Tehran University Medical Journal

Nowadays, there are various animal models of acute and chronic seizures. Some chemical and electrical models such as seizure induced by pentylenetetrazol injection and maximum electric shock has been developed over of six decades and different kinds of chemical, electrical and genetic models have been admitted up to now. Among chemical models of seizure induction penicillin, bicuculline, tetanus toxin, pentylenetetrazol, pilocarpine and kainic acid are the more common chemoconvulsants to induce acute and chronic seizures. Numerous mechanisms involved in different models lead to develop different types of seizures. This variety leads to be confused beginner researchers which model should be carried in a research hypothesis. This study was aimed to illustrate how choose the most proper animal model for a hypothesis as well as different animal models of seizure and epilepsy. Penicillin and bicuculine are most proper models to induce focal seizures. In addition, pilocarpine and kainic acid are able to develop temporal lobe seizures. Pentylenetetrazol and tetanus toxin could develop acute and chronic generalized and tonic-clonic seizures. Furthermore, maximum electric shock has been well known as a proper model for acute seizures induction. Electrical kindling of amygdala could develop repetitive temporal lobe seizures. Hypoxia model of seizure is more used for screening of anti-epileptic drugs, long-term consequences, and epileptogenesis mechanisms. Also, hyperthermic (febrile) models of seizure are reliable for studying epileptogenesis mechanisms and cognitive consequences. Genetic models such as recurrent simultaneous (such as GAERS, WAG/Rij) and reflex seizures (such as GEPR) are more valid in some studies, including absence and audiogenic seizures. WAG/Rij rats have been known as the most valid animal model for absence epilepsy. It should be noted that the animal model is a simple expression of a complex system and it covers only a part of what happens in humans’ body. The most important use of animal models of seizure is developing and finding more effective and new anti-epileptic drugs. Therefore, proper selection of the animal model between numerous animal models of seizure induction is crucial to design an equitable hypothesis. The evidences reviewed in this study made beginner researchers potent to choose the best model.

Background: Due to intrinsic heterogeneity of cellular distribution and density within diffusion weighted images (DWI) of glioblastoma multiform (GBM) tumors, differentiation of active tumor and peri-tumoral edema regions within these tumors is challenging. The aim of this paper was to take advantage of the differences among heterogeneity of active tumor and edematous regions within the glioblastoma multiform tumors in order to discriminate these regions from each other.
Methods: The dataset of this retrospective study was selected from a database which was collected at the medical imaging center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Iran. The quantification was performed as a part of a research study being supported by the Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Iran, between May and September 2017. Twenty patients with histopathologically-confirmed GBM tumors who had been imaged on a 3T MRI scanner prior to their surgery, were included. Conventional and diffusion weighted MR images had been carried out on the patients. The regions of interest including the regions of active tumor and edema were identified on MR images by an expert and overlaid on ADC-maps of the same patients. Histogram analysis was performed on each of these regions and 14 characteristic features were calculated and the best feature combination for discrimination of active tumor from edema was obtained.
Results: It was shown that by combining 8 out of 14 histogram features, including median, normalized mean, standard deviation, skewness, energy, 25th, 75th, and 95th percentiles, differentiation with accuracy of 96.4% and diagnostic performance of 100% can be achieved. Furthermore, by combining mean, energy, and 75th percentile features of histograms, the active tumor region can be discriminated from the edematous region by 92.7% of accuracy and 98.9% of diagnostic performance.
Conclusion: The present study confirms that the heterogeneity of cellular distribution can be a predictive biomarker for differentiation of edematous regions from active tumor part of GBM tumors.

Background: Using natural compounds with low toxicity on normal cells and high efficacy on malignant cells is highly appreciated for treatment of colorectal cancer (CRC). In the present study, the effect of fish-oil derived eicosapentaenoic acid (EPA) on the cell number, cell proliferation rate and caspase-3 enzyme activity in LS174T human colorectal cancer cell line was investigated.
Methods: This experimental study was performed in cell culture lab, Institute of Biotechnology, affiliated to the Urmia University, Urmia, Iran from April to September 2017. LS174T colorectal cancer cells at a density of 5×105 cells per well were cultured in RPMI-1640 medium supplemented with 10% fetal bovine serum (FBS) and kept at 37 °C in a humidified incubator with 5% CO2 for 24 hours. Thereafter, the cells were treated with 50, 100, 150 and 200 μmol EPA for 48 hours and cell numbers were counted using neobauer chamber and caspase-3 activities were measured by performing the caspase-3 colorimetric assay (Abcam, Cambridge, MA, USA). Furthermore, 5×103 LS174T colorectal cancer cells were cultured and treated with the above-mentioned EPA concentrations for 24, 48 and 72 hours, after which cell proliferation rate was evaluated by WST-1 proliferation assay (Roche Diagnostics, Mannheim, Germany).
Results: Treatment of LS174T colorectal cancer cells with 50, 100, 150 and 200 μmol EPA decreased the number of cells in a dose-dependent manner. We also found that treatment of malignant cells with increasing EPA concentrations (50 to 200 μmol) significantly decreased cell proliferation in a dose and time dependent manner. After a 72 hours treatment of LS174T cells with 200 μmol EPA, cell proliferation was calculated to be 30.3% compared to untreated control cells. Following 48 hours treatment, caspase-3 activity increased with increasing EPA concentrations in which at 200 μmol EPA, caspase-3 activity increased by 3.4 fold compared to untreated control cells.
Conclusion: Fish-oil derived eicosapentaenoic acid as a safe compound decreases the number of colorectal cancer cells and their proliferation rate and activates caspase-3 enzyme, as an executor protein in apoptosis.

Background: The transverse abdominis (TrA) muscle is one of the most important muscles that contribute to the stability of the lumbar spine. Strengthening of trunk muscles that have a significant role in trunk stability is very important in the field of professional sport, sport medicine and rehabilitation of patient with low back pain (LBP). Identifying the exercises that can improve the strength and endurance of these muscles in the efficient way is an important challenge in rehabilitation of LBP patients. The aim of this study was to investigate the effect of maximum voluntary isometric contraction of upper and lower limb muscles on ultrasonic thickness of the TrA muscle.
Methods: This is a pre-test post-test study. Thirty healthy young male subjects with mean age of 23 years were recruited from the university staff and student population (non probability sample). Ultrasonic thickness of the right and left TrA muscle (as an indirect measure of muscle activity) was taken at rest and during maximum isometric contraction of six muscle groups: shoulder and hip flexor, extensor and abductor muscles. Mixed-model ANOVA with repeated measures design were used to analyze data. To further analyses post hoc comparisons were performed with paired t-tests adjusted with the Bonferroni method. The significance level was set at P<0.05.
Results: The result showed that mean TrA thickness on right and left sides during maximum isometric contraction of the upper and lower limb muscles was significantly thicker than in resting position (P<0.001). The type of isometric contraction had a significant effect on the thickness of the TrA muscle on dominant side (P<0.05). As a result, the greatest change in the thickness of TrA muscle on dominant side was observed in hip isometric extension (P<0.05). There was a significant difference between the thickness of TrA during upper limb isometric contraction of dominant and non-dominant side (P<0.001).
Conclusion: Isometric contraction of upper and lower limb muscles especially in hip extension can increase the ultrasonic thickness of the transversus abdominis muscle.

Background: The average age of women with breast cancer in Iran is at least 10 years lower in comparison to developed countries and the incidence of the disease in Iranian women is on a rise. According to studies, diets that are diverse in food groups can play a role in protecting against chronic diseases including cardiovascular diseases and cancer. Diet diversity score is an indicator used to measure diversity between and within food groups. This study aimed to assess the relationship between diet diversity score and breast cancer risk.
Methods: This case-control study was carried out from April 2014 to February 2015 at Shohada Hospital in Tajrish, Tehran. Demographic and anthropometric data of 298 participants including 149 breast cancer cases and 149 apparently healthy women were collected. A valid food frequency questionnaire containing 168 food items was completed to assess usual dietary intake through face to face interviews. Energy was calculated using Nutritionist 4 software (First Databank Inc., Hearst Corp., San Bruno, CA, USA) and diet diversity score was calculated using five food group scoring. Odds ratios with 95% confidence intervals were obtained using logistic regression test to evaluate the association between breast cancer risk and diet diversity score tertiles.
Results: There was no significant difference in weight, height, body mass index between the two groups, but physical activity level and daily energy intake showed a significant difference (P<0.001). After adjusting for the effect of confounding variables including energy, body mass index, physical activity, menopause status, family history of breast cancer, contraceptive use, number of pregnancy, age of menarche and smoking, the risk for developing breast cancer was 86% lower in those in the highest tertile of diet diversity score compared to those in the first tertile (OR=0.14, 95% CI=0.06-0.31). An inverse and significant association was found between breast cancer risk and diversity scores of fruits and milk groups (P<0.001).
Conclusion: Higher diet diversity score is associated with reduced risk of breast cancer.

Background: Cervical pregnancy is a rare type of ectopic pregnancy (EP) in which the pregnancy implants in the lining of the endocervical canal. It accounts for less than 1 percent of ectopic pregnancies. The cause is unknown; local pathology related to previous cervical or uterine surgery may play a role given an apparent association with a prior history of curettage or cesarean delivery. The most common symptom of cervical pregnancy is vaginal bleeding, which is often profuse and painless. Lower abdominal pain or cramps occur in less than one-third of patients; pain without bleeding is rare. It is important to think about the possibility of cervical pregnancy in such patients since early diagnosis is critical to avoidance of complications and successful treatment. Management of this pregnancy is dependent on the hemodynamic status of the patient. Conservative management and some more aggressive therapy such as emergency hysterectomy can be used. The aim of this report was to introduce a case of successful conservative management of cervical pregnancy.
Case presentation: A 30-year-old G2L1 woman with history of a previous cesarean section and possible diagnosis of missed abortion referred to the Gynecology Clinic of Ghaem Hospital, Mashhad University of Medical Sciences, Iran, in 21 May 2017. Cervical pregnancy was diagnosed during curettage. Severe hemorrhage occurred after curettage and the hemodynamic status of the patient was unstable immediately after curettage. Severe threatening vaginal bleeding was controlled with intrauterine Foley catheter containing 60 cc normal saline and then vaginal packing. The patient was discharged with good general condition.
Conclusion: In cervical pregnancy and unstable hemodynamic status and desire to preserve fertility, intrauterine Foley catheter and vaginal packing after curettage is helpful.

Background: Obesity is one of the causes of onset and exacerbation of rheumatoid arthritis. However, limited studies have examined the association between body composition and severity of disease. The aim of this study was to evaluate the association between severity of rheumatoid arthritis with various types of obesity and the comparison of anthropometric indices between patients with rheumatoid arthritis and healthy subjects.
Methods: This case-control study was conducted on 95 patients (48.8±10.4 years) with rheumatoid arthritis as a case group and 95 healthy people (46±9.3 years) as a control group carried in Golestan Hospital, Ahvaz, Iran, from April 2016 to February 2017. Weight, height, waist circumference (WC), hip circumference (HC) and body fat percentage (BFP) were measured. The anthropometric indices were calculated. The disease severity was calculated according to disease activity score 28 (DAS28).
Results: There was no significant difference between two groups regarding their gender ratio (1:1), age (P=0.16) and height (P=0.58). The weight, body mass index (BMI), body fat (BF), WC, HC, waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and other obesity indices include a body shape index (ABSI), body adiposity index (BAI), abdominal volume index (AVI), body surface area (BSA) and Conicity index (CI) in patients with rheumatoid arthritis are significantly higher than healthy subjects (P<0.05). No difference in fat free mass was observed between two groups. Waist to height ratio and BAI compared with other indicators had the highest correlation with the DAS28 score. In addition, prevalence of obesity by waist circumference (82% vs. 61%), obesity by BMI (47% vs. 33%), and obesity by BFP (91% vs. 83%) was higher in patients with rheumatoid arthritis than healthy subjects. The risk of rheumatoid arthritis in people with central obesity by waist circumference (OR=2.92, 95% CI 1.50-5.70) was greater than obesity defined by BMI (OR=1.77, 95% CI 0.98-3.18) or BFP (OR=2.37, 95% CI 1.01-5.53).
Conclusion: The results of present study indicate association of rheumatoid arthritis disease severity with obesity types (especially central obesity) and anthropometric indices.
 

Background: Animals have an internal biological clock with melatonin hormone that helps them to adapt to light/dark circles. Since melatonin is associated with an alteration in the expression and production of opioid receptors, this study aimed to evaluate the effect of changes in the light/dark circles on pain sensation in rats.
Methods: This research study in order to investigate the thermal and chemical pain sensation using tail flick and formalin tests, 35 Wistar rats were randomly divided into five groups of seven animals, including 24 hours of light (24L), 16 hours of light / 8 hours of darkness (16L/8D), 12 hours of light / 12 hours of darkness (control), 8 hours of light / 16 hours of darkness (8L/16D) and 24 hours of darkness (24D) were tested. The study was conducted at the Department of Biology of Ferdowsi University of Mashhad, Iran, from April to September 2015. Also besides the Rotarod test was performed to determine the general motor activity of animals.
Results: In the tail flick test, an increase in the time of darkness elevated the threshold of thermal pain and subsequently resulted in analgesic effect in the 24 hours of darkness (24D) group (P=0.03), while reducing the dark period in the group of 16 hours of brightness / 8 hours of darkness caused a reduction in the threshold of thermal pain, resulting in hyperalgesia (P=0.002). In the formalin test, the chemical pain score at the end of the chronic phase was significantly increased in the experimental group of 16 hours of brightness / 8 hours of darkness compared to control, indicating hyperalgesia (P=0.03).
Conclusion: Perhaps, alterations in light duration may change the production of melatonin and opioids and their receptors. Therefore, it is expected that reduction of the duration of darkness and thus shortening the period of increased production of melatonin and the subsequent lower expression of opioid receptors, in this group, resulting in a lower thermal pain threshold and analgesic response.

Background: Coronary artery disease today is a major contributor to mortality and morbidity from cardiovascular disease. The drug, interventional and surgical methods are used to treat coronary artery stenosis. Statins are the most commonly used drugs for stenosis and coronary artery disease. Low-density lipoprotein (LDL) The purpose of this study was to evaluate the effect of atorvastatin on LDL and C-reactive protein (CRP) reduction in patients.
Methods: This study was a systematic review and meta-analysis. Articles were selected using the keywords of atorvastatin, LDL, C-reactive protein (CRP) and reduction, and searches in Scopus, Google Scholar and PubMed databases from March 2003 to February 2018. For this purpose, all analytical, clinical trials, cross-sectional, and case-control studies were searched and collected in association with the efficacy of atorvastatin on low density lipoprotein and CRP.
Results: In the initial search, 90 papers were found and evaluated. Finally, 20 papers were analyzed. The studies were published. The total sample size was 21609 persons with an average sample size of 1080 in each study. Twenty studies were entered into the final analysis. The LDL-lowering rate was 51 mg/dl with atorvastatin (I2=98.48, P<0.001). Also, CRP reduction before and after administration of atorvastatin was   1.99 (0.96-3.03) and 0.76 (0.08-1.43), respectively. The results of meta-regression of age-related studies showed that LDL levels were low in studies with lower age, and LDL levels were low in studies with higher age. The results of a meta-regression study of atorvastatin in terms of body mass and the association of low-density lipoprotein with atorvastatin showed that in those with a higher body mass, low-density lipoprotein decreased.
Conclusion: According to the results, the use of atorvastatin reduces the amount of C-reactive protein (CRP). The rate of low density lipoprotein (LDL) reduction was better and faster in young and obese people. It is recommended that people have a proper diet and regular exercise in their daily schedule.

Background: Systemic sclerosis (SSc) is an autoimmune connective tissue disease characterized by vasculopathy and excessive collagen deposition in the skin and internal organs. Based on the skin damage we divide the patients into two groups: limited and diffuse SSc. In restricted type, the thickness of the skin is limited in the face and distal parts of the elbows and knees, with less involvement of internal organs, whereas in diffuse type, facial skin, organs, and trunk generally increase in thickness and internal visceral involvement is noticeable as renal failure, pulmonary artery pressure, and interstitial lung fibrosis. According to the prevalence studies, the prevalence of systemic sclerosis is estimated to be 15 cases per 100,000, of which the prevalence in women is 3 times more than men. Based on clinical evidence the prevalence of SSc is high in Khuzestan province. The aim of this article was to evaluate the demographic features of SSc in Khuzestan province, Iran.
Methods: This cross-sectional study conducted on two hundred SSc patients referred to Rheumatology Clinic of the Golestan University Hospital in Iran, from 2001 to 2015. Patients were selected based on the American College of Rheumatology classification criteria for SSc and were divided into diffuse and restricted types based on the site of skin involvement. Individual characteristics and clinical symptoms were extracted from the information in the patient records which were carefully compiled by physicians. Data on age, sex, race, duration of illness, and family history of SSc were collected orally.
Results: 91.5% of the enrolled patients were female. The mean age was 44 years and the most common race in our study was Lor. The prevalence of the diffuse form of SSc was 68% and the limited form was 32%. The Raynaud's phenomenon was detected in 100% of patients. Sclerodactyly and interstitial lung disease were found in 88.5% and 54.5% of patients respectively. Laboratory features such as ANA (93%), Anti-Scl-70 (77.5%) and anti-centromere antibody (ACA) (70%) of SSc patients were reported.
Conclusion: According to the results of this article, the most systemic sclerosis patients in Khuzestan province were middle-aged Lor race females and the most common type was diffuse systemic sclerosis.

Background: Intrauterine infections (TORCH) lead to the involvement of various organs of the body of the fetus, including the eye. The aim of this study was to determine the frequency and clinical response of eye lesions to specific drugs, in infants with confirmed TORCH induced ocular lesions.
Methods: This historical cohort study from 2011 to 2017, had done in Pediatrics and Ophthalmology Department of Rasoul Akram Hospital, Tehran, Iran. Cases included; 78 infants with confirmed intrauterine infection (TORCH) with ophthalmologic disorders (glaucoma, cataract, and retinitis), 3 cases died (without any treatment). The cases with incomplete diagnosis, no treatment or without follow-up excluded from study. Out of 74 children with confirmed TORCH induced ophthalmologic disorders, finally 37 children (25 cytomegalovirus, 12 toxoplasma) were treated with specific drugs, and clinical response to treatment was followed-up to 1 year by ophthalmologic examination.
Results: From 12 cases with ophthalmologic disorders due to congenital toxoplasmosis, 5 cases had full treatment, 4 cases had complete response. One case had not any improvement. From 25 cases with congenital cytomegalovirus (CMV), 18 patients continued treatment, 9 cases with complete clinical response, 9 cases had not response to antiviral treatment, indeed most non responder cases had central nervous system involvement from birth. The best response observed in CMV infected cases accompanied with sensory hearing loss (without CNS involvement).
Conclusion: Good clinical response of ophthalmic diseases in 80% of congenital toxoplasma; and 50% of congenital cytomegalovirus infected cases. Probably with initial diagnosis and rapid treatment of cases with TORCH induced ophthalmic disorders (especially cases without CNS involvement) it would lead to stopping ocular lesions.

Background: Today, due to changes in human lifestyle and consumer demand incidence of foodborne diseases is on the rise. The aim of this study was to investigate the mortality rate of foodborne diseases and their related factors.
Methods: In this cross-sectional study, data on deaths registered according to the International Classification of Diseases (ICD-10th revision) were extracted from death registration and classification of causes system in the Ministry of Health and Medical Education of Iran from 2011 to 2018. Data on deaths from food and water borne diseases including Salmonella, Shigella, Escherichia coli O157:H7, Staphylococcus aureus, Clostridium botulinum, and other foodborne diseases were extracted from database of death registration and classification of causes system. The demographic variables of dead people considered in this study include age (under 5 years, 5-20 years, 20-40, 40-60s and over 60 old), gender, nationality, and the location where people died (urban, rural and unknown).
Results: The majority of deaths cases occurred at the age of 60 years and in older age groups (P<0.001). The results show that across all the age groups mortality rate from foodborne diseases was higher among men than among women (P=0.110). Most of foodborne diseases were reported by people living in urban areas (P<0.0001). The results of this study showed that most of the deaths from these diseases occur in the warm seasons. In this study, the crude death rate was 10 cases per one million inhabitants.
Conclusion: The results of this study showed that there was a significant difference between the mortality rate due to different bacterial agents. This study suggests that demographic variables are important predictors of mortality from foodborne illness and should be further investigated.

Background: Cubital tunnel syndrome, a neuropathy of ulnar nerve, is the second most common entrapping syndrome in the upper limb surpassing carpal tunnel syndrome. This syndrome arises from a high pressure decompressing the nerve for a long time. Patients with cubital tunnel syndrome show numbness in the ring and small fingers. The aim of this study was to evaluate the etiology of cubital tunnel syndrome in patients who underwent surgery for treatment of the syndrome.
Methods: In this retrospective study, medical records of 100 patients who underwent surgery for treatment of cubital tunnel syndrome at Department of Neurosurgery, Poursina Hospital, Rasht, Iran from March 2008 to March 2017, were checked. The etiology of cubital tunnel syndrome including inflammatory, tumoral, vascular, orthopedic causes and anomalies in nerve site and information about age, gender, job, and weight were collected and analyzed.
Results: In this study, the mean±SD of age was 33.8±11.5 years. Females and males constituted 21% and 79% of the cases, respectively. Idiopathic and orthopedic etiologies were seen in 84% and 13% of the operated cases, respectively. Vascular, tumoral, and inflammatory causes were found in 1% of the cases. Regarding location of nerve involvement, 57% of the cases had the ulnar nerve entrapment between MCL (medial collateral ligament) and Osborne ligaments; and in 22% of the cases, the cubital tunnel was involved. Arcade of Struthers and medial epicondyle and medial intermuscular septum were involved in 8%, 8%, and 5% of the patients, respectively. Forty-five percent of the cases performed a repetitive manual task by hand and 1.9% of cases were vibrator workers. Moreover, 12.4% of cases had a history of cubitus valgus or cubitus varus. Finally, 20.9% and 18% of the cases suffered from obesity (BMI>30) and diabetes mellitus, respectively. Furthermore, one patient had a history of head injury with contractions of upper limb flexion and one patient had arthritis of medial epicondylitis.
Conclusion: The evidence from the present study indicates that the idiopathic cubital tunnel syndrome constituted the bulk of involvement on ulnar nerve in the patients. Job, obesity, and diabetes were the most important accompanying factors with cubital tunnel syndrome.

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: Coronary artery ectasia (CAE) is dilatation of an arterial segment to a diameter at least 1.5 times that of the adjacent normal coronary artery. The incidence of coronary artery ectasia is distinct in different countries that can be found in 1.2% to 5% of angiographic examinations.
Methods: This is a retrospective study that was conducted from September 2019 to February 2020 in Kermanshah University of Medical Sciences and the results were reported briefly. To obtain the desired articles, electronic searches were conducted in databases including the Scopus, PubMed, and Science Direct databases without time limited until October 2019. The keywords used were Coronary Artery Ectasia AND (Diabetes OR "Diabetes Mellitus"). This was done by two individuals separately and the final results were confirmed by a third person. Mixed method appraisal tool (MMAT) was used to evaluate the quality of studies. The structure of writing and the process of performing and reporting the study are based on the PRISMA checklist.

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: Dermatophyte is a group of keratinophilic fungi that cause various skin lesions depending on the affected area. Dermatophytosis is usually diagnosed by clinical manifestation and confirmed by direct microscopy or fungal culture. There might be diagnostic difficulty with the presence of atypical dermatophytosis. Atypical dermatophytosis presents with clinical appearances ranging from eczematous, psoriasiform, pustular lesions, and others, that interferes with early diagnosis and disturbs patient’s life quality. Genital dermatophytosis is an uncommon presentation of cutaneous fungal infection; moreover, its manifestation without the involvement of the inguinal area, and simulating wart is a rare sign. In this study, we introduce a rare case of dermatophytosis with a wart-like appearance that was restricted to the skin of the genitalia.

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.