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Epidemiology of prothrombin G20210A polymorphism in the Southern Iran
Mohadeseh Arabnejad , Mahboobeh Nasiri , Mehran Karimi , Mohamad Moghadam , Azadeh Khalili , Ahmad Ebrahimi ,
Volume 73, Issue 5 (August 2015)
Abstract
Background: There are many genetic and non-hereditary risk factors that are known to causes venous thromboembolic (VTE) disorders, Cardiovascular diseases and types of cancer. One of these is the Prothrombin G20210A mutation. Prothrombin mutation (guanine to adenine G→A) at nucleotide position 20210, which is present in the 3′ untranslated region of the prothrombin gene. Prothrombin G20210A mutation is present outside the coding region for prothrombin, and hence it does not affect the actual structure of the prothrombin molecule and it does not affect its function as a strong clotting factor when activated into thrombin. However, several studies have shown that, G20210A heterozygosity was associated with a threefold increased risk for VTE. Moreover, the association of PTH G20210A polymorphisms with cancer has been reported. The present study was designed to determine the frequency of PTH G20210A polymorphism in Southern Iran. Methods: In this cross-sectional study, 140 healthy women were from Southern Iran recruited among participants in Namazi Hospital, Shiraz, Iran, from March 2013 to February 2014. A total of 5 ml of peripheral blood was taken from individuals then Genomic DNA was extracted using blood DNA kit (Ron’s Blood and Cell DNA Mini Kit, BioRon, Germany). The amplification refractory mutation system- polymerase chain reaction (ARMS-PCR) method was used for the detection of PTH G20210A single nucleotide polymorphism in each subject. Results: The frequencies of the GG and GA genotypes were as 97.9%, 2.1% respectively. The frequency of G allele was and the frequency of A allele was 1.1%. Conclusion: Results of the present study might be important in understanding the distribution of PTH G20210A polymorphism in the Southern Iran. Minor allele frequency in this population is higher than in the Iranian and European population but similar to the prevalence in the Western Iran, Iranian Jews, American, Irish, Tunisian and Bahraini population.
Association between serum homocysteine and subclinical atherosclerosis markers in subjects with and without diabetes mellitus
Hossein Fakhrzadeh , Mohamad Jafar Mahmoudi , Zahra Droudian, Farshad Sharifi , Yaser Tajalizadeh Khoob, Neda Mehrdad , Fatemeh Jafaraghaei , Zohreh Badamchizadeh ,
Volume 74, Issue 3 (June 2016)
Abstract

Background: The relationship between serum homocysteine levels and cardiovascular diseases has been elucidated since many years ago. In this study, the association between serum levels of homocysteine, folic acid, and vitamin B12 with the pulse wave velocity and Buckberg index or subendocardial viability ratio was assessed in individuals with diabetes and also non-diabetic subjects.

Methods: In this cross-sectional study, 58 individuals with type 2 diabetes and 36 non-diabetic people, from April to October 2013 were enrolled in Dr. Shariati Hospital affiliated to Tehran University of Medical Sciences. Anthropometric and blood pressure measurements were performed with standard methods. Fasting serum glucose, total cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol, Triglyceide, A1C, vitamin B12, folic acid and serum homocysteine levels as well as, highly sensitive complement-reactive protein (hs-CRP) were measured. Artherial stiffness was assessed by calculating pulse wave velocity and aortic agumentation index via Sphygmocor. In addition, Buckberg index (Subendocardial viability ratio) was assessed by dividing myocardial oxygen supply to dimand expressed as percent. The normality of distributions was evaluated by Kolmogorov-Smirnov test and linear regression models were utilized to detect associations.

Results: Diabetic and non-diabetic subjects differed in terms of age, history of hypertension, serum levels of homocysteine, and LDL-C (P< 0.05). The pulse wave velocity in subjects with diabetes and without diabetes were 60.91 m/s and 41.91 m/s, respectively (P= 0.01). After adjustment for confounding factors in multivariate regression analysis pulse wave velocity was associated with age and homocysteine levels in non-diabetic group, (β equal to 0.441 and 0.345, respectively), and it was related to age, diastolic blood pressure and serum levels of c-reactive protein in subject with diabetes (β= 0.417, 0.302, and 0.262, respectively).

Conclusion: Homocysteine levels in non-diabetic individuals were associated to sub-clinical atherosclerosis markers but we could not find this association in diabetic participants.

The effect of BLA GABAB receptors in anxiolytic-like effect and aversive memory deficit induced by ACPA
Katayoon Kangarlu Haghighi , Shahrbanoo Oryan , Mohamreza Zarindast , Mohamad Nasehi ,
Volume 74, Issue 4 (July 2016)
Abstract

Background: As a psychoactive plant, Cannabis sativa (Marijuana) is widely used throughout the world. Several investigations have indicated that administration of Marijuana affects various cognitive and non-cognitive behaviors. These include anxiety-like behaviors and learning and memory deficit. It has been shown that three main cannabinoid receptors [i.e. CB1, CB2 and CB3 are involved in cannabinoids’ functions. CB1 receptors are abundantly expressed in the central nervous system regions such as hippocampus, amygdala, cerebellum and the cortex. Therefore, the neuropsychological functions of endocannabinoids are thought to be more linked to CB1 receptors. Among other brain regions, CB1 is highly expressed in the amygdala which is an integral component of the limbic circuitry. The amygdala plays a major role in the control of emotional behavior, including conditioned fear and anxiety. In present study we examined the possible roles of basolateral amygdala (BLA) GABAB receptors in arachydonilcyclopropylamide (ACPA)-induced anxiolytic-like effect and aversive memory deficit in adult male mice.

Methods: This experimental study was conducted from September 2013 to December 2014 in Institute for Studies in Theoretical Physics and Mathematics, School of Cognitive Sciences, Tehran and Male albino NMRI mice (Pasture Institute, Iran), weighting 27-30 g, were used. Bilateral guide-cannulae were implanted to allow intra BLA microinjection of the drugs. We used Elevated Plus Maze (EPM) to examine memory and anxiety behavior (test-retest protocol). ACPA administrate intra-peritoneal and GABAB agonist and antagonist administrated intra-amygdala.

Results: Data showed that pre-test treatment with ACPA induced anxiolytic-like and aversive memory deficit The results revealed that pre-test intra-BLA infusion of baclofen (GABAB receptor agonist) impaired the aversive memory while phaclofen (GABAB receptor antagonist) improved it. Interestingly, pretreatment with a sub-threshold dose of baclofen reversed and potentiated anxiolytic-like effect and aversive memory deficit induced by ACPA, respectively. Conversely, similar effect with sub-threshold dose of phaclofen showed that this drug only restored aversive memory deficit but did not alter anxiolytic-like effect induced by ACPA.

Conclusion: Data indicated that BLA GABAB receptors have critical and different roles in anxiolytic-like effect and aversive memory deficit induced by ACPA.


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

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

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

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

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


Clinical effectiveness of modified sequential organ failure assessment scoring system for predicting ICU indexing scores
Hassan Babamohamadi , Abbasali Ebrahimian , Fateme Paknazar , Hojat Torkamandi ,
Volume 74, Issue 7 (October 2016)
Abstract

Background: The ability to recognize the severity of the disease in those who their survival depend entirely on admission to the intensive care unit, is very valuable clinically. This study aimed to evaluate the clinical effectiveness of modified sequential organ failure assessment (MSOFA) scale to predict mortality and length of stay in intensive care unit patients respectively.

Methods: This was a retrospective cross-sectional study conducted on hospital records of patients admitted to the intensive care unit. All patients’ records who admitted to the intensive care unit of Kowsar Hospital, Semnan city (the capital of the province), Iran, in 2015 considered as the sample. Collecting data were done during 4 weeks in April and May 2016. The data collection tool was a demographic questionnaire and modified sequential organ failure assessment scale. Exclusion criteria included discharge in the first 24 hours after admission, the patient died a few hours after admission and incomplete information to complete the modified sequential organ failure assessment form.

Results: The study of 105 patients' records of the intensive care unit showed that 45.7% of patients were died, 15.2% and 39% were discharged and moved to other wards respectively. The results of logistic regression analysis and receiver operating characteristic (ROC) curve showed that this criterion had moderate sensitivity and specificity for prediction of mortality and length of stay in ICU patients (Area=0.635, CI= 0.527-0.743) and each unit increase in modified sequential organ failure assessment score is accompanied by increasing 32 percent chance of death (OR=1.325; 95% CI:1.129,1.555; P= 0.001(. Also each unit increase in modified sequential organ failure assessment (MSOFA) score accompanied by increasing 19% length of stay in ICU (OR=1.191; 95% CI: 1.034, 1.371; P= 0.015(.

Conclusion: The results of this study showed that the modified sequential organ failure assessment scale is not useful tool to predict the length of stay and mortality of patients admitted to the intensive care unit.


Molecular identification of candida species isolated from women with vulvovaginal candidiasis: brief report
Maryam Khanmohamadi , Amir Seyed Ali Mehbod , Mojtaba Noraeepour , Mojtaba Didehdar ,
Volume 75, Issue 7 (October 2017)
Abstract
Background: Vulvovaginal candidiasis (VVC) is a common infection, affecting up to 75% of women during their lifetimes. Approximately 5% of patients may experience recurrent VVC. Candida albicans is the most common causative agent of VVC. The objectives of this study were identification of candida species isolated of women with vulvovaginal candidiasis by molecular method in Arak city.
Methods: In this descriptive cross-sectional study, between Jun 2015 to March 2016 from 210 patients with vulvovaginal candidiasis referred to gynecology and obstetrics clinics in Arak city, Iran. Vaginal sampling was performed by wet sterile swabs. Samples were collected from vaginal discharge, vaginal posterior fornix, and sides of the vaginal wall. The swabs were investigated for direct exam and cultured on Sabouraud’s dextrose agar medium contain chloramphenicol. Yeast isolates DNA were identified by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Fungal genomic DNA was extracted from each isolate colony, glass bead method and after amplification of ITS1-ITS4 region with PCR assay, digested by MSP I restriction enzyme.
Results: From 210 patients with vulvovaginitis, 95 (45.2%) patients showed VVC. These patients were positive for Candida growth in culture and were infected with one Candida species. The age range of women with vulvovaginitis was between 14-60 years and the most VVC cases were in age group of 21-30 years. The most common Candida species isolated were Candida. albicans (70.5%), C. glabrata (20%), C. tropicalis (7.4%) and C. parapsilosis (2.1%).
Conclusion: Regarding to the results of this study, C. albicans was the most common Candida species, isolated from patients with vulvovaginal candidiasis and approximately 30% of this infection causing by non-albicans species of Candida.

Effect of aerobic training after long-term inhalation of black carbon particles on IL-β gene expression in the lung tissue of male rats: brief report
Mohamad Fashi,
Volume 75, Issue 12 (March 2018)
Abstract
Background: Air pollution PM exposure associated with increased inflammation and decreased cellular immune function. The innate immune system is one of the first lines of defense against inhaled air pollution and is characterized by activation of lung key signaling pathways. One pathway is initiated by the activation of toll-like receptors (TLRs) that associated with airway cells culminates in the translocation of nuclear factor-kappa B and other transcription factors to the nucleus, and therefore initiation of altered signaling of pro-inflammatory mediators such as IL-1β and TNF-α. The purpose of this study was to investigate the effect of 4 weeks of aerobic training after long-term inhalation of black carbon black particulate matter on IL-β lung tissue in male rats.
Methods: The present study was conducted experimentally in October and November 2015 at the Sport Physiology Laboratory of Tarbiat Modares University of Tehran. 12 adult male Wistar rats (279.29±26.97) were divided to two groups: A: Daily, two hours inhalation of carbon black PM10, n=6), B: 60 minutes aerobic exercise activity, 50 percent average peak velocity, 15 minutes after inhalation of carbon black PM10. The gene expression of IL-1β was analyzed in lung tissue by real-time-PCR and Pfaffl formula. In order to determine the significant differences between groups independent t-test were used.
Results: Although, there were no significant differences among the A and B groups, however, the mean of relative gene expression of IL-1β in group B was slightly lower than group A.
Conclusion: Four weeks regular aerobic exercise activity did not worsen lung tissue inflammation after long-term inhalation of carbon black PM10. It seems regular exercise training mitigate pulmonary inflammatory responses and in part, decrease the risk of pulmonary diseases.

Detection of Alzheimer's disease based on magnetic resonance imaging of the brain using support vector machine model
Mansour Rezaei , Ehsan Zereshki , Hamid Sharini , Mohamad Gharib Salehi , Farhad Naleini ,
Volume 76, Issue 6 (September 2018)
Abstract
Background: Alzheimer's disease (AD) is the most common disorder of dementia, which has not been cured after its occurrence. AD progresses indiscernible, first destroy the structure of the brain and subsequently becomes clinically evident. Therefore, the timely and correct diagnosis of these structural changes in the brain is very important and it can prevent the disease or stop its progress. Nowadays, remark to this fact that magnetic resonance imaging (MRI) provides very useful and detailed information, and due to non-invasiveness, this method has been great interest to the researchers. The aim of this study was diagnosis of AD with MRI by support vector machine model (SVM).
Methods: This is an analytical and modeling research which done in School of Public Health, Kermanshah University of Medical Science, Iran, from February 2017 to November 2017. The data used in this study was a database named Miriad containing brain MRI of 69 individuals (46 Alzheimer's disease and 23 healthy subjects) that was collected at the central hospital in London. Individuals were categorized into two groups of healthy and Alzheimer's disease with two criteria: NINCDS-ADRAD and MMSE (as the golden standard). In this paper SVM model with three linear, binomial and Gaussian kernels was used to distinguish Alzheimer`s disease from healthy individuals.
Results: Finally, SVM model with Gaussian kernel, separated AD and healthy subjects with 88.34% accuracy. The most important Areas for Alzheimer were three Area: Right para hippocampal gyrus, Left para hippocampal gyrus and Right hippocampus. The clinical result of this study is to identify the most important ROI for the diagnosis of Alzheimer's by a clinical specialist. Experts should focus on atrophy in the three Areas.
Conclusion: This study showed that the SVM model with Gaussian RBF kernel can separated AD from healthy subjects by high accuracy. Based on results of this study, can make a software to use in MRI centers for screening AD test by people over the age of 50 years.

Differentiation of benign and malignant breast lesions by apparent diffusion coefficient value in mass and non-mass lesions
Masoumeh Gity , Behnaz Moradi, Rasool Arami , Ali Arabkheradmand, Mohamad Ali Kazemi,
Volume 77, Issue 1 (April 2019)
Abstract
Background: Diffusion-weighted imaging (DWI) is one of methods in evaluation of breast lesions. We aimed to investigate the apparent diffusion coefficient (ADC) values in breast tumors and their accuracy in differentiating benign versus malignant lesions.
Methods: In this cross-sectional study, 72 patients with 88 breast lesions were investigated by 1.5-T breast MRI from 2015 to 2017 in Athari Imaging Center in Tehran, Iran. Nearly all patients has undergone histopathology evaluation. One small region of interest (ROI) were placed on the most restricted region inside the solid part on the ADC map. Care was taken to avoid cystic or necrotic, fatty regions and hematoma inside the mass. A large round ROIs were placed in healthy fibroglandular tissue of contralateral breast ADC values were measured and compared in normal breast tissue and in most restricted parts of breast lesions (mass and non-mass). After determining cut-off for differentiation of benign and malignant lesions, sensitivity, specificity, accuracy, positive predictive value and negative predictive value were calculated.
Results: Mean age of patients was 43.3 years. The average tumor size of benign and malignant lesions were calculated 26.0 mm, 35.3 mm respectively and 23 mm and 46 mm in mass and non-mass respectively. Invasive ductal carcinoma include the majority of pathology result (in 37.5% of the patients). Our results revealed that the measured ADC values in normal breast tissue were higher than breast lesions (P≤0.01). Mean ADC value in benign lesions was 1.40×10-3 mm²/s and for malignant lesion was 1.08×10-3 mm²/s. ADC value in the normal breast tissue was 1.79×10-3 mm2/s and was significantly higher than ADC value of breast lesions (benign and malignant). Cut-off value in non-mass was not valid, but in mass was 1.19×10-3 mm²/s with sensitivity, specificity, positive predictive value, negative predictive and accuracy of 89.7%, 83.8%, 87.5%, 86.6%, and 87.1% respectively.
Conclusion: In DWI imaging, ADC value can differentiate benign and malignant masses with high sensitivity and specificity but not helpful in non-mass lesions.

Role of metalloproteinase matrix in development of cavity and diagnosis of pulmonary tuberculosis
Abbasali Niyazi , Shima Javanbakht , Nezar Ali Muolaie , Mohamad Kazem Momeni , Mosayeb Shahriyar , Mehdi Nourallahzadeh,
Volume 77, Issue 1 (April 2019)
Abstract
Background: Matrix metalloproteases (MMPs) are multi-chain proteins that regulated by tissue inhibitor of metalloproteinases (TIMP) and several other mechanisms. This Includes transcription regulation and protein form secretion. The roles of MMPs in wound healing and tissue repair. In tuberculosis (TB), the activity of MMPs is increased and TIMP inhibitors decrease activity. Therefore, in tuberculosis, MMPs cause excessive damage to the lung tissue and cavity formation.
Methods: In a case-control study, plasma samples of healthy controls, symptomatic respiratory tract controls and tuberculosis patients were evaluated by available sampling in Ali Ibn Abitaleb and Bouali Hospitals, Zahedan, Iran, from Apri1 2015 to April 2018. Patients were divided into two groups: tuberculosis and control group and the level of MMPs were measured by the enzyme-linked immunosorbent assay (ELISA) method in plasma samples of the two groups. For MMP-8, which was important in the diagnosis of tuberculosis, a cutoff point was obtained.
Results: 384 people including 123 healthy controls. 107 non-tuberculosis, and 154 tuberculosis patients were examined; 230 patients in the control group and 154 patients in the tuberculosis group. Levels of MMPs in tuberculosis and symptomatic respiratory group were higher than healthy group. The mean of MMP-8 was significantly different between two groups (P<0.001). In this study, sensitivity, specificity, positive and negative predictive value of plasma MMP-8 in detection of TB in non-TB patients in MMP-8 cutoff point=6650 pg/ml were 65.4%, 78.2%, 50%, and 93% respectively outcome. Significantly, the rate of pulmonary cavity was significantly higher in the TB group; Higher cavity, higher concentration of plasma MMPs.
Conclusion: In this study, first comprehensive analysis of MMPs was performed. Two collagenases, MMP-1 and MMP-8, were active in tuberculosis, but MMP-8 was specifically higher in tuberculosis than in both symptomatic and healthy controls. Level of MMP-1, 3, 8, 9 was higher in men than in women. The analysis of genders separately showed MMP-8 was increased in tuberculosis group in comparison with control group and MMP-1 group in both TB and symptomatic respiratory tract increased.

The comparison of dietary intake of macronutrients in polycystic ovary syndrome with and without metabolic syndrome
Narges Zaeemzadeh , Shahideh Jahanian Sadatmahalleh , Saeideh Ziaei , Azadeh Mottaghi , Maryam Movahedinejad , Neda Mohamadzadeh , Anoshirvan Kazemnejad ,
Volume 77, Issue 9 (December 2019)
Abstract
Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in reproductive age women. The prevalence of PCOS among Iranian women is 14.6% based on the Rotterdam definition. PCOS can increase the risk of chronic metabolic complications. Metabolic syndrome (MetS) is one of the most important of them. Insulin resistance is fundamental in PCOS and MetS pathophysiology. MetS is a collection of chronic metabolic derangements, which promotes the risk of serious diseases such as cardiovascular disturbances and diabetes. The quality of diet is inversely correlated with obesity, which is one of the consequences of PCOS and it is a risk factor for metabolic syndrome. As the first study, the present study aimed to compare the dietary intake of macronutrients in PCOS women with and without MetS.
Methods: In this nested case-control study, the convenience sampling method was used to select participants. The case group included 14 PCOS patients with MetS and the control group included 28 PCOS patients without MetS. The investigated macronutrients included fats (total fat, saturated fatty acids, mono and polyunsaturated fats, trans fatty acids), carbohydrate, protein, and fibers (total and soluble). The dietary intake assessment was carried out by a 168-item semi-quantitative food frequency questionnaire (FFQ). This study was performed on Arash Women's Hospital under support of Tarbiat Modares University, Tehran, Iran, from August 2014 to September 2015.
Results: Dietary intake of total fat was significantly higher in PCOS women with MetS than the control group (P<0.001, 146.62±45.17 vs. 59.91±32.79 g/d). Dietary intake of saturated fatty acids (P=0.004, 11.44±11.08 vs. 19.73±6.76 g/d), monounsaturated fats (P<0.001, 14.15±12.66 vs. 26.16±7.76 g/d), polyunsaturated fats (P=0.002, 9.02±9.18 vs. 17.22±6.45 g/d), carbohydrate (P<0.001, 182.34±121.08 vs. 365.64±77.11 g/d), protein (P=0.001, 42.74±42.85 vs. 78.06±24.04 g/d), total fiber (P<0.001, 17.77±15.09 vs. 35.97±22.64 g/d) was significantly lower in PCOS women with MetS than the control group. All results are expressed in terms of grams consumed per day.
Conclusion: Our results demonstrated that dietary intake of macronutrients was significantly different in polycystic ovary syndrome patients with and without metabolic syndrome.

Sexual satisfaction and some related variables in married women
Abolfazl Ghoreishi, Mohamad Massod Vakili , Maryam Amirmohseni ,
Volume 77, Issue 10 (January 2020)
Abstract
Background: Sexual issues are one of the most important aspects of human life and sexual disorders are issues that can cause some problems in any society. Paying attention to sexual problems can help to deepen the couple's relationship by reducing potential problems. It is also important to note that communication problems between couples and their interplay patterns are effective in shaping sexual behavior between couples and can be a source of sexual behavior disorders for couples. The goal of this research was to determine prevalence of sexual satisfaction of participants and some related factors.
Methods: This descriptive-analytical study was conducted on 564 married women between the ages of 18 and 55 under the cover of Zanjan University of Medical Sciences (ZUMJ), Zanjan City, Iran, among whom referring to ZUMJ educational centers from March to August 2012. A simple random sampling method was used. The data collection tool was a 14-item changes in sexual functioning questionnaire (CSFQ-14) completed by the self-efficacy method.
Results: The results of this study showed that 79.5% of women studied had some degree of sexual dissatisfaction. The study showed that with increasing age, the degree of dissatisfaction with marital relationships increased from 3.1% in the age group of 14-19 years to 38.2% in the age group of 30-39 years. Also, the rate of sexual dissatisfaction increased with the increase in education, and the highest degree of dissatisfaction was in the group with diploma education and the next stage, those with university education. The results of the study reported the highest proportion of dissatisfaction with sexual relations in the housewife group, and dissatisfaction with sexual relations increased significantly with an increasing number of years of marital life.
Conclusion: According to the results of this study, the prevalence of dissatisfaction especially with respect to sexual orientation among women is higher than expected, which is a threat to the individual and social health of individuals.

Familial adenomatous polyposis, diagnosis and surveillance strategies: review article
Sima Sedighi, Maliheh Moradzadeh, Mehrdad Aghaei, Ashraf Mohamadkhani, Mohammad Hassan Jokar,
Volume 78, Issue 7 (October 2020)
Abstract
Familial adenomatous polyposis is characterized by over 100 colorectal adenomas in the colorectum. The disease equally affects both sexes, with an incidence estimated at 1.14025-1.8300. The disease is premature in people with familial adenomatous polyposis. Patients suffering from familial adenomatous polyposis have a range of extra-intestinal diseases such as papillae, gastric, small intestine, and duodenal polyps; cutaneous wounds (lipomas, fibromas, and epidermoid cysts); desmoid tumors; osteomas; nephroderma retinal pigment epithelium, including hepatoblastoma and thyroid cancers; and pancreas, biliary system, and brain cancer. Familial adenomatous polyposis is characterized by >100 polyps in the colon that are often observed on the left side of the colon and rectum. A germline mutation in the adenomatous polyposis coli gene that can be clinically and genetically diagnosed is responsible for this disease. Several methods are available for testing the adenomatous polyposis gene. Whole-gene sequencing of all adenomatous polyposis coli exons and exon-intron boundaries with maximum sensitivity for determining adenomatous polyposis coli mutations is not affordable. Another method, the protein shortening assay, correctly identifies 80% of the mutations in families who show familial adenomatous polyposis and is less expensive than complete gene sequencing. The application of a COX-2 inhibitor for chemical prevention is limited in patients showing familial adenomatous polyposis because of cardiovascular toxicity. Aspirin does not negatively impact cardiovascular diseases and is even used as primary pharmacotherapy in patients who demonstrate cardiovascular risk factors.   After 55.7 months of the diagnosis in hereditary CRC carriers, the incidence of cancer can be decreased by a dose of 600 mg/day aspirin for 25 months. After diagnosis, patients should undergo prophylactic proctocolectomy or ileoanal pouch. Undiagnosed patients having a family history of FAP must be referred to a genetic counselor and enrolled in optimal genetic and clinical surveillance programs. Recent advancements in endoscopic technology, e.g. high-resolution endoscopy, double-balloon endoscopy, and capsule endoscopy have enabled the comprehensive study of the gastrointestinal tract. Despite the limited evidence, more studies on these novel endoscopic technologies may modify the surveillance strategies for FAP patients.

The relationship between intracompartment pressure with symptoms of compartment syndrome and the level of creatine phosphokinase in limb trauma
Mohamadreza Arabi, Simin Najafgholian , Morteza Gharibi, Fateme Rafiaee, Mehran Azami , Mojtaba Ahmadlou,
Volume 79, Issue 6 (September 2021)
Abstract
Background: Acute compartment syndrome is considered a debilitating complication of limb trauma. Early detection of this compartment syndrome helps us in the early initiation of treatment which will result in preventing its subsequent complications reported in these cases.
Methods: This research was an analytical cross-sectional study. Patients with direct trauma to extremities, who were referred to the emergency department of Valiasr and Amir Al-Momenin hospitals were studied from October 2018 to April 2019 in Arak, Iran. Patients were selected if they met all of the inclusion criteria and none of the exclusion criteria. Vital signs were measured and recorded for each patient. Also, the results of physical examination, intra-compartmental pressure measurement by a wick catheter and the level of the creatine phosphokinase were recorded. All data analyses were performed with the use of SPSS v21 software.
Results: A total number of 70 subjects were included in this study, comprising 65 males (93.1%) and 5 females (6.9%). The results showed that there is a significant relationship between intra-compartment pressure and the level of creatine phosphokinase enzyme. The higher the intracompartmental pressure, the higher the creatine phosphokinase level. Statistically significant associations were observed between intracompartmental pressure and pallor, edema, lack of limb pulse, and diastolic blood pressure. No significant relationship was found between intracompartmental pressure and limb pain, numbness, inability to move the injured limbs, and systolic blood pressure. In addition, our findings indicated that creatine phosphokinase is significantly associated with edema and lack of limb pulse. No significant relationship was found between creatine phosphokinase with pain, pallor, numbness, inability to move limbs, and systolic and diastolic blood pressure.
Conclusion: The study findings suggest that measurement of intracompartmental pressure could be considered as an effective alternative approach to creatine phosphokinase levels to diagnose compartment syndrome. So, this will prevent irreparable damage to the extremities and is of great importance.
 

Incidence of radial artery occlusion in radial angiography compared with snuffbox angiography
Seyed Mohamadreza Afshani , Hadise Eghtedari Salimi , Seyed Mohamadhasan Adel, Mohamad Momen Ghribvand ,
Volume 79, Issue 6 (September 2021)
Abstract
Background: Transradial access is one of the main access techniques in angiography. This method is technically more difficult as it is associated with radial artery occlusion. Radial artery cannulation from the dorsal surface of the hand in the snuffbox area has been introduced as a suitable solution to overcome some of the disadvantages of the standard radial artery method. This study was conducted to compare the incidence of radial artery occlusion and other complications in the two methods.
Methods: This study was conducted on 100 patients Who were referred to the Imam Hospital in Ahvaz from 22 September 2020 to 19 Mach 2021. 50 patients underwent angiography with normal radial artery access and 50 patients underwent snuffbox angiography. Basic characteristics including age, sex, underlying disease (diabetes mellitus, hypertension, and dyslipidemia), family history of coronary artery disease, medical history including chronic coronary artery disease, stable ischemic heart disease, smoking, and LVEF, and also the length of hospital stay was also collected and recorded. All subjects in the two groups underwent radial artery ultrasound in the forearm and snuffbox 24 hours after angiography. Also, angiographic complications including radial artery occlusion (thrombosis), pain, hematoma and anesthesia were recorded.
Results: In the present study, the mean age in the two groups was similar (about 50-60 years). The distribution of sex, diabetes, weight, height and blood pressure was homogeneous in both groups. There was a statistically significant difference in the incidence of thrombosis and pain between the two groups. The results of this study showed that in the snuffbox angiography group, the number of uncomplicated cases was significantly more than the radial angiography group and in the snuffbox angiography group, the number of postoperative pain and thrombosis cases was significantly lower. The length of hospital stay in the Snuffbox group was shorter than the radial group, but there was no statistically significant difference.
Conclusion: Snuffbox angiography has fewer complications compared to the usual transradial method, so it can be used as a safe method for angiography.

Assesment the effect of intravenous injection site on the quality of intravenous regional anesthesia (bier block) on upper limb: a double-blinded randomize clinical trial
Kambiz Javadzadeh Siahkelrodi , Shahpour Shoja, Karim Naseri, Farzad Sarshivi, Shahrokh Ebnerasouli, Mohamad Aziz Rasouli , Shaho Shoja ,
Volume 79, Issue 7 (October 2021)
Abstract
Background: Bier block is a reliable technique used in extremity surgeries. Typically, angiocatheters are palced in the distal portion of the extremity that is going to be operated. Although, it is not the case in every operation. Therefore, determining the effectiveness of the local anesthetic injection site on the quality of the upper-extremity block can be helpful.
Methods: In this double-blinded randomized clinical trial that took place in Kowsar Hospital (Sanandaj, Iran) at 2020, 60 patients after complete monitoring and sedation were assigned randomly into proximal bier block (32 in experimental) and distal bier block (28 in control) groups. 10ml/kg Ringer serum was prescribed for patients in both groups on the non-surgical hand. Depending on the patients’ placement in either group, an angiocatheter (22 or 24) was attached to the ante-cubital area (proximal bier block group) or on the back of the patient's hand (distal bier block group). Respectively, after blood was drained by a Smarch band from the extremity that was to be operated, the tourniquet was inflated up to 150mmHg above the patient’s systolic pressure and the smarch band is untied from the hand. For every patient regarding the group they were assigned, 3mg/kg lidocaine 0.5% was administered through an angiocatheter. After 5 minutes, the depth of patient's anesthesia and pain intensity were measured. Sensory and motor recovery was assessed every 10 minutes after surgery. Patient satisfaction with anesthesia was measured after the surgery and characterized by excellent, good, moderate (pain relief), and unsuccessful (need for pain medications) indicators. In case insufficient depth was reached, intravenous Remifentanil was injected.
Results: According to the results of the chi-squared test, there were no significant differences in gender distribution (p=0.063), anesthesia class type (p=0.964), type of surgery (p=0.694), anesthesia satisfaction (p=0.578), sensory block of hand (p=0.529), motor block of hand (p=0.059), pain intensity (p= 0.634), pain relief medication requesting (p=0.755) and also body mass index (T-test used P=0.099) variables comparing both groups together. Additionally; according to the T-test results no significant differences were reported in the mean systolic pressure, mean diastolic pressure and mean heart rate variable in designated times.
Conclusion: There is no significant difference between the two groups. Therefore, using a distal Bier block can be an alternative if needed.

Challenges of teaching medical ethics from the perspective of mentors and students of Tehran university of medical sciences: a brief report
Amir Hossein Mardani, Mohamad Hasanpour, Shahla Khosravi , Alireza Parsapour , Amir Ahmad Shojaee ,
Volume 79, Issue 9 (December 2021)
Abstract
Background: The approach of medical ethics training courses at Tehran University of Medical Sciences to change the attitude and promote medical ethics knowledge of learners has challenges. This study aims to identify the challenges in teaching medical ethics at Tehran University of Medical Sciences.
Methods: This is a qualitative study with semi-structured interviews conducted in April 2018 at Tehran University of Medical Sciences. Using purposive sampling, 23 participants were selected from the clinicians and faculty members of medical ethics and medical students. Data were analyzed by the content analysis method.
Results: The challenges of teaching medical ethics from the participant's point of view are classified into three themes: 1- Hidden curriculum 2- Necessity of completing medical ethics education program 3- Executive and managerial macro factors. The results showed that medical ethics training courses are not effective for changing students' behavior and their moral decision-making. There are substantial shortcomings in the current curriculum in terms of content, format, and implementation that make it unresponsive to ethical needs and concerns. Teaching medical ethics should be turned into a longitudinal theme. The duties and missions of the Department of Medical Ethics at the university are not well understood. The Department does not act as a strong executor and supervisor of medical ethics in interaction with higher authorities to pursue the requirements of effective ethics education and to ensure the implementation of ethical codes. There is no effective mechanism for evaluating the ethical performance of activists and students and giving feedback to them. There is insufficient organizational support for students' complaints and reports about the misconduct and unethical behavior of faculty or staff.
Conclusion: The effectiveness and efficiency of medical ethics courses to change the behavior and attitude of learners are not acceptable. Dealing with the existing challenges requires the efforts of the Medical Ethics Department to make maximum use of available resources and interact effectively with other academic departments.

Evaluation of relationship between the level of inflammatory cytokines Interleukin-10 and tumor necrosis factor-alpha with virologic response to treatment in patients with HIV
Saedeh Ebrahimi, Saeed Kalantari , Soheil Rahmani Fard , Mitra Kohandel, Zahra Amiri, Yousef Alimohamadi , Sara Minaeian,
Volume 80, Issue 2 (May 2022)
Abstract
Background: Despite the considerable advances in acquired immunodeficiency syndrome (AIDS) treatment and management, finding the cure for this disease has been hindered by emerging challenges such as virus resistance and treatment failures. The purpose of this study is to compare the cytokine profiles of patients with successful treatment and patients with unsuccessful treatment to gain a better understanding of treatment failure mechanisms.
Methods: Sixty-nine human immunodeficiency virus (HIV) positive patients who were referred to the west health center of Tehran between September 2018 and March 2021 were included in this study. Blood CD4+ cell count and viral load was measured using the flow cytometry and quantitative real-time polymerase chain reaction (RT-qPCR) methods respectively. Based on the viral load test results patients were divided into successful treatment (viral load<200 copies/ml, n=36) and unsuccessful treatment (viral load>200 copies/ml, n=33) groups. Subsequently, tumor necrosis factor-α (TNF-α) and interleukin-10 (IL-10) serum levels were measured using the enzyme-linked immunosorbent assay (ELISA) method.
Results:  Analysis of data revealed that there was no difference in demographic data, medical history and clinical laboratory test results between the study groups. Elisa test results showed that serum TNF-α levels were significantly higher in the unsuccessful treatment group compared to the successful treatment group (10.43±10.17 vs 5.37±5.25, P=0.01) but no differences were observed in IL-10 levels between the study groups. Furthermore, age and sex-adjusted linear regression models showed that non-nucleoside reverse-transcriptase inhibitors (NNRTI)-based treatment regimen is positively associated with serum IL-10 levels in patients with unsuccessful treatment (B coefficient 10.88 (95% CI: 1.32-20.45), P=0.03). Moreover, based on the results of the linear regression models, no relationship between HIV viral load and serum IL-10 and TNF-α level was observed.
Conclusion: Results of this study showcased the importance of TNF-α in disease progression and treatment failure. Further future studies regarding this relationship can provide vital information in AIDS treatment research.

Ethical considerations in non-heart beating donation: a narrative review article
Keihan Mostafavi, Fariba Ghorbani, Mojtaba Mokhber Dezfuli , Mahdieh Hazrati , Ehsan Alibeigi , Nafise Mohamadizade,
Volume 80, Issue 8 (November 2022)
Abstract
Background: Considering the high death rate of patients on the transplant waiting list, one of the most important ethical challenges of organ transplantation is the lack of transplant organs and different approaches to cover it.
Methods: The ethical issues of organ transplantation have been frequently reviewed recently.
Results: Currently, there are 4 sources for organ transplants, which are: a) organ transplant from animal to human b) transplant from a living donor c) transplant from a brain-dead donor d) transplant from a cardiac-dead donor or donors without a heartbeat, and tissue engineering research continues to prepare a transplantable organ. Each of them has its own limitation and specific consideration. In Iran, organ procurement from brain-dead donors and living donors are the most important sources. Many approaches have been considered to increase the number of procured organs from brain-death cases in the world, but have not yet been able to reduce the gap between supply and demand. Therefore, since the 1980s, the program of organ transplantation from cardiac death (donors with irreversible cardiac arrest) in the world has been reviewed again. Based on the classification of cardiac arrest patients, they are placed in two general categories: uncontrolled and controlled. In a controlled condition, death is predictable, and organ removal is possible by eliminating planned medical interventions and patient support. But in the uncontrolled state, death occurs accidentally, which is more likely to prolong the duration of hot ischemia. Italy's organ donation group has recently introduced type 6 deaths in patients on ECMO, which is mentioned as a semi-controlled group. This group is called donors with abnormal blood flow versus brain-dead donors with normal blood flow. In this study, ethical considerations for organ donation from NHBD were discussed. Regarding the procurement of organs from non-heart beating donors, there are many ethical considerations that include both the donors and the recipients. Considering that the clinical conditions of the brain-dead donors are sometimes very unstable, cardiac arrest may occur before organ harvesting. In these cases, donation after cardiac death is an option.
Conclusion: It is necessary to regulate the ethical considerations for organ procurement from NHBD

Frequency of causes of otalgia in patients referred to the ENT clinic: a brief report
Mohamad Ali Damghani , Ayeh Shamsadini , Elham Abbaszade,
Volume 81, Issue 6 (September 2023)
Abstract
Background: Otalgia is defined as pain localizing in the ear that can be primary or referred. By careful history and physical examination, all causes in this extensive differential diagnosis can be excluded. Given that otalgia is one of the most common causes for patients to visit the clinic and has a wide variety of differential diagnosis, the purpose of this study is to investigate the frequency of different etiologies of ear pain in patients referred to referral clinic.
Methods: This cross-sectional study was performed on patients presenting with otalgia. After entering the study, the patient underwent a thorough examination of the ear, nose, throat, head and neck, teeth and salivary glands by a resident under the supervision of a senior otologist, and based on the findings, relevant para clinical procedures such as x-ray, CT scan or stroboscopy were performed. Data collection was done based on a data log check list. Samples were collected during six months. SPSS software version 20 was used for analyses.
Results: The most common causes of otalgia were acute otitis media 29%, external otitis 17% and chronic otitis media 15%. Cerumen and referral ear pain were next in line (13.5%). There was significant relationship between otalgia with age groups (The age between 13 and 30 years were the most referred due to otalgia). There was no significant relationship between otalgia and gender, underlying disease, economic status, smoking and opium use.
Conclusion: Given that otalgia is a common complaint in patients referred to the clinic, knowing its causes and origin is useful in diagnosing, proper treating it and avoiding unnecessary para clinical procedures and empirical treatment. The most common causes of otalgia in this study were acute otitis media, otitis externa and chronic otitis media, respectively. Referral otalgia and cerumen impaction were the next causes. Among the age groups, the age between 13 and 30 years were the most referred due to otalgia, but there was no significant relationship with any of the variables of gender, economic status and smoking and opium use.

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