Tehran University Medical Journal

Background: CNS infection can be focal or generalized. Meningitis, besides other etiologies, can occur after a viral infection or viral vaccine. Although meningitis can occur in at any age but it is more common in children less than five years old. Aseptic meningitis and meningoencephalitis are two of the most common complications of mumps (wild type or vaccine). As a result of their serious complication, we decided to obtain more information about clinical manifestations and laboratory findings after the injection of the Hoshino MMR vaccine in a group of children in an Iranian referral hospital.
Methods: In this cross-sectional study, performed from March 2013 to February 2015 on 73 children with meningochemical symptoms of meningitis, children who have been diagnosed with aseptic meningitis followed by an MMR vaccine in an infectious ward or emergency department of the Children’s Medical Center were enrolled in the study and their information was recorded from their files. A questionnaire was provided for children with diagnostic criteria of aseptic meningitis and their data were collected.

Background: Even after surgery, as the most effective treatment for colorectal cancer, about 30-40% of cases are recurring. Since growth inhibition is an important strategy in cancer treatment, many attempts are in the program to find new agents, so in this study, the cytotoxic and antimicrobial effects of Lactobacillus sakei on colon cancer cell line (HT-29) and some pathogenic microorganisms have been evaluated. Lactobacillus sakei is a probiotic that, when consumed affects the intestinal flora, causes beneficial effects on host health. Probiotics due to their anti-cancer effects, modulation of the differentiation process in tumor cells, changes in tumor gene expression and lack of immunological responses have attracted a lot of attention as a new and effective treatment for colorectal adenocarcinoma.

Background: At present, in nuclear medicine to calculate the cumulative activity of various organs, different techniques are being used to correct the background radiations in the conjugate view method. Each of these techniques considers the effect and weight of background radiations to a different extent. These background radiations can cause errors in cumulative activity calculations. The purpose of this study was to evaluate and compare different techniques of correcting background radiations to each other in calculating kidney cumulative activity during the nuclear scan of the bladder in children.
Methods: This study was Cross-sectional and performed for patients who were referred to Isfahan Shahid Chamran Hospital between December 2019 and June 2020. In this study using Foley, 1 mCi of TC-DTPA radio-pharmaceutical that was diluted with normal saline was injected into the patient's bladder, then images recorded by gamma cameras were extracted at 2, 5, 10, and 20 minutes, Finally with ROI drawing around kidney with having vesicoureteral reflux, Cumulative renal activity was calculated with four correcting background radiations techniques such as without correction of background radiation, conventional method, Buijs method, and Kojima method Eventually, the data was Eventually, the data was compared to each other to determine how much weight each of these techniques consider for background radiations.

Background: Nicolau syndrome is a rare condition that happens after intramuscular injection. All the intramuscular injections may have mild to moderate complications such as pain, focal abscess, nerve complication and anaphylactic reactions. Among these complications, wide necrosis of the skin like Nicolau syndrome happens very rarely. In this condition, Patients typically report acute, intense pain, immediately after drug injection and it is followed by an erythematous macular evolving after 24 hours into a livedoid violaceous patch with dendritic extensions. The study has been reported a case report of a 6-month-old infant who suffered from Nicolau syndrome after the injection of pentavalent vaccine.
Methods: A 6-month-old girl infant without a history of any disease was referred to the emergency department with the signs of erythema, edema and purple like discoloration in the vaccine injection site at the left tight, after vaccination. One hour after admission, in the lower limb severe edema along with an extension of a dark red to purple discoloration happened on different parts of foot and after 5 days they turned necrotic. The infant suffered from Nicolau syndrome after the injection of the pentavalent vaccine.

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: Primary intraosseous squamous cell carcinoma (PIOC) of the mouth is a very rare but well-known carcinoma. It is locally invasive and its prognosis is quite poor. It may originate from the walls of an odontogenic cyst or de novo from the remnant epithelium at this region. Because the early symptoms of such malignancies are sometimes similar to those of inflammatory or periodontal diseases, early diagnosis is the most important step toward appropriate treatment.
Case Presentation: The case was a 46-year-old female with a sudden luxation of two posterior mandibular molars referred to a general dentist in May 2019. With diagnosis of periodontitis, the teeth were extracted without finding the cause of the tooth luxation. After four months, because of pain, swelling and non-healing socket of extracted teeth she referred to the department of Oral medicine in Mashhad Faculty of Dentistry. The patient was healthy with no systemic disease, drug history or familial history of cancer and no history of trauma, habits, tobacco, alcohol, and smoking. ln clinical examination, a nodular swelling with extensive ulcer and rolled borders along with hyperkeratosis and erythema on the posterior part of the right mandibular ridge was observed. The Extraoral examination revealed a tender mobile lymph node in the right submandibular region. After radiographic evaluation, with an initial diagnosis of SCC originated from the socket of extracted mandibular molars, incisional biopsy was performed, and histopathological analysis of the specimen revealed a primary intraosseous squamous cell carcinoma (grade II) and then necessary treatments (surgery, radiotherapy, chemotherapy) were performed.

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).

Background: Influenza vaccines based on conserved proteins are being developed persistently. The conserved protein vaccines based on Nucleoprotein (NP) are highly protected vaccines against influenza viruses that can be used as a Universal vaccine. Aluminum hydroxide (Alum) is the most common adjuvant used in vaccine formulation to improve immunization by altering the epitopes’ folds. However, due to its toxic effects on the nervous system, especially in infants and young children exposed to multiple vaccine injections during brain development, it is better to use more desirable options such as carbohydrate-based adjuvants. Sucrose ester (SE) is a carbohydrate and non-ionic surfactant that is compatible with the human body and environmentally friendly. This study evaluated the immunogenicity of recombinant NP molecule prepared in a prokaryotic with the accompaniment of sucrose ester adjuvant against lethal influenza virus challenge in a Balb/c mice model.
Methods: The recombinant vector of PET-28a-NP was used to produce NP molecule. The vaccines containing an NP with or without Alum or sucrose ester adjuvants were injected into the mice. The Effectiveness and immunogenicity were examined by evaluating the humeral immunity induction by Immunoglobulin G (IgG), and its subunits production, and cellular immunity induction by Interferon-Gamma (IFN-γ) and Interleukin-4 (IL-4) production by ELISA Method and also animal’s surveillance was documented. The study took part at the Influenza and other respiratory viruses department of Pasteur institute of Iran in November 2018.
Results: The animals’ surveillance in the Np group was 57.1%, NP+SE was (71.4%), and NP+SE was 64.28%. Also, IgG and its subunits, IL4, and IFN-γ production in both Alum and SE combined vaccines compared to NP alone were significant.

Background: People with chronic diseases of the immune system, such as multiple sclerosis (MS), are at risk for Covid-19 disease. However, more research is needed with long-term follow-up. The aim of the study was to follow up people with MS (PwMS) for up to three months after AstraZeneca vaccination for the recurrence of MS and Covid-19 infection.
Methods: This study was a case study (descriptive-analytical) of follow-up type. The study population was PwMS over 18 years of age in Kermanshah province who received both doses of the AstraZeneca vaccine. This study was conducted from August to November 2021. Sampling was done with existing methods based on the National MS Registry of Iran (NMSRI). Demographic information of patients was extracted from NMSRI. A researcher-made form was used to collect information by telephone three months after vaccination about clinical characteristics, Covid-19 infection, and recurrence of MS. Data were analyzed using SPSS-25 software.
Results: Study participants were 40 MS patients with a mean (SD) age of 39.27 (8.8) years, including 32 (80.0%) women. A mean of 9.39 (4.6) years had passed since The patients were diagnosed with MS, and 29 (76.4%) had RR type MS. Four patients (10%) relapsed between the second dose and three months later, of whom two (50%) had sensory symptoms, one (25%) had optic nerve involvement, and one (25%) had motor symptoms and pyramidal pathway involvement. The symptoms of Covid-19 were mild in three patients (10%), while severe symptoms developed in one patient (10%) who received rituximab. Among the patients, no cases of thrombosis were observed. Infusion therapy, a leg fracture, and kidney stones were the only hospitalized cases.

Conclusion: Covid-19 and MS relapse prevalence did not differ significantly in the three months before and after vaccination. There is a need for further studies with a longer follow-up period.

Background: Radiomics is a noninvasive method that reveals information from medical images that are not recognizable by the naked eye. Radiomics has shown a high potential in the accurate diagnosis and prognosis of liver lesions in ultrasound images. Despite this high potential, changes in imaging parameters affect the reproducibility of ultrasound radiomics results. Therefore, the present study aims to investigate the reproducibility of the radiomics features extracted from the images of patients with hepatocellular carcinoma under changes in ultrasound scan parameters.
Methods: This was a cross-sectional study conducted from July 2020 to July 2021 in the radiology department of Tabriz Paramedical Faculty. The images of 20 patients with hepatocellular carcinoma were obtained from the Cancer Imaging Archive database. These images were taken under different imaging conditions and parameters. The areas related to the lesion were manually extracted from the images with software tools. Then, in order to radiomics analysis, different radiomics features, including 24 gray level co-occurrence matrix (GLCM) and 16 gray level run length matrix (GLRLM), were extracted from the images. Then, using the coefficient of variation (CV%) and intraclass correlation coefficient (ICC) statistical tests, the reproducibility of radiomics features under changes in scan parameters was investigated. The values of ICC≥0.90 and CV<20% were considered reproducible in this study.

Results: Among the 40 features extracted from ultrasound images, eight showed high reproducibility in both CV% and ICC tests. These features were joint entropy, Idmn, Imc2, correlation, MCC, sum entropy, gray level non-uniformity normalized, and run entropy in which the two features, Idmn and gray level non-uniformity normalized, showed the highest (CV%=0.24) and the lowest (CV%=14.90) stability against the changes of ultrasound scan parameters, respectively. The average ICC value of these features was obtained at 0.977. Conclusion: Despite the high potential of radiomics in diagnosing liver lesions, changes in imaging parameters directly affect the reproducibility of results. However, some radiomics features still show high stability and reproducibility under changes in imaging parameters.

Background: The success of labor induction depends on the condition of the cervix at the time of delivery. This study examines the effect of labor induction with an intra-cervical Foley catheter and oxytocin compared to a Foley catheter and misoprostol on cervical preparation and delivery rate in the first 24 hours after induction.
Methods: In a randomized clinical study, pregnant women with a singleton pregnancy and a gestational age of more than 40 weeks, with a Bishop score less than 4 and an intact amniotic sac referred to Umm al-Binin Hospital in Mashhad from 2017 to 2018 were included in the study. They were randomly divided into two groups of Foley catheter and oxytocin (1) or Foley catheter and misoprostol (2). In the first group, immediately after placing the Foley catheter; Oxytocin was started with a dose of 2 milliunits per minute, and every 20 minutes, 2 milliunits were added to reach the maximum dose of 30 milliunits per minute (induction method with a low dose). In the second group, after Foley catheter insertion, sublingual misoprostol was prescribed at a dose of 25 micrograms every 4 hours up to a maximum of 6 doses.

Results: 74 pregnant women were randomly evaluated in two groups of 37 people. There is no statistically significant difference in the demographic variables in the two groups. There was a significant difference in the labor rate in the first 24 hours, and it was higher in the oxytocin group (P=0.009). Bishop's score after 24 hours of induction was not significantly different in the two groups. Reaching the active phase was significantly shorter in the oxytocin group. (P=0.01). The time of catheter removal in both groups and the rate of cesarean section and the occurrence of complications were the same in both groups. Conclusion: The use of oxytocin with a Foley catheter inside the cervix can accelerate the preparation of the cervix and increase the chance of labor in the first 24 hours, but it does not affect labor complications.

Background: This study aimed to evaluate the carcinogenic and non-carcinogenic health risks of heavy metals in seven types of tobacco widely consumed in the east of the country through inhalation exposure.
Methods: This descriptive-analytical study was conducted from April 2022 to October 2022 in the city of Bojnord, Iran on sook of seven popular tobacco brands. Metal concentrations in sook of tobacco were determined using inductively coupled plasma-optical emission spectroscopy. In order to analyze the data and ensure the accuracy of the results, the amount of metals in the samples was repeated three times, and their average was analyzed. Monte Carlo software was used to assess possible risks.

Results: The results of this study showed heavy metal concentrations in sook tobaccos were, respectively, Fe>Zn>Mn>Ba>Pb>Ni>Cu>Mo>Cr>As>Cd. The concentration of heavy metals such as arsenic, cadmium and molybdenum in Alrah brand tobacco was higher than other types of tobacco. So that the amounts of heavy metals including arsenic, cadmium and molybdenum for this brand were 14.2±0.05, 10.4±0.06 and 11.6±0.04 micrograms per gram, respectively. The hazard index (HI) values for different types of tobacco, including Al-Rah, Amordadsub, Al-Fakher, Al-Rubi, Mazaya, traditional flavorless, and Nakhle, were 2.64, 2.41, 2.05, 1.7, 1.49, 1.46, and 1.44, respectively. The lifetime cancer risk (ILCR) for Amordadsub, Al-Rah, Nakhla, Mazaya, Al-Rubi, Al-Fakher, and traditional flavorless tobaccos was 2.8×10-3, 2.43×10-3, 1.72×10-3, 1.58×10-3, 1.43×10-3, 9.58×10-4, and 8.08×10-4, respectively. Lead in Alrah tobacco sook had the highest non-carcinogenic risk value with a value of 1.59. Conclusion: According to the obtained results, Alrah tobacco sook has a higher cancer and non-cancer risk than regular tobacco and can cause non-carcinogenic and carcinogenic risks for consumers. Thus, it is necessary to regularly monitor the quality of prevalent tobacco to reduce delete human health risks.

Background: With a national vaccination program, we have achieved success in the prevention of infectious diseases in the community especially in children. Despite this great success, the side effects of vaccination may not encourage some people in the community to get vaccinated. In this study, we investigate the prevalence of common side effects of vaccination in Shahrood city.
Methods: This study investigated the incidence of complications caused by vaccination in infants and children under seven years old in Shahrood city in a 5-year period from April 2016 to March 2020. We collected demographic and clinical information, by referring to the health centers and complications recorded after routine vaccinations such as fever, rash, diarrhea, swelling and other complications of vaccination were collected.

Results: Findings Among the 429 registered complications between 2016 and 2020, most complications were related to pentavalent and trivalent vaccines. Among the registered complications, high fever is the most common complication in both term and pre-term groups. (202 cases, 47.1%) other complications included maculopapular rash (59 cases), mild local complications (55 cases), vomiting (41 cases), and continuous screaming (36 cases), respectively. Among these, 123 cases were resolved without treatment, 297 cases were resolved with drug treatment on an outpatient basis, and only  eight cases required hospitalization. Conclusion: In general, the vaccination program is highly effective despite having limited side effects.  Knowing this information, can increase vaccination in the country.

Background: Correct clinical decision-making has a significant impact on the treatment process, achieving the expected clinical outcome and increasing patient satisfaction, and identifying the factors affecting it is essential for evidence-based medical education. This study aimed to determine the relationship between evidence-based medicine with academic self-efficacy and research self-efficacy of medical students.
Methods: This descriptive analytical study conducted from October 2022 to October 2023 on 45 medical students at Abadan University of Medical Sciences. After obtaining consent from the students and registering demographic and educational information, data collection was performed using evidence-based medicine, academic self-efficacy, and research self-efficacy questionnaires. Then data analyzed by descriptive statistics, Pearson correlation coefficient, Spearman correlation coefficient, and regression model in SPSS.

Results: The findings of our study showed that research self-efficacy in students who had research experience (189.03) was significantly higher than students who did not have research experience (140.76).  In addition, the average score of academic and research self-efficacy and evidence-based medicine in students who had a history of membership in the student research committee was significantly higher than students who did not have a history of membership. Finally, it was found that evidence-based medicine had a direct and significant relationship with research self-efficacy (r=0.361, P<0.05) and academic self-efficacy (r=0.457, P<0.001). In examining the relationship between academic self-efficacy and research self-efficacy, it was also found that these two variables have a direct and significant relationship with each other (r=0.714, P<0.001). As well as, there was no significant relationship between academic self-efficacy, research self-efficacy, and understanding the characteristics of evidence-based practice with any of the variables of age, gender and entry year (P>0.05). Conclusion:  According to the obtained results, it can be concluded that academic self-efficacy and research self-efficacy have an effect on evidence-based medicine, and all of the above can be improved by teaching  medical students to participate in student research committees and doing research work. In this way, it improves the quality of treatment in doctors.

Background: Salmonella enterica subspecies enterica serotype Enteritidis (S. Enteritidis) is one of the leading causes of food-borne infections associated with the consumption of contaminated food products of animal origin in humans. gastroenteritis due to Salmonella is usually a self-limiting disease and does not require antibiotic therapy. However, antibiotic treatment for salmonellosis may be lifesaving for patients with severe infections.The objective of the present study was to examine antimicrobial resistance and determine its genetic basis in recently isolated S.Enteritidis strains.
Methods: During this study, in a cross-sectional descriptive study, 44 isolates of Salmonella enteritidis from human sources were investigated between September 2021 and September 2022.. After identification of the isolates using phenotypic and molecular methods by Multoplex-PCR, antibiotic resistance testing was performed according CLSI 2023. The strains were examined for the presence of qnrA,qnrB,qnrS and gyrA resistance genes by PCR.

Results:  In a cross-sectional descriptive study, 44 isolates of Salmonella Enteritidis from human sources were investigated between September 2022 and September 2023. 100% of the strains were sensitive to imipenem and meropenem, and the sensitivity to the antibiotics ceftriaxone, ceftazidime, and cefotaxime were 93.2%, 90.9%, and 94.1%, respectively. 81.8% of isolates were sensitive to cotrimoxazole, sensitivity to ampicillin was 84.1%. Only 9.1% of isolates were sensitive to ciprofloxacin. Based on MIC results, 16 isolates had MIC between 0.002 and 0.064 and were placed in the sensitive area. 28 isolates had MIC between 0.125 and 0.5 and were placed in the area of reduced sensitivity. None of the strains resistant to disk diffusion method were resistant to MIC method. qnrA, qnrB and qnrS genes were not observed among ciprofloxacin resistant strains. All nalidixic acid resistant strains had gyrA gene. Conclusion: In general, it was shown in this study that the resistance to the fluoroquinolone family is increasing among Salmonella Enteritidis isolates. On the other hand, we see a decrease in the sensitivity and prevalence of strains resistant to broad-spectrum cephalosporins among serovar Enteritidis, which is the drug of choice for extraintestinal infections.

Methods: This two-center, double-blind, randomized clinical trial was conducted between December 2021 and July 2022 in the cities of Kermanshah and Hamadan. In this study, 76 migraine patients were randomly divided into two groups. One group received routine medication with Soda capsules and the other group received routine medication with Valproate capsules. Tow group were examined and followed up for three months. Data related to demographic and clinical information of patients were collected and entered into SPSS software version 25. Data analysis was done with a significance level of 0.05.

Conclusion: In terms of frequency, intensity and duration of migraine headaches as well as side effects, there was no significant difference between Sodium Valproate and Sodae groups.

Background: one of the most common and important complications of COVID-19 is cough. The present study was designed with the aim of comparing the effect of althaea officinalis and eucalyptus nebulizer on the severity of cough in COVID-19 patients.
Methods: in this randomized clinical trial, from January 2022 to June 2022, 36 patients with COVID-19 were selected and randomly divided into three groups. Next, the severity of cough was recorded two hours before the intervention based on the visual analogue (VAS) in both groups until the patient was admitted to the hospital, then, one cc aqueous extract of althaea officinalis with five cc Normal Saline for the althaea officinalis group and four cc aqueous extract eucalyptus whit five cc Normal Saline for the eucalyptus group, were nebulized once a day for 15 minutes. Two hours after the intervention, the intensity of cough was again recorded in two groups. This intervention continued until the hospitalization of the patients. No intervention was done for the control group. The data was analyzed with Spss software at a significance level of less than 0.05.

Results: In this study before the intervention, there was no statistically significant difference between the three groups in terms of cough intensity (p>0.05), but after the intervention on the second and third days, there was a statistically significant difference between the three groups in terms of cough intensity. The rate of reduction in cough severity in althaea officinalis group was higher than the other two groups (p<0.05).  Also, the results of Friedman's test indicated that althaea officinalis and eucalyptus nebulizers incense improved the severity of cough in patients over time. Conclusion: the use of althaea officinalis and eucalyptus nebulizer improved the severity of cough in patients with COVID-19, but althaea officinalis nebulizer had a greater effect on cough severity compared to eucalyptus. It is suggested to use althaea officinalis nebulizer as well as eucalyptus as a treatment method along with other treatment methods.