Case reports
Zahra Javidarabshahi; Sara Najafi; Sara Raji
Volume 23, Issue 6 , 2021
Abstract
Introduction: Coronavirus disease 2019 (COVID-19) emerged in December 2019 in China and caused a catastrophic pandemic in 2020. Significant manifestations of COVID-19 are related to the respiratory system; however, other organs, such as the brain and heart, can also be involved.
Case presentation: A ...
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Introduction: Coronavirus disease 2019 (COVID-19) emerged in December 2019 in China and caused a catastrophic pandemic in 2020. Significant manifestations of COVID-19 are related to the respiratory system; however, other organs, such as the brain and heart, can also be involved.
Case presentation: A 44-year-old-male was hospitalized in our referral emergency center due to being febrile and confused. He experienced five episodes of convulsion in the hospital. Within a day, the respiratory symptoms developed. The polymerase chain reaction of cerebrospinal fluid (CSF) was positive for COVID-19. The analysis of CSF and findings of chest computed tomography scan revealed that the case was infected with meningitis induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and pneumonia.
Conclusions: It has been reported that neurological symptoms of COVID-19 can appear earlier than other symptoms. To the best of our knowledge, few articles have represented COVID-induced meningitis. This case study reported the first case of meningitis induced by SARS-CoV-2 in Iran
Research articles
Elvis Agbo; Dong Hai Liu; Jia Wan Liao; Roland Osei SAAHENE; Precious Barnes
Volume 23, Issue 6 , 2021
Abstract
Background: Growth hormone-releasing peptides (GHRP) have been reported to possess cardioprotective properties; nonetheless, their mechanisms of action are still not very clear.
Objectives: Some studies have suggested that modulation of endothelial nitric oxide synthase (eNOS) and the upregulation of ...
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Background: Growth hormone-releasing peptides (GHRP) have been reported to possess cardioprotective properties; nonetheless, their mechanisms of action are still not very clear.
Objectives: Some studies have suggested that modulation of endothelial nitric oxide synthase (eNOS) and the upregulation of nitric oxide (NO) are cardioprotective. Therefore, the present study strived to test the hypothesis that a potent GHRP analog (hexarelin) could increase serum nitric oxide level and regulate myocardial eNOS to alleviate the development of heart failure.
Methods: Myocardial infarction-induced heart failure in rats was established by permanent coronary artery ligation. The sham group, control group, and heart failure group all received normal saline (100 µg/kg; SC BID; 30days), while the rats in the hexarelin treatment group were treated with hexarelin (100 µg/kg, SC BID, 30 days). The rats were tested for myocardial apoptosis, oxidative stress, left ventricular function, various molecular analyses, as well as pathological and structural myocardial changes.
Results: Hexarelin treatment improved contractile function and attenuated myocardial histopathological damages, oxidative stress, ?brosis, as well as apoptosis. All these were accompanied by the upregulation of myocardial eNOS and an increase in serum NO concentration.
Conclusion: As evidenced by the obtained results, the anti-cardiac failure capacity of hexarelinin in a rat model is mediated by an increase in serum nitric oxide level and the up-modulation of myocardial eNOS; therefore, they can be considered therapeutic targets against heart failure.
Systematic reviews
Batoul Khoundabi; Ahmad Soltani; Milad Ahmadi Marzaleh
Volume 23, Issue 6 , 2021
Abstract
Background: Given the fact that nurses are at the frontier of taking care of COVID-19 patients, they are directly or indirectly faced with many psychological problems.
Objectives: The present research used a systematic review approach to explore the psychological problems of nurses during the COVID-19 ...
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Background: Given the fact that nurses are at the frontier of taking care of COVID-19 patients, they are directly or indirectly faced with many psychological problems.
Objectives: The present research used a systematic review approach to explore the psychological problems of nurses during the COVID-19 pandemic in 2020.
Methods: This systematic review was conducted using PubMed, Cochran Library, Scopus, EMBASE, Science Direct, ProQuest, and Web of Science databases until May 21, 2020. These databases were searched using some keywords and the papers with a focus on the psychological problems of nurses during the COVID-19 pandemic were selected.
Results: Primarily, the academic papers were searched using their titles, abstracts, and full texts. In total, 10 articles were selected for the final analysis; nine of them were cross-sectional in type and one of them was qualitative and phenomenological. Moreover, seven studies were carried out in the Chinese context and were followed by other similar studies performed in Italy, Pakistan, India, and Singapore. Based on the findings, the most prevalent psychological problems were panic, anxiety, stress, sleep disorders, discomfort, depression, lack of self-control, overstimulation, and post-traumatic stress disorder.
Conclusion: During the epidemic and pandemic of infectious diseases, such as COVID-19, a wide range of psychological problems arise among the healthcare staff, especially nurses. As nurses are at the frontier of taking care of and treating COVID-19 patients, they need to be fully supported. Healthcare policymakers should devise educational and psychological supporting protocols to improve the mental health of nurses.
Research articles
Fatemeh Asadi Rahmani; Najmeh Ranji; Hamid Saeidi Saedi
Volume 23, Issue 6 , 2021
Abstract
Background: Gastric cancer (GC) is the most prevalent malignancy worldwide and a common cause of death in Iran. Studies have proved that a variety of dysregulated microRNAs is involved in the development and progression of gastric cancer.
Objectives: The present study aimed to evaluate the expression ...
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Background: Gastric cancer (GC) is the most prevalent malignancy worldwide and a common cause of death in Iran. Studies have proved that a variety of dysregulated microRNAs is involved in the development and progression of gastric cancer.
Objectives: The present study aimed to evaluate the expression levels of plasma circulating oncogenic miR-21 and miR-192 and their association with clinical phenotypes of patients with gastric cancer in the north of Iran.
Methods: Clinico-pathological analysis was conducted using a standard protocol and pathological tests. The expression levels of miR-21 and miR-192 were measured using quantitative reverse transcription-polymerase chain reaction in the plasma of twenty pre/post-operative gastric cancer patients and twenty healthy subjects. The receiver operating characteristic (ROC) curve of these microRNAs was analyzed to investigate their diagnosis properties.
Results: The study results indicated that plasma miR-21 expression was significantly associated with tumor stage and helicobacter pylori infection status (P=0.024, P=0.0004, respectively). However, no association was observed between clinic-pathological characteristics and miR-192 expression. The results showed that the plasma levels of miR-21 (P=0.0001) and miR-192 (P=0.0007) were significantly higher in GC patients compared to those in healthy individuals. Furthermore, the ROC analyses yielded the mean ±SD area under the curve (AUC) values of 0.9525±0.03 (P<0.0001) and 0.5925±0.09 (P=0.316) for miR-21 and miR-192, respectively. Pearson regression analysis showed that there was no significant correlation between the expression of miR-21 and miR-192 (P=0.1507).
Conclusion: Based on the obtained results, the expression of the plasma level of miR-21 was significantly higher in gastric cancer patients compared to that in the healthy group. Furthermore, the higher levels of AUC in miR-21 indicated the potential role of miR-21 as a noninvasive biomarker for the prognosis of gastric cancer in the population of the north of Iran.
Research articles
Seung Hoon Jeon; Yongjin Park
Volume 23, Issue 6 , 2021
Abstract
Background: Out-of-hospital cardiac arrest is considered an important health care problem since it causes family breakdown and enormous social loss due to sudden death. Despite the efforts of many medical policy makers, paramedics, and doctors, the survival rate after cardiac arrest is only marginally ...
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Background: Out-of-hospital cardiac arrest is considered an important health care problem since it causes family breakdown and enormous social loss due to sudden death. Despite the efforts of many medical policy makers, paramedics, and doctors, the survival rate after cardiac arrest is only marginally increasing.
Objectives: This study aimed to determine whether advanced life support (ALS) under physicians direct medical oversight during an emergency through video call on smartphones was associated with improved out-of-hospital cardiac arrest (OHCA) outcomes on the "Smart Advanced Life Support (SALS)" pilot project.
Methods: This study was conducted using a "Before-After" controlled trial. The OHCA patients were divided into two periods in a metropolitan city. The basic life support (BLS group) and ALS using video calls on smartphones (SALS group) were performed in the 'Before' and 'After' phases in 2014 and 2015, respectively. The OHCA patients over 18 years of age were included in this study. On the other hand, the patients with trauma, poisoning, and familys unwillingness, as well as those who received no resuscitation were excluded from the study. The primary and secondary outcomes were survival to discharge and a good neurological outcome (cerebral performance category [CPC] 1-2), respectively. A propensity score matching was conducted to equalize potential prognostic factors in both groups. The adjusted odds ratio (OR) and 95% confidence interval (95% CI) were calculated for survival to discharge and good neurological outcome.
Results: In total, 235 and 198 OHCA patients were enrolled in the BLS and the SALS groups, respectively. The outcomes were better in the SALS group, compared to the BLS group regarding the survival to discharge (9.8% vs. 6.8%, P<0.001) and good neurological outcome (6.6% vs. 4.0%, P<0.001), respectively. Regarding propensity score matching, 304 cases were randomly assigned to the SALS and BLS groups. The survivals to discharge rates after matching were 9.2% and 7.2% in the SALS and the BLS groups, respectively (P=0.06). Furthermore, the good neurological outcome rate was 5.9% in the SALS group versus 3.9% in the BLS group (p=0.008). The adjusted ORs of the SALS group were estimated at 1.33 (95% CI: 1.00-1.77) for survival to discharge and 1.73 (95% CI: 1.19-2.53) for the good neurologic outcome, compared to those in the BLS group.
Conclusion: An emergency medical system intervention using the SALS protocol was associated with a signi?cant increase in prehospital ROSC and improved survival and neurologic outcome after OHCA.
Research articles
Nader Oveisi; Reza Jafarinia; Lobat Taghavi; Jamal Ghoddousi
Volume 23, Issue 6 , 2021
Abstract
Background: Given the crisis of water shortage and the industrial development in Iran, comprehensive water-resource management and planning to handle the water quality of the rivers are the critical issues to tackle with. The concentration of river pollutants is a function of both the quantity and quality ...
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Background: Given the crisis of water shortage and the industrial development in Iran, comprehensive water-resource management and planning to handle the water quality of the rivers are the critical issues to tackle with. The concentration of river pollutants is a function of both the quantity and quality of the river flow regime. In this regard, the construction of large dams leads to quantitative and qualitative changes in downstream rivers. These changes are effective in the health of the river water for uses such as drinking, agriculture, and industry. Therefore, in addition to the quantity of water needs of rivers, their quality needs to be also considered.
Objectives: This study aimed to analyze issues related to the sanitary water flow of large dams. Our case study was the Taleghan River dam, Alborz Province, Iran, on which Taleghan reservoir was built to supply some part of the water needed by Greater Tehran, Iran.
Methods: This study examined a 22-km long section of the river at the riffle of Taleghan Dam in Alborz Province (103 km from Karaj), Iran. The average annual and monthly discharges of the river in four 6-km-apart stations were estimated. The statistics of eight hydrometric stations and a discharge-surface method were used to calculate the average annual discharge of each sub-basin downstream of Taleghan Dam. Moreover, the discharge non-dimensionalization method, along with the observational statistics of the index station, was used to calculate the average monthly discharge in the examined stations. The Hydrologic Engineering Centers River Analysis System (HEC-RAS) software (version 4.0) was then utilized to determine the values ??of river flow rates hydraulically. Additionally, water quality parameters were compared with the standard concentrations proposed by the World Health Organization (WHO) for drinking-water quality to examine possible changes in pollutant concentrations during the study. Correlation and regression statistical tests in SPSS software (version 24) were then used to analyze the relationship between discharge and pollutant concentration.
Results: The experimental equation of Q = 0.0372A0.8641 was obtained to estimate the discharge based on the sub-basins area using the discharge-surface method. The average annual discharge at stations 2, 3, and 4 (B, C, and D) were estimated at 1.39, 2.11, and 3.39 m3/s, respectively, using this equation. Subsequently, the average monthly discharges in the studied stations in September were calculated at 0.21, 0.29, and 0.46 m3/s, respectively. Afterward, the discharge was measured using HEC-RAS software (version 4.0) in the same month at 0.34, 0.44, 0, and 0.62 m3/s, respectively. The examination of water quality values from ??among the 17 water quality parameters revealed that physicochemical elements, pH concentration, lead (Pb), and electrical conductivity were higher than the standard concentration of drinking water proposed by the WHO.
Conclusion: A model was presented to estimate sanitary water flow by performing correlation tests and linear regression calculations between the river discharge at the dam downstream and the concentration of water quality parameters. According to the proposed model, the minimum flow of sanitary water was estimated at 1.82 m3/s to be considered to release from the dam in the driest month of the year. Therefore, the release of water as the minimum flow of sanitary water less than 1.82 m3/s was not allowed in any other month of the year.
Research articles
Mahmoudreza Peyravi; Eric Carlstrom; Per Ortenwal; Amir Khorram-Manesh
Volume 23, Issue 6 , 2021
Abstract
Background: Non-traumatic abdominal pain may have several causes and often needs physicians' consultation. In a pilot study, a template was used to assist ambulance nurses and technicians to assess this medical condition.
Objectives: This study aimed to evaluate the use of the template and the outcome ...
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Background: Non-traumatic abdominal pain may have several causes and often needs physicians' consultation. In a pilot study, a template was used to assist ambulance nurses and technicians to assess this medical condition.
Objectives: This study aimed to evaluate the use of the template and the outcome of the pilot study.
Methods: A prehospital template (protocol) consisting of validated physiological and clinical scales, such as "Rapid Emergency Triage and Treatment Scale-Ambulances", "Patient Behavioral Pain Scale", and "Visual Analog Scale" were used to assist the ambulance crew in Shiraz, Iran, to assess all cases with non-traumatic abdominal pain. The outcome of the evaluation in this group was compared with a control group using the normal routine of assessment.
Results: Of 200 prehospital patients, 170 cases were eligible for evaluation. The majority of the patients in the protocol (n=88) and control groups (n=82) were males (n=46 and n=43, respectively). There was a slight but statistically significant difference between the two groups in favor of the protocol group concerning the need for ambulance transport and direct admission to the hospital (P<0.02).
Conclusion: Although prehospital assessment and management of non-traumatic abdominal pain continue to be challenging for emergency medical staff, educational initiatives together with prehospital guidelines may improve the accuracy of prehospital decision-making and open up for new fast-track diagnosis and direct admission to the hospital.
Research articles
Mahsa Rafiee Alhossaini; Anoshirvan Kazemnejad; Farid Zayeri; Masoumeh Sadeghi
Volume 23, Issue 6 , 2021
Abstract
Background: The risk of obesity commonly changes with age, which is a longitudinal (aging) effect. Moreover, the individuals who enter the study at the same age have similar living conditions that may influence their obesity risk in a particular way; this is a cross-sectional effect. Both cross-sectional ...
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Background: The risk of obesity commonly changes with age, which is a longitudinal (aging) effect. Moreover, the individuals who enter the study at the same age have similar living conditions that may influence their obesity risk in a particular way; this is a cross-sectional effect. Both cross-sectional and longitudinal effects of age should be considered for a better understanding of the effect of age on obesity and the related factors.
Objectives: The present study aimed to (i) assess both the cross-sectional and longitudinal effects of age on obesity and (ii) determine how obesity changes with age in the target population using a Marginal Logistic Regression (MLR) model.
Methods: The current study made use of the information of individuals who had participated in the Isfahan Cohort Study. Participants were a large group of Iranian adults over 35 years of age who lived in the central region of Iran in 2001. Repeated measurements were obtained in 2001, 2007, and 2013.
Results: From 2001 to 2013, the percentage of obesity in men and women raised from 13% and 31% to 18% and 44%, respectively. Both cross-sectional and longitudinal effects of age were significantly associated with the odds ratio of obesity. There was a rise in the probability of obesity for individuals aged 35-60 years at baseline and a decline for the older ones. The odds of obesity had about a 2% increase (on average) per year, regardless of the baseline age.
Conclusion: The obtained results pointed to a difference between the cross-sectional and longitudinal effects of age on the probability of obesity in the target population. The high and rising prevalence of obesity was a serious public health issue among participants, especially women, aged 35-60 years. The assessment of changes in obesity in a population-based study provides opportunities to target subpopulations that need more care and attention in public health interventions.
Research articles
Amir Hosein Ghazale; Ali Ghazvini; Mostafa Ghanei; Ensieh Vahedi; Abolfazl Mozafari; Shideh Omidian; Mohammad Rezapour; Nafiseh Rastgoo; Fatemeh Movaseghi; Fateme Mansouri; Mohammad Ali Zohal; Maryam Gheraati; Seyed Hassan Saadat; Hassan Goodarzi; Mohammad Gholami Fesharaki; Amir Mohammad Dehghan Banadkooki; Shahrzad Saloo; Hesamodin Salou
Volume 23, Issue 6 , 2021
Abstract
Background:
COVID-19 is a new disease for which a definitive treatment has not yet been proposed. Therefore, the present study aimed to investigate the effect of combination therapy on the treatment of COVID-19 due to the importance of finding an appropriate treatment for this epidemic disease.
Materials ...
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Background:
COVID-19 is a new disease for which a definitive treatment has not yet been proposed. Therefore, the present study aimed to investigate the effect of combination therapy on the treatment of COVID-19 due to the importance of finding an appropriate treatment for this epidemic disease.
Materials and Methods:
This two-center cohort study included 175 confirmed COVID-19 inpatients at two medical centers designated for the treatment of COVID-19 patients in Qom and Qazvin, Iran. In this study, four different groups of drug regimens were studied which included G1 (azithromycin, prednisolone, and naproxen), G2 (lopinavir/ritonavir, azithromycin, naproxen, and prednisolone), G3 (hydroxychloroquine, azithromycin, naproxen, and prednisolone), and G4 (levofloxacin, vancomycin, hydroxychloroquine, and oseltamivir). It should be noted that G1, G2, G3, and G4 treatment regimens were used on 48, 39,30, and 77 patients, respectively.
Results:
The study participants included 175 confirmed COVID-19 patients with mean±SD age of 58.9 ±15.1 years, out of whom 80 (46%) patients were male and the rest were females. The results indicated that the hospital stay period was significantly shorter in the G1 compared to other groups (G1:5.9±2.4, G2:8.1±4.2, G3: 6.3±1.7, and G4: 6.4±2.9; [P-value=0.008]). It should be noted that pulse rate, oxygen saturation, hemoglobin, and platelet count (PLT) changed significantly during the study in four treatment groups; however, a significant change in temperature, creatinine, and white blood cell (WBC) was observed only in G3, G4, and G1 groups, respectively. The number of ICU admissions and deaths were not statistically significant among the patients who received the four treatment regimens (P=0.785). Based on the results, the history of ischemic heart disease, baseline oxygen saturation, WBC, neutrophil, lymphocyte count, and C-reactive protein (CRP) are the risk factors for the prolonged hospital stay in COVID-19 patients.
Conclusion:
The obtained results in this study indicated that the combination of azithromycin, prednisolone, and naproxen is the most effective regimen for the treatment of COVID-19, compared to three other combination treatment regimens.
Research articles
Zahra Nashtahosseini; Farzin Sadeghi; mahmodreza aghamaali
Volume 23, Issue 6 , 2021
Abstract
Background: Micro-ribonucleic acids (miRNAs) are noncoding small RNA species considered a varying class with a single-stranded structure whose expression is often dysregulated in cancer. The expression of miRNAs has been used as a promising new biomarker for the detection of breast cancer (BC).
Objectives: The ...
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Background: Micro-ribonucleic acids (miRNAs) are noncoding small RNA species considered a varying class with a single-stranded structure whose expression is often dysregulated in cancer. The expression of miRNAs has been used as a promising new biomarker for the detection of breast cancer (BC).
Objectives: The purpose of the present case-control study was to investigate the expression levels of miRNA-320a and miRNA-497-5p and their potential role in BC patients in comparison to those of the healthy controls in the Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran, in 2019.
Methods: The concentrations of miR-320a and miR-497-5p were analyzed in 80 serum samples of 40 patients with a confirmed diagnosis of early-stage BC in comparison to those of 40 age-matched healthy volunteers. Real-time quantitative polymerase chain reaction was carried out for the detection of the expression level of these miRNAs.
Results: The results of the current study showed that the serum levels of miR-320a and miR-497-5p were down-regulated in the BC patients, compared to those reported for the healthy controls (P=0.651 and P=0.044, respectively). However, the levels of miR-320a in the early-stage BC samples were not statistically different from those of the healthy volunteers. There was a reduction in the serum miRNA-320a of the premenopausal subjects under 48 years of age. Serum miRNA-497-5p also decreased among the cases under 48 years of age.
Conclusions: The identification and effectiveness of these miRNAs were demonstrated in the early-stage BC screening. It seems that miRNAs have the potential to be used as biomarkers for the screening and diagnosis of BC.
