Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 61 6 2023 10 02 315 322 Batool Okhovat Isfahani West Health Center of Tehran, Iran University of Medical Sciences, Tehran, Iran Farzad Khodamoradi Department of Social Medicine, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran 2020 11 24 2023 01 15 A systematic review and meta-analysis was conducted to determine the association between exposure to maternal diabetes and ADHD in the offspring. Major electronic databases, including Web of Science, PubMed, Scopus, Embase, and Proquest, were searched from inception until December 2018. The New Castle-Ottawa scale was used to assess the quality of the included studies. A fixed effects model was applied for analysis. Seven studies including a total of 5,658,871 individuals were retained. A significant association was found between maternal diabetes and ADHD [OR=1.23, 95% CI: 1.117, 1.345]. There was a significant heterogeneity (I^2=77.7, P<0.0001), while Egger’s and Begg’s test were not significant. This study showed a significant relationship between maternal diabetes and ADHD; however, more well-designed studies are needed to confirm the results. https://acta.tums.ac.ir/index.php/acta/article/view/8958 https://acta.tums.ac.ir/index.php/acta/article/download/8958/5795

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 61 6 2023 10 04 323 328 Samrand Fattah Ghazi Department of Intensive Care Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Nima Nazari Department of Anesthesiology, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran Mohammad Taghi Beigmohammadi Department of Intensive Care Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Masoud Ramezani Department of Intensive Care Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Mohammadreza Salehi Department of Infectious Diseases, Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Tehran University of Medical Sciences, Tehran, Iran Yeganeh Abedipour Department of Intensive Care Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran 2022 10 04 2023 06 19 The decision to perform tracheostomy during the COVID-19 pandemic has been based mainly on practical and empirical standards. Also, the amount of scientific evidence to determine the exact timing of tracheostomy in patients with severe COVID-19 on mechanical ventilation is not significant. We conducted a retrospective cohort study on mechanically ventilated COVID-19 patients from April 25, 2021 to January 25, 2022 in intensive care units of Imam Khomeini Hospital Complex, Tehran, Iran. The 30-day survival of patients was calculated and compared between patients under tracheostomy and those without tracheostomy. A number of 135 COVID-19 cases (75 patients in the intubated group and 60 patients in the tracheostomy group) were included in this study. The mean age of the population was 53.6±12.4. The overall mortality rate was 101 (74.8%). The 30-day mortality rate was significantly higher in the intubated group (90.6%) than in the tracheostomy group (55%) (P< 0.001). The mortality rate was 60% in the early (≤ 7 days) tracheostomy group and 50% in the late (>7 days) group. This difference was not statistically significant (P> 0.05). Tracheostomy is a preferred method in airway management of severe COVID-19 patients under mechanical ventilation; however, early tracheostomy during the first week of intubation may not be superior to late tracheostomy in decreasing the mortality rate. https://acta.tums.ac.ir/index.php/acta/article/view/10384 https://acta.tums.ac.ir/index.php/acta/article/download/10384/5796

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 61 6 2023 10 02 329 333 Masoumeh Mohebi Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran Matin Heidari Department of Molecular Biology, Islamic Azad University of Qom, Qom, Iran Mansour Heidari Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran 2022 12 11 2023 01 28 Herein we investigated mutations in the ABCA4 gene in an Iranian patient with Stargardt disease using whole exome sequencing (WES). We evaluated genetic alterations in a 13-year-old Iranian girl with Stargardt disease and her family using WES. The target sequences for the proband and her parents were then amplified through polymerase chain reaction (PCR) and the obtained products were screened for mutations in ABCA4 gene by Sanger chain terminating dideoxy nucleotide sequencing. Two novel potentially pathogenic mutations in compound heterozygous state (c.2713del p.E905Rfs*27 and c.5172G>A p.W1724X) were identified in ABCA4 gene which may contribute to the proband’s Stargardt disease phenotype. In general, the WES successfully identified novel causal mutations in ABCA4 gene which may be used for genetic counseling, prenatal diagnosis (PND), and preimplantation genetic diagnosis (PGD) of Stargardt disease.   https://acta.tums.ac.ir/index.php/acta/article/view/10473 https://acta.tums.ac.ir/index.php/acta/article/download/10473/5805

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 61 6 2023 10 02 334 340 Maziar Maghsoudloo assistant professor Sina Abbassi anesthesiologist Shahram Samadi associate professor Mohammad Taghi Beigmohammadi associate professor Asghar Hajipour assistant professor Mahboubeh Atashgahi Department of Anesthesiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Siavash Abbassi general practitioner Fariba Badrzadeh general practitioner Omid Nabavian assistant professor 2022 07 20 2023 02 06 The aim of this study was to compare the post-operation analgesic effects of patient-controlled epidural analgesia and patient-controlled intravenous analgesia for patients who were undergoing esophageal cancer surgery. This was a randomized clinical trial. 80 patients undergone esophagostomy were randomly divided into two groups: 40 patients in the epidural PCA and 40 patients in the intravenous PCA group were evaluated. Post-operation pain score was assessed using the universal pain assessment tool (UPAT) in both groups at 24 and 48 hours after surgery. Secondary outcomes included AKI, MI, CVA, pulmonary complications, ICU stay and three months survival. Mean pain scores were similar in the two groups (P>0.05). There was no significant difference between the two groups for rescue treatment, three months’ survival, CVA, MI and AKI. However, ICU stay (P=0.008) and pulmonary complications (P=0.05) were greater in PCIA group. The results indicate that none of the PCEA and PCIA methods have any superiority in terms of pain control and the incidence of analgesic-related side effect complications after surgery in patients undergoing esophagostomy and confirm sufficient analgesia by both. https://acta.tums.ac.ir/index.php/acta/article/view/10264 https://acta.tums.ac.ir/index.php/acta/article/download/10264/5806

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 61 6 2023 10 02 341 346 Amir Davoodabadi Farahani Department of Internal Medicine, Qom University of Medical Sciences, Qom, Iran Maryam Hassaninevisi Department of Pulmonology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Ali Sobhani Firoozabadi Department of Rheumatology, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran Seyed Mohamad Hosseinian Department of Internal Medicine, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran Fatemeh Shirani Department of Internal Medicine, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran 2022 06 16 2023 08 15 Osteoarthritis (OA) is the most common type of arthritis and although there is no definitive cure for it, there are treatments for symptom management. The present study was conducted to evaluate the effects of silicon dioxide (SiO2) on clinical symptoms of knee OA and compare it with avocado soybean unsaponifiable (ASU) and placebo. This study is a double-blind randomized clinical trial on 104 patients with knee OA referred to Rheumatology Clinic, Rasoul Akram Hospital, Tehran. Patients were randomly divided into three groups, including patients treated with ASU, SiO2, and placebo for 3 months. Subsequent referral was performed at weeks 4, 8, and 12, and the stiffness, physical function, and pain scores were recorded based on the WOMAC questionnaire. In this study, the effect of treatment of placebo and SiO2 and ASU in patients with knee OA based on WOMAC questionnaire showed a significant reduction in terms of pain, joint stiffness, physical function, and total scores of WOMAC in the cases of the SiO2 group compared with the other two groups. The findings of this study showed that the therapeutic effects of SiO2 in patients with knee OA in terms of pain and stiffness and physical function scores were more than the ASU and placebo groups. https://acta.tums.ac.ir/index.php/acta/article/view/10202 https://acta.tums.ac.ir/index.php/acta/article/download/10202/5808

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 61 6 2023 10 02 347 354 Masoud Motasaddi Zarandi Department of Otolaryngology Head and Neck Surgery, Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran Shadman Nemati Department of Otolaryngology Head and Neck Surgery, Otorhinolaryngology Research Center, Guilan University of Medical Sciences, Rasht, Iran Ahmad Daneshi Department of Otolaryngology Head and Neck Surgery, ENT and Head and Neck Research Center, Iran University of Medical Sciences, Tehran, Iran. Seyed Basir Hashemi Department of Otolaryngology Head and Neck Surgery, Otolaryngology Research Center, Shiraz, Iran. Ali Eftekharian Department of Otolaryngology Head and Neck Surgery, Cochlear Implant Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Mohsen Rajati Department of Otolaryngology Head and Neck Surgery, Sinus and Surgical Endoscopic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. Ali Kouhi Department of Otolaryngology Head and Neck Surgery, Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran Sevil Nasirmohtaram Department of Otolaryngology Head and Neck Surgery, Otorhinolaryngology Research Center, Guilan University of Medical Sciences, Rasht, Iran Ehsan Kazemnejad Leyli Department of Biostatistics, Otolaryngology Research Center, Guilan University of Medical Sciences, Rasht, Iran Maryam Khoshbakht Department of Nursing, Guilan University of Medical. Sciences, Rasht, Iran. 2023 04 28 2023 06 13 In order to decrease medical errors and improve organized, targeted education pre- and post-graduation, we intended to detect 10 most important concepts that neuro-otologists believe family physicians and general practitioners must know. A multi-center study based on Delphi’s method was designed and conducted in three stages. Of 31 topics gathered by expert panel, 10 top priorities were ranked based on 50 neuro-otologists’ opinion over the country. Early diagnosis and management of sudden sensorineural hearing loss, foreign body removal from external ear canal, proper management of otitis extern, and management of emergency situations in chronic otitis media gained the highest scores among all. Also, some topics, such as managing serous and acute otitis media, differentiating peripheral vs. central vertigos, and early hearing screening at birth were among top topics, contrary to others, such as surgery in only hearing ears, or hearing losses after COM surgeries. Almost all of the top-ranked topics are among critical/organ saving, or most prevalent medical concerns in all of the world. Sudden deafness, complicated COM, and mis-diagnosing vertigo may be organ/life threatening, while foreign bodies or inflammations of external ear, acute or serous otitis media, and congenital hearing loss are among the most prevalent medical problems worldwide, with numerous malpractices in their diagnosis and management. Regarding educational and practical priorities should be considered a basic step in neurotology field, and targeted programming policies. https://acta.tums.ac.ir/index.php/acta/article/view/10657 https://acta.tums.ac.ir/index.php/acta/article/download/10657/5809

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 61 6 2023 10 02 355 360 EN Mamak Shariat Maternal, Fetal and Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran Abolfazl Baghban Youssefkhani Tehran University of Medical Sciences, Tehran, Iran Hosein Dalili Breast Feeding Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran Negar Hajinasab l 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 cas