Clinical Utility of Soluble CD163 and its Diagnostic and Prognostic Value in a Variety of Neurological Disorders.

Nowadays, many people suffer from Neurological Diseases (NDs), particularly neurodegenerative diseases. Hence, there is an urgent need to discover new and more effective diagnostic and prognostic biomarkers as well as therapeutic strategies for the treatment of NDs. In this context, detecting biomarkers can provide helpful information on various levels of NDs. Up to now, there has been a lot of progress in recognizing these diseases, but they are not completely clear yet. NDs are associated with inflammatory conditions and there are several differences in NDs' immune biomarkers compared to normal conditions. Among these biomarkers, soluble CD163 (sCD163) levels (as a new biomarker) increase in biofluids, relating to the activation of macrophage/microglia and inflammation levels in NDs. ADAM17/TACE and ADAM10 are the responsible enzymes for producing sCD163 from macrophages. Increased shedding of CD163 is caused by inflammatory stimuli, and a function has been hypothesized for sCD163 in immunological suppression. When the body confronts an inflammation or infection, the concentration of sCD163 drives up. sCD163 is stable and can be easily quantified in the serum. In addition to its role as a biomarker, sCD163 can be a good modulator of adaptive immune suppression after stroke. sCD163, with a long half-life, has been proposed to be a surrogate for some critical markers such as Tumor Necrosis Factor-α (TNF- α). Furthermore, sCD163 production can be regulated by some regents/approaches such as zidovudine, nanotechnology, combination antiretroviral treatment, and aprepitant. Considering the importance of the issue, the critical role of sCD163 in NDs was highlighted for novel diagnostic and prognostic purposes.

Sodium Hypochlorite 0.005% Versus Placebo in the Treatment of Mild to Moderate Acne: A Double-Blind Randomized Controlled Trial.

BACKGROUND: Acne vulgaris is a common inflammatory disease of the pilosebaceous follicle that affects many teenagers and young people. There is an obvious need for topical treatments with good tolerability and efficacy for the management of acne lesions. OBJECTIVE: This study determined the therapeutic efficacy of topical sodium hypochlorite solution (0.005%) in the treatment of mild to moderate acne lesions. METHODS: This placebo-controlled randomized controlled trial compared 0.005% sodium hypochlorite to placebo administered topically on each side of the patients' faces 3 times a day for 1 month. The numbers of papules and pustules were recorded at baseline, 1, 2 and 4 weeks after initiation. RESULTS: The total number of papules and pustules decreased after topical application of sodium hypochlorite 0.005% for 1 month. CONCLUSIONS: Topical sodium hypochlorite solution (0.005%) can be effective in the treatment of mild to moderate acne, and its clinical efficacy was evaluated between the male and female groups and between the hormonal and non-hormonal ones. TRIAL REGISTRATION: Our study was registered in the Iranian Registry of Clinical Trials (IRCT) with the code number IRCT20200701047976N1.

Differentiation of Chest CT Findings Between Influenza Pneumonia and COVID-19: Interobserver Agreement Between Radiologists.

OBJECTIVES: To investigate the chest CT and clinical characteristics of COVID-19 pneumonia and H1N1 influenza, and explore the radiologist diagnosis differences between COVID-19 and influenza. MATERIALS AND METHODS: This cross-sectional study included a total of 43 COVID-19-confirmed patients (24 men and 19 women, 49.90 ± 18.70 years) and 41 influenza-confirmed patients (17 men and 24 women, 61.53 ± 19.50 years). Afterwards, the chest CT findings were recorded and 3 radiologists recorded their diagnoses of COVID-19 or of H1N1 influenza based on the CT findings. RESULTS: The most frequent clinical symptom in patients with COVID-19 and H1N1 pneumonia were dyspnea (96.6%) and cough (62.5%), respectively. The CT findings showed that the COVID-19 group was characterized by GGO (88.1%), while the influenza group had features such as GGO (68.4%) and consolidation (66.7%). Compared to the influenza group, the COVID-19 group was more likely to have GGO (88.1% vs. 68.4%, p = 0.032), subpleural sparing (69.0% vs. 7.7%, p <0.001) and subpleural band (50.0% vs. 20.5%, p = 0.006), but less likely to have pleural effusion (4.8% vs. 33.3%, p = 0.001). The agreement rate between the 3 radiologists was 65.8%. CONCLUSION: Considering similarities of respiratory infections especially H1N1 and COVID-19, it is essential to introduce some clinical and para clinical modalities to help differentiating them. In our study we extracted some lung CT scan findings from patients suspected to COVID-19 as a newly diagnosed infection comparing with influenza pneumonia patients.

Association of C677T (rs1081133) and A1298C (rs1801131) Methylenetetrahydrofolate Reductase Variants with Breast Cancer Susceptibility Among Asians: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis were conducted to investigate the association between methylenetetrahydrofolate reductase (MTHFR) C677T and A1298C polymorphisms with breast cancer (BC) in Asians. Systematic searches were conducted in PubMed, EMBASE, Web of Science, and Scopus by May 2020. Inter-study heterogeneity was also assessed with a Q test, along with I2 statistics. Random-effects models were applied to pooled crude ORs with corresponding 95% CIs for the genetic models. A total of 1097 identified results, along with 36 qualified studies were included: for MTHFR C677T polymorphism, a total of 36 studies was comprised of 11,261 cases and 13,318 controls and for MTHFR A1298C polymorphism, a number of 19 studies contained 7424 cases and 8204 controls. Likewise, for C677T polymorphism, an increased risk of BC was seen for the allelic (OR 1.21, 95% CI 1.09-1.33, P < 0.01, I2 = 78.9%), dominant (OR 1.17, 95% CI 1.05-1.30, P < 0.01, I2 = 71.8%), recessive (OR 1.43, 95% CI 1.23-1.67, P < 0.01, I2 = 55.8%), and homozygous models (OR 1.48, 95% CI 1.25-1.75, P < 0.01, I2 59.9%) among BC patients compared to controls. Also, in terms of A1298C polymorphism, an association was found between the allelic (OR 1.15, 95% CI 1.04-1.28, P < 0.01, I2 70.4%) and homozygous models (OR 1.38, 95% CI 1.15-1.66, P < 0.01, I2 44.2%) with the risk of BC. In conclusion, findings revealed that MTHFR C677T variant might be a factor that predisposes BC in Asians. Furthermore, it was found that A1298C variant acts as a BC risk factor, particularly in a Western Asia population.

Clinicopathological Significance of Tumor Stem Cell Markers ALDH1 and CD133 in Colorectal Carcinoma.

BACKGROUND & OBJECTIVE: Colorectal cancer (CRC) is the third most common cancer worldwide with a high mortality rate. The main causes of death in patients are recurrence and metastasis which are mainly attributed to the small subpopulation of cells within tumors called cancer stem cells (CSCs). This study aimed to evaluate the correlation between the expression of ALDH1 and CD133 as CSC associated markers and clinicopathological characteristics in CRC. METHODS: In this cross-sectional study, a total of 483 CRC tumor samples were immunohistochemically stained for detection of CD133 and ALDH1 markers. Correlations of marker expression with clinicopathological factors were also evaluated. RESULTS: There was a significant correlation between the luminal intensity of CD133 and neural invasion (P=0.05) and between the cytoplasmic intensity of CD133 and metastasis (P=0.05). In terms of H-score, a positive significant relation was observed between cytoplasmic expression of CD133 and lymph node (P=0.02), neural (P=0.04) and vascular invasion (P=0.02). The ALDH1 cytoplasmic expression showed a significant correlation with tumor size (P=0.001). CONCLUSION: Our findings showed that increased expression of CD133 and ALDH1 is associated with tumor progression and worse outcomes in CRC patients. These markers can be good candidates for localized targeting of CSCs using antibodies. Future researches need to be improved approaches for early detection of CRC, and treatment monitoring for CRC and other cancers.

Comparison of QT dispersion in patients with ST elevation acute myocardial infarction (STEMI) before and after treatment by streptokinase versus primary percutaneous coronary intervention (PCI).

BACKGROUND: QT dispersion (QTD) represents inhomogeneous ventricular repolarization such that an increased QTD may predispose the heart to malignant ventricular arrhythmias (VAs). This study was conducted to compare QTD in patients with ST-elevation myocardial infarction (STEMI) before and after treatment by streptokinase (SK) versus primary percutaneous coronary intervention (PCI). METHODS: The present case-control study was conducted on 185 STEMI patients who received SK (115 cases) or underwent primary PCI (70 cases). QTD and QT corrected dispersion before and 24 h after treatment. Likewise, they were also found to correct fatal arrhythmias (VT and VF) during the first 24 h after admission, and ejection fraction (EF) 24 h after treatment was evaluated. RESULTS: QTD decreased in the primary PCI group, though no significant difference was seen between the two studied groups (P > 0.05). A significant increase was detected in the EF mean values for the primary PCI-treated patients (P = 0.022). Moreover, there was a significant reduction in QTD of patients with fatal arrhythmias in the primary PCI group (P = 0.022). CONCLUSION: An overall QTD reduction in the primary PCI group and a significant decrease in QTD of patients with fatal arrhythmias in the primary PCI group show that this treatment strategy is more efficient than thrombolytic therapy. As an important indicator of proper myocardial function, EF can independently predict improved myocardial function in the primary PCI group.

Cutaneous lymphoid hyperplasia induced by Hirudo medicinalis (leeches).

For centuries, Hirudo medicinalis (medicinal leech) has been used as a remedy to treat many discomforts, such as muscle and joint pain. Nowadays, using leech in reconstructive surgery, microsurgery, wound and flap healing, venous insufficiency, varicosities and many other disorders has increased. In this study, we report a 45 year old female patient with six pruritic papules on her legs since10 months ago that appeared about 4 weeks after one session of leech application. Skin biopsy was performed on one of the papules, and in histopathology, superficial ulceration with a dense superficial and deep inflammatory infiltrate within the dermis composed of lymphocytes and eosinophils detected that considering history of leech application at this site, these constellation of data was compatible with the diagnosis of cutaneous lymphoid hyperplasia induced by leeches and the patient was cured by a topical steroid and cryotherapy.

Comparison of visual status of Iranian military and commercial drivers.

BACKGROUND: There is no legal requirement for Iranian military truck drivers to undergo regular visual checkups as compared to commercial truck drivers. OBJECTIVES: This study aimed to evaluate the impact of drivers' visual checkups by comparing the visual function of Iranian military and commercial truck drivers. PATIENTS AND METHODS: In this comparative cross-sectional study, two hundred military and 200 commercial truck drivers were recruited and their Visual Acuity (VA), Visual Field (VF), color vision and Contrast Sensitivity (CS) were assessed and compared using the Snellen chart, confrontation screening method, D15 test and Pelli-Robson letter chart, respectively. A questionnaire regarding driving exposure and history of motor-vehicle crashes (MVCs) was also filled by drivers. Results were analyzed using an independent samples t-test, one-way ANOVA (assessing difference in number of MVCs across different age groups), chi-square test and Pearson correlation at statistical significance level of P < 0.05. RESULTS: Mean age was 41.6 ± 9.2 for the military truck drivers and 43.4 ± 10.9 for commercial truck drivers (P > 0.05). No significant difference between military and commercial drivers was found in terms of driving experience, number of MVCs, binocular VA, frequency of color vision defects and CS scores. In contrast, the last ocular examination was significantly earlier in military drivers than commercial drivers (P < 0.001). In addition, 4% of military drivers did not meet the national standards to drive as opposed to 2% of commercial drivers. There was a significant but weak correlation between binocular VA and age (r = 0.175, P < 0.001). However, CS showed a significantly moderate correlation with age (r = -0.488, P < 0.001). CONCLUSIONS: The absence of legal requirement for regular eye examination in military drivers caused the incompetent drivers to be missed in contrast to commercial drivers. The need for scientific revision of VA standard for Iranian drivers is also discussed. The CS measurement in visual checkups of older drivers deserves to be investigated more thoroughly.

Accuracy of Rapid Ultrasound in Shock (RUSH) Exam for Diagnosis of Shock in Critically Ill Patients.

BACKGROUND: Rapid ultrasound in shock (RUSH) is the most recent emergency ultrasound protocol, designed to help clinicians better recognize distinctive shock etiologies in a shorter time frame. OBJECTIVES: In this study, we evaluated the accuracy of the RUSH protocol, performed by an emergency physician or radiologist, in predicting the type of shock in critical patients. PATIENTS AND METHODS: An emergency physician or radiologist performed the RUSH protocol for all patients with shock status at the emergency department. All patients were closely followed to determine their final clinical diagnosis. The agreement between the initial impression provided by RUSH and the final diagnosis was investigated by calculating the Kappa index. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of RUSH for diagnosis of each case. RESULTS: We performed RUSH on 77 patients. Kappa index was 0.71 (P Value = 0.000), reflecting acceptable general agreement between initial impression and final diagnosis. For hypovolemic, cardiogenic and obstructive shock, the protocol had an NPV above 97% yet it had a lower PPV. For shock with distributive or mixed etiology, RUSH showed a PPV of 100% but it had low sensitivity. Subgroup analysis showed a similar Kappa index for the emergency physician and radiologist (0.70 and 0.73, respectively) in performing rush. CONCLUSIONS: This study highlights the role of the RUSH exam performed by an emergency physician, to make a rapid and reliable diagnosis of shock etiology, especially in order to rule out obstructive, cardiogenic and hypovolemic shock types in initial exam of shock patients.

Accuracy of early rapid ultrasound in shock (RUSH) examination performed by emergency physician for diagnosis of shock etiology in critically ill patients.

BACKGROUND: Rapid Ultrasound in Shock (RUSH) is a recently reported emergency ultrasound protocol designed to help clinicians better recognize distinctive shock etiologies in a short time. We tried to evaluate the accuracy of early RUSH protocol performed by emergency physicians to predict the shock type in critically ill patients. MATERIALS AND METHODS: Our prospective study was approved by the ethics committee of trauma research center, Baqiyatallah University of Medical Science, Iran. We enrolled 52 patients with shock state in the emergency department from April 2013 to October 2013. We performed early bed-side sonographic examination for participants based on RUSH protocol. Patients received all needed standard therapeutic and diagnostic interventions without delay and were followed to document their final diagnosis. Agreement (Kappa index) of initial impression provided by RUSH with final diagnosis, and also sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of RUSH for diagnosis of each shock type were calculated. RESULTS: Fifty-two patients were enrolled in our study. Kappa index was 0.7 (P value = 0.000), reflecting acceptable general agreement between initial impression and final diagnosis. For hypovolemic and obstructive shocks, the protocol had sensitivity of 100% but had lower PPV. For shocks with distributive or mixed etiology, RUSH showed PPV of 100% but had low sensitivity. For cardiogenic shocks, all reliability indices were above 90%. CONCLUSION: We highlight the role of RUSH examination in the hands of an emergency physician in making a rapid diagnosis of shock etiology, especially in ruling out obstructive, cardiogenic, and hypovolemic types.

Characteristics of posttraumatic headache following mild traumatic brain injury in military personnel in Iran.

OBJECTIVES: The primary goal of this study was to evaluate the incidence and characteristics of posttraumatic headache attributed to mild brain injury in military personnel in Iran within a prospective and observational study design. METHODS: A prospective observational descriptive study was conducted with a cohort of military personnel under military education during a 6-month period at the Military Education Center in Isfahan, Iran. 322 military personnel under education were selected randomly and were given a 13-item mild brain injury questionnaire accompanied with affective disorders and headache questionnaires and were reevaluated after a 3-month interval. RESULTS: A total of 30 (9.3 %) of the 322 military personnel met criteria for a mild brain injury. Among them, 18 personnel (60 %) reported having headaches during the 3-month reevaluation. PTHs defined as headaches beginning within 1 week after a head trauma were present in 5.6 % of military personnel under study during 6 months. In total, 67 % of posttraumatic headaches (PTH) were classified as migrainous or possible migrainous features. Patients with affective disorders such as posttraumatic stress disorder and depression were at a higher risk for developing PTH following mild brain injury (p < 0.05). PTH did not relate to demographic factors such as age or type of trauma. CONCLUSIONS: Posttraumatic headache attributed to mild brain injury is a common disorder in military personnel. Migrainous features are predominant among them in comparison with the general population. PTH is not related to a type of trauma, but has association with affective disorders.

Prevalence of low back pain among nurses: predisposing factors and role of work place violence.

BACKGROUND: Ergonomic factors predispose nurses to low back pain (LBP). Few studies have clarified the role of workplace violence in LBP occurrence. OBJECTIVES: The present study was designed to investigate acute and chronic LBP in Iranian nurses and its association with exposure to physical violence as well as its personal and ergonomic risk factors. MATERIALS AND METHODS: In this analytic cross sectional study, the rate of acute and chronic LBP and contributing factors were investigated among 1246 nurses using a validated questionnaire. Statistical analysis was performed by chi square, student t-test, and logistic regression, to determine the association between independent variables and LBP. RESULTS: In total, 1246 nurses, consisting of 576 (46.23%) males and 670 (53.77%) females, were included. The mean age and the mean years of employment were 31.23 ± 5.33 and 16.18 ± 7.05, respectively. Both acute low back pain (ALBP) and chronic low back pain (CLBP) were associated with physical violence experience. Moreover, acute and chronic LBP were predicted by positive past history of LBP as well as two ergonomic factors, frequent bending and frequent carrying of patients. CONCLUSIONS: Besides a history of low back pain and ergonomic factors, physical violence may be considered a contributing factor for acute low back injuries. Special attention to all personal, occupational, and psychological risk factors is recommended.

Anatomic variations found on dissection of depressor septi nasi muscles in cadavers.

OBJECTIVES: To define variations of the depressor septi muscle in Iranians; to provide guidance for modification of this muscle during rhinoplasty in patients with an active muscle and short upper lip; and to correlate our findings with our clinical experience to develop the applied algorithms. METHODS: This study was conducted by dissecting 82 depressor septi nasi muscles in 41 Iranian cadavers. Origin and insertion points of each muscle were studied. RESULTS: Three variations were found in muscle insertion points: periosteal, orbicularis oris, and floating. Forty-four percent of the muscles were inserted into the periosteum of the maxilla (n = 36); 39% of muscles were inserted into the orbicularis oris muscle (n = 32); and 17% were diminutive or floating (n = 14). Periosteal insertion was thicker and stronger than the other variations. In all cadavers, the origin of the muscle was medial crus of alar cartilage and caudal of the nasal septum. CONCLUSIONS: This cadaveric dissection showed that the percentage of depressor septi muscle insertions is not similar to that found in other surveys. In this study, periosteal insertion of the depressor septi muscle was the most common variation.

Carpal tunnel syndrome: the role of occupational factors among 906 workers.

BACKGROUND: Carpal tunnel syndrome (CTS) is common in the industrial setting. However,there is a controversy about the sole role of occupational ergonomic hazards in CTS. OBJECTIVES: This study was conducted among assembling workers of a detergent factory and computer users with the aims of A) determination of CTS prevalence and B) evaluation of personal risk factors and level of exposure to occupational risk factors via Quick Exposure Check (QEC). MATERIALS AND METHODS: In this descriptive cross-sectional study, 906 cases (332 assembling workers and 574 computer workers) were enrolled. CTS was assessed by symptoms on the Katz hand diagram and physical examination. QEC technique was applied to evaluate physical exposure to the risk factors. RESULTS: According to this study, the prevalence of probable CTS was 14% in men and 8.9% in women; the rate of probable CTS was significantly higher in assembly workers than in computer users (P < 0.001). Mean age and work duration in the probable CTS group was statistically higher than in non-CTS group. But both groups were in the same range (fewer than 30, P = 0.024, 0.004); BMI in the probable CTS group was slightly lower than in non CTS group, but BMI in both groups were in the normal range. Wrist ratio > 0.7 correlated with increased risk of probable CTS (P < 0.001) Prevalence of probable CTS was significantly higher in third and fourth levels of QEC (P < 0.001). CONCLUSIONS: Although this article had limitations, our findings suggest that the level of occupational exposure is an indicator of CTS development.

Assessment of impulse noise level and acoustic trauma in military personnel.

BACKGROUND: Military personnel are usually exposed to high levels of impulse noise (IN) which can lead to hearing loss. OBJECTIVES: The purpose of this study was to assess the effects of relatively low level exposure of impulse noise (IN) during shooting practice on hearing using pure tone audiometry (PTA) and transiently evoked otoacoustic emission (TEOAE) in military personnel. MATERIALS AND METHODS: Forty male soldiers (mean age 20.08 years) were recruited for the study. Prior to their first shooting practice, PTA and TEOAE were recorded. After 15 minutes and one week post- practice PTA and TEOAE were compared. RESULTS: Immediately after shooting practice significant differences in PTA at 500, 1000, and 4000 Hz were observed for the right ear and no significant difference at any frequency for the left ear. There was a significant difference in the amplitude of TEOAE 15 minutes after shooting practice at 500, 1000, 2000, 3000, and 4000 Hz in the right ear, while for the left ear the difference was significant at 1000 and 2000 Hz. One week after exposure a significant difference at 500 and 4000 Hz was found only in the right ear and a significant difference in the amplitude of TEOAE was observed at 500, 1000, 2000, 3000, and 4000 Hz. CONCLUSIONS: Even exposure lower than permissible levels may lead to acoustic trauma. TEOAE is more sensitive than PTA in detecting early hearing loss after military shooting exercises. Hearing protection equipment and appropriate surveillance programs are recommended.