مجله علوم پزشکی رازی
سال شانزدهم شماره 1 (پیاپی 62، بهار 1388)

Presence of ischemic changes on the anterior surface of heart and AV block worsen the prognosis of acute Inferior Mycocardial Infarction (MI). The rate of mortality increases with the occurrence of AV block in inferior MI.The aim of this study was to predict and diagnose acute Inferior MI in patients with AV block based on ECG and clinical features.Patients and In this cross sectional study that was conducted retrospectively, we reviewed the medical records of 500 patients with acute Inferior myocardial infarction admitted in Ardabil Bu Ali hospital during 2006-2007.196 patients were excluded because of non ST segment elevation in the inferior leads and/or lack of substantial data. In the other patients presence of artrioventricular block, diabetes melitus, hypertension, smoking, thrombolytic therapy, initial ischemic pattern (J point / R wave < 50% - pattern 1, J point / R wave ≥ 50% - pattern 2 in inferior leads II, III, avF and ischemia in anterior leads) and gender were recorded. The Chi square test was applied to compare differences between discrete variables. P value < 0.05 was considered as statistically significant. The study population included 304 patients. AV block occurred in 75 patients (24.7%) and 299 patients (75.3%) were without AV block.AV block occurred in only 17 patients (11.5%) of 148 patients with initial pattern 1 compared to 58 patients (37.2%) of 156 patients with initial pattern 2 (Pv=0.0001). 50 patients (30.7%) of the 163 patients with ischemic changes, had AV block. While AV block occurred in 25 patients of the total 141 patients without ischemic changes (17.7%) (Pv=0.011).Therefore ECG pattern 2 and ischemic changes in anterior leads were associated significantly with AV block. However significant statistical association between AV block and hypertension, diabetes melitus, smoking, thrombolytic therapy and gender was not detected. In this study, it was demonstrated that the occurrence of atrioventricular block is associated with pattern 2 in the inferior leads and anterior ischemia on initial electrocardiogram. There- fore these patients need extensive care and monitoring.

Thalassemia is a hereditary anemia with treatment of lifelong blood transfusion. Iron overload in vital organs is the consequence of this treatment. According to recent studies Iron could deposit in lung without causing any symptoms and signs in the patients. Our goal in this study was to evaluate the pulmonary abnormalities by Pulmonary function test (PFT) in patients with β- thalassemia. Patients and In this descriptive study 139 patients with β thalassemia were evaluated. History was obtained in regard to blood transfusion and clinical features. Physical examination, chestX ray, ABG and pulmonary function tests (PFT) were performed. Results were analyzed by SPSS software V. 11.5 and Chi square test. 139 patients were enrolled in this study there were 85 (62%) males and 54 (38%) females. Meanwhile 104 Patients (75%) had thalassemia major and 35 (25%) had thalassemia intermedia. Mean age was 21.1 yr and mean duration of treatment was 18 yr. In history of 128 (95.5%) patients, no respiratory problem was noticed. Chest X- ray was done for 112 patients 100 (89.2%) had normal pattern while 12 (10.7%) patients had abnormal patterns on their chest x- rays. In ABG, mean PO2 was 73.5% and mean O2 saturation was 90.6%. Mean ferritin level was 1800 ng/dl. According to PFT results 101 patients (72.7%) had restrictive patterns, 35 patients (25.1%) had normal pattern and 3 (2.2%) had combined pattern. There was significant between PFT results and duration of blood transfusion (Pvalue = 0.05). However there was negative statistical correlation between PFT results and ferritin (Pvalue = 0.62). In our results restrictive pattern was the most common finding(72.7%) in PFT 95% of patients did not have any respiratory complaints and on chest x- ray 89% had normal pattern. Thus lung can be considered as a site for iron deposition during blood transfusion. However despite PFT abnormalities, clinical features are not demonstrated in thalassemic patients because of the high lung capacity / reserves. A healthy lung cannot be assurred by a single physical examination and negative history. Thus, in addition to well chelation, PFT must be performed in patients in order to prevent from any respiratory disorder at the older ages.

Pneumonia is now one of the most important causes of childhood mortality in developing countries like Iran. The increased susceptibility to pneumonia, particularly in malnourished children of developing countries, is postulated to be due to reduction in cellular immunity. One of the reasons for reduced immunological competence in malnourished children may be zinc deficiency. However, relatively well nourished children of developing countries also suffer from pneumonia and it is possible that they have impaired immunity due to zinc deficiency. This study was done to investigate the zinc status of well nourished Iranian children with pneumonia in comparision with control group.Patients and In this case control study, estimation of serum zinc was performed in 142 well nourished children, aged 3-60 months suffering from pneumonia and compared with 142 normal matched controls. Serum zinc was low in children suffering from pneumonia as compared to control (437/1±39/65 mmol/l vs 511/23±36/931mmol/l) We conclude that children suffering from pneumonia, have significantly decreased levels of serum zinc (P=0.0075).

Protein- energy malnutrition is a major problem and one of the risk factors in increasing mortality in hemodialysis patients. Since there is not any single index in the evaluation of nutritional status in these patients, leptin can be used as one of the parameters in this process. In this study, the correlation between serum leptin and biochemical and anthropometric parameters of malnutrition has been evaluated. Patients and This cross- sectional study was performed on 60 hemodialysis patients (32 males and 28 females) in 2006. Patients with hemodialysis duration of less than one year, history of consumption of lipid reducing drugs or glucocorticoids or an infectious or inflammatory disease were excluded. Malnutrition laboratory parameters and serum leptin levels were measured before hemodialysis. Serum leptin was measured by ELISA method with direct dbc kit and malnutrition laboratory parameters were measured with standard laboratory methods patients anthropometric parameters were evaluated after hemodialysis. All of the measured datas were compared with serum leptin. The data were analyzed by SPSS V. 11.5. Parametric (T-test, ANOVA and Pearson Tests) and non-parametric (Spearman’s rho test, Mann Whitney test) tests were used for the evaluation of the results. The mean age of patients was 47.5±16.1 years and the range of serum leptin level was 0.6-64.8 ng/mL. Mean serum leptin level was 22.64±19.54 ng/ml in females and 16.74±20.16ng/ml in males on hemodialysis. Inspite of higher levels of leptin in females, there was not any statistically significant difference between females and males serum leptin. Absolute value of correlation coefficient of serum leptin with anthropometric parameters was lower than 0.25 (except height and weight in males which was between 0.25-0.50). It was also lower than 0.25 with most laboratory parameters (except ferritin, iron and phosphorous in males and total protein, hemoglobin, urea and creatinin in females which was between 0.25-0.50). Our results suggest that increased serum leptin level does not have a major and first role in the cause and diagnosis of malnutrition in hemodialysis patients and there is a poor correlation between malnutrition parameters and serum leptin level.

Rheumatoid arthritis (RA) is a chronic autoimmune disease in which stiffness, pain, and inflammation of joints are common. It has been observed that some dietary factors can ameliorate or woren the disease. Vegetarian diets and dairy products have had useful effects, while allergic foods tend to aggravate the condition. The main objective of this study was to assess dietary intake of antioxidants and nutritional factors affecting the illness in women with rheumatoid arthritis. Patients and In this case-control study, 40 RA diagnosed female patients that had referred to the University clinic and 40 sex and age matched women from the patients relatives were selected as the case and control groups, respectively. Subjects’ dietary pattern was evaluated through food frequency questionnaire (FFQ) on daily, weekly and rarely intake of the main antioxidant sources. Data were analyzed with t and chi-square tests using SPSS software version number 13. Daily intake of tomato and fruits in controls was respectively 3 (P<0.02) and 1.7 (P<0.04) times more than that of patients. Number of healthy subjects who ate tuna fish and fruit juices on weekly basis was 4.3 (P<0.01) and 4.6 (P<0.02) times more than patients, respectively. Consumption of peanut in patients was 5 times more than that of healthy subjects. Eggplant and cucumber were reported to worsen the symptoms of disease in about 30 and 20 percent of patients, respectively. While consumption of fish and garlic was associated with amelioration of symptoms in about one-forth of patients. Prevalence of obesity (based on body fat percent) was 4 times higher in patients compared to the controls (P < 0.05). Intake of tomato, fresh fruits and fruit juices, as the main sources of dietary antioxidants, was lower while intake of peanut-as one of the main allergic foods-was higher in patients compared with the control group. Eggplant and cucumber aggravated, but fish and garlic lessened the severity of RA. Higher rate of obesity was prevalent in RA patients. Considering the above points, weight reduction and consumption of antioxidant rich foods is highly recommended.

Staphylococcus aureus (S.aureus) is one of the most prevalent causes of nosocomial infections. It is also involved in community acquired infections. The resistance of this bacterium towards methicillin which has been reported since 1961, made Vancomycin the last choice for treatment of Staphylococcal infections.Considering the reduced sensitivity or resistance to vancomycin which has been observed since 1996, this study was conducted with the aim of evaluating the vancomycin MIC values (Minimun Inhibitory Concentration) of S. aureus cells isolated from hospitalized patients and compared with those recovered from outpatients. A cross sectional – analytic survey was conducted from 2006 till 2007. A total of 200 S.aureus strains were isolated from various clinical sources including blood, sputum, urine and sinus secretions. Their susceptibilities to vancomycin were initially surveyed by disk diffusion method. Subsequently, the MIC values of each individual strain towards vancomycin were determined by E-test strips, and the obtained data was analyzed by SPSS (V. 11) software. For statistical analysis, t-test was used. In 125 S. aureus strains isolated from hospitalized patients, the growth inhibition zones were 14-18 mm and the MIC values were 1-2mg/ml. In 75 S. aureus strains isolated from outpatients, the growth inhibition zones were 16-20 mm and the MIC values were 0.75-1.5 mg/ml. The result of this survey shows increased MIC values for vancomycin in hospitalized patients as compared to outpatients.

The use of abdominal zippers for temporary abdominal closure was devised to facilitate repeated explorations, allowing multiple cleansing of the peritoneal cavity and the detection and management of septic complications. In our study, an open abdomen using a sterile zip in a patient with gangrenous bowels and reanastomosis derived infection is reported. Case report: In this study a patient with a history of appendectomy one year before referral (had referred to the physician with a one month complaint of abdominal pain) is presented. The patient underwent laparatomy twice. Most of his small intestine was resected due to the gangrene and primary anastomosis was performed. Finally after three days, the patient underwent multiple cleansing of the abdominal cavity following purulent discharge from the incision, acute respiratory distress syndrome and sepsis with diagnosis of discharge from the site of anastomosis. Zipper locked method was used for temporary closure of abdomen wall in order to facilitate multiple access of abdominal cavity. Finally, abdominal wall was closed constantly. Temporary closure of the abdomen by means of devices such as zip gives the opportunity of rapid, easy and safe assessment, management and treatment of these patients to the surgeons.

The laryngeal mask airway (LMA) maintains the airway under anesthesia through spontaneous breathing technique without the need of endotracheal intubations. Although routine LMA supports an adequate tracheal airway, the classic method had some limitations and problems. In this study, we compared the results of the two methods of (new and classic) LMA.Patients and The study was a double blind randomized clinical trial. Patients who were candidates for ophthalmology surgery were enrolled in the study. The patients were randomly divided in to two groups: routine (classic) and new LMA methods of intubation approach. Ease of insertion, local bleeding, postoperative sore throat and hemodynamic changes during operation in the two groups were assessed. In this study Chi-square and t-tests were used for comparing the two groups. SPSS V.13 was used for statistical analysis. The results showed that there was no significant difference between the two methods in regard to the ease of insertion. Also sore throat and bleeding were not seen in any of the two groups. Hemodynamic changes during operation between the groups were not significant. Systolic and diastolic blood pressures did not show any significant differences in the two groups. Our finding showed that the new method of LMA was similar in regard to complications and ease of insertion to the classic method and can be used for reducing contamination with discharges and secretions of patients.

Life long red blood transfusion remains the main treatment for severe thalassemia. The development of anti–RBC antibodies can significantly complicate transfusion therapy. Microtyping (Gel method) is the method which is recommended at present for screening and typing of antibodies. The aim of this study is to screen antibodies by Gel method and to replace the tube method (Indirect coomb’s test) if suitable responses are observed. A cross-sectional study was conducted on 458 transfused thalassemia patients in Ali Asghar Children’s Hospital. Data were analyzed with SPSS V. 11.5. For parametric data, Chi–square test was used and for relation data Pearson chi- square was used. P values less than 0.05 were considered significant. In our study, there were 221 males 48.3%, and 237 females 51.7% with the mean age of 16.96 Yr. (SD±9.021) and age range of 1-60 years. Among the patients 11 (2.4%) had hemolytic reaction, 53 (11.6%) had allergic reaction and 88 cases (19.2%) had febrile reaction during the transfusion.Alloantibody in 49 (11.8%) patients was positive (by microtube method), among which 40 (81/6%) patients had anti Kell or Rh (anti C,D,E,c,d,e) antibodies and 9 (18.3%) had unknown blood group antibodies or auto antibodies.In our study alloantibody with tube method (indirect coomb’s test) was positive in 28 patients. Mismatched RBC phenotype was found for Rh (c,C,E) and Kell, Kidd and Duffy (Fyb, Fya) antigens. Our data showed that screening anti-RBC antibody with the new microtyping method (Gel method) is better than tube method.

Gabapentin is one of the anticonvulsive drugs which can be effective for the management of painful situations such as neuropathies, post herpetic neuralgias and perioperative pains. In the present study, we evaluated the efficacy of 600 mg oral gabapentin administered as a premedication on post thoracotomy pain and total morphine consumption. Patients and In this randomized placebo controlled clinical trial study, eighty patients who were candidates for thoracotomy were enrolled in two groups: gabapentine and control. In gabapentin group, the patients received oral gabapentin (600 mg) as a single dose before operation. Patient sampling was by simple and random method. All of the patients had the same general anesthesia protocol (TIVA, infusion of propofol and remifentanil). For postoperative pain control, intravenous Patient Controlled Analgesia (PCA) with morphine was used. After the operation the pain score in recovery and 1, 6, 12 and 24 hours after surgery was assessed by Visual Analogue Scale (VAS). The amount of morphine consumption and side effects during the first 24 hours after surgery were also evaluated. In this study we used Chi-square, † and repeated measurement tests for data analysis. SPSS V.13 was also used for data analysis. Average morphine consumption in gabapentin group was 21.9±9.2 mg and in control group was 24.5±4.5 mg that had statistical significant difference (p=0.003). The pain score (VAS) during the recovery time and the first hour after operation in gabapentin group was significantly lower than the patients in control group (p<0.001), but in the next hours it was not significant. Demographic data were not significantly different between the two groups. Also, significant difference was not detected in regard to other complications. Our data showed that a single dose of 600 mg oral gabapentin as a premedication could reduce first hour postoperative pain and total morphine consumption in patients undergoing thoracotomy without having any significant side effects.

Respiratory tract infections are one of the important causes of death among children in developing countries. Although their frequency is similar in both developed and developing countries, mortality due to them is 10-50 times higher in developing countries. Viruses are common causes of these infections among children and Influenza, adeno and respiratory syncytial virus (RSV) are some of them. The aim of this survey was to evaluate of frequency of Adeno, Influenza A, B and Respiratory Syncytial virues in the pharyngeal secretion of children (3 months to 15 years old) with upper respiratory tract infection by rapid Immunochromatographic test. A descriptive cross sectional study was carried out on children from 3 months to 15 years old with upper respiratory infection who visited the OPD of Hazrat Rasool-e-Akram hospital in one year (2006). Direct smear of patient’s throat was evaluated by rapid chromatography test for adenovirus, RSV and influenza A and B virus infection. SPSS V. 13 software was used to analyze the data t-test was used for data analysis. 160 children with upper respiratory tract infection with a mean age of 61.5 months were evaluated. 57.5% were boys and 42.5% were girls. 77.4% had fever, 66% had sore throat, 16.4% had abdominal pain, 10% had diarrhea, 15.7% had vomiting, 37.4% had cough, sneeze and nasal discharge, 13.8% had cevical lymphadenopathy, 27% pharyngeal exudate, 5.7% had petechea on palate and 1.9% had conjunctivitis. They were admitted: 24% in spring, 14.1% in summer, 23.1% in fall and 38.5% in winter.Influenza infection was detected in 7 cases (4.4%) with mean age of 82.3 (SD ± 47.6) months. They were detected 28.6% in spring, 14.3% in summer and 57.1% in winter. Adenovirus infection was detected in 10(6.3%) cases with mean age of 83.7 (SD ± 58.5) months. They were detected 20% in spring, 30% in summer, 30% in fall and 20% in winter. RSV infection was detected in 9 (5.7%) cases with mean age of54.7 months (SD ±50.7). They were detected 44.4% in spring, 44.4% in fall and 11.1% in winter. In this study Adenoviruses were the most prevalent, followed by RSV and Influenza viruses. Fever was the most common clinical sign but in RSV sore throat, in Influenza cough, petechea and vomiting and in Adenovirus infection, cervical lymphadenopathy was the most prevalent symptom. Influenza in winter and RSV in spring and fall were the most prevalent infections, but Adenovirus did not obey seasonal pattern.

Rheumatoid arthritis (RA) is the most common autoimmune rheumatic disease, which requires specific diagnostic tests for it’s’ diagnosis. However specific and practical tests for its diagnosis are lacking. We evaluated the diagnostic accuracy of Anti-cyclic citrullinated peptide antibodies (Anti-CCP) in the diagnosis, prognosis and determination of the severity of RA. In a descriptive-cross sectional study Anti-CCP antibodies were determined in 140 serum samples: 82 from RA patients and 58 from controls, including samples of 30 healthy individuals and 28 patients with connective tissue diseases. Anti-CCP was detected by ELISA in the serum samples of patients, Rheumatoid factor of IgA, IgM and IgG classes was determined by ELISA and Anti-Nuclear Antibody was detected by Immunoflourescent method results were compared in the three groups. For comparison of differences between groups t (quantitative variables) and chi-square tests (qualititative variable) tests were used. Correlation between titer of IgM-RF and Anti-CCP was assessed by Pearson’s Correlation test. In addition, Receiver Operating Characteristics (ROC) analysis was carried out to compare sensitivity and specificity of various tests. For data analysis SPSS V. 15 was used. Mean concentration of Anti-CCP in RA patients that had Anti-CCP levels greater than normal was 95.1 IU/ml (range: 7.1-249 IU/ml). While mean concentration of Anti-CCP in RA patients that had Anti-CCP levels less than normal was 2.1 IU/m (range: 1.2-4.9 IU/ml).Controls had a mean Anti-CCP level of 7.35 IU/ml (range: 2.44-13.26 IU/ml) Diagnostic sensitivity and specificity of RF was reported as 81.7% and 44.6% respectively in the patients. As a screening method for rheumatoid arthritis IgM-RF, Anti-CCP antibody assays are superior to other RF isotypes assessments. Anti-CCP proved to be a powerful and specific diagnostic tool, especially in patients with undiagnosed rheumatoid arthritis.

Recent evidences suggest new risk factors especially inflammatory reactions and immunologic factors may play an important role in the pathogenesis of cardiovascular diseases. The aim of this study was to evaluate the serum levels of IL-17 in patients with acute myocardial infarction and unstable angina. In this descriptive study serum samples were obtained from 30 patients with Acute Mycrordial Infarction (MI), 30 patients with Unstable Angina (UA) and 30 sex and age matched healthy subjects. Serum samples of participants were tested for the levels of IL-17 by the use of ELISA. Statistical analyses have been done using ANOVA and t-test. The mean serum levels of IL-17 were 6.68±1.2 pg/ml in AMI group, 5.48±1.01 pg/ml in UA group and 2.07±0.60 pg/ml in healthy control group. Statistical analyses showed that the mean serum concentrations of IL-17 in AMI and UA groups was significantly higher than that observed in healthy control group (P<0.005 and P<0.04, respectively). Moreover, the mean serum levels of IL-17 in total IHD (Ischemic Heart Disease) patients (6.08±0.79 pg/ml) was significantly higher than that observed in healthy subjects (P<0.002). No significant difference was observed between AMI and UA groups regarding the mean serum concentrations of IL-17. These results demonstrated higher serum levels of IL-17 in patients with AMI and UA than the control group. Accordingly, IL 17-associated mechanisms may participate in the pathogenesis of IHD.

Diabetes Mellitus (DM) increases the risk of ischemic cerebrovascular diseases two- to four folds as compared to people without diabetes. Macrovascular disease is the leading cause of death among patients with diabetes mellitus. Transcranial Doppler (TCD) is a noninvasive procedure used to assess the hemodynamic changes in Middle Cerebral Artery (MCA). Knowing the influence of diabetes on brain hemodynamics, is essential for the proper management of cerebrovascular complications in these patients. The aim of this study was to evaluate and compare cerebral vasomotor reactivity in diabetic and non- diabetic patients.Patients and In this cross-sectional study, Transcranial Doppler ultrasound was used to measure Peak Systolic Velocity (PSV), End-Diastolic Velocity (EDV), Mean flow velocityes (MV) and Pulsatility Index (PI) in the Middle Cerebral Arteries (MCA) of 53 Diabetic (confirmed as DM by positive laboratory investigations) and 51 non-diabetic patients. Cerebral Vasomotor Reactivity (VMR) was measured as percentage of changes in peak flow velocity in MCA after inhalation of 5% CO2 for 1-2 minutes. Statistical analysis was done via Independent t-Test and Fischers Exact Test. Non-diabetic patients had higher mean flow velocity as compared to diabetic (53.34±16.7cm/s, 42.47±29cm/s, respectively) which showed significant statistical difference (p=0.021). Also, diabetic group had significantly decreased VMR compared with non diabetics (%5.31±2.6, %6.66±2, respectively) which showed significant statistical difference (p=0.022). According to the results of this study, mean VMR in diabetics was significantly lower than the non-diabetics (%5.31±%2.6 versus %6.66±2 respectively). This means decrease in cerebrovascular reversal capacity and increase risk of cerebrovascular disease in diabetic patients. However, whether diabetes alone is a risk factor for cerebral vascular disease or not, needs more investigations.

Association between type 2 Diabetes mellitus and osteoporosis has been an attractive subject for many researchers, because both of them are very frequent and occure in the same age group. However there are controversial reports on the effect of the type 2 Diabetes mellitus on bone mineral density. Bone mineral density (BMD) of diabetic patients is reported to be equal, more or less than the normal population. The aim of this study was to evaluate the bone mineral density in postmenopausal women with type 2 diabetes mellitus.Patients and In this cross-sectional study, 50 diabetic and 50 nondiabetic postmenopausal patients that had referred to Bandar abbas Milad Bone Mineral Densitometry Centre were enrolled. BMD was measured in the lumbar vertebrae (L2-L4) and hip (femoral neck) using DXA method. Exclusion criteria were endocrine or rheumatologic diseases and use of confounding drugs specially steroids. The study population was selected randomly. T-test using Minitab software was used for statistical analysis and P<0.05 was considered as significant. Age, weight, height and BMI were similar between both groups, but menopausal age was higher in the case group (48.26±4.89 yr vs 45.20±5.75 yr). The mean femoral neck BMD was similar between two groups (0.732 g/cm2 in cases and 0.773 g/cm2 in controls) (P=0.16).There were no statistically significant differences in BMD of lumber spine in both groups (0.875 g/cm2 vs 0.876 g/cm2, p=0.97). No significant difference was noted in regard to prevalence of osteopenia and osteoporosis.The mean femoral neck T-score was lower in the case group (-2.18 vs -1.83), but this was not significant (P= 0.16). There were no statistically significant differences in the lumbar spine in this regard as well (-1.40 vs -1.39, p=0.98). The mean Z-score of both sites was also similar in the two groups. The incidence of fracture was similar between two groups. Also there were no significant differences in the T-score and Z-score between patients receiving oral anti-diabetic medication and those receiving insulin. It seems that type 2 diabetes mellitus is not a risk factor for osteoporosis and does not increase the risk of fracture. So evaluation of BMD is not recommended routinely for prophylaxis of osteoporosis in this patient group.

Annexins are a large family of calcium-phospholipid binding proteins which are distributed among nearly all eukaryotes. These proteins have been found in a wide range of fungi including ascomycetes, basidiomycetes and oomycetes. The aim of present study has been the investigation of cellular localization of ANXC3.1 in filamentous fungus Aspergillus niger (A. niger). The effect of ANXC3.1 overexpression on growth rate and protein secretion of A. niger has also been investigated. In this experimental study, the annexin C3.1 gene was PCR-amplified using genomic DNA of Aspergillus niger as a template. Following the confirmation of gene sequence, it was used in the preparation of two inducible gene constructs. In the first construct, annexinC3.1 was cloned in PGEM–Egfp expression vector as a GFP fusion and under the control of glucoamylase promoter. In the second construct, the gene was cloned in pMJB104 expression vector, driven by cbhB (cellobiohydrolase B) promoter. These constructs, then were transformed into A.niger N402 using a standard method. Overexpression of each construct was induced by an inducer carbon source and the effect of annexinC3.1 overexpression on radial growth rate and protein secretion was analysed in transformants. Comparisons of radial growth rates, as well as protein secretion level, between wild type and transformants was performed using t test. Cellular localization of annexinC3.1 was investigated in annexin-GFP expressing transformant by fluorescent microscopy. The effect of annexinC3.1 overexpression on growth rate and protein secretion was investigated in Aspergillus niger. No significance difference was observed in growth rate or level of protein secretion when transformants and wild type were compared (α <0.05). Microscopic examination of annexin C3.1-GFP fusion protein demonstrated that annexinC3.1 is a cytosolic protein which is distributed along the fungal mycelium. This is the first report on annexinC3.1 cellular localization. Annexin C3.1 is a cytosolic protein and its overexpression in A. niger does not increase the protein secretion level.

Femoral fractures occur in 37 per 100,000 people per year. Distal femoral fractures are one of the challenging therapeutic facts, because of its high complications. So, many techniques have been introduced for its treatment. Up till know, there is no comparative study on Retrograde Intramedullary Nailing (RIN) and Locking Condylar Plate (LCP) in Iran and the results of this study may help surgeons to evaluate the real success in these procedures.Patients and In this observational-analytic-cross-sectional study, 38 patients who had undergone RIN or LCP during 2005-2007 were evaluated. The patients were called to come to clinic for re-evaluation of mobility and any possible deformity. For statistical analysis Pearson's correlation, dependent t-test and Chi-sqaure test was used. SPSS V. 16 was also used for data analysis. The distribution of age and gender were the same in two groups. The means of range of motion (ROM), duration of: ::union::: and reoperation were similar as well. The frequencies of knee pain and septic knee were higher in patients who underwent RIN, but mal:::union::: was higher in LCP group. According to results of this and previous studies, LCP is the recommended technique in distal femoral fractures. We found that the result of RIN was poorer in Iran than other countries. We suggest further prospective studies with more sample size in this regard.

Several factors, including abrupt rise of HCG or female sex hormone has been suggested in the development of Hyperemesis gravidarum (HG). However some authors believe that infectious agents, especially Helicobacter pylori (H.pylori) are responsible for HG. In this study, frequency of H.Pylori antibody was compared between HG and non-HG pregnant women.Patients and In this case-control study, 30 pregnant women with HG and 30 non-HG pregnant women who had referred to the clinics of Iran University of Medical Sciences were studied. IgG anti- H.Pylori antibody was evaluated among the two groups. Statistical anatylis was carried out using t-test, Chi-square test and Fischer’s exact test. Mean (±SD) age of case and control groups was 24±5 years and 26.8±5.1 years, respectively (NS). There were no significant differences between two groups regarding age, gravity and parity. Fifteen (50%) pregnant women with HG and 7 (23.3%) non-HG women were anti H.pylori positive which was statistically significant. H.pylori may have potential role in developoing HG. So, it is recommended that those women who like to get pregnant in the near future, should be evaluated for HP and to be treated if tests are positive.

The accurate determination of HER-2 in invasive breast cancer has become a critical issue, particularly in context of the results of Herceptin adjuvant therapy. The aim of this study was to evaluate inter- and intraobserver reproducibility of assessment of HER2/neu immunostaining in invasive breast cancer This study was cross sectional and the convenience sampling method was applied. IHC for HER2/neu was performed on 107 archival invasive breast carcinoma tissues. Protein overexpression was scored independently by 4 pathologists using the criteria recommended by DAKO (0 to 3+ reflecting the intensity and pattern of the immunohistochemical signal present in 10% or more of tumor cells.). After a session in order to train for better evaluation and standardization of the scoring criteria, the samples were evaluated for the second time. A minimum of two months elapsed between the two examinations. The discrepancies in scoring results were reviewed by the 4 observers using a multihead microscope to obtain consensus. The inter- and intraobserver agreements were calculated by kappa statistics. Complete agreement was achieved in 33 (31%) and 40 (37%) of 107 cases in the first and second examinations, respectively. Generally, interobserver agreement was moderate (Kappa=0.44 in the first examination and 0.51 in the second one), with intermediate categories (1+, 2+) showing fair agreement and extreme categories (0, 3+) showing moderate agreement. Intraobserver agreement was also moderate (from the minimum kappa=0.55 to the maximum of 0.60). Considering three groups as negative (0/1+), weakly positive (2+) and strongly positive (3+), interobserver agreement improved but still staying in the moderate level (kappa=0.54 and 0.60 in the first and second time, respectively) with score 2+ group showing the least level of agreement. However, with dividing the cases into two groups as negative (0/1+) and positive (2+/3+), interobserver agreement improved to substantial level (kappa=0.68 and 0.75 in the first and second time, respectively).Also, with this consideration, intraobserver agreement improved to substantial level (0.71 to 0.84). By consensus there were 42 cases (39.2%) that were scored 0, 19 cases (17.8%) scored 1+, 27 cases (25.2%) scored 2+, and 11 cases (10.3%) scored 3+. For 8 cases (7.5%) no consensus was achieved in 6 of them the problem was placing them into 2+ or 3+ category and in 2 cases the problem was placing them into 0 or 1+ category. Our study showed that reproducibility (interobserver agreement) is moderate for evaluation of HER2 status in invasive breast carcinoma by IHC using DAKO criteria. However, for discrimination between negative and positive state, reproducibility (that is in substantial level) is better.

Chronic liver disease and its complications are major problems in renal transplant recipients. Hepatitis B and C virus infections are currently the main causes of chronic liver disease in this group, and these may affect allograft outcome. Whether hepatitis B and C virus infections after renal transplantation adversely affect graft and patient survival, remains controversial. Therefore, the aim of present study was to determine the effects of viral hepatitis B and C on graft and patient survival who underwent renal transplantation.Patients and In this historical cohort study all 1615 patients who received renal transplants between 1986 and 2003 at Hashemi-Nejad hospital in Tehran, Iran were assessed. In addition to demographic data, the presence of HBsAg and/or Anti-HCV antibody, the incidence of acute rejection, graft loss and patient's mortality were recorded. Short term and long term survival rates of the transplanted kidney and the patient itself were analyzed and compared using Kaplan–Meier survival analysis and Log rank test by SPSS V.11. Chi sqaure and Independent t-tests were also used for data analysis. Viral hepatitis B and C were detected in 49(3.03%) of the patients. The mean survival time of the patients and transplanted kidney was 168(SEM=7.36) and 126.50(SEM=11.50) months, respectively. The graft survival rate was 98% and 92%, at 1 and 5 years after transplantation in patients with HBsAg positivity and 100% and 100% at 1 and 5 years after transplantation in patients with anti-HCV antibody positivity. The results of our study showed that HBV or HCV infection is not a contraindication for kidney transplantation in patients with end-stage renal disease. However, it should be noted that HBV and HCV-infected patients who are candidates for renal transplantation should be carefully evaluated both before and after renal transplantation.

Despite many researches done on the relationship between oxidative stress and cellular antioxidant defenses in different cancers, there are limited researches about the role of oxidative stress in bladder cancer. So we decided to study the serum MDA and total antioxidant capacity in patients with bladder cancer in comparison with healthy individuals. During this case – control study, 51 patients with bladder cancer and 58 normal subjects were selected (considering the inclusion and exclusion criteria) by simple sampling. After obtaining write consent from them, blood samples were prepared after 8 hours of fasting. MDA and total antioxidant capacity was measured in all samples. Finally data were compared with student t test between two groups. SPSS V.13 was used for data analysis. There was a significant increase in serum MDA concentration (P < 0.001) and significant decrease in total antioxidant capacity (P < 0.001) in case subjects in comparison with control group. The results of the present study confirm this hypothesis that oxidative reactions and cellular damages induced by such reactions and insufficient antioxidant capacity can be two of the more important mechanisms in bladder cancer induction.

Intoduction: Morgagni hernia is a herniation through the costosternal portion of diaphragm. Morgagni's defect usually occurs on the right side. Morgagni hernia is a rare hernia and occurs more commonly in adults.Case report: A 4 years old child was referred to office for recurrent pneumonias. The patient was under treatment for his pneumonias since 2 years ago. On chest CT scan, transverse colonic segment and air fluid level was seen in the right hemi thorax. With the diagnosis of Morgagni hernia, the patient was prepared for operation. Surgical approach was right thoracotomy. Herniated colon through morgagni defect was observed. The hernial sac was set free from a 2.5x2.5 cm defect in the anterior part of diaphragm. The colon was moved in to abdomen. The defect was repaired by 1-0 nylon sutures. After operation and often 1.5 years follow up, the patient is well with no complications.

Surgical site infection (SSI) is one of the most common complications in patients undergoing surgery, increasing the mortality and morbidity rates in surgical wards. This prospective study aimed to determine the incidence and the main risk factors of SSI after neurosurgical procedures in patients on antibiotic prophylaxis in a teaching hospital at Tehran, Iran.Patients and In this prospective study 543 consecutive patients undergoing neurosurgery were enrolled. All patients were followed for a minimum of 2 weeks postoperatively and all SSIs were recorded. The complete medical records of each case were extracted. Statistical analyses were performed to identify the risk factors for SSIs by odds ratio and Chi-Square test. Statistical analysis was performed by SPSS V. 13. A total of 41 patients suffered from postoperative SSIs among 543 cases included in the study, with a resulting overall infection rate of 7.6%. The risk of SSI was increased by operation type such as "shunt operations", presence of foreign body, presence of diabetes mellitus, CSF leakage, frequent LP, operation time of more than 3 hr and admission in ICU. SSIs remain an important problem in neurosurgery. Identification of the risk factors for SSI will help physicians to improve patient care and may decrease mortality, morbidity, and health care costs of neurosurgery patients.

Although combined "Chemotherapy and Focal therapy" is very efficient in the treatment of the low grade forms of Retinoblastoma (Rb), more effective therapeutic measures are required to control the spread of the disease into vitreous and subretinal areas.This study was conducted with the aim of evaluating the effectiveness of chemotherapy combined with perioricular injection of carboplatin in the treatment of advanced of intraocular Retinoblastoma.Patients and In this prospective interventional case series, 16 eyes from 16 patients with groups C or D retinoblastoma (Rb) (case group) and 18 eyes from 17 patients with groups C or D retinoblastoma (control group) were investigated. Systemic chemotherapy by VEC protocol and focal treatments were done in both groups. In case group, periocular injection of Carboplatin was done as an adjuvant treatment. Examination under general anesthesia and fundus photography by Ret-Cam was done for all patients before entering the study. The mean volume of Carboplatin injections in each session was 15 mg. SPSS V. 15 was used. For statistical analyses Fischers exact, Chi-square and Mann-Whitney tests were used. Mean age was 28.6 months in case group and 26.6 months in control group. There were 7 males and 9 females in case group and 7 males and 10 females in control group. The mean of chemotherapy sessions were 9 cycles in case group and 9.3 in control group. In case group, the mean number of Carbolatin injections in each eye was 3 times (1 to 5 times). Distribution of other focal treatments (cryotherapy, brachytherapy and transpupillary thermotherapy) was almost the same in both groups.In case group, 9 eyes were in group C and 7 eyes were in group D. In control group, 9 eyes were in group C and 9 eyes were in group D. The mean of follow up period was 27 months.At the end of study, in case group 5 eyes (31%) were enucleated 10 eyes were in complete regression and 1 eye was controlled by brachytherapy. Finally 69% of eyes were in complete regression in case group. In control group 10 eyes (55%) were enucleated and 8 eyes (45%) were in regression. Although adjuvant periocular carboplatin injection associated with systemic chemotherapy and focal treatment resulted in more preservation of globe in patients with advanced Rb, the difference however between case group and control group was not significant statistically. So, a prospective randomized clinical trial with larger sample size and longer follow up period is recommended.

Hypocalcaemia has been reported as a complication of phototherapy especially in premature neonates. However, the cause is unknown. The aim of this study was to evaluate the relation between serum and urinary levels of calcium in neonates under phototherapy and to answer the question that whether phototherapy-related hypocalcemia is associated with hypercalicuria or not.Patients and In a prospective cross sectional study, 50 icteric newborns (30 males and 20 females) that were treated by phototherapy entered the study through non accidental sampling. The consent was taken from parents on admission. All were breastfed. Weight was checked. Serum samples for calcium and bilirubin and urine samples for calcium, creatinine and osmolality measurements were sent on arrival (group I), after 48 hours of starting phototherapy (group II) and 24 hours after discontinuing phototherapy (group III). Hypercalciuria was defined as Uca/Ucr >0.8 mg/dl/mg/dl, hypocalcemia was defined by serum calcium less than 8 mg/dl in the term and less than 7 mg/dl in the premature neonates. Chi square test, Repeated measure test, Wilcoxon signed rank test and multivariate were used to compare frequency, means, median and correlation, respectively. P < 0.05 was considered significant. Between 2004 and 2005, 50 healthy newborns (27 premature and 23 term) with mean age of 7.42 days (range 2 days – 28 days), gestational age 36.8 weaks (range 29 wks – 40 wks), weight 3051 gram (range 1500 – 4300 gr), serum bilirubin 19.7 mg/dl (8.5 – 28 mg/dl) and serum calcium of 8.8 mg/dl (range 7-11 mg/dl) were included in study. Mean serum calcium levels in groups I, II and III were respectively 9, 8.65 and 8.7 mg/dl. Also mean of Uca/Ucr in groups I, II and III was 0.03, 0.85 and 0.60 mg/dl/mg/dl, respectively. Similarly mean of Uca to Urinary Osmolality (mg/dl) in groups I, II and III was 0.05, 0.09 and 0.07 mg/dl/mosmol/kg/H2O respectively. Hypercalciuria was detected in 6% in group I, 52% in group II and 32.7% of group III. None of them showed hypocalcemia. Based on Wilcoxon Signed Rank test, there were significant statistical disperences inregard to the median of Uca/Ucr between groups I and II, I and III and II and III (P<0.05). Hypercalciuria was mostly detected in premature neonates. Hypercalciuria was not correlated with age, weight, sex, serum bilirubin, urine osmolality or serum calcium (P>0.05). According to the results of this study, neonates who are treated by phototherapy are at the risk of hypercalciuria. Further investigations for example follow up renal sonography, clarifying the importance of this phenomenon is highly recommended.