Tehran University Medical Journal

Today, the use of information and communication technology (ICT) is an important and key factor in the progress of all organizations, including health-centered and health systems. Given the importance of the subject matter above, these organizations have created a particular transformation and change in order to upgrade their systems in use, one of which is the creation of Electronic Health Records (EHR). This evolving system, by increasing productivity, both by increasing staffing efficiency and by increasing the effectiveness of the treatment process, simplifies the diagnosis path to treatment and prevents the submission of written and bulky reports. Given the ethical principles of protecting the privacy of patients and the confidentiality of their information, how to archive electronic medical records in a secure database is very important. This is one of the most important issues of ethics and hospital managers should provide mechanisms to keep all patient data properly stored and maintained. In this paper, we have tried to provide a model for the Electronic Health Record Hospital, which many of them could use to optimize their medical records systems. The purpose of this model is to accelerate and apply the process of creating electronic records in the health system, especially government hospitals with a large number of patients. By using this model, internal and external interaction of organization is facilitated, and agile responsiveness can be provided at a given time. In addition to the above, with the implementation and operationalization of the model, the possibility of reducing the volume of criticisms and complaints from hospitals will also be realized and the use of drugs will be based on the actual needs of the community and based on individual data. Implementation of this model also has barriers to addressing some of them in this article, but in order to overcome these barriers, more administrative effort and wider governmental support are needed. These efforts in the context of culture-building use of information technology, both among hospital personnel and among patients and healthcare users, are more important.
 

Background: Tetralogy of Fallot (TOF) refers to a condition in which left ventricular volume is normal or slightly less than normal. Given the differences observed in some Asian patients with TOF, the present study was conducted to investigate left heart by determining Z-scores for the mitral valve in Iranian patients with TOF.
Methods: Eligible subjects in this prospective descriptive study comprised all patients with TOF presenting to Shahid Modarres Hospital in Tehran from March 2012 to March 2015 and diagnosed as the candidates for surgery. After determining the need for surgery and the therapeutic method required, the mitral valve size and Z-scores were calculated. We analyzed sex, age, body surface area (BSA), mitral size (in 2-chamber and 4-chamber view), mitral Z-score, other cardiac anomalies, number of surgery and previous surgery.
Results: Of a total of 80 patients included in the study over 3 years, 29 (36.3%) were male and 51 (63.8%) were female. The mean age of the patients was 7.15±3.37 years and their mitral size was found to be 10-27 mm (16.2±5.99 mm) using echocardiography. Z-scores of the mitral valve were also obtained as -3.09±2.11, ranging between -7.1 SD and +1.3 SD. 58 (72.5%) patients have only TOF and 22 (27.5%) with other cardiac anomalies. 45 patients were for first time underwent surgery and 22 patients for second time, 12 patients for three time and 1 for forth. Of a total of 35 patients had previous surgery, the most common were shunt 15 (42.9%) and then tetralogy of Fallot total correction (TFTC) in 12 (34.3%). Of a total of 80 patients, 59 (73.8%) underwent TFTC, 17 (21.3%) under pulmonary valve replacement and 4 (5%) shunt.
Conclusion: Z-scores of the mitral valve were found to be significantly below the normal value, (i.e. 0±2 SD), in the study patients, suggesting the risk of hypoplastic left heart syndrome in Iranian patients with TOF, nevertheless, the type of TOF examined in these patients might have been different from those observed in other races and regions.
 

Background: The length of maternal hospitalization in uncomplicated delivery has declined and it has become common event around the world. With the expansion of early maternal discharge from hospital in recent years, the identification, follow-up and proper treatment of neonatal problems such as jaundice have been confronted with challenges. Hyperbilirubinemia is the most common disease among neonates especially preterm neonates during the first week of life. This study was performed aiming to investigate maternal hospitalization duration after delivery and its effect on neonatal jaundice level.
Methods: In this descriptive-analytical study, 1347 newborns with the jaundice hospitalized in neonatal clinic or emergency unit or neonatal intensive units of Ghaem Hospital, Mashhad, during May 2011 to November 2017 were investigated. The data collection tool was a researcher-made questionnaire containing three parts. First part was maternal demographic information (age, long hospitalization, and mode of delivery), Second part was neonatal information (serum bilirubin, hematocrit and platelet) and third part was laboratory information (serum bilirubin, hematocrit, and platelet). The relationship between the severity of jaundice in hospitalized infants and maternal hospitalization duration were evaluated. Values were expressed as mean±SD. Student t-test, chi-square and Pearson coefficient tests were used as appropriate. P-value less than 0.05 was considered significant.
Results: 752 (fifty six percent) of mothers are discharged from the hospital at the end of first day. The mean maternal hospitalization duration was 1.31±0.57 days in normal delivery and 1.73±0.65 days in cesarean delivery (P=0.000). Pearson correlation test showed that increasing the duration of maternal hospitalization, some issues were observed including as decreasing serum bilirubin level (P=0.000) in newborns, increasing the admission age in hospital (P=0.045), decreasing daily weight loss rate (P=0.012) and decreasing the percentage of daily weight loss (P=0.002).
Conclusion: By increasing the hospitalization duration of the mother in hospital, serum bilirubin level, rate and percentage of daily weight loss in the newborns would be decreased.

Background: Complete molar twin pregnancy with coexisting fetus is a rare and important diagnosis in obstetrics. Preeclampsia, preterm labor and life-threatening vaginal bleeding are the serious complications of this type of pregnancy. Gestational trophoblastic neoplasia should be ruled out after termination of pregnancy. In this study we reviewed a molar twin pregnancy with a live coexisting triple x fetus which has not been reported till now.
Case Presentation: Our case was a 22-year-old primigravida woman and 17-18th week of pregnancy, who referred to an University Hospital in Mashhad, Iran with complaint of vaginal bleeding On October 2016. Her first trimester ultrasonography in 13th week of gestational age, reported a live single fetus with an anterior great placenta and cystic formation regarding molar pregnancy. According to above-report, Amniocentesis was done in 15th weeks of pregnancy and its result was triple X. After severe and life-threatening vaginal bleeding, she underwent an emergent hysterotomy. A fetus with no obvious anomaly and a great hydropic and vesicular placenta delivered. Episodic crisis of her blood pressure was best controlled with anti-hypertensive drugs. In our case, chemotherapy with methotrexate was started after poor decline of βHCG titration and definite diagnosis of gestational trophoblastic neoplasia. Remission was completely achieved after four courses of chemotherapy.
Conclusion: Differentiation between complete molar pregnancy with live fetus and partial mole is always challenging in obstetrics. Serious complications as preeclampsia and severe vaginal bleeding may become life-threatening. Coexisting molar pregnancy should be ruled out in a pregnancy associated with frequent and unexpectant vaginal bleeding. Amniocentesis and an expert radiologist can help to differentiate them. Following these patients is very important to reveal any trophoblastic neoplasia.

Background: Ovarian cancer is a leading metastatic disease. The epithelial ovarian cancer is one of the most common malignant cancers that usually remains asymptomatic up to metastasis stages, and most patient when diagnosed are in the advanced stage of the disease. Studies have shown that in the majority of epithelial cancers mesenchymal factor expression such as Vimentin increases, and the epithelial factor expression such as E-cadherin decreases, as a result, it causes an epithelial-mesenchymal transition (EMT). The aim of this study was to determine the expression level of these genes and association between EMT phenomenon and development of ovarian cancer based on clinical and morphological findings.
Methods: In the present case series study, 70 samples were chosen from the tumor Bank of Cancer Institute taken from patients at Imam Khomeini Hospital, Tehran, Iran. The amount of expression of two genes, E-cadherin and vimentin, was investigated by real-time PCR method from February 2016 to September 2017. The RNA extraction was done manually, and then cDNA synthesis was performed; In each sample the expression level of vimentin and E-cadherin was measured with real-time PCR method. The patient’s clinical information with other data were analyzed with nonparametric statistical methods in SPSS software, version 19 (SPSS Inc., Chicago, IL, USA).
Results: There was a significant relationship between expression of vimentin gene and the stage (P=0.026) of the disease and metastasis (P=0.009), There was no significant relationship between vimentin gene expression and tumor grade (P=0.207), age (P=0.11), tumor size (P=0.71) and family history (P=0.6). There was a significant correlation between E-cadherin gene expression and metastasis (P=0.027), no significant correlation was found between E-cadherin gene expression with tumor grade (P=0.690), stage (P=0.753), age (P=0.09), tumor size (P=0.537) and family history (P=0.56).
Conclusion: According to the changes in expression of vimentin and E-cadherin genes in ovarian tumor cells, and association between these two genes with clinical and morphological findings and the role of these genes in the migration and invasion, we can use the both genes, vimentin and E-cadherin, as genes involved in the EMT process to assess disease progression and incidence of cell invasion in ovarian cancer.

Background: Welding generates complex metal aerosols, inhalation of which is linked to adverse health effects among welders. Exposure to manganese (Mn) fume in welding processes can have a harmful effect on welders’ health. Long-term, high-level exposure to Mn is associated with impaired central nervous system (CNS) function. The present study aims to investigate relationship between exposure to manganese in welding fumes and incidence of migraine headache symptoms.
Methods: This cross-sectional analytic study was conducted in March 2017 in an Iron Smelting Industry. Forty welders were selected as the exposure group and thirty-five employees were selected from the administrative unit as the control group. Data related to symptoms of migraine headache were collected using with Ahvaz migraine questionnaire (AMQ). Air samples were collected on mixed cellulose ester membrane filters in personal air samplers and then analyzed using inductively coupled plasma atomic emission spectroscopy (ICP-AES) (NIOSH Method 7300).
Results: The average concentration of welder’s exposure to manganese was 7.24±2.91 mg/m3, which is very higher (37 times) than the occupational exposure limit (Threshold limit value-time-weighted average). There was no significant difference between the mean age and work experience of the two groups (P<0.05). Comparison of the mean of migraine headache symptoms in the two groups of welders and office workers also showed that the frequency of these symptoms among welders was significantly higher than those reported by administrative staff (P<0.05). The correlation between the frequency of symptoms of migraine headache and the concentration of manganese in the air of the welders’ respiratory area was statistically significant (P<0.05).
Conclusion: Frequency of migraine headache symptoms was higher among welders compared to control group. Statistically the significant relationship was found between airborne Manganese concentration and occurrence of migraine headache; however, a conclusive conclusion is based on more comprehensive studies with larger sample size.

Background: Due to intrinsic heterogeneity of cellular distribution and density within diffusion weighted images (DWI) of glioblastoma multiform (GBM) tumors, differentiation of active tumor and peri-tumoral edema regions within these tumors is challenging. The aim of this paper was to take advantage of the differences among heterogeneity of active tumor and edematous regions within the glioblastoma multiform tumors in order to discriminate these regions from each other.
Methods: The dataset of this retrospective study was selected from a database which was collected at the medical imaging center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Iran. The quantification was performed as a part of a research study being supported by the Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Iran, between May and September 2017. Twenty patients with histopathologically-confirmed GBM tumors who had been imaged on a 3T MRI scanner prior to their surgery, were included. Conventional and diffusion weighted MR images had been carried out on the patients. The regions of interest including the regions of active tumor and edema were identified on MR images by an expert and overlaid on ADC-maps of the same patients. Histogram analysis was performed on each of these regions and 14 characteristic features were calculated and the best feature combination for discrimination of active tumor from edema was obtained.
Results: It was shown that by combining 8 out of 14 histogram features, including median, normalized mean, standard deviation, skewness, energy, 25th, 75th, and 95th percentiles, differentiation with accuracy of 96.4% and diagnostic performance of 100% can be achieved. Furthermore, by combining mean, energy, and 75th percentile features of histograms, the active tumor region can be discriminated from the edematous region by 92.7% of accuracy and 98.9% of diagnostic performance.
Conclusion: The present study confirms that the heterogeneity of cellular distribution can be a predictive biomarker for differentiation of edematous regions from active tumor part of GBM tumors.

Background: According to the direct connection between congenital hypothyroidism and iodine deficiency in pregnant women, also relatively high incidence of congenital hypothyroidism in some areas of Kerman province, especially Raver district located in North of Kerman province, this study was performed to determine and compare the urinary iodine concentration (UIC) in pregnant women referring to health centers.
Methods: This cross-sectional study was done during March 2014 and May 2015. Inclusion and exclusion criteria to be considered and UIC were measured by spectrophotometry in 384 and 374 pregnant women in Ravar and Kerman cities, Iran. Sampling method for this study was all of pregnant women in Ravar and random stratified sampling in Kerman. data were collected using a structured questionnaire. All statistical analyses were performed using SPSS Software, version 20.0 (IBM SPSS, Armonk, NY, USA). Chi-square test, Pearson's correlation coefficient and Logistic regression were used for associations and differences.
Results: The mean UIC was 200.21 µg/L in pregnant women of Ravar and 238.79 µg/L in pregnant women of Kerman. 22.7% of pregnant women were with low concentrations of iodine, 57.8% within the normal range and 19.5 percent were with high iodine concentrations in Ravar. While 5.3 percent of pregnant women were with low concentrations of iodine, 54.5% were within the normal range and 40.1% were with high UIC in Kerman. There were no significant differences between demographic variables and UIC in the two regions (P> 05/0). Multivariate regression models showed significant connections between the residence and UIC pregnant women (P< 0.001).
Conclusion: The results of this study showed that UIC in pregnant women of Ravar was significantly lower than Kerman and the place of living can be considered as a predictor of UIC in pregnant women.

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: Thrombolytic therapy, an appropriate treatment option, if primary angioplasty is not available for the treatment of these patients in the early hours after the onset of the symptoms. The aim of this study was to evaluate the safety and effectiveness of new tenecteplase (TNKase) drug vs. streptokinase in the treatment of ST elevation myocardial infarction (STEMI) patients in Iran.
Methods: A systematic review and meta-analysis that was conducted in Iran University of Medical Sciences in September 2017. We searched the MEDLINE, Cochrane Library (DARE-EED-HTA, Web of Science and EMBASE (1980 to March 2017) with number of strategies by the words “myocardial infarction, heart infarction, streptokinase, tenecteplase” in combination with other names of drugs and brands for clinical effectiveness. We hand searched US, European, and Iranian cardiovascular journals. Clinical trials and related observational studies in one of the Persian, English and Korean languages were included in this study. Two review authors independently assessed randomized controlled trials (RCTs) and non-RCT studies eligibility and quality, and extracted the data using data extraction form for interventions reviews. We cross-checked and resolved discrepancies by discussion to reach consensus. Finally, the data were entered to the Review Manager, Version 5.3 (The Nordic Cochrane Centre, Cochrane Collaboration, 2014, Copenhagen, Denmark), and then the Cochran-Mantel-Haenszel test (CMH) were used to analyzed the data. The I2 test has been used to calculate the Heterogeneity.
Results: We included 4 observational studies. Observational study assessment by strengthening the reporting of observational studies in epidemiology (STROBE) checklist and quality was high described. All studies entered the final analysis after the quality assessment. All studies reported mortality. In the meta-analysis of mortality, three studies with a sample of 812 people entered. No difference was observed between tenecteplase and streptokinase in the risk of mortality (RR=0.45, CI 95%: 0.20-1.03, P=0.40), hypotension (RR=1.86, CI 95%: 0.53-6.49, P=0.33), bleeding (RR=1.40, CI 95%: 0.49-3.99, P=0.53), and no difference was observed in the ST Segment resolution >50% (P=0.81).
Conclusion: The results of this study showed that the effectiveness and safety of streptokinase are similar to the tenecteplase drug.

Background: Alzheimer's disease (AD) is the most common disorder of dementia, which has not been cured after its occurrence. AD progresses indiscernible, first destroy the structure of the brain and subsequently becomes clinically evident. Therefore, the timely and correct diagnosis of these structural changes in the brain is very important and it can prevent the disease or stop its progress. Nowadays, remark to this fact that magnetic resonance imaging (MRI) provides very useful and detailed information, and due to non-invasiveness, this method has been great interest to the researchers. The aim of this study was diagnosis of AD with MRI by support vector machine model (SVM).
Methods: This is an analytical and modeling research which done in School of Public Health, Kermanshah University of Medical Science, Iran, from February 2017 to November 2017. The data used in this study was a database named Miriad containing brain MRI of 69 individuals (46 Alzheimer's disease and 23 healthy subjects) that was collected at the central hospital in London. Individuals were categorized into two groups of healthy and Alzheimer's disease with two criteria: NINCDS-ADRAD and MMSE (as the golden standard). In this paper SVM model with three linear, binomial and Gaussian kernels was used to distinguish Alzheimer`s disease from healthy individuals.
Results: Finally, SVM model with Gaussian kernel, separated AD and healthy subjects with 88.34% accuracy. The most important Areas for Alzheimer were three Area: Right para hippocampal gyrus, Left para hippocampal gyrus and Right hippocampus. The clinical result of this study is to identify the most important ROI for the diagnosis of Alzheimer's by a clinical specialist. Experts should focus on atrophy in the three Areas.
Conclusion: This study showed that the SVM model with Gaussian RBF kernel can separated AD from healthy subjects by high accuracy. Based on results of this study, can make a software to use in MRI centers for screening AD test by people over the age of 50 years.

Background:  A significant increase in cesarean section in worldwide is known as one of the health system problems. The WHO has estimated that cesarean section in recent years has been 10% in all countries. Despite the increasing popularity of cesarean section, the literature lacks insights about factors affecting the selection of this delivery method. In this vein, this study investigates the factors affecting the choice of cesarean-section from the perspective of pregnant women.
Methods: The sample of this descriptive and analytical study is 200 pregnant women selected using simple random sampling method in Kosar Hospital in Qazvin Province, Iran. The survey questionnaire was used for data collection from March to September of 2017. In order to evaluate the validity and reliability of the research, expert’s opinion and Cronbach alpha coefficient have been used. The questionnaire included scales designed to measure effective factor. Statistical package for social science software (SPSS) version 22 (SPSS Inc., Chicago, IL, USA) were used to analyses the data. T-test and ANOVA were used to compare groups.
Results: The results of prioritizing the items in terms of psychological factors showed that the statements “I am afraid of the pain of normal labor” and “I feel higher stress and anxiety with natural labor were the first priorities”. There was no significant difference between pregnant women who had previous experience and those who did not have a delivery experience. The results of the mean comparison test showed no significant difference between the attitudes of women with previous delivery experience and women who did not have a delivery experience. There were only differences between socio-cultural factors (P= 0.004), factors related to delivery conditions (P= 0.001), consequences of delivery (P= 0.017) among pregnant women with different levels of training.
Conclusion: The results of this study revealed that there is a difference between the attitudes of pregnant women and different levels of education, so pre-pregnancy training should be provided to pregnant women.

Background: Sacrococcygeal pilonidal disease (PD) is prevalent in the young adults. The cause of PD is unclear, and there are different surgical procedures for the treatment. The Pilonidal sinus disease is an unpleasant, chronic relapsing condition that is difficult to cure. There is a wide variety of surgical treatments with sub-optimal results for it. The ideal treatment for the pilonidal sinus disease has yet to be defined. There are many surgical approaches described in the literature. In this study, the long-term outcomes of four current surgical methods for PD were evaluated and compared. We aimed to assess recurrence, satisfaction, complications rate and wound healing time in the four current surgical methods for PD.
Methods: This cross-sectional study was conducted in the Department of Surgery at the Baqiyatallah University Hospital, Tehran, Iran, from April 2017 to September 2017. The study was carried out on 182 postoperative patients. Surgeries were performed in different methods such as; open, closed, semi-closed and limited excision. Diabetics, obese patients and patients with acute pilonidal abscess or prior PD surgery were excluded. All patients were followed for at least three years after surgery. During the follow -up period, patients were assessed for recurrence, satisfaction, complications rate and wound healing time. The outcomes were assessed by case notes analysis and follow-up telephone and postal questionnaires.
Results: In this study forty-four patients were operated via closed Method, 48 patients through open, 48 via semi-closed and 42 one's trough limited excision methods. The highest rate of recurrence was in the open group. There were no cases of recurrence in the closed group. There were also less postoperative hemorrhage and faster wound healing in the closed group. The average satisfaction of all patients was 88.9±8.7. The mean satisfaction rate in the closed group was 95.9±5.3 which was higher than other groups.
Conclusion: The results of this study demonstrated that in the non-recurrent cases of sacral pilonidal sinus, complete Excision and primary repair have fewer complications and shows higher satisfaction rate.
 

In recent years, the use of gold nanoparticles (GNPs) in radiation therapy has been studied by experimentation and Monte Carlo simulation repeatedly. Although the idea of increasing doses has been raised by high-atomic elements since decades ago, but due to the adaptation of gold nanoparticles with the biological system, scientists have incited more about the various uses of these materials in radiation therapy. The results of all studies in this field are consistent with the increase in tumor-derived doses with gold nanoparticles in radiotherapy. But the results of the interaction of radiation energy are still controversial with the size of gold nanoparticles. In other words, in the Monte Carlo simulations the gold nanoparticles with a size of about 10 to 100 nm, and in biological studies, the nanoparticles with a dimension of 1.9 nm were used. On the other hand, some studies of energy dependence have been developed in dose enhancement, and in some other studies the effect of the size of gold nanoparticles has been investigated on photon energy. However, in some respects, the results of radiation therapy using by gold nanoparticles does not appear to be definitive, although the photoelectric effect in low energies is considered to be the dominant phenomenon. The main idea behind the GNP dose enhancement in some studies is not able to explain the results especially in recent investigation on cell lines and animal models radiation therapy using GNPs. With the rapid development of nanotechnology in the biomedical field, GNPs have been widely used in the diagnosis and treatment for disease. Numerous pre-clinical studies in vitro and in vivo have proved the potential value of metal-based GNPs as radio sensitizers in cancer treatment. Various studies have indicated that radio sensitizing ability could be influenced by nanomaterial size, concentration, surface coating, and the radiation energy. Hence, gold nanostructures provide a versatile platform to integrate many therapeutic options leading to effective combinational therapy in the fight against cancer. In this review article, the recent progress in the development of gold-based NPs towards improved therapeutics will be discussed. A multifunctional platform based on gold nanostructures with targeting ligands, therapeutic molecules, and imaging contrast agents, holds an array of promising directions for cancer research.

Background: Leishmaniasis is a zoonosis disease. About 350 million people are at risk of developing a disease, with 1.5 to 2 million new cases every year in the world. The aim of this study was to determine the space-time clusters of cutaneous leishmaniasis in north of Khuzestan Province, Iran.
Methods: In this cross-sectional study, the annual cutaneous leishmaniasis incidence per 100,000 individuals in each county was determined for the past five years. Reported from 2011 to 2015 in North of Khuzestan Province, Iran. Geographical information system (GIS) and spatial scan statistic method were used to identify spatial clusters of cutaneous leishmaniasis cases at the county level. Pure retrospective temporal analysis scanning was performed to detect the temporal clusters of cutaneous leishmaniasis cases with high rates using the discrete Poisson model. The space-time cluster was detected with high rates through the retrospective space-time analysis scanning using the discrete Poisson model.
Results: The overall cutaneous leishmaniasis incidence increased from 2011 to 2015. A total of 3 high-risk counties were determined through Local Moran’s I analysis from 2011 to 2015. Local Moran’s I enabled the detection of the spatial autocorrelation for a county with its adjacent county. The method of spatial scan statistics identified different 11 significant spatial clusters. The space-time clustering analysis determined that the most likely cluster included 11 counties, and the time frame was October 2014. The secondary cluster included one counties in October 2014. The tertiary cluster included six counties, and the time frame was from June 2014 to November 2015.
Conclusion: Spatial and temporal clusters of cutaneous leishmaniasis have increased in the northern region of Khuzestan Province, and most clusters have occurred in November.

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.

Background: Due to the incidence and recurrence of bladder cancer (BC), it could be categorized as a clinical and social problem that often occurs at an advanced age. This study was designed to determine the incidence of BC in Isfahan, Iran.
Methods: A retrospective descriptive survey of information based on bladder cancer (ICD-O, third edition; C67) was obtained from the Isfahan Deputy of Health. The study was in conducted to the department of Urology and Kidney Transplantation Research Center and approved by the University Ethics Committee. The Isfahan Cancer Program is intended to record all cancer cases in the Isfahan. From 20 March 2016 to 19 March 2017, records with linkage to using of pathology, demographic and clinical information were recorded in Microsoft Excel 2013 (Microsoft Corp., Redmond, WA, USA) and analyzed by SPSS statistical software, version 22 (IBM, Armonk, NY, USA). The incidence rates (Irs) were calculated by dividing new cases of BC during the year of study to the population at risk during the same time period×100000.
Results: A total of 417 patients that corresponded to Irs of 8 per 100000 persons were studied. The overall recorded number was comprised of 361 males (IRs of 13.9 per 100000) and 56 females (Irs of 2.2 per 100000). The mean±SD age of patients was 64.7±13 years. The minimum age in males versus females was 12 versus 25 years old respectively. Age in the most patients (80% of cases) was more than 50 years old. The invasion of the muscle was recorded in 44% of cases. Geographical distribution in 65% of cases was related to Isfahan City as a place of birth-residence and in the next categories were Khomeinishahr (7.6%), Najafabad (6.8%), Lenjan (4.5%), Mobarekeh (3.7%) and Felavarjan (2.8%) respectively.
Conclusion: Comparison of BC incidence rate between the year 2014 and 2016 showed that incidence rates decreased by 18.2%. In the 44%, invasive neoplasm of BC was recorded for the population studied. The highest frequency of BC was associated with Isfahan City and then Khomeinshahr, Najaf abad, Lenjan, Mobarakeh and Falavarjan.

Background: Researchers and health specialists are increasingly obtaining information on chronic illnesses from self-reports. This study validates self-reports of hypertension, based on a recently fielded survey in Mashhad City, Iran.
Methods: In this cross-sectional study, we used the results of 2015 census in Mashhad City, a population based survey of people over the age of 30 (n=300745) to determine the proportion of self-reported hypertension. In this study, the data of the studied population was extracted from the databank of Sina Electronic Health Record System (SinaEHR®) and patients with ICD10 codes including I10 and I11 approved by doctors as a reference. Finally using SPSS software, version 20 (SPSS Inc., Chicago, IL, USA) and MedCalc (https://www.medcalc.org/calc/odds_ratio.php), sensitivity, specificity, positive predictive value, negative predictive value were calculated with 95% confidence interval.
Results: Sensitivity of self-reported hypertension was 23.92% (CI95%: 23.43-24.41), specificity 97.03% (CI95%: 96.97-97.09), Positive Linkelihood Ratio 8.06% (CI95%: 7.82-8.30), Negative Linkelihood Ratio 0.78% (CI95%: 0.78-0.79), Positive Predictive Value 46.34% (CI95%: 45.60-47.08), Negative Predictive Value 92.25% (CI95%: 92.20-92.29). The self-reported sensitivity to hypertension in males, Iranian individuals, single, aged 60 and over, body mass index lower 18.5 individual with university education was higher, which was 24.67%, 31.09%, 30.07%, 32.43% and 26.03% respectively.
Conclusion: Although the sensitivity of self-reported hypertension was poor in this study, but specificity and positive and negative predictive values were fairly good.

Background: Retinal vein occlusions are one of the most common form of retinal vascular disorders and could lead to vision loss due to macular edema, macular ischemia and sequelae from neovascularization. Anti-venous endothelial growth factor (anti-VEGF) treatment is the choice strategy of treatment for patients with macular edema secondary to central retinal vein occlusion (CRVO). There is an evidence of body with the controversies regarding increment of choroidal thickness in CRVO condition. The current study was designed to determine whether baseline subfoveal choroidal thickness may be an indicator for visual and anatomical outcome of bevacizumab in patients with CRVO macular edema.
Methods: This study was a prospective clinical cohort study that enrolled in 23 new cases of treatment-naïve central retinal vein occlusion (CRVO) from February to July 2017 who were visited in Feiz Eye Hospital, Isfahan, Iran. Patients received a single injection of bevacizumab and were followed for 30 days. Ratio of subfoveal choroidal thickness (SFCT) was measured using enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT). Ratio of SFCT of the CRVO eye to the fellow healthy eye (SFCT1/F) was taken as independent variable. Changes of best-corrected visual acuity (BCVA) in LogMAR (ΔBCVA, functional response) and secondary to baseline central macular thickness ratio (CMT2/1, anatomical response) in the CRVO eyes were taken for comparative and correlative analytics.
Results: A total of 46 eyes from 23 patients with the mean age of 64.60±10.19 years were included in this study. Baseline SFCT was higher in CRVO eyes (251.91±46.09 µm) in comparison to the fellow eye (206.95±26.62, P<0.0001). Also central macular thickness in CRVO eyes were significantly higher in CRVO eyes in comparison with fellow eye (531.04±38.22 vs 303.30±33.59, respectively, P<0.05). SFCT1/F, correlated moderately with anatomical (CMT2/1) and strongly with functional response (ΔBCVA).
Conclusion: Bilateral evaluation of SFCT by EDI-OCT in all newly diagnosed CRVO cases is recommended to determine if there is a relative increase in choroidal thickness. This may help predict short-term response to anti-VEGF therapy.

Background: Breast cancer is the most commonly diagnosed and the leading cause of cancer death among females worldwide. The rate of breast cancer incidence among Iranian women is 17% of all cancers, it has been ranked first in Iran. This study aimed to investigate the factors affecting axillary lymph node involvement in female patients with breast cancer.
Methods: A cross-sectional study was conducted on 167 patients with breast cancer diagnosed between March 2012 and March 2015 at Shahid Beheshti of Babol, Shahid Rajaei of Tonekabon and Imam Sajad of Ramsar hospitals. A researcher-made questionnaire was used to collect information on the patients and pathology report of tumor and lymph nodes was completed.
Results: The rate of axillary lymph node involvement was observed in 117 patients (70.1%). Mean age was 49.64±11.62 years in the patients with breast cancer. The highest frequency of lymph node involvement was observed in the 40-49 age group (24%). The average size of tumor was 3.39 cm and the majority of patients had a tumor 2-5 cm (T2) but the most involvement was related to T3 (>5cm). The most common type of cancer and grading were invasive ductal carcinoma (93.4%) and tumor grade 2 (52.1%), respectively. Most lymph node involvement was observed in invasive ductal carcinoma and 85.1% of patients had tumor degree 3. 22.2% of patients with vessels involvement had axillary lymph node involvement. 63% of patients’ tumors had receptors of estrogen and progesterone. A statistically significant association was observed between axillary lymph node involvement and tumor size (P=0.031), tumor type (P=0.007), tumor grade (P=0.011), estrogen receptor (P=0.008) and progesterone receptor (P=0.038).
Conclusion: There was a statistically significant association between axillary lymph node involvement and tumor size, type and grade, estrogen and progesterone receptor status, but there was no statistically significant association between axillary lymph node involvement and age and estrogen as well as progesterone receptor status.