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

Rethinking mental health policy-making in Iran: a letter to the editor
Ahmad Ali Noorbala, Ghasem Rajabi Vasokolaei , Hojjat Rahmani ,
Volume 79, Issue 11 (February 2022)
Abstract

Secondary cancers during the radiotherapy of prostate cancer: a review article
Seyed Hamid Zoljalali Moghaddam, Reza Laripour, Ebrahim Hazrati, Hamed Bagheri, Nazila Eyvazzadeh, Hamid Reza Baghani, Emad Parvaneh Aval ,
Volume 79, Issue 12 (March 2022)
Abstract
Prostate cancer is the most common and second leading cause of death among men in the world. Nowadays, radiotherapy has been known as one of the most affecting methods for prostate cancer treatment. Nevertheless, radiotherapy is accompanied by the concern of developing secondary cancers by the scattered radiation to the neighbor  organs at risk. Several studies have shown that secondary cancers after the radiotherapy of prostate cancer treatment, occur in tissues such as the bladder and rectum which have been exposed to direct or indirect radiations. Therefore, this review study aimed to evaluate the influencing factors for developing secondary cancers after the radiotherapy of prostate cancer. To access the previously validated published studies, Persian and English keywords such as prostate cancer, secondary cancers, radiotherapy and organs at risk have been searched in ISID, Google Scholar, Science Direct, PubMed, and World Health Organization, between 1997 and 2021. Totally 246 pieces of literature have been selected which finally, by ignoring the similar and overlapping studies, only 40 studies were reviewed. In the present study, the most affecting factors for developing secondary malignancies including the anatomical status changes, dose variations, smoking and the impact of the various treatment techniques, have been studied. The results of the reviewed studies showed a reduction of secondary cancer risks with performing the modern modalities such as proton therapy to treat prostate cancer. Moreover, organ movements and anatomical status changes which vary from one patient to others, have been reported to make a significant difference in the relative risk of secondary cancers. It has been shown that smoking may increase the risk of secondary cancers after the radiotherapy of prostate cancer, so radiotherapy and smoking may cause genetic mutations. Despite the advantages of radiotherapy for prostate cancer treatment, developing secondary cancers after the radiotherapy should not be ignored. Assessments of the affecting factors for secondary cancers after the radiotherapy of prostate cancer require social and comprehensive studies which can result in an accurate modality with fewer side effects.

A systematic review on risk factors and protective factors related to Parkinson's disease
Negar Heidari , Paria Heidari, Nader Salari, Hakimeh Akbari, Masoud Mohammadi,
Volume 79, Issue 12 (March 2022)
Abstract
                                                                        
 
 
 
 
 
 
 
Background: Parkinson's disease is one of the chronic neurological diseases. It is the second most common neurodegenerative disease after Alzheimer's, affecting 7.5 million people worldwide and its rate is expected to increase by 20% by 2020. three symptoms of tremor, muscle stiffness and movement disorders are among the main diagnostic symptoms of the disease. The prevalence of Parkinson's worldwide varies between 18 and 418 cases per 100,000 people per year. It is generally estimated that the prevalence of this disease in the general population is 0.3%. A systematic review study was performed to determine the factors associated with Parkinson's disease.
Methods: This study was a systematic review that was conducted by searching national and international databases until February 2020. Initially, all articles which had mentioned Parkinson-related factors were collected and accepted by researchers based on studies. Entry and exit criteria were met. Exclusion criteria included irrelevant items, duplication of studies, unclear procedure, and lack of access to the full text of the study. To reduce bias, articles were evaluated independently by two researchers, and the quality of articles was assessed using the STROBE checklist. All final articles submitted to the systematic review process were prepared by a template checklist. Checklists included article title, first author’s name, year of publication, place of study, risk factors, protective factors, and ineffective factors or the ones which their effects have not yet been determined, and the average age.
Results: In these studies, the following risk factors were reported: family history, agricultural occupation, literacy, stress, well water consumption, aging, environmental factors, genetic factors, pesticide exposure, and alcohol abuse. On the other hand, factors such as smoking and oilseeds, high levels of B-complex vitamins, female estrogen hormones, and selenium have been reported to protect against Parkinson's disease.
Conclusion: Considering the results of the present study and although there is no definitive treatment for this disease, protective factors and risk factors should be seriously considered by health policymakers for preventive measures.
 

Ranking the factors affecting the care and provision of health services to patients in medical centers using the VIKOR dempster-shafer method: a brief report
Mahsa Salehinejad Gilchalan , Mehdi Sadeghzadeh,
Volume 79, Issue 12 (March 2022)
Abstract
Background: Determining the rank of important parameters in ranking health care and providing health services to patients in medical centers.
Methods: The research method is descriptive-analytical and applied in terms of classification. The data is from the database of the Faculty of Health and Medicine of the University of Tehran, which was collected as an archive from April 1998 to May 1999. The statistical population were all experts, specialists and experts of the Faculty of Health 29 of whom completed the questionnaire. The weight of the criteria was evaluated using the AHP method and in the next stage, the medical centers were ranked using the DS-VIKOR method. The analysis method in this study consists of the following steps steps:
• Implementing a simple VIKOR method.
• Implementing the Dempster-Shafer and Vicker method.
• Implementing the AHP method
• Implementation of the Topsis method.
• Comparing the proposed methods to review and compare which ones work best.
Results: The weight of medical centers was assessed by AHP method and then the combined centers were ranked by Dempster-Shafer and VIKOR combined methods  using the information of four medical centers, the DS-Vikor approach was implemented. The purpose of six criteria and three experts was used for evaluation. The results show that the effectiveness of care and treatment process is more important from the experts' point of view. Dempester-Schaefer and Vicor The medical centers in question are ranked. For validation, at the end, the medical centers were ranked by TOPSIS method.
The integrated system includes various subsystems giving caring and providing health services to patients in medical centers that can be built and configured and are ranked.
The model can investigate the effectiveness of giving caring and providing health services to patients in medical centers.
Conclusion: By combining the two methods of Dempster-Shafer and Vicker, the confidence in the whole uncertainty is improved and the results are more reliable. This approach can help reduce the uncertainty caused by people's cognition to increase the level of decision-making, allowing us to overcome the problem of choosing the right level of uncertainty and to deal with uncertainty in a practical and justified way.

Evaluation of relationship between the level of inflammatory cytokines Interleukin-10 and tumor necrosis factor-alpha with virologic response to treatment in patients with HIV
Saedeh Ebrahimi, Saeed Kalantari , Soheil Rahmani Fard , Mitra Kohandel, Zahra Amiri, Yousef Alimohamadi , Sara Minaeian,
Volume 80, Issue 2 (May 2022)
Abstract
Background: Despite the considerable advances in acquired immunodeficiency syndrome (AIDS) treatment and management, finding the cure for this disease has been hindered by emerging challenges such as virus resistance and treatment failures. The purpose of this study is to compare the cytokine profiles of patients with successful treatment and patients with unsuccessful treatment to gain a better understanding of treatment failure mechanisms.
Methods: Sixty-nine human immunodeficiency virus (HIV) positive patients who were referred to the west health center of Tehran between September 2018 and March 2021 were included in this study. Blood CD4+ cell count and viral load was measured using the flow cytometry and quantitative real-time polymerase chain reaction (RT-qPCR) methods respectively. Based on the viral load test results patients were divided into successful treatment (viral load<200 copies/ml, n=36) and unsuccessful treatment (viral load>200 copies/ml, n=33) groups. Subsequently, tumor necrosis factor-α (TNF-α) and interleukin-10 (IL-10) serum levels were measured using the enzyme-linked immunosorbent assay (ELISA) method.
Results:  Analysis of data revealed that there was no difference in demographic data, medical history and clinical laboratory test results between the study groups. Elisa test results showed that serum TNF-α levels were significantly higher in the unsuccessful treatment group compared to the successful treatment group (10.43±10.17 vs 5.37±5.25, P=0.01) but no differences were observed in IL-10 levels between the study groups. Furthermore, age and sex-adjusted linear regression models showed that non-nucleoside reverse-transcriptase inhibitors (NNRTI)-based treatment regimen is positively associated with serum IL-10 levels in patients with unsuccessful treatment (B coefficient 10.88 (95% CI: 1.32-20.45), P=0.03). Moreover, based on the results of the linear regression models, no relationship between HIV viral load and serum IL-10 and TNF-α level was observed.
Conclusion: Results of this study showcased the importance of TNF-α in disease progression and treatment failure. Further future studies regarding this relationship can provide vital information in AIDS treatment research.

Aggressive angiomyxoma of the vulva: a case report
Malihe Hasanzadeh, Marjaneh Farazestanian, Afrooz Azad, Parnian Malakuti, Maryam Esmaeilpour,
Volume 80, Issue 4 (July 2022)
Abstract
Background: Aggressive angiomyxoma is a rare mesenchymal tumor with extensive local invasion. It often presents with a lump in the perineal area and pelvic. Since it often does not involve adjacent organs such as the urethra and anus, does not cause obstructive symptoms. Its incidence is 6 times higher in women than men. This tumor grows slowly and has a slight tendency to metastasize. However, the rate of local recurrence is high. MRI is the most widely used diagnostic method. Ultrasound and CT scan are also used for diagnosis. Due to the rarity of this tumor, it is difficult to diagnose before surgery and pathology assessment. Due to the penetrating nature of the tumor and the lack of a clear capsule, incomplete surgical resection is common. Local recurrence is common even after complete mass resection. Therefore, patients need a long follow-up. The main treatment is surgery but non-surgical interventions such as hormonal therapy, radiotherapy, arterial embolization, etc. have been associated with variable success rates.
Case Presentation: A 54-year-old female patient presented with a vulvar mass in February 2021. The patient mentioned that the mass had existed for ten years and had increased in size in the last two years. After discussion on the tumor board, she underwent surgery. The pathology of the mass was reported to be aggressive angiomyxoma. The patient was treated with a GNRH agonist after surgery. The patient is currently under follow-up and has not had a recurrence so far (March 2020).
Conclusion: Aggressive angiomyxoma is a rare mesenchymal tumor. It has extensive local invasion and a high recurrence rate, but distant metastasis is rare. Estrogen receptors or Progesterone receptors are commonly positive in aggressive angiomyxoma. The best treatment for aggressive angiomyxoma remains unknown. Extensive local resection of the tumor has been reported as an important therapeutic measure. In cases of mass recurrence, reoperation and hormone therapy have been effective. It is important for gynecologists to consider this tumor as a differential diagnosis when dealing with vulvar masses.

Costs of services covered by the global payment system in Tehran University of Medical Sciences
Jalal Saeedpour , Mehdi Rezaei , Shamsi Ekhteyar, Sara Akhavan Rezayat , Soheila Damiri , Faezeh Fartaj, Maryam Radin Manesh ,
Volume 80, Issue 4 (July 2022)
Abstract
Background: In Iran, a combination of three methods of budget payment, fee for service and case-based payment (known as the global payment system) is used to reimburse the cost of hospital services. The aim of this study was to investigate the costs of 90 services of the Global Hospital Reimbursement System at Tehran University of Medical Sciences.
Methods: This descriptive cross-sectional applied study was performed from March  2017 to March 2019 in the hospitals of Tehran University of Medical Sciences. The billing and record data of all patients whose services were reimbursed on a global payment system basis were extracted from hospital information systems. Data were analyzed using descriptive statistics (frequency mean. std deviation, maximum & minimum) in SPSS 21 and Excel 2016.
Results: During two years in TUMS, the costs of services provided to 143,866 patients have been reimbursed based on the global payment system., which had a cost of 2300 billion rials. 80% of the total services and costs were related to 10 services. 78.46% of the cases were related to two specialized groups of ophthalmology and obstetrics and gynecology. 83.17% of the total costs of services reimbursed globally at the TUMS were related to these two specialized groups. The average cost per service was about 16 million Rials, but varied greatly for different services, ranging from about 1.8 million Rials to 67 million Rials. On average, for a global service, the share of each of the cost subgroups of diagnostic services, hoteling and nursing services, medicine and consumables, operating room and surgery, physician's visit and consultation, respectively 3.1%, 11.6%, 21.4%, 49.9% and 13.9%.
Conclusion: Managers need to focus on high-frequency and high-cost services to reduce the cost and financial losses for services that are under the global payment system. Depending on the specific cost pattern of each service, the strategies adopted to control the costs of that service should also be different.

Assessment of TUMS affiliated hospitals’ preparedness for dealing with Covid_19
Ebrahim Jaafaripooyan, Haniye Sadat Sajadi , Maryam Tajvar, Elham Ehsani Chimeh , Iman Falah, Farhad Habibi,
Volume 80, Issue 6 (September 2022)
Abstract
Background: The prevalence of emerging and re-emerging diseases has made the need for basic preparations for all health care organizations more crucial. Strengthening preparedness and formulating crisis strategies will have a great impact on reducing casualties. Given the importance of preparing hospitals to deal with such an outbreak and reduce the resulting mortality, the present study was conducted to assess their readiness against Covid-19.
Methods: The present study is a quantitative and descriptive cross-sectional research conducted from October to March 2019. Data collection used the standard checklists prepared by the European Center for the Prevention and Control of Coronavirus and the Centers for Disease Control and Prevention, consisting of eight domains and 21 components. The minimum score that each hospital could get in this checklist was 143 and the maximum was 429. The sampling method in the present study was a census, and nine reference hospitals for Corona were included in the study. All hospitals’ directors, managers, quality officers and crisis secretaries and others related to hospital readiness during Covid-19 were recruited by the census.
Results: On average, the hospitals scored 391 out of 429, indicating a fairly "high readiness" in dealing with Covid-19. The highest score obtained by the hospitals was 425 and the lowest score was 349. In terms of preparation areas, the hospitals’ readiness was higher than 80% in all areas. The highest readiness of hospitals was in the fifth  domain, i.e. Hand hygiene, personal protective equipment and hospital waste management. The 7th domain namely, patient placement and relocation, and patient visitor access was of the lowest preparation.
Conclusion: The hospitals were of fairly appropriate readiness to deal with Covid-19. This level of preparedness, despite being desirable, might not reflect the real capacity of hospitals to deal with this disease. Regular evaluation of the Covid referral hospitals could help make these hospitals more prepared. Also, the experiences of hospitals that were more prepared should be used to improve the condition of other hospitals.

Assessment of mitochondrial DNA copy number in peripheral blood leukocyte of opiate abusers and healthy individuals
Kouros Divsalar, Sara Hesami, Majid Mahmoodi, Navidreza Giahi, Fatemeh Divsalar , Mohammad Pour-Ranjbar , Amin Honarmand,
Volume 80, Issue 7 (October 2022)
Abstract
Background: Based on the studies, variation in the mitochondrial DNA (mtDNA) copy number in peripheral blood leukocytes is associated with increased susceptibility to diseases including cancer. Opiate abusers are at high risk for diseases. In this study, we measured the mtDNA copy number in peripheral blood leukocytes in a group of opiate abusers compared with those in healthy individuals.
Methods: In a case/control study, three groups were selected consisting of 32 opium abusers, 24 heroin addicts and 25 healthy individuals. The amount of 5 ml of whole blood was collected from each individual who participated in the study and stored at -20 centigrade. The sample collection was performed from November 2018 to February 2020. Case groups were recruited from the Methadone maintenance therapy center. Contro group had no history of drug use and cigarette smoking. DNA was extracted from the whole blood samples using the salting out method. The DNA from a mitochondrial gene, dehydrogenase subunit1 (-ND1 gene) and a nuclear gene, human globulin (HGB gene), were quantified by a real-time PCR-based method to measure the relative mtDNA copy number of each group number.
Results: There was no significant difference in demographic characterization between the three study groups, opium abusers, heroin addicts and healthy individuals. We found that opium users had a higher mean of mtDNA copy number than those in the healthy control group (P=0.11). Heroin addicts had also higher mean of mtDNA copy number than those in healthy group (P=0.21). The mean mtDNA copy number in opium abusers was higher than that in heroin addicts (P=0.22), although the difference was not statistically significant.
Conclusion: The results of this study indicated that mtDNA copy number increased in a group of opiate abusers. Considering that alteration of mtDNA copy number is associated with increased susceptibility to several diseases including cancer, further research on mtDNA copy number with a high number of volunteers of opiate addicts may clear the effect of opiate abuse on the human genome.

Skin metastases in breast cancer: a review article
Behnaz Varaminian, Marzieh Ghalamkari , Tayeb Ramim, Masoumeh Roohaninasab ,
Volume 80, Issue 8 (November 2022)
Abstract
Skin metastases from breast cancer usually occur in more advanced stages of the disease, but can sometimes be the first clinical manifestation of breast cancer or the first evidence of a previous tumor recurrence. These demonstrations significantly reduce survival. Skin metastases from breast cancer have different manifestations. The most common manifestations are nodules. These nodules are soft, round or oval, mobile, firm, and elastic in texture and can be single or multiple, often flesh-colored, but can also be brown, bluish black, and pink to reddish brown. In the absence of a previous history of cancer, it can be difficult to diagnose the early location of metastatic cancers. However, metastases usually show histopathological similarities to the primary tumor. Soft tissue breast metastases usually have a better prognosis than breast or bone cancer metastases. Also, skin metastases from breast cancer do not necessarily have a poor prognosis as skin metastases from other malignancies. The relative risk of death from skin metastases to other malignancies is more than four times higher than skin metastases from breast cancer. Differential diagnosis includes cutaneous lymphoma, intracranial leukocyte infiltration, and cutaneous metastasis. Metastatic skin lesions are often mistaken for benign lesions. Recognizing them quickly is important to prevent long-term anti-inflammatory treatment that delays proper diagnosis. Therefore, to rule out metastasis, abnormal or nodular lesions should be considered for biopsy in patients with a history of systemic malignancy or suspected malignancy. Cutaneous metastases are usually a sign of widespread disease and may not be treatable in most cases. Treatment options include systemic and/or topical treatments. Extensive skin metastases require systemic treatment. For thicker skin metastases, radiation therapy, surgical or electrochemical resection is indicated as monotherapy or in combination. Oxygen in combination with topical 5% methotrexate (OFAMTX, 5% methotrexate in a carrier solution) is a recently described method that facilitates drug penetration into the epidermis. In the absence of visceral or lymph node metastases, OFAMTX is useful as a local skin treatment. This treatment is an effective and tolerable method for superficial skin metastases. Using local treatment in combination with systemic agents increases the overall effectiveness of treatment on skin metastases.

Isolated Fallopian Tube Torsion with Fimbrial Cyst in a Pregnant Woman: A case Report
Naser Piri, Salahedin Delshad, Maryam Aghaee,
Volume 80, Issue 10 (January 2023)
Abstract
Background: Among diseases causing acute lower abdominal pain in women, isolated fallopian tube torsion is a rare cause that occurs mainly in women of reproductive ages and if left untreated can lead to fertility problems. Immediate diagnosis and timely surgery are urgent and necessary to preserve the fertility of females. Successful pregnancy with simultaneous involvement of isolated fallopian tube torsion is one of the rare operations in the world.
Case Presentation: The reported case is a 37-year-old pregnant woman (Gravid 2, with 33-week gestational age) with nausea, vomiting and abdominal pain in August 2020 who presented to the Maryam Hospital in Karaj in August 2020. The patient was examined in the operating room under anesthesia, and pain in the right and lower abdomen was observed. There was no anorexia, and on examination, there was severe tenderness in the right lower quadrant (RLQ) area. There was no pain in other parts of the abdomen. Ultrasonography in the patient's tenderness showed an image of a tubular and cystic structure measuring 30×10 mm. In CBC test, leukocytosis with high PMN (Polymorphonuclear), (WBC: 11700 mm3 and Neutrophil: 78%) was observed. During laparotomy, isolated torsion of the right fallopian tube observed, half of which was cyanotic. Due to the confirmation of fimbriae necrosis during surgery, preservation of uterine tube integrity, fallopian tube detorsion, excision of cyanotic fimbriae and hemorrhagic cyst of fimbriae, intra-abdominal fluid suction and fimbriae repair performed. The patient discharged in good condition after two days and gave birth to a healthy baby at 38 weeks of gestation by cesarean section.
Conclusion: Isolated fallopian tube torsion should be considered as a potential differential diagnosis in patients that have acute lower abdominal pain in women of reproductive ages and even adolescents. Early diagnosis and early surgical intervention are critical to maintaining the fallopian tube and fertility in the future. Laparoscopy is one of the main diagnostic tools for assessing, management and maintenance isolated torsion of the fallopian tube.

Evaluation of effective factors on the premature rupture of membranes in pregnant women referred to Afzalipour Hospital, Kerman
, Fatemeh Kalantarimoghaddam, Fatemeh Karami Robati ,
Volume 80, Issue 10 (January 2023)
Abstract
Background: Preterm premature rupture of membranes (PPROM) is one of the factors that can increase maternal and neonatal mortality, which is affected by several factors. This study aimed to investigate the factors affecting the frequency of preterm premature rupture of membranes in pregnant women.
Methods: This descriptive-analytical study was conducted in Afzalipour Hospital in Kerman from January 2018 to January 2019. All pregnant women with PPROM and normal pregnant women referred to this Hospital were included in the study through convenient sampling. The data collection tool was a checklist containing patients' demographic information (age, education, occupation, gestational age, number of pregnancies, urinary tract infection (confirmed by the attending physician), history of premature rupture of the water sac, vaginal bleeding (bleeding in any period of pregnancy as the person had visited the doctor), history of premature birth, pregnancy care and trauma (any trauma)). To analyze the data, descriptive statistics (frequency, percentage, mean, and standard deviation), analytical (Chi-square test) and SPSS software version 22 were used.
Results: In this descriptive-analytical study, 400 pregnant women were studied. Two hundred of pregnant women had preterm premature rupture of membranes and 200 of pregnant women did not have such condistion and were normal. The mean age of pregnant women was 27.4±5.4 years old and the mean gestational age of pregnant women was 34.1±2.1 weeks. The mean parity of pregnant women was 2.3±1.4. Risk factors such as maternal age (P=0.011), number of pregnancies (P=0.035), maternal education (P=0.018), history of preterm premature rupture of membranes (P=0.046), history of preterm delivery (P=0.019), trauma (P=0.037) and pregnancy care (P=0.037) affected preterm premature rupture of membranes.
Conclusion: The results of this study showed that maternal age, number of pregnancies, maternal education, and history of preterm premature rupture of membranes, history of preterm delivery, trauma, and prenatal care are risk factors for PROM. Therefore, by educating pregnant mothers about these risk factors, the incidence and complications of preterm premature rupture of membranes can be reduced.

Is opium addiction a risk factor for benign prostatic hyperplasia?
Amin Abolhasani Foroughi , Jalaleddin Badragheh , Banafsheh Zeinali-Rafsanjani ,
Volume 80, Issue 12 (March 2023)
Abstract
Background: Prostate enlargement is a common issue amongst men, which causes significant side effects for aging men. Regarding the high prevalence of prostate enlargement and opium addiction and its derivatives, assessing the relationship between opium use with prostate enlargement may be an exciting issue.
Methods: This was a cross-sectional study. There were two groups; the case group contained men with a history of at least one year of opium abuse. The control group was men in the same age range referred to university-affiliated hospitals for ultrasonography for other reasons except for prostate problems. The prostate size and demographic information of patients were recorded. The prostate volume of more than 20 ml was considered as an enlarged prostate.
Results: 212 males participated in the study from December 2018 to March 2019 at Namazi Hospital of Shiraz University of Medical Sciences, including 78 drug abuse patients (mean age=39.08±6.52 years old) in the case group and 134 (mean age=40.69±6.28 years old) in the control group. The mean prostate size in the addict group was significantly higher than in the healthy group (P=0.005). There was a significant correlation between the size of the prostate and the age in both groups. However, there was no correlation between prostate size and body mass index.
Conclusion: Due to a decrease in the sexual desire of addicted people, we first expected to face smaller prostates in addicted men; however, the study results proved the opposite. One explanation can be that the decreased libido increases the likelihood  of fluid accumulation in the prostate, this might lead to chronic inflammatory reactions, hypertrophy, and prostate hyperplasia. Therefore, a more comprehensive study is needed to investigate the interaction between the drug and prostate tissue.  Finally, it can be concluded that addiction to opium and its derivatives can increase the chance of prostate enlargement. Due to the lack of previous studies in this field, it seems necessary to conduct additional studies with larger sample sizes and control confounding factors.

 

A survey of awareness, knowledge and attitudes regarding stem cell donation among different people in the community: a systematic review study
Behjat Kalantari Khandani , Fatemeh Irannejad Parizi , Sedigheh Sadat Mousavi, Pouria Salajegheh,
Volume 81, Issue 1 (April 2023)
Abstract
Background: Stem cells play an important role in tissue regeneration and treatment of diseases. This study aimed to investigate the awareness, knowledge and attitudes regarding stem cell donation among different people in the community.
Methods: In this systematic review study, Persian keywords and English keywords such as awareness, knowledge, stem cells, embryonic stem cells, adult stem cells, cord blood stem cells and donation were selected according to MeSH database and then these selected keywords have been searched in the academic databases such as PubMed, Scopus, OVID, Science Direct, Iran Medex and SID. In addition, these selected keywords have been searched in the search engines such as Google Scholar, between January 2010 to December 2021.
Results: The results of this study found a total of twenty-five articles related to the awareness, knowledge and attitudes regarding stem cell donation among different people in the community. They were selected. In this study there were 10 cross-sectional studies, 2 descriptive-cross-sectional studies, 5 descriptive studies, 1 mixed method study, 1 semi-experimental study, 1 intervention study, 1 survey study, 1 review study, and the study type was not mentioned in three studies. Most of the studies were conducted in countries such as India, Saudi Arabia, and then United States (USA) and Turkey. Only one article was found in Iran. The results of studies have shown that the level of awareness and attitude of the majority of different people in the community towards the donation and use of stem cells is medium and low. However, most people have a good and positive attitude towards the donation and use of stem cells and mention the use of stem cells as an effective way to treat diseases.
Conclusion: Considering the importance and application of stem cells, it is suggested that managers and planners provide the necessary conditions to implement educational programs to raise the level of awareness and attitude of different people in the community towards stem cell donation.

Investigating the type and frequency of errors in the medical diagnostic laboratory in a medical center in Tehran, Iran: a medical-laboratory experience
Mohammad Hossein Kalami , Zeinab Borjian Boroujeni , Peghah Ardi, Ahmad Abolfathi, Mohsen Babaei, Ali Asadi, Mahdi Zareei,
Volume 81, Issue 1 (April 2023)
Abstract
Background: Medical Laboratories have a great impact on patient safety and 80-90% of medical diagnoses are based on the results of laboratory tests. Medical procedures from the initial diagnostic steps such as a test or a simple injection to specialized treatment steps may be erroneous. The aim of this study was to determine the type and rate of human error, equipment, materials and procedures in all stages including before analysis, during analysis and after analysis to analyze the causes and find logical solutions to reduce of them.
Methods: This cross-sectional descriptive study was performed in a medical center in Tehran, Iran during the years 1400-1401. Data collection was considered in accordance with the instructions of the Laboratory Affairs Department of the Ministry of Health and Medical Education regarding the type of errors in the field of job description in each of the technical and non-technical sections. Data was analyzed by IBM SPSS software, version 22 (SPSS Inc., Chicago, IL, USA) software.
Results: During the period of study, the number of  referred patients was about 45,000 and the number of tests 594,000. The total number of errors was 837. The ratio of errors to the patients was 1.9% and to the tests 0.15%. The 37 types of errors were identified and reported in this study. Of these, 11 types of errors were in the pre-analysis, 14 types during the analysis and 12 types of errors in the post-analysis stage. The frequency of errors in the three stages was 180(21.5%), 312(37.3%) and 345(41.2%), respectively that the errors rate did not have a normal distribution and a significant difference was observed (P<0.05, df=2).
Conclusion: Due to the variety of reported errors and the importance of their role in other stages of diagnosis and treatment, it is necessary that all human, equipment and process errors in all stages of laboratory analysis be carefully recorded and corrective and preventive measures be taken to minimize them.

Numbness in the jaw, the first symptom of multiple myeloma: a case report
Samaneh Salari, Atessa Pakfetrat, Nooshin Mohtasham, Farzaneh Khosravi, Mahdi Saeedi ,
Volume 81, Issue 2 (May 2023)
Abstract
Background: Jawbone involvement and destructive bone lesions in the mandible and maxilla are reported in 30% of patients with multiple myeloma. In general, plasma cell neoplasia rarely occurs in the maxillofacial area, and an incidence of 2.6-3.3 per 100,000 people is reported for solitary plasmacytoma in jawbones. This study aims to present and evaluate a patient with multiple myeloma and the first symptoms in the maxillofacial area.
Case Presentation: The patient was a 52 years old woman complaining of painful swelling in the left area of the face that had enlarged during the last month. She was referred to the maxillofacial disease department of the Dental School of Mashhad, Iran in Feb 2022. The patient has had paresthesia in the left area of the face since 6 months ago. In the extra-oral examination, a 4×10 cm mass was observed in the left mandibular angle extending anteriorly toward the sublingual area. The oral mucosa was normal. According to the clinical profile, malignancy was considered a differential diagnosis. Incisional biopsy of the lesion revealed the proliferation of neoplastic plasma cells. The positive result of immunohistochemistry (IHC) staining for CD138, performed on the specimen to confirm plasmacytoma and detection of small primary lytic lesions in the skull and spine confirmed multiple myeloma. The usual symptoms of multiple myeloma, including low back pain, were not observed. The patient underwent chemotherapy under the supervision of a hematologist.
Conclusion: Jawbone involvement is often less mentioned as the first symptom of multiple myeloma; however, compared to the vertebral column or skull lesions, these areas are easily biopsied, providing the possibility of early detection and treatment of multiple myeloma, hence a promising disease prognosis. The concurrence of destructive bone lesions and sensory changes in the maxillofacial area is a red flag. Precise radiographic evaluation and blood tests can help early detect multiple myeloma. Awareness of general dentists about the possibility of blood dyscrasia such as multiple myeloma with such early symptoms in patients can lead to early diagnosis of patients. This report reminds inexperienced clinicians of the special importance of sensory changes in the head and neck.

Evaluation of lung transplant patients in Imam Khomeini hospital, Tehran university of medical sciences
Tayebeh Lakzaei, Niloofar Khoshnam-Rad , Maryam Edalatifard , Hamidreza Abtahi,
Volume 81, Issue 3 (June 2023)
Abstract
Background: Despite the progress of medical science and organ transplantation, lung transplantation is associated with significant complications and mortality. In Iran, the first lung transplant was performed in 2000 at Imam Khomeini Hospital in Tehran. So far, there has been no assessment of the patients. The main purpose of this study is to investigate the status of lung transplantation status at this center.
Methods: In this retrospective longitudinal study, all lung transplant patients referred to the Lung Transplantation Center of Imam Khomeini Hospital in Tehran from April 2000 to March 2022 were examined. Demographic and clinical data, and information related to their current status, including pulmonary function tests, transplant-related complications, pharmacotherapy, and drug-related adverse events were recorded. Appropriate statistical analysis was applied.
Results: During the study, 20 lung transplants were observed, 20 percent of transplant recipients were women, and 80 percent were men. The mean age of the patients at the time of transplantation was 39.3±11.4 years. The youngest patient at the time of transplantation was 22, and the oldest was 60 years old. The most common indication for transplantation was interstitial lung disease (70%) followed by chronic obstructive respiratory disease. The average forced expiratory volume in one second (FEV1) value of the patients in the first year was about 50%, which gradually decreased to less than 20 percent in the fifth year. The average survival after transplantation was 5.75±4.6 years. The post-transplant one month, three months, one year, three years, and five years survival were 80, 75, 70, 60, and 50 percent, respectively. Chronic lung allograft dysfunction and serious infections are the most common causes of mortality.
Conclusion: The transplant center at Imam Khomeini Hospital is one of the most important lung transplant centers in Iran. The survival status and transplant outcome are comparable with those reported around the world. More attention should be paid to infection control, patient selection, and perioperative care to improve the outcomes of lung transplantation.

Secondary cancers evaluation inside organs at risk during the prostate cancer radiotherapy: a brief report
Reza Shamsabadi, Seyed Hamid Zoljalali Moghadam, Hamidreza Baghani , Seyed Ali Zoljalali Moghadam ,
Volume 81, Issue 3 (June 2023)
Abstract
Background: In prostate cancer radiotherapy, due to the proximity of the prostate to the rectum, it can be affected by high radiation doses. It has been reported that about 70% of secondary cancers after prostate cancer radiotherapy occur in the bladder and rectum, which are exposed to direct radiation. Since prostate cancer radiotherapy may be accompanied by side effects, the aim of this study is to investigate the risk of secondary cancers after the radiotherapy of prostate cancer inside the outfield organs.
Methods: The dose volume histogram data relevant to 39 patients with prostate cancer (who were treated with 3-dimensional conformal radiotherapy technique in 2022 in Tehran) were extracted, and the uniform absorbed dose inside the sensitive tissues was calculated according to the gEUD concept. Then, the risks of secondary malignancies following prostate cancer radiotherapy were calculated using the model introduced by the BEIR report. Accordingly, the lifetime attributable risk values (LAR) were estimated based on the desired organs and patient age at exposure time through the calculation of Excess relative risk (ERR) and Excess absolute risk (EAR) values.
Results: From the obtained results, the gEUD values for the rectum ranged from 51.04 Gy to 74.69 Gy and for the bladder from 27.22 Gy to 75.51 Gy. The maximum calculated risk values for the rectum and bladder were calculated to be 49.85% and 74.91%, respectively. Besides, a significant level of secondary cancer risk within the rectum and bladder was obtained for most of the studied patients. Furthermore, small values of secondary cancer risks were estimated for patients who were irradiated at older ages, and higher ones were obtained for patients who were irradiated at younger ages.
Conclusion: The results showed that there is a higher probability of developing secondary malignancies in the bladder than the rectum. The information obtained in this research can improve the performance of the treatment process, so that information about secondary cancers following radiation therapy for prostate cancer will ultimately help doctors design more effective and optimal treatment designs.

Biomarker role of CH25H and GYPE genes in osteoarthritis and rheumatoid arthritis
Akram Gholipour, Mahshid Malakootian , Maziar Oveisee,
Volume 81, Issue 4 (July 2023)
Abstract
Background: Osteoarthritis (OA) and rheumatoid arthritis (RA) are both joint diseases with many different causes. Inflammatory arthritis, also known as rheumatoid arthritis, is one of the most complex types of arthritis. Non-inflammatory arthritis, also known as osteoarthritis, is a disease caused when the cartilage between the joints begins to be damaged. Considering the different treatment approaches for OA and RA, an accurate diagnosis of the type of arthritis is very important. The present study was conducted with the aim of finding gene expression and introducing reliable molecular biomarkers for RA and OA.
Methods: The microarray dataset was obtained under the GSE27390 number. The samples included nine samples of mononuclear cells obtained from the bone marrow of RA patients, 10 samples of mononuclear cells obtained from the bone marrow of OA patients. Differential expression analysis between the OA and RA groups was performed using GEO2R, and genes with differential expression were separated by examining two factors such as logFC#1 and p.adj. Value<0.05. Signaling pathways were determined using Enrichr databases. Next, the genes with the most expression changes were introduced. This study is a bioinformatics analysis and was conducted jointly at Bam University of Medical Sciences and Rajaie Cardiovascular, Medical and Research Institute from September 2022 to March 2023.
Results: The results showed that, 5083 genes had significant expression differences. Analysis of signaling pathways showed that antigen processing and presentation,  natural killer cell-mediated cytotoxicity, the, IL-17 signaling pathway, Th17 cell differentiation and cytokine-cytokine receptor interaction, as inflammatory pathways, were important in this disease. It was also determined that CH25H (upregulated in RA samples) and GYPE (downregulated in RA samples) genes can distinguish rheumatoid arthritis from osteoarthritis.
Conclusion: Since accurate diagnosis helps with better disease treatment, it is very important to obtain new biological diagnostic markers. Overall, our data showed that genes can act as novel biomarkers with potential utility in the diagnosis of RA and OA and can be considered novel molecular biomarkers for the diagnosis of these two diseases.

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