Research in Molecular Medicine

en Study of Factors Affecting the Failure of Methotrexate Treatment in Patients Diagnosed With Tubal Ectopic Pregnancy فارماسیوتیکس(داروسازی صنعتی) Pharmaceutics پژوهشي Research Background: Methotrexate (MTX) is the first-line treatment for stable tubal ectopic pregnancy(EP), but its failure can lead to serious complications. This study aimed to identify predictive factors for methotrexate treatment failure to improve patient selection. Methods: In this retrospective cross-sectional study, 371 patients with EP treated with a single-dose methotrexate regimen (50 mg/m²) at Rouhani Hospital, Babol (2013-2024) were analyzed. Demographic, clinical (β-hCG, pain), sonographic (mass size, free fluid), and inflammatory indices (neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII)) data were extracted from medical records. Treatment failure was defined as the need for surgery. Univariate and multivariate logistic regression were used to identify independent predictors, with ROC curves assessing their accuracy. Results: The treatment failure rate was 9.7% (n=36). Multivariate analysis identified a larger mass size (OR=1.32; 95%CI:1.15-1.52; p<0.001) and a higher systemic immune-inflammation index (SII) (OR=1.03; 95%CI:1.00-1.06; p=0.036) as significant independent predictors of failure. Higher red blood cell count and platelet distribution width were protective factors. ROC analysis demonstrated high predictive accuracy for mass size (AUC=0.85) and SII (AUC=0.82) in distinguishing treatment outcomes. Conclusion: Ectopic pregnancy mass size ≥23 mm and elevated SII are strong predictors of methotrexate treatment failure. These readily available parameters can serve as valuable tools for clinical decision-making, suggesting that primary surgery may be a preferable option for patients with these risk factors to avoid the complications of failed medical therapy.   Keywords: Ectopic pregnancy, methotrexate, treatment failure, inflammatory markers, NLR 0 0 http://rmm.mazums.ac.ir/browse.php?a_code=A-10-1462-1&slc_lang=en&sid=1 Afsaneh Bashiri afsanehbashiri28@gmail.com 100319475328460013766 100319475328460013766 No Infertility and Reproductive Health Research Center, Health Research Institute, Obstetrics and Gynecology Department, Babol University of Medical Sciences, Babol, Iran Zinatossadat Bouzari Z_b412003@yahoo.com 100319475328460013767 100319475328460013767 Yes Infertility and Reproductive Health Research Center, Health Research Institute, Obstetrics and Gynecology Department, Babol University of Medical Sciences, Babol, Iran Mehrzad Netadj netadj@soc.msstate.edu 100319475328460013768 100319475328460013768 No Department of Sociology, Mississippi State University, USA. Shahla Yazdani Shahla_yazdani_1348@yahoo.com 100319475328460013769 100319475328460013769 No Infertility and Reproductive Health Research Center, Health Research Institute, Obstetrics and Gynecology Department, Babol University of Medical Sciences, Babol, Iran Soraya Khafri Khafri@yahoo.com 100319475328460013770 100319475328460013770 No Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran

en Emerging Antibiotic Resistance in Klebsiella pneumoniae Among Diabetic Patients With Urinary Tract Infections: A Regional Study from Khorramabad City, Iran باکتری شناسی پزشکی Medical bacteriology پژوهشي Research <div style="text-align: justify;">Background: Diabetic patients are at a heightened risk of urinary tract infections (UTIs) caused by antibiotic-resistant bacteria. This study aimed to determine the antimicrobial resistance patterns of Klebsiella pneumoniae isolated from diabetic patients with UTIs in Khorramabad City, Iran. Methods: In this cross-sectional study (May 2020 to March 2021), 500 K. pneumoniae isolates were obtained from 3130 diabetic patients with culture-confirmed UTIs. Identification was performed using standard microbiological methods. Antimicrobial susceptibility testing against nine antibiotics was conducted via the Kirby-Bauer disk diffusion method, interpreted according to Clinical and Laboratory Standards Institute guidelines. Results: The highest resistance rates were observed for gentamicin (66%) and ampicillin (58%). The lowest resistance was observed for cefazolin (17%), nitrofurantoin (21%), and ceftazidime (22%). Multidrug resistance was identified in 17% of isolates. The patient distribution was 57% female, 39% male, and 4% pediatric. Conclusion: High resistance to empiric antibiotics, such as gentamicin and ampicillin, was found, underscoring the need for revised treatment guidelines and robust antimicrobial stewardship in the management of diabetic UTI in this region.</div> Antibiotic resistance, Diabetic, Klebsiella pneumoniae, Khorramabad, UTI 0 0 http://rmm.mazums.ac.ir/browse.php?a_code=A-10-1447-1&slc_lang=en&sid=1 Nemat Shams Shams.n@lu.ac.ir 100319475328460013842 100319475328460013842 No Associate Professor of Microbiology, Department of Microbiology and Food , School of Veterinary Medicine, Lorestan University of Medical Sciences, Lorestan, Iran Hamed Alami hamedalami1993@gmail.com 100319475328460013843 100319475328460013843 Yes PhD student in Bacteriology, Department of Microbiology and Food Hygiene , School of Veterinary Medicine, Lorestan University of Medical Sciences, Lorestan, Iran . Kiana Shahzamani Kiana.Shah@gmail.com 100319475328460013844 100319475328460013844 No Associate Professor of Medical Virology, Department of Virology, Medical School, Lorestan University of Medical Sciences, Lorestan, Iran Neda Amiri 100319475328460013845 100319475328460013845 No Bachelor of Microbiology, Department of Biology, Faculty of Basic Sciences, Khorramabad Azad University, Khorramabad, Iran

en Influenza A-Induced Rhabdomyolysis Without Acute Kidney Injury: A Case Report عفوني Infectious Diseases گزارش مورد case report <div style="text-align: justify;">Background: Rhabdomyolysis is a clinical syndrome characterized by the breakdown of muscle cells and release of intracellular contents into the bloodstream. Viral infections, including influenza A, are rare but important causes. Case Presentation: A 27-year-old healthy male presented with fever and weakness. His creatine kinase (CK) level was 19,000 U/L, and CK-myocardial band (CK-MB) was 2,636 U/L. He tested positive for H1N1 by polymerase chain reaction. Despite severe rhabdomyolysis, he did not develop acute kidney injury (AKI). Results: The patient received intravenous fluids (1-liter bolus, then 4 liters/day for 5 days). CK levels decreased to 2,500 U/L by day 5. Echocardiography was normal. Conclusion: Influenza-induced rhabdomyolysis can occur without acute kidney injury (AKI), even with CK >19,000 U/L. Early fluid resuscitation may prevent renal injury. </div> Influenza, Infections, Rhabdomyolysis 0 0 http://rmm.mazums.ac.ir/browse.php?a_code=A-10-1337-1&slc_lang=en&sid=1 Ilia Zamani Hajiabadi madwx@yahoo.com 3 100319475328460013754 No Department of Internal Medicine, Semnan University of Medical Sciences, Semnan, Iran. Mohammad Mehdi Niknam Mohammad.niknam10@gmail.com 1 100319475328460013755 No Student Research Committee, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran. Keshvaar Samadaeegelehkolaee k-samadaee@alumnus.tums.ac.ir 2 100319475328460013756 Yes Sexual and Reproductive Health Research Center, Department of Reproductive Health and Midwifery, Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran.

en Conventional and Targeted Therapeutic Approaches in Multiple Sclerosis: A Narrative Review of Disease-Modifying Therapies, Nanoparticles, and Exosomes ايمونولوژي Immunology review review <div style="text-align: justify;">Multiple sclerosis (MS) is a chronic immune-mediated neurodegenerative disease of the central nervous system (CNS) characterized by inflammation, demyelination, and progressive neurological disability. Conventional disease-modifying therapies, including interferon-beta, glatiramer acetate, sphingosine-1-phosphate modulators, anti-CD20 antibodies, and immune reconstitution strategies, can reduce relapse activity and disease burden; however, their efficacy is limited by adverse effects, incomplete control of compartmentalized central nervous system (CNS) inflammation, and insufficient target specificity. In parallel, nanoparticles and exosomes have emerged as promising targeted platforms for drug delivery and immunomodulation because they may enhance blood-brain barrier (BBB) penetration and improve cell-specific delivery. This narrative review summarizes conventional and targeted therapeutic approaches in multiple sclerosis (MS), with emphasis on the translational promise and limitations of nanoparticle- and exosome-based strategies. Preclinical evidence from experimental autoimmune encephalomyelitis models and human clinical data are distinguished where appropriate. The review also highlights the major barriers that must be addressed before these approaches can be translated into routine clinical practice.</div> Multiple Sclerosis, Treatment of multiple sclerosis, Conventional Treatments, Nanoparticles, Exosomes, Targeted Therapy, Narrative Review 0 0 http://rmm.mazums.ac.ir/browse.php?a_code=A-10-1471-1&slc_lang=en&sid=1 Shirin Taghizadeh shirintaghizadeh@ymail.com 100319475328460013771 100319475328460013771 Yes Department of Medical Sciences, Shahrood Center, Islamic Azad University, Shahrood, Iran. Melika Gorgani melika.gorgani_96@yahoo.com 100319475328460013772 100319475328460013772 No Department of Immunology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran. Gilda Parsamanesh g.parsamanesh@gmail.com 100319475328460013773 100319475328460013773 No Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Mir Hadi Jazayeri hoohadi@yahoo.com 100319475328460013774 100319475328460013774 No Department of Immunology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran Hamid Nickho nickho.h@semums.ac.ir 100319475328460013775 100319475328460013775 No Department of Immunology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

en From Screening to Diagnosis: ACADSB Variant Co-Inheritance Causing 2-Methylbutyrylglycinuria in an Iranian Neonate ژنتیک Genetic گزارش مورد case report <div style="text-align: justify;">Short/branched-chain acyl-CoA dehydrogenase deficiency, also known as 2-methylbutyrylglycinuria, is a rare autosomal recessive metabolic disorder affecting the catabolism of L-isoleucine. Early detection through newborn screening programs using tandem mass spectrometry enables timely diagnosis and intervention, potentially preventing severe clinical outcomes. In this study, we report a case identified through Iran's national newborn screening program, presenting with elevated C5-acylcarnitine levels. Whole exome sequencing revealed compound heterozygosity for two ACADSB gene variants: c.908G>C and c.1159G>A. While c.1159G>A is classified as pathogenic, c.908G>C was previously considered a variant of uncertain significance. However, the observed biochemical phenotype and in silico analysis support reclassification of c.908G>C as likely pathogenic. This case highlights the importance of integrating genotype–phenotype correlation and advanced genomic tools to refine variant interpretation and improve diagnostic accuracy in rare metabolic disorders.</div> ACADSB gene, Newborn screening, 2-methylbutyrylglycinuria 0 0 http://rmm.mazums.ac.ir/browse.php?a_code=A-10-856-8&slc_lang=en&sid=1 Hossein Jalali hossein.jalaliakerdi@gmail.com 100319475328460013761 100319475328460013761 No Thalassemia Research Center, Hemoglobinopathy Institute, Mazandaran University of Medical Sciences, Sari, Iran. Ziba Molaei Zibamolaei88@yahoo.com 100319475328460013762 100319475328460013762 No Department of Pediatrics, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran. Fatemeh Ghorbani fatemehghorbani274@gmail.com 100319475328460013763 100319475328460013763 No Sinayemehr Research Center, Mazandaran University of Medical Sciences, Sari, Iran. Hossein Mokhtari mokhtarimsh@yahoo.com 100319475328460013764 100319475328460013764 No Amol Faculty of Paramedicine, Mazandaran University of Medical Sciences, Sari, Iran. Mohammad Reza Mahdavi Mahdavi899@gmail.com 100319475328460013765 100319475328460013765 Yes Thalassemia Research Center, Hemoglobinopathy Institute, Mazandaran University of Medical Sciences, Sari, Iran.

en Serum Level of Sex Hormones in Women With Colon Cancer in Northern Iran هماتولوژی و آنکولوژی Hematology & Oncology پژوهشي Research <div style="text-align: justify;">Background: The incidence of colorectal cancer (CRC) is lower among women than among men in all age groups, and higher estradiol exposure in women is thought to have a protective role. This study aimed to investigate the relationship between sex hormones and the risk of CRC in women. Methods: This study explored the relationship between the risk of CRC and estradiol, testosterone, progesterone, and sex hormone-binding globulin (SHBG) concentrations in non-current users of exogenous hormones. Multivariate conditional logistic regression models were applied to calculate odds ratios and 95% confidence intervals to estimate the association between circulating sex hormone levels and CRC. Results: Median levels of estradiol and SHBG were found to be significantly high in women with CRC but circulating levels of progesterone in patients were significantly lower than those in controls. No correlation was observed between estradiol, testosterone, progesterone, and SHBG and CRC after adjusting for age and menopausal status. Conclusion: Based on current findings, relationships between CRC risk and the levels of progesterone, testosterone, and SHBG seem unlikely. Future studies may be required to elucidate the association between estradiol levels and CRC risk in women using greater sample sizes and well-defined boundaries.</div> Colorectal cancer, Estrogen, Progesterone 0 0 http://rmm.mazums.ac.ir/browse.php?a_code=A-10-777-3&slc_lang=en&sid=1 Ramin Shekarriz raminshf@gmail.com 100319475328460013776 100319475328460013776 No Gastrointestinal Cancer Research Center, Non-Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran Akbar Hedayatizadeh-Omran akbar_hedayati@yahoo.com 100319475328460013777 100319475328460013777 Yes Gastrointestinal Cancer Research Center, Non-Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran Niloofar Sadeghi niloofar.sadeghi9069@gmail.com 100319475328460013778 100319475328460013778 No Gastrointestinal Cancer Research Center, Non-Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran Reza Alizadeh-Navaei reza-nava@yahoo.com 100319475328460013779 100319475328460013779 No Gastrointestinal Cancer Research Center, Non-Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran Omolbanin Amjadi prs.amjadi0o0@gmail.com 100319475328460013780 100319475328460013780 No Gastrointestinal Cancer Research Center, Non-Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran Adele Bahar doctor_bahar2000@yahoo.com 100319475328460013781 100319475328460013781 No Diabetes research center, Mazandaran university of Medical Sciences, Sari, Iran