Iranian Red Crescent Medical Journal
Volume:24 Issue: 5, May 2022

 The most common manifestations of metastatic colorectal cancer are found in the liver, lung, bone, and brain. Cutaneous metastasis is rare in rectal cancer, and it indicates a widespread disease and a poor prognosis.

 In this report and review we present a 58-year-old man who diagnosed with rectal cancer (RC) and underwent abdominoperineal resection. The patient developed a skin lesion (indurated erythema) on his scrotum four months later. Histopathological examination revealed adenocarcinoma with lymphovascular invasion.

 The primary causes of mortality in people with RC have been reported to be disease dissemination and recurrence. Cutaneous metastasis to the scrotum happens seldom, accounting for less than one percent of the total surface area of the body. 

 Even if an RC patient has been asymptomatic for a long time, skin involvements must be considered by clinicians. So, giving specific attention to all skin nodules, non-healing ulcers, and chronic indurated erythema is essential. Early detection relies heavily on patient engagement.

Soft-tissue sarcomas are cancerous growths of mesenchymal tissues, most commonly arising from fat, muscles, and other connective tissues. Due to the fact that these tumors often lie adjacent to nerves and blood vessels, it is difficult to remove them. Traditional surgery is often carried out according to the operator’s discretion and experience of local anatomy; however, the surgery bears the risk of damage to nerves and blood vessels. In cases of postoperative recurrence, the local anatomy is often not clear due to scar formation, and the risk of operation would be greater. This report describes the application of three-dimensional (3D) modeling prior to surgery, which can clearly reveal the tumor tissue and the surrounding important nerves and blood vessels. Considering the relationship between neurovascular and tumor tissue, the intraoperative position, incision, and risk of patients were planned in advance.

One of the most expensive aspects of health care is providing care for burn victims. However, just a few burn cost analysis studies have been conducted in Iran. This study aimed to estimate the cost of treating severe burn patients in a burn center.

This retrospective study was performed on the medical records of 143 severe burns patients who were referred to a specialized burn center between March 2020 and March 2021. The data were collected regarding the treatment costs and analyzed using SPSS software (version 16.0).

The mean±SD total per-patient cost was $US 5445.53±4742.45. Electrical burn patients had an average total cost of care and the length of stay higher than other burn patients. The bed charges (21.97%), surgeon’s salary (27.17%), and equipment and consumables (17.83%) were the main cost drivers.

The results of this study can help hospital authorities and governments understand the direct costs of a burn center and the total budget that a country might need to cover the annual costs of treating burn victims. In addition, the cost of burn care in this study differed from that in other studies. The disparity in reported numbers can be attributed to variation in the used methodologies, costing viewpoints, study site, treatment procedures, hospitalization regulations, medications, surgeries, the health service providers' salary, nonclinical support, and indirect costs.

 The aim of this trial was to determine the effects of selenium supplementation on the levels of genes expression associated with insulin, lipid and inflammatory markers in diabetic hemodialysis patients.

This randomized, double-blind, placebo-controlled clinical trial was done on forty diabetic hemodialysis patients. The study subjects were divided into two groups by random to take either 200 µg/day selenium (n=20) or placebo (n=20) during 24 weeks.

Selenium intake led to upregulation of peroxisome proliferator-activated receptor gamma (PPAR-γ) (1.08+0.22 vs. 0.93+0.18 fold change, P=0.049), LDL-receptor (1.06+0.14 vs. 0.90+0.16 fold change, P=0.008) and transforming the growth of factor beta (TGF-β) (1.15+0.18 vs. 0.91+0.20 fold change, P=0.002) in the levels of gene expression. In comparison with placebo, in this intervention also reduction of gene expression of tumor necrosis factor alpha (TNF-α) (0.90+0.19 vs. 1.08+0.19 fold change, P=0.014) and interleukin-1 (IL-1) (1.00+0.11 vs. 1.12+0.15 fold change, P=0.020) were detected. In this study, gene expression of vascular endothelial growth factor (VEGF) (1.02+0.13 vs. 0.96+0.18 fold change, P=0.333) and (IL-8) (0.98+0.20 vs. 1.03+0.17 fold change, P=0.458) were not affected by selenium supplementation.

Selenium supplementation during 24 weeks had positive effects on gene expression associated with metabolic status inflammatory markers in diabetic hemodialysis patients.

While several antivirals have been considered among the candidate repurposed drugs against SARS-CoV-2 infection, limited evidence exists on Atazanavir/Ritonavir.

This trial was designed to assess the efficacy of Atazanavir/Ritonavir compared to Lopinavir/Ritonavir, another antiretroviral drug investigated in the previous studies.

This randomized, double-blind clinical trial was conducted on hospitalized patients with laboratory or confirmed SARS CoV-2 infection. Patients were randomly assigned (1:1) to receive either Lopinavir/Ritonavir (200mg Lopinavir+50mg Ritonavir, twice a day) or Atazanavir/Ritonavir (300mg Atazanavir+100 mg Ritonavir, once a day) for up to 14 days during their admission along with the standard care. The primary endpoint was total all-cause death in all patients during the hospitalization period. Secondary outcomes included length of hospitalization.  

Out of 103 adults included in the analysis 54 and 49 were assigned to Atazanavir/Ritonavir and Lopinavir/Ritonavir groups, respectively. The occurrence of adverse effects, defined as symptoms attributed to the drugs which no longer appear upon the cessation of the drug, was higher for cardiac side effects in Atazanavir/Ritonavir group. No statistically significant difference was observed between the two groups in terms of the length of hospitalization. After adjustment for other covariates in the study, treatment with Atazanavir/ritonavir did not result in a significant reduction in mortality compared to treatment with Lopinavir/Ritonavir.

The efficacy of Atazanavir/Ritonavir in this preliminary study was not superior to Lopinavir/Ritonavir in reducing mortality and length of hospitalization in COVID-19 patients. However, the limited efficacy of both compounds does not support their use in primary care for COVID-19 patients.

Curcumin is a natural antioxidant known for its neuroprotective properties against cerebral ischemic reperfusion injury (CIRI). Stroke has the greatest impact on the hippocampus CA1 region and leads to cognitive impairment.

This study aimed to investigate the effect of pretreatment with turmeric extract before induction of cerebral ischemia on the structure of the hippocampus CA1 region, learning, and spatial memory.

A total of 32 adult male Wistar rats were randomly divided into four groups: 1) control group, 2) sham group (received DMSO), 3) ischemia group (15 min bilateral carotid artery), and 4) curcumin group (received 100 mg/kg of curcumin daily for five days before induction of ischemia). A Morris water maze test was performed to evaluate memory impairment in mice 48 h after ischemia induction. The animals were then anesthetized, and their blood samples were taken for malondialdehyde measurement. Subsequently, the animals’ brains were removed, and the number of neurons and the volume of the layers were examined using cresyl violet staining.

The results of stereology showed a significant increase in the volume of the CA1 region and its substrates in the curcumin treatment group compared to the ischemia group. In addition, the number of pyramidal neurons in the treatment group showed a significant increase compared to the ischemia group. Moreover, curcumin administration reduced spatial memory impairment in the treatment group compared to the ischemia group.

These results suggest that pretreatment with curcumin can improve memory and learning disorders and hippocampal neuron damage following ischemia.

 The role of environmental determinants in the community's resilience in flood, as a predominant hydrological disaster, has not been investigated.

 This systematic review aimed to discuss the role of environmental determinants on communities' resilience in floods using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol.

 A total of 50 relevant papers were extracted, including those on the subject of water resource planning (n=32), soil-plant systems (n=8), and air and climatic factors (n=10).

 The results revealed that although most studies have investigated climatic factors, biological effects, surface water flooding, and groundwater contamination, the researchers did not have a comprehensive approach to environmental determinants. This study highlighted the role of water, soil, and air, as the main environmental determinants. In addition, the related subdeterminants should simultaneously be considered in flood risk management and community resilience.

 Eventually, a conceptual model is presented for analyzing the effects of environmental factors on the communities' resilience against floods.
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 Detection of abnormal movement patterns and disorders and their classification into specific sub-categories may result in effective therapeutic choices. Classification of movement system impairments has provided seven sub-categories for movement disorders in the knee joint with specific treatment recommendations for each.

 This study aimed to investigate the effectiveness of specific treatments proposed by this classification method and compare the effectiveness of this treatment method with routine ones.

 Participants who met the inclusion criterion were randomly assigned into control and experimental groups after the diagnosis of their movement impairment. Subcategories including patellar lateral glide syndrome and tibiofemoral rotation syndrome were recruited. Experimental groups were treated specifically based on their impairment; however, all control groups received the same routine physiotherapy, regardless of their movement impairment. Two knee function and disability instruments were used, including Knee Injury and Osteoarthritis Outcome Score and the Lower Extremity Functional Scale. Eventually, each experimental group’s outcome scores on the visual analog scale and frontal plane projection angles were compared with those in the control group.

 We will try to figure out whether the specific treatments based on the movement impairment classification have any benefit over the routine treatment. This would also give clues about the validity of this classification in knee pain. If this is the case, detecting the movement impairment and giving treatment on this basis could be used as a comprehensive guideline.

 Geriatric nursing is professional holistic care that requires special attention and the development of professional competence. No valid and reliable tool exists to evaluate professional geriatric competencies (PGC) of nursing students in professional practice which remains a debatable issue in nursing education. Therefore, the present study was conducted to fill data scarcity.

 The present study aimed to develop a Geriatric Nursing-Specific Mini-CEX tool to evaluate the professional geriatric competencies of internship nursing students.

 The present study is descriptive observational quantitative with a cross-sectional design. The Geriatric Nursing-Specific Mini-CEX tool was developed in seven skill domains and 40 items based on the core competencies of geriatric nursing, published literature, and expert opinions. Delphi method was applied to evaluate the face and content validity, and reliability was determined using Cronbach's alpha test through a pilot test. The modified tool was scored between 1 to 9 in each item of skill domains with a total score of 40 to 360. Higher scores indicate a higher professional geriatric competence for nursing students. Then, 160 internship undergraduate nursing students were selected by convenience sampling from one of the major universities of medical sciences  in January 2020, Iran. One-day workshop of evaluators was held in two sessions and the professional geriatric competencies of students were evaluated by implementing case studies. The results were analyzed with inter-rater reliability and descriptive statistics.

 ICC values for seven components of geriatric nursing-specific Mini-CEX ranged from 0.639 to 0.919, indicating an acceptable level of reliability for this scale. The mean score of overall geriatric competence was (M= 6.12, SD=.33), which indicated that the geriatric competencies of students enrolled in the study were at a satisfactory moderate level. The highest and the lowest mean scores were observed in history taking /communication (M= 6.71, SD=.71) and physical examination skills (M= 4.99, SD=.67), respectively.

 The results of this study indicate the possibility of using new developed geriatric nursing-specific Mini-CEX tool to evaluate the professional geriatric competencies of nursing students through implementing case studies in professional clinical settings. The data obtained from the present study could be useful for educators to evaluate and redesign a curriculum for integrative core geriatric competencies as a process of quality improvement.

Although it was initially believed that the coronavirus disease 2019 (COVID-19) only attacked the respiratory system, reports over time demonstrated that this disease could attack the gastrointestinal tract (GIT) as well. The predominant presenting symptoms in patients infected with COVID-19 were gastrointestinal, resulting in gastrointestinal (GI) pathological changes. While clinicians’ concerns are mostly related to respiratory system manifestations, GI symptoms should be monitored and managed appropriately.

This review summarizes the essential information about COVID-19 GIT infection in terms of pathogenesis, major pathological changes, microbiological bases of infection and the possibility of feco-oral transmission, the severity of associated symptoms, the major radiological findings, the impact on GI surgery, the role of therapeutic agents in induction or magnification of GI symptoms, and a pitfall on the nutritional supplementation in COVID-19 patients.