مجله دانشکده پزشکی دانشگاه علوم پزشکی تهران
سال هفتاد و هشتم شماره 10 (پیاپی 238، دی 1399)

Life expectancy has increased throughout the world and, as a result, the population of the elderly is also rising. From the age of 30 years old, the human body mass loses about 0.1 to 0.5% of its skeletal muscle mass annually, which is accelerated after the age of 65 years old. Aging is characterized by a decrease in the progression of musculoskeletal and physical activity known as sarcopenia. Sarcopenia has a complex molecular pathogenesis that includes age-related changes in muscles’ neuromuscular activity, muscle protein replacement, the hormone levels and the related sensitivity of human body to these mentioned factors. The pathogenic conditions and other disorders in sarcopenia are the chronic inflammatory states that include oxidative stress and changes in behavioral factors, especially in nutritional status and physical activity. By definition of the European Working Group on Sarcopenia in Older People (EWGSOP), the diagnosis of sarcopenia is determined by the presence of two main factors which are low muscle mass and low muscle function. Besides, specific sarcopenia-related biomarkers have been identified for early diagnosis and accurate identification of the main pathophysiology mechanisms involved in the development of the disease. Since sarcopenia has adverse outcomes on public health in terms of behavioral factors, frailty, hospitalization and mortality of people, it is an important necessity for the social health system to plan some therapeutic approaches to prevention. The main and more important of these therapeutic approaches have known as exercises, nutritional supplements and hormonal therapies. Also, other new therapeutic strategies are under investigation to be introduced in the future. However, currently, it has been shown that only physical exercise has a positive effect on the controlling and prevention of sarcopenia and its adverse effects on human and public health. However, the role of appropriate nutrition is also effective. Therefore, carefully designed studies in terms of better utilization of physical activity are needed to achieve useful therapeutic results for sarcopenia management. Thus, this survey aims to review the other considerable studies on the pathogenesis, appropriate evaluation of the disease and treatment options for sarcopenia.

Even after surgery, as the most effective treatment for colorectal cancer, about 30-40% of cases are recurring. Since growth inhibition is an important strategy in cancer treatment, many attempts are in the program to find new agents, so in this study, the cytotoxic and antimicrobial effects of Lactobacillus sakei on colon cancer cell line (HT-29) and some pathogenic microorganisms have been evaluated. Lactobacillus sakei is a probiotic that, when consumed affects the intestinal flora, causes beneficial effects on host health. Probiotics due to their anti-cancer effects, modulation of the differentiation process in tumor cells, changes in tumor gene expression and lack of immunological responses have attracted a lot of attention as a new and effective treatment for colorectal adenocarcinoma.

In the present study, which was conducted experimentally from May to September 2018 in bacteriology and Cellular and Developmental Research Centers of Islamic Azad University, Shahrekord branch, the antimicrobial activity of supernatant of Lactobacillus sakei was assessed by Well Diffusion Agar (WDA) method against some pathogenic bacteria. HT-29 Colorectal adenocarcinoma cancer cells were cultured in DMEM medium with 10% bovine serum. The cells were treated in 5, 15, 10 and 20 mg/ml concentrations of sakei metabolites and incubated at 24, 48 and 72 hours. Cell growth was analyzed by celltiter 96® aqueous one solution cell proliferation assay kit to the manufacturerchr('39')s protocol in all three incubation times.

The results of this study indicate that sakei was able to produce antimicrobial metabolites against pathogenic bacteria. Besides, the results of the celltiter 96® aqueous one solution cell proliferation assay showed that the bioavailability of HT-29 cell lines decreased at all concentrations of sakei metabolites in a dose and time-dependent manner.

Since lactic acid probiotic bacteria can alter the metabolic activities of the intestinal microflora, attach to carcinogens and destroy them, prevent carcinogenesis such as ammonia and secondary bile acids, producing anti-cancer substances and creating an acidic state to inhibit the growth and proliferation of carcinogenic bacteria, It seems that there is a good research field for the use of bioactive compounds produced by Lactobacillus sakei in the control of bacterial pathogens and treatment of human colorectal adenocarcinoma (HT-29).

Urinary tract infection (UTI) is one of the most important pediatric health problems, which is occasionally associated with irreversible renal damage. Dimercapto-succinic acid (DMSA) scan is a diagnostic standard for the renal scar. Doppler ultrasonography (D.S) has been considered as a less invasive method. The purpose of this study was to determine the sensitivity and specificity of D.S in the diagnosis of renal scarring in children with a history of acute pyelonephritis (APN).

The present cross-sectional study was conducted on 120 children with APN, aged six months to twelve years in the University Pediatric Hospital of Qazvin, Iran, between August 2017 and August 2018. DMSA scan was performed in the acute phase of pyelonephritis for all patients. Half of the children with acute pyelonephritis had decreased radionuclide uptake in the first DMSA scan of whom thirty patients had kidney scarring in the second scan, six months later. Then renal vascular D.S was performed for these patients. Simultaneously, twenty children with a normal DMSA scan, assigned for D.S.

The mean age of children was 5.30(3.50-11.8), and 4.80(2.50-10.09) in the scar and control group. Most of the patients in both groups were female, 25(83.8%) in renal scar, and 15(75.0%) in control. The scar group showed a greater rate of vesicoureteral reflux, 17(56.6%), of whom 11(36.7%) were bilateral. Among 30 patients with a renal scar, 2(6.7%) had first-time acute pyelonephritis, 11(36.7%) had second, and 17(56.7%) had more than two attacks of pyelonephritis. The frequency of renal scarring was 25% based on DMSA scan and 14% based on D.S. Accordingly, the sensitivity and specificity of D.S in the detection of renal scarring in children with APN was 23.3% and 100%.

Doppler ultrasonography is not a suitable method for diagnosis of renal scarring in children, due to the low sensitivity and negative predictive value of this device in the detection of renal scarring in children with UTI. However, normal Doppler sonography can predict that the patient did not have a kidney scar.

Surgery and accurate removal of the brain tumor in the operating room and after opening the scalp is one of the major challenges for neurosurgeons due to the removal of skull pressure and displacement and deformation of the brain tissue. This displacement of the brain changes the location of the tumor relative to the MR image taken preoperatively.

This study, which is done from March to December 2019 in Tehran, is evaluated on the available database of RetroSpective Evaluation of Cerebral Tumors (RESECT) including pre-operative MR images, and intra-operative ultrasound from 22 patients with low-grade gliomas who underwent surgeries at St. Olavs University Hospital. This study is used for image registration of preoperative MR imaging and ultrasound imaging after resection of the skull to compensate for brain changes. By this method, we obtained a third image that resembles preoperative MR imaging but has the geometry of the brain shape changes. We used a combination of the two transformations named Affine and non-rigid Free Form Deformation (FFD) for hierarchically moving the pixels to compensate for global variations, and also nonlinear local and small variations. Also, by applying the mutual information function, we consider the entropy value as the criterion of similarity due to the non-similarity of the nature of the images. Also, Limited Broyden-Fletcher-Goldfarb-Shannon method is used for optimization.

The results of the proposed method were presented on the available database of RetroSpective Evaluation of Cerebral Tumors (RESECT) including images of 22 patients with glioma type 2 tumors and evaluated based on 15 landmarks per patient and also mutual information criteria. The mean target registration error for affine, FFD and the proposed method are 46.19, 42.85 and 38.01, respectively. It was shown that the proposed method achieved high accuracy by combining the two transformations of affine and FFD compared to the separate use of each of the two models.

In image registration of preoperative MR and ultrasound images for compensation of brain shift, the combination of affine and FFD transformations had better results than the individual use of each of the transformations.

The pandemic of Covid-19 is spreading around the world. Extensive research is needed to focus on identifying the underlying causes of the disease. This study aimed to investigate the clinical and etiological symptoms of the Covid-19.

This descriptive-analytical study, conducted on 510 infected patients in the infectious disease clinic of Imam Khomeini Hospital in Tehran from March 2019 to June 2020 for A period of Four months during the first wave of Covid-19 pandemic. The method of selecting patients was continuous and was divided into two groups of 179 inpatients and 331 outpatients based on lung scan and clinical symptoms. Demographic information, clinical signs, and risk factors were collected through a questionnaire and the data were statistically analyzed.

Symptoms such as fever, chills and cough were reported in the majority of patients in both groups, to such an extent that they were present in 176 (52%) of outpatients and in 101 (59%) of inpatients. The mean hemoglobin measured in hospitalized patients was lower, P=0.001). Vitamin D3 supplementation was reported in 30% of outpatients and in 16.5% of hospitalized patients (P=0.001). This means that vitamin D3 consumption is higher in the outpatient group.The results showed that Chronic diseases such as hypertension was 4.9 times more likely (OR=4.9, 95% CI2. 433-10.25, P=0.0001) and anemia with 22 times more likely (OR=22.905, 95% CI9. 355-56.083, P=0.000) to be effective in the severity of the disease. It seems Vitamin D3 intake has a supportive effect on reducing the severity of the disease and decreases the risk of the disease getting worse.

Fever, chills and cough were important symptoms in identifying infected patients with Covid-19. According to the results of the present study and the findings of other studies, the supportive effect of vitamin D3 in reducing the severity of infectious diseases should be considered. Clinical trials with appropriate sample size are recommended to investigate the functional role of this vitamin in Reducing the severity of viral diseases of the respiratory tract.

There is some demand for nasogastric tube insertion in unconscious or ICU patients. Nasogastric tubes are generally made of flexible plastic materials, prone to twisting and deviation by the tracheal tube, when passing through the pharynx and esophageal opening, making it difficult to insert the NG-tube properly. We hypothesized that NG-tube insertion with help of guidewire can significantly increase a successful first-try insertion rate in contrast with the conventional "neck flexing" technique in unconscious intubated patients.

One hundred adult intubated patients, in the emergency ward at Sina Hospital, Tehran University of Medical Sciences were enrolled in this prospective clinical trial study from February 2020 to July 2020. These patients were randomly divided into two groups, with and without use of the guidewire insertion technique. Parameters such as successful NG tube insertion average time, first and second try failure, total failure and occurrence of complications such as kinking, twisting, sticking, moderate hemorrhage and traumatic injuries to the nasopharynx pathway were studied.

One hundred patients were enrolled in this study. The median age of patients was 55.4±10.8 years (12-75 yr). First-try insertion success was 98% in the guidewire group and 74% in the control group (P=0.001). First, the try insertion failure percentage was 2% in the guidewire group and 26% in the control group (P=0.001). The time needed for NG tube insertion was significantly lower in the guidewire group, as 38.3±4.8 seconds in the guidewire group vs 61.5±6.2 seconds in the control group (P=0.001). A significantly lower number of complications like twisting, sticking, hemorrhage and traumatization were seen in the guidewire group.  Remarkably, that no case of absolute insertion failure was seen in the guidewire group but there were three such cases in the control group.

The incidence of a successful first-try NG tube insertion has been significantly improved by the use of Steel Wire rope against the conventional neck flexing technique, in unconscious intubated patients, and causes less traumatization and complications as well.

Candida auris is a globally emerging yeast pathogen that has shown not only resistance to most anti-fungal drugs but also thermo-tolerance to temperatures higher than the mammalian’s body temperature. Although it has been only a decade since the fungus was identified, its spread of infections has been rapid and quasi-epidemics have been reported. Co-occurrences of the fungus infections in all five continents are one of the strangest aspects of this fungus. All isolates, despite slight genetic differences, belong to a common genetic ancestor. However, different clades appear to have independent evolutionary paths. We have discussed the relationship between the acquired thermal tolerance of C. auris and the environmental temperature changes with the genetic affinities of the isolates.

This basic science survey was carried out at the Shiraz University of medical sciences from July to December 2019. Phylogenetic analysis was used to compare the temperature sensitivity of C. auris and the species with which it is genetically related. The sequences of Internal transcribed spacer (ITS) region and the growth temperature ranges for C. auris and yeasts belonging to the Candida haemulonis complex as well as other environmental yeasts isolated from different geographical areas of the world were randomly selected and evaluated. Their phylogenetic relationship was investigated with the mapping of the phylogenetic tree based on ITS sequences.

Study of temperature ranges which the fungi are capable of growing clearly shows that all species of C. auris can tolerate temperatures higher than the mammalian body temperature. Genetic distances, as well as geographic distances between species of C. auris are visible during phylogenetic studies. These results illustrate the possibility that, despite these distances, the temperature tolerance attribute for each C. auris clade was independently and under a common external pressure such as global warming.

The results of this study have discussed the increased incidence of emerging fungal infections due to climate changes; however the role of other contributing factors in the spread of these infections needs further investigation.

One of the most important duties of a family physician is primary health care. The family doctor plan is one of the developmental measures to provide easy and low-cost access for patients to health care centers. The family doctor and her team are fully responsible for the health of the individuals and families covered. Therefore, this study was conducted to assess the satisfaction of rural areas of Rafsanjan city with the family physician plan.

This study is a descriptive-analytical study that was conducted in rural areas of Rafsanjan from October to December 2018. The study population consisted of twelve randomly selected villages in Rafsanjan. The required sample size was examined according to the size of the statistical population of 480 people. In this study, to collect the required data, a researcher-made checklist was used, which was prepared by reviewing the texts of the questions. The sampling method was cluster random. To check the validity of the checklist, the opinions of 10 health education experts were used. To check the reliability, the checklist was provided to 20 villagers and the reliability was determined using Cronbachchr('39')s alpha method of 82%. The mean was used to describe the data and inferential statistics t-test and ANOVA were used to analyze the data and analyzed by SPSS.

The average satisfaction of villagers with the family physician program was relatively good. The Highest satisfaction is with diploma education and income below 1 million 2.21% and the lowest satisfaction score is 21-30 years old and income over three million 2.16%.

Satisfaction with the implementation of the family physician program in rural areas indicated that the health system reform processes were successful and to increase this satisfaction, we must improve the level of service and improve the quality of family physician services day by day because the health system with effective health care is an important element of family physicians.

Dermatophyte is a group of keratinophilic fungi that cause various skin lesions depending on the affected area. Dermatophytosis is usually diagnosed by clinical manifestation and confirmed by direct microscopy or fungal culture. There might be diagnostic difficulty with the presence of atypical dermatophytosis. Atypical dermatophytosis presents with clinical appearances ranging from eczematous, psoriasiform, pustular lesions, and others, that interferes with early diagnosis and disturbs patient’s life quality. Genital dermatophytosis is an uncommon presentation of cutaneous fungal infection; moreover, its manifestation without the involvement of the inguinal area, and simulating wart is a rare sign. In this study, we introduce a rare case of dermatophytosis with a wart-like appearance that was restricted to the skin of the genitalia.

A 24-years-old woman was referred to the academic dermatology clinic of Boo- Ali SINA Hospital in Sari, Iran, in November 2019 with a 9-month complaint of verrucous and pruritic plaque in the genital area that previously misdiagnosed as wart with no response to treatment. The dermatologist requested a review of the previous pathology documents for diagnosing dermatophytosis. The pathologists reexamined the relevant paraffin-embedded skin tissue block of the patient. By Periodic acid-Schiff staining, some fungal elements had been found in the horny layers of the epidermis, so dermatophytosis was confirmed. Based on this diagnosis, terbinafine was prescribed and the patient responded well to this treatment after four weeks.

Although the occurrence of genital dermatophytosis with the verrucous appearance and without involvement of groin is a rare finding, it should be considered in the differential diagnosis. In each case suspected of genital dermatophytosis, direct examination or fungal culture for definite diagnosis and prevention of delay in the appropriate treatment is required.

Granular cell tumor (Abrikossoff’s tumor) is a rare and slow-growing tumor of the soft tissue. Originated from the Schwann cells, it is often a benign tumor, but it can be malignant in 1-3% of the cases. Malignant cases can cause significant morbidity and mortality. It may develop in many anatomic locations, especially in the head and neck region, and also in skin and subcutaneous tissue.

The patient was a 27 years old female who was referred to the Imam-Reza Hospital of Birjand because of a subcutaneous mass in the left inguinal region. The tumor was appeared six months ago as a painless slow-growing nodule. In physical examination, there was a 3×4 cm subcutaneous tumor in the left inguinal region. The tumor was attached to the skin but not to the deep and surrounding tissues. There was not any evidence of lymphadenopathy or distant metastasis.  The patient was admitted in September 2017. The tumor was excised surgically with a one cm safe margin. The post-operative course was uneventful. In histopathology examination, there was a non-encapsulated neoplasm containing polygonal cells with round to oval nuclei and abundant fine pas-positive granules in the eosinophilic cytoplasm. There were fibrous bands between the tumoral cells. Overlying epithelium shows foci of pseudoepitheliomatous hyperplasia. This finding was compatible with granular cell tumor. Immunohistochemistry (IHC) staining of the cytoplasm and the nucleus for s-100 protein and cytoplasm for CD68 was also positive. The patient is symptom-free and without any sign of local recurrence or distant metastasis for 1.5 years post-operation.

Although it’s a rare tumor, the granular cell tumor must be considered in the differential diagnosis of soft tissue tumors. Surgical excision with a safe margin is the treatment of choice for the tumor. It is recommended that the patients must be observed for two years postoperatively.