Tehran University Medical Journal

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Background: One of the critical unit in each hospital is intensive care unit (ICU). The United States’ Environmental Protection Agency (EPA) recommends to control the noise level of this unit in order to not exceed 45 decibels (dBA) during the day and 35 dBA at night. In this study, our goal was to evaluate the noise level at adult and neonatal ICUs at some Sanandaj’s hospitals, Iran. Methods: This cross-sectional study was conducted from May 4th to June 4th 2012 in adult and neonatal intensive care units at three major hospitals in Sanandaj (Besat, Tohid and Tamin-Ejtemaei). In order to assess the noise level properly, measurements obtained during the days and nights. At a given day, a unit was selected randomly and measurement of sound levels obtained successively within two-hour periods. The noise levels were measured in decibels using a sound level meter (SLM). This process took four weeks to be completed (one week per unit). In the end of study, the total of 336 records of noise levels were obtained. Descriptive analysis as well as fitting a mixed effect models were used to interpret collected observations. All statistical analysis performed using R developed by R core team. Results: The preliminary analysis of observations showed that mean level of noise varied from 65 to 71 dBA among ICUs under study. Noise levels during the day were slightly higher than that of were observed during the night. Descriptive analysis of observations showed no major differences between the noise levels over the time and between the days/nights. Fitting a mixed-effects model showed significant differences of the noise levels between ICUs (P< 0.001). Conclusion: We found the noise levels were always above the EPA thresholds at all three hospitals both during the day and night. It is recommended to train hospital officials and staffs for keeping noise levels to an acceptable level.

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Background: The goal of Induction therapy is to prevent acute rejection during the early posttransplantation period by providing a high degree of Immunosuppression at the time of transplantation. Induction therapy is often considered essential to optimize outcomes, especially in patients at high risk for poor short-term outcomes. The optimal prophylactic induction immunosuppressive therapy to prevent kidney transplant rejection remains controversial and historically, immunosuppressant selection was solely based on efficacy in preventing rejection. Methods: In a cross-sectional retrospective study, 410 cases of renal graft recipients were reviewed in the Hasheminejad Hospital, Tehran, Iran from March 2008 to March 2011. The adult patients with induction therapy with age over 18 years were studied for the indication, results and adverse effects of Induction therapy. Results: From 66 transplanted patients with induction therapy, 44(66.7%) patients were male. The mean age±SD of patients with induction therapy was 39.9±13.2 years. The most common cause of Induction therapy was cadaveric transplantation (45.5%), other causes was the prior history of transplantation (24.2%), without risk factor of rejection, panel reactivity test (PRT)>20% and delay graft function. Anti-thymocyte globulin (rabbit) is the most commonly used agent (97%) for induction therapy. The rate of acute rejection was 16.7% percent (11 patients), that the most of them related to the panel positive patients. The most common adverse effect of anti-thymocyte globulin was thrombocytopenia (15.2%) and the rate of New Onset Diabetes mellitus After transplantation (NODAT) and leukopenia was 10.6%, 1.5%, respectively. The urine culture was positive in 6 (9.1%) patients with induction therapy and positive blood culture was seen in one patient (1.5%). The viral and fungal infections were not seen. Conclusion: No standard Induction immunosuppressive regimen exists for patients undergoing renal transplantation. Anti-thymocyte globulin with low dose regimen is the most commonly used agent. The PRT>20% had the most association with acute allograft rejection. The most common side effect of induction therapy was thrombocytopenia.

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Background: Varicocele is recognized as the most common cause of male factor infertility and is found in 15% of the general population. This prevalence increases to 35% in men presenting with primary infertility and between 70 to 80% in men presenting with secondary infertility. The effect of varicocele on Leydig cell function and testosterone production has been always a question. In this study we examined the effect of varicocelectomy on serum testosterone. Methods: This research protocol was approved by the institutional review board at Royan Institute in infertility department and also this study has been done in Royan Institute (Tehran, Iran) during one year since September 2012 till October 2013. In this cross-sectional study, Serum levels of total testosterone in 79 men with clinical varicocele and in 70 fertile men who served as a control group were compared. Men aged 23–46 years with clinically palpable varicoceles as determined by physical examination were studied. Three to 6 months, testosterone levels were measured again after varicocelectomy, then testosterone levels were compared before and after varicocelectomy. Results: The mean of serum testosterone levels before surgery in infertile men with varicocele and fertile men were 590(230) vs. 583(237) ng/dl respectively. No statistically significant changes were noted in serum testosterone levels for any groups. Three month after varicocelectomy mean serum testosterone levels were significantly increased in infertile men with varicocele compared with preoperative levels from 590 (230) to 663 (242) ng/dl (P=0.009). Also the testis volume of patients were examined, which were divided into two groups included the men with testis volume less than 16 ml (<16) and more than 16 ml (≥16). Conclusion: In infertile men affected with clinical varicocele, varicocelectomy seems to have caused positive impact on the level of serum testosterone increase. It is thought that positive effect is probably caused by improvement of the Leydig cell functions which induce the increase of serum testosterone level.

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Background: Vitamin D deficiency is a widespread problem especially in the developing countries like Iran. The prevalence of vitamin D deficiency differs from moderate to severe among Iranian women, particularly among pregnant women, and it can cause some problems such as preeclampsia, gestational diabetes mellitus (GDM), premature labor and primary cesarean section. The aim of this study was to evaluate whether the mode of delivery is related to serum vitamin D levels or not and if there is any difference in the percentage of cesarean section between vitamin D-deficient and vitamin D-insufficient women. Methods: This cross-sectional study was carried out between the April 2012 and April 2014 in a woman university hospital, Tehran, Iran. One hundred and eighty-six women aged between 17 and 52 years old (Mean age 28.46 and SD5.97) were surveyed in this study. The study group comprised of (N=186) consecutive cases attending Tehran Women General Hospital Clinic for normal vaginal delivery or cesarean section. Women who underwent cesarean section due to previous cesarean delivery were not recruited for the study. The participants were divided into two groups: women with vaginal delivery and women with cesarean section. Serum vitamin D concentration (25(OH) Vitamin D) was measured for each patient. Concentration of serum vitamin D was compared between these 2 groups. Results: One hundred and twenty-eight (68.8%) women had cesarean section and 58 (32.2%) had vaginal delivery. Median and inter-quartile range (IQR) of serum 25(OH) D were 13.64 and 12.47 ng/ml respectively, among women with cesarean section, compared to 11.68 and 12.59 ng/ml in those with vaginal delivery. No statistically significant difference was detected in serum vitamin D between these 2 groups (P=0.72). In addition, no statistically significant difference was detected between women with vitamin D deficiency and women who were vitamin D insufficient (P=0.8). Conclusion: In this study, there was no association between serum vitamin D levels and delivery mode.

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Background: Today obesity and overweightness are the major health problem all over the world. The relation between decreasing serum level of vitamin D and some chronic diseases such as diabetes and obesity was shown in the available studies. The aim of this study was to determine the prevalence of vitamin D deficiency among obese and overweight Iranian population and its relation with age, sex, occupation, body fat percentage and body weight according to body mass index. Methods: In a descriptive cross-sectional study, all patients who were referred to obesity clinic of Imam Khomeini Hospital, Tehran, for weight management throughout one year were included to the study. The prevalence of vitamin D deficiency with serum level lower than 30 ng/ml among 107 subjects was evaluated. The data were analyzed by SPSS, ver. 19 (SPSS, Inc., Chicago, IL, USA). Quantitative variables were presented as mean±SD and qualitative variables were presented as relative frequency. The groups were compared with independent samples t-test and Chi-square test. The level of significance for comparing the groups was considered at P<0.05. Results: In 107 participants, vitamin D deficiency in 81 subjects (75.7%) was reported. The prevalence of deficiency in participants with body mass index between 25 to 29.9, 30 to 34.9 and equal or greater than 35 kg/m2 was 77.3%, 83.7% and 69.4%, respectively. However, the differences between overweight and obese groups were not significant (P=0.193). The prevalence of moderate and severe vitamin D deficiencies among the participants was 50.5% and 25.2 %, respectively. Vitamin D deficiency was more common in participants below 50 years of age compared with those older than fifty (P=0.001). Conclusion: The prevalence of vitamin D deficiency was high in obese and overweight population especially among individuals younger than 50 years. It seems that, it is necessary to add prevention and management of this deficiency to obesity treatment protocols especially in the young adults.

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Background: Smoking is known as the most important preventable risk factor for morbidity and premature death. It is the fourth risk factor attributable to burden of disease globally. Because of the misconception that waterpipe is less harmless than cigarette and also less socially prohibited, people smoke waterpipe more. Studies showed that tobacco consumption rate is increasing among adolescents and it`s initiation age has been declined. The aim of current study was the assessment of the prevalence of different types of tobacco use among students aged between 14 to 18 year old in Tehran. Also we had a comparison with similar studies. Methods: In this cross-sectional study 2877 students between May and July 2014 have been assessed. Samples were collected from language institutes and “Farhangsara”s according to stratified cluster sampling based on the educational zones in Tehran. A structured questionnaire was used for different types of tobacco use habit assessment. Because of sampling method, data analysis was done with complex sample survey analysis in SPSS, ver. 20 (Chicago, IL, USA) and Stata, ver. 12 (College Station, TX, USA) software. P-values less than 0.05 considered as statistically significance. Results: Among participants 11.5% (10.8%-13.3%) had cigarette smoking experience. The prevalence of current cigarette smoking was 4.4% (3.7%-5.3%). 1.4% (0.9%-2.2%) of girls and 7% (5.7%-8.5%) of boys were current cigarette smokers (P< 0.001). Waterpipe smoking experience prevalence was 41.5% (39.7%-43.4%) in total, 41.7% (39.2%-44.2%) in girls and 41.4% (39.2%-44.2%) in boys. Current waterpipe smoking was reported in 25.7% (24.1%-27.4%) of students with no statistically significant difference between boys and girls. Pipe smoking experience prevalence was 3.9% (3.2%-4.7%) and it was more frequent in boys. Conclusion: Cigarette smoking was significantly higher among boys than girls, while waterpipe smoking prevalence showed no difference. In addition, smoking prevalence was higher among students who had smoker parents or smoker friends and also had a bad economic status. It seems that specific interventions should be considered to reduce tobacco burden in adolescents specially in regard to cigarette and waterpipe smoking.

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Background: Staphylococcus aureus is one the most common pathogens causing community-acquired infections and a major concern for public health, and the other hands antibiotic resistance is also of great concern for public health authorities also Staphylococcus aureus produce a lot of virulence factors such as variety of exoproteins included toxic shock syndrome and exfoliative toxin which causes colonization and different infections in their host. The aims of current study were to evaluate the prevalence of Toxic shock syndrome toxin 1 (TSST-1) and ETs genes in isolated S. aureus strains using polymerase chain reaction (PCR) assay. Methods: This cross-sectional study was performed on 100 methicillin-resistant staphylococcal aureus (MRSA) and 100 methicillin-sensitive staphylococcal aureus (MSSA) isolated from clinical specimens of inpatients, outpatients hospitals and nasal carriers in Hamadan University from October 2013 to August 2014. Identified species by biochemical methods were confirmed by the PCR method. Antibiotic resistance was performance by disk diffusion and the presence of TSST-1 and ETs genes was investigated using PCR. Results: Of the 100 isolates MRSA examined, the most frequent resistance was observed to ciprofloxacin (95%), followed by tetracycline (91%), erythromycin (92%), Gentamicin (90%), Rifampin (85%), trimethoprim-sulfamethoxazole (85%), clindamycin (80%) and cefoxitin (100%). Of the 100 isolates MSSA examined, the most frequent resistance was observed to erythromycin (68%), ciprofloxacin (66%), followed by tetracycline (52%), gentamicin (25%), clindamycin (46%), rifampin (45%), trimethoprim-sulfamethoxazole (66%) and cefoxitin (0%). Prevalence of TSST-1 and ETs genes were determined 13% (n=26) isolates, totally. Also the prevalence of TSST-1 was 11% (n=22) and ETs genes was 2% (n=4) isolates and none of the investigated isolates carried eta gene. Conclusion: The increasingly prevalence of MRSA and emerging its antibiotic resistance in clinical isolates can be considered a serious problem for public health. Detection of the high rate prevalence of TSST genes in current study is considered as a serious problem and existing and circle of these strains in according to colonization in community especially old people and immunocompromised patients is very serious.

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Background: Endometrial carcinoma is considered the most common gynecological cancer in the world. Pelvic and para-aortic lymphadenectomy is widely advised based on FIGO staging system. The purpose of this study was to determine whether the biomarker human epididymis protein 4(HE4) correlates with depth of myometrial invasion, histologic grade and metastases in patients with endometrioid adenocarcinoma of the uterus. Methods: This was a cross-sectional study in women with biopsy-proven endometrioid adenocarcinoma in the gynecological ward of Vali-e-Asr Hospital from October 2012 to October 2014. The concentrations of HE4 and CA125 were assessed before surgery and all surgical specimens were reviewed by dedicated gynecologic pathologists. The results were compared with the final histopathology report. Results: A total of 80 patients were initially entered in this study. Twelve patients were excluded because they didn’t have tumor marker. Most of patients (76%) was in stage I disease. Levels of serum HE4 greater than 140 PM and CA125 greater than 35 kU/L observed in 12(17%) and 26(38.2%) of patients, respectively. Of the 52 patients with satge I, 14(26.9%) had CA125&ge35 KU/L, compared with 6(66.7%) of the 9 patients with stage II and 6(85.7%) of the 7 patients with stage III (P<0.002). A significant increase in serum CA125 level was noted in patients with grade III tumors, deep myometrial invasion, cervical stromal involvement and nodal metastasis (P<0.001, P<0.0001, P<0.006, P<0.002). Among the group of patients with early stage disease a significant increase in serum CA125 was noted in patients with deep myometrial invasion. Five out of 52 patients (9.6%) in stage I had HE4 level&ge140 PM, compared with 3 patients (33.3%) with stage II and 4 patients (57.1%) with stage III disease (P<0.003). A significant increase in serum HE4 level was noted in patients with grade III tumors, deep myometrial invasion, cervical stromal involvement and nodal metastasis (P<0.035, P<0.001, P<0.012, P<0.007). Conclusion: Human epididymis protein 4 (HE4) and CA125 may be a useful markers preoperatively in the clinical decision making for determining the need for lymph node dissection in women with endometrial cancer.

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Background: Breast cancer is the most common cancer in women around the world. It has been known for over a century that androgens and androgen receptor (AR) play a role in normal and neoplastic breast cells. The aim of this study was to determined the AR expression on tumor cells and its correlation with other prognostic and predictive factors as well as contribution of AR in patients overall survival (OS) and disease- free survival (DFS). Methods: This retrospective cross-sectional study performed on 189 patients who referred to Medical Oncology Ward of Cancer Institute, Tehran University of Medical Sciences, from April 2007 to February 2010. We performed an immunohistochemistry study for AR (AR441 clone, Dako, Germany) (10% cut-off point) and Ki-67 MIB-1 clone, Dako, Germany) on paraffin embedded blocks. Other data were extracted from patients’ documents. Results: Overall, AR expression was 49.1%. Mean age of the patients with and without AR was 47.86 and 48.49 years, respectively. AR positive tumors presented more in stage I/II than III/IV (P=0.02) and AR were more positive for estrogen receptor positive, lower grade of tumor (grade I/II versus III) and lower Ki-67 (P=0.01). AR positivity had neither correlation with progesterone receptor, HER2/neu, P53 expression or menopausal status. OS and DFS were higher in AR positive patients but did not reach statistical significance. In triple-negative breast cancer (TNBC) group, 25% of tumors showed AR expression. AR had non-significant positive correlation with OS in TNBC cancer patients. OS and DFS had significant statistic positive correlation with ER, PR and stage regardless of AR status. Conclusion: Based on this study, although androgen receptor expression showed correlation with other prognostic factors for survival in patients, we didn’t find statistically significant independent relationship between AR and overall survival in patients. As far as there isn’t any targeted therapy for triple-negative breast cancer (TNBC), prospective basic and clinical studies regarding AR inhibitors in the treatment of TNBC seems to be logical and valuable.

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Background: Tramadol is a synthetic drug which is prescribed in moderate and severe pain. Tramadol overdose can induce severe complications such as consciousness impairment and convulsions. This study was done to determine the convulsions incidence after tramadol use until one week after hospital discharge. Methods: This prospective study was done in tramadol overdose patients without uncontrolled epilepsy and head injury history. All cases admitted in Loghman and Rasol Akram Hospitals, Tehran, Iran from 1, April 2011 to 1, April 2012 were included and observed for at least 12 hours. Time interval between tramadol intake and first seizure were record. Then, patients with second drug-induced seizure were recognized and log time between the first and second seizure was analyzed. The patients were transferred to the intensive care unit (ICU) if clinical worsening status observed. One week after hospital discharge, telephone follow-up was conducted. Results: A total of 150 patients with a history of tramadol induced seizures (141 men, 9 women, age: 23.23±5.94 years) were enrolled in this study. Convulsion was seen in 104 patients (69.3%). In 8 out of 104 patients (7.6%) two or more convulsion was seen. Time interval between tramadol use and the onset of the first and second seizure were 0.93±0.17 and 2.5±0.75 hours, respectively. Tramadol induced seizures are more likely to occur in males and patients with a history of drug abuse. Finally, one hundred forty nine patients (99.3%) were discharged with good condition and the only one patient died from tramadol overdose. Conclusion: The results of the study showed tramadol induced seizure most frequently occurred within the first 4 hours of tramadol intake. The chance of experiencing a second seizure exists in the susceptible population. Thus, 4 hours after drug intake is the best time for patients to be hospital discharged.

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Background: Metabolic syndromes are known as a set of risk factors for the development of cardio-vascular disease and diabetes in the individual. The association between concentration of uric acid and metabolic syndrome in adolescents has yet to be established thoroughly. The aim of this study was to investigate the relationship between uric acid and metabolic syndrome in a sample of adolescents. Methods: This cross-sectional study was conducted from September 23, 2009 to September 22, 2010 in Jundishapur University of Medical Sciences, Ahvaz, Iran. In this study, 240 individuals aged 10-19 years were randomly selected among participants of the Ahvaz MetS study (120 subjects normal and 120 subjects MetS). The serum levels of UA were measured by a colorimetric method. In the normal group, anyone with abdominal obesity, high systolic or diastolic blood pressure, High-density lipoprotein (HDL)&le40 mg/dl, TG&le110 mg/dl, fasting blood sugar (FBS)&le100 mg/dl or diabetes was excluded from the study. History of Anticonvulsive drugs or steroids use was the criteria for exclusion for both groups. Results: Of the 240 subjects aged a mean of 14.95±2.64 years, mean of uric acid in metabolic syndrome group was 4.8±1.4 mg/dl and in the control group was 4.18±1.01 mg/d (P=0.001). Participants were divided into three groups based on uric acid levels: &le4.9 mg/dl, 4.9-5.7 mg/dl and >5.7 mg/dl. The risk of metabolic syndrome was significantly higher in third group of uric acid than the second and first group (odds ratio [OR], 3.7 95% confidence interval [CI], 1.70 - 8.04) and (OR, 5.9 95% CI, 2.42-14.35, P<0.001). In addition, uric acid level was inversely associated with hyperglycemia. The ORs of hypertriglyceridemia for the second and third group of uric acid were 4.36 (95% CI, 2.01- 9.47) 5.75 (95% CI, 2.43-13.61) respectively, compared with lowest group of UA. Conclusion: The results showed that hyperuricemia was significantly linked with increased risk for hypertriglyceridemia, low high-density lipoprotein cholesterol level, high blood pressure and waist circumference. Among Ahvaz adolescents, serum concentrations of uric acid strongly associated with the prevalence of metabolic syndrome and several of its components.

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Background: Jaundice is the most common cause of neonatal admission within the first month after birth. Therefore, by identifying the causes of jaundice based on the infant’s age at disease onset and age at hospital admission and providing the required training, jaundice can be managed and its associated complications can be prevented. This study was performed to evaluate the causes of neonatal jaundice, based on the infant’s age at disease onset and age at hospital admission.

Methods: In this cross-sectional study, out of 3,130 infants with jaundice, referring to Ghaem Hospital, Mashhad, Iran, from 2003 to 2015, 2,658 newborns were selected. Causes of jaundice are determined based on hematocrit, direct and indirect bilirubin, Coombs test, reticulocyte count, blood group and Rh of mother and neonate, thyroid tests, glucose-6-phosphate dehydrogenase (G6PD) enzyme testing, urinalysis, urine culture, and If necessary, Na, blood urea nitrogen, creatinine and other tests depending on the doctor's supervision. After confirming jaundice in infants, based on the physician’s diagnosis and laboratory results, a researcher-made questionnaire including the infant’s characteristics, was completed.

Results: Based on our study, 27.9% of infants had identified as causes of jaundice. Known causes of jaundice were blood group incompatibility (40%), infection (19%), G6PD enzyme deficiency (12%), endocrine disorders (8%), neonatal hypernatremic dehydration (7%), polycythemia (6%), congenital heart disease (CHD) (4%), occult bleeding (3%) and Crigler-Najjar syndrome (2%). The most common time of hospital admission of jaundice was 4-6 days after birth due to blood incompatibilities, occult bleeding, endocrine disorders, hypernatremic dehydration, CHD, polycythemia and G6PD enzyme deficiency. Moreover, the most common time of admission due to infection was after the first week of birth.

Conclusion: The most common age of onset of jaundice was first three days of birth for blood incompatibility, although they were admitted two days later. Therefore, neonatal admission at appropriate time at onset of jaundice and receiving prompt treatments can reduce the probable complications (e.g., kernicterus).

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Background: Congenital hypothyroidism is a major but preventable cause of mental backwardness in infants. In case of hypothyroidism in fetuses, certain complications will occur in vital organs like the central nervous system and the skeleton. Before screening programs were introduced, congenital hypothyroidism was diagnosed with delay due to its few and non-specific symptoms during the first days of life. Given the difference in reference range for various races and populations, this study was aimed to determining a natural range for thyroid hormones used in the screening of infants.

Methods: In a descriptive cross-sectional study at Vali-asr Hospital, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran, from March 2013 to 2014. The level of T4, FT4 and TSH hormones was measured in all natural childbirth, without any complications and with one-minute Apgar score above 7 while this study was underway.

Results: A group of 249 infants (male and female), including 35 (14.1%) aged between 0 and 4 days, 102 (41%) aged between 5 and 7 days and 112 (45%) aged between 7 and 30 days, were examined. The average TSH, T4 and FT4 amounts in infants, aged 0 to 30 days, were respectively 5.35 µU/ml, 10.77 µg/dl and 1.33 ng/dl. The interval was 4.76-6.01 µU/ml for TSH, 10.36-11.17 µg/dl for T4 and 1.29-1.37ng/dl for FT4. The difference between age groups with average TSH concentration is not meaningful (P=0.7) and the average T4 amount in different age groups was meaningfully different (P=0.05). The average FT4 in different age groups is meaningfully different (P=0.007). The thyroid hormone amounts calculated for males and females were not significantly different.

Conclusion: Given the difference in the reference range in race, population and geographical zones, it is necessary to determine a range for screening in Iran. According to the findings of the present study, lower cut-offs, compared with western countries, should be envisaged for TSH in congenital hypothyroidism screening programs that could speed up the diagnosis of minor cases of the disease and prevent complications.

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Background: Background gamma radiation levels vary in different locations and depended on many factors such as radiation properties of soil, building materials as well as construction types which human lives on it. People are always exposed to ionizing radiation, which could badly influence their health. The aim of this study was to evaluate the background gamma-ray dose rate and the estimated annual effective dose equivalent and determination of excess lifetime cancer risk in Sabzevar City, Iran.

Methods: The aim of this cross-sectional study was to determine the dose rate of background gamma radiation in outdoor an indoor areas, 26 stations were selected using the map of the Sabzevar City. The amount of gamma radiation was measured at 4 months (September to January) in 2014 year. The dosimeter used in this study was a survey meter, that is designed for monitoring radiation of x, gamma and beta rays.

Results: The obtained results show that there are significant differences between the indoor and outdoor exposures (P> 0.05). We did not observe significant differences between the time of sampling and sampling locations, (P<0.05). The minimum and maximum values of dose rate were found 66±20 nSvh-1 and 198±28 nSvh-1. The annual effective dose for Sabzevar residents was estimated to be 0.85 mSv and also the amount of excess lifetime cancer risk was estimated 3.39×10-3.

Conclusion: According to the results, the excess lifetime cancer risk and the annual effective dose for the Sabzavar City residents due to the background gamma radiation was higher than the global average (0.5 mSv). The epidemiological studies have been proposed to evaluate the risk of chronic diseases associated with natural radiation exposure among residents.

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Background: Coagulase-negative staphylococci (CoNS) were considered as contaminats previously, but, during the past decade considered as one of the most common photogenic bacteria in hospital. Resistance to beta-lactams especially methicillin in staphylococcus species is being worrying in hospitals. Rapid identification of mechanisms of resistance and confirmation of their resistance to methicillin is a basic principle for antibiotic treatment. The aim of this study was to determine antibiotic resistance, frequency of mecA gene, and determination of SCCmec types in CoNS isolates from teaching hospitals in Iran.

Methods: The descriptive cross-sectional study was carried out one hundred clinical samples isolated from patients with an average age of 7-69 years at teaching hospitals in Hamadan City, Iran, from September 2014 to February 2015. After confirmation of isolates by microbiological standard biochemical tests, antimicrobial susceptibility testing was performed by disk agar diffusion (DAD) method. After extraction of isolated genomicm, mecA gene was detected. Then, the types of SCCmec were performed by PCR.

Results: In this study, 387 clinical samples were collected which among 100 CoNS isolated, Staphylococcus epidermidis was the most prevalent species with frequency 55 (55%), followed by S. haemolyticus 40(40%) and S. saprophyticus 5(5%). The highest antibiotic susceptibility was to rifampin 96(96%) and the lowest resistance was detected for trimethoprim/sulfamethoxazole (TMP/SMX) 47(47%). None of the strains were resistant to vancomycin. Resistance to methicillin was detected in 50% of CoNS isolates. Typing of SCCmec was performed by The polymerase chain reaction (PCR). Frequency types of SCCmec was type III with frequency 13(13%), type V 11(11%), type II 6(6%), type IV 4 (4%), type I 3(3%) respectively. Thirteen isolated was not typable in this study.

Conclusion: The result of this study showed that a large percentage of coagulase-negative staphylococci are resistance to methicillin, and the prevalence of SCCmec type was type III, which encodes the largest number of resistance genes. This information could be use in epidemiological study for preventing of infectious control in hospital and health centers.

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Background: High-resolution manometer (HRM) of the esophagus has become the main diagnostic test in the evaluation of esophageal motility disorders. The development of high-resolution manometry catheters and software displays of manometry recordings in color-coded pressure plots have changed the diagnostic assessment of esophageal disease. The first step of the Chicago classification described abnormal esophagogastric junction deglutitive relaxation. The latest classification system, proposed by Pandolfino et al, includes contraction patterns and peristalsis integrity based on integrated relaxation pressure 4 (IRP4). It can be discriminating the achalasia from non-achalasia esophageal motility disorders. The aim of this study was to assessment of clinical findings in non-achalasia esophageal motility disorders based on the most recent Chicago classification.

Methods: We conducted a prospective cross-sectional study of 963 patients that had been referred to manometry department of Gastrointestinal and Liver Research Center, Firozgar Hospital, Tehran, Iran, from April, 2012 to April, 2015. They had upper GI disorder (Dysphasia, non-cardiac chest pain, regurgitation, heartburn, vomiting and asthma) and weight loss. Data were collected from clinical examinations as well as patient questionnaires. Manometry, water-perfused, was done for all patients. Manometry criteria of the patients who had integrated relaxation pressure 4 (IRP4) ≤ 15 mmHg were studied.

Results: Our finding showed that the non-achalasia esophageal motility disorders (58%) was more common than the achalasia (18.2%). Heartburn (68.5%), regurgitation (65.4%) and non-cardiac chest pain (60.6%) were the most common clinical symptoms. Although, vomiting (91.7%) and weight loss (63%) were the most common symptoms in referring patients but did not discriminate this disorders from each other’s. Borderline motor function (67.2%) was the most common, absent peristalsis (97%) and the hyper-contractile esophagus were rarest in the non- achalasia esophageal motility disorders.

Conclusion: However, achalasia is a treatable esophageal motility disorder but non-achalasia esophageal motility disorders were more common. Thus, manometrial study is an imperative tool for proper diagnosis and treatment of these patients, especially in gastro-esophageal reflux disease. Clinical finding could not accurately diagnosis between different types of non-achalasia esophageal motility disorders from each other’s.

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Background: Human leukocyte antigen E is a member of non-classical HLA class I. Interaction between HLA-E molecule on the target cells and inhibitory CD94/NKG2A receptor on the cell surface of natural killer (NK) cells has an important role in the regulation of immune system against pathogens; therefore different cell surface expression of HLA-E molecule plays an important role in host resistance against viral infections as well as host response to treatment. Considering this fact, we analyzed the frequency of different HLA-E genotypes (HLA-E*01010101, HLA-E*01030103, HLA-E*01010103) in major thalassemic patients who underwent frequent transfusion therapy and are thus more susceptible to infectious diseases.

Methods: This study was a cross-sectional study of 104 major thalassemic patients who referred to Tehran Thalassemia Clinic between the years 2015 to 2016. Blood DNA was extracted and proliferated by sequence-specific primer polymerase chain reaction (SSP PCR). The PCR product was subjected to electrophoresis on 1.5 percent agarose gel then DNA fragment bands on the gel were detected by exposing to UV light. Furthermore, PCR products were also subjected to sequencing analysis for further confirmation.

Results: From 104 patients in this study, 49 (47.1%) were man and 55 (52.9%) were women. These patients were in the age range of 16 to 43 years (mean+SD; 31.03±4.7 year). The frequency of HLA-E*01010103 genotype (64.4 percent) was significantly (P= 0.001) higher than the genotypes of HLA-E*01010101 (15.4%) and HLA-E*01030103 (20.2%) whereas there was no difference between the frequency of HLA-E*0103 allele (52.4%) and HLA-E*0101 (47.6%).

Conclusion: This is the first study that examined the HLA-E polymorphisms in Iranian thalassemic patients referred to Tehran Thalassemia Clinic. This study has shown that the frequency of HLA-E*01010103 genotype was significantly higher than other genotypes of HLA-E whereas there was no difference between the frequency of HLA-E*0103 allele and HLA-E*0101 allele. Whether different frequencies of HLA-E genotype may affect thalassemic patients’ susceptibility to blood-borne infections will be of interest for future studies.

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Background: Ankylosing spondylitis (AS) is an inflammatory disease that mainly affects axial skeleton of the body and ankylosing spondylitis ligaments around the spine at the junction of the spine are inflamed, because the disease is progressive and can lead to significantly cause of disability and the studies could provide a mechanism for the early detection of the disease or help determine when to start treatment, the difference in clinical presentations of AS in men and women is indicative of potential effect of gender on severity of the disease. This study was conducted with the aim to investigate the effect of gender on severity of AS.

Methods: In a cross-sectional study, one hundred and fifteen patients with ankylosing spondylitis who referred to Yazd Rheumatology Clinic between 2001 and 2013 were evaluated. Sampling was performed using non-random convenient method. The most important variables studied included demographic data, clinical presentation, radiographic stage of sacroiliac involvement, and laboratory data extracted from patients’ files and recorded in questionnaires.

Results: Both groups according to age at diagnosis, presence of enteritis, peripheral joint involvement and laboratory data such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and hemoglobin were matched. Inflammatory neck pain was more prevalent in men than in women (77.2% against 51.8%; P< 0.05). Sacroiliac radiographic study revealed stage 1 involvement in 11.3% of men and 37% of women (P= 0.009), and stage 4 in 27.2% of men and 3.7% of women (P< 0.001), with a significant difference.

Conclusion: According to the results of the study, the time between age of onset and age at diagnosis, inflammatory pain in the neck and advanced stage in men than in women was higher. Although these findings suggest that gender may have an impact on the pattern and severity of AS but the time delay in diagnosis as a disease affecting the intensity and pattern should not be overlooked.

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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.

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Background: Thyroid carcinoma is the most common endocrine malignancy. Medullary thyroid carcinoma (MTC) approximately accounts for 5-10% of all thyroid carcinoma. Nowadays, it is obviously, the mutations in REarranged during transfection (RET) proto-oncogene, especially, mutations in exons 10, 11 and 16 are associated with MTC pathogenesis and occurrence. Thus, early diagnosis of MTC by mutation detection in RET proto-oncogene allows to identify patients who do not have any developed symptoms. The aim of this study was to screening of germline mutations in RET proto-oncogene exons 17 and 18 in MTC patients and their first degree relatives in Iranian population.

Methods: In this cross-sectional study, three hundred eleven participates (190 patients, 121 their relatives) were referred to endocrine research center, Shahid Beheshti University of Medical Science during September 2013 until September 2015. The inclusion criteria were pathological and clinical diagnosis. After whole blood sampling, genomic DNA was extracted from peripheral blood leucocytes using the standard Salting Out/Proteinase K method. Nucleotide change detection in exons 17 and 18 was performed using PCR and direct DNA sequencing methods.

Results: In this study, twenty missense mutations [CGC>TGC, c.2944C>T, p.Arg982Cys (rs17158558)] which included 16 heterozygote and 4 homozygote mutations were found in codon 982 (exon 18). In the present study, 154 G>A (rs2742236) and 4 C>T (rs370072408) nucleotide changes were detected in exons 18 and intron 17 respectively. There was no mutation in exon 17. Conclusion: It seems that because of arginine to cysteine substitutions in RET tyrosine kinase protein structure and its polyphen score (0.955) and SIFT score (0.01) the mutation in codon 982 (exon 18) could be have pathogenic effects. On the other hands, the mentioned mutation frequency was 6.4% among MTC patients, so this mutation of exon 18 could be checked in genetic screening tests of RET proto-oncogene. Although this needs more study.