Acta Medica Iranica
Volume:58 Issue: 7, Jul 2020

Tachykinins (TKs) are a family of neuropeptides widely distributed in the human body, especially in the nervous system. TKs have exhibited both neuroprotective and neurodegenerative properties in the central nervous system (CNS) and spinal cord. Also, several studies have shown that substance P (SP), as a pioneering neuropeptide of the TK family, is engaged in the pathogenesis of neurodegenerative disorders (NDs), such as Alzheimer disease, Multiple Sclerosis, Parkinson’s disease, Huntington’s disease, and Amyotrophic lateral sclerosis. However, a huge body of information available about the level of SP in NDs demonstrates that SP and its receptors might be prognostic or diagnostic factors for NDs. The present review article summarizes the roles of TKs in common neurodegenerative disorders.

Helicobacter pylori (H. pylori) is a bacterium that resides in the human stomach,which is associated with gastroduodenal diseases. We investigate the prevalence of cagA, vacA, oipA, cagE1, cagE2and dupAgenotypes in H. pyloriisolated from patients with Gastric ulcer, duodenal ulcer, and Gastric Cancer. Collected 74 samples from the Gastroenterology Unit of the Rasool Akram Hospital were included in this study. Gastric disorders were identified by endoscopy .gastric cancer was further confirmed by histopathology. H. pyloriwere detected by the urease test. Subsequently, DNA was extracted from gastric tissue ofthe subjects with the CLO-test yielded positive results.In general, 74 patients with a mean age of 53.45 years (Range 22 to 86-year-old), including 45 men and 29 women, were studied. Among 74 H. pylori-positive patients, 70 (94.5%) patients were positivefor the cagA gene. About 95.8% (23/24) of the patients with gastric carcinoma were dupApositive and VacA gene (91.8%). The oipA genotype was detected in 71 (96%) of H.pyloripositive samples. This gene was more common in patients with gastritis rather than cancer group. Also, 97.2% of 74 H. pyloriisolates were cagE2-positive. In 25 patients with PUD, the occurrence percent of cagA+/VacA+, cagA+/Vac-, cagA-/VacA+ and cagA-/VaxA-genotypes were found 80%, 12%, 4.2% and 4.2 respectively.The results of the present study suggest that a high prevalence of virulent factors could contribute to the risk of developing gastroduodenal diseases.

The description of histopathological features of spleen specimens in those undergoing splenectomy is necessary and even vital for selecting the best patient's diagnostic and therapeutic management. However, in some cases, the histological findings of those with dramatic clinical presentation may be imperceptible and vice versa.

What we did in the present study was to assess the clinical and histopathological findings as well as the main indications for splenectomy in a sample of Iranian affected population.

This cross-sectional study was conducted on 616 spleen specimens following complete or partial splenectomy performed at pathology laboratory at Besat Hospital in Hamadan, Iran between 2007 and 2017. Demographic characteristics, the main reasons for splenectomy, grading of trauma, and histopathological findings were retrospectively collected by reviewing the hospital recorded files and laboratory reports.

The most common cause for splenectomy included trauma in 59.25% followed by idiopathic thrombocytopenic purpura in 15.58% and symptomatic splenomegaly in 9.09%. The specimens were normal in 38.0%. Among those with lymphoma, the definitive diagnosis included diffused large B cell lymphoma in 42.85%, Hodgkin lymphoma in 42.85%, Follicular cell lymphoma in 9.52% and Marginal cell lymphoma in 4.76%.

Trauma and idiopathic thrombocytopenic purpura are the most common indications for splenectomy. Given the normality of the pathologic findings in more than one-third of patients undergoing splenectomy, closer attention to indications for this procedure through further evaluation of patients and predicting outcome of the procedure is necessary.

Obesity is a risk factor for severe, radicular, and debilitating lumbosacral pain. The use of non-surgical treatment methods in obese patients is important. Epidural steroids injection (ESI) is a common procedure that helps patients with low back pain and radicular symptoms. So far, using ESI in patients with lumbar herniated discs remains to be controversial among physicians. Thus, the current study was carried out to compare therapeutic effects of ESI's in obese and non-obese patients with spinal disc herniation.

This prospective, clinical trial study was conducted among 124 patients (58= non-obese, 66= obese) with low back pain caused by lumbar herniated disc, who referred to our Pain Clinic during 2017 to 2018. The ESI was done using the parasagittal inter-laminar approach.Severity of pain was measured by the patients’ self-report of pain and using the visual analog scale (VAS), before the treatment and two and six weeks after the treatment. The Oswestry Disability Index (ODI) was also measured in the treatment groups. Patients were followed for 6 weeks (IRCT20131124015515N3).

Overall, 58 (46.8%) patients had a BMI of 20-25 kg/m2, 38 (30.6%) had a BMI of 25-30 kg/m2, and 28 (22.6%) patients had a BMI of >30 kg/m2. The changes in the pain scores and ODI at different time periods showed no statistically significant differences in the two groups, (P=0.685, P=0.995), respectively.

The ESI is an effective, safe, minimally invasive, and cost-effective method which can result in pain relief and improvements in patients' function after a short period of time. Hence, we  suggested that this treatment to be considered for all patients with acute/chronic low back pain as well as  radiculopathy.

Platelets activation and aggregation play a major role in thrombosis formation of coronary arteries in patients with Acute Coronary Syndrome (ACS)   and is responsible for most ischemic complications during PCI. There is little information on the benefits and side effects of intracoronary and intravenous injection of Eptifibatide ,a potent antiplatelet agent; therefore, this study was performed with aim to compare coronary blood flow velocity  by measurement of TIMI frame count in intravenous versus intracoronary bolus administration of Eptifibatide during PCI in ACS patients.

This non-randomized clinical trial study was performed on 103 patients with acute coronary syndromes who referred to the cardiac emergency ward of Ghaem hospital, Mashhad University of Medical Sciences, and were candidates for urgent coronary angiography and PCI. 48 cases received intracoronary bolus Eptifibatide and 55 intravenous Eptifibatide. TIMI Frame Count and Corrected TIMI Frame Count were used to compare the effect of these two methods on coronary blood flow velocity. Data were analyzed by SPSS software (version 22). To compare the quantitative variables in the two groups, according to the distribution of variables, the T test was used if it was normal or the Mann-Whitney test was used if it was not normal. Chi-square test was also used to compare qualitative variables in two groups. P<0.05 was considered statistically significant.

Mean of age, gender and cardiovascular risk factors were similar in the two groups.  There was no significant difference in terms of serum Creatine Kinase MB (CKMB) level, Left Ventricular Ejection Fraction (LVEF), coronary artery lesion length, coronary artery diameter, coronary thrombosis and coronary artery thrombectomy in two group. Based on Student's t-test, there was no significant difference between mean TIMI Frame Count  in different coronary arteries in the intracoronary and intravenous injection groups (In LAD, P=0.518; For LCX, P=0.576; and in RCA, P=0.964).The complications was observed in 11 patients (22.9%) of the intracoronary injection group and 9 (16.4%) of the intravenous injection group; the difference was not significant (P= 0.402).

The effects and complications of Eptifibatide were not significantly different in Intracoronary and intravenous administration in ACS patients during PCI and at the time of patients' hospitalization.

Various training methods can be used to enhance the clinical self-efficacy of nurses caring for patients with acute coronary syndrome (ACS). The present study aimed at investigating and comparing the effect of simulated patient and lecture training methods in the self-efficacy of nurses' clinical performance caring for ACS patients in 2016.

This was a quasi-experimental study. The population consisted of 62 nurses working in cardiac intensive care units (CICU) of associated hospitals with Jahrom University of Medical Sciences. Sampling was done with convenience method and divided into 2 groups; "lecture" and "simulated patient" education, through random assignment. Data was collected with the Self-efficacy of Nurses' Clinical Performance Questionnaire before and after intervention. Data analysis was performed with SPSS v16.0 software and paired and independent t-tests.

There was a significance difference between pre- and post-intervention self-efficacy mean scores in the two groups (P<0.05). In addition, there was no significant difference between pre-intervention self-efficacy mean scores in the two groups (P>0.05).

Simulated patient training method was more effective in enhancing nurses' self-efficacy in caring for ACS patients than the lecture method.

Pseudomonas aeruginosa (P. aeruginosa) is a common bacteria associated with burn infections and resistance to a wide range of disinfectants and antimicrobial agents which is able to produce different virulence factors. In this study, the susceptibility of P. aeruginosa isolates from burn (burn=57) and hospital environment (HE=19) to antimicrobial agents and chemical disinfectants was determined by disc and well diffusion agar method, respectively. The results showed 100% sensitivity to polymyxin B, while sensitivity to other agents were low and ranged from 40.8% for imipenem and amikacin to 6.6% for ceftizoxime. Among the disinfectant used the mean diameter of inhibition zones (DIZ) was higher for deconex while nitrofurazone had the lowest DIZ. In most cases the HE isolates were significantly more susceptible to disinfectants and antimicrobial agents compared to burn isolates (P≤0.01). The genes for the exoenzyme T, Y, U and S were detected in 100%, 89.8%, 43.4% and 48.7% of the isolates respectively. Prevalence of exo U and exoY was significantly higher in the burn isolates compared to HE isolates (P=0.001). The results of this study indicate significantly higher level of resistance against the majority of the antimicrobial agents in the burn isolates compared to HE isolates which was significantly higher than the environmental isolates. The prevalence of T3SS effectors proteins and their pattern were also different in the burn and the HE isolates, indicating a divergence in pathogenicity of the burn isolates from those of the environmental isolates.

Valproic acid is a broad-spectrum anticonvulsant drug that is also useful for other diseases such as bipolar disorder and migraine. The most important side effect of this drug is hepatotoxicity. Oxidative stress and mitochondrial dysfunction play a role in the pathogenesis of liver toxicity of valproic acid. Mito-TEMPO is an antioxidant-based compound, which is selectively accumulated in mitochondria. The effects of its mitochondrial protection against oxidative damage in various pathologies, such as liver damage, have been observed. The aim of this study was to evaluate the protective effect of mito-TEMPO on liver toxicity induced by sodium valproate in mice.

Animals were divided into five groups and treated intraperitonealy over a 4-week period. Group 1 received normal saline, served as vehicle control, group 2 treated with 12.5 mg/kg of sodium valproate, group 3 was treated with 1 mg/kg of Mito-TEMPO, group 4 received both sodium valproate (12.5 mg/kg) and Mito-TEMPO (1mg/kg), and group 5 received sodium valproate (12.5 mg/kg) and vitamin E (5mg/kg) served as positive control. At the end of the experiment, blood samples collected by cardiac puncture and all the animals were killed under ether anesthesia. Biochemical parameters including AST, ALT, ALP and GGT in serum samples and glutathione (GSH) and malondialdehyde (MDA) contents in liver homogenates were determined.

Findings of this study showed that activity of AST and ALT were significantly lower in the sodium valproate + mito-TEMPO treated animals as compared to sodium valproate group (group 2). Furthermore, mito-TEMPO was able to recover glutathione content (GSH) of liver tissue. Effect of mito-TEMPO on the activity of ALP and GGT and serum level of MDA was not significant.

Taken collectively, mito-TEMPO has a protective role in sodium valproate hepatotoxicity. Considering the present results, further studies, in view of the potential therapeutic properties of mito-TEMPO in improving liver damage caused by the use of valproic acid, may lead to the clinical applications of mito-TEMPO in the treatment of liver disease.

Inflammatory myofibroblastic tumors (IMTs) are rare with unknown etiology. As pancreas involvement is rare in IMTs, here, we report a case of a girl with IMT, referred to our hospital.

A 4-year-old girl presented with chief complaints of generalized itching and jaundice. Abdominopelvic computed tomography (CT) scans with contrast showed a homogeneous isodense mass lesion in the head of the pancreas with a compressive effect on the distal part of the common bile duct (CBD). Dilatation of intrahepatic bile ducts and CBD (8mm) was observed. Magnetic resonance cholangiopancreatography (MRCP) examination showed dilated gallbladder without stones and intrahepatic/extrahepatic bile ducts. The CBD was dilated and a mass was found in the head of the pancreas. Immune-histochemical studies revealed spindle myofibroblastic tissues with lymphoplasmacyte and eosinophil infiltration. All of them were compatible with pancreatic IMTs. The surgery improved the symptoms.

The IMTs of the pancreas can have symptoms like pancreatic cancer. The careful evaluation by imaging and pathology is recommended.

Neurofibromatosis type 2 is a genetic autosomal dominant disorder, caused by spontaneous mutation in the gene located on chromosome 22 q11-13.1,which usually emerges in adolescence or early adulthood and is characterized by development of bilateral vestibular schwannoma. We hereby report the classical case of Neurofibromatosis type 2 in a 25 years old young male with multiple tumors associated with the disease.This patient presented to us with 3 years history of multiple painless nodules on his skin, facial weakness , left sided progressive hearing loss and 20 days history of weakness in the left lower limb. On Examination he was vitally with a GCS of 15/15. He was anemic with no jaundice. He had left inguinal lymphadenopathy along with multiple subcutaneous nodules on different areas including the scalp, face, left mid axillary line over the abdomen.He also had Right sided facial palsy and horizontal nystagmus. CNS examination revealed upgoing plantar on left side, right facial nerve palsy and bilateral vestibulocochlear nerve paralysis. Spine examination revealed spinal tenderness in the lower lumbar region.Superficial abdominal reflexes were absent. Upper limb and right lower limb power, tone and reflexes were normal while the tone and power in the left lower limb was reduced power being ⅗. Reflexes were also exaggerated in the left lower limb. The right ankle showed swelling most probably a plexiform neuroma. On investigations he had normochromic normocytic anemia with mild leucocytosis. Platelets were normal. Rest of the biochemical investigations including serum electrolytes, liver function tests and renal function tests were also normal.MRI brain and spine confirmed bilateral accoustic neuroma and multiple cranial and peripheral nerves tumors i.e classical presentation of a rare disease neurofibromatosis.He was referred to neurology unit for further assesment and treatment.