Tehran University Medical Journal

Rapid evaluation of mesenchymal stem cell injection technology on the treatment of cerebral palsy: a review study

Asma Sabermahani

Background: Cerebral palsy is a movement disorder syndrome in early childhood. Signs and symptoms vary among people and over time but include poor coordination, stiff muscles, and weak muscles. Some affected children can achieve near-normal adult lives with appropriate treatment. In recent years, transplantation of human mesenchymal stem cells (hMSC) has become a promising therapeutic strategy for CP. Every year, a lot of costs are spent on the treatment and management of this disease. The purpose of this study is to investigate the safety and effectiveness of this method on CP.

Methods: This article is a systematic review. At first, a search strategy was written and performed in Scopus, PubMed, and Google Scholar databases(The search was conducted from March 14 to March 28, 2021), and the inclusion and exclusion criteria were determined. Study inclusion criteria: review studies, cohort studies, clinical trial studies (randomized and non-randomized), control case, and retrospective , exclusion criteria: non-English articles and studying on animals. After removing duplicate articles, two authors independently reviewed the studies according to the inclusion and exclusion criteria. Disagreements among the authors were resolved through discussion.
Findings: In total, 9236 articles were found in the initial search, after reading the titles, of 37 articles, 21 articles were selected in the abstract stage and 18 articles remained in the full-text stage. We finally found 18 articles that showed that using stem cell technology as a scientific method could improve sick patients’ quality of life and movement defects.
Conclusion: According to the available evidence and limited studies, stem cell technology can be safeand cost-effective in improving CP patients, but there is insufficient evidence. On the other hand, there are many studies confirming the effectiveness of these cells in the treatment of movement impairment. In conclusion, stem cells may have a very promising future. Finally, stem cell technology combined with innovative biotechnologies may soon bring promising results to patients.

Prognosis of neonates in maternal diseases

Maryam Zakerihamidi

Background: Maternal diseases such as diabetes, hypertension, preeclampsia, hypothyroidism and epilepsy in pregnancy are associated with fetal and neonatal complications. The aim of this study was to compare the prognosis of neonates in maternal diseases.
Methods: This study was a cross-sectional study. The present study was performed on 600 preterm infants with mothers with diabetes, hypertension, preeclampsia, hypothyroidism and epilepsy. This study was done in Ghaem Hospital of Mashhad from March 2015 to April 2021 with available sampling. The data collection tool was a researcher-made checklist including infant (gestational age, Apgar score of the first minute, Apgar score of the fifth minute) and maternal (mode of delivery, prenatal care, premature rupture of the membranes) characteristics. Neonatal prognosis was compared at birth. All clinical and diagnostic examinations of newborns were performed by a neonatologist. Neonatal and maternal data in the group of newborns with normal mothers and newborns with maternal diseases were analyzed by Kolmogorov-Smirnov and Chi-square tests. The significance level was considered p≤0.05 in all cases.

Results: The results show that 161 newborns (28.90%) had normal mothers, 89 newborns (15.98%) had diabetic mothers, 117 newborns (21.01%) had hypertensive mothers, and 50 newborns (8.98%) had hypothyroid mothers. One hundred tweny newborns (21.72%) had mothers with preeclampsia, 19 newborns (3.41%) had mothers with epilepsy. Newborns with mothers with epilepsy had the lowest Apgar score of the first minute and the lowest gestational age and newborns with mothers with diabetes had the lowest Apgar score of the fifth minute. Mothers with hypothyroidism had the highest rate of premature rupture of the membranes and mothers with hypertension and preeclampsia had the highest incidence of cesarean section.
Conclusion: Maternal diseases including diabetes, hypertension, preeclampsia, hypothyroidism and epilepsy affect the prognosis of neonates in terms of the severity of prematurity, premature rupture of the membranes, type of delivery, Apgar scores of the first and fifth minutes. Therefore, proper control and treatment of these diseases may improve neonatal prognosis.

Success of gonadotropin replacement therapy in men with hypogonadotropin hypogonadism in urology and endocrinology clinics of Golestan Hospital in Ahvaz

Alireza Jahanshahi

Background: The treatment of male hypogonadotropic hypogonadism leading to infertility in men and caused by gonadotropin is the subject of the current thesis. In this research, particularly, the fertility rate has been noticed. However, changes in the secondary traits of testes size, induction of spermatogenesis, and hormonal activity have also been considered. this project is to investigate the effectiveness of the mentioned treatment in creating fertility in the spouses of patients and comparing it with other researches conducted in other centers of the world.

Methods: In this retrospective and descriptive-analytical study, men with isolated hypogonadotropic hypogonadism based on the normality of other pituitary axes who had a tendency to be fertile were studied. From November 2017 to February 2020, these patients had been referred to the doctor at the endocrinology and urology clinics of Ahvaz for fertility purposes. The initial test was based on clinical examinations and testosterone measurement and sperm count for the patients was recorded after the treatment. The treated patients simultaneously received HMG 75 units every other day (three times a week) and HCG 5000 units every other day. Hormonal evaluation and clinical examinations were assessed again.
Results: This research showed that the size of the testicles increased in 54.8% of these patients. Secondary characteristics (secondary hair growth) were developed in 88.9% of the patients. Spermatogenesis induction occurred in 36 patients, 29 of whom became fathers. Meanwhile, in 67.3% of patients, sexual desire and in 69.4% of them hormonal activity increased. In addition, it was observed that the response time to replacement therapy is more than 12 months in 47.5% of the patients. Moreover, 6.6% of the study samples had used assisted reproductive methods.
Conclusion: The results of this research indicate the timely initiation of treatment to improve infertility and treat hypogonadism among men.According to the results, it seems that the use of HMG and HCG in the treatment of hypogonadotropic hypogonadism disease is effective in creating secondary sexual characteristics and increasing hormonal activity and fertility.

Deep learning approach for motor imagery EEG signal classification

Faezeh Moghadas

Background: Brain-computer interface systems provide the possibility of communicating with the outside world without using physiological mediators for people with physical disabilities through brain signals. A popular type of BCIs is the motor imagery-based systems and one of the most important parts in the design of these systems is the classification of brain signals into different motor imagery classes in order to transform them into control commands. In this paper, a new method of brain signal classifying based on deep learning methods is presented.
Methods: This cross-sectional study was conducted at Isfahan University of Medical Sciences, School of Advanced Technologies in Medicine, from February 2020 to June 2022. In the pre-processing block, segmentation of brain signals, selection of suitable channels and filtering by Butterworth filter have been done; then data has transformed to the time-frequency domain by three different kinds of mother wavelets including Cmor, Mexicanhat, and Cgaus. In the classification step, two types of convolutional neural networks (one-dimensional and two-dimensional) were applied whereas each one of them was utilized in two different architectures. Finally, the performance of the networks has been investigated by each one of these three types of input data.

Results: Three channels were selected as the best ones for nine subjects. To separate 8-30 Hz, a 5th degree Butterworth filter was used. After finding the optimal parameters in the proposed networks, wavelet transform with Cgauss mother wavelet has the highest percentage in the both proposed architectures. Two-dimensional convolutional neural network has higher convergence speed, higher accuracy and more complexity of calculations. In terms of accuracy, precision, sensitivity and F1-score, two-dimensional convolutional neural network has performed better than one-dimensional convolutional neural network. The accuracy of 92.53%, which is obtained from the second architecture, as the best result, is reported.
Conclusion: The results obtained from the proposed network indicate that suitable, and well-designed deep learning networks can be utilized as an accurate tool for data classification in application of motion perception.

Investigating the effect of carboxytherapy in the treatment of urinary stress incontinency and sexual dysfunction in patients referred to the clinics of Isfahan University of Medical Sciences

Zahra Allameh

Background: The present study was performed to evaluate carboxytherapy as an outpatient and non-hormonal strategy for the treatment of a number of pelvic floor disorders.
Methods: This randomized block controlled clinical trial study was performed on 60 women aged 35-65 years in 1399-1400 to evaluate the effect of carboxytherapy on the treatment of stress urinary incontinence and sexual dysfunction in comparison with the control group. At the beginning of the study, vaginal examination, cough test and POP-Q test were performed for all patients. Eligible individuals were randomly assigned to either carboxytherapy or control groups. Stress urinary incontinence was assessed using the ICIQ-UI SF questionnaire and sexual dysfunction was assessed using the PISQ-12 questionnaire. In the intervention group, 30 cc of CO₂ gas with a 90-degree angle was injected in three areas of the bladder neck with the help of a needle gauge 30 with a length of 12 mm, so that each person underwent carboxytherapy twice a week for one month. The control group received the same protocol but without CO₂ injection. The results were assessed both at the beginning of the study and one month and three months after the intervention through physical examination and two questionnaires.

Results: The results of the present study showed that the mean of general sexual function index and also the mean index of sexual function of patients in the physical dimension and in the dimension related to sexual partner in the intervention group was significantly different during the two stages of measurement but no significant difference was observed in the control group. The overall score of urinary function, frequency of leakage and the effect of leakage on the quality of life of women in both control and intervention groups were significantly different between the three stages of measurement. While the rate of urine leakage in the intervention group was significantly different between times, no difference was observed in the control group.

Conclusion: Carboxytherapy is a safe, effective, acceptable, inexpensive, affordable, and accessible treatment option compared to other treatments for urinary incontinence, and better results can probably be achieved by increasing treatment sessions.

Evaluation of effective factors on the premature rupture of membranes in pregnant women referred to Afzalipour Hospital, Kerman

Background: Preterm premature rupture of membranes (PPROM) is one of the factors that can increase maternal and neonatal mortality, which is affected by several factors. This study aimed to investigate the factors affecting the frequency of preterm premature rupture of membranes in pregnant women.
Methods: This descriptive-analytical study was conducted in Afzalipour Hospital in Kerman from January 2018 to January 2019. All pregnant women with PPROM and normal pregnant women referred to this Hospital were included in the study through convenient sampling. The data collection tool was a checklist containing patients' demographic information (age, education, occupation, gestational age, number of pregnancies, urinary tract infection (confirmed by the attending physician), history of premature rupture of the water sac, vaginal bleeding (bleeding in any period of pregnancy as the person had visited the doctor), history of premature birth, pregnancy care and trauma (any trauma)). To analyze the data, descriptive statistics (frequency, percentage, mean, and standard deviation), analytical (Chi-square test) and SPSS software version 22 were used.

Results: In this descriptive-analytical study, 400 pregnant women were studied. Two hundred of pregnant women had preterm premature rupture of membranes and 200 of pregnant women did not have such condistion and were normal. The mean age of pregnant women was 27.4±5.4 years old and the mean gestational age of pregnant women was 34.1±2.1 weeks. The mean parity of pregnant women was 2.3±1.4. Risk factors such as maternal age (P=0.011), number of pregnancies (P=0.035), maternal education (P=0.018), history of preterm premature rupture of membranes (P=0.046), history of preterm delivery (P=0.019), trauma (P=0.037) and pregnancy care (P=0.037) affected preterm premature rupture of membranes.
Conclusion: The results of this study showed that maternal age, number of pregnancies, maternal education, and history of preterm premature rupture of membranes, history of preterm delivery, trauma, and prenatal care are risk factors for PROM. Therefore, by educating pregnant mothers about these risk factors, the incidence and complications of preterm premature rupture of membranes can be reduced.

Real-time tracking of hypoxia glycolysis in conization samples for cervical intraepithelial neoplasia detection

Zohreh Sadat Miripour

Background: Although cervical cancer in adult women with early diagnostic tests has better treatment ability and disease management, precise and fast diagnosis of any signs of cervical intraepithelial neoplasia (CIN) I-III and high-risk dysplasia is vital. If any precancerous/abnormal suspicious cells are not detected in the routine diagnostic process (pathology), they cannot be treated before the lesion turns into cervical cancer, consequently help increasing the patient’s survival rate.
Methods: In this clinical study, the efficiency and diagnostic accuracy of the electrochemical measuring device of glycolysis metabolism in cancer cells (HEA: Hypoxia electrochemical assay) on in-vitro human fresh cervical samples were studied. The samples were prepared from 40 candidates of conization through a history of abnormal cell presentation in their pap smear results. The study was conducted at the Gynecology Department, Yas Hospital, Tehran University of Medical Sciences, and assistant hospitals from August 2018 to June 2021. Patients provided consent according to an ethically approved protocol. A CIN-based scoring of HEA responses was proposed by considering the pathology reports of HEA-tested regions.

Results: The diagnostic calibration of the sensor was achieved by comparing the ROS/H₂O₂ electrochemical current related to cell glycolysis with the presence of cancer cells in the samples' histology. The current diagnostic threshold obtained by the sensor to differentiate cancerous areas from others showed an accuracy of 95% (P<0.0001). The accuracy and sensitivity of the sensor were 95% and 100%, respectively. Therefore, a matched clinical diagnostic classification between the pathological results of tested tissues and the sensor's electrochemical ROS/H₂O₂ response was proposed based on CIN categorization.

Conclusion: Further pathological evaluation of the tested samples showed that electrochemical detection of glycolysis metabolism in cervical conization specimens could detect 10% of CIN lesions missed by conventional pathology of assayed patients, which was confirmed in the pathology re-examination. Therefore, as a complementary method, it can help better diagnose CIN lesions in the conization.

Investigating factors affecting the response to treatment in patients with ITP

Saeed Karimi Matlob

Background: Idiopathic thrombocytopenic purpura (autoimmune), the most common cause of acute onset of thrombocytopenia in children who are otherwise healthy. This study was conducted with the aim of investigating the factors affecting the response to treatment in hospitalized children.
Methods: This retrospective study was conducted by examining the files of patients hospitalized due to ITP in Hazrat Masoumeh (S) Hospital from April 2009 to March 2019. The criteria for inclusion in the study included confirming the diagnosis of ITP and the age of 1 month to 14 years, and the exclusion criteria included cases of discharge with personal consent and not completing the patient's treatment course, the presence of pancytopenia or bicytopenia, the presence of moderate or severe splenomegaly or severe in clinical examinations, BMA based on the presence of a diagnosis other than ITP, not receiving any of the ITP treatment protocols, and patients whose first visit with the diagnosis of ITP was in another center or city. The information about age, sex, clinical symptoms on arrival, initial platelets and the platelets of days 3, 5, 14 and 180 were extracted from the patients' files. The type of treatment protocol, the need to repeat the treatment, the recurrence of the disease and the major complications of the treatment were extracted from the patients' files and finally the data were analyzed with SPSS software.
Results: The response to the treatment on different days was unrelated to the age, gender, and initial platelets (except for one exception) (P>0.05). In relation to clinical symptoms, the response to treatment on days three and five was related to the clinical symptoms at the time of presentation and on days 14 and 180 it was unrelated. Response to treatment on days 3 and 5 in different treatment protocols had a significant relationship (P<0.05), but there was no significant difference on days 14 and 180.

Conclusion: The best response was in the combined treatment group with methylprednisolone and IVIg, and the lowest response to treatment was observed in those receiving methylprednisolone alone.

Outcome evaluation of patients with acute lymphocytic leukemia treated by Hyper-CVAD chemotherapy regimen in Omid Hospital, Isfahan, Iran.

Azadeh Moghaddas

Background: Since numerous chemotherapy regimens for the treatment of patients suffering from acute lymphoid leukemia (ALL) have been recently developed, having basic information about the previous results of using the Hyper-CVAD regimen in order to compare with other common chemotherapy regimens is essential. The aim of this study was to evaluate demographic, clinical and outcome of ALL patients receiving Hyper-CVAD regimen.
Methods: In this retrospective study, nighty eligible ALL patients treated with the Hyper-CVAD chemotherapy regimen in Omid Hospital, Isfahan, Iran during April 2016 till April 2019 were considered. We evaluated the demographic variables, pathological data and other clinical factors by an information sheet designed by main investigator. The main purpose of this study was to evaluate overall survival, progression-free survival, and overall response rate of patients along with patients’ clinical characteristics and other relevant factors using Kaplan-Meier or Cox-regression and other statistical analyses.

Results: The mean overall survival and the median survival of patients were 44.8±2.93 and 36.7±7.47 months; respectively. Also the mean progression free survival of patients was 44.44±3.30 months. More than 84.4% of patients encountered complete remission (CR) after receiving Hyper-CVAD regimen. Reaching to CR had positive significant effects on patients’ overall survival and median survival. However, the bone marrow transplantation variable alone did not affect the patients’ overall survival. The variables such as being B/T Cell ALL, Philadelphia, myeloid marker, and central nervous system involvement did not affect the overall survival of patients but the relapse index indicated the significant effects. The median survival time is higher in patients with no relapse episode. None of the initial lab data had any significant effects on patients’ overall survival.
Conclusion: For the first time in Iran, we have obtained the mean survival outcome of ALL patients after applying the Hyper-CVAD regimen. According to the results, the mean overall survival, progression free survival and other survival items in Iranian patients suffering from ALL and receiving Hyper-CVAD regimen were in consistent with previous studies in the world.

Isolated Fallopian Tube Torsion with Fimbrial Cyst in a Pregnant Woman: A case Report

Salahedin Delshad

Background: Among diseases causing acute lower abdominal pain in women, isolated fallopian tube torsion is a rare cause that occurs mainly in women of reproductive ages and if left untreated can lead to fertility problems. Immediate diagnosis and timely surgery are urgent and necessary to preserve the fertility of females. Successful pregnancy with simultaneous involvement of isolated fallopian tube torsion is one of the rare operations in the world.
Case Presentation: The reported case is a 37-year-old pregnant woman (Gravid 2, with 33-week gestational age) with nausea, vomiting and abdominal pain in August 2020 who presented to the Maryam Hospital in Karaj in August 2020. The patient was examined in the operating room under anesthesia, and pain in the right and lower abdomen was observed. There was no anorexia, and on examination, there was severe tenderness in the right lower quadrant (RLQ) area. There was no pain in other parts of the abdomen. Ultrasonography in the patient's tenderness showed an image of a tubular and cystic structure measuring 30×10 mm. In CBC test, leukocytosis with high PMN (Polymorphonuclear), (WBC: 11700 mm3 and Neutrophil: 78%) was observed. During laparotomy, isolated torsion of the right fallopian tube observed, half of which was cyanotic. Due to the confirmation of fimbriae necrosis during surgery, preservation of uterine tube integrity, fallopian tube detorsion, excision of cyanotic fimbriae and hemorrhagic cyst of fimbriae, intra-abdominal fluid suction and fimbriae repair performed. The patient discharged in good condition after two days and gave birth to a healthy baby at 38 weeks of gestation by cesarean section.

Conclusion: Isolated fallopian tube torsion should be considered as a potential differential diagnosis in patients that have acute lower abdominal pain in women of reproductive ages and even adolescents. Early diagnosis and early surgical intervention are critical to maintaining the fallopian tube and fertility in the future. Laparoscopy is one of the main diagnostic tools for assessing, management and maintenance isolated torsion of the fallopian tube.

Managing conflict of interest in health sector: a letter to the editor

Ali Mohammad Mosadeghrad