---

  Background & Objectives: Respiratory distress is one of the most important causes of children admission in hospitals. In most cases, it is due to pneumonia, asthma or acute bronchiolitis. Since theses diseases have a lot of symptoms in common, we decided to study these disorders in more details to facilitate the appropriate diagnosis and treatment based on clinical, laboratory and radiologic findings.

  Methods: 238 children who suffered from respiratory distress and were admitted to pediatric ward in Ghaem hospital were studied. This descriptive study was performed during 3 years including 2 retrospective and one prospective year. The relationship between variables was analyzed using chi-square test.

  Results: The patients were six months to five years old. Pneumonia (40.3%) asthma (30.3%) and bronchiolotis (16.8%) were the most common causes of respiratory distress. Totally, 61.1% of the patients were male. The mean age of the patients was 10.3 months in bronchiolitis and 36.6 months for asthma. The most common symptom among these three diseases was tachypnea. Most of the patients were admitted in winter and fall respectively. The main radiologic pattern in pneumonia was pulmonary infiltration and for asthma and acute bronchiolitis it was pulmonary hyperinflation.

  Conclusion: Proper attention to signs and symptoms as well as laboratory and radiologic fndings is necessary for accurate diagnosis. In this study the most common cause of respiratory distress in children under 5 was found to be pneumonia, asthma and bronchiolitis respectively.

---

 Backgraund & Objectives: Asymptomatic urinary tract infection (AUTI) is common in childhood and will lead to renal scars. Since the prevalence of AUTI has not been studied in Ardabil, this study set out to determine the prevalence of AUTI among primary-school children of Ardabil.

 Methods: In this descriptive-analytical study, 470 cases were selected randomly from 40,000 primary school students. The data were collected with completing a questionnaire. The cases with symptomatic urinary infection and those with discontented parents were omitted. Midstream urine was collected and sent to laboratory for analysis and culture. Colony count ≥ 100,000 CFU / ml and higher was considered as UTI and the prevalence of this complication in the samples was studied.

 Results: Of 470 subjects, 16 ones were ruled out due to urinary symptoms or parents’ discontent, and the study continued with 454 students (238 girls and 216 boys). 19 students (4.2%) had positive culture (13 girls and 6 boys). Prevalence of AUTI was 5.5% in girls and 2.8% in boys. In this study only seven cases (36.8%) had pyuria ( WBC>5).

 Conclusion: The high prevalence of AUTI specially in girls is important. Regarding the known complications of AUTI, other researches seem to be necessary to determine the causes as well as ways to prevent and treat it.

---

  Background & Objectives: Juvenile Immune Arthritis (JIA), which is a disorder with unkuown etiology, occurs in children under 16 and is one of the most common collagen vascular diseases in pediatrics and among the important causes of permanent deformity of joints and blindness in children. With regard to its importance, we studied the incidence, different types as well as clinical and laboratory features of this disorder.

  Methods: This descriptive and cross-sectional study was performed on 24 patients (age range: 6 months-12 years) admitted to pediatric wards of Ghaem and Imam Reza hospitals in Mashhad during 1998-2001. The data were collected from the patients’ records using a questionnaire and analyzed by SPSS software.

  Results: Polyarticular type was the most common form of the disease. Peak age of involvment was 11 years old. Boys were more frequently affected than girls. Knees, ankles and wrists were the most commonly involved joints. Most of the patients suffered from loss of appetite and irritability. Fever was detected in 100% of the patients with systemic type and 2/3 of the cases with polyarticular form. The most important laboratory findings were elevated ESR, positive CRP and anemia. There was an excellent response to aspirin or glucocorticoids.

  Conclusion: In comparison to similar studies the onset of disease in our patients was a little later. Fever was seen in all patients with sytemic disorder and skin rash was observed in most of the cases. So, it would be quite wise to suspect JIA in such cases. Aspirin or prednisolone are suitable drugs to treat most of these patients.

---

  Background & Objective: Cerebrovascular disease mortality rates have declined in some countries during recent decades. Changes in mortality rates over time could be attributed to changes in disease incidence or case fatality rate. Very few studies have provided information regarding survival after stroke. We aimed to determine the case-fatality rate (28 days) among patients with first-ever stroke from a population-based study in Ardabil province, Northwest of Iran.

  Methods: This study was conducted between May 2005 and February 2006, all individuals with an acute stroke who were residents in Ardabil province and hospitalized at Alavi Hospital, were registered prospectively and assessed according to standardized diagnostic criteria. The data were analyzed through SPSS, Chi square and variance analysis.

  Results: A total of 352 patients with first-ever stroke were registered, and 346 (96%) were followed up. 288 (81.8%) ischemic stroke, 16.2% (57) ICH and 2% SAH. By 28 days, 70 patients (20.3%) had died. Hypertension, diabetes and cardiac disease history were reported in 61.6%, 16.8% and 26.1% respectively and 19.8% of patients were smokers. Mean age of survivors was different from patients who died at 28 days after index event (64.2±12.9 VS 69.1±10.9, p=0.03). The proportion surviving 28 days varied from 16.2% among patients with ischemic stroke to 43% among ICH and SAH. For ischemic stroke, Survival rates were similar for men and women, whereas men with ICH had lower survival than women.

  Conclusion: Case fatality rate after first-ever stroke is substantial. Rates of mortality differ according to patients diagnosis, age, sex, and heart disease. These data highlight the importance of long-term secondary prevention.

---

Background & objectives: Antibiotic resistance in Vibrio cholerae is a crucial matter in the world. Objective of this study was the improvement of cholera surveillance by assessing the antimicrobial resistance pattern and bacterial  resistance genes in V. cholerae O1 isolates, reffered to Iranian Reference Health Laboratory, in cholera outbreaks during 2012- 2015.
Methods: This study is a cross sectional- descriptive research. Antimicrobial susceptibility test (AST) to 8 antibiotics was performed on 113 V.cholerae O1 isolates using E-test method. For all isolates, conventional PCR method was used to detect the presence of tetracycline resistance genes (tetA, tetB and tetC) and the sulfamethoxazole-trimethoprim resistance genes (sul2 and dfrA1).
Results: All isolates were sensitive to ampicillin, temocillin, ciprofloxacin and cefixime and 64% of strains showed intermediate susceptibility to erythromycin. The resistance rate of nalidixic acid, sulfamethoxazole-trimethoprim and tetracycline were 90%, 71% and 50% respectively. However, the frequency of multidrug resistant (MDR) strains varied across the years. The frequency of resistance genes (tetA, tetB, tetC, sul2 and dfrA1) were 70%, 34%, 58%, 66% and 70% respectively.
Conclusion: AST should be used to determine the resistance profile at the beginning of a cholera outbreak and to monitor the resistance profile of circulating strains as part of surveillance of the disease. A prominent association was observed between phenotypic resistance to sulfamethoxazole-trimethoprim and presence of dfrA1gene. Determining the presence of resistance genes is necessary for understanding the epidemiology and routes of transmission of antibiotic resistance genes

---

Background & objectives: Stroke is one of the most common causes of death worldwide and has distinctive features. Moreover, the different types of strokes are characterized by different physiopathological mechanisms. In the present study, we aimed to investigate the serum levels of ATG5 and apo B-48 and their diagnostic value in patients with ischemic stroke.
Methods: We selected 100 participants, including 50 ischemic stroke patients (22 women and 28 men) as the case group and 50 healthy individuals (23 women and 27 men) as the control group. Then, we conducted a case-control study in Imam Reza Hospital (Tabriz, Iran) from March 2016 to April 2016. Serum levels of ATG 5 and Apo B-48 were measured in both groups. We also evaluated the additional diagnostic value of these factors in both groups using receptor-related power analysis (ROC).
Results: The mean serum levels of ATG 5 and apo B-48 were significantly higher in the case group than in the control group (p<0.0001). The values under the ROC curve (AUC) for ATG5 and apo B-48 were 0.96 and 0.91, respectively. The area under the ROC curve indicates that ATG 5 and apo B 48 are appropriate biomarkers for diagnosing ischemic stroke.
Conclusion: Serum levels of ATG 5 and apo B -48 are significantly higher in patients with ischemic stroke than in healthy individuals and may be considered diagnostic biomarkers in patients with ischemic stroke.

---

Background & objectives: Knee osteoarthritis is an important cause of pain and disability in the community. The present study investigated the risk factors for primary osteoarthritis of the knee in patients with knee pain and their relationship with knee osteoarthritis.
Methods: 87 patients were included in the study and were matched in terms of age. Cases consisted of female patients less than 50 years of age with knee pain and the control group was selected from patients under 50 years of age with knee pain and no radiographic findings of osteoarthritis.
Results: This study showed that the rate of osteoarthritis of the knee was significantly related to body mass index (p=0.001). The relationship between knee osteoarthritis and ESR was not significant, but an increase in CRP with a p-value of 0.01 was associated with a risk of approximately a 3.5-fold increase in knee osteoarthritis. With increasing education, the rate of knee osteoarthritis decreased (p=0.022). The Increased circadian outpatient activity was significantly associated with increased knee osteoarthritis (p=0.032). In performed assessments on osteoarthritis of the knee, there was no statistically significant relationship between the type of bathroom used, the use of stairs, and residential houses.
Conclusion: Knee osteoarthritis has a relationship with body mass index, Education level, CRP index, and circadian activity level. it is recommended to lose weight in people with abnormal body mass index, exercise, and improve their lifestyle to reduce the incidence of knee osteoarthritis and disability.

---

Background & objective: FoxO1 and STRA13 proteins play an important role in duplication and cellular metabolism, regulation of cell differentiation, apoptosis and reducing the spread of fat tissue in the body. The aim of this study was to investigate the effect of different intensities of aerobic training on the expression level of FoxO1 and STRA13 genes in subcutaneous adipose tissue of male Wistar rats.
Methods: In this experimental study, 32 male Wistar rats with a mean age of 8 weeks and weight of 237±33 gr were selected, and they were randomly divided into 4 equal groups including moderate-intensity aerobic training (MIT), high-intensity aerobic training (HIT), high-intensity interval aerobic training (HIIT) and control group. The training program was implemented 8 weeks and 5 sessions per week for the experimental groups,. Adipose tissue biopsy was performed 48 hours after the last training session to evaluate FoxO1 and STRA13 gene expression using  RT-PCR method. Data were analyzed using One-way analysis of variance test using SPSS 24 software at the significance level of p<0.05.
Results: The results showed that there was a significant difference in the FoxO1 gene expression level in the subcutaneous tissue of male Wistar rats between HIT and control groups (p=0.0001). However, no significant difference was observed between experimental groups. In addition, there was a significant difference in STRA13 gene expression level in the subcutaneous tissue between MIT (p=0.008), HIT (p=0.0001) and HIIT (p=0.009) groups and control group.
Conclusion: According to the results, aerobic exercise with variety of intensity is effective in controlling the genes expression rate involved in fat metabolism and by reducing the FoxO1 and STRA13 genes expression, they cause the duplication and reduce the expansion of fat tissue.
 

---

Background & objectives: Evidence suggests that microRNAs (miRNAs) are essential for immune cell differentiation and function. In addition, miRNAs play an essential role in regulating the expression of pro-inflammatory genes in neurons. Therefore, we investigated the relationship between miRNA expression and inflammatory markers in the CSF of patients with multiple sclerosis.
Methods: RT-PCR analysis was performed on CSF samples from patients with multiple sclerosis (MS) and a control group to measure the expression level of miRNA-21, miRNA-155, miRNA-182, and miRNA-437. In addition, the levels of the inflammatory cytokines including IL-1β, IL-6, and TNF-α in CSF were measured using ELISA. A quantitative turbidimetric method was also used to measure high-sensitivity C-reactive protein (hs-CRP).
Results: A significant difference was found in the expression level of miRNAs and inflammatory factors in the CSF of patients with MS compared with the control group (p<0.05). The results of receiver operating characteristic (ROC) analysis showed the area under the curve for miRNA-21 (AUC=0.97, p<0.0001), miRNA-182 (AUC=0.97, p<0.0001), and miRNA-155 (AUC=0.96, p<0.0001). The miRNA-155 level in CSF played a very important role in the accurate diagnosis of MS. Significant correlations were found between inflammatory cytokines and miRNA-21, miRNA-155, and miRNA-182, as well as an indirect and moderate correlation between miRNA-437 and hs-CRP.
Conclusion: In MS patients, CSF levels of IL-1, IL-6, TNF-α, hs-CRP, and selected miRNAs can be used as biomarkers of CNS inflammation and neurodegenerative processes.
 

---

Background: Opportunistic pathogens such as Cryptosporidium, Isospora belli, Blastocystis, etc. cause various gastrointestinal and non-digestive diseases in people with HIV. These symptoms are especially severe in people with HIV who have a CD4 count of less than 200. This study aimed to determine the prevalence of parasitic infections in people living with HIV in Tabriz.
Methods: This cross-sectional and descriptive study was performed on137 people with HIV referred to Behavioral Disease Counseling Centers in Tabriz, 2019-2021. Then, after receiving written consent, fecal samples were collected and evaluated for the detection of parasitic infections using direct methods, Ziehl-Neelsen and Trichrome Weber stain.
Results: A total of 137 stool samples were collected, including 93 males and 44 females. Most of them were in the age range of 20-60 years. The overall frequency of parasitic infections was 57.7% and the highest prevalence was related to Blastocystis 24.1% and Cryptosporidium 14.6%.
Conclusion: Due to the relatively high prevalence of parasitic infections, especially Blastocystis and Cryptosporidium in people with HIV in Tabriz, which can endanger the health of these patients, essential interventions, including personal hygiene training to control and prevent infection with these pathogens, seem to be necessary.