Acta Medica Iranica http://acta.tums.ac.ir/index.php/acta Tehran University of Medical Sciences en-US Acta Medica Iranica 0044-6025 Universal Scientific Education and Research Network (USERN): Step Strong in Scientific Networking http://acta.tums.ac.ir/index.php/acta/article/view/7699 Farzaneh Rahmani Mahsa Keshavarz-Fathi Sara Hanaei Arya Aminorroaya Farnaz Delavari Sasan Paryad-Zanjani Negar Sadat Ahmadi Parya Akbari Saboura Ashkevarian Farshad Barghi Saleheh Ebadirad Ali Jaberipour Mohammad Reza Kolahi Marjan Moallemian Ali Pourebrahimi Alireza Samimiat Zahra Vahedi Seyedeh-Sanam Ladi Seyedian Nima Rezaei ##submission.copyrightStatement## 2019-02-13 2019-02-13 1 4 Mitochondrial Dysfunction in Multiple Sclerosis: A Systematic Review http://acta.tums.ac.ir/index.php/acta/article/view/6901 <p>Multiple sclerosis (MS) is a chronic inflammatory demyelinating disorder of the central nervous system (CNS) and is characterized by a high degree of heterogeneity in progression and treatment response. Mitochondrial dysfunction is increasingly recognized as an important feature of MS pathology and may be relevant for clinical disease progression. This paper systematically reviews published evidence concerning the role of mitochondrial abnormalities with MS. Literature searched using the Web of Science, PMC/Medline via PubMed and Scopus databases up to May 2017 with no time and language limitation. After quality assessment, 9 articles were included in the study. All data extraction was conducted by two reviewers independently. Based on the results of the studies, it seems that mitochondrial DNA abnormality and mitochondrial dysfunction may be due to primary inflammation in MS or may be occurred itself before any inflammation, but definitely contributes to axonal degeneration and disease progression. Mitochondrial abnormality contributes to axonal degeneration in MS and disease progression.</p> Alia Saberi Samaneh Kazemi ##submission.copyrightStatement## 2019-02-13 2019-02-13 5 16 Severe Decline in Mir-20a and Mir-92a in the Context of the Mir-17-92 Cluster: Ideal Biomarkers of Various COPD Subtypes http://acta.tums.ac.ir/index.php/acta/article/view/7023 <p>Chronic obstructive pulmonary disease (COPD) is going to be the third leading cause of death by 2020. Circulating miRNAs are among the most beneficial feasible non-aggressive biomarkers for diagnosis and treatment of many diseases. Among members of the significant miR-17-92 cluster, miR-20a and miR-92a are greatly involved in both inflammation and hypoxia (known as the main reasons for COPD comorbidities). Thus, the expression of these miRNAs was evaluated in the serum of 26 patients and 19 controls using the sensitive stem-loop RT-qPCR approach. The results revealed a significant reduction of these miRNAs in patients relative to controls (<em>P</em>&lt;0.001). Decreased expression of miR-20a in a patient might reflect a progressive stage of the disease. MiR-92a might be used as an early-detection biomarker of COPD. These miRNAs can be used as therapeutic targets specifically in the context of the miR-17-92 cluster to address the various clinicopathological aspects of the disease.</p> Akbar Ghorbani Alvanegh Mahmood Tavallaei Houri Edalat ##submission.copyrightStatement## 2019-02-13 2019-02-13 17 26 Expression of Pro-Apoptotic Bax and Anti-Apoptotic Bcl-2 Proteins in Hydatidiform Moles and Placentas With Hydropic Changes http://acta.tums.ac.ir/index.php/acta/article/view/7000 <p>Morphologic examination still forms the main diagnostic tool in the differential diagnosis of molar placentas. However the criteria are subjective and show considerable inter-observer variability among pathologists. The aim of the present study was to investigate the role of Bcl-2 and Bax immunostaining in the differential diagnosis of molar placentas. Bax and Bcl-2 immunohistochemical staining were performed in 19 molars (8 partial and 11 complete hydatidiform mole) and 10 non-molar (hydropic abortion) formalin-fixed, paraffin-embedded tissue samples. Ploidy analysis using flow cytometry had confirmed diploidy in hydropic abortions and complete hydatidiform moles and triploidy in partial hydatidiform moles. Bcl-2 expression was observed only in syncytiotrophoblasts, No immunoreactivity was detected in Cytotrophoblasts, and stromal cells, the total score averages of Bcl-2 immunoexpression in partial hydatidiform moles and hydropic abortions were significantly higher than in complete hydatidiform moles, whereas no significant difference was observed between partial hydatidiform moles and hydropic abortions. Bax immunoreactivity was observed in cytotrophoblasts, stromal cells and occasionally in syncytiotrophoblasts. No statistically significant difference in Bax immunoexpression total score was observed among various groups. Based on the results of this study, Bcl-2 immunostaining offers a potential adjunctive diagnostic tool to distinguish complete hydatidiform mole from partial hydatidiform mole and hydropic abortion, but not partial hydatidiform mole from hydropic abortion, Bax immunostaining cannot be helpful in this regard.</p> Alireza Khooei Fatemeh Atabaki Pasdar Alireza Fazel Mahmoud Mahmoudi Mohammad Reza Nikravesh Shahin Daneshmand Shahbazian ##submission.copyrightStatement## 2019-02-13 2019-02-13 27 32 First Cystic Fibrosis Patient Registry Annual Data Report - Cystic Fibrosis Foundation of Iran http://acta.tums.ac.ir/index.php/acta/article/view/7554 <p>Cystic fibrosis (CF), as a fatal genetic condition, is associated with high morbidity and mortality rates. In Iran, limited studies exist on this disease. This study aims to compare the demographic, clinical and paraclinical data of CF patients. This cross-sectional study was conducted in 2014-2015 on 174 CF patients referred to the Tehran Children Medical Center hospital, which is the main referral center for CF. For each patient, the forced &nbsp;expiratory volume in one second (FEV1) was measured and the comparative demographic, clinical and laboratory data of patients were recorded. Overall, 59% of studied patients were boys (n=102) and 41% were girls (n=72). The mean patient age (and standard deviations) was 7.1 ±5.7 years, with a range of 10 days to 28 years. In 67% of cases, the disease was diagnosed before their first birthday. The patients in this study were classified based on the FEV1 into mild (62%), moderate (33%) and sever (5%), indicating the degree of pulmonary complications. Cultures of respiratory secretions were positive for <em>Pseudomonas aeruginosa</em> and Staphylococcus aureus, in 23% and 16% of cases, respectively. In total, 61% of patients (n=83) were assigned to receive oral azithromycin for prophylaxis. Gastroesophageal reflux (reflux) was the most common gastrointestinal complication (35%), Regarding the complex nature of CF and the necessity of constant monitoring of patients during the life-span, the comparative demographic, clinical and laboratory analysis of patients and registering and standardization of patients’ data, can be a major step in the better understanding of the disease, and thereby increasing the quality of life and life expectancy in the affected population.</p> Asghar Aghamohammadi Majid Keivanfar Safoura Navaei Rohola Shirzadi Farzad Masiha Zahra Allameh Amin Heydari Solat Eslami Gholamreza Azizi Mohsen Reisi Mohammadreza Modaresi ##submission.copyrightStatement## 2019-02-13 2019-02-13 33 41 The Correlation of Irisin Levels and Some Trace Element as a Potential Mark Diagnosis of Gestational Diabetes Mellitus. http://acta.tums.ac.ir/index.php/acta/article/view/7467 <p class="Default">The objective of this project was investigating and comparing changes of serum irisin, and trace levels of the elements (Zn, Cu, Mg) in pregnant women with gestational diabetes mellitus GDM in addition to wholesome pregnant group, examining the correlation among (Zn, Cu, Mg) levels and irisin insulin impedance in GDM pregnant women. Sixty GDM pregnant women and thirty wholesome pregnant women were examined. The pair groups were matched for age, and maternal serum irisin. Insulin levels and gestational age were calculated by the assay for enzyme-linked immune sorbent kit at gestation at 24-28 weeks. The confederation between clinical and biochemical parameters and maternal serum irisin levels were predestined. Serum levels of glucose, body mass index, insulin, OGTT, HOMA IR, HOMAβ, HbA1c, Hb%, irisin, Zn, Cu and Mg were investigated and analyzed for the examined collection as well as control samples. Pregnant women with GDM disease had noteworthy rising fast blood glucose FBG (<em>P</em>=0.004), first-hour OGTT glucose (<em>P</em>=0.001), second-hour OGTT glucose (<em>P</em>=0.001), fasting insulin FI (<em>P</em>=0.001) levels, HOMA IR (<em>P</em>=0.001), HOMAβ (<em>P</em>=0.001), HbA1C (<em>P</em>=0.001), Hb% (<em>P</em>=0.017), as contrasted to healthy women. Levels of irisin serum were significantly minimizing (<em>P</em>=0.001) in women, and sequentially more advanced GDM (mean±SD=71.65±8.03) than healthy pregnant controls (mean±SD 136.54±22.56). Analyses among irisin levels of anthropometric and biochemical values in gestational diabetes patients disclosed that none of the scrupulousness values were remediated with serum irisin level. His present outcomes indicate that the levels of serum irisin might be presented as an incoming GDM marker with decreased irisin levels being GDM symptomatic.</p> Majid Jawad AL-Ghazali Hanaa Addai Ali Mohauman Mohammad AL-Rufaie Rawaa Adday Ali ##submission.copyrightStatement## 2019-02-13 2019-02-13 42 50 The Prevalence of a Clinically Silent Nephrolithiasis in Baghdad Population: An Initial Ultrasound Screening Study From Iraq http://acta.tums.ac.ir/index.php/acta/article/view/7458 <p>Asymptomatic or clinically silent kidney stones are possibly serious because, in their expected passage, they may cause infection, obstruction and renal impairment. The purpose of this study was to determine the prevalence of silent kidney stones in a sample of Baghdad population and consider how this value could affect the justification for a screening system. To our best knowledge, this is the first study of its kind conducted in Iraq. We investigated 714 consecutive patients who sustained an abdominal ultrasound at our hospital with further kidney screening. All these patients did not have clinical signs and symptoms of nephrolithiasis. Age, sex, the indication for ultrasound, the size, side, and the number of the discovered stones were recorded. We observed silent kidney stones in 3.4% of patients. Males were stone carriers mostly. Stones were detected more in the left kidney than the right. Distinctly, multiple stones and stones of a large size were minimally seen. We conclude that the prevalence of clinically silent nephrolithiasis of 3.4% does not support a global screening. Yet, this screening may be justified in a limited pattern for those male subjects higher than 50 years, having a positive family history of renal stones, and their socioeconomic status is granted.</p> Nadhum L. Tahir Qays A. Hassan Harth M. Kamber ##submission.copyrightStatement## 2019-02-13 2019-02-13 51 56 Effect of N-Acetylcysteine on Inflammatory and Biochemical Markers of Hemodialysis Patients: A Randomized Controlled Trial http://acta.tums.ac.ir/index.php/acta/article/view/7035 <p>The oxidative stress results in atherosclerosis and cardiovascular diseases in patients receiving hemodialysis. <em>N</em>-acetylcysteine is a well-known antioxidant agent. There are little studies about the effect of <em>N</em>-acetylcysteine on patients receiving hemodialysis, and, if any, their results are inconsistent. This study, as a double-blind, randomized clinical trial, was conducted on 44 hemodialysis patients in Shahid Beheshti Hospital, Yasuj, Iran in 2015. Patients were randomly allocated into two groups, in the intervention group, N-acetylcysteine 600 mg every 12 hours for eight weeks was administered and the second group received placebo during this period every 12 hours. Blood samples were taken to measure C-reactive protein, interleukin-6 and other biochemical markers such as ferritin, albumin, and creatinine at baseline and at the end of treatment. 40 patients completed the study (21 on N-acetylcysteine, 19 on placebo), with a mean age of 60.72±17.60. There was not any significant difference between intervention and control groups in interleukin-6 (8.85±6.9 vs. 10.32±8.68, 95% CI, -3.52 to 6.46; <em>P</em>=0.55) and C - reactive protein (0.85±0.29 vs. 0.9±0.31, 95% CI, -.14 to .24; <em>P</em>=0.60). In addition, there was no significant relationship between the two groups in other biochemical markers. In this study, administering <em>N</em>-acetylcysteine was safe and caused a reduction in some inflammatory markers, but these changes were not significant in comparison with placebo.</p> Rozina Abasi Larki Alireza Panahi Leila Manzori Moslem Sedaghattalab ##submission.copyrightStatement## 2019-02-13 2019-02-13 57 62 The Characteristic Clinical and Pathological Features of Incidental and Non-Incidental Papillary Microcarcinoma of the Thyroid http://acta.tums.ac.ir/index.php/acta/article/view/7016 <p>The incidence of papillary microcarcinoma (PMC) keeps raising due to fine needle aspiration (FNA) biopsies and the pathologic evaluation of thyroid specimens of cases operated for benign thyroid disorders. The files of 78 patients who underwent surgery between January 2006 and May 2013 in our department and were diagnosed with PMC were analyzed, retrospectively.Cases were grouped as incidental and non-incidental depending on the preoperative diagnosis. The diameter of the nodules in the preoperativeultrasonographic examination, pathological parameters such as tumor size, bilaterality, multifocality,and capsular invasion were found significantly high in non-incidental group(<em>P</em>&lt;0.05). No significant difference was detected between the two groups’ age, sex, and vascular invasion.Preoperative radiologic examination by experienced radiologists and FNA performed for suspicious nodules may increase the rate of early and correct diagnosis. In our opinion, determining the most useful criteria for malignancy will help to detect incidental PMC in cases followed up for multinodular goiter.</p> Özgün Akgül Erdinç Kamer Turan Acar Nihan Acar Erdem Sarı Yelda Dere Özcan Dere Ercüment Tarcan Hüdai Genç Mehmet Haciyanli ##submission.copyrightStatement## 2019-02-13 2019-02-13 63 67 A Case of Mitral Valve Metastasis From Breast Carcinoma Mimicking as a Mitral Valve Regurgitation http://acta.tums.ac.ir/index.php/acta/article/view/6699 <p>Metastatic involvement of cardiac valve and pericardium mimicking a cardiac valve pathology accompanied with cardiac tamponade is a rare phenomenon. These metastases commonly arise from the lymphoreticular system, the pulmonary system, and breast. Metastatic spread of breast carcinoma to the cardiac valve is exceedingly rare, and only two case reports have been detected in English literature so far. We report a rare case of a patient with adenocarcinoma of the breast, which presented with severe mitral valve regurgitation and pericardial effusion which was managed urgently with mitral valve replacement. Our case shows the probability of combined metastatic pericardial and valve involvement in patients with breast adenocarcinoma. The patient was treated with mitral valve replacement and intrapericardial infusion of cisplatinum drug to control possible recurrent effusion.</p> Aghigh Heidari Fereidoun Sabzi ##submission.copyrightStatement## 2019-02-13 2019-02-13 68 71 Simultaneous Cesarean Section and Radical Nephrectomy With Tumor Thrombectomy During Pregnancy http://acta.tums.ac.ir/index.php/acta/article/view/6821 <p>Renal cell carcinoma (RCC) is uncommon during pregnancy. Accurate and timely diagnosis and careful preoperative planning are essential to optimize the patient outcomes. A 27-year-old pregnant woman presented with a large mass in left kidney and inferior vena cava (IVC) tumor thrombus, diagnosed at 33 weeks gestation. She was evaluated with an initial impression of pyelonephritis at other institutions and referred to our center after a delay of more than 3 weeks. RCC with IVC tumor thrombus has the potential to increase the likelihood of thromboembolic events including pulmonary embolism during pregnancy. Furthermore, simultaneous radical nephrectomy with IVC thrombectomy and Cesarean section (CS) is challenging and might be associated with significant intraoperative blood loss. After consultation with an obstetrician and cardiac surgery team, our patient underwent CS and simultaneous left radical nephrectomy with IVC thrombectomy at 34 weeks gestation. The postoperative course was uneventful and histologic analysis revealed pT3bN0M0 papillary RCC.</p> Mohsen Ayati Reza Shahrokhi Damavand Mohammad Reza Nowroozi Hasan Inanloo Erfan Amini Elnaz Ayati ##submission.copyrightStatement## 2019-02-13 2019-02-13 72 74 Bilateral Krukenberg Tumor in a Pregnant Lady: A Case Report http://acta.tums.ac.ir/index.php/acta/article/view/7024 <p>Krukenberg tumors are rare metastatic ovarian tumors with its primary site being the gastrointestinal tract as a most common site and poor prognosis. We hereby, present a 25-year-old pregnant female suffering from abdominal pain and iterative vomiting episodes. She was diagnosed with a terminal stage of the malignant disease. She underwent total ovariectomy without any radiotherapy. Histological examination of the specimen yielded diagnosis of Krukenberg tumor. Ten days later, the patient underwent a natural vaginal delivery in the 25<sup>th</sup> gestational week because of labor pain, and we extracted a dead male newborn of 31 cm, 510 g, AP score 0. Three weeks later, the patient died because of pulmonary failure.</p> Parvaneh Dehghan Samaneh Kakhki ##submission.copyrightStatement## 2019-02-13 2019-02-13 75 77