مجله دانشکده پزشکی دانشگاه علوم پزشکی تهران
سال هشتادم شماره 1 (پیاپی 253، فروردین 1401)

Conceptual review is a creative research method for generating new knowledge in the context of a vague and complex concept that helps to explain and clarify the concept, its components and its relation to related concepts. This study aimed to explain the methodology of conceptual review in the health system.

Articles related to the conceptual research method were searched and collected in four databases (i.e., PubMed, Scopus, Embase, Science Direct) and two search engines (e.g., Google and Google Scholar) between January 1950 and September 2021. Finally, 83 articles were selected for final review and analyzed through narrative analysis.

This study was conducted using scoping review between October and December 2021. The conceptual review study is a systematic, scientific and objective inquiry that helps to identify and explain the dimensions, components, features and applications of a particular concept by defining, synthesizing and interpreting the findings of studies. It results in clarification of the meaning of concepts. An eight- steps protocol was introduced for conceptual review including concept selection, entry and exit criteria definition; selection of databases and search strategies; selection and reporting of studies using flowcharts; evaluating the validity of selected studies; extracting information about the definition, components, antecedents, consequences and evaluation criteria of the concept from selected studies, synthesizing data and developing a conceptual model and drawing conclusions from the synthesized findings. In addition, the structure of a conceptual review article was described and a checklist for evaluation of a conceptual review study was introduced.

A conceptual review study is a method that defines the concept by searching for scientific sources about a concept and their comprehensive review, explaining their characteristics, antecedents, consequences and applications to determine the position of the concept beyond their vocabulary definition. The conceptual review helps to develop existing theories by identifying the components of a complex concept and its antecedents and consequences and establishing a logical connection between them.

Type2 diabetes is a metabolic disease that is rapidly increasing in the world. GLUT4 and RBP4 are factors that play a role in glucose uptake. This study aimed to investigate the effect of moderate-intensity continuous training on RBP4 and GLUT4 gene expression of soleus muscle in STZ induced diabetic rats.

This experimental study was conducted between May and September 2016 at Baqiyatallah University of Medical Sciences. In this study, there were 48 8-week-old male Wistar rats (mean weight 250±20) that were randomly divided into four groups: basic control, 12-week control, diabetes, diabetes and moderate continuous training. Diabetes was induced by injection of streptozotocin solution. The training protocol consisted of continuous aerobic training for 12 weeks, five sessions per week in the form of running on a treadmill. After sampling, real-time PCR expression was used to measure gene expression. Statistical analysis was performed by SPSS software, version 22 (IBM SPSS, Armonk, NY, USA) and graphs were drawn using GraphPad Prism, version 8, (GraphPad Software, USA).

According to the results, there was a significant increase in RBP4 in the diabetic group compared to other groups. compared to the two groups of diabetes and diabetes, along with moderate continuous training, RBP4 gene expression was less expressed in diabetic training. Regarding GLUT4, there was a significant difference between diabetes and diabetes groups with training. Also, the expression of the GLUT4 gene in the diabetic group with training was higher than the other groups. According to this study, it was shown that moderate-intensity continuous training somehow reduces the negative effects of diabetes on metabolism and health by activating various cellular and molecular pathways and mechanisms.

the present study showed the effect of moderate-intensity continuous training on the expression of RBP4 and GLUT4 genes in soleus muscle which can be effective in glucose uptake. It was also shown that moderate-intensity continuous training can minimize the complications of diabetes by reducing RBP4 gene expression.

Pioglitazone is the selective PPAR-γ receptor agonist, which is prescribed for the treatment of type 2 diabetes and may also have antidepressant effects. Nitric oxide (NO) has been involved in some crucial roles, including learning, cognition and neurogenesis as well as some neurodegenerative diseases, including Parkinson, Alzheimer's disease (AD) and depression. Reduced estrogen levels throughout ovariectomy, postpartum and menopause make women more likely to suffer from depression. The existing study was designed to examine the antidepressant-like effects of pioglitazone, a PPAR-γ agonist, and the probable involvement of NO with the use of non-specific NO synthase inhibitor (L-NAME) or an NO precursor (L-arginine) in female ovariectomized (OVX) mice.

The present study was conducted experimentally on female NMRI mice from April to December 2019 at the Pharmacology Department of Pharmacy Faculty, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Female mice were subjected to bilaterally ovariectomy, and various doses of pioglitazone (10, 20, 40 mg/kg) were administered either alone or in combination with non-specific NO synthase (NOS) inhibitor (L-NAME) or a NO precursor (L-arginine). Antidepressant-like activity of pioglitazone was evaluated in the forced swimming test (FST) and the tail suspension test (TST). Moreover, the open field test was done to evaluate the locomotor activity of mice following different treatments.

OVX mice demonstrated a major increase in immobility time versus sham therapy following procedure (P≤0.05). Mice were injected with 40 mg/kg pioglitazone Intraperitoneally, 4 h before the behavioral test, exhibited marked antidepressant-like effects in OVX mice (P≤0.01, P≤0.05 in FST and TST, respectively). Co-administration of sub-effective dose of L-NAME (2 mg/kg) with a sub-effective dose of pioglitazone (20 mg/kg) resulted in a strong antidepressant-like effect in OVX mice (P≤0.01), whereas L-arginine inhibited this effect. The various treatments did not change the total locomotion of mice in OFT.

Antidepressant-like effects of pioglitazone may be associated with inhibition of the NO synthase/NO in OVX mice and provided a new strategy for depression.

Neonatal seizures can have many causes. Determining the underlying cause of neonatal seizures is very important in determining the prognosis, outcome, and treatment strategies. In this study, we have evaluated the frequency of Magnetic resonance imaging (MRI) findings in neonates younger than 6 months who had been referred to Shiraz Namazi hospital with seizures to determine the prevalence of various causes of seizures.

This was a retrospective study, that was performed on 199 neonates younger than 6 months of age who were hospitalized due to seizures in hospitals affiliated with Shiraz medical sciences from 21st March 2018 to 20 March 2019. Patient data were extracted by statistics and health information system and imaging data and its reports were extracted from picture archiving and communication system. The data were statistically analyzed by SPSS V26.

In this study, 199 infants under the age of 6 months were examined, of which 124 (62.3%) were boys and 75 (37.7%) were girls. 97 infants (48.7%) were less than one month old and 102 ones (81.3%) were in the age group of 1-6 months. It should be noted that in terms of gender, 57.3% (71) of male infants and 49.3% (37) of female infants had abnormal MRI findings. 54.3% of patients had abnormal MRI findings and 45.7% had normal MRI. The most common abnormal finding was hypoxic-ischemic encephalopathy (HIE), which was the most common cause of seizures in 21.1% of neonates, followed by infection with 12.5% and cerebral hemorrhage with 11% of prevalence. Other important abnormal findings included hydrocephalus, structural abnormalities, venous sinus thrombosis, brain atrophy, developmental abnormality, etc. There was a combination of radiological findings in 18.56% of neonates.

This study showed that hypoxic-ischemic encephalopathy is the most common cause of neonatal seizures. Considering that in this study, a significant percentage (54.3%) of the neonates had abnormal brain MRI, this finding indicates the importance of performing this radiological procedure in the diagnosis, prognosis, and duration of treatment in neonatal seizures.

Cataracts are the leading diseases that cause blindness. Cataracts can be treated with surgery. Pain, itching, burning, and a foreign body sensation in the eye are common ocular complaints of patients in recovery. In this study, we compared the effect of Ketorolac eye drops and naphazoline antazoline eye drops on reducing complaints of surgery.

This randomized clinical trial study was performed from February 2016 to March 2017 on patients who were candidates for cataract surgery at Feyz University Hospital in Isfahan, Iran.  In this study, 54 patients were enrolled in two groups receiving Ketorolac eye drops and naphazoline antazoline (NA) eye drops. After the operation, patients' ocular complaints such as burning, itching, pain, and severity were evaluated every 15 minutes in recovery and every half hour in the ward until discharge from the hospital.

In this study, 54 patients in two groups of 27 were studied. In the post-anesthesia care unit, the burning sensation in the naphazoline-antazoline group was significantly lower than in the ketorolac group (P=0.02). Patients in the NA group had less foreign body sensation in the eye in recovery (P=0.97) and the ward (P<0.001) than in the ketorolac group. Mean Pain intensity in the recovery unit (P=0.39) and ward unit in the ketorolac group were less than NA (P<0.001). In the recovery unit in the NA group, the eye-burning sensation was significantly lower than in the ketorolac group. The foreign body sensation in the NA group was less than the ketorolac group but there was no significant difference between the two groups. In the NA group, itching of the eyes was less than in the ketorolac group.

It can be concluded that ketorolac drops have been more effective in reducing post-operative eye pain than NA and NA drops have been more effective in reducing burning, itching and foreign body sensation in the eyes than Ketorolac.

Exposure to lead, damages vital organs and is now a global concern. Toxic effects of lead on the liver and thyroid gland have been mentioned previously, sometimes with conflicting results. Therefore, the present study aimed to assess changes in liver and thyroid function tests in patients with lead poisoning.

This case-control study was performed on 100 patients with clinical evidence of lead poisoning who were referred to Loghman-e-Hakim hospital in Tehran from April to December 2018. Also, another 100 participants with the matched sex and age, a history of opium use, and exposure to lead or non-work-related metals, and with normal lead levels, were considered as a control group. Demographic information was collected by a trained researcher by reviewing hospital records or interviewing participants. To monitor lead levels in the control group, 5 ml of venous blood was collected from the antecubital vein at 7 to 8 am in sterile tubes containing EDTA as an anticoagulant. Serum lead levels were assessed by GBC Avanta atomic absorption spectrophotometer. Values in the two groups were compared. SPSS version 16 (SPSS Inc. Chicago, Il, The USA) was used for data analysis. A P-value below 0.05 was considered statistically significant.

The mean level of serum lead in case and control groups were 63.0±12.4 μg/dL and 6.0±2.1 μg/dL, respectively with a statistically significant difference (p<0.001). However, Alkaline phosphatase (ALKp), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) enzymes were significantly higher in cases compared to controls (p<0.001). The thyroid-stimulating hormone in patients with lead poisoning (0.3±0.04 MIU/L) was significantly lower than those in the control group (2.5±1.23) (P=0.04).

Lead poisoning could potentially damage liver function and elevate liver enzymes. Moreover, it can also affect the levels of TSH and levothyroxine. Understanding the exact mechanisms might help to control The hepatotoxic effects of lead in patients. Also, knowing the pattern of elevated liver enzymes and thyroid hormones changes might help discriminate lead poisoning with other differential diagnoses.

Psoriasis is a chronic and recurrent inflammatory disease that involves skin, joints and different organ systems. It is associated with Multiple morbidities such as cardiovascular disorders, diabetes, hypertension, hyperlipidemia and chronic kidney disease (CKD). Due to the high importance of the association between psoriasis and CKD which results in major side effects the aim of this study was to evaluation of CKD and associated factors in Psoriasis patients at Razi Hospital, Tehran, Iran.

This retrospective study was conducted as a cross-sectional descriptive and analytical study to evaluate the frequency of CKD and associated factors in psoriatic patients admitted to the Razi Hospital whose last time of admission was from June 2018 to January 2019. According to the K/DOQI guideline, CKD is defined as the GFR<60 mL/min/1.73 m² during at least a period of three months. GFR was calculated based on the MDRD formula. The sample size was equal to 265. The hospital documents of inpatients who have been admitted to Razi Hospital wards or follow-up clinics during 2017-2019 were used for collecting information and data. This information has been extracted based on the initial checklist for data collection. Collected data has been analyzed and performed by using SPSS 25 software.

The study found that 18 (6.8%) of psoriasis patients had CKD. Patients were in the age range of 3.5-92 years, the majority of them were in the age range of 18.65–79.7 years. 171 (64.5%) patients were male and 94 (35.5%) were female. 41 (15.5%) patients had diabetes, 94 (35.5%) had hyperlipidemia and 41 (15.5%) had hypertension. History of NSAID, Methotrexate, Cyclosporine, Acitretin, Infliximab, and Adalimumab medication use among 9 (3.4%), 205 (77.4%), 56 (21.1%), 147 (55.5%), 30 (11.3%), and 28 (10.6%) patients were observed, respectively. Also, 54 (20.4%) had a history of phototherapy. 217 (81.9%) of the psoriatic patients had CPP (Chronic Plaque Psoriasis) and 48 (18.1%) had PP (pustular Psoriasis) and finally, 21 (7.9%) of the patients had psoriatic arthritis.

The prevalence of CKD was shown to increase by age. The other correlated factors are diabetes, hypertension, and hyperlipidemia. On the other hand, there was not found any significant correlation between drugs (NSAIDs, Methotrexate, Cyclosporine, Acitretin, Infliximab, Adalimumab) and CKD prevalence. There was also no significant correlation between phototherapy, psoriasis type and psoriatic arthritis, duration of psoriasis and CKD prevalence.

Appendicovesical fistula in patients suffering from cystic fibrosis is a rare condition. Although this situation is so rare it should be considered in the differential diagnosis, dealing with a patient with cystic fibrosis and chronic abdominal pain with no response to primary management. To the best of our knowledge, this is the third case of appendicovesical fistula in a patient with cystic fibrosis.

In this paper, we are reporting a bladder lesion of a nine-year-old Iranian girl, a known case of cystic fibrosis, who was referred to pediatric urology clinic, Children’s Medical Center, Tehran University of Medical Sciences. The girl is a known case of cystic fibrosis on regular follow-up who had chronic abdominal pain for about one year. While primary management had been failed for her, further workups were done by her pediatric pulmonologist. In her pelvic sonography, the radiologist reported a bladder lesion so she was referred to our clinic. Cystoscopy was done for her, but transurethral biopsy/resection was impossible according to the lesion location. The non-papillary nature of the lesion raised our concern about the possibility of genital rhabdomyosarcoma with bladder invasion. So, an Abdominopelvic CT scan and a pelvic MRI were also done for her. Intact uterus and vagina with an enhancing lesion at the dome of the bladder with some degree of inflammation/attachment around the adjacent GI tract were detected on her images. The urachal inflammatory/tumoral process could not be ruled out. So open surgical exploration was planned. During the attempt for surgical exploration and partial cystectomy, at the Children’s Medical Center in December 2021, we found that the mass, is actually her appendix which has invaded the urinary bladder, and presented as a bladder lesion.

Abdominal pain is a relatively common complaint of patients with cystic fibrosis. Every caregiver or physician should consider rare conditions, dealing with a cystic fibrosis patient whose abdominal pain does not respond to common management.

Hemorrhoids are one of the most common perianal diseases. They have several surgical and non-surgical treatment methods. Among surgical procedures, Stapler hemorrhoidopexy method has recently gained widespread acceptance. Hemorrhoidopexy with a circular stapler usually has a series of common and mild complications and a few rare and life-threatening complications such as rectal perforation, which requires emergency surgery. In this article, a case of rectal perforation in a middle-aged man following hemorrhoidopexy with Circular Stapler in a Procedure for Prolapse and Hemorrhoids (PPH) is reported that he underwent emergency surgery.

The patient is a 43-year-old man who presented to the emergency department of Mashhad Ghaem Hospital in June 2020 due to acute general abdominal pain especially in the lower abdomen that started 3 days ago the patient has a history of hemorrhoidopexy with a Circular Stapler in a Procedure for Prolapse and Hemorrhoids (PPH) 5 days ago. The patient had a fever at the time of referral, other vital signs were normal. During the examination, the patient had tenderness and rebound tenderness, especially in the lower abdomen. Hydropneumoperitoneum or Retropneumoperitoneum or Hydroretropneumoperitoneum was reported on the abdomen and pelvic Computed Tomography (CT) scan with and without oral and intravenous contrast. The patient was diagnosed with intraperitoneal rectal perforation. He was then diagnosed with intraperitoneal rectal perforation and treated with intravenous antibiotics and surgery. After surgery, the patient's general condition improved and he was discharged without mortality and morbidity with the good condition after 6 days.

Hemorrhoidopexy with a stapler is more widely accepted than other hemorrhoidectomy methods especially manual methods for prolapse hemorrhoids due to less postoperative pain, shorter hospital stays, and faster return to work. Although this procedure usually has mild side effects that do not require surgery, sometimes life-threatening complications such as rectal perforation may happen, which requires prompt diagnosis and appropriate treatment.

Multiple sclerosis (MS), as an inflammatory autoimmune disease and chronic degenerative central nervous system degeneration, often occurs in early adulthood. One of the common and debilitating symptoms of this disease is fatigue, which can affect up to 80% of patients with MS. This study aimed to evaluate the effectiveness of magnetic field therapy on fatigue in patients with MS.

Present study is a single-blind randomized clinical trial (RCT) that Was conducted on patients with multiple sclerosis from March 2019 to September 2021. In this study, 46 patients who met our inclusion criteria were divided into two groups randomly: magnetotherapy intervention and control group. The intervention was performed in the form of a pulsed magnetic field with a frequency of 15 Hz and an intensity of 4.5 Millie Tesla. In order to blind patients, they were unaware of the intervention or control group, and the technician in charge of the treatment and the statistician knew about it. Data were then collected and recorded using the Fatigue Severity Scale, the Patient Health Questionnaire, and the Epworth Sleepiness Scale Questionnaire.

Of the 46 patients studied, 22 (48%) were male and the rest of them were female [24 cases (52%)]. The mean age of men and women was 34.4±7.3 and 33.5±1.7 years, respectively. Among the intervention and control groups, 8 people took amantadine equally in each group. In the magneto-therapy intervention group, the mean severity of fatigue reduced from 4.91±0.86 to 4.27±1.10, which was significant (p=0.024). In our control group, the mean intensity of fatigue reduced from 4.83±0.83 to 4.37±0.81, which was significant statistically (p=0.028). Although, the difference between the response of the two groups to treatment was not significant (p=0.382).

Due to the lack of significant differences in the reduction of fatigue severity, this treatment is not recommended for the treatment and management of fatigue in patients with MS.