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Environmental factors and host genetic are important factors indifferent outcomes of HBV infection. One of these genetic factors is polymorphisms of regulatory genes of cytokines. Single nucleotide polymorphisms (SNP) in the promoter region of the interleukin (IL)-10 gene has been reported to have a role in determining of hepatitis B virus (HBV) infection outcome. The present study was undertaken to evaluate the association between HBV infection and SNP in the promoter region of the IL-10 gene. A total of 127 cases including 30 subjects who had spontaneouslyrecovered from HBV infection, 34 healthy carriers, 32 patients with chronic hepatitis B and 31 healthy controls were enrolled in this study. The three biallelic (-819,-592,-1082) polymorphisms in the IL-10 gene promoter were analyzed by PCR and direct sequencing. No significant difference was found in frequencies of genotypes and haplotypes of IL-10 gene promoter region at position -1082, -819 and -592 among controls, individuals spontaneously recovering from HBV infection, carriers and patients with chronic hepatitis B infection. However, frequencies of A/A genotype at position -592 and T/T genotype at position -819 were higher in the HBV clearance group while frequency of G/G genotype at position-1082 was higher in persistence group. GCC/GCC and GCC/ACC haplotypes were significantly more frequent in anti-HBe positive patients. It seems that genetic polymorphisms of IL-10 promoter region are not associated with HBV infection outcome. However, patients with high and intermediate producer haplotypes of IL- 10 had more ability to produce anti-HBe than those with low producer haplotypes.

Regional anesthesia is strongly recommended for caesarean section, but the most important preventing factor is patient refusal. This study is conducted to determine the factors influencing choice of anesthesia and the refusal reasons. 240 pregnant patients candidate for elective caesarean section, just prior to surgery were interviewed about choice of anesthesia and reason for it, history of previous anesthesia and knowledge of anesthesia. Data's were recorded in a questionnaire 120 patients preferred GA while 72 patients chose SA. For 48 patients made no difference. The most common reasons for refusing spinal anesthesia were fears of back pain, hearing or seeing and headache. Fear of not waking up, nausea and vomiting and feeling pain were refusal factors of GA. Patients had knowledge about GA (64.2%) and SA (76.7%). The rest (11.2%) had no information about anesthesia. Level of education related to knowledge of anesthesia (p<0.05) although had no correlation to choice of anesthesia. Source of information were mostly other patients and relatives (50%), previous experience of anesthesia (36.3%), medias (10.08%) and anesthesiologist comment (0.08%) as an influencing factor. The majority of patients prefer GA in odder to avoid spinal anesthesia and its complications. By improving information and effective communication, spinal anesthesia may be encouraged for caesarean patients.

There are several studies which have shown that adenotonsillar hypertrophy can cause airway obstruction, chronic alveolar hypoventilation and even may lead to severe cardiopulmonary complications like pulmonary artery hypertension. The aim of this study was to evaluate the effects of adenotonsillectomy on pulmonary arterial pressure in children with hypertrophic tonsils and adenoids. fourty children (21 males, 19 females) aged between 4 and 14 (mean 7/9±2/3) years with a diagnosis of upper airway obstraction due to hypetrophied tonsils and adenoids were included in our study. Pulmonary arterial pressure was measured by Doppler echocardiography both preoperatively, and 6 weeks after opertion. Preoperative pulmonary arterial pressure (PAP) was 26/1 ± 3/9 mmHg and post-operative PAP was 25/9 ± 5 mmHg. Although in two cases out of three ones who had raised preoperative PAP, adenotonsillectomy resulted in decreasing the pressure, but there was no statistically significant difference between pre-operative and post-operative echocardiographic findings. It seems that whilst increasing of pulmomary arterial pressure (owing to Adenotousillar hypertrophy), adenotonsillectomy can be of beneficial outcomes in decreasing this pressure

Liver fibrosis is an inevitable result of chronic liver diseases which may ultimately lead into liver cirrhosis. Diagnosis and grading of liver fibrosis is of considerable importance in both treatment strategy, treatment response, prognosis and potential risk factors for the disease complications. Although liver biopsy is the best known technique for evaluation of liver fibrosis, researchers have been searching for a more appropriate alternative to be used instead due to its harsh nature along with several side effects. One of the suggested ones is the use of biochemical markers. Our aim in this study, therefore, was the assessment of some of these biochemical markers. In a retrospective trial, 130 patients (94 men (72.3%) and 36 women (27.7%)) of whom had undergone liver biopsy, were studied. Former biopsy samples were reviewed. Gathered data from their medical file and pathology reports were analyzed by SPSS 11.5. It was revealed that there was a positive correlation between age and severity fibrosis. There was no significant relationship between liver fibrosis and gender. Comparing the patients with liver fibrosis and non-fibrotic ones, we found that the AST/platelet index is an appropriate marker for distinction of these patients. To distinguish the patients without liver fibrosis from ones with moderate liver fibrosis, a cut off point=0.39, PPV=0.7 & NPV=0.54 was obtained, whereas for differentiating them from sever liver fibrosis patients, the cut off point of 0.25, PPV=0.76 &NPV=0.7 was achieved. Distincting the mild and moderate fibrosis, platelet was found to be an appropriate variable, having a cut off point of 158500. Moreover, to set mild and sever fibrosis apart, platelet and albumin were more valuable. In this study cut off point of 151000 for platelet and 3.6 for albumin was obtained, respectively. Similar to other relevant studies we also could not find any appropriate marker for making the distinction between moderate and severe fibrosis. Our study outlines that AST/platelet index has an appropriate cut off point for distinction between non-fibrotic and moderate and sever liver fibrosis. Distinguishing the mild cases from both moderate and sever fibrosis, platelet is a good marker. Furthermore, albumin is another marker for distinction between mild and sever fibrosis. The studied markers are not able to distinct all stages of fibrosis. Due to their limitations, they can not be applied in various clinical situations. 3 In this regard, no definite substitute for liver biopsy has been found yet. Acquiring a test or technique that contains all necessary standards for evaluation of liver fibrosis requires further studies and researches

Classically, one’s heart function is mostly based upon its systolic functiom, whereas the diastolic function steps on second order. In recent years it has been revealed that diastolic function plays an important role in both cardiac mortality and cardiac morbidity. On the other hand is hypertension which due to increasing the afterload, interferes with these functions of heart. In this study we assessed the diastolic function of hypertensive patients using pulse tissue Doppler. 30 patients with high blood pressure that had not consumed anti-hypertensive agents and along with 30 healthy control ones enrolled in our survey, all of whom had normal sinus rhythm without detectable symptoms corresponding to congestive heart failure, ischemia, valvular diseases and pulmonary problems. 2D echocardiography was performed in both groups as well as M Mode and Doppler ech. The PTD echo was performed by the lateral annulus of both tricuspid and mitral valves. Systolic and diastolic findings were measured by PTD. Hypertensive patients had negative diastolic findings but no negative systolic ones. PTS illustrated that E/A ratio (early peak velocity / late peak velocity) in right ventricle had significantly decreases (P<0.01) among these patients. In right ventricle, both RT (relaxation time)(P<0.01), DT (decelation time)(P<0.04) and Am (Late Peak Velocity) (P<0.03) were converesly increased. Right ventricular E/A ratio had a significant correlation with that of left ventricl (P<0.005, r =0.5). It seems that hypertension is longitudinally related with diastolic disfunction of right ventricle. This disturbance would be represented by the lengthened RT and decreasing of E/A ratio which are both resulted from interfering of two ventricle’s function and increased pressure of left ventricle. Therefore, PTD can be applied to evaluate the right ventricular diastolic function among patients with high blood pressure.

Liver biopsy is the best known technique for evaluation of liver fibrosis. However, alternative diagnostic methods have been investigated to replace this invasive procedure. Our aim was to assess the diagnostic performance of platelet count and biochemical markers for the staging of liver fibrosis in our patients. In a descriptive study, records of all consecutive patients who underwent liver biopsy at Loghman Hakim & Taleghani hospitals between March 2000 and March 2004 were retrospectively studied. The clinical and laboratory data were obtained from patients'' clinical records. Liver histology samples were reviewed by an expert pathologist. The platelet count, serum albumin levels, and the ratio of serum aspartate aminotransferase (AST) levels to platelet count were used as markers for fibrosis. Cutoff points for some of these markers were established using the ROC curve. One hundred thirty patients (94 males & 36 females) were studied. The AST/platelet ratio at the cutoff point 0.39 had a positive predictive value (PPV) of 0.70 and a negative predictive value (NPV) of 0.54 to differentiate patients without liver fibrosis from those with moderate fibrosis. This ratio had a PPV = 0.76 and NPV = 0.70 to differentiate patients without liver fibrosis from those with severe fibrosis when used at a cutoff point of 0.25. The platelet count at the cutoff point of 158500 was used for the distinction of mild from moderate fibrosis. The platelet count at the cutoff point of 151000 and serum albumin at the cutoff point of 3.6 were used for distinction of mild from severe fibrosis. No single marker was found to diagnose different stages of fibrosis. The AST/platelet ratio had an appropriate cutoff point to differentiate patients without liver fibrosis from patients with moderate to severe liver fibrosis. The clinical utility of these tests requires further investigation.

All chronic hemodialysis patients for hepatitis B infection have to be tested and vaccinated against HBV infection routinely. A descriptive study was designed in 47 hemodialysis patients. After a blood sample was taken for serologic status, three doses (0, 1, 6 month) of hepatitis B vaccine were administered. Repeated titers were obtained one month after the last vaccination and analyzed by ELISA. 39 patients (83%) became immune with protective levels of HBs antibody. There was not a significant correlation between sex, age, smoking, underlying diseases, weight, duration of dialysis and positive HBs antibody after vaccination. Hmodialysis patients need follow-up testing.

Due to threatening of public health, Collection, separation and sanitary disposal of hospital solid waste are important. This research was performed to evaluate the management of hospitals’ solid waste affiliated with Shaheed Beheshti Medical University during 1384. In this descriptive study the status of solid waste management of 13 hospital affiliated with Shaheed Beheshti Medical University was evaluated using a questionnaire in association with technical observation and interview. During the summer and winter, weighting the solid waste were performed in “Ayatollah Taleghani” and “Massih Daneshvari” Hospitals for three continual days and data were analyzed using SPSS program. 64.2% of hospitals were using bucket and plastic bags for keeping their solid waste. 30.8% of hospitals were collecting their solid waste manually. In 46.2% of hospitals, utilities using for collecting the solid waste were not being disinfected. 15.4% of hospital did not have any temporary place for keeping solid waste. 27.3% of temporary places had only water tab and sewer pipe without having refrigerating room. 7.7% of hospital had just an open temporary-solid waste storage. In 25% of hospital which were producing radioactive solid wastes, collect their radioactive solid waste with normal solid ones. Radioactive solid waste containers in 50% of hospitals were not made form lead. None of hospitals had necessary and safety facilities. In 38.5% of hospital, loading of solid wastes were performed manually. In 15.4% of hospitals solid wastes were recycled. 42.3% of them were not separating their infected solid wastes from ordinary ones. 15.4% of hospitals did not have any special bags for separating infected solid wastes. In 92.3% of hospitals both infected and ordinary solid waste were carried out together. None of the hospital had hazardous less process for solid wastes. 79.6% of hospitals had workers without special education. Daily average of production volume of solid waste in these hospitals was measured 6426.9 liters. In “Ayatollah Taleghani” and “Massih Daneshvari” Hospitals 407.41 Kg of solid wastes were produced, whilst 49.7% of these solid wastes were infected. Results show that the management condition of solid waste in the studied hospitals is not satisfactory. Methods for disinfecting hospital waste should be studied. Separation of hazardous solid waste from ordinary solid waste should be performed, precisely. Education of hospital workers should be seriously followed.

Considering the prevalence of dysmenorrhea and its importance for women as well as social qualities and public tendency toward alternative complementary and herbal drugs, this study was carried out to determine the effect of Menastil on primary dysmenorrhea on students residing in Dormitories’ universities of Saveh 2005. This placebo-controlled double-blind clinical trial was performed on 72 single students between 18 and 26 years old with primary dysmenorrhea. Data were collected through a questionnaire which included demographic factors, exercise, stress factors, use of medicines, and the McGill pain ruler for determining of pain severity. Subjects were classified into two groups of moderate (4≤ Score ≤7) and sever (8≤ Score ≤10), base on their pain severity. Subjects with scores of less than 4 were excluded from this study. All Subjects randomly allocated into two groups (1) the experimental group who received the vials of Menastil and (2) the placebo group. Two drops of Menastil (calendula+mint) was used topically during the menstruation in the form of an abdominal massage for two months. The placebo group received the same mode of treatment with the vials contained baby oil and mint. The menstrual cramp levels were assessed, using a visual analogue scale (McGill Ruler) and severity of dysmenorrhea was measured by a verbal multidimensional scoring system. Data were analyzed applying Freedman and Mann-Whitney statistical tests. Demographic characteristics (age, height, weight & menstrual status) were similar between two groups. The score of dysmenorrhaea reduced in both groups. The results showed that compared to placebo, Menastil decreased more the severity of dysmenorrhea so that the difference between two groups was significant (P<0.0001). Also, the consumption of pain relief agents and the amount of menstrual bleeding decreased by Menastil therapy. Moreover, there was no side effect with this mode ot treatment. The consumption of menastil decreases primary dysmenorrhea. The investigation of effects of long term consumption of menastil (6 months) is recommended.

Recently, the high prevalence of Helicobacter pylori infection has been reported in adult patients with chronic immune (idiopathic) thrombocytopenic purpura. Furthermore, after Helicobacter pylori eradication therapy in such patients, their platelet counts have been observed to increase, suggesting that Helicobacter pylori may be a causative agent of adults’ chronic idiopathic thrombocytopenic purpura. However, there have been only a few reports of this subject in children with chronic thrombocytopenic purpura. The purpose of this study is to determine prevalence of Helicobacter pylori infection in Iranian children with chronic thrombocytopenic purpura and role of Helicobacter pylori eradication in rising platelet count of these patients. This descriptive-clinical trial study was performed in 31 children under 14 years old with chronic thrombocytopenic purpura who attended hematology ward of Mofid paediatric hospital. After determining platelet count, and filling the results patients referred to gastrointestinal ward of the hospital to perform urea breath test for evaluation of Helicobacter pylori infection, then Helicobacter pylori-infected patients who were diagnosed by this test, received eradication therapy using triple therapy regimen (containing Omeperasole, Amoxicillin & Clarithromycin) for 2 weeks and their platelet counts were recorded during the follow up period. Mean age of the patients was 8.93.2 years old ranging from 3.5 to 14 years old. They were 17 (54.9%) girls and 14 (45.1%) boys. Mean platelet count of the patients was 51.4 34.3  109/ L ranging form 125109/ L to 8109/ L. Mean duration of disease in the patients was 27.720.2 months ranging from 7 to 96 months. Helicobacter pylori infection was found in only 4 children (12.9%) and Helicobacter pylori eradication therapy was not effective Pejuhandeh Vol.12, No 56, 2007 2 in rising platelet count to achieve complete or partial remission. Comparing Helicobacter pylori-positive and negative patients, there were no significant differences regarding their age, platelet count and duration of disease. This study shows that prevalence of Helicobacter pylori infection in children with chronic immune thrombocytopenic purpura is less than that is in adults. Furthermore, we have found that platelet count in Helicobacter pylori-positive children have not been risen after eradication therapy. We suggest that more studies in different gender groups and different zones in the world with more number of samples should be performed, especially in children in order to determine both the exact role of Helicobacter pylori‘s pathogenesis in developing the chronic idiopathic thrombocytopenic purpura and the effectiveness of eradication therapy in rising platelet count in these patients.

Primary and secondary infections and malignancies are inflammatory causes of fluid accumulation in the pleural space. TB is one of the infective causes of pleural effusion and is similar to malignancies because of its subacute and chronic process; although their management is extremely different.CA-125 is a glycoprotein tumor marker with molecular weight of 200 KD, which is found on the surface of ovarian and some normal and inflammatory cells. In both malignancy and tuberculosis, this tumor marker increases in serum and consequently in pleural fluid. This study was conducted to evaluate and compare CA-125 tumor marker in pleural effusion resulting from malignancies and tuberculosis. twenty-seven TB patients (18 men and 9 women), with the mean (±SD) age of 37.3±13.9 yrs. and 23 patients affected by malignant tumors (16 men and 7 women) with the mean (±SD) age of 57.9±17.7 yrs. were evaluated during 2004-2005. In malignant cases, diagnosis was made through microscopic inspection of the biopsy samples and cytology of pleural fluid. For recognition of tuberculosis, culture and smear of sputum or gastric lavage, biopsy of pleura and pleural fluid and PCR methods were used. Pleural fluid samples were collected and the amount of their CA-125 was measured by CLIA method. The cut-off value of CA-125 was obtained from a ROC curve. The mean (±SD) level of CA-125 in pleural fluid was 159.1±214, and 2149.2±4513.6 U/ml in tuberculosis and malignancies, respectively; which showed a statistically significant difference between the two groups (p<0.01). CA-125 marker levels in pleural effusion may be used as a diagnostic index for differentiation of TB and malignancy induced pleural effusions. (Tanaffos 2005; 4(16):23-27)

We evaluated the association of active pulmonary tuberculosis with level of serum adenosine deaminase in order to have an acceptable rapid test to help the clinicians in the diagnosis of active pulmonary tuberculosis. We measured serum total adenosine deaminase level in three groups:1- Cases of active pulmonary tuberculosis that were confirmed by positive sputum smears for acid-fast bacilli in association with compatible clinical and radiological findings.2- Cases of other infectious diseases including brucellosis, endocarditis, salmonellosis, and meningitis confirmed by clinical findings and related laboratory tests.3- Healthy controls.Serum adenosine deaminase levels were measured before starting the treatment. Data analysis was performed by Chi-Square; ANOVA and LSD tests. The significant level was evaluated for p- value of less than 0.05. We evaluated 51 cases (21 females and 30 males aged 47.7±19 years) of active pulmonary tuberculosis, 11 cases (6 females and 5 males aged 44.7±21 years) of other infectious diseases and 50 cases (14 females and 36 males aged 48.4±11 years) of healthy individuals. Mean serum adenosine deaminase level in pulmonary tuberculosis (42.4±21.5 IU/ml) and other infectious diseases (38.3±23.4 IU/ml) was significantly more than controls (26.6± 8.2 IU/ml), (P<0.0001 and p<0.03 respectively), but the difference between the pulmonary tuberculosis and other infectious diseases was not statistically significant. There was no significant difference in age and gender between the above mentioned groups. We conclude that serum adenosine deaminase level increases in infectious diseases but it cannot differentiate pulmonary tuberculosis from other infectious diseases. (Tanaffos

The need for a rapid, non-invasive method for unwanted hair removal has led to the development of various light sources for this purpose. To evaluate the efficacy of Intense Pulsed Light Source (IPLS) on unwanted hairs. Patients and In this open, uncontrolled clinical trial, 77 different anatomical areas in 34 referred patients to “Novin Didegan Clinic” in Tehran in 1380-1381, were treated by IPLS at fluences ranging from 22 to 34 J/cm² after their demographic data and the number of hairs were recorded. The 3 to 7 treatment sessions were accomplished 4 to 6 weeks apart. All of the patients were followed 6 months after the last therapy. The quantitative data were analyzed by paired t test. Six months after the last therapy, more than 50% reduction in number of hairs were noted in 80% of the treated areas; with mean reduction of 72±23 percent. Side effects were mild and reversible and occurred in ten patients. The IPLS appears to provide an effective and safe method for long-term excess hair removal in various skin types.

Besides charging the patients with outstanding costs, tuberculosis (TB) causes high mortality and morbidity in a country. We studied the sensitivity, specificity, positive and negative predictive values as well as the efficiency of buffy coat smear test in patients who were pulmonary TB suspects. This research was conducted at Massih Daneshvari Hospital, National Research Institute of Tuberculosis and Lung Disease (NRITLD). According to clinical and radiographic records of 50 pulmonary TB suspects, five ml of blood along with smear and culture of sputum were collected. The research method was a clinical trial (Diagnostic test type), and the technique was of observational-interview type. Six buffy coat smears were obtained by Ficoll-Hypaque sedimentation method while the samples were stained by Ziehl-Neelsen stain. On sputum examination, 32 patients (64%) were B.K positive while 22 (44%) had positive sputum culture for Mycobacterium tuberculosis. Buffy coat was positive in 4 patients (8%). In comparison with sputum smear and culture, buffy coat had sensitivity of 12.5% and 13.6%, specificity of 100% and 96.4%, positive predictive value of 100% and 75%, negative predictive value of 39.4% and 58.7%, efficiency of 44% and 60% respectively. In regard to the high specificity of buffy coat as compared to sputum smear (100%) and sputum culture (96.4%), it is possible to consider buffy coat as a method for screening tuberculosis patients that cannot expectorate sputum. Since buffy coat method has a high positive predictive value as compared to sputum smear (100%), it could replace other unavailable accurate methods like sputum culture and PCR and be used as a substitution for sputum smear. (Tanaffos 2003; 2(7): 41-45

Hemodialysis patients are at risk of acquiring tuberculosis, which is most often due to reactivation of the infection. As a result, screening for tuberculosis is recommended in hemodialysis patients. In this study, the rate of response to cutaneous PPD along with tetanus and diphteria toxoid antigens have been evaluated to define in hemodialysis patients. This clinical trial was conducted on 67 chronic hemodialysis patients in Labbafi Nejad Hospital during March- May 2001. PPD, tetanus and diphtheria toxoid solutions, with 1/10 dilution were administered by Manteaux technique and the induration was evaluated 48-72 hours, 7 and 9 days after. Of 64 patients, 18.8% had positive PPD tests and 26.6% had negative anergy tests through the first evaluation. The degree of constancy in the results of PPD and anergy tests during the three-time evaluation period were 23.4% and 18.7%, respectively, and the degree of induration was increased or decreased among the rest. Hemodialysis patients are at the increased risk for acquiring tuberculosis. Thus, negative cutaneous PPD results should certainly be revised and evaluated using anergy tests and repetitive readings of the test results. Attention must be paid to the “Delayed Type Hypersensitivity” (DTH) phenomenon presenting for the first time in the analysis of cutaneous test results. Finally, it is recommended to reconsider the value of cutaneous PPD test and its method of analysis in hemodialysis patients. (Tanaffos 2002; 1(2): 21-26)