Tehran University Medical Journal

Background: Multiple sclerosis (MS) is a degenerative inflammatory disease which is most commonly diagnosed by magnetic resonance imaging (MRI). But, since the MRI device uses of a magnetic field, if there are metal objects in the patient's body, it can disrupt the health of the patient, the functioning of the MRI, and distortion in the images. Due to limitations of using MRI device, screening seems necessary for those patients who have metal objects in their bodies. Therefore, this study is carried out to compare two models: support vector machine and random forest.
Methods: This analytical-modelling research was implemented on MS data collection, the specifications of which are recorded in health registry system in School of Public Health, Kermanshah University of Medical Sciences, Iran, from May 2017 to August 2018. For the purpose of this study, a total of 317 subjects were selected as a sample; 188 subjects were diagnosed with MS and 128 subjects showed no symptoms of MS. In order to fit the support vector machine (SVM) model, radial basis kernel function was used. The parameters of this machine were optimized with genetic algorithm. After this step, the support vector machine and random forest (RF) were compared with respect to three factors: accuracy, sensitivity, and specificity.
Results: Based upon the obtained results of study, accuracy, sensitivity, and specificity of SVM were 0.79, 0.80, and 0.78, respectively. In comparison, accuracy, sensitivity, and specificity of RF were found to be 0.76, 0.81, and 0.70, respectively.
Conclusion: In general, both models which were compared in current study showed desirable performance; however, in term of accuracy, as an important criteria for performance comparison in this area of research, it can be argued that support vector machine can do better than random forest in diagnosing multiple sclerosis.

Background: Infant mortality is important as a standard indicator for the development of health, educational and social health systems in each country. Considering the fact that in different studies of the country there are different statistics on the prevalence of infant mortality in the intensive care unit and the general statistics on the prevalence of mortality in neonates in the country are unclear and unclear, the aim of this study was systematic review and meta-analysis for determine the prevalence of mortality in infants admitted to the intensive care unit (ICU) of hospitals in Iran.
Methods: A meta-analysis was performed for relevant articles in scientific databases including scientific information database (SID) and Magiran, ScienceDirect, Scopus, Medline (PubMed) and Google Scholar. Entrance criteria included cross-sectional studies between March 2000 to September 2018. The search process in these databases was performed using keywords: Neonatal, Intensive Care Unit, Mortality, and Iran. Non-relevant articles included review articles, interventions, cohorts and case-control studies, excluded from the study list. Heterogeneity of study was checked using I2 index and the possibility of publication bias by funnel plot and Egger test. Data were analyzed using the comprehensive meta-analysis software, version 3 (Biostat, Englewood, NJ, USA).
Results: The overall prevalence of infant mortality in ICU hospitals was 21.8% (95% CI 14.4-31.6%), the highest prevalence of infant mortality in Isfahan was 64.4% percentage (95% CI 57.5-70.9%) and the lowest mortality rate in babies in Babol's intensive care unit with 5.1% (95% CI 3.8-6.7%). The results of the study showed that the prevalence of infant mortality was significantly reduced with increasing sample size (P<0.05). Also, with an increase in years of research, the frequency of infant mortality in the intensive care unit increases, which is also statistically significant respectively (P<0.05).
Conclusion: Considering the high prevalence of infant mortality in ICU hospitals in Iran, health policy makers need to take effective measures to raise awareness of parents as well as effective measures to reduce infant mortality.

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

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

Background: 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.