fahimeh afzaljavan

Persistent idiopathic facial pain (PIFP) is one of the chronic pains in the oral and maxillofacial region and its diagnosis has always been challenging. This study aimed to evaluate the diagnostic and therapeutic measures patients underwent before reaching a definitive diagnosis.

Methods and Materials: 

This cross-sectional descriptive study, included patients referred to the pain clinic of Mashhad Dental School from April 2023 to February 2024, whom received a diagnosis of PIFP. In addition to demographic information, the average time between the onset of symptoms and the final diagnosis, the number of consultations before diagnosis and the history of undergone diagnostic and therapeutic measures for pain relief; were recorded. Spearman's correlation test was used to check for any correlation between diagnosis delay time and patients' age, number of previous consultations, and pain intensity score. Investigating the relationship between diagnosis delay and qualitative variables was done using the Mann-Whitney U or Kruskal-Wallis tests, with a significant level of 0.05. 

  A total of 56 patients, consisting of 42 females and 14 males, with an average age of 49.18 ± 14.86 years participated in this study. The average diagnosis delay was 22.37±17.45 months. Before definitive diagnosis, the patients had visited a doctor or dentist on average 6.41 ± 6.53 times and they had taken an average of 2.25 ± 0.94 classes of medication. According to Spearman's correlation test, more consultations before definitive diagnosis had a positive and significant relationship with longer time to visit the pain clinic (P=0.012, r=0.335). The rest of the investigated factors had no significant relationship with the diagnosis delay time.

Our study showed that most patients had undergone dental procedures in an attempt to relieve pain. Despite numerous referrals of patients to general dentists, a very small percentage of patients were referred to the pain clinic; suggesting that professional delay played an important role in delayed diagnosis.

Oral squamous cell carcinomas (OSCC) comprise 90-95% of oral cancers. Early diagnosis improved the survival rate of OSCC patients to 80–90%. Oral lichen planus (OLP) is a chorionic inflammatory disease with malignancy potential. The vitamin D receptor (VDR) plays a critical role in the pathogenesis of oral cancer. This study aimed to determine the association between VDR rs7975232 (Apa I) polymorphism and potential susceptibility to OLP and OSCC risks. In this prospective case-control study, a total of 120 blood samples were obtained from OSCC patients (n=29), OLP (n=50), and controls (n=40). VDR rs7975232 polymorphism was studied using the Polymerase Chain Reaction Restriction Fragment Length Polymorphism (PCR-RFLP) method. Statistical analysis was performed with SPSS Version 23 software. Data were expressed as means ± standard deviation (SD). Age, sex, allelic frequency, and genotyping were compared using the chi-square test. A p-value of less than 0.05 was regarded as statistically significant. The disease risk was estimated by Odds ratio (OR) with a 95% confidence interval. A significant age difference was observed between the controls and the OSCC group (p=0.001). A significant difference was observed in Aa and aa genotypes compared with AA between OSCCs and controls. Moreover, dominant (p<0.001), additive (p<0.001), and allelic (p=0.001) models were different between groups. There was a positive association between rs7975232 VDR polymorphism and susceptibility to OSCC. More experimental evidence must reveal the possible association between rs7975232 and the risk of OLP in a larger cohort.

Despite suggesting many genetic risk markers as the outcome of Genome-wide association studies (GWAS) for breast cancer, replicating the results in different populations has remained the main issue. In this regard, this study assessed the association of two variations in Zinc Finger 365 (ZNF365) in an Iranian population.  In a case-control study conducted at Mashhad University of Medical Sciences, Mashhad, Iran, between 2017 and 2020, ZNF365-rs10822013 and rs10995190 were genotyped using Allele-Specific PCR (AS-PCR). Breast density was assessed using mammography images. PHASE software module version 2 and SPSS version 16.0 were used for haplotype and statistical analyses. Quantitative and qualitative variables were compared between groups using independent t tests and Chi square tests, respectively. Binary logistic regression analysis was performed to calculate odds ratios. Multivariate analysis was then undertaken for the baseline variables, with a P<0.05 in the univariate analysis. The survival analysis was performed using the Kaplan-Meier method and the log-rank test. In this survey, 732 females, including 342 breast cancer patients and 390 healthy subjects, were enrolled. rs10822013-T allele (P=0.014), rs10995190-G allele (P=0.003), and TG haplotype (P=0.002) were significantly associated with the increased risk of breast cancer. Moreover, rs10995190-GG genotype (P=0.042) and C-G haplotype (P=0.019) revealed a significant association with better overall survival. However, considered polymorphisms and their haplotypes indicated no association with breast density and clinical features of breast cancer. ZNF365 variants might be a potential risk marker of breast cancer in the Iranian population. The interaction between alleles in haplotypes may modulate the amount of the risk conferred by these variants. Further studies on different ethnic groups can validate these results.

As glutamatergic system dysfunction is involved in bipolar depression pathophysiology, the glutamate receptor modulators such as Ketamine have been applied as complementary medication for mood stabilizers. While the treatment is currently just the intravenous injection of a single dose, and there is no robust conclusion on Ketamine effectiveness or its side effects in bipolar patients, this study aimed to consider single- and double-dose intravenous injections of Ketamine in bipolar patients compared to the placebo.

In a randomized, double-blind controlled clinical trial, 30 patients diagnosed with bipolar I and II disorders according to DSM-IV-TR (SCID-I) were randomly divided into three groups: the first group received an intravenous injection of Ketamine (0.5 mg/kg) and placebo with a three-day interval, the second group received two doses of Ketamine (0.5 mg/kg) in the same interval, and the third group received two placebo injections. Patients were assessed for depression, anxiety, and mania at various time points, including before the injection, 60 minutes after the injection, on the first, third, fifth, seventh, and 14th day, as well as at the end of the first month using the Hamilton Depression Rating Scale, Beck Anxiety Inventory, and Young Mania Scale, respectively. Data were analyzed using ANOVA and Repeated measure tests.

The mean age of patients was 36.8 ± 7.9 years, with 18 females (60%) and 12 (40%) males. Depression and anxiety showed significant differences in both the single- and double-dose Ketamine groups over time (P < 0.01). Moreover, mania displayed significant changes during the study time in the single- and double-dose Ketamine groups, as well as the in the control group. However, during the study time, there were no significant differences observed in depression, anxiety, and mania among the three groups (P = 0.198, P = 0.416, and P = 0.540, respectively). Patients did not indicate any side effects during the study.

Intravenous Ketamine administration may relieve depressive manifestations in bipolar patients. The findings suggest that a double dose of Ketamine does not lead to greater improvement than a single dose.

Respiratory disorders during sleep are considered a health problem affecting the life quality. There is some evidence indicating the higher prevalence of apnea in substance-dependent patients. However, there is no information on the prevalence of the disease in people under methadone maintenance therapy (MMT). Therefore, the present study was designed to estimate the disease rate in these patients and consider the relationship of the increasing risk of apnea with some psychiatric problems.

Study group included 152 individuals under the MMT program. Baseline data were collected with the interview, and patients were considered using the STOP-BANG questionnaire to evaluate the risk of apnea. Furthermore, Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS), Hamilton Anxiety Rating Scale (HAM-A), and Hamilton Depression Rating Scale (HDRS) tests were performed for all participants. Data were analyzed using SPSS software.

Based on the STOP-BANG score categories, 37.5%, 40.1%, and 22.4% of patients indicated low, intermediate, and high risk of apnea, respectively. Moreover, severe daytime sleepiness, fatigue, depression, and anxiety were observed in 5.3%, 5.5%, 6.0%, and 21.1% of participants, respectively. Sex (P = 0.007) and daytime sleepiness (P = 0.048) were significantly different between low and high-risk groups of apnea after adjustment. Besides, age (P < 0.001) and fatigue (P = 0.007) were factors predicting the STOP-BANG score.

These findings revealed the higher prevalence of apnea in MMT patients compared to the general population of Iran and rising of the risk of apnea along with an increase in age and fatigue score. However, attention to the sleep disorders in MMT is a prominent factor that should be considered as a route of therapy.

There are believed to be several risk factors affecting the prognosis of breast cancer through their effect on the growth rate of tumour. In the present study, we investigated estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), Ki-67, and tumor protein P53 (TP53) as well-known biomarkers, particularly in breast cancer prognosis, associated with age.

In a case-control study, 406 breast cancer patients were considered retrospectively. In order to extract the clinical and pathologic data, we employed the patients’ records. The extracted information was compared between two groups: for patients under 40 (group I) and above 40 years of age (group II). Herein, the researchers performed statistical analysis using SPSS Ver16.

The most prevalent type of cancer in both groups was found to be invasive ductal carcinoma. The major method of treatment was modified radical mastectomy. According to our observations, grade 3 breast cancer was more common in group I. Lymph node involvement significantly increased in group I, while oestrogen and progesterone receptor expressions were less in this group. HER2, TP53, and Ki-67 oncogenes were overexpressed in group I compared with group II.

Expression of HER2, TP53, and Ki-67 biomarkers and a reduction in the number of hormonal receptors in younger patients (<40YO) indicated that breast cancer might be more invasive in younger women with breast cancer and therefore, they might have poorer prognosis and less favourable outcomes.

CC chemokine receptor 5 (CCR5) is introduced as an immune response modulator. The activity of CCR5 influences breast tumour development in a p53-dependent manner. This study aimed to investigate the frequency of CCR5delta32 and its association with the risk of breast cancer in 1038 blood samples in North East of Iran.

In this case-control study, we genotyped 570 control samples and 468 breast cancer patients by a gel electrophoresis-based gap-polymerase chain reaction (gap-PCR) method Mashhad, Iran. The data were analyzed using the SPSS software.

Of 570 controls included, 542 (95.09%) had CCR5delta32 wild/wild (W/W) genotype, 28 samples (4.91%) had CCR5delta32 wild/deletion (W/D) genotype and none of them were CCR5delta32 deletion/deletion (D/D) genotype (0%). While 428 samples of patients (91.45%) had CCR5delta32 W/W genotype, 40 samples (8.55%) had CCR5delta32 W/D and CCR5delta32 D/D homozygous was nil (0%) amongst cases. All samples were in the Hardy–Weinberg equilibrium (P>0.05). According to the allele frequency, D allele, as a risky allele, in the cases was more than the control samples (0.0427 vs 0.0245, respectively) (P=0.0206). Hence, W/D genotype may confer a risk effect (OR=1.77, CI: 1.09-2.90; P=0.0206) compared with WW genotype between case and control groups.

There is a statistically significant association between CCR5W/D and breast cancer risk. CCR5 may be regarded as a target for the prevention of breast cancer in certain conditions such as interaction with p53 variants, which remains to be further investigated.

Cervical cancer is known to be a preventable cancer in which various risk factors play role in increasing the risk of the disease. In this study, we have assessed different risk factors involved in invasive cervical cancer in Northeast of Iran.

In a case control study, 100 patients with advanced cervical cancer were compared to 100 healthy, normal women. In addition, 100 cases of prisoner women who had a high risk profile for cervical cancer were also investigated. Cervical risk factors for these groups were documented using a questionnaire and available medical notes. Univariate analysis was done for each risk factor followed by a multivariate regression analysis to evaluate the most powerful risk factors after adjustment.

Age of first intercourse ≤16 (P<0.001)[OR= 4.18, 95% CI (2.32-7.54)], sexually transmitted diseases (STD) (P<0.001) [OR=8.59,95% CI (4.25-17.37)], passive smoking (P<0.01) [OR= 2.35, 95% CI (1.17-4.72)], smoking (P<0.01) [OR=10.33, 95% CI (2.32-46.17)], age of first pregnancy ≤17 years (P<0.001) [OR= 3.37, 95% CI (1.79-6.33)] were strongly related to the occurrence of cervical cancer. However, STD remained statistically significant (P<0.01) after adjustment.

MYO15A is the third most crucial gene in hereditary sensorineural hearing loss after GJB2 and SLC26A4. In the present study, we reviewed the prevalence of MYO15A mutations in patients with autosomal recessive non-syndromic hearing loss (ARNSHL). In this meta-analysis, we conducted a search of PubMed, Web of Science, Excerpta Medica Database, and Scopus, and identified the articles up to September 2019 without any time limit. Two investigators independently selected the relevant papers and extracted the required information. A total of 44 case-control and case series studies were considered, and 4176 patients and 3706 healthy individuals, as the control group, were included. The pooled frequency of MYO15A mutations between patients suffering from ARNSHL was calculated as 6.2% (95% CI: 4.9-7.8, P-value<0.001). There was heterogeneity between our studies (P-value<0.001, I2=58.1%); therefore, the random-effects model was utilized for analysis. Given the results, in many countries, the MYO15A gene had a significant contribution to hearing loss. Moreover, in several regions, specific dominant mutations in this gene have been reported. Therefore, the ethnic background should be considered to investigate the mutations of the MYO15A gene.

Mutations of TP53 as a tumor suppressor gene are frequently observed in different types of cancer. A codon 72 polymorphism located on exon 4 with two alleles encoding either Proline (CCC) or Arginine (CGC) has been indicated as a common variation in association with cancers. Controversial results have been reported regarding the association of allelic polymorphism of codon 72 of TP53 gene and breast cancer risk in Iranian patients. Therefore, a case-control study was designed. A meta-analysis was also carried out to provide evidence of association between this variation and breast cancer in Iran, based on all available published data.

In this case-control study, blood sample of 622 participants, including 308 breast cancer cases and 314 controls were collected. Genotyping for rs1042522 was conducted by Allele Specific polymerase chain reaction (AS-PCR). In order to set a meta-analysis study, PubMed, Scopus and ISI Web of Knowledge and Persian databases were searched to explore relevant studies, published up to September 2018, containing information on TP53 polymorphism and the risk of breast cancer in Iran. Statistical analysis was performed using SPSS 16.0 and MetaGenyo.

All retrieved available data as well as the results of our current study were consisted of 1965 breast cancer cases and 1999 healthy controls. No significant difference was observed in allele frequencies between groups (P=0.90) in our study. The cumulative results did not also show any association between rs1042522 and breast cancer risk on the dominant (P=0.61) and recessive (P=0.89) models.

These findings cannot support contribution of rs1042522 polymorphism to breast cancer risk in an Iranian population. Future larger studies may help confirm this finding with a greater power.

The extract of different species of Euphorbia has been successfully used as a remedy for treatment of cutaneous leishmaniasis. The aim of this study was to assess the in vitro leishmanicidal effect of Euphorbia petiolata (E. petiolata) extract. Ethanolic percolated and methanolic Soxhlet extract of E. petiolata on promastigotes of L. major at different concentrations of extracts, one positive control group and one negative control group as well as 1 solvent control were prepared and placed in 24-well plates that contained 40,000 parasites/well. Afterwards, plates were incubated at 25 ˚C for six days and number of parasites in each well were determined on days 2, 4 and 6 of the experiment. Both percolated and Soxhlet extracts in methanol and DMSO solvents had significant effects (equal to that of amphotericin B) on promastigote form of parasite at the concentration of 1 mg/ml. At lower concentrations, the extracts of E. petiolata had favorable leishmanicidal activity and killed L. major promastigotes dose-dependently. Our results support the possibility of E. petiolata extracts application as an anti-leishmanial agent with similar effects to amphotericin B

Breast carcinoma is the most common cause of cancer mortality among women globally. Primary and secondary prevention through avoiding known risk factors, screening for early detection of tumors with different methods as well as timely treatment, can be effective in reduction of the burden of this devastating disease. This can in turn prevent death and also increase survival in patients with breast cancer. Both environmental and genetic factors are involved in the pathogenesis of breast cancer. Multiple genetic factors can influence the risk and development of breast cancer. Identification of genetic variants including single nucleotide polymorphisms (SNPs), which are associated with the risk of breast cancer development, are mostly done through genetic association studies. It is demonstrated that SNP allele frequencies vary amongst different populations. It has been shown that genetic risk factors like variations in TOX high mobility group box family member 3 (TOX3), which affect the liability for neoplasm, play an important role in the development of breast cancer. Although TOX3 is expressed mainly in the brain, its expression in other tissues especially breast has also been reported. TOX3 maps to chromosome 16q12 and encodes the nuclear high-mobility group (HMG)-box. It has calcium (Ca2)-dependent transcriptional activities and is a co-factor of cAMP response element (CRE)-binding protein (CREB) and CREB-binding protein (CBP). TOX3, activated with Ca2, is related with activation of the promoter of some other genes including BCL2 and C3 complement and also CITED1 gene expression. It also induces activation of the c-fos promoter and therefore its expression. Genome-wide association studies (GWAS) in different populations including European, Asian and African-American have demonstrated that a SNP near its 5ʹ end and the promoter of TOX3 gene appears to be significantly associated with breast cancer susceptibility. Furthermore, breast cancer–associated SNPs lead to enhanced FOXA1 bindings and in turn, a reduction in TOX3 gene expression. This review has highlighted the importance of TOX3 function, SNPs and its association with breast cancer risk and also its potential effects on breast cancer treatment; TOX3 plays dual and somehow conflicting roles in cancer initiation and progression which remains to be further investigated.

Restriction of calorie by ingesting no or minimal amounts of food and caloric beverages for periods of time is called fasting. Fasting can affect body through changing in physical and metabolic adaptations as well as mineral and hormonal status. However, psychological effects and sometimes medical complications can also be seen if the there would be no appropriate plan. These events are linked with changes in expression of different genes and signaling pathways. In this brief review, physiological effects of fasting, affected pathways during fasting and potential applications of fasting are discussed. In conclusion, fasting as a method of caloric restriction can enhance normal physiological status and help to improve the overall health.