مجله دانشکده پزشکی دانشگاه علوم پزشکی تهران
سال هفتاد و پنجم شماره 10 (پیاپی 202، دی 1396)

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

The members of Mycobacterium tuberculosis complex (MTBC) known as causative agents of human tuberculosis. Tuberculosis infection is one of the most important occupational risks for healthcare workers (HCWs) in most countries, such as Iran. In general, there are two types of tuberculosis, they include: latent infection and active TB. Latent tuberculosis infection (LTBI) means: a patient is infected with Mycobacterium tuberculosis but, the patient does not have active tuberculosis, clinical symptoms and radiological findings. According to studies, TB infection from patients to health care workers, depending on geographic region and economic situation is two to five times more than general population. The lowest incidence and the highest rates of LTBI prevalence among HCWs were 7% in Mashhad and 82.8% in Zahedan respectively. The risk factor acquisition of TB infection was a significant relationship with certain hospital wards (lung disease unit, laboratory, etc.), Increasing age and duration of employment. And results of this study show that TB is a significant problem among HCWs in Iran. Infection control and personal protective measures with training programs to patients and HCW is required to reduce the occupational risk of TB. Early detection of Mycobacterium tuberculosis and prevention treatment in people with latent TB are key elements in control of tuberculosis. Until now, different methods for detection of latent tuberculosis infection has been introduced that are not gold standard none of them. However, the most important methods, tuberculin skin test and the tests that based on measuring the production of interferon gamma are recommended, but each one of them has advantages and disadvantages. However, in all the articles of the tuberculin skin test is used for screening and early diagnosis of latent tuberculosis infection. So, the aim of this study was to Incidence and prevalence of latent tuberculosis infection in health care workers and risk factors, advantages and disadvantages of each method for diagnosis of latent tuberculosis infection and evaluate different strategies for reducing the incidence of latent tuberculosis infection in health care workers.

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

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.
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.
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.
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.

Recurrent pregnancy loss is a form of infertility with at least three consecutive pregnancy losses or more. Y chromosome microdeletions are a class of most likely genetic factors that occur in a special zone of Y chromosome which is named azoospermia factor region. The purpose of this study was to analyze the presence of Y chromosome complete microdeletions in male partner of couples suffering from idiopathic recurrent pregnancy loss among Iranian population.
In the present study, Y chromosome microdeletions were evaluated in ninety-two male partners of couples with the experience of recurrent pregnancy loss as the patient group and also a group containing fifty fertile males as the control group. The research has done in Medical Genetic laboratory of Tehran and Islamic Azad University Science and Research Branch, Tehran, Iran within June 2013 to September 2014. The selected sequence tagged site markers (primers) including sY84, sY86, for azoospermia factor a; sY127, sY134, sY129, for azoospermia factor b and sY254, sY255, for azoospermia factor c were used to screen complete microdeletions in Y chromosome. At the first step DNA samples were extracted from all men’s peripheral blood in both patient and control groups and then multiplex polymerase chain reaction and also agarose gel electrophoresis were performed on this DNA samples so as to detect deletions.
With due attention to the data resulted from multiplex polymerase chain reaction and agarose gel electrophoresis in order to recognize Y chromosome micro deletions in azoospermia factor region, in this work, all the bands related to the mentioned primers which were formed during the polymerase chain reaction, were detected on the gel obviously. It means that none of the samples neither the fifty fertile men nor the ninety-two patient men had complete micro deletions in their Y chromosome.
This study suggests that there is no correlation between Y chromosome micro deletions and occurrence of recurrent pregnancy loss in Iranian population.

Blood pressure decreases during sleep and is markedly increased in the morning in healthy individuals. Lack of nocturnal blood pressure fall (non-dipping) has been associated with cardiovascular morbidity, mortality and other organ damage. However, their importance in chronic renal failure is unclear. This study aimed to investigate relationship between circadian rhythm of blood pressure and renal failure severity in patients with chronic kidney disease.
This cross-section study was done in April 2016. The study population was 95 patients, more than 30 year old with hypertension and chronic renal failure. Patients were selected from clinics of two private and university hospitals affiliated to Qom University of Medical Sciences Shahid Beheshti Hospital and Vali-e-Asr Hospital, Iran. Checklist containing data such as age, sex, duration of renal failure and cause of renal failure were filled. Serum creatinine and serum urea levels were measured and entered in the checklist. The circadian rhythm of blood pressure in all patients was assessed by Holter monitoring. patients who had less than 10% decrease in blood pressure overnight were considered non-dipper and those who had 10% or more decrease in blood pressure overnight were considered dipper.
Average (SD) 24-hour ambulatory systolic and diastolic of blood pressure was 136.56 (16.66) and 84.84 (10.86) mmHg, respectively. 70 patients (73.7%) had non-dipper blood pressure pattern and 25 patients (26.3%) had dipper blood pressure pattern. There was no significant difference between two groups (dipper and non-dipper) based on distribution of gender (P=0.744), age (P=0.407), serum creatinine (P=0.569), serum urea (P=0.689) and renal failure duration (P=0.812). Mean of glomerular filtration rate in dipper group was 68.64±4.13 and in non-dipper group was 65.09±16.27 (P=0.337).
The results of this study did not show a significant relationship between circadian rhythm of blood pressure and renal failure severity. In addition, patients with chronic renal failure showed higher rates of non-dipping pattern of blood pressure.

Prostate cancer is one of the most common diseases that affect men. Although prostate cancer is not the fatal flaw in most cases, detection of effective factors for early diagnosis and treatment is essential. Research results have shown that the use of KLK2 plus PSA can be a good biomarker for diagnosing prostate cancer. During prostate cancer, expression of KLK2 gene increases which can be used as a prostate cancer biomarker. The aim of this study is an assessment of KLK2 gene expression as a potential factor in the prostate cancer diagnosis.
In this case study, 50 prostate cancer urine samples from patients and 50 urine samples from normal individuals who were referred to Mehr Hospital of Tehran (from December 2014 to February 2016) were obtained and stored in the central research laboratory of Shahid Beheshti University of Medical Sciences, Tehran, till tests were being done. The age of collected samples between the 46 up to 71 years. RNA of samples were extracted, and then cDNA was synthesized by using M-MuLV enzyme, Oligo dt, and Random hexamer primers. KLK2 specific primers designed by Primer Express software, version 3.0 (Applied Biosystems, Foster City, CA, USA), and KLK2 gene expression evaluated by using ∆∆ct methods.
In comparison with patients and normal sample`s gene expression, the mean increase expression of KLK2 gene in patients less than 50 years was 2.32 and in patients more than 50 years, it was 5.79, P The expression of KLK2 gene in people with prostate cancer is the higher than the healthy person; finally, according to the results, it could be mentioned that the KLK2 gene considered as a useful factor in prostate cancer, whose expression is associated with progression and development of the prostate cancer.

Peritoneal dialysis is one of the most commonly used treatment methods for the patients with end stage renal failure. In recent years, the mortality rate of patients under this treatment has decreased; however, long-term survival is still an important challenge for health systems. The present study aimed to predict the survival of continuous ambulatory peritoneal dialysis patients.
In this retrospective study, according to the difference of relative importance of demographic characteristics, laboratory data, dialysis adequacy parameters and nutritional status in various patients, the factors affecting the survival of peritoneal dialysis patients have been identified by random forest algorithm. Then, the clinical and laboratory data of patients undergoing continuous ambulatory peritoneal dialysis treatment were evaluated retrospectively from July 1996 to April 2014 in 18 peritoneal dialysis centers, using multi-class one against all support vector machine (OAA-SVM) and multi-space mapped binary tree support vector machine (MBT-SVM) algorithms.
3097 patients were studied with the mean age of 50.63±15.67 years and average follow-up time of 24.48±19.13 months. The results of the random forest algorithm have identified 35 factors as the most important predictors of peritoneal dialysis patient’s survival. Then, the prediction of peritoneal dialysis patients’ survival status was evaluated using one against all support vector machine and multi-space mapped binary tree support vector machine algorithms in 5 classes of patients including “still on peritoneal dialysis”, “transferred to hemodialysis”, “received a kidney transplant”, “died” and “improved kidney function”. The reliability of survival prediction algorithms were 51.99% and 89.57% respectively.
An accurate prediction model would be a potentially useful way to evaluate patients’ survival at peritoneal dialysis that increased clinical scrutiny and timely intervention could be brought to bear. So, in this research, the multi-space mapped binary tree support vector machine algorithm has a high precision in predicting the survival of continuous ambulatory peritoneal dialysis patients considering multiple evaluation indices and different class distribution functions.

The most common cause of death in thalassemic patients is cardiac involvement especially cardiomyopathy. If the early stages of heart disease in people with thalassemia are diagnosed, mortality of patients reduced significantly. In this case-control study we compare the clinical symptoms, signs and para-clinic finding in thalassemia patients with control group.
In this case-control study, thalassemia patients who had visited in special clinic of Vali-e-Asr hospital of Birjand University Medical Sciences during January of 2013 to May of 2014 compared with normal subjects. They matched by age and sex. After explaining the aims of the project, the written consent was received from both groups. Clinical examinations including history taking and auscultation of heart and lungs were performed by Pediatrician. Moreover, using the standard methods, the measurement of height, weight and blood pressure were performed. In following, electrocardiography (ECG) was taken in both groups. Also, both groups underwent transthoracic echocardiography by one cardiologist.
42 thalassemia patients and 42 healthy subjects was compared in this study. Dyspnea was the only different symptom in the two groups. (23.8% in case and 4.8% in control P=0.01) In physical examination respiratory rate (RR) is only higher in patients with thalassemia that controls, but heart rate (HR), abnormal heart and lung sounds were not different significantly between two groups. In ECG, PR interval and QTc interval in patients with thalassemia was longer than healthy subject. In echocardiography, ejection fraction was lower but left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD) and size of the right ventricle and pulmonary artery pressure (PAP) was significantly higher than those in the control group.
According the result of this study, dyspnea was higher in patients with thalassemia from normal subjects and PR interval and QT interval was longer in thalassemic patients. As well as the size of the left ventricle, size of right ventricle, pulmonary artery pressure were higher than normal population. Also, LV ejection fraction was lower in thalassemia than normal population.

Hospitals are dealing with unlimited demands and limited resources. Hospital managers should use appropriate strategies to improve quality of services, enhance patients’ satisfaction and increase financial resources. This study aimed to examine the impact of quality management.
A participatory action research was used for the intervention on income of operating theatre in Vali-e-Asr Hospital in Tehran University of Medical Sciences, between March and September 2014. A quality improvement team was established and improved operational processes of the operating theatre department of the hospital using Mosadeghrad’s ten-step quality management model. The quality improvement team standardized processes, identified goals for the processes and improved them until achieved the goals. Accordingly, an action plan was developed and implemented for increasing the income of the operating theatre department. Income data of the operating theatre department were obtained for a 6-month period in 2014, and were compared with a control 6-month period in 2013.
Implementing quality management increased the number of surgeries by 14.96 percent, decreased cancelled surgeries by 14.6 percent and reduced bill deductions imposed by health insurance companies by 44.9 percent. As a result, the operation theatre department income has increased by 68.8 percent (P=0.028). Some of solutions used for increasing the income were as standardizing and improving working processes, removing unnecessary activities, empowering staff; increasing department’s working hours, on time visit of patients by doctors and surgeons, reducing surgery cancellations, increasing number of patients, reducing deductions applied by the health insurance companies and training staff and patients.
Implementing an appropriate quality management model appropriately helps improve quality of services and enhance hospital departments’ income.