Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 61 5 2023 08 23 257 263 Vahid Asgharzadeh Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran Mir Reza Valiollahzadeh Medical Philosophies and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran Zahra Taghinejad Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran Mohammad Asgharzadeh Biotechnology Research Center, Faculty of Paramedicine, Tabriz University of Medical Sciences, Tabriz, Iran Jalil Rashedi Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran Behroz Mahdavi poor Department of Laboratory Sciences, Faculty of Paramedicine, Tabriz University of Medical Sciences, Tabriz, Iran Hossein Jalaei Nobari Department of Islamic Education, Faculty of Paramedicine, Tabriz University of Medical Sciences, Tabriz, Iran Ahmad Ali Khalili Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Yousof Khairy Department of Islamic Education, Faculty of Paramedicine, Tabriz University of Medical Sciences, Tabriz, Iran Amir Ali Mir Mazhari Department of Laboratory Sciences, Faculty of Paramedicine, Tabriz University of Medical Sciences, Tabriz, Iran 2021 08 25 2023 01 27 Following the discovery of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in China, it has been transmitted to travelers through respiratory droplets and distributed worldwide. Viral, environmental, and host factors all play a role in getting infected with the virus and having severe forms of the disease named coronavirus disease 2019 (COVID-19). Diabetes is one of the most important host risk factors in the progression and severity of COVID-19. In diabetes, hyperglycemia and protein glycosylation increase pro-inflammatory cytokines levels and suppress innate and adaptive immune system by impairing the function of neutrophils, macrophages, and lymphocytes, especially regulatory T lymphocytes. The compromised immune system in diabetic patients makes them vulnerable to infectious diseases like COVID-19. Correspondingly, people with diabetes are usually treated with angiotensin-converting enzyme (ACE) inhibitors and angiotensin II Type-I receptor blockers (ARBs), which increase ACE2 expression as a receptor for SARS-CoV-2. Thus, diabetic patients are more likely to develop severe forms of COVID-19 and die due to chronic inflammation and impaired immune function. https://acta.tums.ac.ir/index.php/acta/article/view/9627 https://acta.tums.ac.ir/index.php/acta/article/download/9627/5780

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 61 5 2023 08 23 264 269 Golshid Sanati Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. AND Division of Biomedical Sciences, School of Medicine, University of California, Riverside, USA 3 Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Riverside, CA, USA. Mehrdad Noruzinia Department of Medical Genetics, School of Medical Sciences, Tarbiat Modares University, Tehran, Iran. Davood Jafari Department of Immunology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran. Mohammad Ahmadvand Department of Medical Genetics, School of Medical Sciences, Tarbiat Modares University, Tehran, Iran Shahram Teimourian Department of Genetics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran Naser Ebrahimi Daryani Department of Internal Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Nima Rezaei Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. ANDResearch Center for Immunodeficiencies, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran. AND Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran. 2021 12 19 2023 04 17 Changes in the expression of nucleotide-binding oligomerization domain containing 2 (NOD2) play an important role in the pathogenesis of several autoimmune diseases, such as inflammatory bowel diseases (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC). It seems that epigenetic modifications, including DNA methylation, have an important role in the suppression of gene activity. In this study, the relationship between DNA methylation patterns of the promoter region of the NOD2 gene and the pathogenesis of CD was assessed. Colonic mucosal samples were obtained from 15 Iranian patients with CD and 15 matched healthy controls with no history of autoimmune diseases. After bisulfite conversion of genomic DNA, the DNA methylation status of three CpG sites in the promoter region of the NOD2 gene was determined by the real-time quantitative multiplex methylation-specific PCR assay. Using this approach, we identified a decreased level of methylation of the NOD2 promoter in the colonic mucosa of patients with CD (0.128±0.093 vs. 0.025±0.016, unmethylated DNA in CD vs. healthy controls, respectively, P<0.000). According to our findings, promoter hypomethylation of the NOD2 gene in the colonic mucosa might contribute to the development and severity of CD. https://acta.tums.ac.ir/index.php/acta/article/view/9867 https://acta.tums.ac.ir/index.php/acta/article/download/9867/5781

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 61 5 2023 08 23 270 274 Atiyeh Vatanchi Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Sedighe Ayati Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Leila Pourali Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Masoumeh Mirteimouri Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Mohammad Taghi Shakeri Department of Statistics and Epidemiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Sara Partanezhad Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran 2021 03 15 2023 01 22 Outpatient use of misoprostol is assessed in a few studies and usually in low doses and vaginal routes. This study aimed to evaluate cervical ripening by outpatient administration of misoprostol to prevent post-term pregnancy. This randomized clinical trial study was performed on 140 patients that were randomly allocated into two groups: 25 μg sublingual SL (group A) and 50 μg PO misoprostol (group B). The patients were primigravid with a gestational age of 40 weeks, with an amniotic fluid index (AFI) of ≥5 cm, a reactive non-stress test (NST) with no evident uterine contraction, Bishop Score of <8, and no notable past medical history. Patients who had a normal vaginal delivery before 41 weeks were considered successful delivery. Maternal age, the number of misoprostol doses, vaginal examination, type of interventions before delivery, the indication of hospitalization, delivery route, the indication of cesarean section, delivery complications, and neonatal outcomes were compared using SPSS software. P<0.05 was considered statistically significant. group A had mean age of 23.27±4.03 years and Group B had a mean age of 24.61±5.46 years with no significant difference (P=0.223). The number of misoprostol doses (P=0.001), extra misoprostol, and oxytocin application were significantly lower in group B (P=0.003). Maternal and neonatal complications showed no significant difference between the two groups (P>0.05). Outpatient cervical ripening with misoprostol appears to be an optimal method. More prospective studies with higher sample sizes are required to ensure its safety for routine recommendations for cervical ripening to prevent post-term pregnancy. https://acta.tums.ac.ir/index.php/acta/article/view/9239 https://acta.tums.ac.ir/index.php/acta/article/download/9239/5782

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 61 5 2023 08 23 275 281 Azim Mehrvar Mahak Hematology Oncology Research Center (MAHAK-HORC), Mahak Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Yasaman Sadeghi Mahak Hematology Oncology Research Center (MAHAK-HORC), Mahak Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Narjes Mehrvar Mahak Hematology Oncology Research Center (MAHAK-HORC), Mahak Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Mohammad Faranoush Mahak Hematology Oncology Research Center (MAHAK-HORC), Mahak Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Mardawig Alebouyeh Mahak Hematology Oncology Research Center (MAHAK-HORC), Mahak Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Mohsen Roozrokh Mahak Hematology Oncology Research Center (MAHAK-HORC), Mahak Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Maryam Tashvighi Mahak Hematology Oncology Research Center (Mahak-HORC), Mahak Hospital 2021 01 31 2023 01 21  In this cross-sectional study, we aimed to evaluate epidemiologic data, survival, and prognosis of pediatric patients diagnosed with neuroblastoma who were referred to Mahak Pediatric Cancer Treatment and Research Center (MPCTRC). One-hundred thirty-seven children younger than 15 years with neuroblastoma from April 2008 to March 2020 were included in this study. Data were retrospectively extracted from their documents, and follow-up was done for alive individuals. Collected data were analyzed using SPSS software version 25 for parametric and non-parametric variables. Of all patients, 51.82% (n=71) were male (M/F ratio was 1.07:1) with a mean age of 2.48±0.26 years. According to the International Neuroblastoma Staging System (INSS), more than 70% of patients were diagnosed with stages 3, 4, and 4S. Primary tumors were located mostly in the adrenal glands (42.34%) and abdomen (29.20%), respectively. Additionally, 62% of children experienced metastasis, with the most common site being bone marrow. Moreover, patients' overall survival, progression-free survival, and event-free survival were 55.2%±5.6, 41.0%±7.9, and 30.0%±5.1, respectively. Early diagnosis and effective treatment of neuroblastoma can directly influence patients' survival, and those who are diagnosed with neuroblastoma within one month of its symptoms onset are more likely to have higher survival rates. https://acta.tums.ac.ir/index.php/acta/article/view/9136 https://acta.tums.ac.ir/index.php/acta/article/download/9136/5783

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 61 5 2023 08 23 282 288 Fatemeh Nayeri Breast Feeding Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran Sara Bahadoram Breast Feeding Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran Zahra Farahani Maternal, Fetal, and Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran Mamak Shariat Maternal, Fetal, and Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran 2021 06 02 2023 01 27 Intrauterine growth restriction (IUGR) is responsible for different post-natal adverse outcomes. This study aimed to evaluate the post-natal psychomotor development status in 6 and 12-month-old IUGR infants who received early preventive interventions. A historical cohort study was done at an Iranian Hospital (2019). The case group included one-year-old infants with a history of IUGR at birth. This group was visited every 2 months to evaluate their growth and neurodevelopmental status. Their parents had also received some training to improve their infant's sensory and motor skills. The control group comprised one-year-old healthy infants with a history of appropriate for gestational age (AGA) at birth. Data related to psychomotor developmental indices based on the ASQ questionnaire at 6 and 12-month for both groups was extracted from subjects' records. Infants' psychomotor development status was compared between groups. Forty-one infants with a history of IUGR and 43 healthy control infants were included in this study. There were significant differences between 2 groups associated with abnormalities in all evaluated psychomotor skills, including gross motor (P=0.014), problem-solving ability (P=0.049), communication (P=0.031), fine motor (P=0.016) and personal-social (P=0.016) at 6 months. After one year of family-based interventions for the case group, significant differences between groups were notable in only fine motor (P=0.016) and personal-social skills (P=0.031). At 12 months, the psychomotor disorders related to gross motor, problem-solving ability, and communication were significantly alleviated in the IUGR group. Early preventive family-based interventions can improve the neurodevelopmental outcomes in 12-month-old IUGR infants. https://acta.tums.ac.ir/index.php/acta/article/view/9436 https://acta.tums.ac.ir/index.php/acta/article/download/9436/5784

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 61 5 2023 08 23 289 293 AlI Bahari Department of Internal Medicine, Emam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran Hamidreza Nazemi Department of Internal Medicine, Amin Hospital, Isfahan University of Medical Sciences, Isfahan, Iran Azita Ganji Department of Internal Medicine, Emam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran Mohammadreza Farzanehfar Department of Internal Medicine, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran Ali Beheshti Namdar Department of Internal Medicine, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran Ladan Goshayeshi Department of Internal Medicine, Emam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran Mitra Ahadi Department of Internal Medicine, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran Lotfolah Fouladi Clinical Anatomical Pathology, Dr. Fouladi Laboratory, Isfahan, Iran Ali Mehrabi Koushki Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Zohreh Bari Gut and Liver Research Center, Non-Communicable Disease Research Institute, Mazandaran University of Medical Sciences, Sari, IranUniversity of Medical Sciences, Sari, Iran 2021 03 24 2023 01 21  Some studies have shown that giardia infection is associated with some abdominal symptoms. The aim of this study was to determine the relationship between giardia duodenalis infection and irritable bowel syndrome (IBS). In this clinical trial study, 60 patients with non-constipation predominant IBS based on Rome III criteria were enrolled in the study. 30 patients with giardiasis who were diagnosed with stool Eliza as patients, and 30 other patients who did not have giardiasis as control enrolled to study. All patients were treated with 250 milligrams of metronidazole TDS for 5 days. Abdominal symptoms including abdominal pain, bloating, and diarrhea were determined and compared in both groups before and after treatment. The mean age and sex distribution of the two groups were similar (P>0.5). The pain, bloating, and diarrhea severity before treatment with metronidazole were not significantly different in the two groups. The pain and bloating and diarrhea severity in both groups significantly decreased after the treatment period, but reductions were significantly higher in the case group (P<0.001 and P<0.001 P<0.001, respectively). The mean score of global symptoms before treatment in both case and control groups was similar. (P=0.88), but after treatment it was 4.85±2.18 (P<0.001) and 10.48±2.14 (P<0.001) respectively and the difference between the two groups was significant (P<0.001). The recovery percentage was 0.61±0.16 in the case group and 0.14±0.17 in the control group (P<0.001). Giardia infection in patients with IBS seems to play a significant role in clinical manifestations of non-constipation IBS and treatment with metronidazole can improve these symptoms significantly. https://acta.tums.ac.ir/index.php/acta/article/view/9257 https://acta.tums.ac.ir/index.php/acta/article/download/9257/5785

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 61 5 2023 08 23 294 296 Farzane Zare Health in Disasters and Emergencies Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran Jamileh Farokhzadian Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran. Monirsadat Nematollahi Department of Pediatric and Neonatal Intensive Care Nursing, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran Sakineh Miri Department of Psychiatric Nursing, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran. Mohammad Ali Zakeri Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.AND Clinical Research Development Unit, Ali-Ibn Abi-Talib Hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran Golnaz Foroughameri Department of Community Health Nursing, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran. 2021 05 30 2023 01 27 Caring behaviors are crucial in intensive care units (ICU) because patients in these wards require high levels of care. Effective communication with patients is one of the most important factors in caring behaviors of nurses working in ICUs. The aim of this study was to evaluate the effect of therapeutic communication skills training on the caring behaviors of ICU nurese. This experimental pre-test/post-test study was carried out on 105 nurses working in ICUs of hospitals affiliated to Yazd University of Medical Sciences in Iran in 2019. Nurses were randomly assigned into control (52 nurses) and intervention (53 nurses) groups. A two-day therapeutic communication training workshop was conducted for the participants. Data were collected using demographic information questionnaire and caring behaviors questionnaire before and one month after the intervention. The findings showed no significant difference between the control and intervention groups regarding the nurses' caring behaviors in the pretest (P = 0.148). However, after implementation of the training program, a significant difference was observed in the mean scores of caring behaviors between the two groups. In the control group, the mean scores of caring behaviors decreased significantly after the intervention (P = 0.001); whereas, the mean scores of intervention group increased significantly after the intervention (P = 0.001). According to the results, ICU nurses' training in therapeutic communication skills had a positive effect on their caring behaviors. Therefore, we suggest the authorities to prepare and implement educational packages of therapeutic communication skills as a coherent program for other nurses. As a result, the caring behaviors and the quality of cares can be improved for patients. https://acta.tums.ac.ir/index.php/acta/article/view/9434 https://acta.tums.ac.ir/index.php/acta/article/download/9434/5792

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 61 5 2023 08 23 297 304 Omar Ajaj Department of Pediatric Surgery, College of Medicine, University of Anbar, Anbar, Iraq 2021 10 25 2023 01 27 Caring behaviors are crucial in intensive care units (ICU) because patients in these wards require high levels of care. Effective communication with patients is one of the most important factors in the caring behaviors of nurses working in ICUs. This study aimed to evaluate the effect of therapeutic communication skills training on the caring behaviors of ICU nurses. This experimental pre-test/post-test study was carried out on 105 nurses working in ICUs of hospitals affiliated with Yazd University of Medical Sciences in Iran in 2019. Nurses were randomly assigned into control (52 nurses) and intervention (53 nurses) groups. A two-day therapeutic communication training workshop was conducted for the participants. Data were collected using a demographic information questionnaire and caring behaviors questionnaire before and one month after the intervention. The findings showed no significant difference between the control and intervention groups regarding the nurses' caring behaviors in the pretest (P=0.148). However, after the implementation of the training program, a significant difference was observed in the mean scores of caring behaviors between the two groups. In the control group, the mean scores of caring behaviors decreased significantly after the intervention (P=0.001); whereas, the mean scores of the intervention group increased significantly after the intervention (P=0.001). According to the results, ICU nurses' training in therapeutic communication skills had a positive effect on their caring behaviors. Therefore, we suggest the authorities prepare and implement educational packages of therapeutic communication skills as a coherent program for other nurses. As a result, the caring behaviors and the quality of care can be improved for patients. https://acta.tums.ac.ir/index.php/acta/article/view/9745 https://acta.tums.ac.ir/index.php/acta/article/download/9745/5794

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 61 5 2023 08 23 305 310 Vahid Mohammadi Department of Cardiology, Faculty of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran. Mohammad Ali Zakeri Clinical Research Development Unit, Ali-Ibn Abi-Talib Hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran. AND Social Determinants of Health Research Centre, Rafsanjan University of Medical Sciences, Rafsanjan, Iran Maryam Zakeri Physiology-Pharmacology Research Center, Research Institute of Basic Medical Sciences, Rafsanjan University of Medical Sciences, Rafsanjan, Iran Vahid Ehsani Clinical Research Development Unit, Ali-Ibn Abi-Talib Hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran. AND Physiology-Pharmacology Research Center, Research Institute of Basic Medical Sciences, Rafsanjan University of Medical Sciences, Rafsanjan, Iran 2021 05 01 2023 01 27 Takotsubo Cardiomyopathy (TC) is transient systolic dysfunction localized with electrocardiographic (ECG) changes, and it mimics acute coronary syndrome (ACS). Studies have shown that 95% of the patients have changes in ECG. ECG changes in TC syndrome may be similar to MI. ECG changes can be seen in the form of ST-segment elevation or deep T-wave inversion. TC can be considered a special form of ACS. TC is not a benign entity and conduction abnormalities can occur. The acute phase can be predicted based on decreased EF and the incidence of arrhythmia. A different treatment is used in the acute phase of TC, depending on the hemodynamic condition. Our case illustrates the importance of symptoms such as stress and emotions, age and female gender, clinical manifestations, ECG characteristics, and echocardiography. This paper describes a case of TC from a hospital affiliated to Rafsanjan University of Medical Sciences. The case was a 75-year-old woman with no history of cardiovascular diseases, who has been admitted to the hospital with myocardial infarction. https://acta.tums.ac.ir/index.php/acta/article/view/9364 https://acta.tums.ac.ir/index.php/acta/article/download/9364/5788

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 61 5 2023 08 23 311 314 Tooraj Zandbaf Department of General Surgery, Faculty of Medicine, Mashhad Medical Sciences, Islamic Azad University, Mashhad, Iran Yeganeh Azadmanesh Department of Emergency Medicine, Razavi Hospital, Mashhad, Iran. Ali Akbar Bagherzadeh Innovative Medical Research Center, Faculty of Medicine, Mashhad Medical Sciences, Islamic Azad University, Mashhad, Iran. 2021 08 23 2023 01 27 The coronavirus disease is a recent pandemic infection, with the first case being discovered in Wuhan, China, in December 2019. Iran is one of the countries that has been afflicted by this pandemic. A 34-year-old man with no history of pre-existing disease and smoking has been hospitalized in another hospital for the past two weeks due to COVID-19 infection and symptoms of fever, cough, and dyspnea. He received standard medical treatments in that hospital. After two weeks, he was discharged from the hospital with his consent. In the afternoon of the same day, he came to the emergency department of our hospital with severe dyspnea. Tension pneumothorax in the left hemithorax, pulmonary collapse, and shifting mediastinal elements to the contralateral side were observed in his chest x-ray. Tension pneumothorax is an unusual symptom in patients with SARS-CoV-2. Pneumothorax has been reported in 1% of COVID-19 patients who need hospitalization, 2% of those who need intensive care unit admission, and 1% of those who die from the infection. Spontaneous pneumothorax must be ruled out in COVID-19 patients with dyspnea and chest pain, tachycardia, tachypnea, or hypoxemia. It is critical to be familiar with these symptoms to make an accurate diagnosis and treatment plan. A thorough physical examination and serial chest X-rays can be helpful tools in the diagnosis and management of the disease. https://acta.tums.ac.ir/index.php/acta/article/view/9623 https://acta.tums.ac.ir/index.php/acta/article/download/9623/5789