Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 55 8 2017 10 07 482 485 EN Meletios Kanakis Department of Experimental Physiology, School of Medicine, University of Athens, Athens, Greece. Aristeides Vaiopoulos Department of Experimental Physiology, School of Medicine, University of Athens, Athens, Greec. George Vaiopoulos Department of Experimental Physiology, School of Medicine, University of Athens, Athens, Greece. Phaedon Kaklamanis Department of Rheumatology, Athens Medical Center, Athens, Greece. 2016 08 04 2017 04 13  Behçet’s disease is a chronic, recurrent, inflammatory disorder characterized by orogenital ulcers and skin lesions; serious manifestations also include ocular, large vessel, gastrointestinal and neurological involvement. Genetic and unknown environmental factors modify the wide clinical spectrum of the disease. During the long clinical course of the disease, testicular and epididymal involvement has been reported, with scrotal pain and swelling being the most common symptoms. In this review, we discuss the various aspects of epididymo-orchitis in Behcet’s disease patients, and we evaluate the diagnostic approaches as well as the empirical therapeutic modalities of this entity.   https://acta.tums.ac.ir/index.php/acta/article/view/5798 https://acta.tums.ac.ir/index.php/acta/article/download/5798/4970

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 55 8 2017 10 07 486 495 EN Mohammad Hassan Golzari Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran Saeed Hosseini Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran. Fariba Koohdani Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran. Ali-Akbar Saboor Yaraghi Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Hassan Javanbakht Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran. Niyaz Mohammadzadeh-Honarvar Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran. Mahmoud Djalali Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran. 2016 12 24 2017 02 01 Paraoxonase 1 is known as one of the most important ant oxidative enzymes associated with HDL-c, and because of its antioxidant and antiinflammatory activities. EPA has the antioxidant, anti inflammatory, antithrombogenic, and antiarteriosclerotic properties. Therefore, we investigated the effect of EPA supplementation on the serum levels and activity of PON1 in type 2 diabetic patients. This study was designed as a randomized, double-blind, and placebo-controlled clinical trial. Thirty-six patients with type 2 diabetes were given written; informed consent randomly was classified into 2 groups. They were supplemented with 2 g/day of the capsules of EPA or placebo for eight weeks. Blood sample was given for measurement of the serum levels of lipids, the activity of PON1, FBS and HbA1c. The patients supplemented with EPA showed a significant increase in the serum levels and activity of PON1 and the serum ratio of PON1/HDL-c. There were no significant differences between the two groups regarding any demographic, clinical or biochemical data, total energy intake, and macronutrient intake at the baseline during the intervention, except for a significant increase of protein intake and the levels of HbA1c in the placebo group, and a significant increase of HDL-c, as well as a slight reduction of total cholesterol, LDL-c, TG and FBS in the supplement group. EPA is atheroprotective via increase in the serum levels and activity of PON1, as well as change in the serum levels of lipids, FBS and HbA1c. https://acta.tums.ac.ir/index.php/acta/article/view/6087 https://acta.tums.ac.ir/index.php/acta/article/download/6087/4971

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 55 8 2017 10 07 521 524 EN Amirhossein Jahanshir Department of Emergency Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Maryam Bahreini Department of Emergency Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Mohsen Banaie Department of Emergency Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Jallili Department of Emergency Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Shahram Hariri Department of Emergency Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Fatemeh Rasooli Department of Emergency Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Hamed Sotoodehnia Department of Emergency Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Javad Seyed Hosseini Department of Emergency Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Arash Safaie Department of Emergency Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Ehsan Karimi Department of Emergency Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Ali Labaf Department of Emergency Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Hadi Mir Fazaelian Department of Emergency Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Elnaz Vahidi Department of Emergency Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. 2016 07 27 2017 05 09 Applying simulation in medical education is becoming more and more popular. The use of simulation in medical training has led to effective learning and safer care for patients. Nowadays educators have confronted with the challenge of respecting patient safety or bedside teaching. There is widespread evidence, supported by robust research, systematic reviews and meta-analysis, on how much effective simulation is. Simulation supports the acquisition of procedural, technical and non-technical skills through repetitive practice with feedbacks. Our plan was to induct simulation in emergency medicine residency program in order to ameliorate our defects in clinical bedside training. Our residents believed that simulation could be effective in their real medical practice. They mentioned that facilitators’ expertise and good medical knowledge, was the strongest point of the program and lack of proper facilities was the weakest. https://acta.tums.ac.ir/index.php/acta/article/view/5792 https://acta.tums.ac.ir/index.php/acta/article/download/5792/4976

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 55 8 2017 10 07 525 529 EN Mauro Chiarito Department of Cardio Thoracic Vascular, San Raffaele Scientific Institute, Milan, Italy. Andrea Scotti Department of Cardio Thoracic Vascular, San Raffaele Scientific Institute, Milan, Italy. Carlo A Pivato Department of Cardio Thoracic Vascular, San Raffaele Scientific Institute, Milan, Italy. Giuseppe Cottone Department of Cardio Thoracic Vascular, San Raffaele Scientific Institute, Milan, Italy. Carlo Ballarotto Department of Cardio Thoracic Vascular, San Raffaele Scientific Institute, Milan, Italy. Cosmo Godino Department of Cardio Thoracic Vascular, San Raffaele Scientific Institute, Milan, Italy. Alberto Margonato Department of Cardio Thoracic Vascular, San Raffaele Scientific Institute, Milan, Italy. 2016 02 16 2016 07 03 A 47-year-old woman presented with a history of resistant arterial hypertension, associated with disabling headache. She was subjected to an enormous number of tests in order to identify an underlying cause of secondary hypertension, such as pheochromocytoma or Cushing syndrome, but all the most common causes of secondary hypertension were investigated and gradually excluded. Factitious use of amphetamine or cocaine was excluded, and therapy compliance was verified by witnessed ingestion of drug therapy, in order to rule out Munchausen syndrome. The patient underwent a first transcatheter renal denervation (RDN) with poor effect on blood pressure (BP) at long term follow up. Because of extremely poor control of BP values, a second RDN was performed two years later, again with inadequate long term efficacy. Despite an uncontrollable pre-procedural BP, RDN had an excessive BP lowering effect in this patient, but only for few months. In conclusion, a definitive diagnosis was not performed in our patient, despite an extremely deepened examination of the most common cause of refractory hypertension. https://acta.tums.ac.ir/index.php/acta/article/view/5444 https://acta.tums.ac.ir/index.php/acta/article/download/5444/4983

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 55 8 2017 10 07 538 538 EN Fausto Fama’ Department of Human Pathology, University Hospital of Messina, Messina, Italy. Maria Gioffrè-Florio Department of Human Pathology, University Hospital of Messina, Messina, Italy. 2016 10 25 2017 04 10 No Abstract https://acta.tums.ac.ir/index.php/acta/article/view/5972 https://acta.tums.ac.ir/index.php/acta/article/download/5972/4982

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 55 8 2017 10 07 496 501 EN Mohammad Reza Emad Department of Physical Medicine and Rehabilitation, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. Leila Zeinali Department of Physical Medicine and Rehabilitation, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. Alireza Nikseresht Department of Neurology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. Mahshid Naseri Department of Physical Medicine and Rehabilitation, Shiraz Geriatric Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. Hajar Karimian Department of Physical Medicine and Rehabilitation, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. 2016 08 05 2017 05 15 Multiple sclerosis (MS) is the most common cause of disability after trauma in young adults in Northern Hemisphere; it imposes a major burden on the affected young people. A significant association between MS and demyelinating peripheral neuropathy which might be due to common pathogenesis for the central and peripheral nerves demyelination has been reported in several studies. We aimed to assess if there is any peripheral nervous system involvement in a sample of Iranian MS population. Extensive nerve conduction studies (NCS) were conducted in 20 MS patients according to McDonald criteria, and 20 age and gender matched healthy appearing controls. The F-wave ratio was calculated through placing the minimum amount of F-wave proximal latency after 10 stimuli and median or tibial nerves compound motor action potential (CMAP) proximal latency in the corresponding formula. Data were compared between groups. Finally, we found the significantly lower median and tibial nerves conduction velocities (NCV) in MS patients than healthy controls (P=0.008 and 0.003 respectively, Independent Samples t-test). Also, tibial NCV had a significant statistical correlation with Kurtzke’s expanded disability scale score (EDSS) as patients with higher EDSS had lower tibial NCV (Pearson's correlation coefficient, r2=0.8). No statistical relationship was found between MS subtypes and NCS parameters. Although we found some electrodiagnostic abnormalities in Iranian MS patients in comparison to the healthy participants, these differences were small and inconclusive. More extensive well-designed electrodiagnostic studies for evaluation of peripheral nervous system involvement and its probable pattern in these patients seems to be needed. https://acta.tums.ac.ir/index.php/acta/article/view/5805 https://acta.tums.ac.ir/index.php/acta/article/download/5805/4972

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 55 8 2017 10 07 530 532 EN Masoud Fallahi Motlagh Department of Oral and Maxillofacial Surgery, Urmia University of Medical Sciences, Urmia, Iran. Hamid Janghi Aghdam Department of Neurosurgery, Azarbayjan Hospital, Urmia, Iran. Behzad Fallahi Motlagh Department of Ophthalmology, Tabriz University of Medical Sciences, Tabriz, Iran. 2016 01 02 2016 Hiva Saffar Department of Pathology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Afsaneh Rajabiani Department of Pathology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Alireza Abdollahi Department of Pathology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. 2016 11 19 2017 04 16 Due to a close link between cardiovascular disorders and increased acute phase responses, it is now proposed the relation of total sialic acid (TSA) and C Reactive Protein (CRP) as main components of acute phase proteins and cardiovascular risk profiles such as diabetes mellitus and smoking. We hypothesized that the elevation in the level of TSA along with other prototype acute phase reactants such as CRP is expected more in the coexistence of diabetes and smoking than in diabetes mellitus alone. Ninety diabetic patients were randomly selected and entered into this case-control study. Using block randomization method, the patients were randomly assigned into smokers (n=45) and nonsmokers (n=45). A group of ten healthy individuals was also included as the control. The serum levels of TSA, CRP, iron, and hemoglobin were measured by the specific techniques. Comparing laboratory parameters across the three groups indicated significantly higher levels of TSA and CRP in smoker diabetics as compared to non-smoker diabetics and the healthy controls, while there was no difference in other parameters including serum iron and hemoglobin. A significant positive correlation was also revealed between TCA and CRP (r=0.324, P=0.030), but no significant association was found between other parameters. In the background of smoking, increasing the level of both TSA and CRP is predicted more than the existence of diabetes mellitus alone. In fact, the increase in these biomarkers is more predictable in smoker than in nonsmoker diabetics. This finding emphasizes the increased risk for cardiovascular disorders in smoker compared to non-smoker diabetics. https://acta.tums.ac.ir/index.php/acta/article/view/6016 https://acta.tums.ac.ir/index.php/acta/article/download/6016/4987

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 55 9 2017 10 30 597 601 EN Aghigh Haydari Department of Anesthesiology, Imam Ali Hospital, Kermanshah University of Medicine, Kermanshah, Iran. Feridoun Sabzi Department of Cardiac Surgery, Imam Ali Hospital, Kermanshah University of Medicine, Kermanshah, Iran. Samsam Dabiri Department of Cardiac Surgery, Imam Ali Hospital, Kermanshah University of Medicine, Kermanshah, Iran. Alireza Poormotaabed Department of Cardiac Surgery, Imam Ali Hospital, Kermanshah University of Medicine, Kermanshah, Iran. 2015 10 24 2016 09 27 We report a patient presented with recurrent pericardial effusion caused by drug-induced systemic lupus Erythematosus (SLE) following mitral valve repair. The surgery was complicated by hemiparesis and convulsion in early postoperative period. The patient had been received carbamazepine for a paroxysmal seizure that occurred following mitral valve repair. The post operative computed tomography showed embolic stroke and its sequel (seizure) that treated with carbamazepine. In the 3rd month of follow-up, however, hemiparesis recovered by physiotherapy but carbamazepine was not discontinued as by request of neurologist. In the 6th month of surgery, the patient admitted by dyspnea and massive pericardial effusion that treated by subxiphoid drainage. This event was re occurred in two times in a short time frame and each event treated by surgical approach. The serologic exam in the last admission revealed drug-induced lupus erythematosus. The carbamazepine as an anti convulsive drug has been described to cause LE like disease in multiple case reports. Laboratory exam exhibited the possibility of carbamazepine-induced lupus in our case, with the extremely rare presentation of recurrent massive pericardial effusion. https://acta.tums.ac.ir/index.php/acta/article/view/5047 https://acta.tums.ac.ir/index.php/acta/article/download/5047/4994

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 55 9 2017 10 30 568 572 EN Mohammad Barzegar Department of Pediatrics, Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Reza Piri Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Mohammad Naghavi-Behzad Student's Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Masoumeh Ghasempour Department of Pediatrics, Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. 2016 11 28 2017 04 16 It is very important to have proper management in children with Seizure. Electroencephalography (EEG) as a diagnostic instrument has a key role in determining the management method of seizure in children. Because of poor cooperation of some children (especially children with attention deficit hyperactivity disorders and developmental disorders) in performing EEG, it is the best choice to sedate children before EEG. The aim of present study is to evaluate the sedation efficacy of clonidine in children before EEG. In a randomized clinical trial, 45 children age 2 to 12 with seizure, who referred to Children Hospital of Tabriz University of Medical Sciences and candidate for EEG, were studied. Sedation before EEG induced by 0.5 to 2.0 mg clonidine orally. Sedation score (0 to 5) measured by using eyes condition, response to voice, and response to touch. Successful sedation, EEG performing, and hemodynamic stability were evaluated during sedation. Of all patients, 40 patients (88.88%) were sedated successfully, and EEG was performed for all of the children. Mean onset time of clonidine effect was 35.47±13.56 minutes and mean time of that the patients’ level of consciousness back to the level before administrating of clonidine was 77.55±26.87 minutes. Hemodynamic states of all patients were stable during the study, and there were no significant changes in vital sign of patients. In conclusion, clonidine can be considered as a safe alternative medication for sedation for EEG, which is fortunately associated with no significant change in vital signs, which may complicate overall status of patients. https://acta.tums.ac.ir/index.php/acta/article/view/6039 https://acta.tums.ac.ir/index.php/acta/article/download/6039/4988

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 55 9 2017 10 30 573 577 EN Mohammad Sobhanardekani Department of Radiology, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Mohammad Reza Sobhan Department of Orthopedics, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Reza Nafisi Moghadam Department of Radiology, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Sepehr Nabavinejad Department of Radiology, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Seid Kazem Razavi Ratki Department of Radiology, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. 2016 12 20 2017 03 30 Patellar instability is a multifactorial common knee pathology that has a high recurrence rate, and the symptoms continue and ultimately predispose the patient to chondromalacia and osteoarthritis. Tibial tuberosity-trochlear groove distance (TTTG) is very important in the assessment of patellofemoral joint instability. The purpose of this study was to report the normal value of TTTG in males and females in different age groups and to assess the reliability of MRI in measuring TTTG. All patients presenting with knee pain and normal examinations of the knee joint, with a normal MRI report, referring to Shahid Sadoughi hospital of Yazd, Iran, from April 2014 to September 2014, were included in the study. MR images were studied once by two radiologists and for the second time by one radiologist. Mean value of TTTG was reported for males and females and in three age groups. Intra- and inter-observer reliability was calculated. A total of 98 patients were eligible to evaluate during 6 months (68 male and 30 female). Mean TTTG was 10.9±2.5 mm in total, which was 10.8±2.8 mm and 11.3±2.3 mm in males and females, respectively (P>0.05). Mean TTTG in males ≤30 years, 30-50 years and, ≥51-year-old were 10.8±2.6 mm, 10.8±2.7 mm, and 10.8±2.6 mm, respectively; that was 12.1±3.4 mm, 11.4±1.9 mm, and 10.5±1.7 mm in females ≤30 years, 31-50 years and, ≥51-year-old, respectively (95% CI). The coefficient of variation was <10% for both intra- and interobserver analysis. The results of the present study showed no significant difference in TTTG value between males and females in different age groups. In addition, it demonstrated that MRI is a reliable method in assessment of TTTG and identified normal value for TTTG at 10.9±2.5 mm. https://acta.tums.ac.ir/index.php/acta/article/view/6075 https://acta.tums.ac.ir/index.php/acta/article/download/6075/4989

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 55 9 2017 10 30 578 584 EN Ahmad Amouzeshi Department of Cardiovascular Surgery, Atherosclerosis and Coronary Artery Research Center, Birjand University of Medical Sciences, Birjand, Iran. AND Surgery and Trauma Research Center, Birjand University of Medical Sciences, Birjand, Iran. Zahra Amouzeshi Surgery and Trauma Research Center, Birjand University of Medical Sciences, Birjand, Iran. AND Department of Nursing, Atherosclerosis and Coronary Artery Research Center, Birjand University of Medical Sciences, Birjand, Iran. Mohammad Abbasi Teshnizi Department of Cardiac Surgery, Atherosclerosis Prevention Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Ali Asghar Moeinipour Department of Cardiac Surgery, Atherosclerosis Prevention Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Mahmood Hosseinzadeh Maleki Department of Cardiovascular Surgery, Atherosclerosis and Coronary Artery Research Center, Birjand University of Medical Sciences, Birjand, Iran. AND Surgery and Trauma Research Center, Birjand University of Medical Sciences, Birjand, Iran. 2016 09 05 2017 04 15 Given the ongoing controversy over the risks and benefits of on-pump versus off-pump coronary artery bypass graft surgery (CABG), we aimed to compare time trends in off- and on-pump CABG long-term outcomes. In this prospective cohort study, the patients who underwent primary isolated non-emergent CABG in Imam Reza Hospital in Mashhad, Iran, in 2006 were followed for 6 years. The patients were contacted to obtain long-term follow-up data such as death, rehospitalization, myocardial infarction, and normal physical activity. The obtained data were analyzed in SPSS software (V: 16) using t-test, Fisher's Exact, chi-square, and Mann-Whitney tests, and relative risk. The significant level was set at P<0.05.The study included 61 patients of whom n=40 (65.6%) underwent off-pump CABG. The mean age of the patients was 59.0±11.31 years, and n=43 (70.5%) were