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Cardioembolic stroke account for one-fifth of ischemic stroke and atrial fibrillation is the most common underlying cause. Taking an oral anticoagulation (Warfarin) is an effective way of preventing ischemic stroke but bleeding complication is common. This study was carried out to evaluate the validation of HASBLED score in prediction of hemorrhagic complications in patients with brain ischemia and atrial fibrillation under warfarin therapy. In this cohort study 112 patients with non-valvular atrial fibrillation in term of major and minor bleeding complications were followed to the predictive value of HASBLED criteria for one year. Major bleeding complications defined as intracranial bleeding, bleeding leading to hospitalization, drop of hemoglubin of more than 2gr/dl or requiring transfusion. HASBLED criteria were defined as hypertension, abnormality in liver and renal function tests, history of stroke, history of bleeding, large fluctuations in coagulation tests results, age more than 65 years and an Anti-platelet and non steroidal anti-inflammatory drugs and alcohol use one point is awarded to each of the aboves. During one year follow up, 10 (9.1%) of patients had major bleeding and 28 (25%) patients had minor bleeding. The risk of major bleeding was significantly related with a history of minor bleeding and HASBLED scores (P<0.05). The risk of minor bleeding was significantly related with warfarin toxicity and high INR (P<0.05). HASBLED score>3 was associated with the likelihood of major bleeding in future. Patients with HASBLED score>3 should be causious in initial stage of taking oral anticoagulant.

To compare recurrence rates and complications of 2 surgical methods for primary pterygium excision: subconjunctival injection of mitomycin C (MMC) 1 month before bare scleral excision and conjunctival rotational flap with intraoperative MMC application. Eighty-two eyes of 82 patients participated in the study and were allocated randomly into two groups. Group A received subconjunctival injection of MMC 1 month before bare scleral excision, and group B underwent conjunctival rotational flap with intraoperative MMC application for 2 minutes. Exclusion criteria consisted of pregnancy and lactation, history of ocular surgery,glaucoma, herpetic keratitis, trachoma and any autoimmune disease. The main outcome measure was recurrence and complications rate in each group. Mean age of the patients was 48.48± 13.67 years and 51.1% of cases were female. Follow up visits were performed at 1,3,6,9 and 12 months after the operation. Two cases of clinical recurrence occurred in group B (4.3%). However there was no statistically significant difference between groups in terms of recurrence rate (P=0.31). Subconjunctival injection of MMC 1 month before bare scleral excision is a quick, easy, and safe surgical procedure for pterygium excision and is at least as effective as conjunctival rotational flap with intraoperative MMC application.

Background and Objctive: Renal transplantation is one of the most effective treatments for chronic liver patients. Some of the risk factors of transplant survival are included Blood pressure، age of patient and hepatitis. The aim of this study is to investigate factor influenced on patients underwent renal translation from 1368 to 1385 in Qaem hospital medical Center who received the transplant for the first time. This study was a historical cohort study that conducted to investigate the effect of risk factors on renal transplant survival and to estimate the rate of transplant rejection. Age and gender of kidney transplant recipient، type of kidney transplant donor، number of dialysis before translation in a month، hepatitis and blood group were included in the study. Statistical analysis was conducted using Kaplan-Meier estimator، Log-Rank test، Cox Regression model by SAS version 9. 2. From 1340 patient under study، 842 patients (63%) were male. number of dialysis in a month and age of recipient are variables that effect on renal survival significantly in Cox model. Hazard for transplant rejection will 4% decreases per unit increase in age and 60% increase per unite increase in number of dialysis. The results showed that age of recipient، having hepatitis C virus and the number of dialysis before transplantation have significant effect on the survival of renal transpiration after adjusting the effect of other variables that should be considered.

Aim and scope: In recent years, the need to decrease pain and anxiety in patients with acute leukemia during invasive diagnostic and therapeutic measures has been emphasized. This study was performed with the aim of evaluating pain and discomfort caused by bone marrow aspiration under general anesthesia compared with local anesthesia. This cohort study was performed on 239 patients with acute leukemia under 18 years of age admitted to Dr. Sheikh Hospital in Mashhad during two years.Children undergoing bone marrow aspiration with either general anesthesia with propofol or local anesthesia with lidocaine were compared in terms of pain intensity (Visual Analogue Scale), resistance to procedure, and the fear and anxiety during aspiration. Results were evaluated with SPSS software version 16 using t test and chi-squared test. Among the 135 patients who were under general anesthesia, 20.1% showed a slight resistance to apply the anesthesia mask. The least amounts of pain, fear, and anxiety were reported. Among the 104 patients under local anesthesia, 80.2% had physical resistance, 44.4% had severe and very severe pain, and 86.1% showed intense fear and anxiety. In the general anesthesia group, physical resistance (p=0.01), pain (p=0.01), and fear and anxiety (p<0.005) were significantly lower than in the local anesthesia group. In bone marrow aspiration, general anesthesia is more acceptable to children and their parents than local anesthesia. This method can greatly reduce pain, resistance, and fear caused by the aggressive actions during bone marrow aspiration in children. (Quarterly Journal of Sabzevar University of Medical Sciences, Volume 19, Number 2, pp.173-180).

Pelvic organ prolapse (POP) and stress urinary incontinence (SUI) are significantly increased in postmenopausal ages. The mechanism about relation between menopause and SUI is not clear. Perhaps decreased level of hormone induced these problems. Therefore, this study was carried out to assess the relationship between estrogen receptor (ER), progesterone receptor (PR), P53 and the development of SUI and to elucidate the bimolecular pathophysiology of SUI.

This is a case control study. Ten menopausal women with pelvic organ prolapse and stress urinary incontinence and 10 menopausal women without POP selected for hysterectomy entered into this study. The sample of anterior vaginal walls and uterosacral ligaments were obtained. The relative ER, PR and P53 levels in the samples were obtained by immunohistochemical staining.

The mean age (±SD) of the control group was 56.2±5.6 years and in the sample group it was 56.4±6.8 years. The mean age and the body mass index and the number of vaginal deliveries and the number of years of menopausal in two groups were similar. The P53 in the control group was 14±6.21 and in the sample group was 0.7±0.67. The ER level in the control group was 36±9.36 and in the sample group was 1.20 ±1.61. The PR level in the control group was 42.5±6.34 and in the sample group was 2±1.33. The result in the anterior vaginal wall and uterosacral ligament were similar. Expression of ER and PR and P53 was significant lower in the study group.

The expression levels of P53, estrogen receptor and progesterone receptor in patients with POP and SUI were significantly lower than the control group.

The use of clustering methods for the discovery of cancer subtypes has drawn a great deal of attention in the scientific community. While bioinformaticians have proposed new clustering methods that take advantage of characteristics of the gene expression data, the medical community has a preference for using "classic" clustering methods. There have been no studies thus far performing a large-scale evaluation of different clustering methods in this context.Method and Material: We present CCK index for assessing clustering result of gene expression data. This index was made by combining two arbitrary classification and clustering algorithms result and finally. the first large-scale analysis of nine different clustering methods, Hierarchical clustering with Single, Average, Complete and Ward linkages, UPGMA, Diana, K-means, PAM and CLARA methods for the analysis of 5 cancer gene expression data sets. Afterward we use Margin Trees method for assessing quality of result of clustering methods. Ultimately we calculate quality of result of clustering methods via Kappa coefficient between result of clustering methods and result of Margin Tree method for each clustering methods. Our results reveal that the PAM, followed closely by CLARA, exhibited the best performance in terms of recovering the true structure of the data sets. Also we found that Partitioning clustering methods (PAM, CLARA and K-means) have better performance than Hierarchical clustering methods (Hierarchical clustering with Single, Average, Complete and Ward linkages, UPGMA and Diana). The validation technique was used in this paper (Margin Trees) can aid in the selection of an optimal algorithm, for a given data set, from a collection of available clustering algorithms.

In the common Cox proportional hazards model one of the basic assumptions is independence between censoring time and event time. In clinical studies, when censoring is caused by competing risks or patient withdrawal, there is always a concern about the validity of treatment effect estimates that are obtained under the assumption of independent censoring. Introduction a solution for checking the assumption of independent and extending the Cox model for dependent censoring is useful. To achieve this goal, we use copula function and extend the Cox model. This model can also perform a sensitivity analysis for checking the assumption of independent. We generalize the likelihood function in R software and estimate the parameters by using a iteration algorithm. We apply the proposed method to the data of breast cancer patients at Ghaem and Omid hospitals and check the independence assumption. We show by Simulation that this algorithm works well and show the effect of dependent censoring on estimated parameters. We apply the proposed method to the data of breast cancer patients at Ghaem and Omid hospitals and show that the independence assumption is true. Not assumption of independence causes bias in estimation in Cox model and the bias is dependent on the degree of association between event and censoring times. In dataset of breast cancer patients the primary diagnosis is an important role in Success in the treatment.

Nowadays with the extension and development of renal transplantation centers, the best treatment of the patients with ESRD is renal Transplantation. Renal allografts from deceased donors are being used in our center following legislation of the laws by Islamic parliament. Renal transplantation is evaluated by graft and patient survival. Therefore in this study graft and patient survival of recipients who received kidney from related, unrelated and deceased donors were reviewed. Following preoperative examinations and live donor angiography, transplantation will be ready to perform. Renal transplantation was performed in 270 patients who received kidney from unrelated and 44 from related and 125 from deceased donors. Graft and patient survival were measured. Statistical analysis was performed using SPSS soft ware, Caplan - Meyer table, Cox regression and Long rank. In this study 439 patients were evaluated. Patient's age ranged between 8 and 71 years. There were no statistical differences among 3 groups (P > 0.1). One year graft survivals of recipients who received kidney from deceased, unrelated and related donors were 90%, 89% and 93%, respectively. Three year graft survival in the mentioned groups were 82%, 84% and 91%, respectively and 5 year graft survival were 81%, 90% and 81%, respectively. Statistical analysis showed no significant differences among 3 groups (P=0.241). One, three and five year recipient's survival were evaluated in patients who received kidney from deceased, unrelated and related donors. One year recipient survivals in the 3 groups were 95%, 93% and 98%, respectively; three year patient survivals were 94%, 98% and 93%, respectively and finally the 5 year patient survivals were 89%, 93% and 88%, respectively which showed no significant differences (P = 0.489). Although graft and patient survivals are slightly better in recipients who received kidney from related donor, regarding static analysis there were no significant differences in 1, 3 and 5 years graft and patient survivals between recipients who received kidney from live (related or unrelated) and deceased donors. Therefore, deceased donors can be used as a valuable source in our country.

Cutaneous leishmaniasis is considered an important health problem in many parts of Iran, especially in Mashhhad. Various species of leishmania are causing the disease. Identification of leishmania is helpful for the control and prevention of the disease. Althought epidemiological and clinical findings are necessary, they are not sufficient for identification of cutaneous leishmaniasis. Difficulties in identification of these parasites, due to the similar morphology of amastigote and promastigote in different species, have been solved by using molecular techniques such as PCR amplification of kDNA. In order to identify leishmania species causing CL in Mashhad by a definite molecular technique (PCR method), a study was undertaken over a 12 months period (Apr. 2004- Feb. 2005) in department of Parasitology, Ghaem hospital, and Bu-Ali Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran. A total of twenty one patients were recruited and samples were isolated and cultured in N.N.N medium followed by sub-cultur in RPMI-1640. Then, DNA was extracted by protein as k and amplified by specific primers of kDNA. The PCR product was analysed by gel electrophoresis using 2% agarose. The gel was stained with ethidium bromide and visible band with the presence of 620 bp fragment indicates of leishmania major and 800 bp indicates of leishmania tropica. The results indicated that 19 of the isolates were identified as L. tropica and the other two were identified as L. major.Discussion & As demonstrated by previous investigations, Mashhad had been known as an endemic focus for anthroponotic cutaneous leishmaniasis (ACL); however, it is now concluded that both ACL and zoonotic cutaneous leishmaniasis (ZCL) are present in Mashhad and L. tropica is the dominant species.

Understanding the effects of orthodontic force on the pulp is of particular interest, especially because altered pulpal respiration rate, secondary dentin formation, internal root resorption, and even pulpal necrosis have all been associated with orthodontic treatment. The aim of this study was to evaluate and compare the effects of orthodontic extrusive and intrusive forces on the histologic changes of the human dental pulp after 3 days and 3 weeks.In this study, 52 sound upper first premolars from 26 patients, scheduled for extraction for orthodontic reasons, were selected. The patients were divided randomly into 2 groups (3 days and 3 weeks). In each group, 10 teeth received orthodontic extrusive forces, 10 teeth underwent intrusive forces and 6 teeth served as controls. Histologic changes were evaluated and the data were statistically evaluated by nonparametric tests.Vacuolization and disruption of the odontoblastic layer showed statistically significant differences between the control and either of the experimental groups in each test period. Furthermore, fibrous tissue formation in the extrusive group was significantly higher than the control group in the 3-week period. There was no significant difference between 3-day and 3-week intervals in each experimental group, except that fibrosis in the extrusive group was significantly increased after 3 weeks of force application. Comparison between extrusive and intrusive groups revealed no statistical significance in each test period. The results indicate that if orthodontic forces are applied in the optimal range and are not more intense than the physiological limit of tissue tolerance, irreversible injuries to the pulp can be prevented.

ntroduction: Bacteremia following middle ear surgeries occurs in a significant number of patients. The aim of this study is to investigate the incidence of bacteremia following middle ear surgeries. Sixty two patients who where candidates for middle ear operation were enrolled in this study. Blood samples were obtained from each patient immediately before and after operation for bacteriologic analysis. Demographic and middle ear disease characteristics were also recorded for each patient. In 2 culture samples obtained before the operation and in 15 culture samples obtained after the operation, blood cultures were positive. One postoperative sample was excluded from the study due to probability of contamination. Of 14 postoperative cultures, staphylococcus epidermidis and streptococcus pyogenes were positive in 8 and 4 cases, respectively. There were no significant correlations between positive culture and age, otorrhea (duration and odor), surgical approach, type of surgery and pathological condition of patients. Risk of bacteremia following middle ear operations should be considered especially in patients who are high risk for postoperative endocarditis. Considering the serious complications of bacteremia, prophylactic measures are necessary in middle ear operations in this group of patients.

ntroduction: Nasal septal deviation and hypertrophy of the adenoids and palatine tonsils are the two common causes of nasopharyngeal obstruction and resulting mouth breathing in children. It is accepted that chronic mouth breathing influences craniofacial growth and development. The aim of this study was to evaluate the differences of craniofacial morphology in children with two different etiological factors of mouth breathing. In this cross sectional study we studied 47 patients aged 6-10 years with predominant mouth breathing during 2005-2007. After otorhinolaryngologic examination, patients were divided into two groups based on the etiology of nasopharyngeal obstruction: group 1 with adenoid hypertrophy and group 2 with nasal septal deviation. Lateral cephalometric radiographs were obtained to assess craniofacial development. For statistical analysis Mann-Whitney and T-student tests were used. With respect to the inclination of the mandibular and palatal planes, anteroposterior relationship of maxilla and mandible to the cranial base, and indexes of facial height proportions, no significant difference was observed between two groups of children with mouth breathing. Only the gonial and craniocervical angle measurements were significantly larger in children with adenoid hypertrophy (P<0.05). The present study did not show any significant morphological differences between children with adenoid hypertrophy and those with nasal septal deviation. Mouth breathing seems to have a similar effect on craniofacial morphology irrespective of its etiology. Prospective studies with larger samples including older children are suggested.

ntroduction: The aim of this research was to determine the prevalence of hearing impairments and its associations with different ear problems among schoolboys in Mashhad, Iran. In this cross sectional research, a representative sample of 1047 schoolboys (between age group 7 to 11 years) was subjected to diapason tests, Otoscopic examination and questionnaire. Then in the next step, suspected cases were visited by an Ear, Nose and Throat (ENT) specialist and subjected to Pure Tone Audiometry (PTA). Data analysis identified 29 children with hearing impairment (72.1% mild, 20.9% moderate, and 2.3% severe and4.7% profound) making a prevalence of 2.76% (60.4% conductive, 27.9% sensorineural and 11.7% mixed hearing impairment).Data analysis revealed ear problems with the following prevalence’s: ear wax (13.7%), otalgia (11%), ear trauma (5.3%) and ear washing (3.6%). The prevalence of hearing impairment was comparable to that in developed countries, but was better than that in developing countries.

Rosa damascena has been found to act on central nervous system including the brain. Several studies confirm that R. damascena inhibits the activity of the hypothalamus and pituitary systems in rat and can suppress the central nervous system. In traditional medicine hypnotic effect of Rose is also suggested. In this study, the hypnotic effect of the ethanol crude extract of R. damascena and its fractions was investigated in mice. Hypnotic method was based on prolongation pentobarbital induced sleeping time by the extract and fractions (with water, ethyl acetate and n-butanol). Two doses of extract and fractions (250 and 500 mg/kg) was injected intraperitoneal in comparison with diazepam (3 mg/kg) as the positive control and saline (10 ml/kg) as the negative control. Thirty minutes after injection of extract and fractions, pentobarbital (30 mg/kg) was injected and the increase in the sleeping time due to the extract and fractions was recorded. The results showed that the ethanol extract and fractions of R. damascena at 250 and 500 mg/kg doses prolonged the pentobarbital induced sleeping time in mice (P<0.05 to P<0.001). Among all fractions, aqueous fraction has the least, and the ethyl acetate fraction at 500 mg/kg dosage has the best hypnotic effect. In conclusion, the results of this study showed hypnotic effect of R. damascena which was more potent in ethyl acetate fraction.