bluuebunny/crossref_metadata_2025 huggingface dataset:
Microflora of autopsy material from HIV-infected patients
Authors: Zhestkov A. V. , Lyamin A. V. , Ketsko Yu. L. , Zolotov M. O.
Published: August 2021

According to literature, lungs are affected in 25 – 60% of HIV-infected individuals. The most common opportunistic disease in this group of patients is pneumonia of various etiology. HIV-positive patients show a wide microbiological landscape of pneumonia pathogens.

The aim of the study was to determine the structure of the microflora of autopsy material obtained from the lungs of HIV-infected patients.

Methods. 83 samples of autopsy material from patients with HIV infection and 27 samples from HIV-negative patients were analyzed. The deceased were treated in the pulmonary departments of Samara with a diagnosis of community-acquired pneumonia. Due to the large variety of microorganisms recovered from the autopsy material, the microorganisms were divided into several groups: Enterobacteria, non-fermentative gram-negative bacteria, Enterococci, Staphylococci, Sterptococci, and Corynebacteria. The fungi were divided into two subgroups. The first included Candida spp., the second included other types of fungi. The tests for pneumocystis infection, Mycobacterium tuberculosis, and non-tuberculosis mycobacteria were not performed.

Results. Enterobacteria were found in 39.2%, non-fermentative gram-negative bacteria – in 27.3% and Enterococci – in 19.6% of the HIV-infected patients. Staphylococcus spp. were found in 4.2%, and Corynebacteria and Streptococci in 0.7% of those patients. Candida spp. accounted for 6.3%, other fungi were found in 2.0% of cases. Enterobacteria and non-fermentative gram-negative bacteria were found in 26.2% of HIV-negative patients. Enterococcus spp. – 21.4%, Staphylococci – 7.1%, Streptococci – 2.4% of those patients. Candida spp. 16.7% were found in 16.7% of HIV-negative patients. Enterobacteria were found significantly more often in the autopsy material from HIV-infected patients. The study shows the high importance of gram-negative flora as a causative agent of infectious lesions of the lung tissue. At the same time, we statistically confirmed an increase in prevalence of Enterobacteria in HIV-positive patients. Although these pathogens are not always detected in the sputum from HIV-infected patients with bronchopulmonary disorders, they are detected only by autopsy examination of the lung tissue.

Conclusion. Diagnosis and treatment of pneumonia in HIV-infected patients with severe immunodeficiency have a few specific features, such as increasing the frequency of sputum culture, reducing the number of errors at the preanalytical stage of collecting the biomaterial, ensuring proper conditions for its transportation to a bacteriological laboratory, improving the quality of analysis. The physicians should be aware of the possible detection of gram-negative flora as a causative agent of lung infections and the possible change of the causative agent.
Clinical and epidemiological features of community-acquired pneumonia during an epidemic of respiratory viral infection
Authors: Izmozherova N. I. , Popov A. A. , Prokopeva E. R. , Kuryndina A. A. , Gavrilova E. I. , Tagiltseva N. V. , Shambatov M. A.
Published: August 2021

Community-acquired pneumonia (CAP) is one of the most common lower respiratory tract diseases. An increase in the CAP incidence has been reported to be associated with epidemics of acute respiratory viral infections (ARVI).

Aim. Аssess clinical and epidemiological features of CAP in patients admitted to hospital during an ARVI epidemic.

Methods. A cross-sectional study included 208 patient records. Medical history, physical examination, laboratory and imaging data were analyzed. CAP severity was assessed by CRB-65 scale and the systemic inflammatory response syndrome (SIRS) criteria.

Results. Most CAP patients (75%) were of active working age; all presented signs of ARVI upon admission. Nasal mucosa diagnostic smears have revealed type A influenza viruses: H1N1 – 5 (83.3%) and H3N2 – 1 (16.7%) cases. 195 (93.8%) patients were not vaccinated against influenza. X-rays showed that unilateral (81.7%) and lobular pneumonia (55.8%) were the most common CAP types. 93.2% patients had nonsevere CAP, according to CRB-65. But 88 (42.3%) subjects qualified for SIRS upon admission. Concomitant conditions as risk factors of an adverse course of CAP were present in 89 patients (42.8%). Sputum analysis, if available, most frequently identified Streptococcus pneumoniae (23 cases or 38.9%) as a causative agent. Antibacterial drugs (ABD) used to treat CAP were ceftriaxone 206 (99%), macrolides 188 (90.4%), and fluoroquinolones 94 (45.2%). The initial antibacterial treatment regimens were: 186 (89.4%) prescriptions of ceftriaxone + macrolides, 16 (7.7%) prescriptions of ceftriaxone alone, and 6 (2.9%) prescriptions of levofloxacin. A switch between ABDs was reported in 78 (37.5%) cases, including 61 switches to fluoroquinolones. The median ABD administration duration was 10 (8 – 13) days.

Conclusion. Most of the hospitalized CAP patients were of working age and not vaccinated against influenza. Streptococcus pneumoniae was the most common causative agent. PCR (polymerase chain reaction) smear analysis was performed only in 6 patients with ARVI, which does not allow us to assess the role of viruses and viral-bacterial associations in the etiology of CAP. In spite of non-severe CAP, all hospitalizations were justified, due to multiple risk factors of unfavorable prognosis of CAP and epidemiological factors. Most patients received a combination of generation 3 cephalosporins and macrolides as the initial therapy for CAP.
Challenges in diagnosis and treatment of pneumothorax and giant bullae
Authors: Korymasov E. A. , Benian A. S. , Bogdanova Ju. V. , Kolmakova K. M. , Medvedchikov-Ardiia M. A. , Konovalova D. Yu.
Published: August 2021

Spontaneous pneumothorax is the most common acute chest disease. Often, giant bullae give the impression of the presence of air in the pleural cavity. Inadequate differential diagnosis leads to vain drainage of the pleural cavity, damage to the lung with its collapse and pneumothorax.

The aim. Analyze diagnostic and tactical mistakes in patients with pulmonary emphysema, which manifests with giant bullae, and outline the ways to prevent complications.

Methods. The analysis of the treatment of 1,636 patients with pulmonary emphysema and its complications undergoing treatment in the thoracic surgical department of the Samara Regional Clinical Hospital named after V.D.Seredavin in the period from 2001 to 2018 is presented.

Results. Giant bulla were diagnosed in 35 (2.1%) patients, 16 of them were hospitalized ungently. In 6 patients, the diagnosis of a giant bulla of the lung was correct, and the patients were referred to the thoracic surgical department. In 10 patients, a giant bulla of the lung was regarded as pneumothorax, and pleural drainage was performed before referral to the thoracic surgical department.

Conclusion. The correct interpretation of the radiological data and comparison with the clinical picture allows avoiding diagnostic errors and the associated danger and complications.
Chronic obstructive pulmonary disease and concurrent cardiovascular conditions: safety of tiotropium/olodaterol combination
Authors: Romanovskikh A. G. , Sinopal’nikov A. I. , Belotserkovskaya Yu. G. , Smirnov I. P.
Published: August 2021

One of the important features of the chronic obstructive pulmonary disease is the presence of concomitant chronic diseases in most of patients. And cardiovascular conditions occupy a special place among these comorbidities. The most common diseases associated with COPD are hypertension, coronary heart disease, and heart failure. They aggravate the clinical manifestations of the disease and have negative effect on the prognosis. In addition, concomitant cardiovascular conditions determine the need for a thorough safety assessment of the ongoing pharmacotherapy for COPD. Core of the treatment is bronchodilators. The priority pharmacological strategy is the use of fixed-dose combinations of long-acting β2 -agonists and long-acting anticholinergic medications.

The purpose of this review was to evaluate the safety profile of tiotropium/olodaterol in COPD.

Methods. This article presents the data obtained from studies of the safety of the use of tiotropium/olodaterol in patients with COPD and concomitant cardiovascular conditions.

Results. The studies showed no increase in the risk of cardiovascular events when using this combination in patients of this category.

Conclusion. А good safety profile of tiotropium/olodaterol was confirmed in patients with COPD and concomitant cardiovascular conditions.
Bronchodilator and anti-inflammatory therapy of chronic obstructive pulmonary disease from the position of interchangeability
Authors: Orlova E. A. , Dorfman I. P. , Orlov M. A. , Andreeva A. K. , Abdullaev M. A.
Published: August 2021

The choice of drugs used to treat patients with chronic obstructive pulmonary disease (COPD) (inhaled β-agonists, M-anticholinergic drugs, inhaled corticosteroids (ICS)) in view of their interchangeability is reviewed in this article. This aspect is especially important for clinicians when choosing an effective and safe treatment for COPD and for increasing patient adherence to treatment.

The aim of this study was to assess the ratio of the number of reference (original), interchangeable, and generic drugs used in COPD.

Methods. In accordance with the Russian clinical guidelines 2018 and GOLD 2019, modern drugs for the treatment of COPD with bronchodilator and anti-inflammatory activity were selected. All trade names of the corresponding drugs for each international non-proprietary name (INN) In the State Register of Medicines website were considered. The information on the availability of reference (original) drugs and the corresponding interchangeable products, as well as their presence in the List of vital and essential drugs was analyzed.

Results. A large number of generic prodcuts are registered in the State Register of Medicines, and only a few of them are interchangeable with the corresponding reference (original) drug.

Conclusion. The analysis will help widen the doctors’ choice of interchangeable drugs in treatment of COPD with an equivalent effect and safety of reference drugs, as well as to increase the patients’ adherence to treatment.
Typical features of the etiology, pathogenesis and pathological morphology of chronic obstructive pulmonary disease in women and men
Authors: Malykhin F. T.
Published: August 2021

Chronic obstructive pulmonary disease (COPD) is a highly debilitating disease that poses a significant and increasing burden on women’s health. There is an increasing amount of information about gender-related differences in risk factors and the progression of COPD. However, very little attention is paid in scientific research and practice to COPD as a significant issue of women’s health. The challenges of COPD prevention in women can be overcome by a multi-vector approach, including increasing patient awareness of the disease, reducing the risk of its occurrence and further research on gender aspects (biological and cultural) that affect the risk of development and the rate of progression of COPD. The article reviews the current literature on this issue.
Thrombosis of the pulmonary arteries branches as a complication of COVID-19 pneumonia (a case report)
Authors: Kalenchic T. I. , Kabak S. L. , Didenko N. S. , Dulub I. P. , Haustovich A. Yu.
Published: August 2021

The article presents a rare case of thrombosis of the pulmonary arteries branches, which developed in a patient two months after infection with the SARS-CoV-2 virus, that caused bilateral polysegmental pneumonia. The thrombosis was suspected because of a high plasma D-dimer level. Contrast-enhanced chest CT was performed to make a definitive diagnosis. The absence of blood clots in the veins of the lower extremities and pelvis allowed us to conclude that the patient did not have thromboembolism, but rather a pulmonary thrombosis in situ. Such possible causes of venousthromboembolic complications as tumors, systemic diseases of the connective tissue, and antiphospholipid syndrome were excluded based on negative tests for tumor and autoimmune diseases markers. The long-stay in the hospital was associated with the inability of the patient to maintain the normal level of blood oxygen saturation independently due to the large area of the lung damage associated with COVID-19 pneumonia and ischemia caused by thrombosis of the branches of the pulmonary arteries.
Investigating Safety Standards and Performance of Emergency Power Diesel Generators in Hospitals of Tabriz, Iran
Authors: Ghoddoosi-Nejad Djavad , Daemi Amin , Janati Ali , Yaghoubi Rouhollah
Published: August 2021

Background: Power outage risk is one of the serious risks that could be eliminated by supplying electricity through the emergency power system installed in a hospital, such as diesel generators and uninterruptible power supplies (UPSs).
Objectives: The present study aimed to investigate the observance of safety and maintenance standards of emergency power diesel generators in the hospitals of Tabriz.
Methods: This descriptive-analytical research was cross-sectionally performed in 18 hospitals of Tabriz in 2014. The data collection tools included a questionnaire and a checklist prepared according to the national standards and consisted of 87 questions in 15 categories. Data were analyzed using SPSS version 19.
Results: The average rates of observance of safety and maintenance standards of diesel generators in 111-question standards and 87-question standards were equal to 61.4 and 52.8%, respectively. Regarding the observance of the 19 standards, “ventilation” and “daily visits” standards with 28.94 and 96.24, respectively, had the lowest and highest degrees of observance in hospitals. There was a significant direct association between observing the standards defined for diesel generators with the number of hospital beds (P = 0.01) and the total capacity of emergency power generation by generators (P = 0.05).
Conclusions: The results of the present study indicate a low level of safety and maintenance for the emergency power systems of hospitals. These scores are not considered favorable for a system called “emergency”, and if the necessary interventions are not made in this regard, in the event of natural disasters and human errors, hospitals will face numerous problems.
Effect of the Health Promotion Plan on the Performance of Hospitals: Evidences from East of Iran
Authors: Ghoddoosi Nejad Javad , Arab-Zozani Morteza , Yaghoubi Rouhollah
Published: August 2021

Background: Hospitals are considered as the most central and resource-consuming units in the healthcare system. They use from 50 to 80% of public expenditures. As hospitals become more efficient, the better the allocated resources in health sector will be used.
Objectives: The aim of this study was to assess hospitals’ efficiency in South Khorasan using the Pabon Lasso model.
Methods: In this quasi-experimental and time-series study, we investigated the efficacy of South Khorasan hospitals during 2010 - 2018 (before and after the implementation of the health reform plan). All public hospitals in South Khorasan province were enrolled. Data including bed occupancy rate (BER), bed turnover (BT), and patient length of stay (LOS) were collected from hospitals in summer 2018 and analyzed using SPSS, version 21.
Results: The means of the Pabon Lasso performance indicators for eight years were 74.4% for bed occupancy rate, 89.9 times for bed turnover, and 3.01 days for the length of stay. The coefficient of occupancy index after the implementation of the health reform plan was 5.7% higher than before, the bed turnover index increased 4.1 times, and the average length of stay increased by 0.08 day. On average, 35% of the hospitals were located in region 1, while 38% in region 2, 21% in Region 3, and 6% in Region 4 in the Pabon Lasso Diagram.
Conclusions: Only 21% of the hospitals were in the region 3 of the Pabon Lasso Diagram, which is the desirable region for the efficiency of hospitals. This situation is not desirable and acceptable for hospitals. To increase productivity, interventions are required, and health planners and authorities need to apply economic tools for the improvement of this situation.
Quality of Services in Health Centers in Western Suburbs of Ahvaz by Examining the Gap Between Expectations and Perceptions
Authors: Rostami Borujeni Nastaran , Sarahi Saham , Haghighizadeh Mohammad Hosein , Fadaei Dehcheshmeh Nayeb
Published: August 2021

Background: Due to the health sector’s serious mission in maintaining the health and care of the community, the quality of provided health services is of particular prominence.
Objectives: This study aims to assess the quality of services in health centers in western suburbs of Ahvaz by examining the gap between expectations and perceptions.
Methods: This was a cross-sectional study and conducted in 2018. The sample size included 291 people visiting health centers in western suburbs of Ahvaz. The data were collected through the SERVQUAL standard questionnaire for assessing the quality. This questionnaire assesses five dimensions of the quality of the provided services. These five dimensions include tangible factors, reliability, responsiveness, assurance, and empathy. Pearson correlation coefficient test was used to investigate the relationship between the variables. Independent t-test was used to compare the means. Data analysis was performed through SPSS version 22.
Results: Overall, 89.55% of the subjects were female. In all the five dimensions of quality, there was a significant difference between the ideal status and the observed status (P < 0.001). The lowest gap was related to empathy (r = 0.25), and the highest gap was reported for tangible factors (r = -0.99). There was a significant positive correlation between each of the dimensions of expectations and the same dimension in the perceptions section (P < 0.001).
Conclusions: Expectations in all the dimensions, except for empathy, were higher than perceptions, and health centers were far from ideal. Among these dimensions, expectations and perceptions in the area of reliability were higher than in other cases, and the mean scores were at a higher level. In the area of increasing the quality of care in health centers in suburbs of Ahvaz, some measures should be taken to promote the quality.
Performance of Health Caregivers in the Eastern Health Center of Ahvaz, Iran, in the Self-Care Program
Authors: Shirzad Shirin , Fadaei Dehcheshmeh Nayeb , Haghighizadeh Mohammad Hosein
Published: August 2021

Background: Human factor has currently become the source of change in organizations. The evaluation of human performance is a practical issue in human resources management and the best way to obtain information for organizational decision-making.
Objectives: The current study aimed to monitor the performance of health caregivers in the eastern health center of Ahvaz, Iran, in the self-care program.
Methods: This cross-sectional descriptive study was conducted on 72 health caregivers in 20 affiliated and 31 non-affiliated health posts in the eastern health center of Ahvaz in 2018. The census sampling method and ministerial checklist were the tools of assessment for the performance measurement of the health caregivers. The checklist consisted of two parts for personal information and technical performance evaluation. The data were analyzed using the t-test and analysis of variance in SPSS software (version 22).
Results: All the participants were female health caregivers. The results showed that there was notanysignificantdifferencebetweenthestudy dimensions with the participants’fieldofstudy (P = 0.798;F = 0.226), academic degree (P value =0.957; t = 0.003), age (P = 0.419; F = 0.955), and work experience (P-value = 0.537; F = 0.627). The health caregiversofthe eastern Ahvaz health center of Ahvaz scored 767.35 out of the total 1,000, indicating that their performance was generally at an acceptable level.
Conclusions: The findings of this study can assist the managers and experts of the health sector in evaluating the performance of health caregivers in their self-care program. For the enhancement of the performance of health caregivers, not only health ambassadors should be identified and trained, but also the dimension of organizational self-care should be reinforced.
Incidence of Febrile Neutropenia in Neutropenic Cancer Patients Admitted to Oncology Ward of Shahid Ghazi Tabatabai Hospital in Tabriz, Iran, During 2018 - 2020
Authors: Ghaderi Loghman , Naseri Ali Reza
Published: August 2021

Background: Chemotherapy-induced neutropenia is one of the risk factors for infection in patients undergoing chemotherapy (due to the weakened immune system). Febrile neutropenia (FN) may be the sole indicator of an underlying infection in these patients.
Objectives: Since infection is associated with an increased risk of mortality in patients undergoing chemotherapy, the present study aimed to assess the incidence of FN in neutropenic cancer patients admitted to an oncology ward.
Methods: This retrospective, descriptive, and cross-sectional study was conducted on 52 patients (selected using the census method) with signs of infection (i.e., FN) hospitalized in Ghazi Tabatabai Hospital in Tabriz, Iran, within 2018 - 2020. The data were collected by a researchermade form and analyzed using descriptive statistics (e.g., frequency, percentage, and mean) and chi-square in SPSS software (version 20). The significance level was considered less than 0.05
Results: The absolute neutrophil count was less than 500 cells/ml in 15.38% of the patients (n = 8). Infection was the cause of FN in 69.23% of the subjects (n = 36). An unknown factor was the cause of infection in 30.77% of the cases. The incidence of all types of infections (i.e., perianal abscess, sepsis, oral infection, cutaneous infection, gastrointestinal infection, pharyngitis, pneumonia, and urinary tract infection) was higher in patients undergoing chemotherapy than that reported for those not receiving chemotherapy.
Conclusions: The results of this study suggested that cancer patients undergoing chemotherapy should be aware of infection signs; accordingly, they can visit treatment centers in case of the first symptoms of infection to prevent progression of infection and reduce mortality rates.
The Effect of Advanced Diagnostic Imaging on Mortality and Length of Stay in Tehran General University Hospitals
Authors: Jaafaripooyan Ebrahim , Akbarisari Ali , Rahimiforoushani Abbas , Abedini Zahra
Published: August 2021

Background: As fast and accurate techniques, advanced medical imaging technologies (AMIT) allow healthcare professionals to better diagnose and treat various health conditions, which translates into higher use of non-invasive operational procedures. Objectives: The current study intended to investigate the effect of inpatient use of MRI and CT scan on the inpatient mortality and length of stay (LOS) in Tehran general university hospitals.
Methods: Data were collected from all general university hospitals in Tehran in 2017. A multiple linear regression model was constructed for each combination of technology and outcomes (i.e., mortality and LOS), and all models were controlled for patients’ demographic and clinical characteristics and structural profile of hospitals. In calculating hospital standardized mortality ratio (HSMR) for each of 72 diagnosis groups related to death, a binary logistic regression model was fitted with predictors including LOS, admission type, comorbidity level, sex, and age.
Results: The use of CT varied from 0.39 to 149.35, and MRI from 0.24 to 80.23 exams per 100 discharges. The HSMR ranged from 76.8% to 146%, and the average length of stay (ALOS) was 3 - 8.46 days. MRI and CT had no significant effect on the HSMR and ALOS.
Conclusions: Further use of AMIT was not linked with improved efficiency and quality but was associated with better resource management in healthcare organizations. Effective management of the AMIT use requires clear rules and regulations with assertive commitment, in addition to establishing clinical guidelines with the support of insurance companies.
Relationship Between Spouse Abuse and Obsessive-Compulsive Disorder and Predictors of Domestic Violence in Women Visiting Comprehensive Urban Health Service Centers in Birjand
Authors: Moasheri Bibi Narjes , Sharifzadeh Gholamreza , Sharifi Masoomeh , Ansarifar Faezeh , Abolhasannezhad Vahideh
Published: August 2021

Background: Spouse abuse is a major human problem in various communities, which not only has legal aspects but also considerably affects family as the primary social institution.
Objectives: The aim of this study was to determine the relationship between spouse abuse and obsessive-compulsive disorder (OCD) and identify the predictors of domestic violence in women visiting comprehensive urban health services centers in Birjand, Iran.
Methods: In this descriptive-analytical study, 475 women visiting comprehensive urban health services centers in Birjand were selected via the cluster sampling method. Data was collected using a demographics form, Samuee’s Standard Spouse Abuse Scale, and Rabie’s Behavioral Measurement Scale for obsessive-compulsive disorder. The collected data was entered into SPSS 16 and analyzed using MannWhitney, Kruskal Wallis, and Spearman non-parametric tests. The level of significance was set at α = 5%.
Results: The mean scores of OCD and domestic violence in the studied women were 9.7 ± 5.1 and 77.1 ± 27.9, respectively. Of all the participants, 86.5% had experienced mild violence, 9.3% moderate violence, and 4.2% severe spousal violence. Moreover, 42.9% of women were suffering from OCD. The mean score of violence was significantly higher in addicted women, women with OCD, and women with unemployed, loweducated, or addicted spouses (P < 0.05). Furthermore, women who had a history of family conflict or parental conflict were significantly influenced by violent, high-risk, and arrogant behaviors of the spouse. The mean score of violence was significantly correlated with some components of OCD, age of women and their spouses, and duration of marriage (P < 0.05). Obsessive-compulsive disorder was determined as a good predictor of violence against women (P < 0.05).
Conclusions: It seems that numerous psychological problems of women, such as anxiety and OCD, can be attributed to family violence. On the other hand, anxiety and OCD can increase the level of incompatibility in women and make them more vulnerable to violence. Therefore, the identification of cases of violence and spouse abuse and the timely detection and treatment of OCD in women can ensure the physical, emotional, and psychological security of women in a family, and thereby contribute to the stability of the family and community and reduce social harms.
Effectiveness of Combination of Leflunomide and Methotrexate Compared to Etanercept in the Treatment of Rheumatoid Arthritis: A Systematic Review and Meta-Analysis
Authors: Iman Rashin , Khaledy Leila
Published: August 2021

Context: Rheumatoid arthritis (RA) is a chronic progressive systemic inflammatory condition, which affects mainly the joint synovial and does not have a definitive treatment. Data was collected using the American College of Rheumatology (ACR) score, and different levels of improvement were shown as ACR20, ACR50, and ACR70. The aim of this study was to compare the effectiveness of combination of leflunomide and methotrexate (LEF + MTX) to etanercept (ETN).
Methods: This systematic review was performed to evaluate the effectiveness of LEF + MTX in comparison with ETN. Electronic databases, including cochrane, PubMed, Scopus, and CRD, were searched up to December 2015. Quality assessment was conducted by the Jadad scale and the Cochrane Collaboration’s tools. Meta-analysis was conducted for effective outcomes of the included studies. Effectiveness was measured by ACR. This review was updated up to January 2019.
Results: Overall, 2780 eligible articles were retrieved, five of which were eligible for inclusion. Effectiveness outcomes showed an improvement in ACR criteria. Differences in the improvement of ACR70, ACR50, and ACR20 criteria in LEF + MTX groups compared to placebo groups were reported 0.78%, 20%, and 27%, respectively, and these differences compared to ETN groups were respectively 0.003%, 21.93%, and 32%.
Conclusions: Combination of leflunomide and methotrexate is effective, and it can be used as before biomedical medications such as etanercept, as it is more cost-effective.
Prevalence of Cytomegalovirus (CMV) and Epstein-Barr Virus (EBV) Subclinical Infection in Patients with Acute Immune Thrombocytopenic Purpura (ITP)
Authors: Abbasi Farshad , Kaydani Gholam Abbas , Tahannezhad Zari , Nakhaie Mohsen , Asnafi Ali Amin , Moradi Maryam
Published: August 2021

Background: Immune thrombocytopenic purpura (ITP) defined as a bleeding disorder in which the number and production of platelets reduced by the immune system; however, the destruction of peripheral blood platelets also occurs. Although its exact etiology and pathogenesis not already know, several studies have shown that Epstein-Barr virus (EBV) and cytomegalovirus (CMV) known as possible causative agents of ITP. This investigation aims to evaluate the presence of CMV and EBV in two groups of case and control by polymerase chain reaction (PCR).
Materials and Methods: We considered the presence of CMV and EBV in 48 acute ITP patients and 48 healthy people. Study participants were recruited from Ahvaz Shafa Hospital between 2017 and 2018 and the presence of two viruses was investigated by (PCR).
Results: Out of 48 acute ITP patients, the CMV DNA was detected from the blood of 12 (25%) patients and the EBV DNA from the blood of 2 (4.2%) other patients. In addition, only one patient was (2.1%) co-infected with CMV and EBV. In contrast, in 48 healthy subjects, 3 (6.6%) had CMV and none of the control group was infected with EBV.
Conclusion: Due to the presence of both EBV and CMV in the acute ITP patients in Ahvaz, they can be considered as factors in the progression of this disease. Therefore, consideration of the methods of elimination and treatment of these two viruses in these patients may be used as a treatment strategy in ITP patients in the future.
Evaluation of Correlation between Serum Free Light-Chain Assay and Bone Marrow Study in Multiple Myeloma Patients
Authors: Zamani Fatemeh , Shokripour Mansoureh , Mokhtari Maral
Published: August 2021

Background: Multiple myeloma is a hematologic malignancy manifested by the secretion of abnormal immunoglobulin. Different methods have been described for diagnosis and patient response to management. Serum free light-chain assay is recently approved in the diagnosis of multiple myeloma patients.
This study aimed to evaluate the diagnostic accuracy of serum free light-chain assay and its agreement to bone marrow findings.
Materials and Methods: Forty-six patients with the diagnosis of multiple myeloma were enrolled in the study. The patients were grouped into newly diagnosed cases (22 patients,47.8%) and known cases who were under treatment (24 patients,52.2%). Bone marrow study was done and percentage and clonal status of plasma cells were evaluated by a combination of immunohistochemistry and flow cytometry. Free light-chain assay was done in all patients and sensitivity, specificity, positive predictive value, and negative predictive value were analyzed.
Results: Thirty of 46 patients showed monoclonal plasma cell infiltration and 16 patients showed polyclonal plasma cell infiltration based on bone marrow findings. An abnormal κ/λ ratio was seen in 15(68.18%) of new cases and 16(66.6%) of known cases. Sensitivity, specificity, PPV and NPV for κ⁄λ ratio were 72.73%, 46.15%, 71%, and 50%, respectively.
Conclusion: In conclusion, due to high false positive and false negative results, the presence of an abnormal serum FLC ratio was not equal to the presence of monoclonal gammopathy, and observation of a normal ratio does not exclude the presence of monoclonal gammopathy.
p53 p.Pro72Arg (rs1042522) and Mouse Double Minute 2 (MDM2) Single-Nucleotide Polymorphism (SNP) 309 Variants and Their Interaction in Chronic Lymphocytic Leukemia(CLL): A Survey in CLL Patients from Western Iran
Authors: Jalilian Nazanin , Maleki Yosra , Shakiba Ebrahim , Aznab Mozafar , Rahimi Ziba , Salimi Mehdi , Rhimi Zohreh
Published: August 2021

Background: Chronic lymphocytic leukemia (CLL) is the most common leukemia in adults. The MDM2 and p53 are interacting proteins that play crucial roles in cell biology. Genetic variations of p53 and MDM2 have been identified in many cancers including CLL; among which are SNP309 in the promoter of MDM2 and SNP codon72 in p53.
Materials and Methods: In this study, we sought to find the impact of two SNPs of p53 and MDM2 in the pathogenesis of CLL. A total of 100 CLL patients and 102 healthy controls were recruited. Genomic DNA was extracted, and genotyping was performed using the PCR-RFLP method. The allele and genotype associations were analyzed using the χ2 test. The gene-gene interaction analysis was studied using GMDR v0.9.
Results: Our study found the absence of a signiﬁcant difference between CLL patients and controls related to the allelic frequencies or genotypic distributions for both MDM2 SNP309 and p53 codon72. A significantly higher frequency of p53 C allele was found in patients with disease duration of more than 36 compared to those less than 36 months. However, GMDR analysis suggests genetic interaction between the genes under study.
Conclusion: Our findings indicated each polymorphism of p53 codon72 and MDM2 (SNP309) was not a risk factor for CLL but the p53 C allele could be associated with the disease duration. Besides, the interaction between p53/MDM2 genotypes may confer susceptibility to CLL. Our study could be useful in genetic association studies of CLL and the role of gene-gene interactions in the susceptibility to the disease.
Study of Peripheral Mononuclear Cells and CD34 Levels as a Predictive Marker for Initiating Apheresis in Autologous Stem Cell Transplant
Authors: PK Kiran , P Vinu Sarathy , BJ Srinivas , Badarkhe Girish V , KS Rajesh Kumar , S Thianeshwaran , Bayas Nitin , Mufti Suhail Syeed , V Hrishi , Naik Radheshyam
Published: August 2021

Background: Autologous HCT in multiple myeloma is done as upfront treatment in newly diagnosed transplant eligible patients after induction chemotherapy. In addition, it is standard for relapsed, aggressive non-Hodgkin lymphoma (NHL) and classical Hodgkin lymphoma (HL), and is curative in ~40% to 45% of patients. Over a decade, many efforts were made to find helpful parameters to predict an optimal time for initiating an efficient peripheral blood stem cell collection so that adequate stem cells are collected.  It has been well accepted that CD34+ cell count in peripheral blood before leukapheresis is the best parameter to predict CD34 cell yield. However, white blood cell count, mononuclear cell count, and other easily obtained parameters are still used to guide the clinical practice of peripheral blood stem cell mobilization and collection. 
Materials and Methods: In the present study, we analyzed the correlation between peripheral blood MNC and Apheresis CD34 levels and also between peripheral blood CD34 by flow cytometry and apheresis CD34 levels.
Results: We found that there was a statistically insignificant weak correlation between peripheral MNC and apheresis CD34. There was a statistically significant strong correlation between peripheral CD34 and apheresis CD34.
Conclusion: The results show that peripheral blood MNC was analogous indicating that no reliable prediction can be done for CD34 cells collected in apheresis while peripheral CD34 by flow cytometry is the strongest predictor for initiating stem cell collection.
Proficiency of Carboxymethyl cellulose as a Cryoprotectant. Clinical and Histological Evaluation of Cryopreserved Heterogenous Mesenchymal Stem Cell-Exosomal Hydrogel on Critical Size Skin Wounds in Dogs
Authors: Bahr Mohamed M. , Amer Mohamed S. , Sooud2 Khaled Abo-EL- , Abdallah Ahmed N. , Shehab Gehan G. , Tookhy Omar S. El-
Published: August 2021

Background: Fresh stem cell exosomes are usually obtained and reused in the same individual. It cannot be kept viable for a long period of time regardless of the lengthy preparation time. Freezing is typically used to preserve the viability of perishable materials and increase their lifetime. Regrettably, normal freezing of biomaterials leads to cell damage. Therefore, a cryoprotectant can save the cells from the conventional cryodamage. Sodium carboxymethylcellulose (NA-CMC) is a powdery substance that is used to manufacture bio-safe hydrofilm gels because of its high viscosity, cytocompatibility, and nonallergenic nature.
Materials and Methods: Sterile CMC hydrogel was prepared, part of which was loaded with exosomal solution derived from MSCs. The gel was kept at −20°C for preservation. Two bilateral full-thickness circular skin wounds of 2-cm diameter were created on the back of experimental dogs. The wounds were at least 2.5 cm apart. Treatment started 24 hours after wound creation. Group I received CMC gel solely, whereas group II received frozen CMC exosomal gel. The gel was applied 4 times, a single application per day with 1- day interval.
Results: Clinically, the frozen exosomal gel significantly promoted wound healing with no scaring. Histologically, enhanced dermal fibroblasts and organized collagen deposition were seen in the treated group.
Conclusion: CMC proved to be an efficient cryoprotectant and a suitable vehicle for exosomes. Deep freezing was proven to conserve the viability, extended the preservation, and facilitated the usage of exosomal gel. This technique of preserved cell-free therapy is inexpensive, time-saving, and proficient and seems suitable for treating cutaneous wounds.
Hyperdiploid Multiple Myeloma with Novel Complex Structural Chromosome Abnormalities Associated with Poor Prognosis : A Rare Case Report
Authors: Ankathil Ravindran , Foong Eva , Siti-Mariam Ismail , Norhidayah Ramli , Yunus Nazihah Mohd , Sangeetha Vijay , Hariharan Sreedharan , Azlan Husin
Published: August 2021

Hyperdiploid multiple myeloma (MM) is associated with better prognosis and non-hyperdiploid subtype is associated with variable to adverse prognosis based on the nature of karyotype abnormality. Rarely exceptions to this hyperdiploid and non-hyperdiploid divisions do exist in a minority. We report an adult male MM patient who showed hyperdiploid karyotype with few novel complex abnormalities and who showed poor clinical outcome. Conventional cytogenetic analysis carried out in 22 GTG banded metaphases showed 53,Y,der(X)t(X;22)(q27;q11.2),+3,+5,+6,+9,+11,+15,der(17)ins(17;1;3)(q11.2;?;?),der(17)ins(17;1;3)(q11.2;?;?),+19,-22,+mar karyotype pattern in 15 metaphases whereas 7 metaphases showed 46,XY karyotype pattern. Interphase FISH revealed biallelic del(13q14) and del(17p13) but no translocations involving the 14q32 region. Through Spectral karyotyping FISH, the origin of complex abnormalities involving der(17) chromosome, translocation t(X;22), and marker chromosome could be clearly delineated. Although the present case showed hyperdiploid karyotype, he showed an adverse prognosis probably due to the co-existence of high risk and complex abnormalities and expired 5 months after initial diagnosis despite standard treatment given.
Association between Thyroid Disease and Severe Coronavirus Disease 2019 (COVID-19) Infection: A Meta-Analysis
Authors: Xu Juan , Li Yang , Xia Quansong , Shi Qiong
Published: August 2021

Background: COVID-19 has resulted in an emerging respiratory infection with a pandemical diffusion since December 2019. We aimed to elucidate whether the presence of thyroid disease might increase the risk of severe COVID-19 infection.
Methods: Studies reporting seriously ill in COVID-19 patients with and without thyroid disease combined were searched and 11 relevant studies were subjected to our analysis, and pooled odds ratios (ORs) together with 95% confidence intervals (CIs) were calculated by using STATA and Review Manager Software.
Results: In total, 2,995 COVID-19 patients were included in this study. The pooled ORs were calculated using a fixed-effects model according to the heterogeneity. The pooled results revealed that thyroid disease was associated with severe COVID-19 infection in patients (OR = 2.14, 95 % CI: 1.23–3.72, P = 0.007). In the subgroup analysis by type of thyroid disease, hypothyroidism was positively associated with risks of severe COVID-19 infection (OR = 4.78, 95 % CI: 1.59–14.36, P = 0.005), however, no obvious difference was found in the risk regarding the severe COVID-19 infection amongst hyperthyroidism or unclassified thyroid disease. In addition, subgroup analysis stratified by ethnic groups demonstrated that thyroid disease was linked to the risks of severe COVID-19 infection in Asian patients (OR = 2.41, 95 % CI: 1.30–4.48, P = 0.005) rather than non-Asian (OR = 1.31, 95 % CI: 0.35–4.87, P = 0.684).
Conclusion: This study indicates a correlation between thyroid disease and severe COVID-19 infection.
Factors Related to Delirium of Intensive Care Unit Patients in Korea: A Systematic Review
Authors: Kim Nam Young , Ryu Se Ang , Kim Yun Hee
Published: August 2021

Background: The delirium in Intensive Care Units (ICU) patients is a major cause of unplanned extubation, increased length of hospital day. This study aimed to review systematically risk factors associated with the occurrence of delirium among ICU patients in South Korea.
Methods: Data collection was done with domestic literature search databases including KMbase, KoreaMed, KISS, and KisTi and also with hand searching, from February 17 to May 19, 2019. Two researchers independently selected research literatures, and three researchers summarized and identified related variables based on data extraction methods.
Results: Overall, 140 articles were identified, 18 articles met the inclusion criteria for review. According to the results of the methodological quality, one article was found to have a high level of quality, while the remaining 17 articles belonged to the medium level. Those factors were highly associated with delirium by more than 9 out of the 18 selected studies were listed as follows; age, the application of ventilator, APACHE II score, comorbidity, the application of restraint, and educational level. In addition, catheter insertion and the application of artificial airway had significant relevance with the occurrence of delirium.
Conclusion: For management of delirium among ICU patients, it is necessary to eliminate and prevent delirium-associated risk factors, and also to detect and treat the delirium early through regular monitoring using an appropriate screening tool for delirium.
COVID-19 Isolation and Contact Tracing with Country Samples: A Systematic Review
Authors: Koçak Cemal
Published: August 2021

Background: COVID-19 was first declared as an international public health emergency and then a pandemic by the WHO. In this systematic review, the importance of isolation and contact tracing has been explained, and what kinds of practices exist in different countries are mentioned.
Methods: A systematic review was conducted in accordance with the PRISMA and Cochrane guidelines by searching articles from major medical databases such as Google Scholar, PubMed/MEDLINE, Cochrane Library, EMBASE, CINAHL between Jan 1, 2020 and Apr 1, 2021. Observational and modeling studies written on contact tracing, screening, quarantine and isolation were included.
Results: 27 observational and modeling studies were included. It was seen that rapid contact tracing to reduce the basic reproduction number (R0) from 3.11 to 0.21. Additionally, each new case requires an average of 36 people to be monitored. Since screening programs missed 75% of cases, high-level contact tracing should also be done simultaneously. Wide quarantine would prevent 79.27% deaths and 87.08% infections.
Conclusion: Effective, rapid contact tracing is the cornerstone of an effective public health response in outbreaks. Its success depends on quickly identifying cases, gathering information from them about their last contacts, and tracing and isolating those contacts.
Graft and Patient Survival Rates in Kidney Transplantation, and Their Associated Factors: A Systematic Review and Meta-Analysis
Authors: Ghelichi-Ghojogh Mousa , Ghaem Haleh , Mohammadizadeh Fateme , Vali Mouhebat , Ahmed Faisal , Hassanipour Soheil , Nikbakht Hossein-Ali , Rezaei Fatemeh , Fararouei Mohammad
Published: August 2021

Background: End-Stage Renal Disease (ESRD) is an irreversible impairment of kidney function that leads to permanently dependent on alternative therapies such as hemodialysis, peritoneal dialysis, and renal transplantation. This study aimed to systematically investigate the survival rate of patients with renal transplantation, graft, and its related factors in Iran.
Methods: This systematic review and meta-analysis drew on articles indexed in six international and one internal databases (Medline/PubMed, ProQuest, Scopus, Embase, SID, and Web of knowledge) until Nov 2020. The reporting of the present study was performed in terms of PRISMA statement. All analyzes were performed using the STATA software.
Results: Overall, 367 titles from 6 databases were evaluated of which 86 articles met the inclusion criteria. According to the random model, the graft survival rate at one, three, five, and 10 years were 92.48%, 85.08%, 79.96% and 68.15% respectively. Additionally, the patient survival rates at one, three, five, and 10 years were 91.27%, 86.46%, 81.17% and 78.15% respectively. There was a significant relationship between the age recipient and three-year graft survival rate (P=0.021). Additionally, there was an inverse and significant relationship between the donor age and 10-year patient survival rate (P=0.011).
Conclusion: The patient and graft survival in transplanted kidney patients is comparable with most developed countries.
Age at Diagnosis of Breast Cancer in Iran: A Systematic Review and Meta-Analysis
Authors: Alizadeh Mahasti , Ghojazadeh Morteza , Piri Reza , Mirza-Aghazadeh-Attari Mohammad , Mohammadi Sahar , Naghavi-Behzad Mohammad
Published: August 2021

Background: Breast cancer is responsible for up to 25% of all cancers in Iran. The age at diagnosis of Iranian breast cancer patients starts a decade earlier than most of developed countries. This study aimed to evaluate the mean age at diagnosis of Iranian breast cancer patients.
Methods: In this systematic review and meta-analysis, the mean age at diagnosis of Iranian breast cancer patients and its pattern between 2008 and 2017, were evaluated. All papers with age at diagnosis of histopathological verified breast cancer patients were considered eligible to enter to the analysis. We used databases including Medline/PubMed, Scopus, Embase, Cochrane Library, Iranmedex and SID for the search process. The meta-analysis was performed only on studies with separate data for female patients, using random-effects model, Mantel and Haenszel method and the Comprehensive Meta-analysis software.
Results: Finally, 92 studies with 19,784 patients (both-genders) were included. The mean age at diagnosis had increased from 47.93 (2008) to 49.91 (2016) years. The meta-analysis was done on 78 studies containing of 15,071 female patients and the mean age at diagnosis was 46.76±1.19. There was a wide range of age at diagnosis within different provinces. The mean age at Hamadan and Khuzestan provinces were the lowest and highest, respectively (42.48±7.96 vs. 51.00±11.47). The heterogeneity of studies was statistically significant (I2=99.744).
Conclusion: Mean age at diagnosis of Iranian women with breast cancer was 46.76±1.19. There was an increasing pattern in mean age of diagnosis at breast cancer patients within the past 10 years.