Razi Journal of Medical Sciences
Year:2006 | Volume:13 | Issue:52|Papers Count:31

Background & Aim: Molecular epidemiology is the using of molecular techniques (e.g. Spoligotyping, RFLP VNTR) in order to study bacterial distribution in human populations. The aim of this study was to investigate the prevalence of all genotypes in M. tuberculosis strains typed by spoligotyping and to determine the associated risk factors in patients with different  nationalities residing in Iran.Patients & Methods: In this analytic cross-sectional study a total number of 439 patients who referred to NRITLD (a referral tuberculosis center in Iran) were registered during March 21st 2003 to March 21st 2004. The isolated Mycobacterium tuberculosis strains were characterized by performing susceptibility tests against four first-line antituberculosis drugs and were then subjected to spoligotyping characterization. T-test and ch-square test were used for analysis of the data.Results: Spoligotyping of M. tuberculosis strains resulted in 140 different patterns divided into three evolutionary groups(I, II, III). 122(87.1%) of these spoligotype isolates were unique and reported for the first time. The remaining 18(12.8%) spoligotype patterns were previously reported from other geographical regions of the world. Haarlem family was more prevalent than other genotypes. Interestingly, 6.3% of the strains belonged to the Beijing family. MDR(multi drug resistance), double and triple resistance were seen in group I of evolutionary scenario. Antibiotic resistance was higher in those isolated from Afghan patients(P<0.001). Other risk factors such as sex and age were also contributing factors to the disease state.Conclusion: Results showed that multi-drug-resistance was more prevalent in bacteria isolated from Afghan TB patients residing in Iran. In addition, the spread of M. tuberculosis strains belonging to Beijing family among Iranian patients has to be considered seriously. It is also important to undertake studies to identify which factors are the most significant to consider in tuberculosis control program.

Background & Aim: There are so far few comparisons of the prevalence of obesity according to the type of definitions and, therefore, more reports are required to show the diversity of obesity patterns across countries with different economic development and cultural background. The objective of the present study was to assess the prevalence and trends in overweight among Iranian children and adolescents using three different definitions.Patients & Methods: Anthropometric measurements were assessed in two population-based cross-sectional studies of children and adolescents aged 3-19y in 1998(n=4528) and 2001-2002(n=2037) within the framework of Tehran Lipid and Glucose Study. Overweight was defined as ≥95th percentile of BMI for age and sex based on: 1) standardized percentile curves of body mass index(BMI) suggested for Iranian children and adolescents, and 2) 2000 centers for disease control and prevention growth charts. The prevalence of overweight using age-and sex-specific cut-points suggested by International Obesity Task Force(IOTF) was also estimated.Results: Using Iranian cut-points, the prevalence of overweight was approximately 3% for 3-5y and 12% for 6-11y and 12-19y in 1998. These estimates rose to 4, 19 and 16%, respectively, in 2001-2002. Using CDC2000 cut-points, the prevalence of overweight among age categories of 3-5, 6-11 and 12-19y were approximately 3.5, 6 and 7%, respectively, in 1998, which rose to 6, 10 and 9%, respectively, in 2001-2002. Overweight, as defined by IOTF cut-points, was prevalent among 2% of 3-5y, 4% of 6-11y and 5% of 12-19y in 1998, which increased to 4%(P=0.20), 6%(P=0.02) and 7%(P=0.01), respectively, in 2001-2002. In the age categories of 6-11 and 12-19y, estimates obtained from Iranian cut points were higher than those obtained by using CDC2000 or IOTF, whereas in the 3-5 age category, there was no significant difference between the estimates obtained from Iranian cut-points and those estimated by CDC2000 or IOTF. Conclusion: The prevalence of overweight among Iranian children is increasing. Our findings also reflect the difference in prevalence estimates based on different definitions.

Background & Aim: Chronic infection of tonsils in childhood is a leading cause of adeno- tonsillectomy. A question has been asked for a long time to find out whether there is any risk of immune impairment after adenotonsillectomy. Therefore, the present study was undertaken to evaluate immunologic parameters in children before and after adenoidectomy.Patients & Methods: In this cohort study, 25 children(14 male and 11 female) candidate for adenotonsillectomy enrolled in Rasoul-e-Akram Hospital. Adequate blood samples were taken in 3 intervals(before surgery and 2 and 6 months after surgery) from patients to measure immunoglobulins IgA, IgM, IgG and IgG subclasses by nephlometry assay and count lymphocyte subsets(markers CD2, CD3, CD4, CD8, CD19, CD23 and CD56) by flowcytometry and ELISA methods. The data was analyzed by repeated measures (Anova and Bonferroni statistical tests).Results: Enrolled patients had median age of 8 years(range 3 to 16 years). IgM and IgG were equal in 3 intervals. IgA somewhat dropped after surgery(2 and 6 months after surgery vs. before surgery) and IgG subclasses(IgG1, IgG2, IgG3 and IgG4) had small rise after surgery. According to lymphocyte subsets CD4+ and CD23+ cells and CD4/CD8 ratio were constant through the 3 intervals. CD23+ and CD56+ cells had small drop in both intervals after surgery vs. before surgery, but these differences were not statistically significant(P>0.05). Mean CD8+ cells had significant changes during these intervals(P=0.02) especially between specimens before and 2 months after surgery(P=0.03). Same pattern was seen for CD19+ cells(P=0.012 and 0.01 respectively).Conclusion: Comparing immunoglobulins of the patients with normal ranges revealed that all antibody classes were highly above normal levels. IgM level in patients with 3 to 8 years remained above median normal level even 6 months after surgery. High antibody level in patients is related to recurrent antigenic stimulation of their immune system. Evaluation of the results in age groups also revealed that changes in immunoglobulins and T and B lymphocytes after adenoidectomy seems to be related to age. Results showed that immune system did not change in short term after adenoidectomy. However, more studies must be conducted to compare patients’ immune system with that of normal subjects in a long term evaluation.

Background & Aim: Human toxocariasis is a helminthozoonosis due to the migration of toxocara species larvae into human organism. Humans, specially children become infected by ingesting either embryonated eggs from soil, dirty hands, raw vegetables, or larvae from undercooked organ of paratenic hosts such as chicken, cattle and sheep. Three clinical forms of toxocariasis are described including visceral larva migrans(VLM), ocular larva migrans(OLM), and covert toxocariasis. Seroprevalence is high in developed countries, specially in rural areas. In order to determine the seroprevalence of toxocariasis in children from Mahidasht area of Kermanshah Province, western Iran, an enzyme linked immunosorbent assay(ELISA) test with synthetic Toxocara canis antigen was performed.Patients & Methods: A total number of 260 children(2-12 years old) of both sexes were examined. The percentage of blood eosinophile and total IgE level was determined by ELISA test. Alternative-three-day stool samples were examined and epidemiological data were obtained by means of a questionnaire given to parents. Results: The total prevalence was 8.46%. No significant difference in the frequency of infection according to age and gender was observed(P>0.05). 1.15% of cases were reported as geophagic, but their toxocara serologic test was negative. No significant difference was observed in this study between dog’s ownership and toxocara infection(P>0.05). Conclusion: This study can effectively increase population awareness about potential zoonotic hazard and also antihelminthic treatment of dogs by veterinarians and more efficient control of stray dogs.

Background & Aim: Water pipe smoking is increasingly becoming a worldwide phenomenon with populations in the Eastern Mediterranean region like Iran. However, most recent researches have put their focus on cigarette rather than water pipe smoking. Although research on the health effects of water pipe is still scarce, preliminary evidence links water pipe use to respiratory, cardiovascular and cancer diseases. Therefore, this study was carried out to evaluate the effects of hubble-bubble(water pipe) smoking on pulmonary function.Patients & Methods: The present cross-sectional study was performed as census procedure. All 1014 individuals with respiratory symptoms who referred to Hazrat Rasoul and Haft-e-Tir Hospitals in Tehran, from October 2003 to October 2004, were enrolled in the study. Spiro metric indices, demographic data, history of cigarette and water pipe smoking were recorded. Data was later analyzed via SPSS V.11.5 software using statistical tests such as Chi2, t-test, one-way ANOVA and correlation and Pvalue<0.05 was considered significant.Results: Out of 1014 individuals evaluated in this study, there were 691(68.1%) men and 323(31.9%) women with the mean age of 51.20(SD=17.74) years. 94(9.3%) individuals had the history of water pipe smoking, whereas the other 920(90.7%) had never smoked hubble-bubble. The mean of Spiro metric indices such as FEV1 and FEF25-75 were 72.24%(SD=24.64) and 67.93%(SD=34.84), respectively. There was not any significant association between water pipe smoking & FEV1(P=0.213), and duration of water pipe smoking & FEV1(P=0.975). Also, no significant relationship was seen between water pipe smoking and FEF25-75(P=0.185). However, both cigarette smoking and its duration had significant effect on FEV1 and FEF25-75.Conclusion: Studies on the health effects of this smoking method(hubble-bubble) are scanty and often suffer from poor control of other confounding factors such as cigarette smoking. While, previous studies suggested that hubble-bubble smoking could affect respiratory function, blood pressure, and heart rate, this study did not show any significant association between water pipe smoking and some Spiro metric indices(FEV1 and FEF25-75). The effect of tobacco in this kind of usage(water pipe) probably becomes ineffective because of other effects such as monolithic effect of this type of smoking.

Background & Aim: Since studies on the efficacy and necessity of prescribing antibiotics in the cases of preterm premature rupture of membrane has not reached a unanimous conclusion, this study was performed to determine whether antibiotic administration prolongs the latency period and improve maternal and neonatal outcome after preterm premature rupture of  membranes (PPROM).Patients & Methods: A total number of 80 women with PPROM enrolled in a randomized clinical trial. Treatment group received 2 gr of intravenous ampicillin every 6 hour and oral erythromycin 400 mg every 6 h for 2 days and then oral amoxicillin 500 mg every 8 h and erythromycin with the same dose every 8 hour for 5 days. Controls did not receive any antibiotics. Both groups received a similar protocol of corticosteriod therapy.Results: Mean latency period in treatment group was significantly longer than no treatment group(P=0.00). Upgar score of neonates was not significant in two groups(P=0.35). There was no difference in the number of patients developing chorioaminionitis in cases and  controls(P=0.6). No significant difference was found in birth weight of neonates in two groups. Conclusion: Antibiotic therapy prolongs latency period and would be of value in reducing  neonatal complication caused by prematurity.

Abstract Background & Aim: Hexokinase and pyruvate kinas are two regulatory enzymes of glycolytic pathway in erythrocytes. Increasing evidence suggests that cigarette smoking which produces free radicals and oxidative stress can cause damage to body macromolecules such as proteins and enzymes. The aim of the present study was to investigate the susceptibility of key enzymes of erythrocytes glycolytic pathway(hexokinase and pyruvate kinas) in smokers. Patients & Methods: Sixty-five smokers and 65 age and sex-matched healthy non-smokers were enrolled in the study. The total activities of hexokinase and pyruvate kinase and total plasma antioxidants were measured and then compared in both smokers and non-smokers. Results: Results showed that hexokinase activity and total plasma antioxidants were significantly lower in smokers than non-smokers, but the activity of pyruvate kinase did not differ significantly from values obtained in non-smokers. The activities of hexokinase and pyruvate kinase were positively correlated with the total plasma antioxidants. The activity of hexokinase and total plasma antioxidant were negatively correlated with duration and also with cigarette number smoking per day, but there was not any significant correlation between activity of pyruvate kinase and duration and also cigarette number smoking per day. Conclusion: It seems that smokers undergo an important oxidative stress due to cigarette smoking. Also, free radicals produced in this process can damage the structure of hexokinase and then reduce hexokinase activity in erythrocytes of smokers. It seems that pyruvate kinas has more stability than hexokinase, and its activity does not differ significantly in smokers from non-smokers.

Abstract Background & Aim: Jaw cysts are uncommon lesions that frequently behave aggressively and attain a large size. For definite diagnosis clinicoradiopathologic features are needed. Due to a great similarity between historical, clinical and radiological features of jaw cysts, the differentiation of one from another just by regarding one of these data is impossible. Not enough information is available on the relative incidence of jaw cysts in Iranian population. The aim of this study was to ascertain the frequency of jaw cysts and correlation of clinicoradiopathologic features in patients referred to Hazrat Fatemeh Hospital and compare these data with other reported studies. Patients & Methods: This descriptive study used easy method for its sampling and SPSS 10 for data analysis. The files of the pathology diagnosis service at Hazrat Fatemeh Hospital between 1993-2003 were reviewed and all accessions of jaw cysts were listed. Clinical and radiographic data were recorded and microscopic slides re-evaluated according to the most recent World Health Organization(WHO) classification. Results: Out of 64 cases of jaw cysts 62.5% were male. The most frequent jaw cysts were: ameloblastoma(34.4%), dentigerous cysts(20%), odontogenic keratocyst(17.2%), radicular cysts(10.9%), giant cell granuloma(7.8%), aneurysmal bone cyst(3.1%), odontogenic myxoma(3.1%), ameloblastic odontoma(1.6%), and ameloblastic fibroma(1.6%). Ameloblasloma was more frequent in male(59%) and more common in the mandibular ramus. Dentigerous cyst was more frequent in male(92.3%) with age range between 8-55 years and more common in the molar area of mandible. Odontogenic keratocyst was more frequent in male(90%) between 1st and 8th decades of life and posterior part of mandibular body was the more common site. Radicular cyst was more frequent in female(57%) in 4th decade of life and more common in dental zone of mandible. Giant cell granuloma was more frequent in female(60%) in 3rd decade of life and more common in molar zone of mandible. Conclusion: More than 80% of the samples were aggressive jaw cysts(ameloblastoma, dentigerous cyst, keratocyst, odontogeic myxoma, giant cell granuloma including odontogenic cyst, tumor and mesenchymal lesion.) Obtained results showed that aggressive jaw cysts are more common in this study than that of other studies. Furthermore, a precise diagnosis is needed in order to have accurate surgical procedure, prevent recurrence and forestall extensive tissue destruction

Abstract Background & Aim: Educational systems need to have committed, concerned and enthusiastic teachers in order to reach their high aims which is educating human beings. Committed teachers feel responsibility and do their duties in the best possible way and the result would contribute to the efficacy, effectiveness and productivity of educational system. This article is a part of a larger study which aimed to explore the experiences and perspectives of nursing & midwifery faculty members about organizational commitment. Methods: A qualitative approach using grounded theory was adopted. Data was collected through semi-structured interviews, from a purposive sample of 34 nursing and midwifery faculty members who were subjected to question and constant comparative analysis. Results: Analysis uncovered a number of themes. Five themes of a committed faculty emerged, including doing the tasks and responsibilities, passion for the work, going to extra mileage, efficacy, and understanding the student. Conclusion: This re-conceptualization of organizational commitment and additional research in this area can assist educational managers to better understand and successfully manage their faculties. New knowledge from this and future studies can contribute and promote faculties’ organizational commitment.

Abstract Background & Aim: Premarital health counseling is very important in all communities, so lots of communities have special planning for this purpose. In premarital counseling, couples are educated on reproductive health such as sexual health and family planning to make them realize its role in their lives, in order to help family health promotion. The aim of this study was to determine the effect of counseling on girls’ awareness after participation in premarital health counseling program. Patients & Methods: In this semi-experimental study, girls’ knowledge about sexual health, family planning and usage of OCP and condom was first determined. Then subjects’ knowledge about the mentioned issues was measured again after their participation in premarital health counseling. The answers of both tests were evaluated and the mean and SD was calculated. Next, changes in grades mean from first to second phase were analyzed with Wilcoxon test. Samples were 600 girls who had been selected from participants in premarital health counseling program in health centers. Sampling method was continuous, the tool was questionnaire and the length of counseling program was 45 min. Results: Mean and standard deviation of sample age was 21.82±3.94. 47.4% of subjects had diploma, 76.6% were housewives and 12% of them had been informed of this program by mass media. Changes in grade mean of their knowledge about sexual health, correct use of OCP and condom were significant(P<0.0001), but this change was not significant for knowledge of family planning. Conclusion: Considering the importance of family planning and results of the present study, couples must be taught before marriage, so high school stage is a suitable time for this purpose. A prospective study on surveying the effect of premarital health counseling program is highly suggested by the researchers.

Abstract The patient was a nine-year-old girl with prolonged focal seizure admitted to the pediatric ward of Rasoul-e-Akram Hospital. The child seemed to be depressed, and in physical examination the only abnormal finding was pink discoid rashes on the cheeks. Brain Ct-Scan performed at the emergency department yielded no specific findings. In order to investigate the precise cause of focal seizure, brain MRI was performed showing widespread areas of increased signal intensity in T1-weighted and decreased signal intensity in T2-weighted images in paritotemporal and frontal area. Specific laboratory tests for lupus erythematosus was positive.

Abstract Background & Aim: Acute promyelocytic Leukemia(APL) is a kind of acute leukemia characterized by a balanced t(15, 17) translocation and the accumulation of neoplastic promyelocytes which fails to develop into mature cells. In the recent years, chemotherapy, differentiation agents and apoptotic drugs have beed used in treatment of leukemia. Recently, plant extracts have been used for treatment of cancers in research and clinical application. The aim of the present research was to study cytotoxicity differentiation and apoptosis of viscum album lectin extract on HL60 cells individually or in combination with ATRA. Materials & Methods: Cytotoxic effect of extract on HL60 cells was studied by MTT colorometric assay and viability was monitored using cell counting and trypan blue. Differentiation induction of cells after treatment was examined by Geimsa staining, NBT test and evaluation of CD11b and CD14 markers flowcytometry. Apoptosis was also observed using Annexin and PI through flowcytometry. Results: The data showed this extract was not cytotoxic in lower than 20µg/ml in 72hrs, but it had cytotoxic effect over this concentration in a dose and time-dependent manner. In concentrations of 30µg/ml, cell proliferation decreased with good viability revealing antiproliferative effects of this agent. However, differentiation induction effect was not observed with this agent. In proper dose(100µg/ml) in 24 hrs, little evidence of apoptosis was seen compared to dexamethasone(dexamethasone as a positive control). The combination of this agent with ATRA did not show any effect on differentiation of cells. However, ATRA preserved its effect of differentiation with higher cessation of proliferation. Conclusion: This extract had antiproliferation and cytotoxic effect on HL60 cells depending on concentration. However, effect on apoptosis was minimal. The combination of this extract with cytotoxic drugs and differentiation agents requires further investigation.

Abstract Background & Aim: Gall bladder carcinoma is 2% to 4% of gastrointestinal malignancies. Approximately 1% to 2% of patients under billiary duct surgeries are cases of gall bladder carcinoma. It has the incidence rate of 3 to 4 times more in females than in males. 90 to 70% of patients with gall bladder carcinoma have billiary stone. Patients & Methods: The present retrospective observational study was carried out cross-sectionally and information was gathered through census method. Gold standard of diagnosis for gall bladder carcinoma was the post-operative pathologic report documented in patients’ folder. Staging of the tumors was done via Novium staging method. Results: 677 cases of cholecystectomy with pathologic report were assessed out of whom 14 cases(2.06%) had gall bladder carcinoma. The average age was between 60 to 70 years. Among the further cases of gall bladder carcinoma, there were 85.71% adenocarcinoma, 7.14% in stage IV, and 35.71% in stage III. Conclusion: The prevalence rate of gall bladder carcinoma in cholecystectomy procedures in this study was the same as others. The commonest type similar to other statistics was adenocarcinoma, but in this study two types of adenoacantoma and fibrosarcoma were also seen. All tumors were in advanced stages during the surgery and were over stage III. Preoperative diagnosis is so difficult unless the physician had a suspicion of this disease in all the patients with billiary system disorders.

Abstract Background & Aim: In patients with a chronic disease such as end stage renal disease, functioning status and quality of life is much lower than general population. The present quasi-experimental study was carried out in order to determine the effects of applying continuous care model on quality of life in Hemodialysis(HD) patients in Hamedan in 2005. Patients & Methods: Thirty-eight HD patients selected as before & after groups for the purpose of this research were investigated over the period of six months. Data collection tools included: KDQOL-SFTm(a specific scale for dialysis patients), QOL demographic questionnaire and control check lists. In the first phase of the research(before), orientation stage was performed in control group, and until the end of the period QOL questionnaire and control check lists were completed only. Immediately after this time the researcher started to have some manipulations over the same group that had been considered as case. SPSS software V(13), descriptive statistics, paired t-test and chi-square statistical test were applied to analyze the collected data. Results: Data analysis showed that with paired t-test, there was a significant relationship between applying continuous care model and general dimensions of HD patients’ QOL(P<0.05). Paired t-test also revealed that there was a significant relationship between applying continuous care model and specific dimension of HD patients’ QOL(P<0.05), except work ability dimension(P=0.083). Conclusion: According to these findings, applying CCM causes significant difference in the levels of both dimensions of HD patients’ QOL; therefore, applying this caring model can promote HD patients’ quality of life. Furthermore, the research hypothesis that applying continuous care model can’t promote quality of life’s level in hemodialysis patients was rejected, while model effectiveness in these patients was confirmed.

Abstract Background & Aim: CPR can prevent 25% of deaths especially in out–of–hospital cases. Cases with cardiopulmonary arrest are usually studied from epidemiological aspects. The outcome of this study would be helpful for emergency department and emergency medical services managements. Patients & Methods: In this observational cross-sectional study, 195 patients admitted to emergency department of Rasoul-e-Akram Hospital during 9 months were included. Age, sex, time, place, cause and witness of arrest, BLS/ALS, intubation, transportation vehicle, CPR outcome and final status of patients were gathered in a data registration form. Results: The mean (±SEM) age was 59.43±1.4, and there was a significant difference in mean age between males and females(P=0.003). 41.5% of cases arrested in ED, 14.9% had no witness, 59.4% were transported to hospital by ambulance, 53.3% received no life support before arrival and 13.3% had been intubated out of hospital. The first rhythm checked in ED was Asistol in 73.3%. Cardiovascular problems consisted 42.1% of causes. There was a significant difference in cause between age groups(P=0.000). 59.5% of CPRs were successful. There was no significant difference in sex(P=0.199) and age groups(P=0.746) and different cause categories. Age(P=0.07), sex, time, place, cause of arrest, being witnessed, BLS/ALS, intubation(P=0.76), and transportation vehicle had no effects on patients’ final status. CPR outcome(P=0.000) and the cause of arrest(P=0.009) affected the final status of patients. Conclusion: CPRs were successful in the majority of cases. However, the overal prognosis was poor. The main determining factor of final status was the cause of arrest.

Abstract Background & Aim: Nitric Oxide(NO) is one of the ten smallest lipophilic molecules synthesized from L-Arginine, O2 and NADPH by nitric oxide synthase enzyme(NOS). NO has various biological activities in different systems. For instance, it plays both protective and cytotoxic roles in immune system, while in cardiovascular system it has physiologic role which controls vascular tonicity. One of the NOS isoforms known as iNOS(inducible NOS) can be induced by variety of some gram negative bacteria membrane that leads to NO production for long period of time. Due to important biological roles of glucose and NO, the present study was designed to investigate the effect of LPS on the level of glucose and NO in serum of SD rats. Materials & Methods: In this study 50 SD male rats with the average weight of 250-300 gram were chosen. Rats were divided into five groups(10 rats in each group). First group received 0.2mg/kg, second group 0.4mg/kg, third group 0.8 mg/kg LPS, fourth group 0.8ml/kg salin via IP injection and the fifth group did not receive any compound. After blood collection and separation of serum, NO level was measured by Griess reagents and glucose by colorimetric method. Results: The obtained results showed that with increased LPS injection, the level of NO increased in group 1, 2 and 3 respectively. The latter group had the maximum level of NO as compared to control group(P<0.05). Glucose concentration increased significantly in third group(P<0.05). Conclusion: It is concluded that increased level of NO production was due to induction of iNOS enzyme by LPS and was dose dependent, and increased level of NO led to increased level of glucose concentration.

Abstract Background & Aim: Bacterial meningitis after brain surgery is rare but serious. The present study was undertaken to determine the frequency of postcraniotomy meningitis, identify etiologic agents, and analyze the risk factors. Patients & Methods: This descriptive cross-sectional study was conducted at Firoozgar Hospital from 1999 to 2004. Data was analyzed by SPSS software(version 11.5). Results: Out of 233 patients undergone craniotomy, 11 patients(4.7%) suffered from meningitis. CSF culture was positive in 4 cases and all of them were gram negative bacilli(Klebsiella in 3 cases and E.coli in one case). Several risk factors including external ventricular device, CSF leak, V-P(Ventriculo-Peritoneal) and V-A(Ventriculo-Arterial) shunt were identified by univariate analysis. There was only a significant statistical correlation between postcraniotomy meningitis and repeating the operation(P<0.05). Conclusion: Nosocomial infections including postcraniotomy meningitis are serious problems in hospital, therefore, all of the health care workers should be educated about prevention of infections(like hand washing, disinfection and sterilization of instruments and rational use of antibiotics).

Abstract Background & Aim: Hemodialysis increases the survival of patients with chronic renal failure. However, prolonged hemodialysis causes some complications including abnormal bone changes. This research was done to evaluate the frequency of the radiological changes of osteoarthropathy in hand joints in hemodialysis patients referred to Hashemi-Nejad Hospital. Patients & Methods: In a cross-sectional study, 240 hemodialysis patients who referred to Hashemi-Nejad Hospital in Tehran were evaluated. Antero-Posterior radiography of hands from finger tips to distal bones of forearm was performed in all of these patients. Results: Prevalence of osteoarthropathy was 39.5%. The most common radiologic finding was osteopenia with frequency of 36%. Other changes included: bone erosion(15%), periarticular cyst(8%), and articular narrowing(2%). Osteoarthropathy was seen in males more than females and in individuals with more than 10-year dialysis. The prevalence of vascular calcification as an incidental finding was 24%. Conclusion: There was a high prevalence of osteoarthropathic changes in patients under hemodialysis. This prevalence increases with long duration of dialysis. Therefore, the early kidney transplantation is necessary for these patients. Also, the amount of aluminium in dialysis solutions should be controlled as much as possible.

Abstract Background & Aim: There are many suggestions for nasal polyp formation mechanism. The present study was carried out to evaluate T-cell infiltration in nasal mucosa and specific allergic reactions in context of probable irregular systemic immune responses in nasal polyp disease. Patients & Methods: 60 patients with nasal polyps who referred to ENT ward of Rasoul-e-Akram Hospital were studied in this cross-sectional study. Median age was 34 years(range 13 to 69 years) and 59.3% of patients were male. Blood and polyp specimen from each patient were sent to laboratory to measure serum IgE and specific IgE(by ELISA method) and count immune cells and subsets [by APAAP(Alkaline Phosphatase Anti Alkaline Phosphatase) and LSAB(Labeled Streptavidin Biotin) methods]. Results: 56.7% of patients had total serum IgE equal or more than 100IU/ml and others (43.3%) had total IgE lower than 100Iu/ml. 45% of the patients had at least one positive test from specific tests. Patients with positive specific IgE had more CD8+cells in comparison to others(P=0.04). They also had further serum IgE(P=0.001). Multivariable analysis showed that serum IgE, CD4/CD8 ratio and age were correlated with specific IgE result in patients with nasal polyp(R2=1; P<0.001). Conclusion: Immunopathologically IgE synthesis in allergic patients is biphasic. Total IgE increased as a response to primary immune system stimulation and then according to affinity maturation phenomenon, specific IgE increased. Therefore, patients with specific IgE have continuously high IgE level. In this study low CD4+cells may be due to low regulatory cells for Th1 lymphocytes and increased CD8+cells may be related to increased cells which secrete cytokines affecting Th1 or Th2 lymphocytes. To understand definite roles of immune cells in nasal polyp formation, more studies are needed to measure T lymphocyte subsets, Th1 and Th2 lymphocytes.

Abstract Background & Aim: Although trust has long been recognized as an important element of patient-nurse relationship, it has seldom been studied and, therefore, there is limited knowledge about it. Explaining factors causing this trust becomes very important when its various positive consequences are taken into consideration. The present study was carried out to explore and explain theoretically the factors led up to patient’s trust in nurse. Patients and Methods: Grounded Theory approach was adopted in this study. Data was collected from 15 patients hospitalized in various wards of three academic hospitals in Uromia using semi-structured interviews. The method proposed by Strauss and Corbin was used for data analysis. Results: The findings of this study revealed that two categories namely nurse’s professional characteristics and ethical principles can help to theoretically explain the concept of trust. Conclusion: Patient’s trust in nurse is an important and complex phenomenon. Therefore, nurses have to develop and reinforce some professional characteristics in themselves and consider some ethical principles in order to attain this trust.

Abstract Background & Aim: Multiple sclerosis(MS) is a chronic autoimmune disease of unknown etiology affecting the central nervous system. The prevalence of MS is the highest where environmental supply of vitamin D is low. Some studies have shown a strong protective effect of vitamin D3 on experimental autoimmune encephalomyelitis(EAE) of MS model, but it is not known how it affects EAE. Vitamin D3 may inhibit EAE by affecting nitric oxide(NO) production. The present study was carried out to investigate the effect of vitamin D3 on the evolution of MOG35-55 induced EAE and level of nitric oxide in male C57BL/6 mice. Materials and Methods: Male C57BL/6 mice with similar age and weight were placed in two therapeutic groups(n=8 per group) as follow: 1) Vitamin D3-treated EAE mice(5µg/kg/every two days of vitamin D3 given i.p from day -3 until day +19 after disease induction), 2) non-treated EAE mice(EAE control) received vehicle alone with same schedule. In addition, 5 age and weight-matched male C57BL/6 mice served as normal(non-EAE) controls. Results: The results showed that vitamin D3-treated mice had significantly less clinical score of EAE(3.2±0.8) than non-treated EAE induced mice(5.3±0.44), (P=0.001). Also, there was a significant difference on the day of onset of disease between vitamin D3-treated and non-treated EAE-induced mice(day 15±1 and day 11±1, respectively). NO concentration in vitamin D3-treated mice was significantly lower than EAE control(P=0.008). Conclusion: By considering the role of NO in the pathogenesis of EAE and MS, it seems vitamin D3 has immune modulatory responses and can reduce or delay the onset of EAE by reducing NO production. Thus, vitamin D3 is potentially important for treatment of MS.

Abstract Background & Aim: Hospitalized neonates are among the groups who are prone to recurrent blood transfusions. Due to neonates’ immune defects and common transfusion problems, blood transfusion complications have risen in neonatal intensive care units. In order to decrease the number of transfusions in premature neonates, new procedures and techniques such as recombinant erythropoietin use, satellite blood bags, and changing transfusions protocols have been recommended in many countries. Since satellite blood bags are not available in Iran and there has been no published study about transfusions in premature infants, a retrospective study was performed in the NICU of Rasoul-e-Akram Hospital to determine the number of blood transfusions, total amount of transfused products and number of donors each infant was in contact with. Patients & Methods: In a retrospective study, information was gathered from 144 premature infants under 37 weeks of gestation who were hospitalized in NICU in 2000-2002. Results: 65 infants(45% of hospitalized infants) received at least one blood product. The mean and range of blood transfusion was 1.2 and 0-16 respectively. Thirty-seven infants(26%) had more than one transfusion. There was a significant correlation between gestational age, birth weight, and transfusions. Out of 68 infants with birth weight under 1500 grams, 47 infants needed transfusion(69%), but from 32 infants with weight over 2 kilograms only, 3 infants(9%) had transfusions(P=0.01). 68% of infants under 30 weeks of gestational age had transfusions in comparison to 41% of 31-34 weeks and 16% of 35-37 weeks(P=0.03). There was no correlation between sex of infants, duration and etiology of hospitalization and use of recombinant erythropoietin. Conclusion: As a lot of newborn infants need transfusion during their hospital stay, (45% in our study), and since there is a correlation between blood transfusions and low birth weight and gestational age, we need to find some resolutions for decreasing number of transfusions and number of contacts with different blood donors. Using satellite blood bags(dividing one bag of blood to smaller ones) is a good suggestion which decreases the amount of blood not used in the NICU. In this study, about 3.4% of packed RBCs and 5.5% of FFP had been used and about 95% of all blood products were discarded. Therefore, it is necessary to find a new way for maximum use of this vital product.

Abstract Background & Aim: Exercise and physical activity have recently been the focus of attention in public health. People who participate in sport, recreation and physical activities are generally healthier and more confident than those who do not. Potential health consequences of physical inactivity reported in other studies include hypertension, coronary heart disease, diabetes, obesity, high blood cholesterol, osteoprosis, cancers of colon, breast, prostate, lung, depression, and muscular disability. In other words, the major cause of mortality and morbidity is physical inactivity. The present study was undertaken to determine the comparison status of sport activities in employed women and men in Iran University of Medical Sciences and Health Services. Patients & Methods: In this comparative study, data was gathered through questionnaire. Selected through a multi-stage sampling method, 393 women and 316 men were the contributers of this study whose height and weight were measured by the researcher. Results: Findings about status of sport activities in women indicated that out of 393 employed women only 88 ones(22.4%) were active and the remaining 305 ones(77.6%) were inactive. Out of 88 active individuals, (12.2%) did regular light sport activity and (10.2%) did regular vigorous sport activity. The status of sport activities in women had a significant relationship with education, kind of job(P<0.05), i.e. sport activity in educated women(female faculty members) was more than others. No significant relationship was found with factors such as age, marital status, B.M.I, number of children and income. Findings about status of sport activities in men indicated that out of 316 employed men only 53 ones(16.8%) were active and the remaining 263(83.2%) ones were inactive. Out of 53 active individuals, (8.9%) did regular light sport activity and 7.9% did vigorous regular sport activity. The status of sport activities in men had a significant relationship with education, kind of job and income(P<0.05), i.e. sport activity in educated men was more than others. No significant relationship was found with factors such as age, marital status, B.M.I, and the number of children. No significant difference was found between employed women and men on the status of sport activities. Conclusion: Results of the present study showed that most of the employed women and men were inactive; therefore, conducting a research on reasons of this inactivity is recommended.

Abstract Background & Aim: The present study was undertaken to compare the results of broncoscopy and HRCT in 84 patients complaining from hemoptysis with normal chest X-ray in order to determine their final diagnosis and investigate association between these tests in different clinical situations. Patients & Methods: This retrospective case-series study was conducted on 84 patients with hemoptysis and normal chest X-ray who referred to the 505 Hospital in Tehran. There was not any obvious source for bleeding in their clinical examinations. All patients underwent fiber optic bronchoscopy and also HRCT. The final diagnosis was made after at least one-week follow-up. Kappa coefficient between the results was calculated. Results: Out of 84 patients, who had done bronchoscopy, no lesion was seen in 63 of them. Only 43 patients underwent HRCT, out of whom 31 patients had no lesion in their HRCT. There was only one patient with malignancy found in his bronchoscopy, but he did not undergo HRCT. Kappa coefficient between bronchoscopy and HRCT was 7%(P=0.67). Conclusion: In spite of the limitations in this study, it seems that none of these two tests can be replaced with the other. In patients without the presence of risk factors for malignancy, HRCT could be of more help.

Abstract Background & Aim: Following the increasing rate of suicide and its outcomes in recent decades, WHO introduced its attempt to decrease suicide rate as one of its aims in world health program by 2000. As a part of multinational project of World Health Organization, this study was undertaken to determine demographic characteristics of suicide attempters attending emergency ward of Karaj Hospitals in 2003-2004. Patients & Methods: Statistical population of this study was all suicide attempters attending emergency department of Karaj hospitals, out of whom 632 attendants ready to participate in the study were selected. Demographic variables, method of suicide, time and place of doing suicide, frequency of attempts and use of health services were all collected by hospital records, as well as interview with accompanies and patients. This cross-sectional study was conducted as a part of multinational projects of WHO between 2003-2004. T-test and chi-square test were used for data analysis. Results: Most of suicide attempters were female(62.5%), single(53.6%), with high school education(52.8%). The mean age was 24.5(±9) years. Suicide attempters were unemployed(29.8%) and housewife(67.5%) in male and female group respectively. There was a positive history of suicide in relatives in 15.4% of attempters(97 subjects). 28% of subjects had previous attempt and 23.7% of them reported a poor physical health in the past 3 months before attempt. Conclusion: Unemployed, female, single individuals, married females, and housewives are at risk of suicide more than others.