مجله پزشکی بالینی ابن سینا
سال بیست و هفتم شماره 3 (پیاپی 97، پاییز 1399)

According to the results of some studies, peripheral blood mononuclear cells activated with human placental gonadotropin increase the success rate of pregnancy in infertile women. This study aimed to compare the effect of two treatment methods of peripheral blood mononuclear cells activated with human placental gonadotropin and platelet-rich plasma on the success rate of pregnancy after embryo transfer.

This randomized clinical trial was conducted on 40 females with repeated implantation failure who were candidates for in vitro fertilization (IVF) and referred to Fatemieh Hospital, Hamadan, Iran, in 2019. Subsequently, they were randomly assigned to two groups of A and B. Peripheral blood mononuclear cells activated with human placental gonadotropin were utilized in group A, and group B received platelet-rich plasma autologous blood before transfusion. The incidence of chemical and clinical pregnancies was measured in both groups. Moreover, the data were analyzed in Stata software (version 14), and a p-value less than 0.05 was considered statistically significant.

The mean ages and duration of the infertility of the females were 32.5 and 34.4 years (P=0.203), as well as 9.1 and 8.5 years (P=0.747) in groups A and B, respectively. Moreover, the mean numbers of the obtained ovum, embryos formed, and transferred embryos were 15.4±11.5 and 12.9±8.9 (P=0.439), 7.1±6.2 and 5.8±3.8 (P=0.427), as well as 2.3±0.7 and 2.3±0.6 (P=1.00) in groups A and B, respectively. Furthermore, the rates of chemical pregnancies were 15% and 25% (P=0.619), and clinical pregnancies were 15% and 20% (P=0.581) in groups A and B, respectively.

The administration of human placental gonadotropin-activated peripheral blood cells showed similar results on pregnancy outcome with platelet-rich plasma after an embryo transfer in females who were candidates for IVF with repeated implantation failure.

The alterations of the adaptive immune system are involved in type 2 diabetes mellitus (T2DM) pathogenesis. T helper 1 (Th1) cells or CD4+ T cells are the pro-inflammatory components of adaptive immunity with the main feature of interferon-gamma (IFN-γ) secretion. The aim of this study was to evaluate the percentage of IFN-γ, assess the expression of related-genes in CD4+ T cells, including T-bet, IRF1, RUNX3, and NFκB, and determine the correlation between them and clinical parameters in T2DM patients.

In this case-control study, peripheral blood CD4+ T cells were isolated from 40 patients and 40 healthy controls (HCs). The percentage of IFN-γ secreting CD4+ T cells was assessed using flow cytometry, and the related-genes were evaluated using real-time polymerase chain reaction.

The percentage of IFN-γ secreting CD4+ T cells significantly increased in the patients in comparison to that of the HCs (P<0.001). The expression levels of IRF1 and NFκB were higher in the patients in comparison to those of the HCs (P=0.02 and P<0.001, respectively). A significant positive correlation between IFN-γ secreting CD4+ T cells and both IRF1 and NFκB was observed in the patients (P=0.001 and P=0.002, respectively). There was a significant positive correlation between IFN-γ secreting CD4+ T cells, IRF1, and NFκB with fasting plasma glucose and hemoglobin A1c in the patients (P<0.001).

Due to the increased response of Th1 cells (the production of IFN-γ and expression of related genes) in the patients and existing correlation between them and plasma glucose level, it seems that these inflammatory factors are involved in T2DM pathogenesis, and the use of IFN-γ pathway antagonists could be considered a novel therapeutic approach.

Carpal Tunnel Syndrome (CTS) is the most common compressive neuropathy of the upper limb and one of the causes of disability. The current study aimed to compare the therapeutic effects of Low-Level Laser Therapy (LLLT) and therapeutic ultrasound (US) in patients with mild to moderate carpal tunnel syndrome.

This single-blind randomized trial was conducted on 30 patients with CTS (58 wrists) who were randomly assigned to two treatment groups: laser therapy group (15 patients, 29 wrist (and Ultrasound therapy group (15 patients, 29 wrists). Low-level laser therapy (9 joules, 808 nm infrared laser at five points) and Ultrasound treatment (1 MHz, 1.5 W/cm2, duty cycle 20%, 5 min/session) were applied to the carpal tunnel for 10 daily treatment sessions (5 sessions/week). Outcome measures were Visual analogue scale, pinch & grip strength and Boston questionnaire (BQ), which measured before and after treatment (the end of the study). The pair and independent t-test were used to evaluate the variables.

In both groups (laser therapy and Ultrasound therapy), there was a significant improvement in visual analog scale (P=0.000 and P=0.000, respectively), grip strength (P=0.01 and P=0.004, respectively), and pinch strength (P=0.001 and P=0.009, respectively). The results of the Boston Questionnaire also demonstrated an improvement (P=0.000 and P=0.000, respectively) at the end of the study, compared to baseline values. However, there was no significant difference in any of the measured variables between the two treatment groups.

As evidenced by the obtained results, both low-level laser therapy and ultrasound are effective in the reduction of pain and improvement of hand function in patients with mild-to-moderate CTS in the short-term.

Multiple sclerosis is an autoimmune disease of the central nervous system that causes demyelination and axonal damage. There are contradictory results regarding the effects of zinc and selenium on the prevention or reduction of multiple sclerosis symptoms. This study aimed to compare selenium and serum zinc levels of the patients suffering from relapsing-remitting multiple sclerosis with those of healthy individuals.

This case-control study compared 30 patients suffering from relapsing-remitting multiple sclerosis (case) with 30 healthy individuals (control)  regarding serum zinc and selenium levels. The cases and controls were matched in terms of age, gender, and smoking history using frequency matching methods. The data were analyzed using STATA software (version 15). A p-value less than 0.05 was considered statistically significant.

The mean ages of the patients in the case and control groups were 34.0±5.1 and 33.8±4.9 years (P=0.439), respectively. Moreover, the results revealed that the serum zinc and serum selenium levels were 110.86±21.32 and 83.60±10.71 micrograms/dl (P<0.001) as well as 78.58±17.75 and 85.61±24.18 micrograms/dl (P=0.102) in the case and control groups, respectively. Furthermore, disease duration and severity had a positive correlation with serum selenium level; however, it was not significant. On the other hand, serum zinc level was negatively correlated with disease duration and severity although it was not statistically significant.

Zinc deficiency seems to play a role in the pathogenicity of relapsing-remitting multiple sclerosis; however, it does not correlate with the disease severity and duration. Considering the low levels of serum selenium in patients with multiple sclerosis, this difference was not statistically significant and may have been affected by the sample size.

Dental implants are a reliable tool for the replacement of missing teeth, and the use of advanced imaging techniques for the examination of the location of implants is on the rise these days. The present study aimed to assess the frequency of different types of bone at the implant site in different age groups in Cone Beam Computed Tomography (CBCT) images.

A number of 320 CBCT images (ProMax®)  which were obtained for implant replacement were evaluated in this descriptive study. Patients were assigned to 10 groups according to age (5-year intervals) from 20-70 years old. The bone type was determined based on Zarb and Lekholm classifications. In order to determine the bone type, cross-sectional images with 1mm thickness were prepared in the most suitable place for implant placement, and the resulting images were evaluated by two observers.

Out of 1042 implant sites, 461 581 sites were in maxilla and mandible, respectively. According to Kappa statistical analysis, there was a significant inter-observers statistical correlation (82%). the most commonly observed bone types were D3, D2, D4, and D1, respectively. Bone type D3 and D1 were the most and least prevalent types in men, whereas in women, the most and least prevalent types were D3 and D1, respectively. The prevalence of D3 and D4 bone type increases with age. Moreover, D1 and D3 were the least and most prevalent bone types in younger ages, respectively.

As evidenced by the obtained results, CBCT is a reliable tool for identifying the type of bone in the implant placement area and subsequently determining the prognosis of the treatment plan.

Cochlear implants make high-frequency information audible for patients, which is usually impossible using hearing aids. This study was conducted to compare cochlear implants with hearing aids regarding word recognition score in the presence of white noise.

In this analytical cross-sectional study, two groups of children with a cochlear implant or hearing aid (n=12 each) participated in 50 auditory rehabilitation sessions. The subjects were subject to hearing tests, namely  Pure Tone Audiometry Tympanometry, Speech Reception Threshold, and Word Discrimination Score in Quiet and in White Noise (WD in WN). Word discrimination in white noise test was performed in two levels: 1) In signal-to-noise (SNR) ratio of +5 dB, with the speaker volume and noise intensity equal to 60 dB and 55 dB, respectively, and 2) In SNR ratio of +10 dB, with the speaker volume and noise intensity equal to 60 dB and 50 dB, respectively.

According to the findings, in SNRs of +5 and +10 dB, the mean scores of WD in WN in children with implants (58% and 65%, respectively) were higher than those of children wearing hearing aids (50% and 58%, respectively). Based on the results of the t-test, the difference between WD in WN scores in the SNR ratios of +5 dB and +10 dB was significant in children with implant prosthesis compared to those wearing hearing aids (P=0.02 and P=0.03, respectively).

It can be concluded that receiving a cochlear implant, rather than hearing aids, along with participating in auditory rehabilitation sessions can lead to more effective and efficient changes in childrenchr('39')s hearing function and increase their speech comprehension.

Phenylketonuria is one of the most common metabolic disorders which causes brain abnormalities in children if they do not receive treatment or their treatment is delayed or ineffective. In this regard, the present study aimed to investigate the demographic characteristics of phenylketonuria patients and determine the reasons for their referral to rehabilitation centers.

This descriptive study was performed on 31 patients diagnosed with phenylketonuria who were willing to participate in this study, in Hamadan, Iran up to summer 2019. Based on the objectives and variables of the study, a questionnaire with 25 items was designed. The questionnaires were completed through interviews with the parents of subjects. Finally, the collected data were analyzed in SPSS software (version 16) using descriptive statistics indicators.

Based on the results, the mean age of the participants was 79.7±65.8 months and 18 (58.9%) and 13 (41.1%) of them were females and males, respectively. Moreover, seven (22.6%) cases were diagnosed through screening. Majority of their parents had below undergraduate education (96.8% of fathers and 90.3% of mothers). In addition, most of the children with phenylketonuria (38.7%) were the first child and the only child of the family. Besides, the reason for their referral to rehabilitation centers included seizures and behavioral, movement, and speech disorders. It was also found that in 71% of cases there was a disorder while only 35% of patients received rehabilitation services.

Despite the fact that the need for rehabilitation services is diagnosable in children with phenylketonuria from an early age (nine months and six days old), only a low percentage of these children benefit from rehabilitation services in the city of Hamadan. Therefore, it is necessary to increase the quantity and quality of such services.

Mycobacterium tuberculosis is an intracellular pathogen, and the main target of this bacterium is the lungs, upper respiratory system, and their mucous membranes leading to acute or chronic infection of the respiratory tract. The purpose of this study was to investigate the microRNA 21 (miR-21) expression levels in the patients suspected of Mycobacterium tuberculosis.

The present study was a case-by-case study, and the results were compared between the two groups of patients and healthy individuals. The serum samples were collected from 200 patients suspected of Mycobacterium tuberculosis during a 3-year period in the hospitals of Kerman, Iran. The expression level of the extracted miR-21 was analyzed using real-time polymerase chain reaction.

There was no significant difference in the serum miR-21 gene expression in the symptomatic patients with negative smear and negative purified protein derivative (PPD) skin test. However, the patients with positive smear and negative PPD, positive PPD and negative smear, and positive smear and positive PPD showed a significant increase in the miR-21 gene expression (P<0.05).

The obtained results confirmed the need for more accurate diagnostic methods, especially molecular techniques, for the detection of M. tuberculosis infection as late detection of infection can eliminate the possibility of effective treatment and endanger the lives of individuals. Due to the correlation between miR-21 and this infection, the miR-21 inhibitors can also be used for the treatment of the disease.