Tehran University Medical Journal

Herbal essential oils are volatile, natural, complex compounds formed by medicinal plants as secondary metabolites. As reported by international organization for standardization (ISO), the term "essential oils" (EOs) is defined for a product obtained from vegetable raw materials or fruit using distillation with water or steam. The EOs are generally complex mixtures of volatile organic compounds include hydrocarbons (terpenes and sesquiterpenes) and oxygenated compounds (alcohols, esters, ethers, aldehydes, ketones, lactones, phenols, and phenol ethers) compounds. In medicinal plants, the EOs chemical profile usually very varies because of both intrinsic (sexual, seasonal, ontogenetic, and genetic variations) and extrinsic (ecological and environmental aspects) factors, also the EOs composition differs not only in the number and type of molecules but also in their stereochemical structures, and can be very different according to the extraction method. EOs represents a “green” alternative in the nutritional and pharmaceutical fields due to reported antimicrobial, antioxidant, anti-inflammatory and anticancer properties thus, in recent times; EOs has gained great popularity as consumers have developed a particular ever-growing awareness toward the use of natural ingredients, especially in food and household. Therefore, the present review provides a comprehensive summary on the method of preparation of EOs from medicinal plants, chemical composition analysis, their biological and pharmacological effects and their potential benefits on health level. Present information was compiled using keywords “Essential oil, Medicinal Plants and Natural additive in scientific database as Science Direct, Elsevier, PubMed, Google scholar and SID, until 2005 to 2015. EOs have great antimicrobial activity and mostly destroy bacteria, fungi and viruses without harmful effects on consumer’s health. Finding of this study showed that the Thymol, α-Pinene, β-Pinene, Cumin Aldehyde, Carvacrol, Germacrene, Linalool were the main components. Also, EOs have antioxidant, anti-inflammatory and many other pharmacological properties which enhance their potential application. EOs have potential biological and pharmacological activities and so have many applications in pharmaceutical and food industries.

Background: Each year, Human influenza A (H1N1) virus causes moderate to severe infections with a high prevalence throughout the world. Accordingly, the rapid, sensitive and cost-effective laboratory diagnosis based on viral antigen detection is important. Moreover, the generation of specific antibodies directed against Influenza antigens is essential to the success of both basic and applied research programs. Hemagglutinin (HA) is the major surface envelope glycoprotein of influenza virus, which is subsequently cleaved into two subunits, HA1 and HA2. Since most antigenic sites are in the HA1 domain of HA, HA1 domain of influenza virus was studied as antigen to produce polyclonal antibody.
Methods: In this experimental study we expressed and purified the recombinant HA1 protein in the second half of 2015 at department of influenza and other respiratory viruses, Pasteur Institute of Iran and then prepared the polyclonal rabbit antibody against it. The vector of pET28aHA1 expressing HA1-His tagged protein of H1N1 influenza A/PR/8/34 virus was used for large scale production of HA1 into E. Coli (BL21). By changing expression conditions such as IPTG (Isopropyl β-D-1-thiogalactopyranoside) concentration, time and temperature of incubation, the expression conditions for HA1 were optimized. The total cell protein harvested and purified by nickel affinity chromatography. All above mentioned experiments monitored by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE).
Results: The efficiency of HA1 recombinant protein was high, equal to 400-600 mg/ml of cell lysate. The polyclonal antibody was prepared by immunizing the rabbits using recombinant HA1 with Freund’s adjuvant according to standard protocols. Efficiency of the antiserum evaluated by enzyme linked immunosorbent assay (ELISA). Determination of antibody level in the collected antiserum using serum-based ELISA showed that the specific antibody has risen well through the immunization schedule.
Conclusion: Our data shows that this polyclonal antibody has potential to be produced in rabbit. It will also be used in the future in influenza diagnosis as well as in other immunological applications such as western blot analyses, immunocytochemistry, and immunohistochemistry.
 

Background: Methotrexate (MTX) is commonly used in the hematology-oncology units and is frequently associated with adverse effects. High-dose methotrexate (HDMTX) is indicated in the treatment of acute lymphoblastic leukemia (ALL), osteosarcoma, systemic non-Hodgkin lymphoma and primary central nervous system (CNS) lymphoma. The side effect profile of MTX varies markedly according to dose. The aim of this study was to evaluate the uses and adverse effects of HDMTX in a cancer center in north of Iran.
Methods: This cross-sectional descriptive study carried out in Emam Sajjad Hospital, Ramsar, Iran from June 2016 to July 2017. Doses more than 500 mg/m2 of MTX was considered as a high-dose. Hydration status, evaluation of the renal and hepatic function, blood tests, urine pH, doses and frequencies of leucovorin administration, measurement of serum levels of MTX and side effects were evaluated. Recommendations of UpToDate 2017 were considered as standards of administration of HDMTX.
Results: Forty-four courses of HDMTX were evaluated in this study. HDMTX were prescribed for lymphoma (30 cases), ALL (8 cases) and osteosarcoma (6 cases). In all patients, hydration was done with 1340.9±894 normal saline plus 25 ml sodium bicarbonate 8.4%, one to two hours before HDMTX. The solution used for dilution of MTX was 5% dextrose (1022.7±105.5 ml). Urine pH was not measured in any patient. The frequency of leucovorin administration was 5.64±3.03 times with doses of 17.6±1.7 mg/m2 every 6 hours. Serum levels of MTX were not measured in any patient. Blood urea nitrogen and creatinine measurement was carried out before administration of HDMTX in all patients. The most common adverse effects were nausea (64.4%), anxiety (44%) and headache (43.2%).
Conclusion: The appropriate aspects of HDMTX usage were good hydration, urine alkalinization with bicarbonate and administration of leucovorin in patients receiving HDMTX, whereas monitoring of serum levels of MTX and administration of bicarbonate based on urinary pH were not done in any of the patients.
 

Background: The prevalence of autism spectrum disorder (ASD) as a child neurodevelopmental disorder has increased significantly during the past 3 decades worldwide and in Iran. This chronic disease does not cause premature death and there is no definitive treatment. Thus, the cost of ASD is extremely heavy and overwhelming. The purpose of this study is to calculate the economic burden of ASD in Iran.
Methods: A cross-sectional descriptive-analytic study was conducted to calculate all-important ASD costs. Two hundred and ninety autism patients in Tehran participated in this study in 2017 with the support of Tehran University of Medical Sciences (TUMS). A valid and reliable questionnaire was used to estimate direct medical costs, direct non-medical costs and indirect costs.
Results: The annual economic burden of ASD is estimated to be 223,561,841 Rials ($6,883 2014 USD) per patient in Tehran, Iran in 2017. Approximately 32%, 52% and 16% of the total cost were direct medical costs, direct non-medical costs, and indirect costs. The average ASD direct cost was $5,765 of which 38% was direct medical costs and 62% was direct non-medical costs. The average annual ASD direct medical cost was $2,215 per patient of which 70%, 16% and 7% were related to rehabilitation, medicine and doctor visit costs. The average annual ASD direct non-medical cost was $3,550 per patient of which 35% was the cost of parents’ immigration to Tehran to receive health care services. The average annual ASD indirect cost for productivity loss from unemployment or reduced work productivity was estimated at $1,118. The largest cost component was parents’ productivity loss due to caregiving (70%).
Conclusion: Autism imposes substantial direct and indirect economic effects on patients and their families. Hence, health policy makers must take the most effective measures to make best use of scarce societal resources, to reduce the cost of the disease for patients and their families and subsequently, reduce its psychosocial burden.

Background: Breast cancer is one of the most common diseases in women and causes more deaths rather than other cancers. The increasing trend of breast cancer in Iran makes clear the need of extensive breast cancer research in this area. Some studies showed that in the variety countries and even in the different areas in one country has different risk of breast cancer incidence and this is a reason that there is a correlation between region of life and risk of breast cancer. The purpose of this study was to determine the spatial structure associated with the incidence of breast cancer based on statistical models and identification of areas with high incidence of breast cancer in Iran.
Methods: This ecological study was conducted in Kermanshah University of Medical Sciences, Iran, from February to July 2018. Data on breast cancer patients in all provinces of Iran (30 provinces) were investigated since 2004 to 2009. Risk factors in this study included fruit and vegetable consumption, physical activity, overweight or obesity, and human development index. In this study, we have used routine and spatial Poisson's generalized linear mixed models for data analysis.
Results: In both routine and spatial models, direct and significant correlation was found between the incidence of breast cancer and the human development index (P<0.05). In addition to human development index, overweight or obesity factors were also had direct and significant relationship to the incidence of breast cancer in the spatial Poisson's generalized linear mixed model (P<0.05). In the spatial Poisson's generalized linear mixed model with correlation structure of Besag Yorg Molie (BYM), two provinces of Gilan and East Azerbaijan had the highest risk of breast cancer incidence and province of Kohgiluyeh and Boyer Ahmad had the lowest risk of breast cancer incidence.
Conclusion: The results showed that the distribution of breast cancer incidence in Iran has a spatial structure. That is, the adjacent provinces have similar incidences of this disease.

Background: Deep learning has revolutionized artificial intelligence and has transformed many fields. It allows processing high-dimensional data (such as signals or images) without the need for feature engineering. The aim of this research is to develop a deep learning-based system to decode motor intent from electromyogram (EMG) signals.
Methods: A myoelectric system based on convolutional neural networks (CNN) is proposed, as an alternative to conventional classification methods that depend on feature engineering. The proposed model was validated with 10 able-bodied subjects during single and combined wrist motions. Eight EMG channels were recorded using eight pairs of surface electrodes attached around the subject’s dominant forearm. The raw EMG data from windows of 167ms (200 samples) in 8 channels were arranged as 200×8 matrices. For each subject, a CNN was trained using the EMG matrices as the input and the corresponding motion classes as the target. The resulting model was tested using a 4-fold cross-validation. The performance of the proposed approach was compared to that of a standard SVM-based model that used a set of time-domain (TD) features including mean absolute value, zero crossings, slope sign changes, waveform length, and mean frequency.
Results: In spite of the proven performance and popularity of the TD features, no significant difference (P=0.19) was found between the classification accuracies of the two methods. The advantage of the proposed model is that it does not need manual extraction of features, as the CNN can automatically learn and extract required representations from the EMG data.
Conclusion: These results indicate the capacity of CNNs to learn and extract rich and complex information from biological signals. Because both amplitude and frequency of EMG increases with increasing muscle force, both temporal and spectral characteristics of EMG are needed for efficient estimation of motor intent. The TD set, also includes these types of features. The high performance of the CNN model shows its capability to learn temporal and spectral representations from raw EMG data.

Background: The ineffectiveness of hemodialysis fistulas causes high costs and increases mortality and morbidity rates. The efficacy of drug-coated balloon and nondrug-coated balloon in dysfunctional arteriovenous Fistula was evaluated over six month period.
Methods: In this randomized clinical trial, a total of a total of 50 hemodialysis patients who referred to Imam Reza Hospital in Kermanshah for failing of arteriovenous fistula in 2018 year, were randomly divided into two separate groups of drug-coated balloon angioplasty and non-drug coated balloon angioplasty. All of these procedures were done with the same surgeon. Patients were followed-up for 6 months. Variables and data of patients like age, gender, diabetes mellitus, hypertension, and location of arteriovenous fistula were documented and analyzed by SPSS software, version 21 (SPSS Inc., Chicago, IL, USA) using statistical tests. T-test and chi-square test were used for data analysis and the significance level was considered less than 0.05.