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Introduction: Pyoderma gangrenosum (PG) of the breast is a rare that present as a painful ulcer on the skin. It usually affects people in their 20s to 50s and occurs in both men and women. Typically, PG affects the legs in adults. In children, it may affect the legs, buttocks, head, and neck. Pyoderma gangrenosum is characterized by a papule, nodule, or pustule that progresses to an injured lesion with unknown boundaries. In this study, a case of Pyoderma gangrenosum is introduced after breast surgery. A 38-year-old woman with a 3 cm wound in the right breast area that has gradually grown has been examined for exudative bloody discharge for the past 2 weeks. Two weeks after breast surgery, a three-centimeter progressive wound has formed on the surface of the breast, which gradually grew larger. During treatment, several oral and injectable antibiotics were prescribed that have not been effective in healing the wound. A biopsy lesion was reported in which a non-specific skin lesion with hyperplasia and vesicle formation without malignancy was reported. The patient had no gastrointestinal symptoms. Infliximab was started and continued for the patient. Conclusion: In the differential diagnosis of resistant skin wounds, especially in the leg area, and in this case in the breast the diagnosis of pyoderma gangrenosome should always be considered. Even if the patient has no history of inflammatory bowel disease, pyoderma gangrenosum may occur before intestinal manifestations.

Background:Nonalcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases worldwide. Experimental evidence has proposed the beneficial effects of Cornus mas L. (cornelian cherry) extract, as a rich source of anthocyanins, on steatosis and central obesity. However, very few clinical trials were conducted in this regard. We investigated the effect of total anthocyanin-base standardized cornelian cherry fruit extract on hepatic steatosis index (HSI) and NAFLD liver fat score (NAFLD-LFS), and visceral adiposity index (VAI) in patients with NAFLD.Methods:The present study was conducted as a double-blind, randomized controlled clinical trial among 50 subjects suffering from NAFLD. Subjects were randomly assigned to receive cornelian cherry extract (20 cc/d, which provides 320 mg/d total anthocyanin) or placebo for 12 weeks.Results:There was no difference between the two groups in HSI, NAFLD-LFS and VAI at the baseline. After 12-week intervention, cornelian cherry extract compared to the placebo demonstrated no significant effect on HSI (change: -0.9 ± 3.5 vs. -1.2 ± 3.2; P = 0.72), NAFLD-LFS (change: 0.2 ± 1.3 vs. 0.1 ± 0.7; P = 0.62), and VAI (change: 0.05 ± 0.7 vs. 0.07 ± 1.0; P = 0.94).Conclusion:Cornelian cherry extract (20 cc/d) for 12 weeks has no effect on steatosis and visceral obesity. To better conclude, further trials with longer intervention durations are required. Trial registration: The study protocol was registered on 30 September 2018 at Iranian Registry of Clinical Trials under code IRCT20180419039359N1 (https://www.irct.ir/trial/30707).

Introduction: Acute hepatitis has several causes. Transfusion of non-infected blood to the virus and avoidance of undesirable social contacts have reduced the prevalence of hepatitis B and C transmission. Improved socioeconomic status and access to healthy food and water have also reduced the prevalence of hepatitis E and A. The transition from Hyper Endimicity to Intermediate or Low Endimicity has increased the incidence of acute Hepatitis A especially in adults. The aim of this study was to determine the epidemiological status of patients with acute liver hepatitis referred to the Shahid Sadoughi Hospital of Yazd from 2015 to 2018 Methods: This cross-sectional study was performed on the patients referring to the gastrointestinal clinic of Shahid Sadoughi Hospital from 2015 to 2018. The sampling method was that after rule out chronic liver disease according to medical history and patient lab data, the patients imported to the category of acute liver disease. SPSS Inc, Chicago, IL; version 16 was used to determine the prevalence of each type of acute hepatitis. Results: 23 patients were diagnosed with acute hepatitis, 14 were male and 9 were female. Hepatitis A was found in 15 patients, 2 patients had acute hepatitis B, 2 patients had autoimmune hepatitis, and 4 patients had other causes for hepatitis. Conclusion: 65% of patients in this study had acute hepatitis A. Therefore, acute hepatitis A is one of the important factors in the development of acute liver disease study and is therefore one of the important factors in the development of acute liver disease.

Summary Background & Aims Non-alcoholic fatty liver disease (NAFLD) is associated with high risk of cardiovascular diseases. The experimental studies have suggested that Cornus mas L. (cornelian cherry) fruit can improve cardiovascular risk factors such as obesity, insulin resistance and dyslipidemia. We designed a study to investigate the effect of cornelian cherry fruit extract on cardiovascular outcomes in patients with NAFLD. Methods We conducted a double-blind, randomized controlled trial. Fifty patients with NAFLD were randomly assigned into the treatment and the control groups. The treatment group received 20 cc/d cornelian cherry fruit extract as liquid form and the control group received 20 cc/d placebo for 12 weeks. The primary outcomes included lipid accumulation product (LAP), atherogenic index of plasma (AIP), Castelli risk index I (CRI-I), CRI-II and atherogenic coefficient (AC). Results At the baseline, there was no significant difference between two groups in values of LAP, AIP, CRI-I, CRI-II and AC. After the intervention, no significant change was found in the treatment group compared to the control group in LAP (-0.64 (-6.25 to 8.29) vs. 0.0 (-8.66 to 19.01); P=0.91), AIP (0.0 ± 0.08 vs. 0.0 ± 0.1; P=0.84), CRI-I (-0.18 ± 0.63 vs. -0.31 ± 0.49; P=0.42), CRI-II (-0.23 ± 0.56 vs. -0.15 ± 0.32; P=0.52) and AC (-0.18 ± 0.63 vs. -0.31 ± 0.49; P=0.42). Conclusion Cornelian cherry fruit extract has no effect on cardiovascular outcomes. Further studies with longer intervention durations are needed. Trial registration Registered on 30 September 2018 at Iranian Registry of Clinical Trials (IRCT20180419039359N1).

This double-blind randomized clinical trial aimed to investigate impact of Cornus mas L. fruit extract (CMFE) on liver function in nonalcoholic fatty liver disease (NAFLD). Fifty patients were randomly assigned into the CMFE and placebo groups to receive 20 ml of the extract or placebo for 12 weeks, respectively. Serum alanine aminotransferase, aspartate aminotransferase, cytokeratin 18 (CK-18) levels, and steatosis and fibrosis scores were examined before and after the intervention. Although, a significant decrease was observed in CK-18 levels among the CMFE group (288.80 ± 85.40 vs. 235.66 ± 60.38; p = .001) after 12 weeks, no significant difference was found between the two groups. Moreover, a significant increase in fibrosis score in the placebo group (8.20 (6.35-9.40) vs. 8.40 (7.70-13.00); p = .03) as well as a significant difference in this marker (CMEF: 7.64 (6.30-8.25); placebo: 8.40 (7.70-13.00); p = .02) and its changes (CMEF: 0.60 (-1.00-1.07); placebo: 0.80 (-0.25-3.95); p = .02) were found between the groups after 12 weeks. No significant effect was noted on other variables. Therefore, consuming CMFE might have some beneficial effects on liver function markers in NAFLD. However, more studies are required in this area.

Objective: Nowadays, lifestyle modification is the best treatment recommended to patients with the nonalcoholic fatty liver disease (NAFLD). The therapeutic effects of vitamin E and silybin on liver functions were documented. The present study was conducted to examine the effect of silymarin and vitamin E on patients with NAFLD. Materials and Methods: From September 2014 to March 2015, clinical trial was conducted on 92 patients with NAFLD at 2 Shahid Sadoughi university clinical research centers. Sampling was based on convenient method. There were no randomization or blinding in this study, but two types of treatments were compared. The patients were divided in two groups of daily intake of vitamin E (400 IU) and Silymarin 280 mg for four months. Alanine aminotransferase (ALT) and liver ultrasonography were done at baseline and after four months. Results: Eighty patients completed the course of treatment successfully .After 4 months, both groups had experienced a significant reduction in their serum ALT levels. The mean change in the ALT level from the baseline was -31.6 U/L in the silymarin group vs. -15.1 U/L in the vitamin E group (P-value= 0.07). Treatment with silymarin was more effective than vitamin E (P-value< 0.0001). The mean ALT level changed to normal was 55.0% (22 of 40 patients )in the silymarin group, while it was 45.0% (18 of 40 cases) in the vitamin E group (P-value= 0.04). Conclusion: The treatment of NAFLD with silymarin appears to be significantly effective in biochemical improvement whereas treatment with vitamin E improves ultrasonographic parameters.

Objective: Diabetes Mellitus (DM) is one of the most common endocrine diseases with many systemic complications such as oral manifestations. The present study aimed to compare the oral manifestations frequency in diabetic patients and healthy subjects. Materials and Methods: This cross sectional study was conducted during 2016-17 on subjects came to Yazd Diabetic Research Center. In this study, 181 type 2 diabetic patients (T2DM) and 181 healthy individuals, based on convenient sample method, were included. Two groups were compared for basic information and oral manifestations including candidiasis, oral lichen planus (OLP), periodontitis, xerostomia, delayed oral wound healing, geographic tongue, gingival hyperplasia, fissured tongue, burning mouth and finally at least one of these lesions. Results: The frequency of candidiasis, OLP, periodontitis, delay oral wound healing, geographic tongue, xerostomia and at least one of lesions in diabetics were significantly higher than control group (P-value< 0.001). After regression analysis and adjusting for confounding factors, candidiasis, periodontitis and xerostomia in diabetics were significantly more prevalent than non-DM patients with odds ratio of 15.16 (1.80-127.57), 9.58 (4.68-19.63) and 78.639 (10.05-615.231) respectively. Conclusion: Xerostomia, candidiasis and periodontitis were significantly more prevalent in T2DM than Non-T2DM persons. Therefore, increasing awareness on oral manifestations in this group is recommended for timely diagnosis and referring to an oral medicine.

Introduction: The clinical features of celiac disease vary. Common classic signs and symptoms include diarrhea, weight loss, and abdominal distention. Celiac as a systemic disease may suffer people of all ages and with many races and ethnic groups. Celiac disease also has other symptoms that got less attention. These signs are constipation, bloating, oral plague, bone pain, anemia, Vitiligo, hypocalcemia, hypothyroidism and seizures. In this study, it was decided to evaluate the prevalence of gastrointestinal and non-gastrointestinal clinical signs of celiac disease. Methods: This descriptive study was conducted on 150 patients with celiac disease referred to Khatamolanbiya Clinic in 2014.The gastrointestinal and non-gastrointestinal clinical signs of the patients were studied. Patients with celiac disease were included who had both positive tissue anti-transglutaminase antibodies and some degree of mucosal atrophy on duodenal mucosal endoscopy. After collecting the data, the coded information was entered into SPSS version 22 software and the results were analyzed using Chi-Square, T and Wilcoxon tests. Results: The results showed that celiac disease in the study was 1.3 times more frequently in women than men. As well as the symptoms of anemia in the population studied (40.67%) had the highest and seizures (0.67%) had the lowest rates. After anemia, hypothyroidism with 26% prevalence was the most prevalent in the community. Diarrhea with 24.7% is the mostcommon in gastrointestinal symptoms and is the third most common after anemia and hypothyroidism. Conclusion: The results of this study showed that non-gastrointestinal symptoms (bone pain, anemia, vitiligo, hypocalcaemia, hypothyroidism, and seizures) are more common than gastrointestinal symptoms such as diarrhea, steatorrhea, weight loss, nausea, vomiting, abdominal pain, bloating, and oral thrush in patients with celiac disease.

Hepatitis C virus (HCV) infection is a major cause of chronic liver disease, with approximately 71 million chronically infected individuals worldwide. Clinical care for the patients with HCV-related liver disease has advanced considerably thanks to an enhanced understanding of the pathophysiology of the disease, and because of developments in diagnostic procedures and improvements in therapy and prevention, recently in Iran new drug direct Acting agent (DAA) was developed that may be equivalent to original drugs that will hope to treat HCV and eliminated HCV in future

Nonalcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases worldwide. Evidence showed that anthocyanins might have effects on NAFLD. Protective effects of Cornelian cherry (Cornus mas L.) extract, as an anthocyanins-rich source, on liver were reported in animal studies. However, very few clinical trials were conducted in this regard. Thus, the aim of this research will be to evaluate the effect of supplementation with total anthocyanin-base standardized cornelian cherry fruit extract on liver function (Serum levels of Alanine aminotransferase (ALT), Aspartate aminotransferase (AST), cytokeratin-18 fragment M30 (CK-18 M30), as well as steatosis and fibrosis of liver), tumor necrosis factor α (TNF-α), malondealdehyde (MDA), and adiponectin in patients with NAFLD. In a double-blind randomized clinical trial, 80 NAFLD patients will be studied. The patients will be randomly assigned into two groups. The intervention group will receive the cornelian cherry extract, containing 320 mg.d− 1 anthocyanins, per day for 12 weeks. The control group will also take the placebo daily for 12 weeks. Liver function (Serum levels of AST, ALT and CK-18 M30; steatosis and fibrosis of liver), serum levels of TNF-α, MDA, and adiponectin will be measured at the baseline and the end of trial for both groups and their results will be compared. Considering evidences about the useful impacts of anthocyanins on NAFLD, the effects of supplementation with cornelian cherry extract will be investigated on the important variables related to NAFLD. Iranian Registry of Clinical Trials ( IRCT20180419039359N1 ).

Background: Esophageal cancer is an invasive lethal disease with a 10-year survival rate since diagnosis. About 45% of the tumor is completely removed by surgery, which has 5% mortality and 20% survival rate. In the locoregional stage, the use of neoadjuvant chemoradiotherapy and then surgery reduces recurrence and increases survival. Objectives: This study was performed to investigate the effect of neoadjuvant chemoradiotherapy and the subsequent chemotherapy with platinum-based regimen on survival, recurrence, and response to treatment. Methods: Planning a descriptive retrospective follow-up study, during 2010 to 2016, 44 patients with esophageal cancer, who received chemotherapy with 5-Fluorouracil + Oxaliplatin + Docetaxel before and after radiotherapy (45 - 50 Gray) accompanying by oral Capecitabin, were followed up. Five operable patients underwent surgery. Response to treatment and recurrence were evaluated by periodic endoscopic biopsy and imaging. To calculate the response rate to treatment, survival, and recurrence, the data were extracted and analyzed, using SPSS version 18. The categorized variables were compared, using Pearson’s test. The survival curves were drawn, using the Kaplan Meier method and compared with the log-rank test. Results: Among 44 patients with an average age of 61.5 ± 11.5 years, 88.6% had squamous cell carcinoma (SCC) and 11.4% had adenocarcinoma; surgery was performed for 5 patients, one of whom had severe complication leading to death and 54.5% had complete response as well as more survival rate. The patients suffering from SCC and middle segment tumors had more response rate. Also, recurrence was seen in 16 patients (36.4%), of whom 9.1% had local recurrence and 27.3% had metastatic recurrence. The mean survival rate was 38.87 months and 1-, 3-, and 5-year survival rate was %81.6, %47.6, and 39.6%, respectively. It was significantly more in middle esophageal segment and also tumors with complete response to treatment. Conclusions: Regarding the results, this treatment approach increases overall and disease-free survival, and response to treatment and reduces locoregional recurrence even if no surgery is performed. This treatment is recommended as a definitive treatment for esophageal cancer without metastasis.

BACKGROUND The number of patients with gastric cancer is growing worldwide. In Iran (in 2009) of 74067 new cases of cancer, 6886 were diagnosed as having gastric cancer. This study was conducted to investigate 5-year survival rate for gastric cancer in Yazd province, central Iran. METHODS In this descriptive study, the medical records of patients with gastric cancer were collected from the archives of Yazd hospitals from 2001 to 2008. The data gathered included age, sex, type of histopathology, site of involvement, cancer staging, and mode of treatment, which were analyzed using SPSS software version 11.5. To investigate the survival and the factors influencing the survival time of patients, which are the main objectives of this study, Kaplan-Meier method was used and Cox proportional hazards model was fitted to the data. To compare survival function in different subgroups, the log rank test or generalized Wilcoxon test was used. RESULTS 295 cases of gastric cancer were enrolled in the study. The mean age of the subjects was 59.3 ± 9 years. 5-year survival rate of the patients was calculated as 18% where the highest rate was 39% for the age group of 50-60 years and the lowest was 3% for the age group of above 80 years. 5-year survival rates in different groups were as follows: 32% in women, 13% in men; 16% in adenocarcinoma, 46% in other pathologies; 16% in gastric cardia involvement, 17% in antrum; 59% in stage 1, 31% in stage 2, 13% in stage 3, and 3% in stage 4. CONCLUSION The results of this study showed that age, stage of the cancer, mode of therapy, and type of histopathology affected the survival rate of gastric cancer. No significant association was found between the site of involvement and survival rate. In general, the survival rate for gastric cancer was low, which might be due to slow but steady progress of the disease and delayed referral of the patients.

Background: Congenital hypothyroidism (CH) is one of the major causes of physical and mental disabilities, which are preventable and treatable. This study aimed to investigate physical growth and to evaluate the effectiveness of performed therapeutic interventions on normality of serum T4 and TSH levels in children with CH of Yazd city. Methods: This retrospective cohort study was performed on all neonates with CH, who were born during years 2006 and 2008. The growth pattern of height, weight and head circumference during the first five years of children with CH and the effectiveness of performed therapeutic interventions on normality of serum T4 and TSH levels were evaluated. The collected data were analyzed using the 22nd version of the SPSS software. Results: The pattern of height, weight, and head circumference of the girls with CH was comparable with the growth pattern of NCHS of healthy individuals. The pattern of height and weight growth of boys with CH gradually became similar to the growth pattern of NCHS of healthy boys. However, there was a decline in their head circumference growth trend after six months of age. Also it was revealed that therapeutic interventions had an appropriate effect on normalization of serum TSH, T4 levels and growth pattern in CH children under treatment. Conclusions: After treatment and care for these patients, the growth patterns and serum T4 and TSH levels of these children reached a normal and desirable range. Keywords: Congenital Hypothyroidism; Growth; Height; Weight; Head Circumference; Yazd

Background: The hepatitis C virus (HCV) is an important human pathogen affecting an estimated 120 - 170 million individuals in the world. Polymorphisms of the IL28B gene are strongly associated with sustained virological response in patients with chronic hepatitis C treated with peginterferon and ribavirin. Objectives: The aims of this study were to compare the allelic and genotypic frequencies of the IL28B rs12979860 polymorphism in sustained virological response in patients who did not respond to the standard of care treatment and to verify whether there is a correlation between the viral load and the IL28B rs12979860 polymorphism. Methods: This cross-sectional study was carried out on 75 HCV-infected patients, including 45 responders to treatment (group 1) and 30 nonresponders (group 2). We compared the allele and genotype frequencies of the IL28B rs12979860 between the two groups using the PCR-RFLP method. Results: The genotype frequencies of rs12979860 polymorphism in group 1 were CC (28.9%), CT (37.8%) and TT (33.3%) and in group 2 were CC (6.7%), CT (43.3%) and TT (50%). There was a significant difference in genotype frequencies of IL28B polymorphism between the two groups (P = 0.03). There was no significant association between the viral load and IL28B rs12979860 genotypes in either group 1 (P = 0.3) or group 2 (P = 0.2). Conclusions: Our findings indicate that patients with the homozygous CC genotype in the IL28B gene had a significantly higher rate of response to treatment than those with the TT or CT genotypes. Nor does the IL28B rs12979860 polymorphism affect the viral load.

Background: Hepatitis C virus (HCV) is an important human pathogen affecting an estimated 120 – 170 million individuals in the world. Toll-Like receptors (TLRs) are pattern-recognition receptors that recognize pathogen-associated molecular patterns, and stimulate immune responses. Objectives: The aim of this study was to determine the mRNA expression level of TLR2 and TLR7 in HCV-infected patients in comparison with normal controls. Patients and Methods: Nineteen consecutive patients with HCV infection and nineteen sex and age-matched healthy controls were studied in a case-controlled research. Results: Our results showed that the expressions of TLR7 in HCV infected samples were significantly increased in comparison those of the controls (P = 0.02), while the expression of TLR2 was similar between the case and the control group (P = 0.8). There were no associations between the expression levels of TLR2 and TLR7 with HCV viral load and HCV genotypes. Also, there was no association between viral load and genotypes of the virus. Conclusions: Our findings showed that HCV infection could lead to increased expression level of TLR7 mRNA in peripheral blood cells of HCV infected samples. The viral load and genotypes of HCV did not affect the mRNA expression levels of TLR2 and TLR7.

Background: Selection of anesthetic approach for lower extremity operations is often a controversial issue for anesthesiologists. Objectives: The aim of this study was to compare the incidence and severity of back pain between general and spinal anesthesia, and to find effective factors in developing postoperative back pain. Patients and Methods: In a randomized clinical trail, 148 patients with elective lower extremity surgeries were randomly allocated into two groups of 74. The first group received general anesthesia and the second group underwent spinal anesthesia. The incidence of back pain was observed and documented. The severity of back pain was assessed at the first, fourth and eighth postoperative weeks by visual analogue scale. Results: The mean of patients' age was 35.50 ± 13.34 years. The incidence and mean of back pain severity among all participants were respectively 35.80% and 15.95% at the first week, 7.40% and 2.43% at the fourth week, and 1.4% and 0.27% at the eighth postoperative week. The incidence and mean of back pain severity in spinal group were respectively 39.2% and 18.11% at the first, 12.2% and 3.92% at the fourth, and 2.7% and 0.54% eighth postoperative weeks. In general anesthesia group, these figures were respectively 32.4% and 13.78% at the first week and 2.7% and 0.95% at the fourth postoperative week. No back pain was reported at the eighth postoperative week. The incidence and severity of back pain in the first week showed significant difference between the two groups, while the mean severity of back pain showed significant difference at the fourth week after operation. Conclusions: Spinal anesthesia could be probably considered as the sole effective factor in the development of back pain after operation.

Background: Helicobacter pylori related-infections are common in developing countries, including Iran. However, little information is available on the antibiotic susceptibility of H. pylori in Yazd. Objectives: The aim of this study was to investigate the antibiotic resistance patterns of H. pylori isolates from gastric biopsy of patients in Yazd. Materials and method: In this descriptive-analytical study, 651 gastric biopsy specimens were taken from May 2012 to February 2013. Samples were cultured into selective Brucella agar media. After 3 to 10 days of incubation and identification of bacteria by using gram stain and biochemical tests, antibacterial susceptibility assay was performed by disk diffusion method. Results: All of 651 gastric biopsy specimens were cultured and 144 (22.12%) isolates of H. pylori were collected. In total, 76 (52.7%) of 144 H. pylori isolates were isolated from females and 68 (47.2%) from males. Rate of antibiotic resistance to metronidazole, tetracycline, clarithromycin, levofloxacin, ciprofloxacin and amoxicillin were 77.8%, 21.5%, 18.8%, 14.6%, 19.4% and 7.6%, respectively. No antibiotic resistance was found against furazolidone. There was no significant association between these isolates antibiotics resistance with sex, age and endoscopic diagnoses (P > 0.05). Conclusions: H. pylori isolates resistance was high to antibiotics, especially metronidazole. Therefore, determining resistance pattern of H. pylori isolates is recommended in all parts of the country.

Background: Propofol is one of common anesthetic drugs used in anesthesia. The most common side effects of propofol are local pain. Pretreatment with lidocaine can reduce propofol injection pain. Objectives: The aim of the present study was to assess and compare the efficiency of lidocaine 0.4% and 2% in reducing the incidence and severity of propofol injection pain. Patients and Methods: This was a double blind prospective clinical trial on children 4-8 years old with class ASA I and II candidates who were referred to Dr. Shaikh Hospital in Mashhad for elective surgery. Sample size calculated 50 patients in each groups based on pilot study. 100 children's were randomly divided equally in two groups, who were injected with lidocaine solutions 2% and 0.4% respectively. patient's pain evaluation based on VSD (verbal descriptor scale) and NRS (Numeric Rating Scale) using patient's verbal reaction and behavior namely fretting, hand drag and tearing. The collated data was analyzed. Results: There was nosignificant difference as to the first three variables (age, gender and weight P > 0.2). The significant difference regarding pain experience in both groups was noteworthy (P > 0.2). Conclusions: Most of the studies compared lidocaine with other drugs or its efficiency at different doses. Our study is different in that we applied a constant dose of lidocaine in various volumes and concentration. This result shows that lidocaine with the same does but lower concentration and higher volume is more effective in preventing propofol injection pain. Using diluted lidocaine with the dosage of 1 mg/ kg and a concentration of 0.4% is an effective way to relieve pain caused by propofol injection in children. Implication for health policy/practice/research/medical education: In this study lidocaine was used as the main pretreatment drug to reduce propofol injection pain, with the same dose but at different volume and concentration. The aim of the present study was to assess and compare the efficiency of lidocaine 0.4% and 2% in reducing the incidence and severity of propofol injection pain.

"Irritable bowel syndrome is the most common diagnosed gastro enteric disorder incriminated for 12% of cases of referring to gastroenterologists. Various studies have shown that the intestinal micro flora of the patients affected with IBS undergoes some changes. Therefore, it seems that the recovery of intestinal flora is a useful therapeutic approach. This study investigated the effect of probiotic Saccharomyces Boulardii on improving the symptoms of IBS. This study was a randomized double-blind clinical trial conducted on 60 IBS patients. The patients were divided into two groups of 30 (case and control groups). The patients in the case group received Yomogi and those in the control group got placebo. Demographic information and symptoms as abdominal pain, flatulence, diarrhea, constipation, gurgling, eructation (belching and burping), urgent defecation, and release of gas from the anus (farting and fizzling) were collected before intervention and three weeks after initiation of treatment, and analyzed. 43.3% of the patients in the case group were male and 56.7% were female. In addition, 40% of the patients in the control group were male and 60% were female. A comparison of the mean scores of abdominal symptoms in the case group before and after intervention revealed that there was a statistically significant difference between before and after intervention values for pain severity (P=0.001), flatulence (P=0.001), diarrhea (P=0.001), gurgling (P=0.001), eructation (P=0.023), and gas release from the anus (P=0.001). Yet, there was no statistically significant difference before and after intervention for symptoms of constipation (P=0.161), and urgent defecation (P=0.09). The consumption of Saccharomyces Boulardii reduces pain severity, flatulence, diarrhea, gurgling, eructation, and gas release from the anus in patients with IBS and improves life quality."

Background Hepatitis C virus (HCV) is a major cause of liver disease. Infection with HCV is a global public health problem. The virus is classified into 6 genotypes and more than 80 subtypes named as a, b, c, etc. HCV genotyping has been an important parameter for the treatment of HCV infection. Objectives The main aim of this study was to estimate the prevalence of HCV genotypes in Yazd, central province of Iran. In addition, the study investigated whether there was any association between HCV load and genotypes. Patients and methods This descriptive cross-sectional study was performed on samples suspicious of HCV infection from March 2010 to June 2013. Peripheral blood sample was obtained and screened for anti-HCV antibodies using Enzyme-Linked Immunosorbent Assay (ELISA). Then sera of anti-HCV positive samples were analyzed using quantitative polymerase chain reaction method. Plasma samples were used to determine the HCV genotypes of 1a, 1b, 2, 3, and 4 in 191 infected patients. Results One hundred fifty-two out of 191 (79.6%) samples were from male patients. The mean of the patients' age was 40.7 ± 11.9 years (range 21-75 years old). Sixty- three (33%) patients were included in 31-40 years group. The mean number of HCV in infected patients was 2.92 × 10(6) ± 1.85 × 10(6) copies/mL (Min: 508; Max: 2.75 × 10(8) copies/mL). HCV genotype 3 was the predominant genotype (50.3%) followed by subtypes 1a (38.7%) and 1b (6.8%). The distribution of other HCV genotypes showed genotype 2 in 1.6% and mixed genotypes in 2.6% of positive samples. Genotype 3 was predominant in all age groups except 21-30 years of age group. We were unable to find any significant difference between mean viral load of the patients infected with genotype 3 and those infected with genotype 1 (1a and 1b). Conclusions Findings of the present study showed that HCV genotype 3 was the predominant genotype followed by the subtypes 1a and 1b in Yazd, central province of Iran. In addition, there was no difference between HCV load and genotypes 1 and 3. HCV genotyping is recommended in other provinces of Iran.

Background and study aims Tamoxifen used in the treatment of breast cancer is reported to cause hepatic steatosis. This study aimed to assess the incidence and risk factors of the development of fatty liver disease, resulting from tamoxifen use, in females with breast cancer. Patients and methods Seventy females aged between 28 and 80 years with breast cancer were recruited from Shahid Sadoughi Clinic, Yazd, Iran in 2006–2008. The patients underwent chemotherapy followed by 20 mg tamoxifen daily as postoperative endocrine treatment. Only in patients with normal baseline liver function, negative test for hepatitis C virus (HCV) and hepatitis B surface antigen (HbsAg) and normal liver ultrasonography were included. The development of fatty changes over a 6-months period of treatment was the main outcome measurement assessed by ultrasonography. Results Thirty-five of 70 patients developed fatty change during follow-up, in which nine were in grade one, 20 in grade two and six patients in grade three. Risk factors associated with the development of fatty change were elevation of triglycerides (2.4, 1.2–4.8), elevation of fasting blood sugar (FBS) and low high-density lipoprotein (HDL) (3.4, 1.4–7.8). No relation was found between the development of fatty change and age (1.3, 0.87–2.00), menopause (1.13, 0.69–1.9), previous history of diabetes (2.4, 0.7–8.4), previous chemotherapy regimen and receptors type (c-erbB2, P53, progesterone receptor (PR), oestrogen receptor (ER)) and stage of breast cancer. Further, there was no relation between the development of fatty change and hypercholesterolemia, low-density lipoprotein (LDL), arterial hypertension and body mass index (BMI). Conclusion Tamoxifen was associated with a high risk of development of non-alcoholic steatohepatitis in patients with higher triglycerides and FBS and lower HDL. However, no relationship was found with the level of BMI, LDL, hypertension, overweight and obesity.