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Mehrnoush Toufan,1 Reza Javadrashid,2 Neda Paak,2 Morteza Gojazadeh,3 Majid Khalili41Cardiovascular Research Center, 2Department of Radiology, 3Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; 4Azerbaijan National Academy of Sciences, Baku, AzerbaijanBackground: Mitral valve calcification is often incidentally detected on chest computed tomography (CT) scans obtained for a variety of noncardiac indications. In this study, we evaluated the association between mitral valve calcification incidentally detected on chest CT and the presence and severity of mitral valve disease on echocardiography.Methods: Of 760 patients undergoing 64-row multidetector CT of the chest, 50 with mitral valve calcification and 100 controls were referred on for echocardiography. Calcifications of the mitral valve leaflet and annulus were assessed for length, Agatston score, and site, and were compared with echocardiographic findings.Results: Mitral valve calcification was noted in 59 (7.7%) patients on multidetector CT. Fifty of these patients were assessed by echocardiography, and 32 (64%) were found to have mitral annular calcification. Nine patients (18%) had posterior mitral valve leaflet calcification, and both mitral valve leaflet and annular calcification were detected in nine (18%) cases. Nine (18%) patients had mild, three (6%) had moderate, and one (2%) had severe mitral stenosis. None of the patients with isolated mitral annular calcification had mitral stenosis; however, all the patients with mitral stenosis showed mitral valve leaflet calcification with or without mitral annular calcification (P < 0.001). Moreover, patients with mitral stenosis had a larger mitral calcification length and greater Agatston scores in comparison with those without mitral stenosis (P = 0.001). While 31 patients (62%) with mitral calcification had mitral regurgitation on echocardiography, 21 (21%) in the control group showed mitral regurgitation (P = 0.001).Conclusion: Mitral valve leaflet calcification, with or without annular calcification, may be an indicator of mitral stenosis. Mitral calcification can also be considered as an indicator for mitral regurgitation in general. Therefore, patients with mitral valve calcification detected incidentally on chest CT scan may benefit from functional assessment of the valve using echocardiography.Keywords: mitral annular calcification, mitral valve leaflet calcification, multidetector computed tomography, mitral regurgitation, mitral stenosis

Objective: In the present study, we aimed to validate the Behçet's syndrome Overall Damage Index (BODI) and compare its performance with that of vasculitis damage index (VDI) in Iranian patients with BD., Methods: This study included 274 patients with a diagnosis of BD and median follow-up of 40 months. The medical records of the patients were reviewed and the demographic characteristics, disease activity status, clinical manifestations, and data on organs damage were collected from all patients., Results: To evaluate the construct/convergent validity, BODI and VDI were applied to all participants. We found a good correlation between BODI score and VDI score. There was a significant and strong correlation between physician global assessment with BODI (r = 0.869, P = 0.001) and VDI (r = 0.817, P = 0.001). The ability of BODI to determine the accumulation of damage over time was assessed by analyzing the changes in BODI score over time. The increase in BODI score was occurred in 53 (19.3%) patients. In comparison, the increase in VDI score occurred in 36 (13.1%) patients. The increase in median BODI was significantly more than median VDI (P < 0.001). Multiple linear regression analysis showed that age at disease onset, disease duration, and disease severity were independent predictors of BODI scores. Reliability of BODI was examined by comparing the BODI scores as determined by two independent assessors in 100 patients. Cronbach's α was 0.942., Conclusion: The BODI demonstrated acceptable validity and reliability in assessing BD-related damage in Iranian patients with BD., (© 2022. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.)

Introduction: The Helicobacter pylori(H. pylori) infection leads to intensification of symptoms and calenture of autoimmune diseases. This study aimed to evaluate the relationship between H. pylori infection and clinical outcomes in rheumatoid arthritis (RA) patients., Methodology: This study was performed on 100 RA patients. Blood samples were collected for measuring Anti-H. pylori IgG antibodies and cytotoxin-associated gene A (CagA) protein. Fresh fecal samples were also collected and the fecal H. pylori antigen was extracted. Clinical condition as well as severity and type of RA symptoms in both groups of H. pylori positive and H. pylori negative were also compared., Results: Serum levels of rheumatoid factor (RF), ESR, CRP, anti-cyclic citrullinated peptide (Anti-CCP), and anti-mutated citrullinated vimentin (Anti-MCV) were significantly higher in H. pylori positive patients than in H. pylori negative patients (P < 0.05). Serum RF, ESR, CRP and Anti-MCV levels were significantly higher in CagA positive patients than in CagA negative patients (P < 0.05). There were no significant differences in DAS-28 scores between H. pylori positive and H. pylori negative patients (P = 0.064) as well as between patients with positive and negative fecal H. pylori antigen (P = 0.237). However, DAS-28 score was significantly higher in CagA positive patients than in CagA negative patients (P < 0.001). Furthermore, mean VAS score was significantly higher in H. pylori positive patients (P = 0.031) and CagA positive patients (P = 0.004); however, there were no significant differences in VAS scores between patients with positive and negative fecal H. pylori antigen (P = 0.310)., Conclusion: Follow-up and examination of RA patients in terms of infection with serum and fecal H. pylori organism and CagA seems necessary that will contribute to better and further control and treatment of the patients., (Copyright © 2019 European Federation of Immunological Societies. Published by Elsevier B.V. All rights reserved.)

Introduction: Early maladaptive schemas (EMSs) that are being shaped through the early period of development of humans have been reported to affect the functions of asthmatic patients. This study focuses on the probable relationship between the personality schemas and areas with severity of asthma., Material and Methods: Fifty asthmatic patients were entered this descriptive cross-sectional study in Tabriz University of Medical Sciences from March to August, 2016. We measured the personality schema of patients by using the Young Schema Questionnaire - Short Form (YSQ-SF; Young, 1994). On the other hand, patients' clinical findings and severity of asthma were assessed by spirometry and the Asthma Control Test (ACT) questionnaire., Results: Uncontrolled (ACT score < 20) and controlled (ACT score ≥ 20) asthma had significant defect in 'Disconnection domain' (p = 0.001). Also, significant reverse linear correlation was found between FEV₁ and 'Disconnection domain', 'Rejection' schema area (r = -0.29, p = 0.03), and 'Over vigilance domain' (r = -0,36, p = 0.01). Whereas, significant reverse linear correlation was revealed between FEV₁/FVC and Over vigilance domain (r = -0.41, p = 0.003)., Conclusion: EMSs possibly have potential effects on clinical characteristics and severity of asthma in asthmatic patients.

Introduction: Lupus nephritis is a common and severe manifestation of systemic lupus erythematosus that can lead to end-stage renal disease and death. The aim of this study was to compare the efficacy and safety of mycophenolate mofetil (MMF) and cyclophosphamide as induction therapy and subsequently as maintenance therapy for lupus nephritis., Materials and Methods: In this retrospective case-control study, 67 patients with proliferative lupus nephritis who were treated with MMF (n = 45) and pulse of intravenous cyclophosphamide (n = 22) were included. Remission of the kidney disease, mortality, and adverse events were evaluated and compared between the two groups., Results: The 45 patients treated with MMF had a mean age of 33.8 ± 10.6 years and 17.1% of them were males. The 22 patients treated with pulse of intravenous cyclophosphamide had a mean age of  38.1 ± 11.1 years and 18.2% of them were males. Complete and partial kidney remission occurred in 40% and 42.2% of the patients treated with MMF and in 31.8% and 59.1% of the patients treated with cyclophosphamide, respectively. No significant differences were observed in complete and partial remission between the two groups. No mortality was reported in the studied patients. There were no significant differences in the frequency of adverse events between the two groups., Conclusions: The efficacy of MMF in long-term treatment of lupus nephritis was comparable to that of cyclophosphamide, and there is no significant differences in the rate of side effects between the two regimens.

Objective: This study aimed to evaluate long-term efficacy of low dose cyclosporine A (CsA) in the treatment of resistant proliferative lupus nephritis., Methods: In this retrospective study, patients with biopsy proven proliferative lupus nephritis who were unresponsive to combination therapy with steroid plus mycophenolate mofetil (MMF) or cyclophosphamide (CYC) and had been treated with CsA were included. Efficacy monitoring was based on the systemic lupus erythematosus (SLE) disease activity index, dose of prednisolone, serum complement, anti-double stranded DNA (anti-dsDNA) titration, urine analysis, proteinuria, creatinine clearance, remission of the renal disease, renal survival and involvement of other organs., Results: This study included 27 consecutive patients (22 females, 5 males) with resistant proliferative lupus nephritis. Mean duration of follow up and treatment with CsA were 40.7 ± 24.9 and 35.2 ± 19.1 months, respectively. Complete and partial renal remission occurred in 66.9% and 25.7% patients, respectively. Creatinine clearance was stable, proteinuria and anti-dsDNA titer decreased, and C3 and C4 increased significantly during the treatment with CsA. Severe complications such as death, dialysis, kidney transplantation and severe infection did not occur in the studied patients during the follow-up period., Conclusions: Low-dose CsA could induce renal remission and ameliorate the SLE disease activity in patients with resistant proliferative lupus nephritis and it would be a safe drug for treatment of these patients.

Background: The aim of this study was to evaluate the freeze-thawing method in reducing viral load of cytomegalovirus (CMV) in breast milk of mothers of preterm infants., Materials and Methods: In this study, 169 nursing mothers of preterm infants were evaluated serologically for CMV infection. We found 29 (17.15%) nursing mothers who had serologic evidence of CMV infections consistent with recent infection (N = 2, IgG + IgM +) or prior infection (N = 27 IgG + IgM-). Two to 6 weeks after delivery, breast milk of seropositive mothers (N = 29) was evaluated for CMV load by real-time polymerase chain reaction (PCR) before and after freezing at -20°C for 72 hours. All preterm infants with milk results positive for DNA particles of CMV (N = 25) were followed up for signs and symptoms of CMV infection until 3 months of age, together with urine testing for CMV by real-time PCR., Results: Examination of breast milk by real-time PCR of the seropositive mothers showed 25 of them with CMV DNA particles in their breast milk. After freezing and thawing, we found virus DNA in 4 of 25 (16%) of the breast milk samples and there was no CMV DNA particles in 21 (84%) of them. In these samples, mean viral load before freezing was 76.04 ± 34.08 copies/μL (20-135.00 copies/μL) and after freezing it was 6.75 ± 4.34 copies/μL (0.00-13.00 copies/μL). Freezing showed a significant decrease in viral load of the samples (p = 0.001)., Conclusion: The study showed that the freeze-thawing method is an effective method in reducing the CMV load in breast milk samples.

Background: Dysmenorrhea is one of the most common types of cyclic pain that affects 50% of women and girls in their menstrual ages. Because of the side-effects and contraindications of chemical medicines, using herbs has been investigated in treating dysmenorrhea., Objectives: The aim of this study was to determine the effect of Rosa damascena extract on primary dysmenorrhea among the students of Kowsar dormitory in Tabriz University of Medical Sciences., Materials and Methods: This study was performed in Iran on 92 single 18-24 year old students with BMI :19-25 and obtaining pain intensity score of 5-8 in Visual Analogue Scale that were randomly classified and included in two groups of 46 persons. The participants received two capsules of Mefenamic Acid and Rosa damascena with the similar physical properties in two consecutive cycles per 6 hours for 3 days in a cross-over form. The data were collected through the questionnaire of demographic characteristics and check-list of visual analogue scale. Descriptive statistics and repeated measurement test and independent samples t test by using SPSS (13/win) were used in order to determine and compare the effects of two drugs on dysmenorrheal pain intensity of the groups., Results: There was a significant difference between the average of pain intensity at different hours of measurement in each group after the end of first cycle and second cycle (P < 0.001). There was no significant difference between the average of pain intensity in two groups in the first cycle (P = 0.35) and second cycle (P = 0.22)., Conclusions: In this study¸ Rosa damascena and Mefenamic acid had similar effects on pain intensity of primary dysmenorrhea . With further studies, Rosa damascena which has no chemical side effects¸ can be suggested for treating primary dysmenorrhea.

Objective(s): The aim of study was to investigate the antinociceptive effect of intracerebroventricular (ICV) microinjection of Origanum vulgare (ORG) extract and possible involvement of opioid receptors., Materials and Methods: Cannula was inserted into left ventricle of male rats. Five days after surgery Tail Flick Latency (TFL) was measured after ICV microinjection of, ORG (1, 3 and 6 µg / rat). Effective dose of ORG was injected ICV in concomitant with morphine (2 mg/kg, IP), naloxone (2 mg / kg, IP) and saline (0.5 µl/rat) and TFL was recorded., Results: The co- administration of ORG extract with morphine showed a significant increase in TFL and naloxone, pretreatment significantly inhibited the antinociceptive activity of ORG and morphine., Conclusion: The aqueous extract of ORG possesses antinociceptive activities in the tail-flick test in a dose dependent manner. ORG - induced antinociception may have been mediated by opioid systems.

Introduction: Perineal pain is the most common complaint after episiotomy. It imposes extra pressure on mothers who attempt to adapt to their new conditions. Therefore, the present study was performed to compare pain severity and perineal repair in two episiotomy repair methods., Methods: In this clinical trial, 100 primiparous women who referred to hospitals of Tabriz (Iran) for delivery were randomly allocated into two groups of 50 to undergo either continuous or interrupted episiotomy repair. A visual analogue scale (VAS) was used to evaluate pain severity 12-18 hours after episiotomy repair and also 10 days after delivery. Perineal repair rate was also assessed using the REEDA (redness, edema, ecchymosis, discharge, and approximation) scoring scale. The obtained data was analyzed in SPSS15., Results: Statistical tests did not show significant differences between the 2 groups in pain severity variations or REEDA scores at 12-18 hours and the 10th day after delivery. However, the mean required time for repair and the number of used threads were significantly lower in the continuous repair group (p < 0.001)., Conclusion: The results of this study showed that pain severity and episiotomy repair rate were similar in the two methods. Nevertheless, shorter time of repair and fewer threads were required using the continuous repair method. Therefore, this method would provide better services for mothers and reduce the required time, energy, and costs.

Objective: The aim of this study was to evaluate maternal and neonatal complications in mothers delivering babies when aged younger than 18 years., Methods: In this retrospective study, all labors attended during a one-year period at Alzahra Referral Hospital were evaluated for level of risk. We recorded maternal risk factors, including age, type of delivery, health status, and other factors including marital status and familial marriage. Neonates were evaluated according to prematurity, birth weight, and general health status., Results: There were 186 mothers under the age of 18 years, comprising 2.6% of all deliveries at our institution. We divided them in two groups according to age, ie, Group 1 (under 15 years) and Group 2 (15-18 years). Rates of normal vaginal delivery and cesarean section were 83% and 17%, respectively. The prevalence of eclampsia and pre-eclampsia in Group 1 was twice that in Group 2. Rates of still birth, prematurity, low birth weight and very low birth weight were higher in Group 1 than in Group 2 (9.09%, 18.1%, 16.7%, and 4.5% versus 4.6%, 13.9%, 13.6%, and 1.9%, respectively). The rate of familial marriage was 18%, and 16% of the offspring of these marriages were complicated by congenital malformations and still birth. These complications were twice as common in Group 1 compared with Group 2 (11% versus 5%, respectively)., Conclusion: Maternal age under 18 years is a risk factor for complications in both mothers and neonates, and even more so in mothers aged younger than 15 years.