Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 58 4 2020 07 28 144 149 Ramin Lotfi Lung and Allergy Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran. Mohsen Molaie Student Research Committee, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran. Ehsan Mohammadi Noori Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran. Khalil Soleimani Student Research Committee, School of Dentistry, Kermanshah University of Medical Sciences, Kermanshah, Iran. Amir Kiani Regenerative Medicine Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran. 2019 11 24 2020 04 27 Adipose tissue-derived hormones known as adipokines, like leptin, have multiple bioactions. Notwithstanding the key roles of leptin in regulating energy homeostasis and metabolism, its cardiovascular functions are complex and not fully understood. This study aimed to investigate the association between serum concentrations of leptin and lipid profiles in patients with valve calcification. Seventy-two patients with valve calcification and 72 healthy individuals participated in this case-control study. The serum levels of biochemical markers and leptin were measured by the standard enzymatic methods and enzyme-linked immunosorbent assay (ELISA) technique, respectively. Significantly increased serum concentrations of FBS (P=0.001), urea (P<0.0001), creatinine (P=0.018), P (P<0.0001), LDL-C (P=0.011) and lower Ca (P=0.006), and HDL-C (P<0.0001) levels were observed in patients compared to controls. There was no significant difference in the serum level of TG and TC of patients than controls. Systolic and diastolic blood pressures were significantly increased in patients relative to controls (P<0.0001). However, a significantly diminished serum level of leptin was observed in patients than controls (P<0.0001). The correlation analysis demonstrated that the serum leptin concentration is negatively correlated with creatinine, but it is positively correlated with systolic blood pressure (P=0.0302, P=0.0362, respectively). There was no statistically significant association between serum levels of leptin and lipid profiles. Our findings indicated dyslipidemia and reduced serum leptin concentrations in patients with valve calcification, suggesting the role of lipid abnormalities and reduced leptin levels in the development and pathogenesis of valve calcification diseases. https://acta.tums.ac.ir/index.php/acta/article/view/8192 https://acta.tums.ac.ir/index.php/acta/article/download/8192/5388

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 58 4 2020 07 28 150 154 Hossein Chiti Zanjan Metabolic Diseases Research Center, Zanjan University of Medical Sciences, Zanjan, Iran. Mohammad Hossein Izadi Zanjan Metabolic Diseases Research Center, Zanjan University of Medical Sciences, Zanjan, Iran. Saeideh Mazloomzadeh Social Determinants of Health Research Center, Zanjan University of Medical Sciences, Zanjan, Iran. 2019 09 29 2020 04 27 Insulin resistance in gestational diabetes increases maternal and fetal complications. Tumor necrosis factor-alpha (TNF-α) is an inflammatory factor associated with insulin resistance. The aim of this study was to determine the association between pregnancy serum TNF-α level and postpartum insulin resistance in patients with gestational diabetes mellitus. 50 pregnant women, including 25 cases of gestational diabetes and 25 healthy pregnant women, were evaluated. First, during the third trimester of pregnancy, serum TNF-α level of all cases were measured. Two months after delivery, based on the obtained results from insulin levels and a 2-hour glucose tolerance test, HOMA-IR and HOMA-B were calculated, and the association between serum TNF-α level and insulin resistance was determined. Data were analyzed using independent t-test, Mann-Whitney, and chi-square test in SPSS software. The mean serum level of TNF-α in women with gestational diabetes mellitus was higher than healthy subjects, but there was no significant difference between the two groups. The serum level of insulin, HOMA-IR and HOMA-B indices in women with gestational diabetes mellitus were higher than healthy subjects, with a significant difference in all of the measures between two groups (P=0.0001). There was no significant correlation between TNF-α and HOMA-IR levels in insulin-resistant mothers two months after delivery (r=−0.33). Also, no significant correlation was detected between pregnancy TNF-α levels and HOMA-B index. Despite the higher serum levels of insulin, HOMA-IR, and HOMA-B in the diabetic group, the serum TNF-α level did not show any correlation with insulin resistance after delivery. https://acta.tums.ac.ir/index.php/acta/article/view/8115 https://acta.tums.ac.ir/index.php/acta/article/download/8115/5389

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 58 4 2020 07 28 155 160 Sedigheh Ayati Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. leila Pourali Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Masoumeh Mirteimouri Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Atiyeh Vatanchi Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Maryam Salehi Department of Socio-Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Elaheh Hasanzadeh Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. 2019 10 06 2020 04 27 Various methods are used in order to describe the heart rate patterns of the fetus. The use of electronic monitoring during labor is widely accepted today. The aim of this study was to compare the neonatal outcomes of continuous Fetal Heart Rate (FHR) monitoring to intermittent auscultation among low-risk pregnant women during labor. This randomized clinical trial was conducted among 900 low-risk pregnant women who met inclusion criteria and were admitted to maternity wards of academic hospitals of Mashhad University of Medical Sciences for labor. They were randomly divided into two groups: the intermittent auscultation group and the Continuous FHR monitoring group. The pregnancy and neonatal outcomes were compared in two groups; data were processed in SPSS16 software. P less than 0.05 was considered as significant level. In this study, the first and fifth minutes Apgar scores, the rate of NICU admission, advance resuscitation requirement, neonatal seizure incidence, and the neonatal or fetal death did not differ significantly between two groups (P>0.05). In the Continues monitoring group, the rate of cesarean section due to fetal distress and operative vaginal delivery was significantly higher rather than the other group (P=0.001). The results of this study showed that continuous FHR monitoring in low-risk pregnancies during labor increases the risk of cesarean and instrumental delivery without improving neonatal outcomes. https://acta.tums.ac.ir/index.php/acta/article/view/8121 https://acta.tums.ac.ir/index.php/acta/article/download/8121/5390

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 58 4 2020 07 28 161 165 EN Amir Ahmadzadeh Amiri Department of Anesthesiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Kasra Karvandian Department of Anesthesiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Ali Ahmadzadeh Amiri Department of Anesthesiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Aida Zeinali Department of Anesthesiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. 2019 10 06 2020 04 23 The experience of pre-operative anxiety in patients is a common and accepted issue; however, anxiety can potentially increase the patients' need for care, the level of post-operative pain, and ultimately patients' morbidity and mortality. The goal of this study was to determine the patients' pre-operative anxiety level right before they undergo surgery in the operating room. This study was conducted as a prospective cross-sectional study. Accordingly, completed State-Trait Anxiety Inventory questionnaires as well as demographic and contextual variables of 230 patients undergoing surgery were evaluated. Data analysis was taken out using SPSS v24. P of less than 0.05 was considered significant. 230 patients with an average age of 48.95 (14.68) years were enrolled. The frequency of mild, moderate, and severe anxiety among the patients was 50.8%, 37%, and 12.2%, respectively. The analysis revealed that the patients' age, gender, occupation, awareness about the type of anesthesia, and place of residence, as well as the type of anesthesia, had no significant correlation with the patients' pre-operative anxiety. However, a significant difference was found regarding patients’ pre-operative anxiety level and their educational, marital, awareness of post-operative complications, and trait anxiety status as well as their history of anesthesia. Therefore, to reduce post-operative complications, it is recommended that the patients with these characteristics be given priority for interventions aimed at reducing pre-operative anxiety. https://acta.tums.ac.ir/index.php/acta/article/view/8122 https://acta.tums.ac.ir/index.php/acta/article/download/8122/5391

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 58 4 2020 07 28 166 170 EN Elham Shobeiri Department of Radiology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran. Mohsen Fath Ordoubadi Department of Radiology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran. Marzieh Jahanian Department of Radiology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran. Nasrin Amiri Department of Radiation Oncology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran. 2019 10 17 2020 04 25 Estimation of breast tumor size is one of the most important diagnostic measures in determining the appropriate treatment. Mammography and ultrasound are the main methods for determining the size of breast tumors. The aim of this study was to compare the correlation between tumor size calculated by breast ultrasound and mammography with the results of pathologic measurements in malignant breast masses. Patients diagnosed with breast cancer by pathologic examination underwent mammography and ultrasound to determine the size of the tumor. The largest observed diameter in ultrasound and mammography was recorded as the tumor size. The mean (SD) tumor size measured by ultrasound (23.58±9.38 mm) was significantly less than the actual size based on histopathologic examination (28.87±11.17 mm) (P=0.008). However, there was no significant difference between the measurements performed between mammography (26.54±10.46 mm) and histopathology (P=0.18). The correlation coefficient between mammography and pathologic examination (r=0.61) was higher than the correlation coefficient between ultrasonography and pathology (r=0.5). Mammography, compared to breast ultrasound, had better accuracy in determining the size of malignant breast masses. https://acta.tums.ac.ir/index.php/acta/article/view/8137 https://acta.tums.ac.ir/index.php/acta/article/download/8137/5397

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 58 4 2020 07 28 171 176 Bahram Ghasemzadeh Department of Cardiac Surgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. Bahador Azizi Department of Anesthesia, Division of Perfusion Technology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. Simin Azemati Department of Anesthesia, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. Mostafa Bagherinasab Department of Anesthesia, School of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran. 2019 11 10 2020 04 23 Anesthetized patient management for pediatric patients with pulmonary arterial hypertension (PAH) is a major challenge. The aim of this study was to evaluate the ability of dexmedetomidine to reduce pulmonary arterial hypertension in patients with pulmonary arterial hypertension undergoing cardiac surgery. Sixty-six patients with pulmonary arterial hypertension underwent the study. Patients were randomly divided into two groups: group D received a dexmedetomidine injection in a dose of 1 μg/kg in the first hour and then decreased to 0.5 μg/kg/hr, injection continued after surgery until extubation in the post-anesthetic care unit (PACU). Group C received normal saline 0.9% in a similar volume. Pulmonary artery systolic pressure (PASP) and systemic systolic blood pressure (SSBP) were recorded during and after the surgery in the post-anesthetic care unit. Needing vasodilators, sedatives, extubation time, and the length of ICU stay were recorded for all patients. Patients in the dexmedetomidine group showed a significant reduction in Pulmonary artery systolic pressure and Pulmonary artery systolic pressure/systemic systolic blood pressure rates during surgery and during the first 24 hours in the post-anesthetic care unit (P<0.001). The dexmedetomidine group, in comparison with the control group, needed a significantly lower dose of a vasodilator (P<0.001) and a lower dose of sedation (P<0.001). It is concluded that the use of dexmedetomidine during the surgery in children with pulmonary hypertension reduces pulmonary artery systolic pressure during and after the surgery. https://acta.tums.ac.ir/index.php/acta/article/view/8182 https://acta.tums.ac.ir/index.php/acta/article/download/8182/5392

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 58 4 2020 07 28 177 182 Shahab Mahmoudvand Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. AND Department of Virology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Somayeh Shokri Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. AND Department of Virology, School of Medicine, Ahvaz Jundishh>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