مجله دانشکده پزشکی دانشگاه علوم پزشکی تهران
سال هفتادم شماره 7 (پیاپی 139، مهر 1391)

Coronary heart disease (CHD) is a leading cause of death worldwide and hypertriglyceridemia and hypercholesterolemia are major risk factors for the disease. Considering the role of hyperlipidemia as the underlying cause of cardiovascular mortalities and morbidities, and the limited and conflicting results of studies on CETP gene polymorphisms in Iran, we aimed to study -971 G/A polymorphism of cholesterol ester transfer protein gene in patients with primary hyperlipidemia. In this case-control study performed in Hamadan University of Medical Sciences (from May 2010 to April 2011), we recruited 200 patients with primary hyperlipidemia (total cholesterol >250 mg/dl and/or triglyceride >200 mg/dl) as the cases and 200 healthy individuals with normal cholesterol and triglyceride as the control group. Gene segments were replicated by polymerase chain reaction (PCR) and -971 G/A polymorphism genotypes were identified by RFLP technique. Subsequently, plasma CETP activity was measured enzymeatically by a kit in a fluorescence spectrometer. The allele and genotype frequencies were not significantly different (P>0.05) between the two groups (in the control group: AA 24%, GA 47% and GG 28.5% and in the case group: AA 18%, GA 51% and GG 31%). In the case group, homozygous individuals with A alleles (AA genotype) had greater cholesterol and HDL-c concentrations than those with other alleles (GG and GA). In both cases and controls, individuals with AA genotype had lower CETP concentrations. We conclude that -971 G/A polymorphism in CETP gene promoter can affect lipid profile and alter CETP activity.

Excessive accumulation of beta-amyliod peptide (Aβ), the major component of senile plaques in Alzheimer's disease (AD), causes neuronal cell death through induction of oxidative stress. Therefore, antioxidants may be of use in the treatment of AD. The medicinal plants from the Lamiaceae family have been widely used in Iranian traditional medicine. These plants contain compounds with antioxidant activity and some species in this family have been reported to have neuroprotective properties. In the present study, methanolic extract of seven plants from salvia and satureja species were evaluated for their protective effects against beta-amyloid induced neurotoxicity. Aerial parts of the plants were extracted with ethyl acetate and methanol, respectively, by percolation at room temperature and subsequently, methanolic extracts of the plants were prepared. PC12 cells were incubated with different concentrations of the extracts in culture medium 1h prior to incubation with Aβ. Cell toxicity was assessed 24h after addition of Aβ by MTT assay. Satureja bachtiarica, Salvia officinalis and Salvia macrosiphon methanolic extracts exhibited high protective effects against Aβ induced toxicity (P<0.001). Protective effects of Satureja bachtiarica and Salvia officinalis were dose-dependent. The main constituents of these extracts are polyphenolic and flavonoid compounds such as rosmarinic acid, naringenin, apigenin and luteolin which have antioxidant properties and may have a role in neuroprotection. Based on neuroprotective effect of these plants against Aβ induced toxicity, we recommend greater attention to their use in the treatment of Alzheimer disease.

Gastric cancer is an important health problem across the world. Chemotherapy in combination with local treatment is the standard treatment for locally advanced gastroesophageal junction (EGJ) cancers. The purpose of this study was to evaluate response and tolerability to neoadjuvant regimen combining epirobicin, oxaliplatin and capecitabin (EOX) in locoregionally advanced gastric cancer. We recruited 28 patients with histologically confirmed advanced gastric or EGJ adenocarcinoma in this study performed in the Cancer Institute of Imam Khomeini Hospital in Tehran, Iran in 2010-2011. Staging workup included chest and abdominal computed tomography (CT) scans, upper gastrointestinal endoscopy, endoscopic ultrasonography (EUS), measurement of carcinoembryonic antigen (CEA), complete blood cell count (CBC), and liver and renal function tests. After three treatment cycles with EOX regimen, we evaluated response to the neoadjuvant chemotherapy by performing endoscopic ultrasonography (EUS) and chest and abdominal CT scans. The mean age of the patients was 56.64±11.08 years (ranging from 37 to 78 years). Most patients were classified as having stage III (98.8%) cancer before chemotherapy while most were classified as stage II (57.14%) after the treatment. Only 28.5% of tumors were resectable before chemotherapy, but 82.1% of them were resectable upon the treatment. 75% of tumors were downstaged after chemotherapy. Regarding the acceptable response and downstaging of tumors and low toxicity of EOX regimen in locoregionally advanced gastric cancer, evaluation of this regimen as a neoadjuvant chemotherapy in larger phase III clinical trials in Iranian patients would be both necessary and logical.

There are conflicting reports about zinc, a trace element, in the pathogenesis of hypertension and other cardiovascular diseases. The aim of this study was to evaluate the role of zinc in high blood pressure.

We conducted this study on 80 patients with primary (idiopathic) hypertension and 80 normotensive people with similar age who attended to Tehran Heart Center between 2007 and 2008. We examined the effect of zinc concentration on blood pressure in both sexes in four age groups (41-50, 51-60, 61-70 and 71-80 years old). We measured plasma zinc concentration by atomic absorption.

The mean plasma zinc concentrations were 0.456±0.04 µg/ml and 0.551±0.055 µg/ml in patients with hypertension and in normotensive people, respectively, (P≤0.05). Nevertheless, the mean plasma zinc concentrations were 0.494 µg/ml and 0.486 µg/ml in men with and without hypertension, respectively. The mean plasma zinc concentrations of women with and without hypertension, respectively were 0.415 µg/ml and 0.596 µg/ml, showing a significant difference between two groups (P≤0.001). Moreover, there was a significant difference in plasma zinc concentration between hypertensive and normotensive people in 51 to 60 years age group (P≤0.05), but difference were not significant between other age groups.

The results of this study revealed the relationship between the decrease in plasma zinc concentration and increase in blood pressure in women and in the men aged 51 to 60 years.

Tuberculin skin test (TST) is a readily available test for the diagnosis of latent tuberculosis infection (LTBI). This study was designed to evaluate LTBI in low-risk children aged 1-15 years. This cross-sectional study was performed in Shiraz, Iran, over six months during 2009. Totally, 1289 boys and girls were selected by stratified multistage random sampling from four municipality areas before allocating them to 15 groups. Inclusion criteria included age 1-15 years, documented history of BCG vaccination at birth, Iranian nationality and a healthy state of being. Children with acute febrile diseases, immunosuppression, on medication and immigrants were excluded. We considered a TST ≥ 10 mm of induration as positive. The prevalence of LTBI in 1-15 years old children was 4.5%. The percentage was 3.5% in 1-5 year old, 4.1% in 6-10 year old and 5.7% in 11-15 year old children. The highest rate of infection was 9.8% in 15 year olds and the lowest was 2.2% in 3-year old children. Gender had no effect on LTBI rate. There is no significant difference of LTBI prevalence between four municipality areas. The prevalence of LTBI in this study was lower in comparison with other studies performed in Iran. Positive predictive value of TST decreases in low endemic areas for tuberculosis, especially in low-risk groups; therefore, most positive results are false-positive created by nonspecific reactions and infection with environmental mycobacteria. Hence, there is a need for new diagnostic tools that are easy and cost-effective.

Finding an acute brain lesion by diffusion-weighted (DW) MRI upon an episode of transient ischemic attack (TIA) is a predictor of imminent stroke in the near future. Therefore, exploring risk factors associated with lesions in DW-MRI of the brain is important in adopting an approach to TIA management. In the current study, we tried to determine the risk factors associated with lesions in DW-MRI of the brain in patients experiencing TIA episodes. Fifty patients with TIA were recruited consecutively in Sina Hospital, Tehran, Iran, over a 6-month period between July 2008 and January 2009. All of the patients underwent a complete neurological examination and laboratory tests. Brain DW-MRIs were performed for all the patients within 72 hours of a TIA episode. DW-MRI revealed an acute lesion in 16% of the participants. There was a significant correlation between presence of an acute lesion in DW-MRI and TIA duration, history of diabetes mellitus and presence of unilateral facial palsy (P=0.0003, P=0.02 and P=0.008, respectively). Other variables such as age, hypertension, hyperlipidemia, past history of TIA, headache, vertigo, and sensory or visual disturbances had no significant relation with the presence of an acute lesion in DW-MRI. Duration of TIA, presence of diabetes mellitus and unilateral facial palsy are risk factors for an acute lesion in DW-MRI, meaning that patients with such risk factors are at risk for stroke in the near future.

The aim of this study was to provide a valid Persian version of the Ages and Stages Questionnaires, in order to compensate the lack of developmental screening tools in Iran. Forward and backward translation, face and content validity determination, and cultural and linguistic adaptation of the questionnaires were performed, consecutively. Next, a pilot study was carried out on 100 Iranian parents of 4- to 60-month-old children, recruited by consecutive sampling in Tehran, Iran during the year 2006 to determine the degree of clarity for each item and explore cultural adaptations. In order to determine inter-rater reliability, we had parents of 38 children complete the questionnaires. For determining the psychometric properties of the tests, we later recruited a representative sample of 555, 4- to 6-year-old children by consecutive sampling from health care centers in five main geographical areas in Tehran. Performing cultural and lingual adaptations, our expert team made some inevitable changes to the questionnaires. Almost in all age groups older than 10 months, cultural or linguistic changes were made in items in the “communication” domain. Overall, the questionnaires’ Cronbach alpha was 0.79. The constructive validity of the tests was also satisfactory. Another important finding was determination of the children’s developmental mean scores. The culturally adapted Persian copies of the Ages and Stages Questionnai-res have proper validity and reliability for being used as developmental screening tools for children in Tehran.

Low bone mass is a serious health problem mostly seen in postmeno-pausal women with rheumatoid arthritis. The purpose of this study was to determine the prevalence of osteoporosis and some related risk factors in postmenopausal women with rheumatoid arthritis. The data for this descriptive analytical study was extracted from the medical records of 98 postmenopausal women with rheumatoid arthritis who had attended the 5th of Azar Teaching Hospital affiliated to Gorgan University of Medical Sciences, in Iran, in 2009. The mean durations of menopause and rheumatoid arthritis were 9.39 and 5.13 years, respectively. The overall prevalence of osteoporosis was 13.3%. We found a significant correlation between age, disease duration, and duration of menopause with bone mineral density (P<0.05). Our results indicate a high prevalence of osteoporosis at the lumbar spine of postmenopausal women with rheumatoid arthritis.

Staphylococcus aureus secretes numerous superantigenes which trigger the inflammatory mechanisms of sinus mucosa and cause chronic rhino-sinusitis. This study was designed to evaluate the role of staphylococcus aureus superantigens in polyp tissues of patients with chronic rhino-sinusitis in comparison with a control group. Polyp tissue samples of 28 patients and mucosal specimens of 19 healthy individuals were evaluated for staphylococcus aureus bacterium superantigens, exotoxins A, B, C and D and TSST-1 with RT-PCR and ELISA methods Rasoul Akram Hospital during 2 years. Polymerase chain reaction (PCR) results revealed that 88.2% of the patients and 45.5% of the controls had at least one type of superantigen (P=0.03). Evaluation of superantigens using ELISA method showed presence of at least one type of superantigen in the nasal samples of all patients and in 35.3% of the controls (P<0.001). A relationship between staphylococcal superantigens and nasal polyps is concluded from this study which indicates the probable role of these superantigens in the pathogenesis of nasal polyposis.

Gitelman syndrome is a rare autosomal recessive disorder that typically presents with recurrent muscle cramps, carpopedal spasms, hypokalemic metabolic alkalosis, hypocalciuria and hypomagnesemia and high urine magnesium during adolescence. Mutation in the gene encoding for sodium chloride co-transporter in distal convoluted tubule causes electrolyte imbalance. We present a 10-year-old boy complaining of carpopedal spasms, tingling of fingers and facial parestesia for three years prior to his admission in endocrinology clinic of H. Ali-Asghar Pediatric Hospital. The patient had metabolic alkalosis, hypokalemia, hypocalciuria, increased urine fraction excretion of Mg, serum magnesium of 1.8 mg/dl, normal serum calcium and phosphorus and normal blood pressure. His clinical manifestations recovered after potassium and magnesium administration. A patient with Gitelman syndrome with normal serum Mg. is presented.