Tehran University Medical Journal

Herbal essential oils are volatile, natural, complex compounds formed by medicinal plants as secondary metabolites. As reported by international organization for standardization (ISO), the term "essential oils" (EOs) is defined for a product obtained from vegetable raw materials or fruit using distillation with water or steam. The EOs are generally complex mixtures of volatile organic compounds include hydrocarbons (terpenes and sesquiterpenes) and oxygenated compounds (alcohols, esters, ethers, aldehydes, ketones, lactones, phenols, and phenol ethers) compounds. In medicinal plants, the EOs chemical profile usually very varies because of both intrinsic (sexual, seasonal, ontogenetic, and genetic variations) and extrinsic (ecological and environmental aspects) factors, also the EOs composition differs not only in the number and type of molecules but also in their stereochemical structures, and can be very different according to the extraction method. EOs represents a “green” alternative in the nutritional and pharmaceutical fields due to reported antimicrobial, antioxidant, anti-inflammatory and anticancer properties thus, in recent times; EOs has gained great popularity as consumers have developed a particular ever-growing awareness toward the use of natural ingredients, especially in food and household. Therefore, the present review provides a comprehensive summary on the method of preparation of EOs from medicinal plants, chemical composition analysis, their biological and pharmacological effects and their potential benefits on health level. Present information was compiled using keywords “Essential oil, Medicinal Plants and Natural additive in scientific database as Science Direct, Elsevier, PubMed, Google scholar and SID, until 2005 to 2015. EOs have great antimicrobial activity and mostly destroy bacteria, fungi and viruses without harmful effects on consumer’s health. Finding of this study showed that the Thymol, α-Pinene, β-Pinene, Cumin Aldehyde, Carvacrol, Germacrene, Linalool were the main components. Also, EOs have antioxidant, anti-inflammatory and many other pharmacological properties which enhance their potential application. EOs have potential biological and pharmacological activities and so have many applications in pharmaceutical and food industries.

Background: Abnormal placental adhesion refers to abnormal placental implantation in which the anchoring placental villi attach to myometrium and even uterine serosa which may invade the bladder and bowels. One of the most important complications of these abnormalities is severe hemorrhage during placental removing which may even necessitate cesarean hysterectomy. Since uterine conservation is an important issue especially in young women at reproductive age, conservative management has a cardinal role to reduce bleeding during surgery. Uterine artery embolization as the first line conservative approach is reserved for women that fertility preservation is very important or whom the risk of severe bleeding during cesarean section is very high due to abnormal placental adhesion. Use of embolization in unstable patients is limited because it usually cannot be performed as rapidly as other measures. The aim of this study was to report two cases of uterine artery embolization before cesarean section in pregnant women with abnormal placental adhesions.
Case presentation: Two 35 and 37-year-old pregnant women at gestational age of 34 weeks diagnosed as placenta previa and abnormal placental adhesion (placenta percreta) who intended to preserve their fertility underwent bilateral uterine artery embolization before cesarean section in Ghaem hospital, Mashhad University of Medical Sciences, Iran at September 2016. Bleeding during surgery was significantly decreased and uterine preservation was successfully preformed without any serious complications during and after the surgery. In the next follow-ups, they had normal menstruation about two months after the cesarean section. 
Conclusion: In placental adhesive disorders, uterine artery embolization at the time of cesarean section could significantly decrease bleeding during surgery, so uterine and fertility preservation could be performed in this situation.
 

Background: Endometrial cancer (EC) is the most prevalent genital related cancer of females. One of the controversial points about endometrial cancer surgery is preserving or dissection of sentinel lymph nodes (SLNs). Lymphatic mapping and sentinel nodes sample has been used widely for diverse solid tumors in order of finding metastasis in lymph nodes. The aim of current study was to evaluate diagnostic value of technetium-99 and methylene blue in diagnosis of sentinel lymph node involvement in low-risk endometrial cancer.
Methods: This cross-sectional study was conducted through 2016 on 14 patients with low-grade endometrial cancer referred to Al-Zahra and Shahid Beheshti Hospitals (affiliated to Isfahan University of Medical Sciences), Iran, in 2016-17. Eighteen and twenty-four hours before operation, patients underwent technetium-99 (Tc-99) injection to uterine cervix. Twenty-four hours prior to surgery, patients were referred to resident of gynecology and filled demographic checklist. In next day during operation, Tc-99 was detected by gamma probe. Methylene blue was injected in operation room and blue nodes were detected by naked eye. All patients underwent total hysterectomy, bilateral salpingo-oophorectomy and pelvic lymphadenectomy. Dissected lymph nodes were sent for frozen section and assessment of positive/negative metastasis. Then data were analyzed with SPSS software, version 20 (SPSS Inc., Chicago, IL, USA).
Results: Mean age of our patients was 60.64±9.18 years. Total number of 80 SLNs was dissected. 18.8% of nodes were detected using methylene blue, 12.5% using tecnethium-99 and 6.3% were in common with both methods. Number of two nodes was metastatic and was detected by blue dye and Tc-99. Sensitivity, negative predictive value and detection rate of Tc-99 alone, methylene blue alone and their combination was 100% and false negativity of all above was 100%.
Conclusion: Due to findings of our study, as sensitivity, detection rate, negative predictive value and false negativity of methods lonely and in combination were similar thus based on higher probability of blue dye adverse effects, use of Tc-99 lonely may be adequate.
 

Background: In three-dimensional conformal radiation therapy (3D-CRT), contrast-enhanced CT (CECT) image is commonly used to assist radiation oncologists in diagnosing regions of interest, so that normal and target tissues can be better delineated. CECT causes the temporary increase in the CT number and the corresponding electron density (ρe). Administrated contrast agents (CA) during CT simulation and altering the ρe of structures can be effective on radiation calculations and dose-volume histograms (DVHs) in radiotherapy treatment planning. Therefore, present study was designed and performed to determine the influence of the administrated CA on DVHs.
Methods: Current study performed as a self-controlled clinical trial study with before/after method at Imam Reza Hospital, Kermanshah City, during the period from June 2015 till August 2016. Ten patients with pelvic cancer included in this study through simple sampling. Cases with prior reactions to CA, diabetes, renal diseases, and asthma were excluded. Two sets of CT-scans were taken for each patient in the same position and coordinates. Primary study sets contained pre-contrast images and secondary study sets were performed post-contrast. Both sets of CT images were transferred to the treatment planning system (ISOgray® software, Version 4.1.3.23 L, DOSIsoft®, Cachan, France). All treatment plans were generated on pre-contrast and subsequently copied to the post-contrast CT. Quantitative calculations were performed in treatment planning including the difference in ρe before and after CA administration.
Results: The prostate (1.27%), the bladder (0.62-0.79%) and the rectum (0.43-0.56%) showed the largest changes in average ρe increase. The results confirm the expected relationship of increasing attenuation, CT number, and ρe with increased tissue density due to the CA. However, the DVHs showed insignificant difference between pre-and post-contrast CTs for 18 MV photon beam.
Conclusion: The results showed statistical insignificant difference between with and without CA CTs treatment plan in pelvic field for targets and OARs. These results may serve as a reference to justify the use of CECT data sets for 3D-CRT planning of pelvic region cancers using DosiSoft ISOgray system.

Background: Children's health, preserving and promoting it is a health priority of any society. Malnutrition affects all age groups, but malnutrition in children is one of the most common nutritional problems that can delay body growth, shortened height, frequent infections, mental retardation, the prevalence of mental disorders, lack of academic achievement and reduced efficacy. Because of the importance and impact of this issue in children, the purpose of this study was a systematic review and meta-analysis of the prevalence of underweight in Iranian children, in order to highlight the importance of this issue to health policy-makers.
Methods: A meta-analysis was performed for relevant articles in scientific databases including Scientific Information Database (SID), ScienceDirect, PubMed and Google Scholar. Entrance criteria included cross-sectional studies (March 1996 to February 2017) that had a low incidence of underweight in Iranian children in different parts of Iran. Non-relevant articles included review articles, interventions, cohorts and case studies, and studies that looked at obesity, overweight and the relationship between these factors and other diseases, excluded from the study list. Reference lists of identified articles were reviewed for additional articles. Heterogeneity of study was checked using I2 index and the possibility of publication bias by funnel plot and Begg and Mazumdar's rank correlation test and a significance level of 0.1. Data were analyzed using the comprehensive meta-analysis software, version 3 (Biostat, Englewood, NJ, USA).
Results: In 26 articles reviewed in the study, total number of participants was 142938  persons at the age of 1 month to 12 years. The overall prevalence of underweight in Iranian children was 15.5% (Cl 95%: 12%-19.7%) during 1996 to 2017. The highest prevalence of underweight in was recorded in Birjand city in 2006 and Zahedan city in 2009, 68.6% (Cl 95%: 63.3%-72.9%) and the lowest prevalence of underweight in was found in city of Jahrom in 2013, 1.8% (Cl 95%: 1.2%-2.9%).
Conclusion: According to the results of this study, the prevalence of low-birth-weight in the country is high and requires interventional measures.

Background: The study of their knowledge, attitude, and behavior toward health is an essential step for health planning. In the urban area, there are several concerns about environmental pollution, health status, the dangers of insecurity, and bad dietary habits. The aim of the study was the determination of knowledge, attitude, and behavior of Tehran citizens in order to plan better municipal services.
Methods: This descriptive, cross-sectional study was conducted on 13000 participants between 15-84 years in 22 districts of Tehran, Iran University of Medical Sciences, in August and September of 2011. Cluster sampling and self-administered reliable and valid questionnaire were used for data gathering. The inclusion criteria are all of citizens of Tehran. Age, sex, marital and job status, obesity, physical activity, hypertension, myocardial infarction, accidents, diabetes, nutrition, stroke, psychological behavior, smoking, addiction and drugs, musculoskeletal, sexual behavior, anemia, physical environment, fat blood, cancer, chronic obstructive pulmonary disease, dietary habits and socioeconomic status were measured under standard protocols and by using calibrated instruments. 
Results: From 13000 participants in the study, 11753 (90%) was fulfilled the questioners. Nonresponse rate from 11753 participants was 8.6%. The proportion of obesity/overweight was 50% and 29.5% of people had appropriate physical exercise, 37.6% reported a tobacco consumer in their family and 4.5% reported an experience of substance misuse. Also, 29.2% and 24.8% from these had anomalistic consuming of salt and soft drink, respectively. Of the participants, 44.8%, 89.1% had a good knowledge and attitude, respectively. Cronbach alpha coefficient was 0.82 and 0.79 for knowledge, attitude and behavior, respectively. In additional, the correlation coefficient between test and re-test questions was 0.91. 
Conclusion: This study was a comprehensive study to measure the knowledge, attitude and practice of Tehran citizens using reliable and valid questionnaires about general health status. A considerable percentage of Tehran citizens suffering from overweight, obesity, hypertension, diabetes, high blood lipids and smoking consuming and using anomalistic from TV and computer. The results can be used as a framework and guide to prioritize problems and planning health education interventions in Tehran

Background: Genital warts are one of the most common sexually transmitted infections, 1% of sexually active population have anogenital warts (AGWs). According to previous studies, the disease affects people's quality of life and imposes financial costs on health systems.
Methods: The present study is a case-control study at spring of 2018. The quality of life of 65 patients with anogenital warts that were referred to Boali-sina Hospital in Sari, Iran compared with 65 control subjects. The World Health Organization Quality of Life Brief (WHOQOL-BREF) questionnaires was used.
Results: According to the results, among the patients with anogenital warts, the quality of sexual contact in majority them were not affected by the disease (70%). The total cost of treatment was less than the monthly income of the family until the time of participating in the study (92%). There was no significant difference between the mean and standard deviation of physical health scores and mental health scores in the control and patient groups. (Respectively P=0.14, P=0.93). There was no significant relationship between the mean of physical health scores with disease severity. However, there was a significant difference between the mental health score in the two groups of patients with low and high levels of severity (P=0.01). Physical health scores in the whole sample have a significant relationship with gender, so that, in women, physical health score was lower than that of male, but the mean score of mental health in both male and female patients was not significantly different (P=0.18). In the control group the score of mental health was lower in women (P=0.041).
Conclusion: In patients with anogenital wart, quality of life doesn’t change significantly, although, mental health scores directly related with disease severity.

Background: Animals have an internal biological clock with melatonin hormone that helps them to adapt to light/dark circles. Since melatonin is associated with an alteration in the expression and production of opioid receptors, this study aimed to evaluate the effect of changes in the light/dark circles on pain sensation in rats.
Methods: This research study in order to investigate the thermal and chemical pain sensation using tail flick and formalin tests, 35 Wistar rats were randomly divided into five groups of seven animals, including 24 hours of light (24L), 16 hours of light / 8 hours of darkness (16L/8D), 12 hours of light / 12 hours of darkness (control), 8 hours of light / 16 hours of darkness (8L/16D) and 24 hours of darkness (24D) were tested. The study was conducted at the Department of Biology of Ferdowsi University of Mashhad, Iran, from April to September 2015. Also besides the Rotarod test was performed to determine the general motor activity of animals.
Results: In the tail flick test, an increase in the time of darkness elevated the threshold of thermal pain and subsequently resulted in analgesic effect in the 24 hours of darkness (24D) group (P=0.03), while reducing the dark period in the group of 16 hours of brightness / 8 hours of darkness caused a reduction in the threshold of thermal pain, resulting in hyperalgesia (P=0.002). In the formalin test, the chemical pain score at the end of the chronic phase was significantly increased in the experimental group of 16 hours of brightness / 8 hours of darkness compared to control, indicating hyperalgesia (P=0.03).
Conclusion: Perhaps, alterations in light duration may change the production of melatonin and opioids and their receptors. Therefore, it is expected that reduction of the duration of darkness and thus shortening the period of increased production of melatonin and the subsequent lower expression of opioid receptors, in this group, resulting in a lower thermal pain threshold and analgesic response.

Background: Alterations of neuroplasticity and cortical excitability are important pathophysiological factors in stroke. Modulation of the neuroplasticity has been proposed as an underlying mechanism of recovery in different neurological disorders. But it is not still clear how the CNS faces the complexity of muscle control. Neuroplastic processes may be used for the functional improvement of stroke, in particular for improving cortical functions. Neuromotor synergies is one of the most attractive hypotheses in motor control. Emerging evidence suggests that rehabilitation efforts that challenge to maximize the extent of neuroplastic changes can provide the greatest potential for rehabilitation success. A better understanding of the basic mechanisms of neuroplasticity will guide advances in neural repair and rehabilitation. Resolving the relationship of neural plasticity and individual field differences and may also have important clinical utility in developing appropriate neurorehabilitation outcomes and recovery. The objective of the present study was to review evidence of the effect of neuroplasticity on neuromotor synergies in healthy and stroke individuals on rehabilitation programs.
Methods: In the present systematic review study, we investigated the neuroplasticity interventions in stroke individuals. Articles published between January 2005 and January 2017 were reviewed. We searched for five keywords (neuroplasticity, motor learning, muscle synergy, rehabilitation, and stroke) using ProQuest, PubMed, Web of Science, and Google Scholar.
Results: After initial screening and deleting irrelevant studies, 41 studies were chosen for the analysis. Studies were assessed and analyzed methodologically. Proper interventions were selected according to the least error criteria and outcome. Using a targeted selection approach. During the review process, eight articles were selected as the main articles for the review.
Conclusion: Considering the results of the current study, it seems that the neuroplasticity affects the domain of rehabilitation and muscle synergy in individuals with stroke and provides a desirable environment for plasticity-based intervention aimed at motor learning in this population. Large studies with long follow-ups are needed to explain the beneficial effects of neuroplasticity based training combined with rehabilitation protocols.

Background: Venous anomalies are the most common vascular malformation of the central nervous system in adult, it can form anywhere in the body, but are most likely to cause symptoms when they grow in the brain or spinal cord. Common symptoms include headaches or seizures. Experiencing symptoms depend on where the lesions grow and how many of the lesions are present. Most of the time, these formations cause no problems. In some people, knowing the clinical signs and possible future complications in the disease can help to treat the disease and diagnose it.
Methods: In this Prospective cohort study, 41 patients with cavernous malformation who were diagnosed by neurologist referred to Sina Hospital in Hamedan City, Iran, from 2016 to 2017 were studied. Patients' information about their referrals during the follow-up period were collected and the results were reported.
Results: This study was conducted on 20 (48.79%) females and 21 (51.21%) males with the mean ages of 50±2 years. The most common manifestation of disease was seizure in 20 patients (48.78%). Most of these lesions were found in parietal lobe in 11 cases (26.82%) and then in the frontal lobe with 8 cases (19.51%). In terms of complications during follow-ups, 16 patients (39.2%) were uncomplicated, 16 patients had 48 episodes of seizure, seven patients had nine episodes of hemorrhage, two patients with hemiparesis, one patient with headache and one patient with sixth cranial nerve paralysis. According to the associated disease and risk factors, nine patients (26.82%) had high blood pressure, five patients (12.19%) had meningioma and three patients (7.31%) had diabetes. Seven patients (17.07%) had a positive family history that symptoms and complications in this patients are higher than the rest of patients.
Conclusion: In this study, most of the cases are sporadic and the most common symptom was seizure. The most common symptom in supratentorial lesions were seizure whereas in multiple and infratentorial lesions were bleeding. Five patients were involved with meningioma which could be considered in more studies with more patients in future.

Background: Infant mortality is important as a standard indicator for the development of health, educational and social health systems in each country. Considering the fact that in different studies of the country there are different statistics on the prevalence of infant mortality in the intensive care unit and the general statistics on the prevalence of mortality in neonates in the country are unclear and unclear, the aim of this study was systematic review and meta-analysis for determine the prevalence of mortality in infants admitted to the intensive care unit (ICU) of hospitals in Iran.
Methods: A meta-analysis was performed for relevant articles in scientific databases including scientific information database (SID) and Magiran, ScienceDirect, Scopus, Medline (PubMed) and Google Scholar. Entrance criteria included cross-sectional studies between March 2000 to September 2018. The search process in these databases was performed using keywords: Neonatal, Intensive Care Unit, Mortality, and Iran. Non-relevant articles included review articles, interventions, cohorts and case-control studies, excluded from the study list. Heterogeneity of study was checked using I2 index and the possibility of publication bias by funnel plot and Egger test. Data were analyzed using the comprehensive meta-analysis software, version 3 (Biostat, Englewood, NJ, USA).
Results: The overall prevalence of infant mortality in ICU hospitals was 21.8% (95% CI 14.4-31.6%), the highest prevalence of infant mortality in Isfahan was 64.4% percentage (95% CI 57.5-70.9%) and the lowest mortality rate in babies in Babol's intensive care unit with 5.1% (95% CI 3.8-6.7%). The results of the study showed that the prevalence of infant mortality was significantly reduced with increasing sample size (P<0.05). Also, with an increase in years of research, the frequency of infant mortality in the intensive care unit increases, which is also statistically significant respectively (P<0.05).
Conclusion: Considering the high prevalence of infant mortality in ICU hospitals in Iran, health policy makers need to take effective measures to raise awareness of parents as well as effective measures to reduce infant mortality.

Background: AIDS is an emerging disease, and despite the fact that it has not been recognized for the first half-century since its inception, it has been known as a century-old disaster. This disease, by proliferation in immune cells and ultimately by weakening the immune system, makes people vulnerable to diseases. Our study seeks to examine existing cases of HIV/AIDS patients in East Azerbaijan province in Iran and provides useful guidance for patient diagnosis, treatment, and care.
Methods: This is a descriptive-analytic study in which the target group includes all HIV-positive or AIDS patients identified or reported from 2004 to 2014 in Tabriz Medical Sciences or Health Centers of East Azerbaijan province. The demographic information of all patients were recorded by a researcher-made questionnaire during visiting the disease-management counseling centers. All data including transmission of the illness (including all possible ways), the diagnostic date, the onset of treatment and the date of death were collected, and then entered into the software Stata, version 11.0 (Stata Corp., College Station, TX, USA). The information were imported in the ArcGIS software, version 10.7.1 (ESRI Inc., Redlands, CA, USA), maps were created, and geographic and spatial data were analyzed.
Results: According to the results of this study, most patients with 89.9% were male, 28.9% were under the age of 36 years, 32.3% had elementary education, and the most common way of transmission with 42.3% is through the shared infusion.
Conclusion: According to the results of this study, the highest prevalence of AIDS in East Azerbaijan province was observed in men under the age of 36 years and primary and lower secondary education in Tabriz and Maragheh cities.

Background: Gastric cancer (GC) is considered as one of the most common types of cancer worldwide with poor prognosis and generally limited treatment options. Recent studies have indicated that HER2, MDM2, MYC, MET, and TP53 play an important role in the development of gastric cancer. Therefore, the aim of this study was to evaluate the incidence of amplification/deletion of these genes in patients with gastric cancer.
Methods: In this descriptive study, a total of 37 gastric cancer tissue samples from GC patients including 23 males (62.2%) and 14 females (37.8%) referred to the Hematology-Oncology and Stem Cell Research Center of Shariati Hospital, Tehran, from March 2015 to February 2016 were evaluated. The patient's age at diagnosis ranged from 33 to 85 years (median: 65 years). The amplification pattern of HER2, MDM2, MYC and MET genes and TP53 deletion were investigated by fluorescence in situ hybridization (FISH) technique performed on 3 to 5 micron section obtained from formalin-fixed and paraffin-embedded cancer tissues.
Results: The tumors were preferably identified at the distal stomach (54.05%) in comparison to tumors arising from the gastric cardia. The tumor size varied between 2 and 5 cm (average, 3.5 cm). Seven of the cases (19%) had advanced tumors at the time of diagnosis. HER2, MDM2, MYC, MET and TP53 copy number alteration were successfully determined in all samples obtained from the GC patients. HER2, MDM2, and c-MYC genes were amplified in 2 (5.41%), 1 (2.7%) and 3 (8.11%) of 37 patient samples, however, MET gene amplification and TP53 deletion were not observed in the obtained GC tissue samples. Co-amplification of HER2, MDM2, and MYC genes, and co-amplification of HER2 and MYC genes were detected in one patient.
Conclusion: The results of this study indicate the low frequency of MDM2, HER2 and MYC genes in gastric cancer patient and their copy number alterations may provide diagnostic and prognostic marker for GC patients.

Neurodegeneration with brain iron accumulation (NBIA) is a rare set of inherited neurodegenerative disorders with abnormal accumulation of iron in basal ganglia. It is a clinically and genetically heterogeneous disorder that is characterized by movement disorders, dystonia, dysarthria, Parkinsonism, intellectual disability, and spasticity. The age at onset varies from childhood to adulthood and the rate of progression is different among affected individuals. Although there is no information about the exact prevalence of NBIA in the world-wide, it is estimated less than 1/1,000,000 in population. NBIAs are inherited in autosomal recessive, autosomal dominant or X-linked fashions. Until now more than 10 genes have been identified for this group of disorders. Among these, only two genes encode proteins that directly involved in iron metabolism. Therefore, how iron contributes to the pathogenesis of NBIA remains unknown. The remaining NBIA-causing genes participate in lipid metabolism, lysosomal functions or autophagy process, and the roles of some of them remain unknown. NBIA is categorized based on the genetic cause of the disease. PKAN, PLAN, MPAN, and BPAN are the most common forms of the disease result from mutations in the PANK2, PLA2G6, C19orf12, and WDR45 genes, respectively. The diagnosis of NBIA is usually based on clinical features and a specific pattern of brain MRI which results from the abnormal accumulation of iron. For example, the pattern of “eye of the tiger” is observed in the brain MRI of PKAN cases. Since, clinical evaluations and neuroimaging have failed in the diagnosis of the disease in some NBIA cases, genetic testing will be helpful. Development of whole-exome sequencing (WES) has facilitated the identification of disease-causing genes but it seems some of NBIA-genes have remained unknown, yet. Identification of novel genes and molecular pathways will enable a deeper understanding of the underlying molecular bases and our knowledge about the pathogenesis of the disease. There is currently no comprehensive study about the NBIA in Iran, however, the latest discovered NBIA gene, GTPBP2, has been identified in an Iranian family.

Background: Previous researches have provided contradictory results about on working memory performance after the coronary artery bypass graft (CABG). In addition, studies have focused on the elderly community. For this reason and with regard to the importance and direct effects of working memory on the quality of life human. This study was designed to compare working memory of young CABG patients with age range of 30-55 years one year postoperatively with healthy subjects.
Methods: In this Case-control study, which was conducted from February 2017 to October 2018, two groups of people, 40 patient men with coronary artery bypass graft that admitted to the heart center of Tehran in last year and 64 healthy males were selected with using available sampling method. Both groups were tested with Wechsler's working memory scale.
Results: The results of the study showed that the mean and standard deviation of the age of coronary artery bypass graft patients were 52.65 and 5.559, respectively, and the mean and standard deviation of healthy subjects were 41.81 and 8.619, respectively. The results showed that The two group had significantly difference (P<0.01), in the sub scales of the working memory including of the forward auditory memory and reverse auditory memory, total score of auditory memory, reverse visual memory and auditory memory span and the two groups had significantly difference (P<0.05), in the total score of visual memory. But the two group had not significantly difference (P>0.05) in the forward visual memory (CABG [mean=5.40 & standard deviation=1.41] Healty people [mean=6.13 & standard deviation=3]) and visual memory span (CABG [mean=5.35 & standard deviation=1.12] Healty people [mean=5.56 & standard deviation=1.97]). The results showed that Patients with CABG than healthy people have overall poorer results for all sub scales the of working memory test.
Conclusion: The results of this study confirm the prevalence of relatively high cognitive decline, especially in working memory after CABG, and provide a pattern of persistence of cognitive decline after one year of coronary artery bypass surgery in young patients aged 30 to 55 years.

Background: Guillain-Barré syndrome is an autoimmune inflammatory disease, which manifests itself as an acute motor weakness of the organs, diagnosed as affecting the motor spinal nerve roots generally and causing muscle and motor weakness, the cause of this disease is the presence of active antibodies against the myelin sheath around the spinal nerve roots. Guillain-Barré syndrome is the most common and most severe unpleasant neuropathy that affects about 100,000 people worldwide annually.
Methods: This is a descriptive analytical study, the data of 354 admitted patients were reviewed and 262 cases, which matched the criteria for entering the study, was included. The criterion for entering the study was clinical diagnosis.Required information were included age, sex, complaints of disease, and visitation period. Data was analyzed by using Microsoft Excel 2013 (Microsoft Corp., Redmond, WA, USA) and study was performed on Imam Reza and Farabi Hospitals of Kermanshah in Iran, from March 1993 to February 2013.
Results: 59.5% were male and 40.5% female, and the mean age of the patients was 44.6±22.9. The most affected individuals were at the age of 30-50 and the highest prevalence was observed in spring. Acute inflammatory demyelinating poly-radiculoneuropathy with 53.4% was the most common backward disorder in patients and 5.7% among deaths among patients.
Conclusion: The results of the present study showed that Acute inflammatory demyelinating poly-radiculoneuropathy had the highest prevalence in patients and decreased with increasing age, and this syndrome was more prevalent in the spring.