مجله دانشکده پزشکی دانشگاه علوم پزشکی تهران
سال هفتاد و نهم شماره 7 (پیاپی 247، مهر 1400)

Glioma is the most common type of brain tumor and according to the 2016 WHO classification, based on invasion level, it is divided into four categories. The most severe and invasive type is grade IV glioma or glioblastoma (GBM), which has a very poor prognosis and a survival rate of only 15 months. However, the molecular pathway of invasion in malignant glioma tumors has not yet been clearly elucidated. Like other cancers, brain tumors are thought to migrate and metastasize to other tissues via epithelial-to-mesenchymal transition (EMT). EMT is a process by which epithelial cells lose their cell polarity and cell-cell adhesion, and gain migratory and invasive properties to become mesenchymal stem cells. Studies have shown that EMT and angiogenesis can help brain tumors to migrate to other parts of the brain as well as surrounding tissues. Thus they can induce metastasis. EMT is controlled by three gene families, including SNAIL, TWIST, and ZEB. During EMT, the expression of epithelial-related genes is silenced, and, conversely, the expression of mesenchymal-related genes is increased. In this way, the cells acquire the mesenchymal tissue’s features and can be prepared for invasion and metastasis. On the other hand, only about 1% of the genome can take its role in the translation of functional proteins, and the large remaining part of the genome is made up of non-coding sequences. Therefore, much attention has recently been paid to the role of such noncoding transcripts, at the top of them, long non-coding RNAs (lncRNAs), in regulating the expression of genes involved in important molecular pathways such as apoptosis, proliferation, invasion, and migration in cancer progression and metastasis. Any interference in regulating the expression of genes involved in each of these molecular pathways leads to cancer in different ways. Understanding and identifying lncRNAs involved in tumorigenesis and invasion of brain tumors, while helping to better identify the molecular mechanisms of metastasis in glioma, can also be effective as biomarkers in the diagnosis, prognosis, treatment, and drug resistance of glioma. Therefore, in this review study, the most important lncRNAs involved in EMT in glioma have been investigated.

At present, in nuclear medicine to calculate the cumulative activity of various organs, different techniques are being used to correct the background radiations in the conjugate view method. Each of these techniques considers the effect and weight of background radiations to a different extent. These background radiations can cause errors in cumulative activity calculations. The purpose of this study was to evaluate and compare different techniques of correcting background radiations to each other in calculating kidney cumulative activity during the nuclear scan of the bladder in children.

This study was Cross-sectional and performed for patients who were referred to Isfahan Shahid Chamran Hospital between December 2019 and June 2020. In this study using Foley, 1 mCi of TC-DTPA radio-pharmaceutical that was diluted with normal saline was injected into the patientchr('39')s bladder, then images recorded by gamma cameras were extracted at 2, 5, 10, and 20 minutes, Finally with ROI drawing around kidney with having vesicoureteral reflux, Cumulative renal activity was calculated with four correcting background radiations techniques such as without correction of background radiation, conventional method, Buijs method, and Kojima method Eventually, the data was Eventually, the data was compared to each other to determine how much weight each of these techniques consider for background radiations.

Cumulative kidney activity after calculation with four correcting background radiations techniques such as without correction of background radiation, conventional method, Buijs method, and Kojima method were 14.970±4.776, 13.544±4.357, 13.885±4.451, 13.879±4.449 mCi.min. respectively After comparing the calculated cumulative activity without correcting the background radiations with the cumulative activity calculated by the three techniques of correcting the background radiations such as the conventional method, Buijs method, and Kojima method, the value (P<0.05) was obtained in all cases, which shows that elimination of background radiations is significantly meaningful in the calculations of cumulative activity in the conjugate method for nuclear exams

after comparing correcting background radiations techniques to each other, it was determined that the conventional method technique considers the effect and weight of background radiations more than the two other techniques such as the Buijs method and Kojima method in cumulative activity calculations.

Bier block is a reliable technique used in extremity surgeries. Typically, angiocatheters are palced in the distal portion of the extremity that is going to be operated. Although, it is not the case in every operation. Therefore, determining the effectiveness of the local anesthetic injection site on the quality of the upper-extremity block can be helpful.

In this double-blinded randomized clinical trial that took place in Kowsar Hospital (Sanandaj, Iran) at 2020, 60 patients after complete monitoring and sedation were assigned randomly into proximal bier block (32 in experimental) and distal bier block (28 in control) groups. 10ml/kg Ringer serum was prescribed for patients in both groups on the non-surgical hand. Depending on the patients’ placement in either group, an angiocatheter (22 or 24) was attached to the ante-cubital area (proximal bier block group) or on the back of the patientchr('39')s hand (distal bier block group). Respectively, after blood was drained by a Smarch band from the extremity that was to be operated, the tourniquet was inflated up to 150mmHg above the patient’s systolic pressure and the smarch band is untied from the hand. For every patient regarding the group they were assigned, 3mg/kg lidocaine 0.5% was administered through an angiocatheter. After 5 minutes, the depth of patientchr('39')s anesthesia and pain intensity were measured. Sensory and motor recovery was assessed every 10 minutes after surgery. Patient satisfaction with anesthesia was measured after the surgery and characterized by excellent, good, moderate (pain relief), and unsuccessful (need for pain medications) indicators. In case insufficient depth was reached, intravenous Remifentanil was injected.

According to the results of the chi-squared test, there were no significant differences in gender distribution (p=0.063), anesthesia class type (p=0.964), type of surgery (p=0.694), anesthesia satisfaction (p=0.578), sensory block of hand (p=0.529), motor block of hand (p=0.059), pain intensity (p= 0.634), pain relief medication requesting (p=0.755) and also body mass index (T-test used P=0.099) variables comparing both groups together. Additionally; according to the T-test results no significant differences were reported in the mean systolic pressure, mean diastolic pressure and mean heart rate variable in designated times.

There is no significant difference between the two groups. Therefore, using a distal Bier block can be an alternative if needed.

Urinary tract infection is one of the most common infectious diseases in children, the most severe form of which is acute pyelonephritis. Vitamin D plays a very important role in regulating the immune system, this study was conducted to compare vitamin D levels in children with urinary tract infections and healthy children in Kerman, Iran in 2020.

This cross-sectional study was performed on 63 children with pyelonephritis hospitalized in Afzalipour Hospital and 68 healthy children who were referred to Samen Al-Hojaj Clinic in Kerman, Iran from January 2020 to January 2021. Inclusion criteria for patients include the following: a) the presence of clinical signs and symptoms of infection such as fever b) pyuria, neurogenic bladder, urinary stones, chronic renal failure and previous diagnosis of urinary reflux. The case group was evaluated by taking a complete history, completing a questionnaire and clinical examination, and laboratory tests. The two groups were compared in terms of variables of sex, age and vitamin D levels.

The mean age of the case group was 34 months and that of the control group was 38 months. The mean serum levels of vitamin D in the case and control groups were 34.66 and 42.9, respectively). P=0.016( Each group was divided into three groups according to the amount of vitamin D, including groups 1, 2 and 3, respectively, with vitamin D levels below 25 nanomoles per liter of deficiency, 25 to 50 inadequate and above 50 as the appropriate amount of vitamin D was considered. There was no significant difference between girls and boys in terms of vitamin D deficiency compared to the three groups of vitamin D levels.

Inadequate vitamin D levels are associated with the prevalence of urinary tract infections, and vitamin D supplementation can be a low-risk option for preventing urinary tract infections.

Spinal anesthesia is a type of neuraxial anesthesia that brings ample benefits. However, due to the fear of this type of anesthesia, many pregnant people refuse to experience it. In this study, we aimed to investigate the levels and causes of fear of spinal anesthesia in candidates for cesarean section.

The current study is a cross-sctional study performed on 67 patients undergoing cesarean section who were referred to the operation room of Shariati Hospital, in Tehran from September 2018 to September 2019. Matthey questionnaire, which consisted of three sections (demographic information, history of spinal anesthesia and fear of anesthesia), was filled out by candidates and after collecting information, the data were analyzed by SPSS software.

Pain over the surgery showed a significant relationship with the history of spinal anesthesia in 4 pregnant women (12.9%) and in 25 women (65.8%) without a history of anesthesia (P<0.0001). In addition, the fear of being awake and looking at the cesarean section during surgery was significant in 7 patients (22.6%) with a history of spinal anesthesia and 18 patients (47.4%) without a history of disease (P<0.0001). Fear of anesthesia needle was also significantly observed in 7 patients (23.3%) with a history of spinal anesthesia and 23 patients (60.5%) with no history of spinal anesthesia (P<0.0001). Fear of back injury was seen in 9 candidates (29%) of patients with a history of spinal anesthesia and in 23 patients (60.5%) of patients without a history of anesthesia (P<0.033). The results of our study also showed a significant relationship between the history of general anesthesia and fear of nausea and vomiting (P<0.046) as well as fear of anesthesia needles (P<0.001).

Patients with a history of spinal anesthesia were significantly less afraid of feeling pain during surgery, seeing surgery, spinal anesthesia needles, and spinal impairments. Moreover, patients with a history of general anesthesia were significantly more afraid of spinal anesthesia, nausea and vomiting than others.

The preparedness and safety of hospitals in disasters are essential to maintain the health and survival of the community. Numerous studies have shown that the level of preparedness of Iranian hospitals is moderate and low. Lack of comprehensive hospital standards for disaster preparedness is one of the reasons. This study aimed to develop hospital accreditation standards for hospital disaster risk management.

This comparative study was conducted between April and September 2016. Hospital disaster risk management accreditation standards were extracted from the hospital accreditation standards of 11 countries including the United States, Canada, Australia, Malaysia, India, Thailand, Egypt, Turkey, Saudi Arabia, Denmark and Iran. Overall, 27 hospital disaster risk management accreditation standards were introduced. The opinions of 22 disaster risk management experts were used to assess the content validity of the proposed disaster risk management accreditation standards.

Differences were observed in the quality and quantity of those countries’ disaster risk management standards. The national accreditation standards of the United States, Australia, and Canada had comprehensive standards and covered all aspects of the disaster risk management cycle. Finally, 27 standards were proposed for developing Iranian hospitals’ disaster risk management accreditation standards. The CVI & CVR validity of the proposed standards were acceptable.There were significant differences in the quantity and quality of hospital disaster risk management accreditation standards in selected countries. The most comprehensive standards belonged to the US National Standards (12 standards and 113 sub-standards), followed by the Australian and Canadian accreditation standards. The accreditation standards of the developing countries and Iran were not comprehensive and did not meet the international goals of disaster risk management. The proposed hospital disaster risk management accreditation standards had high content validity.

Disaster risk management accreditation standards in Iran and developing countries need to be revised and upgraded. Comprehensive standards based on international experiences and expert opinions were introduced in this study that can be used to develop hospital accreditation standards in Iran and other countries.

Gender differences in scientometric indicators among medical faculty members in Iran was investigated.

The Research performance of the faculty at all universities and institutes of medical sciences in Iran was assessed using the Iranian Scientometric Information Database (ISID) on June 12, 2021. Selected variables in our study were name, gender, university, degree, academic rank, type of faculty, the total number of articles, the total number of citations, self-citation percentage, h-index, citation per article, international cooperation percentage, and the number of research collaborators. The Kruskal-Wallis test was used. The extracted data were analyzed using R v4.0.1 statistical software.

A total of 21064 faculty members in 77 universities and institutes of medical sciences were registered in the ISID database, of which 12093 (57.4%) were men. Men faculty members outnumbered women in all academic ranks, except for the “instructor” rank (1134 female instructors against 835 male). In both sexes, most faculty members were assistant professors. There were more articles (346837 vs. 146024) and citations (5177060 vs. 1639246) by men than women. Among the 1789 faculty members with zero articles, 902 (50.4%) were men. One-hundred-and-fifty-four people were among ESIchr('39')s top researcherschr('39') list, with a majority of men (124 people equal to 80.5%). The medians of all the scientometric indicators were higher in men than women. Men had a higher number of articles, the number of citations, h-index, citation per article, percentage of international articles, and co-authors, however, women had lower self-citations (1.56% vs. 2.51%). In all academic ranks, men had higher scientometric indicators. The only exception was the associate professors’ self-citation, in which women’s citations were higher than that of men (3.5 vs. 3.3). The highest mean h-index was in men with a Ph.D. in Pharmacy (13), men with a Ph.D. by Research (12) and women with a Ph.D. by Research (8.5), respectively.

Gender differences were evident in research performance in Iran. Women faculty members of medical sciences in Iran generally had lower scientometric indicators.

Mycoplasma pneumoniae is one of the causes of upper and lower respiratory tract infections especially in children, and antibiotics affecting the cell wall do not affect this type of infection. This study aimed to evaluate the prevalence of Mycoplasma pneumoniae and macrolide resistance in children with community-acquired pneumonia in Kerman city.

This cross-sectional study was conducted in a selected teaching hospital in Kerman city from July 2018 to July 2019. Fifty-one children hospitalized in the pediatric ward were diagnosed with bacterial pneumonia acquired from the community. These children were included in the study by census method. The data collection tool was a standard checklist. The checklist was completed by parents. Pharynx and nasal swab samples were taken from all patients. PCR was used to identify mycoplasma.

The highest number of patients with bacterial pneumonia acquired from the community were male (52.9%). The average age of these cases was 5.52±3.93 years and the average weight of these patients was 17.23±10.55 kg. Lung involvement was one-sided in more than half of the patients. The most of lung involvements were lobar (31.4%). More than half of the patients didn’t have any associated involvement (52.9%). The most common type of associated involvement was peribronchial thickening (29.4%). The most commonly used antibiotic was Ceftriaxone (76.5%). The prevalence of Mycoplasma pneumoniae infection in children with pneumonia was 2%. These children had an rRNA gene at position 2063 that had high levels of macrolide resistance.

The results of this study showed very low rates of Mycoplasma pneumoniae infection in children with bacterial pneumonia acquired from the community. Therefore, it can be concluded that in addition to Mycoplasma pneumoniae, other viral and bacterial agents are also involved in respiratory infections that need to be identified and addressed.

Nicolau syndrome is a rare condition that happens after intramuscular injection. All the intramuscular injections may have mild to moderate complications such as pain, focal abscess, nerve complication and anaphylactic reactions. Among these complications, wide necrosis of the skin like Nicolau syndrome happens very rarely. In this condition, Patients typically report acute, intense pain, immediately after drug injection and it is followed by an erythematous macular evolving after 24 hours into a livedoid violaceous patch with dendritic extensions. The study has been reported a case report of a 6-month-old infant who suffered from Nicolau syndrome after the injection of pentavalent vaccine.

A 6-month-old girl infant without a history of any disease was referred to the emergency department with the signs of erythema, edema and purple like discoloration in the vaccine injection site at the left tight, after vaccination. One hour after admission, in the lower limb severe edema along with an extension of a dark red to purple discoloration happened on different parts of foot and after 5 days they turned necrotic. The infant suffered from Nicolau syndrome after the injection of the pentavalent vaccine.

Although Nicolau syndrome is a very rare complication with no definitive treatment but can be prevented and not be aggravated by doing proper method of intramuscular injection and no application of cold compress (aspiration the needle for 5–10 seconds before injecting to make sure not to hit a blood vessel, the proper method of z-track, holding injection immediately if the patient complains excruciating pain on injection site, appropriate length of the needle to reach muscle, and different sites for multiple injections). However, due to lack of supporting evidence, needle aspiration is not recommended because no major vessel runs through the normal vaccination zone and that faster method is less painful. So, the vaccination must be done in right place with an appropriate length of the needle.

Early outcome prediction of hospitalized patients is critical because the intensivists are constantly striving to improve patientschr('39') survival by taking effective medical decisions about ill patients in Intensive Care Units (ICUs). Despite rapid progress in medical treatments and intensive care technology, the analysis of outcomes, including mortality prediction, has been a challenge in ICUs. Hence, this study aims to predict the mortality of patients admitted to ICUs using data mining techniques.

In this study, among the cases of patients who were admitted to ICUs of the Rasoul Akram and Firoozgar hospitals of Tehran City, Iran, from December 2017 to March 2018, the first 24 hours of the ICUs admission data of 874 cases were gathered. A new model based on the standard methodology CRISP was developed. In the modeling section, two well-known data mining techniques called artificial neural network (ANN), K nearest neighbor (KNN) and decision tree (DT) were used. WEKA 3.9.2 open-source software was implemented for data analysis. Finally, according to the accuracy, sensitivity, specificity criteria and AUC-ROC Curve, the superior model was introduced.

Based on the WEKA results, 19 variables had the most impact on the mortality prediction of patients admitted to ICUs including Glasgow Coma Scale (GCS), mechanical ventilation, surgical service at ICUs admission, gender, temperature, serum creatinine, diabetes, Blood urea nitrogen (BUN), age, addiction, International Normalized Ratio (INR), PH, Partial Thromboplastin Time (PTT), albumin, hemoglobin, glucose, pulse rate, hematocrit (HCT), PO2.  Based on the created models, some rules have been extracted which can be used as a pattern to predict the probability of mortality. Although the AUC of the three models was acceptable (KNN 81.5%, ANN 77.5% and DT 74.3%), but the accuracy of decision tree J48 (74.2%) was higher.

The study indicated that in the KNN model, the rules derived from it can be effective in mortality prediction in patients admitted to ICUs.