Iranian Journal of Medical Sciences
Volume:46 Issue: 1, Jan 2021

Since the emergence of the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) pandemic, an increasing number of reports and studies have tried to warn the medical community about the thrombotic complications of coronavirus disease 2019 (COVID-19). It is suggested that the hyperinflammatory response and endothelial injury, especially in patients with severe disease, lead to a hypercoagulable state. Sudden deaths occurring in some patients also point to fulminant arrhythmias and massive pulmonary embolism (PE). Several expert panels have published recommendations regarding the prophylaxis and treatment of such complications. Nonetheless, there are limited high-quality studies for evidence-based decision-making, and most of these recommendations have arisen from descriptive studies, and optimal anticoagulant agents and dosages are yet to be designated. The coagulopathy persists after the acute phase of the illness, and some panels recommend the continuation of deep vein thrombosis prophylaxis for several days after regaining the normal daily activities by the patient. Here, we review the incidence and possible mechanisms of thrombotic complications, and present a summary of the considerations for the prophylaxis and treatment of such complications in the adult population.

Maternal childbirth satisfaction is one of the important indicators of the quality of the care provided. The use of non-pharmacological therapies can make the childbirth process a pleasurable event for the mother. This study aimed to compare the effects of watching virtual reality videos and chewing gum on the length of delivery stages and maternal satisfaction. This clinical trial study was performed on 93 women with first and second pregnancies, who were referred to Allameh Bohlool Hospital in Gonabad and Sajjadieh Hospital in Torbat-e-Jam, Iran, for childbirth between 2018 and 2019. Pregnant women were randomly assigned to three groups of chewing gum, virtual reality, and control. Interventions were performed twice: in the active (dilation of 4–5 cm) and second (dilation of 7–8 cm) phases of parturition for 20 minutes each. Data were collected using data-gathering forms, including a demographic characteristics form, a midwifery characteristics form, and the Mackey Childbirth Satisfaction Rating Scale. The data were analyzed using SPSS, version 22, via the Chi square tests, ANOVA, Kruskal–Wallis, and Tukey’s post hoc tests. The difference in the mean maternal childbirth satisfaction score between the two intervention groups of virtual reality and chewing gum was not statistically significant (P=0.339), but the mean score in the intervention groups was higher than that of the control group (P<0.001(. There was no significant difference in the mean length of the active and second phases of parturition between the two intervention groups, but this value in the intervention groups was significantly lower than that of the control group. The thought divergence interventions of chewing gum and watching virtual reality videos enhanced childbirth satisfaction, and curtailed parturition stages in our sample of pregnant women. Trial Registration Number: IRCT20181214041963N1.

Little is known about which personality traits determine the effectiveness of various types of cognitive-behavioral therapy (CBT) on animal phobia. The objective of the present study was to investigate a possible association between personality traits and the outcome of single- and multi-session CBT. The present randomized clinical trial was conducted from November 2018 to May 2019 in Shiraz, Iran. Forty female students with rat phobia, who met the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) criteria, were systematically allocated into a single- and a multi-session therapy group (odd numbers one-session treatment, even numbers multi-session treatment). In both groups, the students were gradually exposed to rats as part of the treatment. Psychological measures (state-anxiety, rat phobia, and disgust questionnaires) were used to compare pre- and post-intervention outcomes. Multivariate analysis of covariance was used to assess which personality traits influenced the intervention outcome. The statistical analysis was performed using SPSS (version 20.0) and P values<0.05 were considered statistically significant. Rat phobia was positively and significantly affected by conscientiousness (P=0.001) and agreeableness (P=0.003). Of these personality traits, only a higher degree of conscientiousness resulted in a further reduction of state anxiety after the intervention (P=0.005). There were no significant differences between the pre- and post-intervention outcomes. The outcome of single- and multi-session rat phobia therapies was associated with specific personality traits of the participants, namely conscientiousness and agreeableness. Both intervention methods had an equal effect on reducing rat phobia.

Electron microscopy (EM) is a valuable tool in the diagnosis of renal amyloidosis, particularly in the early stages of the disease. In Iran, studies on EM and the clinical features of renal amyloidosis are scarce. The objective of the present study was to survey EM investigations, pathological classifications, and clinical features of renal amyloidosis. This cross-sectional study was performed in Shiraz, Iran, during 2001-2016. Out of 2,770 kidney biopsies, 27 cases with a diagnosis of renal amyloidosis were investigated. EM investigation and six staining procedures for light microscopy (LM) were performed. Two pathological classifications based on glomerular, peritubular, perivascular, and interstitial involvement were made. Finally, the association between these classifications and the clinical features was assessed. Chi-square, Fisher’s exact, Independent t test, and Multiple logistic regression analysis were used. P values<0.05 were considered statistically significant. In 51.9% of the cases, the clinical diagnosis was nephrotic syndrome. Proteinuria and edema were the most prevalent clinical manifestations. The role of EM investigation for diagnosis was graded “necessary” or “supportive” in 48.2% of the patients. In the classification based on glomerular classes, variables such as the mean blood pressure (P=0.003), history of hypertension (P=0.02), creatinine >1.5 (P=0.03), and severe tubular atrophy (P=0.03) were significantly higher in class B (advanced amyloid depositions). EM plays an important role in the diagnosis of renal amyloidosis. EM in conjunction with LM investigation with Congo red staining is recommended, to prevent misdiagnosis of patients with a clinical suspicion of renal amyloidosis. Among different pathological features of renal amyloidosis, the severity of glomerular amyloid depositions had a clear relationship with clinical presentations.

Cutaneous leishmaniasis caused by Leishmania species (L. spp) is one of the most important parasitic diseases in humans. To gain information on the metabolite variations and biochemical pathways between L. spp, we used the comparative metabolome of metacyclic promastigotes in the Iranian isolates of L. major and L. tropica by proton nuclear magnetic resonance (1H-NMR).

L. tropica and L. major were collected from three areas of Iran, namely Gonbad, Mashhad, and Bam, between 2017 and 2018, and were cultured. The metacyclic promastigote of each species was separated, and cell metabolites were extracted. 1H-NMR spectroscopy was applied, and the data were processed using ProMatab in MATLAB (version 7.8.0.347). Multivariate statistical analyses, including the principal component analysis and the orthogonal projections to latent structures discriminant analysis, were performed to identify the discriminative metabolites between the two L. spp. Metabolites with variable influences in projection values of more than one and a P value of less than 0.05 were marked as significant differences.

A set of metabolites were detected, and 24 significantly differentially expressed metabolites were found between the metacyclic forms of L. major and L. tropica isolates. The top differential metabolites were methionine, aspartate, betaine, and acetylcarnitine, which were increased more in L. tropica than L. major (P<0.005), whereas asparagine, 3-hydroxybutyrate, L-proline, and kynurenine were increased significantly in L. major (P<0.01). The significantly altered metabolites were involved in eight metabolic pathways.

Metabolomics, as an invaluable technique, yielded significant metabolites, and their biochemical pathways related to the metacyclic promastigotes of L. major and L. tropica. The findings offer greater insights into parasite biology and how pathogens adapt to their hosts.

The most prevalent cancer in women over the world is breast cancer. Immunotherapy is a promising method to effectively treat cancer patients. Among various immunotherapy methods, tumor antigens stimulate the immune system to eradicate cancer cells. Preferentially expressed antigen in melanoma (PRAME) is mainly overexpressed in breast cancer cells, and has no expression in normal tissues. FliCΔD2D3, as truncated flagellin (FliC), is an effective toll-like receptor 5 (TLR5) agonist with lower inflammatory responses. The objective of the present study was to utilize bioinformatics methods to design a chimeric protein against breast cancer.

The physicochemical properties, solubility, and secondary structures of PRAME+FliCΔD2D3 were predicted using the tools ProtParam, Protein-sol, and GOR IV, respectively. The 3D structure of the chimeric protein was built using I-TASSER and refined with GalaxyRefine, RAMPAGE, and PROCHECK. ANTIGENpro and VaxiJen were used to evaluate protein antigenicity, and allergenicity was checked using AlgPred and Allergen FP. Major histocompatibility complex )MHC( and cytotoxic T-lymphocytes )CTL( binding peptides were predicted using HLApred and CTLpred. Finally, B-cell continuous and discontinuous epitopes were predicted using ABCpred and ElliPro, respectively.

The stability and solubility of PRAME+FliCΔD2D3 were analyzed, and its secondary and tertiary structures were predicted. The results showed that the derived peptides could bind to MHCs and CTLs. The designed chimeric protein possessed both linear and conformational epitopes with a high binding affinity to B-cell epitopes.

PRAME+FliCΔD2D3 is a stable and soluble chimeric protein that can stimulate humoral and cellular immunity. The obtained results can be utilized for the development of an experimental vaccine against breast cancer.

Misophonia is an unpleasant condition, in which the feeling of excessive anger is triggered by specific sounds. The main objective of the present study was to investigate the effectiveness of cognitive-behavioral therapy (CBT) on anger in female students with misophonia.

A study based on a non-concurrent multiple baseline design was conducted in 2018 at the School of Education and Psychology, Shahid Chamran University of Ahvaz, Ahvaz, Iran. Three female students aged 20-22 years were recruited using the multi-stage random sampling method. The study was conducted in three stages, namely baseline, intervention, and follow-up sessions. The Novaco anger questionnaire was used during the baseline sessions, intervention sessions (sessions three, six, and eight), and six weeks follow-up (two, four, and six weeks after the last intervention session). Data were analyzed using visual analysis, reliability change index (RCI), and recovery percentage formula.

CBT reduced the feeling of anger after the intervention and follow-up sessions. The recovery percentage at the end of the intervention sessions were 43.82, 42.28, and 9.09 for the first, second, and third participants, respectively.

The findings of the present study confirm the effectiveness of CBT in reducing the feeling of anger in female students with misophonia.

Peritoneal hydatid cysts are rare in children even in endemic areas. The primary or secondary origin of this site remains controversial, especially in children. Secondary peritoneal hydatid cysts are mainly the result of spontaneous or traumatic rupture of concomitant liver cysts or the leakage of cystic content during surgery. The purpose of our study is to present the largest case series of peritoneal hydatidosis in children. In addition, we aimed to assess the clinical and paraclinical findings as well as the management of echinococcosis at this location in children. The present case series is a study of ten children with peritoneal hydatid cysts, who underwent surgical intervention between 2013 and 2018 in the Pediatric Surgery Department, University of Monastir (Monastir, Tunisia). The mean age of the children was six years. All children presented abdominal pain, and underwent ultrasonography and contrast-enhanced computed tomography of the abdomen. Two patients had been operated on for lung hydatid cysts six months prior to the study. In two cases, radiologic investigations revealed the presence of an uncomplicated hepatic hydatid cyst located in segments II and IV. All patients underwent surgery, of which four underwent laparoscopy. Post-surgery, all patients received albendazole for three months, and the follow-up period was uneventful. Currently, all patients are in good health. Peritoneal hydatid disease is frequently secondary to the rupture of a primary hepatic cyst. Diagnosis is performed by abdominal ultrasound, computed tomography, and a positive serology result. Open or laparoscopic excision can be combined with medical treatment.