Tehran University Medical Journal

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.

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.

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.

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.

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.

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.

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.

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.

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.

Background: Medical malpractice is a serious problem in the health care system. This study aimed to review the medical negligence in Iran.
Methods: Based on the PRISMA checklist, a search for scientific records was done separately by two researchers. All the articles that had selection criteria were evaluated in terms of methodological quality. Medical malpractice was assessed in four main divisions including negligence, Lack of skill, Carelessness and non-compliance with government regulations). The bias test was performed using the Egger’s test. Revman software was used to analyze the data.
Results: In the present study, 25 studies that examined the country's medical malpractice from April 1994 to March 2018 were included in the meta-analysis. Negligence has been implicated in 1,105 cases of the 2,068 claims. Lack of skill in 255 out of 2068 cases, 432 cases of carelessness and 244 cases of non-compliance with government regulations Were recorded the results of the meta-analysis showed that OR negligence was 0.76 (CI 95%: 0.66-0.87), lack of skill was 0.61 (CI 95%: 0.49-0.76), carelessness was 0.62 (CI 95%: 0.50-0.76) and non-compliance with government regulations was 0.66 (95% CI: 0.60-0.73). In the review of the confirmed negligence ratio of the registered complaint files, only 19 studies mentioned this ratio. The results of the meta-analysis of these 19 studies showed that the OR ratio of the confirmed negligence of complaints was 0.6 (95% CI: 0.41-0.86). From all claims, General surgeons had OR of confirmed medical malpractices, equal to 0.47 (CI 95%: 0.37-0.60), gynecologists with OR equal to 0.49 (CI 95%: 0.36-0.66), general practitioners with OR equal to 0.43 (CI 95%: 0.30-0.63) and orthopedic specialists with an OR of 0.44 (CI 95%: 0.32-0.61).

Today surgery is supposed as the cure for many diseases and the fear of post-operation pain burdens stress over the patients. Postoperative pain can, especially if severe, complicate the patient's condition and may lead to chronic postoperative pain. post-operation pain control is effective in the recovery process, hospitalization period and patients’ satisfaction. Insufficient post-operation pain control increases complications and care costs. Local analgesia is one of the components of multimodal postoperative. analgesic protocol to control pain. Local analgesia technique is a simple, accessible and feasible method for various surgeries. The opioid analgesics to control post-operation pain are associated with some complications such as opium addiction, nausea and vomiting, late return of bowel function and social costs. This review study aims. to review previous studies on the effect of injection of analgesic agents in the surgical incision in post-operation pain control. This is a Narrative review study. to related scientific documentaries a search was conducted in Persian and English using the keywords of local injection of the incision site, wound infiltration with analgesic agents and post-operation pain control in Google scholar, PubMed and Scopus database during the years 2000 to 2020. The obtained articles included systematic reviews, Meta-analyses and randomized clinical trials (RCT). We reviewed studies that had utilized single-dose injection of analgesic agents in surgical incisions at the end of surgery to control post-operation pain. A total of ten studies were reviewed. There were 4 studies in the field of laparoscopic gynecological and non-gynecological surgeries, three studies in the field of laparotomy and three review studies. injection of analgesic agents in the surgical incision to control post-operation pain is easily available and does not necessitate any special skill. On the other hand, it is a safe method without further complications and does not increase the duration of surgery. Regardless of the differences in various studies and the kind of analgesic agents, a general reduction in pain severity and consumption of opioid and non-opioid analgesic agents were observed using the injection of analgesic agents in surgical site incision.

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.

Case Presentation: A 54-year-old female patient presented with a vulvar mass in February 2021. The patient mentioned that the mass had existed for ten years and had increased in size in the last two years. After discussion on the tumor board, she underwent surgery. The pathology of the mass was reported to be aggressive angiomyxoma. The patient was treated with a GNRH agonist after surgery. The patient is currently under follow-up and has not had a recurrence so far (March 2020). Conclusion: Aggressive angiomyxoma is a rare mesenchymal tumor. It has extensive local invasion and a high recurrence rate, but distant metastasis is rare. Estrogen receptors or Progesterone receptors are commonly positive in aggressive angiomyxoma. The best treatment for aggressive angiomyxoma remains unknown. Extensive local resection of the tumor has been reported as an important therapeutic measure. In cases of mass recurrence, reoperation and hormone therapy have been effective. It is important for gynecologists to consider this tumor as a differential diagnosis when dealing with vulvar masses.

Background: Cerebral palsy is a movement disorder syndrome in early childhood. Signs and symptoms vary among people and over time but include poor coordination, stiff muscles, and weak muscles. Some affected children can achieve near-normal adult lives with appropriate treatment. In recent years, transplantation of human mesenchymal stem cells (hMSC) has become a promising therapeutic strategy for CP. Every year, a lot of costs are spent on the treatment and management of this disease. The purpose of this study is to investigate the safety and effectiveness of this method on CP.

Methods: This article is a systematic review. At first, a search strategy was written and performed in Scopus, PubMed, and Google Scholar databases(The search was conducted from March 14 to March 28, 2021), and the inclusion and exclusion criteria were determined. Study inclusion criteria: review studies, cohort studies, clinical trial studies (randomized and non-randomized), control case, and retrospective , exclusion criteria: non-English articles and studying on animals. After removing duplicate articles, two authors independently reviewed the studies according to the inclusion and exclusion criteria. Disagreements among the authors were resolved through discussion.
Findings: In total, 9236 articles were found in the initial search, after reading the titles, of 37 articles, 21 articles were selected in the abstract stage and 18 articles remained in the full-text stage. We finally found 18 articles that showed that using stem cell technology as a scientific method could improve sick patients’ quality of life and movement defects.
Conclusion: According to the available evidence and limited studies, stem cell technology can be safeand cost-effective in improving CP patients, but there is insufficient evidence. On the other hand, there are many studies confirming the effectiveness of these cells in the treatment of movement impairment. In conclusion, stem cells may have a very promising future. Finally, stem cell technology combined with innovative biotechnologies may soon bring promising results to patients.

Methods: In this case control study, 112 newly diagnosed patients with NAFLD referred to the Shahid Rahimi Hospital clinic in Khorramabad between January 1400 and April 1401 and 112 healthy individuals without NAFLD and any other chronic diseases as the control group, with the range 23-59 years old were selected. General information, demographics, physical activity level and food intake were collected using general information questionnaire, physical activity questionnaire and valid semi-quantitative food frequency questionnaire (FFQ). The energy received between the people of the two groups was adjusted. People's diet was divided into two anti-inflammatory and pro-inflammatory groups based on the DII index based on the score quartiles. Results: The results showed a significant relationship between DII score and NAFLD in the crude model (OR: 2.22, 95% CI: 1.04 -4.73), model I (adjusted for energy and age classification) (OR: 2.4, 95% CI:1.07-5.58), model II (adjusted for model I+physical activity, sex, education) (OR:2.77, 95% CI:1.14-6.77) and model III (model II+BMI) (OR: 2.16, 95% CI: 0.81-5.71) and DPI score and NAFLD the crude model (OR: 0.69, 95% CI: 0.32-1.47), model I (adjusted for energy and age classification) (OR: 0.56, 95% CI: 1.29-5.58), model II (adjusted for model I+physical activity, sex, education) (OR:0.58, 95% CI: 0.23-1.44) and model III (model II+BMI) (OR: 0.65, 95% CI: 0.24-1.75). Conclusion: The results obtained from this study showed an inverse relationship between following an anti-inflammatory diet and the risk of NAFLD. However, there was no correlation between receiving a diet with a high phytochemical index and NAFLD.

Epstein-Barr virus (EBV), human herpesvirus 8 (HHV-8), hepatitis B virus (HBV), human papilloma virus (HPV), Merkel cell polyomavirus (MCPyV), human lymphotropic virus type 1 (HTLV-1) and Hepatitis C virus (HCV) are among the most important viruses that cause cancer in humans. These viruses are collectively known as oncoviruses due to their potential to induce malignant transformations in host cells. Oncoviruses exert their cancer-causing effects by utilizing various viral oncoproteins and non-coding RNAs, which can drive host cells toward malignancy through multiple pathways. One critical strategy these viruses employ involves altering the host cell's regulatory mechanisms, particularly by influencing DNA methylation processes.
DNA methylation is a crucial modification that occurs on the promoter regions of genes, effectively reducing their expression levels. Under normal cellular conditions, a delicate balance of methylation and demethylation is maintained by a specific set of enzymes. Key players in this process include DNA methyltransferases (DNMTs) and TET methylcytosine dioxygenases (TETs), which are pivotal in regulating gene expression through methylation. These enzymes are prime targets for oncoviruses because, by altering their activity, viruses can hijack the host cell's regulatory machinery. Viral oncoproteins, though diverse in structure and function, often converge on disrupting the expression of these enzymes. By doing so, they induce widespread changes in DNA methylation patterns, effectively reprogramming the gene expression landscape of the host cell. This reprogramming is not random; rather, it is a calculated mechanism through which oncoviruses can manipulate the cell cycle, promoting uncontrolled cellular proliferation and progression towards cancer. By suppressing or activating specific genes, these viruses can push cells past normal checkpoints, eventually leading to tumor formation. Despite the critical role of DNA methylation in cancer development, the precise mechanisms by which oncoviruses modulate these methylation processes are not fully understood. Researchers have made significant progress in exploring the connection between viral infections and cancer, but many of the detailed pathways through which oncoviruses control methylation remain to be elucidated. As a result, this area remains a fertile ground for further research, offering potential avenues for therapeutic intervention in virus-induced cancers.