Tehran University Medical Journal

Background: Candida auris is a globally emerging yeast pathogen that has shown not only resistance to most anti-fungal drugs but also thermo-tolerance to temperatures higher than the mammalian’s body temperature. Although it has been only a decade since the fungus was identified, its spread of infections has been rapid and quasi-epidemics have been reported. Co-occurrences of the fungus infections in all five continents are one of the strangest aspects of this fungus. All isolates, despite slight genetic differences, belong to a common genetic ancestor. However, different clades appear to have independent evolutionary paths. We have discussed the relationship between the acquired thermal tolerance of C. auris and the environmental temperature changes with the genetic affinities of the isolates.
Methods: This basic science survey was carried out at the Shiraz University of medical sciences from July to December 2019. Phylogenetic analysis was used to compare the temperature sensitivity of C. auris and the species with which it is genetically related. The sequences of Internal transcribed spacer (ITS) region and the growth temperature ranges for C. auris and yeasts belonging to the Candida haemulonis complex as well as other environmental yeasts isolated from different geographical areas of the world were randomly selected and evaluated. Their phylogenetic relationship was investigated with the mapping of the phylogenetic tree based on ITS sequences.

Background: Common treatment for infertile couples is the use of controlled ovulation hyperstimulation (COH) with intrauterine inseminations (IUI). IUI is used in cases such as ovulatory dysfunction, cervical factor infertility, male subfertility, and unexplained infertility. In this study, we evaluated the relationship between IUI outcome and special causes of infertility.
Methods: This was a cross-sectional study and a sampling method was available in this study, from January 2014 to August 2016, 994 cycles in 803 infertile couples referred to Royan Research Institute in Tehran were analyzed. Inclusion criteria were: male factor infertility, combined causes, ovarian disease, and infertility of unknown cause. To evaluate pregnancy, 12-16 days after IUI, it was considered positive if pregnancy test followed by transvaginal ultrasound at week 4 after IUI were positive.
  Data were analyzed using SPSS software, version 20. T-test and chi-square were used to compare the case and control groups. Linear-by-linear test was also used to calculate the relationship between female age and clinical and multiple success rates. P<0.05 was considered significant for the results of these tests.

Background: Infection is a vital problem in intensive care units. Currently, chlorhexidine solution is used to reduce oral colonization. This study aimed to determine the efficacy of chlorhexidine solution on oropharyngeal bacterial colonization in hospitalized patients in the intensive care units.
Methods: This descriptive study (from August 2018 to May 2019) was performed on 60 patients who administered in medical and surgical intensive care units (ICUs) in one of the university hospitals in Semnan city. Patients admitted to (ICUs) were selected according to inclusion criteria. At the time of admission to the intensive care unit, oropharyngeal colonization of patients was assessed. Forty-eight hours after admission and using the chlorhexidine solution 0.2% three times a day, oropharyngeal colonization was assessed again. Data analysis was performed with SPSS software, version. 22 in the significant level of 0.05.

Background: Due to multiple roles of albumin in the body, injection of its medicinal product as one of the therapeutic or management strategies under conditions such as severe bleeding, burns, liver failure, and neonatal hemolytic diseases is on the physicians' agenda. Considering that albumin is the most abundant plasma protein, designing an appropriate method to purify it is highly important. There are several methods such as human plasma fractionation, chromatographic, or Salting-out methods for the isolation and purification of the human albumin. The present study investigates a direct and combined ion-exchange chromatography approach for purification of albumin from human plasma and compares the quality of the final products obtained by both ion-exchange chromatographic methods.
Methods: This study was carried out from January 2019 to October 2019 at the Blood Transfusion Research Center, High institute for research and education in transfusion medicine, affiliated with the Iranian Blood Transfusion Organization. For this study, 10 human plasma bags were randomly collected. After thawing, all 10 human plasma bags were pooled, and in order to separate cryo paste, it was centrifuged at 4000 g for 10 minutes at the temperature of 1 Centigrade degree. Then the obtained cryo poor plasma was used to purify the albumin protein by direct and combined methods of ion-exchange chromatography. The purity of the final products was compared by cellulose acetate electrophoresis and SDS-PAGE tests. The sample obtained by the combined approach was pasteurized and HPLC analysis was performed to investigate any polymer aggregates.

Background: The application of mesenchymal stem cells in the healing of chronic wounds is one of the most challenging issues in cell therapy. The present study investigated the efficacy of intradermal injection of umbilical cord Wharton's Jelly-derived mesenchymal stem cells in diabetic wound healing using ultrasound imaging in an animal model.
Methods: During this experimental laboratory study that was performed in the Skin and Stem Cell Research Center, Tehran University of Medical Sciences between October 2017 and October 2016, mesenchymal stem cells were isolated from umbilical cord Wharton's jelly of 10 neonates. The cells were passage. The differentiation potential of cells to osteocyte and adipose cells was evaluated. The expression of specific markers of mesenchymal stem cells was evaluated using flow cytometry. The viability and quality of cells were evaluated before transplantation. The diabetes model was developed by intraperitoneal injection of streptozotocin in 42 male Wistar rats. The animals were randomly divided into two groups: normal saline injection (control) and cell injection. Cell transplantation was performed intradermally. Skin thickness and density were assessed using ultrasound imaging on days 7, 14 and 21. Finally, the data were analyzed using a t-test and analysis of variance.

Background: Given the huge mental, psychological, and economic impact imposed on patients with chronic renal failure, it seems quite necessary to study life satisfaction in such individuals in to order to provide the necessary information and plan for appropriate services. In form of a systematic review and meta-analysis, the present study was conducted in to order to compare the quality of life in two groups of patients, one undergoing hemodialysis and the other recipients of a kidney transplant.
Methods: In order to fulfill the objective of the present study, among innumerable researches carried out in this field, through the implementation of a meta-analysis checklist nine researches were found to be qualified for the final meta-analysis (specific consideration was given to the following criteria: hypothesis, research method, statistical population, sample size, sampling method, measurement tool, and statistical analysis method). All related studies conducted from June 1995 to July 2016 in Iran.

Background: Trichosporon species are commonly known as causative agents of skin infections and also responsive in some other systemic and disseminated diseases, especially in immunocompromised patients and those with leukemia or lymphoma. Chronic cutaneous infections with Trichosporon have been reported in non-immunocompromised patients, too.
Case Presentation: This study is a case report of tinea pedis caused by Trichosporon asahii in an immunocompetent 39-year-old man who was a member of the military force with continuous wearing of army boots during his daytime work. In April of 2019, after visiting a dermatologist, he was referred to the Ghaem medical mycology laboratory of the Department of Health, Rescue and Treatment of Iran Police Force in Tehran. Clinical symptoms were scaling and erythematous patches on his left foot with intensive itching for four-months. In the laboratory, macroscopic and microscopic examination using direct 15% KOH wet mount was carried out as well as culture methods on fungal media (Sabouraud's dextrose agar with and without cycloheximide and chloramphenicol). According to microscopic observation and appearance of culture media colonies, the diagnosis was Trichosporon genus as the fungal agent of disorder. Molecular method analysis (PCR) using amplification of ITS region with universal primers (ITS1 and ITS4) and sequencing identified Trichosporon asahii as a causative species of the disease. The patient was treated with topical clotrimazole (twice/day) and oral fluconazole (150 mg/day) for four weeks, and recovered.

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

Background: Despite years of continuous research, maternal mortality due to preeclampsia is still a serious threat. Researchers believe that preeclampsia is a multifactorial disease and proposed many risk factors including immunological factors for it. Given the description of preeclampsia as an excessive response of the immune system, the relationship between preeclampsia and immunological changes is of particular importance. Genetic polymorphisms are considered to be one of the causes of immunological defects. Due to the role of immunologic and inflammatory factors in the etiology of preeclampsia, in the present study, the association of rs1028181-513T/C polymorphism of interleukin 19 gene with preeclampsia in the patient and control groups who were referred to Valiasr hospital in Kazerun, was compared.
Methods: The present case-control study was conducted at Islamic Azad University of Kazerun from December 2016 to May 2017. 150 preeclampsia patients and 150 healthy pregnant women who were referred to Valiasr hospital in Kazerun, were enrolled. Genotypes of participants for the -513T/C (rs1028181) variant were determined by the Tetra Primer ARMS-PCR method. SPSS software and Chi-square statistical test were used for data analysis.

Background: Anesthesia duration can play a significant role in post-operative complications. Therefore, the present study investigated the effect of auditory sensory stimulation with a familiar voice on anesthesia return in patients undergoing rhinoplasty.
Methods: This study was performed on 80 patients who were candidates for rhinoplasty surgery in Yazd Trauma and Burn Hospital from September-2018 to October-2019. The patients were randomly divided into two groups of 40: control and intervention. For patients in the control group, routine nursing care was performed after entering the recovery room. In addition to routine care, the patients in the intervention group were stimulated with a 15-minute pre-recorded audio. Patients' hemodynamic parameters were recorded before and after hearing stimulation. Also, the return time of the patient from anesthesia was recorded. Finally, the collected data were entered into SPSS software (Ver. 22) and analyzed using an independent sample t-test and Repeated mesasure ANOVA.

Background: Systemic lupus erythematosus is a systemic autoimmune disease that affects almost all organs of the body, and viral infections are involved in its development and progression. The present study aimed to evaluate the serological status of some viral infections in patients with systemic lupus erythematosus and a healthy population.
Methods: This descriptive study conducted from May 2017 to April 2018 at Shiraz HIV/AIDS Research Center, Shiraz University of Medical Sciences, Shiraz, Iran on 70 patients with systemic lupus erythematosus and 70 healthy individuals who had no autoimmune diseases and were matched with the patient group for age and sex. All patients had active records and were routinely visited in rheumatology clinic of Hafez hospital, affiliated with Shiraz University of Medical Sciences. The evidence of active disease was assessed by the physicians of this practice according to the American College of Rheumatology criteria. Peripheral blood samples were collected in tubes containing EDTA and centrifuged at 3000 rpm for 5 min. The plasma of study participants was evaluated for HBsAg, HCVAb, HIVAb, EBV-VCA-IgG, and CMV-IgG using a commercially available ELISA kit.

Conclusion: Considering the higher frequency of EBV-VCA-IgG and the higher titer of antibodies against CMV and EBV in patient groups compared to healthy individuals group, it seems that periodical assessment of viral load in patients with systemic lupus erythematosus will be beneficial to prescribe medication by physicians if it is needed.

Background: Early diagnosis of patients in the early stages of Alzheimer's, known as mild cognitive impairment, is of great importance in the treatment of this disease. If a patient can be diagnosed at this stage, it is possible to treat or delay Alzheimer's disease. Resting-state functional magnetic resonance imaging (fMRI) is very common in the process of diagnosing Alzheimer's disease. In this study, we intend to separate subjects with mild cognitive impairment from healthy control based on fMRI data using brain functional connectivity and graph theory.
Methods: In this article, which was done from April to November 2020 in Tehran, after pre-processing the fMRI data, 116 brain regions were extracted using an Automated Anatomical Labeling atlas. Then, the functional connectivity matrix between the time signals of 116 brain regions was calculated using Pearson correlation and mutual information methods. Using functional connectivity calculations, the brain graph network was formed, followed by thresholding of the brain connectivity network to keep significant and strong edges while eliminating weaker edges that were likely noise. Finally, 11 global features were extracted from the graph network and after performing statistical analyses and selecting optimal features; the classification of 14 healthy individuals and 11 patients with mild cognitive impairment was performed using a support vector machine classifier.

Conclusion: Combining the features of brain graph and functional connectivity by the mutual information method with a machine learning approach, based on fMRI imaging analysis, is very effective in diagnosing mild cognitive impairment in the early stages of Alzheimer’s which consequently allows treating or delaying this disease.

Background: spacecrafts rotate around the Earth every 90 minutes, so the 24-hour cycle turns to 90 minutes. Retinoic acid, an active metabolite of vitamin A, plays a role in regulating the circadian rhythm and its deficiency can impair the biological clock function and consequently impair the circadian rhythm of locomotor activity. The goal of the study was to assay the effects of simulated spaceship conditions on serum and hippocampal retinoic acid levels in rats.
Methods: The tail-hanging, hindleg-weightlessness rat model was applied to mimic the microgravity conditions from June to September 2017 in the zoo of the Aja University of Medical Sciences. Thirty-two male Wistar rats weighing 200-250 gr/in an experimental study were randomly assigned into 4 groups (n=8): 1) control animals with 12/12 h day-night rotation, 2) animals with 12/12 h day-night rotation under 14 days unloading, 3) control animals with 45/45 min day-night cycle, and 4) animals with 45/45 min day-night cycle under 14 days unloading. At the termination of the simulation step, rats were anesthetized, and blood samples were collected and the entire brain was removed and each brain was segmented into Hippocampus. ELISA assays were used to detect retinoic acid in the serum and homogenized hippocampus. Data were statistically assayed using two-way ANOVA and Bonferroni as a post hoc test. P<0.05 was considered significant.

Background: Ovarian cancer is the fifth leading cancer-related cause of death in women worldwide and is often diagnosed at advanced stages. Regarding the low sensitivity and specificity of the currently available diagnostic techniques, in the present study, we aimed to evaluate the accuracy of RMI and ROMA indexes and comparing these two indexes with CA-125 and HE4 parameters for the diagnosis and differentiation between benign and malignant ovarian tumors. Also, we determined the optimal cut-off level of these markers in patients who attended Arash Women’s Hospital.
Methods: In this cross-sectional study, we included 137 women with ovarian mass who were attended the gynecology clinic of Arash Women's Hospital, Tehran, Iran (April 2017-April 2019), and were eligible according to the inclusion criteria. We included patients with an adnexal mass over 3 cm. Our exclusion criteria were as the following: pregnancy, age under 18 and over 90 years, taking hormonal agents, renal failure, suspected ovarian torsion, ovarian cancer and taking antibiotics, nitric oxide compounds, and heavy metals. Based on serum CA125, HE4, and ultrasound findings, ROMA and RMI indexes were determined for each patient, and the sensitivity and specificity of HE4, RMI, ROMA, and CA125 were compared with the result of the operative histopathologic assessment.

Conclusion: Measurement of HE4 before menopause and CA125 during menopause seems to be helpful in the early detection of ovarian cancers in women with ovarian masses.