Tehran University Medical Journal

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Migraine as one of the most common types of headaches with high intensity and prevalence, affects life significantly. This study was devised to determine the effects of migraine on economic status and life quality of Iranian surffcres.
"Pain database questionnaire", prepared by the International Association for the Study of Pain (IASP) in the year 1995, was translated to Farsi. Then we modified it regaiding cultural, geographical and social characteristics of Iran. 65 patients (55 women and 10 men) were recruited form neurology clinic consultants. Those patients who met the International Headache Society. (IHS) criteria for migraine, were interviewed using IASP questionnaire. Pain effects on sleep, marital life, social, recreational and sexual activities, quality and quantity of drug consumption as well as using paraclinic procedures were considered.
Significant decrease in sleep duration was seen during pain (7.4 ± 1.9 h) compared to pain-free conditions (6 ± 3.7 h) (P < 0.001). The effects of pain on marital life, social, recrealtional and sexual activities during pain were compared with pain-free conditions based on a zero to ten ranking schedule,. Wilcoxone test showed statistically significant (P < 0.02) differences.
We concluded that the economic effect of migraine and its impact on patients' quality of life are significant and should be considered in health planning and disease management

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The poll was designed to let the management system of the university know about the opinions, criticisms and suggestions of the faculty members and create a sense of cooperation and promote the level of relationships. In November and December 1997, short after the new Chancellor of the University was selected, the poll was conducted by the new board to reach the above goals. In this survey, all the faculty members of the University were questioned about the problems they faced in the University. A questionnaire of 23 questions in two pages was given to them and was returned by mail. About 47.5% of the questionnaire were returned. Analysis of the results showed that a significant majority (93%) of the respondents believed that Tehran University should be the best University of Medical Sciences in Iran, and that it dose have the capability to be so, however, a majority (66%) of them claimed that it is not so at the present. A significant majority of the respondents believed that education and research are the two most important duties of the University, and the health, treatment, and cultural duties rank next. Except for the Medicine and Health Faculties others were not satisfied with their status at the University. The satisfaction of the faculty members with educational and research performance of the faculties was questioned the results varied in different faculties. Dissatisfaction with research status was most obvious. Forty-six and 25 percent of the staff in the faculty of medicine were satisfied with educational and research performance of their faculty, respectively. The teaching staff were also questioned about their problems the most important of which was shown to be that of convenience. More than 90% of respondents stated that opinion poll is an appropriate way to relate the management of the University to the faculty members and emphasized on holding periodic sessions with the Chancellor of the University and personal visits to him.

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There are many studies about epidural fibrosis after surgical manipulation of the spine. We have studied formation of the post laminectomy epidural fibrosis after application of two materials (Silicone and Teflon) in this report. This expriment is on two groups of rats. Two separated laminectomies were done in each rat, one serving as control while in the other laminectomy spaces Silicone was used in group A and Teflon in group B. Laminectomy spaces were evaluated with gross dissection and histologic studies after 6 weeks. Silicone decreased intermuscular scar, deep scar, dural adhesion and collagen fiber density in epidural space. Teflon decreased dural adhesion and collagen fiber density but did not decrease intermuscular and deep scar formation in epidural space.

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In order to determine the frequency rate of urinary stress incontinence (S.I) after delivery and related factors a longitudinal study carried on primiparous women in Arash Hospital in 1379. Through a non probability sampling, 400 eligible women were recruited from available population. Patient with complain of urinary stress incontinence on third day after delivery, were examined and undergone for required diagnostic tests. After stabilizing the diagnosis of urinary stress incontinence, they were followed on 6th week, 3th month and the first year after delivery. The mean of maternal age was 23.5±4.3 years and the mean of gestational age was 37.9±2.1 weeks. The vaginal delivery and cesarean section rates were 83.7 percent and 16.3 percent respectively. From the cases, 50 women (12.5 percent) had S.I on third day after delivery, which 28 of them had this problem from their pregnancy (grup A), and in 22 patients (5.5 percent), S.I were began after delivery (group B). On first year after delivery, only 6 patients (1.5 percent) had complaint of S.I, totally. All patients with S.I had a vaginal delivery and no cases of S.I had found in cesarean section group (65 women). This difference was significant (P=0.019). Comparison of 3 groups A, B and C (including 285 women without S.I after vaginal delivery) had represented that the mean of maternal age and gestational age were significantly higher in group B than other two groups (P=0.0001 and P=0.0009 respectively).

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Background: Urinary tract infection is a common bacterial infection in children and may lead to irreversible renal damage. TC 99-m Dimercaptosuccinic acid renal scintigraphy is the most sensitive method for diagnosing acute pyelonephritis. We designed a study to evaluate the ability of DMSA scan and ultrasonography to detect renal paranchymal lesion.

Materials and Methods: 62 children 1 month to 12 years of age with the first episode of acute pyelonephritis were prospectively studied with DMSA scan and ultrasonography during acute phase of infection. A Voiding Cystourethrogram was performed in 60 children when urine culture became negative. Children with renal paranchymal changes were older at the time of acute pyelonephritis (P=0.04) but no difference was found between the groups with regard to levels of CRP, ESR (P>0.05).

Results: Changes on the DMSA scan were found in 106 (85.5 percent) kidneys of 62 children but ultrasonography showed renal changes in 19.4 percent (sensitivity=20 percent, specificity=83 percent) (Kappa=0.06). Vesicoureteric reflux was found in 14 children (23.3 percent) but 83 percent of the affected kidneys were drained by non-refluxing ureters.

Conclusion: It is concluded that DMSA scan is more sensitive than ultrasonography in detecting renal paranchymal changes in acute pyelonephritis and we found out that renal paranchymal changes after acute pyelonephritis is common, even in those without VUR.

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Myocardial infarction sequel of coronary artery diseases, can be sometimes asymptomatic, called silent myocardial infarction. Some risk factors predispose the patients to this condition. In this study, we intend to determine the predisposing factors in such patients.
Methods and Materials: We included those patients with electrocardiogram changes, consistent with myocardial infarction, who had not any symptoms of ischemia or a previous history of coronary artery disease, consulted for preoperative work up of eye surgery during the year 2000.
Results: We analyzed 100 patients with the diagnosis of silent myocardial infarction. (59 males and 41 females). Among our patients. 99 percent were above age 50 years of age. Their mean age at the time of study was 69.7 years. 78 percent of patients were illiterate. In 41 of them body mass index was above the normal limits (overweight and obese). Their past medical history revealed that 46 patients had hypertension, 38 patients had hyper-lipidemia. and 26 patients had diabetes mellitus. Also, a positive family history of coronary artery disease was seen in 52 percent of the patients. The rate of cigarette smokers and opium addicts, among our patients, was 33 and 13 percents. respectively. Analysis of electrocardiogram changes, showed that 43 patients had inferior myocardial infarction, 24 had antero-septal. and 17 of them suffered from anterior myocardial infarction.
Conclusion: Almost all of our patients with silent myocardial infarction were in old age group. Diabetes mellitus, hypertension, overweight, hyper-lipidemia, and a positive family history of coronary artery disease were the most important predisposing factors, found in such patients, thus taking into account these predisposing factors and control of them would dramatically reduce the prevalence of morbidity and mortality of silent myocardial infarction.

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Brucellosis is a zoonotic disease of worldwide distribution. Despite its control in many developing countries the disease remains endemic in Iran. The symptoms, signs and laboratory results are variable and nonspecific. This case series study was conducted to determine the liver complications of Brucellosis in Iran
Materials and Methods: We studied 188 patients (108 males and 80 females) with Brucellosis, fulfilled the diagnostic criteria, aged 1-79 years (mean 34.8 years) were registered in Imam Khomeini Hospital, a referral center in Tehran, during the six years (1995-2001).
Results: Thirty-four of 188 cases (18.08 percent) had elevated liver enzyme (elevated SGOT only, 6 patients elevated SGPT only 1 patient elevation of both transaminases, 27 patients). The prominent symptoms included anorexia (74 cases), weight loss (62 cases), right upper quadrant pain (32 cases), epigastric pain (25 cases) and nausea and vomiting (23 cases). Among the gastrointestinal signs were found in these patients, hepatomegaly was seen in 28 patients. Jaundice and ascitis were present in only 7 and 3 patients, respectively. Other laboratory results showed elevated alkaline phosphatase in 28 cases and abnormal bilirubin in 10 cases. Fifty-seven patients had a focal illness, representing 30.32 percent of all patients. Osteoarticular complications were the most frequent focal forms, being present in 34 cases. Twelve male patients had genitourinary Brucellosis, representing 10.53 percent of focal forms. Also, 5 patients had neurologic complications.
Conclusion: In conclusion liver involvement is frequent in Brucellosis, although the rate of this complication in our study was lower than other studies. So, in patients with evidence of overt clinical or laboratory findings compatible with liver disturbance etiologies other than brucellosis should be considered in Iran.

 

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Background and Aim: While nowadays,great attainments have been achieved in curing and preventing the pathogenic fungal infections, and some how there has been reduction in the number of occurrences, the occurrences of opportunistic infections have been increased. Since the study of fungal infections in various organs (e.g.digestive system) is crucial ,and because of few study were done in this field in the world, it is decided to examine the apendectomide tissue for fungal contamination in Iran.

Materials and Methods: The work has been done for six months. After oparation sergery the appendix tissue in two media (formalin & normal salin) were carried out in the medical mycology laboratory at Tehran University of medical sciences. The specimens were examined directly and cultured in sabourauds dextrose agar with chloramphenicol (sc). In this experiment 200 appendicular tissues were examined.

Results: Out of them some fungi were isolated in 10 cases included 4 Candida albican (40%), 2 Candida tropicalis (20%),1 Cryptococcus sp. (10%),1 Candida sp.and 2 Geotrichum sp. Cryptococcus sp. was identified with mycological methods. This isolation related to a young man that has a history for long contact to pigeon.some of the fungi specially yeast can be a part of mycoflora in digestive system but the finding of Cryptococcus is uncommon.

Conclusion: In this study the fungi were isolated from 5% of appendisits and with pay attention to this finding that the most patients hadn.t background factors causing the proliferation of the fungal agents in the intestine, so with further studies it is probable to consider the fungi as the agents causing appendicitis in this patients.

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Background: The knee is the most commonly injured joint. The internal components of the knee include the meniscuses, the anterior cruciate ligament (ACL) and posterior cruciate ligaments (PCL). Magnetic resonance imaging (MRI) is now used widely because of its high accuracy and noninvasiveness. Our objective was to diagnose internal knee component injuries by MRI and compare its diagnostic value with that of arthroscopic surgery.
Methods: This process research study was carried out between May 2004 and September 2006 on 90 randomly selected patients admitted to the orthopedic ward of Baghiatollah Hospital, Tehran, Iran. Each patient had arthroscopic surgery after undergoing MRI by an expert radiologist.
Results: Out of 90 patients, 81 were male and nine were female. The mean age was 31.6 years (range: 17-71). Among patients with normal ACL as shown by MRI, 42.4% were shown by arthroscopy to have a ruptured ACL. The sensitivity and specificity of MRI in ACL abnormalities were 73% and 77%, respectively. Only 1.3% of the patients with normal PCL by MRI showed PCL rupture upon arthroscopic examination. The evaluation of the lateral meniscus by MRI had a sensitivity and specificity of 40% and 94%, respectively. Likewise, in the medial meniscus, sensitivity and specificity by MRI was 70% and 98%, respectively.
Conclusion: According to our study, considerable differences exist between MRI reports and arthroscopic findings in the diagnosis of internal knee injuries. We therefore conclude that sole reliance on MRI reports is not reasonable for making treatment decisions and MRI should be used as just one of the diagnostic tools, in conjunction with other methods, such as physical examination and arthroscopy.

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Background: Central venous catheter (CVC) related infections are important complications of cathter application. This study assessed the usefulness of mupirocin in prevention and control of these infections.
Methods: In this randomized clinical trial, consecutive surgical patients requiring central venous catheter (for more than 2 days) in Amir-Alam Hospital from 2006-2008 were enrolled. Patients were divided in two groups in “case group” patients received topical mupirocin 2% every 48 hours at the time of insertion of catheter and dressing change and for “control group” mupirocin was not used. All of the patients received chlorhexidine and enoxoparin as complementary treatments. Two groups were comparable in regard of age, sex and risk factors.
Results: One hundred eighteen patients enrolled in the study (57 in case and 61 in control group) completed the study. 84 catheters in case group and 88 catheters in control group were inserted. The catheters in 90% of patients were inserted in jugular vein. At the end of study 29(16.8%) patients (16 in control versus 13 in case group) had catheter colonization (p=NS). Catheter related bloodstream infection was observed in 16(9.3%) patients (6 in case versus 10 in control group) (p=NS).Catheter related local infection was seen in 2(1.1%) patients of control versus none of mupirocin group. (p=NS).
Conclusions: Mupirocin was not effective to control and prevention of bacterial colonization and catheter related infection.

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Background: Estimation of Left Ventricular End Diastolic Pressure (LVEDP) among patients with Mitral Stenosis (MS) helps to diagnose diastolic dysfunction and to explain their symptoms. However, Conventional Doppler measurements have limitation in predicting of LVEDP. This study sought to establish whether the correlation between measurements derived from Tissue Doppler echocardiography and LVEDP remains valid in the setting of severe mitral stenosis.

Methods: Thirty three patients with moderate to severe MS who had indication for left heart catheterization enrolled during 1387-88 in Imam Khomeini Hospital in Tehran, Iran. The mean diastolic transmitral pressure gradient and mitral valve area (MVA) were calculated, and Two-dimensional, M-mode, color Doppler and tissue Doppler Imaging indices such as: early diastolic mitral inflow velocity (E), annular early diastolic velocity (Ea), E/A ratio, Isovolemic relaxation time (IVRT), Pulmonary Vein systolic and diastolic flow velocities, Velocity Propagation, LA size, TE-Ea, Tei Index were obtained in maximum three hours before cardiac catheterization. The echocardiography analysis was performed offline without knowledge of hemodynamic data Linear correlation and multiple linear regression were used for analysis. p< 0.05 was considered significant.

Results: In univariate analysis, E/Ea was associated with LVEDP significantly (p = 0.04, r = 0.38). There was also a significant correlation between TE-Ea and LVDP (p = 0.01, r = -0.44). In multiple linear regression Tei Index (ß = 0.4, p< 0.02), and TE-Ea (ß = 0.5, p = 0.02) were showed as independent predictors of LVEDP (R2 = 49%).

Conclusion: Although we observed a moderate correlation between Doppler measurements and LVEDP in patients with severe MS, more similar studies are required.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Skin-derived precursors (SKPs) are a type of progenitor cells extracted from mammalian dermal tissue and can be differentiate to neural and mesodermal lineage in vitro. These cells can introduce an accessible autologos source of neural precursor cells for treatment of different neurodegenerative diseases. This research was done in order to set up isolation, culture, proliferation and differentiation of human skin derived precursors (hSKPs).
Methods: Human foreskin samples were cut into smaller pieces and cultured in proliferation medium after enzymatic digestion. To induce neural differentiation, cells were cultured in neural differentiation medium after fifth passage. We used immunocytochemistry and RT-PCR for characterization of the cells. Neuron and glial cell differentiation potential was assessed by immunofloresence using specific antibodies. The experiments were carried out in triplicate.
Results: After differentiation, βΙΙΙ- tubulin and neurofilament-M positive cells were observed that are specific markers for neurons. Moreover, glial fibrillary acid protein (GFAP) and S100 positive cells were identified that are markers specifically express in glial cells. Detected neurons and glials were also confirmed by their morphologic characterizations.
Conclusion: Our results demonstrated that skin-derived precursors obtained from human foreskin can exhibit neuronal and glial differentiation potential in vitro, depending on the protocols of induction.

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Background: Respiratory virus infections represent a major public health problem because of their worldwide occurrence, ease of spread in the community and considerable morbidity and mortality. They are one of the most common reasons for hospitalization of children under the age of six. In some cases, infection with two different viruses increase the severity of disease which lead to the hospitalization.
Case presentation: Among 202 samples related to children under the age of six with respiratory infections, two dual infections of Adenovirus with other respiratory viruses with PCR test were detected.
Conclusion: Mixed respiratory viral infections are sometimes associated with severe disease and recognition of coinfection is important. Dual infections of Adenovirus with respiratory syncytial virus (RSV) and Swine origin influenza A (H1N1) virus were demonstrated. The evidence showed that the co-infection of Adenovirus with swine origin influenza A (H1N1), has increased the severity of disease which lead to the hospitalization.

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Background: Common Variable Immunodeficiency (CVID) is a primary immunodeficiency disease, characterized by hypogammaglobulinemia and heterogeneous clinical manifestations. This study was performed to evaluate the clinical and immunological features of pediatric patients with CVID.
Methods: We reviewed the records of 69 children diagnosed under age of 16 years with CVID (35 males and 34 females).
Results: By the year 2008, 15 patients (21%) had died. The total follow-up period was 333 patient-years. The mean diagnostic time between onset and diagnosis in our patient group was 4.40 years. The overall rate of consanguineous marriages was 58%. 10 patients had a positive family history of immunodeficiency. At the time of diagnosis, the mean levels of serum immunoglobulin G (IgG), IgM, and IgA levels were 286.86, 39.92, and 18.39 mg/dl, respectively which were below the normal levels for age. All of the patients presented with infectious diseases at the time of onset, the most common of which were pneumonia, diarrhea and sinusitis. Acute and recurrent infections were also found in almost all of the patients, particularly involving respiratory and gastrointestinal systems. The most common infections during follow-up period were pneumonia (31.9%), acute diarrhea (18.8%), acute sinusitis (18.8%), and otitis media (14.5%). Post-diagnosis survival was estimated to be 79% during the first five years. The survival rate was not shown to be influenced by delayed diagnosis, serum levels of IgG and B-lymphocyte count at the time of diagnosis.
Conclusions: Any child with a history of recurrent infections, decreased levels of serum immunoglobulin isotypes and consanguineous parents should be considered as a CVID patient.

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Background: An increased risk for invasive infections with encapsulated bacteria such as Streptococcus pneumoniae has been described in patients with chronic kidney disease (CKD) or in those on dialysis. The aim of this study was to evaluate the antibody response to pneumococcal capsular polysaccharide vaccine in CKD patients. Methods: Sixty-six patients with CKD and 40 healthy individuals were vaccinated with pneumococcal polysaccharide vaccine. The serum antibody response (IgG and IgG2) to the Pneumovax antigens was determined by enzyme-linked immunosorbent assay (ELISA) prior to and four weeks after vaccination. Results: Out of 66 vaccinated patients with CKD, 14 were found to be hyporesponsive to the vaccine (Group 1). Patients with normal specific antibody response were regarded as respondents and were assigned to Group 2 (n=52). The mean post-vaccination IgG titer to the pneumococcal antigens in Group 1 was significantly lower than those in Group 2 (P=0.012 for IgG and P=0.02 for IgG2). The increased anti-pneumococcal IgG titer was significantly lower in patients in Group 1 versus Group 2 (P=0.001) or the healthy control group (P=0.005). During the follow-up period of patients, patients in Group 1 developed higher episodes of pneumococcal infections than those in Group 2 (P=0.007). Conclusion: A substantial proportion of patients with chronic kidney disease fail to mount an adequate antibody response to pneumococcal antigens and remain at significant risk for such infections. These patients should be offered other prophylactic measures to protect them against invasive pneumococcal diseases.

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Background: Thymidine phosphorylase (TP) catalyses the conversion of thymidine into thymine. Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is an autosomal recessive disease which is caused by mutations in the nuclear gene encoding TP, bringing about severe impairment of TP-enzyme specific activity and accumulation of thymidine in plasma. The clinical manifestations of MNGIE are recognizable and homogenous, but not in the early stages of the disease. In patients who are suspected of having MNGIE, determination of TP-specific activity in leukocytes and thymidine levels in plasma are diagnostic. The methods that are usually used for the measurement of TP activity and plasma thymidine are not rapid or accurate enough and lack sensitivity.

Methods: The specific activity of TP was measured by RP-HPLC in leukocytes of both the controls and the patients exhibiting clinical features suggestive of MNGIE. Moreover, plasma thymidine was assessed by the same method.

Results: The patients had detectable plasma thymidine (>3 µmol/L) but it was undetectable in the healthy controls. The patients' TP-specific activity decreased to less than 5% relative to the controls (14±4 nmol/h/mg vs. 525±165 nmol/h/mg, P<0.05). A diagnostic algorithm for the definitive diagnosis of MNGIE is suggestible based on the results of this study which relies on the measurement of plasma thymidine, TP-specific activity in leukocytes, or both.

Conclusion: In this study, we set up a sensitive and rapid assay for the evaluation of TP-specific activity by using RP-HPLC in Iran. In addition, we established reference values for TP-specific activity and plasma thymidine in the Iranian patients.

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800x600 Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Intrauterine insemination (IUI) is a less expensive and less invasive treatment in comparison with other assisted reproductive techniques, and it has been widely used for a variety of indications as well as in the treatment of couples with infertility. The outcome of IUI may be affected by numerous factors but in this study, we evaluated the effects of cervical mucus removal undertaken before IUI on clinical pregnancy rates.
Methods : In this randomized clinical trial study, all infertile women who were candidates for IUI and attended Shahid Akbar Abadi Hospital during 2009 and 2010 were recruited. The participants were randomly assigned into two groups. Cervical mucus was removed prior to IUI in patients in group A but in group B, a classic IUI was done without removing the cervical mucus. Pregnancy rates were assessed in the two groups by serum levels of β-HCG and detection of fetus in the uterus. 
Results : 291 women including 143 in the classic IUI group and 148 in cervical mucus removal group completed the study. The pregnancy rates were 14.2% (21 pregnancies upon 148 cycles) in the cervical mucus removal group and 7% (10 pregnancies upon 143 cycles) in the control group (P=0.04, OR: 2.199 CI 95%: 0.997-4.85).
Conclusion: The findings showed that cervical mucus removal could result in a two-fold increase in pregnancy rate in comparison with classic IUI. Thus, we suggest this practical and noninvasive method to improve pregnancy rate in these patients.

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800x600 Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: In the last two decades, cryptococcosis has been gaining a distinct public health importance due to the growing number of AIDS cases. Considering the low sensitivity of direct examination with India ink and culture, use of sensitive techniques is crucial in the diagnosis of cryptococcal meningitis. Polymerase Chain Reaction (PCR) can be used to directly detect Cryptococcus neoformans in CSF samples to increase the diagnostic power in cases where conventional methods are unable to detect the organism.
Methods : In this cross-sectional study, CSF samples were obtained from 25 patients suspected of having neurocryptococcosis. The patients were referred to the Medical Mycology Laboratory of the School of Public Health affiliated to Tehran University of Medical Sciences from March 2009 to February 2010. Three different methods, direct India ink examination, culture and PCR were used to evaluate the CSF samples. Two 102 and 106 of Cryptococcus neoformans dilutions in 1ml of CSF were prepared and examined by the three methods. In PCR method, two primer pairs were selected to amplify the Cryptococcus neoformans URA5 gene. The sequences of primers were for A, B, C and D serotypes.
Results : Only in one case PCR, as well as direct examination and culture were positive. All the other samples were negative in PCR, direct examination or culture. Both CSF dilutions were positive in the three tests in the mentioned patient and the positive control.
Conclusion: PCR method can efficiently identify both control and positive samples of Cryptococcus neoformans.

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Background: Steroid cell tumor is one of the rare ovarian tumors and forms 0.1% of all ovarian tumors, divided to three subgroups. Steroid cell tumor that are not otherwise specified (NOS) are the most common type and represent 60% of steroid cell tumors. One of the most known signs of this tumor is hormonal function, especially androgenic effects of it. Primary treatment consists of eradication of tumor via surgery.
Case presentation: The patient is a 29 years old female with history of poly cystic ovarian syndrome since 10 years ago, who attended to the clinic of General Women Hospital of Tehran in January 2011. In pelvic ultrasonography, there was a 6449mm mass in the right adnexa consisting of homogeneous component. She underwent laparotomy and unilateral salpingoophorectomy was done. Pathological report was steroid cell tumor of ovary.
Conclusion: The aim of this study is reporting one of the rare tumors of ovary and assessment of the correct way of diagnosis and treatment of it.

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Background: Recurrent aphthous stomatitis (RAS) is a common disease with unknown etiology. There is no curative treatment. Purslane is considered as a rich source of antioxidants with anti-inflammatory effects. The purpose of this study is to evaluate the effect of Purslane in the treatment of RAS.
Methods: A total of 50 patients were selected for this randomized triple-blind placebo-controlled clinical trial from School of Dentistry of Tehran University of Medical Sciences in 2011. All subjects were randomly divided into two groups. Groups A and B received placebo and Purslane, respectively, for three months. Pain intensity based on the visual analogue scale (VAS), the mean intervals of lesions occurrence, number of lesions and the mean duration of complete healing at baseline and at months 1, 2 and 3 were recorded. 
Results: While no patient complained from increased severity of pain, decreased severity of pain for 4, 3, 2, and 1 grades were recorded in %16, %20, 20%, and 40%, respectively, which were much higher than 4%, 8%, 8%, and 28%, respectively, in the control group. A significant decrease in pain intensity in VAS scores were seen after treatment in group B (P<0.001). The mean duration of complete healing showed significant differences (P<0.001) between groups A (-1.52±4.07 days) and group B (-6.56±4.50 days). The mean intervals between lesions also showed significant differences (P<0.001) between group A (17.88 days) and group B (33.12 days). No significant differences were found between group A and group B regarding to number of lesions. No serious side-effects occurred in either group.
Conclusion: According to our study, Purslane is clinically effective in treatment of RAS and considering the lack of side-effects during the study period, this medicine may be a favorable alternative treatment for recurrent aphthous stomatitis.