Archives of Iranian Medicine最新文献

Bacterial respiratory infections pose significant health risks to children, particularly infants susceptible to upper respiratory tract infections (URTIs). The COVID-19 pandemic has further exacerbated the prevalence of these infections, with pathogens such as Mycoplasma pneumoniae, Streptococcus pneumoniae, Legionella pneumophila, Staphylococcus aureus, Haemophilus influenzae, and Klebsiella species commonly implicated in pediatric cases. The critical need for accurate and timely detection of these bacterial agents has highlighted the importance of advanced diagnostic techniques, including multiplex real-time PCR, in clinical practice. Multiplex real-time polymerase chain reaction (PCR) offers several advantages, including rapid results, high sensitivity, and specificity. By accelerating the diagnostic process, this approach enables early intervention and targeted treatment, ultimately improving patient outcomes. In addition to PCR technologies, rapid and point-of-care testing (POCT) play a crucial role in the prompt diagnosis of bacterial respiratory infections. These tests are designed to be user-friendly, sensitive, and deliver quick results, making them particularly valuable in urgent clinical settings. POCT tests are often categorized into two main groups: those aimed at determining the cause of infection and those focused on confirming the presence of specific pathogens. By utilizing POCT, healthcare providers can make rapid and informed treatment decisions, leading to more effective management of bacterial respiratory infections in children. As the medical community continues to explore innovative diagnostic approaches, the integration of molecular and rapid testing methods offers significant promise in the realm of bacterial respiratory infections. By adopting these cutting-edge technologies, healthcare professionals can enhance their ability to accurately diagnose these infections, tailor treatment strategies, and ultimately improve patient care.

Background: The incidence of kidney stones has been rising globally, particularly among the elderly. This study aims to determine the prevalence of kidney stones and its associated factors in Iran.

Methods: This cross-sectional study was conducted using the data collected in the first phase of Ardakan Cohort Study on individuals aged 50 years and above, in the Yazd province, Iran. Baseline data was collected using a comprehensive checklist and kidney stone occurrence was ascertained through participants' self-reported response to the question "Have you ever been diagnosed with kidney stones?" Logistic regression analysis was used due to the binary nature of the outcome.

Results: Period prevalence of kidney stone was 22.79 (95% CI=19.41 to 24.12). Thus, out of the total sample of 4,884 individuals, 1113 participants had a history of kidney stones. Among these, 412 (37%) were female and 701 (63%) were male. Significant associations were observed between a history of kidney stones and factors such as self-reported poor health, alcohol consumption, dysuria, higher education level, male gender, and presence of calcium oxalate crystals.

Conclusion: This study shows the high prevalence of kidney stones compared to other studies. Considering the relationship between kidney stones and some preventable disorders in the elderly, such as high blood pressure and alcohol consumption, it seems that paying attention to kidney stone disorders can be part of preventive health and treatment interventions for this population group.

Background: Lactating adenoma is an infrequent benign stromal breast tumor mostly seen during pregnancy and lactation. This report seeks to enhance the literature by presenting three cases diagnosed with this condition, while also highlighting its histological subtypes, immunohistochemical characteristics, and differential diagnoses. Case Presentation: In all three patients, a circumscribed, painless, and mobile mass was found in the breast in the third trimester of pregnancy. Pathohistological examination revealed hyperplastic lobules with glandular formations in back-to-back arrangements showing more or less abundant hobnailing phenomena with intraluminal eosinophilic secretions and inconspicuous myoepithelial cell layer separated by fibrovascular stroma. The immune profile showed positive reaction for cytokeratin 14 and p40 markers, indicating the presence of myoepithelial cells and distinguishing these cases from other breast lesions.

Conclusion: Pathohistological and immunohistochemical analysis should be performed to differentiate these lesions from other benign lesions and malignant tumors.

Background: Today, excessive demand for blood products is a common issue across various medical departments. This demand can lead to improper distribution, waste of blood products, and poor availability for emergency patients. Additionally, it increases costs and the workload of blood banks, disrupting the proper distribution of products among medical centers. Ultimately, all these factors contribute to a decrease in the quality of blood products. This study was conducted to investigate the pattern of blood requests and utilization at 5-Azar Educational Hospital in the Golestan province in 2022.

Methods: This cross-sectional study was conducted from June to August 2022. The study population comprised all patients who requested blood product reservations upon admission to the hospital.

Results: In the present study, 514 patients with requests for blood product reservations were included, resulting in 739 cross-matches and ultimately 677 transfusions. The cross-match to transfusion (C/T) ratio for this study was 1.09, while the probability of transfusion (T %) was 91.6%. The highest incidence of blood reservation wastage was associated with the neurosurgery department.

Conclusion: By addressing the identified challenges and promoting adherence to guidelines, healthcare institutions can improve patient outcomes and ensure responsible use of blood resources.

Cytoskeletal dynamics, the interplay of actin, microtubules, and septins, is a highly coordinated and tightly regulated process. Defects in the proteins involved can result in a wide range of cellular consequences. Hearing loss is the most common sensory defect and exhibits extraordinary genetic and phenotypic heterogeneity. Currently, there are more than 170 genes casually linked to non-syndromic hearing loss (NSHL), of which more than 60 are associated with autosomal dominant inheritance. Here, we add to this growing number by implicating MACF1 (OMIM # 608271), as a novel candidate gene for autosomal dominant non-syndromic hearing loss (ADNSHL). MACF1's cytoskeleton integrator function and hair cell expression pattern lead one to believe that it is a necessary protein for hair cells. Many protein domains in MACF1 allow for dynamic interaction with the cytoskeleton. A large Iranian family segregating progressive ADNSHL was recruited for this study. The proband had bilateral mild-moderate sensorineural hearing loss and was negative for GJB2 mutations. After applying exome sequencing on the proband, a missense mutation c.1378C>T (p.His460Tyr) was found in MACF1 and co-segregated with the hearing loss in the extended family. We speculated that MACF1 mutations probably cause non-syndromic hearing loss inherited in an autosomal dominant manner. The potential functional impact of the identified variant will be investigated through further analysis.

Background: Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are rare entities. Generally, they can be localized anywhere in the gastrointestinal or hepatobiliary tract. The purpose of our study is to evaluate the effect of tumor location on prognosis in patients with GEP-NET undergoing surgery. Our secondary objective is to examine other factors affecting the prognosis of patients with GEP-NET.

Methods: We retrospectively analyzed data from 30 patients with GEP-NET who underwent surgery in the General Surgery Clinic between 2012 and 2022. The gNET group (n=18) included tumors located in the gastrointestinal tract, while the pNET group (n=12) included tumors located in the hepatopancreatobiliary system. Surgical, laboratory, radiological, and pathological findings of the patients, as well as follow-up outcomes were recorded and statistically analyzed.

Results: In subgroup comparison, tumor size was found to be larger in the pNET group (P=0.002). The statistical analysis of recurrence (16.7% versus 33.3%) and mortality rates (16.7% versus 41.7%) between the subgroups (P=0.329 and P=0.210, respectively) did not reveal a significant difference. When all patients were evaluated, it was observed that advanced age, presence of carcinoma diagnosis, higher tumor grade, advanced TNM stage, larger tumor size, presence of lymphovascular or perineural invasion, elevated mitotic index, higher Ki-67 index, and having received adjuvant therapy increased the rates of recurrence and mortality.

Conclusion: There was no statistically significant difference in survival outcomes between the GEP-NET groups located in the gastrointestinal tract and the hepatopancreatobiliary system.

Background: Diabetics constitute a significant percentage of hemodialysis (HD) patients with higher mortality, especially among male patients. A machine learning algorithm was used to optimize the prediction of time to death in male diabetic hemodialysis (MDHD) patients.

Methods: This multicenter retrospective study was conducted on adult MDHD patients (2011-2019) from 34 HD centers affiliated with Shiraz University of Medical Sciences. As a special type of machine learning approach, an elastic net penalized Cox proportional hazards (EN-Cox) regression was used to optimize a predictive regression model of time to death. To maximize the generalizability and simplicity of the final model, the backward elimination method was used to reduce the estimated predictive model to its core covariates.

Results: Out of 442 patients, 308 eligible cases were used in the final analysis. Their death proportion was estimated to be 28.2%. The estimated overall one-, two-, three-, and eight-year survival rates were 87.6%, 74.4%, 67.2%, and 53.9%, respectively. The EN-Cox regression model retained 14 (out of 35) candidate predictors of death. Five variables were excluded through backward elimination technique in the next step. Only 6 of the remaining 9 variables were statistically significant at the level of 5%. Body mass index (BMI)<25 kg/m² (HR=2.75, P<0.001), vascular access type (HR=2.60, P<0.001), systolic blood pressure (1.02, P=0.003), hemoglobin (11≤Hb≤12.5 g/dL: HR=3.00, P=0.028 and Hb<11 g/dL: HR=2.95, P=0.021), dialysis duration in each session≥4hour (HR=2.95, P<0.001), and serum high-density lipoprotein cholesterol (HDL-C) (HR=1.02, P=0.022) had significant effects on the overall survival (OS) time.

Conclusion: Anemia, hypotension, hyperkalemia, having central venous catheter (CVC) as vascular access, a longer dialysis duration in each session, lower BMI and HDL-C were associated with lower mortality in MDHD patients.

Background: Right ventricular diastolic dysfunction (RVDD) increases the volume load on the right ventricle. We aimed to evaluate the association of RVDD with perioperative outcomes in patients undergoing isolated coronary artery bypass graft surgery (CABG).

Methods: This single-center observational study included all consecutive isolated CABG patients with a left ventricular ejection fraction (LVEF)>40% from May 2022 to May 2023 who were evaluated for RV diastolic function by transthoracic echocardiography. We divided patients into two groups, with and without RVDD, and then compared the two groups in terms of the primary outcomes of the duration of hospitalization, intensive care unit (ICU) stay, and intubation time, and the secondary outcome composed of postoperative in-hospital complications.

Results: Our study found that 49.1% of patients suffered from RVDD, and patients with RVDD had significantly lower systolic blood pressure and were more likely to take angiotensin-converting enzyme inhibitors than those without RVDD. There was no association between RVDD and primary outcomes of hospitalization time (β=-0.01; 95% CI -0.05, 0.04; P value=0.717), ICU stay (β=0.01; 95% CI -0.18, 0.17; P value=0.984) and intubation time ([β=0.06; 95% CI -0.05, 0.17; P value=0.309). However, more postoperative complications occurred in patients with RVDD (90% vs. 85%). After adjustment for confounding factors, RVDD was not independently associated with primary and secondary outcomes.

Conclusion: Preexisting RVDD in CABG patients with LVEF>40% increased postoperative complications but not significantly. More extensive studies are needed to evaluate RV diastolic function before cardiac surgery to identify high-risk patients and optimize their perioperative management.

Background: Lichen planopilaris (LPP) is a rare, inflammatory condition leading to scarring alopecia, predominantly affecting middle-aged women. Traditional treatments have shown limited efficacy, highlighting the need for novel therapeutic approaches. Tofacitinib, a Janus kinase (JAK) inhibitor, has shown promise in treating various autoimmune diseases, including autoimmune dermatological disorders. This study aims to evaluate the efficacy of tofacitinib in treating patients with LPP.

Methods: We conducted a retrospective, single-center observational study at Shohadaye Tajrish Hospital, reviewing records of 74 patients with biopsy-confirmed LPP who had extensive and treatment-resistant disease. Patients were treated with tofacitinib 5 mg twice daily for at least 16 weeks. Efficacy was assessed using the LPP Activity Index (LPPAI), and adverse events were monitored.

Results: This study evaluated 74 patients with LPP, predominantly female (83.3%), with a mean age of 46.64±8.05 years. The mean LPPAI score significantly decreased from 4.61±1.26 before treatment to 1.73±1.68 after six months (P<0.0001). Response rates varied: 21.62% within 1‒3 months, 24.32% within 3‒6 months, 33.78% within 6‒12 months, and 8.10% within 12‒24 months, with 6.75% showing no response. Adverse effects included headache (8.10%), hyperlipidemia (2.70%), elevated liver enzymes (5.40%), nausea (6.75%), and high blood pressure (4.15%).

Conclusion: Tofacitinib represents a promising treatment for LPP, providing significant improvement in disease activity for most patients. Further research is needed to refine treatment protocols, understand predictors of response, and address gender-specific adverse effects.

In contrast to experimental studies indicating the neuroprotective role of uric acid (UA), recent clinical studies have shown that increased UA is associated with a risk of acute hemorrhagic stroke. However, the association of UA with intraventricular hemorrhage (IVH) has not been adequately evaluated. In this study, we determined the relationship between UA and IVH in patients with intracerebral hemorrhage (ICH). We included 721 patients with ICH who were admitted to a tertiary hospital in South Korea. The patients were stratified into quartiles based on their UA levels. IVH decreased continuously across all quartiles of UA. After adjusting for confounding factors, the odds ratio (OR) for IVH was significantly lower in the fourth quartile compared with that in the first quartile (OR: 0.713; 95% CI: 0.546-0.934; P=0.045). In conclusion, UA is independently associated with IVH, suggesting its protective role against IVH in patients with ICH.