seyed alireza javadinia

Erectile dysfunction (ED) is a common side effect of prostate cancer treatment, affecting up to 50% of patients after radiation therapy.

This study aims to analyze the correlation between the dose received by the penile bulb (PB) and ED in men who underwent definitive radiation therapy for early-stage prostate cancer without androgen deprivation therapy.

The study included 40 patients who received 3D conformal radiation therapy (3D-CRT) for localized prostate cancer and were reported to be potent before treatment, as determined by the International Index of Erectile Function (IIEF-15) questionnaire. The dose to the PB was measured using dose volume histograms (DVHs), and the IIEF-15 questionnaire was completed again 3 months after 3D-CRT. The Pearson correlation coefficient and linear regression test were used to examine the correlation between the ED score and PB doses. Statistical significance was considered if the P value was less than 0.05.

The mean age of the patients was 75.5 ± 5.70 years. The average ED score based on the questionnaire was 15 ± 10.55. Twenty percent of the patients had moderate ED, while 80% had mild ED (all patients reported a decrease in potency after 3D-CRT). However, the correlation between the ED score and the PB mean dose was not statistically significant.

This study revealed ED in all prostate cancer patients after 3D-CRT, but no significant correlation was found between the dose received by the PB and radiotherapy-induced impotence.

Breast cancer is most common in women, and symptoms and treatment depend on ethnicity, screening, and drug availability. The current standard for breast surgery is breast-conserving surgery (BCS) and sentinel lymph node biopsy (SLNB). However, performing axillary lymph node dissection (ALND) and the number of lymph nodes examined to determine the N stage has been insufficient in many patients, with a maximum of 10 lymph nodes assessed in patients undergoing ALND. This limitation leads to inadequate estimation and ultimately affects treatment choices.

This study examined the status of axillary staging in patients with breast cancer and its impact on management.

This retrospective longitudinal cohort study included 272 breast cancer patients at Sabzevar University of Medical Sciences, Sabzevar, Iran, from 2015 to 2019. Data regarding laterality, mass location, histology, grade, in situ status, lymphovascular invasion, perineural invasion, necrosis, and AJCC TNM staging were collected.

Most patients were at stage two (54.1%), and the median size of the primary breast tumor was 1.3 cm (range 1 - 14 cm, mean 3.7 ± 2.1 cm). The median number of dissected lymph nodes was 8 (range 1 - 37, mean 8.3 ± 5.8); however, no lymph nodes were examined pathologically in 23% (n = 63) of patients despite undergoing ALND. Additionally, in 38.2% of patients undergoing ALND, less than 10 lymph nodes were examined, which is considered inadequate for accurate axillary staging.

The rates of inadequate lymph node staging were considerable in our patients, resulting in overtreatment.

To investigate the survival of patients with brain metastases (BM) in Sabzevar.
In this retrospective cross-sectional study at two oncologic centers in Sabzevar, patients with BM either at the presentation or at during the follow-up were enrolled. Patients' documents were reviewed in terms of clinical and pathological features of the primary tumor, first-line treatments and treatments at the time of BM diagnosis and finally overall survival (OS) and BM-related survival rates. The data was entered into SPSS version 26 software and analyzed at a significance level of P<0.05.
Eighty-four patients were enrolled (58.33% female, median age 57 [25-83]). Most frequent primary cancers were lung (non-small cell, 38.1%) and breast (34.52%). BM at the diagnosis of primary tumor was presented in 29 patients (34.5%). 61.9% had ≥5 BM, 97.6% were symptomatic, 80% had extracranial metastases (ECM). Headache (22.6%) and focal neurologic deficit (21.4%) were the most frequent reported symptoms. Primary BM treatments were: Surgery 6.1%; SRT 0%; whole brain radiotherapy (WBRT) 87.8%, systemic treatments 6.1%; best supportive care (BSC) 0%. Median OS after BM diagnosis for all was 5 months (surgery: 11, systemic: 3, WBRT: 5). In patients treated with WBRT, 64.8% had ≥5 BM, 83.3% ECM, 16.9% were ≥70 years.
Survival of patients with BM is extremely poor. WBRT is the main treatment option. Patients who can tolerate the surgery may survive more.

Context: 

During a literature search, we found data indicating how lactate affects cancer patients.

Evidence Acquisition: 

This review discusses metabolism in tumors, the lactate production pathway, and its effects on the host body.

Research has described high lactate concentration as an undesirable clinical condition, and lactic acidosis contributes to the death of patients or some metastatic cancers.

Lactate can lead to angiogenesis, metastasis in the tumor, and resistance to radiation therapy and chemotherapy, especially immunosuppression. It may be possible to reduce the mortality of this disease by affecting treatment worldwide.

Two-dimensional (2D) radiographic parameters have been used to estimate the amount of heart and lung irradiated for minimizing heart and lung complications in breast cancer patients. The aim of this study was to investigate the correlation between traditionally used 2D radiographic and dose-volume parameters during adjuvant radiotherapy of breast cancer.  

In this cross-sectional study, we analyzed 121 female patients treated with breast-conserving surgery (BCS) or modified radical mastectomy (MRM) and 3D conformal radiotherapy (3DCRT) using two-field radiotherapy (2FRT) or three-field radiotherapy (3FRT) technique. All patients underwent computed tomography (CT)-planning. Two-D parameters, including central lung distance (CLD), maximum lung depth (MLD), maximum heart length (MHL), maximum heart distance (MHD), and chest wall separation (CWS), were measured using digitally reconstructed radiographs (DRR) and CT images. DVHs for lung, heart, and target were created. The Pearson correlation test was used to evaluate the correlation between 2D radiographic and dose-volume parameters.  

There was a correlation between CLD and ipsilateral lung V5-20Gy and Dmean and between MLD and ipsilateral lung V5-20Gy. In 2FRT, only moderate correlation between CLD and ipsilateral lung V20Gy (r = 0.453, P = 0.003) and between MLD and ipsilateral lung V20Gy (r = 0.593, P <0.001) were observed. Poor correlation of MHL and heart V25Gy (r = 0.409, P = 0.007) was seen only in 3FRT. There was a correlation between MHD and heart dose-volume data, with a strong correlation between MHD and heart V5-25Gy and Dmean (r = 0.875-0.934, P<0.001) in the 2FRT group. No correlation between CWS and breast Dmax was found.  

There was a correlation between 2D parameters (i.e., CLD, MLD, and MHD) and the heart and lung dose-volume parameters during adjuvant breast radiotherapy. Although CLD was correlated to ipsilateral lung V5-20Gy and Dmean, the correlation between CLD and ipsilateral lung V20Gy was greater than other dose-volume parameters. MHD provided a close estimation of heart dose-volume parameters.

 The northeast of Iran is one of the endemic regions of human T-cell lymphotropic virus type-1 (HTLV-1). This study aimed to evaluate the relationship between nasopharyngeal carcinoma and HTLV-1 infection in northeast Iran, an endemic area for HTLV-1.

 In this case-control study, paraffin-embedded nasopharyngeal tissue samples of patients with definitive nasopharyngeal carcinoma were evaluated for the presence of the HTLV-1 genome by polymerase chain reaction retrospectively.

 Thirty patients with nasopharyngeal carcinoma and 30 healthy people were evaluated. All participants were matched in terms of age and gender, and all were living in Mashhad. The HTLV-1 genome was detected in only one of the people in the healthy group.

 The HTLV-1 infection and nasopharyngeal carcinoma did not correlate significantly.

Previous clinical trials have suggested that herbal medicines can improve the quality of life (QOL) and survival of cancer patients. This study was aimed to evaluate the effects of a polyherbal compound (PHC, formulated as syrup) consisting of Allium sativum, Curcuma longa,Panax ginseng, and Camellia sinensis on the quality of life (QOL) and survival in patients with upper gastrointestinal cancers.

A randomized placebo-controlled trial was carried out on patients with esophageal or gastric cancer who had finished their oncological treatments. The patients were randomly assigned to PHC (n=20) or placebo (n=20) group. The PHC group was treated with the PHC for 12 weeks, while the placebo group received 70% sucrose syrup. The QOL was assessed at baseline and after 12 weeks. The patients were followed for up to 24 months to determine overall survival.

PHC significantly improved cancer-related symptoms, physical performance, and psychological and social functions of the patients (p<0.05 for all cases). Death occurred in 33 and 22% of cases in the placebo and PHC group, respectively. The mean survival time was 16.8 months (95% CI: 12.8-20.9) in the placebo group and 21.4 months (95% CI: 19.1-23.6) in the PHC group but the difference was not statistically significant.

The PHC improved cancer-related symptoms, physical performance, and psychological and social functions in patients with gastrointestinal cancers. It seems that this herbal compound has the potential to be used as a supplement in the management of cancer.

 There is a global concern for the susceptibility of patients with cancer to the adverse effects of novel coronavirus disease (COVID-19). Nevertheless, there is a signal of potentially increased vulnerability of patients with cancer to more COVID-19-induced mortality, this notion needs to be further evaluated in various societies with different cancer epidemiology and practice.

 To investigate the outcomes of cancer patients admitted due to COVID‐19 and compare them with data of COVID‐19 infected patients without a history of cancer.

 In this case-control study, the medical records of patients with cancer (Ca+ patients) who infected with COVID-19 were evaluated and compared with patients without a medical history of cancer (Ca- patients). Clinical data were collected from 19 February 2020 to 17 May 2020. The extracted data were classified into demographics, underlying medical conditions, clinical manifestations, imaging and laboratory findings, and clinical outcomes.

 A total of 24 Ca+ patients were compared with 44 Ca- patients in terms of clinical manifestations and outcomes of COVID-19. The Ca- patients significantly developed more dry cough (75.0% vs 29.2%, P = 0.01) and fever (72.7% vs 45.8%, P = 0.02). Findings of the chest CT scan was comparable between groups, except for pleural effusion and lymphadenopathy that exclusively reported in Ca+ patients. (3% and 4%, respectively). At the end of observation, 13 (19.1%) patients died from COVID-19. This rate was significantly higher in Ca+ patients (41.7 vs 6.8%, P = 001). Likewise, Ca+ patients experienced more mechanical ventilation (25.0 vs 4.7%, P = 0.01). However, the rate of ICU admission was comparable between groups (P = 0.29).

 The patients with cancer had a higher rate of mechanical ventilation and COVID-19-induced mortality.

Rather body mass index (BMI) has a potential prognostic role in determining the outcome of patients suffering from colorectal cancer or not should be clear.

We aimed at determining the potential effects of BMI on the prognosis of patients with colorectal cancer.

In this cohort study, documents of 1550 patients with colorectal cancer between 2002 and 2020 from Omid hospital and Emam Reza hospital (Mashhad, Iran) databases were evaluated, retrospectively. The multivariable logistic regression and Cox proportional hazard regressions were used at the significance level of P < 0.05.

Nine hundred twenty patients included in the current study. Most of patients were categorized as normal weight (38.91%). The prevalence of underweight and overweight/obese were 26.19% and 34.9%, respectively. There was no significant difference in the overall survival (OS) and disease-free survival (DFS) based on BMI (OS: 108.2 ± 7.0 months for underweight, 124.0 ± 6.2 months for normal weight, and 130.9 ± 4.5 months for overweight/obese patients; P = 0.2 and DFS: 97.0 ± 6.5, 110.0 ± 5.6, and 113.7 ± 5.0, respectively; P = 0.3).

The BMI had no significant effect on long-term outcomes of patients with colorectal cancer. However, there was an insignificant trend to better outcome in patients with higher BMI comparing the underweight group

Laryngeal cancer is one of the most common head and neck cancers for which total laryngectomy is the preferred treatment in advanced stages. Major disabilities of this surgical procedure include loss of voice and nasal function, swallowing difficulties, and psychological consequences.

This study aimed to investigate the effect of the Polite Yawning technique on olfactory quality in patients undergoing total laryngectomy.

In this cross-sectional study, after total laryngectomy, the patients with olfactory dysfunction were enrolled and the quality of olfaction was evaluated by the Quick Odor Detection test before and after receiving the Nasal Airflow Inducing Maneuver technique training. Statistical analysis was performed using SPSS 21 software by the Wilcoxon or McNemar’s test. The significance level was considered for P ≤ 0.05.

A total of 40 patients were evaluated. The mean age was 55.98 ± 6.27 years. Eighty-five percent of the patients were male (n = 34). The difficulty score in learning maneuvering was 2.5 ± 1.3, and 90% had no problem with learning it. Before maneuver, none of the patients had normal olfaction and had hyposmia mostly (n = 32, 80%). Immediately after the maneuver, there was a sensation of smell in all patients and the rate of hyposmia in patients was reduced to 65% (P = 0.008). Normal olfactory status was reported in half of the patients one month after the maneuver (21 patients, 52.5%, P = 0.0001), and there was a sense of smell in all patients (P = 0.0001).

The results proved that olfactory quality can be rehabilitated after laryngectomy by the nasal airflow-inducing maneuver (the “Polite Yawning” technique). It is a patient-friendly method; however, a single training session is probably insufficient and most patients may need more training sessions.

We aimed to report a woman suffering from uterine adenosarcoma in perimenopause period

 The patient had undergone total abdominal hysterectomy (TAH) with bilateral salpingo-oophorectomy (BSO) and also received adjuvant chemotherapy and radiotherapy. Moreover, she was reported as disease free with no evidence of recurrence or metastasis despite existence of numerous risk factors such as deep myometrial invasion as well as sarcomatous overgrowth after one year of follow-up.

The results obtained about this patient could highlight the role of adjuvant therapy in terms of managing treatments for patients suffering from MASO especially in the presence of deep myometrial invasion and an advanced stage.

Since Iran has one of the highest mortality rates of car accidents in the world, the study of the pattern and reasons of trauma in car occupants can provide useful information to determine the underlying causes of injuries and deaths in traffic accidents. Accordingly, this study was conducted to determine the pattern, frequency, and causes of traumatic injuries caused by traffic accidents in car occupants.

This cross-sectional study was conducted during the first 6 months of 2017 in Shahid Beheshti Hospital in Sabzevar City, Razavi Khorasan Province, Iran. The data were obtained from the medical records of patients and the checklist designed by our research team.

During the period of study, 300 people were involved in car accidents, of whom 58.3% were men with an average age of 35.16 years. In both sexes, 29.3% of the subjects were in the age group of 30-40 years. Twenty-two car occupants were involved in non-injury car accidents. No significant relationship was found between traumatic injuries and variables of sex, seatbelt use, airbag deployment, and the seat occupant in the cars (P>0.05), as well as between death and variables of sex, airbag deployment and seat occupant in cars (P>0.05). But there was a significant relationship between death and fastening seat belts (P=0.003).

The results of this study revealed that sex, airbag deployment, and seat occupant had no effect on traumatic injury or mortality rate in the car occupants. However, fastening the seatbelt can reduce the mortality rate in car occupants, but it does not impact the traumatic injuries rate.

Along with the complexity of social communications, the rate of suicide is increasing, and according to studies, women commit suicide more than men. Various factors affect the occurrence of this phenomenon. The purpose of this study was to determine the factors affecting unsuccessful suicide among women referring to the emergency room of the hospital of Ardabil City, Iran.

This study was a descriptive cross-sectional study conducted on 236 women who had unsuccessful suicide. Questions were asked from patients with a checklist. This checklist has four parts. The first part relates to the patient’s personal information, and the second part relates to the patient’s previous history of mental, physical, and addiction problems. The third part asked about the causes of suicide and the fourth part related to the prior announcement. The collected data were analyzed by statistical methods in SPSS v. 18.

The Mean±SD age of the women was 27.66±9.95 years, and the majority was between 15 and 20 years old. About 64% of women were housewives, and 37.7% had undergraduate education. Also, 36% had a positive history of psychological diseases, and 30.9% had a history of suicide. The most common causes of suicide among women were emotional problems (91.9%), family and marriage conflict (81.8%), spouse’s disregard (50.4%), and economic issues (44.5%).

The results showed that emotional problems and family and marital conflicts were common causes of suicide among women, and all women had at least one crucial reason for their suicide attempt.

This study aimed to assess mortality and neurotoxicity caused by the pesticide organophosphate and its correlation with the type of poison and treatment in patients admitted to Vasei Hospital of Sabzevar City, Iran, in 2018.

Out of 122 cases, 52 patients (43.3%) were male, and 70 patients (56.9%) were female. The Mean±SD age of the men was 32.65±29.15, and women was 30±15.30 years.

Mortality in women and men was 10% and 17.3%, respectively. Among treated people, diazinon had the highest frequency of 76.4%, and among dead people from diazinon and malathion had the highest rates of 56.3% and 43.8%, respectively.

The prevalence of mortality in patients was 7.3% (n=9). As most people with organophosphorus poisoning have been exposed to diazinon toxins; therefore, strategies to prevent and reduce exposure to this toxin are essential.

To compare the cosmetic outcome and acute cutaneous, cardiac, and pulmonary toxicity profile of accelerated hypofractionated and conventional whole breast radiotherapy (WBRT).This was a blocked randomized, clinical trial on women with early-stage node-negative invasive breast cancer after breast conservation surgery (BCS) with clear margins randomly assigned to receive WBRT either at a conventional dose of 50.0 grays (Gy) in 25 fractions (the conventional group) or at a dose of 42.5 Gy in 16 fractions (the hypofractionated group). Boost irradiation was permitted in both groups. Data were analyzed by SPSS V21.0 using Mann–Whitney U, independent-samples t- and Chi-Square/Fisher's exact tests at the level of P≤0.05.The median follows up was 16 months. Forty-one patients in the conventional WBRT arm and 45 patients in the hypofractionated WBRT group were enrolled. No significant difference was observed in terms of left and right ventricle systolic dysfunction and diastolic dysfunction. Pulmonary function tests after 6 and 12 months follow up, were comparable in both groups (P=0.2). Skin toxicity during and after treatment was acceptable in both groups. Breast size change in the conventional and the hypofractionated WBRT groups was 14.3% and 7.1%, respectively (P=0.6). Excellent or good cosmetic outcome was similar in both groups.The results of our study support the use of accelerated hypofractionated WBRT in women with invasive breast cancer less than five cm and node-negative after breast-conserving surgery, which provides a more convenient shorter course of radiotherapy with a comparable cosmetic outcome and cutaneous, cardiac, and pulmonary toxicity profile.

Prediction of response to neoadjuvant treatment is an important part of treatment of patients with breast cancer. This study aimed to assess changes in serum levels of Cytokeratin 18 during neoadjuvant chemotherapy in patients with locally advanced breast cancer and its association with neoadjuvant treatments.

This research was performed on newly diagnosed breast cancer patients referred to Omid Radiotherapy Center and radiotherapy and oncology departments of Emam Reza and Ghaem hospitals, in Mashhad, Iran. Serum levels of M30 and M65 fragments of Cytokeratin 18 were measured before and 24 hours after the first course of neoadjuvant chemotherapy. Changes in serum levels of Cytokeratin 18 and its fragments and their correlation with pathologic response were analyzed.

Pre- and post-chemotherapy levels of M30 were respectively 223.9±18.94 and 250.7±23.92 U/L (P=0.24). For M65, these levels were respectively 301.5±313.9 and 330.2±352.2 U/L (P=0.1). Changes in M30 level during chemotherapy in patients with and without pathologic complete response were -20±92.69 and 43.1±106.5, respectively (P=0.1). For M65, these changes were respectively -247±55 and 76±240 (P=0.1). Baseline levels of M30 and M65 had no relation with menopausal status, tumor grade, hormone receptor status, Ki67 expression, molecular subtype, and stage.

Our findings showed statistically insignificant changes in the level of Caspase-cleaved- (M30) and uncleaved- (M65) cytokeratin 18 fragments (apoptotic and necrotic indicators, respectively) during neoadjuvant chemotherapy in patients with breast cancer. There was no notable relationship between tumor-related factors and either baseline levels or serum changes of CK18 fragments. Also, there was no correlation between M30/M65 level and pathologic response to neoadjuvant chemotherapy.

 Chemotherapy is one of the fundamental treatments for cancer patients, which has significantly improved the survival rate. Alongside its benefits, many side effects are imposed on the patient following chemotherapy. Ones is hepatotoxicity that initially develops as fatty liver and hepatic steatosis, but may progress to liver failure if the risk factors persist.

 We aimed to determine the prevalence of fatty liver in breast and gastrointestinal cancer patients during and after chemotherapy and its risk factors.

 This cross-sectional study was performed on 140 patients undergoing chemotherapy for either breast or gastrointestinal cancer who referred to the Oncology Clinic of Birjand University of Medical Sciences in 2016 - 2017. Demographic data regarding the disease and chemotherapy regimens were extracted from the patients’ medical records. Before and after chemotherapy, the patients were evaluated by sonography for fatty liver. Data were imported into SPSS version 19 software and analyzed by chi-square (or Fisher test) and McNemar at the 5% significance level.

 A total of 152 patients were enrolled in the study, of whom 85 had breast cancer and 67 had gastrointestinal cancer. Most patients were in the age group of 45 - 54 years (48 cases, 31.6%). The mean Body Mass Index (BMI) was 23.17 ± 4.52. The frequency of fatty liver before and after chemotherapy increased from 2% to 46.7% in all patients (P = 0.0001). The frequency of fatty liver after chemotherapy was significantly higher in females than in males (52.4% and 34.7%, respectively, P = 0.04). There was no significant relationship between chemotherapy-induced fatty liver and age (P = 0.9), BMI (P = 0.17), history of diabetes mellitus (P = 0.2), and the presence of metabolic syndrome (P = 0.4). The highest frequency of fatty liver was observed in patients treated with AC-T, FOLFOX, and ECF with 53.5%, 42.9%, and 29.2%, respectively (P = 0.09).

 The results showed that chemotherapy was associated with a significantly increased risk of fatty liver, which was more in women than in men. However, the occurrence of the fatty liver following chemotherapy could be expected in all scenarios, regardless of diabetes, metabolic syndrome, BMI, and the age of the patients.

Ectopic increase of adrenocorticotropic hormone (ACTH) or ectopic Cushing syndrome is a rare initial presentation of small cell carcinoma and carcinoid tumor of the lung. Here, we reported a 36-year-old male with atypical symptoms of Cushing syndrome managed by Etomidate that had a central pulmonary nodule, and pathologic evaluation of pulmonary lobectomy revealed the diagnosis of well-differentiated, low-grade typical carcinoids of lung.

Pheochromocytoma is a relatively rare tumor with no age preference. This tumor is usually diagnosed accidentally. Pathologic fracture as the primary presentation of malignant pheochromocytoma is an uncommon presentation. The present case is a 23 year old man with malignant pheochromocytoma that his first chief complaint was bone pain due to pathological fracture. The presence of bone lesions as the first manifestation of pheochromocytoma makes this case a quite unusual one.

Conservative treatment in early-stage breast cancer is considered a standard approach. Breast preserving surgery with adjuvant radiotherapy is as effective as mastectomy in the early stages of breast cancer to control local disease and distant metastasis and maintain the overall survival rate. Minimally invasive surgery for the treatment of axillary spread and new techniques of breast preservation surgery will probably lead to a reduction in mastectomy-related complications. However, the complications of adjuvant radiotherapy remain a challenge. Cutaneous, cardiac, and pulmonary toxicity are the main complications of adjuvant breast irradiation. The multidisciplinary features (systemic treatment, endocrine therapy, and surgery), patient profile (history of underlying diseases, age, and habits), and irradiation-associated parameters are the factors affecting safe adjuvant radiotherapy. Advances in irradiation techniques and facilities related to the preservation of organs at risk (such as IGRT, tracing and tracking systems, and respiratory gating) are modern tools for reducing the risk of toxicity. Reported data from clinical trials or retrospective surveys greatly help physicians in consulting the patients on the efficacy and potential side effects of treatment and leads to the improvement of the decision making process.

Melanoma is a neoplasm derived commonly from melanocytic cells of skin. Although coetaneous presentation of malignant melanoma is easily recognizable, the presentation of melanoma in other organs is so confusing. In particular, when it metastasizes to other organs, many bizarre figures and unusual organs may be involved. In this report, we present a case of primary duodenal malignant melanoma.
A 68-year-old man presented with a history of iron deficiency anemia. The upper gastrointestinal endoscopy showed a prominent papilla of duodenum along with an ulcerative lesion adjacent to second part of duodenum. Histopathologic evaluation showed a high-grade malignant neoplasm involving the bowel wall which was labeled for S100 protein and markers of melanocytic differentiation; Melan-A indicating the definitive diagnosis of malignant melanoma of the second portion of duodenal mucosa.
In patients with a history of iron deficiency anemia, any GI symptom should be evaluated carefully. However, the diagnosis of primary GI melanomas in patients without any history of melanoma is possible. Full medical investigations are recommended in these patients with primary mucosal lesions.

Hepatitis A is globally spread and is an important public health problem.
This study aimed at investigating the seroepidemiology of hepatitis A in students aged seven to eighteen years in Birjand, during year 2016.
This study was a descriptive-analytic research, in which 300 school children aged seven to eighteen years in Birjand city were selected through the cluster sampling method. Subsequently, participants and their parents were requested to fill the questionnaire and were referred to the laboratory for blood sampling in order to examine hepatitis A antibody titer. Data were analyzed using SPSS-21 software and the chi-square test.
Hepatitis A antibody test was positive for only 111 out of 300 participants (37%). Females (P = 0.009) and teenagers (P = 0.0001) had significantly higher levels of antibody against HAV. There was a significant difference between the presence of hepatitis A antibody, education level of the mothers of the studied individuals (P = 0.042), and the social level and size of the family (P = 0.041). However, no difference was seen regarding fathers’ literacy level (P = 0.284).
The findings of the study showed that immunity against HAV was reduced during the past years. The reduced level of immunity against HAV along with several major risk factors for HAV infection, such as neighboring with Afghanistan and health hazards of hepatitis A for Iranian pilgrims visiting Karbala-based shrines in Iraq suggest anti-HAV vaccination as an essential priority.

Malignant melanoma (MM) usually present with metastases to unexpected regions of the body. Metastatic MM is a highly lethal condition, and the median survival in this setting is 6 to 7.5 months; however, few reports rarely describe long-term after chemotherapy. Case Report: We describe a 31-year-old man with MM, which got metastatic (to paranasal sinuses) after local and systemic therapy showed complete responses with long-term survival after endonasal endoscopic metastasectomy and radiotherapy of the nasal cavity, paranasal sinuses, and base of the skull. Although long-term survival is rare, few reports describe cases after chemotherapy. MM could be associated with metastasis to any regions and clinicians should be aware of its behavior and perform complete investigation in the presence of any suspicious symptoms, and this should be reinforced periodically. However, the survival is poor in the metastatic setting, and the treatment of choice is debatable, some patients may benefit from metastasectomy and local radiotherapy.