Tehran University Medical Journal

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Background: Female genital tract sarcomas are rare but most aggressive tumors of mesodermal origin. Little is known about the pathogenesis, risk factors, optimal treatment and outcome of these diseases. Therefore, we aimed to evaluate the clinicopathologic characteristics of patients with genital sarcoma.

Methods: This is a retrospective, cross-sectional study. The medical records of 43 female patients with genital tract sarcoma, hospitalized during a 16-year period (from 1991-2007) were retrieved from the medical records office of Ghaem Hospital in Mashad, Iran. The demographic data extracted from the records.

Results: The mean age of the patients was 46.95 years (ranging from 3-77 years). The chief complaint of the patients was abnormal vaginal bleeding (69.8%). The mean interval between the onset of symptom to the pathological diagnosis of sarcoma was 8.53 months (ranging from 1-36 months). Histologically, the tumors included: leiomyosarcoma (79.1%), endometrial stromal sarcoma (18.6%) and embryonal rhabdomyosarcoma (2.3%). Three patients (7%) were in International Federation of Gynecology and Obstetrics (FIGO) stage I, 20(46.5%) in stage II, 6(14%) in stage III and 14(32.6%) in stage IV. 48.8% of the patients had undergone chemoradiotherapy.

Conclusions: In most cases, our patients were referred so late or the disease was recognized very late due to being rare. We should consider this disease for every patient with unusual vaginal bleeding especially in post menopause women who their sonography has reported uterine mass.

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800x600 Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Diabetes insipidus is a rare disease which can be considered as a part of broad spectrum of preeclampsia manifestations.
Case presentation : A 39-year old primigravid woman, with an unremarkable past medical history, was admitted in the 33rd week of gestation for elevated blood pressure. On admission, her blood pressure was 140/90 mmHg and the only abnormal laboratory findings were trace proteinuria and elevated liver enzymes. During the following days her blood pressure rose to 150/100 mmHg with deterioration of clinical and paraclinical status of the patient characterized by excessive thirst, polydipsia and excretion of large amounts of diluted urine. Having considered the patient's aggravating status, termination of pregnancy was planned. Fortunately, all the clinical and paraclinical presentations, including those related to the probable diabetes insipidus disappeared on the second day of postpartum period.
Conclusion: Sign and symptoms of diabetes insipidus should be considered in all cases admitted for preeclampsia.

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Background: Overactive bladder (OAB) is one of the most prevalent diseases of lower urinary system. OAB disease is defined by the Standardization Subcommittee of the International Continence Society as urinary urgency, with or without urge incontinence, usually with frequency and nocturia with no proven infection or other obvious pathology. Treatment with the antimuscarinic agents tolterodine and oxybutynin is the mainstay of therapy for overactive bladder. The study was undertaken to compare the efficacy and side-effects of tolterodine and oxybutynin in a number of Iranian women.

Methods: This study consisted of two trials and done in Imam Khomeini Hospital in 2009 in one trial, 50 patients with overactive bladder were randomized to 4 weeks of treatment with 2 mg of twice-daily tolterodine, and in the other to 5 mg of three times a day oxybutynin. Urodynamic investigations, Episodes of urge urinary incontinence and adverse events were also evaluated.

Results: The results showed a good association between the questionnaire and cystometry data but urodynamic studies showed significant differences in efficacy. Tow groups showed significant improvements in all Symptoms, but The results showed that the two drugs had no significant differences in efficacy.

Conclusion: The data obtained by questionnaire indicated that both drugs increased quality of life but there were no significant differences between the two in symptom cure. Dry mouth was the most common side-effect in the two groups but unlike other studies it was higher in the tolterodine group. Therefore, our study did not show any preference between oxybutynin and tolterodine.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Staphylococcus aureus infection pervasively occurs in communities and hospitals and observing related guidelines is essential in preventing development of antibiotic resistance in Hospitals. In this study we tried to determine the prevalence of Methicillin and vancomycine resistant staphylococcus aureus (MRSA & VRSA) and find the most suitable diagnostic tool and treatment in affected patients.
Methods: This study was performed on hospitalized patients in Sina Hospital in Tehran, Iran during 2009-2010. Eighty-five staphylococcus aureus samples were evaluated for resistance to oxacillin and vancomycine by both disc diffusion and E-test methods.
Results: The study population included 46 male and 39 female patients. The mean age of the participants was 51.46±19.21 years. The MRSA frequency was 50%. 67 (78.8%) patients had hospital-acquired staphylococcus infection. The rate of hospital-acquired MRSA was 93%. Length of hospital stay, undergoing invasive methods, history of antibiotic use three months prior to hospitalization and its kind were recognized as MRSA risk factors. There were no reports of VRSA except one case of vancomycine-intermediate S. aureus (VISA). The results of disk effusion and E-test methods were consistent.
Conclusion: Considering the prevalence of methicillin resistance in hospital-acquired infections, it seems that oxacillin should not be used as the first-line option for empiric therapy against S. aureus till antibiogram results are available. Disc diffusion can also be reliably used instead of the more expensive E-test.

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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.

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Background: Ascorbic acid (AA) is not synthesized in the brain but it is actively transported through blood-brain barrier by SVCT2 cotransporter and it is stored in high concentrations with heterogeneous distribution in areas such as nucleus accumbens shell (AcbSh) in the mammalian brain. Previous studies have shown that Ascorbic acid injection into AcbSh decreases feeding therefore, in the present study we evaluated the effects of oral Ascorbic acid pretreatment on changes in feeding upon its injection in AcbSh in adult male rats.

Methods: Sixty-three adult male rats (220-280 g) were divided into five treatment and five pretreatment groups. The treatment groups included the control (intact) group, sham-operated Ascorbic acid group that received normal saline as vehicle, and three other groups that received different doses of ascorbic acid (10, 50 and 250 µg/rat) by injection into AcbSh for four days. The pretreatment groups received Ascorbic acid (100 mg/kg) for 15 days via gastric gavage before receiving the aforementioned doses in treatment groups into intra nucleus AcbSh. Feeding measurement was repeated every 12 hours by automatic metabolic cage.

Results: The results indicated that all injected doses of Ascorbic acid (10, 50 and 250 µg/rat) into nucleus accumbens shell decrease food intake (P<0.05) in rats and oral Ascorbic acid pretreatment had no effects in this regard.

Conclusion: Our findings show that ascorbic acid is an effective factor in feeding regulation. Oral pretreatment seems to have no influence on the central effects of ascorbic acid in the nucleus accumbens shell.

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Background: Hypercholesterolemia is considered a major risk factor for pancreatitis, atherosclerosis and coronary heart disease. Cholesteryl ester transfer protein gene polymorphisms are known to be associated with changes in lipid levels. We investigated the association between a polymorphism in the CETP gene (D442G) with plasma lipid levels and CETP activity in patients with hypercholesterolemia.

Methods: This case/control study that be done in Hamadan university of medical sciences (from October 2008 to September 2009), included 102 patients with hypercholesterolemia and 200 healthy individuals. Polymerase chain reaction and restriction fragment length polymorphisms were used to determine genotypic distribution and allelic frequencies of polymorphisms. The plasma CETP activity was measured by a kit in a fluorescence spectrometer. Lipid concentrations were measured by routine biochemical and enzymatic assays.

Results: Plasma cholesteryl ester transfer protein activity was significantly higher in the cases than the controls (P<0.05). The genotypic and allelic frequencies for this polymorphism were not statistically different between the patients with hypercholesterolemia and the controls (in controls: DD 96%, DG 4%, GG 0% and in cases: DD 86%, DG 10%, GG 4%), (P>0.05). Plasma HDL-C, LDL-C and TC were higher in both groups with GG and DG genotypes than with DD genotype, whereas serum CETP activity was lower in GG genotype compared with other genotypes (GD or DD), (P<0.05).

Conclusion: The results showed that D442G polymorphism of CETP gene was associated with changes in lipid profile and plasma CETP activity in the selected population and it might have a role in contributing to a genetic risk for developing coronary artery disease.

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Background: Cystic fibrosis (CF) is a multiorgan autosomal recessive disorder. As CF is highly heterogeneous in Iran and many mutations have a low frequency, routine molecular diagnostic methods are not very efficient. The use of highly polymorphic intragenic markers not only can facilitate phenotype prediction in prenatal diagnosis by gene tracking, but also can lead to the demonstration of possible associations between haplotypes and specific mutations. We determined IVS8 polyT and M470V polymorphisms in exon 10 of CFTR gene in this case-control study.

Methods: Polymorphisms of IVS8 polyT in 53 patients with CF were referred to Amirkola children's Hospital of Babol University of Medical Sciences, 2007 to 2011 and 49 fertile healthy individuals were determined by reverse dot blot method. M470V polymorphism was analyzed by PCR-RFLP.

Results: In IVS8 polyT study, T7 was the most frequent allele in healthy individuals than patients with CF (respectively, 82.8% Vs. 77.2%). T9 was more abundant in patients with CF than normal individuals (respectively, 21.7% Vs. 7.4%, P=0.005). T9/T9 genotype was more frequent in patients than healthy individuals (respectively, 15.1% and 2%, P=0.032). Study for M470V polymorphism showed that M/V was the most common genotype in normal individuals and patients with CF (respectively, 49% and 40.4%). M-T9 haplotype was highly associated with the disease in both patients with CF and normal individuals (respectively, 19.1% and 2.4%, (P<0.001)

Conclusion: The allelic distribution and heterozygosity results suggest that both M470V and IVS8 polyT can be helpful in the prenatal diagnosis of CF in Northern Iranians with a positive family history of the disease.

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Background: Obsessive-compulsive disorders and depression have a high prevalence during pregnancy therefore, pregnant women may take clomipramine and also take other drugs or consume foods that contain caffeine. As investigations about the teratogenic effects of clomipramine and its concurrent administration with caffeine during organogenesis period are scarce, we aimed to study the teratogenicity of simultaneous administration of clomipramine and caffeine in rat fetus.
Methods: After dividing 42 pregnant rats to several case and control groups, we injected different doses of caffeine and clomipramine to the animals. All the injections were performed on the eighth until the 15th day of pregnancy. We removed the fetuses on the 17th day of pregnancy and studied the morphological features and apparent anomalies of the fetuses macroscopically.
Results: We found a significant rate of mortality, apparent anomalies, abnormal torsion, shrinkage of skin and subcutaneous bleeding in fetuses of rats receiving high doses of caffeine or a combination of caffeine and clomipramine. Statistical analysis of the data revealed a significant increase (P?0.001) in teratogenicity of high doses of caffeine and its combination with clomipramine.
Conclusion: This study implies simultaneous intake of high amounts of caffeine and clomipramine lead to teratogenicity. We recommend pregnant women to avoid uncontrolled consumption of foods that contain caffeine or drugs that contain high amounts of this substance. They should not also take clomipramine with caffeine in the first trimester of pregnancy.

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Background: Gastric cancer is an important health problem across the world. Chemotherapy in combination with local treatment is the standard treatment for locally advanced gastroesophageal junction (EGJ) cancers. The purpose of this study was to evaluate response and tolerability to neoadjuvant regimen combining epirobicin, oxaliplatin and capecitabin (EOX) in locoregionally advanced gastric cancer.
Methods: We recruited 28 patients with histologically confirmed advanced gastric or EGJ adenocarcinoma in this study performed in the Cancer Institute of Imam Khomeini Hospital in Tehran, Iran in 2010-2011. Staging workup included chest and abdominal computed tomography (CT) scans, upper gastrointestinal endoscopy, endoscopic ultrasonography (EUS), measurement of carcinoembryonic antigen (CEA), complete blood cell count (CBC), and liver and renal function tests. After three treatment cycles with EOX regimen, we evaluated response to the neoadjuvant chemotherapy by performing endoscopic ultrasonography (EUS) and chest and abdominal CT scans.
Results: The mean age of the patients was 56.64±11.08 years (ranging from 37 to 78 years). Most patients were classified as having stage III (98.8%) cancer before chemotherapy while most were classified as stage II (57.14%) after the treatment. Only 28.5% of tumors were resectable before chemotherapy, but 82.1% of them were resectable upon the treatment. 75% of tumors were downstaged after chemotherapy.
Conclusion: Regarding the acceptable response and downstaging of tumors and low toxicity of EOX regimen in locoregionally advanced gastric cancer, evaluation of this regimen as a neoadjuvant chemotherapy in larger phase III clinical trials in Iranian patients would be both necessary and logical.

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Background: Pulseoximetry is widely used in the critical care setting, currently used to guide therapeutic interventions. Few studies have evaluated the accuracy of SPO2 (puls-eoximetry oxygen saturation) in intensive care unit after cardiac surgery. Our objective was to compare pulseoximetry with arterial oxygen saturation (SaO2) during clinical routine in such patients, and to examine the effect of mild acidosis on this relationship.
Methods: In an observational prospective study 80 patients were evaluated in intensive care unit after cardiac surgery. SPO2 was recorded and compared with SaO2 obtained by blood gas analysis. One or serial arterial blood gas analyses (ABGs) were performed via a radial artery line while a reliable pulseoximeter signal was present. One hundred thirty seven samples were collected and for each blood gas analyses, SaO2 and SPO2 we recorded.
Results: O2 saturation as a marker of peripheral perfusion was measured by Pulseoxim-etry (SPO2). The mean difference between arterial oxygen saturation and pulseoximetry oxygen saturation was 0.12%±1.6%. A total of 137 paired readings demonstrated good correlation (r=0.754 P<0.0001) between changes in SPO2 and those in SaO2 in samples with normal hemoglobin. Also in forty seven samples with mild acidosis, paired readings demonstrated good correlation (r=0.799 P<0.0001) and the mean difference between SaO2 and SPO2 was 0.05%±1.5%.
Conclusion: Data showed that in patients with stable hemodynamic and good signal quality, changes in pulseoximetry oxygen saturation reliably predict equivalent changes in arterial oxygen saturation. Mild acidosis doesn’t alter the relation between SPO2 and SaO2 to any clinically important extent. In conclusion, the pulse oximeter is useful to monitor oxygen saturation in patients with stable hemodynamic.

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Background: Ventilator Associated Pneumonia (VAP), developing in mechanically ventilated patients after 48 hours of mechanical ventilation, is the second most common nosocomial infection. Therefore, there is a vital need to study the etiology and risk factors associated with VAP in neonates.
Methods: Neonates admitted to neonatal intensive care unit (NICU), over a period of one year and who required mechanical ventilation for more than 48 hours were enrolled consecutively into the study. Semi-quantitative assay of endotracheal aspirate was used for microbiological diagnoses of VAP. 105CFU/ml was taken as the cut off between evidence of pathological infection and colonization. The primary outcome measure was the development of VAP. Secondary outcome measures were length of mechanical ventilation, NICU length of stay, hospital cost, and death.
Results: Thirty eight patients were enrolled (58% were boys and 42% were girls). 42% of neonates developed VAP. The most common VAP organisms identified were Acinetobacter baumanni (43%). On multiple regression analysis, duration of mechanical ventilation was associated with VAP (P=0.00). Patients with VAP had greater need for mechanical ventilation (18.7 vs 6 median days), longer NICU length of stay (39 vs 21.5 median days) and higher total median hospital costs (79.5 vs 52 million rials) than those without VAP. The mortality rate was not different between two groups.
Conclusion: In mechanically ventilated neonates, those with VAP had a prolonged need for mechanical ventilation, a longer NICU stay, and a higher hospital costs. Longer mechanical ventilation was associated with an increased risk of developing VAP in these patients. Developing of VAP didn’t increase mortality in patients.

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Background: Acquired paralysis of the diaphragm is a condition caused by trauma, surgical injuries, (lung cancer surgery, esophageal surgery, cardiac surgery, thoracic surgery), and is sometimes of an unknown etiology. It can lead to dyspnea and can affect ventilatory function and patients activity. Diaphragmatic plication is a treatment method which decreases inconsistent function of diaphragm. The aim of this study is to evaluate the outcome of diaphragmatic plication in patients with acquired unilateral non-malignant diaphragmatic paralysis. Methods: From 1991 to 2011, 20 patients with acquired unilateral diaphragmatic paralysis who underwent surgery enrolled in our study in Ghaem Hospital Mashhad University of Medical Science. Patients were evaluated in terms of age, sex, BMI, clinical symptoms, dyspnea score (DS), etiology of paralysis, diagnostic methods, respiratory function tests and complication of surgery. Some tests including dyspnea score were carried out again six months after surgery. We evaluated patients with SPSS version 11.5 and Paired t-test or nonparametric equivalent. Results: Twenty patients enrolled in our study. 14 were male and 6 were female. The mean age was 58 years and the average time interval between diagnosis to surgical treatment was 38.3 months. Acquired diaphragmatic paralysis was mostly caused by trauma (in 11 patients) and almost occurred on the left side (in 15 patients). Diagnostic methods included chest x-ray, CT scan, ultrasonography and sniff. Test prior to surgery the average FVC was 41.4±7 percent and the average FEV1 was 52.4±6 percent and after surgery they were 80.1±8.6 percent and 74.4±1 percent respectively. The average increase in FEV1 and FVC 63.4±4, 61.1±7.8. Performing surgery also leads to a noticeable improvement in dyspnea score in our study. Conclusion: In patients with acquired unilateral non-malignant diaphragm paralysis diaphragmatic plication is highly recommended due to the remarkable improvement in respiratory function tests and dyspnea score without mortality and acceptable morbidity.

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Background: Colorectal Cancer (CRC) is the third common cancer in the world. One of the pathways in colorectal tumor genesis is Microsatellite Instability (MSI+). MSI is detected in about 15% of all colorectal cancers. Colorectal tumors with MSI have dis-tinctive features compared with Microsatellite Stable (MSS) tumors. Due to the high percentage of MSI+ in patients with CRC in Iran, screening of this type of CRC is im-perative. In current study, two markers (BAT-26 and BAT-25) were used to determine an appropriate screening technique with high sensitivity and specificity to diagnose MSI status in patients with CRC. Methods: Allelic variation in two markers (BAT-26 and BAT-25) was analyzed in tis-sues and sera of 44 normal volunteers and tumor and matched normal mucosal tissues as well as sera of 44 patients with sporadic colorectal cancer by Real Time PCR (Hy-bridization probe) and High-Performance Liquid Chromatography (HPLC) techniques. The sensitivity and specificity of Real Time PCR and HPLC compared with sequencing as gold standard. The data were statistically analyzed using Student’s t-test and 2 or fisher exact test, where applicable with (P<0.05). Receiver-operating-characteristic (ROC) curves were used to evaluate the sensitivity and specificity. Results: The sensitivity and specificity of BAT-26 with Real Time PCR method (Hy-bridization probe) were 100% in comparison with gold standard method. Whereas the sensitivity and specificity of BAT-26 and BAT-25 with HPLC were 83%, 100% and 50%, 97%, respectively. Neither HPLC nor Real time PCR could detect circulating DNA with MSI property in sera. Conclusion: The sensitivity and specificity of real time PCR in MSI detection is the same as sequencing method and more than HPLC. BAT-26 marker is more sensitive than BAT-25 and MSI detection with Real time PCR could be considered as an accu-rate method to diagnose MSI in CRC tissues not sera.

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Background: In most children with Acute Lymphoblastic Leukemia (ALL) and Non Hodgkin’s Lymphoma (NHL) who have received chemotherapy with and without radi-otherapy, some late effects due to treatment may occur such as endocrinopathies. Methods: We evaluated growth criteria (including short stature, obesity) and thyroid test function in 50 children with ALL (n= 25) and NHL (n= 25) 3-17 year-old in remis-sion period who randomly received chemotherapy with (n= 25) or without (n= 25) radi-ation such as our treatment groups. The values for height, weight and BMI in less than 5th or more than 95 th percentile considers abnormal. Results: Six (12%) patients were in less than 5th percentile height (short stature). Two patients (4.0%) had over-weight and 48 (96%) were in normal range of BMI. Six (12%) patients were in less than 5th and 3 (6%) were in more than 95 th weight percentile. There was no significant difference between two different treatment groups for TSH (P= 0.662 (but there was a significant difference between these groups in case of T4 (P= 0.049(. Mean and SD for T4 in patients with chemotherapy alone was less than in whom received chemotherapy plus radiotherapy. There was no significant difference between ALL and NHL groups for TSH, T4 (P= 0.567, 0.528 respectively). Two boys with ALL without history of radiation had hypothyroidism that had based on their la-boratory data. Conclusion: Regarding to effects of thyroid dysfunction on short stature and obesity in adolescent with ALL and NHL, we suggest to have more attention about growth, thy-roid test to avoid late side effect of malignancy treatment.

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Background: Pseudomonas aeruginosa is a gram-negative pathogens opportunism which causes severe infections in human beings. The most common infection include: endocarditis, meningitis, septicemia and chronic lung infections in cystic fibrosis pa-tients. This bacterium has many pathogenic factors including exotoxin A, lipopoly-sacharide, phospholipase C, pili, elastase and alkaline protease. The purpose of this study was to evaluate the frequency of exotoxin A gene (ETA) as a strong virulence factor and sensitivity determination of polymerase chain reaction (PCR) in pseudomonas aeruginosa isolated from second and third-degree burn patients. Methods: This study has performed in Besat University Hospital in Hamadan from January to December 2012. We used 170 isolated samples. The samples were isolated from blood and skin biopsy in second and third-degree burn patients. We had 79 strains positive culture of pseudomonas aeruginosa. Forward and reverse primers used for PCR were designed by DNASIS and Oligo software. Then genomic of known strains were extracted by DNA purification kit and indentified by PCR. The quality and quantity of the extracted DNA was determined using spectrophotometry. For determination of PCR sensitivity was used culture test as gold standard. DNA of pseudomonas aeruginosa (ATCC 27853) was used as a positive control. Finally data was analyzed using SPSS software. Results: Out of 170 isolated samples, 79 strains of pseudomonas aeruginosa isolated from burn patients had positive culture. PCR of isolated positive culture demonstrated that 5 strains (6.33%) were with out this virulence factor and 74 strains (93.67%) had ETA gene. So the sensitivity of test based on sensitivity formula was 94.04%. Conclusion: Our results showed that sensitivity of PCR mediated ETA gene in detection of pseudomonas aeruginosa strains is considerable and this factor can be used as a good factor identifying of pseudomonas aeruginosa. It seems more studies with larger sample size is necessary in this area.

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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: Colorectal cancer is a major cause of morbidity and mortality throughout the world, and its treatments include surgery, chemo-radiotherapy. Despite improvements in clinical outcomes of patients with this tumor over the past decades, prognosis remains poor with a 5-year survival rate of <10%. Angiogenesis inhibitor agents have been recently added to the treatment regimen of this disease. In the past two decades, it has been recognized that selective inhibitors of the cyclooxygenase -2 (Cox-2) enzyme result in the regression in the size of colorectal tumor, and one of its reasons is attributed to angiogenesis inhibition. The present study aimed at identifying the molecular pathways of angiogenesis inhibition by celecoxib. Methods: HCT-116, which is one of the cell lines of Colorectal cancer (separated from human colorectal adenocarcinoma) was provided by the National Cell bank of Iran (NCBI) affiliated to Pasteur Institute. It was then cultured in DMEM (high glucose) culture medium containing 10% FBS, and then treated in the active substance of celecoxib at pharmacological concentrations of 50 mM (C50) and 100 mM (C100). Afterwards, RNA was extracted and cDNA was prepared. The oligonucleotide of HIF-1 Alpha gene (angiogenesis initiator) was prepared and the level of HIF-1 alpha gene expression was assessed with a real-time PCR device in three control, C50 and C100 groups. Results: HIF-1 alpha gene expression significantly decreased in the celecoxib treatment group (compared with control group) with the concentration of C100 (P< 0.001), but no change was observed in the concentration of C50. Conclusion: Angiogenesis is a key factor in the carcinogenesis process and FDA today approved bevacizumab as a first-line treatment for patients with metastatic colorectal cancer. The results of this study showed one of the causes of angiogenesis reduction in celecoxib-treated colorectal cancer. According to clinical findings and basic studies, celecoxib will be hopefully used as a first-line therapy along with chemotherapy in the near future in colorectal cancer. The advantages of this treatment method include its low cost and low side effects.

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Background: The rabies is a deadly disease and if its symptoms break out in a person, he will certainly die. However, the deaths caused rabies can be prevented by post-exposure prophylaxis (PEP). Methods: In this study, subjects were recruited through census and with respect to in-formation which gathered from Fars Province health centers, Pasteur institution and previous studies In Iran. The mortalities for age groups and by sex type have been cal-culated. The decision tree model using probabilities, which the effectiveness of PEP treatment after getting bitten by an animal suspected, persons to receive specified. Dis-ability adjusted life year score (DALY) was applied to estimate the DALYs saved from PEP. In this study it was assumed that if a person suffering with rabies, a few days af-ter the onset of symptoms, death is compulsory. Therefore YLD rabies was considered zero. Finally, to increasing the accuracy and because inherent uncertainty of the data, and the increase the power of analysis, one-way sensitivity analysis was used. Results: From March 2011 to March 2012, in Fars Province, total cases of animal bites were reported and received PEP treatment. The cases were 5394 (75.85%) male and 1717 (24.15%) female. PEP generally prevented from 177.076 deaths which 134.096 (75.72%) were men and 42.98 (24.27%) of them were women. The age distribution of suspected animal bites in youth more than adults, and in men higher than women. Also due to prevented mortality caused by PEP, it is prevented from 4455.71 DALYs. Based on the sensitivity analysis DALY prevented, except for dogs and cats, there was no change in the other animals. Conclusion: The implementation of PEP for animal bitten people remarkably reduced the burden of disease in community. Calculations with primitive cost estimations im-plicitly revealed that this intervention is a most cost-effectiveness program.

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HIV/AIDS is among the leading causes of morbidity and mortality in world. There are more than 35 million people living with HIV/AIDS in the world. Although the annual incidence of HIV infection is decreasing globally, HIV prevalence is rising due to development of more effective treatment and higher survival. Iran suffers from concentrated HIV epidemics among injecting and non-injecting drug users. There are more than 27 thousand registered cases of HIV infection and it is estimated that there are above seventy eight thousand cases in the country. Regarding the burden of disease, it is projected that HIV/AIDS will have the highest growth during the next 10 years. The outcome of this epidemics will be determined by human behavior. HIV, psychiatric disorders and substance use disorders are closely correlated and are accompanied by similar risk factors. They also share common consequences such as stigma and discrimination. Correlation of psychiatric disorders, as one of the most influential determinants of our behavior, and HIV/AIDS infection is reviewed in this narrative article. Psychiatric disorders are associated with greater risk of HIV acquisition. Substance use disorders, both injecting and non-injecting, as well as severe mental illnesses put the individual at higher risk of acquiring HIV infection. Impaired judgment, diminished inhibition and control over behaviors, lack of insight and poor self-care have been proposed as the underlying mechanisms. On the other hand, HIV infection may put the individual at greater risk of developing a mental illness. Coping with a chronic and life-threatening illness, fear of stigma and discrimination, CNS invasion of the virus as well as the adverse neuropsychiatric side effects of anti-retroviral medications may all contribute to establishment of a psychiatric disorder. Although there exists a bi-directional correlation between mental health problems and HIV/AIDS infection, this reciprocity goes beyond. Psychiatric disorders can affect the patient’s adherence, access to treatment and care and can worsen the course and clinical outcome of the infection. The clinical importance, underlying mechanism and other implications of this correlation are reviewed in this article.