hamit ba?aran; Deniz Arslan; Okan ozdemir; Menek?e Turna; Y?lmaz Ozdemir; Sibel Karaca; Asuman Onol Mirik
Volume 23, Issue 3 , 2021
Abstract
Background: Esophageal cancer (EC) is known as the most common cancer around the world. The evidence supports that preoperative chemoradiotherapy (CRT) improves resectability and survival in locally advanced EC patients.
Objectives: The current study aimed to evaluate the results of treatment in patients ...
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Background: Esophageal cancer (EC) is known as the most common cancer around the world. The evidence supports that preoperative chemoradiotherapy (CRT) improves resectability and survival in locally advanced EC patients.
Objectives: The current study aimed to evaluate the results of treatment in patients suffering from EC in an endemic region.
Methods: In this study, a total of 180 EC patients treated with curative radiotherapy (RT) were retrospectively evaluated. Primary tumor location, histopathological characteristics, tumor, nodes, and metastases (TNM) status, gender, age, treatment modalities, and survival period were also assessed. The effects of prognostic factors on the survival rate were evaluated using single variable analysis.
Results: The median time of follow-up was reported as 22.9 months (range: 6-115 months). After 1-, 3-, and 5-year follow-up, the rates of survival were calculated at 86.6%, 46.6%, and 32.5%, respectively. The present study was conducted on 77 (42.8%) male and 103 (57.2%) female patients (mean age: 60±12 years). In histopathological assessment, squamous cell carcinoma was the most frequent diagnosis (n=156; -86.6%). The clinical stages were reported as II in 36.6% (n=66), IIIa in 23.4% (n=42), IIIb in 15.5% (n=28), and IIIc in 24.5% (n=44) of the patients. In this study, 54 (25%) patients were treated with definitive RT, 33 patients (18.3%) with postoperative adjuvant CRT or RT, 59 patients (32.8%) with preoperative CRT or RT, and 43 patients (23.9%) with definitive CRT. The Eastern Cooperative Oncology Group (ECOG) performance status was observed to be ECOG 0 in 51 subjects (28.4%), ECOG 1 in 95 subjects (52.8%), and ECOG 2 in 34 subjects (18.8%). Moreover, 96 (53.4%) and 84 (46.6%) patients received conventional and conformal RT, respectively. The median time of overall survival (OS) was reported as 29 months. In univariate analysis, the T stage (P=0.041), N stage (P=0.033), TNM staging (P=0.00), and concomitant CRT (0.001) were prognostic factors affecting median OS time. Concomitant CRT (hazard ratio [HR]: 0.513; 95% CI: 0.337-0.779; P=0.002) and TNM stage (HR: 2.265; 95% CI: 1.409-3.641) were observed statistically significant as independent prognostic factors of mortality in multivariate analysis.
Conclusions: Long-term survival using combined-modality therapy was demonstrated in patients with locally advanced EC. Furthermore, based on the results of multivariate analysis, TNM stage and concomitant CRT were considered independent prognostic factors of mortality.
Tolou Babaei Hemmaty; Najmeh Ranji; Fatemeh Safari
Volume 23, Issue 3 , 2021
Abstract
Background and Aims: Gastric cancer (GC) is a global health problem and the second deadly type of cancer worldwide with 1000 deaths per year. Poor prognosis in the early stages is one of the burdens in the treatment of GC. MicroRNAs are 18-22 nucleotide non-coding RNAs which play critical roles ...
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Background and Aims: Gastric cancer (GC) is a global health problem and the second deadly type of cancer worldwide with 1000 deaths per year. Poor prognosis in the early stages is one of the burdens in the treatment of GC. MicroRNAs are 18-22 nucleotide non-coding RNAs which play critical roles in the regulation of gene expression. Nowadays, miRNAs are widely known as non-invasive biomarkers for various kinds of cancers. This study aimed to evaluate the expression level of circulating miR-16 and miR-26a in GC patients and investigate the potential prognostic role of these miRNAs.
Material and Methods: Initially, 20 plasma samples were obtained from pre-and post-operative GC patients, and the expression of miR-16 and -26a were compared with that of 20 healthy controls. The miRNAs expression was investigated using Real-Time quantitative PCR. The association between the expression levels of these miRNAs and clinicopathological features was also investigated in this study.
Results: MiR-16 was down-regulated in GC patients; however, miR-26a expression revealed no significant difference between patients and controls in this regard. Furthermore, the expression of two miRNAs showed no association with the grade, TNM stage, and smoking status of the patients. Eventually, decreased expression of miR-16 was not correlated with the expression level of miR-26a.
Conclusion: The downregulation of circulating miR-16 introduces this microRNA as a candidate biomarker for the non-invasive early prognosis of GC.
Neda Behzadnia; Zargham Hossein Ahmadi; Mandana Chitsazan; Payam Tabarsi; Hamidreza Jamaati; Alireza Bahadorbeigi; Seyed MohammadReza Hashemian
Volume 23, Issue 1 , 2021
Abstract
Background: Infective endocarditis (IE) is a relatively rare disease but with significant rates of morbidity and mortality. Vancomycin and teicoplanin are bacteriostatic glycopeptide antibiotics used for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections.
Objectives: ...
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Background: Infective endocarditis (IE) is a relatively rare disease but with significant rates of morbidity and mortality. Vancomycin and teicoplanin are bacteriostatic glycopeptide antibiotics used for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections.
Objectives: The current study aimed to compare the efficacy and adverse effects of vancomycin and teicoplanin in the treatment of patients with MRSA-IE.
Methods: This parallel, randomized, and controlled trial study was carried out on the efficacy and safety of teicoplanin versus vancomycin in the treatment of MRSA endocarditis within August 2012 and April 2017. The present study recruited adult patients with a definite or possible diagnosis of IE based on the Modified Duke Criteria. Vancomycin was intravenously administered at a dose of 30 mg/kg/day in two doses. Teicoplanin was administered at a loading dose of 6-12 mg/kg every 12 h in four doses and then continued once a day.
Results: Out of 86 patients with suspected IE, 66 patients were randomly assigned to the vancomycin (n=33) and teicoplanin (n=33) groups. The mean age values of the study subjects were 41±11.8 and 39±13.1 years in the vancomycin and teicoplanin groups, respectively. In addition, 27 patients (81.8%) in the vancomycin group met the criteria for microbiological cure, compared to 25 subjects (89.3%) in the teicoplanin group. In this regard, the observed difference was not statistically significant (P=0.41). Overall, the patients in the vancomycin group experienced more adverse events in comparison to those of the teicoplanin group (P=0.04). The rate of acute kidney injury over time, especially in the first week of therapy, was higher in the vancomycin group than that reported for the teicoplanin group (P=0.05).
Conclusion: It was concluded that the administration of vancomycin or teicoplanin does not significantly change the outcome of patients undergoing empirical treatment for MRSA-IE.
Poupak Rahimzadeh; Salome Sehat Kashani; Karim Hemmati; Farnad Imani; Akram Salimi; Seyed Hamid Reza Faiz
Volume 22, Issue 12 , 2020
Abstract
Background: There are various protocols for pain management after anterior cruciate ligament (ACL) reconstruction surgery.
Objective: This study aimed to compare two blocking protocols, including femoral nerve block (FNB) and infrapatellar nerve block (IPNB) in terms of pain severity, patient ...
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Background: There are various protocols for pain management after anterior cruciate ligament (ACL) reconstruction surgery.
Objective: This study aimed to compare two blocking protocols, including femoral nerve block (FNB) and infrapatellar nerve block (IPNB) in terms of pain severity, patient satisfaction, and muscle force preservation.
Materials and Methods: This single-blind clinical trial study investigated the patients who underwent elective knee arthroscopic ACL surgery randomly either by ultrasound-guided FNB or IPNB. Subsequently, the patients were evaluated 1, 3, 6, 12, and 24 h following NB for pain severity, patient satisfaction level, and muscle force.
Results: The pain score (both at rest and in flexion) was significantly lower in the first three h after the intervention in the FNB group. Moreover, the mean score of the patients satisfaction in the first hours was significantly higher in the FNB group after the procedure. Additionally, the IPNB group obtained a significantly faster mean time required for the first dose of opioid request. The mean dose of used opioids over 24 h was significantly lower in the FNB group. There was a significant difference between the groups in terms of the muscle strength score within 24 h; moreover, the FNB group obtained a significantly greater delay in muscle recovery.
Conclusion: The FNB is associated with greater pain relief and satisfaction in patients who underwent arthroscopic ACL reconstruction surgery, compared to the IFNB technique. However, a further delay in the recovery of quadriceps muscle force is evident in the FNB group.
Fardin Faraji; Pegah Mohaghegh; Hosein Rafiee Ravand; Javad Javaheri
Volume 22, Issue 12 , 2020
Abstract
Background: Stroke is one of the major causes of disability and mortality in Iran. Therefore, it is of critical importance to know the factors affecting the effective management of acute stroke for better prevention and treatment of stroke.
Objectives: The present study aims at investigating the risk ...
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Background: Stroke is one of the major causes of disability and mortality in Iran. Therefore, it is of critical importance to know the factors affecting the effective management of acute stroke for better prevention and treatment of stroke.
Objectives: The present study aims at investigating the risk factors associated with prognosis in patients with acute stroke who were registered in the "724" stroke management registry system at Amir Al-Momenin Hospital, Arak, Iran.
Methods: This retrospective observational study included all acute stroke patients who were registered in the "724" stroke management registry system at Amir Al-Momenin Hospital, Arak, Iran, from April 2017 to April 2019. Data were analyzed in SPSS software (version 23) through the Chi-square test, Fisher's exact test, Mann Whitney U test, and logistic regression.
Results: This study investigated 139 patients with acute stroke registered in the "724" stroke management registry system at Amir Al-Momenin Hospital, Arak, Iran, from April 2017 to April 2019. The mean age of the patients was 62.91±13.31 years, and the majority of the cases were male (n=77; 55.4 %). Totally, 104 (75.4%) and 31 (22.3%) patients had hypertension and diabetes, respectively. In-hospital mortality showed a statistically significant relationship with a history of stroke, brain computed tomography scan results and high National Institutes of Health Stroke Scale (NIHSS) at baseline (P<0.05).
Conclusions: High rate of hypertension among stroke patients highlights its significance as an important modifiable risk factor for stroke. Attention to these risk factors is essential for the primary prevention of stroke. History of stroke and NIHSS score at baseline?8 associated with poor outcome at discharge.
Rasoul Heshmati; Mahasti Alizadeh; Solmaz Javadpour; Nilufar Alizada
Volume 22, Issue 12 , 2020
Abstract
Background: Patients with heart failure need to be engaged in adequate cardiac self-care behaviors helping to prevent the development of the disease and ameliorate their health status. However, the conceptual model of the present study has not been tested in previous studies among patients with heart ...
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Background: Patients with heart failure need to be engaged in adequate cardiac self-care behaviors helping to prevent the development of the disease and ameliorate their health status. However, the conceptual model of the present study has not been tested in previous studies among patients with heart failure.
Objectives: The present study aimed to investigate the psychosocial determinants based on Penders health promotion model (HPM) affecting self-care behavior among outpatients suffering from heart failure.
Methods: In this cross-sectional study, a total of 200 patients suffering from heart failure were selected from the outpatient clinics of Tabriz, Iran, using convenience sampling and assessed for self-self-care behaviors and major concepts of HPM via self-administered questionnaires. Path analysis was used in order to analyze the conceptual model
Results: The present hypothetical model showed a good fit. Perceived benefits and activity-related effects directly affected self-care behaviors. Bootstrapping mediation analyses indicated that perceived self-efficacy, perceived barriers, perceived benefits, and activity-related effects indirectly affected self-care behaviors through commitment to action.
Conclusions: The commitment to action can help to promote self-care behaviors among the subjects suffering from heart failure. The interventions should take the role of predictive variables of this study and commitment to action into account in these patients.
hosnie hoseini; Parichehreh Yaghmaei; Gholamreza Bahari; Saeed Aminzadeh
Volume 22, Issue 11 , 2020
Abstract
Background: The activities of programmed cell death 1 (PD-1) and programmed death ligand-1 (PD-L1) have already been identified in various cancers. However, in non-Hodgkin?s lymphoma (NHL), the prognostic value of PD-1/PD-L1 gene polymorphisms and expression levels remains unclear.
Objectives: The present ...
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Background: The activities of programmed cell death 1 (PD-1) and programmed death ligand-1 (PD-L1) have already been identified in various cancers. However, in non-Hodgkin?s lymphoma (NHL), the prognostic value of PD-1/PD-L1 gene polymorphisms and expression levels remains unclear.
Objectives: The present study aimed to investigate the relationship between the genetic polymorphisms of PD-1/PD-L1 genes and NHL in the Iranian population.
Methods: Four single-nucleotide polymorphisms (SNPs) of PD-1/PD-L1 genes were examined in 134 NHL patients and 134 healthy controls using polymerase chain reaction-restriction fragment length polymorphism. The expression levels of PD-1/PD-L1 genes were analyzed using real-time polymerase chain reaction.
Results: The obtained results of the current study demonstrated that PD-L1 rs2890685 (A>C) SNP (P<0.0001) was significantly associated with the increased risk of NHL. The AA genotype of PD-L1 rs2890685 polymorphism was observed to be more prevalent in the NHL patients, compared to that reported for the healthy controls. There was no significant association between PD-L1 rs4143815, PD-1 rs11568821, and PD-1rs2227981 SNPs with the risk of NHL. Furthermore, the obtained findings showed that the messenger ribonucleic acid transcription levels of both PD-1 and PD-L1 were significantly higher in the NHL patients than those reported for the healthy controls (P<0.001).
Conclusion: According to the results of the current study, there was an association between functional PD-L1 rs2890685 polymorphism and risk of NHL, suggesting that the genetic variant of PD-L1 might be a possible prognostic marker for the prediction of the risk and development of NHL.
Elham Nazari; Ho-Chun Herbert Chang; Kolsoum Deldar; Reza Pour; Amir Avan; Mahmood Tara; Amin Mehrabian; hamed tabesh
Volume 22, Issue 10 , 2020
Abstract
Introduction: Decision fusion has emerged as a data management technique due to the diversity and scalability of data in health care. This first-scope review aimed to investigate the use of this technique in health care.
Materials and Methods: A query was carried out on PubMed, Science Direct, and EMBASE ...
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Introduction: Decision fusion has emerged as a data management technique due to the diversity and scalability of data in health care. This first-scope review aimed to investigate the use of this technique in health care.
Materials and Methods: A query was carried out on PubMed, Science Direct, and EMBASE within 1960-2017 using such keywords as decision fusion, information fusion, symbolic fusion, distributed decisions, expert fusion, and sensor fusion, in conjunction with med-* and health-care. The articles were analyzed in terms of methodology and results.
Results: The literature search yielded 106 articles. Based on the results, in the field of health care, the articles were related to image processing (29%), sensors (22%), diagnosis area(10%), biology (6%), health informatics (8%), and signal process (15%). The majority of articles were published in 2011, 2012, and 2015, and the USA had the largest number of articles. Most of the articles were about engineering and basic sciences. Regarding healthcare, the majority of studies were conducted on the diagnosis of diseases (80%), while 9% and 11% of articles were about prevention and treatment, respectively. These studies applied the following methods: intelligent methods (44%), new methods (36%), probabilistic (13%), and evidential methods (7%). The dataset was as follows: research project data (49%), online dataset (42%), and simulation (9%). Furthermore, 49% of articles mentioned the applied software, among which classification and interpretation were reportedly the most and the least used methods.
Discussion and Conclusion: Decision fusion is a holistic approach to evaluate all areas of health care and elucidate diverse techniques that can lead to improved quality of care.
Innovation: This article is the first scope review article about the application of the decision fusion technique in the field of health care, building on an established protocol. Decision fusion can reduce the cost of care and improve the quality of health care provision. Therefore, this article can help care providers understand the benefits of this technique and overcome challenges in adopting decision fusion technology.
Bianchuan Cao; Maohua Wei; Yihua Du; Kui Xiao; Qin Li; Wei Lu; Yongmao Huang; Gang Wu; Fuli Huang
Volume 22, Issue 10 , 2020
Abstract
Introduction: Since December 2019, a new type of pneumonia named coronavirus disease 2019 (COVID-19) has been reported in Wuhan, Hubei province, China. At present, there are no relevant reports on cases of COVID-19 and comorbid pulmonary tuberculosis. We herein report a case of a patient with COVID-19 ...
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Introduction: Since December 2019, a new type of pneumonia named coronavirus disease 2019 (COVID-19) has been reported in Wuhan, Hubei province, China. At present, there are no relevant reports on cases of COVID-19 and comorbid pulmonary tuberculosis. We herein report a case of a patient with COVID-19 and comorbid pulmonary tuberculosis.
Case Presentation: A 47-year-old female patient with COVID-19 positive pharyngeal swabs. She did not have fever, coughing or breathing difficulties. The patient diagnosed as COVID-19, and pulmonary tuberculosis based on the patient's epidemiological history, routine blood test, imaging findings, and COVID-19 nucleic acid test results. Contact and droplet precautions were implemented. Antiviral treatment, anti-tuberculosis treatment, and liver protection treatment were given. The patient has not complained of discomfort, and her condition is stable.
Conclusions: COVID-19 and comorbid tuberculosis is suspected, epidemiological history, clinical presentation, laboratory tests, and imaging examinations must be combined to make a comprehensive diagnosis and prompt quarantine and treatment measures should be implemented.
Reza Noktehsanj; Hamidreza Aslani; Seyyed-Mohsen Hosseininejad; Mohammad-Amin Aslani
Volume 22, Issue 10 , 2020
Abstract
Metaphyseal burst sign, which is soft tissue edema in the metaepiphyseal region, is defined as a novel initial sign of subchondral insufficiency fracture of the knee (SIFK). We reported the first Iranian case of the SIFK in femoral medial condyle characterized by a metaphyseal burst sign which could ...
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Metaphyseal burst sign, which is soft tissue edema in the metaepiphyseal region, is defined as a novel initial sign of subchondral insufficiency fracture of the knee (SIFK). We reported the first Iranian case of the SIFK in femoral medial condyle characterized by a metaphyseal burst sign which could be an early sign of the SIFK. Early diagnosis and treatment could dramatically relieve the sign and symptoms of patients with significant improvement of the MRI scan.
Khodayar Oshvandi; Maryam Aghamohammadi; Farideh Kazemi; Seyedeh Zahra Masoumi; Mehrdokht Mazdeh; Mehdi Molavi Vardanjani
Volume 22, Issue 10 , 2020
Abstract
Background: Among the most important chronic diseases is multiple sclerosis (MS) leading to physical disability and decrease in the patients? quality of life.
Objectives: The present study aimed to investigate the effect of the royal jelly capsule on the life quality of patients with MS.
Methods: This ...
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Background: Among the most important chronic diseases is multiple sclerosis (MS) leading to physical disability and decrease in the patients? quality of life.
Objectives: The present study aimed to investigate the effect of the royal jelly capsule on the life quality of patients with MS.
Methods: This randomized clinical trial study was conducted on a total of 100 patients referring to the MS Society of Hamadan, Iran, in 2018. Allocation sequences were determined using block randomization with a block size of 4, and the subjects were assigned to the intervention and control groups according to a predetermined sequence. The intervention group received one royal jelly capsule (500 mg) daily, and the control group received a placebo capsule for 90 days. The life quality of the patients and their daily activities were evaluated using the specific questionnaire for the life quality of the patients with MS and Barthel Index of Daily Living Activities before and after the intervention. Data analysis was performed by Stata software (version 13) and appropriate statistical tests with a significance level of 0.05.
Results: The comparison of the mean score of the patients? life quality showed that it was higher in the experimental group in the post-intervention (66.51±15.08) than that reported for the control group (51.31±15.08) after controlling possible confounding factors, which was statistically significant (P<0.001). Furthermore, Cohen's d (1.01; 95% CI: 0.59-1.42) also indicated the intended large effect size of the intervention. The comparison of daily activity status scores between the two groups also demonstrated an improvement in the experimental group (18.76±1.44), compared to that of the control group (16.96±3.01), which was statistically significant (P=0.001).
Conclusions: Based on the findings of the current study, it can be concluded that the use of the royal jelly supplement can be effective in the improvement of the life quality of the patients with MS.
Xun Zhu; Hong Li; Zhonghua Shi; Li Zhang; Xiaoyan Feng; Lixiang Yang; Jiaming Cao; Junhui Chen
Volume 22, Issue 9 , 2020
Abstract
Background: Perioperative acute ischemic strokes (PAISs) are rare; however, they have potentially catastrophic complications and outcomes. Endovascular therapy is the standard care in appropriately selected patients with acute ischemic stroke; nonetheless, there are no guidelines on the treatment of ...
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Background: Perioperative acute ischemic strokes (PAISs) are rare; however, they have potentially catastrophic complications and outcomes. Endovascular therapy is the standard care in appropriately selected patients with acute ischemic stroke; nonetheless, there are no guidelines on the treatment of PAIS, and the majority of the patients receive conservative treatments.
Objectives: This study aimed to present two cases of mechanical thrombectomy (MT) for the treatment of PAIS.
Clinical presentation: The first patient was a 43-year-old female who fell into a coma and had left limb dysfunction three h after undergoing hysteromyomectomy with a National Institute of Health Stroke Scale (NIHSS) score of 22. A right middle cerebral artery (M1) occlusion was detected on computed tomography angiography (CTA) leading to MT. The modified Rankin Scale (mRS) score was obtained at 1 three months after treatment. The second patient was a 59-year-old male who suddenly fell into a coma and had right limb dysfunction three h after undergoing a lung cancer operation with NIHSS score of 24. The CTA showed a left M1 occlusion leading to MT. The mRS score was 1 three months after treatment. Both patients were admitted to and treated in the Wuxi Clinical College of Anhui Medical University, Wuxi, China, in 2018.
Conclusion: The PAIS is a rare but serious complication after noncardiac surgery. In both cases, diagnosis and treatment were very difficult. Further evidence was provided to regard MT as a useful and safe method to treat PAIS.
Seyed Mansour Gatmiri; Najmeh Shamspour; Farzaneh Sadat Minoo; Mahboob Lessan-Pezeshki Lessan Pezeshki; Navvab Shamspour
Volume 22, Issue 9 , 2020
Abstract
Background: Chronic renal failure (CRF) and end-stage renal disease (ESRD) are among the underlying reasons for the hospitalization of expeditionary pilgrims to Mecca. This study aimed to evaluate the reasons and consequences of sending the patients with CRF and ESRD to Mecca to perform rites of pilgrimage.
Methods: ...
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Background: Chronic renal failure (CRF) and end-stage renal disease (ESRD) are among the underlying reasons for the hospitalization of expeditionary pilgrims to Mecca. This study aimed to evaluate the reasons and consequences of sending the patients with CRF and ESRD to Mecca to perform rites of pilgrimage.
Methods: This retrospective cross-sectional study assessed the profiles of all pilgrims in 2012 and 2013. The independent variables were awareness and unawareness of the patients with CRF and patients on dialysis; moreover, the dependent variables were reasons for referral and hospitalization in hospital, probable death rate, and indications of dialysis in an emergency.
Results: Out of all Pilgrims, 2416 (1.76% of the total pilgrims population) cases had CRF, out of whom 1.15%, 10.47%, and 88.36% of the patients were on dialysis, aware, and unaware of their disease, respectively. Furthermore, 93 (3.9%) patients with CRF were hospitalized during Hajj. Cardiovascular disease (41%) and respiratory diseases (20%) were the most common reasons for patients hospitalization.
Conclusion: It is suggested that the glomerular filtration rate of the pilgrims be calculated before sending them to Hajj; moreover, the patients with CRF should be screened accurately. Proper vaccination and cardio check-up are necessary before the Hajj expedition. Considering low-salt diet and adequate fluid intake in patients with CRF during Hajj can minimize patients' referral to hospitals.
Seyedreza Mirsoleymani; Seyyed Mojtaba Nekooghadam; Milad Ahmadi Marzaleh; Mahmoudreza Peyravi; Ahmad Soltani; Simintaj Sharififar; Rita Rezaee; Mahnaz Ahmadi; Hossein Akbarialiabad
Volume 22, Issue 9 , 2020
Abstract
Background: The outbreak of Coronavirus Disease 2019 (COVID-19) has led to a major concern for those who are more vulnerable to infections.
Objectives: This study aimed to evaluate the most important risk factors for severe COVID-19 pneumonia.
Methods: This retrospective study included information ...
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Background: The outbreak of Coronavirus Disease 2019 (COVID-19) has led to a major concern for those who are more vulnerable to infections.
Objectives: This study aimed to evaluate the most important risk factors for severe COVID-19 pneumonia.
Methods: This retrospective study included information on clinical and epidemiological features of 105 patients with severe COVID-19 pneumonia hospitalized in Tajrish Hospital, Tehran, Iran. Initially, the medical records of the patients were investigated, and an interview was conducted based on a pre-prepared checklist to seek information about symptoms, past medical history, medication history, and behavior before hospitalization.
Results: Out of 105 participants, 76 (72.5%) cases were male, and 54 (51.4%) patients were older than 54 years old. The majority of the patients (n=18; 17.1%) had both hypertension and diabetes (n=12; 11.4%). Metformin (n=36; 34.3%) was the most used medication amongst the studied patient. In addition, 24 (22.9%) patients were recreational hookah smokers, and the majority (75%) of them were under the age of 46 years old. Eventually, 19 patients were excluded from the study, of whom 11 individuals had diabetes, and 10 cases were using metformin.
Conclusion: Apparently, hookah smoking played a critical role in the spread of COVID-19 in Iran and has made younger people more susceptible. In addition to older age, the immunosuppressive effects of Metformin seem to make diabetic patients with an impaired immune system more vulnerable to severe COVID-19 pneumonia. More studies on the immune system of vulnerable individuals by identifying their differences can help to protect them.
Yuange Li; Shiliang Long; Yue Zhao; Zhan Ge; Weiquan Wu; Jun Xia
Volume 22, Issue 9 , 2020
Abstract
Background: Nowadays, the world is facing COVID-19 pandemic, and seasonal influenza is also sweeping the world. Therefore, it is essential to make an early differential diagnosis between imported COVID-19 and seasonal influenza pneumonia.
Objectives: The present study aimed to determine the diagnostic ...
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Background: Nowadays, the world is facing COVID-19 pandemic, and seasonal influenza is also sweeping the world. Therefore, it is essential to make an early differential diagnosis between imported COVID-19 and seasonal influenza pneumonia.
Objectives: The present study aimed to determine the diagnostic value of high-resolution computed tomography (HRCT) imaging characteristics for imported coronavirus disease 2019 (COVID-19) and seasonal influenza pneumonia.
Methods: The HRCT imaging features with 22 cases of imported COVID-19 and 39 cases of seasonal influenza pneumonia were retrospectively analyzed in the current study. The patients with COVID-19 or influenza were diagnosed according to the World Health Organization guidelines and were confirmed following positive reverse transcription-polymerase chain reaction(RT-PCR) analysis of respiratory secretion samples.
Results: Both imported COVID-19 and influenza demonstrated multiple lesions. In the former, the lesions were mostly distributed in the subpleural of peripheral lung (90.9%), and some of them showed an anti-butterfly wing sign (18.2%; P<0.05). In the latter, the lesions were distributed around the bronchial vascular tree with subpleural lesions in peripheral lung (33.3%); nonetheless, they were fewer than those observed in the former (P<0.05). There were some differences in ground-glass opacity (GGO) (95.5% vs. 66.7%, respectively, P<0.05), consolidation (68.2% vs. 12.8%, respectively, P<0.05), and crazy paving sign (86.4% vs. 10.3%, respectively, P<0.05). The air bronchogram sign in the former appeared earlier than those in the latter. When both GGO lesions were mixed, the latter had more solid areas and higher density.
Conclusions: The different chest HRCT features of COVID-19 and seasonal influenza pneumonia can provide considerable evidence for the early diagnosis of imported COVID-19 and seasonal influenza pneumonia and can be of great help for the prevention and control of COVID-19.
Seyed Amir Miratashi Yazdi; Marjan Heshmati; Mohammadreza Jalali Nadoushan
Volume 22, Issue 7 , 2020
Abstract
Background: Papillary thyroid cancer is the most common type of thyroid malignancies. For a more accurate diagnosis, immuno- histochemistry has been used widely in recent years. Epithelial membrane antigen has been detected in several benign and malig- nant lesions, and its use as a marker of malignancy ...
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Background: Papillary thyroid cancer is the most common type of thyroid malignancies. For a more accurate diagnosis, immuno- histochemistry has been used widely in recent years. Epithelial membrane antigen has been detected in several benign and malig- nant lesions, and its use as a marker of malignancy has been sought in some studies.
Objectives: The current study aimed to determine the presence and level of expression of epithelial membrane antigen in papillary thyroid carcinoma and multinodular goiter.
Methods: Eighty-five samples of papillary thyroid carcinoma and 40 cases of multinodular goiter were stained histochemically for epithelial membrane antigen. The intensity of staining was classified in a semi-quantitative manner (1+ to 4+). Demographic data of the index cases, history of metastasis, and lymph node involvement, if any, were collected as well.
Results: All PTCs and 87.5% of MNGs were positive for EMA. EMA was expressed more strongly in PTCs than in MNGs (P < 0.00). EMA reactivity was directly associated with lymph node involvement, capsular invasion, and size of the tumor (P = 0.008, P < 0.001, and P < 0.001, respectively). The intensity level of 2 or higher had high specificity for differentiating PTC from MNG.
Conclusions: Strong expression of EMA may be a good marker of malignancy in differentiating PTC from MNG. This marker may also be regarded as an index of invasive behavior of PTC.
Weilan Wang; Le Cai; Bingkun Xiao; Rongqing Huang
Volume 22, Issue 7 , 2020
Abstract
Context: Hypertension events are the dominant adverse events observed in patients receiving the antivascular endothelial growth factor (anti-VEGF) monoclonal antibodies bevacizumab and ramucirumab treatment, which severe hypertension, particularly hy- pertensive emergencies, may cause acute target organ ...
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Context: Hypertension events are the dominant adverse events observed in patients receiving the antivascular endothelial growth factor (anti-VEGF) monoclonal antibodies bevacizumab and ramucirumab treatment, which severe hypertension, particularly hy- pertensive emergencies, may cause acute target organ injury and major cardiovascular events, that has limited the administration of anti-VEGF monoclonal antibodies. The current meta-analysis aimed to examine the relative risk (RR) of hypertension associated with anti-VEGF monoclonal antibodies.
Evidence Acquisition: PubMed, EMBASE, ASCO Abstracts, ESMO Abstracts, Cochrane Library, and Clinical Trials.gov were searched until July 2019 for relevant phase II and III randomized controlled trials (RCTs). Statistical analyses were performed to examine the RR (with 95% confidence intervals (CIs)) of hypertension associated with the anti-VEGF monoclonal antibodies.
Results: Ninety four RCTs and 51088 patients were included in the current meta-analysis. According to the results, compared with the control arms, anti-VEGF monoclonal antibodies increased the risk of all-grade (RR: 3.45, 95% CI: 2.98 - 4.00) and high-grade (RR: 5.63, 95% CI: 5.05 - 6.26) hypertension. In the subgroup analyses, the risk of high-grade hypertension varied significantly with cancer type, so that the highest RR was for patients with ovarian cancer (17.27, 95% CI: 8.50 - 35.08), whereas the risk of all-grade hypertension did not vary significantly. When stratified based on drug types and drug dose, no significant difference was discovered.
Conclusions: Anti-VEGF monoclonal antibodies significantly increased the risk of hypertension. The risk may vary with tumor type. Clinicians should be aware of the adverse reaction and clinical monitoring as well as effective management of such situations, particularly for high-risk patients.
Engeng Chen; Zhiyao Xu; Gaoyang Cao; Li Chen
Volume 22, Issue 7 , 2020
Abstract
Introduction: Primary colorectal angiosarcoma is a highly rare malignant tumor. There is no standard treatment method for this disease. No treatment of rectal angiosarcoma with apatinib has been reported so far.
Case Presentation: In the current study, an 87-year-old male presented with the symptoms ...
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Introduction: Primary colorectal angiosarcoma is a highly rare malignant tumor. There is no standard treatment method for this disease. No treatment of rectal angiosarcoma with apatinib has been reported so far.
Case Presentation: In the current study, an 87-year-old male presented with the symptoms of frequent defecation for more than one month in Hangzhou, China, in 2018. The patient was initially diagnosed with a rectal stromal tumor. The patient underwent ultrasound-guided transrectal mass puncture in the next treatment. However, immunohistochemical examinations confirmed the initial diagnosis of rectal angiosarcoma. The patient had advanced age and rectal angiosarcoma with metastasis; he had no surgical indications, and we tried to use apatinib 250 mg/d treatment to control the progression of the lesion. Then, he received apatinib, a novel tyrosine kinase inhibitor of vascular endothelial growth factor receptor-2 (VEGFR-2). The patient has been stable to apatinib with a dose of 250 mg daily by now.
Conclusions: Apatinib may play an important role in the treatment of unresectable angiosarcoma.
Youfu Ke; Jianli Cui
Volume 22, Issue 7 , 2020
Abstract
Context: COVID-19 has turned into a pandemic, threatening the lives of millions of people worldwide. Research has found that some COVID-19 patients will suddenly aggravate, resulting in a cytokine storm, respiratory distress syndrome, and death. It is necessary to articulate the mechanism of cytokine ...
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Context: COVID-19 has turned into a pandemic, threatening the lives of millions of people worldwide. Research has found that some COVID-19 patients will suddenly aggravate, resulting in a cytokine storm, respiratory distress syndrome, and death. It is necessary to articulate the mechanism of cytokine storm and propose a Chinese medicine treatment strategy for COVID-19.
Evidence Acquisition: A literature search was conducted using five databases on April 30, 2020, including PubMed, Google Scholar, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang Data with the keywords of "cytokine storm AND Chinese medicine AND COVID-19 ", "cytokine storm AND Chinese medicine AND SARS-CoV-2". The outcome of interest was the concept and mechanism of cytokine storm, the characteristics, and the Chinese medicine treatment of COVID-19 cytokine storm, etc. A total of 43 articles were retrieved after removing duplicate articles.
Results: The cytokine storm is also called cytokine cascade. The body overreacts with positive feedback without negative feedback, making a variety of abnormal cytokines accumulations, triggering a cytokine storm. COVID-19 cytokine storm does not occur in the early stages, but only after a period of development, it attacks not only the lungs but also the heart, kidneys, and other organs. The key pathogenesis is "toxins and blood stasis, lung failure" in Chinese medicine. The treatment is detoxification, removing blood stasis, and nourishing the lung. Chinese medicine should comprehensively regulate multiple targets and multiple pathways to intervene in the immune regulation of the body to intercept the progress of inflammation and focus on the integration of Chinese medicine with Western medicine to combine anti-virus and anti-inflammatory therapy.
Conclusions: The immune response caused by cytokine storm is a complex signal network with multiple targets and pathways and various cytokines acting together. Immunomodulation can balance the excessive inflammatory response and effectively control the replication and spread of SARS-CoV-2. Returning the immune response to a balanced state is an ideal method for treating COVID- 19 cytokine storm. Chinese medicine can achieve overall coordination and balance. Nevertheless, the pharmacology of Chinese medicine must be further studied, and the mechanism of cytokine storm treatment should be thoroughly clarified
Farzaneh Karami; Fateme Assarian; Fatemeh Sadat Ghoreishi; Mojtaba Sehat
Volume 22, Issue 7 , 2020
Abstract
Background: Methamphetamine dependence is a growing global problem. Currently, there are no approved pharmacotherapy options for the management of methamphetamine dependence. One of the alternatives to manage this addiction is the use of N acetylcysteine (NAC) due to its capacity to restore homeostasis ...
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Background: Methamphetamine dependence is a growing global problem. Currently, there are no approved pharmacotherapy options for the management of methamphetamine dependence. One of the alternatives to manage this addiction is the use of N acetylcysteine (NAC) due to its capacity to restore homeostasis in the brain glutamate systems disrupted in addiction and its ability to reduce craving and the risk of relapse.
Methods: Methamphetamine-dependentvolunteersundermethadonetreatment(n= 38) wererandomizedtoreceivedailydosesof 1200 mg of NAC, or placebo. The participants were followed for 12 weeks (two visits weekly). Craving and Beck Inventory Depression (BDI) was determined at the beginning of the study and also after one month, two months, and three months. Addiction severity index (ASI) was recorded at the beginning of the study and after three months. The data were analyzed via SPSS version 16.0 (SPSS Inc. Chicago, Illinios, USA)
Results: The mean score of craving and BDI reduced after two months with NAC treatment. ASI (e.g., substance, familial, and psy- chiatric categories) was significantly reduced at the end of the study in the NAC group compared to placebo (P < 0.001). The success of the treatment in groups of NAC and placebo were 84% and 73%, respectively (P = 0.001). 63.2% of the NAC group patients avoided substance use for more than a month, but this was 10.5% in the placebo group (P = 0.001).
Conclusions: The NAC showed good efficacy in suppressing methamphetamine craving, addiction severity index, and depression. It may be a useful pharmacological treatment for methamphetamine dependency.
Jin-Xian Huang; Xiao-Yan Huang; Li-Jun Zhang; Ya-Qin Wang
Volume 22, Issue 7 , 2020
Abstract
Introduction: Chronic active Epstein-Barr virus infection (CAEBV) is a rare, life-threatening disease entity involving multiple organs and systems. The disease could be presented in a single organ with atypical symptoms, be misdiagnosed at the early phase, and resolved without aggressive treatment. Previous ...
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Introduction: Chronic active Epstein-Barr virus infection (CAEBV) is a rare, life-threatening disease entity involving multiple organs and systems. The disease could be presented in a single organ with atypical symptoms, be misdiagnosed at the early phase, and resolved without aggressive treatment. Previous studies reported favorable outcomes with early diagnosis and treatment, while in other cases, disease progression and presenting in other organs could result in a very poor outcome. Clinicians from any department should be aware of the CAEBV entity when an unresolved systemic inflammation presents.
Case Presentation: A 61-year-old female presented to the cardiology department due to edema and fatigue with the progression of symptoms, including fever, muscle weakness, and shortness of breath. MR images showed muscular edema, and ultrasound analysis revealed massive pericardial effusion. Results of laboratory tests indicated hematological involvement, liver damage, and positivity for EBV DNA, and EBER in muscle and intestine by staining. She was first misdiagnosed with ulcerative colitis, but the disease evolved to the muscles and cardiovascular system later on. Altogether, the CAEBV infection with enteritis, myositis, and pericardial effusion was confirmed in the case. Although diagnosed, the treatment of the elderly population remains rather challenging in severe cases. The patient died after disease onset for less than three years.
Conclusions: Elderly patients with CAEBV infection tend to have a poor prognosis. Early diagnosis would facilitate early treat- ment and the utilization of available options, which might reduce the disease mortality rate eventually. Individualized therapy and promising approaches should be further developed for CAEBV infection.
Xiaozheng Lu; Zhijun Li; Yahui Liu; Zishuai Wang; Fenghui Peng; Qiong Yu; Xueqi Fu; Bai Ji
Volume 22, Issue 7 , 2020
Abstract
Context: Hepatocellular carcinoma (HCC) is a common malignant cancer and the second leading cause of cancer-related deaths around the world. Radiofrequency ablation (RFA) and laparoscopic hepatectomy (LH) have been adopted for the treatment of HCC. The aim of the meta-analysis was to explore the long-term ...
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Context: Hepatocellular carcinoma (HCC) is a common malignant cancer and the second leading cause of cancer-related deaths around the world. Radiofrequency ablation (RFA) and laparoscopic hepatectomy (LH) have been adopted for the treatment of HCC. The aim of the meta-analysis was to explore the long-term efficacy of RFA compared with LH for small HCC (sHCC) patients in the East Asian population.
Evidence Acquisition: We performed a systematic review and meta-analysis by the literature search on PubMed, Cochrane Library, EMBASE, Chinese Biological Medical Literature (CBM), Chinese National Knowledge Infrastructure (CNKI), and Wanfang from their inception until October 10, 2019, for comparing the long-term efficacy outcomes of RFA with LH.
Results: Fourteen retrospective studies with 1,390 subjects were included in the meta-analysis. Compared with the LH-treated group, RFA could raise the local recurrence rate under median follow-up duration and reduce disease-free survival (DFS) rates at 1 - 3 years. However, it failed to affect 5-year overall survival (OS) and DFS rates. In the subgroup analyses, different RFA approaches
had significantly higher local recurrence rates than the LH group. A similar effect on OS and DFS rates within five years for single early (? 3 cm) HCCs and on the 1- and 5-year DFS rates for nodules ? 5 cm were observed between the two groups, but RFA approaches could reduce the 3-y OS and DFS rates for single nodules ? 5 cm. The percutaneous radiofrequency ablation (PRFA) group had signif-icantly lower 3- and 5-year OS and the 1- and 3-year DFS rates than the LH group, while no significant difference in OS and DFS rates in the laparoscopic radiofrequency ablation (LRFA) approach. The RFA approach improved the 3-year OS compared with the LH group in Japan, but reduced the 3-year OS and DFS rates within 3 years in China.
Conclusions: Our results support that LH treating sHCC had a better long-term efficacy and a lower local recurrence rate than RFA in the East Asian population. Further high-quality prospective studies are required to confirm the long-term efficacy.
Wen-Yan Qin; Jing-Zhen Li; Wen-Ping Peng; Ming-Ming Zhang; Bo Lao; Jie-Ming Hong; Lian-Biao Li
Volume 22, Issue 7 , 2020
Abstract
Context: Self-expandable metal stents (SEMSs) are commonly used in the treatment of malignant biliary obstruction. We performed a meta-analysis to compare the efficacy of covered self-expandable metallic stents (CSEMSs) and uncovered self-expandable metallic stents (UCSEMSs) for patients with malignant ...
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Context: Self-expandable metal stents (SEMSs) are commonly used in the treatment of malignant biliary obstruction. We performed a meta-analysis to compare the efficacy of covered self-expandable metallic stents (CSEMSs) and uncovered self-expandable metallic stents (UCSEMSs) for patients with malignant distal biliary obstruction.
Methods: A comprehensive search was conducted using PubMed, Embase, Cochrane, and CNKI databases from 2010 to 2019. All randomized controlled trials, which compared the use of the CSEMSs and UCSEMSs for the treatment of malignant distal biliary obstruction were included in this study.
Results: This meta-analysis included 1,539 patients enrolled in 13 trials. There was no difference between the two groups in terms of patients survival (hazard ratio (HR) 0.96, 95% confidence interval (CI): 0.87 - 1.07; I2 = 32.6%), stent patency (HR 0.92, 95% CI: 0.69 - 1.22; I2 = 56.3%), and the overall complication rate (relative risks (RR) 1.35, 95% CI: 0.82 - 2.23; I2 = 0%). In particular, the CSEMSs group presented a lower rate of tumor ingrowth (RR 0.30, 95% CI: 0.15 - 0.57; I2 = 58.5%) than the UCSEMSs group. However, the CSEMSs group exhibited a higher rate of tumor overgrowth (RR 1.63, 95% CI: 1.00 - 2.66; I2 = 0%), sludge formation (RR 2.28, 95% CI: 1.36 - 3.82;
I2 = 0%), and migration (RR 5.14, 95% CI: 1.90 - 13.88; I2 = 0%).
Conclusions: Our meta-analysis indicated that there was no significant difference between the two stents, and each one had its advantages and disadvantages.
Yu Hu; Xiao Ming Li; Yi Chao Zhang; Jian Xun Song
Volume 22, Issue 7 , 2020
Abstract
Introduction: Sertoli cell tumors (SCTs) of the testis are relatively rare neoplasms that originate from the sex cord and intersti- tial stromal cells of the testis. Magnetic resonance imaging (MRI) can be used for characterization, particularly recommended when clinical and ultrasonography (US) features ...
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Introduction: Sertoli cell tumors (SCTs) of the testis are relatively rare neoplasms that originate from the sex cord and intersti- tial stromal cells of the testis. Magnetic resonance imaging (MRI) can be used for characterization, particularly recommended when clinical and ultrasonography (US) features are indeterminate for the staging of local lesions. Scrotal MRI may also help in the imaging-based differential diagnosis of a wide range of testicular neoplasms and prevents unessential radical orchiectomy in cases of benign lesions. Accurate and early diagnosis will play a key role in keeping the viability of testicle and fertility.
Case Presentation: We present the case of a 46-year-old male with a 1-year duration of a left painless testicular tumor that has had some recent enlargement. He has been admitted to the Department of Urological Surgery, Shenzhen Baoan peoples hospital, Shenzhen, Guangdong Province, China, on Dec 2nd, 2018. Laboratory tests were within normal limits. A well-defined margin (pseu- docapsule) can be found both on US and pre-contrast MRI, but organ-sparing surgery is not advocated for the suspicious malignant features, including recent enlargement, intratumoral hemorrhageand necrosis, and contrast-enhancing solid tissue with indistinct and irregular marginss on MRI. Finally, this patient proceeded with radical orchiectomy after a sufficient preoperative assessment. Conclusions: The low incidence rate of SCTs and their similar clinical features to those of other testicular tumors make their preop- erative diagnosis challenging, but the identification of the tumors extent, morphologic information, signal component, adjacent relationship, and distant metastasis on MRI images can be vital to make a differential diagnosis, establish reasonable intervention plans, and predict the prognosis.
Mehdi Ahmadi; Mohsen Amiri; Tahere Rezaeian; Amir Mansour Rezadoost; Enayatollah Bakhshi; Iraj Abdollahi
Volume 22, Issue 7 , 2020
Abstract
Background: Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal disorders that can disturb pa- tients respiratory indices. Proton pump inhibitors (PPIs) such as omeprazole are currently the most common treatment in the patients. PPI-refractory GERD is a clinical problem ...
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Background: Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal disorders that can disturb pa- tients respiratory indices. Proton pump inhibitors (PPIs) such as omeprazole are currently the most common treatment in the patients. PPI-refractory GERD is a clinical problem constituting around 30% of patients with GERD.
Objectives: The aim of this study was to investigate the effects of diaphragmatic breathing (DB) and omeprazole on respiratory indices (RI) and diaphragmatic excursion (DEX) in patients with GERD.
Methods: This is a clinical trial conducted for eight weeks among 40 patients with severe GERD in Tehran in 2018. The block ran- domization method was designed to randomize 40 patients into two groups (DB and control) that resulted in equal sample sizes. The control group received omeprazole 20 mg once daily, and the DB group, in addition to omeprazole, performed DB. Respiratory indices, including (Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 second (FEV1), Peak Expiratory Flow (PEF)), and DEX were evaluated before, immediately, and six weeks after the end of intervention by spirometry and ultrasonography; respectively. Results: There was no significant difference in the RI and DEX before the intervention between groups. FVC (P = 0.04) and PEF (P = 0.02) significantly changed in the control group, but FEV1 (P = 0.001), FVC (P = 0.002), PEF (P = 0.001) and DEX (0.001) significantly changed after DB. There was a significant difference in terms of RI between before and followed up in DB.
Conclusions: Diaphragmatic breathing with omeprazole had more effects on RI and DEX than omeprazole alone. The positive effects of DB remain at least six weeks after the end of the intervention
