مجله علوم پزشکی رازی
سال دوازدهم شماره 3 (پیاپی 47، پاییز 1384)

TAR syndrome (thrombocytopenia-Absent Radii) is characterised by the neonatal onset thrombocytopenia and bilateral absence or hypoplasia of the radii with normal organs. This syndrome is a rare hereditary condition with a recessive autosomal character. During the first months of life, prognosis is related to the severity of hemorrhage. This paper focuses on three infants who suffered from Thrombocytopenia-Absent Radii(TAR) syndrome. All cases revealed bilateral micromelia of upper limbs, short and radially curved fore arms and hypoplastic arms at birth. These symptoms as well as severe thrombocytopenia confirmed the clinical diagnosis of Thrombocyopenia-Absent Radii(TAR). All three cases had multiple hemorrhages in neonatal period and also in the first year of their lives, however, they are in good condition right now. One of them needed prosthesis at the age of 7 but the two others are alive and being followed up.

Vitamin K deficiency is one of the commonest causes of coagulopathy and bleeding in patients on prolonged antibiotic therapy. This study was conducted to evaluate the status of vitamin K deficiency in hospitalized children on prolonged antibiotic therapy and its role in reversing the coagulopathy. A prospective non-randomized, cross-sectional study was conducted on children on prolonged antibiotic therapy whose ages ranged from 3 months to 16 years old. These children were under treatment in the ward and pediatric I.C.U. In this study, 25 out of 81 children(30.86%) were hypoprothrombinemic. Children ranging from 3 months to 1 year old developed significant coagulopathy as compared to other age groups(33.33%). Coagulation abnormalities were also seen to be more in children with severe grades of malnutrition(50%), on a more prolonged(>10 days) course of antibiotic therapy(36.36%), on β -lactam+vancomycin combination therapy (40.54%), in children who were NPO(45.45%) and in children who were critically ill in the intensive care unit(I.C.U)(47.61%). we suggest vitamin K prophylaxis in patients on prolonged antibiotic therapy(>10 days) especially the patients suffering from mentioned conditions to prevent mortality and morbidity.

Human T-Lymphotropic Virus type 1(HTLV-1) is a human retrovirus which has been known to cause Adult T-Cell Leukemia/Lymphoma(ATLL), HTLV-1 Associated Myelopathy/Tropical Spastic Paraparesis(HAM/TSP) and some other inflammatory disorders. One of the important pathways of transmission of this infection is transfusion of blood and its products. This study was designed to find seroepidemiologic prevalence of HTLV-1 infection in thalassemic patients with frequent blood transfusion and compare it between male and female population in Tehran province. This cross-sectional epidemiologic study was performed on 175 cases including 101 males and 74 females. Serum samples were screened for Anti HTLV by using ELISA method. The positive samples of screening test were serotyped and confirmed by Western Blot analysis. Results were analyzed by using subjective statistical parameters and compared between males and females by Chi Square test. Prevalence of Anti HTLV-1 was 6.3% in our studied patients, including 6.9% in males and 5.4% in females. This study revealed no significant statistical difference in Anti HTLV-1 prevalence between males and females but showed that prevalence of HTLV-1 infection correlated with increasing age and numbers of received blood units. Also by using ROC curves, the age 21 was defined as an indicator for increasing risk of HTLV-1 infection in our study. With respect to the high prevalence of Anti HTLV-1 in the studied population, it can be expected that prevalence of HTLV-1 infection in blood donor population in Tehran would be considerable.

We report a rare case of myasthenia gravis accompanied by multi-focal tuberculosis. A 47-year-old female suffering from myasthenia gravis underwent thymectomy, however, the incision of operation did not heal for many months. Eight months after surgery, she developed fever and gradual loss of consciousness. Laboratory evaluations were suggestive of tuberculous meningitis and multiple parenchymal tuberculomas. After starting anti-TB regimen, her condition gradually improved. Her wound completely healed up after 45 days which was indicative of sternal tuberculosis. This case highlights the importance of additional diagnostic assessment of resistant wounds particularly in immunocompromised patients and also careful consideration of existent paraclinical findings.

The first step in epidemiological researches is to study patterns of mortality. The aim of this study was to assess causes of death, duration between injury and death, and the probable correlation between them and some variables such as kind of injury. This study was a retrospective one. Through an available sampling, we sampled 1709 of 8304 deceased veterans between 1979 and 2004 whose data was registered in veterans’ foundation. 1239 of the cases(85%) were married and 215(14.7%) were single. Mean disability percent was 24.3±14.7. Kind of injury was psychiatric in 486(28.5%), physical in 1167(68.4%) and chemical in 371(21.7%). The most frequent causes of death were disease(65.4%) and accidents or unintentional injuries(24.7%). The most common disease causing death was cardiac disease(35%). In 170 cases(10.1%) death was due to war, and in 1387(82.4%) death was not related to war. Relative frequency of each cause of death or kind of disease(as a cause of death) was different among veterans with various kinds of injury. While relative frequency of suicide in psychiatric and non-psychiatric veterans was 21% and 3%(P<0.05-X2 test), relative frequency of pulmonary disease in chemical and non-chemical veterans was 32% and 19% respectively(P<0.05-X2 test). Duration between injury and death was also different among veterans with various kinds of injury(P<0.05-independent t-test). This study showed diseases as the most common cause of death in veterans which is similar to mortality profile of normal population, not similar to military personnel mortality. Various causes of death in veterans with different kinds of injury indicate various health needs in this population which should be taken into account by health and treatment supervisors of veterans’ foundation.

Biliary system lesions including ampulla of vater are considered as important diseases of gasterointestinal system because of difficult availability in endoscopy, dangers of biopsy and diagnosis in advanced stages.Regarding previous studies about the role and sensitivity of brushing cytology in diagnosis of lesions in this area and lack of serious complications in this procedure, we decided to evaluate the sensitivity and specificity of this method. Observing 45 patients with biliary system lesions who referred to gasterointestinal research center of Shariati hospital for ERCP, cytologic specimens were provided and biopsies were taken, if possible. Then the patients were followed up periodically and cytologic results were compared with biopsies or follow-ups. All specimens with positive biopsy for malignancy exhibited positive cytologic results and all except one with negative biopsy exhibited negative cytologic results. There was only one case of negative biopsy with positive cytologic result reported. Therefore, the study revealed a significant association between cytology and biopsy results. (df=1, chi square, p= 0.04). Compared to biopsy cytology had relatively good sensitivity and specificity which corresponded to the findings of other studies(sen: 100%, spec: 80%, PPV=Positive Predictive Value: 88.8%, NPV=Negative Predictive Value: 100%). Adding positive results of follow-ups to biopsies and comparing them with cytology illustrated acceptable sensitivity and specificity of this method(sen: 73%, spec: 83.5%, PPV:91.6%, NPV:50%). The results of this study indicate that brushing cytology is a suitable method to diagnose periampullary lesions in comparison with biopsy or follow-up(P<0.05).

Parapharyngeal and infratemporal masses are rare head and neck tumors that constitute about 0.5% of all of them. To assess the distribution of infratemporal and parapharyngeal masses, this study was carried out in ENT department of Hazrat Rasoul Hospital as a sample of Iranian population. In this retrospective study, we evaluated parapharyngeal and infratemporal tumors in Hazrat Rasoul-e-Akram Hospital in Tehran, from Jan. 1991 until Jan. 2001. The sampled population was 39 patients suffering from these masses. The mean age of the patients was 44.9 years. The most frequent complaint was asymptomatic neck mass(69.2%). The findings reported masses of these areas in descending order of frequency: salivary gland tumors(51.2%-esp. PMA: Pleomorphic Adenoma), paraganglioma (15.3%), schwanoma (7.7%), angiofobroma and lymphoma. All patients had been evaluated by imaging techniques, the most common of which was contrast-enhanced CT-scan. All patients except one case of NHL(Non-Hodgkin Lymphoma) were candidates to be operated on and with the exception of 4 cases, surgery via transcervical approach(with or without a combined approach) was done on them.

Osteopenia is a common complication in renal transplant recipient resulting to increased rate of bone fracture especially in spine, ribs and hip. The purpose of this study was to examine the degree and pattern of bone loss in the first three months after renal transplantation. This observational study was carried out on 10 renal transplant recipients(4 males, 6 females) with the age range of 13 to 57 years old. The immunosuppressive therapy consisted of cyclosporine, azathioporine and steroids. In all patients bone mineral density(BMD), Tscore and Zscore were measured at lumbar spine(L2-L4) and femoral neck a few days before transplantation and 3 months post renal transplant. The results of BMD, Tscore and Zscore in lumbar spine before and after transplant was(1.024±0.15, 0.99±0.20), (-1.32±1.48, -1.86±1.69) and (-1.11±1.50, -2.1±1.146, P<0.025), in femoral neck(0.89±0.09, 0.86±0.09, P<0.01), (-1.02±0.883, -1.32±0.86) and (-0.69±0.95, -1.08±0.79, P<0.04) respectively. Three months after renal transplantation, BMD and Zscore in femoral neck and Zscore in lumbar spine decreased significantly.

Congenital Adrenal Hyperplasia(CAH) includes a group of inherited diseases which are caused by enzyme defects in the synthesis of cortisol from cholesterol. It manifests itself in different forms like ambiguous genitalia, adrenal crisis in infants, precocious puberty in children, hirsutism, oligomenorrhea and infertility in adults. Although CAH is one of the most common endocrine congenital diseases, some patients are not identified, or may even die of adrenal crisis without being diagnosed. Considering the prevalence and diversity of clinical manifestations of CAH and numerous diagnostic problems, the objective of this study is to identify and determine the frequency of clinical manifestations and different types of CAH in order to introduce them to medical community and facilitate diagnosis of CAH and its early treatment. In this observational-descriptive study, we observed the frequency of clinical manifestations and different types of enzyme defects in patients with CAH who had referred to the institute of endocrinology and metabolism during the period of 10 years from 1370-1380. 19 patients including 11 girls(58%) and 8 boys(42%) were under examination. Patients were categorized into 3 groups infants(5 boys and 5 girls), children(3 boys) and adults(6 girls). These patients had manifested ambiguous genitalia and/or adrenal crisis, premature puberty, acne and hirsutism respectively. The average age of girls and boys with salt loss type of CAH at the time of diagnosis was 17.3 and 43.5 days respectively. The most common clinical manifestations were ambiguous genitalia(42.1%), ambiguous genitalia and adrenal crisis(31.5%), acne and hirsutism(31.5%) and peripheral precocious puberty(15.7%). The incidence of different types of enzyme defects was 14 patients(73.7%) with 21-hydroxylase deficiency, 4 patients(21%) with 3-beta hydroxysteroid dehydrogenase deficiency and 1 patient(5.2%) with 11-hydroxylase deficiency. Congenital Adrenal Hyperplasia(CAH) should be taken into consideration in infants with ambiguous genitalia, hyponatremia and hyperkalemia and also in every boy with peripheral precocious puberty. The diagnosis of CAH is established in girls more and earlier than boys. The most common types of CAH in our patients were 21-hydroxylase deficiency, 3-beta hydroxysteroid dehydrogenase deficiency and 11-hydroxylase deficiency respectively. Therefore, for an early diagnosis and prevention of infants death(especially boys) due to adrenal crisis, incorrect gender assignment and inappropriate virilisation, neonatal screening and greater awareness of medical community about the disease seem to be necessary.

Non-traumatic pneumothorax is mostly caused by the disruption of small and large bulla in lungs. Approximately 80% of the patients with spontaneous pneumothorax are thin, tall young men without the history of respiratory disorders. In patients over 40 years old there is a noticeable lung disease, mostly emphysema in smokers. Catamential pneumothorax is a rare phenomenon that commonly occurs during the first days of mensturation in women about 30 years old and is always in the right side of thorax. The treatment of spontaneous pneumothorax includes aspiration by simple needle, thoracostomy, thoracotomy or thoracoscopy procedures, resection of the zone and suture of the zone of leakage, and even in advanced cases pleurectomy procedure. But we must always choose the simplest treatment for spontaneous pneumothorax and avoid surgery except in specific cases. Nowadays in cases requiring surgery, the method of video assisted thoracoscopy(VATS) is used to treat cases of primary spontaneous pneumothorax. In this study we assessed the frequency of varied treatments of spontaneous pneumothorax in an educational medical center as well as the necessity of using modern endoscopic methods and tools. In this retrospective and observational cross-section study, a census method for gathering information was used. The obtained data was analyzed descriptively via EPI6 software. The subjects were 17 patients with a mean age of 33.9 years. 76% of spontaneous pneumothorax cases occurred at rest position and 42% of them were during activity. There was a collapse of more than 50% of lungs in 52.94% of patients. The most commonly used method of treatment was using chest tube in 70.56% of cases. According to this study, 76% of spontaneous pneumothorax cases happened at rest which is similar to previous reports. Noting the frequency of the collapse of more than 50% of lungs, the commonest treatment was using chest tube which is in line with other studies.

Chronic obstructive pulmonary disease(COPD) is one of the most common causes of emergency department or hospital admissions in our country. COPD is a chronic progressive inflammatory disease that affects the elderly. Considering these facts, COPD is taken into account as a major cause of disability in developed and developing countries. The purpose of this study is to evaluate high dose(7.5mg) Albuterol effects versus low dose(2.5mg) Albuterol ones on respiratory indices such as peak expiratory flow rate(PEFR), arterial blood gas(ABG) criteria, and dyspnea in exacerbated COPD patients. In order to shorten admission course of these patients, we planned a clinical single-blind trial study. In this study, the respiratory effects(spirometric indices, ABG criteria, levels of dyspea) of different doses of nebulized Albuterol were evaluated in two study groups in Rasoul-e-Akram Emergency Department from 2003. Available sampling was done and 120 cases were enrolled in the study. Then two study groups were designed single-blindly and sixty(60) cases were assigned to each group. Data was analyzed by parametric tests(student t-test,paired t-test). No statistical difference was observed between means of variables of two geoups pre-and post intervention.(PV=0.173 for Age, PV=0.378 for PCO2, PV=0.237 for PH, PV=0.668 for HCO3, PV=0.096 for PaO2, PV=0.207 for PEFR, PV=0.094 for dyspnea). Although our findings confirmed the effectiveness of β -agonist drugs in treatment of COPD patients, higher doses of drugs do not necessarily mean their more efficacy.

Osteoprosis is the most frequent underlying cause of femoral neck fractures in the eldery. These fractures weigh heavily on health care budgets. An accurate and exhaustive evaluation of these costs would be a major contribution to health economic studies evaluating the efficiency of screening and preventive strategies. However, in Iran, very little data on the financial burden of hip fractures is available and no updated estimate has been made. The goal of this paper is to estimate the direct medical expenditures associated with hip fractures for each patient. This cross-sectional study has been based on concerning 200 patients with hip fractures who referred to orthopedic clinic of Sina Hospital during the years of 1377-1382. For each patient, we registered an exhaustive and detailed list of health care services as well as inpatient costs, the kind of traumas and fractures, age, sex, marital status, the kind of prostheses and osteosynthesis materials, patient’s past medical history, the history of taking any medication and smoking, bone fracture history in the family, days of hospitalisation and their health state after the end of hospitalisation. Women represented 51% and men 49% of the patients. The distribution of fracture types in our study was 72% femoral neck and 28% trochanteric. The most common osteosynthesis material used in operations was dynamic hip screw(41.5%). 2% of the patients died before the end of hospitalisation. The average length of hospitalisation for each patient was 16 days with a mean age of 60 years.(The mean age for the patients over 50 was calculated to be 71). The mean inpatient cost for each patient with a hip fracture was 4933320 Rials($588). With a mean cost of 4933320 Rials($588) for each patient with a hip fracture — total cost of 226932720000 Rials in a year — proximal femoral neck fracture should be considered a major health economic problem, and appropriate measures should be clearly defined to avoid this health problem.

Being as one of the common problems in neonatal period especially among preterm infants, jaundice can be found among 60-80% of them. One of the traditional drugs used for newborns’ jaundice is shirkhesht(bot.purgative manna) which has been widely used in Iran & Afghanistan. The purpose of this study is to evaluate the effect of shirkhesht on newborns’ indirect hyperbilirobinemia. In this prospective double-blind assessment, 104 newborns suffering from indirect hyperbilirobinemia in the newborn intensive care unit of Imam Reza Hospital, Mashhad University of Medical Sciences, were selected and then divided into two groups namely case and control groups including 50 and 54 subjects respectively. In this study there was no significant statistical difference in bilirobin levels of both groups when they were admitted into the hospital. This difference was also not significant after treatment. The average length of admission and phototherapy for case and control groups was 39.12 hours and 35.11 hours respectively which was not statistically significant(p=0.80). According to the results of this study, using 6 grams (0.21 ounces) of shirkhesht is not more effective than placebo in the treatment of neonatal jaundice.

Candida genus comprises diverse species of yeast and yeast like fungi that some of them especially candida albicans are parts of the normal flora of human body. They are opportunistic parasites that cause diseases. There are currently limited effective drugs against those fungi. Hence this may lead to the emergence of resistant species. The aim of present study was evaluation of antimycotic effects of nystatin, clotrimazole and miconazole against candida species. Present survey is an experimental study that has evaluated antifungal effects of nystatin, clotrimazole and miconazole on candida species which were isolated from patients. These drugs were applied to 30 cases of candida albicans and 30 of other species of candida. In addition, resistant and sensitive species of candida were used. Broth and Agar mediums were used to culture the mentioned fungi and Minimum Inhibitory Concentration(MIC) was determined for each drug. Results showed that candida albicans species were more sensitive to clotrimazole and nystatin than to miconazole(P<0.01). Other candida species were more sensitive to all these drugs as compared to candida albicans(P<0.01). No significant difference was observed between the MIC averages of two methods. The MIC averages of nystatin, clotrimazole and miconazole for candida albicans were 2.2µg/ml, 2.6µg/ml and 18µg/ml respectively. The mean MIC of the mentioned drugs for other candida species was 0.81µg/ml, 0.56µg/ml and 1.2µg/ml respectively. Our results suggest that determination of species and doing sensitivity tests before any treatment are required and important and on the whole, nonalbicans species were more sensitive than albicans species in the presence of the above drugs.

Epidemiologic studies have shown that infectious agents such as chlamydia pneumonia and helicobacter pylori are linked to ischemic heart disease(IHD). Other studies believe that raised plasma fibrinogen level can be considered as a possible link between H.Pylori infection and IHD. This analytic cross-sectional study was conducted on 261 patients. 131 hospitalized patients were selected from CCU ward as a case group and 130 hospitalized patients from surgery and orthopedic wards of Iran university of medical sciences hospitals as a control group. HP infection, serum fibrinogen level and cardiovascular risk factors were determined in both case and control groups. T-test, chi-square test, general linear model and logistic regression model were used for data analysis. H.pylori infection was not in association with IHD and high fibrinogen level was not associated with IHD in cases with H.pylori infection. Although there was not a link between H.pylori infection, fibrinogen level and IHD in this study, some authors believe that the probable mechanism of this association is that under stimulation by the bacterium mononuclear cells induce a tissue factor-like procoagulant activity that, through the extrinsic pathway of blood coagulation, converts fibrinogen to fibrin.

Kawasaki is an acute multisystemic disease with high fever in infants. Kawasaki is an unknown vasculitis that involves small and moderate size arteries especially coronary vessels. Clinical manifestations of Kawasaki are nonspecific and consist of persistant fever for more than 5 days, maculopapular skin rash, mucosal inflamation, bilateral conjunctivitis, neck lymphadenopathy, erythema and desquamation of feet and hands. A 21-year-old woman was admitted with high fever, skin rash, conjunctivitis, fissure of lips, erythema and desquamation of feet, mucosal inflamation and neck lymphadenopathy which all had started 4 months ago. Laboratory examination showed anemia, CRP(C-Reactive Protein):3+, ESR (Erithroid Sedimant Rate):100-140mm/h but HIV(Human Immunodeficiency Virus), HBV(Hepatitis B Virus), HCV(Hepatitis C Virus), B/C (Blood/Culture), U/C(Urine/Culture), PPD(Purified Protein Degradative), wright, widal, anti ds DNA, ANA(Anti Nuclear Antibody), antitoxoplasmosis were negative. Echocardiography was normal. Imaging examination including spiral CT-scan of lungs, abdomen and pelvic were normal but sonography detected hypoecho mass compatible with submandibular adenopathy. Biopsy of neck adenopathy and skin lesion confirmed reactive adenitis and vasculitis respectively. Therefore, Kawasaki disease was confirmed by ruling out the possibility of other similar diseases. Although Kawasaki disease was often seen in infants, in adults with persistant fever, skin rash, adenopathy, bilateral conjunctivitis and mucosal inflamation, Kawasaki should be considered after ruling out other diseases.

Recent accumulated evidence suggests that prolactin is an important immunomodulator and might have a role in the pathogenesis of systemic lupus erythematosus(SLE). Stimulating immune system, this peptide hormone increases the severity of SLE. The purpose of our study was to assess the frequency of hyperprolactinemia in women with SLE and to evaluate its correlation with the disease activity. This descriptive-analytical study was carried out on 35 women with SLE (patient group) who had been randomly selected and 60 healthy cases(control group) who matched patients in terms of sex and age. Disease activity was assessed by using SLE Disease Activity Index(SLEDAI). Patients with a score above 10 were considered active. In both groups, prolactin levels were determined by Immunoradiometric Assay(IRMA). Hyperprolactinemia could be seen in 28.5% of patient group and 3.3% of control group(P<0.05), which indicates a significant difference in the incidence rate of hyperprolactinemia in the two groups. Mean prolactin level in patient group was significantly higher than this level in control group(770±860 versus 341±335, P.value=0.0078). Patients with active disease showed a trend toward higher mean prolactin levels than inactive patients. SLE was active in 90% of hyperprolactinemic patients, while in normoprolactinemic patients active disease was found only in 36% of them. A statistically significant correlation was found between prolactin levels and SLE disease activity index.

Turner syndrome is a chromosomal abnormality which encompasses multiple disorders. High prevalence of thyroid diseases has been described in patients with TS but the extent of this association is controversial. The purpose of this study was to determine the prevalence of thyroid disorders in patients with TS in the endocrine center of Iran university of medical sciences. In this cross-sectional, descriptive and prospective study, serum samples from 35 patients with TS were assayed for thyroid function tests and thyroid antibodies within one year. Thyroid examination was done as well. Hypothyroidism was observed in 44% of the cases and one patient had Grave’s disease. Autoimmunity was detected in 69% of patients. Women with TS are exposed to an increasing risk of developing thyroid dysfunction ten times more than normal population and all of them should undergo annual TSH(Thyroid Stimulating Hormone) checkups.

Dendritic cells(DCs) play an important role in directing immune response toward TH1(T-Helper 1) or TH2(T-Helper 2). These cells may induce distinct cytokine patterns in different tissues. So the pattern of cytokine induction by liver and spleen DCs may differ from each other. To investigate the difference between immune responses in the liver(as a non-lymphoid organ and tolerogenic tissue) and the spleen(as a lymphoid organ and an immunogenic tissue), we analyzed the function of spleen and liver DCs in the induction of TH1 and TH2 immune responses. DCs were isolated from the liver and spleen of normal C57BL/6 mice by enzymatic digestion and nycodenz centrifugation gradient. Isolated DCs were pulsed with a proper concentration of myelin oligodendrocyte glycoprotein peptide(MOG35-55). About 6 × 105 pulsed DCs from liver and spleen were injected to the footpad of two different groups of mice. Unpulsed DCs were injected to the control group. After 5 days, mononuclear cells(MNCs) of the poplital lymph nodes were isolated from immunized mice and cultured in the presence and absence of MOG35-55 for 96 hours. The supernatant of the cultured cells was collected and the amount of produced cytokines(IL-10: Interleukin-10 and IFN- γ: Interferon gamma) was measured by ELISA(Enzyme-Linked Immunosorbent Assay). Our findings showed that IL-10 and IFN- γ production in mice immunized with DCs pulsed with MOG35-55 was significantly higher than the control group(p=0.004). There was no significant difference in IFN- γ production between mice immunized with liver DCs and those immunized with splenic DCs, but the amount of IL-10 production in the first group was higher than the second group(p=0.01). It seems that higher IL-10 production induced by liver DCs may be one of the main factors in down regulation of immune responses in this organ.

Melissa officinalis(MO) is a herb which grows in different parts of Iran. In previous studies, it was reported that 10% ethanolic extract of the aerial parts of MO, i.e. leaf and stem, could bring about antinociceptive, anticonvulsive, and sedative effects on rats. This study was designed to evaluate anxiolytic effects of different doses of the aqueous decoction extract of MO and also the role of opioid receptors. The subjects of this study were ninety-three male mice whose weights ranged from 25-30gr. Different doses of the extract(5, 10, 25, 50mg/kg-IP) were injected to four separated groups of ten(case groups) and water(10ml/kg-IP) was injected to the control group including 10 mice. A pilot study was also carried out on 15 mice. In order to evaluate the role of opioid receptors on anxiolytic effects of the aqueous decoction extract of MO, the rest of the subjects were divided into 4 groups including seven each. Then Naloxone(2mg/kg) and the extract of MO(5 mg/kg) were injected to them. To increase their activity and curiosity, animals were put inside a box with black walls for 5 min. Then animals were transfered to the elevated plus maze at adjusted intervals and their anxiety reactions including enterance numbers and time spent in open arm were recorded in 5 min. Results indicated that injection of 5mg of the extract reduced anxiety reactions. In comparison to control group, case group animals had both more numbers of entrance and more time spent in open arm(P<0.01). However, higher doses of MO reduced entrance numbers and also time spent in open arm, that is, they had hypnotic effects. Naloxone reduced anxiolytic effects of low doses of Melissa officinalis extract(5mg/kg). It is concluded that the aqueous extract of MO plays an important role in fear, anxiety and drowsiness so that the lowest dose(5mg/kg) produces anxiolytic effects and higher doses exert hypnotic ones. It is also probable that it works through opioid receptors.

This study was carried out to examine the relationship between the scores of various food groups and the adequacy of specific nutrients in Tehrani women. In this cross-sectional study, 286 females aged 18 and over from district 13 in Tehran — chosen as representatives for Tehrani female population — participated. We assessed their food intake through a validated semi-quantitative food frequency and two 24-hour recall questionnaire. Two different dietary diversity indices named dietary diversity score (DDS) and food variety score were used. Mean adequacy ratio(MAR), i.e. the mean ratio of intake to recommended amount of 12 nutrients and their calories, was calculated as an indicator of nutrient adequacy. The mean ± SD of age and body mass index was 41±13 years and 27±4 kg/m2 respectively. The mean of DDS was measured to be 6.11± 1.02. DDS correlated with MAR(r=0.4, p<0.05), the NAR (Nutrient Adequacy Ratio) of Thiamine(r=0.3, p<0.05), vitamin A(r=0.4, p<0.05), Calcium(r=0.4, p<0.05), Phosphorus(r=0.4, p<0.05) and total intake of fat(r=0.3, p<0.05). Variety of whole grains correlated mostly with the NAR of protein(r=0.3, p<0.05). Variety of vegetables and fruits had the highest correlation with the NAR of vitamin C(r=0.3, p<0.05) as well as vitamin A(r=0.3, p<0.05). In the forth quartile of variety score of food groups, the intake of most macro-and micro-nutrients made the highest amount. Variety score of meat and milk was the most important predictor of MAR. Variety of different food groups is a useful indicator of specific nutrients adequacy. Hence to determine the adequacy of a specific nutrient, the variety score of specific food groups can be considered.

Subclinical hypothyroidism is defined by an increased serum TSH(Thyroid Stimulating Hormone) level in the presence of normal concentrations of circulating thyroid hormones and may be a predisposing factor for depression and psychomotor disorders. The aim of this study was to evaluate the effcts of L-thyroxine replacement on anxiety, depression and other neuropsychiatric aspects in patients with subclinical hypothyroidism. twenty-seven patients(19 females and 8 males) ranging from 17 to 61 years old(mean: 38±13.5 years) with basal serum TSH levels of 5.0-16.3 mu/l(mean: 8.4±5.2mu/l) and normal FT4I were enrolled. After being matched for age, TSH level and antithyroid antibodies, patients were randomly allocated into two treatment groups, LT4(Levo Thyroxine) and placebo including 13 and 14 cases respectively. In the LT4 group, dosage was titrated to achieve a serum TSH level between 0.3-3.5 mu/l. Intelligence Quotient(IQ) was assessed using Raven test, memory and psychomotor speed through Caughlan test, anxiety and depression via HADS(Hospital Anxiety Depression Scale) before and after treatment. Patients had follow-up visits for 11-14 months(mean: 12±0.6 months). Ten patients in the LT4 group and 13 in the placebo group completed the study. Mean TSH levels changed from 9.6±7.1 to 1.3±1.2mu/l(P<0.002) and from 7.6±3.1 to 18±15.8mu/l(P<0.024) in the LT4 and placebo groups respectively. No significant difference in IQ, recent and late memory, anxiety and depression was observed in both groups before and after intervention. There is not obvious relationship between subclinical hypothyroidism, cognitive disorders and depression. Further studies to evaluate these problems are recommended.

During two recent decades, patient advocacy has been an arguable topic in nursing profession. Although there is a common consensus on patient advocacy as a nurse’s role, some evidence points to difficulties that nurses encounter to advocate patients. Since recognition of barriers and facilitators is the first step to promote the role of advocacy among nurses, this paper investigates the factors influencing the utilization of advocacy. The present study was conducted through grounded theory method. Participants were 24 Iranian nurses(including clinical nurse, headnurse and supervisor) who were working in Rasoul-e-Akram Hospital in Tehran. Semi-structured interview was used for data gathering. All recorded interviews were transcribed verbatim and constant comparative analysis was used according to Strauss and Corbin method. Through data analysis, several main themes emerged to describe the factors that hindered or facilitated patient advocacy. The nurses in this study identified powerlessness, lack of support, lack of law and code of ethics, limited communication, physicians’ leadership tendencies, risk of advocacy, loyalty to pers, lack of motivation and insufficient time to interact with patients and families as barriers to advocacy. Regarding factors that facilitated nurses to act as a patient advocate, it was found that the nature of nurse-patient relationship, recognizing and paying attention to patients’ needs and conditions, nurses’ responsibilities, physician as a colleague and nurses’ knowledge and skills could be influential on adopting above mentioned role. Considering the current condition and mentioned barriers, participants believe taking advocacy role is difficult for nurses. Therefore, they decide and act as a patient’s advocate in any situation with regard to patient’s needs and the status of barriers and facilitators. However in most cases, they cannot act at optimal level, but rather they accept only what they can do, which is called in this study “limited advocacy”. It can be concluded that advocacy is contextually complex, controversial and a risky component of nursing practice. Further research is needed to determine the correlation that might exist between identified barriers and facilitators and the use of advocacy. It also seems to be necessary to organize attempts to eliminate barriers and strengthen facilitators efficiently, so that nurses will perform their supportive roles in the national health care system.

The effect of simultaneous US(Ultra-Sound) with stretching, however, has not been compared with other manual stretching techniques like PNF(Proprioceptive Nueromuscular Facilitation). Furthermore, the permanency of the two techniques has not been investigated, either. This study was a randomised clinical trial on 20 non-athlete and healthy women. The subjects were between 18-26 years of age with habitual bilateral hamstring shortness(SLR). They were randomly assigned to two groups consisting of 10 subjects each. The first group received simultaneous US with stretching and the second one received hold–relax treatment for 4 weeks three times per week. Before and immediately after treatment period, these variables were measured: passive and active SLR, passive and active knee extension, pelvic tilt and lumbar lordosis. After the last session of treatment, all the variables were followed up every week, for 4 weeks. Both groups showed a significant improvement in all variables except lumbar lordosis. In comparison to hold-relax technique simultaneous US with stretching showed greater effectiveness. Moreover, this efficacy was significant in variables of left leg SLR, left knee extension and pelvic tilt. Comparing the permanency of the two treatment techniques, it was revealed that the treatment results of PNF were maintained up to the end of the 4th week of follow-up and didn’t decrease significantly, while those of simultaneous US with stretching showed a significant decrease from the first week of follow-up. These findings suggest that simultaneous US with stretching and hold-relax are effective techniques for gaining acute treatment results and more stable results respectively.

Diabetes is one the most common non-communicable diseases and a serious health problem in the world. Nowadays, keeping on a specific diet has an important role in type 2 diabetes. One of the basic principles in prevention of complications in these patients is promotion of patients’ knowledge level with regard to treatment method, signs, complications and nutrition. In order to plan nutritional education for diabetic patients, having basic information of their knowledge is necessary. The goal of the present study was to determine knowledge level of type 2 diabetic patients who attended endocrine clinic of Rasoul Hospital. By a cross-sectional study, 160 known type 2 diabetic patients who had referred to endocrine clinic of Rasoul Hospital were assessed through convenience sampling. Method of collecting data was a questionnaire with 2 parts filled out by interview. In part one, demographic characteristics(age, sex, literacy, duration of disease,. ..) and in part two, nutritional knowledge level of patients was studied. SPSS version 11.5 was used for data analysis. Considering score for questions, knowledge with regard to any subgroup of diet and total knowledge as a continuous variable was determined. T-test, correlation, and ANOVA tests were used to compare knowledge score between demographic variables. In this study, 160 type 2 diabetic patients were studied. About 51%(81 subjects) were women and 49%(79 subjects) were men. Mean of age was 61(±13). 26.3% and 57.5% took insulin and pills respectively. Mean of diabetes duration was 10.5(±6.4) years. 32% did not use any specific diet. Average score of knowledge with regard to types of dietary subgroups was: 15.8 out of 21 for bread and cereals, 14.7 out of 21 for meat, 12.2 out of 20 for dairy products, 11.5 out of 21 for lipids, 11.4 out of 15 for vegetables, 11.2 out of 17 for fruits, and 15.3 out of 21 for others. Overall mean of knowledge was 92(±12) out of 130. There was a significant positive association between nutritional knowledge and literacy. Also, there was a significant negative correlation between age, duration of disease and their knowledge. Patients with family history of diabetes had significantly more knowledge than others. Nutritional knowledge level of diabetic patients in this study was average. Considering this result, control of diabetes complications with proper education can be useful.