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Shahla Afsharpaiman , Amir Skandari , Zareian Jahromi Maryam , Shokoofeh Radfar , Shahnaz Shirbazoo , Susan Amirsalari , Mohammad Torkaman ,
Volume 72, Issue 2 (May 2014)
Volume 72, Issue 2 (May 2014)
Abstract
Background: Toxoplasma gondii, is a mandatory intracellular protozoa, that many people worldwide are infected with. In children, the infection enters central nervous system and leads to inflammation of the gray matter. Autism, is a complex develop-mental disorder, altering social communication, with unknown origin. Neuropathologi-cal changes in autism are the same as those occurred in brain toxoplasmosis. The objective of this survey was to evaluate positive serology of toxoplasma gondii, in autistic children. Methods: This case-control study was done on 3-12 years old children, referring to the neurology and psychiatry sub-special clinics of Baqiyatallah hospital and also autistic children of Omid-e Asr and Navid-e Asr general rehabilitation centers in Tehran, Iran. The study performed at 2012-2013. Forty autistic children were placed in the case group and 40 children, suffering from no neuropsychiatric disease or other ones, were placed in the control group. A folder, containing demographic data, type of the disor-der, onset of diagnosis and child characteristics at birth, such as time of birth (preterm/ term) fulfilled for each child. Sampling was done with 5 ml blood, for determining IgM and IgG antibody levels against toxoplasma gondii, using ELISA method. Data ana-lyzed by the software SPSS ver. 17 and descriptive and analytic analysis were done, us-ing central and dispersion indexes and also chi-Square test. Results: The autistic group contained 34 boys and 6 girls (85 and 15 percent respectively), with the average age of 6 (±2.71) years old [minimum of 2.33 and maximum of 12]. The average age at the time of diagnosis was 4.01 (±1.87) years old. 87. The non-autistic group contained 17 boys and 23 girls (42.5 and 57.5 percent respectively), with the average age of 5.67 (±3.09) years old [minimum of two and maximum of 12]. IgM and IgG serology of all autistic children were negative, while in non-autistic group, 2.5 percent (1 child) were positive and 97.5 percent (39 ones) were negative. There were no statistically significant difference among these two groups according to the serology results. (P=0.31). Conclusion: There was no statistically significant difference in comparing positive se-rology of toxoplasmosis, between the two groups. However, to obtain a perfect result, a larger sample size are required.
Soror Roozafzay , Khadijeh Hekmat , Kobra Shojaei , Pourandokht Afshari , Mohammad Bahadoram ,
Volume 72, Issue 5 (August 2014)
Volume 72, Issue 5 (August 2014)
Abstract
Background: Bacterial vaginosis (BV) is the most prevalent causes of abnormal secre-tion in women at fertility age. Also, Bacterial vaginosis is one of the most common dis-eases in women who refer to gynecology clinic. The main cause of the pathogenesis is increasing pH of vagina due to reduced number of lactobacillus and growth of anaero-bic bacteria. Prevalence of BV varies between 10 to 30 percent in different societies. Amsel criteria is used as diagnostic test in BV. This interventional study was designed to assess the impact of vaginal lactobacillus suppository and metronidazole compared to metronidazole alone on the recovery and recurrence of bacterial vaginosis. Methods: This study was a prospective, randomized, double-blind clinical trial which was conducted on 130 women with bacterial vaginosis to compare the effects of vagi-nal lactobacillus suppository and metronidazole. Bacterial vaginosis was diagnosed us-ing Amsel criteria that based on some clinical symptoms. Patients were divided into two groups, first group were treated with oral metronidazole plus lactobacillus and second group were treated with metronidazole alone. Patients were followed-up one week and four weeks after initiation of the treatment. Results: One hundred and thirty women completed the study. Patients were followed at one and four weeks after initiation of intervention. Amsel criteria and recovery rate in both groups compared before treatment one and four weeks after treatment. The crite-ria and treatment were significantly improved, but this improvement was higher and statistically significant in the metronidazole plus Lactobacillus group compared to sec-ond group (P< 0.0001). Conclusion: The protective effects of lactobacillus in dealing with anaerobic patho-gens as well as the negative impact of metronidazole on lactobacillus of vaginal flora, use of lactobacillus along with metronidazole especially in patients with recurrent infec-tions is recommended. In other words, using lactobacillus with metronidazole for treatment of bacterial vaginosis is more effective than metronidazole alone.
Ladan Afshar Khas , Azardokht Tabatabaei , Samileh Noorbakhsh , Atefeh Kargozar ,
Volume 73, Issue 7 (October 2015)
Volume 73, Issue 7 (October 2015)
Abstract
Background: Convulsion is one of the common cause of hospital admission in children. Idiopathic seizure is when no anatomic, electrolytic, metabolic or hemorrhagic causes are found. Recently, lead poisoning, which is considered when serum lead levels are higher than the normal levels (previously 10 &mug/dl changed to 5 &mug/dl). Even lower levels of lead inflict harmful consequences in central nervous system (CNS) development in pediatric group. Due to air pollution and high lead level in air of Tehran, investigation the probable role of lead in producing or predisposing convulsion in children is very important. To determine the cerebrospinal fluid (CSF) lead level in children with idiopathic convulsion in compare with nonconvulsive ones (control). Methods: A case-control study upon 60 children (30 convulsive and 30 nonconvulsive control) admitted in Rasoul Akram and Ali Asghar University Hospitals, Tehran, from 2012 to 2013 had done. One ml of CSF obtained and lead level determined by atomic absorption test. Results: The mean age between cases and controls was not different (mean= 30.18+27.36 vs 25.46±20.56 months, P= 0.1). The CSF lead level (&mug/dl) had not meaningful difference between 2 groups (3.43+3.07 vs 2.78+2.77, P= 0.3), and no related to type of convulsion in cases (P= 0.7), the area under the curve (AUC) was 0.588 1-0.433, P= 0.2). The CSF lead cutoff was 1.65 &mug/dl sensitivity of 70%, specificity of 46%, PPV and NPV was 56% and 60% respectively. Conclusion: The toxic blood level for lead is 3.5 &mug/dl. The CSF lead level even in little amount (1.65 &mug/dl) is an acceptable sensitivity but lower specificity for differentiation the convulsive from nonconvulsive children. Although the role of genetic and other causes should be considered in idiopathic convulsion, probably, the high level of lead in CSF could predispose those children to convulsion. It can effect CNS development in children even in small amounts. Indeed, long-term effects of lead which continue to adulthood should be considered as well. Hence, it is paramount to rectify the ambient air lead pollution in Tehran.
Behshsd Pazooki , Orkideh Olang, Ali Afshari , Nasim Khajavirad , Batool Ghorbani Yekta,
Volume 74, Issue 8 (November 2016)
Volume 74, Issue 8 (November 2016)
Abstract
Background: To assess patient' reaction towards bedside teaching in the nephrology ward of Imam Khomeini Hospital Complex (Tehran) and to identify the factors that may influence it.
Methods: A cross-sectional study was conducted in the nephrology ward of Imam Khomeini Hospital Complex from march to September, 2014. All inpatients present on the day of the study were interviewed using a structured questionnaire.
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Results: 146 patients were examined in this study that 62 patients (42.5%) were women and 84 cases (57.5%) were men. 112 (76.7%) of patients had a good feeling about the training to physicians. The behavior of students was evaluated respectful by 132 individuals (90.4% of patients). Total number of 106 individuals (72.6% of patients) had trusted to the health care team and 120 people (82.2% of patients) knew that the physicians’ behaviors are associated with the respect to their religious beliefs. Not being same sex of the examiners was important for 47 individuals (32.2% of patients). The number of 123 cases (84.2% of patients) evaluated the physicians' behavior with respect to their privacy. The number of 119 individuals (81.5% of patients) received their responses from the examiners. Statistical tests indicate a significant relationship between the respectful behavior of students with patient and good feeling about training to physicians, so that the 95.5% of people who have seen the respectful behavior of students to oneself had a good feeling about training to physicians (P˂0.001). The relationship between the presence of teacher with students and good feeling on training to physicians was significant (P=0.013). Positive feeling about practicing physicians was associated with patient age. So the age average of people who feel good about practicing physicians was significantly lower than the other people (47.2±17 versus 55.6±18 and P=0.028). Conclusion: The relationship between respectful behavior and presence of teacher with students and age and good feeling on training to physicians was significant. |
Zahra Kamali Sarwestani , Alireza Dasdar , Setareh Agha Kuchak Afshari , Mohsen Gerami Shoar , Seyyed Jamal Hashemi , Reza Pakzad , Pegah Ardi , Alireza Abdollahi , Mohammad-Taghi Haghi-Ashtiani, Shahram Mahmoudi ,
Volume 75, Issue 4 (July 2017)
Volume 75, Issue 4 (July 2017)
Abstract
Background: Fungi have a worldwide distribution which can cause a broad spectrum of disease ranging from allergic to systemic infections, particularly in immuno-compromised individuals. Fungal spores are an important group of bioaerosols in hospital environment which are an emerging cause of hospital-acquired infection. Nosocomial infections cause significant morbidity and mortality as well as large financial burden on the healthcare system. This study aimed to evaluate the frequency and species distribution of airborne fungi in selected wards of two tertiary hospitals in Tehran, Iran.
Methods: In this cross-sectional study, samples were collected during six months from July 2016 to December 2016 by using of settle plate method. Samples were collected from selected wards of Imam Khomeini Hospital and Children's Medical Center and then incubated at 28 °C for 8-10 days. Fungal isolates were identified using the macroscopic features of colony and microscopic characteristics in slide cultures. Yeast isolates were identified by CHROMagar candida medium. PCR-sequencing of ITS1-5.8 S-ITS2 region of ribosomal DNA was used for identification of unknown isolates.
Results: A total of 202 colonies including 133 colonies from the Imam Khomeini Hospital and 69 colonies from the Children's Medical Center were isolated. Cladosporium spp. were the most common obtained fungi accounted for 30.1% and 47.8% of all isolates in the Imam Khomeini Hospital and the Children's Medical Center, respectively. Penicillium spp. and Aspergillus spp. were other frequent species in two hospitals. Infectious diseases ward in Imam Khomeini hospital and emergency and urology wards in Children's Medical Center had the highest rate of contamination.
Conclusion: According to the results of this study, the frequency and diversity of fungal spores in hospital wards were different. In addition, since the fungal contamination in the hospital environment are affected by various environmental factors and the efficiency of ventilation systems, some of these wards require better ventilation system as well as regular monitoring to remove these fungal bioaerosols in order to maintain the health of patients and health care workers.
Methods: In this cross-sectional study, samples were collected during six months from July 2016 to December 2016 by using of settle plate method. Samples were collected from selected wards of Imam Khomeini Hospital and Children's Medical Center and then incubated at 28 °C for 8-10 days. Fungal isolates were identified using the macroscopic features of colony and microscopic characteristics in slide cultures. Yeast isolates were identified by CHROMagar candida medium. PCR-sequencing of ITS1-5.8 S-ITS2 region of ribosomal DNA was used for identification of unknown isolates.
Results: A total of 202 colonies including 133 colonies from the Imam Khomeini Hospital and 69 colonies from the Children's Medical Center were isolated. Cladosporium spp. were the most common obtained fungi accounted for 30.1% and 47.8% of all isolates in the Imam Khomeini Hospital and the Children's Medical Center, respectively. Penicillium spp. and Aspergillus spp. were other frequent species in two hospitals. Infectious diseases ward in Imam Khomeini hospital and emergency and urology wards in Children's Medical Center had the highest rate of contamination.
Conclusion: According to the results of this study, the frequency and diversity of fungal spores in hospital wards were different. In addition, since the fungal contamination in the hospital environment are affected by various environmental factors and the efficiency of ventilation systems, some of these wards require better ventilation system as well as regular monitoring to remove these fungal bioaerosols in order to maintain the health of patients and health care workers.
Ali Mohammad Mosadeghrad , Mahnaz Afshari ,
Volume 75, Issue 10 (January 2018)
Volume 75, Issue 10 (January 2018)
Abstract
Background: Hospitals are dealing with unlimited demands and limited resources. Hospital managers should use appropriate strategies to improve quality of services, enhance patients’ satisfaction and increase financial resources. This study aimed to examine the impact of quality management.
Methods: A participatory action research was used for the intervention on income of operating theatre in Vali-e-Asr Hospital in Tehran University of Medical Sciences, between March and September 2014. A quality improvement team was established and improved operational processes of the operating theatre department of the hospital using Mosadeghrad’s ten-step quality management model. The quality improvement team standardized processes, identified goals for the processes and improved them until achieved the goals. Accordingly, an action plan was developed and implemented for increasing the income of the operating theatre department. Income data of the operating theatre department were obtained for a 6-month period in 2014, and were compared with a control 6-month period in 2013.
Results: Implementing quality management increased the number of surgeries by 14.96 percent, decreased cancelled surgeries by 14.6 percent and reduced bill deductions imposed by health insurance companies by 44.9 percent. As a result, the operation theatre department income has increased by 68.8 percent (P=0.028). Some of solutions used for increasing the income were as standardizing and improving working processes, removing unnecessary activities, empowering staff; increasing department’s working hours, on time visit of patients by doctors and surgeons, reducing surgery cancellations, increasing number of patients, reducing deductions applied by the health insurance companies and training staff and patients.
Conclusion: Implementing an appropriate quality management model appropriately helps improve quality of services and enhance hospital departments’ income.
Methods: A participatory action research was used for the intervention on income of operating theatre in Vali-e-Asr Hospital in Tehran University of Medical Sciences, between March and September 2014. A quality improvement team was established and improved operational processes of the operating theatre department of the hospital using Mosadeghrad’s ten-step quality management model. The quality improvement team standardized processes, identified goals for the processes and improved them until achieved the goals. Accordingly, an action plan was developed and implemented for increasing the income of the operating theatre department. Income data of the operating theatre department were obtained for a 6-month period in 2014, and were compared with a control 6-month period in 2013.
Results: Implementing quality management increased the number of surgeries by 14.96 percent, decreased cancelled surgeries by 14.6 percent and reduced bill deductions imposed by health insurance companies by 44.9 percent. As a result, the operation theatre department income has increased by 68.8 percent (P=0.028). Some of solutions used for increasing the income were as standardizing and improving working processes, removing unnecessary activities, empowering staff; increasing department’s working hours, on time visit of patients by doctors and surgeons, reducing surgery cancellations, increasing number of patients, reducing deductions applied by the health insurance companies and training staff and patients.
Conclusion: Implementing an appropriate quality management model appropriately helps improve quality of services and enhance hospital departments’ income.
Ali Mohammad Mosadeghrad , Negar Mirzaee , Mahnaz Afshari , Alireza Darrudi ,
Volume 76, Issue 4 (July 2018)
Volume 76, Issue 4 (July 2018)
Abstract
Background: Tariff setting in healthcare is an important control knob affecting the quality, access and cost of services. As part of Iran Health Transformation Plan (HTP) in 2014, the relative value of health care and services was increased to motivate healthcare providers to deliver high quality services. This study aimed to examine the impact of HTP on health services tariffs.
Methods: This descriptive and cross-sectional study used the data from California Tariff Book (2013 edition) and the new relative value book (2016 edition). The weighted average of the relative value of the anesthetic and surgical services in both books was calculated and compared.
Results: The California book and the new relative value book had 5281 and 3448 service codes respectively in 13 major medical specialties (34.7 percent reduction of service codes in the new tariff book). Overall, 64985.9 K and 125133.6 K were considered in the California book and the new relative value book (92.6% growth). The California book and the new relative value book considered 25,976 K and 22,307 K for anesthesia services, respectively in those 13 medical specialties (14.1% reduction). The HTP has increased the relative value of healthcare services tariff by 1.9 times in average.
Conclusion: The HTP has doubled the tariff of healthcare services. A rise in the relative value of healthcare services has incurred financial burden on Iranian public health insurance companies and made it difficult to finance health system of the country. A sustainable health financing system should be developed as well a change should be applied in provider payment system to control the cost and increase the health system efficiency.
Methods: This descriptive and cross-sectional study used the data from California Tariff Book (2013 edition) and the new relative value book (2016 edition). The weighted average of the relative value of the anesthetic and surgical services in both books was calculated and compared.
Results: The California book and the new relative value book had 5281 and 3448 service codes respectively in 13 major medical specialties (34.7 percent reduction of service codes in the new tariff book). Overall, 64985.9 K and 125133.6 K were considered in the California book and the new relative value book (92.6% growth). The California book and the new relative value book considered 25,976 K and 22,307 K for anesthesia services, respectively in those 13 medical specialties (14.1% reduction). The HTP has increased the relative value of healthcare services tariff by 1.9 times in average.
Conclusion: The HTP has doubled the tariff of healthcare services. A rise in the relative value of healthcare services has incurred financial burden on Iranian public health insurance companies and made it difficult to finance health system of the country. A sustainable health financing system should be developed as well a change should be applied in provider payment system to control the cost and increase the health system efficiency.
Gholamreza Amin, Aram Mousavi Pharm , Shohreh Vosough , Zahra Jafary Azar , Mamak Shariat , Fedyeh Haghollahi , Shima Afshar ,
Volume 76, Issue 6 (September 2018)
Volume 76, Issue 6 (September 2018)
Abstract
Background: Menopause is a critical and sensitive period and has a common symptom of vasomotor signs, psychologic changes and sleep disorders. With regarding the citalopram complications and effects of Iranian herbs, the aim of this study was to compared the therapeutic effect of the combination of area part of Melissa officinalis and fennel fruits extract with Nigella sativa powder with citalopram on menopausal symptoms of post-menopausal women.
Methods: This randomized clinical trial was conducted in Islamic Azad University of Pharmaceutical Sciences, Tehran, Iran, from April 2015 to October 2017. 56 postmenopausal women referred to the clinics of Gorgan health centers with the age between 45 and 65 years, natural menopause confirmed by amenorrhea for at least 12 months, discomfort a hot flash were randomized to two treatment groups. Group 1 (28 patients) received 1000 mg (Melissa officinalis extract, Nigella saliva powder, and fennel fruits) and Group 2 (19 subjects) received 20 mg citalopram in an eight-week course of treatment (1 per day for each group). The frequency of the variables in the Menopause-Specific Quality of Life Questionnaire (MENQOL) was compared in the two groups before and post intervention. The questionnaire included of twenty-nine questions in four domains of vasomotor, psycho-social, physical and sexual symptoms.
Results: The mean age in the herbal treatment group was 47.78±5.5 years and in the citalopram group was 46.4±4.9 years, and t-test did not show this difference in two groups (P=0.362). There was no significant difference in the improvement of menopausal symptoms compared to the citalopram group in the combined product group, but the feeling of anger and fatigue in the citalopram group was greater after treatment (P=0.03).
Conclusion: The present study showed that the combination of Nigella Sativa, Melissa officinalis extract, and fennel fruits generally do not reduce menopausal symptoms in postmenopausal women, and it's just the feeling of anger and fatigue has been better than the citalopram group.
Methods: This randomized clinical trial was conducted in Islamic Azad University of Pharmaceutical Sciences, Tehran, Iran, from April 2015 to October 2017. 56 postmenopausal women referred to the clinics of Gorgan health centers with the age between 45 and 65 years, natural menopause confirmed by amenorrhea for at least 12 months, discomfort a hot flash were randomized to two treatment groups. Group 1 (28 patients) received 1000 mg (Melissa officinalis extract, Nigella saliva powder, and fennel fruits) and Group 2 (19 subjects) received 20 mg citalopram in an eight-week course of treatment (1 per day for each group). The frequency of the variables in the Menopause-Specific Quality of Life Questionnaire (MENQOL) was compared in the two groups before and post intervention. The questionnaire included of twenty-nine questions in four domains of vasomotor, psycho-social, physical and sexual symptoms.
Results: The mean age in the herbal treatment group was 47.78±5.5 years and in the citalopram group was 46.4±4.9 years, and t-test did not show this difference in two groups (P=0.362). There was no significant difference in the improvement of menopausal symptoms compared to the citalopram group in the combined product group, but the feeling of anger and fatigue in the citalopram group was greater after treatment (P=0.03).
Conclusion: The present study showed that the combination of Nigella Sativa, Melissa officinalis extract, and fennel fruits generally do not reduce menopausal symptoms in postmenopausal women, and it's just the feeling of anger and fatigue has been better than the citalopram group.
Babak Mansour Afshar , Mohammad Reza Gheini, Tayeb Ramim ,
Volume 76, Issue 12 (March 2019)
Volume 76, Issue 12 (March 2019)
Abstract
Background: Asymptomatic hemorrhagic transformation infarct (AHTI) is known as a complication of ischemic attack and maybe occurs in the entire stroke. However, the role of AHTI in the result of the treatment is still not clear, because it is based on the definition of an asymptomatic and not identifiable. The aim of this study was assessment and evaluation frequency of AHTI in acute ischemic stroke patients.
Methods: This prospective cross-sectional study was done in Neurologic Department, Tehran University of Medical Sciences, Tehran, Iran, from April 2015 to April 2016. Second evaluation was done about new neurologic signs and symptoms ten days after stroke. In addition, brain CT scan was used to diagnose of hemorrhagic event in infarct area. If the hemorrhagic event was occur in different area, the patient was consider as a non-hemorrhagic transformation and excluded from the study. Other exclusion criteria include intracranial hemorrhage (ICH), trauma to the head during admission, cerebral vein thrombosis, coagulation disorder, anti-coagulant (heparin, warfarin) administration, induced transformation within 10 days of onset of ischemia, lacunar ischemic and unobservable in thirty T-brain scan, patient's lack of referral for examination and CT scan 10 days after the onset of symptoms, died before CT was considered.
Results: Three hundred and eighty seven patients had inclusion criteria. 249 cases were excluded due to lost following, vein thrombosis of the brain, lacunar ischemia, anti-coagulants recipient (heparin, warfarin), asymptomatic hemorrhagic transformation and death. Finally, 138 cases (86 men, 52 women) with 66.61±9.37 years (50-101 years) were participated in data analysis. Frequency of positive CT scan was evaluated for ischemic stroke evidence in two stages. Of the 138 patients who participated in the study, 75 (54.3%) were positive in the first and 63 (45.7%) cases in the second time. 27 cases (19.6%) had AHTI.
Conclusion: Coronary artery bypass graft (CABG) had significant correlation with ATHI in acute ischemic attack. However, stroke history correlated with decreasing of ATHI. Concerning smoking and consuming the results showed that smoking did not affect the asymptomatic hemorrhagic transformation. Also, the results showed that the use of aspirin and Plavix also had no significant effect on increasing the incidence of ATHI.
Methods: This prospective cross-sectional study was done in Neurologic Department, Tehran University of Medical Sciences, Tehran, Iran, from April 2015 to April 2016. Second evaluation was done about new neurologic signs and symptoms ten days after stroke. In addition, brain CT scan was used to diagnose of hemorrhagic event in infarct area. If the hemorrhagic event was occur in different area, the patient was consider as a non-hemorrhagic transformation and excluded from the study. Other exclusion criteria include intracranial hemorrhage (ICH), trauma to the head during admission, cerebral vein thrombosis, coagulation disorder, anti-coagulant (heparin, warfarin) administration, induced transformation within 10 days of onset of ischemia, lacunar ischemic and unobservable in thirty T-brain scan, patient's lack of referral for examination and CT scan 10 days after the onset of symptoms, died before CT was considered.
Results: Three hundred and eighty seven patients had inclusion criteria. 249 cases were excluded due to lost following, vein thrombosis of the brain, lacunar ischemia, anti-coagulants recipient (heparin, warfarin), asymptomatic hemorrhagic transformation and death. Finally, 138 cases (86 men, 52 women) with 66.61±9.37 years (50-101 years) were participated in data analysis. Frequency of positive CT scan was evaluated for ischemic stroke evidence in two stages. Of the 138 patients who participated in the study, 75 (54.3%) were positive in the first and 63 (45.7%) cases in the second time. 27 cases (19.6%) had AHTI.
Conclusion: Coronary artery bypass graft (CABG) had significant correlation with ATHI in acute ischemic attack. However, stroke history correlated with decreasing of ATHI. Concerning smoking and consuming the results showed that smoking did not affect the asymptomatic hemorrhagic transformation. Also, the results showed that the use of aspirin and Plavix also had no significant effect on increasing the incidence of ATHI.
Amir Hossein Hashemian , Sara Manochehri , Daryoush Afshari , Zohreh Manochehri , Nader Salari , Soodeh Shahsavari,
Volume 77, Issue 1 (April 2019)
Volume 77, Issue 1 (April 2019)
Abstract
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.
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.
Dariush Afshari Aliabadi , Nasrin Moradian , Elham Rahmanian , Masoud Mohammadi ,
Volume 78, Issue 3 (June 2020)
Volume 78, Issue 3 (June 2020)
Abstract
Background: Guillain-Barré syndrome is an autoimmune inflammatory disease, which manifests itself as an acute motor weakness of the organs, diagnosed as affecting the motor spinal nerve roots generally and causing muscle and motor weakness, the cause of this disease is the presence of active antibodies against the myelin sheath around the spinal nerve roots. Guillain-Barré syndrome is the most common and most severe unpleasant neuropathy that affects about 100,000 people worldwide annually.
Methods: This is a descriptive analytical study, the data of 354 admitted patients were reviewed and 262 cases, which matched the criteria for entering the study, was included. The criterion for entering the study was clinical diagnosis.Required information were included age, sex, complaints of disease, and visitation period. Data was analyzed by using Microsoft Excel 2013 (Microsoft Corp., Redmond, WA, USA) and study was performed on Imam Reza and Farabi Hospitals of Kermanshah in Iran, from March 1993 to February 2013.
Results: 59.5% were male and 40.5% female, and the mean age of the patients was 44.6±22.9. The most affected individuals were at the age of 30-50 and the highest prevalence was observed in spring. Acute inflammatory demyelinating poly-radiculoneuropathy with 53.4% was the most common backward disorder in patients and 5.7% among deaths among patients.
Conclusion: The results of the present study showed that Acute inflammatory demyelinating poly-radiculoneuropathy had the highest prevalence in patients and decreased with increasing age, and this syndrome was more prevalent in the spring.
Methods: This is a descriptive analytical study, the data of 354 admitted patients were reviewed and 262 cases, which matched the criteria for entering the study, was included. The criterion for entering the study was clinical diagnosis.Required information were included age, sex, complaints of disease, and visitation period. Data was analyzed by using Microsoft Excel 2013 (Microsoft Corp., Redmond, WA, USA) and study was performed on Imam Reza and Farabi Hospitals of Kermanshah in Iran, from March 1993 to February 2013.
Results: 59.5% were male and 40.5% female, and the mean age of the patients was 44.6±22.9. The most affected individuals were at the age of 30-50 and the highest prevalence was observed in spring. Acute inflammatory demyelinating poly-radiculoneuropathy with 53.4% was the most common backward disorder in patients and 5.7% among deaths among patients.
Conclusion: The results of the present study showed that Acute inflammatory demyelinating poly-radiculoneuropathy had the highest prevalence in patients and decreased with increasing age, and this syndrome was more prevalent in the spring.
Mansour Rezaei , Daryush Afshari, Negin Fakhri, Nazanin Razazian,
Volume 79, Issue 4 (July 2021)
Volume 79, Issue 4 (July 2021)
Abstract
Background: Multiple Sclerosis (MS) is one of the most debilitating disease among young adults. Understanding the disability score (Expanded Disability Status Scale (EDSS)) of these patients is helpful in choosing their treatment process. Calculating EDSS takes a lot of time for Neurologists, so having a way to estimate EDSS can be helpful. This study aimed to estimate the EDSS score of MS patients using statistical models including Artificial Neural Network (ANN) and Decision Tree (DT) models.
Methods: This cross-sectional study was performed on MS registry study data of Kermanshah province from April 2017 to November 2018. From the total data available in the registry system, The 12 variables including demographic information, information about MS disease and their EDSS score were extracted. EDSS scores were also estimated using ANN and DT models. The performance of the models was compared in terms of estimation error, correlation and mean of an estimated score. Data were analyzed using Weka software version 3.9.2 and SPSS software version 25 with a significance level of 0.05.
| Results: In this study, 353 people were studied. The mean age of the patients was 36.47±9.1 years, the mean age of onset was 9.2±30.34 years, the mean duration of the disease was 6.20±5.7 years and the mean EDSS score was 2.46±1.8. Estimation errors in the DT model were lower than in the ANN model. The real EDSS score was significantly correlated with scores estimated by DT (r=0.571) and ANN (r=0.623). The mean EDSS estimated by the DT model (2.46±1.1) was not significantly different from the real EDSS mean (P=0.621) but the mean EDSS estimated by the ANN model (2.87±1.3) was significantly higher than the real EDSS mean. (P<0.05). Conclusion: The DT model could better estimate the EDSS score of MS patients than the ANN model and made predictions that were closer to the actual EDSS scores. Therefore, the DT model can accurately estimate the EDSS score of MS patients. |
Fakhroddin Aghajanpour, Reza Soltani, Azar Afshar, Hojjat Allah Abbaszadeh, Reza Mastery Farahani, Mohsen Nourozian,
Volume 79, Issue 4 (July 2021)
Volume 79, Issue 4 (July 2021)
Abstract
Background: The median nerve is one of the most important branches of the brachial plexus. Due to the role of the median nerve in sensory and motor innervation of the forearm and hand in the upper limbs, its blood supply is very important. Awareness of variations in the blood supply pattern to this nerve reduces the incidence of necrosis and ischemia of the nerve during surgical and diagnostic procedures.
Case Presentation: During routine dissection of the cadaver of a 65-year-old man fixed in formalin (10%), in the Department of Anatomy and Reproductive Biology, Shahid Beheshti University of Medical Sciences, a rare variation was observed in the median nerve nutritional artery at the distal end of the left forearm. After dissection of the skin, superficial and deep fascia, anterior compartment forearm muscles, nerves and blood vessels were exposed from surrounding tissues. The median nerve passed through the two heads of the pronator teres muscle and left the cubital fossa in the depth of the flexor digitorum superficialis and the surface of the flexor digitorum profundus in the forearm. It was observed that at the distal end of the left forearm between the flexor carpi radialis and the flexor digitorum superficialis, a relatively thick branch originates from the radial artery and supplies blood to the median nerve. This branch was separated from the radial artery (before the artery enters the anatomical snuffbox) and crossed the surface of the flexor carpi radialis muscle and inserted into the median nerve sheath. In the forearm, this branch was the only artery supplying blood to the median nerve.
Case Presentation: During routine dissection of the cadaver of a 65-year-old man fixed in formalin (10%), in the Department of Anatomy and Reproductive Biology, Shahid Beheshti University of Medical Sciences, a rare variation was observed in the median nerve nutritional artery at the distal end of the left forearm. After dissection of the skin, superficial and deep fascia, anterior compartment forearm muscles, nerves and blood vessels were exposed from surrounding tissues. The median nerve passed through the two heads of the pronator teres muscle and left the cubital fossa in the depth of the flexor digitorum superficialis and the surface of the flexor digitorum profundus in the forearm. It was observed that at the distal end of the left forearm between the flexor carpi radialis and the flexor digitorum superficialis, a relatively thick branch originates from the radial artery and supplies blood to the median nerve. This branch was separated from the radial artery (before the artery enters the anatomical snuffbox) and crossed the surface of the flexor carpi radialis muscle and inserted into the median nerve sheath. In the forearm, this branch was the only artery supplying blood to the median nerve.
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Conclusion: Due to the superficial position of the median nerve at the distal end of the forearm, physical damage to the nerve and its nutritional artery leads to necrosis and ischemia of the nerve, and ultimately disturbed the transmission of sensory and motor messages.
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Ali Mohammad Mosadeghrad, Ghasem Janbabai , Behzad Kalantari, Mahnaz Afshari, Hamed Dehnavi ,
Volume 79, Issue 5 (August 2021)
Volume 79, Issue 5 (August 2021)
Abstract
Background: Hospital accreditation is a systematic external evaluation of a hospital's structures, processes, and outcomes by an independent professional accreditation body using published optimum, evidence‐based, and achievable standards. Accreditation is a strategy for ensuring the quality, safety, and productivity of hospital services. Implementing accreditation standards imposes a high cost on hospitals. Therefore, this cost should be offset by increased hospital efficiency. Hence, this study aimed to examine the relationship between the Iranian public hospitals’ efficiency and their accreditation status.
Methods: This descriptive and cross-sectional study was conducted in May 2019. The efficiency of general hospitals in Iran was assessed using the Pabon Lasso chart and three performance indicators of bed occupancy rate, average patient length of stay and hospital bed turnover. Then, the relationship between the efficiency of hospitals and their accreditation grade was examined. Descriptive statistics and ANOVA tests were used for data analysis using SPSS software.
Methods: This descriptive and cross-sectional study was conducted in May 2019. The efficiency of general hospitals in Iran was assessed using the Pabon Lasso chart and three performance indicators of bed occupancy rate, average patient length of stay and hospital bed turnover. Then, the relationship between the efficiency of hospitals and their accreditation grade was examined. Descriptive statistics and ANOVA tests were used for data analysis using SPSS software.
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Results: There were 834 general hospitals with 108,275 active beds in Iran in 2018. The Iranian general hospitals had an average bed occupancy of 62.8%, an average patient length of stay of 2.6 days, and an average bed turnover of 93.4 times. Almost 15.3% of the hospitals performed well and were located in area 3 of the Pabon Lasso chart. About 36.1% and 48.6% of the hospitals had moderate and low efficiency, respectively. Approximately, 74% and 21% of hospitals had the accreditation status of 1 and 2, respectively. There was a significant relationship between the degree of accreditation of hospitals with their bed occupancy, bed turnover and bed turnover interval.
Conclusion: The efficiency of public hospitals is low. A hospital accreditation grade is related to some of its efficiency indicators. Low efficiency and waste of resources will reduce the effectiveness of hospital and, consequently, its accreditation grade. Accordingly, the hospital's revenue will decrease and therefore, the hospital's productivity and accreditation grade will decrease and the hospital will be in a vicious cycle. Strengthening hospital accreditation standards and their proper implementation will increase the efficiency of hospitals. |
Ali Mohammad Mosadeghrad, Mahnaz Afshari, Fereshteh Karimi ,
Volume 80, Issue 1 (April 2022)
Volume 80, Issue 1 (April 2022)
Abstract
Background: Conceptual review is a creative research method for generating new knowledge in the context of a vague and complex concept that helps to explain and clarify the concept, its components and its relation to related concepts. This study aimed to explain the methodology of conceptual review in the health system.
Methods: Articles related to the conceptual research method were searched and collected in four databases (i.e., PubMed, Scopus, Embase, Science Direct) and two search engines (e.g., Google and Google Scholar) between January 1950 and September 2021. Finally, 83 articles were selected for final review and analyzed through narrative analysis.
Results: This study was conducted using scoping review between October and December 2021. The conceptual review study is a systematic, scientific and objective inquiry that helps to identify and explain the dimensions, components, features and applications of a particular concept by defining, synthesizing and interpreting the findings of studies. It results in clarification of the meaning of concepts. An eight- steps protocol was introduced for conceptual review including concept selection, entry and exit criteria definition; selection of databases and search strategies; selection and reporting of studies using flowcharts; evaluating the validity of selected studies; extracting information about the definition, components, antecedents, consequences and evaluation criteria of the concept from selected studies, synthesizing data and developing a conceptual model and drawing conclusions from the synthesized findings. In addition, the structure of a conceptual review article was described and a checklist for evaluation of a conceptual review study was introduced.
Conclusion: A conceptual review study is a method that defines the concept by searching for scientific sources about a concept and their comprehensive review, explaining their characteristics, antecedents, consequences and applications to determine the position of the concept beyond their vocabulary definition. The conceptual review helps to develop existing theories by identifying the components of a complex concept and its antecedents and consequences and establishing a logical connection between them.
Methods: Articles related to the conceptual research method were searched and collected in four databases (i.e., PubMed, Scopus, Embase, Science Direct) and two search engines (e.g., Google and Google Scholar) between January 1950 and September 2021. Finally, 83 articles were selected for final review and analyzed through narrative analysis.
Results: This study was conducted using scoping review between October and December 2021. The conceptual review study is a systematic, scientific and objective inquiry that helps to identify and explain the dimensions, components, features and applications of a particular concept by defining, synthesizing and interpreting the findings of studies. It results in clarification of the meaning of concepts. An eight- steps protocol was introduced for conceptual review including concept selection, entry and exit criteria definition; selection of databases and search strategies; selection and reporting of studies using flowcharts; evaluating the validity of selected studies; extracting information about the definition, components, antecedents, consequences and evaluation criteria of the concept from selected studies, synthesizing data and developing a conceptual model and drawing conclusions from the synthesized findings. In addition, the structure of a conceptual review article was described and a checklist for evaluation of a conceptual review study was introduced.
Conclusion: A conceptual review study is a method that defines the concept by searching for scientific sources about a concept and their comprehensive review, explaining their characteristics, antecedents, consequences and applications to determine the position of the concept beyond their vocabulary definition. The conceptual review helps to develop existing theories by identifying the components of a complex concept and its antecedents and consequences and establishing a logical connection between them.
Leila Shirani-Bidabadi , Abass Aghaei-Afshar , Saeideh Kazemi , Ismaeil Alizadeh, Moghadameh Mirzaee , Mohammad-Amin Gorouhi ,
Volume 80, Issue 2 (May 2022)
Volume 80, Issue 2 (May 2022)
Abstract
Background: Head lice is one of the threats to public health in advanced and developing societies. In previous studies in Kerman Province, the rate of head lice infection was reported to be 3.8%. The aim of this study was to determine the prevalence of head lice infection among female students of elementary schools of Kerman, and to identify the factors involved.
Methods: This study was a descriptive cross-sectional study from September 2019 to March 2019. The statistical population in the present study was female students from first to sixth grade of elementary school in districts one and two of Kerman. In selected schools, 2850 female students were examined by census. 179 people were randomly selected from different classes and after the examination; a questionnaire was completed for each of them. The extracted data were analyzed using univariate and multivariate logistic regression tests. Odds Ratio was analyzed with 95% confidence (at the level of P<0.05).
Methods: This study was a descriptive cross-sectional study from September 2019 to March 2019. The statistical population in the present study was female students from first to sixth grade of elementary school in districts one and two of Kerman. In selected schools, 2850 female students were examined by census. 179 people were randomly selected from different classes and after the examination; a questionnaire was completed for each of them. The extracted data were analyzed using univariate and multivariate logistic regression tests. Odds Ratio was analyzed with 95% confidence (at the level of P<0.05).
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Results: Female students whose mothers were illiterate were 3.51 times more likely to develop head lice. Students who bathed once a week were 0.03 times more likely, and those who shared personal items were 3.6 times more likely to develop the disease. In terms of father occupation, the highest incidence of head lice among the subjects was 8 people (66.7%) related to people whose father job was free and the lowest was related to other occupations of 4 people (33.4%). There was no significant relationship between father's job and head lice infection in the subjects (P=0.061).
Conclusion: The results of this study indicate the high infection rate of head lice in elementary school students of Kerman. This high level of infestation can cause more contamination among female students consequently, and may cause students to drop out of the school. Serious attention to reducing this infection by holding educational classes for school principals and teachers, as well as parents, seems necessary. |
Daryoush Afshari, Mansour Rezaei, Mojtaba Khazaei, Negin Fakhri ,
Volume 81, Issue 12 (March 2024)
Volume 81, Issue 12 (March 2024)
Abstract
Background: One of the first-line treatments to prevent migraine attacks is Sodium Valproate. "Booali Daroo" pharmaceutical company has made a herbal capsule called Sodae based on traditional Iranian medicine. The aim of this study is to compare the effect of Sodae and Sodium Valproate on migraine headaches.
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Methods: This two-center, double-blind, randomized clinical trial was conducted between December 2021 and July 2022 in the cities of Kermanshah and Hamadan. In this study, 76 migraine patients were randomly divided into two groups. One group received routine medication with Soda capsules and the other group received routine medication with Valproate capsules. Tow group were examined and followed up for three months. Data related to demographic and clinical information of patients were collected and entered into SPSS software version 25. Data analysis was done with a significance level of 0.05.
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Results: Overall, 76 patients assessed (36 in the Sodae group and 40 in the Valproate group). The reduction of headache indicators was not significant between the two groups; in such a way that: the frequency (7.49±6.1 vs. 5.75±4.5, P=0.183), the severity (5.66±1.6 vs. 6.34±1.8, P=0.089), the duration of attacks (23.48±30.5 vs. 32.35±32.6, P=0.069), and the Migraine Disability Assessment Score (53.94±77.3 vs. 95.94±104.2, P=0.061) respectively in Valproate and Sodae. Examining different classes of MIDAS score showed that at the end of the study compared to the beginning of the study, the number of people with severe disability decreased significantly and their disability changed from severe disability to lower degrees of disability (P<0.05). The frequency of side effects was not significantly different between the two groups (12 patients (35%) in Sodae versus 21 patients (55%) in Valproate, P=0.090).
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Conclusion: In terms of frequency, intensity and duration of migraine headaches as well as side effects, there was no significant difference between Sodium Valproate and Sodae groups.
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Khadijeh Rezaei Kahkhaei , Soha Shokri, Tayebeh Azarmehr, Mehdi Afshari , Maryam Nakhaee Moghadam , Kolsoum Rezaie Kahkhaie , Leili Rezaei Kahkhaei ,
Volume 82, Issue 7 (October 2024)
Volume 82, Issue 7 (October 2024)
Abstract
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.
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.
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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. |
Maedeh Afshar, Mahboubeh Haddad , Aliakbar Heydari, Majid Khadem Rezaiyan ,
Volume 82, Issue 8 (November 2024)
Volume 82, Issue 8 (November 2024)
Abstract
Background: Brucellosis is the most frequently encountered zoonosis and one of the most important health challenges, especially in developing countries. This disease can be accompanied by bacteremia and may result in severe complications. A definitive diagnosis may be made by culture of the organism from blood, body fluids or tissues, although serum agglutination test is often recognized as the reference test. While bacteremic brucellosis is not uncommon, research on this topic remains limited. The present study was conducted to determine the epidemiological, clinical, and para-clinical characteristics of patients hospitalized with bacteremic brucellosis.
Methods: This retrospective cross-sectional study evaluated the epidemiological, clinical, and para-clinical characteristics, and clinical outcomes of patients hospitalized with bacteremic brucellosis from March 2011 to February 2021 at Imam Reza and Ghaem hospitals in Mashhad, Iran. A list of adult patients with confirmed brucellosis was assembled from microbiology laboratory records. The inclusion criterion was a positive blood culture for Brucella, regardless of the Brucella serology results. According to the laboratory report, the BACTEC culture medium was used to identify the organism, and the reported results did not specify the Brucella species. Demographic data, clinical presentations, paraclinical findings (including Wright, 2ME Wright, and Coombs Wright), and clinical outcomes were extracted from archived medical records.
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.
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.
Mohsen Ghoryani, Mohsen Ahmadi, Mahdi Atabaki, Jalil Tavakkol-Afshari , Mojgan Mohammadi,
Volume 83, Issue 2 (May 2025)
Volume 83, Issue 2 (May 2025)
Abstract
Background: Rheumatoid arthritis (RA) is a chronic autoimmune disorder marked by persistent inflammation, progressive joint destruction, functional disability, and systemic complications. Key inflammatory mediators, such as tumor necrosis factor-alpha (TNF-α) and interleukin-17 (IL-17), play critical roles in disease progression and tissue damage. Mesenchymal stem cells (MSCs) have recently gained attention as a therapeutic approach for autoimmune diseases because of their abilities in self-renewal, immune modulation, and tissue repair. Considering the role of pro-inflammatory cytokines in the pathogenesis of RA, this study investigated the effect of autologous bone marrow-derived MSCs (ABMSCs) on the gene expression of TNF-α and IL-17A in patients with refractory RA.
Methods: The study utilized archived RNA from the research team's previous clinical trial. In this study, 13 patients with refractory RA who underwent MSC transplantation (MSCT) at an intravenous dose of 1×10⁶ ABMSCs per kilogram of body weight were evaluated at baseline and at 1, 6, and 12 months post-injection. Between November 2023 and March 2024, archived RNA samples were converted into cDNA at the Department of Immunology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Then, the expression levels of TNF and IL-17A were analyzed using SYBR Green-based real-time PCR.
Results: TNF-α gene expression declined significantly 1 month after MSCT (mean±SEM: 1.00±0.00 at baseline vs. 0.38±0.11 at 1 month, P=0.045). However, no significant differences were observed at 6 months (1.21±0.38) or 12 months (0.61±0.18) compared to baseline (P>0.05). IL-17A gene expression remained statistically unchanged across all time points (baseline: 1.00±0.00; 1 month: 0.87±0.31; 6 months: 1.19±0.42; 12 months: 1.79±0.92; P>0.05).
Conclusion: The results of this study suggest that ABMSCs may exert an anti-inflammatory effect by modulating TNF-α in patients with refractory RA. However, the findings related to IL-17A do not support the hypothesis that ABMSC injection exerts anti-inflammatory effects through modulation of IL-17A gene expression in these patients.
Methods: The study utilized archived RNA from the research team's previous clinical trial. In this study, 13 patients with refractory RA who underwent MSC transplantation (MSCT) at an intravenous dose of 1×10⁶ ABMSCs per kilogram of body weight were evaluated at baseline and at 1, 6, and 12 months post-injection. Between November 2023 and March 2024, archived RNA samples were converted into cDNA at the Department of Immunology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Then, the expression levels of TNF and IL-17A were analyzed using SYBR Green-based real-time PCR.
Results: TNF-α gene expression declined significantly 1 month after MSCT (mean±SEM: 1.00±0.00 at baseline vs. 0.38±0.11 at 1 month, P=0.045). However, no significant differences were observed at 6 months (1.21±0.38) or 12 months (0.61±0.18) compared to baseline (P>0.05). IL-17A gene expression remained statistically unchanged across all time points (baseline: 1.00±0.00; 1 month: 0.87±0.31; 6 months: 1.19±0.42; 12 months: 1.79±0.92; P>0.05).
Conclusion: The results of this study suggest that ABMSCs may exert an anti-inflammatory effect by modulating TNF-α in patients with refractory RA. However, the findings related to IL-17A do not support the hypothesis that ABMSC injection exerts anti-inflammatory effects through modulation of IL-17A gene expression in these patients.
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