Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 51 10 2013 10 15 663 674 EN Reza Shirkoohi Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran. Cyrus Azimi Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 11 Cancer is a genetic-epigenetic based disease which contains a complex of alterations that cause irreversible transformation of cells with a new anarchic behavior. Tumor suppressor inactivation and/or oncogene activation will lead to tumorigenesis. Based on the genetic alteration in germ or somatic cells, the affected person will have a different fate of cancer incidence or inheritable cancer susceptibility syndrome. Knowing the mechanism of molecular and cytogenetic alterations in cancer will give an advantage in finding more practical approaches to cancer management. In this review, the cancer genetics is discussed from different aspects. https://acta.tums.ac.ir/index.php/acta/article/view/4385 https://acta.tums.ac.ir/index.php/acta/article/download/4385/4402

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 51 10 2013 10 15 675 680 EN Ali Asghar Hemmati Department of Pharmacology and Toxicology, School of Pharmacy, AND Physiology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. and Physiology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Behnam Ghorbanzadeh Department of Pharmacology and Toxicology, School of Pharmacy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Mohammad Amin Behmanesh Department of Histology, School of Veterinary Medicine, Shahid Chamran University of Ahvaz, Ahvaz, Iran. 2015 10 11 The leukotrienes and prostaglandins are biologically active metabolites derived from arachidonic acid. The leukotrienes have a role in inflammatory diseases such as allergic rhinitis, inflammatory bowel disease and asthma. Montelukast, a cysteinyl leukotriene receptor antagonist, is claimed to be effective in asthma. The present study aimed to assess the role of cysteinyl leukotriene receptor antagonist on peripheral inflammation and whether montelukast treatment enhances the anti-inflammatory effect of indomethacin. Anti-inflammatory response was measured using a plethysmometer. Histopathologic examination for leukocyte accumulation was done. Montelukast (0.5-2mg/kg, i.p.) produced a significant anti-inflammatory effect in dose dependent manner against formalin-induced rat paw oedema at 1h but not in 3 and 5 h. When indomethacin (5 mg/kg, i.p) was co-administered with montelukast (1 mg/kg, i.p), the anti-inflammatory effects of indomethacin were significantly increased as compared to the per se effect at 3 and 5 hour after formalin challenge. In histopathology it has been found that combination therapy significantly decreased migration of leucocytes into the site of inflammation. These results show that montelukast has anti-inflammatory properties in peripheral tissue and markedly potentiates the anti-inflammatory activity of indomethacin at 3 and 5 h. It is expected that combination of montelukast with cyclooxygenase inhibitor would prove to be a novel approach to manage complex inflammatory conditions. https://acta.tums.ac.ir/index.php/acta/article/view/4384 https://acta.tums.ac.ir/index.php/acta/article/download/4384/4405

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 51 10 2013 10 15 681 686 EN Mehdi Hadadzadeh Department of Cardiovascular Surgery, Afshar Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Seyed Habib Hosseini Department of Anesthesiology, Afshar Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Seyed Mohammad Yousof Mostafavi Pour Manshadi Department of Medicine, Ali ben Abitaleb Medical College, Islamic Azad University, Yazd, Iran. Nafiseh Naderi Department of Medicine, Ali ben Abitaleb Medical College, Islamic Azad University, Yazd, Iran. Mahmood Emami Meybodi Department of Cardiology, Afshar Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. 2015 10 11 Myocardial dysfunction is a major complication in cardiac surgery that needs inotropic support. This study evaluates the effect of milrinone on patients with low ventricular ejection fraction undergoing off- pump coronary artery bypass graft (OPCAB). The present study is designed to evaluate the effect of milrinone on myocardial dysfunction. Eighty patients with low ventricular ejection fraction (<35%), candidate for elective OPCAB, were enrolled in this study. They were randomly assigned to two groups. One group received milrinone (50 μg/kg) intravenously and another group received a saline as placebo followed by 24 hours infusion of each agent (0.5 μg/kg/min). Short outcome of patients such as hemodynamic parameters and left ventricular ejection fraction were variables evaluated. Serum levels of creatine phosphokinase, the MB isoenzyme of creatine kinase, occurrence of arrhythmias and mean duration of mechanical ventilation were significantly lower in milrinone group (P<0.05). The mean post operative left ventricular ejection fraction was significantly higher in milrinone group (P=0.031). There were no statistical significant differences between the two groups in terms of intra-aortic balloon pump, inotropic support requirement, myocardial ischemia, myocardial infarction, duration of inotropic support, duration of intensive care unit stay, mortality and morbidity rate. Administration of milrinone in patients undergoing OPCAB with low ventricular ejection fraction is useful and effective. https://acta.tums.ac.ir/index.php/acta/article/view/4383 https://acta.tums.ac.ir/index.php/acta/article/download/4383/4406

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 51 10 2013 10 15 687 692 EN Mehrdad Hasibi Department of Infectious Diseases, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran. Sirus Jafari Department of Infectious Diseases, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran. Habibollah Mortazavi Department of Infectious Diseases, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran. Marjan Asadollahi Department of Neurology, Loghman Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Gholamreza Esmaeeli Djavid Department of Infectious Diseases, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 11 In endemic area the most challenging problem for brucellosis is to find a reliable diagnostic method. In this case-control study, we investigated the accuracy of ELISA test for diagnosis of human brucellosis and determined the optimal cut-off value for ELISA results in Iran. The laboratory diagnosis of brucellosis was performed by blood isolation of Brucella organism with a BACTEC 9240 system and/or detection of Brucella antibodies by standard agglutination test (titer ≥ 1:160). Serum level of ELISA IgG and ELISA IgM from 56 confirmed cases of brucellosis and 126 controls were compared with each other by Box plot graph and Receiver Operating Characteristic (ROC) curve. Box plot graphs showed the high degree of dispersion for IgG and IgM data in patients compared with all controls. We observed partially overlapping for IgM data (not for IgG) between cases and controls in graphs. The area under ROC curve for distinguishing between cases and controls was larger for IgG compared to IgM. Based on results of this study, ELISA IgG test was more reliable than ELISA IgM test in diagnosis of human brucellosis in Iran. Using a cut-off of 10 IU/ml and 50 IU/ml had most sensitivity (92.9%) and most specificity (100%) for ELISA IgG test, respectively. https://acta.tums.ac.ir/index.php/acta/article/view/4382 https://acta.tums.ac.ir/index.php/acta/article/download/4382/4408

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 51 10 2013 10 15 693 696 EN Soghra Rabiee Department of Obstetrics & Gynecology, Fatemieh Women Hospital, Hamadan University of Medical Sciences, Hamadan, Iran. Mahboobeh Hemmati Department of Obstetrics & Gynecology, Fatemieh Women Hospital, Hamadan University of Medical Sciences, Hamadan, Iran. Nazanin Fallah Department of Obstetrics & Gynecology, Fatemieh Women Hospital, Hamadan University of Medical Sciences, Hamadan, Iran. 2015 10 11 Ectopic pregnancy (EP) and miscarriage are important differential diagnosis of first trimester vaginal bleeding. In first trimester, serum progesterone value can be 5-20 ng/ml in EP and miscarriage. Since delay in diagnosis of EP could have high mortality and morbidity, the aim of this study was comparison of serum progesterone value in EP and miscarriage in order to differentiate these conditions. A total of 60 patients (30 EP and 30 miscarriages) with gestational age of 5-7 weeks by LMP were enrolled in this study. The titer of progesterone and βhCG of serum were measured. The mean of progesterone and βhCG titers were compared in two groups by Student's t-test. The mean progesterone titer for all patients was 6.36±5.62 ng/ml, with a minimum value of 0.44 and maximum value of 21.50 ng/ml. Serum progesterone level in 33 patients was lower than 5 ng/ml and in 27 patients was between 5-25 ng/ml. Mean serum progesterone for miscarriage was 6.803±5.72 and for EP was 5.915±5.45 ng/ml. Difference between two values was not significant statistically (P=0.067). Mean βhCG for miscarriage was 1313.04 IU/l and for EP 1805.56 IU/l. Mean patients age were 27.2 totally that for miscarriage was 25.8 and for EP 28.5 years. This study indicated, the mean value of progesterone could not differentiate EP from miscarriage. https://acta.tums.ac.ir/index.php/acta/article/view/4381 https://acta.tums.ac.ir/index.php/acta/article/download/4381/4409

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 51 10 2013 10 15 697 700 EN Zahra Rezaei Department of Obstetrics & Gynecology, Women Hospital, Tehran University of Medical Sciences, Tehran, Iran. Farahnaz Sadat Ahmadi Department of Obstetrics & Gynecology, Women Hospital, Tehran University of Medical Sciences, Tehran, Iran. Shirin Niroomanesh Department of Obstetrics & Gynecology, Women Hospital, Tehran University of Medical Sciences, Tehran, Iran. Shahram Ejtemaee Mehr Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Fatemeh Davari Tanha Department of Obstetrics & Gynecology, Women Hospital, Tehran University of Medical Sciences, Tehran, Iran. Atefeh Aminian Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Azizeh Ghaseminejad Department of Obstetrics & Gynecology, Women Hospital, Tehran University of Medical Sciences, Tehran, Iran. Soleiman Abbasi Health Committee of the Islamic Parliament of Iran, Tehran, Iran. Fariba Yarandi Department of Obstetrics & Gynecology, Women Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 11 The cause of neural tube defects (NTDs) is multifactorial and in this case folic acid has an important role. Since the neural tube is closed during 21-28 days of pregnancy, most of women are not informed about their pregnancy at this time, and as a result the golden time of folic acid consumption is missed. The aim of this study was evaluating the performance of pregnant women attending to Tehran Women's Hospital in regard to folic acid intake during pre-conceptional period between 2011 and 2012. This cross-sectional study was conducted in 370 pregnant women attending the prenatal clinic of a hospital affiliate to Tehran University of Medical Sciences between 2011 and 2012. Data were collected through interview using a questionnaire. Although 70% of the pregnancies were planned, but 70.5% of pregnant women had not taken folic acid before conception or in necessary time. There was found a significant relationship between level of education, history of abnormalities in children and the number of abortions and taking folic acid before pregnancy (P=0.005, P=0.000 and P=0.000, respectively). https://acta.tums.ac.ir/index.php/acta/article/view/4380 https://acta.tums.ac.ir/index.php/acta/article/download/4380/4410

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 51 10 2013 10 15 701 704 EN Mojgan Asadi Osteoporosis Research Center and Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. AND Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. Zahra Jouyandeh Obesity and Eating Habit Research Center, Endocrinology and Metabolism Molecular -Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. Farnaz Nayebzadeh General Physician ,Tehran Women General Hospital, Tehran University of Medical Science, Tehran, Iran. Mostafa Qorbani Department of Public Health, Alborz University of Medical Sciences, Karaj, Iran. AND Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 11 Vitamin D deficiency is the most under-diagnosed medical condition in postmenopausal women. There are few epidemiologic studies on vitamin D status of postmenopausal women in Iran. This study aimed to investigate the 25-hydroxyvitamin D levels in postmenopausal women living in Tehran, capital of Iran. In this cross sectional study, 110 women were selected via convenience sampling method from menopause clinic of Tehran Women General Hospital between 2011 and 2012. For each woman, a questionnaire was completed, and 25-hydroxyvitamin D levels were determined by chemiluminescence's immunoassay. Vitamin D deficiency has been considered as a 25(OH)D of less than 20ng/ml. Vitamin D insufficiency has been defined as a 25(OH)D of 21-29ng/ml, and sufficiency as a 25(OH)D of 30-100ng/ml. The data was analyzed by using Pearson correlation test in SPSS version 16. The mean age of women was 52.67±5 years. The mean age at natural menopause onset was 47.66±4.44 years, and the median menopause age was 49.00. The median 25(OH)D level was 19.28 (Inter Quartile Range=26.08). We found vitamin D deficiency and vitamin D insufficiency 52.7% and17.3% respectively. Serum 25(OH) D concentrations were significantly correlated with age(r=0.21, P=0.024). These findings indicate that 25(OH)D level in postmenopausal women from Tehran is low. There is a statistically significant positive correlation between vitamin D concentration and age in late postmenopausal period. https://acta.tums.ac.ir/index.php/acta/article/view/4379 https://acta.tums.ac.ir/index.php/acta/article/download/4379/4412

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 51 10 2013 10 15 705 710 EN Hojjat Hossein Pourfeizi Department of Orthopedics Surgery, Shohada Hospital, Tabriz University of Medical Sciences, Tabriz, Iran. Ali Tabriz Department of Orthopedics Surgery, Shohada Hospital, Tabriz University of Medical Sciences, Tabriz, Iran. AND Students Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran. Asghar Elmi Department of Orthopedics Surgery, Shohada Hospital, Tabriz University of Medical Sciences, Tabriz, Iran. Hossein Aslani Department of Orthopedics Surgery, Shohada Hospital, Tabriz University of Medical Sciences, Tabriz, Iran. 2015 10 11 Nonunion is common complication of fracture management. Various factors are involved in its occurring. Metabolic and endocrine factors are often overlooked. So that aim of study was to evaluate the level of vitamin D and PTH in patients with unexplained nonunion and fractures due to low energy trauma. In the case control study, 30 patients with tibial nonunion compared with 32 patients with normal bone healing. There were matched according to, surgical treatment, sex, age and body mass index. In order to measure the serum levels of laboratory parameters, vitamin D and parathyroid hormone, blood samples were taken and were sent to a reference laboratory. A high percentage of vitamin D deficiency was observed in tibial unexplained nonunion (60%) versus 30% in normal union. The level of vitamin D in patients with nonunion was significant difference compared with normal union (25.8±20.4 nmol/l versus 49.03±26.9 nmol/l, P=0.002). PTH measurement showed that was not meaningful statistical difference between two groups but prevalence of hyperparathyroidism in nonunion was higher than union (33% versus 9.3%). In other laboratory findings were not statistical difference. According to our results, vitamin D deficiency in unexplained tibial nonunion fractures are common. In areas with high prevalence of hypovitaminosis D, that could be one reason of unexplained nonunion. https://acta.tums.ac.ir/index.php/acta/article/view/4378 https://acta.tums.ac.ir/index.php/acta/article/download/4378/4415

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 51 10 2013 10 15 711 714 EN Ali Abdollahi Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran. Minoo Mohraz Department of Infectious Diseases, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mehrnaz Rasoulinejad Department of Infectious Diseases, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mona Shariati Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran. Parastou Kheirandish Department of Infectious Diseases, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran. Maryam Abdollahi Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran. Tahereh Soori Department of Infectious Diseases, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 11 We tried to evaluate prevalence and characteristics of Iranian HIV infected patients with retinitis due to opportunistic infections. In this cross sectional study, we evaluated 106 HIV infected patients via indirect ophthalmoscopy and slit lamp examination by 90 lens to find retinitis cases. General information and results of ophthalmologic examination were analyzed. Prevalence of retinitis due to opportunistic infections was 6.6%: cytomegalovirus (CMV) retinitis 1.88%, toxoplasmosis retinochoroiditis 1.88% and tuberculosis chorioretinitis 2.83%. CD4 count was higher than 50 cell/µlit in both cases with CMV retinitis. Along with increasing survival in the HIV infected patients, the prevalence of complications such as ocular manifestation due to opportunistic infections are increasing and must be more considered. https://acta.tums.ac.ir/index.php/acta/article/view/4377 https://acta.tums.ac.ir/index.php/acta/article/download/4377/4418

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 51 10 2013 10 15 715 719 EN Sedigheh Saedi Department of Cardiology, Rajaei Cardiovascular, Medical and Research Centre, Iran University of Medical Sciences, Tehran, Iran. Saied Oraii Department of Cardiology, Tehran Arrhythmia Clinic, Iran University of Medical Sciences, Tehran, Iran. Farhad Hajsheikholeslami Department of Cardiology, Research Institute of Endocrinology and Metabolism, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2015 10 11 Recurrent syncope of obscure etiology, particularly in those with structural heart diseases, is associated with higher mortality rates. There are insufficient and conflicting data on prevalence and etiology of syncope in the urban Middle Eastern population. Evaluating the etiologic basis of syncope can be an effective step in prevention of morbidities and sudden cardiac death in susceptible populations. The aim of our study was to determine the prevalence and etiology of syncope in an outpatient cardiology clinic in Tehran the capital of Iran. In this cross sectional study data was collected from patients' records whose first visits were from March 2006 to September 2007 and had undergone thorough examination for syncope (ECG, Holter monitoring, echocardiography, Tilt table testing, Electrophysiological study). All efforts were done to determine underlying heart diseases, physical exam and test abnormalities, final diagnosis and treatment in all selected patients. Overall prevalence of syncope was estimated to be 9%. The age-specific prevalence rates were 5-14 years:  4.14%, 15-44 years: 44.8%, 45-64 years: 31%, 65 years and Older: 20%. The most frequently identified cause (60%) was neurally-mediated (vasovagal) syncope. Mean age of patients was 44.9 years with a minimum of 5 years and maximum of 85 years. In our study, coronary heart disease had a high prevalence among participants (12.4%). Syncope is a common clinical problem. In this study prevalence rates peaked in 15-44 years age group. Considering that recurrent syncope is often disabling and may cause injury and the fact that heart diseases are more common in people affected by syncope, especial cautions should be taken while evaluating this group of patients. https://acta.tums.ac.ir/index.php/acta/article/view/4376 https://acta.tums.ac.ir/index.php/acta/article/download/4376/4424

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 51 10 2013 10 15 720 723 EN Jalal Vahedian Ardakani Department of General Surgery, Iran University of Medical Sciences, Tehran, Iran. Nikdokht Rashidian Department of General Surgery, Iran University of Medical Sciences, Tehran, Iran. Babak Arabpoor Dahooei Department of General Surgery, Iran University of Medical Sciences, Tehran, Iran. Mohammad Reza Keramati Department of General Surgery, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Reza Arab Department of General Surgery, Iran University of Medical Sciences, Tehran, Iran. Azin Shafiei Sabet Department of General Surgery, Tehran University of Medical Sciences, Tehran, Iran 2015 10 11 Bowel stent insertion has a variety of complications one major of which is colonic perforation. The purpose of this article is to reveal two cases with delayed colonic perforation after stent placement to relieve bowel obstruction caused by rectal cancer. The first patient was a 55 year-old man who was a candidate for stent placement to avoid palliative surgery and relieve his bowel obstruction. Although the procedure resulted in complete relief of patient symptoms, but he returned with signs of peritonitis 10 days after the stent placement. A perforation was found at rectosigmoid junction on laparotomy. The second patient was a 60 year-old man who underwent a successful stent placement and returned 3 months later with a complaint of abdominal pain that showed up to be due to a rectal perforation on investigations. In conclusion, bowel perforation following stent placement can be a major complication, so close follow-up is necessary to detect it as soon as possible and prevent it from becoming an irreparable complication. https://acta.tums.ac.ir/index.php/acta/article/view/4375 https://acta.tums.ac.ir/index.php/acta/article/download/4375/4427

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 51 10 2013 10 15 724 726 EN Masoud Mehrpour Department of Neurology, Firoozgar General Hospital, Tehran University of Medical Sciences, Tehran, Iran. Nafiseh Mohebi Department of Neurology, Firoozgar General Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Reza Motamed Department of Neurology, Firoozgar General Hospital, Tehran University of Medical Sciences, Tehran, Iran. Farhad Zamani Gastrointestinal and Liver Diseases Research Center, Firoozgar General Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 11 Motor neuron diseases have been reported as a rare paraneoplastic syndrome (PNS) of a systemic neoplasm. We present a patient with amyotrophic lateral sclerosis (ALS) in association with neuroendocrine tumor (NET) of stomach, which is the first case of motor neuronopathy with underlying neuroendocrine tumor. A 79-year old woman presented with a two months history of progressive dysphagia, spastic dysarthria and marked fasciculation in her atrophic tongue. Gag reflexes were diminished bilaterally. Other cranial nerves were intact. In muscle testing there was significant atrophy in thenar and hypothenar areas of both hands compatible with diffuse motor neuronopathy with active denervation. Upper GI endoscopic study showed patchy erythematous mucosa with congestion in body of stomach, Histological biopsy of stomach confirmed the neuroendocrine tumor (NET). The importance of considering a paraneoplastic syndrome in a patient with presentation of ALS, which can leads to searching for underlying neoplasm before its apparent signs and symptoms, to initiate tumor treatment so much sooner. In addition even though paraneoplastic motor neuron disease is rare, treating the underlying neoplasm may resolve neurologic signs and symptoms. https://acta.tums.ac.ir/index.php/acta/article/view/4374 https://acta.tums.ac.ir/index.php/acta/article/download/4374/4430

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 51 10 2013 10 15 727 729 EN Brahim Eljebbouri Department of Neurosurgery, Med V University, Mohamed V Teaching Hospital, Rabat, Morocco. Miloudi Gazzaz Department of Neurosurgery, Med V University, Mohamed V Teaching Hospital, Rabat, Morocco. Ali Akhaddar Department of Neurosurgery, Med V University, Mohamed V Teaching Hospital, Rabat, Morocco. Brahim Elmostarchid Department of Neurosurgery, Med V University, Mohamed V Teaching Hospital, Rabat, Morocco. Mohamed Boucetta Department of Neurosurgery, Med V University, Mohamed V Teaching Hospital, Rabat, Morocco. 2015 10 11 Pediatric intramedullary schwannoma without neurofibromatosis is extremely rare with only five cases reported so far. We present this rare finding in an 10-year-old boy who presented with a sudden onset of weakness in the lower limbs. An intraoperative diagnosis of schwannoma enabled us to carry out a total excision of the tumor, which resulted in near complete recovery at 10 months follow-up. Although rare, this diagnosis should be considered when a child presents with a solitary intramedullary tumor since its total resection can be achieved improving surgical outcome. https://acta.tums.ac.ir/index.php/acta/article/view/4373 https://acta.tums.ac.ir/index.php/acta/article/download/4373/4436

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 51 10 2013 10 15 730 732 EN Zahra Ahmadinejad Department of Infectious Diseases, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran. Zahra Ghetmiri Department of Infectious Diseases, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mehrnaz Rasoolinejad Department of Infectious Diseases, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran. AND Iranian Research Centre for HIV/AIDS. 2015 10 11 Patients with human immunodeficiency virus (HIV) infection receiving antiretroviral therapy (ART), despite a reduced viral load and improved immune responses, may experience clinical deterioration. This so called "immune reconstitution inflammatory syndrome (IRIS)" is caused by inflammatory response to both intact subclinical pathogens and residual antigens. Cytomegalovirus retinitis is common in HIV-infected patients on ART with a cluster differentiation 4 (CD4+) counts less than 50 cells/mm3. We reported a patient with blurred vision while receiving ART. She had an unmasking classic CMV retinitis after ART. https://acta.tums.ac.ir/index.php/acta/article/view/4372 https://acta.tums.ac.ir/index.php/acta/article/download/4372/4439

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 51 10 2013 10 15 733 735 EN Seyed Jalil Mirhosseini Department of Cardiovascular Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mehrdad Salehi Department of Cardiovascular Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran. Sadegh Ali-Hassan-Sayegh Yazd Cardiovascular Researches Center, Afshar Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Khalil Forouzannia Department of Cardiovascular Surgery, Afshar Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Ali Akbar Karimi-Bondarabadi Yazd Cardiovascular Researches Center, Afshar Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran 2015 10 11 Mediastinitis is an infrequent complication after coronary artery bypass graft (CABG) that is associated with prolonged intensive care unit and hospital stay, and increased early and late morbidity and mortality. Patients with mediastinitis have an osteoporotic, fragile, and broken sternum. All foreign bodies as well as infected tissue should be removed. Osteomyelitis of sternum often perseveres after debridement for mediastinitis. In this report, we describe an unusual case of costochondritis caused by aspergillosis following off pump CABG surgery in a male patient in Yazd-Iran. https://acta.tums.ac.ir/index.php/acta/article/view/4371 https://acta.tums.ac.ir/index.php/acta/article/download/4371/4441

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 51 10 2013 10 15 4370 4370 EN Reza Rahimian Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. AND Brain and Spinal Injury Repair Research Center, Tehran University of Medical Sciences, Tehran, Iran. Shahram Ejtemaei Mehr Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Gohar Fakhfouri Neuroscience Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Ahmad Reza Dehpour Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. AND Brain and Spinal Injury Repair Research Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 11 No Abstract## https://acta.tums.ac.ir/index.php/acta/article/view/4370 https://acta.tums.ac.ir/index.php/acta/article/download/4370/4444