Tehran University Medical Journal

Background: Identifying determinants of maternal mortality is essential in developing appropriate health policies for reduction of maternal death. This study aimed to determine the determinants of maternal mortality in Iran during 1990- 2015 and also to identify the trends of these determinants during the same period.
Methods: This is a quantitative longitudinal study that has been conducted at the Tehran University of Medical Science, Iran, from March to December 2018. Initially, a long list of determinants (n=32) were identified through a comprehensive systematic reviews. Variables with more than 25% missing data were omitted and the missing values for remaining variables were estimated through statistical methods. The data for the identified variables were gathered through internal sources including Iran’s Ministry of Health and international sources including the websites of World Bank, World Health Organization and United Nations. Finally, 12 indicators as determinants of death were constructed after data processing and data management and their associations with maternal mortality rate in Iran were examined through regression analysis.
Results: Maternal mortality rate has been reduced by 80% during 1990- 2015 in Iran. Improvement of indicators including employment status, total health expenditure share (as a percent of GDP), vaccination coverage, urbanization, access to health and welfare facilities, GDP per capita and political performance played a significant role in reduction of maternal deaths according to the multivariate analyses. A reduction in out of pocket payment and total fertility rate also showed a significant association with lower maternal mortality. However neither education level in the country nor life expectancy at birth showed an important role in the maternal mortality rate.
Conclusion: Maternal mortality rate was reduced significantly in Iran during the last quarter of the century. Maternal death is not only affected by health and biological factors of mothers, but also, by macro-economic, social and welfare factors. A high political performance of the countries also is a grantor of better health of mothers and the community in general.

Background: Although significant advances have been made in scientific and medical technology, but the rate of medical complaints has also risen. The purpose of this study was to investigate the effect of handling of medical malpractice cases in the hospital complaints committee on the reduction of patient complaints to law enforcement authorities.
Methods: In this descriptive study, patients complained about ophthalmology from April 2005 to December 2005 at Farabi Hospital, Tehran, were evaluated. The complainant's patients, if confirmed by the trusted doctors, were invited to complaints committee, and the subject of the complaint was examined and tried to obtain patient satisfaction.
Results: A total of 87 patients complained to ophthalmologists completed a complaint form 71 (81.7%) of the cases were male. Statistically, the number of complaints was significantly lower in those with lower education (P=0.02). The prevalence of primary disease, 52 cases (59.8%) was cataract and 14 cases (16%) due to refractive errors and refractory surgery. In the examination of complaints by trusted doctors in the hospital, 11 cases of ophthalmologic error were identified, with a mantle rate of 12.6%, and the cases were reviewed by the complaints committee. Of the cases of complained that confirmed by the committee, only one person sued the law enforcement, which represented 9% of the defaulted item. These statistics showed a significant decline compared to the past year at the same center, and the percentage of defaults to law enforcement was 37.5% (P<0.05).
Conclusion: Establishing committees to handle complaints of ophthalmologic failures in hospitals and providing a clear and honest atmosphere to hear the subject of complaints by patients and their companions, and then trying to get patients' satisfaction and helping them continue their treatment can lead to reduced complaints of patients to the authorities Legal, like forensics medicine department and medical council. 

Background: Cataract is one of the most common eye diseases especially in children and adolescents in two age ranges, and many of these patients need to surgery throughout life. The purpose of this study was to compare the efficacy and side effects of midazolam-ketamine and midazolam-fentanyl for sedation in adult cataract surgery.
Methods: In this study, which was a case-control study, 80 patients were referred to Farabi Hospital in Tehran from November to December 2018 for cataract surgery and underwent surgery. The patients were divided into two groups (n=40). In this study the method of using midazolam-ketamine (ketamine group) was compared with the combination of midazolam-fentanyl (fentanyl group). The hemodynamic variables such as blood pressure and heart rate before surgery were measured and then measured every 5 minutes during operation and were recorded. In addition to hemodynamic variables, other variables such as agitation, surgeon satisfaction, recovery nurse satisfaction, degree of oxygen saturation during surgery, and nausea and vomiting were compared between the two groups.
Results: In this study, 18 patients (45%) of fentanyl group and 17 patients (42.5%) of ketamine group were female. Patients in the two groups had similar demographic distribution before surgery. In this study about blood pressure after surgery, from 80 patients, 22 cases had blood pressure below 119.79 mmHg, of which 3 (13.6%) cases were in ketamine group and 19 cases (86.4%) in fentanyl group. In general, 7.5% of ketamine group and 47.5% of fentanyl group had a blood pressure lower than 119.79 mmHg. Hemodynamic changes and hypotension after sedation was more in fentanyl group. Two groups did not differ in terms of heart rate, arterial oxygen saturation during surgery, surgeon satisfaction during surgery, and postoperative nausea and vomiting.
Conclusion: Administration of ketamine-midazolam versus fentanyl-midazolam in patients who underwent cataract surgery by sedation led to more stable hemodynamic variables intraoperatively and other side effects such as heart rate, oxygen saturation, surgeon satisfaction, nausea and vomiting were similar between two groups.

Background: Due to the incidence and recurrence of bladder cancer (BC), it could be categorized as a clinical and social problem that often occurs at an advanced age. This study was designed to determine the incidence of BC in Isfahan, Iran.
Methods: A retrospective descriptive survey of information based on bladder cancer (ICD-O, third edition; C67) was obtained from the Isfahan Deputy of Health. The study was in conducted to the department of Urology and Kidney Transplantation Research Center and approved by the University Ethics Committee. The Isfahan Cancer Program is intended to record all cancer cases in the Isfahan. From 20 March 2016 to 19 March 2017, records with linkage to using of pathology, demographic and clinical information were recorded in Microsoft Excel 2013 (Microsoft Corp., Redmond, WA, USA) and analyzed by SPSS statistical software, version 22 (IBM, Armonk, NY, USA). The incidence rates (Irs) were calculated by dividing new cases of BC during the year of study to the population at risk during the same time period×100000.
Results: A total of 417 patients that corresponded to Irs of 8 per 100000 persons were studied. The overall recorded number was comprised of 361 males (IRs of 13.9 per 100000) and 56 females (Irs of 2.2 per 100000). The mean±SD age of patients was 64.7±13 years. The minimum age in males versus females was 12 versus 25 years old respectively. Age in the most patients (80% of cases) was more than 50 years old. The invasion of the muscle was recorded in 44% of cases. Geographical distribution in 65% of cases was related to Isfahan City as a place of birth-residence and in the next categories were Khomeinishahr (7.6%), Najafabad (6.8%), Lenjan (4.5%), Mobarekeh (3.7%) and Felavarjan (2.8%) respectively.
Conclusion: Comparison of BC incidence rate between the year 2014 and 2016 showed that incidence rates decreased by 18.2%. In the 44%, invasive neoplasm of BC was recorded for the population studied. The highest frequency of BC was associated with Isfahan City and then Khomeinshahr, Najaf abad, Lenjan, Mobarakeh and Falavarjan.

Background: AIDS is an emerging disease, and despite the fact that it has not been recognized for the first half-century since its inception, it has been known as a century-old disaster. This disease, by proliferation in immune cells and ultimately by weakening the immune system, makes people vulnerable to diseases. Our study seeks to examine existing cases of HIV/AIDS patients in East Azerbaijan province in Iran and provides useful guidance for patient diagnosis, treatment, and care.
Methods: This is a descriptive-analytic study in which the target group includes all HIV-positive or AIDS patients identified or reported from 2004 to 2014 in Tabriz Medical Sciences or Health Centers of East Azerbaijan province. The demographic information of all patients were recorded by a researcher-made questionnaire during visiting the disease-management counseling centers. All data including transmission of the illness (including all possible ways), the diagnostic date, the onset of treatment and the date of death were collected, and then entered into the software Stata, version 11.0 (Stata Corp., College Station, TX, USA). The information were imported in the ArcGIS software, version 10.7.1 (ESRI Inc., Redlands, CA, USA), maps were created, and geographic and spatial data were analyzed.
Results: According to the results of this study, most patients with 89.9% were male, 28.9% were under the age of 36 years, 32.3% had elementary education, and the most common way of transmission with 42.3% is through the shared infusion.
Conclusion: According to the results of this study, the highest prevalence of AIDS in East Azerbaijan province was observed in men under the age of 36 years and primary and lower secondary education in Tabriz and Maragheh cities.

Background: Nausea and vomiting is one of the most common complications after the strabismus surgery. In this study, we evaluated the efficacy of atropine versus ondansetron administration on the incidence of postoperative nausea and vomiting and duration of recovery stay in patients undergoing this procedure.
Methods: In this case-control study, 90 patients between 3 to 30 years old who were candidates for elective strabismus surgery in Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran, from February to April 2019, were randomly divided into three groups (placebo, ondansetron and atropine group). Patients who had taken hypnotic drugs while entering the operating room were excluded. In all patients, after arriving into the operating room and installation of standard monitoring equipment and peripheral vein implantation, anesthesia was induced by receiving 0.05 mg/kg midazolam, fentanyl 1 μg/kg and propofol 2.5 mg/kg. After induction of anesthesia, placebo group was compared with ondansetron group and atropine group that received 0.1 mg/kg ondansetron and 30 µg/kg atropine, respectively. The rate of postoperative nausea and vomiting, duration of recovery stay and satisfaction of recovery nurses were recorded and compared between groups.
Results: There was no statistically significant difference between the three groups in terms of mean age, weight, and gender. It seems that group matching is appropriate and there are no confounding factors for demographic variables. Administration of atropine and ondansetron significantly reduces the incidence of nausea and vomiting postoperatively and in recovery. There was no significant difference in the incidence of nausea and vomiting between the atropine and ondansetron groups. Duration of recovery stay was decreased after ondansetron and atropine administration versus control group. Postoperative laryngospasm and bronchospasm were not observed in any of the three groups after surgery and at the time of recovery. The satisfaction of recovery nurses in both atropine and ondansetron groups were higher than control group.
Conclusion: It seems that the administration of atropine as much as ondansetron can be effective in reducing the incidence of postoperative nausea and vomiting and the length of recovery stay in patients who undergoing strabismus surgery.

Background: Botulism is mostly caused by Clostridium botulinum neurotoxin which has been described as a bilateral symmetric descending flaccid paralysis. Preventing and responding to botulism outbreaks is a public health emergency. In this study, the disease is reported in a family.
Methods: In a case series study, during an outbreak, four members of a family with symptoms including paralysis, ptosis, blurred vision, diplopia, weakness, dysphagia, dry mouth, respiratory problems, vertigo, and lethargy, referred to Loghman Hospital of Tehran. Among the patients was an elderly woman and a pregnant woman. All clinical signs and symptoms of the patients were recorded daily in a researcher-made questionnaire from 27 August to 3 September 2018. At the time of admission, vital signs (pulse rate, respiration rate, and body temperature) of patients were stable and within normal limits. Following clinical suspicion of food-borne botulism in these patients, samples of the first two patients, including serum, stool, gastric secretions, and homemade whey were sent to the Botulism Laboratory of Microbiology Department of Pasteur Institute of Iran for the mouse bioassay.
Results: Type A neurotoxin was detected in homemade whey after the mouse bioassay. Therefore, foodborne botulism was confirmed in patients with laboratory results. Patients included two men and two women with a mean age of 52.7 years old. The length of hospitalized days was between 2 and 6 days. Two of the patients were admitted to the intensive care unit (ICU). Patients under study were fully recovered with timely diagnosis of the disease, treatment with antitoxin, and supportive care.
Conclusion: When conscious patients referred to the hospital with symptoms of paralysis, foodborne botulism is an important differential diagnosis. On-time diagnosis and antitoxin treatment can prevent serious complications.

Primary immunodeficiency diseases (PIDs) is a diverse group of diseases, characterized by a defect in the immune system. These patients are susceptible to recurrent respiratory infections, gastrointestinal problems, autoimmune diseases, and malignancies. In most cases, patients with primary immunodeficiency disorders have genetic defects and are monogenic disorders that follow a simple Mendelian inheritance, however, some PIDs recognize a more complex polygenic origin. Overall, almost 70 to 90 percent of patients with primary immunodeficiency are undiagnosed. Given that these patients are exposing to respiratory infectious agents and some live-attenuated vaccines, thus they have a high risk to some clinical complications. The administration of oral polio vaccine in patients with PIDs especially can increase the possibility of acute flaccid paralysis. These patients will excrete the poliovirus for a long time through their feces, even though they are not paralyzed. Long-term virus proliferation in the vaccinated individuals causes a mutation in the poliovirus and creates a vaccine-derived polioviruses (VDPVs), which is a major challenge to the final stages of the worldwide eradication of polio. 
To increase the diagnosis and identification of patients with immunodeficiency and carrying out a national plan for screening patients with immunodeficiency from the fecal excretion of the poliovirus, a possible polio epidemic can be prevented during post-eradication. Development of laboratory facilities in provincial and city centers, improvement of communications among physicians regarding medical consultation and establishment of referring systems for patients by national network lead to improve status of diagnosis and treatment of patients with primary immunodefiicencies. In this context, launching and activating the national network of immunodeficiency diseases is essential for improving the health of children and reducing the cost of the health system of the country. A national network of immunodeficiency can lead to increase awareness of physicians regarding primary immunodeficiency disorders, improve collaboration among physicians about genetic consultation and establish a practical referral system in Iran that results in increased diagnosis and improve treatment of patients with primary immunodeficiency disorders.

Background: Acute myeloid leukemia (AML) is characterized by the proliferation of myeloid precursors and abnormal differentiation of hematopoietic stem cells, which results in the accumulation of immature cells in the bone marrow (BM). The accumulation of these cells in the bone marrow causes molecular and cellular changes in the microenvironment of the bone marrow. The adiponectin hormone originates from adipose tissue of the bone marrow, which in addition to effective functions in cellular metabolism, suppresses cancer through various mechanisms, including inhibition of metastasis, angiogenesis, and proliferation. In the bone marrow sample, patients with acute myeloid leukemia are associated with different subtypes of the disease.
Methods: In this basic-fundamental research, a total of 40 BM samples from de novo AML patients and 15 BM samples from healthy volunteers as the healthy group referred to the Stem Cell Transplantation Laboratory and Cell Therapy of Taleghani Hospital and with assisting the Research Center, Shahid Beheshti University of Medical Sciences, Tehran, from March 2015 to February 2017, were entered into the study. Then used the Real-time polymerase chain reaction (RT-PCR) method for diagnosis level of adiponectin gene expression in BM samples patients and the healthy group.
Results: The results of the present study showed that the level of adiponectin gene expression in the BM sample of patients was significantly decreased in comparison with the healthy group (P=0.002). While, there was no significant difference (P<0.05) in adiponectin gene expression in AML subtypes myeloblastic, promyelocytic, and myelomonocytic/monocytic.
Conclusion: The results of this study indicate that there was a decrease in adiponectin gene expression in the bone marrow of acute myeloid leukemia patients compared to healthy controls. This decrease in adiponectin expression may be due to myeloid hyperplasia and a decrease in bone marrow adipocytes. In fact, The nutritional, metabolic, and mechanical stresses associated with myeloid cells accumulation cause alterations in bone marrow microenvironment structure and destruction of bone marrow adipose tissue. Therefore, reduced adiponectin gene expression in AML patients is one of the key indicators of bone ‎marrow microenvironmental changes in AML patients.‎‎

Background: Most studies show that 9 to 24% of people who are in in vitro fertilization (IVF) cycles are women who respond poorly to ovarian stimulation. Women with poor ovarian response (POR) are a group of infertile patients whose ovarian reserve, ovarian response to medication, and the quality of ovum are declining. Therefore, the number of female cycles, the number of fetuses from the oocyte and the rate of pregnancy in these women is reduced. The purpose of this study was to investigate the expression of three adrenoceptor receptor genes in the cumulus cells of women with poor ovarian response in culture medium.
Methods: This case-control study was conducted in two groups: study (POR) and control (oocyte donor's women) groups. POR diagnosis was performed by ESHRE Bologna criteria. After puncture of the follicles, cumulus-oocyte complex was collected and the cumulus cells (CCs) were isolated by enzyme and are counted with Neobar lamella and then were added in the culture medium. After completing the culture, RNA was extracted from cumulus cells and the RNA concentration was read by the Spectrophotometer (NanoDrop Technologies, Wilmington, DE, USA). Then cDNA synthesized and primers designed for ADR-α1, 2 and ADR-B2 or gene expression by real-time polymerase chain reaction (PCR) technique. The research was done in Reproductive Health Research Center of Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran, from April to December 2017.
Results: Comparison of the results of ADR-α1, 2 gene expressions in cumulus cells showed a significant decrease, but ADR-B2 was not significant in two groups. Correlation coefficients also showed that there are relationship between three adrenoceptors and their effects on each other.
Conclusion: Our results showed that the decreased expressions of ADR-α1, 2 probably related to activation of the sympathetic system and release of the more neurotransmitter that lead to down-regulation of ADR-α1, 2 in the cell membrane of cumulus in culture medium.

Background: Cataract is one of the most common eye diseases especially in elderly patients and most of these patients require surgery. In the process of sedation, different drugs are used, each with its advantages and disadvantages. Dexmedetomidine is one of the drugs that has recently received special attention for sedation. In this study, we compared the drug combination of dexmedetomidine-fentanyl with midazolam-fentanyl in cataract surgery.
Methods: In a case-control study, the patients who underwent cataract surgery by a surgeon with topical anesthesia and sedation techniques were included in the target group. Seventy patients were divided into two groups of 35 according to a random number table. One group received dexmedetomidine-fentanyl (dexmedetomidine group) and the other received midazolam-fentanyl (midazolam group). Age, sex, weight, systolic and diastolic blood pressure, heart rate, patient sedation, surgeon satisfaction, recovery nurse satisfaction, and postoperative nausea and vomiting were compared between the two groups. The study was performed in the Farabi Hospital, Tehran, Iran, from October to November 2019.
Results: Patients in the two groups were similar in age, sex, weight, and preoperative hemodynamic variables. There was no significant difference in preoperative systolic and diastolic blood pressure between the two groups (P=0.150). However, those who received dexmedetomidine had significantly lower intraoperative heart rate (P<0.001). The difference in postoperative systolic and diastolic blood pressure as well as postoperative heart rate was significantly lower in the dexmedetomidine group (P<0.001). There was no statistically significant difference between the two groups in postoperative sedation (P=0.93). The surgeon’s satisfaction was no significant difference between the two groups (P=0.17). Also, the rate of recovery nurse satisfaction was not significantly different between the two groups (P=0.21). The incidence of nausea and vomiting was similar in both groups (P=1.00).
Conclusion: Sedation with dexmedetomidine decreases blood pressure and heart rate. Therefore, it is recommended to use dexmedetomidine more cautiously in patients with unstable hemodynamics and especially in short surgical procedures.

Background: Despite exist several centers of excellence in the various medical field in the country, most of them lack a single procedure and organizational structures in their functioning, organizing, targeting, etc. So the study aimed to design an organizational model that meets the goals and mission of them in the field of medical sciences.
Methods: This qualitative and applied research was conducted in two comparative and analytical stages from May 2016 to February 2017 in Iran. The location of the study includes a university, research institute, health center, or research center known as a center of excellence. In the analytical stage, 10 experts and managers of the top centers were selected through a targeted sampling method as a study sample. In the comparative section, all 50 centers of excellence and similar specimens in the world were selected. The data collection tool was a semi-structured interview in the analytical section and the ministry of health's documents. In comparative section data, bases and official sites of the centers were analyzed.

Background: Non-viral Nano carriers such as liposomes and cationic polymers based on engineered properties are regarded in gene delivery field. Although these carriers do not have weaknesses of viral vectors, but they are less efficient than viruses and they still need to be improved as favorable gene delivery carriers. Amongst non-viral carriers, cationic liposomes have been proposed for clinical applications, but limitations such as low nucleic acid transfer and endosome escape and conduction of plasmid to the nucleus have challenged their use in clinical trials. Therefore, the combination of liposomes and cationic polymers for nucleic acid transfer has been considered because this approach makes it possible to use the desirable properties of liposomes and polymers so that it is even suggested for the gene treatment of some diseases such as Parkinson's. In this study, a combination of liposomes and cationic polymers were used for the preparation of lipopolyplexes. This approach allows simultaneous utilizing of the desirable properties of liposomes and polymers.
Methods: This interventional-experimental study was conducted in the medical faculty of Mashhad University of Medical Sciences from April 2017 to February 2018. In this study, PEI-based lipopolyplex with a molecular weight of 25 and 10 kDa and a liposome-to-polymer ratio of 1:1 were combined with plasmid containing the GFP (Green Fluorescent Protein) marker. The physicochemical properties of the synthesized carriers such as size, cytotoxicity and gene transferability in human prostate cancer (PC3) cells were evaluated.

Background: Cataract surgery is one of the most common surgeries in the world, especially in elderly patients, and often performed topically with sedative agents. Ketamine is one of the most commonly used agents and the effect of different doses on intraocular pressure is in dispute. The present study investigates the effect of a low dose of ketamine on intraocular pressure in patients undergoing cataract surgery.
Methods: This case-control study was performed in Farabi Hospital, Tehran University of Medical Sciences from January 2020 to February 2020. In this study 92 patients undergoing cataract surgery were randomly divided into two groups of 46 patients. Patients' intraocular pressure and blood pressure were measured at baseline, and then all patients received 1 mg midazolam and 1 μg/kg fentanyl before initiation of the study. In the case group, 0.15 mg/kg ketamine was injected intravenously. Intraocular pressure and blood pressure of all subjects were measured three minutes after injection of sedation. Also, postoperative pain, need for opioids and, postoperative nausea and vomiting were compared between the two groups.

Background: Sore throat after endotracheal intubation during general anesthesia is a common complaint of patients especially in children. Strabismus surgery in one of the common procedures in child patients. The present study investigates the use of intratracheal ketamine administration in reducing sore throat after strabismus surgery.
Methods: This study was performed on 60 patients undergoing elective strabismus surgery under general anesthesia from December 2019 to February 2020 in Farabi eye hospital, Tehran University of medical sciences, Tehran, Iran. These cases were referred to our center for strabismus operation from other centers of our country. Patients were randomly divided into two equal groups. After sufficient depth of anesthesia with sevoflurane and injection of fentanyl, endotracheal intubation was performed. In the control group, the endotracheal tube was inserted and 2 ml of ketamine solution at a concentration of 5 mg/ml were administered in endotracheal tube. The severity of sore throat, length of stay in recovery, incidence of delirium in recovery, satisfaction of recovery nurses and their parents and other complications were compared between the two groups.

Background: Polycystic ovary syndrome is the most common disorder in the endocrine system. Hyperandrogenism, hyperinsulinemia, chronic ovulation, and infertility are important Complications of PCOS. Health-related quality-of-life (HRQoL) has a significant reduction in women with polycystic ovary syndrome (PCOS). This reduction can be due to many disorders including: menstrual and sleep disorders, hirsutism, marital issues, infertility, and emotional/psychosocial problems. The purpose of current study was to investigate the role of sleeping and other environmental factors affecting the quality of life in patients with polycystic ovary syndrome. 
Methods: This case/control study was conducted in 2017 in two groups: control and study (PCOS). The inclusion criteria were women aged 20-40 with a body mass index (BMI)<28. Exclusion criteria included no disease and no medication for all women. The participants were 180 women who were referred to the infertility center of Imam Khomeini Hospital in Tehran. Four questionnaires including Demographics (40 questions), sleep quality (PSQI) (19 items 0-3), quality of life (GHQ) (28 items) and psychometric (DASS-42) with their consent form were filled out. Student’s t-test and Chi-square were used to compare the variables between two groups and the Pearson correlation coefficient to examine the relationship between lifestyle dimensions.

In 2019 a newly emerged coronavirus was detected by the Center for disease control (CDC) in China. Nucleic acid sequencing from nose and throat swab samples of patients revealed that it was like severe acute respiratory syndrome coronavirus (SARS-CoV). World Health Organization (WHO) named it coronavirus disease 2019 (COVID-19) and reported more than 100000 positive tests until March 2020 for COVID-19. During the past 20 years, the world has been affected by three coronavirus epidemics, SARS-COV, Middle East respiratory syndrome coronavirus (MERS-CoV), and COVID-19 that make world attention. The mortality rate of COVID-19 was more than other coronaviruses, but because of more people affected by it, it seems that it has a less fatality rate compared with MERS- CoV. Initial data showed that more than 80% of patients did not have any symptoms or may had light symptoms. 15% showed severe pneumonia, 5% became critically ill, and developed multiorgan dysfunction and septic shock. Due to the epidemic of emerging viruses and the lack of information about it, this study aimed to provide a quick overview of the most recent studies in the world. To perform this review, keywords such as COVID-19, severe acute respiratory syndrome coronavirus 2, and Angiotensin-converting enzyme 2 were retrieved using the medical subject headings (MeSH) system and then searched in English in PubMed, Scopus, Google Scholar, and Web of Science databases.
COVID-19 virus enters its genome into the cells by binding to Angiotensin-converting enzyme 2 in some organs such as the lungs. Although the transmission route is unclear, it enters the body through respiratory droplets. The clinical symptoms includ fever, cough, dyspnea, myalgia, confusion, headache, sore throat, rhinorrhea, chest pain, diarrhea, nausea, vomiting, malaise, and convulsion. The standard diagnostic method is Real-time polymerase chain reaction (RT-PCR), but due to the time-consuming and sensitivity and the existing errors in this technique, chest CT and hematologic data are preferred. No definitive cure for the virus has been suggested so far, but antiviral drugs such as Oseltamivir, Ganciclovir, Lopinavir, Ritonavir and Remdesivir, and the anti-malarial drug Chloroquine phosphate and Interferon are in use until the discovery of the vaccine.

Background: Low-level lasers are used for various medical applications including wound healing and hair loss treatment. Cell Therapy using skin stem cells could be a novel approach to hair transplantation. However, there is no study on the effect of low-level laser on the hair follicle stem cells. So, in this study, we investigated the effect of low level laser irradiation on viability and ROS production in the hair follicle stem cells.
Methods: This study was performed in the cell culture laboratory of Medical Laser Research Center, Yara Institute in 2020 (June 2020 to February 2020). The hair follicle was isolated from the Safe Donor Area (SDA) using the 4mm punch method. In the laboratory, after separating the follicular units, the bulb region of each follicle was isolated via mechanical and enzymatic methods and cultured in FBS+F12-DMEM. Afterward, the stem cells were characterized via flow cytometry. The effect of low-level laser (685 nm) with different doses (1-20 J/cm²) was investigated on cell proliferation, viability and ROS production.

Background: Cholangiocarcinoma is a cancer of the bile duct epithelium that originates from the bile ducts inside or outside the liver. Although this tumor is not common, its mortality rate is high. This tumor accounts for about 3% of all gastrointestinal malignancies. Many patients are being detected when the disease has spread. Evaluating risk factors affecting the incidence of cholangiocarcinoma is very important to avoid exposure to them. Therefore, this study was performed to evaluate the risk factors for cholangiocarcinoma in a population in Iran.
Methods: This was a descriptive cross-sectional study. It was performed on 276 patients with cholangiocarcinoma who had been referred to Firoozgar Hospital affiliated with the Iran University of Medical Sciences in Tehran from March 2020 to February 2021. Demographic information, family and personal history, social history (tobacco or drug use) and blood group of patients were extracted from their files. SPSS version 16 was used for data analysis. A P-value below 0.05 was considered statistically significant.

Background: Today, despite the efforts of the medical community and health staff, the rate of dissatisfaction and complaints among patients is increasing and this highlights the importance of evaluating its related factors. The aim of this study was to analytically investigate complaints against ophthalmologists which were referred to the Legal Medicine Organization of Iran in Tehran during 2017-2019.
Methods: In this cross-sectional (analytical-descriptive) study, the demographic data of patients and physicians including age, gender, marital status and academic degree, type of treatment measures leading to complaints, last decision of the medical commission, characteristics of protesting of patients and vote of revision commissions for all the complaints of ophthalmology were recorded and analyzed.
Results: During 3 years, 176 complaints were recorded in the field of ophthalmology. Of these, 90(51.1%) complaints were from medical interventions which took place in university or government hospitals and clinics. Also, 27(15.3%) cases of malpractice were reported, among which negligent was the most common type, with 22 cases (81.5%). The highest number of complaints was for cataract surgery and the most frequent treatments with malpractice of the physicians were cornea transplantation. Although the most protests to the first decision were from the patients, the effectiveness of physicians’ protest was significantly higher (P<0.001).