Iranian Red Crescent Medical Journal
Volume:23 Issue: 4, Apr 2021

Context: 

Mesenteric and bowel injuries (MBI) are rare and dangerous presentations of blunt abdominal trauma and often cause clinical uncertainty since their diagnosis is difficult and operative treatments are often delayed. No clear guidelines exist regarding this topic, and due to the rarity of the injury, few and highly low-quality data are available. This study aimed to compare early surgical exploration, delayed surgical exploration, and non-operative management in patients with proven and suspected blunt MBI.

Evidence Acquisition: 

Detailed research was performed on Medline, Embase, PubMed, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews databases until 29th November 2019. The studies that were considered eligible to be included in this systematic review and consequent meta-analysis were those focusing on patients with proven MBI or computed tomography (CT) signs suspected for them and comparing early surgical exploration (EOR) with delayed one (DOR) or with selective surgical exploration (SOR) after clinical observation. The eligible studies were sub-grouped into those using a delay cut-off (to distinguish “early” and “deferred” surgical intervention) higher than 12 h and those using a cut-off lower than 12 h, as well as those focusing on patients with high-risk CT signs (pneumoperitoneum and active mesenteric bleeding) and those focusing on patients with low-risk ones.

 Finally, 16 studies fulfilled the inclusion criteria and were included in the meta-analysis with a total of 2,702 patients. All studies, although not randomized, were considered to be at the acceptable risk of bias in the important domains. It was found that in patients with proven MBI, in the subgroup of studies with a delay cut-off for surgical intervention lower than 12 h, the complication rate was significantly lower in EOR, compared to DOR (risk ratio [RR]=0.47, 95% CI=0.29-0.79, P=0.004). In patients with suspected MBI with low-risk CT signs, the complication rate was significantly lower in SOR, compared to EOR (RR=1.79, 95% CI=1.27-2.53, P=0.001). It was also revealed that in patients with high-risk CT signs, the complication rate and the length of stay (LOS) were significantly lower in EOR, compared to DOR (complication: RR=0.38, 95% CI=0.17-0.84, P=0.02; LOS: mean difference=-12.00, 95% CI=-21.44-2.56, P=0.01).

 The present meta-analysis confirmed that in patients with proven blunt MBI a delay of surgical intervention higher than 12 h would lead to a higher complication rate and a longer LOS. Based on the results, in blunt trauma patients with pneumoperitoneum or active mesenteric bleeding at the admission CT scan, complications and LOS could be reduced by performing an early surgical exploration. On the other hand, in blunt trauma patients with low-risk CT signs of suspected MBI, a clinical observation with selective surgical exploration in case of clinical or radiological worsening could reduce the complication rate without increasing mortality and LOS.

 Cardiovascular disease (CVD) is the leading cause of morbidity and mortality across the globe. Activity status is used as a social class marker of CVDs.

 The present study aimed to analyze the associations between occupational status and CVDs in Iranian population.

 The present cross-sectional study was conducted on 9,990 subjects aged 35-70 years enrolled in the Rafsanjan Cohort Study (RCS), as one of the Prospective Epidemiological Research Studies in Iran (PERSIAN). Occupational status, socio-demographic characteristics, physical activity, cigarette and hookah smoking, opium use, and alcohol consumption were assessed through six pre-designed questionnaires. Anthropometric, body mass index (BMI), medical history, and laboratory tests were also performed. CVDs were defined as the presence of ischemic heart disease (IHD) or myocardial infarction (MI). Prevalence ratios were calculated for each activity status and CVD using Poisson regression models.

 The occupational activities were assigned to two classes: homemaker (40.17%) was the largest group of class I, followed by self-employed (34.44%), employed (13.03%), retired (10.38%), and unemployed (1.62%). In class II, the largest group included pistachio farmers (12.61%), copper miners (3.62%), and others (83.76%). A percentage of people were illiterate (9.50%), especially in the homemaker group (61.39%). In general, 8.71% and 2.98% of participants suffered from IHD and MI, respectively. After adjusting the socio-demographic and other characteristics, there was no significant association between occupational status and CVDs.

 As evidenced by the obtained results, activity status was not associated with the risk of IHD and MI.

Dyslipidemia, a genetic and multifactorial disorder of lipoprotein metabolism, is defined by elevations in the levels of total cholesterol, low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non–HDL-C), triglyceride, or some combination thereof as well as lower levels of high-density lipoprotein (HDL) cholesterol.

This study aimed to investigate the prevalence and predictors of dyslipidemia in children and adolescents in the Yazd Greater Area, Yazd, Iran.

This cross-sectional study was conducted as a part of the national project implemented in Yazd Greater Area, Yazd, Iran. The sampling was performed using a multi-stage cluster sampling method on three age groups of girls and boys, including 6-9, 10-14, and 15-18 years old. Out of the total 1,035 children and adolescents who initially participated in this study, only 784 participantsremained until the end. Datacollection was performed using lifestyle questionnaires including Kiddie-SADS-Present and Lifetime Version software.

The rate of high triglyceride was estimated at 1.4% and 4.2% in 6-9 and 10-18 years old children and adolescents, respectively. Moreover, the prevalence of high cholesterol, LDL, and HDL were obtained at 3.2%, 3.2%, and 25.6%, respectively. The prevalence of dyslipidemia in the total population of children and adolescents was estimated at 64.6% and 57.3% in boys and girls, respectively (P=0.038) in terms of demographic variables. Gender and increase in body mass index (BMI) were significantly associated with dyslipidemia with OR=1.35; 95% CI: 1.01-1.81 and OR=13.781; 95% CI: 3.78-46.43, respectively. However, after adjustment for other factors, only an increase in BMI was significantly associated with dyslipidemia (OR=16.08; 95% CI: 4.49-57.59).

Overweight and obese adolescents had a higher concentration of serum blood triglycerides, compared to their counterparts. Weight control, lifestyle, and diet modification are three ways to reduce lipid disorders in adolescents.

Traumatic brain injury (TBI) seriously affects the quality of life of patients. The present study evaluated the role of diffusion tensor imaging (DTI) combined with Neuron-Specific Enolase (NSE) and S100 calcium-bindingproteinB (S100B)protein in predicting the prognosis of moderate and severe TBI.

The TBI patients were divided into moderate TBI (TBIm) and severe TBI (TBIs) groups according to the Glasgow Coma Scale (GCS) after admission. The patients were then divided into good and poor prognosis groups according to the Glasgow Outcome Scale (GOS); moreover, their follow-ups were recorded at 3 and 6 months after injury. This study also included 65 healthy individuals with matched age and gender as the control group. The fractional anisotropy (FA) values of DTI, serum neuron-specific enolase (NSE), and S100B protein levels were detected in this study. The data were analyzed in SPSS software (version 22.0) to evaluate the role of DTI combined with NSE and S100B protein in predicting the prognosis in TBIm and TBIs.

After TBI, the FA values of DTI in the TBI group were lower than those in the control group (P<0.05); moreover, the serum NSE and S100B values in the TBI group were higher than those in the control group (P<0.05). In the TBIm patients, the FA values of the corpus callosum in the good prognosis group werehigher than that in the poor prognosis group (P<0.05); however, there was no significant difference between the two groups regarding the FA values of the internal capsule and the cerebral peduncle (P>0.05). The serum levels of NSE and S100B in the good prognosis group were significantly lower than those in the poor prognosis group (P<0.05). In the TBIs patients, the FA value of all areas in the good prognosis group was significantly higher than that in the poor prognosis group (P<0.05). However, there was no significant difference between the two prognosis groups regarding the serum levels of NSE and S100B (P>0.05).

Although DTI combined with NSE and S100B protein can effectively predict the prognosis of patients with moderate and severe TBI in the early stages, various other measures have been used in the studies to predict the prognosis of TBI patients. Accordingly,comparison with other measures is essential in further studies.

Gastric cancer is the most common gastrointestinal malignancy with an increasing incidence rate worldwide. Finding novel curative and preventive approaches that could target the tumor cells without affecting the normal cells and overcome drug resistance will be tremendously useful.Objectives: This study aimed to evaluate the effects of quercetin (QUE) in combination with doxorubicin (DOX) on apoptosis and its underlying mechanisms in the KATO III gastric cancer cell line.

The effects of Que and DOX on cell viability were measured using an MTT assay. Western blot was used for the measurement of γH2AX protein expression. The expression levels of 8-Hydroxy-2'-deoxyguanosine were evaluated by enzyme-linked immunosorbent assay. The 2, 7-dichlorofuorescin diacetate fluorescence dye was used to detect the formation of reactive oxygen species (ROS). The activities of antioxidant enzymes (superoxide dismutase, catalase, glutathione peroxidase, glutathione reductase, and glutathione S-transferase) were also assessed. For evaluation of apoptosis, the terminal deoxynucleotidyl transferase dUTP nick end labeling assay was used.

Based on the findings, QUE significantly increased the cytotoxic effects of DOX. Besides, QUE considerably increased the expression levels of γH2AX. Upon QUE treatment, ROS levels increased, and antioxidant enzyme expression levels markedly decreased. Moreover, QUE treatment resulted in the potentiation of doxorubicin-induced apoptosis in KATO III cells, compared to the cells treated with either QUE or DOX.

Overall, co-administration of QUE and DOX enhances cytotoxicity, increases ROS levels, induces oxidative DNA damage, and decreases cellular antioxidant defense, and thereby might promise a therapeutic regimen in promoting the clinical efficacy of the treatment of patients with gastric cancer.

Aberrant DNA methylation is a common molecular feature in colorectal cancer (CRC). Hypermethylation of miR-200b promoter, as an epigenetic factor, is involved in CRC tumorigenesis. The methylation status of miR-200b has been examined in CRC and adjacent normal tissues.

This studyaimed to investigate miR-200b methylation in a series of colorectal adenomatous polyps, hyperplastic polyps, and adenocarcinoma tissues as precursors of CRC in the Iranian population for the first time.

In this cross-sectional study (2017-2018), the methylation status of the miR-200b promoter was investigated on 131 fresh samples, including adenocarcinoma specimens (n=30), tumor-adjacent normal tissues(n=17), primary lesions (n=78; 55 adenomatous polyps and 23 hyperplastic polyps) and healthy individuals (n=6) using Methylation-specific polymerase chain reaction.

Methylation of miR-200b was detected in adenocarcinoma samples (86%) and adenomatous polyps (85%); however, most of the hyperplastic polyps were unmethylated (69.6%). Neither control individuals nor tumor-adjacent normal tissues exhibited methylation in the miR-200b promoter. Aberrant methylationof miR-200b wassignificantlymore common in tumor tissues and adenomatous polyps than in hyperplastic polyps (P<0.0001) and tumor-adjacent normal samples (P<0.0001).

The methylation status of the miR-200b promoter was significantly altered during CRC development andmay be identified as an indicative biomarker for the early detection of the disease.

The existence of partnerships between the health system and other organizations, especially city councils and municipalities, which have inherent and legal duties in this regard, is of particular importance in the promotion of public health.

The present study aimed to assess the status of Health System cooperation with City councils and municipalities in Iran basedon rules and documents.

Altheide’s document analysis model (sample selection, data collection, data organization, data analysis, and reporting) was used to prepare and analyze the documents pertaining to the status of Health System cooperation with city councils and municipalities. The documents were classified at three levels of national rules, policies, and guidelines; Ministry of Health (MOH) and city council approvals; and eventually Tehran municipality’s measures.

A total of78 documents were analyzed, including 17 documents at the level of national rules, policies, and guidelines; 8 documents at the level of Ministry of Health and city council approvals; and 53 documents at the level of municipality’s measures.

There are adequate legal capacities for designing, planning, executing, as well as creating interaction and cooperation between the health system and other organizations, especially city councils and municipalities. Moreover, the motives behind creating purposeful and scheduled cooperation and participation are evident among the officials of the health system and city councils and municipalities. Some mechanisms have been established for cross-sectoral cooperation between the health system and other health-related bodies. Nonetheless, these structures lack the necessary competence, appropriateness, and adequacy to create the desired partnership. Moreover, sufficient attention is not devoted to existing capacities in municipalities and the city council. Accordingly, it is necessary to have a fundamental review on the available structures and enough attention has to be paid to the evident and hidden legal capacities in city councils and municipalities, as well as the Ministry of Health, to design an appropriate structure, createcompetent interaction, and provide more cooperation between the two organizations.

Laparoscopic enteral-feeding access is the best option for patients with advanced upper gastrointestinal, oropharyngeal, and laryngeal cancers needing to maintain their caloric intake before surgery or during chemoradiotherapy.

Considering the above-mentionedfactors and after a comprehensive review of the related studies, a very simple procedure was selected and the current study tried to modify it to devise a standard surgery.

During a laparoscopic procedure by a cystostomy catheter system, a jejunostomy tube was placed for 14 patients. All the patients had a 2-month follow-up for complications and performance of the feeding system.

Based on the obtained results, there was no internal leak and peritonitis among the subjects. One patient converted to an open procedure due to perforation during the procedure. In three patients, the extraction of the catheter was encountered during the follow-up period and a replacement was required. Onecase of wound infection and one case of catheter obstruction occurred among the subjects. Catheter obstruction was easily resolved using warm water and pancreatic enzyme irrigation. There was one patient with partial intestinal obstruction who was managedthrough nonoperative means. No significant bleeding was encountered during the surgery.

Laparoscopic jejunostomy with this method is simple and cost-effective and can be performed within an acceptable timeframe with minimum complications. It is the procedure of choice for upper GI and laryngeal cancer patients, those at increased risk of aspiration, and subjects not candidates of percutaneous endoscopic gastrostomy

One of the most toxic effects of organophosphorus poisoning (OP) is the paralysis of skeletal muscles. The oximes are a groupof available antidotes.

This studyinvestigated the effectsof different concentrations of paraoxon on the function of skeletal muscle and reversal or prevention of these effects by three different oximes (i.e., pralidoxime, obidoxime,andHI-6).

This study was conducted based on the chicken biventer cervices(CBC)nerve-muscle preparationand the use of twitch tension recording technique. The twitches of the CBCwere evoked by stimulating the motor nerve at 0.1 Hz with pulses of 0.2 msec duration and a voltage greater than that required to produce the maximum response. Moreover, twitches and contractures were recorded isotonically using GrassBiosystems.

Paraoxon at 0.1 μM induced a significant increase (more than 100%) in the twitch amplitude, while higher concentrations (0.3 and 1μM) inducedpartial or total contracture. Therefore, paraoxon at a concentration of 0.1 μ M was used to examine the capability of oximes to prevent or reverse its effects. Pralidoxime, obidoxime,andHI-6 dose-dependently prevented (when it was used as pre-treatment, 20 min before orat the same time of administration of the toxin)and reversed (when it was used as post-treatment, 20 min afterthe administration of the toxin) the effect of paraoxon.

In conclusion, these resultsrevealed that oximeswerevery useful in the prevention and reversal of the OP toxic effectson the skeletal muscle. Moreover, it was suggested that oximes were more effective when used as pre-treatment.Pralidoxime was more potent than obidoxime andHI-6.TheHI-6, which is a newer oxime, was unexpectedly less effective than the other two.

Hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC) are the most common primary malignancies of the liver. The combined form of these two tumors (i.e., cHC-CC) is a considerably rare type of liver cancer displaying both malignant components.

The present study aimed to explore the factors affecting survival in patients with HCC, ICC, and cHC-ICC through referring to statistical analysis, including demographics, histopathological, and operative and laboratory findings.

In this research, 53 patients were evaluated retrospectively, who had undergone an operation for primary liver tumors in a single tertiary center. Data were analyzed in terms of demographics, operation, tumor features, histopathological analysis, and their relationship with survival.

The study groups consisted of 20 ( 37.7%) and 33 (62.3%) females and males, respectively, with a mean age of 62.3 years. It was revealed that the survival rate was significantly higher in HCC, comparedto other groups (P<0.05). Moreover, alpha-fetoprotein (AFP) was significantly higher in the HCC group than in the intrahepatic cholangiocarcinoma (ICC) group, and carbohydrate antigen 19-9 levels and the presence of jaundice and perineural invasion were significantly higher in the ICC group, compared to HCC patients. In the HCC group, macroscopic vascular invasion, perineural invasion, and T staging were statistically significant. It was also found that in the ICC group, the macroscopic vascular invasion was statistically significant, and in the cHC-ICC group, the increased levels of AFP showed a statistically significant effect on survival (P<0.05).

To the best of our knowledge, the current research was one of the very few studies performed focusing on each group of liver tumors in a single study. Based on the findings of this research, there were statistically significant results in all three groups and their comparison with each other

Ischemia-reperfusion injury (IRI) is an injurious phenomenon that is the primary determinant of liver dysfunction after surgery and transplantation. The present evidence demonstrated that connexin 43(Cx43), Cx32, and Cx26are the essential gap junction proteins involved in the liver IRI.

This study aimed to characterize the beneficial effects of silibinin on Cx43, Cx32, and Cx26gene expression during warm hepatic ischemia-reperfusion (IR).

A total of 32 male Wistar rats weighing 250-300 g were randomly divided into four equal groups of eight animals in each group as follows:1) control (laparotomy+normal saline), 2) laparotomy+silibinin (30 mg/kg) (SILI), 3) liver IR procedure+normal saline (IR), and 4) liver IR procedure+silibinin (30 mg/kg) (IR+SILI). After 1 h of ischemia followed by 3 h of reperfusion, blood samples and tissue sections were gathered to assess the serum liver markers and evaluate the liver histological changes as well as gene expression, respectively.

The obtained data proved no considerable differences between control and SILI groups in all experiments. Furthermore, the gene expression of Cx26, Cx32, and Cx43was significantly induced in the IR group, compared to the control group. Silibinin markedly reduced Cx26and Cx32mRNA expression, whereas increased Cx43mRNA expression. Moreover, serum alanine aminotransferase and aspartate aminotransferase levels were markedly elevated in the IR group (P<0.001), compared to the control group. However, in the IR+SILI group, silibinin could significantly decline these elevations, compared to the IR group. In addition, silibinin diminished hepatic tissue damages during IR.

Silibinin could attenuate liver injury through better cell-to-cell communication via lowering Cx32and Cx26, as well as increasing Cx43gene expression, respectively

Arbaeen Pilgrimageis one of the world’s largest religious gatherings held in Iraq on the occasion of the 40thday of Imam Hussein martyrdom. The identification of the problems and challenges facing the Arbaeen Pilgrimage is of great help in holding this event safer in the future.

The present study aimed to review the challenges of health services provided to pilgrims during the Arbaeen Pilgrimage in 2019.

This cross-sectional study was performed within one month after the end of this event. The statistical population comprised three million applicants registered by the Hajj and Pilgrimage Organization of Iran. Out of this population, 1,200 subjects who had participated in the event were selected using simple random sampling. The needed data were collected using a researcher-made questionnaire containing closed-and open-ended questions. Demographic characteristics, medical records, and subject comments were included in the questionnaire. The researchers contacted the participants and filled out the questionnaire.

The mean age of participants was reported as 41.2±14.1 years, and the majority of them (65.7%) were male. The cold mostly caused the need for medical services. In total, 9.5% of the participants did not receive services, and 90.9% received them from the Iranian Red Crescent Society(IRCS). According to the results, 95.4% of those who received services from the IRCS and 82.4% of those who received services from other service providers were satisfied with medical services.

Iraq’s health system is faced with numerous challenges during the Arbaeen Pilgrimage. These challenges are multiplied due to infrastructural shortcomings in Iraq’s health system, the lack of precise planning, as well as attendees' unpreparedness and unawareness. To obtain pilgrims' satisfaction and minimize the problems, the authorities of Iraq's health system should participate, synergize, and provide health equipment and facilities in cooperation with organizations from other countries participating in the Arbaeen pilgrimage. Comprehensive multi-organizational planning and intra-and extra-organizational coordination before the Arbaeen pilgrimage and training the pilgrims are two key factors that can help the better organization of this event.