Background: laparoscopic sleeve gastrectomy is presently the most common bariatric surgery at our center (King Hussein Medical Center). Portal vein thrombosis is a rare surgical complication with an insidious presentation and a high risk of bowel compromise. The aim of this study is to present a series of patients who developed portal vein thrombosis post sleeve gastrectomy, and to describe the overall incidence, associated risk factors, clinical presentation and management. Case Reports: Four patients developed portal vein thrombosis post laparoscopic sleeve gastrectomy at King Hussein Medical Center during the period (Jan 2006 to Feb 2017). All patients presented with abdominal pain, nausea, and vomiting and decrease oral intake. The abdominal Computed tomography (CT) scan confirmed the diagnosis of portal vein thrombosis in all of them. One patient required medical treatment along with operative intervention and bowel resection. The other three patients were treated conservatively with anticoagulation and fluid resuscitation. Conclusion: Portal vein thrombosis is a rare but severe complication after laparoscopic bariatric surgery. Familiarity with this high-risk entity is critical. Early diagnosis and management, initiated by a high index of suspicion, is crucial.

Introduction: Hyper immunoglobulin-M syndrome (HIGM) is a rare, x-linked recessive inherited disorder with Increased or normal serum IgM and decreased IgA, IgG and IgE and normal peripheral B cells. In this disease, we have defect in class switch recombination (CSR) and somatic hyper mutation that is caused by defects including the enzymes required for CSR and SHM. (SHM) Methods: To update about HIGM, PubMed and Google Scholar database were searched for term, X linked Hyper IgM syndrome and CD40 ligand. In our first search, we received about 90 updated articles, and then we distributed these articles among the authors. After reading the articles and sharing together, finally 33 articles were selected that fully related to the topic as references. Findings: In conclusion, HIGM is rare disease that starts early in life with lifelong recurrent attacks of various infections by a variety of symptoms, including lymph Adenopathy, vomiting, diarrhea, skin lesion and abdominal pain. Allogenic hematopoietic cell transplantation and BMT can be effective in these patients. Conclusion: In conclusion, HIGM is rare disease that starts early in life with lifelong recurrent attacks of various Infections by a variety of symptoms, including lymphadenopathy, vomiting, diarrhea, skin lesions and abdominal pain. Allogenic hematopoietic cell transplantation and BMT can be effective in these patients.

Background: Medical providers continue to maintain a decreased frequency of major hazards after surgery for patients undergoing any surgery. Variable postoperative outcomes can be due to differences in patients’ preoperative risks. The intraoperative surgical Apgar score may predict postoperative one month hazards. Objective: To show the influence of applying the surgical Apgar score by surgeons and anesthesiologists together on clinical outcome after surgery. Methods: Our prospective, double blind and randomized included 166 patients, of both sexes, aged 35-62 years, classed I-IV physical status by the American society of anesthesiologists and scheduled for different elective or emergency general surgical procedures with routine outpatient or inpatient follow up after surgery at Prince Hashim(Zarqa) and King Hussein(Amman) hospitals, Jordan, during the period June 2015-June 2016, after obtaining written informed consent from all participants . Patients were divided into a group I (n=83) with standard outcome after surgery and a group II (n=83) with outcome affected by the surgical Apgar score. In the second group, the surgical Apgar score was calculated by grouping patients into three classes (0-3,4-7 and 8-10). The ten-point surgical Apgar score is recorded at the end of any surgery from the average blood loss, least mean arterial pressure and least heart rate during the surgery. The score is the sum of the points (0, 1, 2, 3 and 4) from each category. The primary outcome included a one month hazards after surgery. Secondary outcome included immediate admissions to the intensive care unit during one month of the primary surgery. Continuous variables were analyzed using Mann–Whitney U test. Categorical variables were analysed using chi-squared test. Univariate logistic regression was used to compare outcomes in the two groups. Results: Frequency of hazards was comparable in both groups (GI: 24/83 (28.9%), GII: 27/83 (32.5%), although it was more in the second group, P>0.05). Immediate admissions to the intensive care unit was more but not significant in the second group (22/83(26.5%) than in the first group (16/83(19.3%), (P>0.05). Conclusions: The surgical apgar score may show a discrepancy in postoperative outcome, especially if differences in clinical outcome are to be implemented, using a quality enhancement method.

Introduction: Copper (Cu) is an essential trace element for the body and seems to play an important role in the final outcome of a successful pregnancy. Some studies have shown an increase in serum levels of copper in pathological pregnancies during the first trimester. This study aimed to evaluate the effect of copper supplementation in pregnant women was designed with copper deficiency on pregnancy outcomes. Methods: This double-blind randomized controlled clinical trial on pregnant women with gestational age of 16-12 weeks was conducted during 2014-2015. The copper levels measured in pregnant women, then 120 qualified mothers have serum levels of copper at less than normal baseline values (120 µg / dL) have been selected. Data analysis with statistical software SPSS-21 and chi-square and independent t-test were done. Findings: Of the 120 cases studied, 20 patients (16.6% of the total) had premature rupture of membranes which 6 women were in the case and 14 women were in the control group and statistical tests showed a significant difference between the two groups (P=0.025). Also among the 120 cases studied, 23 patients (19.1% of total) with pre-eclampsia which 8 women were in the case and 15 women were in the control group and statistical tests showed a significant difference between the two groups (P=0.034). Other variables include spontaneous abortion, preterm delivery, placental abruption, low birth weight, intrauterine growth restriction, and intrauterine fetal death there was no significant difference between the two groups. Conclusion: Based on our findings, supplementation containing copper in pregnant women can reduce the risk of pre-eclampsia and premature rupture of the fetal membranes that Both can be serious consequences, such as infection of membranes, miscarriage or intrauterine death or life-threatening for the mother.

Introduction: Elective induction of labor increase the risk of cesarean section rate. pharmacological methods Including prostaglandins and oxytocin that are used. Another thing that may be helpful in the process of induction (propranolol), which is a type 1 and 2 beta-adrenergic receptor blocker. Stimulation of these receptors inhibits uterine contractions. Due to the inconsistent results from different studies as well as the small number of studies in this field, and the importance of the potential side effects of high doses of oxytocin on the health of the mother and fetus, this study aimed to evaluate the use of propranolol plus oxytocin compared with oxy oxytocin alone on the progress of the delivery. Methods: This study was a controlled double-blind clinical trial, and 50 cases in each group. inclusion and exclusion criteria were considered. In Group oxytocin, oxytocin was started in 2 mIu / ml, and every 15 minutes in the same amount was added to the good contractions (three good contractions in 10 min), respectively, then 8 hours continued. In the propranolol group, before induction, 2 mg propranolol intravenously and slowly at a speed of 1 mg per minute were injected and then with oxytocin induction was established as above. Delivery and patient follow-up data were recorded. Findings: In our study, the effect of propranolol on labor were investigated, propranolol has been able to reduce the duration of latent phase in the case group than the control group. (P =0.000). The mean duration of the active phase and second stage of labor were studied in two groups was not statistically significant, (P =0.703) for the duration of the active phase and (P =0.509) for the second stage of labor. In our study delivery and the cause of cesarean delivery and Apgar score at 5 minutes’ infants were compared. in our study, the cesarean rate in the control group was higher, but the difference was not statistically significant (P =0.106). Conclusion: In total, according to the studies and research it seems that propranolol can be used to help labor.

Abstract: Introduction: Self-care is an important tool in controlling pain in patients with rheumatoid arthritis. The aim of this study was to investigate who to assess pain using Orem Self-Care Model in patients with rheumatoid arthritis. Methods: This was a descriptive aspect of a clinical trial performed on 60 patients with rheumatoid arthritis who referred to a private clinic in Karaj. Data collecting tools were a demographic questionnaire consisted of 19 questions and Numeric Pain Rating Scale. The data result was analyzed using SPSS version 19. Less than 0.05 was considered significance. Findings: The mean age was 44 years, 90% were married and 35% had diploma. ANOVS test with repeated measures showed a significant differences in three measures of pain in the intervention group, while in the control group, this difference was not significant (p=0.59). Conclusion: Conclusively, Orem self-care model is effective in reducing pain in patients with rheumatoid arthritis.

Introduction: The Usher syndrome (USH) is an autosomal-recessive disorder refers to The combinded bilateral sensorineural hearing loss, retinitis pigmentosa (RP), and in some cases vestibular dysfunction. There are three clinical types of Usher syndrome: type 1, type 2, and type 3. Type 3 is characterised by progressive hearing loss and variable age of onset of retinal degenerationand he or she will usually require hearing aids by mid- to late adulthood. Night blindness usually begins sometime during puberty. Case Presentation: The present case reports is a 13 years-old male with type 3 of usher syndrome syndrome who developed a previously undescribed growth hormone de- ficiency. Conclusion: We sugesst usher syndrome type 3 could be a primery GH deficiency disorders.potential link between usher syndrome and GH deficiency is still unclear and needs further studies.

Introduction: The lichen striatus is a rare disease of the skin. LS mainly affects children. LS is a benign self-limited, localized blaschkolinear inflammatory disorder of unknown etiology. Methods: A literature review was performed on any aspects of LS in children using pubmed and google scholar sing following terms: lichenstriatus, nail lichen striatus, facial Lichen Striatus, lichenoidplaque, dermatology. Articles not related to children population were excluded. Findings: In epidemiological review most of cases in children usually were between the age of 3 and 15 years. Females are affected more than males. The etiology of LS is still unknown.in one article there is an increasing incidence in spring and summer. seasonal variation with a peak incidence of lichen striatus further suggests a viral origin. The histologic pattern of LS is well defined. A perivascular inflammatory is seen. A lichenoid pattern with inflammatory infiltrate near the dermoepidermal junction may be present. clinical and histologic findings overlap with other cutaneous disorder that follows the lines of blaschko. Lesions are usually unilateral and characteristically appears as shiny ,flattoped erythematous papules. Lesion occur more frequently on legs, although any part of the body may be affected. Treatment or no treatments was not significantly correlated with duration of disease. Conclusion: LS mainly affects children. LS is a benign self-limited, localized blaschkolinear inflammatory disorder of unknown etiology. The onset of lesions is sudden and progresses to the full clinical aspect in days or weeks. LS is typically asymptomatic, but intense pruritus can occur. There isn’t any specific treatment for LS Its benign, Treatment or no treatments was not significantly correlated with duration of disease, self-limited course is marked by spontaneously involution in 6–12 months, with no scar formation.

Introduction: There is much controversy over whether or not to use CT scan in patients with minor traumatic brain injury. The present study was conducted aiming to examine the results of CT scan in minor traumatic brain injury on the basis of the required indications and final clinical results. Methods: A cross sectional study, the present study was conducted in the emergency section of Namazi Hospital, Shiraz, Iran. Patients with traumatic brain injury and Glasgow Coma Scale scores 13 to 15 were included. The clinical and CT scan results of patients were collected, compared and analyzed using SPSS software. P-values less than 0.05 were regarded as significant. Findings: Out of 263 patients, 182 (62.6%) and 81 (30.8%) were male and female, respectively. Also, the mean age of participants was 21.36±21.79. The most prevalent indication in patients was vomiting (56.3%) and the most prevalent unnatural indication was linear skull fracture. The present study reported that there is a significant association between unnatural CT scan results and indications of loss of consciousness level (P<0.01), headache (P=0.01) and post trauma seizure (P=0.04). Conclusion: The present study came to the conclusion that the four indications, namely, consciousness level, headache, post trauma seizure and vomiting can well predict the necessity for using CT scan in patients with minor traumatic brain injury.

Introduction: Subcutaneous musculoskeletal hydatid cysts are rare ,representing around 1-5%.It mimics a soft tissue tumor ,so preoperative radiological diagnosis is important to choose the treatment. Case Presentation: This case was presented to clinic in Prince Ali Hospital in Karak . A 78 years old female patient was presented complaining of right medial thigh swelling which appeared a few weeks ago.The swelling caused discomfort and pain .On exam ,a lump was located in the medial aspect of the right thigh,round,soft,non mobile. Her US revealed multiple well defined cystic lesions in the posterior aspect of the thigh, with internal septae mostly representing a hydatid cyst. A MRI was ordered and showed a large,multi-lobular, thin walled and non-calcified fluid containing cyst. The appearance was consistent with a hydatid cyst.Next,the patient underwent abrain,chest and abdominal CT to check if there was aprimary source,the results were negative.An Echinococcus Granulosa titer test was ordered, the result was negative. Treatment options were discussed.we preferred to start with the conservative approach.So,a high dose of Albendazole was started,with regular follow up in the clinic,but conservative treatment failed so we decided to continue with surgical treatment by complete excision. Conclusion: Echinococcal disease should be considered in any patient who presents with a cystic mass despite body location. Especially in endemic areas.

Introduction: Abnormal uterine bleeding is a common and serious problem in the women of late reproductive age, and an indication for biopsy. Common diagnostic methods in Iran including the endometrial biopsy with dilatation and curettage (D&C) are the gold standard for diagnosis. The aim of this study is to compare the diagnostic power, complications, and duration of endometrial biopsy caused by two diagnostic methods of endometrial sampling of pipelle with dilatation and curettage (D&C) in patients with AUB. Methods: This single blinded- parallel randomized clinical trial was performed at the Iranian Center for Clinical Trials (IRCT). The research population is the patients referring to the specialized clinic of Mostafavian and Baghban 1 in Sari with complaints of AUB from October 2016 to September 2018. The patient selection was available for study. The patients were divided in simple random method into two groups of D&C and pipelle alternatively. The samples were sent to pathology after sampling, and when sampling is done, the patient was examined for complications such as uterine bleeding or vasovagal shock symptoms for the cervical stimulation, then, the results were compared with D&C, and also it was compared with the sample histopathologically. Findings: A number of 70 patients were included, while many of which were excluded, and finally 50 patients were completed the study. First, the biopsy with pipelle and then biopsy with D&C were performed on all the patients. The mean age of subjects was 47.5 years old. The highest number of patients (28%) was in the 40-45 group. The mean thickness of the endometrium in patients was 11.5 mm. In the pipelle group, 34% of the cases of insufficient samples were obtained, while using the biopsy, only 4% of the insufficient samples are obtained. A total of 23 samples from 50 patients undergoing pathologic diagnosis were obtained from two similar sampling methods. In the pipelle group, the insufficient sample with 34% proliferative, and then the secretion and proliferative samples were the second and third (prophylactic and secretion pathology are considered as normal tissues that was calculated 56% in this study) in the diagnosis, and accommodation of the pipelle and D&C samples in proliferative has allocated the highest percentage of 9%, and the lowest accommodation was in the in atrophy and polyps and hyperplasia. The average duration of the procedure in the pipelle group was significantly lower than D&C. The pain was significantly higher in pipelle group than D&C (P <0.05). Conclusion: Pipelle is a cheap, fast, outpatient method with low side effects without the use of anesthesia and operating room facilities for diagnosis of hyperplasia and cancer with lower susceptibility to D&C. In the D&C with acceptable susceptibility and specificity, the pain was lower, number of insufficient samples was lower, and diagnosis of polyps was higher.

Objective : To assess the survival rate of skin graft management in skin lesions of mycosis fungoides patients after therapy with ultraviolet radiation. Methods : Between February. 2011 and June 2015, 89 [8- 81 yrs. ] mycosis fungoides patients were followed up at dermatology clinic, the initial investigations were skin biopsy and the most common used therapy is photo therapy with ultraviolet radiation ( according to stage in the histopathologic reports ) Results : Of the 89 patients that we followed , 90% treated with phototherapy (80 patients ), 35% of them ( 28patients ) of these patients were managed by skin grafts of skin lesions and ulcers , 10% of them ( 3patients ) the skin graft didn’t survive without previous therapy with ultraviolet radiation , 90% (25patients ) of them the grafted areas survived after phototherapy of UVA ,UVB radiation to the potential donor site, the other 65% (52patients ) of the followed pts were managed without skin graft for the ulcerated skin lesions , 38% of them healed spontaneously , others didn’t healed for a long time and need skin graft. Conclusion: Mycosis fungoides is the most common type of cutaneous T lymphoma, pts who received phototherapy to the potential donor site has proven beneficial for skin graft survival , since ultraviolet radiation A,B ,decrease the cytotoxic T lymphocyte activity and decrease inflammatory cells in both graft and donor tissues , with decrease in the antigen presenting cells expression, which leads to decrease in the delayed type hyper sensitivity reaction and increase graft uptake.

Objective: One of the causes of male infertility is varicocele that has negative effects on sperm parameters.By doing varicocelectomy that it is an effective method for the treatment, there will be significant recovery in sperm parameters. The aim of this study is to evaluate sperm parameters before and after Varicocelectomy and a pregnancy rate in patients. Methods: This cross-sectional study has been performed on patients with primary and secondary infertility who underwent varicocelectomy during 2009-2014 in hospitals of Sari, north of Iran. Demographic data has been extracted from hospital records and necessary information about spermogram has been gathered according to a checklist designed for this purpose. We used a questionnaire that contained demographic characteristics of patients and values of variables before and after varicocelectomy. Finally all data have been analyzed statistically using SPSS ver.20.The significance level was set at 0.05. Results: of51 studied cases with the mean age of 37.3 years 50.98 percentswere above 40 years of old. 24 patients had varicocele grade II and 27 ones had grade three. Bilateral varicocelewas the dominant type in patients. The final finding represented that sperm indexes improved significantly after the varicocelectomy (p=0.001). Conclusion: Results of our study showed that varicocelectomy leads to significant differences in sperm parameters (count, motility and morphology), while the fertility rate also significantly increased.

Objective: The general pathology of cancer was long in turmoil over the two extremes of constitutionalism and localism. Therefore, my mini-Library of historical works was searched so as to obtain a good idea as to the ultimate development. Methods: Many different literatures on the subject matter were reviewed and used. Results: Two major issues were delineated. The constitutional theory saw cancer being a whole body affair with some local manifestations whereas the localists believed in a focal origin which may go on to manifest widely. Naturally, there was the midway group called the dualists who managed to hold both concepts Conclusion: The controversy that reigned in the history of these concepts are deemed to be worthy of documentation. By 1900, the localists gained the upper hand principally on the principle of embolism.

Objective:Femoral neck fracture is associated with several complications and poor prognosis. This study design to survey the complications of femoral neck fracture. Methods: We design a descriptive analytical study. All patients with femoral neck fracture from March 2012 to March 2014 who referred to Imam-Khomeini Hospital of Mazandaran University of medical sciences at Sari city were enrolled to this study. Patients were follow for 12 months. Patient’s demographic data, radiologic data, type of treatment (surgery or supportive Therapy) and type of complication were recorded. Results: from 72 patients how referred to our center, 50 patients (28 men) with mean age of 58.43±6.73 years complete the study. There was not significant difference between men and women age (56.5±21.17 vs. 59.72±16.38 years, P=0.55). 22 cases (40%) (7 men) by arthroplasty, 13 cases (26%) (10 men) by cannulated screw fixation and 15 cases (30%) (11) by dynamic hip screw (DHS) were treated. 14 patients (28%) including 4 men and 10 women were afoul complications that included avascular necrosis (3 patients), dislocation of prosthesis (2 patients), pulmonary embolism (one patient), intraoperative femoral shaft fracture (one patient), relocation of screw and shortening of the femoral neck (2 patients) and death in 5 patients who all of them were women (mean age of 79.35±5.81 years) and surgery by arthroplasty technique. morbidity and mortality were significantly higher in women (p=0.007) Conclusion: morbidity and mortality were significantly higher in women. arthroplasty associated with high rate of complication and death, especially in older patients.

Objective: 1. To assess the histopathologic discrepancy between prostatic needle biopsy and open radical prostatectomy specimens in terms of Gleason score upgrading and bilaterality 2. To evaluate the impact of this discrepancy on the surgical margin status of radical prostatectomy specimens Methods: This study was conducted at Prince Hussein Urology Center, Amman, Jordan. Between May 2010 and August 2015, 74 patients underwent open radical prostatectomy for localized prostatic cancer diagnosed by prostatic needle biopsy based on high PSA level. We compared histopathologic findings regarding Gleason score and bilaterality between prostatic biopsy and radical prostatectomy specimens, and then we evaluated the impact discrepancy between them on the surgical margin status of radical prostatectomy specimens. Results: 52 patients (70%) had upgrade in Gleason score with mean increase by one. All 34 patients who had bilateral disease on prostatic biopsy had bilateral disease on radical prostatectomy, but of the remaining 40 patients with unilateral disease 18 patients (45%) had bilateral disease on radical prostatectomy specimen. Surgical margin was involved in 3 patients (4%), all of them had Gleason score > 7 and bilateral disease on both biopsy and surgical specimens. Conclusion: In spite of the significant histopathologic discrepancy between prostatic needle biopsy and open radical prostatectomy specimens, however in clinically localized prostatic cancer this discrepancy has no impact on surgical margin status.

Objective: The purpose of this study is to examine the effect of musicotherapy on the vital signs of patients in a surgical intensive care unit. Methods: This quasi-experimental research was conducted at Inonu University Turgut Ozal Medical Center General Surgery Intensive Care Unit (ICU). The study population consisted of patients who had been hospitalized in the ICU during the last 24 hours, who remained at least one day in the ICU, and who agreed to participate in the study. They were over 18 years of age, and their levels of consciousness were 5 or higher according to the Glasgow Coma Scoring System. The sample was collected from 202 patients who were hospitalized at TOTM general surgery ICU after power analysis. Patient identification forms and the registration forms containing vital signs before and after the intervention were used for data collection. Information from patient identification forms and registration forms indicating vital signs (pulse rate, systolic and diastolic blood pressure, oxygen saturation level) before music therapy was recorded on the second day after admission to general surgery ICU. This information about the patients was recorded again after music therapy. The data were evaluated with descriptive statistics and a paired t test. Results: Pulse rates, systolic and diastolic blood pressures were lowered by music therapy, and low oxygen saturations were raised by music therapy. Conclusion: The results show that music therapy is effective.

Objective: Physeal injuries in childhood may produce irreversible damage to the growing cells, resulting in growth disturbance. The aim of this study is compare conventional radiography and magnetic resonance imaging (MRI) in the assessment of distal radius epiphyseal and physeal injury. Methods: 31 cases with distal radius trauma were examined with conventional radiography and MRI. One blinded experienced radiologists and one blinded experienced specialist in orthopedics separately evaluated the results. Results: The main age of our patient was 11.74±2.98 years. The results of MRI showed 90.32% injury in all patients whiles conventional radiography showed 64.51% injuries (P=0.014). In survey the physeal injury by conventional radiography we have 6 Salter–Harris II fractures. Meanwhile, the MRI showed 9 physeal injuries that included 6 Salter–Harris II fracture and 3 other fracture with physeal injury (all of them had distal radius microfracture with mild physeal injury) (P>0.05). In patients that conventional radiography showed they were normally, MRI showed 4 Bone Bruising and 4 microfracture. The other results were similar. The sensitivity, specificity, Positive predictive value, negative predictive value and total accuracy of conventional radiography in diagnosis of physeal injury were 66.6%, 100%, 100%, 88%, 90.32%. Conclusion: our study showed MRI and conventional radiography had almost similar power to diagnosis growth plate injuries in distal radius trauma. When we considering high cost of MRI, it’s seems that conventional radiography was beneficial than MRI to use in distal radius injury.

Objective: There are different aspects of the history of pathology which are rewarding. Therefore, my mini-Library of historical works was searched so as to obtain a good idea as to the ultimate development. Methods: Different aspects of the literature on this subject matter were reviewed and used. Results: There were apt acknowledgements of certain themes which are worthy of documentation. Conclusion: The harvest included the co-authorship of pathologists, the quotations being used to eliminate the suspicious of plagiarism, the contribution of microscopy and illustrative plates, as well as the watching of postmortems, the receiving of research grants, and, finally, the pleasure of working under the Director of the Laboratories Committee of the Conjoint College in England.

Objective: Self-immolation is one of the terrible way of suicide. Lack of data about suicide by Self-immolation method in Sari city (north of Iran) caused we designed this study to evaluation of self-immolation suicide attempt in Sari City (north of Iran) between 2011 to 2014. Methods: In a retrospective study we review the medical record of 74 cases that attempt to suicide by self-immolation between 2011 and 2014 in Sari City (North of Iran). The medical record of all these patients included age, sex, marital status, residency in urban or rural, the season in which they attempt suicide, length of hospital stay, history of psychiatric diseases, history of underling disease, history of addiction and results of suicide attempt were collected. Data was analyzed by SPSS version 18. Results: 74 patients included 52 females (70.3%) were attempt suicide by self-immolation method. The female to male ratio was 2.36. the mean age of all patients was 32.32±12.89 years old (between 12 to 75 years). There was no significant difference between mean age of women and men (32.55±13.64 vs. 31.77±11.20 years respectively, P=0.81). the prevalence of self-immolation was higher in spring (36.5%). Majority of the cases were married (59.5%). 19 patients (25.7%) was addicted to drugs included 16 opium addiction (84.2%) and 5 crack addiction (15.8%). 25 cases (33.8%) had history of psychiatric disease and 13 cases (17.6%) had history of seizure. Finally, 68 cases (91.9%) from 74 patents were die. Conclusion: The prevalence of self-immolation was higher in women, spring, between drug user and in married patients. Suicide by self-immolation was associated with high rate of mortality.

A 27- year old lady with severe headache, nausea, vomiting and impaired cerebellar function. She had a history of a left arm synovial sarcoma and she was evaluated with magnetic resonance imaging (MRI) that shows a gadolinium enhanced mass measuring about 7 mm in diameter with both solid and cystic portions in left cerebellar hemisphere causing mass effect. Histologic evaluation confirmed poorly differentiated type synovial sarcoma composed of tumor cells containing pleomorphic round to oval hyper chromatic to vesicular nuclei with coarse chromatin and a little light eosinophilic cytoplasm. The IHC stain is done and showed EMA, CK and vimentin positivity in tumor cells. The patient was treated with surgery, chemotherapy and radiotherapy. In the follow up study at 6 month post chemotherapy evaluation computed tomography (CT scan) showed pulmonary metastases and transthoracic biopsy revealed the same pathologic feature. According to our patient, brain metastasis could occur even in extremities synovial sarcoma and so CNS imaging as screening may be introduced in follow up plan of these patients.

Objective: Brucellosis is an zeonotic disease and it is a health and economic problem in many parts of the world, including Iran. The disease is endemic in Iran and the reported cases increased, however, disease outbreaks are not clear. This review aimed to determine the prevalence of brucellosis in normal and high-risk population in Iran. Methods: This systematic review and meta-analysis was performed in article about Brucellosis in Iran. Systematic search was conducted in the databases, include: Pubmed, Scopus, SID (as a local database) until August 2015. Finally we have 454 article after deleting duplicating material by Endnote software. Data extraction form contains author, publication year, sample size, laboratory test, study population in normal person and high risk person and seroprevalence. Finally, Data were analyzed by STATA 11.1 and random effect. Results: Finally, we enrolled 11 studies and 7688 person in high risk group and 13858 person in normal group were studied. The seroprevalence of brucellosis in normal population was 0.12 (CI95%: 0.08 - 0.17). The seroprevalence of brucellosis in High-risk population was 13.07(CI95%: 12.3 - 13.7). Conclusion: The prevalence of brucellosis in high-risk occupations was high in comparison with normal population and it seems that control of livestock diseases should be considered more.

Human kind has used the herbal plants to treat lots of diseases since a long time ago and there was always a very close connection between people and plants due to the development of all the societies and they were used to treat different diseases in eastern Asia ,India , China and Iran since a thousand years ago .This plant height is one to two meters and has some leaves with separated and narrow laminas .This plant has some estrogenic ,anti inflammatory and antioxidant effects and traditionally is used to treat infertile women .Its specific combinations are Anethole, limonene and fenchone .it’s properties are :pharmaceutical effect on the treatment of the initial dysmenorrhea ,testis growth , excretion channel and Prostate glands , mammary gland weight gain, fallopian tubes, ovaries, endometrium, myometrium protective effect on the liver by reducing Liver enzymes and bilirubin, have estrogenic effects in increasing the milk secretion, early periods, ease at birth and increased libido and anti hyper tension effects through the diuretic and natriuretic effects .

Objective: Matrix metalloprotease 9 (MMP9) is a group of proteolytic enzymes that mediate breaking down the components of the fibrillar extracellular matrix during tissue rearrangement,physical,biological and pathological conditions such as growth, wound healing, inflammation and tumor progression. To investigate the association of these markers with clinicopathologic features and survival of colorectal cancers(CRC),we examined its expression in colorectal cancer tissues. Methods: The expression of MMP9 in 91 paraffin embedded specimens of colorectal cancer and normal tissue adjacent to the tumor of patients referred to Imam Khomeini Hospital in Sari,Iran was studied immunohistochemically and the relationship between the clinical data and pathological features were considered,too. Result: 91 samples (43 women and 48 men) were studied including 6 mucinous carcinoma and 88 adenocarcinoma. MMP9 expression was negative and positive in 31 and 66 cases respectively. Expression of MMP9 in normal tissue around the tumor was 5.5%. Our finding revealed that the MMP9 correlated significantly with tumor depth (p-value: 0.033) and metastasis to lymph node (p-value: 0.007). The association of MMP9 expression with the other clinicopathologic factors was not statistically significant (p-value> 0.05). Conclusion: According to this study,the relationship between the expression of MMP9 with lymph node metastasis and depth of tumor was observed. To confirm the result, vast studies with more samples and also with the other matrix metalloproteinase proteases is recommended.

Introduction: Placenta disorders are the most prevalent and the most serious complications of pregnancy in human beings. In the current study, pathological analysis of placental samples sent to the department of pathology from 2009 to 2016 was done. Methods: The present study is a cross-sectional study on placenta samples sent to the department of pathology taking a census. Age and number of pregnancies, microscopic and macroscopic findings of placenta and umbilical cord, placental length, placental width, placental thickness, placental weight, the length of umbilical cord and the thickness of umbilical cord were recorded. The data were collected by a checklist and were entered in SPSS version 17. Findings: The results also showed that there was a significant statistical difference between microscopic findings of placenta and age and also between microscopic and macroscopic findings of placenta and the number of pregnancies (P-value<0.05). Conclusion: Since there is a meaningful statistical relationship between placental microscopic findings and age, and between placental microscopic and macroscopic findings and the number pregnancy, it can be concluded that age increasing and number of pregnancy are two main factors associated with an increase in the risk of placental changes.

Objective: The aim of this study is to find out the occurrence of calcaneal spurs in plantar fasciitis patients. Methods: Patients with planter fasciitis were diagnosed in the rheumatology clinic at Prince Rashed Hospital and Prince Hashem Hospital. Only 140 eligible patients were exposed to careful examination and hind foot lateral radiographs. All patients were observed in regards to their age, weight and calcaneous bone X-Ray. For calcaneal spurs occurrence, the patients were divided into two groups; (present, absent). Data analysis was done based on simple statistical methods and Chi-squares tests. Results: Planter fasciitis occurrence increase with the increase in age and weight (80%, 76% respectively) (Ps < 0.05). 98 patients out of 140 of patients with planter fasciitis were diagnosed with calcaneal spurs (70%) (Ps < 0.05). Conclusion: This study shows that there is a positive relation between calcaneal spurs and planter fasciitis.

Evaluation of new nutrient sources plays an important role in crop production. A field experiment was conducted at BRRI, Gazipur and at BRRI regional station, Sonagazi, Feni during Boro season of 2014-15. A new fertilizer, NP compound (NPC) was evaluated and compared the performances with di-ammonium phosphate (DAP). Test crop was BRRI dhan29. At Gazipur site, phosphorus (P) control plot produced only 1.97 t ha-1 grain yield that increased with added P along with two N rates. At lower N doses, application of P either from DAP or NPC produced similar grain yield. It was observed that 30% less N produced statistically similar grain yield to 100% N, irrespective of P sources. It can be inferred that 30% N could be saved without significant reduction of rice yield. At Sonagazi site, application of P either from DAP or NPC could not increase rice grain yields compared to P control plot. From the results of both sites it can be concluded that NPC and DAP performed equally either with 100% N or 30% less N rates.

Abstract idiopathic esophageal achalasia (IEA) is a rare motor disorder whose initial manifestation is dysphagia, sometimes versus liquids. IEA can be an uncommon manifestation of some rheumatic inflammatory diseases such as Sjogren syndrome, systemic lupus erythematosus, sclerodermia, rheumatoid arthritis. IEA is considered a precancerous condition and the possibility that it represents a risk factor for development of esophageal carcinoma (EC) has been more and more descripted. These same rheumatic diseases - when long-standing and/or aggressive - can give an esophageal amyloidosis (EA) with AA amyloid deposits . EA is very rarely descripted as unique manifestation of systemic amyloidosis during these diseases. IEA has a typical manometric pattern whereas in EA the anarchic arrangement of amyloid can produce unforeseen and uncharacteristc motility patterns different from the idiopathic one. Both IEA and EA are very rare conditions. For IEA, it has been extimated an annual incidence of 2/100,000 and a prevalence rate of 10/100,000 with a peak incidence between 30 and 60 years of age. The prevalence and incidence of EA are uncertain. The surgical experiences in esophageal pseudoachalasia are aneddhotic. We describe the clinical case of an elderly woman suffering from long-lasting rheumatoid arthritis in which an EA overlapped an IEA, causing the sharp worsening of dysphagia and poor prognosis despite surgical approaches. According to our knowledge, this overlap has been never descripted.

Objective: Leptospirosis is one of the most common zoonosis diseases that presents by involvement of different systems. This infectious disease ranges from mild to very severe but bloody diarrhea is not a known clinical primary manifestation of the illness. Case Presentation: We describe a patient with leptospirosis who was admitted because of bloody diarrhea in the beginning. The patient admitted as a probable shigellosis case. Diagnosis of leptospirosis was confirmed based on result of Leptospira microscopic agglutination test (MAT). After 7 days treatment he made a complete recovery and was discharged. Conclusion: Although leptospirosis with presentation of bloody diarrhea is an unusual report. Leptospirosis should be considered in all febrile patients particularly in farmers endemic area.

Pre analytical factors are probably the most important causes of erroneous trace element reference data in biological matrices today and the development of sensitive , specific, and accurate analytical technology at an acceptable cost has moved determination of trace and ultra trace elements from research facilities into a wide range of clinical laboratories. Besides, expanding knowledge of trace element nutrition and toxicity has increased clinical demand for these assays. However, with increased sensitivity and lower limits of detection the problem of specimen contamination with the element of interest has been magnified. It is vital that the accurately determined trace element concentration to reflect the condition of the patient and not contamination introduced during collection and handling. In the following paper, the concept of pre analytical factors that can contribute to trace and ultra trace elements concentration are discussed. In addition, specific percussions for collecting different sample types and special considerations in patient preparations and sample types for specific Trace and Ultra Trace Elements analysis are addressed.

Abstract Backgrounds: teaching and learning environments are subject of different investigations and many researchers in medical education are working on it. Therefore in this study we examined the clinical skills labs equipment with Ministry of Health and Medical Education standards in different educational hospitals of Shahid Beheshti University of Medical Sciences. Material and methods: The study population involved 15 attending physicians and 40 emergency medicine residents in the three hospitals, Imam Hussein, Lughman Hakim and shohadaye Tajrish of the Department of Emergency Medicine of Shahid Beheshti University of Medical Sciences in the academic year 2015 to 2016. Self-made questionnaire was used to compare the Ministry of Health and medical education standards with the clinical skills labs in these centers. Results: Clinical Skills Centers with the facilities of examination skills, communication skills and procedures, Evaluation the performance of students in each training session under the supervision of clinical faculty members had the highest scores. Conclusion: we concluded that that learning environment is very important in the quality of learning and most of the participants proved it. Educational centers must provide the well-equipped environment to achieve in high quality in teaching and learning.

There is a recent study of the history of the pigmentary tumors. However, it does not mention brain metastases. Accordingly, extensive search of the Transactions of the Pathological Society of London, which I have in my mini-Library, was undertaken. Consequently, the findings are analysed here. They range not only from observing the brain in its “natural” state but also to abstracting useful data. In this context, some eponymous giants were exemplified in terms of anatomical exactitude. Even the concept of “emboli” appeared.

Abstract Introduction: Brucellosis constitutes a major health and economic problem in many parts of the world, including countries Middle East and the Arabian Gulf. Epidemiological investigations conducted in the Middle East, demonstrated a wide spread distribution of brucellosis in the region, with Saudi Arabia having the highest prevalence of brucellosis.Thus the aim of the study was to evaluate the prevalence of brucellosis in Al-Rass city, Qassim region of Saudi Arabia and to determine its associated factors. Materials and Methods: A cross-sectional survey was carried out in March 2013 with a random consecutive sample of 40 subjects visiting Aljreef dispensary, in Al-Rass city, Qassim region, K.S.A. The blood samples obtained from the study subjects were analyzed in two steps namely: (1) Slide agglutination test; and (2) Standard tube agglutination test. Results: The prevalence of brucellosis in this study sample was 15% predominantly in the age group of 34 to 46 years. The two predisposing factors associated with brucellosis prevalence were consumption of raw milk and daily direct contact with animals. Conclusion: It can be concluded that there is a high prevalence of Brucellosis in Al-Rass city, Qassim region. The prevalence of Brucellosis is significantly associated with drinking raw milk and direct contact with animals. An improved healthcare system with outreach programs to educate farmers on Brucellosis preventive measures is needed to minimize the prevalence.

Objective: The aim of our study is to demonstrate the association between psoriasis and CAD in a group of patients at QUEEN ALIA HEART INSTITUTE (QAHI). Methods: This retrospective study was conducted at QUEEN ALIA HEART INSTITUTE from April 2012 to August 2016. 167 psoriatic patients (with moderate to severe psoriasis) and 197 non-psoriatic patients (control group) were matched by sex, age and risk factors of CAD. All patients underwent coronary angiography, and the incidence of coronary artery disease was compared between the two groups. Results: After analysis, the p-value of CAD risk factors in both groups (psoriasis and controls) were: age (41.3 year, 35.4 ,0.04) , male (67% , 64% ,0.06), smoking (60.5% , 56% , 0.4) , HTN (40.5 % , 43% , 0.29 ) ,DM (37.5% ,36.3% ,0.3), hyperlipidemia (20.3% , 17.8% , 0.41), family history (36.1% ,34..4 ,0.05). After matching for all these risk factors, the rate of CAD in psoriasis patients was (8.2%) and (2.1%) in non-psoriatic patients with p-value less than 0.001. Conclusion: Psoriasis (moderate and severe) is an independent risk factor for increasing the risk of coronary artery disease in (sex, age, and other risk factor for CAD) matched patients.

Background: In search of appropriate treatment for most diseases caused by the intestinal pathogens due to antibiotic drug resistance by these organisms, this study is therefore designed to evaluate the antimicrobial effect of natural honey on some enteric pathogens. Methods: The enteric pathogens used in this study were isolated from the stool samples of apparently healthy students of Adekunle Ajasin University Akungba Akoko, Ondo State, Nigeria. Natural honey on the other hand was purchased in Okusa market in Akungba Akoko. The honey was diluted using two different solvents namely; water and ethanol and was made in different concentration with ethanol and water respectively. One hundred stool samples (100) were collected from both males and females gender. The enteric pathogens were isolated using standard microbiology techniques. Results: Out of the hundred samples analyzed, the following pathogens were recovered: Escherichia coli, Salmonella typhi, Klebsiella pneumonae, Shigella dysenterae, Campylobacter jejuni and Helicobacter pylori. The sensitivity patterns of the pathogen to the natural honey were also investigated. The pathogens were sensitive to different concentrations of the test honey in an increasing order as follows: Klebsiella pneumonae, Helicobacter pylori and Campylobacter jejuni (100 %), Escherichia coli, Salmonella typhi and Shigella dysenterae (85%). Statistical analysis showed a significant difference between natural honeys diluted with water and the one diluted with ethanol (P<0.5%). Conclusion: Natural honey has been found to inhibit some intestinal pathogens with highest sensitivity impact on Helicobacter pylori, Campylobacter jejuni and Klebsiella pneumonae. Moreover, this study also shows that natural honey with different dilutions is more potent than the crude- undiluted natural honey for prophylaxis against infections caused by some enteric pathogens.

Two 8 and 10 year- old athletic boys lived in Qaemshahr urban area ( in north of Iran ) presented by erythematous plaques with folicularpostules on head area extending from right occipital to right temporal regions with itching and hair loss about 2 weeks prior their initial visit when the itching and postules and hair loss increased. The diagnosis was Kerion. Endothrix hyphea was seen within hair shaft and Trichophyton Mentagrophytes was isolated from scales and tissue taken from lesions on the head. Postules disappeared 3-4 weeks after oral treatment with terbinafine 125 mg daily. No recurrence has been observed to date.

Primary hyperparathyroidism (PHPT) is a disease caused by excessive secretion of parathyroid hormone (PTH), and occurs because of individual parathyroid adenomas.in this report we discussed prgnant 25 female who suffered from as weakness, lethargy, nausea and vomiting . Primary experimental results suggested severe hypercalcemia. Ultrasonography of patient’s neck revealed a cystic thyroid nodule (12.8mm) in mid of right lube. The observation suggested normal parotid and submandibular glands.Based on ultrasound and MRI results, the patient received protective treatment. Early diagnosis can helpful to best managament of primary hyperparathyroidism especially during the pregnancy.

Inferior vena cava injury in abdominal trauma is rare but it puts a big problem in front of trauma surgeon. Despite improvements in preoperative care, skills and surgical facilities, inferior vena cava injury mortality rate remains high. The most important factors that play a prominent role in mortality are presence of shock on admission, anatomic level of vena caval injury or other major vascular and visceral injuries. In this article we have reported successfully treated a case of the inferior vena cava injury after penetrating abdominal trauma in old age man with hemorrhagic shock, survived due to immediate laparotomy, successful surgical management with team approach and critical postoperative surgical management without any residual complication.

The strategy of price liberalisation and privatisation had been implemented in Sudan over the last decade, and has had a positive result on government deficit. The investment law approved recently has good statements and rules on the above strategy in particular to pharmacy regulations. Under the pressure of the new privatisation policy, the government introduced radical changes in the pharmacy regulations. To improve the effectiveness of the public pharmacy, resources should be switched towards areas of need, reducing inequalities and promoting better health conditions. Medicines are financed either through cost sharing or full private. The role of the private services is significant. A review of reform of financing medicines in Sudan is given in this study. Also, it highlights the current drug supply system in the public sector, which is currently responsibility of the Central Medical Supplies Public Corporation (CMS). In Sudan, the researchers did not identify any rigorous evaluations or quantitative studies about the impact of drug regulations on the quality of medicines and how to protect public health against counterfeit or low quality medicines, although it is practically possible. However, the regulations must be continually evaluated to ensure the public health is protected against by marketing high quality medicines rather than commercial interests, and the drug companies are held accountable for their conduct.

Introduction: Today, with advances in the treatment of cardiovascular patients such as intravascular stents, cardiac valves and intracavitary pacemakers and cardiac transplantation, many cardiovascular patients should use anticoagulants such as warfarin, aspirin, Plavix and Sosix, Ticlopidine and other drugs. The aim of this study was to investigate the effects of coagulation drugs on the rate of bleeding of oral surgeries and warfarin alternative. Methods: For access to studies on anticoagulant drugs and their effect on the bleeding of oral surgery in heart patients, the PUBMED, MEDLINE, MAGIRAN, SID, ELMNET and GOOGLE databases have been used since 1998 to 2015. Keywords include oral surgery, anticoagulants, warfarin, dentistry and bleeding. Findings: In the investigations done on the studied articles, it seems that patients with anticoagulant drugs that are supposed to undergo minor dental surgeries do not require discontinuation, dose reduction, or even control of coagulation factors and bleeding can only be controlled by local dental procedures such as suturing, mouthwash, gel sponge. And the risk of severe complications in case of warfarin interruption and thrombosis is more than uncontrolled bleeding from the teeth. There is also no need for alternative warfarin medicines. Conclusion: The hazard of severe complications in case of warfarin interruption and thrombosis is more than uncontrolled hemorrhage from the teeth. There is also no need for alternative warfarin treatments.

Aim: This study was done to evaluate the awareness of medical interns and trainees about technics of controlling and prevention from nosocomial infections. Methods: In this cross-sectional research, 252 medical interns and trainees (92 boys and 160 girls) from Shiraz and Fasa medical universities were selected. 37 multiple choice questionnaires were prepared and distributed among them to assess their awareness. Results: 33% of students were in low group, 50% were in mean group, and 17% were in the favorite awareness group. About recognizing ethanol application in hospital, awareness was in mean level. There was more favorite data about application of safety box for sterilization, removal of needles and syringes for injection, and 62.8% of trainees and 60% of interns knew their usage. Conclusion: we concluded that for medical and para-medical students and staff to pass the training courses of nosocomial infections control practices.

Listeria monocytogenes is an opportunistic intracellular pathogen that has become an important cause of human food borne infections worldwide. The aim of this study is the determinate sensitivity of diagnostic methods of this organism and achieving a test that can detect Listeria monocytogenes in all circumstances in clinical samples. Materials and Methods: In this study 88 vaginal swabs were collected from women with age of (15-45) referred to gynecologic clinics in the hospital (Sari, Iran). Vaginal swabs were examined by culture on specific PALKAM agar medium and PCR technique by specific primers. Results: Out of 88 studied vaginal swabs, 8 cases with culture method and 27 cases were positive with PCR technique. The sensitivity of PCR and culture is reported %100, %29 respectively. Conclusion: The results show that PCR is a more sensitive, easier, and faster method in comparison to in clinical samples.

Introduction: Rupturing of fetal membranes before week 37 is called preterm premature rupture of membranes (PPROMs). The pathogenesis of PPROM is not definite but it seems that many mechanical and physiological etiologies are involved. As the most important risk factors, having a late history of the same disease, genital infection, prepartum bleeding and smoking can be named. Premature rupture of the membranes is usually seen in preterm births and it accounts for about 1/3 of them. Methods: This interventional semi experiencing study was done on patients visiting the Sayyad Shirazi hospital in Gorgan with a chief complaint of leaking fluid in week 24 up to 34 of pregnancy. Noticeable neonatal complications in this study were birth time Apgar, admission in NICU, birth weight and IUGR. All of the neonates entered the study with a gestational age of fewer than 34 weeks and admitted with a diagnosis of probable sepsis. Neonates with congenital abnormalities, asphyxia, respirational distress syndrome, meconium aspiration syndrome and birth weight less than 1000 gram exited the study. Data was analyzed with SPSS16 statistical software and Chi2 test, independent T-test and ANOVA. Findings: Admission length time until labor in the group that did not receive antibiotics was less than the other group and average admission length time between the two groups was statistically meaningful (P=0.00). In the Group that received antibiotics, on order 25, 50 and 75 percent of patients had admission length time of 7, 4 and 12 days and these percentages for the other group are 5, 3 and 7 days. Also, there was not any significance difference between the other two variables, which are the type of labor and fever frequency, and chorioamnionitis. Conclusion: According to the results, usage of antibiotics lengthens the late stage of labor and it is probably effective in decreasing the premature neonate complications. Therefore using of antibiotics in premature rupture of amniotic fluid is suggested.

Urinary retention is a urologic emergency that is defined by an inability to voluntarily void urine, which can be acute or chronic. Benign inflammatory nervous diseases also cause acute urinary retention, in which patients lack apparent urethral outlet obstruction, but exhibit minor neurological and cerebrospinal fluid (CSF) abnormalities. The development of urinary retention in the context of meningitis and CSF pleocytosis without any lumbosacral radiculomyelitis is known as Meningitis Retention Syndrome (MRS). We report a 24-year-old male with complaints of urine dribbling, fever and also complete urinary retention a few hours later and nausea/vomiting, headache and flank pain. The general and genitalia examinations, routine laboratory tests, diagnostic ultrasound, and brain MRI were normal. But HSV Ab (IgG) and PCR HSV were positive in CSF analysis. Finally, Urologist performed the Urodynamic study and flaccid neurologic bladder was reported due the patient was treated with intravenous acyclovir 500 mg, every eight hours, with the diagnosis of MRS. MRS is a rarely described clinical entity with features of meningitis and acute urinary retention. The most common cause of urinary retention is benign prostatic hyperplasia. Other common causes include prostatitis, cystitis, urethritis, stones, and vulvovaginitis; receiving medications in the anticholinergic and alpha-adrenergic agonist classes; and cortical, spinal, or peripheral nerve lesions. Since MRS has a benign and self-remitting course, the effectiveness of immune treatments (steroid pulse therapy) remains unclear, although such treatments may shorten the duration of the disease. Management of the acute urinary retention is necessary to avoid renal injury due to hydronephrosis.

The majority of adult diaphragmatic hernias is due to a chronic hiatal hernia or caused by a diaphragmatic hernia. Compared to other different forms of congenital hernias, Morgagni hernias are relatively rare. Here we introduce a case of a 73-year-old woman diagnosed with Morgagni Hernia and the choice of treatment used for the patient. The patient, a 73-year-old woman, presented with abdominal pain with the onset of 10 days prior to her visit. In the chest x-ray silhouette sign on the right side border of the heart was seen that suggested a Morgagni hernia as our primary differential diagnosis. The patient was discharged 3 days after the operation. Studies show that a Morgagni hernia should be a differential diagnosis for any patient that presents with unspecific abdominal pain or respiratory symptoms.

Pilomatrix carcinoma is an exceedingly rare malignant tumor derived from hair follicle. Although it has been described at various anatomical sites, fewer than 25 cases have been reported in the face and scalp. The diagnosis of pilomatrix carcinoma is based on histological examination of skin biopsy. . We report a case of pilomatrix carcinoma in an 85 year old male patient presented with cheek nodule.

Viral glossitis is an uncommon condition in an immunocompetent patient. We reported a patient with developed painful pseudo-membranes on the tongue. The diagnosis showed multiple viral infections. The patient promptly responded to antiviral therapy. Multiple viral infections should no longer be considered as a diagnosis only in immunosuppressed patients, but in healthy persons as well.

Carcinoma arising in posttraumatic ulcers and chronic wounds was first described by Jean- Nicholas Marjolin in 1828. Marjolin’s ulcers are malignant neoplasms that originate from chronic irritation such as burn wounds, venous stasis ulcers, traumatic wounds, osteomyelitis, fistulas, and lacerations, Burn wounds are the most frequent underlying etiology of Marjolin’s ulcers. We reported Marjolin’s ulcer that arising from very old burn scar in foot.

Subungual exostosis is a benign osteocartilaginous tumor that mostly occurs in female gender. In present article, we aimed to describe a child (male) which was suffering from rarely subungual exostosis in a toe. A 12 years old boy presented with painful 1?2cm nodule since 6 month ago. Radiography (see figure 2) demonstrated a bony lesion with a broad-based contiguous cortex. The lesion surgically excised and the “Subungual Exostosis” confirmed histologically. According to next follow up, patient did not mention any recurrences.

Objective: To present a profile of impetigo in children in sector Gaza. Methods: All patients that were seen in the outpatient clinic in Jordanian hospital in Gaza between 25/11/2010 and 24/01/2011and presented with skin rash were examined for impetigo. Patients were divided into three age groups: group I: 0-5 years, group II: 5-9 years and group III: 9-14 years. Results: A total of 6530 children were seen in outpatient clinic for various diseases and conditions during study period. 165 cases of impetigo were reported with 108 males and 57 females. Impetigo was higher in age group II: age 5-9 years, followed by group III: 9-14 years. The incidence of impetigo among children seen in clinic was 0.02% and was higher in males. Commonest manifestation was blisters or sores on the face, neck, hands, and diaper area. Conclusion: Impetigo is a common disease among children in Gaza. Major contributing factors to this disease are: crowding, poor hygiene, scarce water supplies, low socio-economic class, warm weather and presence of already irritated skin by problems such as eczema and insect bites.

Objective: Illness behaviour is an important concept studied across various medical conditions. It determines the ways person respond and react to their health status and has significant impact on the health systems and individual. However, there are no systematic reviews on this important topic. To do a selective systematic review of researches done in India on illness behaviours across different health conditions. Methods: Journal articles were identified through search on the PubMed, Medline, PsychInfo electronic databases from 1970 to 2015 with the search terms (Illness behaviour, India, Abnormal illness behaviour). The full articles were reviewed to identify measures used and important findings were extracted and summarised. Results: There were 15 studies which were based on patients and two review articles (non-systematic). The studies on illness behaviour focused on somatoform disorders, tuberculosis and stroke. Scales used for assessment included Illness Behaviour Questionnaire (IBQ), Illness Behaviour Assessment Schedule (IBAS) and Screening for Illness Behaviour Questionnaire (SIBQ). No studies were found on intervention for abnormal illness behaviour. Conclusion: Illness behaviours are an important aspect of somatoform disorders. It is difficult to draw conclusions due to relatively small number of studies. More studies including randomised control designs are needed to understand patterns of illness behaviour across disorders.

Introduction: Caesarean section (also known as C-section or caesarean delivery) has undergone an enormous increase over the recent decades, particularly in Iran where the rate of C-section is five times larger than that of the global standards. Moreover, according to several studies, there is the possibility that caesarean delivery can affect umbilical vein blood gas. Accordingly, the present study was conducted aiming to examine the impact of delivery type on the indices of term newborn infants’ umbilical vein blood gas. Methods: The present cross-sectional study explored a total of 222 newborn infants born in Shahid Motahari Hospital, Marvdasht, Iran in 2015 based on three delivery-type groups, namely, natural delivery, general anesthesia-used caesarean and spinal anesthesia-used caesarean. Of all the infants, an amount of 0.5cc umbilical vein blood was taken and then examined in terms of blood gases. The two groups were compared with each other with regard to 1st and 5th minutes’ Apgar score, anesthesia duration as well as its influence on blood gases. The data was then analyzed using SPSS software. Findings: Mean and standard deviation values for Apgar score in natural delivery at the beginning of birth equaled 8.8 ± 0.59, suggesting a significant difference between natural delivery and other caesarean groups (P= 0.01). It should be noted that no significant difference was reported in infants’ umbilical vein blood in the two groups in terms of pH (P=0.08), PO2 (P=0.79) and PCO2 (P= 0.85). Likewise, there was a significant difference in umbilical base excess of natural delivery and caesarean groups (P=0.03). Conclusion: Based on the research results, compared to infants in caesarean groups, those born naturally enjoy higher Apgar score and base excess.