مجله دانشکده پزشکی دانشگاه علوم پزشکی تهران
سال هفتاد و سوم شماره 2 (پیاپی 170، اردیبهشت 1394)

Helicobacter pylori (H. pylori) cause various diseases especially gastrointestinal disorders. Clinical diagnosis of H. pylori infection can be done in different ways، and new diagnostic methods are under study. This study aimed to assess the levels of interleukin (IL) 6، 17 and 23 in the middle ear effusion of patients with otitis media، and the association between these levels with H. pylori infection. This cross-sectional study conducted in 40 patients who nominated for ventilation tube (VT) placement due to otitis media with effusion، and admitted to ear، nose، and throat (ENT) clinics of Tehran University of Medical Sciences from March 2012 to August 2013. All of patients underwent myringotomy with VT insertion، and then aspirated effusion sample was tested. H. pylori infection diagnosed by polymerase chain reaction (PCR) and bacterial culture. The concentration of IL-6، IL-17 and IL-23 measured by enzyme-linked immunosorbent assay (ELISA). The levels of each interleukins were compared between the two positive and negative PCR groups. In all of samples، PCR test result was positive in 22. 5%. The mean and standard deviation of IL-6 level was 10. 11±2. 95، IL-17 was 5. 89±0. 91 and IL-23 was 4. 07±1. 34. The mean±standard deviation (SD) of IL-6 level in patients with a positive PCR (H. pylori) was 22. 29±6. 40 and in patients with a negative PCR was 6. 16±3. 88 that difference was significant (P=0. 01). The mean±SD of IL-17 level in patients with a positive PCR was 6. 16±1. 29 and in patients with a negative PCR was 5. 81±1. 13 that difference was not significant (P=0. 42). The mean±SD of IL-23 level in patients with a positive PCR was 6. 15±3. 77 and in patients with a negative PCR was 3. 42±1. 33 that difference was not significant (P=0. 27). According to finding، association between H. pylori infection and increased levels of IL-6 in the middle ear effusion was approved. It is recommended to conduct researches aimed to identify other cytokines as inflammatory markers.

Atrial fibrillation (AF) is the most common arrhythmia after cardiac surgery. AF leads to longer duration of hospitalization, thromboembolism, and impaired hemodynamics after heart surgery. One of the most important causes of postoperative AF, inflammation, and oxidative stress status. For this reason, it is useful to control the dysrhythmia. Coenzyme Q10 (CoQ10) as an antioxidant that has an important role in reducing the incidence of postoperative AF. The present study aimed at administering CoQ10 as a way to reduce the incidence of post-CABG atrial fibrillation. In this double-blind randomized controlled trial study, 80 patients with coronary artery disease who underwent coronary artery bypass graft surgery (CABG) in Rajaie Cardiovascular, Medical and Research Center from April to November 2014, randomized are divided into intervention and control groups to receive placebo or CoQ10 The surgical characteristics of the patients in two groups were similar. The intervention group will receive the oral CoQ10 supplement 150 mg/d for 7 days before surgery. After operation two groups were compared regarding important outcomes such as postoperative arrhythmia, intensive care unite (ICU) stay and hospital stay. Atrial arrhythmias are considered significant If more than 10 minutes duration atrial and with a shorter duration of arrhythmia, but with recurrence again. Thirty-eight women and forty-two men with a mean age of 58.37±7.98 years were enrolled in the study in two CoQ10 and placebo groups (each consisting of 40 patients). The incidence of postoperative AF was 45% in the control group to 20% in the intervention group decreased after supplementation (P=0.030). ICU stay and length of in-hospital stay did not significant. The incidence of arrhythmias ventricular tachycardia (VT) and VF in this period was not significant (P=0.865). Q10 supplements have low side effects. Due to the reduction in the incidence of AF in patients after, CABG, these supplements can be recommended for the prevention of AF.

The incidence of Patent Ductus Arteriosus (PDA) in premature infants whose birth weight is less than 1500 grams is approximately 30-60%, most of them need medical or surgical interventions. The purpose of this study is to determine the efficacy of prophylactic treatment with oral paracetamol (Acetaminophen- Hakim® Oral Drops 100 mg/ml, Hakim Pharmaceutical Co., Tehran, Iran) for PDA in preterm infants. A randomized clinical trial conducted from March 2012 to March 2013. Thirty-two preterm newborns whose gestational age was under 32 weeks and birth weight was 1500 grams or less, admitted in neonatal intensive care unit (NICU) of Vali-Asr Hospital, Tehran were studied prospectively. They were randomly assigned in two groups. The prophylaxis group received oral paracetamol for a period of two days starting during first 24 hours of life. No placebo was given to the control group. Echocardiography was performed 24-36 hours after the last given dose in prophylaxis group and on the 4th and 5th day in control group. A p-value less than 0.05 are considered significant. There were 16 newborns in each group (20 boys and 12 girls). In 12 newborns of prophylaxis group the ductus arteriosus was closed although in control group in 8 newborns the duct was closed. No significant difference was observed in sex, gestational age, birth weight, mode of delivery, multifetal gestation and birth order between two groups. The rate of ductal closure was 75% and 50% in prophylaxis group and control group respectively (P=0.27). Our study demonstrated that prophylactic paracetamol is ineffective in PDA closure, although the rate of ductal closure between two groups seems remarkable. Paracetamol as a new strategy for PDA closure because of cost effectiveness and harmlessness may be used in future. However, we presume larger sample size studies are needed to show the efficacy of paracetamol, side effects, and complications in PDA prophylaxis treatment.

Pregnancy is a phenomenon that antigens of semi allogenic fetus are in direct contact with mother's immune system. Immune dysregulation can cause fetus rejection by mother's immune system responses. Human leukocyte antigen-G1, as an immunotolerant molecule has a major role to induce tolerance during pregnancy by suppression of natural killer cells through inhibitor receptors on these cells. Natural killer cells have an important role in immune surveillance and these cells can be reaction with HLA-G molecules on the trophoblast cells surface. This function prevents natural killer cell invasion against fetus trophoblast cells. The purpose of this study was determination of natural killer cells percent and human leukocyte antigen-G1 expression in peripheral blood of threatened-abortion pregnant women in comparison with control group. This case-control study was conducted from, February 2014 to October, 2014 in Baghban Clinic in Sari City, Mazandaran province. We investigated 21 threatened-abortion women with light bleeding or spotting less than twenty weeks of pregnancy in comparison with 21 normal pregnant women as control group. Peripheral blood mononuclear cell was isolated by ficoll histopaque (1.077) and natural killer cells percent were evaluated by flow cytometry. Furthermore, we assessed the human leukocyte antigen-G1 isoforms expression by real-time polymerase chain reaction (PCR) in case and control groups. The results of this study was shown that natural killer cells percent in threatened-abortion pregnant women was significantly higher than normal pregnant women (P=0.03). In addition, human leukocyte antigen-G1 isoform had a lower expression in threatened-abortion pregnant women in comparison with control group (P=0.004). Decreasing of human leukocyte antigen-G1 expression with increasing of natural killer cells level in threatened-abortion pregnant women is an indicator of mother's immune system dysregulation in comparison with control group. Therefore, it is concluded that in the threatened-abortion pregnant women, human leukocyte antigen-G1 expression level with natural killer cells percent as diagnostic marker must be determine.

Although sexual dysfunction is a common problem in patients with obsessive-compulsive disorder (OCD), there are sparse clinical research on the study of the correlation between OCD subtypes and different phases of sexual response cycle. This study was undertaken to assess sexual function and its different phases in a group of Iranian patients with OCD. This was a descriptive cross-sectional study. The subjects consisted of 56 married OCD patients (36 female, 20 male) who suffered from OCD according to a psychiatric interview and DSM-IV questionnaire based on structured clinical interview for DSM (SCID). Patients were between 18 to 50 year age that had been referred to the outpatient clinic of Roozbeh Psychiatric Hospital and three private psychiatric clinics in Tehran (from September 2011 to February 2013). Five Questionnaires were used in this study: Iranian validated form of Female Sexual Function Index (FSFI), International Index of Erectile Function (IIEF), Maudsley Obsessional Compulsive Inventory (MOCI), Obsessive Compulsive Inventory-Revised (OCI-R) and a questionnaire which has provided demographic data and other relevant information regarding sexual function and OCD. The prevalence of sexual dysfunction among female was 80.6% and the frequency of disorders in different subscales of FSFI including sexual desire, sexual arousal, lubrication, orgasm, satisfaction and sexual pain were 50%, 58.3%, 36.1%, 44.4%, 41.7% and 52.8% respectively. Sexual disorder is reported in 25% of male OCD patients which subscale's evaluation of IIEF shows low sexual desire in 10%, erectile disorder in 20%, orgasmic disorder in 25%, sexual dissatisfaction in 40% and 50% decreased in the total sore of IIEF. Moreover, the correlation coefficients between the total score of OCI-R with erectile and satisfaction subscales of IIEF were statistically significant. The score of washing subscale in OCI-R and sexual satisfaction was significantly correlated. High prevalence of sexual dysfunction in OCD women and significant correlation between male sexual dysfunction and OCD (r= -481.0 between total score of OCI-R with erectile dysfunction and r= -458.0 between total score of OCI-R and sexual satisfaction) could confirm a relation between OCD and sexual disorders. So, evaluation of sexual function in all patients with OCD is recommended.

Personal characteristics such as gender, ethnicity, disability, age, goals and personal expectations and academic variables such as the number of classes and grades are among the factors that could have an important role in the development of student satisfaction. Besides these factors, the relationship between emotional intelligence (EI) and academic satisfaction has received little attention. This descriptive cross-sectional study was done in Tehran University of Medical Sciences, Tehran, 2013. Cluster sampling was applied in this study. First, faculties randomly selected from Tehran University of Medical Sciences then randomly selected classes from the faculties. Self-report and Barr-On's emotional Intelligence questionnaires were used to collect data and measuring the variables of educational satisfaction. Questionnaires were completed by students. Overall reliability test using Cronbach's alpha coefficient was 0.73. The cut-off point of questionnaires was considered 70. This means that scores below 70 points showed the low level of satisfaction and scores more than 70 points were considered as a high level of satisfaction. One hundred sixty eight students participated in the study. Average emotional intelligence was 3.25±0.45, the scale of consciousness 3.44±0.59, the self-control scale 3.90±0.59, scale spontaneous 3.17±0.46, Social skills 3.30±0.59, social consciousness 3.24±0.67, satisfactory academic 96.55±14.66 respectively. There was a significant relationship between self-consciousness and educational satisfaction (P=0.002) but self-control variable did not significantly correlated with educational satisfaction (P=0.249). The results showed that emotional intelligence on academic satisfaction can be explained. A change in the variance in one unit emotional intelligence was as much as five unit of the variance student satisfaction in based on standardized beta coefficient. There is a positive and direct relationship between them. The promotion of education satisfaction will increase indirectly possibility of job satisfaction in students in the future. Our results showed self-awareness and motivation skills in students increase their educational satisfaction.

Bispectral Index (BIS) may be used in traumatic brain injured patients with different anatomical sites of injury to evaluate the level of consciousness. The objective of this study is to evaluate the relation between type of brain injury and the presence or absence of frontal lobe damage based on brain CT-scan with BIS monitoring in intubated acute head trauma patients admitted to the intensive care unit (ICU). Participants of this cross-sectional study consisted of 30 intubated head trauma patients over the age of 15 years old, without any known history of visual or hearing impairments, neurologic disorders, mental retardation, or frontal skin laceration, who were admitted to the ICU in Rasool Akram University Hospital, Tehran. Patients who needed muscle relaxant administration, or those who showed instability of vital signs, hypoxemia, disorders of the blood biochemistry, or blood gases, liver or kidney failure, convulsion or hypoxic encephalopathy during the study were excluded. In the first three days of admission, each patient underwent monitoring of BIS every sixty minutes for just six hours a day. All the hypnotic drugs were discontinued six hours prior to the start of monitoring and fentanyl was the only opioid, which was administered if an analgesic was required. Statistical analysis were used to evaluate the data and p-value less than 0.05 was considered statistically significant. Mean age of all patients was 43.6 years with a Standard Deviation (SD) of 18.96. Presence or absence of frontal lobe injury, had no statistically significant correlations with mean BIS in each three days of study and the mean BIS total. However, mean BIS in the second and third days had statistically significant differences in different types of cranial lesions (contusion, subdural hemorrhage, subarachnoid hemorrhage, etc) which usually have different prognoses. Different kinds of acute traumatic cranial lesions with different prognosis may have different values in BIS monitoring. Presence or absence of frontal lobe injury, had no statistically significant correlations with BIS values.

Cytotoxic lymphocyte antigen-4 (CTLA-4) plays an important role in regulating T cell activation. CTLA-4 gene polymorphisms are related with genetic susceptibility to various autoimmune diseases, including systemic lupus erythematosus (SLE). We analyzed the role of CTLA-4 polymorphisms at positions -318CT in patients who suffer from SLE. This study was performed on 180 SLE patients referred to 5th Azar University Hospital in Gorgan, Iran. Three hundred and four ethnically-and age-matched healthy controls with no history of autoimmune diseases entered the study between 5th May 2008 and 23rd October 2009. DNA was extracted from blood samples according to the standard procedure. Polymerase chain reaction- restriction fragments length polymorphism (PCR-RFLP) was used to analyze the genotype and allele frequencies of this polymorphism. PCR was carried out using the following primers: forward 5′-AAATGAATTGGACTGGATGGT-3′ and reverse 5′-TTACGAGAAAGGAAGCCGT G-3′. The frequency of alleles and genotypes were assessed using direct counting. Chi-square test and Fisher’s exact test were used to compare the association between the alleles and genotype frequencies and SLE. P<0.05 were considered statistically significant. The CC genotype was observed in 94.5% of the SLE patients and 82.4% of the controls; the difference was statistically significant (P=0.0001, OR=3.51, CI95%=1.77-7.53). The CT genotype, on the other hand, was more frequently observed in the control group (17.1% vs. 5.5%, P=0.0001, OR=0.28). T allele was significantly more common in the controls compared to SLE patients (P=0.0001, OR=0.26, CI95%=0.13-0.53). Our results suggest that the -318C/T polymorphism of CTLA-4 gene might play a significant role in the genetic susceptibility to SLE. Therefore, further studies on populations, especially from other Middle East countries, are needed to confirm our results.

The aim of this study was to investigate interaction between vanillin and alpha-, beta- and gamma-cyclodextrin carriers for targeted drug delivery and compare the performance between them using theoretical methods. All theoretical calculations were performed on a Intel® Core™ i5 Processors computer at Kerman University using Gaussian 09 program package (Gaussian, Inc., Wallingford, USA) in a three month period (February 2014 to May 2014). Starting geometries were generated employing GaussView software, version 5 (Gaussian, Inc., Wallingford, USA) and then the resulting coordinates were optimized using density functional theory (DFT) calculations. The natural bond orbital method (NBO program, under Gaussian 09 program package) was carried out to study charge transfer energy associated with the intermolecular interactions. The quantum theory of atoms in molecules was applied for DFT results to get insight in the nature of interaction existing in the investigated systems. The calculations were carried out with AIM2000 program and AIMAll 14.10.27 package (Todd A. Keith, TK Gristmill software, Overland Park KS, USA) to find and characterize bond critical points. The vanillin molecule is adsorbed on the surface of carriers by hydrogen bonding between its oxygen atom and hydrogen atoms of cyclodextrin. The hydrogen of -OH group on the cyclodextrin can form hydrogen bond to the oxygen atom of carbonyl group of vanillin molecule. This study indicates a decrease of total energy with increasing surface of cyclodextrin. So gamma-cyclodextrin and its complex with the maximum surface in between carriers have the highest stabilities. The gamma-cyclodextrin shows the strongest interaction with vanillin. In all complexes of vanillin-cyclodextrin, the direction of charge transfer is from drug to carrier. Due to the high solubility of gamma-cyclodxtrin and its stronger interaction with the molecule vanillin, it can be the best option as drug carrier.

Rupture of uterus is a catastrophic complication associated with significant maternal and fetal morbidity and mortality. The prevalence of an unscarred uterine rupture is very rare. Although the most important complication of dilatation and curettage is perforation of uterus, dilatation and curettage is not introduced as an important cause of uterine rupture. Here we present a case of uterine rupture in a pregnant woman that was admitted in Tehran General Women Hospital, in December 2014, with reducing fetal movement in her 41th weeks of pregnancy. She did not have any risk factors for rupture of uterus including cephalo-pelvic disproportion and polyhydramnios, also there was no history of uterine surgery such as myomectomy and uterine abnormality repair. A term dead male neonate was delivered by cesarean section due to arrest of descending in stage 2 of labor. The baby weighed 3400 gr and had anomaly in ears, larynx, uvula and soft palate. Its chromosomal study depicted both trisomy and monosomy for chromosome 13 and 21. Mother had a history of illegal curettage and trauma to the uterus in her first pregnancy two years ago. She did not say to us this history and abortion during admission. After cesarean section we saw that in the left side of the posterior wall of uterus was ruptured and baby was died. At surgical exploration, moderate hemoperitoneum was evident. Fetus was already dead at the time of extraction. Total estimated blood loss was 100 ml, the patient was transfused with two units of packed cell. The woman was discharged on the fifth postoperative day in good condition. Effective contraception and safe curettage can reduce maternal mortality and morbidity. Also special attention to a history of curettage to predict uterine rupture is critical.