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Evaluation of the antidepressant effects of pioglitazone in ovariectomized mice through nitric oxide pathway
Samane Jahanabadi, Samira Dabestani Tafti ,
Volume 80, Issue 1 (April 2022)
Abstract
Background: Pioglitazone is the selective PPAR-γ receptor agonist, which is prescribed for the treatment of type 2 diabetes and may also have antidepressant effects. Nitric oxide (NO) has been involved in some crucial roles, including learning, cognition and neurogenesis as well as some neurodegenerative diseases, including Parkinson, Alzheimer's disease (AD) and depression. Reduced estrogen levels throughout ovariectomy, postpartum and menopause make women more likely to suffer from depression. The existing study was designed to examine the antidepressant-like effects of pioglitazone, a PPAR-γ agonist, and the probable involvement of NO with the use of non-specific NO synthase inhibitor (L-NAME) or an NO precursor (L-arginine) in female ovariectomized (OVX) mice.
Methods: The present study was conducted experimentally on female NMRI mice from April to December 2019 at the Pharmacology Department of Pharmacy Faculty, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Female mice were subjected to bilaterally ovariectomy, and various doses of pioglitazone (10, 20, 40 mg/kg) were administered either alone or in combination with non-specific NO synthase (NOS) inhibitor (L-NAME) or a NO precursor (L-arginine). Antidepressant-like activity of pioglitazone was evaluated in the forced swimming test (FST) and the tail suspension test (TST). Moreover, the open field test was done to evaluate the locomotor activity of mice following different treatments.
Results: OVX mice demonstrated a major increase in immobility time versus sham therapy following procedure (P≤0.05). Mice were injected with 40 mg/kg pioglitazone Intraperitoneally, 4 h before the behavioral test, exhibited marked antidepressant-like effects in OVX mice (P≤0.01, P≤0.05 in FST and TST, respectively). Co-administration of sub-effective dose of L-NAME (2 mg/kg) with a sub-effective dose of pioglitazone (20 mg/kg) resulted in a strong antidepressant-like effect in OVX mice (P≤0.01), whereas L-arginine inhibited this effect. The various treatments did not change the total locomotion of mice in OFT.
Conclusion: Antidepressant-like effects of pioglitazone may be associated with inhibition of the NO synthase/NO in OVX mice and provided a new strategy for depression.

Identifying the dimensions and components affecting paraclinical services in the social security organization
Maryam Noohi , Seyed Hesam Seyedin, Rouhollah Zaboli, Samaneh Ghods, Leila Najafi,
Volume 80, Issue 2 (May 2022)
Abstract
Background: Health & Well-being is one of the most important fundamental human requirements and the main indicators of development and social welfare. However, with rising health costs and unlimited needs and dwindling health system resources, it is necessary to rethink new remedial behavior. Paraclinical services are an important and costly part of health services, it appears crucial to understand the elements that influence them.
Methods: This is a qualitative study that has been designed & performed from 23rd September 2019 to 23rd September 2021 through face-to-face interviews with selected experts. The project has been approved by the institutional review board of Islamic Azad University, Semnan branch through ethical registration codes as IR.IAU.SEMNAN.REC.1399.014. The first stage was to identify the dimensions and components affecting paraclinic services offered at Iran Social Security Organization (SSO) clinics & hospitals. A semi-structured questionnaire was prepared. The interview has been arranged with SSO managers, experts and officials and finally analyzed through the thematic analysis method.
Results: Doing qualitative research and conducting thematic analysis, paraclinical services were classified into three categories: input, process, and outcome. The inputs  category had 5 organizing themes including paraclinical structure, human resource empowerment, cost management, social responsibility and service purchasing. The processes consisted of four themes: organizing the acceptance and delivery of services, monitoring and evaluating implementation, interdisciplinary coordination, applying innovation, and creativity in service delivery. Finally, outputs included three themes: organizing disease prevention and health promotion, gaining a competitive advantage, and reducing health costs.
Conclusion: According to the study's findings, to purchase or rationally use paraclinical services, it is necessary to know the dimensions and components that affect them. Managers of the social security organization are urged to lay a greater focus on employee empowerment, the employment of innovative approaches, and interdepartmental collaboration to enhance paraclinical service supply. Additionally, they may better fulfill their social duties and enhance their workers' health services by monitoring and evaluating executive actions.

Co-occurrence of upper respiratory tract disorders with gastrointestinal infections of Helicobacter pylori in patients; a systematic review and meta-analysis.
Rasoul Samimi, Amir Peymani, Samaneh Rouhi , Shadman Nemati, Sanaz Ahmadi, Afra Hossein Panahi , Somayeh Ahmadi Gorji ,
Volume 80, Issue 3 (June 2022)
Abstract
Background: Helicobacter pylori infection and respiratory tract infection at the same time cause pathogenicity increase and death. The aim of this study was to evaluate the co-occurrence of upper respiratory tract disorders and gastrointestinal infections of H. pylori.
Methods: The present study was conducted as a systematic review and meta-analysis, from August 2019 to Agusut 2020, at Qazvin University of Medical Sciences. Articles in the international databases (April 2001-December 2018) on the coexistence of upper respiratory tract disorders with H. pylori gastrointestinal infections were examined. The random effect model with a 95% confidence level was used to analyze the data.
Results: The highest prevalence of respiratory disorders co-occurrence associated with adenoid tissue (33%), nasal polyps (100%), chronic rhinosinusitis (71%) and gastrointestinal infections of H. pylori was reported in 2006 in Turkey, 2011 in Poland and 2015 in Egypt. Concurrent prevalence of the disease, according to the type of upper respiratory tract disorders in all studies, the estimated effect size according to the random model was 53% in chronic rhinosinusitis, 63% in nasal polyps, 62% in adenoid tissue and 60% in total, which was significant (P=0/000). The prevalence of co-occurrence of upper respiratory tract disorders with gastrointestinal infections of H. pylori in patients was estimated to be 61% at the age of more than 27 years and 60% at the age of fewer than 27 years. Pooled estimation of the concurrent prevalence of infection (in total) was estimated to be 60% and was significant among the studies (P=0/000).
Conclusion: The concurrent prevalence of upper respiratory tract disorders with gastrointestinal infections of H. pylori was observed to be almost equal and significant in elderly and young patients. Due to the fact that the simultaneous occurrence of two types of infections and diseases in people is very dangerous, screening of patients with each of these infections is necessary to identify the other infection and prescribe appropriate drugs.

Ten-year prevalence survey of strongyloides stercoralis in patients referred to Rouhani hospital during 2011-2020 years: a brief report
Hossein Ghorbani, Mohammad Ranaee, Alireza Firouzjahi, Zahra Ahmadnia, Samaneh Rouhi, Farzane Jafarian, Rouzbeh Mohammadi Abandansari , Somayeh Ahmadi Gorji,
Volume 80, Issue 5 (August 2022)
Abstract
Background: Infection with Strongyloides stercoralis is common in tropical and subtropical regions. To prevent and treat these diseases, information on the distribution and frequency of these parasites in different geographical areas is needed. Due to the importance of diseases in the northern provinces of Iran, the present study was performed to determine the prevalence of Strongyloides stercoralis.
Methods: From April 2011 to March 2020, stool samples from patients who were referred to Rouhani hospital in Mazandaran province, Babol, were gathered. For stool samples, microscopic detection was performed immediately using the wet expansion method, followed by a formal-ether concentration process. Based on the sample size calculation, the minimum number of patients with Strongyloides stercoralis infection was considered to be 380 patients from the years 2011-2020. Mean and standard deviation indices were used to describe quantitative data and numbers and percentages were used to describe qualitative data.
Results: Out of the total number of 39,800 archived patient files that were reviewed, a total of 420 (1.05%) patients were confirmed for the presence of Strongyloides stercoralis in their feces. The age range of patients was 3 to 89 years. The population of male patients (249 patients) was higher than females (171 patients). In patients with positive Strongyloides stercoralis, disease symptoms were positive in 206 patients and negative in 214 patients. The most common underlying disease in patients was abdominal pain (220 patients). 271 patients received steroids.
Conclusion: Strongyloides stercoralis infection was detected in the northern region of Iran. The prevalence of this parasite was higher in men, the elderly, and people with underlying comorbidities. These results can be used to identify and compare areas where the prevalence of infection is higher. Therefore, revealing the effect of Strongyloides stercoralis infection on public health makes the need for in-depth clinical and diagnostic studies important. People with chronic diseases, whether symptomatic or asymptomatic, should be screened for parasitic diseases.

Assessment of mitochondrial DNA copy number in peripheral blood leukocyte of opiate abusers and healthy individuals
Kouros Divsalar, Sara Hesami, Majid Mahmoodi, Navidreza Giahi, Fatemeh Divsalar , Mohammad Pour-Ranjbar , Amin Honarmand,
Volume 80, Issue 7 (October 2022)
Abstract
Background: Based on the studies, variation in the mitochondrial DNA (mtDNA) copy number in peripheral blood leukocytes is associated with increased susceptibility to diseases including cancer. Opiate abusers are at high risk for diseases. In this study, we measured the mtDNA copy number in peripheral blood leukocytes in a group of opiate abusers compared with those in healthy individuals.
Methods: In a case/control study, three groups were selected consisting of 32 opium abusers, 24 heroin addicts and 25 healthy individuals. The amount of 5 ml of whole blood was collected from each individual who participated in the study and stored at -20 centigrade. The sample collection was performed from November 2018 to February 2020. Case groups were recruited from the Methadone maintenance therapy center. Contro group had no history of drug use and cigarette smoking. DNA was extracted from the whole blood samples using the salting out method. The DNA from a mitochondrial gene, dehydrogenase subunit1 (-ND1 gene) and a nuclear gene, human globulin (HGB gene), were quantified by a real-time PCR-based method to measure the relative mtDNA copy number of each group number.
Results: There was no significant difference in demographic characterization between the three study groups, opium abusers, heroin addicts and healthy individuals. We found that opium users had a higher mean of mtDNA copy number than those in the healthy control group (P=0.11). Heroin addicts had also higher mean of mtDNA copy number than those in healthy group (P=0.21). The mean mtDNA copy number in opium abusers was higher than that in heroin addicts (P=0.22), although the difference was not statistically significant.
Conclusion: The results of this study indicated that mtDNA copy number increased in a group of opiate abusers. Considering that alteration of mtDNA copy number is associated with increased susceptibility to several diseases including cancer, further research on mtDNA copy number with a high number of volunteers of opiate addicts may clear the effect of opiate abuse on the human genome.

Comparative study of the sedative effect of ketamine-dexmedetomidine (Ketodex)with ketamine-midazolam(Ketomid) in candidates of fibroptic bronchoscopy
Behzad Nazemroaya , Samin Jahanbin,
Volume 80, Issue 8 (November 2022)
Abstract
Background: A variety of sedatives like ketamine, propofol, opioids, and benzodiazepines are used during Fibroptic bronchoscopy. The effectiveness of ketamine-dexmedetomidine and ketamine-midazolam on pain level and sedation after Fibroptic bronchoscopy was examined.
Methods: A double-blind, randomized clinical trial was carried out from October 2020 to April 2021 at educational hospitals affiliated with Isfahan University of Medical Sciences. The participants were 60 candidates for fibroptic bronchoscopy who were allocated randomly into two groups of 30 people. Group one (Ketodex) received 1mg/kg ketamine and 1 µg/kg dexmedetomidine for 10 min followed by an infusion of 0.5 µg/kg of dexmedetomidine and 0.5mg/min ketamine. Group two (Ketomed) received 2.5mg of midazolam and 1mg/kg of ketamine for 10min along with infusion of 1 µg/kg/min midazolam and 0.5mg/min of ketamine. The variables under the study were systolic blood pressure (SBP), mean arterial pressure (MAP), diastolic blood pressure (DBP), percentage of arterial oxygen saturation (SpO2), heart rate (HR), and level of pain. Furthermore, the sedation score of patients were recorded on the basis
of sedation score is a 5-point scale from 1 to 5. The obtained data were analyzed in SPSS (v.26). To compare the data collected at different occasions and different groups, repeated measure tests and independent t-test were used (P<0.05).
Results: Compared to the Ketomed group, the sedation term in patients in the Ketodex group was longer significantly (P<0.001) with a significantly shorter recovery term (P<0.001). In addition, the differences between the groups were insignificant in terms of diastolic blood pressure, systolic blood pressure, mean arterial pressure, heart rate, and percentage of arterial oxygen saturation (P>0.05). The pain levels were notably lower in patients who received Ketomed compared to Ketomed during 20 min (P=0.04) and 30 min (P=0.001) following the procedure.
Conclusion: The use of Ketodex was associated with a longer sedation duration and significantly shorter stay in the recovery room and lower pain intensity compared to Ketomed, therefore it may be more preferable in bronchoscopy.

A new perspective on the determinants of the concept of aging: a letter to the editor
Rahele Samouei,
Volume 80, Issue 8 (November 2022)
Abstract

Bilateral Y shaped ureter (bifid renal pelvis): a case report
Mohammad Bakhtiar Hesam Shariati , Fahimeh Rajabi , Ehsan Motavasel ,
Volume 80, Issue 9 (December 2022)
Abstract
Background: Congenital malformations of the kidney and urinary tracts happen in 3-6 per 1000 live births and these abnormalities are the reason, for (ESRD) in children and also the reason for subsequent kidney problems such as kidney stones, infections and hypertension in adulthood. One of the most common anomalies of the renal system is the double collecting system. Knowledge of anatomical variations and disorders before surgery can make the surgical procedure smoother for the surgeon and prevent unwanted mistakes. Imaging through radiology, computed tomography, and MRI is the best way to diagnose early, follow-up, and planning for surgery, diagnosis of complications and extra kidney abnormalities.
Case Presentation: Our report in this article is about four years old girl who went to the MRA center of Baath Hospital in Sanandaj due to flank pain in December 2019. After abdominal imaging, signs of an abnormality of the double collecting system were revealed. Abdominal and pelvic ultrasound revealed abnormalities of the UVJ, and the distal part of the right urethral duct was approximately 2 mm in size. Also, the anterior-posterior diameter of the right renal pelvis was reported to be 2 mm and the upper calyx of the right kidney was quite dilated. This incomplete integration leads to complete or incomplete forms of the renal collecting system. The prevalence of this anomaly is also mostly unilateral, but our report, in this case, is about bilateral ureters.
Conclusion: We reported a rare case of bilateral Y-shaped bifid ureter, that's in this kind of anomaly 2, pyelocaliceal systems connect at the junction of the ureter to pelvic (bifid pelvis), and this abnormality was accidentally detected on ultrasound and MRI examinations. However, since duplex kidneys are often asymptomatic and therefore mainly diagnosed incidentally in patients, the actual number of patients with symptoms is probably lower.

Short term effect of low-level laser therapy on tooth stability after orthodontic treatment
Batoolalsadat Mousavi Fard , Samaneh Sadeghi, Mehrdad Shahsavaripour,
Volume 80, Issue 9 (December 2022)
Abstract
Background: The purpose of this article was comparing the clinical effectiveness of low-level laser therapy (LLLT) in reducing relapse.
Methods: In this clinical trial study 14 patients (11 females and three males) who were under non-extraction treatment (MBT 022 slot) and at the finishing stage of orthodontic treatment at Orthodontics Department of Kerman Dental Faculty from April 2016 to June 2017 participated. Treatment time was two year and the patients at the finishing stage of orthodontic treatment were divided into two groups (RCT code IRCT2017053034061N1). Group 1 (study) were treated with a low-level Gallium aluminum-arsenide diode laser and group 2: control. The exclusion criteria involved patients who consumed medicine that interrupted bone metabolism and those with conditions for which laser therapy could be contraindicated. The laser apparatus emitted a wavelength of 810 nm about 50 seconds and operated with maximum power of 200 MW in continuous wave mode (200 mW, 50 seconds radiation to mesiolingual, mesiobuccal, distolingual and distobuccal surfaces, 35.7 J/cm2). An alginate impression was made from maxillary arch for all patients immediately, four, five and six months after removing the orthodontic archwire and braces and study casts were prepared. The little irregularity index of anterior maxillary arch was measured on the dental casts, with a 0.01 mm precision digital caliper. Intergroup comparisons were performed with Student's t-test and repeated measure ANOVA was perform to compare measurements among groups in different times. The significance level was considered at P<0.05.
Results: There was significant difference among the irregularity index at five and six months after orthodontic treatment between two groups (P<0.05). In the control group except between five and six months after treatment, there was significant difference in irregularity index. The relapse was higher immediately and after four months in the laser group compared to other sequences (P=0.0001).
Conclusion: Sample showed that Low-level laser therapy (LLLT) is a non invasive method for reducing relapse after orthodontic treatment.

Methodology of pharmacoeconomic evaluation studies in Iran: a brief report
Sara Emamgholipour, Rajabali Darroudi , Abdoreza Mousavi, Samira Alipour , Fakhraddin Daastari,
Volume 80, Issue 11 (February 2023)
Abstract
Background: Given the limited resources of health system, economic evaluations studies can provide appropriate evidences for resource allocation by clarifying the possible consequences of a decision. Present study aimed to evaluate the implemented approaches for economic evaluation studies of pharmacoeconomic in Iran.
Methods: This study was carried out using the critical review method. All studies related to economic evaluation studies of pharmacoeconomic in Iran, indexed in PubMed and SID databases and Google Scholar search engine, were searched by using appropriate keywords and search strategies until 2021. Further, published papers from Iranian researchers in the field of health economics and pharmacoeconomics and pharmaceutical administration were extracted with the scientometric system of the Health Ministry. Then, retrieved papers were screened by title, abstract, and the whole text. Finally, papers were evaluated by applying the Drummond quality assessment checklist, and finally appropriate ones were selected. Finally, 29 papers were selected and analyzed.
Results: Out of total available papers (n=1324), 29 papers had inclusion criteria to evaluate. The selected papers were analyzed based on 10 parameters, including type of analysis, type of comparator, source of clinical effectiveness, time horizon, used model, perspective of the analysis, measured expected outcomes, discounting of costs and outcomes, sensitivity analysis, and subgroup analysis. Most studies have used cost utility analysis. Shortcomings were found in some aspects as follows: some studies did not mention the applied model, or the time horizon. Moreover, some studies had time horizon more than one year, while the cost and consequences were not discounted.
Conclusion: In recent years, economic evaluation studies in the field of pharmacoeconomic in Iran have been center attention in line with global trend. In order to make a decision regarding the allocation of resources based on the findings of economic evaluation studies, these studies should be conducted with the systematic and transparent approach. Therefore, it is necessary to develop a standard framework for implementing and reporting the results of economic evaluation studies in Iran.
Keywords: cost-benefit analysis, cost-effectiveness analysis,

Evaluation of serum albumin as a risk factor for mortality in patients with sepsis admitted to ICU
Farhad Soltani, Foroogh Doraghi, Saeed Hesam, Fereshteh Amiri ,
Volume 80, Issue 11 (February 2023)
Abstract
Background: One of the major challenges in intensive care unit (ICU) patients is sepsis. The incidence of sepsis in patients admitted to the ICU has been reported from 13.6-39.3%. Many factors affect patient mortality, including acute phase proteins such as albumin.
Methods: The present study was a retrospective study in which patients with a diagnosis of sepsis referred to Golestan Hospital in Ahvaz from March to August were collected. In the present study, patients with sepsis admitted to the ICU who did not show improvement for more than 7 days were evaluated for length of hospital stay, survival and the relationship with albumin levels. During the study, albumin was checked every 72 hours and its validation was done. Based on albumin levels less than 2.6, they were treated with albumin. The patients who did not have an increase in the level of albumin remained in the study.
Results: 124 patients including 64 women (51.6) and 60 men (48.4) with a mean age of 66.4±15.4 were included in the study. The mean duration of hospitalization was 31.4±18.9 days, in which 24 patients (19.4%) died and 100 patients (80.6%) were discharged. Age, albumin and protein levels were associated with disease prognosis (P<0.001). Also, the duration of hospitalization in the deceased patients was longer than the recovered patients (27.7±25 vs. 32±17.1) (P=0.04). After further investigations, it was found that there is no difference between the deceased people (66±15.7) and the recovered people (67.7±14.1) (P=0.7).
Conclusion: The results of the present study showed that albumin has a direct effect on the severity of sepsis and this issue affects older patients more. Therefore, it is recommended that albumin be considered as a risk factor and one of the influential factors in choosing the best treatment strategy, which is associated with a reduction in mortality, hospitalization and treatment costs.

Predicting the Performance of Faculty Members of Medical Universities in Providing Virtual Learning in the Covid-19 Pandemic in terms of Problem-Solving Methods and Their Individual Social Characteristics: A Data Mining Study
Mohammad Sattari, Rahele Samouei,
Volume 80, Issue 12 (March 2023)
Abstract
Background: In the Covid-19 Pandemic, virtual education in universities became essential and came with some challenges, especially for professors who had the role of presenters. In this regard, the study was conducted to predict the performance of professors in providing virtual training in Covid-19 in terms of problem-solving methods and their demographics.
Methods: A descriptive-analytical study was performed on 252 professors of Iranian universities of medical sciences from 2021 April to 2021. Also, demographic characteristics such as gender, field of study, position, job rank and work experience were asked. The faculty members' performance questionnaire in providing virtual training (α=0.89) and the problem-solving methods questionnaire (α=0.75) was administered virtually and the data were analyzed by Random forest, CHAID and ID3 techniques.
Results: Based on used data mining methods findings, factors related to teachers' satisfaction with their performance in providing virtual education were "the possibility of monitoring the performance of homework", "establishing order and regulations", "preparing standard educational content", "using multimedia content", "Mastery of software, educational systems, and multimedia content", and "possibility of examining the quality and quantity of students' learning". Also, interpersonal problem-solving methods, such as "believing in the role of personality traits of people in their behavior", "solving problems with effort and follow-up", "notifying people's mistakes in interpersonal interactions", "giving people the opportunity to check their behavior", "proposing solutions to solve problems for the benefit of both parties", and "dividing big problems into smaller parts" have played a big role in professors' satisfaction about their teaching methods. These characteristics are related to more basic areas such as self-regulation, pursuit and challenge, agreeableness, and realism.
Conclusion: The results of the study showed that the performance of teachers in providing virtual education is influenced by some behavioral factors and individual situational abilities. However, despite the virtual training implementation difficulties, it is a productive opportunity that can be used in the days of returning for conditions (after-covid 19 condition) without physical distance along with face-to-face training.

Numbness in the jaw, the first symptom of multiple myeloma: a case report
Samaneh Salari, Atessa Pakfetrat, Nooshin Mohtasham, Farzaneh Khosravi, Mahdi Saeedi ,
Volume 81, Issue 2 (May 2023)
Abstract
Background: Jawbone involvement and destructive bone lesions in the mandible and maxilla are reported in 30% of patients with multiple myeloma. In general, plasma cell neoplasia rarely occurs in the maxillofacial area, and an incidence of 2.6-3.3 per 100,000 people is reported for solitary plasmacytoma in jawbones. This study aims to present and evaluate a patient with multiple myeloma and the first symptoms in the maxillofacial area.
Case Presentation: The patient was a 52 years old woman complaining of painful swelling in the left area of the face that had enlarged during the last month. She was referred to the maxillofacial disease department of the Dental School of Mashhad, Iran in Feb 2022. The patient has had paresthesia in the left area of the face since 6 months ago. In the extra-oral examination, a 4×10 cm mass was observed in the left mandibular angle extending anteriorly toward the sublingual area. The oral mucosa was normal. According to the clinical profile, malignancy was considered a differential diagnosis. Incisional biopsy of the lesion revealed the proliferation of neoplastic plasma cells. The positive result of immunohistochemistry (IHC) staining for CD138, performed on the specimen to confirm plasmacytoma and detection of small primary lytic lesions in the skull and spine confirmed multiple myeloma. The usual symptoms of multiple myeloma, including low back pain, were not observed. The patient underwent chemotherapy under the supervision of a hematologist.
Conclusion: Jawbone involvement is often less mentioned as the first symptom of multiple myeloma; however, compared to the vertebral column or skull lesions, these areas are easily biopsied, providing the possibility of early detection and treatment of multiple myeloma, hence a promising disease prognosis. The concurrence of destructive bone lesions and sensory changes in the maxillofacial area is a red flag. Precise radiographic evaluation and blood tests can help early detect multiple myeloma. Awareness of general dentists about the possibility of blood dyscrasia such as multiple myeloma with such early symptoms in patients can lead to early diagnosis of patients. This report reminds inexperienced clinicians of the special importance of sensory changes in the head and neck.

Prevalence of congenital cytomegalovirus infection in newborns admitted to the intensive care units in Tehran, Iran
Samileh Noorbakhsh, Mohammad Farhadi , Sara Minaeian, Morteza Haghighi Hasanabad ,
Volume 81, Issue 3 (June 2023)
Abstract
Background: Cytomegalovirus (CMV) is the most common cause of congenital infections in newborns which can lead to long-term complications in more than half of the cases with symptomatic infection at birth time. Unfortunately, neonates with congenital CMV infection will mostly remain undiagnosed because the golden time for detection is limited to the first 3 weeks of infants' life. This study aimed to determine the prevalence of congenital CMV infection in newborns admitted to intensive care units of hospitals in Tehran, Iran and assess related risk factors associated with the infection.
Methods: In this cross-sectional study from April to October 2017, newborns within the first three weeks of life who were admitted to the neonatal intensive care units (NICUs) of university-affiliated hospitals in Tehran, Iran, were eligible for enrollment. CMV infection in neonates was diagnosed through testing infants' Guthrie cards and detection of viral DNA via an in-house nested-PCR assay. Congenital CMV infection in neonates with positive results was confirmed by testing urine specimens as a sensitive and gold standard sample. Related data (demographic and maternal factors) were collected by questionnaires and analyzed.
Results: Congenital cytomegalovirus infection was diagnosed in 8 of 63 newborns (12.7%). Hearing loss was seen in 2 infected infants. The mean of head circumferences among infected neonates was significantly lower than that observed in uninfected cases. Infants with CMV related symptoms had statistically more chance to have infection (P=0.02). We also found Guthrie cards as a reliable sample with high sensitivity for CMV detection assays.
Conclusion: The current study showed a high rate of symptomatic congenital CMV infection among neonates attending on NICU sections of hospitals in Tehran, Iran. It is of crucial importance to note that based on evidence, diagnosis of infants with congenital CMV infection at early stages could help to decrease the burden of long-term diseases if associated with prompt interventions and reduce the costs of late-ineffective treatment. Therefore, routine screening of newborns for congenital CMV infection via Guthrie cards is suggested.

Investigating the factors affecting post-laparoscopic cholecystectomy pain in patients referred to mashhad medical sciences of islamic azad university hospitals in 2021-2022
Yasamin Kaheni, Ali Mirsadeghi, Mohammad Ali Raisolsadat , Mohammad Javad Ghamari , Mohammad Barhemmat , Tooraj Zandbaf,
Volume 81, Issue 4 (July 2023)
Abstract
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.

Diagnosis of pneumothorax using machine learning algorithms and radiomics: Investigating the possibility of replacing simple chest radiography instead of CT scan in order to reduce the radiation dose
Hanieh Alimiri Dehbaghi , Karim Khoshgard, Hamid Sharini, Samira Jafari Khairabadi, Farhad Naleini,
Volume 81, Issue 5 (August 2023)
Abstract
Background: The use of artificial intelligence algorithms to help with accurate diagnosis in medical images is one of the most important applications of this technology in the field of medical imaging. In this research, the possibility of replacing simple chest radiography instead of CT scan using machine learning models to detect pneumothorax was investigated in cases where CT is usually requested.
Methods: This study is analytical and was conducted from November 2022 to May 2023 at Kermanshah University of Medical Sciences. The data used in this research was extracted from the files of 350 patients suspected of pneumothorax. The collected images were pre-processed in MATLAB software. Then, three machine learning algorithms, including Logistic elastic net regression (LENR), Logistic lasso regression (LLR) and Adaptive Boosting (AdaBoost) were used. To evaluate the performance of these models, the criteria of precision, accuracy, sensitivity, specificity, area under the receiver operating characteristic curve (AUC), F1 score, and misclassification were used.
Results: In the AdaBoost model, the accuracy value in radiographic and CT images was calculated as 98.89% and 98.63%, respectively, and the precision value was calculated as 99.17% and 98.27%, respectively. In radiographic images, the AUC value for AdaBoost model was calculated as 100% and in CT scan images as 96.96%. The F1 score for the same model in radiographic was 99% and in CT images was 98.68%. The specificity value for the AdaBoost model was calculated as 99.45% in radiographic images and 94.67% in CT scan images. In the LLR model, the AUC value for radiographic and CT scan images was 99.87% and 99.02%, respectively.
Conclusion: According to the criteria evaluated in the present study, two LLR and AdaBoost models have similar performance in radiographic and CT images in terms of pneumothorax detection ability, so that this complication can also be diagnosed with high precision level using machine learning techniques on the radiographic images and thus receiving higher levels of radiation doses due to CT scan can be avoided in these patients.

Investigating of the time and rate of occurrence of hematoma after angiography and its related factors in Mazandaran heart center
Samad Golshani, Zahra Azizi, Aliasghar Farsavian, Abbas Alipour,
Volume 81, Issue 5 (August 2023)
Abstract
Background: Coronary angiography is an elective method to confirm or rule out coronary artery disease and to decide on the treatment plan but it is an invasive method and it has some complications. The most important and common complication was hematoma. It could be the cause of mortality and morbidity. The present study was conducted with the aim of investigating the time of hematoma occurrence after angioplasty and investigating the effect of various factors (for example age, sex, BMI, BP, hematocrit, anticoagulant agent, etc.) on the occurrence of hematoma.
Methods: This was a prospective cohort study from March 2022 to March 2023 in Mazandaran heart center. The study population was patients who underwent angioplasty through the femoral artery. If the ACT is less than 150-180, sheet removal was done by applying pressure with the hand on the proximal puncture site for 15-20 minutes and ensuring sufficient hemostasis. Then, the ultrasound of the puncture site was performed before pulling the sheet/one hour and six hours after pulling the sheet, and after collecting the data, the data were analyzed to study the effect of BMI, BP, sex, hematocrit, hemoglobin, age, time of sheet removal, anticoagulant agent, etc. on prevalence of hematoma and it size.
Results: 200 patients were examined, of which 44(22%) had hematoma. Women had hematoma more than men (P<0.05). BMI and blood pressure in patients with hematoma decreased and increased, respectively (P<0.05). Older age, female gender, lower hematocrit, and longer duration of sheet retention were effective factors in increasing hematoma size (P<0.05). In the logistic regression model, with increasing BMI, the chance of hematoma occurrence decreased (P=0.029, OR=0.831).
Conclusion: Controlling blood pressure and preventing of decreasing the hematocrit, reduces the incidence of hematoma in patients after angiography. Also, preventing hematocrit drop and removal of sheet at the appropriate time, can prevent of increasing in size of hematoma. There is some difference between nursing report and sonography finding. Nursing report overestimated the hematoma size.

Epidemiological Investigation of the mortality rate of patients with alkaptonuria during the years 2013 to 2022 in Iran
Samaneh Eslami, Iman Mousaei, Masoumeh Andish, Ensieh Tavana , Amin Moradi, Ali Taghipour, Ehsan Mosa Farkhani ,
Volume 81, Issue 6 (September 2023)
Abstract
Background: Alkaptonuria is a rare disorder that leads to excessive production and accumulation of homogentisic acid in body tissues, and this increase causes tissue degeneration and organ dysfunction through a process called achromasia. Due to very few studies in the field of this disease and access to epidemiological data for the first time in Iran, the present study was conducted with the aim of epidemiological investigation of the mortality rate of patients with alkaptonuria during the years 2013 to 2022 in Iran.
Methods: The design of the present study was cross-sectional (descriptive-analytical). The data related to the deceased registered according to the international coding system of diseases (ICD-10) were extracted from the system of registration and classification of the causes of death of Iran for death due to alkaptonuria disease. The variables investigated in this study included: age, gender and residence status of the deceased. Chi-square and Fisher's exact test were also used to analyze the data.
Results: The specific death rate was calculated as 0.31 per one million people of the population. In this study, 90% of the deaths occurred at the age of less than five years. The age variable included two groups of less than five years and more than five years, where 90% of deaths occurred at the age of less than five years. 60% of the deceased were men and 40% were women. Regarding the residence status variable, 82% of the cases were urban and the rest were rural. Finally, there was no significant difference between the incidence of death due to alkaptonuria disease and the investigated variables, which are age (P=0.291), gender (P=0.958) and residence status (P=0.273).
Conclusion: According to the findings in the present study, although no significant difference was observed between age and the number of cases of death due to alkaptonuria; But most cases of death have occurred in young age groups, which seems that more studies are needed to understand the different dimensions of this disease

Initial crohn’s disease flare-up following an anal trauma in a 2.5-year-old boy: a case report
Ali Samady Khanghah , Maryam Khalesi , Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Hokmabadi, Khashayar Atqiaee,
Volume 81, Issue 8 (November 2023)
Abstract
Background: Crohn's disease is considered a heterogeneous disorder with multi-factorial etiologies, in which the interaction of genetics and environment manifests the disease. Adverse childhood experiences can affect future physical and mental health outcomes. The rich innervation of the intestine with the Vagus nerve and hormonal interactions on the one hand and the constant contact of the digestive system with various pathogenic and non-pathogenic antigens have a proven role in autoimmune diseases and can gradually be chosen as a therapeutic goal.
Case Presentation: We are reporting a case of Crohn's flare-up after trauma in a pediatric case. A 2.5-year-old male with a through and through anal trauma was presented in Akbar Children's Hospital, Mashhad, Iran, Spring 2023 with active bleeding but conscious. He then underwent a physical examination under general anesthesia in the operating room. At the Lithotomy position, a penetrating wound at the 3 o'clock anal verge and a tear in the perineal area at 9 o'clock, which, according to the evidence of pus discharge, were seen hours after the incident which was irrigated with normal saline and Hydrogen Peroxide respectively. Due to the contamination of the area, a supportive colostomy was decided to be closed after six months. At the appointed time during the colonoscopy, the pediatric gastroenterologist noticed extensive inflammation in the distal patch of the colon, which was consistent with Crohn's disease. Histopathological studies then confirmed this diagnosis. This was even though there were no symptoms of inflammatory bowel disease in the history of the boy's illness before the accident. The patient is then treated with prednisolone, Asacol, and ciprofloxacin, and after the disease subsides, the colostomy surgery team closes the disease.
Conclusion: Trauma can be an immune-disrupting factor in the digestive system, and trying to reset the brain-gut axis can be chosen as a therapeutic goal.

Investigating the mean indexes of the cervical vertebrae through radiography in normal peop
Mahsa Akhavan-Sabbagh, Mohammad Ghasem Hanafi , Mozhgan Samet Zadeh , Arvin Rostami ,
Volume 81, Issue 9 (December 2023)
Abstract
Background: The study of the angles between the vertebrae and the curvatures of the spine plays an essential role in the pathogenesis of spinal disorders. Among the essential topics, the cervical sagittal parameters are widely used in evaluating cervical spine disorders and surgery. Measurement of cervical lordosis curves in healthy people is influenced by various factors. This study was conducted in order to investigate the average indexes of the cervical vertebrae in simple graphs in normal people.
Methods: In this descriptive study, using Gunya and Radiant software, radiographic photographs of the lateral view of the cervical region of 50 people (28 men and 22 women) who were referred for purposes other than problems related to neck pain were examined. Patients who were candidates for surgery and congenital disorders of the cervical spine were excluded. The study was conducted between March to April 2022. In this study, 12 cervical indexes were comprehensively measured and the scope of their changes in relation to age and gender was investigated. The measurements were conducted by an experienced radiologist.
Results:  In this study, 50 participants including 28 male (58%) and 22 female (44%) were included in the study. The mean age of participants 38.42 ± 2.1 years. After comparing the two genders, except for C0-C2/C2-C7 ratio index (4.9 in men and 2.6 in women) (P= 0.012), no significant difference was seen for other indexes (P> 0.05). After comparing the two groups, a significant difference was seen only in the T1 slope (T1S) index, which was significantly higher in people over 35 years old than in people under 35 years old (71.15 vs. 69.04) (P=0.049).
Conclusion: The evidence from this study shows that T1S increases with age and C0-C2/C2-C7 is significantly less in women than in men. These findings can be used to diagnose pathology or destructive changes in the elderly, to evaluate movement disorders, the effectiveness of treatment, and to determine the outcome.

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