Epidemiology of cervical cancer in Iran in 2016: A nationwide study of incidence and regional variation.

BACKGROUND: Cervical cancer is a common, and fatal cancer in women worldwide. This cancer is the fourth most common cancer in women after breast, colorectal, and lung cancer. AIMS: This study aims to investigate the age-standardized incidence rate (ASR) and the geographical distribution of Cervical Cancer in Iran. METHODS: This study was designed as a descriptive cross-sectional investigation. The study sample comprised all individuals registered as cervical cancer patients in the National Cancer Registry system in 2016. The crude rate and ASR for each province were computed independently. Furthermore, we employed ArcMap10.5 software and geographic information system to conduct an analysis of the gathered data. In order to ascertain the spatial distribution and clustering of cervical cancer incidence, we utilized Moran's I, which measures spatial autocorrelation. RESULTS: We studied a total of 808 cases of cervical cancer with a median age to be 52.19 years (IQR≈1.35). Among these cases, 685 (84.7%) were diagnosed based on the pathological reports with morphological verification, while 81 patients (10.1%) were clinically identified, and 42 cases (5.2%) were diagnosed using the death certificate-only method. Squamous cell carcinoma accounted for 61% of all cases (n = 497). The ASR of cervical cancer in Iran was 1.90 per 100 000 populations. The provincial ASR ranged from 0.29 to 5.03 per 100 000, with the highest rates observed in Golestan (5.03), East Azerbaijan (4.07), and Ilam (3.72). We found no clustering patterns in the distribution of provincial crude, age-specific, and age-standardized incidence rates (p > .05). CONCLUSION: The incidence of cervical cancer in Iran was lower than the global average, and we did not identify any significant disparities in the incidence rates among the provinces. Although there were differences in incidence rates among the areas, these were not clustered. It is crucial to remember that cervical cancer is still a major public health issue in Iran, and in order to lessen the disease's burden, national initiatives to enhance screening, early identification, and access to efficient treatment should continue to be top priorities.

Guillain-Barre syndrome after antithymocyte globulin administration in a kidney transplant recipient: A case report and literature review.

This report describes a rare case of developing Guillain-Barre syndrome (GBS) following receiving rabbit antithymocyte globulin (ATG) after kidney transplantation to prevent acute allograft rejection in a 34-year-old man. The patient presented severe pain in the right temporomandibular joint, fever, chills, myalgia, polyarthralgia, and bone pain. Twelve hours later, he developed quadriplegia, paresthesia, and a limited range of active motions in all extremities. No antecedent viral or bacterial infection was identified. The EMG/NCV evaluation displayed acute inflammatory sensory-motor polyneuropathy. After the administration of GBS treatment, the neurologic symptoms started to improve. Over a few days, the reflexes came back completely, and the patient was able to walk. To our knowledge, this is the second case report of ATG-related GBS after kidney transplantation.

Abnormalities of brain imaging in COVID-19 patients with neurological symptoms.

Background: Coronavirus disease 2019 (COVID-19) is a multisystem disease, manifested by several symptoms of various degrees. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) can affect the central nervous system (CNS) through several mechanisms and brain imaging plays an essential role in the diagnosis and evaluation of the neurological involvement of COVID-19. Moreover, brain imaging of patients with COVID-19 would result in a better understanding of SARS-CoV-2 neuro-pathophysiology. In this study, we evaluated the brain imaging findings of patients with COVID-19 in Shohada-e Tajrish Hospital, Tehran, Iran. Methods: This was a single-center, retrospective, and observational study. The hospital records and chest and brain computed tomography (CT) scans of patients with confirmed COVID-19 were reviewed. Results: 161 patients were included in this study (39.1% women, mean age: 60.84). Thirteen patients (8%) had ischemic strokes identified by brain CT. Subdural hematoma, subdural effusion, and subarachnoid hemorrhage were confirmed in three patients. Furthermore, there were four cases of intracranial hemorrhage (ICH) and intraventricular hemorrhage (IVH). Patients with and without abnormal brain CTs had similar average ages. The rate of brain CT abnormalities in both genders did not differ significantly. Moreover, abnormal brain CT was not associated with increased death rate. There was no significant difference in lung involvement (according to lung CT scan) between the two groups. Conclusion: Our experience revealed a wide range of imaging findings in patients with COVID-19 and these findings were not associated with a more severe lung involvement or increased rate of mortality.

Impact of Continued Social Network-based Learning Based on Midwives Knowledge and Implementation of the Helping Babies Breathe Program.

Background: The Helping Babies Breathe (HBB) program is a simple neonatal resuscitation protocol implemented in low-resource clinical systems. Therefore, it is necessary to train midwives on the implementation of this program and ensure the sustainability of the learned materials. The present study aimed to assess the impact of continued social network-based learning based on midwives knowledge and implementation of the HBB program. Materials and Methods: This randomized controlled field trial was performed on 50 midwives who were selected by the available sampling method. All midwives attended the HBB workshop; thereafter, in the intervention group, the learned materials were reinforced for 3 months using WhatsApp messenger. Data were collected using Objective Structured Clinical Examination (OSCE), which was administered before the HBB program and 3 months later (HBB guide; 2th Ed, 2018). The data were analyzed in SPSS software (version 19) using independent and paired t-tests. Results: Based on the results, the mean knowledge score was not significantly different in both groups (control and intervention) immediately after the workshop. The mean scores of knowledge and skill variations did not decrease significantly in the WhatsApp group during the 3 months; nonetheless, a marked decrease was observed in the control group (t21 = 16.68, p < 0.05). Conclusions: The results of this study pointed out that continued social network-based education promoted the knowledge and skills of health care providers, highlighting the importance of social networks in education.

Worldwide Knowledge About Interventional Radiology Among Medical Students: Findings of a Comprehensive Review.

PURPOSE: The objective of this comprehensive review is to investigate the studies assessing the interventional radiology knowledge among medical students worldwide and inspect the feasible solutions for improving their perspective on this specialty. METHODS: A comprehensive literature search was accomplished on PubMed, Scopus, Web of science, and Embase databases. The quality of eligible articles was assessed with the QATSDD assessment tool. RESULTS: After screening of articles, 29 studies were included. All the included articles were published between 2009 and 2021, with 20 studies performed in 2017 and thereafter. Interventional radiologists' duties, procedures, and training pathways were the main subjects investigated in surveys. The interest and exposure to interventional radiology were also assessed. All the studies indicated that the knowledge about interventional radiology compared with other specialties is weak. In 14 studies, over 50% of participants reported their interventional radiology knowledge as either poor or none. The most reason for not considering interventional radiology residency was lack of awareness during medical schools. Studies which held a tutorial course reported the students' awareness and interest improved significantly after the course. CONCLUSION: The present evidence indicates that although the current awareness of interventional radiology is low, timely didactic courses in medical schools can improve this condition significantly, lead to graduation of more oriented referring physicians, and also attract more fit applicants to interventional radiology residency programs.

Relapsing anemia associated with parvovirus B19 infection in a kidney transplant recipient: A case report and review of the literature.

Key clinical message: PB19 infection should be considered an uncommon cause of posttransplant anemia in renal transplant recipients, particularly those whose anemia is not associated with common etiologies. IVIG treatment and reduced immunosuppression could be beneficial. Abstract: Parvovirus B19-associated relapsing anemia is rare in kidney transplant recipients. Herein, we report a case of relapsed anemia due to parvovirus B19 infection in a 53-year-old woman 18 months after kidney transplantation. The patient presented with palpitations, shortness of breath, dizziness, weakness, and lethargy. Early laboratory findings showed a WBC count of 6.000/µL, RBC count of 1.89/µL, hemoglobin (Hb) 3.5 g/dL, hematocrit (Hct) 15%, platelet count 266.000/µL, MCV 89, reticulocyte count 0.8%, and serum iron 221 µg/dL. Upon further evaluation, the RT-PCR test for BK polyomavirus and cytomegalovirus (CMV) was negative, while the parvovirus B19 RT-PCR was positive. The patient was treated with blood transfusion and IVIG 25 g daily for 5 days. Two months after discharge, the patient presented, complaining of palpitation, shortness of breath, and dizziness, with RBC 2.7/µL, Hb 6.5 g/dL, Hct 25%, and MCV 85. Again, the CMV RT-PCR was negative, while the parvovirus B19 RT-PCR was positive. Tacrolimus and mycophenolic acid were stopped, and IVIG 25 g daily for 5 days was administered. Consequently, her Hb level increased to 9 g/dL, and the patient was discharged with prednisolone 5 mg daily and cyclosporine 50 mg daily instead of tacrolimus. Viral infection, particularly PB19 infection, should be considered in the differential diagnosis of posttransplantation anemia in KTRs. IVIG treatment and modification of immunosuppressive medications are suggested standard therapies for such patients. The function of transplanted kidneys should be carefully monitored during treatment.

ß_lactam antibiotics against drug addiction: A novel therapeutic option.

Drug addiction as a problem for the health of the individual and the society is the result of a complex process in which there is an interaction between brain nuclei and neurotransmitters (such as glutamate). ß-lactam antibiotics, due to their enhancing properties on the glutamate transporter glutamate transporter-1, can affect and counteract the addictive mechanisms of drugs through the regulation of extracellular glutamate. Since glutamate is a key neurotransmitter in the development of drug addiction, it seems that ß-lactams can be considered as a promising treatment for addiction. However, more research in this field is necessary to identify other mechanisms involved in their effectiveness. This article is a review of the studies conducted on the effect of ß-lactam administration in preventing the development of drug addiction, as well as their possible cellular and molecular mechanisms. This review suggests the clinical use of ß-lactam antibiotics that have weak antimicrobial properties (such as clavulanic acid) in the treatment of drug dependence.

Assessment of Field-in-Field, 3-Field, and 4-Field Treatment Planning Methods for Radiotherapy of Gastro-Esophageal Junction Cancer.

Background: Gastro-esophageal (GE) junction cancer is the fastest-growing tumor, particularly in the United States (US). Objective: This study aimed to compare dosimetric and radiobiological factors among field-in-field (FIF), three-field (3F), and four-field box (4FB) radiotherapy planning techniques for gastro-esophageal junction cancer. Material and Methods: In this experimental study, thirty patients with GE junction cancer were evaluated, and three planning techniques (field-in-field (FIF), three-field (3F), and four-field box (4FB)) were performed for each patient for a 6-MV photon beam. Dose distribution in the target volume, the monitor units (MUs) required, and the dose delivered to organs at risk (OARs) were compared for these techniques using the paired-sample t-test. Results: A significant difference was measured between the FIF and 3F techniques with respect to conformity index (CI), dose homogeneity index (HI), and tumor control probability (TCP) for the target organ, as well as the Dmean for the heart, kidneys, and liver. For the spinal cord, the FIF technique showed a slight reduction in the maximum dose compared to the other two techniques. In addition, the V20 Gy of the lungs and the normal tissue complication probability (NTCP) of all OARs were reduced with FIF method. Conclusion: The FIF technique showed better performance for treating patients with gastro-esophageal junction tumors, in terms of dose homogeneity in the target, conformity of the radiation field with the target volume, TCP, less dose to healthy organs, and fewer MU.

Novel phenotype and genotype spectrum of WDR62 in two patients with associated primary autosomal recessive microcephaly.

BACKGROUND: Microcephaly is a prominent feature of patients with primary autosomal recessive microcephaly 2 (MCPH2) caused by mutations in the WD Repeat Domain 62 (WDR62; OMIM: 613,583). AIM: The study aimed to identify the underlying genetic factor(s) causing microcephaly in two patients in a consanguineous Iranian family. METHODS: Two male patients (11 and 27 years old) were noticed due to microcephaly, neurodevelopmental delay, and occasional seizures. The younger patient (the proband) was subjected to paired-end whole-exome sequencing followed by Sanger sequencing to detect any underlying genetic factor. RESULTS: Upon examination, both patients showed microcephaly as a prominent manifestation; they were under-weighted as well. The patients had a moderate gross motor impairment, severe cognitive disability and speech delay, increased deep tendon reflexes, flexible joint contractures, sensorineural hearing loss, and vertical nystagmus as a new ocular finding. The proband had more severe neurodevelopmental delay symptoms. The brain magnetic resonance imaging series revealed severe structural and cortical brain abnormalities in addition to hemiatrophy. Using Whole-exome Sequencing, a novel homozygous missense variant-NM_001083961.2; c.1598A > G: p.(His533Arg)-was identified in the WDR62. Subsequently, in silico analyses determined the possible impacts of the novel variant on the structure and function of WDR62 protein. CONCLUSIONS: Herein, we identified a novel homozygous missense variant in the WDR62 in two patients with MCPH2. Vertical nystagmus and sensorineural hearing loss were detected as novel neurological findings. The present study expands the phenotype and genotype spectrum of MCPH2.

Transverse myelitis after SARS-CoV-2 infection: Report of two cases with COVID-19.

Transverse myelitis has been reported as a complication of COVID-19 in recent studies. Here, we report two cases of transverse myelitis related to COVID-19. Both patients underwent plasma exchange after being treated with antibiotics and corticosteroids which lead to the recovery of one of them.

Metoprolol: New and Efficient Corrosion Inhibitor for Mild Steel in Hydrochloric and Sulfuric Acid Solutions.

The inhibition behavior of metoprolol tablet on steel alloy (st37) in 1 M hydrochloric acid and 0.5 M sulfuric acid solutions were studied by three methods (potentiodynamic polarization, electrochemical impedance spectroscopy, and scanning electronic microscopy, SEM). The obtained parameters revealed that different amounts of metoprolol drug inhibited the corrosion of mild steel in the acid solutions of HCl and H2SO4. The corrosion resistance of the alloy increased with the increase in the concentration of metoprolol up to 300 ppm but was reduced by increasing the temperature. The derived parameters from polarization curves indicated that the drug is a mixed type inhibitor. The results obtained from the different methods are consistent with each other. The adsorption of metoprolol was found to be physical, exothermic, and spontaneous, and also fitted the Langmuir adsorption model. SEM micrographs are in accordance with the adsorption performance of the tablet.

Factors affecting emergency medical dispatchers' decision-making: a qualitative study.

INTRODUCTION: Prehospital emergency medical service dispatchers should make prompt and appropriate decisions to save the life of victims. The complexity of timely and reasonable decision-making in life-threatening conditions has driven researchers to investigate varying aspects of the emergency medical dispatch (EMD) process. The purpose of this study was to explore the contributors to appropriate and prompt decision-making among dispatchers. METHODS: A qualitative study through thematic analysis was designed. Data were collected using observation and semistructured interviews with 16 authorities and dispatchers in seven EMDs across Iran. RESULTS: The study found "responsiveness" as the main category contributing to improved decision-making in EMD. The components introduced in this study for dispatchers' responsiveness consisted of two categories. The first was "personal values" including faith and belief, eagerness to help, service excellence, altruism, respect, and impartiality in clinical judgment. The second was "professional attitudes" resulting from education and experience, including the recognition of emergency as a threat to health, sensitivity in triage, response to all requests for help, care for early warnings, commitment to organizational goals and standards, attention to the emergency medical service social support responsibility, and professional temperance. CONCLUSION: In this study, responsiveness was identified as a main category in improving the decision-making process among dispatchers. To attain responsiveness, institutionalization of its values and establishment of EMD-specific professional attitudes in dispatchers should be taken into consideration.

Three years evaluation of retained foreign bodies after surgery in Iran.

BACKGROUND: Medical errors such as retained foreign bodies (RFB) during surgery are not well studied. To define risk factors associated with this type of error, we performed retrospective study. METHODS: We reviewed medical records for unintentional foreign object remaining in the body during surgery such as gender, age, surgery ward, and incident reports referred to several forensic medicine administrations as well as adverse effects of retained foreign bodies and methods for detection of them over a 3-years period from January 2008 through May 2011. RESULTS: Thirty eight patients were involved in the study to have retained foreign bodies (73% sponges and 27% other instruments including 7 (18.42%) cases of other bandages, 2 cases (5.26%) of scissor and 1 case (2.63%) of forceps). The general surgery ward was most commonly involved (47%) followed by the gynecology surgery ward (34%). Men (58%) were more involved with RFB than women (42%). CONCLUSION: Considering the most frequent type of retained foreign bodies and also more frequent involved surgery wards besides detection methods for RFB, a mixed of preventing protocols such as regular counting of devices, post-operative X-ray with radiopaque markers and exact evaluation of surgery site should be employed to reduce the occurrence of retained foreign bodies and its complications.

The relationship between clinicobiochemical markers and depression in women with polycystic ovary syndrome.

BACKGROUND: Previous studies have demonstrated that clinical features of Polycystic ovary syndrome (PCOS) are associated with a lower degree of health, self, and sex satisfaction. OBJECTIVE: Our study aimed to investigate possible associations between depression and different clinicobiochemical markers of PCOS. MATERIALS AND METHODS: In a cross-sectional analytic study, 120 PCOS women aged 18-45 yr, were enrolled. Beck Depression Inventory was used to assess depression. Also, all participants underwent biochemical studies. Individuals with 15 points and more in Beck test were referred to a psychiatrist to participate in a complementary interview for the diagnosis of depression based on Diagnostic and Statistical Manual of Mental Disorders IV (DSMIV-TR) criteria. RESULTS: Among the study participants, 82 women (68.3%) were non-depressed, and 38 patients (31.7%) had some degrees of depression. According to the psychiatric interview, 10 patients (8.3%) had major depression, 22 patients (18.3%) had minor depression and 6 patients (5%) had dysthymia. We failed to show any significant difference in body mass index, hirsutism, infertility, serum total testosterone, lipid profile, and the homeostasis model assessment of insulin resistance (HOMA-IR) between depressed and non-depressed subjects (p>0.05). Using Spearman correlation, we did not find a positive correlation between BDI scores and clinicobiochemical markers for all PCOS subjects (-0.139≤r≤+0.121, p>0.05). CONCLUSION: In spite of high rate of depression in women with PCOS, there was no significant association between Clinicobiochemical Markers and depression.

Comparison of gestational diabetes mellitus and pre-eclampsia in women with high hemoglobin in the first trimester of pregnancy: A longitudinal study.

OBJECTIVE: To determine the association between high hemoglobin with gestational diabetes mellitus (GDM) and preeclampsia in pregnant women in the first trimester. METHODS: This cohort study was conducted among 973 pregnant women who started their antenatal booking in the first trimester (first 14 weeks of gestation). Women with first-visit high Hb levels (> 12.5 g/L) on first visit of the pregnancy period were selected as the study group and were compared with those who had normal Hb value (< 12.5 g/L) as controls. Adverse pregnancy outcomes including preeclampsia and GDM were compared between the two groups. RESULTS: Complete obstetric records of 448 women with high Hb levels and 486 women with normal Hb levels were studied. The follow up showed that the women with high Hb levels had significantly higher rates of preeclampsia and GDM than those with normal Hb levels; the risks were 5.4 (95% cl; 2.8 to 10.5) and 3.7 (95%cl; 2.2 to 6.4), respectively. CONCLUSION: This study found that high Hb in the first trimester is associated with higher risk of subsequent preeclampsia and gestational diabetes mellitus (GDM).

Decreased expressions of Toll-like receptor 9 and its signaling molecules in chronic hepatitis B virus-infected patients.

CONTEXT: Toll-like receptors (TLRs) play crucial roles in immune responses, especially innate immunity, against viral infections. Toll-like receptor 9 recognizes intracellular viral double-strand DNA, which leads to the activation of nuclear factor B (NF-κB) through the myeloid differentiation primary response 88 (MYD88) pathway. Defects in the expression of TLR9 and its signaling molecules may cause attenuated immune responses against hepatitis B virus. OBJECTIVE: To determine expression levels of TLR9 messenger RNA along with MYD88, interleukin 1 receptor-associated kinase 1 (IRAK1), tumor necrosis factor receptor-associated factor 6 (TRAF6), and NF-κB in the peripheral blood mononuclear cells obtained from chronic hepatitis B virus (CHB)-infected patients. DESIGN: In this study, 60 CHB patients and 60 healthy controls were recruited and the expression of TLR9 and its downstream signaling molecules was examined by real-time polymerase chain reaction techniques using ß-actin as a housekeeping gene. RESULTS: Our results showed that expression of TLR9, MYD88, IRAK1, TRAF6, and NF-κB in peripheral blood mononuclear cells of CHB patients was significantly decreased in comparison with healthy controls. CONCLUSIONS: According to our results, it appears that CHB patients are unable to appropriately express genes in the TLR9 pathway, which may impede immune responses against hepatitis B virus infection. These results suggest a mechanism that may partially explain the fact that immune responses are disrupted in CHB patients.

Suicide and associated risk factors in Hamadan province, west of Iran, in 2008 and 2009.

BACKGROUND: Hamadan is a province with high incidence rate of suicide. The present study was conducted to assess suicide and its associated risk factors in this province. METHODS: In this cross-sectional study, all cases of suicide occurred in the province, were investigated from April 2008 to March 2010. The data were collected from Provincial Health Center and Forensic Medicine's databases using a checklist developed according to the available records. RESULTS: A number of 5414 suicide attempts had occurred (with 8.4% deaths) including 2753 women (with 3.4% death) and 2660 men (with 13.7% death). Majority of the suicide attempts and completed suicides occurred among adults aged 20-29 years. About 6.7% of the cases who attempted for suicide and 14.2% of the cases who died from suicide had a previous history of suicide attempt (P<0.001). Familial problems (49.7%) and psychiatric disorders (31.6%) were among the most common reasons of suicide attempt. Using drugs (74.0%) were the most common method of attempting suicide while hanging (83.6%), burning (74.2%), and gunshot (52.4%) were the most common leading causes of completed suicide (P<0.001). Adjusted odds ratio estimate of completed suicide in males against females was 2.27 (95% CI: 1.63, 3.14). The odds of completed suicide increased 1.43 (95% CI: 1.30, 1.57) fold per 10 years of age. CONCLUSION: This survey identified and highlighted the most common and important potential risk factors for suicide. In addition, the effects of various demographic risk factors on suicide attempt and completed suicide were examined. These evidences may be useful for future research, policy, and treatment efforts aimed at understanding and preventing suicide.