Tehran University Medical Journal

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Background: Metabolic syndrome is a complex of metabolic disorders that contemporary occurrence in a person is more than the risk of occurrence of each one separately. this syndrome has gained researcher's attention because of its relationship with cardiovascular disease and diabetes type II and its high prevalence in populations
Methods: A cross-sectional study performed on 1110 participants, 20-74 years old with cluster sampling. All of them had interview and special questionnaire were filled. Epidemiologic and demographic data were about hypertention cardio vascular disease and related lab data.
Results: The prevalence of metabolic syndrome was 32.1% that it was significantly more in women than men .this prevalence increased with age and BMI in both sexes .the most common metabolic disorder was TG>=150. 19.2% have none, 21.1% have one, 27.6% have two, 20.8% have three,9% have four and 2.3% have all criteria of metabolic syndrome.
Conclusion: Approximately one third of population of Yazd have metabolic syndrome and according to other statistics of Iran, this prevalence is more than U.S and Europe. It seems there is an urgent need for a national multicenter program for determinding risk factors for metabolic syndrome.

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Cervical cancer is the second most common gynecologic cancer. A steady 70% annual decline in mortality from cervical cancers has been observed since the mid 20th century after the introduction of widespread papanicolaou cytological screening. But also cervical cancer continues to be an important world health problem for women. Cervical cancer is one of the best- understood neoplasm given its well known viral cause of persistent infection with high risk human papillomavirus (HPV). To date, two manufacturers have developed HPV vaccines composed of noninfectious, recombinant HPV viral-like particles (VLPs). This article presents current advances and perspectives on HPV vaccines.The vaccine is administered by intramuscular injection, and the recommended schedule is a 3-dose series with the second and third doses administered 2 and 6 months after the first dose. The recommended age for vaccination of females is 11-12 years. Vaccine can be administered as young as age 9 years. Catch-up vaccination is recommended for females aged 13--26 years who have not been previously vaccinated. Vaccination is not a substitute for routine cervical cancer screening, and vaccinated females should have cervical cancer screening as recommended.

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Background: Sepsis is the leading cause of death in critically ill patients throughout the world. The incidence is increasing despite the major advances in the development of antimicrobial agents and other supportive treatments. Based on multiple studies, it has been shown that patient outcome depends on Th1 and Th2 cytokine response. Moreover, whenever the Th2 response is predominant, the sepsis is more severe. The aim of this study was to evaluate the correlation between cytokine levels and the severity of sepsis in patients.
Methods: A cross-sectional study on the cellular levels of several pro-inflammatory cytokines was carried out in patients with sepsis and severe sepsis. The study included 37 patients (24 men and 13 women), 26 of them had sepsis and 11 had the severe form of sepsis Thirty-seven healthy volunteers served as controls. The average age of the patients was 57 years (±23.3 years), with a range of 21 to 92 years. From the whole blood of the subjects, we separated the monocytes and leukocytes, which were then cultured. Using an ELISA method, we measured levels of IFN- and IL-12 (associated with Th1), and IL-4 and IL-10 (associated with Th2) in the cultured cells with and without cell stimulation.
Results: No correlation was found for IFN- production in the cells of patients with sepsis and severe sepsis, regardless of whether the patients had died or survived. However, IL-12 levels were significantly decreased in severe sepsis compared with those of sepsis patients (P=0.048). Furthermore, the cells of expired patients also had significantly decreased IL-12 levels compared with those of surviving patients (P=0.028). We also found that the levels of IFN-, IL-4, and IL-10 were decreased in patients compared with those of controls, which correlated to their production. However, there was no correlation for IL-12 production between the cells of the patients compared with those of the controls. There was also no correlation for cytokine production between men and women with sepsis and in adults compared with that of elderly patients (>55 years old).
Conclusion: We have shown that the predominating T helper cell subset in patients with severe sepsis, as well as expired patients, is Th2. In conclusion, the correlation of Th1 cytokine production and progression of sepsis was demonstrated. Most probably IL-12 levels would be significantly lower in patients with severe sepsis and those who expired.

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Background: Traumatic tympanic membrane (TM) perforation is a common injury of the ear with a high rate of spontaneous healing if the patients strictly adhere to water precautions. The purpose of this study was to determine the factors involved in the spontaneous healing of traumatic TM perforations in order to ascertain the best treatment plan including observation, paper patch and finally surgery.
Methods: In this correlative–descriptive study, we recorded the outcome of each patient with three-month follow up. Included in this study were a total of 202 forensic medicine patients from the Dept. of Otolaryngology Head & Neck Surgery at the Yazd University of Medical Sciences, Yazd, Iran. All patients included in this study had traumatic TM perforation. Based on otoscopic examination, the perforations were classified as pinpoint or large. All patients received an audiometry exam and were followed for three months. The data was collected using a special form and analyzed by chi-square test, Fisher exact test and ANOVA.
Results: This study consisted of 118 male and 84 female patients with a mean age of 23.6 years (6-48 years). The types of trauma included compression injury (104 patients), instrumental injury (59 patients), burn–slag injury (2 patients) and blast injury (1 patient). One hundred and eighty patients had pinpoint TM perforations, 99.4% of which healed spontaneously by the second month, and 32 patients had large TM perforations, 50% of which healed spontaneously by the second month. During the first month, 87.3% of the patients observing water precautions had healed, however the healing rate was only 5.6% in patients not adhering to water precautions, who suffered from otorrhea. Therefore, during this study, 185 (91.58%) patients had spontaneous healing by two months and only 6 patients of remaining 17 patients healed with paper patch. The mean hearing loss at 500, 1000 and 2000 Hz was 10.55 dB (5-30 dB).
Conclusion: In our experience, patients with traumatic TM perforations have higher spontaneous healing rate when observing water precautions. Furthermore, we recommend observation and paper patching for three months before attempting any surgical intervention in such patients.

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Background: Although endometrial cancer is primarily a disease of the postmenopausal female, 25% of patients are premenopausal, with 3-5% in women 40 years old or younger. The younger group of women with endometrial carcinoma are frequently nulligravid with a history of infertility, and a strong desire to preserve fertility. This may pose a therapeutic dilemma for both patients and treating physician.
Case report: We reported 3 young patients with atypical complex hyperplasia or early stage endometrial cancer that treated with conservative hormonal therapy.
Conclusion: Medical treatment of young patients with endometrial carcinoma and complex atypical hyperplasia who wish to preserve fertility is a reasonable and appealing option. A comprehensive evaluation prior to counseling the patient should include A complete history and physical examination. A formal D&C with review of history with an experienced gyn-onc pathologist. Evaluation of the pelvic and abdomen preferably with contrast-enhanced MRI or transvaginal ultrasound. In patients found to have a clinical stage I grade I tumor and who want to preserve fertility , thorough counseling include risks and benefits, and explanation that the data is partial and incomplete due to the lack of appropriate controlled studies is mandatory. In patients considered for medical treatment, a high dose progestin regimen should be started with endometrial sampling every 3 months until complete regression of the tumor is documented. Although most responses are long standing, there is a small risk of progression during or after cessation of progestin therapy.

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Background: Opiate-induced addiction is a main social problem in Iran. As treatment of this problem is a health priority among the medical community, studies on this topic are very crucial. The exact mechanism of dependence on opiates and their withdrawal syndrome remain unclear. It seems that dopaminergic system and locus coeruleus (LC) have an important role in the expression of somatic signs during opioids withdrawal. The LC has been shown to contain significant levels of dopamine (DA). In the present study, the effects of different D2 dopaminergic receptor agonist and antagonist administration in the LC on withdrawal sign expression in morphine dependence is investigated in rats.
Methods: Adult male Wistar rats, weighing 220–280 g were divided into eight groups (n=8). Two cannulae were stereotaxically implanted bilaterally into the LC of each rat. After a one-week recovery, seven groups were rendered dependent on morphine by subcutaneous injection during a seven-day period. Non-dependent control animals received saline according to the same protocol. Animals received bilateral intra-LC injections of saline (1 μg/site) and quinpirole (0.1, 0.3 and 0.5 μg/site, a D2 agonist) 15 min and sulpiride (5, 15 and 30 μg/site, a D2 antagonist) 30 min prior to naloxone injection about 24 hours after the last dose of morphine or saline according to their respective group. To calculate the total withdrawal score, as an index of withdrawal syndrome, 20 different withdrawal signs were assessed and the scores of the intensity of these withdrawal signs were added.
Results: Total withdrawal scores were significantly decreased by quinpirole (0.1µg/site) and sulpiride (15 and 30 µg/site).
Conclusion: The D2 dopaminergic system in the LC may be involved in the morphine-induced dependency in rats. Further studies are needed to define the mechanism of this dependency in order to improve methods for the rehabilitation of addicts.

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Background: Following socioeconomic development, the amount of physical inactivity among a given population has typically increased. Physical inactivity is a risk factor for cardiovascular disease. The purpose of this study is to measure the prevalence of physical inactivity among the urban adult population of Yazd, Iran.
Methods: This cross-sectional study was carried out on an urban population of 1500 employed persons over the age of 20 years via cluster sampling. We use the IPAQ (International Physical Activity Questionnaire) to evaluate physical activity levels. We evaluated the subjects according to their level of fitness, attitude toward physical activity and physical activity levels.
Results: According to the fitness information provided by the participants, 2.1% were weak, 10% were moderately fit, 39.9% were fit, and 48% very fit. Regarding the attitudes of the participants toward physical activity, 1% was unfavorable, 32.4% were partly favorable, and 67.7% were favorable. Concerning the intensity of physical activity, 67.3% persons were inactive, 15% were sufficiently active, and 17.7% were highly active. After adjustment for age, 65.8% were inactive, 13.8% were sufficiently active, and 19.8% were highly active. According to gender, 81.6% of men were inactive, as were 54.4% of women. Inactivity according to age was as follows: 57.8% of the 20-24 year old, 66.9% of those aged 30-44 years, 70.4% of the 45-59 year olds, and 68.4% of those over the age of 60. Furthermore, physical inactivity was more prevalent in the higher socioeco-nomic group.
Conclusion: The level of physical activity in urban population of Yazd is low. High risk is associated with employment, retirement, high socioecono-mic class and higher levels of education.

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Background: The extracellular matrix is a complex three-dimensional network of proteins and glycosaminoglycans, which have important roles in cellular physiology and cell-cell and cell-extracellular matrix interactions. Any changes in the extracellular matrix of tumors may be implicated in cellular transformation and metastasis. The aim of the present study was to identify changes in the hyaluronic acid of the stroma of colonic carcinoma.

Methods: Paraffin blocks of 30 patients with colon carcinoma (10 patients at each histological grade) were chosen from the pathology file of Khatam-Al-Anbia Hospital in Zahedan, Iran. Tissue sections (5-6 micrometers thick) were stained with hematoxylin-eosin and the alcian blue critical electrolyte concentration histochemical technique at pH=5.8. The intensity of the staining in each section was graded as 1, 2 or 3, referring to low, moderate or severe staining reactivities, respectively. Statistical data was analyzed with nonparametric tests by SPSS (ver. 10) and histopathological reports were prepared.

Results: The results of this study showed that there is a good correlation between histopathological grading and staining intensity of tumoral stroma for hyaluronic acid (p<0.005). Analysis using the Mann Whitney test revealed significant differences between staining grades 1 and 3 and grades 2 and 3 (p<0.005 and p<0.002, respectively), although there was no significant difference between staining grades 1 and 2 for hyaluronic acid.

Conclusions: The difference in staining intensity of the stroma in colon carcinoma is a result of different amounts of hyaluronic acid in stroma, indicating that increased levels of hyaluronic acid are associated with the invasion and metastasis of neoplastic cells.

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Background: Fanconi anemia (FA) is a rare autosomal recessive disorder characterized by short stature, skeletal anomalies, increased incidence of solid tumors and leukemia, and bone marrow failure (aplastic anemia). FA has been reported in all races and ethnic groups and affects men and women in an equal proportion. The frequency of FA has been estimated at approximately 1 per 360,000 live births. In some populations, including Ashkenazi Jews, Turks, Saudi Arabians and Iranians, this frequency appears to be higher, probably as a result of the founder effect and consanguineous marriage. Because of extensive genetic and clinical heterogeneity (the age of onset, clinical manifestations and survival), diagnosis of FA on the basis of clinical data alone is unreliable and its molecular diagnosis is difficult. The diagnosis of FA exploits the hypersensitivity of FA lymphocytes and fibroblasts to bifunctional alkylating agents such as mitomycin C (MMC), diepoxybutane (DEB) and nitrogen mustard and differentiates it from idiopathic aplastic anemia. In this study, in addition to the patients' clinical profiles, a cytogenetic test using MMC was implemented for an accurate diagnosis of Fanconi anemia.

Methods: In this study, the lymphocytes of 20 patients referred for FA, and those of their normal sex-matched controls, were treated with three different concentrations of mitomycin C (20, 30, 40 ng/ml). Slides were prepared and solid stained. In order to determine the number and kind of chromosome abnormalities, 50 metaphase spreads from each culture were analyzed. Clinical information was obtained from patient files.

Results: Five patients manifested increased chromosome breakage with MMC, confirming the FA diagnosis. Two different concentrations of MMC (30, 40 ng/ml) were most effective.

Conclusion: The chromosomal breakage test is important for the accurate diagnosis of Fanconi anemia. DNA crosslinking agents used to treat idiopathic aplastic anemia may be lethal for patients with FA. Thus, aplastic anemia patients with unknown etiology, infants with congenital abnormalities involved in FA and siblings of FA patients should also be cytogenetically tested.

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Background: Cardiac herniation is a fatal post pneumonectomy complication. We report the signs, clinical findings, diagnosis and management of a patient with post pneumonectomy cardiac herniation.

Case report: A 34-year-old man with lung cancer underwent left pneumonectomy with partial pericardiectomy in the right lateral decubitus position. At the end of the surgery, cardiovascular collapse, severe bradycardia, desaturation and elevated airway pressure occurred just after repositioning the patient to the supine position. This patient survived as we returned him to the right lateral decubitus position and avoided the use of positive pressure ventilation.

Conclusions: Attention to the acute complications of pneumonectomy, diagnosis and rapid therapeutic interventions is essential in post pneumonectomy care.

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Background: To evaluate the possibility that prolactin is involved in the pathogenesis and flare-up of systemic lupus erythematosus (SLE).

Methods: In this cross-sectional study we determined serum prolactin levels in sixty (60) serum samples from sixty patients diagnosed with SLE by the criteria of the American College of Rheumatology (ACR). All patients were females between 13-64 years of age. Disease activity was defined according to lupus activity criteria count and scored by Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). Serum prolactin concentrations were determined by immunoradiometric assay (IRMA) [125I]. Patient blood samples were taken between 10 a.m. and 12 p.m. Serum was separated and kept frozen at -20 ^°C.

Results: Hyperprolactinemia (>21 ng/mL) was found in 7 (11.7%) patients. SLEDAI scores of <4 were considered inactive disease, >15 active disease and 4-15 moderate activity. Accordingly, 6.7% of our patients had active disease.

Normal serum prolactin levels range from 2 to 21ng/mL. Among those with active disease, prolactin levels were higher, with mean prolactin levels of 18.15, 15.11 and 11.5 ng/mL for active, moderate and nonactive groups, respectively. Increased prolactin levels correlated with activity of SLE disease (p=0.019, r=0.305). No correlation was found between tissue involvement and prolactin level (p=0.24) and no significant correlation was found between prolactin level and age (p=0.19).

Conclusion: Hyperprolactinemia, detected in patients with SLE by IRMA, was associated with disease activity. Our findings suggest that prolactin may play a role in the pathogenesis of SLE.

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Background: In the treatment of bronchial asthma, the identification, isolation, and elimination of causative allergens is the most effective part of treatment. With the recent diversification within the pet industry, pet owner exposure to many unknown antigens is on the rise. The results of population studies have been contradictory and some epidemiological studies have failed to confirm this, some indicating that keeping pets might actually reduce the risk of sensitization and asthma. The purpose of this study was to determine the association between pet ownership and asthma.

Methods: This case-control study included 300 asthmatic participants referred to the Children's Medical Center over a two-year period. Participants were asked to fill out a questionnaire regarding pet ownership, pet gender and puberty, the place it was kept, how long the pet was kept and the reason for keeping the pet. The same questions were asked from 300 age- and gender-matched nonasthmatic individuals as the control group. Statistical analysis was performed to calculate odds ratios (OR) of asthma morbidity in individuals who kept pets.

Results: The OR for asthma morbidity in patients who kept pets was 2.59 (CI=1.60-4.21 and p>0.001). Financial aim was the most common reason for keeping a pet and most pets were mature and kept outdoors. No significant correlations for pet genders were observed.

Conclusion: This survey provides evidence that pet ownership is an important risk factor for asthma, therefore we suggest that individuals at risk for asthma (atopic individuals) must avoid contact with pets. However, more research in this field in Iran is necessary.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 !mso]> ject classid="clsid:38481807-CA0E-42D2-BF39-B33AF135CC4D" id=ieooui> Background: Glycoconjugates are a class of cell surface glycoproteins, the terminal sugars of which are important indicators of neoplasia and the aberrant biological behavior of cancer cells. Lectins are a class of plant or animal glycoproteins that specifically bind to the terminal sugars of glycoconjugates. The aim of the present study is to identify the presence of L-fucose in cell surface glycoconjugates and extracellular matrix glycoconjugates of cancer cells of different grades of colonic adenocarcinoma.
Methods: Paraffin blocks of colonic adenocarcinoma tissue from 30 patients were collected from the Pathology Department of Khatam Al Anbia Hospital in Zahedan, Iran. Sections, 5-7μm thick, were prepared and stained using hematoxylin and eosin. Sections were graded histopathologically and then stained using the lectin Ulex europaeus agglutinin (UEA, 10μm/mL), which binds specifically to L-fucose, and Alcian blue (pH=2.5). Sections were graded blindly according to lectin staining intensity on a scale of 0-3. Collected data were analyzed using Kruskall-Wallis and Mann Whitney nonparametric tests with SPSS.
Results: Our results show that there is a significant difference in the staining intensity for L-fucose between tumoral cells of different grades of colon carcinoma (p<0.001). Results show that the degree of UEA lectin binding to cancer cells is lower in the cytoplasm and nucleus and higher in the extracellular matrix in tumors, with the degree increasing with histopathological grade. Furthermore, staining intensity differs in different portions of cancer cells.
Conclusions: The increased staining intensity of L-fucose in the extracellular matrix of colon carcinoma is a reflection of the aberrant protein glycosylation pathway in neoplasia.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 !mso]> ject classid="clsid:38481807-CA0E-42D2-BF39-B33AF135CC4D" id=ieooui> Background: Ovarian cancer is the leading cause of death among all gynecologic cancers in developed countries. The standard treatment for advanced ovarian cancer consists of cytoreductive surgery associated with a platinum/paclitaxel-based chemotherapy. Over than 50% of patients with advanced ovarian cancer will develop recurrent disease. For those patients who have recurrence of disease at least six months after initial therapy, the paclitaxel- platinum combination has been shown to be a superior treatment to platinum monotherapy. However, many patients develop clinically relevant neurotoxicity, frequently resulting in treatment discontinuation. The efficacy and safety of an alternative regimen that dose not show significant neurotoxicity were evaluated by comparing gemcitabin- carboplatin with carboplatin in platinum sensitive recurrent ovarian cancer patients in a Gynecologic Cancer InterGroup trial in Canada and European Organization for research and treatment of Cancer Gynecological Cancer Group. But this study was not done in Iran.
Methods: We performed a study with escalating doses of gemcitabin combined with carboplatin in 21 patients. All patients who were treated in Vali-Asr hospital between 2003- 2005 evaluated. Gemcitabin with dose of 800mg/m² was given on days 1, 8 and 15 followed by one week rest period for a 28 day cycle. Combine with carboplatin with AUC 4 given on day 2. All patients with surgically resected, histologically confirmed epithelial ovarian cancer and who had failed first- line platinum chemotherapy were allocated to this study.
Results: Median age was 49 years (range 23-78 years). Median follow-up was six months (range 4-22). Total of 87 cycles of chemotherapy were administered with median number of four (range 2-6 cycles). Thrombocytopenia (grade I) and leucopenia (grade I) were seen in 4.75% and 9.52% of patients.
Conclusion: Gemcitabin and carboplatin Combination was tolerated in patients with recurrence of ovarian cancer.

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Background: Several therapeutic modalities have been cited for patients with microtia. Recently there are several reports about using cadaveric homograft cartilage for some other purposes. The aim of this study was to assess the results of auricular reconstruct-tion in 10 patients (12 ears) with congenital atresia using homograft rib cartilage from the Iranian Tissue Bank.

Methods: We enrolled 10 patients with microtia who were referred to the Imam Khomeini Hospital from September 2006 to July 2007 for auricular reconstruction. The reconstruction was performed using a pre-shaped homograft(s) of each patient's ear(s) made by the Iranian Tissue Bank from the 6th, 7th and 8th costal cartilage according to the method of Marquette. In six patients, the second stage of reconstructive surgery was performed three months after the first stage. The patients were followed regarding the ear appearance, the dimensions of cartilage and tissue reaction.

Results: The mean age of the patients was 11.08 (SD=5.57) years and the average duration of follow-up was 6.29 (SD=3.12) months. Eight cases had unilateral involvement (six right and two left), in addition to two cases of bilateral involvement. During the follow-up period, the appearance of the helix was satisfactory in 11 ears and the lobule in 10 ears. The height and width of the reconstructed auricles was an average of 1-2 millimeters different from the opposite ear. Erythema was the most common early complication. Late complications, including cartilage exposure and infection, were observed in one patient.

Conclusion: Auricular reconstruction using homograft costal cartilage in patients with microtia has promising results. The short term resorption can be ignored and significant early or late complications are infrequent.

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Background: Myasthenia Gravis (MG) is a neuromuscular disorder with weakness of skeletal muscles. Thymectomy is now recognized as a treatment modality in MG. The aim of this study was to evaluate the clinical effect of thymectomy on MG.

Methods: MG patients with history of thymectomy at a tertiary referral center during twelve year period were included. The medical records were reviewed and telephone survey was conducted to evaluate the effects of thymectomy.

Results: Sixty MG patients, 46 females and 14 males, aged 30.4±11.1 years, underwent open (n=48) or video-assisted thoracoscopic thymectomy (n=12) during study period. The mean dosage of preoperative pyridostigmine was 235.4±86.2mg/day. This figure reached to 129±18mg/day after thymectomy (p<0.0001). 17 patients (28.3%) had complete remission (complete freedom of symptoms without medications). Improve-ment (improved symptoms or less medication requirement) was seen in 34 patients (56.6%). There was no response to surgical therapy in six patients (10%). Three patients (5%) had experienced progression of disease postoperatively. Overall, benefit of thymectomy was observed in 85% of patients. Age, sex, duration and severity of disease, quantity of preoperative drugs, surgical approach, and presence of thymoma did not affect the outcome. Satisfaction was stated as excellent in 17%, good in 43%, moderate in 35% and poor in 5% of patients after operation.

Conclusion: Thymectomy is an effective treatment for MG which leads to less severity of disease and less drug requirement. It would be considered in all myasthenic patients regardless of age, sex, duration and severity of disease and presence of thymoma.

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Background: Ekiri syndrome or lethal toxic encephalopathy is a complication of shigellosis with dysentery, hyperpyrexia, seizures, headache and altered level of consiousness, which rapidly progresses to death. These children die at the beginning of the disease (8-48 hours from the beginning of symptoms), from brain edema. However they had no symptoms or signs of sepsis, dehydration, DIC or Hemolytic Uremic Syndrome (HUS).

Methods: This survey is a case series study of children with Ekiri syndrome in Bahrami hospital from October 1998-2008 presented with loss of consciousness, colitis and high fever shortly after admission. Information about the patients was gathered from the documents according to physical signs and symptoms, lab data of those whom Ekiri syndrome had been diagnosed for them. Studied variables in this assessment were age, sex, fever, convulsions and loss of consciousness. Headache, encephalopathy, dehydration, elevated ICP, colitis, underline disease, stool, blood and CSF cultures.

Results: The subjects contain 13 cases (10 male, 3 female), averaged 30/5 months of age. All had seizure, elevated ICP, encephalopathy and coma. All of the patients had fever between 39 and 40, averaged 39.5 degree of centigrade. Seven patients had headache and three ones was dehydrated. The first presentation symptom in three patients was gastroenteritis, in 9 was siezure and in 1 patient was headache. Stool culture in all patients was positive, but blood culture was positive in only one of them. CSF culture was negative in all of the patients. Mortality was 100%.

Conclusion: Symptoms, signs and presentation of Ekiri syndrome, a rare complication of infection with shigella, in the patients in Bahrami hospital was similar with the other studies beforehand in other countries. In this study, all the patients were died and supportive treatments were ineffective.

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Background: Visual, brain stem auditory and somatosensory evoked potentials (EPs) have been traditional paraclinical tests to evaluate the competency of sensory tracts in multiple sclerosis (MS) patients. It seems that only one of these EPs could be sufficient, at least as a screening test. The objective of this paper is to evaluate the frequency of these three evoked potentials in definite MS patients.

Methods: This descriptive cross-sectional study involved was 25 definite relapsing remitting MS patients who referred to our university hospital. Twenty five individuals from normal population without any neurologic, visual, auditory or sensory disorders have been evaluated as well to determine the standard values in our electrophysiology lab. Values more than mean+2.5SD for latencies and less than mean-2.5SD for amplitudes were considered as abnormal.

Results: Fifteen (60%), 13 (52%), and 13 (52%) had abnormal visual, auditory and somatosensory EPs respectively. The latency of P100 in visual EP (VEP) had the most sensitivity among all of the parameters. It was determined that the possibility of abnormality in each of auditory and somatosensory EPs in the presence of normal VEP could be 30.8%. In other words 30.8% of patients with negative VEP could have a positive auditory brain stem or somatosensory EPs.

Conclusion: In our study, a VEP abnormality was more frequent than auditory brain stem and somatosensory EPs. Thus it is not logical to perform triple EP tests in all suspected MS patients, but auditory and somatosensory EPs could be considered in patients with normal VEP.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 !mso]> ject classid="clsid:38481807-CA0E-42D2-BF39-B33AF135CC4D" id=ieooui> Background: Polyethylene glycol (PEG) solution can induce complications when used as preoperative bowel preparation. The aim of this study was to compare two methods for mechanical bowel preparation in elective operations of colon.
Methods: In a randomized clinical trial, 129 patients elected for anastomosis of colon and referred to the surgical clinic of Imam Khomeini Hospital of Tehran between March 2008 and March 2009 were included. They were randomly allocated into two groups of PEG1 (1liter of PEG or 70gr plus 15 mg bizacodil, n=63) and PEG4 (4 liter of PEG), according to the way of bowel preparation and on the day before surgery, they received oral and IV prophylactic antibiotics and cleared solutions. In the morning of the surgery, they received their medication during 240 minutes. Then, they underwent anastomosic surgery of colon. The principle variables recorded were nausea, vomiting, flatulence, Na and K in the night before surgery, patients' and surgeons' satisfaction from bowel preparation and postoperative infection and leakage.
Results: The majority of the patients were male (62%). Nausea (28.57% vs. 98.48%, p=0.001), flatulence (36.51% vs. 95.45%, p=0.001), and vomiting (4.76% vs. 75.76%, p=0.001) were significantly lower in PEG1 and the patients' satisfaction were significantly higher (59.02% vs. 1.52%, p=0.001) Peroperative Na was significantly higher in PEG4 group (141.21±3.63 vs. 139.94±2.97mg/l, p=0.001) and serum K was significantly lower (3.55±0.25 vs. 3.76±0.21, p=0.001). Surgeons' satisfaction were significantly higher in PEG4 group (good to very good 72.73% vs. 43.54%, p=0.001). Postoperative infection of surgical site, anastomosis leakage and ICU admission were comparable between study groups.
Conclusions: Bowel preparation with 1 liter of PEG plus 3 bizacodile pills instead of 1 liter of PEG in patients undergoing elective anastomosis of colon is not only associated with lesser nausea, vomiting, flatulence, but also increases the patients' satisfaction and tolerance, lessens electrolyte disturbances and do not influence postoperative infection of surgical site and anastomosis leakage.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Asthma prevalence has increased in developed and developing countries in several last decades. Although cigarette smoking is an identified risk factor for many diseases such as coronary Heart disease and chronic obstructive lung disease, its effect on asthma is controversial. The aim of this study was to determine the odds ratio and its confidence interval for asthma morbidity among children referred to the Immunology and Allergy department of children medical center according to their parents' smoking and daily cigarette consumption.
Methods: A case-control study was conducted during two years period on the asthmatic patients who referred to Immunology and Allergy department of children medical center. Demographic information and parents' smoking and daily cigarette consumption assessed by a questionnaire. Healthy children with same age and sex were entered to the study as the control group. Statistical analysis was performed to calculate odds ratio.
Results: Among 215 patients who entered the study 63 patients were exposed the cigarette smoke. Odds ratio for asthma morbidity among children whose parents smoke more than five cigarettes per day in comparison with whose smoke less than five or do not smoke was 2.38 (p<0.01).
Conclusion: Parent's cigarette smoking is a risk factor for childhood asthma and could increase the risk of asthma to 2.38 folds in children whose parents smoke more than five cigarettes. Increasing in parents' knowledge level that probably relate to their education results in cigarette consumption decline.