Tehrān, Iran
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Tajbakhsh M.,Shahid Beheshti University of Medical Sciences | Garcia Migura L.,IRTA - Institute of Agricultural-Alimentary Research and Technology | Rahbar M.,Iranian Reference Health Laboratory | Svendsen C.A.,Technical University of Denmark | And 4 more authors.
Journal of Antimicrobial Chemotherapy | Year: 2012

Objectives: In this study, we wanted to assess the level of antimicrobial resistance, the presence of genes encoding resistance to cephalosporins and plasmid-mediated quinolone resistance (PMQR), and genetic relatedness among Shigella isolates obtained from Iranian patients. Methods: A total of 44 Shigella isolates were collected from Iranian patients admitted to Milad Hospital, Tehran, Iran, during 2008-10. Of these, 37 were serotyped and characterized by MIC determination. A subset of eight suspected extended-spectrum β-lactamase (ESBL) producers (six Shigella sonnei phase II and two Shigella flexneri type 1b) were examined for the presence of genes encoding cephalosporin resistance. The presence of PMQR was assessed in one S. flexneri isolate exhibiting low-level resistance to ciprofloxacin and susceptibility to nalidixic acid. PFGE was performed on 25 S. sonnei phase II isolates. Results: Of the isolates, 25 (68%) were S. sonnei phase II, with 5 (14%) S. flexneri, 5 (14%) Shigella dysenteriae type 2, and 2 (5%) Shigella boydii type 2. Resistance to at least threeclasses of antimicrobials was detected in all species. The presence of bla CTX-M-15 and the AmpC β-lactamase producer bla CMY-2 was confirmed in five and one S. sonnei phase II isolates, respectively. One of the two S. flexneri type 1b that contained bla CTX-M-15 also harboured a qnrS1 gene. PFGE identified sevenPFGE profiles; the main cluster included 15 of the strains, suggesting low genetic diversity between isolates or the presence of an endemic clone in Iran. Conclusions: This is the first known description of ESBL-producing and AmpC β-lactamase-producing Shigella and of PMQR Shigella in Iran. The emergence of CTX-15, CMY-2 and qnrS1 genes may compromise the treatment of shigellosis. Strategies to minimize the spread of ESBL-producing and AmpC-β-lactamase-producing Shigella should be implemented. © The Author 2012. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.


Fazel Zarandi M.H.,Amirkabir University of Technology | Zarinbal M.,Amirkabir University of Technology | Izadi M.,Milad Hospital
Applied Soft Computing Journal | Year: 2011

This paper presents a systematic Type-II fuzzy expert system for diagnosing the human brain tumors (Astrocytoma tumors) using T1-weighted Magnetic Resonance Images with contrast. The proposed Type-II fuzzy image processing method has four distinct modules: Pre-processing, Segmentation, Feature Extraction, and Approximate Reasoning. We develop a fuzzy rule base by aggregating the existing filtering methods for Pre-processing step. For Segmentation step, we extend the Possibilistic C-Mean (PCM) method by using the Type-II fuzzy concepts, Mahalanobis distance, and Kwon validity index. Feature Extraction is done by Thresholding method. Finally, we develop a Type-II Approximate Reasoning method to recognize the tumor grade in brain MRI. The proposed Type-II expert system has been tested and validated to show its accuracy in the real world. The results show that the proposed system is superior in recognizing the brain tumor and its grade than Type-I fuzzy expert systems. © 2010 Elsevier B.V. All rights reserved.


Aeenparast A.,Institute of Management Sciences | Aeenparast A.,Milad Hospital | Tabibi S.J.,Tehran University of Medical Sciences | Shahanaghi K.,Iran University of Science and Technology | Aryanejhad M.B.,Iran University of Science and Technology
Iranian Red Crescent Medical Journal | Year: 2013

Objectives: The objective of this study was to provide a model for reducing outpatient waiting time by using simulation. Materials and Methods: A simulation model was constructed by using the data of arrival time, service time and flow of 357 patients referred to orthopedic clinic of a general teaching hospital in Tehran. The simulation model was validated before constructing different scenarios. Results: In this study 10 scenarios were presented for reducing outpatient waiting time. Patients waiting time was divided into three levels regarding their physicians. These waiting times for all scenarios were computed by simulation model. According to the final scores the 9th scenario was selected as the best way for reducing outpatient's waiting time. Conclusions: Using the simulation as a decision making tool helps us to decide how we can reduce outpatient's waiting time. Comparison of outputs of this scenario and the based- case scenario in simulation model shows that combining physician's work time changing with patient's admission time changing (scenario 9) would reduce patient waiting time about 73.09%.Due to dynamic and complex nature of healthcare systems, the application of simulation for the planning, modeling and analysis of these systems has lagged behind traditional manufacturing practices. Rapid growth in health care system expenditures, technology and competition has increased the complexity of health care systems. Simulation is a useful tool for decision making in complex and probable systems. © 2013, Iranian Red Crescent Medical Journal.


Sotoudeh K.,Tehran University of Medical Sciences | Hashemi F.,Tehran University of Medical Sciences | Madjd Z.,Tehran University of Medical Sciences | Sadeghipour A.,Tehran University of Medical Sciences | And 2 more authors.
Diagnostic Pathology | Year: 2012

Background: c-MET is an oncogene protein that plays important role in gastric carcinogenesis and has been introduced as a prognostic marker and potential therapeutic target. The aim of this study was to evaluate the frequency of c-MET overexpression and its relationship with clinicopathological variables in gastric cancer of Iranian population using tissue microarray.Methods: In a cross sectional study, representative paraffin blocks of 130 patients with gastric carcinoma treated by curative gastrectomy during a 2 years period of 2008-2009 in two university hospitals in Tehran-Iran were collected in tissue microarray and c-MET expression was studied by immunohistochemical staining.Results: Finally 124 cases were evaluated, constituted of 99 male and 25 female with the average age of 61.5 years. In 71% (88/124) of tumors, c-MET high expression was found. c-MET high expression was more associated with intestinal than diffuse tumor type (P = 0.04), deeper tumor invasion, pT3 and pT4 versus pT1 and pT2 (P = 0.014), neural invasion (P = 0.002) and advanced TNM staging, stage 3 and 4 versus stage 1 and2 (P = 0.044). The c-MET high expression was not associated with age, sex, tumor location, differentiation grade and distant metastasis, but relative associations with lymph node metastasis (P = 0.065) and vascular invasion (P = 0.078) were observed.Conclusions: c-MET oncogene protein was frequently overexpressed in Iranian gastric carcinomas and it was related to clinicopathological characteristics such as tumor type, depth of invasion, neural invasion and TNM staging. It can also support the idea that c-MET is a potential marker for target therapy in Iranian gastric cancer.Virtual slides: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/9744598757151429. © 2012 Sotoudeh et al.; licensee BioMed Central Ltd.


Roudi R.,Tehran University of Medical Sciences | Madjd Z.,Tehran University of Medical Sciences | Korourian A.,Tehran University of Medical Sciences | Mehrazma M.,Tehran University of Medical Sciences | And 3 more authors.
Cancer Biomarkers | Year: 2014

BACKGROUND: According to the cancer stem cell theory, tumors originate from a subset of cells known as cancer stem cells (CSCs) that are responsible for tumor initiation, resistance and relapse. CD44 is a cell adhesion molecule that can aid in the identification of CSCs in various malignancies. OBJECTIVE: The purpose of the current study is to evaluate the expression level and clinical significance of CD44 in lung cancer samples. METHODS: One hundred and ninety-five lung tumor samples including 74 (38%) squamous cell carcinomas (SCC), 61 (31%) adenocarcinomas (ADC), 23 (12%) large cell carcinoma (LCC) in non-small cell lung cancer (NSCLC) group and 37 (19%) small cell lung cancer (SCLC) samples were examined for the expression of CD44 using immunohistochemistry method. The correlation of CD44 expression with clinicopathological parameters as well as Ki-67 status was also assessed. RESULTS: Univariate analysis demonstrated that CD44 expression was significantly higher in NSCLC compared to SCLC (P < 0.001). Among NSCLC, higher level of CD44 expression was found in SCC compared to ADC (P < 0.001) and LCC (P = 0.046). Increased expression of CD44 was significantly correlated with higher grade tumors which correspond to poor prognosis in SCC (P = 0.012) and the lower level of CD44 expression was more often found in well differentiated ADC tumors (P = 0.03). In addition, high expression of CD44 was significantly associated with decreased level of proliferative marker Ki-67 (P = 0.04). CONCLUSIONS: CD44 could be a valuable tool for the study of lung CSCs and provide a novel therapeutic target for treatment of the patients with lung cancer in combination with conventional therapy. © 2014 - IOS Press and the authors. All rights reserved.


Madjd Z.,Milad Hospital | Madjd Z.,Tehran University of Medical Sciences | Ramezani B.,Milad Hospital | Molanae S.,Milad Hospital | Asadi-Lari M.,Tehran University of Medical Sciences
Asian Pacific Journal of Cancer Prevention | Year: 2012

Background: Cancer stem cells (CSC) have been described in a variety of malignancies, including breast carcinomas. Among several markers, aldehyde dehydrogenase 1 (ALDH1) has been identified as reliable for breast cancer stem cells. Knockdown of BRCA1 in primary breast epithelial cells leads to an increase in cells expressing ALDH1. Methods: We examined 127 breast carcinomas for expression of ALDH1, using immunohistochemistry and correlated with clinicopathological parameters as well as the BRAC1 status. Results: Comparing the results for both ALDH1 and BRCA1 expression showed a significant inverse association between the two, indicating that reduced BRCA1 was more often seen in breast cancer cells expressing ALDH1 (p-value = 0.044). A total of 24/110 (22%) of tumours displayed the ALDH1 + / BRCA1 -/low phenotype, which showed a trend for a relation with a high grade (p-value= 0.056). Cytoplasmic expression of ALDH1 was not correlated with tumour characteristics. Conclusion: Taken together, our findings suggest that increased ALDH1 is inversely correlated with decreased BRCA1 in a series of unselected breast carcinomas. Therefore, ALDH1 positive (cancer stem) cells with reduced BRCA1 phenotype may indicate a subset of patients for whom specific targeting of the CSC marker ALDH1 and more aggressive adjuvant treatment is appropriate.


Madjd Z.,Tehran University of Medical Sciences | Karimi A.,Tehran University of Medical Sciences | Molanae S.,Milad Hospital | Asadi-Lari M.,Tehran University of Medical Sciences
Cell Journal | Year: 2011

Objective: CD44 +/CD24 -/low breast cancer cells have tumour-initiating properties with stem cell-like features. Breast cancer gene 1 (BRCA1) is a tumour suppressor gene that plays a crucial role in DNA repair and maintenance of chromosome stability. The clinicopathological features of breast cancer in BRCA1 mutation carriers suggest that BRCA1 may function as a stem-cell regulator. Materials and Methods: In the present experimental study we examined the expression and localization of the BRCA1 protein and investigated the prognostic value as well as its relationship with the putative cancer stem cell (CSC) marker (CD44) in 156 tumour samples from a well-characterized series of unselected breast carcinomas using immunohistochemistry. Statistical analysis of the data was performed using SPSS software version 16 (Chicago, IL, USA). Results: In breast tumours, the loss of nuclear expression was detected in 23 cases (15%), whereas cytoplasmic expression of BRCA1 was observed in 133 breast carcinomas (85%). Altered BRCA1 expression was significantly associated with high grade and poor prognosis breast tumours (p=0.006). We further established an inverse significant correlation between BRCA1 expression levels and CD44 + cancer cell phenotype (p=0.02) Conclusion: Loss of BRCA1 expression is a marker of tumour aggressiveness and correlates with CD44 + tumour cell phenotype. Taken together, the present study supports the idea that the loss of BRCA1 results in persistent errors in DNA replication in breast stem cells and provides targets for additional carcinogenic events.


Movahedi Yeganeh M.,Milad Hospital
Foot and Ankle International | Year: 2016

Background: Anterior transfer of posterior tibial tendon (PTT) is the most common technique to correct foot drop in patients with common peroneal nerve palsy. It does not address the loss of toe extension or toe drop. This may affect the gait pattern, and patients may not tolerate it. Described here is a technique that addresses toe drop associated with common peroneal nerve palsy. Method: A new technique of tendon transfer using the PTT, flexor hallucis longus (FHL) tendon, and flexor digitorum longus (FDL) tendon was performed on 15 patients (13 males and 2 females) with complete common peroneal nerve palsy from 2009 to 2013. Minimum follow-up was 12 months (range, 12-50 months). The mean age was 37 years (range, 20-52 years). Results: Based on the evaluation criteria of Carayon et al, the postoperative results for foot drop correction were excellent in 9 (60%), good in 5 (33%), and moderate in 1 (7%), and the mean active range of motion of the ankle was 46 degrees. Postoperative extension evaluation of the toes was excellent in 7 (47%), good in 5 (33%), and moderate in 3 (20%). Conclusion: Releasing and transferring of FDL and FHL to the toe extensors along with the anterior transfer of the PTT neutralized the deforming forces and allowed for active toe extension while strengthening ankle dorsiflexion. Movahedi Tendon Transfer was a reliable method to achieve a balanced foot and toe dorsiflexion for complete common peroneal nerve palsy. Level of Evidence: Level IV, retrospective case series. © American Orthopaedic Foot & Ankle Society.


Gharaei H.,Milad Hospital
Anaesthesia, Pain and Intensive Care | Year: 2015

Regional anesthesia, including central neuraxial block, peripheral nerve block and interventional pain injection is traditionally done with the help of the landmarks and clinical judgment. Today, injections are done with the help of ultrasound (USG). In this paper, two methods are compared and the value of both methods is evaluated. The superiority of USG is obvious, but these two techniques are truly along the same way and complement each other.


Kamrani R.S.,Milad Hospital | Farhadi L.,Milad Hospital | Emamzadehfard S.,Milad Hospital
Archives of Bone and Joint Surgery | Year: 2013

Osteoid osteoma is a benign bone tumor that rarely involves joints. Although there are several reports of arthroscopic osteoid osteoma excisions, to our knowledge, there are no reports of this type of treatment for osteoid osteoma in carpal bones. We report two cases of arthroscopic (a person who had a pain in the left wrist and the other one with carpal tunnel syndrome) with excision of osteoid osteoma in the carpal bones. We think arthroscopic excision is the best choice for treatment as long as the tumor is accessible for arthroscopic surgery, when osteoid osteoma has classic clinical and imaging findings and is near an articular surface. However, when the tumor is far from the joint surfaces, when we need pathologic confirmation or when the tumor is easily accessible using a non-articular approach, arthroscopic excision may not be the most appropriate technique. © 2013 BY The Archives of Bone and Joint Surgery.

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