Tehran University Medical Journal

Background: The prevalence of gestational diabetes is increasing among pregnant women. It is associated with an increased risk of congenital heart disease, including hypertrophic cardiomyopathy. The aim of this study was to evaluate the effect of maternal diabetes control (based on HbA1c) on their hypertrophic cardiomyopathy in newborns.
Methods: This case-control study was performed on 60 neonates born in Afzalipour Hospital (Kerman University of Medical Sciences) from May to November 2014 in two groups of eligible infants using the convenience sampling method. Information about the age, sex, weight, gestational age, maternal age, obstetric history, gestational diabetes through the checklist were collected. Then Doppler echocardiography, M- Mode, Doppler tissue was conducted on two groups. Echocardiographic criteria including ventricular septal thickness and blood HbA1c mothers in both groups were compared. To compare quantitative and qualitative variables between the two groups’ Independent samples t‐test and Chi-square test was used. A significant level of 0.05 was considered in all of the statistical samples and SPSS software, ver. 20 (IBM, Armonk, NY, USA) was used to analyze the data.

Background: Vaginal candidiasis is common in during pregnancy. It may lead to complications like abortions, premature birth, low birth weight, chorioamnionitis and fungal systemic neonatal infection. The aim of present study was identification of Candida species by mycological and molecular methods in pregnant women with vaginal candidiasis.
Methods: This cross-sectional study was performed on 80 pregnant women with or without clinical symptoms of vulvovaginal candidiasis referred to Shahid Noorani Talesh Hospital, Gilan University of Medical Sciences, Iran, from April to December 2015 (8 months). All specimens were examined by direct microscopy and culture on CHROMagar Candida medium for isolation and differentiation of major clinical-significant Candida species (spp.). Cultured media were incubated at 35 °C for 48 hours and evaluated based on color and number of grown colonies. If no growth was observed, the media were incubated for several additional days. Subcultures were done on Sabouraud dextrose agar (Merck, Germany) and Corn meal agar with Tween 80 media (Micromedia, Hungary) for further study. Identification of Candida spp. carried out by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method.
Results: In this study, vulvovaginal candidiasis was observed in 20 (25%) patients. Twenty-two isolates were obtained from culture of specimens on CHROMagar Candida medium (Paris, France). The most common isolated species was Candida albicans 16 (72.8%) and followed by Candida glabrata 5 (22.7%), Candida tropicalis 3 (13.6%) and Candida krusei 1 (4.5%) cases. Two patients had mixed infection with 2 different Candida species (C. albicans and C. glabrata) While using PCR-RFLP method, the Candida species were identified as 13 (59.1%) Candida albicans, 5 (22.7%) Candida glabra, 3 (13.6%) Candida tropicalis and 1 (4.5%) Candida krusei cases, respectively. In direct examination were seen yeast budding cells and pseudohyphae in 8 culture positive specimens. In the present study, results of conventional mycological method in differentiation of Candida spp. were consistent with molecular results in 80% of cases. There was also significant correlation between vulvovaginal candidiasis with clinical symptoms (P<0.0001), including diabetes mellitus (P<0.014), and taking antibacterial drugs (P<0.003) in pregnant women.
Conclusion: PCR-RFLP was able to identify correctly the Candida spp. as a complementary method.

Background: Probiotics are living organisms that are beneficial for human health. Lactobacillus species has been considered as probiotic bacteria due to their adjustment of human immune responses and therapeutic effects in inflammatory disorders. The aim of the present study was to evaluate the effects of Lactobacillus probiotic strains on toll-like receptors (TLR2 and TLR4) expression in HT29 cell line (a human colon cancer cell line) infected with S. enteritidis.
Methods: This experimental study was done in Food Microbiology Research Center of Tehran University of Medical Sciences, Iran, from March 2016 to February 2017. In this study, two strains of Lactobacillus acidophilus PTCC 1643 and Lactobacillus casei PTCC 1608 were used. HT29 cells were cultured in RPMI medium containing fetal bovine serum and antibiotics. Then, the cells were treated with the Lactobacillus strains, after or before challenge with S. enteritidis. After total RNA extraction and cDNA synthesis, the capacity of probiotic lactobacilli to modulate TLR2 and TLR4 expression on treated and un-treated HT29 cells were assessed quantitatively using Real-time polymerase chain reaction technique with specific primers.
Results: Our findings indicated that after treatment of non-infected HT29 cells, with both the probiotics, the expression of TLR2 and TLR4 genes significantly increased. In contrast, the expression of these two genes in HT29 cells which were infected with S. Enteritidis was significantly reduced before and after treatment with each one of the probiotic bacteria. The anti-inflammatory effect of probiotic lactobacilli on S. enteritidis were confirmed in tests. This study showed that L. acidophilus and L. casei play a major role in boosting the innate immune responses, the TLR2 and TLR4 expression levels also decreased, pre and post-infection with S. enteritidis.
Conclusion: According to the results, both Lactobacillus strains have remarkable anti-inflammatory effect in pathogenicity of S. enteritidis, but L. acidophilus display greater anti-inflammatory activity than L. casei in this work. Additional in vivo and in vitro studies are required to further elucidate the mechanisms underlying this anti-inflammatory effect.

Background: Opioid poisoning is the most common type of poisoning in intensive care units (ICUs). This group usually includes patients who have been drug abusers for a long time and now require hospitalization either because of acute overdose or due to side effects of routine opioid use. This study aimed to compare the severity and prognosis of patients using common mortality predictors Sequential Organ Failure Assessment (SOFA), Simplified Acute Physiology Score (SAPS II), Acute Physiology And Chronic Health Evaluation (APACHE II, APACHE IV) on different days of hospitalization.
Methods: This cross-sectional study was performed on all patients with opioid poisoning admitted to the ICU, Imam Reza Hospital, Mashhad, Iran, from the beginning of April 2016 to March 2017 (Persian Calendar). For all poisoned patients enrolled in the study, the four mortality predicting tools were filled daily in the first three days of hospitalization and then every other day until discharge from the ICU or patient's death.

Background: Understanding hand structures is necessary to diagnose its diseases and injuries. Several methods have been used to teach the anatomy of this body part. In this article, we introduce a new educational tool and examine the impact of its use in learning anatomy.
Methods: Color images of different layers of hand structures were connected with a spring. On each page, the desired structure was cut and that part could be turned from another direction so that the tool was beyond a booklet and could create a three-dimensional image of the region. In this way, a multi-layered structure was made that looking at each part of it and going to the next part was equivalent to removing a layer from the palm of the hand and observing the layer beneath. After making the educational tool, 280 students who participated in the study were divided into two groups: control (A) and experimental (B). Both groups participated in a pre-test. After teaching the theory of hand anatomy for both groups, the control group received practical training using the traditional method and the experimental group using the proposed educational tool, and both groups participated in a post-test and the scores of the pre and post-test groups were compared. Data were analyzed using SPSS 24 statistical software using Mann-Whitney and Wilcoxon tests.

Conclusion: According to the findings of this study, the measuring of optic nerve sheath diameter in patients suspected of increasing the pressure of idiopathic intracranial hypertension can be helpful as a non–invasive diagnosis method.

Background: Given the significance of patient care in obstetrics and gynecology, we aimed to assess the satisfaction of Tehran University of Medical Sciences residents with their training program in this field.
Methods: In this cross-sectional descriptive study, 77 obstetrics and gynecology residents from the first to fourth year at Tehran University of Medical Sciences participated with informed consent, adhering to ethical principles, from April to October 2023 across four teaching hospitals: Imam Khomeini, Shariati, Mohib Yas, and Arash.The researcher developed a questionnaire consisting of 62 online questions, including 15 demographic questions and 47 related to satisfaction. Most of the questions are statements with five response options: strongly agree, agree no opinion, disagree, and strongly disagree. Each criterion was assessed and classified on a scale from one to five. The assistants' satisfaction levels were assessed in various areas, yielding an overall score of 47-235. Scores above 70% indicate high satisfaction, 50-69% reflects average satisfaction, and below 50% signifies dissatisfaction. It's important to clarify that the areas include clinics, with specific focus on rotation shifts for assistants in gynecology, oncology, prenatal care, and infertility. Data analysis was conducted using SPSS software, Version 22. Descriptive statistics included the median and range for continuous variables (number of surgeries and satisfaction scores) and frequency and percentage for nominal variables (quality of satisfaction) across three defined levels of desirability: appropriate, relatively appropriate, and unfavorable.

Results: Satisfaction with the number of surgeries and educational quality at Imam Khomeini Hospital was higher than at other hospitals (P=0.07). Significant differences were noted in the gynecology and pelvic surgery departments, with residents at both Imam Khomeini and Arash hospitals reporting greater satisfaction in gynecology (P=0.018) and pelvic surgery (P=0.036). Additionally, regarding the conference program and educational mornings, Shariati Hospital reported a higher level of satisfaction in this area (P=0.47). Conclusion: The satisfaction scores in various areas indicate that 64.5% of assistants at Imam Khomeini Hospital rated their educational status as appropriate, while 60% at Arash Hospital rated it as relatively good, and 25% at Yas Hospital found it unfavorable.

Background: one of the most common and important complications of COVID-19 is cough. The present study was designed with the aim of comparing the effect of althaea officinalis and eucalyptus nebulizer on the severity of cough in COVID-19 patients.
Methods: in this randomized clinical trial, from January 2022 to June 2022, 36 patients with COVID-19 were selected and randomly divided into three groups. Next, the severity of cough was recorded two hours before the intervention based on the visual analogue (VAS) in both groups until the patient was admitted to the hospital, then, one cc aqueous extract of althaea officinalis with five cc Normal Saline for the althaea officinalis group and four cc aqueous extract eucalyptus whit five cc Normal Saline for the eucalyptus group, were nebulized once a day for 15 minutes. Two hours after the intervention, the intensity of cough was again recorded in two groups. This intervention continued until the hospitalization of the patients. No intervention was done for the control group. The data was analyzed with Spss software at a significance level of less than 0.05.

Results: In this study before the intervention, there was no statistically significant difference between the three groups in terms of cough intensity (p>0.05), but after the intervention on the second and third days, there was a statistically significant difference between the three groups in terms of cough intensity. The rate of reduction in cough severity in althaea officinalis group was higher than the other two groups (p<0.05).  Also, the results of Friedman's test indicated that althaea officinalis and eucalyptus nebulizers incense improved the severity of cough in patients over time. Conclusion: the use of althaea officinalis and eucalyptus nebulizer improved the severity of cough in patients with COVID-19, but althaea officinalis nebulizer had a greater effect on cough severity compared to eucalyptus. It is suggested to use althaea officinalis nebulizer as well as eucalyptus as a treatment method along with other treatment methods.

Background: Recently, epinephrine is used to increase the depth and duration of local anesthetic pain, and it is widely used topically to reduce local anesthetic release and reduce bleeding caused by surgery.
Methods: This study was a randomized, double-blind clinical trial on 30 patients aged 18 to 85 years undergoing lower limb orthopedic surgery referred to Peymaniyeh Hospital in Jahrom from September to December 2022. Patients were randomly assigned to two groups, A (epinephrine+fentanyl+bupivacaine) and B (bupivacaine+fentanyl). Systolic blood pressure, diastolic pressure, mean arterial pressure, arterial blood oxygen saturation percentage, and pulse rate were measured and recorded before drug administration, before spinal anesthesia, after anesthesia, and then every half hour until the end of surgery (15, 45, 30, 60, 75, 90, 120) and during recovery. Data analysis was performed using SPSS version 21 software and descriptive (mean, standard deviation) and inferential statistics (t-test, chi-square, Mann-Whitney, Friedman) at a significance level of P<0.05.

Results: Thirty patients aged 18 to 85 years (in two groups of 15) with anesthesia class I and II undergoing lower limb orthopedic surgery were evaluated. The study groups are matched in terms of age and gender variables. There was no significant difference in mean systolic, diastolic, mean arterial blood pressure, and heart rate before and after anesthesia, 15, 45, 30, 60, 75, 90, and 120 minutes after drug injection, and at entry and exit from recovery between the Epinephrine+Fentanyl+Bupivacaine and Fentanyl+Bupivacaine groups. There was a significant difference in mean O2SAT before anesthesia, 15, 30, and 75 minutes after drug injection between the epinephrine+fentanyl+bupivacaine and fentanyl+ bupivacaine groups (P<0.05). Conclusion: The use of the combination of epinephrine+fentanyl+intrathecal bupivacaine compared to the combination of fentanyl+bupivacaine did not have a significant difference in the studied variables of patients' vital signs.

Background: Abortion is the termination of pregnancy before the 20th week of pregnancy, which may be spontaneous or induced. In general, therapeutic abortion is defined as the termination of pregnancy before the 20th week of pregnancy in order to save the mother's life and prevent birth defects. The purpose of this study is to investigate the causes of legal abortion in women referring to Amir al-Mominin Ali hospital in Zabol city.
Methods: This study is a descriptive-cross-sectional study. The studied population included women who had a legal abortion on March 1, 2022 to September 1, 2022 at Amir al-Mominin Ali Zabol Hospital (Zabol-Iran). The tool used was a checklist made by the researcher and approved by the faculty members of Zabol University of Medical Sciences. The researchers collected the necessary information, including demographic information, obstetrics and mother's illness, fetal disorders, test results, ultrasound screenings, pathology results of patients and other conditions that led to the issuance of an abortion license.

Results: In the specified period of time, there were 100 abortion cases that were investigated, and 78 (78%) of these abortions had maternal causes and 22% had fetal causes. The most common maternal causes of abortion were cardiovascular problems (7%) and mothers' age. Also, the most fetal causes were cerebrospinal causes (23%). Mothers who had abortions of maternal origin were significantly older than mothers with abortions of fetal origin (p=0.009). Conclusion: The present study showed that in Sistan region, most cases of legal abortion depended on fetal reasons and mothers' age.

Results: The mean age was 38.8±18 years, and 17 patients (53.1%) were male. Cardiac diseases were the most common underlying disease, and 15.7% of patients were immunocompromised. Fever and mono-arthritis were the most common symptoms and signs, respectively. Serologic investigations were negative in 12 patients (37.5%). 84.4% of patients had anemia. There was no mortality among patients.
Conclusion: A significant property of patients with positive blood culture for Brucella may not be identified with serologic assays, so if there is strong clinical suspicion of brucellosis, blood culture should also be considered. According to this study, bacteremic brucellosis is not accompanied by mortality, and the patients respond well to common antibiotic regimens.