PERSIAN traffic safety and health cohort: a population-based precrash cohort study

PURPOSE

Despite to high burden of road traffic injuries (RTIs), the RTI epidemiology has received less attention with rare investments on robust population cohorts. The PERSIAN Traffic Safety and Health Cohort (PTSHC) was designed to assess the potential causal relationships between human factors and RTI mortality, injuries, severity of the injury, hospitalised injury, violation of traffic law as well as offer the strongest scientific evidence.

PARTICIPANTS

The precrash cohort study is carried out in four cities of Tabriz, Jolfa, Shabestar and Osku in East Azerbaijan province located in northwest Iran. The participants were people who sampled among the general population. The cluster sampling method was used to enrol the households in this study. The PTSHC encompasses a wide and comprehensive range and types of data. These include not only the common cohort data collections such as medical examination measures, previous medical history, bio assays and behavioural assessments but also includes data obtained using advanced novel technologies, for example, electronic travel monitoring, driving simulation and neuro-psycho-physiologic laboratory assessments specifically developed for traffic health field.

FINDINGS TO DATE

A total of 7200 participants aged 14 years and above were enrolled at baseline, nearly half of them being men. The mean age of participants was 39.2 (SD=19.9) years. The majority of participants (55.4%) belonged to the age group of 30-56 years. Currently, approximately 1 200 000 person-measurements have been collected.

FUTURE PLANS

PSTHC will be used to determine the human-related risk factors by adjusting for the vehicle and land-use-related factors. Therefore, a lot of crashes can be prevented using effective interventions. Although this cohort provides valuable data, it is planned to increase its size to achieve the highest level of evidence with higher generalisability. Also, according to the national agreement this cohort is going to be extended to several geographical regions in second decade.

Suppression of E6 Oncogene Induces Apoptosis in CaSki Cervical Cancer Cells

OBJECTIVE

The most important casuse of cervical cancer incidence and high mortality rate is infection to the human papillomavirus (HPV). The aim of the present study was to investigate the effect of silencing HPV E6 oncogene on cervical cancer cells using specific siRNAs.

MATERIALS AND METHODS

CaSki cervical cancer cells, carrying E6 gene, were cultured and then transfected with E6 targeting siRNAs. The cell viability through suppression of E6 expression was explored using MTT assay. Besides, apoptosis induction was investigated by means of flow cytometry using Annexin / PI staining. The changes in the expression of target genes were examined via  Real-Time PCR.

RESULTS

E6 gene silencing caused a significant decrease in the survival rate of CaSki cells through remarkable enhancement of apoptosis induction. Moreover, E6 suppression led to significant upregulation of P53, Bax, Caspase-3, and Caspase-9 mRNA expression while downregulated Bcl-2 expression. Interestingly, it was found that suppression of E6 expression could lead to upregulation of  E5 and E7 expression as a compensatory mechanism for E6 deactivation.

CONCLUSION

According to the results of this study, suppression of E6 expression using specific siRNAs could be considered as a therapeutic approach for cervical cancer.

Survival and prognostic factors among hospitalized pancreatic cancer patients in northwestern Iran

Background

Pancreatic cancer (PC) is associated with a poor prognosis, with various modifiable risk factors affecting the survival of patients. Our aim was to evaluate the survival rate and the prognostic factors influencing survival in PC patients in northwestern Iran.

Materials and Methods

All the PC patients admitted to the Imam Reza Hospital of Tabriz, Iran, from 2016 to 2020, were enrolled in this study. The survival rate and time were calculated, and the risk factors related to survival were evaluated by Cox regressions. The data were analyzed using the Cox proportional hazards model using STATA software.

Results

Of 110 patients, 12-, 24-, 36-, and 48-month survival rates were 29.1%, 19.8%, 14.1%, and 8.5%, respectively, with the median survival time of seven months. The mean age was 65.5 years. The results showed that a higher age (hazard ratio [HR] [95% confidence interval (CI)] = 2.04 [1.20-3.46]), lower education (1.72 [1.03-2.89]), delayed diagnosis (1.03 [1.02-1.05]), hypertension (1.53 [1.01-2.31]), concomitant heart disorders (2.67 [1.50-4.74]), COPD (4.23 [1.01-17.69]), consanguineous marriage (1.59 [1.01-2.50]), and the presence of icterus complications (adjusted HR = 3.64 [1.56-8.49]) were directly associated with a worse survival. On the contrary, radiotherapy (0.10 [0.01-0.85]), chemotherapy (0.57 [0.36-0.89]), and surgical therapy (AHR = 0.48 [0.23-0.99]) were directly related to a good prognosis.

Conclusion

Surgery, chemotherapy, and radiotherapy were the best predictors of survival in PC patients. Moreover, it seems that resolving jaundice can improve survival in these patients. It seems that increasing social awareness, treating underlying diseases, and employing an appropriate therapeutic method may promise a better outlook, improve the survival rate of patients, and reduce PC risk.

Spontaneous pneumomediastinum, pneumothorax and subcutaneous emphysema in critically ill COVID-19 patients: A systematic review

Objectives:

COVID-19 patients develop Life-threatening complications like pneumomediastinum/pneumothorax and emphysema which might experience prolonged hospital stays and additional costs might be imposed on the patient and the health system. The clinical features and outcomes of mechanically ventilated patients with COVID-19 infection who develop a pneumothorax, pneumomediastinum and subcutaneous emphysema has not been rigorously described or compared to those who do not develop these complications. So a systematic review of studies conducted on this subject was carried out to better manage these complications by investigating the underlying factors in COVID-19 patients.

Methods:

The search was conducted between early January and late December 2020 in databases including PubMed, Scopus, ProQuest, Embase, Cochrane Library, and Web of Science, using the following keywords and their combinations: COVID-19 Complication, Pneumothorax, Pneumomediastinum, Pneumopericardium, and Subcutaneous Emphysema. The extracted studies were screened separately by two researchers based on the PRISMA statement. After eliminating the duplicate studies, the title, abstract, and full text of the remaining studies were reviewed. Disagreements in the screening and selection of the studies were resolved by consensus or through a third-party opinion.

Results:

A total of 793 articles were retrieved through the literature search, and 99 studies conducted on a total of 139 patients were finally included The patient mortality was found to have a significant relationship with positive pressure ventilation (P=0.0001). There was no significant relationship between the patients’ death and chest tube insertion (P=0.2) or between the interval of time from the onset of symptoms to the diagnosis of pneumothorax (P=0.7). The mean age was higher in the deceased cases, and the mean difference observed was statistically significant (P=0.001).

Conclusion:

With the expansion of our clinical understanding of COVID-19, recognition of the uncommon complications of COVID-19 especially pneumothorax is crucial. Although in our review we couldn’t find a causal relationship between COVID-19 and pneumothorax or association between pneumothorax and death, as it is limited by many variables such as included studies’ design, or incomplete outcome data especially more information about the associated risk factors, we recommend performing more well-designed studies to describe the pneumothoraxes’ incidence, risk factors, and outcomes in COVID-19 patients.

The outcomes of carpal tunnel decompression based on electro-diagnostic approaches and clinical symptoms in patients suffering from carpal tunnel syndrome (CTS)

Introduction:

The main objective of this study was to assess the outcomes of carpal tunnel release surgery based on the electro-diagnostic approaches and its clinical symptoms in patients who suffered from carpal tunnel syndrome (CTS).

Methods:

This was a prospective cross-sectional study that consisted 50 participants of 100 patients of which 22 of them were men, and 78 of them were female. All the participants were examined through their clinical symptoms including pain, by parentheses, and also using the Levine-Katz Questionnaire before and after the open surgical operation. Additionally, patients with electrophysiological (EP) disorders were evaluated using electromyography (EMG) and nerve conduction velocity (NCV) (EMG-NCV) tests. Then, the association of the findings and results of this study was analyzed and then compared together using a particular statistical analysis model before and after the surgical procedure.

Findings:

The data achieved from the present study demonstrated that a significant improvement in both sexes and age groups was observed, and there was no significant difference in the level of improvement based on age and gender. Moreover, there was a significant correlation between the improvement severity of clinical symptoms and the improvement of severity of muscle nerve disease and their functions.

Conclusion:

It was observed that the surgical procedure for the treatment of carpal tunnel syndrome, improves its clinical symptoms in patients tested with electrodiagnostic techniques. Moreover, diversity of age and sexual condition did not affect the results of the study.

Covid-19 in kidney transplant recipients with immunosuppressive therapy

BACKGROUND

Since the outbreak of COVID-19, various treatments have been frequently reported for patients infected with this virus, especially in transplant patients/recipients. Objective: Investigating of kidney transplant patients under immunosuppressive therapy infected with COVID-19 can pave the way to understanding, handling, and treatment of COVID-19.

METHODS

We had a brief review of the literature on immunosuppressive therapy in kidney transplants infected with COVID-19. This was based on the PubMed Database with keywords "kidney, transplant, COVID-19, and immunosuppress" after hospitalization of kidney transplantation infected with COVID-19. He had already been recorded in the Organ Transplant Registry (ID≠ 64510) of Tabriz University of Medical Sciences /Iran.

RESULTS

We reported the clinical course of a 45-year-old man with a history of kidney transplantation and immunotherapy who was infected with COVID-19 with respiratory infections and positive RT-PCR (Real-time polymerase chain reaction). He was treated with hydroxychloroquine, Kaletra, CellCept, and prednisolone for 5 days, and finally discharged from the hospital. In addition, reviewing of 47 papers with 851 samples showed that immunosuppressant medications alone could be a therapeutic choice in kidney transplants infected with COVID-19 with careful management.

CONCLUSION

Patients with organ transplantation infected with COVID-19 may show different clinical signs, clinical course, and prognosis due to underlying diseases and the use of immunosuppressant medications. It might be best to continue taking the immunosuppressant medications but modify them based on the patients' conditions such as clinical symptoms, laboratory results, paraclinical examinations.

Clinical Efficacy of Hydroxychloroquine or Chloroquine in Patients with COVID-19: An Umbrella Review

Background Many of the known coronaviruses cause a wide range of respiratory infections in humans, and the novel coronavirus is no exception to this rule. Although no drug has yet been discovered to prevent or treat this disease, chloroquine (CQ) and hydroxychloroquine (HCQ) have been widely used in studies showing different results. Methods The present study is an umbrella study. The search was conducted for the articles published from January 2020 to November 2020 using the keywords ("COVID-19" OR "SARS-CoV-2" AND "Hydroxychloroquine" OR "Chloroquine" AND "Systematic Review" OR "Metanalysis"). This study was limited to human samples and systematic reviews with or without meta-analysis. The quality of the articles was also evaluated independently by two researchers. Results To evaluate the clinical efficacy of HCQ and CQ, a total of 176 papers and 643569 cases ranging from patients with mild pneumonia to intubated critically ill patients were evaluated. Finally, 8 studies were included. Conclusion There are conflicting results regarding HCQ or CQ efficacy and safety in the systematic reviews. More evidence is needed to confirm whether these drugs are useful in COVID-19 infection, and their usage as the standard care cannot be recommended based on the majority of the studies included in this umbrella review.

NR3C1 gene polymorphisms in adult patients with nephrotic syndrome

Introduction: Glucocorticoids therapy is a selective treatment strategy for cases with nephrotic syndrome (NS). Objectives: Due to the lack of positive response of all patients to therapy and the dependency of biological effects of glucocorticoids on its receptors (GR), here, the association of the NR3C1 gene (N363S, BclI, GR-9β, and ER22/23EK) polymorphisms with the response to glucocorticoids was investigated in patients with NS. Patients and Methods: In this study, 55 patients with primary NS including 29 steroid-responder (SS) and 26 steroid-resistant (SR) and also 30 healthy individuals were recruited. The polymorphisms of NR3C1 gene were studied by PCR and sequencing of the amplified fragments and the results were compared between the groups. Results: A3669 SNP was observed in 8.7% (n=2) of patients with SRNS and 6.3% (n=2) of responders (P=0.560). In 40.7% of steroid-responsive patients (n=11) and 21.4% of patients with SRNS (n=6), BclI polymorphism was detected that was not statistically significant (P=0.098). The N363S and ER22/23EK polymorphisms were not detected in the studied groups. No significant differences were observed between the frequency of the studied polymorphisms between the different subtypes of NS; focal and segmental glomerulosclerosis (FSGS), membranous glomerulonephritis (MGN), and control group. Conclusion: The NR3C1 gene N363S, BclI, GR-9β, and ER22/23EK polymorphisms do not affect the steroid responsiveness and the pathogenesis of NS in Azari adult patients with primary NS. Other polymorphisms within NR3C1 gene need to be explored in large cohorts.

Misconduct in research integrity: Assessment the quality of systematic reviews in Cochrane urological cancer review group

OBJECTIVE

Cochrane Library provides a powerful and authoritative database to aid medical decision making. We aimed to evaluate the quality of clinical trials and systematic reviews recorded in the Cochrane urology cancers group.

MATERIAL AND METHODS

This analytic cross-sectional study was conducted on 44 published systematic reviews of the Cochrane urology group which were published until May 2020. In the current study, we selected the urological cancer reviews. All types of biases in the understudied randomized controlled trials (RCTs) or quasi-RCTs of these systematic reviews were evaluated using the Cochrane appraisal checklist. We also separated and stratified the types of biases in the included studies. In addition, the quality of systematic reviews was assessed using the Joanna Briggs Institute (JBI) appraisal checklist.

RESULTS

A total of 44 systematic reviews and their understudied 340 RCTs were evaluated. On the basis of the JBI appraisal checklist results, 93.2% of systematic reviews had high quality. In terms of the quality of understudied RCTs in these reviews, the common prevalent risk of bias of the understudied RCTs or quasi- RCTs was unclear selection bias (allocation concealment and random sequence generation). The highest risk of bias was seen in the blinding of participants and personnel (performance bias).

CONCLUSION

Although most Cochrane urological cancer reviews had high quality, performance bias was the highest one in their understudied RCTs. Regarding it and considering the increasing unclear risk of detection, attrition, and reporting biases, it is obvious that they have structural deficiencies; therefore, it is recommended to observe integrity principles for preventing research misconduct.

Associations of TLR4 and IL-8 genes polymorphisms with age-related macular degeneration (AMD): a systematic review and meta-analysis

BACKGROUND

The results of different studies have indicated the possible associations of TLR4 and IL-8 genes polymorphisms with Age-related Macular Degeneration (AMD). A meta-analysis study was designed to evaluate the possible associations of TLR4 (rs4986790/c.896A>G and rs4986791/ c.1196 C > T) and IL-8 (rs4073/c.251A>T and rs2227306/c.781 C > T) genes polymorphisms with AMD.

METHOD

A systematic literature search was carried out in PubMed, Embase, Web of Science, and Scopus databases to identify relevant publications. Pooled Odds Ratio (OR) with 95% Confidence Interval (CI) was used to evaluate the power of association.

RESULTS

A total of 12 case-control studies with 4804 AMD patients and 4422 healthy controls were included in this meta-analysis. The analysis of genotypic and allelic models demonstrated significant associations between IL-8 c.781 C > T (CC vs. TT+TC: OR = 0.62 [0.48-0.81], P < .01; CC vs. TC: OR = 0.65 [0.48-0.89], P < .01; TT vs. CC: OR = 1.64 [1.04-2.57], P = .03; and C vs. T: OR = 0.71 [0.65-0.79], P < .01) and risk of AMD, which all of them passed Bonferroni correction for multiple testing (P-value≤0.01), except for TT vs. CC model. In addition, we found associations under the genotypic model of TLR4 c.896A>G (AA vs. AG+GG: OR = 0.73 [0.55-0.97], P = .03; and AA vs. AG: OR = 0.71 [0.53-0.95], P = .02) although after Bonferroni correction (P'-value<0.02) none of these associations remained significant. However, the data from this meta-analysis declined the associations of TLR4 c.1196 C > T and IL-8 c.251A>T polymorphisms with AMD.

CONCLUSION

The current meta-analysis study suggested that IL-8 c.781 C > T polymorphism is associated with susceptibility to AMD.

Management of COVID-19 in Liver Transplant Recipients With Immunosuppressant Therapy: Experiences of an Iranian Transplant Registry

OBJECTIVES

With the declaration of the COVID-19 pandemic and the increased COVID-19 risk shown in transplant recipients, the prevalence, clinical course, and outcomes of COVID-19 infections among liver transplant recipients were assessed.

MATERIALS AND METHODS

A questionnaire was designed and used to survey medical services for liver transplant recipients seen at our center in terms of COVID-19 infection.

RESULTS

Twenty-five patients infected with COVID-19 were identified from 265 liver transplant recipients. Most patients were male and had COVID-19 despite quarantine at home. All patients received modified immunosuppressive drugs during infection with COVID-19 with minor changes in routine immunosuppressive therapy. Among the identified patients, 21 recovered and 4 patients died. One of the dead patients, in addition to having a liver transplant, had brain cancer with metastasis to the lungs.

CONCLUSIONS

In liver transplant recipients infected with COVID-19, immunosuppressive drugs seemed to cause only mild to moderate illnesses or even helped them recover from the disease. However, more evidence is needed to prove this hypothesis. It is also recommended that transplant recipients should be warned about personal hygiene and be monitored closely by organ transplant centers.

The APC gene rs41115 polymorphism is associated with survival in Iranian colorectal cancer patients

Introduction: The onset of colorectal cancer is a complex process caused by numerous genetic pathways. APC functions as a ``"gatekeeper" and its mutations occur at the initiation stage of the colorectal tumorigenesis. The main aim of this study was to investigate common somatic mutations of exon 15 APC genes in patients with colorectal cancer in East Azerbaijan, Iran. Methods: This study was designed and performed as a cross-sectional and case-only study. Tissue biopsies were obtained during colonoscopy and confirmed colorectal carcinoma cases were evaluated. Two hotspot regions of exon 15 for APC mutations were evaluated using PCR amplification and Sanger sequence analysis. Results: The synonymous (p.Thr1475Thr) polymorphism was observed in all patients; 35 patients (61.4%) had AG genotype and 22 patients (38.6%) had AA genotype. Also, a missense mutation and two deletions were found. Pearson's correlation test showed a significant correlation between the stage of the disease (rho = 0.23, P =< 0.05), and anatomical subsite of the tumor with rs41115 polymorphism (rho = 0.31, P =< 0.05). Overall comparison of survival function in the different genotypes of the APC gene showed significant differences between groups, and CRCs with AG genotype had 3.24-fold higher hazard of mortality than CRCs with AA genotype (HR = 3.24; 95% CI: 1.21 - 8.68, P = 0.020). Conclusion: APC mutation plays an important predictive role in overall survival. However, the pattern and type of APC gene have a diverse impact on clinical outcomes in the Asian population. Moreover, in CRC patients the APC mutations were reported to be diverse variants.

Effectiveness of the educational interventions on improvement of the performance of burning ward nurses

Introduction — Burning is one of the most accidents with a higher rate of morbidity and mortality. The aim of this study was to investigate the status of nursing cares in the burning ward to improve the quality of nursing service following the education. Methods — An after-before intervention-educational audit study was conducted on burning ward nurses in Iran. The data were collected using a researcher-made checklist based on the Ministry of Health standards with “Yes/No” questions. The data were analyzed using SPSS software version.16 through descriptive statistics and Mc-Nemar nonparametric metric test. Results — The population consisted of 20 nurses working in the burning ward of the Sina Hospital in Tabriz/Iran. Presentation of nursing services was good in terms of the primary care (80.5%) and during hospitalization (83.4%); and it was weak in terms of the secondary care (42.5%). A significant improvement was observed following the educational intervention according to the results of the Mc-Nemar test performed before and after intervention (P<0.001). Conclusion — Audit education improved the nursing secondary cares and follow- up care after patients discharge. It is necessary to hold educational workshops for improving the nurses̓ performance in the other fields.

Exploring the association of IL-10 polymorphisms in Behcet's disease: a systematic review and meta-analysis

Background

Polymorphisms in the interleukin-10 (IL-10) gene have been studied in various ethnic groups for possible association with Behçet’s disease (BD). This study aimed to perform a meta-analysis of eligible studies to calculate the association of IL-10 polymorphisms with BD.

A systematic literature search was carried out in PubMed, Embase, Web of Science, and Scopus databases to identify relevant publications, and extracted the respective results. Pooled odds ratio (OR) with 95% confidence interval (CI) was used to evaluate the power of association with a random-effects model.

Results

A total of 19 articles, consisting of 10,626 patients and 13,592 controls were included in the meta-analysis. The meta-analysis revealed significant associations in allelic and genotypic test models of − 819 (C vs. T: OR = 0.691, P < 0.001; CC vs. TT: OR = 0.466, P < 0.001; CC + CT vs. TT: OR = 0.692, P < 0.001; and CC vs. CT + TT: OR = 0.557, P < 0.001), − 592 (C vs. A: OR = 0.779, P = 0.002; CC + AA vs. AA: OR = 0.713, P = 0.021; and CA vs. AA: OR = 0.716, P = 0.016), rs1518111 (G vs. A: OR = 0.738, P < 0.001; GG vs. AA: OR = 0.570, P < 0.001; GG + AG vs. AA: OR = 0.697, P < 0.001; GG vs. GA + AA: OR = 0.701, P < 0.001; and AG vs. GG: OR = 0.786, P = 0.004) and rs1554286 (C vs. T: OR = 0.582, P < 0.001; CC vs. TT: OR = 0.508, P < 0.001; CC + CT vs. TT: OR = 0.605, P < 0.001; CC vs. CT + TT: OR = 0.665, P = 0.012; and CT vs. TT: OR = 0.646, P = 0.001). However, we failed to find any association between − 1082 polymorphism and susceptibility of BD.

Conclusion

This meta-analysis demonstrated that the interleukin-10 -819, − 596, rs1518111 and rs1554286 polymorphisms could be responsible against BD susceptibility, and should probably be regarded as a protective factor for Behçet’s disease.

Mediterranean fever (MEFV) gene profile and a novel missense mutation (P313H) in Iranian Azari-Turkish patients

BACKGROUND

Familial Mediterranean fever (FMF) is common in Azari-Turkish people, one of the biggest ethnic groups in Iran. In this study, we sought to investigate the mutation spectrum of the MEFV gene and any genotype-phenotype correlations.

METHODS AND MATERIALS

400 unrelated Azari-Turkish FMF patients were analyzed in this study. Mutations in exons 2, 3, 5, and 10 of the MEFV gene were investigated using direct Sanger sequencing, and their correlations with the clinical features of the patients were analyzed.

RESULTS

At least one mutation was detected in 248 (62%) patients. The most common mutations were M694V (26.25%) and E148Q (24.75%), respectively. Abdominal pain (65.2%) and fever 204 (51%) were the most frequent clinical problems in all subjects. The analysis recognized a novel missense mutation in the coding region of the MEFV gene, named P313H, which is the first report of a new mutation in exon 2 of the MEFV gene in an Azari-Turkish family.

CONCLUSION

Genotype-phenotype correlations obtained from this study would be helpful in the diagnosis and management of FMF patients in clinical situations. This novel missense mutation may provide useful evidence for further studies of FMF pathogenesis.

Association of HLA-B27 and Behcet's disease: a systematic review and meta-analysis

Background

To calculate the genetic impact of the “HLA-B27” allele on the risk of Behcet’s disease (BD) progression using a systematic review and meta-analysis on case control papers.

Methods

A systematic review search was conducted on the MeSH keywords of Behcet’s disease, HLAB27 and B27 in PubMed, Scopus, ProQuest, EMBASE, SID, Magiran, IranDoc and IranMedex databases from 1975 to Aug 2017. Data underwent meta-analysis (random effect model) in CMA2 software. Pooled odds ratios with 95% confidence intervals were calculated for each study. The heterogeneity of the articles was measured using the I² index.

Results

Twenty two articles met the inclusion criteria for 3939 cases and 6077 controls. The pooled OR of “HLA-B27” in BD patients compared with controls was [1.55 (CI 95% 1.01–2.38), P = 0.04]. The OR differ among different countries or geographical areas, focus on domination the European countries. Quality of studies was moderate and heterogeneity was relatively high (I² = 66.9%).

Conclusions

There is a significant correlation between HLA-B27 and Behcet’s Disease, but it was weak. Environmental and genetic factors might determine which the “HLA-B27” alleles manifest Behcet’s disease progression. Future researches is required to perform about what factors can do to positively and separately influence Behcet’s disease.

Is fish oil supplementation effective on maternal serum FBS, oral glucose tolerance test, hemoglobin and hematocrit in low risk pregnant women? A triple-blind randomized controlled trial

Background

Fish oil contains polyunsaturated fatty acids including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) which were considered as essential fatty acids. The purpose of present study was to evaluate the effects of fish oil supplementation on maternal serum fasting blood sugar (FBS), oral glucose tolerance test (OGTT), hemoglobin (Hb), and hematocrit (Hct).

Methods

In this randomized triple-blind clinical trial, 150 pregnant women were allocated into two groups randomly. In the intervention group, women received one fish oil capsule daily (1,000 mg consisted of 120 mg DHA and 180 mg EPA), and control group received placebo from the end of twentieth week of pregnancy until delivery (140 capsules). FBS, 2-hour 75 g OGTT, Hb, and Hct were measured at 6–10 and 26–30 weeks of pregnancy. Analysis was based on intervention to treat.

Results

At the weeks 26–30, mean FBS in the intervention and control groups were 76.92 (9.8) and 75.64 (8.2) mg/dl, respectively [adjusted mean difference (aMD) (95% CI):1.46 (−2.13 to 5.05)]. Also, there was no significant difference between two groups in 2-hour OGTT [aMD (95% CI): −4.69 (−13.75 to 4.52)]. Mean (SD) Hb was 11.8 (1.1) versus 11.8 (0.7) g/dl in the intervention and control groups, respectively [aMD (95% CI): 0.001 (−0.328 to 0.330)], mean (SD) Hct were 36.12% (2.8%) and 35.84% (2.3%), respectively [aMD (95% CI): 0.25 (−0.65 to 1.14)].

Conclusions

Based on the findings of present study, fish oil supplementation has no significant effect on Hb, Hct, FBS and 2-hour OGTT of pregnant women.

Epstein-Barr Virus-Positive Diffuse Large B-Cell Lymphoma: Is It Different between Over and Under 50 Years of Age?

BACKGROUND

Epstein-Barr virus (EBV) positive diffuse large B-cell lymphoma (DLBCL) of the elderly is an entity introduced in the latest WHO classification of lymphoid tumors and defined in patients older than 50 years without prior lymphoma or immunodeficiency. However, recently it has also been seen in patients under 50. There is thus debate as to whether these are separate entities.

MATERIALS AND METHODS

In this retrospective study, we analyzed de novo DLBCL admitted to our institute over a period of two years. Clinical data included age, sex, nodal and extranodal presentation. The results of an immunohistochemistry (IHC) panel were also reviewed. IHC findings were mainly used to sub-classify DLBCL as germinal center vs. non germinal center types. IHC for identification of LMP-1 (latent membrane protein) and in situ hybridization for detection of EBV- encoded RNA (EBER) was performed. EBV prevalence, clinical data and IHC findings were compared between patients under and over 50 years of age.

RESULTS

Out of 95 DLBCL, 11.6% were EBV positive (7.5% and 14.5% in the young and old groups). We did not find any significant differences in IHC subclasses and clinical data between EBV positive DLBCL (EBV+DLBCL) of young and old groups.

CONCLUSIONS

EBV+DLBCL are not exclusive to patients older than 50 years. With regard to clinical data as well as IHC subclasses, no differences were evident between EBV+DLBCL of young and old groups. Our suggestion is to eliminate any cut off age for EBV+DLBCL.

Gender Differences in Clinical Presentations of Cystic Fibrosis Patients in Azeri Turkish Population

BACKGROUND

Cystic fibrosis (CF) is an autosomal recessive disorder with several clinical presentations. This study was undertaken in the Azeri Turkish population in Iran, to investigate gender differences in the age at onset and diagnosis, age of death, and duration of illness of CF.

METHODS

The data of 331 CF patients from 2001 to 2015 was surveyed. Parameters including age, sex, ΔF508 mutation, age at onset, age at diagnosis, age of death and clinical presentations were evaluated for both sexes, using descriptive analysis. The association of gender with these variables was studied using logistic regression, chi-square test and Mann-Whitney U test by SPSS version 18. Odds ratio with a confidence interval of 95% and p≤0.05 was considered statistically significant.

RESULTS

The study included 191 males (57.7%) and 140 females (42.3%), all showing statistically significant difference (p<0.001). Age duration differed between genders. Male and female patients were further under 9 and 4 years, respectively. The occurrence of ΔF508 mutation was 0.51 times more in females than in males. Age, diagnosis and sex were closely associated: males were diagnosed at a significantly later age than females (p=0.05). While this compression performed based on clinical presentations, males with respiratory disease had a later median age at diagnosis than females at lifespan (p=0.001). The risk of infertility in males was approximately two times greater than in females (p=0.02).

CONCLUSION

These findings indicate gender differences in CF patients. Future studies are needed to establish other differences and evaluate the causes for the gender variations.

Caustic Ingestion in Children: a Systematic Review and Meta-Analysis

Introduction: Caustic ingestion that occurs accidently is one of the most common problems in children. Methods: This systematic review has been performed by searching the databases including Science Direct, ProQuest, Google Scholar, and PubMed. A strategic search was performed with keywords including caustic, corrosive, ingestion, and children, and was limited to articles in English and Persian. Data were analyzed using Comprehensive Meta-Analysis2 and PASW Statistics 18. Results: We selected 64 articles regarding caustic ingestion with a total sample of 11,345 cases. The data analysis indicated a higher consumption in young boys (age range 2.78 (2.02) years (OR=0.53 with a 95% confidence interval of 0.49-0.57 (P=0.08)). The most common caustic substances were household cleaning agents, particularly bleaches and cleaners. Esophageal cancer and death were reported as well as digestive and respiratory complications. Invasive and expensive techniques are frequently used for diagnosis, treatment and follow up. Conclusion: The results demonstrated that although caustic ingestion is a serious problem among children, it is a preventable and manageable issue. Therefore, appropriate efforts by families, government, factories, health team and media should be made to handle adequately this matter.

Association Between Outcomes and Demographic Factors in an Azeri Turkish Population With Cystic Fibrosis: A Cross-Sectional Study in Iran From 2001 Through 2014

Background

Outcomesforcystic fibrosis patients are improving rapidly. The demographic factors are notable variables inoutcomes, which can be evaluated and modified.

Objectives

This study was designed to investigate the association between outcome and demographic factors in patients with cystic fibrosis.

Patients and Methods

This was a cross-sectional study and data were gathered for 331 patients using the census method, from March 2001 to September 2014 in Iran. Data was analyzed using logistic regression analysis, chi-square test, and independent sample t test using SPSS 18. Odds ratio with confidence intervals of 95% and P < 0.05 were considered significant.

Results

There were 85 (25.7%) deceased patients and 246 (74.3%) living patients at the time of the study. Of the 246 living CF patients, 202 (82.2%) were less than nine years of age, and 77 (90.6%) out of the 85 deceased CF patients had died younger than four years of age. There was a significant difference between outcome and location of residence. The risk of mortality was 50% less in urban patients than in rural patients (P = 0.03). The risk of mortality was approximately two times higher in patients with a positive family history than in those with a negative family history (P = 0.02). The proportion of mortality was approximately two times, or 94%, higher for those in a consanguineous marriage than for those in a non-consanguineous marriage (P = 0.01).

Conclusions

The results demonstrated that the mortality rate was higher in CF patients with a positive family history, a consanguineous marriage, and residence in a rural area. Therefore, demographic factors play an important role in the outcome of cystic fibrosis. Unfortunately, these parameters, which can be managed easily and with low cost, have been overlooked.

Intercontinental comparison of caustic ingestion in children

Purpose

To investigate the caustic ingestion in children among different continents according to demographic characteristics (core purpose), main symptoms, common caustic agents, signs and symptoms, management, treatment and complications.

Methods

This systematic review was performed by searching the databases Science Direct, ProQuest, Google Scholar, and PubMed, electronically and manually. We included studies that were published from 1980 to 2013, at University of Medical Sciences of Tabriz, Iran. A strategic search was performed with keywords including caustic, corrosive, ingestion and children, and was limited to articles in English and Persian. Statistical analysis was performed by SPSS ver. 18.

Results

Of 63 selected articles of caustic ingestion with 9,888 samples, the proportion of Africa was 3 articles (4.8%) and 95 samples (1%), America 9 articles (14.3%) and 305 sample (3%), Asia 29 articles (46%) and 2,780 samples (28.1%), Europe 17 articles (27%) and 3,002 samples (30.4%), and Oceania 5 articles (7.9%) and 3,706 samples (37.5%). The average age was in the Africa 3.07±2.02 years, America 3.17±1.83 years, Asia 3.34±1.58 years, Europe 3.58±2.09 years and Oceania 3.52±2.02 years. Sex distribution was in Africa 76 males (0.91%) and 19 females (0.23%), America 49 males (0.58%) and 41 females (0.49%), Asia 1,575 males (18.76%) and 1,087 females (12.95%), Europe 1,018 males (12.13%) and 823 females (9.8%), and Oceania 1,918 males (22.85%) and 1,788 females (21.3%). Statistical analysis of the data indicated higher consumption in Europe and Oceania in the boys with higher average age of years.

Conclusion

The comparison of caustic ingestion indicated that the cause substances of caustic ingestion in children are different among continents, therefore prevention strategy and different treatment guidelines among continents will be needed.

First case report of Rett syndrome in the Azeri Turkish population and brief review of the literature

Rett syndrome is a dominant X-linked male-lethal disorder largely caused by mutations in the gene encoding methyl-CpG binding protein 2 (MECP2). Clinical manifestations include neurodevelopmental disorder characterized by early-onset intractable seizures, severe developmental delay, intellectual disability, and abnormal electroencephalograms. Afflicted females show normal development until the age of 6 to 18 months, followed by gradual loss of speech abilities, microcephaly, social impairment, ataxia, and stereotypic hand movements. We report a 7-year-old girl who was born of a nonconsanguineous marriage presenting with mental retardation and delayed development. Physical examination revealed loss of speech, repetitive hand-wringing movement, short stature (120 cm), strabismus, microcephaly, and autistic behavior. The diagnosis was confirmed by sequencing MECP2 gene with heterozygous mutation C385A in exon 2. The current study aimed to report the first case of Rett syndrome in the Azeri Turkish population.

Minimum data set for cystic fibrosis registry: a case study in iran

BACKGROUND

over the last 25 years several national registries of CF have been set up. Such systems can be very useful in providing an integrated resource for improving patient care and conducting research on the disease. Minimum Data Set is a common set of data items that should be used to collect and report data in the registry. The principal aim of this research was to determine minimum data set for the CF registry in north-west of Iran.

METHODS

data items collected by several selected registries of cystic fibrosis were studied and an initial set of data was selected by the researchers. A group of experts including epidemiologists, pediatricians, and CF specialists were asked to review the proposed data elements and score them based on their importance by using a nine-point Likert scale. The items scored as important or highly important by more than 50 % of the experts, were included in final list of minimum data set. Availability of data was evaluated through reviewing medical records of 144 patients hospitalized in Children Hospital located in Tabriz.

RESULTS

overall six classes of data (46 items) were identified in the selected registry systems for cystic fibrosis: patient demographics, administrative data, survival status, diagnostic procedures, genetic and clinical manifestations, and therapeutics. Thirty two data elements from all six categories of data were approved by the experts as the minimum data set for cystic fibrosis registry system. Availability of data in administrative category and survival class was 100 percent. Collecting data on medications was feasible in 100% of the cases as well. In class of demographic data, accessibility of patient name, age, gender, place of birth, and date of birth was 100 percent. In group of diagnostic procedures, partial availability of data was found for sweat test and genetic test. No data was found on the antenatal screening, exercise tolerance test, and glucose tolerance test.

CONCLUSION

this work can be considered as a first step toward establishing CF registry system in Iran. Minimum data set can be also useful in designing electronic registry or electronic patient records for those suffering from CF toward integration of their fragmented records across continuum of the health care system in order to improve quality of shared patient care.