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1.  Combined Femoral and Acetabular Osteotomy in Children of Walking Age for Treatment of DDH; A Five Years Follow-Up Report 
Background
The prevalence of neglected developmental dysplasia of the hip (DDH) has been decreasing. Nowadays, the disease is rarely seen in walking age children. The purpose of this study is to assess the results of simultaneous osteotomy of femur and pelvic bones in such children.
Method
We performed a retrospective study on 30 children aged 3.8±0.9 (range: 1.5-7) years old, with DDH who underwent surgical operation in our hospital from August 2001 to September 2006. Tönnis and Severin grading systems were used to classify the radiographic status of the hip in pre- and postoperative era, respectively. Improvement in function and limp was also evaluated by the modified McKay’s classification.
Results
From the 30 cases, six patients excluded in the course of the study and among the remaining patients, 12 had bilateral involvement. The mean follow-up period was 7.6±0.8 (range: 5.1-11.3) years. During the last visit, radiographic status of the operated joints, according to Severin classification was as follows: Class I: 12 patients; Class II: 20 patients; Class III: 3 patients; Class IV: 1 patient; and Class VI: 1 patient.
Conclusion
Although through the follow-up, two hips subluxated, necrosis happened in three and one joint was re-dislocated, simultaneous femoral and innominate osteotomy in the walking age children with DDH has relatively good clinical outcomes.
PMCID: PMC4300474  PMID: 25649525
Developmental dysplasia of the hip; Osteotomy; Radiography
2.  Comparison of Prophylactic Infusion of Phenylephrine with Ephedrine for Prevention of Hypotension in Elective Cesarean Section under Spinal Anesthesi: A Randomized Clinical Trial 
Background
Spinal anesthesia is an accepted technique in elective cesarean sections. However, hypotension, resulted from sympathectomy is a common problem, especially in pregnant women. Prevention of this complication by sympathomimetic agents is of potential clinical significance. The aim of this study is to compare the effect of prophylactic infusion of Phenylephrine versus Ephedrine in the prevention of hypotension during spinal anesthesia in elective cesarean section.
Methods
Eighty-three patients were enrolled in this study and randomly divided into three groups. Group Ph received phenylephrine infusion, group E received ephedrine infusion while group P were delivered placebo. Vital signs (blood pressure, heart rate, and arterial oxygen saturation) were recorded throughout the surgery. Maternal and neonatal perioperative complications were also controlled and recorded.
Results
There was an insignificant difference in demographic data between the groups. Systolic and diastolic blood pressures were higher in the phenylephrine group than control, but not higher than the ephedrine group. Maternal dysrhythmias were more common in ephedrine and phenylephrine groups than the control group. Vomiting was more common in ephedrine group (P<0.05). In addition, the fifth-minute Apgar score of neonates was higher in phenylephrine and ephedrine groups than the control group (P<0.05). Neonates of phenylephrine group had less acidosis than the other groups.
Conclusion
Prophylactic infusion of phenylephrine can effectively decrease spinal anesthesia related hypotension without any significant complication for mother or her fetus.
Trial Registration Number: IRCT2012120911700N1
PMCID: PMC4300475  PMID: 25649721
Phenylephrine; Ephedrine; Spinal anesthesia; Cesarean section; Hypotension
3.  Association between the Functional Polymorphism of Vascular Endothelial Growth Factor Gene and Breast Cancer: A Meta-Analysis 
The vascular endothelial growth factor (VEGF) gene single-nucleotide polymorphism involved in the regulation of the protein levels has been implicated in breast cancer. However, the published studies have produced contentious and controversial results. Herein, we performed a meta-analysis (from January to October 2013); to further evaluate the association between +936 C/T polymorphism and the risk of breast cancer. By searching the EMBASE, PubMed, and Web of Science databases, we identified a total of 12 case-control studies with 8,979 cancer patients and 9,180 healthy controls. The strength of the association was assessed using Odds Ratios (ORs) with 95% Confidence Intervals (CI). We found no evidence indicating that the allelic model or the genotype models of +936 C/T polymorphism were associated with the risk of breast cancer in total population (ORCC vs. TT=1.01, 95% CI=0.96-1.06, Ph=1.00; ORCC+CT vs. TT=1.00, 95% CI=0.96-1.05, Ph=1.00; ORCC vs. CT+TT=1.02, 95% CI=0.98-1.07, Ph=0.94; OR allele C vs. allele T=1.01, 95% CI=0.98-1.04, Ph=0.99; ORCT vs. TT=1.01, 95% CI=0.93-1.09, Ph=1.00). Such lack of association with breast cancer was also observed in subgroup analyses according to ethnicity as well as in the analysis by source of controls. In conclusion, this meta-analysis suggests that the functionally important +936 C/T polymorphism may not be associated with breast cancer risk. Larger well-designed studies with gene-to-gene and gene-to-environment interactions are clearly required to validate the results further.
PMCID: PMC4300476  PMID: 25649829
Vascular endothelial growth factor A; Breast neoplasms; Polymorphism; Risk
4.  Comparison of Appetite-regulating Hormones and Body Composition in Pediatric Patients in Predialysis Stage of Chronic Kidney Disease and Healthy Control Group 
Background
Protein-energy malnutrition (PEM) is a common complication in pediatric patients with chronic kidney disease (CKD). Components incorporated in the regulation of appetite and body composition appear to be of the focus in renal insufficiency and may influence the CKD-associated PEM. The purpose of this study was to investigate plasma levels of appetite-regulating hormones and their correlation with the body composition variables in a pediatric in predialysis stage of CKD.
Methods
Thirty children with CKD in predialysis stage were selected and compared with 30 healthy sex- and age-matched controls. Blood samples were collected in fasting. Serum total ghrelin, leptin, and obestatin levels were measured using enzyme immunometric assay methods. Anthropometric parameters measurement and body composition analysis were done using the bioelectric impedance analysis (BIA) method.
Results
Patients showed insignificant elevated total ghrelin (105.40±30.83 ng/l), leptin (5.32±1.17 ng/ml) and obestatin (5.07±1.09 ng/ml) levels in comparison with healthy participants. By using BIA, patients had significantly different Dry Lean Weight (P=0.048), Extra Cellular Water (P=0.045), Body Cell Mass (BCM) (P=0.021), Basal Metabolic Rate (P=0.033) and Body Mass Index (P=0.029) compared with controls. Furthermore, the total body water was slightly and the ECW was significantly higher in CKD participants. There were significant negative correlation between obestatin and BCM (r=-0.40, P=0.03) and fat free mass index (FFMI) (r=-0.40, P=0.029) in patients.
Conclusion
It seems that our results are insufficient to clarify the role of appetite-regulating hormones in PEM in CKD patients. It is apparent that there are still many unknown parameters related to both appetite regulating and CKD-associated PEM.
PMCID: PMC4300477  PMID: 25649956
Chronic renal insufficiency; Ghrelin; Leptin; Obestatin
5.  Application of Bland-Altman Method in Comparing Transrectal and Transabdominal Ultrasonography for Estimating Prostate Volume 
Background
Estimating prostate volume using less invasive transabdominal ultrasonography (TAUS) instead of transrectal ultrasonography (TRUS) is of interest in terms of identifying their agreement level. Previous reports on this subject, applied general correlation coefficient as the level of agreement. This study uses Bland-Altman method to quantify TAUS and TRUS agreement on estimating prostate volume.
Methods
Total prostate gland volume of 40 patients with signs and symptoms of benign prostatic hyperplasia were measured using TAUS and TRUS. The study was carried out at the Urology Research Center, Razi Hospital, Guilan University of Medical Sciences (Rasht, Iran) from March to October 2010. Both methods were performed in one session by the same experienced radiologist. Data were analyzed using Pearson correlation coefficient and Bland-Altman method.
Results
Total prostate volume estimated by TAUS and TRUS were 50.30±23 and 50.73±24.6 mL, respectively. The limits of agreement for the total prostate volume were -6.86/9.84 that was larger than predefined clinical acceptable margin of 5 mL.
Conclusion
There is a lack of agreement between TAUS and TRUS for estimating the total prostate volume. It is not recommended to apply TAUS instead of TRUS for estimating prostate volume.
PMCID: PMC4300478  PMID: 25650064
Prostate; Ultrasonography; Cross-sectional studiy; Bland-Altman approach
6.  On-Pump Beating Coronary Artery Bypass in High Risk Coronary Patients 
Background
There are some conflicting results with Conventional Coronary Artery Bypass Grafts (CCABG) with arrested heart in coronary high-risk patients. Moreover, performing off-pump CABG in these cases may be associated with serious complications. The objective of this study is to evaluate the efficacy of the on-pump beating CABG (OPBCABG) in coronary high-risk patients in comparison with the conventional methods.
Methods
In a prospective research study, 3000 off-pump CABG patients were considered during June 2003 to December 2011. Among these, 157 patients with one or more of the following risk factors were included for OPBCABG; severe left main stenosis, early post-acute myocardial infarction with ongoing chest pain, unstable angina, intractable ventricular arrhythmia, post complicated coronary intervention and severe left ventricular dysfunction. These patients were compared with 157 similar patients undergone CCABG with aortic cross clamp before 2003.
Results
Preoperative patient characteristics revealed no significant differences between the two groups. The patients’ mean age and number of grafts were 57 years and 3 per patient respectively. Hospital mortality was 3.2% and 9% in OPBCABG and CCABG groups, respectively (P<0.001). Preoperative myocardial infarction, requirement of inotropic agents and intraaortic balloon pump, renal dysfunction and prolonged ventilation time were significantly higher in CCABG group.
Conclusion
Our results suggest that OPBCABG is effective in coronary high-risk patients and significantly reduces mortality and the incidence of perioperative MI and other major complications.
PMCID: PMC4300479  PMID: 25650152
Cardio pulmonary bypass; Off pump coronary artery bypass; Efficacy
7.  Effect of S-Methyl-L-Cysteine on Oxidative Stress, Inflammation and Insulin Resistance in Male Wistar Rats Fed with High Fructose Diet 
Background
S-methyl cysteine (SMC) is a hydrophilic cysteine-containing compound naturally found in garlic and onion. The purpose of the present study was to investigate the protective effect of SMC on oxidative stress, inflammation and insulin resistance in an experiment of metabolic syndrome.
Methods
Male Wistar rats were divided into five groups (6 rats in each group), namely; control, control+S-methyl cysteine (SMC), high fructose diet (HFD), HFD+SMC and HFD+metformin. The 60% fructose used for 8 weeks and SMC in the dose of 100 mg/kg bw/day/rat was used in the study. The fasting glucose, insulin, insulin resistance, and tumor necrosis factor alpha and erythrocyte enzymatic antioxidants were measured.
Results
Increased levels of plasma glucose, insulin, malondialdehyde, tumor necrosis factor-alpha, and insulin resistance and decreased levels of glutathione, glutathione peroxidase, and catalase were found in rats on a high fructose diet. Oral administration of SMC (100 mg/kg bw/day/rat) for 60 days resulted in significant attenuation of plasma glucose, insulin, tumor necrosis factor–alpha, insulin resistance and improved antioxidant enzyme activities.
Conclusion
Oral treatment of SMC is effective in improving insulin resistance while attenuating metabolic syndrome, inflammation, and oxidative stress in male rats fed with fructose rich diet.
PMCID: PMC4300480  PMID: 25650289
Fructose; Insulin resistance; Inflammation; Oxidative stress
8.  An Experience of Qualified Preventive Screening: Shiraz Smart Screening Software 
Background
Computerized preventive screening software is a cost effective intervention tool to address non-communicable chronic diseases. Shiraz Smart Screening Software (SSSS) was developed as an innovative tool for qualified screening. It allows simultaneous smart screening of several high-burden chronic diseases and supports reminder notification functionality. The extent in which SSSS affects screening quality is also described.
Methods
Following software development, preventive screening and annual health examinations of 261 school staff (Medical School of Shiraz, Iran) was carried out in a software-assisted manner. To evaluate the quality of the software-assisted screening, we used quasi-experimental study design and determined coverage, irregular attendance and inappropriateness proportions in relation with the manual and software-assisted screening as well as the corresponding number of requested tests.
Results
In manual screening method, 27% of employees were covered (with 94% irregular attendance) while by software-assisted screening, the coverage proportion was 79% (attendance status will clear after the specified time). The frequency of inappropriate screening test requests, before the software implementation, was 41.37% for fasting plasma glucose, 41.37% for lipid profile, 0.84% for occult blood, 0.19% for flexible sigmoidoscopy/colonoscopy, 35.29% for Pap smear, 19.20% for mammography and 11.2% for prostate specific antigen. All of the above were corrected by the software application. In total, 366 manual screening and 334 software-assisted screening tests were requested.
Conclusion
SSSS is an innovative tool to improve the quality of preventive screening plans in terms of increased screening coverage, reduction in inappropriateness and the total number of requested tests.
PMCID: PMC4300481  PMID: 25648047
Cancer; Chronic disease; Software; Quality improvement
9.  Transvaginal Sacrospinous Ligament Fixation for Pelvic Organ Prolapse Stage III and Stage IV Uterovaginal and Vault Prolapse 
The result of transvaginal sacrospinous ligament fixation technique, as part of the vaginal repair procedure for massive uterovaginal (Pelvic Organ Prolapse stage III and stage IV and vault prolapse) is evaluated. A total of 32 women were included in the present case series. Marked uterovaginal prolapse was present in 28 women and four had vault prolapse following hysterectomy. Patients with vault prolapse and marked uterovaginal prolapse underwent sacrospinous colpopexy. The mean follow-up period was 2.5 years. Out of the 28 patients with previous marked uterovaginal prolapse, only one had small cystocele 3 years after the surgery. This patient was asymptomatic and did not require repeat surgery. One woman had post-operative urinary tract infection and two had buttock discomfort, one had ischiorectal abscess and two had cuff cellulitis. All complications were dealt with successfully. No other major intra- and post-operative complications occurred. Transvaginal sacrospinous colpopexy can be performed together with vaginal hysterectomy, with marked uterovaginal prolapse and vault prolapse.
PMCID: PMC4300482  PMID: 25648154
Prolapse; Vaginal hysterectomy; Repair
10.  Identification of Aptamer-Binding Sites in Hepatitis C Virus Envelope Glycoprotein E2 
Hepatitis C Virus (HCV) encodes two envelope glycoproteins, E1 and E2. Our previous work selected a specific aptamer ZE2, which could bind to E2 with high affinity, with a great potential for developing new molecular probes as an early diagnostic reagents or therapeutic drugs targeting HCV. In this study, the binding sites between E2 and aptamer ZE2 were further explored. E2 was truncated to 15 peptides (P1 to P15) and these peptides were used to detect the affinity with ZE2 by ELISA respectively. The peptide with high affinity was then further truncated, detected and compared with six kinds of HCV genotypes. The basic amino acid in 500 aa bound to ZE2 with high affinity, while acidic amino acid in 501 aa reduced the reaction between E2 and ZE2. The results showed the 500 aa and 501 aa of E2 were the key sites that bound to ZE2.
PMCID: PMC4300483  PMID: 25648186
Hepatitis C virus; Glycoprotein E2; Aptamer; Binding site
11.  MEFV Gene Profile in Northwest of Iran, Twelve Common MEFV Gene Mutations Analysis in 216 Patients with Familial Mediterranean Fever 
Familial Mediterranean Fever (FMF) is a hereditary autoinflammatory disease with autosomal recessive inheritance pattern often seen around the Mediterranean Sea. It is characterized by recurrent episodes of fever and polyserositis and rash. Recently, MEFV gene analysis determines the definitive diagnosis of FMF. In this study, we analyzed 12 MEFV gene mutations in more than 200 FMF patients, previously diagnosed by Tel-Hashomer clinical criteria, in northwest of Iran, located in the proximity of the Mediterranean Sea. In the northwest of Iran (Ardabil), 216 patients with FMF diagnosis, based on Tel-Hashomer criteria, referred to the genetic laboratory to be tested for the following mutations; P369S, F479L, M680I(G/C), M680I(G/A), I692del, M694V, M694I, K695R, V726A, A744S, R761H, E148Q. All patients were screened for MEFV gene mutations by a reverse hybridization assay (FMF Strip Assay, Vienna lab, Vienna, Austria) according to manufacturer’s instructions. Among these FMF patients, no mutation was detected in 51 (23/62%) patients, but 165 (76/38%) patients had one or two mutations, 33 patients (15/28%) homozygous, 86 patients (39/81%) compound heterozygous and 46 patients (21/29%) were heterozygous. The most common mutations were M694V (23/61%), V726A (11/11%) and E148Q (9/95%) respectively.
MEFV gene mutations showed similarities and dissimilarities in different ethnic groups, while it is common among Arabs and Armenians genotype. Since common 12 MEFV gene analysis could not detect up to 50% of our patients, who had FMF on the basis of clinical Tel-Hashomer criteria, clinical criteria is still the best way in the diagnosis of FMF in this area.
The abstract of this article has been presented in the 7th Congress of International Society of Systemic Auto-Inflammatory Diseases in Lausanne, Switzerland, 22-26 May 2013.
PMCID: PMC4300484  PMID: 25648235
Familial Mediterranean Fever; MEFV gene; Iran; Tel-Hashomer criteria
12.  Sheehan’s Syndrome Presenting as Major Depressive Disorder 
Sheehan’s syndrome or Simmond’s disease is a rare endocrine disorder seen in clinical practice. The clinical spectrum is diverse and a high index of suspicion together with a good clinical acumen and proper diagnostic approach helps in early diagnosis and prompt treatment of this endocrinopathy. Sheehan’s syndrome presenting as a major depressive disorder finds less mention in the literature.
The patient discussed here is a 45-year-old female who had been on antidepressants and psychiatry follow up for a long time until she presented to our Out Patient Department (OPD), where she was evaluated in detail and diagnosed as a case of Sheehan’s syndrome. The patient is doing well and is on a regular follow-up with us. Further studies are required to demystify the strength of this association in more detail and to elucidate the possible underlying mechanism.
PMCID: PMC4300485  PMID: 25648343
Hypopituitarism; Postpartum hemorrhage; Major depressive disorder
13.  Periosteal Osteoblastoma of the Pelvis: A Rare Case 
Among the rare bone tumors, the osteoblastoma is a fascinating tumor. The rarity, the predisposition to occur in any bone and the diagnostic dilemma makes this infrequent tumor interesting. It is sporadically reported in the literature and what is rarer is its occurrence in the pelvis. The unusual location and inconclusive radiographic findings with diffused diagnostic evidences delays the management of benign osteoblastoma. We encountered a patient with benign osteoblastoma of the pubic ramus of right side. An excisional biopsy was performed. Peroperatively, the tumor appeared as oval, reddish brown, bony hard mass lying just over the cortex of the right pubic ramus and not breaching the cortex. Histopathological study revealed an osteoid rich lesion. Its presence in pubis must not be ignored and periosteal osteoblastoma should be considered as a differential diagnosis.
PMCID: PMC4300486  PMID: 25648425
Periosteal; Osteoblastoma; Pubic bone; Osteochondroma
14.  Low Grade Endometrial Stromal Sarcoma: A Case Report 
Endometrial stromal sarcoma (ESS) is a rare malignant tumor of the endometrium, occurring in the age group of 40–50 years. We report a case of low-grade ESS in a 39-year-old woman, presenting as rapid enlargement of a uterine fibroid polyp associated with irregular and excessive vaginal bleeding. Polypectomy followed by pan hysterectomy was performed. Histopathological examination and immunohistochemistry confirmed LGESS. As the tumor is rarely encountered, management protocols are still questionable. In our case, we tried a different post-surgical protocol and the patient is being closely followed up. Although rare, ESS should be considered in the differential diagnosis of all women who present with a rapid enlargement of a uterine leiomyoma.
PMCID: PMC4300487  PMID: 25648534
Endometrial stromal sarcoma; Uterine leiomyoma; Immunohistochemistry
15.  Association between Iron Deficiency Anemia and Febrile Convulsion in 3- to 60-Month-Old Children: A Systematic Review and Meta-Analysis 
Controversy exists regarding the association between Iron Deficiency Anemia (IDA), iron status, and Febrile Convulsion (FC) during childhood. In this article, a systematic review and meta-analysis is conducted in order to determine possible association and the degree of association between these statuses and FC. To identify all studies related to IDA and FC, various references such as MEDLINE (PubMed), Embase (OVID), Web of sciences (Thomson Reuters) and Google scholar were searched (up until 15 January 2013). Heterogeneity was assessed using the Q statistic, Tau2, and I2. Additionally, subgroup analyses were performed. The outcome of primary interest was the overall Odds Ratio (OR) of FC for IDA and standard mean differences (SMD) of ferritin level. In total, 21 articles were considered to assess the association between IDA and FC. Anemia was more prevalent among the FC patients compared with the controls and the overall OR was 1.52 (95% CI=1.03 to 2.25). In addition, the pooled OR for 17 studies performed in the populations with low and moderate prevalence of anemia was 2.04 (95% CI=1.46 to 2.85). Furthermore, 12 studies assessed the association between the ferritin level and FC. The overall SMD was -0.02 with a 95% CI of -0.09 to 0.06. Besides, the pooled SMD of ferritin was -0.57 (95% CI=-0.7 to -0.46) in 6 studies reporting no difference between the FC and the control group with respect to temperature. IDA was associated with a moderate increased risk of FC in children, particularly in the areas with low and moderate prevalence of anemia.
PMCID: PMC4242983  PMID: 25429171
Febrile; Children; Iron deficiency anemia
16.  Psychometric Characteristics of the Persian (Farsi) Version of Attachment Style Questionnaire 
Background: Attachment relationship provides a secure base for the infants from which to explore the environment and a safe haven to return to in times of danger. Attachment style shapes the behavior of individuals in adulthood. There are many different measures of attachment and a lot of controversy about what they measure and how they relate to each other. Hence, we tried to evaluate the psychometric properties of one of such questionnaires on a sample of the Iranian population.
Methods: “Attachment style questionnaire” designed by Van Oudenhoven measures four dimensions: secure, preoccupied, fearful and dismissing. Psychometric properties of the questionnaire were evaluated in a cross sectional study on 730 adults in Isfahan, Iran. Statistical analysis of data was performed by the explanatory factor analysis with the principal component method, Cronbach’s alpha, Pearson correlation coefficients, and the multiple analysis of variance (MANCOVA).
Results: The Cronbach’s alpha for all items was 0.704. As a whole, the internal consistency was good. There was a high inter-scale correlation between preoccupied and fearful, also the secure style correlated negatively with fearful and preoccupied. The stability coefficient of the attachment scales were 0.625, 0.685, 0.777 and 0.605 for secure, fearful, preoccupied and dismissing styles respectively (P<0.001). Regarding construct validity, factor analysis showed that some items require iterations to fit the Iranian population.
Conclusion: This study showed that the Persian version of ASQ has a reasonable reliability and validity in general and the questionnaire is appropriate for use among the Iranian population in future studies.
PMCID: PMC4242984  PMID: 25429172
Iran; Questionnaire; Culture
17.  Incidence of Potential Drug-Drug Interaction and Related Factors in Hospitalized Neurological Patients in two Iranian Teaching Hospitals 
Background: Reciprocal drug interactions are among the most common causes of adverse drug reactions. We investigated the incidence and related risk factors associated with mutual drug interactions in relation to prescriptions written in the neurology wards of two major teaching hospitals in Shiraz, southern Iran.
Methods: Data was collected from hand-written prescriptions on a daily basis. Mutual drug interactions were identified using Lexi-Comp 2012 version 1.9.1. Type D and X drug interactions were considered as potential drug-drug interactions. The potential risk factors associated with drug-drug interactions included the patient’s age and gender, number of medications and orders, length of hospitalization and the type of neurological disorder. To determine potential drug-drug interactions, relevant interventions were suggested to the physicians or nurses and the outcome of the interventions were documented.
Results: The study comprised 589 patients, of which 53% were males and 47% females, with a mean age of 56.65±18.19 SD years. A total of 4942 drug orders and 3784 medications were prescribed among which 4539 drug-drug interactions were detected, including 4118 type C, 403 type D, and 18 type X. Using a logistic regression model, the number of medications, length of hospitalization and non-vascular type of the neurological disorder were found to be significantly associated with potential drug-drug interactions. From the total interventions, 74.24% were accepted by physicians and nurses.
Conclusion: Potentially hazardous reciprocal drug interactions are common among patients in neurology wards. Clinical pharmacists can play a critical role in the prevention of drug-drug interactions in hospitalized patients.
PMCID: PMC4242985  PMID: 25429173
Drug-related side effects and adverse reactions; Neurology; Risk factor
18.  Healing Effect of Pistacia Atlantica Fruit Oil Extract in Acetic Acid-Induced Colitis in Rats  
Background: Considering the anti-oxidant properties of Pistacia atlantica and lack of data regarding its efficacy in the treatment of ulcerative colitis, this study aims at investigating the effect of the Pistacia atlantica fruit extract in treating experimentally induced colitis in a rat model.
Methods: Seventy male Sprague-Dawley rats (weighing 220±20 g) were used. All rats fasted 24 hours before the experimental procedure. The rats were randomly divided into 7 groups, each containing 10 induced colitis with 2ml acetic acid (3%). Group 1 (Asacol), group 2 (base gel) and group 7 (without treatment) were assigned as control groups. Group 3 (300 mg/ml) and group 4 (600 mg/ml) received Pistacia atlantica fruit orally. Group 5 (10% gel) and group 6 (20% gel) received Pistacia atlantica in the form of gel as enema. Macroscopic, histopathological examination and MDA measurement were carried out.
Results: All groups revealed significant macroscopic healing in comparison with group 7 (P<0.001). Regarding microscopic findings in the treatment groups compared with group 7, the latter group differed significantly with groups 1, 2, 4 and 6 (P<0.001). There was a significant statistical difference in MDA scores of the seven treatment groups (F(5,54)=76.61, P<0.001). Post-hoc comparisons indicated that the mean±SD score of Asacol treated group (1.57±0.045) was not significantly different from groups 4 (1.62±0.024) and 6 (1.58±0.028).
Conclusion: Our study showed that a high dose of Pistacia atlantica fruit oil extract, administered orally and rectally can improve colitis physiologically and pathologically in a rat model, and may be efficient for ulcerative colitis.
PMCID: PMC4242986  PMID: 25429174
Enema; Colitis; Rat
19.  Cross-Cultural Adaptation and Validation of the Persian Version of the Oxford Knee Score in Patients with Knee Osteoarthritis 
Background: The Oxford Knee Score (OKS) is a short patient-reported outcome instrument that measures pain and physical activity related to knee osteoarthritis. The purpose of this study is to evaluate, construct validity and consistent reliability of the Persian version of the OKS.
Methods: The case series consisted of 80 patients who were clinically diagnosed with having knee osteoarthritis. All patients were requested to fill-in the Persian OKS and Short-Form 36 Health Survey (SF-36). Correlation analysis between the Persian versions of these two instruments was then carried out. The scores of the Persian SF-36 were used to evaluate convergent and divergent validity of the 12-item Persian OKS.
Results: From a total of 80 patients, 63 were female (79%) and the remaining 17 were male (21%) with a mean age of 52.2 years. In the present study, high Cronbach’s alpha of 0.95 confirms excellent internal consistency of the Persian OKS scale similar to previous investigations. The results confirm that the Persian version of this instrument is valid and reliable, similar to its English index and its subsequent translations in different languages.
Conclusion: The Persian OKS is a reliable instrument to evaluate knee function in patients with knee osteoarthritis and is a useful tool for outcome measurement in clinical research.
PMCID: PMC4242987  PMID: 25429175
Iran; Knee; Surgery; Osteoarthritis; Knee replacement arthroplasty; Public health
20.  Blockade of Central Angiotensin II AT1 Receptor Protects the Brain from Ischemia/Reperfusion Injury in Normotensive Rats  
Background: Stroke is the third leading cause of invalidism and death in industrialized countries. There are conflicting reports about the effects of Angiotensin II on ischemia-reperfusion brain injuries and most data have come from chronic hypertensive rats. In this study, hypotensive and non-hypotensive doses of candesartan were used to investigate the effects of angiotensin II AT1 receptor blockade by transient focal cerebral ischemia in normotensive rats.
Methods: In this experimental study, 48 male Sprague-Dawley rats were randomly divided into four groups (n=12). Sham group, the control ischemic group, and two ischemic groups received candesartan at doses of 0.1 or 0.5 mg/kg at one hour before ischemia. Transient focal cerebral ischemia was induced by 60 minutes occlusion of the middle cerebral artery, followed by 24 h reperfusion. The neurological deficit score was evaluated at the end of the reperfusion period. The total cortical and striatal infarct volumes were determined using triphenyltetrazolium chloride staining technique. Tissue swelling was calculated for the investigation of ischemic brain edema formation.
Results: In comparison with the control ischemic group, AT1 receptor blockade with both doses of candesartan (0.1 or 0.5 mg/kg) significantly improved neurological deficit and lowered cortical and striatal infarct sizes. In addition, pretreatment with candesartan significantly reduced ischemia induced tissue swelling.
Conclusion: Angiotensin II by stimulating AT1 receptors, participates in ischemia-reperfusion injuries and edema formation. AT1 receptor blockade with candesartan decreased ischemic brain injury and edema and improved neurological outcome.
PMCID: PMC4242988  PMID: 25429176
Angiotensin II; Angiotensin AT1 receptor; Candesartan; Stroke; Rat
21.  Intrathecal Amylin and Salmon Calcitonin Affect Formalin Induced c-Fos Expression in the Spinal Cord of Rats 
Background: Amylin and Salmon Calcitonin belong to the calcitonin family of peptides and have high affinity binding sites in the rat spinal cord. The aim of this study was to characterize receptors for Amylin and Salmon Calcitonin functionally in the spinal cord of rats. We assessed the expression of c-Fos in response to intraplantar formalin in the lumbar regions of the spinal cord in conscious rats.
Methods: Amylin (0.05 nmoles) or Salmon Calcitonin (0.005 nmoles) was administered intrathecally (i.t.) 10 minutes before the start of the formalin test. Antagonists were injected intrathecally 10 minutes before the administration of either of the peptides.
Results: Two hours after formalin stimulation, rats pretreated intrathecally by either Amylin or Salmon Calcitonin, showed lower numbers of c-Fos immunoreactive nuclei in their lumbar spinal cord as compared to rats pretreated with saline. These effects were reversed upon co-administration of either of the Amylin antagonists AC187 or rat amylin8-37, but not rat α-CGRP8-37. A few cells with c-Fos immunoreactivity were found in the lumbar spinal cord of rats two hours after i.t. injection of saline, Amylin and/or Salmon Calcitonin. However, Fos-like immunoreactivity was increased in the lumbar spinal cord two hours after i.t. treatment of either of the antagonists AC187 and rat amylin8-37,when compared to saline treated rats.
Conclusion: Both Amylin and Salmon Calcitonin inhibit formalin induced c-Fos expression in the rat lumbar spinal cord when administered intrathecally. Effects of the two peptides were possibly produced by undefined receptors.
PMCID: PMC4242989  PMID: 25429177
Rats; Spinal cord; Proto-oncogene proteins c-fos; Salmon Calcitonin
22.  Preparation of a Selective L-Phenylalanine Imprinted Polymer Implicated in Patients with Phenylketonuria 
Background: Molecular imprinting is a method for synthesizing polymers with structure-selective adsorption properties with applications such as, selectivity binding, drug delivery systems and anti-bodies. The present study aims at optimizing the preparation of molecularly imprinted polymer (MIP) against l-phenylalanine, in order to increase phenylalanine-binding in Enzymatic Intestinal Simulated Fluid (ESIF).
Methods: The MIP for l-phenylalanine, as a water-soluble template, was successfully synthesized without derivatization. Synthesization was done by a UV polymerization method in which methacrylic acid (MAA), as a functional monomer, and ethylene glycol dimethacrylate (EGDMA), as a cross-linker, were used in the presence of five different porogenic solvents including; acetonitrile, tetrahydrofuran (THF), chloroform, toluene and dimethyl sulfoxide (DMSO). The selectivity of the MIP was examined using 19 different amino acids in human serum and was evaluated by HPLC. In addition, morphological studies were conducted using SEM.
Results: The results showed that the obtained MIP with acetonitrile had the highest capacity and selectivity compared with other solvents. The data indicated that Phe-binding to MIP was significantly more than the former binding to NIP in EISF (P≤0.05). Moreover, in comparison with NIP and control group, MIP showed a better selectivity and binding for Phe. This could be used for the reduction of Phe in human serum samples of Phenylketonuria.
Conclusion: Our findings suggest that the MIP against Phe prepared with acetonitrile, showed a good selectivity and binding, which caused a reduction of blood Phe concentration in enzymatic simulated intestinal fluid and human serum sample of Phenylketonuria.
PMCID: PMC4242990  PMID: 25429178
Phenylalanine; Phenylketonurias; Treatment
23.  The Effects of Low and High Dose Oral Calcium and Phosphor Supplementation on Nephrocalcinosis Diagnosed by Sonography in Premature and Low Birth Weight Neonates 
Nephrocalcinosis is defined as calcium deposition in the renal interstitium. One of the major causes of neonatal nephrocalcinosis is the use of calcium and phosphor supplements for premature neonates. This study aims at assessing the effects of calcium and phosphor supplementation in neonatal nephrocalcinosis by renal ultrasonography.
In this randomized controlled trial, 37 premature neonates with birth weights <1500 g or a gestational age of <34 weeks were considered. Two different doses of calcium 75 vs. 230 mg/kg/day and phosphor 50 vs. 110 mg/kg/day were prescribed and laboratory and sonographic data were then documented and evaluated.
The incidence of nephrocalcinosis was 47.8% in group 1 and 28.6% in group 2. There was a significant association between NC and positive family history of renal stones, shorter duration of TPN and NICU stay. The amount of calcium dosage, gestational age, birth weight, sex, use of surfactants, and mechanical ventilation did not have any significant association with NC.
In this study, the neonates with NC were mostly the white flake type (8 cases) and the majority of the lesions were 1-2 mm. All the lesions were located in the pyramid and papilla areas, acoustic shadows were not prevalent and stones were not observed in any of the patients.
Trial Registration Number: IRCT2013060810441N3
PMCID: PMC4242991  PMID: 25429179
Prematurity; Calcium; Phosphor; Nephrocalcinosis; Ultrasonography
24.  Effectiveness of Treadmill Training on Balance Control in Elderly People: A Randomized Controlled Clinical Trial 
Physical exercise would improve postural stability, which is an essential factor in preventing accidental fall among the elderly population. The aim of this study is to examine the effectiveness of treadmill walking on balance improvement among the elderly people.
A total of 30 community dwelling older adults with a Berg Balance Scale score of 36-48 and the ability to walk without aid were considered and divided into control (n=15) and experimental (n=15) groups. Individuals in the experimental group participated in 30 minutes of forward and backward treadmill training based on three times a week interval for a period of four weeks. Individuals in the control group were instructed to continue with their daily routine activity. Before and after training, gait speed was measured by six-minute walk test and balance ability was evaluated by Fullerton Advanced Balance Scale (FABS) and Berg Balance Scale (BBS) tests. Postural sway items such as the Center of Pressure (COP), average displacement and velocity were evaluated by using a force platform system. Data were collected in quiet standing, tandem position and standing on foam pads before and after intervention.
After intervention, balance variables in the experimental group indicated a significant improvement in quiet standing on firm and foam surfaces, but no considerable improvement was shown in tandem position.
A between-group comparison showed a significant reduction in COP velocity in the sagittal plane (P=0.030) during quiet standing and in the frontal plane (P=0.001) during standing on foam, whereas no significant reduction in COP parameters during tandem position was found.
It is recommended that twelve sessions of forward and backward treadmill walk are effective in balance improvement in elderly people.
Trial Registration Number: IRCT201209199440N2
PMCID: PMC4242992  PMID: 25429180
Exercise test; Postural balance; Elderly; Walking
25.  Indoor Smoke Exposure and Risk of Anthracosis 
The association between indoor smoke exposure due to traditional baking (baking homemade bread) and anthracosis has rarely been investigated. The aim of the present study is to quantify such association among the Iranian population. A hospital based case-control study was carried out on 83 anthracotic cases and 155 controls (83 individuals with non-anthracotic pulmonary disorders from the pulmonary ward and 72 persons from the surgical ward without any known pulmonary disorders). The interview was performed using the “American Thoracic Society” questionnaire, comprising demographic information, occupational history, cigarette smoking, and indoor smoke exposure due to traditional baking. Multivariate analysis was performed by logistic regression. Comparison between cases and pulmonary ward controls showed that only the association between indoor smoke exposure due to traditional baking and anthracosis in women was statistically significant (OR: 4.30, 95% CI: 1.31 to 14.10). This was concluded after adjusting for other risk factors such as occupational exposure to dust, age, and education. When surgical ward controls were considered as control, after controlling for the significant risk factors, we found a significant relationship between indoor smoke exposure due to traditional baking and anthracosis (OR: 3.35, 95% CI: 1.49 to 7.55). Based on the findings from this study, it is concluded that there is an association between indoor smoke exposure and anthracosis. Women are significantly more susceptible to anthracosis than men are when exposed to smoke exposure.
PMCID: PMC4242993  PMID: 25429181
Anthracosis; Indoor air pollution; Iran

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