Tehran University of Medical Sciences

As human life expectancy continues to rise, becoming a pressing global concern, it brings into focus the underlying mechanisms of aging. The increasing lifespan has led to a growing elderly population grappling with age-related diseases (ARDs), which strains healthcare systems and economies worldwide. While human senescence was once regarded as an immutable and inexorable phenomenon, impervious to interventions, the emerging field of geroscience now offers innovative approaches to aging, holding the promise of extending the period of healthspan in humans. Understanding the intricate links between aging and pathologies is essential in addressing the challenges presented by aging populations. A substantial body of evidence indicates shared mechanisms and pathways contributing to the development and progression of various ARDs. Consequently, novel interventions targeting the intrinsic mechanisms of aging have the potential to delay the onset of diverse pathological conditions, thereby extending healthspan. In this narrative review, we discuss the most promising methods and interventions aimed at modulating aging, which harbor the potential to mitigate ARDs in the future. We also outline the complexity of senescence and review recent empirical evidence to identify rational strategies for promoting healthy aging.

Iron is a crucial element for living organism in terms of oxygen transport, hematopoiesis, enzymatic activity, mitochondrial respiratory chain function and also immune system function. The human being has evolved a mechanism to regulate body iron. In some rheumatic diseases such as rheumatoid arthritis (RA), systemic lupus erythematous (SLE), systemic sclerosis (SSc), ankylosing spondylitis (AS), and gout, this balanced iron regulation is impaired. Altered iron homeostasis can contribute to disease progression through ROS production, fibrosis, inflammation, abnormal bone homeostasis, NETosis and cell senescence. In this review, we have focused on the iron metabolism in rheumatic disease and its role in disease progression.

The pharmaceutical industry is poised for transformative advancements amid rapid technological developments and rising challenges. This editorial emphasizes the need to incorporate STEM (Science, Technology, Engineering, and Mathematics) disciplines into educational frameworks to prepare future professionals with the diverse skills essential for success. Effective collaboration between scientific knowledge, business acumen, and interdisciplinary teamwork is crucial for navigating the industry's evolving landscape. Innovations in education, such as e-learning, simulation-based training, and gamification, promote critical thinking, adaptability, and creativity in learners. Furthermore, partnerships between academia and the pharmaceutical sector—through internships, mentorships, and joint research—bridge theoretical knowledge with practical application. By adopting STEM-focused educational strategies and fostering strong industry-academic alliances, the next generation of pharmaceutical professionals will be equipped to tackle complex challenges and drive ongoing innovation and excellence within the industry.

Hyaluronic acid (HA) is a linear, unbranched polysaccharide composed of repeating disaccharide units of N-acetyl-d-glucosamine and D-glucuronic acid. It plays a crucial role in promoting soft tissue growth, elasticity, and scar reduction. The growing demand for HA in pharmaceutical and cosmetic applications has provoked extensive research into diverse production strategies. Current efforts focus on bacterial and yeast fermentation. However, the extraction process presents a significant challenge due to the complex nature of source materials like fermentation broth, which contains numerous components and solutes. Achieving high extraction yields and purity requires careful consideration of extraction techniques. This study provides a comprehensive overview of the primary methodologies employed for HA production, elaborating on the advantages and disadvantages of each approach. Additionally, it highlights recent advancements in HA extraction and purification, with a particular emphasis on bacterial sources and the applications of HA. This review critically evaluates current HA production strategies, identifies key challenges hindering scalability and efficiency, and discusses innovative solutions under development to overcome these limitations.

The Phase Angle (PhA) and water cell distribution ratios are essential indicators of inflammation linked to serum inflammatory markers. We aim to investigate the relationship between PhA and extracellular water to total body water (ECW/TBW) ratio with hematological inflammatory markers. The study utilized data from the PERSIAN Organizational Cohort Study in Mashhad (POCM), incorporating information from bioelectrical impedance analysis (BIA) and blood tests. It examined two groups: individuals of normal weight (N = 1654) and those categorized as overweight or obese (N = 3651). In addition to Hemoglobin (Hgb), hematocrit (Hct), Platelet (Plt), White blood cell (WBC) and its components, the study also computed various hematologic inflammatory markers, such as platelet to HDL ratio (PHR), platelet to lymphocyte ratio (PLR), monocyte to HDL ratio (MHR), lymphocyte to HDL ratio (LHR), RDW to lymphocyte ratio (RLR), RDW to platelet ratio (RPR), and granulocyte to lymphocyte ratio (GLR). In the adjusted model, an increase in PhA is linked to increases in Hgb (Normal-weight: 17.1%, BMI > 25: 12.3%) and Hct (Normal-weight: 15.3%, BMI > 25: 13.6%), WBC (Normal-weight: 9%, BMI > 25: 6.8%), and RPR (Normal-weight: 17.1%, BMI > 25: 12.3%). Additionally, in the BMI > 25 categories, an increase in PhA is associated with increases in Plt (16.7%), Lymphocytes (5.6%), and PHR (5.2%). Furthermore, there is a decrease in RPR (Normal-weight: 7.4%, BMI > 25: 6.6%) with a unit increase in PhA. A unit increase in ECW/TBW is associated with a decrease in Hgb (Normal-weight: 19.9%, BMI > 25: 17.3%) and Hct (Normal-weight: 17.8%, BMI > 25: 17.6%). This is also linked to decreased WBC (9.6%) in the normal-weight category. Furthermore, in the BMI > 25 category, there are decreases in Plt (5.5%), RLR (6.5%), RPR (6.9%), GLR (5.9%), Granulocytes (7.5%), and Lymphocytes (8.3%) with an increase in ECW/TBW. The findings revealed that ECW/TBW demonstrates a stronger correlation with hematological markers than PhA, with these associations being particularly significant among normal-weight individuals. These results highlight the need for further research to explore the underlying mechanisms driving these relationships.

Background and Objectives Studies have indicated a potential link between retinopathy and systemic sclerosis (SSc), but the precise nature of this association remains unclear. This systematic review and meta‐analysis aims to synthesize available evidence to evaluate the relationship between SSc and retinopathy. Methods A systematic search was conducted across four major databases and gray literature to collect all relevant studies. The quality of the selected articles was assessed for risk of bias using standardized tools. A meta‐analysis was performed using standardized mean difference (Std. Mean Difference) to estimate the association between retinopathy and SSc. Additional analyses for heterogeneity, sensitivity, subgroups, and publication bias were also conducted. Results Twelve studies (359 cases, 314 controls) were included in the systematic review. A meta‐analysis of eight studies found a nonsignificant and negligible association (pooled Std. Mean Difference = 0.08; 95% CI = −0.31 to 0.48; p = 0.67) between SSc and retinopathy, with no publication bias ( p = 0.5362). Differences in Std. Mean Difference were observed in subgroup analyses but did not sufficiently explain the heterogeneity. Conclusions The findings suggest no strong association between retinopathy and SSc. While some subgroup analyses revealed potential variations, they did not fully clarify the observed heterogeneity. Further research with larger, well‐designed studies is necessary to determine whether retinopathy could serve as a biomarker for SSc. Systematic Review Registration Number ( PROSPERO ) CRD42024529644 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=529644 .

Background Hospital at Home (HaH) is an effective solution to address the challenges in healthcare systems; however, the inherent complexities of this program have created obstacles in implementing it. This study was conducted to explore the perspectives of managers and policymakers in the Iranian healthcare system on the necessary requirements for the implementation of the HAH program. Methods This qualitative study was conducted from December 2023 to June 2024. The 14 participants consisted of health policymakers, faculty members, and hospital managers from Tehran and Shiraz universities of medical sciences. The participants were selected by purposive sampling. Data were collected through semi-structured individual interviews. Data analysis was conducted using conventional content analysis. Results Following data analysis, 652 initial codes were extracted, which were subsequently classified into 7 categories and 2 themes. The themes were “alignment of macro-level mechanisms in supporting the HaH program” and “organizing the HaH program within the healthcare system”. Conclusions The study highlights that successful implementation of the HaH program in Iran is influenced by economic, legal, and socio-cultural factors, as well as the policies of the Ministry of Health and Medical Education (MOHME). Addressing the challenges in these areas requires a comprehensive and integrated approach. Additionally, the program’s success depends on development of precise structures within the healthcare system, which involves configuring this program within the healthcare service processes, executive support from managers and beneficiary healthcare centers, and the development of essential infrastructure. The findings provide valuable insights for managers, policymakers, and stakeholders, offering guidance on the design and implementation of the HaH program as a supplement to routine healthcare services.

Mesenchymal stem cell (MSC) has attracted significant attention in clinical research due to their immunomodulatory properties and potential to reduce inflammation in autoimmune disorders, such as multiple sclerosis (MS). This study evaluates the safety and feasibility of placenta-derived MSCs (PLMSCs) in five participants with secondary-progressive multiple sclerosis (SPMS). The primary outcomes focused on safety and tolerability, assessed through adverse event monitoring over six months. Secondary exploratory outcomes included clinical, imaging, and immunological measures. Patients underwent baseline evaluations and follow-up assessments comprising cognitive and psychological assessments, expanded disability status scale (EDSS), clinical signs, diffusion tensor imaging (DTI), functional MRI (fMRI), cytokine levels (IL-10, IL-6, IL-17, TNFα), and CD20/CD19 B cell marker analysis. No serious complications were noted, except for temporary headache in two patients, which was resolved with tablet. Results demonstrated sustained improvements in clinical outcomes, as indicated by significant reductions in EDSS scores (P < 0.0001), cognitive and psychological assessments, and radial diffusivity (RD) indices (P = 0.0186) in DTI metrics over six months. Furthermore, fMRI analysis showed significant enhancements in brain connectivity and cognitive function. Immunologically, CD20/CD19 B cell markers decreased significantly (P = 0.0077), and anti-inflammatory cytokine IL-10 increased alongside reductions in pro-inflammatory TNFα, IL-6, and IL-17 (P < 0.0001) three months post-therapy. These findings suggest PLMSC transplantation is safe and feasible in SPMS patients. While exploratory outcomes indicate potential clinical and immunological benefits, this phase 1 trial was not designed to assess efficacy. Larger, controlled phase II trials are warranted to validate these preliminary observations and investigate PLMSCs’ therapeutic potential in MS.

Congenital amegakaryocytic thrombocytopenia (CAMT) is a rare inherited bone marrow failure syndrome, which is characterized by a severe thrombocytopenia at birth without predictive stigmata and by a risk for progression into aplastic anaemia and myeloid malignancy. While CAMT primarily arises from mutations in the MPL gene, recent discoveries have linked biallelic THPO mutations to some CAMT cases. In addition, loss of function monoallelic mutations in this gene have been identified as causing benign autosomal dominant thrombocytopenia. In this study, we report a case of CAMT linked to a homozygous mutation in the promoter region of THPO (c.-324C>T, NM_000460.4). computational analysis indicates that this mutation suppresses the binding of some essential transcription factors to the THPO promoter. Family segregation analysis shows a significant reduction in platelet counts among carriers of the mutation. Our patient received allogeneic haematopoietic stem cell transplantation (HSCT) from her HLA-matched sister (MSD), who carries the mutation. After allogeneic HSCT, the patient showed 100% full donor chimerism, but 1 year after HSCT, despite full donor chimerism, the patient did not complete recover from platelet count, and she has received romiplostim several times. Understanding the MPL–THPO pathway is vital for managing CAMT, emphasizing the importance of identifying and assessing patients’ mutations for tailored treatment.

Aim This research utilized VOSviewer and Bibliometrix to explore the landscape of health anxiety, highlighting current research trends and potential future directions. Subject and methods We performed a broad examination in the Web of Science Core Collection (WoSCC) to identify pertinent studies on health anxiety published over the past 20 years, from the year 2000 until 2025. VOSviewer and Bibliometrix were mainly used to examine different elements such as authors, countries, institutions, publishing journals, keyword co-occurrence, and patterns of reference co-citation, with the objective of creating a knowledge atlas. Results A total of 5081 publications concerning health anxiety were collected. The overall number of publications has shown a general increase over time, albeit with some fluctuations. The United States appeared as the leading country in terms of publication output, with Johannes Gutenberg University of Mainz recognized as the most prolific institution, and Michael Witthoeft identified as the most productive author in the domain. Conclusion This investigation emphasized the key publications, journals, authors, countries, and institutions that have significantly impacted the area of health anxiety investigation. Future research trends include diagnosis and evaluation, advanced treatments encompassing pharmacotherapy and psychotherapy, exploration of cognitive and behavioral mechanisms related to health anxiety, and understanding the influence of social and environmental factors on its expansion.

Diamond–Blackfan anemia (DBA) is a rare, congenital bone marrow failure syndrome characterized by hypoplastic anemia. Earliest descriptions of this disease date back to 1936, and since then, a plethora of treatment strategies have been used to control or treat the disease. In recent decades, hematopoietic stem cell transplantation (HSCT) has been declared the only curative treatment. Despite the time elapsing from the first time HSCT has been used in this setting, no unified standard preparative and prophylactic protocol has been established. In this article, for the first time, the published articles concerning the efficacy of the most verified conditioning regimens established for these patients, the myeloablative conditioning regimen (MAC), were systematically reviewed. A comparison of two groups, based on the presence or absence of radiation in their protocol, was performed. Electronic and manual searches were conducted on PubMed, Scopus, and Web of Science. The primary study domains, selection, and outcome were assessed using the JBI Scale quality assessment for cohort and case series studies. Cohorts were categorized into treatment groups, and the characteristics of patients and donors, in addition to intervention characteristics and outcomes, were synthesized. Among a total of 196 studies reviewed, we included five cohorts in our systematic review. The studies were heterogeneous in various aspects. In conclusion, our analysis suggests that DBA patients who underwent a MAC non‐total body irradiation (TBI) conditioning regimen may experience better post‐HSCT outcomes; however, the findings are inconclusive.

There is limited information regarding organochlorine pesticides (OCPs) residues in tobacco products found in the Iranian market, especially in various types of waterpipe tobacco. The purpose of this research was to evaluate the concentration of OCPs in various waterpipe tobacco—both fruit-flavored and regular—and compare it with cigarette tobacco. Additionally, by analyzing the OCPs levels in fresh tobacco compared to tobacco wastes, an estimate has been made for the quantity of pesticides released into smoke during consumption. Our results indicated that the average detection frequency (DF) of pesticide residues was 46% for fruit-flavored tobacco, 82% for regular tobacco, and 42% for cigarette tobacco. Hexachlorocyclohexane (HCHs) isomers were the predominant pesticides in all three types of tobacco with the mean of 43.11 ± 31.81, 89.63 ± 56.08, and 41.65 ± 35.37 ng/g for fruit-flavored tobacco, regular tobacco, and cigarette tobaccos, respectively. Both the levels and DF of pesticides in post-consumption wastes were significantly reduced compared to that in fresh tobacco (p < 0.05). For all tobacco types—fruit-flavored, regular, and cigarette—notable OCPs residues were released into the gas phase, with cigarette tobacco having the highest rate at approximately ~ 37% because of greater combustion temperatures. The research points out some limitations, particularly the disregard for bowl water and charcoal as elements of waterpipe waste, which could lead to an overestimation of pesticide levels in inhaled smoke. Further studies are needed on the environmental impact of tobacco wastes and promoting for better waste management practices as well as public awareness.

Background Stellate nonhereditary idiopathic foveomacular retinoschisis (SNIFR) is a relatively recent and rare classification introduced. Currently, there is no reliable treatment for the disease. Case presentation We discussed an additional case multimodal imaging including Optical coherence tomography (OCT), fluorescein angiography and Optical coherence tomography angiography (OCTA) as well as treatment result. The case was a healthy, non-myopic woman, where foveal cystic changes persisted despite 9 months of topical dorzolamide and an additional 5 months of oral acetazolamide. Genetic testing for Congenital X-linked retinoschisis (CXLR) was negative. ERG results were near normal. Optical coherence tomography showed no vitreomacular traction, while fluorescein angiography ruled out vascular disease. Conclusions Our findings suggest that bilateral SNIFR can occur in non-myopic females, although this patient did not respond to systemic and topical carbonic anhydrase inhibitors.

Objectives To propose a novel first‐line endoscopic therapy for treating polypoid lesions in solitary rectal ulcer syndrome (P‐SRUS), the rarest and most challenging subtype of SRUS, which encompasses various endoscopic findings including mucosal erythema, superficial or deep ulcers, and polypoid lesions. Methods A prospective, single‐arm study was conducted on 56 patients with histologically confirmed SRUS and broad‐based polypoid lesions in the rectum and anal canal. These patients were referred to the Department of Motility Disorders of the Lower Gastrointestinal Tract. The lesions were removed using snare‐assisted mucosal and fibrosis resection. Patients were monitored for clinical and endoscopic responses at 1, 3, 6, and 12 months post‐treatment. Results The study observed improvement in clinical symptoms, a complete endoscopic response, and the absence of late complications following endoscopic resection. Endoscopic evaluations revealed no recurrence of lesions in the follow‐up period. Conclusion Endoscopic resection using the snare‐assisted mucosal and fibrosis resection method appears to be an effective and safe treatment option for polypoid SRUS. (Clinical Trial Registration Number: IRCT20211101052935N2).

Monocyte chemoattractant protein 1 (MCP‐1) is involved in monocyte chemotaxis, endothelial activation and regulation of leukocyte function in biological activities that promote inflammation, such as in periodontitis. A systematic review and meta‐analysis was conducted with the primary objective of investigating the roles of MCP‐1 in the gingival crevicular fluid (GCF) of subjects with chronic periodontitis compared to periodontally healthy subjects. The study protocol adhered to PRISMA guidelines. Digital searches were carried out across several databases, including PubMed, Dentistry & Oral Science Source, ScienceDirect, Scopus, Web of Science and Google Scholar. The quality of the studies was evaluated using the JBI tool for cross‐sectional studies and clinical trials. To assess the concentration of MCP‐1 in the GCF of the exposure group versus the control group, a meta‐analysis was conducted employing a random‐effects model. The search strategy yielded 1694 articles, with 14 studies meeting the inclusion criteria and 10 articles subjected to quantitative analysis. A total of 497 subjects were examined, comprising 298 cases and 199 controls. The meta‐analysis indicated a significant increase in MCP‐1 levels in the GCF of individuals with chronic periodontitis compared to healthy subjects (GCF: SMD = 20.29, 95% CI: 10.33–30.25, Z = 3.992, p = 0.001*). GCF MCP‐1 levels are elevated in periodontitis compared to healthy controls, suggesting its potential future use as a diagnostic tool in clinical settings.

Lymphoma, a cancer with poor prognosis is a growing global health challenge that encompasses two primary types, Hodgkin (HL) and non-Hodgkin lymphoma (NHL), each further divided into various subtypes with distinct biological behaviors. Conventional therapeutic strategies include chemotherapy, radiation, surgery, and autologous hematopoietic stem cell transplantation (auto-HSCT). Natural killer (NK) cells exhibit intrinsic cytotoxicity against tumor cells without the need for prior immunization or activation. In this prospective clinical trial, we evaluated the feasibility of allogeneic NK cell therapy in patients with high-risk lymphoma who had a poor prognosis. Each patient received 1 × 107 NK cells/kg infusion without interleukin-2 (IL-2) supplementation. Therapy was tolerated without graft-versus-host-disease, cytokine release syndrome, or neurotoxicity. During the follow-up period, 7 had complete responses (CR) (87.5%) and one case exhibited stable disease (SD) (12.5%). In summary, our investigations support the development of allogeneic NK cellular therapies for advanced lymphoma to overcome chemoresistance. Therapeutic efficacy may be further improved by disrupting the immunosuppressive environment and infusion of exogenous IL-15. This approach presents a promising and pragmatic strategy for managing high-risk lymphoma post-HSCT. Future research should focus on optimizing NK cell dosages and infusion frequency to maximize treatment effectiveness.

Transition‐metal‐catalyzed aminocarbonylation reactions using low‐cost and accessible CO gas as a C1 building block and amine as a nucleophile have been widely used to prepare amides, which are broadly exist in bioactive drugs, natural products, and polymers. This type of reaction has also been applied to construct various biologically active heterocycles. In this review, we highlight aminocarbonylation reactions involving amine and CO under various transition metal catalysis systems (palladium, rhodium, ruthenium, iridium, iron, copper, and cobalt) over the past decade.

Background The childbirth experience encompasses a complex interplay of physical, emotional, and psychological factors, shaping a woman’s overall well-being and potentially influencing her future reproductive plans. The current study aimed to evaluate the influential factors of respectful maternity care and its relationship with women’s future fertility decisions. Materials and Methods This cross-sectional study was conducted on 308 postpartum women hospitalized in the postpartum wards of educational hospitals affiliated with Isfahan University of Medical Sciences between April and September 2021. Data were collected using convenience sampling method by a sociodemographic and obstetric checklist and a standard Respectful Maternity Care (RMC) questionnaire and analyzed with descriptive statistics and the linear regression model (95% confidence level). Results Our findings show that 50.65% of participants would like to have another child, and only 26.62% of them reach the desired number of children. The mean score of RMC was 66.55 (7.13), and variables such as duration of hospital stay, oxytocin induction, episiotomy, birth preparation classes, and level of education were the main predictors of RMC (p-value < 0.05). In addition, a positive correlation was found between the total score of RMC, the next intended fertility (r = 0.24), and ideal fertility in the best socioeconomic condition (r = 0.22). Conclusions This study demonstrates a strong association between hospital stay duration, oxytocin induction, episiotomy, birth class attendance, education level, and RMC. Addressing these factors can enhance maternity care quality, childbirth experiences, and ultimately contribute to optimal fertility outcomes.

Background Melanoma of the oral mucosa is an uncommon cancer arising from the tissues lining the mouth. Among oronasal malignant melanomas, tongue melanoma makes up a mere 2%. Optimal treatments for this rare and often late‐stage disease remain elusive. However, surgery with free margins is considered the primary treatment and is often combined with other therapies such as neck dissection, adjuvant radiotherapy, chemotherapy, and immunotherapy. Case This case involves a 33‐year‐old woman with a history of malignant melanoma on her tongue. She had previously undergone a partial glossectomy and was on maintenance imatinib treatment for ~2 years. During her follow‐up, a new lesion was discovered on her tongue, which was confirmed to be malignant melanoma and was resected. The tumor exhibited a depth of invasion of 8 mm. All surgical margins were clear, with the closest margin being 3 mm. The lesion was reconstructed with a submental flap. Adjuvant radiotherapy was also given. The patient has been on maintenance follow‐up for 3 years with no signs of recurrence. Conclusion Malignant melanoma should be considered in the differential diagnosis of pigmented and non‐pigmented lesions of the tongue and oral mucosa. A thorough clinical evaluation, followed by histopathological and immunohistochemical examination of any suspicious lesions, is essential for early diagnosis. Early detection and prompt treatment are crucial for optimizing patient outcomes and improving survival rates.