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Showing 112 results for Type of Study: Review Article
Skin metastases in breast cancer: a review article
Behnaz Varaminian, Marzieh Ghalamkari , Tayeb Ramim, Masoumeh Roohaninasab ,
Volume 80, Issue 8 (11-2022)
Abstract
Skin metastases from breast cancer usually occur in more advanced stages of the disease, but can sometimes be the first clinical manifestation of breast cancer or the first evidence of a previous tumor recurrence. These demonstrations significantly reduce survival. Skin metastases from breast cancer have different manifestations. The most common manifestations are nodules. These nodules are soft, round or oval, mobile, firm, and elastic in texture and can be single or multiple, often flesh-colored, but can also be brown, bluish black, and pink to reddish brown. In the absence of a previous history of cancer, it can be difficult to diagnose the early location of metastatic cancers. However, metastases usually show histopathological similarities to the primary tumor. Soft tissue breast metastases usually have a better prognosis than breast or bone cancer metastases. Also, skin metastases from breast cancer do not necessarily have a poor prognosis as skin metastases from other malignancies. The relative risk of death from skin metastases to other malignancies is more than four times higher than skin metastases from breast cancer. Differential diagnosis includes cutaneous lymphoma, intracranial leukocyte infiltration, and cutaneous metastasis. Metastatic skin lesions are often mistaken for benign lesions. Recognizing them quickly is important to prevent long-term anti-inflammatory treatment that delays proper diagnosis. Therefore, to rule out metastasis, abnormal or nodular lesions should be considered for biopsy in patients with a history of systemic malignancy or suspected malignancy. Cutaneous metastases are usually a sign of widespread disease and may not be treatable in most cases. Treatment options include systemic and/or topical treatments. Extensive skin metastases require systemic treatment. For thicker skin metastases, radiation therapy, surgical or electrochemical resection is indicated as monotherapy or in combination. Oxygen in combination with topical 5% methotrexate (OFAMTX, 5% methotrexate in a carrier solution) is a recently described method that facilitates drug penetration into the epidermis. In the absence of visceral or lymph node metastases, OFAMTX is useful as a local skin treatment. This treatment is an effective and tolerable method for superficial skin metastases. Using local treatment in combination with systemic agents increases the overall effectiveness of treatment on skin metastases.

Prevalence and risk factors of intestinal metaplasia in patients with dyspepsia
Mehdi Ghobakhlou, Hamidreza Ghasemi Basir , Ahmad Jahdari , Elnaz Ataei, Ali Saadatmand,
Volume 80, Issue 9 (12-2022)
Abstract
Background: Intestinal metaplasia in the stomach is one of the precancerous lesions of gastric tissue. If the lesions are diagnosed early before invasive cancer develops, it is possible to prevent the progression to malignant lesions. Therefore, this study was performed to evaluate the prevalence and risk factors of intestinal metaplasia in patients with dyspepsia.
Methods: This descriptive cross-sectional study was performed on patients who were referred to Shahid Beheshti Hospital in Hamadan, Iran from the beginning of 2019 to the end of 2020. A total of 250 patients over 16 years of age who complained of dyspepsia for at least more than three months were included in the study. Examination was performed for patients along with the completion of a pre-designed questionnaire including demographic information and metaplasia risk factors. Also, endoscopy and biopsy specimen of gastric mucosa were performed for histological examination. Finally, the data were analyzed using SPSS software version 16 with related statistical tests.
Results:  There was no significant relationship between job type, level of education, marital status and family history of gastric cancer, smoking, alcohol, high salt, dairy products and high-nitrate diet with the disease. There was a significant relationship between body mass index and the presence of intestinal metaplasia in men (P=0.032). The average age of men with metaplasia was about 13 years older than those without the disease. Also gastric ulcer (84%) and pan gastritis (40.4%) were the most common cases in endoscopic results. The number of female patients with epigastric pain was about 14% higher than male patients. Gastric ulcer was significantly associated with gender, with about 12% more gastric ulcers observed in men than women (P=0.014). Also, no significant relationship was observed between the presence of Helicobacter pylori and the severity of its colonization with intestinal metaplasia. (P=0.230)
Conclusion: In this study, no significant relationship was observed between the presence of Helicobacter pylori and the severity of its colonization simultaneously with intestinal metaplasia. Apart from the two factors of increasing age and type of sex, no serious risk factors for intestinal metaplasia were seen.

The effect of neonatal bloodletting in the treatment of neonatal jaundice: a review article
Reza Saeidi, Ali Saeidi, Azri Izanloo, Mehdi Hosseini,
Volume 80, Issue 9 (12-2022)
Abstract
Neonatal hyperbilirubinemia occurs in 60-80% newborns in the first few days of birth, in most cases, jaundice is physiologic and usually improves without treatment. Bloodletting is the withdrawal of blood from a patient to prevent or cure illness and disease. Recently the Bloodletting is one of the common treatments for neonatal jaundice. In this review study, we have evaluated medical articles and narrative books (hadiths) for the application of this method in neonatal jaundice. In this systematic review we evaluated PubMed databases, Cochrane, Google Scholar, collaboration library, SID, Magiran, and narrative books (hadiths) with the subject of cupping and Bloodletting were included in the study 1983 and September 2019. In this study, all of articles with the title “Bloodletting“, "cupping" and “Wet cupping”, “Dry cupping”, “Air trapping”, “Scarification”, “Hejamat”, “ear cupping” and the abstracts of the articles presented in the conferences were studied. Then, in the evaluation stage of the articles, all the studies unrelated to the issue were excluded from the research. Also, in this study, all Shia and Sunni hadith sources and the Holy Qur'an were evaluated. The evaluation of hadiths was carried out by Jama Al-Ahadith software, which is a collection of Shia and Sunni hadith books. We assessed 1120 articles related to Bloodletting, none of which were related to neonatal jaundice and Bloodletting. Cupping is a therapeutic method that dates back thousands of years. Bloodletting by scarification was an accepted practice in Ancient Egypt. In Greece, bloodletting was in use in the 5th century BC. "Bleeding" a patient to health was modeled on the process of menstruation. During the Roman Empire, the Greek physician Galen, who subscribed to the teachings of Hippocrates, advocated physician-initiated bloodletting. The popularity of bloodletting was reinforced by the ideas of Galen. In our study in Shiite and Sunni narrations, only two narrations recommended infant Bloodletting after four months just for prevention. According to our finding there is no article or narration that recommended Bloodletting for neonatal jaundice.

Influencing factors in the comparison of renal stone size measurements between CT scan and ultrasound
Mohammad Reza Sasani , Leila Fazlollahpour , Mahdi Saeedi-Moghadam ,
Volume 81, Issue 5 (8-2023)
Abstract
Background: Ultrasound is widely used to detect renal stones. A no-contrast CT scan is the most accurate modality for stone examination. Considering that determining the size of a stone is the main criterion in treatment planning, the purpose of this study was to compare ultrasound and non-contrast CT scans in determining renal stone size.
Methods: In this cross-sectional study, 140 patients were assessed from June to October 2017 at Namazi Hospital of Shiraz University of Medical Sciences. A radiologist compared the CT scans of patients with their ultrasound images. The ultrasound and CT scan results in terms of stone size were assessed. The correlation rate of stone size in ultrasound and CT scans in different subgroups was assessed by categorizing the stone size into three subgroups. The impact of stone location and the CT window on measuring stone size were evaluated.
Results: The mean stone size measured by ultrasound and CT scan was 11.23±5.26 and 9.48±4.7mm, respectively, which was significantly different. The highest rate of correlation was observed in the stones>10mm (81%) and then in 5-10mm (69.3%). The lowest agreement was observed in stones <5mm (37.5%).
Conclusion: Using ultrasonography as a screening test or a primary test for detecting the renal stones is recommended. However, considering the importance of a precise assessment of stone size in choosing the treatment method and the limitations of sonography in the evaluation of small stones, a CT scan should be considered as a standard diagnostic tool if there is no contraindication. In CT images, the application of BW might underestimate the stone size in comparison to SW. Considering the results of previous studies, it is better to use magnified BW to assess the stone size on CT scan images. Although the axial view in a CT scan is more routine, for measuring the stone size it is better to use coronal or sagittal views together with axial views.

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 (8-2023)
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 (8-2023)
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.

Investigating of the time and rate of occurrence of hematoma after angiography and its related factors in Mazandaran heart center
Samad Golshani, Zahra Azizi, Aliasghar Farsavian, Abbas Alipour,
Volume 81, Issue 5 (8-2023)
Abstract
Background: Coronary angiography is an elective method to confirm or rule out coronary artery disease and to decide on the treatment plan but it is an invasive method and it has some complications. The most important and common complication was hematoma. It could be the cause of mortality and morbidity. The present study was conducted with the aim of investigating the time of hematoma occurrence after angioplasty and investigating the effect of various factors (for example age, sex, BMI, BP, hematocrit, anticoagulant agent, etc.) on the occurrence of hematoma.
Methods: This was a prospective cohort study from March 2022 to March 2023 in Mazandaran heart center. The study population was patients who underwent angioplasty through the femoral artery. If the ACT is less than 150-180, sheet removal was done by applying pressure with the hand on the proximal puncture site for 15-20 minutes and ensuring sufficient hemostasis. Then, the ultrasound of the puncture site was performed before pulling the sheet/one hour and six hours after pulling the sheet, and after collecting the data, the data were analyzed to study the effect of BMI, BP, sex, hematocrit, hemoglobin, age, time of sheet removal, anticoagulant agent, etc. on prevalence of hematoma and it size.
Results: 200 patients were examined, of which 44(22%) had hematoma. Women had hematoma more than men (P<0.05). BMI and blood pressure in patients with hematoma decreased and increased, respectively (P<0.05). Older age, female gender, lower hematocrit, and longer duration of sheet retention were effective factors in increasing hematoma size (P<0.05). In the logistic regression model, with increasing BMI, the chance of hematoma occurrence decreased (P=0.029, OR=0.831).
Conclusion: Controlling blood pressure and preventing of decreasing the hematocrit, reduces the incidence of hematoma in patients after angiography. Also, preventing hematocrit drop and removal of sheet at the appropriate time, can prevent of increasing in size of hematoma. There is some difference between nursing report and sonography finding. Nursing report overestimated the hematoma size.

Effect of cell therapy compared to renin-angiotensin-aldosterone system blocking agent in chronic kidney disease in cat-animal model
Nahid Askari, Ali Ali Shafieipour , Soudeh Khanamani Falahati-Pour,
Volume 81, Issue 5 (8-2023)
Abstract
Background: Mesenchymal stem cell (MSC) transplantation is a promising therapy for kidney repair. This study compared the regenerative effects of feline MSCs (fMSCs) and telmisartan, a renin-angiotensin blocker (RAB), in a feline model of chronic kidney disease (CKD).
Methods: The fMSCs were obtained from 35 Persian cats with CKD and characterized by CD44, CD90, and CD105 markers by using real-time RT-qPCR. The cats were randomly allocated to four groups, fMSCs injection (first group), telmisartan administration (second group), no treatment (third group), and healthy controls (fourth group). The study was conducted in Kerman province from December 2018 to December 2019. The factors that may affect the risk of CKD, such as age, weight, and history of kidney diseases, were considered as independent variables. The presence or absence of CKD was the dependent variable. The cats were followed up for 120 days and evaluated by physical examination, glomerular filtration rate (GFR), blood urea nitrogen (BUN), serum creatinine (SCr), serum urea, alanine transaminase (ALT), urine specific gravity (SG), and kidney histopathology. Statistical analysis was performed using SPSS software (version 20) with two-way ANOVA and Tukey test. P<0.05 was considered statistically significant.
Results: The fMSCs group showed significant improvement in GFR, BUN, SCr, serum urea, SG, and kidney histology compared to the other groups. The fMSCs group also showed increased expression of CD44, CD90, and CD105 genes in the kidney tissue, indicating enhanced stem cell activity. The telmisartan group showed modest improvement in blood pressure and proteinuria, but no significant effect on other parameters. fMSCs transplantation can restore the kidney function and structure in cats with CKD by modulating the apoptosis and proliferation of renal cells. The telmisartan  patients benefited from the anti-hypertensive and anti-proteinuric effects of the drug, but not from its anti-fibrotic or anti-inflammatory effects.
Conclusion: fMSCs transplantation was more effective than telmisartan in improving kidney function and reducing kidney damage in cats with CKD. fMSCs may be a potential therapeutic option for CKD patients.

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 (8-2023)
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 (8-2023)
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.

Approach and management of congenital cataract: A review article
Parisa Abdi, Zakieh Vahedian, Atefeh Dehghani, Mona Safizadeh, Elias Khalilipour ,
Volume 81, Issue 5 (8-2023)
Abstract
Congenital cataract refers to the presence of any opacity in the lens at birth or during early childhood. Cataracts in children can manifest as unilateral or bilateral, congenital or acquired, with specific inheritance patterns or occurring sporadically. Additionally, the condition can be stable or progressive. Congenital cataracts can be associated with certain systemic diseases, or they may occur in the eye of an otherwise healthy child in isolation. Congenital cataract is one of the main causes of blindness in childhood. According to the report of the World Health Organization in 2001, congenital cataract is responsible for about 5 to 20 percent of cases of childhood blindness in the world based on different geographical regions. Untreated cataract in children leads to a tremendous social, economic and emotional burden for the child, family and society. Common complaints associated with congenital cataracts often include leukocoria (white pupil), reduced vision, a child's inability to track objects up close, light sensitivity leading to eye closure, squinting, the presence of either small eyes (microphthalmos) or large eyes (buphthalmos), strabismus (eye deviation), and abnormal eye movements such as nystagmus. Childhood cataract-related blindness can be cured with early detection and appropriate management. Managing pediatric cataracts is a challenge. Increased intraoperative complications compared to adults, tendency to increase postoperative inflammation, associated with complications such as aphakic glaucoma and persistent fetal vasculature, change in refractive status of the eye, and tendency to develop amblyopia, all complicate the achievement of good vision. Congenital cataract has a good prognosis if it is diagnosed early and surgery is performed before 6 weeks. Factors that may adversely affect the outcome, include the presence of unilateral cataract, presence of nystagmus, strabismus, or any ocular defect such as microphthalmos and PFV. Pediatric cataract surgery has evolved over the years, and with improved knowledge about myopic shift and axial growth, outcomes for these patients have become more predictable. Optimal results depend not only on effective surgery, but also on careful postoperative care and visual rehabilitation. Hence, it is the combined effort of parents, surgeons, anesthesiologists, pediatricians and optometrists that can make the difference.

A survey on the effect of recording rates and causes of surgery cancellation on the incidence of rates in candidates for surgery: a brief report
Arash Heroabadi, Mahsa Zargaran , Alireza Khajehnasiri, Reza Atef Yekta ,
Volume 81, Issue 5 (8-2023)
Abstract
Background: Preventing the cancellation of surgeries is an important and devastating challenge in operating room management. Cancellation of pre-scheduled surgeries at the last moment in the operation room leads to increased length of stay, patient dissatisfaction, human resource consumption and financial burden for patients and the health care system. In this study, we have investigated the effect of recording the causes of surgery cancellations in the operation room on the incidence of surgery cancellations in patients who have been candidates for non-emergent surgeries.
Methods: A total of 545 surgeries which had been canceled in different types of surgery between March 2014 and March 2015 were recorded according to the reasons for cancellation in predetermined forms and the information was analyzed. The most common reasons for cancellation included changing the plan of treatment from surgery, a high-risk comorbidity with a high probability of mortality, patient’s refusal from surgery, an unanticipated duration of previous surgery longer than anticipated, the unavailability of an ICU bed in the hospital, requested laboratory data not being ready, failing to prepare requested packed RBCs and other hospital or patient-related problems.
Results: The percentage of surgery cancellations in most groups including orthopedics, urology, cardiac surgery, general surgery, gynecology and maxillofacial surgery, decreased during the course of this study. According to our findings the most relevant cause of non-emergent surgery cancellation was the unpredictable increased duration of previous surgery. The maxillofacial surgery group reached the highest surgery cancellation reduction rate and the cardiovascular surgery group experienced the lowest cancellation reduction rate. Also, the percentage of surgery cancellations in the field of neurosurgery increased during the study period.
Conclusion: Recording the reasons mentioned by the surgical team as the reason for canceling surgeries and reducing the rate of their occurrence during the study and providing appropriate feedback and dialogue in this case had a positive effect on reducing the rate of cancellation of the surgeries and reducing the mentioned reasons.

Considerations of in-vivo breast tissue assessment using raman spectroscopy: a review article
Sadaf Alipour, Zohreh Dehghani-Bidgoli ,
Volume 81, Issue 6 (9-2023)
Abstract
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.

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 (10-2023)
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.

Enhancing bioterrorism defense, leveraging animal models for viral drug and vaccine development: a review article
Hadi Lotfi, Morteza Izadi, Ehsan Lutfi , Hadi Esmaeili Gouvarchin Ghaleh,
Volume 81, Issue 7 (10-2023)
Abstract
Deliberate or threatening use of viruses, bacteria, toxins, or poisonous substances prepared from living organisms to cause death or disease in humans, animals, and plants is called bioterrorism. These agents can be spread by spraying them in the air, causing infection in animals, transferring this infection to humans, or contaminating water and food sources. Defense measures, such as emergency responses to this type of terrorism, are unfamiliar and unknown. The general state of helplessness caused by the lack of complete preparation and the lack of anti-pollution strategies complicates the issue. The ability and widespread interest of civilian personnel to participate in the development of chemical and biological weapons is directly related to easy access to academic excellence around the world. Another factor is the tempting misuse of freely available electronic data and knowledge about the production of antibiotics, vaccines, and conventional weapons with their various complex details. The use of animals in laboratory research to better understand the mechanisms of disease and treatment and to overcome the limitations of clinical trials has a long history. For many viruses, laboratory diagnostic methods and reagents must be continuously modified to account for genetic variations and variants. Unlike bacterial diseases, many of which can be treated with antimicrobial drugs, there are fewer medical countermeasures to combat viral infections. Many of these pathogens are lethal or cause debilitating diseases in humans, making it ethically inappropriate to test the effectiveness of these countermeasures on human volunteers. Researchers must have a correct understanding of various animal models so that they can make the correct choice, gain a better understanding of the clinical symptoms of viral diseases, and provide possible options for treatment and vaccine development. It should be noted that decision-making when faced with a biological attack should be done away from too much fear, and this requires researchers to have prior knowledge of facing these threats. Despite all these checks and measures taken in advance, the international preparedness against these attacks is weak, which can be attributed to the lack of global plans to deal with the epidemic.

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 (10-2023)
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.

Management of left ventricular thrombus: diagnostic and therapeutic methods: a review article
Maryam Mehrpooya, Zahra Sadeghi,
Volume 81, Issue 8 (11-2023)
Abstract
Left ventricular thrombosis (LVT) is a very serious condition and life-threatening complication that usually occurs after acute occlusion of the left anterior descending (LAD) coronary artery followed by acute myocardial infarction with ST-segment elevation (STEMI), which leads to significant regional wall motion abnormality (RWMA). It should be noted that its diagnosis, treatment, and management are challenging now and depend on various factors such as the type of thrombus, time of percutaneous coronary intervention (PCI), and underlying disease. The preferred diagnostic method is cardiovascular magnetic resonance imaging (CMR), but transthoracic echocardiography (TTE) is routinely used for diagnostic and screening purposes also follow-up of response to treatment. It is worth mentioning that when the diagnosis of left ventricular thrombus is not clear with conventional echocardiography, contrast echocardiography is used for more resolution and detailed information. Left ventricular thrombosis can appear in both acute and chronic forms and lead to significant complications, the most important of them are stroke and systemic arterial embolism (SE). According to previous studies, vitamin K antagonist (warfarin) by keeping INR within the therapeutic range currently used to treat left ventricular thrombosis. Although the use of direct oral anticoagulants (DOAC) has brought excellent outcomes, but due to the lack of large clinical trials, the routine use of these agents is controversial, and only in case of warfarin intolerance or contraindications, DOACs can be used as an alternative. Generally, the best way to prevent left ventricular thrombosis is primary percutaneous coronary angioplasty (primary PCI) which preserves left ventricular function. Depending on the sensitivity of the diagnostic method, thrombus will likely resolve in >50% of patients by six months after the MI. On the other hand, in rare cases, surgery is indicated if a thrombosis remains despite the medical treatment especially if it is accompanied by a left ventricular aneurysm. The purpose of this narrative review is to evaluate the latest evidence in the field of left ventricular thrombosis management and to adopt the best approach for these patients.

Preventable risk factors of hospital readmission in stroke patients: an integrative review
Mohammad Rajabpour, Abbas Heidary , Kavian Ghandehari , Amir Mirhaghi,
Volume 81, Issue 10 (1-2024)
Abstract
Background: Despite advances in medical treatments, readmission of stroke patients remains high and has been reported between 31% and 56.1% during the first year after discharge. The difference between the risk factors of readmission and the risk factors of stroke is not clear. The purpose of this study is: 1) to determine the preventable risk factors associated with stroke readmission and 2) to provide a conceptual model for preventable factors that effective in the readmission of stroke patients.
Methods: This integrated review was performed according to Whittemore and Knafl (2005) method in five stages including problem identification, literature search, data evaluation, data analysis, and presentation. In order to find relevant articles, PubMed, Web of Science, CINAHL, Scopus databases and Google Scholar search engine were searched. The search was conducted using the keywords "stroke," "readmission," "recurrence," "re-hospitalization," "review," and "systematic review," for the period between January 2023 and September 2023, following the PRISMA guidelines. In addition to providing a qualitative synthesis of readmission factors categorized into categories, a conceptual model of these factors was also presented.
Results: Out of a total of 3785 article titles, 38 articles were included in the study for the final analysis after screening and removing duplicates. The most important risk factors for readmission in four categories: (1) knowledge deficit about the comorbidities (such as hypertension, atrial fibrillation, diabetes), (2) unhealthy diet and medicine, (3) high-risk behaviors (smoking, alcohol consumption, and tobacco use disorder), and (4) psychological distress (depression and worry about the future). In addition, the conceptual model showed that the most important preventable factor in readmission of stroke patients is of knowledge deficit about comorbidities (especially hypertension). 
Conclusion: The most important preventable risk factors that are effective in the readmission of stroke patients are knowledge deficit regarding clinical risk factors, especially high blood pressure, high-risk behaviors and unhealthy diet and medicine. Therefore, more detailed care and follow-up programs should be designed for stroke patients after discharge.

The relationship between stroke and physical activity: effects of exercise on prevention and rehabilitation: a review article
Hamid Reza Choobdari , Mohammad Ali Gharaat ,
Volume 81, Issue 10 (1-2024)
Abstract
Stroke is a medical condition in which occluded blood flow to the brain causes cell necrosis. The main types of stroke are ischemic (due to lack of blood flow with much higher prevalence) and hemorrhagic (due to bleeding with low prevalence). Ischemic stroke is caused by the reduction of blood to the brain tissue or complete occlusion of brain vessels by a blood clot following arterial plaques rapture of cerebral arteries due to atherosclerosis, cerebral myocardial infarction and small vascular lesion infarction. Inflammatory reactions, increased oxidative stress, cell death and autophagy are the most aggravating factors in this condition. Instead, hemorrhagic stroke is caused by spontaneous intracranial hemorrhage and subarachnoid hemorrhage, highly common in men. To prevent the possible causes of stroke, investigators attempted to study about the ways that may decrease the risk factors such as trauma, high arterial hypertension, alcohol, low-density lipoprotein and glycerides, tobacco and drugs. Physical activity is a potent inhibitory factor which reported to be effective in prevention of stroke and post-stroke rehabilitation. Aerobic, combined or strenuous activities protect brain tissue by balancing apoptotic and anti-apoptotic pathways, stimulating angiogenesis, reducing oxidative stress, increasing antioxidant activity, optimizing Integrity and preservation of the blood-brain barrier, improving nerve functions and preventing neuronal death. The mechanisms involved in rehabilitation after ischemic stroke with physical activity mostly refer to improved dendrites and synapses, synaptic flexibility, regulation of inotropic receptors with glutamate, increased BDNF, GAP43 and insulin-like growth factor. In patients with cognitive impairments following acute ischemic stroke, high intensity exercise improves processing timing and attention allocation, self-independence, walking ability, aerobic power and reduces memory degradation. Moreover, early start of physical activity after ischemic stroke inhibits the initial physiological response to stroke and prevents optimal recovery. In contrary, reports show positive effects of onset of physical exercise a day after stroke. In hemorrhagic stroke, exercise reduces systolic blood pressure, moderates resting blood pressure via parasympathetic regulations and triggers angiogenesis in the nervous system. Light to moderate or long-term physical training is recommended in comparison to short-term high-intensity training. In addition, early onset of physical activity during recovery after stroke may be beneficial.

Microbiota and probiotics, a new approach in the prevention and treatment of breast cancer: a review article
Saeedeh Keyvani-Ghamsari , Kiana Nouri, Ali Khaleseh Nejad , Shokoufeh Hassani,
Volume 81, Issue 11 (1-2024)
Abstract
Today, despite vast advances in cancer diagnosis and treatment, breast cancer is still the leading cause of cancer-related deaths in women. Various factors such as race, age, family history, mutation in the BRCA1/2 gene, diet, inactivity, alcohol consumption, and estrogen levels have been identified as risk factors for breast cancer. In recent years, microbiota has also been recognized as a new risk factor in breast cancer. In fact, the change in the microbial balance that occurs due to many environmental and internal factors of the body can be effective in the spread of cancer by affecting the intracellular pathways and signals. Studies have shown that intestinal dysbiosis affects the spread of breast cancer by affecting the metabolism and production of estrogen, or mechanisms unrelated to estrogen, such as the production of microbial metabolites that affect the immune system and lead to chronic inflammation. In addition, it has been proven that the breast tissue also has its microbiota, the types of which are different in healthy people, patients, even in different stages of breast cancer, and its subgroups. In such a way that a large amount of Proteobacteria, Firmicutes, Lactobacillus, and Actinobacteria are observed in healthy breasts, while their ratio changes in cancerous tissues. Considering the relationship between microbiota and breast cancer, maintaining a healthy microbiota is a new and significant approach to reducing the risk of developing, spreading, and managing this cancer. In this regard, compounds such as probiotics that can affect the balance of intestinal microbiota are considered as an effective approach to prevent and treat breast cancer. Probiotics can stimulate the growth of beneficial bacteria and inhibit the growth of harmful bacteria by causing physicochemical changes and affecting the metabolism of the intestinal microbiota. Furthermore, the consumption of probiotics can prevent the proliferation of cancer cells and reduce the tumor size by balancing the immune system, reducing inflammation, and inducing apoptosis in the cancer cells. This study describes the importance of microbiota in breast cancer, the difference between microbiota in a healthy person and a sick person, and the role of probiotics in the treatment of breast cancer.

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