Medical Journal of the Islamic Republic of Iran最新文献

Bronchobiliary fistula (BBF) in adults is a quite infrequent complication characterized by the abnormal interconnection between the right bronchial system and the biliary tract. BBF may occur due to various causes, including trauma, infections, malignancies, and complications of certain surgical procedures involving the liver or the hepatobiliary system. In this paper, we report a case of BBF following liver hydatid cyst resection that developed in a 58-year-old Iranian male. The patient had acute dyspnea with yellowish sputum. After diagnostic measures such as bronchoscopy, computed tomography (CT) scan, endoscopic retrograde cholangiopancreatography (ERCP), and confirmation of the diagnosis of BBF, the patient underwent Intravenous (IV) antibiotic therapy, placement of pleural drain, sphincterotomy and CBD stents insertion but unfortunately, these measures were not effective and the patient was a candidate for thoracotomy and resection of fistula and the involved lung. During surgery, absolute lung isolation was done by insertion of a left-sided double-lumen endobronchial tube and uneventful anesthesia was maintained for about 5 hours. Patients with BBF present unique challenges in terms of anesthetic management. Sepsis, pulmonary impairment, electrolyte imbalances and malnutrition will make anesthesiologists face many perioperative challenges. During surgery, absolute lung isolation is typically necessary and achieving effective lung isolation can be quite challenging due to the presence of the fistula. Postoperatively, intensive respiratory support, chest tube drainage, and appropriate antibiotic therapy may be required .In addition, a multidisciplinary approach involving anesthesiologists, thoracic surgeons, and other specialists is crucial.

Background: One of the most effective measures to reduce the cost of medicines for both the healthcare system and patients is the use of generic drugs (GDs). The objective of this study was to identify the physicians' level of knowledge and attitude toward GDs.

Methods: A cross-sectional survey was conducted based on a specially designed validated questionnaire of 19 items. The survey was attended by doctors of various specialties working in polyclinics in six regions in the Republic of Kazakhstan. Construct validity was assessed through principal component factor analysis, whereas reliability was assessed using Cronbach's alpha coefficient. Group differences were assessed using Mann-Whitney and Kruskal-Wallis nonparametric tests when comparing two and more than two groups, respectively.

Results: The study involved 450 physicians. Only 260 (57.8%) believed that GDs are bioequivalent to the brand name drug (strongly agree and agree). About 202 (45%) of respondents doubt the effectiveness of GDs, and 144 (32%) assumed that they cause more side effects compared to similar branded drugs. Also, the majority of the respondents 320 (71.2%) felt that branded drugs should be held to higher safety standards than GDs. Approximately 338 (75%) of the physicians positively expressed that both physicians and pharmacists need standardized guidelines for the brand name substitution process. Further, 372 (82.7%) proposed that more information about the safety and efficacy of GD is needed. Also, 326 (72.4%), 314 (88.2%), and 85 (18.9%) of the respondents assumed that patients' socio-economic factors, trust in manufacturers/suppliers, and bonuses on products respectively influence the prescribing of medicines.

Conclusion: Although the study indicated that physicians in the Republic of Kazakhstan are acknowledging the use of GDs, concerns about the effectiveness and safety of GDs remain high. To enhance the use of GDs, physicians' targeted educational programs on GDs' bioequivalence, safety, and efficacy should be implemented.

Background: Inflammation is important in the pathophysiology of acute respiratory distress syndrome (ARDS). Traumatic injuries have been assumed to be primary ARDS causes. Recently, pentoxifylline, a phosphodiesterase inhibitor (PEI), was shown to have anti-inflammatory effects and reduce the incidence of ARDS. The present study investigated the impact of preventive pentoxifylline administration in trauma patients prone to ARDS development.

Methods: A total of 62 trauma patients admitted to the Kamyab Hospital in Mashhad,Iran, with ARDS risk who fulfilled the inclusion and exclusion criteria were included in this study. The patients were randomly divided into treatment and placebo groups. The treatment group received 400 mg pentoxifylline 3 times a day, while the control group received placebo tablets thrice for 1 week. Before the intervention and during the study, factors such as heart rate, blood pressure, respiration rate, continuous pulse oximetry, CRP, PO₂, PCO₂, and PH were assessed. Finally, the obtained data were analyzed using SPSS Version 26 via a generalized estimating equations model and an independent t test.

Results: The heart rate was significantly lower in the treatment group than in the placebo group (P = 0.036). In addition, PO₂ levels were remarkably higher in the treatment group (P = 0.040). Changes in respiratory rate (P = 0.064), CRP (P = 0.341), PH (P = 0.910), PCO₂ (P = 0.892), HCO₃ (P = 0.172), systolic blood pressure (P = 0.302), and SPO₂ (P = 0.350) were not significantly different between the 2 groups. In addition, no significant difference was observed in the incidence and severity of ARDS between the 2 groups.

Conclusion: The findings of this study revealed that pentoxifylline administration to trauma patients had no beneficial effects on ARDS but improved some vital signs and laboratory variations.

Background: Breast cancer is a complex and heterogeneous disease, and understanding its regulatory mechanisms and network characteristics is essential for identifying therapeutic targets and developing effective treatment strategies. This study aimed to unravel the intricate network of interactions involving differentially expressed genes, microribonucleic acid (miRNAs), and proteins in breast cancer through an integrative analysis of multi-omic data from Cancer Genome Atlas Breast Invasive Carcinoma (TCGA-BRCA) dataset.

Methods: The TCGA-BRCA dataset was used for data acquisition, which included RNA sequencing data for gene expression, miRNA sequencing data for miRNA expression, and protein expression quantification data. Various R packages, such as TCGAbiolinks, limma, and RPPA, were employed for data preprocessing and integration. Differential expression analysis, network construction, miRNA regulation exploration, pathway enrichment analysis, and independent dataset validation were performed.

Results: Eight consistently upregulated hub genes-including ACTB, HSP90AA1, FN1, HSPA8, CDC42, CDH1, UBC, and EP300-were identified in breast cancer, indicating their potential significance in driving the disease. Pathway enrichment analysis revealed highly enriched pathways in breast cancer, including proteoglycans in cancer, PI3K-Akt, and mitogen-activated protein kinase signaling.

Conclusion: This integrated multi-omic data analysis provides valuable insights into the regulatory mechanisms, network characteristics, and functional roles of genes, miRNAs, and proteins in breast cancer. The findings contribute to our understanding of the molecular landscape of breast cancer, facilitate the identification of potential therapeutic targets, and inform strategies for effective treatment.

Background: Thoracolumbar fractures are common traumatic injuries that can be treated conservatively or by surgery, depending on the type and severity of the injury. This study aimed to determine the efficiency of various orthoses used for these fractures based on the available literature.

Methods: Between 1950 and 2023, a search was conducted in some databases, including PubMed Central and MEDLINE, ISI Web of Knowledge, Cochrane-centered Register of Controlled Trial (CCTR), Embase, and Scopus. Some keywords-such as conservative treatment, orthoses, brace, and cast-were used in combination with thoracolumbar fracture, burst fracture, and compressive fracture. The quality of the studies was evaluated using the PEDro scale. Two researchers independently reviewed the studies.

Results: Based on the results of the included studies, orthosis is not necessary for stable burst and compression fractures. Based on the inclusion criteria, 20 papers were selected for the final analysis, 12 of which were on the use of spinal braces and casting (with quality between 1 and 6), 2 on the no-treatment approach, and 6 on comparing the outputs of treatment with spinal braces with no braces.

Conclusion: Although the use of orthosis and cast is one of the conservative treatments recommended for patients with thoracolumbar fractures, it seems that for stable burst fractures and compression fractures, the use of a brace does not provide any benefits. However, the use of a brace or cast is recommended for burst fractures with more than 1 column fracture.

Background: Ensuring the comprehensive and accurate representation of data within cancer registries holds paramount significance across various facets of public health decision-making. This study delves into the evaluation of data completeness in breast cancer (BC) pathology reports within a population-based cancer registration system in Iran, spanning the period from 2016 to 2018.

Methods: Employing a retrospective and descriptive analytical approach, we harnessed secondary data extracted from pathology reports encompassing breast cancer diagnoses, which were duly recorded in the Integrated Cancer Information Management System database during 2016-2018. A total of 4000 pathology reports were thoughtfully selected from each of the three years. The spectrum of pathology information encompassed tumor type, site grade, size (T), and involvement of lymph nodes (N). Summary statistics were provided as percentages of categorical variables and mean with standard deviation of continuous variables. A comparison of categorical variables was performed using the Chi-squared test.

Results: The participants' mean age was 51.8±12.5 years. Among the 12,000 studied patients, 5744 (47.9%) were ≤ 50 years old, 5233 (43.6%) were aged 50-69 years, and 1023 (8.5%) were >60 years old. The completeness of BC pathology reports varied for different variables. Interestingly, the completeness of these variables increased with older age groups. The proportion of specific tumor types differed significantly among age groups (P = 0.001). Notably, the prevalence of invasive ductal carcinoma was higher in the ≤ 50 years age group compared to the older cohorts. Likewise, notable variations in tumor sizes were observed (P = 0.009), with a higher prevalence of missing tumor size data noted in the age group ≤ 50 years. On the other hand, pathologic T stage also demonstrated age-dependent variations (P = 0.014), indicating a higher prevalence of missing stages in the ≤ 50 years age group. Finally, tumor grade exhibited a statistically significant difference (P < 0.001), with a higher proportion of grade 1 tumors observed in the 50-69 years age group.

Conclusion: Tumor grade had the highest completeness rate, while tumor size, pathologic T stage, and pathologic N stage had the lowest. Therefore, a good understanding of completeness of pathology reports, as well as improvement in the registration of stage, integrated system at the national level for BC is warranted.

Background: Mortality has been indicated to be high in patients with underlying diseases. This study aimed to examine the comorbidities is associated with a higher risk of death during the hospital course.

Methods: We retrospectively evaluated the risk of in-hospital death in 1368 patients with COVID-19 admitted to 5 academic hospitals in Tehran between February 20 and June 13, 2020. We also assessed the composite end-point of intensive care unit admission, invasive ventilation, and death. The Cox proportional survival model determined the potential comorbidities associated with deaths and serious outcomes.

Results: The retrospective follow-up of patients with COVID-19 over 5 months indicated 280 in-hospital deaths. Patients with diabetes (risk ratio (RR), 1.47 (95% CI, 1.10-1.95); P = 0.008) and chronic kidney disease (RR, 1.72 (95% CI, 1.16-2.56); P = 0.007) showed higher in-hospital mortality. Upon stratifying data by age, patients aged ˂65 years showed a greater risk of in-hospital death in the presence of 2 (hazard ratio (HR), 2.68 (95% CI, 1.46-4.95); P = 0.002) or more (HR, 3.47 (95% CI, 1.69-7.12); P = 0.001) comorbidities, compared with those aged ≥ 65 years.

Conclusion: Having ≥ 2 comorbidities in nonelderly patients is associated with a greater risk of death during hospitalization. To reduce the mortality of COVID-19 infection, younger patients with underlying diseases should be the focus of attention for prevention strategies.

Background: The invasive, expensive, and time-consuming nature of radiological examinations for vesicoureteral reflux (VUR) has compelled researchers to search for new markers to predict VUR. This study was designed to evaluate the usefulness of serum and urine concentrations of neutrophil gelatinase-associated lipocalin (NGAL) in predicting the existence of VUR.

Methods: This cross-sectional study involved all patients with a first febrile urinary tract infection (UTI) referred to Ali Asghar Children's Hospital. Each patient included in the study had clinical symptoms of pyelonephritis and a positive urine culture. The patients were divided into 2 groups: VUR and non-VUR. The serum and urinary NGAL levels were calculated in both groups. The receiver operating characteristic (ROC) curve was used to look for serum and urinary NGAL cut-points that differentiated the VUR group from the non-VUR group.

Results: Among the 40 children in the study, 23 belonged to the VUR group. The median age was 2.5 years (range, 0.3-8 years), and 35 patients were girls. ROC curve analysis showed that only the urinary NGAL level was significantly related to VUR. There was no association between serum NGAL levels and VUR. According to the ROC curve, a urinary NGAL level cut-off value of 15 ng/mL was likely to be diagnostic of VUR with 82.6% sensitivity and 58.8% specificity.

Conclusion: The urinary NGAL level, specifically with a cut-off value of 15 ng/mL, can indicate the existence of VUR in patients with UTI with near-acceptable levels of sensitivity and specificity.

Background: Medial migration of the cervical screw is a frequent complication of Gamma nails and is observed in 4.3% - 6% of cases. The reasons are a violation of the surgical technique of osteosynthesis of a trochanter fracture, including an unrepaired fracture, a breach of the insertion point of the fixator, and a suboptimal position of the cervical screw. However, the migration of the Gamma nail neck screw into the pelvic cavity is sporadic, and only a few cases have been published in the literature.

Case description: This is the case of a patient born in 1952 who was admitted to the hospital with pain syndrome in the pelvis and dysuric phenomena. As a result of clinical X-ray examination, CT, and MRT examination of the pelvis, medial migration of the Gamma nail cervical screw with damage to the bladder was revealed. The patient was urgently operated on the day of admission. The cervical screw from the bladder was removed, the bladder was sutured, and an epicystostomy was installed. The Gamma nail from the right femur was also released. There were no intraoperative complications. In the postoperative period, the patient was prescribed antibiotics and analgesics. The duration of hospitalization was six days. Being examined for five weeks after the operation, the patient does not make any particular complaints, walks without means of support, and the intertrochanteric fracture of the right femur fused incorrectly. The patient was offered an endoprosthesis of the right hip joint, but he and his relatives refused.

Conclusion: The traumatologist should be aware of the possibility of such complications after osteosynthesis and its associated risks. They should be able to recognize the etiological factors causing the medial migration of the cervical screw of the intramedullary retainer. If medial screw migration is detected, the traumatologist should assess the function of internal organs and the condition of the main vessels and take measures to safely remove the migrated fixator from the anatomical cavity of the body in one team with a surgeon, urologist and vascular surgeon.

Background: Proximal femoral fractures are a global epidemiological concern due to their association with mortality and morbidity in the geriatric population.

Methods: We conducted an epidemiological study using hospital registry data to assess the incidence and associated factors of proximal femur fractures among individuals aged 60 years or older living in Almaty City. Student's t-test was used to assess for between-group differences.

Results: The data showed that the overall frequency of fractures among the population of Almaty City aged 60 years and older between 2014 and 2019 averaged 169.6 per 100,000, with a higher rate among women (190.3) compared to men (135.8). However, in age groups up to 70 years and over 85 years, the frequency of proximal femur fractures was higher among men. From 2014 to 2019, the incidence of proximal femur fractures increased by 1.6 times. An analysis of the distribution of fracture frequency by season revealed that winter was the most dangerous period.

Conclusion: Our research suggests a need for further epidemiological studies on the incidence of proximal femur fractures in various regions, identifying risk factors, and developing targeted regional prevention programs.