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Creutzfeldt-Jakob disease associated with non sterile phlebotomy (case report)
Ghorbani A, Kahnouji H, Shafiei M, Yousefi N,
Volume 65, Issue 3 (2 2007)
Abstract
Background: Creutzfeldt-Jakob disease (C-JD) is a rare disorder characterized with rapidly progressive mental decline, myoclonic jerk and finally death. The transmissible pathogen for this disease is a proteinaceous infectious particle termed prion. The prion protein is encoded by a gene (designated as PRNP) on the short arm chromosome 20.This disorder is diagnosed based on clinical findings, course of disease, EEG, MRI and confirmed with brain biopsy. Case report: A 56- year- old woman presented with confusion, disorientation, hyper somnolence, psychiatric problems such as hallucination, progressive mental deterioration and myoclonic jerks. She had history of several times phlebotomy with traditional and non sterile methods in two past years. She had no past history of other disease. Her illness was diagnosed based on clinical findings, course of her illness, typical MRI, EEG and rule out other dementing disease. She died after one month.
Conclusion: in any patients with psychiatric disorders, rapidly progressive mental deterioration and myoclonic jerks C-JD should be considered as an important diagnosis. Treatable dementing disease should be considered and ruled out at first. The significance of phlebotomy in C-JD has yet to be determined.
Diagnosis and Management of 253 Cases with Cushing's syndrome in Imam Khomeini Hospital
Esteghamati A.r, Eshtiaghi R, Yousefizadeh A.a, Nakhjavani M,
Volume 65, Issue 7 (4 2007)
Abstract

Background: Definite diagnosis and treatment of Cushing's syndrome is still a dilemma. The aim of this study was to evaluate the accuracy of diagnostic tests and follow-up of patients with Cushing's syndrome.
Methods: Two hundred and fifty three consecutive cases with Cushing's syndrome during 1370-78 were studied. The screening tests were performed in all patients. High dose dexamethasone suppression test (HDDST) and ACTH measurement were carried out. MRI/CT Scan were performed and compared with laboratory data and pathologic specimens as a gold standard test.
Results: The age range was 32±11 yrs. The most frequent symptoms were weakness hypertension, typical striae, and depression .The frequency of hypertension in ACTH-dependent case were 77% vs. 36% in adrenal tumors (P< 0.001). HDDST was positive in 99% of micro and 71% of macroadenomas. Adrenal tumors showed 3.6% suppression but none in ectopic cases. HDDST had a sensitivity of 98%, specificity of 97% and accuracy equals to 98%. The frequency of different etiologies was as following: Cushing's disease in 64.8%, adrenal tumors in 32.8% and ectopic ACTH in 2.4% of patients. Trans-sphenoidal surgery (TSS) was performed in 120 patients .The patients were followed for 53±25 months whose remission periods were 46.7±23.8 months (range 4-114 months). Survival analysis showed 93% remission rate in 12mo, 82% in 2yr and only 33% after 5yr.This recurrence didn't have any platue level.
Conclusion: In our study, hypertension was more prevalent in ACTH-dependent Cushing's syndrome. HDDST had acceptable sensitivity, specificity and accuracy. Lifelong follow up of pituitary adenomas is inevitable in the case of progressive and gradual nature of recurrence in these tumors.


Ovarian structural disturbances in epilectic patients treated with Sodium valproate
Kahnouji H, Soltanzadeh A, Sedighi N, Monshi B, Yousefi N, Alaleh A,
Volume 65, Issue 10 (2 2008)
Abstract

Background: Recent studies have raised the issue of an increased incidence of polycystic ovaries (PCO) and menstrual disturbances in women with epilepsy treated with valproate (VPA). It seems that antiepileptic drugs, especially valproate, may have a functional role in altering the endocrine system of child-bearing women with epilepsy. We conducted this study to investigate the association of VPA and ovarian structural/menstrual disorders in epileptic women.

Methods: In this cross-sectional study, we compared a total of 64 epileptic patients, aged 16-45 years, 32 of whom had been taking VPA alone and 32 were on other antiepileptic drugs for a minimum duration of six months. Ovarian sonography was performed and body mass index (BMI) calculated for all subjects. We also recorded the presence of menstrual disturbances in both groups.

Results: Fifteen (46%) of the VPA subjects had PCO compared to 7 (21.9%) of the other group. In the VPA group, four (12.5%) had oligomenorrhea, one (3.1%) amenorrhea and 13 (40.6%) had irregular menstrual cycles. However, from the other group, two (6.3%) subjects had oligomenorrhea and seven (21.9%) had irregular menstrual cycles amenorrhea was not present in the non-VPA treated patients. Mean BMI was 22.5 kg/m2 among the VPA subjects and 20.1 kg/m2 in the non-VPA subjects.

Conclusions: This study supports the association of PCO and high BMI with VPA treatment. The frequency of menstrual disturbances did not differ significantly between the two groups.


Prevalence of head and neck abnormalities among people with consanguineous parents
Razmpa E, Azimi C, Soltan Sanjarei M, Nazari H, Ghasempoure A, Yousefi M,
Volume 66, Issue 7 (6 2008)
Abstract

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 !mso]> ject classid="clsid:38481807-CA0E-42D2-BF39-B33AF135CC4D" id=ieooui> Background: A high percentage of the patients at ENT or plastic surgery clinics have ENT abnormalities, either congenital or those developing later in life. Some are life threatening, while others cause disability and esthetic problems, with profound consequences for the affected child and the family. In addition, ENT abnormalities usually place stress on interpersonal relationships, causing social isolation, unhappiness and depression. The majority of these abnormalities is genetic and follows autosomal recessive pattern of inheritance. Geneticists believe that there is a higher frequency of autosomal recessive disorders among the offspring of consanguineous parents. The aim of this study was to find the frequency of ENT abnormalities among children born of consanguineous parents.
Methods: We studied 3503 files (pedigrees) of patients referred for genetic counseling at the Department of Genetics at Imam Khomeini Hospital, Tehran, Iran, from 1999 to 2000. We studied these cases according to degree of parental consanguinity, patterns of inheritance and gender using SPSS v.15.
Results: Of all 3503 files, 206 had ENT abnormalities, of which 157 had consangui-neous marriages. Among these 157 pedigrees, 496 cases had consanguineous parents. Out of the 496 cases, the four most frequent ENT abnormalities were: 115 cases (23.2%) of deafness, 53 cases (10.7%) of hearing loss, 12 cases (2.4%) of cleft lip and palate, and 5 cases (1%) of cleft palate.
Conclusion: This high frequency of ENT abnormalities indicates that consanguineous marriage should be discouraged by Iranian policy makers in order to reduce the burden of these disorders on society. Further research into the cultural problems that encourage consanguineous marriage and ways of resolving these problems is recommended. 


Splenectomy versus cladribine therapy in hairy cell leukemia patients: a clinical trial
Jalaee Khoo H, Keihani M, Yousefian A,
Volume 67, Issue 8 (6 2009)
Abstract

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Hairy cell leukemia (HCL) is a rare B-cell neoplasm that comprise approximately 2% of all lymphoid leukemias. Over the past 20 years splenectomy was the only effective therapy but with the advent of purine analogues such as cladribine, splenectomy has been limited to certain situations. After cladribine therapy most patients achieve complete and durable remission. The aim of this study was to compare effectiveness of splenectomy and cladribine in Iranian patients with HCL and also to evaluate the clinical and laboratory features of patients at diagnosis.
Methods: 50 patients with the diagnosis of HCL enrolled to our study. The male to female ratio was 3:1, and the median age at diagnosis was 50 years. After diagnosis  20(40%) and 12(24%) of patients had splenectomy and cladribine therapy respectively. The reminder of patients were treated with both splenectomy and cladribine.
Results: The most common clinical findings were splenomegaly (98%) and fatigue (80%) respectively. Leucopenia and anemia was present in 96% and 80% patients in order. 88.6% and 55.5% of patients achieved complete remission after cladribine therapy and splenectomy respectively. After cladribine therapy and splenectomy relapse occurred in 10% and 74% of the patients.
Conclusions: Our finding are comparable with previous studies and show that Cladribine induces complete and durable remission in most hairy cell leukemia patients and should be considered as first line therapy. Splenectomy should be performed in certain cases such as spleen rupture.


Electroconvulsive therapy in drug resistant neuroleptic malignant syndrome: a case report
Yousefi A, Asgari F,
Volume 67, Issue 11 (4 2010)
Abstract

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Neuroleptic malignant syndrome is an idiosyncratic and potentially fatal reaction to neuroleptic drugs and is characterized by fever, muscular rigidity, altered mental status, autonomic dysfunction, elevated serum CPK and leucocytosis Neuroleptic malignant syndrome is treated with dantrolene, bromocriptin, amantadin and electroconvulsive therapy.
Case: A 22 years old, schizophrenic female was refered to the Emergency ward of Roozbeh hospital in Tehran, Iran in December 2008 with aggression, impulsivity, and reduced sleep. After injection of haloperidol, the patient developed a high grade fever, diaphoresis and muscular stiffness. She was diagnosed as neuroleptic malignant syndrome and the treatment with dantrolen, bromocriptin and amantadin initiated. Although fever subsided, other signs continued, therefore we applied electroconvulsive therapy to this case.
Conclusion: Due to excellent response of the patient to electroconvulsive therapy and the rare reports of electroconvulsive therapy in neuroleptic malignant syndrome in the Iranian population, this case may lead to develop studies for further investigations of this issue.


The factors relevant to the onset of vascular complications after coronary intervention in Shahid Rajaei Cardiovascular Center in Tehran, Iran
Yousefi Aa, Madani M, Azimi Hr, Farshidi H,
Volume 69, Issue 7 (7 2011)
Abstract

Background: Vascular complications, as the most common complications of diagnostic catheterization and percutaneous coronary intervention (PCI), are important factors in the morbidity of patients undergoing such procedures thus, this study was done to evaluate the prevalence of these complications and their related factors.

Methods: This is a descriptive study composed of 2097 consecutive patients who underwent percutaneous coronary intervention in Shahid Rajaei Cardiovascular Center in Tehran, Iran from January 2008 to January 2009. Occurrence of vascular complications in course of hospitalization and the related factors leading to the complications were investigated.

Results: Out of 2097 patients, 1544 (73.6%) were male and 553 (26.4%) were female, and the mean age of the participants was 57±10 years. Vascular complications from the time of PCI to the time discharge were observed in 19 (0.9%) patients. The other complications included: hematoma in 10 cases (52.6%), pseudoaneurysm in five cases (26.3%), retroperitoneal hemorrhage and arteriovenous fistula in 2 (10.5%) patients each. The complications were significantly more common in female patients (P=0.003), in patients with a history of hypertension (P=0.02), people of shorter stature (P=0.004), and being on gp IIIa/IIb inhibitors (P=0.003).

Conclusion: The rate of vascular complications post-percutaneous coronary interventions is low and it is considered to be a good treatment option for patients with coronary stenosis provided that sufficient compression is applied on the vascular access point in the right time after removal of the arterial sheath. PCI is of fewer vascular complications, especially in female patients, history of hypertension, and higher anticoagulant concentrations.


Comparing carotid intima-media thickness in type 2 diabetes between patients with and without retinopathy
Naroi Nejad Minoo , Yousefi Maryam, Nazari Hossein, Ghasempoor Adel,
Volume 70, Issue 3 (4 2012)
Abstract

Background: Microangiopathy and macroangiopathy frequently coexist in type 2 diabetes mellitus (T2DM). Both types of the vascular complications share traditional risk factors but it is not clear whether the presence of microangiopathy, such as diabetic retinopathy, constitutes a predictor of atherosclerosis in carotid arteries in patients with the disease. In this study we looked for the association between diabetic retinopathy and intima-media thickness in carotid arteries of patients with T2DM.

Methods: In this case-control study we examined 100 consecutive patients with T2DM in Rasoul Akram Hospital in Tehran, Iran during 2009-2010. We assessed intima-media thickness of carotid arteries by ultrasonography. All patients underwent ophthalmo-logic examination.

Results: Diabetic retinopathy was found in 50 (50%) patients. Intima-media thickness was higher in patients with diabetic retinopathy than those without it (0.77±0.17 mm vs. 0.71±0.2 mm, respectively, P=0.041). Moreover, intima-media thickness was more prevalent in patients with proliferative diabetic retinopathy than patients with non-proliferative form of the disease (0.87±0.16 mm vs. 0.68±0.1 mm, respectively, P<0.001).

Conclusion: Diabetic retinopathy seems to be associated with increased intima-media thickness of carotid arteries in T2DM. It may be a common denominator of pathogene-sis of microvascular complications and atherosclerosis in T2DM. Evaluations of carotid arteries are to be done by non-invasive methods such as color Doppler sonography for screening and preventing prospective cereberovascular accidents in patients with diabetic retinopathy, especially proliferative retinopathy, in routine ophthalmological examination of patients with T2DM.


Citation analysis and co-authorship of Iranian researchers in the field of immunology in ISI Web of Science: a brief report
Yousefi Ahmad, Hemmat Morteza, Gilvari Abbas, Shahmirzadi Tayebe,
Volume 70, Issue 3 (4 2012)
Abstract

Background: Currently, share of the scientific output, citation per paper, and co-authorship for articles indexed in databases such as ISI Web of Science, are very important criteria for the evaluation and ranking of countries, researchers, institutes, articles, disciplines and journals in the world. Therefore, the main objectives of the study were to determine co-authorship, the average citation per paper and the most prolific Iranian university or institution in the field of immunology.

Methods: For performing this scientometric study, we employed survey methods and citation analysis of the indexed papers in the ISI Web of Science from 1974 to 2010.

Results: A total of 1775 articles by Iranian authors in the field of immunology had been indexed in the database for the aforesaid period. Most collaborations and co-authorship of Iranian authors was with their counterparts from the USA. The average citation per paper in the field was 6.26 per paper. Tehran University of Medical Sciences had the highest number of articles in the database.

Conclusion: According to the results, Iranians collaborated with American peers more than any other nationality andthe average citation per paper in the field of immunology is higher than that of other fields in Iran but lower than the global average. Tehran University of Medical Sciences is the most prolific university in the field.


Minimum inhibitory concentration of ciprofloxacin in combination with hexahydroquinoline derivatives against Staphylococcus aureus
Yousefi M, Pourmand Mr, Shahverdi Ar, Amini M, Amin Harati F,
Volume 70, Issue 9 (5 2012)
Abstract

Background: Staphylococcus aureus is the most common pathogen responsible for skin and soft tissue infections worldwide. Methicillin-resistant S. aureus is a major cause of both nosocomial and community acquired infections. The emergence of antimicrobial-resistant S. aureus is of global concern. Fluoroquinolone antimicrobials including ciprofloxacin, levofloxacin, and moxifloxacin are used to treat skin and soft tissue infections due to S. aureus. Emergence of ciprofloxacin resistance has increased in community acquired methicillin-resistant S. aureus strains. The aim of this study was to evaluate the minimum inhibitory concentration of ciprofloxacin and hexahydroquino-line derivatives against methicillin- and ciprofloxacin-resistant S. aureus.
Methods: Identification of S. aureus was performed by routine microbiological tests in the Department of Pathobiology in Winter 2012. The susceptibility of S. aureus strains to both methicillin and ciprofloxacin was examined by the Kirby-Bauer disk-diffusion method. The minimum inhibitory concentration of ciprofloxacin, hexahydroquinoline derivatives and their combination were separately determined by broth microdilution method against methicillin- and ciprofloxacin-resistant S. aureus.
Results: The minimum inhibitory concentration of ciprofloxacin decreased in the presence of hexahydroquinolinein derivatives in comparison with ciprofloxacin alone.
Conclusion: This study showed that hexahydroquinoline derivatives enhance the antibacterial effect of ciprofloxacin against methicillin- and ciprofloxacin-resistant S. aureus. Therefore, these derivatives could be used as inhibitors of antibiotic resistance in combination therapies. This enhancement may be related to the inhibitory effect of hexahydroquinoline derivatives on the expression of antibiotic efflux pump in the bacteria. However, the structural features of a fluoroquinolone that determine whether it is affected by efflux transporters are not fully defined.


Evaluation of exotoxin A gene and frequency of polymerase chain reaction sensitivity in detection of pseudomonas aeruginosa isolated from burn patients
Rasoul Yousefi Mashouf, Rasoul Esmaeili, Mohammad Yousef Alikhani , Mehdi Ghanbari ,
Volume 72, Issue 3 (June 2014)
Abstract
Background: Pseudomonas aeruginosa is a gram-negative pathogens opportunism which causes severe infections in human beings. The most common infection include: endocarditis, meningitis, septicemia and chronic lung infections in cystic fibrosis pa-tients. This bacterium has many pathogenic factors including exotoxin A, lipopoly-sacharide, phospholipase C, pili, elastase and alkaline protease. The purpose of this study was to evaluate the frequency of exotoxin A gene (ETA) as a strong virulence factor and sensitivity determination of polymerase chain reaction (PCR) in pseudomonas aeruginosa isolated from second and third-degree burn patients. Methods: This study has performed in Besat University Hospital in Hamadan from January to December 2012. We used 170 isolated samples. The samples were isolated from blood and skin biopsy in second and third-degree burn patients. We had 79 strains positive culture of pseudomonas aeruginosa. Forward and reverse primers used for PCR were designed by DNASIS and Oligo software. Then genomic of known strains were extracted by DNA purification kit and indentified by PCR. The quality and quantity of the extracted DNA was determined using spectrophotometry. For determination of PCR sensitivity was used culture test as gold standard. DNA of pseudomonas aeruginosa (ATCC 27853) was used as a positive control. Finally data was analyzed using SPSS software. Results: Out of 170 isolated samples, 79 strains of pseudomonas aeruginosa isolated from burn patients had positive culture. PCR of isolated positive culture demonstrated that 5 strains (6.33%) were with out this virulence factor and 74 strains (93.67%) had ETA gene. So the sensitivity of test based on sensitivity formula was 94.04%. Conclusion: Our results showed that sensitivity of PCR mediated ETA gene in detection of pseudomonas aeruginosa strains is considerable and this factor can be used as a good factor identifying of pseudomonas aeruginosa. It seems more studies with larger sample size is necessary in this area.
Metastatic choriocarcinoma in the small bowel: a case report
Zohreh Yousefi , Sedighe Ghasemian Mehrdizaj , Mohamad Bidar Frimany , Farzaneh Rashidi Fakari ,
Volume 72, Issue 5 (August 2014)
Abstract
cBackground: Choriocarcinoma is a highly malignant form of gestational trophoblastic disease. It is characterized by metastatic potential, rapid growth and deeply invasion into blood vessel and then widespread dissemination metastasis. However, the most common sites of metastatic choriocarcinoma are lung, vagina, liver, and brain. But, metastatic choriocarcinomas rarely is extended to gastrointestinal system. It is im-portant to keep in mind that despite extensive metastasis, choriocarcinoma is very curable disease. Due to high responsibility of this disease, early diagnosis of choriocarcinoma and treatment with chemotherapy can prevent mortality and morbidity of these patients. In this case report, we present a rare case of metastatic choriocarcinoma in the small bowel after normal term pregnancy. Case Presentation: A 34-years-old woman G4, P4, L4 presented with abnormal postpar-tum vaginal bleeding (45 days) and unresponsive to usual medical and surgical therapy (oxytocine, metergene, antibiotic, and double curettage). The patient was admitted in the Ghaem Hospital, Mashhad University of Medical Sciences in April 2013. She suf-fered from rectal hemorrhage and severe weakness. Because of unsuitable condition (shock), laparotomy was performed and small bowel involvement was observed. Seg-mental resection of small bowel detected metastatic choriocarcinoma of the lesion. We couldn’t rescue our patient due to unresponsive to combination chemotherapy (actino-mycine, methotrexate, cyclophosfamide, vincrystine, etopuside). Conclusion: In abnormal postpartum hemorrhage, we should consider the possibility of choriocarcinoma. Although, it is important to note rare manifestations of metastatic choriocarcinoma of small bowel in massive gastrointestinal hemorrhage.
Uncommon toxicity of low-dose methotrexate: case report
Zohreh Yousefi , Golrokh Sherafati , Azar Fani ,
Volume 73, Issue 7 (October 2015)
Abstract

Background: Standard treatment of Gestational Trophoblastic Disease (GTD) is chemotherapy. Single-agent chemotherapy regime including Methotrexate (MTX) or Actinomycin. Single-agent is widely used in treatment of persistent trophoblastic disease. We reported an uncommon toxicity of low-dose single-agent methotrexate in a patient. Case Presentation: A 20-year-old woman, primary gravid after two months missed period and spotting with diagnosis of incomplete abortion with uterine size equivalent of ten weeks pregnancy (8-10 cm) underwent evacuation curettage. In serial follow-up, based on rise of beta-hCG titer and absence of metastatic disease, it was categorized as low-risk persistent trophoblastic disease. She was referred to gynecology oncology center of Ghaem Hospital, Mashhad University of Medical Sciences in May 2014. Because of rise of beta-hCG titer, after complete metastatic work-up and lack of disease in other sites, persistent disease was diagnosed and candidate for chemotherapy (single agent low-dose). The patient received first course of therapy with MTX (50 mg/m², intra muscular). Unfortunately, after two days of treatment she developed uncommon severe toxicity, fever, severe nausea and vomiting, tachycardia, and generalized weakness. Also, we found hematologic abnormality (WBC: -14000-15000 µI, platelet- 540 µI and sever neutropenia), and abnormal rising in liver function test (SGOT, SGPT) (three to four times) and renal function test (BUN and Creatinine) (two times). In addition, she had disseminated erosive lesion in all of body especially in face. Due to the fatal side effects of chemotherapy, she was admitted to intensive care unit (ICU). Fortunately, after two to three weeks, she was improved by conservative management. After few weeks beta-hCG titer was in normal limit. However she had normal serial beta-hCG in one year of follow-up. Conclusion: It is important to emphasis unpredictable side effects of chemotherapy with low-dose methotrexate.


Dysgerminoma and ovarian gonadoblastoma in Swyer syndrome
Zohreh Yousefi , Sima Kadkhodayan , Shohre Saeed , Amirhossein Jafarian , Fatemeh Mirzamarjani ,
Volume 74, Issue 3 (June 2016)
Abstract

Background: Swyer syndrome is a type of hypogonadism with 46,XY karyotype. This syndrome was named by Gerald Swyer, an endocrinologist. It leads to a female with normal internal genitalia (uterus, fallopian tubes, cervix, vagina), but instead of ovaries, they have non functional ovary (streak gonads). Also, they have absence of puberty because of gonadal  digenesis. The current practice is to proceed gonadectomy once the diagnosis is made due to the fact that the risk of malignant transformation is high in dysgenetic gonad. In addition, hormonal replacement therapy after surgery is acceptable.

Case Presentation: We present a case of gonadoblastom in right ovary in a Swyer syndrome who referred to the department of Gynecology Oncology at Ghaem Hospital, Mashhad University, Iran in 2015 for evaluation of abdomino-pelvic distention. She was a 18-year-old female with 46, XY karyotype and poor secondary sexual character and normal external genitalia. She suffered of abdominal pain. In palpation of the abdomen, an irregular mobile mass was detected in left lower quadrant. The ultrasound revealed uterine size approximate dimensions 3×2 cm (infantile) and a 19 cm pelvic mass heterogeneous and multi-loculated in left side of the pelvic cavity with possible origin of the left ovary. In addition, in right pelvic fossa, a mass about 6 cm was detected. CT-Scan showed a pelvic mass with overall dimensions of 10 cm with vicinity to the left iliac vessels, modest amounts of ascities along with evidence of peritoneal dissemination (seeding). In laparotomy we observed massive ascities and a 20 cm solid mass in left ovary and a small mass in right ovary and involvement para aortic lymph node. Pathological report indicated as stage III of dysgerminoma in left ovary and gonadoblastom in right ovary.

Conclusion: This case is presented because it could have excellent prognosis if not missed opportunities of early recognizing and furthermore adequate treatment with gonadectomy.


The role of para aortic lymphadenectomy in early stage of ovarian cancer
Zohreh Yousefi , Sima Kadkhodayan , Maliheh Hasanzadeh Mofrad , Behroz Davachi , Mansoureh Mottaghi , Elham Hoseini , Monavar Afzalaghaee , Asieh Maleki ,
Volume 74, Issue 9 (December 2016)
Abstract

Background: Surgical staging is the standard treatment of ovarian cancer. Pelvic and para-aortic lymphadenectomy is the important part of the surgery. The aim of this study was to evaluate the effect of para aortic lymph node dissection in early stage of patients with ovarian cancer.

Methods: This descriptive cross-sectional cohort study was performed on all stage I of ovarian cancer patients admitted in department of gynecology oncology of Ghaem Hospital, Mashhad University of Medical Sciences in November 2012 to March 2014. Every patient with clinical early stage of ovarian cancer candidate to surgical treatment selected. All cases underwent surgical staging surgery with concurrent systematic pelvic and para-aortic lymphadenectomy. In laparotomy after identification of left and right iliac artery, all lymph nodes have been properly exposed and dissected as a part of a staging laparotomy. The dissection was continued up to the nodal tissues surrounding the aorta, and inferior vena cava, until inferior mesenteric artery lymphadenectomy level. The procedure performed only by gynecologist oncologist. In addition, we assessed other parameters such as operation time, estimated blood loss, associated mortality and morbidity and vascular injuries. Finally, the effect of para aortic lymph node dissection in early stage of ovarian cancer evaluated.

Results: Among a total of 57 ovarian cancer patients, 27 of them apparent stage I disease cases were selected. Surgical staging surgery with concurrent systematic pelvic and para-aortic lymphadenectomy was carried for all of them. Positive para-aortic lymph node was found only in one case. The average number removed para-aortic lymph nodes in the pelvis was 9 and in para aortic was 7, respectively. In addition, 20 minutes increase in total length of operation time was observed duo to para-aortic lymphadenectomy. Also the rate increase in intra-abdominal hemorrhage rate was estimated 60 ml.

Conclusion: Lymph node dissection will produce a significant benefit in accurate and complete surgical staging. Staging surgery in addition to systematic pelvic and para aortic lymph adenoctomy in early stage ovarian cancer is preferred in gynecologic oncology centers.

Choriocarcinoma after caesarian section: case report
Zohreh Yousefi , Laya Shirinzadeh , Marjaneh Farazestanian , Amir Hossein Jafarian , Roya Jalali,
Volume 74, Issue 11 (February 2017)
Abstract

Background: The most common symptom of patients with gestational trophoblastic neoplasia is abnormal vaginal bleeding. Despite repeated visits of patients with postpartum choriocarcinoma and abnormal postpartum hemorrhage, delayed diagnosis leads to advanced disease with widespread metastasis. Therefore, occurrence of choriocarcinoma with variable patterns in different diagnosis of late onset postpartum hemorrhage should be considered. Early diagnosis of choriocarcinoma after term pregnancy is important that resulted in decrease of maternal morbidity. Therefor late onset postpartum hemorrhage should have an awareness. The aim of this study was to report a case of choriocarcinoma after caesarian section.

Case Presentation: A 33-years-old woman one month after antecedent caesarian section in her second pregnancy admitted with abnormal vaginal bleeding. Based on raised titer concentration of β-hCG was 187000 u, with clinical suspicious of choriocarcinoma she was referred to oncology department of Ghaem Hospital, Mashhad University of Medical Sciences, Iran, in 2016. Vaginal exam revealed an enlarged uterus about 10 weeks of pregnancy. Transvaginal sonography showed an intracavitary heterogeneous mass with irregular surface in fundus without myometrium invasion. Extra pelvic metastasis excluded via vaginal exam, pulmonary X-ray and, ultrasonography and computed tomography scan. Due to early stage of gestational trophoblastic neoplasia and diagnosis of this condition, single agent chemotherapy (methotrexate) was recommended, but because of unresponsive disease, subsequently, she was treated with combination chemotherapy (etoposide, methotrexate, and actinomycin, followed by cyclophosphamide and vincristine) that led to remarkable response. After three courses of therapy, normal level of β-hCG was observed and now the patient is free of disease and under-serial follow-up visit for choriocarcinoma.

Conclusion: Diagnosis of choriocarcinoma should be considered in any postpartum woman with abnormal vaginal bleeding.

Evaluation of hospital accreditation method
Ali Mohammad Mosadeghrad , Ali Akbari Sari , Taraneh Yousefinezhadi ,
Volume 75, Issue 4 (July 2017)
Abstract
Background: Hospital accreditation is a systematic external evaluation of a hospital’s structures, processes and results (outputs/ outcome) by an independent professional accreditation body using pre-established optimum standards. Hospital accreditation has an important role in improving the quality, safety, effectiveness and efficacy of health care services. The effectiveness of an accreditation system depends on the quality and conformity of its methods, standards and surveyors. This study aimed to evaluate the hospital accreditation method from the perspective of Iranian hospital managers.
Methods: This descriptive, applied and cross-sectional study was carried out in 2015 using a valid and reliable questionnaire. The study population consisted of 914 hospital managers. Overall 547 hospital managers were surveyed through stratified random sampling. SPSS software was used for data analysis.
Results: Almost 71.7 percent of hospitals achieved grade one and above in the first round of national accreditation survey. The mean score of managers’ satisfaction of hospital accreditation method was 3.21±0.63 out of 5 (Average). About 38 percent of hospital managers were satisfied with the hospital accreditation method. Most complaints were related to lack of reliability among surveyors and their low knowledge,  skills and experience. Hospital managers were satisfied with surveyors’ attitude and adequacy of the number of survey days. Hospital managers mostly believed that accreditation is better to be done by Ministry of Health, compulsory, and every two years. About 95 percent of hospital managers agreed that self-assessment is necessary and beneficial prior to the accreditation survey.
Conclusion: Hospital managers were moderately satisfied with the national accreditation system. Developing job description and person specification for accreditation surveyors and recruiting them accordingly, and providing professional education and training for them help improve the effectiveness of Iranian hospital accreditation method. The method of hospital accreditation in Iran has to be changed. Self-assessment, unannounced surveys, review of hospital key performance indicators and patient satisfaction surveys should be added to the current scheduled on-site surveys to enhance the credibility of the accreditation result.

The effect of wet cupping on serum levels of interferon-gamma in laboratory rats with the disease brucellosis
Mohammad Molavi , Rasoul Yousefi Mashouf , Mohammad Yousef Alikhani , Hassan Mahmoudi , Alireza Zamani , Fariba Keramat , Sara Soleimani Asl ,
Volume 75, Issue 6 (September 2017)
Abstract
Background: Brucellosis is a systemic infection caused by gram-negative coccobacilli and facultative intracellular bacteria of the genus brucella. Brucellosis is a bacterial disease common to humans and livestock. Infection with Brucella spp. continues to pose a human health risk globally despite strides in eradicating the disease from domestic animals. The humoral and cellular immunity plays an important role in brucellosis. The effect of phagocytosis and cellular immunity has been demonstrated in brucellosis. The effect of cupping as a therapeutic method on bacterial diseases has been demonstrated. By considering this fact that cupping is an effective method on host immune system functions and has potential effect to regulate the inflammatory reactions.
Methods: This experimental study was carried out on 48 rats in 6 groups (48 rats were divided into 6 groups) during the first 6 months from January 2015 to July 2016 in the laboratory of microbiology and animal of Hamedan University of Medical Sciences. The rats were infected through the injection of Brucella melitensis with plenty 5×105 (cfu/ml) of bacteria. After a week, in order to approve the accuracy of the infection in the studied rats inoculated with coombos Brucella melitensis, Wright test, 2-Mercaptoethanol test and Coombs' Wright test were used. The rats were then treated with cupping method in their sacral area. IFN-γ was measured using enzyme-linked immunosorbent assay. And the study of tissues using hematoxylin and eosin (H&E) Staining.
Results: The results of this study showed that cupping leads to an increase in the mean serum level of interferon-gamma. The histopathological study of liver tissue showed that the radial arrangement was not observed in the infected group with brucellosis and the cells were acidophilus. While, the radial arrangement was observed in treated rats with cupping, but it was not complete. The number of enlarged sinusoids were reduced. But, cell infiltration was observed.
Conclusion: This study showed that cupping can increase serum level of IFN-γ, and thus help to the clearance of disease and improvement of injury in the brucellosis animals lab.

A case report of pyoderma gangrenosum after genital surgery: case report
Mohammad Javad Yazdanpanah , Zohreh Yousefi , Amir Hosein Jafarian , Laya Shirinzadeh , Mina Baradaran ,
Volume 75, Issue 6 (September 2017)
Abstract
Background: Pyoderma gangrenosum (PG) (ulcerating neutrophilic dermatosis) is a rare disease that about of half of these patients have a systemic disorder, particularly Crohn's and ulcerative colitis. In addition, inflammatory lesions play key role in its pathogenesis. In early diagnosis of disease, we will further prevent of serious consequences of the disease. In this report, a case of PG after the vaginal surgery with history of ulcerative colitis was introduced.
Case presentation: A 37-years old woman was admitted in an University Hospital of Mashhad University of Medical Sciences, Iran, in 2016 two weeks after genital surgery. The chief complaints were fever, painful tenderness, ulcerative lesion and inflammatory papule on surgical site and thigh. She suffered of fever despite received oral and then wide spectrum intravenous antibiotic therapy. Blood cultures and wound culture were negative. In addition to two deferent intravenous antibiotics, topical wound debridement was performed. Despite this course of treatment which did not improve the lesion, biopsy was performed. Histopathology features of biopsy specimen indicated prominent neutrophils mixed inflammation and lymphocytic vasculitis indicated as pyoderma gangrenous. The patient's medical history included associated ulcerative colitis from 18 years ago and she was under irregular oral receiving of Asacol (mesalamine). Intravenous corticosteroid therapy was administered which led to response of skin of right thigh and surgical site inflammation. After 6-months follow-up, the patient is still in good condition.
Conclusion: Based on major variable clinical manifestations and no diagnostic serologic test of pyoderma gangrenosum, diagnosis of this disease is difficult. Increased awareness about PG and exclusion of other etiologies such as inflammatory and immunologic disease will aid in prompting of pyoderma gangrenosum diagnosis and proper management of the disease.

Evaluation of serum hepatitis A virus antibodies in patients aged 6 months to 10 years
Alireza Yousefi , Mohammad Sobhani Shahmirzadi , Mohammad Ali Vakili , Maryam Kochaki , Kambiz Eftekhari,
Volume 75, Issue 11 (February 2018)
Abstract
Background: Hepatitis A is one of the most common viral infections in the world. In children, the manifestations of infection are usually milder but in adults they are more severe. The risk of acute hepatic failure increases when the infection occurred in the older ages. The aim of the study was to evaluate of serum hepatitis A antibodies in children.
Methods: This cross-sectional study was performed on two hundred children (two groups of hundred individuals each) aged 6 months to 10 years old hospitalized in the emergency department of Taleghani Hospital (Gorgan city) from May to July 2016. The first group aged 6 months to 3 years and the second group 3 to 10 years old. After obtaining the parental consent, 3 ml of blood sample were taken to determine immunoglobulin M (IgM) against HAV using commercial ELISA kits (Dia.Pro Diagnostic, Milano, Italy) and the children’s’ demographic data were recorded.
Results: The study was conducted on two hundred children. Of these patients 127 (63.5 percent) were boys and 73 (36.5 percent) girls. Overall, 11 percent [twenty-two patients including eight (8 percent) in the first group and Thirteen (13 percent) in the second group] were serologically positive for hepatitis A. There was no significant difference between the groups in terms of age and sex. (P= 0.239) and (P= 0.535). Only 11 percent of children under 10 years old were infected by hepatitis A and 89 percent of children had no history of contact or infection.
Conclusion: Based on this study, the incidence of hepatitis A infection was about 11% in children under 10 years old, which indicates a reduction in exposure with this virus. It may seem reasonable based on health policy but the adverse effect of this trend is later probability of contacts with Hepatitis A patients and occurrence of HAV in older ages. Therefore, we can conclude that HAV infection has been shifted to older ages.

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