Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 56 2 2018 02 17 74 76 EN Sara Rashid Chehreh Bragh Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. AND NeuroImmunology Research Association (NIRA), Universal Scientific Education and Research Network (USERN), Tehran, Iran. Farzaneh Rahmani NeuroImaging Network (NIN), Universal Scientific Education and Research Network (USERN), Tehran, Iran. AND Research Center for Immunodeficiencies, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran. Nima Rezaei Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. AND Research Center for Immunodeficiencies, Children’s Medical Center, 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. 2017 11 01 2017 12 11 No Abstract https://acta.tums.ac.ir/index.php/acta/article/view/6819 https://acta.tums.ac.ir/index.php/acta/article/download/6819/5048

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 56 2 2018 02 17 77 83 EN Ateke Mousavi Nasl-khameneh Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, International Campus, Tehran University of Medical Sciences, Tehran, Iran. Abbas Mirshafiey Department of Immunology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Abdorreza Naser Moghadasi MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Reza Shiri-Shahsavar Department of Nutrition, School of Health, Qazvin University of Medical Sciences, Qazvin, Iran. Mohammad Reza Eshraghian Department of Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Maryam Shadanian Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran. Mina Abdolahi 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, International Campus, Tehran University of Medical Sciences, Tehran, Iran. AND Department of Immunology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. 2017 03 12 2017 04 30 Multiple sclerosis (MS) is an autoimmune disease with the impaired balance of CD4+T cells. This trial is a descriptive study to evaluate the expression of CD4+T cell cytokines, interleukin (IL) ‑2, IL‑4, IL‑17, TGF‑β, and respectively related transcription factors, including T-bet, GATA3, RORγt and FoxP3 in MS patients. Sixteen relapsing-remitting MS (RRMS) patients receiving interferon beta (IFN-β)-1a in the stable phase of the disease and 14 healthy control volunteers (HCs) were enrolled in this study. The expression of cytokines and transcription factors was evaluated in peripheral blood mononuclear cells (PBMCs) of patients using real time PCR. The results of this study showed that the expression of IL-2 (P≤0.05), IL-4 (P≤0.05), IL-17 (P≤0.05) and RORγt (P≤0.01) in PBMCs of RRMS patients were significantly higher than those in HCs. The expression of TGF‑β, GATA3, and FoxP3 were higher but the RORγt expression was lower in the patients than HCs without reaching significant value. Observed results indicated differences in immune system cytokines of healthy volunteers and the patients that were in the stable phase and under immunomodulatory therapy especially in proinflammatory mediators. Therefore, any therapeutic strategy to restore the immune system balance is desirable in RRMS patients. https://acta.tums.ac.ir/index.php/acta/article/view/6298 https://acta.tums.ac.ir/index.php/acta/article/download/6298/5049

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 56 2 2018 02 17 127 131 EN Gholamreza Sivandzadeh Department of Gastroenterology, Gastroenterology and Hepatology Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran. Alimohammad Banazadeh Department of Surgery, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran. Amir Anushiravani Department of Gastroenterology and Hepatology, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2016 11 24 2017 05 07 Foreign bodies are commonly ingested and usually pass through the gastrointestinal tract, but in less than 1% complications can be seen. We aimed to report a very rare case of multiple hepatic abscesses caused by perforation of the sigmoid colon due to a chicken bone. An 82-year-old man presented with a 5-day history of abdominal pain, fever, and coffee ground vomiting. He was febrile and tachycardic and had a mild localized abdominal tenderness in the left lower quadrant. Laboratory findings revealed a lymphocyte dominant leukocytosis with an elevated erythrocyte sedimentation rate. Multiple abscesses were shown in the right lobe of the liver in abdominal computed tomography. Colonoscopy showed a chicken bone perforating both walls of the sigmoid colon. He received broad-spectrum antibiotics and underwent surgery for a complete recovery. Chronic lymphocytic leukemia was diagnosed by flow cytometry phenotyping. Mortality and morbidity of hepatic sepsis caused by foreign body-induced colon perforation depend on a rapid diagnosis.  We presented a very rare condition that should always be kept in mind when dealing with a case of liver abscess and even while confronting septic shock with an unknown origin. https://acta.tums.ac.ir/index.php/acta/article/view/6031 https://acta.tums.ac.ir/index.php/acta/article/download/6031/5057

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 56 2 2018 02 17 84 89 EN Mehran Zarei-Ghanavati Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran. Reza Ghaffari Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran. Hoda Abedkhojasteh Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran. Kasra Raoufian Department of General Surgery, Sina Hospital, Mashhad, Iran. Reza Raoofian Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran. Masoumehe Mohebbi Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mansour Heidari Department of Molecular Biology and Genetics, Islamic Azad University, Bushehr Branch, Bushehr, Iran. AND Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran. 2017 06 01 2017 11 08 Non-syndromic aniridia (iris hypoplasia) as an autosomal dominant eye disorder results from the chromosomal abnormalities and mutations within the paired box gene 6 (PAX6). The aim of this study was to investigate on the clinical and the underlying genetic alteration in PAX6 gene in a large pedigree with five generations of Iranian family with an autosomal dominant aniridia. Here, we reported unique clinical features in terms of presenting nystagmus, ptosis, minimal iris abnormality, foveal hypoplasia and late-onset clinical limbal stem cell deficiency. Genomic DNA was extracted from the affected members and polymerase chain reaction (PCR) was conducted using specific primers to amplify coding sequence of PAX6. Then, PCR products were subjected to bidirectional dye terminator sequencing. A heterozygous transversion mutation A→T (c.1268A>T, p.*423Lext*15) in exon 13 of PAX6 was identified in all affected individuals, but not in the healthy members. This is the first report of non-stop mutation in PAX6 gene in an Iranian family accompanied with an isolated form of unusual congenital aniridia running within this family. https://acta.tums.ac.ir/index.php/acta/article/view/6500 https://acta.tums.ac.ir/index.php/acta/article/download/6500/5050

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 56 2 2018 02 17 132 136 EN Seyed Hossein Fattahi Masoum Endoscopic and Minimally Invasive Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. Azadeh Jabbari Nooghabi Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. Reza Rezaei Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. 2016 05 17 2016 12 31 Castleman’s disease (CD) is a rare benign lymphoproliferative disorder with unknown etiology and pathogenesis. It presents in two identified clinical forms of unicentric or multicentric. The disease is usually found incidentally in the mediastinal or hilar region in asymptomatic patients. In unicentric CD, constitutional symptoms are uncommon, and they can be misdiagnosed as lung infections or malignancy. Although imaging studies are helpful, but definitive diagnosis can be made with pathologic examination. Complete surgical resection is the method of choice for treatment of localized CD, and the prognosis is excellent. In this study, we elucidate clinical features and therapeutic consequences of four cases of unicentric CD referred to our department and review the literature on the diagnosis and management of this relatively rare disorder. Because of the rarity of the disease and nonspecific signs and symptoms of CD it must be considered in differential diagnosis of pulmonary and mediastinal masses. https://acta.tums.ac.ir/index.php/acta/article/view/5640 https://acta.tums.ac.ir/index.php/acta/article/download/5640/5058

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 56 2 2018 02 17 90 94 EN Shabnam Baniasadian Department of Cellular and Molecular Biology, Ahar Branch, Islamic Azad University, Ahar, Iran. AND Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Safar Farajnia Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Behboud Jafari Department of Microbiology, Ahar Branch, Islamic Azad University, Ahar, Iran. 2017 06 07 2017 10 21 Genome-wide association studies in Asian population for the first time identified common variants in the KCNQ1 gene to be associated with type 2 diabetes in Japanese populations, recently. This result has been replied in some other East Asian population but, still now, there is no any report about this subject in Iranian population. The aim of this study was to investigate the frequency of KCNQ1 variants in type 2 diabetes in East Azerbaijan population, northwest of Iran. A total of 75 T2D and 90 normal East Azerbaijan subjects were entered the study. A demographic date was recorded for all subjects. Genomic DNA was extracted from the whole blood, and the KCNQ1 single nucleotide polymorphisms (SNPs) rs2237892 were genotyped with PCR-RFLP technique. The results of the study indicated an increased level of FBS and HbA1C among T2D cases (P<0/0001), as expected. Screening for KCNQ1 rs237892 among T2D case group revealed that the genotype frequencies of CC, CT and TT were 87.0% (67/77), 10.4% (8/77) and 2.6% (2/77), respectively. The allelic frequencies of C and T in case subjects were 92.21% (142/154) and 7.79% (12/154), respectively. Analysis of the normal control subjects showed the genotype frequencies of CC, CT and TT were 94.4% (85/90), 3.3% (3/90) 2/2% (2/90), respectively. The allelic frequencies of C and T among controls were 96.11% (173/180) and 3.89% (7/180), respectively. In conclusion, the results of our study indicated that there are no any significant differences in frequency of KCNQ1 rs237892 alleles between T2D and control subjects. https://acta.tums.ac.ir/index.php/acta/article/view/6514 https://acta.tums.ac.ir/index.php/acta/article/download/6514/5051

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 56 2 2018 02 17 137 139 EN Ebrahim Ghayem Hasankhani Department of Orthopedics and Spine Surgery, Orthopedic Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Farzad Omidi-Kashani Department of Orthopedics and Spine Surgery, Orthopedic Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Seyed Reza Habibzadeh Shojaie Department of Orthopedics and Spine Surgery, Orthopedic Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Golnaz Ghayem Hasankhani Department of Orthopedics and Spine Surgery, Orthopedic Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. 2016 12 07 2017 04 15 Myositis ossificans progressiva is a rare inherited disease characterized by progressive ectopic ossifications associated with thumb and big toe anomalies. Ossification usually progresses from central to the peripheral, proximal to distal, cranial to caudal, and from dorsal to ventral directions and leading to activity limitation, significant eating disability, recurrent pulmonary infection, and atelectasis. In this report, we present a 7-year-old boy with a total spine stiffness (wooden spine) seriously limited his activity of daily living. https://acta.tums.ac.ir/index.php/acta/article/view/6050 https://acta.tums.ac.ir/index.php/acta/article/download/6050/5059

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 56 2 20x.php/acta/article/download/11013/5835

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 61 9 2024 03 16 531 539 Asghar Hajipour Department of Anesthesiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Alireza Montaseri Department of Anesthesiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Mojgan Rahimi Department of Anesthesiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Amirhossein Orandi Department of Anesthesiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Laila Rahmah School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Shahram Samadi Anesthesia, Critical Care and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran. AND Sleep Breathing Disorders Research Center (SBDRC), Tehran University of Medical Sciences, Tehran, Iran 2024 03 16 This retrospective cohort study aimed to assess the frequency of emergency cesarean sections with epidural analgesia and its implications on Apgar scores and Neonatal Intensive Care Unit (NICU) admissions among patients at Tehran University of Medical Sciences Hospitals from 2017 to 2018. Data from 7170 patients were extracted from the hospital information system (HIS) through a consensus method. Descriptive statistics, cross-tabulation, and logistic regression analyses were conducted using Stata v17 software. Out of 9387 patients, 62.7% underwent cesarean sections, and 37.1% had normal vaginal deliveries. Epidural analgesia was administered to 127 patients, with 98.4% achieving successful normal vaginal delivery. Nulliparous women constituted 64.29% of those receiving epidural analgesia. Apgar scores at five and ten minutes were comparable between epidural and non-epidural groups. Emergency cesarean rates with epidural analgesia were low (1.6%). Findings align with previous research indicating no significant impact of epidural analgesia on Apgar scores. Nulliparous women predominated in the epidural group, consistent with pain pattern disparities. The study supports recent research showing epidural analgesia does not increase emergency cesarean rates, even in high-risk pregnancies. This study suggests that epidural analgesia does not significantly impact Apgar scores, NICU admissions, or emergency cesarean rates. While the comprehensive dataset enhances reliability, retrospective design limitations are acknowledged. Prospective studies exploring factors contributing to neonatal mortality and overall labor duration are recommended for more robust evidence. https://acta.tums.ac.ir/index.php/acta/article/view/11014 https://acta.tums.ac.ir/index.php/acta/article/download/11014/5836

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 61 9 2024 03 16 539 546 Saeideh Sadat Mousavi Department of Curriculum Studies and Instruction, Ferdowsi University of Mashhad, Mashhad, Iran. AND Sleep Breathing Disorders Research Center (SBDRC), Tehran University of Medical Sciences, Tehran, Iran Morteza Karami Department of Curriculum Studies and Instruction, Ferdowsi University of Mashhad, Mashhad, Iran Seyed Mohammad Mireskandari Anesthesia, Critical Care and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran Shahram Samadi Anesthesia, Critical Care and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran. AND Sleep Breathing Disorders Research Center (SBDRC), Tehran University of Medical Sciences, Tehran, Iran 2024 03 16 2024 03 16 The use of educational technology is considered a necessity due to the increasing changes in medical education. This study aimed to design a novel blended virtual reality and clinical learning environment (CLE) and to investigate its effectiveness in the learning transfer of anesthesiology residents during spinal anesthesia procedures. In this experimental study, 25 residents (academic year 2020/2021) were randomly divided into blended (n=11) and clinical (n=14) groups. Spinal anesthesia training for the blended group was performed in the virtual training laboratory (week 1) and the operating room (from week 2 to week 4), while for the CLE group, it was only performed in the operating room. Training, based on task-centered learning, was provided for both groups, and then, a 360-degree assessment of learning transfer was conducted by professors, patients, co-workers, and self-assessments using a standard questionnaire. Data were analyzed using non-parametric tests. There was a significant difference in the learning transfer of residents between the blended and CLE groups (U=39, P=0.03<0.05). There was also a significant difference in the subcategories of learning transfer according to the professors and co-workers; however, there was no significant difference according to the patients and self-assessments. The blended VR/CLE learning environment was more effective than CLE in improving residents’ learning transfer. Besides, an increase in scores indicated an improvement in professional competence. https://acta.tums.ac.ir/index.php/acta/article/view/11015 https://acta.tums.ac.ir/index.php/acta/article/download/11015/5837

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 61 9 2024 03 16 547 554 Fariba Mansouri Department of Respiratory, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran Majid Akrami Department of Anesthesiology, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran Neda Faraji Department of Internal Medicine, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran Masoomeh Nataj Majd Department of Anesthesiology, Arash Hospital, Tehran University of Medical Sciences, Tehran, Iran 2024 03 16 2024 03 16 Early commencement of enteral nutrition (EEN) in critically ill patients requiring mechanical ventilation may improve outcomes. But there is a lack of enough data regarding EEN effects on COPD exacerbation patients’ outcomes. This retrospective study involved 129 COPD exacerbation patients who received invasive mechanical ventilation in ICU. The clinical outcomes were compared based on the timing of enteral nutrition (<48h vs >48h) during 60 days of ICU stay. We surveyed and analyzed mortality, pleural effusion, ventilator-associated pneumonia, weaning failure, cardiac arrhythmias, GI bleeding, electrolyte imbalances, renal dysfunction and length of ICU stay. All analyses were performed using SPSS software version 22.0. 129 COPD-exacerbated patients (EEN group n=66; DEN group n=63) who met the inclusion criteria were enrolled in the study. EEN group had a lower death rate (39% vs 44.4%) than the DEN group, but no significant difference was found in the overall mortality during the 60-day follow-up (P 0.561). The EEN group also had lower ICU stay and pleural effusion rate than the DEN group (P:0.006 and 0.020 respectively). No significant differences were found in other outcomes. Early enteral nutrition might be associated with shorter ICU stay and lower odd ratio of acquisition of pleural effusion in COPD patients requiring invasive mechanical ventilation. EEN could not decrease mortality rate compared with DEN in the current study. https://acta.tums.ac.ir/index.php/acta/article/view/11016 https://acta.tums.ac.ir/index.php/acta/article/download/11016/5838

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 61 9 2024 03 16 555 559 Zahra Khazaeipour Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran Niloufar Khoshnam-Rad Thoracic Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Khalil Pestei Department of Anesthesiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. AND Anesthesia, Critical Care and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran Shahram Samadi Anesthesia, Critical Care and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran. AND Sleep Breathing Disorders Research Center (SBDRC), Tehran University of Medical Sciences, Tehran, Iran 2024 03 16 2024 03 16 Propofol is an advantageous agent for anesthesia induction. It can cause dose-related hemodynamic adverse effects. The bispectral index (BIS) is a brain function monitor utilized to assess the depth of anesthesia. This study aimed to compare the adverse hemodynamic effects of BIS-guided response dosing with conventional weight-based dosing of Propofol. In this clinical trial, patients were anesthetized with propofol in two different orthopedic operating rooms. In one operating room, patients received propofol with dose-response method (group A), and the other received weight-based dosing (group B). For both groups, BIS was used as an index of anesthesia depth. Hemodynamic parameters were recorded at baseline, during induction, and at different time points. A total of 73 patients were included in the final analysis. The mean dose of propofol for induction was higher in the control group than in the response-guided group (1.94±1.65 vs. 1.09±0.32, respectively, P=0.006). There were no reported significant adverse hemodynamic effects in patients of the two groups. Response-guided propofol dosing can be used to decrease propofol dose during anesthesia induction. Further studies are needed to investigate the clinical benefit of this dosing strategy. https://acta.tums.ac.ir/index.php/acta/article/view/11017 https://acta.tums.ac.ir/index.php/acta/article/download/11017/5839

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 61 9 2024 03 16 560 566 Masoomeh Nataj Majd Department of Anesthesiology, Arash Women’s Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Asma Tahery School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Raziyeh Erfani School of Medicine, Tehran University of Medical Sciences, Tehran, Iran 2024 03 16 2024 03 16 The present study evaluates the association between epidural analgesia and the duration of the active phase of labor and pregnancy outcomes in mothers with high body mass index (BMI). All term pregnant women undergoing epidural analgesia for pain-free labor entered the study from September 2016 to March 2020. After recruiting 300 subjects into the study, mothers were categorized into six groups based on their BMI levels. Each BMI sub-group was analyzed regarding the duration of the active phase of labor and delivery mode. In addition, the relationship between BMI and labor outcome and characteristics was studied. Overall, 300 laboring women with epidural analgesia were included. 79.3% had a vaginal delivery, and 20.7% undergo cesarean section. Different BMI sub-groups showed no significant difference regarding the duration of the active phase of labor under epidural analgesia. Cox regression analysis revealed that BMI had no significant effect on the length of the active phase of labor (P=0.787). No significant association was found between BMI and the cesarean delivery rate, uterine atony, maternal pyrexia, neonatal Apgar score, and NICU hospitalization rate. However, BMI was significantly associated with the incidence of dystocia and headache. labor with dystocia exhibited a significantly higher Mother’s BMI (P<0.05). The results suggest no significant association between epidural analgesia and the active phase of labor duration in mothers with high BMI. https://acta.tums.ac.ir/index.php/acta/article/view/11018 https://acta.tums.ac.ir/index.php/acta/article/download/11018/5840

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 61