Iranian Red Crescent Medical Journal
Volume:12 Issue: 4, 2010

Women health status has always been one of the major health concerns particularly in developing countries. This study was undertaken to determine the design and implementation of Vulnerable Household Women’s Health Assessment Trial (VH-WHAT) protocol in Iran. The VH-WHAT was conducted in 11 province capitals during a 2 year period from 2007 to 2009 in urban populations. 2730 household women (mean age= 47.6±10.2 years, range=22-88 years) underwent a thorough physical examination including breast exam which revealed abnormal findings such as palpable masses (0.4%) of whom 0.1% had bilateral, 0.2% right breast and 0.1% left palpable masses. Fine Needle Aspiration (FNA) was performed in 0.1% of cases showing benign cystic lesions. 0.1% demonstrated signs of malignancies and were further referred to consulting specialists for follow-ups and procedures such as mastectomy or chemotherapy based on the stage of the disease. Considering the special characteristics of the population of this trial we hope that based on the results and analysis of the collected data in this study more appropriate interventions and more suitable models will be implemented for these susceptible groups.

Hepatitis C infection (HCV) is the major co-morbidity in thalassemia patients; however, literature lacks data from many EMRO counties. There is also enormous heterogeneity in the available study results in this region, and distribution of HCV infection among these patients living in this region is still unknown. This study provides a comprehensive and reliable tabulation of available data on the epidemiological characteristics and risk factors for hepatitis C virus (HCV) infection in thalassemia patients in eastern mediterranean countries. A systematic review was carried out based on the computerized literature database. 95% confidence intervals of infection rates were calculated using the approximate normal distribution model. Pooled Odds ratios and 95% CI were calculated by fixed or random effects models. The heterogeneity was assessed by either Q or c2 statistics. Publication bias was evaluated by either Harbor’s modified or Egger’s test. We identified 40 studies that fulfilled our inclusion criteria involving 8554 thalassemia subjects. Pooled HCV seroprevalence was 18% (95% CI 14-21), 45% (95% CI 43-48), 63% (95% CI 56-69) and 69% (95% CI 58- 80) in Iran, Pakistan, Saudi Arabia and Egypt, respectively. Among Iranian thalassemia patients, splenectomy OR=4.1 (95% CI 1.5-11.2), high transfusion OR=3.5 (95% CI 1.8-7), high age OR=6.1(95% CI 1.2-31.2) and first transfusion before 1996 OR=7.6 (95% CI 4.7 -12.3) were major risk factors of HCV infection. There are no data from many EMRO countries. Among major EMRO countries, Iran has the least seroprevalence of HCV infection among thalassemia patients. This underscores more advanced blood safety in this country compared with other countries with comparable population in this region.

Due to the lack of evidence in relation to violence against pregnant women, particularly in developing countries, this study was conducted to determine the relationship between violence during pregnancy and postpartum depression in Marivan, western Iran. 240 women between 15 and 40 years at the last month of their pregnancy were selected and divided into two groups: those experiencing violence and those without and matched for age, education, occupation of their own and their husbands’, income, marital status, parity and desired or unwanted pregnancy. They were followed 2 to 6 weeks after delivery. Participants were Iranian Kurd, literate and singleton with no known pregnancy complications and depressive disorder in their lifespan. Demographic and obstetrical characteristics, Edinburg’s postpartum depression, violence in three domains of physical, sexual, and emotional were recorded in a questionnaire. Mean age of subjects was 26.02±5.53 years mostly in primary educational level and were housewives. The scores of Edinburg’s questionnaire ranged from 0 to 27 (8.25±6.82) and 34.2% (82 women) of them obtained score 10 or more. The frequency of postpartum depression was 52.5% and 15.8% in women experiencing violence and those without, respectively. A significant relationship was found between domestic violence and postpartum depression (p<0.001) and the estimation of relative risk of depression with 95% confidence interval was between 2.1 and 5.1 (RR=3.3). Based on adverse effects of violence during pregnancy in this study, a routine screening at perinatal clinics is suggested to identify at-risk cases and provide necessary health services.

Although in the last few years there has been increasing awareness of the problem of landmines, there are still an increasing number of people especially children, illed and injured by landmine every week in the world including Iran which is estimated to have the second rank for landmine injuries. Eighteen years after cessation of Iraq-Iran war, the provinces located near the west border of Iran still suffer from the burden of vast areas highly infested with Landmines. This study aims to gather more information on the particulars of mine associated incidents and victims. This is a retrospective study of people with documented deaths or injuries due to landmine and/or unexploded ordnances (UXO) explosions, as documented in their medical files between Jul 1988 (after ceasefire) and Feb 2003. 3713 patients from 3 main organizations in charge of providing health care services for them were included in this study. Of these, 3461 (93.2) were male, and 252 (6.8%) were female. Most of the victims were civilians and the majority of them (40.4%) had one or more amputations. Most of the patients were injured in the period between1994 and 1998. The majority of them were young, and 41.8% were children. The occurrence of death and injuries due to landmine in Iran is regrettably high; this places a significant burden on the health care system, rendering increased commitment of the government a must. Collecting data on accident particulars and landmine victims can provide meaningful information on the risk factors.

While it is expected, different causes to decision making accept parenting responsibility and parenting style based on the single parenthood occurs as a result death of the spouse, it has not been clearly articulated. Therefore, we explored the parenting experiences of Iranian single-parent widows who keep custody of their children after their spouses die. In this descriptive, exploratory study in-depth interviews were held with 24 Iranian single-parent widows. The data generated were analyzed using the constant comparative method. Preliminary results indicated four main thematic categories: (a) development of a paradoxical identity: a hopeless widow vs. a hopeful mother, (b) submerging self in custody role vs. staying from widow role, (c) sentimental parenting and, (d) paradoxical evaluation: fruitful for children vs. fruitless for self. The results indicate that single-parenting after the death of the spouse is a difficult experience. Sentimental parenting practices, related to maladjustment with spousal death and roles transformation is a risk for the health of widow-single parents, so they need to be supported by health care delivery and social welfare systems to cope with their life after spousal death.

Over the past decade, several studies have revealed the role of high sensitivity C-reactive protein (hs- CRP), an acute inflammatory marker, as a prognostic factor in the setting of myocardial infarction, predicting future cardiac outcome of patients suffering from an acute coronary event. This study compares hs-CRP and low density lipoprotein-cholesterol (LDL-C) in predicting degree of coronary stenosis in patients with chronic stable angina. One hundred and five patients with chronic stable angina undergoing angiography were evaluated regarding known cardiovascular risk factors including age, sex, smoking habit, exercise, parental history of premature CAD, history of diabetes mellitus, hyperlipidemia, and hypertension, total-cholesterol, LDL-C, HDL-C and triglyceride. hs-CRP was measured by nephlometery and degree of coronary involvement was quantified by using an angiographic scoring scale. Results showed that hs-CRP was not correlated with angiographic score. When all traditional risk factors were entered as independent variables, age, sex, and history of hyperlipidemia were significant predictors of degree of coronary stenosis, and neither hs-CRP nor LDL-C were statistically significant. It was shown that hs- CRP was only related to sex and HDL-C. We conclude that larger studies with better set points for hs-CRP should be conducted, but our study indicates that traditional CAD risk factors including age, sex and history of hyperlipidemia still predict degree of coronary artery stenosis better than hs-CRP and hs-CRP measurement doesn''t add any information in this regard. Association of low HDL and hs-CRP may warrant further studies, too.

Hemodynamic changes during intubation are extremely important especially in patients with a history of coronary artery disease and arrhythmia. The aim of this study was to compare the hemodynamic changes during video laryngoscopy (glidescope) and the conventional method of direct laryngoscopy. This randomized double-blind clinical trial recruited 200 male patients undergoing elective orthopaedic surgery. Heart Rate (HR) and Mean Arterial Blood Pressure (MABP) were measured before, at the time of induction and every minute for 10 minutes following intubation. Changes of MABP were significantly less in the glidescopy group as compared to direct laryngoscopy group. No significant change was observed between the HR in the two groups. Glidescopic method of orotracheal intubation is considered advantageous over the conventional method for its less alteration of MABP.

The resistance of H. pylori to the recently available antibiotic treatment regimens has been a growing problem. The prevalence of high antibiotic resistance of H. pylori is the most common reason of its eradication failure. The purpose of the present study is to determine the prevalence of antibiotic resistance among H. pylori strains isolated from Iranian patients. We investigated the prevalence of H. pylori resistance to metronidazole, clarithromycin, amoxicillin, and tetracycline among 128 H. pylori isolates from Iranian patients. After the culture of biopsy specimens and identification, susceptibility tests was performed with Modified Disk Diffusion Method (MDDM) and E. test. Resistance rates to metronidazole, clarithromycin, amoxicillin and tetracycline were 64%, 23%, 2.5% and 0%, respectively. Seventy two percent of the metronidazole resistance strains had MIC>256mg/ml (High- Level-Resistance). Due to the increasing rate of antibiotic resistance in H. pylori strains and in order to decrease the treatment cost, testing of susceptibility to metronidazole and clarithromycin is recommended.

Axilla, mouth, and rectum are the most common sites for thermometric measurement. There is no universally accepted belief about how to predict one of them from others. In a cross-sectional hospital-based study at two educational hospitals in Qazvin Province, mercury in glass thermometers were used and then calibrated with digital thermometer within ±0.1 0C. The axillary temperature was compared with oral or rectal ones in 50 infants, 100 children, and 100 adults. The mean difference between axillary and rectal temperature in infants was 0.366 0C (± 0.21), while those between oral and axilary in children and adults were 0.667 0C (±0.37) and 0.4940C (±0.3), respectively. Among infants, 98% of the oral and rectal readings were stabilized at 5 and 3 minutes, respectively. In children, 98% of the oral readings were stabilized at five but for axilla, 99% by 6 minutes. For adults, 95% of the oral readings were stabilized at 5 minutes while for axilla, it was 96% by 6 minutes. In less than 3 month old infants, axillary temperature accurately reflects the rectal temperature. Axillary and rectal thermometry in infants should be read after 5 and 3 minutes, while oral temperature in children and adults should be read after 6 and 5 minutes, respectively.

Computers have become ubiquitous in the workplace offices and since computerized jobs aremore sedentary, requiring more cognitive processing, mental attention and less physical expenditure of energy,many jobs that require heavy computer use have been found to be stressful. Three hundred and sixty two clerks of national statistics centre of Iran participated in this analyticcross-sectional study. All the employees that had worked with computer during the previous three months wereenrolled. The subjects with diseases affecting the patient’s sleep were excluded. In addition to demographicvariables, for assessment of insomnia, we designed a questionnaire consisting of 20 items. Among 362 subjects, Male and female distribution was equal (Mean age: 35.27±8.48 years, range: 20-65 years). The most common degree was bachelor (40.6%). We couldn’t find any significant changes with respectto well-being during the day, final awakening earlier than desired, functioning during the day and with increasingthe hours of working with computer. An association was observed between the duration of daily visual display terminal work and each ofthe eight sleep-related symptoms on the AIS, such as difficulty in falling asleep and early awakening.

Stress has determining effects on the immune response. This study was undertaken to determinethe effect of exam stress on serum IL-6, cortisol, CRP and IgE levels of medical students. Thirty five university medical students in Southern Iran were enrolled. Two blood samples were providedfrom each participant one month (first stage) and one hour (second stage) before the exam at 1.00 PM.The students completed the SpielBerger State-Trait Anxiety Inventory (STAI) questionnaire. IL-6, cortisol, CRPand IgE changes were determined in these students. The mean age of the students was 21 years. The exam stress resulted in a significant decrease in theIgE level and a significant increase in the cortisol level. The exam stress can result in a decrease in the IgE level and a significant increase in the cortisollevel. So, these changes may indicate the alterations of immunological status and presence of stress in an immunosuppressedindividual, affecting his/her health.

As clinical observations have shown, osteoporotic women were complaining of lack of sexual satisfaction and are more prone to depression. Hence, we decided to find the statistical direct relationship between these two factors. The case group included 53 menopause women (21 with osteoporosis and 32 with osteopena) and 53 premenopausal women (37 osteoporotic, and 16 osteopenic). In the control group, there were 53 menopause women, and 53 premenopausal women who had normal bone density. Sexual satisfaction in both groups of case and control was assessed by standard Larson''s sexual satisfaction questionnaire and bone density was investigated by Dual-energy x-ray absorptiometry (DEXA), in Chamran Hospital bone mass densitometry center. The menopause women had significantly less sexual satisfaction in comparison with non-menopause ones. Osteoporotic women showed significantly less sexual satisfaction that means that the main effect of osteoporosis and menopause is significant. Osteoporotic women reported significantly less sexual satisfaction in comparison with the two groups of healthy women and osteopenic women (Scheffe test). Osteopenic women also had less sexual satisfaction in comparison with healthy women. This study suggests that there is a relationship between bone loss and sexual satisfaction in both groups of women. Therefore, this correlation suggests the importance and necessity of quick diagnostic investigation and the management of osteoporosis in women with sexual dissatisfaction.

Cerebral palsy is a group of non-progressive motor impairment syndromes caused by lesions of the brain arising early in development. In this study, we evaluated perinatal risk factors of children born in eastern and northern districts of Tehran city, when perinatal records were widely available. This was a case-control study performed on one to six year-old children living in Tehran, at healthcare centers of Shahid Beheshti University of Medical Sciences and Asma Rehabilitation Center, over 12 months. During the study period, 112 subjects in the case and 3465 in the control groups were studied. The main factors associated with cerebral palsy were (odds ratios, confidence interval): neonatal convulsion (81.35, 35.09-188.6), low Apgar score (<5) at 5 min or beyond (21.83, 13.13-36.26), low birth weight (5.83, 3.47-9.77), mother''s complication during pregnancy (7.83, 4.23-14.50) and maternal age over 35 years (3.88, 2.03-7.42). Neonatal encephalopathy, low birth weight, and high risk pregnancy were the most powerful independent predictors of cerebral palsy in this population. The majority of infants with cerebral palsy were born at term; therefore, cerebral palsy is quantitatively mainly an issue of term infants.

Skeletal muscle biopsy is important for the diagnosis of motor unit disorders, systemic diseases and metabolic disorders. In some cases, routine histopathologic methods are not conclusive and histochemistry, immunohistochemistry and even an electron microscopic study are required. In this study, we describe our experience in the diagnosis of myopathies, considering all of the above-mentioned methods. During a period of 18 months, 43 specimens of patients with the impression of myopathy were submitted to the Pathology Department and were evaluated with H & E and histochemical stainings (PAS, Oil red O, ATPase, NADH-TR, Gomori Trichrome), immunohistochemistry (IHC) for dystrophin and electron microscopy. Three specimens were excluded from the study because there were only adipose tissues and no adequate muscle was present for evaluation. Twenty three (57.5%) males and 17 (42.5%) females with a mean age of 34 years were evaluated. The results were as follows: Becker''s muscular dystrophy (5 cases, 12.5%), Duchenne''s muscular dystrophy (3 cases,7.5%), fascioscapulohumeral dystrophy (3 cases, 7.5%), limb girdle dystrophy (2 cases, 5%), polymyositis (6 cases, 15%), dermatomyositis (2 cases 5%), McArdle''s disease (1 case, 2.5%), hypothyroidism myopathy (1 case, 2.5%), type 2 atrophy secondary to drugs and systemic diseases (2 cases 12.5%), congenital myopathy (2 cases 5%), McArdle (1 case 2.5%), unclassified myopathy (2 cases, 5%), and normal muscle biopsy (8 cases, 20%). Although a genetic study was not available to confirm the diagnosis of cases such as fascioscapulohumeral myopathy, the diagnosis was made after putting all of the findings together including clinical presentation, family history, NCV, EMG, etc. In the cases with no definite diagnosis by the histology, histochemistry and IHC, we should perform an EM study to find out the distinct ultra-structural changes which can be diagnostic for some muscle disorders. EM study in conjunction with light microscopy of muscle biopsy could be very helpful in establishing the diagnosis of some types of myopathies.

Ferropenia and consequent iron deficiency anemia (IDA), β-thalassemia, and glucose 6- phosphate dehydrogenase (G6PD) deficiency are three main common hematologic problems in Iran. This study was conducted on the prevalence of these problems in Lor migrating nomads ethnic group in southern Iran. From June to October 2006, the blood samples of 79 Lor migrating nomadic children including 53 (67.1%) male and 26 (32.9%) female were checked for iron indices and G6PD deficiency. The family history of favism, thalassemiaand, signs and symptoms in relation to anemia of participants were evaluated. RBC count, different types of Hb, Hct, MCV, MCH, MCHC, RDW, SI, TIBC and SF were determined immediately after blood sampling. Fourteen (17.7%) children had SF<12 ng/mL while the prevalence of this low serum ferritin was higher in females than males (19.2% vs. 17%). The low hemoglobin (Hb) level had statistical correlation with the low serum ferritin level. Among all participants, the prevalence of G6PD deficiency was 10.1%, and all of them were male children. The prevalence of β-thalassemia was 2.5% and all were male. The prevalence of IDA was 17.7%. Although IDA figure is less than those reported in other developing countries (25-35%); but it shows that Lor tribes in southern Iran are still behind the health status of developed countries (5-8%). Even the prevalence of β-thalassemia is not very high, but regarding the devastating potential risk of Cooley''s anemia; a careful performance of Iranian thalassemia program is recommended. It seems that G6PD deficiency is prevalent in Lor nomads, so establishment of educational programs and investigation on their dietary habits seem to be a good way to prevent the favism occurrence.

The ability of mesenchymal stem cells (MSCs) to differentiate into other cell types makes these cells an attractive therapeutic tool for cell transplantation. In order to provide a source of human MSCs for autologus cell-based therapy, we have expanded MSCs from the bone marrow and analyzed the biological identities and transdifferentiation potential. The bone marrow of healthy donors was aspirated from the iliac crest. The adjacent cells expanded rapidly and maintained with periodic passages until a relatively homogeneous population was established. The identification of these cells was carried out by differentiation potential into the osteocytes and adipocytes. Transdifferentiation of human MSCs into hepatocyte-like cells was undertaken in response to a specific culture condition. The differentiation of MSCs into osteoblast is determined by deposition of a mineralized extracellular matrix. Adipocytes are identified by their morphology and staining. Hepatic cells were demonstrated in vitro functions characteristic of liver cells. We have defined conditions under which human MSCs can be isolated and expanded from human bone marrow. These cells can be amplified about 108-fold in 6 weeks, and are capable of transdifferentiation into the cells of another developmental lineage.

Immunohistochemical phenotype, distribution and significance of proliferation of myofibroblasts (α SMA positive cells) with evaluation of ultrastructure, in dentigerous cyst, odontogenic keratocyst and ameloblastoma were analyzed. The study included paraffin embedded blocks of ameloblastoma (n=22), odontogenic keratocyst (n=20), and dentigerous cyst (n=18). The expression of α SMA was determined by immunohistochemically stained section. The percentage of positive cells was calculated from a minimum of 1000 cells and H-score was expressed (% positive cells × intensity of staining). For transmission electron microscopy, fresh specimens were obtained from three patients and were fixed in 2.5% glutaraldehyde. The presence of cells with the ultrastructural characteristics of the myofibroblast was recorded. The mean number of positive cells in the three groups was significantly different. The difference between odontogenic keratocyst and dentigerous cyst and also the difference between dentigerous cyst and ameloblastoma were not statistically significant. The mean number of positive cells in the odontogenic keratocyst was significantly higher than that in ameloblastoma. In ultra-structural evaluation, myofibroblasts exhibited abundant cytoplasmic microfilaments, basal lamina-like material, subsurface caveolae, pinocytic vesicles, rough endoplasmic reticulum, and mitochondries. The high frequency of stromal myofibroblast in the odontogenic keratocyst implies that myofibroblast can contribute to aggressive nature of this cyst, but between odontogenic cysts and ameloblastoma, the presence of stromal myofibroblast has no correlation with invasiveness.

Limping is a debilitating problem that can be prevented by screening at risk newborns. Jaundice is a problem that brings approximately one fifth of newborns to hospital in early infancy. The aim of this study was to find out whether the newborns with physiologic jaundice are at an increased risk of developing developmental dislocation of hip and whether it is logical to screen these newborns with Graf’s ultrasonographic method. Throughout a year, 320 icteric newborns (640 hips) that referred to Nemazee Hospital Neonatal Emergency Room for checking their bilirubin were screened by Graf’s ultrasonographic method for developmental dislocation of hip (DDH). Any newborn with other problems such as congenital anomalies were excluded form this study. Of the 640 hips, 21 newborns (3.28%) had a dysplastic hip (Class IIa) that needed follow up and 12 from them came back for follow up of hip ultrasongraphy, all of whom became normal (Class Ia) without treatment. Only 1 hip did have severe dysplasia (Class IIc) (.16%) that needed treatment at the time of discovery. The rate of DDH seems not to increase in the newborns with physiologic jaundice. It seems not to be logical to screen newborns with physiologic jaundice with Graf’s ultrasonographic method, if screening is not cost-effective.

Management of colon injuries in trauma surgery has not yet been standardized. Our aim is to present our findings in patients with colon injury retrospectively in order to contribute to the selection of a surgical algorithm. Patients were evaluated with regard to age, sex, type of trauma, hemodynamic state, the time period between trauma and surgery, amount of transfusion; additional organ injury, localization and severity of colon injury, fecal contamination, surgical procedures, postoperative complications, and mortality, and then the factors affecting morbidity and mortality were investigated. Mean Abdominal Trauma Index (ATI) of 34 cases was 18.9; ATI was over 25 in 6 (18%) cases. The time period between trauma and surgery was over 8 hours in 2 (6%) cases. Mean Colonic Injury Severity Scale (CISS) was 3. Severe fecal contamination was detected in 4 (12%) cases. Primary repair and colostomy were performed in 26 (76.5%) and 8 (23.5%) cases, respectively. Mortality occurred in 2 cases who had received colostomy procedure. Decision of performing either primary repair or resection anastomosis should depend particularly on CISS (which should be equal to or less than III) accompanied by low ATI, prompt admittance (i.e. within the first 8 hours), and little or no fecal contamination.

Having information on characteristics of work load of emergency surgical room in 3 working-shifts per day help to manage facilities and health care providers more efficiently. The aim of this study is to evaluate the workload pattern of 3 working-shifts of a day in Nemazee Hospital, southern Iran. The patients who were admitted in the surgical Emergency Room from April 2007 to May 2008 were enrolled including the patients'' demographics, referral sources, the busiest working-shifts and the type of procedures performed in the Emergency Room. 33,837 emergency surgery referrals were recorded, of which 74.7% were male and 25.3% were female with a mean age of 30.8±20.1 years. The busiest working-shift of the day was between 8.00 PM and 8.00 AM, when 48.4% patients were admitted. 12.1% were admitted in the Emergency Room while 4.8% patients were admitted in the hospital wards and 5.6% underwent emergency surgery. 32.4% of them were discharged while 39.7% left the hospital with their own responsibility and 4.7% patients escaped from the hospital. The total number of the deaths during the study period was 0.7%. Our results showed that patients were mainly male teenagers and most of the accidents happened by motorbike during the busiest working-shift of the day from 8 PM to 8 AM. Therefore, it would be useful to persuade health system administrators to set up some educational programs to increase the awareness of families and teenagers regarding trauma and also to allocate more resources to shorten waiting lists.

Chronic hepatitis C is a major health concern around the world. Although transmission of hepatitis C virus (HCV) infection through parenteral exposure is well documented, sexual transmission of HCV is still debated. Therefore, we evaluated the prevalence of HCV infection within the families of the patients infected with HCV in a central city of Iran, Shahre-kord. We examined eighty patients with chronic HCV-associated liver disease and their 230 first degree families in a cross-sectional descriptive serological study. Their serum samples were tested for anti-HCV antibody, using ELISA and Immunobloting. A questionnaire including risk factors for HCV infection specially drugs addiction, sexual behaviors, and duration of partnership was filled in by the cases. About 2.17% of the household contacts were seropositive. Of them, 8.7% spouses and 20% sisters had anti-HCV antibody. The risk of HCV transmission between monogamous sex partners is higher than that of in other family members, depending on the duration of exposure especially sexual exposure. Infection rate in other family members of HCV-infected persons and community members is the same.

Esophageal cancer is a poor-prognosis cancer which is common in Iran. The main treatment for this cancer is surgery which may be performed with either trans-thoracic (TTE) or trans-hiatal esophagectomy (THE). Each of these methods has some specific complications, morbidity and mortality rate, leading to controversies in method selection. Therefore, in this study we evaluated the outcomes of these two approaches in Iranian patients. In this retrospective survey, we evaluated 100 patients with esophageal cancer who underwent either TTE or THE in Shohada-e-Tajrish Hospital, Tehran, from 2000 to 2008 and categorized them into two groups. The patients in the two groups were compared according to age, sex, tumor location and histopathologic characteristics, surgery results and complications, morbidity, mortality and death results. Sixty nine percent (69%) of patients had squamous cell carcinoma (SCC) and 59% had undergone THE. The mean age of the patients was 61.18 years. There was no difference in age, sex distribution, tumor pathology and location in the two groups. Although neck leakage of anastomoses was more frequent in THE (7.31% vs 10.16%), there was no statistically significant difference between the two groups in complications and mortality. Duration of the surgery was longer in TTE. Trans-hiatal and trans-thoracic esophagectomy are the same in outcomes. Both methods can be considered as therapeutic surgical approach regarding to physician''s opinion and patient''s situations.

Abu Bakr Mohammad Ibn Zakariya al-Razi, known in the west as Rhazes, was born in 865 AD in the ancient city of Rey, near Tehran and died in the same town about 925 AD. He was the first person who distinguished the infectious rashes, in particular smallpox, from measles in a masterful demonstration of clinical observations, providing valid guidelines for the sound treatment of both. This study compares Rhazes Diagnostic Differentiation of Smallpox and Measles. There is an attempt in this study to compare modern microbiology with the chapters of Rhazes’s fi Aljadari wa-al-hasbah. We used this book in its original language (Arabic) along with its Persian and English translations. Rhazes was among the first to recognize the need for sanitation of infected patients in hospitals. Rhazes prepared Al-Jodari Wa Hasbah, the first treatise ever written on smallpox and measles for diagnostic differentiation between these two infections, which is the basis for new medicine to diagnose and treat smallpox and measles, according to his experience of patients in hospital. He also noted that the cause of these infections was the yeast transmitted by the blood route. Today, the cause of smallpox and measles is known to be viruses. Rhazes not only classified the type of infections based on location and the time of the appearance of the symptoms in these two infections, but also he scaled the degree of severity and prognosis of infections according to the color and location of rashes. The method of differential diagnosis of measles and smallpox was precisely described based on his clinical experience and observation in hospitals; it is the best reference in the history of medicine for recognition of these two infections. This article is a review of Rhazes’s views in medicine and their comparison with the modern microbiology.

Stress has determining effects on the immune response. This study was undertaken to determine the effect of exam stress on serum IL-6, cortisol, CRP and IgE levels of medical students. Thirty five university medical students in Southern Iran were enrolled. Two blood samples were provided from each participant one month (first stage) and one hour (second stage) before the exam at 1.00 PM. The students completed the SpielBerger State-Trait Anxiety Inventory (STAI) questionnaire. IL-6, cortisol, CRP and IgE changes were determined in these students. The mean age of the students was 21 years. The exam stress resulted in a significant decrease in the IgE level and a significant increase in the cortisol level. The exam stress can result in a decrease in the IgE level and a significant increase in the cortisol level. So, these changes may indicate the alterations of immunological status and presence of stress in an immunosuppressed individual, affecting his/her health.

Adrenal angiomyolipoma is rare. Only four cases have been reported so far. We report our experience with a 61- year old man who presented with loin pain and abdominal mass. A computerised tomography (CT) scan showed an adrenal mass with features of angiomyolipoma. Adrenalectomy was performed and the histopathological features confirmed the diagnosis of adrenal angiomyolipoma. The patient recovered without any complications following surgery.

A 22-year-old man was admitted with chief complaint of dyspnea on exertion. The patient had a history of operation 10 years ago for coarctation of the aorta. Transthoracic echocardiography showed bicuspid aortic valve, aortic regurgitation, left ventricular (LV) enlargement with ejection fraction of 45%, and a deeply trabeculated LV with deep intertrabecular recesses communicating with left ventricular cavity as demonstrated by color Doppler flow, the characteristic of the left ventricular noncompaction. Medical therapy and aortic valve replacement was performed. In the follow up, he was free of symptoms 12 months later.

Atrial septal defects are communications of variable size that occur in the heart and allow interatrial shunting. We report a 49-year-old lady with sinus venosus type ASD, diagnosed by trans-esophageal echocardiography.

A16 year old boy was admitted to the hospital because of a swelling on the left side of mandible. He had multiple small indurated pearly papules on the head and neck with multiple well circumscribed radiolucent cystic space in mandible on panoramic radiography and CT-scan. Histopathologic studies of mandibular cyst and skin lesions revealed the finding in favor of nevoid basal cell carcinoma syndrome (NBCCS).