Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 63 4 2025 11 17 206 213 Mahsa Seifi Mansour Student Research Committee, Factulty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran. Hamid Noshad Kidney Research Center, Sina Hospital, Tabriz University of Medical Sciences, Tabriz, Iran. Soheil Teimouri Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. AND Department of Biostatistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran. Nasim Nourani Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. AND Social Determinants of Health Research Center, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. Afshin Gharekhani Pharmaceutical Analysis Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. 2024 10 16 2025 03 08 Venous thromboembolism (VTE) poses a significant risk to hospitalized patients, accounting for approximately 10% of morbidity cases among this population. However, preventive measures such as heparin and low molecular weight heparin (LMWH), along with mechanical interventions like graduated compression stockings (GCS), can effectively mitigate this risk. The aim of this study was to investigate the rational use of DVT prophylaxis regimen in hospitalized patients. A prospective and descriptive study was conducted randomly in various wards of the hospital throughout 2017. 335 participants were randomly assessed using an already designed questionnaire containing demographic information (age, weight, height, etc.), medical history, type of prophylaxis administered, laboratory tests, prescribed medications, the Geneva score for thrombosis risk evaluation (low risk: 0-2, high risk: ≥3), and bleeding risk assessment tool (low risk: 0-7, high risk: ≥7). Randomly, the medical records of 335 patients admitted to Sina Hospital and who received VTE prophylaxis with heparin (87.8%), enoxaparin (12.54%), and GCS (1.79%), were carefully reviewed over a period of 12 months. According to the guidelines, only 235 patients (70.1%) required anticoagulant prophylaxis, while the remaining 100 patients (29.8%) were not eligible for such prophylaxis. Additionally, out of the 335 patients studied, only 6 received GCS, although only one patient actually necessitated this intervention. Consequently, the total cost of inappropriate anticoagulant prophylaxis was estimated to be 68,270,500 Rials. The appropriate utilization rate of VTE prophylaxis was 70.1%, with heparin being the most commonly prescribed medication. Further, the study highlights the cost implications of inappropriate prescription practices. To address these issues, educational programs and the implementation of clinical practice guidelines within general Hospitals are highly recommended. https://acta.tums.ac.ir/index.php/acta/article/view/11308 https://acta.tums.ac.ir/index.php/acta/article/download/11308/5971

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 63 4 2025 11 17 214 220 Majid Mahmoud Alilou Department of Psychology, Faculty of Psychology and Educational Sciences, University of Tabriz, Tabriz, Iran. Abbas Bakhshipour Roudsari Department of Psychology, Faculty of Psychology and Educational Sciences, University of Tabriz, Tabriz, Iran. Khadijeh Adabi Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Surgery, Yas Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Zinat Ghanbari Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Farhan Noureh Department of Psychology, Faculty of Psychology and Educational Sciences, University of Tabriz, Tabriz, Iran. 2025 02 28 2025 07 14 Women with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome do not have proper performance and sexual satisfaction because of physical problems. MRKH syndrome leads to psychological and identity problems and has a negative effect on self-concept. This study aimed to compare the sexual satisfaction and self-concept of women with MRKH syndrome before and after vaginoplasty with normal women. The current study was a case study with a pre-test, post-test design and a control group. Fifteen people were selected using the purposeful sampling method, and 15 normal newly married women were also selected as a control sample group. In both groups, sexual satisfaction and self-concept questionnaires were administered; after the relevant vaginoplasty surgery, only in the test group, and after six months, both groups completed the sexual satisfaction and self-concept questionnaires as a post-test. Hudson's sexual satisfaction questionnaire and Rogers' self-concept questionnaire were used to collect the data. Data were analyzed using multivariate covariance analysis. The results indicated that the average levels of sexual satisfaction and self-concept in women with MRKH syndrome significantly increased after vaginoplasty in comparison to their preoperative scores; but compared to the women of the control group, it is lower. To increase sexual satisfaction and improve the self-concept of women with MRKH syndrome, vaginoplasty surgery can be used as an effective treatment and an efficient program. https://acta.tums.ac.ir/index.php/acta/article/view/11561 https://acta.tums.ac.ir/index.php/acta/article/download/11561/5972

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 63 4 2025 11 17 221 224 EN Mamak Shariat Maternal, Fetal & Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran Zahra Molla Ahmadipour Maternal, Fetal & Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran . Hosein Dalili Maternal, Fetal & Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran . Samira Moradi Samira Moradi, Reproductive Health & Midwifery Dep, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran. Yasamin Soufi Enayati Maternal, Fetal & Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran . Farima Raji Maternal, Fetal & Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran . 2024 12 31 2025 02 10 Intraventricular hemorrhage can be associated with various complications that ultimately lead to brain damage. This study aimed to investigate the factors affecting intraventricular hemorrhage in term neonates. This case-control study compared 58 full-term neonates with an IVH diagnosis and 100 healthy full-term neonates. Information on exposure to maternal and prenatal risk factors was collected from Vali-e-Asr Hospital's neonatal information system between 2016 and 2018. Data were collected and analyzed in SPSS software. In this study, risk factors significantly associated with IVH included male gender, respiratory distress, pneumothorax, hydrocephalus, thrombocytopenia, anemia, vitamin K deficiency, asphyxia, hypoglycemia, the need for resuscitation at birth, the requirement for mechanical ventilation, and low weight for gestational age. The mean Apgar score of the first and fifth minutes was significantly lower in the IVH group. The results of this study will determine the risk factors affecting intraventricular hemorrhage to predict and manage brain injury in term neonates. https://acta.tums.ac.ir/index.php/acta/article/view/11441 https://acta.tums.ac.ir/index.php/acta/article/download/11441/5980

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 63 4 2025 11 17 225 230 Alia Kareem Mohamad AL-Qarawy Department of Obstetrics and Gynecology, College of Medicine, University of Al-Qadisiyah, Al-Diwaniyah Province, Iraq. 2024 12 23 2025 02 11 Anti-Müllerian Hormone (AMH) AMH inhibits follicle recruitment and may reduce FSH action, contributing to ovulatory issues in females. PCOS patients often receive metformin treatment. This study aimed to investigate metformin's effect on serum AMH levels in PCOS women and its impact on ovulation and pregnancy rates. This interventional study was performed between June 2023 and June 2024. 100 PCOS women attending the infertility departments of Maternity Teaching Hospital in Adiwniyah province, Iraq, were invited to participate in the study. PCOS was diagnosed based on the Rotterdam consensus statements criteria. Metformin was given to 50 women (study group) and 50 women received placebo o serve as a control group. After 3 months, comparison of mean serum AMH between study groups revealed significant variation (P=0.020) and this significant variation became more pronounced 6 months later (P<0.001). In case of placebo group, comparison of baseline mean serum AMH to those after 3 months and after 6 months revealed minimal no significant changes (P>0.05); whereas the use of metformin resulted in significant reduction of mean serum AMH 3 months later (P=0.006) and the reduction was more significant 6 months later (P<0.001). The rate of ovulation and the rate of positive pregnancy test were reported to be higher significantly in metformin group in contrast to placebo group (P=0.001 and 0.016, respectively). Metformin treatment is efficient and safe in reducing serum AMH in women with PCOS, thus indicating reduction in antral follicle count and changes in overall hormonal status that can improve ovulation and pregnancy in those women. https://acta.tums.ac.ir/index.php/acta/article/view/11426 https://acta.tums.ac.ir/index.php/acta/article/download/11426/5974

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 63 4 2025 11 17 231 236 Farhad Nazarinasi Department of Biochemistry, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Siavash Gerayeshnejad Department of Biochemistry, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Nasrin Dashti Department of Laboratory Science, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran. Khosrow Rahbar Department of Nephrology and Urology, Mehrad Hospital, Tehran, Iran. 2025 05 24 2025 08 27 Chronic kidney disease (CKD) is characterized by systemic inflammation and the accumulation of uremic toxins such as indoxyl sulfate (IS), which induces fibrogenic signaling via transforming growth factor-beta 1 (TGF-β1). Forty CKD patients and ten healthy controls were enrolled. IS was measured by HPLC, TGF-β1 protein by ELISA, and TGF-β1 mRNA by RT-qPCR in PBMCs. IS and TGF-β1 mRNA levels increased significantly with CKD stage, particularly in stages 3 and 4. TGF-β1 mRNA correlated with IS levels (R=0.4, P<0.01), while TGF-β1 protein levels were associated with platelet count (R=0.817, P<0.001). TGF-β1 mRNA in PBMCs may serve as an early biomarker of CKD-related fibrosis. IS is a key uremic toxin influencing fibrogenic gene expression. https://acta.tums.ac.ir/index.php/acta/article/view/11674 https://acta.tums.ac.ir/index.php/acta/article/download/11674/5975

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 63 4 2025 11 17 237 246 EN Razieh Hajizadeh Department of Physical Education and Sport Sciences, Science and Research Branch, Islamic Azad University, Tehran, Iran. Hashem Piri Department of Corrective Exercise & Sport Injury, Faculty of Physical Education and Sport Sciences, Allameh Tabataba'i University, Tehran, Iran. Nader Naserpour Department of Corrective Exercise & Sport Injury, Faculty of Physical Education and Sport Sciences, Allameh Tabataba'i University, Tehran, Iran. Somayeh Mozafari Department of Corrective Exercise & Sport Injury, Faculty of Physical Education and Sport Sciences, Allameh Tabataba'i University, Tehran, Iran. 2025 03 03 2025 04 02 Fatigue decreases muscle strength and functional capacity, disrupting neuromuscular coordination by impairing load control. This negatively impacts the kinetics and kinematics of the ankle, knee, and hip joints, resulting in reduced performance and an increased risk of injury, particularly to the anterior cruciate ligament (ACL). This study aimed to compare the effects of fatigue protocols for lower extremity and core muscles on landing mechanics and performance of female athletes. This study used a cross-sectional, comparative, pretest-posttest design with a control group. A total of 105 female athletes, aged 11 to 49, were selected via convenience and purposive sampling. Participants were divided into three groups: core muscle fatigue, lower extremity muscle fatigue, and a control group. Data were gathered using the Landing Error Scoring System (LESS), Y-Balance, and 45-degree trunk flexion tests. Data were analyzed using descriptive statistics, Shapiro-Wilk test, Levene's test, one-way ANCOVA, and the Bonferroni post hoc test. A P of 0.05 or lower was considered statistically significant. ANCOVA results showed significant differences among the groups for the LESS (P=0.001) and 45 ° trunk flexion test (P=0.001). There was no significant difference between the two experimental groups regarding the LESS (P=1.00). However, a significant difference was observed between the two experimental groups in the trunk flexion test (P=0.001). Fatigue had a greater effect size on landing mechanics (ηp²=0.209) than on the trunk flexion test (ηp²=0.143). However, no significant difference was observed between the groups regarding the Y-Balance Test (P=0.996). The study revealed that fatigue protocols targeting lower extremity and core muscles had a negative impact on kinematic parameters associated with ACL injuries during jump-landing in female athletes. Additionally, core muscle fatigue significantly impacted the 45º trunk flexion test, while lower extremity muscle fatigue had no significant effect on it. https://acta.tums.ac.ir/index.php/acta/article/view/11559 https://acta.tums.ac.ir/index.php/acta/article/download/11559/5976

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 63 4 2025 11 02 247 254 Narsis Ghahramani Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran. Pegah Mirzapour Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran. Tina Eslambeik https://acta.tums.ac.ir/index.php/acta/article/view/11935 https://acta.tums.ac.ir/index.php/acta/article/download/11935/6032

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 64 3 2026 05 20 160 169 Ahmed Ali Al-Mashhadani Surgery department, College of Medicine, University of Al-Mustansiriyah, Iraq. 2025 12 24 2026 01 24 Background: Endo-Venous Radio-Frequency Ablation (EVRF) is widely used for treating varicose veins, offering a minimally invasive alternative to traditional surgery. However, the trajectory of postoperative symptoms, recurrence patterns, and patient-centered outcomes remains variable across populations. Objective: To evaluate postoperative symptom changes, vein occlusion patterns, recurrence, cutaneous effects, patient satisfaction, and quality of life in patients undergoing EVRF over a one-year follow-up period. Methods: A prospective observational study was conducted on 125 patients treated with EVRF in Dijlah Privet Hospital, Miysan, Iraq. Clinical outcomes—including paresthesia, thrombophlebitis, ecchymosis, redness and skin changes, cellulitis, recurrence, occlusion rate, patient satisfaction, and quality of life—were assessed using a standardized four-point scoring system. Evaluations were performed at week one, 30 days, and one year. Paired t-tests were applied to compare temporal changes. Results: Significant early improvements were observed across most clinical indicators. Paresthesia decreased from 1.3462 at week one to 1.0692 at 30 days (p < 0.001). Redness, skin changes, thrombophlebitis, and ecchymosis demonstrated similar reductions. Recurrence improved significantly from 0.9846 to 0.6769 at one year (p < 0.001). In contrast, occlusion scores declined from 2.8846 at week one to 1.9231 at one year (p < 0.001), suggesting partial recanalization. Quality-of-life scores improved significantly from 3.6154 to 2.4154 (p < 0.001). Despite these objective improvements, patient satisfaction decreased from 2.8154 to 1.8538 over the same period (p < 0.001). Cellulitis showed no significant change (p = 0.074). Conclusion: EVRF provides substantial early postoperative benefits and long-term improvements in quality of life, with low complication rates. However, reduced occlusion durability and declining patient satisfaction highlight the importance of standardized imaging follow-up and enhanced patient counseling to optimize long-term outcomes.   https://acta.tums.ac.ir/index.php/acta/article/view/11956 https://acta.tums.ac.ir/index.php/acta/article/download/11956/6035

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 64 3 2026 05 20 170 178 Roozbeh Cheraghali Vascular and Endovascular Surgery Department, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Sepide Javankiani Department of General Surgery, Tehran University of Medical Sciences, Tehran, Iran Yasin Alipour Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran Seyed Amir Miratashi Yazdi Department of Surgery, Sina Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran 2025 08 03 2025 11 02 Introduction: The survival of arterio-venous (AV) fistula and the high rate of hospitalization of these patients (about 20% of the hospitalizations of these patients) are one of the most important challenges of the health system in the management of ESRD patients all over the world. Since AVF failure increases the mortality of patients and causes an increase in treatment costs, determining the optimal site (distal radiocephalic vs. antecubital brachiocephalic) as well as patient factors influencing functional success is crucial. Methods: This observational study was conducted in 2022 on ESRD patients, candidates for hemodialysis who underwent fistula bypass surgery in a tertiary center. Fifty patients we enrolled in the distal radiocephalic fistulas (DRF) groups, and 50 received antecubital brachiocephalic fistulas (ACBF). Demographic characteristics of the patients, such as age, gender, history of diabetes, high blood pressure, and smoking, were recorded. The primary outcome was AVF maturation at 120 days (functional vs. failed). A secondary outcome was early failure, defined as the absence of bruit or thrill within 30 days. Results: 100 patients were examined in two groups (according to the location of the fistula), and the average age was reported as 52.4 ± 12.5. AVF failure was reported in 38% of patients, of which 26% occurred within the first 30 days and 12% occurred within 30 to 120 days. The AVF failure rate was similar between DRF and ACBF groups (P value: 1.00).  No statistically significant difference was seen for the failure rate of fistulas based on gender (P value: 0.715).  In adjusted analysis, each additional year of age increased the odds of maturation by 4.3% (OR 1.043, 95% CI 1.004–1.083; P value = 0.029), and hypertension was independently associated with higher maturation odds (OR 2.747, 95% CI 1.119–6.746; P value = 0.027). For early failure (<30 days), female patients had 4.7-fold higher odds of failure than males (OR 4.676, 95% CI 1.556–14.048; p = 0.006), while other covariates showed no significant associations. Conclusion: This study examined the factors that contribute to the failure of arteriovenous fistulas in ESRD patients who are eligible for hemodialysis. The findings demonstrated that various factors, including age and history of hypertension, can affect its success rate. These results are congruent with previous articles and emphasize the importance of choosing the correct type of fistula and careful management of risk factors in improving treatment. https://acta.tums.ac.ir/index.php/acta/article/view/11751 https://acta.tums.ac.ir/index.php/acta/article/download/11751/6036

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 64 3 2026 04 21 133 137 Rana Matrood Alkhazraji Department of Obstetrics and Gynecology, College of Medicine, University of Al-Qadisiyah, Al-Qadisiyah, Iraq. 2025 12 03 2025 12 23 Some studies have concluded that PI and RI play an inadequate role in distinguishing benign tumors from malignant ones; however, later studies have reported different results, showing that Doppler ultrasound is effective in differentiating malignant from non‑malignant ovarian masses by using specific threshold values for both RI and PI. The presence of such conflicting data justifies our study. The purpose of this project was to use color Doppler and ultrasound imaging to differentiate between malignant and benign ovarian tumors and to verify the findings by comparing them with histopathology. Over the course of two years, 86 patients with ovarian masses were evaluated for morphologic features, pulsatility indices (PI), and resistance indices (RI) using Doppler ultrasound. Histopathologic confirmation served as the basis for the final diagnosis. The cutoff value for RI was ≤0.39 and for PI was ≤1.1, as shown in figures 1 and 2 and table 1. The sensitivity, specificity, and positive and negative predictive values were all 100%. Doppler ultrasound provides effective tools, including resistive and pulsatility indices, that can be used to differentiate between benign and malignant ovarian masses.     https://acta.tums.ac.ir/index.php/acta/article/view/11921 https://acta.tums.ac.ir/index.php/acta/article/download/11921/6029

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 64 3 2026 04 21 11326 11326 Fariba Abbasi Department of Pathology, Solid Tumor Research Center, Cellular and Molecular Medicine Institute, Urmia University of Medical Sciences, Urmia, Iran. َأَِAND Department of Pathology, Faculty of Medicine, Urmia University o Medical Sciences, Urmia, Iran. Ata Abbasi Department of Pathology, Faculty of Medicine, Urmia University o Medical Sciences, Urmia, Iran. AND Department of Pathology, Cellular and Molecular Research Center, Cellular and Molecular Medicine Institute, Urmia University of Medical Sciences, Urmia, Iran