Several studies have evaluated the association between interleukin-6 (IL-6) -174 G/C polymorphism and Graves' disease (GD); however, the results have been inconsistent. In the current study, a meta-analysis was performed to assess the association of IL6 -174 G/C polymorphism with Graves' disease. Medline, EMBASE, and Web of Science databases were searched to identify all eligible studies published before August 2016. Odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) were calculated to assess the strength of association in dominant, recessive, allelic, homozygotes contrast, and heterozygotes contrast models. A total of four case-control studies with 554 GD cases and 1201 healthy controls were included in this meta-analysis. In the combined analysis, the results showed significant association between the IL6 -174 G/C polymorphism and the risk for GD in dominant model (OR=1.39, 95% CI: 1.07-1.80), recessive model (OR=2.75, 95% CI: 1.01-7.55) and homozygote contrast model (OR=3.25, 95% CI: 1.1-9.58). No publication bias was found in the current study (all P>0.05). The meta-analysis results suggested that the IL6 -174 G/C polymorphism was indicated to be associated with the risk of GD. Further studies are warranted to confirm these results.

This study has been conducted to evaluate the allele, genotype and haplotype frequencies of the polymorphic gene coding TGF-β in recurrent aphthous stomatitis (RAS). TGF-β gene typing was done by polymerase chain reaction with sequence-specific primers (PCR-SSP) assay. Allele frequencies were estimated by direct gene counting. C allele at codon 25 was significantly increased, while G allele at this position was significantly decreased in patients compared to the controls. A significantly higher frequency of CG genotype at codon 25 was found in control group. CC genotype and TT genotype at codon 10 of the gene was significantly decreased, while CT genotype at the same position was significantly increased in patients, indicating that CT heterozygosity at codon 10 TGF-β is associated with greater risk of RAS. CG and TG haplotypes were significantly decreased while CC and TC haplotypes were significantly increased in patients compared with controls. This study indicates the TGF-β single nucleotide polymorphisms could play a role in RAS pathogenesis. Thereby certain SNPs of TGF-β gene have an association with RAS pathogenesis.

Juvenile idiopathic arthritis (JIA) is a clinically heterogeneous cluster of complex diseases, in which both the genetic and environmental factors seem to play a role in the development of the disease. The current study aims to assess the association of programmed cell death 1 (PDCD1, also called PD-1) gene variants with JIA vulnerability in Iranian population. In this case-control association study, we investigated a group of 50 Iranian patients with JIA in comparison with 202 healthy controls and evaluated the frequency of alleles, genotypes, and haplotypes of PDCD1 single-nucleotide polymorphisms (SNPs), comprising PD-1.1 G/A, PD-1.3 G/A and PD-1.9 C/T, using PCR-RFLP method. Both the allelic and genotype frequencies of PD-1.1, PD-1.3 and PD-1.9 were similar in two groups of patients and controls. Moreover, no significant difference was observed between the two groups of patients and controls for GGC (PD-1.1 G, PD-1.3 G, PD-1.9 C), GAC (PD-1.1 G, PD-1.3 A, PD-1.9 C), and AGT (PD-1.1 A, PD-1.3 G, PD-1.9 T) haplotypes. Our results did not show any association between PDCD1 SNPs and the development of JIA in Iranian population.

The purpose of this study was to determine the effect of vestibular rehabilitation therapy program on the sensory organization of deaf children with bilateral vestibular dysfunction. This cross-sectional and analytic study was conducted on 24 students between the age of 7 and 12 years (6 girls and 18 boys) with the profound sensorineural hearing loss (PTA>90 dB). They were assessed through the balance subtest in Bruininks-Oseretsky test of motor proficiency (BOTMP). For children which the total score of the balance subtest was 3 standard deviation lower than their peers with typical development, vestibular function testing was completed pre-intervention. Posturography Sensory organization testing (SOT) was completed pre- and post-intervention with SPS (Synapsys, Marseille, France). Children with bilateral vestibular impairment were randomly assigned to either the exercise or control group. Exercise intervention consisted of compensatory training, emphasizing enhancement of visual and somatosensory function, and balance training. The exercise group entered in vestibular rehabilitation therapy program for 8 weeks. The children initially participating in the control group were provided the exercise intervention following the post-test. Based on the results there was significant difference in condition 5 and 6, areas of limits of stability (LOS), vestibular ratio and global score in posturography at the end of the intervention, but there was no significant difference in the control group in posturography (P<0.05). The results indicated that testing of vestibular, and postural control function, as well as intervention for deficiencies identified, should be included in deaf children rehabilitation program.

One of the important reasons for accidents is sleepiness.With this description, the sleep disorders are associated with health and mortality, and not only affect the person but also the family and the whole society. Aim of this study was assessing of relationship between Sleep Quality, Obstructive sleep Apnea and Sleepiness during day with related factors in professional drivers. This was a cross-sectional study measuring correlation between sleep quality questionnaire (Pittsburgh Sleep Quality Index or PSQI), Epworth Sleepiness Scale (ESS) and Stop Bang questionnaire (STOP BANG).the appropriate sample size to achieve a 95% confidence level was 943 people. The study population was chosen among qualified drivers using a convenience sampling method that took place over 12 months duration. Exclusion criterion consisted of the presence of a physical or mental disability. Data analyzed by software SPSS, version 15. In this study, all drivers were men with mean of age 36±9/5 year (minimum 22 year and maximum 72 year), 799 (84.7%) were married, 535 (56.7%) had high school education. Also, 96.4 % of drivers had undesirable sleep quality, 25.8% obstructive sleep apnea and 6.8% abnormal sleepiness during day. Multiple linear regression test showed, Score of STOP-Bang was correlated with smoking (OR (β)=0/2, P=0.006) and history of hurt disease (OR (β)=0.95, P=0.003), shift work (OR (β)=0.19, P=0.006) more probability. Moreover, PSQI was statistically significant with shift work (OR (β)=0.44, P=0.02), smoking (OR (β)=0.98, P=0.001), history of pulmonary disease (OR (β)=3.58, P=0.009) more probability , and ESS was statistically significant with smoking (OR (β)=0.64, P=0.007) and history of pulmonary disease(OR (β)=2.82, P=0.006), shift work (OR (β)=0.59, P=0.008) more probability. In our study, according to the results, it should be planning to reduce the driving time in day and night and also it are recommended short breaks during driving. It is suggested the more widespread and prospective studies, as well as informing the drivers about the benefits of proper sleep and annual checkup drivers of health.

Accurate measurement of Mitral Valve Area (MVA) is essential to determining the Mitral Stenosis (MS) severity and to achieving the best management strategies for this disease. The goal of the present study is to compare mitral valve area (MVA) measurement by Continuity Equation (CE) and Pressure Half-Time (PHT) methods with that of 2D-Planimetry (PL) in patients with moderate to severe mitral stenosis (MS). This comparison also was performed in subgroups of patients with significant Aortic Insufficiency (AI), Mitral Regurgitation (MR) and Atrial Fibrillation (AF). We studied 70 patients with moderate to severe MS who were referred to echocardiography clinic. MVA was determined by PL, CE and PHT methods. The agreement and correlations between MVA’s obtained from various methods were determined by kappa index, Bland-Altman analysis, and linear regression analysis. The mean values for MVA calculated by CE was 0.81 cm (±0.27) and showed good correlation with those calculated by PL (0.95 cm, ±0.26 ) in whole population (r=0.771, P<0.001) and MR subgroup (r=0.763, P<0.001) and normal sinus rhythm and normal valve subgroups (r=0.858, P<0.001 and r=0.867, P<0.001, respectively). But CE methods didn’t show any correlation in AF and AI subgroups. MVA measured by PHT had a good correlation with that measured by PL in whole population (r=0.770, P<0.001) and also in NSR (r=0.814, P<0.001) and normal valve subgroup (r=0.781, P<0.001). Subgroup with significant AI and those with significant MR showed moderate correlation (r=0.625, P=0.017 and r=0.595, P=0.041, respectively). Bland Altman Analysis showed that CE would estimate MVA smaller in comparison with PL in the whole population and all subgroups and PHT would estimate MVA larger in comparison with PL in the whole population and all subgroups. The mean bias for CE and PHT are 0.14 cm and -0.06 cm respectively. In patients with moderate to severe mitral stenosis, in the absence of concomitant AF, AI or MR, the accuracy of CE or PHT method in measuring MVA is nearly equal. But in the presence of significant AI or MR, PHT method is obviously superior to CE and in the presence of AF neither have sufficient accuracy.

Published studies on dermatological emergencies are limited in the literature. To our knowledge, no study has previously explored this subject in Iran. Our aim was to ascertain the characteristics of patients visiting the dermatologic emergency (DE) unit of a university skin hospital in Tehran, Iran. We studied the files of all the patients seen in the DE unit over a 3-month period, collecting data on age, sex, referral mode, duration of consultation, status (true emergency or non-emergency), and diagnosis. A total of 2539 patients were evaluated; 53% of them were female. Infection and infestation (41.9%), urticaria (16.7%), and dermatitis (13.2%) were the most prevalent entities. Almost 1% of the patients were referred by another physician and psoriasis was their most frequent diagnosis. Almost 2.6% of the patients were hospitalized; psoriasis was once again the most frequent cause. The hospitalization rate was significantly higher in referred patients (P<0.001). A sampling bias may have occurred due to the time interval (three summer months) of the study. The majority of the patients did not require emergency consultation. Even the most prevalent acute conditions such as bite, urticaria, infections, and infestations could be diagnosed and easily managed by general practitioners. The presented data showed a need for improvement in the non-dermatologist physicians' knowledge of emergency dermatologic disorders. This data could also help in tailoring the educational curriculum for medical students more appropriately in order to increase their knowledge of the most prevalent skin disorders.

To determine the prevalence of allergic rhinitis (AR) among adult residents and investigate whether second-hand tobacco smoke (SHS) is correlated with AR as one of the global health problems and one of the most common respiratory disorders reducing the quality of life. A telephone interview survey was conducted by calling 16500 randomly selected telephone numbers from 22 regional telecommunications of Tehran (capital city of Iran) in 2010. A modified European Community Respiratory Health Survey (ECRHS) questionnaire was completed for adults aged between 20 to 44-year-old. Two questions about active smoking and being exposed to SHS were added to the questionnaire. five thousands five hundred cases (76.92%) responded to our calls among 7150 eligible telephone numbers. The gender of study population included 3412 female (62%) and 2088 male (38%) with the mean±SD age of 31.15±7.33. The prevalence of AR was 26.7%. There were no significant relationship between active smoking and AR; while a significant relationship was detected between SHS and AR among our participants (P=0.02). However, no significant difference was found between men and women. In addition, more than 50% of adults suffering from AR, showed significant symptoms of asthma (P<0.001). The results of the current study revealed that the prevalence of AR was higher in Iran compared to other countries worldwide and SHS may be considered as a serious risk factor for AR.

Bilateral occlusion of internal carotid arteries is a rare condition usually associated with severe neurological symptoms. It is very uncommon finding among patients with ischemic stroke. In this article, we report a rare case of bilateral occlusion of internal carotid artery who presented with mild reversible neurological symptoms. Angiographic evaluation of her cerebral vasculature revealed no flow across the both cervical internal carotid arteries, but a run off through both posterior communicating arteries from the vertebrobasilar system. We performed a review of the pertinent literature and discussed different management option in these patients.

Hepatocellular carcinoma (HCC) is not uncommon neoplasm, and its occurrences with coronary artery disease (CAD) is more confronted by cardiac surgeon today. In most cases, when the HCC is detected, it has invaded to regional or distant sites. The most frequent location of HCC metastasis includes pulmonary system, musculoskeletal, lymphatic system, and central nervous system. Indeed, intra-atrial metastasis is a rare phenomenon and associated with poor outcome. We report a case of CAD with known HCC that referred for CABG before scheduling for hepatic tumor management. His severe typical chest pain, aggravated by mild activity so his abdominal pain is shadowed by chest pain. The abdominal ultrasound revealed a large mass in the left hepatic lobe. Chest x-ray was unremarkable. Routine preoperative transthoracic echocardiography (TEE) exhibits a large sessile mass in the right atrium. The patient underwent combined resection of right atrial mass and off-pump coronary artery bypass grafting. The most of HCC patients with RA involvement usually presenting with lengthy thrombus that continues from vascular invasion site to RA, however, as in our patient, isolated and sole metastasis to RA is an exceptional phenomenon in HCC. The clinical postoperative course was uneventful, and the patient discharged on the 10^th day of operation. The six-month follow-up revealed no recurrence of right atrial mass when the patient completed his treatment by hepatic lobectomy and combined adjuvant chemotherapy.

Hydatid cysts in humans usually located in the liver or lungs primarily and some case in the other organs. Sometimes, because the trauma or medical manipulating, the cyst may be rupture and protoscoleces spillage resulted in secondary hydatid cyst. Primary dissemination of cyst to multiple organs is a rare phenomenon. Herein, we reported a 14-year-old teenage female patient with symptoms of abdominal pain with an unusual ultrasonographic and computed tomographic presentation mimicking polycystic ovarian syndrome PCOS. Due to numerous masses in the retrovesical region, she was admitted for surgical treatment in the gynecology ward, and after laparotomy, more than 50 cysts removed her internal organs.

Complications of hiatal hernia are potentially lethal, and surgical intervention is necessary. This matter is more important in cases that have ambiguous symptoms and are diagnosed with a delay. Such patients may experience life-threatening course and events. Accordingly, in this report, a 23-year-old male patient with unusual findings is presented. A 23-year-old male patient with acute dyspnea and fever was admitted in infectious disease ward with diagnosis of empyema according to chest radiography and CT-scan findings (Figures 1 and 2). On physical examinations the right lung sounds were normal, and the left lung sounds could not be heard. Then a gastrography was performed because of suspicion to hiatal hernia based on physical examination findings showing the presence of stomach in the thorax (Figure 3). In the surgery, the stomach and the transverse colon were released and reputed in the abdomen (Figure 4). The diaphragm was primarily repaired due to small defect, and the patient was discharged after 4-5 days with good general conditions. This case had a learning note that in the case of acute dyspnea with a positive history of stab wound to the chest, hiatal hernia should be considered as an important diagnosis and in these cases performing a gastrography would help physicians to make true and certain diagnosis and therapeutic decision.