Journal of Kermanshah University of Medical Sciences
Volume:28 Issue: 4, Dec 2024

Cerebral vein thrombosis (CVT) is a rare yet critical condition characterized by blood clot formation within the cerebral venous system. While typically associated with various predisposing factors, such as prothrombotic disorders and hormonal contraceptives, its occurrence following spinal cord detethering surgery is exceptionally rare.

We present the case of a 26-year-old woman who developed CVT shortly after undergoing spinal cord detethering surgery for tethered spinal cord syndrome. Following surgery, the patient experienced persistent headaches, eventually leading to generalized tonic-clonic seizures. Imaging studies revealed evidence of hemorrhagic infarction caused by thrombosis. Prompt initiation of anticoagulation therapy resulted in successful resolution of the thrombus and complete recovery of the patient.

This case highlights the importance of considering CVT as a possible complication following spinal cord surgery, particularly in patients with underlying risk factors. Early recognition and appropriate management, including anticoagulant therapy, are crucial for favorable outcomes in these patients.

The measles, mumps, and rubella (MMR) vaccine is associated with known complications, such as salivary gland involvement and aseptic meningitis. Isolated reports of epididymal orchitis following MMR vaccination have also been reported, but no reported case of testicular torsion in infancy has been explicitly attributed to the MMR vaccine.

Here, we report an 18-month-old male infant presented with a history of gradually worsening painful left scrotal swelling following a booster dose of MMR that finally led to orchiectomy with the diagnosis of testicular torsion.

An 18-month-old male infant presented with a one-day history of gradually worsening painful left scrotal swelling following a booster dose of MMR. No evidence of blood flow was detected in the left testicle in color Doppler sonography, which was compatible with testicular torsion. In surgical exploration, the left testicle seemed firm and dark in color. The spermatic cord vessels were thrombotic in appearance, and the testicular appendix seemed completely necrotic. The nonviable left testicle was removed.

Although testicular torsion after MMR vaccination is rare, in the case of any pain, swelling, and redness of the scrotum, the patient should seek an urgent medical consultation. Physicians should be aware that testicular swelling after the MMR vaccine might not be just epididymal-orchitis but really a medical emergency.

Gram-negative bacteria are the most common infectious bacteria and are life-threatening in burn patients. Phage therapy studies can help the hospital community eliminate these bacterial pathogens.

This study aimed to evaluate the effects of the isolated bacteriophages from hospital wastewater against Gram-negative pathogenic bacteria and investigate their cytotoxicity on two human skin cell lines.

The bacterial strains were isolated from burn wound infections. Bacteriophages were isolated from the hospital wastewater treatment plant in Isfahan, Iran. Transmission electron microscopy, spot tests, and restriction enzyme digestion were considered for phage identification. Finally, the lactate dehydrogenase (LDH) and tetrazolium-based MTT assays were used to realize the cytotoxicity impacts of the isolated phages. The statistical analysis of cell viability was performed using a two-way analysis of variance (ANOVA).

The results showed that among the isolated strains, P. aeruginosa strain NEG_RA1300 (GenBank accession number: MW845642) was sensitive to the isolated phage VbɸPA-1. The TEM results showed a possible viral taxonomy of VbɸPA-1 based on its morphology, which belonged to the Myoviridae (T4-like phages). The MTT and LDH experiments showed no cytotoxicity of VbɸPA-1 on two tested cell lines.

Based on the results, the inhibitory effect of isolated phage on P. aeruginosa isolated from burn wounds with no toxic effect on cell lines was very significant. This phage can also be an acceptable selection against burn wound infections.

Malnutrition affects school-age children's health, growth, and academic performance. Adolescents often consume unhealthy fast foods and follow crash diets influenced by peers, media, and cultural norms. Adolescents with disabilities, including physical, intellectual, sensory, developmental, and mental health disabilities, may face additional challenges in accessing and maintaining a balanced and nutritious diet as they may face additional barriers. Understanding the unique needs and challenges faced by adolescents with disabilities is crucial in promoting their overall health and well-being.

The study aimed to compare the nutritional status of able and disabled adolescents in Government Vocational and Technical College and Niger State School of Special Education in Minna, as well as their food preferences, eating practices, and the factors affecting their nutritional status.

The study used a cross-sectional design, administering 400 questionnaires to disabled and able students. The responses were 100% collected using self-administered structured questionnaires. Data were analyzed, and results were presented utilizing tables and figures, with a statistical significance level set at P < 0.05. The IBM statistical product and service solutions (IBM SPSS statistics), version 27.0 software was employed for data analysis to explore and understand the food preferences, eating practices, and nutritional status of in-school adolescents with disabilities in Minna, Niger State, Nigeria. This approach allowed for a comprehensive assessment of the diverse factors influencing the dietary habits and nutritional well-being of adolescents with disabilities in the study.

The study involved 400 participants, with 12.8% aged over 12 years, 50.3% aged 12 - 15 years, and 37.0% above 15 years. Females made up 51.0% of the participants. About 40% of disabled participants had inadequate dietary patterns, compared to 10% of able participants. There was a significant difference in the distribution of BMI groups between the able and disabled subjects (x 2 = 26.984, df = 3, P = 0.000). Socio-demographic of the participants based on age and gender showed a significant association with the nutritional status of able adolescents at (χ 2 = 44.593, P = 0.000) and (χ 2 = 4.650, P = 0.031) respectively and among disabled at (χ 2 = 18.303, P = 0.000) and (χ 2 = 23.925, P = 0.000) respectively.

The study revealed disabled adolescents often skip meals, consume fast foods, and have poor dietary habits. Interventions like education and increased access to healthy food options are needed.

Rituximab (RTX) is a chimeric antibody that directly targets B cells, which has been suggested as a new treatment option for systemic lupus erythematosus (SLE) resistant to conventional treatments.

This retrospective study aimed to investigate RTX's effect on treating SLE patients with refractory manifestations.

This study was conducted on SLE patients who were resistant to treatment. The patients demographic characteristics and clinical information were collected from their medical records, and the results were compared before and after RTX therapy. Data were analyzed using SPSS software, and the significance level was less than 0.05 (P < 0.05).

Nephritis (26.3%), cutaneous manifestations (23.7%), and arthritis, occasionally secondary to overlap with rheumatoid arthritis (18.4%), were the most common complications that made patients (n = 55) candidates for the RTX biosimilar (Zytax). Ten patients were excluded due to a lack of complete data, and seven patients died immediately after starting Zytax due to disease severity and complications. Improvement in arthritis and cutaneous complications was reported after RTX injection in 57.1% and 44.4% of patients, respectively. Creatinine levels decreased significantly in patients with lupus nephritis after RTX injection compared to before treatment (P = 0.006). Moreover, anti-DNA was significantly different before and after RTX injection (Z = -2.89, P = 0.004). Comparison of C3 ( t = 0.63; P = 0.53) and C4 ( t = 1.72, P = 0.101) levels before and after RTX injection showed no significant differences.

Based on the results, RTX improved nephritis, arthritis, and cutaneous complications in lupus patients.

Developing nursing capacity worldwide includes training nurses to the doctorate level. Due to a global shortage of PhD nursing programs, many nurses are pursuing their doctorates abroad. International nurse students frequently face some barriers because of socio-cultural and other differences. As far as we are concerned, there is limited research on the barriers experienced by international nursing students.

This study aimed to explore the barriers to attending Zhengzhou University from the viewpoint of international nursing students in China.

The study employed a qualitative approach among international nursing students at Zhengzhou University, China. Participants were selected using purposeful sampling, and the sample size was determined by information saturation. A semi-structured interview guide and a conventional content analysis method were used.

In this study, ten international nursing students were interviewed. All participants expressed their concerns regarding the barriers experienced in China. Two major categories were identified from the student data: (1) situations outside the school/university (skin color, language, and socio-cultural differences); and (2) those inside the school/university (expectations and realities of learning experiences, supervisory concerns, and lack of support).

This study indicated that international nursing students experienced different barriers than international students at Zhengzhou University. A secure learning environment is required to adapt and flourish in an educational teaching society. The university/school should create a culturally competent and suitable environment for international nursing students.

Methylphenidate hydrochloride (MPH) is used as a first-line treatment for attention-deficit/hyperactivity disorder. Nonetheless, there are a few studies regarding the relationship between memory and hippocampal neuron changes following long-term MPH treatment.

This study aimed to investigate the effects of pathological changes on memory following long-term MPH treatment.

Forty rats were randomly and equally divided into four groups based on dosages. Animals underwent 0.6, 2.5 (low doses), or 10 (high dose) mg/kg MPH or saline (control) per day for 28 days. The Morris water maze (MWM) test was conducted at two time points: Two hours and four weeks after initiating MPH administration. The two-hour test evaluated single dose effects of MPH on memory, while the four-week test assessed long-term administration of MPH effects on memory performance. Finally, the brains were removed and pathological alterations in the cornu ammonis (CA1) and dentate gyrus (DG) regions of the hippocampus were investigated.

Single-dose administration of 10 mg/kg MPH decreased the latency time in the MWM test, while long-term administration of MPH increased the latency time. Furthermore, histopathology results showed that MPH at doses of 2.5 mg/kg and 10 mg/kg significantly increased the percentage of neurodegeneration in both the CA1 and DG regions compared to controls.

Our findings show that a high single dose of MPH improves memory in rats. However, long-term administration of high dose of MPH impaired memory; such impairment may be associated with the neurodegeneration in the pyramidal layer cell of the CA1 and the granular layer cell of the DG.

The pathogenesis of Severe SARS-CoV-2 is closely linked to severe immune responses and inflammation caused by the SARS-CoV-2 virus. In this context, the suppressor of cytokine signaling 1 (SOCS1) has a crucial role in inhibiting cytokine-induced immune responses. On the other hand, interleukin-29 (IL-29) and lysosomal trafficking regulator (LYST) are important molecules involved in inducing immune responses.

This study aimed to assess the mRNA levels of SOCS1, IL-29, and LYST in the SARS-CoV-2-infected patients with severe symptoms.

In this cross-sectional study, 70 SARS-CoV-2 infected patients with severe symptoms and 70 healthy controls were evaluated. RNA was extracted from peripheral blood and after cDNA synthesis, the mRNA levels of SOCS1, IL-29, and LYST were assessed by Real-Time PCR technique

The study revealed that severe COVID-19 patients exhibited a significant increase in mRNA levels of IL-29 compared to healthy individuals. However, there were no observed alterations in the mRNA levels of SOCS1 and LYST in the patient group.

The results emphasize the importance of IL-29 as a potential biomarker or therapeutic target for severe COVID-19 cases. Further research is needed to investigate the specific mechanisms through which IL-29 influences immune responses and contributes to the development of severe disease. Additionally, exploring other factors that may regulate SOCS1 and LYST expression could provide a more comprehensive understanding of their roles in COVID-19 pathogenesis.

Stroke is one of the most common causes of disability. Spasticity is a common clinical impairment that occurs after a stroke. Spasticity occurs due to changes in the mechanical properties of the muscle and the neural properties following a stroke.

This study aimed to investigate the effect of Nintendo Wii games on ankle spasticity outcomes in stroke patients.

In this parallel single-blind clinical trial study, 30 patients with stroke were randomly assigned to one of the experimental and control groups. The subjects of both groups received conventional physiotherapy, including stretching of ankle plantar flexor muscles and walking exercises on parallel bars. In addition, the experimental group also received Nintendo Wii games for 30 minutes three times a week for a total of 12 sessions. Clinical outcomes of spasticity and neural properties were evaluated using the Modified Modified Ashworth Scale and H-reflex latency and Hmax/Mmax ratio. All statistical analyses were performed using SPSS version 20.

The intragroup results showed that the clinical outcome of spasticity was significantly reduced in the experimental group (P = 0.001). The comparison between the two groups showed no statistically significant difference in clinical outcome and neural properties between the experimental and control groups (P > 0.05).

Based on the results, the clinical outcome of spasticity was significantly reduced after the end of the treatment in the Nintendo Wii group. The use of Nintendo Wii can be suggested as a treatment modality alongside the usual treatments to achieve greater and faster effectiveness in patients with stroke.

A tailored therapy for vitiligo is crucial in enhancing patients' quality of life and decreasing the associated dimensions. In addition, statins play a significant function in modulating the immune system.

This study investigated the efficacy of oral simvastatin in treating skin lesions in patients with vitiligo.

This interventional randomized clinical trial enrolled 50 vitiligo patients referred to Shahid Faghihi Hospital in Shiraz (Iran) in 2015. Participants were divided into control and intervention groups using block randomization. Participants in the control group received “NB-UVB phototherapy plus placebo,” and those in the intervention group received “NB-UVB phototherapy with 40, 60, and 80 mg simvastatin by a monthly increase in the drug dosage”. A reduction in the Vitiligo Area Scoring Index (VASI) score and side effects were measured for four months, and the results were compared between the two groups.

At the start of the study, the mean score for the disease severity was equal for both groups (P ˃ 0.05). However, the disease severity was significantly reduced in the following stages of the study in the simvastatin group compared to the placebo group (P = 0.0001).

Oral simvastatin enhances the photothermal outcomes while exerting trivial side effects. Thus, combining oral simvastatin with phototherapy is recommended as a potent strategy for treating patients with vitiligo.

Enterococci are clinically significant, especially in individuals with compromised immune systems, which are recognized as a critical contributor to nosocomial infections.

This study aimed to determine antibiotic susceptibility profiles and vancomycin-resistance Enterococcus (VRE) isolates in Zahedan, Iran.

A hospital-based cross-sectional study was conducted at Ali Ibne Abi Talib Hospital from March 2019 to February 2022. Clinical samples included urine, blood, abscesses and other body fluids from patients referred to this hospital during the study period. A total of 3000 patients were included in the study, and the Kirby-Bauer method was used to test isolates identified by morphological and biochemical characteristics for antibiotic susceptibility. Data were analyzed using SPSS software version 20. P-values < 0.05 were considered statistically significant.

Out of 3000 culture-positive clinical samples comprised of 82 urine, ten blood, one tracheal, two wound, and one pulmonary isolate, were identified as Enterococcus faecalis (69.1%), Enterococcus faecium (7.3%), and Enterococcus spp. (23.6%). Moreover, two-thirds of isolates were multidrug-resistant (MDR). Although 66.7% and 63.9% were sensitive to nitrofurantoin and linezolid, resistance to ciprofloxacin (74.2%) and ampicillin (65.9%) was frequently observed. Nitrofurantoin or linezolid were the only effective antibiotics for UTIs. In addition, 50% of isolates were resistant to vancomycin.

Based on the results, a combination of vancomycin/or linezolid and nitrofurantoin for urine infections was effective against Enterococci in this clinical center. Nevertheless, continuous and frequent surveillance for resistance patterns is necessary for the reasonable and evidence-based use of antibiotics.

Recently, retrobulbar injection of liposomal amphotericin B has been explored as an alternative treatment of rhino-orbital-cerebral mucormycosis.

This study aims to measure amphotericin B concentration in the periocular fat tissue following intravenous, retrobulbar, and combined intravenous and retrobulbar injections.

In this study, 45 rats were divided into 15 groups, receiving either intravenous, retrobulbar, or combined intravenous and retrobulbar injections. Three groups received the same dose of liposomal amphotericin B. Rats were sacrificed at 4-, 6-, and 24-hours post-injection and the periocular fat tissue was analyzed for amphotericin B concentration using HPLC.

Results showed that amphotericin B concentrations after intravenous injection of 10 mg/kg were 0.0001, 0.1154, and 0.0693 μg/mL at 4, 6, and 24 hours, respectively; for 15 mg/kg, the concentrations were 0.0339, 0.3534, and 0.4209 μg/mL. Retrobulbar injection resulted in concentrations of 8.8965, 9.8124, and 9.4156 μg/mL. Combined injections (10 mg/kg IV + 0.25 mg/kg retrobulbar) yielded concentrations of 8.8401, 7.8869, and 8.6409 μg/mL, while the combined 15 mg/kg IV + 0.25 mg/kg retrobulbar yielded 8.1940, 8.5277, and 9.0889 μg/mL.

The findings indicate that retrobulbar injection of liposomal amphotericin B achieves suitable drug concentrations in periocular tissue, suggesting that for rhino-orbital-cerebral mucormycosis, retrobulbar injection alone may be sufficient, potentially eliminating the need for intravenous administration.

Cesarean delivery is a standard surgical procedure in women. Thus, a practical, affordable, and low-risk anesthetic technique is essential for mother and infant safety. Spinal anesthesia is a popular and efficient technique for anesthesia during cesarean delivery. However, other local anesthesia drugs with negligible side effects should be considered. The most selective medication for this purpose is bupivacaine (marcaine), which creates optimal anesthesia at doses of 10 to 12 mg.

The most available medicine for spinal anesthesia during cesarean delivery is a 0.5% marine solution. However, ropivacaine for spinal anesthesia can occasionally be accessed as a long-acting amide local anesthetic agent used as an alternative to marcaine during the cesarean delivery. The ropivacaine's advantage over marcaine is its less neurotoxicity and cardiotoxicity, as well as the more stable hemodynamical condition of the patients. So far, no proper therapeutic dose of 0.5% isobaric ropivacaine has been proposed to be used during the cesarean delivery. Any increase in the dose may ensure the block performance, but, by contrast, some side effects may arise, including hypotension, bradycardia, vomiting, and nausea. Herewith, the likelihood of maximum block and most minor side effects was attempted to be assessed at the tiniest doses of this anesthetic agent.

This randomized clinical trial was conducted on C-section candidates. Patients were categorized into three groups receiving 22.5, 25, and 20 mg of the 0.5% isobaric ropivacaine solution. Systolic and diastolic blood pressure, heartbeats, the level of sensational and sympathetic nerve block, duration to reach the maximum motor block, the rate of vasopressors and atropine consumption, rate of vomiting and nausea, the rate of using supplementary drugs, block breakdown, and the patient's satisfaction with the anesthesia were measured and recorded. The collected data were analyzed using IBM SPSS Statistics.

No significant difference was found between demographic characteristics. Likewise, there was no significant difference in systolic and diastolic blood pressure, heartbeats, the level of sensational and sympathetic nerve block, duration to reach the maximum motor block, the rate of vasopressors and atropine consumption, rate of vomiting and nausea, and the rate of using supplementary drugs between the three groups. The most significant block breakdown and use of supplementary drugs were found in the first group (20 mg), with a significant difference between the three groups.

The three doses used did not result in meaningful differences between the three groups. However, the differences were significant for the block breakdown, with the higher block breakdown and supplementary drug use observed when using 20 mg of the 0.5 ropivacaine solution.