Acta Medica Iranica

Comparative Evaluation of CD138 Expression in Pleomorphic Adenoma and Mucoepidermoid Carcinoma: An Immunohistochemical Study

Laleh Maleki — 2026-08-06

Salivary gland neoplasms are significant lesions in oral and maxillofacial pathology that exhibit diverse clinical and biological behaviors. Therefore, identifying novel markers capable of predicting the behavior of salivary gland tumors is crucial. CD138 or syndecan-1 is the primary syndecan expressed in epithelial cells and plays a critical role in tumor progression. The aim of this study was to evaluate the expression of this marker in two common salivary gland tumors. In this cross-sectional study, 20 pleomorphic adenomas (PAs) and 20 mucoepidermoid carcinomas (MECs) obtained via excisional biopsy and archived in the Pathology Departments of Al-Zahra and Ayatollah Kashani Hospitals of Isfahan University of Medical Sciences were evaluated. Clinical data including age gender of patients and anatomical location were collected. All specimens were immunohistochemically stained for syndecan-1 and the frequency and intensity of CD138 expression were calculated using the SID staining index and compared between the two tumor types. All statistical analyses were performed using SPSS version 28 employing the Mann-Whitney, Kruskal-Wallis, Chi-square, Fisher’s exact and independent t-tests. A P of<0.05 was considered statistically significant. Statistical analysis of the lesions revealed a significant difference in staining intensity between the two tumor groups (P=0.033). A statistically significant difference was observed between the PA and MEC groups based on the SID index (P=0.002). Spearman’s correlation analysis demonstrated a significant correlation between the SID index and age (P=0.007). Intermediate- and high-grade MECs showed significantly higher expression rates of CD138 (P<0.05). Increased marker expression correlated with a higher histological grade and advanced clinical stage in MECs. The use of this marker should be considered for determining the prognosis of PAs and MECs; specifically, CD138 serves as a useful prognostic predictor for MECs.

The Value of Clinical, Laboratory and Brain CT Scan Findings in Methanol Toxicity

Leila Etemad — 2026-07-12

Methanol poisoning is a severe intoxication that can be fatal. This study aimed to determine the association between clinical and paraclinical findings, particularly brain radiological findings, and the risk of mortality in methanol-poisoned patients. This retrospective cross-sectional study was conducted at the CTD-IRH-MUMS, Mashhad, Iran, from March 2019 to March 2021. Medical and demographic data of adult patients with a confirmed diagnosis of methanol poisoning who had undergone a brain computed tomography (CT) scan were included. A total of 45 methanol-poisoned patients were enrolled in the study, including 36 men (80%) with a mean age of 34.32±13.20 years. Among them, 15 patients (33.3%) had at least one abnormal finding on their brain CT scans. The most frequent finding was diffuse cerebral hemorrhage (n=12, 26.7%), followed by subcortical white matter changes (n=9, 20%), and putaminal hypodensities (n=7, 15.6%). Although abnormal brain CT findings were associated with a higher risk of mortality (OR=4.929, P=0.019), they were not related to any specific type of CT findings. A Glasgow Coma Scale (GCS) score<9 (OR=0.445, P=0.003), respiratory rate>19 breaths/min (OR=2.675, P=0.006), serum creatinine level>1.8 mg/dL (OR=6.258, P=0.009), potassium level>4.3 mEq/L (OR=3.672, P=0.006), glucose level (OR=1.011, P=0.019), bicarbonate level<11.4 mEq/L (OR=0.872, P=0.003), and pH<7.11 (OR=0.001, P=0.003) were predictors of mortality with acceptable sensitivity and specificity. Lower GCS, PCO2, and HCO3 levels, along with higher blood pressure, were associated with a higher incidence of pathological brain CT findings. Physicians should consider acidosis, tachypnea, decreased consciousness, and elevated blood glucose and creatinine levels as predictors of mortality or pathological brain CT findings.

Reducing Pain in the First Stage of Labour Using Counter-Pressure Therapy in the Indonesian Hospital

Sri Rejeki — 2026-07-12

Inadequately managed labor pain can negatively impact the birthing process. Potential adverse effects of labor pain include stress, fatigue, impaired breathing patterns, inhibited oxytocin production, psychological distress, and an increased risk of medical interventions. Counter-pressure is a safe nursing intervention used to alleviate labor pain. This study aimed to determine the effect of counter-pressure on intrapartum maternal pain. A pre-experimental, one-group pretest-posttest design was utilized, focusing on first-stage intrapartum maternal pain within a hospital setting. The study participants included mothers in labor at the obstetrics department of Roemani Hospital, Semarang, Indonesia. A total of 20 participants were selected through purposive sampling. Data were collected using a numerical rating scale (NRS) and laboratory analysis of blood specimens. Results indicated that counter-pressure was effective in significantly reducing intrapartum maternal pain (P=0.0001). Following counter-pressure treatment, participants experienced a mean reduction of 2.4 points on the pain scale. The findings also demonstrated that counter-pressure does not adversely affect the inflammatory process or labor contractions. Sacral counter-pressure proved effective in alleviating pain during the first stage of labor. Nurses in obstetric units are encouraged to implement this intervention as a pain management strategy for intrapartum patients.

The Relationship Between a Genetic Variant in the HSPB1 Gene and a Lower Risk of Cardiovascular Diseases: The Results of the MASHAD Cohort Study

Fatemeh Sadabadi — 2026-07-12

Coronary heart disease (CHD) is a leading cause of death, highlighting the importance of risk stratification and prognostic biomarkers in CHD. There is a growing body of evidence supporting the potential value of heat shock proteins (HSPs) in the pathogenesis of atherosclerosis. Here, we explored the relationship between serum anti-HSP27 levels and a genetic variant, rs2868371, in the HSPB1 gene in the Stroke and Heart Atherosclerotic Disorders (MASHAD) cohort study carried out in Mashhad. A total of 8776 subjects were recruited. Anti-HSP27 levels were measured using an in-house enzyme-linked immunosorbent assay (ELISA), followed by genotyping using a TaqMan® probe-based assay. Demographic, biochemical, and hematological characteristics of the population were evaluated in all subjects. Kaplan-Meier curves were utilized, while logistic regression models were used to evaluate the relationship between genotypic frequencies and clinical characteristics of the population. No significant difference in anti-HSP27 levels was demonstrated between subjects with and without CHD. The frequencies of the CC, CG, and GG genotypes were 68%, 26.8%, and 5.2%, respectively. CAD patients with GG and GC genotypes had a lower risk of myocardial infarction (MI) compared with the reference group after adjusting for confounding factors [OR=0.27 (95% CI=0.08-0.94), P=0.040]. Our data revealed a relationship between the genetic variant in the HSPB1 gene and the risk of developing CHD, supporting further research on the potential value of this emerging marker in predicting

Evaluation of the Positive Impact of Tonsillectomy on Children Health Using Glasgow Benefit Inventory

Duraid H. Abid Alkadem — 2026-07-12

The aim of this survey was to determine the level of health improvement reported by parents of children with a history of chronic tonsillitis who had undergone tonsillectomy in Baqubah City, Iraq. This retrospective cross-sectional study involved a sample of 100 pediatric patients aged 3 to 15 years with previous chronic tonsillitis who underwent tonsillectomy at Baqubah Teaching Hospital. Health improvement was assessed using a self-administered questionnaire known as the Glasgow Benefit Inventory (GBI). This standardized measure consists of 18 retrospective items, each rated on a 5-point Likert scale, and is designed to assess the degree of improvement attributable to surgical intervention. The scale provides a total score and three subscale scores: General Health, Social Support, and Physical Health. Scores are standardized on a scale from -100 to 100, where any positive score indicates improvement in the physical and emotional well-being of patients who have undergone tonsillectomy, whereas negative scores suggest deterioration. Analysis of the findings showed significant differences among the subscale scores, with the Social Support subscale having the lowest score, followed by the General Health subscale, while the Physical Health subscale had the lowest final rank. After tonsillectomy, improvements were observed in the overall GBI score as well as in the General Health, Social Support, and Physical Health subscales. These findings indicate that tonsillectomy has clinical benefits and may help address some claims made against the procedure. This study supports the appropriate use of healthcare budgets and highlights the importance of tonsillectomy in the management of chronic tonsillitis, particularly for otolaryngologists.

Functional Outcomes and Complications in the Treatment of Floating Knee Injuries

Shahin Talebi — 2026-07-12

Ipsilateral femur and tibia fractures (floating knee injury) is a complex injury with severe associated injuries. The aim of this study was to assess the characteristics and treatment outcomes in patients with floating knee in a single trauma center. A retrospective study was conducted among patients with floating knee treated between January 2012 and January 2019 in a single trauma center. Patients with knee osteoarthritis, inflammatory arthritis, pathologic fracture, and with a history of previous fracture in ipsilateral leg were excluded. Data demographics, associated injuries, complications, and treatment outcome were collected. Karlstrom’s criteria were used to assess the results. We identified 48 patients aged 18 to 50 years old. All patients sustained a road traffic accident. Fraser type 1 was the most frequent type (62.5%). Open fracture reported in 25 cases (52.1%) at least in one bone. According to Karlstrom’s criteria, 8 cases (16.67%) with excellent results, 19 cases (39.58%) with good results, 14 cases with (29.17%) fair results, and 7 cases (14.58%) poor results were reported. Floating knee injury occurs in a high energy trauma context. Complication rate remains high, and surgeons should focus on reducing these complications.

Serum 17-Hydroxyprogesterone in Correlation With Semen Analysis Results and Hormonal Profile of Infertile Men

Ali Ibrahim Rahim Al-Dulaimi — 2026-07-06

Semen analysis and the evaluation of male reproductive hormones remain integral to the assessment of infertile men. Recent studies have demonstrated that serum 17-hydroxyprogesterone (17-OHP) levels serve as a reliable marker of the intratesticular testosterone environment. This study aims to determine the correlation between serum 17-OHP levels, seminal fluid analysis (SFA), and the hormonal profiles in infertile men. In this cross-sectional study, one hundred serum and seminal fluid samples were collected from infertile men attending the Al-Kafeel IVF center, Karbala, from October 2024 to May 2025. Participants were divided into four groups according to their SFA results. All included men underwent seminal fluid analysis according to WHO 2021 guidelines, and serum levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), total testosterone (TT), prolactin, estradiol (E2), and 17-OHP were measured using the ELISA technique. The current study showed no significant correlation between 17-OHP and any of the measured hormones in the normozoospermia group, and a strong, statistically significant negative correlation between serum 17-OHP and FSH across all groups (r= -0.375, P=0.000). There was also a negative correlation between sperm concentration and serum 17-OHP across all groups (r= -0.234, P=0.019). In the asthenozoospermia group, serum 17-OHP exhibited a highly significant negative correlation with sperm concentration and semen viscosity (r= -0.670, P=0.001) and (r= -0.590, P=0.005), respectively. A significant positive correlation was found between serum 17-OHP and sperm motility in the asthenozoospermia group (r=0.538, P=0.012), and a positive correlation with round cells in the oligoasthenoteratozoospermia (OAT) group (r=0.438, P=0.025). The study emphasizes the complex relationship between 17-OHP levels and sperm parameters. Although 17-OHP showed a strong negative association with FSH, statistically significant correlations may still have limited or unclear clinical implications, necessitating further studies.

Immunogenicity of COVID-19 Vaccines in Patients Under Immunosuppressive Therapy: Insights Into Antibody Response and Gender Differences

Reza Farrokhseresht — 2026-07-12

The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has impacted millions worldwide. Patients with autoimmune rheumatic diseases (ARDs) may exhibit attenuated responses to vaccination secondary to immunosuppressive therapy, potentially resulting in reduced vaccine effectiveness. This study investigates the immunogenicity of COVID-19 vaccines in patients with ARDs and evaluates antibody responses and the factors associated with such responses. We included 91 patients with rheumatologic diseases receiving immunosuppressive therapy and attending rheumatology clinics in Bandar Abbas, Iran. All had received two or three doses of a COVID-19 vaccine 6 months prior to enrollment. Antibody levels were measured using plaque reduction neutralization tests. We also collected information on demographics, clinical status, and current medication use. All statistical analyses were performed using SPSS version 21. Females constituted 89% of the participants. The majority had received the Sinopharm vaccine. Gender differences were observed, with males showing higher neutralizing antibody levels. No significant associations were detected between antibody levels and age, vaccine type, or medication use, except for adalimumab and etanercept, which showed a positive association with neutralizing antibodies. While most ARD patients demonstrated a detectable response, gender appeared to influence antibody levels, with females exhibiting a weaker response. Vaccine type did not influence antibody levels, and medication use did not show consistent correlations with antibody responses. These findings are consistent with the literature suggesting that vaccine efficacy may be reduced in immunocompromised populations, further supporting individualized vaccination strategies. COVID-19 vaccines provide incomplete protection in patients with ARDs, and immunosuppressive therapy and gender may affect vaccine efficacy. Personalized vaccination schedules, including booster doses, are recommended to improve protection in this population. Further studies are needed to refine vaccination strategies for immunocompromised patients, with the aim of reducing the burden of severe illness and improving public health.

Serum IFN-γ and Electrolyte Dysregulation as Independent Predictors of COVID-19 Severity: A Cross-Sectional Study in Iraqi Patients

Farah A. Alwaeely — 2026-07-12

COVID-19 pandemic has caused a significant mortality and morbidity in Iraq. Evidence is mounting that immune dysfunction and electrolyte derangements are key factors in disease progression and clinical outcome. The aim of this study was to assess the diagnostic utility of serum interferon gamma (IFN-gamma) along with electrolyte levels (potassium, sodium, chloride and calcium) as markers for the severity of the COVID-19 disease using ROC curve analysis. This cross-sectional study included 200 confirmed COVID-19 (severe, 100 patients; non-severe, 100 patients) admitted to Dar Al-Salam Hospital in Baghdad during January to December 2023. Severity was determined at admission according to the criteria set by the WHO. The level of serum IFN-gamma was measured by sandwich ELISA and electrolytes (Na, K, Ca and Cl) were estimated by biochemical assays with standard chemicals. Mann-Whitney U, chi-square, Spearman correlation, and ROC curve analyses were carried out using SPSS version 26 (IBM Corp., Chicago, IL, USA). Median serum IFN-gamma was significantly higher in non-severe patients than in severe patients (30.71 vs 7.81 pg/ml; P<0.001). Sodium levels were lower in severe cases (139.95 vs 146.80 mmol/L; P<0.001), while calcium was elevated (10.27 vs 9.37 mg/dL; P<0.001). Chloride and potassium were significantly higher in severe patients (P<0.001). ROC analysis demonstrated excellent discriminatory ability for IFN-gamma (AUC=0.917, 95% CI: 0.876-0.957), good ability for calcium (AUC=0.857) and chloride (AUC=0.848), and good ability for sodium (AUC=0.827). Potassium showed fair discriminatory ability (AUC=0.702), with elevated levels associated with disease severity. Elevated IFN-gamma in non-severe cases indicates its association with reduced inflammation and recovery, while low levels correlate with disease progression. Electrolyte imbalance plays a pivotal role in COVID-19 severity. IFN-gamma, calcium, and chloride demonstrate excellent to good predictive performance for disease severity.

Designing and Evaluating Psychometric Properties of a Tool for Assessing Primary Elderly Health Services in Iran

Faezeh Bahador — 2026-08-11

Semen Accurately assessing the status of older adults and evaluating service delivery requires a standardized instrument to capture primary healthcare conditions. Therefore, this study aimed to develop and validate a tool to assess the current provision of primary preventive services for the elderly in Iran. This exploratory sequential mixed-methods study was conducted in two phases: a quantitative descriptive survey for instrument development and measurement, and a qualitative phase using content analysis to gather expert perspectives. First, a comparative analysis was performed to describe the provision of primary preventive health services for the elderly in Iran and selected countries. Expert consensus was then obtained across three Delphi rounds to design a structured questionnaire. Face and content validity (CVR and CVI) were assessed to confirm key variables and items, and internal consistency reliability was determined using Cronbach's alpha coefficient. The instrument comprised demographic characteristics and domain-specific items derived from the Delphi process. Content validity ratio (CVR) and content validity index (CVI) were established based on the evaluation of 12 academic experts for each item. Confirmatory factor analysis (CFA) was used to evaluate the relationships between latent variables and their observed indicators. The final tool consisted of 6 dimensions and 64 items. Cronbach’s alpha coefficients for the dimensions were 0.71, 0.84, 0.75, 0.76, 0.82, and 0.92, respectively, demonstrating acceptable to high internal consistency. The findings indicate that the developed tool possesses sound psychometric properties and provides a practical, standardized instrument for healthcare decision-makers to evaluate and enhance primary geriatric healthcare services.