نشریه دانشگاه علوم پزشکی بیرجند
سال پانزدهم شماره 2 (پیاپی 35، تابستان 1387)

Food allergy can be defined as adverse, immunomediated reactions to foods that occur in certain individuals. Food allergy is being increasingly recognized as a public health problem over the last few decades. It has been estimated that up to 10% of children and less than 2% of adults suffer from some type of food allergy. The situation varies in different countries depending on dietary eating pattern. Usually food allergens are proteins or glycoproteins with a molecular weight ranging from 10-70 kDa. Depending on the route of sensitization, food allergy is the result of either genuine reactivity to comestibles through the gastrointestinal tract (class I food allergens) or secondary sensitization to cross-reactive food allergens as a consequence of the initial reactivity to homologous pollen-related allergens (class II food allergens). An allergenic reaction occurs after an initial sensitization to a food allergen where IgE antibodies are produced. Subsequent exposures to the allergen may result in activation/degranulation of mast cells and basophiles (due to cross linking of IgE antibodies by allergens) and release biological mediators (such as histamine) that manifest in observable reaction such as hives, rashes, and anaphylactic shock. Diagnosis of food allergies could be based on in vitro or/and in vivo tests such as clinical history, physical examination, Prick test, elimination of suspected foods from the patient’s diet and different types of food challenge tests. The elimination of food allergens from the diet, pharmacological treatment, immunothrapy and supplementary treatments are the most common treatments. In recent years, the use of recombinant food allergens recruiting genetic engineering, allows highly sensitive detection of sensitization profiles.

Mercury or Hydrargyrum (Hg) is the most non-radioactive toxic element known. Dental amalgam is made up of 50% mercury.. Electromagnetic fields may increase the emission of mercury from dental amalgam fillings. It was thus aimed to study the effects of electromagnetic fields of mobile use on the level of mercury released from dental amalgam restorations. In this case control clinical trial, study urinary mercury concentrations of 14 healthy University students were measured both before amalgam restoration (zero level), and on days 1, 2, 3 and 4 after restoration. All the subjects had the same diet. Dental treatment was given for all 14 students regarding 2 molars on one side (i.e the side of cellphone exposure), one class I and one class II restorations with identical volume and surface area of the amalgam fillings). All the students had not used mobile phones before the study and did not have any previous amalgam restorations. The test group consisting of seven female students were exposed to microwave radiation emitted from a Nokia 3310 mobile phone (SAR=0.96 W kg-1) that was in talk mode for 15 minutes on days 1-4 after restoration. Seven other female students who had the same condition matched the first group except exposure to microwave radiation were taken as the controls. Urine samples were collected 1 hour after each mobile use (real exposure) and one hour without mobile use (false exposure). After freezing, the samples were sent to the Toxicology Laboratory of Imam Reza Hospital (Mashhad, Iran) and mercury levels in samples were measured by cold vapor atomic absorption spectrometry. The obtained data was analysed by means of a statistical software (SPSS version 13.0) and statistical tests of ANOVA and Student-t at the significant level of P≤0.05.

Our study demonstrated an elevation of mercury level released from dental amalgam fillings after exposure to microwave radiation emitted form mobile phones. Mean (±SE) concentration levels of mercury in urine samples in the case group were 2.43±0.25, 2.71±0.27, 3.79±0.25, 4.8± 0.27 and 4.5±0.32 g/L one day before the amalgam restoration and on days 1, 2, 3 and 4, respectively. But mean Hg concentration levels in controls were 2.07±0.22, 2.34±0.30, 2.51±0.25, 2.66± 0.24 and 2.76±0.32 g/L on the respective days. Results obtained from this study show a significant increase of the mercury release in urine after mobile phone use. This finding confirms early reports that showed an increased release of mercury from dental amalgam restorations in undersea welding.

Heart failure is one of the most prevalent diseases with high mortality and disability. Beta blockers are among basic drugs treating the disorder and leading to reduction in cardiovascular mortality, and improvement of symptoms and left ventricular function. Regarding the increasing prevalence of this disease, the present study was carried out to compare carvedilol with metoprolol in the treatment of patients with heart-failure. In this analytical and prospective study, which was carried out between March 2005 and June 2006, 73 patients with advanced heart failure (ejection fraction=EF= %30-35%) and functional class (FC) I to III were followed up for 6 months. 38 cases of the patients received metoprolol tartrate and 33 cases received carvedilol. Clinical data and left ventricular (LV) function indices before and after treatment as shown in echocardiography were recorded in a questionnaire. Then, these changes were compared statistically by means of SPSS (11.5). Mean age of the patients in the metprolol group was 576.6 and in the carvedilol was 56.87.3 years. Average daily dose of metoprolol and carvedilol was 75 mg and 25 mg respectively. Heart rate and blood pressure reduction due to respective treatments (NYHA class) Improvement was similar in two groups. Functional class of patients in both groups improved one degree (P<0.001). In metoprolol treated patients. Left Ventricular End Diastolic Diameter (LEDD) and Left Ventricular End Systolic Diameter (LVESD) reductions were 8.7mm and 2.3mm (P<0.001, P<0.001) as well as Left Ventricular End Diastolic Volume (LVEDV) and Left Ventricular End Systolic (LVES) reductions were 4.3 cc and 7.3 cc (P=0.008, P<0.001), respectively. Mean EF increased 3.3%. (P=0.000). In carvedilol treated patients LEDD and LESD reduced 2.78 mm (P<0.001) and 1.57 mm (P=0.045) and LVEDV & LVES reduced 2.3 cc (P=0.53) and 7.3 cc (P=0.007), respectively, and mean EF Increased 2.2% (P=0.004). There were no statistically significant differences between the two groups. In heart failure patients with FC I to III both metoprolol tartrate and carvedilol administration improves symptoms of the disease and LV function. In this study no significant differences were observed between the effects of the two drugs.

Various investigations have shown that fucosylated glycoconjugates components of the cell surface and extracellular matrix play crucial roles in critical morphogenetic and histogenetic events along neuronal projections of immature neurons during embryonic development. In addition, fucosylated glycoconjugate within the axoplasm of the adult neurons is involved in fast transporting protein molecules (FTP). The aim of the present study was to investigate whether fucose terminal sugar is present during early projection of developing central nervous system. In this experimental study, 24 female Balb/C mice were selected randomly and from embryonic day 10 to 15, all specimens were sacrificed and their embryos were fixed, serially sectioned and lectin histochemistry carried out. by using LTA-1, UEA-1 and OFA which are all specific to fucose. Our study revealed that among the three fucose binding lectins tested only OFA (Aleuria aurantia) reacted with the neural tube during development.These reactions in motor and sensory zones of spinal cord started on the eleventh day of embryonic period and ended by the fourteenth day. During this period anterior, lateral and posterior funiculus, neuronal fibers in alar and basal plates as well as medium-sized neurons around posterior root ganglion showed reactions. The other fucose specific lectins, UEA-1 and LTA, failed to bind to any part of spinal cord during neurolation These data indicate that fucosylated glacoconjugate specific for Aleuria aurantia appears to play a crucial role in neuronal projection during early mouse neurolation and may illustrate also the decisive function of this molecule in controlling cell surface interactions during neuronal development

Angiogenesis is essential in the progression and metastasis of solid tumors. It has been proved that increase in angiogenesis within primary solid tumors is actually associated with nodal metastasis and risk prognosis of some malignancies. In contrast, regarding hematologic neoplasms very limited studies have been done. The goal of the present study was to determine MVD (Microvessel density) in acute leukemia and compare it with MVD in normal tissues. In this study 30 cases with acute leukemia and 30 normal controls were selected. These had been diagnosed and archived in the pathology department of Mashhad Ghaem hospital. Their blocks and slides were prepared and examined. After their final approving, the paraffin blocks were thinly sliced and the slices were immunohistochemically stained for VEGF (Vascular Endothelial Growth Factor) Immunohistochemical slides were evaluated for hot spots of MVD in the tissue in the microscopic field of vision with 400 times magnification. MVD or angiogenesis in acute leukemia was 20.2% which was obviously more than that in the controls (6.9%).The difference between the two groups was statistically significant (P<0.001). Angiogenesis in acute leukemia is significantly higher compared with the controls (who had normal tissues).But there was no significant difference between acute myeloid leukemia and acute lymphoblastic leukemia.

Multiple sclerosis (MS) is a chronic and incurable disease of central nervous system (CNS), which causes a lot of complications and problems for patients and leads to their life dependency and disability. Thus, it is necessary to utilize appropriate methods and interventions in order to reduce these problems in MS patients. The purpose of this research, which was done in the Iranian MS Society, was to find out the effects of a self- care education program on complications of MS patients. In this quasi – experimental study, 34 patients with MS were selected based on purposive and accessible sampling method. Before implementing the education program, primary information (demographic data and complications resulting from MS) were collected through demographic and health- problem index questionnaires. After studying the obtained data and identifying the complications resulted and the necessary care program instructional classes were held for seven sessions to acquaint MS patients with causes, diagnostic methods, treatment, and self-care programs as regards its complications. Then, self-care programme was followed by patients for one month and researchers, too, checked the subjects through reportorial revision checklists. Again, health-problem index questionnaires were filled out by the same subjects after one month. Pre/Post intervention data were analysed by means of SPSS software, descriptive statistical methods, including Student paired-t, and Wilcoxon tests at the significant level P<0.05. There was a highly significant (P=0.0001) difference between the rate of complications before and after the self-care education programme the mean score increased from “3” to “26.76” before and after education, respectively.. Moreover, before the intervention 26.5 % of the subjects had muscular seizure, 55.9% fatigue, 44.1% constipation, and 23.5% suffered from amnesia. But after one month, these percentages changed to 5.9%, 14.7%, 11.8%, and 14.7% respectively (P<0.05). Self-care education increases patients’ taking self- care and reduces some of the complications of MS. Therefore, it is recommend that self- care education programs should be used to decrease these complications.

ِDiabetic ketoacidosis is one of the major complications of diabetes whose due treatment can reduce its mortality. The aim of this study was to evaluate the clinical manifestation, laboratory data and precipitating factors in admitted patients to Booali hospital in Ghazvin. In this descriptive retrospective study, all medical files of DKA patients between 1999 and 2004 in Ghazvin Booali hospital were surveyed. Totally, 60 episodes were evaluated with respect to clinical features, lab. findings and hospital mortality. Finally, the obtained data was statistically analyzed by means of SPSS software. Mean±SD age of patients was 26. 63±11. 74. Females and males were 60% and 40%, respectively. Mean±SD hospitalization time was 7. 2±3. 9 days. DKA as the first symptom of diabetes occurred in 18. 3% of clients. Feebleness and weakness were the most common complaint in 50% of patients, 75% were alert to their problem when hospitalized. Fever was detected in 50 %. The mean PH was 7. 1±0. 1. Hyponatremia occurred in 25%, urinary tract infection (UTI) in 54%, and hypoglycemia in 23% of the patients. During management, recurrent DKA was found in 3. 3% and mortality rate was 5%. Regarding the results of the study, which confirms lack of knowledge of the clinical staff as to how to confront and manage DKA-as a medical emergency due education in this field can reduce prevalence and mortality of DKA.

Non-communicable diseases especially cardiovascular diseases (CVD) are a major health problem in all communities. Moreover, the best preventive measure concerning such diseases is the improvement of lifestyles in which proper nutrition has an important role. Thus, health-care providers have an important role in teaching proper nutrition to the community. The aim of present study was to determine nutritional knowledge, attitude and practice of health-care providers about CVD prevention. In this cross-sectional and descriptive study, 1421 health professionals including physicians, adepts, health technicians, health workers, and health volunteers were chosen. Nutritional knowledge, attitude and practice of the subjects were determined by means of a questionnaire. Food consumption frequency of these health professionals was determined by using a food frequency questionnaire and their respective mean weekly frequency of food consumption was analyzed by means of one-way ANOVA and P≤0.05 was taken as the significant level. Frequency of correct nutritional practice in health professionals was calculated through Chi-Square test. Mean percent of knowledge and attitude scores of health professional were 43±17.7 and 59.3±31.2 respectively. Physicians’ knowledge, attitude, and practice was significantly more than those of other professionals (P<0.05). Physicians had better nutrition practice compared with other health professionals (P<0.05). High knowledge, attitude, and correct practice of most physicians in comparison with other groups is related to their higher education and their better economical and social status. Other health professionals’ practice to inform people about some of basic food stuffs is not enough. Then, with regard to the preventive role of nutrition in CVD, more education of the health staff is necessary.

Malnutrition is one of the important health problems throughout the world, particularly in developing countries, which has undesirable effects on mental and physical health of children. It is an underlying factor of infection and an important cause of child mortality in these countries. The aim of this study was to find out the prevalence of malnutrition in children under 6 in south Khorasan in 2006. This cross sectional and descriptive analytical study was done on 1807 children under 6 in south Khorasan, belonging to six urban and rural regions, applying multistage cluster sampling methodology. Data collection was done by trained family-health associates and family-health workers through measuring of weight and height for Seca, and structural questionnaires ANIS, and face-to-face interviews with mothers. To study malnutrition, three indices were used namely “weight to age” (underweight),”weight to height”(leanness),and “height to age”(shortness).The obtained data was analyzed by means of chi-square test, SPSS software and EPI-Info 2000, and α= 0.05 was taken as the significant level. Out of 1807 children 51.7% were males, 52.2% were living in urban areas and 37% were under 24 months old and the rest over 24. Weight index showed that 52.2% were normal, 34.4% were lightly under weight, 11.7% moderately underweight and 1.2% were severely underweight. Prevalence of underweight had a significant relationship to habitation, mother's job and parent's education level. Regarding standing criteria 55% were normal, 28.4% were lightly short, 12.7% were moderate, and 3.9% were extremely short. Stunting had a significant relationship to habitation, age, mother's job and parent's level of education (P<0.05). Wasting criteria showed that 67.8% had normal wasting, 24.7% light wasting, 5.9% moderate wasting and 1.6% had severe wasting. This had a significant relationship to sex and habitation (P<0.05). With regard to high prevalence of malnutrition in children and its relationship to socio-economic variables, measures such as increasing parents’ education especially mother's knowledge, constancy of breast feeding until the age of 2 years, and promoting nutrition status of children under 6 years and mothers’ knowledge of children’s nutrition are recommended.

Hepatitis B virus is the cause of acute and chronic hepatitis, cirrhosis, and hepatocellular carcinoma. Its prevalence has been reported to be 0.1%-0.5% and 1.6%-6.5% in the United States and Iran respectively. At present, the only sure preventive measure is vaccination but it does not create absolute (100%) immunity. Antibody production is between 79% to 90%, which occurs three days after vaccination. Antibody level decreases as time goes by. The present study was done aiming at determining immunogenicity due to complete hepatitis B vaccination in the nursing staff and its relationship with variables such as age, sex, body mass index, working place, and period of time elapsed after the last dose of vaccine. This descriptive cross sectional study was done in 2004 on 112 nursing staff of Birjand Medical Sciences University hospitals "Vally-e-asr" and "Imam Reza", who had been vaccinated three times and two months to five years elapsed after their last vaccination. First, 4 ml of blood was taken from each subject as their personal information was recorded in a questionnaire. Then, the samples were quantitatively measured by means of Italian Radium Kits using Anti-HBs ELISA. The Study revealed that antibody titer was over 10 mIU/ml in 88.4% of the subjects.11.6% did not have protective antibody but its level was relative and appropriate in 12.5% and 75.9% respectively. There was no significant correlation between HBs-Antibody level and variables such as sex, age, ward, and body mass index in the subjects (P>0.05). Regarding that 11.6% of the subjects did not have protective antibody at all it is suggested that anti-HBs level should be measured in the nursing staff and non-immune- ones must be revaccinated.

While pulmonary thromboembolism is common, thromboembolic pulmonary hypertension is very rare. The present case is a 35 year old woman with chronic thromboembolic pulmonary hypertension, who presented with severe dyspnea and leg edema, following an earlier thrombotic event of 10 years earlier, after her her second childbearing. She also had a history of the first childbearing complicated with congenital heart disease and death of her infant by the age of 5 months. Despite conventional treatments for pulmonary thromboembolism including anticoagulants, her condition developed to severe pulmonary hypertension. The investigations including spiral CT confirmed bilateral pulmonary artery thrombosis, positive antiphospholipid antibody and negative serologic tests for rheumatic disease. Besides, the patient showed no symptoms of systemic vasculitis. Therefore, it was diagnosed that the patient had primary antiphospholipid syndrome without underlying rheumatic disease. Thus, the patient was referred to a thoracic surgeon for endarterectomy because of severe pulmonary hypertension (105 mlHg). However, due to extensive bilateral thrombotic involvement of pulmonary artery, surgical treatment was refused. Treatment with prednisolone 60mg/d and warfarin with high dose was carried out. The clinical condition was improved and dyspnea, edema and general condition recovered. The probable role of this syndrome in the development of chronic thromboembolic pulmonary hypertension, neonatal congenital heart disease, and also therapeutic strategies will be discussed in this report.

Cushing’s syndrome which is an uncommon but lethal disorder occurs due to many causes. The most common endogenous cause is Cushing’s disease or pituitary Cushing. The etiology of this disorder is an adenoma in the anterior pituitary. The most important point in the treatment of this disorder is differentiation between Cushing’s disease (pituitary) and Cushing’s syndrome (adrenal). We can differentiate up to 90% of cases with hormonal test and radiologic anatomy. The incidence ratio of the disorder in females to males is approximately 5:1. Bilateral adrenal hyperplasia, which is seen in Cushing’s disease, is caused by long adrenocorticotropic hormone (ACTH) secretion. This long acting secretion may cause formation of nodules in adrenals. Sometimes these unilateral nodules may cause misdiagnosis. In this article, two cases of cushing’s disease which had been misdiagnosed and led to unilateral adrenalectomy are reported. These surgeries were not effective and after proper hormonal tests approving occurrence of Cushing’s disease, both cases had Trans-Sphenoidal Surgery (TSS). After surgery the symptoms in the cases decreased. But both patients had a recurrence of the disease. Now, by means of radiotherapy and medical adrenalectomy (ketoconazole treatment) both of them are under control.