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Recurrence and survival in early breast cancer subtypes
Ali Taghizadeh, Leila Pourali, Mona Joudi, Bahareh Makvandi , Elahe Hasanzadeh, Saeideh Ahmadi Simab , Golshid Nouri Hosseini , Mehrdad Gazanchian,
Volume 81, Issue 3 (June 2023)
Abstract
Background: Breast cancer is the most common type of cancer in many countries, accounting for over 18% of all cancers in females. There are more than one million new cases of breast cancer each year. Most women diagnosed with breast cancer are over the age of 50, but younger women can also get breast cancer. About one in seven women are diagnosed with breast cancer during their lifetime. There's a good chance of recovery if it's detected at an early stage. In Iran, breast cancer is the most common cancer among women, making up 21.4% of all female cancers. The mortality rate of this cancer is 4.33 for every 100,000 people. The purpose of this research is to see how often different kinds of early breast cancer come back and how long people live after being diagnosed.
Methods: This retrospective study evaluated the medical records of 500 breast cancer patients at two hospitals in Mashhad, Iran during April 2006 to March 2016. We used SPSS software, version 16 (SPSS Inc., Chicago, IL, USA) to analyze data. A P value less than 0.05 means that the results are considered statistically significant.
Results: We included 230 women with breast cancer. The average overall survival was 130.7 months, with 83.2% of people surviving for five years and 78.8% surviving for 10 years. The stage of the disease is strongly linked to the recurrence (P=0.000). Additionally, the specific type of disease is also strongly related to disease recurrence (P=0.01) or metastasis (P=0.01). Patients who have the triple-negative subtype had the highest chance of the cancer spreading and recurrence compared to patients with other subtypes.
Conclusion: The different types of breast cancer are strongly linked to the disease recurrence or metastasis. Patients with triple-negative subtypes had the most cases of cancer spreading to other parts of the body and coming back again, compared to other subtypes. Our findings also showed that patients with the triple-negative disease had the worst overall and disease-free survivals.

Oxytocin plus foley catheter versus misoprostol plus foley catheter on cervical preparation in prolonged pregnancies
Masoume Mirteimouri, Seyyedeh Azam Poorhosseini , Maliheh Rakhshanifar, Seyede Houra Mousavi Vahed , Fedyeh Haghollahi,
Volume 81, Issue 3 (June 2023)
Abstract
Background: The success of labor induction depends on the condition of the cervix at the time of delivery. This study examines the effect of labor induction with an intra-cervical Foley catheter and oxytocin compared to a Foley catheter and misoprostol on cervical preparation and delivery rate in the first 24 hours after induction.
Methods: In a randomized clinical study, pregnant women with a singleton pregnancy and a gestational age of more than 40 weeks, with a Bishop score less than 4 and an intact amniotic sac referred to Umm al-Binin Hospital in Mashhad from 2017 to 2018 were included in the study. They were randomly divided into two groups of Foley catheter and oxytocin (1) or Foley catheter and misoprostol (2). In the first group, immediately after placing the Foley catheter; Oxytocin was started with a dose of 2 milliunits per minute, and every 20 minutes, 2 milliunits were added to reach the maximum dose of 30 milliunits per minute (induction method with a low dose). In the second group, after Foley catheter insertion, sublingual misoprostol was prescribed at a dose of 25 micrograms every 4 hours up to a maximum of 6 doses.
Results: 74 pregnant women were randomly evaluated in two groups of 37 people. There is no statistically significant difference in the demographic variables in the two groups. There was a significant difference in the labor rate in the first 24 hours, and it was higher in the oxytocin group (P=0.009). Bishop's score after 24 hours of induction was not significantly different in the two groups. Reaching the active phase was significantly shorter in the oxytocin group. (P=0.01). The time of catheter removal in both groups and the rate of cesarean section and the occurrence of complications were the same in both groups.
Conclusion: The use of oxytocin with a Foley catheter inside the cervix can accelerate the preparation of the cervix and increase the chance of labor in the first 24 hours, but it does not affect labor complications.

Epidemiological investigation and clinical findings of various types of vasculitis in children of eastern Iran
Abdolreza Malek, Mahdieh Vahedi, Nafiseh Pourbadakhshan,
Volume 81, Issue 4 (July 2023)
Abstract
Background: Vasculitis is a heterogeneous group of diseases that means an inflammatory process in blood vessels. Diagnosing vasculitis in children is challenging due to the variety of symptoms. Classification of childhood vasculitis is usually based on clinical phenotypes, size of affected vessels (small, medium, or large), and pathology of inflammatory infiltrates. The aim of this study is to investigate the epidemiological information on types of vasculitis and their clinical symptoms in children in eastern Iran.
Methods: This 3-year descriptive cross-sectional study was performed on all male and female patients with any vasculitis referred to the outpatient clinic and rheumatology department of Akbar Children's Hospital from the beginning of September 2017 to the end of September 2020. Has been. This study was based on information obtained from the checklist (information from the inpatient and outpatient records and information in the HIS). Checklist information included age, gender, drug history, history of surgery, clinical symptoms in different systems, season of disease onset, etc.
Results: Out of 263 children, 135 (51.33%) had Henoch-Schonlein and 100 (38/02%) of them had Kawasaki. The numbers of Behcet, Takayasu and Churg-Strauss patients were 20, three and two, respectively. In most subgroups, female patients were more common than male patients. Kawasaki and Takayasu had the lowest and highest age of onset, respectively. The most common seasons of appearance for Henoch-Schonlein and Kawasaki were autumn and summer respectively. In most subgroups, skin rashes are the most common clinical symptom, with, the most common types being petechiae and purpura.
Conclusion: In the present study, the most common type of vasculitis diagnosed in children in eastern Iran was reported by Henoch-Schonlein and Kawasaki respectively, which was completely different from the most common types of vasculitis in adulthood and indicated the importance of age in diagnosing the type of vasculitis. The necessity of clinical suspicion of these two diseases in children with skin rashes, along with matching with other clinical findings, is undeniable.

Biomarker role of CH25H and GYPE genes in osteoarthritis and rheumatoid arthritis
Akram Gholipour, Mahshid Malakootian , Maziar Oveisee,
Volume 81, Issue 4 (July 2023)
Abstract
Background: Osteoarthritis (OA) and rheumatoid arthritis (RA) are both joint diseases with many different causes. Inflammatory arthritis, also known as rheumatoid arthritis, is one of the most complex types of arthritis. Non-inflammatory arthritis, also known as osteoarthritis, is a disease caused when the cartilage between the joints begins to be damaged. Considering the different treatment approaches for OA and RA, an accurate diagnosis of the type of arthritis is very important. The present study was conducted with the aim of finding gene expression and introducing reliable molecular biomarkers for RA and OA.
Methods: The microarray dataset was obtained under the GSE27390 number. The samples included nine samples of mononuclear cells obtained from the bone marrow of RA patients, 10 samples of mononuclear cells obtained from the bone marrow of OA patients. Differential expression analysis between the OA and RA groups was performed using GEO2R, and genes with differential expression were separated by examining two factors such as logFC#1 and p.adj. Value<0.05. Signaling pathways were determined using Enrichr databases. Next, the genes with the most expression changes were introduced. This study is a bioinformatics analysis and was conducted jointly at Bam University of Medical Sciences and Rajaie Cardiovascular, Medical and Research Institute from September 2022 to March 2023.
Results: The results showed that, 5083 genes had significant expression differences. Analysis of signaling pathways showed that antigen processing and presentation,  natural killer cell-mediated cytotoxicity, the, IL-17 signaling pathway, Th17 cell differentiation and cytokine-cytokine receptor interaction, as inflammatory pathways, were important in this disease. It was also determined that CH25H (upregulated in RA samples) and GYPE (downregulated in RA samples) genes can distinguish rheumatoid arthritis from osteoarthritis.
Conclusion: Since accurate diagnosis helps with better disease treatment, it is very important to obtain new biological diagnostic markers. Overall, our data showed that genes can act as novel biomarkers with potential utility in the diagnosis of RA and OA and can be considered novel molecular biomarkers for the diagnosis of these two diseases.

Retinoblastoma treatment over time: a review article
Hassan Asadigandomani, Seyed Mohsen Rafizadeh, Elias Khalili Pour , Babak Masoomian,
Volume 81, Issue 4 (July 2023)
Abstract
Retinoblastoma is the most common primary malignant ocular malignancy in children. The management and treatment of retinoblastoma is a very complex process and requires attention to different aspects, such as the stage of the disease based on the International classification of retinoblastoma (ICRB) or International intraocular retinoblastoma classification (IIRC), the genetic status of the tumor and mutations, psycho-social factors of the family and society, cultural beliefs, and available economic resources. From the identification of this malignancy until the beginning of the 20th century (before the introduction of radiation therapy as one of the treatment options), enucleation was the only treatment option for this disease. In addition to not controlling metastatic and extensive features of the disease and increasing the chance of death in these cases, enucleation causes many adverse psychological and aesthetic complications in patients, and especially children, who are the main population affected by this disease. Tremendous progress has been made since the 20th century to identify and invent new methods to preserve the eyes and less invasive treatments (globe salvage treatments), and the set of efforts led to the inventing of new treatment methods such as radiation therapy, systemic chemotherapy, local treatments such as cryotherapy and thermotherapy, intra-arterial chemotherapy and intraocular chemotherapy. In summary, the set of treatments from the beginning until now has gone towards increasing survival, reducing the rate of enucleation and providing more targeted and less invasive treatments. Despite these advances, early diagnosis is the most important prerequisite for better outcomes. However, early detection is influenced by socioeconomic factors and is a major challenge, especially in low- and middle-income countries. In fact, the provision of advanced medical care in high-income areas has provided excellent survival, globe, and vision-saving rates. Unfortunately, these results do not hold true for medical systems in low- and middle-income areas, leading to poor patient outcomes. In this article, we briefly introduce various retinoblastoma treatment methods from the beginning of detection until now, and we assess the evolution of the treatment of this disease from the beginning until now, which has reduced the need for enucleation as a treatment for this disease.

Comparison of diagnostic value of ELISA tests with Brucella serological tests in patients with brucellosis
Hamidreza Ghasemi Basir , Mohammad Mahdi Majzoobi , Abbas Moradi, , Ali Saadatmand,
Volume 81, Issue 5 (August 2023)
Abstract
Background: Brucellosis is one of the most common infectious diseases transmitted from animal to human. Different methods of blood culture, serology, PCR and ELISA are used to diagnose brucellosis. The aim of this study was to compare the diagnostic value of ELISA tests with Brucella serological tests in patients with brucellosis.
Methods: In this cross-sectional descriptive study that was conducted from the beginning of April 2018 to the end of March 2019, 231 patients referred to the Infectious Diseases Clinic of Sina Hospital in Hamadan with clinical symptoms and possible diagnosis of brucellosis were included in the study. 5 cc of blood was taken from the patients to prepare serum, at the same time as Wright, Combs Wright and 2ME serology tests, IgG and IgM ELISA tests were also performed using the ELISA kit of Pishtaz Teb Company (Made in Iran), which is designed with the cut-off method. Then the test results were analyzed with SPSS software, version 16 (SPSS Inc., Chicago, IL, USA).
Results: 231 patients suspected of brucellosis including 147(63.64%) men and 84(36.36%) women with an average age of 44.60±16.16 years and a minimum of 10 years and a maximum of 80 years were examined. IgG and IgM results were positive with brucellosis in 80.1% and 30.30%, respectively. The results of IgG and IgM were positive in 1/80 and 30.30%, respectively, and they were diagnosed with brucellosis. In comparison with 2ME, Wright and Coombs-Wright serology tests, the sensitivity of IgG was between 83.80% and 94.28% and its specificity was between 20 and 33.34%, the sensitivity of IgM was also between 34.78 and 40.0% and its specificity was between 78.67% and 89.47% at different cut points.
Conclusion: Compared to diagnostic serological tests for brucellosis, IgG is more sensitive and IgM is more specific. If serological tests are not available, ELISA can be used to diagnose brucellosis. But because of their lower diagnostic value, they cannot be replaced.

Comparison of thyroid ultrasound results in the diagnosis of metastatic nodules from papillary thyroid cancer with postoperative pathology specimens
Azim Motamedfar , Mohammad Momen Gharibvand, Mohammadghasem Hanafi , Fatemeh Neghab,
Volume 81, Issue 5 (August 2023)
Abstract
Background: The aim of the present study is to determine the accuracy of ultrasound imaging in the diagnosis of metastatic lymph nodes compared to postoperative pathology samples of patients with papillary thyroid cancer.
Methods: This study was carried out using a descriptive and analytical epidemiological method on 103 known patients with papillary thyroid cancer who referred to Imam and Golestan hospitals in Ahvaz for neck ultrasound from September 2021 to August 2022. A total of 103 patients (including 94 women (91.3%) and 9 men (8.7%)) with papillary thyroid cancer with an average age of (39.8±11.9) were included in the study. The average tumor size in these patients was estimated to be (16.8±10mm). The ultrasound results of these patients before surgery were compared with the pathology results of these patients after surgery.
Results: According to the obtained results, metastatic involvement of cervical lymph nodes was diagnosed in 36.6% of patients (38 people). Of these, 30.7% of patients (32 people) were real positive. The results of ultrasound before surgery were shown as false positive in 9.5% of patients (6 people). Lymphatic metastasis was not seen in 58.4% of patients (60 people) before surgery, which was consistent with the pathology result after surgery (true negative). The positive predictive value of examining metastatic lymph nodes by ultrasound was estimated at 84.2% and the negative predictive value at 92.3%. The diagnostic accuracy of ultrasound was 89%, the sensitivity rate was 86%, and the specificity rate was 90% with the area under the curve AUC=0.884 and P<0.001. Ultrasound accuracy is not affected by tumor size, Hashimoto's thyroiditis and metastasis location (P<0.05). In patients with Hashimoto's thyroiditis, the tumor size increases significantly more than 10 mm.
Conclusion: Ultrasound alone has an acceptable diagnostic accuracy in detecting metastatic lymph nodes caused by papillary thyroid cancer. However, the incidence of false negative error increases as the tumor size decreases.

Evaluation of nodule incidence as findings of lung involvement in Covid-19 infection and its comparison in three CT scan centers of Shiraz
Razieh Behzadmehr, Ariana Rasekhi , Banafsheh Zeinali-Rafsanjani , Alireza Rasekhi,
Volume 81, Issue 5 (August 2023)
Abstract
Background: Several typical and atypical findings have been observed in Covid-19 high-resolution computer tomography (HRCT). To our knowledge, there is no study investigating the relationship between the presence of nodules in Covid-19 patients and the patient's condition. Therefore, the present study assessed the frequency of pulmonary nodules in Covid-19 patients according to their condition.
Methods: This cross-sectional study assessed the medical images of the patients referred to three university-affiliated centers (Nemazi, Ali Asghar and Shahid Faghihi Hospital) to perform Covid-19 HRCT from April to September 2020. The centers have been named H1, H2, and H3. Patients who were referred to these centers had good, poor, and fair conditions, respectively. The history of patients was assessed carefully. Patients' demographic information, nodule shape, number, size, location, presence of cavitation, and GGO around the nodule were assessed and recorded.
Results: Overall, 20576 patients (mean age=46.75±16.64 years old) were included in the study. Only 2.1% of cases had solid nodules. Most of them (96.76%) were accompanied by a GGO (halo sign), and only 10.42% were associated with a cavity. The good condition, patients showed significantly more solid nodules (3.46%) than others. In size of the nodules in good-condition patients (1.8 cm) is significantly larger than in fair-condition (1.22 cm) or poor condition patients (1.15 cm). 79.86%, 12.5%, and 7.64% of nodules were multiple, dual/triple, and single, respectively.
Conclusion: The frequency of nodules in the HRCTs of good-condition patients was significantly higher than in fair- or poor-conditionpatients; they also had more multiple and larger-sized nodules. The Pearson-coefficient test also revealed a small negative correlation between the presence of nodules and the patient's condition. It seems the presence of nodules indicates higher immunity to viral infections. In the follow-up, it was revealed that people who had nodules were not hospitalized in the ICU. Further study is needed to prove this point.

Response to treatment of osteoid osteoma after radio frequency ablation and a comparison between drilling and curettage techniques before radio frequency ablation
Alireza Rasekhi, Ali Vatankhah , Saeed Solouki-Mootab , Banafsheh Zeinali-Rafsanjani ,
Volume 81, Issue 5 (August 2023)
Abstract
Background: Osteoid osteoma is a painful benign osteoblastic lesion occurring mainly in the long bones. On the one hand, some studies have declared that post-treatment CT cannot determine the success or failure of radiofrequency ablation, on the other hand, some studies have stated that imaging follow-up can be helpful or even mandatory in some cases. The present study aims to evaluate Osteoid Osteoma's imaging features before or after radiofrequency ablation with or without curettage and during the follow-up period.
Methods: In this retrospective and cross-sectional study, we reviewed twenty seven Osteoid Osteoma patients with radiofrequency ablation who were assessed via drilling with or without curettage from March 2015 to December 2019 at Nemazi Hospital, Shiraz University of Medical Sciences.
Results: Radiofrequency ablation with drilling was used in 22(81.5%) patients, and for the rest 5(18.5%), radiofrequency ablation with curettage and drilling was performed as a treatment procedure. The overall clinical success rate was 92.6%(25/27), with a low complication rate (7.4%). The mean diameter of nidus in pre/pos treatment was 3.46±2.02 and 2.22±1.75 mm, respectively. Femur 12(44.4%) was the most common bone in the patients. Significant differences between pre/post treatment follow up examinations in nidus size (P=0.03), nidus diameter (P=0.02), bone and calcification size (P=0.005) were detected. Additionally, it depicts that the mean values of tumor size and cortical thickening decreased after treatment.
Conclusion: It is noteworthy that the present study had some limitations, including the small sample size and the relatively short follow-up period. There is no significant difference between radiofrequency ablation after drilling and curettage in treating Osteoid Osteoma. It is concluded that although there was a significant difference in pre/post-treatment imaging, there is no need for continuous imaging follow-up in treated patients without clinical complications such as pain to mitigate radiation dose risks and healthcare expenses.

History of heart transplantation: a letter to editor
Hossein Shahzadi,
Volume 81, Issue 5 (August 2023)
Abstract

Comparison of magnetic resonance imaging and CT scan in patients with complaints of mediastinal and chest wall mass
Mahdi Yadollahzadeh, Nader Rezaei , Mohsen Farrokhpour , Mehdi Azimi, Maedeh Barahman, Mohammad Bahadoram , Amirhossein Forouzanmehr , Seyed Ali Javad Mousavi ,
Volume 81, Issue 6 (September 2023)
Abstract
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.

Spontaneous rupture of splenic artery aneurysm in a pregnant woman: a case report
Mansoureh Baradaran, Mohammd Ashraf Azimi , Rasoul Nikdel, Seyed Hassan Seyed Sharifi ,
Volume 81, Issue 6 (September 2023)
Abstract
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.

An overview of future developments of exosomes in cell-free therapies: a review article
Seyed Khalil Pestehei, Mahdieh Ghiasi, Seyed-Hassan Emami-Razavi ,
Volume 81, Issue 7 (October 2023)
Abstract
Human mesenchymal stromal cells are multipotent cells capable of differentiating into the mesenchymal lineage that can be isolated from bone marrow and adipose tissue or from umbilical cord blood and fetal tissues. Among the widely characterized in vitro properties, MSCs show strong anti-proliferative and anti-inflammatory effects on immune responses Exosomes derived from mesenchymal stem cells derived from different tissues are promising cell-free treatments for tissue damage repair. Exosomes serve as a potential portal for cell-free drug delivery systems, as these drugs possess the properties of the parent cell from which they are derived. Extracellular vesicles (EVs) play key roles in cell biology and may provide new clinical diagnostics and therapies. Exosomes, called extracellular vesicles (EcVs), are present in almost all cells, tissues, and body fluids. They contribute to intercellular signaling and maintain tissue homeostasis. The biogenesis of exosomes starts in the endosomal system. Researchers have identified 9769 proteins, 2838 miRNAs, 3408 and 1116 lipids present in exosome of mRNA cargo. Isolation of exosomes from cells, tissues and body fluids follows a different pattern. Exosomes interact with receptor cells through their surface receptor molecules and ligands and are internalized into receptor cells through micropinocytosis and phagocytosis. This varies depending on the origin of the EV, its physiological and pathological state, and even the exact site of cellular release. The composition of the protein inside can also indicate the presence of disease pathologies such as cancer or inflammatory diseases; However, exosomes also contain a number of common proteins as well as proteins involved in vesicle formation. Advanced technologies in regenerative medicine have caused researchers to use exosomes isolated from mesenchymal stem cells (MSCs) with high regeneration ability in diseases. Exosome cargo plays a key role in diagnosis and treatment by controlling the disease process. Various studies in laboratory conditions have shown the effectiveness and therapeutic potential of exosomes in cancer, neurodegenerative, cardiovascular and orthopedic diseases. This article describes the therapeutic role and potential of exosomes derived from mesenchymal stem cells, as well as the necessary precautions for their processing.

Efficacy of filgrastim and Lenograstim drug treatment in patients with neutropenia: a systematic review
Sogol Shirzad, Zeinab Karimi, Mehdi Mohsen Zadeh , Masoud Mohammadi,
Volume 81, Issue 7 (October 2023)
Abstract
Background: Neutropenia refers to a decrease in the absolute number of neutrophils in the blood circulation, certain drugs are used in connection with the treatment of neutropenia. Therefore, the aim of this study is to investigate and compare the efficacy of filgrastim and lenograstim drug treatment in patients with neutropenia in a systematic review.
Methods: This study is a systematic review study conducted in connection with the comparison of the effectiveness of filgrastim and lenograstim in neutropenic patients based on the search in Google scholar, PubMed, ScienceDirect, Irandoc, SID, Magiran databases in the time range of January 2000 to August 2023. This systematic review was based on the criteria of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, including systematic search of databases, organization of documents for review, selection of studies, information extraction and finally presentation of the final report. The keywords used for searching in this study were selected based on published primary studies and MESH, and after a detailed examination of the study questions, they were selected according to the PECO criteria.
Results: 1099 articles were identified in the review of the investigated databases, and after removing duplicate articles, unrelated articles, as well as articles that did not have access to their full text or did not have the required information, eight studies were the final phase, and were checked. Out of the eight selected articles, three articles declared the effectiveness of lenograstim more than filgrastim. Two articles mentioned the greater effect of filgrastim and three articles published in recent years declared the effect of two drugs to be the same. Among these articles, the studies that considered the drug dosage to be the same in the investigated groups and the studies that had a larger statistical population in order to generalize to the society are more important.
Conclusion: According to studies conducted in recent years, both filgrastim and lenograstim recombinant drugs have the same effectiveness in the treatment of neutropenia.

Comparison of the results of different types of vascular repair methods in penetrating trauma of the forearm
Shima Kashani, Seyed Masoud Moosavi , Iraj Nazari , Hossein Minaei,
Volume 81, Issue 7 (October 2023)
Abstract
Background: Vascular traumas are among the important traumas, most of which lead to significant complications due to the lack of correct and timely diagnosis, considering the frequency of penetrating vascular injuries, especially in our country and Khuzestan province, as well as the complications and mortality caused by injuries. This study was designed to investigate the effect of vascular surgery intervention on patients with arterial injury of forearm trauma.
Methods: In this descriptive-analytical study, all trauma patients suspected of penetrating forearm arterial injuries in terms of age, sex, type of trauma, location of trauma, type of intervention, location of arterial repair, angiographic and clinical findings including damaged arteries, type of injury Arterial fracture or dislocation. The proximity of vascular damage and the complications of surgical interventions are investigated.
Results: The results of this study showed that among the penetrating trauma patients requiring surgical intervention, 90.4% were men and only 6.9% were women. The average age of the patients was 32 years. The most frequent trauma requiring surgical intervention in this study was primary repair of a stab wound in the ulnar artery and the least was due to explosive. According to the obtained results, there was a statistically significant relationship between the amount of bleeding, the days of hospitalization and the duration of the operation with the type of trauma. The most damaged artery was ulnar artery 7.50% and the most type of arterial damage was arterial cut with active bleeding (7.39%).
Conclusion: According to the results of the present study, the most damage was in the ulnar artery caused by trauma with sharp objects (knives). The incidence of complications in primary repair surgery was higher than other types of surgical interventions, and there was a statistically significant relationship between the amount of bleeding, days of hospitalization, and duration of surgery with the type of trauma.

Two asthma control test for children and asthma control questionnaire in pediatric asthma patients referred to taleghani hospial clinics, Gorgan
Mohsen Ebrahimi, Zahra Valipour Moghadam , Seyed Ali Aghapour, Azam Rashidbaghan,
Volume 81, Issue 7 (October 2023)
Abstract
Background: Asthma is a chronic inflammatory disease of the airways. Various tests and questionnaires are designed to monitor the severity of asthma and help the therapist and the health system prescribe the best treatment to control it. This study was designed to compare two methods Asthma Control Questionnaires (ACQ) and Asthma Control test-child (ACT-CHILD) in children with asthma.
Methods: This descriptive cross-sectional study was conducted on 92 children with asthma referred to the Taleghani hospital, Gorgan, in 2022-2023. Patients were in a range of age 4-16 years. Asthma control was evaluated and compared by two methods ACT-CHILD and ACQ. ACT-CHILD included one version for 4-11-year patients completed by their parents and another one for 12-16 –year patients completed by the patients. The clinical symptoms, age, gender and the parents' records related to asthma were completed during the clinical interview. Data was analyzed using Chi-square and Spearman correlation tests. The degree of agreement between two questionnaires was determined using the Kappa coefficient.
Results: 84 children aged 4-11 years (91.3%) and 8 children aged 12-16 years (8.7%) were included in the study. According to the ACT-CHILD, 40.2% of children (n=37) had controlled asthma, 44.6% (n=41) had partially controlled asthma, and 15.2% (n=14) had uncontrolled asthma. Based on the ACQ, controlled asthma was observed in 18.5% (n=17), partially controlled asthma in 35.8% (n=33), and uncontrolled asthma in 45.7% (n=42) of children. Asthma control results based on two questionnaires were significantly different from each other (P<0.001). The agreement between the ACT-CHILD and ACQ methods in evaluating children's asthma was at a weak level (P=0.014, κ=0.157), however, a significant negative correlation was observed between the scores of the ACT-CHILD and ACQ questionnaires (r=-0.588, P>0.001) which after categorizing based on age group, this correlation was confirmed only in children aged 4-11 years (r=-0.627, P>0.001).
Conclusion: Our findings showed that there is a poor agreement between ACT-CHILD and ACQ results in the assessment of asthma control. Further studies are recommended.

Evaluating the efficacy of noninvasive ventilation (NIV) in the treatment of acute respiratory failure (an experience from the Covid-19 pandemic)
Nazli Farnoosh, Shahram Seyfi, Khadijeh Ezoji, Asadollah Shakeri, Kayvan Latifi, Parviz Amri Male ,
Volume 81, Issue 8 (November 2023)
Abstract
Background: Noninvasive ventilation (NIV) has been used as one of the most promising methods to treat hypoxic respiratory failure in COVID-19.
Methods: In this study, the clinical outcomes of 80 patients with acute respiratory failure caused by COVID-19 were evaluated. The disease was confirmed in two methods: clinical and radiographic confirmation of disease in patients with an acute respiratory infection (highly suspected) or in some cases with a positive PCR test. The rate of discharge from the ICU without the need for intubation was evaluated as the primary outcome and based on that, the patients were divided into two groups: NIV failure and NIV success. Mortality rate, length of stay in ICU, frequency of intubated patients and laboratory factors of patients as secondary outcomes in two groups were compared.
Results: Regarding the outcome of death and discharge, there was a statistically significant difference between the two groups. Therefore, all patients with corona who were admitted to ICU and received NIV and were intubated due to non-responsiveness to NIV died and the patients were discharged from the hospital without intubation. All the patients investigated in this study, had received antiviral, antibiotic, and glucocorticoid treatment during hospitalization. In this study, the patients who were in the NIV success group and were not intubated had a lower mean age compared to the group without NIV success (54 vs. 67 years, respectively). The number of white blood cells in the NIV success group was 3945.28±10011.21 and in the group without NIV success was 9242.38±17296.16, which was statistically significant (P=0.004). The number of blood neutrophils in the successful and unsuccessful NIV groups was 12.19±83.04 and 4.31±89.49, respectively (P=0.034). The mean APACHEII score in patients in the NIV success group (11.07±5.05) was significantly lower than the group without NIV success (20.16±4.96).
Conclusion: Mortality was higher in the intubated group than in the NIV group. The combination of APACHEII score and respiratory rate one hour after receiving NIV can predict success with NIV.

Cost-effectiveness analysis of colonoscopy compared to sigmoidoscopy for colorectal cancer screening in high-risk individuals in Iran
Ahmad Tahmasebi-Ghorrabi , Zahra Heydarifard, Behrouz Nemati, Majid Davari, Alireza Delavari, Hamideh Salimzadeh , Ali Akbari Sari ,
Volume 81, Issue 9 (December 2023)
Abstract
Background: Screening is a cost-effective method for prevention, early detection of the disease and reducing the burden of the third deadliest cancer in the world, i.e. colorectal cancer. This study aimed to analyze the cost-effectiveness of colonoscopy screening compared to sigmoidoscopy for colorectal cancer in high-risk individuals in Iran.
Methods: This economic evaluation study was conducted using the cost-effectiveness method between July 2016 and February 2017. Evaluation of the effectiveness of screening methods was done using a systematic review. Cost evaluation was also done using the costs obtained from the tariff approved by the Iranian Ministry of Health in 2015 for colonoscopy and sigmoidoscopy. Finally, the combined model of decision tree and Markov was used to evaluate the cost effectiveness. Incremental Cost Effectiveness Ratio (ICER) formula was used for cost effectiveness analysis considering the final outcome of 5-year survival of high-risk individuals. Excel and TreeAge software were used for data analysis.
Results: The effectiveness of sigmoidoscopy and colonoscopy in increasing 5-year survival is 11 and 15.7%, respectively, and colonoscopy screening is 4.7% more than sigmoidoscopy. The cost of colonoscopy and sigmoidoscopy screening was calculated as 1000 and 19920 billion Rials, respectively. Based on cost-effectiveness analysis, the cost of treating patients in the case of screening with colonoscopy and sigmoidoscopy is lower than without screening. The ICER ratio of colonoscopy and sigmoidoscopy compared to no screening was -4/441/389/160 and -4/757/954/940 Rials respectively, and colonoscopy compared to sigmoidoscopy was -3/699/785/880 Rials, respectively. Finally, the use of colonoscopy leads to spending 3/699/785/880 Rials less in exchange for obtaining 4722 additional survivals with the prevention of colorectal cancer compared to sigmoidoscopy.
Conclusion: Screening by colonoscopy and sigmoidoscopy methods are effective in reducing the incidence and death of colorectal cancer compared to no screening. Screening by colonoscopy is a dominant option for the high-risk population in Iran. Colonoscopy screening is more cost effective compared to sigmoidoscopy. However, decisions about colorectal cancer screening and screening methods depend on local resources and personal preferences.

Determining the prevalence of positive cases of IgM and IgG antibodies against Cytomegaloviruses in Shahid Motahari clinic in Shiraz during the years 2019 to 2023
Navid Omidifar, Reza Masoumzadeh , Mansoureh Shokripour, Yousef Nikmanesh,
Volume 81, Issue 9 (December 2023)
Abstract
Background: Cytomegalovirus (CMV) stands out as a significant contributor to congenital viral infections, exhibiting a prevalence ranging from 40% to 90%. Cytomegalovirus has different effects on people, such that it appears without symptoms in people with a healthy immune system, but it leads to severe symptoms in infants and those with a weak immune system. To comprehend the disease's societal prevalence, seroepidemiological investigations are imperative. This study aims to ascertain the serum prevalence of cytomegalovirus and explore potential correlations between age, sex, and the prevalence of CMV in patients attending Shahid Motahari Clinic in Shiraz
Methods: A cross-sectional descriptive study was undertaken on 2,469 individuals who assessed their cytomegalovirus antibody levels between March 2019 and February 2023 at Shahid Motahari clinic in Shiraz. The ELISA method was employed to evaluate CMV, and the obtained data were analyzed using SPSS version 19 software. Chi-square tests and Fisher's exact test were applied to examine the correlation between positive antibody results and age as well as gender.
Results: Among the 2469 surveyed people, 658 people (26.65%) were men and 1811 people (73.35%) were women. Based on ELISA test, antibody titer was reported positive in 1157 people (46.9%), including 315 men and 842 women, and 1312 people (53.1%) had negative antibody titer. The highest number of positives is related to IgG, and in IgM, the test results are mostly negative. IgM prevalence showed no gender correlation but demonstrated a significant association with patient age. Meanwhile, IgG prevalence exhibited significant relationships with both age and gender
Conclusion: Considering that the city of Shiraz is considered as one of the centers of treatment in the country and a large number of patients from all parts of the country and even neighboring countries come to this city for treatment and especially for the purpose of organ transplantation; also with Considering the 46.9% prevalence of CMV infection in the region, it is recommended to use preventive methods such as vaccine and immunotherapy against CMV infection in patients

Determining the relationship between evidence-based medicine with academic self-efficacy and research self-efficacy in medical students
Arghavan Afra, Pouriya Nafari, Masoud Foroutan, Mahboobeh Momtazan , Naser Kamyari,
Volume 81, Issue 9 (December 2023)
Abstract
Background: Correct clinical decision-making has a significant impact on the treatment process, achieving the expected clinical outcome and increasing patient satisfaction, and identifying the factors affecting it is essential for evidence-based medical education. This study aimed to determine the relationship between evidence-based medicine with academic self-efficacy and research self-efficacy of medical students.
Methods: This descriptive analytical study conducted from October 2022 to October 2023 on 45 medical students at Abadan University of Medical Sciences. After obtaining consent from the students and registering demographic and educational information, data collection was performed using evidence-based medicine, academic self-efficacy, and research self-efficacy questionnaires. Then data analyzed by descriptive statistics, Pearson correlation coefficient, Spearman correlation coefficient, and regression model in SPSS.
Results: The findings of our study showed that research self-efficacy in students who had research experience (189.03) was significantly higher than students who did not have research experience (140.76).  In addition, the average score of academic and research self-efficacy and evidence-based medicine in students who had a history of membership in the student research committee was significantly higher than students who did not have a history of membership. Finally, it was found that evidence-based medicine had a direct and significant relationship with research self-efficacy (r=0.361, P<0.05) and academic self-efficacy (r=0.457, P<0.001). In examining the relationship between academic self-efficacy and research self-efficacy, it was also found that these two variables have a direct and significant relationship with each other (r=0.714, P<0.001). As well as, there was no significant relationship between academic self-efficacy, research self-efficacy, and understanding the characteristics of evidence-based practice with any of the variables of age, gender and entry year (P>0.05).
Conclusion:  According to the obtained results, it can be concluded that academic self-efficacy and research self-efficacy have an effect on evidence-based medicine, and all of the above can be improved by teaching  medical students to participate in student research committees and doing research work. In this way, it improves the quality of treatment in doctors.

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