Background: Coughing and laryngospasm are undesirable outcomes occurring during emergence from general anesthesia. We compared the effect of small doses of propofol, ketamine and a combination of them on the occurrence and severity of coughing and laryngospasm in patients awakening from general anesthesia. Materials and Methods: 160 patients who were scheduled to undergo operations under general anesthesia were randomly assigned to one of the following groups, 40 in each group: propofol group (0.25 mg/kg intravenous (IV) propofol), ketamine group (0.25 mg/kg IV ketamine), combination group (0.25 mg/kg IV propofol, and 0.25 mg/kg IV ketamine) and control (0.1 ml/kg IV saline). Drugs were administered before extubation at previously defined time. Presence and severity of coughing and laryngospasm were recorded within twominutes after extubation. Results: The presence of coughing in the combination group (27.5%) was less than that in other groups; also it was less frequent in the propofol group (57.5%) than the control (82.5%) (all P < 0.05). But the incidence did not differ between the propofol and the ketamine (70%) group; nor did it differ between the ketamine and control groups (P = 0.356 and P = 0.121, respectively). The cases with severe coughing (grade 3) in the combination group (none) were significantly less than in the propofol (four) and the control groups (seven) (P = 0.040 and P = 0.006 respectively). There was no significant difference between the groups in frequency of laryngospasm. Conclusion: Administration of propofol or combination of propofol and ketamine decreases the incidence of post extubation coughing. This combination can also decrease severe cases.

Background: Glutathione S-transferases (GSTs) are important factors in cell sensitivity to oxidative stress and susceptibility to cardiometabolic disorders. We aimed to investigate the GSTM1 and T1 gene polymorphisms, as well as their interactions in metabolic syndrome (MetS) patients and healthy individuals in an Iranian population. Materials and Methods: The study sample comprised of 220 healthy individuals (mean age: 41.9 – 15.1 years) and 165 MetS patients (mean age: 49.7 – 11.5 years). The diagnostic criteria for MetS were defined following the criteria provided by the modified National Cholesterol Education Program Adult Treatment Panel III. Genotyping of GSTM1 and T1 genes were performed using polymerase chain reaction. Results: Our analyses have shown that neither GSTM1 (odds ratio [OR] =0.89, 95% confidence interval [CI]: 0.59 – 1.33, P = 0.57) nor GSTT1 (OR = 1.26, 95% CI: 0.76 – 2.02, P = 0.38) null genotypes were associated with increased risk. Moreover, no significant differences were observed between various combinations of GST genotypes. Conclusion: Contrary to our primary hypothesis, what we found disaffirms any kind of association between GSTM1 and T1 polymorphisms and the risk of MetS. However, being the first polymorphism study of GSTs in MetS patients, further studies are required to confirm our results in other populations.

Background: The rising frequency of methicillin resistant Staphylococcus aureus (MRSA) has led to an increased use of antibiotics such as macrolide, lincosamide, streptogramin B (MLS_B) for the treatment of S. aureus infections. Resistance to MLS_Bin S. aureus is commonly encoded by erm genes, which can be constitutive MLS_B (cMLS_B) or inducible MLS_B (iMLS_B). The purpose of this study was to determine the frequency of cMLS_B, iMLS_B, and MS phenotypes using D-test and polymerase chain reaction (PCR) methods. Materials and Methods: A total of 215 isolates of S. aureus were collected from January 2010 to May 2012 from Al-Zahra Hospital in Isfahan. PCR was performed for detection of mecA gene on all isolates using specific primers. The frequency of MLS_B-resistant isolates was determined using D-test, and then a multiplex PCR was performed for detection of ermA, ermB, and ermC genes. Results: Among 215 S. aureus isolates examined, 82 (40.9%) were MRSA, and iMLS_B, cMLS_B, and MS resistance phenotypes had a frequency of 9 (4.18%), 58 (26.9%), and 11 (5.1%), respectively. Among nine isolates with iMLS_Bresistance phenotype, four isolates contained ermC gene, two isolates ermB gene, and one isolate ermA gene. Two isolates did not have any erm gene. Conclusion: In the current study, cMLS_Bwas the most frequent phenotype and ermC was the most common gene in iMLS_Bresistant phenotypes.

Background: Ovarian tumors ranked high among gynecological tumor globally. Reports have it that ovarian tumors cut across all age groups, but more common in adult females. Currently, ovarian cancer is the 4^th most common cancer in terms of incidence and mortality patterns in women globally. To highlight the frequency and histological types of ovarian tumors in a private practice establishment in Benin-City, Southern Nigeria. Materials and Methods: Hematoxylin and eosin stained-slides of ovarian biopsies diagnosed at the Ashamas Foundation Diagnostic Centre, Benin-City for 10 years were archived and studied. Request forms were analyzed for clinical bio-data, diagnosis and nature of biopsies. Ovarian tumors were classified according to the World Health Organization manual series. Results: A total of 236 of all ovarian lesions were encountered in this study. Of these, 200 (84.7%) were benign lesions while malignant lesions accounted for 36 (15.3%). Of this, 200 benign lesions 79 accounting for (39.5%) were a benign neoplastic tumor. The ratio of benign to malignant tumors was 5.6:1.0. The mean age of benign neoplastic tumor was 31.6 years ± 10.4 standard deviation (SD). Out of the 79 benign neoplastic tumors; germ cell tumors was the most common accounting for 49 (62%). The mean age of the 36 malignant ovarian tumors was 40.1 years ± 16.2 SD with the majority as malignant surface epithelial tumors accounting for (n = 16; 44.4%). The malignant germ cell tumor was the most common constituting 10 (27.7%). Conclusion: Germ cell tumor was the most common with the majority occurring in reproductive age. Our finding is a reversal of what obtains in the western countries where surface epithelial tumor was the most common with the majority occurring in elderly females.

Background: Cachexia can occur as part of many end-stage or chronic diseases, and chronic obstructive pulmonary disease. This study was aimed to evaluate the effect of Pentoxifylline in patients with cancer cachexia. Materials and Methods: The present study was conducted as a double-blind randomized controlled trial on 70 patients with advanced malignancy who loss of >5% of ideal or preillness body weight in the previous 2 months. Patients were assessed in two groups: case group, under treatment, using Pentoxifylline (400 mg) three times a day, for 2 months, and in the control group, patients received placebo. Age, sex, weight change, change in arm circumference and quality of life were assessed at baseline, week-4 and week-8. Results: The mean age of the patients was 56 ± 17.3 years and 47% were female. Weight and arm circumference decreased during follow-up in both groups, but these differences between case and controls were not statistically significant. Quality of life (QOL) score in the case group improved after 4 weeks then decreased at the end of treatment but in the control group QOL score decreased during 2 month treatment. In week-4 patients in the case group significantly reported higher score of QOL compare to patients in the control group (P = 0.029). Conclusion: Results of this study demonstrated that Pentoxifylline in the treatment of cancer cachexia did not have any effect in weight gain and arm circumference in cachectic patients. But in short-term (1 month) treatment, QOL was improved in these patients. And after 2 month treatment this was not effective compared to placebo.

Background: A sub-population of tumor cells termed cancer stem cells (CSCs) has an important role in tumor initiation, progression, and recurrence. Selecting a suitable procedure for isolation and enrichment of CSCs is the biggest challenge in the study of CSCs. In the present study, the role of the combination of stem cell culture medium and collagen type-I was evaluated for successful isolation and enrichment of HT-29 CSCs. Materials and Methods: HT-29 cells were cultured in serum-containing medium (parental culture medium: Medium + 10% fetal bovine serum) and serum-free medium (stem cell culture medium); both on collagen-coated plates. Spheres forming ability and CD133 expression, as a potential marker of colorectal CSCs, were evaluated in two culture mediums. Results: The results show spheroids usually give rise completely within 15 days in the stem cell culture medium on the collagen-coated plate. CD133 expression in spheroid cells (84%) is extensively higher than in parental cells (25%). Moreover, relative to parental cells, spheroid cells were more radioresistance. Conclusion: Finding of this study suggested that CSCs derived from colon cancer cell line (HT-29) can be propagated and form colonospheres in serum-free culture medium on collagen type-I. According to maintenance of their original phenotype in these conditions, it seems serum-free culture medium on collagen type-I is a suitable way to drug screening of HT-29 CSCs.

Background: Advantageous times for different people are different to some extent, considering the effective physiological changes during the circadian rhythm, in terms of the peak time of physiological activities. The goal of this study is to compare the educational achievement of students, with different morning–evening habits, in completing difficult and easy courses. Materials and Methods: This research is a retrospective descriptive–analytical study, which has been conducted on students of the fifth semester of General Medicine in the Faculty of Medicine, Isfahan University of Medical Sciences. The morning–evening habits of the students were determined by the Horne-Strauss 19-item questionnaire. The students were asked to determine the courses that were 'difficult' and 'easy,' using a researcher-made questionnaire. The students' scores in the considered courses during the five semesters were obtained from the Education Department of the Faculty and analyzed using the descriptive t-test, analysis of variance (ANOVA), and the multivariate regression test in the SPSS software. Results: Sixty-three students (67% girls and 33% boys) participated in this study, of whom 11, 60, and 29% were morning, morning–evening, and evening students, respectively. The mean scores of the difficult courses in all five semesters were reduced in the evening pattern compared to the morning and morning–evening patterns. Reduction of the mean score in the difficult courses, in the evening group, compared with the morning–evening and morning groups was observed in all five semesters among girls, but in three semesters among boys. Conclusion: This study showed that evening students experienced academic failure in difficult courses, which required a more cognitive performance. It is recommended that difficult specialized courses be presented at hours when all student groups have a better cognitive performance

Background: Postoperative pain is a major problem following laparoscopic cholecystectomy, and there is no general agreement on the effective method of pain relief. Rectal morphine suppositories are one of the newly released morphine forms. The aim of this study is to compare the impact of suppository morphine with placebo on pain relief after laparoscopic cholecystectomy. Materials and Methods: Seventy patients scheduled for elective laparoscopic cholecystectomy under general anesthesia, were randomly allocated to two groups according to the drug used for postoperative analgesia: Group morphine suppository (MS - 10 mg) just before induction of anesthesia And Group placebo suppository (PS) (the pills were made from cocoa butter, physically similar to the real drug). Pain intensity based on visual analog scale (VAS) and opioid consumption were assessed 30 and 60 min, and 2, 4, 8, 16, and 24 h after arrival of the patient to the recovery room. Results: VAS scores were significantly lower in MS group (from 3.8 ± 1 to 5.3 ± 1.6) compared with PS group (from 4.9 ± 0.9 to 6.7 ± 1) from 30 min after arrival to the recovery room until 16 h postoperatively (P < 0.05). There were no additional analgesic requirements in the first 2 h after the entrance of the patient to the recovery room in MS group. The number of patients requiring pethidine was significantly different between two groups (P < 0.05) in all periods except for 24 h postoperatively. Conclusion: Suppository morphine administration is more effective than placebo to reduce pain and analgesic requirements after laparoscopic cholecystectomy.

Background: We conducted a prospective study to elucidate the effects of increased cardiovascular risk factors on future weight gain and also the relation between body mass index (BMI) and other cardiovascular risk factors in children and adolescents. Materials and Methods: This study was conducted on 1525 nonobese children and adolescents with an age range of 3-16 years old, participating in the 1^st phase and follow-up phases of Tehran Lipid and Glucose Study. The subjects were evaluated 4 times with a 3-year time interval regarding lipid profile status and BMI, and other cardiovascular disease (CVD) risk factors. All the cases had a BMI <85% and had been appraised in at least two evaluation points. Results: Cardiovascular risk factors, high-density lipoprotein (HDL) (P = 0.019), low-density lipoprotein (P = 0.016), triglyceride (TG) (P < 0.001), and blood pressure (BP) (P = 0.001); had significant effects on weight gain. There was also no difference between boys and girls and no age trend for increasing weight in both groups. The associations between BMI with cardiovascular risk factors were assessed cross-sectionally. For both sexes, BMI was significantly correlated to systolic and diastolic BP and TG (P = 0.05). For girls, BMI was significantly related to HDL (P = 0.05) regardless to age, but in boys, the relation of BMI with HDL only increased with age (P = 0.05). Conclusion: Increased CVD risk factors are predictors of future overweight in childhood and adolescent and increased weight is linked significantly with dyslipidemia and hypertension in this age group.

Background: Cardiac arrhythmias are responsible for several cases of syncope and sudden cardiac death annually worldwide. Due to overlapping clinical symptoms in some cardiac arrhythmias genetic studies would help to confirm the primary clinical diagnosis made on the basis of solely clinical findings. In addition clinical management of the patient, family screening and provide appropriate counseling and risk assessment for the family members are other advantages of genetic study. Materials and Methods: Totally nine patients from a family included in this study. The primary diagnosis on the basis of clinical findings was second-degree atrioventricular (AV) block for this family. Mutation in SCN5A gene is frequently reported for second-degree AV block and hence the gene was analyzed using whole gene sequencing but no mutation was detected. Subsequently, the samples were subjected to customized Ampliseq 77 gene panel using next generation sequencing to detect the underlying molecular defects. Results: We found c. 5570T>A missense mutation in ANK2 gene for this family. Based on the Online Mendelian Inheritance in Man, ANK2 gene and the mutation detected correspond to long QT syndrome type 4. Conclusion: This mutation, although already known in other populations, but is reported for the first time in Iranian patients with cardiac arrhythmias. As the case with this family, genetic analysis of patients with cardiac arrhythmias would be helpful in reassessment of clinical diagnosis and therefore would help for patients' management and in some cases re-evaluation of ongoing treatment may be needed.

Background: Insulin resistance is the main defect associated with the metabolic syndrome. In obesity, the decreased adiponectin levels and elevation of plasma-free fatty acids are the main factors associated with insulin resistance. In this study, we evaluated the effect of trigonella foenum-graecum (TFG) extract on insulin sensitivity in high fructose-fed insulin-resistant rats. Materials and Methods: Experimental rats were fed with a high fructose diet for eight weeks. After the first six weeks, the animals were treated with trigonella foenum-graecum extract or pioglitazone for two weeks. Serum glucose, triglycerides, cholesterol, and HDL-c were measured. The insulin and adiponectin levels were assayed by the enzyme-linked immunosorbent assay (ELISA), and Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) was calculated. The plasma-free fatty acid profile was obtained by gas chromatography. PPARγ and GLUT4 gene expression were assessed by real-time polymerase chain reaction (PCR) and western blotting. Results: In the trigonella foenum-graecum- extract treated group the following results were obtained: Insulin (49.02 ± 6.93 pmol/L), adiponectin (7.1 ± 0.64 μg/ml), and triglycerides (110.3 ± 16.7 mg/dl), which were significantly different and improved compared to the control group (insulin (137 ± 34 pmol/l), adiponectin (3.9 ± 0.15 μg/ml), glucose (187 ± 15 mg/dl), and triglycerides (217 ± 18 mg/dl). Also the PPARγ gene expression was significantly increased compared to the control group. Conclusion: This study demonstrates the beneficial effects of trigonella foenum-graecum extract on insulin resistance in rats fed on a high-fructose diet. At least three mechanisms are involved, including direct insulin-like effect, increase in adiponectin levels, and PPARγ protein expression.

Background: Cisplatin (CP) is an effective chemotherapeutic drug used in the clinic, which is accompanied with nephrotoxicity. CP may also disturb hemodynamics of the circulation system. We have tested the role of CP in mean arterial pressure (MAP) response to graded angiotensin (Ang) II infusion in rats. Materials and Methods: Male and female rats were treated with CP (2.5 mg/kg/day) for a period of 1-week and compared with the vehicle-treated animals. The blood pressure response to Ang II (100–1000 ng/kg/min) was determined under the anesthesia condition. Endothelial permeability of aorta was measured according to the Evans blue uptake. The kidney tissue was also subjected to histological investigation. Results: Significant increase in serum levels of blood urea nitrogen and creatinine and pathological findings in CP-treated rats verified CP-induced nephrotoxicity. Significant difference in percentage of change in MAP response to Ang II between male and female rats was detected in vehicle-treated groups (P < 0.05) while in CP-treated animals this response difference was not observed. The groups were not significantly different with regard to the endothelial permeability of aorta while the serum level of nitrite in male rats increased significantly following administration of CP (P < 0.05). Conclusion: It seems the different response in percentage of change of MAP to graded Ang II infusion between male and female indicates the effect of CP on renin Ang system parameters.

Background: Vitamin D deficiency and insufficiency are recognized as a worldwide problem with serious consequences. Fortification of foods with Vitamin D is a certain approach to improve serum Vitamin D status if the stability of vitamin in the foodstuffs was controlled. The purpose of this study was to examine the stability of Vitamin D₃added to low-fat yogurt and yogurt drink “Doogh” during the products shelf-life. Materials and Methods: Two kinds of Vitamin D₃, water- and oil-dispersible forms, suitable for food fortification, were compared to find out whether they show different stability in the products. The products were packed in opaque or translucent containers. The content of Vitamin D₃was determined by high performance liquid chromatography method. Results: Vitamin D was not affected by the heat treatment (pasteurization) and other processes (homogenization and fermentation). Both water- and oil-dispersible forms were stable during the shelf-life of yogurt samples packed in opaque containers. The Vitamin D₃content of yogurt fortified with water-dispersible form and packed in translucent containers was not stable during the shelf-life and significantly reduced after 1, 2, and 3 weeks of storage compared to the day 0. The Vitamin D₃content of samples fortified with the oil-dispersible form packed in the same container was only stable after 1-week and significantly reduced after 2 and 3 weeks of storage. The Vitamin D₃content of Doogh packed in the opaque containers remained stable during the shelf-life while it was not stable in the samples packed in translucent containers. Conclusion: The results suggested that both forms of Vitamin D are suitable for fortification, and opaque container is a better choice for packaging of the product.

Background: Spinal cord injury (SCI) is not likely to recover by current therapeutic modalities. Stem cell (SC) therapy (SCT) has promising results in regenerative medicine. We present our experience of co-infusion of autologous adipose tissue derived mesenchymal SC differentiated neuronal cells (N-Ad-MSC) and hematopoietic SCs (HSCs) in a set of patients with posttraumatic paraplegia. Materials and Methods: Ten patients with posttraumatic paraplegia of mean age 3.42 years were volunteered for SCT. Their mean age was 28 years, and they had variable associated complications. They were subjected to adipose tissue resection for in vitro generation of N-Ad-MSC and bone marrow aspiration for generation of HSC. Generated SCs were infused into the cerebrospinal fluid (CSF) below injury site in all patients. Results: Total mean quantum of SC infused was 4.04 ml with a mean nucleated cell count of 4.5 × 10⁴/μL and mean CD34+ of 0.35%, CD45−/90+ and CD45−/73+ of 41.4%, and 10.04%, respectively. All of them expressed transcription factors beta-3 tubulin and glial fibrillary acid protein. No untoward effect of SCT was noted. Variable and sustained improvement in Hauser's index and American Spinal Injury Association score was noted in all patients over a mean follow-up of 2.95 years. Mean injury duration was 3.42 years against the period of approximately 1-year required for natural recovery, suggesting a positive role of SCs. Conclusion: Co-infusion of N-Ad-MSC and HSC in CSF is safe and viable therapeutic approach for SCIs.

Background: Poly3-hydroxyalkanoates (PHAs) are potential candidates for the industrial production of biodegradable plastics. Therefore, in the present study, expression and activity of one of the enzymes involved in the PHA synthesis, phaC2 (isolated from Pseudomonas aeruginosa PTCC1310), were investigated in Fad B deleted Escherichia coli. Materials and Methods: The inserts obtained from recombinant pTZ57R plasmids were ligated into the pGEX-5x-1 expression vector and then transformed into Fad B deleted E. coli cells using the heat shock method. This protein was then expressed using isopropyl beta-d-thiogalactoside (IPTG) as an inducer. By changing expression conditions such as IPTG and glucose concentration, time and temperature of incubation with IPTG, the expression conditions were optimized. Results: The optimum condition for the expression of this enzyme was: 1.5 mM IPTG, 1 mM glucose, incubated at 37°C for 2 hours. Conclusion: We obtained functional expression of the phaC2 gene and investigated various conditions that could influence the expression of protein to optimize production of PHA synthase enzymes. This would allow us to study PHA production in large quantities.

Background: The rising prevalence of obesity in today populations has led obese individuals to seek medical interventions. Aside from special diets, routine exercise and in some cases, medical treatment, most of the obese patients, favoring those with morbid or super obesity can benefit from bariatric surgery to lose weight. Laparoscopic sleeve gastrectomy (LSG) is relatively new method to limit the compliance of stomach. The consequent quick satiety during each meal results in gradual weight loss in patients. We investigated the efficacy and safety of this method among a group of our patients. Materials and Methods: This cross-sectional study was conducted in Isfahan, Iran, from January 2012 to January 2013. Thirty-five cases of obesity that had undergone LSG were enrolled and their baseline data of weight, body mass index (BMI), blood sugar, lipid profile, liver function indexes and blood pressure were collected. The patients were followed up for 6 months. The 6-month results were analyzed. Results: There was significant reduction in BMI, weight, blood sugar, blood pressure, liver enzymes and lipid profile components (P < 0.05), except for alkaline phosphatase (ALP) (P = 0.3). The average of excess weight loss percentage after 6 months was 69.2 ± 20.9%. No mortality occurred. Two of the patients had micro anastomotic leaks that were treated with nonoperative management. A case of gross leakage was treated with tube jejunostomy. Conclusion: Our study confirmed the efficacy and safety of LSG as a single surgical intervention for body weight reduction in morbidly and super obese patients.

Background: Niosomes are non-ionic surfactant vesicles used as drug carriers for encapsulating both hydrophobic and hydrophilic drugs. The aim of this study is to evaluate the effect of different surfactants on the physical properties and stability of carvedilol niosomes designed to improve oral bioavailability. Materials and Methods: Different niosomal formulations were prepared using a film hydration method, with various mixtures of different non-ionic surfactants including Span 20, 40, and 60, and also Tween 20, 40, and 60, along with cholesterol. The physicochemical characteristics of the formulations were evaluated in vitro. Results: The drug encapsulation efficiency was reduced by using lauryl (C₁₂) chain containing surfactants, that is, Span/Tween. Cholesterol content and drug entrapment were the main factors affecting the mean particle size of the niosomes. The drug release profiles from most of the formulations were fitted well with the Baker-Lonsdale model, indicating a diffusion-based drug release mechanism. Niosomes prepared from 50 and 40% of the cholesterol with 25 or 30% of Span/Tween 60 showed the highest stability due to their high transition temperature and solid state feature of these surfactants. Conclusions: From the results obtained, it may be concluded that nanoniosomes are promising stable carriers for the oral delivery of carvedilol.

Background: Migraine is a highly prevalent disorder worldwide. It affects 10–20% of the population during their lifetime. Recent studies have indicated that supplementation with folate and pyridoxine improves migraine symptoms. This study was undertaken to evaluate dietary intake of folate and pyridoxine in migraine patients and assessed their association with the frequency of migraine attacks. Materials and Methods: This is a case–control study performed on 124 migraine patients and 130 non-migraine subjects. Individuals' common dietary intake was determined by using a valid semi-quantitative 168-item food frequency questionnaire (FFQ). Data had been analyzed using independent t-test using SPSS software (version 18). Results: In this study, we found that migraine patients had lower intake of dietary folate compared with control group, but energy and pyridoxine intake were not different between the two groups. Further analysis among men and women revealed no statistically significant changes in these relationships. In addition, we found no significant association between dietary intake of pyridoxine and folate with the frequency of migraine attacks. Conclusion: Migraine patients had lower dietary intake of folate, compared with non-migraine group subjects. There was no significant association between folate and pyridoxine intake with the frequency of migraine attacks. Further studies are needed to confirm our findings.

The complexity of multiple sclerosis (MS) and the incompetence of a large number of promised treatments for MS urge us to plan new and more effective therapeutic approaches that aim to suppress ongoing autoimmune responses and induction of local endogenous regeneration. Emerging data propose that hematopoietic, mesenchymal, and neural stem cells have the potential to restore self-tolerance, provide in situ immunomodulation and neuroprotection, as well as promote regeneration. Thus, in this article, we will first provide an overview of the cell sources for proposed mechanisms that contribute to the beneficial effects of stem cell transplantation, the ideal route and/or timing of stem cell-based therapies for each main stem cell group, and finally, an overview of the current status of stem cell research in clinical trial stages in MS by comparable and healthy therapeutic effects of different stem cell therapies for MS patients.

Background: Cardiovascular hemodynamic changes after laryngoscopy and endotracheal intubations can cause serious complications. This study was carried out to evaluate the correlation between the anthropometric indices and hemodynamic changes after laryngoscopy and endotracheal intubation (EI). Materials and Methods: This descriptive–analytical pilot study was carried out in 2012, in the Kashani Hospital, Isfahan, Iran. After obtaining written informed consent from 130 patients who fulfilled the inclusion criteria, they were enrolled in the study. The recorded data included were, age, weight, height, neck circumference (NC), waist-to-hip ratio (W/H ratio) and body mass index (BMI). The heart rate (HR), systolic blood pressure (SAP), diastolic blood pressure (DBP), and mean arterial blood pressure (MAP) were recorded at baseline (before injection of the anesthetic drugs), just before laryngoscopy, and one, three, five, and ten minutes after EI. Results: The best cut-off points for BMI, NC, and W/H ratio, for prediction of significant cardiovascular changes after EI were, 26.56 kg/m², 38 cm, and 0.82, respectively. There was a significant correlation between BMI and HR changes in the first and fifth minutes and also in MAP in the third and fifth minutes after EI (P < 0.05). Moreover, there was a significant correlation between NC and MAP in the fifth minute (P < 0.05). The W/H ratio was significantly related to the DBP in the tenth minute and MAP in the fifth and tenth minutes (P < 0.05). Conclusions: Based on the results of this study, among the anthropometric indices, the BMI, NC, and W/H ratio were significantly correlated with cardiovascular changes after laryngoscopy and tracheal intubation.

Background: The GLIS family members are zinc fingers with transcriptional repression and activation function. GLIS3 is one of these family members, which aberrant expression of it revealed to be related to several different cancer types. Regarding to the role of GLIS3 in tumor genesis and its probable connection with β-catenin signaling pathway, one of the pathways that involves in both normal development and tumor genesis of breast tissue, the aim of this study is investigating the alteration of GLIS3 mRNA expression level in breast cancer. Materials and Methods: Real-time polymerase chain reaction performed with GLIS3 and GAPDH genes primer on the RNA which extracted from 15 fresh frozen breast tumor tissue samples and also 15 normal samples with slight distance from site of tumor. Results: The relative expression of GLIS3 in breast cancer tissues revealed a 4 times increase comparing normal breast tissues; with a significant difference between cancer and normal samples (P = 0.027) and in patients without lymph node involvement and tissues that had estrogen receptor (ER⁻) and progesterone receptor (PR⁻) statuses. We see no significant difference between cancer and normal tissues based on lobular or ductal origin of the tumor as well as the tumor grade. Conclusions: Our study suggested a probable relationship between GLIS3 overexpression and breast cancer. Furthermore, detection of a probable association between GLIS3 overexpression and triple-negative breast cancer (ER⁻/PR⁻/human epidermal growth factor receptor 2⁻) might be useful for prognostic and diagnostic uses or as a probable target for treatment of these patients.

Background: Neuropsychiatric systemic lupus erythematosus (NPSLE) is a serious and well-known complication of systemic lupus erythematosus (SLE). There is limited evidence about the prevalence of NPSLE and its manifestations in Iran. The aim of this study was to study clinical and demographic characteristics of patients with NPSLE in an Iranian population. Materials and Methods: This was a cross-sectional study that was undertaken in two referral Clinics of Neurological and Rheumatological Disorders in Alzahra Hospital, Isfahan, Iran. Between March 2004 and June 2010, medical records of registered patients with SLE were examined. NPSLE was characterized using the American College of Rheumatology case definitions. Descriptive statistics and logistic regression were performed for statistical assessment. Results: Among 556 patients with SLE, 121 (21.7%) patients were diagnosed as NPSLE and enrolled in the study. Of whom, 94 patients were female (77.7%) and 27 patients were male (22.3%) with a female to male ratio of 3.48:1. The most common NPSLE manifestations were headache (38.8%), cerebrovascular disease (CVD) (38.8%) and seizure (26.4%). Thirty-nine patients have psychiatric disorders. Among them, 32 patients (26.4%) have periods of psychosis and mood disorder was found in 6 patients (5%). Conclusions: We identified NPSLE manifestations in 21.7% of patients; headache and CVD were the most frequent neurological manifestations. Continued studies into the pathogenesis of neurological involvement in patients with SLE are warranted.

Hemorrhagic pleural effusion is a common clinical entity still diagnosis is often missed. An unusual and often over-looked cause of pleural effusion is an intra-abdominal process including complication arising due to pancreatitis. We report a rare case of massive left sided hemorrhagic pleural effusion in a patient due to pancreatic pathology.

Background: Fibrocyte-specific protein, otospiralin, is a small protein, widely expressed in the central nervous system as neuronal cell bodies and glia. The increased expression of otospiralin in reactive astrocytes implicates its role in signaling pathways and reparative mechanisms subsequent to injury. Indeed, otospiralin is considered to be essential for the survival of fibrocytes of the mesenchymal nonsensory regions of the cochlea. It seems that other functions of this protein are not yet completely understood. Materials and Methods: Amino acid sequences of otospiralin from 12 vertebrates were derived from National Center for Biotechnology Information database. Phylogenetic analysis and phylogeny estimation were performed using MEGA 5.0.5 program, and neighbor-joining tree was constructed by this software. Results: In this computational study, the phylogenetic tree of otospiralin has been investigated. Therefore, dendrograms of otospiralin were depicted. Alignment performed in MUSCLE method by UPGMB algorithm. Also, entropy plot determined for a better illustration of amino acid variations in this protein. Conclusion: In the present study, we used otospiralin sequence of 12 different species and by constructing phylogenetic tree, we suggested out group for some related species.

Background: This study aimed to examine the relationship between sonographic diagnosis of fatty liver and liver enzyme level with histopathologic abnormalities and liver biopsy findings in patient with the nonalcoholic fatty liver disease (NAFLD). Materials and Methods: This cross-sectional study conducted on 109 patients with diagnosed and under treatment NAFLD refer to Gastroenterology Clinics of AL Zahra Hospital in Isfahan, Iran. Age, sex, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALP) level recorded for all patients. Liver ultrasonography was performed for all patients. Steatosis grading and fibrosis stage were evaluated by liver biopsy. Results: We enrolled 109 subjects with NAFLD who had an indication for liver biopsy and met inclusion criteria of our study. Of these, 78 subjects (71.6%) were male and 31 subjects (28.4) were female. Mean age was 40.17 ± 11.01 years old. Our results showed there was a statistically significant relationship between ultrasonographic findings and histologic findings based on biopsy. There was statistically significant relationship between liver enzyme (ALT, AST and ALP) level and ultrasonographic findings, but there was no significant relationship between AST and ALT level and histologic findings, but the relationship between ALP level and histologic findings (steatosis and fibrosis) was statistically significant (P = 0.01). Conclusion: Ultrasonographic finding may be can use to identify nonalcoholic steatohepatitis and stage of fibrosis in patients with NAFLD, but AST and ALT level is not reliable screening test to identify stage of fibrosis and steatosis in these patients. Therefore, liver biopsy remains the gold standard for establishing steatohepatitis and advanced fibrosis in patients with NAFLD.

Background: Corneal transplantation is a surgery in which cornea is replaced by a donated one and can be completely penetrating keratoplasty (PK) or included a part of cornea deep lamellar keratoplasty (DLK). Although the functional results are limited by some complications, it is considered as one of the most successful surgeries. This study aimed to compare the refractive errors after same size corneal transplantation through DLK and PK methods in keratoconus patients over 20 years. Materials and Methods: This descriptive, analytical study was conducted in Feiz Hospital, Sadra and Persian Clinics of Isfahan in 2013–2014. In this study, 35 patients underwent corneal transplantation by PK and 35 patients by DLK, after removing the sutures, the patients were compared in terms of best corrected visual acuity (BCVA) and refractive errors. Data were analyzed using Chi-square and t Student tests by SPSS software. Results: The BCVA mean in DLK and PK groups was 6/10 ± 2/10 and 5/10 ± 2/10, respectively, with no significant difference (P = 0.4). The results showed 9 cases of DLK and 6 cases of PK had normal (8/10 ≤ BCVA) visual acuity (25.7% vs. 17.1%), 24 cases of DLK and 27 cases of PK had mild vision impairment (68.6% vs. 77.1%) and 2 cases of the DLK group and 2 cases of PK had moderate vision impairment, (5.7% vs. 5.7%), there was no significant difference in “BCVA” (P = 0.83). Conclusions: Both methods were acceptably effective in improving BCVA, but according to previous articles (5,9,10) the DLK method due to fewer complications and less risk of rejection was superior to another method and in the absence of any prohibition this method is recommended.

Background: Subclinical hypothyroidism (SHT) may increase the risk of cardiovascular disease. We compared endothelial function between SHT patients and euthyroid individuals, and evaluated the effects of levothyroxine therapy on endothelial function in the patients. Materials and Methods: In a quasi-experimental study, flow-mediated dilatation (FMD) and intima-media thickness (IMT) were assessed in SHT patients and healthy controls (n = 25 in each group). Patients then received levothyroxine (50 μg/day) for 2 months, and the FMD and IMT assessments were repeated. Results: Patients and controls were similar in IMT (0.56 ± 0.09 vs. 0.58 ± 0.08 mm, P = 0.481), but FMD was lower in patients than in controls (4.95 ± 2.02 vs. 6.50 ± 2.57%, P = 0.011). A significant increase was observed in FMD (4.11 ± 2.37%, P = 0.001), but not in IMT (−0.004 ± 0.020 mm, P = 0.327), after levothyroxine therapy among the patients. Conclusions: Patients with SHT have endothelial dysfunction which responds to levothyroxine therapy. Randomized placebo-controlled trials are needed to confirm these findings.

Background: Thyroidectomy is one of the most common forms of operations in general surgery. Regarding the status and importance of thyroidectomy and protective measures for avoiding the surgical complications, we aimed at investigating the short-term postoperative complications of thyroidectomy by applying the two methods of ligature use and suture ligation of vessels. Settings: Department of Surgery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Materials and Methods: This Double-blind randomized clinical trial study conducted on 140 candidates of thyroidectomy. The patients were randomlyequally allocated assigned to two groups of 70. In the ligature group, thyroidectomy was performed via ligature use, and in the suture ligation group, it was done with suture ligature. Using a specific questionnaire, the required demographic information, type of surgical operation, duration of surgery, rate of bleeding, the preoperative and postoperative serum calcium concentration, hypocalcemia symptoms, hoarseness, and laryngoscopic findings were collected and analyzed. Results: The findings revealed that the average time of total and subtotal thyroidectomy lasted 93.94 ± 10.53 min with ligature use and 134.15 ± 13.57 min with suture ligation. No case of postoperative bleeding was observed in this study. Two patients (17.1%) in the suture ligation group and two patients in the ligature group showed signs of hypocalcemia. Six patients developed hoarseness of whom five belonged to the ligature group and one belonged to the suture ligation group. Conclusions: Regarding the fact that on the whole, duration of thyroidectomy was shorter in ligature approach compared to the suture ligation, it can be considered as a suitable method to substitute suture ligation. However, meticulous precautions should be taken specifically with regard to the efferent laryngeal nerve and hoarseness.

Background: Oxidative stress has been a frequent finding in epileptic patients receiving antiepileptic drugs (AEDs). In this study, the influence of Vitamin E on the antiseizure activity and redox state of patients treated with carbamazepine, sodium valproate, and levetiracetam has been investigated. Materials and Methods: This double-blind, placebo-controlled trial was carried out on 65 epileptic patients with chronic antiepileptic intake. The subjects received 400 IU/day of Vitamin E or placebo for 6 months. Seizure frequency, electroencephalogram (EEG), and redox state markers were measured monthly through the study. Results: Total antioxidant capacity, catalase and glutathione were significantly higher in Vitamin E received group compared with controls (P < 0.05) whereas malodialdehyde levels did not differ between two groups (P < 0.07). Vitamin E administration also caused a significant decrease in the frequency of seizures (P < 0.001) and improved EEG findings (P = 0.001). Of 32 patients in case group, the positive EEG decreased in 16 patients (50%) whereas among 33 patients in control group only 4 patients (12.1%) showed decreased positive EEG. Conclusion: The results of this preliminary study indicate that coadministration of antioxidant Vitamin E with AEDs improves seizure control and reduces oxidative stress.

Background: Multiple sclerosis may have profound emotional consequences. The relation between psychological and physical factors could lead patients toward unforeseen disease. This study focuses on multiple sclerosis (MS) disease duration on personality type A and B in relation to individuals' behaviors. Materials and Methods: This descriptive-analytical study was conducted in Isfahan Alzahra hospital in 2013. Three hundred MS patients and 100 healthy individuals were determined. The distributed questionnaires related to MS patients and considering the descriptive statistics such as demographic variables. Data were analyzed by SPSS software (version 18) based on Chi-square test and independent T-test. Results: Disease duration varied between 1 to 38 years: 30% (1-4 years), 38% (5-10 years), 20% (10-20 years), and 12% (more than 20 years). Significant relationship was observed between disease duration and tendency to type A (higher stress). This relation was positive and significant in Relapsing Remitting MS patients; but negative correlation was seen in Secondary Progressive MS patients. These patients tended to type B (lower stress) when disease duration increased. Conclusions: Individuals with disease duration of one year and less than one year tend to type A personality, while patients with increment of disease duration have tendency to type B.

Chorioretinal coloboma is a congenital defect of the eye caused by improper closure of the embryonic fissure. Optic nerve head drusen (ONHD) are white calcareous deposits that are generally asymptomatic. We report a very rare association of both in a healthy patient with no any systemic syndrome. A 16-year-old man was referred to our clinic from suffering blurred vision. Best corrected visual acuity of the right eye was 6/10 and 10/10 in the left one. External ocular and slit lamp examination were normal. Dilated ophthalmoscopy showed marked swelling in both optic nerves and chorioretinal coloboma in the right eye inferiorly. Ultrasonography showed an echodense structure with acoustic shadowing in both eyes consistent with buried ONHD. Visual field testing showed normal field in the left eye and moderate superior field depression in the right eye corresponding to inferior coloboma in funduscopy. Results of general medical and neurologic, cardiologic, and other examinations were normal. To the best our knowledge combination of bilateral ONHD and unilateral chorioretinal coloboma in a healthy patient with no any systemic syndrome has not been published in the literature. We reported this very rare association and recommended examine eyes and other body organs. In such cases that coloboma is associated with ONHD, we should keep in mind Noonan syndrome. The diagnosis of Noonan syndrome is clinical and confirm by the consultant pediatricians and clinical geneticists.

Background: Congenital adrenal hyperplasia (CAH) due to mutations in the gene encoding 21-hydroxilase is one of common disease with an autosomal recessive form. In this study, our aim is to detect the prevalence of eight common mutations in nonclassical congenital adrenal hyperplasia (NCAH). Materials and Methods: A total of 30 patients with clinical and laboratory evidence of NCAH was selected. Gene-specific polymerase chain reaction (PCR) without contamination of pseudogene was carried out, and PCR product of this step was used to amplification-refractory mutation system PCR on eight common mutations in CYP21A2 gene. Results: Two heterozygote patients for I2G mutation and six heterozygote patients for Q318X mutation is reported in our study. These mutations associated with the classic form of CAH, and heterozygotes presented with NC symptom, including premature pubarche and hirsutism. Conclusion: There are some data about the association of the mutation with the clinical form of CAH including classic (salt-wasting and simple virilizing) and NC form. I2G and Q318X mutations were reported in classic form in homozygote state, but the heterozygote form associated with NC form. CAH diagnosis with NC symptom and with measurement of 17-hydroxyprogestrone as NCAH is not a trusted assessment and require to molecular analysis for accurate diagnosis.

Acute onset bulbar symptoms with respiratory failure and descending paralysis may occur in several neuromuscular disorders including variants of Guillain-Barre syndrome (GBS), diphtheria, botulism and toxins. We present a 51-year-old man who presented with complains of ptosis and dyspnea following pyrethroids spraying in an enclosed area for eradication of flea. Within 5-6 days of admission limb weakness, dysphagia, dysarthria, blurred vision, diplopia, tremor and respiratory distress added to previous symptoms. Temporal profile of events after exposure, development of similar symptoms in patient's son, electrodiagnostic findings and exclusion of other etiologies confirms intoxication etiology. We reviewed the literature and provide an extensive electrodiagnostic overview.

Background: Trace elements have long been suspected to be involved in Parkinson's disease (PD) pathogenesis, but their exact roles have been remained controversial. In this study, we assessed the levels of copper (Cu), iron (Fe) and zinc (Zn) in different stage of PD patients. Materials and Methods: Serum concentrations of iron, copper and zinc were measured in 109 patients with PD by colorimetric methods. Staging of the disease was evaluated according to Hoehn and Yahr (H and Y) and Unified PD Rating Scale III (UPDRS). Results: Severity values of PD measured by UPRDSIII and HY stages with mean ± SD were 22.9 ± 1.81 and 1.8 ± 1.1, respectively. Mean ± SD values of iron, zinc and copper are 100.7 ± 289.2, 68.3 ± 5.32, and 196.8 ± 162.1 μg/dl, respectively. Serum iron level in most of the patients was normal (76.6%). Whereas zinc concentration in most participants was below the normal range (64.5%) and serum Cu in the majority of patients had a high normal concentration (42.7%) and did not significantly differ among various PD stages. Conclusion: The result of this study does not confirm strong correlation between PD stages and serum levels of tested trace elements. The actual correlations between these elements and PD and whether modulating of these agents levels could be an effective approach in the treatment of this disease remain to be elucidated.

Childhood disintegrative disorder (CDD) is a rare autistic-like clinical condition with unknown etiology, in that previously acquired age-appropriate language, social and adaptive abilities deteriorate significantly in 2-10-year-old healthy children, although physical and neurological evaluations display no observable abnormality. Our case is a 22-year-old female born of a consanguineous marriage, with the appearance of CDD symptoms in her fifth year of age following normal mental and physical development during her initial four years of life. Without any precipitating factor, she gradually lost her language abilities, social relational skills, affectionate behavior, adaptive capacities, peer play and meaningful interest in her surrounding, friends and family members over a period of 4 years, reaching a plateau in her ninth year of age. The unique special clinical symptom in this case is a seasonal total mutism, which after the beginning of her CDD symptoms is revealing every year covering the spring. As no additional physical or psychological change accompanies her total seasonal speech loss, it cannot be attributed to any mental condition known as having a seasonal pattern. Because in the literature CDD is presented mostly as case reports with lacking of advanced research data, describing any new case is recommended to improve the knowledge about this rare condition, especially if it displays some new unusual signs, not reported till now.

Background: Although color Doppler ultrasonography (CD-USG) is useful in the diagnosis of various diseases of the head and neck, flow signals in the malignant oral tumors are less studied. This study aimed to study the usefulness of CD-USG in mapping OSCC of buccal mucosa, tongue, and lip. Materials and Methods: This was a case-control study, conducted among 60 subjects aged 20-70 years. Group A consisted of 30 cases of OSCC of buccal mucosa, tongue, and lip, whereas Group B consisted of 30 controls. CD-USG investigation of each mass was carried out. The spectral waveform (time velocity Doppler spectrum) of flow signal was analyzed for the pulsatility index (PI), resistivity index (RI), peak systolic velocity (PSV) (m/s), and end diastolic velocity (EDV) (m/s). All patients had real-time, gray-scale sonography and CD-USG with spectral wave analysis. Results: In this study, the mean value for RI in patients with malignancy was 0.40 + 0.14, whereas for healthy subjects, it was 0.83 + 0.07. The mean value for PI in patients with malignancy was 0.86 + 0.20, whereas for healthy subjects, it was 2.61 + 0.77. In the present study, the mean PSV in malignant masses was 31.72 + 13.48, whereas for healthy subjects, it was 43.87 + 20.95, and the EDV in malignant masses was 10.33 + 5.21, whereas for healthy subjects, it was 7.07 + 3.44. Conclusions: The said Doppler indices were shown to be sensitive as well as specific for the diagnosis of malignant oral tumors. Although CD-USG cannot replace histopathological procedures, it plays a definite role as an adjunct to the clinical evaluation of OSCC cases.