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High-risk pregnancy due to thyroid storm: case report
Malihe Hasanzadeh , Mina Baradaran Khalkhale , Akram Behroznea, Leila Musavi ,
Volume 75, Issue 12 (March 2018)
Abstract
Background: Graves' disease is the most common cause (85% of all cases) of thyrotoxicosis in women in childbearing age. Many of the symptoms are similar to hyper-metabolic status during pregnancy. The cause of the disease is autoantibodies that stimulate the thyroid-stimulating hormone (TSH) receptor. Hyperthyroidism is uncommon in pregnancy and its prevalence is 0.1-%0.4. In this paper we introduce a patient who was admitted with a primary diagnosis of pulmonary embolism and treatment with final diagnosis of thyroid storm and was discharged with good condition.
Case presentation: In the first pregnancy of a 29-year-old woman with gestation age of 31 weeks was referred to obstetric emergency unit Ghaem Hospital, Mashhad, Iran in March 2015. She had Grave’s disease in her past medical history which was treated with methimazole before pregnancy and propylthiouracil (PTU) during pregnancy. In admission, she presented with tachycardia and tachypnea and hypertension and lower extremity edema. During pregnancy, she used propantheline instead of propylthiouracil due to pharmacy mistake. She admitted in Intensive care unit. After rule out of pulmonary embolism, ultrasonography showed a fetus with 30 weeks of gestational age with an approximate weight of 1680 grams. The amniotic fluid was reduced. She was treated with thyroid storm diagnosis due to a medication error. In serial obstetric visits fetal heart rate was not detected. Due to the fetal death, the pregnancy was terminated. Hyperthyroid therapy continued with PTU after delivery. She was discharged with a good general condition.
Conclusion: Despite the rarity of thyroid storm during pregnancy, in the event of unstable hemodynamic condition and cardiac dysfunction in pregnant women, rule out of thyroid disorders should be considered. Clinician should be paid attention to past drug history and underline disease of patient.

Adjuvant effect of an acute moderate endurance exercise in herpes simplex virus 1 vaccination and its boosters on interleukin 10 cytokine and granzyme B in mice
Mahdieh Molanouri Shamsi , Afsaneh Jamali,
Volume 76, Issue 2 (May 2018)
Abstract
Background: The herpes simplex viruses cause a variety of clinical illnesses that are painful and often distressing. To control the infection, the development of an effective vaccine that prevents or reduces the primary and recurrent infections would be of great significance. With considering to immunological changes following an acute endurance exercise, the purpose of this study was to assess adjuvant effects of an acute endurance exercise in first herpes simplex virus 1 vaccine injection and its booster shots on interleukin-10 cytokine and granzyme B levels.
Methods: This experimental study was carried out in Tarbiat Modares University during May to October 2016. 32 BALB/c mice were divided into 4 groups: control, vaccine, vaccine plus an acute exercise in first injection and vaccine plus an acute endurance exercise in first injection and booster shots. Mice without or with access to acute endurance exercise were immunized intramuscularly with inactivated KOS strain of HSV-1. Two weeks after three booster shots of vaccine, interleukin-10 and granzyme B levels were determined in spleen cell culture with enzyme-linked immunosorbent assay (ELISA) method.
Results: This study was undertaken to test the hypothesis that an acute endurance exercise as an adjuvant in herpes simplex virus 1 vaccine can change interleukin-10 cytokine and granzyme B levels in mouse model. The result of this study showed significant differences between groups in interleukin-10 and granzyme B levels (P=0.001). Increasing in granzyme B levels with concurrent decreases in interleukin-10 levels was observed following using vaccine plus acute exercise in first injection of vaccine and booster shots.
Conclusion: It is suggested that exercise may stimulate parameters related to cellular immunity and hence decrease the risk of infection decreased levels of interleukin-10 in experimental group that had vaccine plus acute exercise in the first injection of vaccine and booster shots as an adjuvant was observed. These results demonstrate alternation of T helper 2 cells function and improve of cell immunity for protection against herpes simplex virus 1 infections.

The study on the knowledge, attitude and practice of Tehran citizens about Health and Disease in 2011 (KAP): overview of methodology and primary results
Masoud Ahmadzad-Asl , Shayan Mostafaei , Shahram Rafiefar , Navid Mohammadi , Malihe Farid , Kourosh Kabir ,
Volume 76, Issue 4 (July 2018)
Abstract
Background: The study of their knowledge, attitude, and behavior toward health is an essential step for health planning. In the urban area, there are several concerns about environmental pollution, health status, the dangers of insecurity, and bad dietary habits. The aim of the study was the determination of knowledge, attitude, and behavior of Tehran citizens in order to plan better municipal services.
Methods: This descriptive, cross-sectional study was conducted on 13000 participants between 15-84 years in 22 districts of Tehran, Iran University of Medical Sciences, in August and September of 2011. Cluster sampling and self-administered reliable and valid questionnaire were used for data gathering. The inclusion criteria are all of citizens of Tehran. Age, sex, marital and job status, obesity, physical activity, hypertension, myocardial infarction, accidents, diabetes, nutrition, stroke, psychological behavior, smoking, addiction and drugs, musculoskeletal, sexual behavior, anemia, physical environment, fat blood, cancer, chronic obstructive pulmonary disease, dietary habits and socioeconomic status were measured under standard protocols and by using calibrated instruments. 
Results: From 13000 participants in the study, 11753 (90%) was fulfilled the questioners. Nonresponse rate from 11753 participants was 8.6%. The proportion of obesity/overweight was 50% and 29.5% of people had appropriate physical exercise, 37.6% reported a tobacco consumer in their family and 4.5% reported an experience of substance misuse. Also, 29.2% and 24.8% from these had anomalistic consuming of salt and soft drink, respectively. Of the participants, 44.8%, 89.1% had a good knowledge and attitude, respectively. Cronbach alpha coefficient was 0.82 and 0.79 for knowledge, attitude and behavior, respectively. In additional, the correlation coefficient between test and re-test questions was 0.91. 
Conclusion: This study was a comprehensive study to measure the knowledge, attitude and practice of Tehran citizens using reliable and valid questionnaires about general health status. A considerable percentage of Tehran citizens suffering from overweight, obesity, hypertension, diabetes, high blood lipids and smoking consuming and using anomalistic from TV and computer. The results can be used as a framework and guide to prioritize problems and planning health education interventions in Tehran

Prevalence of endometrial cancer in young patients
Sima Kadkhodayan , Asieh Maleki , Malihe Hasanzadeh , Zohreh Yousefi,
Volume 76, Issue 5 (August 2018)
Abstract
Background: Cancer of the endometrium is the most common gynecologic malignancy in western and industrial countries, and is the second most common in developing countries, therefore it is of special importance. Adenocarcinoma of the endometrium is the most common type of uterine cancer. The prevalence of endometrial cancer in young women under the age of 40 in western country is very low and about 5 percent. The aim of this study was to determine the prevalence of endometrial cancer at age ≤40 years in our center during 4 years.
Methods: In a cross-sectional study, all medical records of patients with endometrial cancer in Ghaem University Hospital, Mashhad, Iran was reviewed to identify women <40 years of age with endometrial cancer, over the course of 4 years, (from 2012 to 2015). The risk factors for endometrial cancer, such as obesity, polycystic ovary syndrome (PCO), infertility, and a history of cancer in the family or individual, were collected in each patient. Clinical features, histological type of endometrial carcinoma, and therapeutic action also were gathered.
Results: A total of 119 patients with endometrial cancer that was admitted in our genecology oncology center were evaluated. 19 patients (15.9%) were younger than 40 years old. 16 cases (84.2%) with endometrial adenocarcinoma and 3 (15.7%) had endometrial stromal sarcoma. The youngest patient was 27 years old and the oldest was 39 years. Seven patients (8/36%) had infertility and we don’t know about fertility condition in 3, because they were single. 12 cases (63%) were overweight (BMI≥35) and 6 cases (5/31%) had polycystic ovarian disease (PCOD). In 2 patients, there was concomitant ovarian and endometrial cancer. Histology report of both ovaries was endometrioid and both patients were overweight. Obesity, poly cystic ovary syndrome (PCOD) and Infertility were the most important risk factors for endometrial cancer in young patients.
Conclusion: The prevalence of endometrial cancer in young women under the age of 40 in our country is so higher than the statistics provided in industrial countries.

IL-33 polymorphism rs1929992 and its association with susceptibility to different pattern of multiple sclerosis
Mitra Jamali , Mehdi Rostami Rad , Gholamreza Anani Sarab , Roya Mahdavi ,
Volume 76, Issue 7 (October 2018)
Abstract
Background: Multiple sclerosis is the most common autoimmune demyelinating disease of the central nervous system (CNS). Interleukin-33 (IL-33) is a cytokine with both pro-inflammatory and anti-inflammatory activities that implicated in the pathogenesis of some autoimmune diseases. The aim of this study was to determine single nucleotide polymorphism (SNP) of IL-33, rs1929992, in patient’s gene with multiple sclerosis (MS) and investigation of this polymorphism with susceptibility to MS.
Methods: In this case-control study, peripheral blood samples were collected from 140 MS patients (patients in the Afzalipur Hospital in Kerman) and blood sample of 140 healthy subjects (people referred to the Blood Transfusion Organization) as a control group from March 2016 to January 2018. SNP at rs1929992 was determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method.
Results: There was significant difference between healthy control group and patient with multiple sclerosis in the frequency of genotypes. The frequency of AA genotype at rs1929992 was significantly higher in the MS group in comparison with healthy control subjects (P= 0.0001), whereas frequency of AG genotype was significantly higher in the control group as compared with MS group (P= 0.02). There was no significant difference between the MS patients and healthy control group in GG genotype. Moreover, the frequencies of AA genotype at SNP rs1929992 were significantly higher in patients with secondary progressive MS (SP-MS) and primary progressive MS (PP-MS) as compared with control group (P= 0.03). However, the frequencies of AG genotype was significantly lower in patients with relapsing-remitting MS (RRMS) in comparison to the healthy group (P= 0.01). In patients with RR-MS, PP-MS and SP-MS patterns, the frequencies of A allele was significantly higher than that in control group (P= 0.03, P= 0.01, P= 0.001). In patients with RR-MS, PP-MS and SP-MS pattern, the frequency of G allele was significantly lower than control group (P= 0.03, P= 0.01, P= 0.001).
Conclusion: The results of this study suggest that the SNP rs1929992 in IL-33 gene, may be associated with different pattern of MS susceptibility.

Birth of a live fetus in twin pregnancy with hydatidiform mole and co-existent a live fetus: case report
Malihe Hasanzadeh, Lida Jedde , Leila Mousavi Seresht , Khatereh Vatanpoor ,
Volume 76, Issue 9 (December 2018)
Abstract
Background: Twin pregnancy consist a healthy fetus, and hydatidium molar pregnancy is unusual and very rare. Its incidence is in about 1,22,000 to 1,100,000 of all pregnancies. This type of pregnancy is commonly associated with several obstetric complications requiring early termination of pregnancy. Managing a twin mole pregnancy with normal and live fetuses is controversial, although this unusual type of abnormalities in most cases leads to abortion or intrauterine fetal death. In other hand, due to the high probability of obstetric complications during pregnancy, such as preeclampsia in 25% of cases, metabolic complications such as hyperthyroidism and vaginal bleeding pregnancy is terminated. Survival of the normal coexisting fetus is variable and depends on whether the diagnosis is made, and if so, whether problems from the molar component. Present study reported a case of coexisting mole and live fetus twin pregnancy with successful outcome.
Case presentation: A 35 years old woman, G2ab1 which was diagnosed to have twin pregnancy with mole and coexisting live fetus in 11 weeks of gestational age was referred to obstetric department of Ghaem Hospital, Mashhad University of Medical Sciences, Iran in January 2017. Close follow-up and obstetric surveillance had performed for her and at the last her pregnancy was terminated in gestational age of 36 weeks; a healthy male infant. The β-human chorionic gonadotrophin (BhCG) levels still is undetectable after one year.
Conclusion: Twin pregnancy with one normal fetus and a co-existing molar pregnancy could be continued under close surveillance if the live fetus has normal karyotypes and no structural anomaly and decreasing level of serum BhCG level during the time. Close monitoring necessary even after termination due to increasing risk of persistence trophoblastic disease after termination, what was performed in this case also.

Contrastive analysis of diagnostic tests evaluation without gold stand-ard: review article
Fatemeh Masaebi , Farid Zayeri , Malihe Nasiri , Mehdi Azizmohammad Looha ,
Volume 76, Issue 11 (February 2019)
Abstract
Considering the advancement of medical sciences, diagnostic tests have been developed to distinguish patients from healthy population. Therefore, Determining and evaluation of the diagnostic accuracy tests is of great importance. The accuracy of a test under evaluation is determined through the amount of agreement between its results with the results of the gold standard, and this test accuracy can be defined based on sensitivity, specificity, positive predictive value, negative predictive value and the area under the receiver operative characteristic curve (AUC). Gold standard is an accurate and error- free method to determine the presence or absence of disease of interest and classify patients, which is not available in some diseases and situations as this method is costly or invasive. In these cases, reference standard is a best available replacement method to be used by physicians to diagnostic disease. However, in some situation, the acceptable reference standard is invasive or costly and does not exist or unreliable. It can be imperfect and results of the reference standard method are not necessarily error- free and cannot be applied to everyone in the study; all these cases point to the conditions in which the gold standard is not available. The use of reference standard including error causes to incorrect separation of patients from healthy population and thus, it cannot be a comparing measure for other diagnostic tests and its results are inaccurate. Therefore, other alternatives methods are needed for evaluation and determine the diagnostic accuracy tests when the gold standard does not exist. Imputation method, correct imperfect reference standard method, the construct reference standard method, latent class models, differential verification, composite reference standard and discrepant analysis are of these alternative methods. Each of these methods, considering its features, advantages, and limitations can be used to evaluate the accuracy of diagnostic test in the absence of gold standard. The present study gave an overview of methods to evaluation of diagnostic accuracy tests when there is no gold standard and the focus of this study was on explain the concept of these solutions, review and compare them and their strengths and weaknesses.

The healing effect of total contact casting on diabetic foot ulcers
Azadeh Zahedi, Seyed Mokhtar Esmaeilnejadganji , Sekineh Kamali Ahangar , Rahmatollah Jokar,
Volume 77, Issue 1 (April 2019)
Abstract
Background: Diabetes Mellitus is a prevalent disease worldwide and foot ulcer is one of the serious complications of chronic uncontrolled diabetes which could lead to various complications such as amputation of the extremity if left untreated. Total contact casting (TCC) is the gold standard in treatment of neuropathic and neuro ischemic diabetic foot ulcers (DFU) on which less emphasize is seen on routine medical practice. The aim of this study was to emphasize on healing effect of this off-loading method and to study the possible influence of variants on the healing rate of this technique.
Methods: In this cohort study, 92 diabetic patients with complaint of plantar foot ulcer grade 0, 1 and 2 according to Wagner classification had participated in Shahid Beheshti Hospital, Babol City, Iran, from March 2014 to February 2016. The demographic and biochemical information along with dimensions of foot ulcers were carefully recorded. After the primary cleansing, surgical debridement and dressing, TCC was applied on foot by the specialist and they were requested to return weekly for changing the TCC and re-evaluation of ulcers. The healing rate was calculated as decline in ulcer surface area per week.
Results: 92 patients of study sample with mean age of 63.9±10.56 year consisted of 76 patients with DM type 2 with BMI of 31.16±3.8 kg/m² and 58 male patients. The average healing rate of ulcers treated with TCC was 0.406 ±0.168 cm²/week. The duration of diabetes on average was 17.23±6.93 years. Most of the patients (n=45) had an ulcer on the forefoot and the healing rate of midfoot ulcers was slower. The average amount of baseline HbA1c was 8.2±0.19%. There was no relation between smoking history (P=0.94) and anti-diabetic regimen used by patients (P=0.754) with the healing rate.
Conclusion: The healing rate is slower in elderly patients and those with longer duration of diabetes. So in these two groups, TCC is to be applied for a longer duration in order to achieve complete healing.

A case report of ovarian fibroids torsion with ascites and pleural effusion: case report
Seyede Houra Mousavi Vahed , Maliheh Afiat, Fahimeh Alizadeh, Anahita Hamidi Laien , Zeynab Khademi, Azin Nikoozadeh,
Volume 77, Issue 2 (May 2019)
Abstract
Background: Ovarian fibroma is the most common benign solid tumor of the ovary. The most common symptoms are abdominal discomfort and pain. Ovarian fibroids are associated with Meigs syndrome in 1% to 10% of cases. The aim of study is report of a case of Meigs syndrome
Case presentation: A 65-year-old menopausal woman who complained of abdominal pain was referred to our academic hospital of Mashhad, Iran, in April 2018. In abdominal examination, a soft mass with size of 200×100 mm, was detected. Also leukocytosis and increase in CRP was observed. Marker CA125 was higher than 200. In CT scan in right adnexa heterogeneous mass 170×100 mm with enhancement was reveled. pleural effusion was reported in the both lungs and collapse of underlying lung tissue in Chest X-ray. Explorative laparotomy was performed. Ascites and inflamed omentum covered the surface of right ovary was detected. The huge solid-cystic hemorrhagic, irregular mass with a specific pedicle that enclosed in the capsule in right adnexa was seen. Right salpingo-oophorectomy was performed. The result of final pathologic was benign proliferative lesions of mitotic fibroblasts were reported according to ovarian fibroma.
Conclusion: In case of accompanying ovarian mass with ascites and pleural effusion, after the exclude of ovarian malignancies, Meigs syndrome should be considered in differential diagnosis.

Diagnostic error, benign infiltrative pseudotumor or malignant primary lymphoma of cervix: case report
Malihe Hassanzadeh , Amir Hosein Jafarian , Fatemeh Homaee, Lida Jeddi , Parnian Malakuti, Leila Mousavi Seresht ,
Volume 78, Issue 1 (April 2020)
Abstract
Background: Although cervical malignancy rate had grown up in recent years, primary cervical lymphoma is so rare. It must be high index of suspicious for primary cervical lymphoma diagnosis in patient with malignancy-like signs and symptoms for early detection. Primary cervical lymphoma has no standard treatment or follow-up protocol; so the management still is in doubt and based on previous case reports. In the other hand, the precise prognosis of patient is undetermined. In the present study, a case of primary cervical lymphoma is presented which was misdiagnosed at first. The patient accurate diagnosis was made at last due to multidisciplinary team working.
Case presentation: A 51-year-old woman, gravida 2, para 2, presented with complaint of abnormal vaginal bleeding and discharge, with no abnormal finding in cervical cytology and sonography, so uneventfully a diagnostic error had happened in the assessment of her. After several months and multiple different treatment, the patient referred to the Oncology Department of Obstetrics and Gynecology Center, Ghaem Hospital, Mashhad, Iran in May 2017. Re-assessment was performed by biopsy and imaging, and the final pathologic diagnosis of diffuse large B-cell non-Hodgkin's lymphomas was confirmed.
Conclusion: Primary cervical lymphoma is an uncommon malignancy; the diagnosis could be missed simply by low suspicious due to low accuracy of Pap smear and imaging in this situation. So an accurate evaluation and pelvic examination, high suspicious and close communication between clinician and pathologist are needed. By timely diagnosis of patient in early stage and appropriate approach, the prognosis could be excellent most of the time.

The relationship between magnesium levels and complications of jaundice in infants
Razieh Sangsari, Maryam Saeedi, Malihe Kadivar, Mahsa Niknam,
Volume 78, Issue 5 (August 2020)
Abstract
Background: The effects of magnesium physiology are contradictory to the neurotoxic effect of bilirubin, but the relationship between magnesium level and hyperbilirubinemia in neonates has not been well studied. In this study, we investigated the relationship between serum magnesium level and hyperbilirubinemia and hyperbilirubinemia complications at the Children’s Medical Center.
Methods: In this cross-sectional and prospective study, 100 neonates who were admitted to the Children's Medical Center from October 2018 to 2019 due to neonatal jaundice were enrolled. Neonates were divided into two groups: serum bilirubin levels 16-20 mg/dl were included in the moderate hyperbilirubinemia group and bilirubin >20 mg/dl into severe hyperbilirubinemia group. Serum magnesium levels and clinical complications of hyperbilirubinemia including fever, seizure, apnea, bradycardia, and abnormal neurological examinations were recorded in these infants.
Results: In this study, 100 neonates were evaluated. The mean serum magnesium level in these patients was 2.32 mg/dl. This rate was significantly higher in neonates with seizure (P=0.038), hyperbilirubinemia fever (P=0.048), and neonates with chronic encephalopathy (P=0.003). The mean serum magnesium level was significantly higher in severe hyperbilirubinemia (P<0.001). Serum Magnesium in complications of chronic encephalopathy (P=0.007), Fisting (P=0.001), retrocoli (P=0.001), hypertonia (P=0.004), hypotonia (P=0.001) and seizures (P=0.030) were significantly different. The serum magnesium levels were positively correlated with total bilirubin (r=0.443, P<0.001). The magnesium levels correlated with the chronic encephalopathy (OR: 4.15, P=0.040) and it was observed that magnesium levels above 2.15 could predict chronic encephalopathy with a sensitivity of 100%, the specificity of 47.82%, a negative predictive value of 100% and a positive predictive value of 14.28%.
Conclusion: The results of this study showed that serum magnesium levels significantly correlated with serum total bilirubin and magnesium cutting points above 2.15 mg/dl in patients with jaundice could predict chronic encephalopathy.

Familial adenomatous polyposis, diagnosis and surveillance strategies: review article
Sima Sedighi, Maliheh Moradzadeh, Mehrdad Aghaei, Ashraf Mohamadkhani, Mohammad Hassan Jokar,
Volume 78, Issue 7 (October 2020)
Abstract
Familial adenomatous polyposis is characterized by over 100 colorectal adenomas in the colorectum. The disease equally affects both sexes, with an incidence estimated at 1.14025-1.8300. The disease is premature in people with familial adenomatous polyposis. Patients suffering from familial adenomatous polyposis have a range of extra-intestinal diseases such as papillae, gastric, small intestine, and duodenal polyps; cutaneous wounds (lipomas, fibromas, and epidermoid cysts); desmoid tumors; osteomas; nephroderma retinal pigment epithelium, including hepatoblastoma and thyroid cancers; and pancreas, biliary system, and brain cancer. Familial adenomatous polyposis is characterized by >100 polyps in the colon that are often observed on the left side of the colon and rectum. A germline mutation in the adenomatous polyposis coli gene that can be clinically and genetically diagnosed is responsible for this disease. Several methods are available for testing the adenomatous polyposis gene. Whole-gene sequencing of all adenomatous polyposis coli exons and exon-intron boundaries with maximum sensitivity for determining adenomatous polyposis coli mutations is not affordable. Another method, the protein shortening assay, correctly identifies 80% of the mutations in families who show familial adenomatous polyposis and is less expensive than complete gene sequencing. The application of a COX-2 inhibitor for chemical prevention is limited in patients showing familial adenomatous polyposis because of cardiovascular toxicity. Aspirin does not negatively impact cardiovascular diseases and is even used as primary pharmacotherapy in patients who demonstrate cardiovascular risk factors.   After 55.7 months of the diagnosis in hereditary CRC carriers, the incidence of cancer can be decreased by a dose of 600 mg/day aspirin for 25 months. After diagnosis, patients should undergo prophylactic proctocolectomy or ileoanal pouch. Undiagnosed patients having a family history of FAP must be referred to a genetic counselor and enrolled in optimal genetic and clinical surveillance programs. Recent advancements in endoscopic technology, e.g. high-resolution endoscopy, double-balloon endoscopy, and capsule endoscopy have enabled the comprehensive study of the gastrointestinal tract. Despite the limited evidence, more studies on these novel endoscopic technologies may modify the surveillance strategies for FAP patients.

Cervical Cavernous hemangioma in a patient with postcoital bleeding: case report
Malihe Hasanzadeh, Raheleh Ebrahimi, Parnian Malakuti,
Volume 78, Issue 11 (February 2021)
Abstract
Background: Cervical cavernous hemangioma is an extremely rare, benign lesions, and only a few cases are reported. Cervical cavernous Hemangiomas are characterized by an increase in the number of normal and abnormal veins. The majority of these lesions are superficial, often found in the head and neck area, but may also occur in the inner parts of the body. The occurrence of these lesions in the female reproductive tract, especially the the cervix is extremely rare. This disease should be considered as a differential diagnosis of abnormal uterine bleeding because of the low prevalence and importance of the diagnosis of this uncommon disease. The majority of cervical cavernous hemangiomas have been reported in women of childbearing age. Besides, although most lesions are symptomatic (mostly bleeding), diagnosis is often unlikely. They may cause abnormal vaginal bleeding in the form of menometrorrhagia and postcoital spotting. To date, fewer than 55 cases have been reported. This study aimed to report a rare case of cervical cavernous hemangioma.
Case Report: The patient was a 24-year-old woman who had referred to the outpatient clinic of Ghaem Hospital in September 2016 due to prolonged post coital bleeding after intercourse. At the time of the pelvic examination, posterior lip of cervix was very vascular and there was black color that had extend to the vagina. The patient underwent colposcopy. Following colposcopy, due to severe cervical bleeding, the vagina packed. The patient's bleeding was controlled with the pack after 24 hours. Cervical pathology revealed a cavernous hemangioma.
Conclusion: Cervical cavernous hemangioma is extremely rare. This should be considered in the differential diagnosis of patients with abnormal vaginal bleeding, especially those of childbearing age, and no clinical or radiologic findings such as leiomyoma, adenomyosis, or dysfunctional uterine bleeding. Pelvic examination is the first step in the management of the patient with vaginal bleeding. Increased awareness of this unusual cervical lesion can lead to early diagnosis and conservative treatment approaches. In most cases, hysterectomy is performed, but the patient with mild symptoms can be treated with conservative management. Increased awareness of this unusual cervical lesion can lead to early diagnosis and conservative treatment approaches.

Evaluation of the relationship between globus sensation and structural disorder of inlet patch in patients with gastroesophageal reflux disease
Raika Jamali, Reza Zamani, Tayeb Ramim,
Volume 79, Issue 5 (August 2021)
Abstract
Background: Inlet patch (IP) lesion is the presence of gastric columnar epithelial tissue outside of the stomach. Symptoms such as a lump in the throat, chronic cough, laryngitis, or other mouth-throat symptoms may be IP-related only and have no other abnormalities. This study aimed to determine the relationship between globus sensation and structural disorder of Inlet Patch in patients with gastroesophageal reflux disease
Methods: The case-control study was performed in patients who were referred to the endoscopy ward of Sina Hospital in Tehran from October 2016 to October 2017. Inclusion criteria were diagnosis of gastroesophageal reflux and endoscopic indications. Patients who had endoscopic indications and underwent endoscopy were evaluated. Information on reflux esophagitis and inlet patch structural disorder were determined. Symptoms of reflux, including a lump in the throat, were identified and recorded. Then the frequency of globus sensation in patients with inlet patch structural disorder (patient group) and without it (control group) was compared.
Results: A total of 100 patients with gastric reflux participated in this study. Patients included 42 men (42%) and 58 women (58%). The mean age of patients was 41.17±10.35 years (18-77 years). The severity of mild reflux was 57%, moderate reflux was 27% and severe reflux was 16%. 28% of patients had a lump in the throat and 12 patients had an inlet patch. There was a statistically significant relationship between inlet patch and globus sensation (p=0.001). All patients with inlet patch had globus sensation. 81.8% of patients without inlet patch did not feel a lump in the throat. The results showed a statistically significant difference between the two groups with and without inlet patch in terms of globus sensation in general and in terms of different clinical variables (p=0.001).
Conclusion: The findings of the study showed that inlet patch had a significant relationship with the feeling of a lump in the throat and all patients with inlet patch felt Globus sensation.As the result, to diagnose a patient with an inlet patch, other causes such as esophagitis, hernia, heartburn and metabolic syndrome should be ruled out.

Local injection of anesthetic agent in surgical incision in post-operation pain control: a review article
Masoomeh Tabari , Marjaneh Farazestanian, Helena Azimi, Maryam Esmaeilpour, Malihe Hasanzadeh Mofrad ,
Volume 79, Issue 9 (December 2021)
Abstract
Today surgery is supposed as the cure for many diseases and the fear of post-operation pain burdens stress over the patients. Postoperative pain can, especially if severe, complicate the patient's condition and may lead to chronic postoperative pain. post-operation pain control is effective in the recovery process, hospitalization period and patients’ satisfaction. Insufficient post-operation pain control increases complications and care costs. Local analgesia is one of the components of multimodal postoperative. analgesic protocol to control pain. Local analgesia technique is a simple, accessible and feasible method for various surgeries. The opioid analgesics to control post-operation pain are associated with some complications such as opium addiction, nausea and vomiting, late return of bowel function and social costs. This review study aims. to review previous studies on the effect of injection of analgesic agents in the surgical incision in post-operation pain control. This is a Narrative review study. to related scientific documentaries a search was conducted in Persian and English using the keywords of local injection of the incision site, wound infiltration with analgesic agents and post-operation pain control in Google scholar, PubMed and Scopus database during the years 2000 to 2020. The obtained articles included systematic reviews, Meta-analyses and randomized clinical trials (RCT). We reviewed studies that had utilized single-dose injection of analgesic agents in surgical incisions at the end of surgery to control post-operation pain. A total of ten studies were reviewed. There were 4 studies in the field of laparoscopic gynecological and non-gynecological surgeries, three studies in the field of laparotomy and three review studies. injection of analgesic agents in the surgical incision to control post-operation pain is easily available and does not necessitate any special skill. On the other hand, it is a safe method without further complications and does not increase the duration of surgery. Regardless of the differences in various studies and the kind of analgesic agents, a general reduction in pain severity and consumption of opioid and non-opioid analgesic agents were observed using the injection of analgesic agents in surgical site incision.

The effect of oral ibuprofen in doctus arteriosus closure in full- term neonates.
Manouchehr Soltani , Bahman Sadeghi Sedeh , Gholamali Fattahi Bayat , Parasto Mollai Tavana , Mojtaba Ahmadlou ,
Volume 80, Issue 3 (June 2022)
Abstract
Background: This study aimed to assess the efficacy and safety of the oral use of ibuprofen suspension in various doses in the treatment of PDA (Patent ductus arteriosus) in mature babies. Mature babies (37-42 weeks) aged more than 3 days who had been diagnosed with PDA were involved in this study. For the measurement of the ratio of left atrial to aortic root diameters (La/Ao) Color, pressure gradient and the internal ductal diameter, Doppler echocardiography (ECHO) was performed. This clinical trial was performed on 60 infants born born between August 2013 to August 2015.
Methods: This clinical trial study was performed on 60 infants were randomly born between August 2013 to August 2015 which Randomly divided into two groups: The first group, received oral ibuprofen in three doses (5, 5, 10 mg/kg at 24-hour intervals) and the second group received an early dose of OIS, in two doses of 10 mg/kg after 24 and 48 hours (totally 20 mg/kg). A follow-up ECHO was performed 48 hours and 2 weeks after treatment by the same pediatric cardiologist who was not aware of the study groups. Evaluation of changes in platelet count, blood urea nitrogen, creatinine and complications of thrombocytopenia, evaluation of elevated serum creatinine, and complications of gastrointestinal bleeding were compared between the two groups using statistical analysis.
Results: Seventy-three percent (73%) patients in the first group and seventy-six (76%) patients in the second group had successful PDA closure in the first 48 hrs. No statistically significant difference between the two groups (P=0.0001) was obtained and the highest response time was observed in the first 48 hours of treatment. After 2 weeks, the PDA closure in both groups was completely successful (100%). No specific side effects were observed between the two groups.
Conclusion: We conclude that higher doses of ibuprofen (20 and 2×510 mg/kg) do not show better results for PDA closure without renal or gastrointestinal complications.

Aggressive angiomyxoma of the vulva: a case report
Malihe Hasanzadeh, Marjaneh Farazestanian, Afrooz Azad, Parnian Malakuti, Maryam Esmaeilpour,
Volume 80, Issue 4 (July 2022)
Abstract
Background: Aggressive angiomyxoma is a rare mesenchymal tumor with extensive local invasion. It often presents with a lump in the perineal area and pelvic. Since it often does not involve adjacent organs such as the urethra and anus, does not cause obstructive symptoms. Its incidence is 6 times higher in women than men. This tumor grows slowly and has a slight tendency to metastasize. However, the rate of local recurrence is high. MRI is the most widely used diagnostic method. Ultrasound and CT scan are also used for diagnosis. Due to the rarity of this tumor, it is difficult to diagnose before surgery and pathology assessment. Due to the penetrating nature of the tumor and the lack of a clear capsule, incomplete surgical resection is common. Local recurrence is common even after complete mass resection. Therefore, patients need a long follow-up. The main treatment is surgery but non-surgical interventions such as hormonal therapy, radiotherapy, arterial embolization, etc. have been associated with variable success rates.
Case Presentation: A 54-year-old female patient presented with a vulvar mass in February 2021. The patient mentioned that the mass had existed for ten years and had increased in size in the last two years. After discussion on the tumor board, she underwent surgery. The pathology of the mass was reported to be aggressive angiomyxoma. The patient was treated with a GNRH agonist after surgery. The patient is currently under follow-up and has not had a recurrence so far (March 2020).
Conclusion: Aggressive angiomyxoma is a rare mesenchymal tumor. It has extensive local invasion and a high recurrence rate, but distant metastasis is rare. Estrogen receptors or Progesterone receptors are commonly positive in aggressive angiomyxoma. The best treatment for aggressive angiomyxoma remains unknown. Extensive local resection of the tumor has been reported as an important therapeutic measure. In cases of mass recurrence, reoperation and hormone therapy have been effective. It is important for gynecologists to consider this tumor as a differential diagnosis when dealing with vulvar masses.

Maliheh Aminian, Masoud Mohammadi,
Volume 80, Issue 12 (March 2023)
Abstract

Oxytocin plus foley catheter versus misoprostol plus foley catheter on cervical preparation in prolonged pregnancies
Masoume Mirteimouri, Seyyedeh Azam Poorhosseini , Maliheh Rakhshanifar, Seyede Houra Mousavi Vahed , Fedyeh Haghollahi,
Volume 81, Issue 3 (June 2023)
Abstract
Background: The success of labor induction depends on the condition of the cervix at the time of delivery. This study examines the effect of labor induction with an intra-cervical Foley catheter and oxytocin compared to a Foley catheter and misoprostol on cervical preparation and delivery rate in the first 24 hours after induction.
Methods: In a randomized clinical study, pregnant women with a singleton pregnancy and a gestational age of more than 40 weeks, with a Bishop score less than 4 and an intact amniotic sac referred to Umm al-Binin Hospital in Mashhad from 2017 to 2018 were included in the study. They were randomly divided into two groups of Foley catheter and oxytocin (1) or Foley catheter and misoprostol (2). In the first group, immediately after placing the Foley catheter; Oxytocin was started with a dose of 2 milliunits per minute, and every 20 minutes, 2 milliunits were added to reach the maximum dose of 30 milliunits per minute (induction method with a low dose). In the second group, after Foley catheter insertion, sublingual misoprostol was prescribed at a dose of 25 micrograms every 4 hours up to a maximum of 6 doses.
Results: 74 pregnant women were randomly evaluated in two groups of 37 people. There is no statistically significant difference in the demographic variables in the two groups. There was a significant difference in the labor rate in the first 24 hours, and it was higher in the oxytocin group (P=0.009). Bishop's score after 24 hours of induction was not significantly different in the two groups. Reaching the active phase was significantly shorter in the oxytocin group. (P=0.01). The time of catheter removal in both groups and the rate of cesarean section and the occurrence of complications were the same in both groups.
Conclusion: The use of oxytocin with a Foley catheter inside the cervix can accelerate the preparation of the cervix and increase the chance of labor in the first 24 hours, but it does not affect labor complications.

Determining the impact of stoic resilience training on operating room staff
Elmira Hajizade, Hossein Karimi Moonaghi , Jamshid Jamali, Haniye Mastour ,
Volume 81, Issue 10 (January 2024)
Abstract
Background: In health care, the well-being and flexibility of the operating room staff are of great importance due to the hard and stressful nature of their work. Therefore, this study was conducted to determine the effect of Stoic resilience training on the resilience of operating room staff.
Methods: The present study was a semi-experimental pre-test-post-test intervention study with a control group. A study was conducted among 67 people operating room staff working in Imam Ali and Imam Hassan hospitals in Bojnord city in September 2023 In this research, the demographic check list and the Connor and Davidson standard resilience questionnaire were used to collect information. The educational intervention was also implemented using the “SeRenE” Stoic education package. This training package includes 4 exercises, which were used only 3 exercises per day and for 6 consecutive days (45 minutes per day) due to the resilience variable. Statistical analysis was done using SPSS version 24 and at a significance level of 0.05.
Results: Based on the results, the total resilience score increased after the Stoic training (72.03±8.31) and showed a statistically significant difference with the control group (65.03±11.16) (P>0.05). The results showed that after Stoic training, mean of subscales of competence, trust in one’s instincts, tolerance of negative affect, positive acceptance of change and secure relationships, control as well as the total score of resilience increased in the training group. Although the mean score of spiritual influences dimension increased after the training, this increase was not statistically significant (P=0.097).
Conclusion: The findings show that Stoic training had a positive effect on various aspects of resilience among operating room staff, whose effects are more obvious in some subscales such as trusting individual instincts, tolerance of negative emotions, and positive acceptance of change. In general, the results showed that people's resilience increased after Stoic training. It is recommended to include Stoic training programs in the training of health personnel and caregivers.

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