Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 3 2016 04 05 218 219 EN Mojtaba Kamali Aghdam Department of Pediatric, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran. Kambiz Davari Department of Pediatric, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran. Kambiz Eftekhari Department of Pediatric, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. 2015 12 08 2016 01 09 Severe thrombocytopenia with bleeding is rarely reported in children with brucellosis, and recurrent epistaxis is extremely rare. Brucellosis with hemorrhage should be differentiated from viral hemorrhagic fever, malignancy, and other blood disorders. Bone marrow aspiration (BMA) is mandatory to differentiate from other blood diseases. An 8-year-old boy was admitted with recurrent epistaxis, petechiae and purpura on face and extremities and bleeding from the gums. During the hospitalization, he was febrile and complained of muscle pain. Leukopenias associated with thrombocytopenia were observed. BMA showed to be normal. Among the multiple tests requested, only serum agglutination test (SAT) and 2-MercaptoEthanol test (2-ME) were positive. He was treated with Intravenous immunoglobulin (IVIG) associated with co-trimoxazole and rifampin. Finally, fever subsided, and he was discharged with good condition and normal platelet count. Brucellosis should be a differential diagnosis in patients with fever and bleeding disorders and a history of consumption of unpasteurized dairy, in endemic areas. https://acta.tums.ac.ir/index.php/acta/article/view/5251 https://acta.tums.ac.ir/index.php/acta/article/download/5251/4769

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 3 2016 04 05 165 172 EN Mahshid Attari Department of Biology, Islamic Azad University, Qom Branch, Qom, Iran. AND Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran. Fatemeh Jamaloo Department of Biology, Islamic Azad University, Qom Branch, Qom, Iran. Sahar Shadvar Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran. Nahid Fakhraei Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran. Ahmad Reza Dehpour Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran. AND Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran. 2016 04 05 2016 04 05 Withania somnifera (WS) possess anti-inflammatory and antioxidant properties. WS preparations have a potential therapeutic role in the central nervous system (CNS) related disorders in animal models. In this study, the possible protective effect of acute aqueous WS root extract on behavioral despair was explored and compared with fluoxetine, an antidepressant with selective serotonin (5-HT) reuptake inhibitor activity (SSRI). Further, the probable involvement of nitric oxide (NO) determined to measure immobility time in forced swimming test (FST) and tail suspension test (TST) in male mice. Immediately after assessment of locomotor activity, the immobility time was evaluated. WS was administered intraperitoneally (200, 400 mg/kg; i.p.) 60 min before the behavioral tests. To assess the involvement of NO in the possible protective effect of WS, a non-specific NO synthase inhibitor, NG-L-arginine methyl ester (L-NAME, 10 mg/kg, i.p.) was administered 30 min before the extract administration (400 mg/kg, i.p.), 90 min before the tests. Acute WS extract (200, 400 mg/kg, i.p.) dose-dependently decreased the immobility time in FST, P<0.05, P<0.001, respectively and 400 mg/kg proved the most effective dose and this dose was comparable to fluoxetine (20 mg/kg, i.p. WS (400 mg/kg, i.p.) also lowered the immobility measure in TST (P<0.05). However, these effects were not related to change in locomotor activity. Moreover, L-NAME (10 mg/kg, i.p.) did not influence the effect of the extract on the behavioral tests. As a consequence, the immobility time was virtually constant between the group received the extract (400 mg/kg) alone, and the group received L-NAME (10 mg/kg) before the extract. It is probable that NO does not mediate this beneficial effect, and WS may affect other neurochemical systems and pathways. https://acta.tums.ac.ir/index.php/acta/article/view/5549 https://acta.tums.ac.ir/index.php/acta/article/download/5549/4761

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 3 2016 04 05 220 221 EN Farzaneh Motamed Department of Pediatric Gastroenterology, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran. Gholamhossein Fallahi Department of Pediatric Gastroenterology, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran. Faezeh Ahmadi Research Center for Immunodeficiencies, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran. Fatemeh Bazvand Research Center for Immunodeficiencies, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran. Maedeh Ahmadi Research Center for Immunodeficiencies, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran. Kambiz Eftekhari Department of Pediatric Gastroenterology, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran. Nima Rezaei Research Center for Immunodeficiencies, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran. AND Department of Immunology, School of Medicine, Molecular Immunology Research Center, Tehran University of Medical Sciences, Tehran, Iran. AND Universal Scientific Education and Research Network (USERN), Tehran, Iran. 2015 12 15 2016 03 04 Cystic fibrosis (CF) is a hereditary disease of mucous and sweat glands, which affects the respiratory and gastrointestinal systems. Herein, we describe a 3-month-old girl with a history of recurrent episodes of urinary tract infections that required hospitalization. She was referred to our center at the age of three months, with massive gastroesophageal variceal bleeding. In physical examination, she had clubbing, hepatosplenomegaly, and mild ascites. Laboratory studies revealed high serum levels of liver enzymes and low level of Albumin. As of suspicious to CF, sweat tests were performed twice which confirmed the diagnosis of CF. Gastrointestinal bleeding due to gastroesophageal varices is a rare complication of CF, which could result as a consequence of hepatobiliary involvement of disease. Early diagnosis of CF could prevent severe complications and even death in this group of patients. https://acta.tums.ac.ir/index.php/acta/article/view/5269 https://acta.tums.ac.ir/index.php/acta/article/download/5269/4770

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 3 2016 04 05 173 175 EN Alborz Salavati Department of Urology, Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran. Abdolrasoul Mehrsai Department of Urology, Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran. Farzad Allameh Department of Urology, Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran. Farimah Alizadeh Department of Urology, Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran. Farshad Namdari Department of Urology, Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran. Mehdi Hosseinian Department of Urology, Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran. Elaheh Salimi Department of Urology, Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran. Fariba Heidari Department of Urology, Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran. Gholam Reza Pourmand Department of Urology, Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran. 2016 04 05 2016 04 05 Coronary artery disease (CAD) and vascular insufficiency are consequences of modern lifestyle, and vasogenic erectile dysfunction (ED) is one of the leading causes of sexual dysfunction which could be prevented like ischemic heart disease if the risk factors are discovered and managed. Seventy-five men scheduled for coronary angiography were asked to fill out the IIEF5 questionnaire and underwent serum lipoprotein-a, uric acid, lipid profile, testosterone, Sex Hormone Binding Globulin (SHBG), dehyderoepiandrostendion sulfate (DHEAS) tests; and the results were compared with those of erectile dysfunction patients with and without coronary artery disease. Ten out of 32 CAD patients (30%) and 6 of 43 normal coronary men had ED Prevalence (P=0.04). The average serum uric acid in ED patients with normal coronary was 5.6 (± 0.68) 6.5 ±078 mg/dl in ED patients of CAD group P=0.034. Men with both ED and CAD had significantly higher levels of lipoprotein-a compared to those CAD patients with normal sexual function. Higher uric acid and lipoprotein-a levels are correlated with the presence of ED in patients with CAD. https://acta.tums.ac.ir/index.php/acta/article/view/5550 https://acta.tums.ac.ir/index.php/acta/article/download/5550/4762

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 3 2016 04 05 222 225 EN Marino Marčić Department of Neurology, University Hospital Split, Split, Croatia. Ljiljana Marčić Department of Radiology, University Hospital Split, Split, Croatia. Krešimir Kolić Department of Radiology, University Hospital Split, Split, Croatia. Marina Titilić Department of Neurology, University Hospital Split, Split, Croatia. 2015 11 30 2016 04 03 We presented the case of a patient with internal watershed infarction with a nonspecific clinical presentation including hemiplegia, hemisensory deficit, and speech disturbance. Neuroimaging and ultrasound diagnostic procedure are important tools for diagnosis of these rare ischemic events that count for about 6% of all strokes.  Specific therapy is mandatory for the diagnosis of watershed infarction and different from the therapeutical measures than can be taken for embolic and atherothrombotic strokes. Our patient was a 69-year-old, right-handed Caucasian woman who presented to our facility with acute right side weakness and speech disturbance. He had hypothyroidism, permanent atrial fibrillation, diabetes mellitus and she was hypotensive. She reported dizziness few days before the accident. Imaging studies revealed internal watershed infarction. Therapeutic procedures were taken to restore low cerebral blood flow. Internal watershed infarction is rare (less than 10% of all strokes) but well recognized a clinical feature of stroke. Specific pathophysiology generally is connected with hypoperfusion and hemodynamic mechanisms. Specific therapy is mandatory for these conditions. https://acta.tums.ac.ir/index.php/acta/article/view/5225 https://acta.tums.ac.ir/index.php/acta/article/download/5225/4771

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 3 2016 04 05 176 184 EN Mohammad Reza Abassi Nephrology Research Center, Tehran University of Medical Sciences, Tehran, Iran. Amin Safavi Department of Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Masoumeh Haghverdi Department of Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Babak Saedi Department of Otolaryngology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. 2016 04 05 2016 04 05 Kidney failure affects different aspects of normal life. Among different manifestations, sleep problem can be considered as a common complaint of ESRD (End Stage Renal Disease) patients. In this study, we aimed to investigate the interrelationship between sleep disorders in ESRD patients and their characteristics. Through a cross-sectional study (2010-2011), 88 ESRD patients undergoing maintenance hemodialysis thrice weekly were recruited to enter the study. We used a self-administered questionnaire into which the data were reflected. The patients selected their specific sleep disorders using a nine-item scale while the Epworth Sleepiness Scale (ESS) determined both the presence and severity of sleep disorders. The data was finally analyzed with their baseline characteristics, dialysis characteristics, medication/stimulants use, and clinical and biochemical parameters. Over 95% of the patients had, at least, one specific sleep disorder while the ESS revealed 36.36% of patients as normal, 59.09% as having mild sleep disorders, and 4.54% as having moderate to severe sleep disorders. Sleep disorders were significantly correlated with older ages (P=0.035), dialysis dose (P=0.001), blood creatinine levels (P=0.037), upper airways obstruction (P=0.035), hepatomegaly (P=0.006), hepatic failure (P=0.001), higher blood TSH levels (P=0.039), history of hypothyroidism (P=0.005), and the use of levodopa (P=0.004), anti-hypertensive medications (P=0.006), benzodiazepines (P=0.006), Eprex (Erythropoietin) (P=0.001), Venofer (Iron Sucrose Injection) (P=0.013), and phosphate-binders agents (P=0.018). Sleep disorders are common findings among ESRD patients and seem to be a more complicated issue than a simple accumulation of the wastes products in the body. Whatever the causes of sleep disorders are, disorder-specific treatments should be considered. https://acta.tums.ac.ir/index.php/acta/article/view/5551 https://acta.tums.ac.ir/index.php/acta/article/download/5551/4763

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 3 2016 04 05 185 190 EN Laleh Eslamian Department of Obstetrics & Gynecology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran. 2016 06 25 2016 06 26 A 40-year-old male patient with suicidal ingestion of one tablet of aluminium phosphide was referred to the department of toxicology emergency of Baharloo Hospital, Tehran, Iran. The garlic odor was smelled from the patient and abdominal pain and continuous vomiting as well as agitation and heartburn were the first signs and symptoms. Systolic and diastolic blood pressures at the arrival time were 95 and 67 mmHg, respectively. Gastric lavage with potassium permanganate (1:10,000), and 2 vials of sodium bicarbonate through a nasogastric tube was started for the patient and the management was continued with free intravenous infusion of 1 liter of NaCl 0.9% serum plus NaHCO3, hydrocortisone acetate (200 mg), calcium gluconate (1 g) and magnesium sulfate (1 g). Regarding the large intravenous fluid therapy and vasoconstrictor administering (norepinephrine started by 5 µg/min and continued till 15 µg/min), there were no signs of response and the systolic blood pressure was 49 mmHg. At this time, hydroxyethyl starch (HES) (6% hetastarch 600/0.75 in 0.9% sodium chloride) with a dose of 600 cc in 6 hours was started for the patient. At the end of therapy with HES, the patient was stable with systolic and diastolic blood pressure of 110 and 77 mmHg, respectively. He was discharged on the 6th day after the psychological consultation, with normal clinical and paraclinical examinations. This is the first report of using HES in the management of AlP poisoning and its benefit to survive the patient. https://acta.tums.ac.ir/index.php/acta/article/view/5737 https://acta.tums.ac.ir/index.php/acta/article/download/5737/4819

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 7 2016 07 09 430 436 EN Ali Hassanpour-Dehkordi Department of Medical Surgical, Nursing and Midwifery Community-Oriented (Holistic) Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran. Amir Jalali Department of Psychiatric Nursing, Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran. 2015 10 19 2016 03 04 Since the elderly population is increasing rapidly in developing countries which may decrease the physical activity and exercise and in turn could affect the elderly’s quality of life, this study aimed to investigate the effect of progressive muscle relaxation on the elderly’s quality of life in Iran. In a randomized clinical trial, participants were randomly divided into intervention and control groups. For the intervention group, muscular progressive relaxation was run three days per week for three months (totally 36 sessions). In relaxation, a patient contract a group of his/her muscles in each step and relaxes them after five seconds and finally loosens all muscles and takes five deep breaths. Each session lasts for 45 minutes. The instrument of data gathering consisted of questionnaires on individual’s demographic data and quality of life SF-36. After intervention, quality of life increased significantly in the patients undergoing muscular progressive relaxation and fatigue severity decreased significantly in the intervention group compared to prior to intervention. In addition, there was a statistically significant difference in mean score of physical performance, restricted activity after physical problem, energy, socially function, physical pain, overall hygiene, and quality of life between intervention and control groups. By implementing regular and continuous progressive muscle relaxation, quality of life could be increased in different dimensions in the elderly and the context could be provided to age healthily and enjoy higher health and autonomy. Therefore, all of the therapeutic staffs are recommended to implement this plan to promote the elderly’s quality of life. https://acta.tums.ac.ir/index.php/acta/article/view/5009 https://acta.tums.ac.ir/index.php/acta/article/download/5009/4810

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 7 2016 07 09 437 440 EN Mohammad Reza Motie Department of General Surgery, Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. Parham Hashemi Department of General Surgery, Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. 2015 10 19 2016 04 05 To determine whether the medical Treatment of anal fissure can be an effective alternative for surgery Methods: Retrospectively, we randomly selected 190 Patients being treated for anal fissure between the years 2005-2010 in 3 equal groups: group A: Patients who received medical treatment with topical nitroglycerin, group B: Patient treated with topical diltiazem, and group C: Patients underwent surgery. The results were then correlated with the statistical program SPSS using chi-square test. Main complaints of the patients were first anal pain and then bleeding. The response to treatments for relieving pain was: 77% in A, 83% in B, and 98% in group C. Response of treatments for fissure healing, in order of groups A, B and C was: 74%, 83%, and 94%. Despite good response to medical treatment, surgical treatment was more effective and medical treatment of choice in patients who are willing to have surgery. https://acta.tums.ac.ir/index.php/acta/article/view/5005 https://acta.tums.ac.ir/index.php/acta/article/download/5005/4811

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 7 2016 07 09 441 447 EN Mehran Maghsoudloo National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran. Farid Abolhassani National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran. Nasrin Lotfibakhshaiesh School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 10 2016 03 27 The collection of data within the primary health care facilities in Iran is essentially paper-based. It is focused on family’s health, monitoring of non-infectious and infectious diseases. Clearly due to the paper-based nature of the tasks, timely decision making at most can be difficult if not impossible. As part of an on-going electronic health record implementation project at Tehran University of Medical Sciences, for the first time in the region, based on a comprehensive pilot project, four urban healthcare facilities are connected to their headquarters and beyond, covering all aspects of primary health care, for the last four years. Without delving into the technical aspects of its software engineering processes, the progress of the implementation is reported, selection of summarized data is presented, and experience gained thus far are discussed. Four years passed and if time is any important reason to go by, then it is safe to accept that the software architecture and electronic health record structural model implemented are robust and yet extensible. Aims and duration of a pilot study should be clearly defined prior to start and managed till its completion. Resistance to change and particularly to information technology, apart from its technical aspects, is also based on human factors. https://acta.tums.ac.ir/index.php/acta/article/view/4305 https://acta.tums.ac.ir/index.php/acta/article/download/4305/4812

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 7 2016 07 09 448 453 EN Asghar Hajiabbasi Guilan Rheumatology Research Center, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran. Irandokht Shenavar Masooleh Guilan Rheumatology Research Center, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran. Yousef Alizadeh Guilan Eye Research Center, Amir Almomenin Hospital, Guilan University of Medical Sciences, Rasht, Iran. Amir Sadredin Banikarimi Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran. Pooneh Ghavidel Parsa Guilan Rheumatology Research Center, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran. 2015 10 20 2016 03 04 Sjogren syndrome (SS) can occur alone, primary Sjogren syndrome, or in association with other rheumatic diseases, secondary Sjogren syndrome (sSS), such as Rheumatoid arthritis (RA). The occurrence of Sjogren syndrome with RA makes it course worse and increases high morbidity and mortality of RA. In this exploratory study we aim to determine the prevalence of sSS (diagnosed based on the revised version of American–European consensus Group Classification Criteria: AUCG-criteria), sicca symptoms (dry eye, dry mouth), positive autoantibody tests (Anti RO or Anti-LA antibodies), UWSFR (Unstimulated Whole Salivary Flow Rate), Schirmer and Lissamine test. In this cross-sectional study, eighty three consecutive RA patients (according to American College of Rheumatology criteria 1987) who were visited at rheumatology clinic of Razi General Hospital located in the north of Iran entered into our study. Our exclusion criteria was a positive history of past head and neck radiation treatment, Hepatitis C infection, acquired immunodeficiency disease (AIDS), pre-existing lymphoma, sarcoidosis, graft versus host disease, use of anticholinergic drugs (including neuroleptics, antidepressants, antihypertensive and parasympatholytics). They examined with UWSFR by a rheumatologist and with Schirmer test and Lissamine test by an ophthalmologist. Participants were 90.4% female with the mean age 48.3±13 years. Duration of RA was in 36.1% less than 5 years, in 22.9% 5-10 years, in 12.1% 11-15 years and in 28.9% more than 15 years. Our results demonstrated that the prevalence of sSS was 5.9% (CI:0.6%-10.5%). Number of 27.7% of RA patients positively responded to at least one question about sicca symptoms. Among objective tests, only Positive UWSFR and Lissamine test were significantly more common in RA patients with sSS in comparison to ones without sSS (P<0.001, P=0.01 respectively). In RA patients, we found a linear trend between sicca symptoms and aging (P=0.02). In patients with sicca symptoms, among tests that used for assessing decrease in saliva or tear production, only USWFR significantly more common (P=0.01). In conclusion: In RA population in North of Iran prevalence of sSS was less than 10%. In them, a significant linear trend existed between aging and sicca symptoms. Among objective tests of AUCG-criteria (except for lip biopsy that was not performed in the current study) only UWSFR and Lissamine test were significantly more common in patients with sSS in comparison ones without it. https://acta.tums.ac.ir/index.php/acta/article/view/5006 https://acta.tums.ac.ir/index.php/acta/article/download/5006/4813

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 7 2016 07 09 454 457 EN Gholamreza Eshghi Department of Dermatology, Psoriasis Research Center, Farshchian Hospital, Hamadan University of Medical Sciences, Hamadan, Iran. Leila Khezrian Department of Dermatology, Psoriasis Research Center, Farshchian Hospital, Hamadan University of Medical Sciences, Hamadan, Iran. Pedram Alirezaei Department of Dermatology, Psoriasis Research Center, Farshchian Hospital, Hamadan University of Medical Sciences, Hamadan, Iran. 2015 10 17 2016 03 07 Flushing is a condition with episodic attacks of redness of the skin with a sensation of warmth or burning, this disease causes emotional and functional problems in patients. There is various treatments for this condition; one of them is the use of botulinum toxin-A (BTA). In this prospective pilot study we studied the effect of Botulinum toxin-A (BTA) effect on DLQI of patients with facial flushing, we compared the DLQI before and after treatment. The number of 24 women with facial flushing admitted to the department of dermatology of Hamadan Farshchian Hospital, with the age range of 18 to 60 was enrolled in the study. Patients completed Dermatology Quality of life Index questionnaire before and one month after treatment. In our study 1 unit of BTA was injected intracutaneously per square cm in both sides of cheeks, to a total dose of 30 units per session. All of 24 patients completed the study. The mean age was 37.79±13.13. In all patients, DLQI decreased, and in two months follow up, the mean of DLQI improved from 8.08±1.17 to 4.5±1.21 (P.value<0.005). Based on this study BTA is an effective and safe treatment for facial flushing. https://acta.tums.ac.ir/index.php/acta/article/view/4983 https://acta.tums.ac.ir/index.php/acta/article/download/4983/4814

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 7 2016 07 09 458 464 EN Shirin Farahyar Department of Medical Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran. Farideh Zaini Department of Medical Mycology and Parasitology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Parivash Kordbacheh Department of Medical Mycology and Parasitology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Sassan Rezaie Department of Medical Mycology and Parasitology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Mehraban Falahati Department of Medical Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran. Mahin Safara Department of Medical Mycology and Parasitology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Reza Raoofian Legal Medicine Organization Research Center, Genetic Laboratory, Legal Medicine Organization, Mashhad, Iran. Kamran Hatami Department of Language, School of Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran. Masoumeh Mohebbi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mansour Heidari Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. AND Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran. AND Department of Molecular Biology and Genetics, Islamic Azad University, Boushehr Branch, Boushehr, Iran. 2015 10 14 2016 03 05 Acquired azole resistance in opportunistic fungi causes severe clinical problems in immunosuppressed individuals. This study investigated the molecular mechanisms of azole resistance in clinical isolates of Candida glabrata. Six unmatched strains were obtained from an epidemiological survey of candidiasis in immunocompromised hosts that included azole and amphotericin B susceptible and azole resi