فصلنامه یافته
سال ششم شماره 20 (پیاپی 15، بهار 1383)

Meningiomas are considered extra-axial and benign tumors. Though they are pathologically classified as benign, non-benign and other types, it seems that information derived from this classification cannot explain the behavior of the tumor. Pretumoral brain edema (PTBE) is one of the signs that has been less thoroughly studied, and still there is not a single consensus about its mechanism. Despite the benign and extra-axial manifestations of meningioma, in more than 60% of cases, these tumors have PTBE. The goals of this study were to show the role of the level of progesterone positivity in tumor cells as a behavioral factor and to find different features in the MRI and CT scans of meningioma patients that might be related to this issue and also to PTBE. In this study, 77 patients with intracranial meningiomas who referred to the Neurosurgery Department of Imam Khomeini Hospital in Tehran were followed prospectivity between 1999-2003. Initial CT scans and MRIs (T1, T2) were performed on each patient, and certain imaging features of the tumors—including the diameter, volume, location, contour, presence or absence of PTBE, and the shape of tumor—were detected. Then a comprehensive comparison of these factors with surgical and pathological findings, clinical presentations, and immunohistochemical (IHC) staining for estrogen receptors (ER) and progesterone receptors (PR) were carried out. Tumors with higher PR levels had smaller sizes, and their contours were smoother. Images showed that these tumors were less invasive, in that in more than 50% of the cases, the arachnoid space (AS) around the tumor could be observed, and it was less probable to see PTBE. Instead, the duration of the disease was longer, and the intrasurgical bleeding was less. The results of this study show that the future behavior of intracranial meningioma tumors cannot be predicted based on such features as diameter, location, contour, and volume. Instead, we must obtain more in formation about the tumors’ cells in order to predict the future behavior of these tumors.

There is no curative treatment for chronic renal failure (CRF). Important strategies for the control and prevention of the advancement of CRF are increased renal function and decreased blood pressure (BP) and weight. Borage has many benefits, such as increased frequency of urination, decreased BP, and increased renal function. This clinical trial study was designed to determine the effect of borage tea on the urine and blood chemistry of non-dialysis CRF patients in Khorram Abad, Iran, in 2002-2003. For 25 adult patients, borage flower was prescribed to be used as a tea substitute twice a day (70 grams each time, at 10 a.m. and 5 p.m.) for seven days. The first assessment stage was done before the use of borage tea. The second and third assessment stages were done five days after the beginning of borage tea use and one day after the end of BT use, respectively. These assessments were clinical examinations, interviews, and urine and blood lab tests. All the results of the three assessment stages were recorded. The first set of data was collected prior to the patients’ use of borage tea, and the mean of the second and third data sets reflect post borage tea use. To determine the effect of borage tea use, a paired samples test was used. Also, the mean of each parameter’s results was described as a significant or insignificant difference. Twenty-four hours after patients used borage tea, the volume of their urine, uric acid, potassium (K) and glomerular filtration rate (GFR) increased (P<5%). Their weight and BP decreased (P<5%). On the other hand, such parameters as urine creatine, sodium (Na), potassium (K), and urine acid in blood serum decreased. The results of this study show that the use of borage tea had an effect on patients’ urine and blood chemistry and renal function. Additionally, patients’ weight and blood pressure decreased.

It has been demonstrated that free oxygen radicals have a close interaction with lipid peroxidation, causing a modification of low-density lipoproteins (LDL) and facilitating LDL deposition, with the consequent formation of atherosclerosis plaques. Free radical production is catalyzed and accelerated in the presence of iron. This study was conducted to evaluate the possible association between body iron status and coronary artery disease (CAD), confirmed by coronary angiography, in Tabriz Shahid Madani Heart Center. Two hundred and forty-one patients (182 males and 59 females) ages 40-77 years who referred for coronary angiography were selected and examined. One hundred and sixty-eight of the patients (134 males and 34 females) had coronary atherosclerosis (with CAD), and seventy-three of them (48 males and 25 females) had no coronary atherosclerosis (CAD). Both groups were matched for age and sex. Major risk factors for CAD—including age, sex, serum lipids, obesity, smoking, and blood pressure—were evaluated. Serum ferritin, serum iron, total iron-binding capacity (TIBC), and transferrin saturation (as indices of iron stores/serum iron status) and C-reactive protein (CRP) were measured by standard methods. In males with CAD, the mean of TIBC was significantly lower than that of males without CAD (P<0.05). The means of the other iron indices in males with CAD were higher than those in males without CAD, but the differences were not significant. No significant differences were noticed in iron indices between the two groups of females. A significant positive correlation was observed between age and ferritin in females (r=0.261, P=0.05). An analysis of the total population showed significant positive correlations between serum ferritin and triglycerides (r=0.196, P=0.01), and serum iron and triglycerides (r=0.239, P=0.01). Because the mean of TIBC for male patients with CAD was significantly lower than the mean of ITBC for males without CAD, it was concluded that the iron status of arteries may have a role in atherosclerosis in males patients.

Alteration in polymorphism of tissue collagens has been reported in association with some genetic and metabolic disorders. These alterations can be estimated quantitatively by measuring alpha-chain monomers derived from the polymeric form of collagens following treatment with sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). We studied the rate of placental collagen, total protein, and percentage of collagen chains and also electrophoretical movement of the collagen to find correlations between placental collagens and also to determine the standard rate of placental collagen. To extract collagen type IV, five healthy Iranian placentas at term (38 weeks) were placed under pepsin digestion once. To extract collagen type I+III, five healthy Iranian placentas at term (38 weeks) were placed under pepsin digestion twice. The steps of extraction were controlled by SDS-PAGE. The study showed that there is a high correlation (r=0.993) between the rate of collagen type IV and total protein. Also, there is a correlation (r=0.77) between the rate of collagen type I+III and the weight of the placenta after washing. The rate of α1 (III) collagen chains is about 23% of the total collagen.

An assessment of the growth of Iranian children has shown that a large percentage of Iran’s children are afflicted with growth failure. Community participation is one of the principles emphasized by the World Health Organization as necessary for development of health services. The goal of this study is to evaluate the role of the presented model of mothers’ participation on mothers’ practice concerning the development and nutrition of their children. A community-based field trial was conducted with 74 mothers with children less than three years of age. A model was designed to increase mothers’ participation. On the basis of this model, a group of mothers’ volunteered and were instructed in the subjects of growth monitoring and child nutrition. Then the mothers who received training instructed other beneficiaries on the basis of the model. The plan was evaluated by the CIPP evaluation model. Changes in the mothers’ knowledge and practice scores were assessed by a questionnaire before and after intervention. The mean score of the mothers’ knowledge, before and after intervention, was 23 and 43 respectively, and the mean score of their practice, before and after intervention, was 47.3 and 60.2 respectively. In the two cases, the difference was meaningful at P<0.001. This plan considerably increased the individual and social capabilities sincluding self confidence, of the participants. Different effects of the project—including impact, effectiveness, sustainability and transportability—were assessed through the CIPP evaluation model, and special indices, criteria and standards were determined for each part. The considerable improvement in the knowledge and practice of mothers concerning the growth and nutrition of their children and the considerable increase in individual and social capabilities of the beneficiaries of the plan show the efficacy of this model. In addition, as the design of the present model is based on the cultural and social background of Iran according to its health system, the model can be used in other regions to develop other health services.

With an ever-increasing number of vehicles on the road, it is inevitable that drivers will need to call upon an increasing use of sensory and motor skills in order to negotiate safely through traffic. Vision is one of the major senses in human beings, and it is definitely necessary for safe driving. Approximately 95% of the sensory input to the brain required for driving comes from vision. For this reason, visual standards were set up in different countries in order to evaluate drivers’ vision. The object of this study was the comparison of visual fitness of bus drivers based on the standards of Iran, England, France, and Finland. Interviews with and eye examinations of 312 bus drivers were done. First, 312 drivers in South, East and Beihaghi Terminals in Tehran, Iran, were randomly chosen. The drivers were interviewed in order to completed a questionnaire regarding the drivers’ individual characteristics and occupational information. Then the drivers’ vision was examined by Snellen’s chart and a conversation test. The findings were analyzed by the SPSS software and statistical tests. Mean and standard deviations of the age and job duration of the bus drivers were 42.78 and 18.15 years, respectively. Mean time duration after last eye examination was 23.19 months (about two years), and the most common cause for eye examination was exchange of driving permission. The best visual acuity was 10/10 in 51.28% of the cases, and the best visual field was 180 degrees on the horizontal meridian in 48.71% of the cases. 11.6% of the cases were not qualified based on Iran’s driving standard, 7.7% based on England’s driving standard, 49.7% based on France’s driving standard and 17.1% based on Finland’s driving standard. The mean age of qualified persons was 42.24 years, and the mean age of unqualified persons was 46.88 years. This difference was significant (P=0.009). Drivers over 50 years of age were found to have significantly lower visual acuity compared with the two other groups (20-50 years of age and under 20 years of age) (P<0.001). There was not a significant difference in visual field among the three age groups. Based on these findings, it is necessary to conduct a major scientific study to establish appropriate standards of vision for issuing permission to drive.

Although in vitro fertilization (IVF) has been found to bypass the inhibitory effect of high levels of antisperm antibodies on sperm motility, fertilization rates are reduced in approximately 40% of the attempts. In this study, we investigated the relationship between antisperm antibodies measured by the direct mixed agglutination reaction (MAR) and the fertilization rate in infertile couples undergoing IVF. Semen samples were obtained from men from 80 infertile couples undergoing IVF at the Esfahan Fertility and Infertility Center. After IVF, 52 couples had a high fertilization rate (65%) and 28 couples had a low fertilization rate (35%). The percentage of IgA and IgG antisperm antibodies were detected by a direct MAR test of the semen samples. A statistical anylysis was conducted using the T, X2 test and Pearson’s correlation coefficient. There was a statistically significant difference between the mean of the percentage of antisperm antibodies in high and low fertilization rate groups (P<0.001). Statistically significant inverse relationships were observed between IgA and IgG antisperm antibodies levels and fertilization rates. The results of this study clearly show that high levels of antisperm antibodies decrease the fertilization rate. Therefore, it can be suggested that couples with high levels of antisperm antibodies should become candidate for intracytoplasmic sperm injection.

About half of all brain tumors are primary, and the remainder are metastatic. Tumors of the nervous system have unique characteristics that set them apart from neoplastic processes elsewhere in the body. The World Health Organization (WHO) has classified central nervous system (CNS) tumors as grades I to IV in increasing order of malignancy. The goal of this study was to follow the sex, age, and anatomic site distribution of primary brain tumors and the frequency of various pathologic types and WHO grades of these neoplasms. In this five-year interval study, 400 patients with primary brain tumors who were admitted to Alzahra Hospital in Esfahan were studied. There were no significant differences in the frequency of primary brain tumors between males and females. Most patients were over 35 years old, and most of the lesions were located in the hemispheres. Meningioma was the most frequent type of tumor, and most of the cases matched grade I of the WHO grading system for CNS tumors. In contrast to the obtained results, other studies in this field show that the preponderance of primary brain tumors occur in males, and most of the studies mention gliomas as the most frequent type of primary CNS tumors.

Women suffer more often from depression than men. Social research suggests that high androgen levels cause aggressive behavior in men and women, and consequently cause depression. The purpose of this study was to determine serum levels of androgens, especially testosterone, in patients with depression. In this case-controlled study, we measured serum testosterone and dehydroepiandrosterone sulfate levels in 30 women with depression and 30 control subjects of the same age, weight, body mass index (BMI) and menstruation cycle. Total testosterone and free testosterone levels were significantly higher in patients with depression (202.3 ng/dl and 0.4 ng/dl respectively) than in the control group (140.3 ng/dl and 0.1 ng/dl respectively). There was no significant difference in dehydroepiandrosterone sulfate levels. This study may indicate a role of androgen, especially testosterone in the pathogenesis of depression.

Patients with beta-thalessemia major present with severe anemia and need continous transfusion therapy. An important complication of beta-thalessemia major is iron deposition in cardiac tissue, resulting in fibrosis and dysfunction. Cardiac involvement is the major cause of death in beta-thalessemia major. The purpose of this study was to assess cardiac disease patients with beta-thalessemia major. A cross-sectional study was done on 100 patients affected by beta-thalessemia major who referred to Shahid Madani Hospital in Khorram Abad in 2003. Factors studied included age, sex, serum ferretin, patient's age at the time of the initial blood transfusion, patient's age at the time of Desferal (deferoxamine mesylate) use, blood group, and hemoglobin level. All patients were examined and had echocardiographies performed by a cardiologist. Data was collected by questionnaire, and an analysis was made using the SPSS program. 33% of the patients had cardiac disease. Six patients had restrictive type systolic dysfunction of the left ventrical and diastolic left ventricular dysfunction with 50-55% ejection fraction. Two patients had four-chamber enlargement and high output cardiomyopathy failure with 45-55% ejection fraction. Two patients had severe pulmonary hypertension, aortic and tricuspid valve insuficiency, right and left ventricular dysfunction, pericardial effusion with 45-55% ejection fraction. The remaining patients had left ventricular enlargement alone or with right ventricular enlaregement with 60% ejection fraction. 54.5% of the cardiac patients were male and 45.5% were female. In 23% of the patients, serum ferretin was 1501-2000 nanograms per ml. Most of the patients were 11-20 years old, and the age of initial blood transfusion in 20% of the patients was 1-2 years of age. The age at the time of Desferaluse in 25% of the patients was after five years of age. Most of the patients had type O blood. Two patients died from heart failure. Based on the X2 test, there was a postive correlation between age, age of Desferal use, and serum ferretin with cardiac disease (P<0.05). However, there was no correlation between age and blood group with cardiac disease. It is suggested that patients with beta-thalessemia major have blood transfusions and use Deseral regularly. Also, it is necessary to periodically evaluate the heart function of these patients.

Disseminated bacilli calmette-Guerin (BCG) infection after inoculation with live vaccine is considered to result from impaired immunity of the child. However, half of the cases are regarded as idiopathic because no well-defined immunodeficiency condition can account for the infection. Case report: An 8-month-old male infant was admitted with an ulcer on his left arm at the site of a BCG inoculation received five mounths previously. He also had a fever, productive cough and respiratory distress for two weeks prior to admission and the patient received a broad–spectrum antibiotic without any response. A clinical examination revealed a 3×3 cm mass in the upper, left quadrant of the patient’s chest. A chest X-ray showed widespread reticulation and corrosion on the seventh rib. The patient died from cardiopulmonary arrest 12 days post admission. In the antopsy of the patient, samples taken from several organs of he body showed a collection of acid–fast bacilli and a spread of tuberculoid infection (BCGosis). Although the BCG vaccine has been in use since 1921 and its protective effect for disseminated, meningial and pulmonary tuberculosis is clear, controversy continues around its use. The most serious complication of BCG vaccine is a disseminated BCG infection that may lead to death.