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Congenital hypothyroidism (CH) is one of the most common endocrine diseases and is a major cause of preventable mental retardation. Early diagnosis of CH can help prevent future diseases. Although time series techniques are often utilized to forecast future status, they are inadequate to deal with count data with overdispersion. The aim of this study was to apply Poisson hidden Markov model to forecast new monthly cases of CH disease.
Methods & Materials:This study was based on the monthly frequency of new CH cases in Khuzestan province of Iran, from 2008 to 2014. We applied stationary Poisson hidden Markov with ifferent states to determine the number of states for the model. According to the model, with the specified state, new CH cases were forecast for the next 24 months.
The Poisson hidden Markov with two states based on Akaike information criterion was chosen for the data. The results of forecasting showed that the new CH cases for the next 2 years comforted in state two with the frequency of new cases at 6-18. The forecast mode and median for all months were 12 and 13, respectively.
Our estimates indicated that state of frequency of CH case is invariant during the forecast time. Forecast means for the next 2 years were from 13 to 14 new CH cases. Furthermore, forecasting intervals were observed between 7 and 25 new cases. These estimates are valid when the general fertility rate and crude birth rate were been fixed.

A newly phenol-degrading bacterium, identified as Ralstonia sp. strain PH-S1, was isolated from oil-contaminated soil in Khark Island. It was isolated by a multistep enrichment and screening technique on mineral medium (MM) containing 100 mg.l-1 of phenol as the sole source of carbon. The bacterium was able to degrade up to 1100 mg.l-1 of phenol but the cell growth decreased with higher concentrations of phenol. The PH-S1 strain grew well in the pH range of 4 to 9 and in the temperature range of 30 to 40 °C. Different concentrations of NaCl ranging from 10 to 20% on the growth of bacteria was studied and it was found that this strain was able to grow well in 10% NaCl; but, higher concentrations of NaCl decreased the growth of the strain. The laboratory scale results indicated the potential application of the strain in the treatment of low saline industrial wastewaters. However, further investigations are required to confirm the ability of the strain.

Valvular aortic stenosis is a relatively common disease among valvular heart diseases and can be rheumatic, degenerative or congenital. Evaluation of the severity of the disease is sometimes challenging and problematic. Besides, the use of more parameters of non-invasive methods for the assessment of valvular disease and its severity seems attractive and helpful. Transthoracic echocardiography (TTE) is an appropriate modality for the evaluation of the aortic valve. In this study, TTE was performed for 80 patients with valvular aortic stenosis. The goals were to assess the statistical relationships between ejection time (ET) and acceleration time (AT) and their ratio (AT/ET) with the four traditional parameters of the echocardiographic severity of aortic valvular stenosis (aortic jet velocity, aortic valve area, mean pressure gradient and LVOT VTI/aortic VTI ratio). There was a meaningful relationship between adjusted ET with the four above-mentioned parameters. d. ET (ET-adjusted ET according to heart rate and stroke volume) was inversely related with the aortic valve area (calculated with continuity equation). AT/ET was significantly correlated with the four mentioned parameters. The regression equations were calculated. The cut-off value of AT/ET for the echocardiographic diagnosis of severe valvular stenosis was 0.36 (with 95% level of confidence).

When a new left atrial mass is discovered by means of echocardiography, the differential diagnosis is usually between thrombus, vegetation, and tumor. In the past decade, however, the physicians were able to document another cause. Our aim is to introduce a case of postoperative inverted left atrial appendage which caused left ventricular inflow obstruction requiring reoperation. We report a 4- year old boy who had inverted left atrial appendage after atrial septal defect repair. He showed signs and symptoms of pulmonary edema postoperatively. We assessed him by echocardiography and discovered a mass in his left atrium necessitating re-operation. The surgeon found and restored inverted left atrial appendage intra-operatively. Because inverted left atrial appendage can cause severe and occasionally life threatening complications, we believe intraoperative transesophageal echocardiography is highly essential to diagnose this pathology and to avoid restorative reoperation.

Multiple Lymphomatous Polyposis (MLP) is characterized by multiple polyps involving long segments of the GI tract. More than 75% of the cases are derived from pregerminal center B cells (mantle zone B cells) & less than 25% from germinal center B cells. Thus MLP is a heterogenous group that includes Mantle Cell Lymphoma (MCL) & Follicular Lymphoma (FL). Here we present a 75-year-old sailor who referred to us with abdominal pain, bloody diarrhea, iron deficiency anemia & lymphadenopathy in inguinal & femoral regions. The presence of intestinal polyposis in colonoscopic & endoscopic evaluations & the pathologic & immunohistochemical findings on tissue specimens that showed B cell lymphoma with moderate proliferative activity (50%) & nodular proliferation of small lymphocytes; accompanied with positivity for CD5, CD20, CD43 & negativity for CD3, CD10, CD23 revealed that these findings are consequent to MCL with accompanied MLP

Studies on gastric mucosal histological findings among first degree relatives (FDR) of gastric cancer (GC) patients are scarce. The aim is to evaluate the topography and the severity of gastritis among FDR of GC patients. Design: A total of 989 subjects who were FDR of GC patients, ages 40 – 65 years underwent gastroscopies. When no gross lesion was found, five specimens were evaluated according to the Sydney Classification and one for urease testing in order to determine the type of gastritis and its severity. Of the 989 subjects, 107 had significant lesions, including two with GC and one with esophageal cancer. The 864 subjects who had complete morphological data taken from five gastric areas (two from the antrum and three from the corpus) comprised 419 males (mean age 48.5±7 years) and 445 females (mean age 47±6.4 years). The H. pylori rate was 76.6%. Normal mucosa was seen in 6.9%, antrum-restricted gastritis in 7.4%, antrum-predominant gastritis in 63.5% and corpus-predominant gastritis in 20% (both had >80% H. pylori infection) and corpus-restricted gastritis in 2%. More atrophy was seen in the antrum and corpus of FDR females than males. The severity did not differ between those with one or more GC patients’ relatives. Forty-nine percent of FDR had atrophy and 9.4% intestinal metaplasia (IM) in the corpus. After the age of 40, there was progression of intestinal metaplasia from 12.2 to 27.3% in the antrum and from 6.7% to 26.2% in the corpus during two decades. No high grade dysplasia was found in this mid-age population. Only one-fifth of FDR have H. pylori-induced corpus-predominant gastritis who are at risk for cancer and suitable for eradication. Corpus-restricted gastritis is a rare disease in this area.

Anaerobic bacteria are well known causes of sepsis in adults but there are few studies regarding their role in neonatal sepsis. In an attempt to define the incidence of neonatal anaerobic infections a prospective study was performed during one year period. A total number of 400 neonates under sepsis study were entered this investigation. Anaerobic as well as aerobic cultures were sent. The patients were subjected to comparison in two groups: anaerobic culture positive and anaerobic culture negative and this comparison were analyzed statistically. There were 7 neonates with positive anaerobic culture and 35 neonates with positive aerobic culture. A significant statistical relationship was found between anaerobic infections and abdominal distention and pneumonia. It is recommended for those neonates with abdominal distention and pneumonia refractory to antibiotic treatment to be started on antibiotics with anaerobic coverage.

Due to presence of confounding factors in contemporary studies, there are controversial data on correlation between hypertension and chronic H. pylori infection. In our study which was conducted for the first time in the Western Asia, we tried to find any correlation between hypertension and positive H. pylori seropositivity after correction for the confounding factors. To evaluate any correlation between H. pylori infection and hypertension, the randomized multistage stratified cluster sampling method was used to select 1752 subjects from Northern Persian Gulf (Bushehr, Genaveh and Dailam). Hypertension was defined according to WHO criteria. ELISA method was used for seropositivity of H. pylori infection. The prevalence of hypertension and positive H. pylori seropositivity were 26.3% and 61.6%, respectively. According to multivariate logistic regression analysis, we observed correlation between hypertension and positive H. pylori seropositivity, independent of type II diabetes, high LDL cholesterol, smoking, and high BMI [OR=1.49; CI (1.18-1.89); P= 0.001]. There is an association between H. pylori infection and hypertension in the residents of the Northern Persian Gulf after adjustment of demographic and metabolic factors.

Endoscopic gastrostomy provides a secure route for the provision of permanent enteral feeding. We performed this study to determine the incidence of endoscopic gastrostomy complications. Our secondary aim was to determine the efficacy of prophylactic antibiotic at the time of Percutaneous Endoscopic Gastrostomy (PEG) for reducing peristomal wound infection. The complications of endoscopic gastrostomy in 136 consecutive patients who had been referred to department of gastroenterology diseases of Fatemeh-Zahra hospital were recorded. Also in a randomized clinical trial the efficacy of a single dose of 1 g intravenous ceftriaxone or 5 g tetracycline cream 30 min before PEG insertion for prevention of gastrostomy wound infection was compared to those who received no prophylactic antibiotic. A number of 77 male and 59 female patients were enrolled in this study. The mean age of the subjects was 49 ± 8 years. The most common indications for placement of the gastrostomy tube were cerebrovascular accident and brain trauma, respectively. Peristomal leakage was seen in 3.7%; and gastrostomy wound infection after the first week, gastric ulceration and inadvertent PEG tube removal were detected each in 2.2% of subjects. Gastrostomy wound infection in the first 48 hours and one week follow-up after PEG insertion were not seen in the subjects. Percutaneous endoscopic gastrostomy is an easy, secure, and safe way to provide enteral feeding and the risk of major complications is negligible. The benefit of prophylactic antibiotics for prevention of gastrostomy wound infection is questionable.

Multidetector computed tomography (MDCT) with or without ECG-synchronized images can successfully evaluate cardiac morphology and congenital heart diseases which mainly involve great vessels. In this pictorial essay, we present the great capability of MDCT for the evaluation of complex congenital heart disease.

Cardiac involvement which leads to congestive heart failure (CHF) is a major cause of death in patients with thalassemia major due to hemosiderosis and chronic anemia. Although the left ventricular (LV) systolic function in patients with thalassemia major has been considerably studied, LV diastolic function has not been assessed adequately. In this current study we used Doppler echocardiography to assess LV function. The aim of our study is to investigate the consequences of chronic anemia and transfusional iron overload on the LV function, especially the diastolic filling pattern in patients with thalassemia major. We sought to test the hypothesis of measurement of myocardial performance index (MPI) and isovolumetric relaxation time (IVRT) in an early stage of the disease, when iron overload has not yet caused irreversible changes.
65 patients with thalassemia major in New York Heart Association (NYHA) class I, II who have been treated with desferioxamine with mean age of 11±3 years were randomly selected and assessed by Doppler echocardiography and the data were compared prospectively with those obtained in 48 age and sex-matched normal subjects.
MPI was increased in thalassemic patients compared with normal control subjects (0.42 ± 0.06 vs. 0.34 ± 0.04, P value=0.015). IVRT was increased in patients vs. compared to controls (60±11 msec vs. 42±6 msec, P value=0.020), indicating impaired relaxation in the early stage of LV diastolic dysfunction due to hemosiderosis. The peak velocity in late diastole (A) was increased in patients compared to controls (54±6 cm/sec vs. 38±4cm/sec, P value=0.034), while the ratio between the early and late peaks of flow velocity (E/A ratio) was reduced (1.3±0.2 vs. 1.8 ± 0.3, P value=0.028). E deceleration time was increased in patients compared to controls
(180±28 msec vs. 140± 26msec, P value=0.044), whereas no difference was found in left
ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) in patients compared to controls (LVEF 60±8, vs. 64±6, P value 0.068) and (LVFS 34±6 vs. 36± 4, P value=0.072). Left ventricular end-diastolic volume (LVEDV) was increased in patients compared to controls (52±12 cc/m2 vs.38±8 cc/m2, P value=0.012), indicating effects of chronic anemia on LV function.
The findings of this study also suggest that chelating therapy does not completely protect patients with thalassemia major from myocardial damage due to iron – related cardiac toxicity and there was no correlation between ferritin level and LV dysfunction. Evaluation of diastolic function and measurement of MPI and IVRT are simple and useful in early detection of LVdysfunction, especially in asymptomatic young patients in an early reversible stage of the disease when iron overload has not yet caused systolic dysfunction ;