Tehran University Medical Journal

Background: Scleroderma is a chronic systemic disorder that affects the connective tissues. It is characterized by several immune manifestations, inflammation, vascular damage, and fibrosis. Some of the viral infections with complex mechanisms are involved in the development and progression of many autoimmune diseases, such as scleroderma. The present study aimed to investigate the serological prevalence of hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), Epstein-Barr virus (EBV), and cytomegalovirus (CMV) infections in Iranian patients with scleroderma.
Methods: In this descriptive study 65 patients with scleroderma and 65 healthy individuals who had no autoimmune diseases and matched for age and sex, from May 2017 to April 2018 at Shiraz HIV/AIDS Research Center, Shiraz University of Medical Sciences, Shiraz, Iran, were included. The serum of study participants were evaluated for cytomegalovirus specific immunoglobulin G (CMV-IgG), Epstein-Barr virus viral capsid antigen immunoglobulin G (EBV-VCA-IgG), hepatitis B surface antigen (HBsAg), hepatitis C virus antibody (HCVAb), and human immunodeficiency virus antibody (HIVAb) using commercially available the enzyme-linked immunosorbent assay (ELISA) kit.
Results: CMV-IgG was diagnosed in serum of all patients with scleroderma, while 49 (98%) healthy subjects had positive results for this test. In addition, EBV-VCA-IgG was diagnosed in 58 (89.2%) sclerodermic patients and 40 (80%) healthy subjects. The prevalence of CMV-IgG and EBV-VCA-IgG was not significantly different between patients and healthy subjects and had no significant relationship with age and sex. However, the titer of antibodies against CMV and EBV infections in the scleroderma group was higher than that in the control group (P<0.0001, and P<0.0001), respectively. The presence of HBsAg and HIVAb was not confirmed in any of the patients with scleroderma, but HCVAb was detected only in one patient. All of the individuals in control group were serologically negative for HBsAg, HCVAb, and HIVAb.
Conclusion: Serological prevalence of HBV, HCV, HIV, EBV, and CMV infections in patients with scleroderma is similar to the healthy group.

Background: Rapid repair of skin donor sites in partial-thickness skin grafts in burn is critical to the patient. Severe pain during dressing change and scarring also reduce the quality of life and treatment. Recently, nano-silver particles are available which have a high surface to volume ratio and remain effective even at a very low concentration and minimize the chance for tissue toxicity due to silver. Our aim in this study was to evaluate the effect of nano-silver dressings on increasing the rate of repair and reduction of complications in non-infectious wounds of skin graft donor sites.
Methods: This was comparison study that involved patients admitted to a single-center burn unit who required a skin graft donor site. 10 burn patients with thermal injury and 10-30% of total body surface area (TBSA) who referred to Shahid Motahari Hospital, Tehran, in 2016 were studied. Each patient was compared to herself. After anesthesia, the site of the skin graft was randomly divided into three sections in each patient and was covered with Agicoat®, Mepitel and vaseline gauze. On the 4th and 8th of the day, the pain was recorded during the dressing change on the basis of the visual analogue scale (VAS). After 6 months, the patients were evaluated for the remainder of the scars based on VSS (Vancouver scar scale).
Results: The mean time to repair in both groups were similar and significantly shorter than that of vaseline (P=0.005). The pain comparison between groups showed that on the fourth day, the mean pain in the Agicoat group and Mepitel was significantly less than the Vaseline group (P=0.004). Also, the mean pain of the epileptic group was significantly lower than that of the Vaseline group (0.002). However, there was no significant difference between the duration of regeneration and pain between the two groups of Agicoat and Mepitel, but there was no significant difference between the mean pain on the 8th day and the mean VAS 6 months after the graft.
Conclusion: Agicoat dressing has been effective in reducing pain and increasing the repair speed, but this effect was similar to that of the silver-free Mepitel dressing. Expensive silver nano-crystal dressings limit their use. The silver nanocrystal did not have much effect on improving the remaining scar. However, more studies are needed in this regard.
 

Background: Medical malpractice is one of the most important legal issues in medicine committed more or less by physicians. The medical staff has inadequate or deficient awareness of medical errors and their importance. Therefore, this study investigated the frequency of medical malpractices/errors resulting in death in files referred to the Iranian Legal Medicine Organization.
Methods: The study population in this descriptive cross-sectional research consisted of all doctors who had been sued in Tehran's Legal Medicine Organization (Forensic Committees of Tehran Province) from the first day of July 2018 to the end of December 2018. The study was carried out in and under supervision and support of the Legal Medicine Research Center. Data were collected using a checklist of the files from Tehran's Legal Medicine Organization.
Results: The results showed that most medical errors are of organizational types. Major medical failures occur in university-affiliated hospitals among the male technical staff aged 41-50 years with a work experience less than 6 years. Most complaints were recorded against general practitioners, general surgeons, and anesthesiologists, respectively. The smallest percentage of the complaints related to orthopedics, urologists, and ear, nose, and throat (ENT) specialists.
Conclusion: The results of the study indicated that most of medical failures have of an organizational nature and occur in university hospitals among male technical officials who are in the fifth decade of life with a low work experience. So, paying attention to these issues can help the better selection of technical officials. The technical authorities of the hospitals must be careful about the responsibilities given to them. In order to reduce the failure of the technical authorities of the hospitals, doctors with a high standard of service should be appointed as technical officers. These doctors ought to possess legal knowledge and be familiar with the course of complaints filed in the judiciary.

Background: Gastric cancer (GC) is considered as one of the most common types of cancer worldwide with poor prognosis and generally limited treatment options. Recent studies have indicated that HER2, MDM2, MYC, MET, and TP53 play an important role in the development of gastric cancer. Therefore, the aim of this study was to evaluate the incidence of amplification/deletion of these genes in patients with gastric cancer.
Methods: In this descriptive study, a total of 37 gastric cancer tissue samples from GC patients including 23 males (62.2%) and 14 females (37.8%) referred to the Hematology-Oncology and Stem Cell Research Center of Shariati Hospital, Tehran, from March 2015 to February 2016 were evaluated. The patient's age at diagnosis ranged from 33 to 85 years (median: 65 years). The amplification pattern of HER2, MDM2, MYC and MET genes and TP53 deletion were investigated by fluorescence in situ hybridization (FISH) technique performed on 3 to 5 micron section obtained from formalin-fixed and paraffin-embedded cancer tissues.
Results: The tumors were preferably identified at the distal stomach (54.05%) in comparison to tumors arising from the gastric cardia. The tumor size varied between 2 and 5 cm (average, 3.5 cm). Seven of the cases (19%) had advanced tumors at the time of diagnosis. HER2, MDM2, MYC, MET and TP53 copy number alteration were successfully determined in all samples obtained from the GC patients. HER2, MDM2, and c-MYC genes were amplified in 2 (5.41%), 1 (2.7%) and 3 (8.11%) of 37 patient samples, however, MET gene amplification and TP53 deletion were not observed in the obtained GC tissue samples. Co-amplification of HER2, MDM2, and MYC genes, and co-amplification of HER2 and MYC genes were detected in one patient.
Conclusion: The results of this study indicate the low frequency of MDM2, HER2 and MYC genes in gastric cancer patient and their copy number alterations may provide diagnostic and prognostic marker for GC patients.

Background: The H9N2 subtype of the influenza virus, which is endemic in many regions of Iran, is considered as a candidate for future pandemics. In the present study, excretion time of the Iranian endemic influenza virus (H9N2 subtype) from the feces and pharyngeal secretions of laying chicken breeds was evaluated.
Methods: This experimental study conducted at the Diagnostic Laboratory Sciences and Technology Research Center of Shiraz University of Medical Sciences, and the Department of Clinical Science in School of Veterinary Medicine of Shahid Bahonar University of Kerman, from June 2017 to September 2017. At first, the influenza virus A/Chicken/Iran/SH-110/99 (H9N2) was cultured in the allantoic fluid of the embryonated egg and the EID50 for virus was determined by Reed and Muench method. Afterward, the Hy-Line chicks were inoculated intranasally with 106 EID50/ml of influenza virus (H9N2 subtype) and samples were collected from the oropharynx and feces of the birds on days 2, 5, 10 and 17 after inoculation. The presence of the virus in the samples of challenged birds was assessed using the real-time polymerase chain reaction (PCR) method.
Results: The influenza virus was shed from the oro-pharyngeal secretion and feces of the birds 2 days post-infection, and continued until days 10 and 17, respectively. In comparison to the oro-pharynx, the virus was recovered in the feces for a longer time. The influenza virus was detected in 100% and 57.1% of oro-pharyngeal and feces samples of the infected birds on day 2, 85.7% and 100% on day 5, 28.6% and 71.4% on day 10, and 0% and 28.6% on day 17 post-inoculation, respectively. The maximum risk of infected chicken for humans is seen from 2 to 5 days post-infection.
Conclusion: Detection of virus in the samples of birds that challenged with the H9N2 influenza virus showed that the virus could shed from the feces to the surrounding environment longer than the pharyngeal secretions and could be hazardous to humans in contact.

Background: Potency evaluation of rabies vaccine is a cheap, fast, high precision and consistent with ethical values is critical, so researchers have modified a variety of methods such as: National Institute of Health (NIH) method, Single Radial Immunodiffusion (SRID) and so on. The purpose of the present study was to replace an in vitro method consistent with medical ethics criteria instead of an in vivo method. By recognizing that the potency of the rabies vaccine depends on the amount of glycoprotein antigen content and the monoclonal antibody detect the correct folding of antigen of the rabies virus, then the glycoprotein content could be represent of vaccine potency.
Methods: In this study, we designed an immune-capture enzyme-linked immunosorbent assay (ELISA) with three antibodies (capture, primary and secondary) to determine the existent amount of viral glycoprotein in different rabies vaccines, and compared the results at the same time with measuring potency of those vaccines using the NIH method. This applied study was conducted from September 2016 to September 2018 at the Research Laboratory of the World Health Organization Collaborating Center for reference and research on rabies at the Pasteur Institute of Iran in Tehran.
Results: The slope of the standard line was calculated to R2=0.98 (P=0.0013). In the humans’ vaccines, the mean lied between 5.554-7.336 (SD=0.0463-0.1039) and the coefficient of variation was 0.778-2.436 (SD=0.0041-0.2724), at the same time in the animals’ vaccines the mean were 2.293-5.993 (SD=0.0041-0.2724) and the coefficient of variation was calculated 0.182-4.546. For animal vaccines the Pearson correlation coefficient is 0.99 and for the human vaccines this coefficient was 0.95. Also, the concordance correlation coefficient for animal vaccines was 0.98 and for human vaccines is 0.95, indicating a moderate to high concordance in both animals and humans vaccines.
Conclusion: The designed Immuno-capture ELISA kit had a proper acceptance criterion, intermediate precision, good linearity and robustness for measuring the glycoprotein level of the vaccine, which was directly related to the vaccine potency.

Background: Premature infants undergo a lot of stressors during treatment procedures in the neonatal intensive care units which causes significant physiological changes in these neonates. Multi-sensory stimulation is a broad category of interventions designed to improve the evolutionary and physiological outcomes of premature infants hospitalized in the neonatal intensive care unit to minimize stress in this environment. So, the study aimed to evaluate the effect of multi-sensory stimulation on physiological parameters in preterm infants.
Methods: This double-blind clinical trial conducted in the neonatal intensive care unit of Shahid Motahari Hospital in Jahrom from April to December 2016. In this study, 80 preterm infants with a gestational age of 34 to 36 weeks were selected by non-probability sampling method and were randomly divided into two groups of multi-sensory stimulation and control. Neonates in the intervention group received a multi-sensory stimulation program for 60 minute. The multi-sensory stimulation program was included a combination of auditory, tactile, motor and visual stimulation. The preterm infants in the control group received only usual care. The data collecting tool was a questionnaire and checklist for physiological parameters of preterm infants.
Results: The results showed that the two groups were homogeneous in terms of fetal age, birth weight, the height of birth, first and fifth minute Apgar score of birth. The results showed that there was no significant difference between the mean of physiological indexes in the two groups before the intervention. Statistical tests showed that there was a decreasing trend in the average of all physiological indices during the intervention (first and second half during the intervention) (P<0.001), However, these changes were not significant in the control group (P<0.05). Also, analysis of variance (ANOVA) with repeated measures showed that there was a significant difference between changes in physiological variables between the two groups at different stages of evaluation (P<0.001).
Conclusion: Multi-sensory stimulation leads to a decrease in heart rate and respiratory rate and the stability of blood pressure in preterm infants.

Background: Pentoxifylline, a valuable medication with promising clinical characteristics and considerable profile of safety is used in many conditions namely chronic kidney diseases (CKD). However, the decision to prescribe pentoxifylline for anemia in CKD should be based on evidence accrued from randomized controlled trials (RCTs). Yet, substantial heterogeneity exists in studies performed to evaluate pentoxifylline therapy, particularly in relation to classification of patients, the different quality and research design, sample size, baseline parameters, clinical outcome measures, and definition of endpoints and clinically meaningful improvements. As a result, assessment of pentoxifylline in treating anemia of CKD by conducting a systematic review and meta-analysis of the published relevant clinical studies seems rational and promising.
Methods: The present systematic review was done in accordance with the PRISMA guideline for systematic reviews and meta-analysis. Peer-reviewed RCTs with at least four weeks of follow-up were including in the meta-analysis. Online databases (PubMed/Medline, ISI Web of Science, Embase, and Scopus) were searched to December 2017 using selected MeSH terms related to the studied topic. Data was extracted independently by two reviewers using a standard form and then cross-checked. Statistical analyses were carrying out with Stata Software, version 7.0 (Stata Corp., College Station, TX, USA). P value of less than 0.05 was considered statistically significant. Data are presented as standard mean difference (SMD) and confidence interval (CI) 95%.

Background: Health insurance literacy is a nascent concept that has emerged mainly after the implementation of the law known as Obamacare in the United States. This study seeks to identify the themes of health insurance literacy in Iranian society.
Methods: The study approach is qualitative. Data were collected using nine semi-structured interviews, ten focal group meetings with the presence of 86 experts of an insurance organization and a specialized meeting with fifteen academic experts, from September to December 2018 at the organization's location. MAX QDA10 software was used to organize the data. Qualitative data analysis was performed using continuous comparison analysis and in the form of directional qualitative content analysis based on the conceptual model (Paez et al 2014). Coding was performed independently by two researchers and then collected. Results were reviewed by an external observer. Finally, in a specialized meeting with the participation of representatives of specialized (groups secretaries) and academic experts(participants in the initial interviews), the findings of the study were re-examined and confirmed

Background: Neurosurgery practice conflicts with many challenges during the COVID-19 pandemic; Including the lack of beds in intensive care units, as well as the use of some methods such as drills and trans-nasal and trans-oral approaches that produce aerosols or are directly in contact with patient discharge. Due to these challenges, developing a clinical guideline to help neurosurgeons and medical staff in decision making and improving patients and medical staff safety during the COVID-19 pandemic is the purpose of this study.
Methods: First, all of the relevant clinical guidelines to neurosurgical practice during the COVID-19 pandemic were extracted from the data centers. Finally, five clinical guidelines were selected. The questions and the items were designed according to these guidelines. The answers to each of the questions were extracted from these guidelines. The complementary evidence was extracted by searching in the data centers again. Finally, the answers were edited and the edited answers were considered as the recommendations. These recommendations were sent to 4 experts in the Neurosurgery field and 2 experts in the infectious diseases field. The appraisers evaluated the recommendations according to the AGREE-REX instrument.  This instrument has 9 items and 3 domains including clinical applicability, values and preferences, and implement ability. Recommendations with above 80% agreement were considered as the final recommendations.

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: 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.

Background: The aim of this study was to find the causes of failure of natural childbirth in late-term pregnancy that can be useful for managing childbirth in these pregnant mothers and to design a solution to increase natural childbirth.
Methods: This cross-sectional study was conducted in the community of pregnant women with a late-term pregnancy of more than 41 weeks. The studied sample includes 148 pregnant mothers who were referred to Ayatollah Rouhani Hospital in Babol from March 2018 to February 2020. Mother's age, Body Mass Index, gestational age, number of pregnancies, number of deliveries, length of hospitalization, the state of the cervix and preparation method of the cervix for termination of pregnancy were extracted and recorded from patients' files. Data were compared in two groups of pregnancy termination methods (natural childbirth and cesarean delivery). Statistical analysis was done using SPSS software, version 22 (IBM SPSS, Armonk, NY, USA) and Chi-square test and Student’s t-test statistical tests and logistic regression model fitting. P-value less than 0.05 was considered significant.

Results: In this study, 167 pregnant women with late-term pregnancy were studied. The age of pregnant women is reported with mean of 26.03 and standard deviation 5.98 of years. The high Bishop variable, with odds ratio of 0.44, is a variable protective factor for cesarean delivery (P=0.001). Higher body mass index with odds ratio of 1.09, is also known as a risk factor for cesarean delivery (P=0.01), so that for each unit of increase in Bishop score, the chance of cesarean delivery decreases by 56% and for each unit of increase in body mass index, the chance of cesarean delivery increases by 9%. Conclusion: This study showed that nearly half of cases of late pregnancies lead to normal delivery. High body mass index reduces the chance of normal delivery in late term pregnancies. But a higher Bishop score can be effective in the success of natural delivery.

Background: Gastrointestinal bleeding is one of the consequences of COVID-19, which is associated with increased hospitalization and patient mortality. This study was conducted to determine the prevalence of endoscopic findings and the outcome of gastrointestinal bleeding in patients with COVID-19 who were hospitalized from September to December 2019 in Al-Zahra Hospital, Isfahan.
Methods: In this cross-sectional study, out of 5800 patients who were admitted to Al-Zahra Hospital in Isfahan from September to December 2019 due to COVID-19 (according to the positive PCR test result), 87 patients who underwent endoscopy due to upper gastrointestinal bleeding by a skilled gastroenterologist, were selected and studied. Demographic characteristics, underlying diseases, use of anticoagulants, and laboratory findings were studied and evaluated and finally, the disease was evaluated and compared based on endoscopic findings.

Results: Based on the results obtained from this research, the patients with endoscopic lesions had higher average age (P=0.041), lower blood oxygen saturation percentage (P=0.028), and higher bleeding intensity (P=0.018). The frequency of using anticoagulant drugs in the group whose endoscopy results were abnormal was higher but insignificant. Hemoglobin, platelet, lymphocyte, and CRP levels were higher in the group whose endoscopy was normal, and NLR, LDH, and D-dimer levels were higher in the group whose endoscopy was abnormal (P<0.050). Three people (11.55%) from the group with normal endoscopy and 18 people (29.5%) from the group with abnormal endoscopy died, but the frequency of death was not significantly different between the two groups (P=0.070). Conclusion: The findings of the present study showed that the COVID patients with upper gastrointestinal bleeding who had endoscopic lesions had significant differences in some characteristics such as age, bleeding intensity, and blood oxygen saturation percentage with patients with normal endoscopy. Also, the frequency of death in patients with endoscopic lesions was relatively higher. Therefore, COVID patients with gastrointestinal bleeding should undergo endoscopy as soon as possible and necessary measures should be taken to control and prevent gastrointestinal bleeding.

Background: Idiopathic thrombocytopenic purpura (autoimmune), the most common cause of acute onset of thrombocytopenia in children who are otherwise healthy. This study was conducted with the aim of investigating the factors affecting the response to treatment in hospitalized children.
Methods: This retrospective study was conducted by examining the files of patients hospitalized due to ITP in Hazrat Masoumeh (S) Hospital from April 2009 to March 2019. The criteria for inclusion in the study included confirming the diagnosis of ITP and the age of 1 month to 14 years, and the exclusion criteria included cases of discharge with personal consent and not completing the patient's treatment course, the presence of pancytopenia or bicytopenia, the presence of moderate or severe splenomegaly or severe in clinical examinations, BMA based on the presence of a diagnosis other than ITP, not receiving any of the ITP treatment protocols, and patients whose first visit with the diagnosis of ITP was in another center or city. The information about age, sex, clinical symptoms on arrival, initial platelets and the platelets of days 3, 5, 14 and 180 were extracted from the patients' files. The type of treatment protocol, the need to repeat the treatment, the recurrence of the disease and the major complications of the treatment were extracted from the patients' files and finally the data were analyzed with SPSS software.
Results: The response to the treatment on different days was unrelated to the age, gender, and initial platelets (except for one exception) (P>0.05). In relation to clinical symptoms, the response to treatment on days three and five was related to the clinical symptoms at the time of presentation and on days 14 and 180 it was unrelated. Response to treatment on days 3 and 5 in different treatment protocols had a significant relationship (P<0.05), but there was no significant difference on days 14 and 180.

Conclusion: The best response was in the combined treatment group with methylprednisolone and IVIg, and the lowest response to treatment was observed in those receiving methylprednisolone alone.

Background: Osteoarthritis (OA) is the most common form of arthritis characterized by progressive loss of articular cartilage, causing pain and loss of articular function. High glucose is a crucial inflammatory factor playing a pivotal role in the pathogenesis of OA that induces ROS production. Since most of the current therapies for OA are short-term benefits, hence, there is high demand for finding novel therapeutic agents for OA treatment. Recent studies have demonstrated that mesenchymal stem cells secrete important therapeutic factors that protect chondrocytes. In the current study, we investigated the protective potential of Adipose-derived stem cell conditioned medium (CM-ADSC) as an alternative to cell therapy in high glucose-mediated oxidative stress in C28I2 human chondrocytes.
Methods: This experimental study was performed in the Department of Pharmacology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran from May 2018 to August 2020. Adipose-derived stem cells were cultured until they reached 90% confluence then washed with PBS and cultured in a FBS-free medium for 48 hours. The conditioned medium was collected and centrifuged. The protective effect of the concentration of conditioned medium on high glucose (75mM)-induced oxidative stress in C28I2 cell viability was evaluated by WST-1 assay. Total RNA was isolated from the treated and untreated cells with TRIzol reagent. The mRNA expression of antioxidant enzymes including, glutathione S-transferase-P1 (GSTP1), catalase (CAT), and superoxide dismutase1 (SOD1) was evaluated by reverse transcription-polymerase chain reaction in treatment and non-treatment groups.

Results: Adipose-derived stem cell conditioned medium pretreatment remarkably protected C28I2 cells against high glucose. The expression of mRNA of CAT, GSTP1, and SOD1 significantly increased following treatment with the conditioned medium (50%) for 24 hours in high glucose-exposed cells as compared to the control. Conclusion: Present study indicates that the Adipose-derived stem cell conditioned medium can reduce oxidative stress. It seems that the conditioned medium may protect cartilage in the progression of osteoarthritis.

Background: Due to the prevalence of laparoscopic cholecystectomy, controlling common problems after this surgery is essential. This study aimed to determine the factors affecting pain after laparoscopic cholecystectomy.
Methods: In this cross-sectional study, 222 patients over 18 years old with symptomatic gallstones who underwent laparoscopic cholecystectomy from March 2021 to February 2022 in Mashhad Medical Sciences of Islamic Azad University Hospitals, were included. The amount of analgesic received after surgery was the same for all patients (Acetaminophen 1 gram intravenously every 8 hours and diclofenac 100 mg rectal every 8 hours). Demographic information of patients, body mass index, history of abdominal surgery, duration of surgery, carbon dioxide pressure, type of surgery (elective or emergency), number of surgical incisions, and pain intensity six and 24 hours after surgery (using a visual analog scale) were collected, and finally, the findings were statistically analyzed by SPSS version 26.

Results: Out of 222 patients, 179 cases were women (80.6%), and their average age and body mass index were 44.68±12.27 years and 27.08±4.7 kg/m2, respectively. In our study, 110 people (49.5%) had a history of abdominal surgery, of which cesarean section was the most common delete. Pain six and 24 hours after the operation was more common in women than in men, and surgery with three incisions was more painful than surgery with four incisions (P<0.05). In patients with a history of surgery, the pain was greater in six hours after surgery (P<0.05). Pain 24 hours after the operation in patients with gas pressure less than or equal to 14mmHg was greater than in patients with gas pressure greater than 14 mmHg (P<0.05). Pain six and 24 hours after surgery according to age, body mass index, type of surgery (emergency or elective), and duration of surgery had no statistically significant difference (P>0.05). Conclusion: In our study, female gender, use of three incisions for surgery, and history of previous surgery were associated with more pain after laparoscopic cholecystectomy.

Background: The realm of diagnosing intrathoracic lesions involves a spectrum of imaging methodologies, among which computed tomography (CT)-scan and magnetic resonance imaging (MRI) stand prominent. In the context of Iran, where there is no study comparing the efficacy of CT-scan and MRI for evaluating intrathoracic lesions, our study endeavors to bridge this gap. Mindful of the nuanced advantages and drawbacks inherent in each method, we aim to conduct a comprehensive comparative analysis of CT-scan and MRI in diagnosing intrathoracic lesions, focusing on patients seeking care at Firoozgar Hospital's pulmonary clinic.
Methods: Embarking on a cross-sectional exploration at Firoozgar Hospital Pulmonary Clinic in Tehran, Iran, our investigative journey unfolded between April 2020 and March 2021. Thirty patients, spanning ages 21 to 69, presenting with intra-thoracic lesions encompassing mediastinal and chest wall anomalies, underwent simultaneous CT scan and MRI examinations. In pursuit of diagnostic certainty, histopathology was ordained as the gold standard, and the ensuing results underwent meticulous scrutiny and analysis utilizing SPSS 23 statistical software.

Results: Our study cohort comprised 30 patients, averaging 44.83 years (SD=12.71), with males constituting 60% of the population. Delving into the histological reports, CT-scan and MRI accurately diagnosed 25 (83.3%) and 28 (93.3%) cases, respectively, in retrospective analysis. The Kappa matching coefficient for CT-scan stood at 0.783, while for MRI, it soared to 0.912. A notable revelation surfaced as the Kappa matching coefficient for both CT-scan and MRI maintained a robust 0.783 (P<0.001 in all three cases).

Background: Most people often complain of abdominal bloating. The present study was designed and conducted with the purpose of examining the effect of sequential treatment of Metronidazole and Probiotics, and Probiotics alone in reducing the severity of symptoms of functional bloating.
Methods: The present study was a randomized clinical trial that was carried out from March 2022 until June 2023 in Isfahan and Khurshid Hospital. The studied population were suffering from flatulence and were diagnosed with functional bloating by a gastroenterologist based on Rome III criteria. Then they entered one of the two study groups in a double-blind manner. The first group was treated with Metronidazole for two weeks and then with Probiotic for two weeks. The second group was treated with Probiotic for four weeks. The severity of patients' bloating was measured by a 4-question questionnaire in five stages: before the start of the study, two weeks after, four weeks after, six weeks after, eight weeks after and 12 weeks after the start of the study.  Finally, the obtained information was entered into SPSS software version 24 Repeated measures ANOVA was used to investigate the relationship between variables.

Results: After collecting the data, 43 patients in the first group and 44 patients in the second group were examined. 72.1% of the first group were women and 27.9% were men. In group two, this ratio was 72.7% for women and 27.3% for men. In this intervention, it was seen that in the 1st group, the average severity of bloating decreased until the end of the eighth week and after the second week of drug treatment, and then increased. In the second group, the average intensity of bloating decreased until the end of the fourth week and at the same time as the end of drug treatment, and then increased. Conclusion: It was shown that in the study, the effect of this combined treatment had a greater effect in reducing the severity of functional bloating among patients with functional bloating.

Background: Most hemiplegic children experience disorders related to lower limbs such as balance. Considering the importance of balance, in order to participate in activities of daily living, it is very important to use modern neuro-rehabilitation methods such as mirror therapy to improve balance. The purpose of the present study was to determine the effectiveness of mirror therapy on the static and dynamic balance of children with hemiplegic CP aged 5 to 12 years.
Methods: This study was conducted as a double-blind, randomized clinical trial on 20 children with spastic hemiplegia aged between 5-12 years old, from June 2021 to August 2022 in Tehran, Iran. Participating children were randomly allocated into test (n=10) and control (n=10) groups. The children in the treatment group underwent 20 treatment sessions during four weeks. Each session consisted of 30 minutes of routine treatment and 15 minutes of mirror therapy for lower limbs. In the control group, sham therapy was performed instead of mirror therapy. The exercises performed in a seated position were: (1) active flexion of hip, knee, and ankle joints, (2) active knee extension plus ankle dorsiflexion, and (3) knee flexion (> 90°). Both groups were measured by the Pediatric Balance Scale to assess static balance and the Timed Up and Go test to assess dynamic balance at entry and the end of the study. SPSS version 26 software was used for statistical analysis.

Results: Examining the results of the evaluations showed that before the treatment, the static and dynamic balance of the two groups did not differ significantly (p> 0/05), but the static and dynamic balance scores of the children in the treatment group after the four weeks mirror therapy period (five days per week) were statistically significant different from the control group (p<0/05). Conclusion: According to the present study, it seems that mirror therapy as a complementary treatment can have a positive effect on improving balance (static and dynamic) in children with hemiplegic CP.