مجله دانشکده پزشکی اصفهان
پیاپی 437 (هفته اول شهریور 1396)

Despite the importance of psychological factors in adherence to the treatment in patients with hypertension, a few studies have been done to identify the factors affecting adherence to treatment and particularly to investigate the role of psychology factors in Iranian population. This study aimed to investigate the role of mental health in adherence to medication in patients with hypertension in rural areas of Isfahan Province, Iran.
In this cross-sectional study, 300 patients with hypertension were studied. Multistage sampling was performed in health centers. Data collection tools included depression, anxiety and stress scale (DASS) short form and the Morisky 8-items medication adherence questionnaire. The odds ratio (OR) for different levels of depression, anxiety, and stress in both groups with appropriate adherence and non-appropriate adherence to treatment were determined. We used multivariate logistic regression model for statistical analysis.
Findings: Patients with very severe levels of anxiety were more non-adherent to drug therapy than those with normal levels of anxiety (OR = 2.8; CI95%: 1.07-7.38). While other levels of anxiety and severity of depression and stress were not significant predictors for predicting patient's adherence to treatment.
Understanding the severity of depression, stress, and anxiety to ensure adherence and treatment outcomes in patients with hypertension are essential. According to this study, very severe anxiety can be considered as an important predicting factor in the lack of adherence to medication.

One of the significant problems in multiple sclerosis (MS) is damage to the visual system, which is the result of demyelination. Studies have suggested a link between central nervous system demyelinating diseases and thyroid disorders, and probably the treatments that increase the level of thyroid hormones are beneficial in multiple sclerosis. Therefore, in this study, the effects of levothyroxine on lysolecithin-induced demyelination/remyelination in rat's optic chiasm were evaluated.
Local demyelination was induced by injection of 2 µl lysolecithin 1% into the rat's optic chiasm. Experimental groups were control, sham, lesion (multiple sclerosis), and lesion-levothyroxine 20, 50 and 100 µg/kg (n = 9). Demyelination/remyelination was evaluated 7, 14 and 21 days after the initiation of treatment. Histomorphological changes were assessed using hematoxylin and eosin staining.
Findings: Following the injection of lysolecithin into the optic chiasm, a large demyelination was occurred, which decreased over time, indicating remyelination in this area. Following the treatment with levothyroxine, there was a significant reduction in the amount of demyelination in the treated groups compared to the multiple sclerosis group. This decrease was particularly pronounced at the dose of 100 µg/kg.
The results of this study show that injection of lysolecithin in the optic chiasm causes a reversible demyelination. Levothyroxine could produce protective effects against induced demyelination and accelerate remyelination. Therefore, thyroid hormones probably have healing effects in multiple sclerosis, although further studies are needed.

Electron therapy has advantages of dose uniformity in target volume and dose reduction in deeper tissues for breast cancer therapy. The aim of this study was to determine observed dose in target volume and normal tissues such as lung in breast cancer therapy after mastectomy.
The phantom was designed based on the chest wall computed tomography (CT) images after mastectomy and treatment planning software. Two linear accelerator (Neptune 10 and Saturn 20) machines were used to deliver electron beams at a dose of 200 cGy (10 and 13 MeV). Dose measurements were done using thermoluminescence dosimeter lithium fluoride chips (TLD-100: LiF: Mg; Tl).
Findings: The percentage of measured dose in internal mammary nodes, axillary nodes, and chest wall using 13 MeV was found to be 97.5, 96, and 98, respectively. In treatment with 10 MeV electron, this values changed to 99.7, 90.5, and 77 percent, respectively. The anterior lung percentage dose was 78 with 13 MeV electrons while the posterior part of lung received 47 percent with 10 MeV electron beam. Dose values for anterior and posterior part of lung changed to 83 and 45 percent, respectively.
Using 13 MeV, internal mammary and axillary lymph nodes as well as the chest wall received adequate doses but lung received excessive dose. Using 10 MeV, internal mammary nodes and chest wall were well exposed to radiation, but axillary lymph nodes did not receive enough dose. Therefore, this dose shortage should be compensated by additional posterior fields using radiation therapy with photon energies.

Transforming growth factor (TGF)-beta 2 signaling pathways and their receptors exert a pivotal role in behavior and fate of tumor cells. Therefore, these pathways are target of drug discovery researches. In this study, we evaluated the effects of the aqueous extract of Trachyspermum copticum (L.) link (carum) seeds on TGF-beta receptor 1 and 2 genes coding the heterodimer complex of receptor in MCF-7 cell line of human breast cancer.
Non-cytotoxic concentrations of the extract determined by 3-(4,5-Dimethylthiazol-2-yl)-2,5-Diphenyltetrazolium bromide (MTT) test and cells treated with non-cytotoxic concentrations (5 and 40 µg/ml) of extract for 24 hours. Then, to evaluate the expression of TGF-beta receptors 1 and 2 genes at the level of transcription, real-time polymerase chain reaction (PCR) was performed (comparing the control group). Data were analyzed using REST® software and analysis of variance test. Level of significance was set at 0.05.
Findings: Cells treated with concentration of 5 µg/ml of extract showed reduction in gene transcription levels to almost half (0.52) (P = 0.015); and in cells treated with concentration of 40 µg/ml of extract, gene transcription levels increased to 1.34 times (P = 0.066) comparing to control group. Treatment of cells with extract showed no meaningful changes in TGF-beta receptor 2 gene expression at the level of transcription (P = 0.148).
Results suggest that treatment of MCF-7 cells with low concentration of aqueous extract of Trachyspermum copticum (L.) link seeds can affect the TGF-beta receptor 1 gene transcription, but not the TGF-beta receptor 2; and alter the microenvironment of tumor cell. Further studies have to be performed for conclusive evidence.

In this study, effects of L-carnitine on inflammatory parameters and angiogenesis were evaluated in the rat air pouch model of inflammation.
Male Wistar rats were anesthetized; 20 and 10 ml sterile air was injected subcutaneously on the back of rats at first and 3rd day. To induce inflammation, carrageenan 2% was injected intrapouch at 6th day. Saline as control and L-carnitine (250, 500, 1000 and 2000 µg/rat) were administrated intrapouch at the same time as the carrageenan injection, 24 and 48 hours after inflammation induction. After 72 hours, the pouches were opened and pouch fluids were collected to determine exudate volume, leukocyte counts, vascular endothelial growth factor (VEGF), and interleukin-1ß (IL-1ß) levels. The granulated tissue was dissected out and weighed. Angiogenesis in the granulation tissues was measured based on the hemoglobin concentration method.
Findings: All used doses of L-carnitine reduced the leukocyte accumulation in the pouch fluid (P Results of this study showed that the used doses of L-carnitine have anti-inflammatory effects without anti-angiogenesis activity in this model of inflammation. The anti-inflammatory effect of L-carnitine maybe related to its inhibitory effect on IL-1ß.