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Farshid Farhan , Cyrus Azimi , Majid Mahmoodi , Mohammad-Ali Mohagheghi , Farideh Farzanfar , Azam Noor-Mohammadi, Malihea Khaleghian , Abbas Jafari , Mehrangiz Ghaem-Maghami , Kouros Divsalar ,
Volume 74, Issue 1 (April 2016)
Abstract

Background: It is reported that high frequency of chromosomal aberrations in peripheral blood lymphocytes of individuals is a marker of cancer predisposition. The aim of this study was to investigate the in vitro frequency of chromosomal damage in lymphocytes of patients with head and neck cancer against gamma irradiation compared with those in healthy individuals.

Methods: In a case and control study, peripheral blood lymphocytes of 101 patients with head and neck cancer were collected before the onset of radiotherapy. Lymphocytes of 40 healthy individuals were also collected as controls. Head and neck cancer patients and the control group were consecutively recruited between April 2012 and February 2015 from Clinics of Cancer Institute, Imam Khomeini Hospital, Tehran, Iran. Lymphocytes of patients or control group were cultured and exposed to gamma radiation in G2- and G0- phase of the cell cycle. The induced chromosomal aberrations such as chromosome and chromatid breakages, chromosome and chromatid gaps, chromatid exchanges and micronuclei were scored in one-hundred metaphase cells of each individual. The mean of each chromosomal aberration was compared in patient and control groups. Early and late tissue reactions were scored during radiotherapy treatment or thereafter.

Results: There was no significant difference in demographic characterization between the two study groups. The frequency of radiation- induced G2 aberrations in lymphocytes of patients was significantly higher than in those of healthy donors (P= 0.001 for chromosomal breaks). The frequency of radiation-induced micronuclei in G0 assay was also higher in patients than in those in controls (P= 0.05). The results also indicate that there is no correlation between the two assays. No significant correlation was also observed between aberration frequencies in lymphocytes and the degree of both early and late normal tissue reactions.

Conclusion: The results indicate that the in vitro chromosomal radiosensitivity of peripheral blood lymphocytes of patients with head and neck cancer against gamma irradiation was significantly higher than that in healthy individuals.


Farid Abassi , Mandana Sattari , Noushin Jalayer Naderi, Marzie Sorooshzadeh ,
Volume 74, Issue 5 (August 2016)
Abstract

Background: Hydroxyapatite nanoparticles have a more surface contact and solubility than conventional hydroxyapatite. Hydroxynanoparticles enhances the biological and mechanical properties of new regenerated tissues. The hydroxyapatite nanoparticles have received attention as a new and effective osseous graft for using as scaffolds in bone regeneration. The reports on hydroxyapatite nanoparticles biocompatibility are controversial. It has been shown that hydroxyapatite nanoparticles induces inflammatory reaction and apoptosis. The aim of the present study was to evaluate the cytotoxicity of nano-hydroxyapatite on the human epithelial cells.

Methods: The study was experimental and completed in vitro. The study was carried out in department of Immonulogy, Faculty of Medicine, Shahid Beheshti University of Medical Sciences in November 2014. The human-derived oral epithelium cell line (KB) obtained from Pasteur Institute, Tehran, Iran were exposed to hydroxyapatite nanoparticles at 0.01, 0.05, 0.1, 0.5, 0.75, 1, 2.5 and 5 mg/ml concentrations in 24, 48 and 72 hours. Rod-shaped hydroxyapatite nanoparticles with 99% purity and maximum 100 nm sized particles were used. Methylthiazol tetrazolium bromide (MTT) method was employed for cell vitality evaluation. Enzyme-linked immunosorbent assay (ELISA) was used for assessing the viability of cells. Distilled water and fetal bovine serum (FBS) were positive and negative controls. ANOVA and Duncan tests were used for statistical analysis.

Results: The cytotoxicity of different concentrations of hydroxyapatite nanoparticles on human-derived oral epithelium cell line in 24 (P< 0.001), 48 (P< 0.001) and 72 hours (P< 0.001) was significantly different. The nano-hydroxyapatite particles at 0.5 to 1 mg/ml had the highest cytotoxicity effect on human-derived oral epithelium cells in 24, 48 and 72 hours. Lower concentrations than 0.05 mg/ml had the best biocompatibility properties in 24, 48 and 72 hours.

Conclusion: Hydroxyapatite nanoparticles had a good biocompatibility. The biocompatibility of hydroxyapatite nanoparticles were dose and time dependent. The lower concentrations than 0.05 mg/ml of nano-hydroxyapatite had the best biocompatibility over time.


Farideh Zafari Zangeneh, Mohammad Mehdi Naghizadeh , Masoumeh Masoumi ,
Volume 74, Issue 7 (October 2016)
Abstract

Background: Polycystic ovary syndrome (PCOS) is a common complex condition in women associated with reproductive and metabolic systems and also psychological disorders. There is considerable evidence to suggest that the sympathetic nervous system is involved in PCO and metabolic syndromes. Noradrenalin (NA), corticotrophin releasing hormone (CRH) and nerve growth factor (NGF) are the strong stimulants for two axes: hypothalamic-pituitary-adrenal (HPA) and hypothalamic-pituitary-ovarian (HPO) axes which are regulators for the female reproductive system. Following previous studies on sympathetic nervous system over activity in PCOS, the main purpose of this study is to evaluate the role of CRH and NGF as two important findings from the perspective of the psycho-emotional.

Methods: This case-control study was conducted in Reproductive Health Research Center of Imam Khomeini Hospital, Tehran, Iran in the September of 2011. 170 women participated in this study. The diagnosis of PCOS was made according to the joint criteria of the European Society of Human Reproduction and Embryology and the American Society of Reproductive Medicine (ESHRE/ASRM). All women have 20-40 years of age and body mass index (BMI) of less than 28. Demographic questionnaire was used in this study and blood sample was obtained from all participants before 8AM. All analysis was done in SPSS software, version 19 (IBM SPSS, Armonk, NY, USA). P-value less than 0.05 considered as significant level.

Results: Serum levels of CRH and NGF in patients with polycystic ovary was significantly lower than the control group (P< 0.001). This reduction can disrupt two neural axes: the sympathetic nervous system (SAS) and hypothalamus-pituitary-adrenal (HPA). These axes have a fundamental role in psycho-emotional reactions in women with PCOS. Moreover, using demographic questionnaire quantitative and qualitative characteristics of the population studied, the results of which are reported in the regression model.

Conclusion: The results of this study confirmed previous studies. This reduction in serum levels of CRH and NGF shows the hyperactivity of sympathetic nervous system in polycystic ovary syndrome can be one of the causes of mental disorders in women with PCOS.


Farid Suleimani Mohammadi , Abbas Rahimi Foroushani , Mohsen Rokni , Mohammad Farahmand , Kazem Ahmadi Kia , Azadeh Shadab , Hamidreza Ahmadkhaniha, Jila Yavarian ,
Volume 74, Issue 11 (February 2017)
Abstract

Background: Schizophrenia (SC) and bipolar disorder (BD) are two chronic psychiatric illnesses with worldwide distribution. People could be involved at any age, particularly in early adolescence. Main symptoms of SC are non- affective symptoms such as auditory hallucination and illogical thinking. In contrast, BD represents affective symptoms such as depression and mania. Although the main cause of these mood disorders has been remained elusive, there are some potential contributing factors that could be considered in the pathogenesis of mentioned illnesses including, genetic and environmental factors. Cytomegalovirus (CMV) is one of the probable contributing factors in SC and BD. CMV is a prototype of herpesviridae family which may infect different cell types such as endothelial and differentiated hematopoietic cells. CMV infections in immunocompromised patients as well as congenitally infected children represent CNS complication such as microcephaly and hearing loss. This virus has capability to impair the limbic structures in brain.

Methods: This descriptive study was designed to evaluate the role of CMV in these illnesses. We investigated the level of serum IgG antibody and the presence of CMV DNA in serum and peripheral blood mononuclear cells (PBMCs) samples of 46 SC and BD patients admitted to Iran Psychiatry Hospital Tehran, Iran from 2014 to 2015 as well as 46 healthy control groups at Tehran University of Medical Sciences.  First, the level of CMV IgG antibody was evaluated in serum samples, by enzyme-linked immunosorbent assay (ELISA). Then, DNA extraction conducted by using the high pure viral nucleic acid kit (Roche, Germany). Serologically positive sera along with PBMC samples were tested by Real-time PCR, to investigate the presence of CMV DNA.

Results: Results indicated higher levels of CMV IgG antibody in psychiatric patients, compared with a healthy control group. Afterward, we did not observe the presence of CMV DNA in either case or control groups.

Conclusion: According to the CNS impairment mediated by CMV infection, this virus has been supposed to play an important role in pathogenesis of mental disorders such as SC and BD. We suggest further investigation to be conducted, particularly on other samples such as cerebrospinal fluid.


Davood Azimpour , Nahid Tahan , Fereshteh Poursaeed , Farideh Dehghan Manshadi , Erfan Ghasemi ,
Volume 75, Issue 5 (August 2017)
Abstract

Background: Spasticity is a clinical deficit of upper motor neurons lesions that presented immediately or at delayed times after lesions and occurs in about 38% of stroke patients. Extracorporeal shock wave therapy (ESWT) has been recently reported as a safe and effective method for reducing spasticity in stroke patients. In the present study, we sought to investigate the impact of the ESWT on post stroke spasticity using a meta-analysis method.
Methods: All primary reports of spasticity indexed in PubMed, MEDLINE, Science Direct, Scopus and search engine of Google Scholar from January 2000 to December 2016 were searched. The following terms were used as keywords: Spasticity, muscle hypertonicity, ESWT, stroke and hemiplegia. Any report was included if it met the following criteria: involving clinical trials, full-version availability, and being written in english. Two reviewers selected articles independently and reviewed the studies considering quality and eligibility, and then they extracted general information on objectives, design, participants, and outcomes. The methodologic quality of each study was assessed using the Pedro Scale. In the statistical analyses, we considered two outcomes; Modified Ashworth scale (MAS) grade and passive rang of movement (PROM). The meta-analysis was done using random effect model in Stata, version 11 (Stata Corp., TX, USA).
Results: Eleven studies within a total of 261 patients were included in this review. In seven studies the shock waves were applied to the upper limb muscles, and in four other studies, the effects of ESWT on the spasticity of the lower limb muscles were assessed. Immediately after applying the ESW, MAS grade was significantly decreased in comparison to the baseline values. (Standardized mean difference [SMD], -1.62; 95% confidence interval [CI], -2.2 to -1.04). The PROM was significantly increased immediately after ESWT in comparison to the baseline values (SMD, 3.23; CI 95%, 1.35 to 5.12).
Conclusion: The results of this study showed that ESWT can immediately improve the spasticity and increased PROM, but it seems that the mechanism of action of shock waves on spasticity is still unclear. Further clinical trial studies with higher methodological quality should be recommended.

Fateme Khosravi Node , Farida Behzadian , Vahideh Mazaheri , Hadiseh Shokouhi , Maryam Saleh , Behrokh Farahmand ,
Volume 75, Issue 8 (November 2017)
Abstract

Background: Each year, Human influenza A (H1N1) virus causes moderate to severe infections with a high prevalence throughout the world. Accordingly, the rapid, sensitive and cost-effective laboratory diagnosis based on viral antigen detection is important. Moreover, the generation of specific antibodies directed against Influenza antigens is essential to the success of both basic and applied research programs. Hemagglutinin (HA) is the major surface envelope glycoprotein of influenza virus, which is subsequently cleaved into two subunits, HA1 and HA2. Since most antigenic sites are in the HA1 domain of HA, HA1 domain of influenza virus was studied as antigen to produce polyclonal antibody.
Methods: In this experimental study we expressed and purified the recombinant HA1 protein in the second half of 2015 at department of influenza and other respiratory viruses, Pasteur Institute of Iran and then prepared the polyclonal rabbit antibody against it. The vector of pET28aHA1 expressing HA1-His tagged protein of H1N1 influenza A/PR/8/34 virus was used for large scale production of HA1 into E. Coli (BL21). By changing expression conditions such as IPTG (Isopropyl β-D-1-thiogalactopyranoside) concentration, time and temperature of incubation, the expression conditions for HA1 were optimized. The total cell protein harvested and purified by nickel affinity chromatography. All above mentioned experiments monitored by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE).
Results: The efficiency of HA1 recombinant protein was high, equal to 400-600 mg/ml of cell lysate. The polyclonal antibody was prepared by immunizing the rabbits using recombinant HA1 with Freund’s adjuvant according to standard protocols. Efficiency of the antiserum evaluated by enzyme linked immunosorbent assay (ELISA). Determination of antibody level in the collected antiserum using serum-based ELISA showed that the specific antibody has risen well through the immunization schedule.
Conclusion: Our data shows that this polyclonal antibody has potential to be produced in rabbit. It will also be used in the future in influenza diagnosis as well as in other immunological applications such as western blot analyses, immunocytochemistry, and immunohistochemistry.
 

Razieh Nazari , Mehri Ghasemi , Farideh Dehghan-Manshadi , Alireza Akbarzadeh-Baghban ,
Volume 75, Issue 9 (December 2017)
Abstract

Background: Sonography is used for measuring the muscle morphology including length, depth, cross-sectional area, bulk and pennation angle. The supraspinatus is the most common affected muscle among the rotator cuff muscles. There is no study about the reliability of sonographic measurement of supraspinatus thickness in the positions of empty can (EC), full can (FC) and hug up (HU) tests. The present study aims to investigate the intra-rater reliability of the measurement of sonographic thickness of supraspinatus muscle in the rest and positions of the EC, FC and HU tests.
Methods: The present study was a descriptive-analytic study which was carried out in a cross-sectional method on ten healthy women aged: 22.10±2.76 years without any tendon pathology. The study was carried out during four weeks (January to March in 2017). The supraspinatus thickness was scanned during rest and contracted states. The positions of measuring ultrasonic thickness of supraspinatus were as follow: position of EC test: the arm in 90-degree elevation in the scaption plane with the thumb-down, position of FC test: the arm in 90-degree elevation in the scaption plane with the thumb-up, position of HU test: the palm of hand was placed on the opposite shoulder with the elbow flexed using a 0.5-kg weight cuff. Intra-rater reliability of ultrasonic muscle thickness measurements were examined in one day.
Results: All intra-rater reliability values were equal or more than 0.90: the value was 0.90 (95%CI: 0.65-0.97) in the rest position, while for the measurement of ultrasonic thickness of the supraspinatus was 0.96 (95%CI: 0.87-0.99) in the position of EC test, 0.97 (95%CI: 0.90-0.99) and 0.96 (95%CI: 0.86-0.99) in the positions of FC and HU tests, respectively.
Conclusion: Measurement of ultrasonic thickness of supraspinatus muscle is a reliable method in the rest and positions of EC, FC and HU tests. This method can be used to compare the muscle thickness changes in the positions of the above tests.
 

Farideh Zafari Zangeneh , Mohammad Mehdi Naghizadeh , Maryam Bagheri ,
Volume 76, Issue 1 (April 2018)
Abstract

Background: Polycystic ovary syndrome (PCOS) is one of the most common neuroendocrine-metabolic disorders at the infertile age. Patients with PCO often at risk for secondary complications including metabolic difficulties (impaired glucose tolerance, insulin resistance, type 2 diabetes mellitus), reproductive (hirsutism, hypeandrogenism, infertility) and psychological features (worsened quality of life, anxiety, depression). Studies of the past decade suggest that the quality of life is important in the improvement of this syndrome. The purpose of this study was to provide an accurate pattern in the lifestyle of these women.
Methods: This case-control study was conducted to assess the lifestyle of patients with polycystic ovary syndrome who referred to Vali-e-Asr Infertile Clinic of Imam Khomeini Hospital, Tehran, from March to February 2015. After filling the consent form, 168 women participated in this study with the age range of 20-40 years and the body mass index (BMI) less than 28 m2/kg. The dimensions of lifestyle in this study were evaluated by the following questionnaires: general qualities of life (GHQ-28), Pittsburgh sleep quality, depression-anxiety-stress (DASS-42) and researcher-made demographic questionnaire.
Results: The mean of BMI and weight in study group were higher than control group (P= 0.002) (P< 0.001). Symptoms of PCOS such as irregular cycle (P< 0.001) and hirsutism (P< 0.001) in the study group were greater than the control group. Sleep problems such as drug use (P= 0.048), late sleep (P= 0.024), and sleep adequacy (P= 0.049) were also higher in the study group than control group.
Conclusion: These results indicate that environmental factors can easily effect on the quality of life in PCO women. The pattern of sleep is not desirable. Menstrual disorder effects on the mood and the impact of the low income generates negative emotions and affects their quality of life, since the cost of treatment for infertility is high for the low-income families. Therefore, this study indicates that having proper weight and proper sleep can help to plan a correct pattern of lifestyle in these patients.

Ezat-Sadat Haj-Seyed Javadi , Farideh Movahed, Razieh Akbari,
Volume 76, Issue 4 (July 2018)
Abstract

Background: Labor induction is one of the most public ways carried out global for delivering mothers. The aim of labor induction is to encourage uterine contractions before the spontaneous onset of labor, resultant in vaginal delivery misoprostol is used off-label for a variety of indications in the practice of obstetrics and gynecology, including medication abortion, medical management of miscarriage, induction of labor, cervical ripening before surgical procedures, and the treatment of postpartum hemorrhage. Regarding the importance and lack of similar researches in Iran, this research was done to compare the efficacy of buccal and sublingual misoprostol for labor induction in pregnant women.
Methods: This study was conducted as a randomized double-blind clinical trial from March 2017 to February 2018. In this survey, 200 women were randomly assigned to receive 50 µg buccal misoprostol and sublingual (100 buccal and 100 sublingual) in Kosar Hospital, Qazvin University of Medical Sciences, Iran. The maternal and fetal complications, Bishop score, and time of pain onset and its interval with labor were monitored in two groups and the findings were analyzed.
Results: Research variables were age, gestational age, BMI, number of previous pregnancy, neonatal weight, total dose, Bishop score 1, Bishop score 6, oxytocin, and delivery type. The results showed that there were no differences between Bishop score 6 (P=0.07), and 1 (P=0.36), total dose (P=0.58), neonatal weight (P=0.43), number of pregnancy (P=0.67), BMI (P=0.67), and pregnancy weak (P=0.108) of sublingual group and buccal group. About 43 patients (43%) in buccal and 64 (64%) in sublingual group had vaginal delivery (P=0.05). The frequencies of maternal and fetal complications were similar between two groups.
Conclusion: It can be concluded that there is no difference between efficacy of sublingual and buccal misoprostol in pregnancy results, maternal, and fetal complications, however, it seems that the sublingual group is more effective than buccal group due to the significant amount of vaginal delivery, achieving vaginal delivery in less than 24 hours, and less need for oxytocin.

Masoud Ahmadzad-Asl , Shayan Mostafaei , Shahram Rafiefar , Navid Mohammadi , Malihe Farid , Kourosh Kabir ,
Volume 76, Issue 4 (July 2018)
Abstract

Background: The study of their knowledge, attitude, and behavior toward health is an essential step for health planning. In the urban area, there are several concerns about environmental pollution, health status, the dangers of insecurity, and bad dietary habits. The aim of the study was the determination of knowledge, attitude, and behavior of Tehran citizens in order to plan better municipal services.
Methods: This descriptive, cross-sectional study was conducted on 13000 participants between 15-84 years in 22 districts of Tehran, Iran University of Medical Sciences, in August and September of 2011. Cluster sampling and self-administered reliable and valid questionnaire were used for data gathering. The inclusion criteria are all of citizens of Tehran. Age, sex, marital and job status, obesity, physical activity, hypertension, myocardial infarction, accidents, diabetes, nutrition, stroke, psychological behavior, smoking, addiction and drugs, musculoskeletal, sexual behavior, anemia, physical environment, fat blood, cancer, chronic obstructive pulmonary disease, dietary habits and socioeconomic status were measured under standard protocols and by using calibrated instruments. 
Results: From 13000 participants in the study, 11753 (90%) was fulfilled the questioners. Nonresponse rate from 11753 participants was 8.6%. The proportion of obesity/overweight was 50% and 29.5% of people had appropriate physical exercise, 37.6% reported a tobacco consumer in their family and 4.5% reported an experience of substance misuse. Also, 29.2% and 24.8% from these had anomalistic consuming of salt and soft drink, respectively. Of the participants, 44.8%, 89.1% had a good knowledge and attitude, respectively. Cronbach alpha coefficient was 0.82 and 0.79 for knowledge, attitude and behavior, respectively. In additional, the correlation coefficient between test and re-test questions was 0.91. 
Conclusion: This study was a comprehensive study to measure the knowledge, attitude and practice of Tehran citizens using reliable and valid questionnaires about general health status. A considerable percentage of Tehran citizens suffering from overweight, obesity, hypertension, diabetes, high blood lipids and smoking consuming and using anomalistic from TV and computer. The results can be used as a framework and guide to prioritize problems and planning health education interventions in Tehran

Farideh Zafari Zangeneh , Masoumeh Masoumi , Elahe Seyed Aboutorabi ,
Volume 76, Issue 9 (December 2018)
Abstract

Background: Genetic polymorphism is responsible for variations and individual differences. Polymorphism is a major factor of complex diseases with unknown etiology and cancer. Inconsistency in the symptoms of polycystic ovary syndrome (monthly disorder, hirsutism, obesity, diabetes, infertility) is one of the major pathological complications of this syndrome. The present study was conducted to evaluate the polymorphism gene β2 and β3 adrenergic receptors in women with polycystic ovary syndrome.
Methods: This cross-sectional study was performed on 200 patients with polycystic ovary syndrome (PCOS) in Imam Khomeini Hospital, Vali-e-Asr Infertile Clinic in Tehran, Iran, from March 2016 to April 2017. Blood samples in two groups (study and control) were obtained for genomics approved by the DNA Company based on the gene bank. Polymerase chain reaction (PCR) samples were extracted and then the primer design was performed by using Primer Express software, version 3.0 (Applied Biosystems, Foster City, CA, USA) and confirmed by using of the primer blast tool at the NCBI site in terms of compliance with the beta 3 adrenergic receptor gene. Analysis of protein changes was performed by using CLUSTALW (https://www.genome.jp/tools-bin/clustalw). Polymorphism was investigated on codons 16, 27, 113 and 164 from the beta2 adrenoceptor gene and codon 64 of the beta3 adrenergic receptor gene.
Results: The study of the codon beta2 of adrenoceptors showed that only codon 164 (Thr164Ile) polymorphism (44.4%) was significant (P<0/002) in study group. Homozygote and heterozygote ratios also show a significant difference between the study and control groups (P<0/004). Polymorphism exon 1 in codon 64 of beta3 adrenoceptor; which codes the amino acid tryptophan, indicates that the nucleotide T has changed to C. This finding confirms that mutagenic genotype can raise chance of getting to the polycystic ovary syndrome in women. OR: 2.546 (95% CI: 1.02-5.367) (P=0.012).
Conclusion: These results show that polymorphisms of codon 164 (Thr164Ile) of beta2 receptor gene and beta3 adrenergic receptor gene polymorphism Thr164Ile (rs 4994) associate with polycystic ovary syndrome and the risk of PCOS are significantly increased in mutation genotype women.

Fatemeh Masaebi , Farid Zayeri , Malihe Nasiri , Mehdi Azizmohammad Looha ,
Volume 76, Issue 11 (February 2019)
Abstract

Considering the advancement of medical sciences, diagnostic tests have been developed to distinguish patients from healthy population. Therefore, Determining and evaluation of the diagnostic accuracy tests is of great importance. The accuracy of a test under evaluation is determined through the amount of agreement between its results with the results of the gold standard, and this test accuracy can be defined based on sensitivity, specificity, positive predictive value, negative predictive value and the area under the receiver operative characteristic curve (AUC). Gold standard is an accurate and error- free method to determine the presence or absence of disease of interest and classify patients, which is not available in some diseases and situations as this method is costly or invasive. In these cases, reference standard is a best available replacement method to be used by physicians to diagnostic disease. However, in some situation, the acceptable reference standard is invasive or costly and does not exist or unreliable. It can be imperfect and results of the reference standard method are not necessarily error- free and cannot be applied to everyone in the study; all these cases point to the conditions in which the gold standard is not available. The use of reference standard including error causes to incorrect separation of patients from healthy population and thus, it cannot be a comparing measure for other diagnostic tests and its results are inaccurate. Therefore, other alternatives methods are needed for evaluation and determine the diagnostic accuracy tests when the gold standard does not exist. Imputation method, correct imperfect reference standard method, the construct reference standard method, latent class models, differential verification, composite reference standard and discrepant analysis are of these alternative methods. Each of these methods, considering its features, advantages, and limitations can be used to evaluate the accuracy of diagnostic test in the absence of gold standard. The present study gave an overview of methods to evaluation of diagnostic accuracy tests when there is no gold standard and the focus of this study was on explain the concept of these solutions, review and compare them and their strengths and weaknesses.

Mahsa Nazari, Farid Zayeri , Seyed Saeed Hashemi Nazari , Sara Jambarsang, Ali Nikfarjam , Alireza Akbarzadeh Baghban ,
Volume 77, Issue 2 (May 2019)
Abstract

Background: The Multi state Markov models have extensively application with categorization of laboratory marker of CD4 cells for evaluation of HIV disease progression. These models with different states result in different effects of covariates and prediction of HIV disease trend. The main purpose of this study was comparison of four and five states models with the three- state in order to select the model with better prediction ability of occurrence of HIV and finally death in HIV positive people.
Methods: A total of 305 HIV positive people were included in this cohort study in the Iran AIDS center in Imam Khomeini Hospital in Tehran that entered during March 1995 to January 2005 and then fallowed up to October 2014. The three continuous- time Markov models of three-, four- and five- state models were fitted to data to describe the evolution of a HIV disease Trend over different states.
For comparison of models, two criteria of modification of Akaike’s criterion (DRAIC) and likelihood cross-validation criterion (DRLCV) along with their 95% tracking interval was used. For fitting of these models and estimation of transition matrix and the hazard ratio of gender and treatment independent variables, the msm package of R project for statistical computing, version R 3.2.4 (www.r-project.org) was used.
Results: The results showed that the four- state model has more prediction ability than five-state model for evaluation of HIV disease Trend. In the four-state model, the progression hazard ratio to death for people who received highly active antiretroviral therapy (HAART) was 0.64 lower than who didn’t get this therapy. Moreover, the progression hazard ratio for men was 2.33 fold in comparison to women. The disease progression hazard ratio to death was 4.9 fold for men in comparison to women.
Conclusion: The (DRAIC) and (DRLCV) criterions showed that the four-state model has more predictive ability of the progression trend of HIV disease in comparison of five-state model.

Mahshad Ali Karoosi , Farideh Shishehbor , Karim Mola , Meysam Alipour ,
Volume 77, Issue 5 (August 2019)
Abstract

Background: Obesity is one of the causes of onset and exacerbation of rheumatoid arthritis. However, limited studies have examined the association between body composition and severity of disease. The aim of this study was to evaluate the association between severity of rheumatoid arthritis with various types of obesity and the comparison of anthropometric indices between patients with rheumatoid arthritis and healthy subjects.
Methods: This case-control study was conducted on 95 patients (48.8±10.4 years) with rheumatoid arthritis as a case group and 95 healthy people (46±9.3 years) as a control group carried in Golestan Hospital, Ahvaz, Iran, from April 2016 to February 2017. Weight, height, waist circumference (WC), hip circumference (HC) and body fat percentage (BFP) were measured. The anthropometric indices were calculated. The disease severity was calculated according to disease activity score 28 (DAS28).
Results: There was no significant difference between two groups regarding their gender ratio (1:1), age (P=0.16) and height (P=0.58). The weight, body mass index (BMI), body fat (BF), WC, HC, waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and other obesity indices include a body shape index (ABSI), body adiposity index (BAI), abdominal volume index (AVI), body surface area (BSA) and Conicity index (CI) in patients with rheumatoid arthritis are significantly higher than healthy subjects (P<0.05). No difference in fat free mass was observed between two groups. Waist to height ratio and BAI compared with other indicators had the highest correlation with the DAS28 score. In addition, prevalence of obesity by waist circumference (82% vs. 61%), obesity by BMI (47% vs. 33%), and obesity by BFP (91% vs. 83%) was higher in patients with rheumatoid arthritis than healthy subjects. The risk of rheumatoid arthritis in people with central obesity by waist circumference (OR=2.92, 95% CI 1.50-5.70) was greater than obesity defined by BMI (OR=1.77, 95% CI 0.98-3.18) or BFP (OR=2.37, 95% CI 1.01-5.53).
Conclusion: The results of present study indicate association of rheumatoid arthritis disease severity with obesity types (especially central obesity) and anthropometric indices.
 

Razieh Nazari , Mehri Ghasemi , Farideh Dehghan-Manshadi , Alireza Akbarzadeh-Baghban ,
Volume 77, Issue 8 (November 2019)
Abstract

Background: Rotator cuff injuries are the most common causes of shoulder pain and supraspinatus muscle is usually involved. Clinical tests are available and inexpensive tools for assessment of shoulder dysfunctions. The empty can (EC) and full can (FC) tests are considered as shoulder gold standard tests. Recently, hug up (HU) test has been developed to assess the supraspinatus. So far, no ultrasonographic study has compared supraspinatus muscle thickness in these testing positions. The present study aimed to compare the supraspinatus muscle thickness in the hug up testing position with the full can and empty can testing positions in young and healthy women.
Methods: Forty healthy women (mean age 21.62±2.4 years) participated in this cross-sectional-comparative study from April to June 2018 in the Biomechanic Laboratory of Rehabilitation School, Shahid Beheshti University of Medical Sciences in Tehran, Iran. The supraspinatus muscle thickness was scanned during rest and contracted states with a 0.5 Kg weight cuff. For contracted states, (A) EC testing position: the arm was at 90º abduction in the scaption plane with the thumb-down, (B) FC testing position: the arm was maintained at 90º abduction in the scaption plane with the thumb-up, (C) HU testing position: the palm of hand was placed on the opposite shoulder with the elbow flexed.
Results: The Bonferroni test showed significant differences (P<0.001) between the muscle thickness in the rest and the testing positions. The muscle thickness in the empty can testing position was significantly less than the full can testing position (P=0.001), no significant difference was found between the muscle thickness in the hug up testing position compared to the full can and empty can testing positions.
Conclusion: All of the empty can, full can and hug up testing positions demonstrated increased mean muscle thickness when compared to the rest position and the greatest muscle thickness was in the full can testing position. It seems that supraspinatus muscle thickness in hug up testing position is similar with empty can and full can testing positions.

Farideh Zafari Zangeneh , Mohammad Mehdi Naghizadeh , Maryam Bagheri , Masoumeh Dehghan ,
Volume 78, Issue 3 (June 2020)
Abstract

Background: Most studies show that 9 to 24% of people who are in in vitro fertilization (IVF) cycles are women who respond poorly to ovarian stimulation. Women with poor ovarian response (POR) are a group of infertile patients whose ovarian reserve, ovarian response to medication, and the quality of ovum are declining. Therefore, the number of female cycles, the number of fetuses from the oocyte and the rate of pregnancy in these women is reduced. The purpose of this study was to investigate the expression of three adrenoceptor receptor genes in the cumulus cells of women with poor ovarian response in culture medium.
Methods: This case-control study was conducted in two groups: study (POR) and control (oocyte donor's women) groups. POR diagnosis was performed by ESHRE Bologna criteria. After puncture of the follicles, cumulus-oocyte complex was collected and the cumulus cells (CCs) were isolated by enzyme and are counted with Neobar lamella and then were added in the culture medium. After completing the culture, RNA was extracted from cumulus cells and the RNA concentration was read by the Spectrophotometer (NanoDrop Technologies, Wilmington, DE, USA). Then cDNA synthesized and primers designed for ADR-α1, 2 and ADR-B2 or gene expression by real-time polymerase chain reaction (PCR) technique. The research was done in Reproductive Health Research Center of Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran, from April to December 2017.
Results: Comparison of the results of ADR-α1, 2 gene expressions in cumulus cells showed a significant decrease, but ADR-B2 was not significant in two groups. Correlation coefficients also showed that there are relationship between three adrenoceptors and their effects on each other.
Conclusion: Our results showed that the decreased expressions of ADR-α1, 2 probably related to activation of the sympathetic system and release of the more neurotransmitter that lead to down-regulation of ADR-α1, 2 in the cell membrane of cumulus in culture medium.

Masoumeh Mirteimouri, , Farideh Akhlaghi, Roya Jalali Bajgiran,
Volume 78, Issue 6 (September 2020)
Abstract

Background: One of the main causes of maternal death in developing countries is postpartum hemorrhage. Cesarean section is one of the most common surgeries all around the world. In comparison with normal vaginal delivery, cesarean section is a greater risk factor for postpartum hemorrhage and need for blood transfusion. The risk of postpartum hemorrhage will increase when other risk factors such as multiple pregnancies, polyhydramnios, severe preeclampsia, peripartum hemorrhage, protracted labor, labor induction, and obesity are present. Oxytocin is conventionally used for the prevention of uterine atony during the cesarean section. The aim of this study was the evaluation of the effect of sublingual misoprostol in combination with oxytocin in reducing blood loss during and after cesarean delivery.
Methods: This randomized clinical trial was performed in Ommolbanin hospital; an academic hospital that is affiliated to Mashhad University of medical sciences from September 2016 to January 2018. The subjects were 90 pregnant women with a term pregnancies who were candidates for emergent cesarean delivery under spinal anesthesia and were at high risk for postpartum hemorrhage. All participants received 40 IU oxytocin in 1 liter of normal saline after delivery, and then they were randomly assigned to the intervention group who received 400 μg sublingual misoprostol in combination with oxytocin infusion, and the control group who received only oxytocin infusion without adding misoprostol.
Results: Sublingual misoprostol in combination with oxytocin infusion during cesarean section led to a significant decrease in postoperative blood loss for six hours after the surgery (P<0.001). The decline in the hemoglobin and hematocrit levels and the amount of intraoperative hemorrhage were the same in both groups. Less additional uterotonic agents were needed in the misoprostol group. The frequency of fever and other side effects were similar in the two groups.
Conclusion: It seems that adding sublingual misoprostol to oxytocin infusion among high-risk women for postpartum hemorrhage is more effective for reducing blood loss during and after cesarean section.

Farideh Zafari Zangeneh, Mohammad Mehdi Naghizadeh , Masomeh Masomi, Marzieh Mohebbi,
Volume 78, Issue 8 (November 2020)
Abstract

Background: Polycystic ovary syndrome is the most common disorder in the endocrine system. Hyperandrogenism, hyperinsulinemia, chronic ovulation, and infertility are important Complications of PCOS. Health-related quality-of-life (HRQoL) has a significant reduction in women with polycystic ovary syndrome (PCOS). This reduction can be due to many disorders including: menstrual and sleep disorders, hirsutism, marital issues, infertility, and emotional/psychosocial problems. The purpose of current study was to investigate the role of sleeping and other environmental factors affecting the quality of life in patients with polycystic ovary syndrome. 
Methods: This case/control study was conducted in 2017 in two groups: control and study (PCOS). The inclusion criteria were women aged 20-40 with a body mass index (BMI)<28. Exclusion criteria included no disease and no medication for all women. The participants were 180 women who were referred to the infertility center of Imam Khomeini Hospital in Tehran. Four questionnaires including Demographics (40 questions), sleep quality (PSQI) (19 items 0-3), quality of life (GHQ) (28 items) and psychometric (DASS-42) with their consent form were filled out. Student’s t-test and Chi-square were used to compare the variables between two groups and the Pearson correlation coefficient to examine the relationship between lifestyle dimensions.
Results: The mean weight and BMI (P=0.002), hirsutism and irregular menstruation cycle in the study group were greater than the control (P<0.001). In the study group the mean score of the sleep questionnaire in three dimensions: sleep problems (P=0.024), drug use (P=0.048), and the sufficiency of sleep (P=0.049) were higher than control.
Regression analysis showed that there is a significant relationship between quality of life and menstruation cycle (P=0.046), as well as the three dimensions of negative affecting situations with family income (respectively, 0.015, 0.016 and P=0.035).
Conclusion: The environmental factors can easily affect the quality of life in PCO women. Sleep patterns were not favorable, and the effect of menstruation on mood and low family income caused negative emotions in women with PCOS.

Ali Sheidaei, Alireza Abadi, Fatemeh Nahidi, Farzaneh Amini, Farid Zayeri, Nafiseh Gazrani,
Volume 79, Issue 1 (April 2021)
Abstract

Background: Statistical models are used to investigate the relationship between variables in statistical studies. Considering the variety of statistical models, finding the most suitable model is a complex work. This study aimed to compare different models in the treatment of infants' colic and the misspecification of specificity.
Methods: This randomized clinical trial was conducted on 100 infants with colic in the pediatric clinic of Amir Kabir Hospital in Arak, the intervention and control groups were randomly divided into two groups. The collection and analysis of the data was performed in 2016. After teaching massage to mothers of the intervention group, they were asked to perform massage on infants three times a day during the week. In the control group, mothers can relieve the symptoms of colic by shaking the infant. Parents recorded the number and severity of crying daily in the checklist. Finally, by using different models, R software, SAS, and goodness of fit, the best model was introduced.
Results: In the massage group, the mean crying intensity of infants with colic decreased from 5.01 units on the first day to 2.47 units on the seventh day. On the other hand, the difference in mean sleep time changed from 1.81 hours in favor of the shaking group on the first day to 1.26 hours in favor of the massage group on the seventh day. Also, the severity of crying in the infants of the massage group was significantly higher than the impulse group. Regarding the grace of marginal models, the first-order self-return correlation structure was the best grace and for some variables, the model had random effects with a gamma distribution for the random component.
Conclusion: Massage can reduce infants' colic. Statistically, in the case of a nonlinear model, the variance of estimates is more than estimated to be influenced by the misspecification of the correlation structure.

Farideh Zafari Zangeneh , Samad Muhammadnejad, Mohammad Mehdi Naghizadeh, Maryam Bagheri, Elnaz Hekmat,
Volume 79, Issue 11 (February 2022)
Abstract

Background: Connexon is a membrane structural protein in the gap junctions. These cellular connections are responsible for transporting ions and messenger molecules to the oocyte. This study aimed to investigate the role of beta-2-adrenoceptors in the process of follicle growth based on the expression of the two connexins 37/43 in the gap junctions that have a primary role in the mitotic resumption and oocyte maturation.
Methods: This case-control study was conducted from April 2019 to November 2020 at the Reproductive Health Research Center of Tehran Imam Khomeini Hospital was performed on women with the poor ovarian response (POR) and control (women donate eggs) groups. Both groups had entry criteria with a body mass index under 28 m2/kg and 20-45 years old. Exit criteria were including no drug use except ovarian stimulants and no illness. The diagnosis was made agreeing to the Bologna model criterion. Ovulation stimulation cycle was performed, and then after the puncture, cumulus cells were isolated by enzyme and were freezing in -80 centigrade until the time of inserting into the cell culture medium. Isoproterenol (agonist) and propranolol (antagonist) at a concentration of 100 nM were added to the culture medium as the beta-2 adrenoceptors selective drugs. After culture, RNA extraction was performed and the concentration was read by Nanodrop, and then cDNA was synthesized. Gene expression was determined by real-time PCR.
Results: The findings of connexin expression in the three study groups: without the drug (P<0.001), propranolol (P<0.001), and isoproterenol (P<0.001) were significant compared to the control group. Isoproterenol decreased expression but propranolol increased it (P<0.001).
Conclusion: These findings confirm the important role of connexins 37 and 43 in cumulus cleft junctions that propranolol was able to increase its expression. Therefore, we suggest firstly these two connexins can be an effective target for oocyte growth and maturation. Secondly, propranolol could be a new treatment for women with POR and be effective in assisted reproductive technology (ART).
 


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