Tehran University Medical Journal

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Background: Bickerstaff's brainstem encephalitis (BBE) is a very uncommon central nervous system disease with unknown etiology. As it is usually responsive to treatment, the diagnosis this disease is important. It seems There is no reported Bickerstaff's brainstem encephalitis case in Iran.
Case presentation: An 83 year old woman presented with vertigo, ataxia and dysarthria from a week prior to admission. Her T2 weighted MRI revealed high intensity lesions in the pons area. She received treatment with impression of ischemic stroke. After few days, lower extremities became weak symmetrically and deep tendon reflexes depressed. Deep sensory loss was noted too. The EMG-NCV studies showed acute polyneuropathy and in CSF examination increased protein content was noted. The patient improved after IVIG and corticosteroid therapy with impression of Bickerstaff's brainstem encephalitis.
Conclusion: In spite of severe initial presentation, Bickerstaff's brainstem encephalitis has a good prognosis if it diagnosed and treated properly. Although clinical features is too important, but paraclinical work up are necessary to diagnose this syndrome.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Skin-derived precursors (SKPs) are a type of progenitor cells extracted from mammalian dermal tissue and can be differentiate to neural and mesodermal lineage in vitro. These cells can introduce an accessible autologos source of neural precursor cells for treatment of different neurodegenerative diseases. This research was done in order to set up isolation, culture, proliferation and differentiation of human skin derived precursors (hSKPs).
Methods: Human foreskin samples were cut into smaller pieces and cultured in proliferation medium after enzymatic digestion. To induce neural differentiation, cells were cultured in neural differentiation medium after fifth passage. We used immunocytochemistry and RT-PCR for characterization of the cells. Neuron and glial cell differentiation potential was assessed by immunofloresence using specific antibodies. The experiments were carried out in triplicate.
Results: After differentiation, βΙΙΙ- tubulin and neurofilament-M positive cells were observed that are specific markers for neurons. Moreover, glial fibrillary acid protein (GFAP) and S100 positive cells were identified that are markers specifically express in glial cells. Detected neurons and glials were also confirmed by their morphologic characterizations.
Conclusion: Our results demonstrated that skin-derived precursors obtained from human foreskin can exhibit neuronal and glial differentiation potential in vitro, depending on the protocols of induction.

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Background: Respiratory virus infections represent a major public health problem because of their worldwide occurrence, ease of spread in the community and considerable morbidity and mortality. They are one of the most common reasons for hospitalization of children under the age of six. In some cases, infection with two different viruses increase the severity of disease which lead to the hospitalization.
Case presentation: Among 202 samples related to children under the age of six with respiratory infections, two dual infections of Adenovirus with other respiratory viruses with PCR test were detected.
Conclusion: Mixed respiratory viral infections are sometimes associated with severe disease and recognition of coinfection is important. Dual infections of Adenovirus with respiratory syncytial virus (RSV) and Swine origin influenza A (H1N1) virus were demonstrated. The evidence showed that the co-infection of Adenovirus with swine origin influenza A (H1N1), has increased the severity of disease which lead to the hospitalization.

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Background: Common Variable Immunodeficiency (CVID) is a primary immunodeficiency disease, characterized by hypogammaglobulinemia and heterogeneous clinical manifestations. This study was performed to evaluate the clinical and immunological features of pediatric patients with CVID.
Methods: We reviewed the records of 69 children diagnosed under age of 16 years with CVID (35 males and 34 females).
Results: By the year 2008, 15 patients (21%) had died. The total follow-up period was 333 patient-years. The mean diagnostic time between onset and diagnosis in our patient group was 4.40 years. The overall rate of consanguineous marriages was 58%. 10 patients had a positive family history of immunodeficiency. At the time of diagnosis, the mean levels of serum immunoglobulin G (IgG), IgM, and IgA levels were 286.86, 39.92, and 18.39 mg/dl, respectively which were below the normal levels for age. All of the patients presented with infectious diseases at the time of onset, the most common of which were pneumonia, diarrhea and sinusitis. Acute and recurrent infections were also found in almost all of the patients, particularly involving respiratory and gastrointestinal systems. The most common infections during follow-up period were pneumonia (31.9%), acute diarrhea (18.8%), acute sinusitis (18.8%), and otitis media (14.5%). Post-diagnosis survival was estimated to be 79% during the first five years. The survival rate was not shown to be influenced by delayed diagnosis, serum levels of IgG and B-lymphocyte count at the time of diagnosis.
Conclusions: Any child with a history of recurrent infections, decreased levels of serum immunoglobulin isotypes and consanguineous parents should be considered as a CVID patient.

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Background: Molecular DNA markers are one of the most important tools in molecular biology labs. The size of DNA molecules is determined by comparing them with known bands of markers during gel electrophoresis. There are many different protocols to produce these kinds of molecular markers. In this study we have suggested an efficient strategy to produce molecular weight markers in industrial proportions. Methods: To achieve the desired sizes of DNA fragments, a combination of two previously known methods, restriction enzyme digestion and polymerase chain reaction (PCR), were used. The enzymatic digestion process was based on designing and constructing plasmids which equaled in size with the desired length of DNA fragments and produced the desired DNA fragment upon linearization. In the PCR method, the desired length of DNA fragments were cloned in multiple cloning sites of pTZ57R plasmid and in a PCR reaction, the new constructed plasmid was used as a template to produce the final fragment. Results: Upon application of this strategy, 2000 and 3000 bp DNA fragments were produced by enzymatic digestion of plasmids of the same size. Moreover, 100 to 1500 bp fragments were produced during PCR using only a set of forward and reverse primers at the flanking region of pTZ57R multiple cloning site. Conclusion: The highest advantage of this cost-benefit approach is to produce different types of molecular weight markers by using an effective and short protocol

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Background: An increased risk for invasive infections with encapsulated bacteria such as Streptococcus pneumoniae has been described in patients with chronic kidney disease (CKD) or in those on dialysis. The aim of this study was to evaluate the antibody response to pneumococcal capsular polysaccharide vaccine in CKD patients. Methods: Sixty-six patients with CKD and 40 healthy individuals were vaccinated with pneumococcal polysaccharide vaccine. The serum antibody response (IgG and IgG2) to the Pneumovax antigens was determined by enzyme-linked immunosorbent assay (ELISA) prior to and four weeks after vaccination. Results: Out of 66 vaccinated patients with CKD, 14 were found to be hyporesponsive to the vaccine (Group 1). Patients with normal specific antibody response were regarded as respondents and were assigned to Group 2 (n=52). The mean post-vaccination IgG titer to the pneumococcal antigens in Group 1 was significantly lower than those in Group 2 (P=0.012 for IgG and P=0.02 for IgG2). The increased anti-pneumococcal IgG titer was significantly lower in patients in Group 1 versus Group 2 (P=0.001) or the healthy control group (P=0.005). During the follow-up period of patients, patients in Group 1 developed higher episodes of pneumococcal infections than those in Group 2 (P=0.007). Conclusion: A substantial proportion of patients with chronic kidney disease fail to mount an adequate antibody response to pneumococcal antigens and remain at significant risk for such infections. These patients should be offered other prophylactic measures to protect them against invasive pneumococcal diseases.

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Background: Thymidine phosphorylase (TP) catalyses the conversion of thymidine into thymine. Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is an autosomal recessive disease which is caused by mutations in the nuclear gene encoding TP, bringing about severe impairment of TP-enzyme specific activity and accumulation of thymidine in plasma. The clinical manifestations of MNGIE are recognizable and homogenous, but not in the early stages of the disease. In patients who are suspected of having MNGIE, determination of TP-specific activity in leukocytes and thymidine levels in plasma are diagnostic. The methods that are usually used for the measurement of TP activity and plasma thymidine are not rapid or accurate enough and lack sensitivity.

Methods: The specific activity of TP was measured by RP-HPLC in leukocytes of both the controls and the patients exhibiting clinical features suggestive of MNGIE. Moreover, plasma thymidine was assessed by the same method.

Results: The patients had detectable plasma thymidine (>3 µmol/L) but it was undetectable in the healthy controls. The patients' TP-specific activity decreased to less than 5% relative to the controls (14±4 nmol/h/mg vs. 525±165 nmol/h/mg, P<0.05). A diagnostic algorithm for the definitive diagnosis of MNGIE is suggestible based on the results of this study which relies on the measurement of plasma thymidine, TP-specific activity in leukocytes, or both.

Conclusion: In this study, we set up a sensitive and rapid assay for the evaluation of TP-specific activity by using RP-HPLC in Iran. In addition, we established reference values for TP-specific activity and plasma thymidine in the Iranian patients.

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Background: Rosa damascene has a special role in the Iranian traditional medicine due to its sedative, anticonvulsant and analgesic effects. Regarding its alkaloid, flavonoid and other organic compounds, this plant has always been used to reduce nervousness and treat depression and chronic insomnia. In the present time, synthetic drugs with sedative and anxiolytic properties are used for such problems but due to their side- effects and economic issues, the significance of natural medicines with fewer side- effects is of interest. Considering the importance of sedative and anxiolytic effects of Rosa damascene, we decided to compare this plant with synthetic drugs of the same properties. Methods: Two different groups of male Wistar rats received either Rosa damascene extract in doses of 150, 300, 450 mg/kg or Diazepam and dimethyl sulphoxide in doses of 1.2 mg/kg intraperitoneally 30 minutes before assessing the sleep duration, sedation and preanesthetic effects induced by intraperitoneal ketamine, 40 mg/kg. The anti- anxiety effect was evaluated by using an elevated plus maze and a rota rod. Results: The results showed a meaningful increase in the period of sleep induced by Ketamine (P≤0.01) and also a meaningful increase in time spent at the open arms of the device in the group receiving Rosa damascene extract (P≤0.01). Conclusion: The results showed that the Rosa damascene extract dose 450mg/kg has sedative, preanesthetic and anxiolytic effects (P≤0.01).

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800x600 Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Intrauterine insemination (IUI) is a less expensive and less invasive treatment in comparison with other assisted reproductive techniques, and it has been widely used for a variety of indications as well as in the treatment of couples with infertility. The outcome of IUI may be affected by numerous factors but in this study, we evaluated the effects of cervical mucus removal undertaken before IUI on clinical pregnancy rates.
Methods : In this randomized clinical trial study, all infertile women who were candidates for IUI and attended Shahid Akbar Abadi Hospital during 2009 and 2010 were recruited. The participants were randomly assigned into two groups. Cervical mucus was removed prior to IUI in patients in group A but in group B, a classic IUI was done without removing the cervical mucus. Pregnancy rates were assessed in the two groups by serum levels of β-HCG and detection of fetus in the uterus. 
Results : 291 women including 143 in the classic IUI group and 148 in cervical mucus removal group completed the study. The pregnancy rates were 14.2% (21 pregnancies upon 148 cycles) in the cervical mucus removal group and 7% (10 pregnancies upon 143 cycles) in the control group (P=0.04, OR: 2.199 CI 95%: 0.997-4.85).
Conclusion: The findings showed that cervical mucus removal could result in a two-fold increase in pregnancy rate in comparison with classic IUI. Thus, we suggest this practical and noninvasive method to improve pregnancy rate in these patients.

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800x600 Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: In the last two decades, cryptococcosis has been gaining a distinct public health importance due to the growing number of AIDS cases. Considering the low sensitivity of direct examination with India ink and culture, use of sensitive techniques is crucial in the diagnosis of cryptococcal meningitis. Polymerase Chain Reaction (PCR) can be used to directly detect Cryptococcus neoformans in CSF samples to increase the diagnostic power in cases where conventional methods are unable to detect the organism.
Methods : In this cross-sectional study, CSF samples were obtained from 25 patients suspected of having neurocryptococcosis. The patients were referred to the Medical Mycology Laboratory of the School of Public Health affiliated to Tehran University of Medical Sciences from March 2009 to February 2010. Three different methods, direct India ink examination, culture and PCR were used to evaluate the CSF samples. Two 102 and 106 of Cryptococcus neoformans dilutions in 1ml of CSF were prepared and examined by the three methods. In PCR method, two primer pairs were selected to amplify the Cryptococcus neoformans URA5 gene. The sequences of primers were for A, B, C and D serotypes.
Results : Only in one case PCR, as well as direct examination and culture were positive. All the other samples were negative in PCR, direct examination or culture. Both CSF dilutions were positive in the three tests in the mentioned patient and the positive control.
Conclusion: PCR method can efficiently identify both control and positive samples of Cryptococcus neoformans.

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Background: Fumonisins, a family of mycotoxins, are mainly found in wheat, corn and their products. Previous studies have shown that fumonisin B1 (FB1), the most abundant and toxic of known fumonisins, has been associated with many animal and human diseases including cancer. In the present study, the effects of FB1 were examined on the production of inflammatory cytokines in intestine and stomach cell lines.

Methods: This study was performed in the Cancer Research Center of Tehran University of Medical Sciences in 2010. The cell lines of colon adenocarcinoma (SW742) and gastric epithelium (AGS) were purchased from the Pasteur Institute of Iran. The cells were pretreated with different concentrations of FB1 (0 to 100 µM) for 3 days. The cells were later stimulated by lipopolysaccharides. Twenty-four hours after cell induction, the cytokines including tumor necrosis factor-alpha (TNF-α), interlukin-1 beta (IL-1β) and interlukin-8 (IL-8) were measured by ELISA.

Results: Treatment with FB1 induced a dose-dependent decrease in IL-8 production (P<0.05). This decrease was seen in both SW742 and AGS cell lines. Moreover, FB1 induced a dose-dependent increase in the production of TNF-α and IL-1β in both cell lines (P<0.05).

Conclusion: The results of this study indicated that FB1 could increase the inflammatory cytokines including TNF-α and IL-1β in gastric and intestinal celllines. These effects might result in the development of inflammatory responses and subsequent mucosal atrophy in in-vivo conditions.

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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: Pneumothorax is a potential life-threatening condition especially in patients with underlying disorders. In this study we compared the diagnostic accuracy of general practitioners and emergency medicine specialists in interpreting chest x-rays (CXR) suspected of having iatrogenic pneumothorax in emergency departments.

Methods: This cross-sectional study was conducted in Shahid Chamran Hospital in Tehran, Iran during 2008- 2010. The study was designed to compare the ability of general practitioners and emergency medicine specialists in diagnosing iatrogenic pneumothorax regarding 500 CXRs of one-hundred patients admitted for upper central venous catheterization.

Results: General practitioners and emergency medicine specialists could accurately (P<0.001) diagnose pneumothorax in 484 (96.8%) and 497 (99.4%) CXRs, respectively. None of the underlying causes of the condition affected the diagnostic accuracy of both physician groups (P>0.05).

Conclusion: These findings indicate that the diagnostic accuracy of emergency medicine specialists is significantly higher than those of general physicians. The diagnostic accuracy of both physician groups was higher than the values in similar studies that signifies the role of relevant training given in the emergency departments of the Hospital.

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Background: Psoriasis is a common, chronic disease of the skin, in which both genetic and environmental factors play a critical role. The most characteristic lesions consist of red, scaly plaques present particularly over extensor surfaces and scalp. Studies have reported association between psoriasis and many other diseases in both cutaneous and systemic forms of the disease. Several studies with different and sometimes controversial results have been done about the relationship of hyperuricemia and psoriasis. The aim of our study was to assess serum uric acid levels in patients with psoriasis.

Methods: We studied 126 patients with psoriasis in a case-series study in Razi Hospital during one year. After recording the age, sex, duration, type and severity of the disease and presence or absence of psoriatic arthritis in the patients, they were referred to the laboratory for the determination of serum uric acid concentrations.

Results: The mean (±SD) serum uric acid level was 5.4±1.5 mg/dL (ranging from 1.9- 9.5 mg/dL). Although the mean serum uric acid levels were in the normal range but the values were significantly higher in patients with more severe forms of psoriasis (P<0.001), its longer duration (P<0.001) and psoriatic arthritis (P=0.003). Moreover, serum uric acid levels were significantly higher in patients with non-plaque-type than plaque-type psoriasis (P=0.01).

Conclusion: This study revealed that serum uric acid levels exacerbate by increases in the severity and duration of psoriasis, in psoriatic arthritis, and in patients with non-plaque-type psoriasis.

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Background: Bone remodeling has always been the goal of surgeons for a long time. Recently, it was shown that statins that are commonly prescribed for lowering cholesterol also have beneficial effects on bone healing. Therefore, the present study was undertaken to evaluate the probable effects of atorvastatin on osteogenesis in the rat femur.

Methods: This experimental study was conducted on 30 male Sprague-Dawley (SD) rats. The animals were divided randomly into one control and two experiment groups. After induction of anesthesia, a hole of 2 mm in diameter was made in femur width. The control group received physiological serum but the experiment groups one and two, respectively, received 10 and 20 mg/kg/PO of atorvastatin on daily basis. After euthanizing the rats, histopathological and histomorphometrical evaluations of the bones were performed 45 days after the intervention.

Results: In the control group, the defects seemed to be filled with woven bone and bone marrow, depictive of a poor osteogenic activity. In the experiment groups, many osteoblast groupings and young bone trabeculae had been formed and bone trabeculae were more organized. Histomorphometric results, showed that atorvastatin had significantly promoted bone healing in the experiment groups compared with the controls (P<0.001). Moreover, the analysis showed that atorvastatin had more significant effects in group three receiving high doses of the medication in comparison with group two (P<0.001).

Conclusion: The findings of this study showed that atorvastatin is capable of stimulating osteogenesis in rats.

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Background: Perioperative administration of tranexamic acid (TA), decreases bleeding and the need for transfusion after cardiac procedures. Hence, the results may vary in different clinical settings and the most appropriate timing to get the best results is unclear. The primary objectives of the present study were to determine the efficacy of TA in decreasing chest tube drainage, the need for perioperative allogeneic transfusions and the best timing for TA administration following primary, elective, coronary artery bypass grafting (CABG) in patients with a low baseline risk of postoperative bleeding.

Methods: In this double-blind, prospective, placebo-controlled clinical trial in Seiedoshohada Hospital during 2011-2012, we evaluated 150 patients scheduled for elective, primary coronary revascularization. They were randomly divided into three groups. Group B received tranexamic 10 mg/kg prior to, Group A received tranexamic acid 10 mg/kg after cardiopulmonary bypass and group C received an equivalent volume of saline solution. Blood requirement and postoperative chest tube drainage were recorded.

Results: The placebo group (group C) had a greater postoperative blood loss 12 h after surgery (501±288 vs. 395±184 in group B and 353±181 mL in group A, P=0.004). The placebo group also had greater postoperative total blood loss (800±347 vs. 614±276 in group B and 577±228 mL in group A, P=0.001). There was a significant increase in allogeneic blood requirement in the placebo group (P=0.001).

Conclusion: For elective, first time coronary artery bypass surgery, a single dose of tranexamic acid before or after cardiopulmonary bypass is equally effective.

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Background: Musculoskeletal disorders (MSDs) are the most common reported occupational health problem which cause high financial burden and reduce efficiency of workers. MSDs are often multifactorial. This study was done to determine the frequency of MSDs and their relation to occupational stress among office workers.

Methods: 332 office workers were recruited in descriptive-analytical study. To assess the frequency of MSDs, we used Nordic questionnaires and to assess the occupational stress, we used the general Nordic questionnaire for psychological and social factors at work (QPS Nordic+34 questionnaire). The collected data were processed and analyzed.

Results: Our study showed that the frequency of MSDs among office workers was higher than the general population and the stress index was higher (P=0.002) among the office workers with MSDs than employees without it.

Conclusion: This study showed that occupational stress was a risk factor for MSDs, especially in the upper extremities.

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Background: Intracranial lipomas are rare benign neoplasms that comprise 1% of all primary brain tumors. Generally, occur in midline structure and usually identified incidentally on CT scans or in autopsies. The incidence of intracranial lipomas is about 0.08 to 0.46% on autopsies. These benign lesions are slow-growing, usually asymptomatic and rarely require surgery.

Case Presentation: We report a 20 years old male who complained of headache since two years ago. On CT examination, a quadrigeminal cistern lipoma without any pressure effect on neural structures demonstrated. His headache remitted with conservative measures. Here, we have a review on the literature and explain CT scan and MRI findings.

Conclusion: According to the literature and present case, it seems that direct surgical excision of tumor is not justified in the majority of cases and symptoms of patients greatly respond to conservative measures and, at most, in cases of hydrocephalus, CSF shunting relieves their symptoms.

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Background: Several dietary factors are involved in cardiovascular coronary heart diseases, including trans fatty acids, which are generally formed during hydrogenation of vegetable oils, a process that causes conversion of liquid oils into semisolid fats. Nowadays, it is well-known that trans fatty acids form a major risk factor in the occurrence and progression of atherosclerosis. On the other hand, it has been identified that some nuclear receptors, such as PPARs,are involved and play important roles in lipid homeostasis and pathogenesis of cardiovascular diseases. Therefore, we studied the effect of elaidic acid on gene expression of peroxisome proliferator activated receptor gamma (PPARγ).

Methods: Murine macrophage RAW264.7 cells were treated by 0.5, 1, and 2 mM concentrations of elaidic acid for 6 h. The control group was treated by 50% ethanol (as solvent), equivalent to the amount of ethanol used in 2 mM concentration of elaidic acid. Later, the total RNA was extracted and its cDNA was synthesized. Finally, the quantity of PPARγ gene expression was measured by real-time PCR.
Results:  Overall,0.5, 1, and 2 mM concentrations of elaidic acid decreased PPARγ gene expression in RAW264.7 macrophage cell line by -1.36, -1.68, and -3.24 folds compared with the control group, respectively.
Conclusion: By decreasing the expression of nuclear receptor PPARγ, elaidic acid causes, intensifies or accelerates the occurrence of cardiovascular diseases, especially atherosclerosis.This finding shows the importance of reducing the consumption of elaidic acid containing foods.

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Background: Steroid cell tumor is one of the rare ovarian tumors and forms 0.1% of all ovarian tumors, divided to three subgroups. Steroid cell tumor that are not otherwise specified (NOS) are the most common type and represent 60% of steroid cell tumors. One of the most known signs of this tumor is hormonal function, especially androgenic effects of it. Primary treatment consists of eradication of tumor via surgery.
Case presentation: The patient is a 29 years old female with history of poly cystic ovarian syndrome since 10 years ago, who attended to the clinic of General Women Hospital of Tehran in January 2011. In pelvic ultrasonography, there was a 6449mm mass in the right adnexa consisting of homogeneous component. She underwent laparotomy and unilateral salpingoophorectomy was done. Pathological report was steroid cell tumor of ovary.
Conclusion: The aim of this study is reporting one of the rare tumors of ovary and assessment of the correct way of diagnosis and treatment of it.