Tehran University Medical Journal

Background: Animals have an internal biological clock with melatonin hormone that helps them to adapt to light/dark circles. Since melatonin is associated with an alteration in the expression and production of opioid receptors, this study aimed to evaluate the effect of changes in the light/dark circles on pain sensation in rats.
Methods: This research study in order to investigate the thermal and chemical pain sensation using tail flick and formalin tests, 35 Wistar rats were randomly divided into five groups of seven animals, including 24 hours of light (24L), 16 hours of light / 8 hours of darkness (16L/8D), 12 hours of light / 12 hours of darkness (control), 8 hours of light / 16 hours of darkness (8L/16D) and 24 hours of darkness (24D) were tested. The study was conducted at the Department of Biology of Ferdowsi University of Mashhad, Iran, from April to September 2015. Also besides the Rotarod test was performed to determine the general motor activity of animals.
Results: In the tail flick test, an increase in the time of darkness elevated the threshold of thermal pain and subsequently resulted in analgesic effect in the 24 hours of darkness (24D) group (P=0.03), while reducing the dark period in the group of 16 hours of brightness / 8 hours of darkness caused a reduction in the threshold of thermal pain, resulting in hyperalgesia (P=0.002). In the formalin test, the chemical pain score at the end of the chronic phase was significantly increased in the experimental group of 16 hours of brightness / 8 hours of darkness compared to control, indicating hyperalgesia (P=0.03).
Conclusion: Perhaps, alterations in light duration may change the production of melatonin and opioids and their receptors. Therefore, it is expected that reduction of the duration of darkness and thus shortening the period of increased production of melatonin and the subsequent lower expression of opioid receptors, in this group, resulting in a lower thermal pain threshold and analgesic response.

Background: Differentiated thyroid cancer (DTC) frequently occurs in women at fertility age. One of the cornerstones in treating this malignancy is Radioactive Iodine (RAI) therapy following thyroid resection. In this study, we evaluated the effect of RAI therapy on the fertility rate and pregnancy complications.
Methods: This is a retrospective study on 41 patients with differentiated thyroid cancer, with at least one experience of pregnancy after standard treatment (thyroid resection followed by radioiodine therapy). All patients have been signed a written consent form in initial admission to our department. Furthermore, we asked our patients to fill in a questionnaire about their thyroid cancer and its treatment as well as pregnancy and its complication. As a control group with no different mean age, the same checklist has also been filled in for the patient’s healthy sister too, just related to gravidity and its complications. The complications of pregnancy were registered in these patients and compared with the control group consisted of their healthy sisters. Also, the association of abortion rate with other underlying factors has been assessed. All data has been included in SPSS software, version 22 (IBM SPSS, Armonk, NY, USA) and analyzed using logistic regression. This study conducted at the Nuclear Medicine Department of Ghaem Hospital in Mashhad, from May 2017 to February 2018 with the support of Mashhad University of Medical Sciences, Iran.
Results: No significant difference was noted in the mean age between case (differentiated thyroid cancer) and control groups (P=0.9). The two groups were also statistically similar in terms of pregnancy frequency (P=0.05) and number of alive children (P=0.8). Abortion seems to be the only item in DTC patients which was more than healthy sisters (0.2 versus 0.7) (P=0.003). However, this statistical difference showed no direct relationship with radioiodine treatment (RIT). As in DTC patients before and after RIT, no significant difference has been detected in DTC patients before and after RIT (P=0.48). Birth weight was not statistically different in DTC patients before and after RIT (P=0.66) and between DTC patients and their healthy sisters (P=0.2).
Conclusion: Radioiodine therapy for differentiated thyroid carcinoma has no considerable negative impact on pregnancy, whether on fertility rate or on gravity complications.

Background: Abnormal placental invasion in pregnancy is one of the most important dilemmas in gynecology and obstetrics medicine and because of the high potential risk of life-threatening massive bleeding, it has been considered as one of the most important causes of maternal morbidity and even mortality. According to the fact that previous cesarean section is the most highlighted and well-known risk factors for developing these types of abnormal placental invasion, and despite comprehensive recommendations for decreeing of this kind of surgery, the rate of caesarian delivery is raising worldwide, detecting the safer methods of management for optimizing the outcome is mandatory.
Case Presentation: In this report, we are discussing a patient in Firoozgar Hospital, Tehran, Iran, with twin pregnancy accompanying with placenta previa with abnormal invasion, which has got the best possible outcome after performing a multidisciplinary approach without any need to blood transfusion or general anesthesia during cesarean hysterectomy as the standard management of placenta increate. In this case, we have performed magnetic resonance imaging (MRI) before surgery. We found out that we can use the exact site of placental margin and the distance between placental margin and uterovesical junction. So we have done the uterine incision horizontally without damaging to the placenta. Generally, Doppler ultrasonography has enough accuracy for detecting all kinds of placenta creates.
Conclusion: By selecting a safe uterine incision, we can prevent such a sudden and massive bleeding during the operation and also avoid occurring end-organ damage due to hemorrhage for instance, acute tubular necrosis, disseminated intravascular coagulation resulted in maternal morbidity and mortality. In this report, we also discuss the points needed for management and treatment of abnormal placental invasion by reviewing the recent literatures.

Background: Breast cancer is the most commonly diagnosed and the leading cause of cancer death among females worldwide. The rate of breast cancer incidence among Iranian women is 17% of all cancers, it has been ranked first in Iran. This study aimed to investigate the factors affecting axillary lymph node involvement in female patients with breast cancer.
Methods: A cross-sectional study was conducted on 167 patients with breast cancer diagnosed between March 2012 and March 2015 at Shahid Beheshti of Babol, Shahid Rajaei of Tonekabon and Imam Sajad of Ramsar hospitals. A researcher-made questionnaire was used to collect information on the patients and pathology report of tumor and lymph nodes was completed.
Results: The rate of axillary lymph node involvement was observed in 117 patients (70.1%). Mean age was 49.64±11.62 years in the patients with breast cancer. The highest frequency of lymph node involvement was observed in the 40-49 age group (24%). The average size of tumor was 3.39 cm and the majority of patients had a tumor 2-5 cm (T2) but the most involvement was related to T3 (>5cm). The most common type of cancer and grading were invasive ductal carcinoma (93.4%) and tumor grade 2 (52.1%), respectively. Most lymph node involvement was observed in invasive ductal carcinoma and 85.1% of patients had tumor degree 3. 22.2% of patients with vessels involvement had axillary lymph node involvement. 63% of patients’ tumors had receptors of estrogen and progesterone. A statistically significant association was observed between axillary lymph node involvement and tumor size (P=0.031), tumor type (P=0.007), tumor grade (P=0.011), estrogen receptor (P=0.008) and progesterone receptor (P=0.038).
Conclusion: There was a statistically significant association between axillary lymph node involvement and tumor size, type and grade, estrogen and progesterone receptor status, but there was no statistically significant association between axillary lymph node involvement and age and estrogen as well as progesterone receptor status.

Background: The position of each subject area in scientific production can indicate the ability of the scientific performance of that subject field. Since obstetrics and gynecology is one of the most important clinical sciences discipline of medical science, this study aimed to evaluate the scientific production in the field of obstetrics and gynecology before and after the Iran health reform plan.
Methods: This study is a scientometrics, time interval in the study was from 2008 to 2017 on Iranian articles based on the indexes of the number of documents, the number of citations received, the number of citations to each article, and the H-index of obstetrics and gynecology field based on the Web of Science database. It Indicators investigated, was extracted separately from the analysis section of the database.
Results: The average citation per article, the number of documents and the number of citations in the 5 years before the health reform plan respectively in the field of obstetrics and gynecology equal to 10.44, 196.6, 1750.6 and after the implementation of the health reform plan, equal to 3.89, 282.6, 1031.4. Also, the level of international collaboration before and after the project is 13.06 and 13.25, respectively. Also in the field of gynecology and obstetrics, Ramezani Tehrani, with 1.91% of all articles was the most reproductive writer, and Tehran University of Medical Sciences, with the highest scientific productions in the field of obstetrics and gynecology by 23.77% of all productions. Finally, the field of obstetrics and gynecology had the highest share of scientific production by 66.88%.
Conclusion: The findings showed that the scientific production of obstetrics and gynecology, in terms of quantity (number of documents), after the health reform plan, has been growing, but the quality (citation, H-index) is decreasing. Also, international collaboration has grown after the health reform plan. The findings also showed that before and after the health reform plan, the most cooperation was with the United States and the rate has been lower with Asian countries.

Background: Helicobacter pylori (H. pylori) is a highly prevalent, serious and chronic infection. It been associated causally with a diverse spectrum of gastrointestinal disorders including chronic gastritis, peptic ulcer disease, gastric adenocarcinoma. We conducted a study to Evaluation of the role of breastfeeding and breast milk on the colonization of H. pylori in the gastrointestinal tract of 2-24 month old.
Methods: This cross-sectional study was performed on 92 children referred to Ali Asghar Hospital of Iran University of Medical Sciences for two years (from July 2015 to June 2017). At first, a questionnaire was recorded by the neonatal specialist including demographic and clinical characteristics of the infants. Stool samples were taken from infants at 2, 6, 12, and 24 months of age. We used the H. pylori stool antigen test to detection infection in the selected group of children. H. pylori status was evaluated by an enzyme-linked immunosorbent assay (ELISA).
Results: In the study of breastfeeding at 12 months of age, 51.1% were fed only dry milk and 28.3% were breastfed only. At 24 months, 22 infants (24%) were breastfed with supplemental feeding and 54 children (58.7%) were  formula-fed only and 8 children (8.7%) were breastfed only. In our study, the prevalence of H. pylori in infants of Tehran, at 2, 6, 12, and 24 months, were 0%, 6.5%, 15.21%, and 34.4%, respectively. Of the 92 children studied, during the first month, 25 children (27.2%) only formula-fed and 49 children (53.3%) were breastfed only and (19.6%) 18 infants were breastfed with dry milk. The prevalence of H. pylori infection was 28.3%. The prevalence of H. pylori infection was 20% in the breastfeeding group and 44% in the infant dry milk feeding group. The prevalence of H. pylori antigen was greater than 12 IU/ml in infants 2, 6, 12, and 24 months of age, including 19.92 (20.6%), 19.92 (20.6%), 24.92 (26.1%) and 21.92 (22.8%), respectively.
Conclusion: According to the findings of the article, breastfed children compared to formula-fed children were less infected by Helicobacter pylori.

Background: Melatonin is one of the drugs which are used in the treatment of sleep problems, including insomnia and sleep deprivation. The aim of the present study was to evaluate the melatonin effect on sleep quality in patients with cancer.
Methods: This quasi-experimental study was performed on cancer patients with trouble sleeping who were treated with melatonin (3 mg per day) for a month. Sleep quality according to the Pittsburgh sleep quality index (PSQI) questionnaire was evaluated before and after taking melatonin. This study was conducted in the Oncology Clinic of Imam Reza Hospital, Kermanshah City in Iran from August 2016 to February 2018.
Results: There was a significant difference between the sleep quality of patients with cancer before and after taking melatonin (P<0.05). In other words, before taking melatonin, sleep quality of none of the patients was not optimal but after taking melatonin, the sleep quality of 52% of patients was satisfactory. Also, there was a significant difference between the components of subjective sleep quality (P<0.001), sleep latency (P<0.001), sleep duration (P<0.001), sleep efficiency rate (P<0.001), sleep disturbances (P=0.001), and daytime dysfunction (P<0.001) of patients with cancer before and after taking melatonin. There was no significant difference between the components of subjective sleep quality, sleep latency, sleep duration, sleep efficiency rate, sleep disturbances, and daytime dysfunction of cancer patients with age, sex, kind of cancer, and kind of metastasis before and after taking melatonin (P˃0.05).
Conclusion: According to the mentioned findings, it seems that the administration of melatonin to enhance sleep quality in patients with cancer is effective.

The highly contagious new coronavirus virus, SARS-CoV-2, was first appeared in Wuhan, China in late 2019. The virus has spread to 216 countries, including Iran, until 7 September 2020. So far, the number of people infected by the new corona virus and died from the disease is 27032617 and 881464 worldwide, respectively. Therefore, it is necessary to introduce the available treatments for this virus, as a global dilemma. Articles for this review study were selected from Embase, Medline and Google Scholar. Published full articles in English, English full articles published from 1st December 2019 to 23rd July 2020, were included. The search terms included combinations of COVID-19, SARS-COV-2, chloroquine, convalescent plasma, antiviral, antibacterial, Remidesivir, hydroxychloroquine, chloroquine phosphate, vaccines and monoclonal antibodies. There were no restrictions on the types of study eligible for inclusion. Different available therapies generally can be divided into small molecules and biological products. Among the small molecule drugs used for COVID-19 patients Remdesivir, Favilavir, and hydroxychloroquine have been associated with considerable success in disease control. Separation and transfusion of plasma from blood of improved COVID-19 patients to new patients and the use of recombinant Angiotensin converting enzyme 2 (ACE2) have been two very successful biological therapies in the treatment of COVID-19 disease. However, many efforts are being made by researchers around the world to make other effective and promising biological products. The development of a safe and effective vaccine can lead to great success in eradicating the disease. Also, the production of anti-SARS-CoV-2 monoclonal antibodies and using of stem cell-based therapeutics can be a great success in treating the disease. In addition, according to the miRNA properties, many efforts have been made to inhibit the production of viral proteins using natural miRNAs or artificial siRNAs. It has been proposed that aptamers derived from SELEX can be used for the diagnosis and treatment of COVID-19. Subsequently, since the size of miRNAs is at the nanometer level, they can easily incorporate to the targeted exosomes and be delivered via circulation in human blood to the infected cells such as lung cells. Interestingly, miRNAs can be delivered into the lung by inhalation.

Background: Excessive and irrational use of antibiotics in the treatment of acute diarrhea has caused increased resistance to these medications. It is well defined that most cases of diarrhea in children do not require the use of antibiotics. This study was aimed to determine the status of antibiotic administration for treatment of acute diarrhea in children younger than five years. All who admitted at the pediatric ward of Besat Hospital in Sanandaj.
Methods: First, the study was approved by the ethics committee of Kurdistan University of Medical Sciences. The archived files of all children under 5 years with a positive history acute diarrhea who were admitted in Besat Hospital of Sanandaj during the period of 1 years, from May 2016 to May 2016 were reviewed. Demographic information such as age, gender, type of diarrhea, type of nutrition, type of the prescribed antibiotic, results of the stool and blood samples were collected and recorded in the questionnaire.In Stool samples the contained a large number of WBCs and RBCs along with high fever, Shigellosis were considered. The results were analyzed by SPSS software, version 23 (SPSS Inc., Chicago, IL, USA).

Background: Studying and evolution of medical sciences is so important to draw up the future path with a view to per capita of science production. The purpose of this study was to clarify the status and position of Iran in science production and compare it with four competitor countries of the region for 2025.
Methods: This research is conducted using the scientometric method our ranked citations and ranked document data collection source is the SCImago database. The statistical population is the priority fields of Iran health program, which has 25 field names In three categories: infrastructure, survival, perfection, compared with the four competitor countries in the Middle East. The evaluated time period is examined are from 2010 to 2017. Data analysis is performed using Excel software.

Background: Infectious diseases in the pandemic stage have significant life-threatening, psychological and social effects. Identifying the characteristics associated with people's cooperation in self-care leads to greater immunity for themselves and others. Therefore, this study was conducted to predict the self-care of the Iranian people according to their individual and social characteristics in face of the Covid-19 pandemic.
Methods: A survey study was conducted on 1056 adults aged 18 and over in different provinces of Iran through a form of answering online researcher-made questions (n=40, α=0.9) in social networks in four days. This paper studies the level of self-care of people against Covid 19 pandemic which was conducted with the support of Isfahan University of Medical Sciences in April 2016. Data were analyzed using Student t-test and variance. Moreover, "decision tree technique" was used to identify communication patterns.

Background: Granular cell tumor (Abrikossoff’s tumor) is a rare and slow-growing tumor of the soft tissue. Originated from the Schwann cells, it is often a benign tumor, but it can be malignant in 1-3% of the cases. Malignant cases can cause significant morbidity and mortality. It may develop in many anatomic locations, especially in the head and neck region, and also in skin and subcutaneous tissue.

Background: Posterior reversible leukoencephalopathy syndrome (PRLS) is a clinical and radiological syndrome of heterogeneous etiologies that are grouped because of the similar findings on neuroimaging studies which may occur at any age. The pathogenesis of RPLS remains unclear, but it appears to be related to disordered cerebral autoregulation and endothelial dysfunction. The syndrome is more commonly seen in women, RPLS has been described in several medical conditions, with hypertensive encephalopathy, eclampsia, and the use of cytotoxic and immunosuppressant drugs being the most common conditions. Prompt recognition and treatment are important in preventing the permanent damage that can occur in this otherwise typically reversible condition. The pathogenesis of RPLS remains unclear, but it appears to be related to disordered cerebral autoregulation and endothelial dysfunction. This report aimed to introduce a case of reversible posterior leukoencephalopathy following postpartum thrombotic thrombocytopenic purpura (TTP).
Case presentation: The patient was a 30-year-old primigravid woman at 33 weeks of pregnancy who was referred to the Ghaem hospital, Mashhad University of Medical Sciences in Mashhad in July 2017 due to high blood pressure, blurred vision, headache and generalized tonic colonic seizure. She did not report in previous history of high blood pressure or seizure before pregnancy. With a diagnosis of eclampsia remote from delivery, she underwent a cesarean section. After delivery, generalized tonic colonic seizure repeated several times and a significant reduction in consciousness level happened. Renal failure also occurred, so she underwent daily plasmapheresis with a diagnosis of TTP. After 35 days, she was discharged with a good general condition.
Conclusion: In predisposing conditions, such as high blood pressure in pregnancy, in the case of clinical suspicion of posterior leukoencephalopathy, any attempt for early diagnosis and appropriate treatment are important factors in reducing the rate of morbidity and mortality.

Background: Developmental delay in preterm infants was estimated to be more common than term infants. Identifying the factors predisposing to developmental delay can help experts and health professionals in this field to prevent developmental delay of the infants, and leads to better management of the condition of them. This study aimed to evaluate and investigate the predisposing factors of developmental delay in preterm infants in the first year of their lives.
Methods: In this analytical cross-sectional study, 87 preterm infants were enrolled in the study by convenience sampling during the period of April 2016 to the end of March 2017 from two educational hospitals of Shahid Beheshti University of Medical Sciences (Imam Hussein hospital and Mahdiyeh hospital). Demographic and other initial data such as age, sex, gestational age, and the data about clinical problems observed at birth were collected through infants' medical records and were recorded in a special form for each infant. Also, the ASQ test was used to assess infants' developmental status at one year of age.

Background: Phacoemulsification surgery is one of the most common surgeries in the world. Various drugs have been used alone or in combination with each other to provide effective and safe sedation in patients, but so far, a drug method agreed upon by anesthesiologists has not been proposed. The purpose of this research was to evaluate the sedative quality of midazolam or propofol with a low dose of ketamine in phacoemulsification surgery.
Methods: This study was a double-blind randomized clinical trial conducted from November 2017 to August 2019 at Faiz Hospital, Isfahan. In this study, 68 patients were assigned in the groups of midazolam (M) and propofol (P) using randomization software entered the study. The midazolam (M) group received 0.04 mg/kg and the propofol (P) group received 0.5 mg/kg, then in both groups, ketamine 0.3 mg/kg was injected intravenously. The quality of sedation, cardiovascular response and patient and surgeon satisfaction were assessed and recorded. Data were entered into SPSS 23 software and analyzed by using ANOVA and Independent samples t‐test.

Primary Immune Deficiencies are a group of heterogeneous disorders that involve the innate or acquired immune system, or a combination of them. The underlying disorder may be related to decreased levels or function, or a complete lack of one or more components of the immune system in general. These diseases can occur with a prevalence of about 1 in 10000 live births. According to the fourth update on the Iranian national registry of Primary Immune Deficiency in October 2018, the total number of registered PIDs in Iran are 3056 patients. However, it is supposed to be more prevalent and it seems increasing awareness shall reveal many new cases, especially in societies with prevalent consanguineous marriages like Iran. These disorders predispose patients to recurrent infections, autoimmunity and malignancy and can cause a huge burden on health care systems. This group of diseases has a wide range of symptoms, which quick recognition and timely treatment of them, can greatly reduce the complications of the disease. These symptoms may include recurrent or severe infections, failure to thrive, autoimmune disorders, as well as articular-skeletal manifestations. A variety of skeletal manifestations are seen in patients with primary immunodeficiency, among which septic arthritis caused by pyogenic bacteria or mycoplasma arthritis is the most common joint-bone manifestation. Joint and skeletal involvement is less commonly seen as a sign of primary immune defects. This issue is importance in reducing the cost of diseases and improving the patients’ quality of life. Our review attempted to introduce the most common manifestations of bone and joint in patients with primary immunodeficiency and available treatments for these manifestations. Because of the wide range of symptoms in these patients, it is recommended to observe the rare and suspicious manifestations in the patients with any atypical bone and joint presentations such as: recurrent septic arthritis, infection with unusual germs, immunodeficiency in their relatives, and any history of well-known red flags of PIDs. The Rheumatologist should consider these manifestations and think about the possibility of deficiency disorder.