Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 58 3 2020 07 19 96 102 Bahareh Abavi-Torghabeh School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran. Mehrsadat Mahdizadeh Department of Health Education and Health Promotion, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran. AND Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. Seyed-Mousa Mahdizadeh Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran. AND Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. Seyed-Reza Mazloom Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran. AND Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. 2019 09 18 2020 05 07 Colorectal cancer and its treatment have short-term and long-term side effects for patients. One of the factors affecting these side effects is the nursing care method. This study was conducted to determine the effect of care based on the critical pathway on the duration of hospitalization, complications of the disease, and satisfaction with nursing care in patients with colorectal cancer. In a cluster-randomized controlled trial study, 70 patients with colorectal cancer were randomly selected from two hospitals of OMID (N=35) and GHAEM (N=35) in Mashhad, Iran. They were assigned to intervention and control groups. The data were collected using a characteristic of patients, and satisfaction questioner, a checklist of patient status and nursing performance, and analyzed by SPSS software version 18. There was a significant difference in the mean of satisfaction of patients from nursing care and length of hospital stay between pathway and routine care group (P<0.001). There were no significant differences between pathway and routine for the postoperative complications after 12 weeks of follow-up. Our study indicates that critical pathway care can increase the satisfaction of patients and decrease the duration of hospitalization. Future studies should investigate how to increase other clinical outcomes in the oncology wards. https://acta.tums.ac.ir/index.php/acta/article/view/8086 https://acta.tums.ac.ir/index.php/acta/article/download/8086/5378

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 58 3 2020 07 19 103 108 Heshmat Shahi Department of Immunology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Fatemeh Kiaee Department of Immunology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2019 09 21 2020 04 26 Helicobacter pylori (H. pylori) is a spiral bacterium that infects the human gastric mucosa. Various clinical aspects of the infection may mirror distinctive forms of cytokine expression. It has a correlation with immune cell penetration to the gastric mucosa with numerous cytokines production and gastric inflammation. IL-1 and IL-8 are directly contribute to H. pylori effected gastritis. IL-32 is a pro-inflammatory cytokine categorized by the training of Immune cells activation which have a vital role in human immunity. H. pylori virulence and danger factors which are critical in gastritis such as the outer inflammatory protein (OipA) and the cytotoxin associated gene A (cagA). We aimed to study the IL-32 mRNA expression in H. pylori-positive and negative patients as well as its relation with bacterial cagA, oipA, and severity of gastritis. Endoscopic biopsies were taken from the antrum of 60 H. pylori-infected patients and 62 uninfected individuals.  Mucosal IL-32 mRNA expression was assessed by real-time PCR. With PCR the H. pylori virulence factors were evaluated. Showed that the mRNA expression of IL-32 levels were significantly lower in biopsies of H. pylori-uninfected patients compared to positive individual (p = 0.01). A straight communication between virulence factor oipA, cagA and heightening in IL-32 mRNA expression (p <0.001) was observed. Furthermore. IL-32 mRNA expression levels were approximately equal in both chronic and active gastritis (p = 0.1). IL-32 may have critical role in different situation like inflammation and severity of inflammatory changes in the gastric mucosa. https://acta.tums.ac.ir/index.php/acta/article/view/8094 https://acta.tums.ac.ir/index.php/acta/article/download/8094/5379

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 58 3 2020 07 19 109 114 Gholamreza Bahoush Department of Pediatrics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran. Leila Asgarzadeh Department of Pediatrics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran. Marzieh Nojoomi Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran. AND Department of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran. 2019 09 19 2020 04 25 In acute lymphoblastic leukemia (ALL) patients treated with L-asparaginase, discontinuation of the drug occasionally occur due to severe drug complications or resistance, however, due to the high efficacy of this drug in the recovery of patients and the prevention of disease recurrence, resuming the drug regimen is preferred in most patients. What we did in this study was to evaluate and compare the effects of clinical outcomes in the two modes of continuing and discontinuing drug use. In this retrospective cohort study, all children with ALL who had been treated with L-asparaginase during the years 2005 to 2015 were included in the study and categorized into two groups receiving complete treatment regimen (n=160) and those who had to discontinue the drug due to appearing complications (n=9). The rate of relapse and mortality rate was determined and compared across the two groups with a median follow-up time of more than 5 years. 5-yrs Overall survival of all enrolled patients in the groups continued and discontinued was 91.4±2.5% and 71.4±17.1%, respectively (P=0.792). Also, 5-yrs event-free survival of the two groups was 75.8±3.5% and 71.4±17.1%, respectively (P=0.557. Relapse was revealed in 17.5% and 33.3% respectively and mortality in 16.9% and 0.0% (P=0.261). However, the overall prevalence of hypersensitivity reaction to the drug was significantly higher in those patients who discontinued their drug regimen (100% versus 24.4%, P<0.001). Hypersensitivity reaction to drugs may be an important factor in discontinuing L-asparaginase in patients with ALL. The discontinuation of L-asparaginase supplementation due to various complications such as hypersensitivity reactions may be effective in the survival of these patients. However, accurate determination of the effect of discontinuation of this drug on the outcome of children with ALL requires a more comprehensive study with more complicated cases. https://acta.tums.ac.ir/index.php/acta/article/view/8090 https://acta.tums.ac.ir/index.php/acta/article/download/8090/5380

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 58 3 2020 07 19 115 120 Murat Ziyrek Department of Cardiology, Konya Education and Research Hospital, Konya, Turkey. 2019 09 18 2020 04 25 Diabetes mellitus (DM) is one of the most common endocrine disorders. 90% percent of all diabetics are diagnosed with type 2 DM. DM is closely associated with various vascular diseases, and successful glycemic control prevents micro and macrovascular complications. Although there is data about the relation between glycemic control and left ventricle function, there is hardly any data about the relation between the right ventricular function. We analyzed the relationship between glycemic control and right ventricle function in type 2 DM patients free of clinical cardiovascular diseases (CVD). Patients were selected from the cardiology outpatient clinic. 53 patients formed the DM group; 51 patients formed the control group. All patients' demographic data were recorded. Biochemical tests and echocardiographic examinations were performed. RA and RV diameters were significantly higher in DM group (3.36±0.32 vs 3.13±0.34, P=0.015; 2.80±0.32 vs 2.56±0.22 P=0.005 respectively). Myocardial velocity during isovolumetric contraction (RV/IVV) and myocardial acceleration during Isovolumetric contraction (RV/IVA) were significantly lower in the DM group (14.4±3.17 vs 16.04±4.13 P=0,019; 3.25±0.75 vs 3.95±1,25 P=0.015). There was an intermediate negative correlation between RV/IVV and HBA1C (r=-0.406; P=0.036). HBA1C level was an independent risk factor for RV IVV (β=-0.406; P=0.036). It is shown that RA, RV diameter were significantly higher; RV/IVV and RV/IVA were significantly lower in diabetes mellitus patients free of CVD. Furthermore, there was a significant negative correlation between RV/IVV and HBA1C levels. HBA1C level was an independent risk factor for RV/IVV. https://acta.tums.ac.ir/index.php/acta/article/view/8088 https://acta.tums.ac.ir/index.php/acta/article/download/8088/5381

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 58 3 2020 07 19 121 125 Maryam Hatami Departments of Anesthesiology, Pain Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Arezoo Kheirati Departments of Anesthesiology, Pain Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Shekoufeh Behdad Departments of Anesthesiology, Pain Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Atiye Javaheri Departments of Obstetrics and Gynecology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Sedighe Vaziribozorg Department of Otolaryngology-Head and Neck Surgery, Otorhinolaryngology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. 2019 10 26 2020 05 04 The purpose of this study was to evaluate the effect of preoperative administration of duloxetine on postoperative pain after laparoscopic myomectomy. In this double-blind clinical trial study, 57 patients aged 18-55 years with ASA I or II undergoing laparoscopic myomectomy involved. The case group received oral duloxetine 60 mg, and the control group received placebo 2 hours before the surgery. Pain scores, total analgesic consumption during 24 hours, recovery discharging time, nausea, vomiting, dizziness, and hemodynamic changes were recorded and compared between two groups. The pain severity was significantly lower in the case group at 2, 12, and 24 hours after the operation (P<0.05). There were no significant differences in dizziness, nausea, vomiting, systolic and diastolic blood pressure, and heart rate of patients between two groups before the surgery, 5 and 30 minutes after the induction, and after the recovery. Duloxetine administration prior to laparoscopic surgery myomectomy can reduce postoperative pain without inducing side effects in patients. https://acta.tums.ac.ir/index.php/acta/article/view/8161 https://acta.tums.ac.ir/index.php/acta/article/download/8161/5382

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 58 3 2020 07 19 126 129 Mehri Ayati Department of Pediatrics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Amir Hossein Movahedian Department of Pediatrics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. AND Department of Pediatrics, Bahrami Children’s Hospital, Tehran University of Medical Sciences, Tehran, Iran. Ziba Mosayebi Department of Pediatrics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. AND Maternal, Fetal and Neonatal Research Center, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2019 09 14 2020 04 25 Previous investigations have indicated an association between modulation of developing the immune system with increased risk of autoimmune diseases such as type 1 Diabetes Mellitus (T1DM). Objectives: In the present study, we aimed to evaluate correlations between the positive history of blood group incompatibility, neonatal jaundice, and phototherapy with childhood type 1 DM. A case-control retrospective study was carried out in an Iranian Hospital in 2015. One-hundred subjects aged 1-15 years with T1DM were included as the case group. One-hundred healthy children were also considered as the control group. A questionnaire composed of demographic-clinical data was completed for each subject. Correlations between childhood type 1diabetes and some clinical risk factors were determined. One hundred cases with type 1 diabetes and 100 healthy control children entered the study. A significant association between maternal gestational diabetes mellitus and childhood T1DM was observed (P=0.05, OR=3.789). The history of neonatal jaundice in the case group was significantly higher than in the control group (P=0.02, OR=4.667). ABO incompatibilities in the case group were associated with 19 neonates with blood group A and 2 neonates with blood group B (mothers' blood group; O) (P=0.005, OR=7.397). In the case group, 29 of 38 cases with a history of jaundice had received phototherapy while in the control group, 19 participants had undergone phototherapy (P=0.126, OR=1.707). Results have indicated that neonatal Jaundice and ABO incompatibility could increase the risk of childhood T1DM. Moreover, maternal GDM should be considered as an increased subsequent risk of childhood T1D. https://acta.tums.ac.ir/index.php/acta/article/view/8078 https://acta.tums.ac.ir/index.php/acta/article/download/8078/5383

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 58 3 2020 07 19 130 133 Atousa Hakamifard Department of Infectious Diseases, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Rasool Soltani Department of Clinical Pharmacy, Faculty of Pharmacy, Isfahan University of Medical Sciences, Isfahan, Iran. Ali Hjigholami Department of Hematology-Oncology, Isfahan University of Medical Sciences, Isfahan, Iran. Sholeh Yaghoubi Department of Infectious Diseases, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. 2019 05 09 2020 04 24 Epstein-Barr virus (EBV) is a member of the herpes virus family and is characterized by fever, lymphadenopathy, and sore throat. In this report, we present a 20-year-old woman with a four-day history of fever, chills, nausea, vomiting, jaundice and abdominal pain, and a diagnosis of acalculous cholecystitis, acute hepatitis with hemolytic anemia due to infectious mononucleosis. After the confirmation of acute acalculous cholecystitis along with hemolytic anemia, prednisolone was initiated for the patient. Supportive measures resolved the symptoms of acalculous cholecystitis. https://acta.tums.ac.ir/index.php/acta/article/view/7866 https://acta.tums.ac.ir/index.php/acta/article/download/7866/5384

8 2020 02 15 510 517 Hossein Dargahi Department of Management Sciences and Health Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. AND Health Information Management Research Center, Tehran University of Medical Sciences, Tehran, Iran. Golsa Shaham Department of Health Care Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran. 2019 09 27 2019 11 25 The implementation of the Health System Evolution Plan has resulted in an increase in the rate of patient’s referral to hospitals of medical universities, and thus, hospitals’ performance indicators. The aim of the present study is to investigate the changes in hospital indicators after the implementation of the Health System Evolution Plan and the relationship between this plan and distribution of human resources in hospitals of Tehran University of Medical Sciences. This was a descriptive-analytical and cross-sectional study. The research population consisted of information about human resources and performance indicators before and after the implementation of the Health System Evolution Plan in the hospitals. The research tool was a data collection form. The collected data were analyzed in SPSS software, and analytical results were obtained using the Pearson correlation test and Two Sample t-test. The results showed that there was a significant relationship between hospitals performance indicators and the distribution of human resources after the implementation of the Health System Evolution Plan. In fact, this plan has increased the deficit of nursing and paraclinical staff. In addition, the results showed as hospitals’ performance indicators have increased, more human resources has been recruited in these hospitals. The success of Implementation of Health System Evolution Plan and development of general hospitals indicators need comprehensive. Planning for retainment of all groups of health workers and paying attention to appropriate distribution of physicians, nurses, and paraclinical staff in public hospitals and finally a comprehensive review of human resources standards by the Iranian Ministry of Health. https://acta.tums.ac.ir/index.php/acta/article/view/8108 https://acta.tums.ac.ir/index.php/acta/article/download/8108/5306

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 57 8 2020 02 15 508 521 Masoud Heidari Department of Animal Biology, Faculty of Natural Sciences, University of Tabriz, Tabriz, Iran. Morteza Soleyman-Nejad Ariagene Medical Genetics Laboratory, Qom, Iran. Mohammad Hossein Taskhiri Ariagene Medical Genetics Laboratory, Qom, Iran. AND Department of Molecular Biology, Islamic Azad University of Qom, Qom, Iran. Alireza Isazadeh Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Manzar Bolhassan Ariagene Medical Genetics Laboratory, Qom, Iran. Javad Shahpouri Pediatric Clinical Research of Development Center, Qom University of Medical Sciences, Qom, Iran. Mansour Heidari Ariagene Medical Genetics Laboratory, Qom, Iran. AND Department of Molecular Biology, Islamic Azad University of Qom, Qom, Iran. Nahid Sadighi Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran. 2019 08 25 2019 10 31 The Syntaxin Binding Protein 1 (STXBP1) plays an important role in regulating neurotransmitter release and synaptic vesicle fusion through binding to syntaxin-1A (STX1A) and changing its conformation. In this study, we identified a de novo mutation (c.C1162T: p.R388X) in exon 14 of the STXBP1 gene causing an epileptic encephalopathy, early infantile, non-epileptic movement, and unclassified infantile spasms disorders in a 5-year-old boy by whole-exome sequencing. The segregation of this genetic variant was examined in the patient as well as in his parents. We found the R388X in hete