مجله علوم پزشکی رازی
سال هفدهم شماره 5 (پیاپی 74، امرداد 1389)

Intravenous immunoglobulin (IVIG) is a plasma derived product. IVIG has been used in treatment of autoimmune, immunodeficiency and infectious diseases. In this study we assessed the effect of intravenous immunoglobulin administration on WBC, neutrophil, lymphocyte and platelet counts as well as the percent of CD4 and CD8 T-cell lymphocytes and number of lymphocytes in pediatric patients with Immune Thrombocytopenic Purpura (ITP). In this cross-sectional study, we analyzed blood samples from 32 patients with ITP few minutes before and 1 hour after completion of IVIG infusion. In all patients platelet count, white blood cell count and differential cell count was performed with Sysmex kx-21 before and after IVIG infusion. The following lymphocyte phenotypic markers of CD4 and CD8 lymphocytes were also examined. Statistical analysis was carried out using paired t-test (p<0.05). Correlation between age and total volume IVIG infused with variables was analyzed with Pearson coefficient correlation. Cellular blood count showed significant decrease in leukocyte (p<0.001), neutrophil (p<0.001) and lymphocyte counts (p<0.001) 1 hour after IVIG infusion, but this changes was not significant in regard to the number of platelets (p=0.377). CD4/CD8 ratio increased significantly after IVIG infusion (p<0.001). Absolute counts of CD4 and CD8 lymphocytes significantly decreased after IVIG treatment (p<0.001). It seems that the IVIG decreases the Absolute Neutrophil Count (ANC) after treatment (without increasing the risk of infection). It can also decrease lymphocyte number. However, changes in the number and percentage of CD4 and CD8 lymphocytes depend on the time of sample collection after IVIG infusion.

Rheumatoid arthritis (RA) is one of the most frequent autoimmune diseases in the world which affects about 1% of the worldwide population. Measurement of the Anti-CCP1 titer in these patients is one of the new tests that is available in our country. It has been shown to be more specific than Rheumatoid Factor (RF) in the diagnosis of RA (97%) in multiple studies. This test becomes positive in early disease and it has a high predictive value. Patients with high levels of this antibody (positive) have more radiological erosions and destruction in their joints as compared to the negative patients.Some researches show that the level of this antibody has moderate correlation with disease activity. The aim of our study was to determine the relationship between Anti-CCP1 and disease activity in patients with rheumatoid arthritis. A cross-sectional study was performed on 90 patients with RA for evaluating the relation between Anti-CCP1 titer and disease activity index. Patients were selected by simple sampling method. Blood specimens were taken for detection of Anti-CCP1 titer and ESR. DAS28 form was completed for each patient. Data was analyzed with SPSS V.15 software. Statistical analysis performed with t test and Person's correlation coefficient. There was moderate correlation between disease activity index and Anti-CCP1 titer (p<0.001, r=0.57). The largest linear correlation was between Anti-CCP1and VAS; it means that higher titer of Anti-CCP1 is associated with more painful joints in our patients. The average of disease activity index in our positive and negative Anti-CCP1 patients was 5.07±1.1 and 3.5±1.5 (p<0.05), respectively. Because there was moderate correlation between Anti-CCP1 titer and disease activity index (r=0.57), this test cant be used as a marker of disease activity in rheumatoid arthritis patients.

Intensive physical activity is known to induce oxidative stress. Contrarily, there are enzymatic and non enzymatic defence systems against Reactive oxygen Species (ROS) and oxygen radicals in aerobic organisms. As compared to non aerobic excersie, during aerobic exercise the need for oxygen increases up to 10-200 times that of rest time; therefore increasing cell metabilism and stress oxidative. The purpose of this research was to determine the effect of 8 weeks continuous and regularexercise on Total Antioxidant (TAC), Superoxid Dismutase (SOD), Glutathion peroxidase(GSH-px) enzymes activity and Malondialdehyde (MDA- as the index of lipid peroxidation) in young soccer players. The study was of semi-experimental type. For this purpose 32 young male volunteer soccer players were selected and then randomly divided in two groups (experimental and control). The above healthy young men, aged 14-17 years old, did not have any programmed physical activity. Erythrocyte lipid peroxidation, ACT, SOD, GSH-px erytrocyte activities and MDA, were determined in fasting blood samples which were taken (twice) before and after the end of 8 weeks training program at rest. For statistical analysis t-test and SPSS V.15 was used. At the end of training, aerobic and anaerobic capacity increased significantly (respectively p<0.000 and p<0.000). Also MDA (index of erythrocyte lipid peroxidation) and SOD activity after 8 weeks of exercise increased significantly(p<0.000), (p<0.000), while TAC activity decreased significantly (p<0.05); increase in GSH-px was observed which was significant in the experimental group. The present research reveals the fact that continuous and regular exercise increases oxidative stress and SOD activity which is followed by decrease in lipid peroxidation levels. We conclude that exercise makes individuals stronger against oxidative stress and provides a healthy life.

In this survey the absorbed dose by kidneys, bladder, liver and ovaries with 99mTc-EC (99mTc Ethylene dicysteine) renal scintigraphy was measured and compared with the absorbed dose from 99mTc-DTPA (99mTc - Dietheylne Triamine Penta-Acid), which often is used in renal scintigraphy. In this applicable study, we used a water phantom with geometrical sizes similar to that of human body and composed of thorax and hip. Then in accordance with International Committee on Radiation Protection ICRP -23, we placed kidney, liver, bladder and ovary phantoms in to the thorax and hip parts. For dosimetry 30 cubical Lithium fluoride chips (TLD-100) were used. By using different values of 99mTc-EC and 99mTc-DTPA distributed in different phantom parts, the absorbed doses in kidneys, liver, bladder and ovaries were measured. Then by measuring skin dose in the region of kidneys, bladder, liver and ovaries in 20 female patients (10 patients for each radioisotope)that were under renal scan, the absorbed doses of above mentioned organs using phantom results were calculated. Statistical software used was SPSS V.16 and statistical data analysis was done by One sample Kolmogorov-Smirnov and t-tests. The results of skin and organ absorbed doses of kidneys, liver, bladder and ovaries showed a good linear regression. The relationship between organ dose and skin dose with total activity varied linearly. The results of organ absorbed dose in patients that were under renal scan with both radiopharmaceuticals showed: - Bladder absorbed dose with 99mTc-DTPA and 99mTc-EC respectively were: 4.42±0.98 mrad/mCi, 2.91±0.74 mrad/mCi (p=0.001).-Liver absorbed dose with 99mTc-DTPA and 99mTc-EC respectively were: 2.44±0.44 mrad/mCi, 1.58±0.019 mrad/mCi (p=0.000).-Right kidney absorbed dose with 99mTc-DTPA and 99mTc-EC respectively were: 4.04±1.06 mrad/mCi, 2.67±0.036 mrad/mCi (p=0.003).- Left kidney absorbed dose with 99mTc-DTPA and 99mTc-EC respectively were: 4.11±0.93 mrad/mCi, 2.60±0.14 mrad/mCi (p=0.000).-Ovaries absorbed dose with 99mTc-DTPA and 99mTc-EC respectively were: 2.55±0.28 mrad/mCi, 1.62±0.025 mrad/mCi (p=0.000). The results of this study showed that in patients under renal scan with 99mTc-EC, absorbed dose by kidneys, liver, bladder and ovaries is considerably lower than those with 99mTc-DTPA. Also as 99mTc-EC has several other advantages such as: easily prepared, cheap, lower hepatic uptake, produces high quality images and has high renal excretion as compared to 99mTc-DTPA, thus it could be used more in radioisotopic renal scan in nuclear medicine clinics.

Noscapine is a phtalideisoquinoline alkaloid with known anti-tussive properties. Recently, some other pharmacological effects and new potential clinical applications have been proposed for the drug. Since there is no data regarding its cardiovascular effects, cardiovascular actions of Noscapine were investigated in the present study. In this experimental study, the effects of cumulative concentrations of Noscapine on the vascular tone in rat isolated aorta and atrial rate and force of contraction in guinea pig isolated atria were evaluated using organ bath technique. Also, the Systolic Blood Pressure (SBP) was assessed after administration of different single doses of Noscapine (0.5, 1, 2 and 3 mg/kg, i.p.) by tail-cuff method in rats. Moreover, in a randomized, double-blind, placebo-controlled crossover study, the effect of conventional anti-tussive dosage of Noscapine (15 mg, p.o., t.i.d) on the blood pressure and pulse rate of 24 healthy volunteers was assessed. For data analysis Student's t-test and ANOVA were used. 1) High concentrations of Noscapine relaxed endothelium-lined rat aortic segments. Significant reduction in the dilatory response (%) of aortic segments was shown in the presence of Indomethacin (10-5 M), a cyclooxygenase (COX) inhibitor, or L-NMMA (2×10-4 M), a nitric oxide synthase (NOS) inhibitor, 2) Atrial contractility increased progressively with higher concentrations of Noscapine. Conversely, there was a trend for a decrease in spontaneous atrial contraction rate with the same concentrations of the drug, 3) No changes in SBP were demonstrated in rats receiving different doses ofNoscapine and 4) Noscapine did not affect the blood pressure and pulse rate of healthy volunteers in both supine and upright positions. High concentrations of Noscapine caused a direct vasodilation, partly dependent to the COX and NO pathways in rat isolated aorta, and exerted positive inotropic and negative chronotropic effects in guinea pig isolated atria. Also, the drug did not affect the blood pressure either in healthy animal model or human volunteers, but further studies seems to be necessary to evaluate its effects in pathophysiological processes such as hypertension.

There are several studies evaluating Helicobacter pylori (H.pylori) in nasal and sinus mucosa in chronic rhinosinusitis; however studies dealing with the direct evaluation of H.pylori in nasal polyps are limited. So the objective of this research was to evaluate the frequency of H.pylori nasal polyp and sinus mucosa of patients with nasal polyp in comparison to sinus biopsy specimens of healthy control group. In this case-control study 62 patients with nasal polyp and 25 healthy individuals with nasal bone fracture, older than 12 years and without any chronic systemic disease were enrolled by nonrandom consecutive sampling method. Serum anti-H.pylori IgA and IgG were evaluated by ELISA and the antigen was evaluated by PCR in nasal polyp and sinus mucosa specimens of patients and controls, respectively. To compare the study variables between the two groups Chi-square analysis was performed. Median age of patients and controls was 38 years (range: 12-65 yrs) and 26 years (range: 18-54 yrs), respectively. Male percentage was 63% in patients and 40% in controls. IgA positives were similar in both patients and controls (14.5% vs. 4%, p-value=0.27), but significant difference was observed in case of IgG (71% vs. 32%, p-value=0.001). Also the PCR results were different between groups (32.3% vs. 4%, p-value=0.005). There were more cases of both IgG/PCR positive results in patients group (29% vs. 4%, p-value=0.01). Based on the molecular study and variation in IgG concentration for H.pylori, there is a correlation between H.pylori, as a potential etiologic agent, and nasal polyp in our study.

Vitiligo is a common skin disease in which depigmented macules appear on skin. The etiology of disease is unknown. There are many different treatment options available for vitiligo. The purpose of this study was to evaluate the efficacy of Hair follicle autograft in treatment of segmental vitiligo. In this clinical trial study we transplanted pigmented hair follicles on segmental vitiligo patches that were unresponsive to other treatments; and duration plus response of repigmentation was estimated. Ten patients who were suffering from segmental vitiligo were chosen for this study. One or two 5mm punch autografts were harvested from occipital area of the scalp, and trimmed and divided to micrograft (containing one hair follicle in each) and then inserted in to the depigmented areas. Data were analyzed with Chi-square test. SPSS V.14 was used. In all 10 patients, repigmentation spots of about 1-2mm, 2-4mm and 6-9mm in size appeared after 4, 8 and 12 weeks, respectively. Follicular hair graft is one of the effective treatment methods for segmental vitiligo.

Dysmenorrhea or painful menstruation is seen in about 50% of women in reproductive age. It is the most common gynecologic complaint of young women and is one of the most common causes of sick leave; therefore finding a safe treatment for its control, has long been a concern. The purpose of the present study is to evaluate the effect of vitamin E on the reduction of pelvic pain in women suffering from primary dysmenorrhea and to compare its effect with placebo. A double blind randomized clinical trial was performed on 140 women suffering from primary dysmenorrhea. These women were randomly assigned into two groups and finally 94 women finished the study. In the case group (n= 42) Vitamin E was prescribed as a dose of 400 IU daily starting 2 days before the beginning of menstruation and continuing for 3 days (total duration of 5 days), for two consecutive cycles. In the control group (n=52) a placebo was prescribed which was completely similar to Vitamin E pearls in shape, color, taste and smell. Pain severity was evaluated using Visual Analogue Scale (VAS) for one month before the study and during the 2 months of study. The pain severity during these cycles was then compared using SPSS V.15, t-test, Chi square and pair t-tests were used for analysis. There was no statistically significant difference between the two groups according to blood group, age, family history of dysmenorrhea, educational status, and BMI (body mass index). The mean pain severity before the study did not show any significant difference between the two groups (7.15± 1.75 in the case group and 7.47±1.82 in the control group, p=0.3). Pain severity one month (p=0.001) and two months (p=0.001) after treatment with placebo showed significant reduction as compared to that of " before treatment". Similarly pain severity one month (p=0.001) and two months (p=0.001) after treatment with Vitamin E showed significant reduction as compared to that of " before treatment"; thus both conditions led to a decrease in dysmenorrhea. Pain severity during the first month of the study was 5.41 ±2.4 in the case group and 5.76±2.08 in the control group (p=0.1); and 4.73±1.89 and 5.35±2.05 in the case and control groups, respectively during the second month of the study (p=0.6), not showing significant difference.The mean reduction of pain in the case group (-2.7±2.1) was more than the control group (-1.8±2.4), during the second month of the study (p=0.04), showing significant difference. Therefore Vitamin E can lower the pain severity of dysmenorrhea more than placebo. Vitamin E and placebo both may reduce the pelvic pain of dysmenorrhea, but vitamin E can cause a more significant reduction. With regard to its safety, the study indicates that it can be a simple and safe option for the treatment of dysmenorrhea.