Tehran University Medical Journal

Background: The amount of anterior tibial translation during rehabilitation exercises is a key factor in organizing exercise regimen after anterior cruciate ligament injury. Excessive anterior tibial translation could increase the magnitude of tension imposed on injured and reconstructed anterior cruciate ligament knees. Forward lunge and open-kinetic knee extension exercises are commonly used in anterior cruciate ligament rehabilitation. However, there is insufficient data about the amount of anterior tibial translation in the eccentric and concentric phases of these exercises. This study compared the amount of anterior tibial translation in the eccentric and concentric phase of the lunge and seated knee extension in anterior cruciate ligament deficient and intact knees.
Methods: Using a non-probability sampling method, 14 men with unilateral anterior cruciate ligament rupture were selected for participation in this cross-sectional study. Participants were recruited from the university’s physiotherapy clinics. A uni-plane fluoroscope was used to image the knee joint while participants performed the forward lunge and open-kinetic knee extension exercises with the intact and injured legs in random order. Fluoroscopy imaging was performed in the radiology center at Sina Hospital, Tehran, Iran, from September 2013 to February 2014. Two factorial mixed ANOVA was used to analyze the data.
Results: There were no significant differences in the anterior tibial translation between the limbs and contraction phases during the lunge exercise. During open-kinetic knee extension, the anterior tibial translation in anterior cruciate ligament deficient knees was significantly more than that of healthy knees at 0⁰ (P=0.007). The anterior tibial translation in the eccentric phase of open-kinetic knee extension at flexion angles of 0⁰ (P=0.049) and 15⁰ (P=0.024) was significantly greater than that in the concentric phase.
Conclusion: In the lunge exercise, the amount of anterior tibial translation was similar between the eccentric and concentric phases and the intact and anterior cruciate ligament deficient knees, however, during open-kinetic knee extension exercise, in the eccentric phase was greater than that in concentric, and in the intact knees was greater than that in the intact knees, at 0-15⁰ angles.

Background: Herpes simplex virus (HSV) encephalitis is the most common cause of sporadic encephalitis, with significant morbidity and mortality that are effectively reduced by antiviral treatment. Herpes simplex infection in pregnant women rarely results in encephalitis. The most common symptoms of a pregnant woman with herpes simplex infection are colds and skin vesicles. Herpetic encephalitis occurs during pregnancy in the third trimester in 60% of cases and with less prevalence in the second trimester. Among HSVs most, HSV-1 causes encephalitis. Early diagnosis and timely treatment are important as mortality decreases from 70% to 20-30%. This case report, reviews a pregnant woman with a diagnosis of herpes encephalitis due to seizure and consciousness disorder, which was negative in polymerase chain reaction (PCR) assay and diagnostic studies.
Case Presentation: The patient was a 23-year-old woman with a gestational age of 29 weeks who presented with fever, headache, delirium, and cognitive impairment three days prior to admission following seizure. Early magnetic resonance imaging (MRI) showed an increase in the cortical signal in the temporal lobe and PCR assay for the detection of herpes virus was negative. Magnetic resonance venography also showed an increase in the left maxillary sinus with differential diagnosis of herpetic encephalitis. Considering the symptoms of the patient with a strong suspicion of herpes simplex encephalitis, the patient was treated with acyclovir, which was associated with improvement of clinical symptoms. Finally, normal delivery was performed after 36 weeks of gestation.
Conclusion: Given that herpes simplex virus encephalitis is a rare and potentially dangerous and complicated disease, it is imperative for a pregnant patient with atypical symptoms to be identified with an appropriate diagnostic and therapeutic measures.

Background: Alzheimer dementia as the most common cause of dementia is a chronic, progressive, irreversible and incurable disease. The second most common cause of dementia after Alzheimer is vascular dementia. One of the systems involved in dementia is the visuospatial system and visual evoked potential (VEP) can be one of the diagnostic methods for this disease. Therefore, the present study aims to compare visual evoked potential changes in Alzheimer dementia, vascular dementia and patients with minimally conscious impairment (MCI) with healthy people.
Methods: A case-control study was performed on referred clients to Shariati Hospital, Tehran, Iran, from April 2015 to September 2016. Patients with cognitive impairment went through Montreal cognitive assessment (MOCA) test and divided into three groups of Alzheimer dementia, vascular dementia and patients with minimally conscious impairment. Subjects with normal cognition were included in the control group. The visual evoked potential test was performed on all participants in two Methods: pattern shift visual evoked potential (Ps-VEP) and flash visual evoked potential (f-VEP) and results were compared between groups.

Conclusion: This study showed that only Alzheimer was associated with a significant increase in visual evoked potential P100 latency. On the other hand the other hand, there was no significant difference in flash visual evoked potential variables including P1, N2, P2 and N3 between different groups which shows that flash visual evoked potential cannot differentiate between Alzheimer dementia, vascular dementia, patients with minimally conscious impairment and normal people.

Background: Excessive and irrational use of antibiotics in the treatment of acute diarrhea has caused increased resistance to these medications. It is well defined that most cases of diarrhea in children do not require the use of antibiotics. This study was aimed to determine the status of antibiotic administration for treatment of acute diarrhea in children younger than five years. All who admitted at the pediatric ward of Besat Hospital in Sanandaj.
Methods: First, the study was approved by the ethics committee of Kurdistan University of Medical Sciences. The archived files of all children under 5 years with a positive history acute diarrhea who were admitted in Besat Hospital of Sanandaj during the period of 1 years, from May 2016 to May 2016 were reviewed. Demographic information such as age, gender, type of diarrhea, type of nutrition, type of the prescribed antibiotic, results of the stool and blood samples were collected and recorded in the questionnaire.In Stool samples the contained a large number of WBCs and RBCs along with high fever, Shigellosis were considered. The results were analyzed by SPSS software, version 23 (SPSS Inc., Chicago, IL, USA).

Background: Early diagnosis of patients in the early stages of Alzheimer's, known as mild cognitive impairment, is of great importance in the treatment of this disease. If a patient can be diagnosed at this stage, it is possible to treat or delay Alzheimer's disease. Resting-state functional magnetic resonance imaging (fMRI) is very common in the process of diagnosing Alzheimer's disease. In this study, we intend to separate subjects with mild cognitive impairment from healthy control based on fMRI data using brain functional connectivity and graph theory.
Methods: In this article, which was done from April to November 2020 in Tehran, after pre-processing the fMRI data, 116 brain regions were extracted using an Automated Anatomical Labeling atlas. Then, the functional connectivity matrix between the time signals of 116 brain regions was calculated using Pearson correlation and mutual information methods. Using functional connectivity calculations, the brain graph network was formed, followed by thresholding of the brain connectivity network to keep significant and strong edges while eliminating weaker edges that were likely noise. Finally, 11 global features were extracted from the graph network and after performing statistical analyses and selecting optimal features; the classification of 14 healthy individuals and 11 patients with mild cognitive impairment was performed using a support vector machine classifier.

Conclusion: Combining the features of brain graph and functional connectivity by the mutual information method with a machine learning approach, based on fMRI imaging analysis, is very effective in diagnosing mild cognitive impairment in the early stages of Alzheimer’s which consequently allows treating or delaying this disease.

Background: Time management is effective in controlling stress especially for medical residents. Time management in the surgical field and residential education is very important as they are directly involved in treating patients. Proper time management will help decrease work-related stress and increase efficacy, although there is no time management in medical courses. There are few studies in Iran in this field. So, we designed this study to assess the effects of time management on improvement of educational and therapeutic services in surgical residents of Imam Hospital.
Methods: This before–after study was done in Imam hospital between February-March 2015. In this before-after study, 18 surgical residents of Imam Hospital (residents of 1-4 years), were enrolled. Their activities were evaluated in 11 scopes. To evaluate the effects of this self-evaluation, 5 scopes were assessed by the staff. The time during two weeks spent on each item was claimed as a percentage of 336 hours in two weeks. The self-assessment results and their effects on their scores were considered. Data regarding age, sex, and marital status were also gathered. Data were analyzed using SPSS software.

Background: The patient's position during the recovery time after arthroplasty surgery can be a factor in reducing complications and improving patients’ condition. Therefore, this study was performed to compare the knee range of motion after soft tissue repair in both flexion and extension positions of total knee arthroplasty.
Methods: This study is a double-blind clinical trial. The study population was all candidates for total knee arthroplasty surgery in Al-Zahra and Kashani hospitals in Isfahan from July 2011 to September 2012. The sample size was selected using the statistical formula of 88 patients and randomly divided into two groups of flexion and extension. In the first group during the knee soft tissue repair, the knee was in flexion and in the second group it was in extension and then it was repaired. Information such as age, sex, body mass index and surgical position were recorded in the checklist. The knee range of motion was measured at the end of the first, second, fourth, eighth and twelfth weeks and recorded in a checklist. In order to compare the pattern of changes in mean knee range of motion over time in the two groups, mixed linear models and conventional marginal models to generalized estimator equations were used by STATA software.

Background: Due to the chronic nature of diabetes, children with type 1 diabetes are prone to a number of long-term complications. One of the most important complications of this disease is cardiovascular involvement due to atherosclerosis, which is directly related to the control of blood lipids. The use of probiotics may be effective in the process of complications in these patients by affecting fat metabolism. The aim of this study was to evaluate the effect of oral probiotics on lipid profiles in children with type 1 diabetes.
Methods: This study was conducted at Bahrami Children's Hospital from May 2018 to May 2019. In this single-blind randomized controlled clinical trial, 52 children with type 1 diabetes (aged 2 to 16 years) were studied. We created two groups of 26 individuals. The inclusion criteria were determined as follows: Proof of T1DM by history and information of children’s medical record. Also, the Exclusion criteria were determined in this way: Patients consuming probiotics in the last 4 weeks, gastrointestinal infections in the last 2 weeks, and presence of chronic underlying intestinal diseases. The probiotic group received, in addition to insulin therapy, a daily probiotic capsule for 90 days. The control group received only routine insulin therapy. Blood samples were taken to measure lipid profiles at the beginning and end of the trial.
Results: A total of 52 patients were included. The mean age of children was 9.3±2.9 (4 to 14 years). The mean age in the probiotic and control groups was 9.6±3.5 and 9.4±3.0 respectively. The results of this study showed that HDL-C was increased in the probiotic group compared to the control group, although it was not statistically significant (P>0.05). Also, changes in total cholesterol, LDL-C, and triglyceride were not statistically significant.

Conclusion: In this study, the use of oral probiotics for 90 days in children with type 1 diabetes did not have a significant effect on blood lipid profiles compared to the control group.

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.

Background: The neonate's Cardiopulmonary resuscitation (CPR) is the most important and common emergency condition in the delivery room. Approximately 10% of newborns are unable to initiate effective breathing and require assistance. The aim of this study was to evaluate the frequency of CPR levels of the neonates delivered during a year in Moheb Yas Hospital who were resuscitated.
Methods: This was a retrospective cross-sectional descriptive study. The sampling method in this study was census. In this study, all the live neonates born during the year (April, 2010 to April, 2011) in Moheb Yas Hospital who were resuscitated, were enrolled in the study. The information of these infants was recorded in separate checklists. This checklist included the following information: mother's age, gestational age, gender of the baby, method of the delivery, multiple births, complications of the placenta and umbilical cord, amount of amniotic fluid, fetal presentation, meconium excretion, fetal heart rate pattern, Apgar of the baby, resuscitation levels, underlying diseases of the mother, maternal diseases during pregnancy, drug use by the mother and premature rupture of the amniotic sac. Finally, the data were analyzed by SPSS software. P-values less than 0.05 were considered statistically significant.

Results: There were 2,176 live births during the study. Of these infants , a total of 322 neonates (15.27%) underwent CPR. 51.8% were male. The mean gestational age was 36.08 weeks. The first minute Apgar was less than 5, between 5-7, and above 8 respectively in 10.5%, 33.4%, and 56% of neonates. About 42% of neonates needed initial resuscitation (warming, drying, and respiratory stimulation). 48% required respiratory ventilation with bag and mask, 5% endotracheal tube, 2.7% cardiac massage, and 1.3% needed medication. In 96.7% of cases, the CPR team was ready for resuscitation before delivery. Conclusion: If resuscitation is performed in a timely and appropriate manner, very few of these infants will need advanced resuscitation. On the other hand, the high need for resuscitation by bags and masks can be secondary to the educational nature of this hospital.

Methods: This was a cross-sectional study. In this study, in a period of three years from (March 2016 to March 2019), all patients admitted to the PICU of Tehran Bahrami Children's Hospital were examined. The sample size was calculated 380. Demographic information, diagnosis during hospitalization, underlying disease, and initial tests during the first 24 hours of hospitalization were recorded in the checklist. To evaluate the demographic findings between patients with and without UGIB, chi-square and Fisher tests were used. A p-value of less than 0.05 was considered significant. Results: 462 patients were studied, of which about (58%) were male. The mean age of the samples was 48 months and the average length of hospital stay in PICU was ten days. In general, (21.21%) of patients had gastrointestinal bleeding on the first day and (12.12%) on the second day of hospitalization. Gastrointestinal bleeding occurred in 50 patients (10.82%). Use of ventilator, pulmonary diseases, coagulation and blood diseases were significantly more common in patients with gastrointestinal bleeding than in children without gastrointestinal bleeding. Cardiac, neurological, hepatic, and renal disease were not significantly different in patients with gastrointestinal bleeding compared to children without gastrointestinal bleeding. Conclusion: The occurrence of gastrointestinal bleeding in critically ill patients admitted to the PICU is a serious risk. The most important risk factor for upper gastrointestinal bleeding is mechanical ventilation. Other risk factors of gastrointestinal bleeding are lung disease, coagulation diseases, hematologic and oncologic disease.

Results: The average age of patients was 59.59±11.75 and most of them (74.3%) were women. Most patients (75.71%) with a normal to mild FIB-4 index stage had a normal to mild elastography stage. of patients had normal to mild liver fibrosis. FibroScan grade were not related to the age, gender, body mass index, methotrexate dose and duration of the disease (P>0.05). The average FIB-4 was 1.25±0.6, which was not significantly related to gender, body mass index, disease duration and methotrexate dose but directly related to the age of patients (P<0.001, (CL95%, 0.51-0.53)).The correlation between FIB-4 and FibroScan grade of the patients showed a positive association, which was not statistically significant (P=0.594, r=0.06, CL95%, -0.24-0.4). The FIB-4 in normal to mild grade was 85% rejecting the moderate to severe grade in FibroScan but none of them were statistically significant (P=0.146). Conclusion: Overall, the FIB-4 was incapable of predicting the FibroScan result. On the contrary, this case was also inconclusive and the results of FibroScan did not justify FIB-4 results of the patients. The FIB-4 cannot replace in RA patients. It is recommended to conduct future studies with a larger sample size in RA patients.

Background: Infertility is defined as the failure to achieve pregnancy after one year or more of regular unprotected sexual intercourse. Assisted reproductive technologies (ART) represent a key therapeutic approach for infertile couples. Bisphenol-A (BPA), a compound found in plastic polymer products, has been associated with increased infertility risk. This systematic review addresses whether BPA affects ART outcomes.
Methods: A comprehensive and systematic literature search was conducted across PubMed, Google Scholar, Web of Science, and Scopus up to December 2024 without any language or time restrictions. The search strategy combined relevant keywords and medical subject headings such as “bisphenol A,” “infertility,” “assisted reproductive technology,” “in vitro fertilization,” and “embryo implantation.” All human studies assessing the relationship between BPA exposure and ART outcomes were considered. After removing duplicates and screening titles and abstracts, 23 studies that met the inclusion criteria were reviewed in detail. The selected studies included cross-sectional and prospective cohort designs, and data on sample size, BPA measurement methods, and reproductive endpoints were extracted for qualitative synthesis.
Results: The reviewed studies consistently indicate that exposure to BPA is associated with adverse reproductive outcomes, particularly in women undergoing IVF treatment. Evidence suggests that higher BPA levels correlate with fewer retrieved oocytes, reduced oocyte maturation rates, and impaired ovarian response to hormonal stimulation. Several studies also observed reduced estradiol concentrations and lower fertilization and cleavage rates, leading to decreased implantation success and clinical pregnancy rates. In addition, diminished ovarian reserve markers, such as anti-Müllerian hormone and antral follicle count, have been negatively influenced by BPA exposure. Male factors were also affected, with reports of decreased sperm motility, abnormal morphology, and increased DNA fragmentation, which could compromise embryo quality and early development. Variability in study methodologies, small sample sizes, and differences in BPA detection techniques, however, make direct comparison challenging.
Conclusion: Current evidence supports an inverse association between BPA exposure and fertility outcomes, but further prospective studies with larger sample sizes and more precise measurement methods are needed.

Background: To improve hemostasis and optimize the healing process, autologous fibrin sealant (FS) has been introduced in selected cases. However, the clinical benefits of FS in sinonasal surgery remain controversial and require further evaluation. This study aimed to investigate the effects of autologous FS on hemostasis, mucosal healing, postoperative clinical outcomes, and recurrence in patients undergoing bilateral FESS, compared with normal saline as the control.
Methods: This randomized clinical trial included 32 patients who underwent bilateral FESS at Ghaem and Imam Reza University Hospitals in Mashhad, Iran, between 2019 and 2021. For each patient, autologous FS was applied to one nasal cavity, while the contralateral cavity received normal saline. Postoperative outcomes including bleeding, crusting, adhesion formation, and infection were assessed at 1 week, 1 month, and 3 months after surgery. In addition, sinonasal symptom burden and endoscopic findings were evaluated using the Sinonasal Outcome Test (SNOT-22) and the Lund-Kennedy endoscopic score, respectively, both recorded preoperatively and three months postoperatively.
Results: Application of autologous FS significantly reduced immediate postoperative bleeding, and no further bleeding events were noted during follow-up. Pain severity was comparable between the two sides. No statistically significant differences were observed in crust formation, adhesion, infection, recurrence, or changes in Lund-Kennedy scores between the FS and control sides (p=0.08, p=0.8, p=0.17, and p=0.14, respectively).
Conclusion: Autologous fibrin sealant reduced early postoperative bleeding without adversely affecting pain control, mucosal healing, or recurrence after FESS. Larger randomized trials with extended follow-up are recommended to determine its definitive clinical value and potential for routine use in surgical practice.

The findings indicate a multifaceted relationship: virulent Helicobacter pylori strains are significantly and inversely associated with true body iron stores, leading to Iron deficiency anemia (IDA). However, chronic inflammatory states can paradoxically elevate ferritin levels, masking underlying iron deficiency. Complex interaction between bacterial infection, host inflammatory responses, and iron deficiency is an important factor influencing both the severity of the damage caused by this bacterial infection and its chronicity in the pediatric population. Identification and comprehensive understanding of these complex mechanisms is of great importance for the effective management of iron deficiency anemia in children with H. pylori infection. Considering, increase in the incidence of H. pylori infection in childhood, it is essential that H. pylori infection be evaluation in children with unknown reasons IDA. Finally, screening methods for H. pylori infection in children is recommended, as this could improve long-term health outcomes.