Iranian Journal of Medical Sciences
Volume:48 Issue: 2, Mar 2023

More than 50 years have passed since the first family physician programs were established around the world.

Previous studies found that the use of probiotics may have a protective effect on chemotherapy-associated toxicity in cancer patients. A systematic review was conducted to evaluate the effect of probiotics and synbiotics on chemoradiotherapy-associated toxicity in colorectal cancer (CRC) patients.

A systematic review of randomized controlled trials (RCTs) was performed to assess the effect of probiotics and synbiotics in CRC patients undergoing chemotherapy. All RCTs in English, up to January 2021, were included through a literature search in Scopus, Google Scholar, PubMed (PMC Central, MEDLINE), ClinicalTrials.gov, and ProQuest databases. The impact of probiotics and synbiotics on the side effects associated with chemotherapy, radiotherapy, and chemoradiotherapy in CRC patients was evaluated. The quality of the RTCs was independently assessed by two reviewers. EndNote X8 software was used to manage the search results.

Of the 904 identified articles, three studies finally met the inclusion criteria and were systematically reviewed. Two studies reported that patients who received probiotics had less abdominal discomfort and required less bowel toxicity-related hospital care. Although probiotic supplementation lowered radiation-associated diarrhea, it had no significant effect when anti-diarrheal drugs were used. Another study reported that synbiotic supplementation improved quality of life and marginally reduced diarrhea and serum levels of high-sensitivity C-reactive protein (hs-CRP) and matrix metalloproteinase (MMP-2 and MMP-9).

Probiotics and synbiotics do not have a significant effect on reducing chemotherapy-associated toxicity and diarrhea in CRC patients. These findings should be substantiated by further RCTs with rigorous placebo-controlled studies.

Hydatid disease is a zoonotic infection caused primarily by the tapeworm parasite, Echinococcus granulosus. It is considered an endemic disease in the Mediterranean region. In about 90% of cases, hydatid cysts are found in the liver and lungs; however, any other organ in the body may be affected, particularly in endemic areas. When encountering cystic lesions in these areas, the physician should always keep hydatid disease as a possible diagnosis in mind. To avoid life-threatening conditions such as anaphylactic shock or pressure effect on vital organs, timely diagnosis, and proper management are critical. When a rare site is involved, hydatid disease should be diagnosed using a combination of serologic assays and imaging modalities such as ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI). These imaging modalities can also be used to determine the extent of the disease and assess possible complications. Here, we present a pictorial review of typical imaging manifestations of hydatid cysts in unusual sites. Being aware of these imaging features will assist physicians in making an accurate, timely diagnosis and subsequently, providing optimal management.

Tethered cord syndrome (TCS) is a type of occult spinal dysraphism, which necessitates early detection as an essential component of patient management in reducing complications. This study aimed to compare the findings of spinal cord ultrasonography between TCS patients and healthy individuals.  The current study is a case-control study of patients who were admitted to the Akbar and Ghaem Hospitals (Mashhad, Iran) in 2019. The study population comprised 30 children with TCS aged under two years old, and the control group included 34 healthy peers of the same age. The maximum distance of the spinal cord from the posterior canal wall was measured in millimeters using ultrasonography. Demographic and sonographic findings of each participant were recorded in checklists, which were then entered into SPSS software. P values less than 0.05 were considered statistically significant. The study included 30 children with TCS and 34 healthy individuals with a mean age of 7.67±6.39 months. TCS patients had a significantly shorter maximum distance of the spinal cord from the posterior wall of the spinal canal than the control group (1.75±0.62 mm vs. 2.79±0.76, P<0.001). After performing corrective surgery, the TCS patients indicated significant improvement in this interval (1.57±0.54 mm to 2.95±0.49 mm, respectively, P=0.001). In comparison to children without TCS, the spinal cord was substantially closer to the posterior canal wall in TCS patients. However, these outcomes were improved significantly in patients after surgery.

Burn wounds rank among the most serious healthcare issues. Many studies reported the effectiveness of natural products in the wound-healing process. The present study compared the effects of a standardized herbal formulation derived from Boswellia carteri (B. carteri) and silver sulfadiazine (SSD) cream 1% on the healing of burn wounds. This randomized double-blind clinical trial was conducted at Shiraz Burn Hospital (Shiraz, Iran) between July 2012 to August 2013. A sterilized formulation comprising B. carteri 40% was prepared. 54 second-degree burn patients of both sexes with age ranges of 20 to 60 were invited to participate in this double-blind, randomized clinical trial. They were randomly divided into two groups and given either the Boswellia formulation or SSD cream. The healing index was determined based on the wound area assessment using the planimetry technique. The Kaplan-Meier survival analysis was used to assess the primary outcome, which was the amount of time until complete healing. The trial was completed by 17 patients from the SSD group and 15 patients from the Boswellia group. During the study period, both groups showed a progressive healing trend. The mean (95% CI) healing time in the SSD group was 10.94 (9.03-12.85) days and 10.73 (9.23-12.23) days in the Boswellia group (P=0.71), indicating no significant difference. On the 17th day, the healing index of all patients in the Boswellia group reached 1. Boswellia topical formulation had a burn wound healing effect comparable to that of the standard SSD 1% treatment. Based on the findings of this study, the likelihood of contact dermatitis with Boswellia should be taken into consideration.

Circulating microRNAs (miRNAs) can help to predict the chemotherapy response in breast cancer with promising results. The aim of the present study was to investigate the relationships between the miR-199a, miR-663a, and miR-663b expression and chemotherapy response in metastatic breast cancer patients. This study is a case-control study performed at Yasuj University of Medical Sciences (2018-2021). The expression levels of miR-663a, miR-663b, and miR-199a in the serum of 25 patients with metastatic breast cancer versus 15 healthy individuals were determined by the real-time polymerase chain reaction method. The response to treatment was followed up in a 24-month period. All patients were treated with second-line medications. Two or more combinations of these drugs were used: gemcitabine, Navelbine®, Diphereline®, Xeloda®, letrozole, Aromasin®, and Zolena®. Statistical analyses were performed in SPSS 21.0 and GraphPad Prism 6 software. The expression levels were presented as mean±SD and analyzed by Student’s t test. The results and clinicopathological features of patients were analyzed by t test. The statistical analysis showed that miR-663a expression was related to human epidermal growth factor receptor 2 (HER2) status and was significantly lower in the HER2+ than HER2- group (P=0.027). Moreover, the expression of miR-199a and miR-663b was significantly correlated with the response to treatment, in which the expression of miR-199a was higher in the poor-response group (P=0.049), while the higher expression of miR-663b was seen in the good-response group (P=0.009). These findings state that the high plasma level of miR-199a and the low plasma level of miR-663b may be related to chemoresistance in patients with metastatic breast cancer.

The economic burden of asthma is a major public health concern. This study estimates the economic burden of asthma in Northwest of Iran. A longitudinal study was conducted between 2017 and 2018 in Tabriz, Iran using the Persian version of the Work Productivity and Activity Impairment (WPAI) questionnaire. Direct and indirect costs associated with asthma were estimated based on the societal perspective, prevalence-based approach, and bottom-up method. Annual indirect costs were estimated using the human capital (HC) method. The structural equation model was used to evaluate the relationship between costs, sex, and asthma severity.  A total of 621 patients with asthma were enrolled in the study. Significant differences were found between female and male patients for the mean cost of radiology (P=0.006), laboratory (P=0.028), and diagnostic (P=0.017) tests at baseline, and for laboratory (P=0.012), and diagnostic (P=0.027) tests at one-year follow-up. The more severe asthma, the more significant the costs for annual physician office visits (P=0.040) and medications (P=0.013). As asthma severity increased, significantly higher expenditures were observed in women for days lost from work at baseline (P=0.009) and one-year follow-up (P=0.001), and in men for productivity loss at work due to impairment at baseline (P=0.045). A significant association between indirect costs and the cost of impairment-related lost productivity at work (β=3.29, P<0.001), and between severe asthma and indirect costs (β=32.36, P<0.001) was observed.  High costs are incurred by Iranian asthma patients, especially because of impairment-related productivity loss at work associated with asthma exacerbation.

The use of antibiotics with or without prescription is increasing worldwide. With certain limitations, metronidazole (MTZ) is extensively used as an antibacterial and antiparasitic drug. Derivatives of 1,2,4-oxadiazole (ODZ) are used to modify the chemical structure of drugs. The present study aimed to synthesize new MTZ-ODZ derivatives that could potentially lead to new medications.  The reaction of MTZ with ethyl chloroacetate and potassium carbonate anhydrous was used to produce compound 7. This compound was treated with hydrazine hydrate in methanol to obtain compound 8. Carbon disulfide and potassium hydroxide were then added to obtain compound 9, which was then mixed with various α-haloketones to obtain compounds 10a to 10f. Subsequently, the structures of the new MTZ-ODZ derivatives were determined. All new compounds exhibited excellent activity against all tested organisms. The synthesized compounds showed a significant radical scavenging activity. The IC50 value for compounds 10a, 10b, 10c, 10d, 10e, and 10f was 70.42±0.15, 70.52±0.54, 85.21±0.85, 80.10±0.46, 82.52±0.13, and 70.45±0.12 g/mL, respectively. In terms of antigiardial activity, the IC50 value for compounds 10a,10b, 10c, and 10d ranged from 1.31±0.11 µM to 2.26±0.49 µM. In contrast, the IC50 for MTZ was 3.71±0.27 µM. Compound 10f showed the highest antigiardial activity with an IC50 value of 0.88±0.52 µM.  Most of the MTZ-ODZ derivatives showed high radical scavenging activity in the benzene ring due to the activation of certain groups, such as OCH3, NO2, and OH. The results suggest that the newly synthesized compounds could be used as an antiparasitic drug.

Chronic patients need regular follow-ups. During the COVID-19 pandemic, these regular visits can be affected. The delay of chronic patients and its contributing factors in their periodic visits during the COVID-19 pandemic are examined here. This cross-sectional study was conducted between February and June 2021, in Fars, Iran. Two hundred and eighty-six households with at least one chronic patient were recruited. Then, several trained questioners called the studied households and asked about the studied variables. The dependent variable was the number of delays in regular visits during the COVID-19 pandemic. The results were analyzed through Poisson regression by SPSS Statistics version 22 and GraphPad Prism software version 9. A significance level of 0.05 was considered for this study. Out of 286 households 113 (73.4%) fathers, 138 (70.1%) mothers, and 17 (58.6%) children in the households reported delayed referral. In fathers, referring to the health center was significantly associated with a decrease in the number of delays (P=0.033). The higher age of the householder (P=0.005), the higher number of children (P=0.043), and having a family physician (P=0.007) in the mothers' group, also the number of children in households P=0.001 in the children group were significantly associated with increasing the number of delays. COVID-19 pandemic not only creates direct harmful effects but also adversely affects people in danger of chronic diseases. Delays in follow-ups are taken into account as a major challenge during the COVID-19 pandemic. This issue is not limited to rural or urban residency.

Polycystic ovary syndrome (PCOS) is the most common reproductive dysfunction in premenopausal women. PCOS is associated with oxidative stress (OS), which is the main risk factor for renal diseases. This study aimed to investigate the mechanisms responsible for renal injury in a hyperandrogenemic female rat model.  This study was conducted from December 2019 to September 2021 at Shiraz Nephro-Urology Research Centre, Shiraz University of Medical Sciences (Shiraz, Iran). Thirty female Sprague-Dawley rats were randomly divided into three groups (n=10), namely control, sham, and dehydroepiandrosterone (DHEA). Plasma total testosterone, plasma creatinine (Cr), and blood urea nitrogen (BUN) levels were measured. In addition, total oxidant status (TOS), total antioxidant capacity (TAC), oxidative stress index (OSI), and histopathological changes in the ovaries and kidneys were determined. Data were analyzed using the GraphPad Prism software, and P<0.05 was considered statistically significant. Plasma total testosterone levels increased by nine-fold in DHEA-treated rats compared to controls (P=0.0001). Administration of DHEA increased Cr and BUN levels and caused severe renal tubular cell injury. In addition, plasma and tissue (kidney and ovary) TAC levels decreased significantly, but TOS levels and OSI values were significantly increased (P=0.019). Significant damage to both glomerular and tubular parts of the kidney and ovarian follicular structure was observed in the DHEA group. Hyperandrogenemia caused systemic abnormalities through OS-related mechanisms and damaged renal and ovarian tissues. DHEA treatment in rat models is recommended to study the mechanisms that mediate PCOS-associated renal injury.

Sperm cryopreservation reduces sperm quality. Kisspeptin (KP) has beneficial effects on sperm functions. This study compares the effect of KP and Glutathione (GSH) on mitigating the detrimental effects of the freeze-thaw cycle on sperm.  An experimental study was conducted in Birjand (Iran) during 2018-2020. Thirty normal swim-up semen samples were treated with Ham’s F10 medium (negative control), 1 mM GSH (positive control), or KP (10 µM) for 30 min before freezing. The motility, acrosome reaction, capacitation, and DNA quality of the frozen-thawed sperms were assessed according to the WHO guidelines. Statistical analysis was performed using paired t test, one-way analysis of variance, and least significant difference. Pre-incubation with KP significantly increased the percentage of sperm motility (34.00±6.7, P=0.003) compared to the control (20.44±7.4) and GSH-treated (31.25±12.2) aliquots. The frequency of non-capacitated spermatozoa was significantly higher in the KP-treated group (98.73%) than in the control (96.46%) and GSH-treated (96.49%) aliquots (P<0.001). The percentage of acrosome-intact spermatozoa in the KP-treated group (77.44%) was significantly higher than the control (74.3%) and GSH-treated (74.54%) groups (P<0.001). The sperm frequency with normal histone in the KP-treated group (51.86%) and with normal protamine (65.39%) was significantly higher than the controls (P=0.001 and P=0.002, respectively). The percentage of TUNEL-positive sperm was significantly lower in the KP-treated group (9.09±2.71) than both GSH-treated (11.22±2.73) and control (11.31±2.2) groups (both P=0.002). Pre-incubation with KP protects sperm motility and DNA integrity from the detrimental effect of the freeze-thaw cycle. KP is suitable as a pre-treatment to control sperm quality during freezing-thawing.

Anxiety, stress, and fear can adversely affect the mental and physical health of people. The present study aimed to examine the association of these emotional response indicators with outcomes (recurrence, hospitalization, and mortality) in coronavirus 2019 (COVID-19) patients. A prospective cohort study was conducted between February 2020 and July 2021 in three hospitals in Tehran, Iran. The included patients (n=350) completed three questionnaires on COVID-19-related anxiety, stress, and fear. Patients with at least one emotional response indicator were assigned to the exposed group (n=157) and those without to the unexposed group (n=193). After one month of follow-up, the medical condition of all participants was determined through phone calls. Data were analyzed with logistic and multivariate regression models using STATA 9 software. The number of patients with COVID-19 recurrence in the exposed and unexposed groups was 71 (45%) and 16 (8%), respectively, and for hospitalization 79 (50%) and 16 (8%), respectively. The relative risk of recurrence and hospitalization due to COVID-19 in the exposed group was 5.62 and 6.25 higher than in the unexposed group, respectively (P<0.001 for both). The results of regression analysis showed that underlying diseases were not significantly associated with recurrence and hospitalization. The total number of deaths was six, all of which were in the exposed group. Given the greater risk of recurrence and hospitalization in COVID-19 patients with anxiety, stress, or fear, there is a need to devise and implement appropriate strategies to prevent and manage mental disorders.

Herein we present a case of a neonate with congenital left ventricular diverticulum (LVD), a rare anomaly, with an unusual course and unexpected findings. The neonate was born at 35 weeks in Namazi Hospital (Shiraz, Iran) and presented with a pulsatile umbilical mass immediately after birth. Based on multiple imaging modalities, the presence of a connection between the left ventricular apex and the umbilicus was confirmed. Percutaneous closure of LVD was unsuccessful. The patient’s clinical course deteriorated after developing sepsis and multiorgan failure. The patient passed away before any corrective surgery could be performed. Unexpected findings in post-mortem evaluation were severe hepatic macrovesicular steatosis (suggestive of metabolic liver disease) and regulatory factor X6 (RFX6) heterozygous missense mutation in whole-exome sequencing.

The novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is primarily a respiratory virus. However, an increasing number of neurologic complications associated with this virus have been reported, e.g., transverse myelitis (TM). We report a case of a 39-year-old man admitted to Namazi Hospital affiliated with Shiraz University of Medical Sciences, Shiraz, Iran. In December 2020, the patient was infected with Coronavirus Disease 2019 (COVID-19). During hospitalization, the patient suffered from sudden onset of paraplegia, and urinary retention, and had a T6-T7 sensory level. TM was diagnosed and an extensive workup was performed to rule out other etiologies. Eventually, para-infectious TM associated with COVID-19 was concluded. The patient received pulse methylprednisolone therapy of 1 g/day for 10 consecutive days followed by seven sessions of plasma exchange without a favorable response. The patient then underwent regular physical rehabilitation and tapering oral administration of prednisolone 1 mg/Kg. As a result, weakness in the lower extremities improved slightly after six months. Overall, we suspect a correlation between COVID-19 and TM, however, further studies are required to substantiate the association.

Obtaining informed consent is a fundamental aspect of medical ethics to protect patients’ autonomy and human dignity. An adequate practice of informed consent is complex and has not only personal but also ethical, legal, and administrative implications.