Archives of Iranian Medicine最新文献

Background: Mitochondrial DNA (mtDNA) is a valuable marker for population studies and forensic investigations. Recent advancements in massively parallel sequencing technologies enable whole mitochondrial genome sequencing. This study collected blood samples from unrelated Iranian participants from four ethnic groups: Persian, Kurd, Lur, and Azeri. We mapped mtDNA haplogroups according to genetic ancestry and investigated the ethnic similarities within the Iranian population.

Methods: Complete mtDNA sequences were generated with targeted mtDNA sequencing method and haplogroups were determined on the base of mitogenome polymorphisms. Additionally, we used data from the whole exome sequencing (WES) of the current samples to compare the variants identified by two different mitochondrial testing methods. Principal component analysis (PCA) calculations were performed using the R software to determine diversity between unrelated individuals of various ethnicities.

Results: A total of 129 sub-haplogroups were identified in 15 main haplogroups. The findings revealed high frequencies of haplogroups U and H (22.4% and 20.3%, respectively) in the Iranian population. The PCA scatter plots revealed overlapping diversity, with no distinct trends separating the groups in these four groups within the Iranian population. In the present samples, the WES method identified only 57.8% of the variants detected by the targeted mtDNA sequencing method.

Conclusion: Variant studies do not show much difference, which indicate a small genetic difference between the central ethnic groups of Iran. Furthermore, comparing the targeted whole mitochondrial genome to mitochondrial data from WES in our study samples highlights the notion that targeted entire mitochondrial genome is a gold standard method for variant detection.

Background: Hypotension following spinal anesthesia is one of the most common complications of cesarean delivery, posing significant risks to both maternal and fetal health. The use of vasopressors is a primary method for the prevention and management of hypotension. Objective: This study aimed to compare the efficacy of norepinephrine and phenylephrine infusion in preventing hypotension in patients undergoing cesarean section under spinal anesthesia.

Methods: In this randomized, double-blind clinical trial, 90 pregnant women at 37 weeks of gestation scheduled for elective cesarean delivery were randomly assigned to receive either norepinephrine (n=47) or phenylephrine (n=43). The initial infusion rate was set at 5 µg/min for norepinephrine (up to a maximum of 60 mL/min) and 0.5 mg/min for phenylephrine (up to a maximum of 60 mL/min). Hemodynamic parameters, including systolic blood pressure (SBP) and diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate, were assessed. Additionally, umbilical cord blood gas values (PACO₂ and pH) at the time of birth were measured. Statistical analysis was performed using SPSS version 18 with descriptive statistics and independent t-tests or Mann-Whitney U tests (P≤0.05).

Results: The findings revealed no statistically significant differences between the norepinephrine and phenylephrine groups regarding SBP and DBP, MAP, heart rate, and umbilical cord blood gas values (PACO₂ and pH) at delivery (P≥0.05).

Conclusion: Norepinephrine and phenylephrine appear to have similar efficacy in preventing hypotension during cesarean delivery. Clinicians may select either drug based on the patient's clinical conditions and preferences.

Background: Pemphigus consists of a group of rare autoimmune bullous diseases that affect the skin and mucous membranes. Pemphigus includes three major forms: pemphigus vulgaris (PV), pemphigus foliaceus, and paraneoplastic pemphigus. Before the advent of systemic corticosteroids (SCSs), pemphigus was usually a fatal disease. Rituximab (RTX), a monoclonal antibody against the CD20+B cells has been approved for the treatment of patients with pemphigus. Previous studies have confirmed the high efficacy and safety profile of RTX in pemphigus patients. We aimed to estimate the overall mortality and causes of death among pemphigus patients who were admitted to the hospitals of Shahid Beheshti University of medical Sciences, Tehran, Iran, before and after administering RTX.

Methods: We included 480 patients admitted to Shahid Beheshti University of medical Sciences hospitals, Tehran, Iran, from October 2010 to October 2022. The diagnosis of all patients was confirmed by direct immunofluorescence and pathological studies. All variables such as age, sex, type of pemphigus, presence of comorbidities, medications, and cause of death were assessed.

Results: The prevalence of pemphigus was 262 (54.58%) in women and 218 (45.41%) in men (P value=0.004). These included 474 (98.75%) PV, 4 (0.83%) pemphigus foliaceus and 2 (0.41%) paraneoplastic pemphigus cases. The most common comorbidities were hypertension and diabetes mellitus (98 [20.41%] and 93 [19.37%], respectively). The overall mortality was 20 (4.16%), including 15 (75%) patients under treatment with high dose SCSs and immunosuppressive agents, and 5 (25%) patients who received at least 500 mg of RTX and low dose SCSs.

Conclusion: The mean age of the disease was found to be a decade earlier than other parts of the world, with a higher preponderance of women. The most common comorbidities were hypertension and diabetes mellitus. Most deaths were due to infectious and cardiovascular diseases. Mortality rate was 1/3 in patients who received RTX compared to those who were treated with high dose corticosteroids and other immunosuppressive agents.

Background: Hyperglycemia in pregnancy is believed to be associated with negative pregnancy outcomes. However, establishing a causal connection between diabetes mellitus (DM) and adverse pregnancy results is challenging due to the limitations inherent in traditional observational studies.

Methods: Our study used a two-sample Mendelian randomization (MR) technique to examine the possible influence of pregestational diabetes mellitus (PGDM) on adverse pregnancy outcomes. Summary-level data were obtained from genome-wide association studies (GWAS) of European ancestry and FinnGen biobank. The primary analysis employed the random-effects multiplicative inverse variance weighted (IVW) technique to appraise causal relationships between PGDM and adverse outcomes. Heterogeneity and pleiotropy were assessed using Cochran's Q statistic, Rucker's Q statistic, and the I² statistic. Sensitivity analyses were conducted using MR-Egger and weighted median methods. Additionally, outlier detection techniques, including MR-PRESSO and RadialMR, were applied.

Results: The results from the IVW method indicated no significant causal association between PGDM and stillbirth (SB) (OR (SE)=0.99 (0.001); P value=0.992), miscarriage (MIS) (OR (SE)=0.97 (0.016); P value=0.125), and preterm birth (PTB) (OR (SE)=1.072 (0.028); P value=0.014). Pleiotropy and heterogeneity tests revealed no evidence of pleiotropy for SB, MIS, and PTB (MR-Egger intercept P value=0.296, 0.525, and 0.532, respectively), with no observed heterogeneity for SB, MIS, and PTB (Q- P values of IVW were 0.929, 0.999, and 0.069, and MR-Egger were 0.931, 0.999, and 0.065, respectively).

Conclusion: Our findings indicate that there is no direct causal link between PGDM and the likelihood of MIS, SB, and PTB.

Background: Despite the high success rate of bronchial artery embolization (BAE), hemoptysis probably recurs. This study investigated risk factors of 12-month hemoptysis recurrence after BAE in an Iranian population.

Methods: In this prospective cohort, we followed up 101 patients for 12 months after BAE. Outcome of interest was recurrence of hemoptysis. Target arteries were super-selectively catheterized and embolized with non-spherical polyvinyl alcohol particles (150-700 µm). Success of BAE was confirmed using post-BAE angiography. Independent t-test, and chi-square and Fisher's exact test were used to compare variables between "recurrence" and "non-recurrence" groups. We investigated predictors of recurrent hemoptysis through univariate and multivariate logistic regression modeling. We analyzed receiver operating characteristic curve to find the optimal cutoff point for continuous risk factors. Recurrence-free rates stratified by risk factors were plotted against time using the Kaplan-Meier method.

Results: BAE was immediately successful in all patients. During the 12-month follow-up, hemoptysis recurred in 13.9% (95% CI: 8.2-21.6) of participants. Mean (±standard deviation) recurrence-free time was 6.9 (±3.3) months. Lung destruction (OR=5.40 [95% CI: 1.41-20.58], P value=0.013) and arterial diameter≥2 mm (12.51 [1.51-103.59], P value=0.019) were independent predictors of 12-month hemoptysis recurrence.

Conclusion: Patients with destroyed lungs and embolized arteries wider than 2.0 mm are at higher risk of hemoptysis recurrence in the first year after BAE.

Background: The fibrosis 4 (FIB-4) index is typically used in assessing liver fibrosis, and has shown potential in predicting the outcome in various diseases. This study aims to evaluate the predictive power of the FIB-4 index for mortality in COVID-19 patients admitted to a reference hospital in Tehran, Iran.

Methods: In this prospective cohort study, 387 patients with COVID-19 without diabetes, were categorized into deceased and surviving groups. We compared anthropometric and demographic data, liver function tests, CT scores, and FIB-4 indices between the groups. Multivariate logistic regression assessed the independent association of FIB-4 with mortality.

Results: Among the 387 patients, (all non-diabetics), 58 (15%) died, with a higher mortality rate observed in patients with a FIB-4 index≥2.6 (63.4%) compared to those with FIB-4<2.6 (29.7%). Deceased patients were considerably older and more likely to be hypertensive (P values<0.001). After adjustment of confounding factors, a FIB-4 index≥2.6 was found to be independently associated with increased mortality (OR: 13.511, 95% CI: 1.356-134.580, P=0.026).

Conclusion: The FIB-4 index, calculable by routine laboratory tests, may be a valuable prognostic factor for COVID-19 mortality. This easily obtainable marker could help identify high-risk patients early, potentially allowing for more rapid intervention and treatment prioritization.