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The serum level of CRP at the first 24h of admission and acute stroke early detection
Reza Ebrahimi Rad, Mohammad Reza Zarbakhsh Bahri , Samira Sarabi ,
Volume 75, Issue 1 (4-2017)
Abstract

Background: Nowadays, stroke can be considered as the one of the major causes of disability and mortality worldwide. However, relationship between serum C-reactive protein (CRP) level with stroke early prognosis has not been well studied, especially in Iran. Therefore, the present study aimed to study the relationship between CRP level of serum in patients with acute stroke at first 24h of admission and stroke early prognosis.

Methods: This prospective cross-sectional study was performed on 50 patients with acute stroke who were admitted at Emergency Ward of Shahid Rajaie Hospital, in Tonekabon City, Iran, between May 2013 to July 2014. In first step, valid clinical diagnosis was made based on CT scan and magnetic resonance imaging (MRI) of the patients. The ethical observations were considered for all patients. The serum level of CRP was measured by standard method, at first 24h of the admission. Clinical information and risk factors (age, gender, type of stroke, high blood pressure, diabetes mellitus) was detected for each patient. On discharge, early prognosis by modified Rankin Scale (mRS) (mRS< 3= good and mRS≥ 3= bad) was also recognized. In this study, statistical analysis was performed using SPSS software, and logistic regression method was used (P< 0.05).

Results: The results of this study showed that 38% of the patients were 70-80 years old. Also, 52% of the patients were male and 48% were female. The serum CRP level of patients at the first 24h of admission increased in all studied patients. The mean of the serum CRP level was 12.82 that were higher than the normal range. The statistical analysis showed that there was no significant relationship between the serum CRP level and the stroke early prognosis.

Conclusion: Although the serum CRP level was not recognized as an anticipator factor for stroke prognosis at this study, it is recommended to performance of more studies by case-study method on this setting.

Estimation of absorbed dose of radiosensitive organs and effective sose in patients underwent abdominopelvic spiral CT scan using impact CT patient dosimetry
Ayoub Amirnia, Parinaz Mehnati , Nasrollah Jabbari ,
Volume 75, Issue 2 (5-2017)
Abstract

Background: Due to the presence of radiosensitive organs in the abdominopelvic region and increasing the number of requests for CT scan examinations, concerns about increasing radiation doses in patients has been greatly elevated. Therefore, the goal of this study was to determine the absorbed dose of radiosensitive organs and the effective dose in patients underwent abdominopelvic CT scan using ImPACT CT patient dosimetry Calculator (version 1.0.4, Imaging Performance Assessment on Computed Tomography, www.impactscan.org).

Methods: This prospective cross-sectional study was conducted in Imam Reza Hospital from November to February 2015 February 2015 in the Imam Reza Hospital, in Urmia, Iran. The demographic and dosimetric information of 100 patients who underwent abdominopelvic CT scan in a 6-slice CT scanner were obtained through the data collection forms. The demographic data of the patients included age, weight, gender, and BMI. The dosimetric parameters included pitch value, CT dose volume index (CTDIvol), dose-length product (DLP), tube voltage, tube current, exposure time, collimation size, scan length, and scan time. To determine the absorbed dose of radiosensitive organs and also the effective dose in patients, ImPACT CT patient dosimetry calculator was used.

Results: The results of this study demonstrated that the mean and standard deviation (SD) of patients' effective dose in abdominopelvic CT scan was 4.927±0.164 mSv. The bladder in both genders had the greatest mean organ dose, which was 64.71±17.15 mGy for men and 77.56±18.48 mGy for women (P<0.001).

Conclusion: The effective dose values of this examination are in the same range as previous studies, as well as International Commission on Radiological Protection (ICRP) recommendations. However, the radiation dose from CT scan has the largest contribution to the medical imaging. According to the ALARA principle, it is recommended that the scan parameters, especially mAs, should be chosen so that the patient dose is minimum, and the image quality is maximum. Furthermore, other imaging modalities are used as an alternative to the CT scan.

Evaluation of the anode heel effect on the testes dose during pelvic radiography
Vahid Karami , Mansour Zabihzadeh , Nasim Shams , Mehrdad Gholami ,
Volume 75, Issue 2 (5-2017)
Abstract

Background: Anode heel effect refers to reduction of radiation intensity in the anode side of X-ray tube. This variation in radiation intensity across the anode-cathode of X-ray tube can be benefited for decrease radiation exposure in some radiological examinations. The aim of this study was to evaluate the effect of anode heel orientation on the radiation dose received by the testes in male patients undergoing pelvic radiography.

Methods: This is a cross-sectional study, conducted at one of the teaching hospitals of Ahvaz, Jundishapur University of Medical Science Ahvaz, Iran, from September 2015 to March 2016. In order to measure the profile of radiation intensity variation, 13 paired sets of high radiosensitive cylindrical lithium fluoride thermo-luminescent dosimeters (TLD) aligned on the cathode-anode central axis upon the table and then irradiated using routine exposure parameters. The anode of X-ray tube was positioned toward the feet for 40 patients and toward the head for 39 patients undergoing pelvic radiography. For measure the entrance skin dose (ESD), 8 TLD chips were located on the central point of the radiation field and 5 TLDs were located on the testes position to measure the dose received.

Results: Radiation intensity profile showed that radiation intensity decrease from the cathode to the anode side. Discrepancy of radiation intensity on central axis of cathode-anode was calculated about 35%. The radiation dose received by the testes was 26.74% lower for patients the anode directed toward the feet, compared to the patients in which the anode directed toward the head (FTC: 1.260±0.296 mGy, FTA: 0.923±0.167 mGy, P<0.05). There was no meaningful difference for the measured ESD of pelvis between two groups of patients (FTC: 1.256±0.315 mGy, FTA: 1.195±0.205 mGy, P=0.788).

Conclusion: In pelvic radiography, positioning of testes directed to the anode of X-ray tube can decrease the receive dose.

Frequency of major and minor risk factors associated with jaundice in hospitalized newborns
Hassan Boskabadi, Maryam Zakerihamidi, Fatemeh Bagheri,
Volume 75, Issue 2 (5-2017)
Abstract

Background: Hyperbilirubinemia is the most common cause for readmission in the early neonatal period 5 to 36 percent of healthy term infants who are discharged from hospital are again hospitalized due to severe to moderate hyperbilirubinemia. Detection of major and minor risk factors associated with neonatal jaundice helps to identify high-risk infants and prevent neonatal jaundice. This study was performed aiming to evaluate the major and minor risk factors associated with jaundice in infants hospitalized.

Methods: This cross-sectional study was performed on 2207 term infants (<15 days) with hyperbilirubinemia (>15 mg/dl) in neonatal clinic or emergency unit or neonatal intensive unit, of Mashhad Ghaem Hospital, Iran, from April 2010 to May 2016. The jaundice of infants was confirmed by the pediatrician and laboratory tests. Then the researcher-made questionnaire containing maternal information and neonatal characteristics was completed. Values were expressed as mean±SD. Student t-test and Mann-Whitney test were used as appropriate. P-value less than 0.05 was considered significant.

Results: Sixty one percent of neonates had major risk factors and 80% of neonates had minor risk factor for jaundice. For neonatal jaundice, the most common major risk factors were significant weight loss (27.5%), jaundice visible in the first 24 hours (16.3%), history of treatment with phototherapy and exchange transfusion in sibling (14.8%), Gestational age of 35 to 36 week (9.9%), ABO incompatibility (9.2%), RH incompatibility (3.3%) and G6PD deficiency (3.33%), and the most common minor risk factors were age over 25 years (51.4%), male (49.7%), history of hyperbilirubinemia in sibling (22.3%), diabetic mother's infants (1.5%).

Conclusion: The major risk factors for neonatal hyperbilirubinemia were significant weight loss, jaundice visible in the first 24 hours, history of treatment with phototherapy and exchange transfusion in sibling, gestational age of 35 to 36 week, ABO incompatibility, RH incompatibility and G6PD deficiency.

Detection of toxigenic bacillus cereus strains in powdered infant formula (PIF) milk by PCR assay
Mohammad Mehdi Soltan Dallal, Shirin Nezamabadi, Jalal Mardaneh, Zahra Rajabi, Abolfazl Sirdani,
Volume 75, Issue 3 (6-2017)
Abstract

Background: In recent years, use of powdered infant formula (PIF) milk for neonates feed is increasing; therefore, the quality control (QC) of PIF products is very important. The aim of present study was detection of toxigenic Bacillus cereus species in PIF milk using PCR assay.

Methods: The cross-sectional study was carried out on 125 samples of powdered infant formula milk (PIF) purchased between March 2015 and April 2016 in Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Briefly, 0.1 dilutions were prepared and inoculated on Bacillus cereus selective media (MYP) and incubated at 30 °C for 24 hours. The suspicious colonies were verified using biochemical tests based on standard methods. Final confirmation of studied isolates was carried out by ITS gene detection using polymerase chain reaction (PCR) assay. Presence of nonhemolytic enterotoxin (NHE) (linked to diarrhoea syndrome) and emetic toxin (EM) (linked to emetic syndrome) virulence genes were investigated using polymerase chain reaction assay. 

Results: In this study, of 125 PIF samples, 84 (67.2%) were contaminated. Of various recovered bacteria from these samples, 110 bacterial isolates were suspected to be Bacillus spp. using phenotypic methods. The ITS PCR results showed that 91.8% of the isolates were B. cereus. Respectively, 53.63 and 79% of B. cereus isolates possessed NHE and EM virulence genes.

Conclusion: Our data revealed that near 80% of Bacillus cereus isolates have emetic toxin (EM) gene, as result virulence potency of this isolates is very high. However, the low number of this organisms in foods is very important and food safety protocols for these opportunistic toxigenic bacteria should be revised. Since the pasteurization process is ineffective on B. cereus spores; therefore, spores can remain in PIF milk and the vegetative bacterial cells can cause food poisoning in neonates. Therefore, modification of foods quality control protocols is essential in order to identify virulence genes in this bacterium.


Determine the burden of myocardial infarction
Kamran Ebrahimi , Shaker Salarilak , Kamal Khadem Vatan ,
Volume 75, Issue 3 (6-2017)
Abstract

Background: Cardiovascular disease (CVD) is the most common cause of death in the world that is mostly due to vascular disease. Myocardial infarction (MI) is the most lethal form of coronary heart disease Which is increasing in developing countries. This study was done to calculate and compare lost years of life due to death and disability for the most important cause of death (myocardial infarction) in the studied population.

Methods: This cross-sectional study was carried out in Urmia university of Medical Sciences in Western Azerbaijan Province, Iran during 2012 to 2013. Confirmation of the occurrence of myocardial Infarction in hospitalized patients was based on clinical symptoms, changes in electrocardiogram and increases of cardiac enzymes (CK-M Band Troponin). The burden of health from Myocardial Infarction was calculated- using the disability adjusted life years index (DALY). The morbidity data of MI was collected from myocardial infarction Registration System Department of Health, and mortality data were extracted based on death registration ICD10 (I 20-25).

Results: The total occurrence of MI was 7235 patients (60.6% men and 39.4% women) with the mean ages of 69±15 years. Number of disability adjusted life years (DALY) caused by MI was 53804 years (17.7 per thousand people) and the portion of early death Years of Life Lost (YLL) due to premature death was 52170 years (17.1 per thousand people), and Years of Life Lost (YLD) due to disability resulting from the disease was 1634 years (0.54 per thousand people). The disease burden in men was more than in women, and the greatest burden was in the age group of 80 and above in both sexes. Prevalence rate of the MI was estimated 376 (Per hundred thousand people) and the MI accounted for 18.8% of all causes of death.

Conclusion: The high burden of myocardial infarction, especially in men, raises the incidence of Myocardial Infarction a health priority and the need for proper planning in order to take effective measures for the prevention and treatment.


Germline mutation at codon 1309 of the adenomatous polyposis coli gene and exteracolonic manifestations in familial adenomatous polyposis
Faegheh Behboudi Farahbakhsh, Hossein Maghsoudi, Hamid Asadzadeh Aghdaei , Ehsan Nazemalhosseini-Mojarad,
Volume 75, Issue 4 (7-2017)
Abstract
Background: Familial adenomatous polyposis (FAP) is the most common components polyposis syndromes. It incidence is for less than 1 percent of colorectal cancer cases. FAP is characterized by germline mutations in the adenomatous polyposis coli (APC) gene. Generally, there are hundreds to thousands of adenomatous polyps in colon and rectum of patients. The aim of the current study was to evaluate the germline mutation at codon 1309 of the APC gene and its association with extracolonic manifestations in Iranian patients with FAP.
Methods: This Cross-sectional study was conducted at the Gastroenterology and Liver Diseases Research Center, Taleghani Hospital, Tehran, Iran from July 2012 to February 2015. In this study, thirty-three patient with FAP was examined. Demographic and clinical data were gathered from patients. In addition, peripheral blood samples were collected to study the most common mutations of the APC gene and bidirectional sequencing was carried out after genomic DNA extraction by salting out method. Primers were designed by GeneRunner version 5.0.4 (http://www.generunner.com). The samples were run on an applied biosystems 3130XL genetic analyzer. The results were analyzed by SPSS software, version 23 (IBM, Armonk, NY, USA).
Results: After analyzing the mutation cluster region (MCR), we have identified five germline mutations with 5bp deletion at codon 1309 of the APC gene (c.3927_3931delAAAGA), that it is equivalent to 15.2% (5.33). This mutation has been known as a small deletion, that it is a variant of frameshift mutation. Mutation at codon 1309 has significant association with clinical and pathological features including the number of polyps (P=0.001), duodenum demonstration (P=0.008), fundic gland polyp (P=0.002) and congenital hypertrophy of the retinal pigment epithelium (P=0.021).
Conclusion: The analysis of the findings has shown that mutation in Codon 1309 of adenomatous polyposis coli gene may be associated with severe polyposis and extracolonic manifestations. In conclusion, there may be a correlation between a specific germline mutation and the extracolonic manifestations.

Interspecies differences of candida species causing recurrent vulvovaginal candidiasis in response to fluconazole treatment
Siamak Naji , Kambiz Diba , Rasoul Yosefzadeh , Fatemeh Mansouri ,
Volume 75, Issue 4 (7-2017)
Abstract
Background: Looking at the increased incidence of recurrent vulvovaginal candidiasis and refractory resulting from such non-albicans Candida species in recent decades, this study was performed aiming the use of rapid biochemical and molecular detection of drug-resistant Candida species in response to fluconazole in patients with vulvovaginal candidiasis and recurrent vulvovaginal candidiasis.
Methods: The cross-sectional study was performed at Kowsar Gynecology Center, Motahhari educational hospital and Medical Mycology Center, Faculty of Medicine, Urmia, Iran, from October 2013 to July 2015. Those patients referred to the clinic with symptoms of vaginal discharge, itching or burning that swab samples from endo-exocervix and distal fornix discharge were taken. The vaginal discharge samples submitted to Medical Mycology Center, Urmia School of Medicine for the direct microscopic examination and cultures. Identification at the level of species was performed using CHROMagar Candida and Corn meal agar media. The molecular test polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) used for confirming culture results. For the susceptibility assay, disc diffusion method was performed with fluconazole and clotrimazole.
Results: In these study 198 samples collected from patients with symptoms of vulvovaginal candidiasis, 77 vulvovaginal candidiasis cases were identified. Candida species are common in primary and recurrent cases in terms of frequency, Candida albicans (85.7%), Candida krusei (10.2%) and Candida glabrata (4.1%) were identified respectively. Total of 27 cases of recurrent vulvovaginal candidiasis, 10 cases were resistant to both clotrimazole and fluconazole (37%) was observed that the most common species are resistant to treatment were Candida albicans by (82.1%), Candida krusei (14.3%) and Candida glabrata (3.6%) respectively. Drug resistance in Candida albicans, Candida krusei and Candida glabrata causing recurrent vulvovaginal candidiasis included 69.1%, 75% and 100% respectively.
Conclusion: Our findings have shown frequency of resistant non-albicans Candida species to fluconazole and clotrimazole is increasing. There is a considerable difference between Candida albicans and non-albicans species, Candida glabrata for the resistance to fluconazole and clotrimazole.

Diagnosis of fungal keratitis in patients with corneal lesions at Amiralmomenin hospital in Rasht, Iran
Rhoghaye Tighnavard Bejarbane , Roshanak Daie Ghazvini , Shahram Mahmoudi , Reza Soltani Moghaddam, Mahin Safara, Heidar Bakhshi , Parivash Kordbacheh ,
Volume 75, Issue 5 (8-2017)
Abstract
Background: Keratomycosis is a fungal infection of the cornea which could be sight-threatening and even causes eye loss. Considering the high humidity and the dominance of agriculture as important predisposing factors of keratomycosis in north of Iran, this study was carried out for diagnosis of fungal keratitis in patients with corneal lesions in Rasht, Gilan province, Iran. 
Methods: This descriptive cross-sectional study was conducted from July 2015 to November 2016 on 56 patients with corneal lesion suspected to keratomycosis and referred to eye emergency ward of Amiralmomenin hospital, Rasht, Iran. Corneal scraping was performed in all cases and specimens were subjected to direct examination and culture. Only colonies grown in sites of corneal scraping inoculation were considered significant. Fungal isolates were identified according to their macroscopic features of colonies and microscopic characteristics in slide cultures. Data were analyzed in SPSS software, version 21 (IBM SPSS, Armonk, NY, USA) and P<0.05 was considered significant.
Results: The patients included 42 (75%) men and 14 (25%) women with the mean age of 49.5 years (9 to 90 years). Positive culture was observed in 9 cases but, only in one of these patients direct examination was positive and fungal elements were seen in 10% KOH preparation. Though, fungal keratitis was confirmed in 9 (16%) patients including seven (77.8%) men and two (22.2%) women. The majority of cases (88.9%) had a history of corneal trauma with plants and they were mainly farmer. According to statistical analysis, there was a significant association between corneal trauma and keratomycosis (P=0.007). The most common etiologic agents were Fusarium spp. (n: 4, 44.4%), followed by Aspergillus flavus (n: 2, 22.2%), Penicillium sp. (n: 1, 11.1%), Acremonium sp. (n: 1, 11.1%), and Cladosporium sp. (n: 1, 11.1%) respectively.
Conclusion: In the presence of sufficient predisposing factors such as corneal injuries caused by plants, keratomycosis could be caused by a variety of fungi. Furthermore, low sensitivity of direct examination in this study, revealed the necessity of culture in diagnosis of keratomycosis.

Measuring the amount of serum albumin in burn patients and the relationship between the burned area and length of hospital stay
Maryam Roham , Mohammad Javad Fatemi , Mitra Niazi , Mahnoush Momeni ,
Volume 75, Issue 5 (8-2017)
Abstract
Background: Albumin is one of the most important proteins in the body by several important functions, it is essential in the maintenance of normal plasma colloid oncotic pressure and is the primary serum binding protein responsible for the transport of various substances in the circulation including fatty acids, hormones, and drugs. Decrease in the amount of serum Albumin (Hypoalbuminemia) is a common finding in the burn patients, but its relationship with mortality is not accurately clear. Our purpose of this study was to measure the amount of Albumin serum in burn patients and find out its relationship between the burned area and length of hospital stay.
Methods: This cross-sectional study was conducted on patients aged over 16 years who referred to the Motahari Hospital of September 2014 to February 2015 in the first 24 hours of their referral. The amount of Albumin was measured in two groups of discharged patients and patients who died while hospitalized, one week after hospital stay and in the time of discharge and death; and its relationship in terms of each other was determined by statistical analysis. We also assessed the relationship between burn and duration of hospital stay with the amount of Albumin on the day of patient’s admission.
Results: This study showed that the average amount of albumin in the group of discharged patients in the time of admission, one week after and during admission was significantly higher than the group of expired patients (P<0.0001). Also there was a significant relation between the burned area and the amount of albumin (P<0.0001). The more the burned area, the less the amount of Albumin. But there was no significant relationship between the amount of albumin with age and length of hospital stay.
Conclusion: Measuring the level of Albumin is one of the yardsticks that can be used for prognosis of recovery or death of burn patients, and its assessment at regular intervals in burn patients is essential.

Estimation of isoform expression of PI3K and FGFR signaling pathway components by transcriptome analysis in bladder cancer
Zahra Ousati Ashtiani , Javad Tavakkoly-Bazzaz , Seyed Alireza Salami , Mohammad Reza Pourmand , Gholamreza Pourmand ,
Volume 75, Issue 6 (9-2017)
Abstract
Background: Aberrant pre-mRNA alternative splicing is a common event in cancer cells. Many abnormally spliced RNA variants have been observed in tumor cells and they can be used as biomarkers or therapeutic targets in new drug design. Increasing our knowledge in understanding the mechanisms of alternative pre-mRNA splicing for cancer-related genes and determination of cancer specific isoforms are important for the development of new strategies in cancer therapy. The aim of this study was isoforms identification and expression of PIK3CA, FGFR3 and FGFR1 genes in bladder cancer by RNA Sequencing and Real-Time PCR.
Methods: This cross-sectional study was conducted at Urology Research Center of Sina Hospital, Tehran University of Medical Sciences, Tehran, from September 2014 to October 2016. Paired tumor and adjacent normal tissues samples were obtained from 30 bladder cancer subjects. Total RNAs were extracted from bladder tumor and normal tissues. Quantitative and qualitative examinations have been done. After quality control, fragmentation of RNAs and cDNA library construction, next-generation RNA sequencing was performed. Resulting raw data were analyzed with different bioinformatics software. Differential expression was confirmed by Real-Time PCR.
Results: RNA sequencing results showed the number of PIK3CA (1 vs 3), FGFR3 (7 vs 6) and FGFR1 (9 vs 12) isoforms and their expression were different in bladder normal tissues in comparison to tumor tissues. Overexpression of PIK3CA gene have been observed in 42% of tumor samples but statistically was not significant. Increased FGFR3 gene (P=0.01) and decreased FGFR1 (P=0.01) expression were significant. There was an association with overexpression of FGFR3 and cigarette smoking ((P=0.037) and family history (P=0.004).
Conclusion: RNA sequencing make possible to do the accurate assessment of transcript abundance and identification of different isoforms resulted from aberrant pre-mRNA alternative splicing, which is a crucial process for the maturation of transcripts of multi-exon genes. Regarding the differences in isoforms expression in tumor and normal tissues of bladder cancer, they have potential to be used as biomarkers and sensitive targets for cancer therapy.

Plasma levels of calcitonin in medullary thyroid carcinoma patients with and without the RET proto-oncogene mutations in exons 10 and 11
Samira Ehyayi , Mehdi Hedayati , Marjan Zarif Yeganeh , Sara Sheikholeslami , Sayed Asadollah Amini,
Volume 75, Issue 6 (9-2017)
Abstract
Background: Thyroid carcinoma is the most common endocrine malignancy and approximately accounts 2% of all cancer cases. Medullary thyroid cancer (MTC) is an endocrine tumor with differentiation of Parafollicular or C-cells and is categorized into hereditary or sporadic types. Medullary thyroid carcinoma approximately accounts for 5-10% of all thyroid carcinoma. Germ-line and somatic mutations in exons 10 and 11 RET (Rearranged during Transfection) proto-oncogene are responsible for the occurrence of the familial and sporadic types, respectively. Calcitonin is a key marker in MTC diagnose and has been demonstrated to be highly sensitive for differential diagnosis prognostic assessment, follow-up and evaluation of MTC treatment. The aim of this study was to investigate the relationship between plasma levels of calcitonin in MTC patients with or without RET mutation.
Methods: In this cross-sectional study, the population consist of MTC patients who have referred to the endocrine and metabolism research center of Shahid Beheshti University of medical sciences since October 2013 till October 2016. Genomic DNA was extracted from peripheral blood leucocytes using the standard salting out/proteinase K method. Nucleotide change detection in exons 10 and 11 was performed using polymerase chain reaction (PCR) and direct DNA sequencing methods. Participants were then divided into two groups with or without mutation (43 individuals in each group). Plasma calcitonin levels were determined by enzyme-linked immunosorbent assay (ELISA) method in both groups.
Results: Evaluation of the level of plasma calcitonin in 43 patients with a molecular mutation in RET proto-oncogene (mean age 31 years) and 43 patients without molecular mutations in RET proto-oncogene (mean age 43 years) were 7.6 pmol/mL and 3.07 pmol/mL respectively. This difference is statistically significant (P=0.0014).
Conclusion: Routine measurement of calcitonin has been investigated as a screening method for the diagnosis of medullary thyroid carcinoma patients. Nevertheless, additional data are required to definitely support routine measurement of calcitonin due to the role of RET proto-oncogene.

Study of death certificates and burial permit with the criteria of the world health organization and the ministry of health and medical education in Tehran during 2013-2014: brief report
Babak Mostafazadeh , Mohammad Hosien Kamaloddini , Fares Najari ,
Volume 75, Issue 6 (9-2017)
Abstract
Background: The death certificate is a document consisting of the deceased individual’s basic information and identification which is filled out, registered and signed by a doctor. the World health organization’s policies in their health planning, provide a suitable database with knowledge of the required elements for planners and other authorized information demanders. During a multi-year cooperation between various organizations, the first uniformed death certificate according the ICD-10 standard got published in the country in the year 2004.
Methods: This is a retrospective study which is about all of the deceased individuals in  Tajrish and Modares Tehran hospitals from april 2013 until the march 2014 who had death certificates. In this study the data related to 777 individual’s death certificates and medical files was analyzed. The sampling method was census and all the cases in the study’s time period who had death certificates were studied. The cases that had a gap in their required information were ruled out of the study. The data that included age, sex, place of death, issuing doctor’s expertise, general information and the cause of death was extracted from the archived files.
Results: The cases studied, 421 people died in Tajrish Hospital and 356 in Modarres Hospital. The highest number of deaths in both hospitals were in the internal wards (336 cases) and surgery (168 people). 45.6% of death certificates have been issued by a forensic expert. 64.8% cases correctly inserted ICD-10 code.
Conclusion: Training of physicians for the importance of death certificate and how it should be completed is very important. This research showed that in the cases which the death certificates were completed by the hospital forensic medicine specialists were more useful and accurate.

Common mutations assay of KRAS and BRAF genes in patients affected with Head and neck squamous cell carcinoma (HNSCC)
Razieh Zarifian Yeganeh , Abbas Shakoori Garakani , Saman Mehrabi , Nader Ebadi, Maziar Motiee Langroudi , Mohammad Reza Noori Daloii,
Volume 75, Issue 7 (10-2017)
Abstract
Background: Head and neck squamous cell carcinoma (HNSCC) is the malignancy of squamous cells (the epidermal layer of skin) in cavities in head and neck includes: larynx, pharynx, paranasal sinuses and oral cavity. The main goal of this research was to understand the effect of mutations in two important genes (KRAS and BRAF) in RAS/MAP kinase (EGFR) signaling pathway in tumor cells with head and neck squamous cell carcinoma in Iran.
Methods: The present cross-sectional study performed from October 2015 to September 2016 on 40 patients suffering from head and neck squamous cell carcinoma, all confirmed by pathology department of Imam Khomeini hospital. Tumor samples were achieved from the surgical cancer department of Imam Khomeini hospital and stored in liquid nitrogen until starting tests. The tests done in genetic laboratory of Tehran University of Medical Sciences. Techniques we used in this research, were DNA extraction based on phenol-chloroform approach, Multiplex PCR (M-PCR) to amplify mentioned exons and KRAS/BRAF strip assays to detect mutations in mutated hotspots in exon 2 of KRAS and codon V600E in BRAF gene.
Results: In this study, we observed 7 mutations in codons 12 and 13 exon 2 in KRAS gene (about 17.5%) and 4 mutations in codon V600E in BRAF gene (about 10%) of obtained tumor samples. The hotspot mutation in codon 12 were Asp (10%) and Ser (5%) respectively. In BRAF, the most common mutation, as we expected according to other researches, was observed in codon V600E. We also observed that 29 people of these patients were male (about 72.5%) and 11 patients were female (about 27.5%). Moreover, 28 patients were over 50 years, while 7 patients were below the age of 50.
Conclusion: The results of this study showed that mutations in genes KRAS and BRAF especially in studied hotspots, and the effects on their molecules in EGFR signaling pathway are important in involving head and neck squamous cell carcinoma, as other cancers. These findings may be considered in choosing drugs for targeted chemotherapy.

Estimation and assessment of the effective doses for radiosensitive organs in women undergoing chest CT scans with or without automatic exposure control system
Daryoush Khorramian , Soroush Sistani , Amin Banaei , Salar Bijari ,
Volume 75, Issue 7 (10-2017)
Abstract
Background: There are several techniques for reducing the delivered dose from CT (Computed tomography) scanning such as the automatic exposure control (AEC). This technique modulates the tube current regarding the patient size and weight. The aim of this study was to estimate the effect of the AEC on the radiosensitive organs effective doses in women undergoing chest CT scanning.
Methods: This study was a cross-sectional, analytical and quantitative study that was performed during 3 months in the imaging section of the Firoozgar educational and therapeutic hospital (belonging to Shahid Beheshti University of Medical Sciences) in the spring of 2017. CT scan exposure parameters were gathered and registered for 54 women undergoing chest CT scan. 25 of these scans were performed using AEC system and 29 of them were performed without using AEC. CT dose indexes in the center and peripheral regions of the standard phantom were calculated using the exposure parameters. Weighted CT dose index was also calculated and effective organ doses were obtained using CT-Expo software, version 2 (Medizinische Hochschule, Hannover, Germany) for two mentioned groups. In addition, noise was measured for these two groups as an image quality parameter.
Results: Calculated weighted CT dose indexes were 9.94 mGy and 12.46 mGy using AEC system and without using AEC, respectively. The calculated effective doses were equal to 5.4 mSv and 6.3 mSv using AEC and without using AEC, respectively. Maximum organ effective doses were 15, 14, 14 and 14 mSv for breast, esophagus, lung and thymus respectively in the non-using AEC system imaging technique.
Conclusion: Our measurements indicated a decrease about 15% in weighted CT dose index (from 12.46 to 9.94 mGy) using AEC system. Beside of this fact, the noise increased about 11.3% (from 4.2 to 4.74) using AEC system. So, it can be said that using of AEC was an effective way for dose reduction in women undergoing chest CT scanning, and the additional noise was in the acceptable range.

Molecular identification of candida species isolated from women with vulvovaginal candidiasis: brief report
Maryam Khanmohamadi , Amir Seyed Ali Mehbod , Mojtaba Noraeepour , Mojtaba Didehdar ,
Volume 75, Issue 7 (10-2017)
Abstract
Background: Vulvovaginal candidiasis (VVC) is a common infection, affecting up to 75% of women during their lifetimes. Approximately 5% of patients may experience recurrent VVC. Candida albicans is the most common causative agent of VVC. The objectives of this study were identification of candida species isolated of women with vulvovaginal candidiasis by molecular method in Arak city.
Methods: In this descriptive cross-sectional study, between Jun 2015 to March 2016 from 210 patients with vulvovaginal candidiasis referred to gynecology and obstetrics clinics in Arak city, Iran. Vaginal sampling was performed by wet sterile swabs. Samples were collected from vaginal discharge, vaginal posterior fornix, and sides of the vaginal wall. The swabs were investigated for direct exam and cultured on Sabouraud’s dextrose agar medium contain chloramphenicol. Yeast isolates DNA were identified by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Fungal genomic DNA was extracted from each isolate colony, glass bead method and after amplification of ITS1-ITS4 region with PCR assay, digested by MSP I restriction enzyme.
Results: From 210 patients with vulvovaginitis, 95 (45.2%) patients showed VVC. These patients were positive for Candida growth in culture and were infected with one Candida species. The age range of women with vulvovaginitis was between 14-60 years and the most VVC cases were in age group of 21-30 years. The most common Candida species isolated were Candida. albicans (70.5%), C. glabrata (20%), C. tropicalis (7.4%) and C. parapsilosis (2.1%).
Conclusion: Regarding to the results of this study, C. albicans was the most common Candida species, isolated from patients with vulvovaginal candidiasis and approximately 30% of this infection causing by non-albicans species of Candida.

The incidence of major cardiovascular events relied coronary vessels after angioplasty and stent types complications
Siros Norozi , Alireza Rai , Ebrahim Salimi , Hamed Tavan ,
Volume 75, Issue 10 (1-2018)
Abstract
Background: Cardiovascular diseases alone have become the leading cause of death worldwide. One of the treatment methods cardiovascular disease is angioplasty. This study aimed to investigate the clinical results after coronary artery angioplasty, based on the incidence of major cardiovascular events with emphasis on stent types.
Methods: In this retrospective cross-sectional study, the prevalence of risk factors (age, history of previous illness and previous surgery) was assessed by using a case file for patients undergoing coronary angioplasty and stent placement during the years 2006 to 2016 and found during the follow-up. The place of the study was the Imam Ali Hospital's educational center affiliated to Kermanshah University of Medical Sciences, Iran, from July to September 2017.
Results: In this study, 1188 patients undergone to stent containing 909 non-drug stents, 504 sirolimus-eluting stents and 316 paclitaxel-eluting stents. Patients were followed-up one to five years. During follow-up, 98 patients involved major cardiovascular events, 6 cases involved with death and 91 patients involved with myocardial infarction. 1729 of patients undergone angioplasty and during follow-up, 91 patients had stent restenosis. In this study stent restenosis showed the highest correlation with the incidence of major cardiovascular events. With a view to stent type in lesions with stent restenosis, 61.7% was in non-drug stent, 23.5% was in paclitaxel-eluting stent and 14.8% was in sirolimus-eluting stent. This study also showed that despite the superiority of sirolimus-stained stents, there was no difference between paclitaxel-stained stents and non-drug stents in clinical outcomes and restenosis.
Conclusion: The results showed that the syringes impregnated with sirolimus have better quality. Also, stents that have a smaller diameter or need dilatation in the procedure have a worse prognosis and cause more complications in the patient.

Evaluation of serum hepatitis A virus antibodies in patients aged 6 months to 10 years
Alireza Yousefi , Mohammad Sobhani Shahmirzadi , Mohammad Ali Vakili , Maryam Kochaki , Kambiz Eftekhari,
Volume 75, Issue 11 (2-2018)
Abstract
Background: Hepatitis A is one of the most common viral infections in the world. In children, the manifestations of infection are usually milder but in adults they are more severe. The risk of acute hepatic failure increases when the infection occurred in the older ages. The aim of the study was to evaluate of serum hepatitis A antibodies in children.
Methods: This cross-sectional study was performed on two hundred children (two groups of hundred individuals each) aged 6 months to 10 years old hospitalized in the emergency department of Taleghani Hospital (Gorgan city) from May to July 2016. The first group aged 6 months to 3 years and the second group 3 to 10 years old. After obtaining the parental consent, 3 ml of blood sample were taken to determine immunoglobulin M (IgM) against HAV using commercial ELISA kits (Dia.Pro Diagnostic, Milano, Italy) and the children’s’ demographic data were recorded.
Results: The study was conducted on two hundred children. Of these patients 127 (63.5 percent) were boys and 73 (36.5 percent) girls. Overall, 11 percent [twenty-two patients including eight (8 percent) in the first group and Thirteen (13 percent) in the second group] were serologically positive for hepatitis A. There was no significant difference between the groups in terms of age and sex. (P= 0.239) and (P= 0.535). Only 11 percent of children under 10 years old were infected by hepatitis A and 89 percent of children had no history of contact or infection.
Conclusion: Based on this study, the incidence of hepatitis A infection was about 11% in children under 10 years old, which indicates a reduction in exposure with this virus. It may seem reasonable based on health policy but the adverse effect of this trend is later probability of contacts with Hepatitis A patients and occurrence of HAV in older ages. Therefore, we can conclude that HAV infection has been shifted to older ages.

Identification of Candida species by molecular and mycological methods in pregnant women with vulvovaginal candidiasis
Nahid Arefi Lisar , Parivash Kordbacheh , Sasan Rezaie , Mahin Safara , Roshanak Daie Ghazvini , Heidar Bakhshi , Zahra Omidvar Jalali ,
Volume 75, Issue 12 (3-2018)
Abstract
Background: Vaginal candidiasis is common in during pregnancy. It may lead to complications like abortions, premature birth, low birth weight, chorioamnionitis and fungal systemic neonatal infection. The aim of present study was identification of Candida species by mycological and molecular methods in pregnant women with vaginal candidiasis.
Methods: This cross-sectional study was performed on 80 pregnant women with or without clinical symptoms of vulvovaginal candidiasis referred to Shahid Noorani Talesh Hospital, Gilan University of Medical Sciences, Iran, from April to December 2015 (8 months). All specimens were examined by direct microscopy and culture on CHROMagar Candida medium for isolation and differentiation of major clinical-significant Candida species (spp.). Cultured media were incubated at 35 °C for 48 hours and evaluated based on color and number of grown colonies. If no growth was observed, the media were incubated for several additional days. Subcultures were done on Sabouraud dextrose agar (Merck, Germany) and Corn meal agar with Tween 80 media (Micromedia, Hungary) for further study. Identification of Candida spp. carried out by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method.
Results: In this study, vulvovaginal candidiasis was observed in 20 (25%) patients. Twenty-two isolates were obtained from culture of specimens on CHROMagar Candida medium (Paris, France). The most common isolated species was Candida albicans 16 (72.8%) and followed by Candida glabrata 5 (22.7%), Candida tropicalis 3 (13.6%) and Candida krusei 1 (4.5%) cases. Two patients had mixed infection with 2 different Candida species (C. albicans and C. glabrata) While using PCR-RFLP method, the Candida species were identified as 13 (59.1%) Candida albicans, 5 (22.7%) Candida glabra, 3 (13.6%) Candida tropicalis and 1 (4.5%) Candida krusei cases, respectively. In direct examination were seen yeast budding cells and pseudohyphae in 8 culture positive specimens. In the present study, results of conventional mycological method in differentiation of Candida spp. were consistent with molecular results in 80% of cases. There was also significant correlation between vulvovaginal candidiasis with clinical symptoms (P<0.0001), including diabetes mellitus (P<0.014), and taking antibacterial drugs (P<0.003) in pregnant women.
Conclusion: PCR-RFLP was able to identify correctly the Candida spp. as a complementary method.

The prospective validation of EuroSCORE II risk scoring system for patients underwent cardiac surgery: brief report
Alireza Atashi , Shahram Amini , Erfan Ghasemi , Shima Sheybani , Saeid Eslami ,
Volume 76, Issue 4 (7-2018)
Abstract
Background: Various prediction models have been developed aiming to estimate risk-adjusted mortality, morbidity and length of intensive care unit stay following cardiac surgeries. The European system for cardiac operative risk evaluation II (EuroSCORE II) is a prediction model which maps 18 predictors to a 30-day post-operative risk of death. The objective of this study was to evaluate the performance of the EuroSCORE II risk-analysis predictions among patients who underwent heart surgeries.
Methods: A prospective cross-sectional study was conducted to collect required variables for all consecutive patients underwent heart surgeries in Emam Reza hospital, Mashhad, Iran, from March 2014 to March 2015. Once the patient was hospitalized a cardiologist or a general physician evaluated pre- peri- and post-operative state to fill out the pre-designed structural paper form. Comparing the observed and expected mortality, the sensitivity, specificity, area under the receiver operating characteristic curve (AUC) and finally the discrimination power of the model for our patients were calculated and reported. The model value was calculated using the online tool.
Results: A total of 1337 patients (60% males) were included, the observed mortality rate was 3.2%. Although the overall performance was acceptable, the model showed poor discriminatory power (AUC=0.667, CI 95%: 0.648-0.685) and accuracy with sensitivity=61.88% and specificity=66.23%.
Conclusion: Our single-center study, based on consecutive patients who underwent cardiac surgery showed that EuroSCORE II demonstrated a moderate statistical overall performance with poor discrimination and calibration measures remain as concerning issues regarding 30-day post-operative mortality prediction after adult cardiac surgery. Poor performance measures for this system show the need for reformulating this risk stratification tool aiming to improve post cardiac surgery outcome predictions in Iran.

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