Tehran University Medical Journal

---

For monitoring of renal transplant function, serum B2m was evaluated in 23 recipients. According to clinical diagnosis the patients were in four groups: 1) Successful renal transplant the mean concentration of SB2m pretransplantation was 73.1±26.1 mg/L but decreased to nearly normal level (4.43±1.17 mg/L) within 24-48h and then reached to 3.1 mg/L duting 20 days after transplantation. 2) Renal dysfunction (except rejection) the maximum changes of SB2m was 1.1 mg/L/day and no significant changes of SB2m were found between this group and group 1. 3) Accelerated and acute rejection during immunological rejection crisis, SB2m level increased and after response to antirejection therapy decreased. The daily changes of SB2m allowed to diffrentiate renal dysfunction fom rejection in 84% of cases. Moreover according to SB2m fluctuation levels, SB2m had a prognostic pattern for acute rejection due to significant differences between the level of SB2m on the day of clinical diagnosis of rejection and 4 days previously (P<0.025), and also 2 days before rejection (P<0.025), while this pattern was not found for serum creatinin and BUN.

---

This survey, evaluated the level of awareness and knowledge among the medical staff about conditions and methods of performing cardiopulmonary ressucitation. The study sampling comprised 497 subjects including 208 residents and 262 interns of ten university hospitals in Tehran. In regard to the basic principles, this has been 43.54% (SD = 13.36%), in drug and fluid therapy 31.22% (GD = 13.22%), in electroshock 43.6% (SD=21.12%), in appropriate approach to the problem 34.73% (SD=13.42%) and in complications of CPR 17.7% (SD = 15.25%). Considering the results of the project, the medical staff have insufficient knowledge of CPR md it does not improve significantly during internship and residency period. Therefore, there is a great necessity for the medical students to attend basic and advanced CPR courses during their study

---

Our purpose was demographic clinical and pathological aspect of BCE in patients seen in Razi Hospital, during a six-month period (75.8.12 to 76.2.12). Results: From the total 20000 patients, 103 cases of BCE were detected. (0.5%). The male female ratio was 1.71 BCE was more frequent in sixth decade. 40.8% of patients were fair skin (Type II), 54.4% tawny (Type III) and 4.9% brown (Type IV, V). 15.5% of patients had a past history of freckles and history of radiotherapy in childhood was present in 41.7% 89.3% had no history of acne and seborrhea. The scalp was the most common site of BCE. The most common clinical type was nodular BCE and solid BCE was the dominant histological feature. Conclusion: BCE was more common in male and fair skin patients with dry skin. In those having history of radiotherapy of the scalp, lesions were seen mostly on the scalp, forehead and neck: pigmented BCE was predominant in this group.

---

Nowadays, trauma is a major complex of industrial and developed countries. Integrated trauma systems have been used for many years to evaluate and minimize the severity of trauma outcomes (mortality and morbidity). We haven't had any trauma system or any comprehensive study, giving us proper information about our country trauma state. This article is based on comprehensive information of a descriptive prospective cohort study, performed in one year period in 3 major trauma centers in Tehran, evaluating 58005 Traumatic patients, referred to emergency rooms of these hospitals. In this article we have tried to represent a complete report of our patients' epidemiologic and demographic factors and trauma inducing mechanisms including traffic accidents, falls, gunshots, cutting objects ..., and their effect on the severity of injury and patients' outcome. Based on our study, traumatic patients are mainly young (age mode between 20-29) males (80%). The majority of patients were illiterate or had a low level of education. The most common mechanism of trauma was hitting of blunt objects (44.9%), however, it was car accidents in hospitalized and severely injured patients (39.9% and 53.7% respectively). The mechanism of trauma correlates significantly to the severity of injury, the need to hospitalization and the patients' outcome. In our study gunshots, car accidents and falls are the most important trauma inducing factors.

---

The aims of this study were to determine incidence and types of observable congenital abnormalities among births of Mirza Kochak-Khan, Imam Khomeni and Shariatti hospitals between first of Novermber 2000 to the end of September 2001.
Materials and Methods: We used neonates that survived for 24 hours after delivery. A questionnaire was specially designed to explore each of the objectives for our study. A group of experts that were thoroughly trained to completed questionnaires by interview to mothers and evaluation of neonates. Data analysis was performed and by Excel and SPSS.
Results: Results showed that congenital abnormalities were present in 205 (3.2 %) of 6424 neonates, from 3 hospitals. The most frequent abnormalities consisted of musculoskeletal defects (37.3 %), Nervous system defects (24.7 %), urogenital defects (24.3 %) head and neck defects (13.6 %).
Conclusion: The result of this study showed that incidence of visible congenital abnormalities ratio in contrast to other countries have not significant difference but the types abnormalities were significant.

---

Background: Regarding the complications of chronic intractable epilepsy, the presence of respectable lesions in many these patients that can be diagnosed with noninvasive sensitive techniques such as MRI and SPECT and the unrecognized significance of epilepsy surgery in our country, we have decided to review the management of medically intractable epilepsy in patients, who underwent epilepsy surgery in neurosurgery department of Loghman Hakim hospital between 1997-2003.

Materials and Methods: In this study we retrospectively review 30 cases of medically intractable epilepsy that had underwent epilepsy surgery. All patients before surgery were investigated with brain MRI, brain SPECT, EEG and IQ test. Type of surgery was determined by MRI, SPECT and EEG findings. Pre - and postoperative seizure frequency and surgery complications studied. Seizure control was measured with Engel criteria.

Results: Patients mean age was 22.4 years. Three cases (10%) were females that all underwent temporal mesial lobectomy. In 18 cases (60%) there were concordant brain lesion with seizure origin that 9 cases (30%) underwent mesial temporal lobectomy and remainder 9 cases (30%) underwent lesionectomy.other12 cases (40%) that have uncertain brain lesion but suffer from drop attack due to one or combination of atonic, tonic, tonic clonic, clonic, myoclonic, absence or clonic underwent anterior callosotomy. patients that underwent mesial temporal lobectomy, anterior callosotomy and lesionectomy were seizure-free in 77.7%, 58.3% and 55.5% of cases respectively.

Conclusions: Provided to correct patient selection for epilepsy surgery we can manage intractable epilepsy properly. Regarding to the complication of intractable epilepsy, acceptable epilepsy surgery results and available sensitive noninvasive diagnostic techniques such as MRI in our country, epilepsy surgery should be considered seriously in our country and promoted.

---

Background: I Infections due to Candida spp. have increased dramatically in recent years through a rising number of predisposing factors and immunocompromised hosts. Although Candida albicans is the most prevalent and important causative agent of Candida infections, the importance of C. parapsilosis, C. tropicalis, C. krusei, C. glabrata, C. guilliermondii and C. kefyr have increased significantly as they tend to be more resistant to antifungal agents. Therefore, it is critical that infecting Candida spp. be identified and considered. Furthermore, clinical laboratories may need to expand their yeast identification capabilities in order to facilitate rapid identification of clinical yeast isolates.
Methods: In a discroptive – analytic study, the patients suspected of candidiasis were sampled. Direct examination and culture was carried out for all specimens. The isolated yeast colonies were then identified using various different tests such as culture on corn mealagar tween-80, CHROMagar Candida, and assimilation test by API 20C AUX kit.
Results: In the present study, 304 yeast colonies were isolated from referral patients to mycology laboratory of 304 isolated colonies 204 were identified as C. albicans and 100 were identified as non albicans candida as follow 35% C. parapsilosis, 32% C. tropicalis, 8% C. glabrata, 8% C. kefyer, 6% C. krusei, 3% C. guilliermondii, 3% C. famata, 3% C. lusitaniae, 1% C. zeilanoides and 1% C. homicola. C. parapsilosis was the most frequent species. The result showed that clinical specimens were obtained from various infected sites of body and nail samples (59 cases) were found to be the most frequent among those specimens.
Conclusion: In conclusion, our results suggest that no single phenotypic test has proven to be highly effective for definitive identification. Moreover since these organisms can vary greatly in their susceptibility to the current antifungal agent and causing significant patient management problem therefore evaluation of susceptibility of these isolates against antifungal drugs is need to be investigated.

---

Background: Quality assurance is a prevention-oriented system that can be used to improve the quality of care, increase productivity and monitor the performance management in clinical laboratories. ISO 9001: 2000 requirements are a collection of management and technical systems designed to implement quality assurance and monitor performance management in organizations.
Methods: A checklist was prepared to monitor the preanalytical, analytical and postanalytical stages of laboratory performance management in 16 areas and all laboratory activities in 14 of the clinical laboratories of the Tehran University of Medical Sciences (TUMS) hospitals. Collected data were stored and statistically analyzed using SPSS software.
Results: The best performance, in which 77.73% of quality assurance indicators were observed, was found in Sina Hospital. However, only 57.56% of these indicators were fulfilled at Farabi Hospital, with the lowest-level performance among the clinical laboratories of TUMS hospitals. The highest level of compliance with quality assurance indicators was in the hematology departments and for facility demands in management areas. Overall, quality assurance indicators were appropriately followed in only 7% of the clinical laboratories.
Conclusion: The average quality assurance observation rate in the clinical laboratories studied was 67.22%, which is insufficient and must be remedied with stricter enforcement of the ISO 9001: 2000 regulations.

---

Background: Laparoscopic techniques for the placement of peritoneal dialysis catheters are becoming increasingly popular. Recently, with the improvements in laparoscopic surgery, various methods for the insertion of peritoneal dialysis catheters have been reported, indicating that the laparoscopic insertion is preferred over the open and percutaneous techniques. The aim of this study was to introduce and assess a simplified laparoscopic method for the insertion of peritoneal dialysis catheters in continuous ambulatory peritoneal dialysis (CAPD) patients.
Methods: We enrolled 79 consecutive end-stage renal patients (46 men and 33 women) with a mean age of 50 years (range: 19-83 years) in this study. During the surgery, a 5-mm trocar was placed in the left upper quadrant for the optics and another 5-mm trocar was placed to the left of the umbilicus. Using the second trocar, a tunnel was formed 2 cm left of the umbilical plane for the insertion of a Tenckhoff catheter. Under direct vision, the catheter was advanced into the abdomen. The catheter was tested for patency. Catheters of all subjects were capped for two weeks before dialysis initiation.
Results: The mean duration of the operation was 15 minutes. Ten patients died during the follow-up period, all due to other medical problems, and six patients underwent renal transplantation however, no deaths or complications were observed during surgery. Early onset complications were seen in 12 patients (15.1%). The most frequent late-onset medical and mechanical complications were peritonitis (6.3%) and hernia (3.7%). During a follow-up period of four years, removal of the catheter was required in two patients as a result of peritonitis.
Conclusion: We obtained a low complication rate and a high catheter survival rate with this laparoscopic insertion of the Tenckhoff catheter. We believe future experience will encourage the use of this safe, simple and quick procedure.

---

Background: Hypopharyngeal cancer usually presents with cervical mass, hoarseness, radiated otalgia, and dysphagea in the advanced stages. Radical surgery followed by radiotherapy plays an important role in the treatment of patients with hypopharyngeal cancer. However, there is no general consensus as to which is the best method of reconstruction after surgical resection. The aim of this study was to evaluate the complications of pectoralis major myocutaneous flap (PMMF) and gastric pull-up (GPU) techniques to reconstruct a circumferential defect after laryngopharyngoeso- phagectomy.

Methods: We retrospectively reviewed the records of 64 patients who underwent radical surgery and reconstruction with either PMMF or GPU technique. Demographic characteristics, tumor location, proximal margin involvement, history of radiotherapy, presence of lymphadenopathy, cervical dissection, and postoperative complications such as fistula, anastomotic site stenosis, swallowing dysfunction, and stoma stenosis were compared between the two groups. Postoperative complications of the reconstruction methods were compared.

Results: A total of 64 patients, 43(67%) in GPU group and 21(33%) in PMMF group, were studied. The groups did not differ in demographic characteristics. The locations of the tumoral lesions were in larynx (n=7), proximal esophagus (n=5), posterior cricoid (n=5), pyriformis sinus (n=7), posterior wall (n=7), and miscellaneous (n=41). Six patients (6.3%) had proximal margin involvement, 19 patients (29.9%) had history of radiotherapy, 26 cases (40.6%) had lymphadenopathy, and 49 cases (76.5%) had cervical dissection. There was no significant difference between the two groups regarding stenosis or swallowing dysfunction rates, but fistula was seen lower following GPU compared with PMMF (p<0.001).

Conclusions: The GPU technique results in similar functional stenosis or swallowing dysfunction rates, but lower fistula compared with PMMF reconstruction.

---

Background: Because of eventual side effects of chemical drugs, the efficacy of natural wound healing accelerators in long-term diseases and some situations is demanded to practitioners. The initial aim of our study was to assess full thickness excisional skin wound healing and inflammation diminution, Morphometrically and Histopathologically, after topical application of dried extract of Echinacea purpurea aerial part in rats, compared with zinc oxide.

Methods: Sixty wistar rats received four full thickness excisional wounds with the aim of surgical punch on the back skin under surgical anesthesia. All rats were randomly divided into groups 1, 2 and 3, of Echinacea purpurea, zinc oxide and control, respectively. All of them were treated topically once a day for 21 uninterrupted days. Healing of the wounds was daily measured by taking digital photographs and analysis. Histopathologic assessment was carried out in the 0th, 3rd, 7th, 14th, and 21st days of treatment period as well, and wound healing was assessed using 1 to 6 healing grades.

Results: According to Morphometric findings, the wound contraction rate in group 1 after 21 days of skin punching, with wound size of 0.18±0.03 mm² in contrast with group 2, 2.81±0.21mm², was much higher than that in other groups. Group 1 with wound contraction rate of 2.5 times in the day 7 and 3 times in the day 14 more than group 2, had the best wound contraction (p<0.01). histopathologic assessment revealed that, overall healing rate in the group 1 was highest (p<0.01).

Conclusion: Echinacea purpurea dried herbal extract could be a new capable remedy to accelerate skin wound healing because of its potential anti-phlogosis and wound healing stimulatory properties.

---

Background: The clinical importance of yeast infections has increased in recent decades. There are 10-15 pathogenic Candida species. The current morphological and physiological methods for identification of Candida species are generally not easy to interpret and may be expensive or time-consuming. In the present study, we introduce and use a new approach for the identification and differentiation of medically important yeast species of Candida. In this method, size polymorphism of the internal transcribed spacer regions, ITS1 and ITS2, of the ribosomal DNA in various Candida species is used as the basis of species recognition.

Methods: The genomic DNA of 31 standard strains and 60 clinical isolates was extracted and PCR-amplified using two primer pairs (ITS1-ITS2 and ITS3-ITS4) separately. Both PCR products were mixed and analyzed after standard agarose gel electrophoresis. The species of the tested yeasts were identified by the electrophoretic patterns of the mixed PCR products of each sample, comparing the data obtained from the sequence analyses of ITS1 and ITS2 molecules.

Results: By this method, with the exception of C. albicans and C. dubliniensis, we were able to clearly differentiate nearly all common pathogenic Candida species, including C. albicans, C. glabrata, C. gulliermondii, C. parapsilosis, C. tropicalis,      C. krusei, C. kefyr, C. lusinaniae and C. rugosa. All standard and clinical strains were identified correctly, without expensive methods such as sequencing and capillary electrophoresis.

Conclusion: It seems that the PCR-FSP method introduced in this study is the easiest molecular approach for the identification of a wide range of pathogenic Candida species and is applicable for diagnostic and epidemiological purposes in reference laboratories.

---

Background: Meningiomas are among the most common tumors of the brain. Skull base meningiomas comprise s major part of brain meningiomas. They are difficult to treat because of proximity to major vital neuro-vascular structures which makes their surgical resection hazardous and fraught with a high rate of complications. Radiosurgery is considered as an alternative efficient way to treat them, which targets the tumor and its supplying vasculature. The standard treatment consists of tumor eradication and its supplying vessels through homogeneous dose of 201 rays of cobalt 60 source. Methods: In a case-series study, we report 230 meningiomas referred to Iraninan Gamma Knife Center, treated by radiosurgery with type C Gamma Knife. Radio-surgery was performed at a mean dose of 15 Gy and 50% isodose. Results: Two hundred and thirty of all meningioma cases refered to our institute were skull base lesions. Eighty (35%) were new case and the rest were previously treated microsurgically one or more times. None of the patients died after treatment and the most common post-operative complications were headache (30 patients) and peri- tumoral edema (12 patients). Conclusion: Tumoral control is defined as reduced tumor volume or as no change in tumor volume. Tumor control was achieved in 218 (95%) patients. In those who were not treated microsurgically, clinical improvement was more pronounced. Thus when suitable (favorable tumor size and absence of progressive mass effect signs) the patients could be primarily treated with Gamma knife. Other patients could be managed complementarily with radiosurgery after they are treated surgically.

---

Background: Human respiratory syncytial virus (HRSV) is the most important viral agent of acute lower respiratory tract disease in infants and young children worldwide. This virus is responsible for 50% brochiolitis and 25% pneumonia in infants. There are limited data of molecular epidemiology of HRSV from developing countries. This is the report on the molecular epidemiology of human respiratory syncytial virus in Iran. Methods: In this study, RT-PCR for second hypervariable region of the HRSV G glycoprotein was performed on 72 throat swabs collected from children less than 5 years of age with acute respiratory symptoms in 1386. Results: Of the 72 throat swabs collected from children with acute respiratory symptoms, 14 (19.44%) were positive for HRSV. Phylogenetic analysis revealed that all HRSV-positive samples clustered in three genotypes of subgroup A: 12 strains (85/71%) in genotype GA2, 1 strain (7/1%) in genotype GA1, and 1 strain (7/1%) in genotype GA5. In this study we couldn’t identify any genotype of subgroup B. Conclusion: Our results revealed that multiple genotypes of subgroup A were co- circulated during 1386 in children less than 5 years of age in Iran. Also this study revealed that genotype GA2 was predominant genotype in isolates were obtained from several cities (Tehran, Isfahan, Karaj, Qazvin, Bandar Abbas, Shahreza), so we speculate that this genotype may be predominant during 1386 in Iran. This study supported that RT-PCR for second variable region of G protein is an effective method for further studies of HRSV genotype designation in Iran.

---

Background: Rosa damascene has a special role in the Iranian traditional medicine due to its sedative, anticonvulsant and analgesic effects. Regarding its alkaloid, flavonoid and other organic compounds, this plant has always been used to reduce nervousness and treat depression and chronic insomnia. In the present time, synthetic drugs with sedative and anxiolytic properties are used for such problems but due to their side- effects and economic issues, the significance of natural medicines with fewer side- effects is of interest. Considering the importance of sedative and anxiolytic effects of Rosa damascene, we decided to compare this plant with synthetic drugs of the same properties. Methods: Two different groups of male Wistar rats received either Rosa damascene extract in doses of 150, 300, 450 mg/kg or Diazepam and dimethyl sulphoxide in doses of 1.2 mg/kg intraperitoneally 30 minutes before assessing the sleep duration, sedation and preanesthetic effects induced by intraperitoneal ketamine, 40 mg/kg. The anti- anxiety effect was evaluated by using an elevated plus maze and a rota rod. Results: The results showed a meaningful increase in the period of sleep induced by Ketamine (P≤0.01) and also a meaningful increase in time spent at the open arms of the device in the group receiving Rosa damascene extract (P≤0.01). Conclusion: The results showed that the Rosa damascene extract dose 450mg/kg has sedative, preanesthetic and anxiolytic effects (P≤0.01).

---

Background: Bone remodeling has always been the goal of surgeons for a long time. Recently, it was shown that statins that are commonly prescribed for lowering cholesterol also have beneficial effects on bone healing. Therefore, the present study was undertaken to evaluate the probable effects of atorvastatin on osteogenesis in the rat femur.

Methods: This experimental study was conducted on 30 male Sprague-Dawley (SD) rats. The animals were divided randomly into one control and two experiment groups. After induction of anesthesia, a hole of 2 mm in diameter was made in femur width. The control group received physiological serum but the experiment groups one and two, respectively, received 10 and 20 mg/kg/PO of atorvastatin on daily basis. After euthanizing the rats, histopathological and histomorphometrical evaluations of the bones were performed 45 days after the intervention.

Results: In the control group, the defects seemed to be filled with woven bone and bone marrow, depictive of a poor osteogenic activity. In the experiment groups, many osteoblast groupings and young bone trabeculae had been formed and bone trabeculae were more organized. Histomorphometric results, showed that atorvastatin had significantly promoted bone healing in the experiment groups compared with the controls (P<0.001). Moreover, the analysis showed that atorvastatin had more significant effects in group three receiving high doses of the medication in comparison with group two (P<0.001).

Conclusion: The findings of this study showed that atorvastatin is capable of stimulating osteogenesis in rats.

---

Background: Several dietary factors are involved in cardiovascular coronary heart diseases, including trans fatty acids, which are generally formed during hydrogenation of vegetable oils, a process that causes conversion of liquid oils into semisolid fats. Nowadays, it is well-known that trans fatty acids form a major risk factor in the occurrence and progression of atherosclerosis. On the other hand, it has been identified that some nuclear receptors, such as PPARs,are involved and play important roles in lipid homeostasis and pathogenesis of cardiovascular diseases. Therefore, we studied the effect of elaidic acid on gene expression of peroxisome proliferator activated receptor gamma (PPARγ).

Methods: Murine macrophage RAW264.7 cells were treated by 0.5, 1, and 2 mM concentrations of elaidic acid for 6 h. The control group was treated by 50% ethanol (as solvent), equivalent to the amount of ethanol used in 2 mM concentration of elaidic acid. Later, the total RNA was extracted and its cDNA was synthesized. Finally, the quantity of PPARγ gene expression was measured by real-time PCR.
Results:  Overall,0.5, 1, and 2 mM concentrations of elaidic acid decreased PPARγ gene expression in RAW264.7 macrophage cell line by -1.36, -1.68, and -3.24 folds compared with the control group, respectively.
Conclusion: By decreasing the expression of nuclear receptor PPARγ, elaidic acid causes, intensifies or accelerates the occurrence of cardiovascular diseases, especially atherosclerosis.This finding shows the importance of reducing the consumption of elaidic acid containing foods.

---

Background: To compare the success rate and side effects of letrozole and misoprostol versus misoprostol alone for medical termination of early pregnancy. Methods: The patients requesting termination of pregnancy up to 63 days of gestation were randomized into two groups. The letrozole group received letrozole 10 mg daily for 3 days followed by 800 micrograms of vaginal misoprostol, while the placebo group received placebo for 3 days followed by the same dosage of misoprostol. The complete abortion rate and the side effects profiles of the two groups were compared. The primary outcome measure was the abortion rate. Results: A total of 214 women were recruited. Overal complete abortion rate was 81.3%, complete abortion rate in the letrozole group was not significantly higher than that of the placebo group (84.1% compared 78.5%). After receiving 800 mcg misoprostol, 37 case (17.3%) had complete abortion that 13 cases (12%) of the misoprostol group and 24 patients (22.5%) of the cominabtion group and after receiving 1600 mcg, misoprostol, in 137 cases (77.4%) had complete abortion that 71 patients (75.5%) of the misoprostol group and 66 cases (79.5%) was obtained for the combination group. This difference was not statistically significant (P> 0.05). D & C in 40 cases (18.7%) reported that was not significantly different in the two groups, 17 cases (15.9 %) in the combination group versus 23 (21.5%) in the misoprostol group. Side effects such as fever, tachycardia, diarrhea and pain were similar in the two groups there were not significantly fewer women complaining of side effects in the letrozole group than those in the placebo group (P> 0.05). Conclusion: Combination of letrozole and misoprostol is as effective as misoprostol alone in complete abortion rate. Based on these results, the use of misoprostol in combination with letrozole is safe and not expensive.

---

Background: Over the last two decades invasive candidiasis has become an increasing problem in neonatal intensive care units (NICUs). Colonization of skin and mucous membranes with Candida spp. is important factor in the pathogenesis of neonatal infection and several colonized sites are major risk factors evoking higher frequencies of progression to invasive candidiasis. The aim of this study was to detect Candida colonization in NICU patients.

Methods: This cross-sectional study was conducted on 93 neonates in NICUs at Imam Khomeini and Children Medical Center Hospitals in Tehran. Cutaneous and mucous membrane samples obtained at first, third, and seventh days of patients’ stay in NICUs during nine months from August 2013 to May 2014. The samples were primarily cultured on CHROMagar Candida medium. The cultured media were incubated at 35°C for 48h and evaluated based on colony color produced on CHROMagar Candida. In addition, isolated colonies were cultured on Corn Meal Agar medium supplemented with tween 80 for identification of Candida spp. based on their morphology. Finally, polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method was performed for definite identification of isolated species.

Results: Colonization by Candida spp. was occurred in 20.43% of neonates. Fifteen and four patients colonized with one and two different Candida spp., respectively. Isolated Candida spp. identified as; C. parapsilosis (n: 10), C. albicans (n: 7), C. tropicalis (n: 3), C. guilliermondii (n: 2), and C. krusei (n: 1). In present study non-albicans Candia species were dominant (69.56%) and C. parapsilosis was the most frequent isolate (43.47%). Using Fisher's exact test, the correlation between fungal colonization with low birth weight, low gestational age, and duration of hospital stay was found to be statistically significant (P=0.003).

Conclusion: The results of this study imply to the candida species colonization of neonates. Neonates in NICU are at the highest risk for severe infection with Candida parapsilosis. Therefore, isolation of C. parapsilosis as the most common species (43.47%) in present study was noteworthy.

---

Background: Self-immolation is a common method for suicide among women in developing countries. Culture is considered as an influential factor for attempting suicide by selfimmolation. Better understanding of the influence of culture will be useful to develop specific prevention strategies. Therefore, the study aimed to explore how the culture can influence on
attempting suicide by self-immolation among women.
Methods: The study was performed by a qualitative approach using directed content analysis in Imam Khomeini Hospital, Kermanshah, Iran, 2011- 2013. Our participants were selected purposefully among patients who attempted suicide by self-immolation (n= 9), their relatives (n= 6), and treatment staff (n= 6). We used semi-structure interview
for data gathering. The interviews were tape recorded and transcribed. Then, transcribed interview was analyzed by constant comparison.
Results: The main extracted theme was self-immolation sub-culture. Two main categories and 6 sub- categories were also emerged that explored the effect of culture on attempting suicide by self-immolation. The main categories were cultural restriction, and cultural acceptation. Marriage- divorced related traditions, living in extended family, and cultural
conversations and cultural meanings of self-immolation were among extracted subcategories. The category of cultural restriction described the role of culture in the occurrence of family conflicts as a predictor of attempting suicide by self-immolation, and cultural acceptation, the second category, explained how self-immolation is accepted as a
method of choice of suicide in the understudied culture.
Conclusion: Our finding showed that subculture of self-immolation provides influential conditions for attempting suicide by self-immolation. According to the findings, cultural restriction may facilitate conditions to occurrence of attempting self-immolation, and cultural acceptance provides conditions to perdurability of self-immolation as a method of
suicide. Considering these conditions is recommended in designing prevention programs.