Iranian Red Crescent Medical Journal

Efficacy of Laryngeal Mask Airway Impregnation with Diltiazem Gel on Hemodynamic Changes in Patients with Hypertension Undergoing Phacoemulsification Surgery: A Randomized Clinical Trial

Javad Amini-Saman — 2023-05-23

Background: Airway control problems are among the most prevalent causes of anesthesia-related mortality and morbidity. Some devices provide patients with adequate oxygen supply and ventilation during surgery by creating a safe airway in anesthetized patients. One of these devices is the laryngeal mask airway (LMA). The compression and painful stimuli following the LMA cuff inflation can lead to hemodynamic changes. Diltiazem gel is used in the control and treatment of hypertension (HTN) and heart arrhythmia and is absorbed through the tracheal mucosa.

Objectives: By assuming that diltiazem gel is superior to other drugs used to prevent arrhythmias and hemodynamic changes during surgery, this study aimed to evaluate the effect of LMA impregnation with diltiazem gel, compared to lubricant gel.

Methods: This study was conducted as a double-blind, randomized clinical trial on 80 participants with HTN who were candidates for phacoemulsification (phaco) surgery in Imam Khomeini Hospital, Kermanshah, Iran. The participants were assigned to an intervention (LMA impregnated with diltiazem gel) and a control group (LMA impregnated with lubricant gel) through the block random method in the form of 40 blocks of 2 using a random-numbers table. Hemodynamic changes (systolic and diastolic blood pressure and heart rate) were measured before, immediately after, 5 min, and 15 min after intubation, during surgery every 15 min, upon entering the recovery unit, and 15 and 30 min after entering the recovery unit.

Results: The mean systolic and diastolic blood pressure in the intervention group showed a significant decrease, compared to that in the control group. A significant difference was also observed in the mean heart rate difference between the two study groups, but only at the beginning of the study (P<0.05). Additionally, according to the results of repeated measures analysis of variance, the mean of the measured variables showed a significant difference at different measurement times in the intervention group (P<0.05).

Conclusion: The findings supported the effectiveness of diltiazem gel in reducing blood pressure, especially in the final stages of surgery, decreasing the number of premature ventricular contractions, and controlling normal breathing. Therefore, specialists and surgeons can use diltiazem gel to control the hemodynamic status of patients.

Home-based Pulmonary Rehabilitation in Patients with COVID-19: The Efficiency in Pulmonary Function

Fahime Hashemi — 2023-05-23

Background: Coronavirus disease (COVID-19) is a viral disease that mostly affects the respiratory system and leads to respiratory failure. Alongside, pulmonary rehabilitation is one of the most important components in the management of respiratory system diseases and can rehabilitate persons after lung-damaged disease.

Objectives: The present study aimed to determine the efficiency of Home-Based Pulmonary Rehabilitation in pulmonary function in patients with COVID-19

Methods: This simple randomized interventional study was conducted on 70 COVID-19 patients in Kerman, Iran. They were assigned to two equal groups of control and intervention. In the control group, patients received only routine post-discharge care, and in the intervention group, patients received home-based pulmonary rehabilitation procedures containing some movements to improve pulmonary function for four weeks after discharge.

Results: Forced expiratory volume in 1 second (P<0.001), vital capacity (P<0.001) and these two parameters ratio (P<0.02), peak expiratory flow (P<0.001), in four weeks after discharge from the hospital in the intervention group was significantly higher than in the control group. Moreover, 6-min walk distance (P<0.001) was significantly increased, and the severity of dyspnea (P<0.001) was significantly reduced in the intervention group. As well, the number of patients with severe dyspnea decreased significantly (P<0.001).

Conclusion: It seems that our home-based program can result in a marked improvement in vital capacity and other pulmonary function tests, as well as a reduction in dyspnea after discharge. In conclusion, this rehabilitation procedure is effective in pulmonary recovery in COVID-19 patients and can be used as a treatment procedure for recovery in these patients.

Facilitation of Temozolomide Resistance of Glioblastoma by Long Noncoding RNA DLK1-35

Yuhui Li — 2023-05-23

Background: Long noncoding RNAs played critical roles in glioblastoma development.

Objectives: This study aimed to examine the impacts of lncRNA DLK1-35 on glioblastoma cells and mice.

Methods: Methyl Thiazolyl Tetrazolium (MTT) was applied for examining the viabilities of U87 and U251 cells, as well as IC₅₀ values of temozolomide (TMZ). LncRNA DLK1-35 expressions were detected using RT-qPCR. Proliferation and apoptosis of TMZ-resistant U251 (U251 TR) cells were evaluated using colony formation and flow cytometry, respectively. Western blot was applied to analyze O6-methylguanine-DNA methyltransferase (MGMT) protein expressions. The xenograft model was used for detecting the weight and volume of tumors in mice.

Results: TMZ treatment suppressed the viabilities of glioblastoma cells dose-dependently. Moreover, TMZ-resistant glioblastoma cells had higher IC₅₀ values. lncRNA DLK1-35 was upregulated in TMZ-resistant cells while the suppression of lncRNA DLK1-35 caused low proliferation and a higher apoptosis rate. Moreover, MGMT was also inhibited by lncRNA DLK1-35 downregulation. Additionally, the weight and volume of tumors in mice were also inhibited with the knockdown of lncRNA DLK1-35.

Conclusion: Knockdown of lncRNA DLK1-35 inhibited MGMT to decrease the TMZ resistance in vitro and in vivo in glioblastoma.

Development of a COVID-19 Disease Risk Perception Scale

Tevfik Ozlu — 2023-05-23

Background: The COVID-19 pandemic has affected several areas of society, such as social life, the economy, education, and the provision of health services. The need to evaluate individuals’ risk perception has assumed particular importance in this situation in which people find themselves.

Objectives: This study aimed to develop a “COVID-19 Disease Risk Perception Scale” for determining COVID-19 risk perceptions in the adult patient group during the COVID-19 pandemic.

Methods: The proposed scale form was established once the content validity of the item pool created by the research team had been evaluated by experts. Exploratory and confirmatory factor analysis for construct validity, item-total correlation, Cronbach alpha coefficients, and the test-retest method were employed to determine criterion-dependent validity and reliability in a group of 564 individuals aged 18-73.

Results: Following exploratory factor analysis, a nine-factor structure explaining 61.733% of variance was established. Confirmatory factor analysis results were found within the values defined in the literature. The Cronbach alpha coefficient of the scale was 0.906, with an intraclass correlation coefficient of 0.881 (P<0.001).

Conclusion: The developed scale is a valid and reliable inventory capable of using in the examination and evaluation of risk perception of COVID-19 disease in the adult age group.

Correlation Analysis between Apparent Diffusion Coefficient of Prostate Cancer and other Prostate Cancer Indicators

Jie Wu — 2023-05-23

Background: There are very few reports on the correlation between the apparent diffusion coefficient (ADC) of magnetic resonance parameters and other laboratory indicators of prostate cancer in China, and there is no unified clinical conclusion at present from the other parts of the world. Therefore, this study analyzed the correlation between ADC and laboratory indicators, such as serum total prostate specific antigen (TPSA), complex prostate specific antigen (CPSA), free prostate specific antigen (FPSA), Gleason score, and left and right diameters of the prostate so as to provide a basis for the diagnosis and treatment of prostate cancer.

Methods: A total of 104 patients of all age groups with prostate cancer diagnosed in the General Hospital of Wanbei Coal and Electricity Group, Wanbei, China, from January 2017 to December 2022 were retrospectively analyzed as the experimental group. At the same time, 63 patients with benign prostatic hyperplasia who received health examinations were selected as the control group. TPSA, CPSA, FPSA, CPSA/TPSA, FPSA/TPSA, Gleason score, left and right diameters of the prostate, and magnetic resonance parameter ADC were detected in all patients. At the same time, we analyzed the correlation between ADC and other parameters in prostate cancer patients.

Results: The serum levels of TPSA, CPSA, and FPSA in prostate cancer patients were significantly higher (P<0.001) than in those in the control group. The differences between CPSA/TPSA and FPSA/TPSA in the two groups were not statistically significant. Meanwhile, ADC and left and right diameters of the prostate were significantly lower in prostate cancer patients than in subjects in the control group, and the differences were statistically significant (P<0.001). In addition, serum TPSA, CPSA, and FPSA in high-risk prostate cancer patients were found to be significantly higher than in cases in the medium-risk and low-risk groups. The results of our study also revealed that ADC was moderately negatively correlated with FPSA (r=-0.415, P<0.001) and weakly negatively correlated with TPSA (r=-0.222, P=0.024).

Conclusion: There is a correlation between ADC, TPSA, and FPSA in patients with prostate cancer, and there were significant differences in TPSA, CPSA, and FPSA between patients with prostate cancer and patients with benign prostatic hyperplasia. The three parameters can be combined for the diagnosis of prostate cancer.

A Simple Approach to Predict Spleen Volume in Patients with Splenomegaly Due to Portal Hypertension

Tiancheng Luo — 2023-05-23

Background: Splenomegaly and hypersplenism are common presentations of portal hypertension and can result in severe comorbidities. The degree of splenomegaly is associated with disease severity and has been established as a reliable noninvasive indicator for disease surveillance.

Objectives: This study aimed to propose a simple and repeatable splenic measurement model to estimate the splenic volume in patients with portal hypertension.

Methods: In total, 161 patients with portal hypertension were admitted to our hospital from March 2017 to August 2020, with a final enrollment of 106 subjects. The splenic volume calculated via IQQA-Liver software was used for reference. Radiological data were retrospectively reviewed to measure the height, length, and width of the spleen. Different volume prediction models were constructed based on statistically significant laboratory and radiological parameters.

Results: The average spleen volume measured by the IQQA-Liver software was 852.29±362.26cm³. Model 0 was constructed based on hematological and radiological parameters, while Models 1 and 2 were based on radiological parameters alone. Model 1 was superior to the others according to the Bland-Altman scatterplot and correlation analysis.

Conclusion: The proposed estimation model is a reliable predictor for splenic volume, providing valuable information in patients with portal hypertension. The simple technique allows for widespread clinical application.

Sinonasal Cancer: A National Population-based Study in Iran

Matin Ghazizadeh — 2023-05-23

Background: Cancer is a leading cause of death in the 21^st century. Sinonasal malignancies comprise less than 0.5% of all cancers. There are limited epidemiologic studies on them.

Objectives: The current study aimed to estimate the patient demographics, as well as the incidence rates of nasal cavity and paranasal sinuses (NC-PNS) cancers, using a population based registry.

Methods: The current study was a descriptive cohort using the Iranian national population based cancer registry (INPCR) data in 2016. The incidence rate of NC-PNS cancer and its distribution considering age, gender, geographical location and histopathology were determined.

Results: A total of 258 cases (62.4 % males) were included in the study. Age standardized incidence rate (ASIR) of NC-PNS cancer was 0.36 per 100,000 population. ASIR had the highest value in the 7^th, 8^th, and 6^th decades of life, in descending order. Squamous cell carcinoma (SCC) was the most common histopathologic subtype (23.64%). The most frequent non-epithelial cancer were hematopoietic and lymphatic malignancies (12.40%). The most prevalent site of involvement was the nasal cavity (43.02%), followed by the maxillary sinus (24.81%). The geographical distribution of NC-PNS cancer did not follow any particular pattern. The highest crude incidences were detected in Chahar-Mahal-Bakhtiari, Kerman, and West Azarbaijan in decreasing order.

Conclusion: As evidenced by the obtained results, NC-PNS cancers are rare malignancies. Men in their fifties and older are at a higher risk of involvement. Epithelial cancers are more prevalent, among which SCC is the most common histopathologic subtype.

Neurofibromatosis Type 1-Associated Multiple Malignant Peripheral Nerve Sheet Tumors: A Case Report and Literature Review

Parinaz Sedighi — 2023-05-23

Background: Neurofibromatosis type 1 (NF-1) is a genetic disorder characterized by café-au-lait macules, freckling, Lisch nodules, and neurofibromas. NF-1 patients have a special predisposition to tumorigenesis due to genetic mutations, affecting the tumor regulator systems. Malignant Peripheral Nerve Sheet Tumor (MPNST) is a highly aggressive soft tissue tumor that is usually associated with NF-1.

Case presentation: A 32-year-old woman was presented complaining of weakness, severe fatigue, weight loss, peripheral paresthesia, progressive generalized myalgia, bone pain, and a mass sensation in her right thigh since three months ago. She was a known case of NF-1 since childhood. After clinical and radiological evaluation, multiple masses were detected in the retroperitoneal cavity adjacent to the left kidney, uterus, and right thigh. Finally, the patient was planned for surgical excision of two masses with subsequent chemotherapy. Both excised masses were confirmed as MPNSTs by histopathological examination.

Conclusion: Regarding the predisposition of NF-1 patients to tumorigenesis and the high prevalence of peripheral nerve tumors among these patients, any masses changing their character should raise suspicion for malignancy. One of the serious malignant lesions is MPNST. The primary treatment plan for these malignant lesions is surgical excision with subsequent chemotherapy or radiotherapy based on individual characteristics.