Tehran University Medical Journal

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Background : Septic Arthritis is an acute infection of intra-arthicular space. Delay in diagnosis and in appropriate treatment may lead to prolongation of treatment duration and poor outcome. We decided to evaluate clinical aspects of this disease in our department pediatric department, Imam Khomeini Hospital complex, Tehran, Iran during a 10 years period.

Methods : In a retrospective cross-sectional study, 60 patients with age from 1 month to 14 year-old during 1996-2005 were evaluated. The demographics characteristics, clinical observations (signs & symptoms) and paraclinic values were gathered from medical records and analyzed with statistical tests.

Results : Pain and Swelling was seen in all, joint limited motion in 80% ( 50 cases) claudicating in 64% ( 38 cases), fever in 80% ( 48 cases), monoarticular disease in 80% ( 48 cases) and polyarticular one in 20% ( 12 cases) of them. Hip was most Common involved joint 62% ( 37 cases), elevated ESR was seen in all patients. CRP was positive in 85% ( 51 cases). Leuckocytosis was found in 65/8% ( 17 cases) of cases. In infectious cases, Staphylococcus aurous was responsible organism in 65.6% ( 16 cases), klebsiella in 12.4% ( 3 cases), Streptococcus pneumonia in 12.3% ( 3 cases), group b streptococcus in 4.1% ( 1 case), Hemophilus Influenza type b in 4.1% ( 1 case) of study patients. With therapy ESR was normalized in 64% ( 39 cases) and CRP was normalized in all patients.

Conclusions: In general, all children with complaint of fever, pain, and limited joint motion or claudicating should be suspected for septic arthritis.

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Background : Open fractures are associated with an increased risk of infection and healing complications. Management of open fractures is based on the following principles: assessment of the patient, classification of the injury, antibiotic therapy, debridement and wound management, Fracture stabilization, early bonegrafting, and supplemental procedures to achieve healing.
Methods : In a case- control retrospective study we evaluated 33 patients with open tibial fracture (type two gustillo) who were admitted in sina General hospital in Tehran, Iran during years 1999-2009 and were treated uniformly with external fixation as primary treatment in our center as case group and the other 33 patients with the same method and another 33 patients who had not been infected as control group. W e compared the folders of case and control groups retrospectively. 
Results : There was no statisticant difference between two groups in mean age, gender, the mechanism of trauma and body mass index (p >0.05 ), while statistically significant difference between them in smoking habitus, blood transfusion, first debridment time, diabet mellitus, femoral shaft fracture (p <0.05 ).
Conclusions: Accompanying femoral fracture is the sign of high energy trauma and it is logical that it is an important risk factor for infection. In our study the time of the first debridment stablished as a significant factor influencing the infection rate in tibial open fracture. In some studies smoking had been recognized as a significant factor influencing in tibial bone open fracture our study reveals the same.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Multiple myeloma is a plasma cell dyscrasia characterized by proliferation of plasma cells in bone marrow associated with the production of monoclonal immunoglobulins. In recent years, the use of arsenic trioxide, formerly approved for treatment of acute promyelocytic leukemia has been considered for refractory myeloma treatment. This study was designed and carried out to evaluate the efficacy and possible side effects of ATO on patients with refractory multiple myeloma.

Methods: This study carried out on myeloma patients whose diseases were at least refractory to two standard treatment regimens conducted in Ghazi Tabatabaei Hospital in Tabriz- Iran. Arsenic trioxide was administered as an intravenous infusion at a dose of 0.25 mg/kg/d for 5 d/week during the first two consecutive weeks of each 4-week cycle with two week rest. Patients who completed one 4-weak cycle were evaluated for response to treatment.

Results: Twelve patients with refractory disease to conventional treatment regimens received arsenic trioxide. The response to the treatment assessed based on the amount of serum proteins electrophoresis of the 10 patients. Stable disease observed in four patients (33%), progressive disease in five patients (41.6%), complete response in one (3.8%) and the remaning two patients could not be assessed for response (because of increased liver enzymes after the first week). One patient completed six cycles. Some adverse events such as: increase liver enzymes and serum creatinine, neutropenia, pruritus, nausea, vomiting, lower extremities edema, and noninfectious diarrhea were observed.

Conclusions: The use of arsenic trioxide is promising in treatment of refractory multiple myeloma.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Breast conservative therapy is associated with similar outcomes in comparison with mastectomy. The aim of this study is assessment of local recurrence rate and related risk factors in patients who have been treated with radiotherapy after conservative surgery for breast cancer.

Methods: This is a cohort study which data of all breast cancer patients who have visited in follow up clinic in radiation oncology department of cancer institute of Imam Khomeini Hospital complex in Tehran, Iran, during years 2007-2009 were collected. All of the patients were investigated for local recurrence and the possible risk factors.

Results: Two hundred and seventy seven patients have entered the study and all have followed for at least one year since data entry. Median follow-up time from the start of radiotherapy were 35 months (12-148 mo). We had seven cases (2.5%) with local recurrences (2.5%) which most of them occurred in first year after treatment. Because of low rate of recurrence none of the variables such as margin and nodal status has significant correlation with local recurrence which this should be due to small number of patient and short time of follow up.

Conclusions: At median follow up of 35 months from the beginning of radiation therapy, local recurrence rate was 2.5% which is similar to the literature. We recommend to follow a larger group of patients for longer times to estimate recurrence risk after breast conservative therapy.

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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: Infantile colic has been defined as episodes of excessive and persistent crying without known medical cause. Kangaroo mother care is a new method for baby care with several advantages. A universally available and biologically sound method of care for all newborns, with three components: skin-to-skin contact, exclusive breastfeeding, support to the mother-infant dyad. This study designed for evaluating Kangaroo mother care on infantile colic. 

Methods: This study was a randomized controlled trial. From 1th may 2008 to 1 may 2009 a total of 70 children, aged 3-12 weeks with persistent colic symptoms were studied. The children were referred to Sheikh clinic, Mashhad, Iran, because of excessive crying. Normal mother-infant pairs were recruited at 3 to 12 weeks of age after obtaining baseline for two days. Subjects divided randomly to kangaroo care or conventional care group and mothers in both groups filled diary for seven days.

Results: In the beginning of the study, the infants in kangaroo care group had 3.5 hr/d crying and after the intervention, it decreased to 1.7 hr/d, the difference were significant (p<0.05). But there were no difference in feeding duration between two groups (p=0.2). Awake and content (normal behavior) behaviors were significantly increased in the kangaroo care group (p=0.001). Sleep duration was significantly increased in the kangaroo care group (p=0.02).

Conclusions: Kangaroo care may be used as a simple and safe method for treatment of infantile colic.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Salmonellosis is a bacterial gasteroenteritis caused by different serovars of Salmonella. In the recent years, Salmonella enterica subspecies. Enterica serovar enteritidis is a major cause of gastroenteritis and food poisoning in the worldwide.  Different genus of salmonella is increasingly being resistant to common antibiotics. The aim of this study was to determine the frequency and the antibiotic resistance patterns of Salmonella enterica isolated from medical health centers in Tehran.

Methods: In this descriptive cross- sectional study from April to December 2008, 1950 fecal specimens from children with diarrhea were cultivated to identify Salmonella enteritidis. We used Clinical and Laboratory Standard Institute (CLSI) protocol to determine resistance patern of the isolates to 16 different antibiotics.

Results: In this study, out of 26 isolates 14(54%) were S. enteritidis, 2(8%) S. para B, 6(23%) S. para C, 3(11%) S. arizonea and 1(4%) S. para A. all of them were sensitive to ceftazidime, cephalexin, cefotaxime, ceftiraxone, ciprofloxacin, imipenem, meropenem, gentamicin and colistin sulfate. All of the isolates were resistant to nitrofurantoin whereas 71.4% of them were resistant to nalidixic acid.

Conclusions: The most prevalent isolated salmonella was S.enteritidis. According to high sensivity of these isolates to cephalosporin and flourqouinolon family, they can used as infective treatment for salmonellosis infections.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Since the recognition of true number of human chromosomes in 1956, many techniques have been developed to detect chromosomal aberrations. A number of those, such as karyotyping and fluorescence in situ hybridization (FISH), are valuable tools in both research and diagnostics. But these techniques have defects that limit their application. One of the important limitations is resolution resolution limitations make it impossible to detect small aberrations. The other major defect is the disability to analyze whole genome. In 1997 Solinas-Toldo introduced a new technique that could cover other techniques' defects. This new technique called microarray-based comparative genomic hybridization (array CGH). Array CGH, with the powerful resolution of FISH and also the ability of whole genome analysis in single experiment accelerated the genetic research. Array CGH has resulted in to a great progress in oncology and genetic disorders research. In addition, this technique has the ability to be used in diagnostics too. This review article, witch include the data of recent published papers and our experiences, gives an overview of the array CGH and compare it with the other molecular cytogenetic techniques. Its application in oncology and genetic disorder is also discussed.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Cystic fibrosis is a monogenic recessive disorder founds predominantly in caucasian population causes exocrine glands function defect. This disease arises from mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. Because of heterogeneity of the mutations in CFTR gene, phenotypic symptoms in this disease are very variable. In this study we consider poly T polymorphism (T₅, T₇, T₉) in the intron 8 of CFTR gene in normal individuals and cystic fibrosis patients in mazandaran province.
Methods: Forty cases of cystic fibrosis patients and 40 normal individuals were screened for poly T polymorphism in intron 8 of CFTR gene using Reverse Dot Blot method.
Results: T₇ allele is the most prevalent in normal individuals and CF patients and it's abundance is approximately 75%. T₉ and T₅ represent approximately 20% and 5% of normal or mutant alleles respectively. T₇/T₇ genotypes in normal individuals and CF patients are the most prevalent with 72.5% and 60% prevalence rate, respectively. T₅/T₉ and T₅/T₅ genotypes were not found. 22.5% of normal individuals and 30% of CF patients had heterozygote genotypes.
Conclusion: The abundance of T₅, T₇, T₉ alleles and the presence of 22.5-30% heterozygote genotypes in normal individuals and CF patients indicates that poly T polymorphism in intron 8 of CFTR gene can be used as a marker for detection of normal and mutant alleles in prenatal diagnosis or can be used in carrier assessment in families with previous history of the disease.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Recent studies present a high prevalence of multiple sclerosis (MS) in Iran. Treatment with interferon is now the first choice in management of MS. CinnoVex^TM (an interferon beta 1-a) is available in Iran, with achievement of the technology of producing beta interferon. The aim of the present study is to evaluate the efficacy and safety of CinnoVex^TM in a national study named CINA study.

Methods: This study was conducted from 2007 to 2008 in cities of Tehran, Isfahan, Mashhad, Tabriz, and Shiraz. Patients with relapsing/remitting MS with 16-50 years of age and EDSS of <4 received CinnoVex^TM (30µg/week, IM) after diagnosis by a neurologist. EDSS, drug side effects, and frequency of relapse were evaluated for one year in four 3-month visits.

Results: A total of 1050 patients entered the study. Complete data were collected from 627 (60%) patients. Mean age was 30.7±8.6 year and 514 (82%) were female. The most common onset presentations were sensory symptoms (44%). Changes of EDSS through the study showed a significant decrease in the last 3-month of evaluation (p<0.05). Drug side effects were observed in 47%, 50%, 61%, and 61.4% (p>0.05) and relapse was occurred in 13.4%, 15.7%, 16.9%, and 2.4% of the patients in the first, second, third, and forth evaluation visits (p=0.001), respectively.

Conclusion: CinnoVex^TM prevents progression and improves clinical course of MS. The conventional side effects of beta interferon therapy, however, are observed with CinnoVex^TM.

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

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Appendicitis is more common during the second and third decade of life and appendectomy scar is important in terms of cosmetic issues. The scar is an important factor in the patient's satisfaction. Conventional teaching has an emphasis on the closure of skin incision with "separate" sutures. The aim of this study was to reconsider this dogma.
Methods: Among 321 patients with acute appendicitis who came to the emergency unit of Imam Khomeini Hospital in Tehran, Iran since april 2007 till april 2008, 278 (86.6%) patients had uncomplicated appendicitis and were enrolled in our clinical trial. The patients were randomly assigned to two groups of interrupted suture closure (n=139) and subcuticular suture closure (n=139). Anesthesia method and surgical technique were similar between the two groups. All patients were followed up post-operatively (four weeks) for the presence of infectious drainage, pain, erythema, swelling and warmness at the surgical site.
Results: The patients' sex and their mean age were not statistically different between the groups. There was no significant difference in the frequency of surgical site complications between the two groups (five cases in the "interrupted" group and eight cases in the "subcuticular" group p=0.415).
Conclusion: This study showed that appendectomy incision closure with subcuticular sutures did not increase the risk of wound complications. From the point of better cosmetic outcome of subcuticular sutures, this method may be the method of choice for the closure of appendectomy incisions in uncomplicated appendicitis.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Cerebrovascular accidents are the most common complications in premature neonates (gestational age <37 weeks). Intraventricular hemorrhage (IVH) and hydrocephaly are the most common presentations of these accidents. Premature neonates less than 28 week age or 1000 gr have maximum risk of cerebrovascular accidents with prevalence of 30 percent. Early screening in high risk pregnancies with real-time ultrasonography can detect these lesions and affect on final prognosis. The purpose of this study is evaluation of brain ultrasonongraphic findings of 60 premature neonates born in Yazd University Hospitals, Yazd, Iran and relationship between these findings and delivery types.
Methods: In this descriptive cross sectional study 60 cases of premature neonates (less than 37 week) who were born from January to July 2007 in Yazd hospitals were evaluated ultrasonographically to detect cerebrovascular accidents.
Results: Among 60 premature neonates, 52(86.67%) were low birth weight and 8(13.33%) neonates weighted more than 2500gr. IVH was seen in five (9.6%) LBW neonates and hydrocephaly was seen in five (9.6%) LBW neonates. One LBW neonate (1.9%) had haloprocencephaly. Eight normal weight neonates had no abnormal ultrasonographic findings.
Conclusion: All factors that induce preterm delivery and high risk pregnancies can increase cerebrovascular accidents in premature infants. Neonatal weight had most powerful relationship with neonatal ultrasonograohic findings.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: American pediatric Association proposes to screen all neonates with Oto-Acoustic Emission (OAE). In developing countries, because of several limitations, health policy makers recommend to screen only in high risk patients. This study is performed with the aim to screen hearing loss in 950 high risk newborns hospitalized in hospitals affiliated to Tehran University using the OAE test.
Methods: A total of 950 neonates hospitalized in the Neonatal and NICU wards of Vali-e-Asr, Shariati, Medical Center and Bahrami Hospitals during the years 2004-2006 who showed at least one risk factor using TEOAE hearing test were enrolled into this cross-sectional descriptive analytical study and were diagnosed with mild deafness and total deafness. Blood exchange due to hyperbillirubinemia, septicemia, congenital heart disease, the fifth minute apgar scores below six, PROM more than six hours, epilepsia, need to NICU more than five hours, pneumonia and Oto-Toxic drugs were considered as risk factors. Data was past medical history, current disease, admission cause, sign & symptoms and complications of disease.
Results: Multivariate logistic regression and paired t-test showed that blood exchange, low birth weight and low first minute Apgar scores had the highest independent risk for hearing loss among newborn.
Conclusion: Despite of the low prevalence of neonatal hearing loss, screening of hearing loss at early stages is important.

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

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

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Background: Scorpion envenomation is considered as one of the Public Health problems in some countries in the world including Iran. Annually, approximately 30,000 scorpion stings happen in Iran from which 12% belongs to Hemiscorpius lepturus (special small closely spaced, bead-shaped jointed tail, similar in the shape to a cows tail, and is locally called ‘‘gaodim'' (Gao, cow dim, tail)) with 95% mortality. The main treatment is antiserum therapy which is produced in horse and is the only way to neutralize the venom. Due to the anaphylactic shock of the horse antiserum in some of the stung patients other source of antiserum is recommended. In this study the ability of produced camel antiserum in neutralizing the scorpion venom of Hemiscorpius lepturus was performed in Balb/c model.

Methods: Camel is an animal model that genetically is compatible with human genome utilized in this research to produce antiserum against scorpion venom. Two camels were used for immunization with the venom of Hemiscorpius lepturus. ELISA method was used to confirm the immunity. Antiserum was produced and used for neutralizing test. The precipitated antiserum with saturated ammonium sulfate (SAS) was also used to perform the neutralizing test in mice.

Results: The results indicated that the amount of 200 µl of antiserum and 400 µl of SAS antiserum were able to neutralize the amount of 1 LD100 of the venom and the survived the mice from death.

Conclusion: The result indicated that camel antiserum against scorpion venom is capable to neutralize the crude venom in mice model. Due to the safety of camel serum in human, it is suggested that the produced antiserum in camel can be substitute with the traditional horse antiserum in scorpion stung patients.

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Background: Estimation of Left Ventricular End Diastolic Pressure (LVEDP) among patients with Mitral Stenosis (MS) helps to diagnose diastolic dysfunction and to explain their symptoms. However, Conventional Doppler measurements have limitation in predicting of LVEDP. This study sought to establish whether the correlation between measurements derived from Tissue Doppler echocardiography and LVEDP remains valid in the setting of severe mitral stenosis.

Methods: Thirty three patients with moderate to severe MS who had indication for left heart catheterization enrolled during 1387-88 in Imam Khomeini Hospital in Tehran, Iran. The mean diastolic transmitral pressure gradient and mitral valve area (MVA) were calculated, and Two-dimensional, M-mode, color Doppler and tissue Doppler Imaging indices such as: early diastolic mitral inflow velocity (E), annular early diastolic velocity (Ea), E/A ratio, Isovolemic relaxation time (IVRT), Pulmonary Vein systolic and diastolic flow velocities, Velocity Propagation, LA size, TE-Ea, Tei Index were obtained in maximum three hours before cardiac catheterization. The echocardiography analysis was performed offline without knowledge of hemodynamic data Linear correlation and multiple linear regression were used for analysis. p< 0.05 was considered significant.

Results: In univariate analysis, E/Ea was associated with LVEDP significantly (p = 0.04, r = 0.38). There was also a significant correlation between TE-Ea and LVDP (p = 0.01, r = -0.44). In multiple linear regression Tei Index (ß = 0.4, p< 0.02), and TE-Ea (ß = 0.5, p = 0.02) were showed as independent predictors of LVEDP (R2 = 49%).

Conclusion: Although we observed a moderate correlation between Doppler measurements and LVEDP in patients with severe MS, more similar studies are required.

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Background: Nowadays skin damages caused by ultraviolet (U.V.) radiation from the sun were increased accordingly necessity for safe and inexpensive protective products for reducing the harmful effects of this ray is unassailable. The antiradical, anti irritation and anti-cancer properties of silymarin make it a suitable option for use in cream formulation to investigate its effect on skin disorders caused by U.V. radiation. In this research effect of local application of a cream containing silymarin in prevention of the harmful effects of U.V. radiation on the guinea pig skin were studied and evaluated by using histopathologic and clinical findings.

Methods: 75 albino guinea pigs were randomly divided into five groups of fifteens. 2cm2 of the back hair was shaven. In the first group no treatment was applied, in the second group vaseline, in group 3 base cream without silymarin extract, in group 4 silymarin extract and in group 5 cream containing silymarin extract were used.

Results: In clinical assessment, skin scaling, skin irregularity, erythema, skin hyperpigmentation, and edema were observed and in histopathological observation epidermal hyper keratosis, hyperpigmentation, exocytosis, acanthosis, chromatin discoloration in nucleus of epidermal squamous cells, perifolliculitis, dermal vascular hyperemia, edema and dermal thickness, infiltration of plasma cell lymphocytes and eosinophyls into dermis were detected. The statistical comparison of group 1 and group 5 shows statistically significant difference in most indices (p<0.01).

Conclusions: Clinical and histopathologic examinations showed that local application of a cream containing silymarin is effective in prevention of skin damage caused by U.V. radiation in guinea pig's skin also the results of the clinical and histopathologic observation in this study confirm the enzymatic results in other researches.

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Background: Proper nasal tip control is a difficult step in rhinoplasty. The aim of this study was to compare the effects of two cartilage modifying methods, Septocolumellar Suture (SCS) and Lateral Crural Overlay (LCO), on nasal tip projection and rotation.
Methods: In a single-blinded clinical trial, 36 patients who were scheduled for nasal tip deprojection were enrolled. A profile photograph of face was taken from all the patients before and three months post operation. Nasofacial angles, TP:Ln ratio for assessing nasal tip projection, tip columellar angle and nasolabial angles for nasal tip rotation assessment were measured by a computer software. The patients were randomly divided into two groups that underwent open rhinoplasty.
Results: Both the LCO and SCS methods were accompanied by a significant reduction in nasofacial angle and TP:Ln ratio, there was raised nasolabial and rotation angle in comparison to preoperative values. The use of LCO method in comparison to SCS resulted in more increase in the nasolabial angle (11.83±3.05 Vs. 4.56±1.62 degree) and Rotation Angle (11.44±3.22 Vs. 1.56±1.04 degree) and resulted in more reduction in post-operative TP:Ln ratio in comparison to preoperative measures (-0.05±0.01 Vs. -0.03±0.01), however, the difference in the nasofacial angle was not significant.
Conclusion: Both cartilage modifying techniques resulted in significant reduction in the projection and increasing in the tip rotation. Lateral Crural Overlay (LCO) seems to be more effective than Septocolumellar Suture (SCS). Therefore, the SCS method is recommended for patients who need more nasal tip rotation and deprojection in rhinoplasty.

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Background: Gall stone is an important health problem in the world for which different risk factors have been characterized. Gall stone and cardiovascular disease have common risk factors. Homocysteine is accepted as one of the risk factors for cardiovascular disease. We aimed to study the effect of homocysteine level on gall stone formation.
Methods: 54 patients with gall stone-related diseases and 54 patients without stone (control group) were studied from January 2007 to December 2008. Control group consisted healthy subjects with ultrasound proven normal gallbladder. Serum homocysteine level was checked in both groups. Homocysteine level of equal or more than 15 mmol/l was considered as abnormally high.
Results: Cases included 43 women (79.6%) and had mean age of 50.76±15.23 years. Homocysteine level was significantly higher in patients with gallstone in comparison to control group (p=0.014). Risk of gall stone increased 3.4 times in persons who have homocysteine level equal or greater than 15mmol/l (p=0.019). The mean level of homocysteine was higher in men than women (p=0.03). The mean level of homocysteine did not differ significantly in patients with simple gallstone and patients with gallstone-related inflammation disorders (cholecystitis, cholangitis, and pancreatitis). Additionally, one unit increase in BMI level was associated with 1.12 times increase in the risk for gall stone formation (p=0.035).
Conclusion: The homocysteine level is increased in patients with gall stone-related diseases. Homocysteine may be considered as a risk factor of gall stone formation.