Acta Medica Iranica
Volume:61 Issue: 7, Jul 2023

The coronavirus disease (COVID)-19 pandemic led to a new challenge in the field of effective treatment methods for this disease. Antiviral and immunomodulatory agents were suggested as potential therapeutic methods in this field. Since the most severe clinical symptoms associated with COVID-19 disease appear to be acute respiratory syndrome, azithromycin has been proposed as a potentially effective drug in this context. We have updated the evidence and selected all relevant items to understand the mechanism of role of azithromycin, clinical efficacy, and their side effects in coronavirus disease-19 treatment on July 20th and updated on March 20th, 2020. A literature search of electronic databases including the Web of Science, PubMed, and Google Scholar was conducted by searching keywords such as "Azithromycin", "COVID-19", and "Combination therapy". The ultimate goal of this review was identifying eligible studies about the pharmacological activities, safety, and effectiveness of azithromycin in treating COVID-19 patients. Immunomodulatory properties of azithromycin include the ability to reduce cytokine production, maintain epithelial cell integrity, or prevent lung fibrosis. The use of azithromycin in some studies was associated with a decrease in mortality and need for ventilation in patients. These properties can be useful during the period of COVID-19 infection, especially in patients with underlying diseases. However, the evidence for the use of azithromycin is still scarce and the quality of the studies is low. In some retrospective studies, azithromycin was mainly evaluated in combination with hydroxychloroquine, which showed no particular advantage. The results of this review showed that azithromycin has appropriate and well-known safety characteristics in the treatment of patients with COVID-19. However, the most appropriate dosage in different stages of the disease and the effect of its combination with other drugs are important questions that should be considered in future clinical trials.

Systemic arterial hypertension is a clinical condition of great risk in the development of cardiovascular diseases and it has a high impact on public health. The disease is influenced by modifiable and non-modifiable factors. In that context, Dermatoglyphics is a method of analysis of fingerprints as a mark of biological individuality and that can be related to health, sports, and the prognosis of diseases due to being able to point out the individual with the potential to develop certain diseases. This study aimed to investigate the characteristics of the fingerprints of women with systemic arterial hypertension by comparing them with a control group, which does not present the disease. Thus, we intend to find a dermatoglyphic pattern for Brazilian women with systemic arterial hypertension. The sample in the study consisted of 732 women, 366 with a positive clinical diagnosis for systemic arterial hypertension, and 366 individuals forming a control group, which did not present systemic arterial hypertension. All individuals in the sample are of equivalent age and the fingerprints were collected from all fingers. The method used to determine the profile of the individuals is the computerized dermatoglyphic. It was used, for the collection of fingerprints, of the Dermatoglyphic Reader®, which presents results of 400% more precision. There was a statistically significant difference between the groups, and when the Adjusted Residue Analysis was performed, the Ulnar Loop figure on fingers 4 and 5 of the left hand, and fingers 1 and 5 of the right hand, was predominant in the group of women with hypertension. These results demonstrate the existence of a dermatoglyphic mark, characteristic of patients with systemic arterial hypertension. Therefore, it can be concluded that the analysis of fingerprints of the hands by the Dermatoglyphic method can demonstrate the potential that women could have developing systemic arterial hypertension.

Upper airway management in morbid obese patients undergoing bariatric surgery is a major challenge during induction of anesthesia. Bed side Thyromental Height Test (TMHT) is an easy and valid predictor for prediction of difficult airway in non‑obese patients, but its precision in morbid obese patients haven’t been evaluated yet. The purpose of present study is to find the accuracy of TMHT for the prediction of difficult laryngoscopy in morbid obese patients undergoing bariatric surgery. The present prospective observational study was performed on 95 morbid obese patients at Sina hospital during 2020. Preoperative exams of patients include the assessment of Mallampati classification, thyromental height, thyromental, sternomental and interincisor distances. After induction of anesthesia, the laryngoscopy view was evaluated using the Cormack Lehane classification, and the relationship between these tests to prediction of difficult laryngoscopy view based on the Cormack Lehane degrees (grades 3,4) were evaluated. A total of 95 morbid obese patients with a mean BMI of 44.7±5.6 kg/m2.were included in the study. 67.3% of them were women. The incidence of difficult laryngoscopy (C & L III, IV) was 16.8%. TMHT less than 56.5 mm, with 98% positive predictive value and 93% accuracy was the best predictor of difficult intubation in these patients. The accuracy of thyromental, sternomental and interincisor distance, with cut off value less than 51.5 mm, 89.5 mm, 41.5 mm respectively was less than TMHT in prediction of difficult laryngoscopy in morbid obese patients. In morbid obese patients with a BMI greater than 40, thyromental height less than 56.5 mm with 98% positive predictive value and 93% accuracy is the best predictor for difficult laryngoscopy view.

The COVID-19 pandemic restrictions may have significant implications for patients with multiple sclerosis (MS). The objective of this study is to explore the impact of the pandemic on physical activity levels and health outcomes among MS patients, as well as to examine potential associations between these factors. In this cross-sectional study, 197 patients with confirmed MS diagnosis were included. Physical activity and health status were assessed using international physical activity questionnaire-long form (IPAQ-LF) and short form 36 health survey questionnaire (SF-36) during the period of restrictions. The relationship between clinical characteristics, physical activity levels and health status parameters were examined. A total of 45 participants (22.8%) scored low, 73 (37.1%) scored moderate, and 79 (49.1%) achieved a high level of physical activity during the COVID-19 pandemic. We observed no significant association between total physical activity and any domains of SF-36 health status, except for pain. However, correlations were found between IPAQ and SF-36 domains. Specifically, walking showed positive correlations with physical functioning, physical limitation, general health, and physical component summary score. Vigorous activity demonstrated a negative correlation with social functioning, while moderate activity displayed a positive correlation with energy levels. Despite the challenges of home isolation and quarantine, most of our participants managed to achieve a moderate to high level of physical activity, while their overall health status was found to be moderate. Additionally, significant correlations were identified between the domains of health status and different types of physical activity, particularly walking. Further studies are warranted to optimize the care and support provided to patients with MS.

Despite the improvement in COVID-19 therapeutic management the mortality of mechanically ventilated COVID-19 patients remains high. In this study, we determined the risk factors of death in these cases. This cross-sectional study evaluated clinical and paraclinical features of mechanically ventilated COVID-19 patients at the time of hospital admission until death or discharge from hospital between April and September in 2021 in three COVID-19 referral hospitals. The patients were divided into survivors and non-survivors and then the characteristics were compared. One hundred twenty-five patients (60% male, mean age 62±15.18, range 17 to 97 years old) were recruited to the study. 51(40%) survived and 74 (60%) didn’t survive. At the time of hospital admission, the vital signs were not significantly different between the survivors and non-survivors, although diarrhea was not reported in non-survivors, but reported in 9.5% of survivors (P=0.02). The mean age of non-survivors was higher (65.1±14.17 vs 56.9±15.41, P=0.003). The intubation time since the patients were admitted was not significantly different between the two groups (3.38±2.88 days vs 4.16±3.42 days, P=0.34). The mean of serum LDH and D-dimer at the time of ICU admission were significantly higher in the non-survivors (863±449 vs 613±326, P=0.01; 4081±3342 vs 542±634, P=0.009; respectively). However, the mean CRP was not significantly different between the two groups (76±66.4, 54±84.3; P=0.1). Mean APACHE-II score was higher in the non-survivors than the survivors (15 vs 13; P=0.01). Use of remdesivir, interferon beta-1a, and low dose corticosteroids were significantly higher in the survivors group (P=0.009, P=0.001, P=0.000). Success of weaning and ICU discharge among mechanically ventilated COVID-19 patients are probably higher in younger patients with lower D-dimmer and LDH that received remdesivir, interferon beta-1a and low dose corticosteroids, while the intubation time did not seem to play a role on patients' outcome.

To evaluate the prevalence of positive serum antinuclear antibody (ANA) in children with epilepsy using three major antiepileptic drugs (phenytoin, carbamazepine and ethosuximide), 60 children under 18 years with epilepsy who were referred to pediatric neurology clinic or had admitted to neurology ward in Children Hospital in Tehran, Iran, were entered our study. They had been treated with one of the three antiepileptic drugs (carbamazepin, phenytoin, ethosuximide) with suitable dose for at least one month. The patients were divided into two groups according to the classification of the International League Against Epilepsy (ILAE): drug-resistant and drug-responsive. We studied the epidemiological and clinical characteristics and also serum ANA of the patients in both groups. In this research, we studied ANA in 60 epileptic children. 30 patients were diagnosed with drug resistant epilepsy and the other 30 were drug responsive. None of them showed the clinical manifestations of lupus erythematosus. As a whole, 7 patients (11.7%) were ANA-positive, 6.7% of drug resistant and 16.7% of drug responsive group showed this finding. There was no relationship between drug resistancy and ANA according to statistical studies (P=0.21). Although in our study, epidemiological and clinical data of the patients was reported in two separate groups of resistant or responsive to antiepileptic drugs, and no meaningful statistical difference was found between these two groups. Overally in our study, the prevalence of positive ANA in patients receiving antiepileptic drugs was less in comparison with previous studies and was more common in males. Finally, we suggest a more comprehensive and extensive study with more cases and further follow-up period in order to find the cause of immunological reactions to antiepileptic drugs in children with epilepsy.

Cirrhotic patients have hyperdynamic circulation and at-rest tachycardia, and agents that activate the sympathetic pathway, such as physical practice and pharmacologic stimulations, compared with the normal population, cannot cause enough increase in heartbeat, a condition known as cirrhotic cardiomyopathy. Concerning the presentation of 5-HT2 & 5-HT3 receptors in rat hearts, we used Ketanserin as a 5-HT2 receptor inhibitor & Tropisetron as a 5-HT3 receptor inhibitor to evaluate chronic therapeutic effects of 5-HT2 & 5-HT3 antagonists on the cardiac chronotropic response of cirrhotic rats to adrenergics. Cirrhosis was induced by surgical ligation of the bile duct in Male Wistar rats, and another group remained sham. A week after bile duct ligation or sham surgery, the subjects were given an intraperitoneal injection of either saline or Tropisetron (2 mg/kg). In other BDL & Sharm groups, the subjects were given an intraperitoneal injection of either saline or Ketanserin (6 mg/kg) every other 3 days in the last 3 weeks. Four weeks after bile duct ligation or sham surgery, the atria were isolated and chronotropic responsiveness to Isoproterenol was assessed using a standard organ bath. Our data showed that chronic treatment with Tropisetron (5-HT3 antagonist) in cirrhotic rats could decrease the cardiac chronotropic response. Chronic treatment with Tropisetron can cause a significant decrease in cardiac chronotropic response to Isoproterenol in healthy and cirrhotic rats, even lower than that in cirrhotic rats (without any special treatment). Chronic treatment with Ketanserin cannot change their impaired chronotropic response to Isoproterenol.

Chordoma is a bone tumor that is resistant to radiotherapy, and few studies have been published on the concomitant use of radiotherapy in combination with hyperthermia in its treatment. We reported a chordoma patient treated with both radiotherapy and hyperthermia. The patient was a 74-year-old man with chordoma who underwent radiotherapy combined with hyperthermia due to his unwillingness to undergo surgery and responded very well clinically and imaging-wise without increasing in complications. Radiotherapy combined with hyperthermia improves the response to treatment (both clinically and in imaging) and does not increase the complications.

Vertebral body location of hemangioblastomas (HB) is extremely rare. The authors report a case of spinal mass involving lower thoracic region with cord compression, approved to be spinal HB. A 57-year-old man presented to our center with eight months history of progressive intractable back pain and paraparesis. Admission computed tomography and magnetic resonance imaging (MRI) of the thoracolumbar spine demonstrated a lytic and expansile spinal mass with pedicle expansion and vivid contrast enhancement involving T11 and T12 vertebral bodies on the right side. He was a known case of von Hippel-Lindau (VHL) and he had history of 4th ventricular asymptomatic hemangioblastoma near Obex, multiple pancreatic cystic adenomas, multiple liver cysts, and right non-chromaffin adrenal mass. The patient underwent a T11-T12 partial transpedicular corpectomy with T5 to L3 posterior spinal fixation to bridge the invaded segment. The pathological and immunohistochemical findings were consistent with vertebral HB. Spinal HB although extremely rare, may be managed with subtotal tumor resection and fixation of normal adjacent vertebrae by cemented screws.

Choriocarcinoma usually occurs in the uterine body. Non-gestational choriocarcinoma is an extremely rare malignant tumor with a poor prognosis and is difficult to distinguish from gestational choriocarcinoma. In this case report, we describe a case of pure non-gestational choriocarcinoma. A 35-year-old woman was referred to our academic hospital with a pathology report of non-gestational choriocarcinoma of right ovarian cystectomy. Since the diagnosis did not coordinate with the patient's symptoms, PCR amplifying, and genomic DNA were performed. Finally, the diagnosis of pure non-gestational choriocarcinoma was confirmed. In follow-up, lung and brain metastasis was determined. Brain radiotherapy and BEP regimen chemotherapy were prescribed. However, the response was not appropriate, so she is currently undergoing palliative chemotherapy. Stage IV primary pure ovarian choriocarcinoma is a very aggressive tumor. Regardless of the nature of the tumor, the response to the treatment may not be good. Indeed the treatment of each case should be individualized.