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 Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran Abbas Dehghani Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran Kamran Balighi Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran Arghavan Azizpour Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran Mehdi Yaseri Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Seyed Mohammad Seyed Ebrahimi Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran Hamidreza Mahmoudi Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran 2021 05 31 2022 05 10 Vitiligo is the most common cause of skin depigmentation, which relates to a wide range of psychological disorders. Stigma is defined as a negative attitude towards oneself that results from one's perception of being different from the general population. In this study, we have evaluated the quality of life and stigmatization degree among vitiligo patients. In this cross-sectional study, 323 patients with vitiligo referred to Razi Hospital, Tehran, Iran, were evaluated. All patients were asked to fill out a questionnaire containing age, gender, marital status, educational level, employment status, duration of vitiligo, location of lesions, history of underlying diseases, history of previous treatments, as well as history of depression or suicide. Quality of life and stigmatization among patients were assessed by DLQI (dermatology life quality index) and FSQ (feeling stigmatization questionnaire) questionnaires. The prevalence of moderate and severe stigmatization were 49.8 % and 13.3%, respectively. Women were significantly more stigmatized than men. The presence of vitiligo lesions on the face, hands, or forearms, previous topical and oral treatments, and prior depressive disorders were significantly associated with an increased sense of stigma. Patients with thigh or trunk lesions faced less stigmatization. Additionally, stigmatization was meaningfully related to the level of quality of life impairment. In the present study, 63% of patients with vitiligo experienced moderate to severe stigmatization levels related to gender, lesion site, history of prior treatments, and depression. Moreover, there was a significant correlation between the level of stigma sensation and the life quality disturbance. https://acta.tums.ac.ir/index.php/acta/article/view/9435

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 60 7 2022 08 16 429 435 Rabeeh Izadi Amoli Department of Microbiology, Ayatollah Amoli Branch, Islamic Azad University, Amol, Iran. Jamileh Nowroozi Department of Microbiology, North Tehran Branch, Islamic Azad University, Tehran, Iran 2021 08 16 2021 12 31 Stenotrophomonas maltophilia is resistant to a wide range of antibiotics. This study aimed to investigate the beta-lactamase, ESBL, and MBL enzymes and also L1and NDM1 genes in isolates of Stenotrophomonas maltophilia. Antibiotic susceptibility test, beta-lactamase, ESBL, and MBL test was done on 23 isolated Stenotrophomonas maltophilia. The presence of L1 and NDM1 genes was investigated on isolated MBL bacteria by the PCR method. The results showed the most effective antibiotics were tigecycline and gentamicin (100%) and the highest resistance was observed with aztreonam (56.22%). 39.13% of isolates were ESBL, 82.66% of isolates were beta-lactamase positive, 60.86% of isolates were Metallo-beta-lactamase positive. 39.13% of MBL positive isolates, were positive for the L1 gene but the NDM1 gene was not seen. Results of this study showed the higher resistance to beta-lactam antibiotics also the presence of the l1 gene. ESBL and MBL producing S. maltophilia are frequently resistant to a wide range of antibiotics. Therefore, needs to be done antibiotic sensitivity test, ESBL, and MBL test before treatment for this bacterium. https://acta.tums.ac.ir/index.php/acta/article/view/9598

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 60 7 2022 08 16 346 444 Shahin Salarvand Hepatitis Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran Masoumeh-Sadat Mousavi Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran 2021 08 06 2021 12 28 Medical universities need faculty members (FMs) who use high-level thinking and the power of reason to make decisions in conflicting situations. The purpose of this study was to determine the relationship between critical thinking skills and conflict management styles in the Medical University FMs (MUFMs). A descriptive cross-sectional study using the stratified sampling and then Quota sampling was performed. The sample size was 160 people. The Thomas and Kilman's Questionnaire for Conflict Management Style and Critical Thinking Questionnaire Form B were used. This study showed that the total score of faculty members' critical thinking was lower than the expected mean. The participants have more deductive thinking skills. Other skills are descending respectively, including inductive thinking skills, evaluation, inference, and analysis. In the Conflict Management styles, the Compromising style scored the highest. And other styles are used in descending respectively, including; conflict management styles avoidance, competition, and collaboration. This study showed that the Compromising Conflict Management Style was the highest among the FMs and, in contrast to the Collaborating conflict management style, scored the lowest. The deductive Critical thinking skill scored the highest; in contrast, the analysis critical thinking skill was the least scored. This study showed that by increasing the total score of critical thinking skills of participants, the using of avoidance and compromising conflict management style is more likely. https://acta.tums.ac.ir/index.php/acta/article/view/9587

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 60 7 2022 08 16