Iranian Journal of Medical Sciences最新文献

Background: Diabetes mellitus is predominantly a growing global problem interconnected proportionally with obesity escalation. The current study evaluated the prognostic implications of vitamin B12 administration on Body Mass Index (BMI) and glycosylated hemoglobin (HbA1c) levels in type 2 diabetic patients treated with dapagliflozin.

Methods: In this controlled randomized, double-blind trial, 160 patients for each arm were enrolled from July 2022 to June 2023 in Amman, Jordan.; 76 females and 84 males with inclusion criteria of vitamin B12 less than 233 ng/ml, age between 19-76 years, HbA1c range between 6.8-9.1%, and BMI less than 35. Group I received only dapagliflozin 10 mg/daily for a period of 12 months, whereas, group II received vitamin B12 supplements, methylcobalamin 500 µg, once daily with dapagliflozin 10 mg/day. HbA1c, Vitamin B12, and BMI were measured at time intervals of 0, 6, and 12 months. Using SPSS version 23, P values<0.05 were considered statistically significant. The continuous variables were reported as median and IQR. Mann-Whitney-u test and Correlations Spearman's rho were used for continuous variables.

Results: The co-administration of vitamin B12 significantly decreased the levels of HbA1c in group II (54 participants) to 6.66±0.643 by 0.6 %, F(2,78)=172, P<0.001, compared to the subjects in group I (6.92±0.434). A significant impact of vitamin B12 administration on BMI lowering was observed at different time intervals during the study (P=0.002).

Conclusion: The co-administration of vitamin B12 as a supplement for diabetic patients improved BMI and HbA1c levels.Trial Registration Number: NCT06241638.

Background: In the female population, breast cancer is the most common cancer and a leading cause of cancer death. This study was designed to investigate the geographical pattern of breast cancer risk in different counties of Fars province in the south of Iran from 2001 to 2018.

Methods: In this historical cohort study, data of Shiraz Population-Based Cancer Registry between 2001 and 2018 was used. The geographical variations of breast cancer incidence rate in 36 counties of Fars province were analyzed using the Bayesian spatiotemporal model.

Results: Overall, the averages of relative risk (RR), temporal trend (TT), and δ_i for breast cancer were 1.59, 1.025, and 0.00 in the total female population; 1.21, 1.002, and 0.00 in the young female population (under 40 years of age); and 1.54, 1.02, and 0.00 in the female population with invasive ductal carcinoma (IDC), respectively. The steady increase in RR of breast cancer and IDC during 2001-2018 was observed in most counties located in the non-central part of the Fars geographic map. Moreover, a steady increase of young breast cancer RR was observed mainly in southern regions and some northern cities of Fars province.

Conclusion: Between 2001 and 2018 in Fars province, a steady annual increase of approximately 2% was observed in the total female population for all types of breast cancer, including IDC. High-risk areas, TTs, and changing patterns of breast cancer incidence were determined in this region. Furthermore, areas with a high risk of young breast cancer were identified, which requires special attention.

Background: Lung cancer remains a leading cause of cancer-related mortality, necessitating improved treatment strategies. This study collectively highlights the valuable potential of marine sponges as a source for discovering new anti-tumor agents.

Methods: We conducted a bibliometric analysis to identify anticancer compounds from marine sponges using PubMed (2018-2023). The search included keywords such as "marine sponge," "cancer," "neoplasm," "proliferation," "cytotoxicity," "tumor," "sesquiterpene," "alkaloid," and "quinones." Inclusion criteria focused on studies related to lung cancer and marine sponge-derived compounds, excluding non-cytotoxic activities and unrelated species. Data were extracted in comma-separated values (CSV) format and analyzed via VOSviewer. Molecular docking identified compounds with strong binding to apoptotic receptors in lung cancer cells. PROTOX and Way2Drug tools predicted the pharmacological properties of selected compounds as potential drugs.

Results: The bibliometric analysis identified alkaloids, sesquiterpenes, and quinones as key keywords. Dactyloquinone B-D, dysidavarone D, smenohamien F, and sollasin E demonstrated strong binding to apoptotic receptors in lung cancer cells, suggesting potential as anti-lung cancer drugs. Pharmacological analyses revealed promising effects and potential side effects, highlighting their suitability for further drug development. These findings provide a foundation for novel targeted therapies for lung cancer.

Conclusion: This study highlights the potential of alkaloids and sesquiterpenes derived from marine sponges as promising anti-lung cancer agents, emphasizing the need for further in vitro, in vivo, and clinical investigations to validate their therapeutic efficacy.

Background: The cytochrome P450 (P450s or CYPs) enzyme family, particularly CYP2D6, significantly influences drug metabolism, handling approximately 20-25% of prescribed medications. Understanding genetic polymorphisms is crucial for personalized medicine and optimizing drug therapy in specific geographic and racial contexts. Given the complex nature of studying CYP2D6 genotypes, this study aimed to assess the prevalence of rare CYP2D6 star alleles, including rs267608319 (CYP2D6*31), rs1931013246 (CYP2D6*55), rs569439709 (CYP2D6*113), and rs747089665 (CYP2D6*135), within the Iranian population.

Methods: Blood samples were obtained from 389 individuals across several ethnic groups in Tehran, Iran, from May to December 2022. PCR was used to amplify the region containing the desired variant. Genotyping was performed using the Sanger sequencing method.

Results: Our analysis revealed a high frequency of normal alleles for all four studied variants, indicating the absence of the risk allele in the Iranian population. These findings suggest that the studied alleles have no apparent effect on various ethnic groups in Iran.

Conclusion: The Iranian population has a typical genetic makeup for CYP2D6 variations, impacting medication prescribing. Understanding genetic differences is crucial for personalized drug therapies. Further research into Iranian genetic variations is essential for advancing personalized medicine.

Background: Due to the scarcity of treatment options, managing the progression of non-alcoholic fatty liver disease (NAFLD) from steatosis to cirrhosis necessitates innovative approaches. This study focused on endoplasmic reticulum (ER) stress, apoptosis, and autophagy as key mechanisms in NAFLD pathogenesis. It also highlighted the potential of adipose-derived mesenchymal stem cells (AD-MSCs) and their exosomes as promising therapeutic options.

Methods: The study was conducted at the Department of Regenerative Medicine, Shiraz University of Medical Sciences, (Shiraz, Iran) from November 2021 to December 2023. The mice (n=32) were divided into four groups: control, high-fat diet (HFD) without treatment, HFD with AD-MSCs treatment, and HFD with AD-MSCs-derived exosomes groups. The mice were fed HFD for 8 weeks. They received MSC and exosomes for the last 3 weeks. One week after the final injection, mice were tested for serum testing, stereological analysis, and real-time polymerase chain reaction (RT-PCR). The data were analyzed using the Graph-Pad Prism software by one-way analysis of variance (ANOVA) with Tukey analysis as a post hoc comparison between groups. P<0.05 indicated a significant difference.

Results: AD-MSCs-exosomes significantly reduced ER stress indicators (IRE1α [P=0.0001], PERK [P=0.0006], ATF6 [P=0.0001], and GRP78 [P=0.0001]), apoptosis markers (Bax [P=0.005] and Cas3 [P=0.001]), and autophagic flux markers (P62 [P=0.0001] and LC3B/A [P=0.003]).

Conclusion: In this investigation, AD-MSCs-exosomes significantly restored autophagy and suppressed unfolded protein response (UPR) pathways in the early stages of NAFLD.

Background: Effective pain management is crucial in septorhinoplasty and remains a significant challenge. This study investigated the effect of ketorolac and paracetamol on pain control in septorhinoplasty patients and assessed their efficacy in reducing the need for rescue analgesics.

Methods: This double-blind randomized clinical trial was conducted at Madar-Koodak Hospital (Shiraz, Iran), in 2022. Ninety-nine patients were randomly assigned to three groups to receive ketorolac 30 mg (n=33), paracetamol 1000 mg (n=33), and normal saline (n=33), respectively. All the medications were administered intravenously (IV) 30 min before surgery. The randomization procedure followed the block randomization method. If the pain did not subside, patients were also given a single dose of pethidine hydrochloride (25 mg). Pain intensity was measured using visual analog scale (VAS) 1 hour and 6 hours after surgery. The data were analyzed using SPSS software, using paired t tests, ANOVA, and Chi square tests.

Results: One-hour post-surgery, VAS scores in the ketorolac and paracetamol groups were significantly lower than in the placebo group (P<0.001). The mean difference with 95% CI for ketorolac-placebo and paracetamol-placebo was -0.57 (-0.94, -0.21), and -0.79 (-1.12, -0.45), respectively. The ketorolac and paracetamol groups required significantly less pethidine hydrochloride 1 hour post-surgery than the placebo group (P<0.001). The VAS scores and requiring pethidine were not significantly different between the ketorolac and paracetamol groups.

Conclusion: After septorhinoplasty, the administration of 1000 mg of IV paracetamol demonstrated comparable efficacy in pain reduction to 30 mg of ketorolac. It suggested that paracetamol could serve as a viable alternative to ketorolac in preventing postoperative pain after septorhinoplasty, particularly in patients for whom non-steroidal anti-inflammatory (NSAID) drugs could not be a suitable choice.Trial Registration Number: IRCT20180922041084N6.

Colorectal cancer (CRC) ranks among the most prevalent cancers worldwide and is the fourth leading cause of cancer-related deaths. Metastasis poses a significant obstacle in CRC treatment, as distant metastasis, particularly to the liver, remains the primary cause of mortality. Colorectal liver metastasis (CRLM) occurs frequently due to the liver's direct vascular connection to the colorectal region via the portal vein. Standard treatment approaches for CRLM are limited; only a few patients qualify for surgical intervention, resulting in a persistently low survival rate. Additionally, resistance to chemotherapy is common, emphasizing the need for more effective targeted therapies. Emerging evidence highlights the pivotal role of microRNAs (miRNAs) in modulating critical pathways associated with CRLM, including tumor invasion, epithelial-mesenchymal transition, and angiogenesis. MiRNAs exhibit dual functions as tumor suppressors and oncogenes by targeting multiple genes, thus playing a complex role in both the initiation and progression of metastasis. The regulatory mechanisms of miRNAs could help to identify novel biomarkers for early diagnosis and prognosis of CRLM, as well as promising therapeutic targets to overcome chemoresistance. Despite numerous studies on miRNA involvement in CRC metastasis, dedicated reviews focusing on miRNAs and CRLM remain scarce. This review aims to approach targeted therapies by examining the current understanding of miRNA involvement in CRLM and exploring their potential as diagnostic, prognostic, and therapeutic agents. Through an integrative approach, we aim to provide insights that could transform CRLM management and improve patient outcomes.

Background: Hepatitis D is caused by the hepatitis D virus (HDV) and affects those who have already been infected with the hepatitis B virus (HBV). The epidemiology of hepatitis D in Fars Province, Iran, is poorly understood. This study aimed to investigate the epidemiology of HDV and its associated factors in patients attending Shahid Motahari Clinic, affiliated with Shiraz University of Medical Sciences (Shiraz, Iran).

Methods: This prospective cohort study was conducted in Shiraz, Iran, from 2001 to 2023. This study screened individuals with low HBV viral load and elevated liver enzymes for HDV. Pearson Chi square, Fisher's exact, and Mann-Whitney U tests were used to examine the univariate associations between hepatitis D and various risk factors. Risk factors with P<0.2 were analyzed using multiple logistic regression to estimate odds ratios and 95% confidence intervals. P<0.05 was considered statistically significant.

Results: The variables were compared between the HDV⁺ (29) and HDV^- (108). The variables of age (P=0.002) and using hookah (P=0.040) were statistically significant. The other variables examined in this study were not statistically significant. Increasing age (OR=1.06, 95% CI=[1.019, 1.102], P=0.003) was identified as a risk factor, while dental visits (OR=0.290 95% CI=[0.101, 0.836], P=0.022) were assessed as a protective factor.

Conclusion: Age was a significant risk factor for HDV infection, while a history of dental procedures appeared to be a protective factor. To better understand the epidemiology of HDV, further comprehensive research is necessary, focusing on diverse demographic groups in different regions.

Background: X-ray computed tomography (CT) is a standard tool for diagnosing bone abnormalities. CT dose optimization is strongly recommended, due to the stochastic effects of x-ray. This study aims to assess the effectiveness of ultra-low-dose CT (ULD-CT) imaging, reconstructed using an Iterative Reconstruction (IR) algorithm, in detecting bone trauma and disorders.

Methods: In the present cross-sectional study, 71 patients with CT requests for spine or extremity (limb) bone underwent scanning using standard dose (SD) and ULD-CT protocols, in Shahid Faghihi Hospital, Shiraz, Iran from June 2019 to June 2020. The SD and ULD-CT protocols used 120 kVp and 80 kVp, respectively. The CT images were reconstructed using the standard and IR algorithms. CT dose indices, including the volume CT dose index (CTDI_vol), dose-length product (DLP), and effective dose (ED), were employed. To assess image quality, a five-point scoring system was used. The sensitivity and specificity of the ULD-CT images were calculated.

Results: The findings indicated that ULD-CT images accurately identified 113 out of 118 bone trauma and disorders. The quality of ULD-CT images received "very good", "good" and "acceptable" scores for both spine and extremity (limb) bones. The sensitivity and specificity of ULD-CT images for bone trauma and disorders were 67%-95% and 100%, respectively, with about a 98% dose reduction.

Conclusion: The ULD-CT protocol for bone imaging achieved a remarkable dose reduction, while the image quality was reported as acceptable. Consequently, ULD-CT images reconstructed using an IR are suitable and can be tuned further in the future for acceptable use in patients with bone trauma and disorders.