Only 10% (8/78) of the patients had been diagnosed via first-week neonatal screening. The majority of the subjects had been detected by clinical manifestations of PKU. The major reasons for these patients to refer to a physician was symptoms of developmental retardation, dermal and hair Hypopigmen- tation, seizure, urine odor, hyperactivity, a medical history of the disease, skin eczema and hypoactivity, respectively (Figure2).
Cutaneous leishmaniasis (CL) is a widespread tropical infection which has a high incidence rate inIran. Leishmania tropica, the causative agent of anthroponotic cutaneous leishmaniasis (ACL), and Leishmania major, which causes zoonotic cutaneous leishmaniasis (ZCL), are endemic in various parts ofIran with a high incidence rate. The aim of this study was to evaluate the reappraisal of the diagnosis andepidemiologyof CL inIran, by different clinical, parasitological and molecular as- says among patients suspected of CL referred to the Department of Parasitology, at the Pasteur Institute ofIran during 2006-2009. Two hundred samples from patients with ulcerative skin lesions were collected, clinical analyses were applied, data questionnaire was completed and samples were examined for CL by using both direct microscopic and culture methods. Moreover, PCR assay was applied for detection of Leishmania species in CL isolates resulting from parasitological assay. Clini- cal observation revealed that the majority (58%) of lesions was single; double lesions were observed in 22% ofpatients, and only 20% of CL had multiple lesions. Out of 200 patients, Leishman body was observed in 77 samples (38.5%) by direct smear and 40% by cultivation assay. Most patients (21.3%) had a travel history to the Isfahan province, one of the most important endemic areas of CL located in center ofIran. PCR assay by kDNA indicated 32 and 18 out of 50 isolates respectively had similar patterns with standard L. major and L. tropica. In conclusion, clinical manifestations and an appropriate diagnostic assay with a parallel molecular characterization of CL may lead to a screening evaluation of disease, prognosis, treatment and control strategies.
We found out that scorpion antivenom was prescribed for more than two thirds ofpatients, and the relationship between its use andclinical symptoms was not significant. Similar results were obtained by Al Asmari et al.  and Abdolaeifard et al. . In Khaderi’s study  in Khuzestan, Iran, patients envenomed by scorpions were treated only with corticosteroid and sedative medications without using antivenom. In this aspect Mortazavi-Moghadam  stressed only symptomatic therapy, maintaining that, due to numerous side ef- fects, antivenom is unnecessary. According to the World Health Organization (WHO), the indicators for using scorpion antivenom are not well known and there are some controversies . Some researchers also suggested revising the recommendations for use of scorpion antivenom, but in general most experts have emphasized the use of this drug for patients with severe symptoms who are under ten years old . Bernstein  also stated that the use antivenom should be individualized by weighing the risk of ad- ministrating an immune serum with the level of avail- able supportive care, the cost of supportive care, and the cost of obtaining or importing the drug. InIran, most antivenoms are produced by Razi Vaccine and Serum Research Institute . Scorpion antivenoms are administered according to the immunization guide Table 2 The prevalence of scorpion stings per 100,000 people and its confidence interval in the tropical area of Kermanshah
Some people might consider that to call for physicians to have skills in dealing with the linking of scientific evidence to medical practice in developing countries would be an excessive demand. However, those who are practicing evidence-based medicine nowadays are not ahead of their time but simply up to date. The developed countries are ahead.
increased progressively . In a studyof 118 patients with COPD, 60% were colonized and 40% had IA . The patients with IA in that study were more likely to have advanced respiratory disease, as suggested by the Global initiative for Obstructive Lung Disease classifica- tion. The patients with IA had higher severity scores and had worse prognoses than patients with Aspergillus colo- nization. The emergence of IA inpatients with COPD is attributed mainly to prolonged administration of corti- costeroids . Corticosteroids also represent a risk for IA in ICU patients receiving immunosuppression follow- ing solid organ transplant or for autoimmune disease . Corticosteroids predispose patients to opportunistic infections through quantitative and qualitative functional impairment of macrophages and neutrophil function . Liver cirrhosis also unfavorably alters humoral and cellular immune response or complement activity, thereby increasing the risk for infections . Sepsis-associated immunoregulatory disturbances, such as macrophage de- activation and altered cellular immune response, can in- duce a state of immunoparalysis, hampering adequate host response to fungal disease . Recently, IA was also associated with H1N1 infection, suggesting that viral in- fections may play a causal role . Unfortunately, we did not collect data on H1N1 co-infection. We also found that higher SOFA scores and RRT requirement were associated with IA.
The data that were routinely collected included the patient’s age, gender, predisposing clinical conditions, species distribution and antimicrobial susceptibility of causative pathogens and outcome. Predisposing clinical conditions that were routinely recorded included neutropenia (defined as an absolute neutrophil count of ,1000/ m L), peritoneal dialysis or hemodialysis, and presence of intravascular catheters (i.e., central lines, arterial catheters, or peripheral intravenous catheters). Secondary BSIs were regarded as those with a clear source of bacteremia other than a central line. Sources of secondary BSI were identified by cultures of samples (urine, tracheal secretions, intra-abdominal samples, etc.) obtained form distant sites that yielded the same pathogen with an identical resistance pattern. Distant sites were sites where an infection was diagnosed other than a central line (pneumonia, urinary tract infection, abdominal infection, etc). Crude mortality was defined as in-hospital mortality. We also compared pediatric patients hospitalized at private vs. public facilities.
mechanical grinding and polishing. Back scattered electrons (BSE) were utilized in SEM in order to reveal difference in chemical compositions of microcomponents present in particular samples. The SEM investigations were used to reveal the distribution of graphite and other big particles. Transmission electron microscopy (TEM), on the other hand, was applied for examination of nanosized secondary precipitates, i.e. vanadium or niobium carbides and/or nitrides (or carbonitrides). The thin foil technique was implemented for this purpose. The 3 mm disks were ground down on sand papers and then dimpled to about 0.1 mm thickness. Afterwards the disks were further thinned in an ion mill until a perforation had appeared. The TEM investigation was carried out by means of a JEOL 2010 ARP analytical scanning transmission electron microscope operating at acceleration voltage of 200 kV. Imaging was performed by conventional transmission mode while for chemical analysis (X-ray Energy Dispersive Spectroscopy - EDS) the nanoprobe mode was utilized. The nanoprobe mode enabled to obtain electron probes approaching a few nanometers in diameter (practically about 10 nm because at smaller electron probes the number of X-ray counts is usually too low for analysis). The EDS analysis was performed by Oxford-Link system attached to the microscope. The Oxford- Link system was equipped with Si(Li) detector. This system detects all elements down to boron. In order to examine the crystallography of precipitates the Selected Area Diffraction (SAD) patterns analysis was also performed.
Relative advantage is defined as the extent to which a person views an innovation as offering an advantage over previous ways of performing the same task (Roger, 1983; Agarwal & Prasad, 1997). Because Internet banking services allow customers to access their banking account from any location 24 hours a day and 7 days a week, it provides an enormous advantage and convenience to users (Tan & Teo, 2000). It also gives customers greater control over managing their finances, as they are able to check their accounts easily. Besides, a customer’s Internet experience, his or her banking needs can affect his adoption. As there are more financial products and services, it is expected that individuals with many financial accounts and who subscribe to many banking services will be more inclined to adopt Internet banking. Tan and Teo (2000) has reported that potential adopters of Internet banking services are likely to own multiple banking accounts and subscribe to various banking services. Rogers argues that potential adapters, who are allowed to experiment with an innovation will feel more comfortable with the innovation and are more likely to adopt it. Thus, if customers have the opportunity to try the innovation, certain fears of the unknown may be minimized. Government policy could also aid or hinder Internet diffusion (Mbarika, 2002). This is consistent with the national systems of innovation theory that posits that government policies may encourage or mandate technology development and adoption (King et. al., 1994; Wolcott et. al., 2001). Tan and Teo (2000) suggest that the greater the extent of government support for Internet commerce, the more likely Internet banking will be adopted, thus, confirming Goh’s (1995) suggestion that governments can play an interventionist and leading role in the diffusion of innovation. Potential users in turn would view new applications such as Internet banking services more favorably and hence be more like to use them. Thus, the second alternative hypothesis is:
46. Savoia P, Osella-Abate S, Deboli T, Marenco F, Stroppiana E, Novelli M, et al. Clinicaland prognostic reports from 270 patients with multiple primary melanomas: a 34 year singleinstitution study. J Eur Acad Dermatol Venereol. 2012;26:882-8. 47. Stratigos AJ, Forsea AM, van der Leest RJ, de Vries E, Nagore E, Bulliard JL, et
and validity of the questionnaire indices were found by using of Cronbach-Alpha coeficient, higher than 0.7, that was a reason for suitability of the research’s material. The face validity of the questionnaire was conirmed by a panel of faculty members of agricultural extension and education and agricultural experts of region. To measure the effect of risk willingness on famers’ decision and determination of the risk-aversion degree in output production, the Safety First Rule model were used. This model is one of the rules that discuses in relation to risk willingness of the wheat farmers. According to this rule, the beneiciaries take actions to choose a technology and apply it in the production of input just when they feel comfortable and have conidence on providing their own living needs. Randhir (1997), Parikh & Bernard (1988), Sekar & Ramasamy (2001), Rostami (2004) and Ajetomobi & Binuomote (2006) used this method in their surveys in order to determine the risk- aversion degree of farmers.
Objective: To study the presentation, pattern of distribution and correlate histopathological examination of lid tumor. Materials and Methods: A prospective studyof 50 patients presenting to tertiary referral care centre with benign or malignant tumors between July 2010 and June 2012 was carried out. All the cases were biopsied for histopathological examination (HPE). Patients were followed up at 1 month and 6 monthly intervals to observe regrowth or recurrence. Results: Benign tumours presented at a younger age (mean age 37.24 years) Malignant tumours presented at the mean age of 51.60 years and were more common among females (male: female ratio 1:1.67). Amongst benign tumours, nevus and pyogenic granuloma were most common (24.60%). Amongst malignant tumors, Meibomian gland carcinoma was commonest -12 cases (50%). 2 cases benign on clinical examination were malignant on HPE, 3 cases malignant clinically were benign on HPE. Conclusion: Many benign lesions have a tendency to masquerade as malignant lesions. Thus all lid lesions should be subjected to histopathological examination to discern not only the diagnosis but also the management.
excreting toxins (54). Sheng has been used for reducing blood lipids, increasing appetite, stomach and liver tonic in traditional medicine and is known to be beneficial in liver disorders and kidney stones (55,56). Sheng is one of the main sources of inulin (57). It seems that inulin is the main ingredient of sheng to have hypotensive effects. Dill in traditional medicine is used to treat flatulence, indigestion and gastric ulcers. Dill has a strong antibacterial effect (58-60). Dill extract is used as cholestero-lowering drug inIran. Furocoumarins can reduce total triglyceride and total cholesterol in hyperlipidemic rats (61). Dill seed contains D-carvone, D-limonene, α-phellandrene and dihydrocarvone (62). Dill Lowers blood glucose and reduces the blood lipids and cholesterol (63,64). Bioactive substances of dill may be a source of herbal medicines effective against hypertension and diabetes. Almonds play an important role in reducing the risk of heart disease in diabetic patients (65).
Zagros Mountain is stretched along Northwest to Southwest ofIran. It comprises about 10 provinces, more than 50 cities, important rivers, and a strategic place for agriculture and livestock (Fattahi 2001). Furthermore, over 885750 hectares of Lorestan Province cover with vegetation (total of 32 percent). The aims of this study were evaluation of vegetation types, life forms (Phanerophytes, Chameophytes, Semi-Cryptophytes, Cryptophytes and Therophytes), Chorotypes, determination of unique species and environmental conservation status of plant species in Beiranshahr region, located in Lorestan Province (middle Zagros), Iran.
Objective: Although ventilator-associated pneumonia (VAP) is a major cause of nosocomial infection, its role in the prognosis ofpatients remains undefined. The objective of this study was to evaluate the impact of VAP on the clinical evolution ofpatients. Methods: This was a prospective cohort study involving 233 patients on mechanical ventilation (VAP group, n = 64; control group, n = 169). Primary outcomes were time on mechanical ventilation (TMV), time in ICU (TICU), overall length of hospital stay (LHS) andin-ICU mortality. Secondary outcomes were in-hospital mortality, microbiological profile, prior use of antibiotics and risk factors for VAP acquisition. Results: Control and VAP group outcomes were, respectively, as follows: median TMV (days), 9 (interquartile range [IQR]: 5-15) and 23 (IQR: 15-37; p < 0.0001); median TICU (days), 12 (IQR: 8-21) and 27 (IQR: 17-42; p < 0.0001); median LHS (days), 33 (IQR: 18-64) and 46 (IQR: 25-90; p = 0.05); andin-ICU mortality, 38% (95% CI: 31-45) and 55% (95% CI: 42-67; p = 0.02). VAP was a predictor ofin-ICU mortality (OR = 3.40; 95% CI: 1.54-7.48). TMV (OR = 2.27; 95% CI: 1.05-4.87) and prior use of antibiotics (OR = 1.07; 95% CI: 1.04-1.10) were risk factors for VAP. VAP did not affect in-hospital mortality. Acinetobacter spp. was the most common isolate (28%). Inappropriate empirical antibiotic therapy was administered in 48% of cases. Conclusions: In this study, there was a high incidence of infection with resistant bacteria and inappropriate initial antibiotic therapy. Long TMV and prior use of antibiotics are risk factors for VAP.
We found 33.3% clustering among M. tuberculosis strains, suggesting that the majority of the tuberculosis cases in East Azerbaijan are due to reactivation. It is known that in mixed populations the degree of DNA polymor- phism is greater (Van Embden et al. 1993). Although immi- gration from other parts of the country is almost inexis- tent in Tabriz, there is considerable number ofpatients from Nakhichevan (during our study, 11.8% of the initial strains were isolated from Nakhichevaneese patients); these could import new strains and lead to the high ge- netic diversity of M. tuberculosis genotypes. Furthermore, it should be noticed that the study was performed during a period of six months only, and because of the character- istics of disease transmission and development, a study using a larger time frame should be performed to evaluate the real clustering rate.
In our study, maximum cases between 11-30 years. Females were affected more. Most cases occurred during south west monsoon followed by pre-monsoon period. Most of the patients sought medical attentions in the first 2 to 3 weeks. Most have no associated illness. Predisposing factors in most cases are fever, drugs and atopy. Most of the cases showed moderate-to-severe itching. More patients presented with herald patch at the time of examination and was present in the decreasing frequencies over the upper limb, abdomen, back and lower limb. The duration of the secondary rash in majority of the cases within 2 weeks after the herald patch. Most of the secondary rashes are of maculopapular type and majority had involvement of trunk.
It is already known that major resistance mutations are not common in non-B subtypes from drug-naïve pa- tients, although minor mutations are frequent (Apetrei 2004, Kantor et al. 2005). Some of these polymorphisms are consensus sequences in certain subtypes, and sev- eral act as secondary resistance mutations in subtype B (Tanuri et al. 1999, Kantor et al. 2005). Some of the secondary protease mutations have been associated with reduced susceptibility to protease inhibitors in vitro and may also modulate viral fitness and influence the genetic barrier, facilitating the emergence of primary resistance mutations (Accetturi et al. 2000, Frater et al. 2001, Geretti 2006). However, a recent study using a pheno- typic resistance assay did not show any association be- tween the occurrence of the polymorphisms in non-B subtypes and the occurrence of resistance to anti- retrovirals: the authors analysed 58 plasma-samples from drug-naïve patients with non-B subtypes and showed that two of them had reduced susceptibility to PI in the phe- notypic resistance assay and also had mutations in codons K20I, M36I, L63P, and V82I. Curiously they demon- strated that several other viruses displayed the same con- stellation of mutations but did not show any reduction in susceptibility, suggesting that these polymorphisms per se do not affect the susceptibility of non-B subtypes to PI (Holquin et al. 2006). The present study did not show differences in the frequency of mutations between the two subtypes, but detected mutations related to PI which were significantly more frequent in subtype B, such as the mutations in the codons 63, 77, and 71, whereas oth- ers predominated in subtype F, such as the mutations in the codons 36 and 20. This difference did not result in a worse treatment outcome in the patients with the sub- types B or F in the present study, so it does not seem to be clinically relevant. One must however stress that the small number ofpatients who received PI in the two sub- types certainly restricted the analysis of the differences in outcome in this antiretroviral group.
One of the primary concerns in designing civil structures such as water storage dams and irrigation and drainage networks is to find economic scale based on possibility of natural incidents such as floods, earthquake, etc. Probable maximum precipitation (PMP) is one of well known methods, which helps design a civil structure, properly. In this paper, we study the maximum one-day precipitation using 17 to 50 years of information in 13 stations located inprovinceof Zanjan, Iran. The proposed studyof this paper uses two Hershfield methods, where the first one yields 18.17 to 18.48 for precipitation where the PMP 24 was between 170.14 mm
Pericardial effusion was detected in two patients with systemic-onset JIA, only one of whom also had pleural effusion. One patient with oligoarthritis showed mild tricuspid regurgitation by echocardiography. By endoscopy, gastritis and esophagitis was documented each in one patient during the course of disease. Two patients had hepatomegaly and one of whom was complicated with Mycobacterium avium complex (MAC). Depression was appeared in one patient during the course of JIA. Leukocytosis was seen in 25 (41.6%), thrombocytosis in 22(36.6%) and anemia in 20 (33.3%) patients with JIA at the beginning of disease diagnosis. High ESR and elevated CRP was detected inin 50 (83.3%) and 33(55%) ofpatients, respectively. The results of urinalysis were normal at the time of diagnosis and follow-up of the all patients. Laboratory findings in different subtypes of JIA at the first presentation show in (Table.2).