Ahmadreza Dehpour, PharmD, PhD
Vol 59, No 10 (2021)
Based on this point that some cancers do not appropriately respond to conventional therapy, and there is the possibility of relapse, immunotherapy is currently under investigation. Cancer immunotherapies are widely recognized as transformational for several cancers and enable to move to the front-line therapy with few side effects. One of its new branches is treatment with T-cells that have been changed their receptor. The research on these cells is generally according to the design of a receptor against a specific tumor antigen. Also, manipulation of regulatory T-cell (Tregs), as the barriers to proper immune responses in the tumor microenvironment, will promote Tregs-targeted therapeutic opportunities and improve the efficacy of the current cancer treatment, such as radiation and chemotherapy. This review attempts to show novel insights into the roles of Tregs in cancer which can be considered a promising anticancer therapeutic strategy for targeting them and approaches for the generation of tumor antigen-specific T lymphocytes (AST) using chimeric antigen receptors.
The role of laboratory parameters and the relationship of them with radiology reports, CT scan and clinical outcomes in screening of COVID-19 patients not been deﬁnitely established, but this disease presented a major challenge in the field of clinical tests, radiology reports, clinical outcomes that help to monitoring and treatment COVID-19 disease. This study was performed on 340 suspected COVID-19 patients, who presented to Chamran Hospital, Shiraz University of Medical Sciences Shiraz, Iran from 20 February to 31 August, 2020. Information each patient's will be completed using a data collection forms based on records. The evaluation of lungs involvement in CT scan and their relationship with laboratory indicator including biochemical and hematological factors, is the best scale for the severity and prognosis of Covid 19 patients. The ﬁndings of this study indicated ALT, AST, CRP, NEU, LDH, and Urea have very good accuracy in predicting cases with positive RT-PCR for COVID-19, respectively. In this study we shown the correlation of clinical and laboratory findings with CT-based quantitative score of pulmonary involvement in COVID-19 pneumonia and attempted that our findings could be usable to development future clinical research associated with COVID-19 infection and show the relationship of reports CT scan and clinical outcomes in the diagnosis and severity of patients with COVID-19.
The coronavirus disease 2019 (COVID-19) pandemic as an emergency public health concern has caused hundreds of thousands of deaths in the world. Identifying predictors of death in COVID-19 patients is a key to improving survival and helping patients triage, better management, and assist physicians and health care. The present study was conducted on 512 positive COVID-19 patients confirmed by real-time PCR hospitalized in Sina Hospital, Hamadan, in 2020. The data of demographic characteristics, clinical manifestations, laboratory findings, chest examination, and disease outcome were collected. The logistic regression model was performed to explore the predictors of in-hospital mortality. Among 512 patients, 57 (11.1%) deaths have occurred. The adjusted odds ratios (OR) estimate of death in COVID-19 for patients with age more than 60 years versus those lower than 60 years was 3.15 (95% CI: 1.06, 9.37). The adjusted OR estimate of death in patients with hypertension comorbidity versus those with no comorbidity was 3.84 (95% CI: 1.27, 11.59). In addition, the adjusted OR estimate (95% CI) of death in patients with respiratory rate above 30 per minute, BUN >20 mg/dL, LDH >942 U/L and SGOT >45 U/L against lower than those values was respectively 10.72 (1.99, 57.68), 5.85 (2.19, 15.63), 13.42 (2.17, 83.22) and 2.86 (1.02, 8.05). The risk of death was higher among the patients with multiple comorbidity diseases, systolic BP lower than 90 mmHg, SPO2 lower than 88 and more than ten days hospitalization in comparison with COVID-19 patients with no comorbidity disease (P=0.002), systolic BP higher than 90 mmHg (P=0.002), SPO2 higher than 88 (P<0.001) and hospitalization for lower than ten days (P=0.012). Our findings suggest that older age, pre-existing hypertension and/or multiple co-morbidities, high respiratory rate, elevated BUN, LDH and SGOT, low systolic BP, and hypoxemia were independently associated with in-hospital mortality in COVID-19 patients. These results can be helpful for physicians and health care workers to improve clinical management and appropriate medical care of COVID-19 patients.
Applying rehabilitative measures is shown to be influential in relieving the medical complications of the COVID-19 disease. Herein, we aimed to assess the effect of a rehabilitation training class on the knowledge and attitude of the caregivers of the COVID-19 patients. Twenty-three caregivers voluntarily filled the questionnaire before and after attending a training class that evaluated the participants' beliefs about the four types of rehabilitations in COVID-19, including musculoskeletal, respiratory, gastrointestinal, and deep vein thrombosis (DVT) prevention. Significant improvement in the caregiver's attitude about the importance of all four rehabilitation types was detected. Also, the knowledge was increased about the necessity of DVT prevention. The level of knowledge in the caregivers of COVID-19 patients in Iran is not satisfactory, which necessitates proper education to achieve the rehabilitation goals rapidly. In-person caregiver training along with presenting pamphlets is of the most useful methods.
Hospital-related infections have been widely reported during the Covid-19 outbreak that exposes healthcare professionals to at greater risk of infection. This cross-sectional study was designed to evaluate the frequency of absenteeism in hospital staff during the first and second months of the Covid-19 pandemic, from 26 February until 19 April 2020. Occupational data and sickness absenteeism characteristics were collected from the records of the nursing management department. 304 (17.8%) had sick leave due to coronavirus or corona-like symptoms. Nurses and then nursing aid workers constituted the categories with more frequency of sick leave. The more median days of sick leave were observed among supervisors and midwives. About 80% of participants had typical symptoms of Coronavirus. In conclusion, the median days of sick leave due to coronavirus were not as high as we thought. This could be due to human resource shortage and insufficient knowledge regarding return-to-work guidelines in the early phase of this pandemic.
To determine and compare ocular characteristics and refractive errors between major thalassemia patients and normal subjects. In this study, 71 thalassemia major patients and 79 age and sex-matched healthy subjects that were selected in an ongoing manner underwent complete optometric and ophthalmic examinations, including autorefraction, subjective refraction, fluorescein tear break-up time, and pachymetry after anthropometric measurements. The results showed that the mean UCVA was better in the control group versus the thalassemia group (P<0.001), while there was no difference in BCVA between the two groups (P=0.416). Moreover, the mean spherical equivalent was 0.38±0.13 D less in the thalassemia group compared to the control group (P=0.007), while corneal power (P<0.001) and cylinder power (P=0.001) were larger in thalassemia patients. The most common type of astigmatism was against the rule pattern in thalassemia patients and with the rule pattern in the control group (P<0.001). The mean tear break-up time was 11.35±6.43 in the thalassemia group and 14.63±5.79 in the control group (P=0.001), and the mean near the point of accommodation (NPA) (P=0.009) and near the point of convergence (NPC). (P=0.003) were significantly smaller in the thalassemia group compared to the control group. These patients suffer from a myopic shift due to exaggerated responses to changes in ocular growth, dry eye secondary to goblet cell loss, and a higher prevalence of vertical astigmatism due to eyelid laxity and pressure on the cornea. Therefore, regular ophthalmological evaluations are highly recommended in these patients.
The aim of this study was to assess the performance of the Framingham, UK Prospective Diabetes Study (UKPDS), and the Action in Diabetes and Vascular disease: Preterax and Diamicron-MR Controlled Evaluation (ADVANCE) risk equations in the prediction of 4-year cardiovascular disease CVD) in Iranian people with type 2 diabetes. The 4-year risks of CVD were estimated using the three equations in a community of 557 patients with type 2 diabetes and free of CVD at baseline. A trained physician evaluated all of the participants regarding the occurrence of CVD events during follow-up. CVD was defined as major events including fatal/non-fatal myocardial infarction as well as fatal/non-fatal stroke, minor events including treated coronary heart disease (CHD), and established peripheral arterial disease (PAD). During four years of follow-up, 64 CVD events were observed (66% minor CVD events). Despite having a good calibration (estimated to observed ratio ranging from 91.37 to 98.2 percent, Hosmer–Lemeshow χ2 (HLχ2) values <15), both general (Framingham) and diabetes-specific (UKPDS and ADVANCE) equations did not have adequate discriminative ability (Area Under the Curve (AUC) ranging from 0.48 to 0.56). Framingham, UKPDS, and ADVANCE risk equations, regardless of being general or diabetes-specific, could not precisely predict 4-year risk of CVD in Iranian individuals with type 2 diabetes.
Chlorine-containing bleach, as a common disinfectant, can cause mild to severe symptoms from nasal irritation to life-threatening conditions such as acute respiratory distress syndrome (ARDS). However, the toxicity level of chlorine gas depends on the duration and concentration of exposure. Herein, we describe the case of a 44-year-old man admitted to the emergency department with a chief complaint of severe shortness of breathing and hemoptysis following accidental, short-time exposure to chlorine-containing bleach. Because of the life-threatening condition, he was transferred to the Intensive Care Unit (ICU) and received mechanical ventilation along with a corticosteroid agent and antibiotic therapy. Despite limited data on management of the severe complications of the exposure, the patient successfully recovered after four days.
Arhinia is an extremely rare condition reported in less than 100 cases so far. We report a case of arhinia with bilateral anophthalmia. In physical examination, only alar portions of the nose were partially formed. No septal, lower, upper lateral cartilages or nasal bones were detectable. Both nostrils were atretic. The orbital area was covered with skin and eyebrows were partially formed. Bilateral complete cleft lip and palate was evident. Surgical interventions should be considered not only for reconstruction of the external nose, but for timely creation of a lacrimal passage and repair of the accompanying cleft lip and palate.
Pyruvate carboxylase deficiency (PCD) is a rare autosomal recessive defect in a biotin-containing enzyme, Pyruvate carboxylase, which is considered as an enzyme of TCA-cycle regulation, gluconeogenesis, lipogenesis, and biosynthesis of neurotransmitters. Increased lactate to pyruvate ratio and decreased 3 hydroxybutyrate to acetoacetate are the main biochemical features of PCD. The elevated level of Citrulline, Proline, and Lysine with a short life span has been reported previously. Patients’ survival in almost all cases is below three months. Here, the authors aimed to report a girl with manifestations of Type B of PCD and longer survival (two-year and four-month-old). This patient did not have any changes in amino acid level which was a unique case of Type B of PCD.