Journal of Research in Medical Sciences
Volume:26 Issue: 10, Nov 2021

Small‑for‑gestational‑age (SGA) is one of the most important conditions, which is associated with the risk of perinatal mortality and morbidity. The levels of pregnancy‑associated plasma protein A (PAPP‑A) and β‑human‑derived chorionic gonadotrophic (β‑hCG) in the first trimester can predict this adverse outcome, considering the controversial nature of studies in this area, this cohort study was conducted to investigate the role of PAPP‑A and free β‑hCG levels for predicting SGA.

In this cohort study, from 16 randomly selected health centers in Isfahan, Iran, 4605 volunteer pregnant women who had performed first‑trimester fetal anomalies screening tests were chosen based on the census, from July 2016 to June 2018. The multiples of the median (MoM) PAPP‑A <0.4 and MoMβ‑hCG >3 were considered as abnormal; the samples were followed up after childbirth. The biomarkers’ serum levels, relative risk, and odds ratio (OR) of SGA were compared in both SGA and appropriate for gestational age (AGA) groups.

In the SGA group, the mean of MOM PAPP‑A was significantly lower (0.96 vs. 1.1 with P = 0.001) and MoM βhCG was significantly higher (1.24 vs. 1.15 with P = 0.01) than the AGA group. Odds for SGA in subjects with MoM PAPP‑A <0.4 were 3.213; P = 0.001 and for subjects with MoM βhCG >3 reported as 0.683; P = 0.111.

The results of the study showed that the low levels of PAPP‑A would cause 3.213 times increase in the chance of developing SGA and no association between high level of βhCG >3 with SGA. Therefore, low level of the PAPP‑A is a warning indicator for SGA.

Postpartum pain contributes to increased irritability and excessive stress in the mother and consequently may inhibit successful breastfeeding, reduce a mother’s ability to take care of her baby, and cause an imperfect mother‑baby interaction. Evidence suggests the positive effect of ginger on reduction in uterus‑associated pain. The objective of this study is to investigate the effect of ginger capsules on postpartum pain.

The present double‑blinded, randomized, placebo‑controlled trial was conducted in Mahdiyeh Educational Hospital, Tehran. One hundred and twenty‑eight mothers having moderate‑to‑severe pain following vaginal delivery were included. The participants were divided into two groups (A and B). Interventions were performed every 8 h in 24 h. In the first intervention (2 h after the delivery), Group A received 500 mg of placebo capsules (containing chickpea flour) and Group B received 500 mg of Zintoma (ginger rhizome) capsules. In the second and third interventions, Group A received 250 mg placebo capsules and Group B received 250 mg Zintoma capsules. All participants received 250 mg capsules of mefenamic acid in each intervention in addition to ginger or placebo capsules. The pain severity was measured before and half an hour, an hour, and 2 h after each intervention. Statistical analysis was performed using the SPSS software version. 22. The Chi‑square, Fisher’s, and t tests and the GEE model were applied to assess the pain severity.

The average pain severity was not statistically significant between the groups in the beginning of the intervention ( P = 0.623). The mean score of pain significantly decreased within the duration of intervention in both groups (P < 0.001); however, the pain severity was significantly lower in the intervention group as compared to the control group at any point after the intervention (P = 0.006).

Ginger can be used as an effective remedy for postpartum pain relief.

Electroconvulsive therapy (ECT) is nowadays used commonly as one the most effective treatment methods in psychiatric disorders. In patients undergoing ECT, succinylcholine is usually used. In addition, cisatracurium is occasionally used on a case report basis globally. In this study, we compared the hemodynamic changes and serum potassium levels in the use of succinylcholine and cisatracurium in ECT.

The current crossover clinical trial was performed on 45 patients who were candidates for ECT between 2017 and 2018. The patients were given succinylcholine or cisatracurium randomly on two separate occasions of ECT. The independent t‑test and Chi square Test were used to compare the data.

Comparison of mean systolic blood pressure (P = 0.14), diastolic blood pressure (P = 0.33), and mean arterial pressure (P = 0.23) did not show any significant difference between the two groups. The induced seizure duration (P = 0.002), return of spontaneous respiratory from seizure ending (P = 0.001), and apnea duration (P = 0.01) were significantly higher in the cisatracurium group compared to the succinylcholine group. However, the frequency of tachycardia in cisatracurium group was lower than the succinylcholine group ( P < 0.001). In addition, the serum potassium level had a significant difference (P < 0.001) between the two groups.

Using cisatracurium can be an alternative to succinylcholine during ECT since it causes less elevation in serum potassium and creates a longer duration of induced seizure, more rapid re emergence of spontaneous breathing at the end of seizure (P = 0.001), and a lower prevalence of tachycardia compared to succinylcholine (P < 0.001)

Candidemia is a fatal invasive fungal infection that involves thousands of patients annually and is associated with high mortality rate and economic burden. The incidence of candidemia is increasing due to the use of invasive medical instruments and immunosuppressive drugs. The treatment of infection is problematic because of the increased resistance of clinical strains to antifungal drugs. The aim of the present study was to identify Candida species isolated from candidemia and determination of antifungal susceptibility patterns of clinical isolates.

Three thousand eight hundred BACTEC bottles suspected to candidemia were evaluated from April 2019 to June 2020. For primary identification, a positive blood culture was subcultured onto the sabouraud glucose agar and CHROMagar™ Candida. For molecular identification, ITS1‑5.8SrDNA‑ITS2 region was amplified by ITS1 and ITS4 primers andMspI restriction enzyme was applied to digest polymerase chain reaction amplicons. Minimum inhibitory concentration of seven antifungals was determined against clinical isolates by broth microdilution method in accordance with the Clinical and Laboratory Standards Institute M27‑A3 and M27‑S4 documents.

Forty‑six out of 3800 suspected specimens were positive for candidemia (1.2%). The age range of the patients was between 11 days and 89 years, with a median age of 34.8 years. Candida albicans was found to be the most Candida species (58.7%), followed by C. parapsilosis complex (19.6%), C. glabrata complex (8.7%), C. krusei (6.5%), C. famata (4.3%), and C. tropicalis (2.2%). Resistance to amphotericin B, fluconazole, itraconazole, and voriconazole was detected in 13.6%, 11.3%, 6.8%, and 4.5% of clinical isolates, respectively.

The incidence of non‑ albicans Candida species is increasing that must be highlighted. Since resistant Candida strains are found repeatedly, consecutive tracing of the species distribution and in vitro antifungal susceptibility of clinical isolates is recommended for better management of infections.

Melanoma is one of the most invasive cutaneous cancers with characteristics such as rapid progression and distant metastasis. The early diagnosis and staging of melanoma can help better manage the patients. The current study is aimed to assess the values of microRNA‑10b (miRNA‑10b) in the discrimination of metastatic melanomas.

The current cross‑sectional study has been conducted on forty patients diagnosed with melanoma since 2011. Cell culture of melanoma cell lines derived from the cancerous tissue, including WM115, BLM, K1735, WM793, and A375M, was cultured. In order to assess miRNA‑10b levels, the real‑time polymerase chain reaction was utilized. The absence ( n = 20)/presence (n = 20) of metastasis was diagnosed with chest computed tomography or chest X‑ray. The values of miRNA‑10b for the discrimination of metastasis incidence were assessed.

The demographic characteristics, including age and gender of the metastatic and nonmetastatic patients, were similar (P > 0.05). The specimen cultures were positive for miRNA‑10b in 14 (35%) of the metastatic cases versus 4 (20%) of the nonmetastatic ones (P = 0.004). The quantitative analysis of miR‑2b revealed significantly higher levels in metastatic cases (−1.59 ± 1.13 in metastatic vs. −0.16 ± 0.67 in nonmetastatic cases;P = 0.001). The measured area under the curve for the value of miRNA‑10b was 0.923 (P < 0.001; 95% confidence interval: 0.811–1) with sensitivity and specificity of 100% and 94.4%.

Based on this study, metastatic melanoma was associated with elevated levels of miRNA‑10b. This marker had the sensitivity and specificity of 100% and 94.4% for the discrimination of metastatic melanoma from nonmetastatic ones

Preoperative evaluation needs objective measurement of the risk of anastomotic leakage (AL). This study aimed to determine if cardiovascular disease, evaluated by abdominal aortic calcification (AAC), was associated with AL after colorectal anastomoses. We conducted a retrospective case–control study on patients who underwent colorectal anastomosis between 2012 and 2016 at Reims University Hospital (France). Abdominal aortic calcification was the main variable of measurement.

We reviewed all patients who had a left‑sided colocolic or a colorectal anastomosis, all patients with AL were cases; 2 controls, or 3 when possible, without AL were randomly selected and matched by operation type, pathology, and age. For multivariate analysis, 2 logistic regression models were tested, the first one used the calcification rate as a continuous variable and the second one used the calcification rate ≥ 5% as a qualitative variable.

Forty‑five cases and 116 controls were included. In univariate analysis, the calcification rate and the percentage of patients with a calcification rate ≥5% were significantly higher in cases than in control groups (4.4 ± 5.5% vs. 2.5 ± 5.2%, odds ratio [OR] =1.6 95% CI: 1.1–2.5; n = 22, 49% and n = 34.3 3%, OR = 2.8 95% CI: 1.2–6.2). In multivariate models, calcification rate as a continuous variable and calcification rate ≥5% as qualitative variable were independent significant risk factors for AL (respectively, aOR = 1.8; 95% CI: 1.1–3,P = 0.01; aOR = 3.2; 95% CI: 1.4–7.55, P < 0.01).

AAC ≥5% should alert on a higher risk of AL and should lead to discussion about the decision of performing an anastomosis.

Evaluation of insulin‑like growth factor‑1 (IGF‑1) association with retinopathy of prematurity (ROP) is our object.

This study was conducted on IGF‑1 levels of 40 neonates <34 weeks gestational age and 2000 g at 1st week
and 4–6 weeks after birth. All participants were evaluated for ROP after 31 weeks of gestation.

IGF‑1 levels showed a
significant difference between neonates ≤1500 and 1500–2000 g (1 and 4–6 weeks,P = 0.008, P = 0.039, respectively). No significant
association was found between IGF‑1 and ROP.

Finding a meaningful association between IGF‑1 and ROP requires
consideration of factors affecting the IGF‑1.

Due to widespread of coronavirus disease 2019 (COVID‑19) infection, identification of its risk factors and clinical characteristics are important. The aim of the present study was to assess Vitamin D levels in individuals with severe acute respiratory syndrome coronavirus‑19 infection and to report on its potential as a predictive marker.

All patients, diagnosed with COVID‑19 infection from February 16 to March 21, 2020, and referred to Firoozgar Hospital, Tehran, Iran, were enrolled in this study. Vitamin D analysis was undertaken on patient serum samples using a commercial kit (Pars Azmoon Co., Tehran, Iran). SPSS v. 22 was used for statistical analysis.

Vitamin D serum concentration was analyzed in a total of 317 patients whose mean age ± standard deviation was 62.05 ± 15 years and with 62.5% being male. A significant association of Vitamin D level and death was observed. Higher levels of serum Vitamin D had protection against death (odds ratio = 0.955 [95% confidence interval = 0.923–0.988], P = 0.008).

As a preliminary study in the Iranian population who suffered COVID‑19 disease, we identified that Vitamin D deficiency was associated with a higher death rate and intensive care unit admission.

In multisystem inflammatory syndrome in children (MIS‑C) temporarily associated with coronavirus disease‑19 (COVID‑19), myocardial damage has been reported.

A retrospective observational cohort study included children under 18 who had a myocardial injury related to COVID‑19 treated in mother and child health institute from April 2020 to August 2020. Myocardial injury related to COVID‑19 was manifested by elevated serum cardiac troponin and NT‑proBNP with LV dysfunction, arrhythmias, and coronary arteries (CAs) dilatation or aneurysms. During the short‑term follow‑up, cardiac testing (electrocardiography, laboratory analysis, echocardiography, 24‑h Holter monitoring, exercise stress test, and cardiac magnetic resonance) was performed.

Six male adolescents (14.7 ± 2.4 years) were included in the analysis (2/6 had MIS‑C shock syndrome). All patients had elevated acute‑phase reactants and NT‑proBNP, whereas troponins were elevated in 5/6 patients. Echocardiography revealed left ventricular (LV) systolic dysfunction (EF 45.2 ± 6.9%); 2/6 had dilated CAs. IVIG was prescribed to all patients with MIS‑C. Four patients required inotropic drug support. During hospitalization, a significant reduction of CRP, LDH, NT‑proBNP, and D‑dimer (P < 0.05) was registered. LV systolic function recovery was registered 3 days after applied therapy (P < 0.001). None of the patients developed dilated cardiomyopathy or CA aneurysms.

With early recognition and adequate MIS‑C therapy, children recovered entirely, maintained in the short‑term follow‑up period.

There is a growing need for information regarding the recent coronavirus disease of 2019 (COVID‑19). We present a comprehensive report of COVID‑19 patients in Iran.

One hundred hospitalized patients with COVID‑19 were studied. Data on potential source of exposure, demographic, clinical, and paraclinical features, therapy outcome, and postdischarge follow‑up were analyzed.

The median age of the patients was 58 years, and the majority of the patients (72.7%) were above 50 years of age. Fever was present in 45.2% of the patients on admission. The most common clinical symptoms were shortness of breath (74%) and cough (68%). Most patients had elevated C‑reactive protein (92.3%), elevated erythrocyte sedimentation rate (82.9%), and lymphocytopenia (74.2%) on admission. Lower lobes of the lung were most commonly involved, and ground‑glass opacity (81.8%) was the most frequent finding in computed tomography scans. The administration of hydroxychloroquine improved the clinical outcome of the patients. Lopinavir/ritonavir was efficacious at younger ages. Of the 70 discharged patients, 40% had symptom aggravation, 8.6% were readmitted to the hospital, and three patients (4.3%) died.

This report demonstrates a heterogeneous nature of clinical manifestations in patients affected with COVID19. The most common presenting symptoms are nonspecific, so attention should be made on broader testing, especially in age groups with the greatest risk and younger individuals who can serve as carriers of the disease. Hydroxychloroquine and lopinavir/ritonavir (in younger age group) can be potential treatment options. Finally, patients discharged from the hospital should be followed up because of potential symptom aggravation.

Inflammation plays a major role in coronavirus disease (COVID‑19). Factors that convey information about the status of inflammation could predict disease severity and help identify patients prone to clinical deterioration. Here, we aimed to evaluate the predictive value of inflammatory markers on the extent of lung involvement and survival of patients with COVID‑19.

Eighty patients with confirmed COVID‑19 were enrolled. Demographic, clinical, and laboratory data were collected at admission. All patients underwent chest computed tomography (CT); the extent of lung involvement was assessed by a scoring system. Patients were followed up until death or discharge occurred. Logistic regression analysis was performed to evaluate the association of investigated variables with COVID‑19‑related death. The association between different variables and CT score was assessed using linear regression model. Receiver operator characteristic curve analysis was applied to identify the predictive value of inflammatory markers and CT score on survival.

The mean age of patients was 54.2 ± 15.2 years; 65% were male. Increased neutrophil‑to‑lymphocyte ratio (β =0.69, odds ratio [OR] =1.50), platelet‑to‑lymphocyte ratio (β =0.019, OR = 1.01), and decreased lymphocyte to C‑reactive protein ratio (LCR) (β = −0.35, OR = 0.62) were significantly associated with a higher CT score and increased odds of death (P < 0.05). Lactate dehydrogenase level was also positively related with extensive lung involvement and death (β =1.15, OR = 1.52, P < 0.05). The LCR threshold for identifying survivors from nonsurvivors was 0.53 (area under curve [AUC] =0.82, 78% sensitivity and 74% specificity). Lung involvement ≥50% on chest CT was an excellent predictor of death (AUC = 0.83, 81% sensitivity and 79% specificity).

Daily‑performed laboratory tests that represent inflammation have great value for predicting the amount of disease burden and risk of mortality. Moreover, their cost‑effectiveness and feasibility turn them into ideal prognostic markers.

Significant lifestyle changes have been reported after COVID‑19 outbreak. The present study aimed at investigating changes in dietary habits in response to the COVID‑19 outbreak in an Iranian population sample.

In this cross‑sectional study, the dietary habits of Iranian adults were assessed before and during the COVID‑19 outbreak. Consumption of different food groups such as meats, dairy, fruits, vegetables, seeds, and nuts was assessed using a digital questionnaire which was shared on social media platforms. For the statistical analysis, the Wilcoxon signed‑rank test was used.

In this online survey, 1553 questionnaires were completed. The results showed that the reported consumption of protein‑rich foods increased (P < 0.05), but fish and dairy consumption showed a significant reduction (P = 0.006 and <0.001, respectively). There was a significant reduction in reported fast‑food consumption (P < 0.001). Fruits and vegetables (P < 0.001), natural fruit juices (P < 0.001), and water (P < 0.001) were consumed more frequently. Individuals also consumed more vitamin and mineral supplements ( P < 0.001) including those containing Vitamin D.

During the COVID‑19 pandemic, participants reported a significant change in their dietary habits and intake of supplements. Higher intakes of meats, protein‑rich foods, fruits, vegetables, and nutritional supplements and lower intakes of fish, dairy, and fast foods were reported.

Novel coronavirus disease of 2019 (COVID‑19) is the current pandemic causing massive morbidity and mortality worldwide. The gold standard diagnostic method in use is reverse transcription–polymerase chain reaction (RT‑PCR) which cannot be solely relied upon. Computed tomography (CT) scan is a method currently used for diagnosis of lung disease and can play a substantial role if proved helpful in COVID‑19 diagnosis. We conducted this study to evaluate the diagnostic value of CT scan compared to RT‑PCR in the diagnosis of COVID‑19.

We recruited 291 hospitalized patients suspicious of COVID‑19 according to typical clinical findings during February–March 2020. The patients underwent CT‑scan and RT‑PCR procedures on the day of hospital admission. CT scans were reported by two radiologists as typical, indeterminate, negative, and atypical. Statistical indices were calculated twice: once considering “typical” and “indeterminate” categories as positive and the other time counting “typical” results as positive.

The CT reports were classified as typical (64.95%), indeterminate (10.31%), atypical (11%), and negative (13.75%). Considering “typical” and “intermediate” as positive, sensitivity and specificity were 85.3% and 38.8%, respectively, and using the second assumption, the mentioned indices were 75.9% and 50.4%, respectively.

According to our study, CT results do not create enough diagnostic benefit and could result in incorrect confidence if negative. Since widely available, CT integration in the clinical process may be helpful in screening of suspected patients in epidemics. Yet, suspected patients should be isolated till confirmed by (multiple) PCRs.

We aimed to investigate the relationship between hemoglobin A1c (HbA1c) and coronary thrombus load in type‑2 diabetes mellitus (T2DM) patients with non‑ST segment elevation myocardial infarction (NSTEMI).

Ninety diabetic patients with NSTEMI were recruited for the study. They were separated into two groups according to HbA1c levels. Forty‑seven patients having HbA1c ≤6.5% formed Group‑I (35 male, mean age 58 ± 10.5 years) and the remaining 43 patients with HbA1c >6.5% formed Group‑II (23 male, mean age 58 ± 11.1 years). Both the groups were evaluated in terms of thrombolysis in myocardial infarction (TIMI) thrombus score and Syntax score.

Baseline patient characteristics were comparable in both the groups. TIMI thrombus score and Syntax score were higher in Group II than in Group I (3.2 ± 1.4 vs. 4.7 ± 0.5 and 20.2 ± 3.4 vs. 26.3 ± 3.0 respectively, P < 0.05). No significant difference was found in other parameters. In stepwise linear regression analysis, prepercutaneous coronary intervention (PCI) and post‑PCI TIMI frame number and HbA1c were significantly related to the coronary thrombus scale. However, no significant relationship has been found between thrombus formation and hypertension, previous PCI history, pre‑PCI heart rate, pre‑PCI cholesterol status, and high‑sensitive troponin T.

In NSTEMI with T2DM, increased HbA1c (HbA1c >6.5%) is related with coronary thrombus in the target vessel. In those patient population, strict anticoagulation should be considered to prevent potential adverse events.