Acta Medica Iranica
Volume:60 Issue: 4, Apr 2022

The coronavirus disease 2019 (COVID-19) is a single-stranded RNA (+) virus and causes infectious disease by the viral strain "severe acute respiratory syndrome coronavirus 2" (SARS-CoV-2). Now, COVID-19 has become pandemic, and there are neither potential vaccines nor drugs discovered. Its RNA contains genes for structural (S, E, M, N) and non-structural proteins (PLpro, 3CLpro, RdRp, Hel). Interaction between the S protein of SARS-CoV-2 and the ACE 2 receptor of the host cell plays a vital role in the entry of the virus into the cell. Favipiravir, ribavirin, remdesivir, galidesivir, lopinavir, ritonavir, chloroquine, and hydroxychloroquine are the few effective drugs against SARS-CoV-2. Live attenuated virus (mutant MERS-CoV and SARS-CoV or recombination with another live attenuated virus) can act as vaccine platforms against SARS CoV-2 along with DNA vaccine and subunit vaccine.

Patients with COVID-19 frequently experience neurological symptoms. Headaches and dizziness are common but non-specific symptoms. Both peripheral and central nervous systems can be impacted in severe stages. We focused on the neurological manifestations of COVID-19 patients in critical care. A cohort study evaluated the acute neurological manifestations in 204 patients admitted to intensive care units (ICU) tertiary Imam Khomeini hospital complex, Tehran, Iran. Patients with positive COVID-19 tests and severe clinical symptoms in both sexes, older than 16 years, were included in the study. Two groups of patients with positive or negative neurologic complications were compared by chi-square or Fisher exact test for categorical variables. The differences in continuous variables between the two groups were investigated using an independent sample t-test. The Kolmogorov-Simonov test was used to verify the normality assumption. A P less than 0.05 was considered statistically significant. The study included 204 individuals (130 males and 74 females) out of 270 ICU patients. Ninety (44.1%) patients were discharged, while 114 (55.9%) died. Overall, 17 (8.3%) patients had neurological complications, while 187 (91%) did not (P=0.005). The two groups did not have significantly different mean age (P=0.325) and sex (P=.793). The ventilation support was significantly different in the two groups (P=0.002). The death group had a higher incidence of loss of consciousness (P=0.003). COVID-19 causes neurological symptoms, especially during the inflammatory phase, and clinicians should be alert for neurological issues.

Seizure disorder in children is commonly seen in clinical practice and in the assessment of these patients. Magnetic Resonance Imaging (MRI) is found to be the ideal and first imaging modality of choice for pediatric seizure disorder because of lack of radiation exposure. This work aims to assess the role of MRI of the brain in the evaluation of pediatric seizure disorder. Before undergoing MRI, all of the patients received EEG to detect the epileptogenic center. On the superconductive 1.5-Tesla Siemens Avanto Magnetom MR system, patients underwent a brain MRI scan. Percentages and proportions were used in the statistical analysis. Around 70% of children with seizures were found to be controlled by the use of a single antiepileptic drug (AED). Electroencephalogram (EEG) findings were abnormal in 82% of patients. The MRI findings were normal in 45 patients (45%) and abnormal in 55 patients (55%). The common abnormalities were gliosis (45.4%), periventricular leukomalacia (12.7%), neurodegenerative changes in white/grey matter (7.3%), focal cortical dysplasia (FCD) (7.3%), arteriovenous malformations (AVM) (7.3%), polymicrogyria (5.5%), mesial temporal sclerosis (MTS) (5.5%), abnormal spectroscopy (3.6%), space-occupying lesion (SOL) (3.6%) and megalencephaly (1.8%). Our study showed about 55% of children with seizures had MRI abnormalities and common abnormalities were gliosis and periventricular leukomalacia. Improvements in perinatal care, hygiene, and socio-economic status can help in reducing the incidence and thus morbidity associated with a seizure disorder. Thus, MRI plays a pivotal role in the workup of pediatric patients with a seizure disorder.

In patients with supraglottic carcinoma (SGLC), lymphatic metastasis is frequent and can cause a significant reduction in local control rate and survival. Currently, the preferred method of neck treatment in patients with supraglottic cancer is prophylactic bilateral neck dissection that could result in overtreatment in at least two thirds of patients. The purpose of this study is to evaluate factors influencing neck metastasis and to determine whether routine elective neck dissection is necessary for the management of all SGLCs. 66 patients with SGLCs who underwent transoral laser surgery and neck dissection were included in this study. The rate of overall and occult lymphatic involvement was 29% and 20%, respectively. The most common involvement site was level II, and factors such as T category, tumor grade, epilarynx involvement, and extension of tumor to the medial wall of pyriform sinus were significantly related to cervical lymph node metastasis. In conclusion, our results suggest that in selected patients with SGLC (such as small T1 or lateralized tumors), elective neck treatment could be ignored, and instead, close follow-up be considered.

Early administration of thrombolytic agents is the standard treatment and crucial for the outcome for patients presenting with acute myocardial infarction (MI). This study was conducted to evaluate the door to needle time of streptokinase administration and the left ventricular function in patients with anterior MI. This study was a prospective, single-center study on participants with anterior MI who were received streptokinase and non-streptokinase groups. After administration of streptokinase, QTc was measured in hyper-acute, acute, and recent phases of anterior MI in the case group and compared with acute and recent phases in the control group. The left ventricular function in 5 and 42 days after emergency department arrival was measured and compared in two groups. The data were analyzed by descriptive statistics method and variance analysis in the SPSS software, version 22. The level of significance was considered to be 0.05. Among 87 participants (45 streptokinases, 42 non-streptokinase), there was a significant relationship between the door to needle time in patients who received streptokinase in 1 hour (P=0.000), 3 hours (P=0.007), and 6 hours (P=0.016) after onset the chest pain and an ejection fraction of the patients in 5 days after hospitalization. Also, there was a significant relationship between ejection fraction in 5 days (P=0.000) and 42 days (P=0.000) of administration streptokinase and door to needle time. Reduction of the door to needle time after anterior MI has significant effects on QTc and incidence of threatening arrhythmia.

To explore the presence of aflatoxin B1 (AFB1) and fungi in traditional drugs collected in Vietnam.

505 samples of 88 different traditional drugs were obtained from 10 hospitals in Nghe An, a central province of Vietnam. AFB1 contamination was determined by a high-performance liquid chromatography (HPLC) assay. Fungal contaminants were determined according to WHO regulations and the obtained Aspergillus strains were characterized via morphological and molecular identification.

24 samples (4.75% of the total samples) were contaminated with AFB1 and the average concentration was 0.062± 0.030 µg/kg (ranging from 0.009 to 0.097 µg/kg). Fungal isolates were detected from 174 samples (34.45%). The genus Aspergillus was predominant (82.76% of the isolates) but Rhizopus, Alternaria, Corynespora and yeast were also found in a few samples. Among 144 strains of Aspergillus recovered, A. niger (105 strains) was most frequently found, followed by A. tubingensis (31 strains), A. oryzae (4 strains) and A. flavus (4 strains).

This study suggests a low risk of aflatoxin B1 exposure to consumers of traditional drugs in Vietnam.

Chronic kidney diseases affect sex hormones, and thus it is now hypothesized abnormal puberty phenomenon in adolescents suffering renal failure. The primary study endpoint was to assess the frequency of disorders related to the clinical incidence of puberty symptoms among children suffering chronic kidney disease, and the secondary endpoint was also to assess the relationship between such manifestations and the serum level of sexual hormones. This cross-sectional study was performed on children with chronic renal failure (more than three months after the onset of the disease). Al baseline characteristics were retrospectively extracted from the hospital recorded files. The pieces of evidence of anemia and acidosis also appeared more in those with delayed puberty. Comparing the groups with delayed puberty and normal puberty showed significantly lower mean body weight and lower mean height in the group with delayed puberty as compared to those with normal status. Comparing serum hormonal conditions between the groups with normal and delayed puberty also showed significantly reduced serum levels of FSH, LH, testosterone, and dihydrotestosterone, as well as increased the serum level of prolactin in the group suffering delayed puberty. The main determinants for delayed puberty in patients suffering chronic renal insufficiency included abnormality in serum hormonal status, along with pieces of evidence of anemia or acidosis. Children with chronic renal insufficiency suffer from delayed puberty. Such phenomenon might be closely linked to abnormal changes in sex hormones due to the nature of renal dysfunction and hemodialysis.

Non-Progressive Congenital Myopathy is a disease characterized by muscle weakness, and unfortunately, there is no conventional treatment. In the last decade, regenerative medicine practices have become a rising value, and Mesenchymal Stem Cells (MSCs) have fascinating outcomes in regenerative medicine with their high regenerative capacities, their ability to regulate with paracrine secretions, and their immunological properties. Based on our experience in our previous clinical studies, Wharton's-Jelly-derived (WJ-)MSCs are the most suitable source for muscle diseases among all MSC sources. In this study, we evaluated the outcomes of 10 doses of WJ-MSC transplantation to the patient diagnosed with Non-Progressive Congenital Myopathy. A 17-year-old female with a SPEN-1 mutation, Non-Progressive Congenital Myopathy patient received 10 times as 1×10⁶/kg in the intra-arterial, intramuscular and intravenous administration of allogenic WJ-MSC. Before and after the treatment, the patient was followed-up with the upper extremity scale, Vignos lower extremity scale, muscle strength scale, functional independence measure, and evaluation of Serum creatine kinase (CK) levels. Improvement in both upper extremity scale and Vignos lower extremity scales, increasing in muscle strength, and decreasing in CK-level were detected. Although transplantation of WJ-MSC cannot treat any genetic-based diseases, they may benefit in alleviating clinical outcomes of disease. More importantly, WJ-MSC transplantation may offer a better quality of life by alleviating the symptoms of this rare disease with no treatment option that can be provided in conventional methods.

Fecaloma is a very hard stool often located in the rectum of the sigmoid colon. A 63-year-old man with abdominal distention and urinary retention was admitted to an emergency department. Abdominal CT scans showed a urinary bladder displaced by fecaloma. Fecaloma is an infrequent cause of acute urinary retention, especially in bedridden patients with underlying diseases.

Traumatic liver injury can be classified by grading using American Association with Surgery Trauma (AAST). We presented a case of a 22-year-old female who had a motor vehicle accident and sustained a stable Grade 4 liver injury. An angioembolization was performed by the interventional radiologist team, which successfully occluded all the extravasation of the bleed. If the patient is hemodynamically stable in high grade or bleeding liver injury, a non-invasive technique such as angioembolization could be practiced at the bleeding site to minimize or stop the bleeding.