Iranian Journal of Medical Sciences最新文献

Background: Urinary tract infections (UTIs) are common in children and result in frequent hospitalization, creating a social and economic burden for parents and the healthcare system. This study analyzes the patterns of antibiotic resistance of dominant uropathogens and assesses the impact of patient age and sex on these patterns.

Methods: This retrospective cohort study was conducted in Karaganda, Kazakhstan, between 2017 and 2022. Antibiotic resistance was assessed in two age groups: 0-12 months (Group I) and 13-60 months (Group II). Standard microbiological methods were used to identify UTI pathogens, and antibiotic resistance patterns were determined using the Kirby-Bauer disk diffusion method.

Results: Among the 519 isolates (68.1%) from 762 children, the most common pathogens were Escherichia coli (170, 32.7%), Enterococcus faecalis (80, 15.4%), and Staphylococcus epidermidiss (46, 8.9%) in both age groups. Antimicrobial resistance in common pathogens in Groups I and II was high for amoxicillin (33 isolates, 76.7% and 45 isolates, 73.8%) and erythromycin (14 isolates, 73.7% and five isolates, 55.5%). Imipenem (31 isolates, 94%), amikacin (45 isolates, 90%) , and meropenem (47 isolates, 87%) were effective against E. coli, whereas ceftriaxone (31 isolates, 97%) was more active against Gram-positive cocci. 157 (34%) uropatogens were resistant to multiple drugs, increasing with age 72: (28%) (Group I) and 85 (43%) (Group II).

Conclusion: The study demonstrated a progressive increase in the prevalence of multidrug-resistant uropathogens with age in the pediatric population. Periodic monitoring of uropathogens helps track the growth of multidrug-resistant strains.

Background: Esophageal cancer is one of the most devastating cancers of the gastrointestinal tract. We will compare the expression levels of fibrillin-1 (FBN1) and fibrillin-2 (FBN2), a family of extracellular matrix glycoproteins, in esophageal cancer with normal adjacent tumor tissue.

Methods: In this cross-sectional study, 22 esophageal squamous cell carcinoma (ESCC) tumor samples and their matched adjacent normal tissues were collected from hospitals in Gorgan City (Golestan, Iran) between 2020 and 2022. After RNA extraction and cDNA synthesis, we measured the semi-quantitative gene expression level using real-time polymerase chain reaction (PCR). Data from this study were analyzed using SPSS software (version 18), and results were considered statistically significant when the P was <0.05. The primary statistical analyses used in this study were the Paired Samples t test and the Wilcoxon signed-rank test.

Results: The expression of the FBN1 gene decreased in tumor tissue compared to normal tissue (the FBN1 gene fold change=0.5472±0.149, P=0.007), and the FBN2 gene expression increased in tumor tissue compared to normal tissue (the FBN2 gene fold change=7.341±1.299, P<0.0001). We found no significant association between FBN1 and FBN2 gene expression and the clinicopathological features.

Conclusion: The change in FBN1 and FBN2 expression levels in the tumor tissue compared to normal tissue in ESCC suggests that FBN1 and FBN2 genes can be considered therapeutic targets for ESCC.

Background: Despite substantial advancements in reproductive health, unintended pregnancy remains a significant public health challenge in Iran. Qualitative studies revealed profound cultural and social complexities surrounding this issue. This study aimed to synthesize the experiences of Iranian women regarding unintended pregnancy and abortion by examining the interplay of cultural, social, economic, and individual factors.

Methods: A meta-synthesis of qualitative studies published between 2004 and 2024 in Persian and English was conducted. A comprehensive search of Scopus, MEDLINE/PubMed Central, Cochrane CENTRAL, ProQuest, Google Scholar, and Iranian databases (SID, Iranmedex, Magiran) was performed using keywords related to unintended pregnancy, induced abortion, and qualitative studies.

Results: The initial search identified 7,839articles. After screening for relevance, 22 qualitative studies were selected for analysis, encompassing data from 626 individual interviews and 36 focus group discussions. The analysis yielded two main themes and seven sub-themes: 1) Facing an unintended pregnancy (emotional fluctuations, societal norms, and access to health services), and 2) The decision-making process surrounding unintended pregnancies (avoidance reactions, socio-economic factors, psychosocial conflicts in decision-making, and beliefs about maternal roles and fetal life preservation).

Conclusion: Unintended pregnancy poses a serious public health challenge, imposing significant economic, social, and psychological burdens. Synthesizing qualitative evidence on women's decision-making processes is crucial for developing tailored interventions. Policymakers should implement strategies to reduce social stigma through public education and awareness campaigns.

Background: Breast cancer (BC) is the most common cancer affecting women worldwide. There is a strong need to identify molecular pathways that might represent effective therapeutic targets.

Methods: We conducted a large-scale transcriptomic analysis using publicly available datasets from the NCBI GEO and TCGA databases. Microarray datasets (GSE161533, GSE162228, GSE70947, and GSE139038) and RNA-Seq data were analyzed to identify differentially expressed genes (DEGs) using cut-off criteria of adjusted P<0.05 and |log2FC|>1. Gene co-expression networks were constructed using Weighted Gene co-expression Network Analysis (WGCNA) in R (version 1.68), followed by hub gene identification with STRING and MCODE tools. Functional enrichment was further explored through Gene Ontology analysis.

Results: Two regulatory modules enriched in cancer datasets were identified from both microarray and RNA-Seq analyses, corresponding to a network of 85 genes, compared to a distinct network of 474 genes enriched in control tissue samples. Further analyses to identify densely connected gene clusters within these networks revealed a cluster ``containing 29 cancer-related genes that included five hub gene candidates encoding serine/threonine kinase family proteins NimA-Related Protein: Kinase 2 (NEK2), Maternal Embryonic Leucine Zipper Kinase (MELK), Polo Like Kinase 1 (PLK1), Aurora Kinase B (AURKB), and Checkpoint Kinase 1 (CHEK1). Members of this family counter the expression of the tumor suppressor and cell cycle regulator Tumor Protein P53 (TP53), which is more highly expressed in healthy people. Moreover, all hub genes with higher transcript levels were associated with considerably poorer overall survival rates in BC patients. These results imply that these hub genes are relevant in terms of pathophysiology for the treatment of BC and deserve further attention. Kaplan-Meier survival analysis demonstrated that increased expression of all five genes was significantly associated with decreased survival (P<0.001). Hazard ratios (HRs) ranged from 1.41 to 1.77, indicating a substantial negative impact on patient survival for each gene.

Conclusion: Survival analysis showed that tumors with higher expression levels of hub genes were associated with significantly shorter overall survival times among breast cancer patients. This finding suggests that these hub genes are highly relevant to BC pathophysiology and could be considered targets for monitoring.

Background: Gene therapy introduces therapeutic genes into cancer cells to inhibit tumor growth or induce apoptosis. The htsFLT01 gene, a novel anti-angiogenic construct, encodes the sFLT01 protein that functions as a Vascular Endothelial Growth Factor (VEGF) decoy receptor, impeding pathological angiogenesis. When combined with the MiRGD nanocarrier-a versatile peptide-based delivery system optimized for specificity, biocompatibility, and low toxicity-the htsFLT01/MiRGD complex offers a potent strategy against breast cancer.

Methods: The htsFLT01 gene was designed and constructed in previous studies. The MiRGD peptide was expressed and purified using Ni-NTA affinity chromatography in the E. coli C41 (DE3) expression strain. The potency of this peptide, along with the cell viability and toxicity of the nanoparticles, was previously evaluated in MCF7 cell culture. After transfection with the htsFLT01/MiRGD nanocomplex at a nitrogen-to-phosphorus (N/P) ratio of 14, cell lysates were collected, and expression analysis of the key genes, including Fas-Associated Death Domain Protein (FADD), Caspase-8 (CASP8), and Tumor Protein P53 (TP53), was conducted based on findings from prior research. Statistical analyses were conducted using IBM SPSS Statistics version 22 (IBM, USA) and REST 2009 software.

Results: The htsFLT01 gene was previously designed and constructed, and the MiRGD nanocarrier was successfully produced and purified. This nanocarrier exhibited the best performance at an N/P ratio of 14. This study evaluated the effect of this complex on apoptosis induction in MCF7 cells via the extrinsic apoptotic pathway, revealing increased expression of FADD, CASP8, and p53 genes.

Conclusion: These findings highlight a synergistic relationship between anti-angiogenic and pro-apoptotic mechanisms, offering promising avenues for future breast cancer therapies.

Background: Microwave ablation (MWA) is a newly introduced technique for selective fetal reduction in complicated monochorionic (MC) pregnancies. This study aimed to describe maternal and neonatal outcomes after implementing MWA for selective fetal reduction in complicated MC pregnancies and analyze the procedure's success rate.

Methods: This is a case series of 21 complicated MC pregnancies that underwent MWA in the Fetal-Maternal Center affiliated with Shiraz University of Medical Sciences (Shiraz, Iran) to occlude fetal blood circulation from May 2021 to May 2022. The participants were followed until delivery. Gestational age at the time of the procedure, duration of the procedure, survival rate, procedure-to-delivery time, gestational age at delivery, as well as maternal and neonatal outcomes were evaluated.

Results: MWA was successfully performed in all 21 cases. The median (Q1-Q3) gestational age at the time of the procedure was 18 weeks. The fetus's blood circulation was completely stopped in all cases. The median (Q1-Q3) total ablation time was 4 (3-6) min, and the total ablation voltage was 100 (100-200) W. Fetal loss occurred in 19% (4/21) of cases after MWA. The duration of the surgery showed a significant negative correlation with the surgical outcome (P=0.012). The overall procedure-to-delivery time was 16 (14.5-19.5) weeks, with a survival rate of 81%. The median gestational age at delivery was 34 (30.5-37.5) weeks. Among the babies, 70.6% required admission to the neonatal intensive care unit; however, all survived the neonatal period. No maternal complications were observed.

Conclusion: MWA represents a potentially effective alternative modality for selective fetal reduction in complicated MC twin pregnancies. As a newly introduced technique, it is still in its early stages of implementation, and there is a need for reporting and discussing the specific details of its application. The abstract of this article was presented at the International Fetal Medicine Foundation Congress in the Emirates (28-29 September 2024).

Background: Over the past two decades, radiofrequency catheter ablation (RFCA) has emerged as a leading treatment for cardiac arrhythmias due to its high efficacy, despite potential complications. This study evaluated success rates, complications, and the procedure's impact on quality of life (QoL) and anxiety in patients with supraventricular arrhythmia (SVT).

Methods: This prospective cohort study involved patients diagnosed with SVT who were treated in Babol, Iran, between 2018 to 2019. The primary outcomes that were assessed included the immediate procedural success rate, success at 3 months post-ablation, associated complications, and their relationship with demographic and clinical factors. Additionally, changes in patients' QoL and anxiety levels before and after the procedure were analyzed. Procedures included recording His bundle electrograms using quadripolar catheters, performing programmed stimulations, autonomic blockade with atropine and propranolol, and delivering radiofrequency energy at target sites for at least 10 min. Complications and recurrence rates were monitored over a follow-up period of 3 months. Data were analyzed using SPSS software (version 23).

Results: Immediate success was achieved in 98% of cases, with two failures due to complications. Recurrence occurred in 13% of patients within 3 months, significantly associated with higher BMI and diabetes (P=0.024; P=0.026), respectively. Post-procedure, anxiety levels decreased significantly (P<0.001), and all QoL dimensions improved substantially (P<0.001), highlighting the holistic benefits of the procedure.

Conclusion: Overall, RFCA is an effective and well-tolerated treatment for SVT, demonstrating high success rates and significant improvements in patient outcomes, including reduced anxiety and enhanced QoL.