[Effect of combination of Melatonin and All-Trans retinoic acid on maturation, fertilization and embryonic development of immature mouse oocytes]

Background and Objective: With respect to the antioxidant role of melatonin and retinoic acid, it seems to be effective both in the maturation and embryonic development. This study was done to investigate the effect of combination of melatonin and All-Trans retinoic acid [RA] on maturation, fertilization and embryonic development of immature mouse oocytes

Methods: In this experimental study, cumulus - oocyte complex [COCs] were recovered from 4-6 week old female mice NMRI and were divided into 6 maturation medium groups including control, sham, experiment 1[melatonin 100 nM, 1 and 2 microM], experiment 2 [retinoic acid 1, 2, 4, 6 microM], experiment 3 [melatonin 2 microM+RA 4 microM], experiment 4 [Mel 100nM + retinoic acid 4 microM]. The maturation rate was recorded after 24 hours of culture in a humidified atmosphere of 5% CO2 at 37°C. The matured oocytes were fertilized with sperm. Fertilization and embryonic development rates to the blastocyst stage were recorded

Results: Maturation rate in the control and sham groups were 50.6% and 49.4%, respectively. Maturation rate were 54.3%, 54.8%, 59.9% in melatonin group with concentrations of 100 nM, 1 and 2 microM, respectively. Maturation rate were 51.6%, 51%, 59% and 49.6% in t-RA group with concentrations of 1, 2, 4, 6 microM. Maturation rate were 60.4% and 54.2% in the experiment 3 and 4 groups, respectively. The maturation rates in the melatonin 2 microM, retinoic acid 4 microM and experiment 3 significantly increased in compare to control [P<0.05]. The embryonic development rate in the melatonin with 100nM concentration and 4 microM of retinoic acid increased significantly compared to controls [P<0.05]. Although, embryonic development rate in experiment 3 was higher than control, but lower in compare to melatonin 100 nM and the retinoic acid 4 microM. The embryonic development rate in experiment 4 significantly increased in compare to control [P<0.05]

Conclusion: Combination of melatonin and All-Trans retinoic acid in medium culture increase maturation rate and improved embryonic development in dose dependent manner

[Relationship between assertiveness and critical thinking in nursing students]

Assertiveness and critical thinking help improve the academic practice of nursing students. Therefore, the aim of this study was to determine the relationship between assertiveness and critical thinking in nursing students. This analytical and correlation study was performed on 213 nursing students in Tehran University of Medical Sciences using convenient sampling. Main study tools were California critical thinking skills test [CCTST] and assertiveness inventory of Gambril and Richi. Data were analyzed by SPSS 16 software using ANOVA, chi square and Pearson correlation coefficient test. Mean scores of assertiveness and critical thinking for nursing students were 68.15 +/- 12.79 and 9.32 +/- 3.38. Many students had moderate level of assertiveness [89.7%] and most of them had unusual level of critical thinking [94.8%]. Pearson correlation coefficient test showed a direct correlation between assertiveness and critical thinking [r=0.045] with no significant difference between the two variables [P=0.51]. It is necessary to revise the teaching strategy to improve the level of critical thinking in nursing curriculum. To achieve assertiveness training in nurses, efforts should be made to identifying and support nursing students who have low levels of critical thinking

[ comparison of 6-week resistance training and pulsed electromagnetic field on TALP, CA, P, cortisol, and anthropometric parameters in osteoporotic postmenopausal women]

Considering the high sensitivity of bone to mechanical stimulations, one of the potential ways of impressing bone tissue in clinical perspective, is applying physical and mechanical loads. In this study, we compared the effect of progressive resistive exercise versus pulsed electromagnetic fields on total ALP, calcium, phosphorus and cortisol, and anthropometric variables in primary postmenopausal osteoporotic women. Thirty estrogen-deficient postmenopausal women were assigned randomly to pulsed electromagnetic field therapy [PEMF], resistance training [RT], and control groups. Treatment in the PEMF group consisted of 45 min induction of rectangular wave with frequency of 30 Hz and intensity of 40 Gauss; the RT group consisted of performing trunk, upper and lower body resistance exercises that progressed during 6 weeks from 50% to 85% 1RM, for approximately 45 min, 3 days/week. Throughout this duration of six weeks, the control group was requested not to change their physical activity routines and dietary intakes. Blood total ALP, Ca2+, P, and cortisol was measured before and after 6 weeks. After 6 weeks of PEMF or RT, total ALP increased significantly in the control group. Fat mass was significantly decreased in RT group after 6 weeks and increased significantly in controls. In all groups serum Ca, P, and cortisol showed no significant changes after 6 weeks. Regarding the increase of total ALP in the RT and PEMF groups, it seems that PEMF can be used instead of RT for improving bone metabolism in high risk, severely osteoporotic patients

Multiple organ involvement with hydatid cysts

Hydatid disease is the most common infections worldwide, but it rarely involves multiple organs. Herein, a 12-year-old boy is presented, who was admitted to Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran with symptoms of irritability, sleepless, and weakness of the extremities. Patient's brain computed tomography [CT] scan with contrast media showed large multilocular cystic lesions in right temporal lobe associated with two other smaller similar cystic lesions in centrum semiovale bilaterally. Abdominal sonography revealed intestinal mesenteric and a cardiac cyst. Abdomino-pelvic CT scan showed a cyst medial to the cecum and a cortical cyst in the left kidney as well as a heart cyst. The echocardiography confirmed hydatid cysts at apical and interventricular septum. Serology test was positive for hydatid cyst. Albendazole and praziquantel were started for the patient immediately and right temporal lobe lesions were removed via neurosurgery intervention. After one month, cardiac and mesenteric cysts were operated during two separate surgeries. Pathologic findings of all cysts were compatible with hydatid cyst. Cystic hydatidosis should be suspected in any cystic mass, whilst prompt diagnosis and appropriate treatments are the keys in management of affected patients

[Assessment of thyroid dysfunction in patients with beta- thalassemia major]

The thalassemia is believed to be the most prevalent of all human genetic diseases and caused by mutations of the synthesis of hemoglobin.Regular blood transfusions are necessary in major thalassemia patients. The combination of transfusion and chelation therapy has dramatically extended the life expectancy of thalassemic patients but an important complication is iron overload in different organs of the body. Despite improved hematologic care in recent years, in these patients primary hypothyroidism and other endocrine disorders due to iron overload are still common complication and affect the patient's quality of life. The aim of this study was to identify the prevalence of thyroid dysfunction and to determine its correlation with ferritin plasma level, amount of blood transfused and liver function in thalassemic patients. In this cross sectional study, fourty patients with beta thalassemia [20 males and 20 females; mean age, 12.7 +/- 5.8 yrs] were evaluated. Serum ferritin levels, SGOT, SGPT were evaluated by ELISA method and TSH were evaluated byIRMA. Hypothyroid index was defined according to the criteria of Kronberg et al. Normal thyroid hormone values were found in 34 patients [85%] and 6 [15%] had subclinical hypothyroidism. Mean ferritin levels in hypothyroid and normal patients were2220 +/- 1056 mg/l and 2028 +/- 1548 mg/l respectively, [p = 0.2]. Thyroid dysfunction could not be correlated with amount of blood transfused, liver function or ferritin plasma level. The high rate of thyroid dysfunction may be the result of poor disease control and manegement in early life when irreversible tissue damage occurs due to iron overload and chronic hypoxia, and indicates the importance of regular follow-up of beta thalassemia patients for early detection and manegement of associated complications

[Evaluation of hearing loss and otolaryngeal disorders in beta thalassemic patients treated with desferrioxamine]

Thalassemia is one of the most prevalent heamoglobinopathies in the world in particular in Iran. Major thalassemia patients need blood transfusion and desferrioxamin injections throughout their life. Regarding improved life quality of thalassemic patients, new clinical problems, such as hearing loss, need more attention. This study was done to determine the frequency of hearing loss and otolaryngeal disorders together with their related factors in major beta thalassemic patients. This was a descriptive analytic study and 84 beta thalassemia patients were examined and evaluated for hearing loss by an otolaryngologist. Standard pure tone audiometry was performed for the patients. Serum ferritin level was measured. Considering blood transfusion the patients were divided into two groups: those with suitable transfusions and those with unsuitable transfusions. Also in regard to desferrioxamin injections again the patients were divided into two groups: those with regular injections and those with irregular injections. Among 84 beta thalassemic patients [40 M, 44 F] with mean age of 12.8 +/- 5.7 years, 10 [11.9%] had sensorineural hearing loss, 8 [9.5%] had conductive hearing loss, while 8 [9.5%] showed mixed hearing loss. There was no relationship between hearing loss and age, sex, ferritin level, but hearing loss had a significant relationship with doses and duration of desferrioxamine therapy [P<0.01]. Also hearing loss had no significant relationship with regular and irregular blood transfusions and desferrioxamine injections [P<0.01]. The results of this study implicated that high dose desferrioxamine was the main factor in the pathogenesis of ototoxicity in thalassemic patients. For management of these patients it is necessary to use proper doses of desferoxamine. Also blood transfusions should be proportional to body iron burden and hemoglobin. In addition, regular periodic otolaryngologic and audiometric follow up examinations are required for early diagnosis of hearing disorders in prevention of permanent hearing loss

[Correlation of null Btk expression and gene noncoding mutations in XLA patients]

X-linked agammaglobulinemia [XLA] is a primary immunodeficiency disorder characterized by recurrent bacterial infections, profound lack of serum antibodies and reduced circulating B lymphocytes. Mutations in Bruton's tyrosine kinase gene [BTK] result in XLA. It is shown that absence of Btk protein expression may be accompanied by no mutations in coding regions in some cases, instead alterations in conserved regulatory domains of promoter and the first intron of BTK gene maybe occurred The aim of this study was evaluation of Btk expression and mutation analysis in coding and regulatory regions of the gene. In this study, eleven XLA patients were enrolled. Btk expression was analyzed by western immunoblotting method. Mutation analysis was carried out in eight patients. In three cases, PCR of the regulatory regions was performed with designed primers, followed by sequencing. According to western blot, normal Btk expression in three patients and null expression in eight others was observed. Mutation analysis showed two novel BTK mutations in two patients [1038-1040 delAGG and IVS8-2delA]. No coding or regulatory region mutations were found in three cases with null Btk expression. Based on these results, three cases with null expression and had no coding or regulatory region mutations are interesting. It is possible that some rare regulatory defects may have been occurred, other than conventional sites. This must be taken into account for future investgations

[Study of prevalence of hepatitis C and its relationship with impaired glucose tolerance and diabetes mellitus in beta-thalassemic patients]

Impaired glucose tolerance [IGT] and diabetes mellitus [DM] are well known complications in multitransfused beta thalassemia patients. Iron overload and chronic liver disease, viral infection and/or genetic factors may play important roles in the development of glucose intolerance. The aim of the present study is to determine the prevalence of hepatitis C and its relation with diabetes and impaired glucose tolerance. The study included 195 multitransfused beta thalassemic patients, 97 females and 98 males with a mean age of 14.9 +/- 6.07 years [range 5-36 years]. Diagnosis of DM and IGT was based on the criteria of ADA and WHO. Hepatitis markers were detected by use of ELISA test. Results were analyzed by means of Chi-square test. The results of ELISA test revealed forty [20.51%] patients were seropositive for HCV. After removal of confounding factors, serum ferritin level [p = 0.039] and hepatitis C infection [p = 0.006] were identified as independent risk factors, having significant relationship with abnormal glucose tolerance. With increasing age the number of blood transfusions increases and subsequently the possibility of iron overload and infection with hepatitis C virus increases. In our study the prevalence of diabetes in adult thalassemic patients suffering from HCV infection increased. It is probable that hemosiderosis makes the effect of HCV infection on glucose metabolism more evident clinically. Aggressive iron chelating therapy as well as prevention and treatment of hepatitis C infection are the most important measures in glucose homeostasis in transfusion dependent beta thalassemic patient

Cardiovascular complications of thalassemia major and thalassemia intermedia

Cardiac complications due to Iron overload are the most common cause of death in beta-thalassemic patients. Although regular blood transfusions in thalassemia major [TM] patients have improved the quality of life of the patients but the most important complication of such transfusions is iron overload in cardiac tissues. In spite of iron overload in untransfused thalassemia intermedia [TI] patients, the intestinal absorption of iron increases in these patients because of ineffective erythropoesis. The aim of this study was to evaluate cardiac status in thalassemia major and intermedia patients and the investigation of the possible effect of iron overload in the heart of beta-thalassemic patients. 46 patients entered into this study. 26 patients had thalassemia major with regular blood and also chelator transfusions and 20 patients with thalassemia intermedia who had not received regular transfusions. The age of the patients in the 2 groups were similar. The results of clinical evaluation and echocardiographies of the patients of the 2 groups were compared with each other. Collected data were analyzed by means of Chi square and man whitney U tests. Heart failure occurred in two patients with TM [9.52%] and one patient with TI [4.76%]. Considerable pulmonary hypertension [systolic tricuspid gradient >35mmHg] was only present in 3 patients with TI [14.28%]. But systolic dysfunction of left ventricle [ejection fraction<55% or shortening fraction<35%] occurred in 5 patients with TM [23.8%]. In the patients without apparent heart disease, cardiac dimensions, LV mass, LV shortening and ejection fractions, cardiac output and valvular involvement were significantly more in patients with TI. But the maximum speed of systolic flow out of mitral valve in primary phase was higher significantly in TM patients than TI patients. Regular lifelong transfusion and chelation therapy in TM patients prevents premature heart disease and pulmonary hypertension, but LV dysfunction can occur and lead to heart failure. In contrast in TI patients left ventricular function is normal but pulmonary hypertension occurs which may lead to heart failure. Left ventricular performance is better preserved when chelation treatment is adjusted to maintain the serum ferritin concentration at <1000 nanogram/ml

UNESCO chair in health education: a step toward public health improvement

The UNESCO Chair in Health Education in TUMS [TUMS], Iran, was established in Immunology, Asthma and Allergy Research Institute in April 2004. The purpose of this chair is to promote an integrated system of research, training, information and documentation activities in the field of health education. The target group includes the public, health care workers, students, trainees and researchers. During its one year existing, the Chair has supported financially eleven admitted proposals and supported technically eight submitted proposals in divers fields regarding health issues with the cooperation of other research institutes in TUMS. It has made connections with most of the national research institutes and universities to establish multi-centric collaborations. The activities of the Chair are being directed towards the health priorities of the country and region. The Chair has contributed to an important international congress on immunodeficiency disorders as well as another meeting on Asthma in near future. The Chair is to publish several educational books, booklets and CDs related to health education; it is also going to prepare a thorough proposal on HIV/AIDS prevention with collaboration of other institutions, which could be applicable regionally, and in neighboring countries and states

Phenotypic study and molecular analysis of von Willebrand type 1 patients

Von willebrand disease [VWD] is the most common bleeding disorder caused by von willbrand factor [VWF] deficiency and autosomal dominance inheritance pattern. It is divided into three types, one and three [quantitative] and type 2 [qualitative]. Type one is known with mild bleeding symptoms in comparison with type 3. The aim of this study was to determine the mutations responsible for the type one VWD. DNA was extracted from affected members of the family with type 1 VWD and the von willebrand gene was amplified using 63 different PCR, Then PCR fragments were analyzed using CSGE gel electrophoresis, and the fragments with the extra bands were analyzed using DNA sequencing. The average of von willebrand antigen and VWF activity were found 35.18 and 31.4 unit/deciliter in 23 patients from 6 families, respectively. Mutations were found in 4 families from 6. Argenine 1205 to histidine in 2 families and two new mutations including glysine 19 to arginine in exon 2 and a nucleotide change 2821 guanine to adenine [G>A] in intron 21 splice site in two other families. No mutation was found in two other families.This study showed that different kind of mutations causing von willebrand disease in different families

effect of nutrition education on knowledge, attitude and practice of type 1 diabetic patients from Aligoodarz

Medical-nutritional managements would reduce the progress of complications in the diabetic patients. There are a number of controversial findings about the effect of knowledge on improvement of metabolic control in type 1 diabetic patients. Therefore, the aim of this study was to evaluate the effect of nutrition education on knowledge, attitude and practice of patients in Aligoodarz. Using standard methods, the biochemical indices were measured at the beginning of the study and the knowledge, attitude and practice [KAP] questionnaire was filled in by the patients. The patients were trained 12 hrs during 3 days for diet survey and KAP. Three months later, the biochemical indices were measured, the questionnaires were filled in and the data of before and after the training were compared. The data were analyzed by SPSS, using paired t-test and McNemar tests. P values less than 0.05 were considered significant. The mean of the duration of diabetes was 10.9 +/- 6.44 years. FBS, HbA1c%, total cholesterol, LDL-C and hypoglycemic attacks decreased significantly [p<0.001]. Both knowledge and practice scores increased [p<0.001] significantly from 14.2 +/- 3.9 to 21.9 +/- 2.6 and 17.2 +/- 5.8 to 26.9 +/- 4.5, respectively. Attitude also increased significantly [p<0.05]. Based on our results, nutrition education increases knowledge, attitude and practice in the diabetics and changes the biochemical indices to improve their metabolic control. Therefore, the appropriate nutrition education, in addition to insulin therapy, is useful in the control of type 1 diabetes

[Germline RET mutations in exons 10 and 11: An Iranian survey of 57 medullary thyroid carcinoma cases]

Medullary Thyroid Carcinoma [MTC] occurs in either sporadic or hereditary forms. The susceptibility gene for hereditary MTC is the RET proto-oncogene. The aim of this study was to evaluate the prevalence of common germline RET mutations in exons 10 and 11 among Iranian MTC patients. 57 non-related MTC patients were examined in this survey [F: M=1.2:1.0, 40.0 +/- 11.5 years]. Genomic DNA was extracted from their peripheral blood samples and exons 10 and 11 of the RET proto-oncogene were amplified using polymerase chain reaction [PCR]. The PCR products were then digested by specific restriction enzymes and the Restriction Fragment Length Polymorphism [RFLP] patterns were analyzed for common RET mutations in exons 10 and 11. Only the MEN2A patient displayed a C634W mutation in exon 11. Three of the six first-degree relatives of the MEN2A evaluated patient had the same mutation. Among apparently sporadic MTC patients [53 cases], one patient showed a C620R mutation in exon 10 and two other patients displayed C634Y mutations in exon 11 of the RET proto-oncogene. Neither were the only MEN2B patient nor the two FMTC patients found to carry germline mutations in exons 10 and 11 of the RET proto-oncogene. It seems that the prevalence of germline RET mutations in exons 10 or 11 is prominent [5.7%] among Iranian, apparently sporadic, MTC patients. We conclude that a routine germline mutation analysis of the RET proto-oncogene should be advised for apparently sporadic MTC patients. Hereditary forms of MTC require a more extended investigation for RET mutations

[Positive interference in Radioimmunoassay determination of serum total T3]

Determination of thyrotropin, total and free thyroxine and triiodothyronine are widely used as diagnostic methods for thyroid function evaluation. There have been numerous reports of interferences in thyroid hormone immunoassays. Herein, a prominent positive interference is reported for a radioimmunoassay kit of total triiodothyronine. In this study, a total of 3471 patients, referred by endocrinologists, were examined by serum level measurement of thyroid stimulating hormone [TSH], total thyroxine [T4] and triiodothyronine [T[3]]. T[3] analysis was made through a competitive solid-phase radio labeled [I[125]] immunoassay by T[3] Izotop kit [Izotop Co. Budapest, Hungary]. The presence of T[3] assay interference was considered probable if the hormone profile was inconsistent with the clinical picture and/or the obtained value for T[3] was extremely deviated from normal levels, i.e. it was above 780 ng/dL. For such patients, the possibility of T[3] assay interference was investigated through re-measuring T[3] level by another RIA kit [Immunotech kit, Marseille, France]. Among 3471 patients studied, 40 cases [36 women, 4 men], with a mean +/- D age of 38.8 +/- 15.0 years, had T3 serum levels inconsistent with their clinical pictures and/or above 780 ng/dL. The mean serum levels of T4 and TSH in this group were 9.0 +/- 2.0 micro g/dL and 1.79 +/- 1.47 micro U/mL, respectively. In all these 40 cases, T[3] level was in the normal range according to T[3]-Immunotech kit [with a mean +/- SD of 132.k1 +/- 31.0 ng/dL], in accordance with their clinical pictures. Results clearly indicate the presence of positive interference[s] in some of T[3] assays made with Izotop T[3]-RIA kits. The probable explanations for the observed positive interference are discussed

Normal uterine size in women of reproductive age in northern Islamic Republic of Iran

To determine the efficacy of ultrasonographic assessment of uterus size in women of reproductive age, we conducted a cross-sectional analytic study of 231 women aged 15-45 years in Babol, northern Islamic Republic of Iran. Mean uterus size was 86.6 mm x 49.6 mm x 40.6 mm overall, 72.8 mm x 42.8 mm x 32.4 mm for nulliparous women and 90.8 mm x 51.7 mm x 43.0 mm for multiparous women. Mean age was 31.7 +/- 9.6 years and mean body mass index [BMI] was 24.7 +/- 4.0 kg/m2. Uterus size was significantly associated with parity and age; but not with BMI. Our findings show a greater mean uterus size than reported by others. Ultrasonographic measurement of uterus size is valuable for predicting pathologies associated with abnormal uterine size

20-year survey of infectious complications in 64 patients with common variable immunodeficiency

Common variable immunodeficiency [CVID] is a heterogeneous primary immunodeficiency disorder, characterized by hypogammaglobulinemia and increased susceptibility to recurrent bacterial infections. To determine the spectrum of infectious complications in patients with common variable immunodeficiency [CVID], we reviewed the hospital records of 64 CVID patients, who were diagnosed in Children's Medical Center during a period of 20 years. Among our patients, there were 38 males and 26 females, with a median age of 12 years [2-42 years] at the time of study. The median age of diagnosis was 6.1 years, with an average diagnostic delay of 5.2 years in our patient's group. Almost all of our patients have suffered from acute and recurrent infections, particularly in the respiratory and gastrointestinal systems. The majority of patients [82.5%] had pneumonia prior to diagnosis. The other infectious complications seen in our patients were as follows: recurrent otitis media [54%], recurrent sinusitis [50.8%], diarrhea [65.1%], and bacterial meningitis [11.1%]. Unusual or opportunistic infections were also seen in some of our patient population, including oral candidiasis in 10 patients, and Pneumocystis carinii pneumonia in 2 subjects. Based on this study, we suggest that hypogammaglobulinemia should be considered in any patient with a history of recurrent infections in different organs, and such patients should have a full assessment of the immune system