Journal of

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Introduction :Acute myocardial infarction (AMI) is the most common cause of death in many countries, and also one of the common causes of death in Iran. As the death rate due to AMI is not clear and the survival rate of these patients had not yet been studied in the city of Yazd, this study was undertaken. Methods and materials : This was a survival study performed in Yazd between the years 2000 and 2002. 210 patients with definite AMI (according to clinical findings, ECG and enzyme criteria) were enrolled in this study (case series). They were admitted to Shahid Rahnemoon Hospital of Yazd (A general hospital). Results : The population under study included 161 males with mean age of 5914 years and 59 females with mean age of 6610 years. Frequency of hypertension, diabetes mellitus, hypercholestrolemia, hypertriglyceridemia and smoking was 27%, 22%, 20%, 22% and 32%, respectively. All risk factors except smoking were more common in females than men. 83.3% of infarctions were Q-wave infarctions, 16.7% non- Q-wave infarctions. 53% inferior wall and 40% were anterior wall infarctions. Infusion of streptokinase was done for 62% of patients. Mean ejection fraction of left vantricle was 48% in males and 45% in females. In-hospital mortality rate was 12.4% and higher in patients older than 70 years, diabetics, and anterior wall infarction patients. It had no correlation with sex. Surprisingly, smoking was accompanied with a very low in-hospital mortality rate. Conclution : One – year mortality rate of the patients in this study was 16.7% . It was higher in females, diabetics, anterior wall infarction patients and those with an ejection fraction less than 45%. The one year mortality rate in smokers was comparitively lower than non smokers in this study.

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Introduction: It is a fact that iron deficiency anemia in infants leads to unpleasant effects on Growth , Cognition and Psyche for life . During the late seventies,relation of iron deficiency anaemia(I.D.A) and permanent complications was suggested , and later on, several studies proved that handicaps occur when iron deficiency (I.D) is severe enough to develope I.D.A Method & Materials : In our study, we evaluated the prevalence of I.D.A and I.D in children aged between 6&60 months in Yazd . In this cross - sectional study, 449 cases were selected by clustering 239 boys and 210 girls. Hemoglobin( Hb) and ferritin was measured .5 cases were omitted from the study. Data was analyzed using SPSS computer software program. Results : In our study, prevalence of Iron deficiency anemia was 3.8% and that of Iron deficiency was 8.6%. Prevalence of other anemias in the population under study was 8.4% . 79.2% of children in this group were not anemic and considered as normal . Iron deficiency was twice that of Iron deficiency anemia. (p value< 0.05 ). Conclusion : The total prevalance of anemia in this study was 20.8% with Iron deficency anemia 3-4% and Iron deficiency 8.6% . The prevalence of iron deficiency and other forms of anemia in this study was less than many other parts of the world, except USA . Anemia in children aged 6-17 months was more than other age groups. Also, anemia in girls was more prevalent than boys .

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Introduction: Recurrent spontaneous abortion (RSA) is defined as three or more consecutive miscarriages, which affects 0.8 to 1% of pregnant women. Despite several well-established etiologic factors, the cause of RSA cannot be determined in almost 60% of the cases. It has been postulated that a part of these repeated pregnancy losses might be due to immune causes. Material and Methods: In the present case control study using flowcytometry, peripheral NK cytotoxicity was compared in three different groups. 21 women with history of RSA at the time of 3rd or higher abortion (Group I), 32 women with history of three or more previous abortions and at least three months had lapsed since the last abortion (Group II) and 32 pregnant women with no history of abortion and at least one successful pregnancy (Group III) were studied. Results: Group I and Group II showed significantly higher NK cytotoxicity than Group III in all of the effect to target (E: T) ratios (P≤0.045 and P≤0.002 respectively). NK cytotoxicity was similar in groups I and II. There were no significant correlation between the number of abortions, age and NK cytotoxicity. Conclusion: The results indicate an increased peripheral NK cell cytotoxicity in RSA groups as compared to pregnant control. NK cell cytotoxicity may be considered as a risk factor for RSA and for maintaining normal pregnancy, NK cell cytotoxicity may be down-regulated. Peripheral NK cytotoxicity is not elevated during first trimester in RSA women. It is suggested that detection of NK cytotoxicity in RSA women should be performed as a routine.

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Introduction: Everyday, millions of people around the world go through phlebotomy, either to donate blood or for therapeutic intention. The most important worrisome adverse effects are hemodynamic alterations. In this study, hemodynamic changes following blood donation were assessed. Methods & Materials: Three hundred laborers who donated blood voluntarily were enrolled in this study. Blood pressure (BP) and pulse rate were measured before the procedure, ten minutes afterwards, and one week following phlebotomy. Hemoglobin (Hgb) and hematocrit (Hct) were also determined prior to and one week after phlebotomy. Finally, results before and after donation were compared with each other. Results: 242 volunteers had normal BP and 58 were hypertensive. The mean systolic blood pressures (SBP) before phlebotomy, ten minutes after the procedure, and one week later were 120, 117, and 122 mmHg, respectively. During the same periods of time, the mean of diastolic blood pressures (DBP) were 77 , 78 and 78 mmHg , in order , while pulse rates on average were 80 , 82 and 76 beats/minute . None of the aforementioned changes were clinically significant. After one week, Hgb decreased by about 0.3 g/dl (P<0.001) and Hct declined on average of 1.7 (P<0.001). Forty six individuals had high DBP and one week after donation, their DBP was reduced by 7 mmHg. Age, body mass index and smoking did not have any significant effect on hemodynamic status. Conclusion: Hemodynamic changes in healthy blood donors were not clinically significant. It seems that DBP drops desirably in hypertensive individuals. This needs to be evaluated more carefully in future studies.

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Familial Mediterranean fever (FMF) is a hereditary condition which is characterized by recurrent episodes of fever and abdominal pain. On the other hand, Behcet`s disease (BD) is an immune mediated condition typified by recurrent oral aphthous lesions, inflammatory eye disease and multiple organ involvement. Association of these two conditions is rare. We present a pair of twins with FMF and BD in their mother.

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Rickets by definition is a condition in which the bone mineralization is defective. Among the large cause of Rickets (Vitamin D deficiency, gastrointestinal disorders, acidosis, renal tubular abnormalities...), Wilson's disease is a relatively rare cause. There are few cases of Wilson's disease presenting first as rickets in the literature. ‎ Here we present an Afghan girl with Wilson's disease presenting with intractable Rickets.‎

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Introduction: Invasive diagnostic procedures such as coronary angiography, in most cases, are accompanied by stress and anxiety for patients,which may effect on hemodynamic signs. Materials and Methods:This research, as a quasi experimental study, has the objective to determine the influence of applying methods of relaxation on hemodynamic signs in hospitalized 40 patients, experienciny coronary angiography (CA),, has been studied, in regard to existing conditions and methods of sampling and random allocation to two groups of control and relaxation at 2003 . Data collection tool included demographic and disease related information sheet, as well as record sheets for hemodynamic parameters at intervals of 8-12 and ½ hrs before, during and after the angiography. For relaxation group, the researcher would speak individually about the influence of relaxation, the day before angiography Then with the aid of client himself/herself, performed relaxation instances in a single bout, and eventually asked client to perform relaxation technique 2-3 times before going for angiography. In control group was attended in the usual manner preangiographically. Homodynamic parameters were measured in both groups 8-12 and ½ hrs, before during and after CA. Afterward, resulted data were analyzed statistically by T-Test Chi-squre. Results: With T-Test, respiratory rates½ hrs, beforeAngiography, diastolic blood pressure and Respiratory Rate after Angiography showed statisticaly significant difference between two groups (P<0.05). Other hemodynamic parameters showed no statisticaly significant difference between two groups (P>0.05).but most of parameters showed clinically significant difference between two groups. Conclusion: Therfore it is offered that relaxation method is applied after invasive procedures.

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Thiamine responsive megaloblastic anemia (TRMA), also known as Roger syndrome is an autosomal recessive disorder resulting from the deficiency of thiamine (Vitamin B1) transporter protein. This is the report of a 3- year follow up of a female child who presented in 2000 at the age of 11 with severe anemia, congenital deafness and diabetes mellitus. In our follow-up period we prescribed 100-mg thiamine tablet daily and after that there was a rise in her hemoglobin level to normal. Her hyperglycemia was controlled during the early phase of treatment. It recurred several months after start of treatment, but needed lower doses of insulin for control. Hearing loss did not respond to thiamine. Presently, the patient is apparently in good condition with normal hemoglobin level.

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Introduction: Communicational patterns of the parents can either positively or negatively influence children's personality. Parenting manner has long-term effects on behavior, function, expectations and eventually people's future personality. This study investigates parental interaction patterns in children with attention deficit- hyperactive disorder. Methods :In this study, 50 male children aged 7-12 years were selected in two groups including 1) 25 students with ADHD referring to psychiatry clinics in Isfahan according to the diagnostic scale of DSM- IV and 2) 25 healthy boys selected by random cluster multistage sampling from primary schools in five districts of Isfahan from Septamber 2005 until March 2005. Schaffer and Edgerton parental interaction questionnaire was filled for them. Results: In "Communication" interaction pattern, the mean score of healthy children was 15.08, while the mean score of ADHD children was 13.42. In "admission" interactional pattern the mean of the first group was 14.76, while the second group was 11.76. In "control" interactional pattern, mean of group one was 13.28 and the second group was 11.76. In "aggression control" interactional pattern, the mean of group one was 13 and the second group was 14.68. In "lack of aggressive attachment" interactional pattern, mean of the first group was 13.36 and the second group was 16.67. The mean scores of parental interactional pattern in healthy children were all higher than ADHD children except for "aggression control" and "lack of aggressive attachment" interactional patterns. Conclusion: The more the parental "admission" interactional pattern score, the lower the signs of ADHD in children. The signs of severity are lower in cases with more positive parental "control" interactional patterns. If the scores of "lack of aggressive/ attachment" and "aggressive/ control" interactional patterns are higher, ADHD signs are more severe.

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Introduction: Hyperbilirubinemia is a common benign problem in neonates. Nonetheless, if untreated, severe hyperbilirubinemia is potentially neurotoxic. The standard method for diagnosis of hyperbilirubinemia is determination of serum bilirubin levels in the laboratory that requires a blood sample which is both painful and stressful for neonates and entails cost and time. The objective of this study was to study the correlation between transcutaneous bilirubin levels (JH 20-1 bilirobinometer) and serum bilirubin levels. Method: This prospective study was done on 100 jaundiced newborn term infants from March to October, 2006. Initial clinical assessment of jaundice was carried out by a physician (researcher) and simultaneously, blood sample was collected and a JH20-1 bilirubinometer was applied at two sites forehead and sternum. Results: The study group consisted of 57 boys and 43 girls diagnosed as jaundiced neonates. The mean serum bilirubin and mean transcutaneous bilirubin levels at forehead and sternum were 13.35, 12.95 and 12.46 mg/dl, respectively. The correlation coefficient of bilirubin levels estimated by the bilirubinometer at the forehead and sternum and serum levels were 0.773 and 0.731, respectively. At bilirubin levels higher than 12 mg/dl (cut off point), the bilirubinometer had a decreased sensitivity, but an increased specificity. Conclusion: Transcutaneous bilirubin measurements using JH20-1 bilirubinimeter correlate well with total serum bilirubin levels, but when bilirubin levels are higher than 12mg/dl, sensitivity of the device is reduced and therefore not reliable.

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Introduction: The proportion of older adults in the population continues to grow in the developing countries. In addition, persons at or over the age of 60 years have decreased quality of life in geriartrics because of several factors, such as low physical activity and impairment in mobility. This study was performed to assess the effect of group-based exercise program on physical functional independency in order to finally increase the quality of life in older adults. Methods: This quasi-experimental study was conducted in old women and men in 2005-2007. In this study, 50 elderly men and women were randomly divided into two groups experimental (25) and control (25).Group-based exercise program was administrated to the individuals of experimental group for 8 weeks (3 time a week) and subsequently using SF-36 questionnaire, the level of quality of life was measured in the two groups at the beginning and the end of the study. The data was analyzed using manvitni , chi-square and nonparametric tests. Results: Using group-based exercise program, increase in mean level of quality of life in different dimensions physical functional, role functional, pain, general health, emotional well-being, social functional , emotional functional and mental health was statistically significant(p<0.01),whereas in the control group ,these parameters, were unchanged(p>0.01). Conclusion: Our study results showed that use of a regular and prolonged exercise program can increase the level of quality of life in older adults in different dimensions.

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Introduction: The most common neoplasm in childhood is acute leukemia and about 30% of all cancers are luekemias. Treatment based on prognostic factors has improved survival rate during the last two decades. As prognostic factors differ in different populations, this study was done to evaluate the factors in Yazd. Methods: This descriptive observational study was done as a case series study. The population under study included 56 children in the age range of 0-14 years and all of them were admitted to Shahid Sadoghi Hospital of Yazd. To obtain predicting clinical (age, gender.hepatomegaly…) and laboratory (CBC, LDH, Flow cytometry…) factors in outcome of disease (Relapse and death), statistic technique of Cox Proportional Hazard Ratio and chi-square tests were used. All prognostic factors were with univariate and multivariate analyses. Results: Only WBC count 50000 in both univariate and multivariate analyses was predictive factor for death. (p.v:0.008, HR: 21.77, 95% CI=2.33 -75.11). Conclusion: Patients with WBC count 50000 were 22 times more at risk of death than those with lesser counts. Therefore, these patients should be considered as a high risk group.

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Introduction: Multiple sclerosis is a chronic, progressive and degenerative myelin sheath disease of the central nervous system. It frequently occurs in young people in the productive stage of life who are solicitous about their role and family responsibilities. One of the treatment and vigilance intervention index in improvement of chronic illness is quality of life. The objective of the implementation of this study was to assess the effect of Orem self- care program on physical quality of life in multiple sclerosis patients. Methods: This study was a quasi-experimental research on 70 multiple sclerosis patients’ who were randomly allocated to experimental or control group (35 patients in each group). The experimental group was treated with self-care program based on Orem self-care frame work and compared with the control group. Data was analyzed using presumption statistics. Results: T test showed that there was no significant difference in the physical quality of life score before intervention in the two groups (P=0.33, T=-0.69), while after intervention, the same test indicated a significant difference between the two groups (P=0.001, T=14.42). Pair t test showed significant difference in experimental group before and after self care program (P=0.001, T=-14.20), whereas the same test showed no significant difference in the control group (P= 0.95, T= -0.06). Conclusion: According to the study result, self care program based on the Orem frame work can have an effect on the physical quality of life in multiple sclerosis patients. Therefore, if a program is designed on the basis of educational needs and the “Orem self- care model” approach, it can be effective for enhancing the multiple sclerosis patients physical quality of life, and it can be recommended as a nursing interventional program. This intervention is safe, inexpensive and complementary that can be used to support multiple sclerosis patients in treatment centers.

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Introducion: Few studies to date have shown the adverse effects of prolonged latent phase. Related factors, maternal and fetal outcomes of prolonged latent phase were studied in order to prevent these effects. Methods: In a cross-sectional study, 224 women were assessed at Shohada hospital by using questionnaire, examination and follow up to calculate the latent phase duration up to 3cm dilatation. Results: Of the total, 22.8% had prolonged latent phase and there was no difference in the maternal and fetal age/weight, gravid and parity. 41.2% were nulipars. None of the cases had delivery trauma, but 4 out of 7 meconium aspirated cases, 2 out of 6 hospital admissions, and both the 2 cases admitted in NICU were in prolonged latent phase group. None of the infants in this group had APGAR less than 8. There was no significant difference between APGAR<6 and meconium aspiration cases in the two groups. Massive post partum bleeding, cesarean section, and fever during/after delivery showed a significant difference. Other variables didn’t show any significant difference. Parity had a direct correlation in the normal group and indirect correlation in theprolonged latent phase duration group. Conclusion: Maternal age and weight, gravid, parity, infantile weight, gender and gestational age have no effect on latent phase duration. The more the parity, the more prolonged the latent phase and this leads to more cases of cesarean section, fever during/after delivery and post-partum bleeding.

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Introduction: Methadone maintenance therapy is a well-known approach to the treatment of drug use disorders and harm reduction. But the main challenge is retention rate in MMT Methods: Through simple random sampling, 155 addicts aged between 18-60 years who referred to drug addiction center of university and underwent MMT were followed for at least one year and up to two and half years. Results: Of the total, 3.9% female, 62% married, 37.4% workers and 27.1% were jobless. 80% had education level of less than diploma, 43.2% abused marijuana, 54.2% abused alcohol and 49.7% were living in rented houses. 60% referred to this center because of economical problems, 15.5% because of legal issues and 67.7% because of family pressure. 31.6% were opium and opium resin addicts, 60% were heroin addicts, 8.4% were crack addicts and 21.9% were IV abusers. 76.8% had at least one high risk behavior. Average dose of methadone was 86.5+35 mg/day. Mean survival time was 80 weeks. Relapse rate was 3.3% in the first month, 13.9% in three months, 23.2% in six months, 31.7% in first year and 41. 7% was a total relapse rate. Survival rate had a direct significant statistical relationship with the age, type of drug and method of use. Conclusion: According to the results of the present study that indicate a survival rate of 68.2% in a year and 58.3% after a year and also considering the results of other studies, we can conclude that MMP could be an effective method in the treatment of opiate drug disorders.

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Introduction: Considering high prevalence of addiction, the age range of drug abuse and availability of new synthetic drugs, evaluation of knowledge of adolescents about drugs would be a priority in research. Methods: In this descriptive cross-sectional study, 517 rural high school students were asked to complete a questionnaire and through SPSS soft ware version 13, collected data was analyzed by chi-square and analysis of variance tests. Results: 7.1% of rural families with at least one boy in high school had an addict family member. 70.2% of high school students had had a contact with an addict and 42.5% knew an adolescent addict. Also, 17.5% had been offered drugs and 37.9% of high school students claimed that there was at least one addict in their family or relations. Conclusion: Considering the frequency of addiction in families and rate of invitation to drug abuse in students, there is a high risk of increment of addiction in high schools and therefore real and urgent need to do an intervention.

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Introduction: Child abuse includes abuse of the body, mental and sexual abuse or misbehavior against children that leads to damage to the child's heath and comfort. Therefore, the present study was done in order to determine the prevalence of child abuse in opiate addicts referring to addiction withdrawal centers. Methods: The cross sectional study included 300 participations (150 addicts and 150 non-addicts) The addicted group comprised of opiate addicts referring to addiction withdrawal centers of Yazd. The non addicted group was selected randomly from healthy people. Data collection was performed via a standard questionnaire. Data assessment was done via statistical analysis (K S) Results: Collected data in the addicted group showed the following results about 56 percent were child tormentors, 1- 45.3% males, 10.7% females, 2-18.7% uneducated, 3-46% with divorce history in their family and 4-38% child body abuse. The most prevalent type of the body abuse was slapping (24%), mostly because of bad training (26%). Collected data in the no addicted group showed the following results 42% were child tormentors (26% male and 15.3% female) 23.4% with family divorce history, 30.4% were child body abuse and the most prevalent type of body abuse was slapping (22.79%), mostly because of bad training (33.3%) Conclusion: A direct relationship was observed between child abuse and persons addicted to opiates. Factors playing an important role include illiteracy, divorce history in the family and history of child abuse in childhood period. Therefore, compilation of rules supporting children, establishment of support and parent education centers can be effective to reduce child persecution.

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Introduction: Leukemia is a heterogeneous malignant disease in which progression at the level of CD34+ cells has a major impact in drug resistance and relapse. The multi-drug resistance gene product, P-glycoprotein is an inhibitor of apoptosis proteins (IAPs), such as Survivin that are expressed simultaneously with several putative drug resistance parameters in CD34+ leukemia cells. In fact, IAPs over-expression and their anti-apoptotic splice variants are associated with CD34 positivity, poor response to chemotherapy and reduced overall survival in leukemic patients. Recently, adenosine 5ʹ-triphosphate (ATP) has been reported to inhibit proliferation and induce apoptosis in several human cell lines. The K562 CD34+ human myeloid leukemia cell line has the unique feature of expressing significant functional IAPs and other drug-resistance genes. Thus, the efficacy of ATP in overcoming the resistance and expression profile of Survivin and its splice variants were examined in K562 cells in the present study. Methods: K562 cell were cultured and treated several times with different concentrations of ATP. Apoptosis was studied by fluorescent microscopy(Ao/EtBr double staining) and DNA fragmentation assay. The expression level of Survivin and its splice variants was studied by semiquantative RT-PCR method. Results: The results showed that over-expression of Survivin and its anti-apoptotic splice variant, 3b splice variant were decreased after treatment by ATP in a time- and dose-dependent manner. The expression levels of other splice variants (ΔEx3, 2b, 2α and 3α) did not show significant difference between the control and the treated cells. Conclusion: The results showed that ATP attenuated expression of Survivin and its anti-apoptotic splice variant, meaning that this nucleotide can facilitate apoptosis in drug-resistant leukemia cells. In addition, combination of ATP with standard chemotherapies may be utilized for inhibition of drug-resistance in leukemia cells.

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Introduction: Macromycetes are considered as new resources for medicine with various biological properties. One of the most important medicinal fungi in Iran is Phellinus conchatus. This genus contains 359 species around the world of which 12 species are reported from the north regions of Iran. Phellinus species have anticancer, antioxidant and antibacterial effects. Moreover, they have been used in traditional medicines for treatment of several diseases. Due to the increasing bacterial resistance to existing antibiotics, it seems that research for new sources of antibiotics is necessary. Methods: The purpose of this research was to collect and identify the species with respect to hosts, dispersal, macromorphological and micromorphological characters of the species, and their biological effect against Gram-negative bacteria and Gram-positive bacteria was evaluated using total methanol extract and it’s fractional extracts(chloroform, butanol and water extracts) using disk diffusion method, minimum inhibitory concentrations(MICs) and minimal bactericidal concentrations(MBCs). Results: The results of disk diffusion tests showed that all extracts except aqueous extract had growth inhibitory effects on three bacteria Staphylococcus aureus, Bacillus cereus and Pseudomonas aeruginosa. The butanolic extract showed the best result in growth inhibition against the bacteria, especially on Pseudomonas aeruginosa . The MICs and MBCs of the butanol extract of these bacteria were(1, 2mg.disk), (2, 4 mg.disk) and(8, 16mg.disk), respectively. Conclusion: The results show that different extracts, especially butanol extract have high antibacterial activities which indicate the presence of active components in this fraction. More fractionation studies are under way to isolate the antibacterial components in the butanolic extract.

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Introduction: Leishmaniasis is one of important tropical diseases caused by Leishmania parasites which is transmitted by biting of female phlebotomine sandfies. Regarding high densities' and distribution of sandflies in majority areas of Iran, understanding of sandflies identification and distribution as vectors is importation to control disease. Methods: This is a descriptive survey which was done temporarily, Sandflies were sampled from 17 villages of three studied regions to coordinate with authorities of sanitary province to provide the necessary facilities .foci using sticky papers and CDC traps. All sandflies were identified based on external and internal morphological characters of the head and abdominal terminalia, which were slide-mounted in Berlese fluid. Results: In total 3178 Sandflies were sampled and identified. Sandfies species are P. papatasi, P. bergeroti, P. alexandri, P. sergenti, P. mongolensis, P. tobbi and S. dentate, S. sintoni and S. tiberiadis. sandfly species identified and separated based on habitat collections. Females analysed according to their gonotrophic stage which majority were unfed. Conclusion: The collections contained the important putative vectors of Leishmaniasis in Iran. P. papatasi was abundant in three study foci. Of the sandflies recorded from Iran, only P. papatasi was judged to be a proven vector of Leishmaniasis. Understanding criteria of vectors, population variations and ecological aspect of sandflies can help to control better of diseases.