Acta Medica Iranica
Volume:60 Issue: 11, Nov 2022

Adherence to capecitabine, an effective oral chemotherapy agent, is essential in achieving treatment response in cancer. In this study, we aimed to investigate factors associated with non-adherence to capecitabine in a sample of patients with gastrointestinal cancer. We enrolled 98 patients with colon, rectal or gastric cancers who were undergoing treatment with capecitabine as part of their single or multi-agent chemotherapy regimen. The patients were followed during cohort time up to four consecutive cycles of their chemotherapy. For adherence measurement, the participants were asked to bring back the leftover medicines at the time of follow-up visits and were considered adherent if they had taken ≥95% of their prescribed dose. The mean adherence rate was 97.7%, and the patients were adherent to capecitabine in 93.1% of their cycles. The patients who underwent neoadjuvant chemotherapy were significantly less adherent to capecitabine (60%) as compared with adjuvant (95.2%) and palliative chemotherapy (94.6%) [P=0.004]. Multivariable logistic regression revealed that neoadjuvant chemotherapy and the presence of nausea and mucositis were inversely associated with adherence rate. We did not find any association between adherence and any of our laboratory findings. Our findings suggest a high adherence rate to capecitabine among patients with gastrointestinal cancers. Neoadjuvant chemotherapy and the presence of nausea and mucositis may play a significant role in non-adherence to capecitabine.

Hemodialysis access has been considered as a support for end-stage renal patients. We measured the hemodynamic changes of the distal part of the upper extremity immediately after providing the AVGs in each method mentioned above and then compared the results. This method is a novel one and hasn’t been used in any other studies before. We studied 32 patients referred to the vascular surgery department of Rasht Razi Hospital between 2019-2020 (using the Convenient Sampling method). This study is a case-control study. Out of 32 patients referred to the vascular surgery department of the hospital, 68.8% were male, and their mean age was 53.41±12.75 years, ranging from 28 to 78 years. Changes in distal arterial hemodynamics of the upper limb before and after clamping in dialysis venoarterial loop versus straight grafts are different in studied patients (P<0.05). The mean hemodynamic changes before and after clamping in loop venoarterial grafts (19.5000) are less than straight grafts. In dialysis patients who do not have any superficial vein suitable for venous, arterial fistula, surgical placement of artificial grafts in the upper limb is appropriate. Based on the results of this study, the loop method seems to have lesser ischemic Complications and can be applied to dialysis patients.

The pandemic caused by Coronavirus-19 Disease (COVID-19) is having negative effects on healthcare workers (HCW) mental health due to the tremendous amount of stress to which they are exposed to. We aimed to assess the number of mental health outcomes among HCW treating patients with COVID-19. This cross-sectional study collected demographic data and mental health measurements from HCW in different hospitals using an online questionnaire. Participants were asked to complete the 9-item Patient Health Questionnaire (PHQ-9), the 7-item Insomnia Severity Index (ISI), and the 7-item Generalized Anxiety Disorder scale (GAD-7). One hundred and forty-one participants with a mean age of 30.6±25 years and a sex ratio of 0.3 completed the online questionnaire. Participants from major university-hospital centers of northern Tunisia were divided into two groups: 78% medical and 22% paramedical staff. Twenty-two participants (15.6%) had a chronic disease, and 21 (14.9%) had a history of depression. Nineteen (13.4%) of the participants were infected with COVID-19. Thirteen percent of participants experienced the same anxiety level as the first-time taking care of COVID-19 patients, while 65% were rather an at ease compared to the first time. Forty-seven percent of participants felt the need for psychological support, and 16.7% of them had consulted a psychiatrist. Mild depression was detected in 14.1% of cases, moderate depression in 4.2% of cases, and severe depression in 2.1% of cases. As for anxiety, 36.1% of participants suffered from mild anxiety, 14.9% from moderate anxiety, and 4.9% from severe anxiety. Mild insomnia was detected in 44.6% of cases, moderate insomnia in 14.9% of cases, and severe insomnia in 9.9% of cases. Female gender (depression: P=0.05; anxiety: P=0.05; insomnia: P=0.02), having friends or relatives with COVID (depression: P=0.01; anxiety: P=0.05), psychiatric illness (depression: P=0.05; anxiety: P=0.01; insomnia: P=0.01), and chronic disease (depression: P=0.02; anxiety: P=0.03) were significantly associated with more severe mental health symptoms. Tunisian HCW experienced psychological burdens and a high rate of anxiety, depression, and insomnia. HCW should be protected in order to promote mental well-being.

Accidental or intentional poisoning with Aluminum phosphide (AlP) is associated with severe complications such as metabolic acidosis, cardiac failure, and death. Previous animal experiments demonstrated that fresh-packed RBC is protective in an experimental model of AlP poisoning. The aim of this study was to assess the effect of fresh-packed RBC on survival in patients admitted to a referral hospital due to AlP poisoning in a randomized clinical trial. Eighty-two patients were admitted to Clinical Toxicology Unit at Baharloo Hospital due to acute AlP poisoning after approval by the Iranian Registry of Clinical Trials (registration reference: IRCT20180428039443N1). All patients received standard treatment, and forty-one of them received fresh-packed RBC. There was no significant difference between groups in the underlying characteristics, including vital signs and laboratory investigations. But interestingly, the mortality rate was meaningfully decreased (difference: 31.7%, 95% CI: 0.10-0.52) in patients receiving fresh-packed RBC (10 deaths/31 survived; 24.4% mortality) in comparison to standard treatment patients (23 deaths/18 survived; 56.1% mortality). Furthermore, fresh-packed RBC substantially improved the GCS, systolic/diastolic blood pressure, ST changes, and pH 12- and- 24 hours after admission. This study showed that fresh-packed RBC infusion alongside standard supportive treatment leads to a decrease in mortality rate; also, it provided evidence for a protective role of fresh-packed RBC in the management of patients with acute AlP poisoning.

To investigate the prevalence of Meibomian gland dysfunction (MGD) and its relationship with some determinants in underserved villages of Iran. This population-based cross-sectional study was conducted on 3850 subjects that were randomly selected from the villages of two underserved districts in the north and southwest of Iran using multistage cluster sampling. All participants underwent complete ophthalmic examinations, including visual acuity and refraction measurement. Then, slit-lamp biomicroscopy was done by an ophthalmologist to investigate MGD. Of 3850 subjects that were invited, 3314 participated in the study (participation rate=86.07%), of whom 1834 (55.34%) were women. The mean age of the participants was 37.7±21.4 years (range=2-93 years). The prevalence (95% CI) of MGD in at least one eye was 29.20% (27.35 to 31.06). According to the results of multiple regression analysis, MGD had a positive association with the male sex (OR: 1.75; CI 95%: 1.44 to 2.13), age 61-70 years (OR: 7.15; CI 95%: 3.65 to 14.01), and living in southern villages (OR: 1.82; CI 95%: 1.48 to 2.22) and an inverse association with education level (OR: 0.89; CI 95%: 0.80 to 0.98). The results of this study showed a lower prevalence of MGD even in Iranian rural regions compared to other Asian countries. This study found that older age, male sex, and low education level served as MGD risk factors. It seems that improved health conditions are an important factor in preventing MGD.

Anatomical and anthropological study of hyoid bones could be used in the sex prediction from skeletal remains. The aim of this study is to examine the morphometrical parameters of the hyoid bone individuals of the Iranian population. The study was carried out on 248 hyoid bones taken from cadavers Referred to Kahrizak Legal Medicine Center in 2020. Four anthropometric indices of hyoid bone were studied and have been associated with the sex and height of the individuals. The study included 179 (72.2%) males and 69 (27.8%) female cases. No significant difference was observed between the two gender groups in terms of age (P=0.678). The indexes of hyoid bones measured were compared between male and female genders, and the results show that the transverse distance between the tubercle of the greater horn, the Anterior/posterior dimension of the body, the distance between the upper and lower margin of the body in the middle (height) and the maximum depth of concavity on the posterior surface of the body, was associated with the sex determination (P<0.001). The four hyoid bone indexes measured in this study were higher in males compared with females, which indicates that hyoid bone morphometry can be used for sex determination in the Iranian population.

The successful implementation of mobile learning is mainly impacted by learners’ attitudes to accepting and applying mobile learning systems. In the current study, an m-learning application was developed and implemented for university students, and their perspective toward the adoption and application of m-learning was investigated. This cross-sectional study was carried out in 2020. The participants were 114 university students at Abadan University of Medical Sciences. Data were collected by means of a valid questionnaire containing 42 questions in 13 subscales in addition to an open-ended question about the positive and negative aspects of the m-learning application. There was a significant relationship between acceptance and major (P=0.001), mobile usage (P=0.035), and familiarity with m-learning (P<0.001). The total mean of m-learning application acceptance was 3.95±0.32, which shows a good level. Self-efficacy, perceived ease of use, and user interface were, respectively, the most influencing factors; mobile device limitation and governmental support were the least influencing factors. “Direct communication with the teacher/instructor” and “Internet disconnection during video teaching” were among the positive and negative aspects of applying the m-learning application, respectively. The m-learning application was well adopted among the students. Mobile device limitations are a reason for the student's concerns. “Usability features” can be a point for covering mobile device limitations.

Vitamin D deficiency plays an important role in the development of various diseases, including cancer. Regarding the high prevalence of breast cancer and vitamin D deficiency in Iran, this study aimed to investigate the relationship between vitamin D deficiencies and prognostic factors in breast cancer. This descriptive-analytical cross-sectional study was performed from March 2015 to March 2017 at Imam Reza hospital in Kermanshah city, Iran. 145 breast cancer patients with pathologic confirmation and before the neoadjuvant or adjuvant treatments were included by simple and convenient sampling. Serum 25(OH) D levels were measured in all patients before receiving treatment. The collected data were analyzed by using SPSS software (version. 20), and the relationship between the levels of 25(OH) D and the studied factors was assessed by inferential statistical tests in each group. The results showed that there was a statistically significant direct relationship between serum vitamin D levels and some factors, including age, ER, and PR, but a significant inverse relationship was observed between serum vitamin D levels and the level of ki67 and metastasis. There was no statistically significant relationship between the mean serum level of vitamin D and tumor grade and P53 receptor, but high levels of vitamin D were associated with low-grade tumors and P53 negativity. According to the findings, lower levels of vitamin D can be associated with higher levels of ki67 and P53, higher-grade breast cancer, a higher rate of metastases, as well as lower percentage of hormone receptor positivity.

Nowadays, cardiovascular disease, including coronary artery disease, is the leading cause of death around the world. Duke Treadmill Score (DTS) is used as a prognostic score for patients suspected of coronary artery disease. Investigating the Relationship between DTS and syntax score (SxScore) as an indicator of complexity and severity of coronary artery disease in patients with intermediate and high Duke Score. This cross-sectional study was conducted at the exercise test unit of Heshmat Hospital in Rasht from September 2017 to December 2018. Among 1033 patients that passed exercise cardiac stress testing (EST), 118 patients who had positive exercise testing for CAD were enrolled. Coronary angiography was performed, and SxScore, a marker of CAD complexity, was determined. The relationship between DTS and SxScore was then evaluated. The data were analyzed by SPSS version 21. The risk of positive EST raised age more than 61 years (OR=1.072; 95%; CI=1.046-1.099), Hypertension (OR=3.235; 95%; CI=2.097-4.992), Hyperlipidemia (OR=2.109; 95%; CI=1.371-3.242) and Diabetes Mellitus (OR=2.15; CI=1.22-3.14). The presence of the following factors reduced positive EST: female (OR=0.377;95%; CI=0.133-1.068), retired (OR=0.128;95%; CI=0.045-0.361). The results of the present study showed that there was no significant difference between the degree of coronary artery involvement based on syntax with Duke scores (P=0.328). Although both DTS and Syntax scores are useful in evaluating coronary artery disease, there isn't a significant relationship between these scores, and they don't coincide. In other words, we cannot use DTS to predict the Syntax score.

The novel Coronavirus can cause a vast range of symptoms, among which the most famous is respiratory system complications. Brucellosis is a highly contagious zoonotic disease, especially in endemic areas such as Iran. The disease, initially revealed with nonspecific symptoms, shows similar manifestations to SARS-CoV-2 disease. A 37-year-old woman presented with severe pain and swelling of the right inguinal area a week after working in a garden. Brucellosis treatment was initiated, and the patient was transferred to the COVID ward and received COVID medical therapy. The patient's pain reduced, and she was discharged and informed of the warning signs or any condition change. Owing to the high prevalence of COVID-19, other infectious diseases may be neglected. This case is a reminder to clinicians that the co-infection of SARS-CoV-2 and other diseases such as brucellosis may occur and differential diagnoses should be considered, especially for endemic diseases.