acute

Stress, especially immobility stress, is quite common and one of the most important and influential risk factors in neurological disorders. This study aimed to investigate the effect of acute and chronic immobility stress on the level of cortical and hippocampal oxidative stress indicators and memory impairment following global cerebral ischemia.

Experimental approach:

 In this study, 48 male Wistar rats were randomly divided into 6 groups: 1, sham (S); 2, sham-acute stress (SSA); 3, sham-chronic stress (SSC); 4, ischemia (IS); 5, ischemia-acute stress (ISA); 6, ischemia-chronic stress (ISC). The Morris water maze (MWM) test was performed 14 days after surgery, and cortisol levels and oxidative stress factors such as malondialdehyde MDA and total thiol were measured.

In the MWM test, the time to find the platform (latency time) in the ISC and IS groups significantly increased compared to the S group. The time spent in the target quarter in these two groups was significantly reduced compared to the S group on the day of the probe. The results showed a significant increase in cortisol levels and malondialdehyde concentration in the ISA, ISC, and IS groups compared to the S group, but there was no significant difference in total thiol concentration. No significant difference was observed in the level of oxidative stress factors in the cortex.

Conclusion and implication: 

Chronic immobility stress could reduce antioxidant factors in the hippocampus and exacerbate memory impairment caused by global ischemia.

Chlorine gas is readily available as a chemical warfare agent (CWA) and a toxic industrial chemical (TIC). Lots of accidental chlorine releases have been reported worldwide. This review examined the harmful effects of chlorine gas exposure, including both acute and chronic toxicity, in people.  

This systematic review was conducted to determine the acute and chronic toxic effects of acute chlorine gas exposure in subjects after accidental events. Original research studies on acute and chronic effects of patients acutely exposed to chlorine gas in industrial and accident events published in English until August 2023 were included. Related Mesh terms and keywords searched relevant studies from PubMed, Scopus, and Wiley databases.  

Overall, 34 eligible studies with 6301 individuals were included in the final assessment. Reports demonstrated that the early effects of acute exposure to chlorine gas vary from mucosal irritation to decrease, depending on the severity of the exposure. The most common chronic effects were the respiratory tract. The severity of complications depends on the dose and duration of chlorine exposure.  

The findings showed that chlorine exposure could cause respiratory, vascular, cardiovascular, neurological, and psychiatric complications; therefore, it is recommended that subjects exposed to chlorine gas should be monitored regularly after hospital discharge.

This case report documents a unique presentation of hepatic encephalopathy induced by the reactivation of chronic hepatitis B due to Cytomegalovirus (CMV) infection in a 76-year-old female patient. The patient was admitted with a diminished level of consciousness subsequent to a week of anorexia, intermittent fever, chills, postprandial nausea, and vomiting. Laboratory tests revealed significant hepatocellular injury, while imaging suggested cirrhosis. The presence of hepatitis B surface antigen and a detectable hepatitis B virus (HBV) DNA qualitative analysis was noted, alongside an elevated CMV viral load, indicating reactivation of chronic hepatitis due to CMV infection. Therapeutic interventions included Ganciclovir for CMV infection, Colistin for an Enterococcus urinary infection, and Tenofovir for hepatitis. Upon stabilization, the patient was discharged for continued medical management. The case highlights the significance of considering reactivation of chronic viral hepatitis in the differential diagnosis of hepatic encephalopathy. It underscores the critical role of comprehensive diagnostic investigation in patients presenting with reduced consciousness, especially those with a history of liver disease. Moreover, it emphasizes the importance of managing concurrent infections in the context of liver disease, and serves as a reminder of the potential for CMV to reactivate chronic hepatitis, leading to serious complications such as hepatic encephalopathy.

Toxoplasma gondii is one of the most common parasites worldwide. It is of great importance to identify new potential drugs that are effective and less harmful in pregnant women and newborns. We investigated nanoemulsion miltefosine (NEM) in treating experimental acute and chronic toxoplasmosis.

A combination of triacetin, Tween 80, and ethanol (1:2) was used for the development of NEM formulations. The size of NEM was calculated to be 17.463 nm by DLS and TEM. To investigate the performance of miltefosine (MLF), NEM, sulfadiazine (SDZ), and pyrimethamine (PYR) (positive control) in vivo, acute toxoplasmosis was induced in mice by an intraperitoneal injection of RH strain tachyzoites. After five days, the mice were examined for the number and condition of tachyzoites and histopathological changes in the liver and spleen. Chronic toxoplasmosis was investigated in rats and the number and size of brain cysts along with histopathological changes were assessed in different groups.

The results of the in vivo assessment of drugs in acute toxoplasmosis showed the following order regarding a decrease in the number of tachyzoites and an increase in survival rate: SDZ&PYR > NEM > MLF. The effects of drugs on chronic toxoplasmosis showed a significant effect of NEM (50%) on reducing the number of cysts compared to SDZ&PYR (10%) and MLF (12%) and reducing the size of NEM brain cysts (21%) compared to SDZ&PYR (5 %) and MLF (8%).

Increasing the penetration of NEM through the blood-brain barrier (BBB) and subsequently reducing the number and size of T. gondii tissue cysts is a promising new drug in treating chronic toxoplasmosis.

Distinguishing between ruptured and non-ruptured acute appendicitis presents a significant challenge. This study aimed to validate the accuracy of RAMA-WeRA Risk Score in predicting ruptured appendicitis (RA) in emergency department.

This study was a multicenter diagnostic accuracy study conducted across six hospitals in Thailand from February 1, 2022, to January 20, 2023. The eligibility criteria included individuals aged >15 years suspected of acute appendicitis, presenting to the ED, and having an available pathology report following appendectomy or intraoperative diagnosis by the surgeon. We assessed the screening performance characteristics of RAMA-WeRA Risk Score, in detecting the ruptured appendicitis (RA) cases.

860 patients met the study criteria. 168 (19.38%) had RA and 692 (80.62%) patients had non-RA. The area under the receiver operating characteristic curve (AuROC) of RAMA-WeRA Risk Score was 75.11% (95% CI: 71.10, 79.11). The RAMA-WeRA Risk Score > 6 points (high-risk group) demonstrated a positive likelihood ratio (LR) of 3.22 in detecting the ruptured cases. The sensitivity and specificity of score in > 6 cutoff point was 43.8% (95%CI: 36.2, 51.6) and 86.4% (95%CI: 83.6, 88.9), respectively.

The RAMA-WeRA Risk Score can predict rupture in patients presenting with suspected acute appendicitis in the emergency department with total accuracy of 75% for high-risk cases. 

Following the prevalence of severe acute respiratory syndrome-coronavirus (SARS-CoV2) in the world, a type of severe involvement in children was reported as multisystem inflammatory syndrome in children (MIS-C) involving various organs, such as lung, skin, heart, kidney, gastrointestinal tract, and eyes, acute abdomen as a manifestation of this syndrome is rarely reported. To introduce children with MIS-C with fever and acute abdomen who underwent appendectomy.

Case Report: 

Six children between the ages of 8 to 12 years (3 boys and 3 girls) presented with acute abdominal pain, fever, and vomiting, due to obvious tenderness and rebound tenderness in the right lower quadrant of the abdomen and other clinical and laboratory symptoms, 4 of them underwent emergency appendectomy.

Due to the lack of improvement in abdominal pain and the symptoms and problems in various organs in patients, such as heart (three cases of myocarditis, one case of pericardial effusion), kidneys (two cases of increased urea and creatinine), skin (four cases of skin rash), lung (six cases of pulmonary involvement and two cases of pleural effusion), gastrointestinal tract (abdominal pain and vomiting and three cases of diarrhea), and laboratory symptoms in the form of increased acute phase reactors and (D dimer ) and most cases of lymphopenia (six cases) and evidence of COVID-19 infection (positive polymerase chain reaction [PCR] or COVID-19 positive serology, or compatible imaging and laboratory symptoms), MIS-C was diagnosed and treated for these patients. Patients were treated with corticosteroids and intravenous immune globulin (IVIG) and enoxaparin and other medications and fortunately, all cases improved. In addition, the pathology report after appendectomy was appendicitis in most cases.

Four cases that showed clinical manifestations of acute abdomen underwent surgery without overall complications. In some of these patients, appendicitis was the cause of abdominal pain, and in some patients, inflammatory response to COVID-19 (e.g. mesenteric adenitis) was the cause of pain and no mortality was reported. In most patients, inflammatory markers, such as CRP and ESR were elevated, and albumin levels were mildly decreased during admission and ferritin and D-dimer levels were abnormal in most patients. Four cases had cardiac involvement and all MIS-C patients were treated with steroids and IVIG, respectively. Also, no mortality was reported in patients treated with corticosteroids.

Therefore, it is essential to note that in children with a complaint of abdominal pain and have symptoms in favor of an acute abdomen; attention should be paid to the symptoms of the involvement of other body systems due to (MIS-C).

Epilepsy, as a neurological disease, can be defined as frequent seizure attacks. Further, it affects many other aspects of patients’ mental activities, such as learning and memory. Scorpion venoms have gained notice as compounds with potential antiepileptic properties. Among them, Buthotus schach (BS) is one of the Iranian scorpions studied by Aboutorabi et al., who fractionated, characterized, and tested this compound using electrophysiological techniques in brain slices (patch-clamp recording). In the present study, the fraction obtained from gel electrophoresis was investigated through behavioral and electrophysiological assays. At first, ventricular cannulation was performed in rats, and then the active fraction (i.e., F3), carbamazepine, and the vehicle were microinjected into the brain before seizure induction by the subcutaneous (SC) injection of pentylenetetrazol (PTZ). Seizure behaviors were scaled according to Racine stages. Memory and learning were evaluated using the Y-maze and passive avoidance tests. Other groups entered evoked field potential recording after microinjection and seizure induction. Population spike (PS) and field excitatory postsynaptic potential (fEPSP) were measured. The F3 fraction could prevent the fifth stage and postpone the third stage of seizure compared to the control (carbamazepine) group. There was no significant improvement in memory and learning in the group treated with the F3 fraction. Also, PS amplitude increased significantly, and long-term potentiation was successfully formed after the high-frequency stimulation of the performant pathway. Our results support the antiepileptic effects of the F3 fraction of BS venom, evidenced by behavioral and electrophysiological studies. However, the effects of this fraction on memory and learning were not in the same direction, suggesting the involvement of two different pathways.

Allogenic hematopoietic stem cell transplantation is considered as an effective treatment for patients with acute myeloid leukemia. However, complications of transplantation, like aGVHD, affect the efficiency of allogenic hematopoietic stem cell transplantation. The present study aimed to implement different models of data mining (DM) (single and ensemble) for prediction of allogenic hematopoietic stem cell transplantation in patients with acute myeloid leukemia (transplantation against host disease). We conducted this developmental study on 94 patients with 34 attributes in Taleghani Hospital, Tehran, Iran, during 2009–2017. In this practical study, data were analyzed via decision tree (DT) algorithms, including decision tree, random forest and gradient boosting (ensemble learning), artificial neural network (Single Learning), and support vector machine. Some criteria, like specificity, accuracy, Fmeasure, AUC (area under curve), and sensitivity, were reported in order to evaluate DT algorithms. There were 34 transplantation-related variables; some predictors, such as liver, hemoglobin, and donor blood group, were found to be the most important ones. To predict aGVHD, the two selected algorithms included the most appropriate DM models, artificial neural network and support vector machine classifiers, with ROC of 100. This study indicated that DT algorithms could be successfully used for approving the efficiency of the models predicting allogenic hematopoietic stem cell transplantation.

In this study, a patient who developed acute hepatitis due to drinking Pistacia vera L. bud tea is presented. A twenty-eight-year-old woman who had just come out of the postpartum period applied to our clinic with complaints of nausea,vomiting, loss of appetite and weakness. Blood serum alanine aminotransferase and aspartate aminotransferase levelswere increased. All serological tests were negative for viral hepatitis and autoimmune diseases. She had been drinkingan herbal tea containing Pistacia vera L. bud every day for four weeks to increase milk production. Three weeks afterdiscontinuation of herbal tea, liver enzymes returned to normal. Based on our knowledge, this is probably the firsthepatitis report due to the use of an herbal tea containing Pistacia vera L. bud.

Adopting a suitable strategy to reduce the complications of cholecystectomy plays a significant role in the well-being of patients. We investigated the effects of atorvastatin on clinical symptoms, and inflammatory markers of patients undergoing cholecystectomy.

This double-blind randomized controlled trial was conducted in Imam Reza Hospital, Birjand in 2021. In this study, 47 patients received 40 mg atorvastatin (intervention group) and 47 patients received placebo both daily for 4 weeks (placebo group). Then, the frequency of fever, abdominal pain, and nausea before and after cholecystectomy, as well as peri-operative data (duration of operation, and intraoperative bleeding) and laboratory data [White Blood Count (WBC), C-Reactive Protein (CRP), Aspartate AminoTransferase (AST), and Alkaline Phosphatase (ALT)] was collected. The data was analyzed using (SPSS Version 22) based on chi-squared, and independent t-tests at the significance level of (P≤0.05).

The duration of hospitalization was not significantly different in both groups (P=0.26), however, the duration of operation was significantly longer in the intervention group (P<0.001). The frequency of fever, abdominal pain, and nausea after cholecystectomy was not statistically different (P>0.05). The volume of intraoperative bleeding in the placebo group was more than the intervention group (P=0.05). The decrease of WBC, CRP, and the ALT levels after cholecystectomy was not statistically different (P>0.05); however, AST level after cholecystectomy was higher in the intervention group (P=0.05).

The use of atorvastatin effectively reduced the volume of intraoperative bleeding. However, this intervention with this dose and duration could not have a significant role in reducing the duration of patients’ hospitalization, duration of operation, and levels of WBC, CRP, ALT, and AST.

Acute hindlimb ischemia is a peripheral arterial disease that severely affects the patient’s health. Injection of stem cells-derived exosomes that promote angiogenesis is a promising therapeutic strategy to increase perfusion and repair ischemic tissues. This study aimed to evaluate the efficacy of adipose stem cell-derived exosomes injection (ADSC-Exos) in treating acute mouse hindlimb ischemia.

ADSC-Exos were collected via ultracentrifugation. Exosome-specific markers were analyzed via flow cytometry. The morphology of exosomes was detected by TEM. A dose of 100 ug exosomes/100 ul PBS was locally injected into acute mice ischemic hindlimb. The treatment efficacy was evaluated based on the oxygen saturation level, limb function, new blood vessel formation, muscle structure recovery, and limb necrosis grade. 

ADSC-exosomes expressed high positivity for markers CD9 (76.0%), CD63 (91.2%), and CD81 (99.6%), and have a cup shape. After being injected into the muscle, in the treatment group, many small and short blood vessels formed around the first ligation and grew down toward the second ligation. The SpO2 level, reperfusion, and recovery of the limb function are more positively improved in the treatment group. On day 28, the muscle’s histological structure in the treatment group is similar to normal tissue. Approximately 33.33% of the mice had grade I and II lesions and there were no grade III and IV observed in the treatment group. Meanwhile, in the placebo group, 60% had grade I to IV lesions. 

ADSC-Exos showed the ability to stimulate angiogenesis and significantly reduce the rate of limb necrosis.

Research capacity building and self-efficacy are essential skills for medical students that greatly help them to participate in research. The present study aimed to investigate the relationship between academic stress and research self-efficacy in medical students through the mediating role of research spirit.
Materials &

This descriptive-correlational study used path analysis to examine the relationships between the variables. The statistical population was all postgraduate medical students in Ilam in the academic year 2022-2023, of whom 301 students were selected using convenience sampling. They completed the Research Self-Efficacy Scale, the Academic Stress Scale, and the Research Spirit Questionnaire. Evaluation of the proposed model was done using path analysis.

There was a negative correlation between academic stress and research spirit (p<0.001). There was a significant positive correlation between research spirit and research self-efficacy (p<0.001), whereas there was no significant correlation between the direct path of academic stress to research self-efficacy. Also, there was a significant correlation between the indirect path connecting academic stress and research self-efficacy through research spirit (p<0.01).

Based on the results, the proposed model shows a good fit and is a major step toward identifying factors influencing research self-efficacy among medical students.

The B-cell-specific Moloney murine leukemia virus integration site1 (BMI-1) is one of the famous members of the Polycomb ring finger group, which plays a crucial role in the gene transcription regulation through histone changes. Hence, it is believed to be necessary to further clarify the effects of the BMI-1 clinical.

This cross-sectional study was conducted on 70 acute myeloid leukemia (AML), 70 chronic myeloid leukemia (CML), and 20 healthy individuals, as the control group. We used real-time quantitative polymerase chain reaction in order to assess the BMI-1 level expression and its effect on prognosis in AML patients in the Molecular Pathology Research Center.

The results of the present work indicated that the BMI-1 overexpression was significantly higher in the AML and CML patients compared with that in the healthy controls (P < 0.001). Furthermore, a significant relationship was observed between the BMI-1 overexpression and poor prognosis in the AML patients (Hazard ratio=1.749, P < 0.001, 95% confidence interval = 1.31-2.32). Additionally, BMI- 1high was found in chronic and blastic phase in the CML patients (P < 0.001).

We concluded that investigation of BMI-1 gene expression pattern will be conducive to the prognosis and treatment of myeloid leukemia.

Hypocellular acute myeloid leukemia (AML) is an infrequent and challenging entity, and superinfection with coronavirus disease 2019 (COVID-19) could further complicate its diagnosis and management. It is characterized by low bone marrow cellularity, prominent cytopenias, and in many cases, clinically simulate aplastic anemia and hypoplastic myelodysplastic syndrome. We report a case of hypocellular AML-M2 in a 65-year-old male who was found to be COVID-19-positive. The cause of hypoplasia of bone marrow in such cases is still ambiguous and could be due to infiltration by blasts or co-infections. The cause of hypoplasia must be determined for proper management, which requires analysis of more such cases.

In the present research, we reported an acute myeloid leukemia subject. The patient was treated with Cytarabine 200 mg/m2 per day with continuous IV infusion on days 1, 2, 3, 4, Etoposide 100 mg/m2 per day with continuous IV infusion on days 1, 2, 3, 4, Idarubicin 12 mg/m2 as a 4-hour IV infusion on days 2, 4, 6, and Mitoxantrone 10 mg/m2 as a 30-minute IV infusion on days 1, 2, 3. During treatment, the patient suffered from 3 life-threatening complications caused by chemotherapy drugs include sinusoidal obstruction syndrome (SOS), refractory thrombocytopenia, and pericardial effusion with pericardiocentesis limitation. To this end, we tried three novel approaches for patient management by Corticosteroid and Colchicine. Intravenous immunoglobulin infusion and oral prednisolone (2 mg/kg/d) were not effective in thrombocytopenia. However, eltrombopag (25 mg/kg/d) response was dramatic. Moreover, pericardial effusion and respiratory distress during the first chemotherapy course were managed with Lasix (2 mg/kg/d) and Spironolactone (25 mg/d); meanwhile, the massive pericardial effusion during the second chemotherapy course was managed with Colchicine (0.5 mg/d) through the mentioned treatment. Fortunately, these approaches were effective and life-saving.

COVID-19 has affected the pattern of referral to medical centers and quarantine against COVID-19 might delay referral and management of surgical emergencies. This study aimed to compare the pooledevent rate of pediatric perforated appendicitis before and during the COVID-19 pandemic.

This wasa systematic review and meta-analysis study based on the PRISMA guidelines. Scopus, Web of Sciences, andPubMed databases were searched for studies reporting the rate of perforated appendicitis based on the post-appendectomy observations or imaging methods. The Egger bias test and funnel plot were used to detect anddepict publication bias. Statistical analysis was performed in Comprehensive Meta-analysis package version 3.

Twelve studies were eligible for inclusion in our study. The pooled prevalence of pediatric perforatedappendicitis in the pre-COVID era was 28.5% (CI95%: 28.3 to 28.7%) with a heterogeneity of 99%. In the COVIDera, the event rate proportion was 39.4% (CI95%: 36.6 to 42.3%) with a heterogeneity of 99%. There was a sig-nificant difference in the subgroup analysis within the pre-COVID and COVID era (P<0.001), showing a higherperforation rate in the COVID era.

Our study showed that during the COVID-19 pandemic, the rateof perforated appendicitis has significantly increased in comparison to before the COVID-19 pandemic.

During the coronavirus disease 2019 (COVID-19) pandemic, COVID-19 vaccination is essential for controlling the outbreak and preventing severe disease. However, there are still uncertainties about the safety of COVID-19 vaccination in individuals with chronic liver disease.

Three patients with hepatitis B virus (HBV) infection presented to our hospital with acute-on-chronic liver failure (ACLF) due to HBV flare after COVID-19 vaccination (mRNA-1273 and ChAdOx1 nCoV-19). Their COVID-19 antibodies were tested by Elecsys Anti-SARS-CoV-2 S immunoassay, which showed good response after full two-dose course of vaccine. One patient refused the test. The patients’ clinical conditions deteriorated during hospitalization. Patient 1 received Entecavir (Baraclude) 1 mg/day upon presentation, but the serum bilirubin level and international normalized ratio (INR) kept increasing. He was comatose in one week and underwent urgent living donor liver transplantation. Patient 2 was on regular Entecavir (Baraclude) 0.5 mg/day and was increased to 1 mg/day upon admission. The serum bilirubin level and INR kept increasing, and he developed grade 3 hepatic encephalopathy in three weeks. The patient then received urgent living donor liver transplantation. Patient 3 received Entecavir (Baraclude) 1 mg/day upon presentation. Her serum bilirubin and INR kept increasing, and her mental status altered in a week. She did not undergo liver transplantation for her old age.

It is not still unclear whether there is a cause-and-effect relationship between COVID-19 vaccination and HBV infection flare. Furthermore, the mechanism of COVID-19 vaccine-induced HBV reactivation is not established. Further studies are needed in this regard. However, during the COVID-19 pandemic, prophylactic antiviral therapy for HBV infection before COVID-19 vaccination should be considered.