Tuberculosis surveillance using a hidden markov model

Routinely collected data from tuberculosis surveillance system can be used to investigate and monitor the irregularities and abrupt changes of the disease incidence. We aimed at using a Hidden Markov Model in order to detect the abnormal states of pulmonary tuberculosis in Iran. Data for this study were the weekly number of newly diagnosed cases with sputum smear-positive pulmonary tuberculosis reported between April 2005 and March 2011 throughout Iran. In order to detect the unusual states of the disease, two Hidden Markov Models were applied to the data with and without seasonal trends as baselines. Consequently, the best model was selected and compared with the results of Serfling epidemic threshold which is typically used in the surveillance of infectious diseases. Both adjusted R-squared and Bayesian Information Criterion [BIC] reflected better goodness-of-fit for the model with seasonal trends [0.72 and -1336.66, respectively] than the model without seasonality [0.56 and -1386.75]. Moreover, according to the Serfling epidemic threshold, higher values of sensitivity and specificity suggest a higher validity for the seasonal model [0.87 and 0.94, respectively] than model without seasonality [0.73 and 0.68, respectiveiy]. A two-state Hidden Markov Model along with a seasonal trend as a function of the model parameters provides an effective warning system for the surveillance of tuberculosis

[Desired attributes of outpatient services from the perspective of patients: using a choice- based conjoint analysis technique]

Patients' perception of various aspects of health services could provide useful insights to improve health services. In the present study the technique of Choice- Based Conjoint Analysis [CBCA] was used to elicit patients' views on desired attributes of outpatient services. Five attributes related to outpatient services provided by hospital clinics, were surveyed. They included appointment making, waiting time, forming medical records, and presence of medical students and other patients in the examination room. There were 200 patients selected through convenient sampling method. Data were gathered via structured interviews and analyzed by logit regression model. The three main attributes preferred by respondents were: no presence of other patients [57%], appointment making [17%], and forming medical records [15%]. The scenario with maximum utility consisted of the following: telephone appointments, having medical records, no presence of medical students and other patients in the examination room, and the maximum waiting time of half an hour. The sequence of the priorities preferred by the outpatients was found to be firstly, examination by consultants in private, secondly, telephone appointments, and finally, formation of medical records. CBCA could be a potentially useful technique for eliciting the preferences of health service users

[Assessment of the quality of methodology reporting in the randomized trials]

Abstract writing is one of the secondary services for summarizing the content of documents. It represents the major information and is used as an overview of the text. However, abstracts should be written and indexed on the basis of some criteria to provide sufficient and reliable information about the main text. This study aimed to assess the abstracts of Randomized Controlled Clinical Trials [RCTs] indexed in PubMed on the basis of the CONSORT abstract checklist. This was a descriptive cross-sectional survey. The study sample included 314 RCTs indexed in PubMed with the affiliation of Iran and Tehran University of Medical Sciences up to the end of 2010. The abstracts were evaluated by the CONSORT checklist in which the items were scored 0-8. The Mean score for quality was 4.7 +/- 1.02 out of 8. None of the abstracts were assigned as the most qualified [Score=8] and the highest score was 7. Among the RCT designs, parallel trial designs were the most common ones. Indications of the type of randomization, the blinding type, and the number of participants involved were found not to be well reported qualitatively. The findings indicated that the items designated for RCTs abstracts were not thoroughly taken into consideration. It seems that training of researchers and authors is required for betterment of the quality of reporting in abstracts. In addition, journal editors should provide guidelines for authors to report this type of studies correctly

[ survey of the levels of evidence of nursing theses and dissertations in type 1 medical universities of Iran, 1991-2010]

Availability of scientific research at high levels of evidence, provide an appropriate context for evidence-based nursing. This study aims to identify the levels of evidence of nursing theses and dissertations in type-one medical universities of Iran in a period of twenty years. This is a descriptive survey on 1810 nursing theses and 54 dissertations. The abstract and/or method section of the theses and dissertations during 1991-2010 was reviewed and then their levels evidence were determined by comparing these data with the table of evidence-based research assessment. Descriptive analysis on data was performed using SPSS-PC [v.16]. A large percentage of the theses [60.7%] and dissertations [92.6%] were at the 6[th] level of evidence. First and 5[th] levels of evidence were not seen in Msters Theses, and none of the 1[st], 4[th] and 5[th] levels of evidence was found in PhD dissertations. The lowest percentages [1.9%] of theses were situated at the 4[th] level. Only 7.4% of the dissertations were at the 2[nd] and 3[rd] levels of evidence. The trend of theses and dissertations changed into performing research at the 2[nd] and 3[rd] levels of evidence. The results revealed that the majority of theses and dissertations in all educational fields and faculties are at the lowest [6[th] level of evidence during the studied period. Thus, regarding the importance of evidence-based practice for increasing the quality of nursing care, investigating approaches to promote and improve the level evidence of nursing theses and dissertations is recommended

[Qualitative evaluation of central library's web sites of medical universities in Iran with WEBQEM]

The homepage is the initial place at which the users are directed towards having access to the available resources. This makes web designing of high importance to university administrators and authorities. The purpose of this study was to conduct a qualitative evaluation of websites with WEBQEM in libraries of Medical Universities in the Islamic Republic of Iran. This study was a descriptive survey which was conducted on 24 websites. Data were gathered on the basis of WEBQEM checklists. Data analysis was performed by using SPSS software version 13. The evaluation was carried out by applying four criteria of WEBQEM. The websites' reliability was evaluated as "Very Good", with the average score of 0.82, and its efficiency as "Good" with the average score of 0.64. Usability and functionality scored an average of 0.5 and 0.52, respectively. Finally, half of the websites, on which this study was conducted, were evaluated as "Good "while the other half were as "Average". Considering the average scores obtained by using the four main criteria of the study, it was conceived that the in terms of functionality and usability of these web sites had some shortcomings. Although reliability and efficiency scored average, some of the websites were not of the expected quality by the main criteria

[Associations of red blood corpuscle mean volume and hematocrit with severity of beta-globin gene mutations in beta-thalassemia carriers]

Thalassemia, a heterogeneous disease, is one of the most common single-gene diseases worldwide. The aim of this study was to find associations between hematological indices and severity of beta-globin gene mutations in beta-thalassemia carriers. In this cross-sectional study, 30 beta-goblin gene mutations [beta[+] and beta°] in 1206 unrelated beta-thalassemia carriers were investigated. In addition, their hematological indices, including CBC and electrophoresis results, were determined. The association between genetic findings and hematological parameters [mean corpuscular volume [MCV] and mean hematocrit corpuscular hematocrit [MCH]] were determined using the SPSS software, the statistical test being the t-test. The results indicated that beta[+]-thalassemia carriers had higher MCV and MCH means than beta°-thalassemia carriers. These findings would certainly have practical implications in public health. The results show a significant correlation between two hematological indices and certain types of mutations in beta-thalassemia carriers

[ effect of jaw relaxation on pain anxiety of burn dressing: Randomized clinical trial with control group]

Patients with burns, experience high levels of anticipatory anxiety during dressing changes. Anxiety tends to increase after each dressing and during time; on the other hand this anxiety cannot be completely managed by anxiolytic drugs. Nurses contribute to pain management by using pharmacological and non-pharmacological interventions. Relaxation techniques are one of the most used approaches in pain anxiety management. However there is not enough information about the effects of these techniques on pain anxiety of these patients. The aim of this study was to determine the effect of jaw relaxation on pain anxiety of burn dressing. This study was a randomized clinical trial with control group. One hundred patients hospitalized in Shahid Motahari Burn Center in Tehran within July to December, 2009 were recruited by convenience sampling and were randomly assigned to either experimental or control groups using minimization. Experimental group practiced jaw relaxation for 20 minutes before entering dressing room. Data were assessed with Burn Specific Pain Anxiety Scale [BSPAS] and analyzed using descriptive statistics, Chi-Square test, dependent and independent t-test and Fisher's exact test by SPSS-PC [17]. Significant statistical difference was seen between the level of pain anxiety before and after intervention in experimental group. Moreover, after intervention there were a significant difference between the level of pain anxiety after dressing in experimental and control groups. There weren't significant difference between pain anxiety after intervention, before and after dressing in experimental group. Nurses can independently decrease the pain anxiety of burned patients and its subsequent physical and psychological burden by teaching the simple and inexpensive technique of jaw relaxation. Further studies are suggested to assess the effect of this technique on pain anxiety of patients with other disease except burns who suffer from painful procedures

Exon 2 Ovar-DRB1 gene polymorphism in the Iranian Sangsari sheep

The major histocompatibility complex [MHC] plays a central role in the control of disease resistance and immune response. Extensive genetic diversity in MHC genes provides a valuable source for genetic improvement, via selection, in many domestic animals. Exon 2 of the class II MHC, termed Ovar-DRBl in domestic sheep [Ovis aries] has been suggested as important disease resistance and immune response gene. We characterized Ovar-DRBl in DNA samples from 138 individuals of a population of the Iranian Sangsari sheep breed using PCR-RFLP. Eight DRB1 alleles were identified among Iranian Sangsari sheep, including one previously unrecognized allele. Eight homozygous genotypes were observed: a, b, c, d, f, g, h andN. Genotype bb was the most common pattern [46 of 138]. Heterozygous genotypes [ag, cb, cd, bf, and bN] were also observed. The observed homozygosity and heterozygosity values were 0.6377 and 0.3623, respectively, vs expected values of 0.220 and 0.779. Iranian Sangsari population deviate significantly from the theoretical proportions [FIS = 0.5283; p = 0.0005]. In conclusion, PCR-RFLP analysis allows rapid identification of Ovar-DRBl types and discrimination of homozygous and heterozygous genotypes. This study indicates that the exon 2 region of the Ovar-DRBl gene is highly polymorphic in the Iranian Sangsari sheep breed

[Deep anterior lamellar keratoplasty versus penetrating keratoplasty for keratoconus]

To compare the outcomes of deep anterior lamellar keratoplasty [DALK] using the big-bubble technique with that of penetrating keratoplasty [PK] in patients with keratoconus. This double-blind clinical trial included patients with moderate to advanced keratoconus and poor spectacle-corrected visual acuity or contact lens intolerance. Refractive errors, best corrected visual acuity [BCVA], contrast sensitivity function [CSF] and higher order aberrations [HOAs] were compared between the study groups. Forty-two eyes underwent DALK while 35 eyes received PK. Mean patient age was 26.91 +/- 7.9 versus 30.89 +/- 10.3 years in the DALK and PK groups, respectively [P=0.06]. Mean follow-up period was 19.0 +/- 7.9 months in the DALK and 24.6 +/- 3.5 months in the PK group [P=0.32]. Mean postoperative spherical equivalent refractive error was -3.23 +/- 3.4 D in the DALK group versus -2.22 +/- 4.6 D in the PK group [P=0.28] and mean postoperative BCVA was 0.18 +/- 0.08 logMAR and 0.15 +/- 0.10 logMAR, respectively [P=0.12]. There was no significant difference between the study groups in terms of CSF, total aberrations and HOAs. DALK may be considered as an effective alternative to PK in patients with keratoconus

Biochemical, hematological and pathological alterations associated with ascites in broilers and the role of oxygen-derived free radicals

Three hundred and fifteen day -old chickens were used to test the relationship between oxygen- derived free radicals and the biochemical, hematological and pathological alterations[associtd with ascites]. They were randomly divided into three experimental groups and ascites were developed in two groups of animals by exposing them to low temperature or administration of triiodothyronine [T[3],], and the third group was used as control. Different hematological, biochemical and pathological tests were used to determine the incidence of ascites in birds. These include total red blood cell [RBC], hematochrit [PCV], activities of alanine transaminase [ALT] and aspartate transaminase [AST] and the ratio of right ventricular weight to total ventricular weight [RV/TV]. Two hydroxylated salicylic acid [SA] metabolites, 2, 3- and 2, 5-dihydroxy benzoic acids [2, 3- and 2, 5-DHBA], were measured. by HPLC system to detect the generation of hydroxyl [OH] radicals. An analysis of variance [ANOVA] was used to determine the differences between different experimental groups. Ascites syndrome was observed in T[3] and low temperature treated groups as shown by necropsy changes and significant increases [p < 0.05] in the amount of RBC, PCV, ALT, AST and the ratio of RV/TV. While the significant increase was shown in the amounts of 2,3- and 2,5-DHBAfrom day 11, the alteration in the values of enzymes and hematoloic parameters and ratio of RV/TV occurred from days 18, 25 and 32 respectively. It can be concluded that OH radicals may be involved in the initiation of ascites syndrome, but the biochemical, hematological and pathological changes induced by these agents, can cause ascites and other alterations

effect of community-based distribution on appropriate choices and maintenance of using contraception methods in Hamedan

Uncontrolled incremental trend of population growth is the basic problem in developing countries. Establishing family planning programs at an extensive level in these countries increases economical, social, and cultural advantages and decreases maternal and fetal mortality. One of the methods of implementing these programs is community-based distribution. CBD can effectively deliver family planning services at home. CBD facilitates family access to family planning methods that culminate in appropriate choices and continuity of using contraception methods. The aim of this study is to examine the effect of community based distribution on appropriate choices and continuity of using contraception methods among Hamedan households. This study is part of a larger study conducted by controlled field trial design. Using a multi-staged method, the researchers chose 297 subjects and divided them into two groups, control [n=100] and experimental [n=197]. The setting of the study was Hamedan households covered by field workers. Data collection tools were two questionnaires, three checklists, and one referral card. To determine the scientific validity of the tools, the researchers used the content validity method. The scientific reliability of the tools was determined through conducting the retrial method in a random sample of ten subjects. The findings revealed that through delivering family planning services at home, appropriate choices and continuity of using contraception methods were increased [p=0/001]. According to the findings of the present study, CBD led to appropriate choices and continuity of using contraception methods. Therefore, application of this kind of services is recommended. Also, the study of the effect of delivering this kind of services at villages, deserted places, different tribes, and its economic aspects are recommended

Comparison of the effect of omega-3 fatty acid supplementation with and without vitamin E in patients with rheumatoid arthritis

To test the hypothesis that an n-3 fatty acids [n-3] plus vitamin E supplementation is more effective than n-3 supplementation alone in improving the clinical, laboratory and inflammatory indices in patients with rheumatoid arthritis [RA]. A total of 55 RA patients [50 female, 5 male; mean age = 47 +/- 11y], in 3 groups, were included a double-blind randomized clinical trial. The groups were assigned to treatments as follows: group 1 [G1], placebo [2 g/d MCT oil + vitamin E placebo]; group 2 [G2], n-3 fatty acids [1/2 g/d EPA/DHA] +vitamin E placebo; group 3 [G3], n-3 fatty acids [1/2 g/d EPA/DHA] + vitamin E [100 IU/d]. Clinical, inflammatory, and laboratory indicators were determined at the baseline and at the end of the 6the and 12th weeks. Intra- and inter-group comparisons of the values obtained were made using repeated measure-ANOVA and ANOVA, respectively [p<0.05]. In G2 and G3, improvements in clinical, biochemical, inflammation, and oxidative indicators, as well as in the score of health status assessment [by interview] were more pronounced than in G1 [P<0.01]. Also, compared to G1, at the end of week 12 there were higher improvements in morning stiffness and the score of health status assessment in G2 and G3 groups [P<0.05]. Combination of n-3 fatty acids with vitamin E improved most of the clinical and laboratory indices in RA patients. However, there were no significant differences between G2 and G3 other than decreased oxidation and ESR

[ effect of obesity on spinal anesthesia for cesarean section]

Obesity is a global health problem with an increasing prevalence which affects different medical and health care domains including anesthesia. The present study was carried out to answer the question of which anesthesia technique is proper in obese parturients. The aim of this study was to evaluate the effect of obesity on blood pressure reduction, amount and dose of ephedrine, and sensory level duration of spinal technique for cesarean section. In this cohort study the treatment group consisted of 40 expectant women with body mass index [BMI] of over 30, and the control group comprised of 40 expectant women with BMI of under 30, who were all candidate for elective cesarean section: In both groups 70 mg of Lidocaine was injected into spinal cord from L4-L5 space. Then the mean blood pressure, the amount and dose of ephedrine, sensory level of block and duration of spinal technique were measured. The collected data was compared by statistical tests. There was no statistical different in mean blood pressure reduction and sensory level of block between the two groups. Duration of spinal tap, amount and number of ephedrine injection were higher in obese cases. Relative risk of receiving two or more times of ephedrine was 1.63 times higher in obese expectant women than in normal women. Spinal anesthesia is an appropriate method for cesarean section in obese expectant women and blood pressure reduction can easily be controlled by ephedrine

[Simultaneous determination of salicylic acid and its hydroxylated metabolites in poultry serum by HPLC]

To introduce an HPLC method for indirect measuring of hydroxyl radicals in poultry serum. Chromatographic study. Poultry serum. By acidification of serum with 1.0 M HCl, salicylic acid [SA] and its hydroxylated metabolites were extracted into diethylether, dried and redissolved in mobile phase buffer and HCl. It was filtered and 20 micro L of the filtrate injected into the HPLC system. The chromatographic condition was as follows: acetate-citrate buffer [94%]: methanol [6%] as mobile phase run at 1.2 ml/min through a C18 column using UV and EC detectors concurrently. Descriptive statistics good. Separations among these compounds obtained without any interference with poultry serum elements. Calibration curves for SA and Dihydroxy benzoic acids [DHBAs] were linear at 0.28-88 micro g/ml [R[2] =0.996] and 0.3 -12.3 micro g/ml [R[2] = 0.998], respectively. Detection limit for SA and DHBAs were 0.56 micro g/ml and 0.3 micro g/ml, respectively. Precision of the method [CV%] as intra- and inter-day variations were defined for SA [2.5 -6.5%, 4.4-6.8%], 2,3-DHBA [4.2-8.5%, 5.8-9.0%] and 2, 5-DHBA [4.1-6.8%, 5.9- 7.4%]. Recovery of the method for SA and DHBA were 87 +/- 5% and 92 +/- 4%, respectively. This method is useful for simultaneous determination of SA and its hydroxylated metabolites in poultry serum as an indirect measurement of hydroxyl radicals

[ prevalence of periarthritis in patients referred to rheumatology center of Shariati hospital [Tehran, 1996-2002]]

Soft tissue involvements are the most common types of rheumatic diseases. The prevalence of periarthritis in a study in the USA was 20-30% of all rheumatic diseases. The aim of this study was to estimate the prevalence, type, topography and treatment in these disorders. This cross-sectional descriptive study was done on 1600 files of patients that were visited in rheumatology center of Shariati Hospital between 1996-2002. The samples were selected randomly and systematically and the data were extracted. The prevalence of periarthritis was estimated 16.25% [260 cases]. Most of the cases with periarthritis were found in the age group of 40-50 years [26.6%] and the mean of age was 46.48 +/- 13.86. About 78.5% of patients were female and 21.5% were male. The most common forms of periarthritis were tendonitis and bursitis [64.6%] and the second rate was neurovascular [23.6%]. The most frequent disease was carpal tunnel syndrome 21.9% and shoulder capsulitis [13.5%]. Right upper limb and wrist [26.2%] were the most frequent sites of involvement and the rate of bilateral carpal tunnel was 42%. The rheumatic disease, as background, were found in 17.3% of patients. Bilateral carpal tunnel syndrome was the most frequent type of bilateral periarthritis which was statisticaly significant [p<0.001]. As the results showed periarthritis diseases are very common, specially carpal tunnel syndrome and shoulder capsulitis. The future studies need to evaluate the response to treatment, job and trauma must be considered because of their importance in etiology. This study can be considered as a basis study for future reserches

[Prevalence of hypothyroidism in Shariati Hospital 2003-2004]

Scleroderma is an important chronic disease with unknown ethiology and two subtypes: limited type: Skin involvement limited to distal of extremity and face. Diffuse type: Skin involvement is both distal and proximal of extremity, face and thrunk. Thyroid dysfunction is a main problem in these patients but there is no published data of Iranian scleroderma patients This is a cross-sectional study to determine the prevalence of hypothyroidism [clinical, subclinical and autoimmune] in patients with scleroderma 125 patients with scleroderma selected and T3, T4, TSH Anti Tpo Ab and Anti TG Ab measured in them. 33 patients with scleroderma had hypothyroidism. [%26/4]. Two patients with scleroderma had hyperthyroidism. [%1/6].%12/8 had clinical hypothyroidism. And%13/6 had subclinical hypothyroidism,%33/3 of patients with subclinical hypothyroidism and positive autoantibody had limited type. Where as%66/6 of patients with subclinical hypothyroidism and autoantibody had diffuse type,%28/5 of patients with clinical hypothyroidism and positive auto anti body had limited type. Where as%71/4 of patients with clinical hypothyroidism and auto anti body had diffuse type. All of patients with hyper thyroidism had diffuse type and autoantibody positive. It seems hypothyroidism has an increased prevalence in patients with scleroderma and we suggest that thyroid function test must be done in primary evaluation of these patients

[Comparison of the accuracy of diagnostic criteria of behcet's disease in children]

Different criteria for Behcet's diagnosis reveal that there isn't still consensus about the definition of this syndrome. Although a comprehensive study about the accuracy, the sensitivity and specificity of seven different types of diagnostic criteria for Behcet's disease in children, Ras not been performed we planned this study to compare these criteria in the Iranian children with Behcet's disease. Two random samples were selected from the patients less than 16 years of age referring to the Behcet's clinic of rheumatology research center. 177 children had definite diagnosis of Behcet's disease after being visited by the three professors of rheumatology experienced in Behcet's syndrome. Control group were children suspected to have Behcet's disease but it was ruled out. Sensitivity, specificity and accuracy of each of the Behcet's criteria were calculated. Mean age in Behcet's children was 13.6 years and in control group was 12.8 years. In the patients group female to male ratio was 1.1 and in the control group it was 1.3. Sensitivity of different criteria was as follow: Manson and Bames 55.1%, 0' Duffy 60.7%, International criteria 71.9%, Japan criteria 90.4%, Dilsen criteria 79.8%, Iran criteria 93.8%, and Iranian classification tree 94.4%. Specificity of the criteria was as following; M and B 99.5%, O Duffy 99.5%, International 100%, Japan 96.2%, Dilsen 94.6%, Iran 96.2%, classification tree 96.2%. Although some of the researchers believe that current diagnostic criteria of Behcet's diseases due to establishment on the adults clinical data, is not appropriate for children; our study revealed that the current seven Adult BD criteria are reliable and accurate in children too

[ relationship between triglyceride level - HDL level - tumor necrosis alpha factor and its soluble receptors with lupus erythematosus activity]

Systemic lupus erythematosus [SLE] is a disease with life-threatening complications. Since evidence indicates that measurement of triglyceride [TG] and HDL levels and tumor necrosis alpha factor [TNF- alpha] and its types I and II soluble receptors plays a major role in evaluation of lupus activity, this study was conducted to investigate the relationship between the above mentioned factors and lupus activity in Tehran in 2005. In this cross-sectional study fasting blood samples were obtained from 86 SLE patients who had been entered into the study through convenient sampling and the disease activity was calculated using the Systemic Lupus Erythematosus Disease Activity Index [SLEDAI]. Scores >/= 6 were considered as active lupus and <6 as dormant lupus. Serum levels of TNF- alpha, sTNFR[1] and sTNFR[2] were measured through ELISA [Bender Medsystem] and blood TG and HDL through routine biochemical tests within 12 hours overnight fasting. The results were analysed by t-test, Mann-Whitney and Pearson correlation tests. 46 people [53.5%] suffered from dormant disease and 40 people [46.5%] from active disease. TG level had significant relationship with disease activity, sTNFR[2] [P=0.001] and TNF-alpha [P=0/01], while HDL level had inverse significant relationship with SLEDAI [P=0.007], TNF [P=0.01], STNFR1 [P=0.001]. There was no significant relation between TG and HDL with STNFR2. Multiple linear analysis of regression showed that three variables [TG, sTNFR[1] and sTNFR[2]] are maintained in the model for prognosis of the disease while TNF-alpha and HDL are omitted. Dislipoproteinemia [elevated TG and reduced HDL] correlates with SLE activity following an increase in TNF-alpha and its soluble receptors. Thus, serum levels of TG, HDL and TNF-alpha and its soluble receptors are connected with lupus activity and are valuable markers for the disease activity

Quality of life in women with different intensity of low back pain

It is widely believed that pain has a profound effect on health related quality of life. This study was conducted to assess quality of life in patients suffering from different density of chronic low back pain. The sample consisted of 101 patients with chronic low back pain attending to the Rheumatology Research Center of Tehran University of Medical Sciences between July and September 2003. All patients were female, married, aged 18 years or over and underwent rheumatologic clinical examination. Data were collected by face-to-face interviews using the Iranian version of the Short Form Health Survey [SF-36]. Relative to mean score of bodily pain, patients were divided into 2 groups: severe pain group [group 1] and mild pain group [group 2]. Then, quality of life scores was compared between these two groups. Independent sample t-test was applied and the results showed that there were significant differences between quality of life scores among people with different intensity of low back pain in all dimensions but the role emotional and social functioning scales. The findings from this study confirm that quality of life in patients with low back pain depending on its intensity may vary

Ciliochoroidal Melanoma presenting as a Subconjunctival Mass

To report a rare case of ciliochoroidal malignant melanoma presenting as a subconjunctival black-colored mass adjacent to the limbus. A 42-year-old woman presented with a subconjunctival black-colored mass adjacent to the limbus in left eye from 2 years ago. The lesion had increased in size during the previous 2 months. Funduscopic examination with scleral depression disclosed a small mass at the cilioretinal junction. Gonioscopy revealed that the superior portion of the angle was occupied by the mass. Visual acuity and intraocular pressure were normal. Other systemic examinations were unremarkable. Because of extensive extraocular extension of the tumor, the left eye was enucleated and histopathologic examination of the globe disclosed a highly pigmented medium-sized ciliochoroidal malignant melanoma of mixed cell type together with marked anterior extrascleral extension. Results of 6-month follow-up for metastasis were negative.A darkly pigmented epibulbar mass may be the first manifestation of ciliochoroidal malignant melanoma