Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 59 10 2021 11 10 570 577 Mehran Bahraini Department of Hematology, Faculty of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran Alieh Fazeli Diagnostic Laboratory Sciences and Technology Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran 2020 08 15 2021 08 09 Based on this point that some cancers do not appropriately respond to conventional therapy, and there is the possibility of relapse, immunotherapy is currently under investigation. Cancer immunotherapies are widely recognized as transformational for several cancers and enable to move to the front-line therapy with few side effects. One of its new branches is treatment with T-cells that have been changed their receptor. The research on these cells is generally according to the design of a receptor against a specific tumor antigen. Also, manipulation of regulatory T-cell (Tregs), as the barriers to proper immune responses in the tumor microenvironment, will promote Tregs-targeted therapeutic opportunities and improve the efficacy of the current cancer treatment, such as radiation and chemotherapy. This review attempts to show novel insights into the roles of Tregs in cancer which can be considered a promising anticancer therapeutic strategy for targeting them and approaches for the generation of tumor antigen-specific T lymphocytes (AST) using chimeric antigen receptors. https://acta.tums.ac.ir/index.php/acta/article/view/8731

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 59 10 2021 11 10 578 586 Bobby Branson Biomedical Centre Martin, Department of surgery, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia Ramin Tavakoli Faculty of Medicine, Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran. Mansoor Khaledi Department of Microbiology, Faculty of Medicine, Shahed University, Tehran, Iran Javad Fathi Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran Seyed Mohammad Shafiee Faculty of Medicine, Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran. Hamed Afkhami Department of Microbiology, Faculty of Medicine, Shahed University, Tehran, Iran Shahdokht Rastegar Toxicology Research Center, Department of Biochemistry, School of Medicine, Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. 2021 06 18 2021 08 09 The role of laboratory parameters and the relationship of them with radiology reports, CT scan and clinical outcomes in screening of COVID-19 patients not been definitely established, but this disease presented a major challenge in the field of clinical tests, radiology reports, clinical outcomes that help to monitoring and treatment COVID-19 disease. This study was performed on 340 suspected COVID-19 patients, who presented to Chamran Hospital, Shiraz University of Medical Sciences Shiraz, Iran from 20 February to 31 August, 2020. Information each patient's will be completed using a data collection forms based on records. The evaluation of lungs involvement in CT scan and their relationship with laboratory indicator including biochemical and hematological factors, is the best scale for the severity and prognosis of Covid 19 patients. The findings of this study indicated ALT, AST, CRP, NEU, LDH, and Urea have very good accuracy in predicting cases with positive RT-PCR for COVID-19, respectively. In this study we shown the correlation of clinical and laboratory findings with CT-based quantitative score of pulmonary involvement in COVID-19 pneumonia and attempted that our findings could be usable to development future clinical research associated with COVID-19 infection and show the relationship of reports CT scan and clinical outcomes in the diagnosis and severity of patients with COVID-19. https://acta.tums.ac.ir/index.php/acta/article/view/9470

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 59 10 2021 11 10 587 594 Ebrahim Jalili Department of Emergency Medicine, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran Fariba Keramat Department of Infectious Diseases, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran. Saeid Bashirian Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran Salman Khazaei Health Sciences Research Center, Hamadan University of Medical Sciences, Hamadan, Iran Elaheh Talebi-Ghane Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran Manoochehr Karami Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran Ali Reza Soltanian Modeling of Noncommunicable Diseases Research Center, and Department of Biostatistics and Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran. 2021 01 21 2021 08 10 The coronavirus disease 2019 (COVID-19) pandemic as an emergency public health concern has caused hundreds of thousands of deaths in the world. Identifying predictors of death in COVID-19 patients is a key to improving survival and helping patients triage, better management, and assist physicians and health care. The present study was conducted on 512 positive COVID-19 patients confirmed by real-time PCR hospitalized in Sina Hospital, Hamadan, in 2020. The data of demographic characteristics, clinical manifestations, laboratory findings, chest examination, and disease outcome were collected. The logistic regression model was performed to explore the predictors of in-hospital mortality. Among 512 patients, 57 (11.1%) deaths have occurred. The adjusted odds ratios (OR) estimate of death in COVID-19 for patients with age more than 60 years versus those lower than 60 years was 3.15 (95% CI: 1.06, 9.37). The adjusted OR estimate of death in patients with hypertension comorbidity versus those with no comorbidity was 3.84 (95% CI: 1.27, 11.59). In addition, the adjusted OR estimate (95% CI) of death in patients with respiratory rate above 30 per minute, BUN >20 mg/dL, LDH >942 U/L and SGOT >45 U/L against lower than those values was respectively 10.72 (1.99, 57.68), 5.85 (2.19, 15.63), 13.42 (2.17, 83.22) and 2.86 (1.02, 8.05). The risk of death was higher among the patients with multiple comorbidity diseases, systolic BP lower than 90 mmHg, SPO2 lower than 88 and more than ten days hospitalization in comparison with COVID-19 patients with no comorbidity disease (P=0.002), systolic BP higher than 90 mmHg (P=0.002), SPO2 higher than 88 (P<0.001) and hospitalization for lower than ten days (P=0.012). Our findings suggest that older age, pre-existing hypertension and/or multiple co-morbidities, high respiratory rate, elevated BUN, LDH and SGOT, low systolic BP, and hypoxemia were independently associated with in-hospital mortality in COVID-19 patients. These results can be helpful for physicians and health care workers to improve clinical management and appropriate medical care of COVID-19 patients. https://acta.tums.ac.ir/index.php/acta/article/view/9105

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 59 10 2021 11 10 595 598 Mohaddeseh Azadvari Department of Physical Medicine and Rehabilitation, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. AND Department of Physical Medicine and Rehabilitation, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Seyede Zahra Emami-Razavi Department of Physical Medicine and Rehabilitation, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Maryam Hosseini Tehran University of Medical Sciences Mahsa Mayeli Tchool of Medicine, Tehran University of Medical Sciences, Tehran, Iran 2021 02 16 2021 08 23 Applying rehabilitative measures is shown to be influential in relieving the medical complications of the COVID-19 disease. Herein, we aimed to assess the effect of a rehabilitation training class on the knowledge and attitude of the caregivers of the COVID-19 patients. Twenty-three caregivers voluntarily filled the questionnaire before and after attending a training class that evaluated the participants' beliefs about the four types of rehabilitations in COVID-19, including musculoskeletal, respiratory, gastrointestinal, and deep vein thrombosis (DVT) prevention. Significant improvement in the caregiver's attitude about the importance of all four rehabilitation types was detected. Also, the knowledge was increased about the necessity of DVT prevention. The level of knowledge in the caregivers of COVID-19 patients in Iran is not satisfactory, which necessitates proper education to achieve the rehabilitation goals rapidly. In-person caregiver training along with presenting pamphlets is of the most useful methods. https://acta.tums.ac.ir/index.php/acta/article/view/9166

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 59 10 2021 11 10 599 603 Arezu Najafi Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran Khosro Sadeghniiat Haghighi Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran Esmaeil Mohammadnejad Department of Medical Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran Seyed Ali Dehghan Manshadi Department of Infectious Disease and Tropical Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Nazanin Izadi Center for Research on Occupational Disease, Tehran University of Medical Sciences, Tehran, Iran. 2021 01 10 2021 08 23 Hospital-related infections have been widely reported during the Covid-19 outbreak that exposes healthcare professionals to at greater risk of infection. This cross-sectional study was designed to evaluate the frequency of absenteeism in hospital staff during the first and second months of the Covid-19 pandemic, from 26 February until 19 April 2020. Occupational data and sickness absenteeism characteristics were collected from the records of the nursing management department. 304 (17.8%) had sick leave due to coronavirus or corona-like symptoms. Nurses and then nursing aid workers constituted the categories with more frequency of sick leave. The more median days of sick leave were observed among supervisors and midwives. About 80% of participants had typical symptoms of Coronavirus. In conclusion, the median days of sick leave due to coronavirus were not as high as we thought. This could be due to human resource shortage and insufficient knowledge regarding return-to-work guidelines in the early phase of this pandemic. https://acta.tums.ac.ir/index.php/acta/article/view/9082

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 59 10 2021 11 10 603 609 Leili Koochakzadeh Department of Pediatrics, Children’s Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran Hassan Hashemi Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran Reza Pakzad Department of Epidemiology, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran Zahra Hemmatian Rabbani Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran Samira Heydarian Department of Rehabilitation Sciences, School of Allied Medical Sciences, Mazandaran University of Medical Sciences, Sari, Iran 6 Department of Pediatrics, Dezful University of Medical Sciences, Dezful, Iran Abbasali Yekta Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran Fahimeh Khoshhal Department of Pediatrics, Dezful University of Medical Sciences, Dezful, Iran Hadi Ostadimoghaddam Refractive Errors Research Center, Mashhad University of Medical Sciences, Mashhad, Iran Parastoo Tajzadeh Higher Health Education, Complex of Kashmar, Mashhad University of Medical Sciences, Mashhad, Iran Sara Sardari Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran Mehdi Khabazkhoob Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2020 10 26 2021 08 09 To determine and compare ocular characteristics and refractive errors between major thalassemia patients and normal subjects. In this study, 71 thalassemia major patients and 79 age and sex-matched healthy subjects that were selected in an ongoing manner underwent complete optometric and ophthalmic examinations, including autorefraction, subjective refraction, fluorescein tear break-up time, and pachymetry after anthropometric measurements. The results showed that the mean UCVA was better in the control group versus the thalassemia group (P<0.001), while there was no difference in BCVA between the two groups (P=0.416). Moreover, the mean spherical equivalent was 0.38±0.13 D less in the thalassemia group compared to the control group (P=0.007), while corneal power (P<0.001) and cylinder power (P=0.001) were larger in thalassemia patients. The most common type of astigmatism was against the rule pattern in thalassemia patients and with the rule pattern in the control group (P<0.001). The mean tear break-up time was 11.35±6.43 in the thalassemia group and 14.63±5.79 in the control group (P=0.001), and the mean near the point of accommodation (NPA) (P=0.009) and near the point of convergence (NPC). (P=0.003) were significantly smaller in the thalassemia group compared to the control group. These patients suffer from a myopic shift due to exaggerated responses to changes in ocular growth, dry eye secondary to goblet cell loss, and a higher prevalence of vertical astigmatism due to eyelid laxity and pressure on the cornea. Therefore, regular ophthalmological evaluations are highly recommended in these patients. https://acta.tums.ac.ir/index.php/acta/article/view/8898

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 59 10 2021 11 10 610 616 Elaheh Yaghoubvand Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Rokhsareh Aghili Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran Alireza Khajavi Student Research Committee, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran Mohammad Ebrahim Khamseh Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran 2020 06 09 2021 09 10 The aim of this study was to assess the performance of the Framingham, UK Prospective Diabetes Study (UKPDS), and the Action in Diabetes and Vascular disease: Preterax and Diamicron-MR Controlled Evaluation (ADVANCE) risk equations in the prediction of 4-year cardiovascular disease CVD) in Iranian people with type 2 diabetes. The 4-year risks of CVD were estimated using the three equations in a community of 557 patients with type 2 diabetes and free of CVD at baseline. A trained physician evaluated all of the participants regarding the occurrence of CVD events during follow-up. CVD was defined as major events including fatal/non-fatal myocardial infarction as well as fatal/non-fatal stroke, minor events including treated coronary heart disease (CHD), and established peripheral arterial disease (PAD). During four years of follow-up, 64 CVD events were observed (66% minor CVD events). Despite having a good calibration (estimated to observed ratio ranging from 91.37 to 98.2 percent, Hosmer–Lemeshow χ2 (HLχ2) values <15), both general (Framingham) and diabetes-specific (UKPDS and ADVANCE) equations did not have adequate discriminative ability (Area Under the Curve (AUC) ranging from 0.48 to 0.56). Framingham, UKPDS, and ADVANCE risk equations, regardless of being general or diabetes-specific, could not precisely predict 4-year risk of CVD in Iranian individuals with type 2 diabetes. https://acta.tums.ac.ir/index.php/acta/article/view/8535

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 59 10 2021 11 10 617 620 Mohsen Yaghubi Department of Extra-Corporeal Circulation (ECC), Razavi Hospital, Imam Reza International University, Mashhad, Iran Morteza Valaei Department of Internal Medicine, Razavi Hospital, Imam Reza International University, Mashhad, Iran Reza Ghasemi Department of Cardiology, 9 Dey Educational Hospital, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran. Mahmood Hosseinzadeh Maleki Department of Cardiac Surgery, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Sara Rezaei Department of Cardiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Samaneh Kakhki Department of Clinical Biochemistry, School of Paramedical Sciences, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran 2020 12 12 2021 08 10 Chlorine-containing bleach, as a common disinfectant, can cause mild to severe symptoms from nasal irritation to life-threatening conditions such as acute respiratory distress syndrome (ARDS). However, the toxicity level of chlorine gas depends on the duration and concentration of exposure. Herein, we describe the case of a 44-year-old man admitted to the emergency department with a chief complaint of severe shortness of breathing and hemoptysis following accidental, short-time exposure to chlorine-containing bleach. Because of the life-threatening condition, he was transferred to the Intensive Care Unit (ICU) and received mechanical ventilation along with a corticosteroid agent and antibiotic therapy. Despite limited data on management of the severe complications of the exposure, the patient successfully recovered after four days. https://acta.tums.ac.ir/index.php/acta/article/view/9015

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 59 10 2021 11 10 621 624 Goli Golpayegani Otorhinolaryngology research center, Imam Khomeini hospital complex, Tehran University of Medical Sciences Mehrdad Jafari Otorhinolaryngology Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Anita Karimi Shahid Beheshti Medical University, Tehran, Iran 2021 03 26 2021 08 10 Arhinia is an extremely rare condition reported in less than 100 cases so far. We report a case of arhinia with bilateral anophthalmia. In physical examination, only alar portions of the nose were partially formed. No septal, lower, upper lateral cartilages or nasal bones were detectable. Both nostrils were atretic. The orbital area was covered with skin and eyebrows were partially formed. Bilateral complete cleft lip and palate was evident. Surgical interventions should be considered not only for reconstruction of the external nose, but for timely creation of a lacrimal passage and repair of the accompanying cleft lip and palate. https://acta.tums.ac.ir/index.php/acta/article/view/9262

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 59 10 2021 11 10 625 628 Reza Bayat Department of Pediatrics, Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran Shahin Koohmanaee Department of Pediatrics, Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran Nejat Mahdie Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran Fatemeh Kharaee Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran Maryam Shahrokhi Department of Clinical Pharmacy, Faculty of Pharmacy, Guilan University of Medical Sciences, Rasht, Iran Afagh Hassanzadeh Rad Department of Pediatrics, Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran Saber Najafi Chakoosari Student Research Committee, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran Setila Dalili Department of Pediatrics, Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran Seyede Azade Hoseini Nouri Department of Pediatrics, Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran 2021 07 31 2021 09 08 Pyruvate carboxylase deficiency (PCD) is a rare autosomal recessive defect in a biotin-containing enzyme, Pyruvate carboxylase, which is considered as an enzyme of TCA-cycle regulation, gluconeogenesis, lipogenesis, and biosynthesis of neurotransmitters. Increased lactate to pyruvate ratio and decreased 3 hydroxybutyrate to acetoacetate are the main biochemical features of PCD. The elevated level of Citrulline, Proline, and Lysine with a short life span has been reported previously. Patients’ survival in almost all cases is below three months.  Here, the authors aimed to report a girl with manifestations of Type B of PCD and longer survival (two-year and four-month-old). This patient did not have any changes in amino acid level which was a unique case of Type B of PCD. https://acta.tums.ac.ir/index.php/acta/article/view/9573