@article{ author = {Afraz., M and Malki, M}, title = {Prevalence and associated risk factors of silent transmural myocardial infarction in a cardiovascular clinic patients in Rasht.}, abstract ={ABSTRACT To clarify the prevalence and associated risk factors of silent transmural myocardial infarction (SMI), we examined a consecutive series of 1390 patients (mean age 56.6 years, male 70.9 percent, female 29.1 percent) with diagnosis of transmural myocardial infarction (MI) by resting ECG (with or without previous history of MI).during a period of six years in a cardiovascular private clinic in Rasht. 417 subjects (30 percent of the total patients didn't have previous history of MI(SMI) The frequecy of SMI in women was significantly higher than men (P<0.001). Mean age of patients with SMI was significantly greater than Non-Silent myocardial infarction (NSMI) in total patients (P<0.01) and male patients (P<0.01),but non-significant (NS)in female patients. The frequency of high blood pressure (HBP) in SMI was significantly higher than NSMI (P<0.001) in total patients, and (P<0.001) in men, but NS in women. The frequency of diabetes mellitus (DM) with HBP (P<0.005), Inferior (Posterior)wall MI (P<0.005). anteroseptal MI (P<0.01 atrial fibrillation (AF)(P<0.005), and mean high density lipoprotein (HDL)(P<0.02)in SMI were significantly higher than NSMI. The frequency of cigarette smoking (P<0.001) and mean Serum triglycerides (P<0.05)in SMI was significantly lower than NSMI. The frequency of DM, Stroke, transient ischemic attack, peripheral obstructive arterial disease, family history of coronary artery disease in first degree relatives, blood groups of ABO system, congestive heart failure, mean total cholesterol and low density lipoprotein were different in both groups. We conclude that ,SMI is common and is more in females than males. It was frequent in male patients with older age and HBP with higher HDL, and Lower triglycerides, smaller-Sized infarcts and frequent AF than similar patients with clinically recognized MI.}, Keywords = {Myocardial infarction -Diagnosis /Myocardial Infarction- Epidemiology Myocardial infarction –Etiology}, volume = {6}, Number = {23}, pages = {1-11}, publisher = {}, url = {http://journal.gums.ac.ir/article-1-1847-en.html}, eprint = {http://journal.gums.ac.ir/article-1-1847-en.pdf}, journal = {Journal of Guilan University of Medical Sciences}, issn = {2383-4307}, eissn = {2423-4818}, year = {1997} } @article{ author = {Noorsalehi, E and GhallehZari, and Aminian, M}, title = {Determination of Prevalence Rate of Protein - Energy Malnutrition in Children Under 5 in Urban and Rural Areas of Guilan Province}, abstract ={ABSTRACT The term of protein-energy malnutrition refers to disorders that mainly manifest due to nuitritional deficiency in body .Lack of sufficient caloric sources and foods containing essential amino acids can provide the background for these disorders.Because of special nutritional needs for growth , children are significantly exposed to involvement with this disease. Thus,attention to them has special importance. It is clear that identification of nutritional status of children is the most important step in planning for the best methods of providing services. Anthropometric assessment is one of the appropriate methods for sectional evaluation. Therefore research project to determine the prevalence of protein - energy malnutrition among children under 5 in urban and rural areas of Guilan Province was implemented. Accordingly, height and weight of 3478 children with regard to the standards of age were measured. Subsequently various degrees of malnutrition were determined by McLarence formula. Based on obtained results about 22.4 percent of children had various degrees of protein-energy malnutrition .However the majority of these children suffered from mild to moderate degrees of the disease but lack of sufficient attention to them could deteriorate their present nutritional status.}, Keywords = {Child Nutrition /Protein-Energy Malnutrition /Etiology}, volume = {6}, Number = {23}, pages = {12-17}, publisher = {}, url = {http://journal.gums.ac.ir/article-1-1848-en.html}, eprint = {http://journal.gums.ac.ir/article-1-1848-en.pdf}, journal = {Journal of Guilan University of Medical Sciences}, issn = {2383-4307}, eissn = {2423-4818}, year = {1997} } @article{ author = {Salarkia, N}, title = {The Effect of Iron Supplementation on Iron Status and Work Capacity in Exercising Young Women}, abstract ={ABSTRACT storile o In a randomized controlled trial ,the influence of iron supplementation and exercise was studied . 28 normal women with age 18-25 (Mean 21.8+2.3) years were randomly selected in 2 groups of placebo and iron treatment (50 mg iron/day as Feso4) in a Sport Club of Tehran, exercised at least three days per week at 70-80% of maximal heart rate for 12 weeks. Fasting venous blood samples were obtained for hemoglobin (Hb), hematocrit (HC),serum iron total iron binding capacity (TIBG),transferin saturation (TS) and ferritin determination at weeks 0,4,8 and 12 .VO2max consumption test to assess cardiovascular fitness were conducted at baseline and after 12 week of exercise. subjects also completed 3 - day dietary records prior to the start of the study and again during the 12th week of exercise. Mean VO2max increased for both placebo and iron supplementation groups. Iron improvement of 12.5% in placebo group was observed. The change in VO2max was not significantly different between groups.No significant differences were observed in hematocrit, serum iron ,TIBC and TS between groups at weeks of 0,4,8 and 12. Ferritin levels in the iron supplementation group increased(from 2635 to 18+6 ug/dl at week 12). Mean hemoglobin level in the placebo group dropped from baseline to the week 4(from 13.8£0.6 to 12.3+0.7 g/dl)and then rose gradually at weeks of 8 and 12(from 12.5£0.6 to 12.7:0.7 g/dl),while mean Hb value in the iron supplementation group (from 2635 to 18+16 ug/dl at week 12). Mean hemoglobin level in the placebo group dropped from baseline to the week 4(from 13.5+0.6 to 12.7+0.7 g/dl), while mean Hb value in the iron supplementation group remaind fairly constant (from 13.3+0.3 to 13.5+0.3 g.dl at the week 12). There were no significant differences in energy and dietary intakes between groups at baseline and week 12. Increases in maximal O2 consumption (VO2 max)in both groups indicated improved cardiovascular fitness. Women in the placebo group tended to have short er exercise sessions than those in the iron supplementation group.This could be due to the effect of iron supplement leading to the improvement of iron stores in moderately exercising women. These differences most likely account for lower percent improvement in the placebo group.  }, Keywords = {Anemia, Hypochromic/ lron/ Women}, volume = {6}, Number = {23}, pages = {18-23}, publisher = {}, url = {http://journal.gums.ac.ir/article-1-1850-en.html}, eprint = {http://journal.gums.ac.ir/article-1-1850-en.pdf}, journal = {Journal of Guilan University of Medical Sciences}, issn = {2383-4307}, eissn = {2423-4818}, year = {1997} } @article{ author = {Roushani, A and Tavakkol-Nia, R}, title = {A Comparison of Serum Levels of Prostate Specific Antigen (PSA) Before and After Ejaculation in 21 Males in Clinic or in Urology Unit}, abstract ={ABSTRACT Prostate specific antigen (PSA) is a specific marker of prostate tumor which is used for diagnosis of prostate cancer. Apart from prostate cancer,different factors may affect PSA level and ejaculation is one of these possible factors .In a study on 21 patients at ages of 18-37, serum levels of PSA were measured before the ejaculation and about two hours after it. There was no statistically significant difference between the PSA levels before and after ejaculation. Based on this study ,PSA levels can be measured within a short interval of ejaculation without any fear about the false increase or decrease in its serum levels.}, Keywords = {ejaculation /Prostate specificAntigen}, volume = {6}, Number = {23}, pages = {24-27}, publisher = {}, url = {http://journal.gums.ac.ir/article-1-1851-en.html}, eprint = {http://journal.gums.ac.ir/article-1-1851-en.pdf}, journal = {Journal of Guilan University of Medical Sciences}, issn = {2383-4307}, eissn = {2423-4818}, year = {1997} } @article{ author = {Ghanbari, A}, title = {Comparison of laser vs Non-Laser Thermal Modalities for the Treatment of Watermelon Stomach (WMS)}, abstract ={ABSTRACT No comparison exists between laser and other non laser modalities. we have reviewed our 6 years experience in 34 consecutive patients with the endoscopic diagnosis of WMS. All patients were followed up.Coexistent disorders included systemic sclerosis,choronic renal failure ,cirrhosis, rheumatoid arthritis, diabetes mellitus,malignancy . Endoscopic ablation of WMS had been indertaken in 31 patients(mean age 72 yr.6 male) for the purposes of analysis, patients were divided into 3 treatment groups:Laser Thermal „Laser Non -laser Thermal ,C Conclusion :Bleeding from WMS can be effectively treated with Laser and Non - Laser Thermal .Both modalities are equally effective in this comparison ;however, this requires validation with longer follow-up in the Non-Laser Thermal group.}, Keywords = {: Endoscopy /Lasers /Stomach Diseases}, volume = {6}, Number = {23}, pages = {28-34}, publisher = {}, url = {http://journal.gums.ac.ir/article-1-1852-en.html}, eprint = {http://journal.gums.ac.ir/article-1-1852-en.pdf}, journal = {Journal of Guilan University of Medical Sciences}, issn = {2383-4307}, eissn = {2423-4818}, year = {1997} } @article{ author = {Mojtaba'ee, H and Shafaghi., A and Ali-ee, A}, title = {A Clinical Trial Study in Assessment of Effects of Vitamin E in Acute Hemolysis Attack in Glucose -6-phosphate Dehydrogenase DeficientPatients (Favism)}, abstract ={ABSTRACT Glucose -6-phosphate dehydrogenase (G6PD)deficiency is the most common inheritory enzyme defect in human. With this deficiency, red blood cells are susceptible to hemolysis induced by oxidants .Drage and foods (esp. fava beans) are the most common oxidants that cause acute hemolysis (Favism). Vitamin E.that is an potent antioxidant,was studied in chronic hemolysis of these patients. Our study indicates an hemoglobin increase after transfusion with Vitamin E consumption. We included 38 patients with acute hemolysis presentation that had a history of recent fava bean ingestion We divided the patients into two groups randomly.First group received vitamin E (800 U/day) and supportive care for hemolysis and the latter only supportive care as control group. Means of hemoglobin differences were compared in two groups before transfusion and 4 hours after it and also mean hemoglobin differences between admission and discharge were greater in test grouprather than control group. Vitamin E is a potent antitoxidant that can stablize RBC membrane and protect it against lysis. This drug have very few side effects and is a safe drug in usual dosage (400-1000 U/day). Vitamin hemolysis can be used in treatment of acute hemolysis attacks of G6PD(Favism ).}, Keywords = {Favism /Hemolysis /Vitamin E }, volume = {6}, Number = {23}, pages = {35-42}, publisher = {}, url = {http://journal.gums.ac.ir/article-1-1853-en.html}, eprint = {http://journal.gums.ac.ir/article-1-1853-en.pdf}, journal = {Journal of Guilan University of Medical Sciences}, issn = {2383-4307}, eissn = {2423-4818}, year = {1997} } @article{ author = {Kosha, A.R}, title = {A Study of Neck Tumors in Tutonkaran Hospital During a Period of Three Years (1993 - 1996).}, abstract ={ABSTRACT 182 patients who had referred to Tutonkaran Hospital with complaints of tumor in the neck during a period of three years (1372-1375)and had ultimately undergone surgery, were included in a study .Age , sex presenting symptoms , site of tumor in the neck , geographical distribution ,original complaints and physical examination were scrutinized and all paraclinical studies were made . Most of them had undergone FNA prior to surgery. Results were ultimately compared with final pathological diagnosis . Patients were divided into three groups:Group I between ages 4 to 15 years; Group II between ages 16 to 40 years ;Group III between ages 40 and above. Results were as follows : The most common tumors of neck were neoplastic ones in group 1 , the most common tumors were congenital thyroglossal cysts. The most common neoplasms were those of thyroid and salivary glands. Among neoplasms , benign lesions were more common. But benign and malignant lesions were more common in females than in males, and relation of benign to malignant tumor in both sexes was 1:12. Inflammatory tumors were more common in groups II than those in other two groups. They comprised of infections inflammation and non specific tumors of salivary and lymphatic glands As regards to site of tumors 85% were in anterior triangle and the remaining were in posterior triangle. Over 50% of tumors in posterior triangle were of neoplastic type.}, Keywords = {: Head and neck Neoplasms}, volume = {6}, Number = {23}, pages = {43-47}, publisher = {}, url = {http://journal.gums.ac.ir/article-1-1854-en.html}, eprint = {http://journal.gums.ac.ir/article-1-1854-en.pdf}, journal = {Journal of Guilan University of Medical Sciences}, issn = {2383-4307}, eissn = {2423-4818}, year = {1997} } @article{ author = {Shamkhani., K and Barzigar., A and AkbarSMH, and Khatibi, P and Tehrani., M}, title = {A Study on Prevalence of Acute Myocardial Infarction in Young Patients Admitted to Poorsina and DR.Heshmat Hospital ,Rasht}, abstract ={ABSTRACT To determine the prevalence of Acute Myocardial Infarction (AMI)in young adults (Men <40 years and women up to 45 years ),and to get a regional baseline data , in comparison with international statistics, and to evaluate major risk factors among young people of this area, case records of one thousand of AMI patients admitted to the hospitals of Rasht were studied retrospectively. 81 patients were aged. Male female ratio in young patients was 2.3 to one while in aged patients of AMI, it was 3.8 to one. Incidence of smoking habit and hypertension were nearly the same in both age groups; Hypercholesterolemia was significantly higher (16%) among the young people in comparison to 9% in aged patients (P<0.05). We conclude that 8.1% of all AMI events occur in young age. In patients up to 39 years, prevalence of AMI was found 5.1% which is comparable to results of similar studies abroad. Detection and treatment of hypercholesterolemia in young adults need special attention}, Keywords = {Adultscence/Myocardial infarction/Myocardial infarction-Epidemiology /Myocardial infarction -Etiology }, volume = {6}, Number = {23}, pages = {48-52}, publisher = {}, url = {http://journal.gums.ac.ir/article-1-1855-en.html}, eprint = {http://journal.gums.ac.ir/article-1-1855-en.pdf}, journal = {Journal of Guilan University of Medical Sciences}, issn = {2383-4307}, eissn = {2423-4818}, year = {1997} } @article{ author = {Falahatkar., S and Nobakht, A and Inturn-Khoshhal, E}, title = {Result of Cystoscopic Report in 100 Patients with Hematuria}, abstract ={ABSTRACT In this study, 100 patients with negative labaratory test and without definitive diagnosis by imaging ,were evaluated by cystoscopy. Hematuria was defined as the appearance of red blood cells equali to or more than two in high power field (hpf). ¼ of these patients had microscopic hematuria and ¾ of patients had macroscopic hematuria. Male to female ratio increases significantly with age. In this study, bladder tumor was the most common cause of painless macroscopic hematuria. If microscopic hematuria is asymptomatic and it appears accidentally, it is more likely that the result of cystoscopy is reported normal and the most common group with normal cystoscopy are females in childbearing age. With comparison of diagnostic results, normal cystoscopy in female/ male is 6/1 and bladder tumor in M/F is 6/1 In 100 patients that were evaluted with cystoscopy, the most common cause of hematuria in males was blader tumor and in females was normal cystoscopy.}, Keywords = {Cystoscopy /Hematuria /Hematuria-Etiology }, volume = {6}, Number = {23}, pages = {53-56}, publisher = {}, url = {http://journal.gums.ac.ir/article-1-1856-en.html}, eprint = {http://journal.gums.ac.ir/article-1-1856-en.pdf}, journal = {Journal of Guilan University of Medical Sciences}, issn = {2383-4307}, eissn = {2423-4818}, year = {1997} } @article{ author = {Malaki, H and Tootchi, M}, title = {A Comparative Study between VPT and NCV in Patients with Diabetes Mellitus}, abstract ={ABSTRACT In a study ,correlation between the changes in vibratory perception threshold (VPT) and disorders of motor neuron conduction velocity (MNCV) in neuropathic diabetic patients in Neurology Unit, Poorsina Hospital ,50 neuropatic diabetic patients from both sex(mean age 44±18 in males and 46±10 in females) in two groups of insulin dependent and non-dependent patients, 15 patients as control group were undergone the electroneurography (NCV+EMG tests). In all test group of NCV on median, ulnar ,tibial and peroneal nerves neuron conduction velocity and amplitude of evoked wave were recorded as test parameters .Also IF.VPT and CT.VPT were measured . The following results were obtained :A significant correlation was observed between the changes of VPT in hand MNCV in median and ulnar nerves (P<0.003). Furthermore there was an inverse correlation between IF.VPT and AMP of the evoked wave in the patients group. There was a more significant correlation in the lower limb between the NCV of tibia and peroneal and VPT in great toe (P<0.003)but there was a relative correlation between the AMP. in feet nerves and the perception threshold (P<012). The study concludes that with a certain reduction in vibration perception on hands and feet , a similar proportion is reduced in NCV of limbs and it was found out that this correlation in hands was associated with a high amplitude . It can be considered as a quide for examination of neuropathy and diabetes.}, Keywords = {: DiabeticNeurooathies/Neural Conduction/Vibratory Perception Threshold}, volume = {6}, Number = {23}, pages = {57-62}, publisher = {}, url = {http://journal.gums.ac.ir/article-1-1857-en.html}, eprint = {http://journal.gums.ac.ir/article-1-1857-en.pdf}, journal = {Journal of Guilan University of Medical Sciences}, issn = {2383-4307}, eissn = {2423-4818}, year = {1997} } @article{ author = {Mehrafza, M}, title = {Comparison of Transvaginal Ultrasonography and Diagnostic Curettage in the Evaluation of Patient with Abnormal Uterine Bleeding}, abstract ={ABSTRACT One of the common problems of women which causes them to have frequent visiting to gynecologists is abnormal uterine bleeding. It may be due to hormonal abnormalities to dangerous malignancies. So early diagnosis and treatment of abnormal uterine bleeding is very important. During the last few years many studies were published, showing a good agreement of transvaginal ultrasonography and histologic characteristics of the endometrium, especially in postmenopausal patients. With respect to the increasing acceptance of using vaginal ultrasonography for diagnosis of normal and abnormal endometrium and avoidance of unnecessary uterine curretage, this study was conducted and 71 patients with abnormal uterine bleeding were included in the study. Vaginal ultrasonography was done for all of them and then endometrial curretage was carried out under general anesthesia . Findimgs of vaginal ultrasonography were described and compared with histologic findings of endometrial curretage. In this study, transvaginal ultrasonography demonstrated a sensitivity of 94% and a specificity of 84% Transvaginal ultrasonography seems to be an effective procedure to exclude endometrial and intrauterine abnormalities. Its use could be implemeted as a routine first -step procedure in patients with abnormal uterine bleeding and it selects those in need of further diagnostic evaluation in the case of an abnormal or inconclusive sonogram.}, Keywords = {Curettage /Ultrasongraphy /Uterine Hemorrhage}, volume = {6}, Number = {23}, pages = {63-69}, publisher = {}, url = {http://journal.gums.ac.ir/article-1-1858-en.html}, eprint = {http://journal.gums.ac.ir/article-1-1858-en.pdf}, journal = {Journal of Guilan University of Medical Sciences}, issn = {2383-4307}, eissn = {2423-4818}, year = {1997} } @article{ author = {Hosseini, S.M}, title = {Effect of Caffeine on Eesti Development of Skeletal Tissue and Osteofication B}, abstract ={ABSTRACT The Purpose of this study was to identify the effect of caffeine on development of skeletal tissue and osteofication. Since osteofication in rat starts on day 13th, so we started the study on day 13th of pregnancy. A dose of 80mg/kg caffeine (1%) in the 13th ,14th and 15th day of pregnancy was injected to the test group intraperitoneally and a dose of 80mg/kg of Normal saline was injected to the control group in the same way in the 13th,14th and 15th day of pregnancy On the 16th to 19.5th day of pregnancy in every four hours a single group of test and control rats were sacrificed and their fetuses were separated from the pregnant rats by sacrification and their fetuses were separated from the pregnant rats and were fixed separately in Normal salin and 5 m sections were prepared. The study was completed by applying the following staining techniques: Feulgen ,toluidine blue ,P.A.S and H &E;The following results were obtained: 1-Caffeine causes 36 to 48 hours delay in osteofication. 2- Caffeine causes skeletal abnormalities in the test fetuses compared with control ones;These abnormalities include: a- Adactylia b- Syndactily C- Meromelia d- Microcephaly e- Hydrocephaly f- Micrognathia g- Clubfoot}, Keywords = {Caffein/ Embryo/ Musculoskeletal system }, volume = {6}, Number = {23}, pages = {70-75}, publisher = {}, url = {http://journal.gums.ac.ir/article-1-1859-en.html}, eprint = {http://journal.gums.ac.ir/article-1-1859-en.pdf}, journal = {Journal of Guilan University of Medical Sciences}, issn = {2383-4307}, eissn = {2423-4818}, year = {1997} } @article{ author = {Ansari., SH}, title = {Effect of 1500 Kcal .Diet on Weight Redution, F.B.S. and T.G.In Diabetic ,Obese Patients}, abstract ={ABSTRACT In a prospective study,sixty obese diabetic male patients were randomly selected and their weights ,F.B.S and T.G were determined A diet containing 1500 Kcal (55/carbohydrates 30/lipids and 15/proteins ) was designed and the patients used this diet for 55 days. Determination of weights ,F.B.S. and T.G showed that there was significant (P 0.05 & P 0.001 & P 0.001 respectively ) reduction in them as compared with the relevant values. In other words, the reduction of weight could lead to reduction of F.B.S and T.G.}, Keywords = {Body Weight/ Diabetes Mellitus/ Diet}, volume = {6}, Number = {23}, pages = {76-80}, publisher = {}, url = {http://journal.gums.ac.ir/article-1-1860-en.html}, eprint = {http://journal.gums.ac.ir/article-1-1860-en.pdf}, journal = {Journal of Guilan University of Medical Sciences}, issn = {2383-4307}, eissn = {2423-4818}, year = {1997} } @article{ author = {}, title = {}, abstract ={}, Keywords = {}, volume = {6}, Number = {23}, pages = {81-84}, publisher = {}, url = {http://journal.gums.ac.ir/article-1-1861-en.html}, eprint = {http://journal.gums.ac.ir/article-1-1861-en.pdf}, journal = {Journal of Guilan University of Medical Sciences}, issn = {2383-4307}, eissn = {2423-4818}, year = {1997} } @article{ author = {Nateghian., A and Vajary, H}, title = {A Case-Report of Infantile Spasm as a Presenting Feature of Tuberous Sclerosis .}, abstract ={ABSTRACT Tuberous Sclerosis(T.S) is an inherited disease (with autosomal dominant trait). It is characterised by different skin manifestations involvement of central nervous system and hamartomas in different organs of the body .Of Course ,about 10% of cases are due to new mutations Presentation of this patient, a 4-month-old male infant with recurrent convulsions cflexor type infantile spasm and hypopigmented skin lesions, is important because T.S. is considered as a rare skin nervous disease (prevalence rate of 1 per 30/000 population). In the past 5 years , until now a similar case has not been reported in Hefdah-Shahriver Hospital of Rasht which is a referal Hospital in Guilan Province. Mean while, the onset of disease with infantile spasms lack of any history of familial marriages and also early appearance of calcification in brain C.T. Scan of the patient at the age of 5 months are all as noteworthy features in the above -mentioned case „since incidence of calcification in CT Scan of these patients is rare before the age of 5 months.}, Keywords = {Infantile-Spasms/ Tuberous Sclerosis /Tuberous Sclerosis-Diagnosis }, volume = {6}, Number = {23}, pages = {85-87}, publisher = {}, url = {http://journal.gums.ac.ir/article-1-1862-en.html}, eprint = {http://journal.gums.ac.ir/article-1-1862-en.pdf}, journal = {Journal of Guilan University of Medical Sciences}, issn = {2383-4307}, eissn = {2423-4818}, year = {1997} } @article{ author = {Ghaemi., N and Ashrafzadeh., F and Kharazmi., A}, title = {A Case-Report of Dermatomyositis in Infants}, abstract ={ABSTRACT Dermatomyositis is a systemic disease that involves many organs and is characterized by low-grade fever , fatigue anorexy, a typical skin rash , muscular weakness and pain . It rarely begins before the age of 2 years. The diagnosis of dermatomyositis is based on 5 criteria . At present article, we reported a 1.5 year-old girl with inability to walking , indurated muscles and skin rashes. After laboratory studies, she was treated with corticosteroid IVIg and she was discharged with relative improvement.}, Keywords = {Dermatomyositis /Dermatomyositis-Diagnosis/Dermatomyositis-Therapy }, volume = {6}, Number = {23}, pages = {88-92}, publisher = {}, url = {http://journal.gums.ac.ir/article-1-1863-en.html}, eprint = {http://journal.gums.ac.ir/article-1-1863-en.pdf}, journal = {Journal of Guilan University of Medical Sciences}, issn = {2383-4307}, eissn = {2423-4818}, year = {1997} }