Tehran University Medical Journal

Background: The risk of atherosclerosis and cancer is high in hemodialysis (HD) patients. There is evidence that HD causes oxidative stress. However, the causative factors of oxidative stress are unknown. It has been suggested that HD imposes an additional oxidative stress on patients with chronic renal failure by activation of granulocytes on dialyzer membranes resulting in an imbalance between oxidants and antioxidants. In this regard, a number of reports, either measuring specific analytes or enzymes, or estimating the total antioxidant activity of the plasma have given contradictory and inconclusive results. To investigate the oxidative stress status in Iranian HD patients, in this study, we evaluated GSH and FRAP levels along with Ca and pH in the blood of these patients.

Methods: Along with 20 healthy age and gender matched control subjects, 24 patients underwent dialysis, three times per week, for four hours in each session. Before and after dialysis, blood was taken for biochemical and liver function tests and to evaluate oxidative stress markers and measure Ca and pH levels.

Results: There was a significant decrease in FRAP and GSH levels after dialysis compared to those before treatment. Dialysis caused an increase in pH and Ca levels compared to levels in control subjects after dialysis.

Conclusion: In general, before dialysis, there is a balance between oxidants and antioxidants however, due to higher levels of oxidants as well as the possible binding of antioxidants to the dialyzer membrane during dialysis, an imbalance occurs. The instability in the balance of oxidants and antioxidants may be the major cause of cellular oxidative damage found in HD patients. This study indicates that there is a significant level of oxidative stress in renal chronic patients and this stress is augmented by dialysis. Antioxidant therapy should be considered in these patients.

Background: The Biophysical Profile (BPP) is a noninvasive test that predicts the presence or absence of fetal asphyxia and, ultimately, the risk of fetal death in the antenatal period. Intervention on the basis of an abnormal biophysical profile result has been reported to yield a significant reduction in prenatal mortality, and an association exists between biophysical profile scoring and a decreased cerebral palsy rate in a given population. The BPP evaluates five characteristics: fetal movement, tone, breathing, heart reactivity, and amniotic fluid (AF) volume estimation. The purpose of study was to determine whether there are different degree of acidosis at which the biophysical activity (acute marker) are affected.

Methods: In a prospective study of 140 patients undergoing cesarean section before onset of labor, the fetal biophysical profile was performed 24h before the time of cesarean and was matched with cord arterial PH that was obtained from a cord segment (10-20cm) that was double clamped after delivery of newborn. (using cord arterial PH less than 7.20 for the diagnosis of acidosis).

Results: The fetal biophysical profile was found to have a significant relationship with umbilical blood PH. The sensitivity, specificity, positive predictive value, negative predictive value of fetal biophysical profile score were: 88.9%, 88.6%, 50%, 98.1%.

Conclusion: The first manifestations of fetal acidosis are nonreactive nonstress testing and fetal breathing loss in advanced acidemia fetal movements and fetal tone are compromised. A protocol of antepartum fetal evaluation is suggested based upon the individual biophysical components rather than the score alone.

Normal 0 false false false EN-GB X-NONE AR-SA MicrosoftInternetExplorer4 Background: Transthoracic needle biopsy is a well established method for obtaining pathologic diagnosis in the lung mass that performed after a previous negative bronocoscopy. The goal of this study is evaluation of the safety and accuracy of ultrasonographic guided transthoracic needle biopsy for diagnosing peripheral lung mass.
Methods: In a descriptive and prospective study from September 2005, 30 patients with peripheral lung mass with greater than 3cm in diameter and less than 5cm distance through the chest wall, underwent ultrasonographic guided transthoracic needle biopsy and it's diagnostic accuracy and complications were analyzed.
Results: The male to female ratio was two to one, the average age of the patients was 61.2 years and 60% of the lesions were located in right side. Adequate biopsy specimens were obtained in all patients, but transthoracic needle biopsy was diagnostic in 86.6% and 13.3% patients because doubtful diagnosis, who underwent thoracotomy for definitive diagnosis. From these four (13%) patient who needed thoracotomy definitive diagnosis were organized embolism, granulomatouse tuberculosis, bronchoalveolar carcinoma, and metastatic adenocarsinoma. Pathological diagnosis were malignant lesion in 83.3% that squamouse cell carcinoma and adenocarcinoma were the most common malignancies and benign lesions were found in 16.6% that granulomatouse tuberculosis was the most common lesion. Complications were observed in 13.3% that included pneumothorax (6.6%) and hemoptysis (6.6%) that managed medically. No cases of mortality were observed.
Conclusion: Transthoracic needle biopsy with ultrasonographic guide due to appropriale diagnostic accuracy and low complication rate with low cost and availability is recommended for the diagnosis of peripheral lung mass.

Background: Scoliosis is one of the most common spinal deformities with subsequent decrease in pulmonary function. The effects of surgical correction on the pulmonary function of patients with adolescent idiopathic scoliosis are controversial. The purpose of the present study was to compare the postoperative pulmonary function changes in different surgical approaches chosen for its correction.

Methods: Sixty-five patients with adolescent idiopathic scoliosis who had undergone corrective spinal surgery in Shafa Yahyaian Hospital since 1997 to 2007 and had documented preoperative pulmonary function test report, included in our study. The patients had documented preoperative pulmonary function tests and were divided into three groups based on their surgical approach. The first group was comprised of 25 patients who had undergone posterior spinal fusion (PSF), the second group included 29 patients who had anterior and posterior spinal fusion (ASF+PSF), and the third group consisted of 10 patients who had posterior spinal fusion and thoracoplasty (PSF+ thoracoplasty). The preoperative and the final follow-up values of absolute and percent predicted forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) were compared and their relations with the undertaken surgical approach were evaluated.

Results: There were no significant correlations between the surgical approaches and changes in the pulmonary function tests (P>0.05). FVC and FEV1 values were similar to preoperative values in all groups after a minimum follow-up of two years.

Conclusion: There were no significant differences between different surgical approaches for adolescent idiopathic scoliosis regarding the pulmonary function test results after at least two years of follow-up.

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Neutrophil Gelatinase Associated Lipocalin (NGAL) is a new biomarker which can predict acute kidney injury (AKI) in critically ill patients. Usefulness of NGAL in the early diagnosis of all types of AKI is under question. We hypothesized NGAL is an early predictive biomarker of contrast-induced nephropathy (CIN).
Methods: In this process evaluation study, we enrolled 122 patients (Mean age 59.7±10.8 years) undergoing elective angiography/angioplasty with contrast media during April to September 2009. Serial urine samples were analyzed in a double-blind fashion by NGAL enzyme-linked immunosorbent assay. CIN was defined as a 25% increase in baseline serum creatinine. 
Results : The prevalence of CIN was 30.3%. Significant elevations in urinary NGAL concentrations were noted within 12-h and 24-h after the procedure in patients with CIN. NGAL concentrations after 12 hours was 90.62±105.63 vs. 27.6±45.8 ng/ml in patients with and without CIN, respectively P=0.0001, and 79.78±117.7 vs. 30.92±52.84 ng/ml, 24 hours afterwards P=0.002. Some patients had AKI after five days of exposure rather than the second day (P=0.0001). We found using a cut-off point of 8 ng/ml with a sensitivity, specificity, negative predictive value and area under the ROC curve 94%, 25%, 91% and 0.75 respectively are good for the prediction of CIN in 12-h urinary NGAL and a cut-off point of 5.5 ng/ml with respective values of 97%, 24%, 95% and 0.70 for 24-h urinary NGAL.
Conclusion: Urine NGAL may represent a sensitive early biomarker of acute AKI after angiography/angioplasty. We recommend the routine measurement of NGAL in high risk patients receiving contrast agents.

Background: Carpal tunnel syndrome is the most common focal neuropathy that results from pressure on a nerve. The goal of this study was to assess carpal tunnel syndrome and its associated factors such as occupation, sex, and accompanying complications in a teaching general hospital.

Methods: This cross-sectional study investigated 362 patients with the diagnosis of carpal tunnel syndrome admitted in the orthopedic ward of Imam Khomeini Hospital affiliated to Tehran University of Medical Sciences in Tehran, Iran during 2000-2010.

Results: The difference in the mean age of men and women was statistically significant (P<0.0001). The percentage of men with the disease was significantly different from that of the women. The prevalence of idiopathic carpal tunnel syndrome was significantly different (P<0.0001) in comparison with carpal tunnel syndrome due to its leading causes. The most common occupation in women was first housekeeping and then hairdressing while in men it was being a worker. Diabetes Mellitus and hypothyroidisms as the leading causes of the syndrome were highly correlated with the disease (r=08, P<0.001).

Conclusion: According to the findings, most cases of the syndrome were idiopathic. Identifying the leading causes of the disease is important because their diagnosis probably prevents unnecessary surgery. By identifying such causes and/or correction of activity styles incidence of carpal tunnel syndrome and unnecessary surgical procedures would be prevented. Evaluation of patients for underlying causes can be useful, especially in severe forms of the disease to realistically assess the need for surgical treatment.

Background: Carotid endarterectomy (CEA) is a standard method for patient with significant carotid stenosis but direct surgical repair via carotid endarterectomy may not be a good option in some patients because of the overall health status that may make the surgery too risky. Carotid angioplasty and stenting (CAS), is a relatively new procedure for the treatment of carotid artery disease in patients who may not be fit enough to undergo surgery. In this investigation, we determined short- and long-term outcomes of stent angioplasty in high-risk patients for whom the risk of perioperative morbidity and mortality is high.

Methods: We have followed 82 consecutive symptomatic patients with a ≥50% and asymptomatic patients with a ≥70%- 80% carotid stenosis within 15.9 months of angioplasty and stenting in Baqiyatallah and Jamaran hospitals from 2008-2010. All the patients were considered poor surgical candidates by experienced surgeons and anesthesiologists upon pre-surgical consultation.

Results: This descriptive cross-sectional study was performed on 28 women and 54 men with a mean age of 69.7±9.2 years. The procedure was technically successful in 79 (96.3%) cases. There were 6 (7.3%) deaths, 5 (6.1%) strokes, 4 (4.9%) MIs and 4 (4.9%) TIAs during the follow-up period.

Conclusion: The clinical results during the short available follow-up period suggested stent angioplasty to be useful, effective, reliable and safe in the treatment of significant cervical carotid stenosis in high-risk patients. Further analytical investigations with longer follow-up periods for predicting risk factors are recommended.

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.

Background: Several studies have suggested higher incidence of osteoporosis in patients with idiopathic scoliosis in comparison with the normal population. The aim of this study was to assess the prevalence of low bone mass among adolescent girls with idiopathic scoliosis.
Methods: In this cross-sectional study performed in shafa Hospital in Tehran, Iran during 2011-2012, we recruited fifty-seven 12- to-20-year old girls with idiopathic scoliosis and compared them with 100 age-matched healthy girls. The patients had no other diseases including neuromuscular disorders, congenital vertebral anomalies or a history of spinal surgery. Bone mineral densities (BMD) of the hip and spine were evaluated and compared in all 157 participants using dual X-ray absorptiometry (DXA). Standard BMD (sBMD) was also calculated at the lumbar spine.
Results: Analysis of the data revealed that hip BMD was significantly (P=0.004) lower in patients with idiopathic scoliosis versus the controls. Moreover, BMD and sBMD of the Spine were also significantly lower in the patients (respectively, P=0.030 and P=0.030). Curve location had no effect on the values of hip BMD, spine BMD or spine sBMD (respectively, P=0.061 and P=0.274 and P=0.208).
Finally, with more severe curves a lower bone mass was detected for sBMD and spine BMD (respectively, P=0.017 and P=0.016), but it was not significant for hip BMD (P=0.069).
Conclusion: Adolescent girls with idiopathic scoliosis had lower bone mass compared with their healthy peers. The lower bone mass was correlated with the severity of the curve but not its location. 

Background: Widespread of telecommunication systems in recent years, have raised the concerns on the possible danger of cell phone radiations on human body. Thus, the study of the electromagnetic fields on proteins, particularly the membrane nano channel forming proteins is of great importance. These proteins are responsible for keeping certain physic-chemical condition within cells and managing cell communication. Here, the effects of cell phones radiation on the activity of a single nanopore ion channel forming protein, OmpF, have been studied biophysically.
Methods: Planar lipid bilayers were made based on Montal and Muller technique, and the activity of single OmpF channel reconstituted by electrical shock was recorded and analyzed by means of voltage-clamp technique at 20 ˚C. The planar lipid bilayers were formed from the monolayers made on a 60 μm diameter aperture in the 20 μm thick Teflon film that separated two (cis and trans) compartments of the glass chamber. In this practical approach we were able to analyze characteristics of an individual channel at different chemical and physical experimental conditions. The voltage clamp was used to measure the channel’s conductance, voltage sensitivity, gating patterns in time scales as low as microseconds in real time. 
Results: Our results showed that exposure of single voltage dependent channel, OmpF, to EMF of cell phone at high-frequency has a significant influence on the voltage sensitivity, gating properties and substate numbers of the single channel but has no effect on single-channel conductance. Regarding to the relaxation time, the channel also recovers in the millisecond time range when the field is removed.
Conclusion: We observed an increase in the voltage sensitivity of the OmpF single channel while it had no effect on the single-channel conductance, which is remained to be further elucidated.

Methods: This retrospective, descriptive and analytic study was carried out in Baharloo Hospital, Tehran, Iran during March 2014 and February 2015. In current work, all resuscitated patients were imported and patients with uncompleted files and died before entrance to hospital were excluded. The data was obtained from medical records units, office files unit and the unit of quality improvement. Data were analyzed by use of SPSS version 22 (Armonk, NY, USA) software and Chi-square test and Student’s t-test.