Tehran University Medical Journal

Chick embryos are a great historical research model in basic and applied sciences. Along with other animal models, avian and specifically chicken embryo has been attended, as well. Avian fertilized eggs as a natural bioreactor are an efficient tool for producing recombinant proteins and vaccines manufacturing. Due to the limitations of birds' eggs for viral replication, avian stem cells culture technologies access to safe methods as well as large-scale production of a variety of human and animal vaccines. Chicken pluripotent stem cells present the unique property of self-renewal and the ability to generate differentiated progeny in all embryonic lineages such as ectoderm, mesoderm, and endoderm in vitro. For the first time, chicken embryonic stem cells (cESCs) derived from the blastodermal cells of stage X embryos in vitro. Chicken ESC provides a great model of early embryo and they are useful for gene manipulation, virus proliferation, and the generation of transgenic birds. In addition to blastodermal cells, pluripotent cell lines can be produced by reprogramming of chicken fibroblasts into induced pluripotent stem cells (iPSCs) with transcription factors such as OCT4, NANOG, SOX2, KLF4, LIN28, and C-MYC that are well known to contribute to the reprogramming of somatic cells into an iPSCs. Similar to chicken ESCs, iPSCs have properties of unlimited self-renewal in vitro and the capacity for differentiation to all three embryonic germ layers. Chicken iPSCs have been a useful tool for the production of transgenic birds and viral vaccines. Despite the benefits and multiple applications of chicken pluripotent stem cells, the propagation of these cells is limited and some important challenges should be eliminated before their use in vaccine manufacturing. It is necessary to define the appropriate culture conditions for chicken pluripotent stem cells. For example, the presence of endogenous viruses in the avian species should be evaluated for human vaccine production. Currently, primary chicken fibroblast cells are still mainly used for vaccine production. This review covers the resources to achieve chicken derived cell lines for vaccine manufacturing.

Background: The effects of magnesium physiology are contradictory to the neurotoxic effect of bilirubin, but the relationship between magnesium level and hyperbilirubinemia in neonates has not been well studied. In this study, we investigated the relationship between serum magnesium level and hyperbilirubinemia and hyperbilirubinemia complications at the Children’s Medical Center.
Methods: In this cross-sectional and prospective study, 100 neonates who were admitted to the Children's Medical Center from October 2018 to 2019 due to neonatal jaundice were enrolled. Neonates were divided into two groups: serum bilirubin levels 16-20 mg/dl were included in the moderate hyperbilirubinemia group and bilirubin >20 mg/dl into severe hyperbilirubinemia group. Serum magnesium levels and clinical complications of hyperbilirubinemia including fever, seizure, apnea, bradycardia, and abnormal neurological examinations were recorded in these infants.

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: The pandemic of Covid-19 is spreading around the world. Extensive research is needed to focus on identifying the underlying causes of the disease. This study aimed to investigate the clinical and etiological symptoms of the Covid-19.
Methods: This descriptive-analytical study, conducted on 510 infected patients in the infectious disease clinic of Imam Khomeini Hospital in Tehran from March 2019 to June 2020 for A period of Four months during the first wave of Covid-19 pandemic. The method of selecting patients was continuous and was divided into two groups of 179 inpatients and 331 outpatients based on lung scan and clinical symptoms. Demographic information, clinical signs, and risk factors were collected through a questionnaire and the data were statistically analyzed.

Conclusion: Fever, chills and cough were important symptoms in identifying infected patients with Covid-19. According to the results of the present study and the findings of other studies, the supportive effect of vitamin D3 in reducing the severity of infectious diseases should be considered. Clinical trials with appropriate sample size are recommended to investigate the functional role of this vitamin in Reducing the severity of viral diseases of the respiratory tract.

Background: Dermatophyte is a group of keratinophilic fungi that cause various skin lesions depending on the affected area. Dermatophytosis is usually diagnosed by clinical manifestation and confirmed by direct microscopy or fungal culture. There might be diagnostic difficulty with the presence of atypical dermatophytosis. Atypical dermatophytosis presents with clinical appearances ranging from eczematous, psoriasiform, pustular lesions, and others, that interferes with early diagnosis and disturbs patient’s life quality. Genital dermatophytosis is an uncommon presentation of cutaneous fungal infection; moreover, its manifestation without the involvement of the inguinal area, and simulating wart is a rare sign. In this study, we introduce a rare case of dermatophytosis with a wart-like appearance that was restricted to the skin of the genitalia.

Background: Understanding hand structures is necessary to diagnose its diseases and injuries. Several methods have been used to teach the anatomy of this body part. In this article, we introduce a new educational tool and examine the impact of its use in learning anatomy.
Methods: Color images of different layers of hand structures were connected with a spring. On each page, the desired structure was cut and that part could be turned from another direction so that the tool was beyond a booklet and could create a three-dimensional image of the region. In this way, a multi-layered structure was made that looking at each part of it and going to the next part was equivalent to removing a layer from the palm of the hand and observing the layer beneath. After making the educational tool, 280 students who participated in the study were divided into two groups: control (A) and experimental (B). Both groups participated in a pre-test. After teaching the theory of hand anatomy for both groups, the control group received practical training using the traditional method and the experimental group using the proposed educational tool, and both groups participated in a post-test and the scores of the pre and post-test groups were compared. Data were analyzed using SPSS 24 statistical software using Mann-Whitney and Wilcoxon tests.

Background: Ovarian cancer is the fifth leading cancer-related cause of death in women worldwide and is often diagnosed at advanced stages. Regarding the low sensitivity and specificity of the currently available diagnostic techniques, in the present study, we aimed to evaluate the accuracy of RMI and ROMA indexes and comparing these two indexes with CA-125 and HE4 parameters for the diagnosis and differentiation between benign and malignant ovarian tumors. Also, we determined the optimal cut-off level of these markers in patients who attended Arash Women’s Hospital.
Methods: In this cross-sectional study, we included 137 women with ovarian mass who were attended the gynecology clinic of Arash Women's Hospital, Tehran, Iran (April 2017-April 2019), and were eligible according to the inclusion criteria. We included patients with an adnexal mass over 3 cm. Our exclusion criteria were as the following: pregnancy, age under 18 and over 90 years, taking hormonal agents, renal failure, suspected ovarian torsion, ovarian cancer and taking antibiotics, nitric oxide compounds, and heavy metals. Based on serum CA125, HE4, and ultrasound findings, ROMA and RMI indexes were determined for each patient, and the sensitivity and specificity of HE4, RMI, ROMA, and CA125 were compared with the result of the operative histopathologic assessment.

Conclusion: Measurement of HE4 before menopause and CA125 during menopause seems to be helpful in the early detection of ovarian cancers in women with ovarian masses.

Background: Normal vaginal delivery causes sexual dysfunction as well as urinary and fecal incontinence, which can threaten a person's quality of life. It is believed that pelvic floor muscle strength is the most important factor in improving sexual satisfaction and function and urinary control. Therefore, This study aimed to investigate the role of physiotherapy and pelvic floor exercises in reducing sexual dysfunction and incontinence in primiparous women.
Methods: This study was performed as a prospective randomized clinical trial on primiparous women who were referred to Al-Zahra and Shahid Beheshti educational hospitals in Isfahan between march 2019-Mars 2020. In this study, after obtaining ethics approval from the Medical Ethics Committee of Isfahan University of Medical Sciences, patients were divided into control (n=57) and intervention (n=57) groups. In the control group, no intervention was performed and only routine postpartum recommendations (multivitamin tablets and 500 mg calcium tablets once daily for two months) were prescribed. For the intervention group the pelvic floor physiotherapy was performed Sexual function and urinary and fecal incontinence were assessed in both groups at 8 and 16 weeks postpartum by completing two questionnaires.

Conclusion: it seems that simultaneous performance of physiotherapy (biofeedback) and pelvic floor exercises by strengthening the strength of the pelvic floor muscles increases sexual function as well as a relative improvement of pelvic floor irritation in the postpartum period.

Background: Asthma is the most prevalent chronic disease in childhood and has been growing globally over the last three decades. Studies in this regard indicate different and irrelevant results in Iran. Different prevalence of asthma has been reported in industrialized countries, prevalence of 25.9% in the United Kingdom, 12.8% in Spain and 31% in Australia. This study aimed to evaluate asthma in Iranian children through systematic review and meta-analysis.
Methods: This study was performed as a systematic review and meta-analysis from January 2001 to December 2018. Related articles to the reviewed subject were obtained through searches of Scopus, ScienceDirect, Magiran, SID, Medline (PubMed), and Google Scholar databases. Cross-sectional studies were selected for inclusion in the study and observational studies as well as review studies were excluded from the study. Searches on Google search engine and the inspection of sites related to the topic were also incorporated to examine the grays literature. Duplicate articles and articles that were similar and obtained from the same source were removed through the EndNote software. The total number of articles was 896. Subsequently, the number of articles and studies that met the requirements of the first stage was 274. Ultimately after the elimination of 236 irrelevant articles and the elimination of 5 articles in the secondary examination, eventually 33 articles were added to the final stage. By the I² index, the heterogeneity of the studies was investigated and reported.

Background: Nicolau syndrome is a rare condition that happens after intramuscular injection. All the intramuscular injections may have mild to moderate complications such as pain, focal abscess, nerve complication and anaphylactic reactions. Among these complications, wide necrosis of the skin like Nicolau syndrome happens very rarely. In this condition, Patients typically report acute, intense pain, immediately after drug injection and it is followed by an erythematous macular evolving after 24 hours into a livedoid violaceous patch with dendritic extensions. The study has been reported a case report of a 6-month-old infant who suffered from Nicolau syndrome after the injection of pentavalent vaccine.
Methods: A 6-month-old girl infant without a history of any disease was referred to the emergency department with the signs of erythema, edema and purple like discoloration in the vaccine injection site at the left tight, after vaccination. One hour after admission, in the lower limb severe edema along with an extension of a dark red to purple discoloration happened on different parts of foot and after 5 days they turned necrotic. The infant suffered from Nicolau syndrome after the injection of the pentavalent vaccine.

Background: Early outcome prediction of hospitalized patients is critical because the intensivists are constantly striving to improve patients' survival by taking effective medical decisions about ill patients in Intensive Care Units (ICUs). Despite rapid progress in medical treatments and intensive care technology, the analysis of outcomes, including mortality prediction, has been a challenge in ICUs. Hence, this study aims to predict the mortality of patients admitted to ICUs using data mining techniques.
Methods: In this study, among the cases of patients who were admitted to ICUs of the Rasoul Akram and Firoozgar hospitals of Tehran City, Iran, from December 2017 to March 2018, the first 24 hours of the ICUs admission data of 874 cases were gathered. A new model based on the standard methodology CRISP was developed. In the modeling section, two well-known data mining techniques called artificial neural network (ANN), K nearest neighbor (KNN) and decision tree (DT) were used. WEKA 3.9.2 open-source software was implemented for data analysis. Finally, according to the accuracy, sensitivity, specificity criteria and AUC-ROC Curve, the superior model was introduced.
Results: Based on the WEKA results, 19 variables had the most impact on the mortality prediction of patients admitted to ICUs including Glasgow Coma Scale (GCS), mechanical ventilation, surgical service at ICUs admission, gender, temperature, serum creatinine, diabetes, Blood urea nitrogen (BUN), age, addiction, International Normalized Ratio (INR), PH, Partial Thromboplastin Time (PTT), albumin, hemoglobin, glucose, pulse rate, hematocrit (HCT), PO2.  Based on the created models, some rules have been extracted which can be used as a pattern to predict the probability of mortality. Although the AUC of the three models was acceptable (KNN 81.5%, ANN 77.5% and DT 74.3%), but the accuracy of decision tree J48 (74.2%) was higher.

Background: Enhanced recovery after surgery (ERAS) is now firmly established as a global surgical quality improvement initiative that results in both clinical improvements and cost benefits to the healthcare system. ERAS guidelines are based on the highest quality evidence available and as such require updating on a regular basis. The ERAS Gynecologic/Oncology guidelines were first published in February 2016. This is the first updated Enhanced Recovery After Surgery (ERAS) Society guideline presenting a consensus for optimal perioperative care in gynecologic/oncology surgery.^1,2
Methods: Starting from the original ERAS Gynecologic/Oncology guidelines, the first author and senior authors identified topics for inclusion. International authors known for their expertise in gynecologic/oncology perioperative care were invited to participate in the guideline update. A database search of publications using Embase and PubMed was performed. Studies on each item within the ERAS gynecologic/oncology protocol were selected with an emphasis on meta-analyses, randomized controlled trials, and large prospective cohort studies. These studies were then reviewed and graded according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system,³ whereby recommendations are given as follows: Strong recommendations: The panel is confident that the desirable effects of adherence to a recommendation outweigh the undesirable effects, weak recommendations: The desirable effects of adherence to a recommendation probably outweigh the undesirable effects, but the panel is less confident.

Background: Otitis is the most common infectious disease of the ear with internal and external cranial complications. If the infection is in the middle ear, it causes otitis media. If the infection is in the external ear, it’s along with otitis externa (OE). Different types of otitis media include acute otitis media (AOM), chronic otitis media (COM) and Otitis media with effusion (OME). This study aimed to investigate the different types of otitis and its symptoms.
Methods: This cross-sectional study was conducted from March 2019 to February 2020 for 200 patients who have been referred to the ENT center of Shafa hospital, Kerman, Iran. Sampling was conducted with ease and no need for specified sampling distribution. The type of otitis was written in a questionnaire by the physician after the examination. The present research investigated types of otitis along with its symptoms. Also, their demographic information was determined.

Today surgery is supposed as the cure for many diseases and the fear of post-operation pain burdens stress over the patients. Postoperative pain can, especially if severe, complicate the patient's condition and may lead to chronic postoperative pain. post-operation pain control is effective in the recovery process, hospitalization period and patients’ satisfaction. Insufficient post-operation pain control increases complications and care costs. Local analgesia is one of the components of multimodal postoperative. analgesic protocol to control pain. Local analgesia technique is a simple, accessible and feasible method for various surgeries. The opioid analgesics to control post-operation pain are associated with some complications such as opium addiction, nausea and vomiting, late return of bowel function and social costs. This review study aims. to review previous studies on the effect of injection of analgesic agents in the surgical incision in post-operation pain control. This is a Narrative review study. to related scientific documentaries a search was conducted in Persian and English using the keywords of local injection of the incision site, wound infiltration with analgesic agents and post-operation pain control in Google scholar, PubMed and Scopus database during the years 2000 to 2020. The obtained articles included systematic reviews, Meta-analyses and randomized clinical trials (RCT). We reviewed studies that had utilized single-dose injection of analgesic agents in surgical incisions at the end of surgery to control post-operation pain. A total of ten studies were reviewed. There were 4 studies in the field of laparoscopic gynecological and non-gynecological surgeries, three studies in the field of laparotomy and three review studies. injection of analgesic agents in the surgical incision to control post-operation pain is easily available and does not necessitate any special skill. On the other hand, it is a safe method without further complications and does not increase the duration of surgery. Regardless of the differences in various studies and the kind of analgesic agents, a general reduction in pain severity and consumption of opioid and non-opioid analgesic agents were observed using the injection of analgesic agents in surgical site incision.

Background: Short children face many problems throughout their lives. Consumption of growth hormone and the drugs such as Letrozole, Oxandrolone, and Anastrozole can increase the growth of children and adolescents. There is not an overall estimate of the effects of Letrozole, Oxandrolone, and Anastrozole on the growth of children and adolescents with Idiopathic Short Stature (ISS). There are different estimates of the effect of growth hormone and the drugs Letrozole, Oxandrolone, and Anastrozole on growth in children and adolescents with Idiopathic Short Stature. Therefore, the aim of this study was to compare the efficacy of growth hormone, Letrozole, Oxandrolone, Anastrozole, and a combination of growth hormone and aromatase inhibitors on height gain in children and adolescents with idiopathic short stature using meta-analysis method.
Methods: Search was done in databases such as; Scopus, Web of Science(ISI), and PubMed using keywords: Idiopathic, Short Stature, Body Height, Aromatase Inhibitors, Growth hormone, Letrozole, Oxandrolone, Anastrozole. Randomized clinical trial studies ,that have investigated the efficacy of growth hormone and aromatase inhibitors on height gain in children and adolescents with short stature, were selected. Height standard deviation score (HSDS) before intervention and after treatment has been used to measure the rate of height increase in various studies. This study was written based on the PRISMA checklist and the heterogeneity of this study was evaluated using the Q statistic and I² index.

Background: Today, with the advancement of technology in various fields, the importance of recording data in the field of health is increasing so much that for many diseases around the world, including kidney disease, registration systems have been set up. This is happening in our country and in the future, the number of these systems will increase. The medical data set contains valuable information that will be time-consuming and costly to obtain using laboratory methods, so there is a need for low-cost methods for extracting information. This study focuses on developing a predictive model for classifying the cause of kidney stones in Isfahan using three data mining techniques.
Methods: This cross-sectional research has been done from February 2021 to May 2021. The used medical data set includes information of 353 kidney stone patients in Isfahan. In this study, six target attributes of sodium, phosphate, oxalate, citrate, cysteine and uric acid were identified. The techniques for each of the 6 attributes are used separately. The techniques used in this study were three data mining techniques including random forest (RF), artificial neural network (ANN) and support vector machine (SVM).

Conclusion: Kidney stones can occur due to various reasons such as low citrate and high calcium oxalate. For example, for citrate, factors such as blood pH (potential of hydrogen), blood sugar and blood pressure are effective. To prevent any of the causes of kidney stones, factors should be controlled.

Background: Connexon is a membrane structural protein in the gap junctions. These cellular connections are responsible for transporting ions and messenger molecules to the oocyte. This study aimed to investigate the role of beta-2-adrenoceptors in the process of follicle growth based on the expression of the two connexins 37/43 in the gap junctions that have a primary role in the mitotic resumption and oocyte maturation.
Methods: This case-control study was conducted from April 2019 to November 2020 at the Reproductive Health Research Center of Tehran Imam Khomeini Hospital was performed on women with the poor ovarian response (POR) and control (women donate eggs) groups. Both groups had entry criteria with a body mass index under 28 m²/kg and 20-45 years old. Exit criteria were including no drug use except ovarian stimulants and no illness. The diagnosis was made agreeing to the Bologna model criterion. Ovulation stimulation cycle was performed, and then after the puncture, cumulus cells were isolated by enzyme and were freezing in -80 centigrade until the time of inserting into the cell culture medium. Isoproterenol (agonist) and propranolol (antagonist) at a concentration of 100 nM were added to the culture medium as the beta-2 adrenoceptors selective drugs. After culture, RNA extraction was performed and the concentration was read by Nanodrop, and then cDNA was synthesized. Gene expression was determined by real-time PCR.