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BACKGROUND: The relation between Vitamin D deficiency with depressive and fatigue symptoms in both Multiple sclerosis (MS) patients and healthy population have been reported. To represent our regional achievement in this field we investigated the relation between Vitamin D status with fatigue and depressive symptoms in MS patients. MATERIALS AND METHODS: In two hundred MS patients, depressive symptoms and fatigue were measured using Beck PC (BDI-PC) and FFS scale, respectively. Venous blood sample was obtained from all participants and serum 25-hydroxy Vitamin D was measured by radioimmunoassay (RIA) method. Mean score of FSS, BDI-PC and EDSS were compared in patients with normal and low level of Vitamin D. The relation between FSS, BDI-PC score, EDSS and low Vitamin D status was determined. RESULTS: There was a moderate significant correlation between MS disability evaluated by EDSS and fatigue (r = 0.37, P < 0.001) and depression (r = 0.26, P < 0.001). The prevalence of low Vitamin D status was 48.5%. Low Vitamin D status was inversely associated with depressive symptoms of patients with MS (P = 0.02 rs = -0.16), but there was not significant correlation between Vitamin D and fatigue symptoms (P = 0.2). CONCLUSION: More interventional studies for determining the role of Vitamin D supplements in this regard is recommended. [ABSTRACT FROM AUTHOR]

Background: Patients under hemodialysis are exposed to remarkable volume of water. As dialysis water is in direct contact with patients' blood, absence of regular disinfection of pipes will facilitate the transfer of the endotoxins produced by bacteria in water to the patient's body. Thus, regular control of dialysis system and water disinfectant equipment is compulsory. This study aimed at comparing relative frequency of positive culture for microorganisms in piped water before and after filtration, culture of water after passing from pipes, and culture of dialysis fluid before entering the dialysis filter in hemodialysis section of Alzahra Medical Center (Isfahan, Iran). Methods: During 2010 and 2012, an interventional study was performed in Alzahra Hospital. Samples were taken from piped water before and after filtration and from dialysis fluid before passing from membrane. The obtained samples were cultured in tryptic soy agar (TSA) and the isolated bacteria were then evaluated. Interventions included the disinfection of pipes used for transmission of water and replacement of pipes in hemodialysis section. Findings: Purified water was studied before and after passing the pipes. Dialysis fluid was also assessed before and after the intervention. Bacteria had grown in eight out of 14 samples (57%) before the intervention. In fact, five samples developed Escherichia coli, three had pseudomonas, and one had candida. However, after the intervention, only one out of 14 samples was found to have bacteria (alcaligenes) after filtration and before entering dialysis water pipes. Conclusion: According to the results of this study, the probability of bacterial growth is very high in filtration system of dialysis water. Regular disinfection and microbial sampling and culture are hence crucial. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was the evaluation of young couples' knowledge about the ways of transmission and prevention of influenza type A. Methods: The present cross-sectional study was conducted on young couples admitted to a private consulting center in Isfahan (Iran) in year 2010. Subjects were selected by systematic randomsampling method. Data were collected through face-to-face interviews using a standard questionnaire. Findings: In this study, 300 couples were evaluated. The mean age of our study population was 24.2 ± 6.3 years. Our recordings showed that 202 persons (67.3%) had a poor level, 67 participants (22.3%) had a moderate level, and 31 individuals (10.3%) had a good level of knowledge about Influenza. Considerably, the level of knowledge in women was higher than men. Age was not significantly related with the level of knowledge (P > 0.05), but had a significant association with education level (P < 0.05). Conclusion: The findings of this study showed that influenza education programs should be expanded substantially. [ABSTRACT FROM AUTHOR]

Background: This study aimed to determine the relationship between li4 acupuncture point's electrical resistance and the intensity of pain in patients after facial surgery. We speculated that if this relationship could be proved, the construction of a special equipment to assess pain intensity is possible. This technique would not be subjective so the pain will be assessed more precisely. Methods: 100 patients between 17 to 65 years of age with pain after facial surgery participated in this study accomplished in Tehran Rasoule Akram Hospital and Al-Zahra Hospital in Isfahan, Iran. The pain intensity of the participants was entered in questionnaires in verbal rating scale after patients' recovery. Afterwards, the needles were inserted in Li4 and Li11 points and the electrical resistance of these two sites was measured and registered using the same scale. Findings: There were significant differences in the average pain intensity reported before and after narcotic injection. There was significant difference in resistance degrees before and after narcotic injection (P < 0.001). Vomiting and itching were observed in 20% and 3% of patients respectively, but there was no evidence of other possible side effects. Conclusion: It appears that there is a positive relationship between the electrical resistance of Li4 and Li11acupuncture points and pain intensity in facial surgery patients. If these findings would be confirmed by future studies, it would be possible to design an equipment to objectively measure the pain intensity. [ABSTRACT FROM AUTHOR]

Background: Upper limb lymphedema is a rather common and debilitating sequel of breast cancer treatment. The incidence of this sequel has been reported at different rates by different sources ranging from 6% to 31%. The aim of this study was to evaluate the incidence and risk factors including age, body mass index (BMI), region and size of the tumor, presence of metastasis, number of metastatic lymph nodes, excised axillary lymph nodes, type of surgery and radiotherapy and chemotherapy following the invasive breast carcinoma treatment. Methods: Through a retrospective study, recorded data from 170 breast cancer patients referred to Seyed Al-Shohada Hospital, Isfahan, Iran, during 2001 to 2006 was evaluated for the lymphedema incidence and risk factors. Findings: 59 patients (34.7%) with mean age of 47.9 ± 10.9 had lymphedema. In univariate analysis, obesity, estimated by BMI, was significantly associated with the development of lymphedema (P = 0.002). The number of metastatic lymph nodes in patients with and without lymphedema had a significant statistical difference (P < 0.0001). Age, excised nodes, type of surgery, region and size of the tumor, presence of metastasis, radiotherapy and chemotherapy had no associations with the incidence of lymphedema. Conclusion: According to our findings, the number of metastatic lymph nodes as well as BMI was associated with the development of lymphedema with higher incidence in patients with higher BMI and more affected lymph nodes. [ABSTRACT FROM AUTHOR]

Background: Etomidate and ketamine are commonly used to induce sedation in cataract surgery due to their favorable hemodynamic side-effect profile. This study was performed to compare the efficacy and safety of etomidate/fentanyl with ketamine/midazolam combinations for inducing sedation in cataract surgery with phacoemulsification technique. Methods: This study was a double-blind active-control clinical trial. 94 patients scheduled for cataract surgery under sedation, were randomly assigned to receive either etomidate/fentanyl or ketamine/midazolam. Participants' blood pressure, heart rate, nausea and vomiting frequency, decreased arterial O2 saturation episodes, and recovery duration as well as the patients and surgeon satisfaction were recorded during the study period. Findings: No statistically significant differences were observed in systolic and diastolic blood pressure and heart rate between groups. Mean systolic blood pressure was 148.5 ± 25.1 in etomidate/fentanyl and 149.3 ± 22.0 in ketamin/midazolam groups (P = 0.87). Similarly, the patients of both groups reported the same levels of pain and nausea, but not vomiting episodes which have only happened in etomidate/fentanyl group. In contrast, patient satisfaction was significantly higher in ketamine/midazolam group (P = 0.001), although surgeon satisfaction were comparable with both combinations (P = 0.07). The members of both groups reached a desired level of sedation in 30 minutes and the between-group differences of sedation scores remained non-significant. However, myoclonus was only experienced by the etomidate/fentanyl group patients. Conclusion: Overall, this study demonstrated that the combination of etomidate/fentanyl is as efficient and safe as ketamine/midazolam in cataract surgery, without any significant side effects. [ABSTRACT FROM AUTHOR]

Background: Vaginal candidiasis is the second cause of vaginal infections and almost 75% of healthy females get infected by these yeasts at least once during their reproductive age. The present study aimed to isolate and identify Candida species from the patients with vaginal candidiasis and healthy individuals. Methods: The study was cross-sectional and conducted on patients with suspected vaginal candidiasis referred to the private clinics of Shiraz, Iran and healthy individuals. Following the clinical examination, samples were taken from the vaginal discharges for culturing, gram staining, and determining the pH. Afterwards, the species were differentiated by CHROMagar Candida medium and the formation of chlamydospore. Findings: In the present study, the culture of the specimens of 42 patients (35%) yielded positive results. Vaginal discharge was the most prevalent clinical symptom of candida vaginitis with a rate of 78.6% followed by itching (57.1%), burning sensation (47.6%), and lower abdominal pain (45.2%). The most frequently identified species was Candida albicans (57.1%), followed by Candida parapsilosis (14.3%), Candida glabrata (11.9%), and Candida krusei (9.5%). Mixed colonization with two yeast species was observed in 7.1% (n=3) of the cases. Of the 21 healthy controls, the culture of the vaginal swabs yielded yeast colonies identified to be Candida albicans in 5 individuals (23.8%). Conclusion: Since only one third of the suspected patients were diagnosed as vaginal candidiasis through laboratory tests and also due to the lack of specificity of the symptoms, performing laboratory tests for definite diagnosis of this infection is recommended. [ABSTRACT FROM AUTHOR]

Background: Many people want to know about complementary and alternative medicine and its effectiveness. People tend to use such methods, especially the Iranian traditional medicine (ITM) due to various reasons and cultural backgrounds. One way to evaluate the effectiveness of ITM is to assess patients' satisfaction. Methods: In this cross-sectional study, 256 patients who had attended the ITM service providers in Isfahan, Iran for more than three sessions were included. The subjects' complaints and satisfactions from alternative and complementary medicine, practitioners' skills, and effectiveness in improving symptoms were collected by a questionnaire. Findings: The mean age of patients was 37.9 ± 11.8 years. Women constituted 65.2% of the whole population. Back pain was their most common complain (73.4%). Underweight had the highest recovery rate (50%). Herbal medicine (84%) and cupping (77.5%) had been used more than other alternative medicine methods. The mean satisfaction scores from alternative medicine, practitioners' skills, and effectiveness of the treatment were 29.1 ± 3.48 (out of 40), 32.58 ± 6.77 (out of 45) and 34.8 ± 3.24 (out of 50). Conclusion: The findings of this study showed good satisfaction of patients from traditional medicine. Therefore, better planning and research in this field may result in even higher satisfaction rates. Alternative medicine can also be recommended as complementary to the routine medical care. [ABSTRACT FROM AUTHOR]

Background: Insufficient sleep, poor sleep quality, and sleepiness are common problems in children and adolescents. Such problems can affect learning, memory, and academic performance. No previous studies have assessed the relationship between sleep problems/habits and academic performance in Iranian secondary school students. Therefore, we surveyed a sample of secondary school students and their parents in Isfahan (Iran) to assess the relation between sleep problems/habits and academic performance. Methods: In this cross-sectional study, data was collected by a reliable (Cronbach’s alpha = 0.87) and valid self-reporting questionnaire. Multi-stage cluster random sampling was used to select 110 secondary school students in Isfahan, Iran. Academic performance was assessed using the latest term evaluation report provided by the school. Students’ performance was stratified as excellent [grade point average (GPA) ≥ 17], average (GPA = 15-17), and poor (GPA < 15). The collected data was analyzed with SPSS20. Descriptive statistics (mean ± standard deviation), independent t-test, chi-square test, and analysis of variance (ANOVA) were used to analyze the data. Findings: There were 535 boys (48.6%) and 565 girls (51.4%) in this study. The mean age of students was 13.26 ± 1.09 years (range: 11-16 years). While 42.3% of the students had excellent performance, 30.1% and 27.6% of them had average and poor performance, respectively. Conclusion: Academic performance of the students was significantly associated with their age, gender, and fathers and mothers’ education levels and jobs. It was evident that the presence of sleep problems, poor sleep habits, or shortened total sleep time affected the students’ academic performance. In other words, sleep problems and habits may negatively affect academic performance. [ABSTRACT FROM AUTHOR]

Background: Optic neuritis (ON) can be the first presentation of multiple sclerosis (MS) or neuromyelitis optica (NMO). Antiaquaporin-4 IgG (AQP4 IgG) is a highly specific and moderately sensitive biomarker for NMO. This study was designed to assess the rate of seropositivity for AQP4 IgG, and the short-term outcome of patients presenting with single isolated ON (SION). Methods: A cohort of 41 consecutive patients experiencing severe (< 20 / 200) SION (not fulfilling the diagnostic criteria for MS or NMO), was prospectively recruited. Blood sampling was carried out immediately after the diagnosis of ON, and AQP4 IgG was tested qualitatively, using an indirect immunofluorescence kit. After clinical and paraclinical investigations, all the patients were followed up for a short-term period of at least 18 months. Results: The seroprevalence among the initial ON patients was 9.7% (4 / 41). The short-term conversion rate to MS and NMO was estimated to be about 7.3 and 4.9%, respectively. The conversion rate to NMO in initially seropositive patients was greater than that for the whole cohort [2 / 4 (50%) vs. 2 / 41 (4.9%); P = 0.035; Odds ratio: 19.5, 95% confidence interval: 1.73 to 219.50]. Conclusion: AQP4 IgG seropositive SION patients were more likely to develop NMO in comparison to the total SION population. Further studies, with a longer follow-up period and larger sample sizes are warranted to assess the clinical and prognostic value of assessing AQP4 IgG in SION. [ABSTRACT FROM AUTHOR]

Background: The relationship between hepatic disorders and Transfusion transmitted virus (TTV) and the significance of parenteral transmission of TTV are controversial. The aim of this study was to compare the prevalence of TTV in injection drug users (IDUs), hemodialysis patients, and healthy blood donors, in Isfahan, Iran, at the year of 2010. Methods: In a case-control study, 108 subjects included 36 hemodialysis patients, 36 IDUs, and 36 healthy blood donors (as control group) were studied. Five-mL blood sample was taken from each subject on EDTA-containing tubes. Then DNA extraction was implemented using DNA extraction kit, and DNA reproduction was done using specific primers and probe by Rotor-Gene 6000 real-time PCR instrument. Findings: The mean of age in subjects was 38.7 ± 14.7 and 71 (66%) were male. Of 108 cases, 30 (27.8%) were TTV positive and 78 (72.2%) were TTV negative. The prevalence of TTV in IDUs 21 (58%) and hemodialysis patients 6 (17%) was higher than healthy blood donors 3 (8%) that was statistically significant (P < 0.0001). Conclusion: The prevalence of TTV in IDUs and hemodialysis patients is significantly higher than the general population in Isfahan, Iran. It seems necessary to make plans and policies to reduce the risk of TTV transmission to families of hemodialysis patient and IDUs, individuals who have close contact with them and health care workers. [ABSTRACT FROM AUTHOR]

Background: The aim of the present study was to assess the growth pattern (obesity, overweight, and thinness) among 6 to11 year-old schoolchildren in Kermanshah, Iran, during 2010. Methods: A cross-sectional study was performed in a randomly selected population of 1400 elementary school students. Data on weight and height was used to calculate body mass index (BMI). In addition, age, parental education levels, and father's job and employment status of mothers were collected for all children. The BMI cut-offs provided by the Centers of Disease Control and Prevention (CDC) and the percentiles computed in the population studied were used for the classification of the children and adolescents as underweight (< 5th percentile), normal (5-84th percentile), overweight (85-94th percentile), and obese (≥ 95th percentile). Based on the National Center for Health Statistics (NCHS) references, stunting were defined by the 3rd percentile. Findings: The overall prevalence of overweight was 12.6% and 14.3% for boys and girls, respectively. The overall prevalence of obesity was 13.4% and 8.1% among boys and girls, respectively. The corresponding values for the overall prevalence of thinness were 8.2% and 9.3%. The prevalence of stunting was 5.6% in boys and 8.2% in girls. Children with more educated mothers had a higher prevalence of overweigh than children with less educated mothers. There were significant associations between the growth pattern and father's education level and job. Conclusion: Our findings revealed an increasing prevalence of overweight and obesity and a decreasing trend of thinness among elementary school students in Kermanshah in comparison with the national data. [ABSTRACT FROM AUTHOR]

Background: The purpose of evaluating children with mild head trauma is to identify patients with traumatic brain injury and to prevent brain from deterioration and secondary damage while limiting unnecessary imaging procedures. The present study aimed to investigate the frequency distribution of indications for computed tomography (CT) scan in children under 2 years of age with mild head trauma. Methods: In this cross-sectional study, medical files of 100 children under 2 years of age with mild trauma were investigated. Data such as age, sex, mechanism of head injury, level of consciousness before CT scan, repeated vomiting, decreased level of consciousness, craniofacial soft-tissue injuries, distant systemic damages, and the possible existence of brain lesions based on patients' CT findings was collected and evaluated. Findings: The mean age of patients, 63 of whom were male, was 18 ± 7.1 years. The most common cause of head injuries was falling from a height (66%). Based on CT scan findings, 55% of patients had abnormal CT findings. Age, sex, and mechanism of trauma were not significantly different between groups. Although repeated vomiting and decreased level of consciousness were more prevalent in patients with abnormal CT findings compared to those with normal results, the difference between the two groups was not significant. Conclusion: The results of the present study revealed that vomiting and decreased level of consciousness in children under 2 years of age with mild head injuries cannot be considered as the sole criteria to suspect brain injury and necessitate CT scanning. [ABSTRACT FROM AUTHOR]

Objectives: The onset of multiple sclerosis in the majority of the cases occurs as a clinically isolated syndrome (CIS). We sought to assess serum levels of 25-hydroxyvitamin D (25-OHD) in CIS patients and healthy controls. Methods: In this cross-sectional study 40 patients (36 women and 4 men) with CIS manifesting as a single isolated optic neuritis and 40 Age- and sex-matched healthy controls (35 women and 5 men) were enrolled between late October 2010 and early March 2011. General vitamin D deficiency was defined as serum 25-OHD levels of lower than 20 ng/ml and was classified as mild (15 < 25-OHD <20 ng/ml), moderate (8 < 25-OHD <15 ng/ml), and severe (25-OHD <8 ng/ml). Results: We found no difference in the median interquartile range [IQR] between CIS patients and controls (17.95 [10.40-29.13] vs. 17.00 [12.25-31.00]; P=0.57). However, when stratified by the levels of deficiency, among CIS patients a significantly higher proportion had severe vitamin D deficiency in comparison to healthy controls (20% vs. 2.5%; P=0.034). Nevertheless, the frequency of general (62.5% vs. 60%, P=0.82), mild (25% vs. 30%, P=0.80), and moderate (17.5% vs. 27.5%, P=0.42) vitamin D deficiency were not different between the two groups. Conclusions: Our findings do not indicate any significant difference of serum 25-OHD between CIS patients and healthy controls. However, in our series severe vitamin D deficiency was more frequent among CIS patients. [ABSTRACT FROM AUTHOR]

Background: The aim of the study was to determine the relative frequency of abnormal urodynamic findings in new multiple sclerosis (MS) cases without micturition complaints and to find its correlation with the number of MS plaques on magnetic resonance imaging (MRI), urinary tract involvement and the number of disease episodes. Methods: In this prospective study, 50 new female case of multiple sclerosis were enrolled. Age, urodynamic findings, micturition complaints and number of plaques on MRI were recorded on admission. Occurrence of urinary symptoms and number of episodes of the disease were recorded every three months during one-year follow-up. Results: The mean patients' age was 32.4 ± 7.2 years and all patients were female. Of the 50 patients, 19 (38%) had a normal urodynamic test and 31 (62%) had abnormal urodynamic findings at the beginning of the study. The occurrence of micturition complaints during follow-up in patients with abnormal urodynamic findings (94%) was significantly higher (p < 0.0001) than patients with normal urodynamic findings (37%). In addition, the number of plaques on MRI at the beginning of the study in patients with abnormal urodynamic finding was significantly higher (p < 0.004) compared to patients with a normal urodynamic study. The number of episodes during follow-up was not statistically different between patients with normal and abnormal urodynamic findings (p = 0.46). Conclusions: According to this study, 62% of all new MS patients had an abnormal urodynamic test. This is a considerable proportion of patients and it seems urodynamic studies can be used when MS is first diagnosed. [ABSTRACT FROM AUTHOR]

Objective: Multiple sclerosis (MS) is an inflammatory demyelinating disease of central nervous system. Environmental factors such as different viruses have proposed to be involved in the pathogenesis of multiple sclerosis (MS). This study was aimed to evaluate Cytomegalovirus (CMV) seropositivity in Iranian patients suffering from MS compared to controls. Methodology: This case control study was conducted in Isfahan. Using ELISA method, IgM and IgG antibodies to Cytomegalovirus (CMV) in MS patients and age and sex matched controls were detected. CMV IgM titer higher than 25 and CMV IgG titer higher than 0.6 were regarded as seropositive according to laboratory Kit. Results: Total 82 MS patients (64 females and 18 males) and 38 controls (29 females and 9 males) were included (P>0.05). The median [IQR] titer of CMV IgM in MS group was 3.25[2.97- 5.1] versus 3.5[2.5-5.7] in control group (p=0.66); likewise, the median [IQR] titer of CMV IgG in MS patients was 15.15 [8.1-22.5] versus 7.75[5.3-22] in control group (p=0.011). According clinical course median of IgG was 14.94[7.3-24] in RRMS and 20.0[9.8-22] in SPMS and median of IgM was 4.0[2.9-6.5] and 3.0[2.7-4.0] respectively. Conclusion: Seropositivity of CMV was higher in MS patients than controls, therefore, it may have a possible role in MS pathogenesis, but further studies are needed to evaluate this result. [ABSTRACT FROM AUTHOR]

Background: Stroke is the third cause of death in developed countries and is the commonest neurologic disease resulting in disability. This study was designed to evaluate epidemiologic characteristics and seasonal distribution of stroke among patients with first and recurrent stroke. Methods: This cross-sectional study was conducted during 2010-2011 in the departments of neurology at two hospitals affiliated to Isfahan University of Medical Sciences, Isfahan, Iran. Overall, 590 ninety patients above 16 years old with confirmed stroke diagnosis enrolled in this study. Hypertension (HTN), diabetes, dyslipidemia, atrial fibrillation (AF), myocardial infarction, valvular diseases (VD), smoking and addiction, ischemic heart disease, history of prior stroke and seasons of the year were registered. Findings: Among the 590 patients, 287 (48.6%) were females and 303 (51.4%) were males. Moreover, 94 patients (15.9%), 89 (15.1%), 110 (18.6%), 162 (27.5%), 124 (21%) and 11 (1.9%) were < 50, 50-59, 60-69, 70-79, 80-89 and ≥ 90 years old, respectively (P = 0.01). HTN, AF and VD were the commonest risk factors in patients with prior history of stroke compared to those with first strokes (P = 0.01, P = 0.01, and P = 0.02, respectively). Conclusion: This study indicated no difference in the prevalence of stroke between seasons. HTN, AF, and VD were the commonest risk factors in patients with prior history of stroke. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular disease is one of the most common causes of death in today's world. Coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass (CPB) is considered as a treatment for ischemic heart diseases. One of the conflicting points during CPB is maintaining optimum mean blood pressure. This study aimed to examine the impact of two different ranges of mean arterial pressure during CPB on intra- and post-operative clinical and paraclinical variables. Methods: In this randomized clinical trial study, two groups of 54 patients undergoing CABG surgery with CPB were enrolled. During CPB, blood pressure was maintained at about 50-70 mmHg in one group and 70-90 mmHg in the other group by administration of ephedrine and nitroglycerin. The patients were studied for blood gas, urine output, pace maker and inotrope requirements, arrhythmia, blood urea nitrogen (BUN), creatinine (Cr), cognition before, during and after the surgery, and also duration of intensive care unit (ICU) stay and intubation. Findings: In this study, two groups of 54 patients were enrolled. Overall, 92 (85%) subjects were male and 16 (15%) were female. Mean age of patients was 61.3 ± 9.3 years. Results showed that mean values of bicarbonate (Hco3), BE, arterial pressure of carbon dioxide (PCO2), arterial pressure of oxygen (PO2), BUN, Cr, duration of ICU stay, urine output, duration of intubation, level of cognition, pace maker and inotrope requirements and incidence of arrhythmia had significant relationships with blood pressure before, during, and after surgery. Meanwhile, pH did not have any significant relationships with blood pressure. Conclusion: Overall results showed that prognosis in patients with controlled blood pressure at about 70-90 mmHg during CABG surgery was better compared to the group with a blood pressure of 50-70 mmHg. However, more studies seem necessary. [ABSTRACT FROM AUTHOR]

Background: The morbidity and mortality of asthma have risen among children, especially those under 18, during the past 3 to 4 decades. There are various single studies in different target populations of Iran, which have reported different estimations. The present study designed in order to estimate a pooled prevalence among Iranian guidance school children. Materials and Methods: After searching for relevant articles in international and local databases from 1997 to 2009, we found 16 relevant articles and studies having the inclusion criteria. The outcome measure was the prevalence of asthma, and forest plot was used for presenting the findings of the meta-analysis. Heterogeneity between the studies was evaluated by the Cochran test. Moreover, the random effects model was used for estimation of pooled measures in Stata software (version 10). Results: From all the entered studies, 10 articles were published in English and the rest in Persian language. The pooled estimates for females, males and both genders were calculated as 3.9% (95% CI: 3.2% - 4.6%), 5% (95% CI: 4.2% - 5.8%), and 4.4% (95% CI: 3.7% - 5.1%), respectively. Conclusion: The prevalence of asthma among Iranian children varied from 1.26% to 11.6%, which is possibly due to the difference in sex, ethnicity race, and socio-economic level of Iranian population. Also, the prevalence of asthma among Iranian guidance school children was lower in comparison to the other neighborhood countries. [ABSTRACT FROM AUTHOR]

Background: The objective of this study is to estimate the average diagnosis and treatment costs of chronic hepatitis B and C, with respect to different therapeutic strategies in Iran. Methods: This is a descriptive, analytical, and cross-sectional study carried out on patients with hepatitis B and C, who were referred to the Liver Disease Research Center for Prevention and Treatment of Hepatitis, Isfahan University of Medical Sciences, in 2011. We have estimated the direct medical costs including doctors' fees, cost of para-clinical tests, medical treatments, and liver biopsy, in different treatment strategies. Findings: The results of this study showed that the total cost of diagnostic services for hepatitis B virus (HBV) and hepatitis C virus (HCV) patients, with state medical tariffs, was US$ 1499.07 and US$ 2084.89, respectively. The patients' profiles showed that there were currently seven therapeutic strategies available to treat HBV patients. The total cost of treatment strategies varied significantly from US$ 73 to US$ 8256. There were also four main strategies for HCV patients, each of these could be applied in two periods of time. The total cost of these treatment strategies showed a high discrepancy from US$ 242 to US$ 8256. Conclusion: The results confirmed that the total direct medical cost for an HBV patient in Iran exceeded US$ 5.5 Milliard in 2011. The results implied that the market price of direct medical cost of HBV and HCV patients in Iran is much higher than the estimated state costs. These costs would likely be saved or reduced by effective disease management and early prevention. [ABSTRACT FROM AUTHOR]

Background: Stroke is one of the commonest neurological diseases. However, no study has been designed to compare urban and rural stroke risk factors in Iran. Therefore, this study aimed to evaluate epidemiologic characteristics of stroke risk factors among rural and urban population. Methods: In this prospective cross-sectional study, 590 consecutive patients were evaluated in departments of neurology at two university hospitals (associated with Isfahan University of Medical Sciences, Isfahan, Iran). Patients above 16 years of age with confirmed stroke by a neurologist were included. Stroke risk factors such as hypertension (HTN), diabetes, dyslipidemia, atrial fibrillation, myocardial infarction, valvular diseases, smoking and addiction, ischemic heart disease (IHD), history of previous stroke and seasons of the year were registered. The patients were also asked if they lived in the rural or urban areas. Findings Urban and rural patients respectively constituted 78.6% (n = 464) and 21.4% (n = 126) of the 590 participants. According to the performed analyses, HTN, IHD and diabetes were the commonest risk factors in both urban and rural patients. In addition, no significant differences were found in stroke risk factors between rural-urban patients. Conclusion: Similar to previous researches, this study indicated urban population to have a higher probability of having HTN, IHD and diabetes. However, no significant differences were observed in such complications between rural-urban patients. [ABSTRACT FROM AUTHOR]

Background: Epicardial fat tissue is known as a risk factor in cardiovascular diseases. This study was designed to compare the epicardial fat thickness in patients with cardiovascular diseases and normal patients. It also tried to find a correlation between epicardial fat thickness and severity of coronary stenosis. Methods: This study was conducted from September 2010 to April 2011 at two university hospitals (Noor and Chamran Referral centers) associated to Isfahan University of Medical Sciences, Isfahan, Iran. A total number of 196 subjects were allocate to three groups of control (n = 68), acute coronary syndrome (n = 64) and chronic stable angina (n = 64). After registering demographic data, all individuals underwent echocardiography in diastolic subcostal view to determine the epicardial fat thickness. Angiography was also conducted to assess the severity of coronary stenosis. The thickness of epicardial fat was compared between groups and its correlations with age, sex, hypertension, hypercholesterolemia, diabetes, waist circumference, body mass index and severity of coronary stenosis were evaluated. Findings: The mean age of participants was 59.54 ± 11.01 years. There were statistical differences between age, sex, smoking and severity of coronary stenosis (P < 0.001, P = 0.03, P = 0.04, and P < 0.001, respectively). The mean of epicardial fat thickness in acute coronary syndrome, chronic stable angina and control groups were 5.7 ± 2.1, 6.2 ± 2.0 and 4.6 ± 1.9 mm (P < 0.001). There were no independent correlation between predicting factors and epicardial fat thickness (P > 0.05). Conclusion: This study indicated the thickness of epicardial fat to be more in cardiovascular diseases compared with normal persons. Future studies for evaluating the sensitivity and specificity of this diagnostic method are warranted. [ABSTRACT FROM AUTHOR]

Background: There are some paradoxical results about complications of long time stored blood transfusion. In this research we surveyed these clinical complications and relationship between morbidity and mortality with time of storage. Methods: This cross-sectional study was preformed on 100 coronary artery bypass graft (CABG) candidates in Chamran Hospital, Iran, in 2010. We compared the complications of using old blood (with storage time more than 14 days) and fresh blood (with storage time less than 14 days). Renal complications were assessed by blood urea nitrogen (BUN) and creatine (Cr) levels. In addition, liver complications were evaluated based on prothrombin time (PT) and partial thromboplastin time (PTT). We also measured ICU stay, ventilation time and mortality in the two groups. Findings: Renal complications, bleeding after surgery, raised coagulation test values such as PTT were significantly more prevalent in old blood takers (P = 0.001, 0.003, and 0.007, respectively). However, there were no significant differences in hemoglobin (P = 0.001), hematocrit (P = 0.001), platelet count (P = 0.001) and mortality between the two groups. Conclusion: In accordance with previous research, the results of this study showed blood storage more than 14 days to increase complications after surgery. Therefore, fresh blood transfusion is recommended for CABG patients. [ABSTRACT FROM AUTHOR]

BACKGROUND: The aim of the study was to assess the effects of combination of bortezomib moderate dose and continuous oral low dose melphalan and thalidomide and dexamethasone (BMTD regimen) in elderly patients aged ≥ 65 years with relapsed multiple myeloma (MM). METHODS: Twenty four patients with advanced MM were enrolled to receive eight 3-week treatment cycles with bortezomib 1.3 mg/m2 on days 1, 4, 8, and 11 followed by three 5-week cycles with bortezomib 1.3 mg/m2 on days 1, 8, 15, and 22. Within all cycles, dexamethasone 24 mg/d was given intravenously on the day of bortezomib injection and the day thereafter. In addition, patients received oral treatment of melphalan at a dose of 5 mg/d continuously for twenty days for every cycle. RESULTS: Mean age of study patients was 72.8 ± 6.4 years. All patients that completed at least one treatment cycle were evaluated for response. Complete, partial, and minor responses occurred in 19%, 65% and 6% of patients, respectively. Overall response rate was 90% (efficacy analysis). CONCLUSIONS: This study demonstrated potent in vivo activity of combination therapy with BMTD regimen in patients with relapsed MM, with an acceptable safety profile and high overall response rate. [ABSTRACT FROM AUTHOR]

Background and purpose: Topiramate (TPM) is a sulfa-derivative monosaccharide that is used mainly for treating epilepsy and preventing migraine. Within the gamut of side effects attributable to this drug, ophthalmologic manifestations are of crucial importance. In this study, for the first time, the aim was to provide a systematic literature review regarding this issue. Methods: For the time period 1996-2011, a PubMed search was made for the studies concerning the adverse/beneficial effects of TPM on vision. Overall, 404 citations out of a total of 2756 TPM-related studies were examined for relevance. Results: A total of 74 relevant studies were reviewed, 65 of which comprise small observational studies describing the ophthalmic side effects of TPM in 84 patients. Of these patients, 66 were affected by ciliochoroidal effusion syndrome as the cardinal ocular side effect of TPM (17 cases of myopic shift and 49 cases of angle closure glaucoma). A comprehensive statistical analysis is provided on these 66 subjects. Other rare side effects of TPM on the vision were also reviewed, including massive choroidal effusion, ocular inflammatory reactions, visual field defects, probable effects on retina, cornea, and sclera, and neuroophthalmologic complications. In addition, a framework is provided to classify these results. Discussion: Due to the expanding spectrum of indications for the administration of TPM, neurologists and psychiatrists should be aware of its diverse ocular side effects. In conclusion, ocular complications following this drug should be taken seriously and be subjected to ophthalmic counseling. [ABSTRACT FROM AUTHOR]

Background: One of the diagnostic methods for cardiovascular diseases, particularly coronary artery abnormalities, is imaging. Invention of CT devices with a multi-detector row in recent years has created new capabilities in the field of imaging, particularly in cardiovascular imaging. CT coronary angiography is a new imaging technique which can be implemented with these devices. Despite many advantages, this method imposes high absorbed dose (total ionizing dose, TID) to patients. Therefore, assessing the imposed dose rate to patients is very necessary. Given to this subject, we assessed the absorbed dose of organs. This study determined absorbed dose of skin, thyroid and eye in CT coronary angiography and compared them with the values of these doses in the organs in conventional angiography. Methods: In this study, absorbed dose of skin, thyroid and eye of 67 patients assessed who referred to Al-Zahra and Sina Hospitals for CT coronary angiography. The dose calculation method was through actual calculation as point dose using TLD (thermoluminescence). In order for dosimetry of each of the mentioned organs, we used a pair of thermoluminescence dosimeter GR-200. The average value obtained from each pair of TLD was considered as the dose of the required organ. Dosimeters were calibrated using 60 Co source and after the imaging, the dose value was separately calculated for each organ and were compared with the dose values in conventional angiography. The used CT devises consisted of 64-row detector CT Lightspeed VCT Model made in U.S. in Al-Zahra Hospital and 64 cross-sectional Phillips Model in Sina Hospital. Findings: Mean absorbed dose of skin, thyroid and eye in CT coronary angiography were 8.32 ± 1.73 cGy, 2.06 ± 1.68 cGy and 0.3 ± 0.1.6 cGy respectively and these values for the conventional angiography were 6.64 ± 9.3 cGy, 0.15 ± 0.17 cGy and 0.03 ± 0.03 cGy respectively. There was a significant difference between absorbed doses of these organs in the above mentioned imaging methods (P < 0.001). Range of absorbed skin dose in CT angiography tests approximately is 5.15- 12.22 cGy and in conventional coronary angiography is 0.07-39 cGy. Conclusion: Skin absorbed high dose than two other organs in both absorbed dose methods, because skin is directly irradiated. There were some evident and considerable changes in skin dose range in both methods and range of skin dose in conventional angiography was much more than CT coronary artery angiography. Absorbed dose of organs in CT angiography was much higher than conventional angiography. Scanning parameters plays a significant impact on absorbed dose rate. Therefore, technicians should acquire adequate trainings in this regard and utilize them practically. [ABSTRACT FROM AUTHOR]

# BACKGROUND: Lichen planus is recognized as an inflammatory disease of the skin with different morphologic patterns. Different treatment modalities, including topical and systemic corticosteroids, methotrexate, cyclosporine, azathioprine, topical calcineurin inhibitors, and psoralen plus UVA (PUVA), have been suggested for lichen planus. Although the efficacy of narrowband UVB (NBUVB) for treatment of lichen planus has been shown, no randomized clinical trial has compared NBUVB versus systemic corticosteroids for treatment of the disease. In the current study, we evaluated the efficacy of NBUVB versus systemic corticosteroids in the treatment of the lichen planus. # METHODS: Forty-six patients with confirmed diagnosis of lichen planus were randomly selected. The subjects were randomized into two groups of 23 to be treated with either systemic corticosteroids or NBUVB. All of the selected cases had generalized lichen planus that involved at least 20% of the body area and their pruritus was resistant to antihistamine drugs. Patients in the systemic corticosteroids group were treated with prednisolon 0.3 mg/kg for 6 weeks. NBUVB was performed three times a week for 6 weeks. The maximum dose of NBUVB was 9 J/cm2. Data regarding demographic characteristics of the patients was also collected. All collected data was analyzed using SPSS15 and statistical tests including analysis of variance (ANOVA), chi-square, and t-test. # RESULTS: 46 patients (23 patients in systemic steroid group and 23 patients in NBUVB group) were evaluated. There was a significant difference between the 2 groups regarding the efficacy of the treatment. According to chi-square test, NBUVB was significantly more effective than systemic steroid in treatment of generalized lichen planus (p = 0.008). According to the results, patient satisfaction was also significantly higher in the group treated with NBUVB as compared with the systemic corticosteroids (p = 0.012). # CONCLUSIONS: Overall, the results of our study and other previous studies showed that NBUVB may be regarded as an effective treatment for generalized cutaneous lichen planus. This treatment may be especially utilized when there is contraindication for systemic corticosteroids or other immunosuppressive drugs. [ABSTRACT FROM AUTHOR]

Background: photorefractive keratectomy (PRK) is one of the used methods which its impact on elimination of refractive disorders has been evaluated in conducted studies. This study aimed to compare the pain intensity and visual acuity following photorefractive keratectomy surgery using two types of contact lens i.e. Johnson & Johnson and Day & Night lens. Methods: This was a clinical trial study conducted in Feiz University Hospital affiliated to Isfahan University of Medical Sciences. Statistical population included patients with refractive disorders underwent PRK surgery. It was done since late June 2011 for three month. It was also done through convenient and simple sampling method. Patients divided into a group with Johnson & Johnson lens and the other group with Day & Night lens. Thereafter, their visual acuity and epithelial defect size were identified and compared. The data were analyzed through Software PASW version 18. Paired t-test was used to compare the results of visual acuity before and after the test in the two groups, and independent t-test and chi-square test were used at any time. Findings: In this study, 44 patients were studied. Mean age of these patients was 27.18 ± 3.90 years. Mean pain intensity of the patients with Johnson lens after the surgery at the first, third and fifth days was 0.98 ± 1.17, 0.57 ± 0.87 and 0.11 ± 0.32 respectively and in those with Day & Night lens was 2.5 ± 0.97, 1.4 ± 1.0 and 0.59 ± 0.62 respectively. Mann-Whitney test showed a significant difference between pain index in the two groups (P = 0.0001). Mean visual acuity of patients with Johnson lens after the surgery at the first, third and fifth days was 6.68 ± 2.68, 5.57 ± 1.70 and 7.07 ± 1.56 respectively and in those with Day & Night lens was 6.98 ± 2.28, 5.36 ± 2.04 and 7.39 ± 1.6 respectively. ANOVA test showed that there was no significant difference between the two groups in terms of visual acuity at the first, third and fifth days after the surgery (P = 0.67). Conclusion: It seems that probably the pain intensity after the surgery was better using Johnson lens than Day & Night lens. However, visual acuity had no difference with different lenses. Therefore, it is recommended to use Johnson lens in patients who do not have necessary collaboration or have lower pain tolerance. [ABSTRACT FROM AUTHOR]

BACKGROUND: Increased proteinuria would lead to a larger risk for renal failure in the long term. Therefore, proteinuria requires immediate and thorough evaluation. This study was designed to evaluate the effects of pioglitazone on proteinuria in patients with non-diabetic renal disease. METHODS: In this self-controlled clinical trial study, forty four non-diabetic patients aged 18 and more, who had renal disease and a stable proteinuria of over 0.5 g in 24 hour, were studied. All patients received 15 mg of daily pioglitazone for 4 months. Urine protein excretion was measured as a main end point prior to the study, at the end of the 2nd and 4th months of treatment, and 2 and 4 months after the cessation of the active drug. Other evaluated variables included systolic blood pressure, serum creatinine, urea, alanine aminotransferase (ALT), aspartate aminotransferase (AST), fasting blood sugar (FBS), blood urea nitrogen (BUN) and glomerular filtration rate (GFR) levels. RESULTS: Proteinuria (mean ± SEM) prior to the study, at the 2nd and 4th months of the treatment, and 2 and 4 months after the cessation of pioglitazone were 1088.6 ± 131.1, 699.9 ± 118.3, 433.9 ± 68.7, 416.1 ± 54.9 and 646.9 ± 89.1, respectively (p < 0.001). In addition, the reduction of 24-hour urine protein was statistically significant for both male and female patients (p < 0.001 for both). CONCLUSIONS: A reduction of proteinuria in patients with non-diabetic renal disease was observed during the 4-month treatment with pioglitazone which continued for 2 months after the cessation of the treatment. However, 4 months after the cessation of the treatment, a little increase was detected in the level of proteinuria. [ABSTRACT FROM AUTHOR]

Background: Teenage pregnancy is known as a high risk pregnancy. However, some study show that good prenatal care can decrease the rate of complications. This study was done to evaluate the frequency of preterm labor, still birth, premature rupture of membranes, cesarean section, eclampsia, low birth weight and interest of mother's about the type of delivery. Methods: This study was conducted from October 2009 to November 2010 in Isfahan University of Medical Sciences, Isfahan, Iran. Five hundred mothers were followed during their pregnancy and were divided into two groups, under 20 years (teenagers) and-over 20 years. The complications and outcome of pregnancy were evaluated and the collected data was analyzed by SPSS16. Findings: Five hundred pregnant women were evaluated during their pregnancy. The mean age of teenage women was 18.12 ± 1.11 years and the mean age of over 20-years mothers was 26.53 ± 3.08 years. 15(6%) teenage women have experienced eclampsia, while only 4(1.6%) women over 20 years old had eclampsia (P = 0.01). Conclusion: This study showed that teenage pregnancy has more complications than older age, and more education is needed to reduce this type of pregnancy. [ABSTRACT FROM AUTHOR]

Background: BK virus belongs to the polyomaviridae family. It has been reported that up to 80% of normal population change to seropositive status between 5 and 10 years of age. It has been assumed that the rate of multiple virus isolation is significantly greater in children with acute lymphoblastic leukemia (ALL) than normal population. Considering the scarce data on the presence of urinary excretion of BKV in children with ALL, we studied the urine BKV in newly diagnosed leukemic children comparing with normal population. Methods: 62 subjects (31 all cases and 31 controls) were enrolled in the study. Epitelial cells isolated from urine samples were screened for the BKV DNA with PCR method. Findings: Positive PCR for urine BK virus was seen in 3 children (9.7%). No positive result for urine BKV was achieved in control group. However, Fisher Exact test did not show any significant difference between two groups (P > 0.05). In addition, there was no significant correlation between BKV positivity and frequency of relapses. Furthermore, the mean time of diagnosis was not different between BKV positive and negative groups. Conclusion: In our study there was not any significant difference between BK viruria in ALL children and control group, no case of BK viruria had been found in control group. To demonstrate the role of BKV in inducing ALL or increasing number of relapses, prospective studies on larger scale of population and evaluating both serum and urine for BKV are recommended. [ABSTRACT FROM AUTHOR]

Background: The P53 tumor suppressor gene plays important roles in genomic stability. G-to-C at codon 72 in the P53 gene has been associated with increased risk for lung, oral, prostate, breast, colorectal cancers and may be a marker for risk of skin cancer. This project studied the effect of P53 polymorphism on risk of nonmelanoma skin cancers (Squamous and basal cell carcinoma). Methods: This case-control study undertook for study of twenty basal cell carcinoma (BCC), twenty squamous cell carcinoma (SCC) and twenty specimens as controls for each cancer specimen in the city of Isfahan, Iran. Different P53 codon 72 genotypes were identified using polymerase chain reaction. Findings: In control samples, the frequency of Arg/Arg genotype showed 25% and in BCC specimens showed 60%. The differences in this genotype group between the cases and controls were statistically significant (P = 0.048). The differences in the frequency of heterozygot Arg/Pro and also in the frequency of Pro/Pro genotype between the cases and controls were not statistically significant. OR = 4.5 in BCC cases show that the risk for this disease in persons who have Arg/Arg genotype is about 4.5 times more than normal people. The results of χ2 test showed that in this study there is not statistically significant differences between the SCC specimens and controls for frequency of different genotypes. Conclusion: The present study indicate that P53 codon 72 polymorphism is a genetic predisposing factor for risk of nonmelanoma skin cancers (of BCC type) in Isfahan. However, further studies are needed in order to elucidate the role of P53 codon 72 polymorphism in skin cancer development. [ABSTRACT FROM AUTHOR]

Background: This study was conducted to assess the prevalence of Hepatitis C virus (HCV), Hepatitis B virus (HBV) and Human Immunodeficiency virus (HIV) among hemophilia and thalassemia patients. Methods: This cross-sectional study was conducted from October 2008 to December 2010 in Isfahan, Iran. 1160 adult multi-transfused patients suffering from beta-thalassemia (n = 545) and hemophilia (n = 615) were enrolled in the study. Blood samples were obtained from the patients and were tested for HBs Ag, Anti-HCV Ab and Anti- HIV Ab. Patients with HCV positive underwent genotype determination. Findings: 822 males and 338 females (mean age 22.7 ± 11.5 years, range 1-76 years) were investigated in this study.312 males (57.2%) and 233 (42.8%) females had thalassemia. 511 (83%) males and 104 (17%) females were in hemophilia group. Of the 505 (82.1%) persons with chronic hepatitis in hemophilia patients, 495 (98%) patients were HCV antibody positive and 10 (2%) patients had HBs positive. There were 56 (11%) patients with chronic hepatitis in patients with thalassemia. Of them, 50 (89.2%) patients were HCV antibody positive and 6 (10.8%) patients had HBs positive. None of the thalassemia and hemophilia patients was positive for HIV Ab. HCV genotype 1 was the major genotype among patients. Conclusion: HCV is a major virus of concern in the multi-transfused patients. The strategies for prevention of HBV and safety of blood products in this respect have indeed been successful. Family History of hepatitis is the major risk factors among patients. [ABSTRACT FROM AUTHOR]

Background: Multiple sclerosis is an inflammatory and degenerative disease of central nerves, in which myelin appears as several large and small plaques in cerebrospinal white matter. The aim of this study was investigate the familial prevalence of Multiple Sclerosis. Methods: This cross- sectional study was performed from the beginning to the end of 2007 on 539 MS patients in Isfahan, Iran. The patients were selected among all of the MS people who referred to the MS clinics of Isfahan University of Medical Sciences by the simple random sampling. Finally 593 patients were studied; their disease was proved based on the McDonald values by 2 neurologists. Findings: The average of patients' age was 33.44 ± 0.9. 493 patients (83.1%) were female. 85% had partial disability and 83.3%of them had Relapsing Remitting kind of this disease. 53.5% of them had 2 or more hospitalizations. 119 of them (20.1%) had familial history of MS which among them in 47 (40.5%) patients it was in first degree relatives, in 26 (22.6%) was in second degree relatives and in 46 (36%) was in third degree. Conclusion: According to the achieved results it seems the familial prevalence of MS in Isfahan, Iran is more than other regions, so it is recommended to do more etiologic studies based on the genetic and environmental factors. [ABSTRACT FROM AUTHOR]

Background: In many surgical procedures in pelvic and abdomen, gastrointestinal anastomosis has a main role. These days, bowel anastomosis is done with some techniques like handsewn and stapler anastomosis. In some research, the use of fibrin glue in abdomen is convenient, operation time is reduced, and intra abdominal adhesion is lower than standard manner. In this research we evaluated new fibrin glue for small bowel anastomosis in animal model. Methods: In this experimental study, we operated 5 dogs in same race, age and gender. After laparatomy under general anesthesia 5 cm of small intestine resected, then anastomos with new fibrin glue was done. After 15 days, the dogs were reoperated and surgical site was evaluated and then anastomosis was done by handsewn method. PASW version 18 was used for data analysis. Findings: Mean time for anastomosis with fibrin glue was 6:47 and 11:11 for handsewn. Mortality and peritonitis didn't occur. After second operation there was no any sign of leakage, intraperitoneal inflammation and abscess. In microscopic only one case attachment wasn't seen in mucosa and submucosal layers but it was occurred in muscular and serosal layers. Conclusion: The mean time of FG anastomosis was shorter than handsewn and the patency of surgical site was favorable beause there was no significant different between diameters of proximal and distal lumens compare whit normal bowel diameter. Our data reveals that we can use FG (that reinforced by nano particles) for reinforcement of GI anastomosis with high safety level, especially in high risk situation. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study is the evaluation of medical students' academic achievement after the changes in arrangement and courses of some Basic sciences lessons in school of medicine and comparing their academic achievement before and after the changes in arrangement and the courses. Methods: In this descriptive analytical study 156 samples were selected from 2004 (group 1) and 2005 (group 2) medical freshmen. Changing courses, semester, and separating the lessons into smaller curses and elimination and addition were done in 24 Basic sciences lessons. Then the average scores of changed lessons and Basic Sciences comprehensive exams, demographic characteristics, failure rate and educational years were compared and analyzed in both groups. Data analysis was done by SPSS software using Chi-Square, Independent sample t test. Results: This study showed that there is a significant difference between the mean score of following lessons. these are medical physics, physiology 1, theoretical pathology, practical and theoretical limb anatomy, physiology 1-a and 2-b and 2 practical and virology, theoretical bacteriology, practical trunk anatomy, practical head and neck, theoretical and practical immunology as well as the comprehensive exams mean scores (P=0.003) which increased after the changes in march 2008. Conclusion: The results of this study showed that changes had a positive effect on the mean scores of some lessons (including medical physics, physiology 1, theoretical pathology, theoretical and practical limb anatomy physiology 1-a and 2-b and 2 practical and virology.). However, it had a negative effect on the mean scores of some lesson i.e. theoretical bacteriology, applied trunk anatomy, applied head and neck anatomy, theoretical and practical immunology. The mean scores of the rest did not have a significant change and the mean scores of basic sciences comprehensive exams increased in both groups (P=0.003) which shows the changes were necessary and useful. [ABSTRACT FROM AUTHOR]

Background: Malaria is the most important parasitological disease which infected annually 300-500 millions people and caused more than one million people. Eradication process has began since 1950 and Isfahan province was under protection too. In 2003 WHO, put Isfahan in sixth rank after Sistan & Balochestan, Hormozgan, Kerman, Fars and Tehran. Therefore epidemiological study of regional malaria has a special importance. Methods: This study was a cross-sectional study. The study population was all of the patients with malaria who refers to health centers since 2004 to 2009. Sampling method has been unaccidental simple assay. Findings: Totally 726 patients were investigated, 679 patients (93.5%) are male and 47 patients (6.5%) are female. The mean age of studied population was 25.9 ± 9.9 years. Plasmodium vivax was the high prevalent parasite (94.6%). The most prevalence of Malaria was seen in 2005 with 243 patients (23.5%) and during june (11.8%). Afgan immigrants are 91% and Iranian patients were only 2.8% of all patints. After the treatment, 348 patients (47.9%) are fully recovered, 39 patients (5.4%) were remained under treatment and we didn't have any information from 339 patients (46.7%). Conclusion: Isfahan climate, existence of species of anophel masquito (macolypenis, superpictues and sakharovi) and uncontrolled immigration of Afghans, can lead Isfahan to be a new center for growing malaria epidemics. Therefore we can prevent the distribution of malaria by controlling of entrance, prevent of immigration and effective treatment. [ABSTRACT FROM AUTHOR]

Background: Different types of natural and synthetic materials are now available for treatment of thermal injuries in children and adult patients, all of which have their own advantages and disadvantages. Human amniotic membrane is considered as an influential method of treatment due to its availability and low cost. This study has been conducted to survey the long term (six month) effects of human amniotic membrane on deep second degree burns of children as a primary wound dressing in comparison with skin graft. Methods: Over a period of one year, sixty six patients under 18 with less than 30% second degree and minuscule margins of third degree burn (less than 1 cm) were collected and randomly distributed in two groups. The first group including 34 patients treated with human amniotic membrane and the second group (control group) consist of 32 patients were treated with skin graft. Findings: Considering Vancouver scale score as an index of long term wound healing the control group was superior to amnion group (5.9 ± 2.8 vs. 6.8 ± 1.2, P = 0.027). Mean hospitalization days in amnion group significantly decreased (12.4 ± 7.6 vs. 20.2 ± 10.3 P = 0.006). The number of admissions and treatment costs dominantly declined in amnion group. Conclusion: Primary dressing of burn wounds with amnion membrane is a cost-effective and available method for burn wounds treatment, it also has comparable long term effects in comparison with skin graft. So having an amnion membrane bank in burn centers and widespread use of amnion membrane graft in management of partial thickness thermal wounds in children is recommended. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to evaluate the association between clinical symptoms and endoscopic findings among patients with duodenal ulcer. Methods: This cross-sectional study was performed in endoscopic center of Al-Zahra Hospital in Isfahan. We selected 200 patients older than 18 year who had Dyspepsia by simple nonrandom sampling. Finally Endoscopic findings and clinical symptoms data were collected and analyzed for 114 patients with active peptic duodenal ulcer. Finding: The mean age of the study sample was 46.5 ± 10.4 years. There were 44 females (38.6%) and 70 males (61.4%). The average of BMI was 27.2 ± 4.3. There was a significant association between endoscopic findings (site, size and quantity of ulcer) with clinical symptoms (weight loss and heartburn) and there was no association between other endoscopic findings and clinical symptoms. Conclusion: The results of present study showed that weight loss and heartburn can use as marker to determine site, size and quantity of duodenal ulcer. But these findings can not be enough and more study need to be done to determine the association between endoscopic findings and clinical symptoms. [ABSTRACT FROM AUTHOR]

Background: Nosocomial infections are amongst important complications of cardiac surgical operations. The principal types of these infections appear as surgical site or respiratory infections. The rate of surgical site infections after cardiac surgery has been reported between 1 and 9 percent and the rate of respiratory infections has been up to twice this range. Various studies have attempted to make use of methods to prevent post-operative infections in addition to routine measures of preparation before surgery. Topical application of bacitracin or gentamicin ointment, intranasal mupirocin ointment, oral rinse and intranasal application of chlorhexidine solution are among these methods. The current study aimed to investigate the impact of mouth and nose disinfection with chlorhexidine solution on reduction of surgical site as well as respiratory infections after cardiac surgical operations. Methods: This study was conducted in the cardiac surgery ward, Sina Hospital, Isfahan from 1388 to 1389 as a randomized clinical trial. Patients undergoing open heart surgery entered the study. Patients were randomly assigned to two groups, whereby in one group preparation for operating room was implemented by routine methods and in the other group, mouth and nose disinfection with 0.2% chlorhexidine solution was performed every 6 hours from one day before to one day after surgery, in addition to routine hospital measures. Each patient was followed for signs of infection up to one month after surgery. Finding: From 180 patients were recruited too this study, Chlorhexidine solution was used in 88 patients and 92 other patients who comprised the control group,. The age of patients ranged from 43 to 77 years. Mean age was 61.8 years in case group and 61.5 years in control group. Total number of infections in case (intervention) group was 6 (7%) including 2 surgical site infections and 4 respiratory infections. A total of 13 patients (14%) in the control group were diagnosed with infections including 7 surgical site and 6 respiratory infections. There was no statistical difference I using chlorhexidine (P=0.232). In the case group 4 infections (66%) occurred in patients suffering from underlying diseases specially diabetes and 9 infections (69%) in the control group occurred in patients with underlying diseases. 1 patient in the control group died from acute heart failure during a second hospitalization, who also had fever and wound infection. Conclusion: Despite lower number of infections in the case (intervention) group, there was no significant difference. Some studies have attained similar results not considering nasal S. aureus carrier state. But some studies on S. aureus carrier patients have found meaningful reductions in postsurgical. [ABSTRACT FROM AUTHOR]

Background: Allergic rhinitis, one of the rhinitis syndromes, is associated with a symptom complex characterized by paroxysms of sneezing, rhinorrhea, nasal obstruction, and itching of the eyes, nose, and palate. Allergic rhinitis is associated with significant morbidity. Affected individuals have a quality of life significantly worse than otherwise healthy ones. The main goal of this study was to determine the sensitivity and the specificity of these tests and the relationship between clinical manifestation severity and the tests results. Methods: This cross-sectional study with forward direction was performed in allergy clinic of Alzahra hospital in Isfahan. The sampling was done in consecutive nonrandomized mode. The tool of gathering the data was a questionnaires asking about age, sex, family history, smoking, pet contact, allergic rhinitis type, severity and frequency of clinical presentation; also total serum IgE, nasal eosinophil count and Prick skin test results noted in questionnaires. The gathered data were analyzed by SPSS software. Finding: There were significant differences in patients Prick skin test results as the gold standard test depend on their family history and place of life; also total serum IgE titer and nasal eosinophil count in patients with positive skin test was significantly more than patients with negative skin test. For the other analyzed factors, there were no significant differences in patient Prick skin test result as the gold standard test. There was no significant relation between total serum IgE titer and clinical presentation severity and frequency; a same result was seen about nasal eosinophil count too. Based on Spearman's correlation coefficient test, there was no significant correlation between total serum IgE titer and nasal eosinophil count; however this correlation coefficient would be raised ever the clinical presentation severity raises. The calculated cut off point for total serum IgE titer in this study was 61 IU/mL with 75% specificity and 80% sensitivity. The calculated cut off point for nasal eosinophil percentage in this study was 5% with 100% specificity and 72.7% sensitivity. Conclusion: Noticing the obtained results, it seems the physicians should concern family history and place of life in history taking as an important clue to allergic rhinitis diagnosis. This study clarified that total serum IgE titer and nasal eosinophil count can be acceptable paraclinic tests to allergic rhinitis diagnosis; but they should not be used to determine or guess how much the disease severity is. [ABSTRACT FROM AUTHOR]

Background: Circadian rhythm disorders (CRDs) are one of the manifestations of all types of sleep disorders in Multiple Sclerosis (MS) patients. Knowing about these problems and rationale approach to them can increase the health level and treat these patients. The aim of this study was to determine the frequency of circadian rhythm disorders in MS patients in compare with control group and ascertain its association with chronic fatigability. Methods: The case-control study was held on 120 Multiple sclerosis patients and 60 healthy people (as control group) in MS Clinic of Al-Zahra Hospital in Isfahan in 2009. The questionnaires of PSQI, FSS and EDSS was given to patients and for assessing the circadian rhythm disorders, the PSQI questionnaire was given to control group too. All the findings were analyzed in SPSS software. Finding: The amount of circadian rhythm disorders in MS patients was significantly higher than control group (P = 0.002). In this manner, these kind of circadian rhythm disorders in patients with severe fatigue was significantly higher than patients with mild fatigue (P < 0.05). Conclusion: This study showed that the rate of circadian rhythm disorders in MS patients with severe and mild fatigue was higher than control group. Increased distribution of these groups of disorders may empower the more susceptibility of biologic clock, which regulates the circadian rhythm, in the course of MS disease. More studies are required for confirmation of anatomic relationship between location of demyelinative plaque and types of sleep disorders. [ABSTRACT FROM AUTHOR]

Background: Proteinuria has independent deleterious effects on the progression of chronic renal disease. The aim of this study was to determine effect of pioglitazone on proteinuria in patients with non-diabetic renal disease. Methods: This was a self-controlled clinical trial study conducted in Al-Zahara Hospital and few private clinics of nephrology in Isfahan. Forty four non-diabetic patients aged 18 and over, who had renal disease and stable proteinuria over 0.5 g in 24 h and body mass index (BMI) lower than 30 kg/m2, were enrolled in the study. Patients were treated by 15 mg of pioglitazone for 4 months. The primary end point was urine protein excretion, measured prior to the study, at the end of 2 and 4 months during treatment as well as 2 months after cessation of pioglitazone. Secondary end points included systolic blood pressure, creatinine, ALT, AST, FBS, BUN and GFR levels. Findings: Mean urine protein excretion was 1088.6 ± 775.6 mg/24 h before treatment; therefore mean urine protein excretion at the end of 4th month was 433.9 ± 406.2 mg/24 h (P<0.001, CI95%: 0.49-0.82). There was no significant trend for systolic blood pressure, creatinine, ALT, AST, FBS, BUN and GFR levels to increase or decrease during the follow-up period (P> 0.01). Conclusion: Considering complications of proteinuria followed by gradual kidney malfunction based on findings of present study, pioglitazone could significantly decrease proteinuria in patients with nondiabetic kidney diseases. [ABSTRACT FROM AUTHOR]

Background: The main cause of Alzheimer's disease (AD) is loss of cholinergic function. So, the choice strategy of therapy is to increase the level of acetylcholine (Ach) in the brain of by acetylcholinesterase inhibitors (AchEIs) such as Donepezil. This study evaluated the effect of donepezil on cerebral blood flow using non-invasive transcranial doppler (TCD) sonography. Methods: This clinical trial was performed on AD patients in two groups of case and control, each consisting of 11 patients. The case group who received donepezil medication was examined by TCD before (baseline), after four weeks of oral treatment with 5 mg/d donepezil and a further four weeks of 10 mg/d donepezil, administered orally. The control group did not receive any medications effective on AD and were examined by TCD only once. Peak systolic velocity (PSV), end-diastolic velocity (EDV) and mean flow velocity (MFV) velocities of posterior cerebral artery (PCA) and middle cerebral artery (MCA) were assessed and mini-mental state examination (MMSE) was carried out. Findings: There were not any significant difference between the case and control groups, in terms of age and sex. In the case group, mean MMSE score reached 20.2 ± 2.8 from a baseline value of 15.8 ± 3.3 after four weeks of oral treatment with 5 mg/d donepezil, and reached 20.6 ± 3.9 after four more weeks at 10 mg/d donepezil (P < 0.0001). In MCA, the difference in PSV and MFV values after four weeks of treatment at 10 mg/d donepezil was statistically significant, compared with the baseline values (P = 0.002 and 0.025, respectively). In PCA, the values of MFV and EDV after four weeks of treatment with 10 mg/d donepezil were statistically significant in comparison with the baseline value (P = 0.015 and 0.014, respectively). Conclusion: Donepezil, especially administered in doses of 10 mg/d, has an effect on increasing cerebral blood flow velocity and MMSE score in AD, but more extensive trials by other researchers are recommended. [ABSTRACT FROM AUTHOR]

Background: The etiology of multiple sclerosis (MS) is still not fully understood. Infectious agents are believed to play a role in the development of this multifactorial disease. The aim of this study was comparison of HBsAg and HBsAb in multiple sclerosis patients and control group. Methods: We conducted a case-control study within the Multiple Sclerosis Database in Isfahan. Forty multiple sclerosis patients and forty people of their neighbors (as control group) were include in the study. We evaluate the plasma levels of HBsAg and HBsAb in both groups. Statistical analysis was performed by SPSS16 using Independent sample t-test and chi-square test. We considered P < 0.05 as significance. Findings: Plasma levels of HBsAb were positive in 25% of all multiple sclerosis subjects vs 15% of subjects in control group (P > 0.05). Conclusion: The findings indicate no association between plasma levels of HBsAg and multiple sclerosis. [ABSTRACT FROM AUTHOR]

Background: Hormonal therapy is one of the most important regimens for treatment and prophylaxis of recurrences of breast cancer. Among drugs, aromateas inhibitors has established and important role in this field. Letrozole is the most common used drugs in this group in our country. Two brand names of letrozole are available in Iranian drug markets; femara and letrofem. The aim of this study was the comparison of acute side effects of these drugs. Methods: In This clinical trials study, 45 post menopausal women with breast cancer were divided in two groups after surgery and chemotherapy. First one contained 30 patient and the second ontained 15 patient treated with letrofem and femara respectively. Side effects were studied in three steps. Findings: Among 19 studied variables, there were significant differences in frequency and intensity of 7 variables between two groups. These variables were pain, arthralgia, nausea, myalgia, lower extremity edema, fatigue and vertigo. Letrofem had more sever side effects from view point of frequency and intensity in comparison with femara. Conclusion: Observed differences may be due to three reasons including different bioavailability, different levels of estrogen following drug administration and lower amount of samples due to high cost of treatments. Then, it is recommended that bioequivalency test and measurement of estrogen level will be done in future studies with more samples. [ABSTRACT FROM AUTHOR]

Background: Ischemic heart disease is the leading cause of mortality and morbidity in the world. Vascular inflammation is the noticeable risk factors of ischemic heart disease. In this study the relation between intracellular adhesion molecule (ICAM) and vascular adhesion molecule (VCAM) as inflammation indicator with extent of coronary involvement were evaluated. Methods: In this cross sectional study, 82 patients with stable angina who candidates for angiography were studied. Those with acute coronary syndrome, and recent surgery, inflammatory disease, some drug consumption, kidney and liver disease, Phlebitis and PTE are excluding from study. Then blood sampling for biochemical VCAM and ICAM analysis were drawn. After it, coronary angiography was done via standard method. Findings: Mean ages of the patients were 58.4 ± 10.1 year old with 72% male. The mean of ICAM and VCAM were 183.9 ± 78 and 150.3 ± 136 ng/dl, respectively. There isn't any correlation between VCAM and ICAM and the severity of coronary artery disease. In linear regression analysis even with considering of hypertension, hyperlipidemia and diabetes as cofounders, there was not any relation between these factors and CAD. Conclusion: According to our findings, inflammatory markers (VCAM and ICAM) didn't add any further information about extent of CAD. [ABSTRACT FROM AUTHOR]

Background: Myocardial Infarction is a common and lethal disease, especially in first hours. Rapid and correct decision is essential for priority of advance therapies and this study follows the accuracy of a scoring system for this triage. The aim was to assess the correlation of Thrombolysis in Myocardial Infarction Risk score and Angio score in patients with ST Elevation Myocardial Infarction. Methods: In this cross sectional study, 240 patients with ST elevation myocardial infarction from CCU of universal hospitals participated in the study. Thrombolysis in myocardial infarction risk score was calculated and during 2 month they underwent angiography and follow up. Findings: Mean age was 60.02 and 79 patients were female. Correlation between thrombolysis in myocardial infarction risk and angio score was significant (P < 0.001). Correlation between ejection fraction and thrombolysis in myocardial infarction risk score (P < 0.001) and angio score with age (P < 0.001) was significant too. There was no significant correlation between Angio score and recurrent angina (P = 0.143), rehospitalization (P = 0.524) and death (P = 0.179). Pearson's correlation showed significant relation between thrombolysis in myocardial infarction risk score and angio score (P < 0.001, r = 0.556). Conclusion: This correlation shows that thrombolysis in myocardial infarction risk score probably can be used for evaluating angiographic extent of coronary artery disease. Simple clinical use of this score at bedside if confirms with a prospective cohort study, makes this score a method to stratify patients in high and low risk groups and accordingly diagnostic- therapeutic strategies. [ABSTRACT FROM AUTHOR]

Background: Suitable mechanical ventilation strategies can reduce the incidence and severity of ventilator-associated lung injury in patients with acute respiratory distress syndrome (ARDS). In this study, the effects of adaptive support ventilation (ASV) and synchronized intermittent mandatory ventilation (SIMV) on respiratory parameters and arterial blood gases (ABGs) parameters were compared in ARDS patients. Materials and Methods: Twenty-four patients were randomly divided into two groups of ASV and SIMV. Patients were followed up for 3 days, and respiratory parameters including rapid shallow breathing index (RSBI), spontaneous breathing rate (SBR), minute volume, and peak inspiratory pressure (PIP) as the primary outcomes and ABG parameters including PaO2, FiO2, PaCO2, HCO3, and PaO2/FiO2 ratio as the secondary outcomes were measured. Results: PIP in patients in the SIMV group on the 1st day (P = 0.013), 2nd day (P = 0.001), and 3rd day (P = 0.004) was statistically significantly more compared to those in patients in the ASV group. RSBI, SBR, and minute volume between the ASV and SIMV groups during the 3 days were not statistically significantly different (P > 0.05). The mean arterial blood pressure, heart rate, PaO2, and PH between both groups were similar (P > 0.05). At the end of the 2nd and 3rd days, the level of FiO2 and PaCO2 in ASV was significantly lower than those in ASV group. HCO3 in each of the 3 days in the ASV group was statistically significantly lower than that in the SIMV group (P < 0.050). PaO2/FiO2 ratio in patients in the ASV group in the 3 days was statistically significantly higher than that in the SIMV group (P < 0.050). Conclusion: By reducing PIP and improving oxygenation and ABG parameters, ASV mode may be a safe and feasible mode during mechanical ventilation in patients with ARDS. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented offering an update on multiple sclerosis in Isfahan, Iran.