مجله دانشکده پزشکی دانشگاه علوم پزشکی تهران
سال شصت و نهم شماره 10 (پیاپی 130، دی 1390)

Amphibian skins possess various antibacterial compounds that are effective against some microbial pathogens and are mostly released in response to environmental stress. In fact, the skin of Rana ridibunda, a large green frog, is a rich source of antimicrobial compounds that can be developed for therapeutic use. In the present study, the skin extract of Iranian Rana ridibunda was evaluated for its antimicrobial, hemolytic and cytototoxic activities. The frog specimens were collected from Minoodasht located in Golesten province in Iran, during 2009. Subsequently, their skins were removed and the intended compounds were extracted. The crude extract was partially purified by gel filtration chromatography. The antimicrobial effects of skin extract were assessed against various microorganisms such as Escherchia coli, methicillin-resistant and -sensitive Staphyloccus aureus, vancomycin-resistant and -susceptible Enteroccus fecalis, Pseudomonas aeroginosa and Candida albicans. In addition, its minimum inhibition concentration, cytotoxic and hemolytic activities were determined. The crude extract of Rana ridibunda skin had valuable antimicrobial effects against methicillin-resistant and -susceptible S. aureus in comparison with E.coli and vancomycin-resistant and -susceptible E. fecalis. Besides, no antimicrobial activities were seen against P. aeroginosa or C. albicans. Moreover, the hemolytic and cytotoxic activities of the skin extract were minimal. The antimicrobial activity of Iranian Rana ridibunda was comparable to those isolated from other Rana species. In conclusion, the skin extract of Rana ridibunda had the potential for a new therapeutic agent against the emerging drug-resistant bacteria, particularly methicillin-resistant and -sensitive S. aureus.

The techniques used in assisted reproductive technologies have progressed considerably, but many embryos do not implant after transfer upon the use of these techniques. One of the causes of infertility is repeated implantation failure due to decreased endometrial receptivity. Furthermore, in clinical conditions such as endometriosis and myoma, implantation decreases after embryo transfer. In this case-control study the expression patterns of HOXA-10 and BTEB1 mRNAs were evaluated at the time of implantation in patients with myoma and endometriosis. In this study performed in Hamadan University of Medical Sciences during 1389, the cases included 16 patients with endometriosis and myoma (8 in each group) and the control group consisted of 8 fertile women. Endometrial sampling was performed at mid-secretory phase. Later, the expression patterns of HOXA-10 and BTEB1 mRNAs were evaluated using a semi-quantitative RT-PCR method. The optimal PCR cycles determined were 30, 32 and 26 for HOXA10, BTEB1 and β-actin, respectively. Endometrial HOXA-10 and BTEB1 mRNA expression levels (normalized to ß-actin expression) at the time of implantation were significantly decreased in the endometrium of infertile patients with endometriosis compared with that of healthy fertile controls (P<0.05). A similar pattern was seen in patients with myomas for both HOXA10 and BTEB1 genes, (P<0.05). It seems that lower expression of HOXA-10 and BTEB1 mRNAs in the implantation window of endometrium that increase normally, could account for some aspects of infertility in patients with endometriosis and myoma.

Human amniotic membrane (HAM) forms the inner wall of the membranous sac that surrounds and protects the embryo during gestation. The main advantages of amniotic membrane transplantation (AMT) in the treatment of bacterial keratitis are its epithelial bandage properties. Previous studies have documented the presence of some antimicrobial proteins and peptides in amniotic fluid such as lactoferrin, lysozyme, bactericidal or permeability increasing protein, calprotectin (MRP8/14 protein complex), LL37, and neutrophil defensins (Human Neutrophil Peptides, HNP 1-3). Furthermore, the amniotic membrane does not express HLA-A, B, C or DR surface antigens, which may help avoid rejection after its transplantation. Thus, it can be used as a biological immune barrier. The purpose of this study was to evaluate the effectiveness of the amniotic membrane's healing properties in rabbits with pseudomonas keratitis. By using an animal model, 14 rabbits were divided into two groups of controls and cases. A syringe was used to inoculate the corneal stroma of the animals by Pseudomonas aeruginosa ATCC27853. After 20 hours pseudomonas keratitis was created and amniotic membrane was transplanted to the cornea of the case group. The infiltration size were observed on the first, third and seventh days after the experiment. Corneal perforation was seen in the controls (P<0.001) but amniotic membrane prevented perforation in the case group (P=0.02). Transplantation of amniotic membrane in the primary stages of pseudomonas keratitis treatment remarkably prevents corneal perforation and it can be used to control the disease process.

Gastric cancer is one of the most common diseases of digestive system with a low 5-year survival rate and metastasis is the main cause of death. Multi-factors, such as changes in molecular pathways and deregulation of cells are involved in the disease development. Epidermal growth factor receptor pathway (EGFR) which is associated with cell proliferation and survival can influence cancer development. EGFR function is governed by its genetic polymorphism; thus, we aimed to study the tyrosine kinase domain gene mutations of the receptor in patients with gastric cancer. In this experimental study, 123 subjects (83 patients with gastric cancer and 40 normal subjects) were investigated in north of Iran for EGFR gene polymorphisms during 1 year. Genomic DNA was extracted by DNA extraction kit according to the manufacture's protocol. Polymerase chain reaction single-stranded conformation polymorphism (PCR-SSCP) and silver staining were performed for investigating EGFR gene polymorphisms. The participants included 72 men and 44 women. Gene polymorphism in exon 18 was present in 10% of the study population but SSCP pattern in exon 19 did not show different migrate bands neither in patients nor in normal subjects. It seems that screening for tyrosine kinas gene polymorphism of epidermal growth factor receptor in patients with gastric cancer and use of tyrosine kinas inhibitors could be useful in the prevention of disease progress and improvement of treatment process for a better quality of life in these patients.

Hepatitis C virus (HCV) is essentially considered as hepatotropic, but virus sequences have also been found in other important extrahepatic sites, including peripheral blood mononuclear cells (PBMCs). This study was done to investigate the presence of mixed infection and the differences between hepatitis C virus genotypes in plasma, peripheral blood mononuclear cells, and liver biopsy specimens in patients with hepatitis C virus infection. One hundred and fifty two patients with established chronic hepatitis C infection attending Firouzgar Hospital, affiliated to Tehran University of Medical Sciences, from September 2008 to April 2010 were enrolled in the present study. After collecting plasma, peripheral blood mononuclear cell, and liver biopsy specimens, RNA was extracted from the samples and hepatitis C virus genotyping was performed using INNO-LiPATM HCV II kit. The hepatitis C virus genotyping was confirmed by sequencing the RT-nested PCR product of 5'-UTR fragments. The mean age of the participants was 31.2±16.9 years. Multiple hepatitis C virus genotypes were detected in 4 (2.6%) out of 152 plasma samples, 10 (6.6%) out of 152 peripheral blood mononuclear cell samples, and 9 (18.8%) out of 48 liver biopsy specimens. Hepatitis C virus genotypes were different in the plasma, PBMC, and liver biopsy specimens of 21 (13.8%) patients. The present study shows that a significant proportion of patients with chronic hepatitis C infection are infected by multiple hepatitis C virus genotypes which may not be detectable in their plasma specimens.

Recent evidence suggest that group A ß-hemolytic streptococcal (GABHS) infection may increase the risk of pediatric autoimmune neuropsychiatric disorders (PANDAS) composed of the clinical signs of obsessive-compulsive and attention deficit hyperactivity disorders. The objective of this study was to compare the titer of antibodies against GABHS between children with PANDS and the controls. This cross-sectional, case-control study was done in Hazrat Rasoul Hospital, in Tehran, Iran during 2008-2010. We compared serum antibodies streptolysin O, deoxyribonuclease B, and streptokinase against GABHS quantitatively in 79 cases with PANDAS and 39 age-matched controls. The area under ROC curve, sensitivity, specificity and positive predictive value (PPV) of tests were calculated. Most cases were studied in summer (57%) and spring (23%). The three aforesaid antibodies were higher in the cases (P=0.001). Antisterptolysin O (cut-off point 195) had a 90% sensitivity, 82% specificity and a 92% PPV, (CI=95%, 0.99-0.91). Anti streptokinase (cut-off point 223) had an 82% sensitivity, 82% specificity and a 95% PPV, (CI=95%, 0.934-0.735). Anti-DNase (cut-off point 140) had an 82% sensitivity, 82% specificity and a 95% PPV, (CI=95%, 0.99-0.91). The study demonstrated a possible role for streptococcal infection in PANDAS. We found a significantly higher antibody titer against GABHS in OCD and ADHD cases in comparison with healthy children. Treatment of streptococcal infection is achievable by the use of long-acting penicillin. Use of aggressive treatment schedules like plasmaphresis, IVIG, etc needs further RCT studies.

Anterior knee pain is one of the most common complaints of patients in orthopedic clinics. The first step in the treatment of this problem is conservative treatment which includes administration of anti-inflammatory drugs, exercise and changes in life style. Many patients respond well to these measures in about six months, but a small number of patients may not respond to the conservative treatment; therefore, surgical procedures such as Maquet osteotomy or lateral retinacular release may be needed in these cases. The aim of this study was to determine the efficacy of intraosseous drilling and decompression of patella in the treatment of chronic anterior knee pain. This study was performed as a case series on ten patients with chronic anterior knee pain attending the Orthopedic Clinic of Imam Khomeini Hospital, in Tehran, Iran in 2009-2010. Eight of the patients were male and the rest were female. The patients met the inclusion criteria and were followed up for at least 12 months after the surgery. The mean age of the patients was 27.8±4.66 yr and their mean BMI was 22.5±1.71 kg/m2. The mean pain severity before the interventions was 8.2±0.78 based on VAS but it decreased to 2.5±1.26 post-surgically. An average reduction of 5.7 scores were noticed in pain severity depicting a significant reduction of pain (P<0.0001). It may be concluded that intraosseous drilling and decompression of patella is a safe and effective method in the treatment of chronic anterior knee pain not responding to conservative treatment.

One of the difficulties in acetabulum surgery is appropriate exposure of the site of surgery. Trochanteric flip osteotomy is one of the surgical methods for superoposterior and posterior acetabulum exposure. However, due to possible complications some surgeons prefer to avoid this procedure. This study was undertaken to determine the outcome of surgical treatment of acetabular fracture using trochanteric flip osteotomy. In this prospective cohort study, 14 patients with acetabular fracture who had been admitted in Imam Khomeini Hospital in Tehran, Iran, during 2003-2006 underwent trochanteric flip osteotomy. The patients were followed for at least one year post-surgically. Demographics, radiologic findings, intensity of pain using visual analogue scale (VAS), Harris hip score (HHS), force of hip abductors and complications were noted. Data analysis was performed using SPSS ver. 13. The mean HHS was 82.5 (55-95). Heterotopic ossification was observed in three patients. There were no cases of postoperative infection or nonunion. Only two patients showed displacement of osteotomized fragments. Reduction was anatomic in 10 patients. In one patient, the force of hip abductors was three-fifth. The mean hip pain was 3.4 based on VAS. There were no cases of femoral head osteonecrosis. With respect to HHS, the final hip status was excellent and good in four and six patients, respectively. Three patients had fair and only one patient had poor condition. It seems that trochanteric flip osteotomy has much fewer complications in comparison to other methods justifying its use in such cases.

Oral metronidazole has been previously demonstrated to decrease postoperative pain after open hemorrhoidectomy. The aim of this study was to evaluate the effect of topical metronidazole in reducing postoperative pain of hemorrhoidectomy.

In this double-blind, clinical trial forty 20- to 40-year old male patients were scheduled for hemorrhoidectomy under spinal anesthesia at the Imam Khomeini Hospital in Urmia, Iran from April to September 2010. The participants were assigned to receive topical metronidazole (n=20) or placebo (n=20). Pain intensity was assessed using a visual analog scale (VAS), the time of first narcotic request and morphine administrations were also recorded.

The VAS scores were lower in metronidazole than the control group but this difference was not statistically significant, except after 24 hr post-surgically. Morphine administration in the first 24 hr was lower in the metronidazole group (P<0.05).

Although metronidazole could not prolong the time of first analgesic request, but application of metronidazole gel is associated with lower analgesic requirement.

Osteoma is a bony slow growing benign tumor in one of the sinuses. It is usually asymptomatic but clinical symptoms will occur by its overgrowth, occupation of sinus space and obstruction of ostia. This descriptive, cross-sectional, retrospective study was done by accessing the medical records of 17 patients with paranasal sinuses osteomas admitted in Tehran Amir Alam Hospital during 1999-2008. The mean age of the participants was 33.9 years and 12 (70.6%) were male and 5 (29.4%) were female. No positive family histories existed for the lesions. The mean time interval between the onset of symptom and attending the hospital was 4.4 years.Frontal followed by ethmoid sinus osteomas were more common in comparison to other sinuses. The most reported symptoms in frontal sinus osteomas were upper eyelid inflation and headache; and proptosis, nasal congestions and diplopia in ethmoid sinus osteomas. Most patients had been endoscopically treated. In small-to-medium-sized osteomas with no invasion into orbit or skull base, endoscopic surgery is the treatment of choice with minimum side-effects.