Shiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071647120220101Iranian Journal of Medical Sciences: 2021 Review and 2022 Outlook114806210.30476/ijms.2022.48062ENZahraMahdiyarShiraz University of Medical Sciences, Shiraz, Iran0000-0003-3115-9826SaeedNematiBooks and Journals Group, Shiraz University of Medical Sciences, Shiraz, Iran0000-0001-7615-3335ManicaNegahdaripourPharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, IranDepartment of Pharmaceutical Biotechnology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran0000-0002-4265-1499Journal Article20211229While 2021, the second year of the coronavirus disease 2019 (COVID-19) pandemic, has come to an end, we, on behalf of the Iranian Journal of Medical Sciences (IJMS) editorial team, would like to reach out and wish you a happy and healthy 2022. https://ijms.sums.ac.ir/article_48062_90804f57c5146af4ac69988d8a7d6207.pdfShiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071647120220101Pooled Prevalence Estimate of Ocular Manifestations in COVID-19 Patients: A Systematic Review and Meta-Analysis2144796710.30476/ijms.2021.89475.2026ENSaberSoltaniDepartment of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, IranResearch Center for Clinical Virology, Department of Virology, Tehran University of Medical Sciences, Tehran, Iran0000-0003-3369-0856MiladZandiDepartment of Hematology and Blood Banking, School of Allied Medicine, Iran University of Medical Sciences, Tehran, IranHepatitis Research Center, Lorestan University of Medical Sciences, Khorramabad, IranSeyed-EsmaeilAhmadiDepartment of Hematology and Blood Banking, School of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran0000-0002-1227-491XBahmanZarandiDepartment of Hematology and Blood Banking, School of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran0000-0002-8601-5339ZeinabHosseiniHepatitis Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran0000-0002-1242-253XSaraAkhavan RezayatDepartment of Health Economics and Management, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran0000-0002-6646-8605MortezaAbyadehCell Science Research Center, Department of Molecular Systems Biology, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, IranIrajPakzadClinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, IranDepartment of Microbiology, School of Medicine, Ilam University of Medical Sciences, Ilam, IranPoonehMalekifarDepartment of Epidemiology, School of Public Health, Tehran University Medical Sciences, Tehran, IranRezaPakzadDepartment of Epidemiology, Faculty of Health, Ilam University Medical Sciences, Ilam, IranNoor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran0000-0001-8133-3664Sayed-HamidrezaMozhganiDepartment of Microbiology, School of Medicine, Alborz University of Medical Sciences, Karaj, IranNon-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran0000-0003-4570-2252Journal Article20201228Background: There are reports of ocular tropism due to respiratory viruses such as severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Various studies have shown ocular manifestation in coronavirus disease-2019 (COVID-19) patients. We aimed to identify ophthalmic manifestations in COVID-19 patients and establish an association between ocular symptoms and SARS-CoV-2 infection. <br />Methods: A systematic search of Medline, Scopus, Web of Science, Embase, and Cochrane Library was conducted for publications from December 2019 to April 2021. The search included MeSH terms such as SARS-CoV-2 and ocular manifestations. The pooled prevalence estimate (PPE) with 95% confidence interval (CI) was calculated using binomial distribution and random effects. The meta-regression method was used to examine factors affecting heterogeneity between studies. <br />Results: Of the 412 retrieved articles, 23 studies with a total of 3,650 COVID-19 patients were analyzed. The PPE for any ocular manifestations was 23.77% (95% CI: 15.73-31.81). The most prevalent symptom was dry eyes with a PPE of 13.66% (95% CI: 5.01-25.51). The PPE with 95% CI for conjunctival hyperemia, conjunctival congestion/conjunctivitis, and ocular pain was 13.41% (4.65-25.51), 9.14% (6.13-12.15), and 10.34% (4.90-15.78), respectively. Only two studies reported ocular discomfort and diplopia. The results of meta-regression analysis showed that age and sample size had no significant effect on the prevalence of any ocular manifestations. There was no significant publication bias in our meta-analysis. <br />Conclusion: There is a high prevalence of ocular manifestations in COVID-19 patients. The most common symptoms are dry eyes, conjunctival hyperemia, conjunctival congestion/conjunctivitis, ocular pain, irritation/itching/burning sensation, and foreign body sensation.https://ijms.sums.ac.ir/article_47967_5e8837a0a770961a93b4d4ecbf76265c.pdfShiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071647120220101Prevalence of Depression among Iranian Patients with Beta-Thalassemia Major: A Systematic Review and Meta-analysis15244731310.30476/ijms.2020.85941.1557ENZahraJaafariStudent Research Committee, Kerman University of Medical Sciences, Kerman, Iran0000-0002-2702-039XNasrinSadidiStudent Research Committee, Kerman University of Medical Sciences, Kerman, Iran0000-0002-0413-0182ZahraAbdolahiniaStudent Research Committee, Kerman University of Medical Sciences, Kerman, Iran0000-0002-1307-1057ArmitaShahesmaeiliHIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran0000-0001-9270-319XJournal Article20200404Background: Patients with beta-thalassemia (BT) are susceptible to psychological disorders such as depression. The present study was conducted to estimate the pooled prevalence of depression among patients with BT in Iran. <br />Methods: Domestic and international databases were searched for relevant articles published from 1991 until June 2019. We searched international databases such as Scopus, ISI, and Embase; Iranian databases such as SID, Magiran, and IranDoc; and Google Scholar and PubMed search engines. The MeSH keywords used were “depression”, “mental health”, “depressive disorder”, “thalassemia”, “beta-thalassemia major”, “prevalence”, “epidemiology”, and “Iran”. Relevant cross-sectional or cohort studies were included in the analysis. Cochran’s Q test and the I2 index were used to assess heterogeneity. The pooled prevalence and its 95% confidence interval (CI) were calculated using “metaprop” commands in Stata 14. In cases, where the I2 statistic was greater than 50%, the random-effects model was used. <br />Results: Eighteen eligible studies were included. The pooled prevalence of depression was 42% (95% CI: 33% to 52%), whereas the pooled prevalence of mild, moderate, severe, and extremely severe depression was 16% (95% CI: 11% to 22%), 13% (95% CI: 9% to 18%), 13% (95% CI: 9% to 17%), and 3% (95% CI: 0% to 8%), respectively. The pooled prevalence of depression in moderate- and high-quality studies was 45% (95% CI: 29% to 61%), and 39% (95% CI: 27% to 51%), respectively. <br />Conclusion: The high prevalence of depression highlights the urgent need for the establishment of interventions for the prevention, early detection, and treatment of depression among Iranian patients with BT.https://ijms.sums.ac.ir/article_47313_80c338e08f4e936f60e1891b79e6ca47.pdfShiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071647120220101The Comparison of the Efficacy of Early versus Late Administration of Dexmedetomidine on Postoperative Emergence Agitation in Children Undergoing Oral Surgeries: A Randomized Clinical Trial25324750010.30476/ijms.2020.84509.1471ENAfsanehSadeghiAnesthesia Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran0000-0001-5637-6646Seyed SajadRazaviAnesthesia Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IranAhmadEghbaliAnesthesia Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IranSeyed AlirezaMahdaviAnesthesia Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IranFereshtehKimiaAnesthesia Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IranAshkanPanahAnesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran0000-0002-2123-4127Journal Article20200111Background: Emergence Agitation (EA) is a dissociated state of consciousness characterized by irritability, uncompromising stance, and inconsolability. The etiology of EA is not completely understood. Dexmedetomidine is a highly selective α2-adrenoreceptor agonist with sedative and analgesic properties, which has been used to reduce the incidence of EA. We aimed to assess the efficacy of early versus late administration of dexmedetomidine on EA in children undergoing oral surgery.<br />Methods: A randomized, parallel, double-blind clinical trial was conducted at Mofid Children’s Hospital affiliated to Shahid Beheshti University of Medical Sciences (Tehran, Iran) from November 2016 to March 2017. A total of 81 children, who underwent adenotonsillectomy or cleft palate repair surgery were enrolled in the study. Based on simple randomization, the children were assigned to two groups, namely early (group A, n=41) and late (group B, n=40) administration of dexmedetomidine. Intra-operative and postoperative hemodynamic variables, extubation time, post-anesthesia care unit (PACU) length of stay, and the scores on Ramsay sedation scale and FLACC pain scale were measured and compared. The data were analyzed using SPSS software (version 20.0), and p Results: The mean FLACC score was lower in the late group than in the early group (2.0±1.5 vs. 4.2±1.6, p <0.001). The mean Ramsay sedation score was higher in the late group than in the early group (3.5±1.4 vs. 1.8±0.8, p <0.001).<br />Conclusion: Late administration of dexmedetomidine 1 µg/kg reduced the incidence of EA and PACU length of stay and improved postoperative pain management.<br />Trial registration number: IRCT 2016122031497N1.https://ijms.sums.ac.ir/article_47500_961671596fa5891a6948930670b41f1c.pdfShiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071647120220101Aldolase C Profiling in Serum after Mild Traumatic Brain Injury: A Prospective Cohort Study33394762710.30476/ijms.2021.87692.1831ENKavehHaddadiDepartment of Neurosurgery, School of Medicine, Orthopedic Research Center, Mazandaran University of Medical Sciences, Sari, Iran0000-0002-7349-2574SiavashMoradiEducation Development Center, School of Medicine, Mazandaran University of Medical Sciences, Sari, IranLeilaAsadianStudent Research Committee, Mazandaran University of Medical Sciences, Sari, IranSeyed HoseinMontazerDepartment of Emergency Medicine, School of Medicine, Orthopedic Research Center, Mazandaran University of Medical Sciences, Sari, IranSeyed MohammadHosseininejadDepartment of Emergency Medicine, School of Medicine, Diabetes Research Center, Mazandaran University of Medical Sciences, Sari, IranIrajGolikhatirDepartment of Emergency Medicine, School of Medicine, Mazandaran University of Medical Sciences, Sari, IranSaeidAbedian KenariImmunogenetics Research Center, Mazandaran University of Medical Sciences, Sari, Iran0000-0002-4287-2670AbdulrassolAlaeeDepartment of Radiology, School of Medicine, Mazandaran University of Medical Sciences, Sari, IranFarzadBozorgiDepartment of Emergency Medicine, School of Medicine, Orthopedic Research Center, Mazandaran University of Medical Sciences, Sari, Iran0000-0002-5316-8339Journal Article20200817Background: After a traumatic brain injury (TBI), in addition to clinical indices, the serum level of neurological biomarkers may provide valuable diagnostic and prognostic information. The present study aimed to investigate the aldolase C (ALDOC) profile in serum for early diagnosis of brain damage in patients with mild TBI (mTBI) presented to the Emergency Department (ED).<br />Methods: A single-center prospective cohort study was carried out in 2018-2019 at Imam Khomeini Hospital affiliated with Mazandaran University of Medical Sciences, Sari, Iran. A total of 89 patients with mTBI were enrolled in the study. Blood samples were taken within three hours after head trauma to measure ALDOC serum levels. Brain CT scan was used as the gold standard. Statistical analysis was performed using the Kruskal Wallis, Mann-Whitney U, and Chi square tests. The receiver-operating characteristic (ROC) curve plot was used to determine the optimal cutoff point for ALDOC. The sensitivity and specificity of the determined cutoff point were calculated. P values less than 0.05 were considered statistically significant.<br />Results: Of the 89 patients, the CT scan findings showed a positive TBI in 30 (33.7%) of the patients and in 59 (66.3%) a negative TBI. The median ALDOC serum level in the patients with positive CT scan findings (8.35 ng/mL [IQR: 1.65]) was significantly higher than those with negative CT scan findings (5.3 ng/mL [IQR: 6.9]) (p <0.001). The optimal cutoff point for ALDOC serum level was 6.95 ng/mL, and the area under the curve was 99.6% (p <0.001). The sensitivity and specificity of the determined cutoff point were 100% and 98%, respectively. <br />Conclusion: The ALDOC serum level in patients with mTBI significantly correlates with the pathologic findings of the brain CT scan. This biomarker, with 100% sensitivity, is a suitable tool to detect brain structural abnormalities in mTBI patients.https://ijms.sums.ac.ir/article_47627_1c7768c404bd12ff670910d546aa5e9e.pdfShiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071647120220101Association of Estrogen Receptor, Progesterone Receptor, and Human Epidermal Growth Factor Receptor 2 Expression with Breast Cancer Metastasis in Iran40474771810.30476/ijms.2021.88366.1906ENSeyed HamedJafariMedical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, IranDepartment of Radiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran0000-0001-5364-2566ArmaghanJahanmirDepartment of Radiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IranYaserBahramvandDepartment of Radiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IranSedighehTahmasebiBreast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, IranManoochehrDallakiDepartment of Radiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IranElhamNasrollahiDepartment of Radiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran0000-0001-5549-7243Journal Article20201005Background: Metastasis is an important factor in the survival estimate of patients with breast cancer. The present study aimed to examine the frequency of epidermal growth factor receptor 2 (HER2), estrogen receptor (ER), and progesterone receptor (PR) expression in relation to the metastatic site, pattern, and tumor size in patients with metastatic breast cancer (MBC).<br />Methods: In this retrospective study, the medical records of patients diagnosed with MBC at Motahari Clinic (Shiraz, Iran) during 2017-2019 were examined. Metastasis was confirmed using computed tomography, and a total of 276 patients were included in the study. Based on the expression of receptors, the patients were categorized into luminal A, luminal B, HER2, and TNBC groups. The frequency and percentage of receptors in relation to the metastatic site, size, and pattern were compared using the Chi square test. p Results: The frequency of receptor positivity in the 276 selected medical records were of the subtype HER2-enriched (n=48), luminal A (n=43), luminal B (n=146), and TNBC (n=39). The most common metastatic sites were the bones (47.1%), lungs (34.4%), liver (27.9%), brain (20.3%), and other organs (12.7%). The first site of metastasis occurred in the bones (36.6%), lungs (17.4%), liver (15.6%), brain (10.5%), and other organs (7.6%). The frequency of receptor expression was different in relation to the first metastatic site (P=0.024). There was a statistically significant difference between the frequency of receptor expression in patients with bone (P=0.036), brain (P=0.031), and lung (P=0.020) metastases. The frequency of receptor expression was also significantly different in relation to the size of liver metastasis (P=0.009). Luminal A and B subtypes showed higher rates of bone metastasis as the first metastatic site.<br />Conclusion: The difference in the frequency of receptor expression in relation to the metastatic site and tumor size can be used as predictive and prognostic factors in patients with breast cancer.https://ijms.sums.ac.ir/article_47718_e30b06576945a42632ef3c3fe6d50c27.pdfShiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071647120220101Anatomic Variations of the Cystic Duct in Magnetic Resonance Cholangiopancreatography in Shiraz: A Cross-Sectional Study48524785710.30476/ijms.2021.88447.1918ENAlirezaTaghaviGastroenterohepatology Research Center (GRC), Department of Gastroenterology and Hepatology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran0000-0001-5360-6776MasoudAziziGastroenterohepatology Research Center (GRC), Department of Gastroenterology and Hepatology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IranAlirezaRasekhiMedical Imaging Research Center (MIRC), Department of Radiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IranZeinabGholamiMedical Imaging Research Center (MIRC), Department of Radiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran0000-0003-1434-6793Journal Article20201019Background: Anatomic variations of the cystic duct (CD) are commonly encountered. Being aware of these variants will reduce complications subsequent to surgical, endoscopic, or percutaneous procedures. Magnetic resonance cholangiopancreatography (MRCP) is the least invasive and the most reliable modality for biliary anatomy surveys. This study aimed to determine the prevalence of cystic duct variations in the Iranian population. <br />Methods: In this retrospective cross-sectional study, MRCP images of 350 patients referred to Shiraz Faraparto Medical Imaging and Interventional Radiology Center from October 2017 to October 2018 were reviewed. The CD course and insertion site to the extrahepatic bile duct (EHBD) was determined and documented in 290 cases. Descriptive statistics and Chi square test were applied for data analysis via SPSS software.<br />Results: About 77% of cases revealed the classic right lateral insertion to the middle third of EHBD. The insertion of CD to the upper third and the right hepatic duct was 10%, and the insertion to the medial aspect of the middle third of EHBD from anterior or posterior was noted to be about 7.6%. From 2.8% of insertions to the lower third, 1% demonstrated parallel course, and finally, 0.3% of cases presented short CD.<br />Conclusion: CD variations are relatively common, and MRCP mapping prior to the hepatobiliary interventions could prevent unexpected consequences.https://ijms.sums.ac.ir/article_47857_32b3f323c87015780f4c1be8ebe923b6.pdfShiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071647120220101Incremental Healthcare Resource Utilization and Expenditures Associated with Cardiovascular Diseases in Patients with Diabetes: A Cross-Sectional Study53624764710.30476/ijms.2020.87284.1742ENRezaEbrahimoghliDepartment of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran0000-0003-4747-1814AliJanatiDepartment of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, IranHomayounSadeghi-BazarganiRoad Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, IranHadiHamishehkarDrug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, IranAtefehKhalili-AzimiDepartment of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, IranJournal Article20200707Background: Cardiovascular disease (CVD) is the most prevalent comorbid condition among patients with diabetes. The objective of this study is to determine the incremental healthcare resource utilization and expenditures (HRUE) associated with CVD comorbidity in diabetic patients. <br />Methods: In a cross-sectional study, patients receiving antidiabetic drugs were identified using the 2014 database of the Iran Health Insurance Organization of East Azerbaijan province (Iran). The frequency of HRUE was the main outcome. Outcome measures were compared between diabetic patients with and without CVD comorbidity during 2014-2016. The generalized regression model was used to adjust for cofounders because of a highly skewed distribution of data. Negative binomial regression and gamma distribution model were applied for the count and expenditure data, respectively. <br />Results: A total of 34,716 diabetic patients were identified, of which 21,659 (63%) had CVD comorbidity. The incremental healthcare resource utilization associated with CVD compared to non-CVD diabetic patients for physician services, prescription drugs, laboratory tests, and medical imaging was 5.9±0.34 (28% increase), 46±1.9 (46%), 12.9±0.66 (27%), and 0.16±0.40 (7%), respectively (all p <0.001). Similarly, extra health care costs associated with CVD comorbidity for physician services, prescription drugs, laboratory tests, and medical imaging were 10.6±0.67 million IRR (294.4±18.6 USD) (50% increase), 1.44±0.06 million IRR (40±1.6 USD) (32%), 8.36±0.57 million IRR (232.2±15.8 USD) (58%), 0.51±0.02 million IRR (14.1±0.5 USD) (24%), and 0.29±0.02 million IRR (8±0.5 USD) (22%), respectively (all p <0.001).<br />Conclusion: CVD comorbidity substantially increases HRUE in patients with diabetes. Our findings draw the attention of healthcare decision-makers to proactively prevent CVD comorbidity in diabetic patients.https://ijms.sums.ac.ir/article_47647_fa066fc18391ad013d8254c259f56ad9.pdfShiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071647120220101In vitro Cytotoxic Screening of Different Parts from Ornithogalum bungei on Selected Cancer Cells63724779710.30476/ijms.2021.89521.2037ENPariaSharafi-BadrDepartment of Pharmacognosy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran0000-0003-1147-970XSepidehKaroobiDepartment of Toxicology and Pharmacology, School of Pharmacy, Tehran University of Medical Sciences, Tehran, IranHamid RezaMonsef-EsfahaniDepartment of Pharmacognosy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, IranMohammad HosseinGhahremaniDepartment of Toxicology and Pharmacology, School of Pharmacy, Tehran University of Medical Sciences, Tehran, IranToxicology and Poisoning Research Center, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran0000-0001-5051-6214Hamid-RezaAdhamiDepartment of Pharmacognosy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran0000-0003-4914-047XJournal Article20201130Background: Natural products comprise a large section of pharmaceutical agents in the field of cancer therapy. In the present study, the organic extracts and fractions of various parts of Ornithogalum bungei were investigated for in vitro cytotoxic properties on three human cancer cell lines, hepatocellular carcinoma (HepG2), prostate cancer (PC3), and leukemia (K562) cells. <br />Methods: The present experimental study was conducted at Tehran University of Medical Sciences (Tehran, Iran) during 2017-2019. Separately extracted plant materials, including bulbs, stems, and flowers of O. bungei were assessed by the tetrazolium dye-based colorimetric assay (MTT). The selected extracts were submitted to fractionation using vacuum liquid chromatography and after MTT assay, the half maximal inhibitory concentration (IC50 (value for each fraction was determined. The data were analyzed using One-way ANOVA followed by Tukey’s post hoc test. p Results: The cytotoxicity of the bulb’s methanol extract and the dichloromethane extract of aerial parts increased in a concentration-dependent manner. Additionally, cell viability decreased in a dose-dependent manner. In the HepG2 cell line, the best IC50 values of fractions from DCM extracts of aerial parts were determined to be 19.8±10.2 µg/mL after 24 hours of exposure and 19.39±6.4 µg/mL following 48 hours of exposure. In the PC3 cell line, after 48 hours of exposure, the IC50 values of fractions were unaccountable, while the percentage of inhibition for A6 to A11 in 24 hours of exposure was more than 40 µg/mL. <br />Conclusion: O. bungei growing in Iran showed significant potentials as a cytotoxic agent with selective effects on different cancer cell lines.https://ijms.sums.ac.ir/article_47797_f6a5218509d4ae507258cb6cce801388.pdfShiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071647120220101Severe Obstructive Cholestasis and Hypercalcemia Caused by Light-Chain Amyloidosis: A Case Report73774786810.30476/ijms.2021.88694.1942ENZahraDavoudiDepartment of Internal Medicine, Loghman Hakim Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran0000-0003-3332-9382FarahnazBidariDepartment of Pathology, Loghman Hakim Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, IranElenaJamaliDepartment of Pathology, Loghman Hakim Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran0000-0001-5536-9727ShahriarNikpourDepartment of Internal Medicine, Loghman Hakim Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran0000-0002-0562-0941Journal Article20201031Gastrointestinal amyloidosis is a condition caused by the deposition of extracellular protein fragments. It can be associated with complex and diverse pathways and can have numerous manifestations and etiologies. Hepatic amyloid light-chain (AL) amyloidosis is a rare disorder characterized by the deposition of the insoluble amyloid protein in the liver. The clinical presentations of AL amyloidosis are frequently non-specific. In this case report, we describe a patient with amyloidosis, who initially presented with an unusual case of severe intrahepatic cholestasis, which followed a rapidly progressive clinical course that was associated with the acute hypercalcemic crisis. The diagnosis of amyloidosis was made after the liver and bone biopsies were performed. Our findings revealed that AL amyloidosis should be considered, when a patient presents with cholestatic hepatitis, renal failure, and hypercalcemia.https://ijms.sums.ac.ir/article_47868_a78d8057c8540d9a3b64c2439cfd6d23.pdf