---

Background: In Brucella species, various protein and polysaccharide antigens have been identified in the outer membrane, cytoplasm, and periplasmic space. Several of these antigens, including Omp31, TF, and Bp26, have the ability to stimulate the host's immune system. The objective of the present study was to prepare a polyethyleneimine nanostructure containing a triple chimeric protein of Brucella as a candidate for a vaccine.
Materials and Methods: After designing the immunogenic construct using bioinformatics databases, cloning and gene expression were performed in Escherichia coli BL21 (DE3) to evaluate the immunogenicity of the designed recombinant protein. The extracted protein was purified using Ni-NTA columns, and after incorporating the antigen into the polyethyleneimine nanostructure, various characteristics of the nanoparticles, including size, zeta potential, encapsulation efficiency, and antigen release, were assessed.
Results: Characterization results confirmed that the polyethyleneimine nanocarrier containing the triple immunogen was successfully constructed. The average size of the nanoparticles containing the recombinant protein was approximately 100 nanometers (nm), and their zeta potential was around -45 millivolts. Over a 96-hour study period, approximately 84% of the encapsulated protein was released.
Conclusion: The results of our study indicated that the designed recombinant protein, in conjunction with the nanoparticle, possesses significant potential as a subunit vaccine candidate against Brucella species.
 

---

History and Objectives: Much controversy exists regarding the prevalence of Helicobacter pylori in patients with non-ulcer dyspepsia and its complications. Despite the importance of timely diagnosis, there is no consensus on the predictive value of the various methods for identifying this microorganism. All these led us to perform a study on patients with non-ulcer dyspepsia referred to Kashan’s Shaheed Beheshti hospital to determine the prevalence of H.pylori and the diagnostic power of staining with carbol-fuscin or Giemsa, the urea rapid test and bacterial cultures.

Materials and Methods: Using a sample of 107 patients, a descriptive study was performed to determine H.pylori prevalence and a diagnostic experimental trial to measure diagnostic power. Diagnosis of non-ulcer dyspepsia was based on clinical and paraclinical investigation (Including blood cell count, licer, kidney and thyroid function tests, ultrasonography and electrocardiography). A positive culture by calculating each test’s sensitivity, specificity and positive and negative predictive value (PPV and NPV).

Results: H.pylori prevalence in patients with non-ulcer dyspepsia was 47.6%. The PPV of carbol-fuscin staining, urea rapid test and Giemsa staining was 778, 64.2 and 62.9 percent, respectively, with on NPV of 95.5, 82.5 and 81.1%, respectively.

Conclusion: Due to the greater power of carbol-fuscin staining and its simplicity in identifying H.pylori, we suggest this method be used for diagnosis.

---

History and Objectives: Due to importance of blood groups and various reports on the prevalence of each blood group in various regions and discrepancies on the role of some blood groups on the gastrointestinal malignancies and in order to determine the prevalence of various blood groups the present study was conducted on individuals referred to the Kashan Blood Bank in 1993-1997.

Materials and Methods: The present investigation was performed in 2 steps. The first step was a descriptive study on 17287 individuals referred to the Blood bank center. Personal information, as to year to referral, sex and blood group were recorded and statistical data were presented. In the second stage is an analytical study on patients suffering from gastrointestinal malignancies hospitalized at the Shaheed Beheshti hospital in Kashan (170 patients). Final confirmation was based on the pathological findings. Patient’s records (age, sex, location of lesion, pathologic type and blood group) were listed in appropriate forms. Role of blood group on gastrointestinal malignancies were determined and relative risk was estimated.

Results: From 17287 (90.8% male, 9.2% female), O blood group was the most prevalent on blood group (35.5%). Rate of other blood groups were 28.6%, 27.7% and 8.2% for A, B and AB blood group respectively. Rh-positive carriers were 87.8% of the population. In gastrointestinal malignant patients, (170, 66.5% male, 33.5% female) and age interval of 70-79 was the most prevalent age group (55 individuals 32.4%). Gastric lesions (49.4%) were the most prevalent and esophagus, large intestine and small intestine were in lower rates. Adenocarcinoma (77%) was the most prevalent underlying cause. Blood group of 113 of patients were determined and O blood group was the most prevalent blood group among patients (39%) and B and A and AB blood groups with 31%, 28.3 and 1.7% were lower ranks respectively. 94.7% of patients had positive Rh group. B blood group (23 individuals, 38.3%) was the prevalent among gastric malignancies and the chance of occurrence is 60% compared to other blood groups.

Conclusion: Due to high prevalence of one blood group in gastric malignancy, a descriptive and analytical study with larger sample size is suggested in Kashan and other provinces.

---

History and Objectives: Due to prevalence of the urinary tract infection among children especially females and its well defined side effects and some discrepancies on its frequency and causative factors, the present investigation is designed to determine the prevalence of the urinary tract infection among female primary school students at the city of Rafsanjan in 1997.

Materials and Methods: A descriptive study on female primary school students using morning urine test (Comber-9) for nitrates, leukocyte esterase and pH was undertaken. Urine culture test was used to confirm positive cases.

Results: From 5339 cases, 371 (6.9%) had one positive urine test and 48 cases (0.9%) had positive culture urine test. 80% of cases with positive urine test did not display and clinical signs. E.coli (85.4%) was the most causative factor in the urinary tract infection.

Conclusion: Due to its prevalence and absence of clinical signs, analytical studies for causative factor contributing to the emergence of the disease the experimental trial for reduction of the infection are suggested.

---

History and Objectives: Considering the gastric diseases and its side effects and the role of Helicobacter pylori on the disease and since discrepant reports on the role of the microorganism on the diseases and in order to determine the presence of Helicobacter pylori, the present study was carried out on gastric biopsies sent to Department of Pathology of Kashan Medical University at 1996-1997.

Materials and Methods: A descriptive study was carried on 200 gastric biopsies. In order to determine the abnormality, tissue preparation and side was stained with hematoxyllin-eosin. Pathological abnormalities were grouped into 3 groups gastritis, ulcer and neoplasia. Presence of Helicobacter pylori was confirmed by Giemsa staining. The prevalence of Helicobacter pylori and confidence level in population were determined.

Results: The prevalence of gastritis, ulcer and neoplasm were 62.5%, 19.5% and 18% respectively. 76.5% of patients showed signs of Helicobacter pylori infection. Patients with gastritis and neoplasm showed respectively the highest (78.4%) and lowest (69.5%) rate Helicobacter pylori infection.

Conclusion: Due to high rate of Helicobacter pylori infection among gastric patients, it is suggested that gastric biopsies ought to be examined for Helicobacter pylori infection the effect of drug therapy should be determined.

---

History and Objectives: Due to the high mortality rate and the high incidence of complications of severe preeclampsia throughout the world particularly in the developing countries and regarding the controversies on the therapeutic effects and complications of Nifedipine and Hydralazine and in order to compare the therapeutic effect of this 2 medications, the present study was performed on patients with severe preeclampsia hospitalized at Shabihkhani maternity hospital during the years 1367 and 1377.

Materials and Methods: A clinical trial study was performed on patients with ?+2 proteinuria, blood pressure of 160/110 that was measured at least on 2 occasions at an interval of 3 hours or clinical manifestations of severe preeclampsia. Patients were randomly classified into 2 groups. In one group sublingual Nifedipine was administered at a dose of 5 milligrams (Equal to 5 drops) and in the other group, which was considered as the control group, Hydralazine was administered as injection at a dose of 5 milligrams. The effect of the medication on systolic and diastolic blood pressure, fetal heat rate and urinary volume was evaluated at 30 and 60 minutes after the administration of the medication. Also the effect of the medication on Apgar score and hospital length of stay of the neonates were studied.

Results: 2 group were similar, percent reduction of systolic blood pressure 30 minutes after the administration of the medication was 11.4% and 8.03% in the Nifedipine and Hydralazine group respectively (P<0.01) and the percent reduction of diastolic blood pressure 30 minutes after the administration of the medication was 18.7% and 10.9% in the Nifedipine and Hydralazine group respectively (P<0.01). Average urine volume 30 and 60 minutes after the administration of the medication were 68 and 128.8 milliliters in the Nifedipine group and 29.3 and 53.8 milliliters in the Hydralazine group (P<0.01). Average fetal heat rate changes thirty and 60 minutes after the administration of the medication were 1.36 and 0.92 in the Nifedipine group and -2.4 and -1.77 in the Hydralazine group.

Conclusion: Nifedipine administration results in a more fall in systolic and diastolic blood pressure and a more urine volume production than Hydralazine. Hydralazine produces a significant decrease in fetal heart rate. Apgar score at five minutes and hospital length of stay of the neonates does not differ significantly in the Nifedipine group in comparison with the Hydralazine one.

---

History and Objectives: Trichomoniasis is one of the sexual diseases of the urogenital system with multiple known complications. Due to the various prevalence of this parasite in this country and the large number of asymptomatic patients, a research was performed at family planning and clinics of gynecology in Kashan in order to define the prevalence of trichomoniasis and the role of effective factors in the development of this disease in 1372 and 1373.

Materials and Methods: A descriptive study was performed on 900 women. Infestation with trichomoniasis was defined as positive results on wet smear, or modified Diamond culture, Dorset’s culture and Papanicolaou staining. The role of age, educational level, pH, signs and symptoms of the disease and the prevention methods of pregnancy in the development of the disease was determined. Results were presented by using descriptive statistics.

Results: The prevalence of infestation with Trichomonas vaginalis was 2.1% (19 patients) and with a 95% confidence interval, the prevalence of infestation was estimated as at least 1% and at most 3% in the general populations. Trichomoniasis was most commonly observed at pH of 5.6 to 6 in house keeper, illiterate women of 20 to 34 years old. No significance correlation was found between age, occupation, level of knowledge, pH, clinical manifestations (Pruritus, burning sensation, painful intercourse) and the methods of prevention of pregnancy on one side and the rate of infestation on the other side.

Conclusion: The prevalence of trichomoniasis is relatively low in Kashan and its clinical manifestation is not pathognomonic. Correct diagnosis by using laboratory methods and appropriate treatment is recommended.

---

History and Objectives: Due to importance of developmental studies and specially fingers formation and since recent reports indicated a role for apoptosis in the development of free fingers, the present study was carried out to on chick embryo with free fingers as the experimental group and duck embryo with interdigital membrane as control group.

Materials and Methods: An analytical cohort study on white Leghorn eggs and Royal Pekin duck eggs were carried out. Chick embryos were at sixth and 9th days of incubation (Stage 29-35) and duck embryos at eight and half and 11th day of incubation at 12 hour intervals were taken for study. In the present study, neutral red as a vital color by Hinchiffe & Ede method was selected. The staining is specific for apoptotic and macrophage cells. Embryo legs were monitored by stereomicroscope and pattern of apoptosis were followed.

Results: Interdigital cellular apoptosis was observed in chick and duck embryos at 6.5 days and reached a pick level at 7.5 day and ended at 8.5 day when interdigital tissue had complete regression. Interdigital tissue apoptosis for the four fingers of foot was obvious in chick as well duck embryos however the extent of apoptosis was less in duck embryos. Interdigital cellular apoptosis started at the 9th day and continued until the 9.5 day and terminated at 11th day. Interdigital membrane between the first and second finger show similar necrotic region whereas the fingers formation is quite different.

Conclusion: Apoptotic pattern of interdigital membrane of chick and duck is accompanied by removal of mesenchyma and sculpturing and separation of fingers. Comparison of apoptotic intensity reveals other possible factors for the separation of fingers. It is suggested that extended study should be carried out to unravel the mechanism of interdigital regression at cellular as well as genetic level.

---

History and Objectives: Due to complications of pregnancy and labor and several reports on the association of BMI with outcome of pregnancy, the present study is performed in order to determine relationship between maternal BMI with complication of pregnancy and labor on the pregnant women referred at the Shabihkhani hospital in Kashan between years of 1998-1999.

Materials and Methods: A cohort study was performed on 450 nulliparous pregnant women without previous systemic diseases. The individuals were referred to hospital for prenatal care in the first trimester and delivery. Women were divided into three groups (150 individuals) based on the Body Mass Index (BMI) as BMI<19.8, BMI=19.8-26 and BMI>26. Prenatal complication such as hypertension, hospitalization before delivery, weight gain in pregnancy, premature rupture of membrane, decreased fetal movement, preterm labor, post data pregnancy and labor pain was recorded. Intrapartum and postnatal complications was studied with the index of stimulation of labor with oxytocin, type of delivery, maternal hemorrhage during delivery, duration of hospitalization, apgar score and weight of newborns. Statistical analysis was performed using Chi-square test and Fisher exact test.

Results: Three groups were matched for age and porous. Hypertension was present in 10.7% of women with BMI<19.8 and 18.7% women with BMI=19.6-26 and 38.6% women with BMI>26 (P<0.0001). Oxytocin stimulation of labor above groups was 28.7%, 41.3% and 42.7% (P<0.02) and abdominal delivery was 22%, 18.6% and 51.4% (P<0.0001).

Conclusion: Deviation of normal BMI in pregnancy causes increase in complication of pregnancy and delivery. Due to the importance of public health of pregnant women special attention must be paid to increase in maternal weight in reproductive age in order to lower these complication.

---

History and Objectives: Light’s criteria in which serum and pleural LDH activity and proteins levels are the most common variables to differentiate exudative from transudative pleural effusion, for the past 3 decades. Several other biochemical parameters have been suggested, one of which is serum pleural effusion albumin gradient (>1.2: transudate, <1.2: exudate). The present study was performed to assess diagnostic value serum and pleural gradient in the patient with pleural effusion.

Materials and Methods: A descriptive study was carried out on 76 patients. In a sitting position, pleural fluid aspiration was obtained and albumin, lactate dehydrogenase (LDH), protein level and at the same time blood total protein, LDH and albumin was obtained, on the basis of Light’s criteria, pleural fluid is categorized as exudate or transudate. 76 patients presented with pleural effusion referred to the Shaheed Beheshti hospital (Kashan) were studied according to the Light’s criteria and gradient method.

Results: According to Light’s criteria, 41 patients (54%) had transudate and 35 patients (46%) had exudate. These measures were 59% and 41% respectively in gradient method. Thus discrepancy was noted in 6 cases, labeled exudate according to Light’s criteria however transudate according to gradient method. Sensitivity, specificity, positive and negative predictive value were 82.9%, 95%, 93.5% and 86.6% respectively for gradient method.

Conclusion: Sensitivity of Light’s criteria is higher than albumin gradient, but the gradient method has a higher specificity for patients who are clinically suspect of transudate but labeled exudate according to Light’s criteria, albumin gradient is helpful.

---

History and Objectives: Due to the increased frequency of Tuberculosis for the past ten years, specially in developing countries (e.g. Southeast Asia) and importance of role of health care in prevention of the disease. BCG scars and PPD response after BCG vaccination in neonatal period was determined. Their relationship in infants, who come to treatment to health centers of Kashan in the summer of 1998.

Materials and Methods: This is a descriptive-analytical study. 400 infants (3 months old) who come to treatment and health centers of Kashan. Infants receiving BCG vaccination in neonatal period and PPD test were selected.

Results: More than 93% of vaccinated neonates had BCG scar in 3 months old. 53.31% of infants 3 months after vaccination had positive Mathuex test. The bigger BCG scar had bigger Mathuex test induration size.

Conclusion: Due to the importance of preventive measures in control of disease and efficacy of BCG vaccination in prevention of Tuberculosis (Specially in lethal forms) BCG vaccination is necessary in neonatal period in our country and principle of storage and production of good vaccine solution and their usage by experienced staff should be taken into consideration.

---

History and Objectives: Due to the importance of diagnosis of the abnormal epithelial cells of cervix and usual diagnostic method of Pap smear and various reports of ability of Pap smear in diagnosis of abnormal epithelial, in order to determine positive predictive value of Pap smear with abnormal epithelial cells comparing with the biopsy and patients characteristics this study was carried out among women referred to Shabihkhani hospital of Kashan in 1996-1999.

Materials and Methods: A clinical trial was performed on all women with abnormal Pap smear candidate to biopsy. Data were collected by interview and reports of Pap smear, type, results of biopsy were recorded. Analysis was performed and positive predictive value was determined.

Results: From 65 patients analyzed, all samples had abnormal epithelial cell determined by Pap smear test. The positive predictive value of the detection of the disease was 78.5%.

Conclusion: Considering the ease, relative inexpensiveness and availability of the Pap smear and relative low predictive value, further investigation in order to upgrade the quality of Pap smear test and to increase the diagnostic power of abnormal epithelial cells is needed. In addition, a new clinical trial design is required.

---

History and Objectives: Pancreatoblastoma is a rare pancreatic disease. Due to discrepancies as to the origin, histogenesis and type of treatment of the disease, the present article presents a case of pancreatoblastoma of a 10-year-old boy admitted to the Shaheed Beheshti hospital and underwent surgical operation.

Presentation of the case: A 10-year-old boy was presented with abdominal pain for 20 days prior to hospitalization. The pains were more pronounced at night and with ingestion of food. A mass of about 10cm was palpable at the epigaster region. The patient underwent the surgical operation and pathologic findings indicated pancreatoblastoma.

Results: Pancreatoblastoma, although is a malignant tumor, with early diagnosis and with prompt surgical operation, half of children recover fully.

---

History and Objectives: Gynecomasty and ectopic breast are disorders of breast. Due to difficulties in the biopsy diagnosis and different reports on sensitivity of FNA test for diagnosis of gynecomasty and ectopic breast and in order to identify the sensitivity of FNA test, the present study was carried out on patients referred to surgical clinic of Kashan Shaheed Beheshti hospital for clinical diagnosis of gynecomasty and ectopic breast.

Materials and Methods: A descriptive study was conducted on patients with clinical diagnosis of gynecomasty and ectopic breast. FNA test was performed before the surgical operation to remove the mass (Biopsy). The outcome of the 2 tests was compared and the positive cases of FNA in gynecomasty and ectopic breast were identified.

Results: From total of 20 patients, 9 with the mean age of 27.1±11 years had axillary mass with ectopic breast and 11 cases (Mean age of 28.9±9.5 years) had gynecomasty. The rate of positive FNA test was 33.3% for ectopic breast and 54.5% for gynecomasty.

Conclusion: It seems that FNA test for the positive diagnosis of gynecomasty and ectopic breast is less sensitive therefore further research is need.

---

History and Objectives: Considering the high incidence of preterm labor and its known complications and reports on the effectiveness of nifedipine and magnesium sulfate in its prevention and regarding their prices and way of administration, this study was carried out to compare the effect of nifedipine and magnesium sulfate in prevention of preterm labor. In referrals of Shabihkhani obstetric clinic in Kashan during the years 1998-2000.

Materials and Methods: The clinical trial strategy of this study was carried out on patients with pregnancies at 20-37 weeks and hospitalized for uterine contractions without interfering parameters. The patients were randomly divided into two groups. The case and control groups were treated with nifedipine and magnesium sulfate respectively. Fetal heart rate, maternal blood pressure and complications was recorded. On condition of a successful case of labor, the patients were discharged and followed up to the time of delivery. At this time, birth-time weight, period of hospitalization and number of hospitalized infants were recorded and analyzed statistically.

Results: Both groups were similar to each other regarding maternal age, parity and gestational age. Mean delay of labor was 31.72±24.8 days after administration of nifedipine and 42±28.9 days for magnesium sulfate was non-significant. The number of newborns that admitted in NICU was 7 (28%) for nifedipine with an average of 6.85 days and was 5 (20%) for magnesium sulfate 5 (20%) with an average of 7.6 days. In addition, mean weight at labor was 2874g and 2872g for nifedipine and magnesium sulfate groups respectively that was non-significant. Meanwhile, in none of the groups there was not any need to cease the administration of these drugs. The complaint rate was 100% and 40% for magnesium sulfate and nifedipine groups respectively (P<0.0001).

Conclusion: Since both drugs are alike regarding their effect on birth-time weight and delay of labor and in addition, magnesium sulfate is followed by greater rate of complications and nifedipine is a less costly drug and is its easier way of administration, the latter is recommended to be used in prevention of preterm labor.

---

History and Objectives: Considering the high incidence of gastrointestinal disorders and the involvement of Helicobacter pylori in the occurrence of gastritis, duodenal ulcers and gastric adenocarcinoma and the absence of a generally-accepted and standard method for its diagnosis, this study was carried out to compare the invasive and non-invasive methods on referrals of Shaheed Beheshti hospital in Kashan in 2000.

Materials and Methods: The clinical trial and diagnostic strategy of this study was performed on 127 cases with variant symptoms of gastric disorder and with endoscopic indication. During gastroscopy, samples were collected from antrum for culture, pathological diagnosis and fast urease and 5ml of blood was obtained for evaluation of IgG against, bacterium. The golden standard in this study was on the basis of a positive result for culture, pathological evaluation and fast urease. Then, the sensitivity, specificity, PPV and NPV were determined for criteria of culture, fast urease, histology and ELIZA.

Results: The study was performed on 127 cases with an age of 46.3±18 years and 57.5% out of them were male and the remainder (42.5%) were female. The results showed that each test individually or two of the three tests (Histology, fast urease and ELIZA) can not have an appropriate diagnostic value. In this respect, a combination of urease with PPV and/or with NPV can have the greater diagnostic value of 59.3% and 92.3% respectively. Meanwhile, combination of culture and PPV and/or NPV showed the least diagnostic value, i.e. 56.7% and 50% respectively and combination of histology and PPV and/or NPV showed the highest value, i.e. 90% and 100% respectively. Furthermore, ELIZA test in comparison with golden standard had the least sensitivity, even in the presence of histologic evaluation and fast urease.

Conclusion: It can be concluded that a combination of fast urease and histology is of high value in diagnosis of Helicobacter pylori in Iran. In addition, the serologic ELIZA test recommended not to be performed because of its low specificity. However, its negative results might be helpful in some cases.

---

History and Objectives: Morphogenesis is achieved by the effect of different tissue factors including mesenchymal-epithelial interaction, but its chemical basis is unknown. One of the most appropriate models is the mammalian tooth, especially its pulp. The phenomena migration, proliferation and differentiation within dental pulp are affected by the components of extracellular fluid. In this respect, tenascin is one of these components that is involved in the initial stages of development and differentiation of some fetal tissues including teeth and is important in the pathogenesis of tumors.

Materials and Methods: The present study was conducted on 40 ball-c mice. Different development stages of dental pulp were evaluated within the days 12-19, using immunohistochemical methods and monoclonal antibody against tenascin.

Results: The finding showed that at the bud stage, tenascin is found in the ectomesenchymal tissue and basement membrane of enamel organ in a high quantity and there is reduction in its level in cap stage. With developmental progression, the tenascin level increases significantly in early bell stage for pulp and in late bell stage in cortex.

Conclusion: Tenascin can play an important role in morphogenesis during development of pulp. In this respect, epithelial-mesenchymal interaction is very important. Therefore, it is recommended to conduct more studies to determine the role of tenascin in the differentiation oddentoblasts following injury.

---

History and Objectives: Considering the high incidence of thyroidal nodules in mountainous and hot regions of Kashan and the importance of its rapid diagnosis and treatment and the existence of controversies in this field, this study was performed on referrals of health centers in Kashan with thyroidal nodules from 1998 to 2000.

Materials and Methods: The clinical trial strategy of this study was performed on 65 patients. At first, they were tested for FNAc and operated according to indications (Lobectomy, isthmectomy, pyramidectomy, subtotal and/or total thyroidectomy). The biopsies were evaluated pathologically and diagnostic value of FNAc was determined.

Results: Out of 65 studied cases, 55 patients were female and 10 cases were male. In addition, in 5 cases (7.7%), there existed a state of malignancy according to pathological evaluation and FNAc. Meanwhile, the sensitivity and specificity was 100% for FNAc.

Conclusion: FNAc has a high diagnostic value of thyroid nodules and it is recommended to be performed before surgical operations of the thyroid gland for all of the cases to reduce unwanted and costly operations.

---

History and Objectives: Considering the significance of congenital heart disorders and lack of information on its prevalence among neonates in Iran and for determination of the effect of environmental and genetic factors in its etiology, this study was carried out during the years 1996-2000.

Materials and Methods: The study was conducted on existing data and the related data were collected in pre-designed questionnaires and all neonates with a definitive diagnosis of congenital heart disease were evaluated. In this respect, gender, age, type of disorder, family history, history of drug consumption during pregnancy, familial marriage and accompanied anomalies were considered.

Results: The results showed that out 2840 hospitalized neonates, 46 cases (1.6%) had congenital heart disease. The most common from was VSD observed in 22 cases (47.8%). The prevalence was 28.2%, 19.5%, 10.8%, 4.3% and 13% for ASD, TGA, PDA, TOF and other congenital heart disorders respectively. In addition, out of 46 neonates, 20 cases (43.5%) were female and 26 cases (56.5%) were male. Furthermore, in 41.3% of them, there was a familial marriage.

Conclusion: It is concluded that prevalence of CHD is higher than references, especially for TGA. Meanwhile, familial marriage can increase the incidence of CHD. Therefore, it is recommended to perform more studies in this field in Iran.

---

History and Objectives: Considering the significance of analgesia and lower complications following surgical operations and the existence various and sometimes reports controversial reports on the efficacy of addition of fentanyl and for comparison of its effect, this study was carried out on patients under thoracotomy in Masih Daneshvari hospital.

Materials and Methods: The clinical trial, two-blind strategy of this study was performed on 74 patients and cases with contraindication for drugs were excluded from the study. Control group received morphine (0.5 mg/kg) and experimental group received a mixture of morphine and fentanyl. The intensity of pain was measured using verbal pain scoring and they were followed up for post-operative complications for 48h and data were statistically analyzed.

Results: From each group, 7 cases were excluded and study was carried out on 60 cases. In this regard, 31 cases were in control group and 29 cases were in experimental group. Both groups were similar regarding age and gender. Complications rate was 71% (22) in control group and 48.3% (14) in experimental group (P<0.07). There was a complication rate of 92.3% and 55.5% in female cases of control group and experimental group respectively. Meanwhile, duration of unexpected analgesia in control group was 8±4.8 and in experimental group was 9.03±4.5 h. in addition, duration of unexpected analgesia for control and experimental groups were 2±4.8 and 5±4.5 h respectively.

Conclusion and Recommendations: Simultaneous use of fentanyl and morphine could reduce the complications and extension of analgesia. Therefore, it is recommended to carry out further studies using fentanyl.