نشریه پژوهش در پزشکی
سال سی و دوم شماره 2 (پیاپی 126، تابستان 1387)

Gelatinase B or collagenase type IV is a 92 kDa protein. In case of over-expression of the gene, because of its collagenase activity, it can be involved in metastasis activity of few cancers e.g. bladder, colorectal and gastric carcinoma. Single nucleotide substitution base polymorphism of C to T at -1562 of promoter region can increase gene expression by decreasing transcription inhibitor proteins binding at T alleles. The aim of this case-control study is to investigate the role of this polymorphism in development and invasion of breast cancer in Isfahan women population.

At this study 90 breast cancer patients with metastasis and 100 healthy controls were analyzed using polymerase chain reaction-restriction fragment length polymorphism assay (PCR-RFLP). The mean of follow up period was 2 years. Patients were checked every 3-5 months

Data analysis showed a close association between the presence of T allele and invasion of breast cancer (OR = 5.85, 95% CI: 2.64-12.93, P < 0.0001).

According to our findings, the major role of this polymorphism is in cancer cell metastasis and invasion of these cells to adjacent tissues.

Recent studies suggest that normobaric hyperoxia (HO) results in ischemic tolerance to reduce ischemia brain injury. In this research, attempts were made to assess threshold of ischemic tolerance induced by normobaric hyperoxia in rat stroke model.

Rats were divided into two groups and each group into four experimental groups, each containing 21 animals. The first four groups were exposed to 95% inspired Ho for 4h, 8h, 16h, and 24 hr. The second four groups acted as controls, and were exposed to 21% oxygen in the same chamber (room air, RA) continuously for 4h, 8h, 16h, and 24h. All animals were subjected to 60min right middle cerebral arterial occlusion (MCAO) 24h after pretreatment. After 24h reperfusion, each main group was subdivided to three subgroups (n=7) for assessment of neurologic deficit score (NDS), infarct volume, Evans blue (EB) extravasations, and brain water contents.

Preconditioning with 16HO and 24HO decreased NDS and infarct volume significantly. Ischemic tolerance induced by 24 HO decreased EB extravasations significantly. Preconditioning with 4HO, 8HO, 16HO and 24 HO could not decrease brain water content significantly.

Although further studies are necessary to clarify the mechanisms of ischemic tolerance, the lowest Ho duration for ischemic tolerance induction is 16h, but appropriate Ho duration for ischemic tolerance induction is 24 HO.

Obesity is one of the known risk factors of diabetes. Nowadays in parallel with industrialization of societies, changes in lifestyle and diet habits and also decreased physical activity, the prevalence of obesity is increasing. The objective of this study is to evaluate the effect of change in body weight on blood glucose disorders rate after 3 years of Tehran lipid and glucose study.

Demographic indices and fasting blood glucose levels and 2 hours after ingestion of 75 g of oral glucose in 3957 individuals over 20 years of age participating in Tehran lipid and glucose study were registered at first step (1378-79) and then 3 years later (1381-82). According to body mass index, changes in body weight, and also 5 percentile changes in waist circumference and 5 percentile changes in waist to hip circumference ratio from first to second step, individuals were divided into different groups and after modification for age, sex and family history of diabetes, the relative risks of blood glucose disorders in relation to their changes were measured.

After 3 years of follow up 148 (3.7%) individuals affected by diabetes, majority of them were changed from pre-diabetes to diabetes. In individuals with normal blood glucose levels, after modification for age, sex, family history of diabetes and base body mass index, the relative risk of pre-diabetes and diabetes in the 4-10% increased weight group in relation to the steady weight group was 1.2 (95% CI: 1.1-1.53), in >10% increased weight group was 1.3 (95% CI: 1.04-1.86), and in > 4% decreased weight group was 0.4 (95% CI: 0.27-0.65). Increasing relative risk with regarding to base body mass index in pre-diabetics was only seen in obese individuals (2.7, 95% CI: 1.49-4.78). The effect of waist circumference and waist to hip circumference ratio changes on relative risk of diabetes incidence was not significant in any group.

The body mass index and weight increase are independent risk factors for blood glucose disorders incidence.

The objective of this study was the evaluation of genovarum adjustment and the effect of distal part of osteotomy displacement and comparing it with other methods and determination of its complications.

A total of 25 knees from 22 patients in 1381-1383 in Baghiatallah Hospital were undergone proximal tibia osteotomy by lateral closing wedge (Coventry) method with rigid fixation by T-plate and rapid range of motion (ROM). In all patients the distal of osteotomy part was displaced about 1 cm to proximal and was fixed rigidly with a T-plate. ROM and 50% weight bearing with 2 crutches were begun at second day after surgery. After 6 weeks both crutches were put away. Patients were visited again at the end of weeks 4, 6, 8, and 16 and tibio-femoral angle and ROM were measured and registered. Every probable complication and ::union:: at any time and patient’s satisfaction and the time of getting back to work were registered at the fourth month.

The mean of genovarum was 12 degrees varus before surgery which was adjusted to 6.1 degrees valgus after surgery. The majority of patients were able to walk without crutches at the end of the second month. There was ::union:: in all patients at the end of the third month. At the end of the fourth month all patients got back to previous activities. There was pain in only one patient (2 knees), but it was milder than before and the patient was satisfied.

It seems this kind of operation is more advantages than other methods especially non-rigid fixation and casting in patients older than 40 with osteoarthritis and no tolerance to being immobilized in cast and also with high complication risks such as vascular thrombosis.

Drug abusers are persistently trying to use masking techniques for hiding their addiction. Detection of false negative results of urine morphine test which caused by adulterants is the main goal of this study.

Screening test for detecting urine morphine was done by two kinds of Immuno-chromatography rapid tests and the positive results confirmation done by TLC. Sodium chloride, vinegar, lemon juice, nitrite, hydrogen peroxide, and bleach, with effects on pH and gravity were checked as common adulterants in urine morphine check.

This data showed that, double test performance without any increase in threshold amount of morphine (300ng/ml), have 100% sensitivity for preventing false negative results due to adulterants interference.

Urine morphine test in double format, with and without increasing threshold amount of morphine, can reveal adulterants interference and prevent false negative reporting.

Sulfur mustard, Bis [2-chlorethyl] sulfide (HD), is one of the first chemical warfare agents to be used on a large scale. Anti inflammatory treatments might have the potential to prevent some aspects of the primary development of HD-induced lesions. The aim of the present study was to evaluate treatment effects of topically applied betamethasone (B) and diclofenac-Na (D) on the conjunctival epithelial lesions following HD exposure.

A total of 36 rabbits were used. Animals were randomly divided to three control groups: (1) normal (2) solution (3) HD and three experimental groups: (4) betamethasone (5) diclofenac-Na and (6) betamethasone-diclofenac-Na (BD). In each group six animals were examined. Right eye of all animals was selected for experiment. In the experimental groups betamethasone and diclofenac-Na were applied after using HD solution. Application of drugs was performed 3 times a day for 2 weeks. Slit-lamp examinations were performed before exposure and subsequently at days 1, 2, 5, 7, and 14 by professional ophthalmologists. Animals were sacrificed after two weeks with chloroform. The eyes were enucleated. Specimens of palpebra were obtained for histological examination.

There was not any significant difference between normal and solution groups. HD caused a significant decrease in goblet cells and cell infiltration in conjunctiva, injection and chemosis. All experimental groups were better than the HD group. Betamethasone in combination with diclofenac-Na was more effective than betamethasone and diclofenac-Na alone in decreasing eye injuries.

Combination of betamethasone and diclofenac-Na are potential candidates for the treatment of ocular lesions following HD exposure.

It is well known that shift work produces fatigue. This effect is enhanced in seniors and could be potentiated by physical and psychosocial job demands. The aim of this study was to investigate the combined effects of work-related risk factors, age and shift work on fatigue.

The field study was performed based on a questionnaire about sleep characteristics, environmental work-place exposure and fatigue level. Objective noise exposure was also measured. The samples were composed of 201 shift workers of a chemical industry in France. They were divided into two age groups (<40 and >40 years).

No significant effect of temperature, vibration, chemical agents, ergonomics and psychosocial factors was found on fatigue. However, noise exposure resulted in an increase in subjective fatigue (P<0.0001). Older shift workers reported more fatigue than the younger ones (P<0.01). Concerning sleep characteristics, sleep duration progressively decreased from evening to morning shifts, night shift being intermediate (P<0.01). Older shift workers reported more sleep fragmentation (P<0.01), longer sleep duration in the morning shifts (P<0.05) and lesser in the night shifts (P<0.001). Combined effects of noise exposure and age were observed on sleep quality of night workers (P<0.01).

Older workers are less able to adjust to night work especially if they work in the noisy environments.

Labor and birth are two important aspects of human life. At the same time, labor pain is a serious concern for every pregnant woman. Massage as a non pharmacological techniques is a way to overcome this difficulty. Research findings demonstrate that massage has especially positive effects in reducing not only pain, but also stress. Our study has been conducted to determine the effects of massage on intensity of pain during the first stage of labor in primiparous women who have attended Isfahan Shahid Beheshti hospital in 2005.

In this randomize clinical trial, a total of 75 primiparous women in 38-42 week of low risk pregnancy were randomly divided in 3 groups. First group received 20 minutes of back effleurage massage at the periods of 4-5 cm, 6-7 cm, 8-10 cm, cervical dilation. An emotional support was offered for second group in the same duration of time and the same cervical dilation. Third group just received routine care during labor. In all groups, pregnant women were asked to evaluate their severity of pain before and after intervention. Data being obtained through the visual analogue scale, check list and inspection form.

Study result demonstrated that intensity of pain was significantly lower in massage group (p< 0.001). Intensity of pain in supported group was consistent during 4-5 cm dilatation period and 8-10 cm but during 6-7 cm period there was an increase in severity of pain. In routine care group severity of pain increased in every stage.

Receiving back massage is more effective than supporting and routine care for relieving labor pain.

One of the most important problems for street children is the health issue. Many of these children are suffering from malnutrition, anemia, and respiratory, gastrointestinal and dermatologic disorders and also acquired infections such as hepatitis, AIDS, and tuberculosis. According to the emphasis for performing vaccination of high risk children, recognition of these groups has especial importance.

In this descriptive study 203 street children were gathered from different places of Tehran and settled at a welfare center. These children were clinically examined by a pediatrician and requested to answer a questionnaire. Blood samples (3CC) were obtained from each of them in order to determine the existence of Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) infections by ELISA method.

Among 203 street children studied in this research, 196 were boys and 7 were girls. Six cases (3%) were HBsAg positive, 54 cases were HBsAb positive (26.6%) and 16 cases were HBcAb positive (8%). Seven cases (3.5%) were HCVAb positive. All of the positive cases were boys.

According to these positive results for hepatitis B and C, additional laboratory examination for screening of acquired infectious disease such as Hepatitis seems to be necessary.

Cystinosis is an inherited metabolic disease in which transfer of cystine out of lysosome is impaired. This phenomenon leads to accumulation of cystine in different organs and causes organ dysfunction. Growth retardation is seen in these patients and later they go on to develop renal failure needing dialysis or renal transplantation. The aim of this study was to evaluate the outcome and complications of renal transplantation in patients with cystinosis.

In this case series study in years 1996-2006 all patients with renal failure due to cystinosis who received renal transplantation, were followed for 43± 1/1 months. Before operation, all patients were examined to determine if they are appropriate candidate for renal transplantation and after operation DPTA scan was performed to evaluate graft function and in later follow up necessary lab tests were done. All patients received triple immunosuppressive therapy including cyclosporine, prednisolone and Mycophenolate Mofetil. In the presence of rejection symptoms such as fever and a rise in creatinine, graft rejection was confirmed by DPTA scan and sonography of transplanted kidney.

Patient survival was 100% and 4 years graft survival was 86.7%. Mean creatinine level before operation was 5.44 ± 2.58 and post operation was 0.86 ± 1.03 and at the last follow-up was 1.51 ± 1.45 mg/dl, mean GFR at the last follow-up was 54.1 ± 31.2 ml/min/1.73m2. Six (40%) patients were on dialysis before operation, 5 (33%) had acute rejection and 5 (33%) suffered from UTI after the operation. Growth retardation was seen in all of patients. Thirteen patients (86%) were affected by CMV infection and 6 (40%) by CMV disease that were treated successfully by Ganciclovir for 2 weeks. One patient was affected by vessel thrombosis in post operation period and one patient had graft loss due to kink of vessel after operation.

Renal transplantation in patients with cystinosis has favorable outcome. It is the treatment of choice for patients with cystinosis and End Stage Renal Failure (ESRF).

Numerous studies show that working outside home is the key barrier to breastfeeding. The objective of this study was comparing the pattern of breastfeeding in infants whose mothers were employed in public sectors with unemployed mothers.

In this study 630 mothers (254 employed), attending health care centers in northern and western Tehran with 6-30 months infants with the birth weight of at least 2000 g, were interviewed. The results were analyzed by SPSS software.

After logistic regression it was revealed that parental education, infant's sex or birth order had no significant effect on rate or duration of breast-feeding. There were no significant differences in the rate of breastfeeding between the two groups at 0 and 2 months, but there were significant differences after returning to work (at 4, 6 8, 10 and 12 months). Our results showed that the rate and duration of breast feeding were significantly lower in employed mothers at all infant ages, after 4 months. Figures for breastfeeding at 4, 6, 8, 10, and 12 months in the two groups of employed and unemployed mothers were as follows: 69.7% versus 76.9%, 61.4% versus 73.7%, 57.9% versus 69.9%, 54.7% versus 67.7%,and 52.6% versus 67%, and p-values = 0.044, 0.001, 0.002, 0.001, and 0.0001, respectively.

After returning to work the rate and duration of breastfeeding in employed mother are significantly lower than housewives.

irritable bowel syndrome (IBS) is a common functional bowel disorder characterized by abdominal pain and change in bowel movement. On the other hand, preterm labor (PL) is currently one of the most important problems in maternal-child health. The major causes of IBS are yet to be recognized, however some shared factors with PL have been proposed. It is probable that IBS patients are susceptible to have preterm labor. The goal of this study is the evaluation of IBS frequency in preterm labor.

In a case-control study, 150 patients with PL (case group) were compared with 150 people with term labor (control group) for the presence of IBS. The Rome II criteria were employed to diagnose IBS. The subgroups of the diarrhea-predominant and the constipation-predominant of IBS were determined as well.

A total of 36 IBS patients were diagnosed in which 21 (14.7%) were in the case group and 14 (9.3%) were in the control group (p=0.155). The diarrhea-predominant type was recognized in 3 patients, all in the case group (p=0.247). The constipation-predominant type was recognized in 11 patients, 9 cases in the case group (p=0.032).

The rate of IBS patients was higher in the case group, however this discrepancy was significant just for the constipation-predominance type.