A. R. Dehpour, PharmD, PhD
A. Javadian, MD
Vol 52, No 5 (2014)
Phlomis lanceolata is a medicinal plant that has long been used to treat various conditions such as diabetes, gastric ulcer, hemorrhoids, inflammation and wounds. As most of Phlomis species have shown cytotoxic activity against proliferation of different cell lines, a biological investigation of P. lanceolata was carried out in this study. The aim of this study was to find out the in vitro cytotoxic activity of total extract and different fractions of Phlomis lanceolata on four cell lines. Cytotoxic activity of the metanolic total extract and partition fractions of chloroform, ethyl acetate and petroleum ether of flowering aerial parts of Phlomis lanceolata on the HT29, Caco2, T47D and NIH3T3 cell lines is examined by MTT. Petroleum ether fraction showed high cytotoxic activity against proliferation of all four cell lines. Presence of heavy triterpens and lipophil compounds recognized by TLC test in Petroleum ether fraction is responsible for high cytotoxic activity. The results emphasize the importance of phytochemical studies which could lead to the discovery of new active compounds.
Bacteremia continues to result in significant morbidity and mortality, particularly among neonates. There is scarce data on neonatal bacteremia in among Iranian neonates. In this study, we determined neonatal bacteremia isolates and their antibiotic resistance pattern in neonatal insensitive care unit at Beasat hospital, Sanandaj, Iran. During one year, all neonates admitted to the NICU were evaluated. Staphylococcal isolates were subjected to determine the prevalence of MRS and mecA gene. A total of 355 blood cultures from suspected cases of sepsis were processed, of which 27 (7.6%) were positive for bacterial growth. Of the 27 isolates, 20 (74%) were Staphylococcus spp as the leading cause of bacteremia. The incidence of Gram negative bacteria was 04 (14.8%). The isolated bacteria were resistant to commonly used antibiotics. Maximum resistance among Staphylococcus spp was against Penicillin, and Ampicillin. In our study, the isolated bacteria were 7.5 % Vancomycin and Ciprofloxacin sensitive. Oxacillin disk diffusion and PCR screened 35% and 30% mec a positive Staphylococcus spp. The spectrum of neonatal bacteremia as seen in NICU at Beasat hospital confirmed the importance of pathogens such as Staphylococcus spp. Penicillin, Ampicillin and Cotrimoxazol resistance was high in theses isolates with high mecA gene carriage, probably due to antibiotic selection.
Currently, laparoscopic cystectomy is the first-line therapy for ovarian benign cysts that are resistant to current therapies. There are different studies that point to ovarian reserve damage due to laparoscopic cystectomy. In this study, we evaluate the ovarian damage following laparoscopic cystectomy for non-endometriosis cysts using ultrasound and pathology findings. This is a prospective cohort study conducted between 7 rd month of 2011 and 10th month of 2012 in Women hospital affiliated to Tehran university of medical sciences.45 non-endometriosis cysts (17 teratoma,7 mucinous, 10 simple serous and 11 simple cysts) underwent laparoscopic cystectomy with stripping technique. Amount of excised parenchyma, number of lost oocytes and cyst wall fibrosis thickness were histopathologically studied. Before and 3 months after surgery antral follicle count was evaluated by ultrasound. AFC after cystectomy for teratoma and simple serous was significantly reduced P<0.05. By larger teratomas and more parenchyma inadvertently removed during their excision (1.64, 0.255) reduced AFC was seen and in simple serous cysts with more removed parenchyma amount (1.5) reduced AFC occurred. In our study simple cysts excision led to a loss in AFC that was not associated with any other cyst parameters. Mucinous cysts resection led to no specific ovarian reserve damage. Laparoscopic cystectomy for non-endometriosis leads to reduced ovarian reserve.
The relationship between QT dispersion and myocardial ischemia is still controversial. Therefore, we aimed to investigate the relationship between QTd and the severity and extent of myocardial ischemia. In this cross-sectional study, 141 patients having symptoms of CAD who referred to our medical center during 2009-2010, and were examined with myocardial isotope scan and ECG, were enrolled. Based on the Electrocardiography and Single-Photon Emission Computed Tomography results, the patients were categorized as having normal, mild, moderate, and severe ischemia. QTd was measured at rest and under stress as the maximum difference between QT intervals in 12-lead ECG. Ultimately, the correlation between rest and stress QTd and the severity and extent of ischemia (number of ischemic segments and summed ischemic score) were investigated, and the rest and stress QTd was compared between the groups. QTd under stress was positively correlated with the number of ischemic segments and summed ischemic scores in all patients. In normal patients, stress and rest QTd were the same. The QTd under stress significantly increased in patients with ischemia. There was no significant difference between the groups regarding QTd at rest. Stress QTd was significantly greater in patients with severe ischemia and greater in patients with mild and moderate ischemia compared with the normal patients. Stress QTd difference between mild and moderate ischemic groups was not significant. QTd under stress is related to the severity and extent of myocardial ischemia and is clinically useful for identifying ischemic myocardial injuries.
Coronary artery disease (CAD) is the leading cause of mortality in many parts of the world. Genome-wide association studies (GWAS) have identified several genetic variants associated with CAD in Low-density lipoprotein receptor (LDLR) locus. This study was evaluated the possible association of genetic markers at LDLR locus with CAD irrespective to lipid profile and as well as the association of these SNPs with severity of CAD in Iranian population. Sequencing of 2 exons in LDLR gene (Exon 2, 12) and part of intron 30 of SMARCA4 gene include rs1122608, was performed in 170 Iranian patients angiographically confirmed CAD and 104 healthy controls by direct sequencing. Sullivan's scoring system was used for determining the severity of CAD in cases. Our results showed that homozygote genotypes of rs1122608 (P<0.0001), rs4300767 (P<0.005) and rs10417578 (p<0.007) SNPs have strong protective effects on the CAD. In addition, we found that rs1122608 (GT or TT) was at higher risk of three vessel involvement compared to single vessels affecting (P=0.01).
The aim of this study is the normalization of the Wender Utah rating scale which is used to detect adults with Attention-Deficit and Hyperactivity Disorder (ADHD). Available sampling method was used to choose 400 parents of children (200 parents of children with ADHD as compared to 200 parents of normal children). Wender Utah rating scale, which has been designed to diagnose ADHD in adults, is filled out by each of the parents to most accurately diagnose of ADHD in parents. Wender Utah rating scale was divided into 6 sub scales which consist of dysthymia, oppositional defiant disorder; school work problems, conduct disorder, anxiety, and ADHD were analyzed with exploratory factor analysis method. The value of (Kaiser-Meyer-Olkin) KMO was 86.5% for dysthymia, 86.9% for oppositional defiant disorder, 77.5% for school related problems, 90.9% for conduct disorder, 79.6% for anxiety and 93.5% for Attention deficit/hyperactivity disorder, also the chi square value based on Bartlett's Test was 2242.947 for dysthymia, 2239.112 for oppositional defiant disorder, 1221.917 for school work problems, 5031.511 for conduct, 1421.1 for anxiety, and 7644.122 for ADHD. Since mentioned values were larger than the chi square critical values (P<0.05), it found that the factor correlation matrix is appropriate for factor analysis. Based on the findings, we can conclude that Wender Utah rating scale can be appropriately used for predicting dysthymia, oppositional defiant disorder, school work problems, conduct disorder, anxiety, in adults with ADHD.
This study was aimed at determining intra and inter-observer concordance rates in the Gleason scoring of prostatic adenocarcinoma, before and after a web-based educational course. In this self-controlled study, 150 tissue samples of prostatic adenocarcinoma are re-examined to be scored according to the Gleason scoring system. Then all pathologists attend a free web-based course. Afterwards, the same 150 samples [with different codes compared to the previous ones] are distributed differently among the pathologists to be assigned Gleason scores. After gathering the data, the concordance rate in the first and second reports of pathologists is determined. In the pre web-education, the mean kappa value of Interobserver agreement was 0.25 [fair agreement]. Post web-education significantly improved with the mean kappa value of 0.52 [moderate agreement]. Using weighted kappa values, significant improvement was observed in inter-observer agreement in higher scores of Gleason grade; Score 10 was achieved for the mean kappa value in post web-education was 0.68 [substantial agreement] compared to 0.25 (fair agreement) in pre web-education. Web-based training courses are attractive to pathologists as they do not need to spend much time and money. Therefore, such training courses are strongly recommended for significant pathological issues including the grading of the prostate adenocarcinoma. Through web-based education, pathologists can exchange views and contribute to the rise in the level of reproducibility. Such programs need to be included in post-graduation programs.
The emergent abdominal surgeries from either of traumatic or non traumatic causes can result in situations in which the abdominal wall cannot initially be closed. Many techniques have been reported for temporary coverage of the exposed viscera, but the result of various techniques remains unclear. During 94 months, 19 critically ill patients whit an open abdomen underwent surgery using plastic bags (Bogotá bag). The study population comprised of 11 (57.9%) male and 8 (42.1%) female with an average age of 32.26+14.8 years. The main indications for temporary abdominal coverage were as follows: planned reoperation in 11 (57.9%) patients, subjective judgment that the fascia closure is too tight in 6 (31.6%) patient's damage control surgery in one patient (5.3%) and development of abdominal compartment surgery in one patient (5.3%). Surgical conditions requiring temporary abdominal closure was severe post operative peritonitis in 9 (47.4%) patients, post operative intestinal fistula in 4 (21.1%) patients, post traumatic intra abdominal bleeding in 3 (15.8%) patients and intestinal obstructions in 3 (15.8%) patients. Length of hospitalization was 45+23.25 days and the mean total number of laparotomies was 6.2+3.75 times per patient. Three bowel fistulas occurred due to a missed injury at the time of initial operation that was discovered during changing the plastic sheet. They were unrelated to coverage technique. All of them were treated by repair of the defect and serosal patch by adjacent bowel loop. Only one (10.0%) patient underwent definitive closure within 6 months of initial operation. The remaining survivor has declined to have hernia repaired. There were 4 (%21.1) early postoperative deaths that were not related to the abdominal coverage technique. Also, there were 5 (26.3%) late deaths that were due to dissemination of malignancy with a mean survival time of 20.8+13 (range 2-54) months. Currently 10 patients (52.6%) are alive at a follow up of 45 (range 1-94) months. Only one (10.0%) patient underwent definitive closure within 6 months of initial operation. The remaining survivor has declined to have hernia repaired. Bogotá bag technique is a rapid, simple and inexpensive technique for temporary abdominal coverage.
Kaposi's sarcoma is a low-grade vascular tumor that its prevalence is increasing all around the world due to the increasing prevalence of HIV and organ transplantations. In this study, we assessed risk factors of Kaposi's sarcoma among Iranian patients were referred to Dermatopathology Department of Razi Hospital of Tehran University of Medical Sciences between the years of 2006 to 2011. Also, disease stages have been assessed on pathologic specimens. Thirty four patients diagnosed with Kaposi's sarcoma entered the study. Of the 34 patients, 29% were female, and 71% were male, mean age was 66 years and average disease duration was 6 months. The most common patient's pathologic stages were reported: patch 32%, patch to plaque 24%, plaque 12%. The most prevalent location of involvement was lower extremity (88%), and upper extremity was involved in 24%. At presentation time, the mean number of lesions was 3 to 4. 15% of patients had a history of smoking and 15% had a history of immunosuppressive drugs. HIV infection did not observe in the patients. Based on the present study, Kaposi's sarcoma is a disease of elderly and is higher in older men. The most common site of Kaposi's sarcoma involvement is lower extremity, and the most common pathologic stage was the patch to plaque.
The possible effect of iron supplementation has been investigated in the normal population and patients with gestational diabetes mellitus (GDM). In this study, we survey the risk factors of GDM in pregnant women in contrast with normoglycemic patients in a case control study in patients using iron supplement. This case control study conducted on 52 pregnant women with GDM (25 women with type Al and 27 women with Type A2 of GDM). The control group randomly selected 50 normoglycemic women. Venous blood sampling was done between 24 and 28 weeks of pregnancy for measuring of ferritin, lipoproteins, uric acid and malondialdehyde serum levels. Under study variables including age, gestational age, weight and BMI were gathered. All the women were followed up until the time of delivery and pregnancy outcome were gathered. The serum ferritin levels in GDM group was 31.22+15.44, which is significantly higher than 24.76+8.94, in the control group with (P=0.012). Plasma hemogulobin in the control group was 12.2+0.1 compared to 12.9+0.1 in GDM group which was significantly lower (P=0.005). Triglycerides was significantly higher in GDM group in contrast with the control group, 275.08+143.17 and 192.30+92.13 (P=0.001), respectively. Finally, our findings indicate the concentration of serum ferritin levels was significantly higher in The GDM group.
This study aims to investigate the quality of life (QOL) of Tehran University of Medical Sciences' (TUMS) medical students at different educational levels and specify the most important factors related to this quality. A sample of 242 medical students was selected randomly, given their number in three educational levels (basic sciences, physiopathology-stager and intern). The QOL was measured by WHOQOL-BREF. The students obtained average high score in two psychological and environmental health domains, and low score in physical health and social relationship domains. As the educational level of students increased their quality of life decreased at all four domains. At social relationship domain, the female students had overall better situation as compared to males (p=0.009). The female and male students had opposite condition at the level of basic sciences and internship, in a way that the female students earned higher marks at basic sciences level and the males at internship level (P= 0.008). The condition of female students in terms of environmental, physical and psychological health became static while their education rose. However, only environmental health of the male students reduced as their education level increased (P= 0.05). The students were of undesirable conditions in two domains of social relationship and physical health. Internship is a specific level in both groups which has a negative impact on the dimensions of quality of life and naturally needs more care for the students. Married status improved the students' QOL and could moderate the undesired effects of internship.
Arthralgia is a common presenting symptom of many rheumatic diseases. Vitamin D deficiency may lead to progression of skeletal symptoms to definite disease in susceptible subjects. This study was conducted to determine the relationship between vitamin D deficiency and unexplained arthralgia. Patients with arthralgia not related to a definite clinical condition were selected prospectively among subjects presented to a rheumatology clinic. Serum 25-hydroxyvitamin D (25-OHD) was measured by ELISA method and levels less than 20 ng/ml were considered as deficient levels. Serum 25-OHD levels and proportion of 25-OHD deficiency was compared in patients versus control. The association of serum 25-OHD and arthralgia was assessed by calculation of odds ratio (OR) using regression analysis. 167 patients with mean age of 38 ± 13.3 and 283 controls with mean age of 42.6±14.37 years (P=0.001) were studied. In patients mean serum 25-OHD was lower and proportion of deficiency was higher (P=0.001 for both).Serum 25-OHD deficiency was associated with 3.01 times increased risk of arthralgia (OR=3.01, 95% CI, 2.0- 4.25, P=0.001). After adjusment for age and sex, the risk of arthralgia remained significan at OR= 2.71(95%CI, 1.79-4.11,P=0.001).The odds of arthralgia decreased with increasing serum 25-OHD from OR=3.48 (95% CI,197-6,P=0.001) at serum <10 ng/ml to 3.39 (95%CI,1.93-5.98, P=0.001) at 10-19.9; and 1.31 (95%CI, 0.69-2.5, P=0.42) at 20-29.9 ng/ml. These findings indicate significant association of vitamin D deficiency and arthralgia. Regarding vitamin D deficiency as an environmental factor for development or progression of rheumatic diseases, this study justifies identification and correction of vitamin D deficiency in patients with arthralgia.
Assessing learners' needs is an integral part of any curriculum and course design , namely English for specific purposes (ESP), syllabus design, materials development, teaching methods and testing issues. Critical approach to needs analysis, which is a relatively recent approach, acknowledges the rights of different stakeholders including teachers, students and administrators in the process of needs analysis. However, there has been no formal need analysis for syllabus design at postgraduate level in Medical Universities affiliated to the Ministry of Health in Iran. This study, conducted in 2011, was an attempt to assess the reading and writing needs of postgraduate students in ESP courses on the basis of critical approach to needs analysis. The study population consisted of 67 people: 56 postgraduate students, 5 heads of departments, 5 ESP instructors and 1 executive manager at the Ministry of Health in Iran. Ethical and demographic forms, needs analysis questionnaires, and a form of semi-structured interview were the instruments of the study. According to the findings, there was a discrepancy between students' and instructors' perception of learners' needs and the assumed needs appearing in the syllabi prescribed by the Ministry of Health in Iran. This study showed that a call for critical needs analysis in which the rights of different stakeholders are acknowledged is necessary for meeting the requirements of any ESP classes especially at postgraduate level where the instructors and learners are fully aware of learners' needs.
The postgastrectomy recurrence rate is as high as 30-65%, with 5-year overall survival rates of <20%. Local recurrence is very common which occurs in 38-45% of cases. The most common sites of locoregional recurrence are the gastric remnant at the anastomosis, the gastric bed, and the regional nodes. The recurrence may occur as early and late events after gastrectomy. Most recurrences are early, within three years of surgery. Numerous studies reported the late recurrences, but most of them having a survival time of less than ten years. This report elucidates a case of recurrent gastric cancer after 24 years postoperatively.
Variations in the origin of arteries in the abdomen are very common. With the invention of new operative techniques within the abdomen cavity, the anatomy of abdominal vessels has assumed a great deal of clinical importance. We report here a rare case of formation of an "arterial glomerulus" at the hilum of the right kidney by the branches of right renal artery. There were 2 renal veins; a superficial and a deep. The deep vein had a peculiar course through the arterial glomerulus. The right testicular vein drained into the deep renal vein. We also observed a variant origin and course of right testicular artery. Prior knowledge of unusual branching pattern of renal vessels is necessary in the surgical interventions which require hilar dissection. Similarly, abnormal origin or course of testicular artery becomes apparent during surgical procedures like varicocele and undescended testes. Therefore, knowledge of such an anomaly in the testicular artery helps to avoid iatrogenic injuries during radiological or surgical procedures.
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