مجله دانشکده پزشکی دانشگاه علوم پزشکی تهران
سال هفتاد و هشتم شماره 3 (پیاپی 231، خرداد 1399)

Most studies show that 9 to 24% of people who are in in vitro fertilization (IVF) cycles are women who respond poorly to ovarian stimulation. Women with poor ovarian response (POR) are a group of infertile patients whose ovarian reserve, ovarian response to medication, and the quality of ovum are declining. Therefore, the number of female cycles, the number of fetuses from the oocyte and the rate of pregnancy in these women is reduced. The purpose of this study was to investigate the expression of three adrenoceptor receptor genes in the cumulus cells of women with poor ovarian response in culture medium.

This case-control study was conducted in two groups: study (POR) and control (oocyte donor's women) groups. POR diagnosis was performed by ESHRE Bologna criteria. After puncture of the follicles, cumulus-oocyte complex was collected and the cumulus cells (CCs) were isolated by enzyme and are counted with Neobar lamella and then were added in the culture medium. After completing the culture, RNA was extracted from cumulus cells and the RNA concentration was read by the Spectrophotometer (NanoDrop Technologies, Wilmington, DE, USA). Then cDNA synthesized and primers designed for ADR-α1, 2 and ADR-B2 or gene expression by real-time polymerase chain reaction (PCR) technique. The research was done in Reproductive Health Research Center of Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran, from April to December 2017.

Comparison of the results of ADR-α1, 2 gene expressions in cumulus cells showed a significant decrease, but ADR-B2 was not significant in two groups. Correlation coefficients also showed that there are relationship between three adrenoceptors and their effects on each other.

Our results showed that the decreased expressions of ADR-α1, 2 probably related to activation of the sympathetic system and release of the more neurotransmitter that lead to down-regulation of ADR-α1, 2 in the cell membrane of cumulus in culture medium.

Early diagnosis and proper treatment of patient with acute coronary syndrome (ACS) and ischemic heart disease are important in determining prognosis, preventing adverse effects, and may even save lives. In this study, the level of pregnancy-associated plasma protein-A (PAPP-A) in ACS patients was compared with the control group, in addition to cardiac Troponin (cTn) and creatine kinase-myocardial band (CK-MB) markers.

In this cross-sectional study, 116 patients with ACS were selected by convenience sampling method among patients referring to the emergency department of Farshchian Heart Center, Hamadan University of Medical Science in Iran, from June 2017 to May 2018, and then were compared with 116 healthy persons (control group) in term of PAPP-A, CK-MB and serum cTn biomarkers.

The mean and standard deviation of PAPP-A in acute coronary syndrome (ACS) and control group were 93.85±27.56 and 89.63±7.29, respectively. There was no significant statistical difference between patients with ACS and control group. However, the level of PAPP-A in ST segment elevated myocardial infarction patients (STE-MI) was significantly higher than those with unstable angina (UA) and non-ST segment elevated myocardial infarction (NSTE-MI) (P<0.001). The mean and standard deviation of PAPP-A in patients with acute coronary syndrome with positive and negative troponin results was 99.42±27.52 and 90.69±18.79, respectively (P=0.021). The correlation coefficient between serum PAPP-A and creatine kinase-MB obtained 0.070 (P=0.292).

In patients with ACS, in addition to the increase in cardiac troponin markers (cTn), the serum level of pregnancy-associated plasma protein A (PAPP-A) also increases significantly. Therefore in addition to measuring serum cardiac troponin levels, evaluation and measurement of PAPP-A can also be used to diagnose and management of ACS.

Colorectal cancer is the second most common cancer in the world which is mainly caused by epigenetic and environmental factors. Among these epigenetic factors, gut microbiota is an important one. Although it has not been proved a unique group of bacteria correlated with colorectal cancer, these findings have generally demonstrated differences between healthy and disease gut microbiome in population. Actually, the identification and investigation of intestinal microbiota in early detection of colorectal cancer have been highlighted in new researches and studies. Herein, in the current study, we aimed to evaluate the number of selected gut bacteria including Lactobacillus and Escherichia coli and Prevotella in the fecal specimens of adenomatous polyposis patients, colorectal cancerous cases in compared to normal participants in terms of estimating important role of gut microbiota during colorectal cancer initiation and progression.

The current research was a case-control study. Fecal samples were provided from 31 healthy individuals, 42 adenomatous polyposis patients and 20 colorectal cancer cases that were referred to Taleghani Hospital, Tehran, Iran, from August 2016 to August 2017 for colorectal cancer screening tests. Fecal samples were collected to analyze intestinal bacteria including, Lactobacillus, Escherichia coli, and Prevotella by absolute quantitative real-time polymerase chain reaction (PCR). The number of these gut bacteria was precisely determined by this method of real-time PCR.

Higher number of Prevotella with 24.6 CT number (P<0.005) and E.coli with 20.4 CT number (P<0.015) were achieved in colorectal cancer cases and adenomatous polyposis patients in contrast to samples from normal individuals. On the contrary, the opposite range was observed for the quantification of Lactobacillus and greater numbers of bacteria (CT=28.6) were detected in normal, compared to the colorectal cancer cases and adenomatous polyposis (P<0.001).

The gut microbiota composition of individuals with colorectal cancer and adenomatous polyposis differs from that of healthy individuals, and the higher numbers of pathogenic microbiota versus beneficial microbiota present in those with colorectal cancer and adenomatous polyposis. In contrast, healthy individuals have higher numbers of beneficial gut microbiota than pathogenic microbes. These findings need more experimental analysis and investigation to better clarify.

A major problem in surgical procedures is postoperative pain. The effectiveness of prescribing preoperative tizanidine in reducing postoperative pain is not clear. The aim of this study was to determine the efficacy of tizanidine as a premedication in reducing pain after septoplasty.

This double blind clinical trial study was performed in 71 patients aged from 18 to 50 years, undergoing septoplastic surgery for the first time, who were classified in ASA (American Society of Anesthesiologists) classes 1 and 2 in the Ear, Nose, and Throat (ENT) Department of Shafa Hospital, in Kerman, Iran from April 2014  to March 2015. Patients were randomly assigned into two groups using numbers from a randomization table. A dosage of 4 mg of tizanidine was administered orally to the patients two hours before the surgery (septoplasty) in the intervention group. In the control group, placebo pills which were 100 mg vitamin B1 were prescribed. The severity of pain was measured and recorded after 4 and 8 hours, and the morning after the surgery.

62 patients (87.32%) were male and 9 (12.68%) were female. The mean age of the subjects was 24.6±7.5 years. The two groups were similar in regard to age (P=0.54), but the duration of surgery was different in the two groups (P=0.038) and was longer in the group that received tizanidine. The mean of pain was different between the two groups, after 4 hours and was significantly higher in the group that received tizanidine (P=0.043). The mean of pain was not significantly different between the two groups after 8 hours (P=0.95) or one day after surgery (P=0.79).

Although some researchers have reported that taking tizanidine before some surgeries may reduce postoperative pain, in this study the administration of tizanidine before surgery was not effective in reducing pain after septoplasty.

Skin cancer is one of the most common forms of cancer in the world and melanoma is the deadliest type of skin cancer. Both melanoma and melanocytic nevi begin in melanocytes (cells that produce melanin). However, melanocytic nevi are benign whereas melanoma is malignant. This work proposes a deep learning model for classification of these two lesions.   

In this analytic study, the database of HAM10000 (human against machine with 10000 training images) dermoscopy images, 1000 melanocytic nevi and 1000 melanoma images were employed, where in each category 900 images were selected randomly and were designated as the training set. The remaining 100 images in each category were considered as the test set. A deep learning convolutional neural network  (CNN) was deployed with AlexNet (Krizhevsky et al., 2012) as a pretrained model. The network was trained with 1800 dermoscope images and subsequently was validated with 200 test images. The proposed method removes the need for cumbersome tasks of lesion segmentation and feature extraction. Instead, the CNN can automatically learn and extract useful features from the raw images. Therefore, no image preprocessing is required. Study was conducted at Shahid Beheshti University of Medical Sciences, Tehran, Iran from January to February, 2020.

The proposed model achieved an area under the receiver operating characteristic (ROC) curve of 0.98. Using a confidence score threshold of 0.5, a classification accuracy of 93%, sensitivity of 94%, and specificity of 92% was attained. The user can adjust the threshold to change the model performance according to preference. For example, if sensitivity is the main concern; i.e. false negative is to be avoided, then the threshold must be reduced to improve sensitivity at the cost of specificity. The ROC curve shows that to achieve sensitivity of 100%, specificity is decreased to 83%.

The results show the strength of convolutional neural networks in melanoma detection in dermoscopy images. The proposed method can be deployed to help dermatologists in identifying melanoma. It can also be implemented for self diagnosis of photographs taken from skin lesions. This may facilitate early detection of melanoma, and hence substantially reduce the mortality chance of this dangerous malignancy.

Cataract is one of the most common eye diseases especially in elderly patients and most of these patients require surgery. In the process of sedation, different drugs are used, each with its advantages and disadvantages. Dexmedetomidine is one of the drugs that has recently received special attention for sedation. In this study, we compared the drug combination of dexmedetomidine-fentanyl with midazolam-fentanyl in cataract surgery.

In a case-control study, the patients who underwent cataract surgery by a surgeon with topical anesthesia and sedation techniques were included in the target group. Seventy patients were divided into two groups of 35 according to a random number table. One group received dexmedetomidine-fentanyl (dexmedetomidine group) and the other received midazolam-fentanyl (midazolam group). Age, sex, weight, systolic and diastolic blood pressure, heart rate, patient sedation, surgeon satisfaction, recovery nurse satisfaction, and postoperative nausea and vomiting were compared between the two groups. The study was performed in the Farabi Hospital, Tehran, Iran, from October to November 2019.

Patients in the two groups were similar in age, sex, weight, and preoperative hemodynamic variables. There was no significant difference in preoperative systolic and diastolic blood pressure between the two groups (P=0.150). However, those who received dexmedetomidine had significantly lower intraoperative heart rate (P<0.001). The difference in postoperative systolic and diastolic blood pressure as well as postoperative heart rate was significantly lower in the dexmedetomidine group (P<0.001). There was no statistically significant difference between the two groups in postoperative sedation (P=0.93). The surgeon’s satisfaction was no significant difference between the two groups (P=0.17). Also, the rate of recovery nurse satisfaction was not significantly different between the two groups (P=0.21). The incidence of nausea and vomiting was similar in both groups (P=1.00).

Sedation with dexmedetomidine decreases blood pressure and heart rate. Therefore, it is recommended to use dexmedetomidine more cautiously in patients with unstable hemodynamics and especially in short surgical procedures.

Previous researches have provided contradictory results about on working memory performance after the coronary artery bypass graft (CABG). In addition, studies have focused on the elderly community. For this reason and with regard to the importance and direct effects of working memory on the quality of life human. This study was designed to compare working memory of young CABG patients with age range of 30-55 years one year postoperatively with healthy subjects.

In this Case-control study, which was conducted from February 2017 to October 2018, two groups of people, 40 patient men with coronary artery bypass graft that admitted to the heart center of Tehran in last year and 64 healthy males were selected with using available sampling method. Both groups were tested with Wechsler's working memory scale.

The results of the study showed that the mean and standard deviation of the age of coronary artery bypass graft patients were 52.65 and 5.559, respectively, and the mean and standard deviation of healthy subjects were 41.81 and 8.619, respectively. The results showed that The two group had significantly difference (P<0.01), in the sub scales of the working memory including of the forward auditory memory and reverse auditory memory, total score of auditory memory, reverse visual memory and auditory memory span and the two groups had significantly difference (P<0.05), in the total score of visual memory. But the two group had not significantly difference (P>0.05) in the forward visual memory (CABG [mean=5.40 & standard deviation=1.41] Healty people [mean=6.13 & standard deviation=3]) and visual memory span (CABG [mean=5.35 & standard deviation=1.12] Healty people [mean=5.56 & standard deviation=1.97]). The results showed that Patients with CABG than healthy people have overall poorer results for all sub scales the of working memory test.

The results of this study confirm the prevalence of relatively high cognitive decline, especially in working memory after CABG, and provide a pattern of persistence of cognitive decline after one year of coronary artery bypass surgery in young patients aged 30 to 55 years.

Uremic pruritus is one of the important problems in patients undergoing hemodialysis. Causing the mechanism of uremic pruritus in hemodialysis patients is complex and multifactorial. Almost 60 percent of hemodialysis patients suffer from uremic pruritus. Oral hydroxyzine is a common treatment for uremic pruritus of this patients. This study aimed to survey effect of hydroxyzine on uremic pruritus of hemodialysis patients.

This quasi-experimental study (pre and post design) performed on 40 patients with eligible criteria. All of the hemodialysis patients who suffer from pruritus received a tablet of hydroxyzine 25 mg daily for 6 weeks. In this time, drugs and the plan of hemodialysis were constant. Pruritus score of patients, evaluated with 5-D pruritus scale that had 8 items with 5-score Likert scale and evaluate duration, direction, disability, and distribution of pruritus. Severity scores of pruritus before and after treatment with tablet of hydroxyzine were compared. This study was conducted on hemodialysis patients in the Soodeh Center of Hemodialysis in the south of Tehran, Iran, from September 2016 to February 2017.

The findings of this study showed that most of the patients in this study were male (55%) with mean age of 55.97±11.59 years. The most cause of chronic renal failure in these patients was diabetes (37.5%). This study showed that 32.5% of the hemodialysis patients had moderate to severe uremic pruritus. The mean score of pruritus before the treatment with hydroxyzine was 16.73±3.4 and the most effect of this drug was in the social activity item (2.47±0.6). After treatment with hydroxyzine, the mean score of pruritus in the patients was 9.65±2.15 that was decreased significantly (P<0.001). The findings showed that there was no significant relationship between decrease of pruritus and characteristics of patients.    

This study showed that uremic pruritus is still a challenge in hemodialysis patients. According to this study use of hydroxyzine, regardless of uremic pruritus mechanism, could be decreased uremic pruritus of hemodialysis patients.

Guillain-Barré syndrome is an autoimmune inflammatory disease, which manifests itself as an acute motor weakness of the organs, diagnosed as affecting the motor spinal nerve roots generally and causing muscle and motor weakness, the cause of this disease is the presence of active antibodies against the myelin sheath around the spinal nerve roots. Guillain-Barré syndrome is the most common and most severe unpleasant neuropathy that affects about 100,000 people worldwide annually.

This is a descriptive analytical study, the data of 354 admitted patients were reviewed and 262 cases, which matched the criteria for entering the study, was included. The criterion for entering the study was clinical diagnosis.Required information were included age, sex, complaints of disease, and visitation period. Data was analyzed by using Microsoft Excel 2013 (Microsoft Corp., Redmond, WA, USA) and study was performed on Imam Reza and Farabi Hospitals of Kermanshah in Iran, from March 1993 to February 2013.

59.5% were male and 40.5% female, and the mean age of the patients was 44.6±22.9. The most affected individuals were at the age of 30-50 and the highest prevalence was observed in spring. Acute inflammatory demyelinating poly-radiculoneuropathy with 53.4% was the most common backward disorder in patients and 5.7% among deaths among patients.

The results of the present study showed that Acute inflammatory demyelinating poly-radiculoneuropathy had the highest prevalence in patients and decreased with increasing age, and this syndrome was more prevalent in the spring.

Nonpuerperal uterine inversion is a rare medical condition that many gynecologists might not be encountered even with one case during their entire medical practice. It refers to the expulsion of uterine corpus from the dilated cervix resulting in uterus being turned inside out. There are two kinds of uterine inversion, puerperal and non-puerperal, which the second condition is less common. Acute uterine inversion usually presented by crampy abdominal or pelvic pain, vaginal bleeding, anemia, and even symptoms of severe sepsis. We describe a case of uterine inversion in a postmenopausal woman.

A 66 years old grand multiparous woman (6 normal vaginal delivery) who was menopause since 15 years ago, was referred to the emergency unit of an academic hospital of Mashhad University of Medical Sciences at October 2016 due to postmenopausal uterine bleeding, cramp-like abdominal pain and mass protrusion from the vagina. The vital sign was stable at the first visit but a big non-necrotizing red vaginal mass was protruded from vaginal opening that connected to other soft intravaginal mass. Abdominal ultrasonography revealed the dilated vaginal cuff and some air-fluid levels in the uterine cavity. The patient referred to the operative room and vaginal myomectomy was done with diagnosis of pedunculated submocusal leiomyoma. Then, total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed after the correction of uterine inversion by abdominoperineal approach.

Acute uterine inversion is a potentially dangerous condition (due to vaginal bleeding, severe abdominal or pelvic pain, and the possibility of uterine necrosis and even systemic infection). This condition should be considered as an important differential diagnosis as a vaginal mass in the post-menopausal period.