Tehran University Medical Journal

Background: Colorectal cancer is the second most common cancer in the world which is mainly caused by epigenetic and environmental factors. Among these epigenetic factors, gut microbiota is an important one. Although it has not been proved a unique group of bacteria correlated with colorectal cancer, these findings have generally demonstrated differences between healthy and disease gut microbiome in population. Actually, the identification and investigation of intestinal microbiota in early detection of colorectal cancer have been highlighted in new researches and studies. Herein, in the current study, we aimed to evaluate the number of selected gut bacteria including Lactobacillus and Escherichia coli and Prevotella in the fecal specimens of adenomatous polyposis patients, colorectal cancerous cases in compared to normal participants in terms of estimating important role of gut microbiota during colorectal cancer initiation and progression.
Methods: The current research was a case-control study. Fecal samples were provided from 31 healthy individuals, 42 adenomatous polyposis patients and 20 colorectal cancer cases that were referred to Taleghani Hospital, Tehran, Iran, from August 2016 to August 2017 for colorectal cancer screening tests. Fecal samples were collected to analyze intestinal bacteria including, Lactobacillus, Escherichia coli, and Prevotella by absolute quantitative real-time polymerase chain reaction (PCR). The number of these gut bacteria was precisely determined by this method of real-time PCR.
Results: Higher number of Prevotella with 24.6 CT number (P<0.005) and E.coli with 20.4 CT number (P<0.015) were achieved in colorectal cancer cases and adenomatous polyposis patients in contrast to samples from normal individuals. On the contrary, the opposite range was observed for the quantification of Lactobacillus and greater numbers of bacteria (CT=28.6) were detected in normal, compared to the colorectal cancer cases and adenomatous polyposis (P<0.001).
Conclusion: The gut microbiota composition of individuals with colorectal cancer and adenomatous polyposis differs from that of healthy individuals, and the higher numbers of pathogenic microbiota versus beneficial microbiota present in those with colorectal cancer and adenomatous polyposis. In contrast, healthy individuals have higher numbers of beneficial gut microbiota than pathogenic microbes. These findings need more experimental analysis and investigation to better clarify.

Background: Uremic pruritus is one of the important problems in patients undergoing hemodialysis. Causing the mechanism of uremic pruritus in hemodialysis patients is complex and multifactorial. Almost 60 percent of hemodialysis patients suffer from uremic pruritus. Oral hydroxyzine is a common treatment for uremic pruritus of this patients. This study aimed to survey effect of hydroxyzine on uremic pruritus of hemodialysis patients.
Methods: This quasi-experimental study (pre and post design) performed on 40 patients with eligible criteria. All of the hemodialysis patients who suffer from pruritus received a tablet of hydroxyzine 25 mg daily for 6 weeks. In this time, drugs and the plan of hemodialysis were constant. Pruritus score of patients, evaluated with 5-D pruritus scale that had 8 items with 5-score Likert scale and evaluate duration, direction, disability, and distribution of pruritus. Severity scores of pruritus before and after treatment with tablet of hydroxyzine were compared. This study was conducted on hemodialysis patients in the Soodeh Center of Hemodialysis in the south of Tehran, Iran, from September 2016 to February 2017.
Results: The findings of this study showed that most of the patients in this study were male (55%) with mean age of 55.97±11.59 years. The most cause of chronic renal failure in these patients was diabetes (37.5%). This study showed that 32.5% of the hemodialysis patients had moderate to severe uremic pruritus. The mean score of pruritus before the treatment with hydroxyzine was 16.73±3.4 and the most effect of this drug was in the social activity item (2.47±0.6). After treatment with hydroxyzine, the mean score of pruritus in the patients was 9.65±2.15 that was decreased significantly (P<0.001). The findings showed that there was no significant relationship between decrease of pruritus and characteristics of patients.    
Conclusion: This study showed that uremic pruritus is still a challenge in hemodialysis patients. According to this study use of hydroxyzine, regardless of uremic pruritus mechanism, could be decreased uremic pruritus of hemodialysis patients.

Background: Intravenous (IV) injection of drugs is one of the most common methods of drug prescription in hospitals, which is a complex, potentially hazardous and erroneous method; accordingly, it requires control methods to reduce the potential risks. This study focused on determining the frequency and types of different medication errors while preparing and administering mostly used IV drugs in three intensive care units (ICU) and one general department in AL-Zahra hospital, Isfahan, Iran.
Methods: This cross-sectional observational study was conducted for 6 months from September 2017 to March 2018. To determine the frequency of different medication errors, a quoting sampling method was applied to select and observe 400 cases of IV drug administrations. All nurses from any studied department were included in this study. Different stages of preparation and administration of the observed drugs were compared to an instructed checklist prepared by the clinical pharmacist.

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.

Background: Because of geographic variation and regional types of allergens, it is recommended that allergists identify common allergens in their area of activity. In the present study, the prevalence of respiratory allergens in patients with asthma and allergic rhinitis was investigated.
Methods: This study is descriptive and retrospective. The required data of this study were extracted from the records of 661 patients who were referred to the Asthma and Allergy Clinic of Ardabil University of Medical Sciences (Ardabil province, Northwest of Iran) from April 2016 to March 2017. After confirmation of allergic asthma or rhinitis by the asthma and allergy specialist, these patients were subjected to a prick test with allergen extracts. In the group of grasses the extract of nine grasses, in trees the extract of 11 Tree mix, in weeds the extract of Common weed mix, in animal allergens the three extracts of Standard cat, Dog epithelia, Cockroach mix, in weeds the Mite mix and in fungi, three extracts of Mold mix1, Alternaria and Aspergillus mix were used. All the data were analyzed using SPSS software, version 25.

Background: Obesity is associated with chronic inflammation in obese subjects, which leads to an increase of inflammatory cytokines. This study aimed to evaluate the effect of different intensity circuit resistance training on levels of interleukin 1 beta and interleukin-10 in obese men.
Methods: In a semi-experimental trial during May to August 2020, 44 obese men from Tehran city were selected and randomly divided into 4 groups including 1) control (n=11), 2) low-intensity circuit resistance training (n=11), 3) Moderate intensity circuit resistance training (n=11) and 4) High-intensity circuit resistance training (n=11). Resistance training was performed in different intensities including1) High-intensity circuit resistance training: three sets of 10 repetitions with 80% 1RM 2) Moderate intensity circuit resistance: three sets of 13 repetitions with 60% 1RM and 3) low-intensity circuit resistance training: three sets of 20 repetitions with 40% 1RM, three sessions per week for 12 weeks. Also, the control group had their daily life during the 12-week research period and were prohibited from participating in regular exercise. Serum interleukin-1 beta (IL-1β) and interleukin-10 (IL-10) levels were measured using an ELISA kit. Data were analyzed with covariance analysis at P<0.05.
Results: Twelve weeks of low, Moderate and high intensity circuit resistance training significantly decreased IL-1β levels (P=0.001) and increased IL-10 levels in obese men (P=0.001). The decrease of IL-1β was significant in the high-intensity training group compared to low intensity (P=0.009) and moderate-intensity training groups (P=0.046). Also, the increase in IL-10 levels was significant in the high-intensity training group compared to the low-intensity (P=0.002) and the moderate intensity training group compared to the low intensity training group (P=0.004).

Conclusion: According to our findings, resistance training has a positive effect on inflammatory and anti-inflammatory factors in obese men, and high-intensity circular resistance training had more benefits.

Background: The Extensor Carpi Radialis Longus (ECRL) and the Extensor Carpi Radialis Brevis (ECRB) are muscles of the posterior forearm compartment. variations in this area of the forearm are common and are usually diagnosed during surgery. Sometimes these variations are symptomatic and can be helpful in clinical procedures such as surgery. Diagnosis and identification of abnormalities can be used in academic studies to evaluate limb function. Reporting such variations is important in clinical practice and will help treat limb dysfunction. In this report, we report two cases of ECRL and ECRB muscle tendon variations in the upper third of the forearm.
Case presentation: During routine dissection of the body of a 70-year-old man fixed in 10% formalin in the Department of Biology and Anatomy, Shahid Beheshti University of Medical Sciences, Tehran, two cases of ECRL and ECRB muscle tendon variations were observed in the upper third of the left forearm. The fascia of the ECRL and ECRB muscles were separated, and following the ECRL muscle from the external epicondyle of the humerus to the outer third of the forearm, we observed that the tendon of this muscle was divided into two branches. We also observed that the ECRB muscle tendon split into two branches slightly below its origin. The branch had moved obliquely toward the lower end of the radius. at the lower end of the forearm, this tendon was connected to the ECRL muscle tendon by passing over the sub-branch of the ECRL muscle tendon and the depth of the retinaculum extensor. The submandibular tendon was attached to the base of the second Metacarpal bone along with the ECRL muscle tendon. The main branch of this muscle also had its main path to the lower end of the forearm. The lower end of the forearm was connected to the dorsal base of the second and third metacarpals by passing under the retinaculum extensor.
Conclusion: Knowing these variations can help radiologists and surgeons in diagnosis and treatment.

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

Background: The median nerve is one of the most important branches of the brachial plexus. Due to the role of the median nerve in sensory and motor innervation of the forearm and hand in the upper limbs, its blood supply is very important. Awareness of variations in the blood supply pattern to this nerve reduces the incidence of necrosis and ischemia of the nerve during surgical and diagnostic procedures.
Case Presentation: During routine dissection of the cadaver of a 65-year-old man fixed in formalin (10%), in the Department of Anatomy and Reproductive Biology, Shahid Beheshti University of Medical Sciences, a rare variation was observed in the median nerve nutritional artery at the distal end of the left forearm. After dissection of the skin, superficial and deep fascia, anterior compartment forearm muscles, nerves and blood vessels were exposed from surrounding tissues. The median nerve passed through the two heads of the pronator teres muscle and left the cubital fossa in the depth of the flexor digitorum superficialis and the surface of the flexor digitorum profundus in the forearm. It was observed that at the distal end of the left forearm between the flexor carpi radialis and the flexor digitorum superficialis, a relatively thick branch originates from the radial artery and supplies blood to the median nerve. This branch was separated from the radial artery (before the artery enters the anatomical snuffbox) and crossed the surface of the flexor carpi radialis muscle and inserted into the median nerve sheath. In the forearm, this branch was the only artery supplying blood to the median nerve.

Background: The preparedness and safety of hospitals in disasters are essential to maintain the health and survival of the community. Numerous studies have shown that the level of preparedness of Iranian hospitals is moderate and low. Lack of comprehensive hospital standards for disaster preparedness is one of the reasons. This study aimed to develop hospital accreditation standards for hospital disaster risk management.
Methods: This comparative study was conducted between April and September 2016. Hospital disaster risk management accreditation standards were extracted from the hospital accreditation standards of 11 countries including the United States, Canada, Australia, Malaysia, India, Thailand, Egypt, Turkey, Saudi Arabia, Denmark and Iran. Overall, 27 hospital disaster risk management accreditation standards were introduced. The opinions of 22 disaster risk management experts were used to assess the content validity of the proposed disaster risk management accreditation standards.
Results: Differences were observed in the quality and quantity of those countries’ disaster risk management standards. The national accreditation standards of the United States, Australia, and Canada had comprehensive standards and covered all aspects of the disaster risk management cycle. Finally, 27 standards were proposed for developing Iranian hospitals’ disaster risk management accreditation standards. The CVI & CVR validity of the proposed standards were acceptable.
There were significant differences in the quantity and quality of hospital disaster risk management accreditation standards in selected countries. The most comprehensive standards belonged to the US National Standards (12 standards and 113 sub-standards), followed by the Australian and Canadian accreditation standards. The accreditation standards of the developing countries and Iran were not comprehensive and did not meet the international goals of disaster risk management. The proposed hospital disaster risk management accreditation standards had high content validity.
Conclusion: Disaster risk management accreditation standards in Iran and developing countries need to be revised and upgraded. Comprehensive standards based on international experiences and expert opinions were introduced in this study that can be used to develop hospital accreditation standards in Iran and other countries.

Background: Urinary tract infections are among the most common diseases in different communities and occur in all age groups. Failure to diagnose the disease correctly and promptly can cause complications such as damage to the urinary tract and kidney parenchyma, increased blood pressure, uremia. Also, in pregnant female patients It may lead to premature birth and even abortion. Therefore, correct and timely administration of antibiotics is very important in the treatment of patients. This study aimed to compare the results of antibiogram testing of patients with suspected urinary tract infections by both rapid and classical methods.
Methods: This cross-sectional study was performed from the beginning of March to the beginning of September 2019, on patients with urinary tract infection Who had been referred to Sina Hospital of Hamedan, Iran. Urine samples were collected 20 cc from patients. The test was performed directly at the same time with urine culture to determine antibiotic susceptibility. The agreement between the two methods was considered as a huge error, major error and minor error. Finally, the data were statistically analyzed with SPSS software version 16.

Results: No RBC was detected in microscopy. The majority of the leucocytes were lymphocytes with rare accompanying platelets. The radiolabeling efficiency of the procedure was higher than 40%. The viability test indicated more than 80% of viable cells. The radiochemical purity of the final product was more than 95%. Two to four hours after injection, low background images were acquired. The liver and spleen were target organs with low-grade urinary, thyroid, and GI activity. Conclusion: Employing multi-stage centrifugation, Tc-HMPAO labeled leucocyte scan could be efficiently performed.

Background: Febrile seizures (FS) are the most common cause of seizure in children. In order to prevent FS and their recurrence, the recognition of the related factors to recurrence of FS is important. According to the high prevalence of FS and iron deficiency anemia (IDA) in children and that IDA is a possible risk factor for FS, as well as controversies in previous studies in this field, in this study, the relationship between iron deficiency anemia and FS in children was investigated.
Methods: This is a case-control study that investigates the relationship between febrile seizures with anemia in 150 patients aged six months to five years with fever who were admitted to Imam Sajjad Yasouj Hospital, from April to August of 2014. In this study, 75 patients with febrile seizures (case group) and 75 febrile patients without seizures (control group) were compared. Cause of fever (urinary infection, gastrointestinal infections, upper respiratory infection, lower respiratory infection and other causes), Information about blood cell count (white blood cell (WBC) and red blood cell (RBC), hemoglobin (HB), mean red blood cell volume (MCV) and serum ferritin level in patients with hemoglobin below 11 were recorded.

Results: The mean age of the study population was 21.4 14 months. 34.7% of the study population were girls and 65.3% were boys. In this study, 10.7% of the cases and 8% of the controls had IDA. Although the prevalence of IDA was higher in the FS group, this difference was not significant (P=0.58). Also, HB and MCV were not significantly different in the two groups (P=0.49, P=0.69). In addition, the mean serum ferritin level in the FS group with anemia and the FS group with anemia did not show a statistically significant difference (P=0.94). Conclusion: According to the result of this study, IDA is not a risk factor for seizures in febrile children.

Background: Adequacy of dialysis is a very important issue in dialysis patients, so comparing the adequacy of dialysis in different dialysis methods is very important. Therefore, due to the fact that the number of people undergoing dialysis  through fistulas and catheters varies in different centers, and depending on different centers, there is a possibility of decreasing or increasing the adequacy of dialysis, so we decided to do this comparison in Arak support center.
Methods: In this analytical-cross-sectional study, the dialysis patients of Hami Arak Center from April 2019 to September 2019 were divided into two groups (the first group with permanent catheter, the second group with arteriovenous fistula) based on vascular access. The both groups were matched in terms of age, sex, weight, pump speed, filter size and also the duration of dialysis. All patients were dialyzed with the same type of dialysis machine, and the duration of hemodialysis for all samples was 4 hours in each session. To confirm the reliability of the device, it was calibrated before each use and the same setting was used for all samples. The blood samples were taken from the arterial route before dialysis and starting the dilution with heparin or normal saline. Statistical models of dialysis adequacy of patients in two groups were measured using the Kt/V criterion, SPSS and AMOS data analysis was performed.

Results: In the analysis of covariance of BUN before dialysis, there is a statistically significant difference in the studied groups (P<0.05), also in the UF and URR variables, dialysis time and the number of times of dialysis in three consecutive repetitions, there is a statistically significant difference in the studied groups. (dime fistula and catheter) are not present (P<0.05). Conclusion: In this study, during repeated repetitions, 22% of the dialysis adequacy in the two groups did not have good adequacy, and 78% of the patients in the two groups had appropriate dialysis adequacy.

Background: Febrile seizures are the most common cause of seizures in children under 5 years of age. Central nervous system infections are an important differential diagnosis of febrile seizures. Apart from infections, CSF characteristics are affected by many factors including the cause, type and duration of seizures. This study was designed to determine the cerebrospinal fluid (CSF) indices, including white blood cells (WBC), polymorphonuclear cells (PMN) count, and levels of protein and glucose in the CSF of children with fever-induced seizures.
Methods: The present study is a descriptive study that evaluated the results of CSF analysis in 56 children with febrile seizures admitted to Imam Sajjad Hospital in Yasouj from March 2012 to 2013. In the present study, CSF analysis was performed in children with a diagnosis of febrile seizures. In order to collect information from a pre-designed form that includes demographic information (age and gender), degree of fever, and information related to CSF indices including WBC, PMN and levels of protein and glucose in CSF, which have been extracted and recorded, statistical methods are used in this study to express descriptive statistics such as mean, standard deviation, number, percentage, etc.

Results: 56 children with a diagnosis of convulsive fever with a mean age of 21.4±14 months were evaluated. 37.5% (21 individuals) of the study population were females and 62.5% (53 individuals) were males. Among them, 33 individuals had low-grade fever and 23 individuals had high-grade fever. In 10.7%, the number of WBCs was more than 5. The amount of protein obtained was in the normal range, between 20 and 50 mg/dl, in 57.1% of cases. However, a significant percentage (39.3%) of CSF liquid protein was below 20 mg/dl. CSF fluid glucose levels were within the normal range at 91.1%. Conclusion: Based on the results of this study, febrile seizures may be associated with low protein levels in the CSF. However, due to the limited sample size in our study, similar studies with higher sample sizes are recommended.

Case Presentation: A 51-year-old male presented with sudden-onset left side hemiparesis and impaired sensation on the left side of the body, eight years ago. He complained of gradually developing pain on the left side of the body, adding to his symptoms. In his examination, he had dysarthria and his left extremities were spastic and their forces were decreased. Despite numerous medical treatments with gabapentin, pregabalin, duloxetine, carbamazepine and the replacement of an intrathecal baclofen pump during the last few years, he didn't respond very well. This goes so far as to induce severe depression symptoms, which disturbed his daily routine and even induced suicidal ideas. Due to the debilitating symptoms which were resistant to medical treatment, the patient underwent deep brain electrode implantation and deep brain stimulation in the ventral posterior lateral/posterior medial nucleuses in April 2023 at Imam Khomeini Hospital. No remarkable adverse effects were observed after implantation. In the patient’s follow-up, he had a significant improvement in pain and some other symptoms. Conclusion: Deep brain stimulation of the thalamus nucleus is a known treatment in patients with Parkinson's disease and dystonia. However, for patients with chronic refractory pain, deep brain stimulation is a controversial therapy and has been introduced recently as an effective alternative treatment. In our patient, who suffers from severe unilateral refractory pain after stroke, a deep brain electrode was implanted and after deep brain stimulation significant improvement in pain was seen.

Background: Brucellosis is one of the most common infectious diseases transmitted from animal to human. Different methods of blood culture, serology, PCR and ELISA are used to diagnose brucellosis. The aim of this study was to compare the diagnostic value of ELISA tests with Brucella serological tests in patients with brucellosis.
Methods: In this cross-sectional descriptive study that was conducted from the beginning of April 2018 to the end of March 2019, 231 patients referred to the Infectious Diseases Clinic of Sina Hospital in Hamadan with clinical symptoms and possible diagnosis of brucellosis were included in the study. 5 cc of blood was taken from the patients to prepare serum, at the same time as Wright, Combs Wright and 2ME serology tests, IgG and IgM ELISA tests were also performed using the ELISA kit of Pishtaz Teb Company (Made in Iran), which is designed with the cut-off method. Then the test results were analyzed with SPSS software, version 16 (SPSS Inc., Chicago, IL, USA).

Results: 231 patients suspected of brucellosis including 147(63.64%) men and 84(36.36%) women with an average age of 44.60±16.16 years and a minimum of 10 years and a maximum of 80 years were examined. IgG and IgM results were positive with brucellosis in 80.1% and 30.30%, respectively. The results of IgG and IgM were positive in 1/80 and 30.30%, respectively, and they were diagnosed with brucellosis. In comparison with 2ME, Wright and Coombs-Wright serology tests, the sensitivity of IgG was between 83.80% and 94.28% and its specificity was between 20 and 33.34%, the sensitivity of IgM was also between 34.78 and 40.0% and its specificity was between 78.67% and 89.47% at different cut points. Conclusion: Compared to diagnostic serological tests for brucellosis, IgG is more sensitive and IgM is more specific. If serological tests are not available, ELISA can be used to diagnose brucellosis. But because of their lower diagnostic value, they cannot be replaced.