Purpose – The purpose of this paper is threefold, first to investigate if ISO 9001 certified companies in an Iranian province (Kermanshah) perform better than non-certified ISO 9001. Second, what is the main motivation of the manufacturing companies of Kermanshah province on obtaining ISO 9001 certification, i.e., internal or external motivations. And finally, if ISO 9001 certified companies with high scores of internal motivations, show better levels of performance in comparison with certified companies obtaining low scores of internal motivations. Design/methodology/approach – A survey questionnaire was distributed to the 350 companies with ISO 9000 certification, and a total of 287 usable responses were returned. Using a structural equation model, this study empirically examines the relationship between ISO 9000 implementation and firm performance, and the moderating role of firm motivation on organizational performance. Findings – The results demonstrate that ISO 9001 certified companies show better organizational performance than non-certified ISO 9001 companies and internal motivations play more important role on obtaining ISO 9001 certificate than external motivations. Also ISO 9001 certified companies with high scores of internal motivations show better levels of performance than those ISO 9001 certified companies with low scores of internal motivations. Research limitations/implications – The sample is restricted to only a single region and manufacturing, so it would be strongly recommended that data be gathered from various parts of Iran including both manufacturing and service industries. As in this study the data gathered were cross-sectional, it is recommended in order to gain deeper understanding of the cause-and-effect relationship among the variables data to be gathered longitudinally. Originality/value – This study represents a first attempt to construct a conceptual framework that integrates the motivations behind implementing ISO 9000 certification, and ISO 9000 performance in the context of Iran and gives a particular focus on the Iran manufacturing companies.

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U p to 30% of the orbital masses are metastatic. Breast carcinoma is the most common primary source of orbital metastases in 29-51% of cases, followed by lung, prostate, and colon cancer. Overall, 25-45% of patients present with orbital symptoms as the initial feature of their primary cancer. Autopsy reports reveal this form of metastasis in 10-30% of breast cancer patients. Infiltrative or inflammatory syndrome is the initial presentation in nearly 54% of patients, which can be misdiagnosed as scleritis, myositis, enophthalmitis, or inflammatory pseudotumor.A 53-year-old woman presented with a 2-month history of left orbital pain and mild proptosis. Slitlamp biomicroscopy showed only conjunctival vascular injection. Computed tomography and magnetic resonance imaging scans showed an intraorbital, intraconal infiltrative process of the medial wall of the left orbit (Fig. 1).Biopsy of the lesion showed infiltration of the orbital connective tissue, muscles, and lacrimal gland by signet ring cells with relatively bland monomorphic round to oval eccentric nuclei arranged in a sheet or single file with occasional cells showing intracytoplasmic mucin droplets. Subsequent Alcian blue/periodic acid-Schiff stain confirmed an occasional mucin droplet with a bull's eye pattern which made us consider lobular carcinoma of the breast. Immunohistochemistry for cytokeratin and estrogen receptor revealed strong cytoplasmic membrane and nuclear staining, respectively, favoring a diagnosis of breast carcinoma (Fig. 2).Reevaluation of the patient by a breast surgeon revealed a mobile anterior right-side neck lymph node and nodularity of the outer lower quadrant of the right breast. Mammography showed an irregular density in the lower outer quadrant of her right breast without calcification (Fig. 3). Stereotactic wire-guided open excisional biopsy of the mass was done and confirmed the diagnosis of invasive lobular carcinoma (Fig. 4). Figure 1. Computed tomography scan showing an infiltrative mass along the medial orbital wall of the left eye (arrow).

Objectives: Hydrotherapy treatment is a type of complementary therapy which is administered in conjunction with other conventional modes of treatment for the treatment and rehabilitations of cerebral palsy patients. Though it has gained increasing popularity in many countries around the world, its application in Iran is still rare. The aim of this study was to perform an integrative review of the extant literature in the field of hydrotherapy and its applications for the improvement of ICF (International Classification of Functioning, Disability and Health) in spastic diplegia cerebral palsy patients. The review encompassed multifactorial analysis of the articles published between 2000 and 2016.Methods: All related articles published in Iran as well as other countries from across the world (during the last sixteen years) with the keywords: hydrotherapy, cerebral palsy, participation, play, motor function, body function and body structure, were extracted from databases such as Science direct, PEDro, CINAHL, PubMed, ProQuest, magiran. The articles thus obtained were selected for evaluation and analysis.Results: More than 33 papers were found from the literature search (as specified above). Of these, 18 articles were eliminated due to unrelated materials and addressing methods other than hydrotherapy rehabilitation. Of the remaining 15 papers that directly corresponded to the effect of hydrotherapy on improving ICF of spastic diplegia cerebral palsy patients, 11 articles were investigated in this review. The abstracts were evaluated first, followed by the full texts of the 11 articles that met the inclusion criteria. Discussion:The results of the review showed that hydrotherapy when applied along with other conventional methods of rehabilitation, exerts positive effects on all areas of ICF. Hydrotherapy can be used in children and adolescents with spastic diplegia cerebral palsy, but the exercises chosen must be in accordance with the physical and cognitive conditions of the patients. However, studies in some areas of ICF are limited and further studies in this field are felt.

Background:It has been established that presence of lean umbilical cord with reduced Wharton’s jelly in sonographic scans is a fetal marker for risk of small for gestational age at birth. With improvement of ultrasound techniques, more studies have been investigating the alterations of the umbilical cord on pregnancy outcomes.Objectives:To determine the reference ranges of the umbilical cord area during pregnancy and to find out the association between umbilical cord morphometry and fetal anthropometric measurements.Patients and Methods:A cross sectional study was carried out on a study population of 278 low-risk pregnant women between 15 and 41 weeks of gestational age. Fetal anthropometric measurements including biparietal diameter, abdominal circumference, and femur length were calculated. The measurements of the cross-sectional area (CSA) and circumference of the umbilical cord, vein and arteries were done on an adjacent plane to the insertion of umbilical cord into the fetus’s abdomen. The mean and standard deviation of the CSA of the umbilical cord and the 5th, 10th, 50th, 90th, 95th percentiles of it were calculated for each gestational age. Pearson correlation coefficient was used to assess the correlation between the measures of the cord and fetal anthropometric measurements. Polynomial regression analysis was performed for curves.Results:The values of the CSA of the umbilical cord, umbilical vein and Wharton’s jelly (WJ) increase consistently until 30 weeks of gestation, after which they reach a plateau. There was a significant correlation between anthropometric measurements and umbilical cord measurements especially with the CSA of the umbilical cord, umbilical vein and WJ. The regression equation for the umbilical cord CSA according to gestational age up to 30 weeks was y = -0.2159 x2 + 23.828x-325.59 (R2 = 0.6334) and for the WJ area according to gestational age up to 30 weeks, it was y = -0.2124 x 2 +17.613x-221.66 (R2 = 0.4979).Conclusion:Reference ranges for umbilical cord CSA have been generated. The CSA of the umbilical cord and other components of it increase as a function of gestational age. These measurements correlate with fetal size.

Background:Hysterosalpingography (HSG) is considered as a primary test in infertility work up worldwide due to its reliability in evaluating abnormalities related to the uterus and fallopian tubes.Objectives:To assess the efficacy of applying eutectic mixture of local anesthetics (lidocaine-prilocaine cream) (EMLA) on the uterine cervix in reducing pain during HSG.Patients and Methods:Eighty patients undergoing HSG as part of infertility evaluation were randomly allocated to groups receiving either EMLA (N = 40) or placebo cream (N = 40) in a double-blinded prospective study. Fifteen minutes before HSG, 5 grams of 5% cream was applied to the uterine cervix using a cervical applicator. The degree of pain experienced by the patient was evaluated during and after HSG at five predefined steps on a visual analogue scale (VAS).Results:There was no significant difference in the efficacy between EMLA and placebo creams in pain perception during the entire procedure. There was no significant difference in long term pain perception half an hour after the HSG performance.Conclusions:This study does not support the use of EMLA for HSG.

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