Tehran University Medical Journal

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Background: Exogenous natural and synthetic surfactants is a rescue treatment for respiratory distress syndrome (RDS). The goals of the study were to compare the clinical response and side-effects of two frequently used surfactants, poractant alfa (Curosurf) and beractant (Survanta), for the treatment of respiratory distress syndrome in preterm infants.

Methods: This clinical trial study was performed during a two-year period in the Neonatal Intensive Care Unit of Ghaem Hospital in Mashhad, Iran. Sample size calculated by a 95% confidence and power of 80, included 104 premature neonates, 74 in survanta and 30 in curosurf groups. The level of statistical significance was considered to be < 0.05.

Results: There were no statistically significant differences between the infants treated by survanta or cursurf groups regarding their mean gestational age (30.58 Vs. 29.00 weeks) and birth weight (1388 Vs. 1330 g), (p=0.3) There were also no significant differences between the two groups regarding incidences of broncho- pulmonary dysplasia (BPD) (40.5% Vs. 40%), intraventricular hemorrhage (IVH) grades III/IV (13.5% Vs. 13.3%), pneumothorax (both 20%), patent ductus arteriosus (PDA) (28/3% Vs. 20%) or death (28% Vs. 26.6%) on the 28th day postpartum.

Conclusion: This study showed that survanta and curosurf had similar therapeutic effects in the treatment of neonatal respiratory distress syndrome.

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Background: Many chemotherapeutic regimens used in the treatment of cancer generate free radicals that may be a part of their beneficial effects. The aim of this study was to assess the oxidative status in patients undergoing chemotherapy for acute myeloid leukemia (AML).

Methods: Thirty-eight patients with AML (17 female and 21 male patients) with a mean age 34.05±12.49 years were included in the study. All the patients received cytarabine and daunorubicin as their standard induction therapy. Serum levels of malondialdehyde (MDA), total antioxidant capacity (TAC), and also the erythrocyte superoxide dismutase and glutathione peroxidase activities were measured before and 14 days after chemotherapy.

Results: Plasma malondialdehyde concentrations increased significantly (from a former 2.68±0.89 nmol/ml to 3.14±1.29 nmol/ml) 14 days post chemotherapy (p=0.04). Moreover, the total plasma antioxidant capacity changed from 1.09±0.15 mmol/L to 1.02±0.14 mmol/L (p=0.005). Erythrocyte superoxide dismutase and glutathione peroxidase activity decreased over time from 1157.24±543.61 U/gHb to 984.01±419.09 U/gHb (p=0.04) and 46.96±13.70 U/gHb to 41.40±6.44 U/gHb (p=0.02), respectively.

Conclusion: In this study, an increase in malondialdehyde levels and a decrease in the levels of antioxidant enzymes and total antioxidant capacity were observed. It seems that chemotherapy by cytarabine and daunorubicin generates enormous amounts of free radicals in patients undergoing the treatment for AML. Use of antioxidant supplementation during chemotherapy i is discouraged as it may interfere with the generation of free radicals that may be a part of the therapeutic efficacy of these drugs.

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Background: In a recent study, we were able to demonstrate a role for leukocyte transfer in the induction of liver damage in recipient mice after induction of IR (60 min of bilateral renal artery occlusion and 3 hrs reperfusion) injury in donors. The present study investigates the role of leukocyte transfer in the induction of kidney damage in recipient mice after induction of renal IR injury in donors.

Methods: Mice were divided into two sham and renal IR groups. After anesthesia, leukocytes were isolated from blood and were transferred to the two recipient groups: the intact recipient mice received leukocytes from the sham donor group (Sham recipient) and the intact recipient mice that received leukocytes from IR donor group (IR recipient). After 24 hrs, the recipient mice were anesthetized and blood samples and renal tissues were collected.

Results: Renal malondialdehyde (MDA) increased and glutathione and superoxide dismutase (SOD) decreased significantly in IR recipient group in comparison to sham recipient group. Although renal function tests, including BUN and plasma creatinine were significantly different between IR donor and sham donor groups, but they were not significantly different in two recipient groups. Renal tissues in IR donor group showed extensive damage compared to sham group, but in IR recipients' kidneys, they were different from IR donor tissues despite being different from their respective sham group.

Conclusion: These findings are suggestive of implication of leukocytes in renal tissue damage and oxidative stress after renal IR injury.

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

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

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

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

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Background: Diabetes mellitus affects numerous intracellular metabolic processes, which are reflected by changes in the concentration of some plasma constituents. Particularly, the disease may indirectly undermine some functions of the nervous system including learning and memory through altering oxidative stress status. On the other hand, probiotics can enhance the antioxidant capacity. This study was designed to evaluate the effects of probiotics on spatial memory, maze learning and indices of oxidative stress in diabetic rats.
Methods: In this experimental study, 40 male Wistar rats were randomly allocated to 4 groups (n=10 for each): Control (CO), Control probiotic (CP), Control diabetic (DC), and Diabetic probiotic (DP). The probiotic supplement, including Lactobacillus acidophilus, Lactobacillus fermentum, Bifidobacterium lactis (334 mg of each with a CFU of ~1010), was administered through drinking water every 12 hours for 8 weeks. Using morris water maze (MWM), spatial learning and memory were evaluated. Serum insulin and oxidative stress indices, including superoxide dismutase (SOD) and 8-hydroxy-2'-deoxyguanosine (8-OHdG), were measured by standard laboratory kits.
Results: Oral administration of probiotics improved impairment of spatial learning (P=0.008) and consolidated memory (P=0.01) in the rats. Moreover, probiotic treatment increased serum insulin (P<0.0001) and serum superoxide dismutase activity (P=0.007) while it decreased their blood glucose (P=0.006) and 8-OHdG (P<0.0001).
Conclusion: Probiotic supplementation reversed the serum concentrations of insulin and glucose along with an increase in antioxidant capacity in diabetic rats. It also improved spatial learning and memory in the animals. Relevancy of the metabolic changes and behavioral functions need to be further studied.

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Background: Previous studies indicate that morphine dependent and withdrawal from chronic opiates enhanced anxiety-related behaviours in novel and stressful conditions in rats. Recent studies have shown that exposure to a stressor generates a wide variety of adaptive responses, while enhancing abilities to adopt with the stressor. Therefore, the aim of this study was to examine the effect of chronic restraint stress and acute water immersion (WI) stress on the anxiety profile in morphine-dependent rats.
Methods: Thirty two rats were injected with twice daily doses (10 mg/kg, subcutaneous, at 12 hour intervals) of morphine over a period of 10 days in the presence or absence chronic restraint stress (1 hour/day). On day 11, two hour after morphine injection, anxiety-like behaviours were tested in the elevated plus-maze model in the presence or absence acute water immersion stress. Rats were divided into four groups: dependent- No restraint stress (D/NRS), dependent- restraint stress (D/RS), dependent- restraint stress+ water immersion stress (D/RS+WI), dependent- water immersion stress (D/WI).
Results: Finding have shown that D/RS+WI rats exhibited an increase in the elevated plus-maze open arm entries and time as compared with the control groups (P=0.018 and P=0.037, respectively). Also, this measure was significantly lower in the WI rats than the D/RS+WI rats (P=0.049 and P=0.031, respectively).
Conclusion: Our findings indicate that chronic restraint stress followed by acute water immersion stress decreases the severity of the anxiogenic-like behaviours in morphine dependent rats thus it may have a therapeutic application in the treatment of the asso-ciated disorders in addiction.

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Background: Infection with group B streptococcus (GBS) can present with respiratory distress, Pneumonia, meningitis and Osteomyelitis in neonates. The aim of this study was to determine the prevalence of GBS colonization in trachea of intubated neonates.
Methods: This observational analytic study was performed upon 33 intubated neonates due to respiratory distress in neonatal intensive care unit (NICU) Rasoul Hospital in Tehran, Iran during 2010-2012. Tracheal secretions cultured upon TODD-HEWITT BROTH and sheep blood agar 5%., chi-square test was used for compare the qualitative variables. P<0.05 was considered meaningful.
Results: Three cases had positive streptococcal culture (9.1%) and four cases had posi-tive culture for non-streptococcal organisms. no meaningful relation observed between positive GBS culture and neonatal gender, kind of delivery, PROM.
Conclusion: Prevalence of GBS positive results (9%) in present study is very close to GBS colonization in pregnant women although the higher colonization rate of pregnant women are expected.

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Background: We are in new era of knowledge and treatment of women with PCOS. We should find management modalities that can improve their life quality. Due to high prevalence of PCOS, and zinc deficiency in Iran, importance of antioxidants such as zinc on treatment and improvement of PCOS complications, and due to the disadvantages of the current treatment for the disease (i.e. OCPs), finding an efficient alternative therapy with no or less side effects seems to be as important as some methods for changing the life style of these women. This study was performed to assess zinc levels in PCOS versus non PCOS patients to determine if zinc can be helpful in PCOS management.
Methods: This is a case-control study which was performed from January 2012-2013 in 100 infertile women aged 20-45 years who were referred to Vali-e-Asr infertility clinic. Fifty patients had PCOS according to Rotterdam Criteria (case group) and 50 were infer-tile women without PCOS (control group). In both group, serum Zinc levels were deter-mined and the data was gathered using the SPSS software and analyzed by descriptive (percent, mean, standard deviation) and analytical 2, ANOVA, Mann-Whitney and Correlation).
Results: Results did not show a significant difference between case group and control group in respect to serum Zinc levels (P>0/05).
Conclusion: Due to no difference between case group and the control one in zinc levels, it seems that zinc supplementation in PCOS patients is not necessarily useful or of clinical importance. Obviously studies with larger sample size can probably define the role of zinc in these patients.

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Background: Very preterm birth (26-32 weeks) has an important effect on infant morta-lity and disability of infancy. The aim of this study was to investigate the prevalence of very preterm delivery and early neonatal morbidity (the first 28 days after birth).
Methods: In this cross-sectional retrospective study, among 4393 delivery in Arash Women's Hospital in Tehran, 59 deliveries were very preterm that resulted in 79 very preterm neonate births. We assessed maternal risk factors and neonatal complications in women who were admitted for delivery from March 2009 to March 2010.
Results: Among 59 pregnant women, 17 (12/27%) had multiple pregnancies and 17 (12/27%) had premature rupture of fetal membranes. Caesarean section method was more common than normal vaginal delivery (46 cases- 97/77%). Women aged 18 to 35 had the highest rate of preterm delivery (45/86%). Among 79 very preterm neonates about half of them were very low birth weight, 74 neonates (93/67%) suffered from respiratory distress syndrome and 13 deaths were reported.
Conclusion: Premature birth is a multi-factorial phenomenon. Identifying maternal risk factors and increasing knowledge about it can decrease the rate of preterm labor. The prevention of premature labor is better than cure. Further prospective studies with large number of patients and long-term follow-up are recommended for better understanding of the phenomenon.

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Background: Respiratory distress syndrome is developmental immaturity of lungs, that is caused by lack of surfactant. Lack of surfactant lead to wide atelectasis and arterial hypoxemia which is a life-threatening lung disorder. The aim of this study was to compare the function of cochlear in infant who suffer respiratory distress syndrome with normal infants by transient evoked otoacoustic emission (TEOAE) test. Methods: This descriptive- analytic cross sectional study was carried out on 21 respiratory distress syndrome (RDS) infants (42 ear) that consists of 11 male and 10 female, 21 normal infants (42 ear) that consists of 10 male and 11 female in Mirza Koochakkhan Hospital, Tehran University of Medical Sciences, Tehran, Iran, which all of them were 3 to 6 month year old, to collect informations about the health of infants we used the files in hospital and to assess the cochlear function we used computerized recording by TEOAE instrument. Statistical analysis carried out by SPSS software version 17 and Chi-square test. Results: The results of TEOAE test demonstrated that in normal group there is no statistical differences between ears and gender, also there was no statistical differences between ears in respiratory distress syndrome group but there was statistical differences between gender in this group. The frequency of pass result (show normal function of outer hair cell in cochlea) was greater in male than female in male the frequency of pass result was 17 ear (77.3%) but in female was 8 ear (40%). In TEOAE test results there was statistical differences between two groups of study. The frequency of pass result in normal group was 34 ear (81%) and in respiratory distress syndrome group was 25 ear (59%) which was significantly more in normal group than in respiratory distress syndrome infants (P= 0.032). Conclusion: According to results, it seems that the respiratory distress syndrome could affects the cochlear and the function of outer hair cell in it so in infants who suffer respiratory distress syndrome we should use the test battery of hearing.

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Background: Approximately 50% to 80% of women experience varying degrees of postpartum depression. Oxidative stress is involved in many diseases, including depression. Common production of lipid peroxidation by oxidative stress is malondialdehyde (MDA). The endocannabinoid system is a nervous regulator and convoy the impression that the circulatory levels of endocannabinoid is significantly reduced in depressed women. The major purpose of this paper was to evaluate activity of the major antioxidant and endocannabinoid index in postpartum depression. Methods: A total of 130 women were entered in a case-control study in 12 Bahman Health Center from April 2011 to August 2011. In 4th to 6th week after delivery, women were equally divided into 2 groups based on Edinburg questionnaire (normal and postpartum depressive women). Serum MDA, total antioxidant capacity (TAC) and RBC catalase levels were determined to investigate the oxidative status. In addition, Mass spectrometry was applied for the analysis of serum anandamide (AEA) and 2-Arachidonoylglycerol (2-AG). Results: Based on Edinburg questionnaire, however, women age, husband age, husband marital number, gravidity, children number, salary and house size have no significant effect on postpartum depression, marital period was significantly increased postpartum depression (P< 0.05). In addition, women education, husband education, wanted or unwanted pregnancy from women, neonatal sex, satisfaction of neonatal sex from women and husbands, breast feeding and delivery have no significant effect on postpartum depression, and women Job (P< 0.001), husband job (P< 0.001), wanted or unwanted pregnancy from husbands (P< 0.05) were significantly changed postpartum depression. Serum MDA and RBC catalase levels were not significantly higher in depress compared with the normal group. TAC was significantly decreased in patients having postpartum depression (P< 0.05). Serum AEA and 2-AG levels were significantly lower in depress compared with the normal group (P< 0.01). Conclusion: Women’s Job, husband’s job, wanted or unwanted pregnancy from husbands and marital period are associated to postpartum depression. In postpartum depression, TAC, AEA and 2-AG are reduced. So it can be concluded that both antioxidant system and endocannabinoid concentration involved in the development of postpartum depression.

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Background: Bone is a hard and dynamic tissue, which continually undergoes remodeling process. Longitudinal growth of bone is mediated by growth plate that is a cartilage structure at the end of long bones. During puberty, along with the closure (ossification) of growth plate, the longitudinal growth of bone will stop. Diazinon is one of the widely used organophosphorus pesticides that have been known to cause damage to the cells and tissues of the body by enhancing oxidative stress. Due to the dynamism and active process, bone and growth plate tissues are suitable models to investigate the effect of diazinon on bone development and bone growth. The aim of this study was to investigate the effects of diazinon on the epiphyseal growth plate width (including the proliferating cells zone and hypertrophy cells zone) of immature rat. Methods: This is an experimental study. This study was performed on 12 immature male in Ferdowsi University of Mashhad in May 2014, Wistar rats that randomly divided into 2 groups: control group and diazinon group. All treatments were done by oral gavage during 28 days. The animals were sacrificed on day 28 and left femur bones were removed for histomorphometric studies of epiphyseal growth plate width. Assessments were done by ImageJ software, version 1.40g (Wayne Rasband, NIH, USA) and the significance of the results were performed by ANOVA analysis and Tukey’s test. Results: Epiphyseal growth plate width of diazinon group was significantly reduced (P=0.0126) in compared to control group. This reduction was associated with reduced of width of the proliferating zone (P=0.0001) and increased width of the hypertrophy zone (P=0.0166). Conclusion: Diazinon leads to reduction in the Epiphyseal growth plate width of immature male rats. Therefore it could be a factor in the impairment of bone longitudinal growth and premature closure of the growth plate.

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Background: Protozoa are unicellular eukaryotes. A type of intestinal protozoan pathogens is the cause of infection and serious injuries in human with or without clinical symptoms. It seems that parasitic infections as a stressor factor can affect on stress system activity and immune system function and sensitivity. The major purpose of this paper was to evaluate serum cortisol level and the general inflammation by measuring neutrophil to lymphocyte ratio in patients with intestinal protozoa. Methods: A total of 40 men were entered in a case-control study in Besat and Baqyiatallah (a.s.) Hospitals in Tehran from April to September 2014. Men were equally divided into 2 groups based on infection with the intestinal protozoa (control and patient groups). This study was conducted on blood samples of these people. Serum cortisol level and neutrophil to lymphocyte ratio were determined in control and patient with the intestinal protozoa groups. Cortisol was measured using cortisol kit (Diagnostic Biochem, Canada) and by ELISA method. In addition, the samples were treated with Wright stain method, and neutrophil to lymphocyte ratio was calculated using WBC diffraction method. Results: According to the results of this study, mean age between control and patient groups was not statistically significant (P= 0.91). Serum cortisol concentration in patients with the intestinal protozoa was significantly higher than the control group (P= 0.043). In addition, a significant increase was observed in neutrophil to lymphocyte ratio in patients with parasitic infections compared to the control group (P= 0.026). Conclusion: Based on the results of this study, parasitic infection (intestinal protozoa) as a stressor factor can increase serum cortisol concentration. In addition, intestinal protozoa was reduced immune system sensitivity and function. It seems that the neutrophil to lymphocyte ratio can be a potential useful parameters for evaluating the stress system activity and function in patients infected with the intestinal protozoa.

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Background: Acute respiratory distress syndrome (ARDS) is one of the most important complications associated with traumatic brain injury (TBI). ARDS is caused by inflammation of the lungs and hypoxic damage with lung physiology abnormalities associated with acute respiratory distress syndrome. Aim of this study is to determine the epidemiology of ARDS and the prevalence of risk factors.

Methods: This prospective study performed on patients with acute traumatic head injury hospitalization in the intensive care unit of the Shohaday-e Haftom-e-Tir Hospital (September 2012 to September 2013) done. About 12 months, the data were evaluated. Information including age, sex, education, employment, drug and alcohol addiction, were collected and analyzed. The inclusion criteria were head traumatic patients and exclusion was the patients with chest trauma. Questionnaire was designed with doctors supervision of neurosurgery. Then the collected data were analysis.

Results: In this study, the incidence of ARDS was 23.8% and prevalence of metabolic acidosis was 31.4%. Most injury with metabolic acidosis was Subarachnoid hemorrhage (SAH) 48 (60%) and Subdural hemorrhage (SDH) was Next Level with 39 (48%) Correlation between Glasgow Coma Scale (GCS) and Respiratory Distress Syndrome (ARDS) were significantly decreased (P< 0.0001). The level of consciousness in patients with skull fractures significantly lower than those without fractures (P= 0.009) [(2.3±4.6) vs (4.02±7.07)]. Prevalence of metabolic acidosis during hospitalization was 80 patients (31.4%).

Conclusion: Acute respiratory distress syndrome is a common complication of traumatic brain injury. Management and treatment is essential to reduce the mortality. In this study it was found the age of patients with ARDS was higher than patients without complications. ARDS risk factor for high blood pressure was higher in men. Most victims were pedestrians. The most common injury associated with ARDS was SDH. Our analysis demonstrates that Acute respiratory distress syndrome is common after traumatic brain injury. Management of traumatic brain injury is necessary to manage and reduce the mortality.

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Background: Anembryonic gestation (blighted ovum) is the most common identifiable pathology in the first trimester of pregnancy, always leads to miscarriage. Early pregnancy failures from blighted ovum are often due to chromosomal abnormalities and a poor quality of sperm or egg. Oxidative stresses as a factor of disturbance balance between the production of free radicals and antioxidant defenses is involved in the pathogenesis of many diseases, including mouth and throat cancer and cardiovascular disease. Catalase is one of the defensive systems against damages caused by oxidative stress in human. The aim of this study was to compare the activity of salivary catalase in women with blighted ovum and women with history of normal pregnancy.

Methods: This case-control study was performed on 34 patient women with blighted ovum and 34 healthy women as a control group. The study was performed in biochemistry laboratory at the University of Guilan from October 2015 to July 2015. The age range was 20-44 years and 18-45 years in patient and control groups, respectively. Unstimulated saliva samples were collected using spitting method. Catalase activity was measured by evaluating the constant rate of hydrogen peroxide decomposition in patient and control groups.

Results: The patient group matched with healthy subjects in average age and having no other diseases history. The biochemical enzymatic assays indicate that the average catalase activities of saliva in patient and control groups were 14.47±3.8 and 16.42±3.48, respectively. Therefore, the catalase activity was significantly reduced in patient group as compared to the control group (P=0.03).

Conclusion: The obtained results suggested that oxidative stress plays an important role in the pathogenesis of blighted ovum. Therefore, determination the activity of other antioxidant enzymes, in addition to catalse, may be used as a marker for diagnosis of blighted ovum. More studies with larger studied-population is recommended to confidently comment on the results of this study.

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Background: Nonalcoholic fatty liver disease (NAFLD) includes steatosis, nonalcoholic steatohepatitis, fibrosis and liver cirrhosis. The oxidative stress enzymes are the diagnostic markers to prediction of histologic status of liver in nonalcoholic steatohepatitis disease. The aim of the study was to assessment of relationship between serum Zinc (Zn) levels with pathologic manifestation in patients with nonalcoholic steatohepatitis.

Methods: This cohort study was done in patients with nonalcoholic steatohepatitis that had been visited in gastrointestinal clinic of Sina Hospital, Tehran, Iran from April, 2014 to April, 2015. Control group included the patients with no clinical manifestation of nonalcoholic steatohepatitis and normal liver ultrasonography, lab test and liver biopsy. Serum Zn level was measured with atomic absorption spectroscopy. Normal Serum level of Zn was considered 10.7-22.9 µmol/L (70-150 µg/dL) and less than 7 µg/dL was considered as Zn deficiency. Pathological findings were grading according to NAFLD activity score.

Results: One hundred twenty patients were selected for the study in two equal groups. Six and 26 patients were excluded in case and control groups, respectively due to no consent to lab test. Finally, 54 patients (35 male/19 female) and 34 patients (22 male/12 female) in control group were participated in data analysis. The mean age on case and control group was 37.02±9.82 year and 33.24±12.01 year, respectively (P= 0.111). Zn level in case and control groups were 90.82±13.69 and 88.82±13.10, respectively. There were no statistically significant differences between two group in serum Zn level (P= 0.50). Also, there were no statistically significant differences between pathological grading in case group participants (steatosis: P= 0.640; Lobular inflammation: P= 0.882; fibrosis: P= 0.531).

Conclusion: The finding of the study showed no significant association between serum zinc level and hepatic steatosis, lobular inflammation and fibrosis of the liver in nonalcoholic steatohepatitis.

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Background: There are evidences that suggest the impact of stress on pregnancy outcome. Prolong antenatal depression and anxiety may cause lots of adverse pregnancy outcomes such as abortion, still birth, low birth weight and preterm labor. The aim of this pre-posttest randomized control trial study was to determine the role of stress management training in the first trimester on stress reduction in pregnant women referring to General Yas Women Hospital related to Tehran University of Medical Sciences in Tehran, Iran, from May 2014 to January 2016.

Methods: Anxiety status of 75 pregnant women in the first trimester was assessed by standard anxiety questioner using Hamilton anxiety rating score. Scores 18-25, 25-35 and >35 were considered for mild, moderate and severe anxiety, respectively. According to the level of anxiety, women with moderate and severe anxiety as the interventional group were arranged for participation in stress management workshops, applying mindfulness technique including: body scan, setting meditation and passing thought technique in 5 an hour sessions. For this experimental group were made available CD training for practicing lessons during the week. All groups didn’t need to medical treatment according to the psychiatrist interview. In the ending of therapy, clinical groups were assessed by anxiety scale again. Women with mild anxiety as the control group received only regular prenatal care without any psychological interventions. The validity and reliability of questioner were approved by experts in this field. This research was supported by Tehran University of Medical Sciences and Health Services grant and also the study approved by ethics committee of Tehran University of Medical Sciences. Data were analyzed using the statistical software SPSS version 18, and Student’s t-test analyses were performed.

Results: The level of anxiety and stress was decreased significantly between women in clinical groups, 27.5 to 14.1 for moderated level stress (P= 0.001) and 40.1 to 16.6 for high level of stress (P= 0.0001) respectively.

Conclusion: First trimester of pregnancy is a crucial stage of fetal growth and development. Based on our findings, stress management training in this period has beneficial effects on stress reduction and enhances maternal health status.

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Background: Cancer diagnosis is the biggest stress for the child and his family. Diagnosis and treatment of cancer in children can cause stress, which often has a negative effect on the health of parents. Psychological reactions such as anxiety, depression, denial and loss of confidence in parents observed that because of the fear of recurrence and future of children. This study aimed to determine the level of stress and anxiety and depression in parents of children with leukemia who were in the maintenance phase of treatment.

Methods: This cross-sectional study has been conducted on 48 parents have referred to the clinic of Dr. Sheikh Hospital of Mashhad City, Iran, whom selected using easy sampling method. DASS-21 questionnaire was used for data collection. Another questionnaire containing demographic information such as age, sex, income, educational level and duration of illness was filled under supervision of the psychologist and pediatric physician. Data with SPSS software, ver. 20 (IBM, Armonk, NY, USA), descriptive statistics and Pearson correlation analysis was performed. Results: The results showed that in this study, 37% had abnormal stress levels (33% and 2% of mild stress, moderate stress and severe stress 2%) and 79% had abnormal anxiety level (mild 19%, moderate 31% and severe 29%) and 67% had abnormal depression level (mild 33%, moderate depression 33%) tests, respectively. In our study, there was no relationship between age, sex and duration of illness with these variables.

Conclusion: According to this study, in addition to the classic treatment of patients, parent’s mental performance should be paid attention.

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Background: Body pain in multiple sclerosis (MS) is a common phenomenon that can create or exacerbate by different parameters of clinical, psychological and demographic. The aim of this study was to investigate the relationship between parameters of clinical (fatigue, clinical course, body mass index and duration), psychological (depression, anxiety and stress) and demographic (age, gender, marital status and education) characters with multiple sclerosis patient’s body pain. Methods: This cross-sectional study has been performed in the Multiple Sclerosis Society of Guilan Province and Imam Reza Specialized and Sub-specialized Clinic, Rasht City, Iran during June to February 2010. In this study 162 patients with MS were selected by consecutive sampling. We used the clinical and demographic variables inventory, body pain subscale of the health survey questionnaire, depression, anxiety and stress scale and fatigue severity scale along with identical analog-spring balance. The data were analyzed by Pearson correlation coefficient and point bi-serial, one-way analysis of variance, Gabriel test and stepwise multiple regression. Results: The findings showed that patients who scored 3 or higher in relapses experienced significantly more body pain than patients who scored 1-2 times of relapses (P= 0.031). In the meantime, significant differences were not found between the two groups of patients with a score of 3 or higher in relapses and non-relapse and between non-relapse patients and with a score 1-2 times of relapses in terms of body pain. Also, significant differences were not found in different groups of hospitalization in terms of body pain. However, anxiety and fatigue together could explain significantly 25% of the shared variance of body pain (F= 26.29, P≤ 0.0009). Conclusion: This study showed the effect of psychological and clinical factors on body pain exacerbation in MS patients. Therefore, it is necessary for clinicians to consider identifying these factors and the relationships of the factors with increasing pain in patients with MS.

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Breast cancer is the most commonly diagnosed cancer in women worldwide. Enormous advancement has been made over the last decades in understanding the biology of breast cancer. Nevertheless, the molecular mechanisms regulating progression, gaining of invasive and metastatic phenotypes, and therapeutic resistance are still not completely understood. Oxidative stress initiate by disbalance in redox status of body. In this case, increase of free radicals in body cause tissue damage. One of the significant species of free radicals is reactive oxygen species (ROS) that produced by various metabolic pathways, comprising aerobic metabolism in the mitochondrial respiratory chain. They play a serious role in cellular physiology and pathophysiology likewise beginning and evolution of numerous types of cancers. ROS overproduction is deleterious to cells, and considered key-factors for the development of numerous diseases, such as cardiovascular disorders, neurodegenerative diseases, and cancer. Cancer cells are commonly submitted to upper ROS levels that further incite malignant phenotype through motivation to preserved proliferation, angiogenesis, death evasion, invasiveness, and metastasis. ROS impress various signaling pathways, comprising mitogenic pathways and growth factors, and also controls numerous cellular processes, containing cell proliferation, thus stimulates the undisciplined growth of cells which inspires the development of tumors and initiates the progression of carcinogenesis. The importance of ROS on breast cancer development and etiology is being increasingly clarified. Nevertheless, fewer consideration has been given to the progress of redox system-targeted strategies for breast cancer treatment. Augmented oxidative stress caused by reactive species can diminish the body’s antioxidant defense against angiogenesis and metastasis in cancer cells. These processes are core factors in the development of cancer. Bimolecular reactions cause free radicals which create such compounds as malondialdehyde (MDA) and hydroxyguanosine. These substances known as indicators of cancer. In this review, free radicals as oxidizing agents, antioxidants as the immune system, and the role of oxidative stress in cancer, particularly breast cancer, have been investigated by hope that better exploration of the factors involved in the occurrence and spread of cancer will improve the identification of treatment aims.