Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 60 5 2022 06 08 259 269 Ali Garavand Department of Health Information Technology, School of Allied Medical Sciences, Lorestan University of Medical Sciences, Khorramabad, Iran Mahnaz Samadbeik Department of Health Information Technology, Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran. Nasim Aslani Department of Health Information Technology, School of Allied Medical Sciences, Lorestan University of Medical Sciences, Khorramabad, Iran. 2021 08 19 2021 12 31 Multiple Sclerosis (MS) is a common chronic disease that affects society, especially young people. In recent years, data sciences have been used extensively to deal with the disease. Machine learning is one of the main data sciences types which has been used to deal with chronic diseases such as MS. This study aimed to identify the applications of machine learning algorithms in MS disease. This study is a systematic review that conducted in 2020. The searches were done in PubMed, Scopus, ISI Web of Sciences, Ovid, Science Direct, Embase, and Proquest scientific databases, by combining related keywords. Data extraction was done by using a data extraction form to follow the trends of this field of study. The results of the study showed that diagnosis of MS was the main application of machine learning in MS (33.3 %); also, assessment (24.24%) and prediction (18.18 %) of the disease were other main applications. The most used data type was medical images such as MRI and CT scans (55.17 %). The most used machine learning algorithm type was Support Vector Machine (SVM) (30 %) as a classification algorithm. The most optimized algorithm for the diagnosis and prediction of MS was KNN. It’s suggested to use machine learning algorithms to diagnose, assess, predict lesion classification, treatment, and severity determining of MS disease. Although the most common form of data used for MS is medical images, it is suggested that other types of data are generated to be used in machine learning algorithms. Considering the optimization rate of the algorithms used, it is suggested to pay more attention to the type of data and study objectives in data analysis using machine learning. https://acta.tums.ac.ir/index.php/acta/article/view/9604

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 60 5 2022 06 08 270 274 Mansour Salesi Department of Internal Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Sara Hosseinpoor Department of Internal Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran 2020 10 20 2021 12 11 Fibromyalgia (FM) is a chronic musculoskeletal syndrome characterized by pain and fatigue; however, its etiology remains unknown, and various hypotheses and biomarkers have been proposed. This study it is aimed to investigate blood biomarkers in the pathogenesis of FM. The current case-control study has been conducted on 45 females with the documented diagnosis of FM and 45 healthy controls referring to the outpatient clinic of rheumatology in 2018-19. The serum levels of dehydroepiandrosterone (DHEAS), erythrocytic sedimentation rate (ESR), C-reactive protein (CRP), complete blood count (CBC), and thyroid-stimulating hormone (TSH) was measured and compared between the groups. DHEAS serum levels in cases and controls were 27.55±18.80 and 33.55±21.80, (P=0.16), ESR was 29.17±9.75 and 17.37±2.82 (P<0.001), CRP was 4.17±1.53 and 3.53±1.15 (P=0.02), TSH was 3.307±0.27 and 3.41±0.22 (P=0.09), respectively. The two groups were similar in CBC indices, including hemoglobin, hematocrit, white blood cell, lymphocyte, neutrophil, and platelet count (P>0.05). DHEAS was slightly, but insignificantly, lower among the females with FM than healthy cases. On the other hand, the serum ESR and CRP levels were remarkably higher among the females with FM; however, in the normal range, a fact representing the possible traces of inflammation in the pathogenesis of FM. https://acta.tums.ac.ir/index.php/acta/article/view/8885

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 60 5 2022 06 08 275 282 EN Kavous Shahsavarinia Tuberculosis and Lung Research Center, Tabriz University of Medical Sciences, Tabriz, Iran Neda Moghadasian Niaki Tuberculosis and Lung Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Ali Taghizadieh Tuberculosis and Lung Research Center, Tabriz University of Medical Sciences, Tabriz, Iran Peyman Habibi Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran Ahmad Separham Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran Neda Gilani Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran Neda Dolatkhah Physical Medicine and Rehabilitation Research Center, Tabriz University of Medical Sciences, Tabriz, Iran 2021 08 11 2021 12 28 Acute exacerbations are the important reasons for hospitalization and death in chronic obstructive pulmonary disease (COPD) patients. We aimed to evaluate the relationship between serum concentrations of cardiac troponin I (cTnI) and the outcome of COPD patients visiting the emergency department with acute exacerbation of COPD (AECOPD). In this study, we included 90 AECOPD patients between October 2018 and October 2019. Serum cTnI was measured during the first 24 and 48 hours after admission. Patients were categorized into two groups positive cTnI values (≥0.3 ng/dl) and negative cTnI (<0.3 ng/dl). The outcomes of patients were compared between the two groups. Patients in Positive cTnI group in the first 24 hours and 48 hours compared to patients in negative group had significantly higher rate of in-hospital [(66.7% vs. 3.7%, P<0.001) and (50.0% vs. 3.8%, P<0.001), respectively)] and 30-day mortality rates [(88.9% vs. 3.3%, P<0.001) and (66.7% vs. 5.1%, P<0.001), respectively)]. The number of cases requiring intubation [(100% vs. 12.3%, P<0.001) and (75.0% vs. 12.8%, P<0.001), respectively)] and cardiopulmonary resuscitation (CPR) [(100.0% vs. 5.5%, P<0.05) and (100.0% vs. 5.5%, P<0.001), respectively)] as well as the duration of intensive care unit (ICU) stay [(37.00±14.61 vs 9.83±4.93 days, P<0.001) and (37.00±14.61 vs 9.83±4.93 days, P<0.001), respectively)] were also higher in cTnI positive patients. Increased cTnI during AECOPD is associated with higher rates of CPR, need for mechanical ventilation and in-hospital, short-term mortalities, and a longer ICU stay. https://acta.tums.ac.ir/index.php/acta/article/view/9590

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 60 5 2022 06 08 283 292 Rawdha 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. AND Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia Ines Jemmali Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia . AND Department of Biochemistry, Charles Nicolle Hospital, Tunis, Tunisia Aicha Ben Tekaya Department of Rheumatology, Charles Nicolle Hospital, Tunis, Tunisia 2 Faculty 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. Olfa Saidane Department of Rheumatology, Charles Nicolle Hospital, Tunis, Tunisia, AND Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia Selma Bouden Department of Rheumatology, Charles Nicolle Hospital, Tunis, Tunisia. AND Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia Kahena Bouzid Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia . AND Department of Biochemistry, Charles Nicolle Hospital, 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 Fatigue is a common symptom in ankylosing spondylitis. Hypovitaminosis D is one of the factors influencing fatigue during inflammatory rheumatisms. This study aimed to determine the influence of vitamin D deficiency on fatigue in ankylosing spondylitis. In this cross-sectional study, 40 patients with ankylosing spondylitis and 40 patients suffering from low back pain were recruited. Clinical and laboratory data, including vitamin D dosage, disease activity, functional impairment, and quality of life, were evaluated using specific and validated scores. Fatigue was assessed by the FACIT-F score. Both groups of patients were compound of 27 men and 13 women with a mean of 43.55±12.26 years in the study group and 47.77±13.63 years in the case group, respectively. Ankylosing spondylitis was active according to the ASDASCRP score in 67.5% of cases. All patients were suffering from fatigue with a mean FACIT-F score of 21.13. Severe levels of fatigue were noted in 50% of cases. 92.5% of patients were vitamin D deficient with a mean vitamin D of 16.57±7.15 ng/mL. Factors associated with fatigue were: female gender (P=0.05), spinal pain (P<0.001), enthesitis (P<0.001), disease activity (P<0.001), functional impairment (P<0.001), and quality of life (P<0.001). However, smoking was the only factor related to vitamin D deficiency (P=0.05). Vitamin D level was not correlated with fatigue (r= -0.02, P=0.91). In our study, vitamin D status did not seem to have an impact on fatigue in patients with ankylosing spondylitis. https://acta.tums.ac.ir/index.php/acta/article/view/8854

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 60 5 2022 06 08 293 298 EN Ata Abbasi Cellular and Molecular Research Center, Cellular and Molecular Medicine Institute, Urmia University of Medical Sciences, Urmia, Iran. AND Department of Pathology, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran. Elnaz Mehdipour Department of Pathology, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran Hengameh Mojdeganlou Department of Pathology, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran 2021 07 23 2021 12 26 Breast cancer is the most common malignant tumor in women. Some factors, including histological grade, vascular invasion, and metastasis, are known prognostic factors. Many studies have been performed to find more predictive factors such as urokinase plasminogen activator system markers. Here, we tried to evaluate the relationship between Urokinase-type plasminogen activator receptor expression and other histopathologic parameters. 62 malignant breast tumors were enrolled. UPAR immunohistochemistry staining was performed on paraffin blocks. We evaluated the relationship between UPAR expression and histopathologic factors, including tumor size, tumor type, histologic grade, lymph node status, lymphovascular and perineural invasions, and hormone receptors status (ER, PR, and HER2). The patient's mean age was 46.18±10.35 years. We found a positive relationship between UPAR expression and the presence of carcinoma insitu (P=0.027). A negative relationship was observed between UPAR expression and lymph node involvement (P=0.01), the number of involved lymph nodes (P=0.027), and also intensity and percentage of UPAR positivity in the case with lymph node involvement (P=0.005 and 0.029, respectively). UPAR expression is associated with lymph node metastasis which is one of the most important predictors of prognosis in breast cancer. So, it could be used as a favorable prognostic factor in breast cancer. https://acta.tums.ac.ir/index.php/acta/article/view/9559

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 60 5 2022 06 08 299 306 Samrad Mehrabi Department of Internal Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran Bahareh Ebrahimi Shiraz Geriatric Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Fatemeh Heidari 1 Department of Internal Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran . AND Shiraz Geriatric Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. Mohammad Ali Nazarinia Department of Internal Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran AND Shiraz Geriatric Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. 2021 07 29 2021 12 26 Lung disease is a common and important contributor to morbidity and mortality in rheumatoid arthritis (RA) patients. Studies have shown that diagnostic methods can reveal hidden pulmonary diseases even in RA patients with no respiratory symptoms. In this study, we assessed pulmonary function tests (PFTs) and chest radiographs (CXRs) in RA patients with more than three years of illness to find a suitable instrument for prospecting RA-induced lung diseases. We conducted a prospective cross-sectional study on 57 RA patients. Demographic, clinical, and CXR data were recorded. Residual volume (RV), total lung capacity (TLC), forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and FEV1/FVC ratio was assessed. According to the FEV1/FVC ratio, patients were divided into three groups: FEV1/FVC below 70% (obstructive pattern) in 5% and between 70% and 85% (normal) in 50%, and above 85% (restrictive lung disease) in 45% of RA patients. Normal X-ray was the most common finding in CXR, and only cystic changes and reticular changes were found in 5% of patients. Analysis showed a significant relationship between abnormal chest images and the duration of disease (P=0.025), but PFT data did not result in any significance. Respiratory symptoms or clinical examinations are positive findings in the evaluation of asymptomatic patients, and using PFT is more rational than CXR. Our data show that there is no correlation between the disease duration and PFT data; hence, asymptomatic patients with a variety of risk factors should undergo further investigation. https://acta.tums.ac.ir/index.php/acta/article/view/9570

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 60 5 2022 06 08 307 312 EN https://acta.tums.ac.ir/index.php/acta/article/view/8916

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 60 6 2022 07 11 384 384 Hossein Mozhdehipanah Department of Neurology, Bou Ali Sina Hospital, Qazvin University of Medical Sciences, Qazvin, Iran Shirin Mavandadi Department of Neurology, Bou Ali Sina Hospital, Qazvin University of Medical Sciences, Qazvin, Iran Sepideh Paybast Department of Neurology, Neuroscience Research Center, Qom University of Medical Sciences and Health, Qom, Iran 2021 08 16 2021 12 28 Safety monitoring of COVID-19 vaccination is paramount of importance. There are limited reports of Guillain-Barré syndrome (GBS) associated with the COVID-19 vaccination. The present study reported a case of GBS following the first dose of the Oxford-AstraZeneca SARS-CoV-2 vaccine. A 32-year-old man presented a history of progressive descending weakness and autonomic features within a month after receiving the Oxford-AstraZeneca SARS-CoV-2 vaccine. The neurological examination was consistent with acute polyneuropathy. The para-clinical investigations were in favor of acute demyelinating polyneuropathy. The patient was diagnosed with GBS, and IVIG was initiated as an acute treatment, which led to significant clinical recovery. We reported a case of GBS after receiving the Oxford-AstraZeneca vaccine. However, our findings dose not conclude a causal association between GBS and COVID-19 vaccination. https://acta.tums.ac.ir/index.php/acta/article/view/9596

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 60 6 2022 07 11 350 357 Hanan Hanna Department of Basic Science, Faculty of Physical Therapy, Delta University for Science and Technology, Gamsa, Egypt Amany Salama Department of Nutrition and Food Safety, Faculty of Applied Health Sciences Technology, Pharos University in Alexandria, Alexandria, Egypt 2020 11 07 2021 12 27 Obesity/its comorbidities occasionally exist alone, but actually, this is a dynamic network of cross morbidities that are often regarded as separable entities. Obesity is nowadays viewed as an escalating risk factor for iron deficiency, and various theories have been proposed since then explaining their relation. We aimed to determine the relationship of increased body mass index (BMI) with adiponectin, leptin, and iron profile in a sample of middle-aged and older adults with and without iron deficiency anemia. An observational study was performed among 90 participants classified into three groups. Group І included healthy subjects with normal BMI; as a control. Group II included subjects with increased BMI, and group III included subjects with increased BMI and iron deficiency anemia. After overnight fasting, fasting blood glucose, triglycerides, total cholesterol, iron, total iron-binding capacity, complete blood count, serum leptin, and adiponectin were measured. There were significantly higher mean values of BMI among those with anemia, higher mean values of serum leptin, and significantly lower mean values of adiponectin. A significant positive correlation of serum leptin with BMI and a significant negative correlation of serum leptin with iron in Group III were reported. The adiponectin/leptin ratio of (0.8) was correlated with iron and homeostatic model assessment in Group III, and a ratio of (1.1) was significantly correlated with BMI and hemoglobin level in Group II. This could suggest that interventions aimed at increasing the adiponectin/leptin ratio may help in resolving anemia among obese populations by increasing their serum iron and hemoglobin. https://acta.tums.ac.ir/index.php/acta/article/view/8925

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 60 6 2022 07 11 358 365 EN Mamak Shariat Maternal, Fetal and Neonatal Health Research Center, Institute of Family Health, Tehran University of Medical Sciences, Tehran, Iran Fariba Asghari Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran Mahmoud Motevasel Arani Department of Islamic Maaref, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Nahid Farrokhzad Maternal, Fetal and Neonatal Health Research Center, Institute of Family Health, Tehran University of Medical Sciences, Tehran, Iran Yasamin Mohammadzadeh Breastfeeding Research Center, Institute of Family Health, Tehran University of Medical Sciences, Tehran, Iran Farahnaz Mohammadi Shahboulaghi Social Determinants of Health Research Center, Nursing Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran Ameneh Abroun Neonatal Intensive Care Unit, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Sayeh Mirzatavoli Neonatal Intensive Care Unit, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Zohreh Janani Nurse in Neonatal Intensive Care Unit, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Fatemeh Sadat Nayeri Maternal, Fetal and Neonatal Health Research Center, Institute of Family Health, Tehran University of Medical Sciences, Tehran, Iran 2021 05 22 2021 12 10 Advances in medicine and medical technology have presented new moral challenges in terms of the management of extremely preterm infants and newborns with severe anomalies and advanced asphyxia. The aim of the present study was to examine the attitudes of health care providers and parents regarding decisions about the treatment of these neonates. The attitude of the Shia clerics is assessed in this study as well. In this qualitative content analysis research, data were collected through semi-structured interviews and focus group discussions (FGDs) with 98 participants, including physicians, nurse practitioners, medical ethicists, Shia clerics, and parents. Purposive sampling was employed by selecting those members of the community whom we thought would provide us with the best information and were also eager to participate. Data collection continued until data saturation was reached. Data analysis was carried out using conventional content analysis. Analysis of the data resulted in the extraction of 332 codes along with the following four categories: the necessity for preparation of a national guideline for the management of neonates with poor prognosis, the establishment of hospital neonatal-management committees, decision-making regarding the limits of viability, and parental support. This study affirms that the responsibility in terms of decision-making for neonates with poor prognosis lies upon hospital neonatal-management committees based on approved national guidelines such that decisions are made according to the aforementioned guidelines, Islamic moral codes, and scope of services available in medical units. This study dismisses individual decision-making and underlines the responsibility of a hospital neonatal-management committee in maki