Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 53 11 2015 11 29 669 675 EN Somayeh Mahmoodi Department of Medical Biochemistry, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Mahdieh Rahmatollahi Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Fatemeh Shahsavari Department of Oral and Maxillofacial Pathology Dental Branch, Islamic Azad University, Tehran, Iran. Hamed Shafaroodi Department of Pharmacology and Toxicology, Pharmaceutical Sciences Branch and Pharmaceutical Sciences Research Center, Islamic Azad University, Tehran, Iran. Siyavash Grayesh-Nejad Department of Medical Biochemistry, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Ahmad R. Dehpour Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. AND Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 11 28 Increased nitric oxide (NO) formation is mechanistically linked to pathophysiology of the extrahepatic complications of cirrhosis. NO is formed by either enzymatic or non-enzymatic pathways. Enzymatic production is catalyzed by NO synthase (NOS) while entero-salivary circulation of nitrate and nitrite is linked to non-enzymatic formation of NO under acidic pH in the stomach. There is no data on salivary excretion of nitrate and nitrite in cirrhosis.  This study was aimed to investigate salivary levels of nitrate and nitrite in a rat model of biliary cirrhosis. Cirrhosis was induced by bile duct ligation (BDL). Four weeks after the operation, submandibular ducts of anesthetized BDL and control rats were cannulated with polyethylene microtube for saliva collection. Assessment of pH, nitrite and nitrate levels was performed in our research. We also investigated NOS expression by real time RT-PCR to estimate eNOS, nNOS and iNOS mRNA levels in the submandibular glands. Salivary pH was significantly lower in BDL rats in comparison to control animals. We also observed a statistically significant increase in salivary levels of nitrite as well as nitrate in BDL rats while there was no elevation in the mRNA expression of nNOS, eNOS, and iNOS in submandibular glands of cirrhotic groups. This indicates that an increased salivary level of nitrite/nitrate is less likely to be linked to increased enzymatic production of NO in the salivary epithelium. It appears that nitrate/nitrite can be transported from the blood stream by submandibular glands and excreted into saliva as entero-salivary circulation, and this mechanism may have been exaggerated during cirrhosis. https://acta.tums.ac.ir/index.php/acta/article/view/5209 https://acta.tums.ac.ir/index.php/acta/article/download/5209/4710

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 53 11 2015 11 29 667 668 EN Mehdi Zeinalizadeh Brain and Spinal Cord Injuries Repair Research Center (BASIR), Imam Khomeini Hospital, Tehran, Iran. AND Department of Neurological Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran. Zahid Hussain Khan Brain and Spinal Cord Injuries Repair Research Center (BASIR), Imam Khomeini Hospital, Tehran, Iran. AND Department of Neuroanesthesiology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2015 11 28 No Abstract https://acta.tums.ac.ir/index.php/acta/article/view/5208 https://acta.tums.ac.ir/index.php/acta/article/download/5208/4709

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 53 11 2015 11 29 725 727 EN Mozaffar Aznab Department of Internal Medicine, Taleghani Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran. Naser Kamalian Department of Pathology, Tehran University of Medical Sciences, Tehran, Iran. Jaffar Navabi Department of Internal Medicine, Taleghani Hospital, Kermanshah, Iran. Kaveh Kavianimoghadam Department of Paramedical, School of Medicine, Kermanshah of University Medical Sciences, Kermanshah, Iran. 2015 10 20 2015 10 20 Kikuchi-Fujimoto disease or histiocytic necrotizing lymphadenitis is an idiopathic, self-limiting disorder and predominantly affects young women. We report a 35-year-old female who presented with soft to firm cervical lymphadenopathy and neck pain. She had multiple enlarged cervical nodes. Examination of other systems was normal. Lymph node biopsy was performed, and the histological features, and immunohistochemistry confirmed the diagnosis. The Patient was treated with non-steroidal anti-inflammatory drugs and low-dose prednisolone. A significant decrease in the size of lymph node and relief of neck pain occurred. During four years of follow-up, the patient developed no malignant disease or systemic and autoimmune diseases such as systemic lupus erythematosus. Kikuchi-Fujimoto disease is rare, clinicians should be aware of this condition as early diagnosis of the disease will lessen concerns of the patient's family. https://acta.tums.ac.ir/index.php/acta/article/view/5019 https://acta.tums.ac.ir/index.php/acta/article/download/5019/4690

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 53 11 2015 11 29 676 680 EN Mehrdokht Mazdeh Department of Neurology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran. Abbas Taher Department of Anesthesiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran. Saadat Torabian Department of Public Health, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran. Soroush Seifirad Department of Pediatric Cardiology, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 11 28 Oxygen therapy might increase damaged tissue oxygenation, turn on the aerobic pathway, and save neurons from death and could improve clinical outcome of the patients with stroke and head trauma. Hyperbaric oxygen therapy is accompanied by some unfavorable effects. Results of normobaric oxygen therapy on clinical outcomes of patients with stroke were controversial up till now.  This study was therefore designed to evaluate effects of normobaric hyperoxia on clinical outcomes of patients with severe acute stroke. A total of 52 consecutive patients with stroke who meet the inclusion criteria of the study were entered into this randomized controlled clinical trial. The patients in the case group underwent oxygen therapy with Venturi mask for first 12 hours of admission. The patients were examined for neurologic defects at the time of discharge and after six months using both Barthel and modified Rankin Scale (mRS) neurologic disability scoring systems. There was no significant sex difference between the two groups (P=0.5). There was no statistically significant difference between ischemic-hemorrhagic stroke constitutions of two groups (P=0.2). There were no significant difference in Barthel index scores of both groups at the time of discharge as well as the follow-up examination (P=0.7) According to the mRS scoring system, there was no difference between the patients of both groups at the time of admission (P= 0.8), however after treatment there was a significant difference between mRS scores of the treated group compared to the controls (P=0.04). According to the results of this study, normobaric oxygen therapy in the first 12 hours of accident could improve long time outcome of the patients with either ischemic or hemorrhagic stroke. https://acta.tums.ac.ir/index.php/acta/article/view/5210 https://acta.tums.ac.ir/index.php/acta/article/download/5210/4711

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 53 11 2015 11 29 728 730 EN Pedram Paragomi Digestive Diseases Research Center, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran. Kamran Moradi Digestive Diseases Research Center, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran. Pejman Khosravi Digestive Diseases Research Center, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran. Reza Ansari Digestive Diseases Research Center, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran. 2015 11 29 Crohn’s disease (CD) is rarely presented with lower GI bleeding (LGIB) which eludes the clinician. A 25-year-old lady with severe rectorrhagia was presented with no history of constipation, diarrhea or abdominal pain. Colonoscopy revealed ulcers in the rectum, sigmoid colon, and terminal ileum. Crohn’s pathologic features were detected in the terminal ileum. The bleeding was controlled via supportive care and IV corticosteroid. Recurrent LGIB was managed by prednisolone and azathioprine. The patient had an uneventful recovery. The clinicians should consider CD as a possible diagnosis in severe LGIB. Prednisolone and azathioprine efficiently control acute bleeding episodes and prevent the recurrence. https://acta.tums.ac.ir/index.php/acta/article/view/5218 https://acta.tums.ac.ir/index.php/acta/article/download/5218/4719

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 53 11 2015 11 29 681 685 EN Alireza Abdollahi Department of Pathology, Imam Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. AND Thrombosis Hemostasis Research Center, Tehran University of Medical Sciences, Tehran, Iran. Ramesh Omranipour Department of Surgery, Imam Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. 2015 11 28 Patients with malignancy are at higher risk of thrombotic complications due to the hypercoagulability state. Our objective in this study was to assess the serum concentrations of Homocysteine, anti phospholipid antibodies, and anti cardiolipin in patients with benign and malignant breast tumors and study the effect of chemotherapy on the serum levels of these markers. A case control study was carried out on 100 women with malignant breast tumor and 100 age matched control with benign breast tumors.Serum concentrations of heomocystein, anti cardiolipin antibody (IgG and IgMaCL) and anti-phospholipid antibody (IgG and IgMaPL) were measured in all cases. The malignant group was followed for six months, and serum levels of abovementioned markers were measured again after surgical removal of breast tumor and chemotherapy. Current results showed a significantly higher serum concentration of Homocysteine, IgG and IgMaPL, IgG and IgM aCL in patients with malignant tumor before chemotherapy compared with benign tumor patients. We found a significant decrease in these markers after chemotherapy (P Value<0.05).We propose performing these tests (Homocysteine, IgG and IgM aPL, aCL) in patients with breast malignancy and starting prophylactic anti-thrombotic treatment in those with high serum levels of the markers. In addition, since the serum levels of the markers in patients with malignancy reduce after adjuvant therapies, we strongly recommend using adjuvant chemotherapy in these patients. https://acta.tums.ac.ir/index.php/acta/article/view/5211 https://acta.tums.ac.ir/index.php/acta/article/download/5211/4712

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 53 11 2015 11 29 731 732 EN Khadijeh Arjmandi Department of Pediatric Hematology and Oncology, Ali-Asghar Hospital, Tehran, Iran . AND Department of Pathology, Ali-Asghar Hospital, Tehran, Iran. Tahereh Rostami Department of Pediatric Hematology and Oncology, Ali-Asghar Hospital, Tehran, Iran . AND Department of Pathology, Ali-Asghar Hospital, Tehran, Iran. Saeed Yusefian Department of Pediatric Hematology and Oncology, Ali-Asghar Hospital, Tehran, Iran . AND Department of Pathology, Ali-Asghar Hospital, Tehran, Iran. Ghasem Miri-Aliabad Children and Adolescent Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran. Azadeh Kiumarsi Department of Pediatric Hematology and Oncology, Ali-Asghar Hospital, Tehran, Iran . AND Department of Pathology, Ali-Asghar Hospital, Tehran, Iran. Mitra Mehrazma Department of Pediatric Hematology and Oncology, Ali-Asghar Hospital, Tehran, Iran . AND Department of Pathology, Ali-Asghar Hospital, Tehran, Iran. 2015 11 22 Wilms’ tumor is the most common abdominal tumor of childhood, and its cerebral metastasis is apparently very rare. The authors report an 18-month-old girl with Wilms’ tumor and brain metastasis. https://acta.tums.ac.ir/index.php/acta/article/view/5182 https://acta.tums.ac.ir/index.php/acta/article/download/5182/4708

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 53 11 2015 11 29 686 689 EN Seyed Mehdi Ahmadi Health Policy Research Center, Shiraz University of Medical Sciences, Fars, Iran. Sareh Keshavarzi Department of Epidemiology, School of Health and Nutrition, Shiraz University of Medical Sciences, Fars, Iran. Seyed-Ali Mostafavi Psychiatry Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran. Kamran Bagheri Lankarani Health Policy Research Center, Shiraz University of Medical Sciences, Fars, Iran. 2015 11 28 Overweight/obesity and depression are common among women especially in the elderly and can lead to unfavorable outcomes. We aimed to determine the association of overweight with depression and also to find any correlation of depression with some anthropometric indices in old women. A total of 94 depressed elderly women were compared with 99 non-depressed controls. The structured diagnostic interview based on DSM-IV were performed to diagnose depression, and Geriatric Depression Scale (GDS) was completed to rate it. Anthropometric indices were measured and compared between groups. Pearson correlation coefficients were determined for linear relations between variables. Odds Ratio of obesity and overweight in depressed subjec 2015 10 31 2016 03 04 Mental rotation is a cognitive motor process which was impaired in different neurologic disorders. We investigated whether there were deficits in response pattern, reaction time and response accuracy rate of mental rotation in multiple sclerosis (MS) patients compared to healthy subjects and whether cognitive dysfunctions in MS patients were correlated with mental rotation deficits. Moreover, we showed whether there was a difference between upper and lower-limbs mental rotation in MS patients. Thirty-five MS patients and 25 healthy subjects performed hand mental rotation (HMR) and foot mental rotation (FMR) tasks. Visual information processing speed, spatial learning and memory ability, and visuospatial processing were assessed by Symbol Digit Modalities Test (SDMT), Brief Visuospatial Memory Test–Revised (BVMT-R), and Judgment of Line Orientation Test (JLO) respectively in MS patients. Reaction time for both hand and foot stimuli increased, and response accuracy rate for hand stimuli decreased in MS patients compared to healthy subjects, but response pattern of mental rotation in MS patients persisted. Similar to healthy subjects, MS patients performed upper-limbs mental rotation more easily than a lower-limbs mental rotation with more speed and response accuracy rate. Reaction time and response accuracy rate were correlated with the mentioned cognitive functions. MS patients made use of the correct response pattern for problem solving of increasing orientation from upright stimuli. Reaction time and response accuracy rate altered in these patients and this alteration might occur along with impairment in motor planning. Subjects’ better responding to hand stimuli was due to more familiarity with hand stimuli. The correlation of mental rotation ability with cognitive functions indicates the possible role of cognitive functions in mental rotation. https://acta.tums.ac.ir/index.php/acta/article/view/5101 https://acta.tums.ac.ir/index.php/acta/article/download/5101/4824

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 8 2016 09 17 518 524 EN Neda Hasanpour Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran. Behrouz Attarbashi Moghadam Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran, Ramin Sami Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Kamran Tavakol Department of PTRS, School of Medicine, University of Maryland Baltimore, Baltimore MD, USA. 2015 11 21 2016 02 02 The clinical COPD questionnaire (CCQ) has been developed to measure the health status of COPD patients. The aim of this study was to translate CCQ into the Persian language and assess the validity and reliability of the translated version. We used a forward-backward procedure to translate the questionnaire. In a cross-sectional study 100 COPD patients and 50 healthy subjects over 40 years old were selected to assess the reliability and construct validity of the instrument. The face and content validity were used for the questionnaire validity. Validity was examined in a population of patients with COPD, using the Persian validated version of the St George's Respiratory Questionnaire (PSGRQ). In order to assess the questionnaire’s reliability, the Intraclass correlation coefficient (ICC) and Cronbach’s alpha were calculated. Test-retest reliability was tested by re-administering the Persian version of the CCQ (PCCQ) after 1 week. Test-retest carry out of data demonstrates that the PCCQ has excellent reliability (ICC for all 3 domains were higher than 0.9). Internal consistency was found by Cronbach’s alpha to be 0.96, 0.94, 0.97, and 0.98 for the symptom, mental state, functional state and total scores respectively. In addition, the correlation between the components of PCCQ and PSGRQ showed satisfactory construct validity. Analyzing the data from healthy subjects and patients divulged that the PCCQ has acceptable discriminant validity. In general, the PCCQ had satisfactory reliability and validity for assessing health-related quality of life status of Iranian COPD patients. https://acta.tums.ac.ir/index.php/acta/article/view/5172 https://acta.tums.ac.ir/index.php/acta/article/download/5172/4830

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 8 2016 09 17 525 529 EN Talat Ghane Central Division of Iran Drug and Poison Information Centers, Food and Drug Organization, Ministry of Health and Medical Education, Tehran, Iran. Yasna Behmanesh Central Division of Iran Drug and Poison Information Centers, Food and Drug Organization, Ministry of Health and Medical Education, Tehran, Iran. Fardin Khazei Central Division of Iran Drug and Poison Information Centers, Food and Drug Organization, Ministry of Health and Medical Education, Tehran, Iran. 2015 11 28 2016 03 04 Drug and Poison Information Centers (DPICs) have a critical role in the fulfillment of rational drug use programs and provide services to the scientific community with the aim of improving the health and safety of drug use. This was a retrospective study on recorded calls of DPICs in Iran from March 2012 to March 2013. Data consisted of general information; drug and poisoning information, medical history and also the distribution of a number of calls collected by DPICs in Iran. The centers received a total of 171769 calls. Most calls were made by the patients (56.1%) and then the patients’ relatives (38%). Also, 67% of the patients were determined as female. The calls mostly were focused on Adverse Drug Reactions (ADR) (15.3%), indications (14.0%) and drug evaluations (11.8%). Anti-infective agents, non-steroidal anti-inflammatory drugs (NSAIDs) and vitamins with 9.6%, 7%, and 6.8% frequencies were the highest frequently asked questions, respectively. Based on the results, patients do not receive enough information about their medications, from physicians and pharmacists. The DPICs have an important role to guide the people and provide the accurate drug and poison information and fill the absence of information that is not provided by medical staff. So, based on the important role of these centers, it is worth the Iran DPICs being introduced more to people, and we need more advertising around the country. https://acta.tums.ac.ir/index.php/acta/article/view/5206 https://acta.tums.ac.ir/index.php/acta/article/download/5206/4825

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 8 2016 09 17 530 535 EN Anahita Sadeghi Department of Internal Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Hamidreza Aghaei Meybodi Endocrinology and Metabolism Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Behrouz Navabakhsh Department of Internal Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Ahmadreza Soroush Department of Surgery, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Masoud Mohammad Malekzadeh Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Zhamak Khorgami Department of Surgery, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 18 2016 03 21 Quality of clinical education for medical students has always been a concern in academic medicine. This concern has increased in today’s time-squeeze while faculty members have to fulfill their complementary roles as a teacher, researcher, and practitioner. One of the strategies for program evaluation is obtaining trainees’ feedbacks since they are the main customers of educational programs; however, there are debates about the efficacy of student feedback as a reliable source for reforms. We gathered Likert scores on a 16-item questionnaire from 2,771 medical students participating in all clerkship programs in a multidisciplinary teaching hospital. An expert panel consisting of 8 attending physicians established content validity of the questionnaire while a high Cronbach’s Alpha (0.93) proved its reliability. Summary reports of these feedbacks were presented to heads of departments, clerkship program directors, and hospital administrators, at the end of each semester. Analysis of variance was used for comparing hospital scores across different time periods and different departments. Significant changes (P<0.001) were observed in mean scores between different semesters (partial η2=0.090), different departments (partial η2=0.149) as well as the interaction term between departments and semesters (partial η2=0.111). A significant improvement in mean clinical education score is noticeable after three semesters from the beginning of the survey. Periodic, systematic trainee’s feedback to program directors can lead to an improved educational performance in teaching hospitals. https://acta.tums.ac.ir/index.php/acta/article/view/5001 https://acta.tums.ac.ir/index.php/acta/article/download/5001/4826

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 8 2016 09 17 536 541 EN Sedighe Sadat Hashemikamangar Department of Operative Dentistry, School of Dentistry, Tehran University of Medical Sciences, International Campus, Tehran, Iran. Farnoosh Yazdanpanah International Campus, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran. Mansoore Mirzaii Department of Operative Dentistry, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran. Reza Yazdani Department of Community Oral Health, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Javad Karazifard Department of Epidemiology and Biostatistics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran. Esmaeil Yasini Department of Operative Dentistry, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran. 2015 11 09 2016 03 04 The efficacy of methods like e-learning as a supplement to traditional face-to-face instruction needs to be evaluated in dental courses. This study aimed to assess the efficacy of posting case presentations on one of the educational websites of  the virtual school of Tehran University of Medical Sciences called “SARMAD” to enhance the ability of senior dental students to diagnose tooth discolorations and offer treatment plans. This experimental study had a pre-test/post-test control group design and was conducted on 63 senior dental students. After filling out the primary questionnaire and obtaining a written informed consent, students participated in a pre-test and were then randomly divided into two groups of intervention and control. Fifteen case presentations were posted on the university website (SARMAD) during 6 weeks and discussed. Then, students participated in a post-test. Students’ perspectives and their satisfaction with the website were assessed by a questionnaire. For ethical purposes, the same program was also offered to the controls. The post-test score was significantly higher than the pre-test score in the intervention group (P<0.001); but in the control group, the post-test score was only slightly higher than the pre-test score (P=0.128). In the intervention group, 70% stated that they would suggest this method as an efficient educational modality; 93.3% stated that this method would be beneficial as a supplement to conventional education; 16.7% ranked the SARMAD website excellent, 30% ranked it good, 33.3% acceptable, 16.7% moderate and 3.3 poor. It appears that this instructional modality may be efficiently used as a supplement to traditional instruction in undergraduate dental curricula. https://acta.tums.ac.ir/index.php/acta/article/view/5123 https://acta.tums.ac.ir/index.php/acta/article/download/5123/4827

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 8 2016 09 17 542 546 EN Medhi Alizadeh Department of Pediatrics, Mofid Children Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Leila Ghasemi Hashtroodi Department of Pediatrics, Mofid Children Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Zahra Chavoshzadeh Pediatric Infections Research Center, Mofid Children Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.