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Introduction: Diabetic neuropathy is a common complication of diabetes, leading to great morbidity and mortality and resulting in a huge economic burden for care of the patient with diabetes. It is the most common of neuropathy in the developed countries of the world, accounts for more hospitalizations than all the other diabetic complications combined, and is responsible for 30% 1075% of nontraumatic amputations.
Materials and Methods: This investigation is a descriptive analytic, cross-sectional study among 40 diabetic patients without symptoms of peripheral neuropathy referred to Aruk Vali-Asr diabetes clinic from March to september of 2003. Patients were referred to one neurologist for study of peroncal and tibial motor nerves and sural sensory nerve conduction velocity in electrodiagnostic clinic of Arak Amir Kabir hospital. The results of this group were compared to the results of 70 age and Gender matched normal control subjects. Independent samples T-Test, Pearson correlation coefficient and Fisher's exact test were used in analysis.
Results: A total of 40 patients were studied with mean age of 42.6 years and mean duration after the first diagnosis of diabetes 5.72 years. Mean investigated nerves conduction velocity in the normal control group was meaningful more than in diabetic patients. Asymptomatic neuropathy was present in 27 (67.5%) of patients. In these patients mean duration after the first diagnosis of diabetes was 6.5±5.16 years.
Conclusion: Asymptomatic diabetic neuropathy is common (67.5%) sural sensory. Nerve conduction velocity is a sensitive test for early diagnosis of diabetic neuropathy.

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Introduction: The objective of this study is to clarify the opinions of scientific board members of Sina university hospital about medical research and the ways of promoting these researches. Materials and Methods: This is a grounded theory study in which we used in-depth interviews and focus group discussions. Scientific board members and different authorities of the hospital such as the chief of hospital and the deputy of education were participated in the study. We used three different FGDs. Each group included about 5 people. We also interviewed the chief, the deputy of education and the head of clinical research center of the hospital. Results: Most of the participants in our FGDs believed that the most important factor for research promotion in the hospital was preparation of a data base of patients. They also mentioned that, different research workshops are important for empowering scientific board members in research. Conclusion: According to our study the most important strategies for research promotion in Sina hospital are data bank preparation, providing repeated research workshops, revising the bureaucratic process of proposal approvals, revising the manner of evaluation of scientific board members and more participation of the department of epidemiology in clinical researches

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Introduction: In this study, antimutagenesis effect of ethanolic extract of propolis by Ames test against two mutagenic substances named azide sodium and potassium permanganate in the presence and the absence of microsomal homogenate of mouse liver (S9) has been investigated. Materials and Methods: In this experimental study at first, different concentrations of ethanolic extract of propolis (0.1-5%) for determining minimum inhibitory concentration (MIC) against tester strains were used. Then by Ames test, antimutagenesis effect was assessed in nontoxic extent. In this test, various strains of Salmonella typhymurium (TA100 and TA97) that contained selective mutation in their operon histidine, were used. Mutant strains (His-) were grown on culture media containing minimum salt and glucose in the presence of mutagen substances above. So only those bacteria that were reversed by mutation (His+) could grow and form colonies on culture media. If antimutagen (EEP) and mutagen substances were gathered, reversed mutation would be reduced and the rate of mutation inhibition could be calculated by means of formula. The differences between the averages of revertants per plate of the sample in relation to the mutagens were analyzed using SPSS software and one-way ANOVA. Results: The resulted MIC values clearly showed that ethanolic extract of propolis at 5% concentration has antibacterial activity against Salmonella typhymurium, but in 0.1-4% concentrations, such effects were not seen. Findings also showed that propolis in such concentrations could neutralize mutagenic effects of those substances in a dose dependent manner. Conclusion: Finally we found that ethanolic extract of propolis that contains different kinds of major and important substances like flavonoids, has good antimutagenic effects and the best concentration for obtaining such effect is in 4% which also was confirmed with microsomal results. The mechanism of antibacterial effect of propolis is complex and it has no analogy to any classic antibiotics, but it should be emphasized that bacterial cell division is inhibited by propolis. Some researchers also argue that propolis could inhibit DNA-dependent RNA polymerase.

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Background: According to the report of Iranian Center of Disease Control, in the summer of 2005 an outbreak of cholera (Inaba serotype) occurred in Iran. The outbreak lasted the mid of September. The aim of this study was to use the result of different studies performed during this period to determine source of infection. Methods and Materials: This is a meta-analysis study, which studies performed in Qum, Arak, Karaj, Golestan and Ghazvin were eligible. All of these studies were case control ones performed during the August 2005. The total of cases were 531. Pooled odds ratios was used to estimate by fixed and random method. All computations were performed by Stata 8 software. Results: The estimated pooled odds ratios resulted from 5 differemt studies were used in the meta-analysis as the following: travelling (1.64 95% CI: 0.98-1.88), non-pasteurized ice cream (0.88 95%CI: 0.48-1.61), post toilet hand washing (3.72 95% CI: 0.86-16.05), eating meal outside home (2.38 95% CI: 1.46-3.90), raw fruit eating (0.98 95% CI: 0.42-2.18) and raw vegetables use (5.36 95%CI: 2.4-12). Conclusion: According to the results of this study raw vegetable use and having meal outside home were significantly associated to the cholera in mentioned provinc

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Background: Radiotherapy is one of the cancer treatment methods. Prescribed dose for each fraction is considered based on radiosensitivity of tumoral and normal tissues. Viral agents are the effiectiv factors on tissue sensitivity. This research aimed to determine the effect of ionizing radiation of Cobal 60 on radiosensitivity of Hela cells infected with Measles virus. Methods and Materials: In this study, the radiosensitivity of Hela cells is investigated experimentally and qualitively. The cells have been cultivated in two groups (experimental and blank) and plating efficiency has been obtained. Then 100λ measles virus with serial dilution method was used to induce infection in different ratio for experimental group. After cell growth and passage, the two groups were irradiated with 2Gy gamma radiation of cobalt 60. Results: Results respectively indicated cell death increases up to 5-7%, 15-20% and 50-65%, after 2Gy irradiation by Co 60 for contaminating to Measles in low, moderate and high concentrations. Conclusion: Radiosensitivity of tumoral cells increases when they are infected by viral agent. The result in radiotherapy of cancers showed, in prescribing dose fraction non cancer disease should be considered.

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Background: Cervical cancer is a preventable disease and we can determined preventive methods by discovering ethiology of disease. There are no appropriate research about the relation between coitus during menstruation and cervical cancer in Iran. This study is done to investigate the relationship between coitus during menstruation and cervical cancer in women referring to health care centers of Shahid Beheshti University of Medical Sciences in 2007-2008. Methods and Materials: This case-control study was carried out on 100 patients with cervical cancer (case) and 100 healthy women (control). All participates were Moslem with Iranian nationality and habitant in Iran. They had no previous history of frequent pelvic radiotherapy and alcohol consumption. Two groups were matched with age, age of first coitus, age of first vaginal delivery, parity and type of delivery. Data was collected through structured interview and analyzed using Chi-square and logistic-regression. Result: The study showed that 40% of case group and 10% of control group had coitus during menstruation. Coitus during menstruation in case group was 6 times more than control group (p<0.0001, odds ratio =6.0, CI= 2.7-12.9). Discussion: Coitus during menstruation may increase the risk of cervical cancer. A research is recommended to find out the best educational method which to prevent this disease.

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Abstract Background: Different studies have shown the inability of traditional lecture method to active teaching method in concept transmitting of higher learning domain. The aim of this study was comparing the effects of feedback lecture method and conventional lecture method on learning and quality of teaching. Materials and Methods: In quasi-experimental study, 27 Arak medical science midwifery students who were in fourth semester, randomly, were divided to two groups of “teaching by feedback lecture” and “teaching by conventional lecture”. Desired topic were presented by one teacher as a 90- minute lecture in control group and as two 35-minute lectures with 10-minute discussion after each part in case group. Informational form, and post test and student' opinion form were used respectively to identify the demographic characteristics, short tem and long term learning and quality of teaching form. Results: Demographic characteristics, quality of teaching form student’s opinion, total scores of pre and post test were similar in two groups. Results of teaching score in post test in knowledge and perception level were similar. But there was a significant difference between application and analysis level in two groups(p=0.011). Also, total and domain scores of post test after a month were not different in both groups. Conclusion: Results indicated that learning by feedback lecture can be more effective than conventional lecture method in application and analysis domain.

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Abstract Background: Tendency to use of portfolio for evaluating has been developed with the aim of optimum use of assessment culture. Present study was done to determine the effect of portfolio’s evaluation method on midwifery students’ learning and satisfaction in gynecology practical training. Materials and Methods: In this qusi-experimental study, all midwifery students in sixth semester (n=42), were randomly allocated to portfolio and routine evaluation group. Based on educational goals, portfolio groups prepared package which consists of a complete report of history, physical exam and method of patient management for women whom visited gynecology clinic and were evaluated by a portfolio’s evaluation checklist. During the last day of their course, post test, clinical exam and opinion form were taken. Results: The mean of age, score of pretest and gynecology theory were similar in both groups. The mean of pre and post test scores for students of both groups didn’t have significant difference for knowledge and comprehension levels. The mean score of application, analysis and cognitive higher levels questions in portfolio group were significantly greater than routine evaluation group (p=0.001, p=0.02, respectively). The mean of clinical exam score in both groups had a significant difference. In portfolio group, mean of diagnostic and therapeutic solution and Communication between theoretical and clinical leanings scores were more. Students’ overall satisfaction scores in two evaluation methods were similar. Conclusion: Portfolio evaluation provides the opportunity for more learning by increasing the student’s participation in learning process and helping them to apply theory in practice.

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Background: Adolescents, as a large age group in the world, face many physical, mental and social problems in their puberty period. Health education proper to their needs and through new educational methods is of great importance. This study mainly aims to examine the impact of peer education approaches on girls' performance regarding pubertal physical health. Materials and Methods: In this experimental study, through random sampling, 100 female pupils were divided into two groups of experimental (n=50) and control (n=50). The self-made questionnaire, employed in this study, was based on peer approach. After 1.5 months, the participants' performance was evaluated through the post-test and compared to the pre-test results for the two groups. Scoring was conducted out of 100 and the scores under 50 indicated weak performance, those between 50 and 75 showed an average performance while scores above 75 indicated good performance. Results: Peer based educational approaches improved adolescent girls physical health. Statistical tests also revealed a significant difference between the mean of awareness and practice score in the two groups (p<0.001). Conclusion: Peer education methods result in the empowerment of adolescents, the provision of opportunities for them to participate in activities, and the improvement of communication between mothers and their daughters.

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Background: Perineal pain following episiotomy affects mothers’ mental health and their quality of life. Using cooling gel pad is a new approach which is used for pain relief, but the pain related to episiotomy is still typically treated with oral analgesics. This study was conducted to investigate the effect of gel pad on post-episiotomy pain in primiparous women in Kamali Hospital of Karaj. Materials and Methods: This single-blind clinical trial was conducted on 60 primiparous women who referred for labor to Kamali Hospital of Karaj. The participants were randomly allocated to two groups: Those receiving gel pads (for 20 minutes four hours after labor and in case necessary, for up to 5 days) and the control (receiving the hospital routine). The two groups were evaluated in terms of episiotomy pain intensity through visual analogue scale (VAS) and analgesics usage. Results: The two groups did not show any significant differences in demographic features and other intervening variables. In terms of reduction in pain intensity, there were significant differences between the two groups 4 hours (p=0.002), 12 hours (p=0.009), and 5 days (p=0.000) after episiotomy. Analgesics usage, five days after delivery, in gel pad group was significantly lower than the control group (p<0.001) Conclusion: Using gel pad reduces the perineal pain intensity following episiotomy and decreases the need for using analgesics.

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Background: Preeclampsia is one of major reasons of mortality in mother and child and its early diagnosis is one of the most important parts of health care during pregnancy. The current study was done to find the relationship between hemoglobin and hematocrit in the first trimester of pregnancy and the incidence of preeclampsia in women referring to Milad Hospital in Tehran in 2009-2010. Materials and Methods: This prospective cohort study was conducted on 700 pregnant women in the first trimester of pregnancy, selected by convenience sampling. Prenatal tests were run in Milad Hospital and the results were recorded. Then samples were monitored for preeclampsia until delivery. Data were analyzed by SPSS version 18 (P < 0.05). Results: The highest percentage of research groups suffering from preeclampsia was in hemoglobin ≥12/5% g/dl and hematocrit of ≥38% group. There was a significant relationship between hemoglobin and hematocrit levels during the first trimester of pregnancy and preeclampsia (P<0.001, P=0.002). Hemoglobin of ≥ 12.45 g/dl presented a sensitivity of 85%, the specificity of 43.04%, positive predictive value of 9.63%, and negative predictive value of 97.57%. Hematocrit of ≥ 38% presented the sensitivity of 77.5%, the specificity of 50.71, the positive predictive value of 10.1%, and the negative predictive value of 96.93%. Conclusion: The presence of high hemoglobin and hematocrit in the first trimester of pregnancy can be a predictive factor for diagnosing preeclampsia

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Background: The aim of this study is to assess antioxidative and pro-oxidative efficacy of ascorbate on serum albumin during iron-induced oxidative stress. Materials and Methods: In this experimental study, albumin was placed in the oxidative system containing iron ions and different concentrations of ascorbate. To monitor albumin degradation, sodium dodecyl sulfate polyacrylamide gel electrophoresis was performed according to Laemmli procedure. Oxidative modification of albumin was demonstrated using a method for determination of carbonyl groups by 2,4-dinitrophenylhydrazine. Results: By applying the carbonyl assay, ascorbate showed a dual effect: initial pro-oxidative effect on albumin changed to an antioxidant one in a dose-dependent manner. Our findings showed prooxidant effects for ascorbate in low concentrations (0-100 µM) and antioxidant effects in higher concentrations (100-300 µM). Also, electrophoretic pattern of plasma proteins showed significant protein aggregations in the range of 35 to 45 kDa of MW and protein degradations in the range of 115 to 180 kDa. Conclusion: Ascorbate can produce reactive oxygen species and can also inhibit the production of these oxidants in the presence of iron ions as well. These findings may be directly applicable to oxidative states during the administration of ascorbate and may be important in preventing oxidative modifications of proteins in blood circulation and other biological fluids.

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Background: Transient hip tenosynovitis is one of the common causes of pain and limping in children and includes 0.4% to 0.9% of admissions in emergency wards. The aim of this study is to evaluate this disease in terms of clinical presentations, age and sex distribution, and six-month recurrence. Materials and Methods: In this cross-sectional study, 51 children with diagnosis of transient hip tenosynovitis were investigated. Inclusion criteria were physician's clinical suspicion of acute tenosynovitis according to clinical presentations, physical exam, and age range of 3 to 8 years. Results: Among the 51 children with tenosynovitis, 34 patients were male with age of 61.70±19.1 months and 17 patients were female with mean age of 48.35±20.49 months that presented a significant statistical difference (p=0.026). The most common complaint was hip pain and the most commonly involved joint was the hip. Also, most of the patients had the history of viral diseases. Conclusion: Transient hip tenosynovitis is more common in boys. The right hip is the most involved joint and the majority of patients have the history of recent viral diseases.

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Background: Funnel plot is a graphical tool for investigating publication bias in meta-analysis studies. The aim of this study is to introduce another application of funnel plot that is monitoring one of the Iranian family performance indices and determining the position of each health center of Markazi province in terms of patient referral rates by general practitioners to specialists and to compare it with bar and caterpillar plots.

Materials and Methods: In order to draw the funnel plot, the average monthly percent of referrals for each district of Markazi province in 2011 was computed. In this study, Iranian Ministry of Health and Medical Education standard figure of 10% was considered as the limit of referral to the second level of Iranian health services. The 99% confidence interval of the control limit for each district was computed according to 3 standard deviations of the percent of referrals relative to the total patient visits.

Results: Based on funnel plot results, five out of ten districts were in the expected range of referral (Ashtian, Saveh, Tafresh, Khomein, and Komijan). However, in other five districts, the referral rate was greater than the expected rate (Arak, Shazand, Zarandiyeh, Delijan, and Mahallat). Mahallat district had the highest rate of referral.

Conclusion: The funnel plot was more informative than the other two plots Thus, it can be viewed as a useful tool in monitoring health programs throughout the country.

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Background: Heavy menstrual bleeding is one of the leading causes of low quality of life and iron deficiency anemia in women of reproductive age. This study was conducted to compare the therapeutic effects of mefenamic acid and the hydroalcoholic extract of Urtica dioica on the volume of bleeding in heavy menstrual bleeding.

Materials and Methods: In this clinical trial, 90 women with heavy menstrual bleeding were selected and after a control cycle for evaluating the primary bleeding volume, using Excel software, were randomly allocated to Urtica dioica or control groups. Both groups were subjected to mefenamic acid treatment with 500 mg every 8 hours, from the first day to the end of bleeding, up to seven days, for two consecutive cycles. In Urtica dioica group, in addition to mefenamic acid, Urtica dioica capsules, five per day, two in the morning, two at noon, and one at night (every eight hours), from the first day to the end of bleeding, up to seven days, were prescribed. In the control group, instead of Urtica dioica capsules, placebo of Urtica dioica was prescribed with the same order. Data on the amount of bleeding (using PLBAC chart) was checked and compared by SPSS software.

Results: The amount of bleeding before and after treatment, between and within groups, was compared. The obtained results showed that the amount of bleeding reduced significantly in both groups after treatment (p=0.001). The reduction of bleeding amount in the Urtica dioica group was significantly higher than that in the control group (p=0.010).

Conclusion: It seems the extract of Urtica dioica can be effective in reducing the amount of bleeding in women of reproductive age with heavy menstrual bleeding. This drug, due to its short course of prescription, fewer side effects, and not having hormonal effects, seems to be an effective drug for treating heavy menstrual bleeding.

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  Background: Due to the lack of efficient anti-HIV vaccine, anti-HIV pharmaceuticals play an important role in controlling HIV infection. Also significant rise in drug resistance and drug toxicity has caused increased interest in finding new anti-HIV agents. In this study, a nano-sized version of lamivudine based on PEGylated chitosan was synthesized.

  Materials and Methods: In this research, nanoparticles of chitosan were efficiently PEGylated for increasing their stability in water and then the anti-HIV drug, lamivudine, was loaded on these PEGylated nanoparticles. After purification and lyophilization of new synthesized nanoparticle, the raw materials and final product were sampled and FTIR, HNMR and CHN analyses were done.

  Results: Results of HNMR spectroscopy showed that chitosan nanoparticle was successfully PEGylated. HNMR data confirmed FTIR results and indicated that lamivudine was conjugated on chitosan nanoparticle. In addition, CHN analysis data also confirmed both HNMR and FTIR data, and demonstrated that a high yield of chitosan nanoparticle PEGylation (approximately 97%) was done and illustrated a high capacity of lamivudine conjugation on nano-sized PEGylated chitosan (30% _W/W chitosan).

  Conclusion: In this study, lamivudine drug was successfully synthesized, based on PEGylated chitosan nanoparticle.

 

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Background: Increased insulin resistance, inflammatory factors and parameters of oxidative stress are associated with the development of diabetes complications. This study was designed to determine the beneficial effects of synbiotic Gaz on insulin resistance, inflammatory factor and oxidative stress in patients with type 2 diabetes.

Materials and Methods: This randomized crossover double-blinded controlled clinical trial was performed among 62 diabetic patients aged 35-70 y. Subjects were randomly assigned to consume of either the synbiotic (n=62) or control Gaz (n=62) for 6 weeks. A 3-week washout period considered. The synbiotic Gaz was consisted of a probiotic viable and heat-resistance strain Lactobacillus sporogenes (1×107 CFU), 0.04 g inulin and 0.05 g stevia per 1 g as sweeteners' substances. Control Gaz (the same substance without probiotic bacteria and prebiotic inulin) was. Patients were received synbiotic and control foods in a 7 g package thrice a day. Fasting blood samples were taken at baseline and after 6-week intervention to measure insulin resistance, hs-CRP and biomarkers of oxidative stress.

Results: Consumption of synbiotic Gaz, compared with control, resulted in a significant decrease in serum insulin (p=0.02) and hs-CRP levels (p=0.008). Supplementation with synbiotic Gaz led also to a significant increase in plasma total glutathione (p<0.0001) compared to the control.

Conclusion: In conclusion, consumption of synbiotic Gaz for 6 weeks resulted in decreased levels of serum insulin, hs-CRP and increased levels of plasma total glutathione.

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Background: Schizophrenia is a widespread neurodegenerative disorder, which affects approximately 1% of the world population. It is a multifactorial and a highly heritable disease to which genetic factors contribute up to approximately 80%. Nowadays, multitude of genes have been discovered that relate to this disorder mostly by affecting the performance and levels of neurotransmitters in neural systems. Since PAI-1 is a considerable gene in the performance of neural systems, the present study dealt with the relationship between -675 4G/5G polymorphism in PAI-1 gene and schizophrenia among Iranian patients.

Materials and  Methods: This case-control study was carried out on 106 blood samples collected from individuals suffering from schizophrenia and 122 healthy controls. DNA was extracted from the samples and the frequency of the polymorphisms was analyzed using ARMS-PCR method. Finally, the products were detected on 2% agarose gel electrophoresis.

Results: The analysis of the data for -675 4G/5G polymorphism showed that 17.9% of the patients and 1.6% of the controls were mutant homozygous and 65.1% of the patients and 45.9% of controls were heterozygous. Also, 17% of the patients and 52.5% of the controls were normal homozygous.

Conclusion: There was a significant relationship between PAI-1 4G/5G polymorphism and the incidence of schizophrenia. To the best of our knowledge, this is the first study in Iran that assesses the frequency of the polymorphism among Iranian patients. However, further studies with more samples are necessary.

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Background: Pediatricians frequently confront with elevated body temperature in children and subsequent anxious parents. They practice several approaches in management of fever. A recently addressed issue is administration of alternating doses of acetaminophen and Ibuprofen. This method is relatively common , despite lack of sufficient evidence in this field.

Materials and Methods: This study is a randomized clinical trial. A total of 240 children, aged 6 months to 12 years suffering from gastroenteritis was recruited in this research. Children were classified in 3 groups. First group received Acetaminophen, second group received Ibuprofen and third group were treated with acetaminophen – Ibuprofen every other day alternately.

Results: 240 child were taken apart in this research . 112 ones were female (46.66%) and 128 were male (53.33%). The mean time of lowering fever in the first group was 2.07 days. This figure in the second and third groups were 1.82 and 1.87 respectively. Average doses in the first, second and third groups were (in order) 9, 8.17 and 7.13 doses. Medication in the first group minimum effectiveness rather than two other groups.

Conclusion: The alternating regimen of Acetaminophen – Ibuprofen is more effective than monotherapy in reduction of fever in infants and children between 6 months to 12 years.

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Background: Streptococcus pyogenes produce extracellular hyaluronidase enzyme which is directly associated with the spreading of the organism during infection. Hyaluronidase enzyme is able to break hyaluronic acid or interstitial cement. This enzyme might be used in cancer treatment.The objective of the present study was to clone and express the nucleotide sequence of this enzyme which is involved in hyaluronidase enzymatic activity.

Materials and Methods: The enzymatic region of hyaluronidase gene was detected by bioinformatics methods. The polymerase chain reaction method was used to amplify the region. The amplified product was cloned into the expression vector pET32a. E. coli BL21 (DE3) pLYsS was transformed with recombinant plasmids. Then gene expression was induced by IPTG. The expressed protein was purified successfully via affinity chromatography by NiNTA kit. The integrity of the product was confirmed by western-blot analysis.

Results: The nucleotide sequence of amplified gene was consistent with the streptocuccal hyaluronidase gene. The concentration of recombinant protein calculated to 500 mg purified protein per liter. The enzymatic region of recombinant protein from Streptococcus pyogenes was recognized by all five patient’s sera with Streptococcus infection.

Conclusion: In general, it is possible to produce the enzymatic regions of the Streptococcus pyogenes hyaluronidase in Escherichia coli. The antigenic property of the produced protein is well retained. Considering the product's domestic demand and also low efficiency of production and pathogenicity of Streptococcus species, it is possible to produce it as recombinant product.