Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 60 10 2022 12 18 609 614 Amin Hosseini Medical-Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran Alun Jackson Australian Centre for Heart Health, Faculty of Health, Deakin University, Geelong, Australia. AND Centre on Behavioral Health, Hong Kong University, Hong Kong, PRC Fatemeh Bahramnezhad School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran. AND Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Teh 2021 08 05 2021 12 27 Interventional studies are necessary to gain new knowledge in medical sciences; they can also be associated with several risks and impose high costs on patients and healthy people, and ethical considerations must be considered, as well. Understanding the ethical challenges and issues of interventional studies is essential. Using placebo, ethical consent, and clinical trials in specific groups are some of these challenges. This systematic review study was conducted to determine ethical considerations in interventional studies with an emphasis on the four ethical principles, including autonomy, non-maleficence principle, beneficence, and justice. Researchers in interventional studies should pay attention to ethics and take the necessary steps in line with these four biological principles. https://acta.tums.ac.ir/index.php/acta/article/view/9585

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 60 10 2022 12 18 615 615 Simon Byonanuwe Department of Obstetrics and Gynecology, Kampala International University Western Campus, Bushenyi, Uganda Immaculate Kusiima Department of Obstetrics and Gynecology, Kampala International University Western Campus, P.O.Box 71, Bushenyi, Uganda; 2021 07 20 2021 12 26 A 23 year old Gravida 3 Para 1+1 at 26 weeks and four days of amenorrhea presented at our obstetrics and gynecology clinic for assessment following a coincidental scan that revealed a single live intrauterine fetus in cephalic presentation, longitudinal lie with normal cardiac activity, heart rate of 150 beats per minute, normal gross anatomy and estimated fetal weight of 992 grams. Adjacent to it however was a large monoamniotic echocomplex mass of approximately 398 milliliters with a ‘snow storm’ appearance. Patient was asymptomatic at the time of arrival. She had however had occasional episodes of mild per vaginal bleeding about two weeks prior to visiting the clinic which resolved following treatment from a nearby health center at her home where it was managed as threatening abortion. Previous obstetric history was of a molar pregnancy in her second pregnancy about one year ago where a suction evacuation was notably done and patient improved. The first pregnancy was uneventful throughout the prenatal, perinatal and puerperal time. https://acta.tums.ac.ir/index.php/acta/article/view/9552

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 60 10 2022 12 18 616 621 EN Asghar Bagherzadeh Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran Saeed Abdi Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran Mohammad Reza Zali Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran Shooka Mohammadi Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2021 09 27 2022 07 16 There is insufficient data about esophageal body dysmotility in patients with refractory gastroesophageal reflux disease (RGERD) and inadequate response to proton pump inhibitors (PPIs) treatment. This study aimed to assess esophageal motility disorder and reflux parameters among these patients by high-resolution manometry (HRM) and intraluminal impedance and pH (MII‐pH) monitoring after stopping PPI therapy. A retrospective study was conducted among 100 RGERD patients admitted to Taleghani Hospital (Tehran, Iran) for one year. More than half of them were males (55%). Their mean age was 47.10±6.92, and 50% of patients had ineffective esophageal motility (IEM). Middle, distal, and proximal esophageal pressure (MEP, DEP, and PEP), lower esophageal sphincter (LES) basal pressure (LESP), integrated relaxation pressure (IRP), distal contractile integral (DCI), large breaks, upper esophageal sphincter basal pressure (UESP), and LES length (LESL) in IEM patients were significantly lower than the patients with normal esophageal motility (P<0.001). Furthermore, there were more patients in the IEM group with long-term and abnormal weakly acid reflux compared with the non-IEM group (P<0.05). It seems that the evaluation of reflux parameters and esophageal motility could lead to additional insights into the pathophysiological mechanisms of RGERD. Nevertheless, further studies are suggested to evaluate the effects of esophageal motility disorders among RGERD patients. https://acta.tums.ac.ir/index.php/acta/article/view/9696

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 60 10 2022 12 18 622 627 Ebrahim Espahbodi Department of Anesthesiology and Critical Care and Pain Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Seyed Mojtaba Marashi Department of Anesthesiology and Critical Care, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Ali Reza Khajenasiri Department of Anesthesiology and Critical Care, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Mehdi Sanatkar Department of Anesthesiology and Critical Care, Farabi Hospital, Tehran University of Medical Sciences, Tehran, Iran Siamak Yousefi School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Reza Atef Yekta School of Medicine, Tehran University of Medical Sciences, Tehran, Iran 2022 04 08 2022 05 11 The aim of this study was to evaluate the effect of bupivacaine with dexmedetomidine in comparison with bupivacaine during supraclavicular block with ultrasound guide on the hemodynamics of patients undergoing upper limb orthopedic surgery. Eighty patients (40 patients in each group) who were candidates for upper limb orthopedic surgery randomly received 30 ml of bupivacaine alone (group 1) or 30 ml of bupivacaine with 20 μg of dexmedetomidine (group 2). The supraclavicular nerve block was performed using an ultrasound guide. Patients' hemodynamic data (including mean arterial blood pressure, heart rate per minute, respiration rate per minute, and peripheral blood oxygen saturation), the onset of action, and duration of sensory-motor block were compared between the two groups. The mean arterial blood pressure during surgery in group 2 was lower than in group 1, but the differences were not statistically significant. The onset of sensory and motor block in group 2 was significantly shorter than in group 1 (P=0.0001). The duration of sensory and motor block in group 2 was significantly longer than in group 1 (P=0.0001). During this study, none of the patients had hemodynamic disturbance or surgical complications. The addition of dexmedetomidine to bupivacaine during the supraclavicular block, in addition to hemodynamic stability of the patient during surgery, increases the duration of sensory and motor block. https://acta.tums.ac.ir/index.php/acta/article/view/10086

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 60 10 2022 12 18 628 634 Zahra Heidari Department of Endocrinology and Metabolism, Zahedan University of Medical Sciences, Zahedan, Iran Nima Shahriari Department of Endocrinology and Metabolism, Zahedan University of Medical Sciences, Zahedan, Iran 2021 05 16 2021 12 09 Autoimmune thyroid diseases are multifactorial conditions caused by genetic and environmental factors. Among environmental factors, infectious agents include viruses, bacteria, and parasites acting as triggers. The current study intended to investigate the association between Helicobacter pylori infection and autoimmune thyroid diseases in a group of Iranian cases with Hashimoto's thyroiditis (HT) and Graves' disease (GD). This study included adult cases newly diagnosed with GD and HT and euthyroid controls. A number of clinical and biochemical factors were evaluated, including tests of thyroid function and serum Helicobacter Ab (IgG), and then inter-group comparisons were performed. Data from 404 patients with HT and 248 cases with GD were analyzed. Also, data from 480 healthy controls were analyzed. For those with HT, GD, and controls, the prevalence of Helicobacter pylori infection was 93.3%, 92.7%, and 88.8%, respectively. The prevalence of H. pylori infection in cases with HT and GD was significantly higher compared to controls. While concerning the prevalence of H. pylori infection, the two groups (HT and GD) were not significantly different. H. pylori antibody level was significantly correlated with FT4, FT3, Anti-TPO, and Anti-Tg in cases with HT. In the group of patients with GD, the H. pylori antibody had a significant positive correlation with Anti-TPO and Anti-Tg. According to the present results, H. pylori is associated with autoimmune thyroid diseases (both Hashimoto's and Graves' diseases). https://acta.tums.ac.ir/index.php/acta/article/view/9394

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 60 10 2022 12 18 635 639 Amir Asharlous Health Research Center, Lifestyle Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran Asgar Doostdar Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran Hamed Akbari Health Research Center, Lifestyle Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran Omid Hasani Qazvin Islamic Azad University Amir Rakhshan Department of Foreign Languages, School of International College, Tehran University of Medical Sciences, Tehran, Iran Mohammad Ghasemi Health Research Center, Lifestyle Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran Mehdi Khabazkhoob Department of Basic Sciences, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2021 04 10 2022 06 09 To investigate the ocular surface status in individuals having long-term occupational sunlight exposure. This study was carried out with a historical cohort design. Long-term occupational sunlight exposure was considered the main exposure. The exposure group included individuals who had direct sunlight exposure in their workplace (124 people with a mean age range of 31.6±6.32), and the non-exposure group was comprised of 182 people (mean age range of 31.6±6.32) who worked indoors and had no long-term exposure to sunlight during work hours. The mean of TBUT in the Sun-exposure group (10.91±6.64 sec.) was significantly lower than the non-exposure one (13.91±9.67 sec.) (P=0.001). 42.9 percent of the members of the non-exposure and 58.9 of the sun-exposure group demonstrated TBUT values lower than 10 seconds. While the mean of OSDI in the exposure group was higher than in the non-exposure group, this difference was not statistically significant. Based on the OSDI results, 51.6 percent of the non-exposure group and 58.9 percent of the exposure group suffered from dry eye. The prevalence of diseases such as Pterygium, blepharitis, and pinguecula in the sun-exposure group was significantly higher than in the non-exposure group (P<0.0001). Based on the results of this study, people who have long-term occupational sunlight exposure tend to have more unstable tear films compared with people who do not have such exposure. In addition, the prevalence of diseases such as Pterygium, blepharitis, and pinguecula is higher among these people. https://acta.tums.ac.ir/index.php/acta/article/view/9301

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 60 10 2022 12 18 640 645 Hamidreza Hasani Department of Ophthalmology, Madani Hospital, Alborz University of Medical Sciences, Karaj, Iran Armin Khavandegar Department of Student Research Committee, Alborz University of Medical Sciences, Karaj, Iran Parnian Adhami Department of Student Research Committee, Azad University of Medical Sciences, Tehran, Iran Fateme Saberdoust Department of Student Research Committee, Iran University of Medical Sciences, Tehran, Iran 2021 03 30 2022 07 16 We aimed to report the five-year results of Trans-epithelial Photorefractive Keratectomy (TPRK) in treating all kinds of refractive errors. In this retrospective cohort study, we quantitatively compared the clinical findings and assessment of optical and refractive parameters, including slit-lamp, corneal topography, Best Corrected Visual Acuity (BCVA), and Uncorrected Distance Visual Acuity (UDVA) in 172 eyes of myopic, hyperopic, and astigmatic patients before and five years after trans-PRK. The average time for post-surgery epithelial healing was 2.97 0.83 days in male and 2.94 0.87 days in female patients; the pain score in a week following the operation was 1.88 0.68 in males and 2.25 0.73 in females. Corneal haze was observed in five patients. No long-term adverse effect was reported. The pre-operative UDVA was 0.84 0.32 in male and 0.87 0.34 in female patients; while the postoperative UDVA was -0.02 0.04 in male and -0.01 0.02 in female patients. There was a highly significant correlation (P<0.001) in all indices except UDVA, which was almost near to being significant (P=0.07). In this survey, the mean safety and index were nearly 1.00. TPRK is a safe and efficient therapeutic procedure to treat all types of refractive errors, including myopia, hyperopia, and astigmatism, with no significant adverse effect. Being touchless and having a short recovery time are two main characteristics of this refractive surgery. https://acta.tums.ac.ir/index.php/acta/article/view/9268

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 60 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