Iranian South Medical Journal
Year:2015 | Volume:18 | Issue:1|Papers Count:26

Background: Dietary pattern analysis has emerged as an alternative and complementary approach to examine the relationship between diet and the risk of chronic diseases.The aim of this study is to determine the association between major dietary patterns and general and central obesity among adult women living in Bushehr city.Materials and Methods: A cross-sectional study was conducted in Bushehr, with 362 women aged 20-50 years. Dietary intake in the previous year was assessed by a semi-quantitative 133-item food frequency questionnaire. The food items were classified into 38 food groups. In addition, social-demography and anthropometric data were gathered using questionnaires. Weight, height and waist circumstance (WC) were measured with standard methods and Body Mass Index (BMI) was calculated. General obesity was defined as BMI³30 kg/m2 and central obesity as WC³88 cm. Factor analysis and ANOVA were used for data analysis.Results: Mean age and BMI was 31 years and 24.4, respectively. 14% of the subjects had generally obese and 40% centrally obese. Two major dietary patterns were extracted: "Healthy" and "Unhealthy" dietary pattern. Individuals in the highest quartile of the unhealthy dietary pattern score were more likely to be generally obese (23.6 vs 7.9; p<0.05); whereas, those in the upper quartile of healthy dietary pattern were less likely to be generally obese (6.7 vs 20.2; p<0.01).Conclusion: Major dietary patterns of Bushehrian women had a significant association with general obesity. Suggesting that further prospective researches to confirm such associations.

Background: Induced neuropathic pain following nerve injury has behavioral signs such as allodynia and hyperalgesia. There are reports about the age dependent differences in severity and incidence and even therapeutic response of this pain. In this study, we have tried to evaluate behavioral differences of this pain in an induced neuropathic model in different ages, according to important role of N-methyl, D-aspartate (NMDA) receptor and spinal microglia on induction and maintenance of pain.Material and methods: Male rats were grouped in young (5-6 week) and mature (10-11 week). Under general anesthesia, the spinal nerve ligation (SNL) surgery was operated on right leg. The effect of different doses of dextromethorphan (NMDA blocker) and minocycline (microglia inhibitor) on 5th day after surgery was evaluated and compared in two age-groups.Results: In this study, both Minocycline and dextromethorphan diminished neuropathic pain in a dose dependent manner in these two ages. Minocycline in contrast to dextromethorphan was more effective in young rats. The co-administration of ineffective doses of minocycline and dextromethorphan could be effective.Conclusion: Microglia and NMDA receptor function in neuropathic pain is different in different ages and the role of microglia is more evident. On the other hand the inhibition of both microglia and NMDA receptor can be considered for lowering neuropathic pain.

Background: It seems that consumption of fish oil results in reduction of cardiovascular diseases risk factor such as triglyceride and blood pressure in diabetic patients. It is not clear which component of fish oil (EPA or DHA) is more important. The aim of this study was to determine and compare the effects of eicosapentaenoic acid and docosahexaenoic acid on fasting blood sugar, triglyceride, and blood pressure in type 2 diabetic patients.Material and Methods: The study designed as a triple-blind, placebo-controlled trial. 60 diabetic men and women, aged 30-65 years, were randomly assigned to consume 1g/d EPA, DHA, and canola oil for 12 week. Fasting blood sugar, triglyceride, and blood pressure were measured before and after the study. Results were analyzed through repeated measure test.Results: After 12 weeks of intervention, 23 women and 22 men with a mean ±SD age of 54.9±8.2 completed the study. In comparison with the changes from baseline, FBS and triglyceride levels didn't differ between groups (P>0.05). SBP and DBP reduced in three groups (P=0.0015 and P=0.000 respectively); but they didn't differ between groups (P>0.05).Conclusion: Consumption of 1g/d EPA or DHA doesn't have any effect on FBS, triglyceride, SBP and DBP. This study is the first one which has compared fish oil components effects in diabetic patients.

Background: Aequorin is a calcium sensitive photoprotein composed of apoaequorin (189 amino acid), oxygen and coelenterazine (imidazopyrazine chromophore). Activity of this photoprotein in calcium presence is blue photon emission (469 nm). Studies have shown that three amino acids H16, Y82, W86 are involved in color shift and activity of Aequorin. In this work, for study of structural-functional relationship, combinational mutant was used for determine of the interest places importance in single and combination state.Materials and Methods: Using site directed mutagenesis, the single and multiple mutations done in plasmid and mutated aequorin in single and multiple states were prepared. Next, thermo stability, activity and color shift of produced protein determined using luminometer and spectrofluorimetry, respectively.Results: We found that W86 and H16 play a more critical role in color shift and activity respectively. In addition, mutation of W86 provides better term stability compared to other mutations.Conclusion: This investigation was shown that the role of W86 in aequorin shift light and thermo stability is better than Y82 and H16 and this mutant could be used for effective protein production in sensor and other applications.

Background: Enterobacter amnigenus biogroup 1 is a non-sporeforming, rod-shaped, gram-negative bacterium, within the Enterobacteriaceae family. It is opportunistic pathogen and cause disease humans, especially in premature and immunocompromised persons. The aim of this study was to isolation and determination antimicrobial susceptibility pattern of Enterobacter amnigenus biogroup 1 strains isolated from consumed powdered infant formula (PIF) milk in Neonatal Intensive Care Unit (NICU) ward.Materials and Methods: In this cross-sectional study, total 125 consumed powdered infant formula milk in NICU ward were surveyed. Isolation and Identification of microorganisms was carried out according to FDA method. Antimicrobial susceptibility test was performed by using the standard disc diffusion method based on CLSI (2011) recommendations.Results: In this study, Enterobacter amnigenus biogroup 1 was isolated from 2 (1.6%) of 125 powdered infant formula milk samples. The results showed that isolated strains are sensitive to most antibiotics. All isolates were resistant to amoxicillin and carbenicillin.Conclusion: Contamination of powdered infant formula (PIF) samples could have occurred during different steps. It is imperative to prepare the powdered infant formula milk foods according to the manufacturer’s instruction and in an aseptic condition. Contamination of powdered infant formula only could be reduced or prevented by monitoring the critical control points and taking appropriate action during the processing.

Background: The studies have reported that exercise induced apoptosis in various tissues. The abnormal regulation of apoptosis contributes to the progression of pathological processes in the placenta and effects on embryo development. The aim of the present study was to investigate the effect of swimming endurance training during pregnancy on apoptosis induction in pregnant rats' liver.Materials and Methods: Sixteen female Wistar rats with an average weight of 200±20 grams were divided into two groups: swimming and control. The rats of training group were forced from first day of pregnancy to delivery in a particular pool. The time of training in first day of pregnancy was 10 min and this time in second week reached to 60 min by increasing of 5 min per day. The time of 60 min continued to end of third week. The sampling of the rats' liver was performed two days after delivery and the liver apoptotic index was determined with TUNEL technique. Statistical analysis of the data was done using independent t-test (a£ 0.05).Results: The results of study showed that swimming endurance training did not induce significant change in liver apoptosis (p<0.424). The mean of apoptosis in control and training groups was %7.40 and %8.60 respectively. But 3-wk period of swimming training induced significantly minor increase in the amount of post pregnancy weight gain compared to the control group (p<0.001). In addition, it was observed non-significant decrease in weight of training groups rat's liver compared to the control group (p = 1.00).Conclusion: It seems that endurance swimming training during pregnancy has no anguishing effect on apoptosis induction in liver and it is considered as safe exercise way in the improvement of mother and infant health.

Background: Large quantities of radiopharmaceuticals prescribed for treatment and diagnosis are excreted through kidney. Therefore, radiation unwanted dose is created in kidney. As a result, exact calculation of prescribed medicine amount is important. In Mird pamphlet, 5 kidneys have considered in ellipsoidal shape that radiopharmaceutical is uniform distributed in them and gamma absorption fraction is calculated and recorded in the tables and the fraction of beta absorption is considered unit. While, kidney has internal organs and radioisotope is not uniform distributed in and beta absorbed fraction is not unit.Material and method: In this research, for the first time kidney is considered integrated shape and for the second time has been considered that it is consisted of three areas, pelvis, medulla and cortex. It is supposed that radiopharmaceutical is distributed in medulla. Then, beta absorbed dose is calculated in medulla and cortex using MCNPX code and is compared with integrated kidney results.Results: This research has been showed that beta absorbed dose from 203Hg, 166Ho and 177Lu isotopes in medulla is four times as much as dose in integrated kidney and beta dose in cortex is 0.004 to 0.012 times as much as beta dose in integrated kidney.Conclusion: Internal structure of kidney should be considered in simulation to achieve a more accurate prescribed dose. It is recommended that simulation results of three areas kidney are replaced with integrated kidney to prevent from renal toxicity.

Background: Cold crystalloid cardioplegic solution is used for cardiac arrest and myocardial protection during CABG intermittently. There is no defined safety interval time for cardioplegia infusion. Measuremen of the metabolite release from myocardial cells in coronary sinus implicateis accurate protective effect and safety interval of cardioplegia. There is no study that surveys the metabolites of coronary sinus during CABG.Materials and Methods: 13 patients that was scaduled for elective CABG cold crystalloid cardioplegia transfused via aortic root. Coronary sinus blood samples were taken in different times, before and after cross clamping of the aorta at the times of 7, 14 and 20 minutes. The samples were analyzed for pH and lactate immediately.Results: The pH and lactae concentration in coronary sinus at the time of 15 minute after transfusion of the first dose (pH=7.18±0.043 lactate=30±3.983 r=0.02) and 10 minute after the second dose of antegrade cold crystalloid cardioplegia (pH=7.19±0.045 lactate=28±3.438 r=0.03) were out of the range of acceptable level.Conclusion: This study indicates that safe interval time between the first and second dose of cold crystalloid cardioplegia transfusion was 15 minute and the between second and third dose was 10 minutes.

Background: The date palm cultivation has a long history in Bushehr province. Throughout the recent decade; the dusts, in addition to direct harmful effects on humans, have adverse effects on health of the population living in this area. The infestation of pests in the southern province of Bushehr has groves. Due to the importance of dates in this area, the total ash and acid insoluble ash as indexes for assessing of chemical pollution and also, mold and yeast as indicators for microbial contamination were evaluated. Recently in a number of dates packaging industries, washing the products after the harvest is done. In current study, the effects of rinsing to decrease the dust pollution on date palm along with, the time effect on the quality and durability of washed and un-washed dates were investigated.Materials and Methods: Overall, 48 washed and un-washed dates were sampled from traditional and technologically advanced packaging industries, equally, and were confirmed according to ISIRI methods.Results: The Averages of total and acid insoluble ashes in washed date samples were: 1.05±0.14 and 3.32±0.32%, and for un-washed samples were 1.36±0.27 and 4.59±1.64 percent, respectively. In all date samples were presented the yeast, however, their means were lower than the maximum limit (1´104 CFU). Also, all date samples were moldy. The Mean percentage of total ash samples in un-rinsed and rinsed dates were approximately, 1.84 and 1.33 times more than the maximum permissible limit, respectively. The mean of acid insoluble ash in all samples (100%), and 98% of total ash were higher than acceptable levels (p<0.05). The results revealed that the average percentage difference between the two groups were transpicuous, while this difference was not significant (p=0.13). Under the similar conditions, the average amount of yeast in washed date samples, were significantly different (p<0.05) and more than un-wash samples. The Mold levels in un-rinsed and rinsed samples; were 83.3 and 75% higher than the maximum permissible limit. According to the results, regardless of a decrease in amount of molds in washed samples than un-wash samples, the rinsing, was unable to eliminate the pollution, or even decreased it to acceptable levels.Conclusion: According to the findings, present rinsing is not an appropriate method for long storage. Observations, after one year upkeep in the same conditions, expressed that all un-washed date samples were apparently healthy, without any pests and insects. While 91.6% of the washed samples were insectivores, also their textured appearances were very unpleasant.

Background: Chlamydia trachomatis is one of the most common diseases as sexually transferred in world. According to the World Health Organization statistics, approximately 92 million new Chlamydia trachomatis infection occur in the world. Chlamydia trachomatis (CT) is the cause of tubal obstruction, ectopic pregnancy and infertility in women. The aim of this study is prevalence evaluation of Chlamydia Trachomatis by PCR in female infertile referred to Montasarieh study center of infertility in Mashhad.Materials and Methods: The cervical swab specimens were collected from 100 infertile (as case) and 30 fertile (as control group) women attending to the infertility center of Mash-had Medical University. DNA extraction was performed from clinical specimens using DNA extraction kit. In this study, in addition to PCR reaction by commercial kit, PCR test was performed using specific primers and probe for CTCP gene.Results: The results of PCR reaction using the kit was match with PCR test and showed that the prevalence of Chlamydia trachomatis is 21% in infertile women and 3.3% in normal fertile women that was statistically significant (p=0.024).Conclusion: Considering the high sensitivity of PCR method for diagnosis of Chlamydia trachomatis infection, this method can be useful for routine screening.

Background: Although some remedies have been suggested for treatment of primary dysmenorrhea, some free of side effects treatment methods such as herbal drugs and exercise are especially important. The purpose of this study was to compare the effect of ginger and resistance training on physical and psychological symptoms of dysmenorrhea.Materials and Methods: 60 nonathletic female collegiate students of Shiraz university participated in this study voluntarily and were divided randomly to 4 groups including 15 persons ( exercise +placebo, exercise + ginger, ginger, and placebo). Ginger groups were prescribed 250 mg of ginger, four times a day for 3 days from beginning of menstruation and placebo groups were recommended the same prescription with 250 mg of placebo drug. Exercise with ginger or placebo groups participated in 2 months of progressive resistance training (3 times a week) besides consuming Ginger or placebo drugs. Menstrual symptoms were recorded with using validated questionnaire, before intervention and during two consecutive periods of menstruation. The analysis was performed with using Covariate analysis of variance with repeated measures by SPSS version 16.Results: A significant reduction was found in physical symptoms of dysmenorrhea in groups of Ginger but no significant statistically changes were found within other groups. Comparison of four groups indicated more significant reduction of physical symptoms in ginger groups compared with other groups. There were no significant difference in psychologic symptoms within and between groups (P>0.05).Conclusion: Ginger is recommended for treatment of physical symptoms of dysmenorrhea.

Background: Breast cancer is the most common malignancy in women, and is considered as the second causative factor in cancer mortality. E- Cadherin is a trans member glycoprotein and play a essential role in cell-cell adhesion .It seems that E-cadherin Gene expression can plays a role in suppressor of invasion and metastasis tumor. The aim of this study was to evaluate the correlation of E-cadherin Gene expression with breast cancer in the women population of southern Iran.Materials and Methods: 30 patients and 30 healthy individuals as control participated in this case-control study. mRNA extracted from peripheral blood. Real Time PCR technique was used to determine the Gene expression. The statistical analysis was performed by the software SPSS and Mannwithny test.Results: The results indicated that there is no significant difference in level of E- cadherin Gene expression in patients with breast cancer and the control group (Pv>0.05). Furthermore, we found no significant correlation between the E- cadherin Gene expression with the clinic pathological factors in the patients.Conclusion: it seems that E- cadherin Gene expression plays no important role in increasing the susceptibility of women to breast cancer in the population of southern Iran.

Background: Nowadays, the plant of Daphne family (Thymelaeacea is used against microorganisms and cancerous cells. The purpose of this study was to investigate the effects of two Daphne species and purified betulin and betulinic acid on K562 genome and the cell cycle.Materials and methods: This Study was conducted in a complementary randomized design with three replications. 106 K562 cells were treated with Daphne mucronata, Daphne oleides, betulin and betulinic acid for 24 hours. Then, cells were fixed in 70% ethanol and were stained with pripidium iodide 30 min before analysis by flow cytometery. To extract the DNA of cancer cells Miller saline method with little change was used. Data were analyzed with SPSS. version 16 by ANOVA and Dunnett.Results: Percentage of cancer cells that were treated with Daphne mucronata (59.11±1.16%), Daphne oleides (58.25±1.03%), betulin (51.68±0.43%), and betulinic acid (52.05±0.31%) increased in the G0/G1 phase compared to the control (42.94±0.23%). While most percentage the control cells (51.06±0.16%) were present in S phase Electrophoresis of genomic DNA of K562 cell lines revealed band boarding and smearing under the effect of plant material. However, a clear sharp band of DNA was seen in control samples. The lowest and highest smeared band was observed in treated cells with Betulin and Daphne mucronata, respectively.Conclusion: Data showed that materials and compounds of Daphne, block cells in G1 phase and will cause damage to DNA. In fact, these results indicate that there are several effective factors in two species Daphne extract which damage DNA integrity and inhibit cell transfer from control point and can facilitate cell death at higher concentrations.

Background: It is not known whether infection by a specific pathogens is associated with type 2. We examined the association between chronic infection with four pathogens (Chlaydia pneumonia, Helicopacter pylori, Herpes simplex virus type 1 and cytomegalovirus) and type 2 diabetes mellitus in a general Iranian population, in the northern Persian Gulf.Materials and Methods: In a population-based study of men and women aged>25 years, a random sample of 1754 (49.2 % males, 50.8 % females) subjects were evaluated. Sera were analyzed for immunoglobulin G antibodies to C. pneumoniae, HSV-1, H. pylori, and CMV using enzyme-linked immunosorbent assay. Type 2 diabetes mellitus was defined according to criteria of American Diabetes association.Results: A total of 150 (8.6%) subjects had type 2 diabetes mellitus. In the diabetic group, 42% were seropositive for C. pneumoniae, 64.7% for H. pylori, 92.9% for HSV-1 and 94.7% for CMV. In multiple logistic regression analyses, seropositivity for C.pneumoniae (OR=0.89, CI: 0.60-1.34, P=0.602), H. pylori(OR= 0.95, CI: 0.64-1.41, P= 0.808), HSV-1(OR= 1.76, CI: 0.86-3.62, P=0.120) ,CMV(OR=0.99, CI: 0.43-2.27, P=0.982) did not show a significant independent association with type 2 diabetes mellitus after adjustment for age, sex, chronic low-grade inflammation, and cardiovascular risk factors.Conclusion: There was not a strong association between type 2 dibetes mellitus and prior infection with viral and bacterial pathogens that had been previously correlated with coronary artery disease as well as carotid atherosclerosis.

Background: The determination of goiter prevalence in children by thyroid ultrasound is an important tool for assessing iodine deficiency disorders. The main aim of this study was to determine thyroid volume and goiter prevalence in schoolchildren of Bushehr port, based on 2007 normative values.Materials and Methods: A probability proportionate-to-size cluster sampling method was used to obtain a representative sample of 1148 school children of Bushehr port aged 7-10 years. The median and 97th percentile of thyroid volumes for age and body surface area (BSA) was measured by data of ultrasonography. The normative value of thyroid volume of the 2007 study was used as reference.Results: The 97th percentile of thyroid volume based on age or BSA in school children was higher than the international normative reference. The age-, and BSA-adjusted mean of thyroid volume was higher in both sexes than the thyroid volume of school children in the 2007 study (p<0.0001). Application of the native thyroid volume reference resulted in a goiter prevalence of 7.57%.Conclusion The thyroid volumes of schoolchildren and goiter prevalence in Bushehr port were generally high compared to the baseline data obtained 6 years ago. The environmental goiterogenic factors should be investigated in this iodine-sufficient area.

The most important Sasanian-Islamic port of Iran in the Persian Gulf was Siraf, with a total population of 300,000. The ruined site of Siraf lies on the Persian Gulf, 230 Km. south-east of Bushehr. By the time Siraf was mentioned first (c. 850), it was already a flourishing port with merchants dealing with India, East Africa, Madagascar, Malay Peninsula and China. Siraf had a prominent role in the transfer of Indian medical knowledge to Jundi Shahpur medical school during Sasanian period. In addition to Indian medicine and Ayurvedaic medicine, Siraf was the gate of Jundi Shahpur for Egyptian and Hellenistic medicine in the pre-Islamic and Islamic periods. This relationship was bidirectional and the heritage of Jundi Shahpur medical school including its medical books, medicinal plants and medical knowledge were transferred to the East by Indian and Chinese sailors and merchants. The import and export of medicinal plants and the existence of the storages of medicinal plants in Siraf port was mentioned in many times by historical geographists of the middle ages. In conclusion, this Sasanian-Islamic port had a key role in the introduction of medicinal plants and the transmission of knowledge of medicine from India, East Africa, Egypt and China to the rising Jundi Shahpur medical school. The critical function of introduction of oriental medicine and medicinal plants to Iran through Siraf port was continued for several centuries, even after the down of Jundi Shahpur medical school.

Since the mass production of plastic in 1940, contamination of marine environment by plastics particularly micro plastics has been a growing problem. Micro plastics are little plastic particles, fibers and granules which have been defined in different sizes such as diameter less than 10, 5, 2 and 1 mm. The micro plastics that are made in microscopic size and are used in cleaner and cosmetic materials, are called primary micro plastics and secondary micro plastics are derived from larger particles. Micro plastics are directly transmitted to rivers and then sea via wastewater influent or leachates from refuse sites. Micro plastics are found throughout the water column and due to their small size, micro plastics are considered bioavailable for organisms. Their composition and relatively large surface area make them prone for adhering waterborne organic pollutants such as PAHs, PCBs and DDT. Micro plastics consumption by marine organisms have been shown by environmental and laboratory studies. Although adverse health effects via micro plastics are not obvious alone, but the transition of chemical materials from microplastics to organisms throughout the food-chain is a significant concern. In this article, micro plastics properties, micro plastics production resources, their entering effects on environment have been considered.

Resveratrol (3, 5, 4- trihydroxystilbene) is one of the natural polyphenolic bioactive compounds synthesized by plants to serve many functions, especially defense against fungal infections, environmental stresses and UV radiation. It is found mainly in grapes, green tea, peanuts and berries. This compound has recently received increased attention in medical research, due to its effects on prevention and treatment of many diseases, including cancer, cardiovascular disease, and metabolic syndrome. Over the past two decades, researchers from all over the world studied the beneficial effects of resveratrol against cardiovascular diseases and heart failure in different animal models. Importantly, the results of these studies have been promising and recently this knowledge has been translated into examining the efficacy of resveratrol in humans with heart failure. Since heart failure continues to be a significant cause of cardiovascular mortality in the developed and also developing countries, and despite different medicines available for the treatment of such common chronic systemic diseases, preventive measures to be necessary to combat the incidence of heart problems. In this review article the protective effects of resveratrol and its mechanisms of action on different metabolic pathways with respect to heart disease and failure will be discussed.

Background: Hybrid imaging modalities which simultaneously benefit from capabilities of combined modalities provides an opportunity to modify quality of the images which can be obtained by each of the combined imaging systems. One of the imaging modalities, emerged in medical research area as a hybrid of ultrasound imaging and optical imaging, is photoacoustic imaging which apply ultrasound wave generated by tissue, after receiving laser pulse, to produce medical images.Materials and Methods: In this review, using keywords such as photoacoustic, optoacoustic, laser-ultrasound, thermoacoustic at databases such as PubMed and ISI, studies performed in the field of photoacoustic and related findings were evaluated.Results: Photoacoustic imaging, acquiring images with high contrast and desired resolution, provides an opportunity to perform physiologic and anatomic studies. Because this technique does not use ionizing radiation, it is not restricted by the limitation of the ionizing-based imaging systems therefore it can be used noninvasively to make images from cell, vessels, whole body imaging of the animal and distinguish tumor from normal tissue.Conclusion: Photoacoustic imaging is a new method in preclinical researches which can be used in various physiologic and anatomic studies. This method, because of application of non-ionizing radiation, may resolve limitation of radiation based method in diagnostic assessments.

Background: Molecular imaging is a new method of imaging of physiological studies at the cellular and sub-cellular levels. Among the various techniques that have been introduced for this purpose, magnetic resonance spectroscopy has provided an opportunity for study of brain activity and tumors in different areas of the body.Materials and Methods: In this review, using keywords such as MRS, Molecular imaging and Cancer at scientific databases such as PUBMED and ISI, studies in the field of MRS and related findings were evaluated.Results: MRS provides an opportunity to study brain disorders such as Alzheimer's and brain cancers. This method has also been used in diagnosis (between normal and cancerous tissues, different types of cancers and non-neoplastic from neoplastic), designing the most appropriate treatment regimen for each patient and also monitoring patient after treatment.Conclusion: MRS is a new method in molecular imaging that can be used in a variety of cancer diagnoses. This method can cover disadvantage of MRI procedure in evaluation of the tumor pathology.

Background: Stressful life events have suggested as one of etiologic cause of the disease from the middle of last century, but controversies still is going on.Materials and Methods: This study is a case- control study conducted on 100 MS patients in neurology clinic of Shariati Hospital during one year. History of stressful life events one year before beginning of the disease was questioned. These events, according to Holmes and Rahe Stress Scale, were severe and affected the disease progression. The analysis of data was performed using SPSS 15.Results: The mean age of patients was 30.9±7.1. Most of them (n=87) had relapsing- remitting MS. 51% of patients and 26% of controls had stressful life events (P<0.001). Odd's Ratio with confidence interval of 95% was 2.71. The most frequent stressful events were family problems and death of first degree relatives.Conclusion: This study showed that stressful life events were significantly more prevalent in MS, but we cannot conclude that stress lonely is a cause of MS. Although, major stress along with multiple other risk factors may be related to MS.

Synchronous hurthle cell adenoma of thyroid and para thyroid adenoma is very rare .Here we dicuss a 46 year old woman who presented with a thyroid nodule. Thyroid function test was normal but she had mild hypercalcemia. Fine needle aspiration of thyroid nodule was done that it was suspicious to follicular neoplasm or follicular variant of papillary thyroid cancer .Then the patient underwent thyroidectomy. In surgical specimen hurthle cell adenoma of thyroid and parathyroid adenoma was confirmed. Measurment of serum calcium is recommended in patients who are candidate for thyroid surgery.

VP shunt is one of the most popular methods for ICP reduction and treatment of hydrocephalus. Various complications of this method are not uncommon such as shunt malfunction, infection and unusual migration of distal catheter. I present a case of migration of the peritoneal catheter out of the vagina.