Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 60 3 2022 03 14 135 143 Mostafa Shanbehzadeh Department of Health Information Technology, School of Paramedical, Ilam University of Medical Sciences, Ilam, Iran Raoof Nopour Department of Health Information Management, Student Research Committee, School of Health Management and Information Sciences Branch, Iran University of Medical Sciences, Tehran, Iran Hadi Kazemi-Arpanahi Department of Health Information Technology, Abadan University of Medical Sciences, Abadan, Iran. AND Department of Health Information Management, Student Research Committee, Abadan University of Medical Sciences, Abadan, Ir. 2020 10 01 2021 12 09 An outbreak of atypical pneumonia termed coronavirus disease 2019 (COVID-19) has spread worldwide since the beginning of 2020. It poses a significant threat to the global health and the economy. Physicians face ambiguity in their decision-making for COVID-19 diagnosis and treatment. In this respect, designing an intelligent system for early diagnosis of the disease is critical for mitigating virus spread and resource optimization. This study aimed to establish an artificial neural network (ANNs)-based clinical model to diagnose COVID-19. The retrospective dataset used in this study consisted of 400 COVID-19 case records (250 positives vs. 150 negatives) and 18 columns for the diagnostic features. The backpropagation technique was used to train a neural network. After designing multiple neural network configurations, the area under the receiver-operating characteristic curve (AUC), accuracy, sensitivity, and specificity values were calculated to measure the model performance. The two nested loops architecture of 9-10-15-2 (10 and 15 neurons used in layer one and layer two, respectively) with the ROC of 98.2%, sensitivity of 96.4%, specificity of 90.6%, and accuracy of 94 % were introduced as the best configuration model for COVID-19 diagnosis. ANN is valuable as a decision-support tool for clinicians to improve the COVID-19 diagnosis. It is promising to implement the ANN model to improve the accuracy and speed of the COVID-19 diagnosis for timely screening, treatment, and careful monitoring. Further studies are warranted for verifying and improving the current ANN model. https://acta.tums.ac.ir/index.php/acta/article/view/8833

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 60 3 2022 03 16 188 193 Aicha Ben Tekaya Department of Rheumatology, Charles Nicolle Hospital, Tunis, Tunisia . AND Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia Ons Hamdi Department of Rheumatology, Charles Nicolle Hospital, Tunis, Tunisia . ANDFaculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia Leila Rouached Department of Rheumatology, Charles Nicolle Hospital, Tunis, Tunisia. AND Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia Mehdi Bellil Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia . AND Department of Orthopedic, Charles Nicolle Hospital, Tunis, Tunisia Selma Bouden Department of Rheumatology, Charles Nicolle Hospital, Tunis, Tunisia. AND Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia Olfa Saidane Department of Rheumatology, Charles Nicolle Hospital, Tunis, Tunisia. AND Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia Rawdha Tekaya Department of Rheumatology, Charles Nicolle Hospital, Tunis, Tunisia. AND Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia Ines Mahmoud Department of Rheumatology, Charles Nicolle Hospital, Tunis, Tunisia. AND Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia Leila Abdelmoula Department of Rheumatology, Charles Nicolle Hospital, Tunis, Tunisia . AND Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia 2020 10 07 2021 12 09 Bone involvement in sarcoidosis is rare; its estimated prevalence ranges between 3 and 13%. Osseous lesions usually occur in the phalanges of the hands and feet. Involvement of the axial skeleton is more uncommon. Osseous involvement may be asymptomatic. It is often incidentally discovered on imaging modalities. Radiological techniques can reveal sclerotic and/or destructive lesions. We present a case of a 61-year-old woman in whom osseous sarcoidosis of the sacrum was revealed by back pain and sciatica. To our knowledge, only one isolated case of sacral sarcoidosis has been reported in the literature. Sarcoid bone lesions can be present at disease onset without pulmonary involvement. A biopsy is often required in order to eliminate other conditions, especially malignancy. Treatment is not specific and also not needed in a significant number of cases. https://acta.tums.ac.ir/index.php/acta/article/view/8852

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 60 3 2022 03 14 144 149 Reza Ghasemi Department of Cardiology, 9 Dey Educational Hospital, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran. Mohammad Vojdanparast Department of Cardiology, Atherosclerosis Prevention Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.. Mahmood Hosseinzadeh Maleki Department of Cardiac Surgery, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Mohsen Yaghubi Department of Extra-Corporeal Circulation (ECC), Razavi Hospital, Imam Reza International University, Mashhad, Iran 2020 10 20 2021 12 11 Early administration of thrombolytic agents is standard for patients presenting with acute myocardial infarction (MI). Also, prolonged QT intervals indicate a higher risk for sudden death in patients with MI. This study was conducted to evaluate the door to needle time of streptokinase administration and the incidence of life-threatening arrhythmia in patients with anterior MI. This study was a prospective, single-center study on participants with anterior MI, who were divided into streptokinase and non-streptokinase groups. After administration of streptokinase, QTc was measured in hyper-acute, acute, and recent phases of anterior MI in the group and compared with acute and recent phases in the non-streptokinase group. The incidence of life-threatening arrhythmia was measured and compared in two groups. The data were analyzed by descriptive statistics method and variance analysis in the SPSS software, version 22. The level of significance was considered to be 0.05. Among 87 participants, there was a significant relationship between the door to needle time of 30 minutes and QTc interval in the hyperacute phase (P=0.005). Also, QTc in the streptokinase group was significantly lower than the non-streptokinase group in the acute phase (P=0.003 vs. P=0.205) and recent phase (P=0.007 vs. P=0.228). The incidence of fatal arrhythmias in the streptokinase group was lower than in the others. The relationship between the incidence of VT/VF and TIMI flow grade was insignificant (P=0.089). Reduction of the door to needle time after anterior MI has significant effects on QTc and incidence of threatening arrhythmia. https://acta.tums.ac.ir/index.php/acta/article/view/8882

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 60 3 2022 03 16 194 197 Rahim Raoufi Department of Infectious Disease, Jahrom University of Medical Sciences, Jahrom, Iran Zahra Jafarzadeh Jahromi Student Research Committee, Jahrom University of Medical Sciences, Jahrom, Iran Fatemeh Razmjoei Student Research Committee, Jahrom University of Medical Sciences, Jahrom, Iran Navid Kalani Research Center for Social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran 2021 05 16 2021 12 10 Coronavirus Disease 2019 was initially identified as an infection of the lower respiratory tract but has so far manifested itself with very different symptoms. One of these symptoms is skin lesions associated with an active viral infection that can occur from the onset of infection until treatment. Therefore, observing these skin manifestations can be helpful in diagnosing and managing the disease. Our case is a 56-year-old man who came to the infectious clinic with a chief complaint of skin rashes. The patient was in good general condition on arrival and had no evidence of systemic symptoms of infection, such as fever, body aches, and cough. However, the PCR test for COVID-19 was positive. Although many dermatological findings have been reported with Coronavirus Disease, this case has reported with no symptoms other than skin manifestations that describe a viral infection. It seems that this disease can cause unexpected symptoms, even in mild cases. Therefore, it is better to have the COVID-19 in the corner of your mind when examining people with these symptoms.   https://acta.tums.ac.ir/index.php/acta/article/view/9401

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 60 3 2022 03 14 150 155 Masoomeh Nataj Majd Department of Anesthesiology, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran. Maryam Farid Mojtahedi Department of Obstetrics and Gynecology, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran. Arman Taheri Department of Anesthesiology and Pain, Imam Khomeini Medical Center, Tehran University of Medical Sciences, Tehran, Iran. Mehdi Sanatkar Department of Anesthesiology and Pain, Farabi Hospital, Tehran University of Medical Sciences, Tehran, Iran Nader Ali Nazemian Yazdi Department of Anesthesiology, Amir A’lam Hospital, Tehran University of Medical Sciences, Tehran, Iran 2021 11 21 2021 12 26 Epidural analgesia (EA) is one of the best pain relief for many pregnant women in labor. This study was conducted to evaluate the effect of epidural analgesia provided by a combination of bupivacaine plus meperidine or fentanyl on the mother, fetus, and labor process in term nulliparous women. A total of 558 nulliparous women were randomized into two groups of 279 subjects. The BF (Bupivacaine-Fentanyl) group received 16 ml bupivacaine 0.125% plus 50 mg fentanyl as a loading dose; then, an intermittent bolus of the same solution was administered once the patient requested analgesia. The BM (Bupivacaine-Meperidine) group received a loading dose of 16 ml bupivacaine 0.125% plus 20 mg meperidine followed by an intermittent bolus of the same solution if the patient requested analgesia. The time of labor phases 1 and 2 and the incidence of side effects were recorded. After the intervention, the pain score was significantly lower in the meperidine group compared to the fentanyl group during labor (P=0.006). The duration of the active phase of labor (P=0.04) and the rate of cesarean section (P=0.01) were significantly higher in the fentanyl group compared to the meperidine group. The duration of the second stage of labor was not significantly different between the two groups (P=0.24). Apgar score was significantly higher in the meperidine group. This study found that epidural meperidine could be a suitable alternative to fentanyl for improving pain relief and shortening the active phase of delivery without increasing the risk of the neonatal low Apgar score. https://acta.tums.ac.ir/index.php/acta/article/view/9801

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 60 3 2022 03 16 198 201 Farah Ashrafzadeh Department of Pediatrics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Mahla Esmaeilzadeh Student Research Committee (SRC), School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Javad Mohammadi Asl Department of Medical Genetics, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Narges Hashemi Department of Pediatrics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Shima Imannezhad Department of Pediatrics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, . Nazanin Saeedi Zand Department of Pediatrics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Hanieh Sadat Mirzadeh Department of Pediatrics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran 2020 10 26 2021 12 11 Cerebral dysgenesis, neuropathy, ichthyosis, and keratoderma (CEDNIK) syndrome is an autosomal recessive neuro-cutaneous disorder characterized by a collection of clinical manifestations, including microcephaly, cerebral dysgenesis, palmoplantar keratoderma, facial dysmorphism, and ichthyosis. The etiology of this condition has been proved to be a homozygous mutation in the SNAP29 gene, which has an essential role in dermatological and neurological manifestations of this syndrome. In this report, we present the first documented Iranian patient with CEDNIK syndrome. So far, only 14 cases of this condition have been reported globally.   https://acta.tums.ac.ir/index.php/acta/article/view/8893

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 60 3 2022 03 14 156 164 Elham Roshandel Hematopoietic Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.. Mohsen Hamidpour Hematopoietic Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. AND Department of Medical Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Haniyeh Ghaffari Nazari Hematopoietic Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Shayan Zamani Students’ Scientific Research Center, School of Medicine, Tehran University of Medical ScienceirstName> Moradi Firoozgar Development Research Center (FDRC), Iran University of Medical Sciences, Tehran, Iran Mahdi Alemrajabi Firoozgar Development Research Center (FDRC), Iran University of Medical Sciences, Tehran, Iran. Fereidoon Memari Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran. 2020 07 07 2021 02 28  Lower gastrointestinal cancer patients, like other immunosuppressed patients, are vulnerable to develop more severe infections. Iran is one of the countries with a high incidence of COVID-19, and some modifications are needed to adjust international protocols to deal with this pandemic. Therefore, our cancer institute has implemented some changes in the current treatment guidelines. In each specialty, all members agreed to choose the minimal intervention. The members know that some recommendations may interfere with the routine best-practice recommendations and decrease the quality measures in the patient's outcome. Therefore, these recommendations are valid just in the epidemic COVID-19 situation in the country. According to the consensus of colorectal and cancer surgery professors, if a patient is a new case of rectal cancer, he or she should be referred to undergo neoadjuvant chemoradiotherapy. But if the patient comes eight to twelve weeks after receiving chemoradiotherapy in accordance with the COVID-19 epidemic phase, it may be possible to delay surgery. A stent can be implanted in a patient with rectal cancer who presents with obstructive symptoms, and surgery can be postponed until resolving the crisis of the COVID-19 epidemic or its downward trend. For colon cancer, we will request a thoracic spiral CT scan. If there was no evidence of pulmonary involvement with COVID-19, the patient would undergo open surgery considering the patient's health and protection tips. https://acta.tums.ac.ir/index.php/acta/article/view/8612

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 59 5 2021 07 05 298 307 Azam Tavakkoli Far Anesthesiology and Intensive Care Ward, Emam Khomeini Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran Naser Yeganeh Anesthesiology and Intensive Care Ward, Emam Khomeini Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran Mansour Choubsaz Anesthesiology and Intensive Care Ward, Emam Khomeini Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran Afshin Almasi Research Center of Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran 2020 05 11 2021 01 25 In order to induce sedation during cataract surgery, various medications with different side effects are used in separation or in combination. Dexmedetomidine has no effect on the respiratory system, but being dependent on dosage, it may cause cardiovascular disorders. The present study aims to compare the hemodynamic and sedative effects of dexmedetomidine and the combination of sufentanil-midazolam on patients undergoing cataract surgery. In a randomized clinical trial study, 60 patients were randomly divided into two dexmedetomidine and sufentanil-midazolam groups. In sufentanil-midazolam group, dexmedetomidine (DEX infusion at 0.5 μg/ kg for 10  minutes, then adjusted to 0.2 µg/kg/h) was prescribed. In the sufentanil-midazolam group, sufentanil (0.1 μg/kg for 5 minutes) and midazolam (0.2 µg/kg) were injected five minutes before the operation. Hemodynamic variables (Systolic blood pressure, diastolic blood pressure, heart rate), complications (nausea, vomiting, hypoxia), sedation level, and pain intensity were recorded (at the beginning of the study, 5, 10 minutes after anesthesia, at the start of surgery, 5, 10, 15 minutes after the surgery) as well as patient’s satisfaction, surgeon's satisfaction, and complications. Results suggest that apart from gender, other primary characteristics of patients, including age, history of blood pressure, diabetes history, ASA score, mean of systolic, diastolic blood pressure, heart rate, and SPO2 levels, were similar in both groups (P>0.05). Systolic blood pressure patients receiving dexmedetomidine declined significantly more than that of patients receiving sufentanil-midazolam (P>0.5). Diastolic blood pressure suddenly fell 5 minutes after the infusion of sufentanil-midazolam (P>0.05), but then a relative increase and finally a relative decrease occurred, while diastolic blood pressure in patients receiving dexmedetomidine decreased steadily. The mean heart rate in patients receiving dexmedetomidine and sufentanil-midazolam declined gently (P>0.05). SPO2 was reduced significantly in the sufentanil-midazolam group (P<0.05). Drugs used in both groups reduced pain intensity equally (P>0.05). From the beginning of the study, dexmedetomidine produced a relatively stable sedation level (score 2) based on Ramsay's criteria, while the combination of sufentanil-midazolam-medications causes deeper sedation (score 3) in patients (P<0.05). Despite this fact, 23.33% of the patient receiving sufentanil-midazolam could have movements during the surgery, which was 6.66% higher in patients receiving dexmedetomidine (P=0.071). The satisfaction of patients receiving dexmedetomidine was significantly higher (P=0.044), while the surgeon's satisfaction was almost identical in both anesthesia procedures (P=0.94). In the end, the results of the present study showed that although dexmedetomidine is associated with few respiratory problems and higher satisfaction of patients, it decreases blood pressure and heart rate progressively. However, it seems that this medicine is more effective than a combination of midazolam-sufentanil because of more patient satisfaction, lack of hypoxia, fewer complications, and more suitable immobility.   https://acta.tums.ac.ir/index.php/acta/article/view/8464

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 59 5 2021 07 05 253 258 Majid Maleki Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran Freidoun Noohi Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Parham Sadeghipour Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran Mohammad Mehdi Peighambari Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran Ahmad Amin Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran Niloufar Samiee Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran Majid Haghjoo Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran Nahid Rezaeian Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran Saeedeh Mazloomzadeh Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran Elaheh Baghizadeh Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran Farnaz Rafiee Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran Behshid Ghadrdoost Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran 2020 05 11 2021 02 18 Most of the information on the natural history and management of cardiomyopathies and myocarditis in Iran has been obtained from cohort studies in a small number of patients. The prevalence of patients with cardiomyopathies referred to Rajaei Cardiovascular medical and research centers from all over the country is remarkable. Rajaie Cardiomyopathy and myocarditis Registry (RCMR) study is an observational registry of patients with four subtype of cardiomyopathy include: hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM), arrhythmogenic right ventricular cardiomyopathy (ARVC), and restrictive cardiomyopathy (RCM) as well as myocarditis designed to determine clinical characteristics, natural history, current therapeutic approaches, response to treatment and long-term outcomes of patients with cardiomyopathy and myocarditis. Prediction of mortality and response to different treatments in these patients using artificial intelligence is another aim of this Registry. COVID 19 Myocarditis and its sequence as cardiomyopathy seem a new challenge in forthcoming years. At the baseline visit, past medical history, clinical signs/symptoms, risk factors, physical examination and family history of cardiomyopathy, current standards for diagnostic workup and clinical follow-up, and relevant electrocardiogram echocardiography, cardiac magnetic resonance, Holter monitoring, or biomarker analyses will be checked. The outcome and results of various therapeutic approaches currently employed for patients, including implantable cardioverter defibrillator, cardiac resynchronization therapy, septal myomectomy, ablation, cardiac transplantation, and medications, will be assessed. Long-term outcomes, including the benefits and complications of thera