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Prevalence of skin lesions in patients after kidney transplantation referred to Baqiyatallah hospital
Hamideh Molaei, Eghlim Nemati , Ehsan Shojaeefar , Leila Khedmat,
Volume 79, Issue 9 (12-2021)
Abstract
Background: Immunosuppressive drugs that are widely used to prevent acute and chronic organ rejections, predispose organ transplant patients to a variety of diseases including skin problems. This study aimed to determine the prevalence of skin lesions and to investigate their association with demographic characteristics in renal transplant patients.
Methods: This cross-sectional study was performed on 100 patients who were referred to the nephrology clinic of Baqiyatallah Hospital, Tehran, Iran and underwent kidney transplantation within a year (from the first working day of the Iranian Hijri calendar in April 2015 until the last working day in March 2016). Patients were referred to a dermatologist in case of any skin lesions. Patients' data were collected in a researcher-made questionnaire and were analyzed using SPSS software, version 18. The p values less than 5% were considered to be significant.
Results: The mean and standard deviation (SD) of the patients' age was 50/4±11/8 years.  The average time of incidence of skin lesion after transplantation has been 8/1 ± 5/7 weeks. The most common types of non-melanoma cancers were squamous cell carcinoma (2%) and Kaposi's sarcoma (4%) and there was no significant difference between men and women (p>0.05). Sixty-six percent of the patients had skin infections and the most common skin infections were wart (34%) and tinea versicolor (11%). The relative frequency of skin infections was significantly higher in male patients than in females (p=0.004). Considering all other confounding variables including smoking, hypertension, diabetes and other infectious diseases, the only noteworthy finding was the higher relative frequency of tinea versicolor in diabetic compared with non-diabetic patients (p=0.046).
Conclusion: This study showed that skin complications including various neoplastic (Sarcoma and Carcinoma), infectious (fungal and viral), and other (Acne and Hypertrichosis) diseases are common in patients with kidney transplantation who are taking immunosuppressive drugs. Informing these patients and medical staff about skin problems leads to an early referral of patients and increases their life expectancy and improves their quality of life.
 

A systematic review on risk factors and protective factors related to Parkinson's disease
Negar Heidari , Paria Heidari, Nader Salari, Hakimeh Akbari, Masoud Mohammadi,
Volume 79, Issue 12 (3-2022)
Abstract
                                                                        
 
 
 
 
 
 
 
Background: Parkinson's disease is one of the chronic neurological diseases. It is the second most common neurodegenerative disease after Alzheimer's, affecting 7.5 million people worldwide and its rate is expected to increase by 20% by 2020. three symptoms of tremor, muscle stiffness and movement disorders are among the main diagnostic symptoms of the disease. The prevalence of Parkinson's worldwide varies between 18 and 418 cases per 100,000 people per year. It is generally estimated that the prevalence of this disease in the general population is 0.3%. A systematic review study was performed to determine the factors associated with Parkinson's disease.
Methods: This study was a systematic review that was conducted by searching national and international databases until February 2020. Initially, all articles which had mentioned Parkinson-related factors were collected and accepted by researchers based on studies. Entry and exit criteria were met. Exclusion criteria included irrelevant items, duplication of studies, unclear procedure, and lack of access to the full text of the study. To reduce bias, articles were evaluated independently by two researchers, and the quality of articles was assessed using the STROBE checklist. All final articles submitted to the systematic review process were prepared by a template checklist. Checklists included article title, first author’s name, year of publication, place of study, risk factors, protective factors, and ineffective factors or the ones which their effects have not yet been determined, and the average age.
Results: In these studies, the following risk factors were reported: family history, agricultural occupation, literacy, stress, well water consumption, aging, environmental factors, genetic factors, pesticide exposure, and alcohol abuse. On the other hand, factors such as smoking and oilseeds, high levels of B-complex vitamins, female estrogen hormones, and selenium have been reported to protect against Parkinson's disease.
Conclusion: Considering the results of the present study and although there is no definitive treatment for this disease, protective factors and risk factors should be seriously considered by health policymakers for preventive measures.
 

Ranking the factors affecting the care and provision of health services to patients in medical centers using the VIKOR dempster-shafer method: a brief report
Mahsa Salehinejad Gilchalan , Mehdi Sadeghzadeh,
Volume 79, Issue 12 (3-2022)
Abstract
Background: Determining the rank of important parameters in ranking health care and providing health services to patients in medical centers.
Methods: The research method is descriptive-analytical and applied in terms of classification. The data is from the database of the Faculty of Health and Medicine of the University of Tehran, which was collected as an archive from April 1998 to May 1999. The statistical population were all experts, specialists and experts of the Faculty of Health 29 of whom completed the questionnaire. The weight of the criteria was evaluated using the AHP method and in the next stage, the medical centers were ranked using the DS-VIKOR method. The analysis method in this study consists of the following steps steps:
• Implementing a simple VIKOR method.
• Implementing the Dempster-Shafer and Vicker method.
• Implementing the AHP method
• Implementation of the Topsis method.
• Comparing the proposed methods to review and compare which ones work best.
Results: The weight of medical centers was assessed by AHP method and then the combined centers were ranked by Dempster-Shafer and VIKOR combined methods  using the information of four medical centers, the DS-Vikor approach was implemented. The purpose of six criteria and three experts was used for evaluation. The results show that the effectiveness of care and treatment process is more important from the experts' point of view. Dempester-Schaefer and Vicor The medical centers in question are ranked. For validation, at the end, the medical centers were ranked by TOPSIS method.
The integrated system includes various subsystems giving caring and providing health services to patients in medical centers that can be built and configured and are ranked.
The model can investigate the effectiveness of giving caring and providing health services to patients in medical centers.
Conclusion: By combining the two methods of Dempster-Shafer and Vicker, the confidence in the whole uncertainty is improved and the results are more reliable. This approach can help reduce the uncertainty caused by people's cognition to increase the level of decision-making, allowing us to overcome the problem of choosing the right level of uncertainty and to deal with uncertainty in a practical and justified way.

Evaluation of chronic kidney disease and associated factors in psoriasis patients at Razi hospital, Tehran, Iran
Sasan Dogohar, Saber Soltani, Ali Jafarpour, Fatemeh Tavangar , Sara Akhavan Rezayat , Maryam Ghiasi, Maryam Nasimi,
Volume 80, Issue 1 (4-2022)
Abstract
Background: Psoriasis is a chronic and recurrent inflammatory disease that involves skin, joints and different organ systems. It is associated with Multiple morbidities such as cardiovascular disorders, diabetes, hypertension, hyperlipidemia and chronic kidney disease (CKD). Due to the high importance of the association between psoriasis and CKD which results in major side effects the aim of this study was to evaluation of CKD and associated factors in Psoriasis patients at Razi Hospital, Tehran, Iran.
Methods: This retrospective study was conducted as a cross-sectional descriptive and analytical study to evaluate the frequency of CKD and associated factors in psoriatic patients admitted to the Razi Hospital whose last time of admission was from June 2018 to January 2019. According to the K/DOQI guideline, CKD is defined as the GFR<60 mL/min/1.73 m² during at least a period of three months. GFR was calculated based on the MDRD formula. The sample size was equal to 265. The hospital documents of inpatients who have been admitted to Razi Hospital wards or follow-up clinics during 2017-2019 were used for collecting information and data. This information has been extracted based on the initial checklist for data collection. Collected data has been analyzed and performed by using SPSS 25 software.
Results: The study found that 18 (6.8%) of psoriasis patients had CKD. Patients were in the age range of 3.5-92 years, the majority of them were in the age range of 18.65–79.7 years. 171 (64.5%) patients were male and 94 (35.5%) were female. 41 (15.5%) patients had diabetes, 94 (35.5%) had hyperlipidemia and 41 (15.5%) had hypertension. History of NSAID, Methotrexate, Cyclosporine, Acitretin, Infliximab, and Adalimumab medication use among 9 (3.4%), 205 (77.4%), 56 (21.1%), 147 (55.5%), 30 (11.3%), and 28 (10.6%) patients were observed, respectively. Also, 54 (20.4%) had a history of phototherapy. 217 (81.9%) of the psoriatic patients had CPP (Chronic Plaque Psoriasis) and 48 (18.1%) had PP (pustular Psoriasis) and finally, 21 (7.9%) of the patients had psoriatic arthritis.
Conclusion: The prevalence of CKD was shown to increase by age. The other correlated factors are diabetes, hypertension, and hyperlipidemia. On the other hand, there was not found any significant correlation between drugs (NSAIDs, Methotrexate, Cyclosporine, Acitretin, Infliximab, Adalimumab) and CKD prevalence. There was also no significant correlation between phototherapy, psoriasis type and psoriatic arthritis, duration of psoriasis and CKD prevalence.

Vagus nerve stimulation in the treatment of nervous system disease: a review article
Somayeh Nazari , Raheleh Rafaiee, Hamed Ghazvini , Elmira Beirami , Sara Chavoshinezhad , Seyedeh Masoumeh Seyedhosseini Tamijani ,
Volume 80, Issue 4 (7-2022)
Abstract
The vagus nerve (VN), the longest cranial nerve and an essential part of the parasympathetic system, connects the central nervous system to respiratory, cardiovascular, immune, gastrointestinal, and endocrine systems and is involved in the maintenance of homeostasis by controlling these systems. Vagus nerve stimulation (VNS) is related to any method that would stimulate the vagal nerve via electrical stimulation. VNS is a Food and Drug Administration (FDA)-approved treatment for medication-resistant depression, drug-resistant epilepsy, and migraine. However, VNS has also been studied for various other conditions, such as Alzheimer's disease and tinnitus, by targeting the VN in the neck and ear. Currently, there are two methods for VNS: a) invasive-VNS (iVNS), which requires surgical implantation of a pulse generator under the anterior chest wall, that is linked through a wire to an electrode cuff that wraps around a cervical vagus nerve, b) non-invasive transcutaneous VNS which is separated into cervical transcutaneous vagal nerve stimulation (ctVNS) and auricular transcutaneous vagal nerve stimulation (atVNS). The non-invasive transcutaneous VNS techniques are well tolerated and have no significant side effects, making them effective in clinical research for brain diseases. Because with these newer methods, the electrical stimulation is carried out through the skin.
The results of this study were collected using the advanced search in Scientific Information Database (SID), Google Scholar, PubMed, and Scopus between 2011 to 2021. Out of 671 articles surveyed, we used 53 articles in the study after the evaluation. Medical Subject Headings (MeSH) and Keyword Searching was carried out through the MeSH database. VNS has been shown to alter neural activity in multiple areas of the brain related to the regulation of the affective states. However, the precise mechanism of VNS action on the clinical consequences is still unknown. This study aimed to review the therapeutic effect of both methods of VNS in neuropsychiatric and neurological disorders such as depression, migraine, seizure, tinnitus and Alzheimer's disease and discuss several hypotheses on the mechanism of VNS, as a new approach, in the treatment of such disorders. It considers that a brain-mapping approach is needed to discover the therapeutic mechanisms of VNS in brain diseases.

Evaluation of effective factors in the success of resuscitation of patients with in-hospital cardiopulmonary arrest
Mohammad Nasr Esfahani , Aref Javari, Farhad Heydari, Majid Javari,
Volume 80, Issue 4 (7-2022)
Abstract
Background: Previous studies have shown that several factors affect the outcome of cardiopulmonary resuscitation. In this study, we have evaluated the factors associated with the outcome of resuscitation in in-hospital cardiopulmonary arrest patients (IHCA) 002E.
Methods: This cross-sectional non-probability study was performed on patients with in-hospital cardiopulmonary arrest between 2015 and 2020 in the emergency department (ED) of Al-Zahra Hospital, Isfahan, Iran. Data were then collected from medical records to describe patient characteristics, arrest profile, and survival details. Factors associated with the dependent variable were examined Logistic regression.
Results: Among 848 in-hospital cardiopulmonary arrests, 18 patients (2.1%) survived and were discharged from the hospital. The mean age of patients was 62.74±21.17 years, 583 (68.8%) were male, and 265 (31.2%) were female. The mean age of patients with successful resuscitation and those with unsuccessful resuscitation was 62.33±21.79 (6 to 116 years) and 61.58±21.20 (1 month to 108 years) years, respectively. The rate of unsuccessful resuscitation increased with increasing age (P=0.04). Also, the rate of unsuccessful resuscitation increased if there was an underlying disease (P=0.01). In frequency analysis of resuscitation services, emergency medicine with 633 (57.3%) resuscitation is in the first place in the number of resuscitations, of which 22.9% of them have been successful (ROSC). In the anesthesia service, of 2 resuscitations performed, both were successful. In the general surgery service, 36.5% of 63 resuscitations were successful, and the success rate for the neurosurgery service was 32.4% of 102 resuscitations. Analyzing the duration of successful and unsuccessful resuscitation has great importance. In successful resuscitation, the average time was 18.98 minutes and in unsuccessful resuscitation was 39.20 minutes. Also, the maximum and minimum time for successful resuscitations was 63 and 1 minutes. The maximum and minimum time for unsuccessful resuscitations was recorded as 60 and 10 minutes.
Conclusion: The results showed that several factors were influential in cardiopulmonary resuscitation. Increasing age and underlying disease reduced the success of cardiopulmonary resuscitation.

Effect of cardiac rehabilitation on endothelial function in smoker patients with ischemic heart disease
Ahmad Reza Assareh , Marzieh Jafarpor, Mohammad Hossein Haghighzadeh, Nehzat Akiash,
Volume 80, Issue 6 (9-2022)
Abstract
Background: smoking enhances the risk of cardiac events in patients with coronary artery disease. So, it is necessary to evaluate the effects of exercise-based cardiac rehabilitation on endothelial function and functional capacity among smoker patients.
Methods: This randomized clinical trial study was conducted on 56 non-diabetic smokers with a history of percutaneous coronary intervention or coronary artery bypass graft surgery in Imam Khomeini Hospital from May to August 2015. Based on cardiac rehabilitation, patients were divided into intervention and control groups. Before rehabilitation, fasting blood sugar (FBS), lipid profile (LDL, HDL, triglyceride, and total cholesterol), and Ankle-Brachial Index (ABI) were measured for endothelial function. Besides, METs were measured based on the Duke activity status index. After 24 rehabilitation sessions (3 sessions of 1 hour each week for 2 months), all values were checked again and compared with the initial values.
Results: The mean age of the subjects in the cardiac rehabilitation and control groups were 61.18 and 52.32, respectively. Before the intervention, there were no significant differences between the two groups in terms of the ABI variables, BMI, systolic and diastolic blood pressure, LDL, triglyceride, total cholesterol and FBS; only HDL and  METs showed significant differences. After exercise-based cardiac rehabilitation, the mean rate of ABI changes was +0.078 on the right side of the body and +0.084 on the left side of the body. In the control group, these values were 0.002 and 0.003, respectively (P=0.001). The amount of changes in increasing METs as well as decreasing body mass index (BMI), and systolic and diastolic blood pressure in the rehabilitation group were statistically significant compared to the control group. In addition, there were no significant differences in terms of FBS and lipid profiles either (P>0.05).
Conclusion: Two months of cardiac rehabilitation with regular exercise was associated with improved ABI as an indicator of endothelial function and prognosis of cardiovascular disease, as well as improved cardiac functional capacity among smoker patients.

Lean individual’s non-alcoholic fatty liver disease: a review article
Naser Ebrahimi Daryani , Mohammad Reza Pashaei ,
Volume 80, Issue 6 (9-2022)
Abstract
Nonalcoholic fatty liver disease (NAFLD) is defined by steatosis in more than 5% of liver cells, in the absence of a secondary cause such as drugs, alcohol, or other causes. The incidence of NAFLD is increasing every day; almost a quarter of the world's adult population is affected by this disease. The burden of NAFLD is affected by the epidemics of obesity and type 2 diabetes (T2DM), and therefore, we do not expect the prevalence of this disease to decrease in the future. The world is now in the process of passing on health to non-chronic diseases, like NAFLD. The most common cause of chronic liver disease worldwide is non-alcoholic fatty liver disease. About 25 percent of the world's population is affected by the disease, and it ranges from simple steatosis to cirrhosis. 1 in 4 individuals with NAFLD is a person with non-alcoholic steatohepatitis, which is associated with complications and significant mortality and morbidity due to complications such as liver cirrhosis and hepatocellular carcinoma. Non-alcoholic fatty liver disease is closely related to metabolic syndrome, and it can be said that the liver is an integral part of obesity. Diagnostic methods for this disease include laboratory tests, imaging studies and liver biopsy. Although NAFLD is observed predominantly in obese persons or type 2 diabetes, an estimated 7% to 20% of people with NAFLD have lean body habitus. Recent studies have shown that fatty liver can occur in lean individuals, even without abdominal and visceral fat. Fatty liver in lean people (Lean NAFLD) is a relatively new concept that has attracted many people to find the differences between lean and obese people. The pathophysiological mechanisms of lean NAFLD are still poorly understood. Studies have shown that NAFLD without obesity is more closely related to factors such as environmental, genetic susceptibility, and epigenetic regulation. In addition to lifestyle modifications such as weight loss, diet and physical activity, only a few NAFLD-specific drug treatment options such as vitamin E and pioglitazone are considered. This article discusses the pathogenesis of fatty liver in lean individuals, its treatment, prognosis, and its relationship with metabolic syndrome.

Evaluation of the diagnostic function of shear wave elastography in the differentiation of malignant and benign breast masses and its relationship with histological factors
Parivash Parvasi, Zahra Fazelinejad, Fatemeh Mahdipour, Shahram Bagheri , Mohammad Momen Gharibvand ,
Volume 80, Issue 7 (10-2022)
Abstract
Background: Shear wave elastography (SWE) estimates the stiffness of a mass based on the velocity of shear wave propagation by sound waves. Due to higher cell density and angiogenesis, malignant masses have higher stiffness than benign ones.
Methods: The present study was a prospective study and was performed on patients who were referred to Ahvaz Golestan Hospital with breast mass during March 2020 to March 2021. Only patients with 4-5 BI-RAD were evaluated. Patients were graded based on ACR BI-RAD. All patients were subjected to ultrasound and selection of BI-RAD 4-5 patients for evaluation with SWE and sampling for pathology testing. In this study, in order to increase the maximum accuracy and take samples from the main location of the lesion, sampling was done by ultrasound-guided biopsy method. Tumor information was recorded by a specialist doctor after ultrasound and SWE. This information included tumor type, tumor size and grade, presence of metastasis, involvement of lymph nodes, average and maximum elasticity. SWE cutoffs were compared for mean and maximum elasticity to distinguish benign from malignant masses.
Results: In this study, 115 patients were evaluated. 63.5% (73) of the patients had benign mass and 36.5% (42) had malignant ones. There was a significant relationship between tumor size and mean and maximum elasticity (P<0.001 The results showed that the diagnostic accuracy of SWE in identifying malignant masses compared to benign ones was 100%, so that the mean (16.61±8.03 kPa) and maximum (21.14±8.88 kPa) elasticity in benign masses were significantly lower than the mean (32.21±7.59 kPa) and maximum (91.62±8.84 kPa) elasticity of malignant masses (P<0.001). There was also a significant difference between the 4 BI-RAD subgroups, so that in BI-RAD 4a, the lowest mean and maximum elasticity were seen (P<0.001).
Conclusion: The results showed that SWE parameters have sufficient diagnostic accuracy in diagnosing malignant breast masses. Therefore, the use of quantitative SWE parameters in conjunction with ultrasound and BI-RADS classification can avoid unnecessary biopsies.

Atrophy of hippocampal subfields as a diagnostic biomarker in alzheimer's disease patients and its differentiation from mild cognitive impairment disorders
Yunus Soleymani, Amir Reza Jahanshahi, Davood Khezerloo ,
Volume 80, Issue 11 (2-2023)
Abstract
Background: Atrophy of hippocampal subfields is one of the diagnostic biomarkers of Alzheimer's disease, which has also been observed in many patients with mild cognitive impairment. There is still no clear understanding of the atrophy pattern of hippocampal subfields in Alzheimer's disease and its differentiation from mild cognitive impairment. In this cross-sectional study, hippocampal subfield atrophy in Alzheimer's patients were compared with patients with early (EMCI) and late (LMCI) cognitive impairment and the control group.
Methods: This was a cross-sectional study conducted from September 2021 to September 2022 in the radiology department of Tabriz Paramedical Faculty. MRI images of Alzheimer's patients, EMCI patients, LMCI patients, and normal controls (NCs) were obtained from the ADNI database. Different hippocampus subfields of hippocampal fissure, dentate gyrus head, dentate gyrus body, first cornu ammonis body, cornu ammonis head, subiculum body, and subiculum head were isolated using the hippocampus segmentation tool in FreeSurfer 7.0 software. The volume of all subfields was calculated bilaterally and normalized. The volume difference of each hippocampus subfield between the groups participating in the study and the pair volume difference between the groups was analyzed using the Kruskal-Wallis H Test and post-hoc Dunn's test. The P<0.05 was considered as the significance level.
Results: The most significant volume difference between the four groups participating in the study was related to the whole hippocampus, DG body, subiculum body, and subiculum head subfields (P<0.0001). Also, when examining pairs, the most significant difference was observed between the NC/AD pair (P<0.0001) and the least significant difference between the pair of LMCI/AD group (P<0.05) and in the subfield subiculum body showing the progressive course of hippocampal subfield atrophy with cognitive progress towards Alzheimer's disease.
Conclusion: In most subfields of the hippocampus, a significant difference in atrophy can be seen, increasing the severity of atrophy as the disorder progresses toward Alzheimer's. Such findings can help guide future studies to improve diagnostic performance to identify individuals at high risk of Alzheimer's disease.

Evaluation of the relationship between the severity of depression, anxiety and stress with nuclear scan in Urmia
Sara Hassanzadeh, Mahmonir Haghighi, Hojjat Shafipour, Maryam Faramarzpour,
Volume 81, Issue 1 (4-2023)
Abstract
Background: Some negative psychological factors such as depression, anxiety, and stress have been identified as serious risk factors for the final adverse outcome of ischemic heart disease. Given the high prevalence of psychiatric disorders, in this study, we aimed to determine the relationship between the severity of depression, anxiety, and stress, with nuclear scan results in patients referred to Imam Khomeini Hospital in Urmia.
Methods: In this cross-sectional-analytical study, 163 patients with the possibility of ischemic heart disease from various clinics and medical centers referred to Imam Khomeini Hospital in Urmia for nuclear heart scanning from April to July 1400, were assessed by the DASS-21 questionnaire in terms of depression, anxiety, and stress scores. Finally, the data obtained from the DASS-21 questionnaire, nuclear scan, and demographic characteristics were analyzed with SPSS20 software.
Results: According to the results, the mean age of the patients was 54.78±11.54 years, 73% of whom were women. The prevalence of depression, anxiety, and stress was high (72.4, 80.3, and 59.5%, respectively). Although the prevalence of depression, anxiety, and stress in patients with a negative report of ischemia was higher and evaluated as 73.2, 78.7, and 58.3% respectively, there was not a significant difference with the subjects whose heart scan results were positive (P>0.05). Moreover, a weak positive correlation was observed between the severity of depression, anxiety, and stress with the severity of cardiac ischemia in study patients.
Conclusion: The results of this study revealed that the depressive, anxiety, and stress symptoms in patients before a cardiac nuclear scan are often moderate to mild. Likewise, among the different demographic characteristics of patients, only gender played an important role in these disorders. Regardless of the negative nuclear scan results in most patients (77.9%), the prevalence of these psychological symptoms in the studied patients was high. Therefore, considering the possibility of psychological disorders with clinical manifestations mimicking cardiovascular can prevent additional costs for diagnostic and therapeutic procedures in these patients.

Evaluation of lung transplant patients in Imam Khomeini hospital, Tehran university of medical sciences
Tayebeh Lakzaei, Niloofar Khoshnam-Rad , Maryam Edalatifard , Hamidreza Abtahi,
Volume 81, Issue 3 (6-2023)
Abstract
Background: Despite the progress of medical science and organ transplantation, lung transplantation is associated with significant complications and mortality. In Iran, the first lung transplant was performed in 2000 at Imam Khomeini Hospital in Tehran. So far, there has been no assessment of the patients. The main purpose of this study is to investigate the status of lung transplantation status at this center.
Methods: In this retrospective longitudinal study, all lung transplant patients referred to the Lung Transplantation Center of Imam Khomeini Hospital in Tehran from April 2000 to March 2022 were examined. Demographic and clinical data, and information related to their current status, including pulmonary function tests, transplant-related complications, pharmacotherapy, and drug-related adverse events were recorded. Appropriate statistical analysis was applied.
Results: During the study, 20 lung transplants were observed, 20 percent of transplant recipients were women, and 80 percent were men. The mean age of the patients at the time of transplantation was 39.3±11.4 years. The youngest patient at the time of transplantation was 22, and the oldest was 60 years old. The most common indication for transplantation was interstitial lung disease (70%) followed by chronic obstructive respiratory disease. The average forced expiratory volume in one second (FEV1) value of the patients in the first year was about 50%, which gradually decreased to less than 20 percent in the fifth year. The average survival after transplantation was 5.75±4.6 years. The post-transplant one month, three months, one year, three years, and five years survival were 80, 75, 70, 60, and 50 percent, respectively. Chronic lung allograft dysfunction and serious infections are the most common causes of mortality.
Conclusion: The transplant center at Imam Khomeini Hospital is one of the most important lung transplant centers in Iran. The survival status and transplant outcome are comparable with those reported around the world. More attention should be paid to infection control, patient selection, and perioperative care to improve the outcomes of lung transplantation.

Biomarker role of CH25H and GYPE genes in osteoarthritis and rheumatoid arthritis
Akram Gholipour, Mahshid Malakootian , Maziar Oveisee,
Volume 81, Issue 4 (7-2023)
Abstract
Background: Osteoarthritis (OA) and rheumatoid arthritis (RA) are both joint diseases with many different causes. Inflammatory arthritis, also known as rheumatoid arthritis, is one of the most complex types of arthritis. Non-inflammatory arthritis, also known as osteoarthritis, is a disease caused when the cartilage between the joints begins to be damaged. Considering the different treatment approaches for OA and RA, an accurate diagnosis of the type of arthritis is very important. The present study was conducted with the aim of finding gene expression and introducing reliable molecular biomarkers for RA and OA.
Methods: The microarray dataset was obtained under the GSE27390 number. The samples included nine samples of mononuclear cells obtained from the bone marrow of RA patients, 10 samples of mononuclear cells obtained from the bone marrow of OA patients. Differential expression analysis between the OA and RA groups was performed using GEO2R, and genes with differential expression were separated by examining two factors such as logFC#1 and p.adj. Value<0.05. Signaling pathways were determined using Enrichr databases. Next, the genes with the most expression changes were introduced. This study is a bioinformatics analysis and was conducted jointly at Bam University of Medical Sciences and Rajaie Cardiovascular, Medical and Research Institute from September 2022 to March 2023.
Results: The results showed that, 5083 genes had significant expression differences. Analysis of signaling pathways showed that antigen processing and presentation,  natural killer cell-mediated cytotoxicity, the, IL-17 signaling pathway, Th17 cell differentiation and cytokine-cytokine receptor interaction, as inflammatory pathways, were important in this disease. It was also determined that CH25H (upregulated in RA samples) and GYPE (downregulated in RA samples) genes can distinguish rheumatoid arthritis from osteoarthritis.
Conclusion: Since accurate diagnosis helps with better disease treatment, it is very important to obtain new biological diagnostic markers. Overall, our data showed that genes can act as novel biomarkers with potential utility in the diagnosis of RA and OA and can be considered novel molecular biomarkers for the diagnosis of these two diseases.

Realizing the early prediction chronic kidney disease based-on identifing
Mahdieh Jamshidi, Vahid Jamshidi,
Volume 81, Issue 4 (7-2023)
Abstract
Background: Due to the fact that various factors are involved in the development of chronic kidney disease, this disease appears with different clinical and laboratory symptoms. The variety in type and number of clinical symptoms often misguides the treating physician. The aim of this study is to extract the key features of the disease and find the best data mining methods to improve the accuracy of kidney disease diagnosis.
Methods: This cross-sectional study was conducted from September 2021 to March 2023 for 30 months at Rafsanjan Ali Ebn Abi Taleb Hospital. Predictive models were developed and tested using different combinations of disease characteristics and seven data mining methods in RapidMiner Studio software. The limitations of the study are as follows: 1) The models were based on 40-year-old and older patients records, which may limit the generalization of results to a wider age group. 2) Despite the high accuracy and comprehensiveness of the method, the models were based only on the information of kidney disease patients at Ali Ibn Abi Talib Rafsanjan Hospital. 3) The climate parameter has not been considered in the data set of the investigation to discover the hidden relationships of this parameter with the kidney disease.
Results: The results of the experiments in this study showed that the proposed prediction model using the Bayes method and eight identified key features (age, renal biopsy, uremia, sedimentation, albumin, edema, nocturnal enuresis, and urine-specific gravity), can detect kidney disease in people of different clinical characteristics, with 99.38% accuracy.
Conclusion: Considering that the early diagnosis of kidney disease and the adoption of appropriate treatment methods can prevent the progression of kidney damage, in this study, an attempt has been made to achieve this goal by using new statistical methods and artificial intelligence techniques. Based on the proposed method and the conducted experiments, the most important features and the best data mining method were obtained, and finally, kidney disease prediction was possible with high accuracy.

Investigating of the time and rate of occurrence of hematoma after angiography and its related factors in Mazandaran heart center
Samad Golshani, Zahra Azizi, Aliasghar Farsavian, Abbas Alipour,
Volume 81, Issue 5 (8-2023)
Abstract
Background: Coronary angiography is an elective method to confirm or rule out coronary artery disease and to decide on the treatment plan but it is an invasive method and it has some complications. The most important and common complication was hematoma. It could be the cause of mortality and morbidity. The present study was conducted with the aim of investigating the time of hematoma occurrence after angioplasty and investigating the effect of various factors (for example age, sex, BMI, BP, hematocrit, anticoagulant agent, etc.) on the occurrence of hematoma.
Methods: This was a prospective cohort study from March 2022 to March 2023 in Mazandaran heart center. The study population was patients who underwent angioplasty through the femoral artery. If the ACT is less than 150-180, sheet removal was done by applying pressure with the hand on the proximal puncture site for 15-20 minutes and ensuring sufficient hemostasis. Then, the ultrasound of the puncture site was performed before pulling the sheet/one hour and six hours after pulling the sheet, and after collecting the data, the data were analyzed to study the effect of BMI, BP, sex, hematocrit, hemoglobin, age, time of sheet removal, anticoagulant agent, etc. on prevalence of hematoma and it size.
Results: 200 patients were examined, of which 44(22%) had hematoma. Women had hematoma more than men (P<0.05). BMI and blood pressure in patients with hematoma decreased and increased, respectively (P<0.05). Older age, female gender, lower hematocrit, and longer duration of sheet retention were effective factors in increasing hematoma size (P<0.05). In the logistic regression model, with increasing BMI, the chance of hematoma occurrence decreased (P=0.029, OR=0.831).
Conclusion: Controlling blood pressure and preventing of decreasing the hematocrit, reduces the incidence of hematoma in patients after angiography. Also, preventing hematocrit drop and removal of sheet at the appropriate time, can prevent of increasing in size of hematoma. There is some difference between nursing report and sonography finding. Nursing report overestimated the hematoma size.

Considerations of in-vivo breast tissue assessment using raman spectroscopy: a review article
Sadaf Alipour, Zohreh Dehghani-Bidgoli ,
Volume 81, Issue 6 (9-2023)
Abstract
Raman spectroscopy, as an emerging and promising molecular assessment tool, has attracted the attention of researchers, especially for disease diagnosis in human organs such as the breast. Although most of the Raman studies on the breast have dealt with ex-vivo examination of either intact or processed excised tissue specimens, there are some in-vivo studies, including intraoperative tumor margin assessment and a few non-invasive studies. Since the non-invasive or minimally invasive Raman assessment technique is an essential need for translation to clinical approaches, in the present article, the most recent and relevant studies in this regard have been reviewed to find and introduce the most proper Raman spectroscopy system’s specifications for in-vivo assessment of breast tissue.
Scholarly documents, including articles, books, and dissertations related to Raman assessment of breast tissue or in-vivo Raman assessment of other human organs, were perused in search of the most relevant technical details of Raman systems employed so far. On the one hand, the present study has covered Raman instrumentation aspects of diverse types of Raman spectroscopy, different types of laser source and their specifications, optical elements used in the delivery and collection of light to and from the tissue such as lenses and fibers, detectors and even calibration settings. On the other hand, the main Raman features corresponding to different breast pathologies have been studied, speculating their variations in a non-invasive setting. Having studied all, we tried to find the best feasible configuration for a Raman system in terms of the ability to meet the needs of a non-invasive, in vivo clinical examination of the breast. 
In terms of the Raman spectroscopy modality and laser source, SORS/TRS and 785nm laser diode, were selected for in vivo examination of the breast respectively. The pertinent parameters of the spectrograph, detector, and fiber optic probe were introduced as well.
In the present study, detailed specifications of a non-invasive, in vivo Raman apparatus for examination of breast tissue have been studied and specified.

Enhancing bioterrorism defense, leveraging animal models for viral drug and vaccine development: a review article
Hadi Lotfi, Morteza Izadi, Ehsan Lutfi , Hadi Esmaeili Gouvarchin Ghaleh,
Volume 81, Issue 7 (10-2023)
Abstract
Deliberate or threatening use of viruses, bacteria, toxins, or poisonous substances prepared from living organisms to cause death or disease in humans, animals, and plants is called bioterrorism. These agents can be spread by spraying them in the air, causing infection in animals, transferring this infection to humans, or contaminating water and food sources. Defense measures, such as emergency responses to this type of terrorism, are unfamiliar and unknown. The general state of helplessness caused by the lack of complete preparation and the lack of anti-pollution strategies complicates the issue. The ability and widespread interest of civilian personnel to participate in the development of chemical and biological weapons is directly related to easy access to academic excellence around the world. Another factor is the tempting misuse of freely available electronic data and knowledge about the production of antibiotics, vaccines, and conventional weapons with their various complex details. The use of animals in laboratory research to better understand the mechanisms of disease and treatment and to overcome the limitations of clinical trials has a long history. For many viruses, laboratory diagnostic methods and reagents must be continuously modified to account for genetic variations and variants. Unlike bacterial diseases, many of which can be treated with antimicrobial drugs, there are fewer medical countermeasures to combat viral infections. Many of these pathogens are lethal or cause debilitating diseases in humans, making it ethically inappropriate to test the effectiveness of these countermeasures on human volunteers. Researchers must have a correct understanding of various animal models so that they can make the correct choice, gain a better understanding of the clinical symptoms of viral diseases, and provide possible options for treatment and vaccine development. It should be noted that decision-making when faced with a biological attack should be done away from too much fear, and this requires researchers to have prior knowledge of facing these threats. Despite all these checks and measures taken in advance, the international preparedness against these attacks is weak, which can be attributed to the lack of global plans to deal with the epidemic.

Two asthma control test for children and asthma control questionnaire in pediatric asthma patients referred to taleghani hospial clinics, Gorgan
Mohsen Ebrahimi, Zahra Valipour Moghadam , Seyed Ali Aghapour, Azam Rashidbaghan,
Volume 81, Issue 7 (10-2023)
Abstract
Background: Asthma is a chronic inflammatory disease of the airways. Various tests and questionnaires are designed to monitor the severity of asthma and help the therapist and the health system prescribe the best treatment to control it. This study was designed to compare two methods Asthma Control Questionnaires (ACQ) and Asthma Control test-child (ACT-CHILD) in children with asthma.
Methods: This descriptive cross-sectional study was conducted on 92 children with asthma referred to the Taleghani hospital, Gorgan, in 2022-2023. Patients were in a range of age 4-16 years. Asthma control was evaluated and compared by two methods ACT-CHILD and ACQ. ACT-CHILD included one version for 4-11-year patients completed by their parents and another one for 12-16 –year patients completed by the patients. The clinical symptoms, age, gender and the parents' records related to asthma were completed during the clinical interview. Data was analyzed using Chi-square and Spearman correlation tests. The degree of agreement between two questionnaires was determined using the Kappa coefficient.
Results: 84 children aged 4-11 years (91.3%) and 8 children aged 12-16 years (8.7%) were included in the study. According to the ACT-CHILD, 40.2% of children (n=37) had controlled asthma, 44.6% (n=41) had partially controlled asthma, and 15.2% (n=14) had uncontrolled asthma. Based on the ACQ, controlled asthma was observed in 18.5% (n=17), partially controlled asthma in 35.8% (n=33), and uncontrolled asthma in 45.7% (n=42) of children. Asthma control results based on two questionnaires were significantly different from each other (P<0.001). The agreement between the ACT-CHILD and ACQ methods in evaluating children's asthma was at a weak level (P=0.014, κ=0.157), however, a significant negative correlation was observed between the scores of the ACT-CHILD and ACQ questionnaires (r=-0.588, P>0.001) which after categorizing based on age group, this correlation was confirmed only in children aged 4-11 years (r=-0.627, P>0.001).
Conclusion: Our findings showed that there is a poor agreement between ACT-CHILD and ACQ results in the assessment of asthma control. Further studies are recommended.

Initial crohn’s disease flare-up following an anal trauma in a 2.5-year-old boy: a case report
Ali Samady Khanghah , Maryam Khalesi , Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Hokmabadi, Khashayar Atqiaee,
Volume 81, Issue 8 (11-2023)
Abstract
Background: Crohn's disease is considered a heterogeneous disorder with multi-factorial etiologies, in which the interaction of genetics and environment manifests the disease. Adverse childhood experiences can affect future physical and mental health outcomes. The rich innervation of the intestine with the Vagus nerve and hormonal interactions on the one hand and the constant contact of the digestive system with various pathogenic and non-pathogenic antigens have a proven role in autoimmune diseases and can gradually be chosen as a therapeutic goal.
Case Presentation: We are reporting a case of Crohn's flare-up after trauma in a pediatric case. A 2.5-year-old male with a through and through anal trauma was presented in Akbar Children's Hospital, Mashhad, Iran, Spring 2023 with active bleeding but conscious. He then underwent a physical examination under general anesthesia in the operating room. At the Lithotomy position, a penetrating wound at the 3 o'clock anal verge and a tear in the perineal area at 9 o'clock, which, according to the evidence of pus discharge, were seen hours after the incident which was irrigated with normal saline and Hydrogen Peroxide respectively. Due to the contamination of the area, a supportive colostomy was decided to be closed after six months. At the appointed time during the colonoscopy, the pediatric gastroenterologist noticed extensive inflammation in the distal patch of the colon, which was consistent with Crohn's disease. Histopathological studies then confirmed this diagnosis. This was even though there were no symptoms of inflammatory bowel disease in the history of the boy's illness before the accident. The patient is then treated with prednisolone, Asacol, and ciprofloxacin, and after the disease subsides, the colostomy surgery team closes the disease.
Conclusion: Trauma can be an immune-disrupting factor in the digestive system, and trying to reset the brain-gut axis can be chosen as a therapeutic goal.

Seasonal impact analysis on COVID-19 severity: insights from homogeneous epidemiological hospital data using the jaccard correlation coefficient
Ameneh Javanmard, Alireza Salehan,
Volume 81, Issue 10 (1-2024)
Abstract
Background: Coronaviruses were discovered in 1960. Large-sized living organisms from the Coronaviridae family, with single-stranded RNA of animal origin. Coronaviruses in humans can cause mild respiratory illness or severe respiratory illness. In 2020, the World Health Organization declared COVID-19 a global pandemic. The aim of this study is to use the Jaccard similarity coefficient to determine the similarity of COVID-19 behavior patterns in different seasons of the year.
Methods: This study used machine learning systems and similarity metrics to determine the behavior pattern of COVID-19 in different seasons of the year. The location of research was the Mousa ibn Ja'far Hospital in Mashhad, and the time was from May 2020 to August 2021. The symptoms of affected patients were compared with the compiled dataset, and the similarity of patients was prepared in a similarity matrix, and the Jaccard correlation coefficient was calculated on the data. Finally, the analysis of strains from the beginning of emergence to the latest strain was examined. The performance indicators of the algorithm in the Jaccard similarity method showed a recall metric with a value of 0.94, a precision metric with a value of 1, an F1 score with a value of 0.86, and remove accuracy metric with a value of 0.76. The most important factors in the investigation include white blood cells, platelets, RT-PCR, CT SCAN, shortness of breath, fever, SPO2, and respiratory rate.
Results: The transmission of the COVID-19 virus depends on several factors, including human interaction. The evidence of the collected data shows that people with COVID-19 have low lymphocyte count and it is very consistent with the results of recent studies. Due to the lack of a dataset, a comparative study was conducted and a dataset was collected.
Conclusion: This study, leveraging machine learning algorithms, identified a clear seasonal correlation in the spread of COVID-19. Considering geographical and seasonal variations among patients, distinct symptoms were observed in each season corresponding to the prevalent strain during that period.

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