مجله دانشکده پزشکی دانشگاه علوم پزشکی تهران
سال هفتاد و هشتم شماره 12 (پیاپی 240، اسفند 1399)

In 2019 a newly emerged coronavirus was detected by the Center for disease control (CDC) in China. Nucleic acid sequencing from nose and throat swab samples of patients revealed that it was like severe acute respiratory syndrome coronavirus (SARS-CoV). World Health Organization (WHO) named it coronavirus disease 2019 (COVID-19) and reported more than 100000 positive tests until March 2020 for COVID-19. During the past 20 years, the world has been affected by three coronavirus epidemics, SARS-COV, Middle East respiratory syndrome coronavirus (MERS-CoV), and COVID-19 that make world attention. The mortality rate of COVID-19 was more than other coronaviruses, but because of more people affected by it, it seems that it has a less fatality rate compared with MERS- CoV. Initial data showed that more than 80% of patients did not have any symptoms or may had light symptoms. 15% showed severe pneumonia, 5% became critically ill, and developed multiorgan dysfunction and septic shock. Due to the epidemic of emerging viruses and the lack of information about it, this study aimed to provide a quick overview of the most recent studies in the world. To perform this review, keywords such as COVID-19, severe acute respiratory syndrome coronavirus 2, and Angiotensin-converting enzyme 2 were retrieved using the medical subject headings (MeSH) system and then searched in English in PubMed, Scopus, Google Scholar, and Web of Science databases.COVID-19 virus enters its genome into the cells by binding to Angiotensin-converting enzyme 2 in some organs such as the lungs. Although the transmission route is unclear, it enters the body through respiratory droplets. The clinical symptoms includ fever, cough, dyspnea, myalgia, confusion, headache, sore throat, rhinorrhea, chest pain, diarrhea, nausea, vomiting, malaise, and convulsion. The standard diagnostic method is Real-time polymerase chain reaction (RT-PCR), but due to the time-consuming and sensitivity and the existing errors in this technique, chest CT and hematologic data are preferred. No definitive cure for the virus has been suggested so far, but antiviral drugs such as Oseltamivir, Ganciclovir, Lopinavir, Ritonavir and Remdesivir, and the anti-malarial drug Chloroquine phosphate and Interferon are in use until the discovery of the vaccine.

The development of industry and technology, changes in agriculture, trade and global travel, and the adaptation of microorganisms are important factors in the occurrence of emerging diseases. Currently, the world is facing a pandemic caused by an emerging virus called the novel coronavirus (Covid 19) in 2020. This disease led to infect more than one million people worldwide and the death of more than five hundred thousand people during six months. Covid 19 causes death in patients with respiratory problems of varying severity. Fever, soreness, dry coughs, shortness of breath, runny nose, and nasal congestion were observed in coronavirus-infected individuals. Fever was one of its common symptoms. Other unusual signs such as diarrhea and nausea were reported for this disease. For the first time, the bat was introduced as the host of the novel coronavirus in China. Therefore, identifying the initial route of transmission of the novel coronavirus is necessary to prevent the occurrence and its widespread distribution. The virus enters into a human through respiratory particles as well as touching the surfaces contaminated by nasal, mouth and eye secretions. Viruses are obligate intracellular pathogens needing host cells to survive. These microorganisms cannot proliferate in foods and require live cells for existence. Food is introduced as a carrier of viruses to the consumer. There have been no reports of novel coronavirus transmission through food. However, it is important to observe the principles of health and safety by assuming the spread of the virus due to food contamination. Regarding the presence and proliferation of novel coronavirus in the gastrointestinal tract and aerosol formation of this microorganism in the feces and the possibility of re-transmitting it to people from various environmental sources, the most important priority is to remove the virus from food environments. It is also important to update the methods of disinfecting surfaces, especially areas with high contact of hand as well as personal hygiene. Therefore, it is recommended to educate the staff about managing the novel coronavirus and improving health guidelines. Furthermore, keeping distance and washing hands is in priority in different food-related environments.

Due to multiple roles of albumin in the body, injection of its medicinal product as one of the therapeutic or management strategies under conditions such as severe bleeding, burns, liver failure, and neonatal hemolytic diseases is on the physicians' agenda. Considering that albumin is the most abundant plasma protein, designing an appropriate method to purify it is highly important. There are several methods such as human plasma fractionation, chromatographic, or Salting-out methods for the isolation and purification of the human albumin. The present study investigates a direct and combined ion-exchange chromatography approach for purification of albumin from human plasma and compares the quality of the final products obtained by both ion-exchange chromatographic methods.

This study was carried out from January 2019 to October 2019 at the Blood Transfusion Research Center, High institute for research and education in transfusion medicine, affiliated with the Iranian Blood Transfusion Organization. For this study, 10 human plasma bags were randomly collected. After thawing, all 10 human plasma bags were pooled, and in order to separate cryo paste, it was centrifuged at 4000 g for 10 minutes at the temperature of 1 Centigrade degree. Then the obtained cryo poor plasma was used to purify the albumin protein by direct and combined methods of ionexchange chromatography. The purity of the final products was compared by cellulose acetate electrophoresis and SDS-PAGE tests. The sample obtained by the combined approach was pasteurized and HPLC analysis was performed to investigate any polymer aggregates.

In contrast to the direct method, the final product obtained by combined ionexchange chromatography had a good purity by the average of about 95% and the amount of polymer was estimated to be less than 5% by HPLC analysis (P<0.05).

By diluting the plasma and subsequently reducing the ionic strength, albumin can be separated from human plasma with a high degree of purity only by two steps of ion-exchange chromatography

The application of mesenchymal stem cells in the healing of chronic wounds is one of the most challenging issues in cell therapy. The present study investigated the efficacy of intradermal injection of umbilical cord Whartonchr('39')s Jelly-derived mesenchymal stem cells in diabetic wound healing using ultrasound imaging in an animal model.

During this experimental laboratory study that was performed in the Skin and Stem Cell Research Center, Tehran University of Medical Sciences between October 2017 and October 2016, mesenchymal stem cells were isolated from umbilical cord Whartonchr('39')s jelly of 10 neonates. The cells were passage. The differentiation potential of cells to osteocyte and adipose cells was evaluated. The expression of specific markers of mesenchymal stem cells was evaluated using flow cytometry. The viability and quality of cells were evaluated before transplantation. The diabetes model was developed by intraperitoneal injection of streptozotocin in 42 male Wistar rats. The animals were randomly divided into two groups: normal saline injection (control) and cell injection. Cell transplantation was performed intradermally. Skin thickness and density were assessed using ultrasound imaging on days 7, 14 and 21. Finally, the data were analyzed using a t-test and analysis of variance.

Injection of mesenchymal stem cells caused faster closing of the wound. The results of biometric measurement of wound skin in rats showed that skin thickness and density on days 7, 14 and 21 in the Wharton jelly mesenchymal stem cell injection group had a significant increase compared to the control group.

The results of cell analysis showed that the isolated cells are the same as mesenchymal stem cells. The cells were of the required health and quality. Intradermal injection of mesenchymal stem cells in diabetic wound area caused faster healing in diabetic rats, according to which, such stem cells can be considered in cell therapy, especially in the field of chronic wound healing.

Because deep vein thrombosis (DVT) is one of the most common problems in the intensive care unit, it may lead to complecating the patientchr('39')s general condition. This study aimed to investigate the predictive factors of DVT in patients admitted to the intensive care unit (ICU) of Amin hospital in Isfahan.

In this retrospective study, all the records of patients admitted to the ICU ward of Amin Hospital located in Esfahan, from April 2015 to March 2018, were investigated and from all patients with DVT, 20 records were extracted and 40 cases of patients without DVT were also randomly selected. Information such as age, sex, Wells score, Apache score, nutritional status, clinical parameters, cause of hospitalization, length of stay, ICU induced disease and treatment were extracted from these records and compared between both groups with and without DVT

From 2000 patients admitted to the ICU ward, 20 cases were developed DVT. The age of patients in the DVT group was significantly higher (P=0.008). Factors such as increased Wells score, increased length of stay in the ICU, having ICU induced internal diseases and pneumonia increased the chance of DVT incidence as 18.75, 1.92 and 2.75 and 2.28 times, respectively and the increase of potassium level and use of heparin bandage for treatment reduced the chance of DVT by 2.31 and 2.55 times, respectively (P<0.05).

In the general intensive care unit, the incidence of deep vein thrombosis was higher in internal ward patients. Pneumonia was the most common disease associated with deep vein thrombosis and the risk of deep vein thrombosis was higher in the anemic patient. Patients with upper limited normal levels of potassium were less likely to develop deep vein thrombosis. It seems that potassium in the upper limit of normal reference can play a protective role against deep vein thrombosis. Further studies with larger sample sizes are suggested.

Neonatal jaundice is an almost common problem among neonates that may cause complications such as kernicterus in severe cases. Since early diagnosis and proper treatment of neonatal jaundice is vital to prevent the related complications, it is necessary to check bilirubin before discharging the neonates. There are several evaluating and diagnostic methods to measure the level of bilirubin. Thus, this study aimed to compare the transcutaneous method versus measurement of serum bilirubin, using spectrophotometry for jaundice screening of full-term neonates before discharge from hospital.

This observational analytic study was conducted on six hundred neonates with birth weight more than 2000 grams and gestational age more than 35 weeks from September 2012 to March 2013 in Hafez hospital, Shiraz University of Medical Sciences. Parameters such as bilirubin level of neonates were measured and compared, using spectrophotometry and transcutaneous by Bili check with multi waves.

Six hundred neonates were enrolled in this study. The Pearson correlation test showed that there was a significant correlation between the two methods of the transcutaneous versus measurement of serum bilirubin, using spectrophotometry (r=0.63), (P>0.05). There was no significant difference between the mean of measured bilirubin, using each method in some demographic variables such as the different groups of gender (P=0.896), birth weight (P=0.419), and type of feeding in neonates (P=0.323), but it was significant in other demographic variables such as the different groups of gestational age and post-neonatal age (P<0.0001). Also, the results revealed that there was a significant correlation between two methods of the trans cutaneous versus measurement of serum bilirubin, using spectrophotometry based on demographic variables (P<0.0001).

In general, the bilirubin measurement using trans-cutaneous method may estimate bilirubin significantly less than the serum bilirubin measurement method, and this difference can be more obviously noticeable in infants with less gestational age and also less post-natal age.

Developmental delay in preterm infants was estimated to be more common than term infants. Identifying the factors predisposing to developmental delay can help experts and health professionals in this field to prevent developmental delay of the infants, and leads to better management of the condition of them. This study aimed to evaluate and investigate the predisposing factors of developmental delay in preterm infants in the first year of their lives.

In this analytical cross-sectional study, 87 preterm infants were enrolled in the study by convenience sampling during the period of April 2016 to the end of March 2017 from two educational hospitals of Shahid Beheshti University of Medical Sciences (Imam Hussein hospital and Mahdiyeh hospital). Demographic and other initial data such as age, sex, gestational age, and the data about clinical problems observed at birth were collected through infantschr('39') medical records and were recorded in a special form for each infant. Also, the ASQ test was used to assess infantschr('39') developmental status at one year of age.

Based on the findings, 23 infants (26.4%) had the abnormal developmental condition at the end of one year. There was a significant relationship between infantschr('39') developmental status and their age, birth height, one-year-old weight, one-year-old height, duration of ventilator use, Apgar scores at first and twentieth minutes, seizures, reflex reduction, pneumonia, breastfeeding status in the first year of life, Retinopathy of prematurity (ROP), receiving occupational therapy services, and electrocardiogram (ECG) findings at one year of age. Among these variables, only breastfeeding status in the first year of life was able to predict infantschr('39') developmental status at the end of one year (OR=0.18).

This study showed that the risk of developmental delay in preterm infants who are breastfed in the first year of life or fed the combination of breast milk and supplemental feeding is one-fifth lower than other preterm infants who were not breastfed.

Given the huge mental, psychological, and economic impact imposed on patients with chronic renal failure, it seems quite necessary to study life satisfaction in such individuals in to order to provide the necessary information and plan for appropriate services. In form of a systematic review and meta-analysis, the present study was conducted in to order to compare the quality of life in two groups of patients, one undergoing hemodialysis and the other recipients of a kidney transplant.

In order to fulfill the objective of the present study, among innumerable researches carried out in this field, through the implementation of a meta-analysis checklist nine researches were found to be qualified for the final meta-analysis (specific consideration was given to the following criteria: hypothesis, research method, statistical population, sample size, sampling method, measurement tool, and statistical analysis method). All related studies conducted from June 1995 to July 2016 in Iran.

Out of 310 articles that had been selected initially, 262 were removed after reviewing their full text, then, 39 more articles were removed due to over-similarity of titles or exact repetition of the same topic. Finally, 9 studies Were found to be for the meta-analysis process. The sample size included 1736 subjects. The results of the analysis of total quality of life scores in renal transplant patients and hemodialysis patients showed that the mean overall quality of life of transplanted patients was 42.26±42.2 and the mean score for patients with hemodialysis was 42.9±36.36. The difference in the mean quality of life in renal transplant patients and hemodialysis patients was statistically significant (P<0.05), and renal transplant patients had a better quality of life in comparison with patients undergoing hemodialysis.

Patients undergoing hemodialysis experience more severe suffering due to their specific circumstances. Recognizing and applying the predictive factors for the quality of life of these patients can help to design more suitable care and treatment programs. It is also desirable to take effective steps to improve the quality of life of these patients in planning health-care services; the final hope is to provide considerable enhancement within the quality of life for patients with renal failure.

Trichosporon species are commonly known as causative agents of skin infections and also responsive in some other systemic and disseminated diseases, especially in immunocompromised patients and those with leukemia or lymphoma. Chronic cutaneous infections with Trichosporon have been reported in non-immunocompromised patients, too.

This study is a case report of tinea pedis caused by Trichosporon asahii in an immunocompetent 39-year-old man who was a member of the military force with continuous wearing of army boots during his daytime work. In April of 2019, after visiting a dermatologist, he was referred to the Ghaem medical mycology laboratory of the Department of Health, Rescue and Treatment of Iran Police Force in Tehran. Clinical symptoms were scaling and erythematous patches on his left foot with intensive itching for four-months. In the laboratory, macroscopic and microscopic examination using direct 15% KOH wet mount was carried out as well as culture methods on fungal media (Sabouraudchr('39')s dextrose agar with and without cycloheximide and chloramphenicol). According to microscopic observation and appearance of culture media colonies, the diagnosis was Trichosporon genus as the fungal agent of disorder. Molecular method analysis (PCR) using amplification of ITS region with universal primers (ITS1 and ITS4) and sequencing identified Trichosporon asahii as a causative species of the disease. The patient was treated with topical clotrimazole (twice/day) and oral fluconazole (150 mg/day) for four weeks, and recovered.

The conditions that cause the feet to be exposed to excessive sweating, moisture and darkness for a long time (wearing shoes and army boots for a long time); increase the risk of skin fungal infection. Therefore, full respect for an individual healthy manner seems to be essential.

Lightning is one of the most mysterious phenomena of nature that also, it has caused many financial and human losses. In tropical and sub-tropical countries, death due to thunderbolt is not unusual, and even tragic events may occur at high altitudes. Lightning physics is complex and not completely clear. Usually, the clouds are heavily pregnant and high voltages and amperages, they drain their load over earth through a massive arc. The death by lightning is naturally a component of the accident and does not pose a particular problem to the legal pathologist. But sometimes the body is found outdoors without special signs, and there may be doubts about death. The damage caused by the lightning is unpredictable and accidental.

A 23-years-old young man went to a park in southern Tehran for entertainment at dawn, sometime in September 2018, that suddenly lightning hit him and, unfortunately he passed away. After passing the dead body of the young man to the forensic medicine about 14 hours later, an external physical examination showed the appearance of Lichtenberg (fern leaves) on the upper and middle part of the trunk.

Lightning injuries are in different ranges from minor injuries to severe burns, fractures, and tissue laceration. The lightning may cause specific shapes on skin similar to the ferns, which is known as the Lichtenberg. The Lichtenberg figure is known as an image of lightning and is an important clue to lightning strikes with humankind or bodies. This posture is a physical phenomenon with red and tree-shaped on the skin that occurs by lightening after one hour and usually disappears after 24- 48 hours. This sign does not burn and does not have any relation to the vessel or nerves.