Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 53 8 2015 10 06 454 461 EN Reza Ghotaslou Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Fatemeh Yeganeh-Sefidan Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Behnaz Salahi-Eshlaqi Department of Microbiology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. Hamed Ebrahimzadeh-Leylabadlo Department of Microbiology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. 2015 10 06 2015 10 06 Acute bacterial meningitis (ABM) is one of the most severe infectious diseases, causing neurologic sequel, and a case fatality rate of 20-30%. The aim of this paper was to summarize the main causes of ABM in Iran. We searched the data for relevant articles using meningitis, etiology, and Iran as search terms. We found 23 papers for inclusion in the review that focused specifically on the ABM, addressing etiology and acute meningitis. Finally, during the 23 years, a total of 18163 cases were recorded, and 1074 cases of which met the criteria for bacterial meningitis. The most common agent associated with bacterial meningitis was S. pneumoniae, followed by H. influenzae, Enterobacter spp., N. meningitidis, and group B streptococcus. The total incidence of ABM during 1991 to 2002 was higher than during 2003-2013. S. pneumoniae still remains a main cause of bacterial meningitis. For improved outcomes, studies are needed to further clarify the etiology of meningitis in Iran, explore simple, accurate, and practical diagnostic tools as PCR, and investigate the most appropriate specific and supportive interventions to manage and prevent meningitis as vaccination. https://acta.tums.ac.ir/index.php/acta/article/view/4265 https://acta.tums.ac.ir/index.php/acta/article/download/4265/4220

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 53 8 2015 10 06 462 465 EN Mohammad Vahedian-Ardakani Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran. SM Javad Mortazavi Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran. Mahmoud Farzan Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 06 2015 10 06 Primary knee osteoarthritis (OA) is one of the degenerative diseases that destroy auricular cartilage within knee joint and cause pain, varies deformity, decrease knee function. Total knee arthroplasty (TKA) is an effective intervention in order to relieve pain, improve function and QOL (quality of life) in patients with severe osteoarthritis of the knees that have different degrees of varus deformity. However, we are not aware of any study to shows if medial side defect in tibia has any association with outcome. We conceive this study of finding out if medial side defect of tibia affects the outcome. 124 patients (143 knees) with primary knee OA with different stages of defects participated in this study. Patients classified into two groups based on Rand classification of knee defects (patients with Rand I and II in group 1 and patients with Rand III and IV in group 2). Pain and knee alignment have been measured by Visual analog scale (VAS) and 3-joint X-ray and quality of life, knee function and radiographic have been measured by questionnaires of SF 36, WOMAC and KSS score. The mean follow-up was 18. 2 mounts (range 12 to 23 months). The results showed that all of the parameters improved significantly within groups (P≤0.001). Comparison TKA between two groups in the postoperative analysis shows that there was a significant difference between groups in pain, radiographic and functional KSS and WOMAC score (P≤0.05). So group 1 had better results in these parameters than group 2 after surgery. TKA is an effective intervention for all patients with severe osteoarthritis and varus deformity. However, the severity of medial tibial defects is an important determinant of outcome. Patients with a more severe deformity have less favorable outcome. https://acta.tums.ac.ir/index.php/acta/article/view/4266 https://acta.tums.ac.ir/index.php/acta/article/download/4266/4221

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 53 8 2015 10 06 466 470 EN Behzad Heidari Mobility Impairment Research Center, Babol University of Medical Sciences, Babol, Iran AND Department of Internal Medicine, Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran. Yahya Javadian Mobility Impairment Research Center, Babol University of Medical Sciences, Babol, Iran. Mansour Babaei Mobility Impairment Research Center, Babol University of Medical Sciences, Babol, Iran AND Department of Rheumatology, Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran. Behnaz Yousef-Ghahari Mobility Impairment Research Center, Babol University of Medical Sciences, Babol, Iran AND Department of Rheumatology, Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran. 2015 10 06 2015 10 06 Both vitamin D deficiency and quadriceps muscle weakness are associated with knee osteoarthritis (KOA) and pain. The aim of this study was to determine the restorative effect of vitamin D deficiency on pain and quadriceps muscle strength in knee osteoarthritis. Patients with KOA aged≥30 years, the presence of knee pain for at least one month or longer and serum 25-hydroxyvitamin (25-OHD) deficiencies were recruited in the study. Participants with KOA compatible with Kellgren-Lawrence grade 4, joint instability, and effusion, history of surgery or inflammatory arthropathies were excluded. Serum 25-OHD was assessed by ELISA method and concentrations<20 ng/ml was considered deficiency. Quadriceps muscle strength was measured by dynamometry method and intensity of knee pain by Western Ontario and McMaster University Osteoarthritis index scored by Likert scale and visual analog scale. All participants received 50.000 IU oral cholecalciferol weekly for at least two months. The influence of raising serum 25-OHD on  uadriceps muscle strength and pain was assessed by calculation of mean changes from baseline at the end of the treatment period using paired t-test. A total of 67 patients with mean age of 50±6.6 years of age were treated for 2 months. Serum 25-OHD reached to sufficient levels in all except one patient. At the end of the study period, serum 25-OHD and quadriceps muscle strength increased significantly as compared with baseline (P=0.007 and P=0.002, respectively), whereas knee pain decreased significantly based on Western Ontario and McMaster University Osteoarthritis index (P=0.001) as well as visual analogue scale scores (P=0.001).These findings indicated that correction of vitamin D deficiency in patients with KOA exerts a significant favorable effect on quadriceps muscle streng h and knee pain. https://acta.tums.ac.ir/index.php/acta/article/view/4268 https://acta.tums.ac.ir/index.php/acta/article/download/4268/4223

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 53 8 2015 10 06 471 475 EN Farzaneh Agha-Hosseini Department of Oral and Maxillofacial Medicine, Dental Research Center, Tehran University of Medical Sciences, Tehran, Iran. AND Department of Oral Maxillofacial Medicine, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran. AND Department of Oral and Maxillofacial Medicine, The Academy of Medical Sciences, Tehran, Iran. Mina Mohebbian Department of Oral and Maxillofacial Medicine, Dental Research Center, Tehran University of Medical Sciences, Tehran, Iran. Mohammad-Reza Sarookani Department of Oral Maxillofacial Medicine, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran. Iraj Harirchi Department of Cancer Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran. Iraj Mirzaii-Dizgah Department of Physiology, School of Medicine, Aja University of Medical Sciences, Tehran, Iran. 2015 10 06 2015 10 06 Oral lichen planus (OLP) is classified as a potential malignant disorder, and epidermal growth factor (EGF) may play a key role in cancer development. The aim of this study was to compare serum and saliva EGF among patients with OLP and oral squamous cell carcinoma (OSCC). A cross-sectional study was performed on 27 patients with OLP (10 reticular and 17 atrophic-erosive forms), 27 patients with OSCC and 27 healthy control group. The study was conducted at the Cancer Department, Clinic of Oral Medicine, Tehran University of Medical Sciences. The serum and saliva EGF were assayed by ELISA method. Statistical analysis of ANOVA was used. The mean serum EGF in OLP and OSCC patients was significantly lower compared to healthy control group (P < 0.05), but no significant difference was observed between OLP and OSCC patients. There was no significant difference in mean salivary EGF among groups. As serum EGF levels appear to be statistically similar in OLP and OSCC, it seems that EGF might play a role in the pathogenesis of OLP and its cancerization. https://acta.tums.ac.ir/index.php/acta/article/view/4269 https://acta.tums.ac.ir/index.php/acta/article/download/4269/4224

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 53 8 2015 10 06 476 481 EN Roya Sattarzadeh-Badkoubeh Department of Cardiology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran. Babak Geraiely Department of Cardiology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mohssen Nassiri-Toosi Department of Internal Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran. Ali Jafarian Department of General Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 06 2015 10 06 We assessed different systolic cardiac indices to detect left and right ventricular systolic dysfunction in cirrhotic patients before liver transplantation. Between 2010-2011, 81 consecutive individuals with confirmed hepatic cirrhosis who were a candidate for liver transplantation were enrolled in this study. A total of 32 age and sex matched healthy volunteers were also selected as the control group. A detailed two-dimensional, Color Flow Doppler, and Tissue Doppler echocardiography were performed in all patients and control participants. Left atrial diameter and area, right atrial area, left ventricular enddiastolic volume, and basal right ventricular diameter were significantly higher in the cirrhotic group (P<0.05). Left ventricular ejection fraction, stroke volume, left ventricular outflow tract velocity time integral and tricuspid annular plane systolic excursion were also higher in the cirrhotic group (P<0.05). Peak systolic velocities of tricuspid annulus, basal segment of RV free wall and basal seg ent of septal wall, peak strains of basal and mid portions of septal wall, mid portion of lateral wall and peak strain rates of basal and mid portions of septal and lateral walls were higher significantly in cirrhotic group, as well (P<0.05). Isovolumic contraction time, LV systolic time interval and Tei indexes of left and right ventricles which all are representatives of systolic dysfunction were higher in cirrhosis. Peak systolic velocity of a mid-segment of the lateral wall was lower in the cirrhotic group (P<0.05) as well. Most of the cirrhotic patients display signs of cardiovascular disturbances that become more manifest following exposure to stresses such as transplantation. Cardiac failure is an important cause of death following liver transplantation. Because of the load dependency we cannot use most of the cardiac systolic indices for evaluatio of systolic function in cirrhotic patients. Thus, we suggest th t LV systolic time interval and Tei indices of left and right ventricles might be useful in ices in the evaluation of systolic function in cirrhotic patients. https://acta.tums.ac.ir/index.php/acta/article/view/4271 https://acta.tums.ac.ir/index.php/acta/article/download/4271/4226

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 53 8 2015 10 06 482 490 EN Kamran Rakhshan Department of Physiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Alireza Imani Department of Physiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. AND Department of Physiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. AND Department of Physiology, Occupational Sleep Research Center Tehran, Tehran, Iran. Mahdieh Faghihi Department of Physiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Fatemeh Nabavizadeh Department of Physiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Masoumeh Golnazari Islamic Azad University, Hamadan Branch, Hamadan, Iran. SeyedMorteza Karimian Department of Physiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 06 2015 10 06 Exposure to stress leads to physiological changes called “stress response” which are the result of the changes in the adrenomedullary hormone system, hypothalamus-pituitary-adrenal (HPA) and sympathetic nervous system (SNS) activity. In the present study, the effects of chronic physical and psychological stress and also the role of sympathetic system effects in stress on ischemia/reperfusion (I/R) injuries have been= studied in isolated rat heart. Rat heart was isolated and subjected to 30 min regional ischemia and 120 min reperfusion. The daily stress was induced for one week prior to I/R induction. Sympathectomy was done chemically by injection of hydroxyl-dopamine prior to stress induction. There were no significant changes in heart rate and Coronary Flow between groups. Left ventricular developed pressure (LVDP) and rate product pressure (RPP) in both physical and psychological stress groups decreased significantly compared to those in control group (P<0.05), but there was no significant difference betwe n physical and psychological stress groups. Infarct size significantly increased in both physical and psychological stress groups and control group (P<0.05. Sympathectomy before induction of stress led to the elimination of the deleterious effects of stress as compared with stress groups (P<0.05). These results show that induction of chronic physical and psychological stress prior to ischemia/reperfusion causes enhancement of myocardial injuries and it seems that increased sympathetic activity in response to stress is responsible for these adverse effects of stress on ischemic/reperfused heart. https://acta.tums.ac.ir/index.php/acta/article/view/4273 https://acta.tums.ac.ir/index.php/acta/article/download/4273/4228

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 53 8 2015 10 06 864 870 EN Morteza Izadi Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran. Mozhgan Fazel International Travel Medicine Center of Iran, Tehran, Iran Mohsen Akrami International Travel Medicine Center of Iran, Tehran, Iran. Seyed Hassan Saadat International Travel Medicine Center of Iran, Tehran, Iran. Bahram Pishgoo International Travel Medicine Center of Iran, Tehran, Iran. Mohammad Hassan Nasseri International Travel Medicine Center of Iran, Tehran, Iran. Hossein Dabiri Department of Medical Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Reza SafiAryan Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran. Ali Akbar Esfahani Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran. Ali Ahmadi Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran. Davood Kazemi-Saleh Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran. Mohammad Hassan Kalantar-Motamed Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran. Saeed Taheri Dr Taheri Medical Research Group, Tehran, Iran. 2015 10 11 An association between Chlamydia pneumoniae (C. pneumoniae) and cardiovascular disease has been demonstrated. In this study, we aimed to study this potential relationship in 105 Iranian patients. Coronary artery specimens from 105 Iranian patients undergoing CABG were analyzed by PCR method for C. pneumoniae. Serological evaluation for C. pneumoniae IgG and IgM was performed using ELISA. 53 specimens from mamillary artery were also investigated. C. pneumoniae PCR test result was positive for 23 (21.9%) of patients with coronary artery atherosclerosis, but none of the specimens from the mamillary artery was positive for C. pneumoniae when it was evaluated by the PCR (P<0.001). Coronary artery disease patients with and without a history of unstable angina or myocardial infarction were comparable in C. pneumoniae PCR test positive rates (P=0.618). Relevance of IgG and IgM positivity were also studied by correlating it to the study parameters, but no difference was found. CRP was significantly higher in the IgM positive group (P<0.001). A significant proportion of coronary atherosclerotic plaques are infected with C. pneumoniae while no infection was found in the normal mamillary artery specimens. No association was found between acute coronary syndromes and serological and PCR positivity. Further prospective randomized controlled studies with large patient population are needed to confirm our findings. https://acta.tums.ac.ir/index.php/acta/article/view/4332 https://acta.tums.ac.ir/index.php/acta/article/download/4332/4541

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 51 12 2013 12 15 871 878 EN Hossein Khalili Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. Samaneh Bairami Research Center for Rational Use of Drugs, Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. Mona Kargar Research Center for Rational Use of Drugs, Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 11 Drug induced acute kidney injury (AKI) has been implicated in 8% to 60% of all cases of in-hospital AKI and as such is a recognized source of significant morbidity and mortality. Evaluation of incidence, risk factors, onset time, and outcome of  antibiotics' associated acute kidney injury. During one-year period, all patients who developed acute kidney injury during their hospital stay in the infectious diseases ward of Imam Khomeini hospital were included in the study prospectively. Patients' demographic data, baseline diseases, cause of current hospital admission, history of past and current medications and hemodynamic parameters were collected and monitored closely. Drug induced acute kidney injury was defined based on acute kidney injury network criteria. From 424 admitted patients, 76 (17.9%) developed acute kidney injury. Aminoglycosides (gentamicin and amikacin), amphotericin B, vancomycin, beta-lactam antibiotics (cefazolin and ceftriaxone) in monotherapy and combination therapy were the causes of acute kidney injury in most of the patients. From the co-morbid diseases in patients with acute kidney injury, diabetes mellitus (26.3%) and hypertension (5.5%), were the most frequent ones. Presence of diabetes mellitus as comorbidity (OR=2.6; CI=1.3-5.7, P=0.01), dehydration of patients upon admission (OR=3.4; CI=1.9-6.4, P<0.001), and administration of nephrotoxic combinations (OR=2.1; CI=1.2-4.1, P=0.04) were independent risk factors for antibiotic induced nephrotoxicity in our study. About 18% of the patients developed acute kidney injury during their hospitalization period in the infectious diseases ward. Aminoglycosides, amphotericin B, vancomycin and beta-lactam antibiotics were responsible agents for acute kidney injury in this study. https://acta.tums.ac.ir/index.php/acta/article/view/4331 https://acta.tums.ac.ir/index.php/acta/article/download/4331/4544

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 51 12 2013 12 15 879 885 EN Kambiz Kamyab-Hesari Department of Dermatopathology, Razi Hospital, Tehran University of Medical Sciences. Tehran, Iran. Kamran Balighi Department of dermatology, Razi Hospital , Tehran University of Medical Sciences, Tehran, Iran. Nasim Afshar Department of dermatology, Razi Hospital , Tehran University of Medical Sciences, Tehran, Iran. Nessa Aghazadeh Department of dermatology, Razi Hospital , Tehran University of Medical Sciences, Tehran, Iran. Ziba Rahbar Department of dermatology, Razi Hospital , Tehran University of Medical Sciences, Tehran, Iran. Maryam Seraj Department of dermatology, Razi Hospital , Tehran University of Medical Sciences, Tehran, Iran. Maede Rayati Department of dermatology, Razi Hospital , Tehran University of Medical Sciences, Tehran, Iran. 2015 10 11 Adnexal tumors (ATs) are primary skin tumors with benign or rarely, malignant behavior. They have been classified based on differentiation towards hair follicle, sebaceous, apocrine or eccrine gland. Few large-scale studies have focused on ATs. To determine the prevalence of ATs and to assess clinical and histopathological trend of ATs. A retrospective descriptive study of all ATs diagnosed in Razi hospital between 2006 and 2010 was performed. A total of 30,000 pathology records were reviewed, and 1016 ATs were included. The prevalence of ATs was 3.3%. 518 patients (51%) were female, with a mean age of 34.5 years. 953 tumors (93.8%) were benign. ATs were most commonly located in the head and neck area (822, 83.5%). The most common histopathological origin of ATs was sebaceous gland (536, 52.7%). Sebaceous nevus of Jadassohn was the most prevalent single tumor type (40.6% of all ATs). In 63.6% (646) of tumors, ATs were clinically suspected by the clinician prior to biopsy. The most common malignant AT was sebaceous carcinoma (23, 36.5% of all malignant ATs). ATs are infrequent lesions, most commonly occurring in 3rd and 4th decade of life. Diagnosis of ATs is made by histopathological studies as they often express indistinctive clinical features. Malignant ATs are rare, occur at an older age, and are often hard to recognize clinically. https://acta.tums.ac.ir/index.php/acta/article/view/4330 https://acta.tums.ac.ir/index.php/acta/article/download/4330/4546

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 51 12 2013 12 15 886 891 EN Maryam Jalessi Department of ENT-Head and Neck Surgery, ENT-Head and Neck Surgery Research Center, Rasool Akram Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Farhadi Department of ENT-Head and Neck Surgery, ENT-Head and Neck Surgery Research Center, Rasool Akram Hospital, Tehran University of Medical Sciences, Tehran, Iran. Alimohamad Asghari Department of ENT-Head and Neck Surgery, ENT-Head and Neck Surgery Research Center, Rasool Akram Hospital, Tehran University of Medical Sciences, Tehran, Iran. Seyed Kamran Kamrava Department of ENT-Head and Neck Surgery, ENT-Head and Neck Surgery Research Center, Rasool Akram Hospital, Tehran University of Medical Sciences, Tehran, Iran. Ebrahim Amintehran Department of ENT-Head and Neck Surgery, ENT-Head and Neck Surgery Research Center, Rasool Akram Hospital, Tehran University of Medical Sciences, Tehran, Iran. Suzan Ghalehbaghi Department of Family Planning and Population Control, Islamic Azad University South Tehran Branch, Tehran, Iran. Ashkan Heshmatzadeh Behzadi Department of ENT-Head and Neck Surgery, ENT-Head and Neck Surgery Research Center, Rasool Akram Hospital, Tehran University of Medical Sciences, Tehran, Iran. Seyed Behzad Pousti Department of ENT-Head and Neck Surgery, ENT-Head and Neck Surgery Research Center, Rasool Akram Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 11 A wide range of population, 4% to 30%, suffers from tinnitus that is defined as perception of sound without apparent acoustic stimulus. We conducted the present study to determine the prevalence of tinnitus in Iranian population; Tehran province. This cross-sectional study was conducted from January 2009 to December 2009, recruiting 3207 individuals (age range, 7-98) who were residing in Tehran province, Iran. Participants were asked to fill two questionnaires; the validated Persian version of Tinnitus Questionnaire (TQ) and another one that was specifically designed for this study. Prevalence of tinnitus and its association factors were evaluated. 3207 participants enrolled into our study comprising 1429 (44.7%) male and 1765 (55.3%) female with mean age of 55.01±17.85. Of total of 3207 participants, 146 (4.6%) had tinnitus consisting of 80 male (54.8%) and 66 (45.2%) female participants. It showed a rising trend with increasing age that was especially significant after the sixth decade of life (P=0.001). The analysis showed mean TQ global score of 35.96±25.52 that was significantly different between male and female participants (P=0.051) and had no significant correlation with increasing age (Spearman's r=0.1, P=0.10). The tinnitus intensity was moderate to very severe in 95 (56.1%) of the participants. Its severity level was not significantly different between men and women (P=0.09). Tinnitus intensity had no significant association with increasing age (Spearman's r=0.1, P=0.31). Patients with higher TQ global score had higher tinnitus intensities (P=0.001). The annoyance level was significantly different between men and women (P=0.04) and its impact on the participants daily routine functions were significantly higher in men (P=0.003). Given the results of the study, demonstrating that prevalence of tinnitus in Iranian population (Tehran province) was lower than the other countries and had a direct correlation with increasing age only after the sixth decade. TQ global score had significant correlation with tinnitus intensity, annoyance and impact on the participants' daily routine functions. However, none of the above had correlation with increasing age. Tinnitus TQ global score and intensity were not different between men and women; however annoyance of tinnitus and its impact on participants' daily routine functions were significantly higher in men. https://acta.tums.ac.ir/index.php/acta/article/view/4329 https://acta.tums.ac.ir/index.php/acta/article/download/4329/4552

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 51 12 2013 12 15 892 896 EN Abdollah Jafarzadeh Department of Microbiology and Immunology, Medical School, and Molecular Medicine Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran. </