LH and Estradiol.

Results: Our results showed that, Clonidine as central anti-adrenergic drug causes 61% of all pregnancies in the study group. This is high percentage of the pregnancy rate compared with yohimbine (P< 0.001). Yohimbine (Indol alkaloid) as alpha-2 adenoceptor antagonist increases follicular development in this disease. This follicle growth is higher than clonidine (P< 0.01).

Conclusion: Our findings showed that increasing the pregnancy rate and follicular development represent the strategic role of sympathetic nervous system (SNS) in polycystic ovary syndrome and) SNS may thus offer a novel biological and pharmacological target in treatment of PCOS.

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Background: Over the last two decades invasive candidiasis has become an increasing problem in neonatal intensive care units (NICUs). Colonization of skin and mucous membranes with Candida spp. is important factor in the pathogenesis of neonatal infection and several colonized sites are major risk factors evoking higher frequencies of progression to invasive candidiasis. The aim of this study was to detect Candida colonization in NICU patients.

Methods: This cross-sectional study was conducted on 93 neonates in NICUs at Imam Khomeini and Children Medical Center Hospitals in Tehran. Cutaneous and mucous membrane samples obtained at first, third, and seventh days of patients’ stay in NICUs during nine months from August 2013 to May 2014. The samples were primarily cultured on CHROMagar Candida medium. The cultured media were incubated at 35°C for 48h and evaluated based on colony color produced on CHROMagar Candida. In addition, isolated colonies were cultured on Corn Meal Agar medium supplemented with tween 80 for identification of Candida spp. based on their morphology. Finally, polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method was performed for definite identification of isolated species.

Results: Colonization by Candida spp. was occurred in 20.43% of neonates. Fifteen and four patients colonized with one and two different Candida spp., respectively. Isolated Candida spp. identified as; C. parapsilosis (n: 10), C. albicans (n: 7), C. tropicalis (n: 3), C. guilliermondii (n: 2), and C. krusei (n: 1). In present study non-albicans Candia species were dominant (69.56%) and C. parapsilosis was the most frequent isolate (43.47%). Using Fisher's exact test, the correlation between fungal colonization with low birth weight, low gestational age, and duration of hospital stay was found to be statistically significant (P=0.003).

Conclusion: The results of this study imply to the candida species colonization of neonates. Neonates in NICU are at the highest risk for severe infection with Candida parapsilosis. Therefore, isolation of C. parapsilosis as the most common species (43.47%) in present study was noteworthy.

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Background: Spermatogenesis is a complex and highly organized process of proliferation and differentiation of spermatogonial stem cells. Spermatogonial stem cells (SSCs) as a unique stem cell have the potential to self-renewal, differentiation and transmit genetic information to the next generation and play a vital role in maintaining fertility. Sertoli cells as the only somatic cells within the seminiferous epithelium play central roles in the formation of niche and balance between self-renewal and differentiation by secrete many growth factors. Given the importance and widespread use of SSCs, particularly in the treatment of infertility, the aim of this study was to create an optimal environment for the proliferation of SSCs. So we decided to study of undifferentiated (ID4) and differentiated (c-Kit) gene expression in SSCs followed by co-culture with Sertoli cells for a one-month.

Methods: This experimental study was conducted from November 2013 to December 2014 in Department of Anatomy, School of Medicine, Tehran University of Medical Sciences, on immature NMRI mouse (6-3 days old). Initially, Sertoli cells and SSCs were isolated from neonates mouse testes during the two-step enzymatic digestion characteristics Sertoli cells with vimentin marker and SSCs with promyelocytic leukemia zinc-finger (PLZF) marker were confirmed. Then SSCs were cultured in two groups: co-culture with Sertoli and without co-culture (control). Undifferentiated (ID4) and differentiation (c-Kit) gene expression were evaluated by Real-time PCR technique.

Results: Spermatogonial stem cells purity was obtained 66.91% by flow cytometry. The relative expression levels of gene ID4 in co-culture group at the end of each week, compared to the control group showed a significant increase (P<0.05). While the expression of this gene significantly decreased in each group over time (P<0.05). The results of the comparison of the relative expression of c-Kit gene in co-culture group are indicated significant decrease than the control group at the end of each week (P<0.05). In addition, this gene expression was showed significant increase in each group individually over time (P<0.05) ID4 gene expression showed a significant (P<0.05) increase toward the control group, while in the expression of c-Kit was observed a significant (P<0.05) decrease compared with the control group at the end of each week.

Conclusion: According to the results of this study, co-culture with Sertoli cells maintains SSCs in the prolifration stage for long-term, so can be used to optimize the culture medium at the clinic.

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Background: It is reported that high frequency of chromosomal aberrations in peripheral blood lymphocytes of individuals is a marker of cancer predisposition. The aim of this study was to investigate the in vitro frequency of chromosomal damage in lymphocytes of patients with head and neck cancer against gamma irradiation compared with those in healthy individuals.

Methods: In a case and control study, peripheral blood lymphocytes of 101 patients with head and neck cancer were collected before the onset of radiotherapy. Lymphocytes of 40 healthy individuals were also collected as controls. Head and neck cancer patients and the control group were consecutively recruited between April 2012 and February 2015 from Clinics of Cancer Institute, Imam Khomeini Hospital, Tehran, Iran. Lymphocytes of patients or control group were cultured and exposed to gamma radiation in G2- and G0- phase of the cell cycle. The induced chromosomal aberrations such as chromosome and chromatid breakages, chromosome and chromatid gaps, chromatid exchanges and micronuclei were scored in one-hundred metaphase cells of each individual. The mean of each chromosomal aberration was compared in patient and control groups. Early and late tissue reactions were scored during radiotherapy treatment or thereafter.

Results: There was no significant difference in demographic characterization between the two study groups. The frequency of radiation- induced G2 aberrations in lymphocytes of patients was significantly higher than in those of healthy donors (P= 0.001 for chromosomal breaks). The frequency of radiation-induced micronuclei in G0 assay was also higher in patients than in those in controls (P= 0.05). The results also indicate that there is no correlation between the two assays. No significant correlation was also observed between aberration frequencies in lymphocytes and the degree of both early and late normal tissue reactions.

Conclusion: The results indicate that the in vitro chromosomal radiosensitivity of peripheral blood lymphocytes of patients with head and neck cancer against gamma irradiation was significantly higher than that in healthy individuals.

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Background: Hydroxyapatite nanoparticles have a more surface contact and solubility than conventional hydroxyapatite. Hydroxynanoparticles enhances the biological and mechanical properties of new regenerated tissues. The hydroxyapatite nanoparticles have received attention as a new and effective osseous graft for using as scaffolds in bone regeneration. The reports on hydroxyapatite nanoparticles biocompatibility are controversial. It has been shown that hydroxyapatite nanoparticles induces inflammatory reaction and apoptosis. The aim of the present study was to evaluate the cytotoxicity of nano-hydroxyapatite on the human epithelial cells.

Methods: The study was experimental and completed in vitro. The study was carried out in department of Immonulogy, Faculty of Medicine, Shahid Beheshti University of Medical Sciences in November 2014. The human-derived oral epithelium cell line (KB) obtained from Pasteur Institute, Tehran, Iran were exposed to hydroxyapatite nanoparticles at 0.01, 0.05, 0.1, 0.5, 0.75, 1, 2.5 and 5 mg/ml concentrations in 24, 48 and 72 hours. Rod-shaped hydroxyapatite nanoparticles with 99% purity and maximum 100 nm sized particles were used. Methylthiazol tetrazolium bromide (MTT) method was employed for cell vitality evaluation. Enzyme-linked immunosorbent assay (ELISA) was used for assessing the viability of cells. Distilled water and fetal bovine serum (FBS) were positive and negative controls. ANOVA and Duncan tests were used for statistical analysis.

Results: The cytotoxicity of different concentrations of hydroxyapatite nanoparticles on human-derived oral epithelium cell line in 24 (P< 0.001), 48 (P< 0.001) and 72 hours (P< 0.001) was significantly different. The nano-hydroxyapatite particles at 0.5 to 1 mg/ml had the highest cytotoxicity effect on human-derived oral epithelium cells in 24, 48 and 72 hours. Lower concentrations than 0.05 mg/ml had the best biocompatibility properties in 24, 48 and 72 hours.

Conclusion: Hydroxyapatite nanoparticles had a good biocompatibility. The biocompatibility of hydroxyapatite nanoparticles were dose and time dependent. The lower concentrations than 0.05 mg/ml of nano-hydroxyapatite had the best biocompatibility over time.

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Background: Polycystic ovary syndrome (PCOS) is a common complex condition in women associated with reproductive and metabolic systems and also psychological disorders. There is considerable evidence to suggest that the sympathetic nervous system is involved in PCO and metabolic syndromes. Noradrenalin (NA), corticotrophin releasing hormone (CRH) and nerve growth factor (NGF) are the strong stimulants for two axes: hypothalamic-pituitary-adrenal (HPA) and hypothalamic-pituitary-ovarian (HPO) axes which are regulators for the female reproductive system. Following previous studies on sympathetic nervous system over activity in PCOS, the main purpose of this study is to evaluate the role of CRH and NGF as two important findings from the perspective of the psycho-emotional.

Methods: This case-control study was conducted in Reproductive Health Research Center of Imam Khomeini Hospital, Tehran, Iran in the September of 2011. 170 women participated in this study. The diagnosis of PCOS was made according to the joint criteria of the European Society of Human Reproduction and Embryology and the American Society of Reproductive Medicine (ESHRE/ASRM). All women have 20-40 years of age and body mass index (BMI) of less than 28. Demographic questionnaire was used in this study and blood sample was obtained from all participants before 8AM. All analysis was done in SPSS software, version 19 (IBM SPSS, Armonk, NY, USA). P-value less than 0.05 considered as significant level.

Results: Serum levels of CRH and NGF in patients with polycystic ovary was significantly lower than the control group (P< 0.001). This reduction can disrupt two neural axes: the sympathetic nervous system (SAS) and hypothalamus-pituitary-adrenal (HPA). These axes have a fundamental role in psycho-emotional reactions in women with PCOS. Moreover, using demographic questionnaire quantitative and qualitative characteristics of the population studied, the results of which are reported in the regression model.

Conclusion: The results of this study confirmed previous studies. This reduction in serum levels of CRH and NGF shows the hyperactivity of sympathetic nervous system in polycystic ovary syndrome can be one of the causes of mental disorders in women with PCOS.

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Background: Schizophrenia (SC) and bipolar disorder (BD) are two chronic psychiatric illnesses with worldwide distribution. People could be involved at any age, particularly in early adolescence. Main symptoms of SC are non- affective symptoms such as auditory hallucination and illogical thinking. In contrast, BD represents affective symptoms such as depression and mania. Although the main cause of these mood disorders has been remained elusive, there are some potential contributing factors that could be considered in the pathogenesis of mentioned illnesses including, genetic and environmental factors. Cytomegalovirus (CMV) is one of the probable contributing factors in SC and BD. CMV is a prototype of herpesviridae family which may infect different cell types such as endothelial and differentiated hematopoietic cells. CMV infections in immunocompromised patients as well as congenitally infected children represent CNS complication such as microcephaly and hearing loss. This virus has capability to impair the limbic structures in brain. Methods: This descriptive study was designed to evaluate the role of CMV in these illnesses. We investigated the level of serum IgG antibody and the presence of CMV DNA in serum and peripheral blood mononuclear cells (PBMCs) samples of 46 SC and BD patients admitted to Iran Psychiatry Hospital Tehran, Iran from 2014 to 2015 as well as 46 healthy control groups at Tehran University of Medical Sciences.  First, the level of CMV IgG antibody was evaluated in serum samples, by enzyme-linked immunosorbent assay (ELISA). Then, DNA extraction conducted by using the high pure viral nucleic acid kit (Roche, Germany). Serologically positive sera along with PBMC samples were tested by Real-time PCR, to investigate the presence of CMV DNA. Results: Results indicated higher levels of CMV IgG antibody in psychiatric patients, compared with a healthy control group. Afterward, we did not observe the presence of CMV DNA in either case or control groups. Conclusion: According to the CNS impairment mediated by CMV infection, this virus has been supposed to play an important role in pathogenesis of mental disorders such as SC and BD. We suggest further investigation to be conducted, particularly on other samples such as cerebrospinal fluid.

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Results: Eleven studies within a total of 261 patients were included in this review. In seven studies the shock waves were applied to the upper limb muscles, and in four other studies, the effects of ESWT on the spasticity of the lower limb muscles were assessed. Immediately after applying the ESW, MAS grade was significantly decreased in comparison to the baseline values. (Standardized mean difference [SMD], -1.62; 95% confidence interval [CI], -2.2 to -1.04). The PROM was significantly increased immediately after ESWT in comparison to the baseline values (SMD, 3.23; CI 95%, 1.35 to 5.12). Conclusion: The results of this study showed that ESWT can immediately improve the spasticity and increased PROM, but it seems that the mechanism of action of shock waves on spasticity is still unclear. Further clinical trial studies with higher methodological quality should be recommended.

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