مجله دانشکده پزشکی دانشگاه علوم پزشکی تهران
سال هفتاد و هفتم شماره 1 (پیاپی 217، فروردین 1398)

Herpes zoster (Shingles; Zona) is an acute infectious skin disease that is caused by the reactivation of varicella zoster virus (VZV). After the initial infection (chickenpox) or vaccination, the virus remains inactive or latent in the dorsal root ganglia (DRG); when decreasing cell mediated immunity (CMI) occurs, the virus is reactivated from a latent phase to a lytic phase and frequently replicated in the dorsal ganglion cells then move to the sensory nerves into the skin and causes herpes zoster, which is typically characterized by painful neuralgia and unilateral dermatomal vesicular rash that normally lasts 3 to 5 weeks. The most common complication of herpes zoster is chronic pain owing to postherpetic neuralgia (PHN), which is estimated to occur in approximately 20% of the people aged 50 and over. Although herpes zoster is rarely fatal, the pain related to the acute phase of herpes zoster and subsequent PHN can cause psychological distress, physical disability, impaired sleep and consequently negatively affect the quality of life that can be significantly reduced by all of these occurrences. Due to increasing trend in the incidence of herpes zoster and increasing older people population, it will be expected that herpes zoster and subsequent PHN cause a significant economic burden to the healthcare system, the government, and families along with reducing the quality of life. The average lifetime risk of herpes zoster is estimated to be approximately 30% in developing countries. Although the risk of herpes zoster significantly increases with increasing age and diminished immune system function, any factor impacting on VZV-specific humoral and cellular immune responses may affect the risk of herpes zoster. This paper is provided an overview of the incidence and potential risk factors of herpes zoster with emphasis on the role of micronutrients and their deficiencies in the impaired immune system function. Also, the common method for prevention by zoster vaccine and the role of micronutrients in the efficacy of vaccination are shown.

The purpose of prenatal diagnosis tests is insisting of diagnosis of neonatal disorders, preparing a range of informed choices and making couples at risk to be ready for having children with genetic disorders as well. The aim of this article is to investigate all of the tests in order to determine the best one which has the lowest risk and the highest sensitivity. Screening tests (maternal blood test and ultrasonography for first and second trimester) are testing patients without symptoms who are at low risk. These tests are carried out in the early stages of pregnancy, and the risk of genetic diseases would be estimated. They are safe and also might be helpful in determining whether invasive prenatal genetic tests including chorionic villus sampling, amniocentesis, and percutaneous umbilical blood sampling are needed. Diagnostic test is insisting of invasive tests: amniocentesis, chorionic villus sampling (CVS), cordocentesis, and preimplantation genetic diagnosis (PGD), which is a genetic test on cells removed from embryos to help select the best ones to avoid some of genetic diseases, fluorescence in situ hybridization (FISH), QF-PCR, multiplex ligation probe amplification (MLPA), next generation sequencing (NGS), comparative genomic hybridization (CGH), and non-invasive tests: ultrasound, prenatal sonography, cell free fetal DNA, triple and quadruple screen: alpha fetoprotein (AFP), human chorionic gonadotropin (hCG), unconjugated estriol (uE3), inhibin-A). These tests are intended for patients who have apparent symptoms and the results of their early stages of pregnancy have been positive. Non-invasive prenatal tests (NIPT), sometimes called noninvasive prenatal screening (NIPS), have features of both screening and diagnostic tests, but, now screening test is more considerable. Small fragments of DNA would be analyzed by this testing in which they are circulating in a pregnant woman’s blood. While most DNA is found inside a cell’s nucleus, these fragments are free-floating and not within cells, at this point, they are called cell-free DNA (cfDNA) which usually contain fewer than 200 DNA building blocks (base pairs). Non-invasive prenatal tests is more sensitive with the high degree of specify to determine trisomy 13, 18 and 21 in women who are at increased risk of having offspring with genetic disorders.

Diffusion-weighted imaging (DWI) is one of methods in evaluation of breast lesions. We aimed to investigate the apparent diffusion coefficient (ADC) values in breast tumors and their accuracy in differentiating benign versus malignant lesions.
In this cross-sectional study, 72 patients with 88 breast lesions were investigated by 1.5-T breast MRI from 2015 to 2017 in Athari Imaging Center in Tehran, Iran. Nearly all patients has undergone histopathology evaluation. One small region of interest (ROI) were placed on the most restricted region inside the solid part on the ADC map. Care was taken to avoid cystic or necrotic, fatty regions and hematoma inside the mass. A large round ROIs were placed in healthy fibroglandular tissue of contralateral breast ADC values were measured and compared in normal breast tissue and in most restricted parts of breast lesions (mass and non-mass). After determining cut-off for differentiation of benign and malignant lesions, sensitivity, specificity, accuracy, positive predictive value and negative predictive value were calculated.
Mean age of patients was 43.3 years. The average tumor size of benign and malignant lesions were calculated 26.0 mm, 35.3 mm respectively and 23 mm and 46 mm in mass and non-mass respectively. Invasive ductal carcinoma include the majority of pathology result (in 37.5% of the patients). Our results revealed that the measured ADC values in normal breast tissue were higher than breast lesions (P≤0.01). Mean ADC value in benign lesions was 1.40×10-3 mm²/s and for malignant lesion was 1.08×10-3 mm²/s. ADC value in the normal breast tissue was 1.79×10-3 mm2/s and was significantly higher than ADC value of breast lesions (benign and malignant). Cut-off value in non-mass was not valid, but in mass was 1.19×10-3 mm²/s with sensitivity, specificity, positive predictive value, negative predictive and accuracy of 89.7%, 83.8%, 87.5%, 86.6%, and 87.1% respectively.
In DWI imaging, ADC value can differentiate benign and malignant masses with high sensitivity and specificity but not helpful in non-mass lesions.

Matrix metalloproteases (MMPs) are multi-chain proteins that regulated by tissue inhibitor of metalloproteinases (TIMP) and several other mechanisms. This Includes transcription regulation and protein form secretion. The roles of MMPs in wound healing and tissue repair. In tuberculosis (TB), the activity of MMPs is increased and TIMP inhibitors decrease activity. Therefore, in tuberculosis, MMPs cause excessive damage to the lung tissue and cavity formation.
In a case-control study, plasma samples of healthy controls, symptomatic respiratory tract controls and tuberculosis patients were evaluated by available sampling in Ali Ibn Abitaleb and Bouali Hospitals, Zahedan, Iran, from Apri1 2015 to April 2018. Patients were divided into two groups: tuberculosis and control group and the level of MMPs were measured by the enzyme-linked immunosorbent assay (ELISA) method in plasma samples of the two groups. For MMP-8, which was important in the diagnosis of tuberculosis, a cutoff point was obtained.
384 people including 123 healthy controls. 107 non-tuberculosis, and 154 tuberculosis patients were examined; 230 patients in the control group and 154 patients in the tuberculosis group. Levels of MMPs in tuberculosis and symptomatic respiratory group were higher than healthy group. The mean of MMP-8 was significantly different between two groups (P<0.001). In this study, sensitivity, specificity, positive and negative predictive value of plasma MMP-8 in detection of TB in non-TB patients in MMP-8 cutoff point=6650 pg/ml were 65.4%, 78.2%, 50%, and 93% respectively outcome. Significantly, the rate of pulmonary cavity was significantly higher in the TB group; Higher cavity, higher concentration of plasma MMPs.
In this study, first comprehensive analysis of MMPs was performed. Two collagenases, MMP-1 and MMP-8, were active in tuberculosis, but MMP-8 was specifically higher in tuberculosis than in both symptomatic and healthy controls. Level of MMP-1, 3, 8, 9 was higher in men than in women. The analysis of genders separately showed MMP-8 was increased in tuberculosis group in comparison with control group and MMP-1 group in both TB and symptomatic respiratory tract increased.

Evaluation of cell viability is momentous in pharmacologic and oncological research. Cell viability evaluation determines cell sensitivity and consequently treatment outcome. Various methods are available to determine cell survival. Each of these methods evaluates different endpoints. Accordingly, determining the correlation between these methods is important. In this study, in order to determine the viability of human anaplastic thyroid cancer cell line, the sensitivity of MTT [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide] assay, trypan blue test and clonogenic assay were compared. This experimental study was performed in the Cellular and Molecular Research Center at Guilan University of Medical Sciences, Rasht, Iran from October 2016 to March 2017. The human anaplastic thyroid cancer cell line was cultured in Dulbecco's modified Eagle's medium (DMEM) with 10% fetal bovine serum (FBS). The cultured cells were treated with melatonin, for 24 hours. Then, the viability of the cells was evaluated by MTT assay, trypan blue test and clonogenic assay. Furthermore, plating efficiency and surviving fraction were used in order to draw survival curve in the clonogenic assay. The concentration of melatonin at IC50 point was 4.794±0.117 millimolar (mM) in MTT assay, 4.375±0.894 mM in trypan blue test and 2.246±0.326 mM in clonogenic assay. Comparing the IC50 values of these test revealed that C50 values obtained from MTT assay and trypan blue test had no significant difference (P=0.6446), while there was a significant difference between IC50 values obtained from MTT and clonogenic assays (P=0.0032). Moreover, the IC50 values obtained from trypan blue test and clonogenic assay were also significantly different (P=0.0078). The results of the regression analysis of cell viability were shown a linear, positive and significant correlation between these three methods and MTT assay and trypan blue test showed higher correlation (r=0.99, P<0.001). Based on our results, all these methods were effective to identify cytotoxicity in human anaplastic thyroid cancer cell line, while MTT assay and trypan blue test were more sensitive than clonogenic assay.

Multiple sclerosis (MS) is a degenerative inflammatory disease which is most commonly diagnosed by magnetic resonance imaging (MRI). But, since the MRI device uses of a magnetic field, if there are metal objects in the patient's body, it can disrupt the health of the patient, the functioning of the MRI, and distortion in the images. Due to limitations of using MRI device, screening seems necessary for those patients who have metal objects in their bodies. Therefore, this study is carried out to compare two models: support vector machine and random forest. This analytical-modelling research was implemented on MS data collection, the specifications of which are recorded in health registry system in School of Public Health, Kermanshah University of Medical Sciences, Iran, from May 2017 to August 2018. For the purpose of this study, a total of 317 subjects were selected as a sample; 188 subjects were diagnosed with MS and 128 subjects showed no symptoms of MS. In order to fit the support vector machine (SVM) model, radial basis kernel function was used. The parameters of this machine were optimized with genetic algorithm. After this step, the support vector machine and random forest (RF) were compared with respect to three factors: accuracy, sensitivity, and specificity. Based upon the obtained results of study, accuracy, sensitivity, and specificity of SVM were 0.79, 0.80, and 0.78, respectively. In comparison, accuracy, sensitivity, and specificity of RF were found to be 0.76, 0.81, and 0.70, respectively. In general, both models which were compared in current study showed desirable performance; however, in term of accuracy, as an important criteria for performance comparison in this area of research, it can be argued that support vector machine can do better than random forest in diagnosing multiple sclerosis.

Head lice (Pediculus humanus capitis) are obligate ectoparasites of mankind, and are mainly transmitted head to head directly from one person to another. Human head lice treatment is faced with some challenges such as lack of complete treatment and the need for treatment repeatedly. The aim of this study was to evaluate the efficacy of two pediculicide products (substances used to treat human head lice infestation); 1% permethrin shampoo and 4% dimethicone lotion.
In this clinical trial, 140 cases of head lice infested people that were referred to the urban comprehensive health centers of Qom provincial health center related to Qom University of Medical Sciences and Health Services, Iran, from April to March 2017. The cases randomly were treated with two pediculicide products; 1% permethrin shampoo and 4% dimethicone lotion. The outcome of the treatment included removal of adult human head lice, nymphs, and nits in confirmed human cases at 14 and 21 days after starting treatments were considered.
The success rate of human head lice infestation treatment in case of double use (at one-week intervals) with 1% permethrin shampoo and 4% dimethicone lotion was 65.7% and 62.9%, respectively. There was no statistical significance between the therapeutic effects of the two above-mentioned methods (odds ratio=1.22, P=0.59, CI=0.6-2.5). While the recovery rate of men compared to women was 3.8 (P=0.036), it was 3.1 (P=0.05) for housewives compared to students, and in families with one case compared to ones with more than one patient, this rate was found to be 3 (P=0.034). Family size was one of the most important variables that had a significant effect on the therapeutic rate of 1% permethrin shampoo and 4% dimethicone lotion.
The findings of this study do not support the reduction in efficacy of 1% permethrin shampoo and 4% dimethicone lotion as pediculicide products.

Diabetes Mellitus is a prevalent disease worldwide and foot ulcer is one of the serious complications of chronic uncontrolled diabetes which could lead to various complications such as amputation of the extremity if left untreated. Total contact casting (TCC) is the gold standard in treatment of neuropathic and neuro ischemic diabetic foot ulcers (DFU) on which less emphasize is seen on routine medical practice. The aim of this study was to emphasize on healing effect of this off-loading method and to study the possible influence of variants on the healing rate of this technique. In this cohort study, 92 diabetic patients with complaint of plantar foot ulcer grade 0, 1 and 2 according to Wagner classification had participated in Shahid Beheshti Hospital, Babol City, Iran, from March 2014 to February 2016. The demographic and biochemical information along with dimensions of foot ulcers were carefully recorded. After the primary cleansing, surgical debridement and dressing, TCC was applied on foot by the specialist and they were requested to return weekly for changing the TCC and re-evaluation of ulcers. The healing rate was calculated as decline in ulcer surface area per week. 92 patients of study sample with mean age of 63.9±10.56 year consisted of 76 patients with DM type 2 with BMI of 31.16±3.8 kg/m² and 58 male patients. The average healing rate of ulcers treated with TCC was 0.406 ±0.168 cm²/week. The duration of diabetes on average was 17.23±6.93 years. Most of the patients (n=45) had an ulcer on the forefoot and the healing rate of midfoot ulcers was slower. The average amount of baseline HbA1c was 8.2±0.19%. There was no relation between smoking history (P=0.94) and anti-diabetic regimen used by patients (P=0.754) with the healing rate. The healing rate is slower in elderly patients and those with longer duration of diabetes. So in these two groups, TCC is to be applied for a longer duration in order to achieve complete healing.

Nutrition education and introduction of procedures for choosing healthier food have an important role to reduce the rate of non-communicable diseases. It was shown the amount of risk factors of non-communicable diseases such as energy, salt, sugar, fat and trans fatty acid on the traffic light of food labelling. The status of risk is presented through three colors of red, yellow and green that are the signs of risk, precautious and safe use of food. The object of this study was to evaluate the influence of education on the knowledge, attitude and practices of Isfahan University of Medical Sciences students to the traffic light on food labeling.
This project was an empirical study performed by random sampling of 379 students of nine schools in Isfahan University of Medical Sciences from January 2017 to March 2018. The knowledge, attitude and practices of students toward the traffic light were assessed by self-administered and structured questionnaire. Education was performed face to face with the usage of pamphlet. In the period of three to six months, questionnaires were refilled out by students to determine knowledge, attitude and practice. Descriptive statistics were calculated using SPSS in mean± SD. Paired t-test was performed to assess the influence of education in total score of knowledge, attitudes and practices in test-retest. P value was considered less than 0.05 as statistically significant.
Before education, the average of scores for knowledge, attitude and practice was 1.12±0.84, 14.44±4 and 2.25±2.2, respectively. Afterwards, the scores were increased to 11.72±0.75, 18.67±3.18 and 17.69±4.7 after education. Significant difference was observed in the scores of knowledge, attitude and practice of students before and after education (P<0.05).
Education of traffic light had a significant role in the improvement of knowledge, attitude and to some extent of practice of students in selection of healthier food.

Hospital accreditation is an external evaluation of a hospital’s structures, processes and results by an independent professional accreditation body using pre-established optimum standards. Hospital accreditation has an important role in improving quality, safety, effectiveness and efficiency of hospital services. A generic questionnaire is usually used to accredit all hospitals. However, specific instruments should be used for evaluation and accreditation of specialized hospitals considering their unique nature and specific requirements. Thus, this study aimed to develop an accreditation model for children hospitals. A mixed method approach was used for such a descriptive and cross-sectional study. First, using a comparative study, accreditation standards and measurement criteria of children friendly hospitals were extracted from 10 well-known hospital evaluation and accreditation models and initiatives. Second, complementary interviews with 57 hospitals senior, middle and front line managers and pediatrics doctors and nurses were conducted to identify more children friendly hospital accreditation standards and measurement criteria. Third, children friendly hospital accreditation standards and criteria were modified considering the Iranian context. Finally, five pediatrics doctors reviewed, modified, finalized and confirmed accreditation standards and criteria. The Iranian framework for accreditation of children-friendly hospitals was consisted of ten standards covering management and leadership, planning and policy making, education, patient management, employee management, resource management, process management, patients’, employees’ and organization results and 132 measuring criteria. Such a systemic framework covers pediatrics hospitals’ structures, processes, outputs and outcomes. A children friendly hospital achieves better results for employees and patients through strong management and leadership, proper planning and policy making, continuous education and training staff and patients and effective management of employees, patients, resources and processes. The proposed children-friendly hospitals accreditation model can be used for evaluation and accreditation of children hospitals and provide a clear picture of the performance of these hospitals.