Journal of

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Introduction: Hypothermia is used as an adjunct in surgery of different organs including heart, liver, brain and thyroid .It can be produced by different techniques such as superficial cooling ,cooling of blood and pharmacological cooling . Hypothermia has several effects on function of different organs and tissues including heart, lung ,liver, brain ,thyroid and vascular system .In this study, the histological and biochemical effects of hypothermia on liver in rats have been investigated . Materials & Methods : This study was an intervention experimental study . Results: Superficial hypothermia was produced with the aid of hypothermia system by placing rats in it . Wistar rats were chosen as an animal model. Rats were anesthetized using 10% Hydrate chloral and placed in very deep hypothermia (20c1) for 4.5 hours. In the first group, blood sampling was carried out immediately after the hypothermia period. In the second, blood sampling and specimens were obtained 24h later. The histological studies of the liver showed that the nuclei of hepatocytes had become vesicular and the sinusoidal spaces were decreased. The serum levels of GPT were increased in the first group. But the serum levels of GOT were increased in both groups. Conclusion: The results indicate histological and biochemical effects of hypothermia on liver. It appears that the vascular changes induced by hypoxia are responsible for the effects of hypothermia.

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Introdaction: The purpose of this study was to evaluate the therapeutic and side effects of erythropoietin in the management of anemia in chronic renal failure. In this study, 60 patients were given Erythropoietin subcutaneously three times/week for 2 months. Methods: Mean hemoglobin of patients was recorded before beginning Erythropoietin and also one weeks, one month and two months after treatment. Results: Mean hemoglobin value before treatment was 7.6 g/dl that increased to 9.08g/dl 2 months later. Hemoglobin levels were not dependent on the age and sex of the patient, but there was a meaningful difference between diabetics and nondiabetics. Conclusion: The side effects of Erythropoietin in this study in order of frequency were as follows: Hypertension, A.V fistula thrombosis, allergy and seizure.

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Introduction: Hemodialysis patients often develop resistance to recombinant human erythropoietin due to functional Iron Deficiency. In these patients iron therapy can be hazardous leading to hemosiderosis. Recent studies have suggested that intravenous ascorbic acid may be able to improve this hyporeponsiveness. The aim of this study was to evaluate the effect of intravenous ascorbic acid on functional iron deficiency and whether it results in better correction of anemia or not. Methods: Forty hemodialysis patients with serum ferritin >300ug/l, hemoglobin less than 10 gm/dl, and transferrin saturation less than 20% were selected. The reticulocyte index and KT/V was also calculated. Patients were later administered 500 mg intravenous ascorbic acid three times a week for three months. At the end of study, serum ferritin, transferrin saturation, hemoglobin, reticulocyte index and KT/V were rechecked and compared with the base line values by before and after method. Results: Serum ferritin decreased significantly (median base line ferritin 480.45 ug/dl as compared to final ferritin level of 363.78 (P=0.0001), whereas there was a significant rise in hemoglobin concentration (median baseline hemoglobin 8.92 gm/dl compared to 9.88gm/dl (P=0.0001). Transferrin saturation was also significantly raised (median baseline transferrin saturation 17.35% as compared to final level of 25.12% (P= 0.0001). KT/V before and after treatment with ascorbic acid had no significant change (P =0.396). Finally, the rate of decrease in serum ferritin and increase in hemoglobin according to age and duration of dialysis was studied. The effect of ascorbic acid was found to be significantly greater in older patients and those with longer duration of dialysis (P <0.05) but there was no significant relationship between transferrin saturation increase and age or duration of dialysis. Conclusion: Intravenous ascorbic acid may partially correct functional iron deficiency, although anemia is not totally corrected.

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Introduction: Even though there is a high prevalence of carpal tunnel syndrome patients, there are very few reliable papers on the study of normal values and changes in sensory and motor latency parameters of the median nerve in the wrist region on the basis of age of patients .This retrospective study was on the basis of 5 years data (1998 -2003) from the electro diagnostic department of Sh. Sadoughi teaching hospital of Yazd. Methods: In this analytic and observational study, subjects included 1200 patients referring to the electrodiagnostic clinic and also randomly selected healthy patients. Exclusion criteria included systemic diseases such as diabetes, radiculopathy of cervical spine , peripheral neuropathy , positive Phallen test or Tinel sign and atrophy in the thenar region of the hand. Subjects were divided to ten groups on the basis of age. ( 10-80 years ) Sensory and motor latency parameters of median nerve were studied in each age group. All data was evaluated using SPSS statistical software and ANOVA , LSDREST curve regression tests were used for analysis. All values less than 0.05 were considered significant. Results: In this study, normal values for distal motor latency of median nerve were between 2.5-4.2ms with a ±2SD and mean value of 3.3ms. Increment in this value was mild (0.1ms per decade) after 5th decade of life. This value was calculated using the formula: Distal motor latency: Normal value for distal sensory latency of median nerve was 2.7-3.7ms with a ±2SD and mean value of 3.2ms. Increment in this value also was 0.1ms per decade after 5th decade of life. This value was calculated by the formula: Distal sensory latency: Conclusion: It seems that age has a meaningful relationship with distal motor and sensory latencies in the wrist region and therefore in the future, electro diagnostic evaluation along with other increments in these parameters according to age should be considered when evaluating patients with carpal tunnel syndrome.

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Introduction: Osteodystrophy is one of the long term complications of chronic renal failure and is expressed in two formslow turn over and high turn over. It is an important cause of morbidity in patients with renal failure and if diagnosed and managed properly, many problems of these patients can be resolved. In this study we evaluated the prevalence of hyperparathyroidism in hemodialysis patients and its correlation with different factors. Methods: This study was an analytic, observational study that was done by the cross- sectional method. We formatted a questionnaire for hemodialysis patients who were enrolled in the study over a period of 6 months. Fasting blood samples (5-10c.c) were drawn to measure levels of PTH(parathyroid hormone) ,calcium, phosphorous and alkaline phosphatase. Skull and wrist X-rays were also taken and the radiologist evaluated them with regards to hyperparathyroidism. Results: In the 80 patients studied, prevalence of hyperparathyroidism was 45% (36 patients). 44 patients were diabetics. Among different factors, hyperparathyroidism did not correlate with frequency and duration of dialysis, age, sex ,familial history, diabetes, hypertension , bone pains, muscle weakness, purities and level of calcium and phosphorous. But there was a significant relationship between hyperparathyroidism and alkaline phosphatase levels and radiological findings. Conclusion: We can use alkaline phosphatase levels and/or radiographic changes for evaluation of renal osteodystrophy in hemodialysis patients and prevent complications by early diagnosis and proper management.

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Thymoma is the most common neoplasm of anterior mediastinum with incidence peaks during the fourth, fifth and sixth decades of life. Two-thirds of patients are asymptomatic and identified accidentally by chest x-rays . Of the total, 40-70 % of patients have one or more parathymic syndromes of which Myasthenia Gravis (MG) is the most common and reported in 10-50% . Gullain-Barre Syndrome (GBS) has not been reporterd as a parathymic presentation in present literature. We report a 37 years old woman who presented with GBS after thymoma resection. There is one question: Is there any association between thymoma and GBS or is it a complication of surgery (thymectomy)?

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Introduction: Peritoneal dialysis is an established form of renal replacement therapy used in many patients with end – stage renal disease . Peritoneal dialysis has different complications This study was conducted in order to evaluate its complications and different survival probabilities of factors in Shahid Rahnemoon hospital . Methods: In this retrospective, historical cohort study, reports of 161 patients on peritoneal dialysis (Shaheed Rahnemoon hospital, dialysis department) from 3.Dec.1997 to 20.May.2007 were evaluated. Required data was gathered and analyzed by specific statistical tests. Results: The mean age of patients was 49.37 years (2 to 88 years) and most of them (41.6%) included in 40-59 years age group category. Peritonitis, exit site infection and catheter malposition was seen in 41.6% , 6.8% and 9.3% of patients ,respectively.Rate of peritonitis in females was more than males (p=0.002). Diabetes mellitus had no effect on death rate, but hypertension had a protective role. Conclusion: Peritonitis ,exit site infection and catheter malposition is more prevalent in females, but mortality rate is significantly higher in males.

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Introduction: Multiple myeloma represents a malignant proliferation of plasma cells derived from a single clone and it results in bone pain or fracture, renal failure, susceptibility to infections, anemia and hypercalcemia. The hyper viscosity syndrome is rare. Cryoglobulins are immunoglubulins that precipitate at temperatures less than 37degrees Celsius. Monoclonal cryoglobulins are usually present along with a specific hematologic disorder and are often asymptomatic. We report a second case of multiple myeloma with gangrene of all four extremities. Case: The Patient was a 77 year–old farmer with a 2 weeks history of coldness, pain and discoloration of the fingers of both the extremities which had extended to the mid forearm and shin regions. It was accompanied by skin erosions of the lower extremities, dark spots on the ear auricles and discoloration of the tip of the nose. On physical examination, quadrigangrene associated with ischemia of the auricles and tip of nose was seen. Serum proteins electrophoresis demonstrated monoclonal gammopathy and serum was positive for cryoglobulin, Bone marrow study showed neoplastic plasma cells infiltration. The patient was diagnosed as cryoglobulinemia based on multiple myeloma and treated accordingly.

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Traumatic abdominal wall hernia is a rare type of hernia, which follows blunt trauma to the abdomen, where disruption of the musculature and fascia occurs with the overlying skin remaining intact. Diagnosis of this problem is very difficult and delayed. Traumatic hernia is often diagnosed during laparatomy or laparascopy, but CT scan also has a role in distinguishing this pathology. Delay in diagnosis is very dangerous and can result in gangrene and necrosis of the organs in the hernia. The case report of a 35 years old man with liftruck blunt trauma is reported. His vital signs were stable. On physical examination, tenderness of RUQ was seen. He underwent Dpl for suspected hemoprotein. Dpl was followed up by laparatomy. Laparatomy revealed that the transverse and ascending colon partially herniated in the abdominal wall defect. The colon was reduced in the abdomen and repair of abdominal hernia was done. The patient was discharged after 5 day. The etiology, pathogenesis and management are discussed.

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Introduction: Addiction as a social, health problem with its specific complications threatens societies. High risk behaviors such as violence, self mutilation, tattooing, shared injections and unprotected sex behaviors are some of the problems in addicts that need to be treated. One of these treatments is methadone therapy. The purpose of this study was to evaluate effectiveness of methadone in prevention or reduction of high risk behaviors in clients of a MMT center of Shaheed Sadoughi University of medical sciences of Yazd. Methods: This study was done on 93 clients of a MMT center.Questionnaire for this study included items from MAP and questions about some other risky behaviors. This questionnaire was completed at onset of treatment and 6 months after. Data was analyzed with SPSS software program Results: 89.2% of participants were married and 10.8% were single. 63.5% of them were in the20-40 years age group. Most commonly abused substances were heroin and opium. Before onset of treatment, 37.6% of participants had history of imprisonment, 35.5% had shared injections, 32.3%had had unprotected sex, 22.6%had tattooing and 5.4%had mutilated their own selves. Only 36.6% didn’t have any high risk behavior. These behaviors were more common in heroin users and in the20-40 years age group. After onset of treatment and during 6 month of MMT, 86% of clients didn’t have any risky behavior. Only 14%of them continued to have unsafe sex behaviors Conclusion: Addiction can cause high risk behaviors. Data in this paper suggests that young age, heroin use, low education level and no or inadequate information about addictive substances and their consequences are effective and important factors that cause high risk behaviors. Treatment of addicts with methadone maintenance therapy plays an important role in reduction of risky behaviors. Development of appropriate and more MMT centers are recommended.

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Introduction: Social support can be defined as the interactive process through which emotional and instrumental support is obtained. Social support has been found to be a relevant factor in diabetes self-management. Diabetes refers to complex chronic metabolic conditions that are characterized by elevated levels of blood glucose if untreated. Diabetes is one of the biggest health care problems facing Yazd with regards to prevalence, cost, and the onus it places on patients and its high morbidity rates. The purpose of this study was to examine the relationships among social factors on the control and treatment of type II diabetes. Methods: The population under study included 4990 diabetes type II patients referring to Yazd Diabetes Research Center and a sample of 256 cases was selected by simple random sampling method through statistical society. This study was based on survey method and the instrument for collecting data was a questionnaire. Results: About 65.4% of the patients were women and 35.6 were men. The mean age of patients was 56 years. Significant correlations were found between perceived social support (r= 0.193, p= 0.001), positive reinforcing behaviors (r= 0.455, p= 0.000), and adherence to self-care activities. Misguided support behaviors did not show a significant correlation with adherence to self-care activities. A total of 25% of variance in self-care behavior can be explained by positive reinforcing behaviors and misguided support behaviors. Conclusion: The findings of this study showed that by increasing the positive reinforcing behaviors and perceived social support and decreasing the misguided support behaviors, the diabetic patients can adhere better to self-care activities.

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Introduction: Epilepsy is a brain disorder that has neurobiological, cognitive, psychological, and social consequences for affected patients. The purpose of this research was to determine the efficacy of cognitive behavioral therapy(CBT) on modification of dysfunctional attitudes in patients with epilepsy. Methods: In the study, 20 epileptic patients were randomly assigned to two experimental and control groups. CBT during 8 weekly sessions was applied for the experimental group with a focus on cognitive restructuring, modification of cognitive distortions and training of behavioral techniques. Dysfunctional attitudes scale(DAS) was applied as the pre-test, post- test and in the follow- up for both groups. Analysis of covariance was applied for analysis of data. Results: Data analysis showed that the mean scores of DAS in the experimental group as compared to the control group was significantly increased during post-test and follow-up(p<.05). Conclusion: Cognitive-behavioral therapy is remarkably effective in modifying dysfunctional attitudes in epileptic patients.

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Introduction: Clinical pelvimetry is very uncomfortable for the patient and is associated with subjective error, while external pelvimetry is a simple and acceptable method for patients. The objective of this study was to compare the diagnostic accuracy of clinical and external pelvimetry in prediction of dystocia in nulliparous women. Methods: In this study between December 2008 and January 2009, 447 nulliparous women with a single pregnancy in vertex presentation and gestational age 38-42 weeks referring to the Ommolbanin hospital of Mashhad were included. External pelvic dimensions were assessed at the time of admission and clinical pelvimetry was performed by another examiner. These measurements were not available to the clinician in charge of the delivery. Dystocia was defined as caesarean section and vacuum or forceps delivery for abnormal progress of labor ( active uterine contractions, arrest of cervical dilatation or cervical dilatation less than 1 cm /h in the active phase for 2 hours, prolongation of second stage beyond 2 hours or fetal head descent less than 1cm/h). Statistical tests included Fisher exact test and Chi- square test. Results: The highest sensitivity obtained from clinical pelvimetry was 33.3% and related to diagonal conjugate less than 11.5 cm. The sensitivity of external pelvic dimensions was higher than clinical pelvimetry that was highest for the Michaelis transverse diameter(60.72%). Conclusion: External pelvimetry in comparison to clinical pelvimetry is a better method for identifying dystocia in nulliparous women and can replace clinical pelvimetry in antenatal care programs.

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Introduction: Multiple Sclerosis is a chronic disease of central nervous system. Disease is more common in young adults and females and causes neurologic symptoms and signs. Cytokine IL-7 is a 25– kDa glycoprotein that has an important role in Lymphopoiesis. Interleukin VII receptor gene has been identified to be associated with multiple sclerosis, so its assessment is important. Methods: We investigated 60 Iranian patients with clinically definite MS and 60 normal healthy controls with negative family history for MS. After blood sampling, DNA was extracted from the whole blood, then we used 2 sets of primers for promoter and exon 4 of IL-VII gene. These fragments were amplified by PCR technique and early screening was performed by SSCP technic in the presence of control samples. Then different patterns with control samples were sent for DNA sequencing. Results: We observed one SNP in promoter. Most of the alleles of the patients were homozygote. There were two 2 SNPs and two sequence variations in exon 4 as P.H165H and P.V138I, which has been submitted in European Bioinformatics Institute under the access number of FR863587. Conclusion: Further studies on control group will be required to reveal the effects of these SNPs on the ILVII-R α protein and they can probably be useed as a biomarker for early diagnosis of MS.

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Introduction: Despite the discovery of insulin and current improvement in diabetics care, congenital malformations in diabetics are still more frequent than in the general population. The aim of this study was to identify congenital heart dieases (CHD) in the newborns of diabetic mothers (IDMS). Methods: In our prospective study, color doppler echocardiography was performed in 75 consecutive full- term newborns of diabetic mothers by GE Vivid3 echocardiographic device. Newborns were classified into two subgroups according to the type of the mothers’ diabetes: pre-gestational and gestational. They were also those were classified into three subgroups according to their birth weight: appropriate, large and small for gestational age. Data analysis was made by Fisher exact test and Chi-Square test. Results: Forty nine (65%) and thirty six (35%) of subjects were infants of gestational (IGDM) and pre-gestational diabetic mothers (IPDM), respectively. Fifty five Newborns (73%) were apropriate, fourteen (19%) were large and six (8%) were small for gestational age. The most common echocardiographic findings included: patent ductus arteriosus (PDA: 54.7%), hypertrophic cardiomyopathy (HCMP: 24%), ventricular septal defect (VSD: 4%), atrial septal defect (ASD: 2.7%), transposition of great arteries (TGA: 1.3%) and coarctation of the Aorta (COA: 1.3%). Overall incidence of congenital heart diseases was 9.3 after exclusion of PDA and HCMP cases. The incidence of congenital heart diseases was higher in macrosomic than nonmacrosomic infants of diabetic mothers (P<0.001). Congenital heart diseases were more common in infants of pre-gestational than gestational diabetic mothers (P=0.004). Conclusion: Our results showed that diabetic mothers are at increased risk of giving birth to a newborn with congenital heart disease, and transthoracic echocardiography is recommended for all infants of diabetic mothers.

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Introduction: Ghrelin is a peptide which is secreted from human stomach. It has an important role in the secretion of growth hormone, energy balance, obesity, food intake behavior, and some cardiovascular functions. The purpose of this study was to assess the effects of an eight-week of aerobic exercise on plasma concentration of ghrelin and GH in non-athletic young women. Methods: Twenty young non-athletic women with mean age of 22±2/1 years and mean BMI of 21±1/07 Kg/m2 voluntarily entered the study and they were randomly divided into control and experimental groups. Experimental group conducted an aerobic exercise program three sessions each week and 60 minutes in each session with 70-80% of maximum heart rate for 8 weeks. Control group didn’t exercise. Blood samples were taken 48 hours before the first and after the last session of exercise. Plasma concentrations of ghrelin and growth hormone were measured by ELISA and radioimmunoassay methods, respectively. Data was analyzed by independent samples T test and Pearson correlation test by SPSS(version16). Results: The eight-week period of aerobic exercise caused a significant increase in plasma concentration of ghrelin and a significant decrease in plasma concentration of GH. Conclusion: It can be concluded from the study that exercise-induced increase in plasma ghrelin in response to negative energy balance didn’t stimulate GH secretion, so other mechanisms may be effective in this regard.

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Introduction: Relapsing polychondritis is a rare autoimmune disorder which is associated with inflammation of the auricular and costochondral cartilages and may involve ocular tissue and laryngotracheobronchial tree in some occasions. This inflammatory destructive disease can potentially disrupt the structure, function and integration of cartilages. The common age of involvement is 40 to 60 years and it is similar in both genders. Case report: The patient was a 65 year-old woman referred to the cardiovascular center, with chief complaint of sudden severe chest pain. She was hospitalized with the diagnosis of unstable angina but all of the cardiovascular investigations were normal. After a few days, she developed headache, fever, nasal congestion and redness. Computed tomography scan was done with the probability of sinus involvement but it was normal. At the same time, she developed cartilage involvement as a redness and auricular pain (sparing the lobule). Subsequently her hearing progressively diminished. She was hospitalized in the rheumatology ward and treated as a polychondritis.

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Introduction: Gastroesophageal reflux is a common gastrointestinal disorder among infants, which can cause complications, such as esophagitis and Barrett's esophagus if its diagnosis and treatment are delayed. On the other hand, similarity of Gastro esophageal Reflux symptoms with symptoms of other childhood diseases makes its diagnosis and treatment difficult. So a proper tool for early screening and diagnostic test is essential. Methods: This study was conducted on 221 infants(2 to 12 months) with initial symptoms of gastro esophageal reflux(frequent vomiting, restlessness after feeding, no weight gain, coughing repeatedly and refusing to eat) that referred to pediatric Clinic of Rajai Hospital in Tonekabon. Data was collected with demographic and infant gastro esophageal reflux questionnaire by use of the information in records and interview with parents. Then the samples were examined via sonography for gastroesophagial reflux. Results: After initial screening based on infants gastro esophageal reflux tool, gastro esophageal reflux by ultrasound was positive in 63/3% of infants. The mean esophageal diameter was (20/73±2/54mm) in infants with gastro esophageal reflux and (23/71±2/35mm) in infants without gastro esophageal reflux. Conclusion: Due to the similarity of gastro esophageal Reflux symptoms with clinical symptoms of other childhood diseases, use of an initial screening measurement for early assessment of gastro esophageal reflux in infants is necessary. Moreover, appropriate, available and low costs diagnostic method with little complication seems essential such as ultrasonography for confirm diagnosis and early treatment.

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Introduction: Patellofemoral pain syndrome(PFPS) is the most common overuse syndrome in athletes. It is one of the causes of anterior knee pain in athletic population who attend to the sport medical clinics. Patellofemoral is more common among female athletes especially adolescents and young adults. Patellar taping provides an effective treatment in alleviating the symptoms of a high proportion of subjects who suffer from PFPS, though the mechanisms of pain reduction have not completely been established following its application. The purpose of this study was to investigate the effects of taping on dynamic balance and reduction of pain in athletic women with patellofemoral pain syndrome. Methods: Fifteen female athletes with patellofemoral pain syndrome participated in the study. Therefore, dynamic balance was assessed using a SEBT(Star Excursion Balance Test) before and after application of patellar taping. The severity of pain was measured by VAS(Visual Analog Scale). Results: The results of variance analysis by VAS(p<0/008) in repeated measure indicated a statistically significant improvement in pain and in knee function in anterior, anteromedial, medial, posteromedial and anterolateral directions(p<0/05). Conclusion: The study results confirmed a significant improvement in reducing pain and increasing function (dynamic balance) of female athletes with patellofemoral pain syndrome after patellar taping.

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Although the topic of the study seems to be a novel subject and its design looks excellent, there are some points which seem to be missed or neglected by the respected authors of the paper entitled: “Study of the Expression of Survivin & Its Splice Variants ΔEx3, 2b and 3b as Diagnostic Molecular Markers in Breast Cancer”. Through this review, it was attempted to review and criticize some of these issues which may occur in the similar corresponding researches in the future.