Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 59 3 2021 03 13 126 132 Mahdieh Mehrpouri Department of Laboratory Sciences, School of Allied Medical Sciences, Alborz University of Medical Sciences, Karaj, Iran 2020 09 20 2021 01 31 The 2019 novel coronavirus (2019-nCoV) or the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged as a pandemic threat from December 2019. Coronavirus can cause varying degrees of illness that range from mild to severe or fatal disease. The exact mechanism on hematopoiesis induced by this coronavirus is not yet well understood, but scientific evidence indicates that COVID-19 can cause hematological changes in infected patients. The present study summarized pieces of literature regarding hematologic findings of COVID-19 and their correlation with disease severity. Finally, we offered some laboratory abnormalities which help to differentiate severe COVID-19 from non-severe forms of the disease. Among hematological parameters, decreased hemoglobin rather than anemia, leukocytosis, lymphopenia, neutrophilia, and thrombocytopenia have been observed in conducted studies in some patients with COVID-19. Furthermore, as the disease progresses to severe COVID-19, hemoglobin decline, leukocytosis, lymphopenia, neutrophilia, and thrombocytopenia continue to exacerbate. In addition, the neutrophil-to-lymphocyte ratio is also considered as an independent risk factor for severe infection in COVID-19 patients. https://acta.tums.ac.ir/index.php/acta/article/view/8814

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 59 3 2021 03 13 133 141 Raziye Karamikhah Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran Negar Azarpira Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Soheila Zareifar Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Ali Dehshari Department of Pharmaceutical Biotechnology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran Soha Namazi Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran Mohammad Hossein Anbardar Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran Iman Karimzade Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran 2020 06 21 2020 10 23 - Methotrexate (MTX) is the main drug for the treatment of childhood acute lymphoblastic leukemia (ALL). ABCG2 pump is the main transporter of MTX on BBB. Our aim was to investigate the possible relationship between three polymorphisms of the ABCG2 gene, and isolated CNS relapses in Iranian children with ALL receiving high dose MTX. Genotyping of three polymorphisms of the ABCG2 gene, including G34A, C376T, and C421A, was performed by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method for 56 patients. A high frequency of C376T CT genotype was observed among the patients. There was no significant association between C376T and C421 and isolated CNS relapse (P>0.05). C376T and C421A polymorphisms are not associated with isolated CNS relapse in childhood ALL. https://acta.tums.ac.ir/index.php/acta/article/view/8560

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 59 3 2021 03 13 173 176 Shahin Besharati Zanjan Metabolic Diseases Research Center, Zanjan University of Medical Sciences, Zanjan, Iran Zahra Abbaspourrad Zanjan Metabolic Diseases Research Center, Zanjan University of Medical Sciences, Zanjan, Iran Hossein Chiti Zanjan Metabolic Diseases Research Center, Zanjan University of Medical Sciences, Zanjan, Iran Negin Parsamanesh Zanjan Metabolic Diseases Research Center, Zanjan University of Medical Sciences, Zanjan, Iran 2021 02 08 2021 02 19 The 2019 global Coronavirus syndrome pandemic (COVID-19) has entered more than two hundred countries around the world, involving <82 million persons and >1,800,000 deaths (until January, 1st 2021). We report on COVID-19 infection in the context of a Cushing's syndrome (CS) from Iran. A 36-year-old man with proximal myopathy, plethora, and striae with central obesity was evaluated for Cushing's syndrome. During the high dose dexamethasone test, the patient developed symptoms of cough, low-grade fever, and weakness then was admitted to the ICU with a diagnosis of COVID-19. Despite treatment according to national protocols for COVID-19, the patient unfortunately died. In this report, we intend to discuss the various aspects of Cushing's syndrome and severe COVID-19 infection. https://acta.tums.ac.ir/index.php/acta/article/view/9151

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 59 3 2021 03 13 142 147 Zahra Mazloum Khorasani Metabolic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran Saeed Choobkar Mashhad University of Medical Sciences, Mashhad, Iran Ramin Khameneh Bagheri Department of Cardiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Mina AkbariRad Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Abdollah Firoozi Faculty of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran 2020 07 29 2021 01 25 Adiponectin is an adipocytokine that has a higher serum level in healthy people. In type 2 diabetes, insulin resistance, hypertension, MI, and dyslipidemia, the serum level of adiponectin is lower than 4 µg/mL. Adiponectin is proved to have a protective role against atherosclerotic changes where its low serum levels in type 2 diabetes can lead to the progression of atherosclerotic lesions. In this study, we aimed to survey the possible effects of adiponectin in the development of coronary artery disease in type 2 diabetics. Thirty diabetic cases with coronary artery disease, 30 diabetic cases without known coronary artery disease, and a group of 30 healthy volunteers, all of them were between 18-65-year-old, were entered our study. We gathered demographic data by performing a physical examination followed by filling a checklist and a set of laboratory tests. All the groups were sex and age-matched (P=0.284 and P=0.163 respectively). CAD group had the lowest HBA1C (P<0.001). Both LDL and HDL were also lower in the CAD group (P<0.001). Adiponectin was also lower in the CAD group when compared to other groups (P<0.008) or when compared with only normal diabetics (P<0.002). We found a correlation between adiponectin and HDL (r=0.348, P=0.008), suggesting each unit of reduction in serum level of adiponectin could increase the chance of coronary artery disease by 38% in diabetics. In this study, we showed that the lower serum level of adiponectin is correlated with an increased risk of coronary artery disease in type 2 diabetics. https://acta.tums.ac.ir/index.php/acta/article/view/8626

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 59 3 2021 03 13 177 181 Javad Mohammadi-Asl Hearing Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Nader Saki Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Majid Karimi Hearing Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Farideh Ghanbari Mardasi Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran 2020 07 14 2021 01 25 Hearing loss (HL) is one of the most frequent birth defects, and genetic factors contribute to the pathogenesis of the disorder in about half of the patients. In the present study, we performed whole-exome sequencing (WES) based on Next-generation sequencing (NGS) in an Iranian family with hereditary HL. Then, Sanger sequencing was used to verify the segregation of the variant recognized in affected family members. A novel homozygous frameshift variation, c.649-650insC, in TECTA was found in the family, which might lead to a truncated TECTA protein (p. Asn218Gln fsX31). Our findings propose that the homozygous TECTA-p.N218QfsX31 mutation is the pathogenic variant for ARNSHL. To the best of our knowledge, this mutation has not been described in patients with the HL phenotype and so far has not to be reported in any of the mutation databases. Our data expand the spectrum of mutations in the TECTA gene in nonsyndromic hearing loss. https://acta.tums.ac.ir/index.php/acta/article/view/8632

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 59 3 2021 03 13 148 154 Dixit Nutan Department of Pathology, Sarojini Naidu Medical College, Agra-282002, Uttar Pradesh, India. Bansal Vikas Kumar Department of Surgery, Sarojini Naidu Medical College, Agra-282002, Uttar Pradesh, India. Bharti Rajni Department of Pathology, Sarojini Naidu Medical College, Agra-282002, Uttar Pradesh, India. Sharma Priyam Department of Pathology, Sarojini Naidu Medical College, Agra-282002, Uttar Pradesh, India. 2020 08 07 2021 01 31 In 1996, to harmonize the reporting system of breast lesions on fine-needle aspiration cytology (FNAC), National Cancer Institute (NCI) proposed five categories from C1-C5. C3 and C4 categories are noted to be ambiguous during histopathological correlation, hence “grey-zoned.” There have been limited researches regarding its usefulness and its histopathological correlation. This study was undertaken to evaluate C3 and C4 categories and to correlate with histopathological examination. This perspective and retrospective study was undertaken for two years. Forty cases of C3 and 32 cases of C4 were retrieved from a total of 602 cases of breast FNAC. Histopathological follow-up and correlation were available in 30 cases of C3 and 15 cases of category C4 and were selected for further study. On the histopathological correlation of the C3 category, 22 (73.3%) cases turned out to be benign, and 8 (26.7%) cases revealed malignant diagnosis, and among the C4 category, 2 (13.3%) cases revealed benign findings, and 13(86.7%) of the cases showed malignancy. This difference was statistically significant (P<0.001). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the C4 category in the diagnosis of malignancy were 61.9%, 91.6%, 86.6%, and 73.3%, respectively. FNAC is a simple, rapid, cost-effective, and accurate method to diagnose easily accessible breast swellings. However, one should be aware of its limitations as well. Our study supports maintaining C3 and C4 categories, as there was a statistically significant difference in benign & malignant diagnosis for these categories.   https://acta.tums.ac.ir/index.php/acta/article/view/8706

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 59 3 2021 03 13 182 184 Athar Rasekhjahromi Department of Obstetrics and Gynecology, Women's Health and Diseases Research Center, Jahrom University of Medical Sciences, Jahrom, Iran Sahand Goodarzi Department of Obstetrics and Gynecology, Women's Health and Diseases Research Center, Jahrom University of Medical Sciences, Jahrom, Iran Navid Kalani Department of Obstetrics and Gynecology, Women's Health and Diseases Research Center, Jahrom University of Medical Sciences, Jahrom, Iran 2020 07 28 2020 10 23 Ovarian torsion occurs in 10%-22% of pregnant women, and miscarriage occurs in 11%-22% of all pregnancies, both of which are known as gynecological emergencies. The simultaneous occurrence of these two cases is rare. The present study reports a case of ovarian torsion and simultaneous abortion. In this case report, we present a 28-year-old woman in her third pregnancy with a history of two miscarriages. She was referred with an 18-week triplet pregnancy, vaginal pain and bleeding from the previous day, and colic abdominal pain with five episodes of nausea and vomiting. Upon admission to the hospital, despite performing cerclage at 13 weeks, labor pains begin, and 15 minutes later, the amniotic sac ruptures, and all three fetuses are expelled. Due to the persistence of colic pain and moderate tenderness in the lower right quadrant of the abdomen, pelvic ultrasound is reported, which shows an increase in echo parenchyma and the size of the right ovary compared to the left ovary. Doppler ultrasound showed decreased ovarian blood flow, which led to laparotomy with suspected ovarian torsion. The right ovarian peduncle had complete torsion, and the ovary appeared dark. The peduncle of ovarian torsion was opened and preserved. The patient was discharged two days after surgery and after re-color Doppler ultrasounds, which indicated ovarian blood flow. https://acta.tums.ac.ir/index.php/acta/article/view/8676

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 59 3 2021 03 13 155 160 EN Mohammadreza Mirkarimi Department of Pediatrics, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Mohsen Alisamir Department of Pediatrics, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Parastoo Nasiri Department of Pediatrics, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Shahriar Barouti Department of Pediatrics, Faculty of Medicine, Ahvaz Jundishapur University of Medh>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 Ab