Tehran University Medical Journal

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Background: Gross difference in return to work exists in pilonidal sinus patients operated by primary and secondary repair. This survey was to evaluate the results of surgical management of pilonidal sinus with primary or secondary closure.
Methods: In a randomized clinical trial, patients with pilonidal sinus referring to the surgical clinic of Shariati Hospital in Tehran, Iran between March 2007 and March 2009 were underwent either excision with midline closure (primary, n=40), or excision without closure (secondary, n=40). The recorded outcomes were hospital stay, healing time, time off work, postoperative pain, patient's satisfaction and the recurrence rate.
Results: Majority of the patients were male (87.50%). There was no significant difference in the hospital stay. Time off work (8.65±1.73 Vs. 11.53±2.33 days, p=0.001) and healing time (3.43±0.92 Vs. 5.3±0.79 days, p=0.001) were shorter in primary group but, there were no significant differences in hospital stay and number of visits. Intensity of postoperative pain in the 1^st (37.75±6.5 Vs. 43.63±5.06, p=0.001), 2^nd (26.75±6.66 Vs. 34.63±5.48, p=0.001), 3^rd (18.25±6.05 Vs. 27.88±6.88, p=0.001), and 7^th (8.45±3.85 Vs. 17.88±6.19, p=0.001) days were lower in primary closure group. There was not significant difference in complication rates in groups. Patients' satisfaction was higher in primary group (4.15±0.53 Vs. 3.6±0.5, p=0.001).
Conclusion: According to this study excision and primary closure is the preferred procedure in patients with pilonidal sinus. It has the advantages of shorter time off work earlier wound healing, lesser postoperative pain, higher patients satisfaction and comparable complication and recurrence rates with excision and open wound.

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Background: Tuberculosis with high prevalence in HIV/AIDS patients is the main reason for morbidity and mortality in these patients. About one-third of patients with HIV infection have concomitant tuberculosis. Lack of appropriate infection control on many social and economic communities will impose. Comprehensive study on the effects of anti-tuberculosis drugs in patients with HIV infecting less done, also due to the importance of reducing morbidity and mortality, reduce the cost of disease, identifying drug pharmacokinetics, the importance of completing treatment tuberculosis, this study was performed to evaluate the effects of anti- tuberculosis drugs on HIV infection and to identify the drug pharmacokinetics and so more complete tuberculosis treatment.
Methods: A historical cohort study was performed on patients referring to the research center for HIV/AIDS, consultation center, department of infection diseases of Imam Khomeini Hospital in Tehran, Iran. A total number of 75 cases with HIV negative versus HIV positive patients with pulmonary tuberculosis and positive sputum smear in accordance with inclusion and exclusion criteria were selected.
Results: In this study, the frequency of peripheral neuropathy 27(73%), arthralgia 31(83.8%), vomiting 18(48.6%), headache 26(70.3%), dizziness 20(54.1%), renal toxicity 4(10.8%) and of skin rash 10(27%) in patients with HIV virus infection were significantly more than HIV- negative patients. Hepatotoxicity, fever and anemia were not significantly more common in patients who infected with HIV virus.
Conclusion: The HIV patients, who have not received antiretroviral drugs during tuberculosis treatment, may show higher incidence of anti-tuberculosis drugs complications.

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Background: Infections caused by opportunistic yeasts such as Candida species, Trichosporon, Rhodotorula and Saccharomyces have increased in immunocompromis- ed patients and their identification is crucial as intrinsic and acquired resistance of some yeast species to antifungal agents are on the rise. The aim of this study was to identify the organisms to the species level in order to suggest accurate and effective antifungal therapies. Methods: In this study that carried out in Tehran, Iran in 2009, 200 patients with yeast infection were medically examined and clinical specimens were prepared for direct examination and culture on Sabouraud dextrose agar. Subsequently, the isolated yeast colonies were identified using various tests including culture on Corn Meal agar with Tween 80, CHROMagar Candida and casein agar. For the definite identification of organisms some biochemical tests were done based on carbohydrate assimilation by RapID Yeast Plus System kit, and, finally, a molecular method, PCR-RFLP, using Hpa II enzyme, was performed for the remaining unknown yeast species. Results: A total of 211 yeast isolates were identified in 200 patients with yeast infections. The most frequent isolated yeasts were Candida albicans, 124 (58.77%), followed by Candida parapsilosis, 36 (17.06%), Candida tropicalis, 17 (8.06%), Candida glabrata, 13 (6.16%), Candida krusei, 8 (3.79%), Candida guilliermondii, 2 (0.96%), Trichosporon, 3 (1.14%), Rhodotorula, 1 (0.47%), Saccaromyces cerevisiae, 1 (0.47%) and other yeast species, 6 (2.84%). Conclusion: Nail candidiasis was the most prevalent type of yeast infection in the patients and Candida albicans was the most frequent isolated species from all clinical specimens.

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Background: Trauma to the hand is very common and consequently, metacarpal fractures are not rare entities. Some of these fractures need surgery. Considering the diversity of surgical methods available for these kinds of fractures and also the importance of achieving full function and speedy return to work for patients that are mainly young workers or athletes, this study was undertaken to investigate the outcome of treating these fractures by mini-plates. Methods: Eighteen patients with open or comminuted fractures of metacarpal bones who were admitted to the emergency department of Sina Hospital between the years 2007 and 2010 underwent fixation surgery using mini-plates. Fourteen patients with 17 metacarpal fractures completed the study. Results: Thirteen out of 14 patients had complete fracture ::::union::::. The patient with non- ::::union:::: underwent revision surgery and bone graft. Four individuals developed an extensor lag of 15 degrees without functional impairment. Two patients had joint stiffness that was relieved after a period of physiotherapy and one developed wound dehiscence and discharge that improved with debridement and use of antibiotics without plate removal. Six patients had complaints regarding their hardware prominence and were satisfied after its removal. Overall, there was a 79% satisfaction rate upon the treatment. Conclusion: Despite the afore-mentioned complications, use of mini-plates seems to be a suitable treatment option for patients with comminuted metacarpal fractures. However, more studies with larger sample sizes are suggested to reach a firm conclusion.

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Background: Gastrointestinal mesenchymal tumors are classified as tumors that originate from smooth muscles. Gastrointestinal stromal tumors (GIST) are the most common types of the proposed tumors and can be seen in the GI tract from the esophagus to the anus, but they are mostly seen in the stomach. Mostly from the stomach and asymptomatic, the majority of patients would benefit from surgery as the best method of treatment.

Methods: In this retrospective study we evaluated the data of patients with the diagnosis of esophageal or gastric mesenchymal tumors admitted in Ghaem and Omid Hospitals affiliated to Mashhad University of Medical Sciences in Iran, from 1992 to 2010. We analyzed factors such as age, sex, presenting symptoms and signs, diagnostic methods, types of pathology, types of treatment, morbidity, mortality and 3-year survival rates.

Results: Twenty four patients (16 male, 8 female) with a mean age of 50 were included in the study. The common site of tumor was gastric fundus. The most common symptom at the time of diagnosis was epigastric fullness which was observed in almost 50% of the patients. The most common type of surgery in the patients was subtotal gastrectomy and no hospital mortality was recorded. Paralytic ileus was the commonest complication seen in five patients (20.5%). Adjuvant therapy had been performed in eight patients (33.1%). Following the patients three years postoperatively, there were only three deaths (12.45%).

Conclusion: Regarding to the low mortality and morbidity of the surgeries, surgical treatment, if tolerated, is recommended for all Esophagogastric mesenchymal tumors patients.

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Background: Vascular complications, as the most common complications of diagnostic catheterization and percutaneous coronary intervention (PCI), are important factors in the morbidity of patients undergoing such procedures thus, this study was done to evaluate the prevalence of these complications and their related factors.

Methods: This is a descriptive study composed of 2097 consecutive patients who underwent percutaneous coronary intervention in Shahid Rajaei Cardiovascular Center in Tehran, Iran from January 2008 to January 2009. Occurrence of vascular complications in course of hospitalization and the related factors leading to the complications were investigated.

Results: Out of 2097 patients, 1544 (73.6%) were male and 553 (26.4%) were female, and the mean age of the participants was 57±10 years. Vascular complications from the time of PCI to the time discharge were observed in 19 (0.9%) patients. The other complications included: hematoma in 10 cases (52.6%), pseudoaneurysm in five cases (26.3%), retroperitoneal hemorrhage and arteriovenous fistula in 2 (10.5%) patients each. The complications were significantly more common in female patients (P=0.003), in patients with a history of hypertension (P=0.02), people of shorter stature (P=0.004), and being on gp IIIa/IIb inhibitors (P=0.003).

Conclusion: The rate of vascular complications post-percutaneous coronary interventions is low and it is considered to be a good treatment option for patients with coronary stenosis provided that sufficient compression is applied on the vascular access point in the right time after removal of the arterial sheath. PCI is of fewer vascular complications, especially in female patients, history of hypertension, and higher anticoagulant concentrations.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Distinguishing the origin of ventricular tachycardia (VT) by electrocardiogram (ECG) which is performed in all patients, helps to diagnose the cause of VT before trying invasive procedures. The aim of this study was to compare the ECG findings in patients with VT originating from Right or Left Ventricular Outflow Tracts (RVOT or LVOT).
Methods : Fifty nine patients with VT originating from LVOT or RVOT were selected for this cross-sectional study. The patients were recruited while they were attending Shahid Rajaei Hospital in Tehran, Iran in 2009-2010 for catheter ablation. The participants were evaluated for the prevalence of LVOT and RVOT and were compared for the success rate of radiofrequency catheter ablation.
Results : Out of 59 patients, 44.1% were male and 55.9% were female. The mean age of the participants was 41.67 (SD=13.76) years. QRS transition and notch in ECGs were significantly different (respectively, P=0.027 and P=0.007) between patients with LVOT and RVOT. R-to-QRS duration in precordial leads was significantly longer in patients with LVOT than those with RVOT [0.81 (SD=0.06) ms vs. 0.69 (SD=0.16), P=0.015]. Successful ablation was performed in 73.2% of patients with RVOT versus 93.3% of those with LVOT, but despite a higher rate the differences were not statistically significant (P=0.215).
Conclusion: In this study, RF catheter ablation was successful like other studies on patients with ventricular tachycardia and RVOT VT and LVOT VT had significant differences in notch, QRS transition and R-to-QRS duration in precordial leads which are important in differentiating between the two conditions.

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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: The aim of this study was to compare operating time and short-term complications of laparoscopic transabdominal preperitoneal hernia repair during reperitonealization in Trendelenburg versus reverse-Trendelenburg positions.
Methods : Thirty-nine patients with inguinal hernia were enrolled in this clinical trial. Study was done in Milad and Rasoul Akram hospitals in Tehran, Iran, during 2008-2010. The patients neither were pregnant nor did they have any signs of peritonitis, strangulation, perforation or infection. Moreover, they had a Body Mass Index (BMI) below 35 kg/m² and were physically fit for general anesthesia. The participants were divided into two groups by block randomization. The first (20) and the second (19) groups of patients underwent laparoscopic herniorrhaphy in Trendelenburg and reverse-Trendelenburg positions. Respectively all the operations were performed by one surgeon. The patients were visited one day and one week after the surgery.
Results : Most frequent complications were rupture in peritoneal repair in 9 patients (23%), skin site bleeding in one patient (2.6%), and peritoneal tension in 33 patients (84.6%) patients. Duration of surgery and peritoneal repair took a significantly longer time in Trendelenburg versus the reverse-Trendelenburg position. There were no differences in duration for returning to work or resumption of daily activities between the two groups. Pain in the first day following surgery was statistically more severe in the Trendelenburg group.
Conclusion: This study demonstrated that reverse-Trendelenburg position took less time for herniorrhaphy and peritoneal repair than Trendelenburg position, although the complications were the same.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Nocardiosis is a rare and potentially life-threatening infection caused by several species of the Nocardia genus. The objective of this study was to develop and evaluate a rapid and new method to clinically identify relevant Nocardia species. Rapid and accurate diagnosis of Nocardia species is essential for the treatment of severe infections and prevention of cerebral abscess.
Methods:  One hundred and eighty patients, 103 (57.22%) male and 77 (42.78%) female, with severe symptomatic pulmonary infection were studied in the course of a 12-month period in Dr. Shariati Teaching Hospital affiliated to Tehran University of Medical Sciences in 2010. The specimens were cultured and identified using microbiological and biochemical tests. Polymerase chain reaction (PCR) was used to directly identify the organism in the broncoalveolar lavage samples collected from the patients. NG1 and NG2 primers were used to amplify a Nocardia genus-specific 598-bp fragment of 16S rRNA.
Results:  Nineteen samples (10.56%) were positive with PCR and 5 samples (2.78%) with conventional methods. All samples with positive cultures were also positive by PCR.
Conclusion: The results of this study showed that PCR has a high sensitivity and accuracy for the detection of Nocardia compared with culture and biochemical tests. Considering the rapidity, precision, high sensitivity and specificity of molecular techniques, use of these techniques is suggested in conjunction with conventional methods for the detection of Nocardia phenotypes in clinical laboratories and research centers.

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Background: Emergence agitation (EA) is a post-anesthetic problem which interferes with a child's recovery and presents a challenge in terms of assessment and management. In this study, we compared the effects of midazolam and ketamine as premedication in the management of EA in children aged 1-6 years.

Methods: In this prospective, randomized clinical trial study, 58 children aged 1-6 years who were undergoing general anesthesia for elective surgery in Alzahra Hospital in Isfahan during 2008 until 2009. The patients were randomly assigned to receive 0.1 mg/kg midozolam (28) or 0.5 mg/kg ketamine (29) by IV route in the premedication room. All patients received a standardized anesthetic regimen and isoflurane was used for the maintenance of anesthesia. The incidence and severity of agitation (agitation score), severity of pain (pain score), anesthesia, recovery and extubation durations were recorded postoperatively.

Results: The prevalence of agitation in midazolam (21.4%) was lower than ketamine group (34.5% P<0.05). In addition, the duration of agitation in ketamine group (21±16.67 min) was significantly higher than midazolam group (6.83±6.55 min), (P<0.05). However, no significant differences were seen in agitation score, pain score, anesthesia, recovery or extubation durations in the two groups (P>0.05).

Conclusion: The study showed that midazolam could reduce the frequency of agitation better than ketamine but both drugs were able to reduce the severity of agitation after short-time surgeries in young children.

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Background: Pneumothorax is a potential life-threatening condition especially in patients with underlying disorders. In this study we compared the diagnostic accuracy of general practitioners and emergency medicine specialists in interpreting chest x-rays (CXR) suspected of having iatrogenic pneumothorax in emergency departments.

Methods: This cross-sectional study was conducted in Shahid Chamran Hospital in Tehran, Iran during 2008- 2010. The study was designed to compare the ability of general practitioners and emergency medicine specialists in diagnosing iatrogenic pneumothorax regarding 500 CXRs of one-hundred patients admitted for upper central venous catheterization.

Results: General practitioners and emergency medicine specialists could accurately (P<0.001) diagnose pneumothorax in 484 (96.8%) and 497 (99.4%) CXRs, respectively. None of the underlying causes of the condition affected the diagnostic accuracy of both physician groups (P>0.05).

Conclusion: These findings indicate that the diagnostic accuracy of emergency medicine specialists is significantly higher than those of general physicians. The diagnostic accuracy of both physician groups was higher than the values in similar studies that signifies the role of relevant training given in the emergency departments of the Hospital.

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Background: Drugs applied topically to the eye may be absorbed systemically to a substantial degree, with the potential to cause serious systemic side-effects. Children may be particularly vulnerable to systemic effects of topically applied agents as topical doses are often not weight-adjusted.

Case presentation: This article describes a case of serious systemic side-effect by the use of topical phenylephrine, tetracaine, tropicamide and atropine in a 17-year old boy candidate for deep viterectomy in Farabi Hospital in 1389. Following application of the aforesaid eye drops, the patient developed hypertension and subsequent loss of conciseness.

Conclusion: Several types of eye drops and their repeated use can lead to their systemic absorption and medical complications due to overdose. Strategies to minimize systemic absorption should be applied, including use of low concentrations of ophthalmic drugs, administration of one type of the drug, use of microdrops and punctal occlusion to minimize absorption via the nasolacrimal duct. While administering ophthalmic drops, one should take these precautions to minimize the systemic effects of the drugs to prevent subsequent complications.

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Background: Medication overuse headaches (MOH) include headaches that last more than 15 days a month and usually occur after long-term use of analgesic. Most methods of medical treatment are ineffective. In some studies, great occipital nerve block is used to treat the headaches.

Methods: This double-blind experimental study was performed in adult patients with MOH who attended Sina Hospital in Tehran from June 2009 to June 2011. Greater occipital nerve (GON) block was done in the two groups of patients by administering a combination of 3 ml of 0.5% bupivacaine and 2 ml of 5% saline or 3 ml of 0.5% bupivacaine and 80 mg of methyl prednisolone. We evaluated headache severity by Visual analog scale (VAS) and recorded days without headache. If patients were taking pain medications, preventive medications were given as usual before and after the injection. Student's t-test was performed for statistical analysis and a P<0.05 was considered significant.

Results: Overall, 13 male and 19 female patients with a mean age of 39.88±8.76 years participated in the study. The mean reduction in headache severity one hour after injection was 5.56±1.03 and 4.63±1.92 in the first and second groups, respectively. Average days without headache one month after injection were 8.75 and 4.75 days in the first and second groups, respectively. There were no significant differences between the two groups.

Conclusion: Both methods seem to be effective in medication overuse headaches treatment. This finding is important as non-responders to conventional methods will otherwise have a decreased quality of life.

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Background: There are not many reports regarding the treatment approaches of congenital dislocation of the knee in the literature. Therefore, the preferred method of treatment of this rare congenital disease is still controversial. Hereby, we report the treatment outcome of 29 patients admitted in Shafa Yahyaian Hospital during 40 years.

Methods: In this retrospective study done in Shafa Yahyaian Hospital in Tehran, Iran during 2010, we retrospectively reviewed the medical records of 29 patients treated conservatively or surgically for congenital dislocation of the knee. Patients had been evaluated for an average follow-up of 8.5 years.

Results: Overall, 54 knee dislocations had been treated surgically (58%) or conservatively (42%). Range of knee motion, persistent recurvatum, instability, valgus deformity after treatment and limping were the more important factors reported in the two surgically or conservatively treated groups. Knee function was satisfactory in patients with conservative treatment. Despite 80% of instability in the operated knees, patients could ambulate with or without braces and had a range of motion equal to 80 degrees. Knee function was also good after quadricepsplasty with transarticular pins in selected cases.

Conclusion: We recommend a conservative approach to the disease, regardless of the patient's age at the time of treatment and subsequent surgery in patients with dissatisfactory recovery. Quadricepsplasty with transarticular fixation is recommended as a good option in treating these patients. Posterior capsulorrhaphy for patients with CDK and ligamentous laxity is also recommended.

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Background: The purpose of this study was to determine the prevalence and associated factors for postoperative pulmonary complications (PPCs) and extubation failure in patients having undergone intracranial surgery.

Methods: In this retrospective study done in Firozgar Hospital during 2008-2010, we followed up 254 patients through a clinical questionnaire and observation of the clinical course of participants in pre- and post-operative periods.

Results: Overall, 40 (15.74%) patients had postoperative pulmonary complications. The most common PPC was pneumonia, which was seen in 24 patients (60% of complications). The average duration of ventilation in patients with PPC was significantly higher (16.8.±10 vs. 5.09±4.5 days P=0.001) than patients without the complication. The mean Glasgow coma scale (GCS) after surgery in patients with PPC was significantly lower (11.±4 vs. 13.2±3 P=0.001) than the rest of the patients. Moreover, the mean age of patients with PPC was significantly higher (64.02±14 vs. 41.6.±17 years P=0.001). Average duration of stay in ICU in patients with PPC was also higher (24.±27 vs. 8.7±0.5 P=0.001).

Conclusion: GCS before surgery and failed extubation independently of other variables were significantly associated with pulmonary complications independent of other variables.

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Insertion of central venous catheter is an accepted method for hemodynamic monitor-ring, drug and fluid administration, intravenous access, hemodialysis and applying cardiac pace-maker in hospitalized patients. This procedure can be associated with severe complications. The aim of this article is to provide a practical approach to prevent catheter malposition in states that the guide wire will not pass freely.
During central venous insertion in internal jugular vein using modified seldinger technique, when after venous insertion, the passage of the guide wire shows difficulties and don’t pass freely, insertion of an intravenous cannula over the wire and re-insertion of the wire can help to prevent malposition of the wire and the catheter. Use of an intravenous cannula over the guide, in situations that the guide wire cannot pass freely among the needle inserted in internal jugular vein, and re-insertion of the guide can probably prevent or reduce the tissue or vascular trauma and the associated complica-tions. This simple maneuver can be helpful in difficult cases especially in cardiac surgery patients who receive high dose heparin and it is necessary to avoid traumatize-tion of carotid artery.

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Background: Sympathetic complex of over-activation kidneys is one of the main causes of primary hypertension (HTN). We aimed to assess the efficacy and safety of sympathectomy using 5Fr mariner catheter ablation on patients with refractory hypertension.
Methods: In this prospective cohort study, patients who received three or more anti-hypertensive medications with 160mmHg systolic blood pressure (BP) or more were randomly included and divided into 2 groups. Cases in the first group were undergone to renal denervation and the second group was treated by previous antihypertensive medications. Both groups were followed for six month by assessing BP and adverse effects.
Results: One hundred and seventeenth patients (54%) out of 212 screened patients were included in the first group (renal denervation) and 95 patients as the second group. The mean of BP changes in the first group was 35/15 mmHg with standard deviation of 22/11mmHg. (P<0.001) in the second group, the mean changes of BP was not statistically significant. (5/0mmHg± 22/11, P=0.79 for systolic BP and P=0.96 for diastolic BP). 92% of 117 patients in the first group had a favorable BP decrease, which was defined as a 20mmHg or more decrease in BP, in comparison with 15% of 95 patients as controls (P=0.001). There was no observed complication after denervation in the first group.
Conclusion: It seems that the sympathetic renal denervation can be an effective and safe method for treatment of refractory hypertensive patients indeed of routine medications although further studies with longer follow up duration and more cases are suggested for confirming this issue.

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Background: As regard to high prevalence of Helicobacter pylori infection and complications of it's persistence, as well as anti-bacterial activity against of Helicobacter pylori and anti-inflammatory properties of omega-3 fatty acids, this study was conducted to evaluate the effects of supplementation with Docosahexaenoic Acid (DHA) on the eradication of Helicobacter pylori infection, some serum inflammatory markers and total antioxidant capacity. 
Methods: In a double-blind, placebo-controlled clinical trial, 66 H. pylori positive patients (33 in the intervention group and 33 in the control group), along with tetra-drugs H. pylori eradication regimen, randomly received daily two grams morDHA supplement or Medium Chain Triglyceride (MCT) oil as placebo for 12 weeks. Dietary intake data was collected by 24 hour food recall and analyzed by Nutritionist IV software. Sampling from fasting blood and measuring weight, height, body mass index (BMI) and level of physical activity were done at the first and the end of the study. As well as, eradication test of the infection was performed for all patients at the end of the intervention. 
Results: Eradication rate of the infection, the level of interleukin-6 (IL-6), high sensitivity C-reactive protein (hs-CRP) and total antioxidant capacity (TAC) didn't have significant difference between two groups at the end of the study (P>0.05), while the level of interleukin-8 (IL-8) was different between two groups (P=0.008). Difference of the concentration between the beginning and the end of the study was not significant in any factors between two groups (P>0.05).  
Conclusion: Intake of morDHA supplement didn't have significant effect on the eradication of H. pylori, serum levels of IL-6, hs-CRP and TAC, while it was effective on the level of IL-8.

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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.

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Background: Many drugs have been abused by patients for headache management. Celecoxib has not been abuse widely as a pain relief drug for headache. The aim of this study was comparison between celecoxib and prednisolone in bridge stage therapy following medication overuse headache. Methods: A double-blind randomized clinical trial was done in patients admitted to a private headache clinic in Tehran, Iran at 2012. Patients were selected with 18- 65 years old and 15 days headache per month at least. Prednisone was administered as a 75 mg/day, 50 mg/day, 30 mg/day, 25 mg/day and 10 mg/day dose, in 3 days interval. Celecoxib was administered as a 100mg dose three times per day (first 5 days), twice per day (second 5 days) and one time per day (third 5 days). Headache time, headache intensity, headache duration, analgesic consumption due to severe headache and drug side effects was assessed. We used the visual analog scale to determine the severity of the pain. Results: One hundred and three patients were enrolled in two groups: celecoxib (53 cases) and prednisolone (50 cases). Twenty and one men and eighty and one women with a mean age of 33.62±9.65 years participated in the study. The maximum fre-quency for headache time in the celecoxib group was 1-4 hours (19 cases) and more than four hours (19 cases). In the prednisolone group the maximum frequency for headache time was more than 4 hours (28 cases) (P=0.149). The frequency of side effects of prednisolone and celecoxib groups were 42% and 18.9%, respectively (Relative Risk=2.2, P=0.011). The most common side effects in both groups were weakness and lethargy. Conclusion: Considering the positive effect of both drugs in reducing patients' head-ache during withdrawal, celecoxib compared with prednisolone has better efficacy and fewer side effects.