فهرست مطالب seyed hossein abtahi

 To report the first case of ocular syphilis in an Iranian patient and discuss its diagnostic challenges.

Case Report:

 A man in his mid-70s presented with progressive bilateral visual and auditory decline. He had previously lived in a Southeast Asian country for 10 years. Prior steroid therapies entailed no inflammation subsidence. His visual acuity at presentation was light perception OU. Funduscopic findings included severe vitritis, severe optic atrophy, diffuse retinal vascular occlusion, and diffuse retinal atrophy OU. Angiography demonstrated diffuse areas of retinal and choriocapillaris atrophy with no active choroiditis. Scaly cutaneous lesions were noted on his palms and soles – atypical findings of secondary syphilis. Serum analysis revealed an underlying syphilis infection. The cerebrospinal fluid sample was reactive to anti-syphilis antibodies, securing a neurosyphilis diagnosis. Two weeks of antibiotic therapy resulted in cutaneous lesions resolution and relative visual improvement despite extensive baseline retinal atrophic damage.

Ocular syphilis can mimic numerous ocular inflammatory scenarios. In cases of ocular inflammation that is unresponsive to steroids, reconsidering alternative diagnoses, especially infections with the highest clinical relevance, is necessary. We stress the importance of acquiring patients’ sexual history, regardless of cultural barriers and the rarity of the entity in some regions.

To assess the added risk of acute endophthalmitis after intravitreal injections associated with the widespread use of face masks during the COVID-19 pandemic.

In this retrospective, single-center study, records of patients with acute endophthalmitis following intravitreal bevacizumab (IVB) injections during the pre-COVID era—that is, March 1st , 2013 to October 31st, 2019 —and the COVID-19 era—that is, March 1st, 2020 to April 1st, 2021 —were reviewed and compared.

A total of 28,085 IVB injections were performed during the pre-COVID era; nine eyes of nine patients developed acute post-IVB endophthalmitis in this era, giving an overall incidence of 0.032% (3.2 in 10,000 injections). In the COVID era, 10,717 IVB injections were performed; four eyes of four patients developed acute post-IVB endophthalmitis in this era, giving an overall incidence of 0.037% (3.7 in 10,000 injections). The incidences of post-IVB endophthalmitis during these two eras were not statistically significantly different (P = 0.779).

Face masking protocols seem unlikely to impose any additional risk of post-IVB endophthalmitis.

To evaluate the effects of intravitreal ziv-aflibercept injections (IVZ) on subfoveal choroidal thickness (SCT) as well as on central macular thickness (CMT) and on best corrected visual acuity (BCVA) changes in eyes with center-involved diabetic macular edema (CI-DME).

Fifty-seven eyes of 36 patients with CI-DME were included in this prospective interventional case series. Structural optical coherence tomography (OCT) and enhanced depth imaging OCT were performed at baseline followed by three monthly 1.25 mg IVZ injections. Changes of SCT, CMT, and BCVA at each follow-up session were assessed. The association between baseline SCT and its monthly changes with final visual and anatomical outcomes were also assessed.

CMT at baseline, and at the first, second, and third month follow-up sessions were 396 ± 119, 344 ± 115, 305 ± 89, and 296 ± 101 μm, respectively (P-value < 0.001). SCT at baseline, and at months one, two, and three were 236 ± 47, 245 ± 56, 254 ± 54, and 241 ± 54 μm, respectively (Pvalue > 0.99). Corresponding figures for BCVA were 0.58 ± 0.29, 0.47 ± 0.31, 0.4 ± 0.24, and 0.37 ± 0.23 LogMAR, respectively (P-value < 0.001). There was a statistically significant positive correlation between BCVA and CMT changes following IVZ injections (P-value < 0.001). However, there were no significant correlations between SCT changes and visual acuity (VA) and CMT changes following IVZ injections.

IVZ improved visual outcomes and macular thickness profiles in patients with CI-DME. However, IVZ had no significant effect on SCT. Baseline SCT and its monthly changes had no association with visual and anatomical outcomes.

To present the outcome of optic disc pit maculopathy (ODPM) managed successfully with an inverted internal limiting membrane (ILM) flap over the optic disc. A narrative review of ODPM pathogenesis and surgical management techniques are also provided.

Case Report: 

This prospective interventional case series included three eyes of three adult patients (25–39 years old) with unilateral ODPM and a mean duration of unilaterally decreased visual acuity of 7.33 ± 2.40 months (4–12 months). The pars plana vitrectomy with posterior vitreous detachment induction was performed on eyes, followed by an inverted ILM flap insertion over the optic disc and gas tamponade. Patients were followed for 7–16 weeks postoperatively; best-corrected visual acuity (BCVA) improved dramatically in one patient from 2/200 to 20/25. BCVA in other patients improved two and three lines – to 20/50 and 20/30, respectively. A significant anatomical improvement was achieved in all three eyes, and no complication was detected throughout the follow-up period.

Vitrectomy with inverted ILM flap insertion over the optic disc is safe and can yield favorable anatomical improvement in patients with ODPM.

There are numerous sophisticated studies which have investigated risk factors of breast cancer (BC). The purpose of this paper is to use benefits of Bayesian modeling to involve such prior information in determining factors affecting the survival of women with BC in Yazd city.

The checklist included the characteristics of the patients and the factors studied. Then, from the records of patients referred to Radiotherapy Center of Shahid Ramezanzadeh, who had BC, from April 2005 to March 2012, the survival of 538 persons was recorded in the census. Data were analyzed by R software version 3.4.2, and 0.05 was considered the significance level.

The mean age of BC diagnosis was 48.03 ± 11016 years. The Bayesian Cox regression showed that surgery (hazard ratio [HR] =1.631 95% PI; 1.102–2.422), ki67 (HR = 3.260. 95% PI; 1.6308–6.372), stage (HR = 5.620, 95% PI; 4.079–7.731), lymph node (HR = 1.765, 95% PI; 1.127–2.790), and ER (HR = 2. 600 95% PI; 2.023–3.354) were significantly related to survival time.

The parametric and cox models were compared with standard error, and Cox model was selected as an optimal model. Accordingly, stage, ki67, lymph node, ER, and surgery variables had a positive effect on death hazard.

Over the past two decades, we have witnessed the increasing use of photodynamic therapy (PDT) in the field of ocular oncology. Based on a review of the literature and our own experience, we herein review the role of PDT for the management of intraocular tumors. The discussion includes two main topics. First, we discuss the application of PDT for benign tumors, including circumscribed choroidal hemangioma, choroidal osteoma, retinal astrocytoma, retinal capillary hemangioma (retinal hemangioblastoma), and retinal vasoproliferative tumor. Second, we assess the role of PDT for malignant tumors, including choroidal melanoma and choroidal metastasis.

Acute myeloid leukemia (AML) is characterized by the proliferation of myeloid precursors and abnormal differentiation of hematopoietic stem cells, which results in the accumulation of immature cells in the bone marrow (BM). The accumulation of these cells in the bone marrow causes molecular and cellular changes in the microenvironment of the bone marrow. The adiponectin hormone originates from adipose tissue of the bone marrow, which in addition to effective functions in cellular metabolism, suppresses cancer through various mechanisms, including inhibition of metastasis, angiogenesis, and proliferation. In the bone marrow sample, patients with acute myeloid leukemia are associated with different subtypes of the disease.

In this basic-fundamental research, a total of 40 BM samples from de novo AML patients and 15 BM samples from healthy volunteers as the healthy group referred to the Stem Cell Transplantation Laboratory and Cell Therapy of Taleghani Hospital and with assisting the Research Center, Shahid Beheshti University of Medical Sciences, Tehran, from March 2015 to February 2017, were entered into the study. Then used the Real-time polymerase chain reaction (RT-PCR) method for diagnosis level of adiponectin gene expression in BM samples patients and the healthy group.

The results of the present study showed that the level of adiponectin gene expression in the BM sample of patients was significantly decreased in comparison with the healthy group (P=0.002). While, there was no significant difference (P<0.05) in adiponectin gene expression in AML subtypes myeloblastic, promyelocytic, and myelomonocytic/monocytic.

The results of this study indicate that there was a decrease in adiponectin gene expression in the bone marrow of acute myeloid leukemia patients compared to healthy controls. This decrease in adiponectin expression may be due to myeloid hyperplasia and a decrease in bone marrow adipocytes. In fact, The nutritional, metabolic, and mechanical stresses associated with myeloid cells accumulation cause alterations in bone marrow microenvironment structure and destruction of bone marrow adipose tissue. Therefore, reduced adiponectin gene expression in AML patients is one of the key indicators of bone ‎marrow microenvironmental changes in AML patients.‎‎

Purpose Ameloblastoma is a non-encapsulated and slow-growing tumor with high recurrence rate. Orbital involvement by this neoplasm is an extremely rare entity. In this study, we present a systematic review on this situation along with clinical and paraclinical features of a case.
Methods An electronic search was conducted on major medical sources. Data of the cases in the literature in addition to our own case were extracted, summarized, and statistically analyzed.
Results A total of 36 other cases from 20 relevant studies were also reviewed. Review topics included epidemiology, clinical presentation, pathologic features, differential diagnosis, imaging, treatment, and prognosis. We provided a five-year history of a 50-year-old man with orbital/skull base invasion of plexiform maxillary ameloblastoma.
Conclusions Maxillary ameloblastoma is a locally aggressive neoplasm, and physicians must be alert to the biologic behavior of this tumor to detect any invasion to critical structures such as orbit and cranium. Orbital ameloblastoma causes significant morbidity and mortality. We advocate meticulous patient follow-up with regular clinical examinations and paraclinical work-up for timely detection of any invasion or recurrence. The best must be done to avoid extensions by aggressive removal of maxillary ameloblastoma.

The hyperimmunoglobulin E syndromes (HIESs) are very rare immunodeficiency syndromes with multisystem involvement, including immune system, skeleton, connective tissue, and dentition. HIES are characterized by the classic triad of high serum levels of immunoglobulin E (IgE), recurrent staphylococcal cold skin abscess, and recurrent pneumonia with pneumatocele formation. Most cases of HIES are sporadic although can be inherited as autosomal dominant and autosomal recessive traits. A fundamental immunologic defect in HIES is not clearly elucidated but abnormal neutrophil chemotaxis due to decreased production or secretion of interferon ? has main role in the immunopathogenesis of syndrome, also distorted Th 1/Th 2 cytokine profile toward a Th 2 bias contributes to the impaired cellular immunity and a specific pattern of infection susceptibility as well as atopic-allergic constitution of syndrome. The ophthalmic manifestations of this disorder include conjunctivitis, keratitis, spontaneous corneal perforation,recurrent giant chalazia, extensive xanthelasma, tumors of the eyelid, strabismus, and bilateral keratoconus. The diagnosis of HIES is inconclusive, dependent on the evolution of a constellation of complex multisystemic symptoms and signs which develop over the years. Until time, no treatment modality is curative for basic defect in HIES, in terms of cytokines/chemokines derangement. Of note, bone marrow transplant and a monoclonal anti-IgE (omalizumab) are hoped to be successful treatment in future.

Corneal cross-linking (CXL) with riboflavin and ultra-violet A is less invasive in comparison with other procedures such as penetrating keratoplasty. Hence, we planned this study to evaluate the efficacy of CXL in disease progression and to compare keratoconus indices before and 1 year after cross-linking by Pentacam.

In this prospective clinical trial, we enrolled 37 eyes of 37 patients suffering from keratoconus who were candidates for CXL. All eyes were examined before and one 1 year after surgery with a slit lamp and Pentacam for corneal topography. To compare the mean of each Pentacam parameter and index before and 1 year after the surgery, we used paired t-test.

There were 23 males and 14 females. The mean age was 21.5 years 18-30 years). At the 12th month examination, the corneal thickness had decreased (P = 0.0068) and the Index of Height Decentration (IHD) had increased (P = 0.016). There were no statistically significant differences in other indices and parameters 1 year after CXL.

Most of the parameters and indices had not changed during 1 year after CXL. The procedure seems to be effective in stopping the disease progression at least for 12 months after surgery.

Performance appraisal is the key part of performance management in urban management and a process throughwhich we can get useful and beneficial information about acheivment of policies, putting plans into action, urban services and effectivness of activities such as: socio– cultural activities and accountability for citizen needs and expectations. The purpose of this paper based on a scietific, applied research project is: Designing And pilot study of assessment and rating performance appraisal system at Tehran Municipality Deputy for socio – cultural affairs applying AHP & Anthropy techniques (Now, this project is operational and mechanized there). First, the conceptual model has derived from and developed after using theoretical, explorative, comparative studies and reviewed of research literature. Afterward. the model was explained and confirmed, it is implemented. Research data were collected by means of FGD (Focus Group Discussion) and two quistionaires distributed among population, a random sample group of 196 managers and experts of departments and offices of deputy for socio-culture affairs and 60 socio-culture vice presidents of 22 districts of Tehran municipality. Data were analyzed basis quantitative and qualitative statistical methods. Results showed that there were performance gaps between desired and status que situations according organizational struture, resources, technologies, values, organizational culture and admimistration. Also founded that internal factors affecting on performance are: goals, policies, strategies, structures, processes, functions, human resources, management and leadership style. External factors affecting on performance are: values, environment, technology, outputs, citizen satisfaction and effectivness. Applying inferential statistics t. test and ANOVA indicated that there were no significant relationship between managers and experts responses. using multi-dimensional decision techniques, AHP & Anthropy exclusively showed that management process, professional process, procurement process, citizenary process and their indices have high priority and are most important in the headquarters and staff, while professional process, management process, citizenary process, procurement process, and their indices have most preferences in the line and operational levels.

Nephrolithiasis is a major public health problem worldwide. In recent years, growing evidence suggest that this disease may originate from underlying metabolic disorders. This is the first study that reports the frequency of different metabolic abnormalities among patients with nephrolithiasis in Isfahan, a large central province of Iran.

From the time period between March 2009 and August 2010, 437 nephrolithiasis patients in Isfahan province enrolled in this study. Metabolic evaluation was performed by obtaining a 24-hours urine sample and fasting venous blood draw. We analyzed urine samples for volume, creatinine, calcium, citrate, oxalate, uric acid, sodium, and cystine. Fasting blood samples were assessed for serum calcium, phosphorus, sodium, potassium, uric acid, albumin, creatinine and blood urea nitrogen.

The mean age was 46 ± 13.8 years (rang: 18-87). Nearly 50% were first time stone formers. The most common metabolic abnormalities were hypocitraturia (40.5%) and hypernatriuria (31.8%) that was followed by hyperoxaluria (28.8%). Hypercalciuria was detected only in 9.2% of the cases.

Although, high calcium excretion was the most frequent metabolic derangement in several similar studies, in our province with considerably high prevalence of vitamin D deficiency, it is not frequent among nephrolithiasis patients. Instead, other metabolic risk factors were in higher frequencies.

The onset of multiple sclerosis in the majority of the cases occurs as a clinically isolated syndrome (CIS). We sought to assess serum levels of 25-hydroxyvitamin D (25-OHD) in CIS patients and healthy controls. In this cross-sectional study 40 patients (36 women and 4 men) with CIS manifesting as a single isolated optic neuritis and 40 Age- and sex-matched healthy controls (35 women and 5 men) were enrolled between late October 2010 and early March 2011. General vitamin D deficiency was defined as serum 25-OHD levels of lower than 20 ng/ml and was classified as mild (15 < 25-OHD <20 ng/ml), moderate (8 < 25-OHD <15 ng/ml), and severe (25- OHD <8 ng/ml). We found no difference in the median interquartile range [IQR] between CIS patients and controls (17.95 [10.40- 29.13] vs. 17.00 [12.25-31.00]; P=0.57). However, when stratified by the levels of deficiency, among CIS patients a significantly higher proportion had severe vitamin D deficiency in comparison to healthy controls (20% vs. 2.5%; P=0.034). Nevertheless, the frequency of general (62.5% vs. 60%, P=0.82), mild (25% vs. 30%, P=0.80), and moderate (17.5% vs. 27.5%, P=0.42) vitamin D deficiency were not different between the two groups. Our findings do not indicate any significant difference of serum 25-OHD between CIS patients and healthy controls. However, in our series severe vitamin D deficiency was more frequent among CIS patients.

This study aims to review the economic cost of childhood (0-18 years) unintentional injuries (UI) and focuses upon comparing the cost burden between developing and developed countries. Articles were selected from PUBMED using the search words “Economic Cost”, “Unintentional injuries” and “Children”. Nine articles were selected. Studies in China focused upon cost to hospitals, in Bangladesh they focused on personal payment in rural areas, and in Vietnam they focused upon community-based cost analysis. There was one study from Norway on UI at home. There were 5 articles from the USA focusing on submersion injury, UI insurance, unintentional traumatic brain injury, UI due to firearms and UI medical costs. The cost of childhood UI is enormous, ranging from US $516,938 to US $9,550,704 per year. This represents a large economic burden on society. Additionally, there is a large gap between lower-middle income countries (LMIC) and high income countries (HIC) in the burden of injury, injury health care and insurance systems. Different bases and contexts of studies make it difficult to draw a solid conclusion about the amount of costs of UI among children. Therefore, more studies of children’s unintentional injuries should be carried out in low and middle income countries.

Early-onset multiple sclerosis (EOMS) is defined as the first presentation of symptoms in childhood (before the age of 16 years). EOMS occurs in about 0.4% to 10.5% of multiple sclerosis (MS) patients. In this retrospective population-based study we aimed to describe the clinical/paraclinical details and frequency of epileptic seizures in Iranian EOMS patients registered with the Isfahan Multiple Sclerosis Society (IMSS) from April 2003 to July 2010. EOMS cases were extracted from the Isfahan total MS cohort and included 3522 patients. A total of 117 EOMS patients (19 males and 98 females) with a mean age at onset of 14.2 ± 2.0 years (range: 7–16 years) were extracted from our database (3.3% of the total cohort). Of cases, ten (one male and nine females) had experienced at least two epileptic seizures, providing a crude prevalence of 8.5%. The frequency of epilepsy in EOMS patients (3.3%, 10/117) was significantly greater (P < 0.001) than that of non-EOMS cohort (2.0%, 71/3405). Epileptic seizures occurred before MS onset in two patients, after MS onset in seven, and at MS onset in one as the presenting symptom of the disease. Our findings mostly indicate an excessive prevalence of epileptic seizures in Iranian EOMS patients (8.5%), which is higher than any other report concerning seizures or epileptic seizures in a large MS series. These findings might be supportive of increased prevalence of epileptic seizures in EOMS.

To compare the efficacy of a single dose of topical diclofenac 0.1% and ketorolac 0.5%, with placebo and with each other in the prevention of post-PRK pain and discomfort. In this randomized double-masked trial, adults undergoing bilateral PRK surgery were assigned to two arms. The first arm received a single dose diclofenac 0.1%, randomly in either the right, or left eye, and artificial tear (as the placebo) in the other eye. The second arm received ketorolac 0.5%, by the same pattern. The primary outcome of this study was ocular[1] pain assessed by visual analogue scale (VAS), and,[2] discomfort including itching, foreign body sensation, tearing and photophobia which were questioned in 4 degrees. In the final analysis, 47 and 36 subjects remained in the diclofenac and ketorolac treated arms, respectively. In both arms, on the first and second post-operation days, VAS scores were significantly lower in the pretreated eye. Moreover, on the first post-operation day, the intensity of all ocular discomfort items was statistically lower in the pretreated eyes; whereas, on the second day, such a difference was only observed for foreign body sensation and itching in the diclofenac treated arm and for photophobia in ketorolac treated arm. Comparison of the two arms (diclofenac pretreated eyes vs. ketorolac pretreated eyes) on both first and second post-operation days showed no significant difference neither in the VAS scores nor the ocular discomfort items. Either diclofenac or ketorolac instilled at a dose of one drop 30 minutes in advance of the operation would be equally beneficial in the short-term prevention of post-PRK pain and discomfort.

There are different surgical methods for the treatment of patients with keratoconus. The aim of this study was to compare deep lamellar keratoplasty (DLK) and penetrating keratoplasty (PK) methods.

This clinical trial was performed between 2009 and 2011 on 30 Iranian patients. Subjects were recruited consecutively in Feiz hospital, Isfahan, Iran and were randomly entered two groups (each one including 15 cases) under the treatment of DLK or PK.

Two groups (DLK vs. PK) were matched in age (29.4 ± 2.3 vs. 30.9 ± 4.1, P = 0.61) and sex (P = 0.23). Best-corrected visual acuity (BCVA) was decreased significantly in both groups and no difference was found between the decline level between the groups (P = 0.142). Also, regarding improvement of refractive problems, no difference was observed in decline of spherical equivalent (P = 0.533) and astigmatism (P = 0.791). Mean time of suture removal was significantly (P < 0.001) lower in DLK group (6.20 ± 2.11 months) versus PK group (10.93 ± 2.40 months). No complications were observed during both procedures. However, after PK, four cases complicated with endothelial rejection and one with graft failure. Also, after DLK, one case with interface neovascularization and another with stromal rejection were observed.

Both methods are effective in reducing the refractive status of keratoconus patients and result in proper BCVA improvement. However, DLK seems to have more successfulness and fewer complications.

Notwithstanding the fact that Radial keratotomy (RK) is now a neglected surgical method, patients and ophthalmologists are still dealing with its following complications such as hyperopic shift. This study was sought to assess the results and benefits of Photorefractive keratectomy (PRK) in complicated patients who had RK procedure in their clinical history.

This non-controlled clinical trial was carried out on 20 eyes pertaining to 17 patients with history of RK and presenting with significant refractive problems. All patients undergone Wavefront-guided (WG) PRK with Mitomycin-C and were followed for at least three months. Uncorrected distance visual acuity (UDVA), Corrected distance visual acuity (CDVA), total aberration, high order (HO) aberration and complications were compared between the status of patients before and after the procedure.

UDVA was averagely improved about 3 lines (P < 0.001). After the procedure 100% and 50% of subjects had visual acuity of ≥ 4.10 and ≥ 7.10, respectively, while; such frequencies prior to the procedure were about 55% and 0%, respectively. Moreover, 40% and 100% were at the idealistic refraction status of 1 D and 1.75 D, respectively. None of 20 subjects had decline of CDVA. Total aberrations were significantly decreased (P < 0.001) although changes of HO aberrations did not achieve significance level (P = 0.33) Three subjects manifested corneal opacity following PRK (two with grade II and one with grade I).

WG PRK has benefit in most of the cases and our current experience indicates the value of WG PRK in patients with history of RK.

Ocular motor disturbances occur as the presenting or relapsing sign/symptom of multiple sclerosis (MS). In this study we sought to asses the frequency of isolated ocular motor nerves palsy in patients with in Isfahan, Iran.

Our study was a retrospective study on 3522 patients with definite MS (based on McDonald’s criteria), who had experienced isolated ocular motor nerves palsy as a presenting or relapsing sign. All of these patients were resident within Isfahan province until the end of July 2010 and they were registered in Isfahan MS society. Data were obtained retrospectively by analyzing patients’ regular follow-up records.

76 patients (2.15) had history of isolated ocular motor nerves palsy, in whom 32 cases (0.91%) and 44 cases (1.24%) had represented it “at the onset” and “during the course” of MS, respectively (P = 0.19). Abducens nerve palsy was seen in 56 patients (1.59%) and was the most common isolated ocular motor nerves palsy. The second prevailing palsy was pertaining to oculomotor nerve which was seen in 18 patients (0.51%). The least prevailing palsy was of Trochlear nerve that occurred in 2 patients (2.6%). Among 76 cases, only 30 had plaques in their brainstem MRI.

According to our current experience, the frequency of isolated ocular motor nerves palsy (2.15%) in MS is relatively low

Data envelopment analysis model is a model for calculating the efficiency of decision making units (DMUs). In previous models there are some weaknesses that the most important one is changing weights of inputs and outputs in model that lead to evaluate efficiencies of DMUs with different weights. The important subject is that How we should evaluate all of decision making units with one set of weights and optimize their efficiencies simultaneously. This paper aims to present a new model that eliminates the weaknesses of previous models. Odeveloped model is designed based on multi objective decision making models and this model is solved with fuzzy solution method of multi objective decision making models and leads to creating common weights. The main object of research that was better ranking of DMUs rather than basic models have been done by using this model and this is showed with solving the model on an example.