Tehran University Medical Journal

Background: Curcuma longa generally known as turmeric includes curcuminoids and sesquiterpenoids as components, which are known to have antioxidative, anticarcinogenic, and anti-inflammatory activities. Iron, magnetite, and hematite as a micronutrient play an important role in physiological and chemical processes. Chitosan is a natural polymer derived from chitin and is recognized as versatile biomaterials because of their high biocompatibility, nontoxicity, and biodegradability to harmless products. The purpose of this research was to design synthesis and loading of nanocurcumin on iron magnetic nanoparticles modified with chitosan which is used as a targeted drug.
Methods: This laboratory research was conducted in Aja University of Medical Sciences from May to November 2017. Loading of nanocurcumin on iron magnetic nanoparticles modified with chitosan was done in two steps. In the first step, after preparing chitosan and iron magnetic nanoparticles, chitosan is placed as a coating polymer on surface of iron magnetic nanoparticles. In the next step, the final reaction is done by adding nanocurcumin on iron magnetic nanoparticles modified with chitosan. This causes nanocurcumin to penetrate into the polymeric layer core shell nanoparticles.
Results: Findings of transmission electron microscope and scanning electron microscope images show structure, morphology, physicochemical and the presence of nanocurcumin layers on chitosan in nanoparticles with diameter of 20 nm well. In Fourier transform infrared spectroscopy (FTIR), the Fe-O peak indicates magnetic nanoparticles and peak of the O-H in nanocurcumin layers on chitosan. Energy dispersive X-ray spectroscopy spectrum showing iron, carbon, oxygen and nitrogen peaks confirms the presence of these elements in the final composition and shows that chitosan and nanocurcumin groups are well dispersed on iron magnetic nanoparticles. The nanocurcumin loaded at 450 nm wavelength was evaluated by ultraviolet-visible spectrophotometry.
Conclusion: Results of Fourier transform infrared spectroscopy (FTIR), field emission scanning electron microscope image, energy dispersive X-ray spectroscopy spectrum, transmission electron microscope image, vibrating sample magnetometer analysis indicated that nanocurcumin has been successfully loaded on iron magnetic nanoparticles modified with chitosan and can be used as a targeted drug.

Background: Although cervical malignancy rate had grown up in recent years, primary cervical lymphoma is so rare. It must be high index of suspicious for primary cervical lymphoma diagnosis in patient with malignancy-like signs and symptoms for early detection. Primary cervical lymphoma has no standard treatment or follow-up protocol; so the management still is in doubt and based on previous case reports. In the other hand, the precise prognosis of patient is undetermined. In the present study, a case of primary cervical lymphoma is presented which was misdiagnosed at first. The patient accurate diagnosis was made at last due to multidisciplinary team working.
Case presentation: A 51-year-old woman, gravida 2, para 2, presented with complaint of abnormal vaginal bleeding and discharge, with no abnormal finding in cervical cytology and sonography, so uneventfully a diagnostic error had happened in the assessment of her. After several months and multiple different treatment, the patient referred to the Oncology Department of Obstetrics and Gynecology Center, Ghaem Hospital, Mashhad, Iran in May 2017. Re-assessment was performed by biopsy and imaging, and the final pathologic diagnosis of diffuse large B-cell non-Hodgkin's lymphomas was confirmed.
Conclusion: Primary cervical lymphoma is an uncommon malignancy; the diagnosis could be missed simply by low suspicious due to low accuracy of Pap smear and imaging in this situation. So an accurate evaluation and pelvic examination, high suspicious and close communication between clinician and pathologist are needed. By timely diagnosis of patient in early stage and appropriate approach, the prognosis could be excellent most of the time.

Background: Non-viral Nano carriers such as liposomes and cationic polymers based on engineered properties are regarded in gene delivery field. Although these carriers do not have weaknesses of viral vectors, but they are less efficient than viruses and they still need to be improved as favorable gene delivery carriers. Amongst non-viral carriers, cationic liposomes have been proposed for clinical applications, but limitations such as low nucleic acid transfer and endosome escape and conduction of plasmid to the nucleus have challenged their use in clinical trials. Therefore, the combination of liposomes and cationic polymers for nucleic acid transfer has been considered because this approach makes it possible to use the desirable properties of liposomes and polymers so that it is even suggested for the gene treatment of some diseases such as Parkinson's. In this study, a combination of liposomes and cationic polymers were used for the preparation of lipopolyplexes. This approach allows simultaneous utilizing of the desirable properties of liposomes and polymers.
Methods: This interventional-experimental study was conducted in the medical faculty of Mashhad University of Medical Sciences from April 2017 to February 2018. In this study, PEI-based lipopolyplex with a molecular weight of 25 and 10 kDa and a liposome-to-polymer ratio of 1:1 were combined with plasmid containing the GFP (Green Fluorescent Protein) marker. The physicochemical properties of the synthesized carriers such as size, cytotoxicity and gene transferability in human prostate cancer (PC3) cells were evaluated.

Background: Marital satisfaction is considered to be the feelings and understanding of the couple about their marital relationship and their two-way relationship. Many factors play a role in creating marital satisfaction, and on the other hand, marital satisfaction is one of the concepts that cause sexual health in a person. Sexual health has many dimensions and includes coordination and adaptation of physical, emotional, intellectual, and social aspects of sexual affairs in humans. This study was conducted to assess the marital satisfaction of working women in Iran through meta-analysis.
Methods: In this meta-analytic study, the issue of marital satisfaction amongst Iranian working women which has been published in local articles was evaluated. To find pertaining studies, Magiran, IranDoc, SID, Iranmedex, and Pubmed websites were used. Statistical society in this research consists of all studies in Iran in regard to the relationship between being a working woman and having marital satisfaction that has been accomplished since 2001-2018 and was indexed in one of the scientific informative websites.
  To access desired articles we used the English keywords of ‘Sexual dysfunction’, ‘Iran’, ‘Sexual function’, ‘Marital satisfaction’, ‘Working women’ and ‘women’ and their Persian equivalents. After the selection process of articles related to the research objectives, 10 articles were selected and assessed as final samples.

Background: The preparedness and safety of hospitals in disasters are essential to maintain the health and survival of the community. Numerous studies have shown that the level of preparedness of Iranian hospitals is moderate and low. Lack of comprehensive hospital standards for disaster preparedness is one of the reasons. This study aimed to develop hospital accreditation standards for hospital disaster risk management.
Methods: This comparative study was conducted between April and September 2016. Hospital disaster risk management accreditation standards were extracted from the hospital accreditation standards of 11 countries including the United States, Canada, Australia, Malaysia, India, Thailand, Egypt, Turkey, Saudi Arabia, Denmark and Iran. Overall, 27 hospital disaster risk management accreditation standards were introduced. The opinions of 22 disaster risk management experts were used to assess the content validity of the proposed disaster risk management accreditation standards.
Results: Differences were observed in the quality and quantity of those countries’ disaster risk management standards. The national accreditation standards of the United States, Australia, and Canada had comprehensive standards and covered all aspects of the disaster risk management cycle. Finally, 27 standards were proposed for developing Iranian hospitals’ disaster risk management accreditation standards. The CVI & CVR validity of the proposed standards were acceptable.
There were significant differences in the quantity and quality of hospital disaster risk management accreditation standards in selected countries. The most comprehensive standards belonged to the US National Standards (12 standards and 113 sub-standards), followed by the Australian and Canadian accreditation standards. The accreditation standards of the developing countries and Iran were not comprehensive and did not meet the international goals of disaster risk management. The proposed hospital disaster risk management accreditation standards had high content validity.
Conclusion: Disaster risk management accreditation standards in Iran and developing countries need to be revised and upgraded. Comprehensive standards based on international experiences and expert opinions were introduced in this study that can be used to develop hospital accreditation standards in Iran and other countries.

Background: Infection with Strongyloides stercoralis is common in tropical and subtropical regions. To prevent and treat these diseases, information on the distribution and frequency of these parasites in different geographical areas is needed. Due to the importance of diseases in the northern provinces of Iran, the present study was performed to determine the prevalence of Strongyloides stercoralis.
Methods: From April 2011 to March 2020, stool samples from patients who were referred to Rouhani hospital in Mazandaran province, Babol, were gathered. For stool samples, microscopic detection was performed immediately using the wet expansion method, followed by a formal-ether concentration process. Based on the sample size calculation, the minimum number of patients with Strongyloides stercoralis infection was considered to be 380 patients from the years 2011-2020. Mean and standard deviation indices were used to describe quantitative data and numbers and percentages were used to describe qualitative data.

Results: Out of the total number of 39,800 archived patient files that were reviewed, a total of 420 (1.05%) patients were confirmed for the presence of Strongyloides stercoralis in their feces. The age range of patients was 3 to 89 years. The population of male patients (249 patients) was higher than females (171 patients). In patients with positive Strongyloides stercoralis, disease symptoms were positive in 206 patients and negative in 214 patients. The most common underlying disease in patients was abdominal pain (220 patients). 271 patients received steroids. Conclusion: Strongyloides stercoralis infection was detected in the northern region of Iran. The prevalence of this parasite was higher in men, the elderly, and people with underlying comorbidities. These results can be used to identify and compare areas where the prevalence of infection is higher. Therefore, revealing the effect of Strongyloides stercoralis infection on public health makes the need for in-depth clinical and diagnostic studies important. People with chronic diseases, whether symptomatic or asymptomatic, should be screened for parasitic diseases.

Background: Today, the health of mothers and babies is of particular importance in health systems. So far, various interventions have been implemented to improve the health of pregnant mothers. The present study aimed to compare the effect of Entonox gas and Sufentanil epidural anesthesia in labor pain on the umbilical cord blood gas analysis and neonatal Apgar score.
Methods: The present study is a clinical trial on 800 pregnant women It was done in April 2020 to January 2022 at Shahid Akbarabadi Hospital. Mothers were divided into two groups: spinal anesthesia and the group receiving Entonox gas. To measure the effectiveness, Apgar scores were measured at 1 and 5 minutes along with BE, HCO3, and PCO2 parameters. Two independent sample t-tests and ANOVA were used in SPSS version 22 software to analyze the data.

Results: The results of the study showed that the average age of mothers participating in the study was 27 years, and the average Apgar score of 1 and 5 minutes in the group of mothers receiving Entonox gas and spinal anesthesia was 9.9 and 8.6, respectively. Also, the average Apgar score at minutes 1 and 5 in the group of mothers with spinal anesthesia was 9.8 and 8.2, respectively. The results of the analysis and comparison of the parameters obtained from the arterial gases of the umbilical cord of newborns were not significantly different between both groups of mothers. Also, no significant difference was found in Apgar scores between both groups of mothers. Conclusion: There is no significant difference between the effectiveness of using Entonox gas with spinal analgesia in the painless delivery of mothers; Therefore, considering the cost of each intervention along with their effect may cause a difference in the two interventions. This means that although both of the interventions have the same clinical and diagnostic effects, the one which costs less, will be more preferable from the point of view of the health system.

Background: Several typical and atypical findings have been observed in Covid-19 high-resolution computer tomography (HRCT). To our knowledge, there is no study investigating the relationship between the presence of nodules in Covid-19 patients and the patient's condition. Therefore, the present study assessed the frequency of pulmonary nodules in Covid-19 patients according to their condition.
Methods: This cross-sectional study assessed the medical images of the patients referred to three university-affiliated centers (Nemazi, Ali Asghar and Shahid Faghihi Hospital) to perform Covid-19 HRCT from April to September 2020. The centers have been named H1, H2, and H3. Patients who were referred to these centers had good, poor, and fair conditions, respectively. The history of patients was assessed carefully. Patients' demographic information, nodule shape, number, size, location, presence of cavitation, and GGO around the nodule were assessed and recorded.

Results: Overall, 20576 patients (mean age=46.75±16.64 years old) were included in the study. Only 2.1% of cases had solid nodules. Most of them (96.76%) were accompanied by a GGO (halo sign), and only 10.42% were associated with a cavity. The good condition, patients showed significantly more solid nodules (3.46%) than others. In size of the nodules in good-condition patients (1.8 cm) is significantly larger than in fair-condition (1.22 cm) or poor condition patients (1.15 cm). 79.86%, 12.5%, and 7.64% of nodules were multiple, dual/triple, and single, respectively. Conclusion: The frequency of nodules in the HRCTs of good-condition patients was significantly higher than in fair- or poor-conditionpatients; they also had more multiple and larger-sized nodules. The Pearson-coefficient test also revealed a small negative correlation between the presence of nodules and the patient's condition. It seems the presence of nodules indicates higher immunity to viral infections. In the follow-up, it was revealed that people who had nodules were not hospitalized in the ICU. Further study is needed to prove this point.

Methods: This cross-sectional study was conducted on all files of patients admitted to Qaem Hospital in Mashhad City, Iran, in a period of 10 years from March 2009 to February 2018 with a definitive diagnosis of benign or malignant tumors of the CNS, including tumors of the brain, cerebellum, spinal cord, or meningeal membranes. Information sources included the patients' physical files and the hospital information system (HIS). The statistical software SPSS version 28.0 for Windows (IBM SPSS, Armonk, New York, USA) was used for the statistical analysis. Results: In total, 775 patients with benign and 771 patients with malignant CNS tumors were included in the study. Regarding epidemiological aspects of benign tumors, the incidence rate of women was almost twice that of men (68.47% versus 31.53%), with an overall average age of 45.31±19.81 years. The most common benign tumors were meningioma (72.77%), followed by schwannoma (13.67%). Regarding malignant brain tumors, the mean age of affected patients was 36.64±19.67 years, with males accounting for 53.04% of cases and females for 46.96%. The most frequent type of tumor was glioblastoma (32.68%), followed by diffuse astrocytoma (16.47%). Both benign and malignant CNS tumors were associated with significant hospital mortality; in-hospital mortality rates for benign and malignant tumors were 10.1% and 17.5%, respectively. Tumor type and its grade were the main determinants of early death in malignant CNS tumors. Conclusion: The epidemiological characteristics of benign and malignant tumors in our study community were similar to the reports presented in other communities. Knowledge of these characteristics provides the possibility of managing patients and reducing morbidity and mortality related to these tumors.

Background: Cataract surgery is the most common surgery in the world. The prevalence of age-related cataract increases with age, and its prevalence increases with each decade of age after forty years. Various drugs are used to control analgesia and hemodynamics in patients undergoing cataract surgery. The purpose of this study is to compare dexmedetomidine and 2% lidocaine in the control of analgesia and hemodynamic changes in cataract surgery with local anesthesia.
Methods: In this double-blind clinical trial study, 52 patients with anesthesia class I and II underwent cataract surgery. Patients were randomly assigned to two groups: lidocaine (three cc) and dexmedomedin (five μg/kg + lidocaine). The information collection checklist in this study included: age, gender, history of aspirin use, systolic and diastolic blood pressure, heart rate, intraocular pressure, postoperative complications, and postoperative pain.

Results:  The Mann-Whitney U test showed that the Dex-Metomedin group had less pain than the Lidocaine group in the first hour after the intervention (P=0.012). Two hours after the intervention, the dexmedemodin group had less pain than the lidocaine group (P=0.001). In the investigation of IOP after retrobulbar block in the dexmedetomidine group, we saw a significant increase in IOP from 16.56±3.12 to 17.96±2.68 mmHg compared to before the block (P=0.001). In the lidocaine group, we also saw a significant increase in IOP from 16.18±3.66 to 19.66±4.67 mm Hg compared to before the block (P=0.001). Before and after retrobulbar block, there was no significant difference between the two groups (P=0.694 and P=0.108, respectively). To investigate the effect of these interventions more precisely, the amount of IOP pressure change was also compared between the two groups, and we saw a greater increase in the lidocaine group than in the dexmedetomidine group (P=0.002). Conclusion: The results of the present study showed that dexmedetomidine + lidocaine in retrobulbar form compared to lidocaine was able to control the pain level of patients after surgery and systolic and diastolic blood pressure during surgery. It is suggested to use this drug as local anesthesia in cataract surgery.

Background: Recently, epinephrine is used to increase the depth and duration of local anesthetic pain, and it is widely used topically to reduce local anesthetic release and reduce bleeding caused by surgery.
Methods: This study was a randomized, double-blind clinical trial on 30 patients aged 18 to 85 years undergoing lower limb orthopedic surgery referred to Peymaniyeh Hospital in Jahrom from September to December 2022. Patients were randomly assigned to two groups, A (epinephrine+fentanyl+bupivacaine) and B (bupivacaine+fentanyl). Systolic blood pressure, diastolic pressure, mean arterial pressure, arterial blood oxygen saturation percentage, and pulse rate were measured and recorded before drug administration, before spinal anesthesia, after anesthesia, and then every half hour until the end of surgery (15, 45, 30, 60, 75, 90, 120) and during recovery. Data analysis was performed using SPSS version 21 software and descriptive (mean, standard deviation) and inferential statistics (t-test, chi-square, Mann-Whitney, Friedman) at a significance level of P<0.05.

Results: Thirty patients aged 18 to 85 years (in two groups of 15) with anesthesia class I and II undergoing lower limb orthopedic surgery were evaluated. The study groups are matched in terms of age and gender variables. There was no significant difference in mean systolic, diastolic, mean arterial blood pressure, and heart rate before and after anesthesia, 15, 45, 30, 60, 75, 90, and 120 minutes after drug injection, and at entry and exit from recovery between the Epinephrine+Fentanyl+Bupivacaine and Fentanyl+Bupivacaine groups. There was a significant difference in mean O2SAT before anesthesia, 15, 30, and 75 minutes after drug injection between the epinephrine+fentanyl+bupivacaine and fentanyl+ bupivacaine groups (P<0.05). Conclusion: The use of the combination of epinephrine+fentanyl+intrathecal bupivacaine compared to the combination of fentanyl+bupivacaine did not have a significant difference in the studied variables of patients' vital signs.

Background: Diabetic retinopathy is one of the main causes of blindness in the world and one of the causes of disability in diabetic patients. However, no study has been conducted in Iran to Comparison of Quality of Life between Diabetic Patients With and Without Retinopathy.
Methods: This descriptive-analytical study was conducted on 183 diabetic patients referred to the Jahrom Honari Clinic from October to February 2023. The patients were divided into two groups: diabetic patients without retinopathy complications and diabetic patients with retinopathy complications. The data collection tool included two demographic information questionnaires and a quality of life questionnaire (DQOL-BCI). The data of the two groups and subgroups were compared and analyzed using SPSS version 21 software and descriptive statistics (frequency, percentage, mean, and standard deviation) and inferential statistical tests (chi-square, t-test, ANOVA, Pearson correlation coefficient) at a significance level of P<0.05.
Results: The majority of diabetic patients participating in the study in the group with retinopathy (70.3%) and the group without retinopathy (75%) were male. The groups of Diabetic Patients With and Without Retinopathy did not differ significantly from each other in terms of demographic variables and were similar. There was a significant difference between Diabetic Patients With and Without Retinopathy in terms of average quality of life (P>0.001). The mean quality of life in the group of diabetic patients with retinopathy (41.19±7.97) was higher than that of the group of diabetic patients without retinopathy (37.22±7.37). There was no significant difference between the mean quality of life and demographic variables in diabetic patients without retinopathy and diabetic patients with retinopathy (P<0.001).
Conclusion: That patients with retinopathy had a higher quality of life than the group without retinopathy. These results were obtained while none of the demographic variables such as age, gender, marital status, and education level had a significant relationship with the quality of life of these patients.

Results: The mean age of the patients participating in the case group was 52.17±10.6 and in the control group was 51.24±9.7. There was no statistically significant difference in age (P=0.654). There was also no significant difference between the two groups in terms of body mass index and different body index classifications, menopause age, and age of onset of menstruation. The number of months of breastfeeding in the control group was significantly higher than the case group (P=0.001). The results of logistic regression showed that, on the other hand, there was no significant relationship between the type of pathology of the disease and serum vitamin D levels. Conclusion: The results of the present study showed that vitamin D deficiency can be a poor prognostic factor in the course of breast cancer.

Background: Posterior urethral valve (PUV) is recognized as one of the most frequent causes of obstructive uropathy in the pediatric population, particularly in male infants. This congenital anomaly leads to variable degrees of urinary outflow obstruction, which may result in progressive renal damage and deterioration of kidney function over time. Despite advances in diagnostic modalities and surgical interventions, infants and children affected by PUV continue to demonstrate suboptimal long term renal outcomes, with a considerable proportion developing chronic kidney disease (CKD). Understanding early predictors of adverse renal prognosis is essential to guide timely interventions and optimize follow up strategies. The present study aimed to assess the long term renal outcomes, over a minimum of five years, of patients with PUV treated at the Children’s Medical Center, and to investigate the role of preoperative serum creatinine levels as a predictor of future CKD in this patient group.
Methods: A cross sectional and retrospective study design was employed. The medical records of patients diagnosed with PUV between March 2011 and March 2016 who had at least five years of documented follow up were reviewed at the Children’s Medical Center in 2021. Data extracted included demographic characteristics, laboratory tests—particularly pre and post operative serum creatinine—ultrasound imaging results, surgical details, and follow up findings throughout the study period.
Results:  Eighty one patients met the inclusion criteria, with a mean age at diagnosis of 105 days. At the five year follow up, the overall prevalence of CKD among these patients was estimated at approximately 9.9%. During the follow up period, one patient died due to kidney disease, one underwent kidney transplantation, and three required maintenance dialysis. Statistical analysis demonstrated that a preoperative creatinine level exceeding 1.15 mg/dL was strongly associated with the future development of CKD, showing 100% sensitivity and 75% specificity in predicting adverse long term renal outcomes.
Conclusion: This study underscores the persistent risk of CKD in children with PUV, even after surgical intervention. Regular and comprehensive monitoring of renal function remains vital in this high risk group. Preoperative serum creatinine may serve as a reliable, accessible, and clinically useful prognostic marker to identify patients who may benefit from closer follow up and proactive management strategies.