Tehran University Medical Journal

Background: Head and neck squamous cell carcinoma (HNSCC) is the malignancy of squamous cells (the epidermal layer of skin) in cavities in head and neck includes: larynx, pharynx, paranasal sinuses and oral cavity. The main goal of this research was to understand the effect of mutations in two important genes (KRAS and BRAF) in RAS/MAP kinase (EGFR) signaling pathway in tumor cells with head and neck squamous cell carcinoma in Iran.
Methods: The present cross-sectional study performed from October 2015 to September 2016 on 40 patients suffering from head and neck squamous cell carcinoma, all confirmed by pathology department of Imam Khomeini hospital. Tumor samples were achieved from the surgical cancer department of Imam Khomeini hospital and stored in liquid nitrogen until starting tests. The tests done in genetic laboratory of Tehran University of Medical Sciences. Techniques we used in this research, were DNA extraction based on phenol-chloroform approach, Multiplex PCR (M-PCR) to amplify mentioned exons and KRAS/BRAF strip assays to detect mutations in mutated hotspots in exon 2 of KRAS and codon V600E in BRAF gene.
Results: In this study, we observed 7 mutations in codons 12 and 13 exon 2 in KRAS gene (about 17.5%) and 4 mutations in codon V600E in BRAF gene (about 10%) of obtained tumor samples. The hotspot mutation in codon 12 were Asp (10%) and Ser (5%) respectively. In BRAF, the most common mutation, as we expected according to other researches, was observed in codon V600E. We also observed that 29 people of these patients were male (about 72.5%) and 11 patients were female (about 27.5%). Moreover, 28 patients were over 50 years, while 7 patients were below the age of 50.
Conclusion: The results of this study showed that mutations in genes KRAS and BRAF especially in studied hotspots, and the effects on their molecules in EGFR signaling pathway are important in involving head and neck squamous cell carcinoma, as other cancers. These findings may be considered in choosing drugs for targeted chemotherapy.

Background: In three-dimensional conformal radiation therapy (3D-CRT), contrast-enhanced CT (CECT) image is commonly used to assist radiation oncologists in diagnosing regions of interest, so that normal and target tissues can be better delineated. CECT causes the temporary increase in the CT number and the corresponding electron density (ρe). Administrated contrast agents (CA) during CT simulation and altering the ρe of structures can be effective on radiation calculations and dose-volume histograms (DVHs) in radiotherapy treatment planning. Therefore, present study was designed and performed to determine the influence of the administrated CA on DVHs.
Methods: Current study performed as a self-controlled clinical trial study with before/after method at Imam Reza Hospital, Kermanshah City, during the period from June 2015 till August 2016. Ten patients with pelvic cancer included in this study through simple sampling. Cases with prior reactions to CA, diabetes, renal diseases, and asthma were excluded. Two sets of CT-scans were taken for each patient in the same position and coordinates. Primary study sets contained pre-contrast images and secondary study sets were performed post-contrast. Both sets of CT images were transferred to the treatment planning system (ISOgray® software, Version 4.1.3.23 L, DOSIsoft®, Cachan, France). All treatment plans were generated on pre-contrast and subsequently copied to the post-contrast CT. Quantitative calculations were performed in treatment planning including the difference in ρe before and after CA administration.
Results: The prostate (1.27%), the bladder (0.62-0.79%) and the rectum (0.43-0.56%) showed the largest changes in average ρe increase. The results confirm the expected relationship of increasing attenuation, CT number, and ρe with increased tissue density due to the CA. However, the DVHs showed insignificant difference between pre-and post-contrast CTs for 18 MV photon beam.
Conclusion: The results showed statistical insignificant difference between with and without CA CTs treatment plan in pelvic field for targets and OARs. These results may serve as a reference to justify the use of CECT data sets for 3D-CRT planning of pelvic region cancers using DosiSoft ISOgray system.

Cancer/testis antigens (CTAs) are a kind of antigens that their expression mostly is restricted in testis and female’s genital organs. Tumor cells often express antigens whose expression is normally limited to germ cells. CTAs are composed of a vast gene family of closely related members and are commonly classified into two groups: the CT-X antigens that are encoded by the X chromosome and the non-X CTAs that are encoded by the autosomes. CTA are extensively and variably dispersed between tumors of diverse histotypes. CTA are broadly expressed in tumors, but not in normal tissue except for testis that is not available to the immune system, actually, the blood-testis barrier and the lack of HLA class I expression on the surface of germ cells avoid the immune system from the interaction with CTA proteins to be identified as non-self-structures. Consequently, CTA can be regarded as fundamentally tumor-specific targets. With extensive investigations on the function of this important biological molecules, their functions are somewhat revealed. Because of their high immunogenicity, tumor-limited, and biased expression, detection of these molecules provides unprecedented chances for further research and clinical development in the field of immunotherapy and cancer diagnosis. Also, growing evidence discloses that a number of CTAs stimulate epithelial mesenchymal transition (EMT) and generation of cancer stem-like cells, increasing metastasis, invasion and tumorigenesis. According to recent clinical attention, more features of CTA regulation are explored. CTA expression has been confirmed in a variety of human cancer tissues and some of them have been discovered to cause humoral and/or cellular immune responses in cancer patients, likewise, they displayed intertumor and intratumor heterogeneity in expression levels. CTAs are excellent targets for targeted tumor therapy, anticancer drug discovery, and diagnostic biomarkers, similarly, appreciated genes in the study of promoting tumorigenesis, immunotherapy, and malignant progression. This review summaries and classifies our current understanding of the complex and biased process of CTAs mRNA and protein expression in cancer, and provide the most current information on their function and regulation.
 

Immunotoxins such as pseudomonas exotoxin are Molecules with a unique structure like toxin-antibody part. These immunotoxins are two functional which crossing the cell membrane and enters the target cell and destroy the cell. Toxin-based treatments are a widespread research field and can have broad applications in the biology and public health. Immunotoxins act selectively against cancer cells and have a good potential for detecting and targeting cancer cells. Specific immunotoxins to target immune cells due to the selection type antibody and antibodies are responsible for the identification of the target cells. Cancer is becoming a major cause of death in most developed countries. In order to have a strong factor in cancer repression, that agent must target the cancer cells directly and specifically. Often, but not always, immunotoxins are produced for disabling and killing cancer cells, that this issue is one of new therapeutic approaches in recently. Clinical aims to designing and create new cancer therapies focused with this approach, a lot of information about the toxin and intracellular pathways have been obtained. So, toxins in medicine are useful for the treatment of human disease and study of professional cellular functions. So, immunotoxins have a high potential for cancer treatment. Other applications of immunotoxins, including immune system regulation and treatment of viral diseases and parasites diseases. More research is needed to improve the immunotoxin effects and to reduce their side effects. On the whole, with design creative, clever and experienced programs, many human diseases, particularly cancers can be in a short period of time and faster than other methods of treatment that the treatment of long, to be treated. Following the design and implementation of clinical trials, the effects of immunotoxins on animal tumorigenic models were performed. In fact, in this study, we focus on the use of protein-bound toxins with bacterial and herbal sources and more specifically Pseudomonas immunotoxins which attached to antibodies to target cancer cells.

Background: Children's health, preserving and promoting it is a health priority of any society. Malnutrition affects all age groups, but malnutrition in children is one of the most common nutritional problems that can delay body growth, shortened height, frequent infections, mental retardation, the prevalence of mental disorders, lack of academic achievement and reduced efficacy. Because of the importance and impact of this issue in children, the purpose of this study was a systematic review and meta-analysis of the prevalence of underweight in Iranian children, in order to highlight the importance of this issue to health policy-makers.
Methods: A meta-analysis was performed for relevant articles in scientific databases including Scientific Information Database (SID), ScienceDirect, PubMed and Google Scholar. Entrance criteria included cross-sectional studies (March 1996 to February 2017) that had a low incidence of underweight in Iranian children in different parts of Iran. Non-relevant articles included review articles, interventions, cohorts and case studies, and studies that looked at obesity, overweight and the relationship between these factors and other diseases, excluded from the study list. Reference lists of identified articles were reviewed for additional articles. Heterogeneity of study was checked using I2 index and the possibility of publication bias by funnel plot and Begg and Mazumdar's rank correlation test and a significance level of 0.1. Data were analyzed using the comprehensive meta-analysis software, version 3 (Biostat, Englewood, NJ, USA).
Results: In 26 articles reviewed in the study, total number of participants was 142938  persons at the age of 1 month to 12 years. The overall prevalence of underweight in Iranian children was 15.5% (Cl 95%: 12%-19.7%) during 1996 to 2017. The highest prevalence of underweight in was recorded in Birjand city in 2006 and Zahedan city in 2009, 68.6% (Cl 95%: 63.3%-72.9%) and the lowest prevalence of underweight in was found in city of Jahrom in 2013, 1.8% (Cl 95%: 1.2%-2.9%).
Conclusion: According to the results of this study, the prevalence of low-birth-weight in the country is high and requires interventional measures.

Gastric cancer (GC) is the second leading cause of cancer-related deaths worldwide. It has been proposed that the specific genotypes of Helicobacter pylori (H. pylori) are the causative agents in the development of gastroduodenal diseases, such as chronic atrophic gastritis, peptic ulcerations, and GC. However, disease progression to GC occurs in only a small proportion of infected patients. Recently, we identified a novel polymorphic site in the 3ʹ-end region of H. pylori vacA gene. The vacA c1 genotype increased the risk of GC. This association was independent of and larger than the associations of the m-, i-, and d-type of vacA or cagA status with GC. Therefore, treatment of H. pylori infection may be an effective way to prevent GC. Expression of cytokines and their associations with inflammatory responses has been shown. Several cytokine polymorphisms, such as IL-1B, IL-8, IL-10, and TNF-α have been considered as risk factors for GC. It has been shown that the interaction of bacterial genotypes and host factors plays an essential role in developing GC. Several altered molecular pathways are involved in the pathogenesis of GC. Micro-RNAs are small, non-coding RNAs of 18-25 nucleotides in length that regulate the expression of target mRNAs. Expression pattern of cancer cells is different compared with the normal cells. Micro-RNAs plays a critical role in apoptosis and classified in two groups: pro- and anti-apoptotic agents. Recent studies have confirmed the oncogenic or tumor suppression role of micro-RNAs in cancer cells. They play a significant role in the GC cell physiology and tumor progression, by translational suppression of target genes. These small RNAs have therefore emerged as a new type of GC biomarker with immeasurable clinical potential. Generally, a variety of micro-RNAs involved in different stages of cancer, including tumorigenesis, angiogenesis, and metastasis. Considering to this issue more than 50% of cancers can be cured, if they were diagnosed in the early stages. Hence, identifying the biomarkers of GC could play an important role in prevention, early diagnosis and rapid treatment of patients. In this review article, we have reviewed the latest findings about bacterial and tissue biomarkers of GC

Background: Hospital bed capacity is one of problems in intensive care unit during at the time of crisis, emergencies and disasters. At this regard, it seems reverse triage can resolve this issue by using predictive score systems. This study was purposed to develop a reverse triage system in intensive care unit using APACHE II scoring system for crisis, emergencies and disasters situations.
Methods: This study was performed by a prospective longitudinal design that lasted from March 2016 to February 2017. Research population were 420 internal patients that were admitted in intensive care units of Imam Reza Hospital in Mashhad, Iran. Data were collected and documented for each patient by demographic questionnaire and APACHE II scoring system daily until discharging time from intensive care units. The patient’s status after discharge from the intensive care unit was used as a criterion for statistical tests.
Results: APACHE II mean score in first day of admission was 18.9±16.20. Risk ratio of patients’ discharging from intensive care unit was 1.034. The patients were placed in four levels of inverse triage according to mortality rate and risk ratio. The scores of four levels were including: 0-10 (first level and green color), 11-16 (second level and yellow color), 27-71 (third level and black color) and 17-26 (fourth level and red color).
Conclusion: The Apache II system can be used as a tool for reverse triage in intensive care units during at the time of crisis, emergencies and disasters. When using this system for reverse triage, patients at the first to third levels can be discharged from intensive care unit. However, patients on the fourth level should not be discharged from intensive care units under any circumstances.

Background: Cystatin C (Cys C) as a cysteine protease inhibitor is produced in a constant level from all nucleated cells. The purpose of this study was to investigate the correlation between serum levels of Cys C and coronary slow flow (CSF) and body mass index (BMI) in men.
Methods: This investigation is in the form of a descriptive-analytical study. The statistical population was all non-active male aged 34-73 years with CSF candidate for angiography referring to Seyedoshohada University Hospital, Urmia, Iran, from March 2015 to February 2017. After obtaining an inform consent, 74 male patients (mean age 54.77±9.00 years, height 1.74±0.12 cm, weight 73.13±6.85 kg, and BMI 26.98±3.83 kg/m2) were selected by convenience non-random sampling as the sample size (patients were eligible for diagnostic coronary artery angiography for the first time and referring to Seyedoshohada University Hospital in Urmia). Then all the patients were placed under angiography with one mobile angiography system. Patients were assessed for coronary blood flow with a quantitative method using corrected thrombolysis frame count in myocardial infarction (CTFC). All the patients with TFC larger than two standard deviation pre-published area for a specific vessel were counted as CSF. Demographic characteristics of age, height, weight, and BMI in male patients were measured by wall-meter with an accuracy of one millimeter, digital scale with precision of 100 g, and weight/hieght2 formula, respectively. The traditional risk factors including smoking, diabetes mellitus (DM), high blood pressure (HBP), dyslipidemia, and family history were also assessed using a checklist. Serum levels of Cys C were measured by ELISA machine.
Results: The mean demographic and physiological variables of subjects were: age 54.77±9.00 yr, height 1.74±0.12 cm, weight 73.13±6.85 kg, and BMI 26.98±3.83 kg/m2. Also, the results of this study showed that there were no significant correlations between serum levels of Cys C with CSF and BMI in male patients’ candidate for angiography referring to Seyedoshohada University Hospital (P=0.871 and P=0.494, respectively).
Conclusion: The results of this study suggest that serum levels of Cys C had no significant correlations with the CSF and BMI in male patients’ candidate for angiography aged 34-73 years.

Background: Genital warts are one of the most common sexually transmitted infections, 1% of sexually active population have anogenital warts (AGWs). According to previous studies, the disease affects people's quality of life and imposes financial costs on health systems.
Methods: The present study is a case-control study at spring of 2018. The quality of life of 65 patients with anogenital warts that were referred to Boali-sina Hospital in Sari, Iran compared with 65 control subjects. The World Health Organization Quality of Life Brief (WHOQOL-BREF) questionnaires was used.
Results: According to the results, among the patients with anogenital warts, the quality of sexual contact in majority them were not affected by the disease (70%). The total cost of treatment was less than the monthly income of the family until the time of participating in the study (92%). There was no significant difference between the mean and standard deviation of physical health scores and mental health scores in the control and patient groups. (Respectively P=0.14, P=0.93). There was no significant relationship between the mean of physical health scores with disease severity. However, there was a significant difference between the mental health score in the two groups of patients with low and high levels of severity (P=0.01). Physical health scores in the whole sample have a significant relationship with gender, so that, in women, physical health score was lower than that of male, but the mean score of mental health in both male and female patients was not significantly different (P=0.18). In the control group the score of mental health was lower in women (P=0.041).
Conclusion: In patients with anogenital wart, quality of life doesn’t change significantly, although, mental health scores directly related with disease severity.

Background: Probiotics are living organisms that are beneficial for human health. Lactobacillus species has been considered as probiotic bacteria due to their adjustment of human immune responses and therapeutic effects in inflammatory disorders. The aim of the present study was to evaluate the effects of Lactobacillus probiotic strains on toll-like receptors (TLR2 and TLR4) expression in HT29 cell line (a human colon cancer cell line) infected with S. enteritidis.
Methods: This experimental study was done in Food Microbiology Research Center of Tehran University of Medical Sciences, Iran, from March 2016 to February 2017. In this study, two strains of Lactobacillus acidophilus PTCC 1643 and Lactobacillus casei PTCC 1608 were used. HT29 cells were cultured in RPMI medium containing fetal bovine serum and antibiotics. Then, the cells were treated with the Lactobacillus strains, after or before challenge with S. enteritidis. After total RNA extraction and cDNA synthesis, the capacity of probiotic lactobacilli to modulate TLR2 and TLR4 expression on treated and un-treated HT29 cells were assessed quantitatively using Real-time polymerase chain reaction technique with specific primers.
Results: Our findings indicated that after treatment of non-infected HT29 cells, with both the probiotics, the expression of TLR2 and TLR4 genes significantly increased. In contrast, the expression of these two genes in HT29 cells which were infected with S. Enteritidis was significantly reduced before and after treatment with each one of the probiotic bacteria. The anti-inflammatory effect of probiotic lactobacilli on S. enteritidis were confirmed in tests. This study showed that L. acidophilus and L. casei play a major role in boosting the innate immune responses, the TLR2 and TLR4 expression levels also decreased, pre and post-infection with S. enteritidis.
Conclusion: According to the results, both Lactobacillus strains have remarkable anti-inflammatory effect in pathogenicity of S. enteritidis, but L. acidophilus display greater anti-inflammatory activity than L. casei in this work. Additional in vivo and in vitro studies are required to further elucidate the mechanisms underlying this anti-inflammatory effect.

Background: Campylobacter genus is considered some of the most important agents of bacterial gastroenteritis worldwide. Campylobacter coli (C. coli) is accounted to at least 25% of all Campylobacter related diarrheal diseases moreover, C. coli infections can result in severe complications, such as bacteremia, sepsis, meningitis and spontaneous abortion. Finally, there is evidence that the frequency of antimicrobial resistance is higher in C. coli, when compared to C. jejuni. There is no data regarding the frequency and antibiotic resistance profile of C. jejuni isolated from human gastroenteritis samples. The present study aimed to determine the frequency and antibiotic resistance patterns of Campylobacter coli isolated from infectious diarrhea samples.
Methods: In a descriptive cross-sectional study, 200 infectious diarrhea samples collected in Arak University of Medical Sciences Hospitals, Markazi Province, Iran, from May to November 2015 were subjected to the study. In order to identify C. coli modified Gram stain, modified charcoal-cefoperazone-deoxycholate agar (mCCDA) and Brucella agar media with filter and CeuE gene polymerase chain reaction (PCR) were accomplished. Antibiotic resistance against tetracycline, erythromycin, ciprofloxacin, ampicillin and gentamicin was evaluated phenotypically and genotypically.
Results: In total, out of 200 modified gram stained samples, 2 cases (1%) of C. coli were identified. Cultivating methods using mCCDA medium found 2 isolates (1%), 3 isolates (1.5%) were grown on Brucella agar with filter and 5 cases (2.5%) were determined as C. coli using PCR assay. Antibiotic resistance was observed in 5 cases against tetracycline, erythromycin and ciprofloxacin (100%), in 4 cases against ampicillin (80%), in 2 cases against gentamicin (40%), in 5 cases with CmeB, 23srRNA mutation in, qnrS, tet (o) (100%), in 4 cases with gyrA4 (80%), in 3 cases with gyrA5 (60%), in 5 cases with gyrA6 (100%), in 4 cases with Oxa61 (60%) and in 1 case with aphA-3-1 (20%).
Conclusion: In this present study C. coli with low prevalence and entire resistance to ciprofloxacin and erythromycin which are the first line antibiotic for the treatment of campylobacter gastroenteritis is introduced as a causative agent of gastroenteritis in patients at central part of Iran.

Background: Contact lenses are transparent, thin plastic disks that cover the surface of the cornea. Appropriate lens prescription should be performed properly by an expert to provide better visual acuity and reduce side effects. The lens administration is a multi-stage, complex and time-consuming process involving many considerations. The purpose of this study was to develop a decision support system in the field of contact lens prescription.
Methods: In this fundamental study, data were collected from 127 keratoconus patients referred to the contact lens clinic at Farabi Eye Hospital, Tehran, Iran during the period of March 2013 to July 2014. Five parameters in the contact lens prescribing process were investigated. Parameters were collected as follows. “Lens vertical position”, “vertical movement of the lens during blinking” and “width of the rim” in the fluorescein pattern were obtained by recording videos of the patients while wearing the lens. “Fluorescein dye concentration” under the lens was evaluated by the physician and “patient comfort” was obtained by asking the patient to fill a simple scoring system. Approved and disapproved lenses were judged and recorded based on the decision of an expert contact lens practitioner. The decision support system was designed using artificial neural networks with the mentioned variables as inputs. Approved and disapproved lenses are considered as system outputs. Artificial neural network was developed using MATLAB® software, version 8.3 (Mathworks Inc., Natick, MA, USA). Eighty percent of the data was used to train the support vector machine and the rest of the data (20%) to test the system's performance.
Results: Accuracy, sensitivity and specificity, calculated using the confusion matrix, were 91.3%, 89.8% and 92.6% respectively. The results indicate that the designed decision support system could assist contact lens prescription with high precision.
Conclusion: According to the results, we conclude that hard contact lens fitness could be evaluated properly using an artificial neural network as a decision support system. The proposed system detected approved and disapproved contact lenses with high accuracy.

Background: Matrix metalloproteases (MMPs) are multi-chain proteins that regulated by tissue inhibitor of metalloproteinases (TIMP) and several other mechanisms. This Includes transcription regulation and protein form secretion. The roles of MMPs in wound healing and tissue repair. In tuberculosis (TB), the activity of MMPs is increased and TIMP inhibitors decrease activity. Therefore, in tuberculosis, MMPs cause excessive damage to the lung tissue and cavity formation.
Methods: In a case-control study, plasma samples of healthy controls, symptomatic respiratory tract controls and tuberculosis patients were evaluated by available sampling in Ali Ibn Abitaleb and Bouali Hospitals, Zahedan, Iran, from Apri1 2015 to April 2018. Patients were divided into two groups: tuberculosis and control group and the level of MMPs were measured by the enzyme-linked immunosorbent assay (ELISA) method in plasma samples of the two groups. For MMP-8, which was important in the diagnosis of tuberculosis, a cutoff point was obtained.
Results: 384 people including 123 healthy controls. 107 non-tuberculosis, and 154 tuberculosis patients were examined; 230 patients in the control group and 154 patients in the tuberculosis group. Levels of MMPs in tuberculosis and symptomatic respiratory group were higher than healthy group. The mean of MMP-8 was significantly different between two groups (P<0.001). In this study, sensitivity, specificity, positive and negative predictive value of plasma MMP-8 in detection of TB in non-TB patients in MMP-8 cutoff point=6650 pg/ml were 65.4%, 78.2%, 50%, and 93% respectively outcome. Significantly, the rate of pulmonary cavity was significantly higher in the TB group; Higher cavity, higher concentration of plasma MMPs.
Conclusion: In this study, first comprehensive analysis of MMPs was performed. Two collagenases, MMP-1 and MMP-8, were active in tuberculosis, but MMP-8 was specifically higher in tuberculosis than in both symptomatic and healthy controls. Level of MMP-1, 3, 8, 9 was higher in men than in women. The analysis of genders separately showed MMP-8 was increased in tuberculosis group in comparison with control group and MMP-1 group in both TB and symptomatic respiratory tract increased.

Background: Infective endocarditis occurs due to the presence of microorganisms in the endocardium or the heart valves. Nowadays, infective endocarditis is still a major cause of death with an incidence rate of 5 to 7.9 per 100,000 populations. The aim of the study was to determine antibiotic resistance pattern of bacterial agents isolated from blood culture of patients with infective endocarditis.
Methods: In this retrospective study, infective endocarditis patients who were admitted to Sina and Ekbatan hospitals in Hamadan City, Iran, from March 2005 to February 2014, were enrolled. All demographic data, clinical manifestations, physical examinations and echocardiography reports of the patients were recorded in a check list. For all patients, blood cultures in Mueller Hinton agar and antimicrobial susceptibility testing for ceftriaxone, ceftazidime, oxacillin, cefazolin, vancomycin, imipenem, clindamycin, etc. were done by disk diffusion method. All data analyzed by SPSS statistical software, version 16 (IBM, Armonk, NY, USA).
Results: A total of 61 patients with definitive infective endocarditis were included in the study, 50 of them (82%) were males and 11 patients (18%) were females. The mean age of the patients was 37.45±14.79 (range 17-74) years and 37 (60.7%) of the patients lived in urban areas. The mean duration of admission was 20±13.59 days. In addition, 38 patients (62.3%) were injection drug users (IDUs) and 23 (37.7%) non-IDU. Meanwhile, 54 (88.5%) of them had normal valve endocarditis and 7 cases (11.5%) had a prosthetic valve endocarditis. Moreover, the most common underlying disease in the natural valve endocarditis was rheumatoid fever (6.6%). Blood cultures were positive in 44.3% of the patients. The most common isolated organism was staphylococcus aureus in 15 cases (55.55%), which had the highest resistance to oxacillin. Most patients were managed by antibiotic therapy, but 15 cases (24.6%) underwent cardiac surgery. In follow up patients between 3 months to 9 years, 19.7% of the patients had complete recovery and 8.2% of them died.
Conclusion: According to the findings, antibiotic resistance pattern of bacterial agents isolated from blood culture of patients with infective endocarditis was changed.

Background: With increasing immunocompromised patients, fungal infections especially lung infection, have also increased. In this study, fungal contamination of the respiratory system in immunocompromised patients was evaluated.
Methods: This descriptive cross-sectional study was conducted in immunocompromised patients suspicious of pulmonary infections referring to specialized lung clinic of Amir-Al-Momenin University Hospital in Arak City, Iran, from April 2017 to June 2018. Of these 64 patients, including 35 women and 29 men, were selected. After recording the demographic information, a bronchoalveolar lavage (BAL) sample was prepared by the physician from these patients and was immediately sent to the medical mycology laboratory, school of medicine. Bronchoalveolar lavage specimens were investigated by Grocott-Gomori's methenamine silver (GMS) staining and culture method. Data were analyzed by SPSS software, version 16 (IBM SPSS, Armonk, NY, USA).
Results: Of 64 patients, 9 (14%) were infected with pulmonary fungal infections. Among the patients infected with fungal infection, 9 (100%) were positive in the culture examine and 8 (72%) by GMS staining. Among infected people, 7 (77.8%) were female and 2 (22.2%) were male. The most common isolated fungi were Candida albicans, Aspergillus fumigatus and Mucor species (2 cases). The highest infection was seen in the age group of less than 60 (33.3%). 66.7% of infections were among the unemployed persons and 33.3% of other cases of infection were seen in people with free jobs, workers and employees. The most important factors in the development of pulmonary fungal infections in the patients were: 5 cases of malignancy (33.3%), corticosteroid use in 2 cases (33.3%), tuberculosis in 1 case (22.2%) and diabetes mellitus in 1 case (11.2%). There was no significant relationship between fungal contamination with sex, age, occupation, marriage and type of disease.
Conclusion: The results of this study showed that immunocompromised patients are prone to fungal infections, especially Candidiasis and Aspergillosis. Therefore, the use of control methods to reduce the probability of such patients to fungal infections should be considered.

Background: One of the most important criteria of the development of countries at the national and international levels is the survey of scientific productions indexed in authentic databases. This study aimed to analyze the scientific productions by Iranian researchers on gastroenterology and hepatology in the Web of Science (WOS) database.
Methods: This applied study used a scientometric approach to review the scientific productions by Iranian researchers on gastroenterology and hepatology in the WOS database. Therefore, the total number of scientific documents related to the category of gastroenterology and hepatology, Iran, and other countries were recovered. The time frame was until the end of 2017. Data were collected in April 2018. This research was conducted at the Clinical Research Unit in Afzalipour Medical Center in Kerman, Iran.
Results: The results showed that during 1983 to 2017, the total number of 2180 scientific productions (0.31%) on gastroenterology and hepatology were published in Iran, ranking the country 34th in the world. Compound annual growth rate (CAGR) in Iranian scientific publications was 9.5%. The «Tehran University of Medical Sciences» was identified as the most productive center in gastroenterology and hepatology field with a contribution rate of 35.69%. The results also showed that the most international collaboration of Iranian researchers on gastroenterology and hepatology field was with the United States of America (USA) scientific centers (5.82%). Most articles in the field of gastroenterology and hepatology (26.69%) were published in the «Hepatitis Monthly» journal. Most scientific productions in this field were related to the microbiology. The majority of scientific productions on gastroenterology and hepatology field were published in the form of article. Most scientific productions by Iranian researchers on gastroenterology and hepatology in the Web of Science (WOS) database were in English language.
Conclusion: Results showed that although compound annual growth rate (CAGR) in Iranian gastroenterology and hepatology publications was high rather than gastroenterology and hepatology scientific productions CAGR in the world, it’s not satisfying. Most articles have published in journals with low impact factor. Therefore, we should resolve the problems and increase the scientific level of researches.

Background: Venous anomalies are the most common vascular malformation of the central nervous system in adult, it can form anywhere in the body, but are most likely to cause symptoms when they grow in the brain or spinal cord. Common symptoms include headaches or seizures. Experiencing symptoms depend on where the lesions grow and how many of the lesions are present. Most of the time, these formations cause no problems. In some people, knowing the clinical signs and possible future complications in the disease can help to treat the disease and diagnose it.
Methods: In this Prospective cohort study, 41 patients with cavernous malformation who were diagnosed by neurologist referred to Sina Hospital in Hamedan City, Iran, from 2016 to 2017 were studied. Patients' information about their referrals during the follow-up period were collected and the results were reported.
Results: This study was conducted on 20 (48.79%) females and 21 (51.21%) males with the mean ages of 50±2 years. The most common manifestation of disease was seizure in 20 patients (48.78%). Most of these lesions were found in parietal lobe in 11 cases (26.82%) and then in the frontal lobe with 8 cases (19.51%). In terms of complications during follow-ups, 16 patients (39.2%) were uncomplicated, 16 patients had 48 episodes of seizure, seven patients had nine episodes of hemorrhage, two patients with hemiparesis, one patient with headache and one patient with sixth cranial nerve paralysis. According to the associated disease and risk factors, nine patients (26.82%) had high blood pressure, five patients (12.19%) had meningioma and three patients (7.31%) had diabetes. Seven patients (17.07%) had a positive family history that symptoms and complications in this patients are higher than the rest of patients.
Conclusion: In this study, most of the cases are sporadic and the most common symptom was seizure. The most common symptom in supratentorial lesions were seizure whereas in multiple and infratentorial lesions were bleeding. Five patients were involved with meningioma which could be considered in more studies with more patients in future.

Behçet's disease (BD), also known as the Silk Road disease, is a multisystemic and rare inflammatory disorder primarily prevalent in populations along the Mediterranean Sea. Today, BD is defined as a crossroad between autoimmune and auto-inflammatory syndromes. Variety of syndromes including mucocutaneous manifestations such as oral and genital ulcers, papulopustular lesions and erythema nodosum as well as ocular, vascular, gastrointestinal and nervous system occur. The disease etiology has not yet been elaborated, though researchers have reported several reasons that can increase the likelihood of the disease occurrence including a genetic factor, human leukocyte antigen HLA-B51 (B51) antigen, infectious conditions such as herpes simplex virus (HSV), those involved in inflammatory and autoimmune conditions such as imbalance of various cytokines and immune cells levels as well as existence of various gene variants. Among the various immuno dysfunctions that are found in BD, patients have increased neutrophil motility and superoxide production, as well as elevated production of tumor necrosis factor (TNF)-α and decreased production of interleukin-10 (IL-10). Since vasculitis and tissue damage is usually seen with Behcet disease, unusual concentrations of chemokine and adhesion molecules can also help us understand the causes of disease. Among the functional deficiencies of the immune system, increased concentrations of neutrophils and monocytes are of importance leading to an increase in reactive oxygen species (ROS). Behcet's disease has common characteristics with some immune-mediated diseases such as systemic lupus erythematosus (SLE), psoriasis, ankylosing spondylitis, and inflammatory bowel disease (IBD), which suggests that they may share similar etiologies and genes. Genetic and epigenetic modulations have also been proposed as involved in the pathogenesis of BD. Modifications in DNA methylation have been found in BD patient monocytes and lymphocytes, leading to the adverse function of these cells. The positive replies to classical immunosuppressive agents like cyclosporine and azathioprine and participation of autoantigens at the beginning of the illness are the chief BD features that reflect the autoimmune nature of the disorder. This review article attempts to introduce the BD disease and its contributing factors with emphasis on the role of different cells and cytokines based on updated studies.

Background: Renal calculus with increasing prevalence and incidence in recent decades have the highest burden of urologic diseases. While preventive measures could significantly reduce the rate of recurrence, the amount of compliance with the preventive guidelines is unclear among urologists. This study was designated to evaluate the knowledge, attitude, and practice in kidney stones prevention among urologists for the first time in Iran.
Methods: This cross-sectional study was conducted on the participants of the 20th Iranian Urological Association Congress. The questionnaires included questions regarding demographics, educational and occupational information, knowledge, attitude, and practice of urologists in the field of kidney stones prevention. The questionnaires were designed according to the latest guideline of the European Association of Urology and previous studies. Scores related to the knowledge and practice were calculated based on the number of questions with correct answers. The response rate was also calculated. The correlation of knowledge and practice with background variables, including age, work experience, and time since graduation were assessed.
Results: The total response rate was 18.08% (64 out of 354 distributed questionnaires). The mean age of the respondents was 47.25±10.20 and the mean work experience was 15.61±11.70 years. The mean knowledge and practice scores were 8.36±1.48 out of 11 and 4.44±1.45 out of 7 scores, respectively. A total of 96.2% and 73.4% of the urologists earned at least half of the knowledge and practice scores, respectively. There was no significant correlation between knowledge and practice scores (P=0.706). Work experience and time since graduation had a negative relationship with the knowledge scores (respectively, P=0.02 and P=0.026), and faculty membership had a positive correlation with the practice scores (P=0.022). Most respondents had an acceptable attitude regarding the effectiveness of stone prevention.
Conclusion: Although the study participants had good knowledge, attitude, and practice pattern regarding urinary stone prevention, their performance score was less than their level of awareness. However, we could not generalize the results to other urologists due to the low response rate of the study.

Background: Alzheimer's disease (AD) is a chronic neurodegenerative disease characterized by a progressive decline of cognitive performance, which has a harmful impact on social activities. AD is the main cause of dementia and loss of functional independence in the elderly. AD is a worldwide concern because of its adverse consequences and expanding prevalence and incidence. Vitamin D is the most common nutritional deficiency worldwide among children and adults. In addition to its classical function of bone metabolism regulation, vitamin D exhibits multiple biological targets mediated by the vitamin D receptor (VDR). Vitamin D is a risk factor for a wide range of diseases and, as a neurosteroid, has an essential role in nervous system development and protection. Vitamin D regulates mechanisms involved in the pathogenesis of AD, including phagocytosis of amyloid-beta plaques, anti-inflammatory action, antioxidant action, regulation of intraneuronal calcium, ischemic zone size reduction, regulation of choline acetyltransferase enzyme and neurotrophic agents. This study aimed to evaluate the association between AD and vitamin D deficiency.
Methods: In this case-control study, 44 Alzheimer’s disease patients (diagnosed based on DSM-IV-TR criteria) compared with 40 patients that had no disease related to vitamin D. This study was performed in the neurology clinics of Roozbeh and Imam Khomeini Hospitals in Tehran, from April to March 2015. The demographic data were collected. After obtaining informed consent, venous blood was taken by clinical staff to measure the level of 25-hydroxyvitamin D3. Statistical analysis was performed on data.

Results: The Mean age was 71.55 years old (69.88 for females and 73.74 for males) in the case group. Mean vitamin D levels were 26.31 ng/ml and 36.41 ng/ml in case and control groups, respectively. Vitamin D level was deficient (< 30 ng/ml) in 75% of patients, of which 23% were severely deficient (< 10 ng/ml). Statistical analysis showed no significant relationship between Alzheimer's disease and vitamin D levels (P=0.057), but when participants categorized into three groups based on serum vitamin D levels (deficient, insufficient, sufficient), we found a significant relationship between them (P=0.019).
Conclusion: Our results confirm the association between vitamin D deficiency and Alzheimer's disease. Vitamin D supplementation should be considered in individuals at risk of Alzheimer's disease to reach sufficient vitamin D level.