Iranian Journal of Medical Sciences
Volume:46 Issue: 4, Jul 2021

The outbreak of the coronavirus disease-2019 (COVID-19) has become a global public health challenge. Assessing the effect of COVID-19 on liver injury is of great importance. A systematic review and meta-analysis were conducted to establish the characteristics of liver function tests in COVID-19 patients.

A systematic search of publications from December 2019 up to April 2020 in Web of Science, Scopus, and Medline (via PubMed) databases was performed. Both cross-sectional and case series studies reporting an association between liver injury and COVID-19 infection were included. The data were analyzed using the STATA software (version 11.0) and the random-effects model for I2>50% was used to pool the results.

In this meta-analysis, 42 articles comprising a total of 6,557 COVID-19 patients were studied. The prevalence of increase in alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels was 30% and 21% in non-severe patients and 38% and 48% in severe patients, respectively. Patients with severe COVID-19 infection were 4.22, 4.96, and 4.13 times more likely to have elevated AST, ALT, and lactate dehydrogenase (LDH) levels, respectively.

Elevation in liver function tests was higher in patients with severe than non-severe COVID-19 infection. Given the widespread use of drugs that increases the risk of hepatotoxicity, healthcare providers should be aware of changes in liver enzymes in COVID-19 patients. The inclusion of other studies from outside China could confirm the pattern of elevation in liver function tests in COVID-19 patients across the globe.Preprint of this article is available on medRxiv, https://www.medrxiv.org/content/10.1101/2020.05.20.20108357v1

The role of human papillomavirus (HPV), as a common infection, has been evaluated in many cancers such as the cervix and squamous cell carcinoma of the head and neck. To the best of our knowledge, for the first time, the association of HPV with papillary thyroid carcinoma (PTC) and its pathologic features are investigated. A retrospective cross-sectional study was conducted from May 2014 to January 2018 in several hospitals affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. Thyroid tissue specimens of patients diagnosed with PTC (n=82) and benign thyroid nodules (n=77) were collected using the consecutive sampling method. The presence of HPV in PTC, adjacent normal tissue, and benign thyroid nodules was evaluated using the polymerase chain reaction (PCR) method. The frequency of HPV positivity in PTC tissues was compared with benign thyroid nodules and adjacent normal tissue. Association of pathologic features of PTC with HPV positivity was also investigated. Data were analyzed using SPSS version 21.0, and P values less than 0.05 were considered statistically significant. HPV PCR positivity was observed in 3.8% of benign thyroid nodules and 13.4% of PTC samples but in none of the adjacent normal tissues. After adjustment for age and sex, the prevalence of HPV PCR positivity in the PTC tissues was significantly more than the benign thyroid nodules (P=0.015). The prevalence was also significantly higher than the adjacent normal tissues (P<0.001). There was a significant association between PTC and HPV positivity. Further studies are required to determine the cause and effect of the association between these two conditions.

Intrathecal additive drugs are becoming increasingly common in anesthesia practice. We aimed to evaluate the additive effects of dexmedetomidine on spinal anesthesia with sufentanil in patients undergoing lower abdominal or lower limb surgery. This double-blind randomized controlled trial was performed in Mashhad, Iran, between 2017 and 2018. Sixty patients undergoing lower abdominal or lower limb surgery were randomly divided to receive 15 mg of bupivacaine and 3 μg of sufentanil (control group; n=30) or 15 mg of bupivacaine, 3 μg of sufentanil, and 10 μg of dexmedetomidine (intervention group; n=30). Outcomes, comprised of the onset and regression of sensory and motor blocks, the duration of analgesia, analgesic use, hemodynamic parameters, and side effects, were assessed. The data were analyzed in the SPSS software (version 22), using different statistical tests. A P value of less than 0.05 was considered significant. The times of sensory and motor blocks reaching T10 and Bromage 3, respectively, were significantly shorter, while the times of sensory and motor regressions to S1 and Bromage 0, correspondingly, were significantly longer in the intervention group than in the control group (P<0.001). Both the frequency (P=0.006) and the dose (P<0.001) of postoperative analgesic use were significantly lower, and the duration of analgesia was significantly longer in the intervention group (P<0.001). The frequency of side effects and changes in hemodynamic parameters had no significant differences between the groups. The sufentanil and dexmedetomidine combination in spinal anesthesia caused the earlier onset and later regression of sensory and motor blocks, longer postoperative analgesia, and lower analgesic use without significant side effects or hemodynamic changes, which appears to be due to the combined effects of sufentanil and dexmedetomidine.Trial Registration Number: IRCT2017082833680N3.

Epilepsy is a chronic disorder that affects both sexes and causes some physiological and psychological disabilities. The present study aimed to examine the effects of transcranial direct current stimulation (tDCS) on the psychological profile of patients with epilepsy. The design of the present study was a randomized clinical trial with a pretest-posttest and a control group. The statistical population comprised patients with epilepsy, who were referred for treatment to a private health center in Urmia in 2019. The sample consisted of 30 patients with epilepsy selected via the convenience sampling method. Data collection was performed through the use of the Depression, Anxiety, and Stress Scale-21 (DASS-21) questionnaire. After the pretest, 15 subjects were randomly assigned to the intervention group, and 15 subjects were placed in the control group. The intervention was performed in 10 sessions, and the duration of stimulation was 20 minutes. The anode was placed in the F3 region (left hemisphere), the cathode in the F4 (right hemisphere), and the current intensity was 1.5 mA. After the intervention, the posttest was conducted for both groups, and the data were analyzed using a univariate covariance analysis in the SPSS software, version 23. A P value of less than 0.05 was considered statistically significant. The results of the ANCOVA analyses revealed significant differences between the intervention and control groups. The tDCS group represented a significant decrease in the scales of depression, anxiety, and stress in the posttest in comparison with the pretest (P≤0.001). The results showed that tDCS could reduce depression, anxiety, and stress with the changes caused in the brain system. Trial Registration Number: IRCT20190803044417N1.

Targeted drug delivery is a novel method to specifically deliver anticancer therapeutics to tumor sites. Gonadotropin-releasing hormone (GnRH) is a decapeptide, and its target binding property has attracted attention as a means of targeted drug delivery. Human pancreatic ribonuclease 1 (hpRNase1) has been shown to exert anticancer properties, when fused to a targeting moiety. The goal of the present study was to add a GnRH targeting peptide to the N-terminus of hpRNase1 to specifically target GnRH receptor (GnRH-R) expressing cells. This in vitro study was conducted at Shiraz Institute for Cancer Research (Shiraz, Iran) in 2019. The coding sequence of GnRH and hpRNase1 were fused, and the chimeric protein together with non-fused hpRNase1 were produced in E. coli (BL21). The recombinant proteins were purified, and their biological activity was evaluated using MTT and apoptosis assays. Non-parametric Kruskal–Wallis tests with Dunn’s post hoc tests were performed to determine the significant differences between the study groups. GnRH-hpRNase1 chimeric protein specifically inhibited the proliferation of PC-3 (P=0.021), LNCaP (P=0.034), and AD-Gn (P=0.041) cells, while the growth of negative cells (AD-293) was not significantly affected (P=0.081). GnRH-hpRNase1 decreased the IC50 values more than non-fused hpRNase1, by approximately 26.5-fold (P=0.036) for PC-3 cells, and exerted its growth inhibitory effects through apoptosis induction. Fusion of GnRH to hpRNase1 structure produced an enzyme, which could specifically target tumor cells. This approach can be used to eliminate tumors that harbor GnRH-R.

Breast cancer is the second most common cancer in women worldwide. Developing drugs increase the radiosensitivity effect of tumoral tissue, while protecting normal tissues has gained much attention. Ginsenoside Rg3, one of the active components of ginseng, has been shown to possess various pharmacological effects and antiproliferation activity on cancer cell lines. In this study, we assessed the anti-cancer effect of co-treatment with ginsenoside 20(S)-Rg3 and curcumin on MDA-MB-231 breast cancer cells with and without radiotherapy. MTT assay was applied using different concentrations of ginsenoside 20(S)-Rg3 (0, 10, 80, 150 µmol/l) and curcumin (0, 10, 30, 50, 90 µg/mL). The inhibitory effect of co-treatment with these herbal drugs with and without 4 Gy radiotherapy on the MDA-MB-231 cell line was examined. Flow cytometry was applied to measure the effect of co-treatment of the drugs on radiation-induced apoptosis. The data were analyzed using ANOVA and Kruskal-Wallis tests. P values<0.05 were considered statistically significant. The results of the MTT assay showed that ginsenoside 20(S)-Rg3 and curcumin had an inhibitory effect on the MDA-MB-231 cell line in a concentration-dependent manner. Ginsenoside 20(S)-Rg3 and curcumin inhibited tumor cell development and proliferation at concentrations of 80 µmol/L and 30 μg/mL, respectively, with 50% cell viability (P=0.018, P=0.01, respectively) at 48 hour incubation time. Ginsenoside 20(S)-Rg3 and curcumin inhibited MDA-MB-231 cell growth in a dose- and time-dependent manner and increased the radiosensitivity of cancer cells. These herbal drugs can be considered as a radiosensitizer in radiotherapy.

Studies have shown that myeloid cell leukemia-1 (Mcl-1) is the target gene for microRNA -101 (miRNA-101), and decreased levels of miRNA-101 are associated with elevated levels of Mcl-1 and lung cancer survival. The objective of the present study was to investigate the effect of miRNA-101 on the sensitivity of A549 lung cancer cells to etoposide. The study was conducted during 2018 and 2019 at Arak University of Medical Sciences, Arak, Iran. The effect of miRNA-101 on Mcl-1 expression was assessed using reverse transcription-quantitative polymerase chain reaction 3-(4, 5-Dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT), and trypan blue exclusion assays were performed to determine the effect of treatments on cell survival and proliferation, respectively. The interaction between miRNA-101 and etoposide was evaluated using the combination index analysis of Chou-Talalay. Apoptosis was quantified using ELISA cell death assay. ANOVA and Bonferroni’s tests were used to determine statistical differences between the groups (P<0.05). GraphPad Prism software (version 6.01) was used for data analysis. The results showed that miRNA-101 clearly inhibited the expression of Mcl-1 and reduced the growth of A549 cells, relative to blank control and negative control miRNA (P<0.05). Transfection of miRNA-101 synergistically enhanced the sensitivity of the A549 cells to etoposide. Apoptosis assay data also showed that miRNA-101 triggered apoptosis and augmented the etoposide-mediated apoptosis. Up-regulation of miRNA-101 inhibited cell survival and proliferation, and sensitized A549 cells to etoposide by suppressing Mcl-1 expression. miRNA-101 replacement therapy can be considered as an effective therapeutic strategy in non-small cell lung cancer.

Pericardial cysts (PCs) are uncommon benign congenital anomalies residing in the middle mediastinum. The location of PCs is diverse with 70% of cases in the right cardiophrenic angle, 22% in the left cardiophrenic angle, and 8% in the posterior (as in our case) or superior anterior part of the mediastinum. In 2019, a 54-year-old woman was referred to the emergency department of Imam Khomeini Hospital Complex (Tehran, Iran) suffering from progressive shortness of breath. The chest computed tomography scan showed an unusual giant cystic lesion occupying >50% of the right hemithorax. The cystic lesion was primarily located in the posterior mediastinum. The patient underwent video-assisted thoracoscopic surgery (VATS), and the cyst was completely resected from the mediastinum. During past decades, several cases of PCs have been reported in different age and sex groups. Here, we present a case of a giant pericardial cyst (PC) located in the posterior mediastinum. The cyst was successfully resected using VATS. Only one other study has reported a PC in the posterior mediastinum.