Acta Medica Iranica
Volume:61 Issue: 3, Mar 2023

Pancreatic cancer is one of the ten most lethal cancers with a mortality rate of 5.7 per 100,000 individuals worldwide. According to the disease stage, its 5-year survival rate is between 3% and 34%. Treatment options for pancreatic cancer are surgery, chemotherapy, radiotherapy, and immunotherapy. Immune checkpoint inhibitor therapy is a kind of immunotherapy. Immune checkpoints on T cells like cytotoxic T-lymphocyte-associated protein-4 (CTLA-4) and programmed cell death protein-1 (PD-1) suppress the immune system by attaching to their ligands on normal and/or tumor cells. This mechanism protects the body against immune system hyperactivity, especially in autoimmune diseases, but tumor cells can escape from immune responses by expressing these ligands to maintain in the body and to be safe against the immune system. Immune checkpoint inhibitors are immunotherapeutic drugs that bind to proteins in cancer cells to prevent them from suppressing the immune system. Immune checkpoint inhibitors may lead to some adverse effects like vitiligo, thyroiditis, adrenal insufficiency, and other ophthalmologic, hematologic, and respiratory problems. However, it has been shown that the combination of these therapies with each other or other therapeutic approaches could increase the safety and efficacy of this developing method. Here, we will review some trials that have been done or are ongoing about the advances and the effects of immune checkpoint inhibitors on patients with pancreatic cancer.

The emergence of resistance to antiretroviral drugs is the main problem in their long-term efficacy and by considering the wide use of protease inhibitors (PIs), monitoring drug resistance mutations is necessary. Therefore, this study aimed to investigate the PIs drug resistance mutations in Iranian patients as well as subtyping using bioinformatics analysis. Fifteen Iranian patients living with Human Immunodeficiency Virus (HIV) (PLWH) were examined. RNA was used to amplify and sequence the HIV protease gene; also, HIV viral load was determined for all samples. The sequencing results were analyzed by several strong bioinformatics tools to determine the drug-resistance mutations and HIV subtypes. Some polymorphisms in the protease gene were recognized; however, there was no significant rate of major or minor drug resistance mutations in our studied patients. Subtyping analysis revealed the new subtype (D) and the previously reported ones, A and CRF-AD 35, in patients. This study confirmed that the resistance mutations and genetic polymorphisms of the protease region are rare in Iranian-infected patients that can be concluded that prescribing protease inhibitor class in HIV-infected patients is promising in controlling HIV in Iran. In addition, conducting periodic studies to determine the new mutations and the rate of drug resistance to PIs in Iranian individuals highlights the importance of WHO guidelines that recommends monitoring of genotypic-resistance testing and investigation of mutations in HIV-related genes.

Multiple myeloma (MM) is a human B-cell neoplasia arising from malignant plasma cells. Vascular endothelial growth factor (VEGF) is among growth factors essential for angiogenesis in MM. However, chemokine (C-X-C motif) ligand 13 (CXCL13) allows the chemotaxis of mature B cells expressing its receptor CXCR5.CXCL13-CXCR5 interactions are involved in MM progression. This study aimed at investigating 2 serum biomarkers; VEGF-A and CXCL13 levels using enzyme linked immunosorbent assays (ELISA) in 48 Egyptian myeloma patients as well as correlation with different clinic-pathological features, survival and therapy response. VEGF-A and CXCL13 levels were significantly higher in MM cases in comparison to control group (P=0.04* and 0.01*, respectively). An indirect proportional relation between VEGF-A and CXCL13 levels in myeloma patients was found (r= -0.27, P=0.22). Alb/creat ratio change showed indirect proportional relation with VEGF-A (r= -0.446, P=0.043*). Patients obtained complete remission (CR)had insignificantly lower VEGF-A and higher CXCL13 levels compared to other patients, P=0.2 and 0.7, respectively. In conclusion, production of variety of growth factors and cytokines such as VEGF-A and CXCL13 was higher in MM patients. However, our experiment has to be done on larger sample size and extended period of follow up to validate the participation of the VEGF-A and CXCL13 in disease progression and clinical outcome.

Thyroid nodules are a common finding in clinical practice. Although ultrasonography is an accepted method for evaluating these nodules, Fine Needle Aspiration (FNA) is the procedure of choice for assessing the risk of malignancy. This study aims to determine the association between sonographic features of thyroid nodules based on Thyroid Imaging Reporting and Data System classification and the cytology results. In this prospective cohort study, 147 patients from Tehran Medical Imaging Center who had thyroid nodules underwent ultrasonography-guided FNA, and their sonographic features were recorded. The pathologic findings were also obtained according to the Bethesda system. Finally, the association between sonographic features and cytological results was analyzed. Eighteen (12.3%) nodules were malignant, and 129 nodules (87.7%) were benign. The association of TIRADS categories with the risk of malignancy is as follows: TIRADS 1 (n=0, 0%), TIRADS 2 (n=10, 16.9%), TIRADS 3 (n=6, 10.5%), TIRADS 4 (n=2, 16.7%), and TIRADS 5 (n=0, 0%). The bloody lamellae of thyroid nodules were significantly correlated with the risk of malignancy (P<0.05). However, there was no statistically significant association between the risk of malignancy and gender (P=0.47), calcification (P=0.9), firmness (P=0.19), halo sign (P=0.95), location of nodules (P=0.35), and nodules' echogenicity (P=0.058). Although there are trusted classifications such as TIRADS for categorizing thyroid nodules, there is still uncertainty in utilizing them, especially in the management of nodules classified as TIRADS 2, in which various sonographic features are shared between benign and malignant nodules.

The new coronavirus was first reported in China and caused a widespread global outbreak of pneumonia that spread rapidly across this country and many other countries. Acute kidney injury is one of the important complications of COVID-19, which has been shown in some cases. Exploring the diagnostic features of biomarkers of kidney function in COVID-19 patients may lead to better patient management. We collected laboratory data from 206 people with confirmed COVID-19 disease and evaluated their renal biomarkers, Blood Urea Nitrogen (BUN), and creatinine. The age range of the patients was almost 62 years old. The mean age in the dead patients and recovered patients was 71 and 54 years old, respectively. The average LDH value was 755 U/L, and creatine phosphokinase (CPK) was 267 U/L in the patients. The average BUN was 59.1 U/L, and creatinine was 1.5 U/L in COVID-2019 patients. Among all 193 patients, laboratory results revealed that 163 (85.4 %) patients had an elevated BUN level. Based on creatinine levels for total patients, laboratory results revealed that 49 (25.4 %) patients had an elevated value. The average BUN value in dead patients was 85 mg/dL, while in recovered patients was 40.5 mg/dL (P<0.0001). Also, the average creatinine level in dead patients was 1.86 mg/dL, while in recovered patients was 1.24 mg/dL (P=0.0004). Inflammation following COVID-19 disease causes kidney damage and elevated urea and creatinine levels, which may increase the risk of death in these patients.

Postoperative Nausea and vomiting (PONV) are the most complications after laparoscopic surgeries, especially laparoscopic bariatric surgeries. The incidence of PONV has been estimated in over two-thirds of patients undergoing laparoscopic bariatric surgeries. Prophylactic combined antiemetic therapy is recommended for patients undergoing these surgeries. This is a double-blinded randomized clinical trial. Eighty-three patients of ASA physical status I and II undergoing elective bariatric laparoscopic surgery were enrolled in this clinical trial and divided into two equal groups through simple randomization using a random number table. One group (group A) received a combination of ondansetron, dexamethasone, and haloperidol (ODH); and the other group (group B) received a combination of ondansetron, dexamethasone, and promethazine (ODP). The ODP group received promethazine 25 mg IM 30 minutes before extubation and ODH group received haloperidol 2 mg IM at the beginning of the surgery. Nausea and vomiting were assessed in terms of severity and frequency in the recovery room, 6, and 24 hours postoperatively in both groups using the Numeric Verbal Rating Scale (NVRS). The frequency of PONV was significantly lower in the ODH group compared to the ODP group in the recovery room (20% versus 40%). PONV severity was lower in the ODH group compared to the ODP group. The time to first rescue antiemetic prescription in the ODP group was more than in the ODH group (7.2 h versus 2.6 h). In morbidly obese patients undergoing laparoscopic bariatric surgery, both antiemetic combinations decreased the incidence of PONV, but the combination of haloperidol, dexamethasone, and ondansetron was more effective than promethazine, dexamethasone, and ondansetron.

Ovarian cancer management during pregnancy is a topic of limited research due to low occurrence rates of malignant adnexal tumors. To shed further light on this issue, we present a case series of 22 pregnant ovarian cancer patients referred to an academic hospital's gynecology oncology department over six years. Data on each patient's demographic and clinical background were collected using a registry software recording surgical tumor staging, disease-free survival (DFS), and overall survival (OS). According to the data analysis reports, subtype epithelial tumor and germ cell pathology were equally 45.4%. However, sex-cord tumors were observed in a smaller percentage of cases (9.1%). Serous adenocarcinoma was the most common subtype among those with epithelial tumors (60%). Meanwhile, 72.7% of these pregnant women had a palpable mass in physical examination. In addition, adnexal mass was detected in 95.4% of ultrasonography. Due to the young age of the patients, fertility-preserving surgery was performed on 63.6% of patients, and chemotherapy was prescripted on 59% of patients. Over a six-year follow-up period, there was a recurrence rate of 22.7%, while DFS and OS were reported as 56% and 82%, respectively. In conclusion, treatment of ovarian malignancies during pregnancy requires an experienced multidisciplinary approach. However, more extensive studies with larger samples are needed to gain more insight into the treatment of ovarian cancer during pregnancy.

Lesions in the parapharyngeal space are rare and account for 0.5-1.5% of all head and neck tumours. Of these, venous malformations represent 1% of all parapharyngeal space tumors. In the current paper, we reported a 5-year-old patient who presented with a soft tissue swelling of the parapharyngeal space that was discovered by her parents after two weeks following adenoidectomy. The MRI revealed a tumour within the parapharyngeal space with a well-defined mass with low-signal intensity on T1 and high on T2. The internal flow voids also proposed phleboliths. Therefore, the tumour was removed by an intraoral approach. The post-op pathology result explicated a venous malformation.

Sarcoidosis is a systemic disease histologically characterized by the presence of non-caseating granulomas. Granulomas can affect all structures of the body, giving heterogeneous manifestations and making the diagnosis of this disease a real challenge. We report the case of a 72-year-old woman who presented with two rare manifestations of sarcoidosis: an orbital and a pulmonary pseudotumor. The orbital tumor revealed the disease. Clinically, the patient had palpebral swelling. Orbital MRI showed an orbital pseudotumor hypointense on T1, and hyperintense on T2, heterogeneous and enhanced after gadolinium injection. The thoracic localization was asymptomatic, revealed by the chest Computed Tomography (CT) scan. Histological evidence of granuloma was obtained at both locations. The level of angiotensin-converting enzyme was high. All the other systemic granulomatous diseases were eliminated. We started a systemic corticotherapy with good clinical results.