COVID-19 vaccines breakthrough infection and adverse reactions in medical students: a nationwide survey in Iran.

Introduction: There are different types of COVID-19 vaccines approved worldwide. Since no national studies focus on vaccine-related adverse reactions and breakthrough cases, this study aimed to investigate the rate of adverse events and COVID-19 infection in medical students in Iran. Methods: This retrospective cohort study included Iranian medical students who received two doses of COVID-19 vaccines. The medical team gathered the demographic characteristics, comorbidities, type of vaccine, adverse events following vaccination, and history of COVID-19 infection data through a phone interview. The frequency of adverse events and breakthrough infection was stratified by vaccine type (ChAdOx1-S, Gam-COVID-Vac, and BIBP-CorV). Results: A total of 3,591 medical students enrolled in this study, of which 57.02% were females, with a mean age of 23.31 + 4.87. A PCR-confirmed and suspicious-for-COVID-19 breakthrough infection rate of 4.51 and 7.02% was detected, respectively. There was no significant relation between breakthrough infection and gender, BMI, blood groups, and comorbidities. However, there was a significant difference in breakthrough infection rate among different types of vaccines (p = 0.001) and history of COVID-19 infection (p = 0.001). A total of 16 participants were hospitalized due to COVID-19 infection after vaccination for reasons such as dyspnea, abnormal imaging, or decreased oxygen saturation. No severe infection or death was observed in the studied population. Conclusion: Vaccination prevented severe COVID-19 infection, although a high breakthrough infection rate was evident among Iranian medical students during the Delta variant's peak. Vaccine effectiveness may be fragile during emerging new variants and in high-exposure settings. Moreover, adverse events are rare, and the benefits of vaccination outweigh the side effects. However, many limitations challenged this study, and the results should be cautious.

Ultrasound shear-wave elastography applicability in estimation of post-mortem time.

Introduction: Post-mortem rigidity of the tissues is one of the basic principles in forensic medicine to estimate the time of death. Qualitative methods to determine the stiffness of the corpse may have some limitations. Methods that provide quantitative values may be useful. We intended to evaluate the applicability of ultrasound shear-wave elastography of the tissues to estimate the post-mortem interval (PMI). Methods: For 80 corpses, shear-wave elastography of the liver, sartorius muscle, testis, thyroid and parotid was performed before autopsy. Based on the forensic reports as the reference method to define post-mortem interval, the corpses were divided into four groups: group 0 (PMI < 24 hours), group 1 (PMI ≥24 hours and <48 hours), group 2 (PMI ≥ 48 hours and <72 hours), and group 3 (PMI ≥ 72 hours). There were 24, 38, 13, and 5 corpses, respectively, in groups 0, 1, 2, and 3. Results: A significant rise in the elasticity values in comparison to elasticity of normal tissues in live adults was seen very early in the post-mortem period. Between-group comparisons showed that a significant difference in the liver elasticity was present among the groups. The mean (SD) liver elasticity was 10.29 (±0.83) in group 0, 14.98 (±1.56) in group 1, 12.49 (±1.09) in group 2, and 15.64 (±1.68) kilopascals (kPa) in group 3 (P = 0.035). Nevertheless, elasticity measurements in other tissues were not helpful in distinguishing post-mortem interval groups. Conclusion: It is possible to use liver quantitative shear-wave elastography to estimate the time of death.

An Investigation of Post-radiation Gene Expression Profiles: A System Biology Study.

Introduction: Genomics and bioinformatics are useful methods for exploring unclear aspects of radiation effects on biological systems. Many radiation-induced alterations in irradiated samples are post-radiation time-dependent. This study aims to evaluate the post-irradiation effects of the gamma ray on human Jurkat cells. Methods: Gene expression profiles of the samples harvested 6 and 24 hours after radiation to find the critical differential expressed genes and the related pathways. Samples are provided from Gene Expression Omnibus (GEO) and analyzed by ClueGO. Results: Twnety-nine critical genes were determined as the important affected genes and 7 classes of related pathways were introduced. CCNE2, PSMD11, CDC25C, ANAPC1, PLK1, AURKA, and CCNB1 that were associated with more than 6 pathways were related to one of the determined pathway groups. Conclusion: Cell protecting pathways were associated with the genes (HSPA5, HSPA8, HSP90B1, HMMR, CEBPB, RXRA, and PSMD11) which were related to the minimum numbers of pathways. The finding of this study corresponds to repair processes which depend on post-radiation time. It seems these sets of genes are suitable candidates for further investigation.

Introducing GATA3 as a prominent player in Crohn's disease.

AIM: This study was aimed at gene assessment of Crohn's disease (CD) through protein-protein interaction (PPI) network analysis to find crucial genes. BACKGROUND: CD is a major subtype of inflammatory bowel diseases (IBD), which affects gastrointestinal tract. PPI network analysis is a suitable tool to clarify a critical gene as a drug target or diagnostic biomarker for these types of diseases. METHODS: Gene expression profile GSE126124 of 20 CD patients and 20 healthy controls was obtained from the Gene Expression Omnibus (GEO) database. RNA profile of peripheral blood mononuclear cells (PBMCs) and colon biopsy samples of the studied groups was investigated. Crucial genes were selected and analyzed via the PPI network by Cytoscape software. Gene ontology enrichment for the hubs, bottlenecks, and hub-bottlenecks was performed via CluGO plugin of Cytoscape software. RESULTS: Eighty-one differentially expressed genes (DEGs) among 250 initial DEGs were highlighted as significant by FC>2 and p-value ≤ 0.05, and 69 significant DEGs were used for PPI network construction. The network was characterized by poor connections, so 20 top neighbors were added to form a scale-free network. The main connected component included 39 query DEGs and 20 added first neighbors. Three clusters of biological processes associated with crucial genes were identified and discussed. CONCLUSION: The results of this study indicated that GATA3 has a key role in CD pathogenesis and could be a possible drug target or diagnostic biomarker for Crohn's disease.

Perceived social support and self-esteem in sexual violence victims.

Background: Sexual violence can lead to serious consequences. Few studies have simultaneously evaluated Perceived Social Support and Self-Esteem of sexual violence victims. This study aims to investigate the relationship between self-esteem and perceived social support among sexual violence victims. Methods: This study was a cross-sectional study which was conducted in forensic medical centers and all health centers affiliated to Shahid Beheshti University of Medical Sciences of Tehran. This study included 66 women in the sexual violence group (Women were considered sexual violence victims if vaginal or anal penetration had occurred) and 147 subjects in the non- sexual violence group (Women with no experience of sexual violence). Rosenberg Self-esteem Scale and Social support Multidimensional Scale of Perceived Social Support were used. Data were analyzed using IBM SPSS statistical software version 22. The significance level for all tests was considered as p<0.05. Results: There were significant differences in the levels of perceived social support in all subscales between the two groups and it was higher in non-sexual violence group (p<0.001). There was no statistically significant difference in the self-esteem level between the two groups. There was a minor significant positive correlation between self-esteem level of the sexually abused victims and perceived social support level (r=0.274, p=0.026). Others relationships were not found to be statistically significant. Conclusion: Our results indicate that the female victims of sexual violence had low social support from their family, friends in their life, However friend's support had a minor positive effect on their self-esteem.

The comparison of spiritual health and self-esteem in women with and without sexual violence.

BACKGROUND AND AIM: Sexual violence is a serious public health problem which is common around the world. The aim of this study was to evaluate spiritual health and self-esteem in sexual violence victims. METHODS: This cross-sectional study was performed on 66 subjects in the group of sexual violence women and 147 subjects in the group of women with no experience of sexual violence who referred to Tehran Forensic Medical Center and the health centers of Shahid Beheshti University of Medical Sciences respectively, in 2015, in Tehran, Iran. Sexual violence was considered as vaginal or anal penetration. Paloutzian & Ellison spiritual health questionnaire and Rosenberg self-esteem scale were used for data collecting. Data were analyzed using IBM-SPSS version 21. The Kolmogorov Simonov test was used for normality distribution of variables. Descriptive and the Mann-Whitney tests were used to analyze the data. Statistical significance was set to p<0.05. RESULTS: Sexual activity in both groups was started at 20 years old. Most of the abused subjects were single (48.8%), with education level below diploma (55.2%), unemployed (67%) and with an average annual income of 200 million Rials ($7,000). Familiarity with the offender was mostly as friendship (42.4%), and the offence had occurred through deception (37.8%). No significant difference was found between the total mean scores of self-esteem in the two groups (M1: 21.89, M2: 21.02; p=0.76) while a significant difference was seen between the mean scores of spiritual health, which indicates a lower level of spiritual health in women with sexual violence (M1: 74.59 (2.03), M2: 86.39 (3.12); p<0.001). CONCLUSION: The results of the present study highlight the importance of spirituality in sexual violence so policies to promote spiritual health are recommended to protect women.

Virginity Testing Beyond a Medical Examination.

Apart from religious values, virginity is important in different communities because of its prominent role in reducing sexually transmitted diseases and teen pregnancies. Even though virginity testing has been proclaimed an example of violence against women by the World Health Organization, it is still conducted in many countries, including Iran. 16 in-depth, semi-structured interviews were conducted with participants aged 32 to 60 years to elucidate the perceptions and experiences of Iranian examiners of virginity testing.The perception and experience of examiners were reflected in five main themes. The result of this study indicated that virginity testing is more than a medical examination, considering the cultural factors involved and its overt and covert consequences. In Iran, testing is performed for both formal and informal reasons, and examiners view such testing with ambiguity about the accuracy and certainty of the diagnosis and uncertainty about ethics and reproductive rights. Examiners are affected by the overt and covert consequences of virginity testing, beliefs and cultural values underlying virginity testing, and informal and formal reasons for virginity testing.

Electrocardiographic manifestations in acute methanol poisoning cannot predict mortality.

The aim of this retrospective observational case series was to determine electrocardiographic (ECG) manifestations in patients poisoned with methanol and see whether they could predict mortality. We also wanted to see whether there was an association between ECG changes and time elapsed between ingestion and treatment, age, sex, seizure, coma (Glasgow Coma Scale ≤8), arterial blood gas (ABG) parameters, and serum potassium levels on hospital admission. The study included 42 patients aged 31.14±12.5 years. Twenty-five survived and 17 died. Almost all patients had one or more abnormal ECG findings, including heart rate, rhythm, and conduction abnormalities. However, we found no significant difference between survivors and non-survivors. QTc interval did not correlate with time elapsed between ingestion and treatment, age, sex, seizure and coma, HCO3(-), or serum potassium level. Similarly, T waves showed no correlation with serum potassium. ECG abnormalities did not correlate with coma or seizure. Even though cardiotoxicity in methanol poisoning is high, none of the ECG abnormalities found in our study predicted mortality. This however does not rule out the need to routinely run ECG for cardiotoxicity in every single patient poisoned by methanol.

Brain computed tomographic scan findings in acute opium overdose patients.

AIM: Early radiologic evaluations including noncontrast computed tomographic (CT) scan of the brain have been reported to be useful in the diagnosis and management of the intoxicated patients. Changes in the brain CT scan of the acute opium overdose patients have little been studied to date. This study aimed to evaluate changes of the brain CT scans in the acute opium overdose patients. METHODS: In this retrospective study, medical records of all acute opium overdose patients hospitalized in Loghman-Hakim Poison Hospital in Tehran, Iran, between September 2009 and September 2010 were identified. Those who had undergone noncontrast brain CT within the first 24 hours of hospital presentation were included. Patients with any underlying disease, head trauma, underlying central nervous system disease, epilepsy, and multidrug ingestion were excluded. The patients' demographic information, vital signs, and laboratory data at presentation were extracted and recorded. The data were analyzed using SPSS software version 17 (SPSS, Chicago, IL). RESULTS: A total of 71 patients were included. Fifty-eight patients (80.5%) survived, and 10 (13.8%) died. Fourteen cases (19.7%) had abnormal CT findings including 8 cases of generalized cerebral edema and 6 cases of infarction/ischemia. There were no statistically significant differences between the patients with and without abnormal CT scan findings with respect to age, sex, systolic and/or diastolic blood pressures, pulse rate, respiratory rate, occurrence of seizures, pH, Pco(2), HCO(3)(-), blood sodium level, and blood glucose level (all P values were > .05). However, a statistically significant difference was found between these patients in terms of outcome (P = .007). CONCLUSION: Abnormal brain CT findings are detected in about 20% of the acute opium overdose patients who are ill enough to warrant performance of the brain CT scan and associate with a poor prognosis in this group of the patients.

Tricyclic antidepressant poisoning treated by magnesium sulfate: a randomized, clinical trial.

Tricyclic antidepressant (TCA) poisoning is a major problem in medicine, with a high morbidity and mortality rate. The main cause of fatality is cardiac arrhythmias resulting from intoxication. Sodium bicarbonate is the drug of choice, but severe poisoning necessitates further interventions. Magnesium sulfate seems to be effective in this condition. In a randomized, clinical trial, we evaluated all patients with a history of TCA intoxication referred to the Loghman Hakim Hospital Poison Center. The patients were randomly divided into two groups: one treated by bicarbonate infusion (control group) and the other (case group) by the infusion of magnesium sulfate in addition to the treatment in the first group. Seventy-two patients were recruited into the study (36 cases and 36 controls). Mean duration of intensive care unit stay in the cases and controls were 25.63 ± 9.33 and 82.67 ± 21.66 hours, respectively (P < 0.001). Mortality rate in the case group was 13.9% and 33.3% in the other group (P = 0.052). Magnesium sulfate can be an effective drug in the treatment of TCA poisoning; however, several randomized, clinical trials are still necessary to confirm this.

Electrocardiographic manifestations of tramadol toxicity with special reference to their ability for prediction of seizures.

AIM: The aims of this study are to determine the electrocardiographic (ECG) manifestations of the symptomatic patients with isolated tramadol toxicity and to predict seizures based on ECG parameters. METHODS: Medical charts of a total of 479 patients with isolated tramadol toxicity were retrospectively evaluated. Their clinical manifestations were recorded, and their ECG parameters including rate, PR interval, QRS duration, corrected QT interval, terminal 40-millisecond frontal plane QRS axis, and the height of R wave and R/S ratio in the lead aVR were measured. The data were analyzed using Kolmogorov-Smirnov test, Mann-Whitney U test, Pearson χ(2), Pearson correlation coefficient (r), and the Student t test. RESULTS: Electrocardiographic heart rate more than 100 beats per minute in 30.6%, QRS 120 milliseconds or more in 7.5%, corrected QT interval more than 440 milliseconds in 24.6%, height of R wave more than 1 mm in lead aVR in 22.1%, R/S ratio more than 0 in lead aVR in 23.5%, terminal 40-millisecond frontal plane QRS axis greater than 120° in 31.7%, and complete or incomplete right bundle-branch block in 4.6% of the patients were detected. There were no statistically significant differences between the patients who had not convulsed and those who had convulsed after admission regarding age, sex, vital signs, and ECG findings at presentation (all P values were >.05). CONCLUSIONS: Tramadol toxicity shows ECG changes consistent with sodium channel blockade and potassium channel blockage effects. The risk of development of seizures cannot be predicted based on the changes of ECG parameters at presentation.

Depilatory Agents intoxication and factors contributing to its mortality: a 9-year review.

Poisoning with depilatory agents is a rather uncommon entity in western countries. In this study, we describe poisoning with a corrosive arsenic-based depilatory agent (CABD) and factors related to its mortality in a poisoning center in Tehran. In a retrospective study, the medical records of all patients with CABD intoxication who attended the emergency ward of Loghman-Hakim hospital, the only poisoning center in Tehran, over a 9-year period between 2000 and 2009 were reviewed. The majority of patients were men (78.7%, n = 122 vs. women: 21.3%, n = 33). The mean age was 35.55 ± 16.68 years. Mean time of arrival to hospital was 3.63 hours (SD = 4.07). The mortality rate was 5.8% and increased significantly with higher amounts of ingestion and delay in arrival to hospital. CABD poisoning may be lethal if not treated promptly and correctly. Restriction or, if not practical, reduction of harmful components of this substance should be considered.