Acta Medica Iranica
Volume:60 Issue: 9, Sep 2022

The primary immune responses to CoV-19 are inter-individual variability against this virus. Studies on the neuro-immune system demonstrate that interactions in these communication pathways can be a reason for several psychiatric disorders and immune-mediated diseases. Stress-related behaviors are significant in the psycho-immune interactions, and even stress-related factors such as socioeconomic status can also play a vital role in these interactions. A literature review on the topic was carried out, and 150 articles were included. Catecholamine and glucocorticoids are stress neurohormones. Noradrenaline as signaling molecules, through macrophages, can be an essential stimulus for cytokine secretion. Glucocorticoids, by both pro-and anti-inflammatory roles in specific conditions, can inhibit the elevation of the inflammatory response by inhibiting the pro-inflammatory macrophage activation and also enhance the anti-inflammatory activity in monocyte/macrophage populations the further eliminate. Stress with this flawed amplification feedback system can disrupt immune homeostasis (cytokine storm) in the patient with COVID-19. This investigation showed that there is a strong link between psycho-neuroendocrine-immune axis organizations against respiratory viral infections during the COVID-19 epidemic. The stress cascade must be responsible for meeting the body's hemostatic challenges in the necessary physiological and metabolic interactions. The motivation of the stress system leads to behavioral/physical variations that are strangely consistent in their qualitative presentation. These variations must be generally adaptive and increase the chances of the individual's survival. In coronavirus respiratory disease, identifying people with acute/chronic psychosocial stress is of particular importance for providing prompt care as soon as possible, as scheduling intervention appears to be an essential factor in reducing stress and hospitalization rate in the intensive care unit (ICU).

The main complaint after thyroidectomy is pain upon swallowing. It has been proven that postoperative uncontrolled pain can lead to chronic pain. We investigated the effectiveness of superficial cervical plexus block with ultrasound guidance on pain after thyroidectomy. This is a prospective, double-blind clinical trial study on patients aged 18-60 years who are candidates for thyroidectomy. Patients were randomly divided into two groups. The treatment group underwent superficial cervical plexus block under ultrasound guidance with an injection of 10 ml of ropivacaine 0.2%, and the control group received 10 ml of normal saline after sedation and before general anesthesia. The hemodynamic variables, amount of remifentanil used for hemodynamic stability, the severity of perioperative pain, postoperative nausea and vomiting, and the need for analgesics were compared between the two groups. The severity of pain in the treatment group at the time of discharge from recovery, 2, 6, 12, and 24 hours after surgery was 1.36, 1.76, 1.46, 1.24, and 0.44, respectively and in the control group was 3.12, 3.30, 3.82, 2.96 and 2.02 (P<0.001). The average dose of meperidine administration for pain relief during recovery in the treatment group was 2.8 (±7.84) mg, and in the control group was 9.2 (±11.92) mg (P<0.002). The need for diclofenac for analgesia during 24hours after surgery in the block group was 4 (±19.79) mg and in the control group was 64 (±69.28) mg, (P<0.001). Superficial cervical plexus block can significantly reduce perioperative pain and need analgesic administration during and after thyroidectomy.

Access to reliable, rapid, and continuous hemodynamic monitoring parameters is essential for early diagnosis and prompt treatment of hemodynamic disorders in critically ill children. The aim of this observational study was to compare the accuracy of continuous non-invasive cardiac output monitoring (NICCOMO) device data with transthoracic echocardiography (TTE) and inferior vena cava (IVC) ultrasound findings in assessing cardiac output (C.I), circulatory fluid adequacy, and finally Determination of hemodynamic status in patients with Critical conditions hospitalized in the Pediatric Intensive Care Unit (PICU). In this observational study, forty-four critically ill children that were admitted to PICU were evaluated. We used NICCOMO, TTE, and IVC ultrasonography at the same time in critical patients. The association between NICCOMO parameters and echocardiogram cardiac index and IVC quality in ultrasound is compared. The agreement between CI measured by TTE and NICCOMO was assessed using the Bland-Altman analysis method. NICCOMO is not a reliable instrument for determining CI in children with an unstable hemodynamic status. However, the parameters of this device are reliable in assessing the patient's hemodynamic status. Findings showed that 90% of patients in the normal hemodynamic state in NICCOMO have SVR. I in the normal range (P<0.001), and all cases in hypervolemic state had volume overload IVC in ultrasonography analysis. Noninvasive continuous cardiac output monitoring could be used to estimate unstable patients’ hemodynamic status in the initial stages for making timely treatment-related decisions, but its use for accurate cardiac index measurement is not reliable in all cases.

Today, there is ample scientific evidence that Breast Cancer (BC) is a global health challenge given its prevalence and invasive nature. Therefore, early detection of BC can help minimize the devastating effects of the disease. This study aimed to design a Clinical Decision Support System (CDSS) based on the best Artificial Neural Network (ANN) configuration to identify patients quickly. Using a single-center registry, we retrospectively reviewed the records of 3380 suspected BC cases. The independence test of Chi-Square at P<0.01 was utilized to select the most important criteria. Then the different ANN configuration was implemented in the Matlab R2013 environment and compared using some evaluation criteria. Finally, the best ANN configuration was obtained. After implementing feature selection, 20 variables were determined as the most relevant factors. The experimental results indicate that the best performance was obtained by the 20-25-1 configuration with PPV=90.9%, NPV=99.7%, Sensitivity=98.9%, Specificity=97.9%, Accuracy=98.1%, and AUC=0.958. The proposed software can identify cases of BC from healthy individuals with optimal diagnostic accuracy. Additionally, it might be integrated as a practical and helpful tool in natural clinical settings for easy and effective disease screening.

Obesity/bariatric surgery is rising as the most effective treatment for obesity. In previous studies, the history of Helicobacter pylori as the main cause of chronic abdominal pain in patients undergoing bariatric surgery has not been discussed. In this study, we determine in a set of patients how much of the number of people with positive H. pylori before the operation in one year later suffered from chronic abdominal pain. A retrospective study was conducted on 320 patients undergoing bariatric surgery. Data were collected by interviewing and referring to the medical records of patients. Of 320 patients, 125 were H. pylori-positive, and from these numbers, 43 had chronic abdominal pain (34.4%). Although in previous studies of bariatric surgery, the history of H. pylori has not been identified as the main cause of chronic abdominal pain after surgery. However, according to the available evidence in this study, with a prevalence of more than one-third of chronic abdominal pain in one year after surgery in patients with a history of preoperative H. pylori, pylori can be a potential cause of postoperative chronic pain.

The aim of this study was to evaluate the burnout, anxiety, and professional self-concept of nurses according to their demographic and occupational information. 160 nurses from Razi and Poursina hospitals in Iran were selected as a sample in this cross-sectional online survey and answered the tools Demographic and Occupational Information Questionnaire (DOIQ), Maslach Burnout Inventory-Human Services Survey (MBI-HSS), Corona Disease Anxiety Scale (CDAS) and Nurse Self-Concept Questionnaire (NSCQ). Data analysis was performed in two descriptive and inferential sections using SPSS-19 statistics software. The participation rate in this study was 87.5% (n=140). The mean age was 32.56 (SD=7.26) years. The burnout rate in emotional exhaustion (EE) was 24.3%, depersonalization (DP) was 32.1%, and personal accomplishment (PA) was 60.7%, 21.4% of nurses had high anxiety, and 53.6% had low NSCQ. EE score was higher in nurses with less than ten years of experience (t=2.21) and single people (t=-3.18). DP score was higher in people under 35 years (t=3.20), with work experience of fewer than ten years (t=4.34), and single people (t=-3.07). Females in PA reported more burnout (t=-2.43). CDAS score was higher in females (t=3.20). NSCQ score was higher in married people (t=-3.07). CDAS was positively correlated with EE and DP and negatively correlated with PA. NSCQ was negatively correlated with EE and DP and positively correlated with PA. At first, a high CDAS score and then celibacy, less than ten years of work experience, and a low NSCQ score were effective in multiple linear regression analysis for MBI-HSS.

Macrophages and glial activation contribute to the pathophysiology of spinal cord injury (SCI). Some preclinical studies have shown the anti-inflammatory effects of aripiprazole (ARP). In the current study, we evaluated the anti-inflammatory effects of ARP in a rat SCI model. Forty male Wistar rats underwent either T9 vertebra laminectomy or were used as a sham-operated group without laminectomy. There were four major groups in this study: a sham-operated, three treatments (normal saline [vehicle] control versus ARP 10 and 20 mg/kg/day for three days after surgery, first dose 30 minutes post-surgery) SCI groups. We evaluated locomotor scaling and neuropathic pain behavioral tests over 28 days. On Day 28, tissue samples were investigated for neuroinflammatory and histopathology changes through flow cytometry and ELISA. ARP (10 and 20 mg/kg/day, 3 days) treatment significantly reduced locomotors disability (P<0.01) and mechanical (P<0.01) and thermal allodynia (P<0.001) scores. Additionally, Levels of tumor necrosis factor (TNF)-α level and interleukin (IL)-10 were significantly altered in ARP-treated spinal cord tissues 28 days after SCI (P<0.01). Moreover, spinal cord tissue expression of M1 and M2 macrophages, as well as M1/M2 ratio, were reduced in ARP-treated SCI animals, concurrent with decreased M1 and increased M2 and M1/M2 in dorsal root ganglion (P<0.001). Our study indicates that ARP has therapeutic effects on SCI via the reduction of neuroinflammation and SCI sensory and locomotor abnormalities.

To compare Modulation Transform Function (MTF) between standard monofocal spherical hydrophobic acrylic Alcon SA60AT (Bausch and Lomb) and hydrophilic acrylic Rayner Superflex (620H) (Rayner) intra-ocular lenses (IOLs). This cross-sectional study was conducted on 68 patients who underwent cataract surgery. The hydrophobic Alcon SA60AT IOL was implanted in 39, and the hydrophilic Rayner Superflex (620H) was implanted in 29 eyes. The OPD Scan III (Nidek) was used to assess MTF in normal pupils under mesopic light conditions 1 and 3 months after the surgery. t-test showed no significant difference in mean MTF between the two IOLs in the 2 follow-ups (P=0.788). The results of repeated measure ANOVA for each type of IOL indicated that MTF increased significantly in the hydrophilic group versus the hydrophobic group in the 3rd month (P=0.033). Moreover, the results of repeated measure ANOVA showed that MTF was affected by the type of IOL and refractive error in the 3rd month (P=0.029, P=0.025). It seems that the material of IOL and post-surgical residual refractive error can affect the visual acuity of pseudophakic patients. Although the hydrophilic IOL provided a better MTF three months after the surgery, studies with longer follow-ups are required to confirm the results.

Meier-Gorlin syndrome (MGS) is a rare autosomal recessive disorder with homozygous or heterozygous mutations in one of the five following genes (ORC1, ORC4, ORC6, CDT1, and CDC6). This syndrome is characterized by the triad of short stature (pre/postnatal), microtia, and patella hypoplasia/aplasia. Special features included microcephaly, microstomia, full lips, micrognathia, narrow convex, and high nasal bridge nose. Also, it may be accompanied by feeding problems, skeletal disorders, urogenital or respiratory anomalies, and intelligence disorders. This case report describes the first Persian MGS accompanied by neonatal seizure, mental retardation, and attention deficit hyperactivity disorder.

Diagnosis and management of retroperitoneal abscesses caused by ESBL (Extended-Spectrum-β-Lactamase) Escherichia Coli require special attention. A female patient came to the Emergency Department with complaints of abdominal discomfort, bloating, nausea, fever, and urination pain for 1 week, and physical examination demonstrated an enlarged mass in the left flank for the past 6 months. Laboratory results showed an increase in leukocytes and procalcitonin hence the antibiotic cefoperazone sulbactam was given as empirical therapy. An abdominal CT scan revealed multiple retroperitoneal abscesses in the left and right hemiabdomen, therefore levofloxacin and metronidazole were given as additional antibiotics. Percutaneous abscess drainage was performed and from the pus culture obtained grew ESBL Escherichia Coli bacteria. Furthermore, antibiotics were changed to intravenous amikacin according to the results of the susceptibility test. The patient's clinical symptoms improved significantly and she was discharged and evaluated in the outpatient clinic.