مجله دانشکده پزشکی دانشگاه علوم پزشکی تهران
سال هفتاد و دوم شماره 11 (پیاپی 167، بهمن 1393)

Growing and developing are influenced by genetic, social and environmental factors and it's most important and initial phase step is formed of the early life of the fetus and infant. According to the world health organization, the incidence of preterm birth and low birth weight are increasing in most countries that most of it related to developing countries. Low birth weight (LBW) and preterm birth are one the most important causes of death in the world and therefore are considered as one of the major health problems that can affect growing and developing so that it can threaten public health. Advances in medical technology in recent decades at intensive care unit, increased survival of premature infants and high-risk specialist care is needed, but failed, to reduce the complications of premature birth but it couldn’t reduce complications of preterm birth. There is also an increased recognition of the potential disconnect between perinatal outcomes and long-term outcomes. The administration of oxygen and postnatal steroids are prime examples of interventions that may have immediate positive effects but negative long-term effects. Many premature babies will be encounter with mobility problems, cognitive, neurosensory impairments, cerebral palsy, cognitive and language delays, neuromotor developmental delay, blindness and hearing loss, behavioral and psychosocial disorders, learning difficulties and dysfunction in scholastic performances in the future. These disadvantages appear to persist into adulthood and therefore have broad implications for society. Without a doubt, one of the tragedies of the world is people with physical or mental damage caused by premature birth, many of these disorders are not early diagnosed and the prediction of long term complications of infants discharged from the NICU is difficult. Although nourodevelopmental follow-up of these babies is a necessary part of the neonatal assessment but there is no standard process for it. The present review article aims to introduce the care process and tools that is used for following-up these babies, also introduces the application of screening tools for neuro-developmental care.

Depression, as one of the most prevalent and disabling disorders in the world, has a complex and yet not well-known pathophysiology. Genetic, hormonal, neurotransmitter, inflammatory and neurodegenerative theories are all responsible. Studies show that depression leads to structural changes in the hippocampus, prefrontal cortex, amygdala, anterior cingulate, and basal bodies. Hippocampal volume loss is observed due to the death of nerve cells, neurons, and glial cells, and reduced neurogenesis. The hippocampus is a part of the limbic system. The limbic system is the area in the brain that is associated with memory, emotions, and motivation. The limbic system is located just above the brain stem and below the cortex. Despite the many studies related to the reduced hippocampal neurogenesis in depressed patients, no study has compared the amount of neurodegeneration between the left and right hippocampus. In this study, we compared neurodegeneration levels in the right and left hippocampus of the rats. Twenty male Sprague-Dawley rats that were purchased Razi Institute, Karaj, Iran, were evaluated in the study. This study was conducted in cellular and molecular center in Iran University of Medical Sciences, from June 2012 to June 2013. Half of them had unpredictable chronic mild stress (UCMS) for 21 days to develop depression. The forced-swimming test (FST) was used to measure the immobility time (IB), a symptom of depression. One week after the behavioral test, the rats were prepared for transcardial perfusion. Then, paraffin fixed brain was excised and the hippocampus was prepared for Nissl staining. All above-mentioned procedures were performed for the control group too except inducing UCMS. Our results increased IB in the UCMS group, 68.8 second in stress group and 15.1 second in control group. Nissl staining showed prominent neural degeneration in the hippocampus of the rats in the UCMS group. Comparison of the left and right hippocampal cells revealed that the right hippocampus (mean= 49.166) was more vulnerable to stress than the left hippocampus (mean= 76.6). Our study showed different manifestations of depression after UCMS. It showed that UCMS could lead to mental depression. This study showed that the right hippocampus was more sensitive to stress than the left hippocampus. In fact, UCMS resulted in depression. The study showed that the right hippocampus was more sensitive to stress than the left hippocampus. Therefore, the main function of the right hemisphere, which is adaptation to the new environment, is disturbed more.

About 15% of couples have fertility problems and male factor in fertility accounts for half of the cases. In vitro generation of germ cells introduces a novel approach to male infertility and provides an effective system in gene tracking studies, however many aspects of this process have remained unclear. We aimed to promote mouse embryonic stem cells (mESCs) differentiation into germ cells and evaluate its effectiveness with tracking the expression of the Testis specific 10 (Tsga10) during this process. This is an in vitro study that was performed in department of Medical Genetics in Tehran University of Medical Sciences from February 2012 to March 2013. Mouse embryonic stem cells were cultured on mouse embryonic fibroblast as feeder layer. Then mESCs were differentiated into germ cells in the presence of Retinoic Acid. Based on developmental schedule of the postnatal testis, samples were taken on the 7th, 12th and 25th days of the culture and were subjected to expression analysis of a panel of germ cell specific genes (Stra8 as pre-meiotic, Dazl and Sycp3‌ as meiotic and Protamin1 and Spata19 as Post-meiotic). Expression of Testis Specific Gene 10 (Tsga10) at RNA and protein levels was then analyzed. It was shown that transition of embryonic stem cells from mitosis to meiosis occurred between 7th and 12th days of mESC culture and post-meiotic gene expression did not occur until 25th day of the culture. Results showed low level of Tsga10 expression in undifferentiated stem cells. During transition from meiotic to post-meiotic phase, Tsga10 expression increased in 6.6 folds. This finding is in concordance with in vivo changes during transition from pre-pubertal to pubertal stage. Localization of processed and unprocessed form of the related protein was similar to those in vivo as well. Expression pattern of Tsga10, as a gene with critical function in spermatogenesis, is similar during in vitro and in vivo germ cell generation. The results suggest that in vitro derived germ cells could be a trusted model to study genes behavior during spermatogenesis.

Helicobacter pylori is a gram negative microaerophilic spiral bacilli, which causes duodenal and gastric ulceration. Also this organism cause distal gastric adenocarcinoma and primary gastric lymphoma. The most important Helicobacter pylorus virulence factor is cytotoxin associated gene A (cagA) Pathogenicity Island that cause secretion of antibody by stimulation of immune system. Measurement of the serum antibody can be used to diagnosis strain of Helicobacter pylorus that causes peptic ulcer disease (PUD). Serological discrimination between strain types would reduce the need to emergent endoscopic studies. The aim of this study was comparison of serum anti-CagA antibodies of patients with peptic ulcer disease and patients with Non-ulcer dyspepsia. This case-control study was carried out from october 2011 to october 2012, in 130 patients who complained of dyspepsia more than six months and referred to gastroenterology and endoscopic ward of Firoozgar Hospital, Iran University of Medical Sciences, Tehran. Serum sample obtained from all patients. Anti-CagA antibodies levels were measured in serum samples using ELISA technique. Patients with peptic ulcers as cases and patients without peptic ulcer in endoscopy study were considered as controls. One hundred thirty patients were enrolled in the study and equally two groups (65 patients in case group and 65 patients in control group). Fifty nine subjects of case group (90.76%) and 37 subjects of control group (56.92%) had positive serum anti-CagA antibody (P= 0.003). Sixty one percent of anti-CagA antibodies positive patients and 17.6% of anti-CagA antibodies negative patients had peptic ulcer (P= 0.003). (Odds ratio= 7.4; 95%CI: 2.8-19.7; P= 0.003). The detection of CagA antibodies as an additional and noninvasive test in association with determination of serum anti-CagA antibodies, could help better detection of risk factors of peptic ulcer disease. Also it can reduce the emergency endoscopy process. We can use this technique in patients with dyspepsia who had no warning signs or malignant disease and not taking a nonsteroidal anti-inflammatory drugs in primary care of clinical practices.

Functional constipation and gastroesophageal reflux disease (GERD) are two common childhood digestive disorders which can cause a lot of complications among them if untreated. Since an overlap and relationship between functional gastrointestinal disorders have been shown in some studies, so present study was performed to investigate the frequency of functional constipation among children with reflux in compare with children without reflux. A cross-sectional study was conducted on all children who referred to digestive diseases clinic of Ali-Asghar Hospital in Tehran, Iran, from April 2008 to January 2010. Patients that referred for follow up were excluded from study and a total of 474 children were included in this study. A questionnaire including symptoms of reflux and functional constipation was completed for all subjects by design’s executer after parental consent. Other data related to history, physical examination and results of paraclinic investigations for functional constipation diagnosis were also collected. In general 247 children (52%) were male and 227 children (48%) were female. Nineteen children (4%) had gastroesophageal reflux disease in this study which 6 of them (31.5%) were less than 1 year old and 13 of them (68.5%) were greater than 1 year old. Opisthotonic posturing, abdominal pain, heartburn and recurrent vomiting were the most common symptoms in children with reflux. There was also functional constipation in 60 children. Twelve patients (63.2%) had functional constipation among 19 children with reflux, whereas 48 patients (10.5%) had functional constipation among 455 children without reflux. This different frequency ranges of functional constipation among children with and without gastroesophageal reflux was statistically significant (P= 0.001). The frequency of functional constipation in children with gastroesophageal reflux was significantly more than normal children. Further studies are recommended to investigate the relationship between functional constipation and gastroesophageal reflux in children.

Respiratory distress syndrome is developmental immaturity of lungs, that is caused by lack of surfactant. Lack of surfactant lead to wide atelectasis and arterial hypoxemia which is a life-threatening lung disorder. The aim of this study was to compare the function of cochlear in infant who suffer respiratory distress syndrome with normal infants by transient evoked otoacoustic emission (TEOAE) test. This descriptive- analytic cross sectional study was carried out on 21 respiratory distress syndrome (RDS) infants (42 ear) that consists of 11 male and 10 female, 21 normal infants (42 ear) that consists of 10 male and 11 female in Mirza Koochakkhan Hospital, Tehran University of Medical Sciences, Tehran, Iran, which all of them were 3 to 6 month year old, to collect informations about the health of infants we used the files in hospital and to assess the cochlear function we used computerized recording by TEOAE instrument. Statistical analysis carried out by SPSS software version 17 and Chi-square test. The results of TEOAE test demonstrated that in normal group there is no statistical differences between ears and gender, also there was no statistical differences between ears in respiratory distress syndrome group but there was statistical differences between gender in this group. The frequency of pass result (show normal function of outer hair cell in cochlea) was greater in male than female; in male the frequency of pass result was 17 ear (77.3%) but in female was 8 ear (40%). In TEOAE test results there was statistical differences between two groups of study. The frequency of pass result in normal group was 34 ear (81%) and in respiratory distress syndrome group was 25 ear (59%) which was significantly more in normal group than in respiratory distress syndrome infants (P= 0.032). According to results, it seems that the respiratory distress syndrome could affects the cochlear and the function of outer hair cell in it so in infants who suffer respiratory distress syndrome we should use the test battery of hearing.

Approximately 50% to 80% of women experience varying degrees of postpartum depression. Oxidative stress is involved in many diseases, including depression. Common production of lipid peroxidation by oxidative stress is malondialdehyde (MDA). The endocannabinoid system is a nervous regulator and convoy the impression that the circulatory levels of endocannabinoid is significantly reduced in depressed women. The major purpose of this paper was to evaluate activity of the major antioxidant and endocannabinoid index in postpartum depression. A total of 130 women were entered in a case-control study in 12 Bahman Health Center from April 2011 to August 2011. In 4th to 6th week after delivery, women were equally divided into 2 groups based on Edinburg questionnaire (normal and postpartum depressive women). Serum MDA, total antioxidant capacity (TAC) and RBC catalase levels were determined to investigate the oxidative status. In addition, Mass spectrometry was applied for the analysis of serum anandamide (AEA) and 2-Arachidonoylglycerol (2-AG). Based on Edinburg questionnaire, however, women age, husband age, husband marital number, gravidity, children number, salary and house size have no significant effect on postpartum depression, marital period was significantly increased postpartum depression (P< 0.05). In addition, women education, husband education, wanted or unwanted pregnancy from women, neonatal sex, satisfaction of neonatal sex from women and husbands, breast feeding and delivery have no significant effect on postpartum depression, and women Job (P< 0.001), husband job (P< 0.001), wanted or unwanted pregnancy from husbands (P< 0.05) were significantly changed postpartum depression. Serum MDA and RBC catalase levels were not significantly higher in depress compared with the normal group. TAC was significantly decreased in patients having postpartum depression (P< 0.05). Serum AEA and 2-AG levels were significantly lower in depress compared with the normal group (P< 0.01). Women’s Job, husband’s job, wanted or unwanted pregnancy from husbands and marital period are associated to postpartum depression. In postpartum depression, TAC, AEA and 2-AG are reduced. So it can be concluded that both antioxidant system and endocannabinoid concentration involved in the development of postpartum depression.

Diarrhea is the most common bacterial infections, and the main cause of death in the children. Worldwide, food and waterborne diseases are estimated to cause more than two million deaths per year. Foodborne diseases and resistance to antimicrobial agents are two problems worldwide and are increasing. However, standard surveillance systems do not routinely collect information on controls. The aim of this study was to analysis epidemiological data of foodborne outbreaks at the country level. This is a descriptive study, in total 305 fecal swab samples from 73 outbreaks during one year from April 2012 to March 2013 in different provinces of Iran, were collected and transferred to the microbiology laboratory of Public Health School of Tehran University of Medical Sciences to identify the cause’s diarrhea. The patterns of antibiotic-resistance were determined by using Kirby Bauer method. In total 73 food borne outbreaks that were studied, the largest number 26 (35.6%) were found in Hamadan province with 103 samples (34.2%). Out of 73 outbreaks 40 (54.79%) of were related to foods, 6 (8.22%) to water, and 27 (36.98%) were unspecified (P< 0.0001). Fifty seven outbreaks (78.08%) in the city and 16 outbreaks (21.92%) occurred in rural areas (P< 0.0001). The most dominated Gram-negative isolated organisms were Shigella (6.9%) and Gram-positive bacteria Staphylococcus aureus (12.8%). The dominated age group was under five years (16.4%), and dominant gender group was men 186 (61.8%) (P< 0.0001). In total 69 (22.9%) were hospitalized and 11 deaths were reported. Most clinical symptoms of abdominal cramping (82%), nausea and vomiting (68.4%), bloody diarrhea (23.3%), and non-bloody diarrhea (76.7%). All the isolated gram-negative were sensitive to ciprofloxacin and resistant to clindamycin. The gram-positive were sensitive to cephalexin and resistant to penicillin. The knowledge of bacterial agent of foodborne diseases and determination of antimicrobial resistance pattern are helpful to reduce the rate of foodborne outbreaks, the cost of treatment. The prevention control of outbreaks is also very important.

Hematopoietic stem cell transplantation (HSCT) is a therapeutic approach in treatment of hematologic malignancies and incompatibility of bone marrow. Umbilical cord blood (UCB) known as an alternative for hematopoietic stem/ progenitor cells (HPSC) for in allogenic transplantation. The main hindrance in application of HPSC derived from umbilical cord blood is the low volume of collected samples. So, ex vivo expansion of HPSCs is the useful approach to overcome this restriction. Synthetic biomaterials such as nanofibers is used to produce synthetic niches. The aim of this study was the ex vivo expansion of hematopoietic stem cells on biocompatible nanofiber scaffolds. This study was done at Tarbiat Modares University from November 2012 to June 2013 and was a research study. Umbilical cord blood CD133+ hematopoietic stem cells were separated using MidiMacs (positive selection) system by means of monocolonal antibody (microbeads) CD133. Flow cytometry was used to assess the purity of cells. Cell culture was done on plate (2 Dimensional) and fibronectin conjougated polyether sulfone nanofiber scaffold (3 Dimensional). Colony assay test was used to asses the ability of colonization of cells. Cell count analysis revealed the expansion of hematopoietic stem cells in cell culture plate (2D environment) and on nanofiber scaffold (3D environment) after 2 weeks. Expansion of cells in 2D environment was greater than 3D condition. Colony assay test revealed that the colonization ability of cells decreased after 2 weeks, but this decrease was lower in scaffold culture than plate culture. This study demonstrated that umbilical cord blood CD133+ hematopoietic stem cells can expand on fibronectin conjugated polyether sulfone scaffold and we can use this system for expanding of cells in vitro situation.

Mycoplasma contamination in cell cultures is considered as a major economic, research and production problem. In this study, mycoplasma-infected Vero cell lines were treated by various dilutions of ciprofloxacin and enrofloxacin in a timely manner. Removal of mycoplasma contamination from infected cell cultures was evaluated and demonstrated by polymerase chain reaction (PCR) method. This study was done from October 2013 to May 2014, in Human Rabies Vaccine Laboratory, Pasteur Institute Production and Research Complex, Tehran, Iran. Different dilutions of ciprofloxacin and enrofloxacin were used in sequential passages for treatment of infected Vero cell line. Based on lowest passages of the cell line, antibiotic treatment with ciprofloxacin and enrofloxacin was done. Amelioration of the infection and removal of mycoplasma contamination was confirmed in each step by PCR method. The technique for order of preference by similarity to ideal solution, TOPSIS method, was used to suggest the most efficient concentration of ciprofloxacin and enrofloxacin. Proposed concentration of ciprofloxacin is 20 μg/ml, and in the second order is 200 μg/ml. For enrofloxacin the best proposed concentrations are 30, 300 and 3 μg/ml respectively. Ciprofloxacin and enrofloxacin and ability of them for removal of mycoplasma and also the time of treatment were verified by evaluation of the recurrence of infection through consecutive subcultures of the treated cell line. Our results showed that 20 μg/ml of ciprofloxacin was the dilution of choice for mycoplasma elimination followed by 200 μg/ml of ciprofloxacin. Concentrations of 3, 30 and 300 of enrofloxacin, respectively, are appropriate for mycoplasma removal. More detailed works would be needed to verify the authenticity of the proposed simple and affordable way of mycoplasma elimination.