Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 53 7 2015 10 06 393 394 EN Hosein Dalili Department of Neonatology, Breast Feeding Research Center, Tehran University of Medical Sciences, Tehran, Iran Fatemeh Nayeri Department of Neonatology, Breast Feeding Research Center, Tehran University of Medical Sciences, Tehran, Iran Mamak Shariat Department of Maternal and Child Health, Maternal-Fetal-Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran Leila Asgarzadeh Department of Medicine, Breast Feeding Research Center, Tehran University of Medical Sciences, Tehran, Iran 2015 10 06 2015 10 06 Lamotrigine is a safe anti-epileptic drug among pregnant and lactating women. Some concerns exist regarding the safety of lamotrigine during breastfeeding and related neonatal complications. In this brief review, this matter was evaluated and discussed. In this review study, the medical literature available in search databases such as Embase, Scopus, PubMed, and Medline and even also local medical search engines were evaluated. The results indicated that lamotrigine is a safe anti-epileptic drug for breastfeeding women with rare and usually mild adverse effects among neonates exposed to high milk concentration of this drug and its metabolites. However, close periodical monitoring for infants whose mothers are utilizing lamotrigine is recommended to decrease the probability of severe side effects among them. https://acta.tums.ac.ir/index.php/acta/article/view/4264 https://acta.tums.ac.ir/index.php/acta/article/download/4264/4219

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 53 7 2015 10 06 395 402 EN Behnam Heidari Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. AND Endocrinology and Metabolism Research center, Vali-asr Hospital, School of Medicine,Tehran University of Medical Sciences, Tehran, Iran Akbar Fotouhi Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Frshad Sharifi Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran Kazem Mohammad Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Mohammad Pajouhi Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran Koosha Paydary Iranian Research Center for HIV/AIDS (IRCHA), Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran Hossein Fakhrzadeh Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran 2015 10 06 2015 10 06 Type 2 diabetes mellitus is associated with increased inflammation and accelerated atherosclerosis. The association of the pro-inflammatory and potentially pro-atherosclerotic molecule, pregnancy associated plasma protein-A (PAPP-A) with diabetes and vascular diseases remains to be further established. A total of 107 patients with type 2 diabetes and 101 healthy controls participated in this study. Serum levels of PAPP-A was measured by Enzyme-linked Immunosorbent Assay (ELISA). We also evaluated the lipid profile, aortic augmentation index, coronary calcium score, ankle brachial index, flow mediated dilation, and carotid intima media thickness. Serum level of PAPP-A was significantly higher in patients with diabetes compared to controls (PPP=0.021) and was negatively associated with coronary calcification (P=0.050). In conclusion, serum levels of PAPP-A were significantly higher in diabetics compared to healthy controls and correlated with aortic augmentation index and coronary calcification. Our study results suggest that PAPP-A can be a marker of subclinical atherosclerosis in patients with diabetes. https://acta.tums.ac.ir/index.php/acta/article/view/4267 https://acta.tums.ac.ir/index.php/acta/article/download/4267/4222

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 53 7 2015 10 06 403 407 EN Parastoo Tarighi Department of Medical Biotechnology, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran Mohammad Reza Khorramizadeh Department of Medical Biotechnology, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran Armin Madadkar Sobhani Department of Bioinformatics, Institute of Biochemistry and Biophysics, Tehran University, Tehran, Iran Seyed Nasser Ostad Department of Toxicology-Pharmacology, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran Mohammad Hossein Ghahremani Department of Toxicology Pharmacology, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. AND Department of Molecular Medicine, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran 2015 10 06 2015 10 06 Interaction between urokinase-type plasminogen activator (uPA) and its receptor (uPAR) plays an important role in the progression of numerous cancer types including breast cancer by promoting tumor initiating,  proliferation,  invasion  and  metastasis.  Hence,  disruption  of  this  interaction  inhibits  their downstream cascades and subsequently tumor growth. For this, we created two series of 8 and 10 amino acids linear peptides, derived from uPA binding region to target uPAR and studied the inhibition of proliferation in MDA-MB-231 cell line. Results revealed that all of the 10-mer peptides inhibited breast cancer cell proliferation significantly with maximum 40% inhibition of 103 peptides. Meanwhile, none of the 8-mer peptides showed significant toxicity. Current results indicate that the linear 10-mer peptides which mimic a small part of a sequence of a binding domain of uPA to uPAR could be exploited to design a novel class of anti-cancer agents. https://acta.tums.ac.ir/index.php/acta/article/view/4270 https://acta.tums.ac.ir/index.php/acta/article/download/4270/4683

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 53 7 2015 10 06 408 411 EN Marjaneh Zarkesh Pediatrics growth disorders research center, 17 Shahrivar Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran Fatemeh Sedaghat Pediatrics growth disorders research center, 17 Shahrivar Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran Abtin Heidarzadeh Department of Social Medicine, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran Manizheh Tabrizi Pediatrics growth disorders research center, 17 Shahrivar Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran Kobra Bolooki Moghadam Pediatrics growth disorders research center, 17 Shahrivar Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran Soheil Ghesmati Pediatrics growth disorders research center, 17 Shahrivar Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran 2015 10 06 2015 10 06 Since  clinical  manifestations  of  most  febrile  infants  younger  than  three  months  old  are nonspecific, differentiation of Serious Bacterial Infection (SBI) from self-limiting viral illness is a significant challenge for pediatricians. This study was performed to assess the diagnostic value of white blood cell count (WBC), Absolute Neutrophil Count (ANC), Interleukin -6 (IL-6) and C-reactive protein   (CRP) level to predict SBI in febrile infants younger than three months old who were hospitalized. This was a diagnostic test validation study. In this prospective study, 195 febrile infants admitted to 17 Shahrivar Hospital underwent a full sepsis workup including blood, urine, cerebrospinal fluid cultures and chest radiography. WBC count, ANC and CRP and Il-6 level were measured in all patients. Serum IL-6 concentration was measured by Enzyme-linked Immunosorbent Assay test. Then diagnostic, values of these tests for predicting SBI was compared with each other. Of total cases, 112 (57.4%) infants were male. SBI was diagnosed in 29 (14.9%) patients. The most common type of SBI was Urinary Tract Infection (UTI). Serum IL-6 (³20pg/dl) had sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 79/1%, 91.6%,75.4%,  60.3%,  respectively  and  for  CRP  (³  10mg/l)  values  were  81.6%,  89.8%,  78.2%,  and  52%,respectively. The predictive values of CRP and IL-6 were higher than WBC and ANC. IL-6 and CRP are more valid and better diagnostic markers for predicting SBI than WBC count and ANC. CRP level seems to be an accessible and cost-effective marker for early diagnosis of SBI. Since by no marker we can totally rule out SBI in febrile infants < three months of age, it is recommended to administer systemic antibiotics until culture results become available. https://acta.tums.ac.ir/index.php/acta/article/view/4272 https://acta.tums.ac.ir/index.php/acta/article/download/4272/4227

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 53 7 2015 10 06 412 418 EN Fariba Seighali Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran AND Breast Feeding Research Center, Tehran University of Medical Science, Tehran, Iran Zahra Farahani Department of Physiology, Fetal and Neonatal Research Center, Tehran University of Medical Science, Tehran, Iran Mamak Shariat Family Health Institute, Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Science, Tehran, Iran 2015 10 06 2015 10 06 Health professionals play crucial roles on the self-confidence of nursing mothers and their knowledge of breastfeeding. The aim of this study was a comparison of two different breastfeeding workshops on participants’ knowledge, attitude, practice (KAP) and related factors. A cross-sectional study took place in Fetal and neonatal Research Centre (2011- 2012). The intervention composed of two different training courses in breastfeeding. Two workshops were held during three days in two parts: lectures and practical. Each speech regarded the most important aspects of breastfeeding. In training part, a breastfeeding consultant managed the practical exercises. In the second workshop the lecturers used different methods (didactic, strategies to enhance active involvement, educational devices and so on). A questionnaire was used to evaluate participants' KAP before and after each workshop. Among 40 participants in the first workshop, the average age was 37.78 years old, 32 were midwives-nurses and 8 were GPs-residents.   Twenty six had children from which 19 breastfed successfully. Of 27 participants in a second workshop with an average age of 38.59 years, 19 were midwifes- nurses.   Fourteen reported having children from which 11 breastfed successfully. Our data showed that both workshops improved participants’ KAP scores significantly. No significant differences were seen between two groups’ attitude before workshops (P. Value =0.093) but this difference, after the workshop was noticeable (P. Value =0.000). The pertained background factors in changing KAP were: having children, successful breastfeeding experience and age (P. Value< 0.05). In-service breastfeeding training program improves KAP; however, the interactive, practical method is much more effective in changing attitudes of participants. https://acta.tums.ac.ir/index.php/acta/article/view/4274 https://acta.tums.ac.ir/index.php/acta/article/download/4274/4229

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 53 7 2015 10 06 419 424 EN Seyyed Kamran Soltani Arabshahi Department of Medical Education, Center for Educational Research in Medical Sciences (CERMS), School of Medicine, Iran University of Medical Sciences, Tehran, Iran Hoorieh Mohammadi Kenari Medical Sciences Education and Development Office, School of Traditional Medicine,Tehran University of Medical Sciences, Tehran, Iran Gholamreza Kordafshari Department of Traditional Medicine, School of Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran Mohammad Reza Shams Ardakani Department of Traditional Medicine, School of Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran Shoaleh Bigdeli Department of Medical Education, Center for Educational Research in Medical Sciences (CERMS), School of Medicine, Iran University of Medical Sciences, Tehran, Iran 2015 10 06 2015 10 06 The major difference between Iranian traditional medicine and allopathic medicine is in the application  of  evidence  and  documents.  In  this  study,  criteria  for  evidence-based  practice  in  Iranian traditional medicine and its rules of practice were studied. The experts’ views were investigated through in- depth, semi-structured interviews and the results were categorized into four main categories including Designing clinical questions/clinical question-based search, critical appraisal, resource search criteria and clinical prescription appraisal. Although the application of evidence in Iranian traditional medicine follows Evidence Based Medicine (EBM) principles but it benefits from its own rules, regulations, and criteria that are compatible with EBM. https://acta.tums.ac.ir/index.php/acta/article/view/4279 https://acta.tums.ac.ir/index.php/acta/article/download/4279/4234

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 53 7 2015 10 06 425 431 EN Manouchehr Nakhjavani Department of Endocrinology, Endocrinology and Metabolism Research Center (EMRC), Tehran University of Medical Sciences, Tehran, Iran metabolic syndrome and some Cardio-metabolic risk factors Also lipid accumulation product may have been a useful tool for predicting cardiovascular disease and metabolic syndrome risk in postmenopausal women. https://acta.tums.ac.ir/index.php/acta/article/view/5682 https://acta.tums.ac.ir/index.php/acta/article/download/5682/4801

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 6 2016 06 08 376 381 EN Somayeh Sharifynia Department of Medical Mycology and Parasitology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Hamid Badali Department of Medical Mycology and Parasitology, Pharmaceutical Sciences Research Center, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. Mina Sharifi Sorkherizi Department of Medical Mycology and Parasitology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Reza Shidfar Department of Medical Mycology and Parasitology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Atefe Hadian Department of Medical Mycology and Parasitology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Shadi Shahrokhi Islamic Azad University, Varamin-Pishva Branch, Varamin, Iran. Ghazale Ghandchi Pediatric Infections Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Sassan Rezaie Department of Medical Mycology and Parasitology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 18 2015 12 07 Candidiasis, the main opportunistic fungal infection has been increased over the past decades. This study aimed to characterize C.albicans species complex (C.albicans, C.dubliniensis, and C.africana) isolated from patients with respiratory infections by molecular tools and in vitro antifungal susceptibilities by using broth microdilution method according to CLSI M27-A3 guidelines. Totally, 121 respiratory samples were collected from patients with respiratory infections. Of these, 83 strains were germ tube positive and green colonies on chromogenic media, so initially identified as C.albicans species complex and subsequently were classified as C.albicans (89.15%), C.dubliniensis (9.63%), and C.africana (1.2%) based on PCR-RFLP and amplification of hwp1 gene. Minimum inhibitory concentration (MICs) results showed that all tested isolates of C.albicans complex were highly susceptible to triazole drugs. However, caspofungin had highest activity against C.albicans, C.dubliniensis, and C.africana. Our findings indicated the variety of antifungal resistance of Candida strains in different areas. These results may increase the knowledge about the local distribution of the mentioned strains as well as their antifungal susceptibility pattern which play an important role in appropriate therapy. https://acta.tums.ac.ir/index.php/acta/article/view/4996 https://acta.tums.ac.ir/index.php/acta/article/download/4996/4802

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 6 2016 06 08 382 390 EN Gholamali Yousefipour Department of Neurology Sciences, Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. Zabihollah Hashemzahi Department of Neurology Sciences, Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. Masood Yasemi Department of Ophthalmology, Poostchi Eye Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. Pegah Jahani Department of Medicine, Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran. 2015 09 29 2016 02 28 Multiple sclerosis (MS) is the most prevalent disease caused by the inflammatory demyelinating process that causes progressive nervous system degeneration over the time. Optical Coherence Tomography (OCT) is a non-invasive optical imaging technology, which can measure the thickness of retinal nerve fiber layer as well as the diameter of the macula. The purpose of the study is evaluation OCT findings in two common types of multiple sclerosis. For doing the cross-sectional study, 63 patients with two prevalent types of multiple sclerosis (35 patients with Relapse Remitting Multiple Sclerosis (RRMS) and 28 patients with Secondary Progressive Multiple Sclerosis (SPMS) were evaluated for 6 months. Exclusion criteria of the study were a history of optic neuritis, suffering from diabetes mellitus, hypertension, ocular disease, and the presence of other neurologic degenerative diseases. Then, the thickness of retinal nerve fiber layer (RNFL), as well as thickness and volume of the macula, were measured in the patients using OCT technology. The disability rate of patients was evaluated according to Expanded Disability Status Scale (EDSS). Finally, data was analyzed by means of SPSS software. Overall, 35 patients with RRMS (with mean age of 32.37+10.01, average disease period of 3.81+3.42 and mean EDSS of 1.84+0.45) and 28 patients with SPMS (with mean age of 39.21+9.33, average disease period of 11.32+5.87 and mean EDSS of 5.12+1.46) were assessed and compared in terms of retinal nerve fiber layer and size and thickness of macula. In all of these sections, the thicknesses were smaller in SPMS patients than patients with RRMS. But, there was a significant difference in total thickness (81.82µm versus 96.03µm with P=0.04) and thickness of temporal sector (54.5 µm versus 69.34 µm with P=0.04) of retinal nerve fiber layer and macular size at the superior sector of external ring (1.48 mm³ versus 1.58 mm³ with P=0.03), and nasal sector of external ring surrounding macula (1.53 mm³ versus 1.66 mm³ with P=0.03). No significant correlation was found among rising disability and reduced thickness of macula and optic nervous layer. Based on the study results, it can be said that OCT is a useful method for showing axonal degeneration severity and evaluation of various drugs effects on the course of MS disease, and thus we can change drugs based on OCT findings for achieving best results. https://acta.tums.ac.ir/index.php/acta/article/view/4242 https://acta.tums.ac.ir/index.php/acta/article/download/4242/4803

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 6 2016 06 08 391 394 EN Mojtaba Chardoli Department of Emergency Medicine, Haftom-e-Tir Hospital, Iran University of Medical Sciences, Tehran, Iran. Nader H. Firoozabadi Department of Emergency Medicine, Haftom-e-Tir Hospital, Iran University of Medical Sciences, Tehran, Iran. Mohsen Nouri Department of Neurosurgery, Razi Hospital, Zahedan University of Medical Sciences, Zahedan, Iran. Vafa Rahimi-Movaghar Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 11 11 2016 02 22 Cerebrovascular attack (CVA) and transient ischemic attack (TIA) are major causes of emergency department visits around the globe. A significant number of these patients may experience repeat attacks if left untreated. Several risk stratifying scoring systems have been developed in recent years to point out the high risk patients. ABCD2 is based on age, blood pressure, clinical status, diabetes mellitus, and duration of symptoms and is used commonly for this purpose. In this study, we were to enhance its sensitivity and specificity with the addition of another criterion namely atrial fibrillation and making ABCD2-F. A prospective study in two hospitals was performed and 138 patients diagnosed with TIA/CVA were enrolled. Demographic, clinical, and paraclinical data of all patients were registered. All patients were followed for three months for any sign or symptom of a recurrent ischemic attack. Recurrent ischemic attacks happened in 9.4% of the patients. None of the criteria of ABCD2-F was associated with higher chance of ischemic attacks. Similarly, ABCD2-F was not different between patients with or without repeat cerebral ischemia. The addition of atrial fibrillation to ABCD2 did not enhance the accuracy of this scoring system to detect patients high risk for repeat cerebral ischemia. More studies in the future to improve sensitivity and specificity of this test are warranted. https://acta.tums.ac.ir/index.php/acta/article/view/5130 https://acta.tums.ac.ir/index.php/acta/article/download/5130/4804

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 6 2016 06 08 395 400 EN Fatemeh Farahmand Department of Pediatric Gastroenterology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran. Tayebeh Mohammadi Department of Pediatrics, Children’s Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran. Mehri Najafi Department of Pediatric Gastroenterology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran. Gholamhosein Fallahi Department of Pediatric Gastroenterology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran. Ahmad Khodadad Department of Pediatric Gastroenterology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran. Farzaneh Motamed Department of Pediatric Gastroenterology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran. Sayed Mahdi Marashi Department of Forensic Medicine and Clinical Toxicology, Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran. Maryam Shoaran Department of Pediatrics, Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Raheleh Nabavizadeh Rafsanjani Department of Pediatrics, Children’s Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran. 2016 06 05 Helicobacter pylori infection is a prevalent disease among Iranian children. The purpose of this study was to compare the effect of ciprofloxacin and furazolidone on eradicating helicobacter pylori in Iranian children in combination with amoxicillin and omeprazole. In this cohort study, helicobacter pylori infection was confirmed by gastroscopy, rapid urease test or pathologic assessments. A total of 66 children were randomly enrolled; based on the random number table, and were divided into two groups; first, a combination regimen consisting of ciprofloxacin, amoxicillin, and omeprazole; second, a three-medication regimen consisting of amoxicillin, furazolidone, and omeprazole. The effect of both medical regimens on the successful eradication of helicobacter pylori infection was assessed and compared. Chi-square test was used for evaluating the association between quantitative variables. All comparisons were made at the significance of P<0.05. Endoscopic tests prior to initiating treatments showed that 66.7% of the patients had a degree of nodularity while peptic ulcer was only observed in one patient. One month after the end of the treatments, eradication of the helicobacter pylori infect