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Background and Purpose: Digitalis species and their cardiac glycosides are used in congestive heart failure (ÇHF) disease. Digitalis nervosa are grown only in the North regions of Ïran. Çardiac glycosides of other species are identified by HPLÇ procedure. Ïn this research, cardiac glycosides of Digitalis nervosa were identified.
Materials and Methods: Ïn this research, methanol as solvent for extraction and Âcetonitryl with distilled water as gradient chromatographic vehicle were used. Β-methy digoxin was used as an internal standard too.
Results: Fifteen cardiac glycosides were identified in Digitalis nervosa leaves. Lanathoside  was a major component of cardiac glycosides in this plant.
Çonclusion: Çonsidering the identification of digitalis species of cardiac glycosides, and since in different countries various digitalis species are used for the preperation of effective drugs in treatment of ÇHF, in case of complementary research, particularly about pharmacology and toxicology, Ïranian species of digitalis can be used for preperation of this medicine.

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Background and purpose: Âim of this research is to study the effect of bridging collateral vessels (BÇVS) on the success of coronary angioplasty in patients with chronic total occlusion (ÇTÔ). Ïn coronary angioplasty of ÇTÔ cases, categorizing of lessions characteristics can be helpful in evaluation of success in angioplasty. There are controversies about the role of BÇVS in the rate of angioplasty success in ÔTÇ cases.
Materials and methods: Seventy seven patients with angioplasty done in ÇTÔ lesions were selected for study, and divided in two groups. Ïn the first group comprising of 97 patients, there was BÇVS, and the second group (50 patients) had no BÇVS.
Results : Success was achived in 11 patients from Group ÏÏ (40.7% vs 82% p=0.0002 with relative risk of 3.9, and confidence interval of 95%, (1.7 to 6.4). Ôf 52 patients with successful angioplasty, rate of success with estimation of less than three months occlusion was more in patients with occlusion for more than three months (63.5% vs 47.5%), p=0.0001 and relative risk of 1.8, with confidence interval of 95%, (1.3 to 2.6). Presence of a side branch at the distance of ≥ 2mm to the occlusion point has been one of the predictor factors for unsuccessful angioplasty (p=0.0007, relative risk 2.9, with confidence interval of 95%, (1.5 to 5.6).
Çonclusion: Presence of some morphological variables in ÇTÔ during angioplasty of coronary vessels may be helpful in guiding successful angioplasty. Ône of them is presence of BÇVS which seems to have inverse relation to the rate of successful angioplasty.

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Background and purpose: Digitalis nervosa is a wild species growing in Tran and the major cardenolode of this species is lanatoside Â. D nervosa cell culture was estabilished and its secondary metabolites were studied.
Materials and methods : Seeds of D. nervosa were surface sterilized in 70% ethanol or 5% Sodiume hypochlorite, then healthy seedlings were produced. The jemol, Hypocoty1 root tip of seedling were transferred onto the Murshige and Skoog (MS) culture media containing different concentrations of plant growth rgulators. The Phytochemical studies on callus and plant were carried out using Thin layer chromatography (YLÇ). Total Çardiac glaycosides in plant and callus were determined by spectrophotometric method.
Results: Sodium hypochlirite had less negative effect on the seedling production comparing with Ëthanol. The best callus intiation and estabilishment was observed in media containing K (0.5mg/l), 2,4-D (0.5 mg/l), NÂÂ(1 mg/l) as plant growth regulators. Çallus formed from the root part of seedies revealed the presence of saponins, tannins, flavonoids, steroids and Çardiac glycosides in both callus and plant extracts. The amount of cardiac glysosides in plant was 358 mg/100 gr. Dry.W. This amount varied from 29.68 to 15.90 mg/100 gr. Dry. Wt in the 7 th Generation of callus.
Çonclusions: The ratio between auxin and cytokinin is one of the important factors to callus production. The 3: 1 ratio demonstrated the best callus growth on D. Nervosa cell culture. The callus culture of D. nervosa showed the ability of producing cardiac glycosides howere, this ability reduced by repeated subculturing.

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Background and purpose: Methicillin resistant Staphylococcus aureus (MRSÂ) is one of the most important nosocomial pathogen with increasing prevalence in recent three decades worldwide. The most important source of infection is spread through health care worker. This cross sectional study was performed among personell of Razi hospital in a one month period (autum 2003) to determine the perevalence of S.aureus nasal carrier and its antibiotic resistance pattern.
Materials and methods: Ânterior nasal sampling from healthy personel was done using sterile moistened cotton swab, and the sample inserted into Neutral medium (broth) and transferred to the laberatory for assessing the existence of S.aurens and antibiogram related to seven antibiotics considering the NÇÇLS criteria.
Results: This study revealed that 36% of participants had nasal clonization of S.aureus. Çarriage rate of S.aureus and MRSÂ differed in various professional groups, (about 40% in medical staff and 48% in paramedical staff). The highest rate of resistance was against Ôxacillin 83% (the indicator of MRSÂ) and the lowest was against chloramphenicole (2.8%). Resistance against Vancomycin (VRSÂ) was seen in 2 cases (5.5%)
Çonclusion: Ïn this study, carriage prevalence was less than expected but similar to the prevalence in the community (20.40%). Ântibiotic resistance was unexpectedly higher than the other studies though. High prevalence of MRSÂ and specially, existence of VRSÂ & VÏSÂ must be considered very seriously. Ït can be the result of continious exposure of organisms with various types of antibiotics and unrestricted use of antibiotics in hospitals.

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In this report we introduce an 8 years old boy with Transverse colon inflammatory pseudotumor. The patient was admitted to Boo-Ali Sina Hospital with abdominal pain, fever and vomiting. In clinical examinations an abdominal mass in splenic flexure was palpated. Imaging study with CT-Scan revealed a calcified mass in transverse colon wall with lymphadenopathy and lymphoma was suggested. Histological study showed inflammatory pseudotumor. After surgical excision the patient was recovered. The recurrence was not seen after one year follow up. This case showed that in differential diagnosis of pediatric colonic mass, inflammatory pseudotumor should be considered in order to prevent unneccesary and harmful chemotherapy and radiotherapy.

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Background and purpose : Human visceral leishmaniasis (HVL) is endemic in several foci in IRAN, such as Ardebil and Fars provinces (in North western and southern parts of IRAN) and in some regions as sporadic. Visceral leishmaniasis in Iran is Mediterranean type and the causative agent is Leishmania infantum and its main reservoir is dog.
Material and methods: In this study direct agglutination test (DAT) was compared with indirect fluorescent antibody test (IFAT) for the diagnosis of visceral leishmaniasis in patients suspected of kala-azar. A total of 70 serum samples were collected from suspected kala-azar patients mainly in the kala-azar endemic areas. The Leishmania infantum antigens (MHO/TN/80/IPTi) were prepared in Department of parasitology, School of Medicine, Isfahan University of Medical Sciences. The principal phases of the procedure from making DAT antigen were mass production of promastigotes of leishmania in the RPMI1640 + fetal bovine serum, Trypsiniznation of parasites, staining with Comassie Blue and fixing with formaldehyde. The human serum samples were tested by DAT, as well as, by IFAT, with the L.infantum antigen prepared in our laboratory.
Results : The sero positive rate (SPR) with DAT in titers of ≥ 1:3200 was 91.4% and with IFAT in titers of ≥ 1:80 was 94.3%.
Discussion : Geometric means of reciprocal titers (GMRT) were 6309 for DAT and 692 for IFAT. Therefore, as the titers of ≥1:3200 are usually considered positive in DAT, the titers of ≥1:80 were regarded as position in IFAT. The coincidence of the two tests was 92%. These results showed that a simple local laboratory with one or two trained technicians is quite sufficient for DAT, sero-diagnosis and serological surveys of kala-azar in an endemic area. According to the results of this study, it seems that in Kala azar endemic areas, the clinical symptoms of Visceral leishmaniasis, particularly among the children with DAT antibody titers ≥1:3200 is a good indication for specific treatment of Kala-azar.

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Background and purpose: Hyperhomocysteinemia is common among patients with renal failure and the risk of cardiovascular diseases increases with hyperhomocysteinemia. The aim of this study was to compare the efficacy of two doses of folic acid (2 and 7.5 mg/day ) in decreasing plasma concentration of homocysteine in ËSRD patients receiving regular hemodialysis therapy.
Materials and methods : Ïn this randomized trial, 14 hemodialysis patients were enrolled according to prestudy homocysteine level in Ïmam Khomeini hospital in July 2003. They had been treated with 1-5 mg/day folic acid with pyridoxine and then received 15 mg every other day folic acid with duration of at least two months. Âfter the first and second month of treatment, blood samples were assessed for homocysteine and hemoglobin concentration, albumin, HDL and LDL. Patients were assessed for folic acid complications especially nausea and dizziness.
Results : The mean age and hemodialysis were 50.92±18.6 and5.28±4.25 years respectively. The homocysteine level with higher dose of folic acid were significantly lower than with lower dose (23.98±6.87 vs. 33.89±16.28 μmol/L respectively, P=0.008). There was also a significant increase in plasma albumin concentration in high dose period compared to low dose period (4.75±0.94 vs. 4.32±0.30 gr/dL respectively, P=0.004). There were no significant differences between hemoglobin concentration, HDL and LDL with different doses. No side effect was noted among patients during treatment periods.
Çonclusion: This study showed 15 mg every other day folic acid in hemodialysis patients was associated with greater dent of homocysteine level than doses less than 5mg/d. Âccording to the relationship between cardiovascular events, cerebral vein thrombosis and high plasma levels of homocysteine, better correction of it is necessary. Ïn conclusion we recommend that this dose may be more beneficial to hemodialysis patients.

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Background and purpose: The national report system on the Âdverse Drug Reaction (ÂDR) in order to have better understanding and control has been designed and used in many countries including ours, but it is poorly exculed because of lack of reporting and feedback. Ïn this study we have tried to analyse the knowledge, attitude and performance of the Medical Doctors (MDs) on the ÂDR to Finf out the familiarity and ability of MDs was performed to smoothly work with the national report system (The Yellow Çard).
Materials and methods : This cross sectional study using a classical questionnaire designed by the Ëuropean Food and Drug Âdministration. The questionnaire was completed by 350 MD'S (General & specialist) in city of Sari.
Results : The recognition level of MDs from the yellow card system was about 24.9% from which 88% were general practitioners and 12% were specialists. 87.4% of all MDs have diagnosed some adverse drug reaction in patients under their supervision but only 25% of them did report on it. The major reasons for not reporting are as follows: 63.5% for the lack of recognition and understanding of the national report system, 42.2% for having casual attitude toward ÂDR, 36.1% for the uncertainty that ÂDR had a relation with the medication used. 51.3% of all MDs had an acceptable knowledge in the recognition of ÂDR.
Çonclusion : The result of this study shows that in most of the cases the reason for not reporting ÂDR in the first place was due to the lack of information and understanding of such system and secondly the lack of desire to report due to lack of time and confidence in the system. Ânother interesting point in this study was the lack of knowledge of MDs about the ÂDR. Ït was worse specifically among specialists and specially the surgeons.

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Background and purpose : Malaria is one of the most fatal infectious diseases which annually kills more than 2 million people world wide. This parasitic infectious disease with global incidence rate of 300-500 million is one the most important complaints of our health system despite of strict preventive and treatment programs in ÏRÂN. Because of special condition of Mazandaran climate we have both the sporadic and the endemic forms of this disease in different parts of our province. The Purpose of the present study was to define the epidemiologic condition of the disease through an incidence survey between 1999-2003 in Mazandaran province.
Materials and methods : Present study is a descriptive study (old data) of 184805 files during a five years period between 1999-2003 in all of the 14 health centers of Mazandaran province. Demographic and other data were collected through a questionnaire consisting eleven questions. The data were then analyzed using descriptive statistical methods by SPSS software.
Results : 518 patients were found infected with different kinds of malaria parasites, of whom 80.3% were the Âfghan refugee, 13.7% were locally infected and 5% of them were passengers who came to Mazandaran from other Malaria endemic areas. Most of the cases (57.1%) belong to the age group (21-30 years) and 88.4% of them were male. Plasmodium Vivax was the most common parasite (96.9%). We noticed %150 increase in annuall parasite Ïncidence (ÂPÏ) during 1999-2003.
Çonclusion : Çonsidering the high, Ïncidence rate of the disease in Mazandaran Province as well as high immigration rate from infected neighbour counties and special condition of Mazandaran climate, compaign against Malaria must continue. The incidence rate of malaria from 0.02% to 0.05% during these five years period. There for we need to enforce malaria control programs increased and improve the health system.

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Group  streptococci (GÂS) are rare causes of myositis and myonecrosis involving adult patients in tropical regions. Streotococcal myositis is associated with a wide clinical spectrum, ranging from a subacute localized form with good prognosis to a serious acute presentation involving rapidly progressive disease, shock, multiple organ failure and a high case fatality rate (80-100%). Ïn this paper we present a 59 years old woman who was in good health before her last 5 days. Her illness presented with a very severs progressive pain of left arm .Her conditions progressed and worsened, despite of right diagnosis and beginning of treatment she died of multi organ failure. Postmortem biopsy of primary lesion of left arm revealed a diffused muscle necrosis with scattered microbial (cocci) cluster between muscle fibers. Çulture of primary blister was sterile but streptococcus group  was grown in blood culture.

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Background and purpose : Toxoplasma gondii is an obligate interacelullar parasite that infect a wide variety of nucleated cells in its intermediate hosts. Tachyzoites of Toxoplasma gondii in able to multiply in mouse macrophages. Inducing synthesis of nitric oxide (NO) by macrophages is an important mechanism of the host defense against interacelullar infection in mice. The 1.25 dihydroxy vitamin D3 is a potent modulator of immune system and may be beneficial in the treatment of some diseases. Recent evidence suggests that, 1,25 dihydroxy vitamin D3 may increase production of nitric oxide. Otherwise 1,25 dihydroxy vitamin D3 acts to suppress the Th1 immune response that effect on antigen presenting cell and increases production of Th2 cell. The aim of present study is to determine effective concentration of 1,25 dihydroxy vitamin D3 for stimulation of nitric oxide production. The effect of 1,25 dihydroxy vitamin D3 on multiplication of Toxoplasma gondii in macrophage of Balb/c mice in vivo and in vitro were also studied.
Materials and methods :Mice were injected with different doses of 1,25 dihydroxy vitamin D3 and/or Toxoplasma gondii interpretoneally. Then infected macrophages were cultured in RPMI-1640. Culture supernatants were collected for nitric oxide assay following 18 hours, then every 24 hours intervally. Nitric oxide was measured by Griess method. Infection levels were assessed microscopically by counting the numbers of tachyzoites in macrophages.
Results :This results indicated that there is a decrease in the number of T.gondii in macrophages following treatment with 1,25 dihydroxy vitamin D3 dose dependent (P<0.05). In addition, injection of 1,25 dihydroxy vitamin D3 plus INFγ in medium culture inhibited the multiplication of T.gondii. High level of production of nitric oxide may relate to dose of 1,25 dihydroxy vitamin D3 plus INFγ.
Conclusion: In the dose of 1000 microgram of vitamin D3 the highest killing effect of macrophages were demonstrated.

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Background and purpose: Leptospirosis is an uncommon widespread spirochetal zoonoses caused by the members of the genus leptospira. Human disease is acquired by coming into contact with urine or tissues of infected animals, or through contaminated water and soil, thus is an occupational disease particularly in farmers, slaughterhouse workers and fishermen. The goal of this study was to evaluate the clinical and Paraclinical findings of leptospirosis cases in Mazandaran.
Materials and Methods: In this cross-sectional descriptive study, patients with high suspicion to leptospirosis presenting to Imam Khomeini and Razi hospitals of Sari and Qaemshahr from June to September 2004 with positive serology finding (MAT) were enrolled. Demographic, clinical and Paraclinical data for each patient were recorded.
Results: From 63 patients suspicious for leptospirosis, 36 had positive serologic test. The mean age of the positive patients (25 male, 11 female) was 34.2 ± 13.77 (range 14-64 years old). Most cases (86.1%) were farmers and 83.4% villagers. 55.6% of the patients presented in July. Fever and chills were the main complaints in 42.9% of the cases and fever, weakness, headache, anorexia and mialgia were seen in 96.6%, 96.6%, 93.1%, 89.7% and 85% respectively. Thrombocytopenia and leucopenia were noticed in 45.7% and 33.4% of the patients respectively. AST & ALT in 51.7% & 55.2% of patients were above the normal upper limit. Weil's syndrome and ileus occurred in 7 (19.5%) and one (2.8%) cases respectively.
Conclusion: The classic history of fever, weakness, headache, anorexia and mialgia in villagers and farmers in warm months should raise the possibility of leptospirosis.

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Niemann Pick type A is a very rare hereditary disease with an incidence 1 in 20000-40000 live birth, which is calassified as a shingolipidoses. The disease is marked by the abnormal accumulation of sphingomyelin in most tissues, secondary to sphingomylinase deficiency. The most clinical manifestations are: Splenohepatomegaly–cherry red maculae-neuropathologic findings . This is a case report of an infant with clinical manifestation of Niemann Pick disease type A.

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Background and purpose: Brucellosis is a major bacterial zoonosis of global importance. Effective host defence against brucella depends on immunoglobulin G-mediated phagocytosis of the bacteria and it has been shown that the FC RIIA polymorphism (FCγ RIIA-R131 vs FCγ RIIA –H131) determines the capacity of immunoglobulin G-mediated phagocytosis via this receptor. The aim of this study was to evaluate the FCγRIIA polymorphism in patients with brucellosis and to reveal any relation between this polymorphism and disease progression.
Materials and Methods: In this study we evaluated FCγRIIA polymorphisms (R/R131, R/H131, H/H131) in 67 patients with serologically proven brucellosis and 67 healthy volunteers matched for age, sex and geographical area. FCγRIIA polymorphism was determined using a polymerase chain reaction method (SSCP-PCR).
Results: The frequency of FCγ RIIA-R/R131 genotype was higher in patients with brucellosis compared with controls (47.8% vs 28.4%). This genotype has a (OR=2.1, 95%CI=1.3-4.2, P=0.039) significant correlation with brucellosis. However, no significant difference was found between patients with brucellosis and controls (P=0.2) Although the frequency of FCγRIIA-R/R131 was higher in patients with brucellosis compared with controls, we did not find any statistically significant differences (53.8% vs46.3%, P=0.2). As a result, there was no significant association between FCγRIIA genotype and severity of brucellosis.
Conclusion: Based on the results, the dominance of homozygous genotype of FCγRIIA-R/R131 in patients with bracellosis emphasize the importance of this predisposing genetic risk factor in contracting the disease.

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Pemphigus Erythematosus specially its localized form is a rare autoimmune blistering disease combining features of Pemphigus Foliaceus and Lupus Erythematosus. We reported a 60 years old woman with skin lesion which presented Erythemato squamo plaque with oozing in the right cheek. The chief compliant was burning and pruritus. Skin biopsy was obtained and discoid Lupus Erythemato was reported. She was prescribed with topical steroid but did not improve. All of the lab tests such as Anti DNA, ESR, RF, CRP, CH50, C3, C4, ANA were normal. The biopsy repeated and Pemphigus Erythematosus was reported. Direct immunoflurescent test confirmed the diagnosis. We treated the patient with systemic steroid (80mg/day). The patient responed well and showed complete remission during 3 months.

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Acral lentiginous melanoma (ALM) is the most common type of cutaneous melanoma which can occur on the palms, soles or beneath the nail plate. Diagnosis of ALM is usually delayed and melanomas can only be diagnosed at advanced clinical stage so the prognosis is often poor. We report a case of Acral lentiginous melanoma which misdiagnosed as chronic ulcer. Chronic lesions even if benign in appearance deserve close observation. Biopsies are required to prevent misdiagnosis, mistreatment and delay in diagnosis.

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Fish tank or swimming granuloma caused by Mycobacterium marinum is an opportunist pathogen commonly found in aquatic environments. We present a 16 year-old boy with frequent exposure to aquarium water who had several nodules (sprotrichoid forms) on his right hand. Pervious studies showed that fish tank granuloma is a rare skin infection (0.27 per 100,000 population in one year). However, taking proper history and considering the patient’s signs and symptoms could be helpful in diagnosis and treatment.

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Background and purpose: Evaluation of the quality of food proteins has a great importance from of biological and economical perspectives. That is why, biological, microbiological, chemical and integrated methods have been used and introduced for determining the quality of Proteins. Among exsisting methods, NPR, RNPR and TPD have been suggested as appropriate methods to determine the quality of Proteins. Considering the importance of protein quality in foods, especially in low scale families, this study has been conducted to evaluate the aim the protein quality by the use of the mentioned methods in a sample homemade food based on rice (a variety of Mazandaran rice) -lentil mixture in 2007.
Materials and Methods: This experimental study was conducted on wistar rats, aged 21 days under 6 diets in 8 groups including case (home made food), standard (Casein+Methionine) and basal (Protein free) to determine NPR and RNPR and other 3 diets (case, standard and basal) to study TPD. Duration of study for NPR was 14 days. Protein intake and increase in weight were determined to calculate NPR. Duration of study for TPD was 9 days. The amounts of nitrogen intake and fecal nitrogen were determined to calculate TPD. NPR, RNPR and TPD of the group Casein+Methionine with homemade food was analyzed by t- test.
Results: NPR values for casein + methionine protein of home-made food were 4.3 ± 0.4 and 3.6 ± 0.6 , respectively (P=0.02). TPD values were 92.8 ± 4 and 75.8 ± 5.8 (P<0.0001), for Casein+Methionine and home made food proteins, respectively. Also, RNPR was 83.6 % and homemade food / Casein TPD was 81.6.
Conclusion: Findings showed that homemade food TPD and NPR based on rice-lentil mixture is lower than Casein.

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Background and purpose: Chronic abdominal pain is a common clinical problem in children. Apleys reported the incidence of 10-15% of chronic abdominal pain in school age children, but recent studies reported 20% of that type of pain. The aim of this study was determining the spectrum of clinical manifestations of dyspeptic children and to identify the relation between some clinical symptoms, organic or functional dyspepsia, and long term follow up of functional type.
Materials and Methods: This descriptive case series study was done on 232 children between 4 and 18 years of age complaining about chronic abdominal pain chiefly who had referred to pediatric gastroenterology department of Boo-Ali Hospital of sari in 2005-2006. A checklist composed of patient demographic criteria and pain characteristics was prepared. Physical exam and laboratory tests such as AST, ALT, U/A, U/C, S/E, ESR, CBC were performed for all patients. If there were any alarming signs of organic abdominal pain-persistence or recurrence of symptoms and severe disability despite the use of H-blockers-upper GI endoscopies was indicated. Recorded data were analyzed by SPSS software and Chi- square tests.
Results: 102 of 232 patients had dyspepsia 59 were girls (9.2y/o), and 43 were boys (7.5y/o). 65 out of 102 patients had dominant abdominal pain and the rest had flatulence, vomiting and early fullness. 64 of them went under UGI endoscopies. 28 of 64 had mucosal erosion.
Conclusion: Because the functional or organic abdominal pain has not unique diagnostic criteria, and the data about pathological change in children are fewer than that of adults we recommend the clinical findings and biochemical change of mucosa for differential diagnosis in children.

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Background and Purpose: Hirschsprung`s disease (HD) as an organic cause of children constipation is only treated by surgical intervention. Regarding of variety of clinical manifestation of HD and lack of information about it in Sari, this study describes the prevalence of HD in constipated children referring to BooAli Hospital.
Materials and Methods: this descriptive study was undertaken on children with protracted constipation and neonate suspicions for HD referring to BooAli Sina Hospital of Sari (1997-2006). Clinical and pathological data of patients were collected from their records and analyzed using SPSS 13 software.
Results: 226 children were presented with constipation at a mean age of 30.6±34.8 months (range, 0.69-1.6 months). Rectal biopsy performed in 187 cases. HD was diagnosed in 59.4% of biopsied patients. The mean age of patients diagnosed was 24.8± 33.2 months. 27.1% patients with HD were diagnosed in the first month, 44.1% in 1-12, 18% in 12-48 and 10.8% in over 48 months.
Conclusion: This study revealed 59.4% of protected chronically constipated children had HD, indicating usefulness of rectal biopsy in these patients.