Acta Medica Iranica
Volume:48 Issue: 5, Sep -Oct 2010

Fluorescent monitoring of DNA amplification is the basis of real-time PCR. Absolute quantification can be achieved using a standard curve method. The standard curve is constructed by amplifying known amounts of standards under identical conditions to that of the samples.The objective of the current study is to propose a mathematical model to assess the acceptability of PCR resulys.Four commercial standards for HCV-RNA (hepatitis C virus RNA) along with 6 patient samples were measured by real-time PCR, using two different RT-PCR reagents. The standard deviation of regression (Sy,x) was calculated for each group of standard and compared by F-Test. The efficiency kinetics was computed by logistic regression, c2 goodness of fit test was preformed to assess the appropriateness of the efficiency curves.Calculated efficiencies were not significantly different from the value predicted by logistic regression model. Reactions with more variation showed less stable efficiency curves, with wider range of amplification efficiencies.Amplification efficiency kinetics can be computed by fitting a logistic regression curve to the gathered fluorescent data of each reaction. This model can be employed to assess the acceptability of PCR results calculated by standard curve method.

Diet can play a vital role in cancer prevention. Nowadays the scientists are looking for food materials which can potentially prevent the cancer occurrence. The purpose of this research is to examine anti-mutagenic and apoptotic effects of apigenin in human lymphoma cells. In present study human chronic lymphocytic leukemia (Eheb cell line) were cultured in RPMI 1640 (Sigma), supplemented with 10% fetal calf serum, penicillin-streptomycin, L-glutamine and incubated at 37 ºC for 2 days. In addition cancer cell line was treated by and apigenin and cellular vital capacity was determined by MTT assay. Then effect of apigenin in human lymphoma B cells was examined by flow cytometry techniques. The apigenin was subsequently evaluated in terms of anti-mutagenic properties by a standard reverse mutation assay (Ames test). This was performed with histidine auxotroph strain of Salmonella typhimurium (TA100). Thus, it requires histidine from a foreign supply to ensure its growth. The aforementioned strain gives rise to reverted colonies when expose to sodium azide as a carcinogen substance. During MTT assay, human chronic lymphocytic leukemia revealed to have a meaningful cell death when compared with controls (P<0.01) Apoptosis was induced suitably after 48 hours by flow cytometry assay. In Ames test apigenin prevented the reverted mutations and the hindrance percent of apigenin was 98.17%.These results have revealed apigenin induced apoptosis in human lymphoma B cells in vitro.

We studied the effect of different concentrations of alpha-tocopherol on in vitro cupric ions induced oxidation of low density lipoproteins (LDL). Human native LDL (50 µg protein/ml) oxidation was induced by 10 µmol/L of CuSO4. Conjugated dienes were measured spectrophotometrically for up to 440 minutes. The length of the lag phase (Tlag), maximum velocity of the reaction (Vmax) and the maximum amount of generated dienes were obtained from kinetic data. Alpha-tocopherol increased Tlag and decreased Vmax with a dependence upon concentration (0-100 µmol/L). There was no difference between the Dmax obtained with cupric ions alone or in the presence of the various concentrations of alpha-tocopherol. The results suggest that alpha-tocopherol may decrease free radicals presence in LDL and thus decrease velocity of LDL oxidation by cupric ions. This mechanism may be a reason for alpha-tocopherol effect in ameliorating atherosclerosis.

Chronic anal fissure is the most common cause of anal pain associated with internal anal sphincter hypertonia. Reduction of hypertonocity is a special treatment for fissure healing. For this purpose chronic anal fissures were conventionally treated by anal dilatation or by lateral sphincterotomy. However, both of these methods may cause a degree of incontinence in some patients. The uptake of medical therapies that create a reversible chemical sphincterotomy has recently become widespread. The aim of this prospective clinical trial study was to assess the effectiveness of nifedipine in healing anal fissure, a calcium channel blocker that reduces sphincter pressure. A single-blind randomized comparative trial was setup to compare traditional treatment with stool softeners and 2% lidocaine cream against 0.5% nifedipine cream for 4 weeks. 110 patients were included in this study, 60 patients in the nifedipine group and 50 patients in the control group and the therapeutic outcome and side effects were recorded. Healing had occurred in 70% of patients in the nifedipine group and in 12% of patients in the control group after 4 weeks treatment (P < 0.005). Recurrence of symptoms occurred in four of healed patients in the nifedipine group and three patients in the control group in two months. The final result of nifedipine application after 12 months follow up was recurrence in 11 patients (26.19%). Mild headache occurred in four patients (6.6%) of the nifedipine group. Patients in the nifedipine group showed significant healing and relief from pain compared with patients in the control group. Recurrence rate with nifedipine use in spite of control of predisposing factors such as constipation was significant. Another finding was low complication rate with this treatment.

Leptin, a circulating 16-kd polypeptide consisting of 167 amino acids, appears to be involved in the body weight homeostasis. Moreover leptin plays an important role for the reproductive system, early embryogenesis, and fat metabolism during pregnancy and puberty. Significant correlations have been found between leptin and sexual hormones, which is a cytokine and has hormonal properties. The aim of this study was to determine serum leptin levels during the menstrual cycle, and the association between serum leptin and reproductive hormones in young, healthy Iranian women. 42 healthy women volunteered for the study. They all had regular menstrual cycles, with cycle length varying between 26 and 32 days. None of them used oral contraceptives. All were of normal weight, with body mass index (BMI) < 25 Kg/m2. Fasting blood samples were collected during the follicular phase, mid cycle and luteal phase of the menstrual cycle. FSH and LH were measured with coated tube immunoradiometric assay. Estrogen and progesterone were measured using antibody -coated tubes. Serum Leptin concentration were measured by Leptin (sandwich) ELISA. In menstruating women, serum leptin increased from 13.15+/-1.60 ng/ml in the early follicular phase to 16.57+/-1.68 ng/ml (P<0.01) at the luteal phase. Serum leptin concentration negatively correlated with LH and progesterone (P<0.05). Mean serum leptin levels correlated with body mass index (BMI) (r =0.78, P<0.001).

Investigating the frequency of traumatic nasal bone fracture in patients with and without old septal deviation and possible deviation. Prospective study of 105 patients with nose trauma conducted and cases were divided into two groups: a study group 35 patients with nasal fracture and a control group of 70 patients without nasal fracture. Diagnosis of septal condition was made by anterior rhinos copy and endoscopy using manipulation of septum. 31 (89%) of the patients with nasal fracture after trauma were diagnosed with old septal deviation. In comparison, only 39 (34%) of patients in the control group were diagnosed with old septal deviation. In comparison, only 39 (54%) of patients in the control group were diagnosed with old septal deviation. Existing old septal deviation significantly increases the risk of traumatic nasal bone fracture.

Acute injuries of the spine and spinal cord are among the most causes of severe disability and death after trauma. Data about spine fracture with or without cord damage are different. The aim of this study was to determine epidemiology and demographics of spinal injury in main trauma center, Guilan, an Iranian province. The present study was a descriptive study of all cases of traumatic spine injury. Who were admitted to Poursina Hospital, main trauma center of Gilan. The scoring Systems used to evaluate severity of injury were American Spinal Injury association (ASIA) and The Injury Severity Score. Among a total of 245 cases, 71.8%were male and 28.2% were female. Male/Female ratio was 2.55:1. The most common age group at which spinal injury occurred in males was 25-44year-olds and in females was 45-64 year olds. The most common causes were motorcycle vehicle accidents and falls. The most common fracture in spine was thoracolumbar (T10-L2). Among Forty four of patient with abnormal findings on neurological examination, fifteen of them had complete spinal cord injury (class A of ASIA) and twenty nine of them had incomplete spinal cord injury (class B, C, D, of ASIA). Our focus on the spinal injury and its major etiology revealed that efforts should be made to prevention. More detailed information about the causes of spinal injury should be sought as it might lead to more targeted intervention.

Bacterial sepsis is one of the most common causes of mortality and morbidity in neonates. It has been recognized a gradual change in spectrum of organisms responsible for neonatal sepsis. In this study we have evaluated changing trend of incidence and antibiotic susceptibility in neonatal late - onset sepsis (LOS) in 2-periods. This study is based on results of blood culture in neonatal late-onset sepsis, in 2--periods study throughout 12 - years. Neonatal LOS was defined as clinical signs suggestive of infection with a positive blood culture (B/C) after 72 hrs of birth. During first study (period: 1990-1992), the most common bacteremia in LOS was staphylococcus aureus (staph aureus) (34%). Overall gram- negative bacteria (GNB) were the predominant organism (66%). It was shown that 60% of GNB were resisted to gentamicin and 3% to amikacin, while in case of gram-positive bacteria (GPB); about 95% were resisted to ampicillin and 28% to cephalothin. In the second study (period: 2004-2007), the vast majority (56.6%) of septic cases were caused by GNB. The most common cause of late- onset sepsis was klebsiela p. (31%). The GPB were resistant to cephalothin (90%). There has been a dramatic increase resistance to cephalothin and aminoglycosides and 3rd -generation cephalosporins. The combination of cephalothin plus amikacin in suspected LOS was no longer the effective therapeutic regimen in our neonatal intensive care unit (NICU). Now, it seems the best choice for empiric antibiotic regimen in suspected LOS is the combination vancomycin plus amikacin. Constant surveillance is important to guide empirical antibiotic therapy and changes in trends.

The aim of the present study was to determine the effects of adenotonsillectomy on height, weight and body mass index (BMI) in children under 12 years old, with or without airway obstruction and evaluation of the risk of overweight in them. In this case-control study, 120 children with the age of 2-12 years old were studied; 60 children as case group who underwent adenotonsillectomy and 60 healthy children as control group. After collecting the data related to appetite status and sleep breathing disorder of the case group, height, weight and BMI have been measured for all children in two stages; preoperatively and 6 months later. Also in the case group, BMI percentiles, pre and postoperatively have been calculated. Patients with Low appetite in the initiation and at the end of the study in the case group were 80% and 8.3% respectively (P=0.01). Mean of height, weight and BMI variation after 6 months were significantly different between case and control groups (P<0.05). BMI percentiles in the case group preoperatively were: 20% underweight, 67% healthy weight, 10% at risk of over weight, 3% over weight. Postoperatively, after 6 months BMI percentiles in order of above frequency were: 10%, 57%, 22% and 11% (P=0.02). Analysis of the results showed that adenotonsillectomy can lead to increase of height, weight, BMI and appetite not only in the children with low weight due to airway obstruction but also in the normal weight and over weight children. Therefore risk of overweight should be mentioned as a probable undesirable outcome of adenotonsillectomy.

Clostridium difficile is the most common cause of nosocomial diarrhea. It is usually a consequence of antibiotic treatment, But sporadic cases can occur. This study was aimed to determine the frequency of the nosocomial Clostridium difficile (C. difficile) associated diarrhea in Tehran University of Medical Sciences hospitals and study of antibacterial susceptibility of isolates. In this study a total of 942 stool samples from patients with nosocomial diarrhea that were hospitalized in Imam Khomeini hospital, Shariati hospital and Children clinical center were collected. The samples were cultured on a selective cycloserine cefoxitin fructose agar (CCFA) and incubated in anaerobic conditions, at 37°C for 5 days. Isolates were characterized to species level by conventional biochemical tests. Bacterial cytotoxicity was assayed on tissue culture (vero). Antimicrobial sensitivity of isolated toxigenic C. difficile were investigated by kirby Beuer method (disk diffusion). Our findings show that, of the total patients, 57 toxigenic C. difficile (6.1%) were isolated. Results of statistical analysis show significant differences between the rate of isolated toxigenic C. difficile and age group of patients (P<0.05). Among the wards of selected hospitals, in gastroenterology of Children clinical center, Toxigenic C. difficile was isolated from patients most frequently. The sensitivity of isolates to vancomycin, Chloramphenicol and ceftriaxone were higher than other antibiotics. Toxigenic C. difficile is a common hospital-acquired infection. The organism was found in 6.1% hospitalized patients. Further studies to evaluate the rate and role of toxigenic C. difficile in nosocomial diarrheal processes, ecological and pathogenic terms are suggested.

One of the main problems in the efficiency and efficacy of an organization is its structural issue. Organizational culture is also considered as an effective factor in the performance of many organizations. The main goal of the present study was to determine the relationship of Centralization and organizational culture and performance indexes in Teaching Hospitals affiliated to Tehran University of Medical Sciences. This correlation study was performed in the year 2007. The population studied consisted of 4408 personnel from 13 hospitals among whom 441 subjects were selected and studied via a class sampling method. Data was compiled using a check list concerning the evaluation status of Centralization and another form concerning performance indexes as well as Robbin's organizational culture questionnaire. Data were obtained from the subjects by self answering and analyzed by using descriptive statistical indexes, T- test and Fisher's exact tests. Among the organizational culture indexes of the hospitals studied, control and organizational identity was better as compared to others (mean=3.32 and 3.30). Concerning the extent of Centralization in the hospitals studied, 53.85 % and 46.15 % were reported to have upper and lower organizational Centralization, respectively. Mean ratio of surgical operations to inpatients was 40%, the mean rate of admissions per active bed was 60.83, mean bed occupancy coefficient was 70.79%, average length of stay was 6.96 days, and mean net death rate was 1.41%. No significant correlation was seen between Centralization degree, organizational culture and performance indexes in teaching hospitals tehran university of medical sciences. (with 95% confidence interval). Due to the fact that first grade Teaching hospitals use board certified members, expert personnel, and advanced equipments and because of the limitation of patients choice and, the extent of Centralization and many organizational culture components have no significant correlation with performance indexes of these hospitals. Further research regarding structure is suggested in the future.

Evidence-based Medicine (EBM) is becoming an integral component of graduate medical education competency and a requirement for grad medical education practice-based learning core competency. This study tries to compare the efficacy of conferences utilizing small-group discussions with the traditional conference method in enhancing EBM competency. The participants in this randomized controlled trial (RCT) were 170 members of the medical faculty who were divided into two groups of 86 (intervention) and 84 (control). Following the intervention, EBM competency was assessed by a written examination. statistical analysis made use of chi-square test, independent sample t-test and relative risks for univariate analysis. Mantel-Hanszel was used for bivariate analysis. Cox proportional hazard models were used to evaluate multivariate-adjusted associations between EBM educational intervention and EBM knowledge, attitude and skills. A new indicator of number needed to intervention (NNI) was defined and computed. The results proved conference along with small-group discussion to be a more effective teaching method with P=0.001 on knowledge, P<0.001 for attitude and skills P<0.001 in an EBM exam when compared with medical faculty members who did not participate in EBM educational intervention (n=84). Moreover, they had also increased confidence with critical appraisal skills, and searching EBM resources. Conferences followed by small-group discussions significantly enhance EBM knowledge, attitude, critical appraisal skills and literature review skills.

Patients with valvular heart disease suffer from atrial fibrillation for more than 12 months after valve surgery and have a low probability of remaining in sinus rhythm. We performed an intra-operative procedure similar to surgical maze ІІІ procedure for conversion of this arrhythmia to sinus rhythm. We did this study to evaluate the efficacy of this procedure to restore the sinus rhythm in patients with valvular heart disease. 28 patients with valvular heart disease and chronic persistent atrial fibrillation underwent different combinations of valve surgery and concomitant reduction of left and right atrial size and resection of both atrial auricles in Shahid Madani cardiothoracic center from September 2004 to October 2008. The procedure for atrial fibrillation treatment was performed with cardiopulmonary bypass and after mitral valve replacement. There was one in-hospital death postoperatively because of respiratory failure, but no other complication till 6 months after the operation. Out of 28 patients, 23 were in sinus rhythm one week after the operation, one patient had junctional rhythm after the operation that restored to sinus rhythm and 4 patients had persistent atrial fibrillation. During the 12-month follow up, atrial fibrillation was corrected in 82.14%. Doppler echocardiography in these patients with sinus rhythm demonstrated good atrial contractility. This procedure on both atria is effective and less invasive than the original maze procedure to eliminate the atrial fibrillation, and can be performed in patients with valvular heart disease without increasing the risk of operation.

Traumatic abdominal wall hernias are a type of acquired hernia secondary to blunt trauma Caused, by direct trauma from handlebar like objects. This rare hernia is named ‘Handlebar hernia'. We report a case of such hernia without any significant intra-abdominal injury. The abdominal wall defect was repaired in layers by Jones technique. Postoperative course was uneventful. The authors recommend clinical suspicion for traumatic hernia in all patients with traumatic abdominal wall injury. Definitive treatment includes surgical exploration with primary repair of all tissue layers of the abdominal wall.

Fewer than 15% of lipomas occur in the head and neck. Lipomas of the larynx are very rare benign laryngeal tumors (0.6%). To date less than 100 case of laryngeal lipoma have been reported in the literature.Clinical manifestation include progressive horseness, dyspnea, and even dysphagia. In the direct exam smooth or pedunculated mass is seen in the larynx and sometimes if tumor is large enough a mass palpated in the neck. In the computed tomography (CT) low attenuation mass is seen. Treatment of laryngeal lipoma consists of endoscopic removal or external surgical approach depending on tumor size. The authors present a case of laryngeal lipoma that involved the true vocal cord. The following is a report of a single case of laryngeal lipoma, Including esteroboscopy, radiologic and intraoperative finding as well as review of the literature.