Volatile organic compounds analysis as promising biomarkers for Parkinson's disease diagnosis: A systematic review and meta-analysis.

OBJECTIVE: Researchers are investigating the potential of volatile organic compounds (VOCs) obtained from exhaled breath and sebum as non-invasive tools for early Parkinson's disease (PD) diagnosis. The present study aims to assess the feasibility of using VOC analysis for PD diagnosis and determine the overall diagnostic accuracy of the proposed tests. METHODS: We performed systematic searches based on the PRISMA guidelines to identify relevant studies on VOCs in PD diagnosis using exhaled breath or sebum samples. The selected articles were described, and meta-analysis was conducted on those that provided the sensitivity and specificity data. RESULTS: Out of 1268 articles initially identified, 8 met the inclusion criteria and provided specific sensitivity and specificity data for PD, which were included in the current meta-analysis. The pooled analysis of these findings showed a mean area under the receiver operating characteristic curve of 0.85, a sensitivity of 0.81 (95% confidence interval (CI): 0.72, 0.88), and a specificity of 0.76 (95% CI: 0.66, 0.84). CONCLUSION: The analysis of VOCs in exhaled breath and sebum has shown promise as a new avenue for non-invasive diagnosis of PD. VOCs' ability to distinguish PD from healthy controls suggests their potential clinical application in screening for the disease. Consequently, VOCs hold significant potential as biomarkers for PD diagnosis and offer a promising novel approach to identifying and diagnosing the condition.

An Atypical Course of Visceral Leishmaniasis After Kidney Transplantation: A Case Report From Iran.

BACKGROUND: Organ transplantation can lead to human visceral leishmaniasis (VL) transmission in humans. This report aims to describe the possible complications related to an atypical course of VL after kidney transplantation. CASE PRESENTATION: A 61-year-old man who suffered end-stage renal failure received a deceased donor kidney transplant after 2 years of hemodialysis. Tacrolimus, mycophenolate mofetil, and prednisolone were used for immunosuppressive therapy, and renal function remained stable for 2.5 years. He was referred to our hospital because of fever and malaise. Physical and radiological examinations showed mild splenomegaly and cervical and inguinal lymphadenopathy. Laboratory data showed bicytopenia, elevated C-reactive protein, serum creatinine, and non-nephrotic proteinuria. Bone marrow biopsy aspiration showed no abnormality. Polymerase chain reaction confirmed the diagnosis of Leishmania infantum. Anti-leishmanial therapy was initiated with liposomal amphotericin B for 2 weeks, and the patient became clinically stable. So far, there has been no evidence of clinical or biological relapse, and kidney function is stable. CONCLUSIONS: Considering that VL has become increasingly widespread in immunocompromised patients in endemic regions, especially in patients with transplants, it is crucial to screen and rule out VL as a cause of infection in these patients. The probability of this problem should be considered in every patient with a transplant in endemic and nonendemic areas. Furthermore, our study showed that through timely diagnosis using noninvasive methods and standard treatments, mortality caused by this disease can be properly prevented.

Applications of engineered exosomes in drugging noncoding RNAs for cancer therapy.

Noncoding RNAs (ncRNAs) are engaged in key cell biological and pathological events, and their expression alteration is connected to cancer progression both directly and indirectly. A huge number of studies have mentioned the significant role of ncRNAs in cancer prevention and therapy that make them an interesting subject for cancer therapy. However, there are several limitations, including delivery, uptake, and short half-life, in the application of ncRNAs in cancer treatment. Exosomes are introduced as promising options for the delivery of ncRNAs to the target cells. In this review, we will briefly discuss the application and barriers of ncRNAs. After that we will focus on exosome-based ncRNAs delivery and their advantages as well as the latest achievements in drugging ncRNAs with exosomes.

Prediction of Mortality and Morbidity After Severe Traumatic Brain Injury: A Comparison Between Rotterdam and Richmond Computed Tomography Scan Scoring System.

OBJECTIVE: Accurate prediction of the morbidity and mortality outcomes of traumatic brain injury patients is still challenging. In the present study, we aimed to compare the predictive value of the Richmond and Rotterdam scoring systems as two novel computed tomography-based predictive models. METHODS: We retrospectively analyzed 1400 subjects who suffered from severe traumatic brain injury and were admitted to Emtiaz Hospital, a tertiary referral trauma center in Shiraz, south of Iran, from January 2018 to December 2019. We evaluated the 1-month results; considering two primary factors: mortality and morbidity. The patients' condition was the basis for this assessment. We conducted a logistic regression analysis to determine the association between scoring systems and outcomes. To determine the optimal threshold value, we utilized the receiver operating characteristic curve model. RESULTS: The mean age of participants was 36.61 ± 17.58 years, respectively. Concerning predicting the mortality rate, the area under the curve (AUC) for the Rotterdam score was relatively low 0.64 (95% confidence interval: 0.60, 0.67), while the Richmond score had a higher AUC 0.74 (0.71-0.77), which demonstrated the superiority of this scoring system. Moreover, the Richmond score was more accurate for predicting 1-month morbidity with AUC: 0.71 (0.69, 0.74) versus 0.62 (0.59, 0.65). CONCLUSIONS: The Richmond scoring system demonstrated more accurate predictions for the present outcomes. The simplicity and predictive value of the Richmond score make this system an ideal option for use in emergency settings and centers with high patient loads.

COVID-19 as a trigger of Guillain-Barré syndrome: A review of the molecular mechanism.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused a pandemic with serious complications. After coronavirus disease 2019 (COVID-19), several post-acute COVID-19 syndromes (PACSs) and long-COVID sequels were reported. PACSs involve many organs, including the nervous, gustatory, and immune systems. One of the PACSs after SARS-CoV-2 infection and vaccination is Guillain-Barré syndrome (GBS). The incidence rate of GBS after SARS-CoV-2 infection or vaccination is low. However, the high prevalence of COVID-19 and severe complications of GBS, for example, autonomic dysfunction and respiratory failure, highlight the importance of post-COVID-19 GBS. It is while patients with simultaneous COVID-19 and GBS seem to have higher admission rates to the intensive care unit, and demyelination is more aggressive in post-COVID-19 GBS patients. SARS-CoV-2 can trigger GBS via several pathways like direct neurotropism and neurovirulence, microvascular dysfunction and oxidative stress, immune system disruption, molecular mimicry, and autoantibody production. Although there are few molecular studies on the molecular and cellular mechanisms of GBS occurrence after SARS-CoV-2 infection and vaccination, we aimed to discuss the possible pathomechanism of post-COVID-19 GBS by gathering the most recent molecular evidence.

Management of Ear Keloids Using Surgical Excision Combined with Postoperative Steroid Injections.

BACKGROUND: Ear keloids are a challenging problem that affect people of different races with substantial aesthetic consequences. Various types of adjuvant therapies, including intralesional corticosteroid injection are advocated to lower recurrence following excision. We investigated the efficacy of a protocol combined of excision and postoperative intralesional triamcinolone acetonide (TA) injection for treating earlobe keloids in a group of Iranian female patients. METHODS: A retrospective analysis of 21 patients representing 31 ear keloids treated by a single physician between 2013 and 2017 was conducted. All keloids occurred after ear piercing in female cases. Postoperative intralesional TA injection was administered once monthly and continued for several months based on the patients' clinical progress. Results were assessed according to Kyoto scar scale. RESULTS: The patients' mean age was 24.29 years and ranged from 16 to 40 years. After the surgery, the follow-up period ranged from 10 to 29 months (mean: 15.93 months) and patients were given TA intralesional injections 3 to 6 times (mean: 4.22 times) with no complication or adverse effect. Of the treated keloids, success was achieved in all of 31 keloids (100%) and final evaluation revealed that the mean Kyoto scar scale was significantly decreased. No recurrence occurred. CONCLUSION: Surgical excision followed by postoperative intralesional TA injection can be suggested as the primary protocol for the treatment of ear keloids considering its durable results and economic advantage.

Mortality and Body Mass Index in Burn Patients: Experience from a Tertiary Referral Burn Center in Southern Iran.

BACKGROUND: The role of obesity has been widely studied as a determinant factor of increasing mortality in surgical patients. In this study we aimed to investigate the association of mortality determinants with obesity classification and BMI score in burn patients admitted to a tertiary referral center in Southern Iran. METHODS: In this retrospective cross-sectional study, medical profiles of burn patients admitted from 2016 to 2017 were obtained from Amiralmomenin Burn Hospital, a tertiary referral burn center affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. Demographic, and clinical characteristics as well as patient outcomes were recorded to determine prognostic factors in fatal burns based on anthropometric measurements. RESULTS: Among 101 patients who were enrolled in this study including 73 males and 28 females, mean age was 34.85±12.04 years, total burn surface area (TBSA) was 37.37 (10.50%), BMI was 25.46±5.33 kg/m2 and hospital stay was 22.28±13.62 days. Overall mortality rate was 24.7% with 25 expired cases. Logistic regression demonstrated significant association of older age, male gender, and greater TBSA with mortality. However, difference in mortality rate in patients with BMI of 25 kg/m2 (27.4%) in comparison to patients with BMI<25 kg/m2 (18%) did not reach statistical significance. CONCLUSION: Although patients with higher BMI had increased mortality rate following burn injury, this finding showed no significant association. Further studies with larger samples may be necessary to conclude a causal association between BMI and mortality in burn patients.

Efficacy of Azithromycin in Treatment of Acne Vulgaris: A Mini Review.

BACKGROUND: Antibiotics are commonly used in the treatment of acne vulgaris. Considering the rise of antibiotic resistance, alternative medications may be used in the main anti-acne armamentarium. The aim of this study was to investigate the efficacy of oral azithromycin in the treatment of acne vulgaris. METHODS: Database searches were performed in PubMed and Scopus using the keywords "azithromycin" and "acne". RESULTS: Azithromycin 500 mg once daily for 3 days per week or in cycles of 10 days for 12 weeks are the most commonly used regimens. CONCLUSION: Available experimental data suggest that oral azithromycin is an effective and well-tolerated option for treatment of acne vulgaris.

Gastric cancer in patients with gastric atrophy and intestinal metaplasia: A systematic review and meta-analysis.

AIM: Intestinal metaplasia (IM) and gastric atrophy (GA) are precancerous lesions in the stomach. There is a large debate on natural course of these lesions and surveillance strategy in these patients. This meta-analysis was aimed to find the most appropriate follow up and the rate of progression from IM and GA to GC. METHODS: This meta-analysis is followed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic databases including EMBASE, PubMed, Web of Science databases, Scopus, and the Cochrane Library were searched until July 2018. Cochran's Q test and I-square (I2) test were used to examine heterogeneity across included studies. We pooled data using random-effect or fixed effect models indicated as incidence rate or proportion with 95% confidence intervals (CI). The variables of study included demographic data, endoscopy interval, follow up interval and time, GA and IM type and GC stage. Moreover, incidence rate of GC and progress rate, regress and persistence proportion in both GA and IM patients were assessed. RESULTS: Overall, 68 original articles out of 32981 citations were included in our meta-analysis. The pooled GC incidence rate in patients with GA was 1.24 (95% CI, 0.80, 1.76; I2: 83.6%) cases per 1,000 person-years. The rates of later diagnosis of IM and gastric dysplasia in patients with GA were estimated as 41.42 (95% CI, 3.11, 64.45; I2: 95.6%) and 6.23 (95% CI, 2.34, 11.46; I2: 83.0%) cases per 1,000 person-years, respectively. The pooled regressed proportion was 32.23 (95% CI, 18.07-48.02; I2: 94.0%) and the persistence proportion was 38.83 (95% CI, 20.20-59.13; I2: 97.0%) per 100 observations in GA patients. In IM studies, the pooled incidence rate of GC was 3.38 (95% CI, 2.13, 4.85; I2: 93.4%) cases per 1,000 person-years. The progressed rate to dysplasia in IM patient was estimated to be 12.51 (95% CI, 5.45, 22.03; I2: 95.1%) cases per 1,000 person-years. The pooled regressed proportion was 31.83 (95% CI, 25.48-38.51; I2: 91.0%) and the persistence proportion was 43.46 (95% CI, 32.52-54.71; I2: 96.0%) per 100 observations in IM patients. CONCLUSION: Overall, the incidence of GC in patients with IM and GA are low but there is heterogeneity in data with the highest rate in Asian, males with those with incomplete IM. There is probability of regression or persistence without progression in patients with IM and GA who receive appropriate management.

The Healing Effect of Plantago Major and Aloe Vera Mixture in Excisional Full Thickness Skin Wounds: Stereological Study.

BACKGROUND: Previous studies indicated that both Plantago major and Aloe vera have anti-inflammatory, tissue regeneration, antioxidant, and immune-stimulatory effects. It is assumed that a mixture of these two herbal medicines may provide a potent material in treatment of skin wound injuries. Therefore, in this study we investigated the effects of Plantago major and Aloe vera mixture in the process of wound healing in rat models according to stereological parameters. METHODS: In an experiential study, 36 male Sprague-Dawley rats (200±20 g) were randomly assigned into three groups (n=12): The control group which received no treatment, gel base treated group, and the 5% Plantago major and 5% Aloe vera mixture gel treated group (PA group). Treatments were done every 24 hrs for 15 days. Wound closure rate, volume densities of the collagen bundles and the vessels, vessel's length density and mean diameter, and fibroblast populations were estimated using stereological methods. RESULTS: PA treated group showed faster wound closure rate in comparison with control and gel-base groups (p<0.05). Numerical density of fibroblasts, volume density of collagen bundles, mean diameter, and volume densities of the vessels in PA group were significantly higher than the control and the gel-base treated groups (p<0.05). CONCLUSION: We showed that Plantago major and Aloe vera mixture has the ability to improve wound healing by enhancing fibroblast proliferation, collagen bundle synthesis and re-vascularization in skin injuries.

Possible Role of Myopia as a Risk Factor for Mechanical Neck Pain in Medical Students : A Pilot Study.

BACKGROUND: Mechanical neck pain (MNP) is a common health concern. Some studies suggested a relationship between neck pain and visual activity. We assessed the role of myopia as a contributing factor in the development of chronic MNP. MATERIALS AND METHODS: All medical students at Shiraz University School of Medicine, who were 18 to 22 years old, were invited to participate in this retrospective case-control study from March 2016 to March 2017. Numeric Pain Rating Scale (NPRS) was used to assess the average neck pain severity over the past 6 months in order to enroll participants as the case (≥3) or control (<3) groups. Demographic data and medical profile were obtained. After identifying eligible cases, we assigned age- and sex-matched controls, who also met the study criteria. Subsequently, participants completed the Neck Disability Index (NDI) and Neck Pain and Disability Scale (NPDS) questionnaires and were evaluated for myopia severity. Variables were compared between the case and control groups as well as within the case group. P-value<0.05 was considered statistically significant. RESULTS: From over 700 medical students, around 150 cooperated. Eventually, 31 eligible cases (and 31 controls) were studied. NDI and NPDS were significantly higher in the case group (P<0.001). However, no significant differences were noticed between the groups regarding the severity (P=0.123) and the duration (P=0.417) of myopia. Also, the correlation of myopia severity with NDPS (ρ=0.159, P=0.216) and NDI (ρ=0.201, P=0.116) was non-significant within the case group. CONCLUSION: Our findings have not supported the influential role of myopia in the development of chronic MNP.

Avicenna's Concepts on Cancer Metastasis from the 11th Century.

From ancient times to the era of industrialization, medical and philosophical scholars have long been wondering about the nature and the underlying mystery of cancer. Despite the extensive efforts in recent decades trying to shed light on the true histopathologic basis of malignancies, many questions remain to be elucidated. Thus, it's not surprising that even the most notable predecessor physicians knew only very little about cancer and metastasis. In this paper, we present a brief review of the historical assumptions about the origin and spread of tumoral growths. Subsequently, we will look at an impressing notion by Avicenna about the possibility of local metastasis, which had remained unacknowledged so far and highlights the intellect of this great Persian physician even further.

Evidence for the Important Role of Oxidative Stress in the Pathogenesis of Acne.

Acne vulgaris is a common inflammatory skin disorder which is recognizable by dermatological lesions and scars. In addition to some pathogenetic factors such as hyperkeratinization, upregulated sebum secretion, and immunoinflammatory reactions, recent studies have also connected oxidative stress to the pathogenesis of acne vulgaris. In this article, we will briefly review clinical studies that interrogated alterations in oxidative stress biomarkers by a systematic search conducted in PubMed, Web of Science, and Scopus using "acne", "oxidative stress", and "reactive oxygen species" keywords. Overall, studies have shown that oxidative biomarkers (e.g. lipid peroxidation final products) are higher in acne vulgaris lesions. A significant positive correlation has also been noted between acne severity and oxidative biomarkers. In contrast, diminished levels of antioxidant enzymes (e.g. superoxide dismutase and catalase) have been observed in acne. We propose four probable mechanisms for the role of reactive oxygen species (ROS) in acne pathogenesis. We believe that ROS can contribute significantly to the acne vulgaris pathobiology via toll-like receptor (TLR), peroxisome proliferator-activated receptor (PPAR), mTOR pathway, and innate immune system, resulting in inflammation by alterations in the generation of several proinflammatory cytokines including IL-1, IL-8, and TNF-α.

Efficacy of Topical Enalapril in Treatment of Hypertrophic Scars.

BACKGROUND: Angiotensin II activation by angiotensin-converting enzyme (ACE) is a significant mediator in wound healing and collagen production. In this study, the effect of topical application of ACE on hypertrophic scar formation has been studied in a clinical trial. METHODS: Thirty patients with hypertrophic scar and itching after treatment of 2nd or 3rd degree burns participated in this double-blinded clinical trial. Subjects had two same-degree scars on symmetrical sites of body which were randomly allocated into two groups. One side was treated with 1% enalapril ointment and the other side with placebo twice daily. During a 6-months follow-up, a scoring table for itching was completed on a daily basis by patients. Furthermore, a single surgeon measured size of scars once a month. The mean size, thickness and itching score were calculated for each scar and compared between medication and placebo-treated scars. RESULTS: The mean size of scars in enalapril treated side was significantly less than scars in the placebo side. Additionally, enalapril treated scars had significantly lower itching scores compared to the placebo group. CONCLUSION: Topical enalapril significantly decreases the clinical parameters of hypertrophic scar and also itching as an indirect indicative of scar improvement. Furthermore, enalapril proved to be clinically safe for patients with low incidence of adverse drug reactions and acceptable cost effectiveness.

Determinants of the Lethal Area 50 Index (LA50) in Burn Patients Admitted to a Tertiary Referral Burn Center in Southern Iran.

OBJECTIVE: To evaluate the lethal area 50 (LA50) and determinants of mortality in burn patients admitted to a single burn center. METHODS: This retrospective cross-sectional study was conducted in a tertiary burn center affiliated with Shiraz University of Medical Sciences, Shiraz, Iran, during a 1-year period from 2015 to 2016. To determine prognostic factors in fatal burns, medical records of eligible burn patients were reviewed for demographic and clinical variables, as well as patient outcome. Also, LA50 was calculated using Probit analysis. RESULTS: Overall 559 patients with the mean age of 27.2±23.65 years and including 343 (61.4%) males and 216 (38.6%) females were enrolled in this study. The average burn TBSA% was 31.38±24.41% (1-100%). Duration of hospital stay ranged from 1 to 67 days (15.11±10.64). With 93 expired patients, the mortality rate was calculated to be 16.6%. The total LA50 was 66.55% (58.4-79.3). Fire was the most common cause of burn injury. CONCLUSION: Compared to developed countries, in our burn center the LA50 and survival rate of burn patients are lower. This indicates an urgent need for prompt attention in order to improve current policies regarding this public health issue to reduce mortality.