Evaluation of risk management status in selected departments of educational hospitals of Hamadan University of Medical Sciences

BACKGROUND

Healthcare organizations are among high-risk organizations due to the nature of their work as well as structural, physical and technological complexities. Accordingly, it is important to use risk management and control programs in all departments of these organizations.

OBJECTIVE

The present study was conducted for the first time to evaluate the risk management status of the operating room and laboratory departments of Hamadan hospitals in 2022.

METHODS

In this descriptive-observational cross-sectional study, laboratory and operating room departments were selected as the research environment. To conduct this research, a valid and reliable questionnaire was used to collect data, and the data were analyzed using SPSS 22 statistical software.

RESULTS

The findings of the present study showed that the overall mean score of risk management status for the laboratory and operating room departments was 2.66 ± 0.15 and 2.89 ± 0.13, respectively. Furthermore, there was no statistically significant difference in the mean scores of the research components based on work experience, education level, and gender.

CONCLUSION

It is suggested that the laboratory and operating room departments should focus more on adopting policies and solutions to improve the position of risk management, training and budget allocation for risk management.

Serum Trace Element Levels in Cancer Patients Undergoing Chemotherapy: a Before-After Analysis

Trace elements (TEs) play a crucial role in metabolism through their biochemical and catalytic effects, and alterations in their levels have been observed in various malignancies. Given that chemotherapy is a common treatment for cancer, it is important to understand how it may affect the levels of TEs in the body. By investigating changes in TEs levels before and after chemotherapy, this study aims to provide insights into the potential impact of chemotherapy on TEs levels in cancer patients. In the present study, analyses were performed on the serum level of some elements including Zn, Cu, Cd, and Se in 69 patients with leukemia, lymphoma, prostate and breast cancers before and after three courses of chemotherapy. The serum TEs were measured by atomic absorption spectroscopy. The serum Zn levels in patients with leukemia, lymphoma, and breast cancer significantly decreased after chemotherapy (P < 0.05). Significant reductions were also observed in the post-chemotherapy serum level of Cd in patients with prostate (P = 0.020) and breast cancer (P = 0.013). Moreover, the Se serum level significantly decreased after chemotherapy compared to before it in the breast cancer patients (P < 0.001). In contrast, the serum level of Cu was higher before than after chemotherapy in all the patients, but no significant difference was found (P > 0.05). The results show that chemotherapy can alter the level of TEs. The assessment of TEs in cancer patients may provide information about the side effects of chemotherapy as well as the use of appropriate strategies to better manage the clinical conditions of patients.

Radioprotective effect of Malva sylvestris L. against radiation-induced liver, kidney and intestine damages in rat: A histopathological study

Background

Ionizing radiation (IR) is widely used in the treatment of cancer in radiotherapy. One of the main concerns of patients with gastrointestinal cancers undergoing radiotherapy is the harmful side effects of IR on normal tissues. The liver, kidney, and duodenum are usually exposed to high doses of radiation in the treatment of some cancers in abdominal region radiotherapy. We aimed to assess the radioprotective effects of Malva sylvestris L. against IR damages to the abdominal region.

Materials and methods

This current study was conducted on 45 rats divided randomly into nine groups of five: A) negative control group, B) sham group, C) irradiation group, D) mallow treatment-1(200gr/kg), E) mallow treatment-2(400gr/kg), F) mallow treatment-3(600gr/kg), G) mallow treatment-4(200gr/kg) plus irradiation, H) mallow treatment-5(400gr/kg) plus irradiation, I) mallow treatment-6(600gr/kg) plus irradiation. Irradiation was performed with a 6Gy x-ray. Histopathological evaluations were performed 10 days after irradiation.

Results

The histopathological examination results confirmed that preventive therapy with the effective dose of mallow reduced the liver, kidney, and intestine damage induced by radiation. The dose of 400 mg/kg was more effective than other selected dose in improving the damage caused by irradiation in the studied tissues.

Conclusion

This study concludes that Malva sylvestris L. contributed to significant improvements in radiation-induced histological parameters of the liver and kidney and, to a lesser extent, in the intestine. These results collectively indicate that mallow is an effective radioprotective agent.

Survival analysis of coagulation disorders: A retrospective study with a 5-year follow-up

Objective

Rare bleeding disorders (RBDs) are the diseases in which patients experience a deficiency of coagulation factors. In the management of these disorders, surveillance is a significant challenge. This study aimed to assess the survival of patients with RBDs in a five-year follow-up.

Materials and methods

This descriptive cross-sectional study was conducted on 146 patients with RBDs who had referred to Be'sat Hospital of Hamadan, Iran from July 2017 to August 2022. A computerized record search was performed to identify the patients. The surveillance time for a five-year follow-up was assessed with the Kaplan-Meier curve. A log-rank test also served to compare the survival rates according to the type of factor.

Results

Out of 146 patients, 117 (80.2%) were males and 29 (19.8%) were females. They were in the range of 2-59 years of age with a mean of 23.11 ± 14.6. The most common disorder was FVIII deficiency (65.8%), and the rarest one was FXIII deficiency (4.8%). The rate of survival for any reason was 54.42 ± 1.3 months. The survival in combined FV and FVIII deficiencies was found to be longer than in the other deficiencies (55.9 ± 5.7), but there was no significant difference (P ≥ 0.05). In contrast, the survival in FXIII deficiency was observed to be lower than the other cases (44 ± 9.6); however, no significant difference was found in this regard (P ≥ 0.05).

Conclusion

The results of this study show that patients with RBDs have different rates of survival, which suggests that identifying high-risk patients may be helpful for the improvement of their survival time through timely therapeutic interventions.

Hospital mortality prediction in traumatic injuries patients: comparing different SMOTE-based machine learning algorithms

BACKGROUND

Trauma is one of the most critical public health issues worldwide, leading to death and disability and influencing all age groups. Therefore, there is great interest in models for predicting mortality in trauma patients admitted to the ICU. The main objective of the present study is to develop and evaluate SMOTE-based machine-learning tools for predicting hospital mortality in trauma patients with imbalanced data.

METHODS

This retrospective cohort study was conducted on 126 trauma patients admitted to an intensive care unit at Besat hospital in Hamadan Province, western Iran, from March 2020 to March 2021. Data were extracted from the medical information records of patients. According to the imbalanced property of the data, SMOTE techniques, namely SMOTE, Borderline-SMOTE1, Borderline-SMOTE2, SMOTE-NC, and SVM-SMOTE, were used for primary preprocessing. Then, the Decision Tree (DT), Random Forest (RF), Naive Bayes (NB), Artificial Neural Network (ANN), Support Vector Machine (SVM), and Extreme Gradient Boosting (XGBoost) methods were used to predict patients' hospital mortality with traumatic injuries. The performance of the methods used was evaluated by sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), accuracy, Area Under the Curve (AUC), Geometric Mean (G-means), F1 score, and P-value of McNemar's test.

RESULTS

Of the 126 patients admitted to an ICU, 117 (92.9%) survived and 9 (7.1%) died. The mean follow-up time from the date of trauma to the date of outcome was 3.98 ± 4.65 days. The performance of ML algorithms is not good with imbalanced data, whereas the performance of SMOTE-based ML algorithms is significantly improved. The mean area under the ROC curve (AUC) of all SMOTE-based models was more than 91%. F1-score and G-means before balancing the dataset were below 70% for all ML models except ANN. In contrast, F1-score and G-means for the balanced datasets reached more than 90% for all SMOTE-based models. Among all SMOTE-based ML methods, RF and ANN based on SMOTE and XGBoost based on SMOTE-NC achieved the highest value for all evaluation criteria.

CONCLUSIONS

This study has shown that SMOTE-based ML algorithms better predict outcomes in traumatic injuries than ML algorithms. They have the potential to assist ICU physicians in making clinical decisions.

Effects of Lifestyle and Environmental Factors on the Risk of Acute Myeloid Leukemia: Result of a Hospital-based Case-Control Study

Background: Acute myeloid leukemia (AML) is a common malignancy in adults. A vast variety of environmental and lifestyle factors play a role in AML incidence. This study aimed to assess the factors related to AML.

Study design: A case-control study.

Methods: This case-control study was performed on 137 AML cases during 2018-2021 at Beheshti Hospital in Hamadan, Iran, and 137 gender/age-matched controls. A questionnaire including 12 items was used to obtain information about lifestyle and environmental factors. A univariate and multiple variate logistic regression was used to estimate the odds ratios (OR), and a 95% confidence interval (CI) was used to investigate the relationship between the studied variables and the incidence of AML.

Results: Based on findings, 62 (45.3%) out of the 137 leukemic cases were male and 75 (4.7%) were females. A statistically significant increased risk for AML was found with regard to prior usage of cytotoxic agents (OR: 8.00, 95% CI: 1.01, 63.9, P=0.050), family history of malignancies (OR: 3.62, 95% CI: 1.65, 7.92, P=0.001), exposure to electrical power (OR: 3.22, 95% CI: 1.52, 6.81, P=0.002), and history of mental diseases (OR: 8.50, 95% CI: 3.64, 19.80, P=0.001). It was found that the AML incidence had no association with age, gender, radiation therapy, cigarette smoking, prior chemotherapy, congenital disorders, exposure to chemical agents, history of infectious mononucleosis, exercise, and blood transfusion (P>0.05).

Conclusion: The current results suggested that cytotoxic agents, family history of malignancy, mental disorders, and exposure to electrical power could play a role in AML incidence.

A concise review on factors influencing the hematopoietic stem cell transplantation main outcomes

BACKGROUND AND AIMS

As a curative procedure, hematopoietic stemcell transplantation (HSCT) is an approved treatment for many malignant orbenign hematologic and non-hematologic diseases. There are different outcomes of HSCT, as well as several parameters influencing these outcomes.

METHODS

We had searched scientific sources like Web ofScience and PubMed with a combination of keywords such as HSCT, engraftment,survival, outcomes, etc. Totally, 80 articles were included.

RESULTS

Here we have reviewed the effective factors onmain outcomes of HSCT including engraftment, survival, graft versus hostdisease, and Mobilization. Also, the prediction of hematological reconstitutionand some novel suggestions leading to better outcomes are reviewed.

CONCLUSION

The study will be applicable for improvedmanagement of autologous and allogeneic HSCT process to increase the procedureefficiency.

Antioxidative Effects of Nanocurcumin and Curcumin Against Aluminum Phosphide-induced Serum Oxidative Stress

Objectives: Aluminum phosphide (AIP) is the commonly used pesticide in agriculture, which induces oxidative stress in almost all major body systems and organs. The aim of this study was to evaluate the efficacy of nanocurcumin and curcumin on serum oxidative stress level in subacute toxicity with AIP. Materials and Methods: In this study 36 male Wistar rats (220-250 g) were randomly divided into six groups. Control (C) receiving normal saline; group AIPreceiving AIP (2 mg/kg daily); group Cur receiving curcumin (100 mg/kg daily); group Nano-cur receiving nanocurcumin (100 mg/kg daily); group AIP+ Cur receiving AIP (2 mg/kg daily) and curcumin (100 mg/kg daily); and group AIP and Nano-cur receiving AIP (2 mg/kg daily) and nanocurcumin (100 mg/kg daily). Serum total antioxidant capacity (TAC), lipid peroxidation (LPO), total thiol groups (TTG), and catalase (CAT) activity were measured. Results: AIP administration led to a significant increase in LPO, and decreased the CAT activity, TAC, and TTG compared to the control group (P<0.05). Curcumin and nanocurcumin caused a significant decrease in the levels of LPO compared to the AIP-exposed groups (P<0.05). Moreover, in the nanocurcumin-treated groups, compared to a poisoned group, TAC and TTG increased significantly (P<0.01). There were no significant changes in CAT activity improvement. Conclusion: Nanocurcumin and curcumin improved the AIP-induced oxidative damage.

Chemo/radiotherapy-Induced Bone Marrow Niche Alterations

Bone marrow (BM) niche is a specific microenvironment for hematopoietic stem cells (HSCs) as well as non-hematopoietic cells. Evidence shows that chemo/radiotherapy can lead to the disruption of different properties of HSCs such as proliferation, differentiation, localization, self-renewa, and steady-state of cell populations. Investigations have shown that the deregulation of balance within the marrow cavity due to chemo/radiotherapy could lead to bone loss, abnormal hematopoiesis, and enhanced differentiation potential of mesenchymal stem cells towards the adipogenic lineage. Therefore, understanding the underlying mechanisms of chemo/radiotherapy induced BM niche changes may lead to the application of appropriate therapeutic agents to prevent BM niche defects. Highlights Chemo/radiotherapy disrupts the steady-state of bone marrow niche cells and result in deregulation of normal balance of stromal cell populations. Chemo/radiotherapy agents play a significant role in reducing of bone formation as well as fat accumulation in the bone marrow niche. Targeting molecular pathways may lead to recovery of bone marrow niches after chemo/radiotherapy.

Mining of mortality-related findings in rare bleeding disorders: a retrospective study from two centers

BACKGROUND

Rare bleeding disorders include inherited coagulation disorders except for von Willebrand disease and hemophilia A and B. These disorders affect both men and women worldwide and mainly have an autosomal recessive pattern of inheritance. Given the paucity of cases of rare bleeding disorders, there are limited data regarding some topics among bleeding disorders.

METHODS

This retrospective study from 2005-2019 collected demographic data and the causes of death among cases with rare bleeding disorders from 2 provinces of Iran.

RESULTS

Overall, 5 deaths were reported, including 3 cases with factor V deficiency, a case with factor XIII deficiency, and a case with combined factor V and factor VIII deficiencies. The main causes of death were bleeding in the central nervous system (2 cases; 1 with factor V deficiency and 1 with combined factor XIII deficiency). Post-partum hemorrhage was the cause of death in a woman with factor V deficiency while anaphylaxis shock was the cause of death in the case with combined factor V and factor VIII deficiencies. A woman with factor V deficiency died from an internal bleeding episode.

CONCLUSION

Gathering data on the causes of death in rare bleeding disorders through worldwide registries can be helpful for the management of this rare group of bleeding disorders.

Association of long term exposure to outdoor volatile organic compounds (BTXS) with pro-inflammatory biomarkers and hematologic parameters in urban adults: A cross-sectional study in Tabriz, Iran

This study aimed to compare the hematologic variables and pro-inflammatory biomarkers in urban adults living in Tabriz, Iran, facing various levels of outdoor volatile organic compounds (VOCs). Of all 219 people (212 male and 7 female), 71 were from the low traffic area and 148 were from high traffic and industrial areas. To validate the exposure levels, 93 air samples were taken to determine the target VOCs (benzene, toluene, xylenes, and styrene collectively called BTXS) concentrations in the studied areas. ANOVA and Tukey's tests were used for statistical analysis. Based on the results, significant differences were observed between the mean concentrations of BTXS with the following order of abundance: industrial > high traffic > low traffic. The Considerable decrease was observed in red blood cells (RBCs), hemoglobin, hematocrit, and eosinophils of 0.324 ( × 10⁶/μL), 0.57 g/dL, 1.87%, and 0.17 ( × 10³/μL), respectively in industrial area participants as compared to the low traffic area. However, a significant increase was observed in white blood cell count (WBC), neutrophils number, neutrophils percent, TNF-α and INF-γ of 0.88 ( × 10³/μL), 0.80 ( × 10³/μL), 3.53%, 34.2 ng/mL, and 40.06 ng/mL, respectively in the same groups. The comparison of low and high traffic areas showed significant differences in RBC (p = 0.034), tumor necrosis factor alpha (TNF-α) (p < 0.001), and interferon gamma (INF-γ) (p < 0.001). On the contrary, no significant difference was observed in TNF-α and INF-γ among the high traffic and industrial areas. In conclusion, the results showed that the samples from high traffic and industrial areas were regularly exposed to higher values of BTXS due to traffic and industrial pollutants as compared to the samples residing in low traffic regions. Based on the results living in both high traffic and industrial regions can increase adverse effects on hematologic parameters and pro-inflammatory cytokines.

Risk of Acute Lymphoblastic Leukemia: Results of a Case-Control Study

Background: Acute lymphoblastic leukemia (ALL) is the most common malignancy in children. Different environmental factors might be effective in the occurrence of this malignancy during childhood. The aim of this study was to find environmental risk factors in childhood ALL in Hamadan, Iran. Methods: This case-control study was done in 2015-2018 on 125 children younger than 15 years of age suffering from ALL. Patients were matched with 130 controls with respect to age, gender, and residence location. The identification of risk factors for ALL was sought based on the comparison of studied variables between case and control individuals. Results: A statistically significant increased risk for ALL was found with regard to type of delivery (OR: 0.43, 95% CI: 0.20 - 0.92, p˂0.02), childcare (OR: 4.58, 95% CI: 0.95 - 22.20, p˂0.04), birth weight (OR: 1.44, 95% CI: 1.53 - 2.21, p˂0.006), father’s education level (OR: 2.67, 95% CI: 1.10 - 6.45, p˂0.02), and father’s job (OR: 0.2 95% CI: 0.08 - 0.51, p˂0.001). Also observed were increased odds for ALL regarding male gender, mother’s high education level, mother’s freelance job, and medium or high family income. No association with ALL incidence was observed for age, gender, breastfeeding, mother’s age at pregnancy, malignancy in first- or second-degree relatives, or mother’s use of hair dye during pregnancy (p> 0.05). Conclusion: This study showed that father’s education level, father’s job, delivery type, birth weight, and childcare can play a role in the incidence of childhood ALL.

Thrombocytopenia in solid tumors: Prognostic significance

Solid tumors are a heterogeneous group of malignancies that result from out-of-control proliferation of cells. Thrombocytopenia is a common complication among patients with solid tumors that predispose them to bleeding disorders. The aim of this review article is to investigate the underlying mechanisms of the risk and incidence of thrombocytopenia in solid tumors. It can be argued that thrombocytopenia is a poor prognostic factor in solid tumors that can result from several factors such as polymorphism and mutation in some transcription factors and cytokines involved in megakaryocytic maturation or from the adverse effects of treatment. Therefore, an understanding of the exact mechanism of thrombocytopenia pathogenesis in each stage of solid tumors can help in developing therapeutic strategies to decrease bleeding complications in these malignancies.

Antioxidant properties of Resveratrol on Acetaminophen induced toxicity in Wistar Rat liver and HepG2 Cells

Background: Although acetaminophen (APAP) is considered safe at therapeutic doses, intake of high amounts of this drug can cause liver failure. In the present experiment, we examined the hepatoprotective effects of resveratrol (RES) in HepG2 cells and rat liver. Objectives: This study aimed to evaluate the influence of RES on liver function in rat model of necrosis and HepG2 cells. Materials and Methods: In this study, rats were randomly assigned into 4 groups (7 rats in each group) as follows; group 1: control rats (received normal saline), group 2: hepatotoxic control (control rats that received 640 mg/kg/d APAP), group 3: positive control (received 150 mg/kg N-acetylcysteine), group 4: RES (received 30 mg/kg RES). The animals were treated for 7 days. Afterwards, the levels of liver enzymes, protein carbonyl content, glutathione (GSH) level, and Tumor necrosis factor (TNF-α) level were determined. Results: In the in vitro experiment, APAP-induced HepG2 cells were treated with RES at different concentrations and various factors such as cell viability, liver enzymes, GSH and TNF-α levels were measured. Conclusions: Our results indicated that RES could normalize all these factors in vitro and in vivo (P<0.05). In fact, RES had potential hepatoprotective effect against APAP -induced hepatotoxicity in HepG2 cells and animal models mainly via dual change of oxidative stress and cytokine levels.

Neuroprotective Effects of Transplanted Mesenchymal Stromal Cells-derived Human Umbilical Cord Blood Neural Progenitor Cells in EAE

Multiple Sclerosis (MS) is an autoimmune inflammatory demyelinating disease of the central nervous system. The aim of this study was to investigate the neuroprotective effects of transplanted human umbilical cord blood mesenchymal stromal cells (UCB-MSC) derived neural progenitor cell (MDNPC) in EAE, an experimental model of MS. To initiate neuronal differentiation of UCB-MSCs, the pre-induction medium was removed and replaced with induction media containing retinoic acid, b FGF, h EGF, NGF, IBMX and ascorbic acid for one week. The expression of neural genes was examined in comparison to control group by real-time PCR assay. Then, experimental autoimmune encephalitis (EAE) was induced using myelin oligodendrocyte glycoprotein (MOG, 35-55 peptides) in 24 C57BL/6 mice. After induction, the mice were divided in four groups (n=6) as follows: healthy, PBS, UCB-MSCs and MDNPC, respectively. At the end of the study, disease status in all the groups was analyzed using hematoxylin-eosin (H&E) staining of brain sections. We found that UCB-MSCs exhibit neuronal differentiation potential in vitro and transplanted MDNPC lowered clinical score and reduced CNS leukocyte infiltration compared to untreated mice. Our results showed that MDNPC from UCB may be a proper candidate for regenerative therapy in MS and other neurodegenerative diseases.

Improving the neuronal differentiation efficiency of umbilical cord blood-derived mesenchymal stem cells cultivated under appropriate conditions

OBJECTIVES

Umbilical cord blood-derived mesenchymal stromal cells (UCB-MSCs) are ideally suited for use in various cell-based therapies. We investigated a novel induction protocol (NIP) to improve the neuronal differentiation of human UCB-MSCs under appropriate conditions.

MATERIALS AND METHODS

This experimental study was performed in Iranian Blood Transfusion Organization (IBTO), Tehran, Iran. UCB-MSCs were cultured in DMEM medium supplemented with 10% FBS in a humidified incubator in equilibration with 5% CO2 at 37°C. For neuronal differentiation of UCB-MSCs, DMEM was removed and replaced with pre-induction medium containing RA, bFGF, EGF, and basal medium for two days. Then, NGF, IBMX, AsA, and Neurobasal medium were used for six days for this purpose. Real-time PCR was performed to analyze the neuronal differentiation of UCB-MSCs for the first time in Iran.

RESULTS

We found that the maximum and minimum levels of gene expression were related to GFAP and nestin, respectively. In addition, our study showed that compared to other neuronal inducers, RA might play the main role in neuronal differentiation and fate of MSCs compared to other neuronal inducers.

CONCLUSION

Our data showed that the combination of chemical (RA, IBMX, AsA) and growth factors (NGF, EGF, bFGF) in NIP may improve the efficiency of neuronal differentiation of UCB-MSCs and may provide a new method for easy and quick application of UCB-MSCs in regenerative medicine in the future. However, the functionality of neuron-like cells must be carefully assessed in animal experiments prior to use in clinical applications.