Ahmadreza Dehpour, PharmD, PhD
Vol 58, No 9 (2020)
Coronary artery disease (CAD) is one of the leading causes of death worldwide; therefore, identifying new risk factors to predict the severity of the disease is thought to be associated with mortality reduction. In an effort to investigate whether platelet parameters are related to the extent of CAD and can be considered as risk factors, we designed experiments to evaluate platelet parameters in these patients. In a cross‐sectional study, sixty-nine patients with CAD (including fifty-two patients with acute coronary syndrome and seventeen patients with stable angina) and sixty-four healthy volunteers were evaluated for platelet count, mean platelet volume (MPV), and platelet distribution width (PDW). Echocardiography, electrocardiogram (ECG), and coronary angiography were conducted as well. Results showed significantly higher values for MPV and PDW in patients with acute coronary syndrome as compared to patients with stable angina and healthy volunteers (P<0.001 and P=0.009, respectively). There was no significant difference in platelet count between patients and healthy volunteers (P=0.379). Our results also revealed a significant difference in the ejection fraction (EF) percentage between the three groups (P=0.008). Investigating the correlation between platelet parameters and EF percentage, ECG changes, and the results of coronary angiography did not show any significant association. The present study showed that the elevated levels of MPV and PDW in patients with CAD are not related to the extent of coronary artery disease, which was estimated by echocardiography, ECG changes, and coronary angiography. Thus, these parameters cannot be considered as risk factors for coronary artery disease.
Iron deficiency anemia can cause histopathologic alterations in the oral mucosa. Exfoliative cytology is a cheaper and less aggressive method for early diagnosis. The aim of this study was to compare the cytological and cytomorphometric characteristics of buccal exfoliated cells of iron deficiency anemic patients with those of healthy controls. This case-control study compared a group of 40 patients with iron deficiency anemia (IDA) with an age- and gender-matched control group (C) of 40 healthy individuals. The buccal mucosal smears were stained using the Papanicolaou technique for cytological analyses. Cellular clumping, cytoplasmic diameter (CD), nuclear diameter (ND), cytoplasmic area (CA), nuclear area (NA), nucleus to cytoplasmic area ratio (NA/CA), cellular and nuclear pleomorphism, micronuclei (Mn), binucleation, bacterial colonies, and keratin flakes were evaluated using a light microscope and digital image analysis. Mean values for IDA and C groups were: bacterial colonies (1.88 and 0.65; P=0.002); CA (2209.88 and 1687.79 μm²; P=0.006); Mn (1.60 and 0.60; P=0.02). Significant increases in bacterial colonies, CA and Mn were seen for the IDA group. The number of cellular clumps, CD, ND, NA, NA/CA, cellular and nuclear pleomorphism, binucleation, and the number of keratin flakes didn’t show significant differences between studied groups (P>0.05). There wasn’t any significant difference with respect to overall atypia. This study revealed that IDA was able to induce significant changes in CA and Mn of the oral epithelial cells. Exfoliative cytology and cytomorphometry can be used as a tool to assess the mucosal changes in IDA patients.
Although there have been many studies on the effects of electromagnetic fields on humans, scientists still have no agreement on the effects found because several studies showed no statistically significant effects. The effects of radiofrequency electromagnetic fields exposure on the immune system are varied, ranging from no effects to genotoxic effects on lymphocytes. Our study aimed to investigate whether exposure to 1800 MHz radiofrequency electromagnetic fields (RF-EMF) in variable durations and distances could lead to the dysregulation of T helper 1, 2, and 17. The peripheral blood mononuclear cells (PBMCs) cultures from healthy human subjects were exposed to 1800 MHz RF-EMF, with durations of 15, 30, 45, and 60 minutes and distances of 5 and 25 cm. We evaluated the effects of RF-EMF exposure on the number of CD4+ T cells, IL-2, IL-10, and IL-17a after 48 hours of culture with the flow cytometer. The closer the distance, the lower the number of CD4+ T cells. The longer the exposure, the lower the number of CD4+ T cells and the number of IL-2, IL-10, and IL-17a decreases significantly. CD4+ T cells expressing IL-2 increased significantly with the increase of the duration of 1800 MHz RF-EMF exposure (15, 30, and 45 min), but decreased at 60 minutes of exposure when compared to PBMCs without exposure. Sixty minutes of PBMC exposure to RF-EMF with a distance of 5 cm causes a significant reduction in the number of CD4+ T cells, the expression of IL-2, IL-10, and IL-17a.
Considering the importance of ventilator-associated pneumonia (VAP) and the high mortality rate among patients diagnosed with VAP, the aim of the current study was to evaluate the incidence of VAP, and its related risk factors in patients admitted to the intensive care unit (ICU). A total of 197 patients undergoing mechanical ventilation in the ICU diagnosed with VAP was enrolled in this study. Among these patients, 59 (53.6%) cases were male, and 51 (46.4%) were female with the mean age of 69.86±14.62 years. The most common cause of ICU admission was CVA, followed by colorectal cancer, lung cancer, sepsis, and cirrhosis. Our results showed that 110 individuals (55.8%) were diagnosed with VAP. The most common bacteria were Klebsiella, which was found in 20.3% of cases. (47.7%) of patients had diabetes, 21.8% had chronic kidney disease, and 51.8% had cardiovascular disease. 32.7% of patients were bedridden before intubation. The mortality rate due to VAP was estimated at about 20%. In conclusion, the incidence of VAP in ICU is relatively high (55.8%), with a mortality rate of 20%. Among the risk factors, the presence of diabetes, bedridden, reduction in consciousness, and the time duration of mechanical ventilation are relative to this type of infection.
Ovarian cancer is one of the most deadly women's gynecological malignancies in the world, and despite the low prevalence, it accounts for about 5% of all cancer deaths in women. Survival analysis is a regression relationship between a set of variables with a specific outcome, which is considered disease survival or recurrence in medical studies. The aim of this study is to determine the important factors in the first recurrence of patients with epithelial ovarian cancer with two statistics methods. In this study, we review medical records of patients with epithelial ovarian cancer who referred to the oncology and radiotherapy department of Imam Hossein Hospital of Tehran from the beginning of 2007 to the end of 2018. Univariate and multivariate Cox regression, as well as the parametric Weibull method, were used to investigate the factors affecting patients' first recurrence. We perform all calculations with Stata Ver14. Of the 141 patients, 58 patients (41%) had a first recurrence during our follow-up. The mean time to the first recurrence was 24.88 months. Univariate Cox regression and univariate Weibull analysis showed that metastatic tumor and tumor stage had highly significant effects in the first recurrence of epithelial ovarian cancer. In multivariate Cox and multivariate Weibull analysis, the metastatic tumor had a significant effect in the first recurrence of epithelial ovarian cancer. One of the causes of ovarian cancer recurrence may be diagnosis happened at late stages. Therefore, screening programs are needed to reduce illness and death from ovarian cancer.
Medicine is a stressful job. It is shown in several studies that decreased clinical function, disturbance in decision making, and the doctor-patient relationship, anxiety, depression, alcohol and substance abuse, and suicide are associated with stress. So, it is important to investigate the prevalence of depression, anxiety, and stress among medical staff. This is a cross-sectional study on the Tehran University of Medical Sciences residents, and 152 residents were surveyed by the DASS-21 questionnaire, which measures the depression, anxiety, and stress level. One hundred fifty-two residents (24.5% male, 75.5% female) with a mean age of 29.6 (SD=2.96) were surveyed. According to this study results, 23% of residents had severe to extremely severe depression, 24.9% had severe to extremely severe anxiety, and 33.8% had severe to extremely severe stress. Prevalence of depression, anxiety, and stress among Tehran University of Medical Sciences residents are higher than some other countries and universities, and it could be due to more working pressure in our educational hospitals. However, similar studies in different countries have not similar results, especially about the associated factors; so, more studies should be done, especially with the interventional and socioeconomic considerations, to address these issues.
Acute pancreatitis is the most common and serious complication of Endoscopic Retrograde Cholangiopancreatography (ERCP). The use of effective medicines with low side effects should be considered in the process of RCP due to acute pancreatitis prevention. Therefore, we investigate the effects of epinephrine sprayed on the papilla in this study. This randomized clinical trial was performed on 343 patients referred to the ERCP Department of Imam Reza Hospital and Apadana Clinic, Mashhad, Iran. About 10 ml of diluted epinephrine (case group) or normal saline (control group) were sprayed on the papilla before diagnostic ERCP. Afterward, the two groups were assessed in terms of post-ERCP pancreatitis. The data were analyzed using Statistical Package for the Social Sciences (SPSS) software, version 20. The level of significance was considered to be 0.05. The overall results of this study indicated that post-ERCP pancreatitis occurred in 4.95% of the patients. Mild pancreatitis was diagnosed in five patients of the case group and three patients of the control group, respectively. Moderate pancreatitis was diagnosed in three patients of the case group and three patients of the control group. Only one patient in the case group and two patients in the control group were shown to have severe pancreatitis. Moreover, there was no significant difference between the incidence of pancreatitis between the two groups (P>0.05). With regard to the findings of this study, it appears that the topical application of epinephrine is not effective in preventing post-ERCP pancreatitis.
We aimed to determine the frequency of Octamer binding transcription factor 4 (Oct4) expression in human invasive ductal carcinoma. 72 paraffin-embedded samples of breast cancer were enrolled. All blocks were stained for estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor 2(HER 2/neu), ki67, and Oct4 by immunohistochemistry (IHC) method. Of 72 enrolled cases, the mean age was 49.6±1.42 years. 18 (25%) of cases were luminal A, 14 (19.4%) were Her2 positive, 31 (43%) were luminal B, and 9 (12.5%) were triple-negative. IHC staining for Oct4 revealed no Oct4 expression in breast cancer samples. The staining was repeated twice, and seminoma was used as a positive control in each run. The results of both repeats were the same, and none of the examined samples showed Oct4 expression. We found no Oct4 expression in breast cancer samples examined in our study. We also did not find Oct4 expression in normal breast tissue. Our study is one of the few studies which has evaluated Oct4 expression in human breast cancer on tissue samples and is one of the least that has reported no expression of Oct4 in breast cancer.
One of the most common benign tumors in reproductive age women is mature Teratoma. We reported a 35-year-old woman who presented with abdominal pain, nausea, vomiting, and fever. The patient underwent laparotomy with the probable diagnosis of ovarian torsion. The evidence in the peritoneal cavity revealed chemical peritonitis due to the spontaneous rupture of the dermoid cyst.
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