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Major histocompatibility complex (MHC), which plays a major biological function in immune response, is generally associated with so many human disease. During recent years a new clinical relevance of MHC disease. On the other hand there is a strong correlation between some autoimmune diseases and MHC system such as in some allergic abnormalities and its relation with HLA antigens. In order to investigate this concept 30 atypic asthmatic patients and 100 healthy controls were selected. Human leukocyte antigen (HLA) typing was performed by standard NIH procedures and the results analyzed. The frequency of HLA-A2, A11, Aw19 and HLA-B51 decreased in atypic asthmatic patients with no association recorded significantly between HLA-C and allergic asthma. The results of our study indicated that there was a significant relationship between allergic asthma and HLA-I antigens.

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Background & Objective: Transureteral lithotripsy is an effective procedure in lower ureteral stone. This study was done to evaluate lithotripsy method in pediatric ureteral stones in Mashhad’s Imam-Reza Hospital. Materials & Methods: In our institute 38 patients went under ureteroscopy and lithotripsy for ureteral stones. Mean age in our patients was 6.8 years (Range 2-13 years). 16 patients were male and 22 patients were female. The mean stone size was 7 mm (Range 6-16 mm). Ultrasonography and KUB or IVP was performed in all cases. After general anesthesia and cystoscopy guide wire introduced in ureter, ureteroscopy were performed for lithotripsy used ultrasound pneumatic or electrohydrolic. Results: Stone were located in the distal ureter in 32 patients, in the midureter in 4 and in the proximal ureter in 2 cases. Ureteroscopy was successfully in 35 cases. Lithotripsy was used: Ultrasound, electrohydrolic or pneumatic. We were unable to introduce the ureteroscope into the ureter in 3 patients. In 3 patients stone migrated to the kidney after ureteroscopy. Then, they candidated for ESWL. Stone free was done in 32 cases (85%). A complication was 25% and treated with medical treatment. Conclusion: Our investigation demonstrates the high success rate ureteroscopy in pediatric group especially with a small caliber ureteroscope. Ureteroscopy should be considered the first choice for treatments of calculi in the distal ureter in children.

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Background & Objective: About 1.3 billions people are infected with Tuberculosis (TB) all over the world. There is a close relationship between the quality of TB treatment and the rate of drug resistance. The recurrence epidemy of TB and increased resistance to some drugs was the basis for the WHO to suggest the directly observed short course treatment strategy or (DOTS) strategy, for the TB patients. Materials & Methods: This research was a cohort study and aimed to evaluate the epidemiological finding, the clinical basis and strategy of DOTS on improving, and prevention from failure of treatment and was compared with non-DOTS procedure. Sample population were total of 260 smear positive patients that had been under study for a period of 2 years (1999-2000). All of the patients were new cases. SPSS software and Fisher exact test was used to analyzed the data. Results: The rate of treatment failure in DOTS strategy in the beginning of 5th month was 1.7%, but in the control group the failure in the same period was 7.3% (P<0.05). Conclusion: This study indicated that the DOTS strategy is substantially increasing the success rate of TB treatment.

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Background & Objective: Aluminum (Al), the 3rd common element in the earth’s crust has a significant toxin potential for humans. Although the knowledge of Al toxicity has markedly improved in recent years, there is relatively little information regarding the embryotoxic and teratogenic potential of Al. the purpose of this study was to assess the effect of short-term exposure of pregnant mice to Aluminum Chloride on the external organ formation of their fetuses. Materials & Methods: Mature NMRI mice (24-33 g) were used in this study. Day 0 of pregnancy defined as the day in which the vaginal plug was found. Plug-positive mice were randomly divided into size groups. The first, second and 3rd groups of animals were given IP injection of single dose of AlCl3 at 150 mg/kg/day on days 10, 11 and 12 of gestation respectively. Mice in the 3 other groups (Controls) received single injection of 0.3 ml saline on days 10, 11 and 12 respectively. Mice were killed on day 15 of gestation. Live fetuses were weighed and examined for external abnormalities. Results: The fetal body weight was significantly reduced in all Al-treated groups (P<0.05). The proportions of external malformations in 10th, 11th and 12th days treated were 47.0%, 37.0% and 33.1% groups respectively with significantly increase comparing to controls (P<0.05). Conclusion: It is concluded that a single dose of the Al administered to pregnant mice can cause external malformations in their fetuses.

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Background&Objective: Primary dysmenorrhea is one of the common causes of absence from work place and life quality among women. According to some studies, fish oil administration results in production of weaker prostaglandin’s (PG) and reduces the severity of dysmenorrhea. The aim of this study is to experience the efficacy of fish oil on dysmenorrhea, which is a cheap drug and with low side effects. Materials&Methods: In this clinical trial, the students separated into two groups those affected with primary dysmenorrhea by referring to girls' high schools and complete the questionnaires. In the next stage randomly were selected two groups each group included 22 students with primary dysmenorrhea. In first group fish oil capsules and the other group placebo were recommended for duration of two months. These students were evaluated before drug recommendation, at the end of two months treatment and two months afterward. In these three stages pain severity by VAS (Visual Analogue Scale) system and pain duration by Cox scaling system were be recorded in each group. Results: There is not meaningfull statistically difference in the average age, age of menarche, menstrual condition (regular or irregular) and accompaniment with symptoms of PMS (premenstrual syndrome) between fish oil and placebo groups. Before recommendation of capsules the average of pain severity did not have a meaningful statistically difference between two groups. The average pain duration also had similar situation. After two months treatment, the average of pain severity (VAS) in fish oil group was significantly less than which in placebo group (p<0.05). Also the average of pain duration in fish oil group was less than which in placebo group with a statistical difference of (p<0.05). Moreover, two months after the end of treatment the average of pain severity (VAS) and pain duration (hour) had meaningfull statistically difference between fish oil and placebo groups and were less in fish oil group. Conclusion: As compared with placebo, the fish oil capsule after two months of consumption had a significant effect on reduction of pain severity and duration in primary dismenorrhea. Also two months afterward from the end of this clinical trial the effect was more than placebo.

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Background & Objective: Hydrocele is fluid accumulation between the two layers of tunica vaginalis which commonly seen in male patients. Hydrocele is divided as communicating and non communicating categories. There are different methods for treatment of adult non communicating hydrocele which principally consist of aspiration and sclerotherapy, and various surgical techniques. The aim of this study is to evaluate outcomes and complications of a new closed hydrocelectomy technique and comparison with excisional hydrocelectomy procedures. Materials & Methods: In this clinical trial study, we divided all adult patients who refered for surgery of non communicating hydrocele to Imam Reza and Qaem hospital in Mashhad-Iran into two groups during 2004 to 2006. The inclusion criterion was simple non communicating hydrocele without any underlying pathology in adult patients who agreed with this new technique. In the first group (Group I) 23 patients with 24 hydroceles underwent closed hydrocelectomy using a catheter (shunt) between scrotal subcutaneous tissue and the hydrocele sac. In the second group (group II) 29 patients with 29 hydroceles underwent excisional hydrocelectomy. Follow up was possible in 21 cases of group I and 23 cases of group II. The outcomes of both procedures including cure rate, recurrence and complications such as infection, post operative pain, edema, hematoma, and testicular atrophy were compared in Two groups. Results: In group I, 13 cases (62%) were cured but 8 cases (38%) experienced recurrence (treatment failure). In group II, 22 patients (95.6%) were cured but one patient (4.4%) had recurrence. Post operative pain in group I was mild in 9 patients (42.9%), morderate in 11 patients (52.4%) and severe in one patient (4.7%). But in group II all patients (100%) experienced severe pain requiring parentral analgesics (opioids). Hematoma was occured in 2patients (8.7%) in group II but in none patients in group I. No patients in any groups developed infection or testicular atrophy. Conclusion: This study showed that although recurrence rate of closed hydrocelectomy is more frequent but its complications are less than open procedures. In patients with high surgical risks in whom excisional hydrocelectomy is less preferable, this closed hydrocelectomy technique may be the technique of choice.

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Adrecortical virilizing tumors are rare in the pediatric age group. There is 1% incidence for adneral cancer. In comparison with adult patients , there is function adrenalectomy tumor in pediatric group. The patient in this report was a 20 months old female presenting with clinical signs of virilizition that were characterized by increased bone mass, pubic hair growth external genitalia. The laboratory test showed: High level of testosterone (400 ng/dl) , andrestandion (3.6ng/ml) and progestron (19.9ng/ml) and very high level of (8000ng/ml) dehydroepiandrosterone. In CT scan there was right adrenal mass with size>5 cm. The diagnosis of right an adrenocortical functional tumor led to the choice of open surgical adrenal with flank apreach between 10 and 11 ribs. Pathologic examination showed carcinoma of the adrenal. Patient discharged 5 days after operation. Surgery was done via lumbar incision and follow up was carreid out for 10 years, and there was not any pathological lesion.

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Background and Objective: Low electromagnetic fields (LEMF) are produced by instruments which are works with electricity. This study was done to determine the effect of LEMF on fetal death and bone marrow megakaryocytes in NMRI mouse neonates. Materials and Methods: In this experimental study 64 females’ mice with 6-8 old weeks were used. 2 female mice coupled with one male, and positive vaginal plaque was interpreted as the zero day of pregnancy (GD=0). The pregnant mice were randomly categorized into control and experimental groups. The experimental group were exposed to50HZ, 0.5 mT Low electromagnetic fields on 7-11 days of pregnant period (8h/d). The weight of neonate and death fetus were studied after delivery. The live neonates were dissected on 15th day, and 1 ml of bone marrow was extracted from Tibia and vertebral column, by pressing method. The bone marrow cells suspended in 1:1 IMDM in 15cc (FULCON) tubule and cells was counted with neobar lam. The data were tested by t-student test significance was set up at p<0.05. Results: There was significant differences between the mean weight of one day neonate in cases with controls (P<0.05). The mean of dead fetus in experimental group was higher than controls (P<0.05). The mean of megakaryocytes numbers higher than controls, but this differences was not significant. Conclusion: This study showed that the number of megakaryocytes and fetal death were increased by low electromagnetic fields exposure during pregnancy.

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Background and Objective: Esophageal and gastric cancers are among the most prevalent cancers in the world which cause a high mortality rate annually. Several risk factors are supposed for them. Water hardness is considered as a protective factor against above cancers. This ecologic study was designed to determine the correlation between water hardness and upper gastrointestinal cancers. Materials and Methods: In this ecological study data on water components in Golestan's urban areas were obtained during 2004-05 and the averages were reported. All cases of esophageal and gastric cancers resided in urban areas which were diagnosed during this period were recruited to estimate the incidence and age standardized rates (ASR). The province was divided into low, intermediate and high incidence, based on 33% and 66% quartiles of both cancers. Pearson correlation coefficient test and regression model were used to analyze the data. Results: The water hardness was in the normal standard range permitted for the drinking water, and did not have any relation with the risk of esophageal and gastric cancers. Conclusion: This study showed that water hardness has no effect on the incidence of esophageal and gastric cancer in this area.

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Background and Objective: Cervical stabilization training is a method of exercise which is designed to improve the mechanisms by which the cervical spine maintains a stable, injury-free state. The aim of this study was to compare effectiveness of muscle stabilization training with dynamic exercises on the chronic neck pain and disability. Materials and Methods: In this double-blind clinical trail study twenty-six patients with chronic neck pain were recruited. Subjects were randomly assigned to either a stabilization (n=13) or a dynamic exercises group (n=13). Before and after intervention, pain was assessed with visual analog scale (ordinal) and Northwick Park Neck Pain Questionnaire (NPNPQ), disability (ordinal) with Neck Disability Index (NDI), neck muscles strength (bar) using Dynatest and cervical ranges of motion (degrees) with specific neck goniometer. A 24 session exercise program which lasted 12 weeks, two sessions per week, and 45 minutes per session was performed for both groups. Independent t-test or Mann-Whitney U and paired t-test or Wilcoxon were used for comparison between the pretreatment and post treatment test results between groups and within groups, respectively. Results: The mean neck pain (NPNPQ) decreased from 18.23±0.77 to 7.54±4.39 in the stabilization group and from 18.31±3.99 to 11.85±3.89 in the dynamic group (P<0.05). The mean disability (NDI) decreased from 22.69±4.99 to 8.23±4.09 in the stabilization group and from 22.23±4.88 to 14.92±5.54 in the dynamic group (P<0.05). After treatment, neck muscles strength and range of extension increased and both neck pain and disability decreased in the stabilization group compared with the dynamic ones (P<0.05). However, there was no significant difference between two groups regarding flexors and left lateral flexors strength and ranges of flexion, right and left lateral flexion. Conclusion: This study showed that neck specific stabilization and dynamic exercises increase, range of motion, decrease pain and disability. Also specific stabilization exercies was more useful than dynamic procedure.

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Background and Objective: Occult hepatitis B infection is a form of hepatitis in which despite of absence of detectable HBsAg, HBV-DNA is present in peripheral blood of patients. The mechanisms which are responsible for progression of OBI yet to be clarified but some investigators believed that the genetics and immunological parameters may are different in resistant individuals and patients. Cytokine network system could be leading alteration in viral immune response. The aim of this study was to investigate the relation between polymorphisms +874 region of IFN-Gama with occult hepatitis B infection. Materials and Methods: In this study, the plasma samples of 3700 blood donors were tested for HBsAg and anti-HBs by ELISA. The HBsAg negative and anti-HBc positive samples were selected and screened for HBV-DNA by PCR. HBV-DNA positive samples assigned as occult hepatitis B infection cases and ARMS-PCR technique were performed to examine the present polymorphisms in +874 region of IFN-Gama genes of patients with occult hepatitis B infection. Results: 352 (9.51%) out of 3700 blood samples were negative for HBsAg and positive for anti-HBc antibody. HBV-DNA was detected in 57 (16.1%) of HBsAg negative and anti-HBc positive samples. Our results showed that there was not any significant difference between patients and control group in polymorphisms in +874 region of IFN-Gama genes. Conclusion: This study showed that there is not any significant difference between polymorphisms in +874 region with IFN-Gama occult hepatitis B infection.

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Background and Objective: Computerized tomographic angiography (CTA) is a minimally invasive modality to image the vasculature without the morbidity of direct large vessel vasculature access and its major indications in urology are assessment of the renal vasculature in preparation for donor nephrectomy, identification of extravessel in evaluation of ureteropelvic junction obstruction and for diagnosis of renal artery stenosion. This study was done to evaluate vescels of kidney donors using CTA and formal angiography and comparison with intraoperative findings. Materials and Methods: In this descriptive study, kidney vessels of 70 and 30 living kidney donor were assessed with computerized tomographic angiography and formal angiography respectively. The pattern of vessels of kidney during operation were examined. Two observers assessed the findings of preoperative CTA and formal angiography with intra operation observations. Results: In CTA group there were two patients each with two main renal veins which were observed during operation was not recorded on computerized tomographic angiography. In formal angiography group there was one patient with unrevealed two main renal veins prior to surgery. In both groups, the accuracy of anatomical diagnosis of the main kidney artery were 100%. Conclusion: This study showed that kidney vascular assessment by either the computed tomography angiography or formal angiography have similar clinical diagnostic accuracy.

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Background and Objective: Lower ureter is the most common site of stone traped causing renal colic and hydroureteronephrosis. If medical therapy is not effective , the treatment consist of extracorporeal shock wave lithotripsy (ESWL), transurethral lithotripsy (TUL) or on rare cases, open surgery. This study was done to compare the ESWL with TUL in sixty patients with lower ureteral stones which did not responed to thraputic regiment. Materials and Methods: This prospective cohort study was done on sixty patients with obstructive lower ureteral stones for more than 3 weeks, that have not been responded to the thraputic regiment in Imam Reza hospital, Mashhad, Iran during 2004-06. According to treatment indications sixty patients divided in two equal ESWL and TUL groups. Success of procedure were evaluated by ultrasonography and KUB radiography. The success rate of two different technique and the side effects in each patients was recorded. Results: In ESWL group in 14 patients (46.66%) the stone was broken and its particles were removed but in 13 patients (43.33%) the stone was not broken and they became candidates for TUL. In 3 patients (10%) the stone was broken but the particles did not pass. The only complication of ESWL was renal colic which was in 15 patients (50%) and cured by medical treatment. In TUL group, in 93.5% of patients, the stone was broken and particles were removed, but in 6.5% the procedure was not successful and the patients underwented ESWL or open surgery. 10% of patients experienced fever and colic pain, who underwented medical treatment. Conclusion: This study showed that TUL technique has higher successful rate than ESWL technique in lower uretaral stones.

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Buschke–Lowenstein Tumor (BLT) or Giant Condyloma Acuminatum (GCA) is a slow-growing, locally aggressive, cauliflower-like tumor of great size that usually arises in the perineal region. Buschke–Lowenstein Tumor is triggered by human papilloma virus (HPV), usually either genotype 6 or 11. Buschke–Lowenstein Tumor is usually preceded by condyloma acuminatum and occurs at any age after puberty, usually between the 4th and 6th decades. Invasive overgrowth and recurrence after treatment are its characteristics and malignant transformation is also possible. Here, we have reported a case of a 33 year-old man with penile Buschke–Lowenstein Tumor arising from common genital warts.

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Background and Objective: Intercostal and supracostal access tract are usual access for percoutaneous nephrolithotripsy (PCNL) for upper calices stones. But pleural complication of these tracts are high. This study was done to evalute percutaneous nephrolithotomy (PCNL) of upper calices with subcostal access. Materials and Methods: Seventeen patients (12 males, 5 females) with stones limited to upper calices with diameters of 11-27 mm and 1-5 in numbers, candidated for PCNL. Ultrasonography and intravenous urography were performed for all patients prior to surgery. In all patients PCNL performed in prone position and access is made at prolonged and deep inspiration from subcostal with fluoroscopic guidance. Following access to upper calices, guide wire inserted and dilatation of tract up to 28 or 30 Fr informed. After insertion of 28 or 30 Fr Amplatz sheat nephroscopy performed. Results: Two patients excluded and finally 15 patients were accounted. In 15 patients subcostal access performed successfully (88.2 %) . In 5 patients stones of less than 10 mm extracted with grasps. In 10 patients after pneumatic lithotripsy, particles of tones removed. 11 patients rendered stone free (73.3%). 4 patients had residual stones of greater that 5 mm in minor calices that in 3 patients after single ESWL resolved. 3 patients needed infandibular dilatation for complete stone extraction. No infection, transfusion, pneumothorax, hydrothorax, respiratory discomfort in operation and post operation period were seen. In one patient a perirenal collection of liquid with diameter of 5 cm was detected. Perirenal collection of liquid was removed with preventional treatment and antibiotics regiments. Conclusion: PCNL with subcostal access for upper calices stones is a feasible and safe with low complication and can be performed instead of supracostal access tracts.

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Background and Objective: Electromagnetic waved generated by electronic industries and the increasing use of electrical appliances have led to higher rise in chronic exposure to extremely-low-frequency electromagnetic field (ELF-EMF). This study was done to investigate the effects of low electromagnetic field on mice embryos development. Materials and Methods: In this experimental study, eighty female NMRI mice were super ovulated and coupled with male mated over the night. Next morning the female mice with a vaginal plug were identified as pregnant mice. Animals allocated into 2 groups control group was not exposed to EMF and animals in case group exposed to 50 Hz and amp 1.2 mT EMF the pregnant mice were scarified by cervical dislocation at 24, 72, 81, 96, 110 and 120 hours. Embryos were subsequently obtained from the mice by flashing the fallopian tubule and uterus horn. Data were analyzed using SPSS-13.5, ANOVA and student’s t-tests. Results: The number of 2, 3-4 cells and 5-8 of embryo cells and blastocyst decreased in case group compared to controls, but these reduction were not significant. The number of morula in cases significantly reduced in comparison with control group (P<0.05). The average number of fragmented blastocyst in experimental groups siginficantly increased compared to control group (P<0.05). The number of inner cell mass and trophoectoderm in experimental group significantly reduced in comparison with controls (P<0.05). Conclusion: The exposure of extremely-low electromagnetic field in pregnancy reduces the number of morula, inner cell mass and trophoectoderm.

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Background and Objective: Autism is one the most disturbing neurodevelopmental disorders associated with any kinds of communicative problems and physical objects. This study was done to evaluate the effectiveness of pivotal response treatment on communicative and behavioral disorder of 8-12 years-old autistic boys. Materials and Methods: This clinical trial study was done on 24 boys with autism (aged between 8-12 years) in pediatric rehabilitation clinic in Tehran, Iran, during 2011. Patients randomly were divided into two groups: control and pivotal response treatment (PRT). The interventional group was received 20 session of PRT during the two months, but the control did not receive any intervention. All patients were examined in the field of social communicative, interactive disorder and self-stimulation behavior, using autism diagnostic interview revised. Data were analyzed using SPSS-16 and MANCOVA test. Results: The mean±SD of social communicative (18.58±0.45), interactive disorder (17.13±0.46), self-stimulations behavior (1.92±0.36) in interventional group were significantly lower than control with following index, 26.33±0.45, 23.11±0.48 and 6.16±0.37, respectively. Conclusion: This study showed that pivotal response treatment can be useful in communicative behavioral disorder of 8-12 years old autistic boys.

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Background and Objective: The silent brain infarctions are common in first-ever stroke. Some recent studies show the possible role of silent brain infarction in ischemic stroke. The aim of this study was to evaluate the frequency of silent brain infarction in acute first-ever ischemic stroke and its association with stroke risk factors. Materials and Methods: This descriptive - analytical study was carried out on 203 (94 males, 109 females) patients with acute first-ever ischemic stroke in Shafa hospital in Kerman, Iran during 2010. The diagnosis of ischemic stroke was made by physical examination and was confirmed by MRI and CT Scan. A questionnaire containing demographic information and risk factors including hypertension, diabetes, hyperlipidemia, cigarette smoking, ischemic and non-ischemic heart disease for stroke as well as presence of silent stroke was completed for each patient. Data were analyzed using SPSS-16 and logistic regression test. Results: The mean age of patients was 62.56±17.35 years. Among our patients history of hypertension, hyperlipidemia, cigarette smoking, diabetes, history of ischemic heart disease, history of other cardiac disease and silent stroke were observed in 66 (32.5%), 26 (12.8%), 16 (7.9%), 40 (19.7%), 27 (13.3%), 16 (7.9%) and 31 (15.3%), respectively. The probability of silent stroke among patient with hyperlipidemia, was 3.7 times more than those without hyperlipidemia (95%CI: 1.556-12.780, P<0.05). There was no significant correlation between silent stroke and the above risk factors. Conclusion: Silent stroke was found in 15% of patients with ischemic stroke. Control of hyperlipidemia can have a vital role in the prevention of silent stroke.

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Background and Objective: There is not a general protocol strategy about the necessity of routine microscopic examination of tonsillar samples in children. This study was conducted to determine the histopathological characteristic of tonsillar tissue in 1250 children, Tabriz-Iran. Materials and Methods: This descriptive study was conducted on 1250 children (724 male and 526 female) aged 2-14 years old who underwent tonsillectomy in Tabriz, Iran during 2008-11. Variables including age, sex, clinical diagnosis and surgical indications were recorded. Paraffin blocks were prepared from samples of tonsillectomy and stained with haematoxylin and eosin. Histopathologocal results were categorized in four groups: Follicular hyperplasia, follicular hyperplasia with infection, malignancy and normal. Results: None of the children had initial clinical suspicion of tonsil tumor. Patients’ primary complaints were as follows: 92.5% mouth breathing, 93% nocturnal snoring, 74.3% recurrent and chronic cold and infections, 56.4% sore throat, 48.2% halitosis, 26% nocturnal apnea, 22.2% dysphasia, and 18.2% anorexia. Children with tonsillar hypertrophy and obstructive symptoms (57%), and tonsillar hypertrophy and recurrent infections (42.2%) underwent tonsillectomy. In the histopathlogical examination of all patients being hyperplasia together with lymphoid hypertrophy were observed and there was no evidence of malignancy in any of the patients. Conclusion: No instance of malignancy was found in the histopathological examination of children’s tonsil-removed tissues and all of the tonsils had benign hyperplasia with lymphoid hypertrophy.

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Background and Objective: Congenital malformations are among important causes of morbidity and mortality in newborns. This study was done to determine the prevalence and pattern of congenital malformations in newborn. Materials and Methods: This descriptive study was done on 6089 newborns in maternity center in Rafsanjan, Iran during 2007-08. The newborns were examined by pediatricians and based on clinical examination the type of obvious of either minor or major malformations were recorded. Results: The 179 cases had at least a major or minor malformations. Over all the prevalence of malformations was 2.93%. The highest prevalence of obvious malformations was seen in the musculo-skeletal (43.5%), followed by genitourinary (22.9%) and cardiovascular systems (15.08%). There was significant relation between congenital malformations, gestational age and medicine used by mothers (P<0.05). Conclusion: The highest prevalence of obvious malformations was seen in the musculo-skeletal system.