Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 56 7 2018 08 13 421 428 EN Mina Afhami Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran. AND Department of Biology, Faculty of Science, Ferdowsi University of Mashhad, Mashhad, Iran. Mansoureh Hashemi Department of Neuroscience, Functional Neurosurgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Khashayar Afshari Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran. Jamal Chenari Department of Anatomical Sciences, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Seyed Mohammad Tavangar Department of Pathology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mahmoudreza Hadjighassem Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran. AND Department of Neuroscience, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran. Ahmad Reza Dehpour Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran. AND Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Ahad Muhammadnejad Cancer Biology Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran. Arvin Haj-Mirzaian Department of Pharmacology, Tehran University of Medical Sciences, Tehran, Iran. AND Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran. Vafa Rahimi-Movaghar Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran. AND Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran. AND Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2017 10 02 2018 03 13 Olfactory ensheathing cells-based therapy for spinal cord injury (SCI) repair has been a possible treatment for clinical study because of their safety in autologous transplantation and potential regenerative capability. However, there are contradictory reports on the results after transplantation in animal models. The purpose of this research was to investigate the effect of acute transplantation of human mucosa-derived olfactory ensheathing cells (OECs) on the repair of the spinal cord. Human olfactory ensheathing cells were isolated from the human mucosa and cultured under supplemented neuronal cell culture medium. They were characterized by immunocytochemistry for olfactory ensheathing cell markers. We induced spinal cord injury at T8-T9 of rats by aneurysm clips and simultaneously injected two million OECs into subarachnoid space of spinal cord. Sensory and motor behaviors were recorded by tail-flick reflex (TFR) and BBB scores, respectively every week for seven weeks after injury. Morphology and S100-beta antigen expression in olfactory ensheathing cells of the human olfactory mucosa was confirmed by immunostaining. OECs transplantation did not recover inflammation, neuronal vacuolation, hemorrhage, and cyst formation. These findings suggest that OECs transplantation in this experimental setting did not lead to tissue regeneration to enhance locomotion. These results broaden current knowledge and are additions to the science and literature. https://acta.tums.ac.ir/index.php/acta/article/view/6754 https://acta.tums.ac.ir/index.php/acta/article/download/6754/5124

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 56 7 2018 08 13 474 477 EN Saeid Morovvati Human Genetic Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran. Paniz Farshadyeganeh School of Basic Sciences, Tehran Medical Branch, Islamic Azad University, Tehran, Iran. Mojdeh Hamidizadeh School of Basic Sciences, Islamic Azad University Tehran Medical Branch, Tehran, Iran. Ziba Morovvati Department of Medical Genetics, Faculty of Advanced Medical Technologies, Golestan University of Medical Sciences, Gorgan, Iran. Samaneh Doost Mohammadi Faculty of Basic Sciences, Islamic Azad University of Zanjan, Zanjan, Iran. 2017 05 17 2017 12 18 Lipoid proteinosis (LP) is a rare autosomal recessive disorder caused by malfunction mutations in extracellular matrix protein 1 gene (ECM1) with common features such as hoarseness of the voice, infiltration of the skin and mucosa, and varying degrees of skin scars. We studied two LP patients. Clinical and genetic examination and genetic counseling were carried out, and their family pedigree was drawn. Two different variants were found in exon 6 of ECM1 gene in both patients: a homozygous deletion of a nucleotide T at position 507 and a missense variant at nucleotide 389 which the first was a pathogenic mutation and the other one was a non-pathogenic variant. https://acta.tums.ac.ir/index.php/acta/article/view/6466 https://acta.tums.ac.ir/index.php/acta/article/download/6466/5131

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 56 7 2018 08 13 482 483 EN Hussein Baharlooi Department of Immunology, School of Medicine, 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. Ehsan Sharif-Paghaleh Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. AND Division of Imaging and Biomedical Engineering, School of Life Sciences and Medicine, King’s College London, London, United Kingdom. 2017 12 10 2018 03 02 No Abstract https://acta.tums.ac.ir/index.php/acta/article/view/6883 https://acta.tums.ac.ir/index.php/acta/article/download/6883/5134

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 56 7 2018 08 13 429 433 EN Isaura Isabelle Fonseca Gomes-Silva Department of Genetics, Federal University of Pernambuco, Av. Prof. Moraes Rego, 1235-Cidade Universitária, Recife-PE, Brazil. Eliezer Rushansky Department of Clinical Rheumatology, University of Pernambuco, Rua Arnóbio Marques, 10-Santo Amaro, Recife-PE, Brazil. Francisco Geraldo Carvalho-Neto Department of Genetics, Federal University of Pernambuco, Av. Prof. Moraes Rego, 1235-Cidade Universitária, Recife-PE, Brazil. Amanda Virginia Batista Vieira Department of Biology, Rural Federal University of Pernambuco, Rua Manoel de Medeiros-Dois Irmãos, Recife-PE, Brazil. Maria Helena Queiroz de Araujo Mariano Department of Clinical Rheumatology, University of Pernambuco, Rua Arnóbio Marques, 10-Santo Amaro, Recife-PE, Brazil. Paulo Roberto Eleutério de Souza Department of Biology, Rural Federal University of Pernambuco, Rua Manoel de Medeiros-Dois Irmãos, Recife-PE, Brazil. Martín Alejandro Montes Department of Biology, Rural Federal University of Pernambuco, Rua Manoel de Medeiros-Dois Irmãos, Recife-PE, Brazil. Maria Mascena Diniz Maia Department of Biology, Rural Federal University of Pernambuco, Rua Manoel de Medeiros-Dois Irmãos, Recife-PE, Brazil. 2017 04 08 2017 12 12 Rheumatoid Arthritis (RA) is a complex disease with higher level of IL-6. In order to elucidate the alterations related to IL-6 gene in RA, we evaluated the -174 G/C IL-6 gene polymorphism and methylation pattern of its promoter. A total of 120 RA patients and 120 healthy controls were recruited for polymorphism analysis, and 30 individuals of both groups were randomly selected for methylation analysis. The IL-6 gene polymorphism was analyzed by PCR-RFLP and methylation pattern was analyzed by MSP-PCR. Regarding IL-6 gene polymorphism, no significant difference was found between RA patients and controls (P>0.05). For DNA, two CpG regions of IL-6 promoter gene was analyzed. The first region (−1069, −1061, −1057 and −1001 CpG) did not show significant differences, whereas the second region (−628, −610, −574 and −491 CpG) showed a significant hypermethylated status (P=0.0004) in RA patients as compared with controls.These results, suggest a possible relationship between methylation pattern and the susceptibility to RA in our studied population. https://acta.tums.ac.ir/index.php/acta/article/view/6344 https://acta.tums.ac.ir/index.php/acta/article/download/6344/5125

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 56 7 2018 08 13 478 481 EN Leila Pourali Department of Obstetrics and Gynecology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Sedigheh Ayati Department of Obstetrics and Gynecology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Parvaneh Layegh Department of Radiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Atieh Vatanchi Department of Obstetrics and Gynecology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Zahra Rastin Department of Obstetrics and Gynecology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Azadeh Shourvi Department of Obstetrics and Gynecology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. 2017 07 09 2017 12 18 Persistent low level of beta-hCG (PLL) is defined as rising hCG level no more than two-fold over a three months period. Almost many types of PLL can lead to the wrong diagnosis. Here, we presented two cases of the retained product of conception (RPOC) with persistent low levels of beta-hCG. Both cases were presented with persistent low levels of beta-hCG and abnormal uterine bleeding since first-trimester pregnancy termination. Ultrasonography revealed a vascular mass with extension from the endometrial cavity to myometrium imitating gestational trophoblastic disease (GTD) or arteriovenous malformation (AVM). The final pathologies of both cases were retained product of conception. Imaging features of RPOC can closely imitate those of an AVM or GTN; so, hysteroscopy is one of the best non-invasive procedures which may be helpful in diagnosis and selection of appropriate treatment especially in young patients who desire to preserve their fertility.   https://acta.tums.ac.ir/index.php/acta/article/view/6589 https://acta.tums.ac.ir/index.php/acta/article/download/6589/5133

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 56 7 2018 08 13 434 440 EN Ala Habibian Infectious and Tropical Diseases Research Center, Health Research Institute, Jundishapur University of Medical Sciences, Ahvaz, Iran. AND Department of Virology, Jundishapur University of Medical Sciences, Ahvaz, Iran. Manoochehr Makvandi Infectious and Tropical Diseases Research Center, Health Research Institute, Jundishapur University of Medical Sciences, Ahvaz, Iran. AND Department of Virology, Jundishapur University of Medical Sciences, Ahvaz, Iran. Alireza Samarbaf-Zadeh Infectious and Tropical Diseases Research Center, Health Research Institute, Jundishapur University of Medical Sciences, Ahvaz, Iran. AND Department of Virology, Jundishapur University of Medical Sciences, Ahvaz, Iran. Niloofar Neisi Research Center, Health Research Institute, Jundishapur University of Medical Sciences, Ahvaz, Iran. Rahim Soleimani-Jelodar Infectious and Tropical Diseases Research Center, Health Research Institute, Jundishapur University of Medical Sciences, Ahvaz, Iran. Kamyar Makvandi Department of Orthopedic Surgery, Taleghani Hospital Research Development Unit, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Shima Izadi Infectious and Tropical Diseases Research Center, Health Research Institute, Jundishapur University of Medical Sciences, Ahvaz, Iran. 2017 07 16 2017 12 18 Epstein-Barr virus (EBV) is a DNA virus which belongs to the Herpesviridae family, has been infected with 90% of the world’s population. EBV is transmitted through saliva and associated with different diseases such as Infectious Mononucleosis, Nasopharyngeal Carcinoma, Burkitt`s lymphoma, Hodgkin and Non-Hodgkin`s lymphoma. This study was designed to determine the frequency of EBV DNA and genotyping of this virus in histological tissues of Hodgkin and Non-Hodgkin's lymphoma in Ahvaz, Iran. In this study, 12 samples of Hodgkin and 29 samples of Non-Hodgkin`s lymphoma were examined from Ahvaz Imam Khomeini Hospital. After deparaffinization and DNA extraction, Nested-PCR technique was carried out on Epstein-Barr nuclear antigen 1 (EBNA-1) and Epstein-Barr nuclear antigen 3C (EBNA-3C) regions in order to detect EBV genome and genotype in tumoral tissues. Among 12 cases of Hodgkin`s lymphoma, 3 (25%) cases and among 29 cases of Non-Hodgkin's lymphoma, 14 (48%) cases were positive for EBV. All 3 EBV positive cases of Hodgkin`s lymphoma and a number of 8 (57%) cases of Non-Hodgkin`s lymphoma belonged to the adolescence age group which proves an association between age and EBV positive in Hodgkin and Non-Hodgkin`s lymphoma according to Fisher`s exact test (P=0.03). All EBV positive cases in Hodgkin and Non-Hodgkin`s lymphoma were EBV-1. The results of this study revealed that EBV played a possible important role in Hodgkin and Non-Hodgkin`s lymphoma especially in adults. Also, the main genotype of virus in the current study was EBV-1. https://acta.tums.ac.ir/index.php/acta/article/view/6605 https://acta.tums.ac.ir/index.php/acta/article/download/6605/5126

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 56 7 2018 08 13 441 449 EN Doaa M El Demerdash Department of Internal Medicine, Faculty of Medicine, Kasr Al-Ainy Hospital, Cairo University, Giza, Egypt. Heba Moustafa Department of Internal Medicine, Faculty of Medicine, Kasr Al-Ainy Hospital, Cairo University, Giza, Egypt. Rasha S El Rawi Department of Internal Medicine, Faculty of Medicine, Kasr Al-Ainy Hospital, Cairo University, Giza, Egypt. Sherif N Amin Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Giza, Egypt. Mervat M Mattar Department of Internal Medicine, Faculty of Medicine, Kasr Al-Ainy Hospital, Cairo University, Giza, Egypt. 2017 08 28 2017 12 19 Hepatitis C virus (HCV) infection is a major public health concern in Egypt with its unique genotype. Besides liver disease, HCV is a lymphotropic virus involved in the pathogenesis of various extrahepatic diseases. A causative role of HCV in the generation of chronic lymphoproliferative diseases as well as its impact on disease behavior in HCV chronic carriers are not fully understood. We investigated the prevalence of HCV among cohort of Egyptian patients (n:84) with chronic lymphoproliferative diseases, the relation between HCV infection and the immunological state of this opulation and also their clinical and laboratory characteristics. High prevalence of HCV (40%) among Egyptian patients with chronic lymphoproliferative diseases with following subtype frequency was revealed; CLL (38.2%) followed by DLBCL (20.6%), and LPL (17.6%). We found significant correlation between HCV and platelet count (P=0.014), Albumin (P=0.02), LDH (P=0.014) and B2M (P=0.05). Otherwise, there were no significant correlations with other parameters especially the immunological assessment; serum immunoglobulins, Coombs test, and cryoglobulinemia. HCV prevalence among patients with chronic lymphoproliferative diseases is higher than that estimated in the general population. Those patients should be tested for HCV during the assessment. Our observations suggest that HCV may have an oncogenic role in Egyptian patients with chronic lymphoproliferative diseases and it may affect the prognostic markers in those populations. https://acta.tums.ac.ir/index.php/acta/article/view/6671 https://acta.tums.ac.ir/index.php/acta/article/download/6671/5127

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 56 7 2018 08 13 450 456 EN Maryam Node Sharifi Department of Pediatrics, Ghaeam Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Hamid Reza Kianifar Allergy Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. Sepideh Bagheri Department of Pediatrics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Seyed Javad Sayedi Neonatal Research Center, Akbar Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. 2017 11 15 2018 03 02 Cystic fibrosis (CF) is an inherited genetic disorder with chronic respiratory manifestations. The respiratory symptoms may start very early in life. The aim of this study was to evaluate the prevalence and antimicrobial susceptibility of respiratory pathogens in children with CF. In this clinical laboratory study, 100 CF patients were prospectively collected from February 2016 to March 2017. Microbiological cultures and antimicrobial susceptibility tests of the most frequently isolated upper respiratory tract bacteria were performed. According to the results of this study, Staphylococcus aureus was the most frequent microorganism 24 (24%) in CF patients followed by Pseudomonas aeruginosa 21 (21%). In children younger than one-year-old, Enterococci and Klebsiella pneumonia were the most frequently isolated pathogens. In other age groups, Staphylococcus aureus and Pseudomonas aeroginosa were most frequent. All pathogens showed more sensitivity to Ceftriaxone, Amikacin, and Ceftazidime. However, Staphylococcus aureus was most sensitive to Cefoxitin, Clindamycin, and Linezolid and Pseudomonas aeroginosa were most sensitive to Amikacin, Ceftazidime, and Ceftriaxone respectively. In conclusion, Staphylococcus aureus and Pseudomonas aeroginosa were the most frequent microorganisms in CF patients in our population. In patients younger than one-year-old, the most frequent pathogens were Enterococci and Klebsiella. All pathogens and Pseudomonas aeroginosa were sensitive to Ceftriaxone, Amikacin, and Ceftazidime but Staphylococcus aureus was most sensitive to Cefoxitin, Clindamycin, and Linezolid respectively. It seems that Ceftriaxone, Amikacin, and Ceftazidime are the most suitable antibiotics for the treatment of pulmonary infections in CF patients in our population. https://acta.tums.ac.ir/index.php/acta/article/view/6847 https://acta.tums.ac.ir/index.php/acta/article/download/6847/5128

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 56 7 2018 08 13 457 464 EN Fataneh Sadat Bathaie Department of Medical Ethics, Tehran University of Medical Sciences, Tehran, Iran. Bagher Ardeshir Larijani Medical Ethics and History of Medicine Research Center, Endocrinology and Metabolism Institute, Tehran University of Medical Sciences, Tehran, Iran. Farshad Farzadfar Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Institute, Tehran University of Medical Sciences, Tehran, Iran. Saharnaz Nedjat Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Seyed Hassan Emami-Razavi Brain and Spinal Cord Injury Research Center, Tehran University of Medical Sciences, Tehran, Iran. Maliheh Kadivar Department of Pediatrics Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran. Farzaneh Zahedi Anaraki Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Institute, Tehran University of Medical Sciences, Tehran, Iran. Peyman Zinati Department of Social Planning, University of Tehran, Tehran, Iran. Payam Roshanfekr Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation, Tehran, Iran. Alireza Olyaeimanesh Social Development and Health Promotion Center, Tehran University of Medical Sciences, Tehran, Iran. Davoud Nezamoleslami Department of Medical Ethics, Tehran University of Medical Sciences, Tehran, Iran. 2017 10 31 2018 05 01 Ethics is an essential element in the provision of healthcare services. Fundamental ethical values determine the manner in which the professional behavior is implemented in the healthcare area. These ethical principles find meaning in time and place and in the social context of ethical values and among children as vulnerable groups. So, this study examined the ethical principles of providing health care services for children and barriers to their application in Iran from key informants’ perspective. Therefore, qualitative content analysis method was used by means of semi-structured questionnaire to theoretical saturation scale with the participation of 20 key informants. Each interview underwent the process of implementation, evaluation, coding, and analysis, and then its findings were presented in two dimensions: desirable principles and barriers for its application, including 15 classes. Desirable principles include autonomy, beneficence, non-maleficence, justice, confidentiality, accent, consent, and participation. Obstacles to their compliance also included weakness of the policy landscape, weakness of the judicial system, cultural conservatism, socio-economic inequality, services commodification with unequal distribution, resource mismanagement (limitation), weakness of the professional education system, and the emergence of complex situations. From the key informants’ point of view, codes of ethics do not differ significantly from international principles, but their application is faced with difficulties, and they are likely to be improved through evidence-based policies according to the results of scientific studies. https://acta.tums.ac.ir/index.php/acta/article/view/6812 https://acta.tums.ac.ir/index.php/acta/article/download/6812/5129

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 56 7 2018 08 13 465 473 EN Nassim Sodagari Research Center for Improvement of Surgical Outcomes and Procedures, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mehdi Jafari Research Center for Improvement of Surgical Outcomes and Procedures, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Shirzad Nasiri Research Center for Improvement of Surgical Outcomes and Procedures, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Behnam Molavi Research Center for Improvement of Surgical Outcomes and Procedures, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Aidin Yaghoobi Notash Research Center for Improvement of Surgical Outcomes and Procedures, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Ali Mir Research Center for Improvement of Surgical Outcomes and Procedures, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Anooshiravan Hedayat Research Center for Improvement of Surgical Outcomes and Procedures, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Abolfazl Shojaiefard Research Center for Improvement of Surgical Outcomes and Procedures, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Ali Ghorbani Abdehgah Research Center for Improvement of Surgical Outcomes and Procedures, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Mohammad Taghi Raouf Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Shakiba Mosadegh Department of Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Ahmadreza Soroush Research Center for Improvement of Surgical Outcomes and Procedures, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2017 09 01 2017 12 19 About 10% of thyroid nodule Fine Needle Aspirations (FNAs) are reported indeterminate, and this number is much higher in Iran. All of these patients undergo thyroid surgery, whereas, only about 20% of them are malignant and they did not need surgery. Therefore, we decided to evaluate the ultrasonographic features of malignant thyroid nodules to find a predictive scoring model for thyroid nodules and consequently reduce the unnecessary thyroid surgeries. This prospective cross-sectional study was conducted on 114 patients with thyroid nodule who were candidate for thyroid surgery. All the patients were assessed by ultrasonography of thyroid before surgery, and after surgery by the gold standard of permanent pathology, the sensitivity, specificity, positive predictive value, and negative predictive value of each parameter of ultrasonography were determined. Finally, by using the logistic regression analysis, a predictive scoring model was suggested. A total of 114 patients with mean age of 43.13±13 years (90 females (78.9%) were studied. Prevalence of malignancy in final pathology was 75.9%, 39.0%, and 15.9% in FNA biopsies which were malignant, undetermined and benign, respectively. FNA correctly verified 48.9% of the malignant pathologies. In all, smaller nodules, hypoechogenicity, metastatic lymphadenopathy, oval shape, thick or incomplete halo, ill margins, microcalcification, and heterogenicity are associated with malignancy (All, P<0.05). We recommend that complementary tools upon ultrasonographic data along with FNA can be helpful for more accuracy and early diagnosis of malignant thyroid nodules. https://acta.tums.ac.ir/index.php/acta/article/view/6675 https://acta.tums.ac.ir/index.php/acta/article/download/6675/5130