Caspian Journal of Internal Medicine
Volume:16 Issue: 2, Spring 2025

COVID-19 could exacerbate the symptoms of autoimmune diseases such as multiple sclerosis (MS). Literature shows an increase in the incidence of relapse in patients with MS after COVID-19. We designed this systematic review and meta-analysis to estimate the pooled incidence of MS-relapse after COVID-19.

We performed a systematic search in PubMed, Scopus, EMBASE, Web of Science, and Google scholar. Gray literature including references of the references and conference abstracts were also searched to find relevant articles. We extracted data regarding the total number of participants, the name of the first author, publication year, country of origin, mean age, mean disease duration, mean Expanded Disability Status Scale (EDSS), and the number of patients with relapse after COVID.

A literature search revealed 5160 articles, after deleting duplicates, 2270 remained. After careful evaluation of the full texts, twelve studies were included for meta-analysis. Totally, 1595 patients with MS who had a history of COVID-19 were evaluated. Most studies were done in Iran. The mean age of included patients ranged between 35 and 49 years, and mean durations of the disease were between 7and 15.4 years. The incidence of relapse ranged between 2% and 20% in included studies. The pooled incidence of relapse after COVID-19 was 7% (95%CI:5-10%) (I2=64%, p<0.001).

The results of this systematic review and meta-analysis show that the pooled incidence of MS-related relapse after COVID-19 is 7%.

One of the deadliest diseases in the world, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of the ongoing global pandemic known as COVID-19. COVID-19 symptoms range from undetectable to deadly, hyper-inflammatory response and the overproduction of pro-inflammatory cytokines or hypercytokinemia are key factors in the pathophysiology of severe COVID-19. However, no specific and effective treatment was available, anti-inflammatory drugs have been vastly used for treating patients. The goal of this narrative literature review (2020–2022) was to elucidate the connection between anti-inflammatory medications and COVID-19 outcomes, such as safety and survival rate. Overall, these studies are consistent in presenting that anti-inflammatory drug can be advised to target the host immune response in patients and have been beneficial in reducing the mortality rate. This is revealed in current recommendations from prominent global public health authorities, which support anti-inflammatory drug use for a decrease of cytokine storm during COVID-19.

Uterine cancer ranks among the leading causes of mortality in women, particularly prevalent in countries with low to moderate income levels. Present treatment and healthcare success rates are assessed by the survival rate index. This study aimed to determine the uterine cancer survival rate in Asia.

Five international databases were analyzed to perform this systematic review: Medline/PubMed, ProQuest, Scopus, Web of Knowledge, and Google Scholar, until the end of August 2021. The Newcastle-Ottawa quality assessment form was utilized in the evaluation of quality for cohort studies. “I2 statistic and Cochran test were used to check the analysis process and assess the heterogeneity among the studies. Also, the study year was used as the basis for a meta-regression analysis.

The study covered 75 papers in total. The survival rates of uterine cancer after one, three, five, and seven years are 76.68% (95% CI, 66.76–78.61), 63.56% (95% CI, 58.60–68.37), 59.04% (95% CI, 55.62–62.43), and 57.86% (95% CI, 51.16–64.42) according to the random model. Furthermore, according to the outcomes of the meta-regression, there was no correlation found between the study year and the survival rate.

Compared to European and American countries, Asian countries have a poorer uterine cancer survival rate, which makes it crucial to improve the survival rate of patients through ensuring early diagnosis of the disease in its early stages and providing new diagnostic methods, modified surgical techniques, and targeted therapies.

Biofilms are organized communities of microorganisms encased in a self-produced matrix that adheres to surfaces and can have both beneficial and detrimental effects in various environments. These biofilms have been linked to severe infections in humans. We investigated the association between antibiotic resistance and biofilm formation in methicillin-resistant Staphylococcus epidermidis (MRSE) isolates.

A comprehensive search was conducted through data medical data bases using a combination of mesh terms. The data were analyzed using STATA meta-analysis software, and a random effects model was employed to determine the pooled prevalence with a 95% confidence interval (CI).

Our findings revealed that the prevalence of MRSA was 61.75% (95% CI: 35.6-99.1). The cumulative rate of biofilm formation in MRSE strains was reported to be 83.4% (95% CI: 47.8-99.4). Among the biofilm-related genes, the SdrG gene exhibited the highest frequency (98%), followed by the atlG gene with a frequency of 84%.

Out of the seven, three documented a positive association. Given the propensity of MRSE strains to form biofilms, it is crucial to implement preventive measures against infections caused by these strains.

Patients with moderate to severe chronic heart failure (CHF) are at high risk for cardiac mortality. Cardiac resynchronization therapy with defibrillators (CRT-D) as a potentially beneficial option can improve the clinical outcomes of such patients.

We conducted a single-arm clinical trial in which 48 patients with moderate to severe CHF were investigated regarding the beneficial outcome of CRT-D insertion. All participants were evaluated regarding different functional and echocardiographic factors including New York Heart Association (NYHA) functional class (FC), left ventricular ejection fraction (LVEF), mitral regurgitation (MR) as well as left ventricular end-systolic (LVESD) and end-diastolic (LVEDD) before and one month after the procedure. Furthermore, we investigated the influence of different variables including age, gender, and comorbidities on the aforementioned clinical and echocardiographic factors.

Of the 48 CHF patients included in our study, 24 (50%) were males and 24 (50%) were females. The mean ± standard deviation (range) of the participants’ age was 55.6±6.5 (40-69) years. CRT-D insertion significantly improved all functional and echocardiographic factors in CHF patients. The participants had a mean±standard deviation (range) LVEF of 22.1±5.8% (10-30%) before CRT-D insertion. A follow-up echocardiography performed one month after the implantation of CRT-D demonstrated a significant increase in LVEF to 27.1±5.5% (15-38%) (p<0.001). Additionally, echocardiography conducted one month after CRT-D insertion showed a reduction of LVESD from 6.8±0.5 cm (5.8-7.4 cm) to 6.2±0.5 cm (5.3-7.3 cm) (p<0.001).

There is prominent evidence for CRT-D insertion in reducing symptoms of heart failure as well as improving different echocardiography variables in patients with moderate to severe CHF.

Opportunistic infections such as mucormycosis, are spread in COVID-19 patients due to the use of corticosteroids therapy. This study aimed to determine the prevalence of mucormycosis in patients infected with the delta strain of the COVID-19 virus and evaluated some effective factors in the prevalence and patient prognosis.

This study was performed on 44 COVID patients with co-infection to mucormycosis who were admitted to Shahid Beheshti Hospital, Kashan in 2022. The COVID diagnosis was based on clinical signs and a positive PCR test, the diagnosis of mucormycosis was based on a positive laboratory report of fungi culture medium. The patient outcomes were recorded and CALL scoring system was used to determine the severity of the disease. The results were analyzed by descriptive statistics using SPSS 16 software.

Of 44 COVID patients infected with mucormycosis, 26 (59.1%) had diabetes. All 44 patients had a history of taking steroids with an average daily dose of 48.77±65.15 mg. Twenty-six (59.1%) patients were admitted to the ICU, 18 (40.9%) required intubation. Sixteen (36.4%) patients died. A significant decries observed in lymphopenia after treatment of patients (p<0.0001). CALL scores using showed that 33 (75%) patients had severe risk factors.

Uncontrolled diabetes and hypertension are the two most common risk factors of mucormycosis in COVID patients. High use of glucocorticoid drugs and immune suppression are predisposing causes for opportunistic organisms.
Accurate laboratory diagnosis of mucormycosis plays an important role in treatment of patients and in controlling the disease.

Regular physical activity promotes health that can affect liver health, particularly modulating liver enzymes. The objective of this study was to assess the association between physical activities and elevated liver enzyme levels in the population of the Prospective Epidemiological Research Studies of the Iranian Adults (PERSIAN) Guilan cohort study (PGCS).

This cross-sectional study was conducted on 10,519 individuals from the PGCS population. The demographical and clinical data of participants were collected. The study involved measuring the levels of physical activity and liver enzymes, including alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and γ-glutamyl transferase (GGT). The study assessed physical activity intensity using standardized classification based on the energy costs of different activities, which was calculated through questionnaires administered in three tertiles. The relationship between physical activity and elevated liver enzymes was examined using the Cochran–Armitage test for trend and logistic regression.

The average age of individuals was 51.52±8.90 years, and 53.6% were women. The prevalence of elevated ALT, AST, and GGT decreased with increasing physical activity (p<0.001, 0.010, and <0.001, respectively). According to fully adjusted model, participants with low physical activity levels had higher odds for elevated ALT and GGT compared to the participants with high physical activity levels (OR=1.15, 95% CI: 1.04–1.31 and OR=1.37, 95% CI: 1.16–1.61, respectively) (p<0.05).

Higher physical activity levels were associated with a lower prevalence of elevated liver enzymes, suggesting that regular physical activity may positively affect liver health.

Oxidative stress has been well established to participate in the pathology of coronary artery disease (CAD). Sestrin family of proteins have recently emerged as important suppressors of oxidative stress. However, only few studies have reported the levels of sestrins and their clinical significance in CAD patients.

Participants were ninety patients referred to the cardiac angiography unit for cardiac angiography. Thirty-two subjects were diagnosed as having stable CAD, twenty patients had unstable CAD and thirty-eight subjects had no CAD. All patients underwent angiography and the severity of coronary stenosis was calculated by modified Gensini score. The levels of glucose, triglyceride, total cholesterol, HDL, LDL, hs-CRP and hematological parameters were determined in the fasting blood samples by routine methods. Plasma levels of sestrin-1 and sestrin-2 were measured by ELISA.

Although the plasma levels of sestrin-1 were significantly lower in both case groups compared with the control group, there were no significant differences in sestrin-1 levels between the two patient groups. The levels of sestrin-2 were also significantly lower in both CAD groups than in controls, but no significant difference was found between stable and unstable patients. In the whole study subjects, plasma sestrin-1 and sestrin-2 showed negative correlation with the coronary artery score. By multivariate analysis only sestrin-2 levels were significantly related to CAD severity.

Our findings showed a negative association of sestrin levels and the coronary stenosis severity.

Gestational diabetes is defined as glucose intolerance with variable severity which starts or is first diagnosed during pregnancy. Globally on the rise, this health condition is one of the most common complications of pregnancy. Pregnant women with diabetes are at high risk of infection because high blood sugar levels provide food for many infections, including yeast, making it easier for the yeast to grow. This study aimed to examine the relationship between vaginal infections and gestational diabetes.

This study enrolled 300 pregnant women with gestational diabetes as the patient group and 300 pregnant women without gestational diabetes as the control group. The research tool in this study was a questionnaire and performing a warm and wet slide staining test on the vaginal swab sample.

The mean age was 31.97±6.02 in the women with gestational diabetes and 30.98± 6.80 in the women without gestational diabetes. Smoking was zero in both groups. The frequency of vaginal infection was 34 (11.3%) in the patient group and 26(8.7%) in the control group. vaginal infections showed no significant association with gestational diabetes.

Despite its high prevalence, vaginal infections showed no significant association with gestational diabetes. Still, the high prevalence of infection in the two groups demands more attention from the healthcare system and obstetrician-gynecologists to check the infection before and after pregnancy.

Thyroid nodule (TN) is defined as the abnormal growth of thyroid cells, with an increasing trend worldwide. In this case-control study, we intended to evaluate demographic and environmental factors involved in TNs to determine the values predicting the risk of TN incidence.

103 patients with confirmed TN through ultrasound imaging were assigned to the nodular group, and 101 patients with negative results of TN were considered control counterparts. Data collection was performed using a checklist from February 2021 to August 2022. Uni- and multivariable logistic analyses were applied to ascertain prognostic risk factors.

The results showed that the prevalence of TNs was significantly higher in females (90.3%, p<0.001). We also found that a history of exposure to ionizing radiation with a diagnostic dose (83.5%, p<0.001), hypothyroidism (37.9%, P=0.005), hyperthyroidism (7.8%, P= 0.005), family history of thyroid disease (58.3%, p<0.001), unusual stress (68.9 %, p<0.001), and taking medications inferring thyroid function (10.7%, P=0.01) in the nodular group, which were consistent with the results of logistic regression analysis can be considered the potential prognostic values to predict the risk of incident TN.

The role of unusual stress on TN development is highlighted in this study. diagnosis and proper management of determinants such as unusual stress involved Early in TN pathogenesis through lifestyle modification, community awareness, and screening of the family with TN history would be more appreciable in order to decline TN incidence and prevalence, particularly in the predisposed population.

The aim of this study was to evaluate the diagnostic accuracy of various non-invasive methods for Non-alcoholic fatty liver disease (NAFLD) diagnosis in an Iranian population. The methods studied included aspartate aminotransferase to platelet ratio index (APRI), fibrosis-4 (FIB-4) index, aspartate aminotransferase to alanine aminotransferase ratio (AAR), aspartate aminotransferase to platelet count index (AP index), fibrosis index (FI), NAFLD fibrosis score (NFS), Forns index, BARD score, BAAT score and PLALA score. The aim of the current study was to correlate these methods with liver stiffness measurement (LSM) and serum fibrosis markers, using FibroScan as the gold standard.

In a cross-sectional study of 504 patients with NAFLD or non-alcoholic steatohepatitis (NASH), FibroScan examinations were performed and demographic, clinical and biochemical data were collected. Statistical analyses evaluated the performance of each diagnostic panel, calculating sensitivity, specificity, positive predictive value, negative predictive value and accuracy.

The APRI had high specificity (97.27%) but low sensitivity (4.12%) and limited discriminatory power AUC: 0.50) in the fibrosis panel. In contrast, Forns index and NFS had better AUC values (0.64 and 0.63, respectively), with the NFS having a sensitivity of 80%, indicating potential for broad-based screening. In the cirrhosis panel, the APRI was characterized by high specificity (98.21%) but had low sensitivity (4%) and limited discriminatory power (AUC: 0.51), while the FIB-4 had the highest AUC (0.67) and a sensitivity of 60%, suggesting its efficacy as a screening tool.

NFS and FIB-4 showed promising performance among the evaluated panels for population screening.

Multiple sclerosis (MS) is an autoimmune disorder of the central nervous system (CNS). Prognostic markers are essential for predicting disease progression and managing its impact. Oligoclonal bands (OCBs) are significant laboratory findings in MS, yet their prognostic role remains uncertain. This study aimed to evaluate the role of OCBs in the short-term progression of MS.

We enrolled patients diagnosed with Relapsing-Remitting MS and conducted a follow-up for five years, during which we monitored their Expanded Disability Status Scale (EDSS) scores. Clinical manifestations were compared between patients with positive and negative OCBs. Statistical analysis was performed using SPSS 26.

Among the 140 participants, 41 (29%) were OCB-negative and 99 (71%) were OCB-positive. No significant differences were found regarding sex, age, family history, associated disease, and EDSS scores between the two groups at the beginning of the study. Throughout the five-year duration of the study, there was no disparity in the EDSS scores of patients belonging to the two groups. Notably, the mean number of relapses was 1.37 in OCB-negatives compared to 1 in OCB-positives, which was statistically significant (P=0.03). In other words, after 5 years, despite the high rate of recurrence in patients with negative OCB compared to patients with positive OCB, there was no difference in terms of prognosis (EDSS progress) between the two groups.

While the presence of OCBs in patients with MS does not demonstrate a significant prognostic impact over a five-year follow-up period, it could potentially influence the rate of recurrence.

Olfactory changes connection to deteriorated quality of life in chronic kidney disease cases (CKD) and diabetes mellitus (DM). The nutritional status is altered in CKD and DM and it closely interconnected with olfactory function. We aimed to study the olfactory dysfunction in these populations.

We conducted a cross-sectional research on CKD and DM cases aged 20-50 (27 healthy controls, 77 CKD patients, and 36 DM patients). We used the Iran Smell Identification Test (Iran-SIT) version of the University of Pennsylvania Smell Identification Test (UPSIT) to evaluate the olfactory function. The significant level was set as <0.05.

Our 140 cases included 51.4% of men (mean age of 46.7±10.6 years). The total score of the Iran-SIT test indicated that olfactory impairment in the CKD was higher (16.2±4.2) than in the DM (18.8±2.1) and control groups (20.4±1.2) (P=0.001). It was determined that 54.5% of CKD patients and 38.9% of the DM group had olfactory dysfunction compared to 7.4% of the controls (P=0.001). Multiple regression analysis indicated that being men and low-density lipoprotein cholesterol (LDL-C) were related to olfactory dysfunction in the total population (OR: 4.55, P=0.037, and OR: 0.94, P=0.037). Still, it was only associated with LDL-C in the CKD group (OR: 0.93, P=0.013).

Based on the findings of this study, CKD and DM patients had a higher prevalence of olfactory dysfunction than the controls, which could be associated with some preventive nutritional factors. This information may help perform a screening program and early intervention on olfactory dysfunction in these systematic diseases.

Patient management and necessary supportive treatments, an accurate prognosis of the illness is essential for patients with acute pancreatitis. Thus far, no diagnostic technique has demonstrated superiority over the other in terms of clinical judgment. The aim of this study was to examine the predictive accuracy of the Bedside Index for Severity in Acute Pancreatitis (BISAP) score in contrast to Ranson's criteria.

Our research is a retrospective cross-sectional analysis. Inclusion criteria encompassed patients admitted to the emergency department with acute pancreatitis. Exclusion criteria comprised individuals with liver, heart, or renal failure upon admission or during hospitalization. Each patient's demographic data, including age, gender, education level, and consciousness level, were considered. Statistical analysis was conducted using SPSS 16 software with a significance level set at p <0.05.

Out of 286 patients, 221 were diagnosed with moderate acute pancreatitis, while 65 were diagnosed with severe acute pancreatitis. Among these patients, 5 (7.1%) succumbed to complications related to pancreatitis, including 3 males and 2 females. Both the BISAP and Ranson criteria demonstrated significant capability in assessing the severity of both moderate and severe acute pancreatitis with a 95% confidence level. The analysis revealed a statistically significant area under the curve for both criteria (P= 0.002).

Although BISAP and Ranson have both good accuracy and efficacy to determine the severity of pancreatitis, BISAP scoring criteria have higher prognostic accuracy.

This study aimed to explore the patients' reactions when HAM/TSP was diagnosed. This qualitative content analysis study was conducted on HAM/TSP patients referred to an HTLV-1 clinic in Mashhad, Iran.

We selected a purposive sample of 16 HAM/TSP patients meeting the inclusion criteria to participate in semi-structured interviews to explore their reactions and emotions when they first learned about their diagnosis. A qualitative content analysis was utilized with MAXQDA 2020 software.

Four categories and 14 subcategories were extracted, summarized in the main concept "Astonish yourself while worrying about another." The categories included threatened mental health, fear of falling into the path of ambiguity and darkness, fears and conflicts of deciding to expose the disease, and the double stress of threatening the health of others."

HAM/TSP is an incurable and progressive disease with several physical complications. Its first diagnosis can also cause severe psychological damage to patients and profoundly affect the patient's social and family relationships. Therefore, it seems that education and health policies should integrate multidisciplinary teams to minimize the effects of HAM/TSP on the patients' quality of life.

The cost of anticancer drugs and their wastage has become a major concern for patients and health policy makers in developing countries. To date, no figures have been reported on the rate of loss of anticancer drugs in Iran. Therefore, we aimed to conduct a real-world analysis on the anticancer drug wastage in a public hospital.

During a 3-month time span, we observationally collected drug information of all patients admitted for receiving anticancer drugs in the inpatient or outpatient unit of chemotherapy center by two oncology nurses. The amount of drug wastage and its financial cost were calculated based on the price approved by the Food and Drug Administration (FDA) of Islamic Republic of Iran (IRI) during the survey period.

A total of 626 patients were admitted for receiving twenty-four injectable anticancer drugs in 2023 infusions. The percentage of total drug wastage was 9.31% (95% CI, 5.90 –12.71%). Overall, these results indicated that the cost of drug wastage in this 3-month period was roughly 31,473 US dollars (USD) and estimated annual cost of wastage was nearly 125,894 USD (5,287,553,080 Iranian Rial).

This is the first report of investigating anticancer drug wastage in Iran. According to this real-world survey, it was shown that the amount of drug wastage in this center is substantial and imposes a heavy financial burden on patients and the health system that need to be taken into account by policy makers.

Multiple myeloma (MM) is characterized by reduced circulating adiponectin levels, a condition associated with various diseases such as diabetes mellitus, obesity, cardiovascular diseases, cancer, and plasma dyscrasias. Curcumin has been shown to inhibit adipogenesis and elevate serum adiponectin levels. Notably, limited studies investigating the relationship between adiponectin levels and curcumin supplementation in myeloma patients. This study is to evaluate the efficacy curcumin supplements on increasing the levels of adiponectin in myeloma patients

Patients with myeloma were randomly to melphalan, prednisone, curcumin (MPC) (n=17) and melphalan with prednisone (MP) (n=16) groups. The MPC group was treated by melphalan 4 mg/m2 and prednisone 40 mg/m2 for 7 days (MP), and curcumin 8 grams daily for 28 days. The MP group received MP and placebo. Subjects were followed-up every 28 days and a total of four treatment cycles. Hemoglobin, albumin, white blood cell (WBC), platelets, urea, creatinine, calcium, protein M, and adiponectin evaluated before and after treatment. Mann Whitney test or the Independent T-test were used to analysis

Total subject (24 subjects) completed the treatment. Serum adiponectin levels after four treatment cycles in the MPC group were higher than in the MP group [(mean, 12227.1±5748.3) vs (11365.4±9175.5), P = 0.78]

Supplementing MP regimen with 8000 mg curcumin daily for 28 days increases the serum adiponectin level after four treatment cycles in myeloma patients. This research found that myeloma patients may benefit by taking curcumin supplementation.

There is no evidence regarding the crucial topic of possible correlation between duodenal ulcer disease and mitral valve prolapse syndrome. We herein investigated the potential relationship between these two disorders.

Eighty-three hospitalized patients with active duodenal ulcer disease were compared with 31 healthy controls for the presence of mitral valve prolapse syndrome. All participants underwent cardiac examination and echocardiography. Heart rate, systolic and diastolic pressures were estimated in supine baseline and standing positions.

Echocardiographic mitral valve prolapse was present in 36 (43.37%) of the patients and only in 1 (3%) of controls (P=0.001). Auscultatory findings of systolic murmurs (50% vs. 4%, respectively; P=0.001) and symptoms related to the cardiovascular system (i.e., chest pain: 75% vs. 30%, respectively; P=0.001) were more common in patients with mitral valve prolapse than those without it. Heart rate was lesser in patients with mitral valve prolapse in supine location (71.00±1.73 vs. 76.10±1.66, respectively; P=0.04), and was higher in the upright location in patients than those without mitral valve prolapse (91.54±2.73 vs. 83.42±2.71, respectively; P=0.04) and in normal controls (91.54±2.73 vs. 84.06±2.02, respectively; P=0.03). Moreover, blood group O and male gender were more common among the patients with mitral valve prolapse, compared to normal controls (67% vs. 39%, respectively; P=0.03, and 61% vs. 35%; P=0.05, respectively).

Our findings suggest a clinical and genetic relationship between active duodenal ulcer and mitral valve prolapse syndrome connected with autonomic dysfunction. Further studies are warranted to confirm this crucial topic.

Hyperglycemia caused by diabetes is closely related to long-term damage in organ functional disorders. The objective of the study was to determine the prevalence of uncontrolled glycemia and its associated factors in Iranian diabetic patients.

This cross-sectional study was conducted on 496 types 2 diabetic patients in the outpatient clinic of a referral hospital center affiliated with Babol University of Medical Sciences, North of Iran. The data of fasting blood sugar (FBS) and hemoglobin A1C were extracted from recent laboratory tests. The demographic, clinical data, and comorbidity were collected. The reliable and valid scales of self-care and self-efficacy were used to collect data through face-to-face interviews with patients.

About half of the participants, 241(48.6%) patients had poor glycemic control (FBS≥152 mg/dl) and a higher proportion, 382 (79.6%) patients were found based on the criterion of HbA1C≥7%. There was no significant difference in poor glycemic control between genders. The adjusted OR for risk of poor glycemic control (FBS>152mg/dl) after controlling potential confounders was 2.37 (95%CI: 1.34, 4.12) for the duration of diabetes >15 years compared to 5 years or less. The higher level of self-efficacy prevented poor glycemic control (adjusted OR=0.50, 95%CI: 0.29, 0.87). While the high level of self-care tended to protect against poor glycemic control non-significantly (adjusted OR=0.65, 95%CI: 0.41, 1.11). 

Our findings show that majority of diabetic patients have poor glycemic control. The high level of self-care and self-efficacy substantially reduced the risk of poor glycemic control.

Chemotherapy regimens with anthracyclines, widely used in treating breast cancer and lymphoma, are associated with significant cardiac toxicity. While previous studies have primarily focused on left ventricular (LV) function, limited research exists on right ventricular (RV) function. This study aimed to evaluate RV echocardiographic function in breast cancer patients undergoing anthracycline-based chemotherapy.

A cohort of 72 breast cancer patients receiving anthracycline treatment at Ghazi Tabatabai and Madani Hospitals from April to March 2022 participated in this study. Echocardiography was performed before treatment initiation, 15 days after the second chemotherapy session, and 15 days after the final session. Cardiotoxicity levels were calculated using SPSS V22 software with inferential statistical methods, including repeated measures analysis and the Friedman test.

RV-free wall strain remained stable 15 days after the second treatment session compared to baseline but showed a statistically significant decrease 15 days after the final session (P = 0.044). The prevalence of abnormal RV-free wall strain increased significantly during the final assessment (P = 0.037). Tumor regression grade (TRG) also demonstrated significant changes over time (P = 0.003). Right ventricular systolic pressure (RVSP) increased significantly throughout the study (P = 0.035), while no significant changes were observed in other parameters such as LVEF, E/E', LAVI, or TAPSE.

Anthracycline-based chemotherapy leads to a decline in RV-free wall strain over time, highlighting the importance of monitoring RV function alongside LV function during treatment. Advanced echocardiographic techniques, including strain imaging, may help detect subclinical RV dysfunction earlier.

Medication errors are a significant cause of adverse events in cancer patients. The study aimed to investigate unintentional medication errors during chemotherapy regimen prescription.

During the six months’ follow-ups, 201 adult patients admitted to outpatients’ chemotherapy ward of Omid Hospital, Isfahan, Iran were examined. An information checklist by the aim of data gathering including patients' demographic information, laboratory data, medications history, chemotherapy drug doses and protocol of administration, pre-medications drugs, and supportive treatment was prepared. The data was compared by standard guidelines and data were presented in percent and frequency.

Among the enrolled patients, 327 errors were identified. Sixty-five percent of patients were females and the mean age of patients was 49.2±2.8 years old. Gastrointestinal and breast cancers were among the most frequently reported cancers. The highest frequency of errors (67.27%) was attributed to the prescription of pre-medication drug administration primarily in the management of chemotherapy-induced nausea and vomiting. Medication errors in selection and volume of infused serums (20.18%) and in adjusting the dosage of chemotherapy regimens (10.39%) were the most observed errors. 

This study highlighted the important areas to improve cancer management at the medical center. By addressing these challenges and implementing necessary changes, the center can enhance the quality of care provided to cancer patients, ensure adherence to international standards, and improve patient outcomes.

Pulmonary alveolar proteinosis (PAP) is a rare disease caused by the accumulation of surfactant in the lung's alveoli, as a result of malfunction in the cleaning function of alveolar macrophages. The major symptoms include cough and dyspnea. Computed tomography scan usually reveals crazy-paving pattern. Lung biopsy confirms the diagnosis by showing accumulations of periodic acid-schiff-positive lipoproteinaceous materials.

In this report, we present a middle-age man with progressive dyspnea on exertion, and frequent cough with no noteworthy medical history. The results of initial examinations and laboratory tests were non-diagnostic, so imaging studies were requested for the patient. After imaging and suspecting PAP as a differential diagnosis due to results of high resolution computed tomography, a transbronchial biopsy was performed to confirm the diagnosis. Then, according to the histopathology reports, the diagnosis of PAP was made. During the biopsy procedure, the patient developed pneumothorax, and accurate treatment approaches were considered for this complication.

In patients with chronic progressive dyspnea and cough, appropriate and timely imaging and other paraclinic investigations must be considered by the physicians.

Leptomeningeal carcinomatosis involves the diffuse infiltration of neoplastic cells in the central nervous system, affecting 5-8% of leukemia, breast, and lung cancer cases. Gastric cancer instances are rare, mostly in poorly differentiated adenocarcinomas. We report the first Peruvian case, featuring gastric adenocarcinoma.

A 51-year-old woman presented with severe headache, vomiting, dizziness, blurred vision, tinnitus, bradyphrenia, reduced verbal fluency, sixth cranial nerve paresis, and non-reactive anisocoric pupils. Pleocytosis was found, with positive cytology for metastatic adenocarcinoma in cerebrospinal fluid, and a solid gastric mass defined as poorly differentiated adenocarcinoma. Due to her condition, the patient did not receive oncological management, evolving unfavorably and passing away twenty days later.

Leptomeningeal carcinomatosis should be considered in patients with advanced cancer and meningeal symptoms. It is more predominant in women, with an average age of 53.84 years. Clinical presentation of leptomeningeal carcinomatosis varies, and diagnosis involves neuroimaging and cerebrospinal fluid cytology. Prognosis is unfavorable, often leading to fatality. Treatment protocols lack standardization, and personalized approaches, including targeted and systemic therapies, are explored for improved outcomes. The exceptional aspect of our case lies in the unique diagnosis of an abdominal tumor following the manifestation of neurological symptoms.

It is important to suspect this condition among the causes of meningitis, especially in the presence of an underlying malignancy.

Congenital anomalies can pose challenges during electrophysiology (EP) procedures in patients with tachyarrhythmias, making diagnosis and management of these cases quite difficult. An interrupted inferior vena cava, an uncommon congenital defect, is especially rare without associated congenital heart disease. In this setting, catheter ablation from femoral vein access becomes more challenging.

A 23-year-old male with no cardiovascular risk factors or prior cardiovascular disease presented with atrioventricular reentrant tachycardia that converted to sinus rhythm after adenosine administration. The patient was scheduled for an electrophysiology study with catheter ablation if indicated. During the procedure, catheter advancement into the right atrium was unsuccessful, raising suspicion of an interrupted inferior vena cava (IVC). Radiofrequency ablation was subsequently performed successfully via the subclavian vein approach. Post-procedural computed tomography (CT) imaging confirmed interruption of the IVC.

Accessing via the subclavian vein can facilitate catheter ablation when an interrupted inferior vena cava is present.

The use of morphine should be carefully considered and administered under the supervision of medical professionals due to the risks associated with opioids, including respiratory depression and the potential for addiction or dependency. Additionally, it could be potentially harmful in late stages of severe COVID-19, especially in the presence of septic shock. Close monitoring and dosage adjustments are necessary to ensure patient safety and optimal pain management.