@article{ author = {Maddah, GH and Bagheri, R and SaeediSaedi, H and Roodbari, S.S and Sadeghian, M.H and Mohammadian, N}, title = {Evaluation of Bone Marrow Involvement in Surgically Resected Patients with Esophageal Cancer}, abstract ={Abstract Introduction: Bone marrow samples obtained during rib resections in esophageal cancer patients evaluated by immunohistochemical and quantitative polymerase chain reaction techniques revealed disseminated tumor cells in up to 90% samples, but the clinical relevance of these findings is unclear. Objective: Evaluation of bone marrow involvement in these patients and its correlation with clinicopathological finding of tumor. Materials and Methods: 43 patients with esophageal cancer who referred to Omid and Ghaem hospitals from April 2008-2009 were selected to transthorasic surgery(without neoadjuvant treatment).Bone marrow samples from rib were evaluated by Hematoxylin-Eosin staining for tumoral involvement and cytokeratin immunohistochemistry to determine micrometastatic cells. The results were compared with primary tumor histopathologial characteristics T stage, N stage, tumoral length and personal characteristics age & sex. Results: Patients mean age was 60.9(51-70 years), the ratio of male to female was 2.9. 38 cases (88.4%) had squamous cell carcinoma and 5(11.6%) adenocarsinoma. In 9 cases (20.9%) Hematoxylin-Eosin staining and 13 cases (30.2%) immunohistochemistry results were positive. There was no correlation between pathologic type and T stage with Hematoxylin-Eosin and cytokeratin results. (p=0.277, p=0.153) and (p=0.221, p=0.097). There was a significant relation between bone marrow dissemination and mediastinal involvement and tumoral grade (p=0.008, p=0.001) and (p=0.002, p=0.001). Conclusion: According to our study, there is a correlation between grade and N stage and bone marrow involvement in esophageal cancer patients and there is no statistically correlation with other clinicopathologial characteristic there is a low bone marrow involvement in our region patients, overally}, Keywords = {Bone Marrow, Esophageal Neoplasms, Esophagectomy, Neoplasm Metastasis}, volume = {18}, Number = {72}, pages = {1-7}, publisher = {}, url = {http://journal.gums.ac.ir/article-1-219-en.html}, eprint = {http://journal.gums.ac.ir/article-1-219-en.pdf}, journal = {Journal of Guilan University of Medical Sciences}, issn = {2383-4307}, eissn = {2423-4818}, year = {2010} } @article{ author = {Jafroodi, M and Asadi, R and Heidarzadeh, A}, title = {Evaluation of Correlation between Iron over Load and the Response of Chronic Hepatitis C in Thalassemia Major Patients Treat with Alfa- Interferon and Ribavirin}, abstract ={Abstract Introduction: β thalassemia is genetic disorders in β globin chain production. There is either a complete absence of β globin chain production or a partial reduction. In bone marrow, thalassemic mutations disrupt the maturation of red blood cells, resulting in ineffective erythropoiesis and disrupt of red blood cells in spleen causes severe hemolytic anemia in β thalassemia major Patients. Transfusion therapy can lead to normal life expectancy but also exposes Patients to the risks of iron over load and transfusion – transmitted viruse. (Especially HCV) these Patients need for effective anti viral therapy in addition to regular iron chelation. Objective: Evaluation of correlation between iron over load and the response of chronic hepatitis C In thalassemia major Patients treat with alfa- interferon and ribavirin. Materials and Methods: We enrolled 30 Patients with β thalassemia major and chronic hepatitis C who referred to clinic of hematology from December 1998 to April 2006. HIC was measured by atomic absorption spectroscopy before treatment. Hepatitis C virus, genotype, viral load, were analyzed. Multiple variables were analyzed by SPSS (15) Results: Among the 30 Patients, 17 cases (56.7%) were male and 13 cases (43.3%) female. HIC was determined on a liver biopsy specimen. This study showed that HIC was not correlated to a therapeutic response.(p =1). Evaluation of correlation between viral load and therapeutic response showed that viral load was not correlated to a therapeutic response (p= 0.414). Among the 30 Patients, 24 cases (80%) had genotype 1a and 6 cases (20%) had genotype 3a and genotyping was not correlated to a therapeutic response. (p=0.068). Gender and HIC were not correlated to a therapeutic response. (Male p=0.226) and (female p= 0.199). Conclusion: In this study HIC, genotyping, viral load and gender were not correlated to a therapeutic response and it does not need chelation therapy before anti viral therapy.}, Keywords = {Beta- Thalassemia, Genotype, Hepatitis C, Iron Overload, Interferon- alpha, Ribavirin, Viral load }, volume = {18}, Number = {72}, pages = {8-15}, publisher = {}, url = {http://journal.gums.ac.ir/article-1-220-en.html}, eprint = {http://journal.gums.ac.ir/article-1-220-en.pdf}, journal = {Journal of Guilan University of Medical Sciences}, issn = {2383-4307}, eissn = {2423-4818}, year = {2010} } @article{ author = {Pourghasem, M and Jorsaraei, GH and Farsi, M and Soltanpour, N and Kamali, N}, title = {Changes of Glycosaminoglycans in the Brain Tissue of Diabetic Rats}, abstract ={Abstract Introduction: Diabetes mellitus affects the metabolism of components of extra cellular matrix such as Glycosaminoglycans. Although the changes of Glycosaminoglycans have been attended but investigation of the changes of Glycosaminoglycans in the brain tissue of diabetic rat is still in early stages. Objective: Investigation of changes of Glycosaminoglycans in brain of diabetic rats. Materials and Methods: Based on an experimental study, 20 male Rats (Wistar, weight 200-250 gr) were randomly divided to two groups experimental (diabetic, N=10) and non-experimental (non-diabetic, N=10). A single dose of Alloxan (120ml/ km) was injected to the experimental group. Three months after injection, the slides were prepared from the brain of the rats and studied after stained by Hematoxylin- Eosin and Schmorl's method and Critical Electrolyte Concentration (CEC 1-4). Results: CEC staining showed that Heparin sulfate was the only Glycosaminoglycans which have been decreased in the brain tissue of the experimental group and any deposits in neurons, particularly Lipofuscin pigments were not expressed in used of Schmorl's method. Conclusion: According to the important roles of Heparin sulfate in normal functions of the nervous system and its role in repairing of the nervous tissue's injury, decrease of Heparin Sulfate, a kind of Glycosaminoglycans, could induce nervous injury and disorder in brain functions.}, Keywords = {Diabetes Melitus, Glycosaminoglycans, Nerve Tissue, Rats}, volume = {18}, Number = {72}, pages = {16-21}, publisher = {}, url = {http://journal.gums.ac.ir/article-1-221-en.html}, eprint = {http://journal.gums.ac.ir/article-1-221-en.pdf}, journal = {Journal of Guilan University of Medical Sciences}, issn = {2383-4307}, eissn = {2423-4818}, year = {2010} } @article{ author = {Shariati, A.R and Abbasi, A and MojerLou, M and Ghorbani, M}, title = {Comparison of the Effects of Oral Charcoal Capsule with Aluminum Hydroxide Syrup on Pruritus in Hemodialysis Patients}, abstract ={Abstract Introduction: Uremic pruritus is one of the most common and interruptive symptoms in patient with hemodialysis. Approximately, 60% of these patients suffering from this condition. There are several causes for pruritus, thus, various treatments are applied in order to control it. Objectives: Comparison the effects of Oral charcoal capsule with Aluminum Hydroxide Syrup on pruritus in hemodialysis patients in 5 Azar hospital, Gorgan. Materials and Methods: Using a cross-over clinical study, we examined 30 patients with moderate and severe pruritus (two groups n= 15 per group). Subjects received oral charcoal capsule (6g daily in three doses) for two weeks as well as hydroxide aluminum syrup (30 cc three times per day before each meal) for the same time. Wash out period was considered 48 hours. Pruritus severity was determined by visual analog scale (VAS) and measurement of pruritus scale (MPS). Data were analyzed by SPSS using Wilcoxon, Mann-Whitney, unpaired and paired t-test. P=0.05 was considered as statistic significant level. Results: Based on VAS and MPS, patients in the first group showed 40% moderate pruritus and 60% severe pruritus. However, patients in the second group showed 46.7% moderate pruritus and 53.3% severe pruritus at the beginning of the clinical trials. The results also showed that oral charcoal significantly decreased the severity of pruritus in both groups (α<0.05). However, this effect was not the case for hydroxide aluminum syrup. Conclusion: This study showed that oral charcoal capsule was an effective drug to decrease pruritus in hemodialysis patients to compare with hydroxide aluminum syrup}, Keywords = {Aluminum Hydroxide, Oral Charcoal, Pruritus, Renal Dialysis }, volume = {18}, Number = {72}, pages = {22-29}, publisher = {}, url = {http://journal.gums.ac.ir/article-1-222-en.html}, eprint = {http://journal.gums.ac.ir/article-1-222-en.pdf}, journal = {Journal of Guilan University of Medical Sciences}, issn = {2383-4307}, eissn = {2423-4818}, year = {2010} } @article{ author = {Parvizi, P and Hedayati, M}, title = {Leishmania Infections in Rodents, Reservoir Hosts of Zoonotic Cutaneous Leishmaniasis in Turkemen Sahara}, abstract ={Abstract Introduction: Zoonotic Cutaneous Leishmaniasis (ZCL) is a tropical diseases caused by Leishmania major, which sandflies are vectors and rodents are reservoirs host. Turkmen Sahara after Isfahan, is the most important endemic disease focus in Iran. Objective: Determination of Leishmaniasis Infections in Rodents, Reservoir Hosts of Zoonotic Cutaneous Leismaniasis in Turkemen Sahara, Gonbad, Golastan Province. Materials and Methods: Rodents were captured by live-capture tarps. Cucumber and sometimes date were used for bating. A part of rodents ears was used to have serousite. Serosite transferred into NNN media, A part of rodents ears was used for sliding and staining for amastigote detection and other part was used for inoculation to susceptible animal (Balb/c) in suspension form and biopsy was used. Results: 40 rodents were captured, 27 were Rhombomis opimus, 12 were Meriones libycus and one was Meriones persicus. Of 40 rodents captured, 5 were positive in routine laboratory methods which 3 positive were M. libycus, one was R. opimus and one was M. persicus. Conclusion: Besides these new findings in R.opimus as well as in M.libycus and M.persicus. These two rodents should be considered as reservoirs of ZCL in region.}, Keywords = {Leishmania, Major}, volume = {18}, Number = {72}, pages = {30-38}, publisher = {}, url = {http://journal.gums.ac.ir/article-1-223-en.html}, eprint = {http://journal.gums.ac.ir/article-1-223-en.pdf}, journal = {Journal of Guilan University of Medical Sciences}, issn = {2383-4307}, eissn = {2423-4818}, year = {2010} } @article{ author = {KazemiArababadi, M and Pourfathollah, A.A and Hassanshahi, GH.H and Pooladvand, V and Yaghini, N and Shamsyzadeh, A}, title = {Evaluation the Relationship between Alleles of +1188 in Region of IL-12 with Serum Level of Cytokine in Patients with Occult HBV Infection}, abstract ={Abstract Introduction: Occult hepatitis B infection (OBI) is a form of hepatitis, which in despite of absence of detectable HBsAg, HBV-DNA is present in peripheral blood of patients. Objective: Evaluation the relationship between alleles of +1188 in region of IL-12 with serum level of cytokine in patients with occult HBV infection. Materials and Methods: In this study, the plasma samples of 3700 blood donors were tested for HBsAg and anti-HBc by ELISA. The HBsAg negative ve and anti-HBc positive samples were selected and screened for HBV-DNA by PCR. HBV-DNA positive samples assigned as OBI cases and PCR-SSP and ELISA were performed to examine the polymorphisms in region of (+1188 and serum level of IL-12) respectively. Results: The results showed that there is a significant difference in CC allele of +1188 region of IL-12 in two groups and no difference in the other evaluated genes. There is not any significant difference in serum level of IL-12 between OBI patients and controls. Our results also showed that there isn’t any significant statistically relation between alleles of +1188 region of IL-12 with serum level of cytokine. Conclusion: According to the results of this study it could be concluded that OBI patients unable to produce enough quantity of IL-12 and it may be related to different IL-12 gene. CC allele was associated with OBI, hence, it seems that +1188 region of IL-12 gene has an important role in expression of IL-12 gene. Evaluation of relation between polymorphisms in +1188 region of IL-12 gene and its expression. In vitro and under mitogene affect can useful because no association was seen between serum level of IL-12 and alleles of this region.}, Keywords = {Hepatitis B, IL-12, Polymorphism(Genetics)}, volume = {18}, Number = {72}, pages = {39-46}, publisher = {}, url = {http://journal.gums.ac.ir/article-1-224-en.html}, eprint = {http://journal.gums.ac.ir/article-1-224-en.pdf}, journal = {Journal of Guilan University of Medical Sciences}, issn = {2383-4307}, eissn = {2423-4818}, year = {2010} } @article{ author = {MansourGhanaie, M and Haryalchi, K and Heydarzadeh, A and Asgari, A}, title = {Survey Relationship between the Severity of Hyperemesis Gravidarum and Fetus Sexuality}, abstract ={Abstract Introduction: Hyperemesis Gravidarum(HG) is the extreme amount of nausea and vomiting during pregnancy. The incidence of this problem is between 0.3- 2%. HG is multifactorial disorder which fetal sexuality is one of them and some studies indicated the relation between HG and female fetus. Objective: Survey the relationship between the severity of hyperemesis gravidarum and fetus sexuality. Materials and Methods: All medical cases of pregnant women who referred to Alzahra hospital from 1997 to 2007 were considered as a descriptive- analytical study. Known cases of HG were selected (separated) between them. Variables such as fetal sexuality, duration of hospitalization, age, parity, pregnancy trimester, biochemical tests were extracted and analyzed with SPSS 14 and Fisher exact test. Results: Among 197 cases, 150 cases (76.14%) were selected because of their full information 80.2% of women with female fetus, stayed ≥4 days at the hospital. This amount was 33.9% in women with male fetus (p< 0.0001). Ketonuria ≥3+ (P<0.016), Hyponatremia (P<0.035), Hyperuremia (P<0.045) were 16.5 %, 41.8 %, 62.6% in the first group and this amount were 3.4%, 23.7%, and 3.61% in the second group. 84.6% of women with female fetus and 64.4% of women with male fetus hospitalized in their first trimester (p=0.006). HG was sever in 79.1% of women with female fetus and 61% of women with male fetus (p= 0.025). Conclusion: This study showed statistical relationship between fetus Sexuality and severity of HG. The severity of this problem get raised with ketonuria, Hyperuremia, Hypernatermia and hospitalization in the first trimester.}, Keywords = {Fetus, Hyperemesis Gravidarum, Nausea, Pregnancy }, volume = {18}, Number = {72}, pages = {47-55}, publisher = {}, url = {http://journal.gums.ac.ir/article-1-225-en.html}, eprint = {http://journal.gums.ac.ir/article-1-225-en.pdf}, journal = {Journal of Guilan University of Medical Sciences}, issn = {2383-4307}, eissn = {2423-4818}, year = {2010} } @article{ author = {Nikravesh, M.R and Jalali, M and Moin, A.A and Karimfar, M,H and Refighdoost, H and Mohammadi, SH}, title = {The Key Role of Type IV Collagen in Developing Retinal Basement Membrane in Mouse}, abstract ={Abstract Introduction: Basement membranes are specialized extracellular matrices serve as development, proliferation and substrates for migration. Collagen fibers specially type IV, are the most important part of this area. As retina is one of the target organs in diabetes mellitus and diabetic retinopathy and diabetic nephropathy are major cause of end stage - renal and retinal diseases and resulting in increased in morbidity and mortality of effected individuals, therefore early diagnosis leads to better treatment. Objective: Investigation the appearance and distribution of collagen IV during gestational days and early postnatal period. Materials and Methods: 24 intact female Balb/c mice were kept under normal nutrition and environment condition. After mating, vaginal plug was assumed as zero day of pregnancy. From (13th-18th) days, gestation pregnant mice were sacrified and their embryos as well as pups from 1st to 5th days were collected. For histochemichal studies, the head of specimens were fixed, histological preparation was done and by using monocolonal antibody against for tracing of collagen type IV were carried out. Results: Our finding revealed that amount of collagen IV in internal limiting membrane (ILM) and extra cellular matrix (ECM) of the retina appearance on embryonic 16th day and increase continuously until end stage of embryonic life. In addition, strong labeling was observed until 3rd day of postnatal period but these reactions did not increase significantly after these periods. Conclusion: These findings indicate that retinal development is dependent on different proteins by special regards specially collagen IV.}, Keywords = {Collagenases, Evolution, Extracellular Matrix, Mice, Retina }, volume = {18}, Number = {72}, pages = {56-62}, publisher = {}, url = {http://journal.gums.ac.ir/article-1-226-en.html}, eprint = {http://journal.gums.ac.ir/article-1-226-en.pdf}, journal = {Journal of Guilan University of Medical Sciences}, issn = {2383-4307}, eissn = {2423-4818}, year = {2010} } @article{ author = {Alavi, S.M and Moshiri, N and Moosavian, S.M and Yusefi, F and Abbasi, E}, title = {Seroprevalence of Legionella Pneumophila in Patients with Community Acquired Pneumonia}, abstract ={Abstract Introduction: Legionella pneumophila (LP) is a major cause of pneumonia worldwide. In spite of suitable epidemiological conditions and probability of LP existence in the region, the incidence of LP infection has not been determined in Ahvaz. Objective: Determination the seroprevalence of LP in patients with Community Acquired Pneumonia (CAP). Materials and Methods: In this prospective descriptive study, during one year period (2007-2008), 80 admitted patients were selected in Razi Hospital of Jundi Shapoor University of Medical Science in Ahvaz with CAP and was studied the serprevalence of LP among them. Sera were tested for L. pneumophila IgG and IgM by using Elisa kit (Vircell, Spain). Data were analyzed by using SPSS, version 16 statistical package. Results: Among 80 serum samples, 12 cases (15%) were positive for LP- IgG+ IgM. Age, gender and area of residency did not significantly affect the seroprevalence of L P. (P>0.05). The prevalence of L P seropositivity was not significantly affected by co-morbidities except diabetes mellitus (P>0.05). Smoking and receiving antibiotic was observed in 100% seropositive patients. Conclusion: Legionella Pneumophila is a prevalent infectious agent in Ahvaz and should be considered in patients with CAP especially in diabetic and smoker patients.}, Keywords = {Legionella Pneumophila, Pneumonia, Seroprevalence}, volume = {18}, Number = {72}, pages = {63-69}, publisher = {}, url = {http://journal.gums.ac.ir/article-1-227-en.html}, eprint = {http://journal.gums.ac.ir/article-1-227-en.pdf}, journal = {Journal of Guilan University of Medical Sciences}, issn = {2383-4307}, eissn = {2423-4818}, year = {2010} } @article{ author = {Ghayeghran, A.R and BakhshayeshEghbali, B and Heidarzadeh, A}, title = {Survey the Correlation between F Wave Persistence and Level of Consciousness in Stroke Patients}, abstract ={Abstract Introduction: Level of consciousness is an important factor in management of critically ill patients and predicting outcome. However there is no quantitative, reproducible measure for evaluation of consciousness. F wave persistence can be influenced by level of consciousness according to some studies. Objective: Survey the correlation between F wave persistence and level of consciousness in stroke patients. Materials and Methods: In this cross sectional study, 114 patients within 72 hours of stroke onset were divided according to their level of consciousness either with GCS and qualitative method. F wave persistence were obtained in each Tibial nerves. Effects of background variables including side of study, side of hemiparesis, type of stroke, and sex were evaluated. Data were analyzed by SPSS14.o and ANCOVA statistic model. Results: A significant correlation were found between F wave persistence and level of consciousness, either with GCS or qualitative method (P<0.001). These results were independent of the side of study, side of hemiparesis, type of stroke, and sex. Conclusion: F wave persistence can be influenced by level of consciousness. F wave study may be a useful objective and quantitative measure in documenting the severity of consciousness impairment.}, Keywords = {Cerebrovascular Accident, Consciousness, Glasgow Coma Scale}, volume = {18}, Number = {72}, pages = {70-76}, publisher = {}, url = {http://journal.gums.ac.ir/article-1-228-en.html}, eprint = {http://journal.gums.ac.ir/article-1-228-en.pdf}, journal = {Journal of Guilan University of Medical Sciences}, issn = {2383-4307}, eissn = {2423-4818}, year = {2010} } @article{ author = {Zahed, F and Abolghasemi, A and Narimani, M and Salari, A}, title = {The Relationship of Fatigue and Hostility with Health in Patients with Coronary Artery Disease}, abstract ={Abstract Introduction: Fatigue and hostility can be influence quality of life in patients with coronary artery disease. Objective: Investigation the relationship of fatigue and hostility with quality of life in patients with coronary artery disease. Materials and Methods: The samples consisted of 60 coronary heart disease patients which were selected among all coronary artery disease persons who had referred to Heshmat Hospital in Rasht. For gathering data were used. Choreic Fatigue Scale, Hostility Scale and Health survey. Data was analysed by using Pearson correlation coefficient and multiple regression analyses. Results: The results of Pearson correlation coefficient showed that fatigue (r=-.64) and hostility (r= -.25) are related to quality of life (P<0.05). The results of multiple regression showed that physical fatigue, is the best significant contribute in prediction of quality of life in patients with coronary artery disease. Conclusion: These results are in keeping with findings from other studies and indicated that the role of fatigue and hostility in quality of life in patients with coronary artery disease.}, Keywords = {Coronary Arteriosclerosis, Fatigue, Hostility, Quality of Life }, volume = {18}, Number = {72}, pages = {77-84}, publisher = {}, url = {http://journal.gums.ac.ir/article-1-229-en.html}, eprint = {http://journal.gums.ac.ir/article-1-229-en.pdf}, journal = {Journal of Guilan University of Medical Sciences}, issn = {2383-4307}, eissn = {2423-4818}, year = {2010} } @article{ author = {Khalili, M and Kiasalari, Z and Rahmati, B and Ekhlasi, M and Azizi, Y and Heydari, H}, title = {The Effect of Aqueous Crocus Sativus L. Extract on Intracerebroventricular Streptozotocin-Induced Cognitive Deficits in Male Rat}, abstract ={Abstract Introduction: Alzheimer as a prevalent central nervous system disease has no definitive treatment yet. So, regarding to herbal medicine recommendation, an important candidate herb, Crocus sativus L. extract (CSE) was investigated on ICV STZ-induced learning, memory, and cognitive impairment in male rats. Objective: The Effect of aqueous crocus sativus L. extract on intracerebroventricular streptozotocin-induced cognitive deficits in male rat. Materials and Methods: We use STZ injection as a model for Alzheimer's disease. For this purpose due to an animal stereotaxic surgery, the rats were injected with STZ-icv bilaterally, on 1st and 3rd days (3 mg/kg). The learning and memory performance was assessed using passive avoidance paradigm, and for spatial cognition evaluation, Y maze task was used. Sixty male rats were divided to following groups: 1- Control, 2- Sham (which received only ACSF), 3-Control + CSE, 4-STZ, 5-STZ+CSE. The STZ-injected rats received CSE (30 mg/kg i.p.). These rats were treatment one day before surgery for three weeks and then were subjected to learning and memory tests. In Y maze test the non repetitive percentage of arm entrance were considered as alternation behavior (intelligence quotient). Data in Passive avoidance task was the latent period (s) for passing from light to dark room due to adaptation periods. However, for the passive avoidance test nonparametric Kruskal-Wallis test was used, which if significant, was followed by Mann-Whitney U-test for pair-wise comparisons. Data for the Y maze task were evaluated by Wilcoxon’s rank sum test Results: It was found that CSE-treated STZ-injected rats showed higher correct choices and lower errors in Y maze than vehicle-treated STZ-injected rats. In addition, CSE administration significantly attenuated learning and memory impairment in treated STZ-injected group in passive avoidance test. Conclusion: These results demonstrated the effectiveness of CSE in preventing the cognitive deficits caused by STZ-icv in rats and its potential in the treatment of neurodegenerative diseases such as Alzheimer's disease.}, Keywords = {Crocus, Learning, Memory, Rats, Streptozotocin}, volume = {18}, Number = {72}, pages = {85-93}, publisher = {}, url = {http://journal.gums.ac.ir/article-1-230-en.html}, eprint = {http://journal.gums.ac.ir/article-1-230-en.pdf}, journal = {Journal of Guilan University of Medical Sciences}, issn = {2383-4307}, eissn = {2423-4818}, year = {2010} } @article{ author = {}, title = {}, abstract ={}, Keywords = {}, volume = {18}, Number = {72}, pages = {94-102}, publisher = {}, url = {http://journal.gums.ac.ir/article-1-231-en.html}, eprint = {http://journal.gums.ac.ir/article-1-231-en.pdf}, journal = {Journal of Guilan University of Medical Sciences}, issn = {2383-4307}, eissn = {2423-4818}, year = {2010} }