Background: Efficacy of preemptive analgesia with nonsteroidal antiinflammatory drugs (NSAIDs) in comparison with acetaminophen is controversial. The present study evaluates the preemptive analgesia efficacy of celecoxib and acetaminophen in comparison with placebo for postoperative pain relief in patients who underwent orthopedic surgery under general anesthesia. Materials and Methods: Ninetypatients eligible for elective distal extremity surgery were categorized in three groups: group C includedpatients who received oral celecoxib 200 mg 2 h before surgery; group A included those who received oral acetaminophen 320 mg 2 h before surgery; and group P included those who received oral placebo 2 h before surgery. Pain scores were recorded at 4, 12, and 24 h after operation. Results: The pain scores 4 h after operation was significantly less in group C than in groups A and P (4.7±1.7 vs. 5±1.5 vs. 6.8±1.7, respectively, P = 0.015). No significant difference was noted in pain scores at 12 h (4.6±2, 4.9±1.9, 4.3±1.4 in group A, group C, group P, respectively P > 0.05) and 24 h (3.1±1.7, 3.0±1.4, 3.3±1.7 in group A, group C, group P, respectively, P > 0.05) after operation among the three groups. Conclusion: Using oral celecoxib 200 mg 2 h before operation is better thanusing oral acetaminophen 320 mg 2 h before the beginning of surgery for control of postoperative pain in patients who underwent lower extremity orthopedic surgery under general anesthesia.

Background: Nephrolithiasis is a major public health problem worldwide. In recent years, growing evidence suggest that this disease may originate from underlying metabolic disorders. This is the first study that reports the frequency of different metabolic abnormalities among patients with nephrolithiasis in Isfahan, a large central province of Iran. Materials and Methods: From the time period between March 2009 and August 2010, 437 nephrolithiasis patients in Isfahan province enrolled in this study. Metabolic evaluation was performed by obtaining a 24-hours urine sample and fasting venous blood draw. We analyzed urine samples for volume, creatinine, calcium, citrate, oxalate, uric acid, sodium, and cystine. Fasting blood samples were assessed for serum calcium, phosphorus, sodium, potassium, uric acid, albumin, creatinine and blood urea nitrogen. Results: The mean age was 46 ± 13.8 years (rang: 18-87). Nearly 50% were first time stone formers. The most common metabolic abnormalities were hypocitraturia (40.5%) and hypernatriuria (31.8%) that was followed by hyperoxaluria (28.8%). Hypercalciuria was detected only in 9.2% of the cases. Conclusion: Although, high calcium excretion was the most frequent metabolic derangement in several similar studies, in our province with considerably high prevalence of vitamin D deficiency, it is not frequent among nephrolithiasis patients. Instead, other metabolic risk factors were in higher frequencies.

Background: Blood trace elements of people who are living or working in areas with high radioactivity have an important role in vital processes. The scope of this work is to measure the concentrations of blood trace elements of permanent workers in Mahallat's hot springs. Materials and Methods: In this study, 30 persons of hot springs permanent workers in Mahallat (mean background dose: 21.6 mSv) were selected as a sample group and 30 persons with similar social class who received a normal background dose and were not engaged in any type of radiation work were selected as a control group. Five milliliters of blood sample was taken from each person and after preparation of the samples, the concentration of copper, iron, zinc and magnesium was measured with atomic absorption spectrometry. Results: The average concentration of copper, iron, zinc and magnesium in the irradiated group was 0.67±0.11, 1.54±0.41, 1.76±0.34 and 19.78±1.42, respectively and in the control group, was 0.78±0.06, 1.06±0.15, 0.85±0.05 and 20.34±0.57, respectively. Values of copper and magnesium in workers were found to be less than that of the control group. The mean concentration of iron and zinc in permanent workers was significantly more than that of the control group (P<0.05). Overall, no meaningful statistical correlation was found between the concentration of magnesium among the permanent presence in the area (P>0.05). Conclusions: The results showed that increases in the average concentrations of Zn and Fe and decreases in the concentration of Cu of workers was observed. The finding also showed that the probability of chronic exposure effects on body trace element concentrations was increases and each value of the doses could be dangerous.

Background: Alzheimer's disease is a neurodegenerative disease appearing as a result of free radicals and oxidative stress. Antioxidants agents boost memory and control Alzheimer's disease. Since red grape juice contains antioxidant agents, its effects on speed of learning and improvement of memory was studied in Alzheimer's rats. Materials and Methods: Alzheimer's model was induced by bilateral infusion of streptozocine into lateral ventricles of brain of male rats. Rats drank 10% red grape juice for 21 days. Passive avoidance learning test was used for measuring memory and learning in rats. Results: Our results showed that learning and memory in STZ-group decreased significantly compared to Sham group. However, intake of red grape juice increased speed of learning and improvement of memory in Alzheimer's rats. Conclusions: Our results suggest that there are active ingredients in red grape juice, which probably have therapeutic and preventive effects on cognitive impairments in Alzheimer's disease.

Background: Doppler ultrasonography (DU) and measurement of its indexes, resistive index (RI) and pulsatility index (PI), is used to investigate transplanted kidney hemodynamic status and function. The aim of this study was to determine the correlation between Doppler indexes in the early phase after transplantation with long-term transplanted kidney function. Materials and Methods : In this cross-sectional study on 38 newly kidney transplant patients, we performed DU with assessment of its indexes within 48 hours, 1 week, and 6 months after kidney transplantation. Serum creatinine after stability and 6 months after kidney transplantation were assessed. Cyclosporine level was measured 1 week after kidney transplantation and compared with DU indexes. Results: About 71% of kidney transplanted patients reached their normal initial creatinine level(cr<1.5 mg/ dl) and 28% of all patients were involved in kidney dysfunction after 6 months (increase in basic creatinine level more than 25%).There was no significant difference between mean RI and PI in patients with normal and disturbed kidney function based on creatinine level in early posttransplantation period but there was linear correlation between mean RI and PI within 48 hours and 1 week with kidney function after 6 months. Also no association between cyclosporine level and RI and PI was shown. There was a direct association between age and the levels of RI and PI 6 months after transplantation. Conclusion: This study suggests assessment of RI and PI in early period after transplantation and can be used as predictive parameters for long-term function of transplanted kidney and RI more than 0.80 in early phase after transplantation has an acceptable sensitivity and specificity to predict long-term kidney dysfunction.

Wilson's disease (WD) or hepatolenticular degeneration is an inherited neurodegenerative disorder of copper metabolism (autosomal recessive, chromosome13). Psychiatric disorders in WD include dementia, characterized by mental slowness, poor concentration, and memory impairment. Symptoms may progress rapidly, especially in younger patients, but are more often gradual in development with periods of remission and exacerbation. Delusional disorder and schizophrenia-like psychosis are rare forms of psychiatric presentation. In this report, the patient with WD presented by psychosis symptoms and treated mistaken as schizophrenia for almost ten years. Although he has treated with antipsychotics, he had periods of remissions and relapses and never was symptoms free. Since psychosis can be the manifestation of medical diseases such as WD, overall view of these patients is necessary and medical diseases should be considered as a differential diagnosis.

Background: We conducted an epidemiological survey on seroprevalence of toxoplasma infection in women of childbearing age in Isfahan Province. Materials and Methods: In a cross-sectional study in 2010, 217 women in the age range of 10-50 years were randomly selected. The blood samples examined for the presence of IgG anti-Toxoplasma gondii antibody by a commercial ELISA kit (Dia-Pro, Milan, Italy). Chi-square and Fisher's exact tests were employed to examine the antibody status in different age, marriage, education, and residence groups. Results: The overall prevalence was 47.5% (103/217). The peak age of infection acquisition was in the range 30-40 years in rural areas and 20-30 years in urban districts. There was no significant association between residence, education, and marriage groups on the one hand and chance of T. gondii infection on the other hand. Conclusions: The findings of the study suggest a moderate prevalence of T. gondii infection, but a high prevalence in ages of high reproductive activities.

Background: Ultraviolet B (UVB) is the most damaging component of sunlight. It rapidly activates the epidermal growth factor receptor (EGFR) and generates reactive oxygen species (ROS) in excessive quantities that quickly overwhelm tissue antioxidants. Setting and Design: To demonstrate the effects of UVB radiation on EGFR expression in mice skin and to evaluate the role of antioxidants in the exposed group. Materials and Methods: After obtaining the approval of the ethical committee, forty mice from BALB/c strain were used in this experiment and were allocated into 3 groups; 10 (control group); 15 (exposure group); and 15 (exposed and treated with antioxidants). Antioxidants were administered through subcutaneous injection. Skin biopsies from all groups were stained with EGFR antibodies. Total antioxidant status (TAS) was evaluated in all groups. Statistical Analysis: The data obtained were analyzed using ANOVA, Duncan's test, and Pearson's Correlation. Results: The highest EGFR expression in exposure group was of score 3 ⁺ (53%). The highest EGFR expression in treatment group was score 0 (40%). Apoptotic bodies and dermal mast cells increased in exposure group while decreased in treatment group. The mean values for TAS were measured for each group; control group = 1.2 mmol/l; exposure group = 0.87 mmol/l; treatment group =1.3 mmol/l. Conclusions: UVB led to Seborrheic Keratosis (SK) in mice through enhancement of EGFR expression. Antioxidants effectively reduced UVB-induced SK, reduced epidermal changes, apoptotic bodies, and decreased dermal mast cells. TAS measurement declined in exposure group, while it was within normal range in most treated cases.

Background: Due to the heterogeneity of traumatic brain injury (TBI), many of single treatments have not been successful in prevention and cure of these kinds of injuries. The neuroprotective effect of progesterone drug on severe brain injuries has been identified, and recently, the neuroprotective effect of vitamin D has also been studied as the combination of these two drugs has shown better effects on animal samples in some studies. This study was conducted to examine the effect of vitamin D and progesterone on brain injury treatment after brain trauma. Materials and Methods: This study was performed on patients with severe brain trauma (Glasgow Coma Scale (GCS) ≤ 8) from April to September, 2011. The patients were divided to 3 groups (placebo, progesterone, progesterone-vitamin D), each with 20 people. Upon the patients' admission, their GCS and demographic information were recorded. After 3 months, they were reassessed, and their GCS and GOS (Glasgow outcome scale) were recorded. The collected data were analyzed using SPSS 18 software (SPSS Inc., Chicago IL, USA). Results: Before intervention, GCS mean of the placebo, progesterone, and progesterone-vitamin D groups were 6.3 ± 0.88, 6.31 ± 0.87, and 6 ± 0.88, respectively. They increased to 9.16 ± 1.11, 10.25 ± 1.34, and 11.27 ± 2.27, respectively 3 months after intervention. There was a significant difference among GCS means of the 3 groups (P-value = 0.001). GOS was classified to 2 main categories of favorable and unfavorable recovery, of which, favorable recovery in placebo, progesterone, and progesterone-vitamin D was 25%, 45%, and 60%, respectively which showed a statistical significant difference among the groups (P-value = 0.03). Conclusion: The results showed that recovery rate in patients with severe brain trauma in the group receiving progesterone and vitamin D together was significantly higher than that of progesterone group, which was in turn higher than that of placebo group.

Background: Nicotine replacement therapy (NRT) can help smokers to quit smoking. Nicotine chewing gum has attracted the attention from pharmaceutical industries to offer it to consumers as an easily accessible NRT product. However, the bitter taste of such gums may compromise their acceptability by patients. This study was, therefore, designed to develop 2 and 4 mg nicotine chewing gums of pleasant taste, which satisfy the consumers the most. Materials and Methods: Nicotine, sugar, liquid glucose, glycerin, different sweetening and taste-masking agents, and a flavoring agent were added to the gum bases at appropriate temperature. The medicated gums were cut into pieces of suitable size and coated by acacia aqueous solution (2% w/v), sugar dusting, followed by acacia-sugar-calcium carbonate until a smooth surface was produced. The gums' weight variation and content uniformity were determined. The release of nicotine was studied in pH 6.8 phosphate buffer using a mastication device which simulated the mastication of chewing gum in human. The Latin Square design was used for the evaluation of organoleptic characteristics of the formulations at different stages of development. Results: Most formulations released 79-83% of their nicotine content within 20 min. Nicotine-containing sugar-coated gums in which aspartame as sweetener and cherry and eucalyptus as flavoring agents were incorporated (i.e. formulations F _19-SC and F _20-SC , respectively) had optimal chewing hardness, adhering to teeth, and plumpness characteristics, as well as the most pleasant taste and highest acceptability to smokers. Conclusion: Taste enhancement of nicotine gums was achieved where formulations comprised aspartame as the sweetener and cherry and eucalyptus as the flavoring agents. Nicotine gums of pleasant taste may, therefore, be used as NRT to assist smokers quit smoking.

Background: One of the problems in studying serous effusion cytological samples is differentiation of reactive mesothelial cells from metastatic adenocarcinoma cells. Materials and Methods: In this study, the immunohistochemical diagnostic value of E-cadherin and fibronectin markers for differentiation of these 2 groups of cells was studied. 50 cell block samples prepared from serous effusions were examined. Based on clinical and histological studies, 25 cases had primary carcinoma, and the other 25 were proved to be benign effusion cases. All the cases were studied for E-cadherin and fibronectin immunostaining using an envision technique. Statistical analyzes were performed employing Chi-square and exact Fisher tests, using SPSS software (version 16). Results: 24 of the 25 benign cases were stained with fibronectin and 2 with E-cadherin, whereas from among the 25 metastatic cases, 2 reacted to fibronectin and 22 to E-cadherin. Considering the staining of the 2 markers under conditions that the cells were stained with fibronectin but not with E-cadherin, positive predictive value (PPV) and negative predictive value (NPV) to identify reactive mesothelial cells were 100% and 92.5% while under conditions that had not been stained with fibronectin but with E-cadherin, PPV and NPV to detect adenocarcinoma cells were 95.2% and 82.1%, respectively. Conclusion: Employing this short panel can be helpful for better differentiation of adenocarcinoma and reactive mesothelial cells in serous fluids.

Background: Invasive breast carcinoma is one of the most common cancers of women. Parameters such as lymph node status, tumor grade, and the status of hormone receptors are among the main prognostic determinants of this cancer. Immunohistochemical detection of prostate-specific antigen (PSA) is widely used to identify metastatic prostatic adenocarcinoma. However, its immunoreactivity has been found in some non-prostatic tissues. This study was conducted to assess PSA expression in invasive breast carcinoma and its relationship with routine clinicopathologic parameters. Materials and Methods: 100 formalin-fixed and paraffin-embedded invasive breast carcinoma tissue specimens from the pathology archive of Alzahra hospital (Isfahan, Iran) were studied for the expression of estrogen receptor (ER), progesterone receptor (PR), HER2/neu, and PSA by immunohistochemistry. Stained sections were classified according to the intensity of staining and the percentage of cells showing PSA staining. The relationship between PSA expression and other markers, age, lymph node status, tumor subtype, and tumor grade was then studied. Results: No association was found between PSA expression on one hand and PR, Her2/neu, age, lymph node status, tumor grade, and tumor subtype on the other. PSA score was reversely correlated with ER expression (P = 0.015). Conclusion: Despite the reverse relationship between PSA expression and the immunoreactivity of ER, PSA expression was not correlated with other prognostic factors. Therefore, the detection of PSA by immunohistochemistry does not seem to be a significant prognostic parameter in patients with invasive breast carcinoma.

Background: Oncologists today are greatly concerned about the treatment of relapsed/refractory acute leukemia. FLANG regimen, combination of novantron, cytarabine, fludarabine, and granulocyte-colony stimulating factor, has been used in treatment of refractory/relapsed acute leukemia since 1990s. The present study has evaluated mortality and response rate of this regimen. Materials and Methods: In this study, 25 patients with refractory/relapsed acute leukemia aged 15-55 years underwent FLANG regimen at Seyed-Al-Shohada Hospital, Isfahan, Iran during 2008-2009. One month later, bone marrow samples were taken to evaluate the responsiveness to treatment. Participants were followed for a year. The data was analyzed by student-t and chi-square tests, logistic, and Cox regression analysis, and Kaplan-Meier curves in SPSS _19. Results: Out of the 25 patients, 8 patients (32%) had acute lymphoblastic leukemia (5 refractory and 3 relapsed cases) and 17 subjects had acute myeloid leukemia (7 refractory and 10 relapsed cases). According to the bone marrow biopsies taken one month after FLANG regimen, 10 patients (40%) had responded to treatment. Five patients of the 10 responders underwent successful bone marrow transplantation (BMT). On the other hand, 13 patients (52%), who had not entered the CR period, died during the follow-up. Logistic regression analysis did not reveal any significant associations between disease type and responsiveness to treatment. Conclusion: This study indicated higher rates of unresponsiveness to treatment while its mortality rate was comparable with other studies. Overall, according to limitations for BMT (as the only chance for cure) in Iran, it seems that FLANG therapy is an acceptable choice for these patients.

Background: Bupivacaine, tramadol, and pethidine has local anesthetic effect. The aim of this study was to compare effect of subcutaneous (SC) infiltration of tramadol, pethidine, and bupivacaine on postoperative pain relief after cesarean delivery. Materials and Methods: 120 patient, scheduled for elective cesarean section under spinal anesthesia, were randomly allocated to 1 of the 4 groups according to the drugs used for postoperative analgesia: Group P (Pethidine) 50 mg ,Group T (Tramadol) 40 mg, Group B (Bupivacaine 0.25%) 0.7 mg/kg, and Group C (control) 20CC normal saline injection in incision site of surgery. Pain intensity (VAS = visual analogous scale) at rest and on coughing and opioid consumption were assessed on arrival in the recovery room, and then 15, 30, 60 minutes and 2, 6, 12, 24 hours after that. Results: VAS scores were significantly lower in groups T and P compared with groups B and C except for 24 hours (VAS rest) and 6 hours (VAS on coughing) postoperatively (P < 0.05). The number of patients requiring morphine were significantly different between the groups (105 doses vs. 87, 56, 46, doses for group C, B, T and P, respectively, P < 0.05) in all the times, except for 2 and 6 hours postoperatively. Conclusions: The administration of subcutaneous pethidine or tramadol after cesarean section improves analgesia and has a significant morphine-sparing effect compared with bupivacaine and control groups.

Background: The objective of this study was to assess mast cells and TNF-α in oral lichen planus (OLP) and oral lichenoid reactions (OLR) patients as diagnostic marker to the differential diagnosis of OLP and OLR diseases. Materials and Methods: In this cross-sectional study, samples were obtained from 30 OLP and 30 OLR patients, between June 2010 and March 2011 in Dental clinic of the University of Isfahan, Iran. Mast cells in the reticular layer of the lamina propria for samples were evaluated using toluidine blue method and immunohistochemical technique. The clinical relevant data taken into account were: demographical data, total number and degranulated mast cells, ratio of degranulated mast cells and TNF-α positive degranulated mast cells. Results: In OLP and OLR, the total mast cells were 21.2 ± 7.9 and 20.3 ± 6.8, degranulated mast cells were 15.5 ± 6.9 and 19.2 ± 6.9, ratio of degranulated mast cells to total mast cells were 0.716 ± 0.067 and 0.946 ± 0.081, and TNF-α positive degranulated mast cells were 13.6 ± 6.3 and 17.1 ± 6.04, respectively. There was no significant difference for the total mast cells. But degranulated mast cells, ratio of degranulated mast cells and TNF-α positive degranulated mast cells in OLR were significantly higher than OLP patients. Conclusions: Our results showed that the degranulated mast cells, ratio of degranulated mast cells and TNF-α in OLR was significantly more than OLP patients and these may be able to be used as diagnostic markers to the differential diagnosis of OLP and OLR.

Background: Light-emitting diodes (LEDs) are light sources recently used for phototherapy in neonatal jaundice. We compared the efficacy and safety of LEDs with fluorescent phototherapy in the treatment of indirect hyperbilirubinemia. Materials and Methods: This controlled trial was conducted on preterm infants hospitalized in neonatal intensive care unit of Shahid Beheshti Hospital in Isfahan (Iran) who needed conventional phototherapy for uncomplicated indirect hyperbilirubinemia. Neonates received phototherapy through devices with LEDs or special blue fluorescent tubes. Primary outcomes included the rate of fall of total serum bilirubin (TSB, mg/dL/hour) and duration of phototherapy (hours). Secondary outcomes were treatment failure and side effects. Results: A total of 64 infants with gestational age of 33.5 ± 1.2 weeks, chronological age of 73.0 [SE = 7.3] hours, and weight of 1757.5 ± 147.6 gram were enrolled. The rates of fall of TSB were 0.20 [SE = 0.03] and 0.12 [SE = 0.01] mg/dL/hour in the LED and fluorescent groups, respectively (P = 0.472). Treatment duration was 37.5 ± 26.8 and 45.3 ± 32.1 hours in the LED and fluorescent groups, respectively (P = 0.292). There was no treatment failure in the two groups. Mild hyperthermia was occurred in 3.1% and 28.1% of infants in the LED and fluorescent groups, respectively (P = 0.006). Conclusions: LED light source is as effective as fluorescent tubes for phototherapy of preterm infants with indirect hyperbilirubinemia. Considering less frequent side effects, less energy consumption, longer life span, and lower costs, LED phototherapy seems to be a better option than current conventional phototherapy.

Background: Alzheimer's disease (AD) is a prevalent disorder with severe learning and memory defects. Because it has been demonstrated that erythropoietin (EPO) has positive effects on the central nervous system, the aim of this study was to evaluate the effect of EPO on neuronal proliferation in dentate gyrus of hippocampal formation in a well-defined model for AD. Materials and Methods: A rat model of sporadic dementia of Alzheimer's type was established by a bilateral intracerebroventricular injection of streptozotocin (ICV-STZ). Impairment of learning and memory was confirmed 2 weeks after ICV-STZ injection by passive avoidance learning test and then rats were divided into fourgroups:Control, control-EPO, Alzheimer and Alzheimer-EPO. EPO was injected intraperitoneally every other day with a dose of 5000 IU/kg and, finally, the rats were anesthetized and decapitated for immunohistochemical study and neurogenesis investigation (by Ki67 method) in dentate gyrus of hippocampal formation. Results: The results driven from the histological study showed that EPO significantly increases neuronal proliferation in dentate gyrus of hippocampus in the Alzheimer-EPO group compared with the control, control-EPO and Alzheimer groups; however, there were no differences between the other groups. Conclusion: Our results show that even though EPO in intact animals doesnot change neurogenesis in dentate gyrus, it can nonetheless significantly increase neurogenesis if there is an underlying disorder like neurodegenerative diseases.

Introduction: Adenomyosis is one of the most common, yet underdiagnosed, underlying causes of abnormal uterine bleeding (AUB). We aimed to evaluate the prevalence of adenomyosis among subjects who underwent hysterectomy due to AUB. Materials and Methods: We studied the pathological specimens from 100 cases of AUB who underwent hysterectomy and were referred to Jundishapur University of Medical Sciences, Ahwaz (Iran) from 2007 to 2010. All specimens were reviewed by the same pathologist. Results: Pathological findings included adenomyosis 21%, leiomyoma 30%, adenomyosis and leiomyoma 21%, adenomyosis and other pathological causes 7%, and other pathological causes 21%. The overall prevalence of adenomyosis was 49%. Mean age of the patients was 46.9 ± 7.8 years and the highest frequency of adenomyosis was observed in the age group 30-60 years. Conclusions: Overall prevalence of adenomyosis in the population with AUB (49%) that we studied was higher than that in the reports from other populations. Occurrence of isolated adenomyosis in those aged less than 30 years was rare, and adenomyosis was usually accompanied by other lesions.

Generally, skeletal peripheral metastases below the elbow and the knee are rare. Skeletal metastases to the hand or foot are very rare; but when they do it may be a revealing clinical finding. Purely lytic lesions are commonly seen in metastases from lung, renal, and thyroid tumors, but they are also known to occur in primary myeloma, brown tumor and lymphomas. A 70-year-old man was brought to the emergency department with acute painful swelling involving his right hand and the right knee. Due to significant accompanying soft tissue swellings cellulitis, acute osteomyelitis and gouty arthropathy were included in the initial differential diagnosis. Radiographs showed pure lytic bony lesion with complete disappearance of lower two third of the second metacarpal, trapezium and trapezoid bones of the right hand along with a lytic subarticular lesion of medial condyle of ipsilateral femur. Chest X-ray (CXR) was normal but sonography of the abdomen readily demonstrated a large renal mass, later confirmed at biopsy as renal cell carcinoma (RCC). Clinicians should be cognizant of the strong association between digital acrometastases and renal cell carcinoma in male patients with normal CXR findings. In suspected hand acrometastasis associated with a soft tissue component outside the contours of normal bone, screening the abdomen by sonography should be done prior to bone biopsy and before costly or time-consuming investigations are offered. Metastatic RCC should be included in the differential diagnosis of all unilateral expansile bony lesions of the digit. It is particularly important if such lesion/lesions are accompanied by local inflammation. Screening the abdomen by sonography may be of particular value in such elderly male patient when Chest X-ray shows no abnormality.

Background: The utility of ultrasound (US) for therapeutic purposes is still in its infancy. Therapeutic US (TUS) has been used widely in medical field for urological application, surgical intervention, bone healing, and osteointegration in cancer and healing of full thickness excised skin lesions, and within dentistry as a prediagnostic, diagnostic and therapeutic purpose. The purpose of the paper is to review and determine the efficacy of US as one of the treatment modalities for its role in maxillofacial region to reduce pain and promote soft tissue healing. Materials and Methods: A Medline search included of the international literature published between 1976 and 2011 and was restricted to English language articles, published work of past researchers including in vitro and in vivo studies, recent additions of textbooks on surgical and therapeutic applications of US and, current articles in conference papers and reports accessed from the internet using Google search engine on therapeutic ultrasound. Results: Very few article regarding effect of therapeutic of US for its use of insonation for treatment of patient with pain and soft tissue injury are available. This review article mainly emphasizes the therapeutic utility of US in dentistry for its effectiveness to decrease joint stiffness, reduce pain and muscle spasms and improve muscle mobility. In vivo studies have shown very little clinical effects. Conclusions: Further research is warranted in this clinically important area to make the development of noninvasive, multifunctional ultrasound devices for repair, regeneration and other therapeutic utility a success.

Background: Carpal tunnel syndrome (CTS) is the most frequent compressive mononeuropathy, affecting mostly females. Few studies have been performed to assess the electrophysiological parameters before and after carpal tunnel release. The purpose of our study was to evaluate these changes postoperatively and in the course of a 9-month period after operation in comparison with the preoperative values. Materials and Methods: A case-series study was carried out and included 17 cases of moderate or severe electrophysiologically confirmed CTS, who underwent open carpal tunnel release (CTR) from December 2010 to May 2011. Severity grade was assigned following American Association of the Electrodiagnostic Medicine criteria of CTS. Distal motor and sensory latencies and sensory nerve conduction velocity of the median nerve across the carpal tunnel were evaluated and compared before, at 6, and 9 months after surgery. Results: From the 17 evaluated hand with moderate, moderate to severe and severe CTS, severity improvement was reported in 82.3% 6 months and in 88.2% 9 months after surgery, but only 47% had satisfied or completely satisfied opinion about the results. Others, though still complaining of serious symptoms, had improved or normal NCS. Discussion: Electrophysiological investigations outlined severity improvement after CTR. In the current study, the electrophysiological studies were not meaningful in determining outcome.

Background: Nanostructured lipid carriers (NLC) are a mixture of solid and liquid lipids or oils as colloidal carrier systems that lead to an imperfect matrix structure with high ability for loading water soluble drugs. The aim of this study was to find the best proportion of liquid and solid lipids of different types for optimization of the production of LDL targeted NLCs used in carrying 5-Fu by the emulsification-solvent evaporation method. Materials and Methods: The influence of the lipid type, cholesterol or cholesteryl stearate for targeting LDL receptors, oil type (oleic acid or octanol), lipid and oil% on particle size, surface charge, drug loading efficiency, and drug released percent from the NLCs were studied by a full factorial design. Results: The NLCs prepared by 54.5% cholesterol and 25% of oleic acid, showed optimum results with particle size of 105.8 nm, relatively high zeta potential of −25 mV, drug loading efficiency of 38% and release efficiency of about 40%. Scanning electron microscopy of nanoparticles confirmed the results of dynamic light scattering method used in measuring the particle size of NLCs. Conclusions: The optimization method by a full factorial statistical design is a useful optimization method for production of nanostructured lipid carriers.

Increased use of complementary and alternative herbal medicines in the treatment of various diseases.Some herbal therapies may be causes of potential toxicity that may be renal toxicity caused by the ingestion of herbs. The goal of this study is the toxic and beneficial effects of medicinal herbs on renal health by which evidence for benefit or toxicity has been found. Included are nephrotoxicity from aristolochic acid and other components within herbs, herb-drug interactions, heavy metal toxicity in herbs and adulterants during careless preparation of herbal medicine, resulting in adverse renal effects and renal toxicity from contaminants within the extracts. The review aims to provide knowledge and guide to encourage future toxicity studies on the kidney by medicinal herbs.

Background: Carpal tunnel syndrome (CTS) is the most common compression neuropathy of median nerve, which can occur or aggravate during pregnancy and sometimes needs surgery. Since early diagnosis leads to simpler and less risky treatments, this study evaluated the frequency and severity of CTS in pregnancy. Materials and Methods: In this descriptive cross-sectional study, 100 pregnant women who came to gynecology clinic of university hospitals were randomly selected. At first, they were asked for presence of clinical symptoms, and then clinical tests including Phalen and Tinel were conducted to diagnose CTS. Then, electrodiagnostic studies including sensory and motor distal latencies of median nerve were measured and compared with those of ulnar nerve, and then, nerve conduction velocity of median nerve across wrist was evaluated. Results: Among the studied pregnant women, 19% had CTS, out of whom 47.5% were bilateral and 26.3% had severe CTS. The prevalence in the first, second, and third trimesters were 11%, 26%, and 63%, respectively, and 42% were asymptomatic. Sensitivity and specificity of clinical signs as compared with electrodiagnostic findings were 52% and 23%, respectively. Conclusions: The prevalence of CTS is relatively high in pregnant women. The prevalence and severity of CTS increase and the rate of asymptomatic cases reduces with the age of pregnancy. Clinical examination and history taking could not diagnose all cases, and their sensitivity and specificity are much less than electrodiagnostic tests. Therefore, it is recommended that electrodiagnostic studies be conducted in pregnant women during the third trimester.

Linguatulosis occurs accidentally in human by ingestion of raw or undercooked visceral tissues of sheep, goat, camel, and other herbivores. In this case report, 2 patients from an Afghan family infested with this parasite in rural area of Isfahan, Iran are presented. Clinical signs and symptoms including pricking sensation in throat, coughing, sneezing, yellow nasal and ears discharges, which started 2-3 hours after eating raw goat liver. Nymphs of Linguatula serrata were isolated from their tongues and later, several more parasites were discharged by coughing and sneezing. An ancient belief about nutritional benefits of eating raw liver may causes more Halzoun syndrome in future.

Background: C-reactive protein (CRP) is useful as marker of severity in malaria. African studies have shown that serum CRP levels correlate with parasite burden and complications in malaria, especially falciparum. However, there are very few data on CRP levels in Indian malaria patients. Materials and Methods: We assessed CRP levels in malaria patients at presentation and studied for any relation of CRP levels with subsequent prognosis. Statistical tests included student's t-test, Mann Whitney U test, and chi square test, all with 2-tailed analyzes. Results: Of 71 patients in our study, 42 (59.1%) were infected with P. falciparum. 23 (32.4%) patients needed admission and 10 (14.1%) died. Average CRP levels were quite high in malaria patients (31.29 ± 20.4 mg/L). There was no significant difference in CRP between vivax and falciparum cases. Admitted patients had significantly higher CRP levels compared to those treated on outdoor basis (47.11 ± 19.13 vs. 23.71 ± 16.35 mg/L; P < 0.0001). 8 patients were admitted with multiple complications. They had significantly high CRP level compared to those with 1 complication (P = 0.015). Also, patients who died had higher CRP levels compared to survivors (P = 0.000346). CRP levels at presentation showed positive correlation with duration of hospital stay (r = 0.59; P < 0.05). CRP levels >35 mg/L was highly sensitive in predicting mortality. Conclusion: Our study in Indian population corroborates the findings in African studies regarding prognostic role of CRP in malaria. CRP is an effective biomarker in assessing malaria severity and also for follow-up.

Background: C4d as a part of complement activation process is a marker for detecting antibody-mediated rejection (ABMR) and its positivity accompanied by positive donor specific antibody (DSA), and morphologic view of humoral rejection has been suggested to detect ABMR since 2003. Materials and Methods: 41 specimens of transplanted kidney biopsies gathered from 2006 to 2008 were evaluated for morphological changes on light microscopy, and nephro-pathologist made distinct diagnosis for all of specimens then c4d staining was done for all of them. The association between primary diagnosis without c4d staining and c4d scoring on peritubular capillaries and glomerular capillaries were evaluated to determine whether morphological changes were enough for distinct diagnosis or not. Results: Acute tubular necrosis (ATN) 27%, interstitial fibrosis and tubular atrophy (IF&TA) 17%, and T cell mediated rejection (TCMR) 22% were the commonest diagnosis on light microscopy, and 17% of all biopsies had diffuse positive c4d staining. There was not any report of ABMR in morphological evaluation while c4d positive staining was seen in some specimens (17%). It may result from masking of ABMR by other morphological changes such as TCMR and no specific histologic changes for ABMR on light microscopy. Conclusion: We would like to emphasize that c4d staining should be done for all of renal allograft biopsies, and pathologists all over the world should consider the probability of ABMR masked by other morphological changes on light microscopic evaluation.

Background: Melasma, a common disorder of hyperpigmentation, is often difficult to treat. Although 10% zinc sulfate solution has been reported to be useful for patients with melasma, controlled trials are lacking. Materials and Methods: 72 women with moderate to severe melasma were divided randomly into 2 groups. Group A were treated with 10% zinc sulfate solution and group B with 4% hydroquinone cream twice-daily. The results were evaluated by photoevaluation by patients based on subjective satisfaction and a blinded dermatologist using MASI score. Assessments were obtained at baseline and at 2 and 6 months after starting treatment. Results: According to MASI score changes during treatment, there was a reduction in both groups at 2 months, however, the reduction in group B was more significant (the reduction in mean ± SD MASI was 0.7 ± 0.7 in group A vs. 2.7 ± 1.6 in group B). In addition, the patients in group B continued to decrease MASI score for the remainder of the study period at 6 months follow-up (0.3 ± 0.5) in comparison with patients in group A who did not show more reduction in MASI score. Conclusions: The study indicates that topical zinc sulfate is not as effective in treating disease as was observed in the previous open study. A comparative study with sunscreen and placebo is necessary to determine if topical zinc sulfate is truly superior to sunscreen and placebo in this respect.

Background: Application of different kinds of lasers in clinical and experimental studies causes photobiomodulation that works at localized cellular and humoral level on various biological systems. Increased numbers of fibroblasts, myofibroblast, and degranulation of mast cells have been the observed benefits post-irradiation. Objective: Was to find out the effect of irradiation with energy densities of 3.38 J/cm ² , 8 J/cm ² , and 18 J/cm ² on animal tissue (albino wistar rats) in an excisional wound model and to assess changes in biochemical (hydroxyproline) and histopathological levels in excisional wound model. Materials and Methods: The animals were divided into 4 groups, which were labeled as L1, diode laser (18 J/cm ² ), L2 Helium-neon (He-Ne, 8 J/cm ² ), L3 diode laser (3.38 J/cm ² ), and sham treatment for control was depicted by C, respectively. Histological and hydroxyproline analysis was performed on 7, 14, 21 days of post-wounding. One-way analysis of variance, ANOVA and Bonferroni's multiple comparison tests were done for tissue hydroxyproline levels. Results: There was no significant increase in the hydroxyproline content (P < 0.005) when observed in study group and compared to controls. Whereas significant epithelizations was seen in group treated with He-Ne laser of intensity of 8 J/cm ² . Conclusion: The experimental observations suggest that low intensity helium-neon laser of 8 J/cm ² intensity facilitated photo stimulation by tissue repair, but failed to show significant tissue hydroxyproline levels in excisional wound model.

Background: Despite elimination of iodine deficiency, the rates of both permanent and transient congenital hypothyroidism (CH) in our study were higher than the comparable worldwide rates, which emphasize the major role of genetic factors in the pathogenesis of CH and many studies in this regard confirm this possibility. Materials and Methods: In this review, we report all studies that established during CH screening program regarding familial and genetic component of the disease. Results: Although we could not entirely ignore the possible role of environmental and autoimmune factors in the development and function of thyroid gland, our findings strongly suggest the role of genetic factors as dominant etiologic factor in CH. Conclusion: The studies support the existence of a familial component of CH involving dominant genetic predisposition factors with a low penetrance. Considering the polygenic/multifactorial basis of CH, they suggest the possible involvement of other unknown genes in the pathogenesis of the disease, which may also follow non-Mendelian pattern of inheritance.

Background: The benefit of prophylactic combination therapy using crystalloid and colloid preload with ephedrine has not been cleared to prevent maternal hypotension after spinal anesthesia at cesarean delivery. This study evaluated the efficacy of three combinational methods to prevent hypotension following spinal anesthesia. Materials and Methods: In this prospective double blind trial, 150 candidates of elective cesarean delivery under spinal anesthesia were randomly allocated to three treatment groups; 1---Ringer's Lactate (RL) solution (15 ml/kg) plus Hemaxel (7 ml/kg) preload, 2---RL solution (15 ml/kg) preload plus ephedrine (15 mg, IV, bolus), 3---Hemaxel (7 ml/kg) preload plus ephedrine (15 mg, IV, bolus). Maternal hemodynamic changes during 60 min after spinal injection, nausea/vomiting, and neonatal condition were compared among the groups. Results: The cumulative incidence of hypotension was 44%, 40%, and 46% in groups 1 to 3, respectively. There were not significant differences in supplementary ephedrine requirement among groups which received or among groups which did not receive prophylactic ephedrine. Groups were not different in the incidence of hypertension and nausea or vomiting. There were no significant differences among groups in Apgar scores at 1 or 5 min and umbilical artery PH. Conclusion: Combination of preventive methods decreased the occurrence of hypotension following spinal anesthesia to an acceptable level. Overall, the most effective method was a combination of crystalloid preload with ephedrine.

Background: Gutkha is a cheap and convenient betel quid substitute, which is popular among all age groups. Various studies reveal its carcinogenic nature that leads to oral submucosus fibrosis and increases the chances of oral cancer. The micronucleus (MN) assay in exfoliated mucosal cells is a useful method for observing genetic damage in humans. Aim: To observe the genotoxic effect of gutkha on human buccal epithelial cells. Materials and Methods: The MN assay was performed to assess the frequency of MN in human buccal epithelial cells. The study comprises 60 individuals of which 30 individuals were gutkha chewers and another 30 were nonusers (control). The MN frequency was scored to estimate the genotoxic damage. Results: In gutkha users, the frequency of MN was highly significant (17.4 ± 0.944) as compared with nonusers (control) groups (4.53 ± 0.331) (P < 0.001). Conclusions: The MN assay in human buccal epithelial cells is a useful and minimally invasive method for monitoring genetic damage in humans. Asignificantly higher frequency of micronucleated cells are found among gutkha users.

Antibodies and their derivative fragments have long been used as tools in a variety of applications, in fundamental research work, biotechnology, diagnosis, and therapy. Camels produce single heavy-chain antibodies (VHH) in addition to usual antibodies. These minimal-sized binders are very robust and bind the antigen with high affinity in a monomeric state. Vascular endothelial growth factor recepror-2 (VEGFR2) is an important tumor-associated receptor that blockade of its signaling can lead to the inhibition of neovascularization and tumor metastasis. Here, we describe the construction, expression, and purification VEGFR2-specific Diabody. Two variable fragments of a same camel anti-VEGFR2 antibody were linked together by the upper hinge segment of antibody to make a diabody. We showed the ability of diabody to recognition of VEGFR2 on the cell surface by FACS. Diabodies can be produced in the low-cost prokaryotic expression system, so they are suitable molecules for diagnostic and therapeutic issues.

Background: Coronary artery disease (CAD) and myocardial infarction are the most common causes of mortality and morbidity all over the world. Aspirin resistance is an important part of therapeutic failure in patients who experience several atherosclerotic events despite aspirin therapy. Different studies have reported aspirin resistance between 5% and 45% all over the world. According to different responses to aspirin therapy in countries and lack of adequate studies on aspirin resistance in Iran, this study was designed for evaluation of aspirin resistance in ischemic patients. Materials and Methods: Total 170 patients with documented coronary artery stenosis with were enrolled in this cross-sectional prospective study. Two cc urine samples were obtained from all the subjects. Then a questionnaire including questions about major risk factors (hypertension, diabetes, hyperlipidemia, obesity and smoking) was completed for each patient. Thromboxane B2 level in urine was measured two times for each patient by one kit of via ELISA method. Gensini modified was usedfor assessment of severity of coronary arteries involvement. Data were analyzed via SPSS 16. with general linear model (univariate). Results: 75.3% of studied patients were aspirin resistant. There was significant relationship between angiography score and aspirin resistance (P<0.001).Our results also showed that aspirin resistance is more common in studied women than men (P=0.003).Significant correlation was observed between diabetes and aspirin resistance in studied subjects (P=0.023). Conclusion: Our study showed aspirin resistance in a sample of Iranian ischemic patients is so prevalent which is higher than other studies in another communities and also aspirin resistance is more common in patients with severe CAD.