Tehran University Medical Journal

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Background: To determine the incidence and risk factors of acute mountain sickness (A - AMS) in pilgrims. Although it is well known that western trekkers suffer from acute mountain sickness (AMS) in other mountains, not much is documented about the incidence of AMS in the Damavand Mountains, Iranian population that go to high altitude and its related contributing factors.

 Materials and Methods: The design was a cross sectional study. During six weeks (in summer 2000) a population of 459 pilgrims was studied. The period of the study was six weeks in summer AMS symptoms, were assessed by an extensively used standard questionnaier (Lake Louise), applied at 2900 m, after than arrive at 4200 m above sea level, and during descent from summit Damavand (at 4200 m) at Damavand in Iran Alborz Mountain.

Results: The overall incidence of A.M.S. was 60.8 percent. Climbers had 13-71 years and 67.8 percent of the study population was men. Men did not differ significantly higher rate of AMS from women. The incidence being increased in those who residence at an altitude below 600 m, climbed fast, amateur climbers, a previous AMS experience or high altitude illness, a history of AMS at ascent to Damavand and ascent time at night (6pm-6am). It was weakly dependent to rate of ascent (from 2800 m up 4200 m less that 4 hours) and sleep in 4200 m. The incidence of AMS was unrelated to sex, age, body mass index (BMI), height, weight, smoking, to the load carried and knapsack and spent more than 15 hours in shelter (at 4200 m). So it was independent of rate of ascent in the higher altitude (from 4200 m to 5671 m), speed of descent and family history of AMS.

 Conclusions: Data show a strong relation between experiences mountaineer, history of AMS, ascent time at night and the incidence of acute mountain sickness in 459 climbers studied at high altitudes that didn’t report previously.

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Background: It was believed that Inhabitant of Islamshahr avoid referring to their health centers and health posts to receive bargain medical services. In search for the rate and causes of such neglect, this study was formed.

Materials and Methods: In a cross-sectional study from all urban centers and health posts under the supervision of Islamshahr health network, 712 files were selected randomly.

Results: Investigating the selected files it revealed that 25% were complete, 51% were defective and 24% were blank. In other words, only 25% of the files were complete and 75% of the files showed lack of full participation in primary care services. In the process of evaluation of each separate service unit, more defective files were found in family planning and oral health programs. But in the prenatal care and growth observation units, the number of complete files was a little higher than the number of defective ones. This is probably justifiable de to free vaccination of children and pregnant women, which causes the customer to refer to the mentioned units. In search for the causes of this lack of participation, 533 defective files were selected and those families were interviewed through some questionnaires.

Conclusion: In family planning and growth observation and prenatal care, the interviewees believed that there was no need for them to seek such services. This in turn shows their lack of knowledge about the necessity of these cares. In case of oral health, lack of such unite in the health center was mentioned as the reason. More details are discussed in the article.

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Background: Altitude diseases, the most frequent of which is acute mountain sickness (AMS), are among the most common and serious problems that recreational and professional mountain athletes may encounter. If left undiagnosed, they may lead to lethal consequences. In a cross sectional study, we investigate the prevalence of AMS disorder among the overnight guests of a mountain resort hotel.

Methods: Overnight guests staying at Hotel Tochal (elevation 3545 m), near Tehran, Iran, in the winter of 2006 constituted the study participants. A questionnaire, including demographic data, proposed risk factors and Lake Louise score, was completed by a physician for all who had headache or other symptoms of AMS. Data from daily hotel reception records were also collected.

Results: Overall, 328 persons stayed at this hotel for at least one night during the study period. Among these, 47 persons (14.3%) were admitted to the clinic for headache. According to the physician's diagnoses, only 34 guests (10.4% 95% CI: 7.1-13.7%) were affected by AMS. The concurrent symptoms of headache and vertigo or insomnia had the highest predictive value for AMS diagnosis. Ambiguous headache had a higher predictive value than other types of headache.

Conclusions: Despite the height of Tochal peak and the frequent use of high speed telecabin, it seems that the frequency of AMS is lower than that found in other studies on similar altitudes. However, more research should be done in this regard.

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Background: One of the most common orthopedic complaints is direct or indirect trauma to the knee with torn anterior cruciate ligament (ACL). Reconstruction of the torn ACL is emphatically offered in active individuals as by this operation, we prevent osteoarthritis, knee instability and injury to the meniscus. There are numerous methods for graft fixation in the femoral tunnel in ACL reconstruction. If the graft proves to be stable after the operation, patients would not complain of giving way knee joints. In this clinical trial, we compared transfemoral pinning with endobutton fixation of hamstring graft in arthroscopic ACL reconstruction by examining knee stability and use of other relevant functional tests. Methods: Fourteen Patients who had undergone arthroscopic ACL reconstruction in Shariati Hospital during the years 2008-2009 and were being followed up were evaluated at least 15 months post-operatively by physical examination and the use of an arthrometer made by the Faculty of Mechanics of Sharif Technical University. Results: The results showed that two out of seven patients in which their ACL had been reconstructed by hamstring graft fixation by endobutton technique, and in one out of seven patients who had undergone ACL reconstruction by hamstring graft fixation through transfemoral pinning, Lachmann test (in 25 position) was greater than 5 mm but there were not any complaints of giving way knee joints. Conclusion: The clinical results of ACL reconstruction by transfemoral pinning technique seems to be superior to the reconstruction by endobutton technique.

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Background: Anterior cruciate ligament (ACL) reconstruction is a first choice treatment for ACL-deficient knees, and arthroscopic single-bundle reconstruction has been widely accepted around the world in this regard. Although, such single-bundle reconstructions result in sufficient knee stability in most cases, but some patients have not been satisfied with postsurgical results in both short-term and long term clinical studies. One of the reasons for these unsatisfactory results could be related to the fact that normal function of the native ACL has not been restored by the traditional ACL reconstruction which uses only a single-bundle graft. The natural ACL consists of a 3-dimensional structure with multibundle fascicles, which can be anatomically divided into 2 main bundles, the anteromedial (AM) and the posterolateral (PL) bundles named for the orientation of their tibial insertions. The purpose of the present study was to compare double-bundle and single-bundle ACL reconstruction.
Methods: Twenty-two patients with anterior cruciate ligament tear who were candidates for ACL reconstruction were enrolled in the study undertaken in Shariati Hospital from 2009 to 2010. Fourteen patients underwent single-bundle and 8 patients double-bundle ACL reconstruction. The patients were evaluated by arthrometer and physical examination in postoperation follow up visit at least 9 months after the operations.
Results: Four out of 14 patients with single-bundle reconstruction had knee joint translation greater than 5 mm but nobody had knee translation more than 5 mm in the double-bundle reconstruction group.
Conclusion: Double-bundle ACL reconstruction seems to be more stable than single-bundle ACL reconstruction.

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Background: Infeliximab is a form of chimeric antibody which neutralizes the most important inflammatory cytokine, TNF-a, in inflammatory disorders. The aim of current study was to pilot expression of chimeric infliximab in Chinese Hamster ovary (CHO) cells.

Methods: In this research study, pVITRO2-neo-mcs vector that consist of infliximab light chain and heavy chain was used to transform into the E.coli by CaCl2 method. The plasmid was then purified and transfected to cultured CHO cells by Lipofectamine 2000® (Invitrogen GmbH, Germany). Transfected cells were selected upon G-418 treatment after 2 weeks and the level of expression, based on standard curve, was measured using IgG ELISA kit after 48 hours for each clone. High level expressed clone was then cultured in roller bottles and recombinant chimeric product was purified by protein A affinity chromatography. The purity of the product was analyzed by 10% gel SDS-PAGE from eluted samples. The efficacy of the purification was analyzed by ELISA before and after purification step. This article is a master's student thesis from February 2015 to August 2016 in pharmaceutical technology development center, Tehran University of Medical Sciences, Tehran, Iran.

Results: The purified plasmid was analyzed on 2% agarose gel. After selective pressure of G-418, 10 stable transfect clones were assessed for infliximab secretion by IgG ELISA kit at 450 nm. The maximum and minimum expression which detected by ELISA were 23 ng/ml and 6 ng/ml, respectively. The band width of infliximab fraction during purification procedure was observed at 0.7-0.8 min. The efficiency of the purification by ELISA was 70%. On SDS-PAGE analysis, two bands, 25 and 50 kDa, respect to light and heavy chains of Infliximab, was confirmed the expression of recombinant protein.

Conclusion: In the current study, the construct for infliximab monoclonal antibody production was designed using genetic engineering techniques and the expression was confirmed by conventional molecular biology methods. The high yield production was carried out in semi-industrial scale using roller bottles with a 70 percentage of purification efficiency.

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