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Prophylactic teatment with oral paracetamol for patent ductus arteriosus in preterm infants: a randomized clinical trial
Parvin Akbari Asbagh , Mohammad Reza Zarkesh , Firoozeh Nili , Fatemeh Sadat Nayeri , Azam Tofighi Naeem ,
Volume 73, Issue 2 (May 2015)
Abstract
Background: The incidence of Patent Ductus Arteriosus (PDA) in premature infants whose birth weight is less than 1500 grams is approximately 30-60%, most of them need medical or surgical interventions. The purpose of this study is to determine the efficacy of prophylactic treatment with oral paracetamol (Acetaminophen- Hakim® Oral Drops 100 mg/ml, Hakim Pharmaceutical Co., Tehran, Iran) for PDA in preterm infants. Methods: A randomized clinical trial conducted from March 2012 to March 2013. Thirty-two preterm newborns whose gestational age was under 32 weeks and birth weight was 1500 grams or less, admitted in neonatal intensive care unit (NICU) of Vali-Asr Hospital, Tehran were studied prospectively. They were randomly assigned in two groups. The prophylaxis group received oral paracetamol for a period of two days starting during first 24 hours of life. No placebo was given to the control group. Echocardiography was performed 24-36 hours after the last given dose in prophylaxis group and on the 4th and 5th day in control group. A p-value less than 0.05 are considered significant. Results: There were 16 newborns in each group (20 boys and 12 girls). In 12 newborns of prophylaxis group the ductus arteriosus was closed although in control group in 8 newborns the duct was closed. No significant difference was observed in sex, gestational age, birth weight, mode of delivery, multifetal gestation and birth order between two groups. The rate of ductal closure was 75% and 50% in prophylaxis group and control group respectively (P=0.27). Conclusion: Our study demonstrated that prophylactic paracetamol is ineffective in PDA closure, although the rate of ductal closure between two groups seems remarkable. Paracetamol as a new strategy for PDA closure because of cost effectiveness and harmlessness may be used in future. However, we presume larger sample size studies are needed to show the efficacy of paracetamol, side effects, and complications in PDA prophylaxis treatment.
Evaluation of fluconazole effect in prevention of fungal infection and mortality and morbidity in very low-birth-weight infants
Nastaran Khosravi , Nasrin Khalesi , Samileh Noorbakhsh , Mazyar Tarkhani ,
Volume 74, Issue 4 (July 2016)
Abstract

Background: Fungal infections especially Candida species are frequent cause of mortality and morbidity in very low-birth-weight (VLBW) infants receiving intensive care; Candida infections are tissue invasive. This infection increases the risks of adverse neurodevelopmental sequelae. Prevention and treatment of fungal infection is so important in very VLBW infants. The aim of this study was to determine the prophylactic effect of fluconazole in decreasing the mortality and morbidity in VLBW infants (less than 1500gr) admitted in NICU.

Methods: This prospective case control study were conducted among 102 Infants (weighing less than 1500gr at birth at born) admitted in NICU department of Ali Asghar University Hospital from 2012 to 2013, Tehran, Iran. Weigh of birth in cases and groups were less than 1500 gr and both were culture negative. Cases received oral fluconazole 3 mg/kg in 3 days in 1st and 2nd weeks, alternate day in 3rd and 4th weeks, daily in 5th and 6th weeks. Control groups had not received fluconazole. Mortality and morbidity and hospital stay were compared between cases and controls groups.

Results: We studied 49 very low-birth-weight infants with negative culture as cases (received fluconazole prophylaxis), 46 VLBW infants without fluconazole profilaxy (controls). No significant difference in gestational age (P=0.2), and mean weights (P=0.4) were observed between cases and controls. The mortality rate 8.7% (n=4) in controls (without prophylactic fluconazole) observed vs 2% (n=1) mortality rate in VLBW cases (with prophylactic fluconazole). Although the mortality rate in controls was 4 times higher than cases, but without significant differences (P=0.1). Indeed, mean duration of hospital stay in controls was longer than cases (28.41±9.93 vs 19.85±6.19 days, P=0.00001).

Conclusion: Although prophylactic fluconazole in VLBW could decrease the mortality of cases (control the fungal infection) 4 fold in compare with controls (no treatment), it was not significant. The prophylactic effect of fluconazole might decrease the length of hospital stay of VLBW neonates in NICU. Due to limited number of cases and control. For further decision about prophylactic use of fluconazole, prospective RCT studies with larger cases and control would be helpful in future.


HLA-E polymorphism study in Iranian thalassemic patients
Ehsan Sarraf Kazerooni , Ehteramolsadat Hosseini , Zohreh Sharifi , Azita Azarkeivan , Mehran Ghasemzadeh ,
Volume 74, Issue 5 (August 2016)
Abstract

Background: Human leukocyte antigen E is a member of non-classical HLA class I. Interaction between HLA-E molecule on the target cells and inhibitory CD94/NKG2A receptor on the cell surface of natural killer (NK) cells has an important role in the regulation of immune system against pathogens; therefore different cell surface expression of HLA-E molecule plays an important role in host resistance against viral infections as well as host response to treatment. Considering this fact, we analyzed the frequency of different HLA-E genotypes (HLA-E*01010101, HLA-E*01030103, HLA-E*01010103) in major thalassemic patients who underwent frequent transfusion therapy and are thus more susceptible to infectious diseases.

Methods: This study was a cross-sectional study of 104 major thalassemic patients who referred to Tehran Thalassemia Clinic between the years 2015 to 2016. Blood DNA was extracted and proliferated by sequence-specific primer polymerase chain reaction (SSP PCR). The PCR product was subjected to electrophoresis on 1.5 percent agarose gel then DNA fragment bands on the gel were detected by exposing to UV light. Furthermore, PCR products were also subjected to sequencing analysis for further confirmation.

Results: From 104 patients in this study, 49 (47.1%) were man and 55 (52.9%) were women. These patients were in the age range of 16 to 43 years (mean+SD; 31.03±4.7 year). The frequency of HLA-E*01010103 genotype (64.4 percent) was significantly (P= 0.001) higher than the genotypes of HLA-E*01010101 (15.4%) and HLA-E*01030103 (20.2%) whereas there was no difference between the frequency of HLA-E*0103 allele (52.4%) and HLA-E*0101 (47.6%).

Conclusion: This is the first study that examined the HLA-E polymorphisms in Iranian thalassemic patients referred to Tehran Thalassemia Clinic. This study has shown that the frequency of HLA-E*01010103 genotype was significantly higher than other genotypes of HLA-E whereas there was no difference between the frequency of HLA-E*0103 allele and HLA-E*0101 allele. Whether different frequencies of HLA-E genotype may affect thalassemic patients’ susceptibility to blood-borne infections will be of interest for future studies.


Clinical effectiveness of modified sequential organ failure assessment scoring system for predicting ICU indexing scores
Hassan Babamohamadi , Abbasali Ebrahimian , Fateme Paknazar , Hojat Torkamandi ,
Volume 74, Issue 7 (October 2016)
Abstract

Background: The ability to recognize the severity of the disease in those who their survival depend entirely on admission to the intensive care unit, is very valuable clinically. This study aimed to evaluate the clinical effectiveness of modified sequential organ failure assessment (MSOFA) scale to predict mortality and length of stay in intensive care unit patients respectively.

Methods: This was a retrospective cross-sectional study conducted on hospital records of patients admitted to the intensive care unit. All patients’ records who admitted to the intensive care unit of Kowsar Hospital, Semnan city (the capital of the province), Iran, in 2015 considered as the sample. Collecting data were done during 4 weeks in April and May 2016. The data collection tool was a demographic questionnaire and modified sequential organ failure assessment scale. Exclusion criteria included discharge in the first 24 hours after admission, the patient died a few hours after admission and incomplete information to complete the modified sequential organ failure assessment form.

Results: The study of 105 patients' records of the intensive care unit showed that 45.7% of patients were died, 15.2% and 39% were discharged and moved to other wards respectively. The results of logistic regression analysis and receiver operating characteristic (ROC) curve showed that this criterion had moderate sensitivity and specificity for prediction of mortality and length of stay in ICU patients (Area=0.635, CI= 0.527-0.743) and each unit increase in modified sequential organ failure assessment score is accompanied by increasing 32 percent chance of death (OR=1.325; 95% CI:1.129,1.555; P= 0.001(. Also each unit increase in modified sequential organ failure assessment (MSOFA) score accompanied by increasing 19% length of stay in ICU (OR=1.191; 95% CI: 1.034, 1.371; P= 0.015(.

Conclusion: The results of this study showed that the modified sequential organ failure assessment scale is not useful tool to predict the length of stay and mortality of patients admitted to the intensive care unit.


Knowledge and attitude investigation of hospitalized patients in nephrology ward to Clinical Training
Behshsd Pazooki , Orkideh Olang, Ali Afshari , Nasim Khajavirad , Batool Ghorbani Yekta,
Volume 74, Issue 8 (November 2016)
Abstract

Background: To assess patient' reaction towards bedside teaching in the nephrology ward of Imam Khomeini Hospital Complex (Tehran) and to identify the factors that may influence it.

Methods: A cross-sectional study was conducted in the nephrology ward of Imam Khomeini Hospital Complex from march to September, 2014. All inpatients present on the day of the study were interviewed using a structured questionnaire.

Results: 146 patients were examined in this study that 62 patients (42.5%) were women and 84 cases (57.5%) were men. 112 (76.7%) of patients had a good feeling about the training to physicians. The behavior of students was evaluated respectful by 132 individuals (90.4% of patients). Total number of 106 individuals (72.6% of patients) had trusted to the health care team and 120 people (82.2% of patients) knew that the physicians’ behaviors are associated with the respect to their religious beliefs. Not being same sex of the examiners was important for 47 individuals (32.2% of patients). The number of 123 cases (84.2% of patients) evaluated the physicians' behavior with respect to their privacy. The number of 119 individuals (81.5% of patients) received their responses from the examiners. Statistical tests indicate a significant relationship between the respectful behavior of students with patient and good feeling about training to physicians, so that the 95.5% of people who have seen the respectful behavior of students to oneself had a good feeling about training to physicians (P˂0.001). The relationship between the presence of teacher with students and good feeling on training to physicians was significant (P=0.013). Positive feeling about practicing physicians was associated with patient age. So the age average of people who feel good about practicing physicians was significantly lower than the other people (47.2±17 versus 55.6±18 and P=0.028).

Conclusion: The relationship between respectful behavior and presence of teacher with students and age and good feeling on training to physicians was significant.

Clinical outcome of tracheal extubatedcardiac surgery patients who did not meet protocol driven laboratory criteria for extubation
Khosro Barkhordari , Samaneh Yaghooti , Sepideh Nikkhah , Afsaneh Aein , Arash Jalali , Akbar Shafiee ,
Volume 74, Issue 9 (December 2016)
Abstract

Background: We retrospectively compared the clinical outcome of post-cardiac surgery tracheal extubation between patients extubated with a lower than normal pH and patients extubated according to our routine institutional protocol. Our main goal was to clarify that strict adherence to the current criteria is dispensable.

Methods: In this retrospective cohort study, we recruited 256 patients who met our study criteria and divided them into the exposed group (n= 95) and the control group (n= 161). The inclusion criteria consisted of coronary artery bypass grafting alone and age> 18 years. The exclusion criteria comprised the use of corticosteroids in the preceding 2 weeks, Serum creatinine (SCr)> 2 mg/dL, uncontrolled diabetes, liver dysfunction, Glasgow coma scale <13, and acetazolamide and sodium bicarbonate use. The arterial blood gas (ABG) characteristics before and 6 hours after extubation, extubation failure rate, length of stay in the in ICU, length of stay in the hospital and mortality were compared between the two groups.

Results: In the control group, the males outnumbered the females and the ejection fraction was higher relative to that in the exposure group (P= 0.01 and P= 0.02, respectively). There were more patients with chronic obstructive pulmonary disease in the exposure group (P< 0.005) and also the euroSCORE was higher (P< 0.002). There were no significant differences between the groups regarding the ABG values at the time of ICU admission. Significantly higher levels of FiO2 and PaCO2 (P< 0.001 for both) as well as lower HCO3 and pH (P< 0.001 for both) were observed in the exposure group immediately before extubation. Following extubation, there was a significant increase in pH and a significant reduction in FiO2 need in the exposure group (P< 0.001 for both). The extubation failure rate, length of stay in the in ICU, length of stay in the hospital, and mortality rate were not different between the 2 groups.

Conclusion: The patients with a lower than normal pH, tracheal extubated at the discretion of the ICU anesthesiologist did not have a clinical outcome worse than that of the patients extubated in accordance with our routine institutional protocol.


The effectiveness of cognitive-behavioral therapy on mental toughness and life expectancy of patients with multiple sclerosis
Fatemeh Khayat Sarkar , Mahmoud Shirazi ,
Volume 75, Issue 8 (November 2017)
Abstract
Background: Multiple sclerosis (MS) is one of the most common chronic diseases creating major psychological challenges. Hence, the purpose of this study was to investigate the effectiveness of cognitive-behavioral therapy (CBT) on mental toughness and life expectancy of MS patients.
Methods: The design of this quasi-experimental study has been with pre-test, post-test and follow-up with control group that was performed in Zahedan MS community, Iran, from September to November 2016. The sample of the study was selected voluntarily from 30 MS patients which were randomly divided into two experimental and control groups. Among 200 patients, 80 patients had the required qualifications to participate in the study and 38 patients volunteered to enter the study. At last, only 30 patients were selected and put randomly into two experimental and control group. The experimental group received treatment in 8 weekly sessions (90 to 120-minute-long sessions with the classroom task and homework and group discussion) but the control group did not go under such treatment. The research instrument being used in this study was Halajian life expectancy questionnaire and mental toughness questionnaire (MTQ-48).
Results: For the groups to be homogeneous in age and the level of education, T-test and chi-squared test were used respectively, which did not show a meaningful difference between experimental and control group. The analysis of covariance showed that cognitive-behavioral therapy (CBT) group has resulted in meaningful increase in mental toughness and life expectancy of patients. The results showed the average of mental toughness to be 1.05 in for the experimental group in the pre-test, 1.24 in the post-test, 1.21 in the follow-up and the average of life expectancy 4.56 before treatment, 7.20 after treatment and 7.01 in the follow-up (P<0.001).
Conclusion: Practicing group cognitive-behavioral therapy in the process of MS patients’ treatment led to the increase in their mental toughness and life expectancy.
 

Determination of E-cadherin and vimentin genes expression on the tumor specimens of ovarian cancer patients
Seyedeh Hakimeh Rezazadeh, Reza Shirkoohi, Abdolhamid Angaji, Seyed Yusef Seyedena, Amir Nader Emami Razavi,
Volume 76, Issue 2 (May 2018)
Abstract
Background: Ovarian cancer is a leading metastatic disease. The epithelial ovarian cancer is one of the most common malignant cancers that usually remains asymptomatic up to metastasis stages, and most patient when diagnosed are in the advanced stage of the disease. Studies have shown that in the majority of epithelial cancers mesenchymal factor expression such as Vimentin increases, and the epithelial factor expression such as E-cadherin decreases, as a result, it causes an epithelial-mesenchymal transition (EMT). The aim of this study was to determine the expression level of these genes and association between EMT phenomenon and development of ovarian cancer based on clinical and morphological findings.
Methods: In the present case series study, 70 samples were chosen from the tumor Bank of Cancer Institute taken from patients at Imam Khomeini Hospital, Tehran, Iran. The amount of expression of two genes, E-cadherin and vimentin, was investigated by real-time PCR method from February 2016 to September 2017. The RNA extraction was done manually, and then cDNA synthesis was performed; In each sample the expression level of vimentin and E-cadherin was measured with real-time PCR method. The patient’s clinical information with other data were analyzed with nonparametric statistical methods in SPSS software, version 19 (SPSS Inc., Chicago, IL, USA).
Results: There was a significant relationship between expression of vimentin gene and the stage (P=0.026) of the disease and metastasis (P=0.009), There was no significant relationship between vimentin gene expression and tumor grade (P=0.207), age (P=0.11), tumor size (P=0.71) and family history (P=0.6). There was a significant correlation between E-cadherin gene expression and metastasis (P=0.027), no significant correlation was found between E-cadherin gene expression with tumor grade (P=0.690), stage (P=0.753), age (P=0.09), tumor size (P=0.537) and family history (P=0.56).
Conclusion: According to the changes in expression of vimentin and E-cadherin genes in ovarian tumor cells, and association between these two genes with clinical and morphological findings and the role of these genes in the migration and invasion, we can use the both genes, vimentin and E-cadherin, as genes involved in the EMT process to assess disease progression and incidence of cell invasion in ovarian cancer.

Anti-proliferative and pro-apoptotic effects of gallic acid on the breast adenocarcinoma cell lines SKBR3 versus normal fibroblast cells (HU-02)
Roghayeh Larki, Leila Rouhi , Seyed Hossein Hejazi ,
Volume 76, Issue 3 (June 2018)
Abstract
Background: Breast cancer is a malignant proliferation of epithelial cells that lining the ducts or lobules of the breast. Breast cancer is the second common cancer (after lung cancer) in women. Gallic acid, being a polyphenols, has been reported for its antiproliferative activity against many cancer cell lines. Objective of the present study is effect of gallic acid on proliferation and apoptosis of the human breast adenocarcinoma cell lines SKBR3 and normal fibroblasts cells.
Methods: This experimental study was performed in cellular and developmental biology of Shahrekord Islamic Azad University, Iran from April to August 2015. For anti-cancer activity, in this study SKBR3 cells and normal fibroblast cells (HU-02) were cultured in Dulbecco's modified eagle's medium, DMEM (Gibco, Life Technologies, Inc., New York, USA) medium with 10% fetal bovine serum, FBS (Gibco, Life Technologies, Inc., New York, USA). The SKBR3 and normal fibroblast cells were treated in the medium of DMEM medium and gallic acid (20, 40, 80, 100 and 200 µg/ml) for 24, 48 and 72 hours. Cells viability was assessed by MTS (Methyl- Thiazol-) assay. Cells were seeded at 5×103 cells/ml in 96 well plates and incubated for 24 hours. Then metabolites of bacteria were added, after indicated times MTS (20µl) was added and the absorbance was measured at 492 nm using ELISA plate reader. The percentage of apoptosis induction was determined by flow cytometry analysis using Annexin-V fluorescein isothiocyanate (FITC) kit (BioVision Products, CA, USA) in 20, 40, 80, 100 and 200 µg/ml concentration of gallic acid at 48 hours incubation.
Results: Gallic acid decreases significantly the viability of SKBR3 cell line in a time and dose dependent manner. So that the most effective concentration of this substance was 200 µg/ml and 72 hours after treatment (P< 0.05). According to the data of Annexin-PI, the highest apoptosis induction rate was seen in 200 µg/ml (P< 0.05). While gallic acid in various concentrations had no significant effect on normal fibroblast cells.
Conclusion: Objective of the present study is effect of gallic acid on proliferation and apoptosis of the human breast adenocarcinoma cell lines SKBR3 and normal fibroblasts cells.

A survey on clinical effectiveness of orlistat compared to sibutramine, lorcaserin, metformin and placebo on weight loss in obese people: a network meta-analysis
Somaye Fatahi , Hamed Kord Varkaneh , Mehran Pezeshki, Amirhosein Ghahremanian , Sakineh Shab-Bidar ,
Volume 76, Issue 6 (September 2018)
Abstract
Background: Trying to find a drug with more clinical efficacy in treating obesity is one of the priorities. The aim of this study was to evaluate the efficacy of orlistat, sibutramine, lorcaserin and metformin on weight loss in obese people.
Methods: The databases of PubMed, Scopus, Google Scholar and Cochran Library were searched up to November 2016. In present study search strategy was performed by using selected keywords. Two independent investigators scanned and extracted the relevant data. The pairwise method was used to compare the difference between the mean difference weight loss for orlistat, sibutramine, lorcaserin and metformin in two direct methods (comparison of orlistat, sibutramine, lorcaserin and metformin with the control group) and non-direct (Compare orlistat, sibutramine, lorcaserin and metformin together). We assessed the quality of included trials using the quantitative 5-point Jadad scale. The heterogeneity across studies was assessed by using Cochrane’s Q and I2 tests. Publication bias was reported by means of funnel plots and Egger’s tests. 
Results: The present study performed on 36 clinical studies with a population of 3672. Our study results did show that sibutramine (mean difference -4.97 kg, 95% confidence interval -6.70 to -3.23), metformin (mean difference -4.45 kg, 95% confidence interval -9.27 to 0.38), orlistat (mean difference -2.37 kg, 95% confidence interval -3.45 to -1.30), lorcaserin (mean difference -2.36 kg, 95% confidence interval -4.58 to -0.15), respectively, had the most effect on weight loss compared with the placebo group. In addition, orlistat compared to lorcaserin (mean difference -0.01 kg, 95% confidence interval -2.47 to 2.45) resulted in more weight loss, but compared to metformin (mean difference 2.07 kg, 95% confidence interval -2.78 to 7.02) and sibutramine (mean difference 0.52 kg, 95% confidence interval -4.46 to 5.50) lead to less weight loss.
Conclusion: The present study indicated that orlistat had a greater effect on weight loss compared with lorcaserin, and had lower effect on weight loss compared with sibutramine and metformin in apparently healthy obese individuals.

Comparison of MTT, trypan blue, and clonogenic assay, to determine the viability in human anaplastic thyroid cancer cell line
Marjan Ghorbani-Anarkooli , Sara Dabirian, Hasan Moladoust, Adib Zendedel, Mohammad Hadi Bahadori,
Volume 77, Issue 1 (April 2019)
Abstract
Background: Evaluation of cell viability is momentous in pharmacologic and oncological research. Cell viability evaluation determines cell sensitivity and consequently treatment outcome. Various methods are available to determine cell survival. Each of these methods evaluates different endpoints. Accordingly, determining the correlation between these methods is important. In this study, in order to determine the viability of human anaplastic thyroid cancer cell line, the sensitivity of MTT [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide] assay, trypan blue test and clonogenic assay were compared.
Methods: This experimental study was performed in the Cellular and Molecular Research Center at Guilan University of Medical Sciences, Rasht, Iran from October 2016 to March 2017. The human anaplastic thyroid cancer cell line was cultured in Dulbecco's modified Eagle's medium (DMEM) with 10% fetal bovine serum (FBS). The cultured cells were treated with melatonin, for 24 hours. Then, the viability of the cells was evaluated by MTT assay, trypan blue test and clonogenic assay. Furthermore, plating efficiency and surviving fraction were used in order to draw survival curve in the clonogenic assay.
Results: The concentration of melatonin at IC50 point was 4.794±0.117 millimolar (mM) in MTT assay, 4.375±0.894 mM in trypan blue test and 2.246±0.326 mM in clonogenic assay. Comparing the IC50 values of these test revealed that C50 values obtained from MTT assay and trypan blue test had no significant difference (P=0.6446), while there was a significant difference between IC50 values obtained from MTT and clonogenic assays (P=0.0032). Moreover, the IC50 values obtained from trypan blue test and clonogenic assay were also significantly different (P=0.0078). The results of the regression analysis of cell viability were shown a linear, positive and significant correlation between these three methods and MTT assay and trypan blue test showed higher correlation (r=0.99, P<0.001).
Conclusion: Based on our results, all these methods were effective to identify cytotoxicity in human anaplastic thyroid cancer cell line, while MTT assay and trypan blue test were more sensitive than clonogenic assay.

Validity of self-reported hypertension in Mashhad population: brief report
Hamid Reza Bahrami Taghanaki , Ehsan Mosa Farkhani , Saeed Bokaie , Seyed Javad Hoseini , Pegah Bahrami Taghanaki , Sima Barid Kazemi ,
Volume 77, Issue 4 (July 2019)
Abstract
Background: Researchers and health specialists are increasingly obtaining information on chronic illnesses from self-reports. This study validates self-reports of hypertension, based on a recently fielded survey in Mashhad City, Iran.
Methods: In this cross-sectional study, we used the results of 2015 census in Mashhad City, a population based survey of people over the age of 30 (n=300745) to determine the proportion of self-reported hypertension. In this study, the data of the studied population was extracted from the databank of Sina Electronic Health Record System (SinaEHR®) and patients with ICD10 codes including I10 and I11 approved by doctors as a reference. Finally using SPSS software, version 20 (SPSS Inc., Chicago, IL, USA) and MedCalc (https://www.medcalc.org/calc/odds_ratio.php), sensitivity, specificity, positive predictive value, negative predictive value were calculated with 95% confidence interval.
Results: Sensitivity of self-reported hypertension was 23.92% (CI95%: 23.43-24.41), specificity 97.03% (CI95%: 96.97-97.09), Positive Linkelihood Ratio 8.06% (CI95%: 7.82-8.30), Negative Linkelihood Ratio 0.78% (CI95%: 0.78-0.79), Positive Predictive Value 46.34% (CI95%: 45.60-47.08), Negative Predictive Value 92.25% (CI95%: 92.20-92.29). The self-reported sensitivity to hypertension in males, Iranian individuals, single, aged 60 and over, body mass index lower 18.5 individual with university education was higher, which was 24.67%, 31.09%, 30.07%, 32.43% and 26.03% respectively.
Conclusion: Although the sensitivity of self-reported hypertension was poor in this study, but specificity and positive and negative predictive values were fairly good.

Current antiretroviral drugs for human immunodeficiency virus infection: review article
Ahmad Tavakoli , Maryam Esghaei , Angila Ataei-Pirkooh , Mohsen Moghoofei , Hadi Ghaffari , Farah Bokharaei-Salim ,
Volume 77, Issue 5 (August 2019)
Abstract
Currently, there are about 37 million people worldwide living with human immunodeficiency virus (HIV) /AIDS, with an estimated two million new cases per year globally. According to estimates from the World Health Organization (WHO), only 75% of the population with HIV know their status. Initially, HIV infection was associated with significantly increased rates of mortality and morbidity. However, the rapid advances in treatment and the advent of different classes of antiretroviral drugs over time have led to change the face of HIV/AIDS from a deadly infection to chronic and manageable disease. There is strong evidence that HIV-infected patients undergoing antiretroviral therapy have longer lives and are less likely to transmit infection to their sexual partners. Since the introduction of zidovudine in 1987 as the first antiretroviral drug, significant strides have been made in antiretroviral therapy. The introduction of potent antiretroviral drugs for the treatment of HIV infection has been one of the significant events in the evolution of modern medicine. Antiretroviral therapy refers to the use of drugs in the treatment of HIV. Generally, these drugs are categorized based on the steps of the HIV life cycle suppressed by them. There are six main classes of antiretroviral agents including nucleoside/ nucleotide reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, protease inhibitors, fusion inhibitors, co-receptor inhibitors, and integrase inhibitors. Combination antiretroviral therapy should be considered for HIV patients to achieve the highest viral suppression rate, and to reduce the risk of resistance development and morbidity and mortality associated with AIDS. Achieving and maintaining HIV viral load suppression among treated patients has remarkably increased over the last years due to the development of potent and well-tolerated agents which can be co-formulated as a once-daily single-tablet or fixed-dose combination for simplification. However, there are some limitations preventing patients to benefit from this treatment. The main goals of HIV therapy in the future are to overcome the limitations of current treatment, including side effects. This review will provide an overview of advances in the current antiretroviral drugs by focusing on their pharmacokinetics, mechanism of action, dosing recommendations, and adverse events for each drug class.

The effect of oral Aphanizomenon flos-aquae extract on excisional wound healing
Maria Zahiri , Khalil Pourkhalili , Sadegh Darvishi , Hossein Heydari , Zahra Akbari,
Volume 77, Issue 10 (January 2020)
Abstract
Background: Aphanizomenon flos-aquae (AFA) is a type of blue-green algae and contains a source of biological compounds. These microalgae have many beneficial health effects. Recently, fucoidan, known sulfated polysaccharide component of AFA algae, has been claimed to stimulate stem-cell mobilization in animal models. Stem cells play an essential role in tissue repair process. In this study, we use excisional full thickness wound model to investigate the effectiveness of trademark AFA extract on skin wound repair process.
Methods: In this experimental study, 21 adult male Wistar rats (weighing 200-250 g) were used and under general anesthesia (intraperitoneally with a ketamine/xylazine solution), two round excisional wounds were created under sterile conditions by a 6 mm punch on the dorsum (paravertebral area) of all rats. Animals were randomly assigned into 3 groups. In groups 1 and 2 (SE-200, SE-400), StemEnhance© (StemTech Health Sciences Inc. British Columbia, Canada) were given respectively 200 or 400 mg/kg by oral gavage once daily and in group 3 (Sham), distilled water (DW) was given to all subjects. Post-wounding gavage of StemEnhance or DW started from 1st day and continued to 7th day. The wound surface area was monitored daily by digital camera and assessed by Image Tool™ software, version 3.5 (UTHSCSA, San Antonio, TX, USA). At 9th day post-wounding animals were sacrificed and repaired tissues were harvested by and assessed by a 8 mm punch. Repaired skin areas were processed for hematoxylin and eosin (H&E). Histopathological parameters of healing including inflammatory cell infiltration, angiogenesis, and fibroblast count were assessed by pathologist. Our study was conducted in the Physiology Department of Medical School, Bushehr University of Medical Sciences, Iran, from October 2016 to March 2016.
Results: Macroscopic imaging of wound area revealed that there was statistically significant difference in wound area reduction between SE-200 group and sham group on day 6 post wounding (P=0.032). Moreover, histological findings showed that the number of neutrophils, macrophages, fibroblasts, and microvessel density decreased in both StemEnhace-treated groups. There were no significant differences between two treatment groups.
Conclusion: According to the obtained results it seems that the extract of Aphanizomenon flos-aquae algae positively affects wound healing process by ameliorating inflammatory response in early healing phases.

Association of endothelial nitric oxide synthase gene G894T polymorphism with type two diabetes and diabetic nephropathy
Azim Adibmanesh , Narges Mohammad Taghvaei , Mehrnoosh Zakerkish , Hamid Yaghooti ,
Volume 77, Issue 12 (March 2020)
Abstract
Background: Nitric oxide (NO) produced by endothelial NO synthase (eNOS) mediates a large range of processes, and abnormality in the production of NO has been implicated in diabetic complications including diabetic nephropathy (DN). G894T polymorphism in the eNOS gene has been shown to decreased activity the NO levels of plasma. The association between eNOS Glu298Asp gene polymorphism and DN risk is still controversial. The present study investigated the effect of eNOS gene G894T polymorphism on susceptibility to type 2 diabetes (T2D) and DN and measures of kidney function in a population with and without diabetes.
Methods: This case-control study was carried out at the diabetes specialist clinic of Golestan Hospital of Ahvaz Jundishapur University of Medical Sciences, Iran, from September 2016 to December 2017. The study comprised 132 patients with T2D (with and without nephropathy). They were compared to 66 normal subjects. The subjects were genotyped for the eNOS G894T polymorphism by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Blood glucose, HbA1c, BUN, creatinine and urinary albumin were evaluated by a biochemistry analyzer.
Results: Higher prevalence of the mutant T allele and homozygous TT genotypes and biochemical parameters) like FBS, TG, and BUN) were seen in T2D patients compared to healthy subjects. For T2DM, the odds ratios (ORs) for the TT genotype and the T allele carrier were 3.1 (P=0.0001) and 2.6 (P=0.0001), respectively. In contrast to the significant association between the eNOS G894T polymorphism and T2D, we could not find a significant correlation to the DN. For DN, the ORs for the TT genotype and the T allele carrier were 1.1 (P=0.76) and 0.8 (P=0.6). For decreased epidermal growth factor receptor (EGFR) below 60 ml/min/ 1.73 m2 in diabetic patients, the OR for TT was 0.8 (P=0.7).
Conclusion: Our results confirm that the risk of T allele and TT genotype of the eNOS G894T polymorphism were significantly associated with T2D, The TT genotype of this polymorphism also conferred the risk of developing T2D, but they were not correlated with DN and decreased eGFR.

Foodborne related mortality in Iran from 2011 to 2018: brief report
Saied Bokaie , Hessameddin Akbarein , Behnaz Beygi , Ehsan Mosa Farkhani ,
Volume 78, Issue 1 (April 2020)
Abstract
Background: Today, due to changes in human lifestyle and consumer demand incidence of foodborne diseases is on the rise. The aim of this study was to investigate the mortality rate of foodborne diseases and their related factors.
Methods: In this cross-sectional study, data on deaths registered according to the International Classification of Diseases (ICD-10th revision) were extracted from death registration and classification of causes system in the Ministry of Health and Medical Education of Iran from 2011 to 2018. Data on deaths from food and water borne diseases including Salmonella, Shigella, Escherichia coli O157:H7, Staphylococcus aureus, Clostridium botulinum, and other foodborne diseases were extracted from database of death registration and classification of causes system. The demographic variables of dead people considered in this study include age (under 5 years, 5-20 years, 20-40, 40-60s and over 60 old), gender, nationality, and the location where people died (urban, rural and unknown).
Results: The majority of deaths cases occurred at the age of 60 years and in older age groups (P<0.001). The results show that across all the age groups mortality rate from foodborne diseases was higher among men than among women (P=0.110). Most of foodborne diseases were reported by people living in urban areas (P<0.0001). The results of this study showed that most of the deaths from these diseases occur in the warm seasons. In this study, the crude death rate was 10 cases per one million inhabitants.
Conclusion: The results of this study showed that there was a significant difference between the mortality rate due to different bacterial agents. This study suggests that demographic variables are important predictors of mortality from foodborne illness and should be further investigated.

Evaluation of etiologic findings in patients with surgery of cubital tunnel syndrome
Mohammadreza Emamhadi , Ashkan Asgari-Gashtroudkhani , Roxana Emamhadi , Samaneh Ghorbani-Shirkouhi , Sasan Andalib,
Volume 78, Issue 2 (May 2020)
Abstract
Background: Cubital tunnel syndrome, a neuropathy of ulnar nerve, is the second most common entrapping syndrome in the upper limb surpassing carpal tunnel syndrome. This syndrome arises from a high pressure decompressing the nerve for a long time. Patients with cubital tunnel syndrome show numbness in the ring and small fingers. The aim of this study was to evaluate the etiology of cubital tunnel syndrome in patients who underwent surgery for treatment of the syndrome.
Methods: In this retrospective study, medical records of 100 patients who underwent surgery for treatment of cubital tunnel syndrome at Department of Neurosurgery, Poursina Hospital, Rasht, Iran from March 2008 to March 2017, were checked. The etiology of cubital tunnel syndrome including inflammatory, tumoral, vascular, orthopedic causes and anomalies in nerve site and information about age, gender, job, and weight were collected and analyzed.
Results: In this study, the mean±SD of age was 33.8±11.5 years. Females and males constituted 21% and 79% of the cases, respectively. Idiopathic and orthopedic etiologies were seen in 84% and 13% of the operated cases, respectively. Vascular, tumoral, and inflammatory causes were found in 1% of the cases. Regarding location of nerve involvement, 57% of the cases had the ulnar nerve entrapment between MCL (medial collateral ligament) and Osborne ligaments; and in 22% of the cases, the cubital tunnel was involved. Arcade of Struthers and medial epicondyle and medial intermuscular septum were involved in 8%, 8%, and 5% of the patients, respectively. Forty-five percent of the cases performed a repetitive manual task by hand and 1.9% of cases were vibrator workers. Moreover, 12.4% of cases had a history of cubitus valgus or cubitus varus. Finally, 20.9% and 18% of the cases suffered from obesity (BMI>30) and diabetes mellitus, respectively. Furthermore, one patient had a history of head injury with contractions of upper limb flexion and one patient had arthritis of medial epicondylitis.
Conclusion: The evidence from the present study indicates that the idiopathic cubital tunnel syndrome constituted the bulk of involvement on ulnar nerve in the patients. Job, obesity, and diabetes were the most important accompanying factors with cubital tunnel syndrome.

Comparison between GRACE and TIMI scores in predicting significant cardiovascular events in patients with chest pain: brief report
Hamidreza Mehryar, Omid Garkaz, Peyman Atabaki, Shadi Gharibi, Nasser Khalili, Sahar Paryab,
Volume 79, Issue 2 (May 2021)
Abstract
Background: Chest pain is the most common reason for patients to be referred to the emergency department of hospitals. This study was performed to compare the GRACE and TIMI scores in predicting important cardiovascular events in patients.
Methods: This descriptive-analytical study was performed on 862 cardiac patients who were referred to the emergency department of Taleghani Hospital in Urmia in the period of April 1, 2016 to the end of September 2016 by census method. A checklist containing demographic information, medical history and risk factors was used to collect data. After scoring patients, we examined and followed up both groups over the next 30 days and recorded any cardiovascular events such as sudden death, AMI or immediate revascularization. The data were tested using SPSS16 and descriptive statistics tests. T-test and ROC curve were analyzed.
Results: The results showed that in general, out of 862 patients who were studied (50.3%), 433 were female and (49.7%) 429 were male. Most of the patients were under 65 years old 627 (72.7%) and the age range was (17-91). The highest initial diagnosis of nonSTEMI patients was UA with 811 (94.9%) cases. On the other hand, the highest risk factors of patients were HTN 449(52%), CAD 314 (36.425) and DM 22 (25.55). The highest blood pressure was between (100-120) with 328 cases and serum creatinine between (0.6 to 1.3) with 770 cases. MACE after 30 days in GRACE system 17 people (32.69%) were in high risk group and in TIMI 3 people (37.5%) were in high risk group. In MACE evaluation, the specificity of GRACE system (cutoff point=30) was 89.27 vs. 52.24, the specificity of TIMI system (cutoff point=7.3) and the sensitivity of GRACE 93 (cutoff point=10) versus TIMI 85.71 (cutoff point=8.3) is.
Conclusion: The results showed that GRACE was more sensitive and characteristic than TIMI.

Comparing outcomes of slow versus rapid feeding in premature neonates hospitalized in Al-Zahra hospital, Rasht
Seyedeh Zohreh Jalali, Sadroddin Mahdipour, Reza Sharafi, Fariborz Torkipour, Afagh Hassanzadeh Rad , Babak Moqtader, Marjaneh Zarkesh ,
Volume 79, Issue 10 (January 2022)
Abstract
Background: one of the leading clinical problems for premature neonates especially with very low birth weight is the type and amount of feeding. The authors aimed to compare outcomes of slow versus rapid feeding in premature neonates hospitalized in Al-Zahra hospital, Rasht.
Methods: This is a clinical trial that was conducted on 62 premature neonates aged less than 35 weeks of gestation who were referred to Al-Zahra Hospital from April 2015 to April 2016. They weighed 1000-2000 gr at birth. Samples were randomly assigned to intervention or control groups. The intervention included neonatal feeding with breast milk or formula with feeding advancement of 30 cc/kg/day which was compared with the routine method of slow feeding (20 cc/kg/day). Neonates were assessed until discharge or the occurrence of Necrotizing enterocolitis. Data were reported by descriptive statistics including mean, standard deviation, frequency, and percent, and analyzed by independent samples t-test and chi-square test in SPSS software, version 22 (IBM SPSS, Armonk, NY, USA).
Results: All 62 patients finished the study including 31 neonates weighing 1000-2000 gr at birth in the intervention group and 31 neonates weighing 1000-2000 gr at birth in the control group. Neonates in the intervention group reached to full milk feeding of 150 cc/kg/day sooner (6.06±1.34 versus 9.45±2.39), return to birth weight faster (9.89±3.57 versus 12.9±6.46), had a lower duration of needing parenteral fluids (5.10±1.61 versus 8.86±3.81), and had a lower duration of hospitalization (9.97±4.03 versus 16.87±9.13) compared to controls. Results showed that there was no necrotizing enterocolitis in the intervention and control groups.
Conclusion: The results of this study showed that initiating feeding by 30 cc/kg/day method shortened the duration of access to intravenous line and hospitalization and caused sooner discharge. Also, no adverse complication was noted. Therefore, it seems that further investigations assessing these methods can be help manage preterm neonates.

Assessing the role of enema in improving outcomes and complications of benign gynecological laparoscopy: a randomized clinical trial
Zahra Asgari, Azam Barkhordarinasab, Reihaneh Hosseini , Alireza Hadizadeh, Venus Chegini, Sara Farzadi,
Volume 79, Issue 11 (February 2022)
Abstract
Background: mechanical bowel preparation (MBP) is a common practice before laparoscopic gynecologic surgeries but the role and efficacy of preparation have been questioned. this study assesses visualization and bowel handling in a group of patients who receive MBP and the control group and thereafter; compares the results.
Methods: We designed and conducted this randomized, single-blinded and controlled trial on patients who underwent advanced gynecologic laparoscopic surgeries. This clinical trial was carried out between July 2020 and January 2021. The patients were enrolled from l the laparoscopic office. 120 women aged 18-65 years undergoing level 2 and 3 benign gynecologic laparoscopic surgeries were randomized to bowel preparation with a normal saline enema (n=60) or non-bowel preparation (n=60) groups. Our patients underwent level 2 and 3 of benign laparoscopic gynecologic surgeries with or without MBP. The visualization and bowel handling were assessed by the primary surgical team and a questionnaire was later obtained. The outcomes included intraoperative surgical view and bowel handling, preoperative and post-operative patient signs and symptoms. The patients were also assessed in respect to discomfort prior and after the surgery, this assessment was obtained using a questionnaire. The gathered data was analyzed using IBM’s SPSS v26 software.
Results: there was no difference in intraoperative visualization and bowel handling between the two groups. We also found no clinical improvements in respect to discomfort and symptoms. MBP even increased the distention rate amongst patients (P-value=0/04). We tried to evaluate whether MBP had any effects on haemorrhage and blood loss during the surgery and to assess this we compared hemoglobin levels before and after the surgery. We compared the subtracted values between the two groups and found no significant difference (T-test=1.135, P=0/259) (see table 4). However, hospitalization duration was about 5 hours longer in the group who received MBP.
Conclusion: MBP with normal saline enema does not improve intraoperative visualization and bowel handling. And it also does not reduce patient complication rates and post-operative symptoms either. MBP also increases hospitalization duration and puts extra pressure on the healthcare system. Therefore, a normal saline enema is not recommended before benign gynecologic laparoscopic surgeries.
 

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