Iranian Red Crescent Medical Journal
Volume:24 Issue: 4, Apr 2022

Propranolol is a non-specific beta-blocker that is used to treat hypertension, angina, arrhythmia, tremor, and manage thyrotoxicosis. Based on the results of various studies, propranolol can control infantile hemangioma by vasoconstriction, apoptosis induction, and inhibition of cell proliferation signals.

The conventional film hydration method was used to prepare medium size (2-6 m) multilamellar vesicles (MLVs) containing propranolol. At the lipid phase, sorbitan esters (Spans) and their polyethoxylated derivatives (Tweens) were combined with cholesterol, and deionized water was utilized as a hydration medium. Laser light scattering was used to perform the size analysis, and the Franz diffusion cells were utilized to investigate the release of propranolol from niosomal suspensions and carbomer-based niosomal gels. The vesicles were assessed for their stability within six-month storage at 4°C, and ultraviolet spectrophotometer and centrifuge technique were employed to measure the efficiencies of encapsulation.

Based on the findings, the best niosomes were obtained at 40 and 60 spans in the presence of Tween 40 and 60; however, Span/Tween 20 and 80 were not able to form propranolol niosomes. The selected formulations had an MLV appearance and size distribution of 5 μm. Encapsulation efficiency and release rate of selected niosomes were optimal. Niosomes had good stability during six months of storage at refrigerator temperature.

Based on the obtained results in this study, the application of a new topical dosage form of propranolol showed promising results for the treatment of infantile hemangioma.

Coronavirus disease 2019 (COVID-19) is a major health problem worldwide. Vascular thrombosis is increasingly observed in COVID-19 patients. This complication seems to be due to coagulopathy and endothelial damage. In this paper, we report a COVID-19 patient with superior mesenteric artery thrombosis and review of 27 COVID-19 cases with acute mesenteric ischemia (AMI).

A 59-years old man with confirmed COVID-19 readmitted to the hospital due to abdominal pain and diarrhea two days after discharge from the emergency department. He was diagnosed with acute mesenteric ischemia by abdominal CT scan with contrast. The patient underwent emergency laparotomy and the ischemic gangrenous bowel was resected. Unfortunately, the patient succumbed one month after the operation.

AMI is a life-threatening thrombotic event rarely seen in COVID-19 patients, so it is vital to diagnose it. Anticoagulant and anti-inflammatory prophylactic therapies might be useful in preventing AMI, especially in the patients with thrombosis risk factor. So, it is crucial to reduce its incidence in COVID-19 patients.

This study aimed to investigate the risk factors of postoperative recurrence of acoustic neuroma (AN) and provide a reference for its clinical prevention and treatment.

This retrospective study included a total of 30 patients with recurrent AN and 23 patients with non-recurrent AN who were admitted to the Department of Neurosurgery of our hospital from January 2013 to December 2018. The recurrence rate during the same periods was calculated and surgical treatment was decided according to the tumor size. The surgical effects of the recurrent patients further compared and investigated the way different treatments affected the preservation of the auditory nerve, facial nerve, and posterior group nerve and increased facial paralysis in AN patients.

Univariate analysis of 30 recurrent AN cases showed that tumor size, internal auditory canal invasion, and tumor blood supply are linked to the recurrence of AN (P<0.05). In addition, the multi-factor analysis demonstrated that rich blood supply, medium texture, intratumoral canal invasion, incomplete resection, and large-diameter tumor were independent risk factors for recurrent AN. We observed a significant difference in the preservation of the auditory nerve, but not in the preservation of the facial nerve and posterior nerve, and between the recurrent and non-recurrent AN patients.

This study analyzed the risk factors of postoperative recurrence in patients with acoustic neuroma. The results showed that small size of tumor, tumor blood supply, tumor texture, tumor vascular invasion, and incomplete tumor resection were independent risk factors for recurrent AN patients. Therefore, these factors can be included in the reference indexes, and relevant prevention and treatment measures can also be taken during the operation to reduce the risk of postoperative recurrence.

In disasters, patients with chronic diseases, such as diabetes and chronic respiratory diseases, are considered to be a vulnerable population. This study aimed to examine the natural disaster preparedness knowledge of patients with chronic diseases in Iran with a focus on diabetic patients and those with Chronic Obstructive Pulmonary Disease (COPD) admitted to Masih Daneshvari Hospital in Tehran, Iran.

This cross-sectional survey was administered from August 2020 to April 2021. A disaster preparedness knowledge questionnaire was devised and validated, subsequently. A total of 86 eligible patients were selected using the census method and completed the questionnaire. The questionnaire included items on patients’ knowledge of disasters (n=7), personal preparedness of patients in disasters (n=8), and family and community preparedness in disasters (n=4).

A total of 86 patients were included in this survey, including 44 (51.2%) males. In total, 64% (n=55), 34.9% (n=30), and 1.2% (n=1) of patients had diabetes, COPD, and both, respectively. Two-thirds of patients reported that they had no good knowledge of disaster and emergency awareness and preparedness.

Based on the obtained results and due to the low readiness of patients, it is necessary to make decisions to improve the patients’ readiness. Therefore, it is possible to help promote the level of knowledge and preparedness of patients with diabetes and COPD to improve the health results during and after disasters through the adoption of required strategies and comprehensive plans in different areas of public health.

Despite clinical and basic different investigations, the role of plasma adipokines, such as adiponectin as a precise predictor of the risk of colorectal cancer (CRC) is still conflicting.

This study investigated the association between CRC and insulin resistance, obesity, and plasma adiponectin level for the first time in Iran.

A total of 80 subjects (including 45 CRC patients and 35 healthy individuals) were enrolled in this case-control study. Demographic, anthropometric, and clinical data were recorded, and serum levels of adiponectin, insulin, and glucose were evaluated using enzyme-linked immunosorbent assay and glucose oxidase technique, respectively. Insulin resistance index (HOMA-IR) was measured as well.

The mean±SD plasma adiponectin concentration of the CRC patients (7.98±0.64 ng/ml) was not significantly higher, compared to that in the control group (8.05±1.14 ng/mL). The mean±SD of HOMA-IR and plasma glucose levels (1.81±0.61 and 7.64±1.34 mm/L, respectively) of the CRC group were significantly higher (P<0.05), compared to the control group (1.37±0.3 and 119±1.1 mg/dL, respectively); however, plasma insulin wasn’t significantly different in the two study groups. Following the stratification of CRC patients according to the tumor site, a significantly lower level of adiponectin (7.36 ±1.1 ng/ml) (P<0.05) and a significantly higher level of HOMA-IR (2.08±0.44) were observed in patients with colon cancer (P<0.005), compared to the controls. Regression among the plasma adiponectin and the plasma insulin and HOMA was negative in the control and CRC groups.

Insulin resistance has an important role in the development of CRC, especially in genesis colon cancer, regardless of the change that it causes in plasma levels of adiponectin.

Rectus sheath hematoma (RSH) is an uncommon cause of acute abdominal pain that is often misinterpreted. Only about 2% of patients who present with acute abdominal pain display this condition. Damage to the superior or inferior epigastric arteries or their branches, as well as direct rupture of the rectus abdominis muscle, causes bleeding into the rectus sheath. In hospitalized COVID-19 patients, anticoagulant prophylaxis with heparin has become a standard part of medical care. This method may raise the risk of bleeding in older people with comorbidities.

The patient was a 60-year-old woman with a history of asthma and diabetes mellitus who was referred to the emergency department with shortness of breath and cough. Chest X-Ray demonstrated Covid-19 pneumonia. On the second day of hospitalization, after the exacerbation of tachypnea, computed tomography (CT) angiography was performed, and the results confirmed pulmonary embolism; therefore, the therapeutic dose of heparin was initiated. On the 21st day of hospitalization, the patient experienced abdominal pain and was visited by a general surgeon. A large ecchymosis was observed in the periumbilical; nonetheless, there was no significant tenderness in the abdominal exam. The patient's hemoglobin dropped to 7.9 mg/dl at this time. An abdominal and pelvic CT scan showed a 45 mm hematoma in the left rectus muscle.

In patients presenting with acute abdominal pain, any physician in the field of emergency or surgery should include RSH in their differential diagnosis list, especially those who have certain predisposing conditions.

Catheter ablation (CA) is a potentially curative method for treatment of severe symptomatic and drug-refractory atrial fibrillation (AF).

This study aimed to evaluate the impact of steerable sheaths on catheter stability in paroxysmal AF based on contact force (CF).

Fifty-two patients were included in this study and they were randomly enrolled to two groups: Pulmonary vein isolation using steerable (Group 1, n=26) or fixed-curve (Group 2, n=26) sheaths employing a force-sensing ablation catheter. We analyzed the operator-blinded and unblinded CFs when the operators were satisfied with the catheter position.

The average CF was 23.56±9.43 g (Group 1) vs. 22.03±10.56 g (Group 2) for the blind condition (P<0.05) and 24.61±10.46 g (Group 1) vs. 22.18± 9.84 g (Group 2) for the unblinded condition (P<0.05). There was significant heterogeneity of CFs between the segments: the CFs of the anterior-middle, anteroinferior, posterior-middle, and inferior posteroinferior segments of the right pulmonary vein (RPV), as well as of the roof, superior anterosuperior, anterior-middle, inferior anteroinferior, and inferior posteroinferior segments of the left pulmonary vein (LPV), showed statistical differences in the blinded condition (P<0.05). The CFs of the roof, anterosuperior, anterior-middle, and inferior anteroinferior, and posteroinferior segments of the RPV, and LPV showed statistical differences in the unblinded condition (P<0.05). Posterior and roof segments showed enhanced CFs in both groups. Group one had a lower proportion of acute reconnection rate and less tendency for recurrence.

In conclusion, catheter stability improved with steerable sheaths owing to the potential of attaining higher CFs. This advantage was independent of CF guidance and exhibited a specific distribution pattern.

Ovarian cancer is the fifth leading cause of cancer-related deaths among women globally. Cancer stem cells (CSCs) are a subpopulation of tumor cells involved in ovarian tumor formation, metastasis, relapse, and chemoresistance. Moreover, the Notch signaling pathway has a pivotal role in CSCs maintenance. This study was designed to isolate CSCs from the A2780 cell line and determine the effectiveness of Mastermind-like transcriptional coactivator 1 (MAML1) inhibition, a key factor of the Notch pathway, in targeted therapy against ovarian CSCs.

The CD44+ or CD133+ CSCs were isolated from the ovarian A2780 cell line using magnetic cell sorting. The isolated CSCs were also evaluated for stemness markers expression, self-renewal capacity, cell cycle progression, and chemoresistance compared to their negative counterparts. Afterward, MAML1-shRNA was used to inhibit the Notch pathway in CD44+CSCs. The role of MAML1 was also evaluated in the CD44+ CSCs epithelial-mesenchymal transition (EMT) process and migration.

In addition to the high expression of stemness markers, such as Sox2 and Musashi1, ovarian CD44+ or CD133+ CSCs had a high ability for sphere formation, higher percentage in the G1 phase to S phase, and decreased sensitivity to chemotherapy drug compared to CD44- or CD133- cells. Besides, silencing MAML1 significantly reduced the levels of EMT markers and cell migration in CD44+ CSCs, compared to scramble.

Mastermind-like transcriptional coactivator 1 can be considered a pivotal factor in the targeted therapy and eradication of CD44+ CSCs through the inhibition of the Notch signaling pathway in an ovarian cancer patient with a special focus on the ovarian A2780 cell line.

Development of multiloculation and septation in complicated parapneumonic pleural effusion (PPE) may lead to difficult treatment. The studies pointed out that as fibrinolytic therapy might have the potential of complications and a time consuming character, so we should change our management strategy in such patients. In this study, we aimed to investigate whether or not uniportal video-assisted thoracoscopic surgery (UVATS) is an initial effective therapy based on clinical and radiologic manifestations.

İn this retrospective study, sixty patients who underwent UVATS as the initial intervention with the diagnosis of multiloculated PPE were evaluated between 2016-2019. The patients comorbidities, ASA scores, durations of hospital stay and tube thoracostomy, rate of thoracotomy/decortication, the type of pleural fluid cell and also broad-spectrum antibiotic use, culture results, % neutrophil (NE) ratio with other biochemical parameters before and after VATS were recorded and analyzed.

Of the patients, 46 of them (77%) underwent UVATS and a subsequent second port incision was inserted in 14 patients,. Shortening of broad-spectrum antibiotic use after VATS was found to be statistically significant in the patients underwent early VATS (p <0.05). We found a statistically significant decrease in the rate of NE % after VATS (p <0.05), that is consistent with the clinical and radiological improvements. The radiological improvement was detected in 96.6% of the patients.

We conclude that early UVATS without prior tube thoracostomy is a simple, effective and reliable method as the first-line treatment in patients with complicated PPE. It also confirms that earlier administration of UVATS and more aggressive therapy in the proper indications offers better clinical results.