Tehran University Medical Journal

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Background: This study was performed to investigate the rate of inner cell mass of blastocyst which obtain from culture of mouse two cell embryos in presence and absence of recombinant of human leukemia inhibitory factor.
Materials and Methods: ICR female mice that were between 6-8 weeks old received intra peritoneal injection of 7.5 IU of pregnant mare serum gonadotropine for super ovulation, this was followed by intra peritoneal administration of 7.5 of hCG 46-48 hours later. The mice were then mated to mature ICR male mice and were checked for vaginal plug 20 hours later. Female mice were killed by cervical dislocation 48-50 hours after hCG administration and after washing and flushing of the oviduct from the proximal end of the oviduct, two cell embryos were selected and collected by 100 microscopy. All two cell embryos were randomly divided in 4 groups (Groups A, B C and D) and culture in special media. Groups A: KSOM+AA, Groups B: KSOM+AA 500 IU/ml LIF. Groups C: KSOM+AA 1000 IU/ml LIF. Groups D: KSOM+AA 1500 IU/ml LIF media until 120 hours in Co2 incubator .After that time all blastocysts collected and the number of ICM was assessed by differential staining technology.
Results: The rates of ICM of blastocysts which obtain from groups A, B, C and D were 19 2.6, 28 4.4, 24 2.1, 26 2.2 respectively. This data indicated that the rate of ICM in groups B, C and D was statistically higher than group A (P=0.02) and also there was not statistically different between three groups of B, C and D.
Conclusion: Briefly leukemia inhibitory factor can improve the rate of ICM of blastocyst and we suggest that this factor is better added to blastocyst culture medium.

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Background: Hyaluronan has an important role on the permeability and motility of sperm and the interaction of gametes and these can play a considerable role on the fertility rate. Therefore, in this study, we assessed the effect of different doses of hyaluronan on the morphology, motility, vitality and fertility rate of mice.

Methods: We used 40 mice (6-8 week) in this study which twenty of them were male and the rest were female. The sperm of each male mouse were divided into four groups. The group 1 (control): They were maintained in RPMI media without any hyaluronan supplementation for 2 hour. Hyaluronan with the doses of 750, 1000 and 1250 µg/ml were added into RPMI media in groups 2, 3 and 4, respectively. After 2 hour. incubation, the numbers of sperms were assessed, using haemocytometer. Also, their morphology with papanicolaeu staining and their vitality with Eosin B dye were assessed. As well as sperms motility measured under inverted microscope by observation and fertility rate evaluated after routine IVF by counting two-cell stage embryos.

Results: Our results demonstrated that, the dose of 750 µ g/ml has the greatest effect on the motility, vitality and fertility rate of sperms. The effect of dose of 1000 µ g/ml also was positive on them. On the other hand, none of these doses had any effect on sperm morphology.

Conclusion: Hyaluronan may have an influence on motility, vitality and fertility rate of sperms and the dose of 750µ g/ml had a significant effect on these factors.

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Background: Freezing and thawing induce a number of insults to the sperm cells, such as low motility and low fertilization capability. For evaluation of hyaluronan (HA) supplementation on sperm characteristics, we investigated the effect of hyaluronan (HA) on mouse sperm before freezing and after thawing.
Methods: For this purpose we removed cauda epididimes from 24 male mice with aseptic method and freezed the semen in 1.8ml cryotubes with %18 raffinose and %3 skim milk cryoprotectant solution.We had 4 groups: group 1(fresh control) group 2(freeze control) group 3(supplemented 750 µg/ml HA to sperm before freezing) and group 4(supplemented 750 µg/ml HA to sperm after thawing). Fertility rate evaluated after routine IVF by counting two-cell stage embryos.
Results: HA supplementation (750µg/ml) after thawing improved fertilization capability parameters but supplementation before freezing had no effect on mentioned characteristic.
Conclusion: Acording to data of present study the hyaluronan supplemen- tation (750µg/ml) after thawing has the greatest effect on the fertility rate of sperms.

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Background: Microalbuminuria (MA) is associated with increased cardiovascular risk in hypertensive patients, but not many studies have specifically examined the effects of MA-lowering on regression of left ventricular hypertrophy (LVH) among pediatric patients with hypertension.
Methods: Fifty-five patients with essential hypertension, 11 to 19 years old were prospectively studied. All patients received concomitant therapy of hydrochlorothiazide and angiotensin-converting-enzyme inhibitor. Five patients also required angiotensin-receptor blocker to achieve the blood pressure goal. Baseline and 12-month follow-up measures of left ventricular mass index (LVMI) determined by echocardiography and urine microalbumin/creatinine ratio (MA/Cr) were collected. MA was defined as MA/Cr>30. LVH was defined as LVMI>38.6 g/m2. The primary end points were 25% or more reductions in MA and the LVMI.
Results: Weight (r=0.83), body surface area (r=0.85), body mass index (BMI) (r=0.86), systolic blood pressure (SBP) (r=0.57), diastolic blood pressure (DBP) (r=0.49), mean arterial pressure (r=0.53) and MA (r=0.87) were all univariate correlates of LVMI. In a multiple regression analysis, MA, BMI and SBP were significant correlates of LVMI. MA alone explained 76% of the variance of LVMI, whereas BMI and SBP explained only 1.6% and 0.4% of the variance, respectively. MA was the most significant correlate of follow-up LVMI after BMI and SBP were included in the overall multiple regression models.
Conclusion: MA is a strong predictor of LVH in hypertensive children and adolescents. MA-lowering halts the progression of LVH or induces its regression.

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Background: Heat-shock proteins are part of a strictly controlled biological system that allows organisms to respond to environmental stresses. Different proinflammatory cytokines are present in the synovial tissue of rheumatoid arthritis patients. Such tissues respond to stress and induce heat-shock proteins. In addition, synovial cells are exposed to mechanical stress caused by joint motion. The effects of mechanical stress on the metabolism of the synovial cells may be substantial, even pathogenic. Heat-shock proteins are often implicated in the pathogenesis of rheumatoid arthritis. Here, we compare the levels of heat-shock protein 70 from the synovial fluid of rheumatoid arthritis and osteoarthritis patients.

Methods: Synovial fluid samples from 34 rheumatoid arthritis patients and 34 osteoar-thritis patients were analyzed for heat-shock protein 70 by an ELISA method. Statistical analysis was performed using independent T-test and one-way ANOVA. Differences were considered statistically significant at p< 0.05.

Results: The mean value of synovial fluid heat-shock protein 70 levels in rheumatoid arthritis patients was 156.30 ±128.51 and that of osteoarthritis patients was 14.98 ±11.58. The differences were statistically significant at p<0.0001. For seven rheumatoid arthritis patients suffering from mechanical knee pain, synovial fluid analysis revealed non-inflammatory effusion. The mean value of synovial fluid heat-shock protein 70 level in inflammatory synovial fluid of rheumatoid arthritis patients was significantly higher at 191±121.73 and that of non-inflammatory synovial fluid from rheumatoid arthritis patients was 21.93 ±10.06 (p< 0.05).

Conclusion: The level of heat shock protein 70 is higher in inflammatory arthritis than in non-inflammatory arthritis. Considering that patients with rheumatoid arthritis are known to have a hypertrophic synovial-lining layer, and that heat-shock protein 70 is known to protect cells against a variety of toxic conditions as well as apoptotic death, further research is needed to determine if heat-shock protein 70 induction is a sign of significant changes in the cellular and tissue metabolism or is actively participating in the pathogenesis of rheumatoid arthritis.

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Background: Kawasaki disease (KD) is an acute vasculitis in children. Eosinophilia, a reflection of the host's immune response that can cause tissue damage, has been associated with KD, with eosinophils preferentially accumulating in the microvasculature. In early-stage Kawasaki disease (KD), lesions (perivasculitis and vasculitis) first form in the microvessels, which can then extend to the larger vessels and result in coronary artery aneurysms, possibly leading to myocardial infarction even in young children. Overall, the prevalence of coronary artery aneurysms in children with Kawasaki disease is about 10-18%, which is much higher among those not treated early in the course of the illness.  We performed this study to gain a better understanding of the initial pathogenesis of KD and to assess the relationship between eosinophilia and coronary artery disease.

Methods:  The data from forty-eight patients at Vali-asr Hospital of the Tehran University of Medical Sciences (1996-2006) were included in this cross-sectional descriptive analysis. The presence and degree of coronary artery disease was assessed by echocardiography. Data was analyzed via Fisher's exact test and student's t-test using SPSS software, v. 11.5.

Results: Eosinophilia was seen in 10 cases (22%) and cardiac lesions were observed in 19 cases (41%). The frequency of microvessel lesions was significantly lower in patients with eosinophilia (10% with eosinophilia versus 50% without eosinophilia, p<0.03). The frequency of microvessel lesions was lower in males than in females (35 vs. 44%, respectively), although this was not significant. We found no correlation between the frequency of microvessel lesions and age.

Conclusions: In spite of the controversies regarding eosinophilia and microvessel lesions, in this study the number of circulating eosinophils was associated with fewer cardiac lesions. Comparative studies are needed to determine the exact relationship.

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Background: To eradicate a problem such as drug abuse, we need thorough knowledge of the problem and its epidemiological aspects. In response to increasing ecstasy abuse among youth, as noted by the increase in related health issues at emergency clinics, we performed this epidemiologic study on ecstasy use in Tehran.

Methods: In this cross-sectional study, including 1,903 youth aged 15-25 years, at different coffee shops in Tehran, Iran, subjects filled out questionnaires to evaluate the prevalence of ecstasy use with regard to gender, age, family income, level of education, psychological state (Beck test), acute complications of ecstasy use, as well as manner and place of ecstasy use and reason for repeated ecstasy use. Information was gathered from September 2004 to January 2005, using simple nonprobable sampling.

Results: The prevalence of ecstasy abuse among our study population was 18.5%, which meaningfully correlated with gender (male), education level (undergraduate degree), family income (high), drug abuse and Beck test score (high). The mean age of ecstasy abusers was 21.3 years (SD: 2.65), which wasn't statistically different than the study population as a whole and the portion that did not use ecstasy. Tablet was the most common form of ecstasy usage (97.1%). In this study population, 91.4% had heard of the ecstasy name, and 83.7% were familiar with its use. The most common site of usage was in parties (85.7%) and in group forms (84%). Of all the users, 30% stated the reason for repeat ecstasy use was their friends' insistence, 38.8% expressed emotional need, 37.7% had no reason, whereas 6.6% felt a physical need and 1.7% repeatedly used ecstasy to prevent withdrawal symptoms

Conclusion: Some studies have reported that drug abusing friends are the basic cause of drug abuse. In this study, the ecstasy users admitted that the influence of friends and emotional need were the causes of their repeat use. Remarkably, these subjects report withdrawal symptoms with ecstasy use. Most importantly, families have to consider the relationships and emotional needs of their children. The statistical difference between Beck test scores between ecstasy users and the non-users placed them in two clinically different psychological groups. The ecstasy users were in groups that definitely needed psychological consultation and non-users were in the slightly depressed group. These psychological aspect of drug abuse expressed here is an alarm.

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Background: The resistance of Pseudomonas aeruginosa strains to broad spectrum cephalosporins may be mediated by extended spectrum b-lactamases (ESBLs). These enzymes are encoded by different genes located either on chromosome or plasmids. In this study, we determined the antimicrobial resistance patterns of P. aeruginosa isolates and screened for ESBL production.

Methods: After isolation from burn patients in Tehran Hospital, identification of P. aeruginosa isolates were assessed using biochemical tests. We then performed disk agar diffusion (DAD) according to CLSI guidelines to determine the pattern of antimicrobial resistance. The frequency of ESBLs and prevalence of the OXA-10 and PER-1 genes were determined with combined disk and polymerase chain reaction (PCR) methods, respectively.

Results: One hundred strains of P. aeruginosa were isolated. The resistance of these strains to cephpodoxime, aztreonam, ciprofloxacin, ofloxacin, ceftazidime, cefepime, imipenem, meropenem, cefotaxime, levofloxacin, piperacilin- tazobactam and ceftriaxon was 100%, 90%, 83%, 92%, 85%, 88%, 63%, 66%, 98%, 89%, 70% and 91%, respectively. Of these, 40 strains (40%) were ESBL positive, 29 strains (29%) were OXA-10 positive and 18 strains (18%) were PER-1 positive.

Conclusion: Our results confirm the need for proper antimicrobial therapy in burn hospitals, considering the resistance pattern and frequency of strains producing ESBLs and the presence of the OXA-10 and PER-1 genes. Since an increase in the prevalence of ESBL in P. aeruginosa strains might lead to the transfer of these ESBL genes to other gram-negative bacteria, we recommend the use of appropriate drugs, especially cephalosporins, in burn hospitals.

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Background: The components of the classical complement pathway play an important role in the pathogenesis of systemic lupus erythematosus (SLE) and are reportedly useful biomarkers of disease activity. In this study, we evaluate disease activity, complement function (total hemolytic complement, CH50) and complement protein levels (C3, C4, C3d, C4d, SC5b-9), comparing the results of patients with active disease versus those with inactive disease.
Methods: This cross-sectional study included 78 hospitalized women with SLE, 24 of whom were in the active group, with SLE disease activity indexes (SLEDAI.2K) of >6, and 54 in the inactive group, with SLEDAI.2K of ≤6. Serum CH50 was measured using a red blood cell hemolytic assay. C3 and C4 levels were determined by nephlometry and plasma levels of C3d, C4d, SC5b-9 by ELISA. The data were statistically analyzed using SPSS.
Results: The mean (±standard error) C4d levels of the inactive group were significantly higher than those of the active group (23.39±1.1µg/ml and 16.9±1.6µg/ml, respectively p=0.003). There was also a significant correlation between C3 and C4 levels (p=0.807). The mean values of the other proteins (C3, C4, CH50, SC5b-9, and C3d circulating immune complex concentrations) were not significantly different between the inactive group vs. the active group: 89.35±6.8 vs. 85.54±7.6mg/dl, 18.33±2.3 vs. 20.45±2.4mg/dl, 149.03±4.3 vs. 157±4.3U, 1414.4±114.94 vs. 1471.1±216.9ng/ml, 9.43±0.96 vs. 13.31±3.16µgEq/ml, respectively (p>0.05).
Conclusions: According to our results, C4d levels may be used as a biomarker of disease activity. The significant correlation between C3 and C4 may confirm the activity of the classical pathway in SLE patients.

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Background: Mitral valve prolapse is a relatively common valvular abnormality in most communities and joint hypermobility (JHM) is also seen in many healthy people as well as in certain clinical disorders, such as Marfan syndrome. The present study was designed to investigate the association between joint hypermobility and mitral valve prolapse (MVP) in an Iranian population sample.

Methods: Fifty-seven patients with nonrheumatic and isolated mitral anterior leaflet prolapse (24 men and 33 women, mean age 23.5 +/-2.3) and 51 healthy subjects (20 men and 31 women, mean age 22.9+/-2.3) were studied. The presence of JHM was evaluated according to the Carter-Wilkinson & Beighton criteria. Echocardiographic examination was performed in all subjects and the correlation between the echocardiographic features of the mitral valve and the hypermobility score were investigated.

Results: The frequency of JHM in patients with MVP was found to be significantly higher than that of controls (26.3% vs. 7.8%), with mean JHM scores of 3.1+/-2.2 and 1.9+/-1.7, respectively. The patients in the MVP group had significantly increased the anterior mitral leaflet thickness (AMLT, 3.4+/-0.4 mm vs. 3.0+/-0.3 mm p<0.0005) and maximal leaflet displacement (MLD, 2.4+/-0.3 mm vs. 1.5+/-0.2 mm p<0.0005) compared to the controls.

Conclusions: We detect a statistically significant relationship between isolated MVP and joint hypermobility as well as between the severity of JHM and echocardiographic features of the mitral leaflets. These results suggest a common etiology for MVP and JHM, which should be investigated in future well-conducted studies.

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Background: Hepatitis B vaccination has been included in routine immunization of all individuals according to WHO recommendations since 1991. Despite successful coverage, 3-5% of recipients fail to mount a desirable protection level of Ab. Vaccine failure results from: emergence of mutation, immune failure of individuals, decrease in vaccine potency, and etc. The quality of Hepatitis B vaccine should be evaluated by a reliable method.

Methods: The amount of vaccine antigen was measured through the in vitro assay of Hepatitis B vaccines which consists of multiple dilutions of the reference material and samples. The preparations were evaluated by Elisa to determine the amount of HBsAg. The data were analyzed by parallel-line analysis software. The in vivo assay was performed by inoculating multiple doses of the reference and sample preparations in Balb/c mice. A control group was also inoculated with vaccine matrix. Four weeks later, the mice sera were evaluated to determine the presence of antibodies against Hepatitis B by Elisa method. The data were analyzed by Probit analysis software.

Results: Both methods were set up in our laboratory by which different batches of Hepatitis B vaccine were evaluated. It was observed that In vivo and In vitro methods provide comparable results. Therefore we can use the in vitro method for routine testing of HB vaccine quality control.
Conclusion: In vitro method can be used in place of In vivo method because of its time and cost-effectiveness. Moreover, since no animals are used in in vitro method, it complies well with the 3R concept (Reduction, Refinement, and Replacement of animal testing) and the current tendency to use alternative method.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Low-birth-weight (LBW) children are at higher risk for failure to thrive. The aim of the study was to establish the trend of physical growth in Until now their growth was evaluated with normal birth weight baby's chart.
Methods: In this cohort study we investigated demographic characteristics and growth trend during the first of life 406 newborn divided into three groups: LBW (Low Birth Weight) n=103, VlBW (Very Low Birth Weight) n=20 and NBW (Normal Birth Weight) n=303. Body weight, length and head circumference were measured at the time of birth and several follow ups until 12 months of chronological age.
Results: NBW growth trend adopts the standard chart. Significant differences in terms of physical growth (weight- height- head circumference) were seen between the two groups of preterm (LBW & VLBW) and NBW children. Although it was demonstrated that growth velocity of preterm & NBW children were the same. Significant differences for weight was seen between VLBW and LBW group only until 6 months after birth. This difference was seen for height and Head circumference until the end of the first year of life.
Conclusions: VLBW and LBW babies need special growth charts. But the adjustment method of anthropometric traits to gestational age may be useful to evaluate LBW baby's growth.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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