Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 59 7 2021 08 25 386 392 Sayedeh-Somayyeh Mousavipour Department of Health in Emergencies and Disasters, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran. AND Department of Pediatrics, School of Nursing, AJA University of Medical Sciences, Tehran, Iran Sanaz Sohrabizadeh Department of Health in Emergencies and Disasters, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran. AND Air Quality Health and Climate Change Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran . 2020 08 05 2021 06 02 The evacuation of hospitals has special complications and sensitivities in terms of the presence of patients. Since infants are the youngest and most vulnerable patients in the hospital, the readiness of the neonatal intensive care unit (NICU) to respond appropriately and evacuate at the time of disasters is very important. This article examines the emergency evacuation of neonatal intensive care units during disasters. The present systematic review was done based on the PRISMA guidelines for systematic review studies. Accordingly, all English-language articles published in this field were extracted by the end of January 2020, through searching Web of Science, PubMed, Scopus, and Science Direct, as well as Google Scholar Web Search. The search and screen of the articles were conducted independently by the research team members, and the content of included articles was analyzed thematically. After the final evaluation, 11 articles were subjected to content analysis, which was divided into seven thematic categories: command, training and maneuver, manpower, communication, equipment, transportation, support. Considering that infants are the most vulnerable preparing the staff of the (NICU) along with providing them with specialized and technical support is suggested. By preparing and implementing response and preparedness plans, it is possible to prevent high complications and mortality among infants admitted to the hospital pre-disasters. https://acta.tums.ac.ir/index.php/acta/article/view/8699

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 59 7 2021 08 25 393 399 Seyedreza Mirsoleymani School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand Erfan Taherifard Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran Ehsan Taherifard Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. Mohammad Hossein Taghrir Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran Milad Ahmadi Marzaleh 3 Department of Health in Disasters and Emergencies, Health Human Resources Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. AND Health Human Resources Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Mahmoudreza Peyravi Department of Health in Disasters and Emergencies, Health Human Resources Research Center, Shiraz University ofMedical Sciences, Shiraz, Iran AND Health Human Resources Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Rita Rezaee Health Human Resources Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. AND Clinical Teaching Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran Seyyed Mojtaba Nekooghadam Internal Department of Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2020 07 22 2021 05 19 Background: late in 2019, the first case of COVID-19 was detected in China, and the disease caused pandemic state worldwide. Up to now, many studies investigated the impact of comorbid diseases, especially diabetes mellitus on COVID-19 outcomes. Objectives: In this study, we aimed to assess the para-clinic characteristics of COVID-19 patients with or without diabetes mellitus to identify factors indicative of poor prognoses. Methods: In this prospective study, 153 in-patients with COVID-19 were followed up from 1 March to 19 April. Paraclinical information of these patients was gathered from their medical records. Afterward, the association between these factors among both diabetic and non-diabetic patients were assessed in the correlation analyses. Results: discharge and expiration of 77.1% and 22.9% of the study participants resulted in a 1063 person-day follow up for patients who discharged healthily, and 384 person-day follow up for expired patients. 41.8% of the participants had diabetes mellitus. Lymphocytopenia and Neutrolhilia prevalences increased during hospitalization; comparing with their initial prevalences. Thirty-seven patients got acute respiratory distress syndrome; of those, 35 died. The mean of the initial C reactive protein level was 42.49 and serum creatinine of 1.39 Conclusion: The study showed that higher initial neutrophil count, increasing neutrophil count more than 15000 and decreasing lymphocyte count below 1000 during hospitalization; development of acute respiratory distress syndrome and being intubated; initial C reactive protein and serum creatinine level were associated with higher mortality rates in COVID-19 victims. https://acta.tums.ac.ir/index.php/acta/article/view/8655

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 59 7 2021 08 25 400 405 Reza Hajebi Department of General Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran,.Iran . AND School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Ali Ajam Students’ Scientific Research Center (SSRC), School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Shahrokh Karbalai School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. AND Department of Cardiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Haleh Ashraf Research Development Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran 6 Cardiac Primary Prevention Research Center (CPPRC), Cardiovascular Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran Mohammad Reza Ostadali Dehaghi Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran. AND Cell Therapy and Hematopoietic Stem Cells Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran Hedieh Moradi Tabriz School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. ANDDepartment of Pathology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Marzieh Pazoki Department of Internal Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Fatemeh Khalili School of Medicine, Arak University of Medical Sciences, Arak, Iran 2021 03 16 2021 04 16 In the last days of 2019, a new coronavirus emerged in Wuhan, China, and less than three months its disease, now called COVID-19, was announced a global pandemic by WHO. COVID-19 usually causes respiratory symptoms and can lead to more severe conditions like ARDS. HLA has a crucial role in regulating the immune system; thus, different HLA allele types can be a protective or risk factor for some diseases, so we aimed to find such associations to determine whether some alleles can predict susceptibility or resistibility to COVID-19 and finally facilitate vaccine development. In this case-control study, 15 admitted COVID-19 cases with severe symptoms and ten individuals with mild COVID-19 symptoms were enrolled in the case and control groups, respectively. They were genotyped for HLA A/B/DR loci using a low-resolution HLA typing test. These alleles were more prevalent in case (severe COVID-19) group: A*24 (53.33% vs 10%), B*50 (20% vs 10%), B*55 (20% vs 10%), DRB1*04 (40% vs 20%) and DRB1*11 (53.33% vs 30%) but the difference was only statically significant in A*24 allele (P=0.027; odd ratio=10.286). A*24 was also more prevalent in all patients than the general population in Iran. A*24 was the only allele more prevalent in severe COVID-19 cases with statistical significance. This allele was reported to be a risk factor for such autoimmune diseases as type 1 diabetes, myasthenia gravis, and systemic lupus erythematosus, which may be related to reported immune system hyperresponsiveness in severe COVID-19 cases. https://acta.tums.ac.ir/index.php/acta/article/view/9241

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 59 7 2021 08 25 406 415 Mohammad Sheibani Department of Pharmacology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran Hedyeh Faghir-Ghanesefat Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran. AND Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Yaser Azizi Physiology Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.AND Department of Physiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran Tahmineh Mokhtari CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China. AND Department of Psychology, University of Chinese Academy of Sciences, Beijing, China Hasan Yousefi‐Manesh Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran. AND Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Roya Sattarzadeh Badkoubeh Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Amir Hossein Emami Department of Hematology-Oncology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Ahmad Reza Dehpour Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran. AND Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran 2021 06 14 2021 06 26 The clinical use of doxorubicin as a potent chemotherapeutic agent is limited due to its dose-dependent cardiotoxicity. Oxidative stress and inflammatory pathways have a pivotal role in doxorubicin-induced cardiotoxicity. Sumatriptan, a 5-hydroxytryptamine (5-HT)1B/1D agonist that is mainly used to relieve migraine pain, has suggested exerting protective effects in numerous pathological conditions through antiinflammatory properties. The aim of the present study was to investigate the effects of sumatriptan on doxorubicin-induced cardiotoxicity and the contribution of anti-inflammation and antioxidative responses. Cardiotoxicity was induced by the administration of doxorubicin three times a week (2.5 mg/kg i.p) for two consecutive weeks on male rats. The animals were divided into four groups, including Control, Sumatriptan (0.1 mg/kg) received group, doxorubicin received group, and Doxorubicin+Sumatriptan (0.1 mg/kg) received group. Sumatriptan was administered 30 min before every injection of doxorubicin. On the last day of the second week, the body weight, mortality rate, electrocardiogram (ECG) and histopathological changes, cardiac inotropic study, and biochemical factors were evaluated. The loss of body weight, mortality rate, ECG parameters, reduction of papillary muscle contractility force as well as histopathological scores following administration of doxorubicin indicated severe cardiac damage. However, treatment with sumatriptan inhibited the functional and structural impairment induced by doxorubicin. In addition, sumatriptan could significantly reduce cardiac tissue levels of malondialdehyde (MDA) and tumor necrosis factor-alpha (TNF-α), which were increased in the doxorubicin-treated rats. This study illustrated the protective effects of sumatriptan on decreasing doxorubicin-induced cardiac toxicity and mortality rate in part through inhibition of inflammatory and oxidative stress pathways. https://acta.tums.ac.ir/index.php/acta/article/view/9461

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 59 7 2021 08 25 416 420 Abdollah Dehvari Department of Pediatrics, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran. AND Children and Adolescent Health Research Center, Resistant Tuberculosis Institute, Zahedan University of Medical Sciences, Zahedan, Iran Mahmoud Imani Department of Pediatrics, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran Ebrahim Abdollahi School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran Reza Behmadi Firoozabadi Clinical Research Development Unit (FACRDU), Iran University of Medical Sciences, Tehran, Iran 2020 07 27 2021 06 02 Germinal matrix hemorrhage-intraventricular hemorrhage (GMH-IVH) mainly occurs in preterm neonates and is an important cause of brain injury in them. In this retrospective cross-sectional study from march 2017 to march 2018 in our teaching hospitals, we investigated 250 newborns who were admitted to NICU with a birth weight under 1500 grams with ultrasonographic study for presence and grade of GMH-IVH in their first week of life. Risk factors for GMH-IVH were collected from their records and results been analyzed with SPSS software. From 250 neonates who had inclusion criteria of the study, 22 cases had GMH-IVH in ultrasonographic evaluation. 37.6% of all cases and 31.8% of newborns with GMH-IVH had a 5-minute APGAR score of less than six. 91 cases (39.9%) of the control group and 15 cases (68.1%) of the GMH-IVH group need resuscitation at birth. Of 250 cases 54 (21.6%) died, that 14 cases (63.6%) had GMH-IVH. Our study shows significant differences for birth weight, 5 minute APGAR score, and the need for resuscitation at birth as risk factors for the development of GMH-IVH in very low birth weight neonates, but we do not find a significant difference group in terms of gestational age, gender, route of delivery, fetal presentation, maternal parity, CBC parameters, sepsis, RDS, endotracheal tube suctioning and multiple pregnancies for them. In our study, the protective value for antenatal steroid therapy depends on the completion of the course of treatment for mothers. https://acta.tums.ac.ir/index.php/acta/article/view/8675

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 59 7 2021 08 25 421 429 EN Nazdar Alkhateeb Department of Medical Education, College of Medicine, Hawler Medical University, Erbil, Kurdistan Region, Iraq Ali Al-Dabbagh Department of Medical Education, College of Medicine, Hawler Medical University, Erbil, Kurdistan Region, Iraq Yaseen Mohammed Department of Community Health, Cihan University, Erbil, Kurdistan Region, Iraq. Mohammed Ibrahim Department of Child Health, School of Medicine, University of Dundee, Dundee, Scotland, United Kingdom 2020 05 01 2021 01 10 Any high-stakes assessment that leads to an important decision requires careful consideration in determining whether a student passes or fails. Despite the implementation of many standard-setting methods in clinical examinations, concerns remain about the reliability of pass/fail decisions in high stakes assessment, especially clinical assessment. This observational study proposes a defensible pass/fail decision based on the number of failed competencies. In the study conducted in Erbil, Iraq, in June 2018, results were obtained for 150 medical students on their final objective structured clinical examination. Cutoff scores and pass/fail decisions were calculated using the modified Angoff, borderline, borderline-regression, and holistic methods. The results were compared with each other and with a new competency method using Cohen’s kappa. Rasch analysis was used to compare the consistency of competency data with Rasch model estimates. The competency method resulted in 40 (26.7%) students failing, compared with 76 (50.6%), 37 (24.6%), 35 (23.3%), and 13 (8%) for the modified Angoff, borderline, borderline regression, and holistic methods, respectively. The competency method demonstrated a sufficient degree of fit to the Rasch model (mean outfit and infit statistics of 0.961 and 0.960, respectively). In conclusion, the competency method was more stringent in determining pass/fail, compared with other standard-setting methods, except for the modified Angoff method. The fit of competency data to the Rasch model provides evidence for the validity and reliability of pass/fail decisions. https://acta.tums.ac.ir/index.php/acta/article/view/8427

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 59 7 2021 08 25 430 441 Parichehr Hassanzadeh Nanotechnology Research Center, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. AND Sasan Hospital, Tehran, Iran Elham Arbabi Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran Fatemeh Rostami Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2020 09 11 2021 04 16 Nanotechnology has enabled the preparation of various materials for overcoming the rapid clearance of drugs, nonspecific uptake or actions, and poor tumor penetration. Based on the significance of using biomimetic substances, silk fibroin nanoparticles (SF-NPs) have been increasingly prepared for the delivery of therapeutics. Meanwhile, aggregation and low stability in the biological medium may negatively affect their efficiency. This prompted us to coat SF-NPs with polydopamine (PDA), and for efficient accumulation and increasing therapeutic efficiency against breast cancer, paclitaxel (PTX)-loaded PDA-coated SF-NPs were conjugated with targeting peptide, iRGD (iRGD-PDA-PTX-SF-NPs). The peptide impacts on the cellular uptake, cytotoxicity, tumor penetrability of NPs, and their antitumor effects were evaluated. iRGD-PDA-PTX-SF-NPs with suitable physicochemical characteristics and drug loading released PTX in a controlled manner, and efficient cellular uptake was observed. Improved pharmacological profile of PTX was revealed by increased anticancer effects in vitro and in tumor-bearing Balb/c mice, including the delayed growth of the tumor and enhanced rate of survival. The prepared NPs showed no toxic effects against the healthy tissues indicating the histocompatibility and safety of these biomimetic and long-circulating nanoplatforms. The peptide-based SF-NPs could be considered as promising biomimetic nanoformulation against breast cancer. https://acta.tums.ac.ir/index.php/acta/article/view/8794

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 59 7 2021 08 25 442 446 Seyed Rouhollah Miri Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran Alireza Khalaj Mostafa Khomeini Hospital, School of Medicine, Shahed University, Tehran, Iran Vahid Jafarlou Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran Parham Khoshdani Farahani Department of General Surgery, School of Medicine, Lorestan University of Medical Sciences, Lorestan, Iran Ayla Bahramian Department of Oral Medicine, School of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran 2020 12 15 2021 04 07 Surgical resection with curative intent is still a central therapeutic option for resectable esophageal cancer. Thoracoscopicesophagectomy in a prone position would give each benefit of the lateral position. The present research aimed to analyze the short-term outcomes of thoracoscopicesophagectomy in the prone position. This was a retrospective cross-sectional study. Patients who underwent thoracoscopicesophagectomy in the prone position at Tehran University Cancer institute from January 2017 to December 2018 entered the study. The esophagus was mobilized through the thoracoscopic approach in a prone position. The stomach was released using a laparoscopic approach for the gastric pull-up. Finally, an end-to-end hand-sewn cervical anastomosis was performed. Three, four, seven, one, and one patient suffered from pneumonia, leakage, tracheal tearing, chylothorax, and pneumothorax, respectively, after the operation. In 91.5% of patients, more than ten lymph nodes were resected. Sixty percent of patients were discharged from the hospital earlier than one week. Laparoscopicesophagectomy in the prone position is a feasible alternative. Better exposure and fewer complications were reported. https://acta.tums.ac.ir/index.php/acta/article/view/9029

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 59 7 2021 08 25 447 453 EN Mohammad Zohal Metabolic Diseases Research Center, Qazvin University of Medical Sciences, Qazvin, Iran Sima Rafiei Metabolic Diseases Research Center, Qazvin University of Medical Sciences, Qazvin, Iran Neda Esmailzadehha Metabolic Diseases Research Center, Qazvin University of Medical Sciences, Qazvin, Iran Sanaz Jamshidi School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran Nafiseh Rastgoo School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran 2020 12 17 2021 02 27 Socioeconomic and lifestyle factors are regarded as important influencing issues regarding a wide range of chronic diseases, including chronic obstructive pulmonary disease. This study aimed to explore the role of such factors as determinants of disease exacerbation among COPD patients. A cross-sectional study was conducted among 150 COPD patients who were referred to an outpatient respiratory care center in Qazvin, Iran, to undertake respiratory function tests from December 2017 to June 2018. Disease severity was determined by the Initiative for Chronic Obstructive Lung Disease (GOLD) index. Odds ratios were applied to find out factors associated with exacerbation. Study findings affirmed that within COPD severity groups, there were significant differences among patients in terms of educational level, smoking status, income, and occupation. Factors associated with severe COPD were found to be smoking (OR 3.6, 2.6-4.2), lower education (OR 1.4, 0.9-2.6), insufficient income (OR 2.3, 0.6-3.1), and unsupportive family (2.7, 1.5-3.6). Due to the obtained evidence about the effect of socioeconomic status on the prognosis of the disease, it is suggested that clinicians should also consider the nonclinical and social aspects associated with the disease in advancing patients' therapeutic procedures and management algorithms.   https://acta.tums.ac.ir/index.php/acta/article/view/9033

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 59 7 2021 08 25 454 456 EN Ebrahim Nadi Department of Internal Medicine, Division of Pulmonary Sciences and Critical Care Medicine, Beheshti Hospital, Hamadan University of Medical Sciences, Hamadan, Iran. AND School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran. Marzieh Naderishahab School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran. 2020 06 12 2021 05 19 Hemoptysis is defined as blood expectoration from below the vocal cords. Foreign bodies inhaled or consumed can be the cause of hemoptysis. Among alive foreign objects, leech infestation happens via drinking infested bodies of water. Leech infestation in the airway might be the cause of serious complications naming dysphonia, stridor, hemoptysis, choking, respiratory distress, and foreign body sensation. Although intratracheal leech infestation has been rarely reported, in the current case, a 79-year farmer presented recurrent non massive hemoptysis. Via fiberoptic bronchoscopy, a live leech was found in the trachea of the patient and with the use of lidocaine the leech was removed. In order to avoid such incidences, governments play an important role in building and repairing infrastructures regarding sanitary water and meanwhile educating and informing their population about sanitary water consumption. https://acta.tums.ac.ir/index.php/acta/article/view/8542