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Objective: It is suggested that the use of non-invasive and cost effective imaging modalities, including magnetic resonance imaging (MRI), can be beneficial for detecting areas with spermatogenesis and predicting the presence of sperm in testicles, thereby improving the management of patients with azoospermia. Methods: This descriptive and analytical study included 38 patients with azoospermia who presented to the Firoozgar and Hazrat Rasoul Akram Hospitals in Tehran, Iran. The patients underwent MRI, testicular biopsy, and hormonal examination. The data were analyzed and compared between the patients with obstructive azoospermia (OA) and non-obstructive azoospermia (NOA). Results: The present study included 76 testicles from 38 patients with OA (n=14) and NOA (n=24). According to our findings, the patients with OA and NOA did not differ significantly in testosterone (OA: 4.78, NOA: 5.33, p=0.755) and prolactin levels (OA: 10.75, NOA: 9.77, p=0.540). However, those with NOA had significantly higher levels of follicle-stimulating hormone (OA: 4.66, NOA: 20.61, p<0.001) and luteinizing hormone (OA: 3.15, NOA: 12.40, p<0.001), as well as apparent diffusion coefficient (ADC) (OA: 0.96, NOA: 1.16, p<0.001). Moreover, the patients with OA had a significantly higher testis volume (20.37 cm3) compared with those with NOA (8.16 cm3, p<0.001). Additionally, there were significant correlations between pathological grade and the variables of testicular volume (correlation coefficient: 0.672, p<0.001) and ADC (correlation coefficient: 0.480, p<0.001). Finally, the multivariate regression analysis showed a significant relationship between testicular volume and pathological grade. The receiver operating characteristic curves show the performance of ADC [area under curve is 0.954 (95% confidence interval; 0.912-0.995)] between OA and NOA. Conclusion: The MRI-related parameters of ADC and testicular volume help differentiate and diagnose OA and NOA. [ABSTRACT FROM AUTHOR]

Primary biliary cholangitis (PBC), formerly known as primary biliary cirrhosis, is a liver disease. This is a chronic autoimmune disease, which can worsen over time and recur periodically. If left untreated, biliary cirrhosis may lead to liver failure. Considering that PBC is a rare disease in all age groups, especially in children, the purpose of this report was to describe a girl with hepatitis A virus (HAV) who was then diagnosed with PBC. This child is the first case reported in Iran. The patient is a 7-year-old girl with a pale complexion and eyes with a yellowish cross who was referred to the doctor. Considering that this patient had hepatitis, a blood test was requested to check the level of cholesterol and liver enzymes. The absence of cholestatic liver enzymes was observed in tests. Then, an anti-mitochondrial (AMA) test was requested for the patient, the result of which was negative. Finally, with imaging and biopsy, the diagnosis of PBC was confirmed for the patient. After the definite diagnosis of the disease, the child was treated with ursodeoxycholic acid (UDCA). The child in question is suffering from two medical and immunological diseases, HAV and PBC. Since this child was first infected with HAV, it is possible that the cause of PBC was HAV. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to determine whether mammographic and sonographic features of malignant breast lesions are correlated with tumor histologic grade, hormonal receptor, human epidermal growth factor receptor 2 (HER2), and Ki-67 status. Materials and Methods: In this retrospective study, imaging and histopathological findings of 187 biopsy-proven breast cancer cases from November 2019 to February 2021 were reviewed. The Chi-square test was used to examine the potential correlation between mammographic and sonographic characteristics with histopathological features such as hormonal receptor, HER2 status, Ki-67 labeling index, and histological grade. Results: We observed that microlobulated margin as well as oval/round morphology in mammograms correlate with triple-negative intrinsic subtype (P = 0.006 and P = 0.004). The presence of calcification in sonography was significantly higher in the luminal-B subtype (P = 0.002). Furthermore, ill-defined margins in mammography were significantly higher in amplified HER2 expression (P = 0.004) in the same manner as an oval/round shape in higher levels of Ki-67 (P = 0.030). Conclusion: Mammography and sonography features may reflect the biological behavior of various subtypes of breast cancer and can detect more aggressive breast cancers that can mimic benign or less malignant appearing lesions. These findings may be an excellent predictor for some subtypes like triple-negative breast cancer. Studying the range of these imaging characteristics may help in better understanding the prognosis, choosing a treatment strategy, and predicting response to treatment. [ABSTRACT FROM AUTHOR]

Background: Celiac disease (CD) is a multifactorial systemic disease that causes enteropathy and can lead to a wide spectrum of disorders related to infertility. Objectives: This case-control study aimed to evaluate the frequency of celiac disease (CD) and its association with infertility in women. Methods: This study was conducted on women referred to Ghadir Mother and Child Hospital in Shiraz. Women with infertility served as the case group, while fertile women comprised the control group. Blood samples were collected from participants, and tissue anti-transglutaminase (Anti-TTG Ab) levels were measured. Patients with elevated Anti-TTG Ab levels were referred for duodenal biopsy. Results: One hundred subjects were enrolled in the case group and 200 in the control group. Eight patients in the case group tested positive for serology, and four of these had duodenal biopsies confirming CD. In the control group, one individual tested positive for serology, but the duodenal biopsy was negative (P for between-group differences: 0.001 for serology and 0.012 for biopsy results). There was a significant association between high levels of Anti-TTG Ab and infertility (odds ratio = 17.30, 95 % CI: 2.13 - 140.39), which remained even after adjusting for age and body mass index (odds ratio = 9.92, 95 % CI: 1.17 - 84.21). Conclusions: The frequency of CD was higher among infertile women compared to fertile women. Increased levels of Anti-TTG Ab were independently associated with infertility. [ABSTRACT FROM AUTHOR]

Introduction: Considering the importance of agrin, mTOR and AKT proteins in cognitive and physiological function, knowing the effects of different exercise programs is of particular importance. Aim: The purpose of this study was to investigate the responses of agrin, mTOR and AKT proteins in dual resistance-cognitive exercises of healthy people. Method: The research method is semi-experimental. 10 healthy men were randomly divided into two groups (resistance-cognitive group of 5 people and resistance group of 5 people). Resistance contraction included eccentric and concentric knee extension with maximum strength and speed. The contractions included 12 sets of 10 repetitions for the right leg, and in the cognitive group, cognitive task exercises included counting numbers in reverse, multiplying and dividing numbers, counting the months of the year, and counting coins simultaneously with facial resistance exercises. Took A biopsy was performed at the beginning and end of the study. To analyze the data, dependent t statistical method and covariance test were performed in SPSS21 software. Results: The results showed that the intra-group changes of mTOR and AKT proteins after one activity session were significant in the resistance-cognitive and resistance groups (p≤0.05). However, the intergroup changes of agrin, mTOR and AKT proteins showed no difference between the two groups. Conclusion: The present study showed that a session of resistance and resistance-cognitive activity leads to changes in the factors involved in the strength and hypertrophy of skeletal muscles. In addition, these changes are generally more resistance-cognitive in the resistance group. [ABSTRACT FROM AUTHOR]

Background: The aggregation of clonal plasma cells causes plasma cell neoplasms, which vary in severity and clinical outcomes. The present research focused on the epidemiological, clinical, immunologic, and cytogenetic characteristics of plasma cell neoplasms. Methods: In this five-year retrospective cross-sectional study, demographic information such as age and sex, calcium elevation, renal insufficiency, anemia, and bone lesion (CRAB) characteristics, as well as laboratory data including bone marrow and peripheral blood film results, immunohistochemistry, flow cytometry, and cytogenetic study outcomes were collected at Shiraz University of Medical Sciences, Shiraz, Iran. The collected data were analyzed using SPSS Statistics software (version 20.0). Descriptive statistics were reported as numbers, percentages, and mean±SD. Results: 417 newly diagnosed plasma cell neoplasm patients were confirmed by bone marrow or other tissue biopsy tests. 279 patients were men (66.9%). The most prevalent age group was 60-64 years old (18.46%). Plasma cell myeloma (PCM) affected 355 (85.13%) patients, while monoclonal gammopathy of undetermined significance (MGUS) affected 6 (1.43%) patients. Solitary plasmacytoma was seen in 56 (13.42%) patients. At the time of diagnosis, 119 (33.52%) of 355 PCM patients were asymptomatic, whereas 236 (66.47%) patients had at least one CRAB symptom, 55 (15.49%) had two or more, and 14 (3.94%) had three or more. There were 7 (1.97%) cases of amyloidosis. Cytogenetic abnormalities were found in 51.28% (40/78) of the patients. Twenty-one individuals (52.5%) were hyperdiploid with multiple trisomy, while 19 (47.50%) were not. Conclusion: When diagnosed, Iranian PCM patients might have more advanced disease. PCM was more prevalent in young adults, and hyperdiploid was the most common cytogenetic finding in this investigation. [ABSTRACT FROM AUTHOR]

Background: During preimplantation development, single aneuploidies are more commonly tolerated than complex aneuploidies. Some studies have reported that blastocysts with aneuploid karyotypes on Day-3 embryo biopsy can exhibit a normal karyotype on Day-5 rebiopsy, suggesting that single aneuploidies may have a higher likelihood of presenting a normal karyotype on Day-5. The purpose of the current study was to assess the benefit of reanalyzing the karyotypes of Day-3 single aneuploid embryos on Day-5. Methods: Day-3 and Day-5 biopsies of preimplantation embryos were subjected to array comparative genomic hybridization (aCGH). A proof of concept case series study was conducted involving 13 Day-5 embryos from 4 couples across 3 ART centers, collected between October 2019 and June 2020. Each center provided one normal embryo and 3-4 embryos with single aneuploidy based on Day-3 aCGH results. The karyotype of each Day-5 embryo was compared with its corresponding Day-3 karyotype. Results: Among the 10 embryos with single aneuploidy on Day-3, 3 (30%) exhibited discordant karyotypes on Day-5, while the remaining 7 single aneuploid embryos and 3 normal embryos maintained the same karyotype from Day-3 to Day-5. None of the Day-3 single aneuploid embryos displayed a normal karyotype on Day-5. Conclusion: Contrary to previous reports suggesting the potential correction of single aneuploidies in some embryos, the findings of this study did not support such a possibility in the analyzed embryos. Genomic reanalysis of Day-3 single aneuploid embryos on Day-5 does not appear to be a reliable method for identifying euploid embryos suitable for transfer. [ABSTRACT FROM AUTHOR]

Background: Hereditary nephritis (HN), including Alport syndrome (AS) and thin basement membrane nephropathy (TBMN), is a rare genetic cause of hematuria. A definitive diagnosis requires electron microscopy (EM). Therefore, the clinical characteristics of these conditions are less known. This study aimed to determine the percentage and clinicopathological features of HN in patients from a referral center in Iran. Methods: We checked kidney biopsy reports from 2007 to 2021 and extracted cases with HN. Fresh specimens of the cases diagnosed in the last two years were stained by immunofluorescence (IF) for collagen type IV alpha chains. EM findings in these cases were re-evaluated and categorized as diffuse glomerular basement membrane (GBM) thinning, definite, and suspicious features of AS. Results: We analyzed 3884 pathology reports of kidney biopsies from 2007 to 2021 and identified 210 patients (5.4%) with HN, with a mean age of 13.78 ± 12.42 years old. Hematuria with proteinuria (53.3%), isolated hematuria (44.2%), and proteinuria with hematuria and increased creatinine (2.5%) were found in these patients. The re-evaluation of EM findings revealed GBM thinning, definite, and suspicious findings of AS in 37.5%, 43.8%, and 18.8% cases, respectively. The most common diagnosis in 32 cases after the IF study was X-linked AS (71.9%), and 6.2% of cases were autosomal recessive AS. TBMN and autosomal dominant AS remained the differential diagnoses in 21.9%. Conclusion: It was found that EM is helpful for the primary diagnosis of patients with definite AS. Immunostaining improves the diagnostic sensitivity for the differentiation of those with suspicious EM findings and determines the inheritance pattern. However, a multidisciplinary approach for a subset of cases is required for the best diagnosis and management. [ABSTRACT FROM AUTHOR]

Background: Prostate cancer (PC) is one of the most common cancers worldwide. Recently, multiparametric magnetic resonance imaging (mpMRI) has been used to diagnose PC in suspected patients. Prostate Imaging Reporting & Data System (PI-RADS) was developed and applied as a criterion for detecting lesions suspicious of PC. Various studies have been conducted to determine the negative predictive value of non-suspicious mpMRI (PI-RADS 1 or 2). However, the results of these studies have been limited and different. Objectives: This study was conducted to determine the PC rate in patients with PI-RADS 2 lesions in mpMRI and the factors related to clinically significant prostate cancer (CsPC) diagnosis in these lesions. Methods: By referring to the archive department of Shahada-e-Tajrish, Rasul-e-Akram, Treata, and Payambaran hospitals, among the patients suspected of PC who underwent biopsy and had elevated prostate-specific antigen (PSA) serum levels, the prostate biopsy samples of 330 patients were consecutively included in the study. Frequency of samples diagnosed with PC and its histological characteristics, including mass location, Gleason score (GS), Gleason group (GG), percentage of G4 and G5 cells, sample size, percentage of involvement of sample with cancer tissue, and invasion to the surrounding tissues were examined. Adenocarcinoma samples were divided into low-risk, intermediate-to-high-risk groups based on D'Amico criteria and the relationship between age, PSA total (PSAt), PSA density (PSAd), prostate volume, and the presence of a PI-RADS 3 or 4 lesion at the same time with the rate of diagnosed CsPCs were reviewed. Results: The data from 709 tissue samples were collected, among which 249 were from the right inner part, 249 were from the left inner part, and 211 biopsy samples were from the peripheral portion of the prostate. Among these, 390 tissue samples in mpMRI studies were PI-RADS 2, and 319 were PI-RADS 3 or 4. The mean age of the patients was 64.78 ± 37.55. The mean PSAd, PSAt, and prostate volume were 0.15 ± 0.11, 8.73 ± 6.43, and 61.18 ± 25.76, respectively. Seventy-five samples were diagnosed with adenocarcinoma, of which 48% are in PI-RADS group 2, and 52% are in PI-RADS group 3 - 4 (P-value = 0.263). Comparing the histological characteristics of adenocarcinoma samples between the two groups showed that only the amount of GG was significantly higher in the samples with PI-RADS 3 and 4 (P-value = 0.035). Adenocarcinomas diagnosed in 72.2% of cases in PI-RADS 2 samples and 84.6% of PI-RADS 3 and 4 samples were clinically significant, and no significant difference was seen between the two groups (P-value = 0.38). The amount of PSAt in PI-RADS 2 adenocarcinoma samples was significantly higher in clinically significant carcinomas than in low-risk carcinomas (P-value = 0.045). Conclusions: The results of the present study showed that PI-RADS 2 lesions should be considered for biopsy when there is clinical suspicion of PC. PSA levels can effectively determine the need for biopsy in PI-RADS 2 lesions. [ABSTRACT FROM AUTHOR]

Background & Objective: Lung transplantation is a promising therapy for patients with end-stage lung disease. Pulmonary surfactant is a lipid and protein complex which has a key role in lung function. Molecular mechanisms mediating in rejection of lung transplantation related to surfactants are not still comprehensively understood. In this study, we applied bioinformatics approaches to identify genes and molecular mechanisms involved in surfactant function in rejection of lung transplantation. Materials & Methods: At first, transcriptomics data was extracted and analyzed to construct the protein-protein interaction network and gene regulatory network using Cytoscape. Then, networks analysis were performed to determine hubs, bottlenecks, clusters, and regulatory motifs to identify critical genes and molecular mechanisms involve in surfactant function in rejection of lung transplantation. Finally, critical genes selected for repuposing drugs. Results: Analyzing the constructed PPIN and GRN identified SCD, FN1, ICAM1, ITGB8, FOXC1, SIX1, FHL2, KRT5, TFAP2A, GAS5, MALAT1, and lnrCXCR4 as critical genes. Enrichment analysis showed the genes are enriched for pulmonary surfactant metabolism dysfunction, defective CSF2RB causes pulmonary surfactant metabolism dysfunction 4 and 5, Interleukin-4 and Interleukin-13 signaling may be the mechanisms for surfactant function in rejection of lung transplantation. We predicted some candidate drugs for preventing of lung transplantation rejection such as Sunitinib, Gemcitabine, Oxaliplatin, Hyaluronic acid. Conclusion: Following our model validation using the existing experimental data, our model suggested critical molecules and candidate medicines involve in surfactant function in rejection of lung transplantation for furtur investigations. [ABSTRACT FROM AUTHOR]

Background: Celiac disease is one of the most common genetic allergies worldwide. The prevalence of celiac disease in Iran is similar to or even higher than the global prevalence. Celiac disease is a chronic inflammatory disease that affects the small intestine. Affected patients are allergic to gluten protein that exists in some grains, such as wheat and barley. Methods: Serological endomysial IgA antibody (EMA-AB) and tissue transglutaminase IgA antibody (TTG-IgA) tests were performed on 114 patients aged the ages of 0-18 years with histopathological findings of celiac disease. The results of these tests were compared to the results of the histopathological study of the duodenal biopsy. Results: Based on the receiver operating characteristic (ROC) curve and a calculation of the TTG-IgA test's sensitivity and specificity, the best diagnostic limit for the TTG-IgA test is 144, which has the best sensitivity and specificity. At this value (cut-off), the test's sensitivity was 62%, and the specificity was 93.7%. For the endomysial test, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 80%, 93%, 90%, and 75%, respectively. Conclusion: The diagnostic accuracy of the endomysial test is better than that of the TTG-IgA test in general for diagnosing patients with celiac disease. In the TTG-IgA test, false-positive cases are high due to a cut-off of 20, reducing the test's specificity. In these false-positive cases, the endomysial test helps in better diagnosis. [ABSTRACT FROM AUTHOR]

Background: Celiac disease is a small bowel disorder that occurs upon exposure to dietary gluten and is followed by reduced absorption capacity of the intestine. Serological tests are usually used to assess the prevalence of the disease; however, serological tests without pathological results cannot give a precise assessment. In this regard, we attempted to determine the prevalence of celiac disease in the northern regions of Iran by performing a biopsy among adults with positive serological tests. Materials and Methods: This was a population-based cross-sectional study. Serum level of tissue transglutaminase IgA (or, tTg-IgA) was assessed in 5148 individuals, and those with a positive serological test (serum anti-tTG IgA > 20 IU/mL) underwent a biopsy during upper gastrointestinal (GI) endoscopy. Symptoms and other accompanying disorders were also assessed in this study. Results: Among the 5148 participants, 23 patients (12 men) had positive anti-tTG IgA test (0.4%) with a mean age of 45.90 ± 12.45 years. The most common symptoms among the 23 individuals were abdominal distension (100%), abdominal pain (78.26%), chronic constipation (60.86%), and three (13.04%) of them had iron deficiency. 16 individuals out of the 23 accepted to undergo a biopsy during upper GI endoscopy. The pathology results showed that eight (four men) of them had biopsy-proven celiac disease (0.15%). The second serum IgA anti-tTG test was negative in individuals with negative pathologies. Conclusion: The prevalence of celiac disease in Northern Iran was 0.4% and 0.15% based on serological and pathological results, respectively. Half of the patients with positive serum IgA anti-tTG test had negative pathological results, indicating the need to rely on a pathological assessment for a definite diagnosis. [ABSTRACT FROM AUTHOR]

Helicobacter pylori is one of the most common bacteria affecting human societies worldwide, and is mainly associated with gastrointestinal complications due to different virulence factors. This study aimed to investigate some virulence genes of H. pylori in gastric biopsies of patients with gastritis in Sari city, North of Iran. Informed consent forms were obtained from the studied patients, and those who needed endoscopy were included in the study. To evaluate the prevalence of cagA, iceA1, iceA2, vacA, dupA, and oipA genes, gastric biopsies with positive or negative rapid urease test were collected from 50 patients (25 in each group) with gastro-duodenal diseases. The bacterial DNAs were extracted by a specific kit, and the presence of the genes was analyzed by PCR using specific primers. Eighteen (72%) biopsies from 25 H. pylori-positive samples were cagA-positive, while 17 (68%) biopsies contained the vacA gene, and 11 (44%) samples had both vacA and cagA genes. However, 16 (64%), 12 (48%), 13 (52%), and 14 (56%) biopsies contained dupA, iceA1, iceA2, and oipA genes, respectively. Due to the significant role of the studied virulence factors in the pathogenicity of H. pylori, the high prevalence of these factors in biopsies of patients with gastritis is a concern needing to the management in this region. [ABSTRACT FROM AUTHOR]

Background: Celiac disease is an immune-mediated chronic enteropathy of the small intestine that occurs due to gluten sensitivity in genetically predisposed people. Due to the relatively high incidence of celiac disease in Iran and limited studies on oral manifestations in the Iranian population, the aim of this study was to examine hard and soft tissue manifestations of the oral cavity. Materials and Methods: 53 patients with celiac disease and 53 healthy individuals who matched the case group in terms of age and sex were evaluated. The case group included patients whose disease had been previously confirmed by serological testing and small intestine biopsy. Enamel defects and caries were evaluated according to Aine and WHO criteria, respectively. Other soft tissue manifestations, such as aphthous stomatitis, were either confirmed based on the presence of the lesion at the time of clinical examination or reported by the patient. Xerostomia was assessed based on the answers to Dyasanoor’s questionnaire, and Community Periodontal Index for Treatment Needs was used to assess periodontal status. Data were analyzed using SPSS software version 16. The Chi-square and, if required, Fisher’s exact test was used. Results: There was a significant difference between the two groups in the frequency of enamel defects (OR=8.4, P<0.001) and xerostomia (OR=3.3, P=0.025). In addition, there was no significant difference between subjects with classical and non-classical celiac disease in frequency (P=0.337) and pattern (P=0.466) of hypoplasia and xerostomia (P=0.415). The subjects did not differ significantly in mean Decayed, Missing, Filled Teeth index . Although patients with celiac disease brushed less frequently and their xerostomia was significantly higher compared to controls, caries indices were not significantly different (P=0.85) even when the effect of brushing frequency was adjusted. Multivariate linear regression showed that after adjusting for brushing frequency, the mean periodontal index of the celiac disease group was higher than that of controls (P=0.03). Although soft tissue manifestations such as aphthous stomatitis (P=0.231), atrophic glossitis, geographic tongue, and angular cheilitis were more frequent in the patients, no statistically significant difference was observed. Conclusion: Celiac disease increases the risk of enamel defects and xerostomia. Therefore, dentists can play a key role in the early detection of celiac disease using oral findings. However, the presence of soft tissue manifestations, especially in adults, could not be proven as a meaningful criterion for the early detection of celiac disease. [ABSTRACT FROM AUTHOR]

Background and Aim: Soft tissue reactive lesions are the most common oral lesions. Eosinophils are leukocytes with multiple functions, which are considered to have multiple roles including angiogenesis and fibrogenesis. Considering the importance of reactive lesions and their prevalence in the Iranian population, this study attempts to investigate the role of eosinophils in the formation of common reactive lesions of the oral cavity. Material and Methods: In this cross-sectional descriptive-analytical study, 26 case of pyogenic granuloma, 27 case of irritation fibroma and 27 case of peripheral ossifying fibroma were selected from the archive of the Oral Pathology Department of Isfahan Dental School, which were prepared by excisional biopsy method. Clinical information including age, gender and location of the lesion was extracted. Congo red staining was performed and the number of eosinophil was counted. All data was entered into SPSS24 software and was statistically analyzed by Chisquare, Fisher's exact and Mann-Whitney tests. P<0.05 was considered as a significant difference. Result: The highest mean number of eosinophils was counted in pyogenic granuloma (24.88±32.08) and the lowest was counted in irritiation fibroma (10.11±23.22). According to the Kruskal-Wallis test, there was a significant difference in the average number of eosinophils (P = 0.001) Conclusion: The number of eosinophils in the studied lesions, especially pyogenic granuloma is noticeable and can play a role in the pathogenesis of these lesions. [ABSTRACT FROM AUTHOR]

Background & Objective: The prevalence of glomerular diseases, as the leading cause of chronic kidney disease, is increasing. Renal biopsy is still the gold standard for diagnosis of the most kidney disorders. Data on prevalence of the biopsy-proven kidney diseases in Iran is limited and none of the previously reported studies used electron microscopic (EM) evaluation for the diagnosis. This study was conducted to analyze the prevalence of biopsy-proven kidney diseases in a referral center in Iran. Methods: The reports of kidney biopsy samples from 2006 to 2018 referred to a pathology center, affiliated with Tehran University of Medical Sciences were reviewed. The prevalence of different disorders was assessed based on the clinical presentation in 3 age categories, including childhood, adulthood, and elderly. Results: Among 3455 samples, 2975 were analyzed after excluding transplant-related specimens, suboptimal specimens, and those with uncertain diagnoses. Nephrotic syndrome (NS) (39%) was the most common cause of biopsy followed by subnephrotic proteinuria (18%), hematuria in association with proteinuria (15%), renal failure (9%), isolated hematuria (6%), lupus (4%) and the other non-specific manifestations such as hypertetion or malaise (each one less than 2%). The most common diagnoses included membranous nephropathy (MGN) (17.9%), focal segmental glomerulosclerosis (FSGS) (15.9%), lupus nephritis (LN) (13.7%), minimal histopathological findings (unsampled FSGS versus Minimal Change Disease, 12.1%), Immunoglobulin-A (IgA) nephropathy (6.5%) and Alport syndrome (6.1%). MGN was the most frequent disease before 2013, but FSGS became more frequent after that. Conclusion: NS and proteinuria were the most indications for kidney biopsy. Although MGN was the most common disease, the prevalence of FSGS has been increasing in recent years and making it the most common disease after 2013. LN and IgA nephropathy are the most common causes of secondary and primary GN presenting with proteinuria and hematuria, respectively. [ABSTRACT FROM AUTHOR]

To evaluate the diagnostic mismatch (discrepancy) of pathology reports in consulted specimens referred for second opinion. This cross-sectional study was conducted at a major cancer center, Omid Hospital. In this study, 350 primary pathology reports and 350 reviewed pathology reports were extracted from the archives of Omid Hospital from 2011 to 2020 and assessed in terms of the extent of discrepancy, by two pathologists and one oncologist. The required data for each sample were entered into a checklist and then statistically analyzed. Cases with the same diagnosis on both reports were assigned to the matched group and the rest were assigned to the minor or major mismatch (discrepancy) group. Minor mismatches included changes in diagnosis that did not lead to changes in treatment (may lead to changes in prognosis or provide additional information to the oncologist) and major mismatches included changes in diagnosis leading to changes in treatment or remedies. Two hundred seven cases (59.1%) out of three hundred fifty cases had concordant results between the diagnosis of the first pathologist and the reviewing pathologist. In one hundred forty-three cases (40.9%) mismatch (discrepancy) was observed, including eighty- two cases (23.4%) with minor mismatches (discrepancy) and sixty-one cases (17.4%) with major mismatches (discrepancy). In the major mismatch group, fifteen cases (4.3%) changed from malignant to benign, eighteen cases (5.1%) changed from benign to malignant, two cases (0.6%) changed from one stage to another stage of Disease and twenty-six cases (7.4%) had changes in the type of malignancy. In this study, it was found that there was no significant relationship between anatomical areas of sampling and diagnostic mismatch (p = 0.254). The study also found that the rate of diagnostic mismatch in specimens obtained by resection or excisional biopsy was greater than that of small biopsies (eighty cases (22.8%) and sixty-two cases (17.7%, respectively)). There was no significant relationship in this regard (p = 0.077). Compared to most similar studies, the present study reported the highest discrepancy between the diagnosis of the first pathologist and the reviewing pathologist (40.9%). [ABSTRACT FROM AUTHOR]

Background and Aim: Determination of HPV genotypes in cervical lesions is essential in screening programs and the impact of current HPV vaccines. Therefore, we investigated the frequency of various HPV genotypes among different grades of cervical lesions. Materials and Methods: In total, 101 biopsy samples of different grades of cervical lesions were collected. Extracted DNA was subjected to PCR amplification of beta-globin to assess sample integrity. Duplex Taq-Man Real-Time PCR was performed to identify HPV types 16 and 18. Nested PCR following sequencing was done on those samples with HPV16/18 negative results. Results: The mean age of participants was 43±1. Of 101 samples, 91 (90%) were infected with HPVs. In the LSIL group, HPV genotypes 16, 18, and 51; in the HSIL group, genotypes 6, 16, 18, 31, and 53; in the SCC group, genotypes 6, 16, 18, and 3; and in the AD group, HPV genotypes 16 and 18 were detected. Also, 49 (61%) samples had co-infection with HPV16 and HPV18. Conclusion: Our results showed that HPV 16 and 18 were the most prevalent genotypes among different grades of lesions. The presence of low-risk HPV types, including genotypes 6 and 53, might need more attention in HPV screening and prevention programs. [ABSTRACT FROM AUTHOR]

Background: Colorectal cancer (CRC) is considered the second-deadliest and third-most common malignancy worldwide. Studying the carcinogenic mechanism of bacteria or their role in aggravating cancer can be precious. Fusobacterium nucleatum (F. nucleatum) is one of the important bacteria in the occurrence and spread of CRC. In this study, we investigated the expression levels of miR-21, miR-17-5P, miR-155, and the relative frequency of F. nucleatum in biopsy samples from patients with CRC. Method: DNA and RNA samples were extracted using a tissue extraction kit, and then cDNAs were synthesized using a related kit. Based on the sequence of miR-17-5P, miR-21, and miR-155 genes, F. nucleatum specific 16srRNA and bacterial universal16srRNA specific primers were selected, and the expression levels of the target genes were analyzed using the Real-Time PCR method. Results: The expression level of miR-21, miR-17-5P, and miR-155 genes showed a significant increase in the cancer group. Also, the expression of the mentioned miRNAs was significantly raised in the positive samples for F. nucleatum presence. The relative frequency of F. nucleatum in the cancer group was significantly increased compared to the control group. Conclusion: Due to the changes in the expression of genes involved in causing CRC in the presence of F. nucleatum, it is possible to prompt identification and provide therapeutic solutions to cancer patients by studying their microbial profiles and the expression changes of different selected genes. [ABSTRACT FROM AUTHOR]

Background: Gastric cancer is one of the most common types of cancer worldwide. Helicobacter pylori infection is clearly correlated with gastric carcinogenesis. Therefore, the use of a new non-invasive test, known as the GastroPanel test, can be very helpful to identify patients at a high risk, including those with atrophic gastritis, intestinal metaplasia, and dysplasia. This study aimed to compare the results of GastroPanel test with the pathological findings of patients with gastric atrophy to find a safe and simple alternative for endoscopy and biopsy as invasive methods. Methods: This cross-sectional study was performed on patients with indigestion, who were referred to Motahari Clinic and Shahid Faghihi Hospital of Shiraz, Iran, since April 2017 until August 2017 for endoscopy of the upper gastrointestinal tract. The serum levels of gastrin-17 (G17), pepsinogen I (PGI), and pepsinogen II (PGII), as well as H. pylori antibody IgG, were determined by ELISA assays. Two biopsy specimens from the antrum and gastric body were taken for standard histological analyses and rapid urease test. A pathologist examined the biopsy specimens of patients blindly. Results: A total of 153 patients with indigestion (62.7% female; mean age, 63.7 years; 37.3% male; mean age, 64.9 years) were included in this study. The G17 levels significantly increased in patients with chronic atrophic gastritis (CAG) of the body (9.7 vs. 32.8 pmol/L; P = 0.04) and reduced in patients with antral CAG (1.8 vs. 29.1 pmol/L; P = 0.01). The results were acceptable for all three types of CAG, including the antral, body, and multifocal CAG (AUCs of 97%, 91%, and 88% for body, antral, and multifocal CAG, respectively). The difference in PGII level was not significant. Also, the PGI and PGI/PGII ratio did not show a significant difference (unacceptably low AUCs for all). The H. pylori antibody levels were higher in patients infected with H. pylori (251 EIU vs. 109 EIU, AUC = 70, P = 0.01). There was a significant relationship between antibody tests and histopathology. Conclusion: Contrary to Biohit's claims, the GastroPanel kit is not accurate enough to detect CAG; therefore, it cannot be used for establishing a clinical diagnosis. [ABSTRACT FROM AUTHOR]

Background: Liver biopsy remain as the gold standard for diagnosing hepatic fibrosis; however, it has some limitations, such as life-threatening complications, low acceptance by the patients, and variations in the related sample. Therefore, there is a need for the development of non-invasive investigations for diagnosing hepatic fibrosis. Vibration-controlled transient elastography (VCTE) is one of these non-invasive methods. Methods: This study included 73 patients suffering from non-alcoholic fatty liver disease (NAFLD) who were older than 18 years. The patients underwent VCTE at the Baqiatallah and Firoozgar hospitals. Then, they underwent a liver biopsy by an experienced radiologist in the same hospital. A receiver operating characteristic (ROC) curve of different fibrosis stages was used to evaluate the VCTE verification. Results: VCTE could detect any fibrosis levels (stage 1 and higher) with an area under the ROC curve (AUROC) of 0.381. Moreover, it detected stage 2-4 fibrosis with an AUROC of 0.400, stage 3-4 fibrosis with an AUROC of 0.687, and stage 4 fibrosis with an AUROC of 0.984. Conclusion: The VCTE has high clinical validity in diagnosing the advanced stages of fibrosis (stages 3, 4) and can be a suitable alternative to the invasive method of liver biopsy with high reliability. [ABSTRACT FROM AUTHOR]

Background: Despite the importance of a gluten-free diet (GFD) in the management of celiac disease (CD), non-adherence is quite common and varies in different societies. The aim of this study was to survey adherence to a GFD and identify the barriers in the adult celiac population in Shiraz. Materials and Methods: In this cross-sectional study, the patients diagnosed with CD were determined through serum levels of tissue transglutaminase IgA (tTg-IgA) and immunoglobulin A (IgA). In patients with positive anti-tTG, small bowel biopsies were taken. A gastroenterologist routinely assesses CD patients at Shiraz Celiac Clinic. Also, an expert general practitioner describes a list of forbidden food to patients. Adherence to a gluten-free diet was evaluated using interview and tTg-IgA level. Results: Adherence to a gluten-free diet was 58.2% among 170 participating patients aged 15 to 71 years. There was no significant difference in sex (P=0.730), current age, and age at the time of diagnosis (P>0.05) between the adherent and non-adherent groups. However, the adherence among the unemployed (P=0.036) and highly educated ones was significantly higher than others. More patients adhered to the gluten-free diet for 1-3 years (63.7%), so after three years, less adherence was seen (50%). The most reason for non-adherence was lack of proper access and labeling, cost, and feeling different from others. Conclusion: Advances in the catering/food industry, increasing economic support and awareness about CD, GFD, and gluten-free products, as well as removing barriers such as inaccessibility and cost, can improve adherence to a GFD. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate the etiology and contributing factors of cavitary pulmonary lesions in HIV infected patients. Methods: In this study, 844 HIV infected patients with a total of 1000 admissions were investigated at Masih Daneshvari Hospital from Aug 2010 to Oct 2019. After excluding the missing data and distorted documentation, 746 cases and 878 admission episodes finally underwent statistical analysis. The CXRs were observed thoroughly and the cavitary lesions were identified. Eventually, demographic data, diagnostic information, and laboratory findings were extracted and analyzed. Results: Of the 878 episodes of hospitalization, cavitary pulmonary lesions were observed in 145 documents. The most prevalent etiology was TB with 105 cases (72.5%). After that, Pneumocystis jiroveci and septic embolism were responsible for a further 7.6% and 5.6% of the total lung cavities, respectively. 58.5% of the cavities were present in a single lobe, with men being affected in 90.2% of the cases. The upper lobes were the most common site of involvement in the lungs [42.9% for Left Upper Lobe (LUL) and 52.3% for Right Upper Lobe (RUL)]. The rate of definitive diagnosis was significantly higher in patients affected with cavitary lesions (82.8%) in comparison with the unaffected (74.8%) (p=0.001). No significant difference in demographics, HIV and ART status, CD4+ cell count, viral load, and mortality was evident between the two groups. Conclusion: The most common etiology of cavitary lesions in HIV positive patients was attributable to TB, PJP, and septic embolism respectively. Cavitary lesions were more prevalent in males and mainly tend to involve the upper zones of pulmonary parenchyma. [ABSTRACT FROM AUTHOR]

Statement of the Problem: Oral lichen planus (OLP) and other oral lichenoid lesions (OLL) are reported to have the potential of malignant transformation and dysplastic changes, turning into oral squamous cell carcinoma (SCC). While the world health organization (WHO) has classified OLP as a precancerous lesion of the oral cavity, there is still much debate among researchers about its risks and malignancy potential. Purpose: The present study aimed to determine malignant transformation in OLP and OLL and understand related risk factors. Materials and Method: This retrospective study was performed on 356 patients of the Oral Medicine Department of Dental School of Kerman Medical University from 1998 to 2020. All patients’ records were gathered. In addition, patients were followed up routinely. Second biopsy was taken as needed. The samples, previously taken from the patients, were reevaluated according to WHO histopathologic criteria for diagnosing OLP, OLL, dysplasia, and SCC by an experienced pathologist and compared with first reports. Results: Dysplastic changes were observed in 6.2% of the patients. In more than half of the patients, dysplastic changes were present right from the start and 2.20% of the patients had experienced dysplastic changes averagely within 2.05 years of the onset of lesions. Multiple logistic regression showed that the risk of dysplasia increases with aging (p= 0.013), smoking (p= 0.0001), and thyroid disorders (p= 0.008). Conclusion: Given the rather high prevalence of oral lichen planus and lichenoid lesions, further research appears to be needed to determine the etiology of these lesions, malignant transformations, and the factors affecting this probability. Considering the findings, it is imperative to meticulously record the information of all patients with oral lichen planus and lichenoid lesions in the initial examinations as well as close follow-ups and employ diagnostic tools such as toluidine blue staining or even repeat biopsy when necessary. [ABSTRACT FROM AUTHOR]

Introduction: Cytomegalovirus (CMV) is a leading cause of morbidity and mortality among the immunosuppressed population, and it is a common cause of opportunistic infections in human immunodeficiency virus (HIV)-positive patients. In this case series study, we describe our experience with nine HIV-positive patients suffering from pneumonia who demonstrated typical cyto-pathologic evidences of CMV pneumonitis. Material and methods: Clinical records of all HIV-infected patients with pneumonia who were admitted to National Research Institute of Tuberculosis and Lung Diseases (NRITLD), a tertiary center of tuberculosis and lung diseases in Iran, were prospectively reviewed. Results of micro-biological investigations of bronchoalveolar fluid (BAL) and trans-bronchial lung biopsy (TBLB) specimens were evaluated as well as their histological and cytological findings. All patients with cyto-pathologic evidences of CMV pneumonitis found in TBLB were extracted, characteristic of which was shown as enlarged cells with large pleomorphic nuclei, and intra-nuclear and cytoplasmic inclusions. Results: Of these cases, seven patients were diagnosed with concomitant CMV and Pneumocystis jiroveci pneumonitis. Five patients had thrush, two patients tested positive for active tuberculosis, and one patient reported a history of old tuberculosis. Laboratory data analysis revealed LDH ranging from 138 to 1,140, with average amount of 653.22. CD4+ counts ranged from 12 to 156, with average of 56.22. Six patients tested positive for CMV infection with plasma polymerase chain reaction (PCR) method. Conclusions: The differential diagnosis for CMV pneumonia in HIV-infected population is extensive and includes diseases, such as bacterial pneumonias, Mycobacterium tuberculosis infections, PCP, and other HIV-associated respiratory infections. Definitive diagnosis is based upon demonstration of CMV in pulmonary secretions or in lung tissue. [ABSTRACT FROM AUTHOR]

Statement of the Problem: The prevalence of oral and maxillofacial lesions differs in various populations and is an important concern for health care providers. Purpose: The present study aimed to evaluate the relative frequency and distribution of oral and maxillofacial lesions in patients referred to the Department of Oral and Maxillofacial Pathology, Kerman Faculty of Dentistry in southeast Iran. Materials and Method: In the present retrospective study, the collected data consisted of age, gender, lesion location, and the clinical and histopathological diagnoses of all the biopsy samples diagnosed in 23 years (1997–2020). The data were analyzed with SPSS 22, using the chi-squared test and ANOVA (p< 0.05). Results: From 2092 lesions with a definite diagnosis, 1202 (57.5%) and 890 (42.5%) cases belonged to female and male patients, respectively. The mean age of the subjects was 39.06±17.71 years, and the most frequent location of the lesions was the buccal mucosa (25.2%). The frequencies and number of non-neoplastic lesions, neoplasms, and premalignant lesions were 84% (n=1758), 13.3% (n=278), and 2.7% (n=56), respectively. Reactive lesions were the most common cases, with 34.6% (n=724), and lichen planus was the most frequent lesion with 18.1% (n=379). Squamous cell carcinoma was the most frequent lesion in patients >70 years of age (27.6 %). Conclusion: The present study provided useful data on the frequency and distribution of oral lesions over 23 years and made it possible to compare its results with those of studies carried out in other countries. Non-neoplastic lesions were the most common category, and lichen planus, pyogenic granuloma, and irritation fibroma were the most frequent lesions in descending order. [ABSTRACT FROM AUTHOR]

Background: Accurate etiology of azoospermia is required for optimal management of patients. The aim of this study was the determination of serum hormonal levels and testicular long axis cut off points to distinguish obstructive azoospermia (OA) from non-OA (NOA) in Iranian patients as well as the evaluation of the necessity of diagnostic testis biopsy in azoospermic patients. Materials and Methods: In this retrospective study, data of 471 azoospermic patients such as history and physical examination, serum hormonal level, semen fluid parameter, and testicular long axis based on ultrasound were evaluated from 2016 to 2020. All patients were examined by a single urologist and underwent a diagnostic testis biopsy for a definite diagnosis. The diagnostic parameters were analyzed using Statistical Package for the Social Sciences (SPSS) version 16 with t test and chi-square test and receiver operating characteristic (ROC) curves to distinguish NOA from OA. Results: A total of 127 patients with OA and 284 with NOA were included in this study. The mean serum testosterone level was significantly higher in OA than NOA (4.2 vs. 3.4 ng/ml), whereas the mean serum follicular stimulating hormone (FSH, 5.3 vs. 19.1 mIU/ml) and luteinizing hormone (LH, 5.3 vs. 11 mIU/ml) were lower in OA. ROC curve analysis showed that FSH and testicular long axis were the best diagnostic predictors. Using a combination of serum FSH (8.9 mIU/ml) and testicular long axis (39 mm), the positive predictive value for NOA was 97.02% and for OA was 78.8%. Conclusion: Combination of serum FSH higher than 8.9 mIU/ml and testicular long axis lower than 39 mm were strong predictors to distinguish NOA from OA in Iranian participants in this study. In addition, diagnostic testicular biopsy seems to be necessary for patients with OA and NOA characteristics. [ABSTRACT FROM AUTHOR]

Aim: The current study aimed to investigate sequence variations in the C-terminus of latent membrane protein 1 (LMP1) in Epstein- Barr virus (EBV) isolates from Iranian patients with chronic gastritis or gastric cancer (GC). Background: LMP1, an essential viral oncoprotein, is the critical element in the immortalization of B cells. It contains a small twenty-four amino acid cytoplasmic N-terminal region, six transmembrane segments, and a two hundred amino acid cytoplasmic Cterminal domain. Most LMP1-mediated signal transduction events are moderated by some functional parts of the cytoplasmic Cterminal domain. Methods: Thirty-two EBV-positive biopsy tissues were obtained from patients with gastric cancer and patients with chronic gastritis. The C-terminal nucleotide sequences of LMP1 were amplified using nested-PCR and analyzed by DNA sequencing. Results Four to eight copies of the 11 repeat elements (codon 254--302) were observed in the carboxyl-terminal site of patients, but no relationship was found between the number of repeat sequences and disease status. The 30-bp deletion corresponding to codon 345--354 of the B95-8 strain was observed in 34% of isolates, and the remaining samples were non-deleted. In the gastric cancer group, a higher number of 33-bp repeats (≥5 repeats) was observed in 30-bp-deletion (100%) than in non-deleted (42%) isolates, and the difference was statistically significant. Analysis revealed that a gastritis isolate may be the result of recombination between Alaskan and China1 strains. Conclusion: Overall, the current results showed no association between C-terminal sequence variations of LMP1 and malignant or non-malignant isolate origin. [ABSTRACT FROM AUTHOR]

Introduction: Jawbones can be affected by many lesions due to conditions such as genetic, metabolic, inflammatory, cystic, and tumoral. For proper diagnosis and treatment, dentists should be aware of the most prevalent types of lesions, demographic and clinical features, and their distribution patterns within the population. The present study aimed to evaluate the distribution pattern of jaw bone lesions during 7 years in Esfahan. Materials & Methods: This retrospective analytic descriptive study was performed on 370 reports available at the department of oral pathology at Isfahan Azad university. Demographic data, clinical features, and histopathology diagnosis were gathered and analyzed statistically using ANOVA and Chi-Square (α = 0.05). Results: Intraosseous lesions consisted 28.6% of all lesions, 41.5% in females and 58.4% in males (p value < 0.05. (Mean age of male patients was 35.96 and 33.70 for females (p value > 0.05). Lesions were mostly in the right lower jaw (p value < 0.05). The swelling was the only clinical feature reported in only 15%. Of 106 intraosseous lesions, 73 cases were odontogenic cysts, 19 inflammatory,9 odontogenic tumors,2 benign non-odontogenic tumors, and 3 non-odontogenic cysts. The periapical and dentigerous cyst was the most prevalent lesions reported. Conclusion: Results of the present study showed jaw bone lesions mostly occurred in the right lower jaw in male patients. The difference in the distribution of the lesions in comparison to similar studies in this context can be attributed to the difference in geographical region necessitating further studies. [ABSTRACT FROM AUTHOR]

Background: The Sydney system offers a standard biopsy protocol for detection and follow-up of gastric preneoplastic lesions such as intestinal metaplasia (IM). The highest frequency of cardia-type gastric adenocarcinoma (GA) in Iran has been documented in the north-western part of the country. This study aims to investigate the effect of the addition of mucosal biopsies of gastric cardia to the standard Sydney protocol on the rate of detection of IM in the asymptomatic residents of this high-risk region for proximal gastric cancer. Methods: A retrospective new analysis was performed on the previous data obtained in cross-sectional endoscopic screening in 2000 as well as a biopsy study of 508 asymptomatic volunteer residents in Meshkinshahr district, Ardabil province. The screening study was conducted in a group of residents aged 40 years and older who did not have any previous GI or hemodynamic problems. Results: Intestinal metaplasia at the Sydney protocol sampling sites was detected in 107 samples belonging to 76 of the 508 (14.99%) volunteers. Twenty-one patients had IM at the cardia. Of these, five patients had IM-cardia (IM only at the cardia). Therefore, adding a cardia biopsy to the set of biopsies diagnosed five more IM cases which were not diagnosed on the standard Sydney protocol (P = 0.062). Conclusion: The addition of a biopsy from the cardia to the Sydney protocol biopsy set does not seem to improve the frequency of detection of IM in the residents of this high-risk geographic area for proximal gastric carcinoma. [ABSTRACT FROM AUTHOR]

Background: Epidemiologic studies have shown world-wide increasing incidence of ulcerative colitis (UC) as an autoimmune disease of intestine. In the meantime, gastrointestinal H. Pylori infection is being decreased. Objectives: There are very few studies about comparing the presence of H. Pylori in the colon and the disease activity of UC. There is no study form Iran. In this study, we tried to investigate the presence of H. Pylori in the mucosa of colon by molecular and microbiological as well as pathological methods to find any association between the presence of this organism in the colon and the presence and activity of UC. Patients and Methods: In 100 patients who referred to colonoscopy clinic, colonoscopy was performed. Fifty-seven patients with the new diagnosis of UC were considered as cases and 43 patients with normal screening colonoscopy for polyps were considered as controls. Colon biopsies were evaluated according to histopathology, clinical findings, and laboratory results to confirm the diagnosis and the degree of activity in the cases of UC. Molecular studies were also performed to evaluate the presence of H. Pylori genome in the colon biopsies. A sample of colon was also cultured for H. Pylori. ELISA test was performed in a sample of blood to evaluate the level of IL-10 and IL-17 as regulatory cytokines of inflammation. Results: Cases with the diagnosis of UC showed significantly higher number of positive colonic H. Pylori comparing to normal colonic mucosa. Also, the presence of H. Pylori genome in the colon was associated with higher activity in the cases with UC and higher levels of inflammatory mediators especially IL17 and lower levels of inhibitory mediators such as IL-10. Conclusion: Colonic colonization of H. Pylori was higher in the patients with UC and higher activity of this disease comparing with normal control colonic mucosa. [ABSTRACT FROM AUTHOR]

Synovial Sarcoma (SS) is a rare soft-tissue malignancy. Only about 15% of SS originates from the retroperitoneum. Retroperitoneal SS (RSS) is usually diagnosed incidentally due to the anatomy of the retroperitoneum. The most common complaints of patients are abdominal and low back pain. Other common symptoms of RSS are palpable abdominal mass, weight loss, and anemia. In this study, we will describe a 29-year-old white Asian man with a diagnosis of RSS after radical nephrectomy. He was admitted to the Urology Department of Shohada-e Tajrish hospital, Tehran, Iran in March 2019. The distinguishing feature of this case is the size of the mass, which has never been reported so much for retroperitoneal synovial sarcoma. Radiologic imaging showed a huge retroperitoneal mass originating from the kidney. Based on the pathologic features and immunohistochemistry (IHC) study, the diagnosis was consistent with synovial sarcoma. Accurate diagnosis of RSS is usually based on the pathological findings. Therefore, in case of doubt, a biopsy can be employed. Surgical resection of the tumor and lymph nodes dissection is the main and most important part of the treatment. Aggressive resection with free margin is recommended. The role of adjuvant and neoadjuvant chemotherapy in RSS is not certain to date, but it is recommended according to the patient's condition. [ABSTRACT FROM AUTHOR]

Strongyloides stercoralis (S. stercoralis) is a helminth, which infects humans widely in tropical and subtropical countries. This parasitic infestation usually does not produce symptoms in humans; however, severe and life-threatening forms of this infection can occur in immunocompromised individuals. Patients with Coronavirus disease 2019 (COVID-19) with concurrent immunosuppressive therapy are at risk of developing Strongyloides hyperinfection syndrome (SHS). We present a 70-yearold male with a history of high-dose dexamethasone therapy due to severe COVID-19 who was referred to our hospital with chest discomfort, nausea, and anorexia. Histological assessment of the gastric and duodenal mucosae revealed numerous eggs and filariform larvae of S. stercoralis indicative of SHS. Ivermectin and albendazole were administered to the patient. Following the treatment, the patient's symptoms improved. Clinicians must be aware of the risk of SHS, especially in S. stercoralis endemic countries before and during corticosteroid therapy for COVID-19 because early diagnosis and appropriate treatment can significantly reduce mortality in these patients. [ABSTRACT FROM AUTHOR]

Secondary anemia in hemoglobinopathies like thalassemia can cause expansion of the bone marrow cavities because of compensatory marrow hyperplasia. This case demonstrates spontaneous osteonecrosis of the distal left femur in a patient with β-thalassemia that may be secondary to ischemic infarction secondary to occlusion of the microvasculature within the expanded cancellous bone. This subject was referred to Hazrat Rasool Akram Hospital because of fever, cough, and bone pain. In the CT scan she had scattered peripheral CGO in both lungs due to COVID-19 with two paravertebral masses due to extramedullary hematopoiesis. The patient had also generalized bone pain so the physician asked for a whole-body bone scan and incidentally, we found a cold lesion with a rim of increased uptake in the distal left femur that with bone biopsy it was consistent with osteonecrosis. This case illustrates the importance of performing a whole-body bone scan in β-thalassemia for the management of patients and diagnosis of occult osteonecrosis. [ABSTRACT FROM AUTHOR]

Background: Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide. Researchers have tried to develop indices to assess liver fibrosis in NAFLD patients to avoid liver biopsy. In this study we aimed to compare fibrosis-4 (FIB-4), aspartate aminotransferase (AST) to platelet ratio index (APRI), and aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio with FibroScan for the assessment of hepatic fibrosis in patients with NAFLD.Methods: This cross-sectional study included patients with NAFLD or non-alcoholic steatohepatitis (NASH) referred to the Gastroenterology Clinic of Shahid Mohammadi Hospital, Bandar Abbas, Iran, in 2019. Demographic features of the participants including age and gender were recorded. All participants underwent FibroScan and had their AST, ALT, and platelet count measured in a random blood sample, taken within 1 month of the FibroScan.Results: Of the 205 NAFLD patients included in this study with a mean age of 42.95 ± 10.97 years, 144 (70.2%) were male. Fibroscan results revealed that 94 patients (45.9%) had F1, 67 (32.7%) F2, 29 (14.1%) F3, and 15 (7.3%) F4 liver fibrosis. A significant correlation was found between FibroScan score and FIB-4 (r = 0.572), APRI (r = 0.667), and AST/ALT (r = 0.251) (P < 0.001). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of APRI at the 0.702 cut-off for the differentiation of F3 and F4 from F2 and F1 were 84.1, 88.2, 66.1, 95.3, and 87.3%, FIB-4 at the 1.19 cut-off 97.7, 72.7, 49.4, 99.2 and 78%, and AST/ALT at the 0.94 cut-off 61.4, 77, 42.2, 87.9, and 73.7% respectively. Moreover, the area under the receiver operating curve of APRI, FIB-4, and AST/ALT for the differentiation of F3 and F4 from F2 and F1 was 0.923, 0.913, and 0.720, respectively.Conclusions: Based on these results, APRI appears to be the most appropriate substitute of FibroScan for the detection of significant fibrosis in NAFLD patients. FIB-4 was the second best, suggesting that in case of FibroScan unavailability, APRI and FIB-4 are the best indices to assess liver fibrosis in NAFLD patients. [ABSTRACT FROM AUTHOR]

Objectives: Gingiva is one of the supporting tissues around the teeth that can be affected by various neoplastic or nonneoplastic lesions. Previous studies have examined several types of gingival lesions, but the lack of a standardized classification system has hindered meaningful comparisons. Additionally, many studies focused primarily on reactive lesions. Our study aims to contribute to the understanding of gingival lesions by investigating their prevalence across age groups, genders, sites, and by their clinical presentation. This research could lead to improved diagnostic accuracy and treatment strategies., Materials and Methods: This retrospective study explores the prevalence of gingival lesions based on biopsies during a 22-year span. The patient's demographic details, including age, gender, and lesion's clinical presentation were systematically collected. These lesions were categorized into six groups. Descriptive statistics, χ 2 test of independence, and one-way ANOVA were used for data analysis., Results: Among the 7668 biopsied lesions, 684 (8.9%) lesions were located in the gingiva, with a greater occurrence in women (63.5%). Soft tissue tumors represented the most prevalent group in the gingival lesions (72.1%), and peripheral giant cell granuloma (PGCG) was the most frequent lesion (21.2%), followed by, pyogenic granuloma (19.3%), peripheral ossifying fibroma (17.8%) and focal fibrous hyperplasia (7.6%); all of which predominantly affected women, with mean ages falling in the fourth decade of life. Squamous cell carcinoma was recognized as the most common malignancy., Conclusion: In this study, PGCG was found to be the most common lesion in the gingiva in Iranian population. Further analysis using a unanimous categorization is required to confirm these results., (© 2024 The Authors. Clinical and Experimental Dental Research published by John Wiley & Sons Ltd.)

Background: Recent highlights have investigated the possible roles of molecular chaperons like heat shock proteins (HSPs) into Lichen Planus (LP)-onset and pathogenesis. This study for the first, determine the expression of both HSP60 and HSP70 genes in cutaneous LP (CLP) and oral LP (OLP) lesions compared to normal healthy cases and between different subtypes of OLP lesions by real-time (RT)-PCR. Materials and Methods: Paraffin blocks of LP lesions including 56 OLP and 56 CLP samples were selected from theMashhad University of Medical sciences, Mashhad, Iran. Also 56 biopsy samples of healthy normal participants were selected. The demographic and clinical characteristics were extracted from their medical records. The expression of HSP60 and HPS70 genes were evaluated using the real-time RT-PCR method. Results: The comparison of the expression of HSP60 and HSP70 genes among the patients with CLP and OLP showed a significant overexpression of HSP60 and HSP70 genes in both groups compared to the normal participants (P = 0.001). The expression of HSP60 and HSP70 genes was high in both the groups of CLP and OLP patients, but the amount was not significantly different between the two groups. Comparing the two mucosal subgroups of OLP lesions (non-erosive and erosive) showed that the expression of the HSP60 and HSP70 in erosive subtypes of OLP was significantly higher than the non-erosive subtypes of OLP (P = 0.001). Conclusion: Regarding the overexpression of HSP60 and HSP70 in the LP lesions compared to healthy biopsies, we conclude that HSP60 and HSP70 could have key roles in the etiopathogenesis of the OLP and CLP lesions. The overexpression of both HSP60 and HSP70 in the erosive OLP group compared to the non-erosive OLP group emphasized the possible roles of HSPs in the pathogenesis and premalignant changes of OLP lesions. [ABSTRACT FROM AUTHOR]

BACKGROUND Infiltration of IgG4 positive plasma cells has been detected in the colonic mucosa of patients with ulcerative colitis (UC). The aim of the study was to investigate the association between colonic mucosal infiltration of IgG4 plasma cells and the presence, activity, extension, and duration of UC. METHODS In this case-control study (2009-2014), 102 subjects (84 with UC/18 controls) were enrolled. Clinical records and rectosigmoid biopsies of UC patients were selected, and biopsies were stained with IgG4 monoclonal antibodies. IgG4 positive plasma cells were counted by a single pathologist. RESULTS Amongst 84 patients with UC, 73.8% had UC without primary sclerosing cholangitis (PSC), and 26.2% had UC with PSC. IgG4 plasma cells were seen in 35 (41.7%) patients with UC and 0% of controls (p = 0.001). The mean amount of IgG4 containing plasma cells was significantly different between active and inactive patients with UC, although it was not significantly different between UC patients with and without PSC. The presence of IgG4 infiltration was significantly associated with the extension and duration of the disease. Furthermore, IgG4 count had a sensitivity/specificity of 78.6%/83.3% for the diagnosis of UC. CONCLUSION Our study revealed the diagnostic role of IgG4 plasma cells in the colonic mucosa of patients with UC and its association with activity, extension, and duration of disease. [ABSTRACT FROM AUTHOR]

BACKGROUND Functional dyspepsia is a common, troubling, and usually chronic disorder. Although the merit of using pathological assays has not been confirmed, medications affecting eosinophils may result in some improvements. Disseminated distribution of mast cells may also be an essential factor. Given the probable associations and lack of evidenced-based data, this study was conducted to comparatively investigate the number of eosinophils and mast cells in the duodenum in functional dyspepsia patients and healthy controls. METHODS In this case-control study, 150 consecutive subjects in Kerman, Iran, were enrolled in 2015 and 2016; the subjects consisted of 100 patients with functional dyspepsia and 50 asymptomatic healthy controls. Samples from the two groups were compared for the number of eosinophils, mast cells, and Helicobacter pylori presence by grasp biopsy. RESULTS The mean number of mast cells significantly differed between the groups (P = 0.001), but the eosinophil count was similar (p > 0.05). Female gender, no opioid use, and H. pylori may increase mast cell count (p < 0.05). CONCLUSION Overall, the mast cell count was significantly different between people with functional dyspepsia and people without it, but the eosinophil count in the two groups was similar. [ABSTRACT FROM AUTHOR]

Introduction: Biopsy is the most accurate way to make a definitive diagnosis, based on which the prognosis and treatment plan can be determined. This study aimed to evaluate the knowledge, attitude, and practice of general dentists and dental students about the principles of biopsy. Materials & Methods: This descriptive-analytical and cross-sectional study conducted on 188 general dentists and 93 senior dental students of Isfahan University of Medical Sciences using a questionnaire. Then data were analyzed using Pearson correlation coefficient, T-test ) in all tests, the significance level is considered 0.05). Results: The mean score of dentists’ knowledge was 4.62 ± 1.42 and, the mean score of students' knowledge was 4.96 ± 1.77 out of 8 points. The knowledge of dentists who had participated in retraining courses was higher than that of dentists who had not attended any biopsy retraining and was statistically significant (p value > 0.001). The mean score of dentists' attitude (39.6 ± 4.06) was higher than the students' (37.05 ± 3.06). Conclusion: Level of knowledge and attitude of dentists and students about the principles of biopsy was moderate. Their performance was also poor and most of the dentists expressed a lack of necessary skills for not doing a biopsy. This study shows the need for educational programs related to the principles of biopsy, in the form of retraining courses and more emphasis on the student curriculum. [ABSTRACT FROM AUTHOR]

Purpose: Gleason score (GS), as well as other prognostic and diagnostic modalities, can predict the possibility of tumor growth and metastasis during the life of patients with prostate cancer. Based on the prostate biopsy GS, clinicians choose the most appropriate therapy for managing patients. The objective of this cross-sectional study was to determine the discrepancy between needle biopsy and radical prostatectomy GS and to identify its predictive factors among the Iranian population.Materials and Methods: A total of 1147 patients who underwent radical prostatectomy from 2009 to 2019 were initially enrolled in this study. After consideration of the inclusion and exclusion criteria, 439 patients were finally included. The demographic variables and clinical data including age, PSA level, prostate volume, PSA density, GS derived from ultrasonography-guided core needle biopsy specimen, and GS derived from radical prostatectomy specimen were collected from the medical records of patients with prostate adenocarcinoma and were reviewed by a urology resident. Statistical analysis was done by using the Social Sciences Software version 21.Results: The average age of patients was 64.5 years (range 48-84 years), and the average preoperative PSA level was 14.8 ng/mL. On histopathological examination, no changes in GS were observed in 237 (53.9%) patients, whereas GS was upgraded in 144 (32.8%) patients and downgraded in 58 (13.2%) patients at radical prostatectomy. The number of patients who had extracapsular extension, seminal vesicle invasion and positive lymph nodes was significantly higher in the upgraded group compared with the non-upgraded group.  Conclusion: In this study, there was a steady decrease in GS upgrading with the prostate size extending up to 49.7 g. There was also an association between downgrading and extending prostate size. Due to the greater risk of high-grade disease in men with small prostates, smaller prostate bulks are most probably upgraded after radical prostatectomy. A higher maximum percentage of involvement per core was an independent predictive factor of upgrading from biopsy grade 1 to grade ≥ 2. Our study showed that patients' age was not predictive of upgrading, which is consistent with other studies. Also, we demonstrated a non-significant relationship between PSA level and upgraded GS. Findings in this study did not demonstrate a significant relationship between PSA level and upgrading. [ABSTRACT FROM AUTHOR]

Background & Aim: Epithelial odontogenic cysts and tumors originate from the odontogenic epithelium and superficial epithelial lining of the oral mucosa. Differences in the proliferation of epithelial cell islands play an important role in the pathogenesis of these lesions. The aim of this study was to compare the frequency of odontogenic epithelium in the connective tissue of dentigerous cysts and odontogenic keratocysts from registered samples of oral pathology archive, dental dental faculty Isfahan University of Medical Sciences. Material and Methods: In this cross-sectional descriptive study, 30 odontogenic keratocysts and 30 dentigerous cysts prepared by excisional biopsy were selected and clinical information including age, sex and location was obtained from the archives of patients referred to the Oral and Maxillofacial Pathology Department of Isfahan Dental School. Histopathological slides were examined by two pathologists to confirm the diagnosis and evaluation of odontogenic epithelial islands and cords in the connective tissue of the lesions. The data were entered into SPSS23 software and statistically analyzed by Fisher's exact test, Mann-Whitney, Kruskal-Wallis and T-test. Results: The number of specimens with large and small epithelial islands and epithelial cords was significantly higher in odontogenic keratocysts than dentigerous cysts (p-value = 0.014). There was no significant difference between the mean number of large and small epithelial islands and cords in connective tissue based on gender and location in each group (p-value >0.05). There was a significant inverse relationship between the mean number of large and small islands of odontogenic epithelium and epithelial cords in the connective tissue of the two lesions with the mean age of patients (p-value = 0.035). Conclusion: It seems that the samples with large and small epithelial islands and epithelial cords were significantly higher in OKCs than dentigerous cysts and this difference may play a role in the different biological behavior and recurrence of these two lesions. [ABSTRACT FROM AUTHOR]

Background and Aim: Helicobacter Pylori (H. pylori) is one of the reasons for the gastric inflammation and peptic ulcers. It is a predisposing factor of gastric adenocarcinoma. Cytotoxin A encoded by the cagA gene is one of the major virulence factors in bacterial pathogenicity, which is of special importance due to genetic diversity in different geographical areas. The purpose of this study was to evaluate the prevalence of the cagA gene in the patients suffering from gastric ulcers. Materials and Methods: Seventy-five paraffin blocks of stomach biopsy samples from patients infected with H. pylori and suffering from gastric ulcers were randomly evaluated in the province of Kermanshah in the spring of 2016, Iran. DNA samples extracted by the boiling method were investigated using PCR by the use of particular primer pairs for a protected area in the glmM gene, and the existence of the cagA gene. Results: From the 75 samples, 56 cases (%74.66) were glmM-positive and among them, 39 cases (%69.64) tested positive for cagA gene. Comparing patients in terms of gender, the frequency of the cagA gene was 22 (%39.28) and 17 (%30.35) in males and females, respectively. Finally, comparing patients in terms of age, 16 cases (%21.33) were younger than 40 years old and 23 cases (%41.07) were older than 40 years old. Conclusion: The results of this study showed significant association between the frequency of the cagA gene and peptic ulcer in the studied patients. [ABSTRACT FROM AUTHOR]

Canalicular adenoma (CA) is a rare, benign salivary gland tumor that has special tendency to occur in the upper lip. Buccal mucosa is the second most common site. It occurs more often in older patients with peak prevalence in the seventh decade of life. A definitive female predominance has been reported. According to the latest English published literature, 531 cases of CA have been reported. We present a case of CA of the hard palate that presented in a 29-year-old female patient. The histopathological and immunohistochemical findings showed typical features of CA and intense expression of pan-cytokeratin and S-100 protein. We also review its differential diagnosis from other salivary gland tumors. [ABSTRACT FROM AUTHOR]

Background: The DNA mismatch repair (MMR) system is one of the molecular pathways involved in colorectal cancer (CRC) carcinogenesis that consists of several genes, including MLH1 (MutL homolog 1), MSH6 (MutS homolog 6), MSH2 (MutS homolog 2), and MSH3 (MutS homolog 3). The protein encoded by PMS2 (post-meiotic segregation 2) is also essential for MMR. Here, we address the correlation between immunohistochemical and transcriptional expression of PMS2 with the tumor grade and clinical stage of non-hereditary/sporadic CRC disease. Methods: This study retrospectively analyzed 67 colorectal resections performed for 38 male and 29 female patients. Random biopsies were taken by a gastroenterologist from patients referring to three hospitals in the cities of Zanjan, Urmia and Qazvin (Iran) during 2017-2019. All specimens were examined and classified for localization of tumor, pathological stage and grade. The PMS2 protein expression was studied immunohistochemically and analysis of mRNA expression was performed in the same tissue sections. Results: Immunohistochemistry and quantitative real-time polymerase chain reaction (PCR) analysis showed a decrease in PMS2 expression compared with paracancerous tissue (P < 0.001), which correlated with tumor stage. In addition, reduced PMS2 expression was correlated with the tumor differentiation grade, underlining a connection between downregulation of PMS2 and progression of CRC. Comparing the PMS2 mRNA levels in different groups showed the following results: 0.92 ± 0.18 in patients with Stage I CRC tumor, 0.86 ± 0.38 in Stage II, 0.50 ± 0.29 in Stage III, and 0.47 ± 0.23 in Stage IV. Conclusion: These findings suggest that PMS2 may provide a potential reliable biomarker for CRC classification by combined immunohistochemical and mRNA analysis. [ABSTRACT FROM AUTHOR]

Background: Electron microscopy (EM) is a valuable tool in the diagnosis of renal amyloidosis, particularly in the early stages of the disease. In Iran, studies on EM and the clinical features of renal amyloidosis are scarce. The objective of the present study was to survey EM investigations, pathological classifications, and clinical features of renal amyloidosis. Methods: This cross-sectional study was performed in Shiraz, Iran, during 2001-2016. Out of 2,770 kidney biopsies, 27 cases with a diagnosis of renal amyloidosis were investigated. EM investigation and six staining procedures for light microscopy (LM) were performed. Two pathological classifications based on glomerular, peritubular, perivascular, and interstitial involvement were made. Finally, the association between these classifications and the clinical features was assessed. Chi-square, Fisher's exact, Independent t test, and Multiple logistic regression analysis were used. P values<0.05 were considered statistically significant. Results: In 51.9% of the cases, the clinical diagnosis was nephrotic syndrome. Proteinuria and edema were the most prevalent clinical manifestations. The role of EM investigation for diagnosis was graded "necessary" or "supportive" in 48.2% of the patients. In the classification based on glomerular classes, variables such as the mean blood pressure (P=0.003), history of hypertension (P=0.02), creatinine >1.5 (P=0.03), and severe tubular atrophy (P=0.03) were significantly higher in class B (advanced amyloid depositions). Conclusion: EM plays an important role in the diagnosis of renal amyloidosis. EM in conjunction with LM investigation with Congo red staining is recommended, to prevent misdiagnosis of patients with a clinical suspicion of renal amyloidosis. Among different pathological features of renal amyloidosis, the severity of glomerular amyloid depositions had a clear relationship with clinical presentations. [ABSTRACT FROM AUTHOR]

Background: Portal hypertension refers to the pathological increase in portal pressure or pressure gradient difference between the portal vein and lower vena cava. This study aimed to determine the etiology and prognosis of portal hypertension in children of northwest Iran for ten years. Methods: In this descriptive cross-sectional survey, 73 children under the age of 18 years with portal hypertension who were admitted to the Gastroenterology department of Tabriz Children Hospital for ten years were studied. These children were evaluated for demographic data as well as the underlying etiology according to the liver biopsy, abdominal ultrasound, and liver Doppler ultrasound records. Results: The most common cause of portal hypertension was cryptogenic cirrhosis with a frequency of 21 (28.8%). Out of the total number of patients, 7 deaths (9.7%) were observed whereas 84.7% of patients had successful treatment and were discharged without complications. Two patients underwent portosystemic shunt surgery. Liver transplantation was done for 2 cases. Sclerotherapy was performed for 35 patients (48.6%). Out of this group of patients 28 cases (80%) had a good response to sclerotherapy, 4 cases (11.4%) died, two were referred for portosystemic shunt, and one patient underwent liver transplantation. Conclusion: The etiologic factors leading to portal hypertension have a wide diversity in terms of underlying disease and prognosis. A thorough assessment of the cause of portal hypertension is important for making the best therapeutic decision. Early diagnosis has a critical role in improving response to therapy and preventing complications. [ABSTRACT FROM AUTHOR]

Background. Geriatric health care has become a worldwide concern, but a few statistical studies were carried out about skin diseases in this age group in the nursing home of Iran. Aims. In this study, we set out to determine the frequency as well as the age and gender distribution of dermatological diseases in nursing home old age residents. Methods. In a cross-sectional study, all patients over 60 years who were living in a charity nursing home complex of Rasht in 2017 participated in this study. Baseline information on sociodemographic variables, past medical history, and medication were gathered by medical staff during a face-to-face interview. Full-body skin examination was done by dermatologists. Biopsy, and pathological and laboratory methods were used to confirm the diagnosis of suspected lesions or disease. Results. In this study, 259 people underwent the study. 52.9% were male, and their mean age was 73.5 years (SD = 9.1 years). Hypertension (20.9%); diabetes mellitus (9.7%), and hypothyroidism (2.3%) were the most common underlying diseases. Most of them (85.7%) had age-related skin changes. The benign neoplasm was the most common skin disease among patients (68.3%), followed by infectious diseases (46.3%) and erythemo-squamous (31.6%). None of them had precancerous lesions or skin cancers. There were not any differences between skin disorders and gender or age groups in this study. Conclusion. Our study suggests that skin manifestations and diseases are common among nursing home old age residents in this area. Therefore, this should constitute one of the top priorities of aged care physicians and nurses. [ABSTRACT FROM AUTHOR]