Acta Medica Iranica
Volume:61 Issue: 2, Feb 2023

During chronic infections, a distinct physiological condition named “exhaustion” arises that is associated with the dysfunctionality in immune cells and their eventual removal from the environment, which evidently help the progress of infection or tumors in human or animal bodies. This state of immune cells could be under the control of different elements such as the antigen load, help from inhibitory cells, lack of costimulatory signals and etc. Exhaustion that has been found in different immune system cells, is usually accompanied by impaired effector function and proliferation of immune cells, poor memory recall, upregulation of inhibitory molecules, compromised metabolism and altered transcription program, and is considered a reversible process, unlike other physiological states like anergy or senescence, organized through the blockage of several factors. Although the emergence of these cells in viral infections and cancer is an undesirable event, the importance of the presence of exhausted cells in autoimmune diseases and organ transplantation is highlighted as a positive change. In this review, we aimed to determine the occurrence of this process in different immune cells, the characteristics obtained by these cells, effective and primitive factors on exhaustion, metabolic and transcriptional cell changes, and the use of these cells in autoimmune diseases and organ transplantation.

The use of animal models of diseases is essential for the study of the effects of various drugs and the discovery of new drugs. One of the most common problems in researches on diabetes in animal models is the high rate of mortality after diabetes induction. This leads to disrupt the grouping of diabetic animals for interventional evaluations. We introduce a protocol to reduce the rate of mortality in diabetic rats. To do this, we used alloxan at dose of 185 mg/kg to induce diabetes in rats. In this study in addition to provide 5% glucose solution in drinking water from 2 to 12 hrs post alloxan injection, 2 ml of 50% dextrose solution orally gavaged with 2 hrs intervals up to 12 hrs post diabetes induction, and also from 12 to 24 hrs following alloxan injection 2 ml of 5% glucose solution was given by gavage every 2 hrs. Furthermore, from 6 to 48 hrs post alloxan injection the rats were orally received 1 ml of Ringer's serum with 2 hrs intervals via gavage route. Moreover, one unit of Novolin 70/30 (70% NPH and 30% insulin regular) was subcutaneously injected in the back of the neck area for 5 consistence days from the second day post alloxan injection. In the sixth day following alloxan injection the level of glucose was at level of 280 mg/dL which considered as diabetic level. Our findings showed that by abovementioned interventions the rate of mortality significantly reduced (2 percent) and diabetes well established.

The number of mountaineers and climbers has increased over the last few years. Considering the geographical features of Iran, this increase in the number of climbers is more significant in this country. Because of the importance of mountaineering injuries, a comprehensive survey of these injuries is needed. In this base, we designed a survey to investigate skeletal injuries in mountaineering accidents. This cross-sectional study was conducted on athletes from the Mountaineering Federation of Islamic Republic of the Iran (MFIRI) in 2015 and 2016. A total of 110 athletes were included using a simple random sampling method, and they were examined for any complications after skeletal injuries. Their medical records were reviewed. A total of 110 mountaineers completed the checklists, and 15 mountaineers reported a rock-climbing trauma and injury during 2015 and 2016. The most traumatic location was the lower extremities (46.7%). Additionally, most of trauma occurrences were in descent (80%) and times of day between noon and midnight (64.3%). The mean age of the mountaineers who had a trauma incidence was 37.95±8.76 years. Smoking was significantly different between the two groups. Skeletal injuries during mountaineering and rock climbing mostly affect the lower extremities, followed by the upper extremities and spine. There was no significant difference in age, sex or climbing equipment between the group who had an accident and the group who did not. In this study, there was a relationship between smoking cigarettes and an increased incidence of climbing accidents. Longitudinal studies with larger sample sizes are needed to evaluate this relationship.

COVID-19 is caused by SARS-CoV-2 which has structural and non-structural proteins (NSP) essential for infection and viral replication. There is a possible binding of SARS-CoV-2 to the beta-1 chain of hemoglobin in red blood cells and thus, decreasing the oxygen transport capacity. Since hydroxychloroquine (HCQ) can accumulate in red cells, there is a chance of interaction of this drug with the virus. To analyze possible interactions between SARS-CoV-2 NSP and hemoglobin with the HCQ using molecular docking and implications for the infected host. This research consisted of a study using bioinformatics tools. The files of the protein structures and HCQ were prepared using the AutoDock Tools software. These files were used to perform molecular docking simulations by AutoDock Vina. The binding affinity report of the generated conformers was analyzed using PyMol software, as well as the chemical bonds formed. The results showed that HCQ is capable of interacting with both SARS-CoV-2 NSP and human hemoglobin. The HCQ/NSP3 conformer, HCQ/NSP5, HCQ/NSP7-NSP8-NSP12, HCQ/NSP9, HCQ/NSP10-NSP16 showed binding affinity. In addition, the interaction between HCQ and hemoglobin resulted in polar bonds. Interaction between SARS-CoV-2 NSP and HCQ indicates that this drug possibly acts by preventing the continuity of infection.

Since the late 2019 months’ pandemic of Corona Virus Disease-2019 (COVID-19), it has spread globally and claimed abundant lives due to its expeditious interpersonal transmission and high mortality rate. Early studies showed that the upper aerodigestive tract procedures had the highest rates of nosocomial spread due to high viral load in upper respiratory and pharyngeal secretions. Between March 10 and April 10, 2020, a total of 28 rigid endoscopies were performed under general anesthesia for the removal of esophageal foreign bodies at our center. All the patients were screened on admission for symptoms of COVID-19 and a chest CT scan was performed and they were later followed up for further investigations. No patient had symptoms of COVID-19 (fever, cough, and dyspnea) on admission, and only one patient (3.57 %) had a suspicious CT scan for COVID-19. The mean age of 27 asymptomatic cases, including 14 men and 13 women, was 45.2 years old. Their average hospital stay was 0.8 days. all patients were later interviewed, inspected, and closely observed for any upcoming symptoms which would raise suspicion for COVID-19 during isolation. Of the 27 patients who cooperated, none showed COVID-19 symptoms. What makes this experiment prominent is that with suitable plans in a careful and precautionary manner, we can provide first-rate care for patients and meanwhile protect physicians during this pandemic promptly. Conclusion what makes this experiment prominent is that with suitable plans in careful and precaution manner, we are able to provide first-rate care for patients and meanwhile protect physicians during this epidemic in a timely manner.

Novel coronavirus disease 2019 (COVID-19) has become a public health concern with over 6.5 million cases and 390,000 deaths around the world. This research aimed to find an association between computed tomography (CT) scores and clinical and laboratory findings to estimate the extent of lung infection in patients with COVID-19. The study sample enrolled 129 patients diagnosed with COVID-19 from January to February 2020. The chest CT images and clinical data were reviewed, images were segmented and scored by the degree of involvement from 0 to 4, and the relationship between them and clinical and laboratory findings were analyzed statistically. This study included 74 men and 59 women with a mean age of 55.08 years. Different abnormalities were observed; the mean CT score was 8.52 (7.83 to 9.21) and the most frequent lesions were GGO and consolidation. Our results revealed significant differences between groups categorized by dyspnea, sore throat, and low oxygen saturation concerning CT scores. There was also a significant correlation between CT scores and WBC counts and CRP levels (P<0.05). The evidence from this study implies that clinical and laboratory data, such as CRP, dyspnea, lymphopenia, and symptom onset closely correspond to chest CT scores and may be employed as initial tools to estimate the extent of lung involvement in COVID-19 patients.

Hemangioblastoma (HB) is one of the most common primary neoplasms of the posterior fossa in adults. Although single tumors can be sporadic, multiple tumors are almost always associated with von Hippel-Lindau (VHL) disease. In our case report, we are describing a 39-year-old woman with complaints of severe headache, pain, and numbness in both arms. She had a history of VHL disease. We performed contrast-enhanced cranial and cervical spine magnetic resonance imaging (MRI) examinations. Given the patient’s history of VHL disease and characteristic MR imaging features of lesions, cranial and cervical HBs were considered for diagnosis. Surgical excision is the main treatment of these tumors and follow-up optimal imaging of these patients is crucial. In the screening of VHL patients, whole spinal axis imaging in conjunction with routine MRI studies must always be performed to rule out spinal HBs.

Sexual precocity in boys is defined as any sign of secondary sexual characteristics present before the age of 9. Leydig cell tumors of the testes are a rare cause of peripheral precocious puberty in boys. Here, we report 8 years and 4-month-old boys with signs of peripheral precocious puberty because of a testicular Leydig cell tumor that developed true precocious puberty after surgical removal. Examination of genitalia showed Tanner 4 hair growth. The penis length was 14.5 cm with a 2.5 cm width. The right testis was enlarged but the left testis was measured at 2cm in length and 1 cm in width. Laboratory results showed low serum gonadotropin levels and increased androgen levels. Testicular sonography reported one solid mass measured 31×28×15 millimeters. With a presumptive diagnosis of Leydig cell tumor, the patient underwent radical orchiectomy. Pathologic evaluation confirmed it. Two months after surgery, the diagnosis of central precocious puberty was confirmed according to physical examination and rising of serum gonadotropins. We started treatment with a Gonadotropin-releasing hormone (GnRH) agonist. Leydig cell tumor in children is an uncommon cause of precocious puberty. In every boy with the sign of peripheral precocious puberty and asymmetrical testicular enlargement, the testicular tumor should be considered. It may induce central precocious puberty after surgical resection and this diagnosis should be considered in the patient’s follow-up in the next visits.

The association between multiple myeloma and solid cancers is rarely described in the literature. Some authors report that multiple myeloma increases the risk of developing some cancers such as breast cancer. We report three cases of multiple myeloma and breast cancer metachronous in order to study the etiopathogenesis of this association. Such a big spectrum of these studies should be done to understand whether there is a relation between causes of these two diseases or the risk factors behind this rare association. Our objective is to be able to define patients with high and low risk of developing secondary cancer in order to adapt the therapies and propose possibly screening for colon and breast cancers every two years for patients with high-risk multiple myeloma.