A. R. Dehpour, PharmD, PhD
A. Javadian, MD
Acta Medica Iranica (p. ISSN 0044-6025; e. ISSN: 1735-9694) is the official journal of the School of Medicine, Tehran University of Medical Sciences.
The journal is the oldest scientific medical journal in the country pulished in English, from 1956 onward. Although since 2004 it had been published bimonthly, the journal has been published monthly from first issue of 2011.
Acta Medica Iranica is an international journal with multidisciplinary scope which publishes original research papers, review articles, case reports, and letters to the editor from all over the world. The journal has a wide scope and allows scientists, clinicians, and academic members to publish their original works in this field.
The editorial board of the journal hopes that the journal would be welcomed by researchers and academics in universities and related centers in Asia and in the world at large.
Background: In COVID-19 pandemic, underlying diseases such as cardiovascular disease, respiratory illness, liver and kidney disease or malignancies, have a critical prognostic role for these patients.
Aim: Due to the increased risk of mortality in patients with established or new-onset comorbidities, we decided to conduct a study to further investigate the possible comorbidities and treatment recommendations of COVID-19.
Method: All articles published by March 25, 2020 on the new coronavirus infection were reviewed and for cutaneous manifestation as a new emerging concern, by April 25, 2020. ScienceDirect, Google scholar, Scopus, PubMed databases were searched and keywords such as "COVID-19", "2019-nCoV", "Coronavirus2019", "SARS-CoV-2”, and "comorbidity" have been used.
Results: the most important comorbidity in elderly patients with confirmed covid-19 was cardiovascular disease, followed by diabetes and chronic respiratory disease, respectively, and on the other hand, covid-19 itself could cause acute heart, lung, liver, kidney and skin disease. Also the prevalence of underlying diseases in died patients or patients with severe COVID-19 are higher than the others. Considering treatment; Drug interactions and careful drug adjustment based on hepatic and renal metabolism are essential.
Conclusion: The results of this study showed that the mortality rate and ICU admission in people with underlying disease is higher than other people. Also we must pay attention to the possible multi-organ damages and comorbidities, for protection and successful treatment of COVID-19. There are some comorbidities like primary cutaneous manifestations that may have diagnostic or prognostic values in COVID-19 course.
Thyroid malignancies are found in 7% to 15% of all thyroid nodules. Immunohistochemical markers, including CK19, HBME-1and TROP2, have shown an effective role in identifying these malignancies. Hence, due to the lack of appropriate diagnostic tests for the identification of thyroid neoplasms, in this study, we aimed to determine the diagnostic value of these biomarkers in the identification of different types of follicular thyroid neoplasms. In this cross-sectional study, paraffin-embedded tissue blocks from the surgical resection of patients with thyroid nodules, referring to Imam Reza and Razavi Hospitals of Mashhad in 2017, were studied. Sensitivity, specificity, and positive and negative predictive values of these biomarkers for the identification of different types of follicular thyroid neoplasms were also studied. 129 patients with a mean age of 44.65±12.59 years participated in this study, of whom 101 (78.29%) were women. The most common type of follicular thyroid neoplasm was papillary carcinoma (60.47%). The highest sensitivity (94.87%) and positive predictive value (68.51%) in the detection of follicular neoplasms was observed by CK19 in papillary carcinoma. The sensitivity and positive predictive value of TROP2 in the detection of papillary neoplasms was 93.58% and 75.25%, respectively. In addition, HBME-1 had the highest specificity (72.54 %) and positive predictive value (81.57%) in identifying this neoplasm. The results of this study showed that CK19, HBME-1, and TROP2 had high diagnostic value in the detection of papillary thyroid neoplasms. Although these biomarkers had low diagnostic value in identifying follicular adenoma and carcinoma, given the high negative predictive value, they can be considered as powerful markers in identifying negative cases.
Sleep quality plays an important role in people's mental health. Until now, the comparison of factors affecting mental health among clinical and non-clinical workers has received less attention. This study aimed to investigate the relationship between sleep quality and mental health and factors affecting mental health in a large working population. The present study was derived from the first phase of a cohort study of Shahid Beheshti University of Medical Sciences staff in 2019. Participants included 2921 employees. Demographic variables and job characteristics, the Pittsburgh Sleep Quality Index (PSQI) and General Health Questionnaire-28 (GHQ-28) were used for data collection. For finding factors affecting mental health, logistic regression was used. Clinical workers had lower mental health (P<0.001) and lower sleep quality (P=0.04) than others. The relationship between mental health and sleep quality was significant (P<0.001). The prevalence of poor sleep quality was 35.6% and for undesirable mental health was 27.8%. Marital status had a significant relationship with mental health (P=0.02). The chance of undesirable mental health decreased with age (OR: 0.98 (0.97, 0.99)). Women had twice undesirable mental health than men (OR: 1.99 (1.62, 2.50)). The odds of undesirable mental health in staff with poor sleep quality were about five times higher than others (OR: 4.80 (3.99, 5.76)). Sleep quality may be considered as a factor affecting mental health. Due to the importance of the issue, planning for the improvement of clinical workers' sleep quality seems to be necessary by health policymakers.
Objective: Low overall survival (OS) still is a major concern of allogeneic hematopoietic stem cell transplantation (allo-HSCT) which is affected by many individual and environmental factors. In this study, we retrospectively evaluated the association of donor and recipient individual factors with the overall survival of 206 patients underwent allo-HSCT. Methods: Donor and recipient prognostic factors consisted of donor and recipient age, donor-recipient gender status, recipient body mass index (BMI), underlying disease, recipient cytomegalovirus (CMV) serostatus, and time from diagnosis to transplant (DTT) were included to the overall survival analysis. Results: In univariable analysis, recipient age, donor-recipient gender status, underlying disease, recipient CMV serostatus, and DTT were significantly associated with the OS. The hazard of death in patients with DTT less than 14 months was 38% lower than those with a DTT higher than 14 months (P-value=0.06). Multivariate analysis showed that patient with aplastic anemia (HR= 3.58; P-value =0.11) and Hodgkin’s disease (HR= 3.89; P-value=0.11) have much lower survival than unclassified diseases. Moreover, patients with acute myeloid leukemia and acute lymphoblastic leukemia showed better outcomes compared to unclassified group. Conclusion: the donor and patient characteristics such as age, CMV serostatus, underlying disease, and time from diagnosis to transplantation could influence the overall survival of patients after allo-HSCT.
This study aimed to evaluate the abbreviated burn severity index (ABSI) score and the percentage of full-thickness burn in the prediction of hospital mortality in burn patients admitted to Sina Hospital in Tabriz. A total of 250 burn patients admitted to burn and ICU wards during December 2016-Sep 2018 entered the present cross-sectional descriptive study. The collected data included age, gender, burn percentage, anatomical location of the burn, cause of burn, severity of burn, mucosal or inhalation injury, underlying disease, length of stay (day), and the hospital outcome of the patient. There was a significant difference between the two genders in terms of the cause of burns (P<0.0001). The most common cause of burn in women and men was hot liquids and fire, respectively. 40% TBSA with 92% sensitivity and 94% specificity, and 20% full-thickness burns with 98% sensitivity and 88% specificity was obtained in predicting mortality of patients. ABSI score of 9 with 85% sensitivity and 95% specificity was obtained in predicting mortality in patients. By increasing one unit in the ABSI score, odds ratio increases by 17.5 times in terms of mortality probability. The present study showed a significant difference between the two genders in terms of the cause of burn and it is evidently affected by the culture and lifestyle of our country. On the other hand, investigation of the cause of death in patients with ABSI> 9 and taking appropriate measures to reduce their mortality are recommended. Also, it is recommended to use more simple criteria such as burn percentage or full thickness burns to predict mortality rate in case of burning injury patients.
This study aimed to evaluate the effect of macro-level health policies on COVID-19 outbreak control in Iran. This was a descriptive-analytical study of the applied time series performed on April 19, 2020. The effect of four macro-health interventions, including reducing overcrowding, social distancing, limitation of high-risk economic activities, and active case detection, was examined. The Vector auto-regression (VAR) was used to investigate the effect of the interventions. The augmented Dickey-Fuller test (ADF) was used to ensure the time stability of the time series and the existence of a unit-root. To analyzing data and estimation VAR models, STATA software was used. P of less than 0.1 was considered significant. The increase in the number of cases with two days’ lag had a positive and significant effect on increasing the number of new cases of the COVID-19 (C=0.176, P=0.097). Adopting an overcrowding reduction policy with both 2-day lags (c=0.095, P=0.066) and 4-day lags (c=0.314, P=0.000) had a negative and significant effect on increasing the number of new cases of the COVID-19. Our study showed that overcrowding reduction and new COVID-19 case detection could play an effective role in controlling the epidemic of COVID-19 in Iran. It seems that the best advice is to stay home and use strategies to identify more patients.
The reason why the experiments were done: previous studies have shown that the incidence rates vary in different populations. Now we report the preliminary results of the screening study.Pompe disease is a rare but potentially treatable disorder caused by the deficiency of the lysosomal enzyme acid-α-glucosidase (GAA).GAA activity was measured on DBS in 65 patients with undiagnosed myopathies presenting to the hospital of the research setting in Isfahan, Iran from 2016 to 2017 and then was conﬁrmed by a genetic analysis. Of the total of 65 patients, 29 (44.6%) were male and 36 (55.4%) were female. The mean age of the patients was 29±12.55 years and their mean age at the disease onset was 17±12.75. Two patients (one male and one female) were diagnosed with a low acid alpha glucosidase activity. Only one patient (female) showed a compound heterozygotic mutation of the GAA gene (c.-32-13T>G).Early diagnosis of pompe disease is important for improving the outcome.
Background: Up to 40% of global and 7.4- 41.3% of the Middle East population are affected by Allergic Rhinitis (AR). Patients with AR versus control group experience approximately twofold pharmaceutical expenditures and 1.8 fold number of visits. Since drug utilization can show various times of developing a disease in a country, it is used as an alternative for prevalence. In this study we try to examine and explain the consumption of anti-allergic medicines during the past 12 years to have a perspective view of these kinds of medicines.
Method: in this descriptive and cross-sectional study that investigates anti-allergic medicines over a 12-year period (2006–2017) we used Iranian pharmaceutical statistical datasheet published by the Iranian Ministry of Health. According to treatment guidelines of AR and WHO ATC code, we categorized anti-allergic medicines into 5 groups (antihistamines, Beta 2 agonists, Corticosteroids, Fixed-dose and others), Then DIDs for these groups were calculated and analyzed.
Result: Based on our findings in this study, cetirizine, Loratadine and Inhaled Salbutamol got the highest DID among all 5 groups, with 99.2, 65.4 and 57.6 retrospectively. Generally based on the third level of ATC code (second-generation anti-histamines, respiratory system drugs for obstructive airway disease, respiratory system nasal preparation and corticosteroid for systemic use) are faced with ascending market sales.
Conclusion: generally with the upward trend of anti-allergic medicines we can conclude that the incidence of AR in Iran during the past 12 years has increased and policymakers should follow this trend concerning a better supply chain.
Aortoenteric fistula is a rare finding that is potentially fatal and is usually seen as a fistula between the aorta or an aortic graft and the third part of the duodenum. The type without the presence of an artificial graft is considered as primary and the other type as secondary. The patients usually present with the herald symptom of minor hematemesis which later leads to massive and mortal GI bleeding. The most important factor in the diagnosis of an aortoenteric fistula is to have a high clinical suspicion after taking an appropriate and accurate history. In hemodynamically stable patients with clinical suspicion , performing an intravenous-contrast- CT scan of the abdomen and pelvis is of an assistance in diagnosis. In general, stable hemodynamics greatly reduces the suspicion for diagnosis. Treatment is often surgical and in regard to severity of abdominal contamination or the level of visible infection, the extra anatomical or insitu graft repair is considered as the method of choice. This article try to transfer our experiences in two patients each of whom presented with hematemesis and melena without a history of underlying aortic aneurysm.
Key words:Primary aortoenteric fistulae , secondary aortoenteric fistulae, mortal GI bleeding