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Background and Objectives: Graft-versus-host disease (GvHD) frequently complicates hematopoietic stem cell transplantation (HSCT). Emerging evidence suggests a correlation between gut microbiota and GvHD risk. This study aims to elucidate the microbiota profiles in HSCT patients before and after transplantation and their association with GvHD. Materials and Methods: This study, conducted from December 2022 to December 2023, involved the collection of 15 stool samples from HSCT patients. Bacterial content was quantified using real-time PCR, while interleukin-6 levels were assessed via ELISA. Results: Among the 15 participants (8 male, 7 female), 9 underwent allogeneic HSCT (allo-HSCT) and 6 received autologous HSCT. In the aGvHD group, there was a significant reduction in the abundance of Bacteroides and Bifidobacterium compared to those without aGvHD. Additionally, declines were observed in Clostridium and Firmicutes populations. The genus Blautia also showed reduced prevalence in the aGvHD group, whereas no significant differences were noted in the uncomplicated group. ELISA analysis revealed that interleukin-6 levels remained within the normal range (30-960 pg/ml) with no significant elevation in the aGvHD group. Conclusion: The study highlights a notable association between alterations in gut microbiota, specifically reductions in certain bacterial populations and the development of aGvHD following allo-HSCT.

Abstract The current study aimed to investigate the effects of human placental mesenchymal stromal cell‐derived small extracellular vesicles (hPMSC‐sEVs) as a treatment for COVID‐19. This double‐blind, randomized, controlled clinical trial was conducted on two groups of patients with COVID‐19‐associated acute respiratory distress syndrome. After randomization, the control group received standard treatment and placebo, and the intervention arm received standard treatment plus hPMSC‐sEVs. The number of hospital deaths was considered the primary outcome. After meeting the exclusion and inclusion criteria, 21 and 24 patients were allocated to intervention and control arms, respectively. Besides admission SpO2 levels, which were significantly lower in the intervention arm (p = 0.008), all the baseline demo‐biographic and laboratory variables were similar between the groups. It was shown that hPMSC‐sEVs could significantly (p = 0.015) decrease the mortality ratio in the intervention group (4/21 [19.04%]) compared to the controls (13/24 [54.16%]). The mean time to death in the intervention and control groups was 28.06 and 11.10 days, respectively (p

BackgroundDiffuse large B-cell lymphoma (DLBCL) is an aggressive non-Hodgkin lymphoma subtype with a significant relapse rate and poor prognosis in relapsed/refractory (R/R) patients. Polatuzumab vedotin in combination with bendamustine and rituximab (Pola-BR) has demonstrated promising efficacy and safety as salvage therapy for R/R DLBCL. This systematic review protocol aims to comprehensively evaluate the efficacy of Pola-BR for the treatment of R/R DLBCL by synthesizing data from relevant randomized controlled trials.MethodsThis protocol details the eligibility criteria, search strategy, study selection, data extraction, and analysis methods for the systematic review. Randomized controlled trials comparing Pola-BR with other interventions for R/R DLBCL will be included. The primary endpoint is overall survival, with secondary endpoints being progression-free survival and incidence of adverse events. A comprehensive search will be conducted across databases such as Medline/PubMed, Cochrane Library, Web of Science, Scopus, EMBASE, ProQuest, EU Clinical Trials Register, WHO International Clinical Trials Registry Platform (ICTRP), and ClinicalTrials.gov from the January 2000 to April 2024. To assess the potential risk of bias, the Cochrane Risk of Bias 1 tool will be used. Data synthesis will utilize fixed-effect or random-effects models, and subgroup and meta-regression analyses will examine heterogeneity. Additionally, publication bias and sensitivity analyses will be performed, and the GRADE approach will be applied to assess the certainty of the evidence.ConclusionThis systematic review and meta-analysis protocol provides a rigorous framework for evaluating the efficacy of Pola-BR in the treatment of R/R DLBCL. The results will inform clinical decision-making and guideline development, addressing the unmet need for effective and tolerable treatments for this challenging patient population. Potential limitations and biases will be acknowledged, and future research directions will be discussed.

Abstract Background This study compared efficacy and safety of TA4415V, a trastuzumab biosimilar, with reference trastuzumab in patients with human epidermal growth factor receptor 2–positive (HER2-positive) early-stage breast cancer treated in the neoadjuvant setting in Iran. Methods Patients were randomly assigned to receive neoadjuvant TA4415V or reference trastuzumab concurrently with docetaxel (TH phase) for 4 cycles after treatment with 4 cycles of doxorubicin and cyclophosphamide (AC phase). Chemotherapy was followed by surgery. The primary endpoint was the comparison of pathologic complete response (pCR) rate in the per-protocol population. Secondary endpoints included comparisons of overall response rate (ORR), breast-conserving surgery (BCS), safety, and immunogenicity. Results Ninety-two participants were analyzed in the per-protocol population (TA4415V, n = 48; reference trastuzumab, n = 44). The pCR rates were 37.50% and 34.09% with TA4415V and reference drug, respectively. The 95% CI of the estimated treatment outcome difference (− 0·03 [95% CI − 0.23 to 0.16]) was within the non-inferiority margin. No statistically significant difference was observed between the groups for other efficacy variables in the ITT population: ORR (89.13% vs. 83.33%; p = 0.72) and BCS (20.37% vs. 12.96%; p = 0.42) in the TA4415V and reference drug group, respectively. At least one grade 3 or 4 adverse events occurred in 27 (50%) patients in the TA4415V group versus 29 (53.70%) in the reference trastuzumab group (p = 0.70). The decrease in left ventricular ejection fraction (LVEF), as an adverse event of special interest (AESI) for trastuzumab, was compared between treatment groups in TH phase. Results demonstrated an LVEF decrease in 7 (12.96%) and 9 (16.67%) patients in TA4415V and reference trastuzumab groups, respectively (p = 0.59). Anti-drug antibodies (ADA) were not detected in any samples of groups. Conclusions Non-inferiority for efficacy was demonstrated between TA4415V and Herceptin based on the ratio of pCR rates in HER2-positive early breast cancer patients. In addition, ORR and BCS, as secondary endpoints, were not significantly different. Safety profile and immunogenicity were also comparable between the two groups.

Introduction: Cancer is among the leading causes of death worldwide and affects a considerable number of individuals. Chemotherapy is one the most common treatment for this condition and hair loss is among one of the most prevalent side effects. In this study, we report successful treatment of a patient suffering from persistent chemotherapy-induced alopecia (PCIA) with extracellular enriched vesicles (EVs) derived from human placental mesenchymal stromal cells (MSCs). Case presentation: The patient was a 36-year-old woman with a history of invasive ductal carcinoma, underwent six courses of chemotherapy with paclitaxel and adriamycin. Following this treatment and for almost 18 months, she, unfortunately, had no regrowth of hair except some light vellus hairs on the scalp. She then received MSC-derived EVs with scalp injection (subcutaneous) every 4 weeks for 3 continuous months at which point she presented complete regrowth of terminal hair on her scalp. Conclusion: This report demonstrates that MSC-derived EVs could be a possible treatment for permanent chemotherapy-induced alopecia; however, further studies and trials are necessary.

Background: Interstitial lung disease (ILD) is a severe systemic sclerosis (SSc) complication with no current approved or golden standard treatment. This report aims to investigate the effectiveness of treatment with placental mesenchymal stromal cell (MSC) extracellular vesicles (EVs) in a patient with ILD due to SSc. Case presentation: The patient was a 55-year-old woman with a ten years history of SSc complicated by severe ILD. Over time, her lung disease progressed to interstitial fibrosis despite being treated with mycophenolate mofetil and monthly pulses of cyclophosphamide. Thus, she was treated with eight doses of placenta MSC-EVs. Four weeks after the third dose (Day 31 after the first dose), she reported marked improvement in her clinical symptoms, such as dyspnea and cough. Also, chest computed tomography (CT) scans demonstrated a significant reduction in ground glass consolidations and fibrotic changes. The patient was subsequently followed for twelve months, with findings showing significant improvement in exercise tolerance and reduced supplemental oxygen need. Conclusion: In this single case, placental MSC-EVs were seen to provide a potentially efficient treatment for SSc-related ILD; however, further investigation and clinical trials are necessary.

Abstract Introduction Human Cytomegalovirus (HCMV) is the most important viral pathogen in people undergoing bone marrow transplantation (BMT). HCMV detection in the early stages makes is possible to save the patients’ lives through immediate and timely treatment. The aim of this study was to investigate the status of HCMV using the real-time PCR method in BMT patients in Kermanshah, west of Iran. Methods HCMV monitoring was done in 120 patients who underwent BMT, 38 allogeneic cases and 82 autologous cases, using the ELISA serology test before transplantation. The participants were followed up 100 days after transplantation for HCMV detection in blood samples using real-time PCR. Preemptive therapy started with Ganciclovir and Foscarnet when the viral load was > 200 HCMV DNA copies/ml. Results Despite preemptive therapy, infection recurred in less than 1 month. HCMV recurred more frequently in patients undergoing allogenic transplation versus those receiving autologous transplantation. Recurrence was seen in 5 patients receiving allogenic transplantation. HCMV recurrence occurred in five patients with allogeneic transplantation. Twelve patients undergoing allogeneic or autologous transplantation (83%) and a virus load of > 1000 copies/ml showed HCMV-related symptoms. Three patients died, two due to HCMV-related pneumonia and the other one due to a fungal infection. Conclusion Real-time PCR may be a useful method for quantification and monitoring of HCMV recurrence and may be helpful in choosing more efficient HCMV preemptive treatment in BMT recipients.

ABSTRACT: Background: CRC is the second and third most common cancer in women and men, respectively. The national comprehensive cancer network guidelines recommend oxaliplatin-based chemotherapy as a preferred regimen for patients with advanced or metastatic colon cancer. Oxaliplatin is also used in the off-label treatment of gastric cancer. FDA uses post-marketing study commitments to gather additional information about a product’s safety, efficacy, or optimal use. It is necessary to perform safety monitoring after marketing authorization is received; such monitoring can be done by means of characterizing the safety of drugs in patients being treated in real-world clinical practice settings. Objectives: This Phase IV study aimed to evaluate the safety profile of a brand-name formulation of the generic drug oxaliplatin (AlvoxalⓇ, NanoAlvand, Tehran, Iran) in Iranian patients diagnosed with either colorectal or other, different types of cancer. Methods: Patients with colorectal cancer, gastric cancer, or other malignancies receiving oxaliplatin as a part of their treatment were included in this open-label, multicenter, observational Phase IV study. This study aimed to assess the safety profile of oxaliplatin in patients diagnosed with different cancers. Findings: A total of 483 patients from 16 cities in Iran were enrolled. The most common malignancy was colorectal cancer (55.49%), followed by gastric cancer (28.16%). Based on the results, 405 patients experienced at least 1 adverse event. Most of these adverse events were grade 1 or 2, and the most commonly reported adverse event was anemia (60.66%). During the study, 26 serious adverse events occurred in 15 (3.11%) patients, which were perhaps related to oxaliplatin. There were no remarkable differences in the incidences of adverse events in the system organ classes of blood and lymphatic system disorders, gastrointestinal disorders, or nervous system disorders among patients with different malignancies (ie, colorectal cancer, gastric cancer, and other malignancies) or between genders. The results of this open-label, multicenter, observational, postmarketing surveillance study demonstrated no unexpected safety findings from the use of this oxaliplatin product (AlvoxalⓇ) in Iranian patients diagnosed with different types of cancer. Conclusions: This Phase IV study provides data on the safety profile of a number of chemotherapy regimens containing an oxaliplatin product given to Iranian patients diagnosed with different types of cancer.

Immune Thrombocytopenia (ITP) is an autoimmune bleeding disorder. Tyrosine Kinase JAK2 (JAK2 V617F) mutation occurs in nearly 60% of Essential Thrombocythemia (ET) patients. Both diseases produce impaired platelet. We describe a case with ET following ITP. So far, only 3 reports described ET following ITP. We report the fourth patient with JAK2 V617F mutation at the onset of ITP presented 20 years ago that needed splenectomy. The association of these two diseases may recommend similar pathogenic mechanisms between Myeloproliferative Neoplasms (MPNs) and ITP that should be further explored.

The Federal Constitutional Court has decided that the prohibition to strike for career civil servants, as it has traditionally been part of the German legal order, is in compliance with the German Constitution. The Court thereby put a (provisional) end to a long-lasting debate on how to solve the tension between the fundamental freedom to form associations under Article 9(3) of the Basic Law, which arguably encompasses a right to strike, and Article 33(5) of the Basic Law, which protects the traditional principles of the career civil servants, which arguably encompasses the prohibition to strike. Through recognizing that the ban on strike action by career civil servants is not only allowed but required under the German Constitution, the Constitutional Court navigates the German legal order on a potential collision course with the European Convention on Human Rights and the European Court of Human Rights. In this context, the Constitutional Court on the one hand reaffirms the openness of the German constitutional order towards international law in general and human rights and the European Convention on Human Rights in particular. On the other hand, the Court somehow marginalizes the role of the European Court of Human Rights and threatens to not follow the Court should it hold that the European Convention on Human Rights demands a right to strike also for career civil servants.

Background and purpose: Kidney transplant is a major form of renal replacement therapy in many patients at advanced stages of the disease. Transplant rejection is a major complication following kidney transplant that could be reversible or irreversible. The present study was done to investigate the incidence of irreversible kidney transplant rejection. Materials and methods: A retrospective cohort study was performed using the information on 1571 renal transplants in Kermanshah, Iran, 1989 to 2016. Kaplan-Meier, Cox regression, and log-rank test were used to estimate the incidence of kidney transplant rejection 24 hr after surgery, the graft survival rate, and investigating the differences between the subgroups, respectively. Results: The rate of acute transplant rejection was 3.82% and the rejection rates within 6 months, one and three years after the transplantation were 10.06%, 12.41%, and 18.20%, respectively. The Cox regression model showed significant correlations between age (P=0.013), creatinine level (P=0.001), and diabetes (P=0.016) and survival rate of kidney transplants. Conclusion: High incidence of acute rejection and rejection within six months showed the influence of some underlying factors. Further studies on underlying variables that affect transplant rejection and kidney transplantation at younger ages could be of great benefit in increasing kidney transplantation survival.

Abstract Background Breast cancer is currently the most common neoplasm diagnosed in women globally. There is a growing body of evidence to suggest that human papillomavirus (HPV) infection may play a key role in invasiveness of breast cancer. The aim of this study was to determine the presence of HPV in patients with breast cancer and its possible association with cancer progression. Methods Breast specimens were collected from 72 patients with breast cancer and 31 healthy controls. The presence of HPV was investigated by polymerase chain reaction (PCR) and genotyping was performed for positive cases. We also evaluated the viral factors such as E6, E2, and E7 in HPV positive cases. Enzyme-linked immunosorbent assay (ELISA (and Real-time PCR techniques were used to measure the expression level of anti-carcinogenic genes, such as p53, retinoblastoma (RB), breast and ovarian cancer susceptibility gene (BRCA1, BRCA2) and inflammatory cytokines, including tumor necrosis factor α (TNF-α), transforming growth factor β (TGF-β), nuclear factor-kB (NF-kB), and different interleukins [ILs] (IL-1,IL6, and IL-17). Results The HPV DNA was detected in 48.6% of breast cancer samples, whereas only 16.1% of controls were positive for HPV. We observed statistically significant differences between breast cancer patients and HPV presence (P = 0.003). HPV type 18 was the most prevalent virus genotype in patients. The expression of P53, RB, BRCA1, and BRCA2 were decreased in patients with HPV-positive breast cancer as compared to HPV-negative breast cancer and healthy controls. (All P-values were less than 0.05). The presence of the HPV was associated with increased inflammatory cytokines (IL-1, IL-6, IL-17, TGF-β, TNF-α, and NF-kB) and tumor progression. Conclusion The present study demonstrated that HPV infection may implicate in the development of some types of breast cancer.

Aim of the study : Herein, this meta-analysis study evaluated the efficacy of palifermin after HSCT on the incidence and severity of OM or aGVHD in hematologic malignancy patients in randomized clinical trials (RCTs). Materials and methods : To compare the efficacy of palifermin on adverse events, OM and aGVHD compared with placebo , we searched databases of PubMed/Medline, Web of Science and Cochrane Library for RCTs based on a number of criteria. Results : There was no difference observed in the incidence of OM and aGVHD between two groups. The subgroup analysis didn’t show significant differences in two groups for aGVHD grade 2–4 (odds ratio [OR] = 1.54, 95% confidence interval (CI): 0.70–3.39, p = 0.28), aGVHD grade 3–4 (OR = 0.97, 95% CI: 0.48–1.94, p = 0.92), OM grade 2–4 (OR = 0.76, 95% CI: 0.42–1.38, p = 0.37) and OM grade 3–4 (OR = 0.54, 95% CI: 0.25–1.15, p = 0.11], but erythema as an adverse effect in palifermin group was higher than placebo group (OR = 1.86, 95% CI: 1.10–3.15, p = 0.02]. Conclusions : This meta-analysis of six clinical trials found no statistically significant difference in OM and aGVHD grades in patients receiving 60 µg/kg/day dose of palifermin compared with those receiving a placebo . However, oral mucosal erythema was more prevalent among patients receiving palifermin than patients receiving a placebo .

Context: Lung cancer is one of the most common cancers worldwide with high mortality and short survival rate. Radiotherapy is one of the treatment modalities in patients who are non-surgery candidates or refuse surgery. Objectives: The current study aimed at evaluating the effectiveness and safety of this technique compared to similar ones for lung cancer treatment. Methods: In order to answer the research question and find the available evidence, after the development of the search strategy, Pubmed, Cochran, Ovid, Medline, and DARE databases were searched and related articles were selected based on the inclusion criteria. Then, we chose all studies that had the PICO acceptance criteria (Participants: adults with lung cancer; Intervention: tomotherapy; Comparisons: tomotherapy with Cyberknife; Outcomes: local tumor control (LTC), survival rate (SR), complications, and degree of toxicity). The quality assessment of the studies was conducted using the CASP (Critical Appraisal Skills Programme) checklist. Two independent search engines evaluated the articles in terms of methodology, and information was extracted from the papers.ResultsOverall, 12 retrospective studies with 616 patients were found examining the efficacy and safety of a certain technology. According to the results of the studies, the local tumor control (LTC) index varied from 63% to 100%. The two and five-year SRs were 73% and 56%, respectively. In addition, the mortality rate of patients until the completion of the treatment course was 34%, indicating the higher efficacy of tomotherapy than the efficacy of other similar techniques. The toxicity of tomotherapy was less than that of Cyberknife, which indicates its more safety. Conclusions: According to the epidemiology of cancer, especially lung cancer, and due to aging of the population in Iran, and considering the higher efficacy and safety of tomotherapy in comparison with other similar technologies, i.e., Cyberknife and Gamma Knife, tomotherapy is a superior technique in the control and treatment of lung cancer although other aspects, such as cost-efficacy, should be considered.

Aim of the study: The aim of this trial was to compare overall survival (OS), disease-free survival (DFS), and toxicity of two adjuvant regimens in triple negative patients with Iranian ethnicity. Material and methods: In a phase II trial, patients with previously untreated triple negative breaststroke cancer were randomly assigned by using docetaxel 70 mg/m 2 and carboplatin AUC = 7 every three weeks with granulocyte colony-stimulating factor for sin courses (arm A) or doxorubicin hydrochloride 60 mg/m 2 and cyclophosphamide 600 mg/m 2 every three weeks with G-CSF for four courses followed by docetaxel 70 mg/m 2 and carboplatin AUC = 7 every three weeks with G-CSF for four courses (arm B). Results : A total of 119 patients were randomly enrolled in our study (60 patients in Arm A and 59 patients in Arm B) between 2011 and 2016. The mean follow-up was 40 months at the time of treatment analysis. The 2-year and 5-year DFS rates for Arm A were 92.7% vs. 85% and for Arm B were 82.6% vs. 64.4%. The 2-year and 5-year OS rates for Arm A were 96.5% vs. 91.7% and for Arm B were 90.5% vs. 81.3%. There was a significant correlation for DFS and OS in the two arms. There was no significant difference between adverse events with the two regimens. Conclusions : In our research, less progression was found with Arm A as compared to Arm B. Adding of anthracyclines such as doxorubicin hydrochloride did not increase OS and DFS in triple negative breast cancer (TNBC) patients.

Colorectal cancer (CRC) metastasis to the thyroid gland is rare. Here wereport a 45 yr-old man in western Iran referred to Hematology Clinic, Kermanshah city, Iran in March 2014 with complaint of exertional dyspnea, multi-nodular goiter as well as complaint of exertional dyspnea, and multi-nodular goiter. His history included a low anterior resection of rectum in 9 months ago for a high-risk stage II rectal adenocarcinoma. He did not show clinical signs of hyperthyroidism other than thyroid enlargement. In thyroid nodule the FNA cytology, pathology reported anaplastic thyroid malignancy. Pathologists reported final diagnosis of colorectal metastasis of thyroid gland. Then due to metastatic pattern of disease, his pathology was evaluated for RAS molecular assay. In the patients of metastatic CRC, RAS testing is the first step to identify those patients that could benefit from anti-EGFR monoclonal antibodies treatment.

Background: Presently, the graphical data of blood cells (histograms and cytograms or/ scattergrams) that they are usually available in all modern automated hematology analyzers are an integral a part of automated complete blood count (CBC). To find incorrect results from automated hematology analyzer and establish the samples that require additional analysis, Laboratory employees will use those data for quality control of obtaining results, to assist identification of complex and troublesome cases. Methods: During this descriptive analytic study, in addition to erythrocyte graphs from variety of patients, referring from March 2013 to Feb 2014 to our clinical laboratory, Zagros Hospital, Kermanshah, Iran, are given, the papers published in relevant literature as well as available published manuals of automatic blood cell counters were used. articles related to the key words of erythrocyte graphs and relevant literature as well as available published manuals of automatic blood cell counters were searched from valid databases such as Springer Link, google scholar, Pubmed and Sciencedirect. Then, the articles related to erythrogram, erythrocyte histogram and hematology analyzer graphs are involved in diagnosis of hematological disorder were searched and selected for this study. Results: Histograms and different automated CBC parameter become abnormal in various pathologic conditions, and can present important clues for diagnosis and treatment of hematologic and non-hematologic disorders. In several instances, these histograms have characteristic appearances in an exceedingly wide range of pathological conditions. In some hematologic disorders like iron deficiency or megaloblastic anemia, a sequential histogram can clearly show the progressive treatment and management. Conclusion: These graphical data are often accompanied by other automated CBC parameter and microscopic examination of peripheral blood smears (PBS), and can help in monitoring and interpretation of abnormal morphological changes. In the diagnosis and monitoring of anemias, analysis of histograms could also be considered as a new parameter in the combine with red blood cell indices. Histograms ought to use as a screening tool, and not considered diagnostic for pathological conditions.

Introduction: ITP is an autoimmune blood disorder in which platelet destruction is mediated by anti-platelet antibodies. The mechanisms of anti-platelet antibodies development are still a little known. The rate of some bacterial or viral agents in cause of ITP is well known. Recently, some study proposed that H pylori infection may be associated with ITP and H pylori eradication can improves platelet counts in infected ITP patients.Material and method: A baseline platelet count

Menorrhagia is the most common symptom that is experienced by women with bleeding disorders. Von Willebrand disease (VWD) is the most common congenital human bleeding disorder that is manifested as a quantitative deficiency in Von Willebrand factor (VWF) or dysfunction of this factor. The frequency of VWD is similar in both men and women. However, VWD is more readily detected in women due to the presence of severe bleeding associated with menstrual cycles and childbirth. The present study was carried out to find the frequency of VWD, its types, and clinical features of the disease among women with menorrhagia who referred to the Hematology Clinic of the Kermanshah University of Medical Sciences. The study comprised 482 women with menorrhagia. After excluding patients with confounding factors, 56 (11.6%) patients were evaluated for inherited bleeding disorders. We detected 31 (55.3%) patients with VWD. Type 3 of VWD was the most frequent subtype (45.1%) followed in frequency by type 2, (32.2%), and type 1 (22.5%). In conclusion, our study indicated that menorrhagia can be the first symptom of VWD. Therefore, rare coagulation disorders should be considered in women with idiopathic menorrhagia, particularly in regions with high rates of consanguinity.

Background: Transfusion services rely on transfusion reaction reporting to provide patient care and protect the blood supply. Unnecessary discontinuation of blood is a major wastage of scarce blood, as well as man, hours and funds. The aim of the present study was to describe the main characteristics of acute transfusion reactions reported in the 4 hospital of Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran.Material and Methods: The study was carried out at 4 teaching hospital of Kermanshah University of Medical Sciences, Kermanshah, Iran over18 months from April 2010. All adult patients on admission in the hospitals who required blood transfusion and had establish diagnosis and consented were included in the study.Results: In the year 2010 until 2012, a total of 6238 units of blood components were transfused. A total of 59 (0.94%) cases of transfusion reaction were reported within this 3 years period The commonest were allergic reactions which presented with various skin manifestations such as urticarial, rashes and pruritus (49.2%), followed by increase in body temperature of > 1◦C from baseline which was reported as febrile non-hemolytic transfusion reaction (37.2%). pain at the transfusion site (6.8%) and hypotension (6.8%).Conclusion: It is important that each transfusion of blood components to be monitor carefully. Many transfusion reactions are not recognized, because signs and symptoms mimic other clinical conditions. Any unexpected symptoms in a transfusion recipient should at least be considered as a possible transfusion reaction and be evaluated. Prompt recognition and treatment of acute transfusion reaction are crucial and would help in decreasing transfusion related morbidity and mortality, but prevention is preferable.

Background: Acute myeloid leukemia (AML) is a heterogeneous clonal disorder characterized by immature myeloid cell proliferation and bone marrow failure. Various genetic and epigenetic factors have been found to be influential in such patients. Methylation silencing of APAF-1, a putative tumor suppressor gene (TSG), has been found in several human malignancies. In this study, we explored the association of APAF-1 methylation status with AML patients. Subjects and Methods: We studied the methylation status of APAF-1 gene in 101 AML patients and 50 healthy subjects as controls. Genomic DNA was extracted from leukocytes in peripheral blood or bone marrow and the methylation status of APAF-1 gene promoter was detectedusing methylation-specific PCR (MSP) method with specific methylated and unmethylated primers. Gene expression was analyzed using real time RT-PCR. Results: The prevalence of methylated (MM) and hemi-methylated (MU) CpG dinucleotides within the APAF-1 gene promoter of AML patients was 12 (11.9%) and 45 (44.6%), respectively, while no methylation was detected in the control samples (p < 0.001). Our results showed a higher frequency of methylated APAF1 in FLT3-ITD mutated cases(p=0.04). APAF1 mRNA expression was significantly lower in methylated cases compared with normal cases. Conclusion: The present study indicated the increased frequency of hypermethylation of APAF-1 gene promoter in AML patients. APAF-1 aberrant CpG island methylation was associated with transcriptional downregulation in AML patients. Therefore, promoter methylation of APAF-1 gene could be considered as an epigenetic factor that contributes to the development of AML.

Background: In developed or developing countries, the most common cancer in women is breast cancer with a pick in 40–50 years in Asia. Herein, we compared the association between IHC with FISH in HER2-positive breast cancer patients and affection of trastuzumab on disease free survival and overall survival (OS). Subjects and Methods: Immunohistochemical (IHC) analysis of hormone receptors and HER2 was performed in 133 patients with breast cancer between 2003 and 2014. Patients were selected for Herceptin adjuvant treatment, according to IHC 3+ or FISH+. The specimens for pathology reports were fixed at 10% neutral-buffered formalin (pH=7.4) for 24 hours, then sliced into 4 μm sections. Results: The mean age of patients at diagnosis was 46.39 years (range, 24-78 years), 100% female. Concordance rates between IHC and FISH were 31.1% for IHC 2+ and 84.1% for IHC 3+ (p50 years. Of the 133 patients, 30 patients (22.6%) had metastasis and 72 (54.1%) had right involvement. Ninety three (69.9%) patients had lymph node invasion. 48 patients (36.1%) were treated with trastuzumab and 85 (63.9%) were treated without trsastuzumab. The 10-year survival rate was 70% and the mean survival was 49 months. Conclusions: We recommend clinicians that FISH analysis is as a predictor in breast cancer patients with IHC score 2+. In contrast, FISH analysis of IHC 3+ samples was no useful. Trastuzumab therapy is effective and tolerated for breast cancer with IHC 3+ and probably IHC 2+/FISH+.

Background: Emotional Intelligence (EQ) is positively associated with mental health and it can have a crucial role in mental disorder therapy by suitable coping mechanisms. The present study aimed to evaluate the relationship of EQ with anxiety and depression among the women with breast cancer. Subjects and Methods: During 2013 and in a cross-sectional study, 98 breast cancer patients (14 to 21 years old) entered into the study. For data collection, the following instruments were the Bar-On EQ inventory, Beck Depression Inventory and Cattle Anxiety Inventory. Results: There was an inverse relationship between anxiety with intrapersonal (p

Pituitary gland metastasis was seen in elderly patients, and the incidence of pituitary metastasis is 1% to 4% of all cancer patients. Renal cell carcinoma is a primary malignancy in only 2.6% of pituitary metastases. We reported a 50-year-old man with pituitary metastasis from renal cell carcinoma that had signs of diabetes insipidus. He had multiple lesions in both lungs, and bone scan involved L12 and L1 vertebrates. He was treated with combination bevacizumab 600 mg/month and sunitinib 50 mg/D for four weeks with two weeks rest for 6 months. Treatment with targeted drugs without surgery of pituitary or radiotherapy improved metastatic renal cell carcinoma in the patient.

Introduction: The main inhibitors of coagulation pathway are antithrombin (AT), protein C and protein S. These inhibitors are necessary to prevent thromboembolism. Hereditary deficiency of inhibitors is the main cause of alteration in balance between the anti-clotting and the formation of thrombin. Patients with this abnormality are susceptible to venous thromboembolism (VTE). Two major clinical manifestation of VTE are deep vein thrombosis (DVT) and pulmonary embolism (PE). The aim of present study was to investigate the frequency of coagulation inhibitor proteins and resistance to activated protein C (APC-R) in DVT patients from Kermanshah province of Iran with Kurdish ethic background. Materials and methods: We investigated all patients with thrombophilia who referred to Iranian Blood Transfusion Organization from May 2011 to March 2012. The levels of protein C, protein S and antithrombin were measured using STAGO kits, France (Diagnostica Stago) and the APC-R level was detected using Pefakit® kit. Results: After excluding patients with confounding factors, 54 patients were remained. Our results showed that acquired risk factors are the most common causes of DVT in the present study. In our study protein C deficiency was found to be the most hereditary risk factor followed in frequency by APC-R. Also, in 16 patients (29.6%) there were combined hereditary risk factors with deficiency in 2 or 3 factors. Conclusion: Our results showed protein C deficiency was the prevalent cause of DVT in our patients. Also, different pattern of hereditary risk factors in our patients compared to other regions of Iran could be attributed to different ethnic background of our patients.

Introduction: The incidence of malignant melanoma is increasing at a rate greater than any other human cancer. Although melanoma accounts for only 4 percent of all dermatologic cancers, it is responsible for 80 percent of deaths from skin cancer; only 14 percent of patients with metastatic melanoma survive for five years. The optimal therapy varies with the stage of the disease. Surgical excision is the treatment of choice for early disease, while some patients who are at high risk for developing metastatic disease (particularly those with stage II and III cancers may benefit from adjuvant therapy with interferon alfa (IFNa).(1) The management of patients with disseminated disease is a difficult problem. In carefully selected patients, excision of limited distant metastases can occasionally produce durable benefit. However, most patients with stage IV disease require systemic treatment. Traditional systemic treatment approaches include cytotoxic chemotherapy and immunotherapy. Several novel therapeutic approaches are under study, the most promising of which target specific molecular abnormalities that have been identified in melanomas. Molecularly targeted therapy for advanced melanoma will be reviewed here.(2)

Introduction: The myeloproliferative neoplasms (MPNs) are a heterogeneous group of diseases characterized by excessive production of blood cells by hematopoietic precursors. Typically, they include polycythemia vera (PV), essential thrombocythemia (ET), idiopathic myelofibrosis (IMF), and chronic myeloid leukemia (CML). Philadelphia chromosome is the final diagnostic test for CML. Recently, JAK2 mutation introduced as a diagnostic marker for other MPNs. The aim of this study is evaluation of Philadelphia chromosome in CML patients and JAK2 mutation in MPNs patients that had been referred to a hematology/oncology clinic in Kermanshah between 2010-2011. Material and methods: In this study we evaluated common genetic disorders in 124 MPNs patients. Expression of B2A2 BCR-ABL mRNA in peripheral blood leucocytes was detected by a reverse transcriptase polymerase chain reaction (RT-PCR) for CML patients. Also, we used AS-RT-PCR method for the detection of the JAK2 mutation for all of 124 patients. Results: We found 93.7% CML patients (60/64) with positive Philadelphia chromosome. Also, 85% PV patients (17/20), 46.6% ET patients (14/30) and 40% IMF patients (4/10) had JAK2 mutation. Notably, we found a CML patient with positive Philadelphia chromosome and JAK2 mutation. Conclusion: Diagnosis of MPNs is often complex and expensive but, JAK2 mutation is a sensitive test, relatively cost-effective for proving clonality in MPNs. Also, more studies are required to determine the exact frequency and prognostic role of the JAK2 mutation in Philadelphia positive CML patients.

Introduction: Transfusion-transmitted infections (TTI) continue to be a major challenge for Blood transfusion organizations in the world and multi- transfused patients (MTPs) are at higher risk of infection. HTLV-1 is a retrovirus that easily transmitted via blood cell products. The aim of this study is determine the seroprevalence of HTLV-1 in major thalassemic patients from Kermanshah Province, western of Iran. Material and methods: A total of 116 serum samples from all major thalassemic patients that exist in Kermanshah providence and 1000 serum samples from healthy individuals as control group were tested for HTLV specific antibody by ELISA method. All of the ELISA positive samples were confirmed by Western Blotting analysis. Results: From major thalassemic patients, 4 subjects (3.4%) had HTLV-I infection. Also, among 1000 control individuals, 5 subjects (0.5%) had HTLV-I infection. There wasn’t any HTLV-II in major thalassemic patients or control individuals. Conclusion: our results showed this infection exist in our region. These results indicated that screening procedure were not doing carefully. More studies are needed to clarify the reason of this unsuccessfully screening of this virus from donated blood.

Introduction: Normal homeostasis system has several inhibitor mechanisms in front of the amplifiers natural clotting enzyme to prevent fibrin clots in the vessels. The main inhibitors of coagulation pathway are antithrombin (AT), protein C and protein S. Patients with hereditary deficiency of coagulation inhibitors are susceptible to venous thromboembolism (VTE). One of the major clinical manifestations of VTE is deep vein thrombosis (DVT). The present study has investigated the frequency of protein C and S deficiency among DVT patients that by using of these results and results from our previous study; we determined the most important hereditary risk factors for DVT in the Kermanshah Province of Iran with the Kurdish ethnic background. Materials and methods: We studied 150 patients from the Kermanshah Province of Iran with Kurdish ethnic background. Patients with hereditary risk factors were excluded from the study. Estimation of protein C and protein S were performed using kits from STAGO, France (Diagnostica Stago). Results: After excluding patients with confounding factors, 50 patients were remained. We found 14 patients (28%) with protein C deficiency and 10 patients (20%) with protein S deficiency. Also, 2 patients (4%) had both protein C and S deficiency. Conclusion: Comparing the results of this study with our previous study on DVT patients indicates that among inherited risk factors for DVT in our population the deficiency of protein C, S and FVL mutation are the most prevalent factors. Our results show that our population has different pattern for hereditary risk factors compared with other Asian pattern for DVT patients.

The case of a 52 old women with Hodgkin’s disease of 15 years duration is described. During 4 months ago when she be in the remission phase during every 6 months her follow up she complaint with paranoid minds, urinary incontinency, headache, dizziness and blurred vision started. Papilledema and left hemiparesia were detected. Brain MRI pointed to intracranial invasion by the disease. Therapeutic test with steroids brought to amelioration; therefore, subsequent skull irradiation and chemotherapy were given which improved her condition markedly. For the diagnosis we need newer diagnostic procedures that enable for correct diagnosis of intracranial involvement in Hodgkin’s disease. In doubtful cases, therapeutic test with steroids, followed by chemotherapy and skull irradiation, are indicated, and surgery should be advised only if these measures fail.

Objective: Quantification of the BCR-ABL transcript is recommended to follow-up CML patients that treated by Imatinib mesylate (IM) as a tyrosine kinase inhibitor. BCR-ABL transcripts have been recognized as a molecular marker for response to therapy in CML patients (pts). Monitoring of this marker to be more effective for identifying optimal responses and can help to inform the decision to switch to alternative therapies. Quantitative reverse transcriptase PCR (Q-PCR) of BCR-ABL1 RNA is a critical laboratory technique for accurate and sensitive monitoring of the efficiency of tyrosine kinase inhibitor therapy. The aim of our study was to analyze the molecular response (MR) in Kurdish CML patients who are treated with Imatinib. Materials and Methods: We studied 60 blood samples from CML patients in chronic phase (CP), 36 females and 24 males, under IM treatment and monitored by Q-PCR on 12 months. The median duration of CML was 5 years (range: 1-15). The median duration of IM treatment was 4 years (range: 1-10). Results: 40% (24 pts), 28.33% (17 pts) and 15% (9 pts) and respectively had reached early molecular response (EMR) at 1.0-2.0 log, major molecular response (MMR) at 3.0 log and deep molecular response (DMR) at 4.0-5.0 log and also undetectable BCR‑ABL1 levels (CMR) were achieved in 16.67% (10 pts) at 12 months. Conclusion: We highlighted the possibility to use of Q-PCR as a warning at diagnosis, and may use to identify patients who could benefit from a more scrupulous follow-up.

"nAbstract: This paper represents a novel use of artificial neural networks in medical science. The proposed technique involves training a Multi Layer Perceptron (MLP) (a kind of artificial neural network) with a BP learning algorithm to recognize a pattern for the diagnosing and prediction of five blood disorders, through the results of blood tests from H1 machine. The blood test parameters and diagnosis of physician about the diseases of 450 patients from Taleghani Hospital in Kermanshah, Iran, are used in a supervised training method to update network parameters. This method was implemented to diagnose these disorder and cancer: Megaloblastic Anaemia, Thalassemia, Idiopathic thrombocytopenic pupura (ITP), Chronic myelogenous leukemia and Lymphoproliferative.

Background: Hairy cell leukemia (HCL) is a chronic B-cell lymphoid leukemia characterized by pancytopenia, splenomegaly, myelofibrosis and the presence in peripheral blood, bone marrow and spleen of atypical lymphoid cells with a hairy aspect. The study aims to evaluate a group of patients with hairy cell leukemia, hospitalized in the Clinic of Hematology and Oncology, Kermanshah, Iran, on a period of 15 years and affect of between cladribine therapy and IFN therapy on the patients with HCL. Methods: This is a retrospective analysis of 11 patients in the Clinic of Hematology and Oncology, Kermanshah, Iran, between 2004 and 2013. Clinical features at diagnosis, differential count (platelet, Hb and WBC) types of therapy, survival rate and BRAF mutation have been monitored. As a result, cladribine therapy is the best treatment option for patients. Results: The mean age of patients was 50 years with 100% of men. Approximately 45% of them had splenomegaly at diagnosis. 100% of patients had pancytopenia at diagnosis.9% of patients had mutation of BRAF V600E. Before of treatment, there were fatigue, weight loss, vomiting, fever, night sweat and itching in all of the patients. Conclusion: There is presence of hairy cells in peripheral blood and bone marrow and was associated with pancytopenia, splenomegaly, myelofibrosis in HCL patients. Also, cladribine therapy is best option for treatment of patients and it is better than IFN.

Granulocytic sarcomas (chloromas) are rare extramedullary tumors consisting of primitive granulocytic cells. We report here on a case of a 23-year-old man who presented with a generalized swelling. He is known case of acute myelomonocytic leukemia. Granulocytic sarcomas are rare, destructive, extramedullary tumor masses that consist of immature granulocytic cells. In this unusual patient's case, the location and invasive nature of the tumor be important that can die the patient if we cannot treat patient urgently. Optimal therapy for these patients has not been well defined: standard AML chemotherapy is moderately effective and should be considered for all suitable cases. To reduce the risk of subsequent ANLL in patients with nonleukemic GS, it is important that accurate histologic diagnosis is established initially for GS and that all isolated cases of GS, even those that appear to be cured by resection or irradiation of the tumor, are treated with intensive chemotherapy similar to that used to treat ANLL during the nonleukemic period as soon as possible.

Chronic lymphocytic leukemia (CLL) and chronic myeloid leukemia (CML) are the most common leukemias of the elderly (>43 year). However, the sequential occurrence of CML followed by CLL in the same patient is extremely rare. In our report, a 52-year-old female was diagnosed with CLL (type of bone marrow (BM) infiltration was nodular and interstitial) and was treated with chlorambucil. 64 months after the diagnosis of CLL, she developed CML. She was treated with imatinib (400mg/day). After a few months, signs of CML were disappeared and CLL became dominant. This is first reported case.

Hemoglobinopathies are the most common single gene disorders worldwide with a considerable frequency in certain area particularly Mediterranean and Middle Eastern countries. Hemoglobinopathies include structural variants of hemoglobin (Hb S, Hb C, HbE,…) and thalassaemias which are inherited defects in the globin chains synthesis. The present study was conducted to determine the prevalence of hemoglobinopathies in western Iranian patients. A total of 344 patients (151 males and 193 females) with abnormal CBC and/or hemoglobin electrophoresis were enrolled in the present study. Cellulose acetate gel electrophoresis was performed for all patients and abnormal bands were identified by citrate agar gel electrophoresis and PCR based methods. Iron deficiency anemia (IDA) was present in 156 (45.3%) individuals. Thirty four (9.8%) patients had both iron deficiency anemia and α-thalassemia trait trait, 41(11.9%) patients were with both iron deficiency anemia and minor β-thalassemia. There were 31(9%) patients with α-thalassemia trait and 5 (2.2%) patients with Hb H disease. Fifty six (16.2%) patients had minor β-thalassemia. Also, there were 10 (2.9%) individuals homozygous for hemoglobin D-Punjab and one patient with hemoglobin G (0.3%). There was one sample with hemoglobin C. Further, we found 3 patients (0.9%) with sickle cell trait and more 3 patients (0.8%) with S/ β +-thalassemia. Our results indicated that the most frequent cause of hypochromic and/or microcytic anemia in our population was IDA and the minor β-thalassemia was the second cause that needs to more attention in screening programs.

Introduction: The long-term use of immunosuppressive agents for prevention of allograft rejection increases the risk of malignancy approximately 100 times as high as that in the general population and Kaposi’s sarcoma (KS) is a relatively common malignancy after kidney transplantation. The aim of present study was to investigate the frequency of KS in patients with kidney transplantation in 20 years period. Material and methods: In this study Charts and pathology reports of 1487 recipients for kidney allografts treated at Imam Reza hospital between 1991 and 2012 were reviewed. The SPSS software package version 16 (SPSS Inc., Chicago, Illinois, USA) was used for the statistical analysis. Results: There were 17 of 1487 incident cases of KS kidney transplant population at our hospital in period of study. There is no significant difference between age and gender of patients. The mean time between transplantation and non-KS malignant tumors was 34.4 ± 21.8 months (range 12–140 months), while in KS patients it was 18.7 ± 25.2 months, which was statistically significantly different (P < 0.05). After detection of KS in 12 patients, we perform serum antibody detection against HHV. Among them, 8 (66.6%) were seropositive. Conclusion: KS is a common long-term complication in renal transplant recipients, with an increased incidence compared with the general population. Given that candidates for organ transplantation who are seropositive for HHV-8 -and thus at risk for KS- can now be identified, chemoprevention should be available in this high-risk population.