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Background and purpose : Penile fracture is the rupture of the corpus cavernousum due to trauma to the erect penis , which has various background etiologies in different countries according to their habits. The aim of this study was to determine and evaluate the frequency, etiologies and complications of penile fracture in our geographic area.
Material and Methods : This analytical-cross sectional study was performed via census sampling among men referred to Sh. Beheshti Hospital of Babol Medical University during 1995 to 2004. Data were analyzed by Chi-Square, Fisher`s exact and T-test using SPSS release 12.
Results : 84 patients with penile fracture (mean age of 18.1 years) were studied. The frequency was higher in single patients (78%) than married ones. The most important complaint of patients with penile fracture was penile pain (36%), hematoma (30%), and penile swelling (12%). Background factors were manipulation of erect penis (74%), sexual intercourse (18%) trauma to erect pennies (8%). Urethral ruptures were seen in 8% of all patients with feacture. There were significant differences between urethral rupture and background etiologies (P=0.000) and marrital status (p=0.000) as 90% of the cases were single patient, referred to hospital due to manipulation of erect pennies (P=0.000).
Conclusion : High frequency of penile manipulation among young boys in the study area in comparison with other studies results in penile fracture but subsequent urethral rupture was uncommon among men. Better and earlier diagnosis of penile fracture is related to determination of background etologies in the patients.

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Background and Purpose: Lipodystrophy is potentially a clinical adverse effect, associated with insulin therapy and is believed that usage of human recombinant insulin’s is associated with decreasing prevalence of Lipodystrophy. The objective of this study was to determine the prevalence of insulin induced Lipodystrophy, among diabetic out-patients referred to Imam Khomeini Hospital, in Sari during 2007.
Materials and Methods: In this cross sectional descriptive study, 220 diabetic patients referred to the Diabetes Center at Imam Khomeini Hospital, in Sari, who under treatment by insulin at least three months prior to referral was evaluated. First, the demographic and clinical characteristics of the patients were recorded in a questionnaire then all patients were examined clinically to evaluate lipodystrophy. In all subjects, glycated hemoglobin (HbA1C) was measured to assess the range of blood glucose level control. Recorded data were analyzed by statistical methods, such as descriptive T-test and X².
Results: Of 220 diabetic patients studied, thirty-five (15.9%) showed clinical evidences of insulin induced Lipodystrophy 32 out of 35 cases of Lipodystrophic patients (14.5%) had Lipohypertrophy, while 3 cases (1.4%) had Lipoatrophy. The factors included Age, Sex, Education, BMI (Body mass index), type of Diabetes, The duration of insulin consumption and injection site had statistically significant effects on development of insulin induced Lipodystrophy (P<0.05).
Conclusion: The results of this study demonstrated that despite using human recombinant insulin’s, the prevalence of insulin induced lipodystrophy, especially Lipohypertrophy, has remained high up to present. Therefore, regular examination of patients for this side effect is necessary, especially in subjects without good control of blood glucose level.

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Background and purpose: From the second half of 2005, family medicine as reform in primary health care sector was introduced for all rural as well as towns with less than 20000 population in order to improve the performance of this system particularly curative care. In this reform both the method of employment and the payment mechanism that could potentially change the performance of family medicine team were changed. In this paper change in the performance of health centers in ambulatory care before and after the implementation of reform in two cities (Mazandran province) is compared. Materials and methods: This investigation includes two case studied in two cities. Data of 30 rural health centers in Sri and 12 in Joybar were gathered. The collected data were based on existing data of Iran’s primary health network information system. A check list was used for data collection. These data were related to one year before the implementation of scheme and three years after the date that the scheme was started. Results: A substantial increase in the number of patients visited by physician had happened that is about 6 times higher than their performance in the same centres before the reform. A change of about two times increase in the provided services of lab and injection and wound dressing unit had also happened. Conclusion: In this study, health care providers of health centres under the same conditions of primary health care delivery behaved differently so that their performance improved about 6 times compared to prior the reform. The changes, with fewer slopes, were seen on other curative care including lab and injection and wound dressing services.

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Background and purpose: TB is a serious infectious disease in kidney recipients causing high morbidity and mortality. The prevalence of this disease varies in different countries depending on socio-economic levels. The aim of this study was to investigate the occurrence of TB after kidney transplant in kidney transplant center of Shahid Beheshtei Hospital in city of Babol. Materials and methods: This cross-sectional study was done on 363 kidney recipients since the establishment of the kidney transplant center of Shahid Beheshtei Hospital in Babol. Data including the age, sex, duration of dialysis, PPD test, time of TB diagnosis, pulmonary and extra pulmonary presentation, immunsuppression and anti-TB regimen, cyclosporine level after and before TB diagnosis, rejection and function of kidney after transplantation were recorded through a questionnaire. Pulmonary tuberculosis diagnosis was made based on the positive culture of bronco alveolar lavage fluid. Results: From 363 renal allograft recipients, there were 10 (2.75%) documented cases of TB of whom six patients were male and four were female. The mean age was 47.2 years. The mean time for dialysis before transplantat was 30.5 months and the mean time to diagnose TB was 8.1 months after transplant. The most common complaints included coughing, fever and weight loss. The most frequent radiologic findings were diffuse infiltration. Immunsuppressive regimen was changed from azatioperin to mycofenolat in two patients. Anti-TB regimen was four drugs in six patients. Rejection was seen in five patients before the diagnosis of TB. Also, mortality (without autopsy) was observed in four patients. Conclusion: The frequency of TB after kidney transplant in kidney recipients in this centre was lower than other centers but mortality rate of the disease was higher.

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Background and purpose: Thalassemia major is a hematic hereditary disease with high rate of incidence in Iran. Malnutrition and growth retardation is prevalent in these patients. This study was done to assess the nutritional status and blood indices in patients with β-thalassemia major. Material and methods: This cross sectional study was conducted in 72 individuals with thalassemia major aged 10-20 years. Systematic sampling was done in patients attending Mashhad and Sabzevar thalassemia clinics. Written informed consent was obtained from patients who were willing to participate in the study. Data was collected through the semiquantitative food frequency questionnaire which was completed by trained interviewers. Nutritional information was studied in Nutritionist IV. To measure blood indices 5 ml blood was drawn from the patients. Descriptive statistics, one sample t-test and Kolmogorov-Smirnov tests were performed in SPSS V.16. P<0.05 was considered as significant level. Results: In this study there were 55.6% female and 44.4% male. The mean BMI of patients were 19.05±3.74 and 18.99±3.7 kg/m2, respectively. Dietary assessment showed that the mean of macronutrient intakes were more than dietary standard values except for cholesterol and fiber. Also, intake of micronutrient, were less than dietary standard values except in taking B vitamins, calcium, phosphorus, potassium, and sodium. Values of Hb and Hct were found to be less than the standard level but serum ferritin was more than normal range. Conclusion: The findings showed that deficiency of micronutrients due to malnutrition is prevalent in thalassemia patients.

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Background and purpose: A common question of patients with dyslipidemia is to know the priority of nutrients intake in their daily regimen. To make decision about the best diet and recommend it to patients, the physicians and/or nutritionists should consider a lot of factors. Materials and methods: In a cross sectional study, a self-administered questionnaire was used that contained a list of health factors related to dyslipidemia. A number of internal doctors and nutritionists in three different universities of Mashhad, Tehran and Kerman filled the questionnaires. The opinions of respondents about each factor were collected using Visual Analogue Scale. Data was analyzed applying Fuzzification, Alpha Cut Set and Fuzzy Triangular Membership Function. The exact amounts resulted from Analytic Hierarchy Process (AHP) were replaced by the amounts resulted from Fuzzy AHP (FAHP) and the weight of each factor was calculated separately and compared with the other factors by Microsoft Excel® and MATLAB®. Results: The most important factors according to respondents were: Body Mass Index (BMI), level of serum LDL, the pattern of daily repast, level of serum cholesterol and having uncontrolled diabetes mellitus. Conclusion: The findings of this study and the method of determining priorities for nutritional regimen could be used as a practical guideline for nutritionists when recommending daily regimen for dyslipidemia patients and providing better consultations.

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Background and purpose: Balance impairment is a major cause of falls in patients with hemiplegic stroke. The purpose of this study was to compare the effects of two balance training programs in these patients.

Materials and methods: A clinical trial with pretest–posttest design was conducted in 30 patients after a single hemisphere stroke that occurred at least 6 months before the study (2015). Patients were randomly assigned into either a control group or one of two balance rehabilitation groups. All groups received conventional physical therapy program. One group had a balance training program without visual cue while the other had balance training on unstable surface for 30 minutes 3 sessions per week. Patient performance was assessed before and one session after treatment using the time up and go (TUG) and four square steps (4SS) tests.

Results: All the patients had a significant clinical and functional improvement (P<0.05). No significant difference was found between the control group and the group who had balance training on unstable surface. But balance improved more in the group who received balance training without visual cue.

Conclusion: Balance training without visual input is more effective than balance training on unstable surface. To facilitate recovery of balance following stroke, rehabilitation programs that use visual deprivation to promote somatosensory and vestibular input are recommended.

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Background and purpose: The aim of this study was to investigate the relationship between the implant survival rates and the length and diameter in disabled veterans attending Qazi Tabatabai Dental Clinic, Tehran, Iran during 2000-2010.

Materials and methods: A retrospective study was conducted in 181 disabled veterans referring to Qazi Tabatabai Clinic. They received 1,255 implants from three different manufacturers including 3i (Riverside drive, Palm Beach, Gardens, F1, USA), Xive (Friadent GmbH, Mannheim, Germany), and BH (Goteborg, Sweden). The length of implants was classified as short (8-10 mm), medium (11-13 mm), and long (14-15 mm), and the diameter was classified as narrow, regular, and wide. The data analysis was performed using the R statistical software. To evaluate the impacts of the implant length and diameter on its survival rate, the frailty parametric model, with exponential distribution as baseline hazard and gamma distribution as frailty was used.

Results: The mean age and injury rate of the patients were 49.47±5.61 years and 42.98%, respectively. In addition, the estimated medians of survival time for 3i, Xive, and BH implants were 76.15, 79.06, and 77.94 months, respectively. There was no significant difference between the survival rate and type of implant (P=0.353). Regarding the implant length, the 3i implant with with long length (14-15 mm) and the Xive implant with medium length (11-13 mm) had the lowest (88%) and highest success rates (97.8%), respectively. According to the frailty model, the higher length and diameter in 3i and Xive implants were associated with higher failure rates; but this condition was not observed in BH implants.

Conclusion: We found a significant relationship between implant failure and short length implants. However, no relationship was observed between failure of implant and its diameter.

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Background and purpose: The electronic registry of patients with beta thalassemia major was developed in Thalassemia Research Center affiliated with Mazandaran University of Medical Sciences in order to provide an accurate database for researchers and health planners. This study reports the condition of patients registered in Mazandaran province till summer 2016.

Materials and methods: In this descriptive study, the following information was recorded in the registry system: epidemiologic data, clinical examination data, complications, routine laboratory test results, medications, new cases, and death. Descriptive statistics were used to summarize the data.

Results: Until the summer 2016, 1053 patients including 500 (47.5%) males and 553 (52.5%) females were registered in 14 hospitals. These were half of the number of patients receiving care by the aforementioned University.  Among the patients, 920 (87.4%) were transfusion dependent. Single patients included 54.2% (n= 571). The level of formal education was beyond high school in 29.8% (n= 314). Three hundred and fifty (33.2%) patients were employed. Splenectomy was done in 606 (58%) patients. Diabetes mellitus, hypoparathyroidism, and hypothyroidism were diagnosed in at least 12% (n= 120), 14.3% (n= 145), and 11% (n= 112), respectively. Cardiomyopathy was observed in 113 (11.2%) cases. The most common iron chelators medication was desferrioxamine, which was used alone (50.4%) or in combination with deferiprone (24.3%).

Conclusion: Current research showed that in spite of incompleteness of records at the electronic registry of patients with beta thalassemia major, a comprehensive electronic system could enhance the level of care provided for involved patients.

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Background and purpose: Violence is one of the main aspects of gender inequality that is a major barrier to achieving the goals of global reproductive health. It is directly associated with women's access to health care and health outcomes. In a systematic review, we aimed to investigate the articles on the relationship between intimate partner violence and women's reproductive health.
Materials and methods: Electronic databases including, Scopus, ProQuest, PubMed, and Google Scholar were searched for articles published in English between 2010 and 2017.
Results: After evaluation, 31 articles were selected. The lowest and highest prevalence of violence was associated with physical violence (2.8%) and psychological violence (75.9%), respectively. Moreover, violence was found to be associated with six domains of reproductive health including, not using contraceptive methods, abortion, genital tract diseases, poor pregnancy outcomes, and not using reproductive health services.
Conclusion: Systematic review of studies investigated, showed a strong relationship between domestic violence and major aspects of reproductive health. Therefore, it is necessary to prevent domestic violence in order to promote the health of whole community.

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Background and purpose: Vestibular Schwannoma (VS) is a lesion in peripheral vestibular system that leads to reduction of Vestibulo Ocular Reflex (VOR) gain and incidence of corrective saccades. Researches showed that the result of Video Head Impulse Test (VHIT) is positive in peripheral vestibular system disorders and negative in central vestibular system disorders. The aim of this study was to evaluate and compare the results of VHIT in patients with vestibular schwannoma and patients with central vestibular system tumors.
Materials and methods: A descriptive-analytic study was conducted in 12 patients with unilateral VS tumor and 15 patients with unilateral central vestibular system tumors in Iran Gamma-Knife Center (December 2014-September 2015). The patients were selected based on diagnosis of neurosurgeon and their complaints from vertigo, imbalance, and dizziness. Assessment of VHIT was performed using horizontal and vertical head impulses. Finally, the amount of VOR gain and the corrective saccade ratio were evaluated in two groups of patients with tumors. The gain of VOR ≤0.80 was considered as abnormal criterion.
Results: Mean VOR gain in effective side was 0.38 in patients with VS tumor, and 0.96 in patients with central vestibular system tumors (P= 0.001). Also, corrective saccades ratio was 30.34 in patients with VS and 3.44 in patients with central vestibular system tumors (P= 0.007).
Conclusion: The results of VHIT improved differential diagnosis of peripheral vestibular system tumors from central vestibular system tumors.
 

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Background and purpose: Alopecia areata (AA), also known as spot baldness, is an autoimmune disease in which hair is lost from some or all areas of the body. Genetic factors are known to play a role in the onset of this disease. The HLA complex genes are primarily involved in AA. In present study, effect of HLA-DQA2 allele frequency was analyzed in Iranian AA patients and control samples.
Materials and methods: The study group comprised 30 patients with Alopecia areata and 15 healthy controls. Genomic DNA was extracted from whole blood using DNG plus method. Polymerase chain reaction with sequence specific primers technique (PCR-SSP) was performed to detect HLA-DQA2. The association between HLA-DQA2 allele and some risk factors such as family history, anemia, and the onset of the disease was analyzed.
Results: Patients included 13 females and 17 males (mean age 26.3 ±12.5 years) and the controls were five females and 10 males (mean age 30.1±5.8 years). The frequency of HLA-DQA2 allele in AA patients (93.33%) was not significant compared to that of the controls (76.66%) (OR 0.94, 95% CI =0.018-1.018, p>0.05). No association was found between the disease and family history of AA (OR=0.09; 95% CI=0.01-0.119, P= 0), and onset of disease (OR =1.015; 95% CI=0.95-1.07, p=0.607). But significant correlation was observed between AA disease and anemia (OR =0.017; 95% CI=0.02-0.179, p=0.001).
Conclusion: This study did not show strong correlation between HLA-DQA2 allele and developing Alopecia areata. The HLA-DQA2 allele was associated with anemia, but not related to family history and the onset of disease.
 
 

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Background and purpose: Organic chlorine pollutants are stable in the environment and dangerous to the health of living organisms. Among these compounds, polychlorinated biphenyls (PCBs) can be carcinogenic to humans and affect brain function, nervous system, reproductive system, and the immune system. They could enter the body through many ways including eating or drinking contaminated water and food such as chicken egg.
Materials and methods: Sampling of 4 brand of chicken eggs was performed in all seasons in Tehran, Iran 2017. The mixed solvent of Hexane: Dichloromethane (same ratio) was used for extraction applying ultrasonic method. Then, the two phases were separated using concentrated sulfuric acid. They were then condensed by a rotary machine with a vacuum pump under a gentle nitrogen gas and purified using silica gel column or florisil. Finally, the concentration of each PCB was measured by the GC-MS device.
Results: In all samples, the mean polychlorinated biphenyls (1.40±0.3 pg WHO-TEQ /g fat) was lower than the standard range and the highest concentration was associated with PCB 28 (mean value= 0.802 pg WHO-TEQ / g fat). One of the brands (B) had the highest average of PCBs, and the most contaminated eggs were found in winter (1.822 pgWHO-TEQ/g fat).
Conclusion: In this study the average of each PCB was lower than the standard values in different types of eggs, indicating no risk to the consumers.

 

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Background and purpose: One of the most popular methods to control the synanthropic flies is using parasitoid wasps. The aim of this study was to estimate the experimental parasitism rates of pupae of Musca domestica, Lucilia sericata, and Sarcophaga heamorrhoidalis by parasitoid wasps, including Nasonia vitripennis, Spalangia nigroaenea, and Pachycrepoideus vindemmiae.
Materials and methods: Pupae of three species of flies, including Musca domestica, Lucilia sericata, and Sarcophaga haemorrhoidalis were exposed to three parasitoid female wasps, including Nasonia vitripennis, Pachycrepoideus vindemmiae, and Spalangia nigroaenea in laboratory condition. The exposure rate was 8 wasps to 10 fly pupae on alternate days up to 5 days. The experiments were performed in triplicate and a total of 2700 fly pupae was exposed to 432 wasps. The parasitism rate and parasitoid host preferences were also determined.
Results: Total parasitism of flies was estimated at 22.17%. There was no significant differences in parasitism rate of Musca domestica, Lucilia sericata, and Sarcophaga haemorrhoidalis by Nasonia vitripennis, and Pachycrepoideus vindemmiae, but there was a significant difference in parasitism rate of house fly by the three parasitoids investigated (P<0.01). The Spalangia nigroaenea was active just on pupae of Musca domestica. The highest parasitism rate of the fly species studied was found by parasitized wasps of 5–7 days old.
Conclusion: Spalangia nigroaenea can be considered as an efficient and specific parasitoid for biological control of Musca domestica. Other wasp species, including Nasonia vitripennis, and Pachycrepoideus vindemmiae could also be used in integrated fly control programs. Also, in biological control program for flies, 5-7 day parasitoid might be more effective.

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Background and purpose: Hyperlipidemia is known as one of the major risk factors for cardiovascular disease. Thyme is one of oldest medicinal herbs that is used mainly for medicinal aims. Lipoprotein lipase (LPL) hydrolyzes triglycerides in lipoproteins and angiopoietin-like protein (ANGPTL4) is a LPL regulator, therefore, this study aimed at examining the effect of hydroalcoholic extract of thyme on serum levels of ANGPTL4 and LPL in hyperlipidemic rats.
Materials and methods: This case-control study was performed in 48 male Wistar rats weighing 180-250g. The animals were divided into 6 groups, including Becker control, fat control group, and 1, 2, 3, and 4 test groups. After induction of hyperlipidemia, test groups (1, 2, and 3) were subjected to gavage with thyme extract at 100, 200 and 300 mg/kg, respectively and group 4 was subjected to gavage with Gemfibrozil at 10 mg/kg for 10 days. Blood samples were taken from all groups and serums were collected for measuring various parameters.
Results: Serum cholesterol concentration in treatment groups receiving thyme at 200 mg/kg (p=0.035) and 300 mg/kg (p=0.003) and Gemfibrosil (p=0.025) showed a significant decrease compared to fat control group but other factors such as LPL and ANGPTL4 showed no significant changes (p<0/05).
Conclusion: Thyme extract can be effective in lowering cholesterol levels. But further evaluations are suggested to use this extract at higher doses and longer durations to study its effect on lipid factors, LPL, and ANGPTL4.
 

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Background and purpose: Some native species of medicinal plants are abundantly found in Iran. High incidence of ulcers in diabetic patients necessitates research on herbal medicines with fewer side effects. This study was conducted to evaluate the histological variables of the Fumaria parviflora extract on the repair of ulcers in diabetic rats.
Materials and methods: The study was carried out in 48 adult male Wistar rats at 14-15 weeks of age, weighing 200 ± 10 gr. Diabetes was induced by injection of alloxan. The animals were randomly divided into 4 groups (n= 12), including negative control group (healthy without any treatment), positive control group (diabetic with no treatment), experimental group I (diabetic treated by eucerin cream), and experimental group II (diabetic treated by a cream containing 3% F. parviflora). Histopathological examination was done at the end of days 3, 7, 14, and 21. The size of the scars and tissue indices were measured in these groups.
Results: There was a significant difference between the experimental group II and other groups in the rate of recovery (P <0.001). Compared to experimental group I, the scores for some microscopic parameters were higher in experimental group II.
Conclusion: According to current study, topical use of F. parviflora could diminish inflammation and accelerate wound healing. It was also found to be highly efficient in accelerating the transition from inflammatory to fibroblast hyperplasia phase. Therefore, F. parviflora as an efficient low-cost herbal medicine could be used in accelerating wound healing.

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Background and purpose: Flies have a high diversity and are able to transmit many pathogens due to their adaptation and close relationship with humans. Therefore, this study was performed to identify the fauna of medically important flies in the city of Joybar in northern Iran.
Materials and methods: This descriptive-analytical study was conducted twice a month in Juybar at selected sites, including hospital landfills, coastal waste, rural waste, municipal waste, and around a slaughterhouse in 2017. The flies were identified using valid identification keys and the species diversity parameters were evaluated based on Shannon index, Margalef index, and Evenness index.
Results: In this study, seven species of medically important flies, including Muscina stabulans, Musca domestica, Lucilia caesar, Lucilia sericata, Calliphora vicina, Sarcophaga argyrostoma and Sarcophaga africa were caught from Muscidae, Calliphoridae, and Sarcophagidae families. According to Pearson correlation, the population of flies increases significantly (P<0.005) with increasing temperature and decreasing humidity. Shannon index showed the highest and lowest diversity values in coastal waste (H´=1.005) and urban waste (H´=0.27), respectively.
Conclusion: Mosca domestica, as the most common and abundant species could considerably affect the health of the region and cause changes in the species diversity of flies. The difference in diversity of flies in different areas is mainly due to changes in the species evenness in these areas. Also, the diversity of flies in the region can be a warning sign for the spread of diseases. Control measures such as appropriate waste management are necessary to prevent epidemic outbreaks transmitted by flies.
 

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Background and purpose: Depression is one of the significant and common disorders in the elderly. Considering that nutrition plays a crucial role not only in the onset but also in the severity and duration of the depressive episode, the aim of the present study is to investigate the relationship between the Healthy Eating Index (HEI) as an alternative indicator of healthy eating and the dietary quality score with depression in the elderly residents of Shiraz.
Materials and methods: In this cross-sectional study on 80 older adults living in Shiraz, information regarding people's dietary intake was gathered with a 147-item food frequency questionnaire (FFQ). Adherence to healthy eating patterns was assessed using HEI. Diet quality was assessed by DQI-I, which includes four main components of the diet. For evaluating depression, the Beck Depression test was used. The association between food indices and depression was assessed by linear regression in two crude and adjusted models.
Results: Of the 80 people studied, 50% were women. The mean and standard deviation of the age of the studied subjects were 66.18±5.67 and 65.18±6.9 years, respectively. The relationship between the diet quality index and depression score showed an inverse and significant relationship, so an increase in the diet quality index was associated with a decrease in depression score (beta coefficient: -0.281 and P=0.036). This index remained significant after adjusting for age, gender, level of education, body mass index, and energy (P= 0.049).
Conclusion: The findings of the current study revealed that Adhering to a diet with higher DQI-I had an inverse association with the risk of depression in the elderly. Further research is needed, especially prospective studies, to confirm these findings in Middle Eastern societies.
 

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Background and purpose: The classification of prostate cancer patients based on the criteria of the European Urology Association, based on the level of a prostate-specific antigen, digital rectal examination, and Gleason score, is one of the golden criteria for the prognosis of the disease. On the other hand, it seems that in aggressive forms of the disease, cancer cells can spread along nerve cells, which is called perineurial invasion. The relationship between prostate cancer classification criteria and disease recurrence or survival is well known, but the importance of perineurial invasion in the prognosis of the disease is less discussed and investigated, so this study aims to compare two groups of positive and negative perineurial invasion. It is based on the EAU risk classification to investigate the difference between the two groups in terms of disease prognosis.
Materials and methods: This retrospective study was conducted on 200 prostate cancer patients who underwent radical prostatectomy in Babol University of Medical Sciences affiliated hospitals between 1396 and 1400. Inclusion criteria included prostate cancer and, the presence of clinical and pathology test results. The exclusion criterion was the patient suffering from all types of prostate cancer, other than adenocarcinoma. All the demographic, paraclinical, clinical, and pathology data of the patients were obtained using the data recorded in the patient's pathology file as well as the hospital's archive department. Patients' information was extracted from patient files using a checklist including age, results of PSA, DRE, TNM, and Gleason scores, as well as the patient's condition in terms of peripheral nerve invasion. Gleason score is the standard criterion for histological differentiation of prostate cancer, which is graded from 2 to 10 points. A score less than 7 indicates better differentiation, a score of 7 indicates moderate differentiation, and a Gleason score of 8, 9, or 10 indicates poor differentiation of prostate cells. The study data were analyzed using SPSS version 20 software. was analyzed. Chi2 and Fisher Exact tests were used to analyze the data, and independent t-test (to compare two groups) and ANOVA (to compare more than two groups) were used to compare the mean of quantitative variables.
Results: The average age of the subjects under study was 67.13±5.91. By classifying patients according to EAU risk groups, and comparing the risk class between patients with positive and negative perineurial invasion based on PSA, DRE, TNM, and Gleason score statistically significant differences were seen between the two groups. In almost all classifications based on clinicopathological scales, patients with positive perineurial invasion were at higher risk in terms of EAU criteria than patients with negative perineurial invasion.
Conclusion: The results of the study showed that positive perineurial invasion in prostate cancer patients can be considered as a poor prognosis of the disease. The presence of cancer cells in the perineurial space can be an early sign of cancer progression

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Background and purpose: Non-compliance with the principles of swimming pool water hygiene leads to health problems and the transmission of diseases to swimmers. Given the importance of water quality control, the present study examined the physical, chemical, and microbial quality of pool water.
Materials and Methods: In this descriptive-analytical study, comprehensive microbial and chemical sampling was conducted on five active indoor swimming pools in Kashan, Iran. Samples were collected from each pool in four replicates. The parameters of residual free chlorine, temperature, turbidity, pH, heterotrophic bacteria, fecal coliform, and total coliform were examined. Microbial and chemical sampling was performed weekly for one month, and the samples were tested according to standard methods.
Results: In this study, 65% of the samples were within the standard pH range (7.2–7.8). Ninety percent of the samples had residual chlorine levels higher than 1 mg/l. Escherichia coli bacteria were not observed in any of the samples. Twenty percent of the samples had fecal coliform contamination in terms of most probable number (MPN). Ten percent of the samples had turbidity exceeding the permissible limit of 0.5 nephelometric turbidity unit (NTU). The average temperature of the pools was calculated to be 30.99 C.
Conclusion: The temperature of swimming pools in Kashan did not comply with the standard. Half of the microbial contamination cases occurred when the residual chlorine level was outside the standard range. According to the findings, it is necessary to continuously monitor residual chlorine levels and control pH to maintain the bacteriological quality of swimming pool water. It is recommended that swimming pools implement measures such as installing advanced disinfection systems, continuously monitoring pH and residual chlorine, and enhancing temperature control to prevent microbial contamination.