No Abstract

Stem cells are self-renewing and undifferentiated cell types that can be differentiate into functional cells. Stem cells can be classified into two main types based on their source of origin: Embryonic and Adult stem cells. Stem cells also classified based on the range of differentiation potentials into Totipotent, Pluripotent, Multipotent, and Unipotent. Multipotent stem cells have the ability to differentiate into all cell types within one particular lineage. There are plentiful advantages and usages for multipotent stem cells. Multipotent Stem cells act as a significant key in procedure of development, tissue repair, and protection. Multipotent Stem cells have been applying in treatment of different disorders such as spinal cord injury, bone fracture, autoimmune diseases, rheumatoid arthritis, hematopoietic defects, and fertility preservation.

To investigate the effect of anisometropic and strabismic amblyopia on the nerve fiber layer thickness. This cross-sectional study was done on 54 amblyopic subjects, equally in both strabismic and anisometropic groups. The thickness otonerve fiber layer measured in superior, inferior, nasal, temporal quadrants and as a whole in both eyes of both groups. The means of thickness were compared in amblyopic and sound eyes. In strabismus group, the average nerve fiber layer thickness of the sound eye , in superior, inferior, nasal and temporal quadrants and as a whole were 113.23±14, 117.37±25, 68.96±6, 69.55±14 and 93.40±8 microns respectively. In amblyopic eyes of the same group, these measurements were 103.11±18, 67.74±11, and 69.59±16 and 89.59±12 microns in superior, inferior, nasal, temporal quadrants and as whole respectively. In anisometropic groups, the sound eye measurements were as 130.96±22, 129.07±29, 80.62±12, and 83.88±20 and 107.7±13 microns in superior, inferior, nasal and temporal quadrants and as a whole orderly. In amblyopic eyes of this group the mean thicknesses were 115.63±29, 133.15±25, 78.8±15, 80.2±16 and 109.17±21 microns in superior, inferior, nasal, temporal quadrants and as a whole respectively. Statistically, there were no significant differences between amblyopic and sound eyes (P>0.5). Our study did not support any significant change in a nerve fiber layer thickness of amblyopic patients; however, decreased thickness in superior and nasal quadrants of strabismic amblyopia and except inferior quadrant and as a whole. These measurements may be a clue for management and prognosis of amblyopia in old age.

Breast reconstruction (BR) surgery is not common for the treatment of breast cancer in low- and middle-income countries, including Iran. We evaluated the quality of life (QoL) in Iranian breast cancer patients who underwent BR at the Cancer Institute of Iran. We compared patients who had BR with breast cancer patients who had a radical mastectomy as the control group, matched for age, and time since surgery. We interviewed the cases and controls and collected data about QoL using EORTC-Q30 and EORTC-Q23 questionnaires. We also obtained personal and clinical data for the patients and controls. We compared 61 BR and 45 radical mastectomy patients. The BR patients had a higher level of education (73.8%) than the mastectomy patients (27.3%). In addition, the BR patients had a higher employment rate (58%) than the mastectomy patients (4.4%). QoL was significantly better among BR patients compared to the control group (P<0.05). In the multivariable analyses, the BR patients had significantly lower scores of pain, fatigue, and diarrhoea than the controls. Breast cancer patients who underwent BR surgery had a higher quality of life scores in some domains compared to the radical mastectomy. Socioeconomic factors and awareness of the patients about BR was crucial for choosing BR among Iranian patients.

Photorefractive keratectomy (PRK) is a safe and effective surgical keratorefractive technique which is done with the application of mitomycin-C (MMC) in cases of high myopia to prevent the formation of corneal haze This study was conducted to evaluate 3-year visual acuity and quality outcomes of PRK-MMC in high myopia. This before-after study was conducted on 20 individuals (40 eyes) with myopia more than 6.0 diopter (D). Visual acuity and quality indices were evaluated before and three years after the procedure and their stability was examined between the 1^st and 3^rd years. At 3 years after surgery, mean uncorrected visual acuity was 0.03±0.06 in the logarithm of minimum angle of resolution (logMAR) unit which showed a significant improvement when compared to baseline (P<0.001) and means best corrected visual acuity was 0.03±0.06 logMAR, which showed no significant difference (P=0.730). Manifest refraction spherical equivalent (MRSE) at 3 years (-0.12±0.2D) was significantly decreased when compared to baseline (P<0.001), but it did not change significantly after the 1^st year and was stable (P=0.368). Mean coma and spherical aberration 3 years postoperatively were -0.54±0.26 µm and 0.46±0.19 µm, respectively, and neither parameter showed significant differences when compared to baseline (P<0.001). No significant change was found in mesopic contrast sensitivity. The long-term results of this study showed that PRK-MMC could be regarded an effective, safe, and stable procedure in patients with myopia more than 6.0 D.

In orders to promote the level of healthcare in societies, governments try to have different policies to transform the health system. The aim of this study was to measure the level of awareness of practitioners in Iran, after initiating the new transformation of the health system in the country, starting from May 2014. This is a descriptive–cross-sectional study, which was inducted in October 2014. The study population consists of 208 physicians who attended the 26^th International Congress of Pediatrics in Tehran, Iran. Data was collected using a self-structured questionnaire, which was estimated as both reliable and valid. Two hundred and eight questionnaires were returned. The results showed that 79.1% of the practitioners were aware of the new health system. Indeed 48.3% of the participants believed that the system was successful. 57.7% of physicians were completely aware of the time of the new system settlement in the country, while the rest had either no idea or did not know the exact date. The participants suggested a few items promote the health system in the country; among them, decreasing the direct payment between patients and physicians was suggested most frequently. According to the results obtained from the study, it is suggested that health care administrators have a detailed plan for health care workers prior to settlement of a new health policy installment, in order to succeed in settlement of a program.

We conducted this study to compare fecal calprotectin between exclusively breastfed and formula or mixed fed infants aged one month and six months. Sixty term infants were enrolled from the labor ward of Valiasr Hospital between Oct 2011 and July 2015 and their fecal calprotectin was checked by the ELISA method and Hycult biotech kits. The enrolled infants had a birth weight of 2500-4000 g and no perinatal insults or hospitalization. Stool sampling was done at 1±1 week and at 6n±1 months. The six-month infants had no recent disease, antibiotic use or vaccination. The mean fecal calprotectin was higher in exclusively breastfed infants at first and sixth months than formula and mixed fed infants (368.85±204.49 and 283.21±381.41 µg/g versus 152.59±139.13 and 113.62±92.75 µg/g respectively). (P=0.0001 and 0.018) Fecal calprotectin was higher in infants with GERD than healthy babies in the first and sixth months (P=0.0001 and 0.004). Based on the role of calprotectin in inflammation, its higher levels in exclusively breastfed infants is contrary to breast milk benefits and may be a sign of enhanced mucosal immune maturity in them.

In the present study, professional conduct of clinical teachers in Tehran University of Medical Sciences in Iran was assessed by their residents (n=292) and fellowships (n=48) using a standard questioner called self-reported measurement equipment. This evaluation was a descriptive cross-sectional study. Professionalism was questioned in four domains including clinical teacher-patient, clinical teacher-student, inter-professional and clinical teacher-self relationships. Accordingly, mean scores of the teachers in cases of clinical teacher-patient; clinical teacher-student, inter-professional (teamwork) and clinical teacher-self relations were 61%, 62.2%, 60.6% and 57.6%, respectively. Generally, the teachers achieved 60.35% of the positive scores, and as a result, they were assessed intermediate in the professional behaviors. The residents and fellowships stated that they were not completely satisfied with their teacher's professional conduct and had hidden concerns. It shows that the clinical teachers in our project may not be ideal role models. As a result, developing a comprehensive professionalism and implementing regulations to ensure a successful professionalism are necessary. The precise evaluation of professional conduct in clinical faculty could encourage the maintenance of professional behaviors and potentially decrease negative role modeling and positively influence the hidden curriculums. Operational approaches to formulating regulations and appropriate measures for establishing professional ethics are of great importance.

Nowadays, improvement of thinking skills of students is one of the universally supported aims in the majority of medical schools. This study aims to design longitudinal theme of reasoning, problem-solving and decision-making into the undergraduate medical curriculum at Tehran University of Medical Sciences (TUMS). A participatory approach was applied to design the curriculum during 2009-2011. The project was conducted by the contribution of representatives of both basic and clinical faculty members, students and graduates at Tehran University of Medical Sciences. The first step toward integrating cognitive skills into the curriculum was to assemble a taskforce of different faculty and students, including a wide variety of fields with multidisciplinary expertise using nonprobability sampling and the snowball method. Several meetings with the contribution of experts and some medical students were held to generate the draft of expected outcomes. Subsequently, the taskforce also determined what content would fit best into each phase of the program and what teaching and assessment methods would be more appropriate for each outcome. After a pilot curriculum with a small group of second-year medical students, we implemented this program for all first-year students since 2011 at TUMS. Based on findings, the teaching of four areas, including scientific and critical thinking skills (Basic sciences), problem-solving and reasoning (Pathophysiology), evidence-based medicine (Clerkship), and clinical decision-making (Internship) were considered in the form of a longitudinal theme. The results of this study could be utilized as a useful pattern for integration of psycho-social subjects into the medical curriculum.

Necrotizing soft tissue infections (NSTIs) are polymicrobial infections with high morbidity and mortality. We report a case of retroperitoneal NSTI in an immunocompetent young male, with clinical symptoms and signs mimicking acute pancreatitis (pseudo-Cullen’s and pseudo-Grey-Turner’s signs. The initiating lesion was a pustule which progressed and mimics acute pancreatitis. CT scan showed features of retroperitoneal NSTI. After extensive debridement and antibiotics, the patient improved. NSTI of the retroperitoneum is rare. The absence of external clinical signs and anatomical barriers make the disease difficult to manage.

Splenic hamartoma is an unusual accidental finding with non-neoplastic feature that may be incidentally diagnosed because of its compression effect on surrounding organs. The predominant pathological feature leading diagnosis is circumscribed, un-encapsulated bulging nodules with focal fibrosis or cyst. The histopathological feature of splenic hamartoma is the positivity for CD8, and occasionally for CD31, CD34, and CD68 biomarkers on vascular wall but the cells are frequently negative for CD21. Herein, we describe a case with initial diagnosis of nephrolithiasis due to abdominal pain that was finally confirmed as splenic hamartoma by histopathological assessments and detection of CD8, CD31, CD34, and CD68 positivity.

Our aim was to report techniques and our experience in One-stage angioplasty and stenting of ostium of left common carotid and left internal carotid arteries in an octogenarian man with transient ischemic attack, who was completely recovered from neurologic insults short time after the procedure. An 81-year-old man presented with a transient ischemic attack. Neurologic examination showed left side transient visual obscuration or amaurosis fugax and right hemiparesis. Carotid duplex imaging revealed an 80% stenosis of the left internal carotid artery (LICA) and 95 % of the ostium of left common carotid artery (left CCA). Immediate brain MRI wasn’t possible. Angioplasty and stenting of both lesions (left CCA and LICA ) was performed successfully without complications in one session. Stenting of common carotid artery ostial lesion and internal carotid artery (due to significant lesion) in one session could be done even in acute neurologic phase and also in very old patients, provided that, considering technical ways for neuroprotection and avoidance of other complications.

Hemophagocytic lymphohistiocytosis (HLH) is a syndrome of pathologic immune activation, occurring as either a familial disorder or a sporadic condition, in association with a variety of triggers. This article will introduce a neonate with HLH in Iran. We report a case of HLH presenting with respiratory distress and fever, hepatosplenomegaly, jaundice and pancytopenia on the second day of life. Typical clinical and laboratory findings were detected in the neonate. HLH was diagnosed according to HLH-2004 guidelines. In spite of initiating the treatment, the disease did not cure. Post-mortem, extensive hemophagocytosis was found in multiple organs. No specific genetic defect was identified. Since HLH is a potentially lethal childhood illness, early diagnosis of this disorder and commences the therapy is important for pediatricians.