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Background and purpose: Rheumatiod arthritis (RÂ) is one of systemic autoimmune disease. Ïn this disease, autoimmune antibodies are discovered, which have diagnostic and prognostic properties. Ône of them is ÂPF, that can react with keratohyalin granules of buccal mucosal cell. Therefore, at first ÂPF-ÏFÂ kit was designed and then antibody titer (Âb) was evaluated in RÂ patients.
Materials and methods: Designing of kit was as follow: 1- Ïdentification of satisfactory donors. 2- Ântigenic substrate preparation. 3- Ïmprovement of method and quality control. The method is based on the binding of ÂPF to Perinuclear Keratohyaline line granules of buccal mocusal cells and its detection with total Ânti Human Globulin (ÂHG) conjugated to FÏTÇ. Âfter calibration of ÂHG, ÂPF assayed in sera dilution of , to in three RÂ patients (52 RÂ patients mean age 48.0 ± 15.8), 23 sera of patient control groups (Mean age 32.5 ± 16.4) and 30 sera of healthy control group (mean age 32.1 ± 16.9).
Results : From total of 52 RÂ patients (71.2%) were ÂPF positive, in 2(8.7%) cases and in healthy control group 1(3.3%) case were ÂPF positive. The designed ÂPF kit had 98% accuracy by inter and intra assay methods. Sensitivity and specificity of ÂPF in serum dilution was 71.2% and 94.3% respectively.
Çonclusion: Âccording to the results of this study, 1/5 serum dilution has best diagnostic value for RÂ for best sensitivity and specificity, that means, 1/5 as a cutt off, or significant minimum dilution in diagnosis and approving of RÂ, and considering 98% accuracy of designed kit, ÂPF-ÏFÂ assay has medium diagnosis and high aproving property for RÂ patients. Âlso Çomparison between differant groups under investigation showed that there is significant relationship between concentration of ÂPF and Severity of disease.

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Background and purpose: Rheumatoid Arthritis (RA) is a systemic auto immune Rheumatoid diseases. Auto antibodies are detected in this disease, with diagnostic and prognostic properties. One of them is AKA which reacts with the fibrous keratin in epiderm and the stratum corneum of rat esophageal epithelium. Hence at first AKA – IFA kit was designed, then its sensitivety and specificity was measured, and the titer of Anti body was evaluated in RA patients, and finaly the results of AKA were compared with that of RF test.
Materials and method: AKA-IFA kit was designed with protein antigens in the stratum corneum of rat esophageal and anti human IgG conjugated to FITC. 52 patients with RA (mean age 48.0 ±15.8) according to the American College of Rheumatology (ACR) criteria were selected for measuring the sensitivity and specificity. The results of AKA test in sera of RA patients were campared with 23 sera of patient control groupe (mean age 32.5 ±16.4) and 30 sera of healthy control groupe (mean age 32.1 ±16.9). Inter and intra assay method was used to determinig precision of AKA kit. RF test was also performed and it's results compared with result of designed AKA kit.
Results: AKA were found in 75% of patients with RA (39/52), 13% of patient control groupe (3/23) and 3.3% of healthy control groupe .(YBO) The designed AKA kit by inter and intra assay method had 100% and 98% percision respectively. The sensitiviety and specificity of AKA in (1/10) serum dilution was 75% and 92.5% respectively but sensitiviety and specificity of RF was 88.5% , 86.8% respectively.
Conclusion: According to the results, IFA– AKA test could be diagnostic and confirmative for RA , And AKA in (1/10)serum dilution has the best diagnostic Value for RA. (cut off).

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Abstract Background and purpose: Video-assisted thoracoscopic surgery (VATS) has been developed as a minimally invasive alternative approach for various diagnostic and therapeutic thoracic operations that previously required open thoracotomy. Postoperative pain is less after VATS than after conventional thoracic surgery, yet its relief is still important. The purpose of this randomized double blind clinical trial was to compare the effect of interpleural morphine analgesia with traditional intravenous morphine administration on pain and supplemental analgesic usage after VATS. Materials and methods: Thirty patients of class I and II of American Society of Anesthesiologists when underwent VATS under general anesthesia were randomly divided into two equal groups. By the end of the operation, a catheter was placed in the pleural space under thoracoscopic vision. Patients received a single bolus of 0.1 mg•kg-1 of morphine either interpleurally or intravenously. During the first 8 hours after operation, pain score at rest and on coughing, supplemental analgesic requirements, mean arterial pressure, heart rate, arterial blood oxygen saturation, degree of sedation, and side effects were monitored every hour. The pain severity was evaluated by visual analogue pain scales (VAS, 0-10). Results: No statistically significant difference was observed between the groups in relation to pain intensity, hemodynamic variables, or side effects during the study. Conclusion: Interpleural morphine did not provide superior analgesia compared with intravenous morphine after thoracoscopic surgery.

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Abstract Background and purpose: Nowadays, tuberculosis (TB) is still growing as one of the biggest human killers in all ancient years, in spite of there are effective drugs and diagnostic tools. In recent years, the incidence rate of this disease has increased. This study was conducted to evaluate the epidemiologic status of Pulmonary Tuberculosis and its associated risk factors in Qom province during 2002-2010. Materials and methods: This study was performed as a descriptive-analytic study, on TB patient's diagnosing during 2002 to 2010 in Qom Province. The data obtained from TB patient's documented files. Data analysis has been done by SPSS software, and with T-test and chi-square. Results: A total of 1035 Pulmonary TB patients (744 positive smears and 291 negative smears) were diagnosed during 2002-2010. Lowest incidence rate were observed in 2002 (9.59 per 100000) and the highest rate were observed in 2008 (13.6 per 100000). Mean age of injured population was 47.43 ±20.92 Disease incidence rate during years of study hasn't increasing or decreasing significant trend (p>0.05). Conclusion: Based on the findings of this study, more attention to case finding in the age group 65 and upper years and foreign refugees (afghan) is recommended. It seems to be necessary some workshops for general physicians about case finding, early diagnosing of patients, and also general health education for public are suggested.

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Background and purpose: Umbilical cord derived Wharton's jelly is an enriched and accessible ‎source of stem cells with highly proliferative and differentiation potential. This study aimed to evaluate the ‎surface markers and related genes of the stem cells isolated from the human Wharton's jelly.‎ Materials and methods: Explants of the human umbilical cord derived Wharton's jelly was dissected ‎and cultured in Dulbecco's modified Eagle's medium (DMEM) supplemented with 20% Fetal bovine serum ‎‎(FBS). Then, those cells migrated from explant's boundary were replated and passaged in DMEM containing ‎‎10% FBS. Finally, by using flowcytometry and (Reverse–transcriptase polymerase chain reaction) RT-PCR ‎techniques different surface markers and related genes were analyzed.‎ Results: 5-7 days post-plating, the stem cells initiated the migration from cultured explants and ‎showed up to 80% densities on days 16-18. Light microscopy demonstrated two distinct cell populations ‎including fibroblast-like and flat endothelial-like cells. Dual staining with flowcytometry also revealed that ‎the cultured cells were found to be positive for CD44, CD73, CD90, CD105 and negative for CD34 and CD45. ‎RT-PCR showed no changes in CD marker expression pattern during different passages.‎ Conclusion: Human Wharton's jelly derived stem cells appear mesenchymal cell morphology and ‎express related surface markers but no hematopoietic stem cell markers.‎

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Background and purpose: Natural bone is a combination of polymer and biological apatite, therefore, the composite scaffolds made of polymers and bioactive ceramics have found wide applications in bone tissue engineering studies. Among various polymers, the poly-L-lactic acid (PLLA) and hydroxyapatite (HA) have attracted much attention due to their optimal properties. In this study, using PLLA polymer and hydroxyapatite (which is similar to human bone mineral component) three-dimensional composite scaffolds were developed by Electrospinning Method. Then the behavior of human umbilical cord mesenchymal stem cells (MSCs) was investigated on the scaffolds. The aim of this research was to develop an appropriate bioactive and functional scaffold for bone tissue engineering. Materials and methods: In this study mesenchymal stem cells were isolated from the human umbilical cord. The cells were cultured on both PLLA and PLLA/HA (10%) composite polymeric nano scaffolds. Biocompatibility of scaffolds was confirmed by MTT assay. The morphological and cell adhesion characteristics of MSCs on the scaffolds were compared using Scanning Electron Microscopic (SEM) imaging. Finally, the cells were treated with osteogenic differentiation medium for 21 days in order to investigate their differentiation potential on the scaffolds. The differentiation of the stained cells with Alizarin Red and Von Kossa were studied at 7,14 and 21 days after cultivation. Results: SEM studies showed that the surface properties of both scaffolds were desirable and the cells not only had the ability to attach and proliferate better on the nanocomposite scaffolds, but were also in a natural condition morphologically. The comparison of staining results indicated a higher differentiation rate in composite polymeric nano scaffold. Conclusion: The results showed that the PLLA/HA nano scaffold could be a very good candidate for bone tissue engineering.

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Background and purpose: Meningitis is an infectious disease which could lead to mortality in case of outbreak in society, especially in dormitories, schools and resting houses. The aim of this study was to assess the geographical distribution of meningitis in Iran by Geographic Information System.

Materials and methods: In a cross-sectional study all cases of bacterial meningitis in 30 provinces in Iran during 2013 were investigated using existing data. Initially, the national data from meningitis was collected from the disease management offices. The incidence of meningitis in each province was calculated by epidemiologic forms. Then, these data were arranged in a geo-referenced database at provincial level in the Arc-GIS software.

Results: In 2013, 8411cases with bacterial meningitis were reported in Iran. In 250 cases (3%) meningitis was confirmed, in 1823 (22%) the disease was detected as probable and 6338 cases (75%) were suspected to have meningitis. The patients were 40.7% female. Most of the infected individuals were reported from Qazvin, Mazandaran and Kurdestan provinces.

Conclusion: Based on maps, it seems that Qazvin, Mazandaran and Kurdestan provinces have either increased risk of meningitis or have a dynamic care system in which reports to the Centers for Disease Control and vaccine-preventable diseases management offices are fully made.

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Background and purpose: Gastric cancer is the most common cancer associated with high mortality worldwide. One of the genes that is down-regulated in gastric cancer, is the SIRT3 that encodes the histone deacetylase enzyme. There is a variable number tandem repeat (VNTR) polymorphism in the intron 5 of SIRT3 gene and evidence shows that expression of SIRT3 gene increases by increase in the number of repeats. According to the deregulation of SIRT3 gene expression in gastric cancer and the effect of intron 5 VNTR polymorphism in the transcription, we investigated the association between intron 5 VNTR polymorphism of SIRT3 gene and the risk of developing gastric cancer.
Materials and methods: A case-control study was performed in 116 patients with gastric cancer (attending Isfahan Omid Hospital, Iran) and healthy controls (n= 116). After DNA extraction, all samples were genotyped using PCR and electrophoresis techniques and the results were analyzed applying logistic regression and Chi-square tests.
Results: In addition to the alleles that have been reported so far, alleles with 8 and 9 repeats were observed too, in this study. The results showed that genotype 4-1 increases significantly the risk of gastric cancer (P=0.028, OR= 13.00).
Conclusion: Some variants of intron 5 VNTR polymorphism SIRT3 gene is associated with risk of developing gastric cancer.
 
 

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Background and purpose: Proton pump inhibitors (PPIs) are one of the main therapeutic agents for acid-dependent diseases. Inappropriate use of this group of drugs especially Intravenous form of pantoprazole can lead to unnecessary cost. The aim of this study was to assess the IV Pantoprazole utilization in a teaching hospital in North of Iran.
Materials and methods: This cross sectional study was performed within four months in 100 patients hospitalized in Ramsar Imam Sajjad Hospital, 2016. Demographic data, type and doses of Pantoprazole, risk factors for stress ulcer, and other relevant clinical data were recorded. Appropriate use of Pantoprazole was assessed according to recommendations provided by Fact Drug Information 2016, Medscape 2016, and UpToDate 2016.
Results: Among the patients 54% had indication for receiving a PPI and only 16% had indication for parenteral form of PPI. Oral PPIs could have been used in 73% of the patients but they received parenteral form of Pantoprazole. In 92% of IV injections, a vial of 40 mg Pantoprazole was dissolved in 10 ml distilled water and injection was done in less than 10 seconds which was incompatible with guidelines.
Conclusion: In current study, utilization of Pantoprazole was not compatible with guidelines in most cases, including right indication, right preparation methods and right rate of drug administration.
 

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Background and purpose: One of the most popular methods to control the synanthropic flies is using parasitoid wasps. The aim of this study was to estimate the experimental parasitism rates of pupae of Musca domestica, Lucilia sericata, and Sarcophaga heamorrhoidalis by parasitoid wasps, including Nasonia vitripennis, Spalangia nigroaenea, and Pachycrepoideus vindemmiae.
Materials and methods: Pupae of three species of flies, including Musca domestica, Lucilia sericata, and Sarcophaga haemorrhoidalis were exposed to three parasitoid female wasps, including Nasonia vitripennis, Pachycrepoideus vindemmiae, and Spalangia nigroaenea in laboratory condition. The exposure rate was 8 wasps to 10 fly pupae on alternate days up to 5 days. The experiments were performed in triplicate and a total of 2700 fly pupae was exposed to 432 wasps. The parasitism rate and parasitoid host preferences were also determined.
Results: Total parasitism of flies was estimated at 22.17%. There was no significant differences in parasitism rate of Musca domestica, Lucilia sericata, and Sarcophaga haemorrhoidalis by Nasonia vitripennis, and Pachycrepoideus vindemmiae, but there was a significant difference in parasitism rate of house fly by the three parasitoids investigated (P<0.01). The Spalangia nigroaenea was active just on pupae of Musca domestica. The highest parasitism rate of the fly species studied was found by parasitized wasps of 5–7 days old.
Conclusion: Spalangia nigroaenea can be considered as an efficient and specific parasitoid for biological control of Musca domestica. Other wasp species, including Nasonia vitripennis, and Pachycrepoideus vindemmiae could also be used in integrated fly control programs. Also, in biological control program for flies, 5-7 day parasitoid might be more effective.

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Background and purpose: Decreasing the quality of life in cancer patients is an essential factor that influences their lives during the process of treatment and after that. A lot of studies have been done to evaluate the efficacy of medical agents on quality of life. In this study, we evaluate the efficacy of Bupropion as an antidepressant agent in quality of life of cancer patients.
Materials and Methods: In this double-blind randomized placebo-controlled clinical trial, a total of 30 eligible cancer patients suffering from fatigue were randomly divided into two 15-individual groups of bupropion and placebo. Bupropion was administered 75 mg/day for the first three days and 150 mg/day (in two doses) till the end of the study for group bupropion. Quality of life was measured by EORCT-QLQ-C3 scale. Adverse effects were assessed based on NCI Common Terminology Criteria for Adverse Events. The study was six weeks long and assessments were done at baseline, second week and sixth week.
Results: There was no significant difference in scores between placebo and bupropion at baseline and second week. While, significant difference was seen at the week six (P=0.005 for function, P=0.036 for symptoms and P<0.001 for health).  Between group assessments showed better average score for bupropion in comparison to placebo. Only two cases of adverse effects were reported.
Conclusion: bupropion can be effective in improvement of quality of life in cancer patients

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Background and purpose: Tubal pregnancy is a life threatening condition that not only causes mortality but also reduces fertility by less than 50%. In many patients, the level of βhCG does not reach detection threshold, and for definite diagnosis, long-term follow-up considering βhCG titration and transvaginal ultrasonography are needed which could lead to delay in diagnosis and treatment. The aim of this study was to determine the vascular endothelial growth factor (VEGF) levels as a serum biomarker in the diagnosis of tubal pregnancy.
Materials and methods: This descriptive study was performed in 103 pregnant women attending Sari Imam Khomeini Hospital, 2018, of whom tubal pregnancy was diagnosed in 50 at 5 to 7.5 weeks of gestational age and the rest (n=53) had normal intrauterine pregnancy with the same gestational age. An ELISA kit (Bioassay Laboratory-China) was used to measure the levels of serum VEGF.
Results: The patients aged 21 to 47 years old (mean age: 31.2 ± 6.1 years). The median serum levels of VEGF in the tubal pregnancy group and individuals with normal intrauterine pregnancy were 233.5 and 157.9, respectively, indicating significant differences between the two groups (P<0.0001). When threshold concentrations of a serum VEGF level > 280 pg/ml were used, tubal pregnancy could be distinguished from normal pregnancy with a sensitivity of 86%, specificity of 67.9%, positive predictive value of 99.6%, and positive and negative likelihood ratio of 2.68 and 0.21, respectively.
Conclusion: According to current findings, serum VEGF levels could be of great help in differentiating tubal pregnancy from normal pregnancy with appropriate sensitivity and specificity.
 

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Background and purpose: Proton pump inhibitors (PPIs) are one of the main therapeutic agents for acid-related diseases. Pantoprazole, with minimal drug interaction, is one of the well-known PPIs. According to various studies, 25-75% of pantoprazole injections have no indications and cause a high burden on health systems. The aim of this study was to investigate the indication and rate of pantoprazole injections in Yazd Rahnemoon Hospital, Iran.
Materials and methods: This cross-sectional study was performed in 72 hospitalized patients in invasive care units, and internal and emergency wards between March and December 2019. Demographic and clinical data, risk factors, PPI indication, and doses of utilized pantoprazole were recorded. The rationality of pantoprazole prescription was confirmed by comparing the drug information from up-to-date database under the supervision of a clinical pharmacist in the hospital.
Results: In total, out of 60 patients who received IV pantoprazole, 52.8% could have received the oral form and in 69.4% there was no indication to use IV pantoprazole.
Conclusion: In this study, parenteral form of pantoprazole was not indicated in majority of the patients. Guidelines should be approved to prevent irrational administration of parental PPIs in hospitals.

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Background and purpose: Leishmaniasis is a disease caused by the Leishmania parasite and transmitted through the bite of a specific type of mosquito. This disease appears in three forms: cutaneous, cutaneous-mucosal, and visceral. Cutaneous leishmaniasis (CL) is a tropical disease caused by an intracellular parasite of the genus Leishmania. This disease is the most important endemic disease in Iran. Changes in plasma hormone levels have been reported in many parasitic infections, and changes in hormone levels can lead to changes in cytokine profiles. The immune-endocrine system interaction plays an important role in the pathogenesis of cutaneous leishmaniasis. Also, the level of some hormones is related to the level of cytokines and clinical symptoms. The purpose of this study is to evaluate the plasma levels of hormones (cortisol, DHEA-S, estradiol, prolactin, and testosterone) and cytokines (interferon-gamma, TNF-α, IL-4, and IL-10) in patients with cutaneous leishmaniasis and the control group.
Materials and methods: This study was carried out in the cities of Abadan and Khorramshahr located in Khuzestan province in the southwest of Iran. After obtaining permission from the ethics committee of Behbahan Faculty of Medical Sciences and obtaining consent from all subjects under the study, a questionnaire including demographic information was completed by all subjects participating in the study. An amount of 5 ml of blood was prepared from each person under study and after centrifugation at 4000 rpm for 10 minutes, the serum was kept at minus 20 degrees Celsius until the day of the experiment to measure hormones and cytokines. In the present study, 40 patients with cutaneous leishmaniasis and 40 healthy patients with no history of cutaneous leishmaniasis were selected. Using laboratory kits, the plasma levels of the hormones cortisol, estradiol, dehydroepiandrosterone (DHEA), prolactin, and testosterone, as well as the plasma levels of cytokines tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6), interleukin 1 (IL-1) and interferon-gamma (IFN-γ) were measured.  Hormone concentration in the control group and patients was compared using the Mann-Whitney test. The relationship between the levels of cytokines and hormones was investigated by Spearman's test. All statistical tests were performed using Graph Pad software version 5 (GraphPad Software Inc., San Diego, CA, USA).
Results: The results of this study showed that the plasma levels of cortisol, estradiol, DHEA, prolactin, and testosterone were lower in patients than in healthy individuals and these results were statistically significant (P<0.05). Plasma levels of TNF-α, IL-6, and IL-1 were higher in patients with cutaneous leishmaniasis compared to healthy subjects(P>0.05). In addition, the plasma level of IFN-γ was lower in patients than in healthy subjects, and these results were statistically significant(P>0.05).
Conclusion: According to the results of the present study, it seems that endocrine-immune system changes in cutaneous leishmaniasis patients are beneficial for the host and helps to heal the lesions. Also, knowing as much as possible about the endocrine mechanisms involved in the regulation of the immune response in cutaneous leishmaniasis can be important for the diagnosis of the disease or the drug treatment of this disease.