Iranian Journal of Medical Sciences最新文献

Fibrous dysplasia is a slow-progressing benign condition characterized by abnormal bone formation that leads to some skeletal disorders. Although some of the fibrous dysplasia have unusual clinical and radiographic features that can lead to a challenging diagnosis, most lesions reveal an expansile bone defect due to cortex thinning. This report presented a case of monostotic fibrous dysplasia of a 43-year-old woman with involvement of the right maxillary jaw and sinuses, which indicated unusual histopathological features. The patient was referred to the Department of Oral and Maxillofacial Surgery of Tehran University of Medical Sciences (Tehran, Iran) in 2022. Radiological and histological findings were discussed. The unusual histomorphic pattern of the lesion caused uncertainty and resulted in a missed definitive diagnosis in the primary biopsy. It was highlighted that awareness of rare histologic variants in fibro-osseous lesions especially fibrous dysplasia was required to improve diagnostic confidence.

Background: The relationship between diastolic function parameters and the severity of coronary artery disease (CAD) is controversial. This study aimed to determine the relationship between left ventricular diastolic function and the severity of CAD.

Methods: This cross-sectional study included 63 patients with Ischemic heart disease (IHD) or those suspected of having IHD, who underwent angiography. The study was conducted in Shafa Hospital, Kerman, Iran, from 2021 to 2022. Two-dimensional (2D) strain echocardiography was used to assess left ventricular (LV) function parameters, followed by coronary angiography. Based on the severity of the disease, patients with significant CAD were placed in the case group, and patients with insignificant CAD were placed in the control group. The correlation between the CAD severity and the severity of LV diastolic dysfunction was computed. Descriptive tests, independent t tests, and Spearman correlation coefficients were used. P<0.05 was considered statistically significant.

Results: The results indicated that there was no correlation between E/e' (P=0.103), left atrial volume index (LAVI) (P=0.168), tricuspid regurgitation velocity (TRV) (P=0.217), myocardial performance index (MPI) (P=0.106), E wave deceleration time (dt) (P=0.644), and late diastolic strain rate (P=0.502) with CAD severity based on SYNTAX score. However, there was a correlation between left atrial (LA) strain (P=0.017), global longitudinal strain (GLS) (P<0.001), early diastolic strain rate (P<0.001), and systolic strain rate (P=0.047) with SYNTAX score. Besides, there was a correlation between LA strain (P=0.017), GLS (P<0.001), early diastolic strain rate (P<0.001), and late diastolic strain rate (P=0.035) with numbers of epicardial coronary arteries with significant lesions.

Conclusion: In contrast with 2D strain echocardiography, this study showed that conventional echocardiography parameters had no significant relationship with CAD severity. GLS had the strongest correlation with CAD severity, and diastolic strain rates had a weaker correlation with CAD severity.

Background: Labial adhesion (LA) is a total or partial labial fusion mostly seen in pre-pubertal children and is rare in premenopausal and postmenopausal periods. This review aimed to evaluate risk factors for labial fusion and the recurrence rate following surgical intervention in postmenopausal women.

Methods: According to PRISMA guidelines, international databases including Embase, World Cat, Web of Science, Scopus, Dimension, Open Grey, Cochrane, Google Scholar, and also PubMed gateway for PMC and MEDLINE were searched. The included studies were in English and published from 1985 until December 2023 with the keywords including vulvar diseases, agglutination, menopause, postmenopause, and recurrence. All studies that evaluated the clinical course and recurrence of LAs following surgical treatment in postmenopausal women were included. The inclusion criteria were the risk factors of LA recurrence rate, and the exclusion criteria were studies with missing required data, letters to editors, and conference studies.

Results: Thirty-four case reports were enrolled. In total, 54 patients were evaluated. The most common risk factors for LA included hypoestrogenism, virginity, sexual inactivity, cervical cancer, hysterectomy, urinary tract infections, and lichen sclerosis. Only one study reported a recurrence of labial fusion following surgical intervention in a one-year follow-up.

Conclusion: The most common risk factors for LA were hypoestrogenism, virginity, sexual inactivity, cervical cancer, hysterectomy, urinary tract infections, and lichen sclerosis. The low recurrence rate following surgical release of labial fusion has made it an effective and safe method in postmenopausal women with negligible medium-term recurrence rates.

Background: Suicide is a serious global public health issue. It is the fourth-leading cause of death among young people between the ages of 15 and 29. Therefore, the present study was conducted to determine the important risk factors associated with violent and non-violent methods of committing suicide.

Methods: This research was a cross-sectional study that included all people who attempted suicide between 2019 and 2023 and were part of the population covered by Mashhad University of Medical Sciences (Mashhad, Iran). Predictive variables for suicide attempts included age, sex, education, marital status, occupation, place of residence, drug abuse, smoking, psychiatric diagnoses, and the intended outcome of violent and non-violent methods. Logistic regression analysis was used to model the relationship between selected risk factors and the response variable. The data were analyzed using STATA software version 14. P<0.05 was considered statistically significant.

Results: Among the 18,281 people, 53% were men. Men, those who had lost their wives, people who lived in suburban areas, and people who had self-employed jobs or were unemployed, had higher rates of attempted suicide using violent methods. The chance of using violent methods was found to be 64% lower in women than in men (OR=0.36, 95%CI=0.30-0.43) and 45% higher in single individuals than in married people (OR=1.45, 95%CI=1.20-1.75).

Conclusion: This study found that several factors influenced the choice of method for committing suicide. Men, those who had lost their wives, suburban inhabitants, those with insecure jobs or unemployment, and single people were more prone to use violent methods. Meanwhile, women, the elderly, and those with higher education levels showed a preference for non-violent methods.

Background: Inadequate pulmonary blood flow in tetralogy of Fallot (TOF) can lead to the development of major aortopulmonary collateral arteries (MAPCA), which interferes with surgical repair. The present study evaluated the features of MAPCAs among patients with TOF and their treatment approaches. Besides, perioperative parameters and mortality rates of our TOF patients with and without MAPCA were compared.

Methods: This retrospective case-control study was conducted from 2011 to 2020 at Namazi and Shahid Faghihi Hospitals, affiliated with Shiraz University of Medical Sciences, Shiraz, Iran. The significant aspects of MAPCAs, including their quantity, the presence of dual or single supply lung segments, and the employed devices for closure were evaluated. The patients were divided into three groups: TOF patients without MAPCAs as the control group, those with preoperative percutaneous MAPCA closure (Closed MAPCA), and those with small MAPCAs deemed unsuitable for percutaneous closure (Open MAPCA). A comparative analysis, encompassing hospital and surgical data, such as the presence of MAPCA, blood transfusion volume, intubation time, ICU stay, and mortality rates during and post-surgery, was performed among the aforementioned groups. The Chi square, Mann-Whitney, and Kruskal-Wallis tests were used to analyze the data.

Results: 59 patients were enrolled, with a mean age of 27.98±24.19 months. The control group included 34 patients with no collaterals, the closed MAPCA group had 12 patients with occluded collaterals, and the open MAPCA group had 13 patients with small collaterals unsuitable for closure. Blood transfusion volume and intensive care unit (ICU) stay were significantly higher in the open MAPCA group than the control group (P=0.01 and P=0.04, respectively). The highest mortality rate was seen in the Iranian Journal of Medical Sciences group (P<0.001).

Conclusion: In TOF patients, percutaneous MAPCA closure prior to surgical repair was recommended. This approach could potentially decrease the occurrence of complications both during and post-surgery.

Background: In approximately 80% of colorectal cancer cases, mutations in the adenomatous polyposis coli (APC) gene disrupt the Wingless-related integration site (Wnt)/β-catenin signaling pathway, a crucial factor in carcinogenesis. This disruption may result in consequences such as aberrant spindle segregation and mitotic catastrophe. This study aimed to analyze the effectiveness of the ethanolic extract of red okra (Abelmoschus esculentus) pods (EEROP) in inducing apoptosis in colorectal cancer cells (SW480) by inhibiting the Wnt/β-catenin signaling pathway.

Methods: The IC₅₀ of EEROP in SW480 cells was determined by treating the cells with varying doses of EEROP, ranging from 0 to 1000 µg/mL. Apoptosis assay and signaling pathway analysis were performed through immunofluorescence staining and Western Blotting on SW480 cells treated with 250 µg/mL of EEROP for 72 hours.

Results: EEROP treatment induced apoptosis in SW480 cells, marked by elevated levels of active caspase-3 (P<0.001) and cleaved poly-(ADP-ribose) polymerase (PARP)-1. Moreover, it notably decreased β-catenin protein levels, resulting in an augmented occurrence of cells displaying abnormal spindle segregation during mitosis (P=0.04).

Conclusion: EEROP treatment reduces β-catenin protein levels, promotes abnormal spindle apparatus segregation, and finally leads to apoptotic cell death in CRC cells.

Background: The risk of cardiovascular disease (CVD) in patients with chronic kidney disease (CKD) is estimated to be far greater than that in the general population. Adropin regulates endothelial function and may play a role in the pathogenesis of CVD. Angiotensin-converting enzyme inhibitor (ACEI) treatment was reported to have a protective effect on both renal and cardiovascular function. This study investigated whether adropin is associated with renal and cardiovascular outcomes after using ACEI treatment in CKD rats.

Methods: In 2021, in Zagazig, Egypt, rats were assigned to: GI, control group (n=8); GII, CKD group (n=8), and GIII, CKD+captopril group (n=8), in which CKD rats received 100 mg/Kg/day captopril orally. Adropin levels, renal function, blood pressure, and various CVD risk factors were measured. Renal, cardiac, and aortic tissues were examined histologically and immunohistochemically to detect the expression of vascular endothelial growth factor receptor-2 (VEGFR-2). To analyze data, ANOVA and Pearson's correlation tests were used (SPSS version 18, P<0.05 is significant).

Results: Adropin was significantly lower in GII than in GI and GIII (P<0.001). Adropin in GII and GIII was negatively correlated with atherogenic index (P=0.019 and P=0.001, respectively), atherogenic co-efficient (P=0.012 and P=0.013, respectively), troponin I (P=0.021 and P=0.043, respectively), and nitric oxide (P=0.025 and P=0.038, respectively). VEGFR-2 expression decreased in GII and was elevated in GIII (P<0.001).

Conclusion: Adropin levels were significantly correlated with most CVD risk factors in CKD and captopril-treated CKD rats, indicating a role for adropin in the pathogenesis of CVD in CKD. It also refers to its implication in the ameliorative effect of ACEI treatment, possibly by affecting VEGFR-2 and nitric oxide release.

Rupture of a hydatid cyst can lead to the development of a disseminated form of intra-abdominal cystic echinococcosis if not diagnosed and treated promptly. Anaphylactic shock is a definite indication of cyst rupture. The presented clinical case was a young athlete with a disseminated form of cystic echinococcosis, which was investigated in 2023 at the Syzganov National Scientific Center for Surgery of Kazakhstan. The disease developed gradually following a sports injury to the abdomen during sports training and was accompanied by blurred signs of anaphylactic shock. In the next 2 years, echinococcosis of the abdominal cavity was asymptomatic. The clinical manifestation of cystic echinococcosis developed gradually over the last 10-12 weeks, in the form of dull, painful abdominal pain, malaise, weakness, sweating, nausea, poor appetite, and weight loss. Subacute manifestations of the disease resembled those of acute appendicitis. A diagnostic laparotomy revealed an abundance of cystic formations in the abdominal cavity, necessitating a differential diagnosis between a disseminated form of abdominal tuberculosis with damage to the mesenteric lymph nodes. However, instrumental verification of the parasite, together with the morphological exclusion of the extrapulmonary form of tuberculosis, made it possible to establish a disseminated form of cystic echinococcosis. The patient underwent a cystectomy, was discharged in satisfactory condition, and was informed about the possibility of disease recurrence. In conclusion, in hyperendemic zones, it is recommended to carry out immunological testing for echinococcosis on all abdominal sports injuries, independent of the presence of anaphylactic shock symptoms.