Tehran University Medical Journal

Herpes zoster (Shingles; Zona) is an acute infectious skin disease that is caused by the reactivation of varicella zoster virus (VZV). After the initial infection (chickenpox) or vaccination, the virus remains inactive or latent in the dorsal root ganglia (DRG); when decreasing cell mediated immunity (CMI) occurs, the virus is reactivated from a latent phase to a lytic phase and frequently replicated in the dorsal ganglion cells then move to the sensory nerves into the skin and causes herpes zoster, which is typically characterized by painful neuralgia and unilateral dermatomal vesicular rash that normally lasts 3 to 5 weeks. The most common complication of herpes zoster is chronic pain owing to postherpetic neuralgia (PHN), which is estimated to occur in approximately 20% of the people aged 50 and over. Although herpes zoster is rarely fatal, the pain related to the acute phase of herpes zoster and subsequent PHN can cause psychological distress, physical disability, impaired sleep and consequently negatively affect the quality of life that can be significantly reduced by all of these occurrences. Due to increasing trend in the incidence of herpes zoster and increasing older people population, it will be expected that herpes zoster and subsequent PHN cause a significant economic burden to the healthcare system, the government, and families along with reducing the quality of life. The average lifetime risk of herpes zoster is estimated to be approximately 30% in developing countries. Although the risk of herpes zoster significantly increases with increasing age and diminished immune system function, any factor impacting on VZV-specific humoral and cellular immune responses may affect the risk of herpes zoster. This paper is provided an overview of the incidence and potential risk factors of herpes zoster with emphasis on the role of micronutrients and their deficiencies in the impaired immune system function. Also, the common method for prevention by zoster vaccine and the role of micronutrients in the efficacy of vaccination are shown.

Background: Celiac disease is a chronic inflammation of small intestine which is caused by an increased permanent sensitivity to a protein named gluten. This protein is present in some cereals such as wheat, barley, and rye. The immunologic response to this protein can cause clinical symptoms in people with specific human leukocyte antigens (HLAs) (including HLADQ2 or HLADQ8). Most studies have reported an increased incidence of celiac disease in patients with diabetes mellitus type I. This study aimed to determine the prevalence of the celiac disease in patients with diabetes mellitus type I under the age of 18 years old.
Methods: This cross-sectional, analytic descriptive study was performed on forty children with diabetes mellitus type I in Sanandaj Diabetes Association (Kurdistan University of Medical Sciences), Iran, from September 2012 to September 2013. After obtaining consent from their parents, demographic data, including gender, age, family history of diabetes, duration of illness, symptoms of celiac disease, were recorded in the questionnaire. The measurement of the tissue transglutaminase (tTG) antibody and total immunoglobulin type A in the serum was necessary for the screening of celiac disease. Therefore in the laboratory, 5 ml of the venous blood sample was taken and then the serum levels of tTG antibody (from immunoglobulin type A) and total serum levels of this immunoglobulin were measured by the enzyme-linked immunosorbent assay (ELISA) method. Upper endoscopy with multiple biopsies from small intestine was performed in patients with positive serological screening. Finally, the disease was evaluated by histological finding.
Results: Forty children with diabetes mellitus type I included 19 boys (47.5%) and 21 girls (52.5%) were enrolled in the study. The mean age of these patients was 10.53±4.05. The prevalence of celiac disease was 7.5% in these individuals. In the subjects, there was no significant relationship between gastrointestinal symptoms and celiac disease.
Conclusion: In the present study, the prevalence of the celiac disease in type 1 diabetic patients was 7.5% which is higher than the normal population.

Background: Infertility is associated with high levels of stress which can pose a tremendous challenge on treatment. These psychological disorders such as depression and anxiety among the barrens are very important and have a crucial role as well. On-time detection and evaluation of such disorders are effective in the successful treatment of infertility. Some variables can interfere and influence on psychological occasions, such as education, age and duration of infertility. This study aims to investigate depression and anxiety on couples with infertility.
Methods: In this study, 60 infertile couples were enrolled. Thirty couples with male factors and 30 couples with female factors. The study is a cross-sectional study carried out in the Amiralmomenin Hospital of Semnan, Iran in 2016-2017. Symptoms of psychological disorders were documented via questioner. Date were entered into SPSS software, version 23 (SPSS Inc., Chicago, IL, USA), P<0.05 was significant.

Thalassemia is an autosomal recessive hereditary disease that occurs due to a decrease in the synthesis of Please recheck. In beta thalassemia, defects in β-globin synthesis lead to an imbalance of β- and α-globin chains and the accumulation of α4 chains in the erythroid precursor which leads to ineffective erythropoiesis, shortened red blood cell survival, and finally clinical symptoms such as delayed sexual and physical maturation, endocrine dysfunction, cardiomyopathy, liver disease, bone deformities and hepatosplenomegaly. Current treatments such as transfusion, iron chelating agents and allogeneic stem cell hematopoietic transplantation have limitations in their use, including iron overload, lack of a human leukocyte antigen (HLA) matched compatible donor, and graft versus host disease (GVHD). Gene therapy is a new therapeutic option for beta thalassemia patients that induces the continuous expression of beta globin chains in the patient’s hematopoietic stem cells. The idea of gene therapy was first proposed in the early 1970s, and the ultimate goal of this treatment method is to express the defective gene in the target cell in a way that can reduce the symptoms of the disease or eliminate them (symptoms) altogether. There are two general methods for gene therapy: the integrating vector, in which the desired gene is inserted into the genome of the target cell and its lifelong expression follows, is the non-integrating method, in which the vector doesn’t integrate into the genome of the target cell and the cytoplasmic form enables gene expression. The first beta thalassemia gene therapy was performed in France in 2006, and in this clinical trial, the first patient with the E/β0 thalassemia was treated at the age of 18. Gene therapy for beta-thalassemia has been approved by the food and drug administration in 2022 for patients aged 12 years and older who have a non β0/β0 phenotype. It seems that this therapeutic option is the definitive treatment method for blood transfusion-dependent beta-thalassemia patients.     However, this treatment method still has limitations: high cost, sensitivity of lentiviral vector production, and the possibility of integration of the vector near the proto-oncogene and its activation are some of them.

Background: Preventing the cancellation of surgeries is an important and devastating challenge in operating room management. Cancellation of pre-scheduled surgeries at the last moment in the operation room leads to increased length of stay, patient dissatisfaction, human resource consumption and financial burden for patients and the health care system. In this study, we have investigated the effect of recording the causes of surgery cancellations in the operation room on the incidence of surgery cancellations in patients who have been candidates for non-emergent surgeries.
Methods: A total of 545 surgeries which had been canceled in different types of surgery between March 2014 and March 2015 were recorded according to the reasons for cancellation in predetermined forms and the information was analyzed. The most common reasons for cancellation included changing the plan of treatment from surgery, a high-risk comorbidity with a high probability of mortality, patient’s refusal from surgery, an unanticipated duration of previous surgery longer than anticipated, the unavailability of an ICU bed in the hospital, requested laboratory data not being ready, failing to prepare requested packed RBCs and other hospital or patient-related problems.

Results: The percentage of surgery cancellations in most groups including orthopedics, urology, cardiac surgery, general surgery, gynecology and maxillofacial surgery, decreased during the course of this study. According to our findings the most relevant cause of non-emergent surgery cancellation was the unpredictable increased duration of previous surgery. The maxillofacial surgery group reached the highest surgery cancellation reduction rate and the cardiovascular surgery group experienced the lowest cancellation reduction rate. Also, the percentage of surgery cancellations in the field of neurosurgery increased during the study period. Conclusion: Recording the reasons mentioned by the surgical team as the reason for canceling surgeries and reducing the rate of their occurrence during the study and providing appropriate feedback and dialogue in this case had a positive effect on reducing the rate of cancellation of the surgeries and reducing the mentioned reasons.

Background: Exercise programs can lead to different physiological adaptations, but the effects of low-volume, low-frequency HIIT protocols with varying interval structures have not been thoroughly investigated. This study aimed to explore the impact of HIIT with high compression (HC) and low compression (LC), with or without berberine (BBR) supplementation, on hematological parameters in pre-diabetic men.
Methods: This semi-experimental study was conducted between October and December 2021 at Mazandaran University. Fifty-four overweight/obese men with a mean age of 48.6±6.6 years, a body mass index of 30.7±7.3 kg/m², and a body fat percentage of 34.4±4.3% were randomly and equally divided into one of six groups: HC, LC, HC+BBR, LC+BBR, BBR, and control. The HC group (2:1 work-to-rest ratio) and LC group (1:1 work-to-rest ratio) underwent training programs comprising 2-4 sets of 8 exercises at an intensity of 80-95% of their maximum heart rate twice a week for 8 weeks. Hematological responses to Bruce's incremental exercise test were measured before and after the intervention. Data were analyzed using a two-way ANOVA with Bonferroni's post hoc test, with a significance level set at P<0.05.

Results: Baseline hematological indices showed no significant differences between pre-diabetic and non-diabetic groups (all, P>0.05). Following the 8-week intervention, there were significant decreases in white blood cells (WBCs) in the LC and LC+BBR groups, and in lymphocytes across all intervention groups except BBR (all, P<0.05). Additionally, hemoglobin and hematocrit levels showed significant reductions in the HC and HC+BBR groups (both, P<0.05). However, in response to Bruce's incremental exercise test, a significant decrease in WBCs was observed in the LC and LC+BBR groups, with reductions of 18% and 25%, respectively (both, P<0.05). Conclusion: The LC protocol, even without berberine supplementation, seems to provide better immunological benefits and result in less hemolysis compared to the HC protocol, as evidenced by reductions in white blood cell counts.