bluuebunny/crossref_metadata_2025 huggingface dataset:
Duodenal monomorphic epitheliotropic intestinal T cell lymphoma along with unpredictable intestinal Epstein-Barr virus infection; a rare newly redefined entity in a rare site and review of literature
Authors: Saad El-Din Somaia Ahmed , Al Hashmi Khalid , Hamad Khaled , Al-Ghafri Fahad
Published: May 2022

Introduction: Monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL), previously known as type II enteropathy associated T-cell lymphoma (EATL), was redefined by the WHO (2016) as separate entity from the celiac disease-associated lymphoma. It is an extremely rare and highly aggressive peripheral T-cell lymphoma. It mainly involves jejunum and ileum and rarely duodenum. Case Presentation: This was a 38-year-old male patient presented by daily vomiting related to meals for 8 months along with generalized colicky abdominal pain associated with constipation and marked weight loss. Upper endoscopy showed large ulcerated mass at the third part of the duodenum. Histopathological examination showed the diffuse malignant lymphoid infiltrate with morphology and immunophenotyping consistent with MEITL associated with unpredictable Epstein-Barr virus (EBV) in intestinal epithelial cells. The patient underwent five cycles of chemotherapy (cyclophosphamide, hydroxydaunorubicin, oncovin and prednisone) followed by duodenectomy. Conclusion: This case represents a rare newly redefined lymphoma entity in a rare site associated with unpredictable non-neoplastic epithelial EBV infection, which proved to be oncogenic agent involved in various hematopoietic and other neoplasms with unclear relationship to the development of this MEITL.
The effect of supplemental oxygen on 6-minute walk test in chronic obstructive pulmonary disease patients
Authors: Ghiasi Farzin , Sajjadfar Fatemeh , Sadeghi Somayeh
Published: May 2022

Introduction: Chronic obstructive pulmonary disease (COPD) is an inflammatory lung disease that associated with abnormal airflow during respiration. It has been demonstrated that supplemental oxygen used in the time of exercise testing has a considerable positive effect in cases with COPD. Objectives: Present study was aimed to investigate the possible effects of supplemental oxygen on the outcomes of 6-minute walk test (6MWT). Patients and Methods: COPD cases were randomly divided into two groups (n= 50/each). Group1; patients who received nasal oxygen during the 6MWT, and group two were patients who did not receive supplemental oxygen during the test. Results: The Shapiro-Wilk test showed that the distribution of all parameters in two groups followed the normal distribution. The total distance walked was 431.54±40.76 m in the intervention group and 399.08±49.94 m in the control group, with a significant difference between the two groups (P= 0.001). After 6MWT, the mean of SpO2 in the intervention group was significantly higher than the control group (P= 0.002) and the degree of dyspnea was significantly lower than the control group (P= 0.031). Conclusion: Overall, supplemental oxygen has significant positive effects in COPD patients, but definitive commentary is needed for further studies. Trial registration: The trial protocol was approved by the Thai Clinical Trials Registry (identifier: TCTR20220122001; https://www.thaiclinicaltrials.org, ethical code; IR.MUI.MED.REC. 1396.308.3).
Comparison of prone and supine status on oxygenation of patients with COVID-19 with acute hypoxemia treated using reservoir mask; a randomized clinical trial
Authors: Darban Mahboubeh , Memarian Mohammad , Malek Farhad , Bahrami Mohammad , Gohari Ali
Published: May 2022

Introduction: In early December of 2019, the first coronary pneumonia cases were identified, an emerging disease which is associated with higher mortality and morbidity and a higher proportion of deaths in population. Objectives: A significant number of patients progress towards acute respiratory distress syndrome (ARDS). Therefore, if we can control pulmonary involvement in the initial stages and before reaching severe degrees of ARDS, we will have given a great assistance to patients. Patients and Methods: A randomized clinical trial was conducted on 30 SARS-CoV-2 patients with acute respiratory hypoxia. The study population was randomly divided into two equal parts including group P (prone) and group S (supine). Patients in the prone group were placed in the prone position, six hours per day for three days, while received oxygen therapy by reserve bag and another group received oxygen therapy in the supine position by using reserve bag. Finally, the data were analyzed using statistical software. Results: In total, both groups showed significant results during three days of hospitalization, however, the considered variables of relative arterial oxygen pressure and PA/FiO2 during three days of the hospitalization in the prone group were significantly higher than the supine group (P=0.022 and P=0.012). Other variables did not show any statistically significant differences. Conclusion: Relative arterial oxygen pressure and PA/FiO2 in the prone group were significantly higher than the supine group. This finding shows the importance of prone status in the process of oxygenation and recovery of patients. Trial Registration: The trial was registered by the Iranian Registry of Clinical Trials (identifier: IRCT20151020024625N12; https://www.irct.ir/trial/55690/view, Ethical code# IR.SEMUMS.REC. 1399.201).
Vaginal versus intrauterine extra-amniotic administration of misoprostol for second-trimester pregnancy termination; a randomized clinical trial
Authors: Beheshti Monfared Niloufar , Raoofi Zahra , Soleimani Reza , Mohammadi Sassan , Hosseini Shima , Ghaderi Hamid , Beheshti Monfared Mahmoud
Published: May 2022

Introduction: Misoprostol is a widely used prostaglandin to terminate pregnancy in the second trimester. The route of drug administration has a significant effect on the quality of treatment. Objectives: In this study, we aimed to compare efficacy and adverse effects of vaginal and intrauterine extraamniotic administration of misoprostol in second-trimester termination. Patients and Methods: In a randomized clinical trial, 112 women with an intrauterine fetal death between 13– 24 weeks of gestation attended Akbarabadi hospital were enrolled during 2018-2019. Patients were randomly divided into two groups. In group A, 200 µg misoprostol was diluted in 10ml of normal saline and administered extra-amniotic every 4 hours. Group B received vaginal tablets (200 µg in each) according to FIGO protocol. The primary outcomes were the time needed to expel gestational products and hemoglobin level changes. Results: In group A, conception product expulsion occurred within an average of 7.52 ± 0.29 hours, significantly faster than group B (12.02 ± 0.42 hours; P<0.05). In group A, the Hemoglobin level decreased after intervention (-1.23 ± 1.20 g/dL), and the changes were more prominent than group B (-0.15 ± 0.51 g/dL; P<0.05). Conclusion: For pregnancy termination, intrauterine extra-amniotic administration of misoprostol is a more effective method than the vaginal route in the second trimester. However, regarding further hemoglobin decrease in this method, its safety is still unclear and needs to be approved by further clinical trials with a larger sample size. Trial Registration: The trial protocol was approved by the Iranian Registry of Clinical Trial (identifier: IRCT20190606043830N1; https://en.irct.ir/trial/40184, ethical code: IR.IUMS.FMD.REC1396.941129004).
The therapeutic effects of chicory seed aqueous extract on cardio-metabolic profile and liver enzymes in nonalcoholic fatty liver disease; a double blind randomized clinical trial
Authors: Marzban Maral , Bahrami Mohsen , Kamalinejad Mohammad , Tahamtan Maryam , Khavasi Narjes , Haji Monfared Mahdie , Jameshorani Maryam
Published: May 2022

Introduction: As diabetes and obesity increase worldwide, non-alcoholic fatty liver disease (NAFLD) becomes a more worrying health threat. Objectives: This study was designed to assess the impacts of chicory seed aqueous extract on the treatment of NAFLD. Patients and Methods: Around 60 patients with NAFLD who referred to Zanjan Metabolic Disease Research Center between March 2016 and April 2017 were allocated into treatment and placebo groups, randomly. The participants in the treatment group (n=30) were scheduled to consume 8 ml of chicory seed syrup (made by soaking 100 g of dried seeds in one liter of boiling water) twice daily for 12 weeks. The control group’s patients received placebo syrup with an identical figure and flavor and also with the same prescript. The analysis of covariance (ANCOVA) test, chi-square test, independent t-test and paired t test were applied for analysis of data. From the point of statistical view, P < 0.05 was considered significant. Results: The body mass index (BMI), liver enzymes, fasting blood sugar test (FBS), HbA1c, fatty liver grading and all the indices of lipid profile decreased significantly (all P values < 0.001) in the chicory group. The shifting change in fatty liver grading was also striking in treatment group’s patients compared to controls. Conclusion: The findings of this study support the application of chicory seed in the treatment of NAFLD due to the ameliorative effects on the metabolic indices of the disease. Trial Registration: This clinical trial protocol has been registered in Iranian Registry of Clinical Trial (identifier: IRCT2016061228411N1; https://en.irct.ir/trial/23063, ethical code #IR.ZUMS.REC.1395.195).
Alleviative effects of fibroblast growth factor 21 on fibrogenic genes expression in the fructose activated hepatic stellate cells, an in vitro study
Authors: Shakerian Elham , Yaghooti Hamid , Kheirollah Alireza , Mohammadtaghvaei Narges
Published: May 2022

Introduction: Liver fibrosis occurs through hepatic stellate cells (HSCs) activation during chronic liver injury. Cytokines especially transforming growth factor-β (TGF-β), activate HSCs by an autocrine effect. The activated HSCs generate more α-smooth muscle actin (α-SMA) and Collagen1. The activation of human HSCs by high fructose concentrations has been confirmed. Fibroblast growth factor 21 (FGF21) as a hepatic hormone possesses favorable metabolic effects, but its effect on activated HSCs and the process of fibrogenesis have not been studied yet. Objectives: In this study, we evaluated the effect of FGF21 on suppressing the fructose-activated human HSCs and its effect on the TGF-β/ Smad3 signaling pathway. Materials and Methods: The LX-2 cells were grown in the presence of high fructose concentrations (25 and 30 mM) for 48 hours for activation and then were treated with FGF21. Quantitative real-time polymerase chain reaction (real-time PCR) was performed to measure the expression of fibrogenic genes and western blotting to analyze the TGF-β signaling. Results: Our results showed increased levels of mRNA expression of αSMA, collagen1, and TGF-β genes and smad3 phosphorylation in fructose-activated HSCs. FGF21 treatment significantly attenuated the induced fibrogenic gene expression and smad3 phosphorylation. Conclusion: High fructose leads to fibrogenic pathways in the liver by activating HSCs and increasing TGF-β signaling. FGF21 is effective in reducing fibrogenesis in activated HSCs through downregulating the TGF-β/smad3 signaling and fibrogenic gene expression. Therefore, FGF21 may provide anti-fibrotic properties in liver fibrosis.
Prediction of preeclampsia incidence by measuring serum uric acid levels in patients with gestational hypertension
Authors: Pooransari Parichehr , Mohamadi Maryam , Afrakhteh Maryam , Dehghani Zahra , Didar Neda
Published: May 2022

Introduction: Some studies have pointed to the predictive role of high uric acid levels and the occurrence of preeclampsia; however, the finding in this field are still controversial and the appropriate level has not been determined. Objectives: The aim of present study was to investigate the relationship between serum uric acid level and preeclampsia occurrence and also determine the appropriate predictive level in patients with gestational hypertension (GHTN). Methods: At this prospective cohort study, the serum uric acid levels of 168 singleton pregnant women at the time of diagnosis of GHTN were measured and the patients were followed up until delivery. At the time of delivery, their uric acid levels were re-measured and symptoms of preeclampsia and eclampsia and neonatal outcomes were recorded. Results: Preeclampsia and eclampsia occurred in 126 (75%) and five of the patients (3%), respectively. Patients with preeclampsia/eclampsia had higher age and body mass index, most of them were primiparous, and had a history of miscarriage. Moreover, their gestational age at the time of diagnosis of GHTN was significantly lower (P<0.05). Treatment of hypertension was also significantly more prevalent in the preeclampsia/eclampsia group (P<0.001). The level of uric acid at the time of diagnosis of GHTN and at the time of delivery in patients with preeclampsia/eclampsia was significantly higher. In addition, the rate of uric acid elevation during pregnancy in the preeclampsia/eclampsia group was significantly higher (P<0.001). In receiver operating characteristic analysis, the uric acid level of 4.65 mg/dL at the time of diagnosis of GHTN with a sensitivity of 96.9% and a specificity of 81.1%, and a diagnostic accuracy of 93.5% was a predictor of preeclampsia/eclampsia in patients with GHTN. Conclusion: Our findings showed that 78% of patients with GHTN eventually developed preeclampsia/eclampsia and had significantly higher levels of serum uric acid levels both at the time of diagnosis of GHTN and at delivery. A uric acid level of 4.65 mg/dL at the time of diagnosis of GHTN was considered a predictor of preeclampsia/ eclampsia in patients with GHTN.
Composition of the essential oils, antioxidant and antibacterial activities of the methanolic extract of Prangos uloptera
Authors: Valibeik Ali , Tavakoli Narges , Amiri Hamzeh , Heydari Rouhollah , Hasanvand Leila , Rostami Reza , Tavakoli Dastjerd Niloufar , Ahmadvand Hassan
Published: May 2022

Background: Prangos uloptera is a medicinal plant from the Apiaceae family which is native to Iran. Objectives: In the current study, phytochemical constituents of the essential oils, antibacterial and antioxidant activities of methanolic extract of the aerial parts of P. uloptera were investigated. Materials and Methods: To determine the main ingredients of the essential oils and to investigate the antioxidant and antibacterial activities of this plant, the GC-MS (gas chromatography - mass spectrometry) analysis, DPPH (2,2-diphenyl-1-picrylhydrazyl) assay and microdilution method were used. Results: The GC–MS analysis showed that the leading constituents of the essential oils were butyl octanoate (24.88%), 9-Octadecenoic acid (Z) (14.19%) and alpha-pinene (19.28%) in the flowers, fruit and leaves, respectively. The greatest amount of phenolic compound was observed in methanolic extract of the leaves (0.5 ± 0.11 mgGAEs/g). Likewise, the greatest level of flavonoids (0.074 ± 12.4 mg QEs/g) was identified in the leaves. Furthermore, DPPH assay showed the most radical scavenging activity (IC50 201.7 ± 20.39 μg/mL) in the methanolic extract of the leaves. The highest total antioxidant capacity was observed in the fruit (0.004 ± 0.0005 g AAE/ml). The antibacterial activity of the plant extracts against the pathogenic fungal and bacterial species was investigated by broth microdilution method. Minimum bactericidal concentration (MBC) and minimum inhibitory concentration (MIC) amounts were in the ranges of 312 to 10000 and 1000 to 10000 mg/ml, respectively. Conclusion: The results of this research demonstrated that P. uloptera was a potent source of useful bioactive compounds, making it a promising candidate for further studies.
Primary Burkitt lymphoma of breast presented by bilateral breast enlargement
Authors: Asghari Rahim , Abbasi Ata , Mojdeganlou Hengameh , Farrokhi Yasin , Mahmoodzadeh Leila
Published: May 2022

Burkitt lymphoma is a very aggressive B cell lymphoma, which can rarely involve breast tissue. Although it usually affects children, but primary breast lymphomas usually, occur in older age. In this report, we present a rare case of Burkitt lymphoma in a 40-year-old woman primarily presented by bilateral breast enlargement which shortly followed by gastrointestinal and bone marrow involvement.
Correlation between capillaroscopic findings and bone mineral density results in the systemic lupus erythematosus patients
Authors: Rajaei Alireza , Sadraee Haleh , Dehghan Pooneh , Emam Mohammad Mehdi , Ahmadzadeh Arman , Farsad Faraneh , Abbasi Zahra
Published: May 2022

Introduction: Systemic lupus erythematosus (SLE) is an autoimmune disorder that can cause vascular involvement. The vascular changes can be seen in the bed of the nails. It was observed that SLE has a relationship with bone mineral density (BMD) changes. Objectives: This study aimed to investigate the frequency and types of capillaroscopic change in SLE and its relationship between capillaroscopic changes with BMD in SLE. Patients and Methods: Thirty-three patients with SLE who were referred to Resalat hospital (Tehran, Iran) underwent nailfold capillaroscopy (NFC). In addition, these patients were evaluated for BMD from spine and hip. Moreover, the correlation of these data was assessed. Result: Scleroderma pattern was seen in 12.12% of patients, non-scleroderma pattern (NSP) in 27.3% patients and normal pattern in 60.6% based on NFC. There was no relationship between gender and NFC. The mean age was 43.30 years and 78.8% of patients were female. Dimension and morphological abnormalities had a relationship with scleroderma pattern (P=0.033 and P=0.014 respectively). There was a relationship between spine BMD and morphological abnormality too (P=0.013). Conclusion: NFC is a good method for evaluating vascular change in patients with SLE and in this method, abnormal morphology and dimension have higher prevalence than other abnormalities in patients with SLE. Additionally, a relationship between abnormal morphology in NFC and spinal osteoporosis in SLE patients was detected.
Tisdale score successfully predict outcomes of QT-prolonging treatment in COVID-19 patients
Authors: Naderi Zohre , Tajmirriahi Marzieh , Dolatshahi Kian , Hashemi Hurieh , Sadeghi Somayeh , Mansouri Vahid , Shakibaei Najmeh , Nikpour Mina , Ebrahemi Sara , Mansourian Marjan
Published: May 2022

Introduction: Hydroxychloroquine, one of the challenging drugs used for COVID-19, has shown to be beneficial in some studies, although concerns about the side effects of the drug have limited its use. Several electrocardiogram changes have been described in these patients which could be exacerbated using hydroxychloroquine, especially QT-prolongation. Struggles to identify the population at risk of side effects of these drugs result in few scoring systems, one of which is the Tisdale score that showed to have successfully predicted the at-risk population. Objectives: In this study, we aimed to assess the degree of QT prolongation provoked by hydroxychloroquine, either alone or in combination with azithromycin in association with the treatment outcomes based on their Tisdale score. Patients and Methods: We conducted a historical cohort study on 659 patients with COVID-19 at Khorshid hospital, Isfahan, Iran from March to April 2020. Tisdale risk score was used for predicting high-risk patients for QT corrected (QTc) interval prolongation. Results: Mean (SD) of baseline QTc was 390.66 (14.65), 390.74 (16.52), 389.67 (19.51), 390.68 (17.35) for patients who received hydroxychloroquine, hydroxychloroquine plus azithromycin, Kaletra, respectively. QTc was not increased significantly after starting treatment in each group. Conclusion: Despite that none of our patients have a high Tisdale score, our findings showed the predictive value of this score for treatment outcomes. Individuals with medium Tisdale scores showed much worse outcomes and in-hospital mortality. Tisdale score could be employed as a valuable tool to predict the COVID-19 patients’ prognosis after treatment with QT-prolonging drugs.
The STAT4 SNP (rs7574865) and systemic lupus erythematosus
Authors: Bayat Golnaz , Hejazian Seyyedeh Mina , Ahmadian Elham , Hejazian Seyed Sina , Khabbazi Alireza , Zununi Vahed Sepideh , Ardalan Mohammadreza
Published: May 2022

Introduction: Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease affecting several systems and organs in the body. The association of STAT4 transcription factor with SLE risk remains unclear. Objectives: The aim of this study was to investigate the association of STAT4 gene polymorphism (rs7574865) with the incidence of SLE. Patients and Methods: One hundred and sixty participants (80 patients with SLE and 80 healthy individuals) were included in this study. Gene analysis was conducted by amplification refractory mutation system-polymerase chain reaction (ARMS-PCR) in peripheral blood samples. Results: Fifty-seven percent (n=45) of patients with SLE had SLE disease activity index (SLEDAI) above six and had active disease. In the SLE group, the frequency of G and T alleles were 81% and 19%, respectively. Moreover, 72.50% (n=58) of patients carried the GG genotype, 17.5% (n=14) had the GT genotype and 10.1% (n=8) carried the TT genotype. There was no significant difference between allele frequency and genotypic distribution for rs7574865 polymorphism (P>0.05) between SLE and control groups. Significant differences were observed between the distribution of genotypes and clinical manifestations including leukopenia (P=0.04), pulmonary (P=0.01) and ophthalmic (P=0.049) problems. The T allele with an odd ratio of 1.47 and confidence interval of 0.80 to 2.6 could increase the risk of SLE; however, it was not statistically significant (P=0.20). Conclusion: The T allele and TT genotype of the STAT4 rs7574865 polymorphism could increase the risk of lupus; however, these observations were not statistically significant.
Evaluating the analgesic and sedative effects of intravenous ketamine versus morphine administration on relieving long/short bone-fracture pain in the upper/ lower limbs; a phase II clinical trial
Authors: Motamed Hassan , Moezi Meisam , Khilghi Azam , Fahimi Mohammad Ali
Published: May 2022

Introduction: The importance of pain control in patients with limb trauma admitted to emergency departments as well as its complications is among the main concerns in post-emergency care, which contributes to the accelerated improvement of patients’ conditions in a significant manner. Objectives: The present study was to evaluate the analgesic and sedative effects of intravenous (IV) ketamine versus morphine administration on relieving long/short bone-fracture pain in the upper/lower limbs. Patients and Methods: The present study is as a double-blind randomized clinical trial. For this purpose, the effect of ketamine and morphine were initially examined using IV ketamine and morphine administration, respectively, at the doses of 0.4 and 0.1 mg/kg/IV/10 min in patients, aged 18-65 years with limb trauma, and admitted to hospital emergency departments. Afterward, the duration of the analgesic effect, the amount of pain relief, according to the visual analog scale (VAS) outcomes, and the complications for each drug, including apnea, bradycardia, tachycardia, altered level of consciousness, nausea, vomiting, hypertension/hypotension, seizures and disturbed sleep were compared, and then the preferred method was introduced. Results: In this study, 120 patients in total, including 60 cases receiving ketamine and 60 individuals receiving morphine, were recruited. The participants’ age range was between 19 -70 years. The patients’ mean age was 47.04±12.57 years of whom 89 patients (74.2%) were male. The study results indicated that the potency of the low-dose ketamine infusion in relieving pain in patients was comparable to that of morphine. Conclusion: It was concluded that ketamine could be administered as an alternative to IV morphine to reduce long/short bone-fracture pain in the upper/lower limbs. Trial Registration: The trial protocol was authorized by the Iranian Registry of Clinical Trials, (identifier: IRCT20170716035105N3; https://en.irct.ir/trial/26628, ethical code: IR.AJUMS.REC.1396.248).
Morphological diversity of the corneal small fibers in patients with type 1 diabetes mellitus
Authors: Bregovskaya Anna , Lukashenko Maria , Kamaeva Evelina , Gavrilova Natalia , Soprun Lidiia , Grigoryeva Nyurguyana , Pchelin Ivan , Churilov Leonid P.
Published: May 2022

Introduction: Diabetic neuropathy (DN) affects up to 50% of patients with type 1 diabetes mellitus (T1DM). Clinical manifestations include painful polyneuropathy with autonomic and orthostatic symptoms. Corneal confocal microscopy (CCM) is one of the promising non-invasive methods for DN evaluation and tracking the effectiveness of treatment. Objectives: To perform the early diagnosis of DN in T1DM patients and describe the morphological changes in nerve fibers during the treatment process. Patients and Methods: This prospective study included 77 T1DM patients and 42 healthy controls. All patients underwent CCM and electroneuromyography (ENMG). Twenty-five patients with T1DM and HbA1c 7-10% underwent strict glycemic control with the correction of insulin therapy and the subsequent CCM and ENMG investigations for the second time. Results: In T1DM patients a decrease in the main nerve trunks with age was revealed, as well as an increase in corneal nerve tortuosity (P<0.05). The number of branches of nerve fibers did not change with the increasing age (P=0.07). After reaching T1DM compensation, patients underwent a course of alpha-lipoic acid therapy. Confocal microscopy of the cornea parameters did not undergo significant changes during therapy since significant positive dynamics were noted only in the tortuosity of nerve fibers (P<0.05), which decreased by 11.8%. Conclusion: In patients with T1DM, strict glycemic control, correction of insulin therapy, and courses of alpha-lipoic acid prescription help to reduce the morphological changes of small fiber neuropathy, which can be evaluated by the confocal microscopy of the cornea.
The confocal microscopy of the cornea in post-COVID syndrome; the clinical observation
Authors: Lukashenko Maria , Soprun Lidiia , Bregovskaya Anna , Gavrilova Natalia , Utekhin Vladimir I.
Published: May 2022

One of the most important complications of the post-COVID-19 syndrome may be a small fiber neuropathy, which cannot be evaluated by a routine electroneuromyography. Confocal microscopy of the cornea (CCM) may be a promising method for early neuropathy verification. To study the possibility of the small fiber neuropathy evaluation using the CCM in a patient with the post-COVID-19 condition. The patient is a female of 61 years old, which suffered from a COVID-19 infection in October 2020. After a month, she noted the presence of myalgia and polyneuropathy. A year after the onset of the disease, in addition to myalgia, headaches, neuropathy pain, the patient also experienced bowel disorders and stomach aches, which cannot be explained with an alternative diagnosis. The patient underwent CCM to assess the structure of nerve fibers to prove the presence of the small fiber neuropathy as a complication of the COVID-19 infection. The presence of the small fiber neuropathy was evaluated in the patient as well as enlarged Langerhans cells in the cornea. Considering the pivotal role of these cells in the immunological processes, the "activated" dendritic cells in post-COVID-19 patients may serve as another evidence of the autoimmune nature of this complication and possibly, a method for the monitoring treatment effectiveness of this disease. In this clinical case of a 61-year-old patient with the post-COVID-19 syndrome, the possibility of application of the confocal microscopy of the cornea for the diagnosis of neuropathy of small fibers and monitoring of the patient›s condition is shown.
Efficacy of herbal tea preparation including mallow flower, chicory seeds, sweet violet, Melilotus officinalis, and bindii for improving respiratory symptoms in patients with COVID-19; a randomized controlled clinical trial
Authors: Mazaheri Mohammad , Babaeian Mahmoud , Ekhveh Mehdi , Vakili Zohreh , Vakili Ziba
Published: May 2022

Introduction: Coronavirus disease 2019 (COVID-19) as a viral disease has now become a public health emergency of international concern and has not yet received an approved treatment protocol. The potential of a phytotherapy approach in the management of this disease and also numerous claims regarding its effect on the recovery of COVID-19 patients has received remarkable attention especially in developing countries. Objectives: The present study aimed at investigating the efficacy of the combination of bindii, Melilotus officinalis, sweet violet, chicory seeds and mallow flower used as an herbal tea for improving respiratory symptoms in patients with COVID-19. Patients and Methods: The present randomized controlled clinical trial was conducted on 80 patients with COVID-19 that were divided into one control group and one case group. Patients in the control group received only the routine treatment while the case group, in addition to receiving the routine treatment, also received the herbal medicine combination prepared in this study. Then, patients’ cough severity and also respiratory symptoms such as the shortness of breath, the percentage of the saturation of peripheral oxygen (SpO2) and the number of breaths were evaluated and recorded daily and then compared between the two groups. Results: The results of this study revealed that 75% of patients in the case group had no cough at all on the fifth day of the intervention while the cough of only 35% of patients in the control group was completely eliminated (P<0.001). In addition, the patients’ cough severity, SpO2 and shortness of breath followed up from the intervention onset up to the fifth day after the intervention had a significant improvement in the case group as compared to the control group (P<0.05). Conclusion: According to the results of the present study, the mentioned herbal tea used in this study had a significant effect on improving respiratory symptoms and cough severity in COVID-19 patients. Therefore, it can be stated that the use of herbal compounds, especially the herbal tea introduced in this study, as a complementary treatment can play a significant role in improving the patients’ condition. Trial Registration: The trial protocol was approved by the Iranian Registry of Clinical Trial (# IRCT20200806048318N1; https://en.irct.ir/trial/50227, ethical code; IR.MUI.MED.REC.1399.359).
Association of Helicobacter pylori infection with chronic obstructive pulmonary disease
Authors: Hosseininia Saeid , Mohammadi-Kebar Susan , Pourfarzi Farhad , Bahadoram Mohammad , Aslani Masoud
Published: May 2022

Introduction: Chronic obstructive pulmonary disease (COPD) is a disease that is systematically characterized by an abnormal inflammatory response affecting the airways, interstitium and vascular bed through reactions to gas and particles, especially cigarette smoking. Recent studies have shown an association between Helicobacter pylori infection and various inflammatory diseases. H. pylori is a gram-negative, microbial bacterium that can be resistant to acidic stomach conditions and can interfere with gastric urease production. In this study, we examined the relationship between H. pylori infection in patients with COPD and the prevalence of H. pylori infection. Objectives: Determining the association between H. pylori infection and COPD. Patients and Methods: This case-control study is based on the Persian cohort study of patients who were referred to the digestive disease research center after being identified in the pulmonary clinic for H. pylori fecal antigen. Information on demographic variables and other related variables were obtained. Finally, the collected information was entered into SPSS software version 24 and the results were displayed descriptively using distribution and frequency tables and graphs and analytical statistics were analyzed using t test and logistic regression. Results: Out of 250 patients, 134 (53.6%) tested positive for H. pylori and 116 (46.4%) tested negative. Out of a total of 250 non-infected people; 106 patients (42.4%) were positive and 144 patients (57.6%) were negative. The two groups were statistically significantly different based on the chi-square test (P = 0.012). Conclusion: Our study showed a direct and significant relationship between H. pylori and COPD, which can be due to the effect of bacteria on lung growth in early life and also the development of systemic inflammation throughout life.
Crescentic glomerulonephritis in renal transplant; a case series
Authors: Ali Ala Sh. , Al-Taee Huda A. , Kadhim Thaeer J.
Published: May 2022

Crescentic glomerulonephritis (GN) is a severe proliferative renal lesion with an aggressive clinical scenario. The occurrence of crescentic GN post-transplant is mainly related to the recurrence of the primary glomerular disease. De novo crescentic GN in renal allografts is rare. We present five patients diagnosed with crescentic GN post-transplantation during 10 years period. There were two males and three females with age range 20-50 years. Three cases were crescentic phenotypes of recurrent disease and two were de novo. The post-transplant time range was (7-144 months). Three patients lost their grafts and returned to dialysis. One patient had chronic allograft dysfunction and one patient died because of severe renal failure. Recurrent or de novo crescentic GN is not uncommon, especially in a live donor program. It leads to graft loss in most cases.
A deep-learning approach at automated detection of electron-dense immune deposits in medical renal biopsies
Authors: Alsadi Alaa , Majeed Nasma K. , Saeed Dereen M. , Dharmamer Yash , Singh Manmeet B. , Patel Tushar N.
Published: May 2022

Introduction: Identification of electron-dense immune deposits in electron microscopy (EM) images is integral to the diagnosis of medical renal disease. Deep learning has the potential to augment this process, especially in areas with limited resources. Objectives: Our study explores the feasibility of applying deep learning to detect electron dense immune deposits in electron microscopy images from medical renal biopsies. Patients and Methods: EM images (N=900) from native and transplant kidney biopsies were processed into 4530 tiles (512 x 512 pixels). These tiles were reviewed and classified into one of three categories: deposits absent, deposits present, and indeterminate. This classification resulted in 1255 images with consensus agreement for deposits present and deposits absent. These 1255 images were then used to train a machine learning model, using 1006 images for training, and 249 images for testing. Results: The overall accuracy on the test data was a competitive 78%, and the F1 scores for deposits absent and present was 0.76 and 0.79, respectively. Conclusion: This study demonstrated the feasibility of creating and applying a machine learning model that performs competitively in identifying electron dense deposits in EM images.
Late onset primary hyperoxaluria after kidney transplantation in a 36-year-old woman
Authors: Alirezaei Amirhesam , Ebrahimibagha Hamed , Parvin Mahmoud , Ali Asgari Majid , Bagheri Leyla
Published: May 2022

Primary hyperoxaluria is a rare congenital autosomal recessive disorder disrupting the glyoxylate metabolism pathway in the liver. Type1 primary hyperoxaluria is caused by a deficiency in a specific liver enzyme namely, alanine glyoxylate-aminotransferase which catalyzes the conversion of glyoxylate to glycine. By the absence of this enzyme, glyoxylate is converted to oxalate and high oxalate level causes deposition of insoluble calcium oxalate crystals in different organs specifically kidneys. The disease usually manifested by recurrent nephrolithiasis and/or nephrocalcinosis leads to renal failure. This report describes an end-stage renal disease case of a 36-year-old Iranian woman without any history of nephrolithiasis who underwent kidney transplantation. She developed an early onset transplant kidney failure. The patient underwent kidney biopsy, which revealed oxalate nephropathy, accordingly the genetic study confirmed diagnosis of primary hyperoxaluria. This rare case shows how type 1 primary hyperoxaluria can develop after kidney transplantation without having any manifestation prior to transplantation
Role of the scrotal color Doppler ultrasound findings in management of severe orchitis to do orchiectomy
Authors: Bagheri Seyed Morteza , Mohammad Mirzaei Morteza , Mousavian Tohid , Ghadamzadeh Mostafa
Published: May 2022

Background: Introduction: Determination of the type of treatment and prognosis of epididymoorchitis is a challenge for clinicians. Objectives: The current study aimed at investigating the relationship between the indexes of vascular resistance index (RI) (%) of the intra-testicular artery by color Doppler ultrasonography (CDUS), and its relationship with the treatment and prognosis in patients with epididymo-orchitis. Patients and Methods: The current prospective observational study was conducted on the collected data of 30 patients with epididymo-orchitis. Initial and secondary CDUS (24 hours after admission) were conducted on all patients and RI was calculated from the mean of two intratesticular arteries for all patients. Patients were divided into four groups based on RI through, RI; 70-80%, RI; 80- 90%, RI >90%, and absent of flow. Results: The mean and standard deviation (SD) of the patients’ age was 47.70 ± 15.56 years (ranged 30-79 years). Among 30 patients, 15 (50%) had left epididymo-orchitis, 13 (43.5%) right, and in two subjects (6.71%), it was bilateral. The mean ± SD of RI in the initial and secondary CDUS were 0.8516 ± 0.1022% and 0.7845 ± 0.1235%, respectively (P=0.031). The ROC under area of RI diagnosis power for the types of epididymo-orchitis treatment were 0.904 [95% confidence interval (CI): 0.774-1.000] and 0.990 (95%CI: 0.958-1.000) in the initial and second day of CDUS, respectively. Additionally, the mean ± SD of RI in initial CDUS were 0.7633 ± 0.03786%, 0.84400 ± 0.02944%, and 0.7600 ± 0.03162% in patients with a decreased prognosis, atrophy, and parenchymal heterogeneity, which were significantly different (P= 0.011). Accordingly, in the CDUS of 24 hours after admission, the mean ± SD of RI in patients with low prognosis was 0.6600 ± 0.0100%, in patients with atrophy was 0.0170 ± 0.7575%, and in patients with parenchymal heterogeneity was 0.7100 ± 0.04729%. Conclusion: RI of intratesticular artery in CDUS is a useful index to determine and predict the type of treatment and prognosis of patients with epididymo-orchitis.
Clinical and laboratory features of 496 cases of biopsy-proven lupus nephritis; a study at Shiraz University of Medical Sciences, Iran
Authors: Owji Seyed Mohammad , Kamalinia Amirhossein , Owji Seyed Hossein , Raeisi Shahraki Hadi , Bagheri Bahar , Dehghani Farshad
Published: May 2022

Introduction: Systemic lupus erythematosus (SLE) is a systemic autoimmune disease that can involve various organs. Renal involvement has been seen in about 60% of SLE patients, while the most common presentation of lupus nephritis (LN) is proteinuria. Objectives: This study aimed to investigate the clinical and laboratory features of LN patients, confirmed by kidney biopsy and compare these among different classes of LN. Patients and Methods: This cross-sectional study was conducted on clinical and laboratory data of patients with LN from 2001 to 2016. All patients diagnosed with definite LN by biopsy and electron microscopy (EM) were included in this study. Results: A total number of 496 patients were enrolled. The mean age of all patients was 28.32 ±11.41 years; 82.4% (409) were females. The biopsies were classified into LN classes II, III, IV, V, and VI, whose frequencies were 98 (20.6%), 93 (19.5%), 225(47.3%), 46 (9.7%), and 14 (2.9%), respectively. Tubular atrophy (P<0.001) and interstitial fibrosis (P<0.001) were found to be significantly associated with classes of LN. Additionally, 72.7% (8) and 48.2% (92) of patients in classes Ⅵ and Ⅳ of LN had blood urea nitrogen (BUN) levels more than the normal range (P< 0.001). Regarding serum creatinine levels, 81.8% (9) and 42.9% (81) of patients in classes Ⅵ and Ⅳ of LN had high levels (P<0.001). Moreover, nephrotic syndrome (NS) was reported in 47.5% (47) of patients with class Ⅱ of LN followed by 38.8% (36) in class Ⅲ. Besides, edema was significantly more dominant in classes Ⅳ (74.3%, 133) and VI (75%) of LN patients (P=0.03). Conclusion: Tubular atrophy and interstitial fibrosis were more commonly seen in LN class Ⅵ followed by class IV. Edema, hypertension, and proteinuria are common presentations in class IV. Complete assessment of renal biopsy is still helpful for the definite classification of LN.
Shunt Nephritis: A Rare and Forgotten Diagnosis
Authors: Reis Marina , Gomes Ana Marta , Furtado Antónia , Santos Clara , Almeida Clara
Published: May 2022

Shunt nephritis is a rare complication of ventriculoatrial and ventriculoperitoneal shunt infection. The clinical manifestations are nonspecific and include asthenia, arthralgias, anorexia, weight loss, hematuria, proteinuria, and progressive renal impairment. Therefore, diagnosis can be delayed up for to several years after the first clinical manifestations, which increases the risk of progressive renal impairment and neurological dysfunction. A 57-year-old woman who had undergone ventriculoperitoneal shunt placement in 1990 was admitted to the nephrology department to perform an elective kidney biopsy due to hematuria, proteinuria, and rapidly progressive renal failure. The patient presented with asthenia and weight loss with a duration of one year. No other symptoms were reported. The kidney biopsy was suggestive of infection associated glomerulonephritis, particularly a subacute infection, as a membranoproliferative pattern was seen in light microscopy, and IgM staining was predominant in immunofluorescence imaging. During the hospital stay, the patient developed neurological symptoms. Cerebrospinal fluid examination showed pleocytosis. Shunt nephritis was suspected, and antibiotic treatment was initiated. Due to the patient’s worsening neurological status, an urgent surgical shunt removal was performed. Two months later, her renal function was normal, and the urinalysis result was unremarkable, even though her neurological status did not improve. Although rare, shunt nephritis should be considered in patients that have a history of ventriculoperitoneal shunt placement and present with a proliferative or membranoproliferative glomerulonephritis and prominent IgM deposits in immunofluorescence imaging. Early diagnosis and shunt removal are critical for improving the neurological and renal prognosis.
In the absence of cardiometabolic diseases, is age an independent factor in assessing renal health and filtration? A pilot study
Authors: Forsse Jeffrey S. , Buckley David , Ismaeel Ahmed , Adair Kathleen , Torres Ricardo , Lowry Catherine , Dhillon Anurag , Koutakis Panagiotis
Published: May 2022

Introduction: Serum creatinine (sCr) is conventionally used to characterize the progressive decline in renal filtration (RF). Assessment of RF and renal health (RH) is traditionally believed to be agedependent. However, in the absence of cardiometabolic disease (CMD), this may not be the case. Objectives: The purpose of this study was to determine the magnitude of age as an influencing factor independent of CMD with novel markers of RH/RF in a single health assessment. Patients and Methods: Fifty-four participants (n = 27 men; n = 27 women; age 33.4 ± 12.5 years; BMI 26.5 ± 5.5; SBP 120 ± 10.4; DBP 77.7 ± 6.7; CHOL 174 ± 30) free of CMD were recruited to assess sCr, urine creatinine (uCr), cystatin C (CyC), and urine epidermal growth factor (uEGF) to calculate estimates of RH/F via uEGF/uCr ratio (uEGFR), eGFR - modification of diet in renal disease (MDRD), CKD-EPI, and sCr/CyC eGFR. Results: There were no significant differences between age groups (20s, 30s, 40s, 50s) in biomarkers and estimates of RH/RF, sCr (P=0.91), uEGF (P=0.46), CyC (P=0.13), CyC eGFR (P= 0.10), MDRD (P=0.12), CKD-EPI (P=0.80), and sCr/CyC eGFR (P=0.12). Post-hoc analysis revealed uEGFR was the only significantly different variable between 40s and 50s age groups (P= 0.02). Conclusion: Changes in RH/RF appear to be independent of age in the absence of CMD. Indicating RH/RF could potentially be maintained in adulthood and throughout the older adult years with the continued absence of CMD.
Histological changes associated with early and late renal allograft dysfunction in a large three-center transplant program in Iraq
Authors: Ali Alaa Abbas , Sharif Dana A , Almukhtar Safaa E
Published: May 2022

Introduction: Transplantation is the sole viable option for the long-term survival of patients with end-stage renal disease (ESRD) in low-resourced countries. Objectives: To report the histopathological characteristics of kidney graft dysfunction in a large transplant program of a developing country. Patients and Methods: Renal transplant biopsies were analyzed by the Banff 2017 classification and subdivided into early (≤1 year) or late (>1 year) post-engraftment periods during the 12 months of 2019. Results: Here, 290 satisfactory graft biopsies were obtained on 290 patients for graft failure and/ or proteinuria. The median age of the recipient was 39 years (interquartile range 28-47), where 77% were male and 5.5% had been previously transplanted and 84% of donors were unrelated. Histological diagnosis was as follow; acute T-cell mediated rejection (A-TCMR; 23.1%), acute tubular necrosis (ATN; 14.8%), interstitial fibrosis and tubular atrophy (IFTA; 11.4%), recurrent or de novo kidney disease (R/DKD; 8.6%), transplant glomerulopathy (TG; 7.6%), calcineurin inhibitor toxicity (CNI; 6.9%), and active antibody-mediated rejection (A-AMR; 8.6%). Early graft dysfunctions were A-TCMR (29%) and ATN (22.4%). Late graft dysfunction included IF/TA, (20.2%), TG (20.2%), R/DRD (17%), and A-TCMR (9.5%). C4d+AMR was equally represented in early (5.6%) and late (6.3%) biopsies. Conclusion: A-TCMR was the most common cause of early graft dysfunction and was replaced by chronic conditions as the cause of 57.8% of late graft biopsies. The causes of graft dysfunction are not remarkably different from the west and TG will be a major cause of late graft failure in Iraq.
Hypoglycemic agents and prognostic outcomes of chronic kidney disease patients with type 2 diabetes
Authors: Hoe Kyaw Kyaw , Han Tin Lynn , Hoe Thant Hnin Saint
Published: May 2022

Introduction: Chronic kidney disease (CKD) poses a financial burden on most patients from low/ middle income countries. Glycaemic control with affordable hypoglycemic agents may influence on the prognosis of diabetic nephropathy. Objectives: We aimed to compare the rates of CKD progression and proteinuria in the type 2 diabetic population in response to the use of various hypoglycemic agents. Patients and Methods: A retrospective cross-sectional study of a total of 250 patients of Afro-Caribbean descent at the University hospital of the West Indies between 2018 and 2019 was conducted. The use of hypoglycaemic agents and changes in albuminuria were calculated as odds ratios with a 95% confidence interval (CI). A P value<0.05 was considered statistically significant. Results: Of 250 patients with diabetic nephropathy, the number of rapid CKD progression was highest in patients on insulin (26.3%). In comparison, number of rapid progressions in patients receiving metformin, dipeptidyl peptidase 4 (DPP-4 inhibitors), sulfonylurea and pioglitazone were 19.1%, 22.2%, 21.9% and 20%, respectively. After eliminating confounding factors, comparison within the group analysis on DPP-4 inhibitors (n= 171) demonstrated 62.6% significant improvement in quantitative proteinuria with reduction of mean spot urine albumin creatinine ratio (ACR) from 362.1 ±338.9 mg/g to 303 ±300.1 mg/g (ORs, 0.77; 95% CI 0.41 to 0.97; P = 0.03). Conclusion: Type 2 diabetic patients requiring insulin were found to have progression of CKD than patients on oral hypoglycaemic agents. Among the affordable oral hypoglycaemic agents, DPP-4 inhibitors had an association with reduction in albuminuria.