Infectious Diseases
Mahsa Abdorahimi; Alireza Abdollahi; Sadegh Khodavaisy; Haleh Sarrafnia
Abstract
Background & Objective: Fungal co-infections increase the incidence and mortality of viral respiratory tract infections. This study systematically reviews and conducts a meta-analysis to evaluate the prevalence of COVID-19 patients with fungal coinfections. The aim is to provide a concise overview ...
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Background & Objective: Fungal co-infections increase the incidence and mortality of viral respiratory tract infections. This study systematically reviews and conducts a meta-analysis to evaluate the prevalence of COVID-19 patients with fungal coinfections. The aim is to provide a concise overview of the impact of these infections on patient outcomes especially association with risk of mortality, informing future research and optimizing patient management strategies.Methods: To identify relevant studies on COVID-19 patients, we conducted a systematic search of databases from the beginning of the year until July 2023, including fungal co-infections, mortality, and sequelae. Eligibility criteria were developed using the PICO framework, and data extraction was carried out separately by two authors using standard techniques. Statistical analysis was performed using the correlation model and differences between studies were evaluated using the I2 test. R and RStudio were used for statistical analysis and visualization.Results: We initially identified 6,764 studies, and after checking for equivalence and consistency, 41 studies were included in the final analysis. The overall COVID-19 odds ratio for people who died from fungal infections was 2.65, indicating that patients infected with both COVID-19 and fungal infections had a higher risk of death compared to patients with COVID-19 alone. Specifically, COVID-19-associated pulmonary aspergillosis (CAPA) has a higher odds ratio of 3.36, while COVID-19-associated candidiasis (CAC) has an odds ratio of 1.84, and both are much more associated with death. However, coinfection of the fungus with other fungal species did not show a significant difference in the risk of mortality.Conclusion: This study identified CAPA and CAC as the most common infections acquired in healthcare settings. Fungal coinfections may be associated with an increased risk of death in COVID-19 patients.
Microbiology
Arezoo Salami; Mahsa Falahatinejad; Mahsa Abdorahimi; Mohammadreza Salehi; Farzad Aala; Alireza Abdollahi; Hana Saffar; Sadegh Khodavaisy
Abstract
There has been a rise in COVID-19-associated mucormycosis (CAM) cases, particularly in low-income countries. We describe a case of primary cutaneous mucormycosis after recovering from COVID-19 in a kidney transplant recipient who had a known case of diabetes mellitus. The patient developed cutaneous ...
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There has been a rise in COVID-19-associated mucormycosis (CAM) cases, particularly in low-income countries. We describe a case of primary cutaneous mucormycosis after recovering from COVID-19 in a kidney transplant recipient who had a known case of diabetes mellitus. The patient developed cutaneous ulcers due to Rhizopus oryzae in the right hand. She did not recall any trauma or injury at the affected site. Based on the appearance of the wound we suspected that healthcare-associated mucormycosis could be the causative agent. Due to the initial misdiagnosis as a bacterial infection, the appropriate treatment was delayed, and the lesions progressed rapidly to necrotic ulcers with jagged margins that deteriorated during hospitalization. She underwent consecutive surgical interventions and received broad-spectrum antifungal therapy. Finally, the patient deceased after 32 days of hospital stay. We reviewed the previous case reports of cutaneous mucormycosis occurring in COVID-19 patients and described patient characteristics, predisposing factors, location of ulcers, clinical presentation, management, and outcome. This report and existing published literature indicate a poor outcome for cutaneous mucormycosis in COVID-19 patients and the importance of early diagnosis, aggressive multidisciplinary management, and regular follow-up as a life-saving measure, especially in immunocompromised patients.
Endocrine Pathology
Shiva Didehban; Alireza Abdollahi; Alipasha Meysamie
Abstract
Background & Objective: The most frequent type of cancer found in the endocrine system is thyroid carcinoma. Among well-differentiated thyroid malignancies, the most commonly occurring type is identified as papillary thyroid carcinoma (PTC), which makes up 70-90% of the cases. A subtype of PTC is ...
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Background & Objective: The most frequent type of cancer found in the endocrine system is thyroid carcinoma. Among well-differentiated thyroid malignancies, the most commonly occurring type is identified as papillary thyroid carcinoma (PTC), which makes up 70-90% of the cases. A subtype of PTC is papillary thyroid microcarcinoma (PTMC), which includes tumors smaller than 10 mm in diameter. Due to the advancements in diagnostic techniques, the incidence of this type of cancer is on the rise. In this study, we aimed to analyze the factors worsening the PTMC prognosis.Methods: In the first step, we searched various databases for the factors affecting this tumor. The relevant articles were collected and different outcomes of this tumor and its associated factors which were studied in more than one article, were classified. Finally, we conducted a meta-analysis of these outcomes and their related factors.Results: In the meta-analysis, a significantly association was found between the following factors: recurrence with gender (P<0.001) lymph node metastasis (LNM) (P= 0.003), and extrathyroidal invasion (P<0.001); lymph node metastasis with extrathyroidal invasion (P<0.001), and multifocality (P<0.001); central lymph node metastasis (CLNM) with gender (P=0.001), tumor size (P<0.001), extracapsular invasion (P<0.001), lateral cervical lymph node metastasis (P<0.001), and extrathyroidal invasion (P<0.001); lymph node metastasis resulted in poor outcomes (P<0.001); and finally tumor size with BRAFV600E mutation (P<0.001).Conclusion: In conclusion, it is essential to note that greater awareness and understanding of this tumor characteristics and special and separate attention to PTMC can significantly improve the society overall health.
Microbiology
Mohammadreza Salehi; Shahram Mahmoudi; Omid Rezahosseini; Sayed Jamal Hashemi; Kazem Ahmadikia; Farzad Aala; Nasim Khajavirad; Neda Alijani; Alireza Izadi; Muhammad Ibrahim Getso; Alireza Abdollahi; Arezoo Salami; Seyedeh Rana Khatami; Alireza Adibimehr; Mojtaba Hedayat Yaghoobi; Mohammadmahdi Sabahi; Behshad Pazooki; Farhad Yazdi; Jayran Zebardast; Arash Seifi; Malihe Hasan Nezhad; Masoud Mardani; Sadegh Khodavaisy
Abstract
Cerebral mucormycosis (CM) is a life-threatening manifestation of mucormycosis, an angioinvasive fungal infection caused by Mucorales. We sought to systematically review all available case reports to describe epidemiologic features, clinical manifestations, predisposing factors, and diagnostic and treatment ...
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Cerebral mucormycosis (CM) is a life-threatening manifestation of mucormycosis, an angioinvasive fungal infection caused by Mucorales. We sought to systematically review all available case reports to describe epidemiologic features, clinical manifestations, predisposing factors, and diagnostic and treatment strategies of CM. A systematic search was conducted using a combination of the following keywords: "Mucor", "Zygomycetes", "mucormycosis", "cereb*", "brain", "central nervous system", and "intracranial", separately and in combination until December 31st 2018. Data sources included PubMed, Scopus, EMBASE, Web of Science, Science Direct, and Proquest without limiting the time of publication. We included 287 articles corresponding to 345 cases of CM. Out of the 345 cases, 206 (60%) were male with a median age of 44 years; 130 (38%) were reported from North America; 87 (25%) from Asia; and 84 (24%) from Europe. The median time from onset of symptoms to presentation was 3-7 days (65/345, 65%). The highest mortality was observed among patients with diabetes mellitus (P=0.003). Debridement of infected brain tissue was associated with improved survival in CM cases (OR 1.5; 95% CI 01.3-1.8; P<0.0001). The use of liposomal amphotericin B (L-AMB) was significantly associated with patients' recovery (OR 2.09; 95% CI 1.2-3.4; P=0.003). The combination of L-AMB and posaconazole (12.5%) was more effective than the monotherapy treatment of CM cases (P=0.009). Clinicians should consider DM as an important risk factor for CM. Moreover, surgical debridement and antifungal combination therapy could be an effective approach in the management of CM patients.
Microbiology
Alireza Abdollahi; Samaneh Salarvand; Vahid Mehrtash; Bita Jafarzadeh; Mohammadreza Salehi; Reza Ghalehtaki; Saeed Nateghi
Abstract
Background & Objective: COVID-19 reverse transcription-polymerase chain reaction (RT-PCR) has been a reference test for diagnosing a disease since the very beginning of the pandemic. COVID-19 serology tests have also been developed and used to estimate the prevalence of individuals who have already ...
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Background & Objective: COVID-19 reverse transcription-polymerase chain reaction (RT-PCR) has been a reference test for diagnosing a disease since the very beginning of the pandemic. COVID-19 serology tests have also been developed and used to estimate the prevalence of individuals who have already been infected. We aimed to evaluate the performance of serology tests for the diagnosis of patients who had been referred to medical centers with acute symptoms.Methods: In this cross-sectional study, 80 individuals suspected of COVID-19 who had been referred to Imam Khomeini Hospital Complex, Tehran, Iran, were examined. Upper respiratory tract specimens for RT-PCR and blood samples for COVID-19 IgM and IgG antibody level tests were collected and the results were compared. Results: The overall proportion in agreement, the agreement between positive results, and the agreement between negative results when comparing RT-PCR and IgM serology test were 40% (kappa = -0.006, P = 0.9), 32%, and 66.6%, respectively, and when comparing RT-PCR and IgG serology test were 46% (kappa = -0.006, P = 0.94), 43.5%, and 55.5%, respectively.Conclusion: The absence of a gold standard method for the diagnosis of COVID-19 makes it very challenging to determine the true sensitivity and specificity of different methods. The study results revealed no agreement between the two methods; so the RT-PCR test for upper respiratory tract specimen cannot be replaced with COVID-19 serology test for the diagnosis of patients with acute symptoms.
Microbiology
Alireza Abdollahi; Samaneh Salarvand; Vahid Mehrtash; Bita Jafarzadeh; Reza Ghalehtaki; Saeed Nateghi
Abstract
Background & Objective: The prevalence of COVID-19 and its severity have been observed to be on a lower level in underdeveloped countries with poorer standards of hygiene. This disparity may be attributed to the higher seroprevalence of other viral diseases which can result in the presence of antibodies ...
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Background & Objective: The prevalence of COVID-19 and its severity have been observed to be on a lower level in underdeveloped countries with poorer standards of hygiene. This disparity may be attributed to the higher seroprevalence of other viral diseases which can result in the presence of antibodies protective against COVID-19. Two of the widespread diseases in such countries are infection to hepatitis A and E viruses (HAV and HEV). In the present study, we explored the relationship between the level of antibodies against these viruses and the susceptibility to COVID-19.Methods: Ninety patients were studied in two groups of controls and cases each consisting 45 individuals. The cases were patients with the clinical symptoms of COVID-19 and positive RT-PCR test results. The controls were individuals referred to the respiratory triage of Imam Khomeini Hospital Complex and were not demonstrating relevant clinical symptoms of COVID-19 and their RT-PCR test results were negative. Levels of HAV and HEV antibodies were measured and compared in these two groups.Results: The median of HAV antibody level was 13.6 (IQR=11.5-16.9) and 13.2 (IQR =10.7-14.7) in cases and controls, respectively, showing no statistically significant difference (P = 0.1). Likewise, the median of HEV antibody level was 6.7 (IQR=5.3-7.1) and 7.1 (IQR=6.3-7.5) in cases and controls, respectively, which again showed no statistically significant difference (P=0.41).Conclusion: The present study was carried out in a region with a relatively high prevalence of HAV and HEV infections. Contrary to our expectations, no statistically significant relationship was observed between the levels of antibodies against these viruses and the susceptibility to COVID-19. Further studies with larger sample sizes and in other countries are needed to come to a definite conclusion.
Breast Pathology
Nazanin Mirmohseni Namini; Alireza Abdollahi; Monireh Movahedi; Amirnader Emami Razavi; Reza Saghiri
Abstract
Background & Objective: This study examined the potential of human epididymis protein 4 (HE4) as a marker in early diagnosis or as a prognostic factor for breast cancer (BC) patients.Methods: A total of 31 patients diagnosed with BC were enrolled in the study between 2008 and 2018. The mRNA and protein ...
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Background & Objective: This study examined the potential of human epididymis protein 4 (HE4) as a marker in early diagnosis or as a prognostic factor for breast cancer (BC) patients.Methods: A total of 31 patients diagnosed with BC were enrolled in the study between 2008 and 2018. The mRNA and protein expression levels of HE4 were analyzed by immunohistochemistry (IHC) and real-time polymerase chain reaction (PCR) in the BC tissue and the non-tumoral adjacent tissue. Using ELISA technique, HE4 plasma levels were also measured in 43 BC patients compared to 43 healthy individuals. The correlation between HE4 expression and clinicopathological features was then investigated.Results: An increase in HE4 expression was observed at mRNA and protein levels in the BC group compared to the control group (p <0.01, p <0.0001, respectively). In addition, the relative expression of HE4 mRNA in BC patients showed a significant correlation with the differentiation grade of cancer cells (p <0.001). Plasma levels of HE4 was also associated with grade (p <0.0001), stage, and tumor size in BC patients (for both p <0.01). Patients with metastatic BC (p <0.01), lymphatic invasion, and lymph node involvement (for both p <0.05) showed significantly higher plasma levels of HE4 expression than patients without metastasis.Conclusion: According to our findings, upregulation of HE4 is probably related to invasive BC phenotype, and measuring plasma levels of HE4 could be useful as a screening test in early diagnosis of BC.
Head and Neck Pathology
Mitra Rezaei; Mahboobeh Karimi-Galougahi; Azin Kheradmand; Mihan Pourabdollah Toutkaboni; Hassan Mir Mohammad Sadeghi; Alireza Abdollahi; Amirnader Emami Razavi; Ali Safavi Naini; Farahnaz Bidari- Zerehpoosh
Abstract
Background & Objective: Human papillomavirus (HPV) has been associated with prognosis in patients with head and neck squamous cell carcinoma (HNSCC). Similar to the global studies, different prevalence rates of this viral infection have been reported in Iran. Therefore, we aimed to report the prevalence ...
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Background & Objective: Human papillomavirus (HPV) has been associated with prognosis in patients with head and neck squamous cell carcinoma (HNSCC). Similar to the global studies, different prevalence rates of this viral infection have been reported in Iran. Therefore, we aimed to report the prevalence of this virus and its significance in HNSCC patients.Methods: Patients who were referred to the five hospitals of Tehran city from May 2018 to May 2019 were enrolled in this study. All patients were diagnosed with HNSCC based on pathologic study. The pathologic disease staging was defined, and DNAs were extracted from the fresh tissue samples via kits. After polymerase chain reaction (PCR), HPV positive samples were evaluated for determining genotypes and data analysis.Results: Of the 46 patients, three patients (6.5%) had positive HPV with the following subtypes: 18 (in two patients), 52 (in three patients), 61 (in two patients), 67, and 73.Comparison of variables between the groups with and without HPV showed a significant difference based on the tumor’s lymphatic invasion (p =0.041), peripheral lymph node involvement (p =0.008), and histologic grade (p =0.011), but there was no statistically significant difference in terms of other variables such as age, primary tumor site, size, pathologic stage, vascular or perineural invasion, metastasis, smoking, and alcohol consumption.Conclusion: HPV positivity is an important factor in the lymphatic invasion, peripheral lymph node involvement, and histologic grade of cases with HNSCC and should be further investigated for its effect on prognosis.
Breast Pathology
Armin Borhan; Zohreh Nozarian; Alireza Abdollahi; Reza Shahsiah; Hadiseh Mohammadpour; Arash Borhan
Abstract
Background & Objective: Nowadays, actin-binding proteins such as Villin and Gelsolin have been considered to be associated with aggressive tumors. This study mainly aims to determine the relationship between Gelsolin and Villin genes expression and metastasis of axillary lymph nodes in patients with ...
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Background & Objective: Nowadays, actin-binding proteins such as Villin and Gelsolin have been considered to be associated with aggressive tumors. This study mainly aims to determine the relationship between Gelsolin and Villin genes expression and metastasis of axillary lymph nodes in patients with breast cancer.Methods: The included population consisted of 40 confirmed cases of female breast cancer (including 20 patients with breast cancer along with axillary lymph node metastasis and 20 patients without axillary lymph node metastasis). Expression of Villin and Gelsolin genes was evaluated using Real-time PCR and pre-designed primers.Results: The mean expression level of Villin in groups with and without axillary lymph node metastasis was 3.33±1.35 and 0.87±0.88, respectively (p <0.001). The mean Gelsolin expression levels in both groups (with and without axillary lymph node metastasis) were 4.13±2.40 and 1.00±0.35, respectively (p <0.001). The significant relationships were independent of individuals’ age.Conclusion: Patients with axillary lymph node metastasis may express significant higher level of Villin and Gelsolin gens.
Diagnostic Pathology
Alireza Abdollahi; Ali Labbaf; Mahboobeh Mafinejad; Maryam Sotoodeh-Anvari; Farid Azmoodeh-Ardalan
Abstract
Background & Objective: The world is facing COVID-19 pandemic, and medical education system and consequently the evaluation of students at different levels have been overshadowed. Residency students are among those affected. In the present study, we aim to share our experiences regarding holding ...
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Background & Objective: The world is facing COVID-19 pandemic, and medical education system and consequently the evaluation of students at different levels have been overshadowed. Residency students are among those affected. In the present study, we aim to share our experiences regarding holding exams for pathology residents before and during the pandemic.Methods: This cross-sectional study was carried out in Tehran University of Medical Sciences. The online exam, which consisted of 30 multiple-choice questions, was designed and held in April 2020 to evaluate pathology residents. To assess the quality of the exam, indices such as the number of questions, highest and lowest scores, the average score, the standard deviation, the variance, Cronbach’s alpha reliability coefficient, standard error of measurement, discrimination index, difficulty index, number/percentage of questions on three difficulty levels of easy, normal, hard were reviewed and analyzed.Results and Discussion: The average score of the participants in the January exam which was held in the university’s exam center was 16.23 (±5.03), while the average score in the online exam which was held after the onset of the pandemic was 20.86 (±5.18). The average discrimination indices in the first and second exams were 0.36 and 0.38, respectively, and the average difficulty indices in the first and second exams were 0.54 and 0.70, respectively. We found the administration of this online examination would be a positive experience. By sharing it, we hope to pave the way for similar ventures in the other departments.
Molecular Pathology
Alireza Abdollahi; Abbas Shakoori; Hoda Khoshnevis; Mohammad Arabzadeh; Seyed Ali Dehghan Manshadi; Esmaeil Mohammadnejad; Dorsa Ghasemi; Maryam Safari Aboksari; Shaban Alizadeh; Vahid Mehrtash; Arezoo Eftekhar-javadi; Masoomeh Safaei
Abstract
Background & Objective: A simple approach to prevent close contact in healthcare settings during the COVID-19 outbreak is to train patients to collect their own nasopharyngeal and oropharyngeal swabs and deliver them to medical laboratories to have them processed. The aim of our study ...
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Background & Objective: A simple approach to prevent close contact in healthcare settings during the COVID-19 outbreak is to train patients to collect their own nasopharyngeal and oropharyngeal swabs and deliver them to medical laboratories to have them processed. The aim of our study was to compare lab technician- with patient- collected oropharyngeal and nasopharyngeal samples for detection of the coronavirus disease 2019 (COVID 19) using rapid real-time polymerase chain reaction (rRT-PCR). Methods: Fifty adult patients with flu-like symptoms and radiologic findings compatible with atypical pneumonia who were admitted to the infectious diseases ward of Imam Khomeini Hospital Complex, Tehran, Iran, with a clinical diagnosis of COVID-19 from February 28 to April 27 of 2020 were randomly selected and entered in our study. Two sets of naso- and oropharyngeal swabs were collected, one set by a lab technician and the other by the patients, and the COVID-19 rRT-PCR test was performed. Results: Of 50 selected cases, in seven patients all collected naso- and oropharyngeal swabs tested positive, and in 22 patients all samples tested negative for COVID-19 in rRT-PCR. Discrepancies between rRT-PCR results of lab technician- and patient-collected swabs were observed in 12 nasopharyngeal and 13 oropharyngeal specimens. Positive lab technician-collected and negative patient-collected samples were observed in 10 and 5 nasopharyngeal and oropharyngeal specimens, respectively. Negative lab technician-collected and positive patient-collected samples were observed in two and seven nasopharyngeal and oropharyngeal specimens, respectively. The overall percentage of agreement among both nasopharyngeal and oropharyngeal swabs taken by a lab technician and patients was 76% with a kappa value of 0.49 (p =0.001). Conclusion: Based on our findings, lab technician-collected naso- and oropharyngeal swabs cannot be replaced by patient-collected ones with regard to COVID-19 rRT-PCR.
Transfusion Medicine
Alireza Abdollahi; Maedeh Mahmoudi-aliabadi; Vahid Mehrtash; Bita Jafarzadeh; Mohammadreza Salehi
Abstract
Background & Objective: Coronavirus disease 2019 (COVID-19) is the most recent emerging viral disease. Defining the epidemiological aspects and factors influencing the susceptibility of the patients to COVID-19 has been an ongoing struggle. In the present study, we have investigated the connection ...
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Background & Objective: Coronavirus disease 2019 (COVID-19) is the most recent emerging viral disease. Defining the epidemiological aspects and factors influencing the susceptibility of the patients to COVID-19 has been an ongoing struggle. In the present study, we have investigated the connection between ABO histo-blood group phenotypes and the COVID-19. Methods: This study was conducted on 397 patients with confirmed diagnoses of COVID-19 admitted to our center. Also, 500 individuals were selected to form the controls, all of whom had been disclosed to the same medical center in June 2019, before the onset of the outbreak. Results: Our results demonstrated ABO histo-blood phenotypes are correlated with patients’ susceptibility to the infection. A higher rate of infection was observed among patients with the AB histo-blood group, while patients with the O histo-blood group have shown a lower rate of infection. The Rh blood group phenotype was not statistically significant in determining a patient’s vulnerability. Conclusion: Similar to several previous studies about other viral diseases’ association with ABO histo-blood groups, we have concluded that an individual’s ABO histo-blood group phenotype and his/her susceptibility to COVID-19 are indeed connected. So far, only one research has been conducted about this association. Interestingly, while we observed a decreased vulnerability to the disease among patients with an O histo-blood group, we have reached discordant results regarding the increased susceptibility among individuals with an AB histo-blood group, unlike A histo-blood group in the previous study.
Diagnostic Pathology
Hiva Saffar; Alireza Abdollahi; Atefe Sadat Hosseini; Mojgan Torabi Farsani; Ghazal Hajinasrollah; Pegah Mohaghegh
Abstract
Background & Objective: Accurate and timely reporting of critical values is an important issue. There is some doubt whether repeat testing of critical values would offer any advantage over single testing or not. The aim of this study was evaluation of utility of routine repeat testing of critical ...
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Background & Objective: Accurate and timely reporting of critical values is an important issue. There is some doubt whether repeat testing of critical values would offer any advantage over single testing or not. The aim of this study was evaluation of utility of routine repeat testing of critical values in our referral center and to compare probable variations in different working shifts. Methods: Clinical results of serum Potassium, Calcium, Blood Hemoglobin and Prothrombin Time (INR: International Normalized Ratio) were evaluated for three months. Results: Totally, 178, 96, 67 and 107 consecutive critical values for Potassium, Calcium, Hemoglobin and INR were reported, respectively. In potassium and Hemoglobin 5.05% and 1.17% of retest runs exceeded the acceptable tolerance limit. All of the calcium retest results were within the acceptable limit. For INR, 21/107 retest results did not meet the acceptable tolerance limit, nine still were critical. Afternoon working run performance was significantly better than the two others. Conclusion: Our observation suggests that routine repeat of hematology and chemistry critical test result is not necessary and may adversely affect patient safety measure. However, attention should be paid to results greater than analytical measurement range and all such results should be repeated before reporting.
Breast Pathology
Alireza Abdollahi; Sepideh Jahanian; Nima Hemmati; Hadiseh Mohammadpour
Abstract
Background & Objective: Recent studies from gene profiling have revealed some genes that are overexpressed in the epithelial-mesenchymal transition (EMT) process and are responsible for its initiation and activation resulting in tumor progression and metastasis. The present study aimed to assess ...
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Background & Objective: Recent studies from gene profiling have revealed some genes that are overexpressed in the epithelial-mesenchymal transition (EMT) process and are responsible for its initiation and activation resulting in tumor progression and metastasis. The present study aimed to assess the role of genes involved in the EMT process and the association of these genes with axillary lymph node and vascular invasion in breast cancer (BC) patients. Methods: In this case-control study, the tumor samples were initially extracted from 33 BC patients. The samples of 15 BC tissues without vascular and axillary invasion were also prepared from the biobank as a control group. RNAs from both tumor and control samples were extracted and stabilized. For assessing overexpression in tumor tissues of selected 18 genes, the real time technique was employed. Results: There was a significant increase in MMP-2 gene fold expression in tumor cells with vascular invasion regardless of axillary involvement compared to the control group (P=0.0008) and also in the comparison of the control group with those with vascular invasion and not axillary lymph node involvement (P=0.003). In addition, gene fold expression of tissue inhibitors of metalloproteinase-1(TIMP-1) was decreased in axillary involving tumor cells compared to control group (P=0.045), and also in comparison with all samples that did not present any axillary lymph node involvements including the control group and the group with isolated vascular invasion (P=0.012). Conclusion: Overexpression of MMP-2 and under-expression of TIMP-1 were associated with more invasive behavior in breast tumor cells.
Microbiology
Mehdi Yousefipour; Mehrnaz Rasoulinejad; Azar Hadadi; Negin Esmaeilpour; Alireza Abdollahi; Siroos Jafari; Atieh khorsand
Abstract
Background and Objective: There is a growing concern regarding the lack of new antibiotics, especially for multidrug-resistant bacteria that produce Extended Spectrum β-Lactamases (ESBLs). The present study aims to assess the prevalence of bacteria producing ESBLs, their antimicrobial resistance ...
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Background and Objective: There is a growing concern regarding the lack of new antibiotics, especially for multidrug-resistant bacteria that produce Extended Spectrum β-Lactamases (ESBLs). The present study aims to assess the prevalence of bacteria producing ESBLs, their antimicrobial resistance pattern, and its main determinants among hospitalized patients.Methods: The study population included 383 consecutive patients with a definitive diagnosis of urinary tract infection (UTI). All eligible subjects for the study had a positive culture for gram-negative microorganisms in urine specimens. ESBL producing isolates were characterized phenotypically for ESBL production using the double disc synergy test.Results: In total, 383 specimens were assessed, among which 212 (55.4%) were related to bacteria producing ESBLs (ESBL+). Of those with ESBL + infections, 65.5% were sourced from catheters (as hospital-associated UTIs), and 35.5% were categorized as community-associated UTIs. In the group consisting of bacteria producing ESBLs, the highest sensitivity was observed with Imipenem (72.2%), while the highest resistance was revealed with ceftriaxone (100%). Conclusion: We have shown that our community faces a high prevalence of bacteria producing ESBLs, mostly sourced from the catheterization of hospitalized patients. The highest bacterial sensitivity was observed with Imipenem, nitrofurantoin, and amikacin, while the highest resistance was found with ceftriaxone and cotrimoxazole, suggesting the ineffectiveness of using the two latter antibiotics for eradicating these bacterial infections. On the other hand, a history of urinary catheterization and previous hospitalization were two main determinants of their presence, a finding which emphasizes the importance of avoiding catheterization and hospitalization of patients with UTIs without proper indications.
Alireza Abdollahi; Samaneh Salarvand; Hiva Saffar
Abstract
Electronic learning introduces a teaching device for deeper and more efficient learning. A study was conducted by the Pathology Department of Tehran University of Medical Sciences, Tehran, Iran. The topic of practical pathology was selected earlier based on the curriculum. High-quality digital images ...
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Electronic learning introduces a teaching device for deeper and more efficient learning. A study was conducted by the Pathology Department of Tehran University of Medical Sciences, Tehran, Iran. The topic of practical pathology was selected earlier based on the curriculum. High-quality digital images of the slides were presented in the form of an e-file. The medical students were asked to register for participation in conventional or virtual groups. The first group underwent traditional education and members of the virtual group were given the website address to click into the website where the materials were uploaded. At the end of the semester, both groups were scientifically evaluated. The mean final pathology exam grade in the virtual group was higher than that of the control group; however, the difference between groups was not statistically significant (P=0.658). In conclusion, it was observed that in teaching practical pathology, virtual education may be as effective as conventional method.
Gynecologic Pathology
Fatemeh Nili; Niusha Noubari; Alireza Abdollahi
Abstract
ysgerminoma is one of the two most common types of ovarian germ cell tumors. Providing accurate pathologic diagnosis and treatment planning, the prognosis is good even in advanced stages. Pathologic diagnosis is generally straightforward. In microscopic examination, the usual known growth patterns in ...
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ysgerminoma is one of the two most common types of ovarian germ cell tumors. Providing accurate pathologic diagnosis and treatment planning, the prognosis is good even in advanced stages. Pathologic diagnosis is generally straightforward. In microscopic examination, the usual known growth patterns in tumor cells are solid, trabecular, insular and rarely pseudoglandular. In this paper, we reported an advanced ovarian dysgerminoma with different microscopic patterns of growth, including pseudopapillary and macrofollicular structures, in an 18-year-old woman. The patient underwent staging laparotomy and is currently receiving chemotherapy.
Biochemistry
Zohreh Nozarian; Alireza Abdollahi; Vahid Mehrtash; Hirbod Nasiri Bonaki
Abstract
Background:The current study aimed at evaluating the association between thyroid-stimulating hormone (TSH) level in upper normal limits with metabolic syndrome, modifiable risk factor for cardiovascular disease, and its components according to Adult Treatment Panel III of National Cholesterol Education ...
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Background:The current study aimed at evaluating the association between thyroid-stimulating hormone (TSH) level in upper normal limits with metabolic syndrome, modifiable risk factor for cardiovascular disease, and its components according to Adult Treatment Panel III of National Cholesterol Education Program. Methods: The current cross sectional study recruited 82 patients with euthyroid overweight or obesity. They all had body mass index (BMI) higher than 25 kg/m2. The patients were categorized in 2 groups: Group 1 (patients with metabolic syndrome) and Group 2 (patients with non-metabolic syndrome). Demographic features and anthropometric indices were all appraised by a trained examiner. Metabolic syndrome components, BMI, age, gender, C-reactive protein (CRP), and thyroid function test (TFT) were assessed and compared. Results: Age, triglyceride level, waist circumference, hypertension frequency, BMI and CRP were significantly higher in group 1. The most prevalent metabolic syndrome criterion was low level of serum high density lipoprotein (HDL). Patients with metabolic syndrome had greater TSH level, but it was not statistically significant (P-value=0.636). Euthyroid patients with TSH levels in the range of 3.88-5 mIU/L had 5.89 (95% confidence interval (CI) = 1.02 to 17.64) times higher risk of developing metabolic syndrome than other TSH values. After age adjustment, the relationship between the upper quartile of TSH level and the metabolic syndrome became insignificant (OR=2.97, 95% CI=0.51 to 17.2). Conclusion: TSH in upper normal limits was statistically correlated with metabolic syndrome. However, after adjustment for age, it became insignificant. Relationship between thyroid hormones and metabolic syndrome may be confounded by other important cardiovascular risk factors in euthyroid patients.
Uropathology
Alireza Abdollahi; Masoud Etemadian; Saeed Shoar; Zohreh Nozarian
Volume 11, Issue 4 , October 2016, , Pages 323-327
Abstract
Background: The optimal treatment is not possible yet for chronic prostatitis due to the unknown etiology of the diseases. We aimed to investigate the association of Helicobacter pylori infection with chronic prostatitis.
Methods: In this prospective case-control study that conducted in Imam Hospital ...
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Background: The optimal treatment is not possible yet for chronic prostatitis due to the unknown etiology of the diseases. We aimed to investigate the association of Helicobacter pylori infection with chronic prostatitis.
Methods: In this prospective case-control study that conducted in Imam Hospital Complex affiliated to Tehran University of Medical Sciences in Tehran, Iran from 2014 to 2015, patients with diagnosis of chronic prostatitis according to the criteria of National Institute of Health (NIH) were enrolled. Control group constituted of consecutive healthy patients.Blood samples were obtained for each patient and control and evaluated for serum levels of anti H. pylori IgG, A. Data analysis was carried out using SPSS, version 18. Values of P<0.05 were considered statistically significant.
Results: Mean ± SD age of patients was 59.5 ± 3.08 yr in the case group and 56.88 ± 3.20 yr in the control group with no significant difference (P>0.05). Mean ± SD levels of anti H. pylori IgG and IgA in the control group were 9.36 ± 7.45 U/ml and 6.25 ± 7.29 U/ml, respectively compared with 20.94 ± 16.98 U/ml and 18.63 ± 15.65 U/ml in the case group, respectively both of which revealed statistically significant (P<0.05).
Conclusion: Chronic prostatitis is associated with H. pylori infection. Both anti H. pylori IgG and IgA are increased in patients with chronic prostatitis. Therefore, treatment of HP infection could be effective in the prostatitis cure.
Biochemistry
Alireza Abdollahi; Zoreh Nozarian
Volume 11, Issue 4 , October 2016, , Pages 363-369
Abstract
Background: Accumulation of pleural and peritoneal fluid is seen in some diseases. In order to diagnose the disease and start the treatment, one of the most important actions will be to differentiate between exudates and transudates. The objective of this study was to determine the diagnostic value of ...
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Background: Accumulation of pleural and peritoneal fluid is seen in some diseases. In order to diagnose the disease and start the treatment, one of the most important actions will be to differentiate between exudates and transudates. The objective of this study was to determine the diagnostic value of measuring the specific gravity of the fluid through refractometer and strip in differentiation of exudates from transudates. Methods: The serum of patients was evaluated for protein, LDH, cholesterol, bilirubin and albumin. The fluid was evaluated for the number of white blood cells, protein, LDH, cholesterol, bilirubin and albumin. Then the fluids were divided into exduate and transudate categories based on Light and Gradient criteria. Finally, the specific gravity of the fluids was measured by refractometer, Erma, Japan and Medi-Test Combi II. The categorized fluids were compared with Gold Standards (final diagnosis) so that the sensitivity and specificity of Light and Gradient criteria in the transudate-exudate differentiation were specified. Results: In comparison with Light criteria, the cut off level of 1022 specific gravity measured by refractometer for pleural effusion has sensitivity, specificity of 92.1%, 68.1%respectively. In evaluation of peritoneal fluid considering cut off point 1023, measured by refractometer has reliable sensitivity 92.4%, specificity 70.4 compared with standard gradient method. Conclusion: Differentiating transudate from exudates by measuring its special gravity by refractometer will have acceptable sensitivity and specificity, and when rapidity is necessary or access to lab equipment is limited, this method could be used.
Uropathology
Mojtaba Mojtahedzadeh; Farhad Etezadi; Javad Motaharinia; Alireza Abdollahi; Abdorasul Mehrsai; Shadi Ziaie; Soheil Saadat
Volume 11, Issue 4 , October 2016, , Pages 391-398
Abstract
Background: Delayed graft function is a main complication after deceased donor kidney transplantation that adversely affects graft outcome. Difficulties in prediction and early detection of delayed graft function have hindered the ability to perform proper therapeutic interventions. We investigated whether ...
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Background: Delayed graft function is a main complication after deceased donor kidney transplantation that adversely affects graft outcome. Difficulties in prediction and early detection of delayed graft function have hindered the ability to perform proper therapeutic interventions. We investigated whether measuring urinary interleukin 18 and neutrophil gelatinase-associated lipocalin as markers of ischemia reperfusion injury could predict delayed graft function in deceased donor kidney transplant patients. Methods: We studied 69 patients undergoing kidney transplantation from deceased donor during early October 2013 to December 2014 at the Urology Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Serial urine samples at 2, 24, and 48 h after transplantation were analyzed for interleukin 18 and neutrophil gelatinase-associated lipocalin levels. Results: Thirteen patients (18.9%) developed delayed graft function. Urine interleukin 18 to urine creatinine ratio was significantly higher in patients with delayed graft function compared to those with non-delayed graft function, at 2 (P=0.003), 24 (P<0.001) and 48 h (P=0.018) points. The levels of neutrophil gelatinase-associated lipocalin to urine creatinine ratio were significantly higher in the group with delayed graft function at the 24 (P=0.004) and 48 h (P=0.015) points. The receiver–operating characteristic curve analysis suggested that both urinary biomarkers at 24 h after transplantation had better accuracies for prediction of delayed graft function. In multivariate analysis, only urinary interleukin 18 to urine creatinine ratio improved the ability of clinical model for predicting delayed graft function. Conclusion: Urinary interleukin 18 to urine creatinine ratio at 24 h post-transplantation, along with traditional markers such as relative fall in serum creatinine, urine output and other risk factors for delayed graft function, increased the ability to predict delayed graft function.
Gholamreza Toogeh; Hassan Abolghasemi; Peyman Eshghi; Mohammadreza Managhchi; Mohammadreza Shaverdi-niasari; Katayoon Karimi; Samin Roostaei; Neda Emran; Alireza Abdollahi
Volume 11, Issue 3 , July 2016, , Pages 204-209
Abstract
Background: Recombinant activated factor VII induces hemostasis in patients with coagulopathy disorders. AryoSeven™ as a safe Iranian Recombinant activated factor VII has been available on our market. This study was performed to establish the safety of AryoSeven on patients with coagulopathy disorder. ...
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Background: Recombinant activated factor VII induces hemostasis in patients with coagulopathy disorders. AryoSeven™ as a safe Iranian Recombinant activated factor VII has been available on our market. This study was performed to establish the safety of AryoSeven on patients with coagulopathy disorder. Methods: This single-center, descriptive, cross sectional study was carried out in Thrombus and Homeostasis Research Center ValiAsr Hospital during 2013-2014. Fifty one patients with bleeding disorders who received at least one dose of Aryoseven were enrolled. Patients’ demographic data and adverse effect of drug and reaction related to Aryoseven or previous usage of Recombinant activated FVII were recorded in questionnaires. Finally data were analyzed to compare side effects of Aryoseven and other Recombinant activated FVII brands. Results: Aryoseven was prescribed for 51 Patients. Of all participants with mean age 57.18+21.38 yr, 31 cases were male and 26 subjects had past history of recombinant activated FVII usage. Glanzman was the most frequent disorder followed by congenital FVII deficiency, hemophilia with inhibitors, factor 5 deficiency, acquired hemophilia, hemophilia A with inhibitor, and hemophilia A or B with inhibitor. The majority of bleeding episodes had occurred in joints. Three patients (5.9%) complained about adverse effects of Aryoseven vs. 11.5 % about adverse effects of other brands. However this difference was not significant, statistically. Conclusion: Based on monitor patients closely for any adverse events, we concluded that Aryoseven administration under careful weighing of benefit versus potential harm may comparable with other counterpart drugs. How to cite this article: Toogeh G, Abolghasemi H, Eshghi P, Managhchi M, Shaverdi-niasari M, Karimi K, et al. Evaluation of Aryoseven Safety (recombinant activated factor VII) in patients with bleeding disorders (An observational post-marketing surveillance, study). Iran J Pathol. 2016; 11(3):204-9.
Alireza Abdollahi; Reyhaneh Abdollahpouri; Seyed-Mohammad Tavangar
Volume 11, Issue 3 , July 2016, , Pages 281-285
Abstract
Intracranial hemangiopericytomas (HPC) are rare vascular tumors. They account for 0.4% of primary central nervous system tumors. HPC is more commonly located supratentorially and tends to occur in a younger age group, with average age at presentation of 38–42 years. The tumor was found throughout ...
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Intracranial hemangiopericytomas (HPC) are rare vascular tumors. They account for 0.4% of primary central nervous system tumors. HPC is more commonly located supratentorially and tends to occur in a younger age group, with average age at presentation of 38–42 years. The tumor was found throughout the entire CNS, usually superficially and closely related to the meninges. Moreover, they have a strong tendency for local recurrence and extracranial metastasis. Given the clinical, pathological and imaging similarities between Hemangiopericytoma and angioblastic/anaplastic meningioma and the necessity of differentiating these two (choosing the proper treatment and prognosis), we present a report of meningeal Hemangiopericytoma tumor in a 33-year-old female. Our study suggests that in addition to routine histopathological examination, immunohistochemical study is essential to differentiate it from other differential diagnosis. How to cite this article: Abdollahi A, Abdollahpouri R,Tavangar SM. Meningeal Hemangiopericytoma in a 33-yr-Old Female; a Case Report. Iran J Pathol. 2016; 11(3):281-5.
Biology & Genetic
Alireza Abdollahi; Hana Saffar
Volume 11, Issue 2 , April 2016, , Pages 89-96
Abstract
It is estimated that the number of HIV infected children globally has increased from 1.6 million in 2001 to 3.3 million in 2012. The number of children below 15 years of age living with HIV has increased worldwide. Published data from recent studies confirmed dramatic survival benefit for infants started ...
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It is estimated that the number of HIV infected children globally has increased from 1.6 million in 2001 to 3.3 million in 2012. The number of children below 15 years of age living with HIV has increased worldwide. Published data from recent studies confirmed dramatic survival benefit for infants started anti-retroviral therapy (ART) as early as possible after diagnosis of HI. Early confirmation of HIV diagnosis is required in order to identify infants who need immediate ART. WHO has designed recommendations to improve programs for both early diagnoses of HIV infection and considering ART whenever indicated? It is strongly recommended that HIV virologocal assays for diagnosis of HIV have sensitivity of at least 95% and ideally greater than 98% and specificity of 98% or more under standardized and validated conditions. Timing of virological testing is also important. Infants infected at or around delivery may take short time to have detectable virus. Therefore, sensitivity of virological tests is lower at birth. In utero HIV infection, HIV DNA or RNA can be detected within 48 h of birth and in infants with peripartum acquisition it needs one to two weeks. Finally it is emphasized that all laboratories performing HIV tests should follow available services provided by WHO or CDC for quality assurance programs. Both clinicians and staffs providing laboratory services need regular communications, well-defined SOPs and nationally validated algorithms for optimal use of laboratory tests. Every country should use assays that have been validated by national reference laboratory.
Parya Bameni Moghaddam; Fatemeh Mahjoub; Amirhossein Emami; Alireza Abdollahi
Volume 11, Issue 2 , April 2016, , Pages 97-103
Abstract
Background: Automatic Cell Counter devises make the CBC differential very easy and delivering the results in few second. However, the problem with this device is facing a flag requires a time-consuming microscopic review of the specimen which causes unacceptable wait times for patient as well as costs ...
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Background: Automatic Cell Counter devises make the CBC differential very easy and delivering the results in few second. However, the problem with this device is facing a flag requires a time-consuming microscopic review of the specimen which causes unacceptable wait times for patient as well as costs for laboratories. In this study, we calculated the validity of WBC diff flags in Sysmex XT-1800i. In addition, we verified the correlation between manual and automated samples. Methods: Overall, 1095 flagged samples were selected in the period of 6 weeks (Imam Hospital complex, Tehran Iran, 2014). The results of both automated and manual counting of the samples were carefully studied and compared. Totally, 624 NRBC flags, 450 Blast flags, 155 abnormal WBC Scatter gram flags, 140 Eosinophilia flags and 468 Monocytosis flags were identified. Results: Considering NRBC and blast flags there was a significant difference between our manual counted and automated counted NRBCs and blasts (P<0.05). There was no significant difference between automated and manual counting of flags for WBC Scatter gram. A significant difference between automated and manual counting data in flags, eosinophilia and monocytosis was foun (P<0.05). Conclusion: We propose the NRBC flags to be ignored and report negative except for the neonatal ward, and the Blasts flags to be ignored and report negative in all the cases. The WBC Scatter gram should be report positive. For eosinophilia and monocytosis flags, we propose, the Sysmex results should be considered correct and the manual checking would not be necessary.