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Abstract Early diagnosis of colorectal advanced neoplasms (ANs), including colorectal cancer (CRC) and advanced adenoma (AA), has a positive effect on the survival rate. As a first attempt, the aim of this meta-analysis was to compare the diagnostic accuracy of faecal protein biomarkers for the detection of colorectal neoplasms with consideration of a wide range of covariates. A systematic literature search was performed up to Jun 10, 2021 on Web of Sciences, Scopus and PubMed. The diagnostic accuracies were calculated using the bivariate/hierarchical random effect model. Biomarkers were determined to be clinically applicable (CA) if they had areas under the curve > 0.70 and positive and negative likelihood ratios > 2 and

Background: Several reports have determined that cardiovascular diseases (CVDs) are common complications in patients with coronavirus disease 2019 (COVID-19) and lead them to poor outcomes. CVD biomarkers have, thus, great potential to be used as prognostic biomarkers. We aimed to determine the accuracy of CVD biomarkers for the prognosis of the COVID-19 patient’s outcome via a diagnostic test accuracy (DTA) meta-analysis. Methods: Until September 30, 2020, we searched Web of Sciences, Scopus, and MEDLINE/PubMed databases to obtain related papers. The summary points and lines were calculated using bivariate/HSROC model. As outcomes, we considered critical conditions and mortality. Results: A total of 17 659 patients from 33 studies were included. Five biomarkers, namely increased levels of lactate dehydrogenase (LDH), cardiac troponin I (cTnI), creatine kinase (CK), D-dimer, and thrombocytopenia, met the inclusion criteria. Our results indicated that LDH and cTnI had good accuracy for the prognosis of critical condition (AUCHSROC=0.83 and 0.80, respectively), while LDH, cTnI, and D-dimer had acceptable accuracy (AUCHSROC=0.74, 0.71, and 0.72, respectively) for the prognosis of mortality. LDH and D-dimer had high sensitivity, whereas cTnI had high specificity. The other biomarkers did not have acceptable accuracy. Significant publication bias was found for D-dimer (P=0.053). Conclusion: Among CVD biomarkers, LDH and cTnI had good accuracy for the prognosis of critical outcomes and acceptable accuracy for the prognosis of mortality, without publication bias. Given their different sensitivities and specificities, we recommend the use of these 2 biomarkers concomitantly.

Several reports have determined that changes in white blood cell counts and inflammatory biomarkers are related to disease outcome of coronavirus disease 2019 (COVID-19) and they can be utilized as prognostic biomarkers. For introducing a factor as a diagnostic/prognostic biomarker, diagnostic test accuracy (DTA) systematic review and meta-analysis are recommended. For the first time, we aimed to determine the accuracies of white blood cell counts and inflammatory biomarkers for prognosis of COVID-19 patient’s outcome by a DTA meta-analysis. Until August24, 2020, we searched Web of Sciences, Scopus, and MEDLINE/PubMed databases to achieve related papers. Summary points and lines of included studies were calculated from 2×2 tables by bivariate/hierarchical models. Critical condition and mortality were considered as outcomes. A total of 13387 patients from 28 studies were included in this study. Six biomarkers containing leukocytosis, neutrophilia, lymphopenia, increased level of C-reactive protein, procalcitonin (PCT), and ferritin met the inclusion criteria. Analysis of the area under the curve (AUCHSROC) indicated that the PCT was the only applicable prognostic biomarker for critical condition and mortality (AUCHSROC=0.80 for both conditions). Pooled-diagnostic odds ratios were 6.78 (95% CI, 3.65-12.61) for prognosis of critical condition and 13.21 (95% CI, 3.95-44.19) for mortality. Other biomarkers had insufficient accuracies for both conditions (AUCHSROC< 0.80). Among evaluated biomarkers, only PCT has good accuracy for the prognosis of both critical condition and mortality in COVID-19 and it can be considered as a single prognostic biomarker for poor outcomes. Also, PCT has more accuracy for the prognosis of mortality in comparison to critical condition.

Background and Aim: There has been a long-lasting debate among medical laboratory-associated specialists about required competencies and educational background to qualify for directing medical laboratories in Iran. The aim of this study was to provide a comprehensive review regarding required training and competencies for becoming a medical laboratory director in Iran and all around the world. Materials and Methods: A thorough search of the literature was carried out in scientific databases including Web of Science, Science Direct, Springer Link, Wiley Online, PubMed, Scopus, SID and web-based search engines such as Google and Google Scholar. Results: The results revealed detailed required competencies for directing medical laboratories in the United States of America, Canada, European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) and its many affiliated European countries. Conclusion: Our results indicate that in all assessed countries, specialists of basic medical sciences and also physicians, after passing certifying examinations, are equally qualified to direct medical laboratories. Indeed, Iran is the only country within the evaluated ones, in which basic medical sciences specialists (which have their own specific curriculum and are educated as clinical majors) have been eliminated from directing medical laboratory and the position has almost exclusively been available for graduates of pathology and it is important to revise this approach.

Tumor cells rely on glycolysis for their energy supply with the production of lactate even in normoxia condition, which is named aerobic glycolysis or Warburg effect. Therefore, high glucose (HG) concentration provides a favorable condition for increasing proliferation, angiogenesis and decreasing apoptosis, but its molecular mechanisms are still unknown. The objective of this study is to investigate HG condition on tumor cells behavior including proliferation, apoptosis, and an angiogenesis mediator. In this study, MCF-7 derived from human breast adenocarcinoma, were cultured in DMEM with two different concentrations of glucose for 48 h (5.5 mM as normal glucose (NG) condition and 25 mM as HG condition). We used Zingiber officinale extraction for the inhibition of NF-κB. Cell proliferation assay was done by direct counting, cell viability by MTT method, bcl-2 by Immunocytochemistry, apoptosis by Hoechst/PI double staining and vascular endothelium growth factor (VEGF) by ELISA. Results showed that HG increased lactate production, significantly. HG increased cell proliferation, cell viability, VEGF secretion, and bcl-2 expression while it decreased apoptosis. However, when HG was combined with Zingiber officinale extraction, cell proliferation, cell viability, VEGF secretion and bcl-2 expression decreased and apoptosis increased significantly due to inhibition of NF-κB. Results revealed that HG increased cell proliferation, angiogenesis and decreased apoptosis due to activation of NF-κB pathway. Moreover, the probable mechanism of the activation of NF-κB in HG is increasing reactive oxygen species (ROS) in this condition that can activate NF-κB directly.

Pathogenesis of systemic lupus erythematosus (SLE) is complex and multi-factorial. Among various suggested mechanisms for the disease, the hormonal theory has been considered as one of the most important mechanisms. Recently, the association of sex hormones with manifestations of antiphospholipid antibody syndrome (APLS) has been hypothesized. The aim of present study was to assess the serum levels of anticardiolipin antibody (ACA), sex hormones and prolactin in SLE female patients and their association with the disease. This study comprised 40 SLE female patients and 41 healthy age-matched female subjects. For all patients and controls, the serum levels of ACA (IgG and IgM), estradiol, testosterone, progesterone, dehydroepiandrosterone sulfate (DHEA-S) and prolactin were measured by ELISA method. Our study revealed that serum levels of testosterone, DHEA-S and progesterone were significantly lower in SLE patients than control (p

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.

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 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.

Myeloproliferative neoplasms (MPNs) such as polycythemia vera, essential thrombocythemia, primary myelofibrosis and chronic myeloid leukemia have too similar and accurate way to differentiate their is study of genetic disorders in these patients. Philadelphia chromosome is a sure way to definitively diagnose CML. Recently, JAK2V617F mutation introduced as a diagnostic marker for other Myeloproliferative neoplasms. Many studies show that the absence of the JAK2 mutation in chronic phase Philadelphia positive CML. In contrast with these reports, more recently, several cases with the coexistence of Philadelphia positive chromosome and JAK2V617F mutation in blood and bone marrow samples were reported. Here, we report a patient that have the Philadelphia chromosome disorder and JAK2V617F mutation in same time.

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.

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.

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.

Idiopathic thrombocytopenic purpura (ITP) is an autoimmune hematological disordercharacterized by auto antibody-mediated platelet destruction. Although the main cause of ITPremains unclear, but its relationship with some infection was demonstrated. In recent years, many studies have demonstrated improvement of platelet counts in ITP patients after treating Helicobacter pylori infection. The aim of this study was to investigate the effects of H. pylori eradication on platelet count response in Iranian ITP patients.A total of 26 patients diagnosed with both ITP and H. pylori infection. ITP were diagnosed whose platelet counts were less than 100×103/μL. These patients were tested for H. pylori infection by Urea Breath Test and serum H. pylori antibody. All patients received triple therapy for 7 or 14 days to eradicate H. pylori infection. These patients followed for six months.Prevalence of H. pylori was 67.3%. H. pylori eradication achieved in 89.5% (26/29). Of the 26 patients, 15 (57.7%) exhibited a complete response (CR) and 11 (42.3%) were unresponsive. We did not find partial responders. There was a significant difference in the baseline platelet count of responders and non-responders patients (p

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.

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 dur ng the nonleukemic period as soon as possible.

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: 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.

Ganglioneuromas presented as a retroperitoneal tumor around the vital organs is a rare entity. A case with unusual presentation is reported. Young woman of 44 years old presented without any complaint ,that known during incidental abdominopelvic ultrasonography. It was treated with partial resection for debulking surgery. Debulking surgery with preservation of organ functions is feasible in these slow growing tumors for better quality of life.

Introduction: Normal homeostasis system has several inhibitor mechanisms in front of the amplifier’s 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 DVTpatients 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 DVTpatients.

Myeloproliferative neoplasms (MPNs) such as polycythemia vera, essential thrombocythemia, primary myelofibrosis and chronic myeloid leukemia have too similar and accurate way to differentiate their is study of genetic disorders in these patients. Philadelphia chromosome is a sure way to definitively diagnose CML. Recently, JAK2V617F mutation introduced as a diagnostic marker for other Myeloproliferative neoplasms. Many studies show that the absence of the JAK2 mutation in chronic phase Philadelphia positive CML. In contrast with these reports, more recently, several cases with the coexistence of Philadelphia positive chromosome and JAK2V617F mutation in blood and bone marrow samples were reported. Here, we report a patient that have the Philadelphia chromosome disorder and JAK2V617F mutation in same time.

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.

Ganglioneuromas presented as a retroperitoneal tumor around the vital organs is a rare entity. A case with unusual presentation is reported. Young woman of 44 years old presented without any complaint ,that known during incidental abdominopelvic ultrasonography. It was treated with partial resection for debulking surgery. Debulking surgery with preservation of organ functions is feasible in these slow growing tumors for better quality of life.