Ahmadreza Dehpour, PharmD, PhD
Vol 59, No 7 (2021)
The evacuation of hospitals has special complications and sensitivities in terms of the presence of patients. Since infants are the youngest and most vulnerable patients in the hospital, the readiness of the neonatal intensive care unit (NICU) to respond appropriately and evacuate at the time of disasters is very important. This article examines the emergency evacuation of neonatal intensive care units during disasters. The present systematic review was done based on the PRISMA guidelines for systematic review studies. Accordingly, all English-language articles published in this field were extracted by the end of January 2020, through searching Web of Science, PubMed, Scopus, and Science Direct, as well as Google Scholar Web Search. The search and screen of the articles were conducted independently by the research team members, and the content of included articles was analyzed thematically. After the final evaluation, 11 articles were subjected to content analysis, which was divided into seven thematic categories: command, training and maneuver, manpower, communication, equipment, transportation, support. Considering that infants are the most vulnerable preparing the staff of the (NICU) along with providing them with specialized and technical support is suggested. By preparing and implementing response and preparedness plans, it is possible to prevent high complications and mortality among infants admitted to the hospital pre-disasters.
Background: late in 2019, the first case of COVID-19 was detected in China, and the disease caused pandemic state worldwide. Up to now, many studies investigated the impact of comorbid diseases, especially diabetes mellitus on COVID-19 outcomes.
Objectives: In this study, we aimed to assess the para-clinic characteristics of COVID-19 patients with or without diabetes mellitus to identify factors indicative of poor prognoses.
Methods: In this prospective study, 153 in-patients with COVID-19 were followed up from 1 March to 19 April. Paraclinical information of these patients was gathered from their medical records. Afterward, the association between these factors among both diabetic and non-diabetic patients were assessed in the correlation analyses.
Results: discharge and expiration of 77.1% and 22.9% of the study participants resulted in a 1063 person-day follow up for patients who discharged healthily, and 384 person-day follow up for expired patients. 41.8% of the participants had diabetes mellitus. Lymphocytopenia and Neutrolhilia prevalences increased during hospitalization; comparing with their initial prevalences. Thirty-seven patients got acute respiratory distress syndrome; of those, 35 died. The mean of the initial C reactive protein level was 42.49 and serum creatinine of 1.39
Conclusion: The study showed that higher initial neutrophil count, increasing neutrophil count more than 15000 and decreasing lymphocyte count below 1000 during hospitalization; development of acute respiratory distress syndrome and being intubated; initial C reactive protein and serum creatinine level were associated with higher mortality rates in COVID-19 victims.
In the last days of 2019, a new coronavirus emerged in Wuhan, China, and less than three months its disease, now called COVID-19, was announced a global pandemic by WHO. COVID-19 usually causes respiratory symptoms and can lead to more severe conditions like ARDS. HLA has a crucial role in regulating the immune system; thus, different HLA allele types can be a protective or risk factor for some diseases, so we aimed to find such associations to determine whether some alleles can predict susceptibility or resistibility to COVID-19 and finally facilitate vaccine development. In this case-control study, 15 admitted COVID-19 cases with severe symptoms and ten individuals with mild COVID-19 symptoms were enrolled in the case and control groups, respectively. They were genotyped for HLA A/B/DR loci using a low-resolution HLA typing test. These alleles were more prevalent in case (severe COVID-19) group: A*24 (53.33% vs 10%), B*50 (20% vs 10%), B*55 (20% vs 10%), DRB1*04 (40% vs 20%) and DRB1*11 (53.33% vs 30%) but the difference was only statically significant in A*24 allele (P=0.027; odd ratio=10.286). A*24 was also more prevalent in all patients than the general population in Iran. A*24 was the only allele more prevalent in severe COVID-19 cases with statistical significance. This allele was reported to be a risk factor for such autoimmune diseases as type 1 diabetes, myasthenia gravis, and systemic lupus erythematosus, which may be related to reported immune system hyperresponsiveness in severe COVID-19 cases.
The clinical use of doxorubicin as a potent chemotherapeutic agent is limited due to its dose-dependent cardiotoxicity. Oxidative stress and inflammatory pathways have a pivotal role in doxorubicin-induced cardiotoxicity. Sumatriptan, a 5-hydroxytryptamine (5-HT)1B/1D agonist that is mainly used to relieve migraine pain, has suggested exerting protective effects in numerous pathological conditions through antiinflammatory properties. The aim of the present study was to investigate the effects of sumatriptan on doxorubicin-induced cardiotoxicity and the contribution of anti-inflammation and antioxidative responses. Cardiotoxicity was induced by the administration of doxorubicin three times a week (2.5 mg/kg i.p) for two consecutive weeks on male rats. The animals were divided into four groups, including Control, Sumatriptan (0.1 mg/kg) received group, doxorubicin received group, and Doxorubicin+Sumatriptan (0.1 mg/kg) received group. Sumatriptan was administered 30 min before every injection of doxorubicin. On the last day of the second week, the body weight, mortality rate, electrocardiogram (ECG) and histopathological changes, cardiac inotropic study, and biochemical factors were evaluated. The loss of body weight, mortality rate, ECG parameters, reduction of papillary muscle contractility force as well as histopathological scores following administration of doxorubicin indicated severe cardiac damage. However, treatment with sumatriptan inhibited the functional and structural impairment induced by doxorubicin. In addition, sumatriptan could significantly reduce cardiac tissue levels of malondialdehyde (MDA) and tumor necrosis factor-alpha (TNF-α), which were increased in the doxorubicin-treated rats. This study illustrated the protective effects of sumatriptan on decreasing doxorubicin-induced cardiac toxicity and mortality rate in part through inhibition of inflammatory and oxidative stress pathways.
Germinal matrix hemorrhage-intraventricular hemorrhage (GMH-IVH) mainly occurs in preterm neonates and is an important cause of brain injury in them. In this retrospective cross-sectional study from march 2017 to march 2018 in our teaching hospitals, we investigated 250 newborns who were admitted to NICU with a birth weight under 1500 grams with ultrasonographic study for presence and grade of GMH-IVH in their first week of life. Risk factors for GMH-IVH were collected from their records and results been analyzed with SPSS software. From 250 neonates who had inclusion criteria of the study, 22 cases had GMH-IVH in ultrasonographic evaluation. 37.6% of all cases and 31.8% of newborns with GMH-IVH had a 5-minute APGAR score of less than six. 91 cases (39.9%) of the control group and 15 cases (68.1%) of the GMH-IVH group need resuscitation at birth. Of 250 cases 54 (21.6%) died, that 14 cases (63.6%) had GMH-IVH. Our study shows significant differences for birth weight, 5 minute APGAR score, and the need for resuscitation at birth as risk factors for the development of GMH-IVH in very low birth weight neonates, but we do not find a significant difference group in terms of gestational age, gender, route of delivery, fetal presentation, maternal parity, CBC parameters, sepsis, RDS, endotracheal tube suctioning and multiple pregnancies for them. In our study, the protective value for antenatal steroid therapy depends on the completion of the course of treatment for mothers.
Any high-stakes assessment that leads to an important decision requires careful consideration in determining whether a student passes or fails. Despite the implementation of many standard-setting methods in clinical examinations, concerns remain about the reliability of pass/fail decisions in high stakes assessment, especially clinical assessment. This observational study proposes a defensible pass/fail decision based on the number of failed competencies. In the study conducted in Erbil, Iraq, in June 2018, results were obtained for 150 medical students on their final objective structured clinical examination. Cutoff scores and pass/fail decisions were calculated using the modified Angoff, borderline, borderline-regression, and holistic methods. The results were compared with each other and with a new competency method using Cohen’s kappa. Rasch analysis was used to compare the consistency of competency data with Rasch model estimates. The competency method resulted in 40 (26.7%) students failing, compared with 76 (50.6%), 37 (24.6%), 35 (23.3%), and 13 (8%) for the modified Angoff, borderline, borderline regression, and holistic methods, respectively. The competency method demonstrated a sufficient degree of fit to the Rasch model (mean outfit and infit statistics of 0.961 and 0.960, respectively). In conclusion, the competency method was more stringent in determining pass/fail, compared with other standard-setting methods, except for the modified Angoff method. The fit of competency data to the Rasch model provides evidence for the validity and reliability of pass/fail decisions.
Nanotechnology has enabled the preparation of various materials for overcoming the rapid clearance of drugs, nonspecific uptake or actions, and poor tumor penetration. Based on the significance of using biomimetic substances, silk fibroin nanoparticles (SF-NPs) have been increasingly prepared for the delivery of therapeutics. Meanwhile, aggregation and low stability in the biological medium may negatively affect their efficiency. This prompted us to coat SF-NPs with polydopamine (PDA), and for efficient accumulation and increasing therapeutic efficiency against breast cancer, paclitaxel (PTX)-loaded PDA-coated SF-NPs were conjugated with targeting peptide, iRGD (iRGD-PDA-PTX-SF-NPs). The peptide impacts on the cellular uptake, cytotoxicity, tumor penetrability of NPs, and their antitumor effects were evaluated. iRGD-PDA-PTX-SF-NPs with suitable physicochemical characteristics and drug loading released PTX in a controlled manner, and efficient cellular uptake was observed. Improved pharmacological profile of PTX was revealed by increased anticancer effects in vitro and in tumor-bearing Balb/c mice, including the delayed growth of the tumor and enhanced rate of survival. The prepared NPs showed no toxic effects against the healthy tissues indicating the histocompatibility and safety of these biomimetic and long-circulating nanoplatforms. The peptide-based SF-NPs could be considered as promising biomimetic nanoformulation against breast cancer.
Surgical resection with curative intent is still a central therapeutic option for resectable esophageal cancer. Thoracoscopicesophagectomy in a prone position would give each benefit of the lateral position. The present research aimed to analyze the short-term outcomes of thoracoscopicesophagectomy in the prone position. This was a retrospective cross-sectional study. Patients who underwent thoracoscopicesophagectomy in the prone position at Tehran University Cancer institute from January 2017 to December 2018 entered the study. The esophagus was mobilized through the thoracoscopic approach in a prone position. The stomach was released using a laparoscopic approach for the gastric pull-up. Finally, an end-to-end hand-sewn cervical anastomosis was performed. Three, four, seven, one, and one patient suffered from pneumonia, leakage, tracheal tearing, chylothorax, and pneumothorax, respectively, after the operation. In 91.5% of patients, more than ten lymph nodes were resected. Sixty percent of patients were discharged from the hospital earlier than one week. Laparoscopicesophagectomy in the prone position is a feasible alternative. Better exposure and fewer complications were reported.
Socioeconomic and lifestyle factors are regarded as important influencing issues regarding a wide range of chronic diseases, including chronic obstructive pulmonary disease. This study aimed to explore the role of such factors as determinants of disease exacerbation among COPD patients. A cross-sectional study was conducted among 150 COPD patients who were referred to an outpatient respiratory care center in Qazvin, Iran, to undertake respiratory function tests from December 2017 to June 2018. Disease severity was determined by the Initiative for Chronic Obstructive Lung Disease (GOLD) index. Odds ratios were applied to find out factors associated with exacerbation. Study findings affirmed that within COPD severity groups, there were significant differences among patients in terms of educational level, smoking status, income, and occupation. Factors associated with severe COPD were found to be smoking (OR 3.6, 2.6-4.2), lower education (OR 1.4, 0.9-2.6), insufficient income (OR 2.3, 0.6-3.1), and unsupportive family (2.7, 1.5-3.6). Due to the obtained evidence about the effect of socioeconomic status on the prognosis of the disease, it is suggested that clinicians should also consider the nonclinical and social aspects associated with the disease in advancing patients' therapeutic procedures and management algorithms.
Hemoptysis is defined as blood expectoration from below the vocal cords. Foreign bodies inhaled or consumed can be the cause of hemoptysis. Among alive foreign objects, leech infestation happens via drinking infested bodies of water. Leech infestation in the airway might be the cause of serious complications naming dysphonia, stridor, hemoptysis, choking, respiratory distress, and foreign body sensation. Although intratracheal leech infestation has been rarely reported, in the current case, a 79-year farmer presented recurrent non massive hemoptysis. Via fiberoptic bronchoscopy, a live leech was found in the trachea of the patient and with the use of lidocaine the leech was removed. In order to avoid such incidences, governments play an important role in building and repairing infrastructures regarding sanitary water and meanwhile educating and informing their population about sanitary water consumption.