Archives of Iranian Medicine最新文献

We present a case with an intrathoracic caudate lobe in a 45-year-old woman who referred with a complaint of nonspecific chest pain. She denied previous history of trauma or surgery. Computed tomography (CT) pulmonary angiography showed a paravertebral, soft tissue mass which raised suspicion of a pleural tumor. In the coronal plane, the mass was protruding to the abdomen and had similar density with liver. Magnetic resonance imaging confirmed the diagnosis.

Background: Retinopathy of prematurity (ROP) is a significant cause of preventable premature infant vision loss. Many studies have reported different risk factors depending on the region. In this study, we evaluated the incidence of ROP and associated risk factors in a referral eye hospital in southeastern Iran.

Methods: This was a retrospective cohort study of preterm infants with birth weight (BW)≤2000 g or gestational age (GA)≤34 weeks and infants with GA between 34-37 weeks or GA<37 weeks and BW>2000 g referred by their pediatricians to our center from March 2022 until March 2023.

Results: Totally, 920 infants met the inclusion criteria for the study. The incidence of ROP and ROP requiring treatment was 20.2% and 3.58% respectively. Results of logistic regression analysis showed higher GA and BW as protective factors against ROP occurrence. History of blood transfusion and phototherapy increased ROP development.

Conclusion: Lower GA, lower BW, history of blood transfusion, and phototherapy were associated with ROP development. Phototherapy decreased the need for treatment among ROP patients.

Background: Pulmonary embolism (PE) is a significant public health concern. This retrospective cohort study examines the clinical profiles and outcomes of patients diagnosed with PE at a medical center in central Iran, aiming to identify mortality predictors during hospitalization and follow-up.

Methods: Data from 109 patients diagnosed with PE were analyzed, with a median follow-up of 23 months. The collected information included demographic and clinical characteristics, laboratory findings, treatment protocols, and outcomes. Logistic regression and Kaplan-Meier survival analysis were used to identify independent mortality predictors and assess survival impact.

Results: The mean age was 59.2 years (±19.7), with 51.4% male. Common symptoms included dyspnea (86%) and chest pain (53%), with non-massive PE being the most prevalent (63%). Independent mortality predictors identified were age (odds ratio [OR] 1.065 per year, P<0.001), female sex (OR 4.421, P=0.009), and PE severity (OR 0.262, P=0.023). Kaplan-Meier analysis showed reduced survival probabilities in females (P=0.009), those with provoked PE (P=0.002), patients over 65 (P=0.016), and individuals with comorbidities (P=0.018). In-hospital mortality was 10.1%, linked to provoked massive PE, absence of thrombolytic therapy, and reduced left ventricular ejection fraction (LVEF).

Conclusion: In this cohort, age, sex, and PE severity were significant mortality predictors, while provoked PE, advanced age, and comorbidities were associated with lower mid-term survival probabilities.

Infectious diseases were one of the most important public health problems in Ardabil during the first Pahlavi period (1925-1941 AD). These diseases caused the illness and death of many people. The purpose of this study is to investigate the factors and consequences of the spread of infectious diseases in Ardabil during the first Pahlavi period. The research method is descriptive and historical-retrospective, which tries to answer the research questions using documentary and library sources. The findings show that malaria, trachoma, smallpox, tuberculosis, rinderpest, venereal diseases, and diphtheria were among the most common infectious diseases. Poverty, illiteracy, poor public health, lack of medical facilities, and the geographical location were the main factors in the spread of these diseases. Considering the critical nature of the issue, the first Pahlavi government tried to control and prevent diseases by carrying out measures such as public education, establishing health and treatment centers and reforming their structure, sending doctors and distributing medicine, and implementing quarantine and vaccination. The results showed that the efforts of the first Pahlavi government in fighting infectious diseases in Ardabil were relatively successful and reduced the prevalence of some diseases.

Background: Xanthogranulomatous cholecystitis (XGC) is a rare, chronic gallbladder inflammation often mistaken for gallbladder cancer (GBC) on imaging. Accurate differentiation is vital for appropriate treatment. This study aims to enhance computed tomography (CT) scan diagnostic accuracy for distinguishing XGC from GBC.

Methods: This retrospective study included patients diagnosed with XGC and GBC between 2014 and 2023. CT images of 70 patients (16 GBC, 54 XGC) were reviewed. Radiologists assessed CT parameters: gallbladder wall thickening, intramural hypoattenuating nodules, enhancement characteristics, mucosal line continuity, pericholecystic fat stranding, presence of stones, bile duct dilatation, hepatic invasion, invasion to adjacent structures, and lymph node size.

Results: Among 70 patients, there were 38 males (54%) and 32 females (46%), with a median age of 62 years. GBC patients were significantly older (median age 72 years) compared to XGC patients (60 years) (P=0.001). Diffuse gallbladder wall thickening was more frequent in XGC (70%) than GBC (12.5%) (P<0.001). Continuous mucosal lines and intramural hypoattenuating nodules were more common in XGC (P<0.001 and P=0.010, respectively). Intrahepatic bile duct dilatation and invasion to adjacent structures were significantly linked with GBC (P<0.001 and P=0.043). Lymph nodes with a short axis>8 mm indicated GBC (P<0.001), with a cutoff providing 71.4% sensitivity and 84% specificity (AUC: 0.843, P<0.001). CT showed 75% sensitivity (95% CI: 48-93%), 74% specificity (95% CI: 60%-85%), and 74% accuracy (95% CI: 62%-84%).

Conclusion: CT imaging can effectively differentiate XGC from GBC, and larger studies can further improve diagnostic accuracy.

Here, we report a case with concomitant variants: a novel homozygous HERC1 gene variant and a novel heterozygous PMP22 duplication. The 2-year-old male presented with seizures, developmental delay, macrocephaly, hypotonia, unilateral hypertrophy, thoracic scoliosis, normal brain MRI, and elevated homocysteine level which normalized after treatment. Whole exome sequencing (WES) revealed a co-occurrence of a homozygous novel likely pathogenic variant in the HERC1 gene (NM_003922.3:c.1280dup (p.ILe469Aspfs*33) and a novel heterozygous large duplication of exon 1-5 in the PMP22 gene, which has not been reported previously. The case underscores the challenges in understanding genotype-phenotype correlations and suggests a potential interplay between these genetic variants in shaping the current and future clinical phenotype of the patient. In the case of genetic diseases, this event may have important implications on family members' counseling, and concomitant variants in Charcot-Marie-Tooth (CMT) families should be considered when significant intra-familial clinical heterogeneity is observed.

Background: Blood cancers account for a significant proportion of cancer-related deaths worldwide. In this study, hematological cancer mortality in northern Iran was examined during 2013-2021, along with age-adjusted mortality rates.

Methods: In a cross-sectional study, we conducted an analysis of all deaths from hematological neoplasms registered in Babol city between 2013 and 2021. In order to estimate the population, the most recent census data was used. The mortality rates and trends for each hematological malignancy were reported in crude mortality rate (CMR) and age-standardized mortality rate (ASMR).

Results: In total, 357 deaths (10.8% of all cancer-related deaths) were attributed to hematological neoplasms, with an average age of 61.9±19.3 years. The crude and age-adjusted mortality rates of hematological neoplasms increased from 3.1 and 2.7 per 100000 people in 2013 to 8.1 and 6.9 per 100,000 people in 2021, respectively. Mortality trends of hematological cancers increased with age decade for both sexes (P<0.001). Additionally, when examining the trends of each hematological neoplasm, there was a significant increase in neoplasms including non-Hodgkin lymphoma (P=0.033), multiple myeloma (P=0.002), and leukemia (P<0.001), except for the consistent trend observed in Hodgkin lymphoma (P=0.247).

Conclusion: The trend of hematological malignancies in Babol city is increasing across all age groups and in both sexes. This study emphasizes the need for effective prevention and treatment strategies, including improving access to cancer care, enhancing surveillance in families with blood malignancies and reducing modifiable risk factors. Additionally, further research is warranted to develop targeted interventions.

Background: Monitoring and evaluation are crucial in ensuring the effective implementation of health priorities. This descriptive study examined the progress towards implementing Iran's General Health Policies (IGHP) to illustrate how countries can effectively monitor and evaluate their national plans. Additionally, the study sought to identify factors that impede the full implementation of these policies.

Methods: Available data sources, formal reports, and studies were examined to gather data on selected indicators. Then, documentary analysis and 21 semi-structured interviews were conducted to identify measures taken to materialize IGHP and factors that hindered the full implementation of IGHP. Data were analyzed using the content analysis method.

Results: The results showed that several indicators improved during these years, while there was no data for some indicators. There are some barriers to implementing the IGHP, including lack of full understanding of the policies, absence of necessary mechanisms and infrastructures, lack of coherency and alignment of national health plans and policies, absence of monitoring and evaluation framework, and lack of transparency and accountability in the health system. As countries continue to develop their health plans and policies, lack of clarity regarding the progress of these plans remains a concern.

Conclusion: Countries need to strengthen their health planning systems and expedite the implementation of accountability mechanisms within the health system. Enhancing capacity building is essential to establish a comprehensive monitoring and evaluation framework. By fortifying these systems, countries will be better equipped to measure and track progress toward achieving their health objectives.

Dengue infection is an emerging public health issue in Iran, with about 149 confirmed newly infected cases. It can be transmitted by the bite of infected Aedes mosquitoes and even nosocomial routes. Due to the rapid replication and geographical spread of the mosquito, there is a potential risk of increased infected individuals. Given the possibility of the transmission of dengue infection through transfusion, it is important to implement policies to improve blood safety. Proper donor selection by utilizing appropriate blood donor questionnaires and performing general physical examinations, along with performing sensitive diagnostic tests on blood donor samples, utilizing pathogen reduction techniques, and implementing lookback programs, can be effective in reducing the risk of transfusion-transmitted dengue virus (TT-DENV).

Background: Xenogeneic graft-versus-host disease (xGvHD) is an inevitable confounder of preclinical evaluation of adoptive immunotherapies on tumor-bearing immunodeficient mouse models. This study was designed to appraise the clinical and histopathological effects caused by xGvHD in severely immunodeficient mice considering the T cell dosage.

Methods: Fifty NOG mice underwent intraperitoneal injection of three different doses of human-derived total T cells, a high dose of CD8⁺T cells, or vehicle (as control). Clinical and histopathological status of the study subjects were evaluated and compared according to scoring systems.

Results: In mice receiving higher doses of total T cells, the clinical severity of xGvHD was greater. However, recipients of CD8⁺T cells developed none to mild xGvHD manifestations. Higher doses of T cells were associated with poorer outcomes including premature death and more severe histopathologic damages. Greater CD3⁺T cell tissue engraftment (immunohistochemical CD3 positivity) was associated with more severe xGvHD-induced histopathological damages. Clinical xGvHD scores were significantly correlated with histopathological xGvHD scores in total and in each tissue. Mice with severe cutaneous symptoms had higher scores of xGvHD-induced histopathologic changes in the skin. Lethargy was associated with higher histopathological scores in the lungs, liver and spleen.

Conclusion: In preclinical evaluations, lower doses of T cell-based therapies are associated with milder xGvHD. Development of xGvHD may be averted by the use of CD4⁺T cell-depleted grafts. Histopathological and clinical scoring systems for evaluating xGvHD are significantly correlated. The lungs and liver are reliable organs for histopathological assessment and scoring of xGvHD.