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Showing 25 results for Soheila
Scolicidal effects of Berberis vulgaris fruit extract on hydatid cyst protoscolices
Nima Salehi , Soheila Rouhani , Mohammad Kamalinejad , Farid Zayeri , Afshin Motaghifar ,
Volume 72, Issue 2 (May 2014)
Abstract
Background: Surgery is one of the best choices for the treatment of hydatidosis. The use of effective scolicidal agents during surgery for hydatid cyst is essential to prevent the secondary infection. Up to now no effective and safe agent has been identified for this purpose. Berberis vulgaris called “Zereshk” in Persian has been traditionally used as herbal remedy for the treatment of complaints and it is widely cultivated in Iran. Many studies have shown that it has antibacterial, antifungal and antiparasitic effect. Methods: In this study the scolicidal effect of Berberis vulgaris aqueous and hydro-alcohol extract for different concentrations (for aqueous: 0.5, 1, 2 and 4 mg/ml and for hydro-alcohol: 0.25, 0.5, 1 and 2 mg/ml) at different exposure times (5, 15 and 30 minutes) was evaluated. For this purpose, we obtained liver hydatid-cysts from a slaughter house. Viability of protoscolices was assessed by 0.1% eosin staining. Normal saline and hypertonic saline were used as negative and positive controls respectively. Results: All the different concentrations of Berberis vulgaris aqueous and hydro-alcoholic extracts had scolicidal effect. An aqueous extract with 4mg/ml concentration acted as positive control and we observed to lead to the death of 100% of protoscolices in the first 5 minutes. The least scolicidal effect (12.3%) was observed in an aqueous extract with 0.5 mg/ml concentration.The scolicidal activity of hydro-alcoholic extract with concentration of 2 mg/ml was 100% after 5 min of application, which was the same as positive control group. We noticed a significant increase in protoscolicidal activity with an increase in concentration in the two extracts of Berberis vulgaris (P<0.001). Conclusion: It is important to mention that all the concentration levels and exposure times applied in this experiment are relatively low, since scolitical activity in both of the extracts is at its highest in this low spectrum. For further experiments, we suggest that the stability of cyst fluid in both of the extracts should be assessed. Therefore, after In vivo examination and additional experiments, it may be used as a suitable and effec-tive scolicidal in surgery.
Radiographic changes of lumbar spine and pelvis in chronic spinal injury
Shamsa Shariatpanahi , Soheila Khodakarim , Fateme Abolpour Mofrad,
Volume 72, Issue 9 (December 2014)
Abstract
Background: Chronic spinal cord injury has an important role in sensorimotor disor-ders which is associated with many complications and the rate of these complications should be certainly considered. The most important complications are the changes in bones and joints which come with pain and lead to increase in their motor disability. In this paper, the radiographic images were studied and the ossifications of spinal cord and pelvis were described and also the type of changes and their prevalence was eval-uated. Methods: In this study, 500 patients and veterans with spinal cord injuries who were hospitalized in Khatam-Ol-Anbia Hospital were examined. The spinal and pelvis x-ray of the patients have been studied for spinal cord ossification, the hip joint narrowing, sacroiliitis, heterotopic ossification, osteophyte and the presence of quiver in the graph. Results: Among the patients, 485 cases were males and 15 cases were females, the av-erage age was 50.26 and the mean duration of injury was 26 years. Four hundred and forty six patients were paraplegic and 54 cases were quadriplegic. There was a signifi-cant relationship between age and the number of involved vertebrae (P= 0.000), psori-asis like ossifications (P= 0.048) and large osteophytes (P= 0.037), also between the du-ration of the injury and the hip joint narrowing (P= 0.008), the number of involved ver-tebrae (P= 0.008). In addition the presence of shrapnel in the graph is correlated with large osteophytes and more heterotopic ossification. Conclusion: The most frequent cause of chronic spinal injuries of our patients has been the injury by quiver, it seems our results may not be extended to all patients with spinal cord injury. In lumbar spine radiography of the patients, osteophytes, the quiver and psoriasis like ossifications were mostly seen. In the pelvis x-rays the most changes were hip joint narrowing, sacroiliitis and the heterotopic ossification.
Intraoperative visualization, frozen section, and permanent pathology in endometrial cancer
Soheila Aminimoghaddam , Fatemeh Mahmoudzadeh , Andisheh Maghsoudnia , Fatemeh Ghaemmaghami ,
Volume 72, Issue 9 (December 2014)
Abstract
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. Intra-operative frozen sections analysis is used to identify pa-tients at high risk for pelvic and para-aortic nodal metastasis evading lymphadenec-tomy in low-risk patients. However there is still some controversy concerning the effi-ciency of IFS. The aim of this study was to determine the validity and precision of fro-zen section diagnosis and gross examination of uterine specimen compared to the final histological results in patients with endometrial cancer. Methods: Patients diagnosed as endometrial cancer based on office biopsy using a Pipelle or D&C who underwent surgical staging were compared for frozen section anal-ysis and permanent diagnosis. Patients with the history of radiotherapy or other types of cancer or co existence malignancies were excluded. Results: There was no relation between the tumor size and lymph node involvement and the results were not significant (P= 0.1). Frozen section analysis was significantly accurate and correct in predicting final histopathological results (P< 0.0001). It has been shown that in more than 90% of patients the diagnosis made by frozen section analysis was in accordance with final pathology with considerable sensitivity and spec-ificity. Gross examination was also precise in determining myometrial microscopic in-vasions (P< 0.0001). Conclusion: Although the sample size of the studied population was small but our study results support the previous data and suggest that in early stages and low grade tumors, gross examination and frozen section diagnosis are conveniently predictive of lymph node metastasis. These data might be useful for prediction of tumor invasion using frozen section and gross examination in low grade tumors and early stages and for doing complete surgical staging and lymph node sampling. However the im-portance of surgical staging always must be considered in patients who need systemat-ic lymphadenectomy. In overall these data might help to come up with new guidelines for surgical risk assessment in endometrial cancer.
The correlation of serum S100β protein levels and hippocampal Seladin-1 gene expression in a rat model of sporadic Alzheimer's disease
Soheila Hosseinzadeh , Maryam Zahmatkesh , Gholam-Reza Hassanzadeh Hassanzadeh , Morteza Karimian , Mansour Heidari , Mahmoud Karami ,
Volume 73, Issue 8 (November 2015)
Abstract

Background: Seladin-1 protein protects the neural cells against amyloid beta toxicity and its expression decreased in vulnerable regions of Alzheimer's disease (AD) brains. On the other hand, changes in serum levels of S100 have been considered as a marker of brain damage in neurodegenerative diseases. Furthermore, this study was carried out to determine the relation between the change profile of serum S100&beta protein levels and hippocampal Seladin-1 gene expression in a rat model of sporadic AD. Methods: In this experimental study that established in Department of Neuroscience, School of Advanced Technologies in Medicine, Tehran University of Medical Science, from March 2011 to April 2013, 72 animals were randomly divided into control, 4, 7, 14, and 21days ICV-STZ/Saline administrated rats. Alzheimer's model was induced by intracerebroventricular (ICV) injections of streptozotocin (STZ) [3 mg/kg] on days 1 and 3. Serum levels of S100&beta and hippocampal Seladin-1 gene expression were evalu-ated in experimental groups. The initial and step-through latencies (STL) were deter-mined using passive avoidance test. Results: Serum levels of S100&beta were significantly different between the STZ-7 day and STZ-14 day groups in comparison with the control, saline and STZ-4 day groups. As well as, there was a significant difference between the STZ-7 day group in comparison with the STZ-14 day and STZ-21 day groups (P=0.0001). Hippocampal Seladin-1 gene expression in STZ-14 day and STZ-21 day groups significantly decreased as compared to the control, saline and STZ-4 day groups (P=0.0001). However, significant correla-tion was detected between serum S100&beta protein decrement and Seladin-1 down regula-tion (P=0.001). Also, the STL was significantly decreased in 21 days ICV-STZ adminis-trated rats as compared to the control or saline groups (P=0.001). Conclusion: Monitoring the changes of serum S100&beta protein levels by relationship with changes in hippocampal Seladin-1 gene expression can be a useful indicator of neu-ronal damage in patients with Alzheimer's disease.


Sexual dysfunction and the underlying medical problems in post-menopausal women
Soheila Nazarpour , Masoumeh Simbar , Rameza Fahimeh Ramezani Tehrani , Hamid Alavi Majd ,
Volume 73, Issue 11 (February 2016)
Abstract

Background: Sexual dysfunction could be under the influence of some underlying medical problems. The purpose of this study is to examine the relationship between medical problems and sexual function in post-menopausal women.

Methods: This is a community-based, descriptive-correlation study of 405 post-menopausal women residing in Chalus and Nowshahr cities, North of Iran, aged 40 to 65 years old from October 2013 to May 2014. A multistage, randomized sampling was conducted. The data was acquired through interviews using the Female Sexual Function Index (FSFI) questionnaire and a researcher-made questionnaire, and was analyzed using descriptive and analytical tests such as multiple linear regression and logistic regression models.

Results: 51.4% of the subjects had medical conditions. Cardiovascular disorders were the most common diseases among the subjects. 61% of the women were suffering from female sexual dysfunction (FSD). Sexual dysfunction in patients with medical conditions was significantly higher (P= 0.037). Scores of arousal (P= 0.000), orgasm (P= 0.018), and satisfaction (P= 0.026), as well as the FSFI total score (P= 0.005), were significantly lower in subjects with cardiovascular disorders. Scores of desire (P= 0.001), arousal (P= 0.006), lubrication (P= 0.010), orgasm (P= 0.004), and satisfaction (P= 0.022), as well as the FSFI total score (P= 0.017), were significantly lower in subjects with diabetes. Scores of pain were significantly lower in subjects with musculoskeletal disorders (P= 0.041), they experienced more pain during intercourse. In domains of arousal (P= 0.030), satisfaction (P= 0.040), and pain (P= 0.044), the scores of those taking antihypertensive medications were significantly lower than the scores of the rest of the subjects. Scores of desire (P= 0.001), arousal (P= 0.006), orgasm (P= 0.006), and satisfaction (P= 0.048), as well as the FSFI total score (P= 0.006), were significantly lower in those taking antidiabetic drugs. And lastly, the mean satisfaction score in women whose spouse had medical conditions was significantly lower (P= 0.040).

Conclusion: Cardiovascular disorders, diabetes, and musculoskeletal disorders could have a negative impact on sexual function in post-menopausal women. Thus, these diseases must be considered and treated in order to improve women’s health, particularly their sexual function.


Ovarian failure due to cancer treatment and fertility preservation options
Soheila Aminimoghaddam , Sara Norouzi ,
Volume 74, Issue 1 (April 2016)
Abstract

Primary ovarian insufficiency (POI), commonly referred to premature ovarian failure, is defined as ovarian failure before the age of 40 years. It is the loss of ovarian function caused by a process directly affecting ovaries. Cancer therapy which includes surgery, radiotherapy, and chemotherapy influence ovarian function, leading to premature menopause and loss of fertility. POI is idiopathic in most cases (74-90%). The known causes, in addition to anticancer treatment, are other processes like chromosomal abnormalities, autoimmunity, and natural aging can result in secondary ovarian failure, which is detected by an increase in serum gonadotropin levels (FSH and LH). There are evident risks of POI in women treated for cancer. Those who receive anticancer treatments have an increased risk of developing POI. There by, anticancer drugs and radiation therapy are considered as the most common toxins of ovaries. Although cancer incidence rates in women less than 50 years old continue to increase during recent years, mortality rates are dramatically decreasing due to modern advances in treatment. Increasing numbers of survivors are now confronted with the long-term consequences of exposure to these treatments. The pool of primordial follicles in the ovary is fixed and any injury to the ovary can potentially reduce this ovarian reserve, effectively advancing the patient’s reproductive age, thus narrowing the window of reproductive opportunity. Ovarian failure occurs in a significant percentage of childhood cancer survivors and many of them will seek care for reproductive dysfunction. Nevertheless, Embryo cryopreservation, oocyte cryopreservation, ovary tissue cryopreservation, ovarian suppression and oophoro-pexy are some options to preserve fertility in these groups. As a result, having foreknowledge of potential treatment related ovarian failure will allow the physician to give a better counsel to patients and their family regarding the importance and timing of fertility preservation by giving an estimated window of fertility. The objectives of the current review are to report on the etiology of POF induced through cancer therapy.


Awareness and practice of cervical cancer and Pap smear testing in a teaching hospital in Tehran
Mansoureh Ghaoomi , Soheila Aminimoghaddam , Hasan Safari , Ahmadreza Mahmoudzadeh ,
Volume 74, Issue 3 (June 2016)
Abstract

Background: Cervical cancer is known to be preventable because of long period of pre-invasive stage, availability of screening tools, and effective treatments for early invasive cervical lesions. Screening is main measures to prevent the disease and Pap smear is a screening strategy for cervical cancer. Current paper aimed to evaluate levels of awareness and practice regarding Pap smear screening among women aged between 20 to 65 years in Tehran (Iran).

Methods: This was a descriptive-analytical study conducted in Tehran City of Iran in 2015 at Firoozgar Hospital. The research population included all married, widowed and divorced women aged 20-65 years. Data analysis was performed using the Pearson correlation and Student’s t-tests in SPSS, ver. 23 (Chicago, IL, USA).

Results: Among 90 individuals who have fill questionnaire completely, 66.6% subjects had Pap smear tests. 40% of the individuals aged between 30 to 39 and the education level is distributed equally between Intermediate, Diploma and graduate and only 3 percent of them, continue their education to higher level. There was a significant relationship between the awareness of Pap smear and educational level (of both wives and husbands). The people who have graduate degree, have the best awareness. Working women revealed higher level of awareness about Pap smear. Shame and fear of taking the cancer were the most common reasons which lead to avoidance in doing the test by the women, while the most encouraging factors for performing the test were the information mostly provided by physicians and after that, the information provided by friends.

Conclusion: The awareness of Pap smear test which was measured by weighting different questions in the questionnaire by experts, prove that the women aged above 39, have an average level of awareness of Pap smear test. Due to high prevalence of cervical cancer and prolonged pre invasive course, role of Pap smear for early diagnosis necessitate the use of proper and inexpensive instructional methods to increase awareness in women about cervical cancer and preventive strategies.

Diagnostic accuracy of MRI in staging of cervical cancer
Soheila Aminimoghaddam, Sara Norouzi, Elham Nasrolahi, Narmin Karisani,
Volume 74, Issue 6 (September 2016)
Abstract

Background: Cervical cancer is the third most common gynecologic cancer in women worldwide. Cervical cancer has lower incidence and mortality rates than uterine corpus and ovarian cancer, as well as many other cancer sites. Unfortunately, in countries that do not have access to cervical cancer screening and prevention programs, cervical cancer remains the second most common type of cancer. Staging of the disease is made clinically. The aim of this study was to evaluate the role of magnetic resonance imaging (MRI) for diagnosing the invasion of cancer to organs and staging of cervical cancer and the relationship between clinical and pathological findings and the sensitivity and specificity of the assay in cervical cancer.

Methods: The study included records of 40 patients with cervical cancer that undergo surgery or Chemoradiation in Firoozgar University Hospital. In this study that made retrospectively, non-randomized, the MRI reports and clinical findings records and pathology results was discussed. The sensitivity and specificity of MRI for diagnosing the invasion to parameters, bladder, rectum, vagina, pelvic wall and it’s accuracy to determine tumor stage has been set.

Results: A total of 40 patients with pathology information of cervical cancer was retrospectively reviewed in the study. The patients were 28-83 years old by mean age of 49.3 Pathology of cervical cancer in 80% of cases was SCC, 15% adenocarcinoma and 5% melanoma. The sensitivity and specificity of MRI for diagnosing invasion of parameter was 76% and 88%. The sensitivity of MRI in the detection of bladder invasion was 100% and specificity of 100%. The sensitivity of MRI in the diagnosis of rectal invasion was 50% and specificity of 100%. The sensitivity of MRI in the diagnosis of pelvic wall invasion was 100% and specificity of 86%. Sensitivity in detecting invasion into the upper third of the vagina was 100%.

Conclusion: Overall, this study showed a good sensitivity and specificity for detecting invasion into the bladder, vagina, pelvic wall and parameters and good specificity for the diagnosis of rectal invasion and acceptable accuracy at 67.5% for detection of tumor stage by MRI show.


Outcome of pregnancy subsequent to chemotherapy with actinomycin-D in low risk gestational trophoblastic neoplasia
Soheila Aminimoghaddam , Sara Norouzi , Arefeh Fayazi ,
Volume 75, Issue 4 (July 2017)
Abstract
Background: The histological terminology of persistent gestational trophoblastic disease (GTD) is an excessive abnormal trophoblast. GTN will mostly occur after the molar pregnancy; while, it might occur after each kind of pregnancy such as abortion, ectopic pregnancy (EP), etc. too. The follow-up process is to interest to scholars as a mandatory procedure in patients with GTN for detecting the recurrence. This disease is frequently seen in reproductive ages. It should be noticed that an approach for assessing the success in this procedure carried out by monitoring outcomes of pregnancy after chemotherapy.
Methods: A retrospective cohort study was conducted on patients with GTN who were referred to Firoozgar and Mirza Koochak Khan teaching hospitals during 10 years, starting from 2004. The inclusion criterion was patients with low-risk persistent GTN after molar pregnancy, EP, and abortion, that treated with single agent chemotherapy actinomycin-D. After following the patients for 12 months, patients with serum βHCG lower than 5 mIU/ml, who intended to have child were allowed to become pregnant. The following items were observed in the study: age, body mass index (BMI), parity, chemotherapy duration, and pregnancy outcomes such as spontaneous abortion or preterm labor, pre-eclampsia, stillbirth, fetal malformation, and repeated molar pregnancy.
Results: 74 patients were monitored, 83.78% of them had uncomplicated pregnancy and labor, 4.05% had the abortion, 4.05% had second molar pregnancy, 2.7% had pre-eclampsia, 5.40% had preterm labor. Moreover, stillbirth and malformation did not occur in this study even after chemotherapy treatment. There was not any significant correlation between age, BMI, parity, and chemotherapy duration with pregnancy outcomes.
Conclusion: The outcomes of pregnancy after chemotherapy with actinomycin-D is similar to the general population who did not have chemotherapy. The abortion rate and repeated molar pregnancy were similar between population and sample too. Thus, the study shows that the cured patients with low-risk GTN have as much chance of having a normal pregnancy as normal women. In other words, treatment with actinomycin-D does not have any adverse effect in future pregnancies.

Huge mucinous cystadenoma of ovary, describing a young patient: case report
Soheila Aminimoghaddam, Saeedehsadat Batayee , Mahsa Velaei ,
Volume 75, Issue 5 (August 2017)
Abstract
Background: About 90% ovarian cancers are epithelial and 10-15% of this group are mucinous. The treatment is the hysterectomy with bilateral salpingo-oophorectomy.  However, most of these tumors occur in young women that have not yet given birth in which preservation of fertility should be considered. We present a case of huge mucinous cystadenoma and massive ascites managed by preserving uterus and ovaries. Meigs’ syndrome is found in fibroma, and thecoma of ovary, however, in rare occasion this syndrome is occurred in mucinous cystadenoma.
Case presentation: A 21-year-old unmarried woman presented with the complaint about weight gains and irregular menstruation for four months to gynecology clinic of Firoozgar hospital in Tehran in October 2016. Preop lab data including tumor marker was gathered, and sonography with CT scanning of pelvic and chest was performed. The ascitic fluid was negative for malignancy. Also, laparotomy with staging the ovarian tumors was carried out including cytology of ascitic-fluid, cytology of diaphragm, ovarian cystectomy, biopsy of the paracolic gutter, exploring abdomen and pelvis. Histopathology report revealed mucinous cystadenoma. Moreover, according to the normal appearance of the appendix in this case, the appendectomy was not performed.
Conclusion: Ovarian cysts in young women who are associated with elevated levels of tumor markers and ascites require careful evaluation. Management of ovarian cysts depends on patient's age, size of the cyst, and its histopathological nature. Conservative surgery such as ovarian cystectomy or salpingo-oophorectomy is adequate in mucinous tumors of ovary. Multiple frozen sections are very important to know the malignant variation of this tumor and helps accurate patient management. Surgical expertise is required to prevent complications in huge tumors has distorted the anatomy, so gynecologic oncologist plays a prominent role in management. In this case, beside of the huge tumor and massive ascites uterine and ovaries were preserved by gynecologist oncologist and patient is well up to now.

Uterine sarcoma diagnose and treatment: review article
Shahrzad Sheikhhasani , Nadereh Behtash , Soheila Aminimoghaddam ,
Volume 75, Issue 10 (January 2018)
Abstract
Uterine sarcomas comprise a group of rare tumors with different tumor biology, natural history and response to treatment, contain just 3-7% of total uterine malignancies and about 1% of all gynecologic cancers. Although they cause important part of women death due gynecologic cancers. These tumors have aggressive behavior and high recurrence rate, even when confined to the uterine corpus at the time of diagnosis. The most common of uterine sarcomas is leiomyosarcoma. The incidence of leiomyosarcoma is increased after age 50. Traditionally, carcinosarcomas were named as Malignant Mixed Mullerian tumor (MMMT), but in recent classification according to their pathologic structure and its behavior, these tumors are classified as carcinomas. The rare group of sarcomas is endometrial stromal sarcoma (ESS), which occurres in younger women. In a medical studies search from 2000 to 2017, all kinds of uterine sarcomas, pathologic diagnostic methods, primary treatment and supportive treatment have been analyzed. Last histological classification is based on FIGO 2009 and WHO. According to such classification, sarcomas divided into three subtypes: leiomyosarcoma, endometrial stromal sarcoma and carcinosarcomas. Diagnosis of sarcoma before treatment and discrimination from benign myoma by current diagnostic methods is difficult. Preoperative endometrial sampling identifies only 25% of sarcomas. It may be the myometrial origin of tumor. Currently, MRI, ultrasound and PET scan may be used for the diagnosis of tumor. The gold standard of treatment is complete and intact resection of tumor considereing free margins. In advanced or recurrence disease, cytoreductive surgery followed by chemotherapy is the choice of treatment. If technically it is not possible or there are extra abdominal metastases, palliative chemotherapy should be considered. Combination of gemcitabine and docetaxel is an acceptable choice. Recent studies are going to approve the effective role for targeted agents with or without cytotoxic chemotherapy in these group of aggressive tumors. The only drug in this group has approval is pazopanib. However, it did not achieved acceptable responses in phase I, II studies. As regards of tumor biology and inappropriate response to chemotherapy and radiotherapy, sarcoma have poor prognosis in all stages.

Sex determination by the length ratio of metacarpals and phalanges: X-ray study on Iranian population
Maryam Ameri , Soheila Ghorbani, Ebrahim Ameri , Forouzan Fares ,
Volume 76, Issue 8 (November 2018)
Abstract
Background: In forensic anthropological identification, we usually use body remains. Accurate sex estimation from these remains is very important and needs the knowledge of specific population standards of that area. Sometimes, human remains are damaged by environmental circumstances. So, we must examine single bones for sex estimation. One of the relatively resistant bones to environmental conditions are hand bones. Specific hand phalanges and metacarpals have significantly different dimensions in two sexes depending to each population and can be a helpful tool to estimate the gender of individuals. The aim of this study was to investigate the possibility of estimating gender using phalanges and metacarpals dimensions in Iranian people.
Methods: This prospective study was conducted on the X-ray images of adult people hands between the months of March and September 2017. They referred to Shafayahyaian Hospital, the educational and referral center of orthopedic disease of Iran University of Medical Sciences, in Iran. 200 adult persons (100 male and 100 female) without any background of specific disease, entered in our study. In each case, the length of D: distal phalanx, M: middle phalanx, P: proximal phalanx, MC: metacarpal, Fl: finger length, and T: total (Distal phalanx+middle phalanx+proximal phalanx+soft tissue of the finger tip) were measured in millimeter and reported in ratio. All analyses were done using SPSS software, version 20 (SPSS Inc., Chicago, IL, USA).
Results: Student t-test showed that many ratios were significantly different between two genders. It is concluded that the length ratio of metacarpals and phalanges could be used for sex determination. The most valuable ratios were FL1/FL3 and MC4/MC5. Multivariate logistic regression test reported an equation by which the gender is predictable. Z= 5.856+ -3.904 X FL1/FL3+ -1.865 X MC4/MC5.
Conclusion: If “Z=0”, the gender is male and if “Z=1”, it is female without any doubt. In our knowledge, this study provides the first population sex estimation formulae from the hand bones in Iranian population. However, we need further studies in larger groups to use this equation for sex determination in forensic contexts.

Hepatitis B infection: review article
Jafar Mohammadshahi , Soheila Refahi , Bahareh Yousefipour , Mehran Sardari , Roghayeh Teimourpour ,
Volume 76, Issue 9 (December 2018)
Abstract
Hepatitis B virus (HBV) is an etiological agent of hepatitis B infection. Hepatitis B is a life-threatening disease that affects the liver. The clinical outcomes of the disease are varied from asymptomatic disease to serious complication such as cirrhosis and hepatocellular carcinoma (HCC). Despite availability of the vaccine and appropriate treatment, hepatitis B infection still remains a major public health problem worldwide. Based on WHO reports, over 887.000 people die annually from hepatitis B complication including cirrhosis and hepatocellular carcinoma. Hepatitis B is very contagious and spreads through infected blood, body fluids, mother to baby during birth, contaminated needle and between sexual partners. HBV uses sodium taurocholate cotransporting polypeptide (NTCP) receptor to enter hepatocytes and by replicating in these cells interferes with liver functions. In fact liver damage is as result of virus multiplication and activation of immune responses especially virus-specific cytotoxic T lymphocytes (CTLs) against infected cells. CTLs and CD4Th1 cells by killing infected cells and releasing antiviral cytokines control virus replication in infected individuals. Also, the functions of these cells in patients who successfully clear the infection are potentially strong. In contrast to acute self-limited HBV infection in persistent HBV infection, these cells are exhausted. Several studies have showed that the great challenge in clearance of the HBV infection is related to stability of covalently closed circular DNA (cccDNA). cccDNA produce in viral life cycle and remains inside the infected cells for a long time and act as a template for generating new pre-genomic RNA and virus propagation. So far, no antiviral treatment has been effective in the complete elimination of this structure. Prevention of the disease can be achieved by using effective vaccine. Previous studies indicated that neutralizing antibodies against surface antigen of the virus known as S antigen have protective properties. Therefore, a subunit vaccine containing S antigen is available. Currently S antigen is produced in recombinant form and WHO recommended the first dose should be given within a day of birth. Pegylated IFN-γ and nucleotide-nucleoside analogues are effective drugs against HBV infection, but they may have severe side effects. Ineffectiveness of the vaccine on premature infants and immunocompromised people and also drug side effects has made HBV infection a great trouble.
 

Incidence, risk factors and prevention of herpes zoster: review article
Soheila Nasiri Nasiri, Reza Mahmoud Robati , Mehdi Hedayati, Marjan Khazan ,
Volume 77, Issue 1 (April 2019)
Abstract
Herpes zoster (Shingles; Zona) is an acute infectious skin disease that is caused by the reactivation of varicella zoster virus (VZV). After the initial infection (chickenpox) or vaccination, the virus remains inactive or latent in the dorsal root ganglia (DRG); when decreasing cell mediated immunity (CMI) occurs, the virus is reactivated from a latent phase to a lytic phase and frequently replicated in the dorsal ganglion cells then move to the sensory nerves into the skin and causes herpes zoster, which is typically characterized by painful neuralgia and unilateral dermatomal vesicular rash that normally lasts 3 to 5 weeks. The most common complication of herpes zoster is chronic pain owing to postherpetic neuralgia (PHN), which is estimated to occur in approximately 20% of the people aged 50 and over. Although herpes zoster is rarely fatal, the pain related to the acute phase of herpes zoster and subsequent PHN can cause psychological distress, physical disability, impaired sleep and consequently negatively affect the quality of life that can be significantly reduced by all of these occurrences. Due to increasing trend in the incidence of herpes zoster and increasing older people population, it will be expected that herpes zoster and subsequent PHN cause a significant economic burden to the healthcare system, the government, and families along with reducing the quality of life. The average lifetime risk of herpes zoster is estimated to be approximately 30% in developing countries. Although the risk of herpes zoster significantly increases with increasing age and diminished immune system function, any factor impacting on VZV-specific humoral and cellular immune responses may affect the risk of herpes zoster. This paper is provided an overview of the incidence and potential risk factors of herpes zoster with emphasis on the role of micronutrients and their deficiencies in the impaired immune system function. Also, the common method for prevention by zoster vaccine and the role of micronutrients in the efficacy of vaccination are shown.

Optimizing outcome of cesarean hysterectomy by performing placental imaging: a case report
Soheila Aminimoghaddam , Setare Nassiri , Fatemeh Chegini ,
Volume 77, Issue 7 (October 2019)
Abstract
Background: Abnormal placental invasion in pregnancy is one of the most important dilemmas in gynecology and obstetrics medicine and because of the high potential risk of life-threatening massive bleeding, it has been considered as one of the most important causes of maternal morbidity and even mortality. According to the fact that previous cesarean section is the most highlighted and well-known risk factors for developing these types of abnormal placental invasion, and despite comprehensive recommendations for decreeing of this kind of surgery, the rate of caesarian delivery is raising worldwide, detecting the safer methods of management for optimizing the outcome is mandatory.
Case Presentation: In this report, we are discussing a patient in Firoozgar Hospital, Tehran, Iran, with twin pregnancy accompanying with placenta previa with abnormal invasion, which has got the best possible outcome after performing a multidisciplinary approach without any need to blood transfusion or general anesthesia during cesarean hysterectomy as the standard management of placenta increate. In this case, we have performed magnetic resonance imaging (MRI) before surgery. We found out that we can use the exact site of placental margin and the distance between placental margin and uterovesical junction. So we have done the uterine incision horizontally without damaging to the placenta. Generally, Doppler ultrasonography has enough accuracy for detecting all kinds of placenta creates.
Conclusion: By selecting a safe uterine incision, we can prevent such a sudden and massive bleeding during the operation and also avoid occurring end-organ damage due to hemorrhage for instance, acute tubular necrosis, disseminated intravascular coagulation resulted in maternal morbidity and mortality. In this report, we also discuss the points needed for management and treatment of abnormal placental invasion by reviewing the recent literatures.

Presentation of a case with perineal and bartholin gland inflammations as an initial manifestation of acute myeloid leukemia: case report
Soheila Aminimoghaddam , Setare Nassiri , Zeinab Najafi ,
Volume 77, Issue 8 (November 2019)
Abstract
Background: Acute myeloid leukemia (AML) is a malignant hematological disorder which has numerous manifestations at the initial step such as infections and hemorrhagic signs. This is the first report in which the diagnosis of AML was made after managing of Bartholin gland site swelling and pain as the chief complaint of a patient.
Case presentation: Herein, we present a young girl who was referred to us in our tertiary level hospital, Firoozgar Hospital, Tehran, Iran, in october, 2017 just with pain and swelling of the left Bartholin gland. At first, it was suspected to be a cyst or abscess of Bartholin gland, she did not have any history or symptoms of infection on comprehensive physical examinations such as pneumonia, meningitis, Nevertheless, the ultimate diagnosis of AML was made after generalized and precise systemic examination and laboratory findings were done. According to the guidelines for the treatment of AML, systemic chemotherapy with multiple drugs was given immediately but unfortunately, she died due to severe septicemia which was resistant to broad-spectrum antibiotics and disseminated intravascular coagulation.
Conclusion: Based on our searching, this is the first case. Because we expected other more common symptoms of acute lukemia, systematic and precise generalized examination must be performed gently in all of the patients even in women just with genital symptoms as their chief compliant for instance, pain and swelling of Bartholin gland. Finally, not focusing just on the perineal site and detailed examination for all parts of the body may reveal an accurate diagnosis of the main underlying disease.

Predictive factors of deep vein thrombosis in patients admitted to intensive care unit
Hossein Mahjobipoor, Mojtaba Rahimi-Varposhti , Hamidreza Shetabi , Soheila Heidari,
Volume 78, Issue 12 (March 2021)
Abstract
Background: Because deep vein thrombosis (DVT) is one of the most common problems in the intensive care unit, it may lead to complecating the patient's general condition. This study aimed to investigate the predictive factors of DVT in patients admitted to the intensive care unit (ICU) of Amin hospital in Isfahan.
Methods: In this retrospective study, all the records of patients admitted to the ICU ward of Amin Hospital located in Esfahan, from April 2015 to March 2018, were investigated and from all patients with DVT, 20 records were extracted and 40 cases of patients without DVT were also randomly selected. Information such as age, sex, Wells score, Apache score, nutritional status, clinical parameters, cause of hospitalization, length of stay, ICU induced disease and treatment were extracted from these records and compared between both groups with and without DVT.
Results: From 2000 patients admitted to the ICU ward, 20 cases were developed DVT. The age of patients in the DVT group was significantly higher (P=0.008). Factors such as increased Wells score, increased length of stay in the ICU, having ICU induced internal diseases and pneumonia increased the chance of DVT incidence as 18.75, 1.92 and 2.75 and 2.28 times, respectively and the increase of potassium level and use of heparin bandage for treatment reduced the chance of DVT by 2.31 and 2.55 times, respectively (P<0.05).
Conclusion: In the general intensive care unit, the incidence of deep vein thrombosis was higher in internal ward patients. Pneumonia was the most common disease associated with deep vein thrombosis and the risk of deep vein thrombosis was higher in the anemic patient. Patients with upper limited normal levels of potassium were less likely to develop deep vein thrombosis. It seems that potassium in the upper limit of normal reference can play a protective role against deep vein thrombosis. Further studies with larger sample sizes are suggested.

Costs of services covered by the global payment system in Tehran University of Medical Sciences
Jalal Saeedpour , Mehdi Rezaei , Shamsi Ekhteyar, Sara Akhavan Rezayat , Soheila Damiri , Faezeh Fartaj, Maryam Radin Manesh ,
Volume 80, Issue 4 (July 2022)
Abstract
Background: In Iran, a combination of three methods of budget payment, fee for service and case-based payment (known as the global payment system) is used to reimburse the cost of hospital services. The aim of this study was to investigate the costs of 90 services of the Global Hospital Reimbursement System at Tehran University of Medical Sciences.
Methods: This descriptive cross-sectional applied study was performed from March  2017 to March 2019 in the hospitals of Tehran University of Medical Sciences. The billing and record data of all patients whose services were reimbursed on a global payment system basis were extracted from hospital information systems. Data were analyzed using descriptive statistics (frequency mean. std deviation, maximum & minimum) in SPSS 21 and Excel 2016.
Results: During two years in TUMS, the costs of services provided to 143,866 patients have been reimbursed based on the global payment system., which had a cost of 2300 billion rials. 80% of the total services and costs were related to 10 services. 78.46% of the cases were related to two specialized groups of ophthalmology and obstetrics and gynecology. 83.17% of the total costs of services reimbursed globally at the TUMS were related to these two specialized groups. The average cost per service was about 16 million Rials, but varied greatly for different services, ranging from about 1.8 million Rials to 67 million Rials. On average, for a global service, the share of each of the cost subgroups of diagnostic services, hoteling and nursing services, medicine and consumables, operating room and surgery, physician's visit and consultation, respectively 3.1%, 11.6%, 21.4%, 49.9% and 13.9%.
Conclusion: Managers need to focus on high-frequency and high-cost services to reduce the cost and financial losses for services that are under the global payment system. Depending on the specific cost pattern of each service, the strategies adopted to control the costs of that service should also be different.

Real-time tracking of hypoxia glycolysis in conization samples for cervical intraepithelial neoplasia detection
Zohreh Sadat Miripour, Mahsa Faramarzpour, Parisa Aghaee, Elham Shirali , Soheila Sarmadi, Parisa Hoseinpour , Mohammad Abdolahad ,
Volume 80, Issue 10 (January 2023)
Abstract
Background: Although cervical cancer in adult women with early diagnostic tests has better treatment ability and disease management, precise and fast diagnosis of any signs of cervical intraepithelial neoplasia (CIN) I-III and high-risk dysplasia is vital. If any precancerous/abnormal suspicious cells are not detected in the routine diagnostic process (pathology), they cannot be treated before the lesion turns into cervical cancer, consequently help increasing the patient’s survival rate.
Methods: In this clinical study, the efficiency and diagnostic accuracy of the electrochemical measuring device of glycolysis metabolism in cancer cells (HEA: Hypoxia electrochemical assay) on in-vitro human fresh cervical samples were studied. The samples were prepared from 40 candidates of conization through a history of abnormal cell presentation in their pap smear results. The study was conducted at the Gynecology Department, Yas Hospital, Tehran University of Medical Sciences, and assistant hospitals from August 2018 to June 2021. Patients provided consent according to an ethically approved protocol. A CIN-based scoring of HEA responses was proposed by considering the pathology reports of HEA-tested regions.
Results: The diagnostic calibration of the sensor was achieved by comparing the ROS/H2O2 electrochemical current related to cell glycolysis with the presence of cancer cells in the samples' histology. The current diagnostic threshold obtained by the sensor to differentiate cancerous areas from others showed an accuracy of 95% (P<0.0001). The accuracy and sensitivity of the sensor were 95% and 100%, respectively. Therefore, a matched clinical diagnostic classification between the pathological results of tested tissues and the sensor's electrochemical ROS/H2O2 response was proposed based on CIN categorization.
Conclusion: Further pathological evaluation of the tested samples showed that electrochemical detection of glycolysis metabolism in cervical conization specimens could detect 10% of CIN lesions missed by conventional pathology of assayed patients, which was confirmed in the pathology re-examination. Therefore, as a complementary method, it can help better diagnose CIN lesions in the conization.

The role of rectal sparing devices in post-prostatectomy radiotherapy: a review article
Arezoo Mehrabian, Hamed Ghaffari, Soheila Refahi , Mohammad Haghparast , Abolhasan Rezaeyan,
Volume 80, Issue 12 (March 2023)
Abstract

                                                                
Adjuvant or salvage radiotherapy can control biochemical relapse after radical prostatectomy and reduce the risk of distant metastases. Dose-escalated radiotherapy after radical prostatectomy can lead to improved biochemical relapse-free survival. Over the last decades, despite the technological advancements in prostate radiotherapy, radiation-induced rectal toxicity is still the main limiting factor for dose escalation owing to the anatomical proximity of the prostate gland to the rectum. To this end, several rectal sparing devices, including Endorectal balloons (ERBs), prostate-rectum spacers (e.g. SpaceOAR hydrogel), and rectal retractor have been explored to increase the distance between the prostate and the rectum to reduce rectal radiation doses and toxicities. Over the last decade, several studies applied these devices during post-prostatectomy radiotherapy setting. Therefore, the purpose of this review is to evaluate the impact of rectal sparing devices on dose-volume parameters of anorectal, radiation-induced rectal toxicity, and prostate bed motion during post-prostatectomy radiotherapy. The results showed that although using ERBs can lead to stability in the target volume position, it cannot reduce rectal radiation doses, in particular dose to the anterior rectal wall. The application of ERBs can reduce the received dose of the anal wall and increase the geometric reproducibility of the clinical target volume (CTV) position. However, the role of ERBs in reducing the received dose of the rectal wall is still controversial, which can be associated with the displacement of the anterior rectal wall towards the prostate bed (high radiation dose area). The use of SpaceOAR hydrogel can significantly increase the distance between the rectum and the prostate bed and ultimately reduce the dose received by the rectal wall. Also, the use of rectal retractor remarkably reduces rectal radiation doses. The dosimetric and clinical results of the use of SpaceOAR hydrogel and rectal retractor are very promising, and these devices can be used for patients after the necessary evaluations by radiation oncologist in post-prostatectomy radiotherapy. However, further studies will be required to elucidate the efficacy of SpaceOAR hydrogel and rectal retractor in reducing radiotherapy-induced rectal toxicity following post-prostatectomy radiotherapy.

Keywords: prostatectomy, prostate cancer, radiotherapy, rectum.


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