TEHRAN UNIVERSITY MEDICAL JOURNAL
Year:2022 | Volume:80 | Issue:6|Papers Count:11

Nonalcoholic fatty liver disease (NAFLD) is defined by steatosis in more than 5% of liver cells, in the absence of a secondary cause such as drugs, alcohol, or other causes. The incidence of NAFLD is increasing every day,almost a quarter of the world's adult population is affected by this disease. The burden of NAFLD is affected by the epidemics of obesity and type 2 diabetes (T2DM), and therefore, we do not expect the prevalence of this disease to decrease in the future. The world is now in the process of passing on health to non-chronic diseases, like NAFLD. The most common cause of chronic liver disease worldwide is non-alcoholic fatty liver disease. About 25 percent of the world's population is affected by the disease, and it ranges from simple steatosis to cirrhosis. 1 in 4 individuals with NAFLD is a person with non-alcoholic steatohepatitis, which is associated with complications and significant mortality and morbidity due to complications such as liver cirrhosis and hepatocellular carcinoma. Non-alcoholic fatty liver disease is closely related to metabolic syndrome, and it can be said that the liver is an integral part of obesity. Diagnostic methods for this disease include laboratory tests, imaging studies and liver biopsy. Although NAFLD is observed predominantly in obese persons or type 2 diabetes, an estimated 7% to 20% of people with NAFLD have lean body habitus. Recent studies have shown that fatty liver can occur in lean individuals, even without abdominal and visceral fat. Fatty liver in lean people (Lean NAFLD) is a relatively new concept that has attracted many people to find the differences between lean and obese people. The pathophysiological mechanisms of lean NAFLD are still poorly understood. Studies have shown that NAFLD without obesity is more closely related to factors such as environmental, genetic susceptibility, and epigenetic regulation. In addition to lifestyle modifications such as weight loss, diet and physical activity, only a few NAFLD-specific drug treatment options such as vitamin E and pioglitazone are considered. This article discusses the pathogenesis of fatty liver in lean individuals, its treatment, prognosis, and its relationship with metabolic syndrome.

Background: Prostate cancer (PCa) has been one of the most prevalent cancers in men in recent years. Multi-parametric magnetic resonance imaging (mp-MRI) has been increasingly applied in the diagnosis, localization and staging of prostate cancer. This approach uses a combination of morphology information obtained from T2-weighted image along with at least two functional imaging modalities, such as diffusion-weighted (DWI), dynamic-contrast-enhancement (DCE), and magnetic-resonance-spectroscopy (MRS). This review gives a comprehensive overview of the theories and methodologies of the mp-MRI for diagnosing prostate cancer. The search was fulfilled using a list of search engines. Methods: In this study, with a systematic review of studies conducted during February 2015 to October 2021, the role and potential of integrating the results of morphological and functional imaging in a multi-parameter approach were evaluated and the optimal combination was introduced. This article collected studies that have employed mp-MRI in prostate cancer including: peer-reviews, research articles, academic reports and conferences. This review has been studied from September 2016 to January 2022. Results: According to the reported results, the optimum combination of T2-w, DWI and DCE in the mp-MRI approach provides the highest sensitivity and specificity in the diagnosis, localization and staging of prostate cancer. Applying the field strength of 3T versus 1. 5T improves detection accuracy including improving sensitivity and specificity as well, and also the application of endorectal coils does not provide much advantage compared to pelvic phased-array coil in term of prostate cancer detection accuracy. Conclusion: MP-MRI as a precision instrument plays a valuable role in the diagnosis of prostate cancer. The most suitable combination of the pulse sequences to achieve the goals of this approach is T2-w, DWI and DCE. This review is comprehensive overview covered previous articles of mp-MRI in prostate cancer for all the researchers in this field and expresses the positive and negative points of each modality. Moreover, this article reports the sensitivity and the Specificity of the recent researches.

Background: The image quality is paramount in interpreting the hepatic dynamic CT scan. A poor quality image results in repeating the procedure, which is very timeconsuming for the patient and staff, and besides, it is not cost-efficient. This study intended to determine the correlation between image quality and the Hounsfield unit (HU) of the liver and its vessels in the arterial and venous phase to define the acceptable range of HUs for hepatic CT images. Methods: The image quality of 146 dynamic CT scans was assessed by qualitative and quantitative methods at Namazi Hospital of Shiraz University of Medical Sciences from September 2019 to August 2021. Two radiologists performed the qualitative evaluation. They categorized the image qualities into three groups,poor, acceptable, and high quality. For quantitative assessment of image quality, the Hounsfield unit of the aorta, hepatic vein, main portal vein, right anterior, right posterior, and left lateral lobe of the liver were evaluated in both arterial and venous phases. Results: According to the results of the qualitative evaluation of image quality, 59. 6%, 17. 8%, and 22. 6% of triphasic CT scans had good, acceptable, and poor quality, respectively. There was a significant relationship between image quality and Hounsfield units of all ROIs in the arterial phase (P<0. 005). Also, a significant relationship was observed between the Hounsfield units of the portal vein right on the anterior and posterior segments of the liver (P<0. 03) in the venous phase. Conclusion: In a high quality triphasic CT scan, the Hounsfield unit of different parts in the arterial phase should be as follows: aorta 310±, 78, portal vein 150±, 40, hepatic vein 44±, 7, right posterior and anterior and left lateral segments of liver 77±, 11, 77±, 7 and 78±, 12. Hounsfield units of the portal vein, hepatic vein, and right posterior and anterior segments of the liver in the venous phase should be 155±, 27, 167±, 30, 111±, 19, and 112±, 16, respectively.

Background: smoking enhances the risk of cardiac events in patients with coronary artery disease. So, it is necessary to evaluate the effects of exercise-based cardiac rehabilitation on endothelial function and functional capacity among smoker patients. Methods: This randomized clinical trial study was conducted on 56 non-diabetic smokers with a history of percutaneous coronary intervention or coronary artery bypass graft surgery in Imam Khomeini Hospital from May to August 2015. Based on cardiac rehabilitation, patients were divided into intervention and control groups. Before rehabilitation, fasting blood sugar (FBS), lipid profile (LDL, HDL, triglyceride, and total cholesterol), and Ankle-Brachial Index (ABI) were measured for endothelial function. Besides, METs were measured based on the Duke activity status index. After 24 rehabilitation sessions (3 sessions of 1 hour each week for 2 months), all values were checked again and compared with the initial values. Results: The mean age of the subjects in the cardiac rehabilitation and control groups were 61. 18 and 52. 32, respectively. Before the intervention, there were no significant differences between the two groups in terms of the ABI variables, BMI, systolic and diastolic blood pressure, LDL, triglyceride, total cholesterol and FBS,only HDL and METs showed significant differences. After exercise-based cardiac rehabilitation, the mean rate of ABI changes was +0. 078 on the right side of the body and +0. 084 on the left side of the body. In the control group, these values were 0. 002 and 0. 003, respectively (P=0. 001). The amount of changes in increasing METs as well as decreasing body mass index (BMI), and systolic and diastolic blood pressure in the rehabilitation group were statistically significant compared to the control group. In addition, there were no significant differences in terms of FBS and lipid profiles either (P>0. 05). Conclusion: Two months of cardiac rehabilitation with regular exercise was associated with improved ABI as an indicator of endothelial function and prognosis of cardiovascular disease, as well as improved cardiac functional capacity among smoker patients.

Background: People with chronic diseases of the immune system, such as multiple sclerosis (MS), are at risk for Covid-19 disease. However, more research is needed with long-term follow-up. The aim of the study was to follow up people with MS (PwMS) for up to three months after AstraZeneca vaccination for the recurrence of MS and Covid-19 infection. Methods: This study was a case study (descriptive-analytical) of follow-up type. The study population was PwMS over 18 years of age in Kermanshah province who received both doses of the AstraZeneca vaccine. This study was conducted from August to November 2021. Sampling was done with existing methods based on the National MS Registry of Iran (NMSRI). Demographic information of patients was extracted from NMSRI. A researcher-made form was used to collect information by telephone three months after vaccination about clinical characteristics, Covid-19 infection, and recurrence of MS. Data were analyzed using SPSS-25 software. Results: Study participants were 40 MS patients with a mean (SD) age of 39. 27 (8. 8) years, including 32 (80. 0%) women. A mean of 9. 39 (4. 6) years had passed since The patients were diagnosed with MS, and 29 (76. 4%) had RR type MS. Four patients (10%) relapsed between the second dose and three months later, of whom two (50%) had sensory symptoms, one (25%) had optic nerve involvement, and one (25%) had motor symptoms and pyramidal pathway involvement. The symptoms of Covid-19 were mild in three patients (10%), while severe symptoms developed in one patient (10%) who received rituximab. Among the patients, no cases of thrombosis were observed. Infusion therapy, a leg fracture, and kidney stones were the only hospitalized cases. Conclusion: Covid-19 and MS relapse prevalence did not differ significantly in the three months before and after vaccination. There is a need for further studies with a longer follow-up period.

Background: The prevalence of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) in men increases with age. Alpha-adrenergic receptor antagonists are first-line drugs for the treatment of LUTS, and tamsulosin is the drug of choice. The aim of this study was to compare the efficacy of tamsulosin 0. 4 mg and 0. 8 mg on lower urinary tract symptoms in patients with benign prostatic hyperplasia. Methods: This double-blind clinical trial was conducted in the Urology unit of Emam Hassan Hospital in Bojnurd from May 2019 to Feb 2020. In this study, 92 patients with LUTS due to BPH were selected according to available method and randomly assigned into two groups of intervention. In the first group, patients received tamsulosin 0. 4 mg and in the second group, tamsulosin 0. 8 mg once daily for 8 weeks. The effectiveness of treatment was evaluated using IPSS criteria before and 8 weeks after treatment. According to a checklist, side effects were evaluated during treatment. Data was analyzed based on independent t-tests and repeated measures ANOVA by SPSS software version 22. A significance level of 0. 05 was considered. Results: The results showed that the two groups were not significantly different in age and duration of symptoms. According to the statistics test, there is a significant difference between the two groups in the post-treatment phase. Also, based on analysis of variance with repeated measures statistical test, there was a significant difference between and within two groups in IPSS criteria at different stages of evaluation. The prevalence of complications was (8. 6%) in the first group and (11. 9%) in the second group. The prevalence of complications was not significant between the two groups. Conclusion: Tamsulosin is effective in reducing lower urinary tract symptoms and Tamsulosin 0. 8 mg is an effective treatment regimen for the treatment of LUTS secondary to benign prostatic hyperplasia in those who have not responded to 0. 4 mg treatment. Drug side effects were well tolerated in patients.

Background: Coronavirus in 2019 was recognized as one of the leading causes of death worldwide. According to reports, the mortality rate in people who need mechanical ventilation varies from 50 to 97 percent. The aim of this study was to evaluate the outcome of Covid-19 disease based on different characteristics in patients and mechanically ventilated variables. Methods: This descriptive-analytical study was conducted on 160 patients with a definite diagnosis of Covid-19 who were under mechanical ventilation and admitted to the intensive care unit of Alzahra Hospital in Isfahan from March 2020 to March 2021. Data was collected by checklist. The checklist included demographic information, including age, gender, as well as information such as underlying diseases, disease outcome, length of hospitalization, etc. After collecting the data, they were analyzed in SPSS software version 22 and at a significance level of less than 0. 05. Results: In this study, the overall mortality rate among mechanically ventilated patients was 62. 5%. The mean age of patients was 69. 99±, 17. 87 years and the mean duration of hospitalization in surviving patients was 15. 47±, 11. 73 days and for deceased ones was 55. 21±, 69. 14 days. The mean age of the deceased group (65. 71±, 16. 59) was significantly higher than the surviving group 53±, 21. 17 was (P=0. 0001). The length of hospital stay in the deceased group was significantly longer than the surviving group (P=0. 005). As a result, ventilator mode and inotropic agent intake during treatment increased the chance of mortality in patients under mechanical ventilation (P=0. 001). There was a significant relationship between underlying diseases of hypertension, kidney disease and autoimmune disease with mortality in patients (P<0. 05). Conclusion: Various factors including the length of stay in the hospital, comorbidities such as hypertension, renal disease and autoimmunity may affect the outcome of critically ill ICU patients under mechanical ventilation. Patients who require long-term invasive ventilation and the use of inotropic drugs to maintain their cardiovascular status while hospitalized in the ICU are at higher risk for mortality.

Background: The prevalence of emerging and re-emerging diseases has made the need for basic preparations for all health care organizations more crucial. Strengthening preparedness and formulating crisis strategies will have a great impact on reducing casualties. Given the importance of preparing hospitals to deal with such an outbreak and reduce the resulting mortality, the present study was conducted to assess their readiness against Covid-19. Methods: The present study is a quantitative and descriptive cross-sectional research conducted from October to March 2019. Data collection used the standard checklists prepared by the European Center for the Prevention and Control of Coronavirus and the Centers for Disease Control and Prevention, consisting of eight domains and 21 components. The minimum score that each hospital could get in this checklist was 143 and the maximum was 429. The sampling method in the present study was a census, and nine reference hospitals for Corona were included in the study. All hospitals’,directors, managers, quality officers and crisis secretaries and others related to hospital readiness during Covid-19 were recruited by the census. Results: On average, the hospitals scored 391 out of 429, indicating a fairly "high readiness" in dealing with Covid-19. The highest score obtained by the hospitals was 425 and the lowest score was 349. In terms of preparation areas, the hospitals’,readiness was higher than 80% in all areas. The highest readiness of hospitals was in the fifth domain, i. e. Hand hygiene, personal protective equipment and hospital waste management. The 7th domain namely, patient placement and relocation, and patient visitor access was of the lowest preparation. Conclusion: The hospitals were of fairly appropriate readiness to deal with Covid-19. This level of preparedness, despite being desirable, might not reflect the real capacity of hospitals to deal with this disease. Regular evaluation of the Covid referral hospitals could help make these hospitals more prepared. Also, the experiences of hospitals that were more prepared should be used to improve the condition of other hospitals.

Background: The gender of the baby is one of the risk factors for neonatal jaundice, but the difference in the severity of jaundice and its prognosis between the two sexes is not clear. Therefore, in this study, we investigated the severity, duration and prognosis of jaundice in both sexes. Methods: The present study is a cross-sectional study that was performed on 2847 icteric neonates over 35 weeks admitted to Ghaem Hospital in Mashhad from May 2014 to May 2021. This study is done by available sampling. After confirmation of jaundice in infants, data were recorded using a researcher-made checklist including maternal demographic information (maternal age, mode of delivery), complete infant characteristics (age, birth weight, age at onset of jaundice, jaundice recovery age) and laboratory findings (Bilirubin, Indirect Coombs, direct Coombs, G6PD), and neonatal development up to two years of age was performed based on the Denver 2 test. Then data analysis was performed by SPSS software using Chi-square test and Student’, s ttest. Results: 1642 infants (57. 7%) were boys and 1205 infants (42. 3%) were girls. Mean and standard deviation of bilirubin in values less than 20 mg/dl in boys was 17. 20±, 2. 48 mg/dl and in girls was 16. 54±, 2. 80 mg/dl (P=0. 000), birth weight was 3. 16±, 0. 49 (kg) for boys and 3. 07±, 0. 45 for girls (P=0. 000). In two groups of male and female infants, age (P=0. 004), direct bilirubin (P=0. 001), direct and indirect Coombs (P=0. 000), and G6PD enzyme deficiency (P=0. 000) had a significant difference. Acute kernicterus was reported in 25 (2. 03%) boys and 4 (0. 46%) girls (P<0. 001). In the two-year follow-up, 23 boys (1. 9%) and 11 girls (1. 28%) had developmental delay (P<0. 05). Conclusion: The incidence of jaundice in male infants was higher than female infants, which is probably due to a higher prevalence of G6PD deficiency in boys. The severity of jaundice was higher in boys less than 20 mg/dl. Jaundice has a worse prognosis in male infants.

Background: Medical ethics is an applied branch of ethics that deals with ethical challenges in medical and health environments, and its related topics have a long history, but its education as an academic subject in universities has received a lot of attention in the last 40 years. In recent years, medical universities have made extensive efforts to expand medical ethics education, which has been accompanied by significant progress, but given that the modern medical ethics education system is a growing and nascent structure, more research is needed. Therefore, this study aims to assess the status of the medical ethics education system at Tehran University of Medical Sciences to identify its gaps so that the current situation can be improved with proper planning. Methods: The type of this research is descriptive quantitative-qualitative and it was collected from December 2018 to September 2019 at Tehran University of Medical Sciences. First, the educational curriculum of 165 educational levels at Tehran University of Medical Sciences was reviewed and described in terms of the existence of a medical or professional ethics course in the educational curriculum. Then, a semistructured interview was conducted with the 13 professors in charge of teaching this course in all faculties, and content analysis was performed to describe and identify the obstacles in its effectiveness. Results: The results showed that in 53% of the educational levels, there was no separate medical or professional ethics course in the educational curriculum and the most educational coverage of this course took place in the faculties of medicine, dentistry, nursing and midwifery. The obstacles in the effectiveness of teaching this unit were categorized into five main themes of educational curriculum, hidden curriculum, teaching methods, teachers and education management. Conclusion: The results show that the content of curricula needs to be revised and education should be inclusive. Creating a coherent educational organization and monitoring the hidden curriculum are other issues that should be considered to increase the effectiveness of this education.