Acta Medica Iranica
Volume:58 Issue: 8, Aug 2020

Coronary artery disease (CAD) is a common multifactorial disease with a high rate of morbidity and mortality worldwide. The MEF2A gene transcription factor belongs to the myocyte enhancer factor-2 (MEF2) family and is involved in critical processes such as calcium-dependent signaling pathways and cardiac development. Although the variants of the MEF2A gene were studied in different CAD and myocardial infarction (MI) populations, the reality of this gene association with CAD is still unclear. This study reports the first in silico investigation on MEF2A variants. All reported variants in CAD/MI patients were collected from eleven countries. Their pathogenicity and variant position conservation were surveyed by online prediction tools, including Mutation-Taster, Polyphen-2, PROVEAN, SIFT, CADD, and GERP. In silico analysis did not confirm the pathogenic effect of 21-bp deletion, which was introduced as a monogenic cause of CAD. c.704C>A (p.S235Y), c.812C>G (p.P271R), c.836C>T (p.P279L) and c.848G>A (p.G283D) missenses, c.1315C>T (p.R439X) nonsense, and seven out-of-frame deletions were predicted as disease-causing variants. Although some variants of the MEF2A gene affect protein structure, the MEF2A variation studies in CAD/MI patients and in silico analysis do not approve the association and pathogenicity of MEF2A variants in the familial/sporadic CAD.

The high risk of lipid abnormalities in type 2 diabetic (T2D) patients with uncontrolled hyperglycemia may be associated with an increased risk of cardiovascular complications. The aim of the current study was to investigate the association between glycated hemoglobin )HbA1c( and lipid profile levels in T2D patients. This cross-sectional study was conducted on 802 T2D patients, aged≥ 40 years, visiting the Abu Reyhan Clinic of Shahid Mohammadi Hospital in Bandar Abbas, Iran. Serum lipid profiles were measured by the enzymatic method. Diabetes was defined based on the criteria of the American Diabetes Association. The association of HbA1c and estimated glomeruli filtration rate (eGFR) with lipid profile indices was assessed using the Spearman correlation coefficient test and linear regression model. The mean±SD age of participants (27.7% of men) was 53.55±5.56 years. The mean±SD of HbA1c and eGFR for all subjects were 8.97±2.14 and 86.30±17.48, respectively. In this study,a positive association was observed between HbA1c and fasting blood glucose (r=0.619, β=0.635), total cholesterol (r=0.165, β=0.188), triglycerides (r=0.103, β=0.095), and low-density lipoprotein cholesterol (r=0.162, β=0.173), (P<0.01). Also, an inverse association has been observed between eGFR level and TGs (r=-0.08, β=-0.096) and FBS (r=-0.123, β=-0.172), (P<0.05). Our findings suggested that HbA1c is not only an applicable predictor of long-term glycaemic control but also can be considered as a potential biomarker for predicting lipid abnormalities in T2D patients.

Cerebral venous sinus thrombosis is an important pathology with various clinical symptoms. Early detection of thrombosis is very important for the improvement of the prognosis. The aim of this study was to calculate the diagnostic value of T2-weighted sequences of magnetic resonance imaging (MRI) in detecting subacute thrombosis. All patients that were suspected of having subacute cerebral venous sinus thrombosis and were referred to the emergency center of Kashani hospital (between September 2018 and September 2019) were entered into the study. Magnetic resonance venography (MRV) and T2-weighted MRI were accomplished for each patient. The sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of MRI using MRV as the reference method were calculated. A total of 630 patients were entered into the study. A positive subacute venous sinus thrombosis was detected in the MRV of 53 patients; consequently, the sensitivity of 60%, the specificity of 80%, the PPV of 21%, and the NPV of 96% were calculated. MRI was highly specific for detecting the subacute thrombosis of superior sagittal sinus, transverse sinuses, sigmoid sinuses, and straight sinus (specificity>94%). A substantial agreement was detected between MRI and MRV in distinguishing thrombosis of superior sagittal sinus, transverse sinuses, sigmoid sinuses, and straight sinus (kappa>0.6). T2-weighted MRI is a specific method in detecting cerebral venous sinus thrombosis. In a patient with signs of thrombosis in the T2-weighted sequence, additional workups are highly suggested to rule out the pathology.

The diagnosis of polycystic ovary syndrome (PCOS) and metabolic syndrome (MS) in adolescents is clinically challenging. It is on the rise as consistent with the increasing trends in obesity rates. This study aimed to investigate the prevalence of PCOS in adolescents by the National Institutes of Health (NIH) criteria and compare the prevalence of insulin resistance (IR) and metabolic syndrome (MS) between obese (OB) and non-obese (NOB) adolescents with PCOS. This was cross-sectional research with multi-stage cluster random sampling. Participants were 15-18-year-old girls from high schools in Semnan, Iran. The ones who had a history of menstrual dysfunction underwent clinical and hormonal tests. From among a total of 900 participants, 74 girls (8.2%) had a history of menstrual dysfunction. The prevalence of PCOS was 6.44% by NIH criteria. The prevalence of abnormal glucose metabolism, MS, and IR in girls with PCOS were 8(13.7%), 6(10.3%), 24(41.4%), respectively. The OB-PCOS group with a mean BMI of 28.21±1.26 kg/m2 had a significantly greater prevalence of MS, high BP, waist circumference ≥88 cm, and higher IR than NOB-PCOS cases with a mean BMI of 20.54±2.97 kg/m2. Abnormal glucose metabolism was prevalent in adolescents with PCOS and occurred with equal frequency in OB and NOB PCOS groups. Obesity could worsen IR, MS, and some of the components of Mets in PCOS adolescents.

There is little consensus about type of the maintenance fluid therapy and it’s effect on serum sodium in adults. Thus, this study was conducted to assess the effect of maintenance fluid therapy on serum sodium of hospitalized patients in intensive care unit. This randomized clinical trial was carried out on 64 patients aged 18-90 years hospitalized in intensive care unit (ICU) of Imam Sadjad and Shahid Beheshti hospitals, Yasuj, Iran in 2017. These patients were randomly allocated to take 2500-3000 milliliter of intravenous maintenance isotonic (0.9% saline) or hypotonic (0.45% saline) fluids daily. Blood and urine samples were taken to measure biochemical parameters before and 48 hours after intervention.  Data analyses were done by using SPSS 16 software via descriptive and analytic statistics. Twenty eight patients in 0.9% saline group (19 male and 9 female) and 32 patients in 0.45% saline (20 male and 12 female) completed the study. There was no significant difference between two groups in sodium (P=0.94), potassium (P=0.21), sugar (P=0.91), creatinine (P=0.21), Blood Urea Nitrogen (P=0.99), systolic (P=0.81) and diastolic (P=0.73) blood pressure, PH(P=0.27), bicarbonate(P=0.8), and urine specific gravity(P=0.73). Based on the results of this study, it was shown that administration of maintenance hypotonic fluids has been appropriate for the patients and will not face them with the risk of hyponautremia.

Fertility preservation counseling has a high priority in young breast cancer (BC) patients. Cytotoxic chemicals used for chemotherapy in these patients increased the risk of premature ovarian failure. This study evaluated the anti-mullerian hormone (AMH) level at the time of diagnosis and within a month after the end of chemotherapy, while predicting the time of the return of ovarian function in BC cases (n=46) younger than 46 years for the first time in Iran. Cases were selected from those attending the breast oncology clinic of the two hospitals with a newly diagnosed in situ or invasive BC. The present study results showed AMH levels were significantly decreased in almost all women within a month after chemotherapy. It seems that the need for fertility preservation depends on patient age and baseline AMH level, but counseling should be offered by the clinician in young breast cancer patients.

The aim of the study was to determine the psychological characteristics of mothers of children with cerebral palsy. The study included a sample of 30 respondents. The sample consisted of mothers of children with cerebral palsy, chronologically aged 25 to 60. The research was conducted at the Centre for Children with Multiple Disabilities “Koraci Nade”. For the purpose of checking the set research aim, Symptom Checklist-SCL-90-R, consisting of a list of 90 particles (problems), was applied, and the task was to assess the respondent's anxiety about each of the aforementioned problems over the past week (e.g., headaches, tension or anxiety, excessive worrying). The survey data were processed using the parametric statistics method. Central tendency measures, dispersion measures were calculated, and a tabular presentation of the results was done. Based on the results of the research, it can be concluded that the mothers of children with cerebral palsy have the most pronounced problems in areas of somatization, depression, obsessive-compulsive disorders, as well as anxiety.

The present study intended to determine the relationship of occupational adjustment with psychological empowerment and job burnout of nurses. This descriptive correlational study was conducted on 209 nurses working in educational hospitals. The eligible nurses were enrolled in the study through simple random sampling and filled out the demographic questionnaire, the Dawis and Lofquist Occupational Adjustment questionnaire, the Spreitzer Psychological Empowerment Instrument, and the Maslach Burnout Inventory. There was a significant positive relationship between occupational adjustment and psychological empowerment (P<0.001) and a significant negative relationship between occupational adjustment and job burnout of nurses (P<0.001). Regression analysis showed that occupational adjustment explained 46% of the psychological empowerment variance and 52% of the job burnout variance. The occupational adjustment has a significant positive relationship with psychological empowerment and a significant negative relationship with job burnout among nurses. Considering that nurses experience severe burnout in their work environment, programs should be developed to improve the psychological empowerment of nursing care.

Tuberculosis (TB) is the major problem being faced worldwide, particularly in developing countries, and therefore, it is important to recognize the unusual presentations of the disease. Although TB is primarily lung disease, it can affect several other organs such as bone, brain, liver, and intestine etc. Liver involvement in TB is not uncommon but isolated liver TB is the rarest form of TB. A common observation is that the mortality rate is higher in intra-abdominal TB as compared to pulmonary TB, but it is a difficult diagnosis to make, often requiring laparotomy. Liver tuberculoma is, in particular, rare, with fewer than 100 cases reported in the literature, most of which are secondary and associated with miliary TB. We present a case of primary hepatic tuberculoma in an immuno-competent host and illustrate how these cases can be managed non-surgically.

Acinar cystic transformation (ACT) or acinar cell cystadenoma is a rare benign tumor of the pancreas. Their clinical presentation is nonspecific, thus hampering their detection and frequently leading to misdiagnosis. In this report, we present a case of ACT of the pancreas in a 54-year-old man that was vague abdominal symptoms. A magnetic resonance imaging was shown a well-defined cystic mass located in the head of the pancreas, measuring 57×47×23 mm. Our patient was treated by pancreaticoduodenectomy. In the macroscopic examination of the mass, a multicystic lesion was found in cream-colored pancreatic tissue. Histological and immunohistochemical studies examination revealed a cystic mass containing multiple cysts at varying sizes, lined by epithelial cells without atypia and positive staining of CK7, CK8/18, and CK19. A high index of clinical suspicion is required to diagnose this tumor. The surgical approach is to ensure accurate diagnosis and to avoid complications.