Journal of

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Introduction: Auto – immune disorders have been implicated as a cause for chronic uricaria and/ or angioedema and thyroid autoimmunity has been increasingly introduced to be associated with that. This study explores the association of thyroid autoimmunity with chronic urticaria and / or angioedema in Isfahani patients. Methods: Anti – thyroperoxidase (Ani – TPO) and anti – thyroglobulin (Anti – Tg) antibodies, T4 and TSH were detected in 57 patients with chronic urticaria and / or angioedema and were compared with that of normal subjects without chronic urticaria or other autoimmune diseases. Results: Anti – TPO and Anti – Tg antibodies had been increased in 26 (45.6%) and 28 (49%) of patients in case group, as compared to 8 (13.2%) and 10 (16.7%) of subjects in control group, respectively. In total, raised titers of thyroid autoantibodies were found in 34 (60%) and 12 (20%) of subjects in case and control groups, respectively. Conclusion: Considering the high prevalence of thyroid autoantibodies in patients with chronic urticaria and / or angioedema, these antibodies should be detected in affected patients, specially in young and middle– aged women.

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Introduction: Toxoplasma gondii is a coccidian parasite and has, as intermediate hosts, many warm-blooded animals, including mammals and birds. Congenital toxoplasmosis is one of the most important infectious diseases seen in fetuses and infants born from mothers infected with Tox.gondii during pregnancy. Congenital infection, which may occur if a mother is infected for the first time during pregnancy, is often serious, resulting in abortion or severe neurological and ophthalmological disorders. Information on human cases of neonatal toxoplasmosis makes it unquestionable that Toxoplasma crosses the placenta and invades the fetus in utero in each of the two cases. . Methods: Tox. gondii infection in newborn rat litters was detected by a bioassay and parasitological method. Rat litters were billed and where possible, separated from their mothers in order to prevent feeding. Their tissues were separately homogenized in normal saline or PBS and inoculated intraperitoneally in 3 mice. The tissues used for bioassays were brain, hearts, lungs, livers, and spleen of pups, which were killed on the day of birth. In addition, control infected rat were sacrificed and their different tissues were evaluated for parasite burden at each time point of reinfection and chronic infection. Results: Data in the occurrence of congenital transmission from chronically infected mother rats given similarly graded inoculums of the RH strains (1(106 to 5(106) presented that none of the 36 pups was infected with Tox.gondii. The occurrence of congenital transmission in rats reinfected with Toxoplasma shows that none of the 14 pups was infected with Tox.gondii. Rats were reinfected intra- peritoneally with 1(106 parasite at 1,2 and 4 months after primary infection, respectively. Conclusion: Thus, this study demonstrated that Rats chronically infected with Tox.gondii, have immunity capable of protecting their embryos from congenital infection, even if they are reinfected during pregnancy and the immunity systems of these mothers can fully protect the fetus from such infections

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Introduction: Breathing rehabilitation techniques are designed to reduce symptoms, decrease disability, increase participation in physical and social activities, and improve the overall quality of life for individuals with chronic respiratory disease. However, the role of these techniques remains unclear. This study examined the effects of pursed-lip breathing (PLB) education on the respiratory function, arterial blood gases and day to day life in patients with COPD. Methods: A before-after quasi-experimental research was conducted on 40 patients with COPD at Shahid Beheshti Hospital in Kashan. Spirogram and ABG were tested before and after three-months of PLB exercise and a questionnaire (AQ20) was used to assess day to day activities. Wilcoxon matched- pairs signed-rank and descriptive tests were used for statistical analysis of collected data. Results: The study showed that after three months breathing exercise, O2 saturation was significantly increased (P=0.002). Although there was an increase in PaO2 , it was not significant. In addition, a decrease in PaCO2 (P=0.014) and the respiration rate (P < 0.000) was observed. The level of activities of daily living was also increased (P < 0.000). Forced expired volume second one (FEV1%) and forced vital capacity (FVC) did not change. Conclusion: We conclude that pursed-lip breathing education can improve lung function, arterial blood gas levels and also the levels of day to day activities. Therefore, breathing exercises education should be a part of physiotherapy programs in COPD patients until improvement in the quality of their life.

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Introduction: Chronic renal disease (C.R.D) is a pathophysiological process due to progressive and irreversible decrease in number and function of nephrons in the kidney. Anemia is one of the most important complications in CRD patients. Anemia is caused mainly due to diminished production of erythropoietin (EPO), which is treated by weekly injection of the EPO. L-carnitine added to EPO can increase the efficacy of EPO. Methods: Present study, from March 2003 until September 2004 (18 months), evaluates the effects of L-carnitine added to EPO in 30 patients at Shaheed Rahnemon hemodialysis center of Yazd. Each patient was administered one oral table (250 mg) of L-carnitine, twice a day along with EPO for 90 days. EPO was in the form of injection 2000 iu/sc after dialysis.(three times per week). One questionnaire was completed for each patient, which included demographic characteristics, type of disease, duration of the hemodialysis, Hb and Hct levels, transferrin saturation and ferritin levels. Hb ,Hct and transferrin saturations were measured on days 1, 45 and 90. Results were analyzed by paired t test and analysis of variance. Results: Results of this study showed that the mean Hb levels and Hct were significantly raised up to 1.1 mg/dl (P.value<0.001) and 2.7% (P.Value<0.001), respectively. In addition, significant decrease of 5.75% in transferrin (P.Value< 0.001) and 121ng/ml in ferritin levels (P.Value< 0.001) was observed. Efficacy of EPO plus L-carnitine was affected only by duration of hemodialysis and not by age, sex or causes of CRD. Conclusion: L-carnitine added to EPO increases the efficacy of EPO after 3 months.

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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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Introduction: Conductive hearing loss due to chronic otitis media (COM) can be treated by surgery. COM, however, may be associated with functional damage to the inner ear. Sensorineural hearing loss (SNHL) due to COM has been found to be significant by some authors, whereas it has been considered negligible by others. The present study aimed to answer the question Does COM cause SNHL ? Methods: 120 patients with unilateral COM admitted for tympano-mastoidectomy were selected for this observational case-control study. Air conduction threshold (ACT) and bone conduction threshold (BCT) averages were calculated at the speech frequencies (500, 1000, 2000Hz) and 4 KHz, in affected (case ear) and non affected (control ear) and then entered in the questionnaire along with intraoperative findings. Multiple statistical tests were used to clarify the relationships between SNHL and COM. Results: COM was seen to be associated with SNHL. The Threshold shift was more accentuated at 4 KHz in older patients. SNHL at 4 KHz seemed to be higher than that at the speech frequencies. There was a significant positive relationship between the elevated BCT and duration of COM. The relationship between elevated BCT and cholesteatoma was also significant. Conclusion: The inner ear is vulnerable to COM. The proximity of the sensory cells to the potential source of harm (inflamed middle ear) may mean higher exposure, as reflected by the fact that sensory cells processing high frequencies are more seriously damaged. SNHL in affected ear is strongly dependant on duration of disease.

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Introduction: Since time memorial, herbal medicine has played an important role for relief of various symptoms including pain relief. Many researches have focused on the curative as well as antinociceptive effects of herbal extracts. Cinnamon Zeylanicum has long been prescribed in traditional medicine for the treatment of inflammatory-related diseases such as rheumatisms, bronchitis and muscle pains. However, there is little if any scientific research indicating this effect Methods: This experimental study was carried out in Shaheed Sadoughi Medical School on 25 Wistar Rats (200-300grams) randomly divided into 5 groups. In this study, the analgesic effect of intraperitoneal administration of hydro-alcoholic Cinnamon extract in different doses (50,100,500mg/kg) was assessed by using Formalin Test (for chronic pain) during 1hr. post Formalin injection. Results: Our results indicated that cinnamon extract in high dose (500mg/kg) decreased the chronic pain intensity in the 2nd phase of formalin test. This analgesic effect was significant (P<0.001) as compared with sham group, but the lower doses (50 &100mg/kg) of cinnamon extract did not show any analgesic effect on chronic pain in Formalin Test. Conclusion: Data from this study confirms the analgesic effect of high doses (500mg/kg) of cinnamon extract on chronic pain in Formalin Test which may be due to anti-inflammatory effect of this plant material.

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The etiology of ESRD under the age of 20 almost is the inherited kidney disease or congenital disorders of urinary tract. NPHP/ medullary cystic disease includes a group of tubulo- genetic kidney disorders. NPHP is the cause of 15-20% ESRD in children and adolescents. The extra renal manifestations include: oculomotor Apraxia(Cogan syndrome), mental retardation, retinitis pigmentosa, (Senior- Loken syndrome) liver fibrosis and skeletal disorders. Recently, on the basis of genetics and type of the protein product of these mutations, NPHP is divided to 6 types. The presented case is a 17 year old boy with end stage renal disease that he has been managed with hemodialysis. As the patient has polyuria and disturbance in vision from childhood and on physical examination he had retinitis pigmentosa and horizontal nystagmus with a history of chronic kidney disease in his 12 years old sister, and familial marriage between his parents, we suggest NPHP4 for the patient.

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Introduction: Determining virus genotype is a major factor for initiation of treatment because various kinds of genotypes need different antiviral drugs. Distribution of hepatitis C genotype in the word is variable in each country or even in each province. So we need to determine distribution pattern of hepatitis C genotype in our region. This study was performed in referral clinic of Yazd province. Methods: This was a descriptive study conducted between 2007 and 2010 on patients who were observed by Yazd referral clinic (the clinic for evaluating and management of patients with high risk behaviors). Ninety two patients who had positive RIBA test for hepatitis C infection were randomly selected and entered the study. Genotyping was performed using RT-PCR method. The primer was "universal primer HCV". Prevalence of various genotypes was analyzed according to gender, addiction and co- existence of HCV-HIV infection. Personal information and laboratory results were analyzed using SPSS. Results: The most common genotype in our study was genotype 3a (65% of cases), followed by 1a (35%). Globally 83% of patients were IV drug addict. Genotype distribution in these patients was similar to others. Fifteen patients had co-infection of HCV-HIV, and 47% of them were contaminated by genotype 1a and 53% with 3a. We could not find any patient contaminated with genotypes 2 or 4. No other genotypes except 1 & 3 or mixed genotype infection could be determined in our patients. Twenty three percent of patients had negative PCR despite positive RIBA test. This indicates that self improvement from acute hepatitis C infection in IV drug addict patients is similar to other people. Conclusion: According to the results of our study, about 2/3 of patients were infected by genotype 3a. This kind of chronic hepatitis C shows a better response to treatment comparing genotype 1a (or 1b) with shorter duration and lower cost drugs. But despite higher incidence of genotype 3a, we can not start chronic hepatitis C therapy without knowing virus genotype. Determination of genotype is mandatory for the initiation of specific antiviral treatment.

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Introduction: Based on data from recent trials, peginterferon and ribavirin combination therapy is the standard of care in treating patients with chronic HCV infection, but because of high costs, many patients may deprive from treatment. Methods: We conducted a clinical trial on HCV patients in Yazd in gastroenterology clinic. Thirty patients received conventional subcutaneous interferon alfa-2b (PDferon B®,PooyeshDarou, Tehran, Iran) at a dose of 3 million units three times per week plus oral ribavirin 1000 mg, and 30 patients received PEG IFN -2a (Pegasys: Roche company)180 mcg weekly plus ribavirin 1000 mg/day. Patients with genotype 1 were treated for 48 weeks and those with genotypes 2 and 3 were treated for 24 weeks. Ribavirin was used according to weight based regimen. Sustained virological response(SVR) was the primary objective outcome. Two groups were matched for age, sex and BMI. Results: Three females and fifty seven males participated in the study. SVR was 93.3% in peginterferon group and 90% in conventional interferon group regardless of genotype. Frequency of genotype 1a, 1b, and 3a was 51.7 %, 3.3%, and 36.7%, respectively and in 8.3% of cases genotype was undetermined. SVR in peginterferon group with genotype 1a, 1b, 3a and undetermined genotype was 94.4%, 100%, 87.55 and 100%, respectively. SVR in conventional group with genotype 1a, 1b, 3a and undetermined genotype was 92.3%, -, 85.7% and 100%, respectively. SVR was not significantly different between two groups (p= 1). There wasn't a significant difference between two groups regarding response to treatment or side effects. The treatment cost was 3.240.000 Rls and 36.000.000 Rls in conventional interferon and peginterferon groups, respectively. Conclusion: This study showed a continuous and acceptable response to treatment with conventional interferon and ribavirin.

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Chronic sclerosing sialadenitis(also known as Kuttner tumor) is a chronic inflammatory condition of the salivary glands and one of the salivary gland enlargment that was first described by Kuttner in 1896. Unilateral or bilateral involment of the submandibular gland occurs more commonly than any other salivary glands. Few cases of chronic sclerosing sialadenitis in minor salivary glands have been reported. This article presented a case of chronic sclerosing sialadenitis in minor salivary gland of the floor of the mouth.

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Introduction: Within chronic pains, back pain has the highest percentage. Psychological factors play an important role in the establishment and continuation of physical disability as well as in functional limitation in patients with chronic low back pain. Therefore, the purpose of this study was to compare the effectiveness of Mindfulness Based Cognitive Therapy (MBCT) and Cognitive Behavior Therapy (CBT) on decreasing the pain, depression and anxiety of patients with chronic low back pain. Methods: This study was an experimental study by pretest- posttest design with a control group. Thirty patients were selected by random sampling among patients with chronic low back pain who referred to Imam Reza and Behsat clinics in Rasht from 2012 to 2013. The study participants were placed in three groups (two experimental and one control group). MBCT (first experimental group) and CBT (second experimental group) were administered in 8 sessions for 90 minutes. The short-form McGill pain Questionnaire (Dworkin et al, 2009) and depression, anxiety, stress scale (Lavibond & Lovibond, 1995) were used for collecting the data in pre-test and post-test stages. One way and multivariate Analysis of Variance were used for analyzing the data. Results: The results showed that there was no meaningful difference between two experimental groups in the mean score of pain, depression, anxiety, though a meaningful difference was observed between these two groups and the control group in regard to above variables. Conclusion: The results support the effectiveness of MBCT and CBT in decreasing pain, depression and anxiety. Therefore, taking account of these two therapeutic methods is very important for patients with chronic low back pain.

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Introduction: The present study aimed to evaluate the Effect of topical tetracycline gel application with non surgical periodontal therapy on HbA1c and lipid profile in type 2 diabetic patients. Methods: A total of 30 type 2 diabetic patients were randomly divided into two groups. The first group received scaling and root planning, whereas the second group received scaling and root planning with topically applied tetracycline gel. Clinical factors such as GI, PI, PPD and biochemical factors such as HbA1c and lipid profile were assessed in beginning of study and 3 months later. Results: Comparing the clinical factors between the two groups revealed that periodontal pocket depth significantly reduced in tetracycline-received group. Regarding the biochemical factors, triglyceride levels decreased significantly in tetracycline-received group. No significant difference was observed between the two groups in regard with other clinical and biochemical factors. Conclusion: The study findings demonstrated that clinical and biochemical parameters have been improved after non surgical periodontal treatment in both groups. Although it seems that application of topical tetracycline gel combined with non-surgical periodontal therapy is effective in improvement of some clinical and biochemical factors like PPD and TG, it doesn’t offer any superiority in regard with other factors compared to mere non surgical periodontal therapy.

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Introduction: The routine use of drains in uncomplicated laparoscopic cholecystectomy(LC) has still been controversial. Therefore, this study aimed to investigate the advantages and disadvantages of applying drains in uncomplicated LC. Methods: This study is a randomized prospective interventional study without blindness. After removing gallbladder, 60 patients were randomized to have corrugated drain positioned in the subhepatic space and 60 patients were randomized to have no drain. Patients were assessed for abdominal pain, nausea, vomiting, and the length of hospital stay 24 hr after the surgery. Then, they were assessed for biloma two weeks after the surgery. Results: No significant difference was observed in regard with nausea, vomiting and biloma in either group. However, abdominal pain (p-value: 0.001) and the length of hospital stay (p-value :

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Introduction: Host immune responses are considered as an an important factor concerning the progression of HBV infection. B cells population following Hepatitis B infection has received scant attention. A Poroliferation-Inducing Ligand (APRIL) can be introduced as a stimulator of B cell activities. Therefore, this study intended to investigate the proportion of IgD positive B lymphocytes in liver as well as to determine the level of APRIL serum in relation to the clinical findings in chronic hepatitis B patients.

Methods: Fifty-seven subjects suffering from chronic hepatitis B(CHB) were selected, who  attended the Hepatitis Clinic of Shariati Hospital. APRIL ELISA kit was used in order to measure the APRIL serum concentration. HBV DNA was quantified by RealArt^TM HBV LC PCR. Liver biopsy sections were stained with immunohistochemistry in order to indentify IgD.

Results: The mean score of liver fibrosis and inflammation was reported 4.20 according to the modified histologic activity index system. The mean score for patients with liver IgD positive B-cells was 1.9. Moreover, linear regression analysis showed that increasing the score of intrahepatic IgD positive B cells was propotionate to the increase of HBV DNA amplification, whereas it revealed a negative relationship with the APRIL serum level.

Conclusion: The study findings revealed that IgD positive B-cells imply the presence of naïve B cells, more within patients who had higher level of HBV DNA. Moreover, higher score of IgD positive B cells population was negatively related with the serum level of APRIL.

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Introduction: Hepatitis B virus (HBV) infection is a major health problem worldwide and may lead to serious clinical complications, including chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma. The host’s genetic background in immune system genes is a crucial etiologic factor in progression of HBV infection to chronic disease or clearance of the virus from the body. Interleukin 12 and its receptor (IL12 Receptor) play an important role in the clearance of viral infections, especially HBV. The aim of this study is to investigate the association between interleukin 12 receptor B1 gene single nucleotide polymorphism (rs401502 C/G) and chronic HBV infection.

Methods: In this case control study, genomic DNA of 105 chronically HBV infected patients and 105 healthy controls was extracted. Genotype of (rs401502 C/G) single nucleotide polymorphism was determined using polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) method.

Results: The frequency of (rs401502 C/G) SNP for GG, GC, CC genotypes and G, C alleles was %53.3, %41, %5.7 and %73.3, %26.7 in the chronic patients and %51.4, %41, %7.6 %71.9 , and %28.1 in the control group, respectively. Statistical analysis of the results showed that there was not any significant difference between the case and control groups (p=0.851).

Conclusion: In this study, no association was found between (rs401502 C/G) single nucleotide polymorphism within IL12RB1 gene and chronic hepatitis B virus infection. It seems that this SNP does not play a crucial role in susceptibility to HBV chronic infection

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Introduction: Relationship between periodontal infection and pulp pathosis has been debated for many years. This human case control study was performed to evaluate the possible effects of moderate to advanced chronic periodontitis on pulp stone formation and pulpal calcifications.

Methods: Current study is an experimental case control study.  Samples included 23 hopeless permanent teeth, affected with periodontitis in the case group and 23 periodontally healthy teeth in the control group, which were extracted for reasons like full denture treatment plan. After extraction and sectioning the apical 2-3 mm of root, teeth were immersed in 10% Formalin solution for 7 days. Then, teeth were decalcified in 5% HNO₃ for 10 days. After implementation of tissue preparation steps, sections were made of apical, middle and coronal part of root of each sample. After histological processing, sections were examined by an experienced pathologist under a light microscope. Prescence of pulp stone was investigated in the sections and the results of the two groups were compared with each other.

Results: Frequency of pulp stone showed no significant differences between the case and control groups in non of sections. (P-value= 0.730, 0.300, 0.760).

Conclusion: Inflammation of periodontium in chronic periodontitis has no influence on pulp stone formation.

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Introduction: The long-acting anticholinergic Tiotropium, which used in the treatment of patients with chronic obstructive pulmonary disease, prescribed once a day, unlike other bronchodilators that used several times a day for patients. The study was a systematic review that examined the effectiveness and safety of β2 Agonists and Tiotropium in the patients with chronic obstructive pulmonary disease.
Methods: RCT(randomized controlled trials) and CCT (controlled clinical trials) studies that compared Tiotropium and β2 agonists extracted from PubMed, SCOPUS, Ovid Medline and Cochran databases regardless of the time limitation were studied. Only studies were reviewed that were in English. In total, eight articles have been evaluated. Meta-analysis was performed using STATA software
Conclusions: The results showed less efficacy based on two outcomes include FEV1(Forced expiratory volume in 1 second) and FEV1 / FVC, and a little higher efficacy based on other outcomes such as (FVC). In terms of safety it can be said, the overall incidence of adverse events in both treatments was the same and it has been reported from moderate to severe according to the findings. Mostly, serious side effects were in form of intensifying attacks. The percentage of patients with severe complications in the Tiotropium group were less than Salmeterol group (0.9 vs. 3.1%, p = 0.04). In addition, a limited number of deaths observed in both treatment which were often unrelated to the applied treatment.
Conclusion: The results showed that Tiotropium treatment compared to β2 agonists was superior to safety. On the other hand, it showed less efficacy in the efficacy outcomes (FEV1 and FEV1 / FVC), and in the case of (FVC) effectiveness at a higher rate.

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Introduction: In periodontal pockets, the exposed root surfaces are contaminated with an accumulation of plaque and calculus. Usually, in the initial phase of periodontal therapy, debridement of the diseased root surface is non surgically. However, complete removal of plaque and calculus is not always achieved with only the use of conventional mechanical therapy. The outcome of other studies showed that adding diode laser therapy to the initial phase of periodontal therapy significantly improved treatment results. The aim of this study was the evaluation of the effects of diode (980 nm) laser on clinical periodontal parameters after nonsurgical periodontal therapy.
Methods: Twenty-one patients with moderate to severe chronic periodontitis (11 men and 10 female with mean age of 42.2) were selected and divided into the control group (SRP) and test group (SRP + laser). Two months after the last scaling and laser radiation, clinical parameters were recorded and compared with baseline. This clinical trial study was in splint mouth design which was done on randomized selection in two quadrant (Maxilla and Mandible) in test group. the data were entered in computer and analysed bying SPSS 16 and Mannywhitny and Wilcoxon test.
Results: After two months, clinical parameters improved in both groups. There were statically significant difference between two groups in PI and PD (0-3) mm, however in CAL and PPD (3-5) mm, (>5) mm no statically significant difference were seen.
Conclusion: According to an overall improvement in clinical parameters, usage laser as an adjunctive treatment besides common methods could be suggested.