Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 58 8 2020 11 10 366 375 Soodeh Omidi Department of Genetic, Faculty of Advanced Medical Technologies, Golestan University of Medical Sciences, Gorgan, Iran. Serwa Ghasemi Department of Biology, School of Basic Sciences, Islamic Azad University Research Tehran Branch, Tehran, Iran. Samira Kalayinia Cardiogenetic Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. 2020 03 03 2020 05 04 Coronary artery disease (CAD) is a common multifactorial disease with a high rate of morbidity and mortality worldwide. The MEF2A gene transcription factor belongs to the myocyte enhancer factor-2 (MEF2) family and is involved in critical processes such as calcium-dependent signaling pathways and cardiac development. Although the variants of the MEF2A gene were studied in different CAD and myocardial infarction (MI) populations, the reality of this gene association with CAD is still unclear. This study reports the first in silico investigation on MEF2A variants. All reported variants in CAD/MI patients were collected from eleven countries. Their pathogenicity and variant position conservation were surveyed by online prediction tools, including Mutation-Taster, Polyphen-2, PROVEAN, SIFT, CADD, and GERP. In silico analysis did not confirm the pathogenic effect of 21-bp deletion, which was introduced as a monogenic cause of CAD. c.704C>A (p.S235Y), c.812C>G (p.P271R), c.836C>T (p.P279L) and c.848G>A (p.G283D) missenses, c.1315C>T (p.R439X) nonsense, and seven out-of-frame deletions were predicted as disease-causing variants. Although some variants of the MEF2A gene affect protein structure, the MEF2A variation studies in CAD/MI patients and in silico analysis do not approve the association and pathogenicity of MEF2A variants in the familial/sporadic CAD. https://acta.tums.ac.ir/index.php/acta/article/view/8344

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 58 8 2020 11 10 376 382 Hamidreza Samimagham Department of Nephrology, Shahid Mohammadi Hospital, Hormozgan University of Medical Sciences, Bandar Abbas, Iran. Mariana Bargak Department of Endocrinology, Hormozgan University of Medical Sciences, Bandarabbas, Iran. Mehran Ghasemzadeh Department of Endocrinology, Shahid Mohammadi Hospital, Hormozgan University of Medical Sciences, Bandar Abbas, Iran. Mitra Kazemi Jahromi Department of Endocrinology, Shahid Mohammadi Hospital, Hormozgan University of Medical Sciences, Bandar Abbas, Iran. 2020 01 20 2020 05 03 The high risk of lipid abnormalities in type 2 diabetic (T2D) patients with uncontrolled hyperglycemia may be associated with an increased risk of cardiovascular complications. The aim of the current study was to investigate the association between glycated hemoglobin )HbA1c( and lipid profile levels in T2D patients. This cross-sectional study was conducted on 802 T2D patients, aged≥ 40 years, visiting the Abu Reyhan Clinic of Shahid Mohammadi Hospital in Bandar Abbas, Iran. Serum lipid profiles were measured by the enzymatic method. Diabetes was defined based on the criteria of the American Diabetes Association. The association of HbA1c and estimated glomeruli filtration rate (eGFR) with lipid profile indices was assessed using the Spearman correlation coefficient test and linear regression model. The mean±SD age of participants (27.7% of men) was 53.55±5.56 years. The mean±SD of HbA1c and eGFR for all subjects were 8.97±2.14 and 86.30±17.48, respectively. In this study,a positive association was observed between HbA1c and fasting blood glucose (r=0.619, β=0.635), total cholesterol (r=0.165, β=0.188), triglycerides (r=0.103, β=0.095), and low-density lipoprotein cholesterol (r=0.162, β=0.173), (P<0.01). Also, an inverse association has been observed between eGFR level and TGs (r=-0.08, β=-0.096) and FBS (r=-0.123, β=-0.172), (P<0.05). Our findings suggested that HbA1c is not only an applicable predictor of long-term glycaemic control but also can be considered as a potential biomarker for predicting lipid abnormalities in T2D patients. https://acta.tums.ac.ir/index.php/acta/article/view/8286

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 58 8 2020 11 10 383 387 Ghazaleh Jamalipour Soufi Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Ali Hekmatnia Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Arezoo Shafieyoun Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Mahdieh Afzali Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. 2020 02 17 2020 05 04 Cerebral venous sinus thrombosis is an important pathology with various clinical symptoms. Early detection of thrombosis is very important for the improvement of the prognosis. The aim of this study was to calculate the diagnostic value of T2-weighted sequences of magnetic resonance imaging (MRI) in detecting subacute thrombosis. All patients that were suspected of having subacute cerebral venous sinus thrombosis and were referred to the emergency center of Kashani hospital (between September 2018 and September 2019) were entered into the study. Magnetic resonance venography (MRV) and T2-weighted MRI were accomplished for each patient. The sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of MRI using MRV as the reference method were calculated. A total of 630 patients were entered into the study. A positive subacute venous sinus thrombosis was detected in the MRV of 53 patients; consequently, the sensitivity of 60%, the specificity of 80%, the PPV of 21%, and the NPV of 96% were calculated. MRI was highly specific for detecting the subacute thrombosis of superior sagittal sinus, transverse sinuses, sigmoid sinuses, and straight sinus (specificity>94%). A substantial agreement was detected between MRI and MRV in distinguishing thrombosis of superior sagittal sinus, transverse sinuses, sigmoid sinuses, and straight sinus (kappa>0.6). T2-weighted MRI is a specific method in detecting cerebral venous sinus thrombosis. In a patient with signs of thrombosis in the T2-weighted sequence, additional workups are highly suggested to rule out the pathology.   https://acta.tums.ac.ir/index.php/acta/article/view/8329

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 58 8 2020 11 10 388 393 Azam Azargoon Abnormal Uterine Bleeding Research Center, Semnan University of Medical Sciences, Semnan, Iran. AND Department of Infertility, Amir-aL-Momenin Hospital, Semnan University of Medical Sciences, Semnan, Iran. Majid Mirmohammadkhani Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran. AND Department of Epidemiology and Biostatistics, Semnan University of Medical Sciences, Semnan, Iran. Sara Borjian Department of Infertility, Amir-aL-Momenin Hospital, Semnan University of Medical Sciences, Semnan, Iran 2020 01 20 2020 05 03 The diagnosis of polycystic ovary syndrome (PCOS) and metabolic syndrome (MS) in adolescents is clinically challenging. It is on the rise as consistent with the increasing trends in obesity rates. This study aimed to investigate the prevalence of PCOS in adolescents by the National Institutes of Health (NIH) criteria and compare the prevalence of insulin resistance (IR) and metabolic syndrome (MS) between obese (OB) and non-obese (NOB) adolescents with PCOS. This was cross-sectional research with multi-stage cluster random sampling. Participants were 15-18-year-old girls from high schools in Semnan, Iran. The ones who had a history of menstrual dysfunction underwent clinical and hormonal tests. From among a total of 900 participants, 74 girls (8.2%) had a history of menstrual dysfunction. The prevalence of PCOS was 6.44% by NIH criteria. The prevalence of abnormal glucose metabolism, MS, and IR in girls with PCOS were 8(13.7%), 6(10.3%), 24(41.4%), respectively. The OB-PCOS group with a mean BMI of 28.21±1.26 kg/m2 had a significantly greater prevalence of MS, high BP, waist circumference ≥88 cm, and higher IR than NOB-PCOS cases with a mean BMI of 20.54±2.97 kg/m2. Abnormal glucose metabolism was prevalent in adolescents with PCOS and occurred with equal frequency in OB and NOB PCOS groups. Obesity could worsen IR, MS, and some of the components of Mets in PCOS adolescents. https://acta.tums.ac.ir/index.php/acta/article/view/8287

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 58 8 2020 11 10 394 399 Moslem Sedaghattalab Department of Internal Medicine, School of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran Soheila Khajezadeh Department of Internal Medicine, School of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran Akvan Paymard Department of Internal Medicine, School of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran Parisa Mansouri Department of Internal Medicine, School of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran Rozina Abasi Larki Department of Nephrology, School of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran Leila Manzouri Department of Community Medicine, Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran 2020 02 12 2020 05 04 There is little consensus about the type of maintenance fluid therapy and it’s the effect on serum sodium in adults. Thus, this study was conducted to assess the effect of maintenance fluid therapy on serum sodium of hospitalized patients in the intensive care unit. This randomized clinical trial was carried out on 64 patients aged 18-90 years hospitalized in the intensive care unit (ICU) of Imam Sadjad and Shahid Beheshti hospitals, Yasuj, Iran, in 2017. These patients were randomly allocated to take 2500-3000 milliliters of intravenous maintenance isotonic (0.9% saline) or hypotonic (0.45% saline) fluids daily. Blood and urine samples were taken to measure biochemical parameters before and 48 hours after the intervention. Data analyses were done by using SPSS 16 software via descriptive and analytic statistics. Twenty-eight patients in the 0.9% saline group (19 male and 9 female) and 32 patients in 0.45% saline (20 male and 12 female) completed the study. There was no significant difference between two groups in sodium (P=0.94), potassium (P=0.21), sugar (P=0.91), creatinine (P=0.21), Blood Urea Nitrogen (P=0.99), systolic (P=0.81) and diastolic (P=0.73) blood pressure, PH (P=0.27), bicarbonate (P=0.8), and urine specific gravity (P=0.73). Based on the results of this study, it was shown that the administration of maintenance hypotonic fluids has been appropriate for the patients and will not face them with the risk of hyponatremia. https://acta.tums.ac.ir/index.php/acta/article/view/8323

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 58 8 2020 11 10 400 403 EN Bita Eslami Breast DiseasesResearch Center (BDRC), Tehran University of Medical Sciences, Tehran, Iran Amirmohsen Jalaeefar Department of Surgical Oncology, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran Ashraf Moini Breast Diseases Research Center (BDRC), Tehran University of Medical Sciences, Tehran, Iran. AND Department of Gynecology and Obstetrics, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran. AND Department of Endocrinology and Female Infertility at Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran. Ramesh Omranipour Breast Diseases Research Center (BDRC), Tehran University of Medical Sciences, Tehran, Iran. AND Department of Surgical Oncology, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran. Maryam Haghighi Breast Oncology Clinic, Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Sadaf Alipour Breast Diseases Research Center (BDRC), Tehran University of Medical Sciences, Tehran, Iran. AND Department of Surgery, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2020 02 26 2020 05 04 Fertility preservation counseling has a high priority in young breast cancer (BC) patients. Cytotoxic chemicals used for chemotherapy in these patients increased the risk of premature ovarian failure. This study evaluated the anti-mullerian hormone (AMH) level at the time of diagnosis and within a month after the end of chemotherapy, while predicting the time of the return of ovarian function in BC cases (n=46) younger than 46 years for the first time in Iran. Cases were selected from those attending the breast oncology clinic of the two hospitals with a newly diagnosed in situ or invasive BC. The present study results showed AMH levels were significantly decreased in almost all women within a month after chemotherapy. It seems that the need for fertility preservation depends on patient age and baseline AMH level, but counseling should be offered by the clinician in young breast cancer patients. https://acta.tums.ac.ir/index.php/acta/article/view/8337

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 58 8 2020 11 10 404 407 Senad Mehmedinović Department of Special Education and Rehabilitation, Faculty of Education and Rehabilitation, University of Tuzla, Univerzitetska 1, 75000, Tuzla, Bosnia and Herzegovina 2020 03 03 2020 05 04 The aim of the study was to determine the psychological characteristics of mothers of children with cerebral palsy. The study included a sample of 30 respondents. The sample consisted of mothers of children with cerebral palsy, chronologically aged 25 to 60. The research was conducted at the Centre for Children with Multiple Disabilities “Koraci Nade”. For the purpose of checking the set research aim, Symptom Checklist-SCL-90-R, consisting of a list of 90 particles (problems), was applied, and the task was to assess the respondent's anxiety about each of the aforementioned problems over the past week (e.g., headaches, tension or anxiety, excessive worrying). The survey data were processed using the parametric statistics method. Central tendency measures, dispersion measures were calculated, and a tabular presentation of the results was done. Based on the results of the research, it can be concluded that the mothers of children with cerebral palsy have the most pronounced problems in areas of somatization, depression, obsessive-compulsive disorders, as well as anxiety.   https://acta.tums.ac.ir/index.php/acta/article/view/8343

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 58 8 2020 11 10 408 412 Zohreh Karimi Department of Operating Room, School of Paramedicine, Yasuj University of Medical Sciences, Yasuj, Iran Abdolhadi Jahanfar Department of Nursing, School of Nursing, Yasuj University of Medical Sciences, Yasuj, Iran Mohammad Behnammoghadam Department of Nursing, School of Nursing, Yasuj University of Medical Sciences, Yasuj, Iran Azizallah Dehghan Department of Community Medicine, School of Medicine, Fasa University of Medical Sciences, Fasa, Iran 2020 01 27 2020 05 04 The present study intended to determine the relationship of occupational adjustment with psychological empowerment and job burnout of nurses. This descriptive correlational study was conducted on 209 nurses working in educational hospitals. The eligible nurses were enrolled in the study through simple random sampling and filled out the demographic questionnaire, the Dawis and Lofquist Occupational Adjustment questionnaire, the Spreitzer Psychological Empowerment Instrument, and the Maslach Burnout Inventory. There was a significant positive relationship between occupational adjustment and psychological empowerment (P<0.001) and a significant negative relationship between occupational adjustment and job burnout of nurses (P<0.001). Regression analysis showed that occupational adjustment explained 46% of the psychological empowerment variance and 52% of the job burnout variance. The occupational adjustment has a significant positive relationship with psychological empowerment and a significant negative relationship with job burnout among nurses. Considering that nurses experience severe burnout in their work environment, programs should be developed to improve the psychological empowerment of nursing care. https://acta.tums.ac.ir/index.php/acta/article/view/8301

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 58 8 2020 11 10 413 415 Aamer Ubaid Department of Medicine, Khyber Teaching Hospital, Peshawar, KPK, Pakistan Farishta Waheed Department of Medicine, Khyber Teaching Hospital, Peshawar, KPK, Pakistan Awais Naeem Department of Medicine, Khyber Teaching Hospital, Peshawar, KPK, Pakistan 2019 09 01 2019 09 08 Tuberculosis (TB) is the major problem being faced worldwide, particularly in developing countries, and therefore, it is important to recognize the unusual presentations of the disease. Although TB is primarily lung disease, it can affect several other organs such as bone, brain, liver, and intestine etc. Liver involvement in TB is not uncommon but isolated liver TB is the rarest form of TB. A common observation is that the mortality rate is higher in intra-abdominal TB as compared to pulmonary TB, but it is a difficult diagnosis to make, often requiring laparotomy. Liver tuberculoma is, in particular, rare, with fewer than 100 cases reported in the literature, most of which are secondary and associated with miliary TB. We present a case of primary hepatic tuberculoma in an immuno-competent host and illustrate how these cases can be managed non-surgically. . https://acta.tums.ac.ir/index.php/acta/article/view/8057

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 58 8 2020 11 10 416 418 EN Mehmet Yildirim Department of General Surgery, Izmir Bozyaka Education and Research Hospital, University of Health Sciences, Izmir, Turkey Asuman Argon Department of Pathology, Izmir Bozyaka Education and Research Hospital, University of Health Sciences, Izmir, Turkey Sedat Tan Department of General Surgery, Izmir Bozyaka Education and Research Hospital, University of Health Sciences, Izmir,Turkey. Ahmet Cekic Department of General Surgery, Izmir Bozyaka Education and Research Hospital, University of Health Sciences, Izmir, Turkey 2020 03 20 2020 05 05 Acinar cystic transformation (ACT) or acinar cell cystadenoma is a rare benign tumor of the pancreas. Their clinical presentation is nonspecific, thus hampering their detection and frequently leading to misdiagnosis. In this report, we present a case of ACT of the pancreas in a 54-year-old man that was vague abdominal symptoms. A magnetic resonance imaging was shown a well-defined cystic mass located in the head of the pancreas, measuring 57×47×23 mm. Our patient was treated by pancreaticoduodenectomy. In the macroscopic examination of the mass, a multicystic lesion was found in cream-colored pancreatic tissue. Histological and immunohistochemical studies examination revealed a cystic mass containing multiple cysts at varying sizes, lined by epithelial cells without atypia and positive staining of CK7, CK8/18, and CK19. A high index of clinical suspicion is required to diagnose this tumor. The surgical approach is to ensure accurate diagnosis and to avoid complications. https://acta.tums.ac.ir/index.php/acta/article/view/8367