مجله دانشگاه علوم پزشکی شهید صدوقی یزد
سال چهاردهم شماره 4 (پیاپی 57، زمستان 1385)

Breast Cancer is one of the most important fatal cancers in women. The mean age of breast cancer in Iran is 48.8 years which is very lower than other countries. Selenium can play an important role in reduction of cancer in several ways, for example selenium increases immunity response and protects cells from oxidation of free radicals and also decreases carcinogenic metabolites. Breast cancer is one of the most important cancers in our country because its incidence is very high and the mean age of patients is very low. Different studies have shown the benefits of selenium in prevention of cancer and since many years selenium has been used as a dietary supplement in advanced countries. Several studies regarding relationship between selenium levels and breast cancer have been done in different countries. We therefore planned a study to evaluate serum selenium levels in breast cancer patients and compare them with a healthy control group. We selected 45 patients younger than 48 years old and 33 patients older than 48 years old who had not yet received any therapy (surgery, chemotherapy, etc) for their cancer as a case group and 46 healthy people who were matched with the patients as a control group and included 23 persons younger and 23 persons older than 48 years old. From each participant, 5cc blood was derived and in several stages, serum selenium levels were evaluated using atomic absorption technology. Data about type of cancer, stage, grade, IHC and cigarette smoking were also collected. The mean Se level was 161.20 μg/l (SD=46.27 μg/l) in the patients and 189.13 μg/l (SD=48.75 μg/l) in the control group that was statistically significant (P<0.001). The mean Se level in younger patients (< 48 years old) was 169.35 μg/l (SD=47.34 μg/l), while that in older patients (>48 years old) was 155.39 μg/l (SD=46.68 μg/l) that was lower than the control groups. Difference in serum selenium levels between patients and controls in the older group was significant (P=0.007), but in the younger group, it was not statistically significant (P=0.23). Prescription of selenium as a dietary supplement may have a protective role against development of breast cancer, particularly in older ages and widespread studies need to be performed to prove this postulation.

According to the results of studies from different parts of the world, malignancies in children are rare. Despite this fact, malignant neoplasms remain the second leading cause of death in children after accidents. ALL, CNS tumors and lymphomas are the most common malignancies in children. They account for approximately more than 50% of malignancies and occur more frequently in boys than girls. There are 2 peak incidences early childhood and adolescence in the < 19 years old age group. The distribution of malignant diseases in the pediatric age group on the basis of age and sex has been evaluated in this study. This descriptive – observational study was done by cross- sectional method from 1998 till 2003. We evaluated the frequency and distribution of malignant diseases in children younger than 10 years old according to age and sex in Yazd. The files of children whose malignancy was confirmed by the pathological reports were studied and data related to age, sex, type of malignancy and time of admission was entered in the questionnaires. Frequency and distribution of malignant diseases in male children < 10 years old is 60.4%which is more than females (39.6%). It is most frequent in children aged 6-7 years and least common in children<1 years of age. ALL has the highest frequency of distribution, while histiocytosis has the lowest. The other malignancies following ALL are as follows: Hodgkins lymphoma (8.5%), Neuroblastoma (8.5%) soft tissue sarcoma (7.5%) bone tumors (6.6%), Wilm’s tumor (6.6%), Germ cell tumors (3.8%), AML (2.8%), Retinoblastoma (1.9%), malignant neoplasms of the liver (1.9%) and Histiocytosis (0.9%). The frequency and distribution of malignant diseases in the pediatric age group is more common in males than in females which is the same as other studies. The frequency and distribution of malignant diseases is the most in children aged 6-7 years that is different from other studies. ALL is the most prevalent malignant disease in the pediatrics age group followed by Hodgkins lymphoma and CNS tumors.

The differential diagnosis of idiopathic and syringomyelia associated scoliosis is important because corrective surgery for scoliosis associated with syringomyelia prior to management of syringomyelia can be dangerous. There are important imaging indicators for diagnosis of syringomyelia associated with scoliosis. A few of these indicators have been assessed in our study. A retrospective descriptive study including 38 patients with both scoliosis and syringomyelia was performed at the Shafa Yahyaeian center. Standard scoliosis series radiographs and MRI of all patients were studied. The type of scoliosis, location and magnitude of deformity, kyphosis or lordosis in the sagittal plane, location and size of syrinx were assessed. Thoracic kyphosis was present in 94.7% of patients. 37% of patients had scoliosis with convexity to left. Arnold –chiari malformation was present in 36% and cord tethering in 21% of patients. The locations of syrinx were as follows: 47.4%cervical, 44.6 thoracic, 2.7% lumbar and 5.3% were holocord. Kyphosis, abscence of lordosis in sagittal plane, progressive scoliosis and scoliosis with convexity to left are atypical findings and could be indicators of the presence of syringomyelia. If these indicators are present, a diagnosis of idiopathic scoliosis should be made with caution.

Atherosclerotic stenosis of carotid territory is the most common cause of ischemic stroke. A higher frequency of intracranial arterial stenosis has been reported in Africa and the Far East. 304 geriatric ischemic stroke patients admitted in Mackenzie hospital, Canada and the same number of geriatric ischemic stroke patients with similar sex ratio admitted in Valie-Asr hospital, Iran during 2003-2005 were enrolled in a double center and prospective study. Diagnosis of brain infarction in the carotid territory was made by stroke neurologists. All of the patients underwent transcranial and carotid doppler studies. Doppler studies performed were based on the standard method by a neurosonologist. Fisher exact test served for statistical analysis and p<0.05 was declared significant. In Iranian group 71 patients (23.3%) and in North American group 83 patients (27.3%) had extracranial ICA stenosis without a significant difference df=1, p=0.305. Sever ³70% Extracranial ICA stenosis was found in 14 Iranian patients (4.6%) and 23 North American patients (7.5%) without a significant difference. df=1, p=0.17. In Iranian group, 14 cases (4.6%) and in North American group 5 cases (1.6%) had intracranial stenosis in carotid territory which was significantly different df=1, p=0.038. Mixed intracranial and extracranial carotid territory stenosis was present in 2 Iranian and 1 North American patient. Atherosclerotic stenosis of intracranial branches of carotid territory is more common in Iranian than North American populations.

The rate of tooth decay and periodontal diseases today is still high, regardless of progress in oral and dental hygiene. The traditional toothbrush or chewing stick called "Miswak" has been used since ancient times. Many significant effects of Miswak such as antibacterial, anti-caries and antiperiopathic effects have been recognized today. Tooth care is a very important issue and both prevention and treatment of dental caries could be very helpful in maintaining good personal health. In this research, the efficacy of natural toothbrush or Miswak in prevention of dental caries was investigated and compared with the efficacy of ordinary toothbrush and toothpaste. Miswak was introduced for preventing dental caries by the Holy Prophet Mohammad (S.A.W) 1400 years ago and has been used since then in many Islamic countries. In this research, the efficacy of Miswak in prevention of dental caries was investigated and compared with the efficacy of ordinary toothbrush. This analytical and clinical trial was performed in a high school student population (girls and boys) in the city of Yazd, Iran in 2001-2002. Twelve high schools were randomly chosen. From these high schools, 380 second year students (190 cases and 190 controls) were enrolled and their teeth condition such as the number of decayed, missing and filled teeth (DMF) were recorded in a specific questionnaire. The degrees of decay in the decayed teeth were recorded as well. Then, Miswak sticks were distributed to the case group and required dental training was given to both groups. After one year, the examinations were repeated and findings recorded in the same questionnaires. For analyzing the data, one-way variance analysis, Chi square, Paired t-test and two variable analyses were used. At the start of the study, there were no significant differences between the two groups (case and control) with regards to their dental condition and the frequency of brushing of their teeth (p-value=0.162). In addition, there were no significant differences in DMF between the two groups. The prevalence of dental caries was slightly less in the control group (0.89 times of this in the case group). The data collected at the end of the study showed a significant increase in DMF in the control group (P-value=0.000). There was a 55% increase in the rate of dental caries in the control group as compared to the case group (0.89 before the study and 1.38 after the study). The risk of dental caries for each tooth in the control group was 9.35 times more than the case group (9.14% and 0.98% respectively). Despite the same training and similar intention in brushing of teeth and the same dental situation in two groups at the start of the study, rate of dental caries which was primarily more in the case group in the beginning was lesser than the control group at the end of this study. This might be as a result of the antimicrobial effects of Miswac. A study with more cases and longer time period is needed to prove this suggestion. Our data shows the need to encourage the use of Miswac in the general population, especially in developing countries for its effectiveness in the prevention of progress of dental caries.

Honey has been one of the most complete and a delicious edible since ages and there has been a special consideration towards it in Islam. In the Holy Quran, there is a full chapter named “The Bee (Nahl)” and there is a verse in it as follows: “And your lord revealed to the bee saying make hives in the mountains and in the trees and in what they build, then eat of all of fruits and walk in the ways of your lord submissively. There comes forth from within it a beverage of many colors, in which there is healing for men, most surely there is a sign in this for a people who reflect.” (2) Honey has been used traditionally in medicine throughout history, for healing chronic wounds resistant to antibiotics and various kinds of burns. Because honey has low humidity, high osmotic pressure and pH, it causes stasis of growth of infectious agents and a sterile layer on sorts. A former survey showed that honey contains 20 types of sugars, 8 types of vitamins, 11 types of mineral substances,16 types of amino acids, a large of enzymes and so on. In this study we surveyed the properties of honey from the Islamic point of view and its effects on cutaneous leishmaniasis wounds in BALB/c rats in the laboratory. Sufficient natural honey from Golpayegan, a city in Isfahan province renown for its natural, good quality honey and ointment Paramo-U (made in Iran) were obtained. 30 BALB/c mice were infected with the parasiteLeishmania(L)major[MRHO/IR/75/ER] (Parasitology Dept on Faculty Medicine in Tarbiat Modares University). They were divided into three groups Honey study group, Negative and Positive groups and as soon as the Leishmania lesion was obvious, weight of the mice and size of the lesion were measured in all by using Scale and Coliss(Mettler,Switzerland)weekly until the death of the last mouse in the Negative control group. The data was analyzed using SPSS software. The mean weight of the mice that received honey was not significantly different from the mean weight of the mice in the negative and positive groups. (p>0.05). But the mean wound size in the mice that received honey was significantly different from the mean wound measurement in the negative and positive controls groups (p=0.0001). When BALB/c mice are infected with Rural Cutaneous Leishmaniasis Leishmania(L) major [MRHO/IR/75/ER], it results in gradual loss of weight and increase in the size of the cutaneous lesion. If not treated, it develops into visceral leishmaniasis and ultimately death of the animal. Use of honey did not affect the weight significantly, but showed a significant decrease in the size of the lesions.

Implantation is one of the most important steps in ART cycles and it depends upon embryo and endometrial reception. Different protocols have been suggested for getting better endometrium. It seems estrogen increases the endometrial reception and pregnancy rate by inducing changes in the hormonal status. The aim of this study was to evaluate the effect of estradiol(E2) on luteal phase support and pregnancy rate in ART cycles. This prospective randomized study was done in Yazd at the IVF center from March until December, 2002. 68 patients who had undergone IVF or ICSI were enrolled in the study. Exclusion criteria was age>40, endometriosis and ovarian hyper stimulation syndrome. Induction ovulation protocol was long suppression with GnRH analogues.After embryo transfer, patients were divided in two groups randomly. Both groups received 100mg progesterone IM daily from the transfer day. Estradiol valerate 2 mg/day was added from the 7th transfer day to progesterone in Group I and continued if the BhCG became positive. Abortion and malformations were measured in all patients. Data analyzed with SPSS 11.0 and P value <0.05 considered statistically significant. Pregnancy rate in the 34 patients of estradiol group (group I) was 26.5%which was significantly higher than 11.8 %(4 cases) in the other group (Pvalue=0.034). Abortion rate was higher in estradiol group (3 cases), but there was no abortion in the progesterone group(P=0.119). 2 cases of major fetal malformations were observed in E2 supplementation group (P=0.246). E2 suplementation to progesterone in the luteal phase of ART cycles, especially in the long GnRH analogues causes higher endometrial receptivity and pregnancy rate.

The aim of the study was determination of the rate of bleeding, abortion, and ectopic pregnancy in three methods of treatment of infertility in patients with different ages and realization of the predictive value of bleeding result. This study was done prospectively on 252 female patients who had become pregnant through infertility treatment at the IVF ward of Imam Khomeini Hospital (Ahwaz). They were followed until the end of the 20 th week of pregnancy. Three groups of patients included 100 patients who had become pregnant through induction ovulation, 122 patients who had become pregnant through IUI and 30 patients who had become pregnant through IVF. Group I(Pregnant women via induction Ovulation): 37% had bleeding of which 35% were aborted. 63% did not have bleeding of which 11% were aborted and one EP was detected as well. 40% of the bleeding cases were younger than 30 years old and 29% of them were older then 30 years. The rate of abortion in this group was 20% and EP was 1%. The highest abortion rate was detected inpatients older than 36 years. Group II: Pregnant women via IUI: 37% had bleeding of which 31% had abortion. 63% didn’t have bleeding of which 10% had abortion and 3 cases had EP. The rate of abortion was 18% and EP 3% The rate of abortion increased with age but the rate of bleeding stayed constant. Group III: Pregnant women via IVF: 36% had bleeding of which 27% had abortion. 64% didn’t have bleeding of which 10.5% had abortion. The rate of abortion was 17% and EP 6.6%. All of them were greater than 30 years old. The rate of abortion and bleeding was not different in three groups and did not disagree with world’s statistics. The rate of EP in IVF group was higher than other groups but similar to world’s data (2-8%). The rate of bleeding didn’t increase with age. However, bleeding in all ages and groups could predict a 2.5-3 fold increase in the rate of abortion (PV =0.008, 0.014 and 0.05 in three groups). Also, 11% of all abortions were without bleeding.

Life expectancy at birth is an indicator of the mean age that a new born will live and this indicator is one of the criteria for evaluation of the heath, economic and social conditions. In this descriptive study, the life expectancy table of men and women in Yazd state is calculated on the basis of probability of death in different age groups during the years 1996 and 2003. In 1996, the life expectancy at birth of women and men were 74.5 and 71.9 years, respectively, while these figures in2003 were 79.5 and 71.9 years, respectively. In 1996, the most and the least life expectancies were in Taft and Mehriz, while in 2003, the most and the least life expectancies were in Mehriz and Yazd city. The results show that the life expectancies of both man and women has increased in Yazd and this increase was more marked in women than men.

Dimensional changes in acrylic patterns during laboratory process to fabricate casting are an important issue which could lead to many clinical consequences. Microleakage, lack of retention and fitness are few of problems which could be predicted in the case of dimensional changes in acrylic patterns. So, investigating the factors which could minimize the dimensional change is necessary. This study compares how different proportions of silica-sol and distilled water affect the dimensional changes in castings. This study was an experimental study wherein 30 specimens of acrylic patterns (Duralay) with similar dimensions were prepared and equally divided in five different groups and studied. Using extensiometer digital machine, the acrylic patterns were measured at three portions (length, coronal diameter and apical diameter) with accuracy of 10 microns. 1- The mean average of casting post length compared to changed acrylic patterns was statistically significant in pure distilled water group only. 2- The mean average of changes in casting coronal diameter did not demonstrate any significant differences compared to acrylic patterns. 3- The mean average of changes in casting post apical diameter compared to acrylic patterns using pure distilled water was significant. Because the least value in dimensional change was seen in ratio of silica-sol and distilled water, these ratios are recommended in fabrication of casting posts in order to have maximum accuracy and minimum micro leakage while building crowns and bridges.

Wide and universal distribution of Legionnaires’ disease, abundance of reports about its prevalence and Pontiac fever from different countries, unresponsiveness to conventional antibiotic therapy in a number of pneumonia patients and the lack of any report about it in Iran directed us to perform this project. Legionnaires’ disease is seen in sporadic and epidemic form and the most prevalent cause is legionella pnuemophilia which produces a severe disease in vulnerable individuals with a high fatality rate (50-80%). It is also considered as one of the most fatal nasocomial infections. In the present research for isolating and detecting of L. pneumophila, bronchoalveolar specimens of patients were examined using culture and DFA methods. After 3-5 days of incubation at 370C, and humidity (about 95%), thin, convex and round colonies with blue-gray to blue-green appearance developed. Slides were prepared from these colonies and stained with Gram and Gimenez methods which displayed Gram –negative, small successive coccobacilli. Statistical analysis were performed by a software (SPSS, v10) using Fisher exact and McNemar Tests. From among the 96 bronchoscopic specimens, 4 strains of Gram negative bacilli were isolated. Further investigations by means of biochemical tests and specific DFA revealed that they were L.pneumophila. In vitro drug resistance and sensitivity tests of Legionella showed that these bacteria were sensitive to Erythromycin, Riphampicin, Gentamycin, Doxycycline and Tubramicin, the sensitivity being more pronounced against Erythromycin than others. The above–mentioned organisms were resistant to Tetracycline and Ampicillin. The Fisher exact Test revealed that there is no correlation between frequency of L.pneumophila and the sex of patients (P value= 0.72). McNemar Test was performed and the results revealed that there is no significant difference between the results obtained by culture and DFA tests (P value= 1). L.pneumophila has no correlation with the sex of patients. According to the results obtained by McNemar test, DFA method can be used for rapid detection of L.pneumophila, although further studies with larger quantity of specimens need to be performed to substantiate results.

As there is a high prevalence of cutaneous Leishmaniasis in Iran, the problems and expenses for culture of the parasite are important. The effect of different types of blood human, cattle, sheep and goat on growth of leishmania tropica promastigote, L.major were examined and compared with rabbit blood. This study was preformed during 2001-2003 in Kashan. This analytical study was performed on promastigote L. tropica and L. major which was confirmed by the World Health Organization. The examination was repeated 10 times. The time of compatibility with culture medium, maximum and minimum growth based on decrease in number of active parasite as compared to the basic number at the time of culture were determined and judged statistically. The time of compatibility with culture medium was equal in all cases and it was about 1 to 3 days. With human, sheep and goat blood, maximum growth of parasite was reached in a shorter time period as compared to0 cow blood. The minimum growth in the blood of rabbit and cow was more than human, goat and sheep blood. The growth of 2 kinds of parasites in rabbit blood was more than human, goat and sheep blood (P<0.05), but it was similar to the amount of growth of these parasites in rabbit and cow blood. In places where it is difficult to have access to rabbit or cow blood, human B negative blood can be used.

Mitochondrial myopathy, lactic acidosis, and siderobastic anemia (MLA SA) syndrome is one of the newly reported mitochondrial diseases, seven cases of which have been reported. We report a child with inflammatory myopathy, sideroblastic anemia and lactic acidosis. The patient is a 8.5 year old boy with normal cognitive function suffering from chronic progressive weakness in lower extremities, inability to walk since four months and pallor. In paraclinical evaluation, sideroblastic anemia, mild lactic acidosis and elevated muscle enzymes were seen. Inflammatory myopathy (myositis) in muscle biopsy was detected as well. The patient was administered oral prednisolone, folic acid, B6 and underwent regular physiotherapy. He ambulated after four months and resumed education and schooling.

Traumatic spondyloptosis is a rare condition. It is a neurogenic complication due to high energy trauma and unstable spine which almost always needs surgical treatment. A 30 years old man with L4 spondyloptosis and L5 fracture, neurologic deficit in both lower limbs, urinary incontinence and visceral perforation referred to Shafa Yahyaeian Hospital He underwent nonsurgical treatment because he was a poor surgical candidate (Poor medical condition, visceral perforation and buttock bed sore) At the last follow up three years after trauma, he was in good general condition with full recovery of his neurologic problem and ambulated without assistance. Although traumatic spondyloptosis needs surgical treatment, in special situations for very high risk patients, nonsurgical treatment can be a good alternative.