Tehran University Medical Journal

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Cesarean section (CS) is a relatively safe procedure, performed for different maiernal and fetal indications. Despite complications of general anesthesia, post-operative infections, and thromboembolic events, CS is being performed with increasing frequency. In this study, we have examined the indications and complications of CS's performed in Arash Hospital from December 1993 to November 1994. Of the total 3480 cases of chiidbrilh, 900 (24.45%) were performed by CS, most and last frequently in December/January and November/December respectively. However, Ute ratio of CS cases to all cases was equal throughout the year. The most common indication of CS was failure to progress in labor (38.54%), and the other causes were repeat CS (21.77%), meconium excretion (11.97%), malpresenlation (8.55%) and fetal distress (5.58%). The indication of CS varies with meternal age. Between 41-45 years, the most common indications were prior CS (42.5%), and request for concommitant tubal ligation (12.5%), whereas in the younger age groups, the most common indication was failure to progress in labor. In primiparous cases, 44.55% of the CS's were performed due to failure to progress in labor, while the latter was the indication of CS in only 14.5% of the multiparous women. Complications were observed in only 4.54% of CS cases

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Background: Post-menopausal hemorrhage is one of the most common complains in gynecologic clinics. More than 60% of these cases have abnormal findings in diagnostic work ups. There is contraversy about the best diagnostic method for evaluating post-menopausal hemorrhage. The aim of this study was to evaluate the results of Trans-Vaginal Ultrasonography and compare its result to ones derived from direct endometrial biopsy and Hysteroscopy findings.

Methods: In a cross-sectional study, menopausal women who attended the outpatient clinic of Arash Hospital, Tehran University of medical Sciences, from April 2005 to March 2006 with the complain of hemorrhage were evaluated. In all of these patients, after getting informed consent, Trans-Vaginal Ultrasonography, Dilatation and Curettage and Hysteroscopy were performed.

Results: The total number of 90 women was recruited to the study with the age range of 41-80 years. The mean age of participants was 53.84 ± 6 years and 4.3 ± 5.1 years had passed from their menopause. The mean thickness of endometrium, measured by Trans Vaginal ultrasonography was 6.25 ± 3.7 millimeter. In the biopsy derived specimens, the most finding pathological presentation was atrophy (48.9%) and the Proliferative endometrium had the second prevalence (36.7%). Atrophy (44.4%) and Proliferative endometrium (33.3%) were the most prevalent finding in Hysteroscopy. There was a significant difference in endometrial thickness between groups of different pathological findings. A significant difference in endometrial thickness was also seen between groups with different Hysteroscopic finding. By grouping the data according to endometrial thickness, it became evident that endometrial thickness can predict the outcome of endometrial biopsy and Hysteroscopic finding efficiently. We used ROC curves to find the best grouping threshold for endometrial thickness to achieve the best sensitivity and specificity.

Conclusion: Measuring the endometrial thickness by Trans-Vaginal Ultrasonography is an appropriate non-invasive test for screening post-menopausal hemorrhage. 

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Oropharyngeal candidiasis is the most frequent fungal infection in HIV patients. The aims of this study were to appraise prevalence of oropharyngeal candidiasis and to determine factors associated with oropharyngeal candidiasis and oral yeast colonization among Iranian HIV patients.
Methods: The patients were composed 150 Iranian HIV positive individuals referred to Iranian Research Center for HIV & Aids (IRCHA), Imam Khomeini Hospital complex in Tehran, Iran. Oral samples were obtained and cultured on mycological media. TCD₄ lymphocyte count/percentage was measured and patients were categorized. Patients evaluated for some risk factors for oropharyngeal candidiasis and oral candida colonization.
Results: Fifty nine percent of patients were presented with oropharyngeal candidiasis and the carriage rate of yeasts was 116 (77.2%). The most frequent isolated candida species were Candida albicans (102) 50.2% and Candida glabrata (45) 22%. Thrush in 57(38%), perleche in 30(20%) and erythematous lesions in 7(4.7%) of patients were observed. Significant differences in TCD₄ count (p=0.01), gender (p=0.02), antifungal therapy (p=0.001), smoking (p=0.02), and intravenous drug use (p=0.03), between asymptomatic and symptomatic patients were observed.
Conclusion: Oral candidiasis is a frequent complication among Iranian HIV individuals. C. albicans and C. glabrata are most important etiologic agents of oral candidiasis. In Iranian HIV individuals TCD₄ count, antifungal therapy, gender, smoking and intravenous drug use are important risk factors for oropharyngeal candidiasis. Denture wearing and age are predisposing factors for oral colonization.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Placenta accreta is a life-threatening complication after previous cesarean delivery. The aim of this case report is to present a case of placenta percreta with bladder involvement and subsequent maternal death.
Case presentation: The patient was a 37-year old who had an unwanted pregnancy due to tubectomy failure two years afterwards. She was hospitalized at 26^th and 30^th week of gestation because of gross hematuria. Sonography reported placenta previa. Cesarean section was performed at 34^th gestational week. Due to severe hemorrhage, hysterectomy with resection of some part of the bladder was done. Died at the operating room after four hours of severe uncontrollable hemorrhage.
Conclusion: The increasing prevalence of different forms of placenta accreta is the result of the ever-increasing rate of cesarean deliveries. One of the strategies to prevent this catastrophic obstetric complication is decreasing the number of cesarean deliveries without appropriate indications.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Breast cancer is the most common form of hereditary cancer worldwide and is an important cause of morbidity and mortality. Approximately 5-10% of breast and ovarian cancers are due to the highly penetrating germline mutations in cancer predisposing genes. Two genes, BRCA1 and BRCA2, account for at least half of these cases. The demand for BRCA1 and BRCA2 mutation screening is rapidly increasing as their identification will affect the medical management of people at increased risk for the disease. Therefore, the aim of this study was to investigate BRCA1/2 mutations in 100 high risk Iranian families.
Methods:  One hundred families who met the minimal risk factors for breast/ovarian cancer were screened among the families referred to Kawsar Human Genetics Research Center for the diseases in 2009-2011. The entire coding sequences and each intron/exon boundaries of BRCA1/2 genes were screened for by direct sequencing and MLPA in both patients and the controls.
Results:  In the present study, we could detect the following novel mutations: p.Gly1140Ser, p.Ile26Val, p.Leu1418X, p.Glu23Gln, p.Leu3X, p.Asn1403His, p.Asn1403Asp, p.Lys581X, p.Pro938Arg, p.Thr77Arg, p.Leu6Val, p.Arg7Cys, p.Leu15Ile, p.Ser177Thr, IVS7+83(-TT), IVS8 -70(-CATT), IVS2+9(G>C), IVS1-20(G>A), IVS1-8(A>G), p.Met1Ile, IVS2+24(A>G), IVS5-8 (A>G), IVS2(35-39)TTcctatGAT, IVS13+9 G>C in BRCA1 and p.Glu1391Gly, p. Val1852Ile, IVS6-70(T>G), 1994-1995 (InsA) in BRCA2.
Conclusion: Ten mutations seemed to be pathogenic and the disease-causing mutations were seen in 16% of the families. In addition, from the total number of substitutions and reassortments (42), 80% related to BRCA1 and 20% to mutations in BRCA2 genes.

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Background: Cystic fibrosis (CF) is a multiorgan autosomal recessive disorder. As CF is highly heterogeneous in Iran and many mutations have a low frequency, routine molecular diagnostic methods are not very efficient. The use of highly polymorphic intragenic markers not only can facilitate phenotype prediction in prenatal diagnosis by gene tracking, but also can lead to the demonstration of possible associations between haplotypes and specific mutations. We determined IVS8 polyT and M470V polymorphisms in exon 10 of CFTR gene in this case-control study.

Methods: Polymorphisms of IVS8 polyT in 53 patients with CF were referred to Amirkola children's Hospital of Babol University of Medical Sciences, 2007 to 2011 and 49 fertile healthy individuals were determined by reverse dot blot method. M470V polymorphism was analyzed by PCR-RFLP.

Results: In IVS8 polyT study, T7 was the most frequent allele in healthy individuals than patients with CF (respectively, 82.8% Vs. 77.2%). T9 was more abundant in patients with CF than normal individuals (respectively, 21.7% Vs. 7.4%, P=0.005). T9/T9 genotype was more frequent in patients than healthy individuals (respectively, 15.1% and 2%, P=0.032). Study for M470V polymorphism showed that M/V was the most common genotype in normal individuals and patients with CF (respectively, 49% and 40.4%). M-T9 haplotype was highly associated with the disease in both patients with CF and normal individuals (respectively, 19.1% and 2.4%, (P<0.001)

Conclusion: The allelic distribution and heterozygosity results suggest that both M470V and IVS8 polyT can be helpful in the prenatal diagnosis of CF in Northern Iranians with a positive family history of the disease.

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Background: In molar pregnancy, when hydatidiform changes are local and some embryonic components are observed, the term of partial mole is used. The risk of persistent trophoblastic tumor after partial mole is much lower than complete mole. In this persistent cases almost all are non metastatic. The aim of this study is to report a case of uterine rupture following incomplete molar pregnancy.
Case presentation: The patient was a 26 year old woman with obstetric history of an abortion and one molar pregnancy and no child. She was referred to emergency unit in Ghaem University Hospital, Mashhad, Iran in May 2011. She had an evacuation curettage following molar pregnancy three months before and without any follow up visit. The patient was referred to emergency unit with hemorrhagic shock. She immediately underwent laparotomy. The uterine fundal rupture was repaired and evacuation curettage performed. In post operative evaluation, she had a nine millimeter metastatic nodule in base of right Lung. As a patient in low risk stage III, she received weekly intramuscular methotrexate (40mg/m2) for six courses. In follow up visit -hCG titer was negative (<10miu/ml) at 5th week.
Conclusion: In cases of in complete molar pregnancy risk of metastasis is very low. Serial beta-hCG titer is the most accurate method for detection of persistent gestational trophoblastic disease (GTN). In neglected cases like this case preservation of ruptured uterus in GTN is possible.

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Background: Calcium channel blockers have an important role in treatment of various cardiovascular diseases including hypertension, angina pectoris and cardiac arrhythmias, so study of cardiovascular effects of derivatives of these drugs are useful. Nifedipine is one of these drugs that used widely to treat hypertension and other cardiovascular diseases. The aim of the present study was to evaluate the central effects of synthesized dihydropyridine derivatives on systolic blood pressure and heart rate of rats and comparison to nifedipine. Methods: Sixty four male rats, after induction of anesthesia and intracerebral ventricu-lar cannulation using stereotaxis method, were divided into eight equal groups. One week after the stereotaxis surgery, the systolic blood pressure and heart rate were eval-uated in times 15 to 60 minutes after intracerebral ventricular injection of DMSO (di-methylsulfoxide) and nifedipine in doses of 80 to 320 microgram/rat and also three synthesized dihydropyridine derivatives (A, B and C) in dose of 240 microgram/rat. Effects of these drugs on systolic blood pressure and heart rate were analyzed using two way repeated measure ANOVA statistical test, followed by Bonferroni posthoc test. All data were considered significant at P<0.05. Results: The inhibitory effects of derivative B on systolic blood pressure and heart rate in dose of 240 microgram/rat in times of 15 and 30 minutes after injection were more potent than nifedipine (P<0.001), while A and C derivatives showed weaker inhibitory properties, compared with nifedipine. Also the inhibitory effects of derivative B on heart rate in dose of 240 microgram/rat were stronger than nifedipine in times of 15 to 60 minutes after injection (P<0.05). Conclusion: Novel dihydropyridine derivatives can possess more potent and stable in-hibitory effects on systolic blood pressure and heart rate, and some part of these properties at least, can be attributed to their direct inhibitory effects on brain neurons.

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Background: In advanced stages, Colorectal cancer remains often refractory to classic therapies. In consequence, search for new therapeutic modalities with minimal toxicity is of particular interest in colon cancer management. In this regard, powerful growth-inhibitory effect has been shown for fish-oil derived Eicosapentaenoic Acid (EPA) and Docosahexaenoic Acid (DHA) against cancer cells. In the present study, we evaluated the anti-cancer effect of EPA and DHA (n3-polyunsaturated fatty acids, n3-PUFAs) on the human colorectal cancer cell line (LS174T) on a dose-response and time-course ba-sis. Methods: LS174T cells were cultured in RPMI-1640 medium supplemented with 10% fetal bovine serum at 37 ºC in a humidified incubator. Cancer cells were treated to vari-ous concentrations of EPA and DHA (50, 100, 150 µM/L) and incubated for 24-72 hours. Following treatments, dose-response and time-course cytotoxicity using viability and MTT assays were performed. Results: Viability analysis showed that 150 µM/L PUFAs decreased significantly the proliferation of treated cells, as compared to untreated cells. In this regard, cell viabil-ities were found to be %31±%5.1 and %30±%2.6 for DHA and EPA respectively. Moreover, treatment of cells with increasing concentrations of EPA and DHA signifi-cantly decreased growth rates in a dose-and time-dependent manner. Following 72 hours treatments with 150 µM/L PUFAs, growth rates were found to be %19±%5.5 and %20±%5 for DHA and EPA relative to untreated cells respectively. Conclusion: The results of this study indicate that n3-PUFAs decrease cell proliferation and could provide new approaches in malignant tumor therapeutic strategies.

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Background: Twin pregnancy with a fetus and a diploid complete mole is not rare, but, the cases of twin pregnancy with a partial mole are rare. Nowadays, the prevalence of these cases has been increased due to the high rate of assisted reproductive techniques in reproductive medicine. The importance of twin pregnancy with a fetus and a diploid complete mole is mainly due to systemic complications such as hypertension and maternal hemorrhage and the possibility of trophoblastic tumor following delivery. Different studies have reported some results about similar cases, but limited case reports are presented in our country. The aim of this study is to report a case with incomplete molar pregnancy concomitant with a live fetus. Case presentation: A 21 yr old woman (G2 ab1) referred to emergency department of Ghaem University Hospital in Mashhad. She complained of scant vaginal bleeding and spotting and a sonography report of a combined molar and normal pregnancy with 15 weeks gestational aged. During hospitalization, the pregnancy complicated with hypertension and proteinuria. Termination of pregnancy was planned at 17th weeks of gestation due to severe preeclampsia. After evacuation of uterus, during follow up visits, -hCG titer raised. Metastasis evaluation was negative. Pathology reports showed patial mole. Then, three doses of methotrexate (50 mg/m2 intra muscular) was administered and finally, according to the monthly follow up, -hCG level was undetectable. Conclusion: The rate of pregnancy complications such as hypertension, hyperthyroidism, and obstetrics hemorrhage and also the risk of Gestational Trophoblastic Neoplasm (GTN) are increasing in incomplete molar pregnancy. Therefore, early diagnosis and timely treatment of molar pregnancy is very important to reduce maternal morbidity and mortality.

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Background: A balanced reciprocal translocation is a structural abnormality, which at least consist of breakage of two non-homologous chromosomes along with pieces exchange and form quadrivalant structure that can produce unbalanced chromosomes during meiosis I and result in a fetus abortion. The aim of the present study is to offer using preimplantation genetic diagnosis (PGD) 24sure array, which delivers aneuploidy screening of 24 chromosomes, within a few hours to increase fertility and bearing a child without chromosomal abnormality of this couple. This technique could replace embryo donation for child bearing of this couple. Case presentation: A young couple with recurrent pregnancy loss in 6th and 7th week of pregnancy without family history of recurrent miscarriage and any clinical signs had conferred. All laboratory tests including hormonal, infections, semen and hysterosalpingography were normal except karyotype that showed balanced reciprocal translocation between chromosomes 5 and 18 in male. Chromosomal study of male parents showed normal karyotype. Conclusion: A balanced reciprocal translocation carrier is phenotypically normal, but during meiosis І, carrier chromosomes cant pair normally and form quadrivalant instead of bivalant that depend on type of their segregation (alternate, adjacent 1, adjacent 2,3:1,4:0), produce gametes that are chromosomally unbalanced which can result in early fetus abortion. Considering the number of abnormal gametes, the most effective way to help couples with this problem seems to be PGD 24sure, since it can identify reciprocal and Robertsonian translocation and allows concurrent screening of all chromosomes for aneuploidy. Another technique that can be compared with PGD 24sure is fluorescence in situ hybridization (FISH), but it has several technical limitations such as it is expensive and complexity, in addition it has only few probes (for chromosomes 21, 13, 18, X, Y) so sometimes necessary to create patient specific protocols.

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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: Respiratory distress syndrome is developmental immaturity of lungs, that is caused by lack of surfactant. Lack of surfactant lead to wide atelectasis and arterial hypoxemia which is a life-threatening lung disorder. The aim of this study was to compare the function of cochlear in infant who suffer respiratory distress syndrome with normal infants by transient evoked otoacoustic emission (TEOAE) test. Methods: This descriptive- analytic cross sectional study was carried out on 21 respiratory distress syndrome (RDS) infants (42 ear) that consists of 11 male and 10 female, 21 normal infants (42 ear) that consists of 10 male and 11 female in Mirza Koochakkhan Hospital, Tehran University of Medical Sciences, Tehran, Iran, which all of them were 3 to 6 month year old, to collect informations about the health of infants we used the files in hospital and to assess the cochlear function we used computerized recording by TEOAE instrument. Statistical analysis carried out by SPSS software version 17 and Chi-square test. Results: The results of TEOAE test demonstrated that in normal group there is no statistical differences between ears and gender, also there was no statistical differences between ears in respiratory distress syndrome group but there was statistical differences between gender in this group. The frequency of pass result (show normal function of outer hair cell in cochlea) was greater in male than female in male the frequency of pass result was 17 ear (77.3%) but in female was 8 ear (40%). In TEOAE test results there was statistical differences between two groups of study. The frequency of pass result in normal group was 34 ear (81%) and in respiratory distress syndrome group was 25 ear (59%) which was significantly more in normal group than in respiratory distress syndrome infants (P= 0.032). Conclusion: According to results, it seems that the respiratory distress syndrome could affects the cochlear and the function of outer hair cell in it so in infants who suffer respiratory distress syndrome we should use the test battery of hearing.

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Systemic lupus erythematosus (SLE) is a chronic autoimmune disease, involves almost all organs such as skin, heart, kidneys and central nervous system. The disease is characterized by vascular and connective tissue inflammation in a recurring pattern of remission and flare. Although the exact pathophysiology of disease has not been fully understood yet, the fundamental defect in SLE is attributed to dysfunction of T lymphocytes in controlling of B-cell that leads to polyclonal activation of B lymphocytes and production a large quantity of autoantibodies against nuclear and cytoplasmic components. These autoantibodies can damage tissues either directly or as a result of immune complex deposits. Several factors are involved in pathogenesis of SLE which can be divided into three major groups, environmental factors, genetic components, and immunological disturbances. They could breakdown body tolerance towards endogenous antigens and cause abnormal immunologic response to the healthy tissue, resulting in tissue damage. SLE occurs more frequently in female than male. It seems that immunological factors have important role in SLE. Inflammation and vascular endothelium irregularities are a number of main pathologies seen in SLE. Cytokines are protein mediators that play an essential role as regulator of innate and adaptive immune response against microbial agents or self-antigens. Influences of cytokines in autoimmune diseases such as SLE are poorly understood. Studies in both experimental animal models of lupus and patients with SLE have revealed a number of cytokine pathways that are important in the disease process. These studies showed that overexpression of inflammatory cytokines increases the proliferation of auto reactive B-cells and results in higher production of autoantibodies. Among them, the role of B-cell activating factor (BAFF), a proliferation-inducing ligand (APRIL), TNF-α, IFN-α, IL-6, IFN-γ, IL-23/IL-17, IL-10, IL-21 are prominent, which is associated with the generation of pathogenic autoantibodies and formation of immune complexes. In this paper, the role of cytokines and their encoding genes are described, while therapeutic applications are also briefly presented.

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Background: The influenza virus is one of the most important factors for higher morbidity and mortality in the world. Recently, researchers have been focused on influenza conserved antigenic proteins such as hemagglutinin stalk domain (HA2) for vaccine production and serological studies. The HA2 plays a major role in the fusion of the virus with host cells membrane. The immunity system enables to produce antibody against HA2. The aim of this study is polyclonal antibody production against influenza HA2. Methods: This study was done in the Influenza Research Lab, Pasteur Institute of Iran, Tehran for one year from September 2013 to October 2014. In the present study, recombinant HA2 protein was produced in prokaryotic system and purified using Nickel affinity chromatography. The purified HA2 was mixed with Freund’s adjuvant (complete and incomplete) and injected into two New Zealand white rabbits by intramuscularly and subcutaneously routes. Immunization was continued for several months with two weeks interval. Before each immunization, blood was drawn by venous puncture from the rabbit ear. Function of rabbit's sera was evaluated using radial immunodiffusion (RID) in both forms, Single RID (SRID) and Double RID (DRID). Finally, antiserum activity against HA2 was evaluated using western blotting as serological assay. Results: Sedimentary line and zone was observed in RID assays (SRID and DRID) represent interaction between HA2 protein and anti- HA2 antibody. As well as, western blotting results was positive for HA2 protein. Therefore, these results showed that polyclonal antibody produced against HA2 protein can identify HA2 protein antigenic sites. Conclusion: These findings show that humoral immune responses have properly been stimulated in rabbits and these antibodies can identify HA2 protein and may be suitable for other serological methods.

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Background: Pain control after orthognathic surgeries due to severity of pain and limitations of opioids use in these patients are particular importance. The aim of this study was to evaluate the effect of oral gabapentin and intramuscular ketorolac in combination with intravenous acetaminophen for pain control after this surgery.

Methods: This study was a randomized clinical trial (RCT) on 75 patients (18-60 years old American Society of Anesthesiologists (ASA) physical status classification system, I, II) that undergo orthognathic surgery in Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran from June 2013 to August 2014. The patients were randomly divided in 3 groups. All of groups received 1 gr (intravenous acetaminophen) 30 minutes before the end of surgery. The control group (n= 25) received placebo. The second group (n= 25) received 30 mg ketorolac intramuscular after induction of anesthesia and the third group (n= 25) received 600 mg Gabapentin orally 30 minute before the induction of anesthesia. The pain severity score assessed by visual analogue scale (VAS), the level of sedation assessed by Ramsey scale, opioid requirement, nausea and vomiting was recorded in the post-anesthesia care unit (PACU) at 1, 3, 6, 12 and 24 hours after surgery. For rescue pain management intravenous morphine was administered.

Results: Seventy-five patients were enrolled in this study. Use of Ketorolac and gabapentin declines the pain intensity, level of agitation and morphine requirement in the recovery room and early hours in the ward (P= 0.011). The 24-hour opioid consumption, nausea and vomiting was significantly higher in control group compared with the both intervention groups (15±1.4 vs. 5±0.5 mg) (P< 0.05) retrospectively. Mean arterial pressure and heart rate changes was significantly lower in ketorolac and gabapentin groups compare to control group in recovery room (P< 0.05).

Conclusion: The result of this study suggest that ketorolac as well as gabapentin can decline the pain intensity and opioid requirement with less nausea and vomiting and good hemodynamic control after orthognathic surgery.

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Background: The major issue to address in obesity etiology is to identify the genetic changes in the disease and their occurrence in different populations. Uncovering these genetic changes may be important in developing potential biomarkers for early diagnosis and prognosis of obesity. Among all obesity susceptibility genes studied before, convincing association has been found with variants in the FABP2 gene and this disease; however, the contributions of these genetic variants in different populations and ethnic groups are not similar. Accordingly, this study was carried out to replicate the previous findings to assess whether a missense variation (rs1799883) in this gene is associated with obesity in the Tehran Lipid and Glucose Study (TLGS) population.

Methods: A case–control study was designed to determine the possible association between rs1799883 and occurrence of obesity “in phase IV of the study between the years of 2008 to 2011”. The study group consisted of 217 subjects with body mass index (BMI, kg/m2) greater than 30 as cases and 159 healthy individual as control group (1820). All subjects were recruited among the Tehran Lipid and Glucose Study (TLGS) participants in phase IV of the study between the years of 2008 to 2011. The genomic DNA was extracted from peripheral blood leucocytes using the salting out method and subsequently subjects were genotyped for this marker using The tetra-primer amplification refractory mutation system-polymerase chain reaction (ARMS-PCR). Association of risk allele with obesity was assessed using the SPSS software, version 20 (Chicago, IL, USA).

Results: The results showed no significant differences between case and control groups in terms of allele frequency (P=0.61). According to the findings, the presence of T allele as the risk allele was not associated with increased risk of obesity in carriers of this allele compared to individuals carrying the normal allele (OR=1.17; CI%95= 0.62-2.19, P=0.61).

Conclusion: The results did not support the previous findings of an association between genetic polymorphism in the FABP2 gene and risk of obesity. However, a number of replicated studies with other ethnicity are suggested to make a conclusion about the role of this genetic polymorphisms and susceptibility to obesity in Iranian population.

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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: Even though replantation surgery has now become a routine procedure, it remains delicate and demanding surgery, requiring adequate training and expertise in microsurgical techniques. Functional outcomes following replantation vary with the level of injury. Replants of the fingers distal to the flexor superficial are insertion, the hand at the wrist, and the upper extremity at the distal forearm can achieve good function. With the advent of refined microscopes, sutures, and needles, along with specialized surgical training, replantation has become a routine part of hand-surgery practice in centers all over the world. Clearly, survival does not equate with function. Amputations constitute multisystem injury, with disruption of skeletal support (bone), motor function (muscle), sensibility (nerve), circulation (blood vessel), and soft-tissue coverage (skin). A lot of News work-related accidents published daily. Complete amputation of the palm with sharp objects electric disrupts quality of life and irreversible effects on their life. Replantation or repair the damaged organ can improve their quality of life, functional body.

Case presentation: The case is a man with complete amputation of the palm while working with an electrical machine, at the same time as damage and severe crush was also the distal phalanx of the first finger of the right hand. Patient was admitted to the emergency unit at Fatemi Hospital of Ardabil city in January 2014, Iran, and underwent to surgery for replantation.

Conclusion: Complete amputation of palm and its successful replantation are among rarely occurred and reportable cases. Complete amputation of palm and successful replantation and the 10-month follow-up indicated that the patient had a successful operation. No abnormalities were found in the blood circulation, and finger grasping was acceptable. Nerve development was acceptable.

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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.