Tehran University Medical Journal

Secondary cancers during the radiotherapy of prostate cancer: a review article

Nazila Eyvazzadeh

Prostate cancer is the most common and second leading cause of death among men in the world. Nowadays, radiotherapy has been known as one of the most affecting methods for prostate cancer treatment. Nevertheless, radiotherapy is accompanied by the concern of developing secondary cancers by the scattered radiation to the neighbor organs at risk. Several studies have shown that secondary cancers after the radiotherapy of prostate cancer treatment, occur in tissues such as the bladder and rectum which have been exposed to direct or indirect radiations. Therefore, this review study aimed to evaluate the influencing factors for developing secondary cancers after the radiotherapy of prostate cancer. To access the previously validated published studies, Persian and English keywords such as prostate cancer, secondary cancers, radiotherapy and organs at risk have been searched in ISID, Google Scholar, Science Direct, PubMed, and World Health Organization, between 1997 and 2021. Totally 246 pieces of literature have been selected which finally, by ignoring the similar and overlapping studies, only 40 studies were reviewed. In the present study, the most affecting factors for developing secondary malignancies including the anatomical status changes, dose variations, smoking and the impact of the various treatment techniques, have been studied. The results of the reviewed studies showed a reduction of secondary cancer risks with performing the modern modalities such as proton therapy to treat prostate cancer. Moreover, organ movements and anatomical status changes which vary from one patient to others, have been reported to make a significant difference in the relative risk of secondary cancers. It has been shown that smoking may increase the risk of secondary cancers after the radiotherapy of prostate cancer, so radiotherapy and smoking may cause genetic mutations. Despite the advantages of radiotherapy for prostate cancer treatment, developing secondary cancers after the radiotherapy should not be ignored. Assessments of the affecting factors for secondary cancers after the radiotherapy of prostate cancer require social and comprehensive studies which can result in an accurate modality with fewer side effects.

A systematic review on risk factors and protective factors related to Parkinson's disease

Negar Heidari

Background: Parkinson's disease is one of the chronic neurological diseases. It is the second most common neurodegenerative disease after Alzheimer's, affecting 7.5 million people worldwide and its rate is expected to increase by 20% by 2020. three symptoms of tremor, muscle stiffness and movement disorders are among the main diagnostic symptoms of the disease. The prevalence of Parkinson's worldwide varies between 18 and 418 cases per 100,000 people per year. It is generally estimated that the prevalence of this disease in the general population is 0.3%. A systematic review study was performed to determine the factors associated with Parkinson's disease.
Methods: This study was a systematic review that was conducted by searching national and international databases until February 2020. Initially, all articles which had mentioned Parkinson-related factors were collected and accepted by researchers based on studies. Entry and exit criteria were met. Exclusion criteria included irrelevant items, duplication of studies, unclear procedure, and lack of access to the full text of the study. To reduce bias, articles were evaluated independently by two researchers, and the quality of articles was assessed using the STROBE checklist. All final articles submitted to the systematic review process were prepared by a template checklist. Checklists included article title, first author’s name, year of publication, place of study, risk factors, protective factors, and ineffective factors or the ones which their effects have not yet been determined, and the average age.
Results: In these studies, the following risk factors were reported: family history, agricultural occupation, literacy, stress, well water consumption, aging, environmental factors, genetic factors, pesticide exposure, and alcohol abuse. On the other hand, factors such as smoking and oilseeds, high levels of B-complex vitamins, female estrogen hormones, and selenium have been reported to protect against Parkinson's disease.
Conclusion: Considering the results of the present study and although there is no definitive treatment for this disease, protective factors and risk factors should be seriously considered by health policymakers for preventive measures.

Early prediction of COVID-19 mortality risk based on demographic, vital sign and blood test

Ahmad Shalbaf

Background: Early prediction of the outcome situation of COVID-19 patients can decrease mortality risk by assuring efficient resource allocation and treatment planning. This study introduces a very accurate and fast system for the prediction of COVID-19 outcomes using demographic, vital signs, and laboratory blood test data.
Methods: In this analytic study, which is done from May 2020 to June 2021 in Tehran, 41 features of 244 COVID-19 patients were recorded on the first day of admission to the Masih Daneshvari Hospital. These features were categorized into eight different groups, demographic and patient history features, vital signs, and six different groups of laboratory blood tests including complete blood count (CBC), coagulation, kidney, liver, blood gas, and general. In this study, first, the significance of each of the extracted features and then the eight groups of features for prediction of mortality outcomes were considered, separately. Finally, the best combination of different groups of features was assessed. The statistical methods including the area under the receiver operating characteristic curve (AUC-ROC) based on binary Logistic Regression classification algorithm were used for evaluation.

Results: The results revealed that red cell distribution width (RDW), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), and mean corpuscular volume (MCV) in CBC features have the highest AUC with values of 85.29, 80.96, 79.94 and 79.70, respectively. Then, blood oxygen saturation level (SPO2) in vital features has a higher AUC with a value of 79.28. Moreover, combinations of features in the CBC group have the highest AUC with a value of 95.57. Then, coagulation and vital signs groups have the highest AUC with values of 85.20 and 83.84, respectively. Finally, triple combinations of features in CBC, vital signs, and coagulation groups have the highest AUC with the value of 96.54.
Conclusion: Our proposed system can be used as an assistant acceptable tool for triage of COVID-19 patients to determine which patient will have a higher risk for hospitalization and intensive care in medical environments.

Evaluation of demographic information and consequences of in vitro fertilization in pregnant women in 2019-2020

Fedyeh Haghollahi

Background: Assisted reproductive techniques have increased the chances of pregnancy for couples looking for a way to treat their infertility. To increase the effectiveness of these methods, studies are needed to identify the determinants of a successful pregnancy with these techniques.
Methods: The present study is a cross-sectional retrospective study that was performed on 253 couples who were referred for infertility treatment to the infertility clinic of Shahid Beheshti Hospital in Isfahan from April 2019 to March 2020 to evaluate the results of pregnancy in vitro fertilization. Demographic, clinical, and laboratory data from patient records were collected and entered into checklists.

Results: Out of 253 couples, eighty-five (33.6%) became pregnant by IVF. The mean age of women with successful pregnancies was 33.96±5.2 years and in the unsuccessful pregnancies was 35.84±5.07 years. The results of this study showed that women who had a successful pregnancy after IVF were significantly younger than women who did not have a successful pregnancy (P=0.006). In the classification of patients into two groups of positive and negative pregnancies, younger age, adequate vitamin D levels, and higher sperm motility were the determinants of pregnancy in the first period of fertilization (Fresh protocol). Also, the existence of a failed history of infertility treatment in couples has been introduced as a negative factor for IVF fertility. 13(15.9%) abortions occurred and 11(12.9%) infants who were born with this method needed intensive care.
Conclusion: Lower age at the time of fertilization, higher vitamin D levels, and more active sperms were found to have important and prognostic roles in the success of pregnancy by in vitro fertilization technique.
The results of the present study showed that, Increased unsuccessful treatment has been associated with the history of failed treatment. Therefore, to respond to the relationship between previous infertility treatments and success in subsequent pregnancies in the IVF process, It is recommended to conduct studies with larger sample size and at a higher time efficiency.

Evaluation of the success rate and quality of teaching of tracheal intubation to medical students by using video laryngoscope

Pejman Pourfakhr

Background: Training of airway management and tracheal intubation skill in emergencies for resuscitation of patients are basic skills for medical students. However, the success rate of beginners in this skill is low. Video laryngoscopes are new devices that can increase the success of endotracheal intubation training.
Methods: This clinical trial was conducted with 30 medical students who came to learn anesthesia care at Sina Hospital in 2020. After dividing the students into two groups (n=15) of glide scope and Macintosh, the glide scope group first performed laryngoscopy and tracheal intubation with a glide scope on the manikin 10 times. Then, in the operating room they were trained for endotracheal intubation on 5 patients by glide scope. The Macintosh group first got trained for intubation on the manikin, 10 times and then on five patients in the operating room with a Macintosh laryngoscope. Then all students in the operating room intubated two patients with a Macintosh laryngoscope and their performance was assessed and scored by an anesthesiologist. They evaluated the training course with a questionnaire. The duration of laryngeal access and the time spent for tracheal intubation were compared in the two groups.

Results: In the glide scope group, 76% of students were able to see the epiglottis and larynx in 20 seconds, but in the Macintosh group, 43% of students were able to see the larynx in 20 seconds. In terms of endotracheal intubation time, 72% of the students in the glide scope group were able to successfully perform endotracheal intubation within 40 seconds in their first attempt, but in the Macintosh group, 44% completed endotracheal intubation within 40 seconds (P=0.00). In the evaluation of the quality of skill, the average score of the students in the Macintosh group was 15.30±0.56, while the average score in the glide scope group was 17.20±0.83 (P=0.00). The scores and satisfaction of the students in the glide scope group were higher than the Macintosh.
Conclusion: The use of video laryngoscope in teaching of intubation in trainees will increase the speed, and accuracy of their training and satisfaction compared with the Macintosh laryngoscope.

Determining the effect of sun exposure and physical activity on the incidence of primary progressive multiple sclerosis

Hasan Asadi Gandomani

Background: The onset of primary progressive multiple sclerosis (PPMS) can be triggered by sun exposure and physical activity. The present study aimed to determine the risk of sun exposure and physical activity in PPMS development.
Methods: The case-control study recruited PPMS cases and healthy controls from the general population from September 2019 to September 2020 in Tehran, Iran. The selection of sex-matched controls from the same source population of cases was performed. Sun exposure was assessed in terms of exposure time in two age groups of 13-19 years and over 20 years in winter and summer.

Results: This study examined 146 PPMS cases and 294 controls. The sun exposure in summer in the age group 13-19 was negatively associated with the incidence of the disease (OR=0.68 (CI=0.57-0.82)). This relationship was also observed in the groups of men (OR=0.55 (CI=0.40-0.74)) and women (OR=0.70 (CI=0.53-0.91)). Exposure to sunlight in winter in the age group 13-19 was negatively associated with the incidence of the disease (OR=0.28 (CI=0.19-0.42)). In the group over 20 years, sun exposure was negatively associated with disease incidence in summer (OR=0.49 (CI=0.36-0.66)). Exposure to sunlight on average in winter in the age group over 20 years was negatively associated with the incidence of the disease (OR=0.14 (CI=0.07-0.28)) which in the male group OR=0.12 (0.04-0.32)) and women (OR=0.06 (CI=0.02-0.21)) were seen. Regarding physical activity, only physical activity above 4000 MET per week in the group of women was negatively associated with the incidence of the disease (OR=5.30 (CI=1.05-26.59), but in other groups, this negative relationship was not observed.
Conclusion: Exposure to sunlight in winter and summer had a negative relationship with the incidence of the disease. Physical activity was only negatively associated with the incidence of the disease in very high doses and women.

Comparison of antibiogram test results of patients suspected of urinary tract infection with two methods, fast and classic

Hamid Reza Ghasemi Basir

Background: Urinary tract infections are among the most common diseases in different communities and occur in all age groups. Failure to diagnose the disease correctly and promptly can cause complications such as damage to the urinary tract and kidney parenchyma, increased blood pressure, uremia. Also, in pregnant female patients It may lead to premature birth and even abortion. Therefore, correct and timely administration of antibiotics is very important in the treatment of patients. This study aimed to compare the results of antibiogram testing of patients with suspected urinary tract infections by both rapid and classical methods.
Methods: This cross-sectional study was performed from the beginning of March to the beginning of September 2019, on patients with urinary tract infection Who had been referred to Sina Hospital of Hamedan, Iran. Urine samples were collected 20 cc from patients. The test was performed directly at the same time with urine culture to determine antibiotic susceptibility. The agreement between the two methods was considered as a huge error, major error and minor error. Finally, the data were statistically analyzed with SPSS software version 16.

Results: 92 patients, 23 men (25%) and 69 women (75%) with a mean age of 53.18±18.49 years were included in the study. Direct testing had a significant agreement with the standard test in 90.8% of the results (P<0.001). 9.2% of the antibiogram tests did not match, of which 0.3% were huge errors, 4.7% were major errors and 4.2% were minor errors. The highest number of microorganisms found were Escherichia coli (n=66), Klebsiella pneumoniae (n=13), Pseudomonas aeruginosa (n=6), Acinetobacter (n=1), Enterococcus (n=2), Alcaligenes (n=1), Streptococcus (n=1), Staphylococcus haemolyticus (n=1) and Moraxella (n=1) respectively. The highest rates of urinary tract infections were with Escherichia coli, third-generation cephalosporin antibiotics, and broad-spectrum antibiotics.
Conclusion: The agreement between the direct and standard antibiogram method was acceptable, and the direct antibiogram method can be cited by doctors in many cases.

Providing a model for predicting blood pressure fluctuations after induction of general anesthesia with data mining: a brief report

Zahra Manouchehri

Background: Fluctuations in blood pressure after induction of general anesthesia have played a significant role in complications of surgery. Therefore, the present study was performed by identifying the causes of blood pressure fluctuations after induction of anesthesia, predicting and preventing them.
Methods: For this study which is a retrospective cohort, data mining methods in the data set including the information related to 3150 patients who underwent anesthesia and surgery from April 2018 to September 2019 in Imam Khomeini Hospital in Kermanshah were used. The data set included patients aged 18 years and older (age range of 18 to 96) who underwent a general anesthesia induction test using Propofol and subsequently endotracheal intubation for non-cardiac surgery. If patients did not have intubation, data were missing, or patients underwent intubation after repeated trials, they got excluded. In total, 2640 patients were included in this analysis. Preoperative patient clinical information was collected from pre-anesthesia evaluation records. Intraoperative data were obtained from computer anesthesia records. This data from the patient monitoring system and the anesthesia machine was automatically stored in the anesthesia files, while drug doses and anesthesia techniques were recorded manually. The data were then pre-processed using SPSS software, version 26 (IBM SPSS, Armonk, NY, USA).

Results: In this study, 53 features of patients' records were used (The maximum number of features used in previous studies were 48 features, which compared to them, 5 new features were included in the study) for which a P-value was calculated. Finally, features with a P<0.05 (Indicates the level of significance of the variable) were selected. Then, three data mining algorithms, logistic regression, neural networks and decision tree (the most repetitive data mining algorithms based on previous studies) were used to predict blood pressure. Also, using the criteria of accuracy, precision, sensitivity and F function, the performance of three prediction algorithms in data mining was evaluated.
Conclusion: Six features with P<0.05 were selected that the logistic regression model was more accurate, which was presented as the final model for predicting increased blood pressure fluctuations with path coefficients.

Ranking the factors affecting the care and provision of health services to patients in medical centers using the VIKOR dempster-shafer method: a brief report

Mehdi Sadeghzadeh

Background: Determining the rank of important parameters in ranking health care and providing health services to patients in medical centers.
Methods: The research method is descriptive-analytical and applied in terms of classification. The data is from the database of the Faculty of Health and Medicine of the University of Tehran, which was collected as an archive from April 1998 to May 1999. The statistical population were all experts, specialists and experts of the Faculty of Health 29 of whom completed the questionnaire. The weight of the criteria was evaluated using the AHP method and in the next stage, the medical centers were ranked using the DS-VIKOR method. The analysis method in this study consists of the following steps steps:
• Implementing a simple VIKOR method.
• Implementing the Dempster-Shafer and Vicker method.
• Implementing the AHP method
• Implementation of the Topsis method.
• Comparing the proposed methods to review and compare which ones work best.

Results: The weight of medical centers was assessed by AHP method and then the combined centers were ranked by Dempster-Shafer and VIKOR combined methods using the information of four medical centers, the DS-Vikor approach was implemented. The purpose of six criteria and three experts was used for evaluation. The results show that the effectiveness of care and treatment process is more important from the experts' point of view. Dempester-Schaefer and Vicor The medical centers in question are ranked. For validation, at the end, the medical centers were ranked by TOPSIS method.
The integrated system includes various subsystems giving caring and providing health services to patients in medical centers that can be built and configured and are ranked.

The model can investigate the effectiveness of giving caring and providing health services to patients in medical centers.
Conclusion: By combining the two methods of Dempster-Shafer and Vicker, the confidence in the whole uncertainty is improved and the results are more reliable. This approach can help reduce the uncertainty caused by people's cognition to increase the level of decision-making, allowing us to overcome the problem of choosing the right level of uncertainty and to deal with uncertainty in a practical and justified way.

Sigmoid colon volvulus in pregnancy: a case report

Arezoo Sedaghati

Background: Sigmoid volvulus is a rare complication in pregnancy. The clinical presentation is similar to that of non-pregnant volvulus, although the symptoms can be masked by the enlarged uterus and physiological changes during pregnancy and it can be challenged and delayed in diagnosis and treatment. Delay in diagnosis can also lead to ischemia, necrosis and perforation of the intestine, which can have adverse maternal and fetal outcomes.
Case Presentation: A primigravid woman with gestational age of 31 weeks was admitted to a 3^rd level center with abdominal pain and abdominal distention. From the beginning of pregnancy, the patient complained of bloating and epigastric pain, And had used herbal medicine for defecation. The patient's constipation had worsened since six days before admission to the hospital. She had no vomiting and her general condition was good. Abdominal Supine X-rays were reported completely dilated sigmoid and she was treated with a possible diagnosis of ileus. Due to the progression of symptoms and abdominal distension, rectosigmoidoscopy was performed for her, and scattered mucosal erythema was seen. Discoloration of the purple mucosa was seen from a distance of about 35 cm from the annulus and the secretions inside the sigmoid lumen were seen as blood. Ischemic necrosis and sigmoid volvulus were strongly suggested for the patient and she was immediately transferred to the operating room. The abdomen was opened with a midline incision. A 30 weeks uterus was seen and sigmoid volvulus was confirmed. Detorsion and colostomy were done. Due to the unprepared intestine and the possibility of leakage from the site of anastomosis, sigmoidectomy was not performed. After 4 days, the patient was discharged in a good general condition and became a candidate for sigmoid colon resection after delivery.

Conclusion: All abdominal signs and symptoms during pregnancy, especially in late pregnancy have a complex interpretation and management, due to the impossibility of accurate abdominal examination. The most important factors in the proper management of sigmoid volvulus in pregnancy are fast diagnosis and treatment, hydration and antibiotic therapy.

Physician retention in deprived areas: a letter to the editor

Ali Mohammad Mosadeghrad