Background: The efficacy of steroid administration in the prevention of postextubation complications in critical care remains controversial. The purpose of this study was to determine whether administration of nebulized budesonide in critically ill patients reduces the occurrence of postextubation airway complications. Materials and Methods: This was a prospective, randomized, double-blind, placebo-controlled study.We prospectively followed up 70 adult patients in the intensive care unit who were intubated for more than 48 h. Patients received either nebulized budesonide (1 mg every 12 h; n = 35) or placebo (normal saline; n = 35) until 48 h after extubation. Then, the postextubation complications were assessed and recorded within 48 h of extubation. Results: The incidence of respiratory distress was lower in budesonide group (8.6% vs. 31.4%, P = 0.017). Reintubation with mechanical support was necessary in 8.6% (3.35) of patients in the budesonide group and 31.4% (11.35) of patients in the placebo group (P = 0.017). Conclusion: Nebulized budesonide after extubation is effective in reducing the incidence of reintubation and respiratory distress in adult patients.

Background: Exercise training increases oxygen consumption, which was associated with the high generation of reactive oxygen species and markers of lipid peroxidation in the blood. The aim of this study was to assess the responses of total antioxidant capacity (TAC), biomarker of oxidative stress and erythrocyte, leukocyte and hematocrit (Hct) levels in plasma in athlete girls (handball players) and non-athlete girls. Materials and Methods: We evaluated two groups, which known as athlete and non-athlete women and they were similar in anthropometric characteristics. The athletic women engaged in the regular handball training 3 times a week for at least 6 months. However, non-athletic women didn't have any regular activity over the last 6 months. Each subject referred to the lab and after 12 h fasting, the blood samples were taken for measuring all variables. Independent sample t-tests were used to identify the differences. Result: Significant differences were observed in malondehyde (P = 0.00), red blood (P = 0.00) cell and hemoglobin (P = 0.00). However, other evaluated factors such as of TAC, white blood cell, Hct and the mean corpuscular volume were higher in athletes than in non-athletes, but statistical significant differences weren't seen in these variables between two groups. Conclusion: Regular exercise training for handball players may increase the activity of antioxidant enzymes and blood cells and reduces oxidant production.

Background: Microbial contamination of cosmetic products is very crucial because of their daily use and direct contact with the skin. These products are at high risk for microbial contamination from various sources such as environment, consumer's hands, body sweat and during the time of manufacturing. Therefore, this study aimed to investigate the microbial quality of sunscreens products, manufactured in or imported to or formulated in local pharmacies in Iran. Materials and Methods: The microbial quality were determined in three different levels; the intact product (at the time of purchase) and after three and after six months of opening it. Total Aerobic Viable Count (TAVC) and the presence of coliforms, Pseudomonas aeruginosa, Staphylococcus aureus, molds, and yeasts were studied. Results: At the time of purchase, 40, 73.3 and 43.3 percentage of Iranian made, imported and pharmacy formulated sunscreens were contaminated with at least one of the objectionable microorganisms, respectively. After three months of opening it, 36.6, 70 and 46.6 percentage of Iranian made, imported and pharmacy formulated sunscreens were contaminated with at least one of the objectionable microorganisms, respectively. The percentages of contaminated samples were 36.6, 70 and 50 after six months of opening for Iranian made, imported and pharmacy formulated sunscreens, respectively. Conclusion: Microbial contamination of these sunscreens products is a potential health risk for consumers. It seems that it is necessary to inspect and monitor the products during the manufacturing and shelf life period. It is highly recommended to control and regulate cosmetic products by health organizations to ensure the quality and safety of this kind of products.

Background: Adjustable suture used for years to improve the outcome of strabismus surgery. We surveyed outcome of our patients with strabismus who underwent adjustable suture. Materials and Methods: This retrospective study was performed at Ophthalmology Centre of Feiz Hospital in Isfahan on 95 participants that candidate for adjustable suture strabismus surgery. Patients were divided into three age groups: Under 10 years, 10-19 years, and 20 years and over. Outcome of adjustable suture surgery consequence of residual postoperative deviation was divided into four groups: Excellent, good, acceptable, and unacceptable. Results: Out of 95 patients studied, 51 (53.7%) were males and 44 (46.3%) were females. The mean of deviation angles were 53.8 ± 17.9 PD (Prism dioptres) in alt XT, 44.5 ± 12 PD in alt ET and 52 ± 13.5 PD in const ET, 47.1 ± 13.1PD in cons XT, respectively. There was no significant difference between the groups (P = 0.051). Results of surgery were in 38 patients (40%) excellent, in 31 patients (32.6%) good, in 19 patients (20%) acceptable, and in 7 patients (7.4%) unacceptable. Seven (7.4%) patients required reoperation. Conclusions: In the present study, the frequency of re-operation was much lower than other similar studies (7.4% vs. 30-50%). This suggests that the adjustable technique that used in our study can be associated with lower reoperation than other adjustable techniques used in the other similar studies.

Background: Recent studies have shown that addiction may be caused by abnormality of neurotransmission in the brain. Two neurotransmitters that involve into morphine addiction are dopamine and glutamate. The glutamatergic and dopaminergic systems are also involved in morphine tolerance and morphine withdrawal syndrome signs. Ascorbic acid (AA), as the antioxidant releases from the glutamatergic neurons, modulates the action of the dopamine and glutamate systems. In this study, the effect of AA on morphine self-administration and morphine withdrawal symptoms has been investigated. Materials and Methods: Male Wistar rats (250 - 300g) were anesthetized with ketamine (11%) and xailazine (15%). The cannula was inserted into the right jugular vein, and it was fixed subcutaneously on the skull. After surgery the animals were placed in individual home cages, and they were allowed to recover from the operation for five days, before the test. The animals were subjected to self-administration morphine for12 consecutive days, two-hour/sessions. The number of infusions and number of active and passive lever pressings were recorded. Results: An intra peritoneal injection of Ascorbic acid (AA) (400 mg/kg, i.p.), 30 minutes before morphine self-administration, produced a significant decrease in 12 days self-administration of morphine and withdrawal syndrome signs (P < 0.05).The morphine withdrawal signs (MWS) were recorded after naloxone precipitation, which decreased significantly with the injection of AA (400,700mg/kg), (<0.05). The number of self-infusions and the number of active lever pressings had significantly decreased after AA injection (P < 0.05). Conclusion: The chronic administration of AA may prevent the development of tolerance and physical dependence on morphine self-administration via the glutamatergic system.

Background: Acne vulgaris, a common human skin condition, is an inflammatory disease characterized by comedones, papules, nodules and possibly scarring. This study aimed to evaluate the efficacy of a combination of 5% dapsone gel plus oral isotretinoin in the treatment of acne vulgaris. Materials and Methods: A randomized, placebo-controlled, study was carried out on patients with moderate to severe acne. The patients were randomly divided in two groups: (dapsone gel and vehicle gel). All Patients were administered oral isotretinoin 20 mg daily and topical gel twice a day for 8 weeks. The Global Acne Assessment Score (GAAS), the number lesions and side-effects were documented at base line and weeks 4, 8 and 12. Results: A total of 58 patients (age range: 18-25 years) were included in our study. The number of lesions was significantly lower in the dapsone-treated group at all follow-up visits (P < 0.001). The mean GAAS score in the dapsone-treated group and in the Placebo-treated group decreased, but there was no statistical difference in two groups (P < 0.001). The side-effects on the dapsone-treated group were a mild burning sensation in 7 patients (24.13%), mild erythema of the skin and mild dryness in 4 (13.79%) and 3 (10.34%) cases respectively (P < 0.001). In our study, adverse effects were common but they were minor and tolerable. No clinically significant changes in laboratory parameters were observed (P < 0.001). Conclusions: Dapsone gel was an effective medication for patients who received isotretinoin for acne vulgaris treatment resulting in a significant reduction of the number of lesions.

Background: Studies have shown significant correlation between time to pregnancy (TTP) and pregnancy  outcomes. But  understanding of these mechanisms may not be facilitated. The aim of this study was to determine the relation between TTP and pregnancy outcome. Materials and Methods: This study was a case cohort study that was done in Shahid Beheshti Educational Hospital during 2006-2007. Women aged 18-35 years, who had only one pregnancy without using any contraception method before pregnancy and delivered their first child, were enrolled in this study. Thus, 801 women were selected and followed up for pregnancy outcome and TTP until the end of pregnancy. All the participants filled in a special questionnaire. Finally the collected data were entered into computer and analyzed by SPSS ver. 20 software. Results: The frequency distribution of TTP-based pregnancy outcome showed that TTP >48 weeks was higher in normal delivery than in abnormal delivery (5.6% vs. 19.4%). According to Chi-square test, the frequency distribution of pregnancy outcome was related to TTP (P < 0.001). Conclusion: According to the results of this study, there is a significant relationship between TTP and pregnancy outcome, and TTP may lead to unwanted complications such as ectopic pregnancy, preterm labor, and abortion. Thus, all women with a long time of contraception, especially in the rural areas, mast be controlled.

Background: Increasing of age cheating in sports makes problems to athletes comparable to taking illegal substances. Current method used by AFC and FIFA is applying MRI of growth plate of distal of radius to determine the bone age. This study was designed to evaluate the diagnostic accuracy of ultrasonography in bone age determination by measuring the width of growth plate in distal of radius, and comparing it with identity documents. Materials and Methods: The study was conducted from September to December 2009 in the Department of Radiology at Al-Zahra University Hospital, Isfahan, Iran. Ultrasonography was done for 82 (15-20 years old) young professional football players and results were compared with identity documents (such as National ID card). Young football players were divided into three age categories: < 16 and > 16 years old, < 17 and > 17 years old, and < 18 and > 18 years old. Receiver Operator Characteristics (ROC) curves for discriminant values and sensitivity and specificity were analyzed. Results: Cut-off point was set for each group, based on the width of the growth plate, and negative test was defined as subjects < cut-off point, showing subjects over the defined age in each group. ROC curve analysis demonstrates consistently acceptable diagnostic sensitivity and specificity values in age determination of each group. Conclusions: The overall predictive accuracy of ultrasonography, as described by the area under the ROC curve, was high for determination of bone age. It has an acceptable sensitivity and specificity to use for determination of age in sport competitions, and has the capability to become the screening test for age determination, especially because it is inexpensive and without any risk of radiation. It seems to be comparable with MRI in age determination.

Background: Diabetic neuropathy is one of the serious problems due to microvessel vasculopathy in diabetes. It has been reported that hyperglycemia and hypertriglyceridemia are the underlying mechanisms in inducing and progression of diabetic neuropathy. The aim of the present study was to investigate the effects of melatonin on serum glucose and lipid levels, as well as food consumption and water intake in streptozotocin-induced diabetic rats. Materials and Methods: Eighty male Wistar rats were randomly assigned to six groups including; normal control group, diabetic control group and 4 diabetic experimental groups that received melatonin intraperitoneally at doses of 2.5, 5, 10, and 20 mg/kg at the end of sixth week after verification of neuropathy by means of evaluation of sciatic nerve conduction velocity (MNCV), for two weeks. Blood glucose and lipid levels, body weight, the amounts of food consumption, and water intake were determined in all groups at weeks 0 (before diabetes induction), 3, 6, and at the end of eighth week. Results: Treatment with melatonin reduced significantly the serum glucose (P < 0.001) and triglyceride (P < 0.05) levels, food consumption (P < 0.001), and water intake (P < 0.001) in diabetic rats at the end of eighth week. However, melatonin had no significant effect on body weight of diabetic animals. Conclusions: Treatment with melatonin could improve several signs of diabetes, including hyperglycemia, hypertriglyceridemia, polyphagia, and polydipsia. Therefore, melatonin may be used as an adjunct therapy in the treatment of diabetes.

Background: Nasal cannula, beside administering low-flow therapy, showed the capability for the administration of continuous positive airway pressure (CPAP) through high-flow nasal cannula (HFNC). Meeting specific physical criteria of 100% relative humidity (RH) and temperature of 37 ^o C are the basic interventional requirements to administer oxygen for the newborns through a nasal cannula. Recently, two systems, MR850 and PMH7000, received the Food and Drug Administration (FDA) approval to administer heated, humidified HFNC (HHHFNC). These systems are evaluated in this study based on their humidifying and heating capabilities. Materials and Methods: This study was done as an RCT on newborns weighing 1,000 to 1,500 g recovering from respiratory distress syndrome (RDS) while nCPAP was administered at CDP = 4 cmH ₂ O, Fio ₂ <30%. Patients were randomized to two groups of 35 receiving HHHFNC after treatment with nCPAP, with one group using MR850 humidifier and the other PMH7000. The patients were compared according to the duration of HHHFNC administration, repeated need for nCPAP respiratory support, the need for invasive ventilation, apnea, chronic lung disease (CLD), nasal trauma, RH, and temperature of the gases. Results: The average time of support with HHHNFC did not show any significant difference in the two groups. There was no significant difference between the groups in the need for nCPAP, invasive ventilation, apnea, nasal trauma, and CLD. The difference in the levels of average temperature and humidity was significant (P value <0.001). Conclusion: Although the records of temperature and RH in the PMH7000 system was lower than the records from the MR850 system, no clinical priority was observed for respiratory support with HHHNFC in the two systems.

Background: Morphine withdrawal usually results in undesired outcomes , despite partial benefits of alternative medication such as methadone, because of the lack of mental sedation during the withdrawal period, may not lead to the desired result. In this study, forced exercise by treadmill is used to manage morphine dependence in animal model. Materials and Methods: Forty adult male mice were divided into 5 groups, from which 4 groups became dependent by increasing daily doses of morphine for 6 days (20-45 mg/kg, SC). Afterwards, the animals were treated for 21 days by either of the following protocol: Positive control (dependent) received once daily 45 mg/kg of morphine sulfate (SC) for 21 day, group under treatment by clonidine (0.4 mg/kg, SC) for 21 day group under treatment by forced exercise by treadmill for 21 day, group under treatment by combination of clonidine (0.4 mg/kg, SC) and forced exercise by treadmill for 21day and the negative control group(independent) received saline injection like other groups. Each of this administration was injected at 8 AM. Finally, in the test day (day 28), all animals received a single dose of naloxone (3 mg/kg, SC) at 8 AM and then were observed for withdrawal signs, and Total Withdrawal Score (TWS) was determined as described previously. After withdrawal sign evaluation for evaluation of stress level of dependent mice, blood cortisol and glucose level were measured in non-fasting situations well. Results: This study showed that TWS significantly decreased in all treatment groups in comparison with positive control group (P < 0.001). Moreover, blood cortisol and glucose level significantly decreased in group under treatment by clonidine (0.4 mg/kg) and group under treatment by combination of clonidine (0.4 mg/kg) and forced exercise by treadmill groups in comparison with control positive (dependent) (P < 0.05). Conclusion: This study suggested that forced exercise can be useful as adjunct therapy in dependent people and can ameliorate side effects and stress situation of withdrawal syndrome periods.

Background: Fragile histidine triad (FHIT) is considered as a member of the histidine triad (HIT) nucleotide-binding protein superfamily regarded as a putative tumor suppressor executing crucial role in inhibiting p53 degradation by MDM2. Accumulating evidences indicate FHIT interaction with p53 or MDM2; however, there is no certain study deciphering functional domains of FHIT involving in the interaction with MDM2 and/or p53. In this regard, such evident interaction can spring in mind determining important domains of FHIT binding to MDM2 with regard to p53. Materials and Methods: Since there were not any previous studies appraising complete three-dimensional structures of target molecules, molecular modeling was carried out to construct three-dimensional models of full FHIT, MDM2, P53 and also FHIT segments. Truncated structures of FHIT were created to reveal critical regions engaging in FHIT interaction. Results: Given the shape and shape/electrostatic total energy, FHIT structures (β1-5), (β3-7, α1), and (β5-7, α1) appeared to be better candidates than other structures in interaction with full MDM2. Furthermore, FHIT structures (β6-7), (β6-7, α1), (β4-7, α1) were considered to be better than other structures in interaction with p53. FHIT truncates that interact with MDM2 presented lower energy levels than FHIT truncates interacting with p53. Conclusion: These findings are beneficial to understand the mechanism of the FHIT-MDM2-p53 complex activation for designing inhibitory compounds.

Background: Streptococci are the main causative agents in plaque formation and mutans streptococci are the principle etiological agent of dental plaque and caries. The process of biofilm formation is a step-wise process, starting with adhesion of planktonic cells to the surfaces. It is now a well known fact that expression of glucosyltransferases (gtfs) and fructosyltransferase (ftf) genes play a critical role in the initial adhesion of Streptococcus mutans to the tooth surface, which results in the formation of dental plaques and consequently caries and other periodontal diseases. Materials and Methods: In the present study, we have determined the effect of biosurfactants purified from Lactobacillus reuteri (DSM20016) culture on gene expression profile of gftB/C and fft of S. mutans (ATCC35668) using quantitative real-time polymerase chain reaction. Results: The application of biosurfactant caused considerable down-regulation of the expression of all three genes under study. The reduction in gene expression was statistically very significant (P > 0.0001 for all three genes). Conclusions: Inhibition of these genes by the extracted L. reuteri biosurfactant shows the emergence of a powerful alternative to the presently practicing alternatives. In view of the importance of these gene products for S. mutans attachment to the tooth surface, which is the initial important step in biofilm production and dental caries, we believe that the biosurfactant prepared in this study could be considered as a step ahead in dental caries prevention.

Background: Statins are one of the most frequently prescribed medications to reduce the risk of cardiovascular events. Statins appear to be safe however, there are contradictory data regarding their adverse effects, which might be due to genetic variation in their metabolism. Hence, this prospective study was aimed to evaluate the effects of atorvastatin on liver transaminase changes in a clinical setting, in north Iran. Materials and Methods: This prospective semi-experimental study was performed on hyperlipidemic adults in 2010-2011. Patients received atorvastatin (5-40 mg/d) based on the American National Cholesterol Education Program guidelines. Liver aminotransferases were measured in three occasions of baseline, 8 and 16 weeks period. Results: A total of 206 patients were included in the study. Of which 178 were female and 30 were male. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were in normal range before intervention in the majority, except in 25 (12.1%) and 16 (7.8%) of patients, respectively. In general, ALT and AST remained in normal range over the study period (23.3 IU/L and 21.8 IU/L, respectively). There was found no relationship between different doses of atorvastatin prescribed and ALT/AST changes in the patients. The males' ALT means at baseline (26.9 IU/L), 8 weeks (30 IU/L) and 16 weeks (28.8 IU/L) after statin therapy were significantly higher than females (22 IU/L, 22.2 IU/L and 22.1 IU/L, respectively; P < 0.05 for all). Conclusion: The absence of any hepatic adverse effect in the present study supports safety of atorvastatin and emerging opinion that routine screening of liver function tests is not necessary in patients on statins.

Background: Leishmaniasis, a parasitic disease, is caused by the Leishmania genus, a protozoan parasite transmitted by sand fly arthropods. Cutaneous leishmaniasis (CL) in old world is usually caused by L. major, L. tropica, and L. aethiopica complexes. One of the most important hyper endemic areas of CL in Iran is Isfahan province. Varzaneh is a city in the eastern part of Isfahan province. Due to different biological patterns of parasite strains which are distributed in the region, this study was design to identify Leishmania species from human victims using Kinetoplastid DNA as templates in a molecular PCR method. Materials and Methods: Among 186 suspected cases, 50 cases were confirmed positive by direct microscopy after Giemsa staining. Species characterization of the isolates was done using Nested- PCR as a very effective and sensitive tool to reproduce mini circle strands. Results: After Nested-PCR from all 50 cases, 560 bp bands were produced which according to products of reference strains indicate that the infection etiologic agent has been L. major. 22 (44%) of patients were females and 28 (56%) of them were males. Their age ranges were between 7 months and 60 years. Conclusion: According to the results of the study and the particular pattern of infection prevalent in the region, genetic studies and identification of Leishmania parasites are very important in the disease control and improvement of regional strategy of therapy protocols.

Background: Failed intubation is imperative source of anesthetic interrelated patient's mortality. The aim of this present study was to compare the ability to predict difficult visualization of the larynx from the following pre-operative airway predictive indices, in isolation and combination: Modified Mallampati test (MMT), the ratio of height to thyromental distance (RHTMD), hyomental distance ratios (HMDR), and the upper-lip-bite test (ULBT). Materials and Methods: We collected data on 525 consecutive patients scheduled for elective surgery under general anesthesia requiring endotracheal intubation and then evaluated all four factors before surgery. A skilled anesthesiologist, not imparted of the noted pre-operative airway assessment, did the laryngoscopy and rating (as per Cormack and Lehane's classification). Sensitivity, specificity, and positive predictive value for every airway predictor in isolation and in combination were established. Results: The most sensitive of the single tests was ULBT with a sensitivity of 90.2%. The hyomental distance extreme of head extension was the least sensitive of the single tests with a sensitivity of 56.9. The HMDR had sensitivity 86.3%. The ULBT had the highest negative predictive value: And the area under a receiver-operating characteristic curve (AUC of ROC curve) among single predictors. The AUC of ROC curve for ULBT, HMDR and RHTMD was significantly more than for MMT (P < 0.05) . No significant difference was noted in the AUC of ROC curve for ULBT, HMDR, and RHTMD (P > 0.05). Conclusion: The HMDR is comparable with RHTMD and ULBT for prediction of difficult laryngoscopy in the general population, but was significantly more than for MMT.

Background: This investigation compared the effects of exercise rehabilitation and bracing on muscle flexibility and strength as well as knee proprioception and pain in female sufferers of lateral displacement of patella (LDP). Materials and Methods: Twenty-two females with unilateral LDP were randomly divided into two groups to receive exercises (n = 12) or patellar brace (n = 10). Both groups were evaluated before and after 8 weeks with isokinetic dynamometer (Biodex System 3 Pro) for muscle strength and proprioception, with SLR, Active Knee Flexion, and Sit and Reach tests for flexibility assessment and with a visual analog scale for pain. Results: Muscle flexibility in both exercise and bracing groups improved (F_(1,20)≥5.99 and P ≤ 0.024), whereas improvement in bracing group was not significant. Significant interaction was observed in favor of exercise group in 2 strength tests of knee flexion and knee extension (F_(1,20)≥6.564 and P ≤ 0.019). For proprioception, a significant interaction was observed in favor of bracing group (F_(1,20) =7.944 and P = 0.011). Also the results showed both exercise rehab and brace decreased significantly pain severity during stair ascending and descending. Conclusion: These results suggest that better flexibility and more strength in exercise group somehow reduced the stress on patellofemoral joint and it, in turn, alleviated the symptoms and pain. It is also likely that relieving effects of brace and improvement of proprioception by it allows patients to be more physically active and it could have, more or less, effects similar to exercise. Therefore both exercise and brace could be prescribed for patients with LDP. It seems application of the patellar brace combined with exercise might be a better treatment for these patients, because they could improve strength, flexibility and proprioception.

Background: The aim of this study was to evaluate the analgesic efficacy of pre-operative single dose of intravenous (I.V.) magnesium sulfate infusion in patients undergoing elective Cesarean section. Materials and Methods: Seventy pregnant women who underwent elective Cesarean section were randomly divided into two groups. Before induction of anesthesia, the magnesium group (Group A) received magnesium sulfate 50 mg/kg I.V. in bolus dose. The control group (Group B) received the same volume of isotonic saline. The pain scores at rest and also upon movement were evaluated up to 24 h post-operatively and analgesic requirement was recorded during the first 24 h after operation. Results: Cumulative analgesic consumption (24 h after operation was 11.2 ± 6.3 mg in group A vs. 13.9 ± 3.9 mg in group B). Post-operative pain scores (24 h after operation was 1.8 ± 2.1 in group A vs. 2.9 ± 1.2 in group B) and shivering incidents (8.57 in group A vs. 14.28 in group B) were significantly lower in Group A (P < 0.05). Mean arterial pressure just after intubation and during the immediate post-operative period was significantly lower in Group A (P < 0.05). Conclusion: Pre-operative intravenous magnesium sulfate infusion decrease post-operation pain and requirement of analgesia in Cesarean section.

Background: Correcting the pre-existing astigmatism is an optimal goal in cataract surgery. The aim of this study is to compare the astigmatic correcting effect of a single regular 3.2 mm clear corneal incision (CCI) with paired opposite CCI in cataract patients and effect of these incisions on optical aberrations using the wavefront quantitative analysis. Materials and Methods: This was a randomized controlled trial study undertaken in an ophthalmology referral center on 50 patients planned for cataract surgery who were randomized to either single 3.2 mm CCI or paired opposite CCI group. Post-operative evaluation was performed at 12 weeks and included refraction, keratometery, corneal topography and wavefront analysis. Corneal astigmatism and post-operative values were compared in two groups. Results: The mean pre-operative corneal astigmatism was 2.58 ± 1.03 D in the single incision group and 2.70 ± 0.94 D in the paired opposite incisions group. After 12 weeks of surgery, the corneal astigmatism was reached to 2.15 ± 0.82 D in single incision group and 1.63 ± 1.21 in the paired opposite incisions group. There was a statistically significant difference in two arms of treatment regarding to surgically induced astigmatism after 3 months. The mean post-operative total and higher order aberrations and values were not significantly different in two groups. Conclusion: The results of our study showed that paired opposite incisions is an effective procedure for reducing pre-existing corneal astigmatism in cataract surgery. Paired incisions did not show any beneficial effect regarding wavefront aberrations compared with conventional single incision method.

Background: This study was done to evaluate the effect of itraconazole on clinical symptoms and radiologic findings in patients with chronic rhinosinusitis and nasal polyposis after surgery. Materials and Methods: In a clinical trial which was conducted in Alzahra and Kashani hospitals, from November 2011 to December 2012, 22 patients with recurrent postsurgical chronic sinusitis and polyposis entered the study. At the start of the study demographic data, subjective clinical symptoms (severity of rhinorrhea, nasal obstruction, hyposmia, and dyspnea), quality of life (QoL) by sinonasal outcome test-20 (SNOT-20), serum immunoglobulin E (IgE), and score of computed tomography (CT) scan (by Lund-Mackay) were recorded. Itraconazole (100 mg, twice per day) prescribed for 3 months and patients were followed in the 1 ^st , 3 ^rd , and 6 ^th months. Liver enzyme tests and side effects were evaluated monthly. Results: Severity of rhinorrhea, nasal obstruction, hyposmia, dyspnea, and QoL (by SNOT-20) improved during 3 months of treatment. Serum IgE was 265 (±277) at the start of the study, and decrease to 193 (±183) after 3 month. After 3 month, Lund-Mackay score of CT scan lowered from 19 (±4) to 15 (±6) (P < 0.05). At the 6 ^th month, severity of clinical symptoms except dyspnea and QoL were better than first evaluation. Conclusion: This study showed the beneficial effect of 3-month itraconazole treatment on clinical symptoms and radiologic findings and QoL in patients with recurrent postsurgical chronic rhinosinusitis and nasal polyposis.

Background: Several markers have been used to make a distinction between metastatic adenocarcinoma and reactive mesothelial cells in the body cavity effusions. This study aimed to evaluate the diagnostic value of claudin-4 marker in making such a distinction. Materials and Methods: In this cross-sectional study, a total of 92 pleural/peritoneol effusions have been studied, including 47 cases of definite metastatic carcinoma and 45 cases of reactive mesothelium, and definitely negative for malignancy. Specimens were collected from patients; cell block samples were derived and used for immunohistochemical staining. The antibody used for immunohistochemical labeling was monoclonal anti-claudin-4. In the evaluation, membrane-bound reactivity was considered as significant and positive cases were defined when at least more than 10% of tumor cells were distinctly labeled. Results: Claudin-4 protein was positive in 40 specimens of metastatic carcinoma, while none of the cases of reactive mesothelium stained with the marker. This was not detected in the mesothelial cells, though. Positive staining for claudin-4 was significantly more frequent in metastatic carcinoma than in the reactive mesothelium (P > 0.0001). The sensitivity and specificity of claudin-4 to distinguish reactive mesothelium from metastatic carcinoma were 85% (95% confidence interval [CI], 71.1-93.8%) and 100% (95% CI, 91.1-100%), respectively. Furthermore, negative likelihood ratio was 0.15 (95% CI, 0.08-0.29). Conclusion: The results of this study demonstrated that claudin-4 is less frequently expressed in reactive mesothelium. Thus, this claudin may be helpful in differentiating metastatic carcinoma from reactive mesothelial cells in pleural and peritoneal fluid cytology specimen.