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The Iranian Integrated Care Electronic Health Record
Get PDFE-health plays a crucial role in E-government by proposing healthcare services based on information technology. However, the way to administer these services by using E-health solutions is one of the challenging issues. One of these significant challenges is how one integrates heterogeneous healthcare information of the different point of care systems. This paper introduces the Iranian integrated care electronic health record using the information gathered from several point-of-care systems in healthcare enterprises in Iran. This service-oriented architecture has a remarkable characteristic - its accessibility to medical knowledge and medical concepts through archetypes and ontology, respectively. The Ministry of Health and Medical Education of the Islamic Republic of Iran has designed and implemented this national architecture
Multifunctional Theranostic Graphene Oxide Nanoflakes as MR Imaging Agents with Enhanced Photothermal and Radiosensitizing Properties
Get PDFThe integration of multiple therapeutic and diagnostic functions into a single nanoplatform for image-guided cancer therapy has been an emerging trend in nanomedicine. We show here that multifunctional theranostic nanostructures consisting of superparamagnetic iron oxide (SPIO) and gold nanoparticles (AuNPs) scaffolded within graphene oxide nanoflakes (GO-SPIO-Au NFs) can be used for dual photo/radiotherapy by virtue of the near-infrared (NIR) absorbance of GO for photothermal therapy (PTT) and the Z element radiosensitization of AuNPs for enhanced radiation therapy (RT). At the same time, this nanoplatform can also be detected by magnetic resonance (MR) imaging because of the presence of SPIO NPs. Using a mouse carcinoma model, GO-SPIO-Au NF-mediated combined PTT/RT exhibited a 1.85-fold and 1.44-fold higher therapeutic efficacy compared to either NF-mediated PTT or RT alone, respectively, resulting in a complete eradication of tumors. As a sensitive multifunctional theranostic platform, GO-SPIO-Au NFs appear to be a promising nanomaterial for enhanced cancer imaging and therapy. © 2021 American Chemical Society
Clinical and epidemiological characteristics of hospitalized COVID-19 patients in Hormozgan, Iran: A retrospective, multicenter study
Get PDFBackground: To better manage the COVID-19 pandemic, it is necessary to carefully study information about patients with COVID-19. Objective: To report clinical and epidemiological characteristics of COVID-19 patients in southern Iran. Methods: This cross-sectional retrospective study was conducted based on data extracted from the COVID-19 registry of Hormozgan. Data from patients with confirmed COVID-19 based on CT-scan results or real-time reverse transcriptase�polymerase chain reaction (RT-PCR) results until September 25, 2020, were analyzed for this study (2351 inpatients). We reported demographics, signs and symptoms on admission, comorbidities, and treatments, as well as clinical outcomes, hospital stay, and intensive care unit (ICU) admission. Results: Most of patients were men (1235/2351; 52.5) and the most common signs and symptoms included cough (1343/2351; 57.1), shortness of breath (1224/2351; 52.1) and fever. The most common comorbidities included hypertension (410/2351 (17.4), diabetes (343/2351; 14.6) and chronic cardiac disease (282/2351; 12). Also, 228 patients (9.7) were hospitalized in the ICU. The mortality rate was 12.5 (295/2351) among all patients and 64.5 (147/228) in ICU wards, respectively. The number of cases with comorbidities including hypertension, chronic cardiac disease, diabetes, chronic neurological disorders, chronic kidney disease, chronic hematologic disease, malignant neoplasm, moderate or severe liver disease, dementia and fauvism in the ICU was significantly higher than the general wards. Conclusion: Most characteristics of our patients were similar to those reported in other studies; however, our patients were younger and suffered from a less severe disease. The mortality rate in the ICU was higher than other studies. © 2021 Academy of Medical Sciences of I.R. Iran. All rights reserved
Relapse, mortality, and the associated factors in children with acute lymphoblastic leukemia; a competing risks analysis
Get PDFBackground: Acute lymphoblastic leukemia (ALL) is the most frequent form of malignant neoplasia diagnosed in ages 0 to 14 years old. Efforts have not yet converted into a better prospect. Bone marrow relapse is still the leading cause of person-year of life lost in this malignancy. Objectives: This study aimed at identifying the associated risk factors for relapse and mortality for pediatric patients with ALL in standard and high-risk groups. Methods: This study included a cohort of pediatric (0-16 years old) patients with ALL referred to Sheikh Hospital, Mashhad, Iran from 2007 to 2016. The demographic, clinical, and laboratory information were considered. Hazard ration (HR) with 95 highest posterior density region was obtained, using a Bayesian competing risks model. Results: Of 424 patients with a mean age of 5.56 ± 3.75 years, 172 (40) were female. Median follow-up time was 43.29 months, 10.6 had a relapse, and 17.2 had mortality related to ALL. Relapse-free survival rates at 1, 3, and 5 years were 97, 91, and 88, respectively. Overall survival rates were 86, 83, and 82, respectively. In the standard-risk group, tumor lysis syndrome (TLS) significantly increased either the relapse risk HR: 13.47 (2.05-67.54) or mortality risk HR: 19.57 (2.24-32.18). In the high-risk group, the higher level of hemoglobin, platelet, and lactic acid dehydrogenase was significantly associated with higher relapse risk. TLS was associated with a higher risk of mortality in high-risk groups. Conclusions: It was suggested that TLS was a predictor for the disease relapse as well as mortality in pediatric patients with ALL. However, further evaluation on the larger population of patients is demanded to ascertain the precision of such parameters in leukemic management strategies. © 2021, Author(s)
Percutaneous balloon pulmonary valvuloplasty of critical pulmonary stenosis and severe pulmonary stenosis in neonates and early infancy: A challenge in the cyanotic
Get PDFIntroduction: Pulmonary stenosis with an intact ventricular septum (PS-IVS) is one of the common causes of cyanotic heart disease in neonates with diverse morphologies as well as management and treatment protocols. The aim of this study was to evaluate short and midterm results of balloon pulmonary valvuloplasty (BPV) for this disorder. Methods: Between 2012 and 2016, Totally 45 neonates and infants under 6 months old were evaluated. The patients had a minimum right-to-left ventricular pressure ratio of 1, right-to-left shunting at the patent foramen ovale or atrial septal defect level, and tricuspid valve Z-scores higher than -4. Results: Immediately after the procedure, the right ventricular pressure dropped to the normal values in 8 (20) patients. The immediate procedural success rate was seen in 42 (93.3) cases: the right-to-left ventricular pressure ratio dropped to below 50 or the level of O2 saturation rose above 75. Of three cases unresponsive to BPV, two of them underwent patent ductus arteriosus (PDA) stenting and one procedural death occurred. At 6 months' follow-up, of 42 patients, this pressure was still within the normal range in 36 (80) infants, while it had returned to high values in 9 (20) patients and necessitated repeat valvuloplasty. After BPV, severe pulmonary valve regurgitation was observed in 14.2 patients; the condition was more common when high-profile noncompliant balloons were used. Conclusion: Balloon pulmonary valvuloplasty in infants with PS-IVS confers acceptable results insofar as it improves echocardiographic parameters and hemodynamic changes at short- and midterm follow-ups. Balloon selection with sizes more than 1.2 of the diameter of the pulmonary valve annulus and the use of noncompliant high-pressure balloons results in higher degrees of pulmonary regurgitation. © 2021 The Author(s)
A systematic review of N-acetylcysteine for treatment of acne vulgaris and acne-related associations and consequences: Focus on clinical studies
No full textAcne vulgaris is one of the most common dermatologic disorders affects people of all races and ethnicities and has many adverse effects on the quality of life. The increased bacterial resistance to antibiotics has reduced the effectiveness of treatment with these agents. There is an increasing focus on the involvement of oxidative stress in the pathophysiology of acne. This study investigates the effect of N-acetylcysteine (NAC) as an antioxidant in the treatment of acne vulgaris. This systematic review was conducted through a search in databases such as Science Direct, PubMed, Scielo, and Medline using keywords including acne vulgaris, anti and NAC, and all the keywords associated with each of the subtitles. The factors affecting the occurrence and expansion of acne include increased sebum synthesis, hyperkeratinization of pilosebaceous units, colonization with Propionibacterium acnes, and increased release of inflammatory mediators and ROS. Studies have shown that glutathione stimulation following the administration of NAC increases glutathione levels for the detoxification of oxygen-free radicals. Moreover, NAC prevents the synthesis and release of inflammatory cytokines such as TNF-α, IL-8, IL-6, MP9, and IL-1β and has shown antibacterial activities against important bacteria including E. coli, S. epidermidis, Pseudomonas, and Klebsiella. This medication has anti-proliferative effects and is also used for excoriation and PCOD. The results of the present study showed the beneficial effects of using NAC in patients with acne vulgaris in terms of the disease complications and comorbidities. Given its diverse functional mechanisms, this medication can be used to treat acne and its consequences. © 2021 Wiley Periodicals LLC
Giant saccular abdominal aortic aneurysm with manifestation of gastric inlet obstruction mimicking a fundal gastrointestinal stromal tumor: A report on an unexpected case
Get PDFWe present an extremely rare report on gastric inlet obstruction due to giant abdominal aortic aneurysm. Despite the rare occurrence of this manifestation, it should be considered in the differential diagnosis of gastric inlet obstructions. © 2021 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd
Irreversible coronary aneurysm presenting as acute coronary syndrome in a child with hypereosinophilic syndrome: A case report
No full textHypereosinophilic syndrome is defined as persistent eosinophilia in the blood for more than 6 months, without any identifiable cause and with end-organ involvement evidence. Cardiac manifestations of HES include heart failure due to restrictive cardiomyopathy, arrhythmia, intraventricular thrombosis, and coronary artery involvement occurs frequently. In rare instances, coronary ectasia, aneurysms, or dissection can occur and cause morbidity and mortality in these patients. A coronary aneurysm occurs rarely in adult patients with HES but to our knowledge, this is the first report of this association in a 14-year-old boy who was presented to us as coronary aneurysm due to hypereosinophilic syndrome. © 2021 Cambridge University Press. All rights reserved
Imaging data in COVID-19 patients: focused on echocardiographic findings
Get PDFTo assess imaging data in COVID-19 patients and its association with clinical course and survival and 86 consecutive patients (52 males, 34 females, mean age = 58.8 year) with documented COVID-19 infection were included. Seventy-eight patients (91) were in severe stage of the disease. All patients underwent transthoracic echocardiography. Mean LVEF was 48.1 and mean estimated systolic pulmonary artery pressure (sPAP) was 27.9 mmHg. LV diastolic dysfunction was mildly abnormal in 49 patients (57.6) and moderately abnormal in 7 cases (8.2). Pericardial effusion was present in 5/86 (minimal in size in 3 cases and mild- moderate in 2). In 32/86 cases (37.2), the severity of infection progressed from �severe� to �critical�. Eleven patients (12.8) died. sPAP and computed tomography score were associated with disease progression (P value = 0.002, 0.002 respectively). Tricuspid annular plane systolic excursion (TAPSE) was significantly higher in patients with no disease progression compared with those who deteriorated (P value = 0.005). Pericardial effusion (minimal, mild or moderate) was detected more often in progressive disease (P = 0.03). sPAP was significantly lower among survivors (P value = 0.007). Echocardiographic findings (including systolic PAP, TAPSE and pericardial effusion), total CT score may have prognostic and therapeutic implication in COVID-19 patients. © 2021, The Author(s), under exclusive licence to Springer Nature B.V. part of Springer Nature
Accumulation of potentially harmful elements (PHEs) in lettuce (Lactuca sativa L.) and coriander (Coriandrum sativum L.) irrigated with wastewater: a systematic review and meta-analysis and probabilistic health risk assessment
No full textWater shortage and stress around the world lead to increasing wastewater reuse for the agricultural sector. In addition to its benefits, it can be a way to transfer pollutants such as potentially harmful elements (PHEs) to the human food chain. Many studies have been conducted for this purpose on various vegetables; however, no comprehensive study has been performed on lettuce (Lactuca sativa L.) and coriander (Coriandrum sativum L.). In this respect, the study was aimed to meta-analyze the PHEs concentration in the edible part of lettuce and coriander vegetables irrigated by wastewater. Carcinogenic risk (CR) and noncarcinogenic risk (non-CR) assessments were also done for consumers. After reviewing 32 included articles (41 studies), the rank order of the PHEs in lettuce was obtained as Fe (194.76 mg/kg) > Zn (133.47 mg/kg) > Cu (55.70 mg/kg) > Ni (26.96 mg/kg) > Pb (12.80 mg/kg) > Cr (9.68 mg/kg) Cd (8.24 mg/kg) > As (1.13 mg/kg) and for coriander Fe (1056 mg/kg) > Zn (79.80 mg/kg) > Cr (28.34 mg/kg) > Ni (24.71 mg/kg) > Cu (17.46 mg/kg) > Pb (13.23 mg/kg) > Cd (2.23 mg/kg). Total target hazard quotient (TTHQ) for adults in all countries except UAE, France, and Kenya and for children all countries except Kenya was more than 1 value. The carcinogenic risk for adult groups in Nigeria, France, China, and Iran countries was not acceptable (CR > 1E-4). As a consequence, it can be noted that wastewater reuse in the agriculture sector can endanger the health of consumers. © 2021, The Author(s), under exclusive licence to Springer-Verlag GmbH, DE part of Springer Nature