Tehran University Medical Journal

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

Background: 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.

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.

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.

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.

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.

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.

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.

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.

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.