mojgan karimi

In the electric discharge machining process, the material is separated from the surface of the work piece by an electric spark, and in the presence of the dielectric material and tool electrode, changes are made on the surface of the work piece. In this project, we investigated the effect of dielectric material and brass tool electrode diffusion on the surface of carbon steel workpiece by means of quantmetric analysis, X-ray diffraction and electrochemical impedance spectroscopy. The effect of the parameters such as electric current intensity (I), pulse on time (ton), pulse off time (toff) and machining time (τ) on the composition of work peace, microstructure and electrochemical corrosion of machined work peace, were investigated. The results of quantmetric analysis showed that with the increase of machining parameters, the amount of diffused copper (from brass tool electrode) and carbon (from pyrolysis of flashing dielectric material) on the surface of machined carbon steel was increased. X-ray diffraction results confirmed that the formation of different phases such as Fe1.92C0.08, Cu4, Cu2 and Fe2 on the surface of workpiece, which was accordance with the quantmetric results. Electrochemical studies showed that during the EDM process, the electrochemical corrosion resistance was increased.

The goal of Customer Relationship Management (CRM) is to create new relationships, increase customer value, retain customers and increase profitability. The Patient Relationship Management System (PRM) is a key strategy in managing interactions between healthcare organizations and customers. In PRM, the focus of organizations is on determining and meeting the needs of the patient.

This review article has been performed the role of customer relationship management system in the health care sector using method of library research and searching valid websites.

PRM has the ability to achieve better coherence between health care departments, which in turn improves clinical outcomes and patient satisfaction. Moreover, PRM improves the patient follow-up system, better understanding of their needs, and Provides better care services to patients. Increasing operational efficiency, centralizing data, better management of current customers, and strengthening the hospital image are some of the effects of implementing CRM in hospitals.

Nowadays, health care sector has become a competitive market. New technologies have changed the care environment. Therefore, health care organizations are trying to keep their customers. Customer relationship management is a strategy that enables more insights for customers as well as more effective and satisfying interactions for healthcare organizations.

The purpose of this study is to design a model of the place of public sports in the health-oriented lifestyle of the Navy personnel of the Army of the Islamic Republic of Iran. The research was conducted by mixed method. Data collection methods included library studies, content analysis method and review of 73 semi-structured researches and interviews. The statistical population in the qualitative section were naval sports and health experts. Since this study sought to describe the qualitative characteristics and themes of Klinger, thematic analysis was used. The results showed that after reviewing the interviews and deleting similar codes, first 169 basic themes codes were classified, then they were classified into organizing themes 1 and 2. Organizer 1 with 40 themes and Organizer 2 with 12 themes were classified and then a researcher-made questionnaire was designed and provided to the statistical population of Tehran Navy personnel which was 450 people and calculated by Cochran's formula 207 people as a statistical sample in the form of They were randomly selected and answered a researcher-made questionnaire. The results after ranking the factors showed that management ranked first, education ranked second, facilities ranked third, physiology ranked fourth, media ranked fifth and other topics ranked next, and finally the model was designed.

The variety of sweets along with significant difference level of hygiene in the production, supplies and high potential contamination of sweets ingredients with Escherichia coli, led to investigate the frequency of broad-spectrum beta lactamase strains of E. coli in sweets and determine the presence of SHV, TEM and CTX-M genes. In this descriptive cross-sectional study, 150 confectionery samples were collected from traditional confectionery workshops in Yazd. Detection of E. coli strains was carried out by standard biochemical tests and antibiotic susceptibility test was performed using CLSI guidelines. Via combined ESBL disk method on the muller hinton agar medium producing strains were identified. All the ESBL producing strains were evaluated using the PCR test for the existence of SHV, TEM and CTX-M genes. In 30 isolates, (20%) E.coli was obtained. The results of antibiotic susceptibility test showed that the highest and the lowest antibiotic resistance was related to chloramphenicol l (22 isolates, 73.3%) and Imipenem (8 isolates, 26.6%). The results of the combined disk test was showed that only 9 isolates produced ESBL. The molecular analysis on considered genes indicated that 2, 4 and 3 isolates were positive for presence of TEM, SHV, and CTX-M genes, respectively. The prevalence of antibiotic-resistant isolates in traditional Yazd sweets in this study highlights the importance of more observing and control measures in the preparation and distribution of sweets.

In vitro maturation (IVM) of immature oocytes retrieved from ovarian tissue has been considered as a valuable approach for fertility preservation in cancerous patients. To evaluate the efficacy of vitrification on oocyte maturation, survival rates, as well as the subcellular oocyte quality post IVM. The ovarian cortexes from 19 women with cervix and uterine malignancy aged 21–39 yr were collected. Cumulus-oocyte complexes were aspirated from all visible antral follicles. 102 immature oocytes were collected, and 43 oocytes were detected appropriately for IVM (control group). Also, 59 immature oocytes were vitrified, then matured in vitro (IVM) in two groups: with Growth/differentiation factor 9 (GDF9) (group 1) and without GDF9 (group 2) supplementation. Rates of oocytes viability, maturation, and survival along with meiotic spindle visualization and zona
pellucida birefringence were assessed with Polyscope. The rate of maturation was significantly higher in controls (55.8%) compared to the other groups. Maturation rate was 23.3% in oocytes cultured in IVM medium enriched with GDF9, and 27.6% in those cultured in IVM medium lacking GDF9 (p=0.86). Also, the meiotic spindle was present in 74.4% of control oocytes which was significantly higher than the other groups. The proportion of high zona pellucida birefringence was higher in the controls when compared with group 1 (51.2% vs. 23.3%, respectively, p= 0.04). Vitrification had a detrimental effect on oocyte maturation, viability as well as the subcellular quality of the oocytes after IVM in cancerous women.

Context: Pelvic masses are a prevalent cause for referral to gynecologic oncology departments to evaluate the possibility of benign or malignant conditions. Pelvic mass often was found in pelvic examinations among females with ovarian. Tumor markers are advantageous biomarker in tumor diagnosis. Evidence Acquisition: We performed a computerized search in Medline/PubMed databases and Google Scholar with key words: “Cancer antigen 125 (CA125), Human epididymis protein 4 (HE4), risk of ovarian malignancy algorithm (ROMA), Risk of malignancy index (RMI), and Pelvic mass”. The usage of tumor marker CA125 alone is associated with serious limitations like low sensitivity for early or stage I disease and lack of specificity especially in pre-menopausal women. Serum HE4 is a good biomarker for discriminating ovarian cancer from benign pelvic disease, but could be affected by several factors including pregnancy, age, and smoking. ROMA has a high sensitivity, specificity, and negative predictive value to predict the presence of ovarian cancer in women with a pelvic mass. RMI could differentiate between benign and malignant pelvic masses, but RMI expression was higher in women with 55 years or more. According to the results of this study, combination of these biomarkers or at least 2 or 3 biomarkers are suggested for early stage diagnosis of pelvic mass with high sensitivity and specificity.

Background: Multiple studies have been carried out examining the association of tumor necrosis factor-α gene (TNF-α) promoter region polymorphisms with recurrent pregnancy loss (RPL) risk. However, the results remain con- troversial and incomplete. Hence, we performed a meta-analysis to evaluate the association of the TNF-α -308G>A and -238G>A polymorphisms with RPL risk.
Materials and Methods: In this meta-analysis, a comprehensive search of PubMed, Web of Knowledge and EM- BASE was performed to identify relevant studies published until December 1, 2017. The associations were assessed by odds ratio (OR) and its corresponding 95% confidence interval (CI).
Results: A total of 29 case-control studies, comprising 20 studies on TNF-α -308G>A (3,461 cases and 3,895 con- trols) and nine studies on TNF-α -238G>A (2,589 cases and 2,664 controls), were included in the meta-analysis. Over- all, we found TNF-α -308G>A to be associated with an increase in RPL risk under the homozygote (OR=1.716, 95% CI: 1.210-2.433, P=0.002) and the recessive (OR=1.554, 95% CI: 1.100-2.196, P=0.012) models. TNF-α -238G>A was also significantly associated with increased risk of RPL under the allele model (OR=1.554, 95% CI: 1.100-2.196, P=0.012). Stratified analysis revealed a more significant association between the TNF-α -308G>A polymorphism and increased RPL risk in Asians under the homozygote (OR=2.190, 95% CI: 1.465-3.274, P≤0.001), the dominant (OR=1.642, 95% CI: 1.269-2.125, P≤0.001) and the recessive (OR=1.456, 95% CI: 1.039-2.040, P=0.029) models, but not in Caucasians. A non-significant association was, however, identified between TNF-α -238G>A and RPL risk based on ethnicity. Moreover, TNF-α -308G>A and -238G>A polymorphisms were significantly associated with in- creased risk of RPL in high quality studies and polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) subgroups.
Conclusion: The present meta-analysis demonstrates that TNF-α -308G>A and -238G>A polymorphisms are associ- ated with an increased risk of RPL.

human papillomavirus (HPV) is the most common sexually transmitted disease (STD) throughout the world. The incidence of HPV has been increasing over recent years. Since scant information has been reported on the prevalence of HPV and its related risk factors in Yazd province, the present study aimed to evaluate effects of demographic characteristics as well as the risk factors associated with HPV in Yazd province, Iran.
A total of 119 patients with genital warts entered this case series, who referred to Shahid Sadoughi hospital. Demographic information and productivity factors were collected using some questionnaires.
The mean age of the patients was (32.9) that most of the infected were between the ages of 31 to 35. Approximately, 58.8% of the patients started sex under the age of 20, and only 5% of the patients had more than one sex partner. Besides, almost 8 .4% of the participants were infected with other STDs. In 87.4% of cases, the diagnosis of genital warts is first appear in woman then their sex partner, and % 61.3 of the patients chose vaccination.
The findings of the current study revealed that HPV is more prevalent within young adults, in particular those who are sexually active. As a result, further research seems to be demanded in regard with sexual health, relationship training, as well as HPV vaccines such as Gardasil for high-risk people.

human papillomavirus (HPV) is the most common sexually transmitted disease (STD) throughout the world. The incidence of HPV has been increasing over recent years. Since scant information has been reported on the prevalence of HPV and its related risk factors in Yazd province, the present study aimed to evaluate effects of demographic characteristics as well as the risk factors associated with HPV in Yazd province, Iran. A total of 119 patients with genital warts entered this case series, who referred to Shahid Sadoughi hospital. Demographic information and productivity factors were collected using some questionnaires. The mean age of the patients was (32.9) that most of the infected were between the ages of 31 to 35. Approximately, 58.8% of the patients started sex under the age of 20, and only 5% of the patients had more than one sex partner. Besides, almost 8. 4% of the participants were infected with other STDs. In 87.4% of cases, the diagnosis of genital warts is first appear in woman then their sex partner, and % 61.3 of the patients chose vaccination. The findings of the current study revealed that HPV is more prevalent within young adults, in particular those who are sexually active. As a result, further research seems to be demanded in regard with sexual health, relationship training, as well as HPV vaccines such as Gardasil for high-risk people.

Malignancies are not rare in girl and women during their reproductive years. Over the past three decades, the survival rate for cancer has been improving due to progress in cancer diagnosis and treatment. These patients frequently experience a variety of treatment, and disease-related side effects that diminish their quality of life during and after treatment; among these are loss of fertility and sexual dysfunction. There have been recent advances in the field of fertility preservation, which can allow many of these genital cancer survivors to have children in the future. This topic review discusses available options and specific strategies for fertility preservation in adolescent and young women with malignancies who wish to preserve their ability to become pregnant in the future.

The aim of this study was to assess the role of consolidative intraperito-neal chemotherapy with carboplatin in decreasing relapse and increasing survival in advanced epithelial ovarian cancers, as well as evaluation of its toxicity. In this clinical trial 30 patients with epithelial ovarian cancer in stages II-IV who had complete surgery (optimal debulking surgery) received six standard cycles of intravenous carboplatin and paclitaxel. They were enrolled through non-random se-quential selection. The control patients were similar to case group in stage (II-IV) and pathology (epithelial ovarian cancer). The control group was evaluated retrospectively through hospital files. This clinical trial performed in Gynecology Oncology department in Tehran Valiasr University Hospital, during 2005-2010. They including 18 cases as the intervention group receiving intraperitoneal chemotherapy and 12 patients as the control group with only retrospective follow-up. The cases received 3 cycles of 400 mg/m2 intraperitoneal carboplatin every 21 days following intravenous chemotherapy. Relapse of disease was diagnosed as increasing or even doubling CA125 serum titer during one month, or any CA125 above 100 IU, or an abdominal or pelvic mass in ul-trasound or physical exam. Mean survival of two and five years, progression-free inter-val (PFI), overall survival (OS), relapse, demographic parameters, drug toxicities, path-ologic types of cancers in two groups were coded and compared using SPSS 14. Any P<0.05 was considered as a significant difference. The mean ages of cases and controls were 52.4±8.6 and 55.1±11.5 years. The mean duration of relapse-free survival was 13±8.6 months for the cases and 9.5±4.3 months for the control patients (not statistically different, P>0.05). The mean overall survival for cases and controls were 39±16.5 and 30.8±16.2 months, respectively (no significant difference, P>0.05). The frequency of drug toxicities in the cases was 5.6%, and consisted of mild-to-moderate abdominal pain, nausea and vomiting. It seems that consolidation therapy with intraperitoneal carboplatin may not increase overall survival, reduce relapse rate or decrease mortality, though it does not induce considerable side effects. Since the mean survival in the intervention group was nine months more than controls, this difference may be clinically significant.

Isolated fallopian tube torsion is rare and often difficult to diagnose. Definitive diagnosis is always made at laparoscopic or via laparotomy exploration performed for suspected ovarian torsion. Early diagnosis and conservative laparoscopic treatment especially in a reproductive age woman is warranted as a means of preserving fallopian tube integrity and maintaining fertility. Here, we describe a case with isolated right fallopian torsion being managed by conservative laparoscopic surgery.

Infertility affects about 10-15% of reproductive-age couples. About half the causes ofinfertility are female related and approximately 40% of the cases are caused by anovulation, mostlyin PCO women.

This study was conducted to determine and compare the effects of two drug treatmentregimens: higher dose of clomiphene and a combination of lower dose of clomiphene and tamoxifenin treating infertile women with PCO.

The study was a randomized clinical trial conducted on 100 infertilepatients who referred to Yazd-Iran Infertility Clinic between the years 2001-2003. The patientswere selected who had received at least 3 periods of clomiphene, but no pregnancy had occurred.They were randomly divided into two groups. In the first group, clomiphene was increased to 100mg and the second group 20 mg of tamoxifen was added to 50 mg of clomiphene from day 5-9 ofmenstruation cycle. Infertility duration, duration of medicine used, PCT score, endometrialthickness, ovulation, and pregnancy rate were studied in both groups.

Ovulation rate in clomiphene group was 54.9%; Tamoxifen + clomiphene group was73.5% without significant differences in both groups. (PV = 0.053). Positive pregnancy rate inclomiphene group was 39.2%; clomiphene + tamoxifen group was 61.2% (P value < 0.05), whichcould be concluded that pregnancy rate was higher in clomiphene/tamoxifen group than in theclomiphene group. The presence of a dominant follicle in the two treatment groups in womenbetween 18-24 was not significant, but in women between 25-39 years was significant (PV= 0.049)(Table III).

The recommendation is to add Tamoxifen to Clomiphene in 35-39 women with 20≤BMI ≤26.99 before the use of gonadotropins treatment in PCOS with or without IUI, because theseoptions have higher risk of multiple pregnancy and ovarian hyperstimulation syndrome.