مجله دانشکده پزشکی دانشگاه علوم پزشکی تهران
سال هفتادم شماره 1 (پیاپی 133، فروردین 1391)

Regarding the immunomodulatory effects of lactobacillus bacteria, this study aimed to evaluate the effect of oral administration of Lactobacillus reuteri, as probiotic bacteria, on natural killer cell cytotoxicity and tumor-specific lymphocyte proliferation in Balb/c mice with breast adenocarcinoma. A total of 30 female mice, aged 6- 8 weeks and with a weight of approximately 17- 19 g, were randomly divided into two groups of 15 mice. The case group received Lactobacillus reuteri at a dose of 2.7× 108 bacteria in half a milliliter of sterile phosphate buffer saline (PBS) and the control group only received PBS. The probiotic group received the regimen for two weeks prior to tumor transplantation, as they did for 30 days after transplantation with three-day intervals and durations of seven days. For the evaluation of natural killer cell cytotoxicity and also tumor-specific lymphocyte proliferation response, LDH and BrdU assays were performed respectively according to the manufacturer's instructions. The study showed that the mice in the case group which were receiving Lactobacillus reuteri had statistically significant differences in the replication of tumor -specific lymphocytes, natural killer cell cytotoxicity and delayed hypersensitivity responses Compared to the mice in the control group. Daily consumption of probiotics seems to regulate the immune system and consequently it can be helpful in people with cancer. Moreover, consumption of probiotics in healthy individuals can also boost the efficiency of the immune system against a variety of abnormalities.

Paraoxonase-1 (PON1) moves with high-density lipoprotein (HDL) particles in blood and prevents low-density lipoprotein (LDL) particles from oxidation. The aims of this study were to investigate the correlation between fatty acid composition of HDL phospholipids with pon-1 polymorphisms and response to lovastatin treatment in people with high blood cholesterol. In this descriptive study, 265 patients were selected and divided into two groups based on LDL-C concentrations; 131 patients with LDL-C greater than 130 mg/dl (cases) and 134 patients with LDL-C lower than 130 mg/dl (controls). Fatty acids of HDL phospholipids were measured with gas chromatography and lipid profile (cholesterol, triglyceride, LDL-C, HDL-C), apolipoprotein A1 and apolipoprotein B were measured by relevant commercial kits. Oxidized LDL was measured by ELISA method and activity of paraoxonase was determined by a relevant standard manual method. Genotypes of L55M polymorphism were determined by polymerase chain reaction-restriction fragment length polymorphism procedure. Prevalence of L allele from L55M polymorphism was 0.65 and 0.53 in the case and control groups, respectively (P=0.04). PON1 paraoxonase activity in LL homozygote genotype was higher than other genotypes upon treatment with lovastatin. Concentrations of oleic, linoleic and eicosapentaenoic acids in LL genotype were increased by lovastatin administration. Allele (L) from L55M polymorphism had a higher frequency in patients with higher LDL-C concentrations. PON1 genotypes seemed to have a modifying role on paraoxonase-1 activity after lovastatin therapy.

Diabetes mellitus (DM) is a group of metabolic disorders such as DM I, DM II, secondary causes of DM and gestational diabetes mellitus characterized by hyperglycemic phonotype. The etiology of gestational diabetes mellitus is unknown. Recent studies address the chronic activity of immune system against infections (not autoimmunity) as an important cause of gestational diabetes mellitus. This study aimed to compare T-helper cells 1 and 2 cytokines and associated antibodies in patients with gestational diabetes mellitus and normal pregnant women.

This cross-sectional study was performed on 45 female patients with GDM and 45 healthy pregnant women in Bandar Abbas, Iran, from 2008- 2009. The exclusion criteria were presence of any infectious diseases or autoimmune disorders such as SLE or RA. Present and past medical histories were taken from the participants thorough physical examination. Blood samples (10 mL) were drawn and sent to laboratory for measuring serum IgE, IgG1, IgG2, IgG3, IgG4, interleukin-10 (IL-10), interleukin-12 (IL-12), transforming growth factor-beta (TGF1), and interferon-gamma (IFN) measurements. T-test and Kolmogorov-Smirnov test were used for data analysis.

The mean age of the patients with GDM and healthy pregnant women was 32.5 and 27.9 yrs, respectively. T-helper 1 and 2 associated antibodies and cytokines had no significant differences between the case and control groups.

The changes in T-helper 1 and 2 associated antibodies and cytokines are not associated with gestational diabetes mellitus and could not be considered as a predictor for gestational diabetes mellitus.

Ischemia/reperfusion induced acute renal failure causes excretory functional disorders of nephrons. Ischemia/reperfusion injury is accompanied by generation of reactive oxygen species that leads to dysfunction, injury, and death of renal cells. Antioxidants of plant origin minimize the harmful effects of reactive oxygen species. The aim of this study was to determine the possible therapeutic potentials of Rosa canina L. in preventing renal functional disturbances during the post-ischemic reperfusion period. In this experimental study undertaken for evaluating renal excretory function in 30 male Wistar rats, renal ischemia was induced by occluding both renal arteries for 45 min, followed by 24 h of reperfusion. The rats received 2 ml of tap water or a hydroalcoholic extract of Rosa canina (500 mg/kg) orally for 7 days before induction of ischemia. In plasma samples, creatinine and urea nitrogen levels were measured, and in renal tissue samples, red blood cells were counted. The data were analyzed using ANOVA and Duncan tests. Renal ischemia for 45 minutes increased plasma levels of creatinine (P<0.001) and nitrogen urea (P<0.01) while reducing red blood cell counts in renal glomeruli (P<0.001). Rosa canina administration diminished the increase in creatinine (P<0.001) and nitrogen urea concentrations (P<0.01), and prevented reductions in red blood cell counts in renal glomeruli (P<0.001). Rosa canina seems to be useful as a preventive agent against renal damages induced by ischemia/reperfusion injuries in rats.

Carpal tunnel syndrome is the most common focal neuropathy that results from pressure on a nerve. The goal of this study was to assess carpal tunnel syndrome and its associated factors such as occupation, sex, and accompanying complications in a teaching general hospital. This cross-sectional study investigated 362 patients with the diagnosis of carpal tunnel syndrome admitted in the orthopedic ward of Imam Khomeini Hospital affiliated to Tehran University of Medical Sciences in Tehran, Iran during 2000-2010. The difference in the mean age of men and women was statistically significant (P<0.0001). The percentage of men with the disease was significantly different from that of the women. The prevalence of idiopathic carpal tunnel syndrome was significantly different (P<0.0001) in comparison with carpal tunnel syndrome due to its leading causes. The most common occupation in women was first housekeeping and then hairdressing while in men it was being a worker. Diabetes Mellitus and hypothyroidisms as the leading causes of the syndrome were highly correlated with the disease (r=08, P<0.001). According to the findings, most cases of the syndrome were idiopathic. Identifying the leading causes of the disease is important because their diagnosis probably prevents unnecessary surgery. By identifying such causes and/or correction of activity styles incidence of carpal tunnel syndrome and unnecessary surgical procedures would be prevented. Evaluation of patients for underlying causes can be useful, especially in severe forms of the disease to realistically assess the need for surgical treatment.

Several studies that have evaluated psychological and counseling interventions suggest that a proactive approach may be effective in preparing patients for the experience of living with an implantable cardioverter-defibrillator (ICD). The purpose of this study was to develop and assess cognitive and behavioral interventions in reducing stress and anxiety and improving quality of life. One hundred Patients with ICD in Shariati and Imam Khomeini Hospital in Tehran, Iran during 2009- 2010 were divided randomly into two groups to undergo cognitive and behavioral interventions (case group) or serve as the control group. The patients in the case group were received relaxation, cognitive and ICD alarm trainings three times during the study period. Routine care was the same in both groups after ICD implantation. We evaluated anxiety and depression by, respectively, Beck anxiety and Beck depression inventories in the two groups before and after ICD implantation. Quality of life was also evaluated by SF-36 instrument before and after the interventions. The results were later compared between the two groups. Beck scores for anxiety in the case and control groups before the interventions were 24.9±15.5 and 24.2±15.8 (P=0.590), respectively; and after six months they were 13.5±8.3 and 17.9±10.1 (P=0.005), respectively. Beck scores for depression in the case and control groups before the interventions were 17.7±9.8 and 18.4±10.6 (P=0.590), respectively; and after six months the scores, respectively, were 13.5±8.3 and 17.9±10.1 (P=0.005). It seems that psychological interventions can reduce anxiety and depression after ICD implantation. Further studies with more sample sizes are necessary for the final judgment.

Determining the etiologic causes of septic arthritis is of the most importance. Goal of this study was to investigate presence of staphylococcal enterotoxins A, B, C and Toxic Shock Staphylococcal toxin-1 in the synovial fluid of patients with arthritis. This cross-sectional study was performed in the Pediatric and Orthopedic Wards of Hazrat Rasoul Hospital in Tehran, Iran during 2008- 2010. Gram stains, conventional cultures, direct detection of soluble bacterial antigens were used to detect H. influenza, S. pneumonia, group B streptococci, and N. meningitidis while Latex particle agglutination test was used for staphylococcal supper antigens (by enzyme immunoassays) upon synovial fluid tapping of 62 individuals (5 mo to 16 yrs, mean=113.8 yrs). P<0.05 was considered statistically significant. Positive SF cultures (n=11): 5 positive cases of S. aureus; 5 S. pneumonia; 1 H. influenza, and 1 Klebsiella. Positive gram stains: 10%; and positive LPA: 4%. Staphylococcal arthritis was diagnosed in 7 (39%) cases upon positive culture or positive gram stain. The most common type was TSST-1 (47%) and the least common was enterotoxin B (18%). Isolation of S. aureus (positive culture) was correlated to presence of enterotoxin A in synovial fluid but not to enterotoxins B, C or TSST-1. Staph. aureus had a prominent role in arthritis. 47% of cases with negative culture for S. aureus had at least one type of staphylococcal super antigens in the synovial fluid. Searching for antigens of usual organisms or staphylococcal supper antigens could be helpful for diagnosis

Ovarian hyper stimulation syndrome (OHSS) and its consequences, especially thromboembolic events, are of the most dangerous complications of assisted reproductive technologies (ART). It is unclear whether a thrombophilic predisposition or changes in blood components during clinical presentation of OHSS increase thrombotic risks. Testing for certain thrombophilias in selected high risk patients may help risk assessment and decision-making about prophylactic measures. In this study carried out in April 2010 to March 2011, 108 in vitro fertilization candidates with ≥20 follicles following ovarian stimulation were recruited. Protein S, protein C, antithrombin, lupus anticoagulant and anticardiolipin antibodies were measured. Blood tests were compared between severe and non-severe OHSS groups and their changes were traced after onset of clinical OHSS in 43 patients presenting with severe symptoms by repeating the tests at hospital admission. Mean protein S activity was lower in severe OHSS group (101.7±16.3 vs. 118.4±17.0; P<0.001). After clinical presentation of severe OHSS, this level decreased to 91.6±20.1 (P<0.001). Antithrombin levels decreased 2.09% after the onset of symptoms in the group with severe OHSS, but this difference was not statistically significant (P=0.051). Protein C, lupus anticoagulant and anticardiolipin antibodies were not correlated to severe OHSS development. Patients with relatively lower protein S activity were at higher risk for the development of severe OHSS, and its dangerous consequences. During clinical OHSS presentation, protein S decreased even more, and patients were more vulnerable to hypercoagulability states. These points should be kept in mind in risk assessment and adoption of prophylactic strategies.

Psoriasis is a common, chronic disease of the skin, in which both genetic and environmental factors play a critical role. The most characteristic lesions consist of red, scaly plaques present particularly over extensor surfaces and scalp. Studies have reported association between psoriasis and many other diseases in both cutaneous and systemic forms of the disease. Several studies with different and sometimes controversial results have been done about the relationship of hyperuricemia and psoriasis. The aim of our study was to assess serum uric acid levels in patients with psoriasis. We studied 126 patients with psoriasis in a case-series study in Razi Hospital during one year. After recording the age, sex, duration, type and severity of the disease and presence or absence of psoriatic arthritis in the patients, they were referred to the laboratory for the determination of serum uric acid concentrations. The mean (±SD) serum uric acid level was 5.4±1.5 mg/dL (ranging from 1.9- 9.5 mg/dL). Although the mean serum uric acid levels were in the normal range but the values were significantly higher in patients with more severe forms of psoriasis (P<0.001), its longer duration (P<0.001) and psoriatic arthritis (P=0.003). Moreover, serum uric acid levels were significantly higher in patients with non-plaque-type than plaque-type psoriasis (P=0.01). This study revealed that serum uric acid levels exacerbate by increases in the severity and duration of psoriasis, in psoriatic arthritis, and in patients with non-plaque-type psoriasis.

Accidental ingestion of poisons in children is an important health problem all over the world. Over 90% of poisonings occur in household settings, and 40% happen during childhood. Recognition of the current etiologies of poisonings may be helpful in adoption of strategies for their prevention and prophylactic therapy. In this cross-sectional study, the medical records of children aged 12 years or younger were collected from the 17th of Shahrivar Hospital in Rasht, Iran in 2010. The study was performed in collaboration with the Adverse drug reaction (ADR) Committee of Guilan University of Medical Sciences. Out of 3299 pediatric admissions, 4.27% were identified as accidental poisoning. 86.5% of children were below the age of five and the majority was in 1-5 year age group. Admission rates were higher during the spring season. The most common toxicities occurred by ingestion of drugs (56.73%) and kerosene (9.92%). Chlorine bleach (8.51%), rodenticides (5.67%), opium (4.25%) and mushrooms (3.54%) were other causes, respectively. No deaths had been recorded. Informing parents about hazardous materials, especially kerosene, and medications which need to be kept out of reach of children seems to be helpful in reducing occurrences of poisonings and their subsequent complications.