Tehran University Medical Journal

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Background: In 2-4% of couples in fertile ages, recurrent pregnancy loss (RPL) occurs which consisted one out of 300 pregnancies. The aim of this study was to comparison insulin resistance (IR) in patients with RPL to normal individuals.
Materials and Methods: In a case-controlled, prospective study, 49 non-pregnant, non-diabetic women with early RPL as the case group and 49 non-pregnant, non-diabetic women without RPL who had at least one live infant as the control group, and were matched by age, weight, and height, were enrolled. In both groups fasting insulin and glucose levels were measured and insulin resistance, which was defined as a fasting insulin (FI) level ≥20 microU/mL or a fasting glucose to insulin ratio (FGI ratio) of <4.5, was calculated.
Results: The RPL and control groups were similar with respect to age, BMI, fasting glucose levels and glucose to insulin ratios. FI was significantly higher in RPL group than control group (15.20±5.82 vs. 12.23±5.64 microU/mL). Also the frequency of patients with high FI (FI≥20µU/ml) in RPL group was significantly higher than in control group (22.45% vs. 6.12%, Odds Ratio=4.44, Confidence Interval 95%=1.15-17.07). Among the RPL group, 24.49% demonstrated insulin resistance, whereas only 8.16% of the matched controls were insulin resistant (Odds Ratio=3.65, Confidence Interval 95%=1.08-12.26). The RPL and control groups had similar in frequency of low FGI ratio. Also there was no significant difference between mean of FGI ratio in patients with fewer than 12 weeks miscarriage compared to over 12 weeks in RPL group.
Conclusion: Women with RPL have a significantly increased prevalence of insulin resistance when compared with matched fertile controls. It's recommended that in all women with RPL the glucose and insulin measurement should be carried.

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Background: coronary artery disease (CAD) is one of the most important causes of mortality around the world. The mortality rate in acute myocardial infarction is about 30%. CAD risk factors change with time and there are very few studies in this field in Iran. These changes may be due to bio-environmental conditions. In this study our objective was to track these changes during a ten years period.

Methods: This study was done in three general hospitals of Tehran University of medical sciences on patients with first acute myocardial infarction (AMI) in years 1371 and 1381. Demographic and specific data were obtained from patient data sheets. Comparison of means was done by t-test and prevalence of risk factors by chi-square test.

Results: Two hundred fifty eight patients in 1371 and 289 patients in 1381 were admitted to three university hospitals due to acute myocardial infarction for the first time. The mean age of women with AMI decreased 4 years (P=0.022). No significant change was seen in other coronary risk factors. We also observed a significant increase in prevalence of myocardial infarction in women with three risk factors (P=0.01).

Conclusion: We found no significant change in the age of male patients and in the CAD risk factors in 1371 and 1381. Mean age of occurrence of AMI in female shows a four-year decrease during this period. More studies are needed to find reasons for this change.

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Background: Anti-dsDNA antibodies frequently found in the sera Systemic Lupus Erythematosus patients, particularly in active disease stage. Nowadays exploit different eukaryotic and prokaryotic dsDNA as antigen source and different reagents as binder. The aim of this study to compared two dsDNA different sources and tow different kinds of reagents for binder in ELISA test.

Methods: In this study bacterial genomic DNA from E.coli (ATCC 25922) and genomic DNA from calf thymus extracted with high purity and were used as antigens for IgG anti-dsDNA detection by ELISA. To coat dsDNA in microtiter wells, tow different kinds of reagents including methylated -BSA and poly-l-lysine (for pre-coating) are used. Sera from systemic lupus erythematosus patients and from normal blood donors are used to assess sensitivity and specificity of our ELISA test in compared with IF test and commercial kits.

Results: Our results displayed pre-coating of microtiter plates with methylated -BSA reduce nonspecific binding reaction and the relative sensitivity and specificity of ELISA increased when calf thymus DNA is employed as antigenic source in compared with IF test and commercial kits 80%, 88% and 100%, 98% respectively, but when E.coli DNA is used 73%, 69% and 85%, 79%, respectively.

Conclusion: The genomic DNA from calf thymus is a potentially useful source of antigen for detection of anti-dsDNA by ELISA. Also the use of methylatted- BSA could have an effective role in reducing of nonspecific binding reactions.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: During recent three decades, parallel to the improvement of arthroscopic techniques, intra-articular block by direct injection of anesthetics into the joint has been used in knee arthroscopy. In this study the efficacy of intra- articular block by complex of bupivacaine, lidocaine and adrenaline in knee arthroscopy has been assessed.
Methods: Forty one healthy adults (age range: 18-55 years) with knee problems selected for diagnostic arthroscopy. Anesthesia was induced by direct injection of 10ml 2% bupivacaine, 10ml 0.5% lidocaine plus 1/100000 adrenaline into the knee joint.  Duration of operation and volume of serum used for irrigation during the procedure pain and analgesics requirement, during and after arthroscopy VAS (Visual Analogue Scale) score, at time of discharge from recovery and also patient's and surgeon's satisfaction were assessed.
Results: Sixty eight percent and 29% of cases reported mild and moderate degree of pain perception during arthroscopy, respectively, and only one case for which general anesthesia was performed, reported severe pain. VAS mean was 2.78. Seventy eight percent of cases and the surgeon in 80% of procedures had excellent or good satisfaction with intra-articular block.
Conclusions: Considering high level of satisfaction in both patients and surgeon and mean of VAS, complications of other modalities of anesthesisa and simplicity of the technique, intra-articular block can be used as an easy, safe and efficient method for knee arthroscopy.

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Background: Increased rate of oxidative stress have important role in diabetic nephropathy. Oxidative stress induces the synthesis of antioxidant enzymes. One of them, Extracellular- SOD (EC–SOD) is a major anti-oxidative enzyme and the only one that neutralizes superoxide ion, a precursor of reactive oxygen species (ROS). The aim of this study was to evaluate the correlation between diabetes- associated oxidative stress and antioxidative defense in macroalbuminuric type 2 diabetic patients.

Methods: One hundred and thirty three patients (74 women, 59 men) with type 2 diabetes were studied during 1385-86. According to level of urinary protein, two groups of patients normoalbuminuric (urinary protein excertion below 30mg/24h) and macroalbuminuric (urinary protein excretion more than 300mg/24) were recognized. In each group serum level of oxidized- LDL and EC-SOD were measured.

Results: The mean age of patients and the mean duration of diabetes was 59.09±8.26 years and 137.92±65.91 months, respectively. The plasma oxidized-LDL level and extracellular- superoxide dimutase level were significantly higher in macroalbuminuric than normoalbuminuric group (88.57±33.36 versus 78.24±27.59u/l, p=0.039 for oxidized-LDL and 87.60±21.18 versus 76.25±16.25mu/l, p<0.001 for EC-SOD). Oxidized- LDL was significantly correlated to EC-SOD in macroalbuminuric patients (r=0.425, p<0.0001). Oxidized-LDL and EC-SOD does not correlate to Fasting Plasma Glucose and HbA1c in each two groups.
Conclusion: The significantly elevated plasma oxidized-LDL in patients with macroalbuminuria suggests that, oxidized-LDL may play an important role in the progression of diabetic nephropathy. Besides severity of oxidative stress in macroalbuminuic patients, increase level of EC-SOD enzyme could be a compensatory mechanism to prevent tissue damage.

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Background: Behcet’s disease (BD) is a multisystemic inflammatory disease with unknown origin characterized by recurrent oral aphtous ulcers, genital, ocular and skin lesions. A single point mutation 1691G to A in the factor V gene increases the risk of venous thrombosis. This study designed to determine factor V Leiden mutation in Behcet’s disease, and to find out it's relationship with the clinical manifestations in Khuzestan province, Iran. Methods: One hundred patients with Behcet's Disease (44 males and 56 females) based on international diagnostic criteria and 70 healthy subjects were included in the study.Patients and controls were tested for the presence of factor V Leiden mutation using polymerase chain reaction method. Results: The prevalence of factor V Leiden mutation was significantly higher in BD (10 out of 100, 10%) compared with healthy control subjects (1 out of 70, 1.4%), (p=0.025). Vascular lesions in this study were deep vein thrombosis (DVT) (7%), subcutaneous thrombophlebitis (5%), stroke (1%) and retinal vasculitis (39%). It was found that there was no association between venous thrombosis and the factor V Leiden mutation in Khuzestanian patients. Also, no association between other vascular lesions and the factor V Leiden mutation was recognized. On the other hand there was a significant association between DVT and anterior uveitis (p=0.033). Conclusion: In this study we did not find any association between clinical manifestations in BD patients and factor V Leiden mutation in Khuzestan province, Iran but in BD patients with DVT, factor V Leiden mutation might be a risk factor for the development of anterior uveitis.

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Background: Coarctation of aorta is narrowing of proximal descending aorta. Interventional procedures such as balloon angioplasty & stent implantation has been progressively in use as alternatives for surgery in increasing number of children with diagnosis of coarctation of aorta. The aim of this study was to evaluate the use of endovascular stent in children with coarctation of aorta.

Methods: We evaluated effectiveness and safety of stenting in all patients younger than 18 years old with coarctation and re-coarctation of aorta which treated by stenting between years 2004-9 at rajaei - heart centre in Tehran, Iran.

Results: we studied 53 patients younger than 18 years old with a follow up of six months. Totally 54 stents were implanted. Mean (±SD) age of the patients was 11.6±4.2yrs. Seventeen cases (32%) were younger than 10 years old, and 36 cases (68%) were 10 years and older. Mean (±SD) weight was 39.24±18kg. 16 cases weighting less than 25kg. Peak systolic pressure gradient (SPG) decreased from 46.26±17.07 to 1.03±0.19mmHg after procedure (p<0.001). There was no significant difference (p<0.001) in the gradient before and after stenting in the patients with native coarctation (Vs re-coarctation cases), less than 25 kg and under 10 years old groups. Complications developed in 44% of cases while dominantly were minor except in two cases re-dilatation of stent was not needed during six month of follow-up of the patients.

Conclusions: Stenting of coarctation of aorta can decrease complications and can be used safely in children weighing bellow 25kg and in children below 10yrs old.

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Background: Female genital tract sarcomas are rare but most aggressive tumors of mesodermal origin. Little is known about the pathogenesis, risk factors, optimal treatment and outcome of these diseases. Therefore, we aimed to evaluate the clinicopathologic characteristics of patients with genital sarcoma.

Methods: This is a retrospective, cross-sectional study. The medical records of 43 female patients with genital tract sarcoma, hospitalized during a 16-year period (from 1991-2007) were retrieved from the medical records office of Ghaem Hospital in Mashad, Iran. The demographic data extracted from the records.

Results: The mean age of the patients was 46.95 years (ranging from 3-77 years). The chief complaint of the patients was abnormal vaginal bleeding (69.8%). The mean interval between the onset of symptom to the pathological diagnosis of sarcoma was 8.53 months (ranging from 1-36 months). Histologically, the tumors included: leiomyosarcoma (79.1%), endometrial stromal sarcoma (18.6%) and embryonal rhabdomyosarcoma (2.3%). Three patients (7%) were in International Federation of Gynecology and Obstetrics (FIGO) stage I, 20(46.5%) in stage II, 6(14%) in stage III and 14(32.6%) in stage IV. 48.8% of the patients had undergone chemoradiotherapy.

Conclusions: In most cases, our patients were referred so late or the disease was recognized very late due to being rare. We should consider this disease for every patient with unusual vaginal bleeding especially in post menopause women who their sonography has reported uterine mass.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Breast cancer is the most common form of hereditary cancer worldwide and is an important cause of morbidity and mortality. Approximately 5-10% of breast and ovarian cancers are due to the highly penetrating germline mutations in cancer predisposing genes. Two genes, BRCA1 and BRCA2, account for at least half of these cases. The demand for BRCA1 and BRCA2 mutation screening is rapidly increasing as their identification will affect the medical management of people at increased risk for the disease. Therefore, the aim of this study was to investigate BRCA1/2 mutations in 100 high risk Iranian families.
Methods:  One hundred families who met the minimal risk factors for breast/ovarian cancer were screened among the families referred to Kawsar Human Genetics Research Center for the diseases in 2009-2011. The entire coding sequences and each intron/exon boundaries of BRCA1/2 genes were screened for by direct sequencing and MLPA in both patients and the controls.
Results:  In the present study, we could detect the following novel mutations: p.Gly1140Ser, p.Ile26Val, p.Leu1418X, p.Glu23Gln, p.Leu3X, p.Asn1403His, p.Asn1403Asp, p.Lys581X, p.Pro938Arg, p.Thr77Arg, p.Leu6Val, p.Arg7Cys, p.Leu15Ile, p.Ser177Thr, IVS7+83(-TT), IVS8 -70(-CATT), IVS2+9(G>C), IVS1-20(G>A), IVS1-8(A>G), p.Met1Ile, IVS2+24(A>G), IVS5-8 (A>G), IVS2(35-39)TTcctatGAT, IVS13+9 G>C in BRCA1 and p.Glu1391Gly, p. Val1852Ile, IVS6-70(T>G), 1994-1995 (InsA) in BRCA2.
Conclusion: Ten mutations seemed to be pathogenic and the disease-causing mutations were seen in 16% of the families. In addition, from the total number of substitutions and reassortments (42), 80% related to BRCA1 and 20% to mutations in BRCA2 genes.

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Background: The purpose of this study was to determine the prevalence and associated factors for postoperative pulmonary complications (PPCs) and extubation failure in patients having undergone intracranial surgery.

Methods: In this retrospective study done in Firozgar Hospital during 2008-2010, we followed up 254 patients through a clinical questionnaire and observation of the clinical course of participants in pre- and post-operative periods.

Results: Overall, 40 (15.74%) patients had postoperative pulmonary complications. The most common PPC was pneumonia, which was seen in 24 patients (60% of complications). The average duration of ventilation in patients with PPC was significantly higher (16.8.±10 vs. 5.09±4.5 days P=0.001) than patients without the complication. The mean Glasgow coma scale (GCS) after surgery in patients with PPC was significantly lower (11.±4 vs. 13.2±3 P=0.001) than the rest of the patients. Moreover, the mean age of patients with PPC was significantly higher (64.02±14 vs. 41.6.±17 years P=0.001). Average duration of stay in ICU in patients with PPC was also higher (24.±27 vs. 8.7±0.5 P=0.001).

Conclusion: GCS before surgery and failed extubation independently of other variables were significantly associated with pulmonary complications independent of other variables.

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Background: Influenza viruses are one of the most important etiological agents of res-piratory disease in humans and cause epidemics and pandemics with substantial mor-bidity and mortality worldwide. Vaccination and antiviral treatments are the sole and essential way for the prevention and control of influenza infection. During an influenza epidemic before the production of effective vaccine, antiviral treatments are the first step for the prevention and treatment of influenza infection. Adamantanes and neuraminidase inhibitors are influenza antiviral drugs. Because of the increase of drug resistant viruses, the aim of this study was the evaluation of the antiviral drug resistance in influenza A/H3N2 viruses from 2005-2013 in Iran. Methods: In this study 50 influenza A/H3N2 viruses isolated in cell culture were tested. All samples were subjected to M and NA gene sequencing at the National Influenza Center, School of Public Health, Tehran University of Medical Sciences. RNA was ex-tracted from 200 µl of cell culture supernatants using the Roche high pure viral nucleic acid kit. RT-PCR with the Qiagen one step RT-PCR kit was done. The expected size of the PCR products were analyzed by electrophoresis using 1% agarose gels. The PCR products were sequenced for finding the drug resistant mutants. Results: All influenza A/H3N2 viruses except four viruses circulating during 2005-2006 had Ser31Asn mutation at M2 channel protein. In the analysis of neuraminidase gene none of the A/H3N2 viruses had K292R, E119V and N294S mutations responsible for drug resistant strains. Conclusion: This study showed circulating A/H3N2 viruses was resistant to adaman-tanes but susceptible to neuraminidase inhibitors. The national data analyzed in this re-search may help increase knowledge about influenza virus antiviral drug resistance, which is a global public health concern. The authors suggested continuing this study and also the investigation of antiviral drug resistance of influenza A/H1N1 and B viruses.

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Background: The effects of consumption of nutrients on coronary artery disease (CAD) are widely observed. The aim of this study is to assess the exclusive Iranian dietary pattern on coronary artery diseases (CAD) and its risk factors. Methods: In this description-cross sectional study, 801 inhabitants of Borujerd City were included by random stratification method and a questionnaire regarding micro- and macronutrients for subjects over 35 years old from March 2011 to February 2012 was filed out. Of all the subjects consent to participate were prepared by volunteers. The complete description and a standard questionnaire to record demographic and socioeconomic status of people were taken. The prevalence of coronary artery disease and its risk factors determined Based on rose questionnaire and Monica questionnaire respectively. Results: In this study mean age of the subjects were 54.8±1.2 years, 388 male and 413 female. There was no meaningful relation between red meat consumption and coronary artery disease (P= 0.117). Nut consumption was higher in patients with CAD (P= 0.028). Use of fresh and cooked vegetables, dried fruit, animal oils cakes, french fries and some dairies are correlated with CAD (P< 0.05). However, artificially flavored soda in contrast to ordinary soda was not associated with coronary artery disease. Conclusion: Although there are some differences between dietary pattern in patient with coronary artery disease, nutritional attitudes are not significantly different in normal and CAD patients. However, according to the importance of diet in CAD, balancing these attitudes should be on the educational system high priority.

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Background: The relationship of the base of appendix to the cecum remains constant, whereas the tip can be found in a retrocecal, pelvic, subcecal, preileal, or right pericolic position. These anatomic considerations have significant clinical importance in the context of acute appendicitis. The knowledge about the correct anatomical position of appendix may facilitate in generating an accurate diagnosis of appendicitis as well as assist in achieving a better prognosis and early treatment. The present study aimed to determine the anatomical location of the appendix in Iranian cadavers. Methods: This descriptive cross-sectional study was conducted on 200 cadavers who were referred to the Forensic Center of Tehran from March to September 2013. The data including age, sex, weight, and appendix length and position were collected and analyzed using SPSS software, version 16 (SPSS, Inc., Chicago, IL, USA). Results: In the present study, 200 cadavers were evaluated accidentally, of which 173 (86.5%) were males and 26 (13%) were females, and the mean age was 39.96 years±16.31 (SD). The mean wall thickness of the appendix was 9.78 cm±16.31 (SD). The mean appendix length was 9.86 cm±1.79 (SD) in men and 9.30 cm±1.56 (SD) in women. The appendix height was long in 20 cadavers (10%), short in 3 cadavers (1.5%), and moderate in 177 cadavers (88.55%) cadavers. The appendix position was posterior in 120 (60%), ectopic in 32 (16%), and pelvic in 48 (24%) cadavers. Conclusion: Majority of appendices examined in the present study were positioned at the posterior (Retrocecal) of pelvis. According to different positions of appendices in different populations and different races, the knowledge of appendix position in various populations is necessary for early diagnosis and treatment and fewer complications for related disease.

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Background: The incidence rate of gastric cancer in Western countries has shown a remarkable decline in recent years although it is still the almost common cancer between men in Iran. The proto-oncogene MYC, located at 8q24.1, regulates almost 15% of human genes and is activated in 20% of all tumors. MYC amplification and overexpression of its protein product are observed in 15-30% of gastric neoplasia. The objective of this study was to find the preference of CISH or IHC in the diagnosis and prognosis of gastric cancer. Methods: In this cross-sectional investigation, 102 paraffin blocks samples of Iranian patients with gastric cancers were studied. All the patients had undergone primary surgical resection at the Cancer Institute Hospital, Tehran University of Medical Sciences from 1987 to 1993. CISH and IHC techniques were applied to the samples. CISH was carried out on 3-µm-thick tissue sections and with a ZytoDot CISH Implementation Kit (ZytoVision GmbH, Germany). IHC was down using the HRP method with the monoclonal antibody. A universal peroxidase-conjugated secondary antibody kit was used for the detection system. All samples were gastric adenocarcinoma and were selected randomly. Results: Our data revealed that both diffuse and intestinal types of gastric cancer occurred significantly in men more than women. Our results showed an indication of some correlation between grades and CISH results, although the difference was not significant. Our data also showed that CISH+ patients (43.1%) were more frequent in comparison with IHC+ patients (14.7%). There was a correlation between CISH and IHC. This result revealed that there was a significant difference between grades and IHC. There was also no statistically significant difference between CISH amplification in diffuse and intestinal types. Conclusion: Our conclusion is that for the treatment, management of stomach cancer, and monitoring of progress and prognosis of the tumor that is almost important for patients and clinicians, CISH test is a better and feasible to IHC test, with regards to sensitivity and specificity.

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

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Background: It is reported that high frequency of chromosomal aberrations in peripheral blood lymphocytes of individuals is a marker of cancer predisposition. The aim of this study was to investigate the in vitro frequency of chromosomal damage in lymphocytes of patients with head and neck cancer against gamma irradiation compared with those in healthy individuals.

Methods: In a case and control study, peripheral blood lymphocytes of 101 patients with head and neck cancer were collected before the onset of radiotherapy. Lymphocytes of 40 healthy individuals were also collected as controls. Head and neck cancer patients and the control group were consecutively recruited between April 2012 and February 2015 from Clinics of Cancer Institute, Imam Khomeini Hospital, Tehran, Iran. Lymphocytes of patients or control group were cultured and exposed to gamma radiation in G2- and G0- phase of the cell cycle. The induced chromosomal aberrations such as chromosome and chromatid breakages, chromosome and chromatid gaps, chromatid exchanges and micronuclei were scored in one-hundred metaphase cells of each individual. The mean of each chromosomal aberration was compared in patient and control groups. Early and late tissue reactions were scored during radiotherapy treatment or thereafter.

Results: There was no significant difference in demographic characterization between the two study groups. The frequency of radiation- induced G2 aberrations in lymphocytes of patients was significantly higher than in those of healthy donors (P= 0.001 for chromosomal breaks). The frequency of radiation-induced micronuclei in G0 assay was also higher in patients than in those in controls (P= 0.05). The results also indicate that there is no correlation between the two assays. No significant correlation was also observed between aberration frequencies in lymphocytes and the degree of both early and late normal tissue reactions.

Conclusion: The results indicate that the in vitro chromosomal radiosensitivity of peripheral blood lymphocytes of patients with head and neck cancer against gamma irradiation was significantly higher than that in healthy individuals.

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Background: One of the today most common and incurable diseases that is associated with central neural system is ‘MS’ disease. Multiple sclerosis (MS) is a demyelinating disease in which the insulating covers of nerve cells in the brain and spinal cord are damaged. In this disease become apparent a wide spectrum of symptoms such as lose muscles control and their coordination and vision derangement. The goal of this research is to consider to two problems: 1- Recognition of effective clinical symptoms on MS disease and 2- Considering levels of effectiveness of age, sex and education levels factors on MS disease and association between these factors according to verity of categories of this disease. Methods: Data mining science in medicine is worthy of attention with main application in diagnosis, therapy and prognosis, respectively high volume of collected datum. The data that were used in this article are about patients of Chaharmahal and Bakhtiari Province and collected by cure assistance. In this paper classification and association methods in software engineering field are used. Classification is a general process related to categorization, the process in which ideas and objects are recognized, differentiated, and understood. Association rules are created by analyzing data for frequent if/then patterns and using the criteria support and confidence to identify the most important relationships. Results: In consideration of first problem in this paper, concluded vision-clinical symptoms are the most effective symptoms and in consideration of second problem, concluded that from 584 records, women affected four times more than men. In other word 70% of MS patients with high graduate are in relapsing-remitting category and 62.5% of MS patients are 20-40 years old. Conclusion: Some of symptoms are quite temporary and transitory and are ignored by people. Awareness of clinical-symptoms prevalence manner can be warning for people before starting critical cycle of illness. This would cause early diagnosis, effective therapy and even prevention of disease progress, respectively to MS chronicity.

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Background: Millions of deaths occur around the world each year due to lack of access to appropriate treatment for chronic kidney disease patients. Given the importance and mortality rate of this disease, early and low-cost prediction is very important. The researchers intend to identify chronic kidney disease through the optimal combination of techniques used in different stages of data mining.
Methods: This cross-sectional research was conducted from February 1999 to May 2014. The used data set included 4145 samples and 32 attributes, where Each sample corresponded to a patient and each attribute corresponded to the demographic and clinical traits. There were several eligibility criteria for the patients for clinical testing. These criteria for the clinical testing included having 18 years of age and older, living in Isfahan city, willing to participate in the study, lack of fever and cold during laboratory tests, no strenuous exercise 48 hours before laboratory tests, and fasting. Individuals who had an incomplete questionnaire or were unwilling to perform accurate tests were excluded from the study. The target variable is kidney disease, the values of which include sick and healthy. Four data mining techniques have been used in the dataset. These techniques are support vector machine (SVM), random forest (RF), artificial neural network (ANN) and Chi-square automatic interaction detection (CHAID).
Results: Accuracy is the evaluation criteria for comparing available data mining methods. Based on the accuracy criterion, the support vector machine performed better than other techniques (random forest, neural network and CHAID). The best rule is that if the patients consume salt in their diet, their age is between 50 and 69, and they have diabetes. they are 82% more likely to develop chronic kidney disease.

Conclusion: The derived rules also showed that if we use salt and we have diabetes, we are at the risk of developing chronic kidney disease. Moreover, having diabetes can increase the risk of mortality in chronic kidney patients. Aged people should also be more careful about getting chronic kidney disease. Because, they are more prone to develop chronic kidney disease.