Tehran University Medical Journal

  SARS-CoV-2 emerging from Wuhan, China is a member of the Coronaviridae family, which has so far infected and killed many people. The SARS-CoV-2 pandemic affected various aspects of life in Iran and Worldwide, and governments have imposed quarantines and travel bans on an unprecedented scale. The virus causes COVID-19, which can spread through close contact with the infected person, contaminated equipment, and suspended air droplets. The most common symptoms of the disease include fever, cough, shortness of breath, gastrointestinal symptoms, and diarrhea. In severe cases, the lung infection can occur, which causes Severe Acute Respiratory Syndrome that leads to ICU admission and even death.
  Besides, this infection can cause gastrointestinal, neurological, and renal impairments. Not merely, this new coronavirus has infected many more people worldwide in comparison to MERS and SARS, but also it has killed more people. Patients with underlying diseases such as hypertension, diabetes, respiratory problems, kidney disease, heart disease and Immunodeficiency are at higher risk of infection and potential death. Also, the risk of death and complication increases in older adults, while most of the infected children are asymptomatic. Some infected people may have mild or no symptoms but can still transmit the disease and spread it to others.
To diagnose COVID-19, serology tests, and level of ESR, CRP and other acute-phase reactants are helpful, whereas molecular tests, such as RT-PCR tests, that detect the virus’s genetic material are still the golden standard. Also, CT scan detects lung involvement; Ground-glass opacification, especially in lower lobes and subpleural region, is the most common CT characteristic, although it is not specific for COVID-19. Because the disease is difficult to diagnose, hard to prevent and challenging to treat, it has become a major concern for many countries. This review aims to gather existing information in the fields of virology, molecular pathogenesis, disease symptoms, epidemiology, clinical presentations, diagnosis, treatment, and the spread of the disease. This study also provides evidence-based prevention and treatment strategies for health policymakers, doctors, nurses, and practitioners in the field of public health, including researchers and students.

Background: Cervical cavernous hemangioma is an extremely rare, benign lesions, and only a few cases are reported. Cervical cavernous Hemangiomas are characterized by an increase in the number of normal and abnormal veins. The majority of these lesions are superficial, often found in the head and neck area, but may also occur in the inner parts of the body. The occurrence of these lesions in the female reproductive tract, especially the the cervix is extremely rare. This disease should be considered as a differential diagnosis of abnormal uterine bleeding because of the low prevalence and importance of the diagnosis of this uncommon disease. The majority of cervical cavernous hemangiomas have been reported in women of childbearing age. Besides, although most lesions are symptomatic (mostly bleeding), diagnosis is often unlikely. They may cause abnormal vaginal bleeding in the form of menometrorrhagia and postcoital spotting. To date, fewer than 55 cases have been reported. This study aimed to report a rare case of cervical cavernous hemangioma.
Case Report: The patient was a 24-year-old woman who had referred to the outpatient clinic of Ghaem Hospital in September 2016 due to prolonged post coital bleeding after intercourse. At the time of the pelvic examination, posterior lip of cervix was very vascular and there was black color that had extend to the vagina. The patient underwent colposcopy. Following colposcopy, due to severe cervical bleeding, the vagina packed. The patient's bleeding was controlled with the pack after 24 hours. Cervical pathology revealed a cavernous hemangioma.

Background: Lymphoma is a malignant proliferation of lymphoid cells. External T-cell lymphoma is very rare. Lymphomas are neoplastic growth of lymphocytes caused by organisms like EBV, HIV, etc. This malignancy is classified as Hodgkin’s lymphoma and non-Hodgkin’s lymphoma. Oral lymphomas account for a small percentage of head and neck malignancies, and intraoral lymphoma is rare and mostly seen in Waldeyer's ring of immunocompromised patients.
Case presentation: A 67-year-old female was referred with a palatal wound that developed within two months. In medical history, she had a peptic ulcer since last year, and intestine lymphoma was diagnosed 4 months later. After that, her gastrointestinal lymphoma was treated with surgery and chemotherapy for 6 sessions. The oral examination revealed an endophytic ulcer with a granular surface in the left posterior part of the hard and soft palate and maxillary alveolar ridge. The lesion was under biopsy with clinical differential diagnosis of squamous cell carcinoma or metastatic lymphoma or deep fungal infection. Microscopic examination with hematoxylin and eosin (H&E) staining revealed malignant mononucleated lymphocytes and hyperchromatic, polymorphic, dysplastic cells. Also, acinic cells and muscular cells were destructed. Moreover, immunohistochemistry (IHC) analysis was positive for CD3, showing the presence of T lymphocytes. Therefore, diagnosis of metastasis of intestinal T-cell lymphoma to oral cavity was established. Because the patient had a history of intestinal lymphoma, she was referred to the oncologist for treatment. In further examinations, lung and liver metastasis were detected and the patient died on the second session of chemotherapy.
Conclusion: Malignant metastases to the oral cavity can occur in various forms, including swelling and ulcer, periodontal lesion and tooth luxation. Since, metastatic lesions in the oral cavity, could imitate the feature of inflammatory lesions, a thorough examination and taking history can be helpful in the early diagnosis and appropriate treatment planning to increase patients’ survival.
 

Background: Systemic lupus erythematosus is a systemic autoimmune disease that affects almost all organs of the body, and viral infections are involved in its development and progression. The present study aimed to evaluate the serological status of some viral infections in patients with systemic lupus erythematosus and a healthy population.
Methods: This descriptive study conducted from May 2017 to April 2018 at Shiraz HIV/AIDS Research Center, Shiraz University of Medical Sciences, Shiraz, Iran on 70 patients with systemic lupus erythematosus and 70 healthy individuals who had no autoimmune diseases and were matched with the patient group for age and sex. All patients had active records and were routinely visited in rheumatology clinic of Hafez hospital, affiliated with Shiraz University of Medical Sciences. The evidence of active disease was assessed by the physicians of this practice according to the American College of Rheumatology criteria. Peripheral blood samples were collected in tubes containing EDTA and centrifuged at 3000 rpm for 5 min. The plasma of study participants was evaluated for HBsAg, HCVAb, HIVAb, EBV-VCA-IgG, and CMV-IgG using a commercially available ELISA kit.

Conclusion: Considering the higher frequency of EBV-VCA-IgG and the higher titer of antibodies against CMV and EBV in patient groups compared to healthy individuals group, it seems that periodical assessment of viral load in patients with systemic lupus erythematosus will be beneficial to prescribe medication by physicians if it is needed.

Background: Posturography is a method in which the postural stability of adults is evaluated by measuring the center of pressure sway. This study aims to evaluate the reproducibility of measuring the center of pressure oscillation in standing position with internal perturbation in healthy young women with and without hyperkyphosis.
Methods: Ten women with dorsal hyperkyphosis with the mean age of 23.5±2.65 years and 10 healthy women with the mean age of 21.9±1.3 years (October 2018 to February 2019) were recruited for the study. Subjects were asked to perform rapid bilateral arm elevation while standing on a force plate. Standard deviation of the amplitude and The standard deviation of the velocity of the center of pressure sway in anterior-posterior, Medio-lateral directions and the area of sway were used for statistical analysis. Measurements were carried out by one examiner with a 1-day interval in The Biomechanics laboratory of The School of Rehabilitation Sciences, Shahid Beheshti University of Medical Sciences. The relative reproducibility of the measurements was calculated by Intra-class Correlation Coefficient (ICC), standard error of measurement (SEM) and minimal detectable changes (MDC).

Background: Long-term and intensive physical exercise can change the function of different cells in the immune system in athletes, predisposing them to viral infections such as coronavirus disease (COVID-19). The purpose of this brief report was to provide protocols related to the immune system in athletes to prevent infectious diseases.

Background: Medical malpractice is a serious problem in the health care system. This study aimed to review the medical negligence in Iran.
Methods: Based on the PRISMA checklist, a search for scientific records was done separately by two researchers. All the articles that had selection criteria were evaluated in terms of methodological quality. Medical malpractice was assessed in four main divisions including negligence, Lack of skill, Carelessness and non-compliance with government regulations). The bias test was performed using the Egger’s test. Revman software was used to analyze the data.
Results: In the present study, 25 studies that examined the country's medical malpractice from April 1994 to March 2018 were included in the meta-analysis. Negligence has been implicated in 1,105 cases of the 2,068 claims. Lack of skill in 255 out of 2068 cases, 432 cases of carelessness and 244 cases of non-compliance with government regulations Were recorded the results of the meta-analysis showed that OR negligence was 0.76 (CI 95%: 0.66-0.87), lack of skill was 0.61 (CI 95%: 0.49-0.76), carelessness was 0.62 (CI 95%: 0.50-0.76) and non-compliance with government regulations was 0.66 (95% CI: 0.60-0.73). In the review of the confirmed negligence ratio of the registered complaint files, only 19 studies mentioned this ratio. The results of the meta-analysis of these 19 studies showed that the OR ratio of the confirmed negligence of complaints was 0.6 (95% CI: 0.41-0.86). From all claims, General surgeons had OR of confirmed medical malpractices, equal to 0.47 (CI 95%: 0.37-0.60), gynecologists with OR equal to 0.49 (CI 95%: 0.36-0.66), general practitioners with OR equal to 0.43 (CI 95%: 0.30-0.63) and orthopedic specialists with an OR of 0.44 (CI 95%: 0.32-0.61).

Background: Hospital accreditation is a systematic external evaluation of a hospital's structures, processes, and outcomes by an independent professional accreditation body using published optimum, evidence‐based, and achievable standards. Accreditation is a strategy for ensuring the quality, safety, and productivity of hospital services. Implementing accreditation standards imposes a high cost on hospitals. Therefore, this cost should be offset by increased hospital efficiency. Hence, this study aimed to examine the relationship between the Iranian public hospitals’ efficiency and their accreditation status.
Methods: This descriptive and cross-sectional study was conducted in May 2019. The efficiency of general hospitals in Iran was assessed using the Pabon Lasso chart and three performance indicators of bed occupancy rate, average patient length of stay and hospital bed turnover. Then, the relationship between the efficiency of hospitals and their accreditation grade was examined. Descriptive statistics and ANOVA tests were used for data analysis using SPSS software.

Background: At present, in nuclear medicine to calculate the cumulative activity of various organs, different techniques are being used to correct the background radiations in the conjugate view method. Each of these techniques considers the effect and weight of background radiations to a different extent. These background radiations can cause errors in cumulative activity calculations. The purpose of this study was to evaluate and compare different techniques of correcting background radiations to each other in calculating kidney cumulative activity during the nuclear scan of the bladder in children.
Methods: This study was Cross-sectional and performed for patients who were referred to Isfahan Shahid Chamran Hospital between December 2019 and June 2020. In this study using Foley, 1 mCi of TC-DTPA radio-pharmaceutical that was diluted with normal saline was injected into the patient's bladder, then images recorded by gamma cameras were extracted at 2, 5, 10, and 20 minutes, Finally with ROI drawing around kidney with having vesicoureteral reflux, Cumulative renal activity was calculated with four correcting background radiations techniques such as without correction of background radiation, conventional method, Buijs method, and Kojima method Eventually, the data was Eventually, the data was compared to each other to determine how much weight each of these techniques consider for background radiations.

Background: Urinary tract infection is one of the most common infectious diseases in children, the most severe form of which is acute pyelonephritis. Vitamin D plays a very important role in regulating the immune system, this study was conducted to compare vitamin D levels in children with urinary tract infections and healthy children in Kerman, Iran in 2020.
Methods: This cross-sectional study was performed on 63 children with pyelonephritis hospitalized in Afzalipour Hospital and 68 healthy children who were referred to Samen Al-Hojaj Clinic in Kerman, Iran from January 2020 to January 2021. Inclusion criteria for patients include the following: a) the presence of clinical signs and symptoms of infection such as fever b) pyuria, neurogenic bladder, urinary stones, chronic renal failure and previous diagnosis of urinary reflux. The case group was evaluated by taking a complete history, completing a questionnaire and clinical examination, and laboratory tests. The two groups were compared in terms of variables of sex, age and vitamin D levels.

Conclusion: Inadequate vitamin D levels are associated with the prevalence of urinary tract infections, and vitamin D supplementation can be a low-risk option for preventing urinary tract infections.

Background: Surgical margin determination in malignant lesions is essential and has a direct impact on the choice of postoperative treatments and patient follow-up. Therefore, the processes affecting this variable are worth exploring. This study aimed to evaluate the difference in surgical margin values in excisional skin samples during surgery and after formalin fixation.
Methods: A cross-sectional study was performed on forty randomly selected patients with benign and malignant skin lesions who were referred to the plastic surgery ward of Ghaem Hospital in Mashhad from November 2018 to January 2019. Malignant and benign skin lesions were excised with a healthy margin, then the specimens were sent to the pathologist in a formalin-containing container. The amount of tissue shrinkage and the factors affecting them were compared.