---

Introduction: The reason of infertility can have a direct influence on the plan and outcome of management. In this paper we intend to show the effect of tuberculosis (TB) history on female infertility among infertile couples attending to Rooyan infertility management center. Materials and methods: In this case-control study our cases were those who were diagnosed as infertile female and controls were those women whose husbands were infertile due to some male factor. We used logestic regression for analyzing the association of history of Tuberculosis and female infertility with attributable risk estimation. Results: 308 cases were compared to 314 controls. Considering the odds ratio and its 95% confidence interval, there was a significant difference between the history of TB and infertility (OR=4.7, 95% CI: 1.01-29.91). The attributable risk of TB for female infertility was 0.023±0.01 (which is significant at 5% level). Conclusion: These figures show that at least 2% of female infertility can be prevented by prevention and proper treatment of tuberculosis.

---

Background: Since of the importance of publishing medical articles in evaluation of faculty members’ activity and ranking of universities, this study was designed investigate faculty members’ opinion about intendancy in writing Persian and non Persian articles. Methods and Materials: This cross-sectional analytical study is carried out by census method. Data were gathered by a questionnaire which its validity and reliability were confirmed. Data was analyzed by ANOVA,T-test, Chi square and correlation coefficient. Results: The most important barriers in academic members' intendancy to articles were too busy in education or clinical treatment with the mean of 4.281.06, lack of experienced persons for writing non Persian articles as counselor with the mean of 3.981.00 , lack of research teams with the mean of 3.950.98, long time in proposal approval with the mean of 3.961.02, lack of journal editorial board supporting in accepting of descriptive articles with the mean of 3.951.02 and long time from receiving articles until their approval and publishing with the mean of 3.951.07. Conclusion: By decreasing education hours, shortening the process of proposal approval, introducing expert persons in writing non Persian articles as counselor, shortening the process of evaluating and publishing or rejecting articles can increase academic members’ tendency in writing articles.

---

Abstract Background: Approximately 15-20% of pregnancies terminate to abortion. More than 50% of spontaneous abortions in 8-15 weeks pregnant mothers are related to genetically abnormalities. So, approximately 95% of them are related to numerical and 5% structural chromosome aberrations. Until now, neither of known human chromosomal abnormalities are treatable, and only way against these diseases limit to prenatal diagnosis and abortion of affected fetuses. The purpose of this study was determined the chromosome aberrations with cytogenetically methods. Materials and Methods: In this cross-sectional analytic study, 56 aborted fetuses were studied to detection of abnormalities frequency. Amnion-chorine culture, placenta, fetal tissue and aborted products from metaphase cells for gathering metaphase cells were used. Results: After cell culture, chromosome typing and GTG-banding Technique, trisomy 21 with highest frequency (12.5%) and isochromosomy 21, X and monosomy X with lowest frequency (1.8% for each them) was resulted. Conclusion: Not only chromosomal aberrations have important role in recurrent miscarriages, but also frequency rates of chromosomal aberrations in our country are similarity with other countries. Also cytogenetically diagnostic methods such as GTG-banding are a powerful and reliable technique for investigation of parents with recurrent abortion.

---

Total of number 48 (All Articles)

---

Background: Since cardiac surgeons have not kept up with advancements in pacing technology, there has been a tendency to limit the implantation of pacemakers by surgeons. This study compares two eras of pacing therapy including pacemaker implantation by cardiac surgeons and pacemaker set-up by a group of cardiologists in Shahid Rajaee Hospital in Tehran. Materials and Methods: In this cross-sectional study, we compared the existing data from all pacemaker implantations in the first half of 1999 (surgical era, era 1) to that of the first half of 2001 (cardiologists era, era 2). Results: During era 1, a total 114 pacemakers (46.5% male, mean age 63.3 ±18.4) and during era 2, 299 pacemakers (63.9% male, mean age 63.9±18.2) had been implanted. Indications for implantation were nearly similar, with AV block as the most common reason in 21.9% and 19.1% of implantations in eras 1 and 2, respectively. Single chamber pacemakers comprised 86% of implantations during era 1 compared to 54% during era 2 (p<0.01). The mean duration of admission was 18 days during era 1 while it was 10 days during era 2. Pacemaker malfunctions were detected following 7.9% of implantations in era 1 compared to 0.3% of cases in era 2 (p<0.01). Re-do procedures were performed after 2.7% of implantations during era 1 in comparison to 0.3% during era 2 (p<0.01). Conclusion: Pacemaker implantation was performed better by a coordinated pacemaker service run by cardiologist trained in pacemaker implantation.

---

Background: The use of proper contrast agents is very effective in improving the quality of medical imaging. In this study, we dealt with the effect of high PH blackberry juice accompanied with omeprozole in reducing the upper fluid artifact in MRCP images. Methods: This single blinded before-after clinical trial was done with the enrollment of 34 patients. After receiving official agreement from the patients and applying the enrollment criteria, they were ordered to take two 20mg omeprozole capsules the night before the exam. The next day, while they had been held NPO, they were exposed to the first MRCP. After this, they drank 300cc blackberry juice and were re-examined after 15 minutes. The related checklists were printed and three radiologists independently inspected the reduction of artifact checklists and the resolution of images. Eventually, the quality of images and the mean of artifact reductions in the images before and after black berry Juice consumption were compared. Results: Reduction of artifact scores due to gastrological secretions did not show any significant differences before and after black berry juice consumption (2.97±0.37 and 2.89±0/87, respectively). Additionally, no significant changes were observed in the visibility of gall bladder, water ampoula, common hepatic duct, intrahepatic ducts and head of pancreatic duct images. There was a decrease in the common bile duct visibility (p=0.01). In the case of pancreatic duct tail and body visibility, images showed improvements (p=0.04 and 0.03, respectively). Conclusion: Blackberry juice, as a contrast agent, does not seem to have enough paramagnetic metals and does not improve the quality of MRCP.

---

Background: Job satisfaction is viewed as all inclinations or positive feelings that individuals have towards their jobs. Medical universities are in need of motivated professors, as one important paradigm of education, to instruct students of medicine and to improve health and medicine in the society. Noticing the importance of job satisfaction among faculty members in promotion of university aims and enhancement of productivity, this study was conducted to evaluate job satisfaction among faculty members of Arak University of Medical Sciences (AUMS) in 2010. Materials and Methods: This study was a cross-sectional, observational one and the study population consisted of all faculty members at AUMS. Sampling was performed by census and data were collected through demography questionnaire including sex, age, scientific stage, educational department, employment status, and job experience, and Herzberg job satisfaction questionnaire. Results: The mean (standard deviation) of job satisfaction in faculty members of AUMS was 60.72 (11.51) and the mean (standard deviation) of the surveyed stages were as follows: work nature (74.46(12.60)), supervision and relations (62.15(13.69)), job security (57.58 (15.72)), promotion opportunities (57.28(15.74)), physical conditions and work environment (55.84 (14.14)), and salary and benefits (55.56(16.87)) from the maximum 100 score. Conclusion: AUMS faculty members were satisfied with their jobs on the whole. The greatest job satisfaction was related to work nature and the least job satisfaction was with salaries and benefits. By increasing salaries and benefits and providing promotion opportunities, job satisfaction can be enhanced in this group.

---

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.

---

Background: Differentiation of M. tuberculosis complex organisms were assigned to one of three genotypic groups based on the combinations of polymorphisms at katG codon 463 and gyrA codon 95. Early identification of strains belonging to any particular group is very important. This study was planned to identify major genetic groups of clinically isolated Mycobacterium tuberculosis. Materials and Methods: In this cross sectional study 33 sputum samples were collected from tuberculosis patients of the Markazi province. DNA purification from isolated samples was performed by Chelex 100. Identification of isolates was confirmed by detection of katG gene and the mutation in KatG463 by using PCR method and RFLP respectively. Finally 620-bp of katG gene and 194-bp of gyrA gene purified from PCR product were sequenced. Results: Amplification of 620-bp fragment of katG gene was a good way to confirm the detection of bacteria as a molecular approach. Results of sequencing codon GyrA95 in combination by results of PCR-RFLP determined type of the major genetic group (MGG). Therefore it showed that among the 33 Mycobacterium tuberculosis isolates 12 samples were MGG 1, 15 Samples were MGG2 and 6 samples were MGG 3. Results revealed that MGG 2 was dominant form of M. tuberculosis strains of Markazi province by frequency of 45.5%. Conclusion: Based on the results of this study MGG2 occurrence was more frequent among clinical strains in Markazi province that its accordance with susceptibility of these strains to conventional antibiotics is notable. In this study, three applicable benefits from the test as: MGG typing, molecular detection of M. tuberculosis and bacterial resistance to Isoniazid were proven.

---

Background: Tuberculosis is an old problem that is currently considered a great challenge. Noticing Iran’s borders with Afghanistan and Pakistan, which are among the 22 high burden countries around the world, the present study was conducted to analyze the current molecular epidemiology of TB and survey genetic diversity of Mycobacterium tuberculosis strains in Markazi province, Iran. Materials and Methods: In this experimental study, 57 sputum specimens from smear positive patients admitted to health centers in Markazi province were cultured on specific mycobacterial culture media. Genomic DNA was extracted by standard protocols of WHO and digested separately by PvuII and AluI. Electrophoresis was performed and DNA fragments were transferred to positively charged nylon membrane by southern blotting method and hybridization by PGRS probe. The hybridized strains were subsequently detected by enzymatic reaction and analyzed. Results: Genotyping of the isolates by PGRS-RFLP with Pvu II and AluI displayed a wide range of genetic diversity so that 50 and 45 genotypes were identified, respectively. Conclusion: Noticing the great diversity of PGRS in the Mycobacterium tuberculosis strains, it can be concluded that in the study population, the majority of the patients hadtuberculosis with different etiologies. Therefore, it seems that reactivation of latent infection has had the main role in the spread of tuberculosis

---

Background: Psoriasis is a common chronic skin disease which usually appears as white and silvery spots on the skin. The purpose of this study is to investigate the effect of berberine on patients with psoriasis. Materials and Methods: This double-blind clinical trial was conducted on 60 psoriasis patients who referred to Imam Khomeini Hospital, Ahvaz, between July and December 2011. The patients were randomly divided into two equal groups that applied berberine and placebo to the treatment of their lesions twice a day. Lesions severity rate in the patients was assessed 7 times using a Psoriasis Area Severity Index (PASI). Data were analyzed by ANOVA with repeated measurements and Chi-square using SPSS software. Results: After 6 months, severity of lesions showed a significant decrease in the group receiving the berberine cream compared with the placebo group so that the mean PASI score of the group receiving berberine decreased from 3.99 to 2.11 while in the placebo group this decreased from 3.98 to 3.71. Mean difference in PASI score was not significant before receiving the treatment till the third month in berberine and placebo groups, but in the fourth to sixth months it was statistically significant (p=0.013). Conclusion: Berberine cream was more effective than the placebo in reduction of skin lesions of psoriasis patients. Therefore, it is recommended that plant-based drugs, like berberine, be used more besides the main medications of patients.

---

Background: Considering the fact that more than one third of the world’s population is infected with Mycobacterium tuberculosis bacteria, identifying individuals with latent tuberculosis infection (LTBI) is vital for controlling TB. Tuberculin skin test (TST) and IFN-gamma release assays are practical methods used for screening people with LTBI. Due to the insufficiency of data on endemic tuberculosis region and the need for evaluation of these methods in a high-risk population, this study was performed in Zahedan.

Materials and Methods: This descriptive study was carried out on 75 individuals, including 21 health care workers (HCWs) as well as 54 family members of patients with active TB. IFN-&gamma release assay and TST were also carried out on the participants.

Results: Of the 75 participants, 26 had positive IFN-&gamma release assay results and 49 persons showed negative results. TST was also performed and 12 participants did not show up for taking the results. Among the remaining 63 participants, 60.31% had more than 10 mm indurations. The results in 32.25% of the participants were positive for both IFN-gamma release assay and skin test, whereas 34.92% of the participants presented negative tests results for both IFN-gamma release assay and skin test. The agreement between these two tests was 66.67 % (P=0.001, K=0.36, 95% Confidence Interval).

Conclusion: The results showed a weak agreement between the two tests.

---

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.

---

Background: The emergence of drug-resistant strain of M.tuberculosis is one of the most critical issues facing TB researchers and clinicians. Rapid diagnosis of drug-resistant tuberculosis is essential for the prompt initiation of effective second-line therapy to improve treatment outcome and limit transmission of this obstinate disease. The aim of this study is to develop a Real-time PCR assay for the detection of mutations in RRDR (rifampcin resistance determinant region) of rpoB which conferring rifampicin resistance in Mycobacterium tuberculosis.

 Materials and Methods: In this experimental study, the primer and probe set were designed for a RRDR region of rpoB gene using a specialized software. Clinical specimens that had previously been evaluated resistant or sensitive by using convential method, were used for assessing the clinical sensitivity and specificity of the assay.

Results: The clinical sensitivity of the assay was determined 100%. The primers and the probes were rpoB specific and no cross-reaction was observed with other microorganisms and human genome bioinformatically. The clinical specificity of developed Real-time PCR assay was examined experimentally using 25 negative samples and determined to be 100%.

Conclusion: The developed real-time PCR assay can be used as an appropriate and efficient tool for the rapid detection of rifampicin-resistant Mycobacterium tuberculosis.

---

Background: The aim of this study was to determine the prognosis of visual acuity and contrast sensitivity in keratoconus patients according to the correlation between aberrations changes before and after RGP lenses.

Materials and Methods: A total of 40 eyes of twenty patients 20 to 40 years with mild, moderate keratoconus were participated in this study. Ocular examinations were included VA with standard Snellen chart, CS with CSV 1000 chart and HOAs with technolas aberrometer objective (Bush & Luamb). All these tests were performed before and after RGP lenses. Refraction and corneal radius of curvature were measured using Autokeratometr. Data were then analyzed with Spss softwair version 11.5.

Results: Mean contrast sensitivity at each spatial frequency with RGP lenses was higher than the best correction in both male and female. Compairing with best correction mean high order aberration of the 5 and 6 mm pupil was reduced with RGP lenses but the effect was not statistically significant different. Mean high order aberration with pupil 6 mm was more than pupil 5 mm. Using Pearson correlation test, there was no significant correlation between visual change and Contrast sensitivity changes with high order aberrations.

Conclusion: Visual performances and visual acuity were improved with RGP lens than best correction by reduction of high-order aberrations. However, there was no correlation or relationship between high order aberrations and visual performance. This indicates that Aberrometery condition was unrelated with Prediction of visual acuity changes in this patients.

---

Background: Motivation is one of the most important tools to push faculty members to perform effectively and efficiently in the workplace is. This study is based on Herzberg's theory of motivating factors to consider requiring faculty at the University of Medical Sciences deals.

Materials and Methods: In this cross-sectional study, a total of 168 faculty members of Tehran University of Medical Sciences, 102 persons conducting a completely free and informed, a 40-question questionnaire based on Herzberg's two-factor theory, design, a questionnaire. Data using t-test and Mann-Whitney U and indicators of central tendency and dispersion were analyzed by SPSS 16 software.

Results: Response rate to the questionnaires, 7.60, respectively. 5.24% of the faculty in the basic sciences and 5.74% at the clinical level of activity. Of "communication" and "progress and development", the motivation faculty have the greatest impact. Factors "physical condition" and "salary" have been less effective. Between the ages of faculty motivating factors, "nature", "responsibility and career" and "supervision and monitoring", there was a significant correlation. The relationship between work experience and of "salary" and "job security" was also significant.

Conclusion: Communication is one of the most important factors in increasing the motivation of faculty members in the physical conditions of work and wages are minimal impact in this area. With an aging faculty, salary, supervision and monitoring, and job security are more important motivation. In other words, with increasing age and work experience, academic expectations of the management of change and the proper evaluation of the activities of the officials do not have the decision-making, and because the quality of activities, good participate Ndah encouraged do not motivate members to create good will.

---

Nontuberculous mycobacteria (NTM), also known as atypical mycobacteria or mycobacteria other than tuberculosis are environmental organisms that are normally found in soil and water. Many of the mycobacterial species that have been described in the past decade are involved in human diseases, especially in patients with AIDS and immunocompromised HIV-negative patients. In this study, pathogenicity and clinical significance of new species of mycobacteria were evaluated. A total of 63 new species of non-tuberculosis mycobacteria, recognized in the past ten years (2003-2013), were classified in different Runyon groups. Approximately, 40 isolates were reported to infect human. Of these, 27 (67.5%) were non-chromogenic and 13 (32.5%) were scotochromogenic. The majority of the 40 isolates belong to the slow grower group. Photochromogenic species were not pathogenic to human. The most frequent infections included respiratory infections in elderly people and cervical lymphadenitis in children caused by Mycobacterium kyorinense and Mycobacterium mantenii, respectively. NTM also causes disseminated infections, the most frequent agents of which are M. boenickei, M. houstonense, M. neworleansense, and M. brisbanense in immunocompromised HIV-negative persons. Some of the NTMs, such as Mycobacterium riyadhense, are considered the primary pathogens for human. Considering the progressive spread of HIV co-infected mycobacteria in recent years, accurate identification of these agents’ pathogenicity, drug resistance, and appropriate treatment in epidemic regions, such as Iran, is essential.

---

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.

---

Background: Since the anti-inflammatory effects of usual doses of morphine (10mg/kg) is proved, and also, regarding to the role of C-fibers in the release of substance P and CGRP and progression of inflammation were found, and the other hand, the excitatory effects of very low doses of morphine (1µg/kg) on C-fibers have also been reported, present study has examined the role of C-fibers, usual and very low doses of morphine in presence or reduced C-fibers on paw edema induced by sub plantar injection of formalin.

Materials & Methods: In this study, male Wistar rats (180-200g) were Categorized into two groups. One as vehicle (which received neonatal capsaicin vehicle, C-normal) and experimental (which received neonatal capsaicin, C-lesion). Each category contains three groups which were treated by saline, 10 mg/kg and 1µg/kg of morphine (i.p). In each group, paw edema volume induced by injection of 0.05 cc of 2.5% formalin, was acquired by plethysmometric test.

Results: In C-normal groups, morphine showed an anti-inflammatory effect at the dose of 10mg/kg (p<0.01) and pro-inflammatory effect at the dose of 1µg/kg (p<0.01). Reduction of C-fibers in C-lesion groups diminished the inflammation induced by formalin (p<0.001). Also in these groups, 10 mg/kg dose of morphine showed a more potent anti-inflammatory effects (p<0.001) and the pro-inflammatory effects of 1µg/kg dose of morphine reduced (p<0.001).

Conclusion: C-fibers by releasing substance P and CGRP can play an important role in inflammation induction in injured tissue. The results showed that, the reduction of these fibers can lead to inflammation reduction. So, the presences of C-fibers are so important in inflammation induction and edema.

---

Background: Despite control, prevention and the availability of drugs to cure tuberculosis, TB remains an important cause of death from an infectious agent in Iran. Pulmonary tuberculosis is more than 80% of tuberculosis cases. Chest x-ray is sensitive, cheap and accessible instrument for the diagnosis of tuberculosis. The aim of this study was to determine the radiological changes in patients with pulmonary tuberculosis.

Materials and Methods: In this cross-sectional study, after consideration of inclusion and exclusion criteria, finally 477 radiographic patients referred to rural and urban clinics in recent decade were enrolled. The affected lobe or lobes of the left or right lung were recorded. The types of involvement were categorized based on patchy consolidation, cavitation, fibrosis, bronchiectasis, gohn lesion, bronchogenic spread and bronchopneumonia. Pearson correlation coefficient was used to measure the strength of association between continuous variables. For analysis of qualitative parameters, we use from Chi-square test. Data analysis was done in SPSS18 and p value below than 0.05 was significant.

Results: Out of 477 patients, mean age was 48.24±22 years old, male including 33.3%, Iranian and urban cases were 44% and 91.3% respectively. The most frequent involved site was the left upper lobe followed by the right upper lobe. The most frequent radiographic finding was patchy consolidation and then bronchogenic spread and pneumonic consolidation respectively. There was significant correlation between lung cavities in patients with nationality.

Conclusion: This study could  help to early diagnosis and treatment of suspect patients to pulmonary tuberculosis.