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Paget's disease of bone is a metabolic bone disorder characterized by localized areas of increased bone production and cycle with excessive and irregular bone formation. Rapid bone resorption and formation lead to irregular bone tissue. Most cases are diagnosed incidentally on radiographs or as an isolated elevation of serum alkaline phosphatase. Primary sclerosing cholangitis is a chronic progressive disorder of unknown etiology characterized by inflammation, fibrosis, and narrowing of medium and large ducts in the intrahepatic and/or extrahepatic biliary tree. The association of both diseases with other diseases has been reported, but there are few reports of the association of these two diseases together. This association can present the physician with an important challenge for both diseases because both diseases lead to an increase in alkaline phosphatase. Here, we present a 52-year-old man who was also diagnosed with Paget's disease of the femur on evaluation for abdominal pain and elevated alkaline phosphatase. Zoledronic acid 5 mg was prescribed for the patient. Six months later, the patient did not complain of hip pain. The femur graph remained unchanged and the patient's alkaline phosphatase decreased and reached the normal range. Laboratory findings, imaging, and histology of the patient were explained. It seems that in patients with high alkaline phosphatase and primary biliary cirrhosis, the presence of pain or deformity of bones and joints should be checked with imaging to detect the presence of co-morbidities.

Background and purpose: Trauma to the knee is one of the most common injuries in people, especially young people, and delay in the diagnosis of knee fractures and soft tissue injuries in the knee causes limitation of movement, instability, and constant knee pain. In this research can show the correlation between the initial symptoms of the patients and the need for further procedures. To be able to identify traumatic knee injuries that are not clear in the simple knee radiography and to evaluate the findings of the patients for further procedure. Materials and methods: This research is an observational study in which all patients who presented with knee trauma during the course of the study were included in the study. All the information of these patients in a form including age, age group and sex, admission and discharge information such as visit date, discharge date, duration of hospitalization, mechanism of trauma, underlying disease, knee pain, limitation of range of motion, hemarthrosis, associate injury, skin abrasion, Inability to walk, history of knee trauma, radiography findings, knee CT findings, MRI findings, arthroscopy findings, Lysholm and Tegner knee score, probable diagnosis in the emergency room, type of treatment the emergency room, duration of hospitalization in the emergency room, discharge from the emergency room, in The hospitalization form of the performed procedures, the time of hospitalization in the ward and the definitive diagnosis were collected, and then 4 weeks after discharge, they were followed up by phone call with referral to the orthopedic clinic, and other diagnostic and therapeutic measures were reviewed in these patients. The information was provided by the project manager without interfering in the patient care process. Quantitative data were expressed as mean and standard deviation and qualitative data were expressed as frequency and percentage. Independent student t-tests were used to evaluate quantitative variables in two groups, and the Chi-Square test and Fisher's exact test were used to evaluate qualitative variables. Results: During the study period, 177 people were studied. The average age of the patients was 24.21±13.08, of which 138 (76.7%) were men. Most of the injury was caused by traffic accidents. The initial diagnosis in the emergency department had a significant relationship with the definite diagnosis. A statistically significant relationship was seen between MRI findings with knee movement limitation and non-weight bearing. There was a statistically significant relationship between the existence of definitive injury in the knee, limitation of knee movement, lacerations and scratches on the knee, and non-weight bearing. The mechanism of knee injury and laceration, the inability to weight bearing, and the positive findings of X-ray and MRI in the patients who underwent invasive procedures were significantly different from those who received conservative treatment. Conclusion: Injury mechanisms in patients and clinical symptoms such as knee range of motion limitation and non-weigh bearing and abrasion or laceration of the skin on the knee, despite the lack of findings in the initial investigations in the emergency department, is a high chance of injury to the knee joint and they need further evaluation and follow-up.

Abstract Background Vitamin D supplementation is recommended as an effective adjunct to counteract malaria pathogenesis, but the evidence on this point is limited and controversial. This systematic review and meta-analysis aimed to investigate the effect of vitamin D administration on the survival rate of Plasmodium-infected animals in experimentally-induced malaria on days 6 and 10 post-infection. Methods Five electronic databases were searched up to 20 December 2021. The pooled risks ratio (RR) and associated 95% confidence interval were estimated using the Restricted-maximum likelihood (REML) random-effects model. Heterogeneity was assessed by Cochran’s Q test and I2 value. Sub-group analyses were used to identify the sources of heterogeneity for several variables, such as type of vitamin D, type of intervention, and dose of vitamin D. Results Out of 248 articles found in the electronic database, six were eligible for inclusion in the meta-analysis. The current study found that the pooled random effect of risks ratio favored a statistically significant effect of vitamin D administration on survival rate in infected mice on day 6 post Plasmodium infection (RR = 1.08, 95%CI 1.03, 1.15, p

Background and purpose: Septic arthritis is a serious orthopedic surgery and delayed management causes irreparable damages. The knee is the most common site involved in septic arthritis. The purpose of this study was to determine mortality rate, adverse joint outcome and prognostic factors in adult patients diagnosed with septic arthritis of the knee who had undergone debridement surgery. Materials and methods: This retrospective cohort study was carried out using the medical records of all adult patients admitted to Sari Imam Khomeini Hospital and Sari BuAliSina Hospital between 2009 and 2019 who were treated with either arthrotomy or arthroscopic irrigation for acute septic arthritis of the knee. Patients with prosthetic joints were excluded. The rate of mortality was determined. Clinical findings, laboratory evidence, knee radiographs, and the Knee injury and Osteoarthritis Outcome Scores (KOOS) were compared through statistical analysis to identify possible prognostic factors. Radiographic severity was classified based on the Kellgren-Lawrence grading. Results: We included 31 patients and there were 41.9% female patients (mean age= 51.1±20.56). The most common underlying diseases were hypertension (29%) and diabetes mellitus (25.8%). Staphylococcus aureus was identified in 16.1% of synovial fluid cultures. The mortality rate was 22.6%. Factors influencing mortality included older age (P=0.003), diabetes mellitus (P=0.031), fever (P=0.038), length of hospital stay (P=0.019), high C-reactive protein levels (P=0.002), low creatinine clearance (P=0.003), and type of pathogenic microorganisms (P=0.028). Age was the only factor significantly associated with higher radiographic severity (P=0.014). Conclusion: Septic arthritis is an infectious orthopedic emergency that is associated with a high mortality rate even after joint surgery and debridement. Therefore, proper management and updating information about this disease and its treatment methods are necessary.

Background and purpose: Carpal tunnel syndrome (CTS) is one of the most common neuropathies caused by entrapment of the median nerve in the wrist. The purpose of this study was to evaluate the electrodiagnostic changes before and after carpal tunnel release (CTR). Materials and methods: The present descriptive study was conducted in 24 patients (38 hands) with CTS in order to evaluate the electrodiagnostic changes before and 12 months after CTR and to investigate the relationship between electrodiagnostic changes and Boston score, DASH score, and Grip and Pinch strength. Data were analyzed using SPSS V20. Results: Electrodiagnostic study showed that the mean distal motor latency (DML) significantly decreased from 6.7 ±2.12 ms to 4.70 ±0.61 ms (P=0.0001) and the mean distal sensory latency (DSL) significantly improved (from 4.98 ±1.06 ms to 4.54 ±0.75 ms, P=0.012). Findings showed no significant differences in mean DML and DSL between right and left hands (P=0.378, P=0.233). There was a significant positive correlation between age and DML and DSL after CTR (r=0.475, P=0.001, and r=0.341, P=0.024, respectively). No significant correlation was observed between postoperative electrodiagnostic findings and Boston score, DASH score, and Grip score ({sss: P=0.931, fss: P=0.629}, P=0.169, P=0.1000, respectively). Conclusion: Postoperative electrodiagnostic findings significantly improved, but there was no clear association between EMG NCV and the severity of postoperative clinical symptoms. Therefore, in order to evaluate the outcome of CTR, combination of clinical symptoms with electrodiagnostic findings is considered valuable.

BACKGROUND: Patients undergoing hemodialysis are vulnerable to intestinal parasites due to a weakened immune system. This study aimed to determine the prevalence of intestinal parasites in patients undergoing hemodialysis. METHODS: The feces of 168 under hemodialysis patients were collected from Sari and Zanjan hospitals, Iran, and the demographic and clinical information of the patients was recorded in a questionnaire. Samples were tested using wet-mount method, formalin-ether concentration, modified Ziehl-Neelsen staining for coccidia, conventional trichrome for intestinal protozoa, and modified trichrome for Microsporidia. Data were entered into SPSS software and analyzed by the chi-square test method (P < 0.05). RESULTS: The prevalence of parasitic infections in patients under hemodialysis in Sari and Zanjan was 43.58% and 33.33%, respectively, with a total of 40.4%. With a prevalence of 23.28%, Giardia had the highest prevalence rate. Then, Entamoeba coli had a prevalence of 14.3% and other parasites were, respectively, Endolimax nana (6.54%), Blastocystis hominis, Entamoeba histolytica/dispar, Dientamoeba fragilis, and Cryptosporidium (each one: 1.19%), and Chilomastix mesnili (0.59%). There was no significant difference between the prevalence of intestinal parasites with age, gender, place of residence (urban or rural), and duration of hemodialysis (P ≤ 0.05). CONCLUSION: Pathogenic parasites such as Giardia have a high prevalence in patients undergoing hemodialysis in Sari Region. Given the potential risks of these infections, especially giardiasis, amoebiasis, and cryptosporidiosis, it is recommended that regular screening be performed to diagnose and treat parasitic diseases in this population.

Background and purpose: Intertrocentric femoral fracture is the most common fracture and has the highest mortality rate after surgery. The main treatment for this type of fracture is surgery and the choice of appropriate surgical instrument plays a key role in reducing the incidence of complications. This study amed at comparing clinical outcomes between Dynamic Hip Screw (DHS) and Proximal Femoral Nail (PFN) in surgical treatment of unstable intertrochanteric fractures of the femur. Materials and methods: A cross-sectional study using causal-comparative design was conducted in all patients attending orthopedic clinic in Sari Imam Khomeini Hospital with intermittent femoral fractures who needed surgical treatment between 2012 and 2018. Thirty patients were randomly divided into two groups to be treated either by DHS or PFN implants. The two groups were compared for clinical results, including operation time and and anesthesia time, the need for blood transfusion during and after the surgery, cut out of the device, fracture fusion, and neck and emoral trunk angles. Data analysis was done in SPSS V21. Results: Findings showed no significant difference between DHS and PFN implantation in terms of fracture fusion (P= 0.234) and cut-out of the device after the surgery (P= 0.157). It was also found that DHS required less time for surgery and anesthesia (P= 0.012). Patients treated with DHS also required significantly less blood transfusion than those in PFN group (P= 0.02). Conclusion: In this study, treatment of unstable intertrochanteric fractures using DHS was found to be superior to PFN due to lower length of surgery and anesthesia, and lower need for blood transfusion.

We report a rare case of bilateral subtrochanteric femoral fracture related to prolonged treatment with Alendr onate. Bisphosphonates are the most common drugs used for treatment of osteoporosis and prevention of the risk of osteoporosis-related fractures. Atypical femoral fractures (AFF) have been reported in patients who have been on long term treatment with bisphosphona te especially Alendr onate. our case was a 68- year- old woman who sustained bilateral subtroc- hanteric femoral fracture after a simple falling down. She had a past medical history of osteoporosis and had been on treatment with alendronate for 5 years. Radiographs showed bilateral fractures in femur subtrochanteric area. We decided to use double plating technique and we used angled blade plate and locking plate (LCP). Alendronate was discontinued and Teriparatide was started. Careful evaluation of hip or thigh pain in patients who are on prolonged courses of bisphosphonates is essential. Our method of fixation with double plating can be used in pa tients with poor bone quality.

Introduction: The Unicameral Bone Cyst (UBC) is a benign osteolytic lesion primarily found in the metaphyseal part of long bones in children. It is important as it can involve growth plate involvement, cause pathological fractures and deformities of the affected limb. We report this case to emphasize that hip area pathologies can be represented with knee pain and discomfort. Case Presentation: The patient was a 9-year-old girl with a bone cyst in the right proximal femur, with functional knee pain and limping. The diagnosis was made after two years of pain in the knee area. As the cyst was symptomatic and the signs of impending pathological fracture were seen, the lesion was managed by curettage and fibular strut allograft and proximal humerus locking plate. Conclusions: The patient has been examined for knee joint problems for a long time, and her femur bone cyst was diagnosed after two years of pain. However, it could become a pathologic fracture or involve the growth plate and stop the limb’s growth, thus affecting the patient’s quality of life. Therefore, in children with chronic knee pain, careful assessment of the hip area is recommended.

Background and purpose: Almost half of non-specific knee pain can be attributed to patellofemoral pain syndrome (PFPS). There is paucity of information about the effects of different types of combination therapies including exercise and taping and optimizing training variables. The aim of this study was to evaluate the effectiveness of combination of taping and quadriceps strengthening and hamstring stretching exercises on PFPS. Materials and methods: In a randomized clinical trial, 60 male patients (20-50 years old) with PFPS were randomly divided into four groups: 1) Quadriceps strengthening exercise and taping, 2) Hamstring stretching exercise and taping, 3) Quadriceps strengthening and hamstring stretching exercise, and 4) Quadriceps strengthening, hamstring stretching exercise, and taping. Pain and functional outcomes were assessed before and immediately after treatment using VAS scale, KOOS scale, and 6 MWT test. Data were analyzed in SPSS V20. Results: Compared to beginning of the study, significant decrease in mean VAS scores (P

Background and purpose: One of the most important complications of bone fractures is nonunion. This research aimed at comparing the effect of exchange nailing and plate augmentation on complications after surgery and the time to achieve desired outcomes. Materials and methods: This descriptive-analytical study was conducted in 12 femoral shaft nonunion cases treated operatively in 2011-2018 (eight patients were managed with plate augmentation and four patients were treated with exchange nailing). Demographic characteristics of the patients, type of fracture and type of surgery were recorded. A year after the surgery, anteroposterior and lateral view profiles were prepared from all patients and the extent of bone fusion was evaluated by orthopedic surgen. Results: Four patients (33.33%) underwent intraosseous nail replacement surgery and eight (66.67%) underwent plate augmentation surgery. Two patients (16.67%) developed infections and five (41.67%) had a short limb complication. The average limb shortness in these patients was 1.10±0.22 cm. The average duration of union after discharge was lower in patients with plate augmentation than those with replacement of the intramedullary nail. Conclusion: In current study, faster uninon achieved, so, augmentation plating could be a good choice in patients with femoral shaft nonunion.

Genu valgum is an angular deformity caused by several reasons, such as congenital syndromes, post-traumatic bone dysplasia, or an idiopathic form. It generates cosmetic problems, difficulties in function, and pain. Manipulating the growth plate by hemiepiphysiodesis with implants helps to achieve the correct alignment. We presented twin girls diagnosed with genu valgum deformity who were suffering from cosmetic problems and pain. We used growth modulation to temporarily arrest the growth plate. This procedure was followed by photographs and after 8 months, the implants were removed without having overcorrection. A brief literature review was also performed concerning the reported cases in the international databases, such as PubMed and Google Scholar on growth modulation for genu valgum deformity in twins. Twin girls with genu valgum deformities underwent hemiepiphysiodesis surgeries. We used reconstruction plates and 3.5 mm non-cannulated screws to fix both the distal femur and proximal tibia to temporarily arrest the growth plate. When we achieved the correct alignment the devices were removed.

Traumatic rupture of the posterior tibialis tendon is an extremely infrequent condition, which mostly occurred due to a traumatic mechanism of pronation and external rotation, less commonly in direct trauma on the medial side of the ankle. This lesion is overlooked preoperatively most of the time because of the limitation of physical examination owing to acute pain and swelling secondary to a medial malleolar fracture. Early diagnosis and treatment of this injury are very important to prevent the complications like acquired flatfoot deformity. Few cases have been described in the literature for the posterior tibialis tendon rupture associated with a closed ankle fracture. Here we report an acute rupture of the posterior tibialis tendon associated with a closed medial malleolar fracture after a high-energy trauma in a healthy 33-year-old man. We fixed the medial malleolar fracture with two screws and repaired the tendon with a direct end-to-end suture. We hope that our study can be helpful for other colleagues to consider this lesion in similar circumstances.

Introduction: Half of all fractures of the elbow and almost 30% of all limb fractures occur in children under the 7 years of age, supracondylar humerus fracture being the most common. Neurological complications associated with supracondylar humerus fractures in children such as Anterior Interosseous Nerve (AIN) syndrome are well known. Cases Presentation: Thirty-three children with humeral supracondylar fracture were admitted to the orthopedic surgery centers at Imam Hospital in Sari, north of Iran from November 2014 to November 2016. Of them, four cases had AIN syndrome. The treatment of fracture involved closed reduction with percutaneous pinning, open reduction, and pin fixation. Conclusions: According to the only motor (no sensory) dysfunction of AIN and by deceiving children using the third finger to flex the second one, underestimation of AIN syndrome in supracondylar fracture of the humerus can be expected. So, the physician should be more careful about physical examination in supracondylar fracture of humerus beside to vascular state.

Background: Cryptosporidiosis is an important cause of diarrhea in children and immunosuppressive patients. The current study was intended to evaluate the prevalence rate of Cryptosporidium infection and clarify the epidemiological characteristics of the infection in both children and immunosuppressive patients in Iran. Methods: Five English electronic databases including PubMed, Google Scholar, Science Direct, Scopus and Cochrane, and two Persian language databases Magiran and Scientific Information Database were searched. Additionally, reports from the Iranian congresses of parasitology and graduate student thesis dissertations were assessed manually. Results: Out of 1856 studies from the literature search, our search resulted in a total of 27 articles published from 1991 to 2016. These include 14 reports on cryptosporidiosis in children and 13 papers regarding immunosuppressive patients. 8520 children and 2015 immunosuppressed cases were evaluated. Oocysts of Cryptosporidium were found in 3.8% and 8% children cases and immunosuppressed patients, respectively. There was a relatively high variation in the prevalence estimates among different studies, and the Q statistics was high among articles regarding children (p

Background: Finding and choice the best treatment for the plateau tibia complex fracture has always been discussed. The present study aimed to compare the therapeutic outcomes of the external hybrid fixation method with a double-plate classic method in the treatment of plateau tibia complex fracture. Methods: Forty patients with plateau tibia complex fracture were treated with either a double plate or an external hybrid fixation. A knee score and clinical-functional table were used to evaluate patients after surgery. Level of evidence for this article is level one. Results: Knee score in the double and hybrid group was good to excellent in 60% and 75% of patients, respectively (P = 0.675). In patients, the union was formed correctly and skin necrosis was not observed in any of the cases. There were no significant differences between the two groups in the complications. In the double group, the risk of deep infection of the surgical site was 2.33 times in the patients. The pin-tract infection was observed in only 8 patients (40%) of the hybrid group. Depression was observed in 5 patients in the double group (25%) and 9 patients in the hybrid group (45%) (P > 0.05). Conclusion: In the treatment of plateau tibia complex fracture, both double plate and external hybrid fixation methods have almost the same therapeutic results and complications. However, the rate of pin-tract infection in the external hybrid surgical technique of fixation and the degree of deep infection is more common in double-plate surgery.

Background and purpose: Despite numerous advances in diagnosis and treatment of diseases, complaints against doctors and medical assistants are increasing. The aim of this study was to investigate the complaints of patients against orthopedic surgeons in Mazandaran province, Iran. Materials and methods: A cross-sectional study was done on the complaints of orthopedic malpractice cases made to Department of Forensic Medicine in Mazandaran province between 2011 and 2014. Results: A total of 64 complaints was made in which the doctors were convicted in 49 cases (76.6%). The patients in these cases included 37 (75.5%) males and 12 (24.5%) females. The mean age of patients was 34.4 years. The most common complaint was malfunction Lack of organ function (39%, n=25). Among the cases 21 (42.9%) were admitted in state hospitals while 28 (57.7%) were hospitalized in private hospitals. Conclusion: A considerable number of orthopedic malpractice claims was proved. In order to prevent such cases, appropriate planning is required.

Objectives: The primary infection of pregnant women by Toxoplasma gondii can cause severe complications in the fetus, and can also lead to neurological complications. The aim of the present study was to determine the seroprevalence and seroconversion rates of Toxoplasma gondii in female students who were at childbearing age in Iran. Methods: This cross sectional study was performed on female students at Babol University of Medical Sciences (Babol, Iran) over a three-year period between 2012 and 2014. Two ml blood sample was obtained from volunteers, and the specific antibodies (IgG) to T. gondii were detected by Enzyme-Linked Immunosorbent Assay. Second, the blood samples obtained from seronegative cases were used to evaluate the seroconversion during a year. Results: The mean age of the subjects was 21±2.2, ranging from18 to 35 years. Overall, 28% of the participants were positive and 232 (72%) were negative for anti-Toxoplasma antibodies (IgG). The rate of this infection was higher among female students from Mazandaran province (31.7% vs 12.5%) (P=0.031). Based on the results of Enzyme-Linked Immunosorbent Assay, the seroconversion rate of Toxoplasma infection among female students was estimated to be 2.5%. Conclusion: This study found a noticeable rate of seroconversion in female students. Therefore, there is an urgent need for a national screening project to determine the seroconversion rate of Toxoplasma infection in women at childbearing age, particularly pregnant women from all over Iran.

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Background: The occurrence of chronic knee dislocation is rare. To the best of our knowledge, total knee arthroplasty for treatment of chronic anterior knee dislocation has not been reported. Method: This report describes 3 cases of chronic anterior knee dislocation treated by total knee arthroplasty. Results: Three female patients with chronic anterior knee dislocation were treated by hinged prosthesis total knee arthroplasty using the Insall rectus snip approach. At a mean of 17 months (range, 12-24 months) of follow-up, all patients showed a painless stable prosthesis and expressed satisfaction with the results. Conclusions: Total knee arthroplasty for chronic anterior knee dislocation is a challenging procedure. The Insall rectus snip approach with quadriceps release and constrained prosthesis is recommended.

Objective: To investigate the possible association between Toxoplasma gondii (T. gondii) infection and breast cancer by examining the seropositivity and serointensity rate of anti-T. gondii antibodies in breast cancer patients and healthy volunteers. Methods: This study was carried out on 66 women with breast cancer which consists of 29 newly diagnosed patients (Group 1) and 37 cases undergoing treatment and regular checkups (Group 2). Also, 60 healthy women (Group 3) with no history of cancer confirmed by clinical examination and imaging participated in this study. The participants were tested for T. gondii immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies by enzyme-linked immunoassays. Results: The mean age of Groups 1, 2 and 3 were 43.3±6.8, 41.8±5.5 and 42.3±4.9, respectively (P=0.72). Overall, 104 (82.5%) and 8 (6.3%) out of 126 women were positive for anti-T. gondii IgG and IgM antibodies, respectively. Higher seropositivity rate of anti-T. gondii antibodies (IgG) was seen in breast cancer patients (86.4%) compared with control group (78.3%) (P=0.24). IgG antibodies were detected in 89.2% of cancer patients under treatment, 82.7% of newly diagnosed patients (P=0.18). IgM antibodies were found in 3 (10.3%), 2 (5.4%) and 3 (5%) in Groups 1, 2 and 3. No significant difference was found between the mean titers of T. gondii IgG antibody among these groups (P=0.87). Conclusions: This study did not find any significant association between toxoplasmosis and breast cancer besides higher rates of seropositivity and serointensity in patients compared with healthy volunteers.

Background and aims : Emergency evacuation is one of the necessary measures to protect employees in the event of emergency situations (such as fire, flood, earthquake, chemical spill, etc). For this purpose, it is necessary to predict enough number of suitable emergency exits to be ensured that people could be evacuated from buildings and transported to a safe place. This study aimed to assess the state of emergency exit routes in 5 hospitals of Shiraz university of medical sciences. Methods : In this cross-sectional study, quantitative indices including occupant load, number and width of emergency exits were calculated using filed data. Emergency response plan and qualitative indices including general specifications, marking, and lighting of emergency routes, were measured using a structured questionnaire adapted from national regulation and requirements. The compliance percent of each indicator were calculated and analyzed. Results : The percentages of compliance for quantitative and qualitative indices in all studied hospitals were 37.5±29.1% and 20.8±16.8% respectively. The average rate of criteria for emergency response planning program was calculated 46.6±27.4%. From all five hospitals studied, only two had hospital emergency exits. Conclusion: The result of this study showed that in studied hospitals quantitative and qualitative indices of emergency exits and emergency response planning were inappropriate and, especially in the case of number of emergency exits, they need to be improved.

BACKGROUND AND OBJECTIVES: Effective learning of parasitology and mycology has been always a challenge for medical students. Attention toward students’ viewpoints can develop the education of this course. This study aimed to assess the viewpoints of medical students about the methods for improvement of education of medical parasitology and mycology's module. METHODS: This cross-sectional study was carried out on medical students at Babol University of Medical Sciences in autumn 2010. The 2nd, 3rd and 4th year of medical students who passed the course, participated as easy and available allocation procedure and filled a self-constructed questionnaire. Questionnaire, s validity and reliability were confirmed with a Cronbach alpha 0.7 and expert’s opinions, respectively. Chi-square was used for data analysis. FINDINGS: In overall, 91 participants filled the questionnaires (response rate = 76%) fifty seven (62.6%) were female and 34 (37.4%) were male. The mean age of participants was 21.66±38 years. Students believed that using of educational videos has the best effect on learning outcome. Development in the quality of training classes and dissociation of the module to separate sections should be the short-term and long-term solutions for improvement of the education respectively. There was no significant relationship between sex, educational level of students and their viewpoints (p>0.05). CONCLUSION: Reconsideration of parasitology and mycology curriculums and new training methods such as application of educational videos and internet are offered.

Background: To differentiate Sarcocystis macro-cyst-forming species in slaughtered sheep in Babol area, Mazandaran Province, sequence analysis of 18S rRNA gene was performed. Methods: Overall, 150 slaughtered sheep were examined macroscopically in slaughterhouse, Babol and intra-abdominal and diaphragm muscles tissues infected with macro-cyst of Sarcocystis spp. were collected in 2013. One macro-cyst was isolated from the infected muscles of each sheep. The partial 18S rRNA gene was amplified by PCR and sequenced afterward. Results: The rate of infection with macro-cyst producing Sarcocystis spp. was 33.3% (50 / 150). The partial 18S rRNA gene of Sarcocystis species was amplified at the expected PCR product size (~1100 bp) from all 50 macroscopic cysts samples. From 30 sequences DNA samples, 20 samples (66.7%), six (20%) and four (13.3%) isolates were identified as S. gigantea, S. moulei and Sarcocystis spp., respectively. Eight and thirty-four variations in nucleotide position were seen in partial sequence of the18S rRNA gene of S. gigantea and S. moulei.Conclusion: Sheep can be considered as an alternative intermediate host for S. moulei. Furthermore, multiple alignments showed some variations in the consensus sequences of the isolates obtained in the current study compared with previously published isolates. To understand better the genetic diversity among Sarcocystis species complete sequences of the18S rRNA gene or sequence analysis of other genetic loci would be beneficial.

Objective: To perform a comparative diagnosis of Cryptosporidium infection in fresh and old stool specimens. Methods: A total of 518 stool samples including 464 diarrheic human samples, 53 samples from calves with or without diarrhea and one sample from a sheep were screened. Initially, the auramine phenol, modified Ziehl-Neelsen and ELISA techniques, were preformed. Subsequently, PCR of the 18S rRNA gene of Cryptosporidium was carried out on all positive samples obtained by microscopy and ELISA. Results: Auramine phenol and Ziehl-Neelsen identified Cryptosporidium oocysts in 49 (9.5%) and 56 (10.8%) out of 518 samples, respectively. Cryptosporidium specific antigen was found in 97/518 (18.7%) of the samples by the ELISA test. The 18S rRNA gene of the parasite was amplified in 79 out of 119 (66.4%) samples by PCR. Comparison of the detection rates between the diagnostic methods, i.e. PCR and ELISA, showed that there was a moderate level of agreement between these tests (Kappa=0.55). Conclusions: The current study suggested that PCR or ELISA methods with one of microscopy technique should be used for screening of Cryptosporidium infection in a stool sample collection.

Background: Cryptosporidium species are important cause of diarrheal diseases in both developing and developed countries. This study aimed to compare the perfor-mance of several molecular methods for identification of Cryptosporidium species, and to detect genetic variation among each of these species isolated from Iran, Ma-lawi, Nigeria, Vietnam and the United Kingdom. Methods: The oocysts DNA samples were derived from 106 Cryptosporidium posi-tive feces. Polymerase chain reaction, PCR- restriction fragment length polymor-phism and DNA sequence analysis of the 18S rRNA and the Cryptosporidium oo-cysts wall protein genes; PCR and DNA sequence analysis of a fragment of 70 kDa heat shock protein and 60 kDa glycoprotein genes were carried out. Results: Based on these analysis, three species of Cryptosporidium including C. homi-nis, C. parvum and C. meleagridis, and both C. hominis and C. parvum were found in Iranian and the UK samples, respectively. Also, three C. hominis (Ib, Ib3& Id) and three C. parvum (IIa, IIc & IId) subtypes were identified by sequence analysis of the GP60 gene. Of these, C. hominis Ib was predominant and interestingly, one subgen-otype (C. hominis Ib A10G2) accounted for the majority of the samples. Conclusion: The current study demonstrates the complex subtypes of Cryptosporid-ium isolates in both developing and developed countries. This is the first report of C. parvum IId subgenotype and three new subtypes of C. parvum IIa in the UK, a new subtype of C. hominis Id from Malawi; and the first multi-locus study of three species of Cryptosporidium in human from Iran.