Tehran University Medical Journal

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PTK (Phototherapeutic Keratectomy) is the use of laser in corneal diseases. We can replace PTK for many other invasive procedures. The objective of this study is the assessment of this procedure in several cases in our practice. This investigation was a retrospective study, which was conducted based on comparison of 11 eyes with corneal eschars, induced by recurrent corneal erosions, pterygium surgery, corneal dystrophies and trachoma from 1994 to 1995. The mean age of cases was 32 years. The mean augmentation rate in hyperopia after one month was 1.5 diopter, and after one year it was 1 diopter. Although in two cases, the cylinder more than one diopter was induced, the mean rate for it was not increased significantly. One patient with recurrent erosion, who had not replied to any treatment, had no any complaint during one year follow up. During the follow up procedure, there were no any cases of vision loss among the patients.

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Background: There are many surgical approaches for hyperinsulinemic hyperglycemic treatment. Subtotal pancreatectomy which has been used for many years, is abounded know due to high recurrence rate, and has been replaced by near total resection. This study focuses on “near total resection”.

Materials and Mehods: In this study 15 cases of hyper insulinemic hyperglycemia patients which has been operated since year 1985 till 2000 in the Children's Medical Center, has brought into consideration and described as a case series study.

Results: From the patients, three cases were operated by subtotal pancreatomy and all of them have had recurrence. In the remaining twelve cases, the method used was different and “near subtotal pancreatomy” were used. The recurrence rate in this group was zero and there were not also any case of sepsis. Postoperative complications were rather low and the most common postoperative finding in these patients was transient hypoglycemia.

Conclusion: Near total pancreatomy for hyperinsulinemic hypoglycemia which is implemented by an expert surgeon with low complication and high cure rate, can be considered as a safe technique with high cure rate and satisfactory results.

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The aim of this study was to compare the effects of intraoperative autotransfusion and tranexamic acid on post-operative bleeding and need for allogeneic transfusion.
Materials and Methods: In a prospective, randomized study, 200 patients undergoing CABG allocated into two groups:
□ AT group = 100 patients received 1-2 units (300-450cc) autologous blood after termination of CPB D TX group = 100 patients received tranexamic acid, 15mg/kg before the injection of heparin and 15mg/kg after protamin injection Postoperative bleeding, transfusions, complications, ICU stay and hospital stay were recorded.
Results: The postoperative bleeding was lower in TX group (600 ml) than in AT group (1100 ml) (P <0.001). The rates of transfused patients in AT and TX groups were 72% and 65%. Patients in the AT group received more whole blood (2.82 units per patient vs. 1.93 units in TX group) (P<0.01). The numbers of FFP units administered per patient in AT and TX groups were 3.08 and 2.38 (P <0.01). In TX group, ICU stays and hospital stays were 0.8, 5.4 days (vs. 1.2s, 6.7days in AT group). In AT group, there were 2 transient renal dysfunctions and two re-operations. There was no difference between all groups regarding to neurological dysfunction and coagulopathy. There is no hospital mortality in all groups.
Conclusion: Tranexamic acid in comparison with intra-operative autotransfusion effectively reduces postoperative complications and allogeneic transfusions in CABG. In addition this technique due to shorter ICU and hospital stay is cost- effective.

 

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Background: Total Intravenous Anesthesia (TIVA) compared to general anesthesia has some pits and falls. Many drugs have been employed for this anesthesia. Propofol is accounted as the last advent anesthetic drug. It belongs to alkyl phenol families and has been accounted one of the best choices for the continuous infusion. Invention of midazolam as the first water soluble benzodiazepine was also an important event in anesthesia and it can be used as continuous infusion for the anesthesia.

Materials and Methods: In this randomized controlled clinical trial, alfentanyl plus propofol or midazolam were used for TIVA anesthesia in 60 female patients undergoing Dilatation and Curettage (D&C) in Dr.Shariati hospital in March 2002 till March 2003. They were allocated reandomly in two group of alfentanyl plus propofol (propofol group) or alfentanyl plus midazolam (midazolam group)

Results: There was no significant difference in mean of age between propofol group and midazolam group (P>0.05), also There was no significant difference in preanesthesia condition such as blood pressure and heart rate between propofol group and midazolam group (p>0.05). After induction of anesthesia there was a gross blood pressure decrease in both group that it was greater in midazolam group (85 mmHg versus 73 mmHg, P<0.05 ) following this, there was an increase in heart rate in both groups that it was modest in propofol group (98 Beat/Sec versus 118 Beat/Sec, P<0.05). There was no significant difference in mean infused alfentanyl (P>0.05) also there was just one naloxane injection in midazolam group that have no significant difference between groups (P>0.05). Recovery room stay was significantly lower in propofol group (25 minutes versus 39 minutes, P<0.05).

Conclusion: The results of this study was similar to Vuyk et.al.In their study there was a significant lower recovery time estimated by psychomotor reflexes and there was significant lower drowsiness, place and time orientation time compared to midazolam group. Finally according to the results of this study it can be resulted that TIVA with propofol is more suitable than midazolam and it can lower hospitalization time and cost. In future studies using other narcotics and other narcotics-anesthetic compounds with various dose can be mentioned.

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Background and Aim: Total laryngectomy following laryngeal cancer has many sequelae , that loss of voice is the most important of them. Tracheoesophageal puncture (TEP) and prosthesis insertion has evolved into the most widely used and accepted technique for vocal rehabilitation.

Materials and Methods: 10 patients that underwent TEP in Amir Alam and Imam Khomeini hospitals from Feb. 2002 through Nov. 2003 were included in this study. Prosthesis insertion in 4 patients is primary and in 6 patients is secondary and all patients are men.

Results: The age of patients was between 50 to 70. 90% of patients had history of cigarette smoking and 10% of them had history of drinking alcohol. Salivary leakage was seen in 30% of patients that was improved with conservative management. Fluency of speech in 30% of patients and intelligibility of speech & voice quality in 40% of patients is good.

Conclusion: We could conclude that TEP has less complication & better speech results of other vocal rehabilitation methods. Carefully selection of patients & size of prosthesis has important role in results of TEP.

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Background: Jaundice is a common and benign problem in neonatal period. Several therapeutic procedures for decreasing of serum bilirubin level has been recommended. phototherapy is most common them. Our goal Form this study is the evaluation of serum therapy effects in decreasing of serum bilirubin concentration in icteric infants that are treated with phototherapy.
Methods: This is a prospective clinical trial in Najmeih Hospital in 2002. In this study 80 term icteric infants with bilirubin level greater than 17 mg/dl were randomized in two groups, both groups underwent phototherapy and in the case group intravenous fluid supplementation was added. There were no significant differences in the mean gestational age, birth weight, hemoglobin, and also in total serum bilirubin level at admission in the two groups.
Results: There were no significant differences in the mean rate of of serum bilirubin level decline during first 24 and 48 hours of hospitalization and also the time of bilirubin decreasing to less than 15 mg/dl and the length of hospitalization in two groups.
Conclution: Our study showed intravenous fluid supplementation could be limited to special cases of neonatal icter such as moderate to severe dehydration.

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Background: Job stressors in managers are progressively affecting and destroying their immune systems. The relationship between hardiness, stress and immune system is important for mental health. This study was designed to determine the resources in managers against stress, resources herein designated as “hardiness” and “social support". Also in this research, the correlation between hardiness, defined collectively as feelings of challenge, commitment and control, as a resource against stress and the immune system of high school managers in Khozestan Province were studied.
Methods: The study sample was comprised of 340 managers (male and female), selected by the cluster sampling method. Each subject completed the personal view survey scale and social support questionnaire. Then the individuals were divided into four groups (n= 35 in each group) of high and low hardiness and social support as follows: high hardiness / high social support, high hardiness / low social support, low hardiness / high social support and low hardiness / low social support. Subjects who suffered from disorders that affect the immune system were excluded. The number of T-helper cells (CD4), T-suppressor cytotoxic cells (CD8), natural killer cells (CD56+ CD16), complement system (C3, C4, CH50), immunoglobulin M and G (IgM and IgG), cortisol hormone, eosinophils, neutrophils and lymphocytes were measured for each subject.
Results: The results revealed that, there was a significant positive correlation between hardiness and CD4, CD4/CD8, CD56, CD16, CH50, IgM and neutrophil levels. Also, there was a significant negative correlation between hardiness and CD8, cortisol and eosinophil levels. There was a significant difference between the four groups of in CD4, CD8, CD4/CD8, cortisol, C3, C4, CH50 and lymphocyte levels. Also, there was a significant positive correlation between social support and CD4, CD4/CD8, CD56, CD16, CH50, IgM, C3 and neutrophil levels.
Conclusions: The results revealed that the performance of the immune system in managers with high hardiness and high social support is significantly better than that of managers with low hardiness and low social support. Furthermore, high hardiness and high social support act as resources and moderating factors against stress.

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Background: Hypothyroidism is a well-documented complication after treatment of laryngeal cancer and is particularly significant among patients undergoing laryngectomy. We investigated the frequency of hypothyroidism in patients treated with total laryngectomy for laryngeal cancer. We also evaluated the effect of neck radiotherapy on thyroid function after total laryngectomy for laryngeal cancer.
Methods: In a cross-sectional study, we evaluated 31 patients with laryngeal squamous cell carcinoma (mean age 53.6 years). Among these patients, 14 were treated with surgery only and 17 were treated with surgery plus radiotherapy. Laboratory evaluation included levels of thyroid stimulating hormone (TSH), free T4, free T3, and antithyroid antibodies both preoperatively and postoperatively at the first day, as well as one and six months after surgery.
Results: All patients had normal thyroid function before treatment however, after 6 months, five patients (16.1%) were hypothyroid. Of these, three patients (9.6%) had subclinical symptoms, including elevated thyroid-stimulating hormone with normal free T4, and two patients (6.5%) showed clinical symptoms of hypothyroidism. Radiotherapy and neck dissection were significantly associated with higher incidences of hypothyroidism.
Conclusion: Our data suggest that hypothyroidism occurs in a substantial proportion of patients undergoing surgery for laryngeal cancer. The results indicate that thyroid function studies should be routinely performed in the follow-up care of laryngeal cancer patients, especially if radiotherapy and neck dissection were part of the treatment. We suggest that this approach will improve the patient's quality of life and diminish the co-morbidity associated with this kind of surgery.

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Background: Abdominal hysterectomy is one of the therapeutic options in treatment of gynecologic diseases. The most common methods are total and subtotal abdominal hysterectomy. The effect of hysterectomy on sexuality is not fully understood and, until recently, total and subtotal abdominal hysterectomies have been compared only in observational studies. In this study, we compare total vs. subtotal abdominal hysterectomy in terms of surgical complications and postoperative sexual function of patients.

Methods: In a single-blinded randomized clinical trial, we enrolled 25 patients who underwent subtotal abdominal hysterectomy (STAH), and 25 patients who underwent total abdominal hysterectomy (TAH). All patients were followed for 24 months after surgery. Three, six, 12 and 24 months after the procedures, all variables were compared between these two groups.

Results: The duration of operation (p=0.007), volume of bleeding (p=0.0007) and duration of hospital stay after surgery (p=0.03) were less in the STAH group than the TAH group. No complications were experienced during the operation, nor excessive post-operative pain or infection for either group. No significant differences were seen between the two groups with regard to dyspareunia, sexual satisfaction of the patients and their partners were. Spot bleeding in the STAH group was significantly more frequent than in the TAH group.

Conclusion: TAH and STAH do not have significantly different outcomes with regard to sexual satisfaction and function and surgical complications.

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Background: Immune deficiency is one of the major causes of morbidity and mortality in the modern world. Primary immunodeficiency comprises a wide range of disorders that mainly manifest in early childhood as devastating infections with opportunistic organisms. Thymic aplasia is found on autopsy of some patients afflicted with immune deficiency disorders, such as DiGeorge syndrome and severe combined immunodeficiency (SCID). After a thorough search of the literature, we found little information on the cellular characteristics of these thymuses. Our study aims to elucidate role of apoptosis in the pathogenesis of thymic aplasia and compare various lymphocytic and epithelial markers in normal and aplastic thymuses.

Methods: We selected 12 subjects who died of severe infections with aplastic thymus found on autopsy, and 11 control subjects who died of unrelated causes, such as congenital heart disease. The presence of several markers, including Bcl2, P53, lymphocytic markers, and CD68, was examined using immunohistochemical methods on paraffin-embedded thymus sections. Positively-stained cells were counted per 1000 cells and the results stated as percentage of positive cells.                       

Results: The mean age of the control group was between 7 days to 18 months (mean: 4.5 months). Parental consanguinity was present in 45.5% and 9.1% of the control and case groups, respectively however, this was not statistically significant. We found significantly lower expression of Bcl2 in the case group (p value: 0.038). Furthermore, expression of CD68 was significantly higher in the case group. Epithelial markers were significantly higher in case subjects, although CD8 expression was higher in the control group. The presence of other markers was not significantly different between the two groups.

Conclusions: Increase in apoptosis has a role in aplastic thymuses and prevention of apoptosis may halt this process. Also high CD68 expression denotes increased phagocytic activity in aplastic thymuses.

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Background: The aim of this study was to assess the efficacy and safety of a new minimally-invasive surgical procedure using trans-obturator Tape (TOT) to treat female stress urinary incontinence.

Methods: This clinical trial study was performed from 2003 to 2004 in the Gynecology Department of Imam Hospital, Vali-e-Asr, Tehran, Iran. A total of 35 women with stress urinary incontinence underwent the TOT procedure. All patients underwent pre-operative clinical examination, cough-stress test (full bladder), uroflowmetry and post-voiding residual volume assessment.

Results: The mean age of patients was 50 years, ranging from 26 to 74 years, with an average urinary stress incontinence duration of six years. The mean time of follow-up was 14 months (at 1, 6, 12 and 24 months) and the average duration of surgery was about 20 minutes. The perioperative complication rate was 9% with no vascular, nerve or bowel injuries. The rate of hemorrhagic side effects (spontaneously-absorbed hematoma and blood loss not requiring blood transfusion) was 2.9%. Post-operative urinary retention and vaginal erosion occurred in one case each the former was treated by intermittent self-catheterization. In total, 91.4% of patients were completely cured and 8.6% were improved without failure of treatment.

Conclusions: The present study confirms the results obtained by Delorme and coworkers, and allows us to consider TOT as a safe, minimally invasive and efficient short-term surgical technique for the treatment of female stress urinary incontinence, alone or in combination with prolapse repair. Following this study, a randomized control trial is recommended to compare TOT with the gold standard surgery for women with urinary incontinence.

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Background: Total spinal anesthesia is a complication of lumbar epidural anesthesia following undiagnosed subarachnoid or subdural injection of local anesthetic. Although many achondroplastic dwarfs have a normal spine, catheter insertion may be more problematic with a narrow epidural space making a subarachnoid tap more probable.  Other malformations associated with achondroplasia, such as prolapsed intervertebral discs, reduced interpedicular distance, shortened pedicles, and osteophyte formation, combined with a narrow epidural space may make identification of the space difficult and increases the risk of dural puncture. Furthermore, subarachnoid tap or dural puncture may be hard to recognize if a free flow of CSF is difficult to achieve due spinal stenosis. Yet, for those who meet the criteria, epidural regional anesthesia is frequently preferred over other forms, which often have more or more dangerous side effects in this type of patient.

Case report: A 22-year-old achondroplastic male dwarf patient was scheduled for pelvic mass resection and was considered a candidate for continuous epidural anesthesia. The anesthesia became complicated by total spinal anesthesia, which was reversed following supportive management for about two hours.

Conclusion: There is significant debate over the composition and volume of the test dose, especially for patients with achondroplasia. We nevertheless recommend repeated test-doses during the accomplishment of epidural anesthesia to exclude unintended intravascular, intrathecal or subdural injection, keeping in mind that a test dose of local anesthetic does not completely prevent complications.

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Background: There is a growing interest in understanding the biological effects of time-tested folk medicinal plants including the green leafy vegetables, which supply minerals and vitamins to the diet. Trigonella foenum-graecum L (fenugreek) is a dietary vegetable and there are reports concerning its antinociceptive effects in Iranian traditional medicine. Its seeds are also known for their carminative, tonic, antidiabetic, antineoplastic and restorative properties. These reports and the hypoglycemic effect of fenugreek leaf extract encouraged us to assay fenugreek aqueous extract for cytotoxicity on NIH3T3 mouse fibroblast cells.

Methods: The NIH3T3cell line was purchased from National Research Center for Genetic Engineering and Biotechnology of Iran. The cells were plated in 24-well microtiter plates with DMEM+F12 medium containing 10% fetal calf serum supplemented with 445 mg/L L-glutamine and maintained at 37^oC with 5% CO₂/95% air. Following a 24-hr incubation period, various concentrations (0.01-20 mg) of the extract to the culture wells. Cell viability was assessed using trypan blue and MTT assays after five days of incubation.

Results: The results show that the IC₅₀ of the fenugreek extract as calculated from the trypan blue and MTT assays were 1.25 and 2.5 mg/mL, respectively.

Conclusions: Our findings, therefore, suggest that the aqueous extract of fenugreek is classified as nontoxic. This observed cytotoxicity is not specific and could be due to membrane disturbances.

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Background: 4-Aryl-4H-chromenes are novel anticancer agents which induce apoptosis in cancer cells. These compounds were found to induce apoptosis by targeting the tubulin/microtubule system in cell proliferation process. The aim of this study was to report cyototoxic and apoptosis inducing activities of a new series of synthesized 4-aryl-4H-chromenes compounds. Methods: The in vitro cytotoxic activity of the synthesized 4-aryl-4H-chromenes was investigated against a paned of human cancer cell lines including MCF-7 (breast carcinoma), A549 (lung carcinoma), HEPG-2 (liver carcinoma), SW-480 (colon adenocarcinoma), U87-MG (glioblastoma), 1321N1 (astrocytoma), and DAOY (medulloblastoma). The percentage of growth inhibitory activity was evaluated using MTT colorimetric assay versus controls not treated with test derivatives. The data for etoposide, a well known anticancer drug, was included for comparison. For each compound, the 50% inhibitory concentration (IC50) were determined. Apoptosis inducing activity were assessed by DAPI staining. Results: Preliminary screening showed that those chromenes analogs bearing phenyl-isoxazole-3-yl substitution or the derivatives containing methoxyphenyl in chromene ring exhibited cytotoxic and apoptotic inducing activity comparable with or even superior than the reference drug, etoposide. The compounds without this type of substitution have lower activity. Conclusions: Replacement of 3, 4, 5-trimethoxyphenyl group with thiazol ring in the synthesized derivatives reduced the cytotoxic activity. However, the derivatives with phenyl-isoxazole analogue showed potent cytotoxic and apoptotic inducing activity.

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Background: Over the past 50 years, subtotal or supracervical hysterectomy has come to be viewed as a suboptimal procedure reserved for those rare instances in which when concern over blood loss or anatomic distortion dictates limiting the extent of dissection, the aim of this study was to compare total and subtotal laparoscopic hysterectomy.
Methods: The patients who were candidates for hysterectomy with benign disease, with no contraindication for laparoscopic surgery entered the study in Arash Hospital, from March 2007 to April 2009. By simple randomization 45 patients (25 for TLH and 20 for SLH) were selected. Demographic Details and intra and post operative complications, were recorded by the staff and were compared between two groups.
Results: The average time for TLH operations look significantly longer than SLH operation (148.6±29.7 minutes 128.5±25.64 minutes, p=0.03). Although, the hemoglobin (gr/dl) drop in TLH was significantly higher than SLH (1.54 Versus 0.9, p<0.05) Blood transfusion were common in SLH (1 case Versus 3 Cases). The total length of hospital stay, was significantly shorter after SLH than TLH (3.6±1.47 day and 2.85±0.59, p=0.04). The drug requirements to control pain during hospitalization after both surgeries with analgesic injection were not significantly different, but with suppositories analgesic in SLH more than TLH. The time of return to normal activity was reported (p<0.0001) significantly shorter after SLH than TLH (13.12±18.1 and 5.04±1.79, p=0.0001). Sexual function had no significant difference between two groups but dysparunia in SLH was significantly lower than TLH (p=0.02). Cyclic bleeding and cervical prolaps, was not reported in two groups. Finally intra and post operative complications were more frequent in TLH.
Conclusions: SLH is a safe and effective surgery. Our data suggest that SLH can replace TLH in selected cases.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: CD4 T-Lymphocyte counts have proven to be a standard laboratory marker of disease progression and severity of immunodeficiency in adults infected with HIV is used to initiate and monitor highly active antiretroviral therapy however, its application may not be feasible for its expensive equipments and reagent in resource-limited setting. There is a need to have another marker of immunodeficiency that is less resource-demanding. In April 2002, the World Health Organization (WHO) recommended that, when CD4 cell count is not available, a TLC of 1200cell/mm3 or less in individuals with stage 2 or 3 of the disease may be used as an indication to initiate ART.
Methods: The aim of this study was to determine the relationship between total lymphocyte count and CD4 count in HIV-infected adults. This was a retrospective cross-sectional study. Subject characteristics were patients who had positive serologic HIV test results, confirmed via western blot. Analysis unit was the results of CBC and CD4 measurements on the same blood sample each time. Data of 100 patients were collected. In this study, TLC accounts for the main predictor of CD4 count. The amounts of TLC which can predict CD4 less than 200cell/mm3 were considered eligible.
Results: Our data revealed high sensitivity and specificity of TLC as a surrogate measure of CD4 count. In this study, TLC cutoff of 1300cell/mm³ indicated the optimal combined sensitivity and specificity altogether.
Conclusion: Total lymphocyte count and its changes can be used as alternative to CD4 count and its changes in the management of HIV-infected individuals.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Stress incontinence is the most common type of urinary incontinence which has been treated by different surgical techniques. The objectives of our study were to compare the laparoscopic Burch colposuspension with Trans- obturator Tape (TOT) procedure.
Methods: This randomized clinical trial was conducted on 40 patients with stress incontinence referred to Arash hospital from 2007 to 2009. All patients were randomly divided in two groups (laparoscopic Burch and TOT). Patient information was using obtained demographic, I-QOL (Which contained 22 questions), UDI-6 (urinary symptoms), ISI (Severity of urinary incontinence) questionnaires and urodynamic test.
Results: The data collected from 19 patients in TOT group and 16 patients in laparoscopic Burch groups. The objective cure rate which was determined by no urinary leakage during stress and were analyzed urodynamic evaluation was 75% in laparoscopic and 84.2% in TOT (p=0.53). Result of ISI questionnaire with showing the subjective cure rate following surgery had no significant difference between two groups (p=0.23). UDI-6 questionnaire was used to compare the result of both groups before and after surgery and showed that the improvement in Urgency was significant in TOT in compare to Burch (p=0.04). I-QOL score significantly increased in both groups after six months of operation (p<0.05). But the differences were not statistically significant.
Conclusion: Based on our results subjective and objective cure rate were not significantly different between TOT and laparoscopic Burch colposuspension.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Stress urinary incontinence is a major confounding factor which impairs health quality in women. Some procedures cannot resolve it&aposs impact on life quality. This study aims to assess a less common and newly method use of transobturator tension- free vaginal tapes (TOT) in regard to short- term and long-term morbidity and impact on patient&aposs quality of life (QOL).

Methods: Fifty four patients diagnosed with urinary stress incontinence, underwent a transobturator tension free vaginal tape procedure with or whitout prolapse surgery. Pre and post operative quality of life assessed with Incontinence- specific Quality of Life questionnaire (I-QOL), and objective and subjective cure rate according to patients signs and symptoms before operation, early and late surgical complications like hemorrhage, Injury and/ or perforation of bladder, intestine, urethra and infection were mentioned.

Results: The overall intraoperative and early post-operative complication rates were 5.5% and 3.7%, respectively. No case of hematoma, bladder or bowel injury was seen.   I-QOL scores were significantly higher after surgery. The mean I-QOL score were 23.6 and 64 before and after surgery respectively (p<0.0001). This improvement was independent of the concomitant pelvic floor repair surgery, menopause, underlying diseases, number of parity, body mass index (BMI) and age. The global rate of objective cure was 94.4% (p<0.0001). The majority of women were satisfied with the outcome. (subjective cure was 90.7%- p<0.001).

Conclusions: This study demonstrates that the TOT approach in the treatment of stress urinary incontinence is a safe and effective procedure which promotes health quality of life.

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Background: Tuberculosis with high prevalence in HIV/AIDS patients is the main reason for morbidity and mortality in these patients. About one-third of patients with HIV infection have concomitant tuberculosis. Lack of appropriate infection control on many social and economic communities will impose. Comprehensive study on the effects of anti-tuberculosis drugs in patients with HIV infecting less done, also due to the importance of reducing morbidity and mortality, reduce the cost of disease, identifying drug pharmacokinetics, the importance of completing treatment tuberculosis, this study was performed to evaluate the effects of anti- tuberculosis drugs on HIV infection and to identify the drug pharmacokinetics and so more complete tuberculosis treatment.
Methods: A historical cohort study was performed on patients referring to the research center for HIV/AIDS, consultation center, department of infection diseases of Imam Khomeini Hospital in Tehran, Iran. A total number of 75 cases with HIV negative versus HIV positive patients with pulmonary tuberculosis and positive sputum smear in accordance with inclusion and exclusion criteria were selected.
Results: In this study, the frequency of peripheral neuropathy 27(73%), arthralgia 31(83.8%), vomiting 18(48.6%), headache 26(70.3%), dizziness 20(54.1%), renal toxicity 4(10.8%) and of skin rash 10(27%) in patients with HIV virus infection were significantly more than HIV- negative patients. Hepatotoxicity, fever and anemia were not significantly more common in patients who infected with HIV virus.
Conclusion: The HIV patients, who have not received antiretroviral drugs during tuberculosis treatment, may show higher incidence of anti-tuberculosis drugs complications.

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Background: Deposition of bilirubin in neurons causes permanent neuronal injury. Bilirubin exhibits an affinity for the phospholipids of plasma membrane like N-methyl-D-aspartate (NMDA) receptors. Magnesium is an NMDA antagonist and it acts against the neurotoxic effects of bilirubin. We compared pre- and post-phototherapy serum magnesium level of neonates with hyperbilirubinemia to find the best time of discharge and evaluate new management techniques such as magnesium supplementation.

Methods: In this semi-experimental study, we evaluated neonates admitted in Ali Asghar Children's Hospital in Tehran, Iran with signs of icter from 2009 to 2010. The inclusion criteria included age less than four weeks, no history of magnesium sulfate administration in the mother and absence of sepsis.

Results: From 106 patients with icter, 50.9% were male and 49.1% were female neonates. Their mean gestational age was 37.341.286 (33-41) weeks and the mean birth weight was 3172.12436.936 (2022-4300) grams. The frequency of underlying causes of hyperbillirubinemia included: ABO mismatch 9.34%, Rh incompatibility 4.7%, breastfeeding 16% and breast milk 44.3%. There was a significant difference (P≤0.001) between serum magnesium levels before (2.24mg/dl) and after phototherapy (2.12mg/dl). There were no significant differences between serum magnesium values in the two sexes (male=2.28, female=2.19), among different gestational age groups (<34 wks=2.35, 35-37 wks=2.27, >38 wks=2.17), between different birth weight groups (1500-2500 g=2.4 and >2500 g=2.23) or severity of hyperbilirubinemia (mild=2.23, moderate=2.21 and severe=2.29).

Conclusion: Phototherapy decreases the total magnesium concentration and magnesium administration will prevent bilirubin neurotoxicity in icteric neonates.