مجله دانشکده پزشکی دانشگاه علوم پزشکی تهران
سال هفتاد و ششم شماره 3 (پیاپی 207، خرداد 1397)

Depression is the psychological disorder which caused by chronic stress and extensive communication network between the gastrointestinal system via the “gut–brain-microbiota axis”. Depression can systematically activate/deactivate many genes and signaling molecules involved in the pathogenesis of the gastrointestinal disease. Whereas, most of the anti-depressant drugs suppress the depression symptoms by altering the neurotransmitters activity; studies on probiotics have shown the anti-depressant potential of them. Nutritional psychiatry is a field of psychiatry that investigates the relationship between dietary patterns and risk of mental disorders. The special type of probiotic has been identified to improve a number of diseases, such as diabetes, obesity, gastrointestinal infections, cancers, reduction of allergies and mood disorders such as depression. There is an evidence about therapeutic effects of probiotics in symptoms of depression, but because of the low number of samples, the limitation in use of different strains of bacteria and the limited laboratory equipment, it is difficult to make a definitive view about these results and need to more clinical study to determine the effective dose of probiotics in the treatment of depression. The articles related to this subject were collected from reliable database till the 2017 year, new studies and reviews articles which determine the effects of probiotics on the treatment of digestive and neurological diseases. The objective of this review is to study the current clinical research about the effects of probiotics in the treatment of symptoms of depression and discuss future directions in this field. Most of the studies demonstrated probiotics’ ability to improving mood, change behavior and improve the symptoms of stress and depression such as insomnia by increasing of serotonin and reducing of inflammation; and modulation of emotional behavior with effect on specific cytokines in brain. It has been discovered that probiotics have therapeutic effects extend beyond the gut and into the central nervous system by influence signaling pathways. In conclusion, it seems they have the potential to be used as a dietary supplement to optimize and enriched the food products and effective step in the prevention and treatment of various disorders in the nervous system instead of chemical drugs.

Breast cancer is a malignant proliferation of epithelial cells that lining the ducts or lobules of the breast. Breast cancer is the second common cancer (after lung cancer) in women. Gallic acid, being a polyphenols, has been reported for its antiproliferative activity against many cancer cell lines. Objective of the present study is effect of gallic acid on proliferation and apoptosis of the human breast adenocarcinoma cell lines SKBR3 and normal fibroblasts cells.
This experimental study was performed in cellular and developmental biology of Shahrekord Islamic Azad University, Iran from April to August 2015. For anti-cancer activity, in this study SKBR3 cells and normal fibroblast cells (HU-02) were cultured in Dulbecco's modified eagle's medium, DMEM (Gibco, Life Technologies, Inc., New York, USA) medium with 10% fetal bovine serum, FBS (Gibco, Life Technologies, Inc., New York, USA). The SKBR3 and normal fibroblast cells were treated in the medium of DMEM medium and gallic acid (20, 40, 80, 100 and 200 µg/ml) for 24, 48 and 72 hours. Cells viability was assessed by MTS (Methyl- Thiazol-) assay. Cells were seeded at 5×103 cells/ml in 96 well plates and incubated for 24 hours. Then metabolites of bacteria were added, after indicated times MTS (20µl) was added and the absorbance was measured at 492 nm using ELISA plate reader. The percentage of apoptosis induction was determined by flow cytometry analysis using Annexin-V fluorescein isothiocyanate (FITC) kit (BioVision Products, CA, USA) in 20, 40, 80, 100 and 200 µg/ml concentration of gallic acid at 48 hours incubation.
Gallic acid decreases significantly the viability of SKBR3 cell line in a time and dose dependent manner. So that the most effective concentration of this substance was 200 µg/ml and 72 hours after treatment (P Objective of the present study is effect of gallic acid on proliferation and apoptosis of the human breast adenocarcinoma cell lines SKBR3 and normal fibroblasts cells.

Tenderness, pain, muscle weakness, and limited range of motion (ROM) are symptoms of myofascial pain syndrome, which leads to restrictions on physical, occupational and social activities and ultimately reduction of productivity and quality of life. Different methods of rehabilitation are used to improve the symptoms of these patients. One of the new methods is the use of kinesio tape. The aim of this study was to evaluate the effect of kinesio tape on neck pain and disability and also muscle strength in myofascial pain syndrome.
In this single-blind randomized clinical trial, from June to November 2017 in Imam Hossein Hospital of Mashhad, Iran, thirty individuals (male and female) with Myofascial pain syndrome were divided into two groups (treatment and control), randomly by lottery. In treatment group, the kinesio tape with appropriate tension was applied directly over pain place and on upper trapezius muscle; and control group received placebo kinesio tape (kinesio taping without tension). In this study, before and three days after application of kinesio taping, numerical pain rating scale (NPRS), neck disability index (NDI) and manual muscle testing (MMT) were used to assess pain, disability and strength, respectively.
To compare the effect of treatment, the mean of variables were compared with independent sample t-test before and after treatment. Pain and strength of upper trapezius were significantly different in both groups (P According to the results of this study, kinesio tape can reduce neck pain, increase the strength of upper trapezius, and ultimately reduce the disability of neck in myofascial pain syndrome. Therefore, this method can be used in rehabilitation clinics to improve the symptoms of patients with myofascial pain syndrome.

Due to intrinsic heterogeneity of cellular distribution and density within diffusion weighted images (DWI) of glioblastoma multiform (GBM) tumors, differentiation of active tumor and peri-tumoral edema regions within these tumors is challenging. The aim of this paper was to take advantage of the differences among heterogeneity of active tumor and edematous regions within the glioblastoma multiform tumors in order to discriminate these regions from each other.
The dataset of this retrospective study was selected from a database which was collected at the medical imaging center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Iran. The quantification was performed as a part of a research study being supported by the Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Iran, between May and September 2017. Twenty patients with histopathologically-confirmed GBM tumors who had been imaged on a 3T MRI scanner prior to their surgery, were included. Conventional and diffusion weighted MR images had been carried out on the patients. The regions of interest including the regions of active tumor and edema were identified on MR images by an expert and overlaid on ADC-maps of the same patients. Histogram analysis was performed on each of these regions and 14 characteristic features were calculated and the best feature combination for discrimination of active tumor from edema was obtained.
It was shown that by combining 8 out of 14 histogram features, including median, normalized mean, standard deviation, skewness, energy, 25th, 75th, and 95th percentiles, differentiation with accuracy of 96.4% and diagnostic performance of 100% can be achieved. Furthermore, by combining mean, energy, and 75th percentile features of histograms, the active tumor region can be discriminated from the edematous region by 92.7% of accuracy and 98.9% of diagnostic performance.
The present study confirms that the heterogeneity of cellular distribution can be a predictive biomarker for differentiation of edematous regions from active tumor part of GBM tumors.

One of the most important causes of chronic liver disease is hepatitis C virus (HCV), which causes liver cirrhosis and hepatocellular carcinoma. To control the prevalence of the disease, knowledge and information in risk factor of HCV are required. The aim of this study was to compare the risk factors of infection between HCV patients with genotypes 1a and 3a.
This is an observational analytical study. HCV patients who referred to the clinic of hepatology, Rasoul-e-Akram University Hospital from July 2015 to July 2017, were assigned to the genotype 1a and 3a. Demographic (age, sex, family history), clinical (cirrhosis, hepatocellular carcinoma) and laboratory data, history of intravenous drug and alcohol usage, and history of imprisonment were gathered and compared between two groups. All the patients completed the informed consent form. Data analysis was performed by SPSS software, version 22 (IBM SPSS, Armonk, NY, USA). P value less than 0.05 was considered statistically significant.
Overall, 97 HCV patients were included in this study. Mean age was 45±12 years and 78 (80%) of patients were male. Among them, 58 (60%) and 39 (40%) had genotype 1a and 3a. respectively. History of injection drug usage was recorded in 34/39 (87%) of patients with genotype 3a, and significantly higher in genotype 3a as compared to genotype 1a [OR adj: 3.1, CI (1.3-6.2)]. Also, in this study, genotype 3a was significantly recorded in younger patients [OR adj: 1.7, CI (1.2-4.1)]. However, cirrhosis and hepatocellular carcinoma was more common in patients with genotype 1a as compared to genotype 3a [OR adj: 2.05, CI (1.6-5.4) and OR adj: 2.8, CI (1.3-5.7)] respectively.
According to the results of this study, hepatitis C virus transmission risk factors differed in genotypes 3a and 1a. Genotype 3a is found among young patients with a history of intravenous drug usage and genotype 1a in patients with cirrhosis and hepatocellular carcinoma.

Rash is a common complaint in children that has many causes and the various differential diagnoses. Therefore, urgent and appropriate clinical diagnosis is necessary to provide immediate medical intervention. Therefore, the purpose of this study was to investigate the causes of skin rash in children hospitalized due to rash.
This descriptive-analytic study was performed on all patients admitted for skin rashes in Hazrat Masoumeh Hospital in Qom, Iran from 2010 to 2015. In this study, the data of 317 patients who were admitted to the early diagnosis of rash were collected from patient's files and recorded in the checklist.
According to our study, the most common causes of skin rashes in children were viruses with a share of 40.69% (129 cases), allergic causes being as prevalent as 21.77% (69 cases) and drug induced rashes that accounted for 20.50% (65 cases). Based on the site and type of rashes, the most common type of rashes were maculopapular rashes with 42% and hives with 31.9% prevalence, and the most common site of involvement was diffuse involvement that would account for 84% of the cases. In terms of drug use history, 35.6% had a history of antibiotic use prior to admission, and 14.5% had an antiepileptic drug use history. There was a significant relationship between the cause of rashes and the season of presentation (P This study showed that there is a significant relationship between the season and age of occurrence, but the use of these factors as a benchmark for the diagnosis of rash requires more studies. Paying attention to the causes of rash in children, knowing about these factors, and continuous evaluation of these patients can help in advancing a proper management of the problem of patients. The most frequent factors were viruses and then allergic and pharmaceutical agents, and the most common type was maculopapular.

Despite advances in diagnosis and treatment, leishmaniasis is now considered a severe public health problem, particularly in developing countries, such as Iran. Leishmaniasis is among the six most important, parasitic diseases of the world affecting 88 countries in almost every continent. The disease is complex with different clinical presentations such as visceral, cutaneous and mucocutaneous forms. Cutaneous leishmaniasis (CL) is the most common form of the disease in Iran. Antimony compounds are the first line treatment of CL. The treatment of leishmaniasis in endemic areas relies on chemotherapy, and in several parts of the world the mainstay remains the pentavalent antimony (SbV)-containing drugs Pentostam (sodium stibogluconate) and Glucantime (meglumine). There is no comprehensive study on treatment failure rate of this compounds. This study was designed to evaluate treatment failure rate and possible involving factors of antimonial resistance in CL to facilitate and improve treatment strategies of this disease.
All patients with CL referred to Skin Disease and Leishmaniasis Research Center (SDLRC), from October 2011 to October 2013, treated with antimony compounds were assessed in this study. Patient characteristics (gender, age and place of residence), number, type and location of the lesions, comorbidities and type of treatment were recorded and analyzed.
Rate of treatment failure with Meglusan was 4.3%. Failure rate in men and in patients with previous history of cutaneous leishmaniasis was more than women or patients without CL history (P= 0.000, 0.024 respectively). The results of this study showed that treatment failure was higher in patients with systemic treatment than intralesional (IL) or combination therapy (both IL and systemic treatment) group but this difference was not statistically significant. Also, size and number of the lesions, wound infection, the patient's age, location, education and occupation do not have a significant correlation with treatment failure.
Greater treatment failure rate of Meglusan compared to Glucantime (4.3% versus

Developmental and behavioral disorders are the most prevalent problems in children after infection and trauma. Growth and development are influenced by genetic, social and environmental factors that incept of the early life of the fetal and neonatal periods. Due to the importance of the development in children, this study was conducted to determine the relationship between growth indices at birth and developmental status in infancy.
This case-control study investigated 6 to 18 months old infants, who referred to comprehensive health centers affiliated to Qazvin University of Medical Sciences, Iran, from August to December 2017. The sample size in this study was 200 infants and the participants were evaluated in two groups of 100 subjects (developmental delay and normal development). Anthropometric indices at birth were collected from healthcare records, and developmental status was measured using the ages and stages questionnaire (ASQ). The developmental status of the children was measured in five domains, i.e., motor (gross and fine motor skills), problem-solving, personal-social skills and communication. A significance level was considered statistically The mean age of the infants in the developmental delay group was 12.63±1.72 months and the mean age of the infants in control group was 12.68±1.69 months and 45.6% of children in the developmental delay group were female and 54.4% of children in the developmental delay group were male. The most prevalence developmental delay in case group was in the area of personal-social domain (26.9%) and the lowest prevalence developmental delay in the area of the gross motor (12.7%). No correlation was found between head circumference (P= 0.32) and height at birth (P= 0.11) and developmental status. However, there was a significant relationship between developmental delay in the area of the communication (P= 0.04) and gross motor (P= 0.02) with birth weight. Pearson correlation indicate a correlation between developmental delay in the area of the gross motor and birth weight (P= 0.01).
It seems that birth weight was a factor that is associated with developmental delay. In this study low birth weight correlated with developmental delay in communication and gross motor aspects of ASQ.

Polycystic ovary syndrome (PCOS) is an endocrine disorder and one of the main reasons of infertility in women. PCOS causes many symptoms in women, one of the most important of them is ovulation failure. It affects the women at the age of fertility. Many factors are detected to exacerbate PCOS including insulin, anti-Mullerian hormone, obesity and androgen. The aim of this study was to evaluate endocrine and metabolic factors and its relation with obesity in patients with polycystic ovary syndrome in exacerbation of disease.
This cross-sectional study was carried out at the Caucasus Infertility Treatment Center of Ardabil from July 2015 to March 2016 and on 321 patients with polycystic ovary syndrome. Blood samples were investigated to measure serum levels of fasting insulin, dehydroepiandrosterone sulfate (DHEAS), 17OHP, fasting blood sugar, sex hormone binding globulin (SHBG), anti-Mullerian hormone, vitamin D, total testosterone, free testosterone, prolactin, FSH, LH and TSH. Also, body mass index (BMI), duration of infertility and age were measured. BMI was evaluated to measure the obesity of patients.
We were able to demonstrate significantly high level of total testosterone and fasting insulin in PCOS women by having weight gain (P Insulin resistance, obesity, hyperandrogenism and metabolic syndrome are very important factors in pathogenesis of PCOS. These factors could affect the fertility of women by effecting the reproductive processes. Therefore, it is better in the patients who are older, treatment strategies further underline on reduce these factors (insulin resistance, obesity and hyperandrogenism) to prevent disease progression and increase duration of infertility.

According to the direct connection between congenital hypothyroidism and iodine deficiency in pregnant women, also relatively high incidence of congenital hypothyroidism in some areas of Kerman province, especially Raver district located in North of Kerman province, this study was performed to determine and compare the urinary iodine concentration (UIC) in pregnant women referring to health centers.
This cross-sectional study was done during March 2014 and May 2015. Inclusion and exclusion criteria to be considered and UIC were measured by spectrophotometry in 384 and 374 pregnant women in Ravar and Kerman cities, Iran. Sampling method for this study was all of pregnant women in Ravar and random stratified sampling in Kerman. data were collected using a structured questionnaire. All statistical analyses were performed using SPSS Software, version 20.0 (IBM SPSS, Armonk, NY, USA). Chi-square test, Pearson's correlation coefficient and Logistic regression were used for associations and differences.
The mean UIC was 200.21 µg/L in pregnant women of Ravar and 238.79 µg/L in pregnant women of Kerman. 22.7% of pregnant women were with low concentrations of iodine, 57.8% within the normal range and 19.5 percent were with high iodine concentrations in Ravar. While 5.3 percent of pregnant women were with low concentrations of iodine, 54.5% were within the normal range and 40.1% were with high UIC in Kerman. There were no significant differences between demographic variables and UIC in the two regions (P> 05/0). Multivariate regression models showed significant connections between the residence and UIC pregnant women (P The results of this study showed that UIC in pregnant women of Ravar was significantly lower than Kerman and the place of living can be considered as a predictor of UIC in pregnant women.