مجله پزشکی بالینی ابن سینا
سال بیست و هشتم شماره 2 (پیاپی 100، تابستان 1400)

Acute pulmonary thromboembolism is an emergency disease that can lead to mortality if not diagnosed on time. Proper triage of patients based on clinical findings and the Wells Score will have a significant impact on the medical team's decision-making and patient management.

This descriptive cross-sectional study was conducted on 300 patients selected by the census sampling method. The patients were suspected of acute pulmonary thromboembolism referring to Farshchian Heart Hospital in Hamadan, Iran, within October 2017-March 2020. The cases considered a candidate for computed tomography (CT) pulmonary angiography were selected and compared regarding CT pulmonary angiography results and the risk of embolism based on Wells Score.

According to the results of CT angiography, 91 (30.3%) patients had acute pulmonary thromboembolism, 16.5%, 45.1%, and 38.4% of which were in the low-risk, moderate-risk, and high-risk groups, respectively (P<0.001). Involvement of segmental and subsegmental branches, followed by the involvement of the pulmonary lobar branches, were the most common patterns of pulmonary artery involvement in acute pulmonary thromboembolism. Accompanying findings were significantly lower in patients with acute pulmonary thromboembolism than in patients with negative acute pulmonary thromboembolism (P<0.001(.

There was a significant relationship between the result of CT pulmonary angiography and clinical findings in patients suspected of acute pulmonary thromboembolism. The careful examination of the clinical symptoms of patients and determination of the level of risk in such patients according to the Wells Score can lead to the more efficient management of the process of diagnosis and treatment of patients.

Due to the significant importance of the teeth in mastication, speech, and aesthetics, it is necessary to identify all involved genes in the tooth development. Therefore, this study aimed to evaluate the role of endothelin-1 and its A receptor in dental lamina in different stages of tooth development.

This cross-sectional study included 33 fetal samples that were divided into three groups regarding gestational age. All samples were then stained by immunohistochemistry. Subsequently, the analysis was conducted in SPSS software (version 20) through the two-way ANOVA and Tukey's tests to examine the differences between the variables.  A p-value less than 0.05 was considered statistically significant.

There was a significant difference between the gestational age and the expression level of endothelin-1 in dental lamina (P<0.001). In addition, a significant relationship was observed between age and anatomic area (P<0.001). There was also a significant difference between the gestational age and the expression level of endothelin-1 receptor (ETAR) in dental lamina (P<0.001). A significant association was found between gestational age and anatomic area (P<0.001).

The expression levels of endothelin-1 and its receptor (ETAR) in each jaw were higher in anterior dental lamina, compared to posterior dental lamina. These results may confirm the role of endothelin-1 and its receptor in cell proliferation, differentiation of dental lamina, and  calcium ion transport during tooth development

Anxiety is an important aspect of neuroticism and may be related to potential mechanisms such as resilience. This study aimed to predict generalized anxiety in neurotic people based on resilience.

This was a correlational forecasting study. The study population consisted of students of Arak University, Arak, Iran, in 2019, from whom a sample of 300 individuals was selected using the convenience sampling method. The study tools for data collection included the Neuroticism scale of NEO Five-Factor Inventory, Generalized Anxiety Disorder Scale-7, and Connor-Davidson Resilience Scale. Eventually, 70 participants who obtained high scores on the Neuroticism Scale (score 24 and over) were studied.

Simultaneous multiple regression analysis showed that resilience components predicted about 31% of the variance of generalized anxiety in neurotic people (F=5.846, P< 0.001). It was revealed that the components of notion of personal competence, high standards, and tenacity (with a Beta coefficient of -0.446), and positive acceptance of change and secure relationships (with a Beta coefficient of -0.439) had a negative and significant role in this prediction. However, other components did not have a significant role in this regard.

Based on the obtained results, resilience in accordance with the components of notion of personal competence and positive acceptance of change is an important variable for the prediction of generalized anxiety in neurotic people that should be seriously considered and strengthened to reduce anxiety.

The lumbopelvic rhythm is the coordinated movement of the lumbar spine and hip during trunk flexion and return. It is recognized as a clinical indicator of low back pain (LBP); nonetheless, the reported patterns of lumbopelvic rhythm in patients with LBP are inconsistent. The investigation of more homogeneous subgroups of patients with LBP is essential to clarify the lumbopelvic rhythm patterns. Therefore, the present study aimed to compare lumbopelvic rhythm between healthy individuals and patients with lumbar clinical instability.

A total of 44 subjects (22 healthy cases and 22 lumbar clinical instability (LCI) patients) participated in the present study. The kinematic parameters during the trunk flexion and return task were recorded using a Qualisys motion capture system. Hip flexion angle, lumbar flexion angle, and lumbopelvic rhythm were statistically analyzed in every 25% of the flexion and return phase of flexion. Data were analyzed using Kolmogorov-Smirnov, Chi-square, and independent t-test.

In the second quarter of trunk flexion, the flexion angle of the lumbar spine was larger in the lumbar clinical instability group, as compared to that in the control group (P=0.016). Furthermore, the hip flexion angle was smaller in the lumbar clinical instability group, in comparison with that in the control group (P=0.011).

These results show that the lumbopelvic rhythms are different among healthy subjects and patients with lumbar clinical instability.

Cosmetic facial surgery and soft tissue are among the main reasons for orthodontic treatment and referral to dentistry. This study aimed to conduct a cephalometric evaluation of facial soft tissue thickness in patients candidates for orthodontic treatment in terms of age and gender referring to School of Dentistry, Hamadan, Iran.

This cross-sectional study investigated the cephalometric radiography of 200 patients (100 males and 100 females) with skeletal class I (ANB 1-4) and vertical growth patterns. The patients were then divided into four age groups of 10-15, 15-20, 20-25, and 25-30 years with an equal number of males and females. Following that, the soft tissues in the glabella frontal, nose, subnasal, upper lip, lower lip, and chin were measured. The data were analyzed in SPSS software (version 21) through the t-test and ANOVA.

In general, the soft tissue thickness of the nose increased with age. Regarding gender (regardless of age), the males had thicker upper and lower lips, as well as subnasal, compared to females. Considering the simultaneous assessment of age and gender, the males had thicker soft tissue in the lower and upper lips, as well as subnasal areas.

With an increase in age, only the soft tissue of the nose increased significantly. Moreover, in the same age groups, the males had thicker lower and upper lips.

Percutaneous Nephrolithotomy (PCNL) in the ectopic pelvic kidney is highly challenging due to the presence of pelvic bone structures behind the kidneys and intestine loops in the anterior. Therefore, combining PCNL with laparoscopy will help prevent undesirable complications.

This case series was performed on eight patients with pelvic kidneys. Patients became candidates for PCNL, which was performed by an intra-abdominal laparoscopic guide, under fluoroscopic control. The best tract for access to the pyelocaliceal system was obtained and renal stones were completely crushed and removed. The stone clearance status was assessed with a plain X-ray and postoperative ultrasound.

The mean scores of maximum diameter of the stones, duration of the surgery, and hospitalization length were estimated at 23.5 mm, 114 min, and 3.3 days, respectively. There were no major complications during or after the surgery. All eight patients became stone-free and none of them needed to be readmitted.

Laparoscopic-assisted PCNL in ectopic pelvic kidneys is a safe and feasible technique with good results. This combined technique requires sufficient experience and expertise in both laparoscopic and endourologic fields since it has potential side effects of both methods.

The mutation of F2 and PAI-1 genes can cause thrombophilia in women. The present study aimed to assess the relationship of recurrent pregnancy loss (RPL) with rs3136520 in F2 and rs6090 in PAI-1.

This case-control study was conducted on 120 women with idiopathic RPL as case group and 120 healthy women without any history of infertility or abortion with at least one healthy child as the control group. These subjects were referred to a private genetic lab by a gynecologist. Both polymorphisms were studied using the amplification-refractory mutation system-polymerase chain reaction approach, and the obtained data were analyzed in SPSS software (version 26) using the chi-squared test (P˂0.05).

In the multiplicative model, there was a significant association between rs6090 and RPL (OR=0.222; 95%CI=0.082-0.599); nonetheless,
no relationship was detected between rs3136520 and RPL (OR=1, 95%CI=0.488-2.049). Moreover, according to additive model, there was no association between rs3136520 and RPL; however, there was a significant relationship between AG genotype in rs6090 and RPL (OR=0.245; 95% CI=0.066-0.901).

As evidenced by the obtained results, there was a protective association between rs6090 and RPL; nonetheless, there was no relationship between rs3136520 and RPL.

Multiple Sclerosis (MS) is a chronic and progressive disease of the central nervous system that severely affects the individuals' physical health and psychological well-being. This study aimed to investigate the effect of acceptance-commitment therapy on the resilience and psychological well-being of women with MS in Hamadan Province, Iran.

This quasi-experimental study was conducted based on a pretest-posttest design with a control group. The statistical population consisted of women with MS in Hamadan, Iran. In total, 40 women were randomly selected and randomly divided into two groups of intervention and control (20 cases per group). The intervention group participated in eight 90-min sessions of virtual acceptance-commitment group therapy (one session per week). On the other hand, the control group received no intervention. The resilience and psychological well-being of the both groups were measured before and after the intervention using Connor-Davidson Resilience Scale and Ryff Scale of Psychological Well-Being, followed by analysis of covariance. Regression analysis and Pearson correlation coefficient were used after ensuring that the statistical assumptions were met.

The mean values of resilience in the intervention and control groups at pretest were obtained at 43.33±3.16 and 43.80±3.53 (P>0.05), and the corresponding values were determined at 53.13±2.85 and 43.47±4.05 (P<0.05) at the posttest, respectively. Furthermore, the mean values of the psychological well-being in the intervention and control groups at pretest were calculated at 119.38±7.59 and 94.07±7.36 (P>0.05), and the corresponding values were 163.67±10.96 and 94.97±9.63 (P<0.05) at the posttest, respectively. This indicated a significant difference between the intervention and control groups.

The results showed that the acceptance-commitment therapy increased the resilience and psychological well-being of the patients with MS.

Congenital renal anomalies cover a significant portion of abnormalities, which may be due to variations in number, position, shape, and size of the kidney(s). Most studies are based on structural, local, and vascular abnormalities, while few of them, to the best of our knowledge, were conducted on abnormal renal rotation (renal malrotation).

The patient was a 25-year-old woman who presented with right kidney pain with a history of pain in the same area. Examinations and tests were normal. The patient underwent retrograde pyelography. The right and the left kidneys were observed with excessive rotation and below the normal location, and severe hydronephrosis, respectively.

Ectopic kidneys are accidentally diagnosed and are prone to complications such as hydronephrosis, kidney stones, Urinary Tract Infections (UTI), and urologic problems.