The Impact of Prophylactic Post-Chemotherapy G-CSF on the Relapse Rates in Patients with Acute Myeloid Leukemia: A Meta-Analysis.

This meta-analysis evaluated the impact of prophylactic post-chemotherapy granulocyte colony-stimulating factor (G-CSF) in patients with acute myeloid leukemia (AML). Overall, the relapse rate, overall survival, event-free survival, and mortality rate were similar in G-CSF (+) compared to G-CSF (-) patients. However, the relative risk (RR) of relapse was higher in children and in secondary AML patients who were treated with G-CSF compared to the G-CSF (-) group [RR, 95% confidence interval: 1.26, 1.04-1.52, and 1.12 (1.02-1.24)]. Treatment with post-chemotherapy G-CSF should be prescribed with caution in pediatric patients with AML and secondary AML as possibly increasing the relapse risk.

The effect of self-care training programs on lifestyle and breast self-examination of immigrant Afghan women.

BACKGROUND: Breast cancer is the most prevalent cancer and a major cause of mortality among women. Breast self-examination (BSE) is a key technique for early diagnosis of breast cancer, which, along with lifestyle changes, can alleviate the risk of mortality. This study aimed to examine the effect of self-care training programs on lifestyle change and BSE of immigrant Afghan women residing in Iran. MATERIALS AND METHODS: In this quasi-experimental study, 140 immigrant Afghan women visiting health-care centers in Shiraz (Iran) were selected via convenience sampling during 2019-2020. The data were collected using a lifestyle questionnaire, a demographic information checklist, and a BSE checklist. Following the pretest, the experimental group received three sessions of self-care training and took the posttest 2 months after the intervention. The control group did not receive any intervention, but took the same posttest 2 months after the pretest. Data analysis was performed using paired and independent t-test and Chi-squared test in Statistical Package for the Social Sciences (SPSS) 22. RESULTS: The post-intervention level of knowledge and performance of the experimental group significantly increased in terms of a healthy lifestyle (P < 0.001) and performance of BSE (P < 0.001) compared to the control group. The intervention also had a significant positive effect (P < 0.000) on all dimensions of lifestyle. CONCLUSION: Self-care training for lifestyle and BSE can promote the prevention and early diagnosis of breast cancer in immigrant Afghan women who have limited access to health care.

Protective effects of melatonin against the toxic effects of environmental pollutants and heavy metals on testicular tissue: A systematic review and meta-analysis of animal studies.

Background: Environmental pollution and infertility are two modern global challenges that agonize personal and public health. The causal relationship between these two deserves scientific efforts to intervene. It is believed that melatonin maintains antioxidant properties and may be utilized to protect the testicular tissue from oxidant effects caused by toxic materials. Methods: A systematic literature search was conducted in PubMed, Scopus, and Web of Science to identify the animal trial studies that evaluated melatonin therapy's effects on rodents' testicular tissue against oxidative stress caused by heavy metal and non-heavy metal environmental pollutants. Data were pooled, and standardized mean difference and 95% confidence intervals were estimated using the random-effect model. Also, the risk of bias was assessed using the Systematic Review Centre for Laboratory animal Experimentation (SYRCLE) tool. (PROSPERO: CRD42022369872). Results: Out of 10039 records, 38 studies were eligible for the review, of which 31 were included in the meta-analysis. Most of them showed beneficial effects of melatonin therapy on testicular tissue histopathology. [20 toxic materials were evaluated in this review, including arsenic, lead, hexavalent chromium, cadmium, potassium dichromate, sodium fluoride, cigarette smoke, formaldehyde, carbon tetrachloride (CCl4), 2-Bromopropane, bisphenol A, thioacetamide, bisphenol S, ochratoxin A, nicotine, diazinon, Bis(2-ethylhexyl) phthalate (DEHP), Chlorpyrifos (CPF), nonylphenol, and acetamiprid.] The pooled results showed that melatonin therapy increased sperm count, motility, viability and body and testicular weights, germinal epithelial height, Johnsen's biopsy score, epididymis weight, seminiferous tubular diameter, serum testosterone, and luteinizing hormone levels, testicular tissue Malondialdehyde, glutathione peroxidase, superoxide dismutase, and glutathione levels. On the other hand, abnormal sperm morphology, apoptotic index, and testicular tissue nitric oxide were lower in the melatonin therapy arms. The included studies presented a high risk of bias in most SYRCLE domains. Conclusion: In conclusion, our study demonstrated amelioration of testicular histopathological characteristics, reproductive hormonal panel, and tissue markers of oxidative stress. Melatonin deserves scientific attention as a potential therapeutic agent for male infertility. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO, identifier CRD42022369872.

Cytokine Levels in Patients with ß-Thalassemia Major and Healthy Individuals: a Systematic Review and Meta-Analysis.

BACKGROUND: Cytokine levels in patients with ß-thalassemia major (ß-TM) have been assessed in several studies. Accordingly, a wide variety of immune disturbances has been shown in patients with thalassemia. Recurrent transfusions cause iron overload, which induces an increase in the production of cytokines. However, no systematic approach or meta-analysis has been done to provide a clear feature of cytokine levels in ß-TM. The present meta-analysis aimed to summarize the existing evidence regarding different levels of cytokines in patients with Β-TM compared to healthy controls. METHODS: This study was performed according to the PRISMA checklist. A systematic search was done in Web of Science (ISI), Scopus, and PubMed databases. The quality of the included studies was assessed based on the New-castle-Ottawa Scale. Meta-analysis was run via STATA 13 software. The standardized mean difference was considered the effect size for comparing the continuous variables. RESULTS: This meta-analysis included 16 studies conducted on 805 ß-TM patients and 624 healthy individuals (with the mean age of 16.10 ± 4.33 and 16.22 ± 3.78, respectively). The results showed significantly higher levels of Tumor Necrosis Factor-alpha (TNF-α), Interleukin-6 (IL-6), and IL-10 in patients with ß-TM compared to the healthy controls. CONCLUSION: The results indicated that the levels of both inflammatory and anti-inflammatory cytokines were higher in patients with ß-TM compared to the healthy population, which could be associated with higher levels of oxidative markers in these patients. Further studies are suggested to evaluate the difference in cytokine levels among different types of thalassemia.

Current Status and Outcomes of Critical Traumatic Brain Injury (GCS = 3-5) in a Developing Country: A Retrospective, Registry-Based Study.

BACKGROUND: Patients sustaining critical TBI [initial Glasgow Coma Scale (GCS) ≤ 5] generally have poor outcomes. Little is known about the frequency, mortality rate, and functional outcomes of such patients in Iran. METHODS: In this retrospective, registry-based cohort study, the demographic and clinicoradiological findings of TBI patients were queried from March 21, 2017, to March 21, 2020. We included TBI patients with initial GCS of 3-5. The functional outcome was assessed using the Glasgow Outcome Score-extended 6 (GOSE-6) months after the hospital discharge. Patients were classified as having unfavorable (GOSE-6 ≤ 4) and favorable (GOSE-6 > 4) outcomes. Gathered data were compared between groups. Multivariable logistic regression analysis was done to find factors affecting the outcome. RESULTS: Four hundred ninety-seven patients (mean age = 37.59 ± 17.89) were enrolled, and 69.2% had unfavorable outcomes. Elderly patients (age ≥ 65 years) were highly overrepresented among the unfavorable group. 48.9% had bilateral fixed dilated pupils (BDFP), who mostly attained unfavorable outcomes. The overall in-hospital mortality rate was 50.3%. The in-hospital mortality rate was appalling among elderly patients with BFDP and GCS 3( 90%) and GCS 4(100%). Age ≥ 65 years [odds ratio (OR) 3.45, 95% confidence interval (CI) 1.19-10.04], and BFDP (OR 4.48, 95% CI 2.60-7.73) increase the odds of unfavorable outcomes according to the regression analysis. CONCLUSION: The survival rate and favorable outcomes of critical TBI patients are generally poor. However, we believe that the neurotrauma surgeons should discuss with patients' proxies and explain the clinical conditions and possible outcomes.

Potential of four definitions of metabolic syndrome to discriminate individuals with different 10-year cardiovascular disease risk scores: a cross-sectional analysis of an Iranian cohort.

OBJECTIVE: We aimed to reveal the potential of four different metabolic syndrome (Mets) definitions to differentiate subjects according to 10-year risk of cardiovascular disease. DESIGN: A cross-sectional analysis of a prospective cohort. SETTING: This study used baseline data from the Shiraz Heart Study, a prospective cohort study in Shiraz, Iran. Participants were screened against Mets definitions including modified WHO, National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), American Heart Association (AHA) and International Diabetes Federation (IDF). Also, Framingham risk score (FRS) and atherosclerotic cardiovascular disease (ASCVD) risk score were determined for each participant. PARTICIPANTS: A total number of 7225 participants of both genders entered the study. They were selected through defined family physician centres in different geographical areas. Urban residents with no migration plan were included. Those who were far from study centres or with disabilities that made them incapable to cooperate were excluded. RESULTS: Participants were 47.68% (N=3445) male with the mean age of 52.13±8.00 years. The number of subjects with Mets identified by WHO was the lowest (N=1676), while the percentage of subjects with high risk score was the highest, 17.1% (N=282) in FRS and 9.8% (N=162) in ASCVD risk score. There were statistically significant differences in the mean risk scores between participants with and without Mets according to AHA, WHO and NCEP ATP III definitions (p<0.001). In IDF definition, the risk scores of subjects with Mets were not statistically different compared with peers without Mets, neither based on FRS (p=0.247) nor ASCVD risk score (p=0.193). CONCLUSIONS: IDF was not the appropriate definition for discrimination of subjects with Mets and/or those at high risk of future cardiovascular events. AHA, WHO and NCEP ATP III definitions were effective to discriminate subjects with Mets from peers without Mets.

Survival Rate of Renal Transplant and Factors Affecting Renal Transplant Failure.

OBJECTIVES: The most important complication in kidney transplant is acute/chronic rejection. In this study, we investigated the factors affecting kidney rejection and transplant survival. MATERIALS AND METHODS: In this survival analysis study, 352 patients (mean follow-up of 12.9 ± 4.4 years) who underwent renal biopsy due to increased creatinine level from 2012 to 2016 were identified by glomerular filtration rate level and rejection. Probable factors affecting renal function and survival rate after transplant rejection were assessed. P < .05 was considered as significant. RESULTS: Among our study patients, 40.9% developed early and 59.1% developed late acute kidney injury. Graft survival rates at 1 and 5 years were 98.9% and 68.5%, respectively, which was significant when rejection type was considered (P = .002). In addition, patient survival rates at 1 and 5 years were 99.7% and 98.6%, respectively. Graft survival at 5 years was significantly lower among older subjects, those with diabetes, those who received deceased donor organs, and those with late acute kidney injury (P < .002). Patient survival was significantly higher among young patients, those with systemic lupus erythematosus, those who received living donor organs, and those without cytomegalovirus infection (P < .003). CONCLUSIONS: We observed that recipient age, type of donor, underlying disease, infection, and late acute kidney injury had great negative impacts on renal dysfunction and survival. In our center, because of the large number of kidney transplants from deceased donors, the necessity of antithymocyte globulin induction therapy was considered, since this study showed that patients who received rabbit antithymocyte globulin induction had better outcomes.

The Impact of Smoking on Clinical Outcomes after Percutaneous Coronary Intervention in Women Compared to Men.

BACKGROUND: For decades, cardiovascular diseases (CVD) have been known as men's disease. However, recent research studies showed that they have become more common in women. Smoking is a strong risk factor for CVD especially that of coronary artery disease (CAD). Several studies reported that women are more susceptible to drastic sequels of smoking than men. There is limited data regarding the impact of smoking on post-revascularization clinical events stratified by gender. This study aimed to investigate if gender significantly changes the incidence of adverse clinical outcomes after percutaneous coronary intervention (PCI) among those with history of smoking. METHODS: Participants were selected from two hospitals from 2003 to 2019. Among patients who had PCI (index PCI), those with stable CAD who underwent elective PCI were included. Exclusion criteria were defined as primary PCI and those with multiple prior revascularizations. Participants were followed up seeking for major adverse cardiac events (MACE) including revascularization (PCI or coronary artery bypass grafting), myocardial infarction, and coronary death in three time intervals according to the time of index PCI (short term: up to 24 hours, mid-term: 24 hours to less than 6 months, and long term: more than 6 months). RESULTS: Of the 1799 patients, 61% were men and 47.08% had history of smoking (75% of the smokers were men). At the time of index PCI, smokers were significantly younger than nonsmokers. Also, MACE were significantly higher in smokers than nonsmokers, which was particularly pronounced at the long-term interval. In the nonsmokers group, there was no difference in MACE occurrence between men and women. However, of the smokers, women showed significantly higher MACE rate compared with men peers. CONCLUSION: Smoking makes women more prone to MACE in comparison to men among patients with stable CAD after PCI with drug-eluting stent.

High risky behavior and HIV/AIDS knowledge amongst street children in Shiraz, Iran.

Background: Street children around the world are accompanying a wide range of risky behaviors. The most common ones include risky sexual behavior, substance and alcohol abuse, and violence. This study aimed to assess risk behaviors and HIV knowledge of street children in Shiraz. Methods: A total of 329 street children (7-18 years of age who spend days or nights on streets with or without their family for earning money) were interviewed through 2014-2016 in Shiraz. Data were collected through a structured interview about high-risk behaviors and HIV/AIDS Knowledge based on a form and questionnaire. Street children were asked to identify HIV/AIDS mode of transmission. All correct answers were scored as one (1), and incorrect, "don't know" responses and no responses scored as zero. The data were analyzed by SPSS software 16 (SPSS, Inc. Chicago, USA) using the Independent t-test and chi-square test, and Pearson's correlation test. P value< 0.05 was considered as statistically significant Results: The mean ± SD age was 13.46±3.09. A total of 86.6% of them were boys. A total of 97.6% of them reported staying with their parents. Street children reported sleeping place as follow: with their parents (n=312, 94.8%), sharing accommodation with other kids (n=13, %4), sleeping in parks (n=2, 7%), and one with relatives. The frequency of smoking, alcohol drinking, and drug abuse were 35 (10.6%), 47 (14. 3%), and 6 (1.8%) respectively. A total of 43 (13.1%) street children reported sexual activity, among them 30 (9.1%) had sexual activity without a condom. Mean ± SD HIV/AIDS knowledge scoring of street children was, 4.1±3.9. Conclusion: Special programs should be implemented in order to reduce high-risk behavior among street children. Intervention should include increasing awareness about alcohol and drug abuse, HIV/AIDS knowledge, sexual and verbal abuse through an organized system with the help of peer education.