مجله دانشکده پزشکی اصفهان
پیاپی 636 (هفته چهارم مهر 1400)

Some of studies have shown that measurement of some laboratory parameters such as D-dimer and arterial blood gases can be helpful in the diagnosis of pulmonary embolism. This study aimed to determine the diagnostic values of D-dimer and alveolar-arterial gradient (A–a gradient) for detection of pulmonary embolism in patients with shortness of breath.

In a descriptive-analytical study, 196 patients with symptoms of shortness of breath referred to the emergency departments of Alzahra and Ayatollah Kashani hospitals in Isfahan City, Iran, were studied, and their D-dimer and arterial blood gas levels and A-a gradient were measured. All patients underwent CT scan of the lungs, and the presence of pulmonary embolism was evaluated. The diagnostic value criteria of the two tests including sensitivity, specificity, and positive and negative predictive values were evaluated in comparison with CT scan.

Sensitivity, specificity, and positive and negative predictive value were obtained 70.41, 94.79, 93.20, and 75.80 percent for the D-dimer test, respectively, and 92.7, 17.24, 55.3, and 68.2 percent for the A–a gradient test, respectively. The area under the rock curve of receiver operating characteristic (ROC) was 0.85 (P < 0.001) for the D-dimer and 0.5 (P = 0.820) for the A-a gradient.

The D-dimer test has high diagnostic value criteria for diagnosis of pulmonary embolism in patients with symptoms of shortness of breath, while parameters related to arterial blood gases such as A-a gradient do not have high diagnostic values to diagnose this complication.

Here, the cytotoxicity of various Allium giganteum extracts was evaluated on MCF-7 and HeLa cell lines, to introduce novel anti-cancer agents from natural resources,

Flowers of the plant were subjected to extraction in a four steps method, and the extracts were evaluated for their cytotoxicity on MCF-7 and HeLa cell lines. MTT assay was performed 48 hours. Following treatment of the cells with 10, 20, and 50 µg/ml of different extracts. The mechanism of the induced cell death was assessed by flow cytometry following Annexin/PI staining of the treated cells.

The MTT results showed significant toxicity of dichloromethane, chloroform-methanol (9:1), and butanolic extracts at 50 µg/ml on MCF-7, and at 20 and 50 µg/ml on HeLa cells compared to control (P < 0.05). No significant cytotoxicity and apoptosis induction was observed following treatment with aquatic extract. The flow cytometric analysis results indicated apoptosis induction by all the three extracts on MCF-7 cells.

The dichloromethane, chloroform-methanol (9:1), and butanolic extracts of Allium giganteum showed cytotoxic effects on the cancer cells, and up to 26% apoptosis of MCF-7 cells. Due to the desirable results of this study, extraction and identification of constituents of the extracts, especially steroidal saponin constituents, could be valuable.

There is a controversial effect of Tamoxifen in reducing breast cancer recurrences, while it may increase the chance of uterine cancer occurrence. In this study, we report a rare case uterine neoplasm shortly after breast cancer treatment.

A 50-year-old woman, gravida 6 live 5 and abortion 1, with history of treated breast cancer referred with the complaint of prolonged abnormal uterine bleeding from one year before. Her breast cancer was treated by surgery and Tamoxifen therapy, which was exchanged to letrozole after her new complaint. Although, no further evaluation had been performed earlier, recently uterine myxoid leiomyosarcoma was defined.

Tamoxifen is one of the most effective drugs in the treatment of breast cancer, but it can increase the risk of uterine cancer. In our case, after taking tamoxifen, she developed uterine leiomyosarcoma. As a result, users of this drug, especially in cases with symptoms such as abnormal bleeding, should be carefully screened for uterine cancer.