Tehran University Medical Journal

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Background: Total Intravenous Anesthesia (TIVA) compared to general anesthesia has some pits and falls. Many drugs have been employed for this anesthesia. Propofol is accounted as the last advent anesthetic drug. It belongs to alkyl phenol families and has been accounted one of the best choices for the continuous infusion. Invention of midazolam as the first water soluble benzodiazepine was also an important event in anesthesia and it can be used as continuous infusion for the anesthesia.

Materials and Methods: In this randomized controlled clinical trial, alfentanyl plus propofol or midazolam were used for TIVA anesthesia in 60 female patients undergoing Dilatation and Curettage (D&C) in Dr.Shariati hospital in March 2002 till March 2003. They were allocated reandomly in two group of alfentanyl plus propofol (propofol group) or alfentanyl plus midazolam (midazolam group)

Results: There was no significant difference in mean of age between propofol group and midazolam group (P>0.05), also There was no significant difference in preanesthesia condition such as blood pressure and heart rate between propofol group and midazolam group (p>0.05). After induction of anesthesia there was a gross blood pressure decrease in both group that it was greater in midazolam group (85 mmHg versus 73 mmHg, P<0.05 ) following this, there was an increase in heart rate in both groups that it was modest in propofol group (98 Beat/Sec versus 118 Beat/Sec, P<0.05). There was no significant difference in mean infused alfentanyl (P>0.05) also there was just one naloxane injection in midazolam group that have no significant difference between groups (P>0.05). Recovery room stay was significantly lower in propofol group (25 minutes versus 39 minutes, P<0.05).

Conclusion: The results of this study was similar to Vuyk et.al.In their study there was a significant lower recovery time estimated by psychomotor reflexes and there was significant lower drowsiness, place and time orientation time compared to midazolam group. Finally according to the results of this study it can be resulted that TIVA with propofol is more suitable than midazolam and it can lower hospitalization time and cost. In future studies using other narcotics and other narcotics-anesthetic compounds with various dose can be mentioned.

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Background: In order to evaluate bone induction and repair in cranial bone defects by the use of combination of Octacalcium Phosphate/Bone Matrix Gelatin (OCP/BMG), this study was conducted.

Materials and Methods: We used 40 young male Sprague dawley rats (5-6 weeks age). A full thickness standardized trephine defect, 5mm in diameter, was made in the rat parietal bone and OCP combined with BMG was implanted into the defect. No OCP/BMG particles were implanted in control group that was otherwise treated identically. On the 5th, 7th, 14th, and 21st days after implantation, the rats were killed and bone samples collected. After processing the tissues by routine histological procedures, 5mm thick sections of bone were cut and stained with Haematoxyline and Eosin (H& E) and alcian blue and examined by light microscope.

Results: On the 5th day after implantation, inflammatory cells were seen around the implanted materials, especially around the OCP particles. A few clusters of cartilage cells were observed between the BMG particles in the central position of defects on the 7th day after implantation. On the 14th day after implantation, osteogenesis was seen at the margins of the defects. In addition to bone formation from the margins toward the center, interstitial growth of new bone tissue was seen around the implanted materials. By the end of 21st day, almost all of the OCP/BMG particles were absorbed and bone trabeculae, bone marrow cavities and bone marrow tissues were seen. In the control group, at the end of 21th day, a few areas of new bone were seen near to the defect margins and host bone, but much less than in the experimental group.

Conclusion: Therefore, implants of OCP/BMG appear to stimulate new bone growth in bone defects and these biomaterials could be used in the repair of cranial bone defects and injuries in clinical situations.

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Background: This study was performed to investigate the rate of inner cell mass of blastocyst which obtain from culture of mouse two cell embryos in presence and absence of recombinant of human leukemia inhibitory factor.
Materials and Methods: ICR female mice that were between 6-8 weeks old received intra peritoneal injection of 7.5 IU of pregnant mare serum gonadotropine for super ovulation, this was followed by intra peritoneal administration of 7.5 of hCG 46-48 hours later. The mice were then mated to mature ICR male mice and were checked for vaginal plug 20 hours later. Female mice were killed by cervical dislocation 48-50 hours after hCG administration and after washing and flushing of the oviduct from the proximal end of the oviduct, two cell embryos were selected and collected by 100 microscopy. All two cell embryos were randomly divided in 4 groups (Groups A, B C and D) and culture in special media. Groups A: KSOM+AA, Groups B: KSOM+AA 500 IU/ml LIF. Groups C: KSOM+AA 1000 IU/ml LIF. Groups D: KSOM+AA 1500 IU/ml LIF media until 120 hours in Co2 incubator .After that time all blastocysts collected and the number of ICM was assessed by differential staining technology.
Results: The rates of ICM of blastocysts which obtain from groups A, B, C and D were 19 2.6, 28 4.4, 24 2.1, 26 2.2 respectively. This data indicated that the rate of ICM in groups B, C and D was statistically higher than group A (P=0.02) and also there was not statistically different between three groups of B, C and D.
Conclusion: Briefly leukemia inhibitory factor can improve the rate of ICM of blastocyst and we suggest that this factor is better added to blastocyst culture medium.

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Background: Intra-rater agreement in observing and decision making in diagnosis of any disease is of great importance.This investigation is to observe and read ultrasound pictures of ovarian cysts and distinguish its category for any radiologist. Distinguishability is one of the related entities in this matter and radiologists&apos ability in correct diagnosis is of great concern. In this study, we evaluated radiologist’s distinguishability of ordered categories of ovarian cyst diseases (benign, borderline and malignant) in ultrasonography. To do this, we measured intra-rater agreement of radiologists by Weighted Kappa coefficient, and then by the help of “square scores association model” and “agreement plus square scores association model” we evaluated their distinguishability in diagnosis of the severity of the ovarian cyst’s diseases.

Methods: In this analytical cross-sectional study, two radiologists and three radiology residents assessed ultrasounds of 40 patients separately and independently in two periods (with the interval of one week). Patients selected from those who were referred to Mirza Koochak Khan Hospital in January 2005. Ultrasounds were performed by an expert radiologist and by a single apparatus.

Result: Data from radiologists was evaluated by “square scores association model” due to their superior results of distinguishability. Mean of Weighted Kappa coefficient was 0.81 and intra-rater agreement was 0.99 for our radiologists, but due to weaker results of our residents, we used “agreement plus square scores association model” for analyzing and mean of Weighted Kappa coefficient was 0.65 and intra-rater agreement was 0.97 for them.

Conclusion: Although radiologists had a better function than their residents, all of them showed appropriate distinguishability and intra-rater agreement in diagnosis and categorizing of the ovarian cyst’s disease. To distinguish benign category from borderline was more difficult than to distinguish malignant category from borderline and radiologists showed better results in this than their residents did.

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Background: Hyaluronan has an important role on the permeability and motility of sperm and the interaction of gametes and these can play a considerable role on the fertility rate. Therefore, in this study, we assessed the effect of different doses of hyaluronan on the morphology, motility, vitality and fertility rate of mice.

Methods: We used 40 mice (6-8 week) in this study which twenty of them were male and the rest were female. The sperm of each male mouse were divided into four groups. The group 1 (control): They were maintained in RPMI media without any hyaluronan supplementation for 2 hour. Hyaluronan with the doses of 750, 1000 and 1250 µg/ml were added into RPMI media in groups 2, 3 and 4, respectively. After 2 hour. incubation, the numbers of sperms were assessed, using haemocytometer. Also, their morphology with papanicolaeu staining and their vitality with Eosin B dye were assessed. As well as sperms motility measured under inverted microscope by observation and fertility rate evaluated after routine IVF by counting two-cell stage embryos.

Results: Our results demonstrated that, the dose of 750 µ g/ml has the greatest effect on the motility, vitality and fertility rate of sperms. The effect of dose of 1000 µ g/ml also was positive on them. On the other hand, none of these doses had any effect on sperm morphology.

Conclusion: Hyaluronan may have an influence on motility, vitality and fertility rate of sperms and the dose of 750µ g/ml had a significant effect on these factors.

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Background: Freezing and thawing induce a number of insults to the sperm cells, such as low motility and low fertilization capability. For evaluation of hyaluronan (HA) supplementation on sperm characteristics, we investigated the effect of hyaluronan (HA) on mouse sperm before freezing and after thawing.
Methods: For this purpose we removed cauda epididimes from 24 male mice with aseptic method and freezed the semen in 1.8ml cryotubes with %18 raffinose and %3 skim milk cryoprotectant solution.We had 4 groups: group 1(fresh control) group 2(freeze control) group 3(supplemented 750 µg/ml HA to sperm before freezing) and group 4(supplemented 750 µg/ml HA to sperm after thawing). Fertility rate evaluated after routine IVF by counting two-cell stage embryos.
Results: HA supplementation (750µg/ml) after thawing improved fertilization capability parameters but supplementation before freezing had no effect on mentioned characteristic.
Conclusion: Acording to data of present study the hyaluronan supplemen- tation (750µg/ml) after thawing has the greatest effect on the fertility rate of sperms.

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Background: Microalbuminuria (MA) is associated with increased cardiovascular risk in hypertensive patients, but not many studies have specifically examined the effects of MA-lowering on regression of left ventricular hypertrophy (LVH) among pediatric patients with hypertension.
Methods: Fifty-five patients with essential hypertension, 11 to 19 years old were prospectively studied. All patients received concomitant therapy of hydrochlorothiazide and angiotensin-converting-enzyme inhibitor. Five patients also required angiotensin-receptor blocker to achieve the blood pressure goal. Baseline and 12-month follow-up measures of left ventricular mass index (LVMI) determined by echocardiography and urine microalbumin/creatinine ratio (MA/Cr) were collected. MA was defined as MA/Cr>30. LVH was defined as LVMI>38.6 g/m2. The primary end points were 25% or more reductions in MA and the LVMI.
Results: Weight (r=0.83), body surface area (r=0.85), body mass index (BMI) (r=0.86), systolic blood pressure (SBP) (r=0.57), diastolic blood pressure (DBP) (r=0.49), mean arterial pressure (r=0.53) and MA (r=0.87) were all univariate correlates of LVMI. In a multiple regression analysis, MA, BMI and SBP were significant correlates of LVMI. MA alone explained 76% of the variance of LVMI, whereas BMI and SBP explained only 1.6% and 0.4% of the variance, respectively. MA was the most significant correlate of follow-up LVMI after BMI and SBP were included in the overall multiple regression models.
Conclusion: MA is a strong predictor of LVH in hypertensive children and adolescents. MA-lowering halts the progression of LVH or induces its regression.

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Background: The currently accepted treatment of scoliosis are bracing and surgery. Two-stage anterior and posterior spinal fusion is used to correct scoliosis. It seems that the application of a longitudinal force to the axis of the spinal column as a means of stabilizing by halo traction, may increase the correction of the curve. The aim of this study was to evaluate the effect of halo traction used between the two stages of corrective surgery, anterior and posterior spinal fusion, on the correction of scoliosis curvature.
Methods: In this randomized clinical trial twelve scoliotic patients, aged from 12-19 years old, were treated by two-stage anterior spinal release and fusion (ASF) and posterior spinal fusion (PSF). The patients were divided in two groups: 6 scoliotic patients without any traction between ASF and PSF surgeries (group A), and 6 scoliotic patients were undergone halo traction for one week between ASF and PSF surgeries (group B). Major curve angle was measured before surgery, one week after ASF and one year after PSF surgeries. Data were collected and analyzed using SPSS v.13.5.
Results: The mean baseline curve angles were 90° (SD=18.70) and 94.17°(SD=28.18) in groups A and B, respectively. Whereas, the mean final curve angles (one year after PSF) were 51.17°(SD=29.59) and 39.17°(23.11) in groups A and B, respectively. Final angle improvement was 46.58% (SD=20.31) in patients without traction and 61.32% (SD=14.02) in patients with halo traction. The major curve angles showed significantly better correction in patients with traction one week after ASF [38.67°(SD=7.86) vs. 25°(SD=6.28), P=0.012]. This difference persisted at the end of the first year after operation. [55°(SD=8.94) vs. 38.83°(SD=11.65), P=0.022].
Conclusion: Application of halo traction between ASF and PSF surgeries may lead to better improvement of the scoliotic curvature and short time application of halo traction decreases possible complications.

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Background: Although there have been many studies on the role of mosquitoes in malarial transmission, the biology and interaction of plasmodium with its host is still not completely known. The aim of this study was primarily to follow the sporogony cycle of Plasmodium vivax in Anopheles stephensi mysorensis and then to explore the inhibitory effects of certain carbohydrates on parasitic development.
Methods: In a restricted insectary, An. stephensi were fed blood containing gametocytes from donor malaria patients. The development of plasmodium was followed by dissecting the infected mosquitoes and taking a smear at different time intervals. Other groups of Anopheles were fed infected blood plus one of the following carbohydrates: N-acetyl-glucosamine, N-acetyl-galactosamine, arabinose, fucose, manose, lactose or galactose.
Results: Exflagellation occurred at 5 minutes after the blood meal and then ookinet was observed at 20 hours, while oocysts and sporozoites appeared in days 8 to 12. The results indicate that An. stephensi strain mysorensis has can transfer P. vivax extremely well. Furthermore, the development of P. vivax was completed in the mosquitoes that had been fed with N-acetyl-glucosamine, arabinose, fucose and galactose. In contrast, lactose, mannose and N-acetyl-galactosamine interrupted the life cycle of the parasite.
Conclusion: The sugars lactose, mannose and N-acetyl-galactosamine have an inhibitory role in of oocyst and sporozoite development. Therefore, the results of this study can be used as basic information for inhibiting malarial transmission.

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Background: Malaria is still one of the main health problems in south and southeast provinces of Iran and recently on average 10,000-30,000 malaria cases were reported annually. Mosquitoes of Anopheles superpictus are one of the main malaria vectors in Iran and have been reported from all areas of the country including central plateau and plains of Alborz and Zagrous Mountains chains, and with low numbers in shore plains of the Persian Gulf and Caspian Sea. There are variations in larval and adult morphological characters and also in vectorial capacity of this species in different areas of Iran.
Methods: This study has been conducted to investigate rate of mtDNA variation among various populations of this species in Iran. The sequence variation of an 1512 bp length of mitochondrial DNA (mtDNA) cytochrome oxidase subunits 1 and 2 (COI-COII) and an 708 bp sequences of COI gene were analyzed by PCR-RFLP and PCR-direct sequencing respectively.
Results: This study showed that there are considerable variations between and within populations. Rate of variation was 12.3 % between populations and this was 2-5% for within Baluchistan population. Totally 4 haplotypes were observed between populations where 3 occur in Baluchistan and one in other places.
Conclusion: This is the first report on existence of various haplotypes in An. superpictus in science, and presumably this species comprising siblings and is a species complex. Further studies need to confirm this result and to determine the relationship between mtDNA haplotypes and their role in malaria transmission in each locality.

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Background: Heat-shock proteins are part of a strictly controlled biological system that allows organisms to respond to environmental stresses. Different proinflammatory cytokines are present in the synovial tissue of rheumatoid arthritis patients. Such tissues respond to stress and induce heat-shock proteins. In addition, synovial cells are exposed to mechanical stress caused by joint motion. The effects of mechanical stress on the metabolism of the synovial cells may be substantial, even pathogenic. Heat-shock proteins are often implicated in the pathogenesis of rheumatoid arthritis. Here, we compare the levels of heat-shock protein 70 from the synovial fluid of rheumatoid arthritis and osteoarthritis patients.

Methods: Synovial fluid samples from 34 rheumatoid arthritis patients and 34 osteoar-thritis patients were analyzed for heat-shock protein 70 by an ELISA method. Statistical analysis was performed using independent T-test and one-way ANOVA. Differences were considered statistically significant at p< 0.05.

Results: The mean value of synovial fluid heat-shock protein 70 levels in rheumatoid arthritis patients was 156.30 ±128.51 and that of osteoarthritis patients was 14.98 ±11.58. The differences were statistically significant at p<0.0001. For seven rheumatoid arthritis patients suffering from mechanical knee pain, synovial fluid analysis revealed non-inflammatory effusion. The mean value of synovial fluid heat-shock protein 70 level in inflammatory synovial fluid of rheumatoid arthritis patients was significantly higher at 191±121.73 and that of non-inflammatory synovial fluid from rheumatoid arthritis patients was 21.93 ±10.06 (p< 0.05).

Conclusion: The level of heat shock protein 70 is higher in inflammatory arthritis than in non-inflammatory arthritis. Considering that patients with rheumatoid arthritis are known to have a hypertrophic synovial-lining layer, and that heat-shock protein 70 is known to protect cells against a variety of toxic conditions as well as apoptotic death, further research is needed to determine if heat-shock protein 70 induction is a sign of significant changes in the cellular and tissue metabolism or is actively participating in the pathogenesis of rheumatoid arthritis.

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Background: Congenital scoliosis is a developmental disorder defined as a lateral curvature of the spine. Its progressive trend and complications, such as cosmetic problems, pain and pulmonary symptoms, have put scoliosis as an important skeletal deformity that should be corrected. One of the currently accepted methods of treatment is posterior spinal fusion (PSF) that may be performed with or without instrumentation. However, the use of implants in conjunction with PSF in congenital spine deformity has been debated over the past three decades primarily because of increased risk of neurological deficit and implant displacement. The aim of this study was to compare short-term and long-term outcomes of spinal fusion with and without posterior instrumentation in congenital scoliosis.

Methods: In this historical cohort study, 41 patients with congenital scoliosis were recruited. All patients underwent PSF surgery between 1977 and 1996. They were divided into two groups according to the use of instrumentation: 22 congenital scoliotic patients who were treated by PSF without any instrumentation (group A), and 19 instrumented PSF patients (group B). Instrumentation was mostly performed using the Harrington rod. The major curve angle was measured before surgery, two weeks and one year after PSF surgery and at the end of the follow-up period.

Results: The mean baseline curve angles were 66.3° and 69.1° in groups A and B, respectively. The mean Cobb angles one year after PSF were 43.1° and 38.4° in groups A and B, respectively. The mean follow-up period was 8 years (SD=3) and, at the end of this period, the final Cobb angles were 47.3° and 39.4° in groups A and B, respectively. Therefore, the final angle correction was 28.7% in patients without instrumentation and 43% in patients with instrumentation. The mean loss of correction was 5.5% and 4.3% in groups A and B, respectively. The final curve angles was significantly more corrected for those patients in whom instrumentation was used than those without instrumentation (p<0.05).

Conclusion: The treatment of congenital scoliosis can be very challenging despite the benefits of modern surgeries and instrumentation methods. The results of our study demonstrate that the application of an implant with PSF surgery may lead to increased improvement of the scoliotic curvature in the short-term and long-term periods, as well as a decrease in the loss of correction and the rate of reoperation. In addition, the low incidence of complications in our study indicates the safety of the posterior instrumentation for the treatment of congenital scoliosis.

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Background: Kawasaki disease (KD) is an acute vasculitis in children. Eosinophilia, a reflection of the host's immune response that can cause tissue damage, has been associated with KD, with eosinophils preferentially accumulating in the microvasculature. In early-stage Kawasaki disease (KD), lesions (perivasculitis and vasculitis) first form in the microvessels, which can then extend to the larger vessels and result in coronary artery aneurysms, possibly leading to myocardial infarction even in young children. Overall, the prevalence of coronary artery aneurysms in children with Kawasaki disease is about 10-18%, which is much higher among those not treated early in the course of the illness.  We performed this study to gain a better understanding of the initial pathogenesis of KD and to assess the relationship between eosinophilia and coronary artery disease.

Methods:  The data from forty-eight patients at Vali-asr Hospital of the Tehran University of Medical Sciences (1996-2006) were included in this cross-sectional descriptive analysis. The presence and degree of coronary artery disease was assessed by echocardiography. Data was analyzed via Fisher's exact test and student's t-test using SPSS software, v. 11.5.

Results: Eosinophilia was seen in 10 cases (22%) and cardiac lesions were observed in 19 cases (41%). The frequency of microvessel lesions was significantly lower in patients with eosinophilia (10% with eosinophilia versus 50% without eosinophilia, p<0.03). The frequency of microvessel lesions was lower in males than in females (35 vs. 44%, respectively), although this was not significant. We found no correlation between the frequency of microvessel lesions and age.

Conclusions: In spite of the controversies regarding eosinophilia and microvessel lesions, in this study the number of circulating eosinophils was associated with fewer cardiac lesions. Comparative studies are needed to determine the exact relationship.

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Background: To eradicate a problem such as drug abuse, we need thorough knowledge of the problem and its epidemiological aspects. In response to increasing ecstasy abuse among youth, as noted by the increase in related health issues at emergency clinics, we performed this epidemiologic study on ecstasy use in Tehran.

Methods: In this cross-sectional study, including 1,903 youth aged 15-25 years, at different coffee shops in Tehran, Iran, subjects filled out questionnaires to evaluate the prevalence of ecstasy use with regard to gender, age, family income, level of education, psychological state (Beck test), acute complications of ecstasy use, as well as manner and place of ecstasy use and reason for repeated ecstasy use. Information was gathered from September 2004 to January 2005, using simple nonprobable sampling.

Results: The prevalence of ecstasy abuse among our study population was 18.5%, which meaningfully correlated with gender (male), education level (undergraduate degree), family income (high), drug abuse and Beck test score (high). The mean age of ecstasy abusers was 21.3 years (SD: 2.65), which wasn't statistically different than the study population as a whole and the portion that did not use ecstasy. Tablet was the most common form of ecstasy usage (97.1%). In this study population, 91.4% had heard of the ecstasy name, and 83.7% were familiar with its use. The most common site of usage was in parties (85.7%) and in group forms (84%). Of all the users, 30% stated the reason for repeat ecstasy use was their friends' insistence, 38.8% expressed emotional need, 37.7% had no reason, whereas 6.6% felt a physical need and 1.7% repeatedly used ecstasy to prevent withdrawal symptoms

Conclusion: Some studies have reported that drug abusing friends are the basic cause of drug abuse. In this study, the ecstasy users admitted that the influence of friends and emotional need were the causes of their repeat use. Remarkably, these subjects report withdrawal symptoms with ecstasy use. Most importantly, families have to consider the relationships and emotional needs of their children. The statistical difference between Beck test scores between ecstasy users and the non-users placed them in two clinically different psychological groups. The ecstasy users were in groups that definitely needed psychological consultation and non-users were in the slightly depressed group. These psychological aspect of drug abuse expressed here is an alarm.

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Background: The resistance of Pseudomonas aeruginosa strains to broad spectrum cephalosporins may be mediated by extended spectrum b-lactamases (ESBLs). These enzymes are encoded by different genes located either on chromosome or plasmids. In this study, we determined the antimicrobial resistance patterns of P. aeruginosa isolates and screened for ESBL production.

Methods: After isolation from burn patients in Tehran Hospital, identification of P. aeruginosa isolates were assessed using biochemical tests. We then performed disk agar diffusion (DAD) according to CLSI guidelines to determine the pattern of antimicrobial resistance. The frequency of ESBLs and prevalence of the OXA-10 and PER-1 genes were determined with combined disk and polymerase chain reaction (PCR) methods, respectively.

Results: One hundred strains of P. aeruginosa were isolated. The resistance of these strains to cephpodoxime, aztreonam, ciprofloxacin, ofloxacin, ceftazidime, cefepime, imipenem, meropenem, cefotaxime, levofloxacin, piperacilin- tazobactam and ceftriaxon was 100%, 90%, 83%, 92%, 85%, 88%, 63%, 66%, 98%, 89%, 70% and 91%, respectively. Of these, 40 strains (40%) were ESBL positive, 29 strains (29%) were OXA-10 positive and 18 strains (18%) were PER-1 positive.

Conclusion: Our results confirm the need for proper antimicrobial therapy in burn hospitals, considering the resistance pattern and frequency of strains producing ESBLs and the presence of the OXA-10 and PER-1 genes. Since an increase in the prevalence of ESBL in P. aeruginosa strains might lead to the transfer of these ESBL genes to other gram-negative bacteria, we recommend the use of appropriate drugs, especially cephalosporins, in burn hospitals.

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Background: The components of the classical complement pathway play an important role in the pathogenesis of systemic lupus erythematosus (SLE) and are reportedly useful biomarkers of disease activity. In this study, we evaluate disease activity, complement function (total hemolytic complement, CH50) and complement protein levels (C3, C4, C3d, C4d, SC5b-9), comparing the results of patients with active disease versus those with inactive disease.
Methods: This cross-sectional study included 78 hospitalized women with SLE, 24 of whom were in the active group, with SLE disease activity indexes (SLEDAI.2K) of >6, and 54 in the inactive group, with SLEDAI.2K of ≤6. Serum CH50 was measured using a red blood cell hemolytic assay. C3 and C4 levels were determined by nephlometry and plasma levels of C3d, C4d, SC5b-9 by ELISA. The data were statistically analyzed using SPSS.
Results: The mean (±standard error) C4d levels of the inactive group were significantly higher than those of the active group (23.39±1.1µg/ml and 16.9±1.6µg/ml, respectively p=0.003). There was also a significant correlation between C3 and C4 levels (p=0.807). The mean values of the other proteins (C3, C4, CH50, SC5b-9, and C3d circulating immune complex concentrations) were not significantly different between the inactive group vs. the active group: 89.35±6.8 vs. 85.54±7.6mg/dl, 18.33±2.3 vs. 20.45±2.4mg/dl, 149.03±4.3 vs. 157±4.3U, 1414.4±114.94 vs. 1471.1±216.9ng/ml, 9.43±0.96 vs. 13.31±3.16µgEq/ml, respectively (p>0.05).
Conclusions: According to our results, C4d levels may be used as a biomarker of disease activity. The significant correlation between C3 and C4 may confirm the activity of the classical pathway in SLE patients.

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Background: Mitral valve prolapse is a relatively common valvular abnormality in most communities and joint hypermobility (JHM) is also seen in many healthy people as well as in certain clinical disorders, such as Marfan syndrome. The present study was designed to investigate the association between joint hypermobility and mitral valve prolapse (MVP) in an Iranian population sample.

Methods: Fifty-seven patients with nonrheumatic and isolated mitral anterior leaflet prolapse (24 men and 33 women, mean age 23.5 +/-2.3) and 51 healthy subjects (20 men and 31 women, mean age 22.9+/-2.3) were studied. The presence of JHM was evaluated according to the Carter-Wilkinson & Beighton criteria. Echocardiographic examination was performed in all subjects and the correlation between the echocardiographic features of the mitral valve and the hypermobility score were investigated.

Results: The frequency of JHM in patients with MVP was found to be significantly higher than that of controls (26.3% vs. 7.8%), with mean JHM scores of 3.1+/-2.2 and 1.9+/-1.7, respectively. The patients in the MVP group had significantly increased the anterior mitral leaflet thickness (AMLT, 3.4+/-0.4 mm vs. 3.0+/-0.3 mm p<0.0005) and maximal leaflet displacement (MLD, 2.4+/-0.3 mm vs. 1.5+/-0.2 mm p<0.0005) compared to the controls.

Conclusions: We detect a statistically significant relationship between isolated MVP and joint hypermobility as well as between the severity of JHM and echocardiographic features of the mitral leaflets. These results suggest a common etiology for MVP and JHM, which should be investigated in future well-conducted studies.

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Background: Chlamydia Trachomatis is the most common cause of trachoma and subsequently give rise to neonatal chlamydial conjunctivitis (NCC), adult ophthalmic inclusion infection, sexually transmitted diseases (STD) and pneumonia. The goal of this study was to access the incidence of chlamydia trachomatis in the normal (ophthalmic infection free) population.

Methods: In a cross sectional study 250 patients referring to Farabi Eye university Hospital Tehran, Iran for non infectious ophthalmic disease in different age categories were selected and accessed for chlamydial IgM and IgG by ELISA method.

Results: 250 patients (50% men and 50% women) with the mean age of 40 (ranging from one to 83 years old) were tested. IgG was detected in 11 (five females and six males) patients (4.4%) All of them had more than 31 years old. IgM was detected in 18 (13 females and 5 males) patients (7.2%). No test revealed simultaneous high IgG and IgM titre in the same patient.

Conclusions: There was a low grade of chlamydial infection in our study population. So it is recommended to use serological methods for screening of ophthalmic infections in centers where no other test methods are available and in case of positive results confirmatory antigen tests to be used.

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Background: Hepatitis B vaccination has been included in routine immunization of all individuals according to WHO recommendations since 1991. Despite successful coverage, 3-5% of recipients fail to mount a desirable protection level of Ab. Vaccine failure results from: emergence of mutation, immune failure of individuals, decrease in vaccine potency, and etc. The quality of Hepatitis B vaccine should be evaluated by a reliable method.

Methods: The amount of vaccine antigen was measured through the in vitro assay of Hepatitis B vaccines which consists of multiple dilutions of the reference material and samples. The preparations were evaluated by Elisa to determine the amount of HBsAg. The data were analyzed by parallel-line analysis software. The in vivo assay was performed by inoculating multiple doses of the reference and sample preparations in Balb/c mice. A control group was also inoculated with vaccine matrix. Four weeks later, the mice sera were evaluated to determine the presence of antibodies against Hepatitis B by Elisa method. The data were analyzed by Probit analysis software.

Results: Both methods were set up in our laboratory by which different batches of Hepatitis B vaccine were evaluated. It was observed that In vivo and In vitro methods provide comparable results. Therefore we can use the in vitro method for routine testing of HB vaccine quality control.
Conclusion: In vitro method can be used in place of In vivo method because of its time and cost-effectiveness. Moreover, since no animals are used in in vitro method, it complies well with the 3R concept (Reduction, Refinement, and Replacement of animal testing) and the current tendency to use alternative method.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Low-birth-weight (LBW) children are at higher risk for failure to thrive. The aim of the study was to establish the trend of physical growth in Until now their growth was evaluated with normal birth weight baby's chart.
Methods: In this cohort study we investigated demographic characteristics and growth trend during the first of life 406 newborn divided into three groups: LBW (Low Birth Weight) n=103, VlBW (Very Low Birth Weight) n=20 and NBW (Normal Birth Weight) n=303. Body weight, length and head circumference were measured at the time of birth and several follow ups until 12 months of chronological age.
Results: NBW growth trend adopts the standard chart. Significant differences in terms of physical growth (weight- height- head circumference) were seen between the two groups of preterm (LBW & VLBW) and NBW children. Although it was demonstrated that growth velocity of preterm & NBW children were the same. Significant differences for weight was seen between VLBW and LBW group only until 6 months after birth. This difference was seen for height and Head circumference until the end of the first year of life.
Conclusions: VLBW and LBW babies need special growth charts. But the adjustment method of anthropometric traits to gestational age may be useful to evaluate LBW baby's growth.