Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 64 8 2026 07 12 477 481 Narjes Yektaeian Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. Ali Abbas Saheli Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. Majid Dousti Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran Vahid Ķhatamifar Vice Chancellor for Health, Shiraz University of Medical Sciences, Shiraz, Iran. Manouchehr Shirani 1 Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. Gholamreza Hatam Basic Sciences in Infectious Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. 2024 11 06 2025 12 07 Iran ranks among the top ten countries for leishmaniasis and COVID-19 outbreaks. This study compared cutaneous leishmaniasis (CL) cases in Shiraz one year before and one year after the COVID-19 outbreak. In this study, the recorded information of 988 suspected cutaneous leishmaniasis (CL) patients referred to Valfajr Health Center was meticulously collected, prepared, and analyzed using the SPSS-24 Software and the Chi-square test. Comparing the pre-outbreak period (February 2019-March 2020) to the post-outbreak period (March 2021), 57.9% of 526 suspected CL cases were positive before the outbreak versus 76.4% of 462 cases after the outbreak. Pre-outbreak, women constituted 53.8% of CL cases, whereas post-outbreak, men constituted 55.8% of cases. The presence of underlying conditions, notably diabetes and hypertension, increased 3.5 times after the COVID-19 outbreak. Employment status also shifted, with increases in employed (from 5.3% to 10.5%) and self-employed (from 44.4% to 47.7%) individuals and a decrease in housewives (from 48.3% to 37.6%). COVID-19 has significantly impacted CL parameters, particularly gender distribution, employment status, and the acute-chronic nature of the disease, due to increased economic activity and community presence. https://acta.tums.ac.ir/index.php/acta/article/view/11347 https://acta.tums.ac.ir/index.php/acta/article/download/11347/6082

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 64 8 2026 07 12 482 488 Shahad Sabah Khudhair Asst/Lecturer, College of Nursing/ University of Kerbala/Iraq Haneen Qahtan Abadi Department of Nursing, College of Nursing, University of Kerbala, Kerbala, Iraq Aqelah Mohmmed Hashim Department of Nursing, College of Nursing, University of Kerbala, Kerbala, Iraq. Mithal Yaseen Abed Department of Nursing, College of Nursing, University of Kerbala, Kerbala, Iraq. Zineb Hussien Department of Nursing, College of Nursing, University of Kerbala, Kerbala, Iraq. Noor Ali Department of Nursing, College of Nursing, University of Kerbala, Kerbala, Iraq. 2026 01 25 2026 02 24 Skin cancer is an emerging public health challenge worldwide, and nurses are pivotal in preventing and detecting this disease. It is crucial to evaluate the skin cancer knowledge and preventive behavior of nursing students. This study aimed to determine the level of knowledge and prevention behaviors on skin cancer among nursing students and to determine the relationship between the variables of knowledge, prevention behaviors, and selected demographic variables. Cross-sectional descriptive research was carried out from November 2024 to April 2025 among undergraduate nursing students at the College of Nursing, University of Karbala, Iraq. Sixty undergraduate nursing students constituted the purposive sample. The data were collected using a structured 20-item questionnaire consisting of 8 preventive behaviors and 12 knowledge questions, scored on a uniform five-point Likert scale. The content validity was assessed through expert review, and good reliability was confirmed by high Cronbach’s alpha (α=0.87). Data analysis was performed using SPSS version 27. Non-normality of distribution was determined via the Kolmogorov-Smirnov test, which led to employing the Spearman correlation and multiple linear regression. Most of the participants had moderate levels of preventive practices (98.3%) and knowledge (95%). There was no statistically significant relationship between the participants’ knowledge and their preventive practices (r=0.044, P=0.737). There were no statistically significant effects of demographic factors on preventive practices (P>0.05). Nursing students demonstrated moderate levels of knowledge and preventative practice; however, there are still deficiencies in terms of early detection techniques. There is need to reinforce structured education and training approaches in nursing courses. https://acta.tums.ac.ir/index.php/acta/article/view/11983 https://acta.tums.ac.ir/index.php/acta/article/download/11983/6095

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 64 8 2026 07 12 482 488 Shima Movahed Department of Radiology, Ali Ibne Abitaleb Hospital, Zahedan University of Medical Sciences, Zahedan, Iran Amin Mashhadi Department of Radiology, Ali Ibne Abitaleb Hospital, Zahedan University of Medical Sciences, Zahedan, Iran Abdulbaset Maleknejad Department of Surgery, Ali Ibne Abitaleb Hospital, Zahedan University of Medical Sciences, Zahedan, Iran Mahshid Mashhadi Freelance Researcher, Zahedan, Iran Mohamad Hoseinian Freelance Researcher, Elina private medical center, Tehran, Iran Sedigheh Masoodian Freelance Researcher, Elina Private Medical Center, Tehran, Iran Mohadeseh Zadehmir Department of Radiology, Ali Ibne Abitaleb Hospital, Zahedan University of Medical Sciences, Zahedan, Iran 2024 07 15 2025 04 03 Common Bile Duct (CBD) dilation is detected in many patients, both symptomatic and asymptomatic. It can be challenging to diagnose unexplained dilated CBD. The purpose of this study was to investigate the causing factors of CBD dilation in bowel obstruction and their relationship to one another. The prospective cross-sectional study included patients with bowel obstruction referred to two tertiary referral hospitals between 2019 and 2021. All patients in the emergency unit were examined by colorectal surgeons, and they were given IV and oral contrast-enhanced CT scans. We included patients with a dilated common bile duct and bowel obstruction. After that, we determined the causes of CBD dilatation in patients with obstruction. In cases without a specific cause, we investigated its relationship to the bowel loop diameter. Of 226 patients with intestinal obstruction referred to our hospital, 97 underwent CT scans of the abdomen, of which 35 (36%) had dilated CBDs. The mean age of the patients was 58±13 years; 66% of patients were male. CBD dilatation was commonly associated with aging (18 cases, 51%), addiction (4 cases, 11%), and cholecystectomy (3 cases, 9%). A CT scan showed dilated CBD in eight patients (23%) without a specific cause. CBD diameter and, sex did not differ significantly. Patients with unknown causes have a mean bowel diameter of 53.75±11.97 mm. CBD diameter correlated considerably with bowel diameter (P=0.001). This cross-sectional study suggests a possible association between CBD and bowel loop dilation, rather than establishing a cause-and-effect relationship. https://acta.tums.ac.ir/index.php/acta/article/view/11163 https://acta.tums.ac.ir/index.php/acta/article/download/11163/6093

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 64 8 2026 07 12 494 498 Ashraf Alhusseini Hammurabi College of Medicine, University of Babylon, Babylon, Iraq 2026 04 07 2026 05 02 - Bilateral total hip replacement (BTHR) is an effective surgical solution for patients with bilateral hip osteoarthritis and avascular necrosis. The procedure can be performed either as a single-stage operation or as two staged session surgeries. To compare single-stage bilateral total hip replacement with staged two-session bilateral total hip replacement, with particular emphasis on functional outcomes and early postoperative recovery. A prospective comparative observational study. Sixty patients aged 45-65 years with bilateral hip osteoarthritis or avascular necrosis and without any major comorbidity were enrolled. Thirty patients were operated on in a single stage, and 30 had the two hips replaced separately with an interval of 6-12 weeks. All surgeries were conducted through a posterolateral approach. Measures were total hospital stay, total rehabilitation time, and time to symmetric normal gait 12 months post-surgical follow-up using the OHS. Baseline demographic characteristics and underlying diagnoses were comparable between groups. The single-stage group demonstrated a significantly shorter hospital stay, reduced rehabilitation duration, and earlier achievement of symmetric normal gait compared with the staged group (P<0.001). Additionally, functional outcome was significantly higher in the single-stage group, as reflected by superior OHS scores at 12 months (P<0.001). Single-stage bilateral total hip replacement provides a better early functional recovery, shorter hospital stays, and faster rehabilitation than staged two-session surgery in properly selected patients. Our results justify single stage BTHR as a safe and effective option when selection of patients and preoperative optimization are well thought out. https://acta.tums.ac.ir/index.php/acta/article/view/12000 https://acta.tums.ac.ir/index.php/acta/article/download/12000/6094

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 64 8 2026 07 12 499 505 Mobin Khoshbin Cardiovascular Research Center, Shahid Rahimi Hospital, Lorestan University of Medical Sciences, Khorramabad, Iran. AND Department of Clinical Biochemistry, Lorestan University of Medical Sciences, Khorramabad, Iran. Seyyed Amir Yasin Ahmadi Clinical Cancer Research Center, Milad General Hospital, Tehran, Iran Fatemeh Ahmadpour Razi Herbal Medicines Research Center, Lorestan University of Medical Sciences, Khorramaba Gholamreza Shahsavari Cardiovascular Research Center, Shahid Rahimi Hospital, Lorestan University of Medical Sciences, Khorramabad, Iran. AND Department of Clinical Biochemistry, Lorestan University of Medical Sciences, Khorramabad, Iran. 2024 09 10 2025 04 05 According to importance of PECAM1 in pathogenesis atherosclerosis, we intend to investigate the Val125Leu and Gly670Arg polymorphisms with risk of atherosclerosis in the Lur population of Iran among the individuals who underwent coronary angiography. A genetic association study was performed on 154 approved cases of atherosclerosis and 145 ruled out cases for atherosclerosis based on the expert opinion of interventional cardiologists. Atherogenic indices including atherogenic coefficient (AC), non-HDL-C fraction, Castelli’s Risk Indices-I and -II (CRI-I and -II), atherogenic index of plasma (AIP), and Triglycerides-Glucose (TYG) were all calculated. Logistic regression was used and odds ratio (OR) was reported. Genotype Leu/Leu showed an association with increased risk of atherosclerosis. However, this association was not statistically significant (odds ratio [OR]=1.86, P=0.066). Allele Leu showed an association with increased risk of atherosclerosis. However, this association was not statistically significant (OR=1.34, P=0.069). For polymorphism Gly670Arg, no genotype or allele was associated with risk of atherosclerosis (P>0.05). The most important atherogenic index was AC (area under curve=0.719). After adjusting genotype Leu/Leu with AC as well as age, gender and body mass index, a significant harmful effect was observed for this genotype (OR=2.35, P=0.041). Susceptibility to atherosclerosis does not have a crude association with Val125Leu and Gly670Arg polymorphisms of PECAM1 gene among the patients with acute chest pain in Lur population of Iran. However, besides AC and some demographic variables, genotype Leu/Leu showed a harmful association https://acta.tums.ac.ir/index.php/acta/article/view/11240 https://acta.tums.ac.ir/index.php/acta/article/download/11240/6086

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 64 8 2026 07 12 506 514 Nada Hamzah Shareef Al Shabbani Department of Pathology, College of Medicine, Wasit University, Kut, Iraq Marwa Jamal Hussain Al-Kinani College of Medicine, University of Sumer, Dhi Qar, Iraq Iqbal Abed Fahad Department of Obstetrics and Gynecology, College of Medicine, Wasit University, Al-Kut, Iraq 2026 02 24 2026 04 06 Tumor stage and molecular phenotype are both powerful predictors of clinical behavior and therapeutic responsiveness of breast cancer. Although the most used IHC biomarkers, including ER, PR, HER2, Ki-67, and PD-L1, are actively applied in practice, the dynamics of their integration and their connection with the tumor microenvironment (TME) have not been fully described within a single cohort. This retrospective cross-sectional study involved 70 consecutive patients with primary invasive breast carcinoma (Al-Zahraa Teaching Hospital, Iraq; January 2023-December 2024), stratified according to AJCC TNM staging (8th edition). ER, PR, HER2, Ki-67, and PD-L1 (clone 22C3; tumor proportion score [TPS]) IHC were performed on FFPE tissue. Surrogate IHC criteria were used to assign molecular subtypes; TME characteristics (TILs, stromal density, CD163) were evaluated on H&E sections. Inter-observer agreement (Cohen’s κ), chi-square/Fisher’s exact tests, and Cramer’s V effect sizes were applied. ER positivity declined from 85.7% (Stage I) to 28.6% (Stage IV) (P=0.008; V=0.41); PR declined similarly (78.6% to 14.3%; P=0.004; V=0.44). HER2, Ki-67 (>20%), and PD-L1 (TPS≥1%) increased with advancing stage (P=0.042, <0.001, and 0.011, respectively). Spearman’s correlations confirmed significant stage trends: Ki-67 (ρ=0.62; 95% CI: 0.45-0.75; P<0.001), PD-L1 (ρ=0.38; 95% CI: 0.16-0.56; P=0.001), ER (ρ=−0.44; P<0.001), and PR (ρ=−0.46; P<0.001). Stages III-IV were characterized by a predominance of aggressive subtypes (HER2-enriched, TNBC). High TILs were correlated with TNBC and PD-L1-positive tumors; dominance of M2 macrophages was significantly correlated with PD-L1 expression (Fisher’s exact P=0.009). Combinatory biomarker profiling and TME characterization identify stage-specific changes that could be used to improve patient stratification and guide therapeutic choices, especially the choice of immunotherapy in metastatic breast cancer. Future multicentric validation using standardized genomic subtyping is justified. https://acta.tums.ac.ir/index.php/acta/article/view/12037 https://acta.tums.ac.ir/index.php/acta/article/download/12037/6087

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 64 8 2026 07 12 515 520 Nader Faraji School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran Mohammad kazem Sabzehei Department of Pediatrics, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran Fatemeh Eghbalian Department of Pediatrics, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran Maryam Shokouhi Department of Pediatrics, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran Hamid Borghi Department of Health Information Technology, Hamadan University of Medical Sciences, Hamadan, Iran. 2025 01 26 2025 10 05 Phenobarbital has long been recognized as a first-line treatment for neonatal seizures. However, due to its side effects and variable effectiveness, levetiracetam has emerged as a potential alternative in some studies, though consensus on this issue remains elusive. This clinical trial aims to compare the efficacy and safety of levetiracetam as a first-line agent for managing neonatal seizures. The study involved 40 neonates, aged 36 to 44 weeks gestational age, who were admitted to the neonatal intensive care unit for clinical seizures and met the inclusion criteria. Participants were randomly assigned to receive either phenobarbital (20 mg/kg intravenously over 15 minutes) or levetiracetam (50 mg/kg intravenously over 15 minutes). If seizures persisted or recurred a second dose was given. If seizures continued after the second dose, a second anticonvulsant was added to the treatment regimen. Cessation of seizures for 24 hours duration after drug administration is considered as primary outcome measure. The two groups were compared based on seizure termination, number of doses administered, need for additional medications, and side effects. Baseline characteristics were similar between the two groups. After the first dose, seizure termination rates were 95% for the levetiracetam group and 85% for the phenobarbital group (P=0.333). Side effects were reported in 20% of neonates receiving phenobarbital (including two cases of bradycardia and irritability) compared to 5% in the levetiracetam group (one case of irritability) (P=0.196). There were no statistically significant differences regarding changes in the treatment regimen or the number of anticonvulsant drugs used. In conclusion, the results of this study indicate that levetiracetam is equally effective as phenobarbital in controlling neonatal seizures and may present a preferable option due to its reduced side effect profile. https://acta.tums.ac.ir/index.php/acta/article/view/11504 https://acta.tums.ac.ir/index.php/acta/article/download/11504/6088

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 64 8 2026 10 18 521 530 Venkatesan Ram Department of Periodontology, Manipal College of Dental Sciences Mangalore, Manipal, Academy of Higher Education, Manipal, India Ashita Uppor Department of Periodontology, Manipal College of Dental Sciences Mangalore, Manipal, Academy of Higher Education, Manipal, India David Kadakampally Department of Periodontology, Manipal College of Dental Sciences Mangalore, Manipal, Academy of Higher Education, Manipal, India 2025 01 04 2025 07 26 The objective of the present study was to compare the clinical outcomes between Coronally Advanced Flap (CAF) without Vertical Releasing Incisions (VRIs) and Modified Semilunar Coronally Advanced Flap (MSCAF) and to evaluate the patient centered outcome for CAF without VRIs and MSCAF using Visual Analog Scale (VAS). Ten systemically healthy patients (8 males and 2 female) with a mean age of 41.9 years (range 24-54 years) presented with 47 labial/buccal Miller class I gingival recession defects, were randomly assigned to CAF without VRIs or MSCAF. Clinical parameters assessed included recession height, recession width, probing depth, clinical attachment level, width of keratinized tissue, gingival thickness, full mouth plaque and gingival score. Clinical recordings were performed at baseline and 6 months later. Inter-measurements differences were analysed with a paired t-test, with significance set at α<0.05. Both techniques were effective in obtaining and maintaining a coronal displacement of the gingival margin. The CAF without VRIs resulted in significant clinical improvements better than MSCAF for percentage of root coverage (RC). A statistically significant difference between groups was demonstrated in terms of overall aesthetic result (P=0.01; S), root coverage (P=0.04; S) on visual analog scale. Six months results showed both techniques can be successfully used to treat Class I gingival recession. However, patient-centered outcomes, such as overall esthetic result and root coverage favoured CAF without VRIs therapy. https://acta.tums.ac.ir/index.php/acta/article/view/11447 https://acta.tums.ac.ir/index.php/acta/article/download/11447/6092

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 64 8 2026 07 12 531 544 Paulraj Ranjith kumar PSR Engineering College, Sivakasi, Tamilnadu, India. P Govindamoorthi PSR Engineering College, Sivakasi, Tamilnadu, India. 2024 07 22 2026 02 10 Atherosclerosis is a medical condition where plaque accumulates in the arteries. It is important to detect and intervene early to minimize the negative effects of atherosclerosis on a person's health. The World Health Organization (WHO) states that 17.9 million deaths globally are caused by cardiovascular diseases (CVDs), the primary cause of death in the country. Several medical innovations and advancements were being explored in the field of atherosclerosis. The proposed research aims to build a system based on artificial intelligence (AI) automatic framework for an accurate detection and classification of Atherosclerosis using a hybrid REMORA Optimized Recurrent Neural Network with Long Short. Term Memory (RO-RNN-LSTM) method. In this work, various techniques for feature selection, preprocessing, and classification are implemented to achieve more accuracy. The min-max normalization followed by the relevant features from the preprocessed data are extracted using the innovative REMORA Optimization method. To maximize accuracy and minimize classifier time, the dimensionality of features was reduced in this work. The publicly available datasets such as Cleveland, Kaggle (CVD) and Stulong are used to evaluate the proposed algorithms. The prediction findings indicate that utilizing the RO-RNN-LSTM algorithms improves accuracy up to 98.5%, sensitivity to 98.7%, specificity to 95.4%, recall to 98.7% and f1-score to 98.7%. The RO-RNN-LSTM exhibits superior performance outcomes while processing large dimensional medical datasets, according to the overall comparison investigation and analysis. https://acta.tums.ac.ir/index.php/acta/article/view/11173 https://acta.tums.ac.ir/index.php/acta/article/download/11173/6090

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 64 8 2026 08 11 11862 11862 Farahnaz Ahmady Department of Obstetrics and Gynecology, Golestan University of Medical Sciences, Gorgan, Iran. Mahvash Nematollahi Department of Pathology, Golestan University of Medical Sciences, Gorgan, Iran. Mahboubeh Tajaldini Ischemic Disorders Research Center, Jorjani Clinical sciences Research Institute, Golestan University of Medical Sciences, Gorgan, Iran. 2025 10 28 2026 05 16 Ovarian cysts are a common occurrence during pregnancy and are typically benign and asymptomatic. Their treatment is based on size, symptoms, and possible complications. Most cysts can be limited to the adnexal region, but as the embryo grows, anatomical displacement may cause some unexpected intraoperative findings. We report the case of a 32-year-old primigravida with a progressively enlarging ovarian cyst, initially measured at 70 mm and later reaching 95 mm by term. Repeat prenatal ultrasounds consistently localized the cyst to the right adnexal area. During elective cesarean section, however, the cyst was not found in its expected location. Extensive intraoperative exploration revealed the mass in the upper abdomen, near the liver and adherent to the posterior abdominal wall. Due to its high position, removal through the standard Pfannenstiel incision was not feasible. A paramedian incision was performed, allowing successful excision of the cyst with no intraoperative or postoperative complications. This case highlights the potential for adnexal masses to migrate during pregnancy, complicating surgical management. It underscores the importance of thorough intraoperative exploration and surgical adaptability when imaging findings do not correlate with anatomical reality. The innovative use of a paramedian incision enabled safe and effective removal of the cyst, demonstrating a successful outcome in a complex scenario. This report contributes valuable insight into the management of atypically positioned ovarian cysts during cesarean delivery. https://acta.tums.ac.ir/index.php/acta/article/view/11862 https://acta.tums.ac.ir/index.php/acta/article/download/11862/6091