Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 57 8 2020 02 15 472 477 EN Sahar Tavakolian Medical Genetics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.AND Department of Biology, University of Sistan and Balouchestan, Zahedan, Iran. Matineh Barati Bagherabad Medical Genetics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. AND 3 Department of Biology, Ashkezar Branch, Islamic Azad University, Ashkezar, Yazd, Iran. Dor Mohammad Kordi-Tamandani Department of Biology, University of Sistan and Balouchestan, Zahedan, Iran. AND Genetics and Biotechnology Research Institute, University of Sistan and Baluchestan, Zahedan, Iran. Mohammad Reza Abbaszadegan Medical Genetics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. AND Department of Medical Genetics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. AND Immunology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran . Mohammad Amin Kerachian Medical Genetics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. AND Department of Medical Genetics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. AND Cancer Genetics Research Unit, Reza Radiotherapy and Oncology Center, Mashhad, Iran. 2018 12 22 2019 10 31 Aberrant promoter methylation of CpG islands of tumor-suppressor genes has been recognized as one of the important tumor markers for cancer detection. The aim of this study was to investigate the promoter methylation status of protocadherin 10 (PCDH10), a tumor suppressor gene, in Iranian colorectal cancer (CRC) patients. Cancerous and the adjacent normal tissues obtained from 38 CRC patients were used to assess the methylation status of PCDH10 with Methylation Specific PCR, in addition, to study the expression level of this gene by quantitative PCR. The relationship between hypermethylation and the demographic characteristics of these patients was analyzed. The promoter methylation level of PCDH10 was statistically different between tumoral and normal tissues in CRC patients. Twenty-seven out of 38 patients showed hypermethylation with a sensitivity of 73% and a specificity of 97%. PCDH10 expression decreased in 15 cases (46%) as 16 cases (50 %) showed overexpression and 1 case (4%) had no changes. Not a significant association was reported between PCDH10 hypermethylation and the clinicopathological characteristics (P>0.05). Our results indicated that PCDH10 methylation has a critical function in CRC, with a nearly elevated sensitivity and a high specificity in the Iranian population, qualify it as a potential candidate biomarker. https://acta.tums.ac.ir/index.php/acta/article/view/7640 https://acta.tums.ac.ir/index.php/acta/article/download/7640/5300

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 57 8 2020 02 15 478 483 Hamid Reza Jamshidi Department of Toxicology-Pharmacology, School of Pharmacy, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. AND Pharmaceuitical Sciences Research Center, School of Pharmacy, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Mohammad Naeem Malmir School of Pharmacy, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. 2019 04 27 2019 11 04 Hyperglycemia may associate with improper use of glucocorticoids, impaired insulin function, or both, and is associated with many complications such as hyperlipidemia and Hyperglycemia. Researches suggest that proper use of glucocorticoids can delay the onset and progression of complications of hyperglycemia and hyperlipidemia. In the present study, we compare two of these compounds on glucose and lipid profile level. We use 40 male Wistar rats from the Yazd Animal infertility center. Initially, the rats were randomly divided into 2 groups, and then each group was divided into 4 groups. Subsequently, fludrocortisone doses of 12, 24 and 36 mg/kg were administered to rats, and dosages of 6, 12 and 18 mg/kg for betamethasone administered to rats on a daily basis at 1 o'clock for 21 days by intraperitoneal injection. Betamethasone and Fludrocortisone increased blood glucose and AST, ALT, TG, LDL, VLDL, and decreased HDL, causing red pigmentation in the skin, and obesity and puffiness of the rats. In all of the measured factors, fludrocortisone changes were more than betamethasone. Fludrocortisone and betamethasone also had significant effects on weight, which was more pronounced with fludrocortisone. As the dose increased, the levels of AST, ALT, and cholesterol, TG, VLDL and LDL in the blood increased significantly and HDL levels decreased more in the blood, but fludrocortisone showed a stronger effect than betamethasone. Therefore, it can be expected that the use of Betamethasone would be logical due to fewer side effects than fludrocortisone. https://acta.tums.ac.ir/index.php/acta/article/view/7849 https://acta.tums.ac.ir/index.php/acta/article/download/7849/5301

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 57 8 2020 02 15 484 491 Masoud Etemadifar Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Shadi Ghourchian Deprtment of Neurology, School of Medicine, University of Maryland, Baltimore, MD, USA. Nazanin Mahinparvar Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Mehri Salari Deprtment of Neurology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Fatemeh Etemadifar Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Yalda Nikanpour Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Shahin Sanaei Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Mojtaba Akbari Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. 2019 09 23 2019 11 10 This study aimed to compare the efficacy of rituximab versus Cyclophosphamide on active secondary progressive multiple sclerosis (SPMS). The randomized clinical trial was performed from 2015 to 2017 in multiple sclerosis (MS) clinics affiliated to Isfahan MS society (IMSS). Patients were randomized to two groups, and one of them received Rituximab that was repeated every six months in case of medical indication. The other one received a monthly pulse of methylprednisolone plus cyclophosphamide (Endoxan, Baxter, UK) until two years. Expanded disabilities status scale (EDSS), clinical, and MRI findings were assessed every six months. Statistical analysis was performed using SPSS software. 39 patients in the Rituximab group and 30 in the Cyclophosphamide group with similar age and gender distribution were entered for analysis. At baseline, the mean number of attacks in the Rituximab group was significantly more than the Cyclophosphamide group (P=0.0001). After 6, 12, and 18 months of treatment, the rate of attacks was similar between groups although it increased significantly in the Rituximab group (P=0.030) after 24 months of treatment. EDSS was increased in the Rituximab group more than the other group at the end of the study. Both drugs were well-tolerated by patients. The EDSS was increased in the Rituximab group but the disability score did not worsen in the Cyclophosphamide group. Both therapies were associated with a reduction in disease attacks and improvement in radiologic findings in a two-year period of follow-up. https://acta.tums.ac.ir/index.php/acta/article/view/8096 https://acta.tums.ac.ir/index.php/acta/article/download/8096/5302

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 57 8 2020 02 15 492 498 Bharti Bhandari Department of Physiology, Government Institute of Medical Sciences, Greater Noida, Uttar Pradesh, India. Manisha Mavai Department of Physiology, Govt. Medical College, Bharatpur, Rajasthan, India. Yogendra Singh Department of Physiology, All India Institute of Medical Sciences, Raebarelli, Uttar Pradesh, India. Bharati Mehta Department of Physiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India. Omlata Bhagat Department of Physiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India. 2019 01 14 2019 10 05 A single episode of breath-holding (BH) is known to elevate the blood pressure, and regular breathing exercise lowers the blood pressure. This prompted us to investigate how a series of BH epochs would affect the cardiovascular system. To observe arterial blood pressure (ABP) and heart rate (HR) changes associated with a series of “BH epochs” following maximum inspiration and maximum expiration and find the underlying mechanisms for the change by autonomic activity. Thirty-five healthy young adults were instructed to hold their breath repetitively, for 5 minutes, in two patterns, one following maximum inspiration and other following maximum expiration. ABP and ECG (for Heart Rate Variability) were continuously recorded at rest and during both the maneuvers. Capillary blood gases (BG) were zanalyzed at baseline and at the breakpoint of the last epoch of BH. ABP rose significantly at the breakpoint during both the maneuvers. No change in HR was observed. There was significant fall in PO2 from 94.7 (4.1) mmHg at baseline to 79.1 (9.0) mmHg during inspiratory and 76.90 (12.1) mmHg during expiratory BH. Similarly, SPO2 decreased from 96.3 (1.9) % at baseline to 95.4 (1.5) % and 94.5 (2.7) % during inspiratory and expiratory BH, respectively. Rise in PCO2 from 39.5(3.1) mmHg at baseline to 42.9 (2.7) mmHg and 42.1 (2.8) mmHg during inspiratory and expiratory BH respectively was observed. There was no significant correlation between blood gases and arterial blood pressure. Among HRV parameters, a significant decrease in SDNN, RMSSD, HFnu, total power and SD1/SD2 and the significant increase in LFnu, LF/HF and SD2 were observed during both BH patterns. Rhythmic BH patterns affect the cardiovascular system in similar way as a single episode of BH. Sympathetic overactivity could be the postulated mechanism for the same. https://acta.tums.ac.ir/index.php/acta/article/view/7687 https://acta.tums.ac.ir/index.php/acta/article/download/7687/5303

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 57 8 2020 02 15 499 502 EN Alireza Aziz-Ahari Department of Radiology, Rasool-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran. Mohammadreza Khaleghi Department of Radiology, Rasool-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran. Zahra Farahani Department of Radiology, Rasool-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran. Kaveh Samimi Department of Radiology, Rasool-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran. 2019 01 23 2019 10 31 It is known that liver biopsy is the gold standard of diagnosing liver iron deposition. By considering liver biopsy complication and cost, introducing a method to restrict unnecessary biopsy or even an alternative for liver biopsy can be useful. This study examined the relationship between serum iron profile and liver density on CT-Scan without contrast material injection. In this study, 76 patients were referred from different Rasoul-Akram Hospital parts in 2015-2016 (People who have undergone abdominal CT-scan for any reason, and blood tests included iron and lipid profiles). To calculate the liver mean density of a CT-scan, densities of 12 sites with an individual area of 1 cm2 on 3 different sections of the liver were obtained, and their average was recorded. Data were analyzed by SPSS V.16 using Kolmogorov-Smirnov,  independent T-test, and two-sample T-tests with a significance level of P<0.05. There is a significant relationship between the serum iron and serum ferritin levels with liver density. By increasing TIBC levels, the difference between liver and spleen densities increases, but no significant correlation was found between TIBC level and liver density. Moreover, there was no relationship between serum iron levels and serum ferritin with the difference between liver and spleen densities. The evaluation of liver density may be an alternative to liver biopsy in some cases or at least can be considered to restrict unnecessary biopsies. https://acta.tums.ac.ir/index.php/acta/article/view/7707 https://acta.tums.ac.ir/index.php/acta/article/download/7707/5304

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 57 8 2020 02 15 503 509 Mohammad Mahdi Majzoobi Department of Infectious Diseases, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran. AND Brucellosis Research Center, Hamadan University of Medical Sciences, Hamadan, Iran .AND Sina Hospital, Hamadan University of Medical Sciences, Hamadan, Iran. Zahra Jalalvand Department of Infectious Diseases, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran. Elham Khanlarzadeh Department of Community Medicine, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran. Abbas Moradi Department of Community Medicine, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran. 2019 02 10 2019 10 31 Accurate diagnosis and timely treatment of pneumonia, as one of the most common infectious diseases in elderly patients, require careful attention to the clinical and paraclinical findings, which may be different between the elderly and non-elderly patients. The aim of the present study was to compare the clinical, laboratory, and radiological findings of elderly and non-elderly patients with pneumonia and pneumosepsis. This cross-sectional study was performed on 97 elderly and 93 non-elderly patients with pneumonia, admitted to Sina hospital in Hamadan, west of Iran, in 2017. Patients in both groups were also compared in terms of the underlying diseases, sepsis rate, electrolyte disturbances and CURB-65 criteria. All underlying diseases, except for HIV infection, in addition to clinical findings such as tachypnea, lethargy, decreased consciousness, hypotension, and respiratory alkalosis were significantly more common in the elderly, compared to the non-elderly group. In the elderly group, the average length of hospital stay, sepsis rate, and mortality rate were 9.4 days, 74.2%, and 21.7%, respectively versus 6.2 days, 46.3%, and 3.2%, respectively in the non-elderly group. Patients in the two groups were significantly different in terms of CkkURB-65 criteria and radiological findings. For the timely diagnosis of pneumonia and pneumosepsis in the elderly, it is necessary to consider any alteration in respiratory rate and consciousness status. Also, for proper treatment, the clinicians should pay attention to the existence of any comorbidities and electrolyte disturbances. https://acta.tums.ac.ir/index.php/acta/article/view/7749 https://acta.tums.ac.ir/index.php/acta/article/download/7749/5305

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 57 05 18 2020 10 19 The aim of this study was to evaluate the abbreviated burn severity index (ABSI) score and the percentage of full-thickness burn in the prediction of hospital mortality in burn patients admitted to Sina Hospital in Tabriz. A total of 250 burn patients admitted to burn, and ICU wards during December 2016-Sep 2018 entered the present cross-sectional descriptive study. The collected data included age, gender, burn percentage, anatomical location of the burn, cause of the burn, severity of the burn, mucosal or inhalation injury, underlying disease, length of stay (day), and the hospital outcome of the patient. There was a significant difference between the two genders in terms of the cause of burns (P<0.0001). The most common cause of burn-in women and men was hot liquids and fire, respectively. 40% TBSA with 92% sensitivity and 94% specificity and 20% full-thickness burns with 98% sensitivity and 88% specificity was obtained in predicting mortality of patients. ABSI score of 9 with 85% sensitivity and 95% specificity was obtained in predicting mortality in patients. By increasing one unit in the ABSI score, the odds ratio increases by 17.5 times in terms of mortality probability. The present study showed a significant difference between the two genders in terms of the cause of the burn, and it is evidently affected by the culture and lifestyle of our country. On the other hand, an investigation of the cause of death in patients with ABSI>9 and taking appropriate measures to reduce their mortality is recommended. Also, it is recommended to use more simple criteria such as burn percentage or full-thickness burns to predict mortality rate in case of burning injury patients.   https://acta.tums.ac.ir/index.php/acta/article/view/8482

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 59 1 2021 02 08 44 49 Mohammad Meskarpour-Amiri Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran Parisa Mehdizadeh Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran Maryam Yaghoubi Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran Sayyed Morteza Hosseini Shokouh Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran. Taha Nasiri Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran. Babak Hassanlouei Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran Hossein Amini Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran 2020 08 26 2020 10 13 This study aimed to evaluate the effect of macro-level health policies on COVID-19 outbreak control in Iran. This was a descriptive-analytical study of the applied time series performed on April 19, 2020. The effect of four macro-health interventions, including reducing overcrowding, social distancing, limitation of high-risk economic activities, and active case detection, was examined. The Vector auto-regression (VAR) was used to investigate the effect of the interventions. The augmented Dickey-Fuller test (ADF) was used to ensure the time stability of the time series and the existence of a unit-root. To analyzing data and estimation VAR models, STATA software was used. P of less than 0.1 was considered significant. The increase in the number of cases with two days’ lag had a positive and significant effect on increasing the number of new cases of the COVID-19 (C=0.176, P=0.097). Adopting an overcrowding reduction policy with both 2-day lags (c=0.095, P=0.066) and 4-day lags (c=0.314, P=0.000) had a negative and significant effect on increasing the number of new cases of the COVID-19. Our study showed that overcrowding reduction and new COVID-19 case detection could play an effective role in controlling the epidemic of COVID-19 in Iran. It seems that the best advice is to stay home and use strategies to identify more patients. https://acta.tums.ac.ir/index.php/acta/article/view/8755

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 59 1 2021 02 14 50 53 EN Keivan Basiri Department of Neurology, Isfahan Neurosciences Research Center, Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran Behnaz Ansari Isfahan Neurosciences Research Center, Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran 2020 05 15 2020 10 19 The reason why the experiments were done: previous studies have shown that the incidence rates vary in different populations. Now we report the preliminary results of the screening study. Pompe disease is a rare but potentially treatable disorder caused by the deficiency of the lysosomal enzyme acid-α-glucosidase (GAA). GAA activity was measured on DBS in 65 patients with undiagnosed myopathies presenting to the hospital of the research setting in Isfahan, Iran, from 2016 to 2017 and then was confirmed by genetic analysis. Of the total of 65 patients, 29 (44.6%) were male, and 36 (55.4%) were female. The mean age of the patients was 29±12.55 years, and their mean age at the disease onset was 17±12.75. Two patients (one male and one female) were diagnosed with a low acid alpha-glucosidase activity. Only one patient (female) showed a compound heterozygotic mutation of the GAA gene (c.-32-13T>G). Early diagnosis of Pompe disease is important for improving the outcome. https://acta.tums.ac.ir/index.php/acta/article/view/8472

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 59 1 2021 02 14 54 59 Hoda Faraji Pharmaceutical Management & Economic Research Center, Tehran University of Medical Sciences, Tehran, Iran. AND Department of Pharmacoeconomics and Pharmaceutical Administration, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. Abbas Kebriaeezadeh Pharmaceutical Management & Economic Research Center, Tehran University of Medical Sciences, Tehran, Iran. AND Department of Pharmacoeconomics and Pharmaceutical Administration, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. Akbar Abdollahiasl Pharmaceutical Management & Economic Research Center, Tehran University of Medical Sciences, Tehran, Iran. AND Department of Pharmacoeconomics and Pharmaceutical Administration, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. 2020 05 11 2020 10 18 Up to 40% of the global and 7.4-41.3% of the Middle East population are affected by Allergic Rhinitis (AR). Patients with AR versus control group experience approximately twofold pharmaceutical expenditures and 1.8-fold number of visits. Since drug utilization can show various times of developing a disease in a country, it is used as an alternative for prevalence. In this study, we try to examine and explain the consumption of anti-allergic medicines during the past 11 years to have a perspective view of these kinds of medicines. In this descriptive and cross-sectional study that investigates anti-allergic medicines over a 11-year period (2006-2017), we used the Iranian pharmaceutical statistical datasheet published by the Iranian Ministry of Health. According to treatment guidelines of AR and WHO ATC code, we categorized anti-allergic medicines into five groups (antihistamines, Beta 2 agonists, Corticosteroids, Fixed-dose, and others), Then DIDs for these groups were calculated and analyzed. Based on our findings in this study, cetirizine, Loratadine, and Inhaled Salbutamol got the highest DID among all five groups, with 99.2, 65.4, and 57.6 retrospectively. Generally based on the third level of ATC code (second-generation anti-histamines, respiratory system drugs for obstructive airway disease, respiratory system nasal preparation, and corticosteroid for systemic use) are faced with ascending market sales. Generally, with the upward trend of anti-allergic medicines, we can conclude that the incidence of AR in Iran during the past 11 years has increased, and policymakers should follow this trend concerning a better supply chain. https://acta.tums.ac.ir/index.php/acta/article/view/8463

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 59 1 2021 02 14 60 63 Mohammad Hassani Department of Vascular and Endovascular Surgery, Aiatillah Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Peyman Bakhshaei Shahrbabaki Department of Vascular and Endovascular Surgery, Aiatillah Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Sina Zarrintan Department of Vascular and Endovascular Surgery, Shohadaie Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Mohamad Moradmand Department of Vascular and Endovascular Surgery, Aiatillah Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2020 05 10 2020 10 18 Aortoenteric fistula is a rare finding that is potentially fatal and is usually seen as a fistula between the aorta or an aortic graft and the third part of the duodenum. The type without the presence of an artificial graft is considered as primary and the other type as secondary. The patients usually present with the heralding symptom of minor hematemesis, which later leads to massive and mortal GI bleeding. The most important factor in the diagnosis of an aortoenteric fistula is to have a high clinical suspicion after taking an appropriate and accurate history. In hemodynamically stable patients with clinical suspicion, performing an intravenous-contrast-CT scan of the abdomen and pelvis is of assistance in diagnosis. In general, stable hemodynamics greatly reduces the suspicion for diagnosis. Treatment is often surgical, and in regard to the severity of abdominal contamination or the level of visible infection, the extra anatomical or insitu graft repair is considered as the method of choice. This article tries to transfer our experiences in two pati