Researcher Bulletin of Medical Sciences
Volume:12 Issue: 4, 2007

Oxidative stress and lipid abnormalities are two major risk factors for development of atherosclerosis among hemodialyzed patients. Administrating of Lipid-normalising agents, solely or in combination together, can not correct all lipid abnormalities in hemodialyzed patients. The present study, therefore, was desinged to evaluate the effects of combination therapy of vitamin E and tolerable doses of nicotinic acid on serum lipids and apoproteins in hypertriglyceridemic hemodialyzed patients. The study was a double-blind randomized clinical trial. Thirty-nine hemodialyzed patients with fasting triglyceride range between 230 and 500 mg/dl were randomly assigned into three groups, receiving combination of vitamin E (600mg/d) and nicotinic acid (500mg/d), nicotinic acid alone (500mg/d), and placebo, respectively. All patients received their supplements for 13 weeks. The blood samples were collected after a 12 to 14-hour duration of fasting at the beginning of the study, followed by other samplings performed at the end of sixth and thirteenth weeks, respectively, and serum lipids and apoproteins were measured.accordingly. During the study, the mean serum triglyceride level was significantly reduced in the group receiving combination therapy of vitamin E and nicotinic acid, compared to the placebo group. Compared to that of placebo group, mean serum HDL-C levels were significantly increased two groups of combination therapy, and nicotinic acid alone, although LDL-C/HDL-C ratios were significantly decreased. There was no significant difference in the means of total cholesterol of serum, LDL-C, apoAI, apoB100 and Lp(a) between three groups. It is concluded that combination therapy of vitamin E and nicotinic acid in hypertriglyceridemic hemodialyzed patients can result in improvement in almost every lipid abnormalities, but except high levels of Lp(a).

Considerable evidences have indicated the differences between different sexes in their pain responses and opioid antinociception in which Opioids have been more potent in males than females. GIRK2, the primary post-synaptic effectors of opioids in the CNS, possibly contributes in these sex-related differences. In the present study, we examined the role and effect of gonadal steroid hormones on GIRK2 gene transcription in rats.

Male and female Wistar rats were divided into four groups of intact infant or adult, GDX, sham and GDX+T groups. ˝semiquantitave RT-PCR˝ was used to determine the GIRK2 gene expression in spinal cord tissue of the rats.

Our results showed that in the spinal cord of male rats, gene transcription of infant group did not fluctuate along with expression level of this gene in GDX or adult intact groups. Elimination of gonadal hormones in male rats significantly decreased the expression level of GIRK2 gene. These changes were not restored by testosterone replacement. However, in females, a greater expression of GIRK2 gene was found in intact adult or GDX rats than those of infants. Ovariectomy of animals failed to alter the GIRK2 mRNA level. No significant preferential differences were observed in GIRK2 gene transcription between both sexes of intact, sham and infant groups.

These findings show that regulation of GIRK2 gene transcription by gonadal hormones is male-dominant. Whereas, other sex-dependent developmental factors prominently affect on GIRK2 gene transcription in female animals. Further investigations are needed to clarify the exact mechanism.

Regarding environmental pollution cauesed by carcinogenic hexa-valent chromium compounds from spent refractory chromite bricks, a new method for neutralizing of the toxic industrial solid wastes was requested by a group of cement plants. In previous studies, neutralizing methods for toxic chromium compounds were resulted in reduction of these compounds in liquid phase. However, considering the environmental impact of dumping the immense refractory solid wastes of cement kilns, the objective of this study was to install a new procedure for reduction of hexa-valent chromium in solid phase. Considering the novelty of neutralizing the chromium compounds in solid phase, the first part of this study was the exploration of a new reduction procedure by utilizing sugar beet pulp and ferrous compounds, separately and combined together. The second stage was the application of new reduction procedure in a reactor, placed in the outdoor environment. The reactor consisted of a plastic cylinder with diameter of 20 cm with different layers: top layer consisted of clay materials (30 cm in length), second layer was filled with spent refractory chromite bricks mixed with very small amount of ferrous compounds (20cm), third layer was filled with sugar beet pulp (50cm) and the fourth layer was filled with clay (40cm). The reactor was also equipped by a pump for recirculation of leachate and assembled in the outdoor environment during the cold months of winter. Efficiency of reduction of chromium compounds in spent refractory chromite bricks and leachate of the reactor were close to hundred percent. The presented novel procedure for reduction of hexa-valent chromium compounds in spent refractory solid waste could be used for neutralizing toxic industrial waste generated by cement kilns and prevent its environmental impacts. Regarding the availability and low price of sugar beet pulp in close proximity of cement plants, this new method is quite practical, whereupon neutralized solid waste could also be recycled for further uses.

Regarding to the role of opioid receptors in peripheral cutaneous sensations and central itch procession, this study was designed to determine the efficacy of oral Naltrexone in the treatment of pruritus in patients with eczema in comparison with placebo. Thirty eight patients with eczema complaining of pruritus were studied. Pruritus scores were evaluated. Patients were given the placebo (n=20) or Nalterxone 50 mg (n=18) for a two-week period. During the study, pruritus scores were distinguished by a visual analogue scale (VAS) system and recorded in patients questionnaires three times, at the start of study, after 1 week, and after 2 weeks In the both groups VAS score were decreased, although Naltrexon was more effective than placebo in decreasing the VAS scores, both in 1st week week (P < 0.005) and 2nd week (P< 0.001). Adverse events (mainly nausea and sedation were observed in 3 patients (2 in Naltrexon group and 1 in placebo group) Naltrexone is more effective than placebo in treatment of pruritus in patient affected with eczema. Naltrexone might be considered as an adjuvant remedy in treatment of pruritus.

Due to threatening of public health, Collection, separation and sanitary disposal of hospital solid waste are important. This research was performed to evaluate the management of hospitals’ solid waste affiliated with Shaheed Beheshti Medical University during 1384. In this descriptive study the status of solid waste management of 13 hospital affiliated with Shaheed Beheshti Medical University was evaluated using a questionnaire in association with technical observation and interview. During the summer and winter, weighting the solid waste were performed in “Ayatollah Taleghani” and “Massih Daneshvari” Hospitals for three continual days and data were analyzed using SPSS program. 64.2% of hospitals were using bucket and plastic bags for keeping their solid waste. 30.8% of hospitals were collecting their solid waste manually. In 46.2% of hospitals, utilities using for collecting the solid waste were not being disinfected. 15.4% of hospital did not have any temporary place for keeping solid waste. 27.3% of temporary places had only water tab and sewer pipe without having refrigerating room. 7.7% of hospital had just an open temporary-solid waste storage. In 25% of hospital which were producing radioactive solid wastes, collect their radioactive solid waste with normal solid ones. Radioactive solid waste containers in 50% of hospitals were not made form lead. None of hospitals had necessary and safety facilities. In 38.5% of hospital, loading of solid wastes were performed manually. In 15.4% of hospitals solid wastes were recycled. 42.3% of them were not separating their infected solid wastes from ordinary ones. 15.4% of hospitals did not have any special bags for separating infected solid wastes. In 92.3% of hospitals both infected and ordinary solid waste were carried out together. None of the hospital had hazardous less process for solid wastes. 79.6% of hospitals had workers without special education. Daily average of production volume of solid waste in these hospitals was measured 6426.9 liters. In “Ayatollah Taleghani” and “Massih Daneshvari” Hospitals 407.41 Kg of solid wastes were produced, whilst 49.7% of these solid wastes were infected. Results show that the management condition of solid waste in the studied hospitals is not satisfactory. Methods for disinfecting hospital waste should be studied. Separation of hazardous solid waste from ordinary solid waste should be performed, precisely. Education of hospital workers should be seriously followed.

Liver steatosis and chronic hepatitis B infection are the most common causes of chronic liver diseases in Iran. There have been a a limited number of studies throughout the world, evaluating the association of hepatitis B infection and steatosis. We studied the association between some of viral and host factors and the presence of steatosis among patients with chronic hepatitis B infection. In this analytical cross-sectional study, 71 patients with chronic hepatitis B infection were preliminarily assessed by liver biopsy. The patients were divided into two groups based on either presence or absence of steatosis in liver tissue. These two groups were compared in terms of different host and viral factors along with their stage of fibrosis. Of 71 patients, 30 (42.3%) had significant steatosis (in >5% of hepatocytes, according to Brunt classification). Sex and gender were not significantly different in 2 groups. The mean BMI, serum levels of FBS, cholesterol, TG, GGT, were significantly higher in steatosis group compared to those of non-steatosis one (P<0.05). In contrast, the mean levels of AST, ALT, ALK-P were not significantly different in these groups. The frequency of HBeAg positivity and the mean level of viral load of two groups had no significant difference. There was also no significant difference in the mean stages of fibrosis between two groups. It seems that certain metabolic hosts factors such as BMI, FBS, cholesterol, TG, GGT are associated with steatosis in patients with chronic hepatitis B infection while such an association was not found with the evaluated viral factors. We suggest further investigations to evaluate the role of other factors (such as HBV genotype) in the future.

Facial nerve palsy can occur due to several causes and accordingly, several treatments have been proposed by plastic surgeons. This study is to determine the efficacy of temporal myoplasty in correcting the facial deformity of patients suffering from hemi-facial palsy whom were referred to “15 Khordad” hospital between 1381- 1385. Participants were 6 patients with hemi-facial palsy who referred continuously and were neither candidated for microscopic surgery, nor can tolerate free muscle transposition surgery. We conducted a clinical case study to compare pre and post-operation stages. In these patients, the new one-stage method of temporal tendon transposition to lip's commissure (without any grafting) was performed. They were followed for an average of 2 years. Assessments were made in terms of their age, sex, facial palsy cause, palsy duration, complications, and lip's commissure range of motion. Pre and post-operation photos were taken and physical examination was documented and analyzed for each case. Two cases (out of six ones) were men and the others were women. Their age range was 38.2 ±14 years old. In three cases, facial palsy was a post-traumatic result. One patient had congenital form. In another one it was due to tumor resection complications. The last patient was a tympanoplasty case. Palsy duration range was 28.7 ± 11 months. No complication was seen after the operation. In early post-operation stage, 50% of patients had good static facial position and in remained 50% the result was excellent. However, in delayed stages, the percentages for excellent, good and moderate outcomes were 66, 17 and 17, respectively. Despite the well dynamic facial position in early post-operation stages among all the cases, in delayed stages the percentages for excellent, good and moderate results were reduced to 50, 33 and 17, respectively. It seems that for those who can not tolerate long operations nor like to do so, temporal myoplasty might be an acceptable method as an alternative for the standard surgical methods applied for hemi-facial palsy (i.e. the microscopy procedure). It is recommended to conduct an absolute experimental study in this regard.

Accurate and precise hemoglobin separation and quantitation of HbA2 and HbF are essential for diagnosis of thalassemia. To evaluate the potential application of cation-exchange chromatography by HbGold IVD in performing hemoglobin A2 quantificative assay, comparsion between this technique and reference method of micro-chromatography was carried out. The blood samples were obtained from individuals who had either thalassemia trait or healthy status (n=321). Variability of HbA2 quantitation was quite low; the CVs of within-run between run & interlaboratory studies were:1.8-3.1%, 3.4-6% and 6.6-8.8%, respectively. The results of HbA2% quantitated by HbGold analyzer correlated with those given by Helena microchromatogrophy system (r=0.974.p=0.001). The HbGold was simple, rapid and reproducible. The application of HbGold analyzer for disgnosis of various phenotypes of thalassemia (the ailment which is frequently observed in Iran) is considered. In conclusion the HbA2 assay of HbGold analyzer could be used for both the quantition of HbA2 and the presumptive identification of thalassemia.

Endometriosis has been widely implicated as one of the causes of chronic pelvic pain, dysmenorrhea, and infertility.The purpose of our study was to define the correlation between the visual and histological diagnosis of endometriosis by comparing peritoneal findings identified at laparoscopy in a diagnostic trial with a standardized technique; including complete excision of lesions suggestive of endometriosis and systematic biopsies of normal appearing pelvic peritoneum. This study was performed in Mahdieh Hospital and IRHRC from 1383 to 1384. A diagnostic study of 30 patients (15- 45 yr.) undergoing diagnostic laparoscopy for the evaluation of chronic pelvic pain, infertility, dysmenorrhea and dysparonia was carried out (average age was 28.6 ± 5.14 (mean ±SD)). All suggestive areas of endometriosis were excised and examined pathologically. Additionally, peritoneal biopsy specimens were obtained from normal appearing peritoneum to rule out microscopic endometriosis. The positive predictive value, sensitivity, negative predictive value and specificity of visually identified endometriosis were determined in comparison with histological findings (definitive diagnosis). The mean prevalence of endometriosis abnormalities in visual and histological diagnosis were 63% and 42%, respectively. The measured values, therfore, for visual versus histological diagnosis of endometriosis were 42.1% for positive predictive value, 88.8% for sensitivity, 90.9% for negative predictive value and 47.6% for specificity. A diagnosis of endometriosis should be established only after histological confirmation.

One of the consequences of Multiple Sclerosis is action tremor which significantly reduces the patient’s quality of life. Quantitative effect of Thalamic Deep Brain Stimulation (DBS) is a known method to reduce this effect. The aim of this study was to quantitatively measure the action tremor in such patients, alomg with studying the effect of DBS on it. A video tracking system was used to trace an infrared marker on the tip of the index finger. Both hands of seven patients and six healthy participants were tested for three times. Subjects were asked to directly move their examined hand in a come and go pattern from a near to a far marker attached on a table, for several times. Patients performed the test in two different settings, once with their stimulator on (DBS On) and anothoer time with their stimulator off (DBS Off). "Deviation from direct path" and "Cumulative power" were considered as time and frequency domain indicators of hand’s tremor, respectively. "Deviation from direct path" is significantly lower in healthy subjects compared to that that of patients (P<0.001). This value was less in patients with DBS On than patients with DBS Off (P<0.02), showing an overall-positive effect of DBS in reducing the hand’s action tremor. Same results, but with less significancy, were found for "Cumulative power" (P~0.05). For one patient both of measurements did not reveal a significant change, after turning the DBS on. For another one, the DBS-On mode had an adverse effect so that it was increasing his action tremor. "Deviation from direct path" was found to be an appropriate indicator of action tremor in patients with Multiple Sclerosis, and Thalamic Deep Brain Stimulation, therefore, is an effective treatment for reduction of action tremor.

Respecting the high incidence of epilepsy among children and several reports coresponding the weight gaining of some during the valproate therapy, this study was conducted in “Mofid Children's Hospital” during 1384 to determine and compare the occurrence and severity of weigh gain among children treated with either valproate or phenobarbital. This clinical trails study was performed studying on 60 epileptic patients. We applied "International League against Epilepsy" classification to diagnose the patients. They were randomly equally divided into two groups (random allocation). First group was treated with valproate 20 mg/kg/day, whereas second one received phenobarbital 5 mg/kg/day [in divided dose]. Patients were followed for a six-month period. Body mass index (BMI) was measured at first, 2nd, 4th and 6th months of therapy and BMI6 was compared with expected BMI6 (according to BMI curve) and the difference of latter two BMIs (BMI6 and expected BMI6) were calculated. McNemar’s test was used to compare the weight difference in each group and Chi-square test was applied for between-groups comparison. In valproate-treated patients whose their weights increased, some characteristics (including age, sex and primary weight) were evaluated by Fisher’s exact test. Two groups were identical with respect to their age, sex, primary BMI and weight. 4 patients of phenobarbital group (13.3%) versus 20 patients of valproate group (66.7%), had weight gain (P=0.6 and P<0.0001, respectively). Final-stage data revealed that compared to phenobarbital, valproate resulted in further weight gaining of children and adolescent (P<0.001). Moreover, in valproate treated group, patients with older age and higher BMI, were more at risk of gaining weight. The risk of weight gainning in epileptic children treated with valproate is high. It seems that in patients above 10 years old and fat patients, this risk become more. We recommend further study to evaluate the effect of valproate on weight of epileptic patients older than 10 years and also fat patients.

In order to evaluate the success rate of Comprehensive Plan for Reduction of Air Pollution (1999-2005) of Tehran city, this study was carried out to measure the levels of carbon monoxide pollutant in this city during the execution of the mentioned plan. Data from Air Pollutants Measuring Stations in Tehran were analyzed using Excel software in which the daily levels of carbon monoxide were formerly extracted from 8-hour data and using daily rates, therefore, the relative monthly and annual rates were calculated. Studying the process of changes in carbon monoxide level in Tehran city, we may conclude that execution of this plan was not effective enough to reduce the level of CO pollutant to the extent expected. Nevertheless, due to the increasing trend in number of motor vehicles, (which are considered to be the main source for producing the CO in this city) it seems that it has, somehow, prevented the increase of this pollutant. Due to the increasing trend of CO production in Tehran city and consequent dissatisfaction from this trend, reviewing the “Comprehensive Plan for Reduction of Air Pollution” which has been executing since 2000, is of indisputable importance. This may provide us another apportunity to control the level of CO pollutant in the remained years of Plan (2006-2010).