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Herpes encephalitis during pregnancy: a case report of maternal death
Leila Pourali , Azadeh Khazaee , Sedigheh Ayati , Parvaneh Layegh , Salmeh Dadgar , Fatemeh Mirza Marjani , Ehsan Esmaeelpour ,
Volume 74, Issue 1 (April 2016)
Abstract

Background: Herpes encephalitis is the most common cause of fatal encephalitis in the world which often presents with sudden fever, headache, seizure, focal neurologic symptoms, and consciousness loss. The aim of this study was to report a case of maternal death caused by herpes encephalitis which appropriate antibiotic therapy delayed because of early diagnosis of eclampsia.

Case Presentation: A 16-year-old pregnant woman at 36th weeks of gestation was referred to gynecology emergency department of Ghaem Hospital, Mashhad University of Medical Sciences in 2016. She was admitted due to 4 times of generalized tonic-clonic seizures and blood pressure of 140/90 mmHg with diagnosis of eclampsia. Cesarean section was performed for fetal distress and eclampsia remote from delivery. 6 hours after cesarean section because of higher than 39 °C and reduction in consciousness status, she was transferred to intensive care unit (ICU). The first brain magnetic resonance imaging (MRI) was normal. Lumbar puncture (LP) was performed and brain MRI was repeated that increased signal was observed in two sides of basal ganglia. Intravenous acyclovir was administered by possible diagnosis of viral meningoencephalitis. Cerebrospinal fluid (CSF) was positive in terms of herpes simplex virus type 1 (HSV-1). Unfortunately, the patient died 35 days after hospitalization by diagnosis of HSV-1 encephalitis and bilateral infarction with frequent seizures and clinical manifestation of septic shock refractory to treatment.

Conclusion: Although the first diagnosis for generalized convulsion during pregnancy is eclampsia, but in case of recurrent and specially atypical seizures and low consciousness level, other diagnosis like meningoencephalitis, brain lesions and cavernous sinus thrombosis (CVT) must be considered and ruled out.


The study of psychiatric comorbidity in patient with pemphigus
Yousef Fakour, Nafiseh Esmailie, Najmeh Khosrovan Mehr, Tahereh Souri, Kamran Balighi, Maryam Danesh Pazhouh, Hossein Mortazavi, Leila Mokhtari,
Volume 74, Issue 6 (September 2016)
Abstract

Background: The relationship between skin, neuron system and mental status is complicated. Pemphigus is severe and painful autoimmune skin disorder that occurs in 0.5-1 person in 100000. Regarding the critical role of mental status in autoimmune diseases such as pemphigus, the aim of this research was to investigating psychiatric comorbidity in patient with pemphigus.

Methods: This research was a descriptive survey study. The society of this research included the patients with pemphigus referred to Razi Dermatology University Hospital in Tehran. Participants were 200 persons who were selected through available sampling. Finally, 198 persons filled out the demographic questionnaire and symptom checklist-90 (SCL-90).

Results: This research showed that the prevalence of psychiatric disorders in this sample was 62.62%. 28.78% (57 persons) of patients were male and 33.84% (67 persons) were female. In both genders the symptoms of paranoia were the most prevalent disorders (45% in female and 60% in male) and phobia was the least prevalent in our sample (8.2% in female and 24% in male). The upper grade in education, the less prevalent disorders. 81.45% of participants with mental disorders were married and 18.55% of them were single. Of patients only 26.32% had visited the psychiatrist or psychologist and 95.15% of them had used medications. This research also showed that there was a significant difference between two genders. Men showed higher rate of prevalence in psychiatric symptoms than women.

Conclusion: The results showed that psychiatric disorders in patients with pemphigus are high compared to general population. This research congruent with other researches showed that higher age, lower grade of education and marriage related to worse prognosis in psychological status in patient with pemphigus. Thus dermatologists must recognize and manage these psychiatric comorbidities to treat patients effectively and to improve the quality of life in patients with autoimmune diseases such as pemphigus. 


Profile of neonatal mortality in Iran in 1391
Mohammad Ali Heidarnia , Alireza Abadi , Mohamad Fsmaeil Motlagh, Mohammad Heidarzadeh , Abbas Habibelahi , Farima Raji ,
Volume 74, Issue 7 (October 2016)
Abstract

Background: The first duty of any government is to ensure the health of its children and neonates. Today's countries are classified as declining mortality in this group. To increase neonatal survival rate, classified causes of newborn mortality are the core strategy and policies. This study was aimed to determine the classification of causes of neonatal death in Iran.

Methods: Neonatal mortality refers to deaths of young children. It is measured by the neonatal mortality rate (NMR), which is the number of deaths of neonates per 1000 live births. This study was used data from 11693 neonatal deaths (from 22 weeks gestational age to neonatal death less than 30 days), in Iran's hospitals in 2012 that registered in the perinatal mortality surveillance system (hospital-based system). Demographic characteristics and other factors associated with neonatal death were investigated. To aid in cause of death analysis, burden of disease analysis, and comparative risk assessment we classified the causes of death according to international statistical classification of diseases version 10 (ICD 10), divided into three cause mortality strata.

Results: Results showed the most common cause of neonatal mortality was "certain conditions originating in the perinatal period" (77.92%) with the highest incidence of "disorders related to length of gestation and fetal growth" (37.7%) in this group. Also it shows that 20.82% of deaths caused by "congenital malformations, deformations and chromosomal abnormalities" and 1.26% cases had occurred as a result of "accidents and injuries". The greatest cause of death in the neonates with weight over one thousand grams was "certain conditions originating in the perinatal period" (71.29%), with the highest percentage in the disorders related to "length of gestation and fetal growth" (29.65%).

Conclusion: According to this study the "certain conditions originating in the perinatal period" special "disorders related to length of gestation and fetal growth" was the main cause of neonatal mortality. Also "congenital malformations, deformations and chromosomal abnormalities" was the second cause of neonatal mortality.


The measurement of polychlorinated biphenyl level in breast milk after delivery, and its association with breast milk fat and mother's BMI
Fatemeh Nayeri , Hosein Dalili , Mamak Shariat , Tahere Esmaeilnia , Elahe Amini , Vafa Ghorban Sabagh ,
Volume 74, Issue 8 (November 2016)
Abstract

Background: Human breast milk contains high levels of fat and toxins. These substances which exist in our country based on many reports. This study aimed to evaluate the concentration of polychlorinated biphenyls (PCBs) in the mother’s milk during the first postnatal week.

Methods: This study was accomplished on 50 mothers who gave birth to a healthy infant at Vali-e-Asr University Hospital, Tehran University of Medical Sciences, Tehran, Iran, from 2014 through 2015. Within the first postnatal week a 20 cc sample of mother’s breast milk was obtained and was sent for laboratory analysis to measure PCB levels via GC-Mass method. Except of PCBs, triglycerides (TG), high-density cholesterol in breast milk was also measured. Also the relation between fat and polychlorinated bi phenyl was assessed. The association between PCBs and body mass index of mothers was investigated.

Results: Mean age of mothers was 29.41±6.14 year. PCB180 was significantly correlated with TG values, while this correlation was not observed for other types of PCBs. There was no correlation between cholesterol and fat high-density with PCBs. Other PCB isomers 138, 153, 180 and 101, had not correlation with triglyceride, cholesterol and high density fat. There was a significant correlation between increasing weight and the concentration of PCB101, and PCB180 concentrations. It was also observed between increasing weight and the concentration of PCB101 (P=0.033, r=0.293) and concentrations of PCB180 (P=0.034, r=0.428), there was a significant correlation. In our study PCB101, (r=0.278, P=0.048) and PCb28 (r=0.328, P=0.021) were significantly correlated with body mass index (BMI).

Conclusion: The present study showed a higher than normal concentration of polychlorinated biphenyls in breast milk. And therefore these compounds will be transferred to the baby. Due to the damaging effects of these toxins, it is recommended additional studies on larger groups and other types of samples (mother blood, cord blood etc.).


The A-kinase anchoring proteins correlation with disease free survival in breast cancer
Rezvan Esmaeili , Tannaz Samadi , Nasrin Abdoli , Keivan Majidzadeh-Ardebili , Leila Farahmand , Malihe Salehi ,
Volume 74, Issue 10 (January 2017)
Abstract

Background: Researchers are always trying to find specific markers which express specifically in cancer. These specific markers help to diagnose and treat cancer without affecting normal tissues. Cancer-testis antigens are among the new promising biomarkers, especially for targeted therapy. These markers are specially expressed in testis. Various studies have been reported individual expression of these proteins in some tumor tissues. Since testis is an immune privilege organ, abnormal expression of the above mentioned genes raises immune response and the serum antibody against them (CT antigene) can be detected as a marker of cancer. However, understanding their differential role in normal and cancer tissues may introduce them as new candidates of cancer biomarkers. The aim of this study was to evaluate AKAP3 gene expression in breast cancer and its correlation with clinicopathologic features of the disease.

Methods: This study is a case-control study conducted at the Brest Cancer Research Center (BCRC)- Iran, between October 2014 to May 2016. AKAP3 gene expression was investigated with real-time PCR in breast samples including: 74 tumors, 73 normal adjacents and 15 normal tissues. On the other hand the correlation between gene expression, clinicopathologic features of the tumors and treatment regimen were evaluated.

Results: Statistical analysis showed a significant correlation between lack of AKAP3 expression, tumor size (P=0.01) and stage (P=0.04). The association between poor prognosis and the absence of AKAP3 expression in normal adjacent tissues were observed. Kaplan Meier plot showed a significant better disease free survival in the normal adjacent patients group that are expressed AKAP3.

Conclusion: It was observed that the better free survival in the normal adjacent group is because of the different AKAP3 expression, not treatment variations between two patient groups. As a result, AKAP3 can be a suitable candidate biomarker for breast cancer patients. Also, the study of gene expression in normal tissue of patients may be used to predict response to therapy.

The relationship between intake of macronutrients and vitamins involved in one carbon metabolism with breast cancer risk
Mahshid Hatami , Mohammad Esmaeil Akbari , Morteza Abdollahi , Marjan Ajami , Yasaman Jamshidinaeini , Sayed Hossein Davoodi ,
Volume 75, Issue 1 (April 2017)
Abstract

Background: Breast cancer is the most common cancer among females in the world. Identifying the nutrients that modify the risk of the disease is one of the key strategies for improving the quality of life and reducing treatment costs. Epidemiological studies support the role of macronutrients and vitamins involved in one carbon metabolism in the etiology of the disease. This study aimed in investigation of the relationship between the intake of macronutrients and vitamins involved in one carbon metabolism with breast cancer risk.

Methods: This case-control hospital base study was conducted at Shohada Hospital, Tehran from April to February 2015. Demographic data, physical activity level and nutrients’ intake from diet and supplements were collected through interview from 151 cases and 154 controls. Dietary intake was assessed by a valid and reliable 168-item semi-quantitative food frequency questionnaire. Then intake of macronutrients and B vitamins was assessed by Nutritionist 4 software (First Databank Inc., CA, USA). Comparing categorical variables between the two groups was done by Chi-squared test and the relationship between intake of studied nutrients and risk of breast cancer was determined using logistic regression test.

Results: There were no difference in age, menarche age, menopause age, body mass index (BMI), number of live births between two groups. But the difference in physical activity, energy intake, marital status, educational level, occupation, oral contraceptives use was significant (P< 0.001). After modifying the effects of confounding variables, the risk of breast cancer was significantly lower in the highest intake quartile category relative to the lowest quartile category for total protein, total fiber, intake of vitamins B2, B6, B12 and folate (Ptrend< 0.001). Before modifying the effects of confounding variables, the risk of breast cancer was significantly higher in the highest intake quartile category relative to the lowest quartile category for carbohydrate and fat; but after modifying the effects of confounding variables, results were not significant.

Conclusion: The results showed that high intake of protein, fiber, vitamins B2, B6, B12 and folate are associated with lower risk of breast cancer.


Factors affecting the results of lumbar discectomy
Maryam Esmaili , Nahid Tahan , Seyed Mojtaba Miri , Ali Montazeri , Alireza Akbarzade Bagheban ,
Volume 75, Issue 2 (May 2017)
Abstract

Background: Low back pain is one of the most important causes of disability among people around the world. Although only 2-5% of low back pain disorders resulting from herniation of lumbar intervertebral discs but surgery for lumbar disc herniation is a common procedure. The aim of this study was to determine the relation between some bio-psycho-social variables and treatment outcomes in patients who undergo first time single-level lumbar discectomy.

Methods: This is a prospective observational analytic study comprised 100 patients (age range 18-73 years) underwent single-level lumbar disc surgery. The patients who met our inclusion criteria and were willing to participate in the study were recruited from the neurosurgery ward of Logman and Imam Khomaini hospitals in Tehran, Iran, between October 2015 and March 2016. The patient completed SF-36 quality of life Questionnaires before, one and two months after surgery.

Results: In comparison to standard values, before the surgery patients had significantly lower baseline SF-36 (36-Item Short Form Survey) Questionnaire value in all 8 domains. The role limitations due to physical health had greatest impact on quality of life. At the eight weeks’ follow-up SF-36 scores showed significant improvement in both physical and mental scales. Age had no significant impact on mental scales of weeks’ Questionnaire but in age less than 30 years there was a positive relation between the patient’s age at surgery and physical aspects of quality of life. Although there was no significant difference in physical aspects of SF-36 Questionnaire between males and females but males had a significantly higher mean mental health score than females after surgery. Smokers had lower value of mental scales of SF-36 Questionnaire than in nonsmokers.

Conclusion: The result of this study showed that surgery for lumbar disc herniation had a great impact on both physical and mental scales of SF-36 Questionnaire two months after surgery. Factors such as age, sex, smoking and psychological factors can play the role of predictor for patient’s outcomes after lumbar disc surgery.

HLA-DRB1, DQB1 allele frequencies in Iranian patients (sistani ethnic) with tuberculosis and healthy control
Sadegh Baniaghil, Gholamreza Nikbakht Borujeni , Hassan Tajbakhsh, Atefeh Esmailnejad, Ali Akbar Amirzargar ,
Volume 75, Issue 3 (June 2017)
Abstract

Background: HLA disease association was investigated in several autoimmune, cancer and infectious diseases. The outcome of tuberculosis (TB) infection may be influenced by host genetic factors like MMP-1, MCP-1, IL-10, IL-12, TNF-α, IFN-γ and human leukocyte antigen (HLA). Given the paucity of information with regard to the association between the human leukocyte antigens (HLA) and TB infection among Iranians, we aimed to identify HLA polymorphisms that might confer susceptibility or protect against TB.

Methods: In this case-control study, to investigate the association between the HLA-DRB1 and DQB1 alleles and TB, 50 patients with tuberculosis were selected from Sistani population in Golstan University of Medical Sciences, Golestan Province, North East of Iran, from September 2015 to February 2016. Allele frequencies in patients were compared with a 100 aged and sex match control group from healthy blood donor of that ethnic population. HLA-DRB1 and -DQB1 alleles were determined using polymerase chain reaction based on sequence specific primer (PCR-SSP) method by low to intermediate resolution kits supplied by CTS (Collaborative Transplant Study, Heidelber University, Germany). Using EPI-info statistical software Chi-square test and fisher exact test, 95% confidence interval and odd ratio were calculated and allele frequencies in patients and control subjects were compared. P-value less than 0.05 were considering statistically significant.

Results: The results of this study showed a significant increase and positive association  with -DRB1*04:03 (OR=3.13, CI 95% (2.47-3.96), -DRB1*14:04 (OR=3.13, CI 95% (2.47-3.96), -DQB1*0201 (OR=2.67, CI 95% (1.18-6.04), -DQB1*0601 (OR=3.16, CI 95% (1.36-7.73) ,while the frequency of -DRB1*07 (OR=0.16, CI 95% (0.05-0.52) were lower in patients than control group and shows negative association.

Conclusion: The results of this study confirmed some of the previous positive and/or negative association, however it is suggested that HLA-DRB1*04:03, -DRB1*14:04, -DQB1*0201, -DQB1*0601- have an important role in susceptibility to tuberculosis infection and -DRB1*07 was associated with protection in Iranian Sistani population. Larger case-control sample size studies may be helpful to confirm our investigation. In addition population-specific studies is needed for evaluation of the role of HLA polymorphisms in tuberculosis in different ethnic groups.

Association of CFI p.Gly119Arg gene polymorphism with age-related macular degeneration (AMD) disease in the population living in Tehran
Neda Norouzi , Mortaza Bonyadi , Esmaeil Babaei , Mohammad Hossein Jabbarpour Bonyadi ,
Volume 75, Issue 5 (August 2017)
Abstract
Background: Age-related macular degeneration (AMD) is the leading cause of blindness in the developed world and is characterized by progressive degeneration of the retinal pigment epithelium and secondary photoreceptor loss, resulting in visual loss. Etiological research suggests that age related macular degeneration is a complex disease, caused by the interactions of several genetic and environmental factors. Polymorphisms in genes encoding the alternative complement pathway, complement factor I (CFI), are associated with the risk for age related macular degeneration. The purpose of this investigation was studying of complement factor I p.Gly119Arg (C.355G>A) polymorphism with age related macular degeneration in the population living in Tehran, Iran.
Methods: This case-control study was conducted at Tabriz University from June 2015 to June 2016. In this study the association of p.Gly119Arg polymorphism in complement factor I gene was investigated in 150 patients suffering from age-related macular degeneration and 150 healthy age, sex and ethnicity matched unrelated people as control group. Both of the case and control groups were originated from the population living in Tehran. Genotypes of both groups were determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and data was analyzed the Chi-square test in 2x2.Contingency table.
Results: Investigation of the association of p.Gly119Arg polymorphism in complement factor I gene with age related macular degeneration showed that there are statistically significant differences between patients and controls in genotype and allele frequencies of this polymorphism (P=0.005 and OR=6.68 in TT, P=0.04 and OR=0.61 in CC, P=0.03 and OR=1.76 in T, P=0.04 and OR=0.56 in C). Therefore CC, TT genotypes and C, T alleles were significantly associated with age related macular degeneration.
Conclusion: This study showed a significant association between this polymorphism p.Gly119Arg (C.355G>A) complement factor I gene and age related macular degeneration disease in the population living in Tehran (P<0.05). Our data suggests that this locus polymorphism is not as rare in our studied population as previously reported from different population.

Bacterial and tissue biomarkers of gastric cancer: new findings and future perspectives: review article
Esmat Abdi , Saeid Latifi-Navid , Hamid Latifi-Navid , Saber Zahri, Abbas Yazdanbod ,
Volume 76, Issue 6 (September 2018)
Abstract
Gastric cancer (GC) is the second leading cause of cancer-related deaths worldwide. It has been proposed that the specific genotypes of Helicobacter pylori (H. pylori) are the causative agents in the development of gastroduodenal diseases, such as chronic atrophic gastritis, peptic ulcerations, and GC. However, disease progression to GC occurs in only a small proportion of infected patients. Recently, we identified a novel polymorphic site in the 3ʹ-end region of H. pylori vacA gene. The vacA c1 genotype increased the risk of GC. This association was independent of and larger than the associations of the m-, i-, and d-type of vacA or cagA status with GC. Therefore, treatment of H. pylori infection may be an effective way to prevent GC. Expression of cytokines and their associations with inflammatory responses has been shown. Several cytokine polymorphisms, such as IL-1B, IL-8, IL-10, and TNF-α have been considered as risk factors for GC. It has been shown that the interaction of bacterial genotypes and host factors plays an essential role in developing GC. Several altered molecular pathways are involved in the pathogenesis of GC. Micro-RNAs are small, non-coding RNAs of 18-25 nucleotides in length that regulate the expression of target mRNAs. Expression pattern of cancer cells is different compared with the normal cells. Micro-RNAs plays a critical role in apoptosis and classified in two groups: pro- and anti-apoptotic agents. Recent studies have confirmed the oncogenic or tumor suppression role of micro-RNAs in cancer cells. They play a significant role in the GC cell physiology and tumor progression, by translational suppression of target genes. These small RNAs have therefore emerged as a new type of GC biomarker with immeasurable clinical potential. Generally, a variety of micro-RNAs involved in different stages of cancer, including tumorigenesis, angiogenesis, and metastasis. Considering to this issue more than 50% of cancers can be cured, if they were diagnosed in the early stages. Hence, identifying the biomarkers of GC could play an important role in prevention, early diagnosis and rapid treatment of patients. In this review article, we have reviewed the latest findings about bacterial and tissue biomarkers of GC

Relationship between diet diversity score and breast cancer risk
Sepideh Haghifar , Yasaman Jamshidi Naeini , Mohammad Esmaeil Akbari , Morteza Abdollahi , Mahdi Shadnoush , Marjan Ajami , Sayed Hossein Davoodi ,
Volume 76, Issue 8 (November 2018)
Abstract
Background: The average age of women with breast cancer in Iran is at least 10 years lower in comparison to developed countries and the incidence of the disease in Iranian women is on a rise. According to studies, diets that are diverse in food groups can play a role in protecting against chronic diseases including cardiovascular diseases and cancer. Diet diversity score is an indicator used to measure diversity between and within food groups. This study aimed to assess the relationship between diet diversity score and breast cancer risk.
Methods: This case-control study was carried out from April 2014 to February 2015 at Shohada Hospital in Tajrish, Tehran. Demographic and anthropometric data of 298 participants including 149 breast cancer cases and 149 apparently healthy women were collected. A valid food frequency questionnaire containing 168 food items was completed to assess usual dietary intake through face to face interviews. Energy was calculated using Nutritionist 4 software (First Databank Inc., Hearst Corp., San Bruno, CA, USA) and diet diversity score was calculated using five food group scoring. Odds ratios with 95% confidence intervals were obtained using logistic regression test to evaluate the association between breast cancer risk and diet diversity score tertiles.
Results: There was no significant difference in weight, height, body mass index between the two groups, but physical activity level and daily energy intake showed a significant difference (P<0.001). After adjusting for the effect of confounding variables including energy, body mass index, physical activity, menopause status, family history of breast cancer, contraceptive use, number of pregnancy, age of menarche and smoking, the risk for developing breast cancer was 86% lower in those in the highest tertile of diet diversity score compared to those in the first tertile (OR=0.14, 95% CI=0.06-0.31). An inverse and significant association was found between breast cancer risk and diversity scores of fruits and milk groups (P<0.001).
Conclusion: Higher diet diversity score is associated with reduced risk of breast cancer.

The healing effect of total contact casting on diabetic foot ulcers
Azadeh Zahedi, Seyed Mokhtar Esmaeilnejadganji , Sekineh Kamali Ahangar , Rahmatollah Jokar,
Volume 77, Issue 1 (April 2019)
Abstract
Background: Diabetes Mellitus is a prevalent disease worldwide and foot ulcer is one of the serious complications of chronic uncontrolled diabetes which could lead to various complications such as amputation of the extremity if left untreated. Total contact casting (TCC) is the gold standard in treatment of neuropathic and neuro ischemic diabetic foot ulcers (DFU) on which less emphasize is seen on routine medical practice. The aim of this study was to emphasize on healing effect of this off-loading method and to study the possible influence of variants on the healing rate of this technique.
Methods: In this cohort study, 92 diabetic patients with complaint of plantar foot ulcer grade 0, 1 and 2 according to Wagner classification had participated in Shahid Beheshti Hospital, Babol City, Iran, from March 2014 to February 2016. The demographic and biochemical information along with dimensions of foot ulcers were carefully recorded. After the primary cleansing, surgical debridement and dressing, TCC was applied on foot by the specialist and they were requested to return weekly for changing the TCC and re-evaluation of ulcers. The healing rate was calculated as decline in ulcer surface area per week.
Results: 92 patients of study sample with mean age of 63.9±10.56 year consisted of 76 patients with DM type 2 with BMI of 31.16±3.8 kg/m² and 58 male patients. The average healing rate of ulcers treated with TCC was 0.406 ±0.168 cm²/week. The duration of diabetes on average was 17.23±6.93 years. Most of the patients (n=45) had an ulcer on the forefoot and the healing rate of midfoot ulcers was slower. The average amount of baseline HbA1c was 8.2±0.19%. There was no relation between smoking history (P=0.94) and anti-diabetic regimen used by patients (P=0.754) with the healing rate.
Conclusion: The healing rate is slower in elderly patients and those with longer duration of diabetes. So in these two groups, TCC is to be applied for a longer duration in order to achieve complete healing.

Prevalence of metronidazole-resistant clostridium difficile: a meta-analysis in Iran
Ghobad Moradi, Seyyede Maryam Bechashk, Nader Esmailnasab , Behzad Mohsenpour, Rashid Ramazanzadeh , Daem Roshani , Ebrahim Ghaderi,
Volume 77, Issue 2 (May 2019)
Abstract
Background: Metronidazole resistant clostridium difficile is one of significant pathogens in Iran. It is one of the WHO-declared microbial resistance emergencies. Prevalence of metronidazole resistant clostridium difficile is rising. The aim of this study was to detect prevalence of metronidazole-resistant clostridium difficile using meta-analysis in Iran.
Methods: This study was conducted as a meta-analysis. Articles and derivatives were reviewed by two researchers. Initially, each of the researchers searched the databases separately and used all available Persian and English articles in Kurdistan University of Medical Sciences, Iran, from October 2017 to February 2018. Persian databases (including Magiran, Irandoc, Barakat and SID) and international databases (including PubMed, Sciencedirect, and Scopus) were searched during this period (2007-2016) with a combination of phrases and keywords. The list of references to these studies has also been evaluated and relevant articles have been included in the study. First, all the articles were extracted and then duplicated articles were deleted using the EndNote software, version X6 (Thomson Reuters™, New York, NY, USA) through the search for electronic banks. Such that the high heterogeneity (50% Results: From the search of medical databases at first, 68 articles were selected. In total, 19 remaining studies entered the meta-analysis phase. In this study, the overall prevalence of clostridium difficile is 32.57% (CI95%: 21.86-44.30); in 2016 it was 55.25% (CI95%: 50.22-60.19) and in 2009 was14.26% (CI95%: 12.32-16.37). The heterogeneity was estimated to be 98.7% (CI95%: 98.5-98.8).
Conclusion: Based on the results of this study, the prevalence of metronidazole resistant clostridium difficile in Iran is high and increasing.

The effect of ten weeks ginger consumption on lipid profile and body composition in obese women following the exercise Pilates
Asma Soleimani , Afra Khosravi , Enayat Asadi ,
Volume 77, Issue 3 (June 2019)
Abstract
Background: Disruption of lipid metabolism threatens human life in all countries with different percentages and causes cardiovascular disease. Reducing physical activity and eliminating some of the food medications have exacerbated these complications. The aim of this study was to investigate the effect of ginger supplementation on the lipid profile and body composition of obese women following Pilates exercises.
Methods: This semi-experimental study was carried out at the Medicinal Plants Research Center of Ilam University of Medical Sciences, Iran, from September to December 2012. In this study, 90 pregnant women with type 2 diabetes mellitus were randomly divided into three groups: complement, placebo and control (30 objects in each group). The exercise protocol includes a ten-week Pilates exercise. The supplement group consumed 2 grams of ginger powder daily for ten weeks. The placebo group used starch (placebo) capsules for these ten weeks. The control group did not take any supplement and did not have any activity at all. Blood samples were taken prior to physical activity and 48 hours after the end of 10 weeks Pilates training three sessions per week (30 sessions). In order to investigate intra-group changes, t-test and one-way ANOVA were used to compare the groups.
Results: The results showed that after 10 weeks of using zinc supplements following Pilates exercise training in pretest and posttest, increases in HDL levels and decreased TG, LDL, Tcol, body composition and body weight in obese women. Also, consumption of 10 weeks of ginger supplement after aerobic exercise training on TG (P=0.001), LDL (P=0.02), Tcol (P=0.05) and HDL (P=0.01) in obese women in supplement and placebo groups had a significant impact.
Conclusion: The results of this study showed that Pilates exercises with daily consumption of 2 grams of ginger supplement for 10 weeks caused a significant decrease in lipid profiles, body fat percentage, weight, and hip circumference.

Comparison of the efficiency of data mining methods in predicting type 2 diabetes
Hossein Tireh , Mohammad Taghi Shakeri , Sadegh Rasoulinezhad , Habibollah Esmaily , Razieh Yousefi ,
Volume 77, Issue 5 (August 2019)
Abstract
Background: Diabetes mellitus as a chronic disease is the most common disease caused by metabolic disorders and it is one of the most important health issues all around the world. Nowadays, data mining methods are applied in different fields of sciences due to data mining methods capability. Therefore, in this study, we compared the efficiency of data mining methods in predicting type 2 diabetes.
Methods: In this cross-sectional study, the data of 7,000 participants in the Diabetes Screening Project in Samen, Mashhad City, Iran, were considered in 2016. There were 540 untreated diabetic patients. The Samen Project was included in the routine examinations of diabetes patients like blood glucose, eyes health, nephropathy, and legs health. So, in order to maintain balance, 600 healthy individuals were selected in a proportional volume sampling in this study. Therefore, the total sample size was 1140 people. In this study, people with diabetes aged over 30 years old were enrolled and participants with the previous history of type 2 diabetes, with normal blood glucose due to drug use or other issues at the time of the study, were excluded.
Results: All three models (Logistic regression, simple Bayesian and support vector machine models) had the same test accuracy (86%), however, in terms of area under the receiver operating characteristic (ROC) curve (AUC), logistic regression and simple Bayesian models had better performance (AUC=90% against AUC=88%). In the simple Bayesian model and logistic regression, body mass index (BMI) and age variables were the most important variables, while BMI and blood pressure variables were the most important factors in the support vector machine model.
Conclusion: According to the results, all three models had the same accuracy. In terms of area under the curve (AUC), logistic and simple Bayes models had better performance than the support vector machine model. Totally all three models had almost the same performance. Based on all three models, BMI was the most important variable.

Diagnosis of bacteremia in patients with suspected septicemia using polymerase chain reaction method
Azam Shiralinezhad , Farzaneh Firoozeh , Mansooreh Momen Heravi, Esmat Aghadavod , Mojtaba Sehat ,
Volume 77, Issue 10 (January 2020)
Abstract
Background: Sepsis or blood stream infection is a clinical lethal syndrome with severe systemic inflammatory response to infection, if not treated quickly, is associated with dangerous consequences and high morbidity and mortality. The traditional and conventional method for identification of sepsis is blood culture method which is so time-consuming and long that it eliminates the possibility of rapid treatment. Although, new molecular methods, due to their high sensitivity, specificity, and speed, lead to the rapid and accurate and exact detection of bacterial sepsis within only a few hours. The aim of this study was diagnosis of bacteremia in patients with suspected sepsis using amplification of 23S rRNA gene by polymerase chain reaction (PCR).
Methods: This cross-sectional study was performed in two clinical and analytical steps at Shahid Beheshti University Hospital in Kashan City, Iran, in twelve months from November 2016 to December 2017. The blood samples of two hundred and fifty-six patients with suspected sepsis admitted to Shahid Beheshti Hospital were studied by PCR method using specific primers of 23S rRNA gene of the bacteria.
Results: The finding of molecular assays using PCR showed that of 256 blood samples that were collected from patients with clinical signs and symptoms of sepsis, 80 (30.2%) diagnosed with bacteremia. Of these patients diagnosed with sepsis, 46 out of 80 (57.5%) were male while 34 out of 80 (42.5%) were female. The most PCR positive results were obtained among patients with diabetes and bedsore as underlying diseases (21.3%). Statistical analysis showed that there was a significant correlation between results of molecular methods by PCR assays and history of antibiotic use. 
Conclusion: Overall, the results of the present study showed that the molecular methods such as polymerase chain reaction using universal 23S rRNA primers is an appropriated test for diagnosis of bacteremia in blood samples of patients with suspected sepsis.

Effect of multi-sensory stimulation on physiological parameters in preterm infants: randomized clinical trial
Fatemeh Nasimi , Hossein Zeraati , Javad Shahinfar , Mohammadreza Safdari , Ali Esmaeili , Maryam Ghorbanzadeh ,
Volume 78, Issue 2 (May 2020)
Abstract
Background: Premature infants undergo a lot of stressors during treatment procedures in the neonatal intensive care units which causes significant physiological changes in these neonates. Multi-sensory stimulation is a broad category of interventions designed to improve the evolutionary and physiological outcomes of premature infants hospitalized in the neonatal intensive care unit to minimize stress in this environment. So, the study aimed to evaluate the effect of multi-sensory stimulation on physiological parameters in preterm infants.
Methods: This double-blind clinical trial conducted in the neonatal intensive care unit of Shahid Motahari Hospital in Jahrom from April to December 2016. In this study, 80 preterm infants with a gestational age of 34 to 36 weeks were selected by non-probability sampling method and were randomly divided into two groups of multi-sensory stimulation and control. Neonates in the intervention group received a multi-sensory stimulation program for 60 minute. The multi-sensory stimulation program was included a combination of auditory, tactile, motor and visual stimulation. The preterm infants in the control group received only usual care. The data collecting tool was a questionnaire and checklist for physiological parameters of preterm infants.
Results: The results showed that the two groups were homogeneous in terms of fetal age, birth weight, the height of birth, first and fifth minute Apgar score of birth. The results showed that there was no significant difference between the mean of physiological indexes in the two groups before the intervention. Statistical tests showed that there was a decreasing trend in the average of all physiological indices during the intervention (first and second half during the intervention) (P<0.001), However, these changes were not significant in the control group (P<0.05). Also, analysis of variance (ANOVA) with repeated measures showed that there was a significant difference between changes in physiological variables between the two groups at different stages of evaluation (P<0.001).
Conclusion: Multi-sensory stimulation leads to a decrease in heart rate and respiratory rate and the stability of blood pressure in preterm infants.

The relationship between Tonic-Clonic sizures in children and increased time of ventricular repolarization
Mohammad Radgoodarzi, Sepideh Ammooeian, Hassan Esmaeili, Shima Salehi, Mohammad Nikoocar,
Volume 78, Issue 8 (November 2020)
Abstract
Background: Long QT syndrome (LQTS) is a disorder in which electrical cardiac ventricular repolarization is impaired. It results in an increased risk of an irregular heartbeat which can result in palpitations, fainting, drowning, or sudden death. Long QT Syndrome may present as tonic-clonic seizure or a seizure-like disorder. By taking a superficial electrocardiogram (ECG) and proper diagnosis, Sudden death, one of the most important complications of Long QT syndrome can be easily prevented.
Methods: This is a prospective case-control study that was conducted in the emergency department of Taleghani Children's Hospital of Gorgan University during 2017.
Four hundred and eighty subjects in three groups (two cases and one control groups), were included in this study. These comprised as patients with afebrile convulsion (n: 160), patients with seizures associated with fever (n: 160), and the control group (patients who have been hospitalized for any reason other than seizure (n: 160)). Those with severe cerebral palsy, acute meningitis, prolonged loss of consciousness, severe disturbances of electrolytes and those who were taking drugs that affect the QT interval were excluded. Once admitted with a primary diagnosis of seizure, a 12 leads superficial ECG was performed.
Results:  In the group of patients with febrile convulsion, 123 children were Low probability Long QT syndrome, 33 cases were Intermediate and 4 were high probability Long QT syndrome. Probability of Long QT syndrome in children with afebrile seizures showed that 112 children were in Low probability Long QT syndrome, 42 children in Intermediate and 6 children in High probability Long QT syndrome group. Comparison of Probability of Long QT syndrome among the three evaluated groups showed that children with afebrile seizure (48 children) and subsequently children with febrile seizure (37 children) were more in Intermediate and High categories than others. Only 11 children in the control group were in the Intermediate and High groups. Chi-square test results showed a significant difference with P<0.001.
Conclusion:  The results of this study show that in patients who present with seizure as the initial symptom, it is always mandatory to account Long QT syndrome into differential diagnosis. Doing a simple electrocardiogram makes it easy to distinguish two issues and prevent sudden death.

Preparation of tissue-engineered wound dressing consisting of chitosan fibers containing silver ion-doped bioactive nanoparticles for wound healing
Mahnaz Mahmoudi Sohi , Asadollah Asadi , Peyman Brouki Milan , Esmaeil Sharifi, Arash Abdolmaleki,
Volume 79, Issue 4 (July 2021)
Abstract
Background: Wound healing is a complicated process involving the proliferation of the epithelial cells, deposition of granulation tissue as well as recruitment of inflammatory cells. It also is a hot topic of research for trauma, orthopedics and general surgery studies. There are many forms of cells involved in this process. This study aimed to design a tissue-engineered wound dressing consisting of chitosan fibers containing silver ion bioactive nanoparticles for wound healing.
Methods: The present study is an experimental study that was conducted in the research laboratory of the Department of Biology of Mohaghegh Ardabili University from April to November 2019. All experiments of this study have been performed under the ethical guideline of Helsinki and in accordance with the Ethics Committee of the Mohaghegh Ardabili University of Ardabil (Iran). The wound dressing of nanofibers was prepared by the sol-gel method. Cytotoxicity was assessed by MTT assay. Then the antimicrobial properties of nanofibers were determined by the disk diffusion method. SEM and AFM images were obtained from nanofibers. Finally, nanofibers were analyzed by the FTRI method.
Results: Results of the prepared tissue-engineered wound dressing consisting of chitosan fibers containing silver ion-doped bioactive nanoparticles showed that cytotoxicity was at an appropriate level. The nanofibers prepared with 2% silver nanoparticles produced a 10 mm inhibition zone against Staphylococcus aureus and a 9 mm inhibition zone against Escherichia coli. Therefore, the best percentage of scaffolds in the present study was 2%. Also, results of the SEM micrographs and AFM image analysis of the scaffolds showed that the nanofibers had good roughness and a proper structure for cell seeding and attachments. Besides that, FTIR analysis also showed that the prepared nanofibers had standard bonds.
Conclusion: Chitosan-Silver nanoparticles scaffold have antimicrobial activity on Gram-negative and positive bacteria. The results of the toxicity test also showed that it did not have much toxicity on the cultured cells. Therefore, it can be considered for therapeutic applications, such as wound dressing.
 

Prevalence of microcytic anemia among newborn infants from baharloo hospital, tehran, iran
Mohammad Ali Shaban, Asghar Ghorbani, Mohammad Kaji Yazdi , Neda Hakimian, Monir Al-Sadat Sahlabadi, Zahra Shokri, Zahra Mollah Esmaeili,
Volume 79, Issue 5 (August 2021)
Abstract
Background: Anemia has a very high prevalence across the world. Microcytic anemia is the most common nutritional disorder and a major health problem in infants and children associated with inadequate growth and development. Diagnosing anemia at the birth can be difficult. Due to the fact that conditions such as thalassemia and iron deficiency are causative factors of microcytic anemia are prevalent in Iran, early diagnosing and treating these diseases can prevent excessive costs and further complications. Therefore, recognizing the practical factors with this complication is an effective step in controlling and preventing it. Therefore, the present study was performed to determine the prevalence of microcytic anemia in newborns in Baharloo Hospital in Tehran, Iran.
Methods: This cross-sectional study was performed on 210 infants, which were newly born on Baharloo Hospital from march2018 to march2019. 2.5 cc cord blood sample was extracted from each infant, and microcytic anemia were diagnosed according to factors such as Hb, MCV and others parameters.
Results: in this study, we demonstrated that there is a significant association between MCH and microcytic anemia. Our results showed that the rates of newborn infants with anemia disease (Hb<13ml/dl) were 14.3% and the rates of microcytic anemia were 9.5%. There were not any significant differences between mother's age, neonatal weight and height, type of parturition, pregnancy age and parental ratio with the incidence of microcytic anemia.
Conclusion: Anemia has a relatively high prevalence in the center of Baharloo Hospital, Tehran, Iran. So screening and further investigation for anemia and related factors are critical. According to the results of our investigation, studies showed that anemia is a multifactorial disease that depends on different factors. The existence of variable results in different studies requires evaluating more parameters that affect the incidence of microcytic anemia, such as iron deficiency, eating habits, level of parental education, and use of iron supplements in pregnancy. Management of this disease requires screening and early diagnosis for more effective treatment and reduction of its potential complications.

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