Journal of Research in Medical Sciences
Volume:26 Issue: 3, Mar 2021

The role of surgery in the treatment of patients with distant metastatic (M1) gastric cancer (GC) remains controversial currently. This study aimed to clarify the impact of primary tumor resection (PTR) on the survival of such patients.

The surveillance, epidemiology, and end results database was adopted to extract eligible patients. We designed a retrospective case–control study. The patients were divided into two groups according to whether they received PTR. The 1:1 propensity score matching (PSM) analysis was performed to balance the confounding factors between no‑surgery and surgery groups. The categorical variables were described with Chi‑square tests. Cancer‑specific survival (CSS) and overall survival (OS) were evaluated by Kaplan–Meier method with log‑rank test. Cox proportional hazard models were utilized to identify prognostic factors of CSS.

A total of 1716 patients were included, including 1108 (64.6%) patients without surgery and 608 (35.4%) patients with surgery. After PSM, most confounders were well balanced between the two comparison groups. Survival analysis in matched cohorts indicated that surgery exerted significant survival advantages in both CSS and OS curves. The median CSS was 11.0 (9.8–12.2) months in the surgery group versus 9.0 (8.0–10.0) months in the no‑surgery group (P < 0.001). Multivariable Cox regression analysis identified surgery as an independent prognostic factor for favorable prognosis (hazard ratio: 0.689, 95% confidence interval: 0.538–0.881, P = 0.003).

Surgery showed significant survival benefits for the patients with M1 stage GC. Our study has provided additional evidence to support PTR for these patients.

Pertussis is a vaccine‑preventable respiratory infection and seroepidemiology of the infection could be a marker of the pertussis immunity in a population. In many countries, despite vaccination coverage, high prevalence of pertussis has been observed. The present study aimed to evaluate the immunoglobulin G (IgG) antibody against pertussis and the role of demographic and anthropometric variables on the immunity rate in the Iranian pediatric population to evaluate the impact of existing immunization program in order to envisage future vaccination strategies to prevent infection.

In a cross‑sectional multi‑centric study, 1593 samples of the students aged 7–18 years, who had been enrolled in a national survey (Childhood and Adolescence Surveillance and Prevention of Adult Noncommunicable disease‑V), were randomly selected and tested for IgG antibody against Bordetella pertussis (BP) by enzyme‑linked immunosorbent assay. The age, gender, education, residency, geographical region, and body mass index (BMI) were extracted from the questionnaires of the COSPIAN‑Survey. Multiple logistic regression models were used to assess the associations between the variables with the IgG antibody against BP. Data were presented by odds ratio (OR), 95% confidence interval (95% CI) and P values (P): (OR [95% CI]; P).

Subjects were consisted of 774 boys and 750 girls, with a mean (standard deviation) age of 12.39 (3.03) years. Overall, BP seroprevalence was 59.8%. There were higher BMI values in seronegative ones versus seropositive (18.62 ± 4.07 vs. 18.15 ± 3.94, P = 0.041, 95% CI = 0.23 [0.02–0.92]). However, the categorized BMI for age was not significantly associated with IgG levels (0.27 [0.25–0.29]; 0.27). BP seroprevalence was not significantly different between geographical regions (0.06 [0.05–0.07]; 0.06), genders (1.17 [0.93–1.47]; 0.18), area of residence (1.07 [0.82–1.4]; 0.61), and educational levels (0.94 [0.75–1.19]; 0.62).

IgG antibody against pertussis was not detected in nearly 40% of the subjects who had history of vaccination against pertussis. It is recommended to monitor the incidence of pertussis in high‑risk populations closely and administer a booster dose of acellular pertussis vaccine in adolescents.

Several studies have demonstrated that the genetic polymorphisms in the genes encoding immune regulatory molecules, namely cytotoxic T‑lymphocyte‑associated protein 4 (CTLA4) and CD28, play a fundamental role in susceptibility to rheumatoid arthritis (RA). Several disperse population studies have resulted in conflicting outcomes regarding the genetic polymorphisms in these genes and RA risk. This systematic review and meta‑analysis study was performed to reach a conclusive understanding of the role of single‑nucleotide polymorphisms (SNPs) of CTLA4‑rs231775, CTLA4‑rs5742909, and CD28‑rs1980422 in susceptibility to RA. Databases (ISI Web of Science, MEDLINE/PubMed, and Scopus) were searched to find the case–control studies surveying the association of CTLA4 gene rs231775, CTLA4 gene rs5742909, and CD28 gene rs1980422 polymorphisms and RA susceptibility in different population until August 2020. Association comparison between the polymorphisms and RA proneness was assessed using pooled odds ratio (OR) and their corresponding 95% confidence interval. This study was conducted on 16 population studies, comprising 1078 RA patients and 1118 healthy controls for CTLA4‑rs231775, 2193 RA patients and 2580 healthy controls for CTLA4‑rs5742909, and 807 RA patients and 732 healthy controls for CD28‑rs1980422. Analysis indicated that G‑allele, GG and GA genotypes, and dominant model for rs231775, recessive model for rs5742909, and C‑allele, CC and CT genotypes, and recessive model for rs1980422 were significantly associated with increased RA risk. This meta‑analysis showed that genetic polymorphisms of both immune inhibitory and activating genes, including CTLA4‑rs231775, CTLA4‑rs5742909, and CD28‑rs1980422 polymorphisms, may increase susceptibility to RA.

Medication related osteonecrosis of the jaw (MRONJ) is a severe condition affecting the jaws of patients exposed to specific drugs, and is primarily described in patients receiving bisphosphonate (BP) therapy. However, more recently it has been observed in patients taking other medications, such as the RANK ligand inhibitor (denosumab) and antiangiogenic drugs. It has been proposed that the existence of other concomitant medical conditions may increase the incidence of MRONJ. The primary aim of this research was to analyze all available evidence and evaluate the reported outcomes of osteonecrosis of the jaws (ONJ) due to antiresorptive drugs in immunosuppressed patients. A multi-database (PubMed, MEDLINE, EMBASE and CINAHL) systematic search was performed. The search generated twenty-seven studies eligible for the analysis. The total number of patients included in the analysis was two hundred and six. All patients were deemed to have some form of immunosuppression, with some patients having more than one disorder contributing to their immunosuppression. Within this cohort the commonest trigger for MRONJ was a dental extraction (n=197). MRONJ complications and recurrence after treatment was sparsely reported in the literature, however a total of fourteen cases were observed. The data reviewed have confirmed that an invasive procedure is the commonest trigger of MRONJ with relatively high frequency of post-operative complications or recurrence following management. However, due to low-quality research available in the literature it is difficult to draw a definitive conclusion on the outcomes analysed in this systematic review.

Oxidative stress is an important factor in the etiology of several chronic diseases that include cardiovascular disease (CVD), Type 2 diabetes (T2D), and rheumatoid arthritis (RA). Oxidative stress can lead to inflammation, and this can contribute to these chronic diseases. Reducing inflammation and oxidative stress may, therefore, be useful in the prevention and treatment of these conditions. One of the treatment options for chronic diseases is the use of traditional medicine and herbs, such as Nigella sativa. This is one of the herbs that have recently been assessed for its ability to reduce inflammation and oxidative stress. We have reviewed the reported effects of N. sativa on risk factors of chronic diseases (CVD, DM, and RA) with emphasis on molecular and cellular mechanisms in controlling inflammation and oxidative stress. Various mechanisms have been proposed to contribute to the beneficial properties of N. sativa, including a reduction of lipid peroxidation via its antioxidant properties; agonist of peroxisome proliferator‑activated receptor gamma in adipose tissue; activation of AMP‑activated protein kinase, increased antioxidants, inhibition of nuclear factor‑kappa B pathway; increased in interleukin‑10 expression, CD4+ T‑cell percentage, T regulatory cell percentage (CD4+ CD25+ T‑cell) in peripheral blood, and CD4+/CD8+ ratio, but to prove this claim, it is necessary to conduct experimental and well‑designed clinical trial studies with a larger sample size on the effects of N. sativa on these chronic diseases.

Urinary tract infection (UTI) is a mainly common infection in kidney transplant recipients. This study decided to investigate UTI, bacterial agents, and antibiotic resistance pattern in kidney transplant recipients from Iran.

Search process was conducted for UTI, bacterial agents, and antibiotic resistance pattern in kidney transplant recipients from Iran via electronic databases (Scopus, PubMed, Web of Science, etc.,) with Mesh terms in either Persian and English languages without limited time to May 31, 2020. Data were analyzed by comprehensive meta‑analysis software.

The combined prevalence of UTI in renal transplant recipients was reported by 31.1%. The combined prevalence of Gram‑negative bacteria was 69%. The most common pathogens among Gram negatives were E. coli followed by Klebsiella pneumoniae with frequency 43.4% and 13%, respectively. Subgroup analysis for Gram‑positive bacteria showed the combined prevalence of 31%. The most common microorganism among Gram positives belonged to coagulase‑negative Staphylococci and Enterococci with a prevalence of 10.2% and 9%, respectively. Subgroup meta‑analysis of antibiotic resistance for Gram‑negative showed the most resistance to cephalexin followed by carbenicillin with a prevalence of 89.1% and 87.3%, respectively.

Our review showed a noticeable rate of UTI (31.1%) among renal transplant recipients in Iran and a high prevalence of Gram‑negative (69%) and Gram‑positive (13%) microorganisms. A high resistance rate was seen against almost all antibiotics used for the treatment of UTI.

Bezoars are collections of indigestible foreign material found in the gastrointestinal tract. Phytobezoars are the most common among the types of bezoars. Treatment of phytobezoars is categorized into four types: chemical dissolution, endoscopic removal, adjuvant prokinetics, and surgery. Complications from phytobezoars can include gastric outlet obstruction (GOO), ileus, ulcerations, gastrointestinal bleeding, and perforation. Herein, we present an 86‑year‑old woman with refractory postprandial vomiting. Then, exploratory laparotomy was performed and the diagnosis was gastric phytobezoar. Phytobezoars‑induced GOO is rare and its diagnosis is still a challenge.