Therapy

A stroke is defined as the rapid loss of brain function due to a disturbance in blood supply. Age is a major risk factor for stroke, and genetic influences may be more significant in younger stroke patients. Patients with positive results should receive appropriate counseling. This study is the first to comprehensively investigate thrombophilia genes in Iranian populations with ischemic stroke. The purpose of this study was to determine the occurrence of genetic mutations linked to thrombophilia in individuals with ischemic stroke and examine their correlation with clinical parameters and the genetic markers of thrombophilia.

This cross-sectional study was conducted on 62 patients with ischemic stroke at the Department of Stroke in Shahid Beheshti Complex Hospital affiliated with the Qom University of Medical Sciences from October 2017 to October 2018. DNA extraction was done using CVD StripAssay® kits. SPSS software, version 25, was used to analyze the data and the statistical significance level was defined as P<0.05.

Sixty-two patients with ischemic stroke had a mean age of 67.9±3.76 years. The prevalence of risk factors included smoking at 11.1%, hypertension at 79.4%, and previous diabetes and hyperlipidemia at 44.4%. Women exhibited a lower prevalence of risk factors. The most common mutation was the polymorphism of ACE at 82.5%. The second and third most common mutations were the polymorphism of FGB at 76.2% and the polymorphism of LTA at 71.4%. The prevalence of polymorphisms was as follows: ACE I/D 82.5%, FGB -455G>A 76.2%, LTA 804C>A 71.4%, eNOS 894G>T 52.4%, eNOS -786T>C 12.7%, Apo B R3500Q 33.3%, HPA1 a/b 31.7%, and Apo E (E2E2: 54%, E2E3: 3.2%, E2E4: 9.5%, E3E3: 14.3%, E3E4: 15.9%, E4E4: 1.6%). The relationship between the genes and age, sex, smoking, hyperlipidemia, diabetes, and hypertension was measured, but no significant relationship was found.

Thrombophilia risk factors were separated into high- and low-risk factors. There was no significant association between demographic characteristics, including age, sex, smoking, preexisting comorbidities, and thrombophilia (P>0.05). It is suggested to conduct studies with larger sample sizes, aimed at investigating gene-environment interactions as well as gene-gene interactions.

Endometriosis is a chronic inflammatory disease characterized by the presence of endometrial lesions outside the uterus. Current treatment methods primarily focus on hormone-based therapy or invasive procedures. However, given the crucial role of the immune system in disease initiation and progression, there is an opportunity to explore new treatment approaches. Bispecific antibodies, which bind two different cells using their bivalent arms, have shown promise in treating cancers and autoimmune diseases. This study postulates that due to the similarities in pathogenesis between endometriosis and the aforementioned diseases, a novel therapeutic method based on this new target could be introduced. This could potentially lead to a reduction in limitations to patients' quality of life. In addition, it is important to highlight that future studies should prioritize the identification of specific binding markers on endometrial cells. This could contribute to the development of new diagnostic tools for the disease. Furthermore, the production of bispecific antibodies that selectively bind to these receptors on immune cells may prove effective in improving immune response.

One of the biggest factors reportedly interfering with the lives of individuals who suffer from multiple sclerosis (MS) is fatigue. Prior research has demonstrated that combined training may benefit patients with MS. However, it has not been studied how combined exercise can lessen fatigue in people with MS. This systematic review and meta-analysis summarizes the results of studies that examine the effects of combined training on fatigue in individuals with MS.

We investigated randomized controlled studies (RCTs) that examined how combination training affected fatigue and were published from the start of the research until May 2024. The Wiley online library, PubMed, Medline, PEDro, ScienceDirect, and Frontiers were among the electronic databases that were searched. PEDro and McMaster’s measures were used to assess the quality of included research. 

The study’s requirements were satisfied by six RCTs with 279 participants. Using a random effect model of meta-analysis, the weighted mean differences of fatigue were 1.81 (95% CI, 2.83%, 0.79%) with P=0.002. Accordingly, exercise training is useful in lowering fatigue in individuals with MS since all included RCTs revealed significant differences between the subjects assigned to the combined exercise group and the control group. 

Combined training can be a useful strategy for helping individuals with MS manage their weariness.

Given the progress in comprehending various forms of cancer and the subsequent pursuit of a remedy, along with improved survival rates for cancer patients, it is crucial to discover a therapeutic that may effectively counteract the aggressive mechanisms of this illness. Oncolytic viruses (OVs) have shown to be very advantageous in the treatment of cancer due to their ability to induce antitumor effects via several mechanisms. Viruses may be used to infect cancer cells, particularly in comparison to normal cells, to introduce tumor-associated antigens, trigger “danger signals” that create a less immune-tolerant tumor microenvironment, and function as delivery vehicles for the release of inflammatory and immunomodulatory cytokines. These modified OVs, which have been designed to have improved capacity to target tumors, increased oncolytic activity, or the potential to generate strong anti-tumor immune responses, are evaluated in animal models during preclinical testing and in clinical trials involving cancer patients. OVs have been recognized as one of the primary agents for cancer immunotherapy due to their ability to target tumors via many mechanisms. Nevertheless, given the restricted efficacy of innovative anti-cancer treatments including immunotherapies and cell-based therapies, it is imperative to evaluate the potential of combination therapy using OVs. This study aims to introduce oncolytic viruses and review their capacity to induce antitumor responses, their challenges and limitations.

The exact molecular and cellular processes that cause benign urological diseases in the stromal and epithelial components of the urinary tract are yet unknown. Reviewing and analyzing the data linking microRNAs (miRNAs) expression in the pathophysiology of benign urological conditions, including overactive bladder (OAB), bladder outlet obstruction (BOO), bladder pain syndrome/interstitial cystitis (BPS/IC), and Lower urinary tract dysfunction (LUTD) is the objective of the current systematic review.

Evidence including all case-control, cohort, and cross-sectional studies that measure participants’ MicroRNA as a biomarker for benign urological diseases has been gathered in January 2024, through searching MEDLINE via PubMed, Scopus, Web of Science, Embase, and ProQuest databases. Studies considered eligible that present information on the reference Gene, profile type, and serum levels of microRNA from patients diagnosed with benign urological disease including benign prostate hyperplasia (BPH) or benign prostate enlargement (BPE), overactive bladder (OAB), and bladder outlet obstruction (BOO). These studies were appraised by the quality assessment checklist of Joanna Briggs Institute (JBI).

A total of 4,587 records related to miRNAs in urological diseases were retrieved. Of these, we identified 28 records for our systematic study. The most frequently associated miRNA was 92a-3p identified which was found upregulated in OAB diagnosis. In BOO, miR-146a-5p was identified to be upregulated. miR-146a-5p was upregulated in BO, and for other benign conditions, different miRNAs were reported. 491-5p miRNAs were found deregulated in OAB-related studies. We expected other miRNAs to have the same trend in the OAB studies. InSUI miR-93 was the most frequent downregulated miRNA. The other reported miRNAs had similar frequencies.

When it comes to the early detection and treatment of benign urological conditions, 92a-3p, miR-21, miR-199a-5p, and miR-146a-5p, and 491-5p have the potential to be employed as both a biomarker and a therapeutic target. The creation of pre-RNA or anti-RNA molecules within carrier vehicles that may be safely administered to patients should be made possible by technological advancements.

Triple-negative breast cancer (TNBC) is characterized by a poor prognosis. Consequently, the current research aims to identify new therapeutic targets for TNBC patients. Trichorhinophalangeal syndrome type 1 (TRPS1), a novel GATA transcription factor, and CYP4Z1, a fatty acid hydroxylase, present potential targets for novel therapies. This retrospective study included 70 TNBC patients. The immunohistochemical expression of TRPS1, GATA3, and CYP4Z1 was evaluated. Data regarding the patient's clinical and pathological responses to chemotherapy were collected and analyzed for response assessment. SPSS version 20 software facilitated the data analysis. Quantitative variables were described using means and standard deviations, whereas categorical variables were examined using the chi-square test or Fisher's exact test as appropriate. Survival analysis was performed using Kaplan-Meier plots, including disease-free and overall survival. A P-value of less than 0.05 was considered statistically significant. The analysis showed that 37 cases (53%) were positive for TRPS1 expression, 45 cases (65%) for GATA3, and 40 cases (57%) for CYP4Z1. There was a significant association between the expression of GATA3, TRPS1, and CYP4Z1 and various prognostic factors such as tumor size, grade, stage, lymphovascular invasion, recurrence, and mortality. Notably, the overall recurrence and progression rates were significantly correlated with the overexpression of GATA3, TRPS1, and CYP4Z1. The overexpression of TRPS1, GATA3, and CYP4Z1 in TNBC patients may be novel prognostic factors for predicting tumor prognosis. Furthermore, these markers could assist in selecting patients for future therapies in both localized and metastatic breast carcinoma settings.

Cancer is a significant global cause of mortality, and enhancing therapy is essential to save lives and minimise adverse consequences. Aptamers, composed of DNA or RNA, have the potential for cancer treatment by precise targeting of certain molecules. Aptamers, unlike conventional therapies such as chemotherapy, have the specific objective of delivering medications directly to cancer cells, while reducing injury to healthy cells. This paper examines the process of aptamer development and utilisation in cancer treatment, with a specific emphasis on their capacity to enhance therapy and surmount drug resistance. Additionally, it explores the obstacles and potential advancements in using aptamers to transform cancer therapy.

Emotion dysregulation and cravings play a pivotal role in the relapse of individuals grappling with substance use disorders.

This study aimed to assess the efficacy of Interpersonal and Social Rhythm Therapy (IPSRT) in ameliorating emotion regulation deficits and cravings among methamphetamine abusers in Tehran city.

The study employed a semi-experimental design, featuring both a control group and intervention group. A sample was selected using convenience sampling, and 40 methamphetamine abusers in Tehran city were selected and randomly allocated into two groups: The intervention group (n = 20) and the control group (n = 20). The assessment tools employed included the Difficulties in Emotion Regulation Scale (DERS), the Desires for Drug Questionnaire (DDQ), and the Severity of Dependence Scale (SDS). Data analysis was conducted through mixed repeated ANOVA, independent t-tests, and chi-square tests. Participants were evaluated at pre, post-intervention, and follow-up.

The results demonstrate that IPSRT significantly improves emotion regulation and substantially reduces cravings. This was conclusively indicated by the achievement of statistical significance (P < 0.05). The effects of IPSRT were not only immediate but also enduring, as evidenced by consistent positive outcomes observed during the follow-up period.

This investigation demonstrated the significant advantages of IPSRT in enhancing emotion regulation, reducing the severity of drug dependence, and craving tendencies among methamphetamine abusers. The findings of this study offer promising implications for the treatment of substance use disorders, reinforcing the potential adoption of IPSRT as a fundamental therapeutic strategy.

Cardiac disease significantly impacts global health, causing substantial disability and mortality. This study compared the effectiveness of mindfulness-based cognitive therapy (MBCT) and integrated transdiagnostic psychotherapy (ITP) on emotion regulation and distress tolerance in patients with type D personality, characterized by social inhibition and negative affectivity.

A semi-experimental design randomly assigned 60 cardiac patients with type D personality from Simorgh Heart Clinic, Mashhad, Iran, in 2022, to MBCT group (n = 20), ITP group (n = 20) and control group (n = 20). The MBCT and ITP groups received respective interventions, while the control group received no intervention. Emotion regulation and distress tolerance were assessed using validated scales before and after the interventions.

MBCT demonstrated significantly greater improvement in both emotion regulation and distress tolerance compared to ITP and the control group.

This study suggests that MBCT may be a more effective intervention than ITP in improving emotion regulation and distress tolerance in cardiac patients with type D personality. Mindfulness-based approaches could offer valuable tools for managing emotional challenges in this population.

 Extended low serum thyrotropin (TSH) levels may increase the risk of cardiovascular events in patients with hyperthyroidism.

 This study aimed to compare the time spent with sustained normal TSH concentration following short- and long-term methimazole treatment.

 A total of 258 patients with Graves’ hyperthyroidism completed 18 - 24 months of methimazole therapy and were randomized to discontinue treatment (n = 128, short-term group) or continue an additional 36 - 102 months of methimazole therapy (n = 130, long-term group). Clinical and laboratory evaluations were performed every 6 months for 132 months after randomization.

 There was no difference in serum-free thyroxine, triiodothyronine, and TSH concentrations between the 2 groups at the time of randomization. Of 128 patients in the short-term group, 5 left in follow-up, 2 became hypothyroid, 67 (54%) had a relapse of hyperthyroidism, and only 54 (44%) were euthyroid at the end of the study. Among 130 patients on the long-term methimazole therapy, 4 were left in follow-up, 24 developed hyperthyroidism, 4 developed hypothyroidism, and 98 (78%) were euthyroid 132 months post-randomization. Total time spent on euthyroidism was 90.4% ± 8.1% of the study period in the short-term and 95.8% ± 7.0% in the long-term treatment groups (P < 0.001). The lowest time spent in euthyroidism (74.6% ± 6.4% of the study period) belonged to 29 (24%) patients in the short-term group under levothyroxine therapy because of fluctuation in serum TSH. Patients in both groups with hyperthyroidism relapse who chose methimazole therapy spent >90% of the study time in euthyroidism.

 In patients with Graves' hyperthyroidism, sustained normal serum TSH levels were more common in the long term as compared to the short-term methimazole treatment.

Exposure to phosgene, a colourless poisonous gas, can lead to various health issues including eye irritation, a dry and burning throat, vomiting, coughing, the production of foamy sputum, difficulty in breathing, and chest pain. This systematic review aims to provide a comprehensive overview of the clinical manifestations and treatment of phosgene toxicity by systematically analyzing available literature. The search was carried out on various scientific online databases to include related studies based on inclusion and exclusion criteria with the use of PRISMA guidelines. The quality of the studies was assessed using the Mixed Methods Appraisal Tool (MMAT). Thirteen articles were included in this study after the screening process. Inhalation was found to be the primary health problem of phosgene exposure with respiratory symptoms such as coughing and dyspnea. Chest pain and pulmonary oedema were also observed in some cases. Furthermore, pulmonary crackle was the most common reported physical examination. Beyond respiratory tract health issues, other organs involvements such as cardiac, skin, eye, and renal were also reported in some studies. The symptoms can occur within minutes to hours after exposure, and the severity of symptoms depends on the amount of inhaled phosgene. The findings showed that bronchodilators can alleviate symptoms of bronchoconstriction caused by phosgene. Oxygen therapy is essential for restoring oxygen levels and improving respiratory function in cases of hypoxemia. In severe cases, endotracheal intubation and invasive mechanical ventilation are used for artificial respiration, along with the removal of tracheal secretions and pulmonary oedema fluid through suctioning as crucial components of supportive therapy.

The studies in the literature have focused on the biomechanical and neurophysiological aspects of cervical and temporomandibular joint function. Addressing the cervical spine correlation with the temporomandibular joint may lead to long-term improvement in the derangement. This study desired to deduce the effectiveness of deep neck muscle strengthening exercises on jaw motion and clicking sounds in anterior disc displacement with reduction of the temporomandibular joint.

This controlled clinical trial was conducted using a single-blinded design in a tertiary care teaching hospital affiliated with The University of Lahore- from March 2020 to January 2021. A count of 68 patients were enrolled each with 34 patients. The inclusion criteria were being 18–50 years old, suffering from temporomandibular joint pain and disc displacement with reduction, medical referral for temporomandibular disorders by a dentist or a maxillofacial surgeon, and having symptoms for more than one month before the first treatment. The exclusion criteria were having a tumor, fracture, or trauma in recent medical history, systemic, rheumatic diseases, degenerative changes, and history of surgery of the cervical spine or temporomandibular joint. The control group (Group A) was only given temporomandibular joint mobilization and soft tissue release. The Intervention group (Group B) did neck strengthening exercises in addition to the temporomandibular joint mobilization. The subjects were assessed twice.

To analyze the data, SPSS version.21 was used. To assess the frequency of qualitative factors like clicking, the chi-square test was employed. The mean scores of quantitative factors such as mandibular lateral deviation and maximal mouth opening were approximated between the two categories of subjects using the Mann-Whitney test. The findings demonstrated that there was no change between the groups' pre- and post-treatment means for jaw mobility and clicking sounds. Nonetheless, the Intervention group's mandibular lateral deviation significantly improved (P-value ≤0.037)*. 

The findings revealed that neck strengthening exercises in addition to routine physical therapy of the temporomandibular joint do not affect clicks and mobility between the two groups. The exercises were found out to be effective only in improving the lateral deviation of the mandible.

Wound healing in grade II burns is one of the treatment priorities. Advances in new sciences, such as stem cell therapy, biological scaffolds, and growth factors, have renewed hopes in this area. The present study aimed to assess the impact of ADSCs encapsulated in PRP/Chitosan-based gel and PRP/Chitosan cell-free gel on the healing of grade-II burn wounds in rats as compared to the control group. Thirty rats were randomly assigned to one of three groups. Following adipose stem cell extraction, a deep grade II burn was induced in the back of the rats using a standardized catheter. The first group served as a control and received simply routine treatments. The second group received a gel based on PRP/Chitosan and ADSCs, and the third group received a gel free of PRP/Chitosan cells. The results were based on response to treatment, observable granulation tissue formation, or epithelialization at 7, 14, 21, and 28 days after treatment. The findings revealed that the use of a cell-based PRP/ Chitosan scaffold or cell-free PRP/Chitosan scaffold reduced the rate of necrosis and inflammation and increased the rate of epithelialization, granulation, and neovascularization compared to the control group (P < 0.05). Moreover, the use of stem cells in scaffolds resulted in greater wound healing than the cell-free scaffolds group (P < 0.05). Due to their porosity and the improved efficacy of stem cells placed in them, PRP/Chitosan scaffolds could have a positive impact on healing and speed up the wound healing process.

Asthma and chronic obstructive pulmonary disease (COPD) are the most common chronic diseases with a high global burden of disease. Today, the use of complementary and alternative medicine (CAM) has become more popular. In general, in developing countries, easy access and low cost of traditional medicine, and in developed countries, more access to health information, the prevalence of old age and the increase in chronic diseases are the reasons for this increasing use of traditional medicine. This study aimed to determine the rate and pattern of CAM used and their relationships with demographic characteristics among asthmatic and COPD patients. This research was a cross-sectional study performed on asthma and COPD patients (n=357) referring to the Pulmonary Diseases affiliated with Ardabil University of Medical Sciences, Ardabil, Iran from 2019 to 2020. Data were collected by using semi-structured questionnaires including open and closed questions and face-to-face interviews. Three hundred and thirty-nine patients (95%) used at least one type of CAM in the last year of study. About half of the patients (49.9%) used more than two types of CAM during the last 12 months. Three hundred and four patients (85.2%) used medicinal plants. Few patients reported with the use of CAM to their physician or health care providers (16.1%, 12.5%, and 16.7% of the users of medicinal plants, bloodletting, and dry cupping respectively). Relatives and friends (77.9%) were with the most common sources of recommendation of CAM to the patients. The present study showed the high prevalence of using different types of CAM, especially herbal medicines in Iranian asthmatic and COPD patients. The main incentive for using CAM was for friends and family members, not health care providers. The use of CAM is associated with age patients age, family size, habitat, education, and occupation.

Celiac disease (CD) is a prevalent autoimmune enteropathy triggered by the ingestion of gluten. The management of CD involves adhering to a gluten-free diet (GFD). Recent studies have been actively exploring potential supplementary or alternative therapies for individuals with CD. The primary objective of the present study was to assess the effectiveness of Spirulina platensis in regulating the intestinal barrier-related gene expression and alleviating inflammation and oxidative stress associated with CD in PT-gliadin-triggered Caco-2 cells.

S. platensis extracts and a pepsin/trypsin (PT) digest of gliadin were prepared and exposed to the human colon carcinoma Caco-2 cell line. Cell viability was assessed. Total RNA was extracted from Caco-2 cells and cDNA synthesis was performed. A quantitative real-time polymerase chain reaction (qRT-PCR) assay was conducted to evaluate the mRNA levels of interleukin (IL)-6, transforming growth factor beta (TGF-β), COX-2, nuclear factor kappa B (NF-κB), ZO-1, and occludin.

Treating Caco-2 cells with S. platensis alone (P=0.01 for both) or in combination with PT-gliadin (P=0.004 and P=0.02, respectively) resulted in decreased IL-6 expression and increased occludin mRNA expression. Additionally, S. platensis extract enhanced Zo-1 mRNA levels (P=0.002) and reduced NF-κB mRNA expression (P=0.02). The combination of gliadin and S. platensis led to decreased mRNA expression of COX-2 (P=0.03) and NF-κB (P=0.04). No significant differences were observed in TGF-β mRNA expression between the studied groups (P>0.05).

Additional investigation is needed to examine the influence of interactions between S. platensis and gliadin regarding the comprehensive response of CD to gliadin, encompassing the activation of gluten-sensitive immune cells.

Most patients with X-linked agammaglobulinemia are susceptible to infections, while some cases also suffer from inflammatory or autoimmune complications. We describe a patient with progressive encephalitis who improved after the use of immunomodulatory treatment with corticosteroids, fluoxetine, and nitazoxanide. In most of the cases the evolution of the progressive encephalitis is complicated and catastrophic. Based on our experience and the review of the literature, we propose the use of this combined treatment to control this devastating complication.