مجله دانشکده پزشکی دانشگاه علوم پزشکی تهران
سال هفتادم شماره 6 (پیاپی 138، شهریور 1391)

Obsessive-compulsive disorders and depression have a high prevalence during pregnancy; therefore, pregnant women may take clomipramine and also take other drugs or consume foods that contain caffeine. As investigations about the teratogenic effects of clomipramine and its concurrent administration with caffeine during organogenesis period are scarce, we aimed to study the teratogenicity of simultaneous administration of clomipramine and caffeine in rat fetus.

After dividing 42 pregnant rats to several case and control groups, we injected different doses of caffeine and clomipramine to the animals. All the injections were performed on the eighth until the 15th day of pregnancy. We removed the fetuses on the 17th day of pregnancy and studied the morphological features and apparent anomalies of the fetuses macroscopically.

We found a significant rate of mortality, apparent anomalies, abnormal torsion, shrinkage of skin and subcutaneous bleeding in fetuses of rats receiving high doses of caffeine or a combination of caffeine and clomipramine. Statistical analysis of the data revealed a significant increase (P?0.001) in teratogenicity of high doses of caffeine and its combination with clomipramine.

This study implies simultaneous intake of high amounts of caffeine and clomipramine lead to teratogenicity. We recommend pregnant women to avoid uncontrolled consumption of foods that contain caffeine or drugs that contain high amounts of this substance. They should not also take clomipramine with caffeine in the first trimester of pregnancy.

Induction of medical abortion during the second trimester of pregnancy is considered under certain medical conditions. Abortion in the second trimester of pregnancy could be accompanied by several side effects including hemorrhage and placenta retention. Several types of medications including oxytocin، ergots، and prostaglandins are used to control and optimize the third stage of labor and condition of delivery. The aim of this study was to compare the efficacy of intravenous oxytocin versus rectal misoprostol for the management of the third stage of labor during pregnancy termination. In this randomized clinical trial، 80 pregnant women between 14 to 24 weeks of gestational age were randomly assigned into two intervention groups. Twenty units of intravenous oxytocin was used as the standard regimen and it was compared with 400 µg of rectal misoprostol to manage the third stage of labor. In this study، the frequency of placenta retention was significantly (P=0. 034) lower in the misoprostol group (n=3، 7. 5%) compared with oxytocin group (n=10، 25%). The average duration of placenta delivery was significantly lower in the misoprostol group (7. 95 min Vs. 19. 22 min، respectively; P=0. 015). Decreases in hemoglobin concentration was not significantly different between the two groups. Generally، management of the third stage of labor in second-trimester abortions could reach a better outcome، regarding lower risks of placenta retention and duration of delivery، if rectal misoprostol is administered instead of intravenous oxytocin.

Diffuse large B-cell lymphoma (DLBCL) is the most common type of lymphoma. There are various types of DLBCL including immunoblastic and centroblastic. Epstein-Barr virus (EBV) is a member of Herpes virus family found in all human populations inducing different lymphoproliferative disorders. The role of EBV in the development of DLBCL is known. Multiple laboratory methods are available for detecting EBV. This study was conducted to determine the correlation of EBV with DLBCL in samples referred to pathology ward in Shariati and Sina Hospitals by chromogenic in situ hybridization (CISH) method. In this case/control study، pathological specimens of 50 patients with DLBCL as well as 50 reactive lymph nodes and tonsils (control group) were collected from archives of Shariati and Sina Hospitals and were evaluated for EBV encoded RNA (EBER) expression based on CISH method. A peptide nucleic acid (PNA) EBV probe (Dakocytomatin) was used while all the processes were done in RNAase-free conditions using RNAase-free water، sterile gloves and samplers. Out of fifty specimens in the case group، eight were positive for EBER in comparison with two in the control group (P=0. 046). No statistically significant difference was observed between intranodal or extranodal samples (P=0. 736) or between males and females (P=0. 0746). Our study showed that EBV positivity for EBER in patient with DLBCL could be determined more effectively by CISH method than immunohistochemistry (IHC). Comparative analysis between CISH، PCR and IHC methods is recommended.

Inadequate ventilation، esophageal intubation and difficult intubation are the most common adverse respiratory outcomes in patient undergoing anesthesia. The aim of this study was to compare Mallampati test in supine and sitting positions in traditional approach and during phonation for predicting difficult laryngoscopy and intubation.

In this study performed in Imam Khomeini Hospital in Tehran، Iran، Mallampati test was performed on 661 patients who met the inclusion criteria for the study. The test was done in supine and sitting positions with and without phonation by a rater who was blind to Mallampati test. Subsequently، laryngoscopy view and difficult intubation were evaluated in the four aforesaid positions by Mallampati test for predicting difficult laryngoscopy and intubation. For each situations، sensitivity، specificity، positive and negative predictive values and accuracy were calculated.

Overall، 28 (4. 2%) patients had difficult laryngoscopy and 9 (1. 4%) patients had difficult intubation. The highest sensitivity for Mallampati test in predicting difficult laryngoscopy and intubation was in supine and sitting positions without phonation، and the highest specificity was seen in sitting position with phonation. Negative predictive values were more than 95% in all different positions for Mallampati tests and the highest positive predictive value was seen in supine position with phonation.

According to our findings، the highest correlation between Mallampati test and different positions in predicting difficult laryngoscopy and intubation was seen in supine position with phonation. Phonation improved Mallampati score in supine rather than sitting position.

Anosmia is a physical sign in post-traumatic patients، which significantly reduces the quality of life. Anosmia occurs in up to 30% of cases with head trauma. In this study we aimed to compare the Olfactory Bulb Volume (OBV) in patients with posttraumatic anosmia in different impact positions and also with healthy individuals to find the relation between the two variables.

Thirty-eight patients with posttraumatic anosmia and 27 healthy individuals with normal olfactory function were recruited in this case-control study performed in Amir Alam Hospital in Tehran، Iran. Variables of age، sex، time of trauma، site of trauma (frontoparietal/occipital)، side of trauma، OBV، the results of olfactory identification tests and olfactory threshold were extracted and evaluated. We used non-contrasted 1. 5-Tesla coronal brain MRI for the measurement of OBV.

There were no significant differences between cases and controls regarding sex and age. Olfactory bulb volume was significantly smaller in cases compared to the controls (P=0. 004). Among the case group، OBV was smaller in anterior versus posterior head traumas (P=0. 02). OBV was also smaller in ipsilateral rather than the contralateral side of trauma (P=0. 01).

The direction of trauma had a significant effect on OBV and it was smaller in traumas to the anterior and also ipsilateral sides of the head. It seems that changes in OBV differ due to the direction of head trauma and it can be helpful in predicting the prognosis of posttraumatic anosmia. Further studies are required for more conclusive statements.

Anti-Müllerian Hormone (AMH) is secreted from granulosa cells of growing follicles and is a useful marker of ovarian reserve. Fertility in women is determined by the quality and quantity of follicle pool and ovarian follicular reserve positively correlates with AMH. In this study we aimed to determine if AMH can predict ovarian response in IVF treatments. In this retrospective observational study undertaken in Mehr Institute during 2010 to 2011، we studied the medical records of 101 patients and recorded the concentrations of AMH، day two or three FSH، LH، basal estradiol (E2)، E2 on day of HCG administration and the number of metaphase II oocytes. Having undergone ovarian hyperstimulation، the women were divided into three groups: poor responders (retrieved oocytes? 3)، normal responders (retrieved oocytes 4 to 15) and high responders (retrieved oocytes? 16). Overall، 20% of patients were defined as poor responders، 71% as average responders and 10% as high responders. There were significant differences in the concentration of AMH، E2 on day of HCG administration، FSH، the number of metaphase II oocytes and age between the three groups. MII oocyte count correlated positively with AMH (r=0. 487)، basal E2 (r=0. 275) and LH (r=0. 07) but it did negatively with FSH (r=-0. 26) and age (r=-0. 04). The areas under curve for AMH، FSH، LH، E2 and age were 0. 799، 0. 32، 0. 429، 0. 558 and 0. 304، respectively. We determined the 0. 85 ng/ml AMH concentration as the cut-off point with 71% specificity and 79% sensitivity for the prediction of poor responders. anti-müllerian hormone is an appropriate predicator of ovarian response following induction of ovulation.

Various therapeutic protocols have been recommended for treating dyslipidemia، particularly in patients with coronary artery disease. The purpose of this study was to assess the efficacy of statin use with or without fenofibrate on echocardiographic findings of patients with coronary artery disease and dyslipidemia.

This clinical trial was conducted on 124 patients with coronary artery disease and dyslipidemia in Baqiyatallah Hospital in Tehran، Iran during 2008 to 2010. The first group of patients (64) received simvastatin (20 mg) and fenofibrate (200 mg) with low lipid diet and exercise while the second group (60) only received simvastatin with low lipid diet and exercise for one year.

The mean age of the participants was 54. 3±6. 5 years. The first group showed significant changes in lipid profile and left ventricular ejection fraction (LVEF)، (P<0. 05). Left ventricular diastolic function parameters showed no significant changes in both groups upon 12 months of treatment.

The results of this study show، one-year treatment by simvastatin and fenofibrate can be effective on lipid profiles، and improve LVEF with resultant positive effect on heart function.

Although the conventional vaccines have been instrumented in the incidence of many infectious diseases، the advances in genetic engineering and bioinformatics have provided the opportunity for developing improved and new vaccines. Reverse vaccinology was pioneered by a group of researchers investigating development of a vaccine against serogroup B Neisseria meningitidis. Reverse vaccinology analyzes the entire genome of a pathogen with the aid of computational programs to identify potentially antigenic extracellular proteins. Using this method for Neisseria meningitidis genome analysis، 600 secretory or surface-exposed proteins were identified and، subsequently، 350 proteins were expressed and purified. Finally، seven proteins capable of activating the immune system against a range of strains were identified. Improved computational techniques are now able to provide researchers with high-confidence predictions for complex biological characteristics. This will herald a move to computer-aided biotechnology in which time-consuming and expensive large-scale experimental approaches are progressively replaced by functional bioinformatic investigations.

Tramadol is a synthetics 4-phenyl-piperidine analogue of codeine used for treating moderate to severe pain. Tramadol is a FDA pregnancy category C medication which induces release of serotonin and inhibits the reuptake of norepinephrine. Chronic use of this drug during pregnancy may lead to physical dependency and withdrawal syndrome in the neonate. We report the newborn of a woman admitted in the delivery ward of Mostafa Khomeini Hospital in Tehran، Iran in 2011. The mother suffered from chronic low back pain and headache and frequently took tramadol during pregnancy. The infant had a gestational age of 38. 5 w، a birth weight of 2950 gr and an Apgar score of 9/10 at 1 and 5 minutes after birth. The first signs of withdrawal syndrome occurred after 24 h with nausea، vomiting، poor feeding، and tremor. Later، agitation، tremor، hyprertonicity، and repeated multifocal myoclonus، and generalized tonic-clonic seizures developed. Clinical signs of withdrawal syndrome waned under phenobarbital therapy. Drug withdrawal syndrome should be considered in the neonates of pregnant mothers who chronically take tramadol. Tramadol administration during pregnancy should be restricted to carefully selected cases.