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Investigating factors affecting the response to treatment in patients with ITP
Seyed Kamal Eshagh Hossaini , Javad Hakimelahi, Mohammad Aghaali, Zahra Mehrabi, Rasool Karimi Matlob , Saeed Karimi Matlob,
Volume 80, Issue 10 (January 2023)
Abstract
Background: Idiopathic thrombocytopenic purpura (autoimmune), the most common cause of acute onset of thrombocytopenia in children who are otherwise healthy. This study was conducted with the aim of investigating the factors affecting the response to treatment in hospitalized children.
Methods: This retrospective study was conducted by examining the files of patients hospitalized due to ITP in Hazrat Masoumeh (S) Hospital from April 2009 to March 2019. The criteria for inclusion in the study included confirming the diagnosis of ITP and the age of 1 month to 14 years, and the exclusion criteria included cases of discharge with personal consent and not completing the patient's treatment course, the presence of pancytopenia or bicytopenia, the presence of moderate or severe splenomegaly or severe in clinical examinations, BMA based on the presence of a diagnosis other than ITP, not receiving any of the ITP treatment protocols, and patients whose first visit with the diagnosis of ITP was in another center or city. The information about age, sex, clinical symptoms on arrival, initial platelets and the platelets of days 3, 5, 14 and 180 were extracted from the patients' files. The type of treatment protocol, the need to repeat the treatment, the recurrence of the disease and the major complications of the treatment were extracted from the patients' files and finally the data were analyzed with SPSS software.
Results: The response to the treatment on different days was unrelated to the age, gender, and initial platelets (except for one exception) (P>0.05). In relation to clinical symptoms, the response to treatment on days three and five was related to the clinical symptoms at the time of presentation and on days 14 and 180 it was unrelated. Response to treatment on days 3 and 5 in different treatment protocols had a significant relationship (P<0.05), but there was no significant difference on days 14 and 180.
Conclusion: The best response was in the combined treatment group with methylprednisolone and IVIg, and the lowest response to treatment was observed in those receiving methylprednisolone alone.

Prognosis of neonates in maternal diseases
Hassan Boskabadi , Nafiseh Pourbadakhshan, Maryam Zakerihamidi,
Volume 80, Issue 10 (January 2023)
Abstract
Background: Maternal diseases such as diabetes, hypertension, preeclampsia, hypothyroidism and epilepsy in pregnancy are associated with fetal and neonatal complications. The aim of this study was to compare the prognosis of neonates in maternal diseases.
Methods: This study was a cross-sectional study. The present study was performed on 600 preterm infants with mothers with diabetes, hypertension, preeclampsia, hypothyroidism and epilepsy. This study was done in Ghaem Hospital of Mashhad from March 2015 to April 2021 with available sampling. The data collection tool was a researcher-made checklist including infant (gestational age, Apgar score of the first minute, Apgar score of the fifth minute) and maternal (mode of delivery, prenatal care, premature rupture of the membranes) characteristics. Neonatal prognosis was compared at birth. All clinical and diagnostic examinations of newborns were performed by a neonatologist. Neonatal and maternal data in the group of newborns with normal mothers and newborns with maternal diseases were analyzed by Kolmogorov-Smirnov and Chi-square tests. The significance level was considered p≤0.05 in all cases.
Results: The results show that 161 newborns (28.90%) had normal mothers, 89 newborns (15.98%) had diabetic mothers, 117 newborns (21.01%) had hypertensive mothers, and 50 newborns (8.98%) had hypothyroid mothers. One hundred tweny newborns (21.72%) had mothers with preeclampsia, 19 newborns (3.41%) had mothers with epilepsy. Newborns with mothers with epilepsy had the lowest Apgar score of the first minute and the lowest gestational age and newborns with mothers with diabetes had the lowest Apgar score of the fifth minute. Mothers with hypothyroidism had the highest rate of premature rupture of the membranes and mothers with hypertension and preeclampsia had the highest incidence of cesarean section.
Conclusion: Maternal diseases including diabetes, hypertension, preeclampsia, hypothyroidism and epilepsy affect the prognosis of neonates in terms of the severity of prematurity, premature rupture of the membranes, type of delivery, Apgar scores of the first and fifth minutes. Therefore, proper control and treatment of these diseases may improve neonatal prognosis.

The effect of intravenous dexamethasone on pain, nausea and vomiting after laparoscopic ovarian surgery
Hamidreza Shetabi, Behzad Nazemroaya , Mohsen Abron ,
Volume 80, Issue 11 (February 2023)
Abstract
Background: In this study, the effect of intravenous dexamethasone on pain, nausea and vomiting after laparoscopic ovarian surgery was investigated.
Methods: This randomized clinical trial was conducted from June 2019 to March 2019 on patients undergoing laparoscopic ovarian cystectomy in Beheshti Hospital, Isfahan. In this study, 88 patients aged 18 to 45 years were included in the study. Patients were randomly divided into two groups receiving dexamethasone (D) and normal saline (S). Two minutes before induction of anesthesia, the first group received 8 mg (2 ml) of dexamethasone and the second group received normal saline (2 ml). The duration of surgery and stay in recovery, the frequency of pain and nausea and vomiting, the need for analgesic and anti-nausea drugs, and the cardiovascular response during the study were evaluated and recorded.
Results:  No significant difference was seen in terms of demographic characteristics between the two groups (P>0.05). The frequency of pain during recovery (P=0.4) was not significantly different between the two groups, but at 2 hours (P=0.005), 12 hours (P<0.001) and 24 hours after the operation (P=0.005) (P=0) was significantly lower than S group. The frequency of nausea in group D during recovery (P=0.003), 2 hours later (P<0.001), and 12 hours (P=0.002) was significantly lower than group S, but 24 hours after the surgery, there was no significant difference between the two groups (P=0.15). During recovery, there was no vomiting in both groups (P=1), the frequency of vomiting in 2 hours (P=0.003), 12 hours (P<0.002) and 24 hours after the operation (P=0.48) in group D was lower than S. At the time of the study, the dose of diclofenac and metoclopramide received in group D patients was lower than group S. There was no significant difference in cardiovascular response between the two groups during the study (P>0.05).
Conclusion: Dexamethasone with a dose of 8 mg before induction of anesthesia can be effective in reducing pain, nausea and vomiting after laparoscopic ovarian surgery and reducing the need for analgesics and anti-nausea drugs.

Sporadic pulmonary lymphangioliomyomatosis (LAM) in a 24-year-old female: a case report
Shahram Seyfi, Nazli Farnoosh, Kayvan Latifi, Parviz Amri Male , Hamed Mehdinezhad Gorji , Asadollah Shakeri, Khadijeh Ezoji ,
Volume 80, Issue 11 (February 2023)
Abstract
Background: Sporadic lymphangioleiomyomatosis (S-LAM) is a rare disease that generally affects young women and involves the abnormal proliferation of smooth muscle cells (LAM cells) in the lungs (pulmonary LAM). There are two types of LAM, sporadic and LAM with tuberous sclerosis, which is an autosomal dominant genetic disease caused by mutations in the Tsc1 and Tsc2 genes. The most common manifestation of this disease is pneumothorax due to cyst rupture. Median transplant-free survival for pulmonary LAM is 23 years from diagnosis. Factors associated with a poor prognosis are often those associated with a more rapid decline in lung function.
Case Presentation: The patient was a 24-year-old woman who presented with pneumothorax and multiple bullae in both lungs. The patient had no family history of respiratory disease, and the patient herself had no symptoms other than mild shortness of breath following activity from a year ago. A lung CT scan was performed for the patient and multiple bullae were evident in both lungs, which confirmed the diagnosis. There was no evidence of involvement of other organs but the lung. For the patient in the ICU with the diagnosis of left pneumothorax, a chest tube was inserted and she underwent mechanical ventilation. Finally, after 24 days of hospitalization, oxygen therapy of the patient was performed with a normal mask, and she underwent left lung pleurodesis with talcum powder, and a few days later, right lung pleurodesis was performed on the patient. On the 36th day of hospitalization, her general condition improved and she was discharged from the ICU. The patient was discharged in good general condition and had no problem on her four months follow-up.
Conclusion: Fortunately, with the diagnosis of LAM for the patient according to the CT scan of the patient's lung, she was treated with insertion of a chest tube and by performing pleurodesis, the recurrence of pneumothorax was prevented. In a young woman with spontaneous pneumothorax, sporadic LAM is one of the differential diagnoses.

Clinical and radiological evaluations in patients with chorea-acanthocytosis referreing to rasool-e-akram hospital
Mohammad Rohani, Seyed Amirhassan Habibi , Elahe Amini, Omid Aryani, Mahdi Dadfar, Hamzeh Zangeneh,
Volume 80, Issue 11 (February 2023)
Abstract
Background: chorea-acanthocytosis is a form of the autosomal recessive disease. The onset of disease symptoms usually starts from the third decade of life and presents with chorea, other abnormal movements such as eating dystonia, tongue and lip biting, vocal and motor tics, seizure, and behavioral impairment. In this study, the clinical presentations and brain imaging of these patients were reported.
Methods: In this descriptive study, information about patients with a specific movement disorder who were referred to a tertiary center in the Rasool Akram hospital (Tehran) from March 2018 to February 2019 were recorded. The inclusion criteria were the presence of chorea (a form of abnormal movement) and the presents of acanthocyte cells higher than 10% in a peripheral blood smear. The exclusion criteria were the evidence of secondary causes of the chorea or endocrine disorders. The clinical symptoms and brain imaging findings were evaluated by two expert neurologists and recorded in the patient's electronic files.
Results: Twenty-seven eligible patients were included. 18 patients were male and 9 were female. Sixteen patients had seizures and 90% of them were categorized as generalized tonic-clonic seizures. 21 patients had eating dystonia (71 percent were male and 29 percent were female) and 18 patients had complex motor and vocal tics, 11 patients presented extra ocular movement disorders, and 11 patients had evidence of tongue and lip biting. The absence of the deep tendon reflex was detected in 23 patients. Considering all the patients' movement disorders, the prevalence of eating dystonia was significantly higher in men than in women. (P=0.049). Other abnormal movements were not different between men and female. All patients had caudate atrophy and increased signal intensity in T2/Flair sequences in caudate nuclei and putamen in the brain imaging.
Conclusion: The most common abnormal movement after chorea was eating dystonia. The male gender was more susceptible to present eating dystonia than the female. However, this superiority was not seen in other movement disorders.

What styles do students of medical sciences use to learn? Systematic review and meta-analysis
Seyed Hossein Hosseini, Hossein Karimi Moonaghi , Seyed Masoud Hosseini, Hassan Gholami, Vahid Ghavami,
Volume 80, Issue 12 (March 2023)
Abstract
Background: According to numerous research related to learning styles and also the difference of these styles in students, this study was designed in order to determine the status of learning styles in medical students in Iran.
Methods: This study was conducted as a systematic review and meta-analysis. Searching for articles in this study was done from September 24 to October 15, 2022 in databases: Proquest, PubMed, Iran medex, Scopus, Sid, Magiran, Google Scholar, Eric and medical education journals. The research environment of Iran has been Mashhad. Using the PICOTS model, the keywords: learning styles, clubs, medical students were used to search the mentioned databases. OR, AND operators and possible combinations of keywords were used when searching for articles in databases. The extracted articles were first evaluated in terms of the research title, then the abstract of the article, and finally the text of the article using the "PRISMA Checklist". In each stage, repetitive articles and articles that did not mention the percentage of learning styles were excluded from the study, and the articles that met the inclusion criteria were stored in the (EndNote software, version 20, Clarivate, USA), and at the end, 53 articles were analyzed.
Results: The results of the study showed that the most used learning styles among students of medical sciences in Iran was convergent learning style (32% with 95% confidence interval). In the investigation of the adaptive learning style in the fields of basic sciences during the years 2006 to 2021, the percentage of using this style increased and this trend was statistically significant (P=0.0078).
Conclusion: According to the findings of the study, the most used learning style in medical sciences in Iran is convergent learning style, and considering the characteristics of convergent people, it is necessary to provide effective and efficient training in medical sciences to Students' learning styles should be given special attention so that training can be guided based on their learning styles.

Evaluation and comparison of statistical models of hemodialysis adequacy in hemodialysis patients in two groups (fistula and permanent catheter) in Arak dialysis center
Kowsar Sadat Ashrafi, Nasser Saeedi, Parvin Soltani, Ali Sadough Abbasian , Mohammad Rafiei, Fereshteh Nejati, Mahdieh Gholamzadeh, Mojtaba Ahmadlou,
Volume 80, Issue 12 (March 2023)
Abstract
Background: Adequacy of dialysis is a very important issue in dialysis patients, so comparing the adequacy of dialysis in different dialysis methods is very important. Therefore, due to the fact that the number of people undergoing dialysis  through fistulas and catheters varies in different centers, and depending on different centers, there is a possibility of decreasing or increasing the adequacy of dialysis, so we decided to do this comparison in Arak support center.
Methods: In this analytical-cross-sectional study, the dialysis patients of Hami Arak Center from April 2019 to September 2019 were divided into two groups (the first group with permanent catheter, the second group with arteriovenous fistula) based on vascular access. The both groups were matched in terms of age, sex, weight, pump speed, filter size and also the duration of dialysis. All patients were dialyzed with the same type of dialysis machine, and the duration of hemodialysis for all samples was 4 hours in each session. To confirm the reliability of the device, it was calibrated before each use and the same setting was used for all samples. The blood samples were taken from the arterial route before dialysis and starting the dilution with heparin or normal saline. Statistical models of dialysis adequacy of patients in two groups were measured using the Kt/V criterion, SPSS and AMOS data analysis was performed.
Results: In the analysis of covariance of BUN before dialysis, there is a statistically significant difference in the studied groups (P<0.05), also in the UF and URR variables, dialysis time and the number of times of dialysis in three consecutive repetitions, there is a statistically significant difference in the studied groups. (dime fistula and catheter) are not present (P<0.05).
Conclusion: In this study, during repeated repetitions, 22% of the dialysis adequacy in the two groups did not have good adequacy, and 78% of the patients in the two groups had appropriate dialysis adequacy.

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.

Antioxidant effects of adipose derived stem cells conditioned media against high glucose-induced injuries in cultured of C28I2 chondrocytes
Sedigheh Safari, Akram Eidi, Mehrnaz Mehrabani, Mohammad Javad Fatemi , Ali Mohammad Sharifi ,
Volume 81, Issue 1 (April 2023)
Abstract
Background: Osteoarthritis (OA) is the most common form of arthritis characterized by progressive loss of articular cartilage, causing pain and loss of articular function. High glucose is a crucial inflammatory factor playing a pivotal role in the pathogenesis of OA that induces ROS production. Since most of the current therapies for OA are short-term benefits, hence, there is high demand for finding novel therapeutic agents for OA treatment. Recent studies have demonstrated that mesenchymal stem cells secrete important therapeutic factors that protect chondrocytes. In the current study, we investigated the protective potential of Adipose-derived stem cell conditioned medium (CM-ADSC) as an alternative to cell therapy in high glucose-mediated oxidative stress in C28I2 human chondrocytes.
Methods: This experimental study was performed in the Department of Pharmacology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran from May 2018 to August 2020. Adipose-derived stem cells were cultured until they reached 90% confluence then washed with PBS and cultured in a FBS-free medium for 48 hours. The conditioned medium was collected and centrifuged. The protective effect of the concentration of conditioned medium on high glucose (75mM)-induced oxidative stress in C28I2 cell viability was evaluated by WST-1 assay. Total RNA was isolated from the treated and untreated cells with TRIzol reagent. The mRNA expression of antioxidant enzymes including, glutathione S-transferase-P1 (GSTP1), catalase (CAT), and superoxide dismutase1 (SOD1) was evaluated by reverse transcription-polymerase chain reaction in treatment and non-treatment groups.
Results: Adipose-derived stem cell conditioned medium pretreatment remarkably protected C28I2 cells against high glucose. The expression of mRNA of CAT, GSTP1, and SOD1 significantly increased following treatment with the conditioned medium (50%) for 24 hours in high glucose-exposed cells as compared to the control.
Conclusion: Present study indicates that the Adipose-derived stem cell conditioned medium can reduce oxidative stress. It seems that the conditioned medium may protect cartilage in the progression of osteoarthritis.

The satisfaction of infertile patients with the quality of medical services in Tehran university of medical sciences hospitals during the year 2020-2021
Batool Hossein Rashidi, Maryam Bagheri., Ashraf Aleyasin, Ladan Kashani, Fatemeh Davari Tanha , Elham Feizabad , Fedyeh Haghollahi,
Volume 81, Issue 1 (April 2023)
Abstract
Background: Patient satisfaction is considered as one of the most important elements of the evaluation of healthcare centers. In this research, the level of satisfaction of infertile patients was evaluated.
Methods: This study is a cross-sectional descriptive study. The research population is infertile patients who referred to the infertility clinic (at least 4 visits) and hospitalized in four hospitals affiliated with the Tehran University of Medical Sciences. The satisfaction questionnaire was valid researcher-made which included 56 questions in 9 areas, and were collected from May 2021 to September 2022. In order to comply with the ethical principles in research, hospitals were named 1-4.The results were analyzed using the chi-square test or Fisher's exact test for qualitative variables and analysis of variance for quantitative variables in SPSS software, version 24 (SPSS Inc., Chicago, IL, US).
Results Three hundred–four infertile women in four hospitals were studied. The mean age of the participants was 33.8 years, with a standard deviation of 5.8 years. The average satisfaction with admission and discharge services, medical services, nutrition, accounting, and insurance services in the number-1 Hospital had the highest score, and the average satisfaction with nursing or midwifery services, diagnostic and therapeutic services (radiology/laboratory), hospital services, charter patient rights, management services, paid expenses in Hospital 4 received the most points. The mean score of satisfaction was the highest among those who visited the infertility clinic of Hospital 3 (161.54±21.41). Average satisfaction with admission and discharge services, medical services, nutrition, accounting, and insurance services in Hospital No. 1 had the highest score, and average satisfaction with nursing or midwifery services, medical diagnostic services (radiology/laboratory), hospital services, respecting the patient's rights, management services, paid expenses in hospital number 4 got the most points. The average of nursing or midwifery services, respecting the patient's rights, and hotelling in all hospitals received the highest score, respectively, and nutrition services and paid expenses received the lowest points (most dissatisfaction) (P<0.05).
Conclusion: The level of satisfaction of women referring to the infertility clinic in 35.9% of cases was considered to be at an appropriate and exceptional level, in 49.3% of cases it was at a partially appropriate level, and in 14.8% at an inappropriate level.

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.

Presenting a model for assessing general medical students: a brief report
Neda Negahban Jouzan , Hossein Karimi Moonaghi , Hoorak Poorzand, Mohammad Khajedaluee,
Volume 81, Issue 1 (April 2023)
Abstract
Background: By examining the comprehensive system for evaluating the academic progress of general medical students, often the objectives of the cognitive domain and the form of cumulative evaluation were used, and the tests were not used much for feedback to the students. The aim of the study is to develop a model that fits the levels of Miller's evaluation pyramid in formative-cumulative forms.
Methods: The search was started in Iranian and international databases, magazines, curriculum of prestigious universities in the world. To find out about the latest events in the field of assessment, AMEE international virtual conferences in August 2021 and the summary booklet of medical education articles of Shahid Motahari 1400 (the 22nd national conference of medical education) were reviewed. Data analysis was done by Beredy's adaptive model. The search and analysis lasted for 11 months. Finally, a model was developed according to Miller's evaluation pyramid. Its validation was done in the focus group meeting in two ways, in person at Mashhad Medical School and virtual.
Results: According to the extracted data, the approach of assessment is towards formative assessment format and improvement of traditional methods along with modern methods, which was clearly observed in the study of the curriculum of Harvard-Stanford University in America and Oxford University in England. Integrating the results with Miller's evaluation levels, and the formative and cumulative evaluation format, led to the formulation of a model with the most favorable opinions of experts. In addition, the majority of opinions and suggestions of experts were related to the change in the way of executive policies of universities and providing a context for the emergence of new idea.
Conclusion: A model including measurement methods according to the levels of Miller's evaluation pyramid was developed in formative-cumulative. It is suggested that the model be reviewed by the relevant experts and notified by taking into account the implementation conditions for the correct evaluation process.

Investigating the effect of surgery time on improving the performance of fine movements of lower limbs in patients with traumatic spinal cord injury
Loghman Barani, Hossein Jafari Marandi , Masoud Zeinali, Hossein Safari,
Volume 81, Issue 2 (May 2023)
Abstract
Background: Traumatic Spinal Cord Injury (TSCI) is one of the catastrophic events, the rate of which has been growing compared to the past decades. Complications caused by TSCI have a wide spectrum and can range from complete paralysis to numbness of the limbs. Additional to the injury severity and disability of the patient, the recovery rate depends on the treatment strategies. Despite extensive efforts and research in this field, there are still few treatment options for TSCI patients. Controversial results have been reported, however, spinal cord decompression is the only certainty for the treatment of these patients. In the present study, patients with thoracic and lumbar fractures were undergone decompression, less and more than 24 hours, and the recovery rate (RR) was compared after 6 months.
Methods: In this study, patients with lumbar and thoracic fractures who were referred to the neurosurgery department of Ahvaz Golestan Hospital during May 2019 to December 2021 were included. Decompression was performed at the fracture level as a total and at the upper and lower levels of the fracture as a partial decompression. To evaluate fine motor movements, picking up a small object with toes and following a rectangular path were used. Also, the gross motor movements, upper and lower proximal and distal muscle forces were measured.
Results: 160 patients including 133 men (83.1%) and 16.9% women (27) with 36±12 years mean age were included. The most fracture location was lumbar (53.1%), followed by the thoracic (43.1%) and fractures in both regions (3.8%). The most injured  vertebras were L1 (27.5%) and T12 (18.8%). Six months later, 61.9% of patients had a good score for removing a small object with toe, of which 67.5% belonged to patients with<24 hours surgery (P=0.01). Also, RR for ability to follow a rectangle (P=0.017) and lower limit gross motor were significantly better in patients with<24 surgery (P=0.02). However, no significant difference was found between the two groups for improved sensations (P<0.05).
Conclusion: This study showed that decompression<24 hours in TSCI is associated with a significant improvement in lower fine movements.
 
Spontaneous rupture of accessory spleen 16 years after splenectomy: a case report
Seyed Hassan Seyed Sharifi , Mansoureh Baradaran,
Volume 81, Issue 2 (May 2023)
Abstract
Background: In most patients, the accessory spleen (AS) is small in size. However, in patients who have undergone splenectomy, AS may hypertrophy. This manuscript presents a rare case of spontaneous AS rupture nearly two decades after a prior splenectomy due to trauma. After searching multiple databases, only a few similar cases have been reported to date. In any acute abdominal patient with a history of previous splenectomy who presents with a mass in the anatomical location of the spleen, along with evidence of hematoma and free abdominal fluid on imaging, the possibility of AS rupture should be considered.
Case Presentation: In February 2022, a 36-year-old man who had undergone splenectomy due to trauma 16 years ago was referred to the emergency department at Imam Ali Hospital in Bojnord. He complained of sudden onset of severe abdominal pain, preferably in the upper region of the abdomen. The patient denied having any recent issues. Based on the patient's history and examination, at perforated stomach ulcer and pancreatitis were initially suspected. However, except for leukocytosis, no other abnormalities were observed in the laboratory tests. Ultrasound revealed a low-echo mass-like lesion in the anatomical location of the spleen. Another low-echo mass-like lesion, indicating a hematoma with abundant free fluid in the abdomen and pelvis, was also observed near the aforementioned mass. CT scan confirmed these findings. Open surgical and re splenectomy procedures were performed, and the diagnosis of spontaneous AS rupture was made based on clinical examination and imaging findings.
Conclusion: In any patient with a history of previous splenectomy who presents to the emergency room with diffuse and acute abdominal pain, even without recent trauma, if a mass-like lesion is observed in the anatomically suspicious location of the spleen in the left subphrenic space, along with other evidence of rupture such as hematoma/laceration and free fluid in the abdominal cavity, accessory spleen rupture should be considered as the main differential diagnosis.

Effect of low-dose ketamine versus lidocaine on hemodynamic response to endotracheal intubation in general anesthesia: a prospective, triple-blinded, randomized controlled trial
Behzad Nazemroaya, Hosein Mahjobipoor , Elham Saberi,
Volume 81, Issue 3 (June 2023)
Abstract
Background: A smooth endotracheal intubation minimizes hemodynamic changes. We assessed the effect of ketamine and lidocaine on Diastolic blood pressure (DBP) Systolic blood pressure (SBP), heart rate (HR), Mean arterial pressure (MAP) and, oxygen saturation (SpO2) changes after endotracheal intubation compared to a control group.
Methods: In this randomized, triple-blind clinical trial (IRCT20200825048515N56) approved by the Medical Ethics Committee of the Isfahan University of Medical Sciences (IR.MUI.MED.REC.1400.721) 90 patients aged 18-65 years as candidates for surgery under general anesthesia at Alzahra Hospital in Isfahan were included between December 2022 and February 2023. They were randomly allocated to the ketamine hydrochloride (ketamine) (0.5 mg/kg), lidocaine hydrochloride 2% (Lignodic)          (0.5 mg/kg), and control groups. The subjects, age, height, weight, gender, Body mass index (BMI) and clinical information, such as mean blood pressure, HR, SBP, DBP, MAP, and, oxygen saturation 1, 3, 5 and 10 minutes following endotracheal intubation, recovery stay and, extubation time were noted and analyzed by repeated measure analysis using SPSS version 28. The significance level in all analyses was considered less than 0.05.
Results: Ninety candidates for electroconvulsive therapy (ECT) were randomly assigned to three groups of 30: one group receiving lidocaine hydrochloride, one receiving ketamine hydrochloride, and the other a control group. Overall, 60 cases (66.7%) were male and 30 cases (33.3%) were female.
Both lidocaine and ketamine effectively reduce hemodynamic changes during endotracheal intubation, but lidocaine potentially has greater benefits in terms of improving oxygenation and reducing heart rate variability, as well as reducing recovery time during anesthesia. No significant difference was detected between the two studied groups regarding diastolic blood pressure, systolic blood pressure, heart rate, mean arterial pressure changes, recovery stay, extubation time, and laryngoscopy grade.
Conclusion: Based on the findings in this study, lidocaine offered more desirable hemodynamic stability than ketamine and resulted in fewer hemodynamic disturbances. Also, in the case of persistent hypertension or tachycardia. This was not observed in any of the groups.

Comparative study of the effect of neurotec vs gabapentin on sensory symptoms of patients with diabetic neuropathy
Hadi Gharebaghian, Mehri Amiri, Sepideh Seydi,
Volume 81, Issue 3 (June 2023)
Abstract
Background: Diabetes is the most common cause of peripheral neuropathy throughout the world and has negative impact on patient's quality of life. There is no cure and to date several drugs have been used for its symptomatic treatment, including antidepressants and antiepileptics. Neurotec is a herbal medicine (combination of wild star anise, nettle and tansy) that can be potentially effective in the treatment of this disorder. Proposed mechanisms include its effects on increasing nerve conduction velocity and repairing peripheral nerves.
Methods: In a single-blind randomized clinical trial from April to September 2018 in Kermanshah of patients referred to Taleghani Hospital Clinic, 100 diabetic patients with sensory complaints, were randomly divided into two groups. The first group received 100 to 300 mg gabapentin (a well-known effective antiepileptic drug) daily and the second group received 100 mg Neurotec daily. At the beginning of the study and at the weeks of 6 and 12, patients were evaluated with DN4 questionnaire and the visual analog scale (VAS) for severity of sensory symptoms including paresthesia and numbness and the results were compared and analyzed. In each serial visit, possible drug side effects were asked from patients and recorded.
Results: Neurotec reduced the feeling of coldness, pain, paresthesia and numbness VAS and DN4 scores (P of 0.01,0.05, 0.05, 0.05, 0.001, 0.05 respectively). Neurotec showed a significant advantage over gabapentin in reducing pain intensity and in other parameters the difference between the two groups was not significant. The only significant complication of Neurotec was dyspepsia that could be minimal in patients who receive the drug after a meal. Conversely in the gabapentin group, dizziness, drowsiness, and vertigo were significantly more common (P>0.05).
Conclusion: Neurotec can be useful for sensory symptoms of diabetic neuropathy. Its effect on symptomatic therapy is comparable to gabapentin or even better for painful diabetic neuropathies. Its proposed mechanism in neuronal repair needs to be evaluated and can be a potential advantage over symptomatic therapies. Neurotic has no serious side effects.

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.

The effectiveness of tDCS on insomnia and mood of female with insomnia
Tahereh Motevalizadeh, Fatemeh Rezaei, Khosro Sadegh Niat Haghighi , Mohammad Ali Sepahvandi ,
Volume 81, Issue 3 (June 2023)
Abstract
Background: Insomnia is the most common sleep disorder that is associated with cortical hyperexcitability. Potentially transcranial direct current stimulation (tDCS) modifies the cortical state related to insomnia. Therefore, we hypothesized that by using tDCS the intensity of insomnia can be reduced, followed by improvement of the mood symptoms.
Methods: This study was an experimental design with a pre-test and post-test with a control group. The statistical sample included 32 females with chronic insomnia that were randomly divided into an experimental group (active stimulation) and a control group (sham stimulation). Transcranial direct current with an intensity of 2 mA was applied for 30 minutes during 12 sessions (three times in the week) in the active stimulation group. In this protocol, anodal stimulation of left Superior temporal gyrus (STG) and cathodal stimulation of right dorsolateral prefrontal cortex (DLPFC) and left secondary motor cortex (SMA). In the control group, sham stimulation was performed for 30 minutes during 12 sessions (three times in the week). The participants were evaluated before and after of the intervention using the Insomnia Severity Index (ISI) and Positive and Negative Affect Scale (PANAS).
Results: The findings of this research showed that the application of transcranial direct current stimulation was effective in reducing the severity of insomnia and improving positive and negative affect (P<0.001, F=19.87). The value of this effect (eta2) in the severity of insomnia, negative mood and positive mood is 0.64, 0.34 and 0.6 respectively.
Conclusion: The results of the present study showed that the implementation of our designed tDCS protocol for the treatment of insomnia, significantly reduced the intensity of insomnia in women with chronic insomnia and improved their mood symptoms.

Evaluation of sensitivity and specificity of filter paper in screening of congenital hypothyroidism
Maryam Razzaghi-Azar , Mina Sepehran, Bahareh Lesani-Gouya ,
Volume 81, Issue 3 (June 2023)
Abstract
Background: Congenital hypothyroidism (CH) is one of the most preventable causes of mental retardation throughout the world. The aim of this study was to evaluate the sensitivity and specificity of filter paper in screening for congenital hypothyroidism and to determine an appropriate cut-off point for filter TSH for recalling screened neonates.
Methods: In this cross-sectional study (descriptive analytic), the records of 2739 neonates who had been recalled during the CH screening program in the east of Tehran, Iran (health care centers of the Iran University of Medical Sciences), from March 2011 to March 2015, were studied. According to the CH screening program in Iran, the TSH on filter paper>5 is the current cut-off point for recalling the neonates. The data was analyzed with SPSS software, version 21. The ROC curve was used to determine the TSH cut-off point and the sensitivity and specificity of the filter test. The relationship between the filter and serum TSH was also determined. The study was approved by the Ethics Committee of the Iran University of Medical Sciences.
Results: The recall rate was 5.4%. The prevalence of hypothyroidism was 3/1000 neonates (164). The prevalence in males and females was 51.1% and 48.9%, respectively, with no significant difference. The number of recalled neonates diagnosed as patients with congenital hypothyroidism based on the filter TSH level was 5
Conclusion: Based on the findings of the study, considering the kits available in the country and their sensitivity and specificity, the importance of diagnosing infants with congenital hypothyroidism, and the lower cost of filter paper than missing a hypothyroid infant, the current cut-off point is acceptable. However, more studies are needed in different regions of Iran to obtain more accurate results.

Comparing the rate of complications of sore throat and hoarseness caused by ETI support method with LMA method in surgical patients under general anesthesia
Farzaneh Boluki Moghaddam , Zhaleh Yousefi, Ali Baghery Hagh , Masoud Latifipour, Mahdi Raei,
Volume 81, Issue 3 (June 2023)
Abstract
Background: Respiratory support during the patient's anesthesia is done in different ways, such as endotracheal intubation and laryngeal mask. Endotracheal intubation is inevitably used for respiratory support in general anesthesia patients. The use of alternative methods for respiratory support during the process of general anesthesia is one of the most significant ways to control anesthesia complications. The laryngeal mask is placed around the larynx to allow spontaneous and controlled ventilation. Both of the respiratory support methods can cause complications. The purpose of this study is to compare the side effects of sore throat and hoarseness caused by two methods in surgical patients.
Methods: This study was conducted in the period from September to November 2022 on patients who were referred and underwent surgery at Baqiyatallah Hospital. The study is a cohort study that was conducted retrospectively on 60 patients who underwent any surgery with two methods of anesthesia by ETI and LMA. In order to evaluate hoarseness, the standard Voice Handicap Index (VHI-10) questionnaire was used. In order to evaluate the complication of sore throat caused by the respiratory support method, a 4-point pain checklist was used for 24 hours and 14 days after the surgery.
Results: The findings of our study showed that the average amount of sore throat 24 hours after surgery in the LMA and ETI groups was 2.13 and 2.2, respectively, and these values 14 days later were 1.17 and 1.07, respectively. The average level of hoarseness in the 24 hours after surgery in LMA and ETI groups was 2.66 and 3.13, respectively. The statistical comparison of the severity of side effects between the two groups showed that in the LMA method, the amount of sore throat and hoarseness is less than the ETI method, although this reduction does not have a significant difference.
Conclusion: The results of this study showed that the rate of complications of sore throat and hoarseness in the laryngeal mask group is reduced compared to the endotracheal intubation group, although this difference is not significant.

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