Tehran University Medical Journal

---

Background: Psychological debriefing has been widely advocated for routine use following major traumatic events. Cognitive Behavioral Interventions, art supportive therapies, and sport and recreational support activities are other interventions for reducing posttraumatic stress disorder. We assessed the effects of theses methods individually and in combination on reduction posttraumatic stress disorder symptoms in adolescents who had experienced Bam earthquake.
Methods: In a field trial, we evaluated the efficacy of psychological debriefing, group cognitive-behavioral therapy, art and sport supportive interventions in 200 adolescents with PTSD symptoms who survived of Bam earthquake and compare it with a control group. Patients were randomly assigned to one of intervention programs including: group cognitive-behavioral therapy group CBT plus art and sport interventions art and sport interventions without group CBT and control group.
Results: Thirty one individuals were excluded because of migration. A statistically significant reduction in overall PTSD symptoms as well as in avoidance symptoms was observed after group cognitive-behavioral therapy. There was no significant difference in reduction of overall PTSD and avoidance symptoms between the other groups.
Conclusion: Psychological interventions in form of group cognitive behavioral therapy can reduce the symptoms of PTSD symptoms but we couldn't find the art and sport supportive therapy alone or in combination with group CBT to be useful in this regard.

---

Background: The most frequently used test for evaluation of fetal health is the Non Stress Test (NST). Unfortunately it has a high incidence of false positive results. The combination of vibroacoustic stimulation with the NTS has been shown to reduce non reactive results.
Methods: A tests assessment method was chosen with a simple randomized sampling. 40 pregnant women with non reactive NST in the first 20 minutes who received VAS in one of Tehran University's Hospitals were compared with BPP scores. A vibroacoustic stimulation was applied for a 3 seconds on the maternal abdomen and fallowed within 10 minutes.Data collection tools were NST, sonography instruments ,NST result paper, tooth brusher, watch, demographic questioner and check list. Data analysis was made by descriptive static and by using the Fisher's Exact Test (with level of significant at p<0/05). All statistical analysis were performed using an spss/win.
Results: After VAS, 70% of non reactive tracing became reactive. All cases with fetal reactivity response after a VAS had a subsequent BPP score of 8 (negative predictive value of 100%). False positivity of VAS was lower than NST.
Conclusion: VAS offers benefits, by decreasing the incidence of non reactive test and reducing test time. VAS lowers the rate of false positive NST. VAS is safe and allows more efficient of prenatal services. This test could be used as a rapid antepartum test to predict fetal well-being.

---

Background: Many studies have shown the efficacy of cognitive – behavioral therapy and psychological debriefing in treatment of post traumatic stress disorder (PTSD) and a few evidences are available for using these techniques in large scale disasters. This study aimed to asses the effect of some psychological interventions in reducing PTSD symptoms after Bam earthquake in different age groups.
Methods: In a before-after quasi experimental clinical trial, we compared the efficacy of one session of psychological debriefing and three sessions of group cognitive-behavioral therapy in bam earthquake PTSD symptoms in different age groups. We evaluated PTSD symptoms before and immediately and three months after interventions by CASP scaling system and analyzed data.
Results: one hundred and thirty persons entered in the study and 51 persons excluded during interventions because of migration. Interventions were showed to be effective only in short term period. The means of PTSD symptoms frequency and severity of avoidance symptoms were reduced during three months period of study which were statistically significant P<0.05. Interventions showed no efficacy for recall symptoms in long term and hyper arousal symptoms in short term and long term periods. There was no statistically significant difference among age groups.
Conclusion: Psychosocial supportive interventions may be effective on some of the PTSD symptoms but there is no difference in different age groups.

---

Background: Access to a safe and efficient chemotherapy regimen for improving the survival and live quality is a goal in ovarian carcinoma. Despite surgery is the base treatment of ovarian cancer, but in most patients chemotherapy is used due to progression of their disease. This study designed to compare two important chemotherapy regimens.
Methods: This historical cohort study compared two chemotherapy regimen cisplatin (75mg/m2)+ cyclophosphamide (750mg/m2), versus taxol (175mg/m2)+ carboplatinium (GFR+25)AUC between 1998-2005 in valiasr hospital. In this study toxicities of two regimes were compared. The survival function in these two groups were analysed with Kaplan-Meire curve.
Results: Gastrointestinal and mucosal toxicity were significantly higher in CP group compared TC group (p=0.02). Also there were no significant relation between decrease of serum CA125 and patient remission length in CP group but in other group with decrease of CA125 in lower than three cycle we had an increase in patient remission period. (P=0.02). Disease free interval in cisplatin group was longer versus taxol group (p<0.05), there was no significant difference in overall survival in two group.
Conclusion: This study revealed that cisplatin plus cyclophosphamide regimen can yet be used as a chemotherapy treatment in ovarian cancer. In this study there was no significant benefit in taxol regimen compared CP. In the adjuvant therapy of epithelial ovarian carcinoma.

---

Background: Infant formula, depending on the source, contains various fatty acids, which may possess important nutritional and biological value for infants. The presence of some of these fatty acids in infant formula, however, can be harmful and toxic for the infant. In this regard, more attention has been paid to erucic acid since its accumulation in myocardial tissues may cause damage to the heart. Therefore, a limit has been set by the Codex Alimentarius for the presence of erucic acid in infant formula (less than 1% of total fatty acids). The purpose of the present study is to investigate amount of erucic acid present in three infant formulas used predominantly in Iran.
Methods: Gas chromatography (GC) is a valuable method applied for the separation of fatty acids, including erucic acid, from oils and oily food. Three brands of infant formulas, namely Humana, Biomil and Multi, were analyzed by GC using a wall coated open tubular (WCOT) fused silica column and flame ionization detector (FID). Heneicosanoic acid was employed as an internal standard.
Results: The findings showed that Humana and Biomil infant formula samples contained 0.06% and 0.002% erucic acid (from total fatty acids), respectively, while no erucic acid was detected in the Multi infant formula samples.
Conclusion: The amount of erucic acid in the studied infant formulas was far below the Codex limit of 1% total fatty acids.

---

Background: Pain control after posterolateral thoracotomy is very important for adequate respiration and to reduce pulmonary complications. Narcotic-induced respiratory depression requires different intercostal nerve block procedures with local anesthesia, such as bupivacaine, through an extrapleural catheter, paravertebral catheter and intrapleural injection in order to control pain and reduce narcotics consumption. The aim of this study is to determine the efficacy of bupivacain versus normal saline (N/S) in pain control after thoracotomy.
Methods: In a single-blind clinical trial, forty patients were divided into two groups of 20 patients each. Group 1 (G.1) received a single dose (10 ml) of bupivacaine 0.5%, followed by continuous infusion of N/S (0.1 ml/kg/h) four hours after surgery. Group 2 (G.2) received a single dose (10 ml) of bupivacaine 0.5%, followed by a continuous infusion of bupivacaine (0.1 ml/kg/h) four hours after surgery. Postoperative pain was assessed every four hours for 48 hours by linear visual analog scale (VAS). If VAS > 5, then pethidine was injected at a dosage of 1 mg/kg/IM. VAS ≤ 3 was considered pain control.
Results: TThe mean VAS at 8, 12, 16, 20 and 24 hours after surgery in G.1 was 7.6, 5.5, 6.6, 5.5 and 5.7, respectively, and in G.2 was 3.4, 3.7, 2.8, 2.1 and 1.9, respectively. There were significant differences between the two groups (for 12 hours P<0.001 and for other time points P=0.0001). During the 4-24 hour period after surgery, pain control in G.1 was 5% and in G.2 was 81%. The mean VAS at 28, 32, 36, 40, 44, and 48 hours after surgery in G.1 was 5.2, 5, 5.3, 4.4, 5.1, and 4.8, respectively, and in G.2 was 1.6, 1.8, 1.5, 1.6, 1.5 and 1.4, respectively, with a significant difference between the two groups (P<0.0001). In the first 24 hours, the mean of pethidine injection in G.1 was 3.7 and in G.2 was 0.6 (P<0.0001). In the second 24 hours, the mean pethidine injection in G.1 was 2.2 and in G.2 there was no need for pethidine (p<0.0001).
Conclusion: Continuous extrapleural infusion of bupivacaine is effective in pain control and decreasing demand for narcotics after thoracotomy.

---

Background: Propofol, an anesthetic noted to give rapid recovery, causes discomfort at the site of injection. A number of methods to reduce propofol-induced pain have been tried, including pretreatment with lidocaine, with varying results. Here, we evaluate the efficacy of magnesium sulfate compared to that of lidocaine and normal saline in mitigating propofol-induced pain.
Methods: One hundred ASA I and II adults, aged 20-50 years, scheduled for elective surgery requiring two IV lines with 20-gauge cannulae in the dorsum of each hand, were enrolled in this study. The patients were randomly placed into two groups of 50 patients. In each patient, one hand was the case study and other hand was the control. Group A received 10% magnesium sulfate in one hand and normal saline in the other hand. Group B received 10% magnesium sulfate in one hand and 1% lidocaine in the other hand. All injections had a volume of 2 ml. After 30 seconds, 2 cc of 1% propofol was injected simultaneously into each hand. Pain was assessed according to the VAS rating system, ranging from 0 (no pain) to 10 (the most severe pain), with a minimum interval of 3 as significant pain. Data were analyzed by chi-square and independent t tests. A P value <0.05 was considered significant.
Results: In Group A, the mean pain in the hand premedicated with magnesium was 1.46±1.07, compared to 4.54±2.15 for that of the other hand that had received normal saline (P=0.001). In group B, the mean pain in the hand that had received magnesium was 0.82±1.34, compared to 0.78±1.07 for that of the other hand, which had received lidocaine (P=0.86).
Conclusion: Intravenous magnesium and lidocaine pretreatments are equally effective in attenuating propofol-induced pain, and were better than normal saline in attenuating propofol-induced pain.

---

Background: Although endometrial cancer is primarily a disease of the postmenopausal female, 25% of patients are premenopausal, with 3-5% in women 40 years old or younger. The younger group of women with endometrial carcinoma are frequently nulligravid with a history of infertility, and a strong desire to preserve fertility. This may pose a therapeutic dilemma for both patients and treating physician.
Case report: We reported 3 young patients with atypical complex hyperplasia or early stage endometrial cancer that treated with conservative hormonal therapy.
Conclusion: Medical treatment of young patients with endometrial carcinoma and complex atypical hyperplasia who wish to preserve fertility is a reasonable and appealing option. A comprehensive evaluation prior to counseling the patient should include A complete history and physical examination. A formal D&C with review of history with an experienced gyn-onc pathologist. Evaluation of the pelvic and abdomen preferably with contrast-enhanced MRI or transvaginal ultrasound. In patients found to have a clinical stage I grade I tumor and who want to preserve fertility , thorough counseling include risks and benefits, and explanation that the data is partial and incomplete due to the lack of appropriate controlled studies is mandatory. In patients considered for medical treatment, a high dose progestin regimen should be started with endometrial sampling every 3 months until complete regression of the tumor is documented. Although most responses are long standing, there is a small risk of progression during or after cessation of progestin therapy.

---

Background: The aim of this study was to compare the outcome of treatment for ovarian cancer patients who have been treated by gynecologist oncologists and patients who have been treated by general gynecologists or general surgeons.

Methods: We enrolled in this cohort retrospective study all patients diagnosed with primary ovarian cancer in Vali-e-Asr Hospital, Tehran, Iran, between April 1999 and January 2005. A total 157 consecutive patients with ovarian cancer were available for analysis. Of these, 60 patients were treated by gynecologist oncologists and 95 by general gynecologists, and two patients were treated by general surgeons.

Results: The number of patients who underwent optimal cytoreductive surgery (residual tumor <1 cm) was higher in the gynecologist oncologist group, than in the general gynecologist group (P<0.001). Repeated surgeries were required for a majority of patients in the general gynecologist group, while only a few patients in the gynecologist oncologist group needed a second operation (P<0.0001). The interval between the initial surgery and the beginning of chemotherapy was significantly longer in the gynecologist oncologist group compared to that of the general oncologist group (P=0.001). Overall survival and disease-free survival was considerably greater in the gynecologist oncologist group. Optimal cytoreductive surgery and stage of disease are prognostic factors in patients with ovarian cancer. We can therefore conclude that patients with ovarian cancer who are treated by gynecologist oncologists have a better outcome.

Conclusions: We suggest that patients requiring cytoreductive surgery for ovarian cancer be referred to a gynecologist oncologist rather than having a less specialized physician care for such cases.

---

Background: The object of this study was to determine the epidemiological characteristics of deliberate self-poisoning in adolescents referred to the only poisoning center in Tehran.
Methods: In a cross-sectional study, all cases of acute poisoning at the Loghman Hakim Hospital from May to December 2003 were reviewed. Data for adolescents (13-19 years of age) were analyzed by SPSS for Windows, version 13 and STATA, version 8.
Results: From a total of 9203 cases of deliberate self-poisoning, 28.5% were adolescents (2626 cases). The male/female ratio was 1/2.2. Approximately 87% were unmarried and 56% were students, while a total of 4859 different drugs/agents were used for self-poisoning (an average of 1.85 for each case). The majority of patients was from urban areas and had no history of attempted suicide. There was no difference between males and females regarding history of psychiatric and somatic disorders, though there was a significant difference in the average of age between male and female adolescents.
Conclusions: Among adolescents, self-poisoning is more common in girls while the mean of age is younger in boys. Although the prevalence of psychiatric disorders in adolescents appears to be less than the general population, this may be related to differences in their situations or due to underestimation of their frequencies. Psychiatric care should be a necessary component of the care administered to adolescents who attempt suicide and must be based on the needs and basic assessment of the patient’s status. Research regarding the familial history of abuse, neglect, self-harm/ poi- soning should be undertaken so that such social issues can be prioritized and addressed.

---

Background: Propofol and Thiopental are intravenous anesthetics having relatively different hemodynamic influences and adverse effects. In addition, there is significant pain on intravenous injection of propofol. This study was performed to examine the effects of Propofol-Thiopental admixture on hemodynamic variables, pain on injection and hypnotic dose at the time of induction of general anesthesia.
Methods: One hundred and twenty-five ASA I or II patients scheduled for elective surgery were randomized into four groups for induction of anesthesia in a double-blinded manner. With an original concentration of Propofol of 1% and that of Thiopental of 2.5%, we used these drugs in each group as follows: group P100: Propofol alone group P75: ¾ Propofol and ¼ thiopental (volume/volume) group P50: ½ Propofol and ½ thiopental group T100: Thiopental alone (control group). Hemodynamic variables (before and after induction), score of pain on injection and hypnotic doses were recorded and statistically analyzed.
Results: Admixture of Thiopental and Propofol reduces the injection pain of Propofol, as admixtures P75 and P50 were significantly less painful on injection than P100. Induction of hypnosis was significantly more rapid in group T100 than in groups P100 and P75. The interaction of Propofol and Thiopental with regard to their hypnotic effect is additive. Therefore a reduction in the dose of one was compensated by proportional increase in the dose of the other drug for a hypnotic effect. After anesthesia induction, systolic and diastolic blood pressures were significantly lower in group P100 than in groups P75, P50 and T100. The heart rate after laryngoscopy and tracheal intubation was significantly lower in group P100 than in groups P50 and T100.
Conclusion: Propofol-Thiopental admixture causes minimal pain on injection for intravenous induction of anesthesia with modified hemodynamic effects in comparison with each drug when used separately.

---

Background: Sexual function in women may be affected by their menstrual cycle. Lack of sexual drive is a deficiency or absence of sexual fantasies and desire for sexual activity. This study aims at determining the changes in sexual desire during the menstrual cycle and those associated with premenstrual syndrome (PMS) and evaluates sexual desire during the menstrual cycle and the associated changes with PMS.

Methods: The sample for this cross-sectional study includes 150 women employed in factories in Tehran. The instruments for data collection were questionnaires and journals of premenstrual experiences.

Results: Analysis of the data showed that the mean age of the subjects was 31 years )standard deviation = 8.46(. The most frequent decrease in sexual desire was during the week prior to the start of menstrual bleeding (27.3%) and the least frequent was from the end of bleeding to one week before the next period of menstrual bleeding (5.3%). In 24.7% of the cases, an increase in sexual desire occurred during the middle of the menstrual cycle and 27.3% during the course of menstrual bleeding. Moreover, 10.7% of the subjects had an increase in sexual desire during the week before bleeding. Furthermore, a positive correlation was found between changes in sexual desire and PMS (p<0.001). In addition, a positive correlation was found between changes in sexual desire and breast tenderness, joint and muscle pain.

Conclusions: The sexual desire of women, with or without PMS, changes during the menstrual cycle. The greatest decrease in sexual desire occurs during the first week before menstrual bleeding in women with PMS. Such information can greatly help toward understanding and treatment in sexual therapy for couples.

---

Background: Hearing is one of the most significant senses There fore, any defect can be frightening. The incidence of sever hearing loss following coronary artery bypass surgery has been estimated as one per thousand. This Prospective study carried out to determine hearing effects of coronary artery bypass surgery.
Methods: age, audiometric changes before and after surgery (hearing levels at multiple frequencies, speech reception threshold and speech discrimination score), minimum blood pressure during the operation, and the time on bypass, measured on One hundred consecutive patients who candidate for coronary artery bypass surgery and the results analysed.
Results: One hundred patients completed the tests. Based on hearing changes found on pre- and post-operative tests, the patients were divided into 3 groups: Those with no change (47 patients) according to their audiometric results those with slight changes ≤10 db (43 patients) and those having average deficits of more than 10 db (10 patients). All the patients were male. None of the patients had complete or severe sensorineural hearing loss. The third group had more prolonged pumping duration when compared with the others groups (p=0.002). Furthermore, 90 percent of patients with a sensorineural hearing loss more than 10 db had diabetes mellitus and hyperlipidemia as risk factors.
Conclusion: Sudden sensorineural hearing loss is a sequela in patients who undergoing coronary artery bypass surgery however, it was usually mild and asymptomatic. Pumping time during the operation is a significant factor in occurring of this complication. With proper treatment of underlying diseases and eliminating the risk factors with improvement of our cardiopulmonary pumps we probably can get better hearing results.

---

Background: Lead poisoning has proven to be one of the most important environmental health problems among developing countries with both direct and indirect effects on human life. Lead is known to cross the blood-brain barrier and placenta, and accumulates in soft and hard tissues. Lead can be excreted in urine, stool, milk, sweat, nails and saliva. During pregnancy and lactation, lead is released from bones into the blood along with Ca²⁺. The toxic effects of lead on various human tissues have been studied extensively, but few studies have addressed its impact on fetal development during pregnancy. Blood levels of lead are higher in people living in lead-polluted regions. It has been reported that Tehran (central and southern parts) is the most problematic city in terms of lead poisoning.

Methods: From 86 sets of mothers and newborns in a non-polluted area of rural Rasht, Iran, we examined specimens of maternal blood, cord blood and colostrum (86×3=258) and specimens from 85 sets of mothers and newborns in a polluted area of Tehran, Iran (85×3=255) for lead levels using atomic absorption spectrophotometry (AAS) and analyzed the results by t-test, SPSS, and linear regression.

Results: The mean blood lead concentrations of mothers, cord blood of newborns and colostrum were 7.6±4.1, 5.9±3 and 4.2±2.5 μg/dl, respectively, in the non-polluted area and 9.1±8.4, 6.5±5.2 and 5.8±5.5 μg/dl, respectively, in the polluted area. The mean weights of the newborns in non-polluted and polluted areas were 3.2±0.5 kg and 3.2±4.5 kg, respectively.

Conclusions: Our data revealed an association between mean concentrations in blood lead of mothers and newborns and between mean concentrations of colostrum lead and newborn blood lead in both areas (p=0.01). There was no association between mean blood lead concentration of mothers with the weight of their newborns (p=0.89).

---

Background: Rationalize of drug use in societies is one of the main responsibilities of health policy makers. In our country irrational use of dugs has increased in the recent years, for example one study in 1998 has shown that average number of medicines per prescription was 3.6, percentage of prescriptions containing antibiotics was 43% and percentage of prescriptions containing Injections was 39%. One of the best tools for evaluation of drug use is the WHO guideline for calculating prescribing indicators. In this study, we had an assessment about prescribing patterns in South of Tehran, Islamshahr and Rey Health Centers.
Methods: In order to evaluating prescribing indicators in Tehran University of Medical Sciences region 35 facilities which had pharmacy were selected according to WHO gridline and 4190 prescription from these facilities were studied. Indicators were calculated according to formulas has explained in article. Results: The average number of drug per prescription was 2.58, percentage of drug prescribed by generic name: 99.8%, percentage of encounters prescribed Antibiotics: 62.39% percentage of encounters prescribed Injection: 28.96% & the percentage of drugs prescribed from PHC formulary 99.46%. These findings were almost similar in the three Health Centers.
Conclusions: Health facilities are one of the most important bases to improve rational use of Drugs and general practitioners are the major chain in RUD cycle. Results show that we need to design intervention especially educational interventions to improve two WHO prescribing indicators, percentage of encounters prescribed Antibiotics & Injections in this region. For reaching this goals we need to design educational programs for physicians, pharmacists and people too. These educations can be as workshops, seminars, conferences or printed materials such as books, leaflets and etc

---

Background: Multiple sclerosis (MS) is an inflammatory disease of the central nervous system with multifocal areas of demyelination. Despite an increased understanding of the mechanisms causing MS, immunological factors that indicate disease activity are only starting to be discovered. Chronic brain inflammation is often associated with an increase in production of IgG in the CSF as determined by the IgG index (normal ≤0.77) and oligoclonal bands (OCBs). Different studies have found variable correlations between these two factors and disease progression. We herein evaluate the correlation of IgG index and OCB with disease progression in Iranian MS patients.

Methods: The IgG index was measured in 54 patients with multiple sclerosis. The progression index (PI), type of disease course and the presence of OCBs were compared in patients with normal, high and very high IgG index.

Results: PI was higher in patients with very high IgG indexes (0.10±0.13) vs. patients with high (0.06±0.05) and normal IgG indexes (0.05±0.07 p>0.05). Secondary progressive (SP) patients had higher IgG indexes than those with relapsing-remitting (RR) courses (2.04±1.24 for SP vs. 1.78±1.45 for RR p>0.05). The PI was higher in OCB-positive MS patients (0.08±0.10) vs. OCB-negative patients (0.05±0.04) (p>0.05).

Conclusion: Although the findings of this study need to be treated with some caution since this is not a prospective evaluation, the results indicate a trend toward better prognosis of the disease in patients with lower IgG index values. We think that the IgG index is a useful marker of disease activity in MS. Patients with IgG indexes above 1.1 could have an increased risk of progression and they would benefit from early treatment with immunomodulator agents. Our results did not reveal statistically significant prognostic value for IgG index in patients with multiple sclerosis. Thus the results warrant prospective studies to verify the prognostic value of intrathecal IgG synthesis in multiple sclerosis.

---

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: Cirrhosis and portal hypertension influence the hepatic circulation. The purpose of this study was to evaluate the diagnostic accuracy of liver Doppler ultrasonography parameters in cirrhosis.

Methods: This case-control study involved 118 subjects. All case subjects had biopsy-proven hepatic cirrhosis. The controls were healthy people, case-matched for age and gender. All cases and controls underwent Doppler ultrasonographic evaluation. We compared the area under the ROC curve of each parameter for cases vs. controls using Fisher's exact test, with p <0.5 indicating significance.

Results: The means of the following parameters for case vs. control subjects were: frequency of portal venous flow inversion, portal vein diameter 12.67±2.72 vs. 10.59±1.69, and hepatic arterial resistance index 0.81±0.07 vs. 0.74±0.09. The mean hepatic artery pulsatility index (1.87±0.48 vs. 1.34±0.23), was significantly higher among the case subjects (P=0.001). The maximum flow rate of the portal vein was also significantly lower in the case subjects (16.50±5.59 vs. 36.74±8.74 cm/s, P=0.001). We did not observe significant differences in the means of the hepatic artery maximum flow rate and end-diastolic flow rate. For diagnosing cirrhosis, the application of 24.1 cm/s as the cutoff point for the portal vein maximum flow rate, we obtain an accuracy of 95.45% (91.23%-97.70%, CI=95%), whereas a cutoff point of 1.54 or more for the hepatic artery pulsatility index yields an accuracy of 85.71% (79.48%-90.29%, CI=95%). Utilizing a hepatic arterial resistance index of 0.765 or greater is associated with an accuracy of 71.05% (62.81%-78.11%, CI=95%) in diagnosing cirrhosis.

Conclusions: Doppler ultrasonography and assessment of hepatic artery and portal vein parameters are accurate methods in the diagnosis of cirrhosis.

---

Background: For the purpose of ascertaining myocardial infarction (MI) and ischemia, the sensitivity of the initial 12-lead ECG is inadequate. It is risky to diagnose posterior MI using only precordial reciprocal changes, since the other leads may be more optimally positioned for the identification of electrocardiographic changes. In this study, we evaluated the relationship between electrocardiography changes and wall motion abnormalities in patients with posterior MI for earlier and better diagnosis of posterior MI.
Methods: In this prospective cross-sectional study, we enrolled patients with posterior MI who had come to the Emergency Department of Shariati Hospital with their first episode of chest pain. A 12-lead surface electrocardiogram using posterior leads (V7-V9) was performed for all participants. Patients with ST elevation >0.05 mV or pathologic Q wave in the posterior leads, as well as those with specific changes indicating posterior MI in V1-V2, were evaluated by echocardiography in terms of wall motion abnormalities. All data were analyzed using SPSS and p<0.05 were considered statistically significant.
Results: Of a total 79 patients enrolled, 48 (60.8%) were men, and the mean age was 57.35±8.22 years. Smoking (54.4%) and diabetes (48%) were the most prevalent risk factors. In the echocardiographic evaluation, all patients had wall motion abnormalities in the left ventricle and 19 patients (24.1%) had wall motion abnormalities in the right ventricle. The most frequent segment with motion abnormality among the all patients was the mid-posterior. The posterior leads showed better positive predictive value than the anterior leads for posterior wall motion abnormality.
Conclusion: Electrocardiography of the posterior leads in patients with acute chest pain can help in earlier diagnosis and in time treatment of posterior MI.

---

Background: Parkinson's disease (PD) is a degenerative neurodopaminergic disease in nigrostriatum pathway of animals and human, the resultant loss of nerve terminals accompanied by dopamine-glutamate and other related neurotransmitters-imbalances in this pathway are responsible for most of the movement abnormalities. Increasing evidence suggests that an inflammatory reaction accompanies the pathological processes caused by Cyclooxygenase-2 (COX-2) seen in many neurodegenerative disorders, including PD. These findings have not indicated any evidence based on the effect of selective and non selective COX-2 inhibitors on the rigidity of PD.
Methods: The rats left substantia nigra pars compacta (SNc) was destroyed using the electrical lesion thus PD model was created. Then oral aspirin and celecoxib (200, 400 mg/kg) were administrated to parkinsonian rats acutely and then the rigidity was evaluated using Murprogo's Method.
Results: Both compounds were able to decrease the rigidity of parkinsonian rats (p<0.05) respectively but selective cox-2 inhibitor (celecoxib) was found more effective and potent than that of non selective cox-2 inhibitor (aspirin). Conclusion: The findings suggest that COX-2 inhibition decreases the rigidity of PD in the animal model. Therefore, as results of the study COX-2 inhibition was shown good evidence based on the use of aspirin and celecoxib and PD affiliated rigidity improvement that this can be beneficial and interest for neuroscientists. These findings are additional pharmacological and medicinal information to further assess of non steroidal anti inflammatory drugs (NSAIDs) as alternative therapeutic agents for PD affiliated rigidity treatment. Further experiments seem to be necessary to complete this research such as investigation the effects of NSAIDs on the striatum neurotransmission pathway