Tehran University Medical Journal

Considerations of in-vivo breast tissue assessment using raman spectroscopy: a review article

Sadaf Alipour

Raman spectroscopy, as an emerging and promising molecular assessment tool, has attracted the attention of researchers, especially for disease diagnosis in human organs such as the breast. Although most of the Raman studies on the breast have dealt with ex-vivo examination of either intact or processed excised tissue specimens, there are some in-vivo studies, including intraoperative tumor margin assessment and a few non-invasive studies. Since the non-invasive or minimally invasive Raman assessment technique is an essential need for translation to clinical approaches, in the present article, the most recent and relevant studies in this regard have been reviewed to find and introduce the most proper Raman spectroscopy system’s specifications for in-vivo assessment of breast tissue.
Scholarly documents, including articles, books, and dissertations related to Raman assessment of breast tissue or in-vivo Raman assessment of other human organs, were perused in search of the most relevant technical details of Raman systems employed so far. On the one hand, the present study has covered Raman instrumentation aspects of diverse types of Raman spectroscopy, different types of laser source and their specifications, optical elements used in the delivery and collection of light to and from the tissue such as lenses and fibers, detectors and even calibration settings. On the other hand, the main Raman features corresponding to different breast pathologies have been studied, speculating their variations in a non-invasive setting. Having studied all, we tried to find the best feasible configuration for a Raman system in terms of the ability to meet the needs of a non-invasive, in vivo clinical examination of the breast.
In terms of the Raman spectroscopy modality and laser source, SORS/TRS and 785nm laser diode, were selected for in vivo examination of the breast respectively. The pertinent parameters of the spectrograph, detector, and fiber optic probe were introduced as well.
In the present study, detailed specifications of a non-invasive, in vivo Raman apparatus for examination of breast tissue have been studied and specified.

Comparison of magnetic resonance imaging and CT scan in patients with complaints of mediastinal and chest wall mass

Mahdi Yadollahzadeh

Background: The realm of diagnosing intrathoracic lesions involves a spectrum of imaging methodologies, among which computed tomography (CT)-scan and magnetic resonance imaging (MRI) stand prominent. In the context of Iran, where there is no study comparing the efficacy of CT-scan and MRI for evaluating intrathoracic lesions, our study endeavors to bridge this gap. Mindful of the nuanced advantages and drawbacks inherent in each method, we aim to conduct a comprehensive comparative analysis of CT-scan and MRI in diagnosing intrathoracic lesions, focusing on patients seeking care at Firoozgar Hospital's pulmonary clinic.
Methods: Embarking on a cross-sectional exploration at Firoozgar Hospital Pulmonary Clinic in Tehran, Iran, our investigative journey unfolded between April 2020 and March 2021. Thirty patients, spanning ages 21 to 69, presenting with intra-thoracic lesions encompassing mediastinal and chest wall anomalies, underwent simultaneous CT scan and MRI examinations. In pursuit of diagnostic certainty, histopathology was ordained as the gold standard, and the ensuing results underwent meticulous scrutiny and analysis utilizing SPSS 23 statistical software.

Results: Our study cohort comprised 30 patients, averaging 44.83 years (SD=12.71), with males constituting 60% of the population. Delving into the histological reports, CT-scan and MRI accurately diagnosed 25 (83.3%) and 28 (93.3%) cases, respectively, in retrospective analysis. The Kappa matching coefficient for CT-scan stood at 0.783, while for MRI, it soared to 0.912. A notable revelation surfaced as the Kappa matching coefficient for both CT-scan and MRI maintained a robust 0.783 (P<0.001 in all three cases).

Conclusion: MRI might wield a superior diagnostic prowess compared to CT-scan in evaluating intrathoracic lesions. The robust Kappa matching coefficients endorse a substantial concordance between the two imaging modalities. The implications further beckon contemplation that, in select scenarios, the acquisition of biopsy and histopathology may prove redundant when scrutinizing intrathoracic lesions using the tandem approach of CT-scan and MRI. However, to etch these findings into the annals of medical certainty, a multicenter study endowed with a judicious sample size emerges as an imperative next step.

Complications of trans-obturator mesh surgery in the treatment of stress urinary incontinence; A 10 Year Review

Shahnaz Barat

Background: Urinary stress incontinence occurs due to weakness of the urethral sphincter and/or weakness of the pelvic floor muscles. The purpose of this study is to investigate the complications of TOT surgery in the treatment of women with stress urinary February.
Methods: This is a cross-sectional study that was conducted on women suffering from stress urinary incontinence who underwent TOT surgery in Rohani and Mehregan Hospitals of Babol between March 2010 and February 2019. In order to record early complications, the medical records available in the clinic were referred to for the examination of patients one week and two months after the operation. The late complications of the operation were also investigated at the time of entering the study. Also, satisfaction with the procedure was scored using a visual scale (score 0 to 100). SPSS version 26 software was used in this study. Also, the significance level is less than 0.05.

Results: The study included 59 patients, the majority of whom were housewives (91.5%), had an education level below high school (74.6%), and were menopausal (71.2%). The average age of the participants is 54.92±9.40 years. The most common postoperative complications were Dyspareunia (20.3%), lower urinary symptoms (13.6%), and incontinency (10.2%). Also, the rarest complications were intraoperative injury to the urethra or bladder (1.7%), mild Vaginal erogenous (1.7%), pain at the operation site (3.4%), and need for adjuvant treatment (3.4%). In response to the question of whether you would recommend this surgery to others who have the same problem, 53 people (83.89%) responded positively. The average level of patients' satisfaction with the operation (on a scale of 0 to 100) was 88.64±23.44. According to the T-test, there is a statistically significant relationship between the incidence of postoperative complications and the level of patient satisfaction (P<0.001).
Conclusion: Dyspareunia is the most common and complications during surgery such as damage to the urethra are the rarest complications of TOT surgery.

Epidemiological Investigation of the mortality rate of patients with alkaptonuria during the years 2013 to 2022 in Iran

Samaneh Eslami

Background: Alkaptonuria is a rare disorder that leads to excessive production and accumulation of homogentisic acid in body tissues, and this increase causes tissue degeneration and organ dysfunction through a process called achromasia. Due to very few studies in the field of this disease and access to epidemiological data for the first time in Iran, the present study was conducted with the aim of epidemiological investigation of the mortality rate of patients with alkaptonuria during the years 2013 to 2022 in Iran.
Methods: The design of the present study was cross-sectional (descriptive-analytical). The data related to the deceased registered according to the international coding system of diseases (ICD-10) were extracted from the system of registration and classification of the causes of death of Iran for death due to alkaptonuria disease. The variables investigated in this study included: age, gender and residence status of the deceased. Chi-square and Fisher's exact test were also used to analyze the data.

Results: The specific death rate was calculated as 0.31 per one million people of the population. In this study, 90% of the deaths occurred at the age of less than five years. The age variable included two groups of less than five years and more than five years, where 90% of deaths occurred at the age of less than five years. 60% of the deceased were men and 40% were women. Regarding the residence status variable, 82% of the cases were urban and the rest were rural. Finally, there was no significant difference between the incidence of death due to alkaptonuria disease and the investigated variables, which are age (P=0.291), gender (P=0.958) and residence status (P=0.273).
Conclusion: According to the findings in the present study, although no significant difference was observed between age and the number of cases of death due to alkaptonuria; But most cases of death have occurred in young age groups, which seems that more studies are needed to understand the different dimensions of this disease

Effect of resistance training modalities on angiogenic indices in sedentary male students

Mohammad Ali Gharaat

Background: Angiogenesis is a physiological process leading to capillary density enhancement and better blood distribution in skeletal muscles, which triggers in response to physical training. The present study aimed to investigate the changes in physiological factors involved in angiogenesis in response to circuit or traditional resistance training.
Methods: Thirty-six healthy sedentary students who were studying at Shahid Rajaee Teacher Training University of Tehran (age: 22.1±2.3 years; height: 172.7±5.1 cm) volunteered to participate in the study (from October 2021 to February 2022). Following a pre-test to evaluate one repetition maximum (1RM) of selected movements (Leg Press, Leg Curl, Leg Extension, Bench Pull, Seated Row, Biceps Curl), subjects randomly divided into Circuit Resistance training (CRT) (training protocol included 4 circles/3 times a week/8 weeks circuit performance/50-55% 1 Repetition Maximum (1RM), n=12), Traditional resistance training (RT) (training protocol included 8 repetition/3 set/3 time per week/8 weeks of same movements with 75% 1RM followed by 2 minutes break to rest between the sets; n=12) and the control group without any regular training (n=12). We assessed the level of Vascular Endothelial Growth Factor (VEGF), plasma level of growth hormone (GH), and Basic Fibroblast Growth Factor (BFGF) to the mentioned training methods. Data were evaluated by utilizing SPSS version 14.

Results: Present findings showed that CRT and RT protocols resulted in significant increases in post-test compared to pre-test in VEGF (P=0.00), GH (P=0.04), and BFGF (P=0.00). In addition, the magnitude of changes in VEGF and GH were significantly greater than the magnitude of changes in control group in post-test (P=0.03, and 0.001, respectively). Furthermore, there was a strong correlation between absolute values of GH and VEGF (r=0.74 and r=0.71) following CRT (P=0.01) and RT (P=0.02).
Conclusion: This study demonstrated that CRT and RT might enhance angiogenesis through an increase in VEGF, bFGF and GH, leading to better blood distribution in muscles.

The study of predisposing factors related to perforation in patients with peptic ulcer in shahid beheshti hospital using fuzzy logic, qom, during 2019 to 2022

Pouya Derakhshan-Barjoei

Background: Gastrointestinal ulcers occur due to an imbalance between the defense mechanisms of the gastric mucosa and damaging forces, especially gastric acid and pepsin. Overall, complications occur in 10%-20% of these patients, and 2%-14% of wounds eventually perforate. The use of non-steroidal anti-inflammatory drugs, steroids, smoking, Helicobacter pylori and high salt diet can be mentioned as important etiologies in this regard.
Methods: In this study, the information of patients with peptic ulcer who referred to Beheshti Hospital from 2019 to 2022 was analyzed. They were divided into two groups with perforation and without perforation. Then the variables of age, sex, smoking, NSAID and opium use, Helicobacter pylori infection and proton pump inhibitor use and previous history of peptic ulcer were investigated in two groups.

Results: The findings of the present study showed that the average age in the group with perforation was 48.7 and in the group without perforation was 42.04. In the non-perforated group, 58.5% of the patients were male, and in the group with perforation, 82.2% of the patients were male. In terms of smoking, 29.6% were smokers in the group without perforation and 50.4% were smokers in the group with perforation. Opium consumption was about 15.6% in people without perforation and about 33.3% in people with perforation. In terms of NSAID use, the prevalence was 35.6% in the group without perforation and 27.4% in the group with perforation. PPI consumption was 46.7% in the group without perforation and 21.5% in the group with perforation. In terms of the prevalence of H.pylori infection, the prevalence in the non-perforated group was 45.2% and in the perforated group it was 30.4%. The previous history of PUD was 56.3% in the non-perforated group and 37.8% in the group with perforation.
Conclusion: There was a significant difference between cigarette and opium consumption in the perforated and non-perforated groups, and PPI consumption in these two groups. In general, the prevalence of PUD was higher in males in both perforated and non-perforated types. Fuzzy results also confirmed the effect of risk factors concordance with perforation.

Frequency of causes of otalgia in patients referred to the ENT clinic: a brief report

Ayeh Shamsadini

Background: Otalgia is defined as pain localizing in the ear that can be primary or referred. By careful history and physical examination, all causes in this extensive differential diagnosis can be excluded. Given that otalgia is one of the most common causes for patients to visit the clinic and has a wide variety of differential diagnosis, the purpose of this study is to investigate the frequency of different etiologies of ear pain in patients referred to referral clinic.
Methods: This cross-sectional study was performed on patients presenting with otalgia. After entering the study, the patient underwent a thorough examination of the ear, nose, throat, head and neck, teeth and salivary glands by a resident under the supervision of a senior otologist, and based on the findings, relevant para clinical procedures such as x-ray, CT scan or stroboscopy were performed. Data collection was done based on a data log check list. Samples were collected during six months. SPSS software version 20 was used for analyses.

Results: The most common causes of otalgia were acute otitis media 29%, external otitis 17% and chronic otitis media 15%. Cerumen and referral ear pain were next in line (13.5%). There was significant relationship between otalgia with age groups (The age between 13 and 30 years were the most referred due to otalgia). There was no significant relationship between otalgia and gender, underlying disease, economic status, smoking and opium use.

Conclusion: Given that otalgia is a common complaint in patients referred to the clinic, knowing its causes and origin is useful in diagnosing, proper treating it and avoiding unnecessary para clinical procedures and empirical treatment. The most common causes of otalgia in this study were acute otitis media, otitis externa and chronic otitis media, respectively. Referral otalgia and cerumen impaction were the next causes. Among the age groups, the age between 13 and 30 years were the most referred due to otalgia, but there was no significant relationship with any of the variables of gender, economic status and smoking and opium use.

Spontaneous rupture of splenic artery aneurysm in a pregnant woman: a case report

Seyed Hassan Seyed Sharifi

Background: Splenic artery aneurysm is seen in less than 0.1% of the population. Aneurysm of the splenic artery is more common in pregnant women. One of the life-threatening complications of splenic artery aneurysm is the spontaneous rupture of the aneurysm, which causes hemorrhagic shock. This complication is more common in pregnant women than other people in the society and has more mortality and morbidity. In this study, a pregnant patient with spontaneous rupture of splenic artery aneurysm is reported.

Case Presentation: The patient is an 18-year-old woman, 20 weeks pregnant, who came to the Emergency department of Bentolhoda Hospital in Bojnurd with diffuse sudden onset of abdominal pain in the September of 2023. On examination, the patient's vital signs were unstable, which was due to the presence of hemorrhagic shock. In the examination of the patient's abdomen, or generalized tenderness and rebound tenderness? was evident, suggesting peritonitis. According to the ultrasound report, abundant free fluid and fluid containing blood was drained from the abdomen under ultrasound guidance. The patient underwent surgery with the diagnosis of hemorrhagic shock with a midline incision of the abdomen above and below the umbilicus. In the performed surgery, evidence of splenic artery aneurysm rupture was evident. For the patient, ligature and resection of splenic vessels (artery and vein) and splenectomy were performed. After surgery and stabilization of the patient's condition, fetal health ultrasound was performed, and the fetus had no heartbeat. Therefore, medical induction of abortion was performed, and after 48 hours, the fetus was completely expelled, and then mother was transferred to the ward. And four days after the surgery, she was discharged with general improvement. No remarkable adverse effects were observed after surgery.
Conclusion: One of the rare diseases is splenic artery aneurysm, which is difficult to diagnose due to its asymptomatic rupture and high mortality rate.

Actual and potential health benefactors: a letter to editor

Ali Asghar Khaleghi