مجله دانشکده پزشکی دانشگاه علوم پزشکی تهران
سال هفتاد و هفتم شماره 12 (پیاپی 228، اسفند 1398)

Nitric oxide (NO) produced by endothelial NO synthase (eNOS) mediates a large range of processes, and abnormality in the production of NO has been implicated in diabetic complications including diabetic nephropathy (DN). G894T polymorphism in the eNOS gene has been shown to decreased activity the NO levels of plasma. The association between eNOS Glu298Asp gene polymorphism and DN risk is still controversial. The present study investigated the effect of eNOS gene G894T polymorphism on susceptibility to type 2 diabetes (T2D) and DN and measures of kidney function in a population with and without diabetes.

This case-control study was carried out at the diabetes specialist clinic of Golestan Hospital of Ahvaz Jundishapur University of Medical Sciences, Iran, from September 2016 to December 2017. The study comprised 132 patients with T2D (with and without nephropathy). They were compared to 66 normal subjects. The subjects were genotyped for the eNOS G894T polymorphism by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Blood glucose, HbA1c, BUN, creatinine and urinary albumin were evaluated by a biochemistry analyzer.

Higher prevalence of the mutant T allele and homozygous TT genotypes and biochemical parameters) like FBS, TG, and BUN) were seen in T2D patients compared to healthy subjects. For T2DM, the odds ratios (ORs) for the TT genotype and the T allele carrier were 3.1 (P=0.0001) and 2.6 (P=0.0001), respectively. In contrast to the significant association between the eNOS G894T polymorphism and T2D, we could not find a significant correlation to the DN. For DN, the ORs for the TT genotype and the T allele carrier were 1.1 (P=0.76) and 0.8 (P=0.6). For decreased epidermal growth factor receptor (EGFR) below 60 ml/min/ 1.73 m2 in diabetic patients, the OR for TT was 0.8 (P=0.7).

Our results confirm that the risk of T allele and TT genotype of the eNOS G894T polymorphism were significantly associated with T2D, The TT genotype of this polymorphism also conferred the risk of developing T2D, but they were not correlated with DN and decreased eGFR.

The H9N2 subtype of the influenza virus, which is endemic in many regions of Iran, is considered as a candidate for future pandemics. In the present study, excretion time of the Iranian endemic influenza virus (H9N2 subtype) from the feces and pharyngeal secretions of laying chicken breeds was evaluated.

This experimental study conducted at the Diagnostic Laboratory Sciences and Technology Research Center of Shiraz University of Medical Sciences, and the Department of Clinical Science in School of Veterinary Medicine of Shahid Bahonar University of Kerman, from June 2017 to September 2017. At first, the influenza virus A/Chicken/Iran/SH-110/99 (H9N2) was cultured in the allantoic fluid of the embryonated egg and the EID50 for virus was determined by Reed and Muench method. Afterward, the Hy-Line chicks were inoculated intranasally with 106 EID50/ml of influenza virus (H9N2 subtype) and samples were collected from the oropharynx and feces of the birds on days 2, 5, 10 and 17 after inoculation. The presence of the virus in the samples of challenged birds was assessed using the real-time polymerase chain reaction (PCR) method.

The influenza virus was shed from the oro-pharyngeal secretion and feces of the birds 2 days post-infection, and continued until days 10 and 17, respectively. In comparison to the oro-pharynx, the virus was recovered in the feces for a longer time. The influenza virus was detected in 100% and 57.1% of oro-pharyngeal and feces samples of the infected birds on day 2, 85.7% and 100% on day 5, 28.6% and 71.4% on day 10, and 0% and 28.6% on day 17 post-inoculation, respectively. The maximum risk of infected chicken for humans is seen from 2 to 5 days post-infection.

Detection of virus in the samples of birds that challenged with the H9N2 influenza virus showed that the virus could shed from the feces to the surrounding environment longer than the pharyngeal secretions and could be hazardous to humans in contact.

Potency evaluation of rabies vaccine is a cheap, fast, high precision and consistent with ethical values is critical, so researchers have modified a variety of methods such as: National Institute of Health (NIH) method, Single Radial Immunodiffusion (SRID) and so on. The purpose of the present study was to replace an in vitro method consistent with medical ethics criteria instead of an in vivo method. By recognizing that the potency of the rabies vaccine depends on the amount of glycoprotein antigen content and the monoclonal antibody detect the correct folding of antigen of the rabies virus, then the glycoprotein content could be represent of vaccine potency.

In this study, we designed an immune-capture enzyme-linked immunosorbent assay (ELISA) with three antibodies (capture, primary and secondary) to determine the existent amount of viral glycoprotein in different rabies vaccines, and compared the results at the same time with measuring potency of those vaccines using the NIH method. This applied study was conducted from September 2016 to September 2018 at the Research Laboratory of the World Health Organization Collaborating Center for reference and research on rabies at the Pasteur Institute of Iran in Tehran.

The slope of the standard line was calculated to R2=0.98 (P=0.0013). In the humans’ vaccines, the mean lied between 5.554-7.336 (SD=0.0463-0.1039) and the coefficient of variation was 0.778-2.436 (SD=0.0041-0.2724), at the same time in the animals’ vaccines the mean were 2.293-5.993 (SD=0.0041-0.2724) and the coefficient of variation was calculated 0.182-4.546. For animal vaccines the Pearson correlation coefficient is 0.99 and for the human vaccines this coefficient was 0.95. Also, the concordance correlation coefficient for animal vaccines was 0.98 and for human vaccines is 0.95, indicating a moderate to high concordance in both animals and humans vaccines.

The designed Immuno-capture ELISA kit had a proper acceptance criterion, intermediate precision, good linearity and robustness for measuring the glycoprotein level of the vaccine, which was directly related to the vaccine potency.

The rate of recurrence and mortality in high-risk prostate cancer remains high. On the other hand, the use of chemotherapy in metastatic prostate cancer has improved overall survival of patients. The aim of this study was to evaluate the effect of neoadjuvant chemotherapy alone on increasing survival of patients with high risk localized prostate cancer

This is a systematic review study. Databases including Scopus, Medline, PubMed, Google Scholar, Cochrane, Embase were searched. The terms used include prostate cancer, adenocarcinoma, neoadjuvant, chemotherapy, chemotherapy alone, systemic therapy. Of the various types of articles, only oiginal research studies that specifically focused on neoadjuvant chemotherapy (not chemotherapy with target therapy, immunotherapy, or hormone therapy) were identified. Inclusion criteria included study type (original research studies) and sample type (high-risk localized prostate cancer patients) and outcome type (patient survival).

A total of 17 original research studies were identified. All of these studies were phase one or phase two. Docetaxel was the most commonly used chemotherapy drug. Also, the most common regimen used was the use of docetaxel alone. The rate of decrease in prostate-specific antigen (PSA) (>50%) after neoadjuvant chemotherapy was reported in 24 to 58% of patients. PSA declines of less than 50% after neoadjuvant chemotherapy occurred in 40 to 100% of patients. No studies reported a complete pathologic response following neoadjuvant chemotherapy. However, the relative pathologic response and reduced tumor volume were seen in the majority of patients. All of these studies showed that neoadjuvant chemotherapy alone, in high-risk prostate cancer patients, was almost well tolerated and that the complications were mostly mild (grade 1 and 2). Grade 3 and 4 complications were negligible. A 2-year recurrence-free survival of up to 68.5% and a 5-year recurrence-free survival of up to 49% were reported. The overall 5-year survival also ranged from 35 to 48%.

The use of neoadjuvant chemotherapy alone has not clearly increased the survival of patients with high-risk localized prostate cancer, and there is controversy in studies.

Arterial pressure is one of the most important physiological variables and often needs to be monitored repeatedly or continuously in perioperative period. Arterial pressure monitoring is one of the standard monitoring in operating room. During general anesthesia, blood pressure can be measured by using a noninvasive arterial pressure method or continuous invasive arterial pressure by an invasive arterial line. Comparison of invasive measurements in the patient’s candidate to esophagectomy has not been assessed. The aim of this study was to compare invasive and noninvasive blood pressure in these patients.

In a prospective, cross-sectional, observational study, 42 hemodynamically stable patients candidate for esophagectomy under general anesthesia in supine position were evaluated at Urmia Imam Khomeini Hospital operating room from June 2017 to April 2018. The patients had American Society of Anesthesiologists (ASA) physical status II or III and the patients who had complete heart block and marked arterial blood pressure differences greater than 10  mmHg in the two arms were excluded. After induction of anesthesia and patients monitoring, the radial artery was cannulated for invasive blood pressure monitoring and noninvasive blood pressure was measured via the arm cuff on the other hand at the four-time intervals: after radial artery cannulation (T1), during release of esophagus (T2), during anastomosis (T3) and at the end of operation (T4).

The mean difference between indirect and direct systolic blood pressure was 0.85±2.93, -8.42±2.9, 6.50±3.60 and 2.67±2.6 mmHg and for diastolic blood pressure was 3.53±2.67, 4.57±2.22, 2.10±2.58 and 1.03±1.53 mmHg respectively, at the T1 to T4. At the all-time intervals, there were no statistically differences between systolic and diastolic blood pressure measurement regarding invasive and noninvasive blood pressure (P=0.77)

Noninvasive arterial blood pressure showed acceptable agreement with invasive measurements for systolic, diastolic and mean pressure. According to fhe finding of this study, there were no statistical differences between systolic and diastolic blood pressure measurement regarding invasive and noninvasive blood pressure and these two methods can be used in selected patients.

Amphotericin B is one of the most useful therapeutic modalities for the treatment of patients with invasive fungal infections, in spite of serious side effects, namely kidney injury, electrolyte imbalances, and infusion-related reactions. The goal of this study was to assess the different aspects of premedication practice and the incidence and types of infusion-related reactions in patients receiving amphotericin B.

This observational study was performed on 70 hospitalized patients who received amphotericin B in different departments of two university hospitals, affiliated to Isfahan University of Medical Sciences, Isfahan, Iran, from January 2017 to February 2018. Information on physicians’ performance regarding premedication administration for amphotericin B, including the types and doses of medications administered prior to amphotericin B infusion, as well as patients’ clinical data including infusion-related side effects were collected and then analyzed in comparison with the standard practice guidelines.

The study population consisted of 70 patients with the mean age of 51.6±18.3 years, who received amphotericin B for 8.2±3.5 days. From 70 evaluated patients, 21 patients (30%) had encountered the infusion-related reactions, including chills, fever, urticaria, headache, and hypotension. These side effects were evident in 19 patients (27%) who received no premedication and 2 patients (3%) who received only one drug as premedication, before amphotericin B administration. Twenty patients (28%) experienced chills, fever and headache, while 7 patients (10%) had nausea and vomiting during amphotericin B infusion. Hydrocortisone 50-200 mg, was the most prescribed agent for premedication (in 67% of patients), while chlorpheniramine 10 mg (in 50% of patients) and promethazine 10 mg (in 35% of patients) were the second and third prescribed ones, respectively.

In this study, the patients who received no or only one drug as premedication experienced infusion-related side effects. This emphasizes the necessity for standard premedication practices to prevent this type of adverse reactions. Considering the higher price of liposomal form of Amphotericin-B, if prescribed correctly, even the conventional form would be an effective and tolerable treatment for invasive fungal infections.

Changing the mental structure of students and identifying creativity inhibitors are essential for academic survival and the pursuit of innovation. This study aimed to identify the inhibitory cognitive factors in medical students.

This study was a directional qualitative content analysis that conducted based on scientific literature review and opinions of experts in a semiformal expert panel by using semi-structured interviews ranging from 20 to 70 minutes from February 2015 to October 2016. Seventeen talented students were interviewed and conversations were recorded with a digital voice recorder at the Exceptional Talent Development Center (ETDC). The extraction and content analysis was continuously done by listening and writing through several times. The students were in various medical disciplines, and most of them were first rank students in scientific performance and they were collaborating with ETDC.

The inhibition variables of creativity were classified in the four main subcategories according to the semantic relationship and after compression, these classes of inhibitory factors included: teacher-related inhibitors, teaching and assessment methods related inhibitors, student barriers and inhibitors of the university's educational system. Finally, 10 codes were extracted from the 4th categories, which were mentioned as inhibitory variables of creativity. The teachers' lack of enthusiasm with the new ideas, the lack of creativity in the academic context and the lack of motivation among the students were the main inhibitors of creativity that were extracted from interviewing with talented students.

In this study, the most important cognitional inhibitory factors in creativity promotion were the inhibitors related to the teacher’s character and his attitude to creativity, methods of teaching and the university environment. Planning for the removal of these barriers in medical students recommended.

It is difficult to treat infections caused by Acinetobacter baumannii due to multiple drug resistance. The aim of this study was to determine the efficacy of combination therapy with two broad-spectrum antibiotics colistin and rifampin on clinical and para clinical indexes of the patients with ventilator-dependent pneumonia due to imipenem-resistant to A. baumannii in intensive care units of a tertiary hospital.

In a descriptive cross-sectional study, fifty patients admitted to the intensive care units in Vali-Asr Hospital, Arak, Iran, from October 2014 to May 2015, with established ventilator-associated pneumonia were subjected to this study and were treated with standard dosage of colistin and rifampin daily. Once the minimum inhibitory concentration (MIC) of the A. baumannii isolates were susceptible to colistin (MIC˂2 µg/ml) and rifampin (MIC˂2 µg/ml) they were treated with three million international units of colistin in 100 ml of normal saline three times a day and 600 mg of rifampin daily. Side effects of combination therapy and variables of patients like fever, blood pressure, white blood cell count, differential count and, mortality were documented and statistically analyzed.

31(62%) patients were improved after combined treatment with colistin and rifampin, 4(8%) patients were died due to bloodstream infection with A. baumannii and 15(30%) passed away in effect of other reasons. The mean of BUN (P=0.07) and creatinine significantly increased (P=0.02). Clinical variables such as fever, white blood cell count, white blood cell percentage and red blood cell sedimentation rate significantly decreased (P≤0.05).

Colistin and rifampicin appear to be an effective and safe combination therapy for treatment of ventilator-dependent pneumonia due to imipenem-resistant to A. baumannii

Today, overweight and obesity are major health concerns in developed and developing countries. Meanwhile, the issue is particularly important in children due to its consequences in adulthood. This study aimed to investigate the frequency of overweight and obesity in preschool children in Kerman, Iran.

This cross-sectional survey was conducted from December to March of 2016 among 731 preschool children (5 to 6 years old) who were selected using convenience sampling. The nutritional status of children was assessed according to the World Health Organization (WHO) expert committee guideline and based on body mass index (BMI) curves for age for boys and girls. Data were analyzed by SPSS software, version 21 (SPSS Inc., Chicago, IL, USA). Chi-square test was used for data analysis, and the significance level was considered less than 0.05.

In this study, 376 boys (51.5%) and 355 girls (48.5%) were investigated. The mean and standard deviation of the age of the participants was 68.7±4.2 months, 53% of these children were first children of the family and 30% of them were only children. The prevalence of overweight and obesity was 9.2% and 8.1% respectively. There was no significant relationship between overweight and obesity with gender, number of siblings and parents' education. There was a borderline difference in birth order (P=0.05) and the frequency of overweight and obesity in the firstborn children was more than other birth orders.

The prevalence of overweight and obesity was high in preschool children. Since these risk factors in children are predictors of chronic diseases during adulthood, we need to design and implement interventions to decrease the prevalence of overweight and obesity in children.

One of the most significant factors in the success of dental implant procedures, can be mentioned by the quality and quantity of jaw bone. The occurrence of some problems such as trauma, infection, pathological lesions and the long-term absence of teeth in patients, it causes irregularities in the jaw bone and can get bone resorption. Sever defects after trauma or tumor resection needs bone reconstruction. Sticky bone is a new biological agent that provides stabilization of bone graft in the defect, and therefore, ameliorates tissue repairing and decreases bone loss during healing period. In this study, the evaluation of sticky bone performance to reconstruction of defects in two patients jaw's bone was considered.

Two patients (1 male, 1 female) with an average age of 50 years underwent surgery, due to the history of tooth extraction. They had resorption of jaw bone for implant surgery. The teeth were 11 and 37. This study was performed in Al-Mortaza's Clinic, Qom province, Iran, from May 2016 to January 2017. 10 ml of blood were taken individually and centrifuged at 1300 revolutions per minute (rpm) for 8 minutes to separate the platelet-rich fibrin. Then, platelet-rich fibrin was combined with allogeneic bone to form sticky bone. Sticky bone prepared during implant surgery, with implant inside the patient's jaw bone was used.

The use of sticky bone to stimulate and induce bone resorption in toothless area was associated with increased implant's success. Sticky bone due to multiple growth factors, such as TGF-β1 and VEGF, usability is an appropriate and efficiency method for stimulation of bone resorption.