Acta Medica Iranica
Volume:59 Issue: 3, Mar 2021

The 2019 novel coronavirus (2019-nCoV) or the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged as a pandemic threat from December 2019. Coronavirus can cause varying degrees of illness that range from mild to severe or fatal disease. The exact mechanism on hematopoiesis induced by this coronavirus is not yet well understood, but scientific evidence indicates that COVID-19 can cause hematological changes in infected patients. The present study summarized pieces of literature regarding hematologic findings of COVID-19 and their correlation with disease severity. Finally, we offered some laboratory abnormalities which help to differentiate severe COVID-19 from non-severe forms of the disease. Among hematological parameters, decreased hemoglobin rather than anemia, leukocytosis, lymphopenia, neutrophilia, and thrombocytopenia have been observed in conducted studies in some patients with COVID-19. Furthermore, as the disease progresses to severe COVID-19, hemoglobin decline, leukocytosis, lymphopenia, neutrophilia, and thrombocytopenia continue to exacerbate. In addition, the neutrophil-to-lymphocyte ratio is also considered as an independent risk factor for severe infection in COVID-19 patients.

- Methotrexate (MTX) is the main drug for the treatment of childhood acute lymphoblastic leukemia (ALL). ABCG2 pump is the main transporter of MTX on BBB. Our aim was to investigate the possible relationship between three polymorphisms of the ABCG2 gene, and isolated CNS relapses in Iranian children with ALL receiving high dose MTX. Genotyping of three polymorphisms of the ABCG2 gene, including G34A, C376T, and C421A, was performed by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method for 56 patients. A high frequency of C376T CT genotype was observed among the patients. There was no significant association between C376T and C421 and isolated CNS relapse (P>0.05). C376T and C421A polymorphisms are not associated with isolated CNS relapse in childhood ALL.

Adiponectin is an adipocytokine that has a higher serum level in healthy people. In type 2 diabetes, insulin resistance, hypertension, MI, and dyslipidemia, the serum level of adiponectin is lower than 4 µg/mL. Adiponectin is proved to have a protective role against atherosclerotic changes where its low serum levels in type 2 diabetes can lead to the progression of atherosclerotic lesions. In this study, we aimed to survey the possible effects of adiponectin in the development of coronary artery disease in type 2 diabetics. Thirty diabetic cases with coronary artery disease, 30 diabetic cases without known coronary artery disease, and a group of 30 healthy volunteers, all of them were between 18-65-year-old, were entered our study. We gathered demographic data by performing a physical examination followed by filling a checklist and a set of laboratory tests. All the groups were sex and age-matched (P=0.284 and P=0.163 respectively). CAD group had the lowest HBA1C (P<0.001). Both LDL and HDL were also lower in the CAD group (P<0.001). Adiponectin was also lower in the CAD group when compared to other groups (P<0.008) or when compared with only normal diabetics (P<0.002). We found a correlation between adiponectin and HDL (r=0.348, P=0.008), suggesting each unit of reduction in serum level of adiponectin could increase the chance of coronary artery disease by 38% in diabetics. In this study, we showed that the lower serum level of adiponectin is correlated with an increased risk of coronary artery disease in type 2 diabetics.

In 1996, to harmonize the reporting system of breast lesions on fine-needle aspiration cytology (FNAC), National Cancer Institute (NCI) proposed five categories from C1-C5. C3 and C4 categories are noted to be ambiguous during histopathological correlation, hence “grey-zoned.” There have been limited researches regarding its usefulness and its histopathological correlation. This study was undertaken to evaluate C3 and C4 categories and to correlate with histopathological examination. This perspective and retrospective study was undertaken for two years. Forty cases of C3 and 32 cases of C4 were retrieved from a total of 602 cases of breast FNAC. Histopathological follow-up and correlation were available in 30 cases of C3 and 15 cases of category C4 and were selected for further study. On the histopathological correlation of the C3 category, 22 (73.3%) cases turned out to be benign, and 8 (26.7%) cases revealed malignant diagnosis, and among the C4 category, 2 (13.3%) cases revealed benign findings, and 13(86.7%) of the cases showed malignancy. This difference was statistically significant (P<0.001). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the C4 category in the diagnosis of malignancy were 61.9%, 91.6%, 86.6%, and 73.3%, respectively. FNAC is a simple, rapid, cost-effective, and accurate method to diagnose easily accessible breast swellings. However, one should be aware of its limitations as well. Our study supports maintaining C3 and C4 categories, as there was a statistically significant difference in benign & malignant diagnosis for these categories.

Pediatric complicated pneumonia (PCOMP) is the leading cause of mortality in children under the age of five. The study was conducted to determine the epidemiological and clinical characteristics of children with PCOMP. A retrospective study was carried out among all pediatric patients who were hospitalized due to complicated pneumonia in Abuzar Hospital (Ahvaz, Iran) during two years. The patients were evaluated in terms of epidemiological and clinical characteristics. A total of 65 hospitalized children and infants were identified. More than half of the patients were females (n=36; 55.3%). Their mean age was 4.21±3.80 years (range six months-15 years), and 64.1% of them (n=42) were under the age of five. There were 12 (19.4%) patients with failure to thrive (FTT). In addition, 58.5% of patients (n=38) had no history of hospitalization, and 66.2% of them (n=43) did not have any underlying disease. The mean length of hospital stay (LOS) was 12.46±6.85 (range 4-45) days. Admission was more common in winter (40%) and autumn (33.8%). Moreover, there were no significant associations between the types of complications and patients’ gender, age, FTT, and LOS. Further studies are warranted to identify factors contributing to disease severity and develop appropriate strategies for the prevention and treatment of PCOMP among Iranian children.

Personality disorders (PDs) would be associated with an unhealthy lifestyle. To date, however, there have not been sufficient studies on the relationship between them. This study aimed to investigate the association between personality disorders and an unhealthy lifestyle by using an analytical cross-sectional study. We selected 1538 married women based on the multistage cluster sampling method. We used the Millon Clinical Multiaxial Inventory (MCMI) and Lifestyle Questionnaire (LSQ). Apart from descriptive statistics, a one-sample t-test, multivariate analysis, and structural equation modeling were used. Analysis of the data suggested that negativistic (β= -0.321), schizotypal (β= -0.285), schizoid (β= -0.159), borderline (β= -0.136), melancholic (β= -0.079) PDs had a significant association with an unhealthy lifestyle, respectively. Cluster A personality disorders were prone to an unhealthy lifestyle more than the other two clusters.

Fetal hemodynamic changes can occur immediately following invasive chorionic villus sampling (CVS). We decided to study the possible effect of CVS on fetal heart rate (FHR), and uteroplacental resistance index (RI) changes using color Doppler ultrasound. Thirty-five pregnant patients with a gestational age of more than 12 weeks were included. Trans-abdominal CVS was done to assess the possibility of thalassemia. Before and after the CVS, color Doppler ultrasound was done to measure FHR and uteroplacental RI. Mean (SD) values for FHR before and after the CVS were 175.22 (±9) and 173.62 (±9.94) beats per minute, respectively; P=0.18. Mean (SD) uteroplacental RI before the CVS was 0.79 (0.07) which significantly increased to 0.82 (0.08); P=0.03. We observed a significant increase in resistance of blood flow in placental circulation after CVS. However, no significant change was observed regarding FHR after CVS.

The 2019 global Coronavirus syndrome pandemic (COVID-19) has entered more than two hundred countries around the world, involving <82 million persons and >1,800,000 deaths (until January, 1st 2021). We report on COVID-19 infection in the context of a Cushing's syndrome (CS) from Iran. A 36-year-old man with proximal myopathy, plethora, and striae with central obesity was evaluated for Cushing's syndrome. During the high dose dexamethasone test, the patient developed symptoms of cough, low-grade fever, and weakness then was admitted to the ICU with a diagnosis of COVID-19. Despite treatment according to national protocols for COVID-19, the patient unfortunately died. In this report, we intend to discuss the various aspects of Cushing's syndrome and severe COVID-19 infection.

Hearing loss (HL) is one of the most frequent birth defects, and genetic factors contribute to the pathogenesis of the disorder in about half of the patients. In the present study, we performed whole-exome sequencing (WES) based on Next-generation sequencing (NGS) in an Iranian family with hereditary HL. Then, Sanger sequencing was used to verify the segregation of the variant recognized in affected family members. A novel homozygous frameshift variation, c.649-650insC, in TECTA was found in the family, which might lead to a truncated TECTA protein (p. Asn218Gln fsX31). Our findings propose that the homozygous TECTA-p.N218QfsX31 mutation is the pathogenic variant for ARNSHL. To the best of our knowledge, this mutation has not been described in patients with the HL phenotype and so far has not to be reported in any of the mutation databases. Our data expand the spectrum of mutations in the TECTA gene in nonsyndromic hearing loss.

Ovarian torsion occurs in 10%-22% of pregnant women, and miscarriage occurs in 11%-22% of all pregnancies, both of which are known as gynecological emergencies. The simultaneous occurrence of these two cases is rare. The present study reports a case of ovarian torsion and simultaneous abortion. In this case report, we present a 28-year-old woman in her third pregnancy with a history of two miscarriages. She was referred with an 18-week triplet pregnancy, vaginal pain and bleeding from the previous day, and colic abdominal pain with five episodes of nausea and vomiting. Upon admission to the hospital, despite performing cerclage at 13 weeks, labor pains begin, and 15 minutes later, the amniotic sac ruptures, and all three fetuses are expelled. Due to the persistence of colic pain and moderate tenderness in the lower right quadrant of the abdomen, pelvic ultrasound is reported, which shows an increase in echo parenchyma and the size of the right ovary compared to the left ovary. Doppler ultrasound showed decreased ovarian blood flow, which led to laparotomy with suspected ovarian torsion. The right ovarian peduncle had complete torsion, and the ovary appeared dark. The peduncle of ovarian torsion was opened and preserved. The patient was discharged two days after surgery and after re-color Doppler ultrasounds, which indicated ovarian blood flow.