Tehran University Medical Journal

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Background: Influenza viruses are one of the most important etiological agents of res-piratory disease in humans and cause epidemics and pandemics with substantial mor-bidity and mortality worldwide. Vaccination and antiviral treatments are the sole and essential way for the prevention and control of influenza infection. During an influenza epidemic before the production of effective vaccine, antiviral treatments are the first step for the prevention and treatment of influenza infection. Adamantanes and neuraminidase inhibitors are influenza antiviral drugs. Because of the increase of drug resistant viruses, the aim of this study was the evaluation of the antiviral drug resistance in influenza A/H3N2 viruses from 2005-2013 in Iran. Methods: In this study 50 influenza A/H3N2 viruses isolated in cell culture were tested. All samples were subjected to M and NA gene sequencing at the National Influenza Center, School of Public Health, Tehran University of Medical Sciences. RNA was ex-tracted from 200 µl of cell culture supernatants using the Roche high pure viral nucleic acid kit. RT-PCR with the Qiagen one step RT-PCR kit was done. The expected size of the PCR products were analyzed by electrophoresis using 1% agarose gels. The PCR products were sequenced for finding the drug resistant mutants. Results: All influenza A/H3N2 viruses except four viruses circulating during 2005-2006 had Ser31Asn mutation at M2 channel protein. In the analysis of neuraminidase gene none of the A/H3N2 viruses had K292R, E119V and N294S mutations responsible for drug resistant strains. Conclusion: This study showed circulating A/H3N2 viruses was resistant to adaman-tanes but susceptible to neuraminidase inhibitors. The national data analyzed in this re-search may help increase knowledge about influenza virus antiviral drug resistance, which is a global public health concern. The authors suggested continuing this study and also the investigation of antiviral drug resistance of influenza A/H1N1 and B viruses.

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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: Gonadotropin-releasing hormone analog (GnRHa) therapy is used in central precocious puberty (CPP) worldwide and it is the treatment of choice for this condition. Many of the previous studies concerning the effect of gonadotropin-releasing hormone analog (GnRHa) therapy on height. Much less attention has been paid to changes in body weight. However, concerns have been expressed that CPP may be associated with increased body mass index (BMI) both at initial presentation and during GnRH agonist treatment, but it is controversial in some studies. Methods: We have retrospectively reviewed 52 female patients that the majority of them had CPP. We assessed height, height SDS, weight, weight SDS, BMI and BMI SDS. All patients were treated with GnRHa over 12 months. The variables were evalu-ated at 0, 6 and 12 months after initiation of treatment.8 girls received growth hormone concomitantly. Also bone age and sexual maturity were measured. Bone age was assessed according to the Greulich-Pyle method and sexual maturation was classified according to the Marshall-Tanner method. Results: Before the initiation of therapy, the girls had a mean BMI SD score for chronological age of 0.80± 1.18 after 6 months of therapy BMI SDS was 0.82± 1.15 and after 12 months was 0.82± 1.28 the P value is 0.909 and it is not statistically signif-icant. Height SD score for chronological age was 0.41± 1.65 before the initiation of therapy and was 0.41± 1.65 after 6 months and 0.43± 1.60 after 12 months of therapy. The P= 0.66 and it is not statistically significant. Eight girls received growth hormone concomitantly, in this group increasing height SDS is statistically significant P= 0.044 but increasing BMI SDS is not significant. Conclusion: Gonadotropin-releasing hormone analog (GnRHa) therapy in central precocious puberty (CPP) is safe for BMI and increasing of BMI is not significant, long- term follow-up study is required to elucidate whether GnRHa treatment affects adult obesity. Using growth hormone concomitantly, the effect on increasing height is significant.

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Background: Anabolic-Androgenic Steroids (AAS) are mainly abused by athletes for improvement of muscle performance. Data suggest that the effect of AAS on neurobiochemicals related to behavioral response, may be underlies psychological adverse effects. Physical activity has beneficial psychophysiological effects, which may be related to increased serum levels of endogenous opioid peptides during exercise. In the present study we aimed to study the effect of chronic administration of nandrolone decanoate on beta-endorphin and met-enkephalin level in exercising rats. Methods: In this experimental study, forty male Wistar rats were randomly assigned in two main groups of sedentary and trained (2 weeks swimming exercise). Animals in each group were divided in two subgroups of control (received nandrolone solvent) and drug treatment (received nandrolone 15 mg/kg, 5 times/week). After two weeks of swimming exercise and drug treatment, serum levels of beta-endorphin and met-enkephalin were measured using ELIZA. Results: Our data showed that two weeks of swimming exercise training significantly increased serum beta-endorphin (114±5 vs. 98±5 ng/l in control group, P= 0.038) and met-enkephalin levels (1556±42 vs. 1475±27 ng/l in control group, P= 0.25). However, chronic administration of nandrolone decanoate in trained group considerably de-creased beta-endorphin (84±4 vs. 114±5 ng/l in control group, P= 0.002) and met-enkephalin levels (1378±36 vs. 1556±42 ng/l in control group, P= 0.011). The effect of supraphysiologic doses of nandrolone decanoate in control sedentary group was not statistically significant. Conclusion: In the present study we show that chronic nandrolone decanoate admin-istration attenuates effects of two weeks swimming exercise on serum opioid peptide and reduces the level of beta-endorphin and met-enkephalin. Keeping in mind that opi-oidergic system play an important role in behavior, athletes abusing anabolic steroid drugs may potentially experience changes in mood and behavior.

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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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Helicobacter pylori (H. pylori) is the causative agent in development of gastroduode-nal diseases, such as chronic atrophic gastritis, peptic ulcers, mucosa associated lym-phoid tissue (MALT) lymphoma, and gastric cancer. H. pylori has been associated with inflammation in cardia, showing the fact that infection with this bacterium could also be a risk factor for gastric cardia cancer. Gastric cancer is the fourth most common cancer worldwide. This is the second leading cause of cancer-related deaths, and ap-proximately 700,000 people succumb each year to gastric adenocarcinoma. It has been estimated that 69% of the Iranian population currently harbor H. pylori infection. The prevalence of duodenal ulcer and gastric cancer is high in Iranian populations. However, this has been largely influenced by geographic and/or ethnic origin. Epidemi-ology studies have shown that host, environmental, and bacterial factors determine the outcome of H. pylori infection. The bacterium contains allelic diversity and high genet-ic variability into core- and virulence-genes and that this diversity is geographically and ethnically structured. The genetic diversity within H. pylori is greater than within most other bacteria, and its diversity is more than 50-fold higher than that of human DNA. The maintenance of high diversification makes this bacterium to cope with particular challenges in individual hosts. It has been reported that the recombination contributed to the creation of new genes and gene family. Furthermore, the microevolution in cagA and vacA genes is a common event, leading to a change in the virulence phenotype. These factors contribute to the bacterial survival in acidic conditions in stomach and protect it from host immune system, causing tissue damage and clinical disease. In this review article, we discussed the correlation between H. pylori virulence factors and clin-ical outcomes, microevolution of H. pylori virulence genes in a single host, microevolu-tion of H. pylori during primary infection and progression of atrophic gastritis to ade-nocarcinoma, and H. pylori infection status in Iran. Finally, we put forward the hy-pothesis that if the pattern of nucleotide sequence evolution shifts from recombination (r) to mutation (m) and the r/m ratio is reduced, bacterial pathogenicity may be re-duced while maintaining the bacterial life. However, this hypothesis should be further studied with future experiments.

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Background: Maternal mortality is one of the most important indicators of women health standard in developing countries. This study aimed to determine the prevalence of risk factors and etiology of maternal mortality in a geographic region of Iran. Methods: This descriptive- analytic cross sectional study included all pregnant women who died during pregnancy and six weeks after delivery due to pregnancy related fac-tor. The study was done in Sistan region in the north of Sistan and Baluchestan Prov-ince of Iran from April 2002 to March 2014. The immigrant women were excluded. Data were collected using 3 parts questionnaire. The validity and reliability of ques-tioner were approved by experts in this field. Data were analyzed using the statistical software SPSS version 18, Chi-square test and ANOVA analysis were performed. Results: The total number of deliveries during this time period was 60496. The total number of maternal mortality was 57 patients which means 94.2 out of 100.000 live births. Most of the dead mothers had more than 35 years old (46.9%), gestational age was more than 22 weeks (77.2%), gravidity more than 4 (21.1%), pregnancy interval lower than two years (46.9%) and 75.4% of death was in post-partum. The main cause of mortality was post-partum hemorrhage (19.3%). Conclusion: Based on our findings, some factors including multiparity, pregnancy his-tory more than 4 times, short interval between pregnancies lower than 2 years and ma-ternal age more than 35 years were some risk factors for maternal death. Maternal mortality in the postpartum period was more than pre-delivery period. Bleeding was the main cause of maternal mortality. Therefore monitoring of vital signs in the post-partum period and the proper management of bleeding are very important. It is sug-gested that risk assessment should be done for pregnant women in delivery ward for detecting high risk pregnant women. Suitable management for these women especially for patients with postpartum hemorrhage plays an important role to decrease the ma-ternal mortality.

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Background: Diabetes can cause undesirable changes in structure of the placenta, re-sulting increase in size and weight of placenta. The aim of this study was, to investigate the placenta weight, size and birth weight of infants in pregnant women with controlled gestational diabetes compared with normal pregnancy. Methods: This study was conducted from October, 2012 to February, 2014 in two dif-ferent hospitals, Valiasr and Shariati Hospitals in Tehran. Sixty-seven healthy singleton pregnant and 42 pregnant women with diabetes were selected during 26-28 weeks of gestational ages. Glucose tolerance tests (GTT) were performed to evaluate blood glu-coses. Blood glucoses were controlled in diabetic cases very well. Length and width of the placentas were measured using ultrasonography during pregnancy. After termina-tion of pregnancy, placental weights were measured and recorded using weighting scale with 10 gram accuracy by someone who didn't know about diabetes status. Baby weights were measured after birth and initial stabilisation. Results: In this study, there were no significant differences between gestational diabe-tes mellitus (GDM) and healthy groups in Body Mass Index (BMI) factors. There was no statistically significant differences between the mean weight of infants born with gestational diabetes and control groups. There were no statistically significant differ-ences between the mean placental weights between two groups. Ratio of the placental weights to the birth weights between the two groups were not statistically significant. The mean placental length, width and placenta length times by width in two groups had no significant differences, but the mean gravidities in healthy group was 1.7910 and in gestational diabetes mellitus was 1.9762 that are significantly different (P=0.0217). The mean parities respectively were 0.6567 and 0.8100 which was not sig-nificantly different (P=0.0183). Conclusion: The present study has shown there was no significant differences between fetal and placental weights in normal pregnancies and women with controlled gesta-tional diabetes.

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Background: Diarrhea is the most common bacterial infections, and the main cause of death in the children. Worldwide, food and waterborne diseases are estimated to cause more than two million deaths per year. Foodborne diseases and resistance to antimicrobial agents are two problems worldwide and are increasing. However, standard surveillance systems do not routinely collect information on controls. The aim of this study was to analysis epidemiological data of foodborne outbreaks at the country level. Methods: This is a descriptive study, in total 305 fecal swab samples from 73 outbreaks during one year from April 2012 to March 2013 in different provinces of Iran, were collected and transferred to the microbiology laboratory of Public Health School of Tehran University of Medical Sciences to identify the cause’s diarrhea. The patterns of antibiotic-resistance were determined by using Kirby Bauer method. Results: In total 73 food borne outbreaks that were studied, the largest number 26 (35.6%) were found in Hamadan province with 103 samples (34.2%). Out of 73 outbreaks 40 (54.79%) of were related to foods, 6 (8.22%) to water, and 27 (36.98%) were unspecified (P< 0.0001). Fifty seven outbreaks (78.08%) in the city and 16 outbreaks (21.92%) occurred in rural areas (P< 0.0001). The most dominated Gram-negative isolated organisms were Shigella (6.9%) and Gram-positive bacteria Staphylococcus aureus (12.8%). The dominated age group was under five years (16.4%), and dominant gender group was men 186 (61.8%) (P< 0.0001). In total 69 (22.9%) were hospitalized and 11 deaths were reported. Most clinical symptoms of abdominal cramping (82%), nausea and vomiting (68.4%), bloody diarrhea (23.3%), and non-bloody diarrhea (76.7%). All the isolated gram-negative were sensitive to ciprofloxacin and resistant to clindamycin. The gram-positive were sensitive to cephalexin and resistant to penicillin. Conclusion: The knowledge of bacterial agent of foodborne diseases and determination of antimicrobial resistance pattern are helpful to reduce the rate of foodborne outbreaks, the cost of treatment. The prevention control of outbreaks is also very important.

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Background: Maternal Body Mass Index (BMI) is considered as one of most effective determinant of delivery rout, by increase in this index, risk factor of cesarean section enhanced. Based on high prevalence of obesity in women, this study designed to assess the relationship between admission BMI and type of delivery. Methods: Five hundred and forty pregnant women in third trimester of pregnancy (≥37weeks) were studied within 1 year (from June 2012 to June 2013), at Sayad Shirazi Referral Hospital, Gorgan, Iran, through a analytic cross-sectional study. BMI was calculated for each mother at the time of labor admission. Height and weight were measured, and were categorized into 3 groups according to their BMI which included of underweight and normal (BMI<25), overweight (BMI=25-29.9) and obese (BMI≥30). And in each group route of delivery (cesarean or natural delivery) were assessed. Pregnant women with the previous cesarean delivery, history of diabetes type 1, 2 or gestational diabetes, hypertension, twin pregnancy and unwilling to participate in study were excluded from study. Results: Mean of age and mean of gestational age were 25.8±5.4 years and 38.2±2.6 week, respectively. 50.6% of mothers were undergone cesarean delivery and there was a significant relationship between BMI and type of delivery (P<0.0001). For each unit increase in BMI, risk of cesarean section rose 1.08 times (CI95%=1.04-1.13, P<0.0001) and the risk of cesarean delivery in obese pregnant women was 2.8 (CI95%=1.7-4.4, P<0.0001) times higher than those with underweight and normal weight. Conclusion: There is a significant relationship between maternal BMI at the time of labor admission and type of delivery and increasing of BMI is associated with increasing of cesarean section rate. Thus, keeping the BMI in normal range during pregnancy is suggested to pregnant women to reduce the pregnancy complications.

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Background: Due to the overlap between the databases of the subject and content, resulting in the purchase of duplication and waste of resources, in this study, the degree of overlap between respiratory system papers indexed in the database, Scopus and Web of Science during the years 2001 to 2010 were examined. Methods: In this survey study, researcher followed by obtaining percent overlap in the articles related to respiratory system field from 2001 to 2010. At first sub-headings contained in the following subject headings from medical thesaurus of (Mesh 2012) extracted and then each keyword in title of articles in both database search and articles were retrieved. Then bibliographic information of these articles enter into EndNote version X3 (Thomson Reuters Inc., New York, NY, USA) and then in alphabetical order title arranged and as a result, common articles between the two databases and unique articles to each site was determined. Using SPSS software version 0.1.0.8 amount of the relative overlap and traditional overlap between the two databases was calculated and the results by using descriptive statistics to determine and were presented in tables. Results: In total 18099 articles were retrieved. That number of 9768 common articles, there were 7225 articles uniquely Scopus and 1106 articles from Web of Science. Amount of percent traditional overlap 53.97% and the overlap percent Web of Science with Scopus was 57.48% and Scopus with Web of Science was 89.83%. Conclusion: Because of overlaping the contents of two information databases such as scopus and web of sciences searching for accessing to respiratory system from scopus is better due to containing unique papers ,However it is highly recommended to pay to this point while buying and sharing the mentioned resources.

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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: Ondansetron is a 5-hydroxytryptamine receptor antagonist which is a highly effective antiemetic for postoperative and chemotherapy induced nausea and vomiting. It is an off-label drug to treat nausea and vomiting of pregnancy but availa-ble data about its safety is limited. In this study our purpose was to evaluate neonatal outcomes in women who received this treatment. Methods: This study is a descriptive retrospective case series study, included 22 preg-nant women who treated with ondansetron due to repeated nausea and vomiting unre-sponsive to our center's protocol, at Mahdiyeh Hospital, Tehran, Iran from May 2006 to September 2014. We investigated neonatal factors including: gestational age at birth, stillbirth, neonatal birth weight, apgar score, need to NICU admission and major birth defects. Results: The outcomes of 22 pregnancies and 22 newborns are presented here. We had two twin pregnancies and two abortions. Ondansetron was initiated in 18 cases (72%) on average gestational age of 9 weeks, during organogenesis. In 8 cases (32%) on-dansetron continued till third trimester of pregnancy. In primary evaluation, all the pa-tients had ketonuria, 15 cases (60%) had hypokalmia (K< 3.5), 3 cases (12%) had ab-normal TSH that all of them were hyperthyroidism and 5 cases (20%) had abnormal liver function test (LFT) Three patients (12%) had positive urine culture, one patient had hypercalcemia and one patient who was known a case of hypocalcemia had low serum calcium. The mean time of admission due to hyperemesis gravidarum (HG) was 5 days (2-10 sd=1.92). In this study we had only one preterm birth and the mean neo-natal birth weight was 3110 gram, one newborn was low birth weight due to preterm birth. Finally none of newborns had low apgar score, no one needed to NICU admis-sion and no congenital anomaly was seen in neonates. Conclusion: Ondansetron taken during pregnancy was not associated with increased risk of adverse fetal outcomes.

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Background: Pregnancy is a phenomenon that antigens of semi allogenic fetus are in direct contact with mother's immune system. Immune dysregulation can cause fetus rejection by mother's immune system responses. Human leukocyte antigen-G1, as an immunotolerant molecule has a major role to induce tolerance during pregnancy by suppression of natural killer cells through inhibitor receptors on these cells. Natural killer cells have an important role in immune surveillance and these cells can be reaction with HLA-G molecules on the trophoblast cells surface. This function prevents natural killer cell invasion against fetus trophoblast cells. The purpose of this study was determination of natural killer cells percent and human leukocyte antigen-G1 expression in peripheral blood of threatened-abortion pregnant women in comparison with control group. Methods: This case-control study was conducted from, February 2014 to October, 2014 in Baghban Clinic in Sari City, Mazandaran province. We investigated 21 threatened-abortion women with light bleeding or spotting less than twenty weeks of pregnancy in comparison with 21 normal pregnant women as control group. Peripheral blood mononuclear cell was isolated by ficoll histopaque (1.077) and natural killer cells percent were evaluated by flow cytometry. Furthermore, we assessed the human leukocyte antigen-G1 isoforms expression by real-time polymerase chain reaction (PCR) in case and control groups. Results: The results of this study was shown that natural killer cells percent in threatened-abortion pregnant women was significantly higher than normal pregnant women (P=0.03). In addition, human leukocyte antigen-G1 isoform had a lower expression in threatened-abortion pregnant women in comparison with control group (P=0.004). Conclusion: Decreasing of human leukocyte antigen-G1 expression with increasing of natural killer cells level in threatened-abortion pregnant women is an indicator of mother's immune system dysregulation in comparison with control group. Therefore, it is concluded that in the threatened-abortion pregnant women, human leukocyte antigen-G1 expression level with natural killer cells percent as diagnostic marker must be determine.

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In situ hybridization (ISH) is a method that uses labeled complementary single strand DNA or RNA to localize specific DNA or RNA sequences in an intact cell or in a fixed tissue section. The main steps of ISH consist of: probe selection, tissue or sample preparation, pre-hybridization treatment, hybridization and washing, detection and control procedure. Probe selection is one of the important aspects of successful hybridization. ISH sensitivity and specificity can be influenced by: probe construct, efficiency of labeling, percentage of GC, probe length and signal detection systems. Different methods such as nick translation, random priming, end tailing and T4 DNA polymerase replacement are used for probe generation. Both radioactive and non-radioactive labels can be used in order to probe labeling. Nucleic acid maintenance in samples, prevention of morphological changes of samples and probe penetration into tissue section are the main aims of sample preparation step. Then, a small amount of solution containing probe, is added on slides containing tissue sections for hybridization process, then slides are incubated overnight. Next day, washes are carried out to remove the probes which are not bound to target DNA or RNA. Finally, in order to be sure that the observed labeling is specific to the target sequence, using several control procedures is very important. Various techniques based on ISH consist of: Fluorescence in situ hybridization (FISH), chromogenic in situ hybridization (CISH), genomic in situ hybridization (GISH), comparative genomic hybridization (CGH), spectral karyotyping (SKY) and multiplex fluorescence in situ hybridization (MFISH). One of the most common techniques of ISH is fluorescence in situ hybridization. FISH can be used to: 1) detect small deletions and duplications that are not visible using microscope analysis, 2) detect how many chromosomes of a certain type are present in each cell and 3) confirm rearrangements that are suspected after microscope analysis. In this technique different fluorescent labels are attached to the probes. In this review article ISH, its different types, their application, advantages and disadvantages have been considered.

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Background: Warfarin is the most common oral anticoagulant. This drug is used for the prevention and treatment of thromboembolic patients. It is difficult for physician to predict the results of warfarin prescriptions because there is narrow boundary between therapeutic range and complications of warfarin. Therefore drug dose adjustment is normally performed by an expert physician. Decision support systems that use extracted knowledge from experts in the field of drug dose adjustment would be useful in reducing medical errors, especially in the clinics with limited access to experts. The aim of this study was to propose a method for boosting the maintenance dose of warfarin for a maximum period of three days to eliminate disruptions in International Normalized Ratio (INR). Methods: In a retrospective study, from December 2013 to February 2014 in Shahid Rajaee Heart Center, Tehran, Iran, 84 patients with International Normalized Ratio below (INR) the therapeutic range was selected who was undergone a boosting dose during three days. Patients with unstable maintenance dose were excluded from the study. In this study, data from 75 patients receiving warfarin therapy were used for developing and evaluation of the proposed model. The INR target range for 37 patients out of remaining 75 cases was between 2.5 and 3.5, while for 38 patients the intended INR range was between 2 and 3. A separate fuzzy model was designed for each of the above-mentioned therapeutic ranges. Results: The recommended dose for 37 patients having INR therapeutic range of 2.5 to 3.5 has mean absolute error and root mean squared error of 1.89 and 2.78 respectively for three days. These error rates are 1.97 and 2.88 respectively for 38 patients who are in therapeutic range 2 to 3. Conclusion: The results are promising and encourage one to consider this system for more study with the aim of possible use as a decision support system in the future.

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Background: Today obesity and overweightness are the major health problem all over the world. The relation between decreasing serum level of vitamin D and some chronic diseases such as diabetes and obesity was shown in the available studies. The aim of this study was to determine the prevalence of vitamin D deficiency among obese and overweight Iranian population and its relation with age, sex, occupation, body fat percentage and body weight according to body mass index. Methods: In a descriptive cross-sectional study, all patients who were referred to obesity clinic of Imam Khomeini Hospital, Tehran, for weight management throughout one year were included to the study. The prevalence of vitamin D deficiency with serum level lower than 30 ng/ml among 107 subjects was evaluated. The data were analyzed by SPSS, ver. 19 (SPSS, Inc., Chicago, IL, USA). Quantitative variables were presented as mean±SD and qualitative variables were presented as relative frequency. The groups were compared with independent samples t-test and Chi-square test. The level of significance for comparing the groups was considered at P<0.05. Results: In 107 participants, vitamin D deficiency in 81 subjects (75.7%) was reported. The prevalence of deficiency in participants with body mass index between 25 to 29.9, 30 to 34.9 and equal or greater than 35 kg/m2 was 77.3%, 83.7% and 69.4%, respectively. However, the differences between overweight and obese groups were not significant (P=0.193). The prevalence of moderate and severe vitamin D deficiencies among the participants was 50.5% and 25.2 %, respectively. Vitamin D deficiency was more common in participants below 50 years of age compared with those older than fifty (P=0.001). Conclusion: The prevalence of vitamin D deficiency was high in obese and overweight population especially among individuals younger than 50 years. It seems that, it is necessary to add prevention and management of this deficiency to obesity treatment protocols especially in the young adults.

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Background: Smoking is known as the most important preventable risk factor for morbidity and premature death. It is the fourth risk factor attributable to burden of disease globally. Because of the misconception that waterpipe is less harmless than cigarette and also less socially prohibited, people smoke waterpipe more. Studies showed that tobacco consumption rate is increasing among adolescents and it`s initiation age has been declined. The aim of current study was the assessment of the prevalence of different types of tobacco use among students aged between 14 to 18 year old in Tehran. Also we had a comparison with similar studies. Methods: In this cross-sectional study 2877 students between May and July 2014 have been assessed. Samples were collected from language institutes and “Farhangsara”s according to stratified cluster sampling based on the educational zones in Tehran. A structured questionnaire was used for different types of tobacco use habit assessment. Because of sampling method, data analysis was done with complex sample survey analysis in SPSS, ver. 20 (Chicago, IL, USA) and Stata, ver. 12 (College Station, TX, USA) software. P-values less than 0.05 considered as statistically significance. Results: Among participants 11.5% (10.8%-13.3%) had cigarette smoking experience. The prevalence of current cigarette smoking was 4.4% (3.7%-5.3%). 1.4% (0.9%-2.2%) of girls and 7% (5.7%-8.5%) of boys were current cigarette smokers (P< 0.001). Waterpipe smoking experience prevalence was 41.5% (39.7%-43.4%) in total, 41.7% (39.2%-44.2%) in girls and 41.4% (39.2%-44.2%) in boys. Current waterpipe smoking was reported in 25.7% (24.1%-27.4%) of students with no statistically significant difference between boys and girls. Pipe smoking experience prevalence was 3.9% (3.2%-4.7%) and it was more frequent in boys. Conclusion: Cigarette smoking was significantly higher among boys than girls, while waterpipe smoking prevalence showed no difference. In addition, smoking prevalence was higher among students who had smoker parents or smoker friends and also had a bad economic status. It seems that specific interventions should be considered to reduce tobacco burden in adolescents specially in regard to cigarette and waterpipe smoking.

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Background: To reduce cesarean section rate, we need complex interventions to modify related behavior. We aimed to identify the effectiveness of a community-based intervention on prenatal care status, delivery and decline of cesarean section rate. Methods: A quasi-experimental study was carried out on mothers residing in Khak Sefid and Javadiyeh in Tehran from January 2011 to September 2014. Study population was 274 mothers attending in health centers for first vaccination of their neonates. Mothers' demographic data were recorded in some questionnaires. One year interventions including consultation, distribution of educational package and training courses (for mothers, fathers and their families, educational programs for midwives, obstetricians and gynecologist, residents, medical students), accomplishment of 10 steps baby-friendly principles and provision adequate personnel in labor-delivery room were implemented in community, hospitals and health centers. After intervention, 250 mothers who were attending in health centers for vaccination of 2 months aged neonates were assessed and their data were recorded in the same questionnaires. The effectiveness of intervention on cesarean section rate and cesarean tendency in before and after intervention groups were compared. P< 0.05 was considered as level of significance. Results: Of 274 mothers in "before intervention" group 193 (70.44%) and of 250 mothers in "after intervention", 169 subjects (67.6%) had cesarean section. Although a significant decline was seen in cesarean tendency in "after intervention" group (P= 0.034), no significant difference was seen between 2 groups' cesarean section rates (P= 0.48). In "after intervention" group episiotomy, induction of labor rate and maternal morbidity were significantly lower than "before intervention" group (P= 0.0001, 0.0001, 0.01). Although no significant difference was seen between two groups neonatal birth weight (P= 0.69), a significant difference was seen between two groups' gestational age (P= 0.007). Conclusion: After intervention, in spite of no decline in cesarean section rate, NVD tendency and morbidity rate were raised and improved respectively. It seems that cesarean section rate was influenced by other important factors.

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Background: The influenza virus is one of the most important factors for higher morbidity and mortality in the world. Recently, researchers have been focused on influenza conserved antigenic proteins such as hemagglutinin stalk domain (HA2) for vaccine production and serological studies. The HA2 plays a major role in the fusion of the virus with host cells membrane. The immunity system enables to produce antibody against HA2. The aim of this study is polyclonal antibody production against influenza HA2. Methods: This study was done in the Influenza Research Lab, Pasteur Institute of Iran, Tehran for one year from September 2013 to October 2014. In the present study, recombinant HA2 protein was produced in prokaryotic system and purified using Nickel affinity chromatography. The purified HA2 was mixed with Freund’s adjuvant (complete and incomplete) and injected into two New Zealand white rabbits by intramuscularly and subcutaneously routes. Immunization was continued for several months with two weeks interval. Before each immunization, blood was drawn by venous puncture from the rabbit ear. Function of rabbit's sera was evaluated using radial immunodiffusion (RID) in both forms, Single RID (SRID) and Double RID (DRID). Finally, antiserum activity against HA2 was evaluated using western blotting as serological assay. Results: Sedimentary line and zone was observed in RID assays (SRID and DRID) represent interaction between HA2 protein and anti- HA2 antibody. As well as, western blotting results was positive for HA2 protein. Therefore, these results showed that polyclonal antibody produced against HA2 protein can identify HA2 protein antigenic sites. Conclusion: These findings show that humoral immune responses have properly been stimulated in rabbits and these antibodies can identify HA2 protein and may be suitable for other serological methods.