nima azh

Acute cholecystitis, primarily an inflammatory condition of the gallbladder, has been associated with electrocardiographic (ECG) changes that mimic cardiac pathology. While laparoscopic cholecystectomy is a well-established treatment for acute cholecystitis, its potential impact on postoperative ECG changes in patients without pre-existing cardiovascular disease remains unclear. This study aims to investigate the incidence and nature of ECG alterations following laparoscopic cholecystectomy in patients without prior cardiac disease.

In this single-arm cohort study, we reviewed 75 patients who underwent laparoscopic cholecystectomy for acute cholecystitis at Firouzabadi General Hospital between March 2020 and March 2021. Patients with pre-existing cardiac conditions or abnormal preoperative ECGs were excluded. A 12-lead ECG was performed within 48 hours before and 24 hours after surgery. ECGs were analyzed by a cardiologist and an internist, and discrepancies were resolved through consensus. The difference in the incidence of postoperative ECG changes was assessed using McNemar’s Chi-Square test.

Among the 75 patients included (mean age: 47.38 ± 13.16 years, 74.7% female), four patients (5.3%) had benign T-wave inversions before surgery. Following surgery, 13 patients (17.3%) exhibited new ECG changes, including T-wave inversions (precordial: 5, limb leads: 5) and ST-segment depressions (precordial: 1, limb leads: 2). McNemar’s Chi-Square test indicated a statistically significant increase in ECG changes postoperatively (p = 0.012). All patients were discharged without persistent ECG abnormalities or major postoperative complications.

This study suggests a potential association between laparoscopic cholecystectomy and transient ECG alterations in patients without prior cardiac disease. Proposed mechanisms include gallbladder manipulation, sympathetic adrenergic stimulation, and laparoscopy-induced hemodynamic stress. Future studies with larger cohorts and control groups undergoing non-biliary laparoscopic surgeries are needed to delineate the effects of cholecystectomy from those of laparoscopy itself on cardiac electrophysiology.

Coronavirus disease 2019 (COVID-19) leads to the activation of immune cells, especially in patients developing severe disease, and induces lymphopenia, primarily affecting the cluster of differentiation 4 T-cell (CD4+ T) subset. The presence of lymphopenia and cytokine storm may play a major role in the pathogenesis of COVID-19. This prospective single-center study aimed to assess the association between CD4 cell levels and the severity and prognosis of COVID-19 pneumonia, comparing the differences in lymphocyte subsets and inflammatory biomarkers between severe and non-severe cases using flow cytometry.

Between March 1 and June 30, 2020, a cohort of 122 RT-PCR-confirmed COVID-19 patients was enrolled in this prospective study. CD4 levels and other laboratory data were measured at the beginning of hospitalization.

Of the 122 patients, 56 were admitted to the respiratory ward and 66 to the ICU. ICU patients had significantly lower CD4 counts (368.93 cells/μL) compared to non-ICU patients (562.24 cells/μL) (P = 0.001). Serum C-reactive protein (CRP) levels were significantly higher in ICU patients (85.06 ± 41.85 mg/dL) than in non-ICU patients (57.29 ± 27.51 mg/dL) (P = 0.01), and a negative correlation was observed between CRP and CD4 levels (P = 0.03). Mortality was significantly higher in ICU patients (40.9%) compared to non-ICU patients (19.6%) (Odds Ratio = 2.83, P = 0.006).

Our study demonstrates that lower CD4+ T-cell counts on admission are strongly associated with increased disease severity and poor prognosis in COVID-19 patients. The correlation between lower CD4 levels and higher CRP suggests that CD4+ T cell depletion may be a critical marker for predicting clinical outcomes. These findings highlight the potential role of CD4+ T-cell monitoring in managing severe COVID-19 cases and improving prognostic assessments.

 Health systems must have functional and efficient preparedness and response plans to manage pandemics. Moreover, it is essential to adjust to changing circumstances and the dynamic character of pandemics. The World Health Organization (WHO) introduced the Strategic Preparedness and Response Plan (SPRP), emphasizing 144 measures across 10 pillars, helping governments prepare and respond to the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to determine how the Iranian health system, based on the WHO—SPRP, addresses strategic preparedness and response plan in the COVID-19 pandemic at the national level.

 The WHO–SPRP was adopted and translated into Persian by 2 bilingual natives. The chief of the health office requested that authorized officers complete the SPRP. Then, a meeting was held by officers of related units involved in COVID-19 management to address the SPRP at regional and national levels. 

 Our findings suggest that up to August 2020, effective risk communication and community engagement were not fully established. Our response plan lacked evidence-based information and educational messaging to consistently shape public opinion and impression of a respiratory pandemic.

 The Iranian health care system and services were almost able to address the SPRP and perform the major indicators that the WHO had proposed.  However, special attention should be paid to risk communication and community engagement to empower informed decision-making by individuals and communities.

Uterine cancer affects more than 1.28 million people worldwide; considering current world trends in obesity and aging, a +52.7% growth by 2040 is foreseen. Around 5% of endometrial cancer patients are less than 40 years old, meaning that conventional oncologic approaches would result in fertility loss; thus, it is essential to consult patients regarding their fertility and family planning. Owing to developments of oncofertility, patients are now able to preserve their fertility and complete their childbearing, drafting from the standard of care in endometrial cancer. Strict criteria should be applied to make sure of selecting patients who benefit most from the fertility preservation approach. Furthermore, careful selection of patients increases the possibility of successful treatment. Most candidates for fertility preservation have risk factors in common with infertility, including polycystic ovarian syndrome, obesity, increasing of age and irregular menses; therefore, Advanced Reproductive Technology (ART) can improve their chances for pregnancy. Current applied knowledge towards the fertility preservation approach in patients with endometrial cancer is reviewed in this article.

The evaluation of reinfection and the genetic structure of all human and virus genomes could help to develop programs and protocols for providing services and ultimately to prevent the disease by producing more effective vaccines. Therefore, the aim of this study was to investigate the presence and occurrence of COVID-19 reinfection through a narrative review study.

We searched the Medline (PubMed), Embase, Scopus, Web of Science, Cochrane library, Ovid, and CINHAL databases. Inclusion criteria included all studies whose main purpose was to provide information about the occurrence or presence of reinfection in patients with COVID-19. An independent samples t test was used to compare the continuous outcomes between the 2 groups.

The mean duration of the first episode in the group with mild or moderate COVID-19 was 24.42±1.67 days, and it was 21.80±3.79 days in the group with severe COVID-19.  The mean duration of the second episode (reinfection) in patients with mild or moderate form was 15.38 ± 5.57 days, and it was 19.20±2.98 days in patients with severe form. In both episodes, the duration of the disease did not significantly differ between the 2 groups (p=0.484 in the first episode; p=0.675 in the second episode), but the interval to the occurrence of reinfection in patients with the mild or moderate form was significantly longer than those with the severe form (p<0.001). In this instance, the time interval in patients with the mild or moderate form was 36.63±5.71 days while in those with the severe form of the disease it was 29.70±5.65 days. Besides, the genomes of the viruses isolated from the first and second episode were different. 

According to the results, all patients should be very careful about the severity of the second episode because of the more need for medical interventions for saving the patients. The interval between the first end and the second episode as well as the duration of each episode is highly important for better management of the disease.