Reviews in Clinical Medicine
Volume:6 Issue: 4, Autumn 2019

Cancer is defined as uncontrolled cell division, which could spread or invade various tissues. There are more than 200 types of cancer, including breast, skin, lung, colon, and prostate cancer, and lymphoma, the symptoms and indications of which vary depending on the type of tissues. Cancer has several treatments with different applications. For instance, chemotherapy, radiation therapy, surgery or their combination are common treatment modalities for cancer. However, a complete cure for cancer has not been achieved yet. On the other hand, novel drugs for cancer treatment are not efficient due to the ability of cancer cells to develop resistance against chemotherapeutic agents. Recently, natural compounds have been reported to improve the efficiency of cancer treatment. Polyunsaturated fatty acids (PUFAs) are natural compounds that could be used as dietary supplements in cancer patients. PUFAs are classified into two main categories, including n-3 and n-6 PUFAs. According to the literature, n-3 PUFAs exert protective effects against cancer through the induction of apoptotic pathways and suppressing cell proliferation, while n-6 PUFAs cause tumor formation by inducing cell growth and proliferation. Using PUFAs in combination with chemotherapeutic agents is considered to be an effective approach to the treatment of cancer patients through increasing cancer cell death. This review aimed to discuss the interactive effects of the structure and function of PUFAs on cancer and cell processes through various signaling pathways.

Mycobacterium tuberculosis (Mtb) is considered to be a major public health concern and a successful intracellular pathogen associated with high mortality worldwide. The Bacillus Calmette-Guerin (BCG) vaccine is the only available vaccine for the prevention of tuberculosis (TB) and tubercular meningitis in children. However, BCG is not adequately effective in the treatment of the adults affected to TB. According to the literature, there are controversial data on the potential role of B cells. B cells and humoral immune response play a key role in the amplification of the host immune response against TB. This review study aimed to discuss B cells and humoral immune responses in TB infection and assess its application as a therapeutic option. The monitoring of various B cell phenotypes in TB could be a reliable marker for the prediction of TB in individuals, especially in the latent form. According to the findings, the CMI response (especially Th1 activities) is not sufficient for efficient protection against TB, and B cells and Abs influence the innate immunocytes and Th1, while playing a pivotal role in various outcomes of exposure with tubercle bacilli. Although B cells may contribute to Mtb in the development of active TB, further investigations are required regarding the effects of B cells and humoral immunity on TB pathogenesis and the targeted harmful humoral-mediated response. Moreover, B cells and antibodies could be proper biomarkers to promote the studies regarding the detection of reliable diagnostic tools for the reactivation of latent TB, as well as use as a new generation of therapeutic options.

Enterobacter spp. is a gram-negative environmental bacterium, which belongs to the Enterobacteriaceae family and is found in water, sewage, soil, and plants. These bacteria are common among humans and animals, and the most frequently isolated species is Enterobacter cloacae. The species of this genus are often opportunistic pathogens with expanding significance in nosocomial infections, particularly in neonates, immunocompromised patients in intensive care units, emergency sections, skin and soft tissue infection wards, and urology wards. With the unexpected and rapid increase in antibiotic resistance in various bacterial species, there has been a new alarm for the health of the human community. Enterobacter species cause pneumonitis, bacteremia, post-neurosurgical meningitis, neonatal meningitis, skin and soft tissue infections, and urinary tract infections. Some of the main risk factors for the occurrence and dissemination of Enterobacter spp. infections are poor hand hygiene, crowding, low birth weight, premature birth, intubation of patients, prolonged hospital stay, contaminated infant formula, intravenous feeding, use of extended-spectrum antibiotics and use of intravenous catheters.

Aspergillosis is a common fungal infection with systemic characteristics, which is caused by various species of Aspergillus. The infection could develop in immunocompromised and immunocompetent patients under specific circumstances. Based on the clinical features and type of invasion, aspergillosis could be classified into four main categories, including invasive pulmonary aspergillosis (IPA), noninvasive aspergilloma, semi-invasive chronic pulmonary aspergillosis, and allergic bronchopulmonary aspergillosis (ABPA). Treatment with immunosuppressive drugs for inflammatory diseases, such as rheumatoid arthritis (RA), increases the infection rate with aspergillosis. RA is an autoimmune disease characterized by several chronic symptoms in the joints, including pain, stiffness, and chronic synovitis. Previous studies have denoted an association between RA and aspergillosis. Inhibitory drugs of tumor necrosis factors and steroids are widely used in the treatment of RA. ABPA and IPA are the most commonly diagnosed diseases in patients with RA. The present study aimed to review the effects of RA and its treatment on the development of aspergillosis.

Bronchiolitis is the main cause of lower respiratory tract infection during the first year of life. This systematic review aimed to assess the effectiveness of systemic corticosteroids in the treatment of bronchiolitis in children aged less than two years during their first hospitalization.

This systematic review was conducted via searching in databases such as PubMed, Scopus, Web of Science, and Cochrane Library until August 2019. Randomized clinical trials regarding the effects of systemic corticosteroids on children with bronchiolitis aged less than two years were evaluated in the retrieved studies. The quality of the studies was assessed based on the Jadad scale.

Three studies were included in this systematic review. In two studies, dexamethasone versus placebo were used, and in one study, prednisolone was applied. In one study, use of dexamethasone versus placebo resulted in the faster resolution of respiratory distress, shorter duration of respiratory distress syndrome, reduced oxygen therapy time, and reduced length of hospital stay. In another study, children receiving treatment with dexamethasone had no significant difference in the clinical score, respiratory rate, and pulmonary function compared to the control group. In another study, use of prednisolone within two weeks led to the partial improvement of rhinitis, wheezing, breathing problems, nocturnal respiratory symptoms, and coughing. However, no significant difference was observed between the prednisolone treatment and control groups after 12 months.

Despite the improvements in respiratory symptoms, evidence is scarce regarding the effectiveness of systemic corticosteroids in the treatment of bronchiolitis in children aged less than two years. Therefore, well-designed randomized clinical trials on large sample sizes are required in this regard.

Intoduction: 

Sore throat is a common postoperative complication in patients undergoing general anesthesia. Several factors contribute to this complication, and the airway management method plays a pivotal role in this regard. The present study aimed to assess the effect of diphenhydramine gargling on sore throat in patients undergoing cataract surgery with laryngeal mask insertion.

This placebo-controlled, double-blind, clinical trial was conducted on two groups of intervention and control. The patients in the intervention group gargled 8 cc (20 mg) of diphenhydramine diluted to 20 cc with normal saline 20 minutes before anesthesia induction. The control group patients gargled 20 cc of normal saline 20 minutes before anesthesia induction. The score of sore throat severity was determined based on the visual analogue scale during recovery three, six, 12, and 24 hours postoperatively.

Initially, 176 candidates of eye surgery using laryngeal mask airway (LMA) were enrolled in the study, and three patients were excluded from the intervention group due to withdrawal. In the intervention group, 36 patients (42.9%) were female, and 48 patients (57.1%) were male. In the control group, 46 patients (52.3%) were female, and 42 patients (47.7%) were male. The mean age of the subjects was 59.5±16.74 and 57.94±15.74 years in the intervention and controls groups, respectively. No significant differences were observed between the groups in terms of age and gender (P=0.53 and P=0.29, respectively). The mean score of pain severity was 0.3±0.14 and 1.7±0.14 in the intervention and control groups, respectively, which indicated a significant difference between the groups at each measurement point (P<0.001). However, the reported pain severity scores were not correlated with age, gender, mask size, and duration of surgery.

Gargling 20 milligrams of diphenhydramine suspension 20 minutes prior to LMA insertion in the patients undergoing eye surgery significantly reduced the post-anesthesia sore throat compared to the control group. Moreover, sore throat had no associations with the age, gender, duration of surgery, and mask size of the patients.

Medial collateral ligament (MCL) injury is highly common in athletes and the elderly. This ligament is in the knee region and is often at the risk of injury. Severe pain and motor limitation are the most important signs in the acute phase of the injury. In patients receiving anticoagulants, damage to the knee joint may lead to intra-articular bleeding, which exacerbates the symptoms and prolongs the recovery period. The present study aimed to describe the case of a 76-year-old woman with a sudden spin on the left knee while getting off a car. After a few minutes of walking, the patients felt pain, heard a pop-like sound on the injured knee, and was unable to walk, experiencing pain in the knee. The patient was transferred to the emergency department by the caregivers. The present case report was focused on the MCL injury in a patient receiving an anticoagulant due to atrial fibrillation.

Wilson’s disease is a rare genetic disorder, which is associated with clinical manifestations such as liver dysfunction, psychological and neurological issues, and specific laboratory findings demonstrating the increased urinary excretion of copper and copper accumulation in the body. Wilson’s disease is occasionally presented by atypical features, which delay the diagnosis of this rare disorder. This study aimed to describe the case of a patient with pulmonary and portal hypertension as a primary manifestation of Wilson’s disease. A young male patient was admitted to the emergency department due to the deterioration of respiratory symptoms and overall weakness. The patient had a history of dyspnea and fatigue, which was diagnosed as idiopathic pulmonary hypertension. In the previous admission, the liver function test of the patient was not disrupted, and serum/urinary copper and ceruloplasmin levels were normal. In the current admission, the patient had elevated bilirubin and enzyme levels, as well as abnormal copper and ceruloplasmin levels. Moreover, portal hypertensive gastropathy and Kayser-Fleischer ring were detected in further investigations, confirming the diagnosis of Wilson’s disease. To the best of our knowledge, this was the first report on Wilson’s disease initially presented with pulmonary and portal hypertension.