Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 59 12 2021 12 15 687 698 Elham Behrangi Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), Iran University of Medical Sciences, Tehran, Iran Mohammadreza Ghassemi Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), Iran University of Medical Sciences, Tehran, Iran Afsaneh Sadeghzadeh-Bazargan Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), Iran University of Medical Sciences, Tehran, Iran Masoumeh Roohaninasab Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), Iran University of Medical Sciences, Tehran, Iran Niloufar Najar Nobari Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), Iran University of Medical Sciences, Tehran, Iran. Azadeh Goodarzi Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), Iran University of Medical Sciences, Tehran, Iran 2021 01 13 2021 08 09 Coronavirus could affect almost any part of the body including the skin. In this systematic review, the primary skin lesions resulting from the direct activity of the virus or the medications used for treatment and the changes in the behavior of the virus regarding the occurrence of these symptoms over time were assessed. PubMed/MEDLINE, Embase, PsycINFO, TRIP Cochrane, Cochrane Skin were searched for all published articles from February 19 to July 1, 2020, which met the inclusion criteria. Thirty-six related articles were extracted. Twenty-eight studies reported virus-related mucocutaneous eruptions and 8 articles, the drug-reactions. Data of 583 patients were included. Skin lesions of COVID-19 could be caused by both the virus itself or the influence of drugs used for the treatment. Morbilliform rashes, urticaria, and acral-vasculopathic cutaneous lesions were at the forefront of primary COVID-dependent skin lesions with no significant change during time, Also, Hydroxychloroquine, lopinavir/ritonavir, paracetamol, and antibiotics were reported as the main causes of drug-induced rashes. Since dermatologic manifestations may occur prior or simultaneously/after other COVID clinical symptoms, so they may helpful in patients’ early diagnosis or prediction of internal organ involvements via histopathologic evaluations of skin biopsies especially about vasculopathic and vasculitic, respectively. https://acta.tums.ac.ir/index.php/acta/article/view/9089

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 59 12 2021 12 15 699 703 Hossein Hemmati Department of Vascular Surgery, Razi Clinical Research Development Unit, Guilan University of Medical Sciences, Rasht, Iran Behrang Motamed Department of Internal Medicine, Razi Clinical Research Development Unit, Guilan University of Medical Sciences, Rasht, Iran Mehdi Pursafar Department of General Surgery, Razi Clinical Research Development Unit, Guilan University of Medical Sciences, Rasht, Iran Mohaya Farzin Department of Physiology, Razi Clinical Research Development Unit, Guilan University of Medical Sciences, Rasht, Iran Zakiyeh Jafaryparvar School of Nursing and Midwifery, Nursing and Midwifery Care Research Center, Tehran University of Medical Sciences, Tehran, Iran Mohammad Sadegh Esmaeili Delshad Department of Vascular Surgery, Razi Clinical Research Development Unit, Guilan University of Medical Sciences, Rasht, Iran Pirooz Samidoost Department of General Surgery, Razi Clinical Research Development Unit, Guilan University of Medical Sciences, Rasht, Iran Elahe Rafiei Razi Clinical Research Development Unit, Guilan University of Medical Sciences, Rasht, Iran Soudabeh Bahush Razi Clinical Research Development Unit, Guilan University of Medical Sciences, Rasht, Iran 2021 02 16 2021 08 10 Vitamin D plays a crucial role in calcium metabolism through the parathormone-dependent process. The deficiency of this important nutrient may be associated with hypocalcemia after thyroidectomy. To evaluate the role of vitamin D in predicting hypocalcemia following total thyroidectomy. In this study, sixty-two patients who underwent total thyroidectomy for benign or malignant thyroid disease were included in this prospective study. Preoperative vitamin D serum levels and parathormone (PTH) levels were determined. The association between preoperative vitamin D status and the development of hypocalcemia was investigated. In this study, 62 patients were evaluated. The mean age of the subjects was 47 years. Of the 62 patients studied, of which 9 were male patients (14.5%), and 53 were female (85.5%), the results of our study showed. In both groups with and without vitamin D deficiency, calcium levels decreased significantly (P=0.01). In our study, it was found that there was no significant relationship between postoperative hypocalcemia and vitamin D deficiency. (P=0.441). After reviewing the data and according to Spearman correlation statistical test, no significant relationship was observed between serum parathyroid hormone (PTH) and calcium after thyroidectomy (P=0.340). Vitamin D deficiency is a risk factor of hypocalcemia after total thyroidectomy for benign goiter. Although post thyroidectomy hypocalcemia is multifactorial, vitamin D deficiency, particularly severe form, is significantly associated with the development of biochemical and clinical hypocalcemia. Vitamin D supplementation can prevent this unwanted complication in such patients. https://acta.tums.ac.ir/index.php/acta/article/view/9167

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 59 12 2021 12 15 704 712 Mahan Shafie School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. AND NeuroTRACT Association, Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Ira. Mahsa Mayeli School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. AND NeuroTRACT Association, Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran. Hamed Hosseini School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Mahnaz Ashoorkhani Department of Health Promotion and Education, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. AND Community Based Participatory Research Center, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran. 2021 02 23 2021 08 23 COVID-19 pandemic obligated applying population-level behavioral modifications to effectively prevent the spread of the disease. This necessitated investigating those measures that determine population behavior. Herein we have studied risk perception and information exposure that are among those determinants in Iran. 402 cases from medical sciences students were enrolled during the last week of September 2020. Using an online questionnaire, risk perception and sources of information about COVID-19 were investigated. Although most students considered COVID-19 preventable, merely a few considered the disease curable. A higher risk was perceived concerning the families compared to themselves. Moreover, most of them believed the prognosis good even in high-risk patients. Social media was the most informative source used; however, health professionals were considered the most reliable. The risk perception was equal between those diagnosed with COVID-19 or had a family member diagnosed compared to those without such exposure in most questions. Also, no significant difference was observed in risk perception between those students with serious underlying medical conditions and those without one regarding most items. Lastly, major and grade were the most significant demographic contributors to the risk perception. Moderate risk was perceived overall among the cases in which major and grade were the only remarkable demographic contributors. Unexpectedly, underlying medical history was not significantly correlated with the perceived risk. Lastly, previous COVID-19 exposure merely altered the curability and preventability perception. https://acta.tums.ac.ir/index.php/acta/article/view/9195

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 59 12 2021 12 15 713 719 Ebrahim Hassani Department of Anesthesiology, Clinical Research Development Unit, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran Nazli Karami Department of Anesthesiology, Clinical Research Development Unit, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran. Asma Hassani Department of Anesthesiology, Seyyed-al Shohada University Hospital, Urmia University of Medical Sciences, Urmia, Iran. Leila Hassani Department of Anesthesiology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran. Veghar Ashraf Department of Anesthesiology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran. 2021 05 09 2021 08 10 Nausea and vomiting are common complications in women undergoing cesarean section with spinal anesthesia. This study aimed to compare the propofol, dexamethasone, and ondansetron effects on nausea and vomiting. In this double-blind randomized clinical trial study, 120 women aged 15 to 35 years candidates for cesarean section under spinal anesthesia were enrolled. Patients were randomly divided into four groups (three-drug groups and the control group). Patients received 0.05 mg /kg ondansetron (group O), 0.1 mg /kg dexamethasone (group D), 0.2 mg/kg propofol (group P) and normal saline in controls (group C). Nausea and vomiting in recovery and 6 hours after surgery compared between groups. In recovery and 6 hours after surgery, both nausea and vomiting were the highest in group C while they were lowest in group O. the frequency of nausea was 11(36.7%) in both recovery and 6 hours after surgery and the frequency of vomiting was 12(40%) and 10(33.3%) in the recovery and 6 hours after surgery respectively. Among the three drug groups, nausea and vomiting were higher in group D in both recovery rooms and 6 hours after surgery.  The frequency of vomiting was 10 (33.3%) and 5 (16.7%) in recovery and 6 hours after surgery in group D respectively. these differences were statistically significant between the four groups (p<0.05). The preventive effect of dexamethasone is not very useful in both periods. Therefore, it can be recommended that in the short period after surgery, propofol has a beneficial effect in preventing postoperative nausea and vomiting. https://acta.tums.ac.ir/index.php/acta/article/view/9386

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 59 12 2021 12 15 720 725 Fateme Zahra Karimi Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran Leila Pourali Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Elahe Hasanzadeh Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. Seyede Fateme Nosrati School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran. Nasim Pouresmaeili School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran Mahbubeh Abdollahi Department of Public Health, Torbat Heydarieh University of Medical Sciences, Torbat Heydarieh, Iran 2020 07 06 2021 11 08 Nowadays, women have a longer menopausal duration due to the worldwide dramatic life expectancy increase. Sexual dysfunction is one of the most prevalent problems during menopause that affect women`s quality of life, mental health, and interpersonal relationship. This study aimed to investigate sexual dysfunction and its contributing factors amongst married postmenopausal women. This cross-sectional study was conducted among 164 postmenopausal women who attended the menopause clinic of the academic hospitals in Mashhad during 2017-2018. Data were collected using a checklist that included demographic and reproductive information and the validated Persian version of the Female Sexual Function Index questionnaire (FSFI). The mean age of participants was 53.55±6.25 years. The mean FSFI score was 20.06±6.66, and 65.2% of women had sexual dysfunction. The most disturbed sexual domains were; desire (86%, n: 141), arousal (82.3%, n: 135), lubrication (71.3%, n: 117) and sexual satisfaction (70.1%, n: 115), respectively. The partner`s age (P=0.01), time since menopause onset (P=0.01), age at marriage (P=0.02), and frequency of sexual intercourse (P˂0.0001) had a significant relationship with sexual function. The sexual function of postmenopausal women in this study was highly deteriorated. The associated factors were; older age of the spouse, younger age at marriage, longer time since menopause onset, and lower frequency of sexual intercourse. It is important to determine perimenopausal women who are at potential risk of sexual dysfunction and consult them for preventive programs and strategies.   https://acta.tums.ac.ir/index.php/acta/article/view/8607

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 59 12 2021 12 15 726 732 Alireza Jahangirifard Lung transplant Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran. Ashkan Omidi School of Medicine, Tehran Medical Branch, Islamic Azad University, Tehran, Iran Kurdistan Sharifzadeh Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Seysd Bashir Mirtajani Lung Transplant Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran. Farzad Peyravian School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Saeid Safari Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Maedeh Sadat Jafarzadeh Critical Care Quality Improvement Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Seyed Hadi Mirhashemi Department of General Surgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Behrooz Farzanegan Critical Care Quality Improvement Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2021 07 05 2021 08 09 The severity of COVID-19 disease and its mortality may be due to a localized vascular problem owing to the activation of bradykinin B1 receptors on endothelial cells in the lungs that occur following inflammation. Bromelain acts as an anti-inflammatory factor and can lower the level of bradykinin in the serum and tissues. Patients with the novel coronavirus (COVID-19) referred to Masih Daneshvari Hospital in Tehran were included in the study after providing full explanations and obtaining written consent. The 40 patients with mild to moderate symptoms were randomly divided into the control group (No: 20) and sample (No: 20). In the sample group, a dose of 200 mg bromelain was given to patients every 8 hours. In the control group, placebo capsules were administered exactly at the above intervals. Clinical and paraclinical factors (including SaO2, RR body temperature, MAP, HR, CRP, ESR, AST, ALT, Bil, BUN, Cr, WBC, Lymph, LDH, Plt were evaluated on a regular basis for up to five days. The results were evaluated using t-test and SPSS21 software. After treatment, the sample (Bromelain) group indicated significant improvement in SaO2, RR, HR, AST, ALT, BUN, ESR, LDH, and WBC and Lymphocyte count (P<0.05). Other factors did not have a significant difference with the control group. Bromelain causes improvement in some clinical symptoms such as respiratory parameters and para clinical items of mild to moderate hospitalized COVID-19 patients, so it can be a promising treatment. Furthered evaluation of larger groups is recommended. https://acta.tums.ac.ir/index.php/acta/article/view/9514

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 59 12 2021 12 15 733 739 Saeid Emamdost Department of Exercise Physiology, Ayatollah Amoli Branch, Islamic Azad University, Amol, Iran Asieh Abbassi Daloii Department of Exercise Physiology, Ayatollah Amoli Branch, Islamic Azad University, Amol, Iran Alireza Barari 1 Department of Exercise Physiology, Ayatollah Amoli Branch, Islamic Azad University, Amol, Iran Ayoub Saeidi Department of Physical Education, Damghan Branch, Islamic Azad University, Damghan, Iran 2021 10 26 2021 11 15 Obesity and associated chronic inflammation lead to insulin resistance. The aim of this study was to evaluate the effect of varying intensity circuit resistance training on metabolic and inflammatory markers in obese men. In a semi-experimental trial, 44 obese men were selected and randomly divided into four groups, including 1) Control (n=11), 2) Low-intensity circuit resistance training (n=11), 3) Moderate-intensity circuit resistance training (n=11), and 4) High-intensity circuit resistance training (n=11). Resistance training was performed at different intensities, including 1) High-intensity circuit resistance training (80% 1RM), 2) Moderate-intensity circuit resistance (60% 1RM), and 3) Low-intensity circuit resistance training (40% 1RM), three sessions per week for 12 weeks. Serum levels of Dectin-1, TLR2, TLR4, MyD88 were measured using an ELISA kit. Data were analyzed with covariance analysis at P<0.05. Twelve weeks of moderate and high-intensity circuit resistance training significantly reduced weight, body mass index, serum levels of Dectin-1, TLR2, TLR4, MyD88, and HOMA-IR (P=0.001). The reduction of weight, body mass index, serum levels of Dectin-1, TLR2, TLR4, MyD88, and HOMA-IR were significant in obese men in the high-intensity training group compared to low-intensity training (P=0.001). It seems that circuit resistance training, especially high-intensity circuit resistance training, can be used as an option to reduce the inflammatory and metabolic complications associated with obesity.   https://acta.tums.ac.ir/index.php/acta/article/view/9746

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 59 12 2021 12 15 740 742 Mahya Shabani Students' Research Committee, Tehran University of Medical Sciences, Tehran, Iran Besharat Rahimi Advanced Thoracic Research Center, Tehran University of Medical Sciences, Tehran, Iran Mohammad Mehdi Mehrabi Nejad Department of Radiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. AND Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Reza Erfanian Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Arezoo Najafi Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran 2021 01 02 2021 08 23 Coronavirus infectious disease 2019 (COVID-19) is confirmed to develop neurocognitive complications. In the present paper, we describe two patients with laboratory-confirmed COVID-19 and excessive daytime sleepiness. In the present study, we reported two laboratory-confirmed cases of COVID-19 with excessive daytime sleepiness. Patients had drowsiness and mild confusion on presentation. In both cases, CNS infections, including meningitis and encephalitis, were ruled out. Both patients’ symptoms remarkably improved following the therapeutic course indicating the direct effect of SARS-CoV2 in sleep modulating centers on the brain. COVID-19 should be considered in patients with excessive daytime sleepiness and drowsiness in the current outbreak. https://acta.tums.ac.ir/index.php/acta/article/view/9057

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 59 12 2021 12 15 743 746 Houman Hashemian Department of Pediatrics, Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran. Yasaman Ashjari Department of Pediatrics, Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran. Esfandiar Nazari Department of Pediatrics, Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran 2020 07 17 2021 11 08 Kawasaki disease (KD) is the most common cause of acquired heart disease today. An important and enduring complication of KD is coronary aneurysm whose early diagnosis and treatment can reduce the risk from 25% to 3%. Diagnosis of this disease is mainly clinical, although leukocytosis, increased erythrocyte sedimentation rate, and echocardiography are helpful in diagnosis. The cause of KD remains unknown, but the most common hypothesis is an abnormal immune response that is likely caused by an infectious agent, possibly in a favorable genetic background and leads to vasculitis of the middle arteries especially, coronary arteries of the heart. Numerous infectious agents have been suggested in this regard. Co-infection with KD can also delay diagnosis. In this article, we introduce a 5 years and 7 months child who developed Kawasaki disease within a few days of the onset of Epstein-Barr virus infection. https://acta.tums.ac.ir/index.php/acta/article/view/8637

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 59 12 2021 12 15 747 750 Minoosh Moghimi Department of Medical Hematology and Oncology, Vali-e-Asr Hospital, Zanjan University of Medical Sciences, Zanjan, Iran. AND School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran Samad Ghodrati School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran. AND Department of Pulmonology, Vali-e-Asr Hospital, Zanjan University of Medical Sciences, Zanjan, Iran Zahra Abbaspourrad School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran. AND Zanjan Metabolic Diseases Research Center, Zanjan University of Medical Sciences, Zanjan, Iran. Amirhossein Moghtader Mojhdehi School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran. AND Department of Infectious Diseases, Vali-e-Asr Hospital, Zanjan University of Medical Sciences, Zanjan, Iran Sattar Jafari School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran. AND Department of Gastroenterology, Vali-e-Asr Hospital, Zanjan University of Medical Sciences, Zanjan, Iran Reza Mansouri Department of Medical Hematology and Oncology, Vali-e-Asr Hospital, Zanjan University of Medical Sciences, Zanjan, Iran. AND School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran. Kasra Khodadadi Department of Medical Hematology and Oncology, Vali-e-Asr Hospital, Zanjan University of Medical Sciences, Zanjan, Iran. AND School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran. ANDDepartment of Internal Medicine, Vali-e-Asr Hospital, Zanjan University of Medical Sciences, Zanjan, Iran Muhammmad Javad Muhammmadi Department of Medical Hematology and Oncology, Vali-e-Asr Hospital, Zanjan University of Medical Sciences, Zanjan, Iran . AND School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran. Negin Parsamanesh Zanjan Metabolic Diseases Research Center, Zanjan University of Medical Sciences, Zanjan, Iran 2021 02 20 2021 08 10 The novel corona virus infection involve both Central & Peripheral Nervous System. Some of the presentations include: acute cerebrovascular disease, impaired consciousness, transverse myelitis, encephalopathy, encephalitis and epilepsy. Our patient was 78 year –old man with dementia and diabetic nephropathy which was admitted two times for possibly COVID-19 infection. At the first hospitalization, the patient is treated with hydroxychloroquine and kaletra based on clinical symptoms and initial laboratory findings due to suspicion of COVID-19. After the negative RT-PCR test of nasopharyngeal sample for COVID-19 and evidence of aspiration pneumonia in CT scan, the patient was discharged with oral antibiotics. Five weeks later, he was rehospitalized with loss of consciousness, fever and hypoxemia in physical exam he had neck stiffness in all directions, So the central nervous system (CNS) infection was suspected, the cerebrospinal fluid (CSF) sample was in favor of aseptic meningitis and second RT-PCR test of nasopharyngeal sample for COVID-19 was positive but Brain MRI just showed small vessel disease without evidence of encephalitis. In the second hospitalization, he had acute renal failure, which was treated with supportive care, and also suffered from pulmonary embolism with cavitary lesions in his lungs. Meningitis with pulmonary embolism and acute renal failure have not yet reported. Our patient is the first one, so we decided to share it. This case showed different presentation of COVID-19 without typical lung involvement. So we must pay attention to any sign & symptoms in a patient suspected of having a COVID-19. https://acta.tums.ac.ir/index.php/acta/article/view/9180