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Introduction: Kikuchi-Fujimoto disease or histiocytic necrotizing lymphadenitis is a rare but important etiology of cervical lymphadenopathy in young women. This disease is self limited and improves during 2-8 months. Diagnostic key is the pathology of involved lymphnode. Association of the disease with viral and autoimmune disease is not proved yet. In this article two cases of Kikuchi-Fujimoto disease are reported. Case: The first case was a 31 years old female patient with sever fever and right axillary lymphodenpathy (size: 57cm) in which one month after the disease, diagnosis was proved by pathology studies. This patient has erythematous patches in her face and nose in several times that were improved spontaneously. The second case was a 20 years old female patient with fever, chill, headache, weigh loss and cervical lymphadenopathy (size: 21cm). She received antibiotic at several times without any improvement. Finally after 5 months since the beginning of symptoms, the disease was diagnosed as Kikuchi-Fujimoto disease by surgical excision of lymhnode and pathology studies. After the surgery two small lymphnodes were appeared around the surgical site. Conclusion: In differential diagnosis of lymphadenpathy especially cervical in young women, Kikuchi-Fujimoto should be considered. Consumption of antibiotic in lymphadenopathy without clear diagnosis should be avoided. After diagnosis of Kikuchi-Fujimoto, long term work up for recurrence or the appearance of autoimmune disease symptoms is necessary.

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Background: Aurein 1/2 is a 13-residue peptide with a vast antimicrobial and anticancer activity. Two- dimensional NMR spectroscopy of peptide solubilized in the 70% TFE (2, 2, 2-Trifluoroethanol) indicated an alpha-helical conformation. The mechanism of its action is not yet fully recognized. This study was designed to improve the antimicrobial activity and relationship between subsequence-activity in Aurein 1/2 and its analoges. Analogs of this peptide were designed and synthesized. Methods and Materials: The G1F3/RW and F3W analogs and retro - analog were synthesized with solide phase and purified via HPLC and lyophilized. These analogs were assayed by several methods: amino acid analysis, HPLC, and electrospray mass spectrometry. Then antimicrobial activity of the peptides was assessed by using the standard microdilution susceptibility test. Results: The data demonstrated that G1F3/RW analog had a higher activity and results of test figure of minimum inhibitory concentration for F3W analog had three levels. But the native, F3W analog and retro-analog was inactive. Conclusion: The higher activity of G1F3/RW in compare to F3W may be related to the positive charge of Arg that leading stronger interaction with the negative charges on the membrane surface. The result showed that reversed direction of aurein 1/2 significantly effects on activity of the peptide. It is also suggested inactivation of reto-analog amino acid type, position and size should be cautious for peptides designed as drug because it may be effect to control dimerization and maintenance of antimicrobial activity of the peptide.

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Background: Recent advances in biology and medicine have revolutionized human knowledge on the brain and neurology. This has resulted in the emergence of psychological theories on religious beliefs and experiences in different cultures. This review article deals with religious experiences from a neurologic perspective. Materials and Methods: Functional imaging techniques such as SPECT, positron emission tomography (PET), and functional MRI (fMRI) allow for the study of brain functions of religious individuals. Religious acts activate a circuit in the brain site which is known as religious circuit that involves the amygdale, the hippocampus, the limbic system, the anterior temporal lobe, the orbito-frontal, and dorsomedial and dorsolateral prefrontal cortices. The religion circuit is regulated by serotonin and dopamin. Long-term religious exercises, such as meditation, activate the frontal lobes which give human beings greater control over the functions of the “self”. The word “self” has been referred to as the nafs in Quran which consists of ‘that which incites to evil’ (alnafs al-ammara), ‘the nafs that blames’ (al-nafs al-lawwama), and ‘the serene self’ (al-nafs al-mutma’inna). Conclusion: Survival of ethical behaviors belonging to the inhibitory behavior depends on the formation of brain connections which can only be obtained through consistent long-term religious exercises.

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Background: Brucellosis is one of the zoonotic diseases that has always been considered a health problem in Iran. Since this disease is endemic in Arak and Markazi Province, this study was done to investigate its epidemiology during 2001-2010. Materials and Methods: In this epidemiological study, data on patients with brucellosis were obtained from the medical records in Arak Health Center during 2001-2010. The collected data were analyzed by SPSS software version 16. Results: During this period, 3880 new cases were reported. The mean incidence rate of brucellosis was 60 per 100000 people during 2001-2010. The greatest incidence was in 2004 (111.5 per 100000 people), whereas the lowest incidence was in 2006 (40.5 per 100000 people). Overall, 72% of the patients lived in villages, and 60% of them were male. The majority of the patients were in the second decade of their lives (10-19 years old). The majority of the patients had Wright test titer=1:320 and 2ME titer=1:80 in serology titration. Conclusion: Arak is one of the regions with high incidence of brucellosis. In this region, the patients are mostly male, live in villages, and age 10-19.

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Background: Guillain-Barré syndrome (GBS) has several variant signs and it often presents as an acute monophasic paralyzing illness provoked by a preceding infection. Campylobacter jejuni infection is the most commonly identified cause of GBS while cytomegalovirus, Epstein-Barr virus, and human immunodeficiency virus (HIV) infections have also been associated with GBS. Case: A 55-year-old villager man who was an animal keeper was admitted to Vali-Asr Hospital with symptoms of general weakness, fever, and night sweats. With positive serology of brucellosis (Wright=1:1280, 2ME =1:640), the patient was treated with rifampin, doxycyclin, and tereptomycin (1g/daily). Having received 9 injections of streptomycin, with weakness in the right extremity, the patient was hospitalized. Brain MRI and CT-Scan were reported normal. Within two days, however, the extremity weakness progressed and spread to 4 extremities (2.5 at the proximal and 3.5 in the distal). Generalized areflexia occurred and, three days later, impaired swallowing and facial weakness ensued. Streptomycin was discontinued upon admission. EMG indicated acute and severe demyelinating polyradiculoneuropathy. CSF analysis confirmed Guillain Barre Syndrome while Wright test for CSF was negative. The patient was admitted to the ICU and underwent intubation with progressed paralysis of four limbs, the patient died in 8 days after hospitalization. Conclusion: In endemic areas, brucellosis should be considered in patients with Guillain Barre syndrome.

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Background: Nowadays, one of the basic problems of tuberculosis treatment is drug resistance. This study was done to determine the drug resistance of mycobacterium strains isolated from patients with pulmonary tuberculosis to anti-tuberculosis drugs and determine the affecting factors. Materials and Methods: In a cross-sectional study, all patients with tuberculosis who were covered by Markazi Province Health Center (917 persons) during 2005 to 2010 were included in this study. For all patients with resistant pulmonary tuberculosis, culture and antibiogram by standard method (proportional) were done. Effective factors in drug resistance were identified by logistic regression model using SPSS software. Results: Overall, the rate of resistance in patients with smear-positive was 7.3% and the rate of MDR-TB was equivalent to 4.3%, and 0.5% of smear positive patients were resistant to all five drugs. The most resistant strains were isoniazid (68.8%), rifampin (62.5%), pyrazinamide (25%), ethambutol (21.9%), and streptomycin (21.9%), respectively. The highest rate of resistance was in the 15-45 years age group. The incidence of resistance was significantly associated with sex, grade of smear positivity, relapse of TB, and HIV infection. Conclusion: The study of drug resistant mycobacterium strains over six years showed a growing trend. Therefore, close attention to prevent the production and dissemination of resistant strains is very essential.

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Background: Enterococcus is known as an important pathogen in Iran like all around the world. The increasing use of vancomycin makes vancomycin-resistant enterococci (VRE) an important nosocomial pathogen. Vancomycin in combination with an aminoglycoside can provide effective treatment for severe enterococcus infections, while resistance to vancomycin antibiotic is increasing in enterococci. In this study, the pattern of antibiotic resistance and prevalence of vancomycin resistance enterococci have been explored. Materials and Methods: In this experimental study, after isolating and identifying 150 strains of enterococci from clinical specimens, the antibiotic resistance pattern of these strains to erythromycin, teicoplanin, vancomycin, ciprofloxacin, tetracycline, gentamicin, co-trimoxazole and linezolid was examined. The MIC test by using micro dilution broth method was performed for the vancomycin resistance enterococci specimens with the vancomycin and teicoplanin antibiotics. Results: Antibiotic susceptibility test showed 14% and 5.3% of the samples were resistant to vancomycin and teicoplanin respectively. Resistant to erythromycin, co-trimoxazole, ciprofloxacin, tetracycline, linezolid and gentamicin were 64, 40, 38.6, 6.6, 0, 38.76 percent respectively. Fourteen samples had high resistance to vancomycin which MIC were ≥ 256 µg/ml. Conclusion: Based on the results of present study, there are vancomycin-resistant enterococci in Arak as well as other parts of the world. The percentage of vancomycin resistance enterococci is high in Arak and appropriate treatment of infections caused by enterococcus is essential

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Background: Mycobacterium Tuberculosis usually infects the lungs but organs other than the lungs may also be involved. This study is an analysis of the situation of extra-pulmonary tuberculosis in the central province of Iran.

Methods and Materials: In this cross-sectional study, the information in the registration software of tuberculosis in health centers collected and for analyzing of data statistical software SPSS16 was used.

Results: In the survey a total of 1787 TB patients were identified, of which 24.2% were diagnosed with extra-pulmonary tuberculosis and 1.9% of patient with extra-pulmonary TB were associated with HIV infection. Female to male sex ratio is equal to 1.3. The 82.5% of the patients were Iranian citizen and mean age of patients were 43.3 years. Tuberculosis of the lymph nodes, skletal and pleural tuberculosis had the highest prevalence. Also extra-pulmonary tuberculosis in females, age 15-55 was more and the diagnosis delay was more in extra-pulmonary tuberculosis and relapse was more in pulmonary tuberculosis.

Conclusion: Because of more diagnosis delay in extra-pulmonary tuberculosis it is necessary to train physicians and other healthcare workers in the field of extra-pulmonary TB diagnosis and more planning to do about learning of it.

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Background: The importance of maintaining and enhancing the quality of life in (tuberculosis TB) patients is essential. The purpose of this study was to use N - acetylcysteine to improve the quality of life in patients with tuberculosis.

Materials and Methods: This study is a double-blind clinical trial that performed on 88 patients on anti-TB treatment that aged over 50 years in the central province of Iran within 15 months. Data collection tools included a demographic questionnaire and the Short Form Quality of life (SF12). Data were analyzed using SPSS software and t-test, Chi-square, Mann-Whitney, ANOVA and Pearson correlation analysis were used. p less than 0.05 was considered significant.

Results: This study showed that the two groups before the intervention in different features were not significantly different, but in quality of life at the end of the first month. The intervention group compared with the control group in physical subscale score (p=0.0068) and psychological subscale scores (p=0.0284) and quality of life score (p=0.0112) were better. Also, our study showed that age of patients (p=0.0331), duration of disease (p=0.0416), and serum CRP mean (p= 0.0234) and type of tuberculosis (p=0.0372) were significantly related to total score of quality of life at the end of the first month in the intervention group.

Conclusion: According to this survey results we hoped to combine the use of adjuvant therapy with N-acetylcysteine and standard tuberculosis treatment improves quality of life and increase life expectancy of patients.

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