مجله پزشکی دانشگاه علوم پزشکی تبریز
سال چهل و چهارم شماره 3 (پیاپی 159، امرداد و شهریور 1401)

This systematic review evaluated the studies conducted on Guillain-Barré syndrome (GBS) due to COVID-19 vaccination to clarify any possible connections and the type of vaccines causing GBS.

A comprehensive search was performed on July 2021 through MEDLINE (via PubMed), Scopus, Cochrane, and Web of Science databases to detect published and unpublished papers. Our PICO was all COVID-19 vaccinated individuals as the population, COVID-19 vaccines as the intervention, and patients experiencing GBS following COVID-19 vaccination as the outcome. Critical appraisal instruments from the Joanna Briggs Institute case series or case report were used to evaluate the quality of included studies.

In the present systematic review, 12 case reports and case series including 21 patients were assessed. More than half of the patients were male, and the mean age of male patients was lower than females. In terms of vaccine type, the most common kind of vaccine injected was Oxford/AstraZeneca, and all the cases except one patient had received only one dose of the vaccine. Regarding the interval between receiving the vaccine and the onset of GBS symptoms, the mean duration was 14 days. The lowest mean time interval between receiving the vaccine and the onset of symptoms of GBS was related to the unnamed vector-based COVID-19 vaccine, and the highest was associated with Oxford/AstraZeneca.

Through this systematic review of case reports, we neither attempt to establish nor rule out a causal link between the COVID-19 vaccine and GBS, because such a link requires extensive case-control studies. However, we must highlight any events that may occur following the injection of existing vaccines. Practical Implications. The most common symptoms seen in patients experiencing GBS after vaccination included progressive bilateral lower limb weakness, paresthesia, numbness of limbs, generalized body aches, and back pain.

A higher prevalence of cardiovascular disorders has been observed in women after menopause. This study aimed to determine the long-term effects of ovariectomy on hemodynamic functions and the level of nitric oxide metabolites (NOx) in the heart tissue of ovariectomized rats.

Fourteen female Wistar rats were divided into two groups (n=7 in each group) of control and ovariectomized (OVX). OVX rat model was induced using the two dorsolateral skin incision method. Cardiac hemodynamic function indices, including the left ventricular developed pressure (LVDP), peak rate of positive changes in the left ventricular pressure (+dp/dt), and peak rate of negative changes in the left ventricular pressure (-dp/dt) were measured at the time of systole in hearts after 11 months of the ovariectomy. Serum and left ventricular levels of NOx were measured at the end of the study.

At the end of the study, OVX rats had lower LVDP (19%, P=0.001), +dp/dt (30%, P<0.001) and -dp/dt (23%, P=0.004) than control group. In addition, the OVX group had lower serum NOx levels (30%, P=0.021) compared to the control group; heart tissue NOx was also lower by 31% in the OVX rats, but it was not statistically significant (P=0.056).

Long-term ovariectomy disrupts cardiac hemodynamic function in ovariectomized rats, which is associated with decreased NOx levels in serum. Practical Implications. Our findings indicated impaired cardiac function following long-term estrogen deficiency in OVX rats. These results can be used to prevent and treat the cardiovascular disease in post-menopausal women. However, these results need to be confirmed in humans.

The novel coronavirus disease 2019 (COVID-19) was declared a global pandemic. There is an urgent need for finding efficient medical treatments to diminish the high mortality rate of the mutant variants of the virus. This study aimed to determine the efficacy of edaravone in patients with moderate COVID-19.

This single-center non-randomized controlled clinical trial was performed on hospitalized patients with moderate COVID-19. The patients were divided into two groups of intervention (n=17) and control (n=16). Patients in the intervention group received three doses of edaravone (30 mg) for three interval days (Days 2, 4, and 6). Admission to the intensive care unit (ICU), need for intubation, and mortality were the primary outcomes.

All cases had 15-60% lung involvement. Although edaravone reduced the admission to ICU, need for intubation, and mortality rate in patients with moderate COVID-19, the results were not statistically significant. Baseline characteristics, admission days, and clinical parameters were similar between the two groups (P>0.05).

Administration of edaravone 30 mg for three days had no significant effect on the overall outcome of patients with moderate COVID-19. Practical Implications. In this study, none of the COVID-19 patients receiving edaravone had ICU admission, intubation, and mortality. However, no significant difference was found between the clinical outcomes of the control and intervention groups.

The extrapyramidal system is part of the central nervous system (CNS) involved in motor control. Extrapyramidal symptoms include a variety of acute and chronic movement disorders caused by medications. Currently, antipsychotic medications are the mainstay of treatment for schizophrenia and other psychotic disorders and can cause extrapyramidal symptoms. The St. Hans Rating Scale (SHRS) is a multidimensional scale designed to quantify the severity of dystonia, parkinsonism, akathisia, and dyskinesia caused by antipsychotic drugs. This scale has not yet been translated into Persian so far. Considering the importance of assessing the quality of life in patients with severe or chronic psychiatric disorders, this study aimed to translate the SHRS into Persian and evaluate its validity and reliability. Also, we presented the software version of the SHRS.

This descriptive-analytical (methodological) study was performed on patients with psychiatric disorders treated with antipsychotic medications. After translating the SHRS into Persian, the validity and reliability of the Persian version was evaluated and the necessary corrections were made. Then, the Persian version was back-translated into English, followed by re-translation into Persian. A total of 30 patients were examined for extrapyramidal symptoms using the prepared version. The expert group concluded that there is no need to translate SHRS.

Regarding face validity, Cronbach's alpha coefficient was 0.99 and reliability was 0.99. The mean scores by the first psychiatrist were 2.03 in the first visit and 2.1 in the second visit. These scores were 2 in the first visit and 2.03 in the second visit by the second psychiatrist.

The software version of SHRS has good reliability and validity and can be used to evaluate the extrapyramidal symptoms of patients. Practical Implications. English version of the SHRS and its application for cellphone can be used to assess extrapyramidal symptoms.

Induction of general anesthesia may cause hemodynamic instability. Remifentanil is often prescribed to suppress the hemodynamic response to anesthesia. The aim of this study was to investigate the effect of remifentanil on hemodynamic response to induction of anesthesia with propofol fentanyl or propofol ketamine and laryngeal mask airway (LMA) insertion.

This double-blind randomized clinical trial study was performed on 44 candidates for cataract surgery in Feyz Hospital, Isfahan, Iran from March to June 2020. Patients were randomly assigned into two groups using random allocation software. The first group received 1 mcg/kg fentanyl and the second group received 0.5 mg/kg ketamine. Also, both groups received 1 mg/kg propofol and 0.5 mcg/kg remifentanil intravenously. Hemodynamic parameters were measured and recorded at study times, and the results were analyzed statistically.

The mean age (P=0.199), weight (P=0.050), height (P=0.9), and frequency distribution of gender (0.763) and American Society of Anesthesiologists (ASA) score (0.069) were not significantly different between the two groups. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) in fentanyl group were significantly lower than the ketamine group immediately before LMA insertion, as well as 1, 3, and 5 minutes after LMA insertion (P <0.050). In addition, the mean heart rate (HR) in the fentanyl group decreased significantly at different time (P<0.001), but no significant difference was observed in ketamine group (P=0.056). In addition, the mean HR did not differ significantly between the two groups in any of the follow-up times (P>0.050).

Intravenous administration of remifentanil in induction of anesthesia with propofol-ketamine and propofol-fentanyl reduced changes in hemodynamic responses to LMA insertion. This hemodynamic stability was increased by adding remifentanil to the propofol-ketamine combination.

Remifentanil is associated with weakening of hemodynamic responses to LMA insertion in induction of anesthesia with propofol and ketamine or propofol and fentanyl; this effect can be associated with safety in cardiac patients.

Micro-ribonucleic acids (miRs) take part in post-transcriptional gene regulation. MiR-155 regulates hematopoiesis, oncogenesis, and immunologic and inflammatory processes. We investigated the expression levels of miR-155 in sera of patients with Burkitt’s lymphoma, diffuse large B-cell lymphoma (DLBCL), and rheumatoid arthritis.

In this cross-sectional observation, we used real-time polymerase chain reaction to evaluate expression of miR-155 in sera of 92 Iranian adults who were healthy or had Burkitt’s lymphoma, DLBCL, or rheumatoid arthritis. The relative quantification of gene expression was calculated in terms of cycle threshold values (Ct). We conducted Pearson’s and Spearman’s correlations, Fisher's exact test, and one-way analysis of variance and Games-Howell post-hoc test, with the level of significance of 0.05.

The expression of miR-155 was independent of sex and age in each study group. In comparison with healthy subjects(-ΔCt: -2.29 ±SD: 1.92), miR-155 expression increased in DLBCL (2.49±1.01), and rheumatoid arthritis (2.30±1.34) patients, but did not change in adults with Burkitt’s lymphoma (-1.29±2.11).

MiR-155 was significantly elevated in the sera of patients with DLBCL, and rheumatoid arthritis. Further studies with larger sample sizes are needed to assess the diagnostic, and therapeutic applications of miR-155 in these patients.
Practical Implications. The expression of miR-155 increases in sera of patients suffering from DLBCL, and rheumatoid arthritis. The expression of miR-155 was independent of sex and age of patients in this study.

If the pregnancy attempt fails, it may become a stressful event. Therefore, in many cases, problem solving can lead to greater satisfaction and cohesion of couples and prevent psychological and social harm to families. The aim of this study was to determine the significant difference in the expression of miR-146a miRNA in maternal blood between the control and observation groups and to determine whether the miRNA can be used as diagnostic biomarkers or not.

The present study is a basic and descriptive survey in terms of data analysis. The samples included pregnant women referred to Tabriz University of Jahad from September 2019 to February 2021. We used Exel, Spss v.21 and Roc software for data analysis. Data were prepared in Exel software with reference gene and by calculating CT. Were used in Roc software.

The results showed a difference between the control and observation groups. Early detection of recurrent miscarriage should be used in these mothers.

Through using diagnostic kits of the studied miRNAs, effective steps can be taken for early detection, prevention of abortion, and reducing the heavy psychological, economic, and social burden on families. Therefore, it is suggested that diagnostic kits be made for these biomarkers and used in infertility centers. Practical Implications. Among the practical implications of this study, we can mention the diagnosis and prevention of abortion, which can reduce the burden on families and society.

Obstetric brachial plexus injury (OBPI) occurs as a result of excessive stretching of the baby's neck and an increase in cervical and shoulder angle during the second stage of labor. This study aimed to investigate the prevalence, electrophysiological panel, and motor outcome of cervical paralysis in East Azerbaijan province, Iran during 2008-2018.

The total number of deliveries was obtained by census method. The annual relative frequency of OBPI was calculated using the medical records of children with this injury. Then, the electrophysiological findings and Modified Mallet Classification System (MMCS) were extracted.

The prevalence of OBPI during 2008-2018 was 0.026% in East Azerbaijan province. The involved nerve roots were C5 and C6 in 59.6% of cases, C5, C6, and C7 in 28.4% of cases, and wider injuries were observed in 12% following C5 to T1 involvement. No significant association was found between electrophysiological findings and MMCS in children with OBPI (P>0.05).

Due to the sudden increase in OBPI since 2017, it seems necessary to pay special attention and take preventive measures in this regard. Practical Implications. Due to the increasing prevalence of OBPI compared to previous years, it is necessary to take the necessary measures to prevent this injury in vaginal delivery.