Iranian Journal of Medical Sciences
Volume:34 Issue: 4, Dec 2009

Currently clomiphene citrate is the first-line treatment to induce ovulation in women with polycystic ovarian syndrome (PCOS). Surgical therapy with laparoscopic ovarian drilling (LOD) may avoid or reduce the need for gonadotropins. To determine the effectiveness and safety of LOD compared with ovulation induction in subfertile women with clomiphene-resistant PCOS. Search Strategy: A systematic search was performed on PubMed (1966 to August 2007), the Ovid database (1966 to August 2007), and EMBASE (1974-2007). The search terms included: infertility, menstrual disorder, hirsutism, PCOS, surgical intervention, electrocautery, electrocoagulation, diathermy, drilling, and laparoscopic ovarian drilling, ovulation, pregnancy rate, post operation adhesions and ovarian blood flow. Selection Criteria: Randomized controlled trials of women with clomiphene-resistant PCOS who were treated with LOD to induce ovulation were included. Data Collection and Analysis: 3141 patients from 35 trials preformed in different geographic settings were included. All trials were assessed for quality criteria. We included those trials which followed hormonal changes, ovulation, and pregnancy rates after LOD. The primary outcomes measured were hormonal changes, ovulation, and pregnancy rates as well as ovarian artery blood flow, and the secondary outcome was rate of pelvic organ adhesion. Main The overall ovulation rate after LOD was 79.2% (74.9%-83.5% 95% CI). Of all women who ovulated only 66.6% (60.8%-72.4% 95% CI) conceived. The mean peri-adnexal adhesion rate was 22.7% (21.4%-24% 95% CI). Compared with medical therapy, LOD has many advantages including: to be done once, no need for intensive monitoring, no chance of multiple pregnancy or ovarian hyperstimulation syndrome. LOD effectively decreases ovarian androgens and improves folliculogenesis and increases chance of ovulation and pregnancy rate. Finally, in vitro fertilisation should be considered as the last resort.

Goiter is thyroid enlargement, which is the most common visible symptom of iodine deficiency. Some studies have shown iodine deficiency in water, soil, and food in many places worldwide.We aimed to determine the prevalence of goiter and the association between urine iodine levels in children with severity and prevalence of goiter in mountainous villages of Kashan city (center of Iran). This descriptive-analytical study was performed on 263 children aged 6-12 years in villages of Kashan. In the present study, goiter and its grading was determined by WHO standard method. The patients’ urine iodine levels were measured by Pino method (ammonium oxidation) and compared with standard scales. Of the children, 39.5% had goiter and the prevalence in girls was higher than boys (45.8% v 33.3%; P<0.03). All the patients with urine iodine level less than 25 µg/grcr (gram creatinine), 87.5% of patients with urine iodine level less than 100 µg/grcr and 24% of patients with urine iodine level more than 100 μg/grcr had goiter. The prevalence of goiter in mountainous places of Kashan is 39.5%. Although the people of these villages used iodized salt for years, these regions remain endemic parts of iodine deficiency. There was a significant association between urine iodine levels and the severity and prevalence of goiter (P< 0.001).

It has been estimated that 67 million people worldwide are affected with a primary glaucoma and that one-third have primary angle closure glaucoma. We aimed to determine the biometric differences between the eyes of patients with acute attack of primary angle closure and their non-involved fellow eyes. Twenty eight patients with acute attack of primary angle closure were recruited in this prospective study. Three weeks after laser iridotomy and resolution of corneal edema, all patients had a complete ocular examination including slit lamp biomicroscopy, pachymetry, keratometry, and ocular biometry. The following A-scan parameters were measured: anterior chamber depth, lens thickness, axial length, lens– axial length factor, relative lens position, and corrected anterior chamber depth. There were 22 (78.5%) women and six (21.5%) men with mean age of 52.82±9.25 years. There were no statistically significant differences in the biometric figures between the affected and fellow eyes [anterior chamber depth (P=0.4), lens thickness (P=0.4), axial length (P=0.7), lens-axial length factor (P=0.6), relative lens position (P=0.7), and corrected anterior chamber depth (P=0.8)]. The mean ± standard deviation of central corneal thickness in the affected and fellow eyes were 560.12±41.93 and 557.727±18.53, respectively (P=0.806). There was no statistically significant difference between the both eyes in the mean keratometric diopters in the affected and in the fellow eyes (45.05±2.02 v 44.91±1.73; P=0.78). The present study did not reveal any statistically significant differences regarding the ocular biometric parameters between the affected and fellow eyes in patients with acute primary angle closure. The biometric parameters were similar between male and female patients as well.

Cell-based treatment approach using differentiated mesenchymal stem cells (MSCs) and mature chondrocytes has been considered as an advanced treatment for cartilage repair. We investigated the differentiated level of these two cell types that is crucial for their repair capacity for cartilage defect at a co-culture micro mass system. Passaged-2 MSCs isolated from the mouse bone marrow and the primary-cultured chondrocytes obtained from rat costal cartilage were mixed at different ratios including 1:1, 1:2, and 2:1, and cultivated in the micro mass culture systems (experimental groups). Both the MSCs and chondrocytes alone in micro mass cultures were considered as the controls. After 21 days, the cultures were sectioned and examined by toluidine blue staining. Furthermore, the cells at different groups were analyzed by semiquantitative reverse transcription-polymerase chain reaction using the specific primers designed to detect the expression of both mouse and rat cartilage-specific genes. According to the toluidine blue staining, metachromatic stain appeared to be more intense at 1:2 ratios than the other groups. Based on semiquantitative analysis, all co-cultures possessed significantly more cartilage-specific gene expression than the controls (P<0.01). While mouse aggrecan and collagen II genes had significantly more expression at 1:2 ratio, rat collagen II gene was expressed in higher rate at co-culture with 2:1 ratio (P<0.01). Co-culture of MSCs with mature chondrocytes seemed to provide an appropriate microenvironment whereby the two cell types exhibit higher differentiated phenotype than when they were cultured alone, and sufficient to be used as the cellular material for repair of cartilage defects.

The common psychiatric disorder of attention deficit hyperactivity disorder (ADHD) and the knowledge of teachers about it are well discussed in literature. While teachers can play an important role for the management of ADHD, it is not clear whether informing of teachers about children with ADHD affects their behavior and attitude toward the children. In the present study, we studied whether the disclosure of children with ADHD is associated with social rejection and negative attitude of their teachers. In addition, we studied the perception of teachers for treatment and its benefits. A total of 558 primary school teachers of students in grade I in Shiraz, south of Iran, participated in this study. They completed the questionnaires after studying one of the randomly selected four vignettes. One of the vignettes with inattentive type and one of the vignettes with hyperactive-impulsive type symptoms were not labeled as ADHD children. The teachers did not show any difference in their attitude on various types of disclosed and undisclosed ADHD vignettes. The four groups of teachers were not different regarding their belief for treatment and its benefits. Parents of the children with ADHD could be assured that informing of teachers about the disorder does not cause the social rejection or negative attitude towards the affected children. Lack of difference among the teacher groups for the necessity of the treatment and its benefits shows that their knowledge about ADHD is not enough. Improving the knowledge of teachers about ADHD is a preceding step for disclosing the children''s disorder.

The effects of electromagnetic field (EMF) on reproductive system have been of critical concern for a long time. It has been shown that the EMF can adversely affect testicular cells and tissue and decrease male fertility. The most important determinants of male fertility are sperm development and motility, which are affected by changes in several factors including lipocalin 2 proteins. In the present study, we investigated the effects of exposure to EMF on testis tissue and expression of lipocalin 2 gene. Male BALB/c mice (8 weeks old) were exposed to 3 mT EMF for 8 weeks, 4 hours/day. Control group (10 mice) did not receive EMF exposure. After the experimental period, the mice were sacrificed, and their testis tissues were examined by using light microscopy after hematoxylin-eosin staining. Additionally, total RNA and proteins were extracted from testis tissue and used to study the lipocalin 2 expression by real time RT-PCR and Western blot analysis. The histological changes observed in the testes of experimental group included increased number of spermatocytes and Leydig cells, and increased thickness of basement membrane compared with the control group. The mRNA and protein studies showed that expression of lipocalin 2 gene was down regulated in testes of the mice exposed to EMF. Our study showed that EMF down regulates the expression of lipocalin 2, a cytoprotective molecule, in testis tissue. This down regulation can be one of the mechanisms that contribute to the decreased fertility observed after exposure to EMF.

Cyclosporine A (CsA) is a nephrotoxic immunosuppressive drug. Antioxidants might attenuate its toxicity. In the present study, the effects of vitamin E and quercetin on the morphology of kidney in CsA-treated rats were investigated. Six groups of rats were used in this gavage feeding study either for 4 or 8 weeks. Groups 1 and 2 received either olive oil or 25% ethanol in olive oil per day. Group 3 received CsA (25 mg/kg/day) in olive oil. All other groups received CsA plus the following: group 4, vitamin E (100 mg/kg/day) in olive oil; group 5, quercetin (15 mg/kg/day) in 25% ethanol in olive oil; and group 6, vitamin E plus quercetin. In the final day of the study, the animals were sacrificed and kidney sections were prepared for morphologic studies using light microscopy. Acute morphologic alterations induced by CsA in the kidney tubules included isometric vacuolization, brush border loss, microcalcification, and presence of inclusion bodies. Smooth muscle degeneration and necrosis were developed in arterioles. Treatment with vitamin E plus quercetin prevented severe, moderate, and mild abnormalities of the tubules. However fibrosis was the only microscopic change of the interstitium that was not present in animals treated with vitamin E plus quercetin after both periods.Some mild morphological changes of the blood vessels such as arteriolar medial smooth muscle degeneration and necrosis, arteriolar myocyte dropout and arteriolar wall hyalinization caused by CsA disappeared with administration of vitamin E, quercetin or vitamin E plus quercetin in both periods. Co-administration of vitamin E plus quercetin with CsA in renal transplant patients may be beneficial in reducing the nephrotoxic effects of CsA.

We had previously identified the genes involved in squamous cell carcinoma of the head and neck using differential display and DNA microarray techniques. We also reported the first analytical study on a novel human gene called LOC92912, which was identified by differential display as a gene up-regulated in such carcinomas. LOC92912, which is a putative member of the E2 ubiquitin conjugating enzyme family, is located on chromosome 15q and encodes a protein of 375 amino acids. In this study, we present the extended analysis of LOC92912 gene in order to uncover the pathway implicated in cancer development or progression. We established a series of RPMI 2650 cell line permanently over-expressing LOC92912 gene, together with their related controls. LOC92912 gene was cloned in pSG5-expressing vector. In vitro translation assay was performed using pSG5-expressing LOC92912. The construct was used for transient and permanent transfection of LOC92912 gene into RPMI 2650 cell line. Cell cycle analysis, clonogenicity, and cell growth assay for cells permanently over-expressing LOC92912 were performed. Focus-like formation studies, also, were investigated on cells permanently over-expressing LOC92912. We found that RPMI 2650 cells permanently over-expressing LOC92912 show an increase in the number of cells accumulated in G0/G1 phase of the cell cycle, a decrease in clonogenicity and cell growth and formation of focus-like structures. Preliminary data also showed changes in cell shape and cell-cell adhesion. Our results demonstrated that LOC92912 induced alterations in the proliferation of cells and might represent a putative novel regulator of cell cycle and some other cellular functions. This novel human gene may also represent a new target for treatment of cancers.

Gentamicin is an important aminoglycoside antibiotic. However its use is limited to serious and life threatening gram negative infections, because of its high nephrotoxicity potential in patients. There are reports that safranal, the active ingredient of saffron with antioxidant properties, exerts protective effect against ischemic injuries occurred by certain nephrotoxins including gentamicin. Therefore, in the present study, we examined the protective effect of safranal against gentamicin-induced nephrotoxicity in rat. After acclimatization, animals were randomly divided to three groups (8 rats /each group). On day one, each animal was placed separately in a metabolic cage for collecting 24-hour urine samples. On day two, after collecting urine samples for measuring glucose and protein, the rats in group 1 received saline 1 ml/kg for 6 days, those in group 2 received gentamicin 80 mg/kg/day for 6 days, and the remaining rats in group 3 received safranal 0.5 ml/kg followed by gentamicin 80 mg/kg/day for 6 days. Injections were intraperitoneally. All the animals were euthanized 24 hours after the last dose. Blood samples were collected by cardiac puncture, and concentration of blood urea, creatinine, and urinary glucose and protein, as the indicators of nephrotoxicity were measured. Our results showed that in group 2, concentration of blood urea nitrogen p<0.01, creatinine p<0.05, urinary glucose p<0.001, and protein p<0.01 were significantly increased compared with the control and safranal-treated groups. There was no significant difference between the control and safranal-treated groups. Safranal exerts protective effects against gentamicin-induced nephrotoxicity in rat.

Histiocytic necrotizing lymphadenitis or Kikuchi''s disease is a rare, benign condition of unknown etiology, which is usually characterized by cervical lymphadenopathy and fever. This disease is rarely associated with systemic lupus erythematosus. Here we describe, for the first time in Iran, a patient who developed systemic lupus erythematosus about 3 years after the initial diagnosis of Kikuchi''s disease.

A 13-year-old girl presented with a history of not being well during the past six months. The ultrasound examination showed an epigastric mass, which was diagnosed as a bezoar within the stomach in upper gastrointestinal endoscopy. The patient was managed by operative evacuation. It was interesting that such a large bezoar did not cause any significant obstruction for the patient.

The response rate to the treatment of obsessive compulsive disorder (OCD) is 21.6% to 61.3%, which shows a relative resistance to current treatments and a need for novel therapeutic approaches. Here we report a case of resistant OCD with fast and dramatic response to a relatively new method of repeated transcranial magnetic stimulation. In this method a pulse magnetic field emits from a coil over the surface of the scalp to induce a localized electrical current in the cortex below. Cortical activity can then be either inhibited or stimulated. The patient was a 40-year-old woman with severe OCD who admitted to our psychiatric hospital. She was treated with 10 sessions of rTMS (110% intensity, 1 Hz frequency and duration of 30 minutes per day / a total of 1200 pulses per day) on right supplementary motor area. Her improvement evaluated serially with Yale Brown Scale. By the end of the 2nd day she reported a major improvement of symptoms. Dramatic improvement was observed in her obsessive and compulsive behaviors, and avoidance recovered completely. She also reported significant improvement in ability to control obsessive thoughts and impulses, and anxiety symptoms. Since repeated transcranial magnetic stimulation is a low risk method with almost no interaction with the common medications, as well as the faster response obtained by using this method, it can be used as an add-on treatment in resistant cases of OCD and even in the initial stages of this disorder.