Tehran University Medical Journal

---

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Seroma formation, or the subcutaneous collection of fluid, is a common problem after surgery for the breast cancer. It may lead to wound-related complications and also can delay adjuvant therapy. The aim of this study was to investigate the effect of various clinical and therapeutic variables on seroma formation.
Methods: A prospective cross sectional study of patients who underwent surgical therapy for breast cancer was carried out. Modified radical mastectomy was performed on 67 patients (65%) and 28 patients (27.2%) underwent breast conservative surgery. Simple extended mastectomy was done for the remaining 8 patients (7.8%). Seroma formation was studied in relation to age, type of surgery, tumor size, nodal involvement, preoperative chemotherapy, surgical instrument (electrocautery or scalpel), use of pressure garment, and duration of drainage. All of the patients followed for 4 weeks after surgery.
Results:  A total of 103 patients with breast cancer were studied. The mean age of the patients was 48.3 years (25-82). Seroma occurred in 27 (26.2%) patients. There was statistically significant relation between age and seroma formation after breast cancer surgery (p=0.005), while other factors studied was found to be significantly ineffective. In addition, there was not any relation between seroma formation and drain duration. However, two factors including type of the operation and level of lymphatic dissection was considerable with confidence interval up to 90%, but it was not statistically significant with confidence interval >95% (p=0.068 and 0.063 respectively).
Conclusion: These findings suggest that the age is a predicting factor for seroma formation in breast cancer patients, while other factors do not significantly affect that.

---

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Latent Epstein- Barr virus (EBV) genomes are found in the malignant cells of approximately one-third of Hodgkin's lymphoma (HL) cases. Detection of EBV viral DNA could potentially be used as a biomarker of disease activity. Our goal was to compare of EBV DNA detection in samples obtained from lymphoma patients versus controls.
Methods: One milliliter uncoagulated and 1ml coagulated blood sample for DNA extraction and serum analysis using ELISA for IgG anti EBNA-1 were obtained from 44 lymphoma patients and from 44 normal controls, respectively. EBV genome, EBNA-2, was examined from DNA extracts of paraffin embedded and blood samples using Nested PCR with type specific inner primers.
Results: Positive results for ELISA, Blood and biopsy PCR in study group were, 84.1%, 27.3% and 13.6%, respectively. However, these results in control group were 47.7% and 16% for ELISA and Blood PCR assays, respectively. Positive results in ELISA, Blood PCR and Biopsy PCR in Hodgkin and non-Hodgkin patients were found in 21(84%), 6(24%), 4(16%) and 16(84.2%), 6(31.6%), 2(10.5%) of specimens, respectively. No significant differences in EBV detection were found between these two patient groups (p values for ELISA, Blood PCR and Biopsy PCR were 0.26, 0.73 and 0.68, respectively).
Conclusion: Comparison of ELISA and Blood PCR results in children and adult patients with the same age of controls have showed difference in ELISA results of children, only. None of the test results have showed statistically significant difference between Hodgkin and non-Hodgkin patients. However, the mean of ELISA results in Hodgkin patients was higher as compared with controls. Blood PCR assay cannot be recommended as a biomarker of disease activity in EBV positive Hodgkin's lymphoma patients.

---

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 !mso]> ject classid="clsid:38481807-CA0E-42D2-BF39-B33AF135CC4D" id=ieooui> Background: Recombinant antibodies are new versions of monoclonal antibodies that are produced by recent molecular biology techniques. These antibodies can be isolated by phage display technology from immune or non-immune libraries. Recombinant antibodies are applied to treatment of some diseases and also are increasingly used for diagnosis and detection of many antigens. In the latter case, the presence of antigen-antibody complexes has to be detected by further approaches. The aim of current research was to stain an anti-K99 phage antibody with two different protein dyes and to apply them directly for detection of E. coli K99 fimbriae.
Methods: In order to stain above antibody, a phagmid vector carrying the anti-K99 single-chain Fv (scFv) antibody was isolated, purified and transformed into TG1 strain of E. coli. Afterward, the antibody was expressed in this cell as phage-scFv antibody. Phage antibodies were subsequently eluted, purified and stained with Disperse Red dye 60 and Coomassie Brilliant Blue. Finally, the binding activity of coloured phage antibodies towards the purified K99 fimbriae was verified by immunoblotting.
Results: The results showed that anti-K99 phage antibody was stained with both dyes and the coloured phages were able to recognize the corresponding antigen.
Conclusions: These protein stains that they usually do not alter the protein structure can be used for staining phage antibodies. The coloured phage antibodies retain their binding affinity for the antigens, and therefore can be applied to detection of relevant antigens.

---

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Insulin resistance is common in women with Polycystic Ovary Syndrome (PCOS) and can cause poor outcome of infertility treatment. The aim of our study was to assess the effect of treatment with metformin on outcome of Intra Cytoplasmic Sperm Injection (ICSI) in infertile PCOS women.

Methods: A randomized clinical trial study was carried out in infertile women with PCOS, before ICSI, referred to infertility clinic of Mirza Koochackhan Hospital of Tehran University of Medical Science Tehran, Iran, between 2006 and 2008. The patients were randomized in two groups of metformin 500 mg Po, three times daily, six weeks before the ICSI cycle and placebo patients in each group were divided into BMI <28 kg/m² and BMI &ge28 kg/m².

Results: Of 52 study women 26(50%) were in metformin group. mean age were 29.8±4.9 year in metformin group versus 29.4±5.9 year and placebo groups. Treatment with metformin, in subgroup of BMI <28 kg/m², significantly increased number of mature follicle (p=0.01), embryo (p=0.04), oocytes (p=0.007) and mature oocytes (p=0.03) but in subgroup of BMI&ge28 kg/m², there was no significant difference in the metformin and placebo groups (p>0.05). Metformin treatment caused more chemical and clinical pregnancy rates, and less abortion rate in overweight and normal patients, but the differences were not significant (p>0.05). Logestic regression analysis showed, adjusting number of mature follicle, number of embryos, quality of embryos, oocytes and BMI and treatment showed no significant effect on clinical pregnancy rates (p>0.05).

Conclusions: Among normal weight PCOS women, effect of treatment with metformin is better than overweight PCOS women. However further studies are needed.

---

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Salmonellosis is a bacterial gasteroenteritis caused by different serovars of Salmonella. In the recent years, Salmonella enterica subspecies. Enterica serovar enteritidis is a major cause of gastroenteritis and food poisoning in the worldwide.  Different genus of salmonella is increasingly being resistant to common antibiotics. The aim of this study was to determine the frequency and the antibiotic resistance patterns of Salmonella enterica isolated from medical health centers in Tehran.

Methods: In this descriptive cross- sectional study from April to December 2008, 1950 fecal specimens from children with diarrhea were cultivated to identify Salmonella enteritidis. We used Clinical and Laboratory Standard Institute (CLSI) protocol to determine resistance patern of the isolates to 16 different antibiotics.

Results: In this study, out of 26 isolates 14(54%) were S. enteritidis, 2(8%) S. para B, 6(23%) S. para C, 3(11%) S. arizonea and 1(4%) S. para A. all of them were sensitive to ceftazidime, cephalexin, cefotaxime, ceftiraxone, ciprofloxacin, imipenem, meropenem, gentamicin and colistin sulfate. All of the isolates were resistant to nitrofurantoin whereas 71.4% of them were resistant to nalidixic acid.

Conclusions: The most prevalent isolated salmonella was S.enteritidis. According to high sensivity of these isolates to cephalosporin and flourqouinolon family, they can used as infective treatment for salmonellosis infections.

---

Background: Systemic Lupus Erythematosus (SLE) is a prototypic autoimmune disease with diverse clinical manifestations in association with autoantibodies to components of the cell nucleus. SLE as a chronic autoimmune disease has a worldwide distribution. There is a wide variation in the natural history of SLE among different ethnic and geographic groups. Our SLE registry is one of the largest series in Asia-Pacific region. The aim of this study was to show the manifestations of SLE in Iranian patients.

Methods: This study is on clinical and Para clinical manifestations of SLE according to the database of the Rheumatology Research Center (RRC), Tehran University of Medical Sciences as a major referral center for rheumatic disease in Iran during the period of 1976 to 2009.

Results: A total of 2143 SLE patients were studied. The female to the male ratio was 8.8:1 and the mean age at the presentation was 24.2± 10 Years. Prevalence of clinical manifestations included: musculoskeletal, cutaneous, renal, neuropsychiatric, pulmonary, cardiac and hematologic were 85.2%, 83.1%, 66.6%, 24%, 22.3%, 17.5% and 67.1% respectively. There were seen positive FANA in 78.3% and anti-DNA in 70% of patients. Overlap syndrome and positive family history with other autoimmune diseases were detected in 14.9% and 3.4% of patients respectively.

Conclusion: The prevalence of some manifestations (such as cutaneous and renal involvement) in our patients were similar to those of nearby countries (with similar climate), while other manifestations (such as hematologic and joint involvement) were similar to the European countries (with similar ethnicity). Genetic and/or climatic factors may lead to different presentations of lupus.

---

Background: Based on the reports, high frequency of special alleles of HLA class II genes might be associated with susceptibility to or protective from a particular cancer. These alleles might vary depending on the geographical region. Here we investigate the association between alleles of HLA class II genes and breast cancer in Iranian women.
Methods: 100 patients with pathologically proved breast cancer who referred to Cancer Institute, Tehran University of Medical Sciences in Tehran, Iran, were divided to two groups based on ages (40 years old and less/ or more than 40 years old) and were randomly selected and compared with a group of 80 healthy blood donor subjects. HLA class II alleles were determined by amplification of DNA with polymerase chain reaction (PCR) method followed by HLA-typing using sequence-specific primer (SSP) for each allele.
Results: The most frequent alleles in the DR and DQ regions in group 1 (40 years old and less) in comparison with control group were HLA-DQA1*0301 (p=0.002) and HLA-DQB1*0302 (p>0.05). In contrast HLA-DQA1*0505 (p=0.004) had significantly lower frequency in this group compared with control group. Patients of group two (more than 40 years old) had a higher frequencies of HLA-DQA1*0301 (p=0.001) and HLA-DRB1*1303 (p=0.02) and a lower frequency of HLA-DQA1*0101 (p=0.002) compared to healthy control.
Conclusion: These findings provide information of a positive and negative association between certain alleles of HLA class II and breast cancer in our population and also might support that the pattern of inheritance in the early and late onset of breast cancer differ substantially.

---

Background: Pseudomonas aeruginosa is an important opportunistic pathogen causes clinical infections among burn patients. Metallo-β-lactamases (MBLs) are important mechanisms of Carbapenem (drug of choice) resistance among Pseudomonas aeruginosa isolates. The aims of this study were to determine the antibiotic susceptibility pattern and to detect the prevalence of MBLs among Pseudomonas aeruginosa
Methods: Initially, the antibiotic resistance patterns of 170 clinical strains isolated from burn patients in Motahari Hospital in Tehran, Iran were determined by Kirby-Bauer disc diffusion method. All of the clinical isolates using two phenotypic and genotypic methods.  Pseudomonas aeruginosa isolates resistant to Imipenem were screened for production of MBL by E test with Imipenem / Imipenem plus EDTA (E test MBL). PCR assay was performed for detection of blaVIM genes.
Results: Based on the study results, the percentage of resistance was as below: Imipenem (10 μg) 52.9%, Amikacin (30 μg) 81.7%, Carbenicilin (100 μg) 74.7%, Polymixine B (300 unit) 10%, Ticarcilin (75 μg) 84.7%, Tobramycin (10 μg) 88.2%, Colisitin (10 μg) 34.1, Colisitin (25 μg) 28.3%. Of 90 Carbapenem resistant isolates, 10(11/1%) isolates were positive by E test, all were sensitive to Colisitin and Polymixine B. All of the Imipenem resistant Pseudomonas aeruginosa isolates were examined by PCR for the presence of the blaVIM genes. All MBL-producing isolates carried blaVIM-1 genes.
Conclusion: Considering the high prevalence and clinical importance of MBL-producing isolates, rapid identification of them and use of the appropriate infection control measures are necessary to prevent further spread of infections by these organisms.

---

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: More than 80 years, the standard treatment of locally advanced cervical cancer was radiotherapy. However, based on several phase III randomized clinical trials in the past decade, concurrent cisplatin-based chemoradiotherapy is the current standard of treatment for this disease. Gemcitabine has potent radiosensitizing properties in preclinical and clinical trials, so it can be utilized simultaneously with radiation.
Methods:  Thirty Women with untreated invasive squamous-cell carcinoma of the cervix of stage IIB to stage IVA were enrolled in the study in Radiation Oncology department of Imam Khomeini Hospital in Tehran from September 2009 to September 2010. Sixty mg/m² gemcitabine followed by 35 mg/m² cisplatin were concurrently administered with radiotherapy to the whole pelvic region on day one of each treatment week for five weeks One and three months after treatment, patients underwent a complete physical examination and MRI to determine the response to treatment.
Results:  The mean age of the participants was 58.13±11.83 (29-78) years. After 3 months of treatment, 73.3% had complete and 26.7% had partial response to treatment. Grade 3 anemia was seen in 10%, grade 3 thrombocytopenia in 3.3% and grade 3 leukopenia in 10% of the patients.
Conclusion: According to the positive results of this study in stage IIB, further phase II and III clinical trials are suggested to evaluate the role of chemoradiation by gemcitabine in advanced cervical cancers.

---

Background: Uterine environment and fetal period can profoundly affect health of the neonat. Hypoxia-inducible factor-1α (HIF-1α) is a transcription factor that regulates cellular stress responses and its activity is essential in both embryogenesis and postnatal life. The aim of the present study was to investigate the effects of maternal swimming on rat pups' HIF-1α levels as a key regulator of oxygen in lungs.

Methods: Sixteen female Wistar rats weighing 180- 200 grams were acclimated to a new environment consisting of equal light-darkness cycle and ad lib access to chow and adapted to the stress caused by water for two weeks. The rats were divided into two swimming and control groups. Swimming training began on the first day of pregnancy in a pool and continued for 3 weeks (1 h/day, 5 days/wk). Pups' lungs were removed two days after birth and their HIF-1α concentration was determined with enzyme-linked immunosorbent assay (ELISA). Statistical analysis of the data was done using independent t-test. A p-value smaller than 0.05 was considered statistically significant.

Results: Swimming lead to a significant (P<0.001) increase in the pups' lung HIF-1α levels compared with the control group. Although 3-wk period of swimming training, showed no significant increase in weight and also lung weight of newborns. Thus it can be concluded that swimming endurance training in pregnancy, can be considered as appropriate alternative in order to embryos development.

Conclusion: Our research suggests that HIF-1α level is an essential element for the development of the lungs of embryos. Moreover, further studies on the lung HIF-1α levels at post-natal period with different modes of exercise will provide more clear insight into the mechanisms of the findings resulting from this study.

---

Background: Hypothermia is an important determinant of survival in newborns, especially among low-birth-weight ones. Prolonged hypothermia leads to edema, generalized hemorrhage, jaundice and ultimately death. This study was undertaken to examine the factors affecting transition from hypothermic state in neonates.
Methods:  The study consisted of 439 neonates hospitalized in NICU of Valiasr in Tehran, Iran in 2005. The neonates' rectal temperature was measured immediately after birth and every 30 minutes afterwards, until neonates passed hypothermia stages. In order to estimate the rate of transition from neonatal hypothermic state, we used multi-state Markov models with two covariates, birth weight and environmental temperature. We also used R package to fit the model.
Results:  Estimated transition rates from severe hypothermia and mild hypothermia were 0.1192 and 0.0549 per minute, respectively. Weight had a significant effect on transition from hypothermia to normal condition (95% CI: 0.1364-0.4165, P<0.001). Environmental temperature significantly affected the transition from hypothermia to normal stage (95% CI: 0.0439-0.4963, P<0.001).
Conclusion:  The results of this study showed that neonates with normal weight and neonates in an environmental temperature greater than 28 °C had a higher transition rate from hypothermia stages. Since birth weight at the time of delivery is not under the control of medical staff, keeping the environmental temperature in an optimum level could help neonates to pass through the hypothermiastages faster.

---

Background: Patent ductus arteriosus (PDA) is a common finding among premature or low-birth-weight infants and it often does not close. Nowadays, drugs used for its treatment include indomethacin and more commonly ibuprofen. Oral ibuprofen was recently shown to be as effective and have several important advantages in preterm infants. Studies performed to find the best dose of ibuprofen for PDA treatment are limited hence, we compared the effects of two different doses of ibuprofen in this interventional study.
Methods: In this randomized controlled clinical trial, we randomly divided 60 patients with echocardiographically confirmed PDA into two groups of 30. This study was done in NICU of Valiasr hospital in 1387-89 years. In the first group, we administered a loading dose of 10 mg/kg ibuprofen on the first day, followed by two doses of 5 mg/kg in the next two days. In the second group, we administered a loading dose of 15 mg/kg ibuprofen on the first day followed by two doses of 7.5 mg/kg in next two days. Eventually, we compared PDA closure rates and complications of therapy between the two groups.
Results: Thirty (100%) patients in 15-mg/kg group and 23 (76.7%) patients in 10 mg/kg group had successful PDA closure with no need for surgery. The two groups had a statistically significant difference (P=0.011) and the highest response to treatment was seen within the first 24 hours of treatment.
Conclusion: We may conclude that higher doses of ibuprofen (15 and 2×7.5 mg/kg) would offer better outcomes for PDA closure without gastrointestinal or renal complications and less need for surgery.

---

Background: Autograft is the best option in nerve defects when end-to-end repair can not sufficiently preserve nerve continuity. Theoretically, if the severed nerve is reversely grafted, it may prevent axonal growth into nerve branches, and larger amounts of axons will reach the target organ and more satisfactory results will be obtained. In this study we aimed to compare conventional versus reverse nerve grafting.
Methods: This study was performed in Animal laboratory of Hazrat Fatemeh Hospital from April till August 2011. We randomly divided 40 Wistar rats into two groups. We excised 1.5 cm of the right sciatic nerve and anastomosed it conventionally between the proximal and distal ends of the nerve in rats in group A and in a reverse manner in rats in group B. The rats’ footprints were recorded in the first and 16th weeks after surgery. In week 16, the grafted nerves were removed under anesthesia for pathological examination and axon count. Subsequently, the results were compared clinically by sciatic functional index (SFI) through footprint analysis and paraclinically by axon count. A p-value smaller than 0.05 was considered statistically significant.
Results: Conventional and reverse nerve grafting no had statistically significant differences in clinical assessment in the first and 16th weeks (P=0.87) post-surgically and also no difference in paraclinical assessment in week 16 (P=0.68).
Conclusion: We had no significant clinically or para clinically differences between two approaches. It should be considered that the diameter and length of nerves and muscles in human is larger than rats, so the results of nerve repair may differ in human. We suggest a study in animal model which is anatomically more similar to human.

---

Background: Long QT syndromes (LQT) are genetic abnormalities of ventricular repo-larization, with an estimated incidence of about one per 10000 births. It is characterized by prolongation of the QT interval in electrocardiogram (EKG) and associated with a high risk for syncope and sudden death in patients. Type of this syndrome is association with congenital deafness. Our objective was to evaluate QT interval in children with congenital deafness.
Methods: For 219 patients referred to Imam Khomeini Hospital audiometric clinic in 2011, questionnaire were completed. A total of 23 congenitally deaf children were incl-uded. All patients’ examinations were done by a pediatric cardiologist. Electrocardio-gram is conducted in all children (23 patients) with sever and deep congenital deafness. Then the QT interval was measured based on Bazett’s formula. Echocardiography was also performed in these children to assess left ventricular function and the presence of mitral valve prolapse.
Results: The overall patients were two hundred and nineteen children. A total of twenty three congenitally deaf children were included and electrocardiogram was obtained. Three children had obviously prolonged QTc (0.48±0.02) second. The median age of them was 6.1±5 year, the median weight was 18±11.3 kilogram and the median of QT interval was 0.48±0.02 second.
Conclusion: The QT interval obtained 0.48±0.02 second. In the present study we found prolonged QT in congenital deafness, thus we recommend to evaluate the electrocardio-gram of children with congenital deafness.

---

Background: The incidence and clinical presentation of congenital toxoplasmosis in our newborns was not studied until yet. Goal of study is to evaluates the newborns for congenital Toxoplasma.Gondii infection and describe the clinical presentation from birth and follow up them. 
Methods: We conducted a prospective study upon 270 newborns were born in two university hospitals in Tehran (Rasoul akram & Akbar Abadi) during 2011-2012. Cord blood sample obtained from the newborns during labour. The samples centrifuged, transported and restored in -80 centigrade freezer in our Research Laboratory. Specific T.Gondii- antibodies (IGG, IGM) evaluated by ELISA methods. Neonates with positive T.Gondii- IGM diagnosed and studied as infected cases. The infected cases treated and followed for progression of disease.
Results: Gestational age of newborns was between 28-41 weeks. Positive T.Gondii -IGM and T.Gondii -IGG determined in 1.5%, 44.1% of cases respectively. The most common clinical presentation in seropositive cases was eye involvement (50%), and brain disorders (50%). Positive PCR had not found in cerebrospinal fluids of seropositive (IgM) cases.
Conclusion: One and a half percent of newborns were seropositive for T.Gondii. Wide variation of clinical presentation and early diagnosis of infected newborns in our country is so important. Adding the serologic tests (IGM) to neonatal screening test is recommended strongly.

---

Background: Varicocele is a dilated vein of the pampiniform plexus that cause to det-rimental time-dependent effects so this study describes the effect of varicocele on the level of IL-6 and interferon gamma in serum and testis tissue, number of sertoli and spermatogonia cells, seminiferous tubules diameter and sperm activity in immature rats. Methods: Thirty six immature rats, 5-6 weeks aged were investigated in this study. The sham groups underwent sham operation and varicocele groups underwent partial liga-tion of the renal vein. Serum, testis and sperm samples were collected at 9, 11, and 13 weeks after induction of varicocele or sham operation to evaluate histological parame-ters (seminiferous tubules diameter, number of sertoli and spermatogonia cells), per-centage of sperm motility and viability and levels of cytokines. Testicular morphology was evaluated. Results: Varicocele significantly caused an increase in serum and testis IL-6 and inter-feron gamma, compared to related sham groups and previous varicocele groups (P<0.05). Varicocele significantly caused decreases in sertoli cells and spermatogonia cells number with increasing varicocele time, compared to related sham groups and previous varicocele groups (P<0.05). In the evaluation of seminiferous tubules diameter external, internal and epithelium diameter were decreased compared to sham related groups and previous varicocele groups. In all varicocele groups, all kind of sperm motility and viability decreased compared to the related sham-operated groups (P<0.05). Varicocele had deteriorating effects on testis tissue because our observations in varicocele groups demonstrated that the external, internal and germinal epithelium height was reduced by the time and in the evaluation of testicular cells, sertoli and spermatogonia cells number were decreased by the time compared to sham related groups and previous varicocele groups. Conclusion: This study suggests varicocele had a detrimental time-dependent effect on cytokines levels and decrease in sertoli and spermatogonia cells number, seminiferous tubules diameter and sperm indices.

---

Background: The application of CAM visual stimulation returns to the date of more than fifty years ago. However, the reports of previous studies in this field vary from no effect to significant effects of this method in amblyopia treatment. The purpose of this study was to determine the effect of CAM visual stimulation along with conventional occlusion therapy in anisometropic amblyopic children. Methods: Forty amblyopic children aged 4 to 6 years old with no previous treatment were enrolled in this randomized clinical trial study. The subjects were randomly as-signed in two different groups. The group 1 included conventional occlusion therapy and group 2 includes occlusion therapy with complementary CAM visual stimulation. In terms of visual acuity and stereopsis improvement and reduction of amblyopia sever-ity, two groups were compared using the repeated measure ANOVA and LSD Post Hoc tests. Results: In group 1 including conventional occlusion therapy, visual acuity improved from 0.444±0.077 logMAR to 0.138±0.023 logMAR, i.e., improvement of 0.306 log-MAR (P< 0.001) whereas in group 2 including complementary CAM usage, visual acu-ity improved from 0.398±0.075 logMAR to 0.047±0.022 logMAR, i.e., improvement of 0.351 logMAR (P< 0.001). Regarding Stereopsis, the improvements were 157 (from 258±34 to 101±13 seconds of arc, P< 0.001) and 171 (from 237±33 to 66±12 seconds of arc, P< 0.001) for groups 1 and 2 respectively. All subjects of group 2 gained the normal vision at the end of the treatment period, whereas only 47% of subjects of group 1 could achieve this level of vision in that time. Improvement of visual acuity in group 2 was significantly better than group 1 (P< 0.05). Conclusion: Using of CAM visual stimulation along with conventional occlusion will further improve visual acuity and stereopsis in amblyopic children. These findings recommended the CAM visual stimulation as an accompanying and complementary method in amblyopia treatment.

---

Background: Abacavir is an anti-retroviral medication used to treat HIV infected/AIDS patients and its efficacy has been proven in randomized clinical trials. The most significant adverse reaction associated with abacavir is the acute hypersensitivity phenomenon which manifests in many forms and in severe cases could result in death. Hypersensitivity reaction to abacavir has been closely linked to the presence of HLA-B*57:01 allele. Avoidance of abacavir initiation in allele-positive patients is the most effective strategy in preventing possible severe hypersensitivity reactions. Previous epidemiologic studies have made great strides toward delineating HLA-B*57:01 allele frequency in different regions of the World and the available results indicate significant discrepancy between geographical regions. Despite these efforts, no study to date has determined the allele frequency among Iranian HIV-positive patients. The aim of the present study was to determine the proportion of allele-positive patients among a group of Iranian HIV-infected patients. Methods: Between September 2012 and February 2013, 122 HIV-positive patients were selected among patients referred to Imam Khomeini Hospital’s Consultation cen-ter for high risk behaviors using the convenience sampling method. Sampling scheme was designed in a manner to include equal number of infected patients with and without clinical Acquired Immunodeficiency Syndrome (AIDS). Patient data was collected using available records and a blood sample for DNA analysis was also obtained. Presence of HLA-B*57:01 allele was determined using the Polymerase Chain Reaction- Sequence Specific Method (PCR-SSP). Results: Seventy three patients (59.8%) were male. Co-infection with hepatitis B and C was observed in 1.7% and 40.7% of the patients, respectively. History of addiction and anti-retroviral therapy was positive in 50.0% and 60.7% of the patients, respectively. Overall, three patients were allele-positive which corresponds to a frequency of 2.46% (95% CI: 0.005-7.30). No association between presence of allele and investigated vari-ables were identified. Conclusion: Frequency of HLA-B*57:01 allele among a group of Iranian HIV-infected patients is estimated to be 2.5%. This rate is comparable to those reported in other Middle-Eastern countries, yet is relatively lower than reports generated from South-Eastern Asia, Europe, and the United States. Future studies with larger sample sizes are needed to corroborate these findings.

---

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.

---

Background: The incidence of Patent Ductus Arteriosus (PDA) in premature infants whose birth weight is less than 1500 grams is approximately 30-60%, most of them need medical or surgical interventions. The purpose of this study is to determine the efficacy of prophylactic treatment with oral paracetamol (Acetaminophen- Hakim® Oral Drops 100 mg/ml, Hakim Pharmaceutical Co., Tehran, Iran) for PDA in preterm infants. Methods: A randomized clinical trial conducted from March 2012 to March 2013. Thirty-two preterm newborns whose gestational age was under 32 weeks and birth weight was 1500 grams or less, admitted in neonatal intensive care unit (NICU) of Vali-Asr Hospital, Tehran were studied prospectively. They were randomly assigned in two groups. The prophylaxis group received oral paracetamol for a period of two days starting during first 24 hours of life. No placebo was given to the control group. Echocardiography was performed 24-36 hours after the last given dose in prophylaxis group and on the 4th and 5th day in control group. A p-value less than 0.05 are considered significant. Results: There were 16 newborns in each group (20 boys and 12 girls). In 12 newborns of prophylaxis group the ductus arteriosus was closed although in control group in 8 newborns the duct was closed. No significant difference was observed in sex, gestational age, birth weight, mode of delivery, multifetal gestation and birth order between two groups. The rate of ductal closure was 75% and 50% in prophylaxis group and control group respectively (P=0.27). Conclusion: Our study demonstrated that prophylactic paracetamol is ineffective in PDA closure, although the rate of ductal closure between two groups seems remarkable. Paracetamol as a new strategy for PDA closure because of cost effectiveness and harmlessness may be used in future. However, we presume larger sample size studies are needed to show the efficacy of paracetamol, side effects, and complications in PDA prophylaxis treatment.