Archives of Iranian Medicine
Volume:25 Issue: 2, Feb 2022

Although investigating the probable side effects of post intraoperative radiotherapy wound fluid secretion (PIWFS) is crucial, especially in clinical cases, no report has been published on the effect of PIWFS on the remaining tumor cells (in the vital state) in cavity side margins or surrounding regions. These tumor cells might be directly/indirectly exposed to intraoperative radiation therapy (IORT). Here, for the first time, we investigated the effect of PIWFS on tumor cells of the same patient extracted from the excised tumor in the spheroid form.

We generated 8 human-derived breast tumor spheroids from 4 patient specimens who received to IORT, dissociated and cultured them in microfluidic devices. The spheroids from each sample were treated with the patients’ PIWFS and DMEM medium separately. Two different parameters, called area and number of detached cells (NDCs), were determined and investigated to evaluate the spheroids’ vital and proliferative states.

The results showed severe transformation in tumor spheroids’ function into more invasive and proliferative functions after treatment with PIWFS.

Although the radiation-induced bystander effect may have a role in this observation, further experiments must be done to better clarify the probable desired or non-desired effects of post-IORT secretion for both the remaining tumor cells and the surrounding immune cells.

The financing function within a health system is considered inherently complex, so it is of utmost importance to design a suitable future for this system given uncertainties and complexities of the environment. With regard to the current and future complicated conditions, health system financing is also likely to succeed if it can anticipate the impacts of effective factors in the future and further plan appropriate interventions ahead of time. Thus, the purpose of this study was to develop scenarios for the health system financing in Iran.

This mixed-design research of exploratory future studies type was conducted using the scenario method. In this respect, the key variables were evaluated using a questionnaire from two aspects of importance and uncertainty as well as formation of a future studies group (focus group). Finally, sensitivity analysis was carried out through cross-impact balance (CIB) analysis using the Scenario Wizard (Version 4.31) software.

A total of 25 factors were selected based on the type and the position of the variables (driving force, bi-dimensional, risk, secondary leverage or modifiable-to-secondary leverage) over the diameter of the MICMAC chart. Considering the degree of significance and uncertainty, eight variables including all four driving force variables (oil sales and economic blockade, leadership and advocacy, bureaucracy and corruption, and possibility of using information technology in providing services), as well as the variables of resource sustainability, natural disasters, regional security, and specialization culture were chosen. Then, five variables were finalized as the key changes that would create the scenario based on sensitivity analysis and final expert opinions. According to the defined conditions, 270 scenarios were developed, of which fourteen scenarios were identified as poorly adaptable and five cases as highly adaptable.

The best scenario identified in this study based on the degree of adaptation included the use of massive technology and oil sales, mediocre economic conditions with high probability of occurrence, strong leadership and advocacy, high regional security, as well as bureaucracy and low corruption with medium probability of occurrence.

In this study, we assessed the prevalence of positive rapid detection test (RDT) among healthcare workers (HCWs) and evaluated the role of personal protective equipment (PPE) and knowledge of the pandemic.

In a cross-sectional study conducted between August 2020 and October 2020 in a tertiary referral center (Tehran, Iran), we enrolled 117 physicians, nurses, and other HCWs (OHCWs)—aides, helpers, and medical waste handlers—regularly working in coronavirus disease 2019 (COVID-19) wards. The RDT kit was utilized to reveal recent infection; data on demographics, PPE use and availability, and knowledge of the pandemic was collected through pre-defined questionnaires.

Overall, 24.8% (95% CI: 16.8–32.7%) of HCWs had positive RDTs. The more PPE was available and used, the less the chance of positive RDT was (OR: 0.63 [0.44–0.91], P = 0.014 and 0.63 [0.41–0.96], P = 0.030). The same was true for the knowledge of prevention and adhering to preventive rules (OR: 0.44 [0.24–0.81], P = 0.008 and 0.47 [0.25–0.89], P = 0.020). OHCWs had the highest prevalence of positive RDT, while they had more shifts per month, less accessibility to PPE, and less knowledge of the pandemic than physicians.

The findings of this study suggest that HCWs should have a thorough knowledge of the pandemic along with using PPE properly and rationally. Furthermore, adhering to preventive regulations plays a crucial role in HCWs’ safety. It is also noteworthy that shifts should be arranged logically to manage exposures, with a special attention being paid to OHCWs.

Caffeine is commonly used to prevent or treat apnea in preterm neonates. The present trial was designed to determine the effect of caffeine on reducing the time required for nasal continuous positive airway pressure (NCPAP) in neonates with respiratory distress syndrome (RDS).

In a randomized controlled trial, a total of 90 neonates (birth weight between 1250 and 2000 g) who were clinically diagnosed with RDS were subjected to random assignment to one of the two groups of caffeine (n=45) or control (n=45). Infants in the caffeine group received 20 mg/kg caffeine as the initial dose, and then 10 mg/kg daily as the maintenance dose. Infants in the control group did not receive any placebo or similar drugs. The primary outcome was the duration time of respiratory support with NCPAP.

The mean (SD) duration of NCPAP differed significantly and was shorter among the infants in the caffeine group than those assigned to the control group (41.53 (43.25) versus 78.48 (114.25) hours, respectively; mean difference: -36.95; 95%CI: -73.14, -0.76; P = 0.04). Apnea of prematurity (AOP) occurred in 2 (4.4%) newborns in the caffeine group and in 9 (20%) of the infants in the control condition [proportion difference: -15.6% (-29.8,-1.8); (P = 0.02)]. The incidence of intraventricular hemorrhage (IVH) was higher in the control group than in the caffeine group after one week (P = 0.03). The incidence of chronic lung disease (CLD), infection, necrotizing enterocolitis (NEC), seizure, vomiting and pneumothorax was similar in the two groups.

The results suggest that preventative caffeine can reduce the duration of NCPAP support in neonates with RDS.

Coronary artery disease is among the first causes of death in Iran. Secondary prevention with drug therapy is recommended following acute myocardial infarction (MI) to reduce the risk of new cardiovascular events and death.

This is a retrospective cohort study on data collected from 21181 cases of MI recorded by the MI Registry of Iran from 2013 to 2014. Ten therapies that were prescribed to patients at the time of discharge were divided into 6 groups. Survival rates were estimated using the Kaplan-Meier method and Cox regression analysis.

The most common MI location was in the anterior wall (31.87%). Anticoagulants, aspirin, clopidogrel were the most common prescribed medications (94.73%). Overall, 28-day (short-term) and 3-year survival rates were 0.95 (95% CI: 0.95–0.96) and 0.82 (95% CI: 0.81–0.82). In non-ST-elevation myocardial infarction (NSTEMI) patients, the lowest short- and long-term survival rates were observed when diuretic, anticoagulants/ aspirin and clopidogrel, beta-blockers and statins medication were simultaneously taken and the highest short- and long-term survival rates were observed in patients who took anticoagulants, aspirin and clopidogrel, nitrate agent and calcium blockers, beta-blockers and statins medication. In STEMI patients, the lowest short- and long-term survival rates were observed when diuretic, anticoagulants, aspirin and clopidogrel, nitrate agent and calcium blockers, angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) were simultaneously taken. The highest short- and long-term survival rates were observed in patients who received anticoagulants, aspirin and clopidogrel, nitrate agent and calcium blockers, beta-blockers, statins, ACEIs and ARBs.

Prescription of the best combination of drugs, in addition to adherence to a healthy lifestyle and medication, can improve the survival rates after MI.

There is limited evidence on the epidemiology and time trend analysis of incidence rates of gynecological cancer in Asia as a whole. We conducted this study to demonstrate breast and gynecological cancers incidence and trends in selected Asian populations.

We conducted this ecological study using cancer and population data from cancer incidence in five continents (CI5). We extracted the data of breast, uterine, cervix and ovary cancers in selected Asian populations from 1998 to 2012 from CI5plus. We used Joinpoint regression model (version 4.8.0.1) to evaluate the annual percentage change (APC), which characterizes trends in cancer rates over time, and the average annual percent changes (AAPCs), which describes the average APCs over a period of multiple years. Results were considered statistically significant at P < 0.05.

Between breast and gynecological cancers, breast cancer has the highest incidence rates among women in Asia. The time trend of the incidence rates showed a constant growth in breast, ovary and corpus uteri cancers. This rising trend was obviously sharper for uterine cancer (AAPC 95% CI = 3.4 [3.0, 3.7]) followed by breast [AAPC 95% CI = 2.1 (2.0, 2.2)] and ovarian cancers (AAPC 95% CI = 0.5 [-0.4, 1.3]). The age-adjusted incidence rate (ASR) of cervical cancer displayed a declining trend from 1998 to 2012 (AAPC 95% CI = -1.4 [-2.4, -0.5]).

Incidence rates of breast and gynecological cancers have a rising trend in Asian countries. However, breast and gynecological cancers have different patterns of time trend.

In the last two decades, the simple low-cost abdominal ultrasound (US) examination for the diagnosis of advanced fibrosis and cirrhosis was displaced by very expensive and not readily available modern imaging systems like magnetic resonance imaging (MRI), computed tomography (CT) scan and transient elastography. The aim of this study is to evaluate and emphasize the potential of US for diagnosis of advanced liver fibrosis and cirrhosis.

US, laboratory tests (blood counts, transaminases, aspartate platelet ratio index [APRI], international normalized ratio [INR], serum albumin and bilirubin) and liver biopsy were performed on 197 patients with chronic liver diseases. Development of liver fibrosis was categorized in six stages, with stages 1–3 considered as mild to moderate and stages 4–6 as advanced fibrosis. Sonographic parameters (interrupted liver surface line, nodularity of liver surface, biconvexity of liver edges, grade of liver angle, caudate lobe diameter, parenchyma echotexture and spleen size) were obtained. All variables were dichotomized into zero and one and compared with respect to the different stages of liver fibrosis. The sensitivity, specificity, and positive and negative predictive values of all variables as well as their summations scores through receiver operating characteristic (ROC) curve analysis were calculated for the correct histologic diagnosis.

Totally, 39 cases had severe fibrosis and cirrhosis and 158 had mild to moderate fibrosis. The area under the curve by ROC curve analysis of sonographic variables (surface nodularity, angle of left lobe, echotexture of liver and spleen size) was 85%, that of laboratory data (APRI, serum albumin and INR combined) was 83.8%, that of APRI alone was 81.8% and all combined (sonography and lab data together) was 92.4% for the correct diagnosis.

The simple US examination, alone or combined with lab data, is able to diagnose advanced fibrosis and cirrhosis with excellent accuracy, making the use of other modern imaging modalities unnecessary.

Severe cases of coronavirus disease 2019 (COVID-19) often experience hyper-inflammatory reactions, acute respiratory distress syndrome (ARDS), blood clotting, and organ damage. The most prominent immunopathology of advanced COVID-19 is cytokine release syndrome, or “cytokine storm” which is attributed to a defect of immune-regulating mechanisms. This study aimed to evaluate the role of regulatory T cells (Tregs) as one of the main cells that maintain immune homeostasis.

A systematic search was performed on PubMed, Scopus and Google Scholar. All English articles related to Treg’s role in COVID-19 were extracted and evaluated by two researchers independently. Study eligibility was assessed based on modified Evidence-based librarianship (EBL) checklist.

Nineteen eligible studies comparing Treg cells in COVID-19 patients with the control group or comparing alterations of this cell in severe and moderate patients were evaluated. Currently, there is no consensus regarding the increase or decrease of Tregs in COVID-19 patients compared to the control group. However, it was observed that Tregs in severe COVID-19 patients were significantly lower than moderate patients, resulting in uncontrolled inflammation and cytokine storm.

Regulatory T cells can be one of the determinants of disease severity and prognosis in patients with COVID-19 by inhibiting rampant inflammation and preventing cytokine storms.

Hepatocellular carcinoma (HCC) is the second leading cause of death due to cancer. Liver transplantation, surgical liver resection, chemotherapy, and radiotherapy are the main options for the treatment of HCC. However, these methods are unable to limit the growth, survival, and metastasis of HCC cells. Several signaling pathways control propagation, metastasis, and recurrence of HCC. Recent studies have established new approaches for the prevention and treatment of HCC using miRNA technology. MicroRNAs are a class of non-coding RNAs with an average of 22 nucleotides that play critical roles in controlling gene expression in a variety of biological processes. miRNAs can induce or suppress HCC proliferation, migration, metastasis, and tumorigenesis. The anti-cancer effects of molecular agents can be evaluated directly in animal models or indirectly through the injection of HCC cell lines treated with anti-cancer agents. Targeting cancer-specific signaling pathways with miRNAs can be novel therapeutic strategies against HCC. This study provides the latest findings on using miRNAs in the control of HCC in both in vitro and in vivo models.