Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 55 7 2017 09 16 416 421 EN Kazem Koohi Mohammad Department of Basic Sciences, School of Veterinary Medicine, Tehran University, Tehran, Iran. Mahmoud Ghazi-Khansari Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Farzad Hayati Department of Surgery and Radiology, School of Veterinary Medicine, University of Tehran, Tehran, Iran. Hamid Staji Department of Pathobiology, School of Veterinary Medicine, Semnan University, Semnan, Iran. Morteza Keywanloo Department of Veterinary Clinical Medicine, School of Veterinary Medicine, Semnan University, Semnan, Iran. Ebrahim Shahroozian Department of Basic Sciences, School of Veterinary Medicine, Semnan University, Semnan, Iran. 2016 07 20 2017 04 30 Aflatoxin B-1 (AFB1) is one of the major mycotoxins causing food contamination. Previous studies have shown that AFB1 can induce carcinogenicity and toxic effects in the isolated perfused rat liver and these effects are associated with its metabolites and peroxidation activity. Here we surveyed whether these pathogenic effects of AFB1 are associated with TNF-α as an inflammatory cytokine in general liver damages. In this study, we used twenty male Wistar rats (250-300 g). Rats were divided into four groups. Control group was pre-treated with LPS and then perfused with KHBB. The second group was pretreated with PTX and LPS and then perfused with KHB. The third group was pre-treated with LPS and then perfused with AFB-1 and KHB. The last group was pretreated with LPS and PTX and then perfused with AFB1 and KHB. Results revealed that aflatoxin B1 significantly increased the enzyme activity of aminotransferase and levels of lipid peroxidation. Also, the levels of Glutathione decreased in the aflatoxin group significantly. TNF-α released in perfusate and increased in aflatoxin B1 group significantly and decreased in AFB-1+PTX. Exposure to Aflatoxin B1 may induce reactive oxygen species, so these species may induce overproduction of proinflammatory cytokines such as TNF-α and may cause more damage to hepatic cells. https://acta.tums.ac.ir/index.php/acta/article/view/5784 https://acta.tums.ac.ir/index.php/acta/article/download/5784/4958

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 55 7 2017 09 16 464 469 EN Feridoun Sabzi Department of Cardiac Surgery, Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran. Aghigh Heidari Department of Anesthesiology, Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran. 2015 12 23 2016 10 10 Prepartum or postpartum right ventricular thrombosis (RVT) is an exceedingly rare and potentially lethal phenomenon in pregnancy. We here report a case of a pregnant patient with near term pregnancy admitted for dyspnea, amniotic fluids discharge and labor pain in a gynecology center that an eight-month dead fetus was diagnosed and delivered vaginally by induction. A post delivery period was complicated by aggravation of her dyspnea and pleuritic chest pain that she referred for further evaluation in our cardiac center. Physical exam revealed normal head and neck exam, and history taking revealed that her fetus had intra-uterine growth failure as reported by her gynecologist. Chest exam except to left lung crackle was normal. Lower and upper left extremities were normal. However, acrocyanosis was found in tips of 4 and 5th right-hand digits. Chest x-ray revealed some linear consolidation in left lower lung lobes, and the precordial exam was normal. ECG was normal. Post delivery transthoracic echocardiography (TEE) showed a 1.5×1.5 cm mobile right ventricular clot. C-T angiography revealed obstruction of left upper lung pulmonary artery branches. Complete thrombophilia assay showed the presence of high titer of antiphospholipid, anticardiolipin antibody, and β1 glycoprotein antibody. However, others test were normal. The patient was scheduled for cardiac surgery, and her hemodynamic was monitored by left radial artery line and central pressure venous line, and thrombus was removed from the right ventricle (RV), and subsequent anticoagulation therapy constituted. Six-month follow-up revealed no recurrence of thrombus and recovery of patient’s symptoms. https://acta.tums.ac.ir/index.php/acta/article/view/5305 https://acta.tums.ac.ir/index.php/acta/article/download/5305/4965

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 55 7 2017 09 16 480 481 EN Majid Nimrouzi Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. AND Essence of Parsiyan Wisdom Institute, Phytopharmaceutical Technology and Traditional Medicine Incubator, Shiraz University of Medical Sciences, Shiraz, Iran. AND Department of Traditional Persian Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. Mohammad Reza Sanaye Essence of Parsiyan Wisdom Institute, Phytopharmaceutical Technology and Traditional Medicine Incubator, Shiraz University of Medical Sciences, Shiraz, Iran. Babak Daneshfard Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. AND Essence of Parsiyan Wisdom Institute, Phytopharmaceutical Technology and Traditional Medicine Incubator, Shiraz University of Medical Sciences, Shiraz, Iran. 2016 08 24 2017 04 15 No Abstract https://acta.tums.ac.ir/index.php/acta/article/view/5839 https://acta.tums.ac.ir/index.php/acta/article/download/5839/4969

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 55 7 2017 09 16 422 428 EN Parisa Sarkhail Department of Bioactive Natural Products, Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran. Mona Salimi Department of Pharmacology and Physiology, Pasteur Institute, Tehran, Iran. Pantea Sarkheil Department of Bioactive Natural Products, Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran. Hirsa Mostafapour Kandelous Department of Pharmacology and Physiology, Pasteur Institute, Tehran, Iran. 2016 07 10 2017 04 25 Pistacia vera seed is a common food and medicinal seed in Iran. It's hull (outer skin) as a significant byproduct of pistachio, is traditionally used as tonic, sedative and antidiarrheal and has been shown to be a rich source of antioxidants. The aim of the present study is to evaluate the anti-melanogenic activity of the pistachio hulls in order to discover a new alternative herbal agent to treat skin hyperpigmentation disorders. In this work, antioxidant and anti-tyrosinase activity of MeOH extract from Pistacia vera hull (MPH) were evaluated in vitro, respectively, by DPPH radical scavenging and mushroom tyrosinase activity assays. Then the effect of MPH on the melanin content, cellular tyrosinase activity and cytotoxicity (MTT assay) on human melanoma SKMEL-3 cell were determined followed by 72 h incubation. The results indicated that MPH had valuable DPPH radical scavenging effect and weak anti-tyrosinase activity when compared to the well-known antioxidant (BHT) and tyrosinase inhibitor (kojic acid), respectively. MPH, at a high dose (0.5 mg/mL), showed significant cytotoxic activity (~63%) and strong anti-melanogenic effect (~57%) on SKMEL-3 cells. The effect of MPH in the reduction of melanin content may be related to its cytotoxicity. The results obtained suggest that MPH can be used as an effective agent in the treatment of some skin hyperpigmentation disorders such as melanoma. https://acta.tums.ac.ir/index.php/acta/article/view/5762 https://acta.tums.ac.ir/index.php/acta/article/download/5762/4959

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 55 7 2017 09 16 470 473 EN Fariba Abbasi Department of Pathology, Solid Tumor Research Center, Urmia University of Medical Sciences, Urmia, Iran. Ata Abbasi Department of Pathology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran. Mansour Alizadeh Department of Urology, Urmia Urology and Nephrology Research Center, Urmia University of Medical Sciences, Urmia, Iran. Parisa Modarresi Department of Pathology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran. 2015 11 14 2016 10 14 Angiomyolipoma (AML) and oncocytoma are uncommon benign neoplasms of the kidney which their simultaneous occurrence in the same kidney is extremely rare. This study reports a 60-year-old diabetic woman with the rare simultaneous occurrence of three renal masses. Histologic evaluation revealed two angiomyolipomas and one oncocytoma within the same kidney, in a background of histologic features of diabetic nephropathy. Renal angiomyolipoma and oncocytoma are uncommon neoplasms, and their simultaneous occurrence in the same kidney is extremely rare. https://acta.tums.ac.ir/index.php/acta/article/view/5140 https://acta.tums.ac.ir/index.php/acta/article/download/5140/4966

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 55 7 2017 09 16 429 436 EN Mamak Shariat Department of Pediatrics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Nasrin Abedinia Department of Pediatrics, Institute of Family Health, Maternal, Fetal and Neonatal Health Research Center, Valiasr Hospital, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Nima Rezaei Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.AND Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. AND Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran. Nahid Farrokhzad Department of Pediatrics, Institute of Family Health, Maternal, Fetal and Neonatal Health Research Center, Valiasr Hospital, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. 2016 06 14 2017 03 21 Several studies have shown an imbalance between proinflammatory and anti-inflammatory cytokines in depression and anxiety disorders. However, less attention has been paid to the role of cytokines in psychological disorder in mothers who breastfeed. This study looks at whether concentration levels of TGF-β2 are altered in anxious and depressive breastfeeding mothers. This study checked the concentration level of TGF-B2 in relation with psychological symptoms on 110 breastfeeding mothers; based on random sampling method with using of Beck Depression Inventory (BDI), General Health Questionnaire (GHQ) and Spielberger Stress Scale (STAI) in 2015 also TGF-β2 was measured in breast milk using ELISA. We used of Pearson Correlation Method, independent t-test and one-way analysis of variance (ANOVA) to analyze the data. Psychological symptoms (Anxiety and depression) showed positive correlation with TGF-Beta level in which relationships were significant (P=0.01). Psychological problems may be uniquely associated with the level of TGF-β in breast milk. More attention should be paid to the mental health of mothers during breastfeeding, and more research needs to be done in this subject to clarify the relationship between psychological variables with the level of TGF-β in breast milk. https://acta.tums.ac.ir/index.php/acta/article/view/5706 https://acta.tums.ac.ir/index.php/acta/article/download/5706/4960

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 55 7 2017 09 16 474 476 EN Abbas Darjani Department of Dermatology, Skin Research Center, Guilan University of Medical Sciences, Rasht, Iran. Rana Rafiei Department of Dermatology, Skin Research Center, Guilan University of Medical Sciences, Rasht, Iran. Alireza Mesbah Department of Dermatology, Skin Research Center, Guilan University of Medical Sciences, Rasht, Iran. Razieh Golmohammadi Department of Dermatology, Skin Research Center, Guilan University of Medical Sciences, Rasht, Iran. Behnam Rafiee Department of Pathology, NYU Winthrop Hospital, New York, USA. Mehriar Movaseghi Department of Dermatology, Skin Research Center, Guilan University of Medical Sciences, Rasht, Iran. 2016 03 15 2016 10 14 Discoid Lupus Erythematosus (DLE) is an autoimmune disorder that usually occurs on sun exposed areas of head and neck. Infrequently it could be presented by palpebral involvement and rarely unilateral upper eye lid edema and erythema have been reported as the sole manifestation of DLE. We describe a 38-year-old woman with chronic left upper eye lid edema and erythema from one year ago which was induced by steroid injection for left eyebrow alopecia. Histopathologic and direct immunofluorescent studies were made on palpebral skin tissue and confirmed DLE diagnosis. Antinuclear antibody (ANA) titer was 1/160 with speckled pattern. She was treated by oral hydroxychloroquine (400 mg daily) with moderate improvement after three months. We should think about DLE in cases with chronic upper eye lid edema and erythema. The aim of this case report is to emphasize that ophthalmologist and dermatologists should be aware of different presentations of DLE in the periorbital area to prevent misdiagnosis. https://acta.tums.ac.ir/index.php/acta/article/view/5520 https://acta.tums.ac.ir/index.php/acta/article/download/5520/4967

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 55 7 2017 09 16 437 446 EN Maryam Nazemipour Department of Epidemiology and Biostatistics, School of Public Health, International Campus, Tehran University of Medical Sciences, Tehran, Iran. Abdol-Mohammad Kajbafzadeh Department of Pediatric Urology, Pediatric Urology Research Center, Children’s Medical Center, 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. Abbas Rahimi Foroushani Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Mahmood Mahmoudi Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran 2016 05 23 2017 04 10 The aim of this study was describing methodological aspects and applying a trivariate Weibull survival model using the competing risks concept to predict time to occurrence different types of reflux (unilateral (left, right) or bilateral) in children with antenatal hydronephrosis. Data from 333 children in Pediatric Urology Research Center of Children’s Hospital Medical Center, affiliated with Tehran University of Medical Sciences was used. The effect of some demographic and clinical factors on child’s reflux was studied. The assumption of independent between times of different types of reflux was evaluated. Of infants 80.5% were boy. The percentage of children experienced right, left and bilateral reflux or have been censored are 15.3%, 14.1%, 60.4% and 10.2% respectively. For the time of left reflux, variables, Week of diagnosis ANH, UC, UA, HUN, HN, APD_Right, Direction of ANH, CA19-9 baby, Urethra were significant. For the time of right reflux, variables, constipation, UC, UA, HUN, APD_Right, Direction and Severity of ANH, Bladder, and finally for the time of bilateral reflux, variables, Week of diagnosis ANH, Gender, UA, HUN, HN, APD_Left, Urethra, and Bladder were significant P<0.05. In the presence of competing risks, it is inappropriate to use the Kaplan-Meier method and standard Cox model which do not take competing risks into account. Trivariate Weibull survival model using competing risks not only is able to calculate the hazard rate of variables with different type of events but also it will be able to compare the hazard rate within the same type of event with different covariates. https://acta.tums.ac.ir/index.php/acta/article/view/5653 https://acta.tums.ac.ir/index.php/acta/article/download/5653/4961

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 55 7 2017 09 16 477 479 EN Hossein Parsa Department of Surgery, Velayat Hospital, Qazvin University of Medical Sciences, Qazvin, Iran. Arash Miroliaee Department of Internal Medicine, Velayat Hospital, Qazvin University of Medical Sciences, Qazvin, Iran. Zafar Doagoo Department of Internal Medicine, Zakariya-e-Razi Hospital, Qazvin, Iran. Saeed Sina Department of Surgery, Velayat Hospital, Qazvin University of Medical Sciences, Qazvin, Iran. 2015 12 28 2016 05 23 Colonoscopy is widely used for the diagnosis, treatment and a follow up of colorectal diseases. Perforation of the large bowel during elective colonoscopy is rare but serious life threatening complication. We report a 51-year-old woman who experienced recto sigmoid perforation during diagnostic colonoscopy. During 8 days of total hospitalization, she spent 3 days in ICU with gastrointestinal rest. The patient was hydrated and took intravenous antibiotics. In take-output and temperature were closely monitored. Serial abdominal examinations were performed to rule out peritonitis. After transferring to surgery ward in the day 4, liquid diet started slowly, and she was ambulated. At the day 8, she was discharged with the good clinical condition. Conservative management of the patients with early diagnosis of perforation and no signs and symptoms of peritonitis or sepsis could be the modality of choice. https://acta.tums.ac.ir/index.php/acta/article/view/5319 https://acta.tums.ac.ir/index.php/acta/article/download/5319/4968

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 55 7 2017 09 16 447 452 EN Pierre Nanyan Didaxis, Orleans University, Paris, France. 2016 07 03 2017 04 13 Obesity is a growing public health problem in France, but modifiable co-morbidities in obese patients during their hospital admissions excluding bariatric surgery are lacking. Data were extracted from the French national hospital discharge database. Data on patient admissions, age, gender, and length of stay were extracted by selecting any stay coded primary as obesity. Obesity was defined as body mass index (BMI) between 30-39 kg/m², and morbid obesity as BMI≥40 kg/m². Only modifiable co-morbidities frequently diagnosed during the 6-year period with a rate≥3% were chosen. The admission rate for obesity decreased by 27.2% (P<0.001) with more females than males (71.9% vs. 28.1 %; P<0.001). The main modifiable co-morbidities were hypertension (22.72%), sleep apnea (13.64%), diabetes (12.34%), vitamin D deficiency (7.09%), hyperlipidemia (6.9%), hypercholesterolemia (4.98%), and nonalcoholic steatohepatitis (4.94%). Significant decreases were observed for hypertension (14.5%), diabetes (20%), hypercholesterolemia (30%) with steeper increase for vitamin D deficiency (830.7%) and nonalcoholic steatohepatitis (165.2%). Considering obesity class, admission for obesity (BMI: 30-40 kg/m²) and morbid obesity (BMI≥40 kg/m²) increased (P<0.001) by 6% and 7% respectively. Taking into account severity in proportion, stay>3 days significantly increased by 29.2% (P<0.001). The increase in the proportion of morbid obesity, vitamin D deficiency, and nonalcoholic steatohepatitis adds further evidence on the likely adverse health consequences of modifiable obesity-related comorbidities. There is a need for Health Authorities to promoting healthy lifestyle. https://acta.tums.ac.ir/index.php/acta/article/view/5754 https://acta.tums.ac.ir/index.php/acta/article/download/5754/4962

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 55 7 2017 09 16 453 458 EN Mahmood Akhlaghi Department of Anesthesiology, Clinical Research Development Unit, Kashani Hospital, Shahrekord University of Medical Sciences, Shahrekord, Iran. Mohammadreza Abedinzadeh Department of Anesthesiology, Shahrekord University of Medical Sciences, Shahrekord, Iran. Ali Ahmadi Department of Epidemiology and Biostatistics, School of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran. Zohre Heidari Shahrekord University of Medical Sciences, Shahrekord, Iran. 2016 07 11 2017 04 13 Airway assessment is fundamental skill for anesthesiologists and failure to maintain a patient’s airway is the tremendous cause of anesthesia-related morbidity and mortality. None of the tests which have recommended for predicting difficult intubation stands out to be the best clinical test or have high diagnostic accuracy. Our study aimed to determine the utility of a new test as “laryngoscopic exam test (LET)” in predicting difficult intubation. Three hundred and eleven patients aged 16-60 years participated and completed the study. Airway assessment was carried out with modified Mallampati test, upper lip bit test and LET preoperatively, and Cormack and Lehane's grading of laryngoscopy were assessed during intubation as a gold standard, and difficult laryngoscopy was considered as Cormack and Lehane's grade ΙΙΙ or ΙV of laryngoscopic view. The incidence of difficult intubation was 6.1%. The LET showed higher sensitivity, specificity, and accuracy (P<0.05), without revealing significant differences among three tests (P=0.375). The LET is a simple bedside test and an alternative method for predicting difficult intubation. https://acta.tums.ac.ir/index.php/acta/article/view/5766 https://acta.tums.ac.ir/index.php/acta/article/download/5766/4963

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 55 7 2017 09 16 459 463 EN Seyed Mohammad Kazem Aghamir Department of Urology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Negar Behtash Department of Urology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Morteza Hamidi Department of Urology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.AND Department of Urology, AJA University of Medical Sciences, Tehran, Iran. Hasan Farahmand Department of Urology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Alborz Salavati Department of Urology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Sara Mortaz Hejri Department of Medical Education, Helath Professions Education Research Center, Tehran University of Medical Sciences, Tehran, Iran. 2016 07 05 2017 04 13 Percutaneous nephrolithotomy (PNL) is a complicated procedure for urology trainees. This study was designed to investigate the effect of trainees’ ages and previous experience, as well as the number of operated cases, on proficiency at PNL by using patient outcomes. A cross sectional observational study was designed during a five-year period. Trainees in PNL fellowship programs were included. At the end of the program, the trainees’ performance in PNL was assessed regarding five competencies and scored 1-5. If the overall score was 4 or above, the trainee was considered as proficient. The trainees’ age at the beginning of the program and the years passed from their residency graduation were asked and recorded. Also, the number of PNL cases operated by each trainee was obtained via their logbooks. The age, years passed from graduation, and number of operated cases were compared between two groups of proficient and non-proficient trainees. Univariate and multivariate binary logistic regression analysis was applied to estimate the effect of aforementioned variables on the occurrence of the proficiency. Forty-two trainees were included in the study. The mean and standard deviation for the overall score were 3.40 (out of 5) and 0.67, respectively. Eleven trainees (26.2%) recognized as proficient in performing PNL. Univariate regression analysis indicated that each of three variables (age, years passed from graduation and number of operated cases) had statistically significant effect on proficiency. However, the multivariate regression analysis revealed that just the number of cases had significant effect on achieving proficiency. Although it might be assumed that trainees’ age negatively correlates with their scores, in fact, it is their amount of practice that makes a difference. A certain number of cases is required to be operated by a trainee in order to reach the desired competency in PNL. https://acta.tums.ac.ir/index.php/acta/article/view/5758 https://acta.tums.ac.ir/index.php/acta/article/download/5758/4964