Tehran University Medical Journal

Background: Herpes simplex virus (HSV) encephalitis is the most common cause of sporadic encephalitis, with significant morbidity and mortality that are effectively reduced by antiviral treatment. Herpes simplex infection in pregnant women rarely results in encephalitis. The most common symptoms of a pregnant woman with herpes simplex infection are colds and skin vesicles. Herpetic encephalitis occurs during pregnancy in the third trimester in 60% of cases and with less prevalence in the second trimester. Among HSVs most, HSV-1 causes encephalitis. Early diagnosis and timely treatment are important as mortality decreases from 70% to 20-30%. This case report, reviews a pregnant woman with a diagnosis of herpes encephalitis due to seizure and consciousness disorder, which was negative in polymerase chain reaction (PCR) assay and diagnostic studies.
Case Presentation: The patient was a 23-year-old woman with a gestational age of 29 weeks who presented with fever, headache, delirium, and cognitive impairment three days prior to admission following seizure. Early magnetic resonance imaging (MRI) showed an increase in the cortical signal in the temporal lobe and PCR assay for the detection of herpes virus was negative. Magnetic resonance venography also showed an increase in the left maxillary sinus with differential diagnosis of herpetic encephalitis. Considering the symptoms of the patient with a strong suspicion of herpes simplex encephalitis, the patient was treated with acyclovir, which was associated with improvement of clinical symptoms. Finally, normal delivery was performed after 36 weeks of gestation.
Conclusion: Given that herpes simplex virus encephalitis is a rare and potentially dangerous and complicated disease, it is imperative for a pregnant patient with atypical symptoms to be identified with an appropriate diagnostic and therapeutic measures.

Background: Alzheimer dementia as the most common cause of dementia is a chronic, progressive, irreversible and incurable disease. The second most common cause of dementia after Alzheimer is vascular dementia. One of the systems involved in dementia is the visuospatial system and visual evoked potential (VEP) can be one of the diagnostic methods for this disease. Therefore, the present study aims to compare visual evoked potential changes in Alzheimer dementia, vascular dementia and patients with minimally conscious impairment (MCI) with healthy people.
Methods: A case-control study was performed on referred clients to Shariati Hospital, Tehran, Iran, from April 2015 to September 2016. Patients with cognitive impairment went through Montreal cognitive assessment (MOCA) test and divided into three groups of Alzheimer dementia, vascular dementia and patients with minimally conscious impairment. Subjects with normal cognition were included in the control group. The visual evoked potential test was performed on all participants in two Methods: pattern shift visual evoked potential (Ps-VEP) and flash visual evoked potential (f-VEP) and results were compared between groups.

Conclusion: This study showed that only Alzheimer was associated with a significant increase in visual evoked potential P100 latency. On the other hand the other hand, there was no significant difference in flash visual evoked potential variables including P1, N2, P2 and N3 between different groups which shows that flash visual evoked potential cannot differentiate between Alzheimer dementia, vascular dementia, patients with minimally conscious impairment and normal people.

Background: Excessive and irrational use of antibiotics in the treatment of acute diarrhea has caused increased resistance to these medications. It is well defined that most cases of diarrhea in children do not require the use of antibiotics. This study was aimed to determine the status of antibiotic administration for treatment of acute diarrhea in children younger than five years. All who admitted at the pediatric ward of Besat Hospital in Sanandaj.
Methods: First, the study was approved by the ethics committee of Kurdistan University of Medical Sciences. The archived files of all children under 5 years with a positive history acute diarrhea who were admitted in Besat Hospital of Sanandaj during the period of 1 years, from May 2016 to May 2016 were reviewed. Demographic information such as age, gender, type of diarrhea, type of nutrition, type of the prescribed antibiotic, results of the stool and blood samples were collected and recorded in the questionnaire.In Stool samples the contained a large number of WBCs and RBCs along with high fever, Shigellosis were considered. The results were analyzed by SPSS software, version 23 (SPSS Inc., Chicago, IL, USA).

Primary Immune Deficiencies are a group of heterogeneous disorders that involve the innate or acquired immune system, or a combination of them. The underlying disorder may be related to decreased levels or function, or a complete lack of one or more components of the immune system in general. These diseases can occur with a prevalence of about 1 in 10000 live births. According to the fourth update on the Iranian national registry of Primary Immune Deficiency in October 2018, the total number of registered PIDs in Iran are 3056 patients. However, it is supposed to be more prevalent and it seems increasing awareness shall reveal many new cases, especially in societies with prevalent consanguineous marriages like Iran. These disorders predispose patients to recurrent infections, autoimmunity and malignancy and can cause a huge burden on health care systems. This group of diseases has a wide range of symptoms, which quick recognition and timely treatment of them, can greatly reduce the complications of the disease. These symptoms may include recurrent or severe infections, failure to thrive, autoimmune disorders, as well as articular-skeletal manifestations. A variety of skeletal manifestations are seen in patients with primary immunodeficiency, among which septic arthritis caused by pyogenic bacteria or mycoplasma arthritis is the most common joint-bone manifestation. Joint and skeletal involvement is less commonly seen as a sign of primary immune defects. This issue is importance in reducing the cost of diseases and improving the patients’ quality of life. Our review attempted to introduce the most common manifestations of bone and joint in patients with primary immunodeficiency and available treatments for these manifestations. Because of the wide range of symptoms in these patients, it is recommended to observe the rare and suspicious manifestations in the patients with any atypical bone and joint presentations such as: recurrent septic arthritis, infection with unusual germs, immunodeficiency in their relatives, and any history of well-known red flags of PIDs. The Rheumatologist should consider these manifestations and think about the possibility of deficiency disorder.

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: Due to the chronic nature of diabetes, children with type 1 diabetes are prone to a number of long-term complications. One of the most important complications of this disease is cardiovascular involvement due to atherosclerosis, which is directly related to the control of blood lipids. The use of probiotics may be effective in the process of complications in these patients by affecting fat metabolism. The aim of this study was to evaluate the effect of oral probiotics on lipid profiles in children with type 1 diabetes.
Methods: This study was conducted at Bahrami Children's Hospital from May 2018 to May 2019. In this single-blind randomized controlled clinical trial, 52 children with type 1 diabetes (aged 2 to 16 years) were studied. We created two groups of 26 individuals. The inclusion criteria were determined as follows: Proof of T1DM by history and information of children’s medical record. Also, the Exclusion criteria were determined in this way: Patients consuming probiotics in the last 4 weeks, gastrointestinal infections in the last 2 weeks, and presence of chronic underlying intestinal diseases. The probiotic group received, in addition to insulin therapy, a daily probiotic capsule for 90 days. The control group received only routine insulin therapy. Blood samples were taken to measure lipid profiles at the beginning and end of the trial.
Results: A total of 52 patients were included. The mean age of children was 9.3±2.9 (4 to 14 years). The mean age in the probiotic and control groups was 9.6±3.5 and 9.4±3.0 respectively. The results of this study showed that HDL-C was increased in the probiotic group compared to the control group, although it was not statistically significant (P>0.05). Also, changes in total cholesterol, LDL-C, and triglyceride were not statistically significant.

Conclusion: In this study, the use of oral probiotics for 90 days in children with type 1 diabetes did not have a significant effect on blood lipid profiles compared to the control group.

Background: The neonate's Cardiopulmonary resuscitation (CPR) is the most important and common emergency condition in the delivery room. Approximately 10% of newborns are unable to initiate effective breathing and require assistance. The aim of this study was to evaluate the frequency of CPR levels of the neonates delivered during a year in Moheb Yas Hospital who were resuscitated.
Methods: This was a retrospective cross-sectional descriptive study. The sampling method in this study was census. In this study, all the live neonates born during the year (April, 2010 to April, 2011) in Moheb Yas Hospital who were resuscitated, were enrolled in the study. The information of these infants was recorded in separate checklists. This checklist included the following information: mother's age, gestational age, gender of the baby, method of the delivery, multiple births, complications of the placenta and umbilical cord, amount of amniotic fluid, fetal presentation, meconium excretion, fetal heart rate pattern, Apgar of the baby, resuscitation levels, underlying diseases of the mother, maternal diseases during pregnancy, drug use by the mother and premature rupture of the amniotic sac. Finally, the data were analyzed by SPSS software. P-values less than 0.05 were considered statistically significant.

Results: There were 2,176 live births during the study. Of these infants , a total of 322 neonates (15.27%) underwent CPR. 51.8% were male. The mean gestational age was 36.08 weeks. The first minute Apgar was less than 5, between 5-7, and above 8 respectively in 10.5%, 33.4%, and 56% of neonates. About 42% of neonates needed initial resuscitation (warming, drying, and respiratory stimulation). 48% required respiratory ventilation with bag and mask, 5% endotracheal tube, 2.7% cardiac massage, and 1.3% needed medication. In 96.7% of cases, the CPR team was ready for resuscitation before delivery. Conclusion: If resuscitation is performed in a timely and appropriate manner, very few of these infants will need advanced resuscitation. On the other hand, the high need for resuscitation by bags and masks can be secondary to the educational nature of this hospital.

Methods: This was a cross-sectional study. In this study, in a period of three years from (March 2016 to March 2019), all patients admitted to the PICU of Tehran Bahrami Children's Hospital were examined. The sample size was calculated 380. Demographic information, diagnosis during hospitalization, underlying disease, and initial tests during the first 24 hours of hospitalization were recorded in the checklist. To evaluate the demographic findings between patients with and without UGIB, chi-square and Fisher tests were used. A p-value of less than 0.05 was considered significant. Results: 462 patients were studied, of which about (58%) were male. The mean age of the samples was 48 months and the average length of hospital stay in PICU was ten days. In general, (21.21%) of patients had gastrointestinal bleeding on the first day and (12.12%) on the second day of hospitalization. Gastrointestinal bleeding occurred in 50 patients (10.82%). Use of ventilator, pulmonary diseases, coagulation and blood diseases were significantly more common in patients with gastrointestinal bleeding than in children without gastrointestinal bleeding. Cardiac, neurological, hepatic, and renal disease were not significantly different in patients with gastrointestinal bleeding compared to children without gastrointestinal bleeding. Conclusion: The occurrence of gastrointestinal bleeding in critically ill patients admitted to the PICU is a serious risk. The most important risk factor for upper gastrointestinal bleeding is mechanical ventilation. Other risk factors of gastrointestinal bleeding are lung disease, coagulation diseases, hematologic and oncologic disease.

Background: Vasculitis is a heterogeneous group of diseases that means an inflammatory process in blood vessels. Diagnosing vasculitis in children is challenging due to the variety of symptoms. Classification of childhood vasculitis is usually based on clinical phenotypes, size of affected vessels (small, medium, or large), and pathology of inflammatory infiltrates. The aim of this study is to investigate the epidemiological information on types of vasculitis and their clinical symptoms in children in eastern Iran.
Methods: This 3-year descriptive cross-sectional study was performed on all male and female patients with any vasculitis referred to the outpatient clinic and rheumatology department of Akbar Children's Hospital from the beginning of September 2017 to the end of September 2020. Has been. This study was based on information obtained from the checklist (information from the inpatient and outpatient records and information in the HIS). Checklist information included age, gender, drug history, history of surgery, clinical symptoms in different systems, season of disease onset, etc.
Results: Out of 263 children, 135 (51.33%) had Henoch-Schonlein and 100 (38/02%) of them had Kawasaki. The numbers of Behcet, Takayasu and Churg-Strauss patients were 20, three and two, respectively. In most subgroups, female patients were more common than male patients. Kawasaki and Takayasu had the lowest and highest age of onset, respectively. The most common seasons of appearance for Henoch-Schonlein and Kawasaki were autumn and summer respectively. In most subgroups, skin rashes are the most common clinical symptom, with, the most common types being petechiae and purpura.

Conclusion: In the present study, the most common type of vasculitis diagnosed in children in eastern Iran was reported by Henoch-Schonlein and Kawasaki respectively, which was completely different from the most common types of vasculitis in adulthood and indicated the importance of age in diagnosing the type of vasculitis. The necessity of clinical suspicion of these two diseases in children with skin rashes, along with matching with other clinical findings, is undeniable.

Background: Most hemiplegic children experience disorders related to lower limbs such as balance. Considering the importance of balance, in order to participate in activities of daily living, it is very important to use modern neuro-rehabilitation methods such as mirror therapy to improve balance. The purpose of the present study was to determine the effectiveness of mirror therapy on the static and dynamic balance of children with hemiplegic CP aged 5 to 12 years.
Methods: This study was conducted as a double-blind, randomized clinical trial on 20 children with spastic hemiplegia aged between 5-12 years old, from June 2021 to August 2022 in Tehran, Iran. Participating children were randomly allocated into test (n=10) and control (n=10) groups. The children in the treatment group underwent 20 treatment sessions during four weeks. Each session consisted of 30 minutes of routine treatment and 15 minutes of mirror therapy for lower limbs. In the control group, sham therapy was performed instead of mirror therapy. The exercises performed in a seated position were: (1) active flexion of hip, knee, and ankle joints, (2) active knee extension plus ankle dorsiflexion, and (3) knee flexion (> 90°). Both groups were measured by the Pediatric Balance Scale to assess static balance and the Timed Up and Go test to assess dynamic balance at entry and the end of the study. SPSS version 26 software was used for statistical analysis.

Results: Examining the results of the evaluations showed that before the treatment, the static and dynamic balance of the two groups did not differ significantly (p> 0/05), but the static and dynamic balance scores of the children in the treatment group after the four weeks mirror therapy period (five days per week) were statistically significant different from the control group (p<0/05). Conclusion: According to the present study, it seems that mirror therapy as a complementary treatment can have a positive effect on improving balance (static and dynamic) in children with hemiplegic CP.

Results: Then bacterial colonies were counted, contamination reduction was measured, and the shelf life of the solution was determined according to the standards.  Results showed that a 60-to-90-second scrub with an alcohol-based disinfectant is the best way to reduce hand contamination and, thereby, nosocomial infections. Conclusion: Based on the study findings, alcohol-based solutions can be recommended for surgical scrubs, according to WHO guidelines.

Background: Preoperative anxiety assessment allows for better analgesia in the postoperative period and a better experience for the patient. Previous studies have investigated anxiety factors specific to cataract surgery, reporting vision problems, particularly blindness, among the main preoperative fears. However, there is little research that fully and accurately investigates the causes and factors of anxiety in this population. Therefore, in this study, the factors related to anxiety in the elective eye patients.
Methods: In this descriptive-analytical study, the comparison of the level of anxiety in elective eye patients of Shahid Mohammadi Bandar Abbas Hospital in the spring and summer of 2023 was investigated. Patients referred to Bandar Abbas Shahid Mohammadi Hospital were included in the study according to the entry criteria and obtaining informed consent. In this study, after the approval of the research committee of the university, the necessary information was made by the researcher's checklist, which includes gender, age, causes of anxiety, patient's level of education, previous history of eye surgery, previous history of non-eye surgery and other underlying diseases. Was collected and the level of anxiety was measured in 2 stages before and after eye surgery based on VAS criteria.
Results: In this study, 85 (47.2%) patients were male and 95 (52.8%) were female. Also, most of the patients had a diploma-level education. Most patients mentioned a non-ocular surgery history (18.3%). Also, most of the patients (52.8%) noted an unknown cause as an anxiety-causing factor, and the least frequent among the anxiety-causing causes mentioned by the patients was the fear of death due to surgery. The level of anxiety in patients who had a history of non-ocular surgery was significantly lower. Patients who mentioned the unknown cause, the surgery itself, and financial problems as the cause of their anxiety experienced significantly higher preoperative anxiety and postoperative anxiety.
Conclusion: The level of anxiety in patients who have a history of eye and non-eye surgery is significantly lower. Preoperative anxiety and postoperative anxiety are significantly higher in patients who mention the unknown cause, the surgery itself, and financial problems as the cause of their anxiety.

Background: This study was designed to compare the effects of using a laryngeal mask airway (LMA) and endotracheal intubation on airway resistance and compliance in patients undergoing orthopedic surgery under general anesthesia. Evaluating these two methods is crucial for improving respiratory quality and reducing complications related to airway management in patients.
Methods: This analytical cross-sectional study was conducted on 50 patients undergoing orthopedic surgery under general anesthesia at Hospital in Bandar Abbas between May and September 2024. The patients were equally divided into two groups: the first group received a laryngeal mask airway (LMA), while the second group underwent endotracheal intubation under general anesthesia. The primary variables, including airway resistance and compliance, were measured at 0, 15, 30, and 60 minutes after anesthesia induction. Demographic characteristics such as age, gender, and ASA class were also recorded. Data analysis was performed using SPSS version 21, with descriptive statistics (frequency, percentage, mean, and standard deviation) and inferential statistical tests (Mann-Whitney U test and Chi-square test), considering a significance level of P<0.05.
Results: The findings of the present study showed no statistically significant differences between the two groups regarding age distribution and ASA class. A comparison of airway resistance and compliance between genders revealed no significant differences at 0, 15, 30, and 60 minutes. There was no significant difference between the two anesthesia groups (laryngeal mask airway and endotracheal tube) in terms of age distribution. There was no statistically significant difference in ASA classification between the two anesthesia groups. At minute 0 of anesthesia, airway resistance was significantly higher in the endotracheal intubation group compared to the LMA group (P<0.001). At 30 and 60 minutes of anesthesia, airway resistance remained significantly higher in the endotracheal intubation group (P<0.001). Airway compliance was significantly higher in the LMA group at all measured time points (0, 15, 30, and 60 minutes) compared to the endotracheal intubation group (P<0.001).
Conclusion: The results of this study demonstrated that using a laryngeal mask airway (LMA) compared to endotracheal intubation leads to improved airway compliance and reduced airway resistance during anesthesia. These findings may influence the selection of anesthesia methods and enhance postoperative care quality.

Background: Endoscopy is a common medical procedure that often involves the administration of sedative agents to ensure patient comfort and cooperation. Midazolam, a short-acting benzodiazepine, is commonly used as a premedication for its anxiolytic and amnestic properties. Despite its widespread use, there is limited research specifically assessing the occurrence of anterograde amnesia, a potential side effect associated with midazolam administration during endoscopic procedures. Understanding the frequency of this adverse effect is crucial for optimizing patient safety and procedural outcomes.
Methods: In this prospective cohort study After obtaining approval and ethical clearance, patients eligible for endoscopy at Bandar Abbas Shahid Mohammadi Hospital were included in the study. They received 2mg midazolam intravenously before the procedure, followed by propofol for anesthesia maintenance. A memory test involving personal details was conducted before and after the procedure to assess progressive amnesia. Additionally, patients were asked about the procedure 5 minutes before discharge.
Results: 342 endoscopy candidates participated, with an average age of 46.77 years, over half being men. Less than a quarter had a diploma. Average endoscopy time was 2.96 minutes, mostly ASA class 2. Recall scores after midazolam injection and endoscopy were 5.22 and 2.87, respectively. Post-graduate education showed a significant difference in midazolam amnesia. No significant gender difference was observed. Longer endoscopy duration correlated with decreased recall scores. ASA class 2 patients had lower post-endoscopy recall scores than ASA class 1. Recall scores decreased with age, with the highest in the 19-29 age range, a statistically significant finding.
Conclusion: This study In conclusion, this study provided valuable insights into the factors influencing midazolam anterograde amnesia. Key findings include a significant association between higher education levels, particularly post-graduate education, and increased recall scores after midazolam injection. Gender did not show a significant impact on midazolam amnesia, but the duration of endoscopy played a crucial role. Additionally, patients in ASA class 2 exhibited lower recall scores than those in class 1, highlighting the influence of overall health status. Age also emerged as a factor, with the youngest age group showing the highest recall scores after endoscopy. These findings contribute to our understanding of factors affecting midazolam-induced amnesia during endoscopy procedures.

Background: Today, cesarean section is one of the most common surgeries performed in different countries. Shivering after surgery is one of the common complications of spinal anesthesia in cesarean surgery. Many drugs have been investigated to prevent or reduce shivering, but the ideal drug has not yet been finally approved. The purpose of this study is to investigate the effect of dexmedetomidine in preventing shivering after cesarean section surgery under spinal anesthesia in the form of a systematic review.
Methods: In this systematic review, the Persian keywords "dexmedetomidine", "spinal anesthesia", "caesarean" and dexmedetomidine" and the English keywords dexmedetomidine", "Caesarean section", "Spinal Anesthesia" "Dexmedetomidine and "C-Section" in databases PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Clinical Trials.gov and Scopus, SID, Magiran, Medlib and Google Scholar search engine, without time limit Done. Data extraction was performed independently by two authors. Study name, year of study, country, study groups, and incidence of shivering were extracted from the studies. Our primary outcome was the severity of shivering in patients. All disagreements in data extraction were resolved through discussion between the reviewers or, if not possible, by a third reviewer. Data were entered into an Excel file.
Results: In this systematic review, 19 studies were examined. The total number of patients included in the study was 2001 patients. The study range was from 2016 to 2022. The age group of most patients was between 18-45. The drugs studied in combination with dexmedetomidine in the studies included: pethidine, dexamethasone, nalbuphine, ondansetron, and morphine. The most studied drugs were pethidine and dexamethasone in three studies. In 13 studies, dexmedetomidine was more effective in controlling shivering than the other groups studied. Also, in five studies, dexmedetomidine, along with three drugs: pethidine, dexamethasone, and ondansetron, had similar effects in controlling shivering in patients. In one study, dexmedetomidine produced less anti-tremor effects than nalbuphine.
Conclusion: In the review of the studies, the results indicated that dexmedomedin is effective in preventing post-operative shivering in patients undergoing caesarean section. Therefore, it seems that the use of dexmedetomidine to prevent shivering after surgery is useful in these patients.

Background: One of the most common cancers in women is cervical cancer, which is the most preventable cancer leading to death among women worldwide. Among the causes related to cervical cancer, the human papillomavirus (HPV) is the main factor responsible for causing cervical intraepithelial neoplasia (CIN) and cervical cancer. The aim of this study was to investigate the prevalence of high-risk HPVs (HPV16 and HPV18) and to determine the immediate absolute risk of CIN2+ in individuals with a positive HPV test.
Methods: This cross-sectional study included women who tested positive for HPV and visited the Gynecologic Oncology Clinic at Tehran University of Medical Sciences from October 2022 to March 2025. Individuals with a positive high-risk HPV result were referred for colposcopy and biopsy. The immediate absolute risk of CIN2+ in HPV-positive patients with HPV16, HPV18, or concurrent HPV16/18 genotypes (Multi. HPV+) was evaluated across different cytologic grades, ranging from NILM (Negative for Intraepithelial Lesion or Malignancy) to SCC (Squamous Cell Carcinoma).
Results: A total of 727 patients participated in the study. The mean age and standard deviation of the participants were 35.99 and 8.48 years, respectively. Among all referrals, the number of women who were positive only for HPV 16 was 170 (23%), and 24 (3.3%) were positive only for HPV 18. The highest number of positive cases for HPV16 and HPV18 were in the age range of 30 to 39 years (45%). In the Multi. HPV+ group, the highest number was observed in individuals under 29 years old (50%). The calculated immediate absolute risk of CIN2+ in HPV16+ individuals was 14% for NILM and 8.6% for ASCUS, while in HPV18+ individuals, it was 8.3% for NILM.
Conclusion: Cytologic triage combined with HPV genotyping testing can be utilized firstly as an approach to identify cellular abnormalities in HPV-infected individuals and subsequently as an appropriate method to reduce referrals for colposcopy.