Archives of Iranian Medicine最新文献

Anticholinergic agents, such as atropine and glycopyrrolate, are commonly utilized during anesthesia for their effects on secretion reduction and vagal activity. However, substantial dosages can induce mydriasis, which poses diagnostic challenges, particularly in head and neck surgeries. Despite their clinical relevance, limited studies explore these effects. A 35-year-old female presented with a left parotid mass and scheduled for a left superficial parotidectomy. Preoperatively, the patient exhibited normal ocular and neurological function. Postoperatively, fine bilateral ptosis, predominantly on the left side, and bilateral unresponsive mydriasis were noted. Anticholinergic-induced pupillary changes may mimic neurological pathology, underscoring the necessity for meticulous postoperative evaluation and awareness among clinicians.

Background: The Global Burden of Disease (GBD) studies highlight oral health as a significant global concern, particularly in regions such as Iran, the Middle East and North Africa (MENA). This study synthesizes GBD data on the incidence, prevalence, and disability-adjusted life years (DALYs) associated with dental caries and oral disorders to inform targeted interventions aimed at alleviating their burden and improving outcomes in these regions.

Methods: This study employs estimation techniques to comprehensively assess the occurrence and impact of dental caries in deciduous and permanent teeth, along with oral disorders across Iran, MENA, and globally. Data were drawn from the GBD site. We analyzed incidence, prevalence, and DALYs, utilizing disability weights with joinpoint regression models to inform public health interventions.

Results: From 1990 to 2021, global and regional trends in dental caries and oral disorders were examined. Descriptive statistics illustrate significant regional disparities in incidence, prevalence, and DALYs. Globally, the incidence rate of caries in deciduous teeth decreased at an average annual percent change (AAPC) of -0.25% (95% CI: -0.30 to -0.20), while the MENA region and Iran showed AAPCs of -0.57% (-0.65 to -0.49) and -0.08% (-0.15 to -0.01), respectively. These trends highlight both progress and persistent disparities. The models reveal temporal changes in disease burden, with notable declines and fluctuations over time. These findings underscore persistent challenges in oral health, particularly in regions such as Iran and MENA, where socioeconomic conditions and healthcare access vary significantly.

Conclusion: This study underscores considerable regional variation in dental caries and oral disorders, emphasizing ongoing public health challenges. Demographic shifts and reduced sugar intake, influenced by sociopolitical factors like war, have significantly decreased the global burden of oral conditions since 1990. The findings underscore the urgency of integrating oral health into primary care systems, expanding subsidized fluoride programs in rural areas, and addressing socioeconomic barriers to dental access in MENA. Community-driven initiatives, such as school-based screenings and mobile dental clinics, should be prioritized in underserved regions.

Background: Uric acid (UA) may influence bone health through its antioxidant and pro-oxidant properties. While previous studies have investigated the relationship between serum UA levels and bone mineral density (BMD), their findings have been conflicting. This study aimed to examine the impact of serum UA levels on BMD in peri- and postmenopausal Korean women.

Methods: We evaluated 3,566 women aged 50-80 years who voluntarily underwent laboratory tests and BMD measurements as part of a general health examination between March 2014 and March 2020. Participants were stratified into quartiles according to their serum UA levels. Univariate and multivariate analyses were performed to assess the association between serum UA levels and BMD.

Results: The mean age of the participants was 56.9±5.8 years. BMD at the lumbar spine and hip was significantly higher in women with elevated serum UA levels, showing a continuous increase across the quartiles. Furthermore, after adjusting for covariates, the mean total lumbar spine BMD increased from 0.892 g/cm² (95% CI: 0.884-0.900) in the lowest UA quartile to 0.918 g/cm² (95% CI: 0.909-0.927) in the highest quartile (P<0.001). Similarly, the adjusted total hip BMD was higher in the highest UA quartile at 0.847 g/cm² (95% CI: 0.840-0.854) compared with 0.828 g/cm² (95% CI: 0.821-0.834) in the lowest quartile (P=0.001).

Conclusion: Our results suggest that elevated serum UA levels are associated with higher BMD in peri- and postmenopausal Korean women, indicating a potential protective role in bone metabolism.

Background: Dietary factors are a key risk for breast cancer. This study examines the global burden of breast cancer attributed to a high red meat diet from 1990 to 2021.

Methods: Using Global Burden of Disease Study (GBD) 2021 data, deaths and disability-adjusted life-years (DALYs) were analyzed globally, regionally, and nationally. Trends were assessed through estimated annual percentage changes (EAPCs) in age-standardized mortality (ASMR) and DALY (ASDR) rates. A decomposition analysis quantified the contributions of population growth, aging, and epidemiological changes. The relationship between sociodemographic index (SDI) and burden was examined using Spearman rank test. Health inequalities were assessed using the Slope Index of Inequality for absolute inequality and the Concentration Index for relative inequality.

Results: By 2021, breast cancer deaths and DALYs linked to high red meat intake had increased significantly compared to 1990, despite a decline in ASMR [EAPC: -0.77 (95% CI -0.82 to -0.72)] and ASDR [EAPC: -0.65 (95% CI -0.70 to -0.60)]. These trends were driven by population growth and aging, with regional variability in the pace of demographic transitions. North Africa and the Middle East experienced the largest rise in ASMR [EAPC: 2.03 (95% CI 1.79 to 2.26)], while Pacific Island nations had the highest ASMR and ASDR. High-SDI regions had the highest ASMR [1.14 per 100000 (95% UI -0.01‒2.43)] and ASDR [33.07 per 100000 (95% UI -0.02‒69.90)], with a positive SDI-burden correlation in low- and middle-SDI regions (P<0.05), but a negative correlation in high-SDI regions (P<0.05). From 1990 to 2021, absolute inequality [35.79 (95% CI 29.13‒42.46) vs. 4.99 (95% CI -1.59-11.56)] and relative inequality [0.18 (95% CI 0.16‒0.21) vs. 0.02 (95% CI -0.01‒0.05)] decreased.

Conclusion: Although ASMR and ASDR have declined, the absolute burden of breast cancer due to high red meat intake remains significant, particularly in aging and rapidly urbanizing populations. Policy interventions should include taxation on red meat, restrictions on processed meat, and public health campaigns promoting dietary modifications. Targeted screening programs in high-risk regions, especially for middle-aged and elderly populations, are critical for mitigating the future disease burden.

Background: A comparative study of the structure, characteristics, background, and functions of scientific associations of medical sciences in Iran with other leading countries in the field of medical sciences can serve as a way forward for the future planning of these associations. This research was conducted to compare the status of medical associations in Iran and European and American countries.

Methods: This is a descriptive-comparative study. After selecting scientific associations in Iran, Europe, and America, data were collected by triangulation. To validate the study's findings, the results of the comparisons were discussed in a meeting attended by ten medical association's representative.

Results: The structure of medical associations in Iran reveals significant differences compared to their counterparts in European and American countries. The primary mission of medical associations in Iran is focused on professional development; however, their roles in policymaking are not clearly defined. All analyzed associations, whether in Iran, Europe, or the US, operate as private, non-profit entities. In terms of performance, Iranian medical associations display the highest activity levels in education (66.6%), social engagement (70%), and research (76.6%). However, they lack engagement in advisory services and advocacy-related activities. Conversely, medical associations in the US are active across all these domains, playing a significant role in healthcare.

Conclusion: The results of the present study show that in Iran, most scientific associations are limited to activities in the field of education and research, while in European and American countries, they play a role in policy making and as advocates for their members.

Background: Biofilm formation by bacteria on the lower limb arises from reduced peripheral arterial blood flow, which can lead to the failure of antibiotic therapy or require longer duration of intravenous antibiotic therapy in diabetic foot infection-associated osteomyelitis. N-acetyl cysteine (NAC), an agent known to prevent and treat biofilm-related infections, was used as a novel strategies beside antibiotic therapy in osteomyelitis of diabetic foot with the aim of accelerating the response to antibiotic therapy regimen.

Methods: To assess the synergistic effect of NAC with antibiotic therapy, patients with diabetic foot osteomyelitis (DFO) (grade III or IV Wagner) were randomly assigned to either NAC 600 mg effervescent tablet twice daily for 2 weeks or the control group. Clinical and laboratory data, including white blood cell with differentiation and inflammatory factors (ESR and CRP) were measured at baseline (time 0), after one week and after three weeks of initiating the intervention.

Results: Fifty-three eligible patients completed the study. All evaluated infectious-related laboratory parameters showed significant reductions in the NAC group compared to control (P<0.05), except for lymphocyte proportion and NLR (P; 0.11 and 0.84, respectively). The drop rate of ESR and CRP were accelerated by NAC compared to the control group (-49.44±6.04 vs -7.17±3.99; -44.43±4.21 vs -14.02±4.05, respectively, P<0.05).

Conclusion: In order to accelerate antibiotic responses and the trend of reduction in infectious inflammatory markers during the therapy, oral NAC 600 mg twice daily may be considered in the treatment protocol of patients with DFO.

Background: Immunoglobulin G4-related disease (IgG4-RD) is a rare, chronic inflammatory condition characterized by fibrosis and tendency for multi-organ involvement. This study aims to analyze the clinical characteristics associated with multi-organ versus single-organ involvement in IgG4-RD, thereby enhancing clinicians' understanding of the differences between these two patient groups and ultimately improving patient prognosis.

Methods: We performed a retrospective analysis of clinical data from 82 patients diagnosed with IgG4-RD admitted to Yichang Central People's Hospital between January 2019 and December 2024.

Results: Among the 82 patients diagnosed with IgG4-RD, 47 patients (57.32%) exhibited involvement of multiple organs. The incidence of multi-organ involvement was significantly higher in male patients than female patients [63.49% vs. 36.84%, odds ratio (OR): 2.98, 95% confidence intervals (CI): 1.03-8.64, P<0.05]. The misdiagnosis rate in the multi-organ involvement group was significantly higher than that in the single-organ involvement group (29.79% vs. 8.57%, OR: 4.525, 95% CI: 1.19-17.26, P<0.05). In patients with involvement of the pancreas (72.50% vs. 42.86%, OR: 3.515, 95% CI: 1.39-8.86, P<0.05), or lymph nodes (83.72% vs. 28.21%, OR: 13.091, 95% CI: 4.50-38.11, P<0.05), the incidence of additional organ involvement was significantly higher than those with involvement of other organs. The eosinophil percentage [median difference (Hodges-Lehmann): 1.60%, 95% CI: 0.40-2.80, P<0.05], absolute eosinophil count [median difference (Hodges-Lehmann): 0.10×10⁹/L , 95% CI: 0.30-0.16, P<0.05], serum immunoglobulin G (IgG) levels [median difference (Hodges-Lehmann): 4.10 g/L, 95% CI: 0.10-7.80, P<0.05], and erythrocyte sedimentation rate (ESR) [median difference (Hodges-Lehmann): 30.50 mm/h, 95% CI: 13.00-48.00, P<0.05] were significantly higher in the multi-organ involvement group compared to the single-organ involvement group. There was a positive correlation between the number of involved organs and ESR (r=0.404, 95% CI: 0.166-0.597, P=0.001), eosinophil percentage (r=0.287, 95% CI: 0.068-0.480, P=0.009), absolute eosinophil count (r=0.293, 95% CI: 0.075-0.485, P=0.007), serum IgG levels (r=0.370, 95% CI: 0.130-0.570, P=0.003), and serum IgG4 levels (r=0.370, 95% CI: 0.130-0.570, P=0.003).

Conclusion: The clinical features associated with multi-organ involvement in IgG4-RD are characterized by significant diversity and complexity. Clinicians must enhance their understanding of the characteristics associated with multi-organ involvement to more effectively improve patient prognosis.

Background: Lung cancer (LC) is a common life-threatening malignancy in humans. Cisplatin has been widely used in the treatment of various types of cancer. miR-383 is dysregulated in multiple cancers, and participates in tumorigenic processes, including apoptosis, proliferation, metastasis, and drug resistance. This study aimed to investigate the synergistic effect of miR-383 and cisplatin in LC.

Methods: A549 cells were treated with cisplatin and miR-383 separately or in combination. Cell viability, apoptosis induction, stemness features, migratory capacity, and autophagy were measured by various methods. In addition, quantitative real-time PCR (qRT-PCR) was used to evaluate the expression levels of genes involved in apoptosis, stemness, and migration.

Results: The results demonstrated that miR-383 transfection in A549 cells increased their chemosensitivity to cisplatin, enhancing cisplatin-induced apoptosis (from 11.28% to 37.86%). This effect was mediated by regulating key genes such as Bcl-2 and Caspase-3 (P<0.0001). Moreover, the combination of miR-383 and cisplatin synergistically reduced cell migration and colony formation. It also downregulated metastatic and stemness-related genes, including MMP-2 and CD44, respectively (P<0.0001).

Conclusion: The findings indicate that the combination treatment of miR-383 and cisplatin suppressed cell proliferation, migration and colony formation while enhancing the sensitivity of A549 cells to chemotherapy compared to monotherapy. These results suggest that miR-383 combination therapy warrants further investigation as a potential strategy for LC treatment.