Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 1 2016 02 01 72 75 EN Hamid Ahmadi Department of General Surgery, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Mahdieh Mohammad Khan Tehrani Department of General Surgery, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. 2016 01 20 Wandering spleen is an uncommon entity in adults and has been described only rarely with sigmoid volvulus, that rarely affects children and adolescents. It is usually described in adults.Wandering spleen characterized by the abnormal location of the spleen, caused by incomplete fusion of the four primary splenic ligaments, allowing the spleen to be mobile within the abdomen.The wandering spleen can lead to torsion and subsequent splenic infarction or rupture. Clinical suspicion plus urgent investigation and intervention are important. We present a rare clinical case of acute abdomen due to torsion of wandering spleen and volvulus of sigmoid in a 14-year-old girl presented with painful periumbilical mass. Detorsion of sigmoid occurred while undergoing exploratory laparotomy and splenectomy was performed. The possibility of torsion and its complication like gastric, pancreas tail and colon volvulus should be kept in mind in the differential diagnosis of the acute abdomen to avoid serious complications. https://acta.tums.ac.ir/index.php/acta/article/view/5392 https://acta.tums.ac.ir/index.php/acta/article/download/5392/4741

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 1 2016 02 01 9 14 EN Soraya Emamgholizadeh Minaei Department of Radiology, School of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Hossein Mozdarani Department of Medical Genetics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran. Morteza Motazakker Department of Clinical Virology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran. Mohsen Mansouri Department of Radiotherapy, Omid Center, Urmia, Iran. Seyed Mahmoud R. Aghamiri Department of Radiation Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2016 01 18 2016 01 18 The effects of combined radiotherapy (RT) and chemotherapy in the severity of cytogenetic alterations expressed as micronucleus (MN) in peripheral blood lymphocytes of patients treated for esophageal cancer was evaluated. To do this, blood was obtained from 23 and 15 esophageal cancer patients scheduled for chemo-radiotherapy and RT alone, respectively, before, during, and after treatment. Blood samples were cultured in RPMI-1640 complete medium containing 1% phytohemagglutinin and incubated in a CO2 incubator. Cytochalasin-B was added to the cultures at a final concentration of 5μg/ml. Finally, harvesting, slide making, and analysis were performed according to standard procedures. Results indicate that there was no significant difference between the frequencies of MN in lymphocytes of individuals before being treated with RT alone or chemo-radiotherapy. In the middle of treatment, (after 12 fractions of RT) the frequency of MN increased significantly compared with their concurrent pre-treatment samples in both groups (four-fold). However, the frequency of MN observed for RT patients was not significantly different with those received chemo- and radiotherapy. At the end of treatment, (after 24 fractions of radiotherapy) an increase in the MN frequency was observed for chemo-radiation group significantly higher than RT group (P=0.022). Mild increase in MN frequency in lymphocytes of patients receiving chemoradiation only after the completion of treatment course might be indicative of resistance induced by chemotherapeutics to the clastogenic effects of radiation. Therefore, using these agents repeatedly for cancer treatment in combination with radiation might not cause severe adverse biological effects in normal tissues. https://acta.tums.ac.ir/index.php/acta/article/view/5381 https://acta.tums.ac.ir/index.php/acta/article/download/5381/4732

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 1 2016 02 01 4 8 EN Mohsen Rezaeian Department of Epidmeiology and Biostatistics, Occupational Environmental Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran. 2016 01 18 2016 01 18 There are many published articles which cover current and future challenges of epidemiology. However, up until now, most of them are written by developed world epidemiologists. Therefore, despite a common use of assumptions, they did not have the opportunity to discuss the different range of practical tasks and priorities away from developed countries. The topics covered are; facing poverty, non-democratic government that has links to developed countries, man-made and natural disasters, handling low-quality data and accessing it, and finally improving contribution to the world epidemiological knowledge for the 21st century. https://acta.tums.ac.ir/index.php/acta/article/view/5380 https://acta.tums.ac.ir/index.php/acta/article/download/5380/4731

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 1 2016 02 01 1 3 EN Nima Rezaei Research Center for Immunodeficiencies, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran. AND Universal Scientific Education and Research Network, Tehran, Iran. 2016 01 18 2016 01 18 No Abstrat https://acta.tums.ac.ir/index.php/acta/article/view/5379 https://acta.tums.ac.ir/index.php/acta/article/download/5379/4730

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 1 2016 02 01 76 78 EN Manouchehr Hekmat Department of Cardiovascular Surgery, Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Hamid Ghaderi Department of Cardiovascular Surgery, Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Mahnoosh Foroughi Department of Cardiovascular Surgery, Cardiovascular Research Center, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. S. Adeleh Mirjafari Brain and Spinal Injury Research Center (BASIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2016 01 20 Guillain-Barre syndrome is a neurologic disorder that may appear after infection or major surgery.  Guillian-Barre syndrome following cardiac surgery is rare and only based on case reports, and we review all of the published cases. A 52-year-old man after 5 months suffering from chest pain was referred to our hospital and underwent coronary artery bypass graft for 3 vessel disease. The patient was discharged without complication on the 5th postoperative day. He presented Guillain- Barre syndrome after 12 months. He has not completely recovered weakness of upper extremities grade 4/5 with atrophy of both upper extremities remains after 18 months. This disorder is similar to classic GBS. It is important to be alert to de novo autoimmune neurological disorders after cardiac surgery. These disorders are similar to classic autoimmune disease and treated with standard therapies. https://acta.tums.ac.ir/index.php/acta/article/view/5393 https://acta.tums.ac.ir/index.php/acta/article/download/5393/4742

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 1 2016 02 01 15 23 EN Elchin Barzegar Department of Clinical Pharmacy (Pharmacotherapy), School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. Arezoo Ahmadi Department of Anesthesiology and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Sarah Mousavi Department of Clinical Pharmacy and Pharmacy Practice, School of Pharmacy, Isfahan University of Medical Sciences, Isfahan, Iran. Masoumeh Nouri Department of Clinical Pharmacy (Pharmacotherapy), School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. Mojtaba Mojtahedzadeh Department of Clinical Pharmacy (Pharmacotherapy), School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. 2016 01 19 Arginine vasopressin as a supplementary vasopressor in septic shock restores vascular tone and mean arterial pressure, meanwhile decreases dose and exposure time to catecholamines. The objective of this study was to evaluate the effect of vasopressin on lactate and lactate clearance as markers of tissue perfusion during septic shock. In this prospective, randomized, controlled trial, 30 patients with septic shock were enrolled in two groups. One group received norepinephrine infusion (titrated to reach the target MAP of ≥65 mm Hg) and the other group in addition to norepinephrine, received vasopressin at a constant rate of 0.03 u/min. Serum lactate levels were assessed at baseline, 24 and 48 hours after randomization. Lactate clearance was estimated for each patient at 24 and 48 hours. Venous lactate was measured in both groups. Despite a tendency toward higher venous lactate at 24 and 48 hours in the norepinephrine group (3.1 vs. 2.5, P=0.67 and 1.7 vs. 1.1, P=0.47), the conflict was not statistically significant among them. While lactate clearance after 24 hours was significantly higher in vasopressin treatment group (46% vs. 20%, respectively; P=0.048), the 48-hour lactate clearance did not differ from statistic viewpoints despite their clinical values (66% vs. 40%, P=0.17). Although lactate levels did not significantly differ between treatment groups, lactate clearance at 24 hours was significantly higher in vasopressin group. This may be the effect of vasopressin effect on microcirculation and tissue hypoperfusion or its catecholamine sparing effect. https://acta.tums.ac.ir/index.php/acta/article/view/5384 https://acta.tums.ac.ir/index.php/acta/article/download/5384/4733

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 1 2016 02 01 79 82 EN Farzad Omidi-Kashani Orthopedic Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Mohammad Faraji Rad Orthopedic Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. 2016 01 20 Lumbar disc herniation (LDH) is the most common cause of sciatica and only in about 10% of the affected patients, surgical intervention is necessary. The side of the patient (the side of most prominent clinical complaints) is usually consistent with the side of imaging (the side with most prominent disc herniation on imaging scans). In this case series, we presented our experience in four cases with huge intracanal LDH that a mismatch between the patient’s side and the imaging’s side was present. In these cases, for deciding to do the operation, the physicians need to rely more on clinical findings, but for deciding the side of discectomy, imaging characteristic (imaging side) may be a more important criterion. https://acta.tums.ac.ir/index.php/acta/article/view/5394 https://acta.tums.ac.ir/index.php/acta/article/download/5394/4743

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 1 2016 02 01 24 31 EN Hossein Mirmiranpour Department of Biochemistry, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran. AND Department of Clinical Biochemistry, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. shahnaz khaghani Department of Clinical Biochemistry, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. S. Zahra Bathaie Department of Clinical Biochemistry, School of Medical Sciences, Tarbiat Modares University, Tehran, Iran. Manouchehr Nakhjavani Endocrinology and Metabolism Research Center, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran. Abbas Kebriaeezadeh Departments of Toxicology/ Pharmacology, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. Maryam Ebadi Endocrinology and Metabolism Research Center, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran. Siavash Gerayesh-Nejad Department of Clinical Biochemistry, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Zangooei Department of Clinical Biochemistry, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. 2016 01 19 Lysozyme is a bactericidal enzyme whose structure and functions change in diabetes. Chemical chaperones are small molecules including polyamines (e.g. spermine), amino acids (e.g. L-lysine) and polyols (e.g. glycerol). They can improve protein conformation in several stressful conditions such as glycation. In this study, the authors aimed to observe the effect of L-lysine as a chemical chaperone on structure and function of glycated lysozyme. In this study, in vitro and in vivo effects of L-lysine on lysozyme glycation were investigated. Lysozyme was incubated with glucose and/or L-lysine, followed by an investigation of its structure by electrophoresis, fluorescence spectroscopy, and circular dichroism spectroscopy and also assessment of its bactericidal activity against M. lysodeikticus. In the clinical trial, patients with type 2 diabetes mellitus (T2DM) were randomly divided into two groups of 25 (test and control). All patients received metformin and glibenclamide for a three months period. The test group was supplemented with 3 g/day of L-lysine. The quantity and activity of lysozyme and other parameters were then measured. Among the test group, L-lysine was found to reduce the advanced glycation end products (AGEs) in the sera of patients with T2DM and in vitro condition. This chemical chaperone reversed the alteration in lysozyme structure and function due to glycation and resulted in increased lysozyme activity. Structure and function of glycated lysozyme are significantly improved by l-lysine; therefore it can be considered an effective therapeutic supplementation in T2DM, decreasing the risk of infection in these patients. https://acta.tums.ac.ir/index.php/acta/tases were evaluated. The 5 -year survival probability of patients was 28 %, and median survival time was 25.69 months. Univariate tests showed that sex, cancer site, and pathologic type have no significant effects on patient’s survival. But the probability of 5-year survival significantly decreases with increasing age, and as it is expected, those with metastases were significantly less likely to have 5-year survival, and disease stage was significantly effective on patients’ life (P<0.001). Simultaneous evaluation of different variables’ effects on the probability of survival using the multiple Cox proportional hazards models showed that age and stage disease variables were effective on the survival of patients. The 5-year survival of patients with gastric cancer is low in Iran, although it is improved compared to the past. It seems that one of the main reasons for low survival rate of these patients is a late referral of patients for diagnosis and treatment. Most patients refer in the final stages of the disease, at this stage most patients are affected by lymph nodes metastases, liver and as the result, their treatment will be more difficult. https://acta.tums.ac.ir/index.php/acta/article/view/5115 https://acta.tums.ac.ir/index.php/acta/article/download/5115/4752

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 2 2016 03 12 119 123 EN Singh Brijendra Department of Anatomy, Jodhpur Medical College, India. Gupta Renu Department of Anatomy, Jodhpur Medical College, India. Agrawal Dushyant Department of Anatomy, Jodhpur Medical College, India. Garg Rajneesh Department of Orthopeadics, Jodhpur Medical College, Hamdard Institute of Medical Sciences & Research New Delhi, India. Katri Sunil Saraswati Hospital, Jodhpur, Rajiv Gandhi Super Speciality Hospital Tahirpur, New Delhi, India. 2016 03 09 Various dermatoglyphic parameters like finger print pattern, atd angle, absolute ridge count & ab, bc ,cd, and ad ridge counts were observed in 150 cases of congenital cardiac disease, comprising of 72 cases of Ventricular Septal Defects (VSD), 60 cases of Atrial Septal Defects (ASD), 9 cases of Coarctation of Aorta (COA) & 9 cases of Tetralogy of Fallot’s (TOF). Same dermatoglyphic parameters were also studied in 300 controls and statistical comparison of cases and controls was done. In our study it was observed that the congenital cardiac disease cases exhibited preponderance of whorls (55.8%) with decrease in loop pattern (36.2%) as compared to those of controls and the difference was highly significant (P<0.001). The difference in the mean total finger ridge count (TFRC) of the controls and of the cases of Congenital Cardiac Diseases (CCD) was found to be highly significant (P<0.001), while the  mean atd angle in the cases of Congenital Cardiac Disease (CCD) was widen up and was statistically significant too. The mean ab, the mean bc ridge, the mean cd ridge and the mean ad ridge counts were also higher in the various type of CCD as compared to that controls and on statistical comparison, the difference was found to be highly significant. https://acta.tums.ac.ir/index.php/acta/article/view/5497 https://acta.tums.ac.ir/index.php/acta/article/download/5497/4753

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 2 2016 03 12 124 133 EN Amin Torabipour Department of Health Services Management, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. AND Department of Health Economics & Management, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Arab Department of Health Economics & Management, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Hojjat Zeraati Department of Epidemiology & Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Arash Rashidian Department of Health Economics & Management, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Ali Akbari Sari Department of Health Economics & Management, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Mahmuod Reza Sarzaiem Department of Cardiac Surgery, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. 2016 03 09 Length of hospital stay (LOS) is a key indicator for hospital management. Reducing hospital stay is a priority for all health systems. We aimed to determine the length of hospital stay following Coronary Artery Bypass Surgery (CABG) based on its clinical and non-clinical factors. A cross-sectional study of 649 consecutive patients who underwent coronary artery bypass graft surgery was conducted in Imam Khomeini and Shariati university hospitals, Tehran, Iran. Data was analyzed by using non-parametric univariate tests and multiple linier regression models. Thirty seven independent variables including pre-operative, intra-operative and post-operative variables were analyzed. Finally, an appropriate model was constructed based on the associated factors. The results showed that 70.3% of the patients were male, and the mean age of the patients was 59.3 ± 10.4 years. The Mean (±SD) and median of the LOS were 11.7 ± 7.1 and 9 days, respectively. Of 37 investigated variables, 24 qualitative and quantitative variables were significantly associated with length of stay (p<0.05). Multiple linear regression analysis showed that independent variables including age, medical insurance type, body mass index, and prior myocardial infarction; admission day, admission season, Cross-clamp time, pump usage, admission type, the number of laboratory tests and the number of specialty consultation had more effect on the hospital stay. We concluded that some significant factors influencing hospital stay after CABG were predictable and modifiable by hospital managers and decision makers to manage hospital beds. https://acta.tums.ac.ir/index.php/acta/article/view/5498 https://acta.tums.ac.ir/index.php/acta/article/download/5498/4754

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 2 2016 03 12 134 139 EN Seyedeh Hajar Shahrami Department of Obstetrics and Gynecology, Reproductive Health Research Center, Guilan University of Medical Sciences, Iran. Zahra Abbasi Ranjbar Department of Endocrinology and Metabolism, Reproductive Health Research Center, Guilan University of Medical Sciences, Iran Forozan Milani Department of Obstetrics and Gynecology, Reproductive Health Research Center, Guilan University of Medical Sciences, Iran. Ehsan Kezem-Nejad Department of Statistically, Guilan University of Medical Sciences, Iran. Afagh Hassanzadeh Rad Pediatric Growth Disorders Research Center, Guilan University of Medical Sciences, Iran. Seyedeh Fatemeh Dalil Heirat Reproductive Health Research Center, Guilan University of Medical Sciences, Iran. 2016 03 09 Critical issue regarding to variation of findings based on different phenotypes led investigators to define whether they are distinct features or overlapping ones. Therefore, we aimed to investigate the association between diverse phenotypes of PCOS (Poly Cystic Ovary Syndrome) with clinical manifestations, anthropometric indices, and metabolic characteristics. This was a descriptive cross-sectional study conducted in 15-39 years old women with PCOS referred to infertility clinics in the north part of Iran, Rasht during 2010-2011. Data were gathered through an interview by a form consisted of demographic characteristics, laboratory findings, ovarian volume and anthropometric indices. A total of 214 patients consisted of 161 PCOS (cases) and 53 normal women (controls) participated in this study. The most prevalent phenotype in PCOS population was IM/PCO/HA (54%), followed by IM/HA (28%) and IM/PCO (13%). PCO/HA was present only in 6 PCOS patients (5%). PCOS patients were significantly younger than controls (P=0.07). Results showed that increased ovarian volume were higher in PCOS group in comparison with controls and IM/PCO/HA, and IM/PCO had respectively the largest ovarian volumes. Also, a significant relation was observed based on Cholesterol, 17OHP, LH, TG, 2hpp, and LH/FSH between patients with PCOS and control groups. There were significant differences in demographic, anthropometric, hormonal and ultrasound findings between PCOS and controls. Therefore, it seems that classification of the characteristics of each phenotype could offer an appropriate guide for screening risks of PCOS and may facilitate performing most favorable treatment for these complications. https://acta.tums.ac.ir/index.php/acta/article/view/5499 https://acta.tums.ac.ir/index.php/acta/article/download/5499/4755

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 2 2016 03 12 140 145 EN Simin Mahdikhani Pharmaceutical Care Center (Related to Food and Drug Department), Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran. AND Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran. Fatemeh Dabaghzadeh Pharmaceutical Care Center (Related to Food and Drug Department), Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran. AND Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran. 2016 03 09 This study was performed to assess the incidence of medication errors and irrational use of human albumin in two wards of our hospital and also aimed to evaluate the ability of pharmaceutical care center and pharmacists in improving patient care. Albumin administration was evaluated for patients who received albumin during the study period, in gastroenterology and general surgery wards. The indications for Albumin administration were evaluated on the basis of reliable guidelines. The prescribing errors were simultaneously evaluated by reviewing patients’ medical records. Prescribing errors were defined as selecting improper drug (based on indications, contraindications, known allergies, drug-class duplications and drug-drug interactions), dose, dosage form, and route of administration. It was found that 465 containers of human albumin solution 20 % were used for 54 patients treated in gastroenterology and general surgery wards of our hospital. A total of 306 (65.81%) vials of the albumin administrations were in concordance with the reliable protocol. The cost of irrational use of this drug (159 vials) for patients is equivalent to $ 8215. From 609 reviewed cases, 81 prescribing errors were detected in 64 patients. This study showed that the pharmacists were effective in identifying irrational drug use and medication errors. https://acta.tums.ac.ir/index.php/acta/article/view/5500 https://acta.tums.ac.ir/index.php/acta/article/download/5500/4756

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 2 2016 03 12 146 150 EN Hamid Rajebi Department of Radiology, SUNY Upstate Medical University, Syracuse, NY, USA. Ahmad Khodadad Department of Gastroenterology, Pediatrics Center of Excellence, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran. Golshan Fahimi School of Medicine, Urmia University of Medical Sciences, Urmia, Iran. Hassan Abolhassani Research Center for Immunodeficiencies, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 15 2016 01 18 Vitamin D deficiency is one of the most preventable challenges worldwide. The aim of this study was to determine the prevalence of vitamin D deficiency among female nurses working at Children’s Medical Center Hospital in Tehran, Iran, due to the risk factor of being a notably long period indoors and the fact that their health status may have consequences on the process of patients’ treatment. A total of 114 female nurses who were at least 20 years old entered the study voluntarily, and a questionnaire was applied to collect information on lifestyle and other factors associated with vitamin D deficiency. A sample of blood was taken to measure 25-hydroxyvitamin D (25-OHD) and cut off value to indicate deficiency was considered below 10ng/ml, and the amounts of 10-29ng/ml were declared insufficient. The mean of 25-OHD was 11.7±9.3ng/ml. A total of 79 subjects (69.3%) had a deficient level of vitamin D, 28 subjects (24.6%) had an insufficient level and only 7 subjects (6.1%) had sufficient level of vitamin D. The deficiency was more noticeable in the age group of 26-35 years old. Prevalence of vitamin D deficiency had a significant correlation with younger subjects (P<0.001). There was no significant association among other factors such as body mass index (BMI), health status complications, regular exercise, and duration of sun exposure. High prevalence of vitamin D deficiency in the study popula