Tehran University Medical Journal

Human papilloma virus (HPV) vaccine, prevention of cervical cancer: a review article

Sahar Seddiq

According to the official statistics of the World Health Organization (WHO), cervical cancer is one of the most common cancers among women after breast, colorectal, and lung cancers. The US Centers for Disease Control and Prevention (CDC) says all women have the chance to get the disease, and women over the age of 30 are more likely to get it. However, this cancer is a types of cancer that can be prevented through vaccination. This study aimed to investigate the role of vaccines in the prevention of cervical cancer. In this review study, articles published between 2016-2022 from PubMed, SID, Cochrane Library, Science Direct, and Google Scholar databases were examined. Keywords Papilloma vaccine and cervical cancer in Persian sources and HPV vaccine and Cervical Cancer in English sources were used. The subject search was also performed using MeSH medical subject headings and through the Pubmed database. Vaccination against human papillomavirus is the most cost-effective public health measure against cervical cancer. In many developed and developing countries, serious programs are underway for HPV vaccination and screening for cervical cancer. In most countries, HPV vaccination has been added to their mandatory immunization programs, effectively reducing the incidence of cervical infections and cancers. In countries where vaccination is not complete, health education and screening programs such as PAP smears every 2 years for all women and every year for those with high cancer risk or abnormal smears, have been consolidated. HPV vaccination is highly effective and has been added to immunization programs in many countries. Nowadays, three types of vaccines have been presented, of which the 9-valent Gardasil vaccine is more effective than the other two types, but in terms of cost-effectiveness, the 4-valent Gardasil vaccine is more suggested. Due to the high prevalence of cervical cancer in Iran, it is suggested that the HPV vaccine be used, screening tests be optimized and performed on a regular basis, and ways to prevent cervical cancer be taught.

Evaluation of Combination Treatment of BM-MSCs And Lotion containing honey, Aloe, propolis in the Healing of Second Degree Burns in Animal Models.

Tahere Abbasi Moayyer

Background: One of the most important issues in medical science is the healing of burn wounds. The use of medicinal plants has been common for many years and today cell therapy offers new approaches to the management of skin wound healing. The present study aimed to evaluate the the combination treatment of lotion containing honey, Aloe, and propolis with BM-MSCs in the healing of second-degree burns in animal models.
Methods: this experimental study from October 2020 to November 2020, was performed in the animal house of Tehran University of Medical Sciences. 72 rats with an age range of 3-4 months and a weight of about 200-250 gr, after burns were randomly divided into 6 groups of 12 with study periods of 7, 14 and 21 days. The groups were as following: control (no treatment), Positive control (SSD1%), First experimental (Stem cells), Second experimental(lotion), Third experimental(Stem cells and lotion), and Fourth experimental (DMEM). To measure the percentage of healing from the wound surface on days 0, 4, 7, 10, 14, 17, and 21 photos were taken and the wound surface area was calculated by Image J software. After sacrificing rats, tissue samples were taken on days 7, 14 and 21 after burning induction. Samples were prepared for staining H&E and Trichrome Masson’s, as well as RT-PCR examination. The results were analyzed using Graph Pad Prism8 software and Tukey and one-way variance tests.
Results: Treatment preference was with the combination therapy group and then with the lotion group. According to macroscopic and microscopic images of H&E and Trichrome Mason, the highest amount of wound coverage and the presence of mature collagen fibers were also observed in the combination therapy group. The results of statistical analysis and scoring also showed increased epithelization, granulation tissue formation, collagen deposition, angiogenesis and fibroblast cell proliferation, and decreased inflammation in the combination therapy group. The combination therapy group also had the highest expression of the TGF-β gene. (P<0/05)
Conclusion: Due to its epithelialization, anti-inflammatory and angiogenesis properties, the lotion has healing properties in second-degree burn wounds and its simultaneous use with mesenchymal stem cells leads to healing and acceleration of burn wound healing.

Evaluation of the relationship between blood group and intubation and mortality rate in COVID 19patients.

Sogol Asgari

Background: Coronavirus (COVID-19) represents a global public health crisis that is causing significant deaths and affecting health systems around the world. There are several risk factors for the severity of infection, complications and mortality of COVID-19. One of them is blood group. The aim of this study was to investigate the relationship between blood group and rate of covid 19 disease.
Methods: A cross sectional study was performed on 130 patients over 18 years of age admitted in ICU of Shohada Tajrish Hospital between August 2020 and April 2021.The positive COVID-19 diagnosis was confirmed by polymerase chain reaction (PCR) test. Blood groups were determined and then, we monitored and followed up the patients' outcome during staying in ICU, the need for intubation, recovery and death. Data were collected using a questionnaire and analyzed by Pearson correlation coefficient and stepwise multiple regression analysis. Results were determined based on Fisher’s exact test. P<0.05 was considered significant.
Results: 60 (46.1%) patients had blood type A, (20%) 26 patients blood type AB, 12 (9.2%) patients’ blood type B and (24.7%) 32 patients blood type O. Blood group A was significantly higher in these patients. 55 patients (42.3%) were female and 75 patients (57.7%) were male. Their mean age was 43.19±19.05. Totally, 43.1% of hospitalized patients were intubated regardless of blood type. The number of cases requiring intubation was higher in people with positive blood type A. The lowest need for intubation was seen in blood type B negative. Blood group A positive (39.6%) and then AB negative (33.3%) had the highest mortality rate. Death was not observed in blood group A negative, B negative, B positive and O negative.
Conclusion: The number of patients with COVID-19 with blood type A was significantly higher (46.1%). The most common blood group in these patients was A and the lowest was blood group B. The number of cases requiring intubation was higher in people with positive blood type A.

Diagnostic Value of high sensitivity C-reactive protein in Differentiating Transudate and Exudative Fluid in Patients with Pleural Effusion.

Mohammad Ranaee

Background: Pleural effusion is the accumulation of fluid in the pleural cavities resulting from an imbalance of fluid production and reabsorption. Early detection of the cause of pleural effusion leads to early treatment and reduces effects on the patient. The most important step in pleural effusion diagnosis is to determine its nature and to determine whether it is transudate or exudate. CRP(C-reactive protein) is an acute-phase protein that is synthesized by hepatocytes during inflammatory states, the highly sensitive type of CRP is more sensitive than the standard CRP test and measures lower levels. It may help differentiate the nature of pleural effusion. The aim of this research was to evaluate the hs-CRP diagnostic value in differentiating the nature of the pleural effusion
Methods: In this descriptive-analytical cross-sectional study, in Rohani hospital of Babol from March 2017 to February 2019, 75 pleural effusion patients, undergoing thoracentesis, the hs-CRP level was measured in their pleural fluid and were compared based on Light´s criteria in two groups of transudates and exudates. Using the ROC curve, the appropriate cut-off point was determined for hs-CRP to differentiate the nature of pleural effusion.

Results: Out of 75 patients, 45 patients were in the exudative pleural effusion group and 30 patients in the transudative group. The mean of hs-CRP in the exudate group was 18.27±10.74 mg/L and in the transudative group 2.98±2.15 mg/L (p˂0.001). The cut-off point for hs-CRP of pleural fluid was calculated to be 5.94 mg / L, which has a sensitivity of 88.9% and a specificity of 93.3%. This marker was also studied in exudative subgroups, and there was a significant difference between pleural hs-CRP levels in two groups of pleural effusion due to malignancy and Parapneumonic effusion (p=0.011).

Conclusion: The pleural fluid hs-CRP can be used as a useful marker for differentiating the nature of pleural effusion and differentiating the pleural effusion of transudate and exudate.

The effect of oral ibuprofen in doctus arteriosus closure in full- term neonates.

Mojtaba Ahmadlou

Background: This study aimed to assess the efficacy and safety of the oral use of ibuprofen suspension in various doses in the treatment of PDA (Patent ductus arteriosus) in mature babies. Mature babies (37-42 weeks) aged more than 3 days who had been diagnosed with PDA were involved in this study. For the measurement of the ratio of left atrial to aortic root diameters (La/Ao) Color, pressure gradient and the internal ductal diameter, Doppler echocardiography (ECHO) was performed. This clinical trial was performed on 60 infants born born between August 2013 to August 2015.
Methods: This clinical trial study was performed on 60 infants were randomly born between August 2013 to August 2015 which Randomly divided into two groups: The first group, received oral ibuprofen in three doses (5, 5, 10 mg/kg at 24-hour intervals) and the second group received an early dose of OIS, in two doses of 10 mg/kg after 24 and 48 hours (totally 20 mg/kg). A follow-up ECHO was performed 48 hours and 2 weeks after treatment by the same pediatric cardiologist who was not aware of the study groups. Evaluation of changes in platelet count, blood urea nitrogen, creatinine and complications of thrombocytopenia, evaluation of elevated serum creatinine, and complications of gastrointestinal bleeding were compared between the two groups using statistical analysis.

Results: Seventy-three percent (73%) patients in the first group and seventy-six (76%) patients in the second group had successful PDA closure in the first 48 hrs. No statistically significant difference between the two groups (P=0.0001) was obtained and the highest response time was observed in the first 48 hours of treatment. After 2 weeks, the PDA closure in both groups was completely successful (100%). No specific side effects were observed between the two groups.
Conclusion: We conclude that higher doses of ibuprofen (20 and 2×5₁₀ mg/kg) do not show better results for PDA closure without renal or gastrointestinal complications.

The effect of empagliflozin administration on lipid profile in diabetic patients with acute coronary syndrome after PCI.

Seyed Mohammad Hassan Adel

Background: Diabetes mellitus is associated with an increased risk of cardiovascular disease. The effects of add-in Sodium-glucose cotransporter 2 (SGLT2) inhibitors to standard statin treatments in acute coronary syndrome (ACS) patients remains controversial. The effects of the empagliflozin treatment after percutaneous coronary intervention (PCI) on the lipid profile of patients with type 2 diabetes mellitus (T2DM) have not been investigated yet. This study aimed to evaluate the efficacy of empagliflozin administration on lipid profile in diabetic patients with ACS after PCI.
Methods: This randomized, double-blind, placebo-controlled trial study was conducted from March until December 2020 on type 2 diabetes patients who underwent PCI and were referred to the Golestan and Imam Khomeini Hospitals. 93 patients (56 males and 37 females, mean age of 56.55 years old) were included. The patients were randomly assigned into two groups of receiving empagliflozin (10 mg, once daily) or a matching placebo, in addition to standard therapies for 6 months. The changes in metabolic parameters including lipid profile before and 6 months after interventions were assessed.

Results: After treatment in placebo group the level of LDL-C (median 0.90 mg/dl to 0.82, P=0.008) and HDL-C (median 0.40 mg/dl to 0.35, P=0.090) were decreased, while in the empagliflozin group the levels of LDL-C (median 0.87 mg/dl to 0.96, P=0.875) and HDL-C (median 0.38 mg/dl to 0.48), P=0.007) increased. Treatment with Empagliflozin and placebo had no significant effect on changing the levels of total cholesterol, TG and eGFR (P>0.05). The weight loss and FBS reduction in the empagliflozin group were significantly higher than placebo (P=0.001 and P=0.048, respectively).

Conclusion: Our results showed that adding Empagliflozin to standard treatment compared with a placebo for 6 months significantly increased LDL-C and significantly increased HDL-C. Also, except for weight loss and FBS, Empagliflozin was not more effective in improving the metabolic parameters of diabetic patients after PCI compared with placebo, so it seems that the use of this drug in diabetic patients with ACS after PCI is not very cost-effective.

Co-occurrence of upper respiratory tract disorders with gastrointestinal infections of Helicobacter pylori in patients; a systematic review and meta-analysis.

Shadman Nemati

Background: Helicobacter pylori infection and respiratory tract infection at the same time cause pathogenicity increase and death. The aim of this study was to evaluate the co-occurrence of upper respiratory tract disorders and gastrointestinal infections of H. pylori.
Methods: The present study was conducted as a systematic review and meta-analysis, from August 2019 to Agusut 2020, at Qazvin University of Medical Sciences. Articles in the international databases (April 2001-December 2018) on the coexistence of upper respiratory tract disorders with H. pylori gastrointestinal infections were examined. The random effect model with a 95% confidence level was used to analyze the data.
Results: The highest prevalence of respiratory disorders co-occurrence associated with adenoid tissue (33%), nasal polyps (100%), chronic rhinosinusitis (71%) and gastrointestinal infections of H. pylori was reported in 2006 in Turkey, 2011 in Poland and 2015 in Egypt. Concurrent prevalence of the disease, according to the type of upper respiratory tract disorders in all studies, the estimated effect size according to the random model was 53% in chronic rhinosinusitis, 63% in nasal polyps, 62% in adenoid tissue and 60% in total, which was significant (P=0/000). The prevalence of co-occurrence of upper respiratory tract disorders with gastrointestinal infections of H. pylori in patients was estimated to be 61% at the age of more than 27 years and 60% at the age of fewer than 27 years. Pooled estimation of the concurrent prevalence of infection (in total) was estimated to be 60% and was significant among the studies (P=0/000).

Conclusion: The concurrent prevalence of upper respiratory tract disorders with gastrointestinal infections of H. pylori was observed to be almost equal and significant in elderly and young patients. Due to the fact that the simultaneous occurrence of two types of infections and diseases in people is very dangerous, screening of patients with each of these infections is necessary to identify the other infection and prescribe appropriate drugs.

Prevalence of beta group streptococcal colonization in rectovaginal discharge of pregnant women and comparison of maternal and neonatal complications in culture-treated individuals with those treated in risk factor at Arash Hospital.

Reihaneh Pirjani

Background: Streptococcus beta group (GBS: Group B Streptococcus) is a gram-positive coccus that colonizes in the rectovaginal area. About 4.6% to 31.3% of women of childbearing age carry GBS infection. GBS colonization is a risk factor for subsequent infections in pregnant women that can be transmitted to the fetus through vertical transfer and aspiration of infected amniotic fluid. 2% of cases lead to an invasive infection in the baby. In most countries, treatment is done according to the CDC (Centers for Disease Control and Prevention) protocol which is based on culture results. According to studies conducted in our country, treatment is based on risk factors. Therefore, during this study, we decided to compare the results of treatment based on risk factors and treatment based on culture results and other maternal and neonatal complications in these two groups.
Methods: This case-control study was performed on 98 pregnant women aged 35 to 37 weeks who were referred to the perinatal clinic of Arash Hospital from April 2018 to the end of March 2020 and also 200 pregnant women with a GBS risk factor. Samples of rectovaginal discharge of 98 pregnant women were sent to a selected laboratory for culturing. In this group, treatment was performed based on the culture result. The control samples included 200 pregnant mothers who were treated based on risk factors without culture. Then the two groups were compared in terms of pregnancy outcomes.

Results: Out of 98 subjects, 24 (24.5%) had positive rectovaginal culture. Individuals treated with antibiotics based on positive culture results did not show a significant difference in terms of observed pregnancy outcomes compared with the control group.
Conclusion: The prevalence of GBS colonization was significantly higher in patients with a history of vaginal discharge than in those without a history. Due to the small number of studies conducted in Iran, it is recommended to conduct studies with a larger sample size in order to explain a more appropriate protocol in terms of effectiveness and economics.

The effect of Perineoplasty surgery and anterior-posterior repair (APR) on body image, sexual function, and quality of life in women.

Fedyeh Haghollahi

Background: Pelvic organ prolapse is one of the elements increasing the prevalence of Female Sexual Dysfunction which influences the lifestyles of women and their marital relationships. One of the critical desires of surgical remedies of those women, further than enhancing signs and symptoms and restoring regular anatomy, is to preserve and enhance sexual function. The effect of perineorrhaphy and anterior-posterior vaginal repair on body image, sexual function, and quality of life in postoperative women is one of the objectives of this study.
Methods: The present study is a clinical trial without a control group. 119 women referred to Shahid Beheshti and Al-Zahra hospitals in Isfahan, aged 28-49 years, with rectocele and cystocele, uterine prolapse and a candidate for perineal surgery and anterior-posterior vaginal repair, entered the study from October 2020 to August 2021. Data collection tools were three questionnaires on Female Sexual Function Index (FSFI), Multidimensional Body–Self Relations Questionnaire (MBSRQ), and Short-Form Health Survey (SF-36) that were completed before and 6 months after surgery by interviewing individuals. All surgeries were performed by a Fellowship in pelvic floor disorder, and the type of surgery was the same in all patients. Data were analyzed using a dependent t-test.
Results: Data of 119 women with rectocele, second and third-degree cystocele with maximal grade 1 apex prolapse, and candidates for perineorrhaphy and anterior-posterior vaginal repair were evaluated. The mean age of the study samples was 36.40±6.39 years and the age range was 28 to 49 years (before menopause).
In the postoperative stage; perineorrhaphy and anterior-posterior vaginal repair affect body image, improvement of sexual function, and quality of life in women (P<0.001).
Conclusion: It seems that perineorrhaphy and anterior-posterior vaginal repair affect the body image, Improving sexual function and quality of life, and can be effective in improving the quality and improving the relationship between couples who need this surgery.

Evaluation of optic nerve sheath diameter in comparison with cerebrospinal fluid pressure in children with idiopathic intracranial hypertension.

Maryam Haghighi Morad

Background: The purpose of this study is a non-invasive diagnosis of increasing the pressure of cerebrospinal fluid in patients involved in idiopathic intracranial hypertension (IIH) that is done with transbulbar sonography.
Methods: In this descriptive cross-sectional study all the non-toxic children under 18 who were referred to the neurology clinic of Loghman Hospital of Tehran from October 2017 to October 2018 with increased intracerebral pressure symptoms were studied. The increased intracerebral pressure symptoms were headache or vomiting or blurred vision or 6th nerve palsy and they had papillary edema. Also, if their diagnostic brain imaging measures were normal such as: Magnetic Resonance Imaging (MRI), Computed Tomography scan (CT scan) and in some cases Magnetic Resonance Venography (MRV), they were suspected to Idiopathic intracranial hypertension and were entered into the study consecutively. Their complete medical history and comorbidities and biographical information were recorded in the file. All patients were candidates for a lumbar puncture to measure cerebrospinal fluid pressure. After full explanation to the parents and obtaining written consent from them before performing a lumbar puncture, patients in coordination with the ultrasound unit without delay in performing a lumbar puncture, first underwent trans orbital ultrasound in supine position and were awakened with closed eyes. Opticians were implanted in both eyes by a skilled sonographer. And then sedated with sedatives (ketamine or midazolam) prescribed by an anesthesiologist. It was placed in a sterile position in a supine semi-flexion position and with lateral decubitus aligned with the body. Cerebrospinal fluid pressure to cm of water was recorded using a serum set in the lumber intervertebral space 4-5. Then a sample was sent for analysis and smear.
Results: Out of 10 patients (age 2.5–14 year, mean 9 years) 10% were girls, 90% were boys, and mean BMI was 22.5 kg/m². Their symptoms included: 80% Headache, 40% Vomiting, 40% Diplopia, 20% Blurred vision, 10% 6^th nerve palsy, and 10% Tinnitus when being reffered. In All patients, CSF pressure was more than 25 cm H2o (mean 40 cm H2o), right and left eyes optic nerve sheath diameter (ONSD) was more than the cutoff point (ONSD≤4.5 mm), the mean right ONSD was 6.31 mm and left eye was 6.64 mm.

Conclusion: According to the findings of this study, the measuring of optic nerve sheath diameter in patients suspected of increasing the pressure of idiopathic intracranial hypertension can be helpful as a non–invasive diagnosis method.