Acta Medica Iranica
Volume:52 Issue: 4, Apr 2014

Nowadays, cell -based and tissue engineered products have opened new horizons in treatment of incurable nervous system disorders. The number of studies on the role of Schwann cells (SC) in treating nervous disorders is higher than other cell types. Different protocols have been suggested for isolation and expansion of SC which most of them have used multiple growth factors, mitogens and fetal bovine sera (FBS) in culture medium. Because of potential hazards of animal-derived reagents, this study was designed to evaluate the effect of replacing FBS with human autologous serum (HAS) on SC’s yield and culture parameters. Samples from 10 peripheral nerve biopsies were retrieved and processed under aseptic condition. The isolated cells cultured in FBS (1st group) or autologous serum (2nd group). After primary culture the cells were seeded at 10000 cell/cm2 in a 12 wells cell culture plate for each group. At 100% confluency, the cell culture parameters (count, viability, purity and culture duration) of 2 groups were compared using paired t-test. The average donors’ age was 35.80 (SD=13.35) and except for 1 sample the others cultured successfully. In first group, the averages of cell purity, viability and culture duration were 97% (SD=1.32), 97/33% (SD=1.22) and 11.77 (SD=2.58) days respectively. This parameters were 97.33% (SD=1.00), 97.55% (SD=1.33) and 10.33 days (SD=1.65) in second group. The difference of cell count, purity and viability were not significant between 2 groups (P>0.05). The cells of second group reached to 100% confluency in shorter period of time (P=0.03). The results of this study showed that autologous serum can be a good substitute for FBS in human SC culture. This can reduce the costs and improve the safety of cell product for clinical application.

Neural Cell Adhesion Molecules (NCAMs) are known to influence memory by affecting neural cell-cell and cell-extracellular matrix junctions. This study investigated the possible role of cAMP pathway in the expression of hippocampal NCAM and its polysialylated derivative (PSA-NCAM). The following pharmacological tools were employed for manipulation of cAMP pathway: a) forskolin; the activator of adenylyl cyclase (AC), b) 8-Br-cAMP; a protein kinase A (PKA) agonist, c) 8-pCPT-2′-O-Me-cAMP; a selective enhancer of exchange protein activated by cAMP (Epac) and d) Rp-cAMP; a PKA inhibitor. Memory acquisition was tested by passive avoidance paradigm after injecting the above compounds for three consecutive days into the CA1 region of dorsal hippocampus of rats. Forskolin and 8-Br-cAMP enhanced memory retrieval while Rp-cAMP significantly reduced memory and NCAM levels. 8-pCPT-2′-O-Me-cAMP failed to alter memory performance or NCAM levels as compared to vehicle. We observed no significant changes in PSA-NCAM, however the expression of St8sia4 and St8sia2 (the polysialyltransferase isoforms) were altered. The mRNA levels of St8sia4 was down-regulated by 8-Br-cAMP, Rp-cAMP and 8-pCPT while forskolin led to almost 3 and 5 fold increase in mRNAs of St8sia2 and St8sia4, respectively. The current insight might endorse the predominant role of PKA as compared to Epac in cAMP pathway in expression of NCAM and memory function.

Search results show that numerous primary studies have been carried out in different parts of Iran regarding prevalence of G6PD deficiency; if results of these studies are combined, a reliable estimation of prevalence of this factor will be achieved in Iran. Thus, present study, aimed to determine the prevalence of G6PD deficiency by combining findings of qualified primary studies using meta-analysis and taking into account heterogeneity considerations. Searching the relevant keywords in Iranian and International databases, primary studies were selected. After quality appraisal and applying inclusion and exclusion criteria, relevant primary studies were selected. In each study, standard error of prevalence of G6PD was calculated according to binominal distribution formula. Finally, heterogeneity index was determined among studies using Cochran's test. Prevalence of G6PD in Iran was estimated by STATA software ver 11 using fixed or random effect model based on heterogeneity results. 148916 subjects in 36 primary studies which entered this meta-analysis were examined. G6PD deficiency prevalence was 6.7% in Iran (men: 8.8% and women: 2.2%). Also, this deficiency in the present study was four times higher in men than in women. Its prevalence was adjusted in different parts of Iran and it was shown that it was between 0.8 and 15.2 using Bayesian analysis. This meta-analysis showed that Iran is among countries with high frequency of G6PD deficiency and there is a significant difference in prevalence of G6PD in different parts of Iran. According to these results, screening newborn children seems very vital. Carrying out other primary studies regarding prevalence of G6PD seems unnecessary.

Calcification and inflammation are among the important cases of exudative age-related macular degeneration (E-ARMD). The aim of the present study was to elucidate if there is any relationship between serum Osteoprotegerin (OPG), soluble receptor activator of nuclear factor-kappa B ligand (RANK-ligand) and E-ARMD. In a cross-sectional study, we compared 45 E-ARMD patients with 45 matched controls. Diagnosis was confirmed by fluorescein angiography. Serum samples were analyzed for OPG, RANK-ligand, low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), total cholesterol (TC), and triglyceride (TG). The levels of OPG and RANK-ligand were measured by ELISA methods. The mean age was 72.0±11.5 years in the E-ARMD group and 68.2±8.9 years in the control group (p=0.09). The level of serum OPG was 132.10±75.49 pg/ml in the E-ARMD group and 94.88±61.65 pg/ml in the control subjects. E-ARMD patients had significantly high levels of OPG (p=0.012), as well as significantly high levels of LDL-C and TC (p=0.001 and p=0.005, respectively). We could not find any significant difference in RANK-ligand, HDL-C, or TG between two study groups (p>0.05). To the best of our knowledge, this is the first study investigating the levels of OPG in E-ARMD patients. The present study showed that E-ARMD patients had high levels of serum OPG. It may act as a protective factor for E-ARMD or only as a secondary phenomenon of different processes of E-ARMD. Further prospective studies would be necessary for prognostic and predictive significance of OPG in patients affected by E-ARMD.

Although triple (Omeprazole, Amoxicillin, and Metronidazole) and quadruple (Omeprazole, Tetracycline, Metronidazole, and Bismuth Subcitrate) therapeutic regimens for H. pylori eradication has been studied much in the general population, there is a lack of data in renal transplanted patients. So, this study aimed at comparing regimens in these patients who were considered being immunocompromised. The present clinical trial was carried out in Mashhad, Iran in 2010. Fifty-five patients who had received a kidney transplant in six months or earlier and referred for chronic dyspepsia were selected. They were resistant to H2-receptor antagonists or proton pump inhibitors therapy and had positive Rapid ‎Urea Test. They randomly divided into two groups: triple and quadruple therapy. The treatment duration in both groups was similar (antibiotics for two weeks plus omeprazole for 4 weeks). Urea Breath Test (UBT) was performed two weeks after treatment for assessment of its result. Total numbers of 39 patients (71%) were positive for H. Pylori which were divided into triple therapy group (21 patients) and quadruple therapy (18 patients). Overall, the treatment was successful in 80% (71% in triple therapy and 89% in quadruple one) which was not different significantly between the groups (p=0.247). The result of this study revealed that the prevalence of H. pylori infection in renal transplant patients is similar to the normal population. In these cases, triple and quadruple therapies were similar in eradication of H. pylori. So, triple therapy can be recommended in renal transplant recipients.

Recent studies in animal models indicate that recombinant human erythropoietin (rhEPO) is very effective in enhancing neurological recovery after spinal cord injury (SCI). We aimed to evaluate the effect of rhEPO plus methylprednisolone sodium succinate (MPSS) compared to MPSS alone to improve neurological function of patients after SCI in a randomized clinical trial. During a 15-month period 30 patients presenting to emergency departments of two university affiliated hospitals within less than 6 hours after acute SCI were randomized to two groups. Both groups received MPSS 30 mg/kg initially and 5.4 mg/kg every hour till 23 hours if admitted within 3 hours and till 47 hours if recruited within 3-6 hours after injury. Group EPO also received 500unit/kg rhEPO on admission and another 500 unit/kg 24 hours later instead of placebo in group MPSS. Neurologic evaluation was performed on admission, 24, 48, 72 hours and one and 6 months later. Range of patients’ age was 18-65 years. There was no significant difference between patients receiving two types of treatment in neurological exam on admission (P=0.125), 24 hours after admission (P=0.108) and 48 hours after admission (P=0.085). However, one week (P=0.046), one month (P=0.021) and six months (P=0.018) after admission these differences were significant. MPSS plus rhEPO started within 6 hours after acute spinal injury may be more effective than MPSS plus placebo in improvement of neurologic dysfunction. More studies with larger sample sizes are warranted.

Passive smoking was long overlooked by those in the medical and legal professions as being harmful to one's health, but in recent years the negative effect of passive smoking has come to the fore in the media and laws have been changed so that less people are obliged to unwillingly suffer from passive smoking, particularly in the workplace and in indoor settings. To study the effects of environmental tobacco smoking exposure during the breast-feeding period on maternal milk lipids. This cohort study was conducted on 45 mothers environmental tobacco smoking exposure and 40 non-exposed post-partum mothers referred to the Shahid Ayat health center, Tehran, Iran. Socioeconomic conditions and the demographic characteristics of exposed and non-exposed groups were recorded. Milk samples were collected twice- at baseline (5-7 days after delivery) and four months after delivery. The samples were reserved at −20°C until assay. Milk lipids including cholesterol, triglyceride (TG), high density lipoprotein (HDL) and low density lipoprotein (LDL) were evaluated. Dietary intake assessment was performed by means of the 24-hour dietary recall questionnaire both times. Maternal occupation status and education levels were significantly different between the two groups. Lipids profiles of milk were significantly higher 5-7 days after delivery in the non-exposed group and four months after delivery. Dietary intake was not significantly different between the two groups. Maternal environmental tobacco smoking exposure affects milk lipids which are essential for infant growth.

T/NK cell proliferative EBV associated disease is a rare one which is more common in eastern Asian countries. EBV is originally associated with B cells, and EBV associated T cell lymphoma is so rare. Hence we decided to describe a patient treated with misleading diagnoses such as TB and sarcoidosis for almost two years. The liver was biopsied after admission in this center, and gastric and colonic biopsy was also performed due to gastrointestinal bleeding. Diffuse infiltration of chronic inflammatory cells was seen, especially lymphocytes some of which were atypical. T lymphocyte markers were seen in these cells by immunohistochemical staining. Further studies demonstrated T lymphocytes associated with EBV to be positive which is very rare event. Although going under chemotherapy, there were no response and the patient died.

Vitamin D deficiency has been proposed as an associating factor with increased blood pressure. We studied the relationship between serum vitamin D and blood pressure in a large representative sample of Iranian population. In this cross-sectional study, based on the data of 2508 adults (aged between 20 and 70 years) from the Iran Multicenter Osteoporosis Study (IMOS), the association between serum vitamin D and blood pressure was investigated. There was a significant difference between mean (±SD) vitamin D levels of the individuals with stage I hypertension and that of the three other groups (Normal: 32.9 (±27.5); Prehypertension: 34.4 (±27.2); Stage-I: 38.7 (±29.2); Stage-II: 34.7 (±24.0) ng/ml; P<0.05. In multivariate regression models, the weak positive association of vitamin D and systolic blood pressure values disappeared after age and Body Mass Index (BMI) adjustment. We found a statistically positive but weak association between vitamin D serum concentration and systolic blood pressure. Considering the difference noted between our results and previous studies, further research is needed to assess the potential effect of ethnicity and genetic factors on these findings.

One of the identified risk factors for anxiety disorders in adolescence and adulthood is inhibited behaviors in childhood. The present study sought to examine the relationship between behavioral inhibition with some of the internal (personal) and external (family environment) factors in a sample of preschool children in kindergartens. In a cross sectional study in 2009, data was collected trough a structured questionnaire completed by parents and teachers in day-care centers. A total of 1403 children were assessed. Analysis was performed through complex sample analysis. The results showed that 7.4% (CI95%= 6.1%-9.1%) of children according to parents’ and 8.1% (CI95%= 6%- 10.7%) according to teachers’ evaluation classified as behaviorally inhibited. The higher levels of behavioral inhibition were shown by girls, first children, single parent families and older children. Birth year before 2004, birth rank, living in a single parent family and maternal level of education were independent predictors for behavioral inhibition in logistic regression modeling. There is relatively high prevalence of inhibited behaviors among Iranian children. Further examination of diagnosed children with behavioral inhibition by experienced psychiatrists is needed. Also establishing consultation centers for behaviorally inhibited children and instructing their parents and teachers are recommended.

Cytomegalovirus (CMV) and rubella are considered as dangerous viral infections to the fetus. The findings of this research can clear the possible progress made thus far toward prevention in this part of the country. The data of all referees to genetic center of Shahid Beheshti Hospital in Hamadan, including the rubella and CMV tests were recorded in questionnaires and analyzed by logistic regression models. Univariate and multivariate logistic regression were utilized to assess the affected factors on CMV and Rubella separately. STATA and SPSS16 statistical software were used with setting P-value as 0.05. Logistic regression analysis indicates a statistically significant relationship between CMV IgM and on occupation (P=0.045), pregnancy (P=0.03) and years of referring the patients (P<0.001). The results of multivariate logistic regression analysis showed that job was significantly affected on the CMV infection [OR (95% C.I) = 1.71(1.1-2.83)]. Univariate logistic regression showed that age (P=0.001), the residential area (P=0.03), pregnancy (P=0.03), the marital status (P=0.022) and years of referring the patients (P<0.0001) has a significant effect on rubella IgG. However, multivariate logistic regression analysis also showed that residential status (OR=1.77) and age (OR=0.63) were significantly affected on the Rubella infection. The high level of IgG positivity against rubella in females may highlight the considerable impact of increasing public vaccination in this part of Iran. Also, the current data demonstrating frequency of primary infections with CMV in females which support the conclusion that regular prenatal screening tests is justified.

Knee infection after arthroscopic surgeries is rare but devastating complication. A serial knee joint infection occurred in our hospital after the contamination of arthroscopic equipments set with an unknown microorganism. Herein we describe the natural course of these patients and suggest a treatment protocol according to the experiment gained from management of these patients.

Multiple sclerosis (MS) is an inflammatory disease of central nervous system (CNS) and sexual dysfunction (SD) is one of the most common disabilities of MS women. The aim of this study was to determine sexual function of women with MS (multiple sclerosis). One hundred definite MS patients MS patients and fifty age-matched healthy controls were enrolled. Demographic data (sex, age), duration of the disease and disease pattern extracted from patient’s files and Kurtzke Expanded Disability Status Scale (EDSS) recorded for each patient by an expert neurologist. Participants were asked to answer the valid and reliable Persian version of Beck depression inventory (BDI) and Female Sexual Function Index (FSFI) questionnaires. The total FSFI score and subscale scores differed significantly between the MS patients and the controls. There was a significant negative correlation between EDSS and FSFI scores (rho=-0.44, P<0.001) and significant positive correlation between EDSS and BDI (rho=0.36, P<0.001) in patients. Mean BDI and all subscales of FSFI differed significantly between patients with total FSFI score higher and lower than 26.55. Sexual dysfunction should be considered in women with multiple sclerosis.

Intramuscular cavernous hemangiomas represent less than 1% of all hemangiomas. Typical presentation is a soft-tissue mass and/or pain without cutaneous changes. Whereas calcification of hemangiomas is common; ossification of these lesions is very rare. We describe a case of ossified intramuscular hemangioma of quadriceps presented with painless knee extension contracture and thigh mass.

We presents an infant with several indurated plaques and nodules scattered on her body. She was brought to the hospital because of fever, runny nose and cough from one month ago. During the examination and investigation the plaques and nodules grabbed the attention of the clinicians and the skin biopsy and other lab works revealed the diagnosis of congenital leukemia.

In this case we present a previously healthy child with sudden behavioral change and acute confusional state (ACS). ACS is a neurologic emergency. The clinical manifestations of ACS are; confused affect, limited verbal response, disturbance in performing orders, some automatism, stable vital signs and absence of tonic-clonic movements and it has a wide range of differential diagnosis which should be assessed by detailed medical history, medical examination and laboratory tests. The only abnormal test found in this patient, was cerebrospinal fluid abnormality, consistent with viral encephalitis.