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Background&Objective: 15-20% of TB cases are extra pulmonary tuberculosis (EPTB). Abdominal TB is the most common type of extra intestinal TB. Signs and symptoms of abdominal TB are unspecific. In this study, we identified all GITB cases in Golestan province (Iran) between 1999 and 2003 and determined their demographic characteristics. Materials&Methods: We reviewed all new cases of TB reported during 1999-2003 from TB centers of Golestan province .Then EPTB and especially GI and abdominal TB cases were selected. We completed a questionnaire containing demographic information for each of them. The information entered the computer in SPSS-13 was used to analyze the data. Results: 30 patients had been treated for GI and abdominal TB, most of them were females (22 cases, 73.3%). Mean age of the patients was 32.03±13.73 with higher incidence in age before 40 years old (70%). Most common complaints of the patients were fatigue, weight loss, anorexia, fever and abdominal pain, respectively. In 66.7% of patients the diagnosis was pathologically documented. Conclusion: Our data suggest that 38.46% of all TB cases in Golestan province were EPTB, and this scale is higher than other studies. In this study, 5.27% of EPTB cases were GI and abdominal TB, higher than the world reports (3%).

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Background&Objective: Celiac is a digestive disease. In this disease, small bowel is damaged and the absorption of nutrients are adversely affected. These patients do not absorb gluten. There is probably a correlation between esophagus cancer and celiac. The aim of this research was to study the seroepidemiology celiac disease in this area with high prevalency of esophagus cancer. Materials&Methods: This research was a descriptive study, which was performed on blood donors in Golestan province during the year 2005-06. blood samples were taken from 2547 subjects. tTG-IgA determination were carried out using ElISA technique, the titre<4U/ml, 4-10U/ml and >10Um/l were considered to be as negative, weakly positive and positive respectively. EMA antibody assessment were carried out on all sample population with more than 4U/ml, using IFA method. Results: 28 subjects (1.1%) had tTG-Ab positive test, out of this number 18 subjects (0.7%) were weakly positive and 10 persons (0.4%) were considered to be positive. EMA test were positive in 70% of subjects with tTG positive results. There was not any significant meaning between positive tTG test and ethnicity from weakly positive tTG, 15 subjects (83.3%) and 3 subjects (16.7%) were male and female respectively. The entire tTG positive were male subjects. Conclusion: In regard to high prevalency of esophagus cancer in the region and the relation of celiac disease with above cancer, it seems necessary to look more seriously at the celiac disease.

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Background&Objective: Silis (SiO2) is an oxide of silicon that its existence in food products is known as a contamination, classified as a human carcinogen. Some suggest it as an etiology of esophageal cancer. Golestan province has a high incidence and prevalence of esophageal cancer and is on the world belt of this disease. This study was designed to determine the concentration of silis in flour produced in Golestan province, north of Iran Materials&Methods: This descriptive study was done in spring 2005. Census method was used to gather flour samples from flour manufactures. Samples were transported to laboratory. Base-melting method in nickel cruise was used in 550°c and the extract was reduced with acid. The complex was evaluated with spectrophotometer. Data entered into SPSS-12, and the differences between silis concentration in various regions were compared with non-parametric Kruskul Walis test. Results: Median silis concentration was 0.0030 grams, mean concentration was 0.008760 with 0.004265 standard deviation, minimum was 0.003 and maximum was .018 grams in each 100 grams flour produced in province's factories. Mean silis concentrations were 0.012, 0.01 and 0.003 in Gorgan and the central part of the province, western and eastern part, respectively. The differences were not significant. Conclusion: Although in earlier reports it was shown that silis level in the flour is high, but the findings of this study indicated that the above element is in normal range.

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Background & Objective: The Acquired Immunodeficiency Syndrome (AIDS) is in its third decade and has become a pandemic disease that threatens the world population. Educational programs are well known as the most effective strategy to preventing the AIDS. The purpose of this study was to determine the knowledge and attitude of participants about AIDS and to test the effects of an AIDS education program on it. Materials & Methods: This case-control study was conducted during 2005. 149 Red Crescent personnel in Golestan, Iran. The sample subjects participated in a pre/post intervention study. The activity consisted of a workshop 90 minutes in length, in conjunction with educational material. A 13-item questionnaire was used as the gauging tool. Results: 47% of subjects had adequate knowledge about AIDS. Mean level of knowledge in post-test exam was significantly higher than pre-test one (P<0.0001). Individuals with higher educational level (high school and university) had lower knowledge in pre-test (P=0.001), but the difference in pos-test was not significant. A significant relationship was shown between the history of participation in previous AIDS education programs and subject's knowledge in pre-test (P<0.001). Conclusion: This study indicated that education program based on special traing considerably increase general awareness and attitde towards AIDS.

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Background & Objective: Hepatitis B virus (HBV) infection is one of the most important health problems all over the world. This study was conducted to determine the co-infection of hepatitis C virus (HCV), hepatitis D virus (HDV) in HBV infected patients in Golestan province of Iran. Materials & Methods: This population based cross sectional study was done in 2004. 139 HBsAg positive cases were assessed for co-infection with HCV and HDV. Serologic tests were done by ELISA method using available kits. Data were analyzed by SPSS-12 and STATA8 software. P-values of less than 0.05 were considered as significant. Results: Sixty eight (48.9%) of 139 cases were males and 71 (51.1%) were females. The mean (±SD) of participant's age was 41.89 (±11.3) years (range: 25-64 years). Anti-HCV and Anti-HDV antibodies were positive in 17 (12.3%) and 8 (5.8%) cases, respectively. Females were more infected with HCV and HDV than males. But the differences were not significant. Conclusion: The prevalence of co-infection with HCV and HDV in HBV infected cases is relatively high and notable in Golestan province of Iran. Because of negative effects of these co-infections in clinical outcome of the disease, it is recommended to assess possible HCV and HDV infection in individuals with HBV infection. This may result in more efficient management of the disease.

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Background and Objective: Esophageal and gastric cancers are among the most common and fatal cancers. These are diagnosed at the latest phase and the prognosis is too poor. Due to the importance and high incidence rate of the upper gastrointestinal cancers in Golestan province, this study was conducted to explore the overall survival rate of these patients in rural area of this region. Materials and Methods: In this descriptive cross-sectional study, a total of 121 pathologically confirmed esophageal or gastric cancers, with rural place of residence, were retrieved from the cancer registry at the health department in Gorgan. After conducting interview with patients or their relatives, analysis of their sociodemographic and clinicopathologic features was performed. The median survival rate was compared regarding age groups and gender using Kaplan-Meier statistical test. Results: Male to female ratio in esophageal and gastric group were 1.2 to 1 and 3.8 to 1, respectively. Short-term survival rates were 54.76% and 26.2% for esophageal cancer and 66.6% and 37.5% for gastric cancer. Collected information regarding patients’ sociodemographic and clinicophathologic factors did not have significant association with patients’ survival in both esophageal and gastric cancers. The mean survival rate in patient with gastric and esophageal cancers according to age and gender was not significant. Conclusion: This study showed that the overall short-term survival rates for upper gastrointestinal cancers are very low in Golestan province. Therefore the need for intervention the need and allocating more diagnosis and therapeutic resources for upper gastrointestinal cancers are required.

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Background and Objective: Stress has been known as an important causative factor in irritable bowel syndrome. Various studies have indicated the relationship between serum leptin levels and stress levels. This study was undertaken to investigate the relationship between serum leptin levels with irritable bowel syndrome. Materials and Methods: In This case-control study, eighty irritable bowel syndrome patients and 80 controls were recruited. All participants were asked to fill in a questionnaire included demographic information and medical history as well as a stress questionnaire. Serum leptin level was measured by ELISA method. Chi-square, student t-test, pearson correlation and logistic regression were used for investigating the relationships between variables. Results: Participants in irritable bowel syndrome group had significantly higher stress levels than controls (p<0.05). In the other hand, Serum leptin levels were significantly lower in irritable bowel syndrome group than the other one (p<0.05). Multivariate logistic regression analysis showed that after adjustment of stress level and body mass index, serum leptin level was still significantly lower in irritable bowel syndrome group (Odds ratio=0.9 CI95%:0.85-0.94). Conclusion: The present study indicated that there is a relationship between leptin and irritable bowel syndrome and serum leptin level is significantly lower in irritable bowel syndrome group than controls. This relationship is independent of other variables such as stress levels, BMI.

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Background and Objective: Colorectal cancer is the third common malignancy in the world. Personal habits including life style and nutrition have been proposed as risk factors of colorectal cancer. We conducted this study to assess the nutritional characteristics in colorectal cancer patients in Golestan province of Iran.

Materials and Methods: This case-control study was done on 47 colorectal cancer cases, diagnosed during 2004-05 and 47 healthy controls. A questionnaire containing socio-demographic and nutritional characteristics (FFQ) was filled for each of the participants. Chi square test was used to assess the relationship between variables.

Results: In each of the two groups, 40.4% were females and 59.6% were males. The mean±SD age of age in cases and controls were 52.4±13.4 and 52.1±13.1 years, respectively. Total energy expenditure of higher than 1837.5 Kcal/ day was significantly related to colorectal cancer (OR=3.8 95% CI: 1.2-11.3). Colorectal cancer risk was higher in individual with frying cooking method (OR=3 95% CI: 0. 8-11.1). The risk of colorectal cancer was 6.5 times higher in individuals with fat consumption of higher than 118.5 grams/day (95% CI: 1.5-28.8). No significant relationship was seen between vegetables consumption and the risk of colorectal cancer.

Conclusion: This study showed that high total energy expenditure, high fat consumption and using frying method for cooking are risk factors of colorectal cancer in Golestan prevince in Nothern of Iran.

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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: Golestan province, located in north of Iran has been known as a high risk area for esophageal cancer. The relationship between esophageal cancer and Selenium (Se) has been assessed in previous studies. This study was conducted to assess the relationship between Soil selenium levels and development of esophageal cancer in Golestan province of Iran. Materials and Methods: In this ecologic study, Golestan province in northern Iran was divided into 135 blocks based on geographical altitude and longitude on the map. One Soil sample was collected from the center of each block. Selenium level in Soil samples was determined by flame atomic absorption spectrometry. Statistical analysis was performed by Pearson correlation and T-Student tests. Results: The mean±SD of Soil Selenium level in Golestan province was 3.7±1.61 mg/kg. There was a positive correlation between Soil level of Selenium and esophageal cancer rates in this area (P=0.03), (Pearson correlation coefficient=0.19). The Soil Selenium level for high risk and low risk area for esophageal cancer were (4.13 mg/kg) and (3.39 mg/kg) respectively (P=0.01). Conclusion: This study showed that there is high Soil Selenium level in Golestan province in north of Iran. Also it is found to be a significant positive relationship between Soil Selenium level and esophageal cancer rate in this area.

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Background and Objective: Placenta previa (PP) is a common cause of pri-partum bleeding leading to high mortality and morbidity in mothers and neonates. This study was conducted to determine risk factors and outcomes of PP in Golestan province of Iran. Materials and Methods: This case-control study was done on pregnant women admitted for deliverly to the Dezyani hospital of Gorgan, Iran during 2002-07. All PP cases were recruited as case group and 251 non-PP ones were entered into the study as control group. Student t-test and Chi-Square test were used to assess the relationship between variables. Results: In this study out of 33473 pregnant cases, 82 women (0.24%) had PP. The mean (±SD) age of mothers with PP was 28.5 (±6.2) years. There was a significant correlation between PP and delivery method (P<0.05). History of cesarean section was significantly higher in cases than controls (P<0.05). The prevalence of hysterectomy due to PP was significantly higher in women with history of cesarean section (24%) than other ones (5%) (P<0.05). Conclusion: We found a significant relationship between history of cesarean section and hysterectomy due to PP. Therefore, PP should be considered in women with a history of cesarean section.

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Background and Objective: Celiac is a hereditary disease presented with chronic inflammation of small intestine. Several studies supposed a relationship between Celiac disease and Inflammatory Bowel Disease (IBD). Tissue trans-glutaminase antibody is one of the best serological markers in Celiac disease. This study was designed to evaluate the association of Celiac and IBD using tissue trans-glutaminase antibody.

Materials and Methods: In this descriptive study 127 confirmed IBD patients who were referred by gastroentrologists 2005-08 enrolled into the study. A questionnaire was completed and tissue trans-glutaminase antibody was evaluated with ELISA method with a Cut-off=12 U/ml.

Results: Among 127 referred patients, serum samples of 102 patients were collected. Mean±SD of age was 36.17±15.2 years and 48% were males. Ulcerative colitis, Crohn’s disease and other colitis were observed in 76 (74.5%), 7 (6.9%) and 19 (18.6%) of patients, respectively. Tissue trans-glutaminase antibody was positive (19.8 U/L) in one 46-years-old male patient with ulcerative colitis.

Conclusion: Tissue trans-glutaminase antibody titer was not significantly different between IBD patients and controls, thus it seems not appropriate to suggest as one of the routine tests in IBD patients.

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Background and Objective: Lead threaten living creature’s life as air pollutant and causes several diseases such as degenerative disease of nervous system. This research was conducted to determine the effect of Curcumin on BDNF changes and oxidative/antioxidative process in rat’s hippocampus which exposed to Lead acetate.

Materials and Methods: In this experimental study, 40 male Wistar rats were randomly assigned to four groups of ten: Base, Sham(control), lead and Curcumin+Lead. lead and Curcumin+Lead groups received 20 mg/kg lead acetate and Curcumin+Lead group also received 30 mg/kg Curcumin, peritoneally for 8 weeks (3 days in weeks). MDA (oxidative stress biomarker) and TAC (total antioxidative capacity) levels were measured by TBARS and FRAP methods, respectively, and hippocampus BDNF level was measured by ELISA method in rat hippocampus region. Data was analyzed by one-way ANOVA test and Tukey at P<0.05 level.

Results: Injection of lead acetate significantly increased MDA, non-significantly decreased hippocampus BDNF and significantly decreased TAC levels in the Lead group compared with control groups. On the other hand, curcumin administration led to non significantly decreased MDA, nonsignificantly increased BDNF and significantly increased TAC levels compared with other groups (P<0.05).

Conclusion: This study showed that Curcumin adminstration in long term lead acetate-treated male Wistar Rats did not increased BDNF of hippocampus, but it prevent the reduction of BNDF due to lead-intoxification.

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Background and Objective: Hemoglobinopathies are among the most prevalent genetic disorders worldwide, and occur as a result of mutations in the gene involved in synthesizing hemoglobin chains. By now more than 1000 defects in hemoglobin chains are discovered. Hemoglobin D (Hb D) is one of these disorders, identified by a single nucleotide mutation on codon 121 of beta globin chain. This study was carried out to evaluate Hb D mutations through molecular methods in Mazandaran province of Iran. Materials and Methods: This descriptive laboratory study was done on 70 patients with an electrophoresis band in hemoglobin-S zone in Mazandaran province of Iran during 2010-11. Capillary zone electrophoresis was done to find out Hb D in 51 patients. Subsequently, PCR-RFLP was performed to evaluate the samples at molecular level. Results: Molecular investigation revealed all cases are carriers of hemoglobin D-Punjab. Two patients were shown to be homozygote carriers of the abnormal gene. Conclusion: This study showed all Hb D affected patients were carriers of Hb D Punjab.

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Background and Objective: Oxidative damage associated with the presence of Lead in the brain has been proposed as one possible molecular mechanism involved in Lead toxicity. Aerobic exercise is known to protect the brain through a cascade of molecular and cellular processes. The purpose of this study was to investigate the effect of 8 week aerobic training on the brain-derived neurotrophic factor (BDNF) and malondialdehyde (MDA) levels in rat's cerebellum exposed to Lead acetate. Materials and Methods: In this experimental study, 40 Male Wistar rats were randomly allocated into four groups: sedentary base, sham (30 mg/kg of ethyloleate), Lead and exercise+Lead (20 mg/kg Lead acetate, intraperitoneally). The exercise program consisted of progressive running training on the treadmill for 15 to 22 m/min, 25 to 64 min/day, and 5 days/week for 8 weeks. BDNF and MDA levels were measured by ELISA and TBARS methods, respectively. Results: Chronic Lead acetate administration enhanced significantly (P<0.05) cerebellar MDA levels in rats compare to base and sham groups but had no effect on BDNF levels. Cerebellar MDA significantly was reduced and BDNF non significantly was increased in Lead acetate+ training group. Conclusion: Regular aerobic exercise with moderate intense may exert role neuroprotective against Lead-induced cerebellar injury by down-regulating oxidative stress and promotes brain health through increases in BDNF.

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Background and Objective: Children constipation is one of the common causes of abdominal pain. Cow´s milk in children diet is suggested to be one of the main cause of chronic constipation. This study was performed to determine the effect of cow´s milk elimination from children diet with chronic constipation. Methods: This quasi-experimental study, was performed on 80 children with chronic constipation. Rome-III criteria were considered for disease diagnosis. Cow’s milk was eliminated for three weeks from children’s diet and the clinical symptoms in children were surveyed, subsequently. Results: Constipation was cured in 33.8% of children as result of cow's milk free diet. The rate of treatment response in affecting children whom their disease in began under 2 years of age (52.6%) was significantly higher than others (16.6%) (P<0.05). Children treatment was not significantly related to child’s gender and amount of milk consumption. Conclusion: Eliminating of cow's milk from the diet improves the chronic constipation in children.

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Background and Objective: Colonoscopy is the best method for management of patients with Hematochezia or lower gastrointestinal bleeding (LGIB). This study was conducted to assess the endoscopic and histopathologic findings in patients with hematochezia. Methods: This descriptive –analytical study was done on 117 (50 males, 67 females) patients whom referred to 5th Azar hospital in Gorgan, northern Iran during 2010. Demographic characteristics, medical history and colonoscopic and histopathologic findings were recorded for each patient. Results: Hemorrhoid was the most common finding in colonoscopic examination. Inflammatory bowel disease (IBD) and cancer were the most common feature in the under and higher than 43 age old patients, respectively (P<0.05). Ulcerative colitis (22.2%) was the most common finding in histopathological examination. Rectosigmoid was the most common anatomical location of involvement in IBD cases. Cancer and IBD were occurred in the left colon. Conclusion: Flexible sigmoidoscopy can be a selected procedure for evaluation of hematochezia in the <43 age old patients but in >43 age old subjects sigmoidoscopy or colonoscopy should be made based on patients' status.

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Background and Objective: Repeated blood transfusion is the major treatment for patients with major thalassemia. However due to antigen encounters, it may initiate body reactions, including alloantibodies against red blood cell antigens. This study was done to determine the Prevalence of alloimmunization in major beta thalassemia patients in northern Iran. Method: This descriptive - analytic study was carried out on 218 thalassemic patients (100 males and 118 females) with average age of 22.5±7 years in northern Iran during 2010. Each sample was tested for the presence of Alloantibodies including C, Cw, Lea, E, Lua, Leb, K, Jkb, N, P1, D, Jka, M, S, Xga, e, Fya, s, c, Fyb, k, Kpa, Jsb, Lub and Coa. Results: Eighty eight cases (40.4% 95% CI: 33.9-46.9) were positive for the presence of alloantibodies. Alloantibodies against C, Cw, Lea red blood cell surface antigens were the most prevalent (40%). No significant correlation was found between emergence of alloantibody with the age of initial, frequency and duration of blood transfusion. Conclusion: Alloimmunization is a common observation in thalassemic patients and should be prevented by transfusing compatible blood.

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Background and Objective: Drug resistance to tuberculosis and especially multiple drug resistance tuberculosis (MDR-TB) variants are a serious problem in tuberculosis patients and make difficulties in controlling the disease. This study was coducted for detection of common mutations causing drug resistance of mycobacterium tuberculosis strains among tuberculosis patients using line probe assay method. Method: In this descriptive study, fifty four sputum samples of tuberculosis patients were randomly selected in health centers of Mazandaran, northern Iran during 2012. After culturing of sputum samples on Lowenstein–Jensen medium, genomic DNA was extracted from colonies using CTAB method. Molecular analysis of mutations causing resistance to five different antibiotics including Isiniazide, Rifampin, Sterptomycine, Amicasin / Canamycine, Kinolon were performed using long probe assay (LPA) method. Results: Out of 54 sputum samples, three (5.5%), three (5.5%), four (7.4%) were resistance to Kinolon, Amicasin / Canamycine and Sterptomycine, respectively. Mutation in KATG was seen in 2 samples resistant to Isiniazide. Mutation in rpoB 516 was seen in 3 samples resistant to Rifampin. Four samples (7.4%) were resistant to the two anti-tuberculosis antibiotics, while three samples were resistant to Sterptomycine and Kinolon and one sample was resistant to Rifampin and Canamycine. Conclusion: 7.4% of sputum samples were resistant to the two anti- tuberculosis antibiotics. Line probe assay is a rapid and suitable method for detecting tuberculosis drug resistance.

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Background and Objective: Hemoglobin D-Punjab is one of the variant of hemoglobin caused by a mutation on position 121 of beta globin gene which is frequent in India, Pakistan and Iran. Heterozygote form of this variant is mainly asymptomatic while in combination with hemoglobin S, severe form of anemia occure. This study was carried out to determine the beta globin gene haplotypes associated with hemoglobin D-Punjab in Northern Iran. Methods: This descriptive study was carried out on families of 18 individuals whom were carriers of hemoglobin D-Punjab in Sari in Northern Iran. Genomic DNA was extracted from peripheral blood samples using Phenol-chloroform standard protocol. In order to identify different haplotypes associated with hemoglobin D-Punjab, PCR-RFLP method and family linkage analysis were used. Results: In 17 subjects hemoglobin D-Punjab was linked to [+ - - - - + +] haplotype and in one case association with [- + + - + + +] haplotype was observed. Conclusion: The hemoglobin D-Punjab alleles have mainly unicentric origin and [- + + - + + +] rare haplotype may have different genetic origin or is created as a result of gene recombination.