Acta Medica Iranica http://acta.tums.ac.ir/index.php/acta Tehran University of Medical Sciences en-US Acta Medica Iranica 0044-6025 Evaluation of the Effects of Chronic Injection of D-Galactose on Auditory Brainstem Responses as a Model for Studying Age-Related Hearing Loss http://acta.tums.ac.ir/index.php/acta/article/view/7595 <p style="margin: 0in 0in 8pt; text-align: justify; unicode-bidi: embed; direction: ltr;">The D-galactose induced mimetic aging rat model has been widely used in studies of age-associated diseases recently. Evidence indicates that D-GAL could also play a key role in age-related hearing loss. However, there is conflicting data about the relationship between the D-GAL injection and tone-burst auditory brainstem responses (ABRs). The present study aimed to compare ABRs in D-GAL injected rats compared with young and naturally aged rats. Tone-burst ABR was recorded and analyzed at the frequencies of 4,6,8,12 and 16 kHz in male young (3-month-old, n=10), naturally aging (18-month-old, n=10) and D-GAL injected (3-month-old, 500 mg/kg D-GAL injection for 8 weeks, n=10) Wistar rats. When the ABRs thresholds obtained in the D-GAL group and the natural aging group were compared with the thresholds in the young group, we observed a significant increase in thresholds, which affected all of the frequencies (<em>P</em>&lt;0.05). A statistically significant decrease in amplitude of wave PI at 4 and 8 kHz, PII at 4,8 kHz, PIV at 4,6,8,12 and 16 kHz was also observed in naturally aging group compared with young group. However, in D-GAL group, a significant difference was exclusively detected in amplitude of PIII at 4 kHz. Latency did not reveal any significant difference between the groups (<em>P</em>&gt;0.05). The present study confirmed that experimental injection of 500 mg/kg/day D-GAL for 8 weeks to Wistar rats could lead to ABRs threshold shifts but not latency. Because there are several types of presbycusis, further studies are needed to determine what type of presbycusis is induced by D-GAL and where is the first region affected by it to provide the best treatment and prevention methods.</p> Elham Tavanai Ghassem Mohammadkhani ##submission.copyrightStatement## 2019-09-30 2019-09-30 281 288 The Comparison of Hemodynamic Responses Following Laryngeal Mask Airway Insertion Versus Tracheal Intubation in Hypertensive Patients Scheduled for Elective Ophthalmic Surgery Under General Anesthesia http://acta.tums.ac.ir/index.php/acta/article/view/7708 <p>We compared hemodynamic responses following laryngeal mask airway insertion versus tracheal intubation in hypertensive patients who were scheduled for elective ophthalmic surgery under general anesthesia. We studied 48 controlled hypertensive patients that were randomly divided into two groups (n=24) for insertion of laryngeal mask airway (LMA) and endotracheal intubation (EI). The mean arterial blood pressure (MAP), heart rate, rate pressure product (RPP), and ST-segment changes were recorded preoperatively, immediately preintubation and 1, 3, and 5 minutes after LMA insertion or tracheal intubation in all patients and compared between two groups. There was a reduction in MAP after induction and immediately preintubation in all of patients of both groups (<em>P</em>&lt;0.05). The MAP, heart rate and RPP increased immediately after both LMA insertion and tracheal intubation (<em>P</em>&lt;0.05). The elevation of MAP and RPP were maintained for longer time in intubation group versus LMA group (<em>P</em>&lt;0.05). There was no difference between the groups with respect to ST-segment variation. The incidence of airway injury was similar between two groups. The laryngeal mask airway insertion may be preferable to endotracheal intubation in hypertensive patients where attenuation of hemodynamic stress response is desired.</p> Mehdi Sanatkar Mehrdad Goudarzi Alireza Ebrahim Soltani ##submission.copyrightStatement## 2019-09-30 2019-09-30 289 294 The The Effect of Pre-Emptive Dose of Intravenous Ketamine on Oculocardiac Reflex in Pediatric Strabismus Surgery: A Randomized Clinical Trial http://acta.tums.ac.ir/index.php/acta/article/view/7741 <p>- To evaluate the effect of pre-emptive dose of intravenous ketamine on Oculocardiac reflex (OCR) in pediatric strabismus surgery. 60 children with age between 2 to 8 years old candidate for strabismus surgery were randomly divided into two groups of 30 participants. After induction of anesthesia, in one group, pre-emptive dose of ketamine (0.15 mg/kg) was given intravenously (ketamine group), while the other group was given the same volume of normal saline (control group). During the surgery, OCR was recorded if the heart rate had decreased 20% or more from the baseline. In the recovery room, the incidence of nausea and vomiting, bronchospasm, laryngospasm, hallucination and recovery nurse satisfaction score were recorded. The incidence of OCR in total participants was 31 (51.7%). In control group 21 (70%) patients had OCR during surgery while this incidence was 10 (33.3%) in ketamine group which was significantly lower (<em>P</em>:0.004). the incidence of postoperative nausea and vomiting and the mean of recovery nurse satisfaction score in recovery room were not significantly different between two groups. The hallucination was not seen in any cases of two groups after surgery. The pre-emptive dose of ketamine (0.15 mg/kg) can reduce incidence of OCR in the pediatric strabismus surgery.</p> Mehrdad Goudarzi Mohammad Mehrpour Mohammad Saleh Rajabi Mehdi Sanatkar Ebrahim Espahbodi Mohammad Reza Akbari ##submission.copyrightStatement## 2019-09-30 2019-09-30 295 298 Evaluation of the Relationship Between Childhood Asthma and Helicobacter pylori Sero-Prevalence http://acta.tums.ac.ir/index.php/acta/article/view/7634 <p>In recent years, the prevalence of asthma and allergic rhinitis has increased in developed countries. Helicobacter pylori (<em>H. pylori</em>) infection can exacerbate asthma. The purpose of this study was to investigate the relationship between asthma and <em>H. pylori</em> seroprevalence in children. In this cross-sectional study, 100 children aged 5-15 years hospitalized in Besat hospital in Sanandaj were investigated from 2015 to 2016. Fifty children with asthma were considered as the case group and 50 non-asthmatic children as the control group. The questionnaires were completed, including demographic information, history of asthma, exposure to cigarette smoke, and family history of gastric and duodenal ulcers. Blood samples were collected from the children, and the serum level of specific antibodies (IgG) of <em>H. pylori</em> was measured. There were 42 and 31 boys in the case and control group, respectively. The mean age in the case group was 8.12±2.29 and in the control group was 8.9±2.52 years. In the case group, 48% were exposed to cigarette smoke and in the control group, 18%. There was a statistically significant difference between the groups in terms of gender and exposure to cigarette smoke (<em>P</em>=0.001 and <em>P</em>=0.013, respectively). There was no significant difference between the case and control groups in terms of H. pylori seroprevalence. (<em>P</em>=0.211). There was no significant association between asthma and <em>H.</em> <em>pylori</em> seroprevalence. (<em>P</em>=0.22). According to our study, there no correlation between childhood asthma and <em>H. pylori</em> seroprevalence.</p> Rasoul Nasiri Pedram Ataee Azad Abdi Ghobad Moradi Borhan Moradveisi Kambiz Eftekhari ##submission.copyrightStatement## 2019-09-30 2019-09-30 299 302 Association of Neonatal Asphyxia With Serum Levels of Heat Shock Protein 27 in a Small Sample of Newborns http://acta.tums.ac.ir/index.php/acta/article/view/6912 <p>Neonatal asphyxia is a state of hypoxia and hypercapnia caused by failure to breathe spontaneously and regularly soon after birth. Heat shock proteins (HSPs) are a ubiquitous and diverse group of highly conserved proteins which are rapidly up-regulated following periods of cellular stress including exposure to heat, ultraviolet irradiation, or chemical toxicity. The aim of the current study was to explore whether there is a relation between serum levels of HSP27 and neonatal asphyxia in a small sample of newborns. A total of 25 healthy newborns and 25 newborns diagnosed with neonatal asphyxia were recruited form Imam Reza Hospital, Mashhad, Iran. The Apgar score was recorded at one minute after delivery by trained nurses and newborns with the Apgar score of less than 7 were considered to be asphyctic. The mean birth weight of newborns in the case and control groups were 3110.47±613.5 g and 3230.4±584.83 g, respectively (<em>P</em>=0.4). Moreover, the mean maternal age of infants in the case group was higher than the mean maternal age of infants in the control group (31.1±6.1 vs. 30.1±5.0). Although it was marginally significant, the level of HSP27 was higher in the case group than the control group (0.23±0.08 vs. 0.19±0.09; <em>P</em>=0.07). Levels of HSP27 were found to be higher in newborns with neonatal asphyxia compared with healthy controls.</p> <p>&nbsp;</p> Ahmadshah Farhat Mojtaba Shafiee Ashraf Mohammadzadeh Reza Saeidi Rana Amiri Majid Ghayour Mobarhan ##submission.copyrightStatement## 2019-09-30 2019-09-30 303 307 Lived Experiences of Undergraduate Medical Students about Hidden Curriculum: A Phenomenological Study http://acta.tums.ac.ir/index.php/acta/article/view/7416 <p>The hidden curriculum refers to&nbsp;student experiences that occur outside the formal structure of the curriculum, and especially the messages provided by the education system concerning values, perspectives, behaviors, and attitudes which has a strong influence on students' professional development. This study aimed at explaining the lived experiences of undergraduate medical students about the “hidden curriculum.” This was a qualitative phenomenological study. Participants were medical students of Iran University of Medical Sciences and they were chosen by purposive sampling method based on the inclusion criteria. Semi-structured interviews with open-ended questions were conducted with 10 students until data saturation, and 7-step Colaizzi's method was utilized for the purposes of analyzing the study findings. In the process of analyzing data from medical students' lived experiences about hidden curriculum, the following three themes were extracted: 1. Conflict in value beliefs (sub-themes: not giving priority to students education, applicability to the clinical practice of&nbsp; basic sciences, attitude towards discipline, professional ethics, justice in evaluation”) 2. Modeling teacher’s communication skills patterns (sub-themes: “teacher-patient relationship,” “teacher -student relationship and professor-colleagues relationship) 3. Effective teaching (sub-themes: “clinical teaching” and “theoretical teaching”). Based on the results of the study, the hidden curriculum has both positive and negative impacts on various aspects of learning, especially the attitudinal domain. Consequently, paying specific attention to hidden curriculums is an absolute need.</p> Shoaleh Bigdeli Hamid Reza Koohestani Seyed Kamran Soltani Arabshahi Mohammad keshavarzi ##submission.copyrightStatement## 2019-09-30 2019-09-30 308 315 Diphenhydramine definitely suppresses fentanyl-induced cough during general anesthesia induction: a double-blind, randomized, and placebo-controlled study http://acta.tums.ac.ir/index.php/acta/article/view/7735 <p><strong>Background:</strong> &nbsp;Fentanyl-induced cough (FIC) is a known complication and many studies have been conducted to prevent it. The aim of this study was to evaluate the effectiveness of Diphenhydramine as an antihistamine in suppressing of FIC during induction of anesthesia.</p> <p><strong>Material and Methods:</strong> In a prospective double-blind randomized controlled trial, a total of 100 patients, ASA Class I and II, scheduled for elective laparoscopy surgery were randomly assigned into two equally sized groups (<em>n</em> = 50). Diphenhydramine diluted with distil water as 10mg/ml. Then, patients in Group D, received diphenhydramine 30 mg (3ml) through peripheral IV line within 1 min and Group C received same volume normal saline 0.9% as placebo. Two min later, fentanyl 2 µg/kg was administered through the peripheral IV line within 5 sec in all patients. The occurrence and intensity of cough within 2 min after the fentanyl injection were observed and recorded by a resident who was blinded to the study groups. The frequency of PONV, analgesic requirement in recovery room and as a secondary outcome were recorded.</p> <p>&nbsp;</p> <p><strong>Results</strong>: The incidences of FIC were 47% in control group and there is no any cough in the diphenhydramine group (<em>P</em> = 0.02). The frequency of PONV was also reduced in diphenhydramine group (16% <em>vs</em> 40%) and less number of patients in diphenhydramine group were needed to analgesia in recovery room (60% <em>vs</em> 82%)</p> <p>&nbsp;</p> <p><strong>Conclusions:</strong> Our study determines that diphenhydramine (30 mg, IV) bolus injection 2 min before fentanyl injection can prevent FIC and PONV and also reduce analgesic requirement in recovery room.</p> <p>&nbsp;</p> <p>&nbsp;</p> <p>&nbsp;</p> pejman pourfakhr Seyed Hashem Ziaei Seyed Hashem Ziaei Farhad Etezadi Mohammad Reza Khajavi hamidreza sharifnia ##submission.copyrightStatement## 2019-09-30 2019-09-30 316 319 Bupropion as a Treatment for Sexual Dysfunction Among Chronic Kidney Disease Patients http://acta.tums.ac.ir/index.php/acta/article/view/7649 <p>Sexual dysfunction is a common complication among male patients with chronic kidney disease. Common disturbances include erectile dysfunction, decreased libido, and infertility. Sexual dysfunction is a multifactorial problem, and the treatment options are limited, it associated with lower quality of life scores in patients. Chronic kidney disease also has a critically impairing effect on the quality of life. To investigate the efficacy of bupropion on sexual dysfunction and quality of life in men with chronic kidney disease, a single-blind placebo-controlled trial was conducted. A total of 40 male patients with chronic kidney disease suffering from erectile dysfunction (Mean age 41/25±8/8) were randomly assigned to receive 10 weeks of treatment with either bupropion or placebo. Sexual function and quality of life were assessed by IIEF5 and WHOQOL-BREF questionnaires, respectively. Baseline demographic and clinical features were similar in both groups. The results showed a significant difference between the intervention and control groups in sexual function (<em>P</em>=0/005) and total quality of life (<em>P</em>=0/001); also the difference was significant in physical health (<em>P</em>=0/012), psychological health (<em>P</em>&lt;0/001) and social relationship (<em>P</em>&lt;0/001) domains. Our findings suggest that Bupropion is effective and safe for treating sexual dysfunction in men with chronic kidney disease and also could positively affect the quality of life among the patients.</p> Abolfazl Ghoreishi Lila Dashtaki Bahareh Hajisalimi ##submission.copyrightStatement## 2019-09-30 2019-09-30 320 327 Eosinophilic Gastroenteritis and Familial Mediterranean Fever in a Child With MEFV Gene Mutation http://acta.tums.ac.ir/index.php/acta/article/view/7193 <p class="Body">Eosinophilic gastroenteritis (EG) is a rare inflammatory disorder affecting both children and adults. The exact etiology of the disease is not clear. A child presented with episodic generalized abdominal pain since a year ago without fever at first. After endoscopic and colonoscopic examinations, histopathological examination showed an increased number of eosinophils and diagnosis of EG was made. After elimination of dairy products from his regimen, abdominal pain attacks was reduced, but he got a fever. Familial Mediterranean Fever (FMF) diagnosis was made by genetic evaluation which showed MEV gene mutation. Symptoms were resolved with the treatment of colchicine which confirmed FMF diagnosis.&nbsp;</p> Sanaz Mehrabani Mohammad Pornasrollah Leila Moslemi ##submission.copyrightStatement## 2019-09-30 2019-09-30 328 331 Non Salicylate-Associated Reye Syndrome: A Case Report http://acta.tums.ac.ir/index.php/acta/article/view/7089 <p>Reye's syndrome (RS) is a rare disease, usually associated with consumption of salicylates during viral illness. In 1965, the first case of association between RS and salicylates was described in United Kingdom (UK). The incidence of RS decreased dramatically after warnings of UK and US health agencies against using aspirin in children. Patients with RS presented with neurologic compromise, cerebral edema, acute hepatitis, and liver failure-especially in the children.&nbsp; In this paper, a four-month-old boy with diagnosis of RS was described, who presented with malaise, cyanosis and decreased level of consciousness, but the history of salicylates consumption was negative for him and his mother.</p> Arsalan Azizi Moslem Sedaghattalab ##submission.copyrightStatement## 2019-09-30 2019-09-30 332 334 Unilateral Nevoid Acanthosis Nigricans on the Back: A Case Report http://acta.tums.ac.ir/index.php/acta/article/view/7315 <p>Unilateral Nevoid Acanthosis Nigricans (UNAN) is a rare, benign, autosomal dominant form of Acanthosis Nigricans (AN), which is a disorder of keratinization. Unlike AN, the lesions of UNAN are distributed unilaterally while the histopathological findings are similar to the common form of AN. The first description of UNAN was given by Krishnaram in 1991, and following that report, very few cases have been reported. Herein, we present another case of UNAN localized over the back, in a young adult female.</p> Mohammad Ebrahimzadeh Ardakani Narges Ghanei Mitra Shafihosseini ##submission.copyrightStatement## 2019-09-30 2019-09-30 335 337 Non-Symmetric Bilateral Three Headed-Biceps Brachii http://acta.tums.ac.ir/index.php/acta/article/view/7583 <p>Anatomical muscles’ variation may face clinician and surgeon with some dilemmas. Obviously, reporting a rare case of variations could explore some unexplained and unexpected clinical symptoms. Bilateral three head biceps, which had a supernumerary head with different origins in both right and left arms, is reported in this case report article. The crucial importance of arm muscles variations’ is because of their adjacent location to brachial nerve plexus and brachial vessels. Every single alteration in the direction of anatomical elements could result in pressure on nerve or vessels with clinical symptoms. Taken together, investigation and popularization of variations make a well-knowledged background for clinicians and surgeons.</p> <p>&nbsp;</p> <p class="BodyA">&nbsp;</p> Raziyeh Kheirjou Kobra Velaei Maryam Ezzati ##submission.copyrightStatement## 2019-09-30 2019-09-30 338 340 Promoter Hypermethylation of the Eyes Absent 4 Gene Is a Tumor-Specific http://acta.tums.ac.ir/index.php/acta/article/view/8117 Matineh Barati Bagherabad Sahar Tavakolian Mohammad Reza Abbaszadegan Mohammad Amin Kerachian ##submission.copyrightStatement## 2019-10-01 2019-10-01 341 341