مجله دانشکده پزشکی دانشگاه علوم پزشکی تهران
سال هفتاد و دوم شماره 3 (پیاپی 159، خرداد 1393)

Radiotherapy has been used to treat many types of cancers over the past years. Radiotherapy generates side effects on normal tissues. Radiosensitizer products provide decrease in tumor proliferation and reduce radiation dose in radiotherapy. Docosahexaenoic Acid (DHA) as an omega-3 polyunsaturated fatty acid has anti-proliferative effects on malignant cells. In this study، the effects of DHA accompanied by ionizing radiation on growth rate and survival fraction of HT29 colorectal cancer cells were evaluated. The present study was performed at the Institute of Biotechnology، affiliated to Urmia University، Urmia، Iran in the year 2013. In this laboratory experiment، ma-lignant cells were cultured in RPMI-1640 supplemented with 10% fetal bovine serum. HT-29 cells were cultured at 5105 cells/well into 6-well culture plates for overnight. Thereafter، the cells were pretreated with either 50 or 100 µM DHA for 4 hours and malignant cells were irradiated with either dose of 2 or 10 Gy. Cell viability was evalu-ated by trypan blue staining after 48 hours. Moreover، malignant cells were pretreated with either 50 or 100 µM DHA for 48 hours and irradiated with dose of 2 to 10 Gy. Thereafter، survival rate was evaluated by 3- (4،5-Dimethylthiazol-2-Yl) -2،5-Diphenyltetrazolium Bromide (MTT) assay after 6 days. Cell viabilities were found to be 59. 8% and 17. 5% for 50 µM DHA in combi-nation with doses of 2 and 10 Gy respectively. Using 100 µM DHA diminished cell vi-ability up to 47% and 13. 9% following doses of 2 and 10 Gy respectively. Treatment of cells with DHA accompanied by increasing doses of γ-rays significantly diminished survival rate. In treated cells with 50 and 100 µM DHA، survival rate were measured to be 79. 1%، 57. 6%، 42. 8%، 40. 5%، 34% and 55. 8%، 43. 7%، 33. 6%، 27. 9%، 23. 5% for doses of 2، 4، 6، 8 and 10 Gy respectively. Our study indicates that DHA decreases colorectal cancer cells prolifera-tion and could provide a new radiosensitizer drug to enhance the efficacy of colorectal cancer radiotherapy.

The occurrence of Atrial Fibrillation (AF) is linked to an increased inflam-matory response after cardiac surgery that is significantly decreased by anti-inflammatory treatments. The present study aimed at administrating Colchicine as a way to reduce the incidence of post- Coronary Artery Bypass Graft (CABG) atrial fibrillation. In this double-blind، parallel clinical trial، 216 patients with coronary artery disease who underwent CABG surgery، by using a table of random numbers are divided into intervention and control groups to receive placebo or Colchicine. The clinical and surgical characteristics of the patients in two groups were similar. The intervention group received 1. 0 mg of Colchicine tab، the night before surgery and on the morning of surgery. This drug followed by 0. 5 mg twice a day for five days after surgery. On the other hand patients in the control group received only placebo (ineffective pill with similar size to Colchicine). After operation two groups were compared regarding important outcomes such as postoperative arrhythmia، ICU stay and hospital stay. The data were assessed using SPSS software (version 17) and t-test and 2 statistical tests. One hundred fifty six men and sixty women with a mean age of 59. 9±9. 3 years were enrolled in the study in two Colchicine and placebo groups (each consisting of 108 patients). The incidence of postoperative atrial fibrillation was 14. 8% in the Col-chicine group and 30. 6% in the control group (P= 0. 006). ICU stay in the Colchicine group were 2. 4±1. 3 days versus 3. 1±1. 5 days in controls (P< 0. 001) and hospital stay in the Colchicine group were 6. 6±1. 5 days versus 8. 1±2. 0 days in controls (P< 0. 001). Colchicine is an anti-inflammatory medication and has very few side effects at low doses. According to the 48% reduction in the incidence of atrial fibrillation in Colchicine patients undergoing coronary artery bypass grafting surgery، this drug can be prescribed as a prophylaxis for prevention of post-CABG atrial fibrillation.

Septate uterus is the most common congenital malformation of the uterus in normal population and also patients with recurrent abortions. Pathogenesis of the disease is incompletely elucidated. It is clarified that incomplete absorption of paramesonephric ducts in the first trimester is responsible for septum formation. Hysteroscopy is known as the standard diagnostic and therapeutic procedure for septate uterus. In this study، our aim was to evaluated the effects of hysteroscopic septal resection in improving pregnancy outcomes in patients with unexplained infertility or recurrent abortion. Prospective cohort study was conducted in a Tehran University Medical Sci-ences affiliated hospital from April 2012 to May 2013. Eight patients were excluded from the study because of non-reproductive related complains. The other 40 patients went through a prospective cohort study and were treated for septate uterus. All patients had complete history taken and underwent physical examination. Septum size was measured by hysteroscopy. Patients underwent hysteroscopic metroplasty with resectoscope with an equatorial semicircular loop cutting 12 with monopolar energy. Some septum resected by 5 french hysteroscopic scissor. The patients were visited 2 month later for evaluated surgical outcome. This assessment was done by hysterosalpingography (HSG). Patient’s reproductive outcome were followed for 10. 33 (SD: ±6. 43) months. The mean age in patients was 31. 5 (SD; ±3. 02) years. In whole، 48 patients un-derwent hysteroscopic metroplasty. In 52. 1% length of septum occupied two third of uterine cavity. Eight patients were excluded from the study because of non-reproductive related complains. There were 29 pregnant patients (72. 5%). Fifteen patients became pregnant without intervention (51. 7%). 14 patients had pregnancy under ART، while the pregnancy did not occur in 11 patients (27. 5%) during this period. Among pregnant population there were 9 miscarriage (31%)، 3 preterm (13. 3%) and 17 term delivery (50%). Live birth rate in our study was 68. 9%. In control hysterosalpingography (HSG)، no patients had adhesion or residual ridge. The findings of this study indicate that hysteroscopic septoplasty is ac-ceptable for improving reproductive outcomes in patients with septate uterus.

Any time before labor that termination of pregnancy for mother and fe-tus is better than keeping pregnancy، this is indication of induction for labor. The condi-tion of cervix is the most important factor for labor induction. Cervical condition، In many cases that candidate for induction of labor before labor pain، is poor. As the cervical ripening is quite important for success of labor induction. This study is attempting to compare two methods of cervical ripening. During this clinical study، 100 patients admitted in Ahwaz Imam Khomeini Hospital from 2010 to 2011. All of these patients had BISHOP score bellow 5، were di-vided to two groups for cervical ripening. Group one: trans cervical catheter and group two: laminaria. After placing transcervical foley catheter and laminaria for patient in-duction with oxytocin was started according to classic protocol. Then the time lapse from the beginning of induction to enter the active phase of labor and also from start of induction till delivery and appearing the side effect in both group was assessed. The result was analysed by SPSS 16 program. Fifty three of patient (53%) were primiparous and the rest 47 (47%) were mul-tiparous. All of them had bishop score bellow 5. The average age for the patient group 1 was 27. 1 and the average age for other group was 27. 18. The time lapse from start of induction to enter active phase of labor in first group was 5. 7±2. 67 hours and this time for 2nd group was 7. 51±2. 33 hours. Also the time interval between the start of induction and delivery in group 1 was 10. 3±4. 35 hours and this time for group 2 was 12. 5±4. 9 hours. In both cases there was meaningful difference between two groups. There was no difference between both group for appearing the side effects. Based on this study، it seems using trans- cervical catheter for cervical rip-ening and aid to successful induction of labor is beneficial.

Pseudomonas aeruginosa is a gram-negative pathogens opportunism which causes severe infections in human beings. The most common infection include: endocarditis، meningitis، septicemia and chronic lung infections in cystic fibrosis pa-tients. This bacterium has many pathogenic factors including; exotoxin A، lipopoly-sacharide، phospholipase C، pili، elastase and alkaline protease. The purpose of this study was to evaluate the frequency of exotoxin A gene (ETA) as a strong virulence factor and sensitivity determination of polymerase chain reaction (PCR) in pseudomonas aeruginosa isolated from second and third-degree burn patients. This study has performed in Besat University Hospital in Hamadan from January to December 2012. We used 170 isolated samples. The samples were isolated from blood and skin biopsy in second and third-degree burn patients. We had 79 strains positive culture of pseudomonas aeruginosa. Forward and reverse primers used for PCR were designed by DNASIS and Oligo software. Then genomic of known strains were extracted by DNA purification kit and indentified by PCR. The quality and quantity of the extracted DNA was determined using spectrophotometry. For determination of PCR sensitivity was used culture test as gold standard. DNA of pseudomonas aeruginosa (ATCC 27853) was used as a positive control. Finally data was analyzed using SPSS software. Out of 170 isolated samples، 79 strains of pseudomonas aeruginosa isolated from burn patients had positive culture. PCR of isolated positive culture demonstrated that 5 strains (6. 33%) were with out this virulence factor and 74 strains (93. 67%) had ETA gene. So the sensitivity of test based on sensitivity formula was 94. 04%. Our results showed that sensitivity of PCR mediated ETA gene in detection of pseudomonas aeruginosa strains is considerable and this factor can be used as a good factor identifying of pseudomonas aeruginosa. It seems more studies with larger sample size is necessary in this area.

Gonadotropin-releasing hormone analog (GnRHa) therapy is used in central precocious puberty (CPP) worldwide and it is the treatment of choice for this condition. Many of the previous studies concerning the effect of gonadotropin-releasing hormone analog (GnRHa) therapy on height. Much less attention has been paid to changes in body weight. However، concerns have been expressed that CPP may be associated with increased body mass index (BMI) both at initial presentation and during GnRH agonist treatment، but it is controversial in some studies. We have retrospectively reviewed 52 female patients that the majority of them had CPP. We assessed height، height SDS، weight، weight SDS، BMI and BMI SDS. All patients were treated with GnRHa over 12 months. The variables were evalu-ated at 0، 6 and 12 months after initiation of treatment. 8 girls received growth hormone concomitantly. Also bone age and sexual maturity were measured. Bone age was assessed according to the Greulich-Pyle method and sexual maturation was classified according to the Marshall-Tanner method. Before the initiation of therapy، the girls had a mean BMI SD score for chronological age of 0. 80± 1. 18 after 6 months of therapy BMI SDS was 0. 82± 1. 15 and after 12 months was 0. 82± 1. 28 the P value is 0. 909 and it is not statistically signif-icant. Height SD score for chronological age was 0. 41± 1. 65 before the initiation of therapy and was 0. 41± 1. 65 after 6 months and 0. 43± 1. 60 after 12 months of therapy. The P= 0. 66 and it is not statistically significant. Eight girls received growth hormone concomitantly، in this group increasing height SDS is statistically significant P= 0. 044 but increasing BMI SDS is not significant. Gonadotropin-releasing hormone analog (GnRHa) therapy in central precocious puberty (CPP) is safe for BMI and increasing of BMI is not significant، long- term follow-up study is required to elucidate whether GnRHa treatment affects adult obesity. Using growth hormone concomitantly، the effect on increasing height is significant.

The rate of using firearm in criminal acts، even in countries with strict le-gal controls on these weapons is increasing. The most common methods of homicides and suicides are using firearm in United States. In this study we aimed to evaluate the epidemiology of gunshot bodies referred to Forensic Medicine. Information about firearm-related injuries in autopsy hall of Forensic Medi-cine center in Tehran during 2011-2012 were evaluated from patients’ documents. Necessary information including age، sex، education، employment، drug and alcohol addiction، as well as information related to shot such as suicide or homicidal، shoot number (incoming bullets)، shot location، type of firearm، organ damage، shot distance and location of the incident were extracted and analyzed using SPSS version 16. In this cross sectional study، 38 deaths were identified. These were over-whelmingly males (100%) with mean age of 32. 4 (SD= 6. 57). The typical entrance wound sites in suicides were the head (42. 2%) and chest (24. 3%) and abdomen (5. 4%) and limb (2. 7%) and others (48. 6%). place a bullet in the head، 16 (42. 2 %)، chest 9 (24. 3%)، the abdomen، 2 cases (5. 4%)، an organ (2. 7%) and hit a different place (9 cas-es 24. 3 percent). Brain damaged in 18 cases (84. 6%) and lung 5 (13. 5%) and 12 (32. 4%) and several organs were damaged. The typical entrance wound sites in suicides were the head (42. 2%) and chest (24. 3%) and abdomen (5. 4%) and limb (2. 7%) and others (48. 6%). This total included 33% attempted or completed suicides، and 47. 5% assaults/homicides The scene of disaster were the 12 patients (50%) outdoors، 8 (33. 3%) at home and in 4 cases (16. 7%) at work. Based on results of this study، age of victims is higher than previously ob-served patterns، such as gender of victims، location of shots، type of weapon used is different with international reports due to differences in availability of Iranian weapons and cultural differences. The results of this study can be a base for other investigations’s changes in trends of total firearm death rates، mass fatal shooting incidents، rates of firearm homicide، suicide and unintentional firearm deaths، and of total homicides and suicides.

Juvenile Rheumatoid Arthritis (JRA) is the most common chronic pediat-ric rheumatologic disease. There is a wide range of variation in disease subgroup distri-bution and evolution according to different populations، environments and genetic pre-disposition. This study was designed to evaluate epidemiologic characteristics of JRA in Iran. A cross-sectional studies was performed on children suffering from JRA ac-cording to American College of Rheumatology during 10 year (2002-2011). Patients'' data was recorded in hospital questionnaires; Patients'' age at the first presentation and time of diagnosis، sex، ethnicity، early clinical and constitutional presentations، joint in-volvement pattern and presence of associated diseases were evaluated. In this study، 171 children (91 boys and 80 girls) were enrolled. The mean age of patients was 5. 2±3. 5 years at the time of presentation and 5. 7±3. 6 years when the diagnosis was confirmed. The most common type of disease was polyarticular arthritis (41. 9%). The prevalence of pauciarticular and systemic onset subtype were 31. 6% and 19. 3%، respectively. According to ethnicity، the most common incidence was seen in Fars and Turk populations respectively. The most common constitutional presentation was fever. Fever and morning stiffness was significantly higher in polyarticular pa-tients. Extra articular manifestation was seen in 40. 4% patients. Among extra-articular manifestations، skin involvement was seen more than others. There was no correlation between sex and type of chronic arthritis. Uveitis was detected in 5. 8% of our cases. The mean age was significantly higher in polyarticular group (6. 04 year) in comparison to pauciarticular and systemic group (4. 4 year in both groups) (P= 0. 005). There was no correlation between sex and type of chronic arthritis. The prevalence of JRA subgroups was different in Iran comparing with western countries and polyarticular disease was the most common subgroup in this study. Uveitis was less common in this study in comparison to studies in other coun-tries. There is no sex predilection in each subgroup of JRA.

Judicious use of antibiotics is essential considering the growth of antimi-crobial resistance and escalating costs in health care. Ceftriaxone is a third-generation cephalosporin used widely for the treatment of various infections in outpatient and in-patient. The purpose of this study was to evaluate the ceftriaxone utilization before and after implementation of guidelines and physicians education. A descriptive cross-sectional، before-after intervention study was performed in 6 wards of a teaching hospital in Tehran، Iran. The study was conducted in three phases: pre-guideline، educational interventions and post guideline implementation. The pre intervention phase included chart analysis of current ceftriaxone use in 200 consecutive patients from the representative wards included in the study. The educational interventions included preparation and distribution of ceftriaxone guidelines as pamphlets among physicians working in the studied wards. Also the clinical pharmacist returned to each ward and trained physicians regarding the correct use of ceftriaxone. In the post intervention phase immediately after the instruction، and in the follow up phase، one month later، a prospective analysis of ceftriaxone utilization was performed by chart review of 200 patients to detect changes in ceftriaxone utilization pattern. Four hundred cases were evaluated during study (200 before and 200 after physician’s education). The correct indication of ceftriaxone was 93% and 96% before and after the educational interventions respectively. Analysis showed that correct indi-cation of ceftriaxone did not change significantly before and after education (P= 0. 188). Regarding to proper administration (dose، interval and duration) ceftriaxone utilization significantly changed after education (P< 0. 001). Adoption of the guidelines with associated training resulted in significant improvement in ceftriaxone administration pattern in the hospitals.

Anabolic-Androgenic Steroids (AAS) are mainly abused by athletes for improvement of muscle performance. Data suggest that the effect of AAS on neurobiochemicals related to behavioral response، may be underlies psychological adverse effects. Physical activity has beneficial psychophysiological effects، which may be related to increased serum levels of endogenous opioid peptides during exercise. In the present study we aimed to study the effect of chronic administration of nandrolone decanoate on beta-endorphin and met-enkephalin level in exercising rats. In this experimental study، forty male Wistar rats were randomly assigned in two main groups of sedentary and trained (2 weeks swimming exercise). Animals in each group were divided in two subgroups of control (received nandrolone solvent) and drug treatment (received nandrolone 15 mg/kg، 5 times/week). After two weeks of swimming exercise and drug treatment، serum levels of beta-endorphin and met-enkephalin were measured using ELIZA. Our data showed that two weeks of swimming exercise training significantly increased serum beta-endorphin (114±5 vs. 98±5 ng/l in control group، P= 0. 038) and met-enkephalin levels (1556±42 vs. 1475±27 ng/l in control group، P= 0. 25). However، chronic administration of nandrolone decanoate in trained group considerably de-creased beta-endorphin (84±4 vs. 114±5 ng/l in control group، P= 0. 002) and met-enkephalin levels (1378±36 vs. 1556±42 ng/l in control group، P= 0. 011). The effect of supraphysiologic doses of nandrolone decanoate in control sedentary group was not statistically significant. In the present study we show that chronic nandrolone decanoate admin-istration attenuates effects of two weeks swimming exercise on serum opioid peptide and reduces the level of beta-endorphin and met-enkephalin. Keeping in mind that opi-oidergic system play an important role in behavior، athletes abusing anabolic steroid drugs may potentially experience changes in mood and behavior.