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Introduction & Despite recent advances in both medical and surgical treatment strategies, no defined treatment algorithm exists for massive pulmonary embolism (PE). Our objective was to analyze our experience with surgical embolectomy in patients with acute massive pulmonary embolism.
In an observational study, 15 patients were studied who suffered from acute massive pulmonary embolism. They had visited the cardiothoracic ward of the Masih Daneshvari Hospital and undergone embolectomy, in which the cardiopulmonary bypass technique was used and the median sternotomy surgical procedure was performed, between the years 2006 and 2012. Acquired data were analyzed statistically with the SPSS 17, and T-test and Non parametric test were used whenever was necessary.
The average age of the patients was 52.13 years. The average time between diagnosis of the disease and the surgical operation was 44.53±53.40 hours, and the average time spent at the ICU after the operation was 12.26±9.95 days. Twelve patients suffered from short breath, six from pleuritic pain, five from coughs, three from hemoptysis, and two from weakness and premature tiredness. Tachycardia was observed in 66.6 percent of the patients and tachypnia in 60 percent. Fourteen patients had undergone echocardiography and sonography had been performed on 11 patients. Four patients (20%) had undergone fibrinolytic therapy before the operation. Forty percent of the patients died.
Results of this study, show that pulmonary embolectomy is a suitable procedure with acceptable results in treating acute massive pulmonary embolism.

IGFs (Insulin-like growth factors) and some binding proteins can cause occurrence and recurrence of breast cancer. Since the role of combined exercise training on these factors is not clear, therefore, the aim of this study was to look at the changes of IGF axis and some binding proteins in postmenopausal women with breast cancer after 15 weeks of combined exercise training. Twenty- nine women with breast cancer (58.27 ± 6.31 years) who underwent surgery, chemotherapy and radiation- therapy with current hormone therapy were divided into two groups of experimental and control. Subjects of the experimental group performed 15 weeks of combined exercises including walking (2 sessions per week) and resistance training (2 sessions per week that differed from walking days). Data were analyzed by using ANCOVA (p≤ 0.05). Combined exercise training had significant effect on IGF-1 levels (P= 0.001), IGFB-3 levels (P= 0.000) and IGF-1: IGFB-3 (P= 0.000) in postmenopausal women with breast cancer. After 15 weeks, IGE -1 reduced in the experimental group up to 9 percent and IGFB-3 increased by 28 percent. On the other hand, exercise training had no significant effect on the IGFB-1 (P= 0.652) in postmenopausal women with breast cancer. While the IGF axis factors and some binding proteins play an important role in breast cancer and its recurrence, it seems that changes in these factors through combined exercise training programs can delay its recurrence.

This study has examined the relationship between the XPD Lys 751 Gln polymorphism and colorectal cancer in 88 patients and their 88 age and sex-matched controls. Genomic DNA from peripheral whole blood was extracted using standard method to determine the genotype of subjects with RFLP-PCR analysis. Although this study shows cancer patients harbor more heterozygous genotype (XPD Lys 751 Gln) (OR=1.33, CI: 0.679-2.620 and less wild genotype (Lys751 Lys) compare to control group. However, it is not statistically significant (P = 0.406). Furthermore, colorectal cancer was less common in individuals with recessive homozygous genotype (OR=0.097, CI: 0.032-0.297; P= 00.000). Notably, in our study colorectal cancer was more frequent in male gender, elder people compared younger people and individuals with positive colorectal cancer in their first relatives (OR=4.5; CI= 2.010-10.044, P=0.000).

To compare the cosmetic results of whole breast radiotherapy between cobalt 60 and photon 9MegaVolt in patients underwent breast conserving surgery. The patients with breast saving surgery who were treated by whole breast radiotherapy with either cobalt 60 or photon 9MV between 2001-2006 in Sayed-al-Shohada hospital entered the study. The cosmetic results were evaluated by an expert radiation oncologist with definite criteria. Frothy patients in cobalt 60 group and 43 patients in photon group were compared, with median follow up of 40.5 months. The patients in photon group had less telangectasia and discoloration (p=0.018 and p=0.01, respectively). The consistency of breast in photon group was better (p=0.019), but for fibrosis the difference was not statistically significant (p=0.055).Overall cosmetic results in photon group was much better rather than cobalt 60 group (p=0.005). No recurrences were observed in both groups. Cosmetic results in group with photon 9MV were superior to cobalt group, but the effect of these two beam energy on disease free survival (DFS) and /or overall survival (OS) should be in more consideration.

Treatment for tobacco dependency involves a combination of behavioral therapy, antidepressants, and nicotine replacement therapy. This study was conducted in order to compare the outcome of smoking cessation by using each of the four forms of nicotine replacement therapy (NRT) among participants using Trazodone tablet 50 mg. In this non-randomized quasi-experimental study the efficacy of four mentioned forms of nicotine replacement therapy (NRT) including patches, gums and microtabs and two forms of NRT together was evaluated. Smoking cessation while using Trazodone was also studied. All the smokers who referred to the smoking cessation clinic of Iranian National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Tehran, Iran from Oct. 2005 to Oct. 2007 entered the study. They attended 4 weekly sessions followed by 2 sessions in the next 12 months. A total of 286 subjects participated in this study. Trazodone was prescribed for them and 253 used at least one form of NRT. There were 181 (74.6%) males. The mean age was 42.43±13.4 yrs.Thirty three cases selected nicotine patches, 99(39.4%) used nicotine gums, 64(25%) chose microtabs and 57(23%) preferred using two types of NRT simultaneously. A total of 152 participants (60%) quit smoking at the fourth session. At the fourth session, it was proved that nicotine patches had the highest success rate and were most efficient for quitting smoking (94%). Also, after 6 and 12 months follow-up it was found that nicotine patches were most effective for abstinence. Nicotine patches used in combination with Trazodone tablets could result in higher success rates for smoking cessation. (Tanaffos2010; 9(3): 50-57

Several organization such as AAPM (American Association of Physicist in Medicine), ACR (American College of Radiology), ACMP (American College of Medical Physics) and ESTRO (European Society for Therapeutic Radiology and Oncology) recommended the need for periodic quality control procedure in radiation oncology. One of the best methods for quality control is in vivo dosimetry, while radiotherapy is performed. The aim of this study was to design and optimiz a protocol for the quality control of radiation treatment of patients with head and neck malignancy.

In this case series study midle line dose was measured in vivo in conjunction with portal imaging in 19 patients that were treated using a Co-60 unit, in August and December 2007. Distribution of entrance and exit dose was determined using two diodes, off axis ratios and portal imaging together with a user code written in MATLAB. User code was applied to convert optical intensity of portal film to optical density. Midline dose was calculated in one centimeter intervals using entrance and exit dose with the Huyskens algorithm method.

The midline dose was calculated in 165 points. The mean and standard deviation between measured and prescribed dose was about 4.27±3.61%. In 110 points (66.66%), the deviation was less than 5% (2.27±1.37), in 41 points (24.84%) the mean deviation was between 5 and 10% (6.51±1.2) and in 14 points (8.48%) mean deviation was more than 10% (13.37±2.34). The maximum and minimum deviations were found in center of the field (2.6±1.63) and 5cm away from center of the field (7.24±4.86) respectively. Maximum and minimum deviations correspond to the equivalent field of 14cm2 (5.08±3.53) and 8cm2 (2.95±2.13) respectively.

This study showed that using a portal detector in conjunction with two diodes is a simple and accurate method for daily quality control in radiotherapy. The data is acquired in this way can be used for evaluating the accuracy of treatment steps including determination of output of a treatment machine, quality control of a treatment planning system and precision of calculations and patient setup.

Smoking causes 5.2 million deaths annually in the world of which 70% occur in developing countries. Hookah smoking is increasing around the world especially in the Eastern Mediterranean Region including Iran. This study was carried out to evaluate the pattern of tobacco smoking in both forms of cigarette and hookah smoking. A cross- sectional study was conducted among a random population in the main squares of Tehran in 2006. The sample size consisted of 2053 people in the age range of 10 to 80 years. Non-Probability Sampling method was used. Questionnaires designed and adapted according to WHO and IUATLD questionnaires given to these people. Forty-six percent of the sample had experienced hookah smoking. The prevalence of occasional hookah smoking in the previous year was 45%, while 10% of the participants used hookah at least once a week, 17.9% at least once a month and 17.1% at least once a year;47.2% of participants had experienced cigarette smoking. Prevalence of daily cigarette smoking was 22.7%; 22.7% of current smokers and 25.01% of non-smokers consumed hookah at least once a week. Prevalence of hookah smoking is very similar among cigarette smokers and non-smokers. In this study the prevalence of cigarette smokers was more than national data and the rate of cigarette and hookah smoking among women was higher than that of other studies in this realm. These issues need to be further investigated and more serious studies are required in this regard.

Air pollution is a major horror in many cities in Iran especially in Tehran. The cost of traffic congestion in the capital is put at two billion hours of time wasted each year. Tehran has also recorded SO2 levels four times the standard prescribed by the World Health Organization. Tehran is the capital of the Islamic Republic of Iran with almost 11 million inhabitants (one sixth of the country’s population), and is the most densely populated city of the country. The purpose of this research was to investigate the effects of air pollution on cardiorespiratory system. We assessed the relationship between the levels of air pollutants and emergency visits for asthma and cardiovascular diseases in Tehran, Iran. Two research questions investigated in this study were as follows: a) Which criteria elements of hazardous toxic air pollution were associated most strongly with the level of hospital admissions for cardiorespiratory conditions? b) What proportion of the variation in hospital admissions for cardiorespiratory conditions was explained by variations in levels of air pollution? During a 12-month period (from April 2004 to March 2005), the concentrations of 5 air pollutants (CO, NO2, O3, SO2 and PM10) were measured in four stations located in north, west, south and central part of Tehran. The level of air pollution was calculated according to PSI (Pollution Standard Index). Based on the results obtained during the study period, concentration of CO was reported as “above standard” on most of the days, leading to an “unhealthy” situation. 51.9% of measurements were made at PSI≤100 and standard conditions. 34.7% of measurements were at “unhealthy” levels with PSI= 101- 200. 13.2% of measurements were in “very- unhealthy” conditions with PSI= 201- 300. and 0.2% of measurements were recorded in one station and in a “hazardous” condition with PSI>300. For ozone (O3), all measurements were at standard conditions, PSI≤100. The concentration of SO2 on most of the days was at “standard” condition. Only 6% of the measurements (2 samples) were at “unhealthy” or “hazardous” levels, PSI=101-200.Regarding particulate matter (PM10), all samples were evaluated as 88.7% of the measurements were at standard conditions with PSI≤100 while 11.3% of the measurements showed “unhealthy” condition with PSI=101-200. It was observed that carbon monoxide and particulate matter were the main air pollutants in Tehran that had levels higher than standard values. The results showed that the number of admissions because of cardiopulmonary complaint was positively correlated with concentration of all studied pollutants except for ozone (O3). The main source for these air pollutants was motor vehicles. It is notable that atmospheric condition along with geographical situation of Tehran help augment the air pollution in this city. Thus, in addition to encouraging the use of CNG as the combustion material for cars, buses and minibuses, other extensive measures should be implemented in this regard.

After Sistan and Balouchestan, Golestan province is ranked second in terms of TB prevalence in Iran. Therefore, a 5-year study was conducted to evaluate the alterations of TB epidemiologic indices in this province. This was a trend study. All patients suffering from various forms of pulmonary tuberculosis (smear positive, smear negative, extrapulmonary and miliary) during 1999-2003 in Golestan province were studied. Alterations of TB epidemiologic indices were evaluated by using Chi-square test. Out of a total of 3,417 registered TB patients during 1999-2003 in the Center for Communicable Disease Control in Golestan, 2,773 (81%) were available and entered the study; 47% were male. 62.7% of patients had smear positive, 16.4% had smear negative, 20.7% had extrapulmonary and 0.1% had miliary tuberculosis. The overall incidence of all forms of TB during the study period was 36 in 100,000 and no significant difference was detected while assessing the alterations of this index during the study period. Incidence of TB had an increasing trend among children; its prevalence among 0-14 year old females was higher than males during the study period. Although Golestan province is not adjacent to the provinces with high TB prevalence, it is ranked second in terms of incidence and prevalence of TB and various factors such as immigration can affect TB epidemiologic indices. An independent study is required to evaluate the distribution of TB among different ethnic groups. (Tanaffos

Generally, non-smokers have healthier lifestyles compared to smokers. Typical foods eaten more by non-smokers are fruits and vegetables, whereas smokers eat more meat and fat and drink more alcoholic beverages. We aimed to compare nutritional knowledge, attitude and practice (KAP) of smokers participating in smoking cessation clinics with their non-smoker family members. Two hundred twenty-six smokers and 260 non-smokers aged 18 years and over were compared in a cross-sectional study. A Likert type KAP questionnaire including 36 items was used. Knowledge and attitude scores were compared between smokers and non-smokers using the Mann-Whitney test. Practice patterns were compared by the Chi-square test. Differences were significant at p =0.05. The mean age of male smokers and non-smokers were 38.5±11 and 33.5±14 years respectively and in women these rates were 42±10.4 and 31.3±15 yrs. respectively (p<0.0001). In males, the mean percentage of knowledge in non-smokers was higher than smokers (2.41 vs. 1.85) and the average score of attitude in smokers was less than that of non-smokers (37.5 vs. 37.9; the differences were not significant). Sixty (26.5%) smokers and 93 (35.8%) non-smokers reported having regular physical activity (p=0.005). In women, the mean percentage of knowledge in non-smokers was higher than smokers (3.37 and 2.93 respectively; the difference was not significant). Attitude score of female non-smokers was higher than smokers (40.3 vs. 37.1; p=0.001). Among female non-smokers, 68 (46.9%) reported daily meat consumption; this rate for female smokers was 41 (56.2%; p=0.001). Female non-smokers consumed daily breakfast more than female smokers (107, 73.8% vs. 35, 47.9%; p=0.001). Our data showed a significant difference in nutritional KAP between smokers and non-smokers.

Children are highly vulnerable to TB and childhood tuberculosis is a sign of TB transmission in community. This study aimed to determine the epidemiologic trend of this disease in Iranian children. A Trend Study was conducted to evaluate all Iranian patients aged below 14 who had been diagnosed with pulmonary or extrapulmonary TB from 1992 to 2005. Statistical relationships were tested using chi square tests (c²) and the software package SPSS (version 11.5). Out of the 6168 cases studied, 2528 (40.1%) were boys. Patients were assigned to three groups based on disease type: there were 1812 (29.4%) sputum- positive, 1920 (31.1%) sputum-negative, and 2449(39.7%) extrapulmonary cases.The incidence of sputum-positive TB declined from 0.8 per 100000 in 1992 to 0.2 per 100000 in 2005. A similar declining trend was observed for the overall TB incidence and in the incidence of sputum-negative and extrapulmonary cases. There was significant difference in TB incidence between girls and boys in the 10-14 year age group (P<0.001), but no sex difference was observed in 0-4y and 5-9y age groups. The incidence of sputum-positive TB decreased by 75 percent over the study period. This could be partly due to improvements in health status, better disease knowledge and the effects of Iran's National TB Control Program. In children aged below 10 years, there was no significant difference in the incidence of tuberculosis between girls and boys. At puberty, the incidence of all types of TB was higher in girls. Based on these findings, further studies are needed to elucidate the gender distribution of childhood tuberculosis in Iran.

Background and As in many countries, Medical Education (ME) is offered in three levels including Undergraduate ME, Graduate ME, and Continuing ME. Informtion tehnology development has provided a suitable chance for ME. E-learning in ME is growing more and more. The present study seeks to determine the key success factors (KSF) in E-learning in medical fields. KSF has been scrutinized in the literature following of which, and due to similarity, a classification with seven groupings was established including institutional factor, technology, interested parties, information knowledge, methods and approaches educational resources, and environmental factors. Through a questionnaire, the data were gatered from the information technology (IT) directors in all medical universities throughout the country. The data collected were subjected to factorial analysis. Data from heads of educational groups were obtained through focus group discussion. Cronbach reliability coefficient was calculated for questionnaire used. Factorial analysis was used to identify meaningful KSF. T-Test, and one-way variance analysis as well as Pearson’s correlation were used. The analysis was conducted with SPSS software The results showed no significant differences between age, sex, career, and level of education, and KSF. The preparedness factors were analyzed through group discussions with the heads of the academic departments under the study. By factorial analyses, five factors were found including the departmental interest and potential (27.3%), task performance potential (25.1%), E-teaching development in basic and clinical sciences, and continuing education (20.1%), suitable cultural environment (16.8%), and infrastructures (10.8%). Fisher Exeact Test was used to compare the obtained ratios in 5% curve whose results showed that among the three factors including legal and technocal environment, specialized hardwareand software, and high speed internet, performance interest and potentials showed a significant difference (p=0.002). A p=0.011 was found for the authorities’ interest and financial and non-financial rewards. No other significant differences were found anywhere else. Our results showed that sex, age, career, work has no relation with KSF which means that if other factors such as technology, organizational and financial preparedness, curriculum content, human resources, teaching methods, standards, literacy, communications systems, trainers and learners, environment and culturewere ready motivated person can experience success in e learning in medicine

Over the last few years, the province of Golestan has ranked second among all Iranian provinces in terms of TB prevalence after Sistan and Balochestan. The present study was done with the aim of evaluating the incidence of TB among different ethnic groups residing in Golestan. In a descriptive study, all TB patients including sputum smear-positive and negative, extra-pulmonary, and milliary cases were evaluated from 1999 to 2003. The incidence of all types of TB was compared among different ethnicities in the province. Forty-seven percent of the 2773 cases registered for Golestan Province in the Communicable Disease Control Center from1999 to 2003 were male. As regards the type of disease, 62.7% of the cases were sputum smear-positive, 16.4% were smear-negative, 20.7% had extra-pulmonary disease, and 0.1% were milliary TB cases. The incidence rate of all types of TB was 36 per 100000 population and the rate did not show any significant changes over the study period. As for the ethnic distribution of the cases, more than 50% of all TB cases were observed among Sistanis and Baluches, who together account for only 20% of all Golestan residents. The incidence in Sistanis was ten times that in Turks and Kurds, six times that in Persians, 4 times the rate in Torkamans, and 2.5 times that in Afghans living in the same region. The incidence rate of tuberculosis was significantly different among various ethnicities of Golestan province, being highest in Sistanis.

Fiberoptic bronchoscopy is a diagnostic method for respiratory diseases. At present, its diagnostic yield has been increased by different cytologic and histologic procedures by convention. This study was conducted to evaluate the concordance and agreement between cytologic and histologic findings in conventional diagnostic bronchoscopic methods (washing and biopsy) for lung malignancies. This was a cross-sectional study performed on 2076 cases of bronchial biopsy and bronchial washing between 1996 and 2003. Of 2163 patients who underwent fiberoptic bronchoscopy after omitting 87(4%) cases due to unsatisfactory specimens, 2076 cases were studied including 832 (36.9%) females and 1244 (63.1%) males in the age range of 2 to 100 years, (mean age 57.7±16.3 yrs). Male to female ratio was 1.5. Malignancy was diagnosed in 657(31.6%) biopsy and 283(13.6%) cytology specimens. Two hundred and sixty-five cases had malignant lesions according to both bronchial biopsy and bronchial washing; therefore, Kappa coefficient in both methods was 46.7% (P value = 0.000). Concordance rate was 77.4%. Ninety-seven point three percent of malignant cases were diagnosed by biopsy and 41.9% by cytology. Cytology contributed to an additional diagnostic rate of 2.6%. Kappa agreement is classified as fair and although there is a very good concordance between the two sampling techniques, the diagnostic yield of cytology for malignancy must be improved by combination of multiple assays. (Tanaffos 2007; 6(2): 46-50)

Prostaglandins (PGs) can enhance tumor growth and metastasis by stimulating angiogenesis and invasiveness, in addition to apoptosis and immune surveillance. Microtubule-interfering agents induce cyclooxygenase-2 (COX-2) and PG biosynthesis and this might reduce the efficacy of paclitaxel. Preclinical studies suggest that treatment with a selective COX-2 inhibitor may augment the antitumoral effects of chemotherapy. Thus, we designed a phase II trial to evaluate the efficacy of the combination of paclitaxel, carboplatin and celecoxib in advanced non-small cell lung cancer. Thirty-seven patients were enrolled in this trial. The inclusion criteria were: chemotherapy-naïve advanced NSCLC (non-resectable locally advanced stage IIIA, stage IIIB and IV), age>18 yrs. and performance status (PS) of 0-2 (ECOG). All patients were given paclitaxel (200 mg/m2) and carboplatin (AUC 6) on day 1, every 21 days and celecoxib (400 mg) daily. Most of the patients were male and the mean age was 58 yrs. Old. Performance status 0, 1, and 2 were 8.2%, 40.5% and 51.3%, respectively. Four patients were in stage IIIA (10.8%), 12 patients in stage IIIB (32.4%) and 21 (56.8%) in stage IV. The overall response rate was 54%. Time to progression and median overall survival were 5.7 and 9 months, respectively. Only one patient had grade 3 anemia. There was no grade 4 cytotoxicity. Three patients had cytotoxic drug allergy. Based on this study, adding 400 mg celecoxib to the standard regimen (paclitaxel plus carboplatin) does not enhance time to progression and overall survival compared to historical data. Thus, we recommend combining higher dosage of celecoxib with other targeted agents in phase I/II trials. (Tanaffos 2007; 6(1): 37-46)

Health related quality of life (HRQL) questionnaires allow clinicians to measure daily the impact of disease on a patients daily life and is valuable in clinical trial designed to assess benefits and costs of management. We describe the adaptation into Persian version of the St.George Respiratory Questionnaires (SGRQ); a recognized valid self administered questionnaire for chronic obstructive pulomnary diseases. In order to adapt the face validity, the forward and back- translation method was used. Then this questionnaire was edited by researchers and a single pulmonologist as an internist. The content of tests evaluated for feasibility and comprehension by 15 educated COPD patients. In following, the professional committee of researcher assessed the content validity. At last, 55 COPD patients with wide range of disease severity fulfilled the Persian version of the SGRQ. Internal consistency were measured by Cronbach’s alpha coefficient test. The test coefficiency for reliability was 0.74 in part I of questionnaire; "symptoms". Factor analysis indicated that if latest question of part 1 was eliminated [“If you wheeze, is it become worse in the morning?”] Cronbach’s alpha would be elevated to 0.78. Cronbach’s alpha was 0.95 in Part II (Activity & impact) and for overall scale, the result was found to be 0.93. Data from this study revealed that Persian version of SGRQ, as a research tool, is of good validity and sufficient reliablity. The present study suggest the feasibility of adapting a specific instrument of health related quality of life in patients with respiratory disease to be used in different settings from where the instrument has been originally developed.

Transthoracic CT-guided percutaneous fine-needle aspiration biopsy (FNAB) has become a well- established diagnostic technique and been useful in differentiating malignant and benign pulmonary lesions. 505 patients (311 men and 194 women) aged 7-90 years old (mean age 56.2 years) with pulmonary lesions underwent CT-guided transthoracic fine-needle aspiration biopsy.Cytopathologic evaluation of FNAB samples was performed in all patients. In addition, each case was reviewed for complications, including pneumothorax and hemoptysis. Data were analysed using SPSS software for windows ver. 11.5. FNAB samples were adequate for diagnosis in 410 (81.2%) of 505 patients. Two hundred and forty-nine lesions (60.7%0) were malignant, and 161 (39.3%) were benign or atypical. Thirty-four (6.7%) patients had pneumothorax out of which none of them required thoracostomy tube placement. Additionally, hemoptysis was noted in 9 (1.8%) patients and follow-up was carried out. No further complications were reported. CT-guided FNAB of pulmonary lesions can yield well-established diagnoses and it can be useful in the management of patients with suspected lung cancer. (Tanaffos 2006; 5(3): 37-44)

Many studies have been performed to compare WHO and ADA criteria for detection of diabetic patients. This study aims to compare these two criteria in a community-based epidemiological survey in an urban population of Tehran, Iran. Subjects were chosen from among 15005 urban individuals, 3 years old and over, selected by cluster random sampling in the cross-sectional phase of a longitudinal study conducted in the east of Tehran; there were 3870 men and 5359 women aged 20 years and over. Those with known diabetes were excluded. Blood samples were taken after 12-14 hours overnight fast and 2 hours post 75gr glucose taken orally. Prevalence of glucose tolerance categories and the level of agreement (ĸ statistic) were obtained using WHO and ADA criteria. Based on WHO criteria 6.0% (0.95 CI, 5.5-6.5) had type-2 diabetes and 13.0% (12.3-13.7) had IGT (Impaired glucose tolerance). Using ADA, 3.3% (2.9-3.7) had type-2 diabetes and 4.8% (4.4-5.2) had IFG (Impaired fasting glucose); p<0.05 and <0.001 for diabetes and IGT, respectively and 7355 (84%) had concordance with both criteria. Among 7105 normal subjects classified according to WHO criteria, 153 (2.2%) had IFG or diabetes by ADA, whereas from 8068 normal subjects according to ADA criteria, 1116 (13.8%) had IGT or diabetes based on WHO criteria. The level of agreement (ĸ statistic) between the two criteria was 35% (p<0.001). Sensitivity and specificity of ADA criteria were 45.5 and 100%, respectively, considering WHO as the gold standard. Our data shows a low level of agreement between WHO and ADA diagnostic criteria for detection of diabetes. Patients with unknown diabetes, glucose disorders are detected more frequently using WHO criteria.

It is believed that H1 histamine receptor blocker does not have any beneficial effect on treatment of asthma, but combination of H1 and H2 receptor antagonists has a good effect on chronic resistant urticaria. Since the pathogenesis of asthma and urticaria are similar, we expected that this combination might have some benefits in treatment of asthma. In this study, we selected 66 patients with known diagnosis of asthma in acute exacerbation of their disease. The patients did not have any history of smoking, GERD, postnasal discharge and rhinorrhea, but experienced symptoms such as cough, dyspnea, and wheezing. All patients underwent spirometry (Spirosift 3000 Fukuda Denshi), and those who had obstructive pattern and improved FEV1 more than 20% after using bronchodilator were randomly entered either the case or control groups after signing the consent. Spirometry parameters were VC, FVC, FEV1, FEV1/FVC, PEF, FEF 25-75%, MEF25%, and MEF 50%.Phase 1: Case group treated with 0.5 mg/kg prednisolone and salbutamol orally plus terfenadine (bid) and Ranitidine (tid), for one week.Phase 2: Case group treated with salbutamol and beclomethasone spray with antihistamines as mentioned, for two weeks.Phase 3: Same as phase two for one month. Spirometry was done at the end of each phase.In control group since exclusion of corticosteroid and bronchodilator from treatment was dangerous, management was similar to the case group. The only exception was the omission of antihistamines.Statistical analysis: Chi-square was used for interpretation of qualitative variables. F statistics and Kruskal Wallis tests as well as paired t- test were used for comparison of changes in spirometry findings. 66 patients finished first and second phases and 24 patients went through the third phase. M/F ratio was 2/3, median age was 33 years in both groups (range10-70 yrs.). Comparison of symptoms between case and control groups showed that in study group during second phase, cough improved more than control group. Otherwise, there were no significant differences in symptoms and signs of the two groups. During all three phases, spirometry measurement showed no significant difference between study and control group, except for MEF25% that improved in study group more than control group in the second phase. Corticosteroids and b-2 agonists are very potent and effective drugs in treatment of asthma. Addition of H1 and H2 histamine receptor antagonists to standard therapy of asthma has minimal effect but in case of troublesome cough that is not relieved with that treatment, addition of antihistamines may be beneficial.

Lower gastrointestinal (GI) tract bleeding has different ethiologies in different populations and in different ages. This study was aimed to demonstrate relative frequency of causes of lower GI bleeding in patients admitted in Besat hospital of Sanandaj. This was a descriptive study. The subjects included all patients with lower GI bleeding that were admitted in Besat hospital in 1999. They were 112 patients with age range from 1 to 81 years. Data was collected from the patient`s files. Seventy six patients (67.9%)were male and 36 patients (32.1%) were female. Sixty three patients (56.3%) were town resident and 49 patients (43.8%) were village resident. Ethiology of lower GI bleeding was not diagnosed only in 1 patient (0.9%). Most of the patients had less than 55 years-old-age (76.8%). Nine patients had less than 25 years-old age that was the least freqnency (8.1%) among the age groups.Twenty three patients(20.5%) had another disease associated with lower GI bleeding. The most prevalent chief complaint of the patient was discharge of clear blood from rectum that was present in 29 patients (25.9%)alone. Rectal bleeding was at least one of the patients` complaints in 103 cases (92.7%). Seven patients(6.3%) had no clear rectal bleeding and in five of them the chief complaints were weakness,weight loss and defecation changes. Two of them (1.8%) had melena and abdominal Pain. Fifty eight patients(51.8%) had hemorrhoid in different grades.Hemorrhoid was one of the associated diseases in 68 patients (60.7%). Ten patients(8.9%) had only anal fissure while it was an associated disease in 15 patients (13.6%).Polyps was the cause of lower GI bleeding in 11 patients (10%) while it was an associated disease in 12 patients (10.7%).Colorectal cancer was the cause of lower GI bleeding in 13 patients(11.6%). One patient(0.9%) had both colorectal cancer and hemorrhoid. Inflammatory and infectious colitis were the causes of lower GI bleeding in 6 patients(5.4%).In 2 patients(1.8%) rectal prolapse was the cause of lower GI bleeding. Relative freqnency of causes of lower GI bleeding including colorectal cancer in our study are the same as other researchs.