Tehran University Medical Journal

---

Background: Vasoactive intestinal peptide (VIP) plays an important role in modulating coronary blood flow and heart rate. The purpose of the present study was to investigate the effect of eight weeks of low intensity aerobic exercise on plasma levels of VIP hormone, blood pressure and heart rate in healthy elderly men and women, and patients with coronary artery disease (CAD).
Methods: In this study, 15 healthy women and 15 healthy men and 15 female and 15 male with CAD disease were randomly chosen as the experimental and control groups. Subjects did aerobic exercises tree days/week, for eight weeks, with the heart rate of 10010 beats per minute. Blood samples were taken from each subject in three stages, (before, immediately after and 24 hours after the 8 weeks of exercising).
Results: The results showed that there was a significant difference among plasma VIP levels in the four groups. Moreover, a significant difference was observed between the systolic blood pressure in the four groups (P=0.01) and the systolic blood pressure in male patients and healthy women (P=0.03) while there was no meaningful difference the systolic blood pressure in the two other groups. There was also a significant difference in the heart rate of the three rounds of sampling in the three of groups (P=0.002) but no significant difference was observed in healthy men.
Conclusion: According to the above results, it seems that the duration and intensity of each workout should be considered to reach the VIP stimulation threshold. It may bring about considerable changes in VIP levels.

---

Background: Alopecia areata (AA) is a common cause of noncicatricial alopecia that occurs as a patchy, confluent or diffuse pattern. Exact etiologic factor of AA not yet recognized. Among many hypothesis, relationship between AA and autoimmune disease, especially thyroid disorders, was more interesting. The objective of this study was to determine the prevalence of thyroid test disorders in the patients with alopecia totalis and universalis in comparison with normal population.
Methods: We analyzed medical records of 100 patients, including 44 male and 56 female in Tehran Razi Hospital from 1388 to 1389. The mean age was 24.1 years. Patients having totalis and universalis form of AA considered as case group while 100 normal person (42 male and 58 female with mean age of 26.1) who had not any form of AA considered as control group. Both groups had not any sign of thyroid disease at clinical examination according to their available medical records. Collected data were analyzed statistically in SPSS software 17th version.
Results: In the majority of patients (54%) the disease was manifested in the first two decades of life. History of atopia was seen in 9.8% of patient. Presence of the similar disease in first-degree family members was seen in 14.3% of patients. Abnormal T3, T4 and TSH were significantly higher in case group. Abnormal T3 uptake was higher in case group but not statistically significant.
Conclusion: Paraclinical thyroid disorders were significantly higher in the alopecia areata patients than in normal population. There was no significant association between the age, sex and duration of disease and presence thyroid dysfunction.

---

Background: The purpose of this study was evaluation of risk factors of peripheral artery disease (PAD) and effective markers on it.
Methods: This descriptive-analytical study was done during 2010-2011 in the surgical units of Khorramabad Shohada Hospital. Fifty patients who had symptoms of PAD undergoing CT angiography and biochemical markers for them were measured. The investigated variables were family history, site of arterial obstruction, underlying diseases, smoking history, physical activity and stress level. A control group was considered for the study. The comparison was made between these two groups.
Results: Aging showed a significant role in prediction of PAD (70% sensitivity and 64% specificity). Homocysteine had the highest sensitivity (80%) in prediction of PAD, compared with other biomarkers. CRP (74% sensitivity) was the best marker that had positive predictive value for PAD. Fasting blood sugar (FBS) showed a significant role in prediction of true positive cases of PAD (72% sensitivity and 74% specificity). HbA1C with 68% sensitivity and 64% specificity and TG with 50% sensitivity and 44% specificity could be considered as factors related with PAD.
Conclusion: The levels of C-Reacative protein, homocysteine, and FBS were correlated with PAD, HbA1C and TG levels were associated with PAD, but lower than the previously named markers. In this study a significant relationship between lipoprotein levels and PAD was also observed. PAD was associated with sex and age.

---

Background: Gestational trophoblastic disease (GTD) is a heterogenous group of neoplastic lesions that is derived from placental trophoblastic epithelium. According to World Health Organization (WHO) classification they include: Hydatidiform mole (complete and partial), invasive mole, choriocarcinoma and placental site trophoblastic tumor. Hydatidiform mole is the most common and the diagnosis is achieved by pre-evacuation ultrasonographic evaluation, laboratory tests and finally histological assessment as gold standard. Since these disorders show varying potential for local invasion and metastasis, the accurate diagnosis, follow up and recommendations given to patients may differ.
Methods: Consecutive cases with diagnosis of GTD from archive of pathology department of women (Mirza Kochak Khan) hospital were reviewed in whom results of clinical presentation and pre-evacuation ultrasound examination were documented. There were overall 220 cases for which the following clinical features were determined: gravidity, parity, history of previous abortion and gestational trophoblastic disease, the clinical symptoms such as vaginal bleeding and hypertension. Finally concordance between pre-evacuation ultrasonographic and histological diagnosis by kappa test is calculated.
Results: Out of 220 cases with clinically gestational trophoblastic disease diagnosis, 197 cases were confirmed by histological diagnosis. The concluding histological diagnosis includes: 98 cases of complete mole (CM), 84 partial mole (PM), 4 invasive mole and 11 cases of choriocarcinoma. Outside 98 cases with histological diagnosis CM only in 4 cases misdiagnosed by ultrasonoghraphy (4.1%) and high degree of concordance between ultrasonography and histological diagnosis is seen.
Conclusion: Ultrasonographic examination accompanied with clinical examination, beside histological assessment as gold standard have high efficacy in diagnosing  complete mole. This study did not show this finding for partial mole.

---

Background: Advanced glycation end-products (AGEs) came up with the recent researches regarding new biomarkers for the diagnosis of heart failure. AGEs are the end products of non-enzymatic glycation and oxidation of proteins, lipids and nucleotides during Maillard biochemical reaction. Although it has been known that AGEs have a role in the pathogenesis of chronic heart failure (CHF), information regarding its role and its pathogenetic mechanism is very limited. The aim of this study was to find any relationship between AGEs with the etiology and severity of chronic heart failure.
Methods: This study is a prospective cross sectional study that enrolled 85 patients with chronic heart failure. Measurement of left ventricle ejection fraction (LVEF) was done by echocardiography. Blood samples were collected for measuring AGEs just before or after echocardiography assessment (in the same session). Measurement of AGEs was done by the enzyme-linked immunosorbent assay (ELISA) method. The relationship between AGEs with the severity of CHF and as well as the etiology of CHF were evaluated via SPSS-15.
Results: Of 85 patients 48 (56.5%) patients were male and 37 (43.5%) were female Mean±SD of their ages was 55.8±13.4 years old (ranges from 27 to 84 years). Correlation coefficient between LVEF and AGEs was 0.269 (P=0.013). Mean of AGEs in patients with and without ischemic etiology of their heart failure were 16.8±9.8µg/ml and 11.6±7.3 µg/ml, respectively. Although trend was in favor of ischemic heart failure, the difference between two groups was not statistically significant (P= 0.141).
Conclusion: According to this study the rate of AGES could be helpful in the diagnosis and assessment of severity of CHF. Based on our findings, higher blood levels of AGEs in the ischemic CHF cases, also it could be concluded that in the future this marker may be used for etiologic differentiation of heart failure syndrome.

---

Background: Androgenetic alopecia (AGA) is the most common type of progressive balding that appears with early loss of hair, chiefly from the vertex. There has been significant relationship between AGA with coronary artery disease and related risk factors, such as hypertension in some studies. The aim of this study is to investigate the association between androgenetic alopecia with hyperlipidemia.
Methods: This cross-sectional study was performed on 112 patients with vertex type AGA (in male grade 3 or higher Hamilton- Norwood scale, and in female grade 2 or higher Ludwig scale) (study group) and 115 persons age and sex matched, with normal hair status (Normal group). None of participants had diabetes mellitus, hypothyroidism, liver disease, kidney disease and none of them had history of smoking and using drugs with effect on serum lipids. They were 20-35 years old and their body mass index were 20-30. Blood samples were obtained following 12 hours fasting status and serum levels of triglyceride (TG), cholesterol, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) were determined using standard laboratory methods. Total cholesterol greater than 240 or TG greater than 200 or LDL greater than 160 or HDL less than 40 in men or HDL less than 50 in women were considered hyperlipidemia.
Results: In androgenetic alopecia group 46.4% and 47% of normal group were female. Mean (±SE) of total cholesterol (172.4±3.1, 148.8±3.1, P< 0.001), TG (133.6±5.5, 88.3±4.3, P< 0.001), LDL (96.4±2.9, 84.9±2.7, P= 0.004) and HDL (54.9±2.0, 45.5±0.9, P< 0.001) in AGA patients were higher than normal group. %46.4 of patients and %52.2 of controls had hyperlipidemia. Relationship between AGA with hyperlipidemia was not significant (P> 0.05).
Conclusion: The findings showed that there is no relationship between AGA and hyperlipidemia. Regarding to high levels of total cholesterol, LDL and triglyceride in AGA patients, it seems that, AGA increases risk of coronary heart disease. To determine a definite association between AGA and hyperlipidemia more studies are recommended.

---

Background: Adipokines are peptides secreted by adipose tissue that affect whole-body energy metabolism. Exercise training exerts beneficial effects on adipose tissue. However, less is known regarding visfatin’s, IL-6 & TNF-α response to an interval acute training. Therefore, we investigated the effects of acute interval exercise on plasma visfatin, TNF-α and IL-6 levels, in healthy female rats. Furthermore, correlate between changes probably these factors were also assessed.
Methods: This study was conducted experimentally. Forty five female sprague dawley rat were randomly divided into three groups: pre test (n= 15), treadmill exercise (n= 15) and sedentary controls (n= 15). The acute alternative exercise consisted of treadmill running: 3 session/ week for 8 week. The changes of plasma IL-6, TNF-α and Visfatin levels were measured by ELISA analysis. Data were analyzed using analysis of variance with measures (ANOVA) and post hoc Tukey test.
Results: Acute interval treadmill exercise led to significant decreases in visfatin (P= 0/036), IL-6 (P= 0/009) and TNF-α (P= 0/022) plasma levels between the groups. Also, this study no significant correlations between the changes in adipokines were observed.
Conclusion: Decreased levels of TNF-α and IL-6 correlated with intensity and duration exercise. Furthermore, probably there were some factors except weight decreasing that affects on visfatin decrease. Therefore, the reduction of this factor may cause in preventing metabolic disease.

---

Background: Nosocomial infection is one of the major causes of death in neonates. In recent years, the results of nosocomial infection control committee, which carried out, based on a protocol of National Nosocomial Infection Surveillance (NNIS) is not consistent with neonatal review articles. This study was performed to determine the prevalence and incidence of nosocomial infection with an active, prospective method based on definitions and characteristics of Center for Disease Control and prevention (CDC) and comparing it with routine method of NNIS. Methods: This cross-sectional and prospective study was independent from Beasat Hospital nosocomial infection control committee and preformed by daily active visiting of neonatal ward (that is level-II) for six month period. The results of this study were compared with the results of the NNIS committee of nosocomial infection. Collected data were statistically analyzed by SPSS software. Results: From all hospitalized neonates, 369 cases (1292 patients / day) were enrolled in the study. The overall rate of nosocomial infection (frequency) was 2.71% and the overall incidence of nosocomial infection was 7.73 cases per 1,000 patients / day. The most common nosocomial infection in this study was skin and soft tissue infections totally 50%. The incidence of Central Line-Associated Bloodstream Infection (CLA-BSI) was 14.2 per 1000 central catheter/day for the six months of study. Nosocomial infection rate preformed by Beasat Hospital nosocomial infection control committee (based on NNIS) was 0.1 % and incidence of nosocomial infection 0.3 per 1,000 patients/ day at the same 6 month study. Conclusion: It seems that a large part of this considerable differences between the results of this study compared to NNIS based study, is this fact that, for nosocomial infection surveillance in the neonatal field, the presence of a specialist as a performer and leader of the team, is necessary.

---

Background: Although a few studies have shown the positive correlation between patients’ serum concentration of 25 OH-Vitamin D3 and type II diabetes mellitus, metabolic syndrome, and insulin resistance, there are controversies regarding the relationship between 25 OH-Vitamin D3 as a risk factor for cardiovascular atherosclerotic diseases that has to be cleared. The aim of this study was to evaluate the association between the rate of 25 OH-Vitamin D3 and the presence and severity of coronary artery disease (CAD) in Patients with suspected CAD. Methods: This study was a cross sectional study that has been conducted in the department of cardiology in Imam Khomeini Hospital complex in collaboration with endocrinology research center. In this study 178 patients with suspected coronary artery disease (CAD) were enrolled. Based on their history and clinical findings coronary angiography was performed in all patients. Severity of CAD has been assessed by using Gensini score, based on their coronary angiography findings. The relationship between severity of CAD and their serum level of 25 OH-Vitamin D3 was evaluated. Serum level of 25OH- Vitamin D3 was measured by the enzyme-linked immunosorbent assay (ELISA) method by Euroimmiune kits (from Germany). Results: Of 178 patients, 50 (28.1%) were female and 128 (71.9%) were male. Mean±SD of their ages was 56.2±11.8 years old. Significant coronary artery stenosis (stenosis more than 50% luminal diameter) was observed in 91 (51.1%) of patients. Mean±SD of serum level of vitamin D3 in patients with CAD was 45±35 nm/l and in patients without CAD was 55±44 nm/l (P= 0.047). Mean±SD of Gensini score was 26.3±21.1, as well. Therefore correlation coefficient between 25 OH-Vitamin D3 and Gensini score was -0.262 (P= 0.043). Conclusion: Although there is a trend toward association between deficiencies of 25 OH-Vitamin D3 and the presence of CAD but their association is not statistically significant. For achieving more convincing findings larger studies are needed.

---

Background: Helicobacter pylori has been classified as the class I carcinogenic agent by world health organization. Colonization of the human stomach with H. pylori is a risk factor for gastroduodenal diseases. The secreted vacA toxin is an important H. pylori virulence factor that causes multiple alterations in gastric epithelial cells and T cells. Several families of vacA alleles have been described, and H. pylori strains containing certain vacA types (s1 and m1) are associated with an increased risk of gastric disease, compared to strains containing other vacA types (s2 and m2). We examined the association between H. pylori vacA s alleles and gastroduodenal diseases in Iran. Methods: A total of 149 H. pylori strains were obtained from patients with gastritis, peptic ulcer, and gastric cancer referring to endoscopy units of several cities in Iran. Biopsy culture and DNA extraction were performed and the frequency of vacA s alleles was investigated by using PCR amplification. Linear regression and binary logistic regression models were used to analyze the association between vacA (vacuolating cytotoxin A) s alleles and gastroduodenal diseases. Results: There was no significant association between the frequency of vacA s alleles and gastroduodenal diseases (gastritis or peptic ulcer disease and gastric adenocarcinoma (P> 0.05)). Conclusion: It is proposed that the H. pylori vacA s1 genotype could not be considered as an important determinant of gastroduodenal diseases in Iranian population and probably if s1 allele is associated with other virulence alleles of this gene, it will cause diseases.

---

Background: Nonalcoholic Fatty Liver Disease (NAFLD) is one of the most wide-spread human diseases that can impair liver function and sometimes progresses to cir-rhosis. Recently NAFLD has been identified as an independent risk factor for cardio-vascular disease. The aim of this study was to investigate the correlation of fatty liver disease and its sonographic severity on the resistance of the intracranial arteries. Methods: This study was a cross-sectional study of 55 patients referred from Gastroen-trology clinic with diagnosis of NAFLD to Sonodoppler department of Iranian Center of Neurological Research. Pulsaltile index as a Hemodynamic parameter of Middle Cerebral (MCA) and basilar Arteries of NAFLD Patients was measured by Trans Cra-nial Doppler (TCD) sonography and the measurements were compared with normal values. Also the association of these indices with serum liver enzymes and sonographic grading of liver involvement was assessed. The analysis was done by SPSS 16. Fre-quency distribution, mean and standard deviation were used in descriptive analysis and statistical test 2 to compare qualitative variables. Results: Pulsatile Index (PI) were normal (MCA, P= 0.166, Basilar, P= 0.053) and there was no significant difference with relation to severity of fatty liver based on so-nography findings (P= 0.789), but serum liver enzyme levels were inversely correlated with basilar artery PI (P= 0.014). Conclusion: Considering the increase of cerebral arteries PI in advanced liver disease, absence of increase in vascular PI of patients in the present study could be attributed to the short duration of disease from diagnosis to perform TCD, lack of advanced liver involvement (absence of liver dysfunction) and the response effect to treatment before the TCD. Therefore, to assess vascular changes over time, repeating the TCD with assess other parameters such as Fibroscan and K18 factor that has more compatibility of liver function, could help to understand the pathophysiology of liver diseases and its effect on vascular resistance.

---

cBackground: Choriocarcinoma is a highly malignant form of gestational trophoblastic disease. It is characterized by metastatic potential, rapid growth and deeply invasion into blood vessel and then widespread dissemination metastasis. However, the most common sites of metastatic choriocarcinoma are lung, vagina, liver, and brain. But, metastatic choriocarcinomas rarely is extended to gastrointestinal system. It is im-portant to keep in mind that despite extensive metastasis, choriocarcinoma is very curable disease. Due to high responsibility of this disease, early diagnosis of choriocarcinoma and treatment with chemotherapy can prevent mortality and morbidity of these patients. In this case report, we present a rare case of metastatic choriocarcinoma in the small bowel after normal term pregnancy. Case Presentation: A 34-years-old woman G4, P4, L4 presented with abnormal postpar-tum vaginal bleeding (45 days) and unresponsive to usual medical and surgical therapy (oxytocine, metergene, antibiotic, and double curettage). The patient was admitted in the Ghaem Hospital, Mashhad University of Medical Sciences in April 2013. She suf-fered from rectal hemorrhage and severe weakness. Because of unsuitable condition (shock), laparotomy was performed and small bowel involvement was observed. Seg-mental resection of small bowel detected metastatic choriocarcinoma of the lesion. We couldn’t rescue our patient due to unresponsive to combination chemotherapy (actino-mycine, methotrexate, cyclophosfamide, vincrystine, etopuside). Conclusion: In abnormal postpartum hemorrhage, we should consider the possibility of choriocarcinoma. Although, it is important to note rare manifestations of metastatic choriocarcinoma of small bowel in massive gastrointestinal hemorrhage.

---

Mesenchymal Stem Cells (MSCs) are well known as the regulator of the immune system. These multipotent non-hematopoietic progenitor cells have been originally isolated from bone marrow, and later on found in several other tissues, such as skeletal muscle, umbilical cord blood, adipose and fetal liver tissues. Immunomodulatory effects of MSCs on a variety of immune cells such as T and B lymphocytes, Natural Killer cells (NK), neutrophils, macrophages and dendritic cells, has made a good candidate of them for the treatment of inflammatory disorders, particularly autoimmune diseases such as multiple sclerosis and rheumatoid arthritis. In addition, several studies have indicated mechanisms by which MSCs could reduce immune cell proliferation and activation leading to immune tolerance induction. Since T lymphocytes are considered as the most important immune cells, effect of MSCs on the activity of these cells has a very special significance to direct immune response. Under various conditions, T-lymphocytes have different phenotype and performance and can be differentiated into particular subtype such as regulatory T cells. Both in vitro and in vivo studies have indicated that MSCs modulate innate and adaptive immune system by promoting generation of CD4+CD25+ T regulatory cells which have important role in immune tolerance induction and autoimmune disease prevention. MSCs are able to block pro-inflammatory and increase anti-inflammatory cytokines secretion. So such unique immunomodulatory features make MSCs ideal candidates for clinical application as immunosuppressants which can be considered for autoimmune diseases treatment. Therefore, in this short-review, we attempt to focus mainly on the existing information about MSCs in association with immunomodulatory function of them on the immune system. In addition, the possible mechanisms and the performance impact of MSCs in autoimmune diseases improvement are discussed here. However, increasing knowledge of how MSCs will influence on the immune system suppression, leading us to better use of these cells as a promising tool in the treatment of autoimmune diseases.

---

Background: Lack of precise diagnostic criteria and sufficient findings in support of biopsy sampling during upper gastrointestinal endoscopy is one of the special challenge in endoscopy assessment in Barrett's esophagus. The aim of this study was to evaluate the mucosa in the distal esophagus tissues through a biopsy during upper gastrointesti- nal endoscopy in gastroesophogeal reflux disease patients whose symptoms don't im- prove or only partially resolve with treatment. Methods: A cross-sectional study was done in patients with gastroesophogeal reflux disease medically resistant to treatment. The patients were assessed by gastroenterology department in Sina Hospital, Tehran, Iran, since September 2012 to September 2013. Patients with coagulopathy, esophageal varicose, esophageal cancer, earlier detection of developing Barrett's esophagus, history of irritable bowel syndrome, psychological dis- orders and using of nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, were excluded. Esophageal squamous epithelium and cylindrical tissue of stomach was carefully checked by endoscope. Then 2 to 4 biopsy of the Z-line above the gastroe- sophageal mucosa were obtained. Results: One hundred and fifty three patients included 78 men (51%) and 75 females (49%) with a mean age of 47.92±17.57 years participated in the study. The mean of body mass index of patients was 25.05±4.17 kg/m2 and body mass index in 45.8 % of the patients more than 230 kg/m2. Biopsy specimens were taken in 31 cases were not enough for histological examination. In other patients, 25 cases (20.5%) were normal and 97 cases (79.5%) had the following pathological diagnosis: mild esophagitis (49 cases 40.2%), moderate esophagitis (24 cases 19.7%), severe esophagitis (14 cases 11.5%), Barrett's esophagus (8 cases, 6.5%), fungal esophagitis (1 cases, 0.8%), and eosinophilic esophagitis (1 cases 0.8%). 117 patients (76.5%) had H. pylori infection. Sensitivity and specifity of endoscopy for detection of Barrett's esophagus during upper gastrointestinal endoscopy were 100% and 84.13% (CI 95%:78.53-89.09%), respec- tively. Conclusion: Our data showed that doing of accurate and adequate biopsy samples from lesions in upper GI endoscopy can be helpful in the diagnosis of Barrett's esophagus

---

Background: Mycosis fungoides (MF) is the commonest T-Cell lymphoma (CTCL) involving skin and its appendages to variable degrees. Nail involvement is one of multiple dermatologic manifestation of this disorder and could have negative impact on psychological status of patients and producing therapeutic challenge to physician. We aimed to evaluate prevalence and subtypes of nail involvement in MF patients attending dermatology clinic, Razi Hospital in Tehran, Iran. Methods: All patients having MF confirmed via histopathology, visiting Razi Hospital Dermatology Clinic, Phototherapy and follow-up on inpatient wards from 2010 to 2011, were included. Patients examined by dermatologist researcher focusing on nail changes and all detected nail changes including onycholysis, longitudinal ridges and 11 more other changes, recorded in appropriated questionnaires. Treatment regimen prescribed to the patients also recorded as well as clinical CTCL staging. Results: A total of 60 patients, including 28 (46.7%) males and 32 (53.3%) females entered the study. 18 patients (12 males and 6 females) had different nail changes including longitudinal ridging, leukonychia, pitting and nine more morphological changes in decrescendo order. Ten patients had smoking history including four patients with nail changes. The commonest used treatment was local bath Psoralen and UVA light therapy (PUVA). Overall nail involvement in our study was approximately 30%. There was no significant relationship between prevalence of nail changes, demographic and clinical specification of underlying CTCL disorder especially tumor stage. Also, no significant relationship between prevalence and type of nail involvement with prescribed therapeutic regimen was found. Conclusion: We found about 30% prevalence that is a little higher than previously shown. It seems that nail changes in CTCL have no relationship to CTCL staging or other specifications including demographic specifications.

---

Background: Cardiovascular complications have very high incidence and are the main cause of mortality in human. Although the cardiovascular risk factors among apparently healthy subjects have been studied, these factors among patients who have undergone coronary artery bypass graft surgery have not evaluated clearly. Methods: The present study is a descriptive, cross-sectional survey on 1592 patients which suffered coronary artery bypass surgery (CABG) from May 2009 to May 2013 in Baqiyatallah Hospital, Tehran. Before surgery, all patients were carefully assessed and typical and atypical cardiovascular risk factors were determined and the desired data were collected. Results: More than 70.8% of subjects were men and 29.2% were women. Average age of all patients was 60.39±7.5 years and the mean weight was 73.91±6.3 kg. Typical risk factors including: smoking, plasma cholesterol level, hypertension, diabetes mellitus and family history of cardiac problems, were common in these patients. Forty seven percent of patients had diabetes mellitus, 79.4% had hypercholesterolemia, 34.3% had a smoking history, 64.5% had hypertension and 44.2% of patients had a family history of cardiovascular disease. Among atypical risk factors, various types of angina (chest pain) had high prevalence (88.8% of all). Also, mean body mass index (BMI) were higher than normal (27.46±2.1) which showed the incidence of obesity among these patients. But, other atypical risk factors did not have high incidence. Conclusion: We demonstrated that typical and well known risk factors have also high prevalence in CABG patients. Our results indicates that we can recognize high risk persons with continuous and accurate screening as a safe and inexpensive preventive tool. This can be done in both apparently healthy subjects and in cardiovascular patients. We can prevent the occurrence of severe degrees of atherosclerosis and also CABG. So the cost and performing surgeries will be decreased.

---

Background: Diarrhea is the most common bacterial infections, and the main cause of death in the children. Worldwide, food and waterborne diseases are estimated to cause more than two million deaths per year. Foodborne diseases and resistance to antimicrobial agents are two problems worldwide and are increasing. However, standard surveillance systems do not routinely collect information on controls. The aim of this study was to analysis epidemiological data of foodborne outbreaks at the country level. Methods: This is a descriptive study, in total 305 fecal swab samples from 73 outbreaks during one year from April 2012 to March 2013 in different provinces of Iran, were collected and transferred to the microbiology laboratory of Public Health School of Tehran University of Medical Sciences to identify the cause’s diarrhea. The patterns of antibiotic-resistance were determined by using Kirby Bauer method. Results: In total 73 food borne outbreaks that were studied, the largest number 26 (35.6%) were found in Hamadan province with 103 samples (34.2%). Out of 73 outbreaks 40 (54.79%) of were related to foods, 6 (8.22%) to water, and 27 (36.98%) were unspecified (P< 0.0001). Fifty seven outbreaks (78.08%) in the city and 16 outbreaks (21.92%) occurred in rural areas (P< 0.0001). The most dominated Gram-negative isolated organisms were Shigella (6.9%) and Gram-positive bacteria Staphylococcus aureus (12.8%). The dominated age group was under five years (16.4%), and dominant gender group was men 186 (61.8%) (P< 0.0001). In total 69 (22.9%) were hospitalized and 11 deaths were reported. Most clinical symptoms of abdominal cramping (82%), nausea and vomiting (68.4%), bloody diarrhea (23.3%), and non-bloody diarrhea (76.7%). All the isolated gram-negative were sensitive to ciprofloxacin and resistant to clindamycin. The gram-positive were sensitive to cephalexin and resistant to penicillin. Conclusion: The knowledge of bacterial agent of foodborne diseases and determination of antimicrobial resistance pattern are helpful to reduce the rate of foodborne outbreaks, the cost of treatment. The prevention control of outbreaks is also very important.

---

Background: In Nov 2013, the instruction for controlling high cholesterol has been released by the American College of Cardiology (ACC) and the American Heart Association (AHA) which need to be assessed in the different communities. Methods: Of total 6275 individual aged 40-75 years who entered at the Tehran Lipids and Glucose Study from March 1999 to 20 March 2010 in first examination cycle, 5153 with the median follow-up of more than ten years were eligible to enter in this study. The 10-year risk of hard cardiovascular disease (Hard CVD) for Statin therapy based on ACC/AHA clinical guideline was calculated and this risk was calculated for each subgroup of the guideline who recommended for statin therapy comparing to the risk in individuals with prevalent CVD. Results: Of nearly 6.5 million urban population of Iran (according to the 1996 census) about 4 million individuals (2.55 million men and 1.4 million women) were eligible for statin therapy. With respect to the urban population growth from the 1996 to the 2011 census (about 2.5 percent increases) the number of individuals for receiving statin increased by 50% (5 million men and 3 million women). Also, the risk in non-diabetic men with calculated risk of 5-7.5% and diabetic women with calculated risk of <5% for hard CVD was lower than 0.2. By removing these people from total eligible population, the burden of statin therapy will reduced about 8% which is about 540.752 persons, according to the Census 1996 and 1.155.079 individuals based on the census 2011. Conclusion: The new guideline of ACC/AHA for statin therapy is relatively reasonable except for some subgroups. To reduce the burden of medical expenses, statin prescription can be ignored by physicians in these subgroups. Of course further research is required to calculate the net benefit for estimating the clinical usefulness of statin therapy in recommended guideline subgroups.

---

Background: Polymorphisms of the upstream transcription factor 1 (USF1) have been associated with familial combined hyperlipidemia (FCHL), type 2 diabetes and coronary heart diseases (CHD). In the current investigation, the association of USF1s2 variant of human USF1 gene with premature coronary artery disease (PCAD) was evaluated in a population from southern Iran. USF1s2 has the best potential as a functional variant .in the USF1 gene. Methods: In a case-control study USF1s2 variant of human USF1 gene was determined by polymerase chain reaction- restriction fragment length polymorphism (PCR-RFLP) technique using BsiHKA I restriction enzyme for 186 women under 55 years of age and 135 men less than 50 years of age who underwent diagnostic coronary angiography in Saadi, Nemazee and Kowsar Hospitals of Shiraz, between July 2009 and March 2012. Data on the history of familial myocardial infarction or other heart diseases, hypertension, and smoking habit were collected by a simple questionnaire. Blood sugar level and serum lipid profile of all participants were also obtained by measuring the levels of fasting blood sugar (FBS), total cholesterol (TC), triglycerides (TG), low density lipoprotein (LDL) and high-density lipoprotein cholesterol (HDL). Results: Frequencies of the major (G) and minor (A) alleles of usf1s2 gene variant were 0.74 and 0.26 in the whole population, respectively. Meanwhile, the prevalence of the minor allele was significantly higher in PCAD patients compared with control subjects. This difference remained significant even after adjustment for confounding parameters. Indeed, subjects with mutant homozygous genotype (AA) were about 5 times more likely to suffer from early-onset CAD than those with wild-type homozygous genotype (GG). Moreover, the baseline characteristics of the control subjects and patients were statistically similar for almost all parameters except for the number of male individuals there was no significant difference among various genotypes in the patient group for any of these investigated variables. Conclusion: It appears that the usf1s2 variant in upstream transcription factor 1 gene is an independent predictor of premature coronary artery disease in our population and applies its effects without affecting blood sugar and lipid levels.

---

Background: The effects of consumption of nutrients on coronary artery disease (CAD) are widely observed. The aim of this study is to assess the exclusive Iranian dietary pattern on coronary artery diseases (CAD) and its risk factors. Methods: In this description-cross sectional study, 801 inhabitants of Borujerd City were included by random stratification method and a questionnaire regarding micro- and macronutrients for subjects over 35 years old from March 2011 to February 2012 was filed out. Of all the subjects consent to participate were prepared by volunteers. The complete description and a standard questionnaire to record demographic and socioeconomic status of people were taken. The prevalence of coronary artery disease and its risk factors determined Based on rose questionnaire and Monica questionnaire respectively. Results: In this study mean age of the subjects were 54.8±1.2 years, 388 male and 413 female. There was no meaningful relation between red meat consumption and coronary artery disease (P= 0.117). Nut consumption was higher in patients with CAD (P= 0.028). Use of fresh and cooked vegetables, dried fruit, animal oils cakes, french fries and some dairies are correlated with CAD (P< 0.05). However, artificially flavored soda in contrast to ordinary soda was not associated with coronary artery disease. Conclusion: Although there are some differences between dietary pattern in patient with coronary artery disease, nutritional attitudes are not significantly different in normal and CAD patients. However, according to the importance of diet in CAD, balancing these attitudes should be on the educational system high priority.