Tehran University Medical Journal

Before the recent outbreaks of Zika virus, few people have ever heard of its name. Even virologists had paid little attention to this member of the Flaviviridae family. Hence, up to January 2016, only 269 articles about Zika virus had been indexed in PubMed compared to the 9187 articles related to dengue virus. However, declaration of the World health organization (WHO) about the global Zika virus spreading, which has been associated with birth defects and some neurological problems, diverted more attention to this forgotten virus. Afterwards, the virus hit the headlines and became a research interest. Since then, up to 9 August 2017, the number of Zika related articles indexed in PubMed reached to 3214. Zika virus is a re-emerging arbovirus. The First detection of Zika virus was in Uganda in 1947. It belongs to the Flavivirus genus in the Flaviviridae family. Zika can typically cause a mild and self-limiting disease in a healthy person. However, in pregnant women, it might cause birth defects and occasionally it can be associated with peripheral neuropathy such as Guillain-Barre syndrome. Although many research have been conducted to find out the casual link between this virus and these disorders but this relationship is still dim and controversial. Considering its recent epidemics in 2015 and 2016 the geographical distribution of Zika virus seems to expand all over the world progressively. Interaction between virus and vector is dynamic. Variety of competent vectors and adaptability of virus to new arthropod vectors are the two major factors for this process. According to the last report published by WHO, 84 countries/territories in five continents have reported the circulation of Zika virus in their area. In the recent outbreak, WHO regional office in our region (EMRO) have reported no case of Zika virus transmission from this region. Nonetheless, because specific and competent vectors exist in some countries, this region has a potential of epidemic risk. Until now we have neither autochthonous nor imported case of Zika virus in our country but we should prepare for any unexpected situation. In this review, we will discuss new findings about the history, virological features, vectors, transmission routes and epidemiological aspects as well as laboratory diagnosis of Zika virus. In addition, the epidemiology of this virus in Iran will be discussed.

Background: Bronchiolitis is one of the most common diseases of the lower respiratory tract in infants. Vitamin D has been shown to be protective against lower respiratory infections; however, there are limited and contradictory results in relation to serum vitamin D level and the incidence of bronchiolitis in children. The aim of this study was to compare serum levels of this vitamin in healthy infants and infants with acute bronchiolitis.
Methods: This case-control study conducted at Abuzar hospital in Ahvaz city, during October to March of 2014. Three groups of 45 eligible infants including control, low and high intensity of bronchiolitis enrolled to study. The severity of bronchiolitis classified according to scores derived from the respiratory distress assessment index. One to eight scores considered as low intensity and 9 to 17 scores considered as high intensity of bronchiolitis. Subsequently, 3 ml of venous blood sample were taken from them and the serum levels of 25(OH)D were measured by using an enzymatic kit.
Results: 60 (44.4%) infants were girls. The mean age of the control, low and high intensity of bronchiolitis groups were 11.2±5.2, 10±5.8 and 9.8±4.7 months, respectively (P=0.1). The mean of 25(OH)D concentrations in the control, low and high intensity bronchiolitis groups were 28.3±19.4, 17.7±11.7 and 13.6±5.7 nm/l, respectively. There was a significant difference in levels of 25(OH)D between the control-low intensity bronchiolitis groups (P=0.001) and the control-high intensity bronchiolitis groups (P=0.002), this difference was not significant between the two groups of bronchiolitis. There was a direct and significant correlation between serum level of 25(OH)D and age (r=0.2, P=0.005), breast milk consumption (r=0.3, P=0.001), and vitamin D supplementation (r=0.6, P=0.000).
Conclusion: In the present study, levels of 25(OH)D were significantly lower in infants with bronchiolitis than control group. In addition, 25(OH)D levels did not affect the severity of bronchiolitis.

Today, nanoscience has grown and developed in various medical and therapeutic areas, including cancer treatment. On the other hand, cancer and its types have been rumored and inclusive and many people suffer from this fatal and deadly disease. Currently, existing therapeutic method, including chemotherapy, radiotherapy, and etc., along with the therapeutic effect, cause complications that are unpleasant for patients. Hence, scientists and researchers are looking to develop and improve treatment options and methods to deal with this serious disease. Today, nanoscience and nanotechnology have become widespread, and its various fields, including nanoparticles, are widely used for a variety of applications, especially for delivery of drugs and diagnostic items and imaging cases. Nanotechnology-based release systems have a significant impact on the release of cancer drugs. Advances in bio-materials and bio-engineering are contributing to new approaches to nanoparticles that may create a new way for the improvement of cancer patients. Nano-technology in the drug release system has had a great impact on the selection of cancer cells, the release of a targeted drug, and overcoming the limitations of conventional chemotherapy. At the present many drug delivery systems are now made of nanoparticles, and various substances have been used as drug-stimulating agents or as a reinforcing agent to improve the efficacy of the treatment and durability and stability and also the safety of anticancer drugs. The materials used to release cancer drugs are divided into various categories such as polymer, magnetic, biomolecules. In the meantime, polymer nanoparticles have been organized in the carriers of anti-cancer nanoparticles due to the process of easy production, biocompatibility, and biodegradability. Although the loading of hydrophilic compounds is still confronted with limitations, due to the diversity of nanoparticle structures, it is possible to encapsulate various molecules. Also, surface changes and modification such as binding to antibodies and target ligands can also be applied to these materials, to act as target drug delivery to increase the effectiveness of treatment process. In this article, we will have an overview of cancer disease and cancer drugs and also nanoparticles and their contribution to cancer treatment.

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

Background: Association of Addison's disease with connective tissue diseases such as scleroderma and Sjogren have been rarely reported. Anti-centromere antibody (ACA) has been associated with exocrine gland dysfunction in anti-Ro, anti-La negative Sjogren’s syndrome and may be one of the causes of xerostomia in community. The purpose of this article was to introduce a rare case of scleroderma-Sjogren intermediate phenotype with positive anti-centromere antibody in a known case of Addison’s disease admitted for dental caries and xerostomia.
Case Presentation: A 29-year-old woman with Addison’s disease referred to a dental clinic due to recurrent dental caries. Addison’s disease was confirmed by low basal serum cortisol level and unresponsive serum cortisol level to adrenocorticotropin hormone (rapid ACTH stimulation test). Signs of xerostomia, xerophthalmia, Raynaud’s phenomenon, gastro-esophageal reflux, masked face, osteoporosis, positive anti-centromere antibody, negative anti-Ro and anti-La antibodies and failure to match the pathology of the minor salivary gland of lip with Sjogren's disease were found. The diagnosis of scleroderma-Sjogren intermediate phenotype was raised with considering some of the symptoms of scleroderma and Sjogren and not the exact classification criteria for each of these two diseases. Hydroxychloroquine, fluoride and Biotene® mouthwash (Laclede, Inc., CA, USA) (oral moisturizing saliva), chewing gum containing xylitol plus artificial tear droplet was prescribed. Drinking plenty of fluids was recommended. Due to gastroesophageal reflux and osteoporosis, Pantoprazole and CinnoPar® (Cinnagen, Iran) (parathyroid hormone analogue) plus calcium and vitamin D supplements was administered. Regarding adrenal insufficiency, Prednisolone and Fludrocortisone were continued.
Conclusion: For evaluation of recurrent dental caries, especially in patients with autoimmune disease, anti-centromere antibody may be useful to identify the cause of dry mouth, as well as early detection of limited scleroderma or scleroderma-Sjogren intermediate phenotype.

Background: Alzheimer's disease (AD) is the most common disorder of dementia, which has not been cured after its occurrence. AD progresses indiscernible, first destroy the structure of the brain and subsequently becomes clinically evident. Therefore, the timely and correct diagnosis of these structural changes in the brain is very important and it can prevent the disease or stop its progress. Nowadays, remark to this fact that magnetic resonance imaging (MRI) provides very useful and detailed information, and due to non-invasiveness, this method has been great interest to the researchers. The aim of this study was diagnosis of AD with MRI by support vector machine model (SVM).
Methods: This is an analytical and modeling research which done in School of Public Health, Kermanshah University of Medical Science, Iran, from February 2017 to November 2017. The data used in this study was a database named Miriad containing brain MRI of 69 individuals (46 Alzheimer's disease and 23 healthy subjects) that was collected at the central hospital in London. Individuals were categorized into two groups of healthy and Alzheimer's disease with two criteria: NINCDS-ADRAD and MMSE (as the golden standard). In this paper SVM model with three linear, binomial and Gaussian kernels was used to distinguish Alzheimer`s disease from healthy individuals.
Results: Finally, SVM model with Gaussian kernel, separated AD and healthy subjects with 88.34% accuracy. The most important Areas for Alzheimer were three Area: Right para hippocampal gyrus, Left para hippocampal gyrus and Right hippocampus. The clinical result of this study is to identify the most important ROI for the diagnosis of Alzheimer's by a clinical specialist. Experts should focus on atrophy in the three Areas.
Conclusion: This study showed that the SVM model with Gaussian RBF kernel can separated AD from healthy subjects by high accuracy. Based on results of this study, can make a software to use in MRI centers for screening AD test by people over the age of 50 years.

Background: Sexually transmitted infections are the most common human infections that lead to severe complications. Mycoplasma genitalium (MG) and Ureaplasma urealyticum (UU) are common and important cause of genitourinary tract infections. MG is a member of genital mycoplasmas which is emerging as an important causative agent of sexually transmitted infections both in males and females. This study aimed to determine the prevalence of UU and MG in pregnant women and to assess the risk factors which may contribute to the predisposition of the individuals to the infection.
Methods: In this cross-sectional study, The population of 210 pregnant women admitted to the Rasoul Akram Hospital in Tehran, were selected for the study using non-random sampling. The urine specimens were collected from 194 pregnant women from May to December, 2015. The samples were transferred to the Infectious Disease Research Center of Rasoul Akram Hospital under sterile condition. Samples were exposed to DNA extraction followed by multiplex polymerase chain reaction (PCR) to detect the infection. Data including sex, age, history of abortion, history of genitourinary tract infections were collected subsequently.
Results: The prevalence of MG and UU infections in urine samples was 5.6%, 11.2%, respectively. The mean and standard deviation of the risk of UU was 2.08 (3.56-1.22) in women with a history of abortion and 0.70 (1.03-0.47) in women without a history of abortion. There was a significant relationship between the history of sexually transmitted diseases and the frequency of UU (P<0.022). From 22 patients with UU infection, six patients had a history of sexually transmitted diseases. A significant correlation was found between prevalence of MG and UU infections. The History of abortion was significantly related with the frequency of UU and MG infections. The prevalence of MG infection is negatively correlated with pregnancy trimesters. The History of genitourinary tract infections was significantly associated with the frequency of UU.
Conclusion: The presence of UU and MG could be associated with abortion.

Background: Cystatin C (Cys C) as a cysteine protease inhibitor is produced in a constant level from all nucleated cells. The purpose of this study was to investigate the correlation between serum levels of Cys C and coronary slow flow (CSF) and body mass index (BMI) in men.
Methods: This investigation is in the form of a descriptive-analytical study. The statistical population was all non-active male aged 34-73 years with CSF candidate for angiography referring to Seyedoshohada University Hospital, Urmia, Iran, from March 2015 to February 2017. After obtaining an inform consent, 74 male patients (mean age 54.77±9.00 years, height 1.74±0.12 cm, weight 73.13±6.85 kg, and BMI 26.98±3.83 kg/m2) were selected by convenience non-random sampling as the sample size (patients were eligible for diagnostic coronary artery angiography for the first time and referring to Seyedoshohada University Hospital in Urmia). Then all the patients were placed under angiography with one mobile angiography system. Patients were assessed for coronary blood flow with a quantitative method using corrected thrombolysis frame count in myocardial infarction (CTFC). All the patients with TFC larger than two standard deviation pre-published area for a specific vessel were counted as CSF. Demographic characteristics of age, height, weight, and BMI in male patients were measured by wall-meter with an accuracy of one millimeter, digital scale with precision of 100 g, and weight/hieght2 formula, respectively. The traditional risk factors including smoking, diabetes mellitus (DM), high blood pressure (HBP), dyslipidemia, and family history were also assessed using a checklist. Serum levels of Cys C were measured by ELISA machine.
Results: The mean demographic and physiological variables of subjects were: age 54.77±9.00 yr, height 1.74±0.12 cm, weight 73.13±6.85 kg, and BMI 26.98±3.83 kg/m2. Also, the results of this study showed that there were no significant correlations between serum levels of Cys C with CSF and BMI in male patients’ candidate for angiography referring to Seyedoshohada University Hospital (P=0.871 and P=0.494, respectively).
Conclusion: The results of this study suggest that serum levels of Cys C had no significant correlations with the CSF and BMI in male patients’ candidate for angiography aged 34-73 years.

Background: Twin pregnancy consist a healthy fetus, and hydatidium molar pregnancy is unusual and very rare. Its incidence is in about 1,22,000 to 1,100,000 of all pregnancies. This type of pregnancy is commonly associated with several obstetric complications requiring early termination of pregnancy. Managing a twin mole pregnancy with normal and live fetuses is controversial, although this unusual type of abnormalities in most cases leads to abortion or intrauterine fetal death. In other hand, due to the high probability of obstetric complications during pregnancy, such as preeclampsia in 25% of cases, metabolic complications such as hyperthyroidism and vaginal bleeding pregnancy is terminated. Survival of the normal coexisting fetus is variable and depends on whether the diagnosis is made, and if so, whether problems from the molar component. Present study reported a case of coexisting mole and live fetus twin pregnancy with successful outcome.
Case presentation: A 35 years old woman, G2ab1 which was diagnosed to have twin pregnancy with mole and coexisting live fetus in 11 weeks of gestational age was referred to obstetric department of Ghaem Hospital, Mashhad University of Medical Sciences, Iran in January 2017. Close follow-up and obstetric surveillance had performed for her and at the last her pregnancy was terminated in gestational age of 36 weeks; a healthy male infant. The β-human chorionic gonadotrophin (BhCG) levels still is undetectable after one year.
Conclusion: Twin pregnancy with one normal fetus and a co-existing molar pregnancy could be continued under close surveillance if the live fetus has normal karyotypes and no structural anomaly and decreasing level of serum BhCG level during the time. Close monitoring necessary even after termination due to increasing risk of persistence trophoblastic disease after termination, what was performed in this case also.

Background: Genital warts are one of the most common sexually transmitted infections, 1% of sexually active population have anogenital warts (AGWs). According to previous studies, the disease affects people's quality of life and imposes financial costs on health systems.
Methods: The present study is a case-control study at spring of 2018. The quality of life of 65 patients with anogenital warts that were referred to Boali-sina Hospital in Sari, Iran compared with 65 control subjects. The World Health Organization Quality of Life Brief (WHOQOL-BREF) questionnaires was used.
Results: According to the results, among the patients with anogenital warts, the quality of sexual contact in majority them were not affected by the disease (70%). The total cost of treatment was less than the monthly income of the family until the time of participating in the study (92%). There was no significant difference between the mean and standard deviation of physical health scores and mental health scores in the control and patient groups. (Respectively P=0.14, P=0.93). There was no significant relationship between the mean of physical health scores with disease severity. However, there was a significant difference between the mental health score in the two groups of patients with low and high levels of severity (P=0.01). Physical health scores in the whole sample have a significant relationship with gender, so that, in women, physical health score was lower than that of male, but the mean score of mental health in both male and female patients was not significantly different (P=0.18). In the control group the score of mental health was lower in women (P=0.041).
Conclusion: In patients with anogenital wart, quality of life doesn’t change significantly, although, mental health scores directly related with disease severity.

Anaplasma phagocytophilum is a gram-negative intracellular bacterium that transmitted by hard ticks. A. phagocytophilum infect and multiply in the organs of ticks, in particular the salivary glands which enable the transmission to vertebrate hosts during feeding. The tick becomes infected by feeding on an infected host and there is transstadial but not transovarial passage of the organism. The majority of ticks are infected with the organism in enzootic areas. There are strains of A. phagocytophilum that have biological and ecological difference, including variations in host pathogenicity, vectors and geographical distribution. The organism has an interesting feature to grow in neutrophils by stopping the antibacterial activity of neutrophils. The bacterium is able to survive in the immune host, using complex mechanisms of antigenic variation. A. phagocytophilum infects humans and various animal species including dogs, sheep, cows, horses, wild deer and rodents. The disease is known as human granulocytic anaplasmosis in humans, canine granulocytic anaplasmosis in dogs, equine granulocytic anaplasmosis in horse and tick borne fever in ruminants. Cattle tick borne fever caused by A. phagocytophilum is characterized by high fever, reduced milk yield, inclusions in circulating neutrophils, leukopenia, abortions, reduced fertility, coughing, respiratory signs and swelling of the hind limbs. Clinical signs of human occur a week after the tick bites, the disease usually presents as an acute, sometimes fatal febrile syndrome, illness characterized by headache, chills, myalgias, arthralgia, malaise, and hematological abnormalities, such as neutropenia, lymphocytopenia, thrombocytopenia, leukopenia, and elevated hepatic aminotransferase levels and may lead to death. In this review article the history, bacteriology, epidemiology, pathogenesis, diagnosis, treatment and prevention of the disease caused by A. phagocytophilum is written based on the latest scientific findings. Several hard tick species are distributed in Iran and they are the most important ectoparasites of animals. A. phagocytophilum has been detected not only in Ixodes ricinus but also in cattle and sheep of Iran using molecular techniques. However, despite the zoonotic potential of the agent, there is no evidence in the identification of A. phagocytophilum in humans, and it seems necessary to research on the prevalence and epidemiology of the disease in the human population.

The purpose of prenatal diagnosis tests is insisting of diagnosis of neonatal disorders, preparing a range of informed choices and making couples at risk to be ready for having children with genetic disorders as well. The aim of this article is to investigate all of the tests in order to determine the best one which has the lowest risk and the highest sensitivity. Screening tests (maternal blood test and ultrasonography for first and second trimester) are testing patients without symptoms who are at low risk. These tests are carried out in the early stages of pregnancy, and the risk of genetic diseases would be estimated. They are safe and also might be helpful in determining whether invasive prenatal genetic tests including chorionic villus sampling, amniocentesis, and percutaneous umbilical blood sampling are needed. Diagnostic test is insisting of invasive tests: amniocentesis, chorionic villus sampling (CVS), cordocentesis, and preimplantation genetic diagnosis (PGD), which is a genetic test on cells removed from embryos to help select the best ones to avoid some of genetic diseases, fluorescence in situ hybridization (FISH), QF-PCR, multiplex ligation probe amplification (MLPA), next generation sequencing (NGS), comparative genomic hybridization (CGH), and non-invasive tests: ultrasound, prenatal sonography, cell free fetal DNA, triple and quadruple screen: alpha fetoprotein (AFP), human chorionic gonadotropin (hCG), unconjugated estriol (uE3), inhibin-A). These tests are intended for patients who have apparent symptoms and the results of their early stages of pregnancy have been positive. Non-invasive prenatal tests (NIPT), sometimes called noninvasive prenatal screening (NIPS), have features of both screening and diagnostic tests, but, now screening test is more considerable. Small fragments of DNA would be analyzed by this testing in which they are circulating in a pregnant woman’s blood. While most DNA is found inside a cell’s nucleus, these fragments are free-floating and not within cells, at this point, they are called cell-free DNA (cfDNA) which usually contain fewer than 200 DNA building blocks (base pairs). Non-invasive prenatal tests is more sensitive with the high degree of specify to determine trisomy 13, 18 and 21 in women who are at increased risk of having offspring with genetic disorders.

Background: Sesame oil can be used to treat cardiovascular diseases, such as atherosclerosis, by reducing the levels of fibrinogen and factor VII. The aim of this study is to prepare a microemulsion containing sesame oil as a drug nanocarrier for improving the aqueous solubility and therapeutic effects of this vegetable oil on the reduction of the fibrinogen and factor VII levels in animal model.
Methods: This experimental study was performed for microemulsion preparation and animal test at Ferdowsi University of Mashhad and Cardiovascular Research Center of Mashhad University of Medical Sciences, Mashhad, Iran, respectively, from April 2015 to January 2017. To prepare the microemulsion samples, Tween 80 and span 80 were selected as surfactant couple and surfactant ratios of 8:1, 9:1 and 10:1 were determined for construction of pseudo-ternary phase diagrams. The Zealand white rabbits were categorized in three groups: receiver of base diet group, high cholesterol diet and high cholesterol diet plus microemulsion.
Results: The average particle size of the samples was in the range of 16.64±0.1 to 21.16±0.2 nm with a uniform particle size distribution. Zeta potential was in the range of -10.7 to 18.4 mV, refraction index was approximately 1.39. Electrical conductivity coefficient was in the range of 297 to 311 μz and pH of all the samples were approximately 6.42 for all samples. All of the microemulsion samples were physically stable and the prepared sample with 9:1 surfactant ratio was selected to investigate the animal test due to the higher oil percentage in comparison with the other samples that be stable over 6 months. Significant decrease in the levels of fibrinogen and factor VII in the third group of rabbits was observed compared to the other groups.
Conclusion: The results of this study showed the effective performance of nanostructured drug delivery systems in the form of microemulsion to improve the aqueous solubility and therapeutic effects of hydrophobic compounds such as vegetable oils.

Background: Diabetes mellitus as a chronic disease is the most common disease caused by metabolic disorders and it is one of the most important health issues all around the world. Nowadays, data mining methods are applied in different fields of sciences due to data mining methods capability. Therefore, in this study, we compared the efficiency of data mining methods in predicting type 2 diabetes.
Methods: In this cross-sectional study, the data of 7,000 participants in the Diabetes Screening Project in Samen, Mashhad City, Iran, were considered in 2016. There were 540 untreated diabetic patients. The Samen Project was included in the routine examinations of diabetes patients like blood glucose, eyes health, nephropathy, and legs health. So, in order to maintain balance, 600 healthy individuals were selected in a proportional volume sampling in this study. Therefore, the total sample size was 1140 people. In this study, people with diabetes aged over 30 years old were enrolled and participants with the previous history of type 2 diabetes, with normal blood glucose due to drug use or other issues at the time of the study, were excluded.
Results: All three models (Logistic regression, simple Bayesian and support vector machine models) had the same test accuracy (86%), however, in terms of area under the receiver operating characteristic (ROC) curve (AUC), logistic regression and simple Bayesian models had better performance (AUC=90% against AUC=88%). In the simple Bayesian model and logistic regression, body mass index (BMI) and age variables were the most important variables, while BMI and blood pressure variables were the most important factors in the support vector machine model.
Conclusion: According to the results, all three models had the same accuracy. In terms of area under the curve (AUC), logistic and simple Bayes models had better performance than the support vector machine model. Totally all three models had almost the same performance. Based on all three models, BMI was the most important variable.

Background: Celiac disease is a chronic inflammation of small intestine which is caused by an increased permanent sensitivity to a protein named gluten. This protein is present in some cereals such as wheat, barley, and rye. The immunologic response to this protein can cause clinical symptoms in people with specific human leukocyte antigens (HLAs) (including HLADQ2 or HLADQ8). Most studies have reported an increased incidence of celiac disease in patients with diabetes mellitus type I. This study aimed to determine the prevalence of the celiac disease in patients with diabetes mellitus type I under the age of 18 years old.
Methods: This cross-sectional, analytic descriptive study was performed on forty children with diabetes mellitus type I in Sanandaj Diabetes Association (Kurdistan University of Medical Sciences), Iran, from September 2012 to September 2013. After obtaining consent from their parents, demographic data, including gender, age, family history of diabetes, duration of illness, symptoms of celiac disease, were recorded in the questionnaire. The measurement of the tissue transglutaminase (tTG) antibody and total immunoglobulin type A in the serum was necessary for the screening of celiac disease. Therefore in the laboratory, 5 ml of the venous blood sample was taken and then the serum levels of tTG antibody (from immunoglobulin type A) and total serum levels of this immunoglobulin were measured by the enzyme-linked immunosorbent assay (ELISA) method. Upper endoscopy with multiple biopsies from small intestine was performed in patients with positive serological screening. Finally, the disease was evaluated by histological finding.
Results: Forty children with diabetes mellitus type I included 19 boys (47.5%) and 21 girls (52.5%) were enrolled in the study. The mean age of these patients was 10.53±4.05. The prevalence of celiac disease was 7.5% in these individuals. In the subjects, there was no significant relationship between gastrointestinal symptoms and celiac disease.
Conclusion: In the present study, the prevalence of the celiac disease in type 1 diabetic patients was 7.5% which is higher than the normal population.

Background: Growth disturbance is a common phenomenon in children with congenital heart diseases (CHD). Malnutrition and nutritional disturbances have a higher prevalence among children with down syndrome, especially children with Down syndrome; on the other hand, the prevalence of CHD is higher among syndromic children, which needs surgical repair as the definitive treatment. The nutritional status plays an important role in determining the postoperative complications and recovery. The purpose of this study was to investigate the growth status of children with Down syndrome and congenital heart disease before cardiac surgery.
Methods: This study was conducted as a retrospective study by evaluating the records of all syndromic patients undergoing cardiac surgery at Children’s Medical Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran, from March 2011 to March 2017. Age, weight, height, weight-for-age z-score (WAZ), weight-for-height z-score (WHZ), height-for-age z-score (HAZ), mortality and hospitalization rate in an intensive care unit (ICU) were recorded in these patients. The z-scores more than -1 were considered as normal, between -1 and -2 as mild malnutrition, between -2 and -3 as moderate malnutrition and below -3 as severe malnutrition.
Results: 35 (51.5%) patients were female and 33 (48.5%) were male. The mean age, weight, and height of these children were 26.9±24.9 months, 9.1±4.95 kg, and 79.55±17.95 cm, respectively. The mean of WHZ, WAZ, and HAZ in these children was -2.18+1.65, -1.95+2.25 and -1.22+3.11, respectively. Based on the values of WAZ, WHZ, and HAZ, 85.3%, 77.9% and 75% of patients have malnutrition (mild to severe forms, z-score less than -1). The most common cardiac defect was ventricular septal defect (VSD) accompanied by pulmonary arterial hypertension.
Conclusion: Considering the high prevalence of impaired nutritional status in these children and considering the effect of preoperative malnutrition on surgical outcomes, including mortality, assessing the nutritional status is much important. The adequate nutritional support in these patients leads to a reduction of the mortality, postoperative complications and morbidities.

Background: Systemic sclerosis (SSc) is an autoimmune connective tissue disease characterized by vasculopathy and excessive collagen deposition in the skin and internal organs. Based on the skin damage we divide the patients into two groups: limited and diffuse SSc. In restricted type, the thickness of the skin is limited in the face and distal parts of the elbows and knees, with less involvement of internal organs, whereas in diffuse type, facial skin, organs, and trunk generally increase in thickness and internal visceral involvement is noticeable as renal failure, pulmonary artery pressure, and interstitial lung fibrosis. According to the prevalence studies, the prevalence of systemic sclerosis is estimated to be 15 cases per 100,000, of which the prevalence in women is 3 times more than men. Based on clinical evidence the prevalence of SSc is high in Khuzestan province. The aim of this article was to evaluate the demographic features of SSc in Khuzestan province, Iran.
Methods: This cross-sectional study conducted on two hundred SSc patients referred to Rheumatology Clinic of the Golestan University Hospital in Iran, from 2001 to 2015. Patients were selected based on the American College of Rheumatology classification criteria for SSc and were divided into diffuse and restricted types based on the site of skin involvement. Individual characteristics and clinical symptoms were extracted from the information in the patient records which were carefully compiled by physicians. Data on age, sex, race, duration of illness, and family history of SSc were collected orally.
Results: 91.5% of the enrolled patients were female. The mean age was 44 years and the most common race in our study was Lor. The prevalence of the diffuse form of SSc was 68% and the limited form was 32%. The Raynaud's phenomenon was detected in 100% of patients. Sclerodactyly and interstitial lung disease were found in 88.5% and 54.5% of patients respectively. Laboratory features such as ANA (93%), Anti-Scl-70 (77.5%) and anti-centromere antibody (ACA) (70%) of SSc patients were reported.
Conclusion: According to the results of this article, the most systemic sclerosis patients in Khuzestan province were middle-aged Lor race females and the most common type was diffuse systemic sclerosis.

Background: Congenital heart diseases are the second group of congenital anomalies in infants. These disorders are a major cause of death in the first year of a child's life. Early detection helps to treat these diseases better. In this study cardiology consultations of hospitalized infants in the neonatal intensive care unit were evaluated.
Methods: In this cross-sectional study, two hundred and fifty pediatric cardiology consultations conducted in Shahid Beheshti Hospital in the year 2012 were reviewed. Information such as the cause of consulting, delivery type, age of parents, relative couples, family history of congenital heart disease, maternal medications, maternal background diseases, the final diagnosis, and prognosis follow-up of the patients were recorded in a designed questionnaire. Finally, the data were entered into the SPSS software, version 16 (IBM SPSS, Armonk, NY, USA) and analyzed using descriptive statistics and chi-square test. P-value of less than 0.05 was considered significant.
Results: The mean age of the consulted neonates was 4.845±5.14 days with a gestational age of 33.933±3.65 weeks. Male sex and cesarean section were the most frequent. Fifty-six percent of consulted infants were male. The present study revealed that prematurity (76%), murmurs (30.8%), respiratory distress syndrome (14.4%) and cyanosis (13.2%) were the most common causes of the cardiac consultation seeking among infants. Seventy-six percent of infants were consulted due to prematurity. Eighty-four percent of infants had a normal conditions. Septal defects (ventricular or atrial septal defect) and patent ductus arteriosus were the most common disease diagnosed with the prevalence of 27.5 and 17.5%, respectively. There was a significant relationship between preterm labor and congenital heart disease (P<0.001). Additionally, prematurity associated with respiratory distress syndrome and using assisted reproductive techniques.
Conclusion: The higher prevalence of congenital heart disease in the present study, compared with other studies, reflects the fact that cardiology consultation based on clinical suspicion leads to the more identification of congenital heart disease that means the right referral of newborns for consultation was accompanied with a higher incidence of heart failure.

Background: Nowadays, cardiovascular diseases (CVDs) are among the most common causes of mortalities worldwide. Parathyroid hormone (PTH) has an important role in the pathogenesis of CVDs. The aim of the current study was to compare serum PTH levels between patients with acute myocardial infarction (MI), unstable angina, and normal coronary function.
Methods: This descriptive and analytic study was performed on patients with acute MI, unstable angina, and normal coronary function visiting Imam Ali Hospital of Kermanshah city in Iran, during years 2016 to 2017. Data collection was done from December 2017 to March 2018. Of the patients who met inclusion criteria, 120 were selected by accessible sampling and were allocated into three groups. Serum level of PTH was determined in the three groups.
Results: Among the studied subjects, females and males comprised 43 (35.8%) and 77 (64.2%) respectively. Among those with normal coronary function, 22 (55%) and 18 (45%) were females and males respectively. In acute MI group, women and men comprised 8 (20%), and 32 (80%) respectively. Finally, males and females constituted 13 (32.5%) and 27 (67.5%) in unstable angina group. Based on this study, the overall mean serum PTH level was obtained 18.32 pg/ml. The highest PTH level was observed in individuals with normal coronary function, while the lowest level was recorded in patients with unstable angina. There was a significant difference in mean serum parathyroid hormone levels between the study groups in those with no history of smoking.
Conclusion: Our results indicated that parathyroid hormone serum level can be associated with cardiovascular diseases including unstable angina. There were significant differences in the means of parathyroid hormone level between the studied groups depending on the presence or absence of hyperlipidemia. In vitro evaluation of parathyroid hormone level in suspected subjects should be performed in the case of myocardial infarction, unstable angina and normal coronary, prevented from these diseases by testing.