مجله دانشکده پزشکی دانشگاه علوم پزشکی تهران
سال هفتادم شماره 5 (پیاپی 137، امرداد 1391)

Several dietary factors are involved in cardiovascular coronary heart diseases, including trans fatty acids, which are generally formed during hydrogenation of vegetable oils, a process that causes conversion of liquid oils into semisolid fats. Nowadays, it is well-known that trans fatty acids form a major risk factor in the occurrence and progression of atherosclerosis. On the other hand, it has been identified that some nuclear receptors, such as PPARs, are involved and play important roles in lipid homeostasis and pathogenesis of cardiovascular diseases. Therefore, we studied the effect of elaidic acid on gene expression of peroxisome proliferator activated receptor gamma (PPARγ).

Murine macrophage RAW264.7 cells were treated by 0.5, 1, and 2 mM concentrations of elaidic acid for 6 h. The control group was treated by 50% ethanol (as solvent), equivalent to the amount of ethanol used in 2 mM concentration of elaidic acid. Later, the total RNA was extracted and its cDNA was synthesized. Finally, the quantity of PPARγ gene expression was measured by real-time PCR.

Overall, 0.5, 1, and 2 mM concentrations of elaidic acid decreased PPARγ gene expression in RAW264.7 macrophage cell line by -1.36, -1.68, and -3.24 folds compared with the control group, respectively.

By decreasing the expression of nuclear receptor PPARγ, elaidic acid causes, intensifies or accelerates the occurrence of cardiovascular diseases, especially atherosclerosis. This finding shows the importance of reducing the consumption of elaidic acid containing foods.

Hypothermia is an important determinant of survival in newborns, especially among low-birth-weight ones. Prolonged hypothermia leads to edema, generalized hemorrhage, jaundice and ultimately death. This study was undertaken to examine the factors affecting transition from hypothermic state in neonates. The study consisted of 439 neonates hospitalized in NICU of Valiasr in Tehran, Iran in 2005. The neonate's rectal temperature was measured immediately after birth and every 30 minutes afterwards, until neonates passed hypothermia stages. In order to estimate the rate of transition from neonatal hypothermic state, we used multi-state Markov models with two covariates, birth weight and environmental temperature. We also used R package to fit the model. Estimated transition rates from severe hypothermia and mild hypothermia were 0.1192 and 0.0549 per minute, respectively. Weight had a significant effect on transition from hypothermia to normal condition (95% CI: 0.1364-0.4165, P<0.001). Environmental temperature significantly affected the transition from hypothermia to normal stage (95% CI: 0.0439-0.4963, P<0.001). The results of this study showed that neonates with normal weight and neonates in an environmental temperature greater than 28 °C had a higher transition rate from hypothermia stages. Since birth weight at the time of delivery is not under the control of medical staff, keeping the environmental temperature in an optimum level could help neonates to pass through the hypothermia stages faster.

Regarding the limited number of studies on the feasibility of resection and repair of the small intestine by ligasure, we performed this study to compare ligasure with linear stapler for the previously mentioned operation. This phase 1 clinical trial study was performed in Ghaem Hospital, an educational hospital affiliated to Mashhad University of Medical Sciences, from 2010 to 2011. After obtaining permission from the University's ethics committee and a written informed consent from each patient, we recruited 18 patients. The participants who had morbid obesity and were candidates for laparoscopic gastric bypass surgery were randomly allocated to two stapler and ligasure groups. The data were collected and analyzed by three statistical tests, including Mann-Whitney U test, by SPSS 16. All patients were female with the age range of 20-65 years. Cost in the stapler group ranged between 29,500,000 to 40,000,000 Rial (mean 31,830,000± 3,500,000 Rials) and in ligasure group it was between 24,000,000 to 35,000,000 Rials (mean 26,720,000± 3,290,000 Rials). There was a significant difference between the two groups in cost (P=0.004(. Duration of the operations were 200±3.4 and 240±10 minutes in the stapler and ligasure groups, respectively. The difference in duration was significant between the two groups (P=0.043). No significant differences were observed in complications. Application of ligasure in resection and reconstruction of small intestine is more cost-effective than stapler, although duration of surgery is longer.

Multifocality, multicentricity and extension beyond the prostate capsule are all characteristics of prostatic adenocarcinoma that may escape diagnosis by conventional CT scanning or MRI. This study was designed to assess the diagnostic value of magnetic resonance spectroscopy (MRS) in prostatic carcinoma and its compatibility with prostatic specific antigen (PSA) as the conventional method. In this cross-sectional study, we recruited 139 patients with previous radical prostatectomy referring to Radiology department of Hazrate-e-Rasul Hospital during the first half of 2011 for the evaluation of local recurrence. Traditionally, local recurrence is defined as serum PSA concentration >0.2 ng/dl. We used 1.5-tesla Siemens Avanto MRI unit with endorectal coil and measured creatine, choline and citrate levels before calculating choline-creatine/citrate ratio. Correlation between MRS findings with PSA concentration was evaluated in regards to the multiple levels of the previously mentioned ratio. Local recurrence was found in 107 (77%) patients based on PSA levels. The mean values for serum PSA levels and creatine-choline/citrate ratio were significantly different in patients with and without local recurrence. Creatine-choline/citrate ratios greater than 50, 100 and 150 (as different cut-off points of recurrence) were respectively seen in 104, 102 and 97 patients and agreement ratio between MRS and PSA in these levels were 94.1%, 94.4% and 85.1%, respectively. Correlation coefficient between these two methods was 0.481. MRS is a valuable tool for evaluating recurrence inpatients with prostate cancer treated by radical prostatectomy and it is in good agreement with serum PSA levels.

Sexual dysfunction in males is characterized by the inability to achieve or maintain an erection sufficient for a satisfactory sexual activity. Erectile dysfunction is a common disorder in males and intracavernosal injection of papaverine followed by color Doppler ultrasonography of the penis is used to diagnose and treat vascular impotence. In this study, we examined the relationship between changes in peak systolic velocity (PSV) and erectile dysfunction with vascular cause after a cavernosal injection of papaverin.

We performed this self-controlled clinical trial in Shahid Hasheminejad Hospital in Tehran, Iran during 2010 and 2011. The study population consisted of 90 patients with erectile dysfunction. The peak systolic velocity (PSV) of cavernosal arteries was evaluated before and after injection of 40-80 mg papaverine and it was compared in the patients with and without response to injection.

The mean age of participants was 47.7 13.7 years. Response to papaverine injection was positive in 41(45.5%) patients. The mean PSV values were 14.68+5.65 and 53.74+18.8 cm/s before and after the injection, respectively (P<0.001). A PSV cut-off point of 10 cm/s was determined for the condition before injection. The sensitivity and specificity of the value for diagnosis of arterial erectile dysfunction were calclulated as 50% and 100%, respectively.

A PSV cut-off point of 10 cm/s in flaccid status before papaverine injection has a low sensitivity but high specificity for the diagnosis of arterial erectile dysfunction. Future studies with sufficient cases of arterial erectile dysfunction are necessary for final judgments and suggestion a new cut off point.

Medication overuse headaches (MOH) include headaches that last more than 15 days a month and usually occur after long-term use of analgesic. Most methods of medical treatment are ineffective. In some studies, great occipital nerve block is used to treat the headaches. This double-blind experimental study was performed in adult patients with MOH who attended Sina Hospital in Tehran from June 2009 to June 2011. Greater occipital nerve (GON) block was done in the two groups of patients by administering a combination of 3 ml of 0.5% bupivacaine and 2 ml of 5% saline or 3 ml of 0.5% bupivacaine and 80 mg of methyl prednisolone. We evaluated headache severity by Visual analog scale (VAS) and recorded days without headache. If patients were taking pain medications, preventive medications were given as usual before and after the injection. Student's t-test was performed for statistical analysis and a P<0.05 was considered significant. Overall, 13 male and 19 female patients with a mean age of 39.88±8.76 years participated in the study. The mean reduction in headache severity one hour after injection was 5.56±1.03 and 4.63±1.92 in the first and second groups, respectively. Average days without headache one month after injection were 8.75 and 4.75 days in the first and second groups, respectively. There were no significant differences between the two groups. Both methods seem to be effective in medication overuse headaches treatment. This finding is important as non-responders to conventional methods will otherwise have a decreased quality of life.

There are not many reports regarding the treatment approaches of congenital dislocation of the knee in the literature. Therefore, the preferred method of treatment of this rare congenital disease is still controversial. Hereby, we report the treatment outcome of 29 patients admitted in Shafa Yahyaian Hospital during 40 years. In this retrospective study done in Shafa Yahyaian Hospital in Tehran, Iran during 2010, we retrospectively reviewed the medical records of 29 patients treated conservatively or surgically for congenital dislocation of the knee. Patients had been evaluated for an average follow-up of 8.5 years. Overall, 54 knee dislocations had been treated surgically (58%) or conservatively (42%). Range of knee motion, persistent recurvatum, instability, valgus deformity after treatment and limping were the more important factors reported in the two surgically or conservatively treated groups. Knee function was satisfactory in patients with conservative treatment. Despite 80% of instability in the operated knees, patients could ambulate with or without braces and had a range of motion equal to 80 degrees. Knee function was also good after quadricepsplasty with transarticular pins in selected cases. We recommend a conservative approach to the disease, regardless of the patient's age at the time of treatment and subsequent surgery in patients with dissatisfactory recovery. Quadricepsplasty with transarticular fixation is recommended as a good option in treating these patients. Posterior capsulorrhaphy for patients with CDK and ligamentous laxity is also recommended.

Adipokines are proteins which are secreted from the adipose tissue. These groups of proteins are involved in the control of metabolism. Chemerin is one of these adipokines with different proposed biological roles. Serum levels of chemerin have been associated with increased body mass index, insulin resistance, metabolic syndrome, diabetes and cardiovascular diseases. The aim of this study was to assess the association between serum chemerin concentrations and polycystic ovarian syndrome. This case-control study was performed in Taleghani Hospital in Tehran, Iran during 2011. On 45 patients with polycystic ovarian syndrome and 45 normal individuals as the control group. The participants were selected by easy given sampling method. Body mass index, fasting chemerin and serum insulin concentrations were measured by Enzyme-Linked Immunosorbent Assay (ELIZA) method. Fasting serum glucose was measured by the enzyme-calorimetric method and insulin resistance index (HOMA-IR) was measured by the calculation of relevant equation. Data was analyzed using independent t-test and Pearson's correlation coefficient by SPSS version 18. Serum chemerin, insulin, and glucose concentrations were significantly higher in patients with polycystic ovarian syndrome than the control group. There was no significant correlation between body mass index, serum levels of insulin, glucose, HOMA-IR, or chemerin in cases and controls. This study showed that serum chemerin levels increase in polycystic ovarian syndrome. The findings also suggest that changes in chemerin serum levels could be considered as a criterion for polycystic ovarian syndrome.

The purpose of this study was to determine the prevalence and associated factors for postoperative pulmonary complications (PPCs) and extubation failure in patients having undergone intracranial surgery.

In this retrospective study done in Firozgar Hospital during 2008-2010, we followed up 254 patients through a clinical questionnaire and observation of the clinical course of participants in pre- and post-operative periods.

Overall, 40 (15.74%) patients had postoperative pulmonary complications. The most common PPC was pneumonia, which was seen in 24 patients (60% of complications). The average duration of ventilation in patients with PPC was significantly higher (16.8.±10 vs. 5.09±4.5 days; P=0.001) than patients without the complication. The mean Glasgow coma scale (GCS) after surgery in patients with PPC was significantly lower (11.±4 vs. 13.2±3; P=0.001) than the rest of the patients. Moreover, the mean age of patients with PPC was significantly higher (64.02±14 vs. 41.6.±17 years; P=0.001). Average duration of stay in ICU in patients with PPC was also higher (24.±27 vs. 8.7±0.5; P=0.001).

GCS before surgery and failed extubation independently of other variables were significantly associated with pulmonary complications independent of other variables.

Tuberculosis is one of the most important diseases with annually 8 million new cases worldwide. The purpose of this study was to investigate the risk factors for tuberculosis (TB) infection. In this descriptive study performed in Health center of Maznadaran province during 2010-2011, 183 patients with pulmonary and extrapulmonary TB infection were recruited. After measuring fasting blood sugar, and human immunodeficiency virus (HIV) antibodies, history of smoking was taken by using a questionnaire. The mean age of the participants was 46.8±19.8 years. The most common risk factor was diabetes and the lowest was HIV infection. Moreover, the prevalence of diabetes in women compared with that of men (OR=0.19, 95% CI=0.07±0.46) and smoking in men compared with women (OR=12.4, 95% CI=2.8±54.4, P<0.05) had statistically significant differences (P<0.05). The results of this research show that diabetes and smoking could be risk factors for tuberculosis infection. It is concluded that, in case of respiratory symptoms in patients with diabetes and smoking, tuberculosis can be considered as an important differential diagnosis.