مجله علوم پزشکی رازی
سال پانزدهم شماره 2 (پیاپی 59، تابستان 1387)

The levels of lactic dehydrogenase(LDH) in the cerebrospinal fluid(CSF) have been used to evaluate a variety of neurologic disorders. However, few studies have been performed on CSF LDH in febrile convulsion patients. The aim of this study is to compare CSF LDH in children with simple and complex febrile convulsion. Patients and In this study, which was prospective, analytic and cross-sectional, CSF samples were collected from 225 children: 75 with simple febrile convulsions(group A), 75 with complex febrile convulsions(group B) and 75 with no neurological or intracranial pathology(controls, group C). Lactic dehydrogenase(LDH) levels in CSF were measured by a Hitachi analyzer. Then CSF LDH was compared between the three groups. The results were analyzed via Student's t-test. Mean total LDH levels in groups A, B and C were 64.62 ± 12.44, 81.93 ± 21.37, and 51.10 ± 11.82 IU/L respectively. The LDH level in group B was significantly higher(P<0.05) than that in the other two groups. In group A, mean CSF LDH level was also higher than that in group C(P<0.05). This survey is the second report on the LDH level in the CSF of the patients with simple and complex febrile convulsions. The important finding is that simple and complex febrile convulsions may be associated with cell damage and change in aerobic and anaerobic metabolism, and this damage is greater in complex febrile convulsions.

Giardia Lamblia, a flagellate protozoan, is localized to the small bowel where it causes damage to the mucosa with or without gastrointestinal symptoms. In its life cycle this protozoam goes through two stages: trophozoite or active, motile from and resistant or encysted form, by which the infection is transmitted. A number of reports have described some changes in intestinal alkaline phosphatase in rats infected with giardia. Therefore, we planned to evaluate the level of serum IALP(intestinal alkaline phosphatase) in humans infected with giardia via electrophoresis. Patients and In this descriptive cross-sectional study, we examined a group of 67 patients infected with giardia as the case group and also a group of 30 normal humans with no giardiasis as the control group. Both groups underwent the following tests: fecal examinations including direct smear and formol-detergent, GPT(glutamic-pyruvic transaminase or also called alanine aminotransferase), γ GT(γ -glutamyltransferase) for liver function, and total ALP. Then we isolated ALP bands in the patient's serum samples by electrophoresis. Pearson correlation coefficient was applied to analyze the data. The study showed an increase in the level of IALP in patients with severe giardiasis. Giardia infection causes a reduction in the intestinal absorption of calcium which can subsequently lead to a decrease in the amount of serum calcium. This decrease makes parathyroid gland increase the secretion of PTH. This hormone activates vitamin D3 which, in turn, stimulates intestinal epithelial cells to produce more IALP on the one hand and increases the absorption of calcium on the other hand.

Rubella is an infectious viral disease with a worldwide distribution. Infection during early pregnancy may cause fetal death or congenital rubella syndrome(CRS). The high risk of CRS is found in countries with high susceptibility rates among women of child bearing age. Expanded program of vaccination has increased vaccine coverage and exerted a substantial impact on the reduction of rubella infections such as CRS. This study was done to evaluate rubella serology before and after MR vaccination in women who were going to get married in 2000 and 2006. Patients and A cross-sectional analytic study was done on 250 pre-marriage women who had already participated in the national program of MR vaccination and now were referred to the health center for pre-marriage screening tests. Being selected at random, the subjects entered the study. Anti-rubella IgG was measured by ELISA. The results of this study were compared with the results of a previous study done in 2000, that is, before the national MR vaccination program. SPSS software version 13 was used to analyze the data. The present study revealed that 98.4% of the subjects in our studied group were immune against rubella, while the study conducted in 2000 reported that 83.5% of the studied population were so, suggesting a statistically significant difference before and after vaccination(P=0.000). The national MR vaccination program has resulted in a meaningful increase in anti-rubella immunity level in women who are evaluated for pre-marriage tests.

stomach or intestine, leading to distension of the organs. Approximately 20% of people aged 65-93 have experienced abdominal distension, often due to gaseous build-up. A wide range of approaches, including chemical drugs and dietary modifications, are utilized to treat flatulence. One of the most common therapies for flatulence is dimethicone. On the other hand, the use of alternative therapies, particularly herbal remedies, is also becoming increasingly common. The aim of this study was to compare the effects of carmint as herbal therapy versus those of dimethicone on flatulence.Flatulence is a condition which is defined as the presence of excessive amounts of air or gas in thePatients and flatulence. After determining appropriate inclusion and exclusion criteria, the patients without any organic disorders were selected and randomly divided into two groups: 42 patients under herbal therapy with carmint in group A and 40 patients receiving dimethicone in group B. Both groups received the treatment for two weeks. Then the patients were followed up with phone calls one and three weeks after the beginning of the treatment and asked about their gastrointestinal symptoms. The symptoms were recorded in the checklists provided and the data were analyzed by SPSS version 13 using Chi-square, paired t-test, independent t-test, Mann-Whitney U test, and repeated measures.This double-blind, randomized, controlled, clinical trial was conducted on 82 patients with 1.08) and 1.15(SD=1.00) respectively, suggesting that the difference between the two groups was statistically significant (P=0.019). In addition, the mean changes of distension in group A(1.21, SD=0.97) were significantly higher than group B(0.73, SD=1.06)(P=0.01). However, there were not any significant differences in the relapse of most of their symptoms after stopping the therapy in the third week of follow-up.At the end of the first week of follow-up, the mean changes of flatulence in groups A and B were 1.73(SD= gastrointestinal diseases. On the other hand, dimethicone is also useful in reducing froth in the lumen of the gastrointestinal tract. Nevertheless, in some studies dimethicone does not exhibit any beneficial effects on the symptoms of intestinal gas. In addition, our results show that the effect of carmint is significantly higher than that of dimethicone on relieving flatulence symptoms, especially in a short period.Carminatives are among the oldest known remedies and were reportedly used by Hippocrates for.

Escherichia coli is one of the most important and prevalent bacteria isolated from clinical cases especially from hospitalized patients. Recently multiple drug resistant E.coli strains have been isolated from clinical cases. Resistances were seen against drugs belonging to different antibiotic families. In this survey, drug resistance in clinical isolates was studied with special reference to extended spectrum betalactamases.Patients and A total of 113 E. coli strains isolated from hospitalized patients were initially surveyed for drug resistance by disc diffusion method. The minimal inhibitory concentration (MIC) of isolates resistant to different antibiotics was determined by E-test. Beta lactamases production was tested with nitrocephin disc and extended spectrum beta lactamases assays were performed with double disc synergy tests. Finally, Chi-square and t-tests were used to analyze the data. From the total of 113 E.coli isolates tested, 47 (41.5%) showed multi drug resistant trait. All of these MDR strains were positive in nitrocephin test, indicating beta lactamases production. Double disc synergy tests results showed production of extended spectrum beta lactamases in all MDR isolates. Detection of 41.5% MDR trait, especially extended spectrum beta lactamases, in the clinical E.coli isolates points to the potential dangers posed by the widespread usage of extended spectrum cephalosporins. It also necessitates conduction of a wider study to determine the extent of MDR E.coli occurrence at national level.

Typical laryngeal carcinoid tumor, only 14 cases of which have been reported so far, is one of the rarest neuroendocrine tumors of the larynx. In all these cases supraglottic area was involved. Wide local excision is the treatment of choice. Case Report: This article represents a 68-year-old man who presented with progressive hoarseness since 6 months ago. Indirect laryngoscopy showed an exophytic mass in the right supraglottic area. Direct laryngoscopy and biopsy were performed. Pathologic findings were compatible with a typical carcinoid tumor. Owing to different biological behaviors and special treatment modality, accurate diagnosis of neuroendocrine neoplasms of the larynx is very important. When the surgeon is suspicious about the presence of these tumors, special immunohistochemical staining is essential to confirm the diagnosis.

Sudden Unexpected Death after Epilepsy (SUDEP) is one of potentially lethal side effects of the seizures. Cardiac arrhythmia and myocardial damage have been postulated as underlying causes. On the other hand, serum cardiac troponin I (cTnI) level is one of the most specific cardiac markers for myocardial damage. Therefore, the aim of the present study was to evaluate the level of troponin I in non-cardiac uncomplicated epileptic patients. Patients and This analytical cross-sectional study covered forty-nine 12-65-year-old patients with a history of uncomplicated epileptic seizures and no previous history of cardiac problems following an episode of ictal attack during recent 6 hours to 10 days. The subjects underwent cardiac evaluations including ECG, echocardiography, and serum cTnI level measurement. The number of seizures, the age at the onset of seizures, and the time past the last seizure were recorded as well as demographic variables. The mean age of the patients was 21.18(SD=8.37) with the male/female ratio of 2.26. The mean of hours past the recent seizure episode was 54(SD=52.97) hours. Serum cTnI values were reported as normal in all the patients with the mean of 0.026(SD=0.015) ng/ml. However, a significant correlation was found between the level of cTnI and the number of seizures (r Spearman=0.743, P<0.001). Our study showed normal values of serum cTnI following an episode of epileptic seizure attack in 12-65-year-old patients with uncomplicated epileptic seizures and no history of previous cardiac problems. However, the level of cTnI was increased in patients with frequent episodes (>3) of epileptic seizures. An experimental model may be suggested to clarify the correlation between serum cTnI levels and ictal states in uncomplicated epileptic seizures.

Febrile seizures are the most common type of childhood seizures. Despite numerous researches which have been done on various aspects of the problem such as genetic ground, risk factors for the recurrence of seizures, probable development of epilepsy, etc., many aspects of it still remain obscure. Therefore, investigations are being conducted in different centers around the world. Considering many reports about the increased frequency of the occurrence of seizures in special seasons and parts of the day, we conducted this study to find whether any special pattern exists in the occurrence of this event. Patients and In a descriptive cross-sectional study, the medical files of 221 children aged 6 months to 5 years who were admitted with febrile seizure to the pediatric ward of Rasoul-e-Akram Hospital were reviewed. Patient's data including age, gender, etiology of fever, season and time of seizures were collected. Mean ± SD was used to define quantitative variables. Chi-square, one-way ANOVA and t-tests were used to analyze the data. The mean age of the children was 29.09(±18.64) months. The occurrence of febrile seizures was as follows: 39 children(17.6%) presented with febrile seizures in spring, 58(26.3%) in summer, 47(21.3%) in autumn, and 77(34.8%) in winter. The occurrence of febrile seizures was significantly more common in winter, especially in January (p<0.015). Considering circadian rhythm, more seizures occurred in the afternoon(12 MD to 5:59 PM) and evening(6 PM to 11:59 PM) than at night(12 MN to 5:59 AM) and in the morning(6 AM to 11:59 AM). In our study febrile seizures occurred more frequently in winter compared to other seasons of the year. In addition, the frequency of the occurrence of seizures in the evening and afternoon was significantly higher than other parts of the day.

Thrombosis occurs when blood comes into contact with unepithelialized surfaces after vascular clamp and also blood stasis during vascular surgeries. Heparin is administered to prevent thrombosis, and aPTT (activatedPartial Thromboplastin Time) test is used to make sure of anticoagulative effect of heparin. At the end of the operation, heparin is neutralized by protamin sulfate in some centers. In this study we assessed the necessity of aPTT and using protamin during vascular surgeries.Patients and In this case-control survey, 154 cases of vascular surgery were divided into two groups which were matched regarding age and underlying diseases. The subjects were monitored for vascular complications during the first postoperative 24 hours. In group A (62 cases), aPTT was determined after 2 minutes of heparin administration but heparin was not neutralized by protamin at the end of the operation. In group B (92 cases), aPTT was not determined after heparin administration but heparin was neutralized by an appropriate dose of protamin at the end of the operation. To obtain mean and frequency the data were analyzed descriptively and analytical techniques such as Chi-square and t-test were implemented using SPSS 14. Vascular surgery complications were seen in 4 cases (26%): right leg embolus in 1 case (0.65%), spinal ischemia in 1 case (0.65%), left leg neuropathy in 1 case (0.65%), and hypotension due to protamin in 1 case (0.65%). 3 cases were from group A and 1 case was from group B. Nevertheless, the observed difference was not statistically significant although the power was high enough (power=70%). According to our findings, it seems by applying appropriate techniques and accomplishing surgical principles, there is no need for aPTT assessment and protamin administration. This can reduce the cost, duration and complications of operation and prevent adverse effects of protamin.

Mutations in c-kit gene cause autonomously proliferation of leukemic cells with an unfavorable prognosis.These mutations including exon 8 deletion and insertion in the fifth extracellular Ig-like domain and exon 17 point mutation in tyrosine kinase domain of c-kit receptors are important in acute myeloid leukemia. The aim of this study was to set up molecular diagnosis and screening of these mutations in AML patients. Patients and This observational descriptive study of mutations in c-kit receptors was done on 212 patients with AML. Exon 8 mutations were analyzed by PCR method with specific primers.Then, PCR products were run in 10% CSGE and the results were documented. We also studied exon 17 point mutations with RFLP technique and using AatII enzyme on PCR products of these patients. Exon 8 mutations were seen in 1.4% of AML patients though, the results were different in different subtypes. Also, 4.7% of the patients showed D816 (exon 17) mutations with different findings in the subtypes of AML. This study revealed that c-kit mutations constitute a significant percentage of AML (M2&M4 subtypes) cases in Iran. Thus, molecular diagnosis of these mutations could help to select a better treatment.

Viral hepatitis has existed since the creation of human. The estimated prevalence of hepatitis is about 3-5%. For patients with chronic hepatitis C and moderate to severe liver fibrosis, antiviral therapy is strongly suggested, while the cases without fibrosis or with mild liver fibrosis are often followed up without receiving antiviral therapy. The purpose of the present study was to assess laboratory factors associated with the severity of liver fibrosis in patients with chronic hepatitis B or C, so that the results could be used for the follow-up and management of the disease. Patients and This cross-sectional study covered 109 patients with chronic hepatitis B or C who attended Hepatitis Clinic in Hamedan between 2000 and 2005. None of the cases had received antihepatitis treatment before the study. Patients suffering from co-infection of two or more types of hepatitis, immunodeficiency and chronic or incurable diseases were not included in the study. The data were analyzed by independent t-test, and correlation and univariant model. The mean age of the cases was 36.70 years (SD=12.23). The mean duration of hepatitis infection was 3.77 years(SD=1.62). The most common liver fibrosis severity was stage I in 59 cases (54.1%) and then stage II in 24 cases (22%). The mean of liver fibrosis severity was 1.51 (SD= 1.16). There was a relation between liver fibrosis stage and three factors, namely age at the time of infection (Pv=0.034, r=0.203), duration of infection (Pv=0.006, r=-0.259) and platelet count (Pv=0.012, r=-0.24).However, there was no statistically significant relation between liver fibrosis severity and other assessed factors. Considering the findings of the present study and other reports, it seems that age at the time of infection, duration of infection and platelet count are the three crucial factors which bear a strong relation to liver fibrosis severity and, therefore, could be applied to create prognostic models in other studies.

Reactive oxygen species can affect many cellular functions through protein oxidation or initiation of lipid peroxidation cascade. The study was designed to investigate changes in erythrocyte glutathione peroxidase activity and plasma total antioxidant level due to Securigera Securidaca extract in diabetic rats. The present experimental study was carried out on 30 male rats scientifically named Ratus Norvegicus, including normal and diabetic groups. In addition, each group was divided into three subgroups (5 rats per each): a control group and two subgroups which received 100mg/kg and200 mg/kg of the extract. The rats received all the injections intraperitoneally for thirty days. After the termination of injection period, blood was drawn from the heart and glutathione peroxidase activity and plasma total antioxidant levels were assessed. Statistical differences were evaluated by ANOVA and Student's t- test. Glutathione peroxidase activity in diabetic subgroups treated at doses of 100mg/kg and 200mg/kg was heightened in comparison to the diabetic control subgroup(P=0.01 and P=0.004 respectively). Plasma total antioxidant level in diabetic subgroups treated at doses of 100 mg/kg and200mg/kg was increased compared to the diabetic control subgroup (P=0.005and P=0.035 respectively). Securigera Securidaca extract probably increases antioxidant defense in diabetic rats by making changes in glutathione peroxidase activity and plasma total antioxidant level.

Helicopter emergency medical services (HEMS) decrease the mortality rate in emergency cases by minimizing rescue time and providing advanced facilities and also medical care. The aim of this study was to determine the prehospital care in patients transported by Tehran HEMS. Patients and This retrospective cross-sectional study was conducted on the patients transported by Tehran HEMS to Imam Khomeini Hospital from March 2003 to March 2004. All possible data were gathered from the records of Tehran Emergency Data Center. Calculations and analysis were performed by SPSS 11.5. By conducting 244 missions, 518 patients were transported to Imam Khomeini Hospital. Trauma was the most common cause of patients’ transport (94.8% blunt and 1.9% sharp) and only 3.3% of the patients were transported due to other causes. Most of the missions were carried out between 10 and 11 in the morning and 2 and 5 in the afternoon. The most dangerous point of coverage area was Haraz Road, from which 18.1% of the patients were transported. About one-third of the transports were tertiary. The main emergency treatments given to the victims were serum therapy (84.4%), control of bleeding (53%), orotracheal intubation (22.6%) and chest tube insertion (1.3%). Mean response and rescue times were 17 and 40 minutes respectively. The mean of revised trauma score (RTS) was 7.5 and only 3% of the injured had a score less than 4. It seems that prehospital care provided for the patients was not satisfactory and only very limited number of drugs have been used by medical crews. High average of RTS indicates that the patients had not been screened by specific triage criteria and there was an exceedingly high over triage in patient selection. More than half of the missions were made just in 7 points of coverage area and this shows that these areas have a high ratio of accidents. Therefore, it seems necessary to pay more attention to dangerous points of coverage area and also to international standards for transporting patients by HEMS. It is also suggested that Tehran HEMS be equipped with facilities such as telemedicine.

The usual causes of flexor tendon injuries in hand are penetrating wounds. Closed injury and avulsion of flexor tendon are rare and mostly occur as avulsion of flexor digitorum profundus tendon of ring finger from its bony insertion at distal phalanx. Closed avulsion of flexor digitorum superficialis is even rarer. The rarest is simultaneous closed avulsion of both flexors in the same finger, only ten cases of which have been reported in the literature. Case Report: The patient of the present study was a healthy 23-year-old right-handed male farmer who had fallen down during power lifting in a body building club six weeks prior to being referred to the hospital. After this event he was unable to flex his fourth left finger through interphalangeal joints. There was no injury to the skin of his hand. Six weeks later he had full passive range of motion in interphalangeal joints of that finger without active range of motion. With the impression of closed rupture of both flexors of the ring finger, he underwent two- stage tendon graft because of contracture of pulley system. Closed injury of both flexor tendons should be considered in similar situations, though it is rarely observed.

Among infectious diseases, tuberculosis(TB) is the second leading cause of death worldwide, killing nearly 2 million people each year. Defining high-risk groups(IDUs= Injection Drug Users), cases of diabetes mellitus(DM), and those having close contact with TB patients) is vital in terms of diagnosis, prevention, and control programs. The aim of this study is to determine the frequency of risk factors for tuberculosis. Patients and We conducted an observational, descriptive, cross-sectional study. All the files concerning TB patients who were admitted to Firoozgar Hospital between 2002 and 2004 were evaluated. The designed questionnaire contained information about age, sex, nationality, history of smoking, HIV infection, close contact with TB patients, DM, chronic renal failure(CRF), lymphoma, leukemia, and immunosuppressive therapy like glucocorticoid. Statistical analysis was done via SPSS software version 15. Frequency, mean and standard deviation were defined. Among these 8 patients, the most frequent risk factor was smoking(20.45%) followed by DM(10.22%), close contact(7.95%), IDU(6.81%), CRF(3.4%), HIV infection(2.27%), and leukemia(1.13%). The present study may have shown the marked effects of risk factors on acquiring tuberculosis, so the identification of TB infection in these high-risk groups is very important.

Foreign body aspiration commonly involves very young children and taking a precise history and doing a careful physical examination can lead to diagnosis. If the extraction of the object is delayed beyond 24 hours, it will lead to complications such as pneumonia, abscess, and atelectasis. Therefore, the present study tries to investigate the duration and reasons of delayed diagnosis of airway foreign body aspiration in children admitted to pediatric Hospital in Tabriz. Patients and This cross-sectional descriptive study was done over a period of 36 months, from 2001 to 2004, in the ENT Department of Children’s Hospital in Tabriz. 155 cases who had been admitted for foreign body aspiration and had undergone successful bronchoscopic removal were studied. The information such as the history of choking, the gap between initiation of symptoms and admission (duration of delayed diagnosis), outpatient visits, the first diagnosis, and the results of bronchoscopy was all recorded in the checklists. To analyze the data, descriptive statistics, and Excell 11.0 were used. The mean age of the patients was 21.58 (±12.90) months. 81.3% were under 3 years of age and 18.7% were above 3. Protracted cough lasting beyond 3 weeks was the most common symptom found in 73.5% of the cases. The average interval between aspiration and admission was 24.71 (± 8.96) days. Only 24.5% arrived in the first 24 hours. The main causes of delayed diagnosis were lack of notice on the part of parents and incorrect diagnoses made by physicians. 75.5% of the cases with foreign body aspiration were referred after 24 hours and the duration of delayed diagnosis in the present study was longer than that mentioned in the reports of other centers. Parent's unawareness and physician's insufficient training can delay the diagnosis of airway foreign body aspiration and cause serious complications. Thus, providing proper education is necessary to prevent them.

Unstable angina accounts for about 30% of cardiovascular patients referred to emergency departments. Low risk patients can be discharged and receive outpatient treatment if clinical and paraclinical assays are normal. The recommended pre-discharge evaluations are controversial. However, because of the availability and safety of bedside echocardiography in emergency departments, we decided to conduct this study.Patients and This cohort study was done on 140 patients with chest pain who were diagnosed with low risk unstable angina and admitted to the Emergency Department of Hazrat Rasoul-e-Akram Hospital. All of the cases underwent bedside echocardiography before their discharge. Calling the patients one month after their discharge, their outcomes were recorded. Then we made a comparison between echocardiographic findings and their one-month outcomes. The data were analyzed via SPSS software using statistical tests such as Fisher, Chi-square and t-test. The mean age of the patients was 51.39(SD=10.13) years. 42.1%(59 cases) were female and 57.9%(81 cases) were male. The patients with abnormal echocardiographic findings, i.e. EF(Ejection Fraction)<40% and wall motion abnormality, had a significantly higher rate of re-hospitalization because of chest pain(p=0.000). The study shows that bedside echocardiography before discharge is a reliable method for predicting cardiovascular events in low risk unstable angina patients.

Preeclampsia is one of the important complications of pregnancy and knowing its risk factors can help us to understant it better. The aim of the present study is to evaluate some of th risk factors for preeclampsia. Patients and This retrospective case-control study covered 636 preeclamptic women. 318 preeclamptic women constituted the case group and the other 318 preeclamptic women who were normotensive at the time of delivery were considered as the control group. The following factors were evaluated and compared between the two groups: maternal age, gestational age, nuliparity, occupation, educational status of mother, maternal BMI(Body Mass Index), maternal hemoglobin, blood group and Rh, family history of preeclampsia, history of preeclampsia in the previous pregnancy, being relative to spouse, urinary tract infection(UTI) during the present pregnancy, season in which preeclampsia occurs, neonatal sex, and the method of contraception. The obtained results were analyzed using statistical tests such as Chi-square and Mann-Whitney. UTI(P=0.027, phi=0.031), history of preeclampsia during the previous pregnancy(P=0.000, phi=0.144), nuliparity(P=0.008, phi=0.108), blood group of A+(P=0.000, phi=0.129), and low educational status of mother(P=0.009, phi=0.007) were significantly more common in the case group. Maternal hemoglobin was also higher in the case group(12.23 ± 1.41gr/dl vs 11.9 ± 1.46gr/dl P=0.014, phi=0.042). The rate of cesarean section was higher in the case group than in the control group[245 cases(77%)vs 85 cases(26.7%), P=0.000]. The Apgar score of less than 8 in the first minute of birth was more commonly seen in the case group(28.6%vs 47.4%, P=0.000). Gestational age at the time of delivery was lower in the case group(36.48 ± 3.4 weeksvs 37.12 ± 3.3 weeks, P=0.000). UTI, history of preeclampsia during the previous pregnancy, nuliparity, blood group of A+, low educational status of mother, and high maternal hemoglobin might be the risk factors for preeclampsia.

Diabetic nephropathy is a common cause of end-stage renal disease. Microalbuminuria is a predictor of diabetic nephropathy. The aim of this study was to determine the prevalence of proteinuria in patients with recently diagnosed type 2 diabetes mellitus.Patients and This observational, descriptive, analytical study was carried out on 288 recently diagnosed type 2 diabetic patients referred to the Institute of Endocrinology and Metabolism between 2004 and 2006. The patients were evaluated for age and sex and the following tests were performed: FBS, HbAlc, BUN, Cr, and 24-hour urine microalbumin. The results were compared by t-test. From a total of 288 diabetic patients, 165 cases(57.3%) had diabetic nephropathy. In this group, 147 cases (51%) had microalbuminuria. 64.6% of the subjects were female and 35.4% were male. The sex/age ratio in the two groups, i.e. with and without diabetic nephropathy, was similar. The mean age of the patients was 52.60(±9.45) years. There was no significant difference between the two groups in terms of the mean values of FBS, BUN, age, and sex(p<0.05), but there was a significant correlation between diabetic nephropathy and HbAlc and Cr concentrations (P≤0.05). The overall prevalence of diabetic nephropathy in the patients with recently diagnosed type 2 diabetes mellitus was 57.3%. Screening all newly diagnosed type 2 diabetic patients for microalbuminuria is recommended.

Low back pain (LBP) is one of the common ailments which usually lead to considerable limitations and problems for the patients and community. Measurements of the curvature of the lumbar spine are useful in the investigations of low back pain. It is unclear whether the degree of lumbosacral angulation is the same for all normal adults. Therefore, regarding considerable prevalence of back pain in Iranian population, this study was performed to measure lumbosacral angle in Iranian individuals.Patients and This cross-sectional study was performed on individuals who were referred to orthopedic clinic of Hazrat-e-Rasoul Hospital in Tehran. Having essential eligible criteria of the study, 130 individuals were recruited conveniently by using non-probability sampling. All individuals were evaluated for demographic variables such as age and sex by using a checklist. In addition, a standing lateral radiograph was performed on all to evaluate and measure the lumbosacral angle. The data were collected, described and analyzed using SPSS software. Out of 130, 70 were female and 60 were male. The total mean lumbosacral angle was 13.77°(SD=0.47) whereas the mean lumbosacral angle in men and women was 13.84°(SD=1.8) and 13.17°(SD=0.6) respectively. However, the difference was not statistically significant (P>0.05). Additionally, a significant correlation was found between age and the mean of lumbosacral angle (P=0.025). The results of current study show that lumbosacral angle is about 12-14° in Iranian individuals. However, more studies are needed to evaluate the association between lumbosacral angle and the incidence of low back pain.

Ulnar dimelia (mirror hand) is a congenital anomaly of upper extremities. Approximately 70 cases have been reported worldwide, including 3 with shoulder dislocation.Case Report: Herein we present a 10-month-old boy whose anomaly was duplication of ulnar_half of forearm, wrist and hand_with substitution of the radial elements. The patient underwent amputation of the 1st and the 3rd digits and their corresponding metacarpus with classic policization of the 2nd digit. Early treatment of this anomaly can prevent future disabilities.

There are several point mutations in hemoglobin(Hb) genes which can cause hemoglobinopathy. Since the mutant Hbs do not have any obvious electrical charge, globin chain separation is helpful for the diagnosis of unknown Hbs. Therefore, the present study was carried out to detect alpha or beta chain variants by cation exchange chromatography. In this descriptive study, 20 samples having abnormal Hb were selected. Complete blood cell count(CBC), HbA2 and HbF percentages were determined by routine methods, and cellulose acetate and citrate agar electrophoresis were performed on all the samples. For HbS confirmation, solubility test was performed and globin chains were separated by carboxymethyl cellulose(CMC) chromatography in the presence of 8 M urea. SPSS version 14 was used for statistical analysis. According to the obtained results, all of the samples had an abnormal band on cellulose acetate and citrate agar electrophoresis. CMC chromatography revealed that three patients had abnormal beta chains, 15 had abnormal alpha chains, and 2 remaining samples had abnormal alpha and beta chains. Mutant alpha and beta chains can be detected by CMC chromatography and globin chain separation is a helpful guideline for the selection of an appropriate gene for DNA sequencing. Moreover, this method is useful to screen the cases for hemoglobinopathies and beta thalassemia coexistance, which can sometimes lead to severe clinical manifestations.

Worldwide increasing number of allergic disorders is one of the most important health challenges, and achieving safe prophylactic and therapeutic procedures is the main aim of the investigators. CpG oligodeoxynucleotides (CpG ODN) which modulate the immune responses and change the cytokine patterns by severalmechanisms are among these procedures. In this experimental study we investigated the effects of CpG motif on immune responses to Chenopodium album (CH.a), a common allergenic plant in Iran, in a murine model of asthma. We used CH. a pollen extract with CpG to sensitize the mice and compared a number of immunologic parameters such as interferon gamma (IFN- 􀇄) and IgE levels between case and control groups. To do this, IFN-􀇄 and IgE levels were measured in splenocyte and lung culture supernatants. Histological studies were also conducted to identify inflammatory cells in lung airways. ANOVA test was used to analyze the data. The study showed although CpG ODN cannot reduce IgE levels to the normal range, they can lower IgE levels by 80% and have a potent influence to augment both systemic and local levels of IFN-􀇄 as a Th1 activity marker (P<0.01) The results of the study have consistency with other reports and confirm the benefits of CpG motifs in reducing lung inflammatory responses. Since CpG components have potency to shift immune activity from Th2 to Th1 responses, it seems that co-administration of CpG/antigen can modulate inflammatory responses to different allergenic antigens.

Adrenal cysts are rare and usually asymptomatic; they are occasionally identified during ultrasound or CT scans (incidentaloma). Among adrenal cysts the most common types are epithelial cysts and pseudocysts. Intracystic hemorrhage is one of the possible complications of adrenal pseudocysts.Case Report: The patient of the present study was a young woman with right superior abdominal pain, vomiting and acute anemia. CT scan showed a huge mass between the liver and the right kidney. Thereafter, the cyst was resected. It contained 5000 ml of bloody dark and brown thrombotic liquid. Histopathological examination revealed adrenal pseudocyst with a dense fibrous tissue wall and foci of chronic inflammation. The patient was fully recovered after the surgery. Adrenal cysts may cause differential diagnostic problems with masses of contiguous organs like kidney, liver and gallbladder. Intracystic hemorrhage, whether spontaneous or post-traumatic, may lead to acute anemia which, as soon as the diagnosis is confirmed, indicates surgery. The operation is usually laparotomic adrenalectomy, since the laparoscopic approach is not sufficient to control large masses with active bleeding inside.

Maternal steroids modulate various functions in the developing brain. Tamoxifen (TAM) treatment, as an estrogen antagonist, induces cell death in rat's developing hippocampus. Estrogen has a variety of physiological effects on the nervous system, including regulation of cognitive functions, learning, aging, angiogenesis, neurogenesis, and neuroprotective effects. In the present study, we demonstrated the effects of TAM as an estrogen antagonist on nitric oxide synthase activity in rat's developing hippocampal pyramidal neurons. The present experimental study was conducted on twelve groups of adult rats. The animals were divided randomly into control, experimental and sham groups. Each group contained full term embryo (E22), one-day neonate (P1), one-week neonate (P7), and three -week neonate (P21). The experimental group received a total of four doses of TAM,i.e. 250 mg/kg TAM in propylene glycole was injected intraperitoneally twice a day for two days. Their hippocampus was removed 6 hours after the last injection. Animals at the same gestational age were used as shams and controls. The latter received only propylene glycole. The hippocampus was dissected out and stored in fixative and sucrose. Cryostat sections were thawmounted on gelatin slides. The sections were incubated for NADPH-diaphorase histochemistry by light microscope. Independent sample t-test and SPSS version 11.0 were used to analyze the data. We found that in the early stage of development cellular density decreases and gradually cellular thickness increases so that the most thickness is seen in the third week after birth. Considering the short halftime of TAM, it was observed that tamoxifen had its greatest effects on E22, P1 and P7 groups and blockaded estrogen receptors. In the group that didnt receive tamoxifen, due to the presence of estrogen NADPHdiaphorase activity, which indicates NOS activity level, strengthened. On the other hand, the animals which received tamoxifen in the early stage showed a decrease in NADPH-diaphorase activity owing to estrogen receptor blockade. Furthermore, the number of neural cells in CA1 hippocampal region showed a decrease in proportion to the reduction in NOS activity level in this region. The decreased number of neural cells and NOS activity, which was seen in E22, P1, P7 groups, seems to be due to the short half-time of tamoxifen. These findings indicate that estrogen and selective estrogen modulators can influence nitric oxide-mediated growth and development of hippocampal pyramidal cells.