مجله علوم پزشکی رازی
سال پانزدهم شماره 1 (پیاپی 58، بهار 1387)

There are many studies about statins showing that these drugs have some anti-inflammatory and immunomodulatory effects and might reduce inflammatory markers in rheumatoid arthritis. The aim of this study is to evaluate atorvastatin effect on clinical and laboratory markers in rheumatoid arthritis. Patients and This study is a randomized, double-blind, clinical trial carried out from March 2005 to July 2006. 66 patients with active rheumatoid arthritis who had been referred to rheumatology clinic in Hazrat Rasool-e-Akram Hospital were selected and divided into two groups to receive atorvastatin or placebo in a double-blind manner. The two groups were similar in terms of disease duration and activity and anti-rheumatoid therapy. 32 patients received atorvastatin and 34 patients received placebo. Patient's data were recorded in the first visit and at the end of the 4th and 24th weeks of therapy. The mean age of the subjets was 51.84 years in atorvastatin group and 47 years in placebo group. Mean duration of the disease was 7.06 years in atorvastatin group and 7.8 years in placebo group. Except for morning stiffness in placebo group, no significant difference was seen in clinical and laboratory findings. This study showed no significant decrease in inflammatory markers in rheumatoid arthritis treated with atorvastatin.

Delayed graft function(DGF) generally refers to oliguria or the requirement for dialysis in the first week post-transplantation. It is the earliest and most frequent post- transplantation complication that can occur. DGF is an extremely important post- transplantation complication because its occurrence has short-term or long-term consequences for allograft survival. However, limited studies have been conducted on DGF and its complications in pediatric renal transplantation. Therefore, the aim of the present study was to determine short-term and long-term effects of DGF on allograft outcome in kidney transplanted children. Patients and In this historical cohort study, 230 children who received kidney transplants between 1985 and 2005 in Labafi Nejad Hospital in Tehran were assessed through a mean follow-up period of 60.96(SD=40.46) months (ranging from 1 to 180 months). The children were divided into two groups: 183 children in group B(no DGF) as the control group and 47 patients in group A (DGF) as the case group. Risk factors of DGF and the impact of DGF on renal function within the first year, long-term graft survival, and post-transplantation complications were investigated and compared using Logistic regression model and Kaplan–Meier survival analysis. The incidence of graft failure at the end of follow-up period was significantly higher in DGF group(53.2% vs. 22.4%, P<0.001). The mean graft survival length was 134.2(SEM=6.17) months in group B and 76.52(SEM=12.41) months in group A(P<0.001). The graft survival rate was 94.9%, 91.9%, 83.9%, 79.2% and 72% at 1, 3, 5, 7 and 12 years after transplantation in children without DGF versus 75.6%, 53.2%, 47.2%, 31.9% at 1, 3, 5 and 8 years after transplantation in patients with DGF. Dialysis before transplantation(P=0.039), acute rejection(P<0.001), immunosuppressive protocol without celcept(P<0.001) and the presence of DGF(P<0.001) were found as the significant risk factors for the occurrence of graft failure in the future. The results of our study showed that delayed graft function could remarkably and independently affect graft survival and worsen both short-term and long-term transplantation outcomes. This result is in contrast with the studies that only believe in the effect of DGF on short-term graft survival. However, in our study when patients whose grafts had failed during the first year after transplantation were censored, still significant differences were noted in graft survival between patients with and without DGF. Thus, the prevention of DGF is one of the most important issues in graft survival improvement.

Phototherapy plays a significant role in the treatment and prevention of hyperbilirubinemia in neonates. However, this treatment modality may itself result in the development of some complications. A lesser-known complication of the phototherapy is hypocalcemia. Some studies reported hypocalcemia accompanied by a decrease in serum melatonin concentration, yet this effect can be prevented by shielding the occiput. The aim of the present study was determining the prevalence of phototherapy-induced hypocalcemia and comparing its incidence between a group of neonates whose heads were covered during phototherapy and a group of neonates who received phototherapy without hat. Patients and In a randomized clinical trial, 120 icteric neonates were evaluated in two groups of 60. All of the subjects were full term and weighed more than 2500 grams. For group A routine phototherapy was done without shielding the head and the second group(B) used hats that covered occipital area. All neonates were completely normal on physical examination. Serum bilirubin and calcium was checked on arrival, 48 hours after starting phototherapy, and 24 hours after discontinuation of the treatment. Group A was considered as the control group. A comparative study was made between these groups to determine the efficacy of hat for prevention of hypocalcemia. 18 neonates(15%) developed hypocalcemia after starting phototherapy. There was a statistically significant difference between the prevalence of hypocalcemia in group A(77.77%) and group B(22.22%)(p=0.000). None of the hypocalcemic neonates was clinically symptomatic. Serum level of calcium returned to normal 24 hours after discontinuation of phototherapy in almost all hypocalcemic neonates. The study showed that covering neonate's head and occipital area during phototherapy decreases phototherapy-induced hypocalcemia.

Almost any medical illness that causes significant pain or discomfort may negatively affect the quality of sleep. Illnesses affecting cardiovascular, respiratory, gastrointestinal, and nervous systems and injuries disrupt the quality of sleep. The objective of this study is to investigate the parameters of sleep and the factors affecting the quality of sleep in medically ill patients. Patients and In a descriptive cross-sectional study, a total of 300 medical patients with various somatic complaints who attended internal, ENT, orthopedic, neurology, urology and surgery clinics were selected. The assessment instrument was Pittsburgh Sleep Quality Index(PSQI) which measures the quality of sleep in 7 major domains. A score of >5 is considered as a significant sleep disturbance. The data were analyzed using descriptive statistics and one-way ANOVA. The mean PSQI score of the patients from all six selected clinics was higher than anchor point(M=8.02). Significant differences were found in sleep duration, sleep disturbances and daytime dysfunction among the clinics. Pain and worry were the major causes of sleep disturbances. Based on the findings of this study, the majority of medical conditions can cause sleep disturbances per se. Because pain and worry may adversely affect the quality of sleep, they should be considered in the assessment and treatment of various medical conditions.

Brucella is one of the most important zoonotic diseases and is caused by the members of Brucella genus especially B. melitensis. The bacteria begin to synthesize heat shock proteins(hsp) when facing elevated temperatures. In this investigation, clinical isolates of B. melitensis were subjected to heat shocks and the hsps produced were surveyed by SDS-PAGE electrophoresis. The immunogenicity of hsp-60 was then investigated in both sick and healthy sera by Western blot. In this analytical descriptive study, five B. melitensis isolated from sick people were cultured. The bacterial isolates were subjected to 39, 40, and 42˚C heat shocks and after lysing the cells by lysozome, cell proteins were extracted by SDS(sodium dodecyl sulfate). The extracted proteins were exposed to electrophoresis in SDS-PAGE followed by staining with Coomasie Blue. Finally, antibodies against hsp-60 in control as well as sick sera were surveyed by Western blot. SDS-PAGE gels revealed protein bands mainly in the range of 10-100 KDa. The major protein groups were in the range of 45-75, 20-30, and 14-20 KDa. The amount of 60 KDa protein band(hsp-60) was significantly enhanced following heat shock in comparison to unheated cells. The sera from Brucellosis patients reacted with several of these cell-derived protein bands in Western blots, none of which were reactive with the sera from healthy individuals. These reactive proteins were in the range of 10, 60, and 100 KDa. The 60 KDa band was the most significant one and showed strong reactions with all Brucellosis serum samples. Significant differences in protein bands were detected by the electrophoresis of the cells subjected to 39 and 40˚C heat shocks in comparison to unheated bacteria. The SDS-PAGE results indicated that Brucella melitensis begins to synthesize heat shock proteins when facing elevated temperatures. The Western blot protein bands of the heat shocked bacteria incubated with sera from sick and healthy individuals showed striking differences. This observation points to the immunogenic properties of hsps, especially the overwhelming response to hsp-60. Therefore, hsp-60 can be a good antigen candidate for ELISA test development as well as for engineering subunit vaccine against Brucella.

Blastocystis hominis is an intestinal parasite in humans and animals. Despite extensive studies, pathogenic role of this organism is controversial. Prevalence rate of contamination with this organism varies from 1.5% to 10% in developed countries and reaches up to 50% in developing countries. The purpose of this study was to investigate total IgG, total IgA and IgG2 subclass in adults infected with Blastocystis hominis and compare them with healthy individuals. Patients and In this cross-sectional case-control study, we selected 100 adults infected with Blastocystis hominis and 100 healthy subjects referred to health service sectors of Iran University of Medical Sciences and Milad Hospital. Serum immunoglobulin examinations were performed by means of nephelometry and Minineph human Ig kit made by the Binding Site Ltd., Birmingham, UK. Data analysis was done by SPSS version 12 and independent t-test. According to the obtained results, there was no significant difference in the level of total IgA between the case and control groups(t=409, P=0.683), but the levels of total IgG and IgG2 subclass showed a significant difference between the case and control groups(IgG: t=2.83, P= 0.005 IgG2: t= 2.02, P= 0.002). The results showed that the immune system response to carbohydrate and glycogenic antigens of the central vacuole of this protozoon leads to an increase in the level of serum IgG especially IgG2 subclass.

Tracheostomy has a distinct role in dealing with upper airway problems. Due to immaturated physiology and structure of airways and differential causes and complications of tracheostomy in children, obstructions and problems of airways are of great value. Unfortunately, there is not enough information about airway problems of this age group available for physicians and other care givers. Owing to the lack of basic information about causes and complications caused by this kind of surgery in Iran, we developed this study to distinguish existing differences between different centers and detect positive and negative points. Patients and In this retrospective case series, we reviewed the files of all patients who had undergone tracheostomy in Hazrat Rasool-e-Akram Hospital from 1993 to 2004. 365 patients who had undergone tracheostomy were investigated but only the files of 344 cases were reliable. 51 patients were under 12 years old, including 12(23.5%) females and 39(76.5%) males. The most common primary causes of tracheostomy were neurologic disorders(19.6%) and subglottic stenosis(15.7%). 9 patients(17.6%) encountered early and 13 patients(25.5%) faced late complications. 11 patients(21.6%) had died but none of these deaths were related to tracheostomy. Primary causes of tracheostomy, complications and their incidence, and patient's mortality rate in our hospital are similar to other centers. It reveals that information level and management of these patients in this hospital are acceptable.

Maxillary sinus lymphoma, regardless of being primary or secondary, is almost always of B-cell type and in most cases is presented with the symptoms of the involvement of sinus, oral, nasal and orbital cavities. Case Report: The patient was a 20-year-old man with no sinonasal and orbital involvement symptoms who had complaints of having a mass in the hard palate and loosening of the two incisor teeth. Diagnostic procedures such as X-ray and local biopsy confirmed B-cell lymphoma. Although loosening of the teeth is a rare presentation, it can open up the possibility of sinus malignancies specially lymphoma if happening spontaneously and without a vindicating reason.

A significant part of "Golden Hour" for urgent health care of children is wasted in prehospital setting, and delays in providing health care may be followed by undesirable outcomes. The current study was conducted with the aim of assessing time indices of pediatric prehospital emergency care in Tehran. Patients and In this cross-sectional observational study, 115 calls requesting urgent health care services for children at the age of 15 and less were extracted from all recorded calls between 2005 and 2006. Demographic variables, accident type, very early outcomes, and time indices(Response time, Scene time, Total run time, Transport time, Round trip time) were registered. We described qualitative variables using frequency tables, and mean and standard deviation were used to describe quantitative variables. Independent t-test and Chi-square were applied to analyze the data. Out of 6787 calls, 1052(15.5%) were related to children. 717(68%) of these calls were because of the problems of internal medicine and the rest(32%) were related to trauma. Road accident(18.7%), epilepsy(18.3%), unconsciousness(12.4%) and respiratory disorders(10.4%) were among the most common causes for 115 calls. 21 subjects(5.36%) died before ambulance arrival, but no one died while being taken to the hospital. The means(SD) of response time, scene time, total run time, transport time, round trip time were 14.98±6.72, 20.90±11.12, 52.60±23.98, 18.45±12.10 and 60.79±30.34 respectively. The mean ages of deceased and survived patients were 7.95±5.04 and 10.74±4.41 respectively(p=0.009). Average ambulance response time was 16.75±3.88 vs. 14.23±6.31 in deceased and survived patients respectively(p=0.022), which was indicative of a significant difference. Some of the time indices in this study are at the level of reported standards around the world but some others are not. The rate of very early mortality in our country is higher than other countries. Therefore, careful planning to improve time indices, assessing the causes of prolonged time indices, and making effective interventions are highly recommended. Also, staff training courses should focus on more common problems such as trauma, convulsion, unconsciousness, and respiratory disorders.

Opiates addiction is a phenomenon with complex physiological and social causes and consequences. The exact mechanisms of development of dependency and relapse remain unclear. Among the several possible mechanisms, the role of learning and memory in opiate dependency and relapse has received considerable attention in recent years. Therefore, in the current study the effect of morphine dependency induced by repeated subcutaneous injection of morphine on the above-mentioned parameters was examined. In this experimental study, animals in both dependent and withdrawal groups received morphine sulfate(10 mg/kg, s.c.) and normal saline was given to the control group. The administration of morphine sulfate and normal saline was done twice per day(8:00 AM & 8:00 PM) for 15 consecutive days. Dependent and control groups were observed from the 11th to 15th day but withdrawal animals were studied from the 16th to the 20th day. The animals were tested for four consecutive days(4 trials/day) to evaluate spatial learning process. During these 4 days(training days) the position of the hidden platform was unchanged. On the fifth day(probe trial) the platform was removed from maze to evaluate spatial memory process. The recorded spatial learning and memory parameters were subjected to ANOVA. The data showed that traveled times and distances to find the hidden platform, the mean of swimming speed on training days, and also the percentage of times and distances traveled in the target quarter in the probe trial stage were not statistically different among the studied groups. These findings clearly imply that morphine dependency induced by the current method has no significant effect on spatial learning and memory, which may result from a relative tolerance to morphine in dependent animals.

Numerous researches have shown that the consumption of ferrous sulfate pills in non-pregnant women causes gastrointestinal complications. Furthermore, pregnancy itself causes changes in gastrointestinal system and induces gastrointestinal disorders. The aim of this study was evaluation of ferrous sulfate side effects in pregnant women with Hb>13.2gr/dl. Patients and This research was a double-blind clinical trial which was carried out on 139 pregnant women with Hb>13.2gr/dl. 88 persons were placed in the case group and 51 in the control group. In the case group, individuals consumed one ferrous sulfate pill containing 50 mg iron, per day, from the 20th week to the end of pregnancy. The control group consumed one placebo tablet per day from the 20th week to the end of pregnancy. The side effects of iron and placebo were investigated in the 24th and 36th weeks of gestation. The results of this study revealed that there was no statistically significant difference in terms of nausea, vomiting, diarrhea, constipation, heartburn, and abdominal cramp between the two groups in the 24th and 36th weeks of pregnancy. It seems that gastrointestinal complications in pregnancy relate more to pregnancy itself than ferrous sulfate side effects.

Auditory steady state response(ASSR) is an auditory evoked response that has received a lot of attention nowadays. At present, ASSR is mostly used to estimate pure-tone thresholds. Clinical evidence of ASSR in combination with findings for auditory middle latency response (AMLR) and 40 Hz response support the assumption that based on stimulus modulation rate, the ASSR anatomic generators are sub-cortical and/or cortical. The goal of the present study was to investigate ASSR findings in a group of young adults with auditory neuropathy/dys-synchrony(AN/AD). Patients and This cross-sectional analytical study was performed on 16 adults with AN/AD (mean age: 20 5.30 years) and 28 subjects with normal hearing(mean age: 22 3.80 years). ASSR test with high rate modulated stimulus was done at four octave frequencies of 500, 1000, 2000 and 4000 Hz on each ear individually in both AN/AD and control groups. Independent t-test was used to compare hearing thresholds obtained by behavioral evaluation and ASSR recording in each studied group individually. Average pure-tone thresholds revealed moderate hearing loss in AN/AD individuals with focus on low frequencies so that the low-tone loss seen in audiograms was observed in almost two-thirds of the subjects, a finding which is common in adults with AN/AD. However, ASSR revealed profound hearing loss at four studied frequencies in all AN/AD patients regardless of behavioral hearing thresholds, and a significant difference was shown between hearing thresholds gained by these two methods, namely PTA and ASSR. Although in clinical setting ASSR is usually used to estimate hearing thresholds in different populations and degrees of hearing loss, its findings are different in AN/AD patients and can be used for differential diagnosis of this disorder. Using high rate modulated stimulus, severe and profound hearing loss or no ASSR is expected in AN/AD. Considering the fact that ABR also leads to the same abnormal results in AN/AD, it seems that the brain generators of both ABR and ASSR are the same and the concordance between their findings can confirm a defect in auditory brainstem function in patients with suspected AN/AD.

The use of opioids to control pain during and after surgeries is a current method in anesthesia, but the side effects of these drugs like nausea, vomiting and respiratory depression have made us decrease their use. One proposal is to use NSAIDs in order to decrease the doses of opioid drugs. One of these drugs is paracetamol which can be used intravenously. In this study we administered two different doses of intravenous paracetamol to help control pain in patients who had upper limb surgeries. The aim of the present study is to investigate whether intravenous paracetamol has a role in decreasing the use of opioids for pain control during and after surgeries. And if the answer is positive, what dose might be effective. Patients and This is a double-blind study which was carried out on 60 ASA(American Society of Anesthesiology) class I patients between the ages of 20 and 40. The subjects were divided into 3 groups, each of which included 20 patients. Group A received 15mg/kg and group B received 30mg/kg intravenous paracetamol before the induction of anesthesia. Group C was the control group. The method of induction and maintenance of anesthesia and pain control during and after surgery was the same in the three groups. The amount of recommended opioids in the three groups was measured and recorded according to a similar protocol. The obtained results were assessed by Chi-square, ANOVA and Scheffe tests. With regard to the amount of administered fentanyl at the time of surgery, the difference between groups A and C and groups A and B was not significant, but the difference between groups B and C was significant(P=0.01). With regard to the amount of administered pethedin for pain control 6 hours after surgery, the difference between groups A and C and groups A and B was not significant, but the difference between groups B and C was significant(P=0.01). It is recommended that 30mg/kg intravenous paracetamol be administered before the induction of anesthesia to decrease the doses of opioids for pain control during and until 6 hours after upper limb surgeries.

Preeclampsia is the major cause of maternal and perinatal morbidity and mortality. Transcranial Doppler(TCD) as a noninvasive procedure is used to assess hemodynamic changes in middle cerebral artery(MCA). Knowing the influence of normal pregnancy and preeclampsia on brain hemodynamics is essential for proper management of anesthesia, labor and vasoactive drug usage in these patients. The aim of the present study is to measure and compare MCA flow velocity in preeclamptic and normal pregnant women using transcranial doppler. Patients and In this case-control study, transcranial Doppler ultrasound was used to measure peak systolic velocity(PSV), end-diastolic velocity(EDV), mean flow velocity(MV), and pulsatility index(PI) in the middle cerebral artery(MCA) of 30 preeclamptic and 30 normotensive pregnant women in the third trimester. Preeclamptic subjects matched the normotensive ones for maternal age, gestational age and gravidity. Statistical analysis was done using independent t-test and Fisher Exact test. Preeclamptic women had significantly higher baseline peak(113.3 compared with 76.31cm/s, P<0.001), end-diastolic(59.1 compared with 38.4cm/s, p<0.001) and mean velocity(73.8 compared with 46.1cm/s, P<0.001) in the middle cerebral artery. Preeclamptic patients had elevated baseline peak, end-diastolic and mean velocity in the MCAs. These findings are consistent with a state of vasoconstriction in preeclamptic women which is unresponsive to stimuli that under normal circumstances result in vasodilation.

Although shivering is one of the consequences of perioperative hypothermia and is rarely considered as the most serious complication, it occurs frequently and remains poorly understood. While cold-induced shivering has an obvious etiology, post-general anesthetic shivering is attributed to numerous causes. Until now, dexamethasone has been used for the treatment of post-general anesthetic shivering. The objective of the present study is to evaluate the effects of intravenous dexamethasone on the prevention of post-general anesthetic shivering. Patients and 80 patients who were candidates for elective knee arthroscopic surgery were selected and randomly divided into case and control groups. Immediately after the induction stage of anesthesia, which was the same for both groups, 0.15 mg/kg of intravenous dexamethasone was administered to the case group. The same amount of distilled water was intravenously administered as placebo to the control group. The temperature of the operating room was kept between 20 and 25 degrees centigrade. When the operation ended, shivering score was measured and recorded by a trained nurse in the recovery room. The patients and the nurse were blind to case and control allocation of the patients. The mean age of the patients, the temperature difference between operating room and patient's body, and shivering score were 27.34 years, 9.52 degrees centigrade and 1.76 respectively. Both groups were matched for age, weight, operating room and patient's body temperature difference, surgery time, recovery time, and the amount of administered fluids. There were statistically significant differences in score and incidence of shivering between the two groups. A statistically significant correlation was also found between administered fluid volume and shivering score in both groups. The obtained results revealed that intravenous dexamethasone is effective in the prevention of post-general anesthetic shivering. This confirms previous studies and it seems that this study supports central mechanism of post-general anesthetic shivering rather than peripheral one.

Preeclampsia is the major cause of maternal and perinatal morbidity and mortality. Transcranial Doppler(TCD) as a noninvasive procedure is used to assess hemodynamic changes in middle cerebral artery(MCA). Knowing the influence of normal pregnancy and preeclampsia on brain hemodynamics is essential for proper management of anesthesia, labor and vasoactive drug usage in these patients. The aim of the present study is to evaluate and compare vasomotor reactivity in normal pregnancy and preeclampsia. Patients and In this case-control study, transcranial Doppler ultrasound was used to measure peak systolic velocity(PSV), end-diastolic velocity(EDV), mean flow velocity(MV), and pulsatility index(PI) in the middle cerebral artery(MCA) of 16 preeclamptic and 15 normotensive pregnant women in the third trimester. Cerebral vasomotor reactivity(VMR) was measured as percentage of changes in peak flow velocity after inhaling 5% co2 for 1-2 minutes. Statistical analysis was done using independent t-test and Fisher Exact test. There was no significant difference in terms of maternal age, gestational age and gravidity between the two groups. Preeclamptic women had higher baseline peak(113.3 compared with 76.31 cm/s, P<0.001), end diastolic(59.1 compared with 38.4cm/s, P<0.001) and mean velocity(73.8 compared with 46.1 cm/s, P<0.001). In comparison to normotensive group, preeclamptic women showed a significant decrease in vasomotor reactivity(4.41% compared with 8.51%, P<0.001). Preeclamptic patients had elevated baseline peak, end-diastolic and mean velocity in the MCAs and decreased VMR in reaction to 5% co2 inhalation. These findings are consistent with a state of vasoconstriction in preeclamptic women which is unresponsive to stimuli that under normal circumstances result in vasodilation. Cerebral edema, hemorrhage, ischemia, and convulsion are all considered as complications developing in preeclampsia or eclampsia. The precise etiology of these complications is unknown but they might be seen due to vascular disturbance. Under normal circumstances, autoregulation maintains the blood flow of the brain subject to a wide range of changes in systemic blood pressure. It seems that autoregulation malfunctions in preeclampsia. Abnormal response given to cerebral perfusion pressure by cerebral vessels might have a role in pathophysiology of cerebral dysfunction which is seen in preeclampsia.

Osteoarthritis(OA) is the most frequent disorder seen in the population and imposes a great financial load on the health systems worldwide. This issue necessitates more evaluations to elucidate factors influencing its incidence, severity or clinical presentations. The aim of the present study is to find out whether helicobacter pylori(H.pylori) seropositivity differs significantly in patients suffering from OA in comparison with healthy population. Patients and In an analytic observational cross-sectional study, an enzyme-linked immunosorbent assay(ELISA) was used to detect H.pylori specific immunoglobulin G(IgG), immunoglobulin A(IgA) and antibodies against cytotoxin-associated-protein A(anti-Cag A) in 90 patients with OA referred to Baqiyatollah rheumatology clinic and 95 healthy control individuals. For data analysis independent t-test was used. The average age was 53(±0.64) years for 84 women and 6 men in OA group and 39.67(±1.12) years for 78 women and 17 men in the control group. Mean serum IgA level was 40.3(±3.75) and 27.26(±2.05) for OA and control groups respectively. In our evaluation this disparity was statistically significant(P=0.003). Anti H.pylori IgG serum level was not significantly higher in patients with OA in comparison with healthy individuals(P=0.128). Also, anti-CagA antibody serum level did not show a significant difference between OA and control groups(P>0.05). Serum level of anti H.pylori IgA antibody was significantly higher in patients with OA than healthy individuals(p=0.003). This finding was not true for anti-Cag A and IgG antibodies.

Breast cancer is the most common cancer in women. Early detection of breast cancer is effective in reducing its mortality rate, and the best method of its screening is breast self-examination. The purpose of this study was to determine the knowledge of breast self-examination among the female students of Shiraz university of sciences and Shiraz university of medical sciences in 2004. Patients and A cross-sectional study was conducted. The sample contained 198 female students of Shiraz university of sciences and 180 female students of Shiraz university of medical sciences. The subjects were selected through stratified random sampling(the major was strata). Data were collected by a questionnaire with a reliability of more than 80% and analyzed by SPSS 11.5. Judging from the answers given to the total 12 questions on the knowledge of BSE, the results showed that the mean knowledge of BSE in the students of Shiraz university of sciences and Shiraz university of medical sciences was 4.7±7.6 and 5.8±2.9 respectively, which was indicative of a significant association(P<0.049). There was no significant relation between the level of knowledge of BSE and family history of breast cancer, age, educational year, and marital status. However, there was a significant association between the level of knowledge of BSE and major(P<0.000). In conclusion, the student's level of knowledge of BSE was lower than average. Therefore, it is recommended that educational practical workshops on the aforementioned matters be held.

Some headaches may originate from sinonasal area and can develop without any inflammation or infection signs. Contact points between lateral nasal walls and the septum may trigger pain via trigeminovascular system. The aim of the present study is to evaluate the role of endonasal endoscopic surgery in the management of sinonasal headaches with special regard for diagnostic criteria and patient's choice. Patients and In this prospective, non-randomized, quasi-experimental study, 36 patients suffering from chronic and refractory headaches were evaluated by examination(rhinoscopy and/or endoscopy), sinus CT scan, anesthetic test and then categorized into four groups according to the diagnostic method. Pain severity prior to and after surgery(with an average follow-up period of 18 months) was assessed by VAS(visual analogus scale) method(0-10 scale) and analyzed by ANOVA. Overall success rate was 83%, including 11% cure and 72% improvement. The best response was noted in patients whose diagnostic criteria were all positive. The response in all patient groups except those who only had positive examination was statistically significant. 39% of the patients had been previously diagnosed with migraine and 78% of them developed improvement. Surgery in cases with more positive evidence of contact points, particularly if medical therapy has failed, could be successful. This issue may be acceptable even in migrainous patients.

Vitiligo is a common skin disorder with unknown origin. An increased prevalence of autoimmune diseases, including thyroid diseases, has been described in patients with vitiligo. The aim of this study was to assess the prevalence of thyroid dysfunction and hypoparathyroidism in patients with vitiligo. Patients and One hundred and nine patients(38 males & 71 females) with vitiligo were studied. Thyroid physical examination and thyroid function tests were done. Thyroid antibodies, calcium and phosphorus were measured. The collected data were analyzed by using SPSS version 11. 30.1% of the patients had thyromegaly. Hypothyroidism was found in 16(15.7%) out of 109 cases. Two of them had clinical and 14 subclinical hypothyroidism. One patient had Graves disease. Anti-body positivity was the most common disorder(anti-TPO & anti-tg were positive in 36.7% & 32.1% respectively). No patient had hypoparathyroidism. According to our study, thyroid dysfunction especially hypothyroidism and thyroid antibodies increase in patients with vitiligo. Therefore, we recommend thyroid antibodies assessment and thyroid function evaluation in these patients.

During recent years, the quality of life as one of the important outcomes of chronic diseases has been paid attention to by clinical researchers. The aim of this study was to determine the quality of life of the patients with HIV/AIDS referred to the West consulting center of behavioral diseases in Tehran and to draw a comparison with the quality of life of healthy persons. Patients and Using simple sampling method, this cross-sectional study was carried out on 139 patients and 139 healthy subjects in the control group matching the patients for age and sex. The study made use of the summarized quality of life questionnaire of World Health Organization(WHO-Qol-Brief). Demographic and clinical variables associated with the quality of life of HIV/AIDS patients were assessed. Statistical tests like t-test, Chi-square, One-way ANOVA, and Linear regression were used for data analysis. The majority of the patients(88.5%) were male with secondary education. 28.1% were married and the majority of them were unemployed. The average age of the cases was 35.49 years(6.42 SD). A significant difference was seen between the patients and the control group in all aspects of quality of life(P<0.001). The variables such as sex, marital status, education, job, CD4+ cells count, and the clinical stage of the disease had a significant effect on the quality of life of the patients. In multivariable analysis, the most important predictive factor in the quality of life of the patients was the clinical stage of the disease. Providing psychosocial services with continuous and multidisciplinary care models besides medical interferences can promote the health-related aspect of quality of life in patients suffering from HIV/AIDS.

5-iodo-2-deoxyuridine(Iudr) is a thymidine analog that is known as a radiosensitizer for human cancer cells in in vitro and in vivo studies. The investigations on the spheroid have shown that Iudr uptake of cells increases with the increasing Iudr incubation time. The aim of this study was to evaluate the extent of cytogenetic damage induced by ionizing radiation at different intervals of cell incubation with Iudr using comet assay. In this basic experimental study, U87MG, a Glioblastoma cell line was cultured as spheroid in two different sizes, 100 and 300µm. The spheroids were incubated with Iudr in three different volume doubling times. Then they were irradiated by 2Gy of gamma radiation of cobalt 60. The extent of DNA damage was measured using alkaline comet assay and the data were analyzed by Student's t-test. The results showed the extent of DNA damage induced by gamma radiation in combination with Iudr was greater in spheroids with 300µm of diameter than spheroids with 100µm of diameter. Investigations revealed that the DNA damage after two volume doubling times of incubation with Iudr is significantly more than one volume doubling time of incubation in two different sizes of spheroids, but the extent of damage in spheroids with 300µm of diameter was larger. However, there is no significant difference between the DNA damage after incubation for two and three volume doubling times. As it can be seen, two-volume-doubling-time incubation of cells is more suitable than one or three volume doubling times to develop radiation sensitivities.

Good balance is essential to do daily activities. Recent studies have focused on the adaptability of balance through previous experiences and training. Study of the balance of people who have had some kind of these experiences can clarify the nature of the adaptability of balance. The aim of the present study is to evaluate balance ability in persons who are exposed to balance perturbations during daily activities for a long time in order to confirm the effects and durability of balance training exercises that are important in rehabilitation. Patients and This is a cross-sectional experimentalloid study conducted on 60 healthy subjects divided into 2 groups, each containing 30 adult women who were selected by simple random sampling and inclusive criteria. Group 1 had no experience of using high-heeled shoes during 6 months prior to the experiment and group 2 had the experience of continuous use of high-heeled shoes(more than 3 cm) for at least 6 months. Using Biodex Stability System, Overall Dynamic Stability Index(ODSI) and Overall Limits of Stability Index(OLSI) were recorded while the subjects were wearing shoes designed at three heel heights(0cm, +3cm, +5cm) in different trials. ODSI and OLSI were dependent variables that were compared in each group by repeated measurement test and between the groups by independent t-test. The data analysis was done by SPSS version 10. In group 1, with increasing heel height to +5cm as compared with 0cm or +3cm, the ability of balance control decreased significantly(p<0.05), but in group 2, with increasing heel height, no significant difference was detected in the ability of balance control. Besides, the two groups were significantly different in terms of ODSI for +5cm heel height(p<0.05). Different biomechanical factors such as changing the position of ankle joint and neural factors such as dependency on feedback system could explain lack of rapid and suitable muscular responses and balance control with increasing heel height in the subjects of group 1. Although there were the same changes in heel height and biomechanical factors in group 2, it seems that the changes in neural factors which are due to the prolonged use of high-heeled shoes might be the reason for the difference between the two groups. Suitable anticipatory responses to control the balance with increasing heel height could explain the results in this group. There might be some kind of adaptation and learning in group 2 due to the prolonged use of high-heeled shoes. The findings support the adaptation in C.N.S and permanent changes in the strategies of balance control during daily motor activities.

Cupping therapy(Hejamat) as one of the methods used in traditional Iranian medicine is now progressively applied. Some scholars are seriously against this method of treatment, while some others admit it without questioning. The goal of this study is to assess traditional treatment centers and their clients in Tehran. The study also intended to determine demographic features of the clients, the frequency of illnesses for which the patients were referred to these centers, and the client's satisfaction with cupping therapeutic effects. Patients and This cross-sectional study was done on 400 clients attending 15 traditional medical centers through a questionnaire and interviews. Random sampling and simple sampling methods were used to select the studied Hejamat centers and the subjects respectively. Mean, SD(standard deviation) and frequencies were reported to describe the data. Chi-square and Kruskalwalis test were used to analyze the obtained results. The results revealed that over 85% of the clients were satisfied with the therapeutic effects of Hejamat. Most of the subjects were men, married, low educated and had a below-average monthly income. 63% believed that this method was less expensive than other methods of treatment. Strong faith in the usefulness of Hejamat and religious beliefs were the most common motivations on the part of the clients. With regard to increasing use of cupping to treat a wide group of illnesses and the client's satisfaction, presenting suitable and proper use, informing people of its usage, and supervising the above-mentioned centers should be considered by authorities.

Infants suffering from chronic renal failure should be treated by peritoneal dialysis, hemodialysis or renal transplantation. Unfortunately, the last two modalities are fraught with too many technical difficulties to be used in very young infants. Therefore, until proper weight and age are achieved, prescribing CAPD(Continuous Ambulatory Peritoneal Dialysis) will be mandatory. Providing national registry in many countries has helped to improve the quality of care provided for the patients on CAPD. For this reason we decided to do a multicentral epidemiological study of Iranian children on CAPD. Patients and The records of children on CAPD referred to three main dialysis centers(Ali Asghar, Markaz Tebi, and Mofid Children's Hospitals) from 1993 to 2004 were collected and reviewed retrospectively. The incidence rate of peritonitis and patient's survival rate were determined. T-test, Chi-Square, and Kaplan Mayer were used to compare means, frequency and survival respectively. Cox regression was applied to determine factors influencing survival and correlation coefficient was calculated to reveal the relation between variables. P<0.05 was considered significant. Between 1993 and 2004, 57 children(27 females, 30 males) with a mean age of 32.3 months(ranging from 0.08 to 156 months) were on CAPD. The etiologies of renal failure were hereditary(10.5%), cystic(22.8%), glomerulopathy(33.2%), uropathy(14.3%), dysplasia(8.7%), and miscellaneous or unknown(10.5%). 99 Tenckhoff catheters were inserted surgically. The most frequent surgical complications were hernia and leakage. Peritonitis rate was 1:4.85 patient's months. The rate of peritonitis was higher in children under 12 months, those with Tenckhoff catheters, and children with a low weight and BMI(Body Mass Index) at the start of CAPD(P=0.01). The results of peritoneal fluid cultures were as follows: gram positive(32%), gram negative(28%), negative(30%), and fungi(10%). There was a significant correlation between fungal peritonitis and peritonitis rate and the first episode of peritonitis(P=0.01). The mean of patient's survival rate was 0.9 years(95% CI 0.61-1.16). The outcomes of children were recovery(10.5%), transplantation(8.8%), switch to hemodialysis(7%), still on CAPD(14%), death(57.9%), and 1.8% were missed out. Due to the high rate of mortality and morbidity in children on CAPD, we recommend tighter nutritional control, periodical re-education to parents, and expert medical staff to improve the prognosis.