Tehran University Medical Journal

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This was a retrospective review of a consecutive series of patients with spinal disease in year 2000, who underwent posterior fusion and instrumentation with Harrington distraction and Cotrel-Dobousset system to evaluate causes of hardware failure. Many cases of clinical failure has been observed in spinal instrumentation used in spinal disorder like spondylolisthesis, fractures, deformities, … . Thirty six cases that were operated because of spinal disorders like spondylolisthesis, fractures, deformities, …, were included in this study. Seventeen of this cases had breakage of device. Factors like age at surgery, type of instrumentation, angles before and after surgery and …, were compared in two groups of patients. The most common instrument breakage was pedicle screw breakage. Pseudoarthrosis was the main factor that was presented in failure group (P value<0.001). Other important causes were, age of patient at surgery (P value=0.04), pedicle screw placement off center in the sagittal or coronal plane of the pedicle (P value=0.04). Instrumentation loads increased significantly as a direct result of variations in surgical technique that produce pseudoarthrosis, pedicle screw placement off center in the sagittal plane of the pedicle, or using less than 6 mm diameter screw. This factor can be prevented with meticulous surgical technique and using proper devices.

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Background: There are several million new cases of peptic disease annually. The disease has a various range of presentations. Gram negative helicobacter pylori bacilli is considered as an etiologic factor in this disease. Goal of treatment in peptic disease is eradication of the helicobacter pylori (HP). Combination therapy has been implemented in the treatment of this disease. Different modalities have been recommended up to now. In order to lower adverse effects, cost and drug resistance, researchers have introduced a new combination therapy in which honey is substituted for metronidazole.

Methods: A step II of clinical trial was designed. The sample size was 15 children. Diagnosis of HP infection was confirmed with histopathology. Treatment regimen consisted of omeprazole, amoxicillin, bismuth and honey. After a 3-4 week follow- up, eradication was evaluated.

Results: 15 children completed the follow- up period. Mean age of patients was 9.4 years. Treatment effectiveness was 80 percent.

Conclusion: Combination therapy with 3 drugs along with honey has significant effectiveness on HP eradication.

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Background: The most frequently used test for evaluation of fetal health is the Non Stress Test (NST). Unfortunately it has a high incidence of false positive results. The combination of vibroacoustic stimulation with the NTS has been shown to reduce non reactive results.
Methods: A tests assessment method was chosen with a simple randomized sampling. 40 pregnant women with non reactive NST in the first 20 minutes who received VAS in one of Tehran University's Hospitals were compared with BPP scores. A vibroacoustic stimulation was applied for a 3 seconds on the maternal abdomen and fallowed within 10 minutes.Data collection tools were NST, sonography instruments ,NST result paper, tooth brusher, watch, demographic questioner and check list. Data analysis was made by descriptive static and by using the Fisher's Exact Test (with level of significant at p<0/05). All statistical analysis were performed using an spss/win.
Results: After VAS, 70% of non reactive tracing became reactive. All cases with fetal reactivity response after a VAS had a subsequent BPP score of 8 (negative predictive value of 100%). False positivity of VAS was lower than NST.
Conclusion: VAS offers benefits, by decreasing the incidence of non reactive test and reducing test time. VAS lowers the rate of false positive NST. VAS is safe and allows more efficient of prenatal services. This test could be used as a rapid antepartum test to predict fetal well-being.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: CD4 T-Lymphocyte counts have proven to be a standard laboratory marker of disease progression and severity of immunodeficiency in adults infected with HIV is used to initiate and monitor highly active antiretroviral therapy however, its application may not be feasible for its expensive equipments and reagent in resource-limited setting. There is a need to have another marker of immunodeficiency that is less resource-demanding. In April 2002, the World Health Organization (WHO) recommended that, when CD4 cell count is not available, a TLC of 1200cell/mm3 or less in individuals with stage 2 or 3 of the disease may be used as an indication to initiate ART.
Methods: The aim of this study was to determine the relationship between total lymphocyte count and CD4 count in HIV-infected adults. This was a retrospective cross-sectional study. Subject characteristics were patients who had positive serologic HIV test results, confirmed via western blot. Analysis unit was the results of CBC and CD4 measurements on the same blood sample each time. Data of 100 patients were collected. In this study, TLC accounts for the main predictor of CD4 count. The amounts of TLC which can predict CD4 less than 200cell/mm3 were considered eligible.
Results: Our data revealed high sensitivity and specificity of TLC as a surrogate measure of CD4 count. In this study, TLC cutoff of 1300cell/mm³ indicated the optimal combined sensitivity and specificity altogether.
Conclusion: Total lymphocyte count and its changes can be used as alternative to CD4 count and its changes in the management of HIV-infected individuals.

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Background : Septic Arthritis is an acute infection of intra-arthicular space. Delay in diagnosis and in appropriate treatment may lead to prolongation of treatment duration and poor outcome. We decided to evaluate clinical aspects of this disease in our department pediatric department, Imam Khomeini Hospital complex, Tehran, Iran during a 10 years period.

Methods : In a retrospective cross-sectional study, 60 patients with age from 1 month to 14 year-old during 1996-2005 were evaluated. The demographics characteristics, clinical observations (signs & symptoms) and paraclinic values were gathered from medical records and analyzed with statistical tests.

Results : Pain and Swelling was seen in all, joint limited motion in 80% ( 50 cases) claudicating in 64% ( 38 cases), fever in 80% ( 48 cases), monoarticular disease in 80% ( 48 cases) and polyarticular one in 20% ( 12 cases) of them. Hip was most Common involved joint 62% ( 37 cases), elevated ESR was seen in all patients. CRP was positive in 85% ( 51 cases). Leuckocytosis was found in 65/8% ( 17 cases) of cases. In infectious cases, Staphylococcus aurous was responsible organism in 65.6% ( 16 cases), klebsiella in 12.4% ( 3 cases), Streptococcus pneumonia in 12.3% ( 3 cases), group b streptococcus in 4.1% ( 1 case), Hemophilus Influenza type b in 4.1% ( 1 case) of study patients. With therapy ESR was normalized in 64% ( 39 cases) and CRP was normalized in all patients.

Conclusions: In general, all children with complaint of fever, pain, and limited joint motion or claudicating should be suspected for septic arthritis.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Recent studies present a high prevalence of multiple sclerosis (MS) in Iran. Treatment with interferon is now the first choice in management of MS. CinnoVex^TM (an interferon beta 1-a) is available in Iran, with achievement of the technology of producing beta interferon. The aim of the present study is to evaluate the efficacy and safety of CinnoVex^TM in a national study named CINA study.

Methods: This study was conducted from 2007 to 2008 in cities of Tehran, Isfahan, Mashhad, Tabriz, and Shiraz. Patients with relapsing/remitting MS with 16-50 years of age and EDSS of <4 received CinnoVex^TM (30µg/week, IM) after diagnosis by a neurologist. EDSS, drug side effects, and frequency of relapse were evaluated for one year in four 3-month visits.

Results: A total of 1050 patients entered the study. Complete data were collected from 627 (60%) patients. Mean age was 30.7±8.6 year and 514 (82%) were female. The most common onset presentations were sensory symptoms (44%). Changes of EDSS through the study showed a significant decrease in the last 3-month of evaluation (p<0.05). Drug side effects were observed in 47%, 50%, 61%, and 61.4% (p>0.05) and relapse was occurred in 13.4%, 15.7%, 16.9%, and 2.4% of the patients in the first, second, third, and forth evaluation visits (p=0.001), respectively.

Conclusion: CinnoVex^TM prevents progression and improves clinical course of MS. The conventional side effects of beta interferon therapy, however, are observed with CinnoVex^TM.

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Background: Pain is one of the greatest concerns of patients undergoing total knee arthroplasty (TKA) which is severe and intolerable within 72 hours post-surgery. Appropriate pain management is a key factor in patient's early mobilization, launching physiotherapy, less hospital length of stay and more importantly, patient's satisfaction. New studies with the infiltration of combined analgesic agents peri and intra-articularly has shown encouraging results in pain reduction, good clinical outcome and patient's satisfaction. The purpose of this study was to compare the analgesic effect of locally infiltrated analgesia (I) compared with single injection femoral nerve block (F) and its impact on pain relief, patient's satisfaction, morphine consumption and clinical outcome.

Methods: This research was a double-blind randomized clinical trial on 36 consecutive patients undergone TKA divided into group (F) in which the ipsilateral femoral nerve in the inguinal area was blocked by a single injection of 20 ml ropivacaine (10 mg/ml) and group (I) which a combination of ketorolac, ropivacaine and epinephrine was injected peri and intra-articularly on the knee during TKA. Pain intensity measured by visual analog scale (VAS), clinical outcome (based on range of motion), morphine consumption and patient's satisfaction of pain management after TKA were compared between the two groups.

Results: Pain intensity score (VAS) and Morphine consumption were statistically less in group I than group F during the first 6 hours and 24 hours post surgery respectively (P< 0.05) however, group F had 12-hour VAS score of 5 which was less than group (I) by 1 grade in pain scale (VAS) (P< 0.05). Other parameters were not statistically different in the two groups and patients' response to our pain management protocols proved to be satisfactory in both groups.

Conclusion: Lower level of pain and morphine consumption in group (I) during the first 24 hours post-surgery in contrast to group (F) and its ease of use by a surgeon intra-operatively, introduce local infiltration analgesia as an effective method to decrease the patient's pain and improve patient's satisfaction in early post-surgery period after total knee arthroplasty.

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Background: The goal of this study was to evaluate, functional capacity of the knee in flexion and internal rotation after hamstring ligament harvest for Anterior Cruciate Ligament (ACL) reconstruction.
Methods: Fifty patients (male and 18-45 years old) with isolated ACL injury, randomly allocated in two equal groups (in one group, ACL reconstruction was performed with Tibialis Posterior allograft and in another group with quadruple hamstring ligament auto graft) and before and 6 months after surgery in both groups isokinetic flexion strength and isometric internal rotation strength of knee evaluated with Biodex System 4 dynamometer and rotational torque recorder, in order. Isokinetic flexion strength evaluated in sitting and prone position the later position was performed for deep flexion strength evaluation. Also subjective and objective assessment of all patients pre operatively and 6 months post operatively was documented with International Knee Documentation Committee (IKDC) questionnaire. In this study for first time, rotational torque strength of knee was recorded with new design measure, from isometric aspect and not isokinetic.
Results: Although significant improvements in IKDC scores, flexion and internal rotation capacity of the knee were observed in both groups, post operatively in respect to pre operatively there was no significant difference between 2 groups. (P<0.05 or more than 95% confidence Interval of the difference)
Conclusion: This study demonstrates that ACL reconstruction surgery, improves knee performance in flexion and internal rotation, regardless of hamstring tendon harvesting. Considering potential complications of allograft (for example: transfer of harmful diseases from donor to recipient), it is logical to use hamstring auto graft ligament for ACL reconstruction surgery. Because result of this study is not longstanding follow up and limited to male sex, for more worthfull conclusion, we suggest future study in both sex and with long duration of follow up.

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Background: Immune Thrombocytopenic Purpura (ITP) is an acquired autoimmune disorder characterized by a low platelet count because of anti platelet auto-antibodies. ITP patients have auto antibodies against platelet antigens. T CD4+ lymphocytes are effective cells in immune system that has an important role in auto reactive antibody production and class switching. The pathophisiology and mechanism of ITP is complex and unknown. Numerous studies have difference results about role of T cells in ITP patients. T lymphocytes have been characterized to different subsets. To further investigate about the pathogenesis of ITP, we studied the role of T CD4+ cells and cytokines attributed with platelet count. Therefore, in this research, we evaluated T CD4+ lymphocytes count and interleukin 17 (IL-17), interleukin 11 (IL-11) levels in ITP in comparison with control. Methods: In a case-control study, we have studied 60 patients with ITP and 50 normal individuals as the control group. Peripheral blood mononuclear cells were isolated by ficoll histopaque 1.077. T CD4+ cells count in ITP patients and control subjects were studied by flow cytometry method and serum interleukin 17 (IL-17), interleukin 11 (IL-11) concentration were measured by enzyme-linked immunosorbent assay (ELISA) test. All data were expressed as mean±SD. Differences between means were considered significant at the P< 0.05. Tests were performed using SPSS software version 16. Results: This study showed, T CD4+ cells and plasma IL-17 concentration were not significantly different between patients with ITP and the control group. But plasma IL-11 levels were significantly increased in immune thrombocytopenic purpura patients in comparison with controls (P= 0.031). Conclusion: In summary, our study indicated a role of IL-11 in ITP patients, also showed that ITP may not be associated with changes of plasma IL-17 levels and T CD4+ cells count relative to control population. Therefore, measurement of plasma IL-11 levels may be important criteria in development of ITP. In addition, it is concluded that determination of IL-11 can be a diagnostic marker to recognize thrombocytopenic purpura patients.

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Background: Juvenile Rheumatoid Arthritis (JRA) is the most common chronic pediat-ric rheumatologic disease. There is a wide range of variation in disease subgroup distri-bution and evolution according to different populations, environments and genetic pre-disposition. This study was designed to evaluate epidemiologic characteristics of JRA in Iran. Methods: A cross-sectional studies was performed on children suffering from JRA ac-cording to American College of Rheumatology during 10 year (2002-2011). Patients' data was recorded in hospital questionnaires Patients' age at the first presentation and time of diagnosis, sex, ethnicity, early clinical and constitutional presentations, joint in-volvement pattern and presence of associated diseases were evaluated. Results: In this study, 171 children (91 boys and 80 girls) were enrolled. The mean age of patients was 5.2±3.5 years at the time of presentation and 5.7±3.6 years when the diagnosis was confirmed. The most common type of disease was polyarticular arthritis (41.9%). The prevalence of pauciarticular and systemic onset subtype were 31.6% and 19.3%, respectively. According to ethnicity, the most common incidence was seen in Fars and Turk populations respectively. The most common constitutional presentation was fever. Fever and morning stiffness was significantly higher in polyarticular pa-tients. Extra articular manifestation was seen in 40.4% patients. Among extra-articular manifestations, skin involvement was seen more than others. There was no correlation between sex and type of chronic arthritis. Uveitis was detected in 5.8% of our cases. The mean age was significantly higher in polyarticular group (6.04 year) in comparison to pauciarticular and systemic group (4.4 year in both groups) (P= 0.005). There was no correlation between sex and type of chronic arthritis. Conclusion: The prevalence of JRA subgroups was different in Iran comparing with western countries and polyarticular disease was the most common subgroup in this study. Uveitis was less common in this study in comparison to studies in other coun-tries. There is no sex predilection in each subgroup of JRA.

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Background: Orthopedic trauma is a common type of injury in children and may cause deep and permanent psychological and physical damage both for the patient and the parents. This study aimed to analyze the epidemiology age, gender distribution and the mechanism of injury in patients presenting to a level I trauma center in urban population of Tehran. Methods: In this prospective descriptive study, the patients under 19 years old with orthopedic trauma who were hospitalized in Tehran Shafa University Hospital were entered. This hospital is the main orthopedic referral center in Iran. The patients were prospectively evaluated from April 2013 to March 2014. The data were collected and analyzed. Results: The study included 1081 patients under 19 years old. There was a male predominance (76.8% n= 830). The boys had a higher mean age 11.04±5.06 year, versus girls with mean age 8.67±4.63 year (P< 0.05). The peak age of boys was 18 and the girls had two peaks at three and nine. The fractures occurred in upper limb in 70.8% (n= 621) and 29.2% (n= 256) in lower limb of patients. There were 27 cases with joint dislocation, 5 cases with knee ligamentous injuries, 128 cases with soft tissue injuries and 44 cases with spine injuries. The most frequent mechanism in both gender were falls from standing position (48.5%). The most common fractures were foreman both bone fractures (n: 146 16.7%), elbow supracondylar fractures (n: 134, 15.3%) and distal radius fractures (n: 84, 9.6%). The most fractures occurred in summer (30.1%) and the least in winter (18.1%). Conclusion: Evaluation of epidemiologic factors can lead to the best prediction and treatment planning of trauma. Early recognition of injury, even minor, and expected care using specialized teams will help to improve outcomes for these patients. This study determines the most at risk children for trauma and fractures and may help the parents to prevent damage.

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Background: Prostate-Specific Antigen (PSA), also known as gamma-seminoprotein or kallikrein-3 (KLK3), is the best marker for early diagnosis of prostate cancer. Since age and race are affecting PSA levels, determining age-specific reference ranges of PSA in every community is necessary for increasing the efficiency rate of PSA. The aim of the present study was to evaluate the normal distribution of total prostate-specific antigen (TPSA) and free prostate-specific antigen (FPSA) and determine age-specific reference ranges of PSA in Iranian men. Methods: In this cross-sectional study, 1200 normal men with the age range of 50 to 79 referred to Shahid Rajaie Hospital, Qazvin Province in Iran, from 2011 to 2013. After excluding patients with prostate cancer and urinary tract infection, 1020 men were included in this study. Then, their blood samples were collected and after the extraction of serum from blood, serum levels of FPSA and TPSA were measured using commercial kits the reference range of PSA was specified for each age group and compared with reference ranges of other populations. Results: The mean age of the patients was 61.03±7.5 years and the mean values of FPSA and TPSA were 0.47±0.6 ng/ml and 1.56±2.05 ng/ml, respectively. PSA serum levels (95th percentile range) in 50 to 59, 60 to 69 and 70 to 79-year age groups were 0-3.6 ng/ml, 0-5.7 ng/ml and 0-6.8 ng/ml, respectively. TPSA (r= 0.2, P< 0.001) and FPSA (r= 0.22, P< 0.001) were significantly associated with age. In addition, a significant relationship was found between TPSA serum levels and alcohol consumption (P= 0.017), smoking (P< 0.001) and family history of prostate cancer (P= 0.014). Conclusion: Findings of the present study showed that PSA levels are correlated with age. It was also revealed that the PSA age-specific reference range obtained in this study is different from other races and is specific to Iranian men. Therefore, age-specific reference ranges of PSA obtained in the present study can increase PSA test sensitivity and specificity by reducing unnecessary diagnostic procedures and early detection of prostate cancer in Iranian men.

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Background: To reduce cesarean section rate, we need complex interventions to modify related behavior. We aimed to identify the effectiveness of a community-based intervention on prenatal care status, delivery and decline of cesarean section rate. Methods: A quasi-experimental study was carried out on mothers residing in Khak Sefid and Javadiyeh in Tehran from January 2011 to September 2014. Study population was 274 mothers attending in health centers for first vaccination of their neonates. Mothers' demographic data were recorded in some questionnaires. One year interventions including consultation, distribution of educational package and training courses (for mothers, fathers and their families, educational programs for midwives, obstetricians and gynecologist, residents, medical students), accomplishment of 10 steps baby-friendly principles and provision adequate personnel in labor-delivery room were implemented in community, hospitals and health centers. After intervention, 250 mothers who were attending in health centers for vaccination of 2 months aged neonates were assessed and their data were recorded in the same questionnaires. The effectiveness of intervention on cesarean section rate and cesarean tendency in before and after intervention groups were compared. P< 0.05 was considered as level of significance. Results: Of 274 mothers in "before intervention" group 193 (70.44%) and of 250 mothers in "after intervention", 169 subjects (67.6%) had cesarean section. Although a significant decline was seen in cesarean tendency in "after intervention" group (P= 0.034), no significant difference was seen between 2 groups' cesarean section rates (P= 0.48). In "after intervention" group episiotomy, induction of labor rate and maternal morbidity were significantly lower than "before intervention" group (P= 0.0001, 0.0001, 0.01). Although no significant difference was seen between two groups neonatal birth weight (P= 0.69), a significant difference was seen between two groups' gestational age (P= 0.007). Conclusion: After intervention, in spite of no decline in cesarean section rate, NVD tendency and morbidity rate were raised and improved respectively. It seems that cesarean section rate was influenced by other important factors.

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Background: Seladin-1 protein protects the neural cells against amyloid beta toxicity and its expression decreased in vulnerable regions of Alzheimer's disease (AD) brains. On the other hand, changes in serum levels of S100 have been considered as a marker of brain damage in neurodegenerative diseases. Furthermore, this study was carried out to determine the relation between the change profile of serum S100&beta protein levels and hippocampal Seladin-1 gene expression in a rat model of sporadic AD. Methods: In this experimental study that established in Department of Neuroscience, School of Advanced Technologies in Medicine, Tehran University of Medical Science, from March 2011 to April 2013, 72 animals were randomly divided into control, 4, 7, 14, and 21days ICV-STZ/Saline administrated rats. Alzheimer's model was induced by intracerebroventricular (ICV) injections of streptozotocin (STZ) [3 mg/kg] on days 1 and 3. Serum levels of S100&beta and hippocampal Seladin-1 gene expression were evalu-ated in experimental groups. The initial and step-through latencies (STL) were deter-mined using passive avoidance test. Results: Serum levels of S100&beta were significantly different between the STZ-7 day and STZ-14 day groups in comparison with the control, saline and STZ-4 day groups. As well as, there was a significant difference between the STZ-7 day group in comparison with the STZ-14 day and STZ-21 day groups (P=0.0001). Hippocampal Seladin-1 gene expression in STZ-14 day and STZ-21 day groups significantly decreased as compared to the control, saline and STZ-4 day groups (P=0.0001). However, significant correla-tion was detected between serum S100&beta protein decrement and Seladin-1 down regula-tion (P=0.001). Also, the STL was significantly decreased in 21 days ICV-STZ adminis-trated rats as compared to the control or saline groups (P=0.001). Conclusion: Monitoring the changes of serum S100&beta protein levels by relationship with changes in hippocampal Seladin-1 gene expression can be a useful indicator of neu-ronal damage in patients with Alzheimer's disease.

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Background: Coagulase-negative staphylococci (CoNS) were considered as contaminats previously, but, during the past decade considered as one of the most common photogenic bacteria in hospital. Resistance to beta-lactams especially methicillin in staphylococcus species is being worrying in hospitals. Rapid identification of mechanisms of resistance and confirmation of their resistance to methicillin is a basic principle for antibiotic treatment. The aim of this study was to determine antibiotic resistance, frequency of mecA gene, and determination of SCCmec types in CoNS isolates from teaching hospitals in Iran.

Methods: The descriptive cross-sectional study was carried out one hundred clinical samples isolated from patients with an average age of 7-69 years at teaching hospitals in Hamadan City, Iran, from September 2014 to February 2015. After confirmation of isolates by microbiological standard biochemical tests, antimicrobial susceptibility testing was performed by disk agar diffusion (DAD) method. After extraction of isolated genomicm, mecA gene was detected. Then, the types of SCCmec were performed by PCR.

Results: In this study, 387 clinical samples were collected which among 100 CoNS isolated, Staphylococcus epidermidis was the most prevalent species with frequency 55 (55%), followed by S. haemolyticus 40(40%) and S. saprophyticus 5(5%). The highest antibiotic susceptibility was to rifampin 96(96%) and the lowest resistance was detected for trimethoprim/sulfamethoxazole (TMP/SMX) 47(47%). None of the strains were resistant to vancomycin. Resistance to methicillin was detected in 50% of CoNS isolates. Typing of SCCmec was performed by The polymerase chain reaction (PCR). Frequency types of SCCmec was type III with frequency 13(13%), type V 11(11%), type II 6(6%), type IV 4 (4%), type I 3(3%) respectively. Thirteen isolated was not typable in this study.

Conclusion: The result of this study showed that a large percentage of coagulase-negative staphylococci are resistance to methicillin, and the prevalence of SCCmec type was type III, which encodes the largest number of resistance genes. This information could be use in epidemiological study for preventing of infectious control in hospital and health centers.

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Background: Lots of vitamin D functions are mediated by its steroid family receptor (VDR). Vitamin D role in infertility is reported by significant fertility reduction in many male laboratory animals with vitamin D deficiency. The reason for reduced fertility in male VDR-null mouse model has been reported to be reduced sperm count and sperm motility. Vitamin D has effects on sperm motility, sperm-ovum coupling, and acrosome reaction stimulation. As VDR is expressed in human male reproductive system, the aim of the current study was to investigate the role of rs2228570 polymorphism of VDR gene in male infertility.

Methods: Investigation was done as a case-control study on infertile azoospermic or oligospermic men referring to Avicenna Research Institute from March 2014 to April 2015. Rs2228570 single nucleotide polymorphism (SNP) located in exon 1 of VDR gene was chosen according to its role on protein function. Blood sampling was done on cases and control groups and after DNA extraction the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) reaction was designed and performed on 100 normal cases, 100 azoospermic and 100 oigospermic control samples. Distribution of quantitative age variable was done using Student’s t-test and qualitative variables (genotype and allelic frequencies) was done using SPSS, ver. 22 (Chicago, IL, USA).

Results: Chi-square test didn’t show significant difference between two case groups and controls (Azoosperm and control P=0.5 and oligosperm and control P=0.09). Comparing CC genotype frequency with TT and CT genotypes (azoosperm and control P=0.48 OR=0.77, oligosperm and control, P=0.17 OR=0.77) and in comparing between TT genotype with CT and CC genotypes (azoosperm and control P=0.49 OR=3.03, oligosperm and control P=0.19 OR=7.21) the difference between these groups was not significant and didn’t increase the probability of disease and didn’t show protective role against it.

Conclusion: According to the findings, the association between rs2228570 polymorphism of vitamin D receptor gene and infertility was not significant and investigation of other polymorphisms might show a relationship with male infertility.

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Background: Acute osteomyelitis is one of pediatric emergency which can cause unpleasant complications among them. This is especially accurate if the diagnosis had been delayed or the treatment was inappropriate. There is some misunderstanding in the detection of patients’ hospital files and it’s difficult to detect the diagnostic and treatment malpractice. We performed an investigation of the clinical and paraclinical data in children with acute osteomyelitis.

Methods: We performed a retrospective cross-sectional study in pediatric department of Imam Khomeini University Hospital in Tehran, Iran, from April 1997 to March 2010. The hospital records of all neonates and children from 15 days old to 15 years old were investigated. Patients with any defect in records were excluded from the study. A total of 54 children were included in this study. A questionnaire including clinical features, paraclinical findings and treatment response was completed for all subjects by design's executer. Data were analyzed using the software package SPSS version 16 (IBM, Armonk, NY, USA).

Results: In general, 35 children were male and 19 children were female. The average of age was 5.89 years. Children were divided into 4 groups based on age (less than 2, 2-7, 7-12 and 12-15 years) that majority of them were less than 2 years old (38.9%). The most common symptom and sign were pain (46.3%) and swelling (88.8%) respectively in this study. The most primary presenting symptoms were pain (46.3%) and swelling (24.1%). The comparison of frequency ranges of fever between children younger than 2 years and children 2-15 years old demonstrated a significant different (14.3% vs 84.8%, respectively) (P= 0.001). Staphylococcus aureus was the most commonly isolated organism (73.5%). Thirty-two patients (59.2%) needed surgical procedures in addition to antibiotic therapy that had successful outcome in all cases. The average of treatment duration with intravenous antibiotic was 28.14±12.84 days.

Conclusion: More than half of the children with acute osteomyelitis didn't response to antibiotic therapy and they needed different types of surgeries.

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Discovery of x-ray and using of it for medical imaging have produced tremendous outcomes for diagnosis and treatment of diseases. More than 10 million diagnostic radiological procedures and 100,000 nuclear medicine exams are being performed daily around the world. According to the national commission on radiological protection and measurements (NCRP)-report 160, medical x-ray is contribute to approximately 95% of all radiological examinations that is responsible for 74% of the collective dose to the US population. Despite of unique benefits of ionizing radiations, in the field of radiation protection, they are associated with potential risks such as cancer and genetically abnormalities. The cancer risk attributable to diagnostic radiology is estimated about 0.6% to 3%. It is estimated that the radiation dose from diagnostic x-ray procedures are annually responsible for 7,587 and 5,695 cases of radiation induced cancer in the population of Japan and US, respectively. Although the radiation dose associated with most radiological procedures are very low, but rapid increasing use of radiography procedures during two past decades have been concerned due to the cancer risk associated with ionizing radiations. On the base of linear no-threshold (LNT) model of dose-response curve, any level of exposure is dangerous. Deoxyribonucleic acid (DNA) is the main target of ionizing radiation. For radiological exposure with low dose, the stochastic effects such as genetic damages and leukemia are concerned. According to the recommendations of the radiation protection regulatory organizations, radiological procedure must be done with respect to social and economic factors in which exposure of patient and population kept as low as reasonable and achievable. Hence, prescription of a radiological test is acceptable only when its advantages are higher than its damages. Optimizing the different parameters such as: collimating the primary beam field to the area of diagnostic interest, exposure conditions (high kVp and low mAs), projections, exposure time and shielding can reduce the patients' exposure besides the saving of image quality. Following the radiation protection guidelines can considerably decrease the exposure risks.

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Background: Anode heel effect refers to reduction of radiation intensity in the anode side of X-ray tube. This variation in radiation intensity across the anode-cathode of X-ray tube can be benefited for decrease radiation exposure in some radiological examinations. The aim of this study was to evaluate the effect of anode heel orientation on the radiation dose received by the testes in male patients undergoing pelvic radiography.

Methods: This is a cross-sectional study, conducted at one of the teaching hospitals of Ahvaz, Jundishapur University of Medical Science Ahvaz, Iran, from September 2015 to March 2016. In order to measure the profile of radiation intensity variation, 13 paired sets of high radiosensitive cylindrical lithium fluoride thermo-luminescent dosimeters (TLD) aligned on the cathode-anode central axis upon the table and then irradiated using routine exposure parameters. The anode of X-ray tube was positioned toward the feet for 40 patients and toward the head for 39 patients undergoing pelvic radiography. For measure the entrance skin dose (ESD), 8 TLD chips were located on the central point of the radiation field and 5 TLDs were located on the testes position to measure the dose received.

Results: Radiation intensity profile showed that radiation intensity decrease from the cathode to the anode side. Discrepancy of radiation intensity on central axis of cathode-anode was calculated about 35%. The radiation dose received by the testes was 26.74% lower for patients the anode directed toward the feet, compared to the patients in which the anode directed toward the head (FTC: 1.260±0.296 mGy, FTA: 0.923±0.167 mGy, P<0.05). There was no meaningful difference for the measured ESD of pelvis between two groups of patients (FTC: 1.256±0.315 mGy, FTA: 1.195±0.205 mGy, P=0.788). Conclusion: In pelvic radiography, positioning of testes directed to the anode of X-ray tube can decrease the receive dose.

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