bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictors of Mortality among COVID-19 Patients Admitted to Intensive Care Units: A Single-Center Study in Tehran, Iran
Authors: Amini Arash , Najafi Atabak , Ahmadi Arezoo , Mojtahedzadeh Mojtaba , Karimpour-Razkenari Elahe , Sharifnia Hamidreza , Shahsavar Mistani Shahriar , Kamangar Farin
Published: January 2023

Background: Iran was one of the first countries to become an epicenter of the coronavirus disease 2019 (COVID-19) epidemic. However, there is a dearth of data on the outcomes of COVID-19 and predictors of death in intensive care units (ICUs) in Iran. We collected extensive data from patients admitted to the ICUs of the one of the tertiary referral hospitals in Tehran, Iran, to investigate the predictors of ICU mortality. Methods: The study population included 290 COVID-19 patients who were consecutively admitted to the ICUs of the Sina hospital from May 5, 2021, to December 6, 2021, a period that included the peak of the epidemic of the delta (δ) variant. Demographic data, history of prior chronic diseases, laboratory data (including markers of inflammation), radiologic data, and medication data were collected. Results: Of the 290 patients admitted to the ICUs, 187 (64.5%) died and 103 (35.5%) survived. One hundred forty-one (141, 48.6%) were men, and the median age (10th percentile, 90th percentile) was 60 (41, 80). Using logistic regression models, older age, history of hypertension, high levels of inflammatory markers, low oxygen saturation, substantial lung involvement in computed tomography (CT) scans, and gravity of the disease as indicated by the WHO 8-point ordinal scale were primary predictors of mortality at ICU. The use of remdesivir and imatinib was associated with a statistically non-significant reduction in mortality. The use of tocilizumab had almost no effect on mortality. Conclusion: The findings are consistent with and add to the currently existing international literature. The findings may be used to predict risk of mortality from COVID-19 and provide some guidance on potential treatments.
Risk Factors Related to Esophageal Cancer, a Case-Control Study in Herat Province of Afghanistan
Authors: Eser Sultan , Özgür Su , Shayan Nasar Ahmad , Abdianwall Mohammed Haris
Published: January 2023

Background: The Herat province of Afghanistan is located on the Asian Esophageal Cancer Belt (AECB), a wide area in Central and Eastern Asia where very high rates of esophageal cancer (EC) have been observed. Several risk factors have been reported in the AECB Region by previous studies. Considering lack of information in Afghanistan on this issue, a study was conducted to determine the major risk factors related to EC in order to guide protective measures. Methods: A population-based case-control study was performed from July 2015 to August 2016 among 657 EC patients in the Herat Province and 180 histopathological confirmed cases and 189 controls were interviewed. A structured questionnaire was used and face-to-face interviews were conducted. Results: Low body mass index (BMI), low socio-economic status, family history of EC, consumption of dark tea, very hot beverage and qulurtoroosh were found to be statistically significant for EC and esophageal squamous cell carcinoma (ESCC) in univariate analyses. According to multivariate analyses, sex (OR=2.268; 95% CI=1.238–4.153), very hot beverages (OR=2.253; 95% CI=1.271– 3.996), qulurtoroosh (OR=5.679; 95% CI=1.787–18.815), dark tea (OR=2.757; 95% CI=1.531–4.967), high previous BMI (OR=0.215; 95% CI=0.117–0.431) and low socio-economic status (OR=1.783; 95% CI=1.007–3.177) were associated with ESCC. Being male was found to increase the risk of ESCC with OR=2.268 (95% CI=1.238–4.153). Conclusion: Consuming very hot beverages dark tea and a local food, qulurtoroosh, were found as important risk factors for EC. Our findings warrant further studies and necessitate the implementation of protective measures for EC which is one of the leading cancers in the region.
Genetic Diagnosis of Pyruvate Kinase Deficiency in Undiagnosed Iranian Patients with Severe Hemolytic Anemia, using Whole Exome Sequencing
Authors: Mehrabi Sisakht Jafar , Mehri Maghsood , Najmabadi Hossein , Azarkeivan Azita , Neishabury Maryam
Published: January 2023

Background: After ruling out the most common causes of severe hemolytic anemia by routine diagnostic tests, certain patients remain without a diagnosis. The aim of this study was to elucidate the genetic cause of the disease in these patients using next generation sequencing (NGS). Methods: Four unrelated Iranian families including six blood transfusion dependent cases and their parents were referred to us from a specialist center in Tehran. There was no previous history of anemia in the families and the parents had no abnormal hematological presentations. All probands presented severe congenital hemolytic anemia, neonatal jaundice and splenomegaly. Common causes of hemolytic anemia were ruled out prior to this investigation in these patients and they had no diagnosis. Whole exome sequencing (WES) was performed in the probands and the results were confirmed by Sanger sequencing and subsequent family studies. Results: We identified five variants in the PKLR gene, including a novel unpublished frameshift in these families. These variants were predicted as pathogenic according to the ACMG guidelines by Intervar and/or Varsome prediction tools. Subsequent family studies by Sanger sequencing supported the diagnosis of pyruvate kinase deficiency (PKD) in six affected individuals and the carrier status of disease in their parents. Conclusion: These findings show that PKD is among the rare blood disorders that could remain undiagnosed or even ruled out in Iranian population without performing NGS. This could be due to pitfalls in clinical, hematological or biochemical approaches in diagnosing PKD. Furthermore, genotyping PKD patients in Iran could reveal novel mutations in the PKLR gene.
Ectopic Opening of Common Bile Duct into Duodenal Bulb and Gastric Antrum and Its Importance
Authors: Karabulut Ümit , Üzel Ali , Yolaçan Ramazan , Uçmak Feyzullah , Kaya Muhsin
Published: January 2023

Background: Ectopic opening of the common bile duct (CBD) is extremely rare, and its importance has not been adequately defined. The aim of our study is to present the characteristics of patients with this abnormality. Methods: This retrospective study was conducted in a tertiary center in Dicle University Hospital, Diyarbakır, Turkey, between October 2008 and December 2020. We present clinical, laboratory, endoscopic and cholangiographic features as well as the success rate of therapeutic interventions of consecutive patients with this abnormality undergoing endoscopic retrograde cholangiopancreatography (ERCP). Results: Ectopic opening of the CBD was identified in 29 (21 men; mean age 62) out of 3872 (0.74%) patients. There was a history of cholecystectomy in 14 (48%) and recurrent acute cholangitis in 20 (69%) patients. We found peptic ulcer in 13 (45%) and duodenal deformity associated with apical stenosis in 21 (72%) patients. Opening site was seen as abnormal in all patients, and it opened into the antrum in 2 (6.8%) and into the first part of the duodenum in 27 (93%) patients. Copious amount of bile and/ or bile sediment in the stomach were seen in all patients. We observed dilatation in both intrahepatic and extrahepatic bile ducts together with tapered narrowing and a hook-shaped distal end of CBD in all patients. There was bile stone in 26 (89%) and sludge in 3 (10%) patients. Sphincterotomy was not performed in any patients because there was not enough incision distance. Balloon dilatation was performed for extraction of stone and sludge in all patients. Complete stone extraction was achieved in only 7 out of 26 (27%) patients. Conclusion: Ectopic opening of CBD is usually associated with gastroduodenal and bile ducts disease. Endoscopic treatment is unsatisfactory in most patients with this abnormality.
Unusual Left Superior Vena Cava, Connected to the Left Atrium via the Left Superior Pulmonary Vein
Authors: Boukhmis Abdelkader , Nouar Mohamed El-Amin
Published: January 2023

Persistent left superior vena cava (LSVC) that drains into the left atrium (LA) via the left superior pulmonary vein (LSPV) is a rare systemic venous drainage anomaly. It can cause cyanosis and unexplained recurrent strokes. Undiagnosed, it can seriously disrupt the conduct of the cardiopulmonary bypass (CPB), causing sudden air lock and/or flooding of the operative field with venous blood. Its connection with the LSPV outside the pericardium makes its intraoperative diagnosis difficult. We report here the case of a 48-year-old man operated for mitral and aortic valve endocarditis, complicating a Laubry-Pezzi syndrome. The opening of the LA was followed immediately by the entrance of high volume of air bubbles into the superior vena cava cannula which resulted in sudden air lock of the venous outflow line. After multiple lowerings and cessations of pump flow, partial clamping of this cannula resulted in flooding of the LA with venous blood coming from the LSPV. The heart luxation did not allow us to find the LSVC in its usual intrapericardial location, between the LSPV and the left appendage. We had to widely open the left pleura to expose its completely extrapericardial path and its communication with the LSPV. The LSVC was temporally clamped during the remainder of the surgical procedure, then ligated at both ends. The patient underwent mitral valve repair, closure of the infundibular septal defect, aortic valve replacement and tricuspid annuloplasty. He was discharged 10 days later.
Neonate, Infant, and Child Mortality by Cause in Provinces of Iran: An Analysis for the Global Burden of Disease Study 2019
Authors: Sepanlou Sadaf G. , Rezaei Aliabadi Hossein , Naghavi Mohsen , Malekzadeh Reza
Published: January 2023

Background: Since 1990, neonatal, infant, and child mortality has substantially decreased in Iran. However, estimates for mortality by cause at subnational scale are not available. Methods: This study is part of the Global Burden of Diseases, Injuries, and Risk Factors study (GBD) 2019. Here we report the number and rates of neonate, infant, and child deaths by cause across provinces of Iran from 1990 to 2019. Results: Between 1990 and 2019, the neonatal mortality rate per 1000 live births decreased from 31.8 (95% UI: 28.1–35.5) to 6.8 (6.1–7.4). The child mortality rates decreased from 71.2 (63.6–79.1) to 11.1 (10.2–12.0) per 1000 live births. Mortality rates among neonates per 1000 live births ranged from 3.1 (2.6–3.7) to 10.0 (9.2–10.8) across provinces in 2019. Child mortality rate per 1000 live births ranged from 5.5 (4.6–6.5) to 17.9 (16.4–19.4) across provinces in 2019. Neonatal disorders, congenital birth defects, and lower respiratory infections were the three main causes of mortality in almost all provinces of Iran. The majority of neonatal disorders were due to neonatal preterm birth and neonatal asphyxia, trauma, and infections. The trends of mortality across provinces from 1990 to 2019 were converging and decreased along with increase in sociodemographic index (SDI). Conclusions: All provinces achieved the Sustainable Development Goal 3.2 of neonatal mortality less than 12 and child mortality less than 25 per 1000 live births. However, disparities still exist across provinces, specifically in low-SDI provinces.
Predictive Utility of the Glasgow Coma Scale and the Head Abbreviated Injury Scale in Traumatic Brain Injury: Results from the National Trauma Registry of Iran
Authors: Khormali Moein , Payandemehr Pooya , Zafarmandi Sahar , Baigi Vali , Zafarghand Mohammadreza , Sharif-Alhoseini Mahdi
Published: January 2023

Background: Trauma severity indices are commonly used to describe the severity of sustained injuries in a quantitative manner perceivable by healthcare providers in different settings. In this study, we aimed to assess the predictive utility of the Glasgow Coma Scale (GCS) and the 2015 revision of the head Abbreviated Injury Scale (head AIS) as two of the most widely used severity indices for traumatic brain injury (TBI). Methods: In this cross-sectional study, we used data from the National Trauma Registry of Iran. The area under the receiver operating characteristic curve (AUROC) was calculated to assess the utility of GCS and head AIS scores in predicting patients’ outcomes. Results: A total of 321 patients, predominantly males (81.9%) with an average age of 41.9 (±19.5) years were enrolled in the study. The most common cause of injury was road traffic accidents (73.5%) followed by falls (20.2%). The mean admission GCS and head AIS scores were 13.5 (±3.2) and 2.5 (±1.0), respectively. AUROC of the GCS was significantly higher than the head AIS for all outcome variables (P<0.05). AUROC of both severity scoring systems for predicting in-hospital mortality was significantly higher in the 15–44 age group than the 65 or older age group (P<0.05). Conclusion: Based on our study results, GCS had better performance in predicting patients’ outcomes than the head AIS. Also, we found that age significantly affected the ability of these indices in predicting in-hospital mortality of TBI patients.
Epidemiology of Dermatophytosis in Tehran, Iran: A Ten-year Retrospective Study
Authors: Aref Saeed , Nouri Sara , Moravvej Hamideh , Memariani Mojtaba , Memariani Hamed
Published: January 2023

Background: Dermatophytosis still remains a major public health concern worldwide, particularly in developing countries. This study was undertaken to determine the etiological and epidemiological factors of dermatophyte infections in Tehran, Iran. Methods: A total of 1530 patients clinically suspected of cutaneous fungal infections were examined in two hospitals over a period of 10 years (2010–2020). Samples were analyzed using direct microscopic examination and culture. Data regarding age, gender, and clinical manifestations were also recorded. Results: Out of 1530 cases examined, dermatophytes were detected in 493 (32.2%) patients. Of these patients, 288 (58.4%) were males and 205 (41.6%) were females. The most affected age group was the 25–44 years old (31.6%). Tinea corporis (n=134) was the most prevalent type of ringworm, followed by tinea cruris (n=131), tinea pedis (n=90), tinea manuum (n=65), tinea unguium (n=29), tinea faciei (n=20), tinea capitis (n=18), and tinea barbae (n=2). Both tinea cruris (P<0.001) and tinea pedis (P=0.002) had a significant association with male gender. As for etiological agents, Trichophyton mentagrophytes (29.0%) was the most frequent isolate, followed by Trichophyton tonsurans (25.8%), Trichophyton rubrum (25.3%), Epidermophyton floccosum (6.9%), Trichophyton verrucosum (4.9%), Microsporum audouinii (4.5%), Microsporum canis (2.0%), and Trichophyton violaceum (1.6%). Conclusion: Dermatophytes are still the prevailing causes of fungal infection of the skin, hair, and nails in Iran. Further studies with larger samples sizes and inclusion of diverse locations would yield more accurate results.
Association of Opium Consumption and Coronary Artery Ectasia: A Propensity Score-Matched Study
Authors: Shafie Mahan , Aminorroaya Arya , Vasheghani-Farahani Ali , Jalali Arash , Baradaran Abdolvahab
Published: January 2023

Background: Opium consumption is associated with increased risk of atherosclerosis and a hyper-inflammatory state which are suggested as contributing factors to the development of coronary artery ectasia (CAE). We aimed to determine if opium consumption is an independent risk factor of CAE. This study aimed to explore the relationship between opium consumption and CAE. Methods: In this propensity score-matched study, we enrolled patients who underwent elective coronary angiography between September 2004 and March 2017 in Tehran Heart Center. We studied patients with CAE and without coronary artery disease (CAD) as cases. The control group, patients with normal coronary angiograms, were selected after applying the propensity score matching to match for age, sex, diabetes mellitus, hypertension, hyperlipidemia, family history of coronary artery disease, and cigarette smoking. Results: We studied 242 patients with pure CAE and selected 968 control patients. The prevalence of opium consumption was not significantly different across these groups: 17 (7.5%) in the pure CAE group compared to 76 (8.6%) in the control group (Odds ratio: 0.81; P=0.455). Amongst the patients with pure CAE, Markis scores were not significantly different between opium consumers and non-consumers (P=0.136). Conclusion: We found no significant difference regarding opium consumption between patients with pure CAE and those with normal coronary angiograms. In addition, there was no correlation between opium consumption and Markis scores in patients with pure CAE.
Factors Associated with the Transition Time to Full Enteral Feeding in Newborns with Hypoxic Ischemic Encephalopathy
Authors: Okbay Gunes Asli , Karadag Nilgun , Topcuoglu Sevilay , Ozalkaya Elif , Hakyemez Toptan Handan , Dincer Emre , Cakir Hakan , Karatekin Guner
Published: January 2023

Background: We aimed to assess the factors associated with the transition time to full enteral feeding (FEF) in newborns with hypoxic ischemic encephalopathy (HIE) undergoing therapeutic hypothermia. Methods: We obtained data retrospectively from medical records of the neonates diagnosed with HIE and treated by therapeutic hypothermia to evaluate the factors associated with transition time to FEF. Results: Sixty-one neonates were included in the study. The median gestational age (GA) and birth weight were 39 (37–40) weeks and 3245 (2715–3575) grams, respectively. APGAR scores at the first and fifth minutes were 3 (1–5) and 6 (4–7), respectively. Fifty-seven (93.4%) of the newborns were diagnosed as having moderate HIE, and 4 (6.6%) of them had severe HIE. Transition time to FEF was found to be negatively correlated with gestational week (r, P: -0.280, 0.029) and birth weight (r, P: -0.315, 0.013); and positively correlated with lactate (r, P: 0.295, 0.044), BUN (r, P: 0.285, 0.026) and creatinine levels (r, P: 0.345, 0.007); duration of invasive (r, P: 0.565, 0.0001) and non-invasive mechanical ventilation (r, P: 0.261, 0.042), use of antibiotics (r, P: 0.556, 0.0001) and inotropic agents (r, P: 0.524, 0.0001) and hospitalization (r, P: 0.654, 0.0001). Conclusion: Clinicians should be more careful while starting to feed babies undergoing therapeutic hypothermia with higher lactate levels and impaired renal functions, and should be encouraged to feed clinically stable neonates with HIE as soon as possible, as the transition time to FEF could be related with better clinical outcomes.
Six-Month Follow-up of COVID-19 Patients: Mortality and Related Factors
Authors: Haji Aghajani Mohammad , Sistanizad Mohammad , Toloui Amirmohammad , Madani Neishaboori Arian , Pourhoseingholi Asma , Asadpoordezaki Ziba , Miri Reza , Yousefifard Mahmoud
Published: January 2023

Background: Currently, there is lack of evidence regarding the long-term follow-up of coronavirus disease 2019 (COVID-19) patients. The aim of this study is to present a 6-month follow-up of COVID-19 patients who were discharged from hospital after their recovery. Methods: This retrospective cohort study was performed to assess the six-month follow-up of COVID-19 patients who were discharged from the hospital between February 18 and July 20, 2020. The primary outcome was 6-month all-cause mortality. Results: Data related to 614 patients were included to this study. Of these 614 patients, 48 patients died (7.8%). The cause of death in 26 patients (54.2%) was the relapse of COVID-19. Also, 44.2% of deaths happened in the first week after discharge and 74.4% in the first month. Risk factors of all-cause mortality included increase in age (odds ratio [OR]=1.09; P<0.001), increase in neutrophil percentage (OR=1.05; P=0.009) and increase in heart rate (OR=1.06; P=0.002) on the first admission. However, the risk of all-cause death was lower in patients who had higher levels of hematocrit (OR=0.93; P=0.021), oxygen saturation (OR=0.90; P=0.001) and mean arterial pressure (OR=0.93; P=0.001). In addition, increase in age (OR=1.11; P<0.001) was an independent risk factor for COVID-19-related death, while higher levels of lymphocyte percentage (OR=0.96; P=0.048), mean arterial pressure (OR=0.93; P=0.006) and arterial oxygen saturation (OR=0.91; P=0.009) were protective factors against COVID-19-related deaths during the 6-month period after discharge. Conclusion: Death is relatively common in COVID-19 patients after their discharge from hospital. In light of our findings, we suggest that elderly patients who experience a decrease in their mean arterial pressure, oxygen saturation and lymphocyte count during their hospitalization, should be discharged cautiously. In addition, we recommend that one-month follow-up of discharged patients should be take place, and urgent return to hospital should be advised when the first signs of COVID-19 relapse are observed.
Objectives, Outcomes, Facilitators, and Barriers of Telemedicine Systems for Patients with Alzheimer’s Disease and their Caregivers and Care Providers: A Systematic Review
Authors: Amiri Parasto , Niazkhani Zahra , Pirnejad Habibollah , ShojaeiBaghini Mahdie , Bahaadinbeigy Kambiz
Published: January 2023

Background: Alzheimer’s disease is an extremely expensive chronic disease, which is rapidly becoming a major cause of mortality in adults. For over two decades, telemedicine has been used to assist patients and their caregivers to manage this disease. The present study aimed to evaluate the objectives, outcomes, facilitators, and barriers influencing the use of telemedicine systems for patients with Alzheimer’s disease and their caregivers and care providers. Methods: In this systematic review, we searched for the original articles published in databases such as PubMed, Web of Science, and Scopus until November 2021 using relevant keywords. A qualitative content analysis was performed the based on the theory of planned behavior and the health belief model using the ATLAS.ti software. Results: In total, 1191 articles were identified, and 60 articles were included in this study. While having different objectives, most of the studies compared telemedicine systems to in-person visits (21.43%) and assessed the feasibility of the implemented method (16.07%). The overall outcomes of telemedicine in the articles were classified as cost-effectiveness (e.g., reduced commute, fuel, and time to access care), clinical outcomes (e.g., lower anxiety, stress, and depression), and patient, caregiver, and healthcare provider satisfaction. In total, 19 facilitators and 12 barriers influencing the use of telemedicine for patients with Alzheimer’s disease and their caregivers were identified. Conclusion: According to the results, telemedicine systems could be implemented for various reasons. Developing a clear framework of the drivers and barriers before the implementation of these systems could improve decision-making prior to the design and implementation of telemedicine systems.
Asymtomatic Mass In The Tail Of The Pancreas: Intrapancreatic Accessory Spleen (IPAS)
Authors: Yıldırım Fatma , Erdogan Fazli , Kilic Mehmet , Metin Melike Rusen
Published: January 2023

We present a 48-year-old male patient with a mass in the tail of the pancreas on abdominal ultrasonography. The lesion was suspicious for a well-differentiated pancreatic neuroendocrine tumor and spleen preserved distal pancreatectomy surgery was performed. It was diagnosed as intrapancreatic accessory spleen (IPAS) after pathological examination. Accessory spleen is not an infrequent congenital entity caused by the localization of normal splenic tissue in ectopic regions. As it is known, an accessory spleen is a benign entity and does not require surgical treatment or follow-up when detected. However, it is important to recognize IPAS tissue as it may mimic a pancreatic neoplasia when it is located in the pancreas. In this article, we discuss the differential diagnostic possibilities of the IPAS entity.
Prevalence of Diabetes and Prediabetes, and Achievements in Diabetes Control in Iran; The Results of the STEPS of 2016
Authors: Shahraz Saeid , Saeedi Moghaddam Sahar , Azmin Mehrdad , Peykari Niloofar , Yoosefi Moein , Mohebi Farnam , Khatibzadeh Shahab , Mohammadi Fateh Sahar , Djalalinia Shirin , Modirian Mitra , Mahmoudi Negar , Mahmoudi Zohreh , Dashti Sarina , Mahdavi Hezaveh Alireza , Larijani Bagher , Farzadfar Farshad
Published: January 2023

Background: Using the WHO STEPwise approach to NCD risk factor surveillance (STEPS), first round of Iran’s STEPS completed in 2005. It has been repeated six times afterward. Here we report the results of 2016 round on the population characteristics and prevalence of diabetes and prediabetes, along with an assessment of the country-level performance on diabetes care in Iran. Methods: Using a proportional-to-size cluster random sampling method, the STEPS 2016 included 18947 subjects aged≥25 years who matched the criteria (non-missing information on diabetes self-report, and biomarkers). For the analyses, survey design methods with weighted samples were employed. Different definitions of diabetes (biomarker-based, self-report, anti-diabetes medication use, or a combination) and prediabetes (different cutpoints of the biomarker) were calculated and presented. Results: An estimated 5171035 persons aged≥25 years or 10.6% (95% CI: 10.0%–11.1%) had diabetes according to the serologic diagnosis of diabetes (FPG≥126 mg/dL) or the use of at least one anti-diabetes medication (1896 out of 18947). Employing the serologic diagnosis of diabetes among those who responded no to the self-reported question, 2.7% (2.5%–3.0%) of the population were not aware of their diabetes compared to 11.5% (10.9%-12.0%) who were diabetics according to the just self-reported question. Defining prediabetes as 100≤FPG<126 mg/dL or 5.7≤HbA1c<6.5%, an estimated 15244299 persons had prediabetes (5885 out of 18947). Overall, 52.1% (49.4%–54.7%) of patients with self-reported diabetes were under strict glycemic control (HbA1c<7%). Poor diabetes control (HbA1c>9%) was found in 18.4% (16.3%-20.6%) of the patients with self-reported diabetes. Conclusion: Since 2005, the prevalence of diabetes in Iran has been on a gradual increase in both genders with an increasing gap between females and males.
Targeted Next Generation Sequencing Revealed Novel Variants in the PKD1 and PKD2 Genes of Iranian Patients with Autosomal Dominant Polycystic Kidney Disease
Authors: Hosseinpour Maryam , Ardalani Fariba , Mohseni Marzieh , Beheshtian Maryam , Arzhangi Sanaz , Ossareh Shahrzad , Najmabadi Hossein , Nobakht Ali , Kahrizi Kimia , Broumand Behrooz
Published: January 2023

Background: Autosomal dominant polycystic kidney disease (ADPKD), one of the common inherited disorders in humans, is characterized by the development and enlargement of renal cysts, often leading to end-stage renal disease (ESRD). In this study, Iranian ADPKD families were subjected to high-throughput DNA sequencing to find potential causative variants facilitating the way toward risk assessment and targeted therapy. Methods: Our protocol was based on the targeted next generation sequencing (NGS) panel previously developed in our center comprising 12 genes involved in PKD. This panel has been applied to investigate the genetic causes of 32 patients with a clinical suspicion of ADPKD. Results: We identified a total of 31 variants for 32 individuals, two of which were each detected in two individuals. Twenty-seven out of 31 detected variants were interpreted as pathogenic/likely pathogenic and the remaining 4 of uncertain significance with a molecular diagnostic success rate of 87.5%. Among these variants, 25 PKD1/2 pathogenic/likely pathogenic variants were detected in 32 index patients (78.1%), and variants of uncertain significance in four individuals (12.5% in PKD1/2). The majority of variants was identified in PKD1 (74.2%). Autosomal recessive PKD was identified in one patient, indicating the similarities between recessive and dominant PKD. In concordance with earlier studies, this biallelic PKD1 variant, p.Arg3277Cys, leads to rapidly progressive and severe disease with very early-onset ADPKD. Conclusion: Our findings suggest that targeted gene panel sequencing is expected to be the method of choice to improve diagnostic and prognostic accuracy in PKD patients with heterogeneity in genetic background.
Long-term Survival and Prognostic Factors of Breast Cancer
Authors: Olfatbakhsh Asiie , Heidari Leila , Omidi Zahra , Hashemi Esmat-o-Sadat , Ansari Maryam , Mozaffarian Samaneh , Haghighat Shahpar
Published: January 2023

Background: Breast cancer survival rate is an important index for assessment of treatment effect in reducing the mortality. Weaimed to determine the fifteen-year survival rate for breast cancer at a referral center in Iran and its correlated factors. Methods: This survival study enrolled patients with breast cancer who referred to Motamed Cancer Institute (MCI) from 1998 to2016. The survival rate was calculated using the Kaplan-Meier method. The relationship of demographic, clinical and therapeuticfactors with overall survival (OS) was studied using Cox’s proportional hazard model. Results: Totally, 3443 patients were studied. Their mean age and follow-up period were 47.7 (±11.43) years and 61.66 (±52.1)months, respectively. The median follow-up time was 48.4 months (range: 1-413 months), 49.7% of the patients had high schoolor higher education, and 71.3% presented in the early stage of the disease. Death occurred in 505 (14.7%) of the patients. Theoverall 2-, 5-, 7-, 10- and 15-year survival rates were 93%, 82%, 78%, 74%, and 66%, respectively. Lymph node involvement(HR=2.07; 95% CI: 1.38–3.09), tumor size≥5 cm (HR=2.83; 95% CI: 1.59–2.04), being single/divorced/widowed (HR=1.65;95% CI: 1.13–2.4), and education level<high school diploma (HR=1.57; 95% CI: 1.13–2.17) were independent predictors ofbreast cancer survival. Conclusion: The five-year breast cancer survival rate in this study was higher than reported by some other studies in Iran, whichcould be due to the multidisciplinary treatment approach in MCI. Tumor size and lymph node involvement as indicators ofdelayed diagnosis may affect breast cancer survival, even though their true effect due to lead-time bias should be considered. Thecorrelation of education level with survival confirms the importance of awareness and the need to establish strategies for earlydiagnosis in Iranian women.
Clinical Evaluation of an HTK Solution for Liver Transplantation: A Phase 3 Randomized Pilot Clinical Trial Study
Authors: Malekhosseini Seyed Ali , Ghasemi Younes , Rousta Javad , Aghaei Roghayyeh , Kianpour Sedigheh , Negahdaripour Manica , Heidari Reza , Shamsaeefar Alireza , Gholami Siavash , Nikeghbalian Saman
Published: January 2023

Background: Organ preservation solutions are not easily accessible in Iran, similar to many resource-limited countries. We aimed to evaluate the efficacy of a locally-produced HTK solution among adult liver transplantation candidates in a pilot clinical trial study. Methods: Adult patients undergoing liver transplantation were randomly allocated into two groups. One received the HTK solution (PharMedCina Inc., Shiraz, Iran), and the second received the commercially available HTK solution (Custodiol ®). Results: Overall, 28 individuals entered the study, including 11 and 9 males (78.6% and 64.3%) in the Custodiol® and local HTK groups, respectively. Clinical characteristics, including postoperative biliary complications, reperfusion syndrome, infection and primary non-function (PNF) rates, amount of intraoperative bleeding, length of hospital and ICU stay, peak aspartate aminotransferase (AST) and alanine aminotransferase (ALT), and duration of follow-up were similar between the two groups (P>0.05). One patient died in the locally-produced HTK group. The patient underwent re-transplantation 20 days after his first liver transplantation due to PNF. Two patients died in the Custodiol group, both due to PNF of the liver, which occurred five and three days after transplantation. The two groups did not show any difference regarding serum levels of AST, ALT, alkaline phosphatase (ALP), bilirubin, platelet count, prothrombin time and international normalized ratio, white blood cell count, blood urea nitrogen, and creatinine on the first postoperative day and on the day of discharge (P>0.05). Conclusion: Based on the findings of this pilot study with the current sample size, no statistically significant difference was found between our locally-produced HTK solution and Custodiol® regarding clinical outcomes
Incidental Findings on Computerized Tomography Images of Trauma Cases
Authors: Kaya Ahsen , Senol Ender , Eraslan Cenk , Karaca Ali Mert , Durdagi Elif
Published: January 2023

Background: This study aimed to evaluate the characteristics of incidental findings (IFs) on computed tomography (CT) scans of trauma admissions, examine associations between IFs and gender and age-groups, and discuss the management strategies. Methods: The CT reports were retrospectively reviewed to evaluate IFs. Cases were divided into five age-groups (0–19, 20– 39, 40–59, 60–79,≥80). IFs were classified as "Group 1": congenital anomalies that do not require further investigation, non-degenerative/minor degenerative findings; "Group 2": findings that do not require immediate intervention, require outpatient follow-up/in case of symptoms; and "Group 3": findings that require immediate intervention/further investigation. Results: There were 2385 CT scans and 1802 incidental findings (IFs) in 783 trauma cases. CT scans with IFs constituted 50.2%. The percentage of IFs was 75.6% in males and 24.4% in females, and they occurred in 4.8%, 27.6%, 44.3%, 20.9%, and 2.4% of age groups 1 to 5, respectively. Group 1 had 34.6%, group 2 had 54.6%, and group 3 had 10.8% IFs. There was not any significant association between the classification and gender or age-groups. In terms of organs, IFs of the thyroid and gall bladder & bile ducts were significantly higher among females (P=0.044 and P<0.001, respectively), while IFs in the head & neck region were significantly higher in males (P<0.001). Incidental findings in the kidney, liver, adrenal gland, and vascular structures differed significantly across age-groups (P<0.05). Conclusion: There were no significant relationships between the classification of IFs and gender or age-groups. However, the distribution of IFs was significantly associated with gender and age-groups in terms of organs. Healthcare professionals should consider this relationship when following up and treating patients.
Reliability of Cone-Beam Computed Tomography in Diagnosis of Root Resorption Due to Impacted Maxillary Canine
Authors: Goodarzi Pour Daryoush , Golshani Shaghayegh , Kheirandish Yasaman , Aliasghari Sara
Published: January 2023

Background: This study aimed to evaluate the cone-beam computed tomography (CBCT) technique considering its reliability to diagnose resorption due to maxillary impacted canine. Methods: In this cross-sectional study, 68 CBCT images were observed by two oral and maxillofacial radiologists. The position of the impacted maxillary canine was assessed, and the severity of root resorption in adjacent teeth was determined in two rounds by viewing. Finally, statistical analyses were performed according to the percentage of agreement, intra-class correlation coefficient, and kappa. The data sheets were filled out by two radiologists who observed the CBCT images in two separate weeks and recorded their opinions about the position of the crown and root of the impacted maxillary canine. Further, four adjacent teeth were examined for root resorption. Results: In most cases, no root resorption was observed in the lateral, central, and first premolars; however, the reported percentage of root resorption in the lateral premolar was higher than that of the others, and no root resorption was reported in the second premolars. Agreement on crown and root position was reported to be above 90% in all observations. In addition, the percentage of agreement was 98.5%, 95.6%, 98.5%, and 100% for root resorption, central incisor, lateral incisor, the first premolar, and the second premolar, respectively. Maxillary impacted canines were examined considering root resorption in adjacent teeth using CBCT, and its interpretation was reliable. Conclusions: Utilization of CBCT provides a worthy data about the impacted maxillary canine localization and effects on adjacent teeth, for more explanation and treatment of these cases.
Effect of Dental Students’ Dressing on Dentist-Patient Relationship
Authors: Alijani Sara , Khamverdi Zahra , Miresmaeili Amir Farhang , Malak Khorshidi Farzad , Salehzadeh Maryam
Published: January 2023

Background: To establish a good and effective relationship between a doctor and his/her patient, certain non-verbal standards are as necessary as knowledge and skills. According to evidence, one of these standards may be the dentist’s attire. Therefore, this study aimed to determine the effect of dental students’ dressing on patients’ trust and confidence. Methods: This cross-sectional descriptive study was performed to evaluate the perception of dental school patients. After reviewing pictures of dental students in six different dress styles, the respondents were asked some questions on their preference for dental students’ attire, as well as several questions targeting patients’ trust and confidence. The collected data were analyzed using SPSS 16. Results: In the present study, 169 respondents with a mean age of 27.5 years old were enrolled, including 47% men and 53% women. The included respondents significantly favored male dentists with a long white coat and surgical scrubs and preferred a long white coat with a white scarf for women (P<0.001). They believed that dentists with this attire are more knowledgeable, skilled, and professionally competent, and they were more appealing to share their personal issues with this kind of dentist. Conclusions: The respondents preferred dental students in professional attire. Wearing professional dress (a white coat) could have a favorable effect on patients’ trust and confidence.
Deep Margin Elevation With Resin-modified Glass Ionomer in Posterior Adhesive Indirect Restorations Based on Biomimetic Principles: A Case Report
Authors: Farhadi Elham , Ranjbar Omrani Ladan , Estedlal Taraneh , Ahmadi Elham
Published: January 2023

A ceramic onlay restoration is a more conservative treatment than full-coverage crowns for endodontically treated teeth (ETT); thus, it helps preserve the tooth structure. Deep margin elevation (DME) is a method to relocate subgingival margins into a more coronal position with resin-modified glass ionomer (RMGI) or direct composite resin before the cementation of the indirect restoration. A 33-year-old male was referred to restore two ETT (teeth N. 46 and 47) with extensive coronal defects extending subgingivally between two teeth. Tooth N. 47 could not undergo a crown lengthening (CL) procedure due to its short root trunk. DME with RMGI was done for both teeth before preparation for ceramic onlays. In this case, by following the principles of biomimetic dentistry, we aimed to restore the tooth defect with a material that bore all functional stresses, in addition to achieving esthetic. It seems that DME in combination with ceramic onlay restoration can be a conservative method to restore ETT in the posterior region. The goal of considering the principles of biomimetic dentistry is to maintain the function of teeth using a good bond to hard tissue that unifies the tooth and its restoration hence distributing the stresses through the tooth as a unit with near-normal functional, biological, and esthetic features.
Effect of Liquorice-Extract-Containing Antimicrobial Mouthwash on Helicobacter Pylori: An In Vitro Study
Authors: Bohlouli Sepideh , Esmaeilzadeh Mahdiyeh , Samadi Kafil Hossein , Negahdari Ramin , Shokouhi Behnaz , Aghazadeh Zahra
Published: January 2023

Background: The oral route is one of the main portals for Helicobacter pylori transmission. The elimination of this bacterial species from the oral cavity might be useful in oral health and decreasing infections due to H. pylori. This study aimed to evaluate the effect of a liquorice-extract-containing mouthwash at different concentrations on the proliferation of H. pylori in vitro. Methods: H. pylori bacterial species was cultured, and the isolated strains from the specific culture medium were prepared for the welling procedures. The liquorice (Glycyrrhiza glabra) mouthwash at 12.5% and 25% concentrations was added to the case group wells at 1,1/2,1/4,1/8, and 1/16 dilutions. In the control group, regular daily mouthwash containing cetylpyridinium chloride and sodium fluoride components was used. The growth inhibition zones were analyzed in the study groups. The data were analyzed by SPSS and reported using descriptive statistics (means±standard deviation). Results: In both the mouthwashes containing 25% and 12.5% concentration, the means of growth inhibition zones at 1, 1/2, 1/4, 1/8, and 1/16 dilutions were larger than those in the control group. Further, the largest growth inhibition zone was seen with the undiluted 25% mouthwash. There were no significant differences in the H. pylori growth inhibition zones between 25% and 12.5% mouthwashes (P=0.14). Conclusions: Mouthwashes containing liquorice extracts inhibited the growth of H. pylori more significantly than mouthwash with no liquorice extract. Therefore, it is suggested that liquorice extract-containing mouthwashes be used to prevent H. pylori infections in the oral cavity in clinical studies.
Effects of Processing Delays in Different Coverages on the Image Quality of Photostimulable Phosphor Plates With Acteon and Digora Scanners
Authors: Bardal Roghieh , Mobini Mahshid , Hemmati Nahid
Published: January 2023

Background: Delay in the processing of photostimulable phosphor storage plates (PSP) is a common occurrence in crowded clinics. Accordingly, the effects of processing delays in different coverages on the image quality of photostimulable PSPs were investigated with Acteon and Digora scanners. Methods: Three Acteon (group A) and three Digora (group B) PSPs were used in this in vitro study. Each group had three subgroups according to three coverages, including protective box (A1 , B1 ), semitransparent (A2 , B2 ), and original dark case plates (A3 , B3 ). An aluminum step wedge was subjected to constant exposure conditions. The exposed plates were immediately processed with their corresponding scanner device (the golden standard), 5, 10, 20, 30, 40, and 60 minutes after exposure. The average gray level information of the 2nd, 5th, and 8th steps of the Al wedge was considered as the mean gray values (MGVs) of each wedge. The difference between the gray values of the 8th and 2nd steps was measured as image contrast. Results: There was a significant difference between the contrast and MGVs of Acteon and Digora PSPs at all processing delay times (P<0.05). In general, there was no significant difference in the image MGVs and contrast between subgroups in any of the scanners (total P>0.05). In each subgroup, MGVs increased, while contrast decreased by increasing the processing delay time; the difference was significant except for the MGVs in the first 5 minutes of A1 (P=0.12) and A3 (P=0.06). Conclusions: Thus, the type of scanner was effective on image quality; the type of PSP coating in the first few minutes could affect the rate of image quality loss. However, the scan time had a greater effect on the amount of image loss.
Influence of Inlays/Onlays and Their Material on Stress Distribution in Mandibular Molars: Finite Element Analysis
Authors: Darwich Ayham , Aljareh Abeer , Aladel Omar , Szávai Szabolcs , Nazha Hasan
Published: January 2023

Background: This study aimed to evaluate the influence of inlays/onlays and their material on stress distribution in mandibular molars with large cavities, using finite element analysis (FEA). Methods: 3D models of the first mandibular molar were created. Then, a mesio-occluso-distal cavity was created, and cusps were reduced (1.5 mm for buccal cusps and 1 mm for lingual cusps). The restorations were: inlay, onlay that covered buccal cusps (B models), and onlay that covered all cusps (LB models). Inlays and onlays were represented by two materials: nanofill composite resin and polymer-infiltrated ceramic network (PICN). Vertical load of 600 N was applied and von Mises stresses were calculated. Results: Inlay models showed higher stress concentration in tooth structures than onlay models. Composite resin inlays and onlays transmitted most of the stress to adjacent structures. On the other hand, PICN inlays/onlays absorbed most of stress and transmitted less stress to dental structures than composite resin restorations. Moreover, stress concentrations in PICN onlay models (B-buccal cusps and LB-all cusps) were similar, while composite resin LB onlay showed higher stress concentration in dental structures than composite resin B onlay. Conclusions: Onlays showed better stress distribution than inlays. PICN might be a suitable choice as a restorative material of inlay/onlay for large cavities in molars, while the composite resin is unfavorable material for such restorations in terms of stress redistribution in dental structures.
Cardiovascular Property of Resistance Training With an Emphasis on PI3K/AKT1 Genes Expression in Type 2 Diabetic Rats
Authors: Dastyar Mohammad , Eizadi Mojtaba , Roozbayani Mania
Published: January 2023

Background: The potential role of exercise in physiological cardiac hypertrophy is rooted in both hormonal and genetic components. Objectives: The aim of this study was to determine the impact of resistance exercise on the expression of PI3K and AKT1 in cardiac tissue of type 2 diabetes (T2D) rats and their physiological cardiac hypertrophy. Methods: First, 21 male Wistar rats (220±20 g) were obese with 6-week high-fat diet (HFD) and were randomly assigned into non-diabetes, control T2D, and exercise diabetes groups. After inducing obesity, T2D was induced by intraperitoneal injection of streptozotocin (25 mg/kg) for diabetes groups. Rats in the exercise group completed a 6-week resistance exercise program, 5 sessions per week. PI3K/AKT1 expression and the weight ratio of left ventricular to heart, heart to body, and left ventricular to body were compared by analysis of variance (ANOVA) between groups. Results: In response to the induction of diabetes, the expression of PI3K/AKT1 in heart tissue decreased significantly compared to that of non-diabetic rats (P=0.001 and P=0.001, respectively). Further, resistance training led to a significant increase in PI3K expression (P=0.028) and AKT1 (P=0.032) and the weight ratio of left ventricular to heart (P=0.001), heart to the body (P=0.001), and left ventricular to the body (P=0.001) compared to control diabetic rats. Conclusion: Resistance training is associated with physiological cardiac hypertrophy in diabetic rats, and this improvement may be attributed to the PI3K/AKT1 signaling pathway.