Repository of Research and Investigative Information Isfahan University of Medical Sciences
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Comparative Evaluation of Simplified and Modified Histologic Criteria in the Diagnosis of Chronic Autoimmune Hepatitis
No full textBackground: The present study aimed at comparing simplified and modified histologic criteria alone and along with other indicators in the diagnosis of chronic autoimmune hepatitis (AIH). Materials and Methods: In this cross-sectional study, 48 cases were selected from slides and paraffin blocks of patients suspected of chronic AIH according to clinical and laboratory data, including serology and autoantibody findings and viral hepatitis test results. Then, scores equal to 1 (compatible hepatitis), 2 (typical hepatitis), = 7 (definite hepatitis) were calculated based on the simplified histologic criteria, modified histologic criteria, and these two criteria, along with other indicators including antinuclear antibodies (Ab), smooth muscle Ab or liver-kidney microsomal Ab or soluble liver antigen (Ag) and serum immunoglobulin G (IgG) and absence of viral hepatitis. Results: The results of this study revealed that based on the simplified histologic criteria, 43.8 and 56.3 of these cases were assigned a score of 1 and 2 points, respectively. However, calculating the total score using the simplified criteria along with other indicators showed that 60.4 and 39.6 of cases were assigned a score = 7 points, respectively. Moreover, the modified histologic criteria indicated that 25 and 75 of cases were assigned a score of 1 and 2 points, respectively. Conclusion: According to the findings of the present study, the modified histologic criteria compared to the simplified histologic criteria identified a higher percentage of patients assigned a score of 2 points. Moreover, modified histologic criteria, along with other indicators, were more accurate in detecting definite AIH (score >= 7 points)
External cold and vibration with BUZZY versus topical anesthetic gel for pain and anxiety associated with infiltrative anesthesia in pediatric dentistry: a double-blinded, split-mouth, randomized, controlled trial
No full textPurpose A way to reduce the pain of injection is applying of external cold or vibrations with BUZZY, along with spinal cord gate control systems. We aimed to evaluate the effectiveness of this method in reducing children's pain and anxiety during infiltrative anesthesia. Materials and Methods This was a double-blinded, randomized, split-mouth, controlled, trial. Thirty 6 to 12-year-old children with decayed first permanent molar tooth on both sides of their maxilla were enrolled. Each side of the children's mouths was randomly allocated to either BUZZY or topical anesthetic gel prior to infiltrative anesthesia. Pain and anxiety during infiltrative anesthesia were measured with the Baker-Wong (BWS), FLACC (Face, Leg, Activity, Cry, Consolability), and heart rate (HR) scales. Results A generalized estimating equation (GEE) adjusted for age and baseline HR, indicated, significantly-lower intra-procedural HRs associated with BUZZY (aOR 95%CI: 0.02 0.00, 0.91, p=0.04). GEEs adjusted for age revealed the BWS (aOR 95%CI: 0.59 0.30, 1.14, p=0.12) and FLACC (aOR 95%CI: 0.82 0.62, 1.09, p=0.17) scores to be comparable between the study arms. Conclusion Our study failed to demonstrate the superiority of BUZZY over anesthetic gels regarding WBS and FLACC measures of pain and anxiety, but demonstrated a decrease in HR associated with BUZZY
The prevalence of cancer in patients with multiple sclerosis (MS) who received rituximab: a systematic review and meta-analysis
No full textObjective: To estimate the pooled prevalence of cancer in patients with multiple sclerosis (MS) cases who were under treatment with rituximab. Methods: We searched PubMed, Scopus, EMBASE, Web of Science, and google scholar along with gray literature up to April 2021. The search strategy included the MeSH and text words as (("CD20 Antibody" AND Rituximab) OR "Rituximab CD20 Antibody"OR Mabthera OR "IDEC-C2B8 Antibody"OR "IDEC C2B8 Antibody"OR IDEC-C2B8 OR "IDEC C2B8" OR GP2013 OR Rituxan OR rituximab) AND ((Sclerosis AND multiple) OR (sclerosis AND disseminated) OR disseminated sclerosisOR multiple sclerosisOR Results: The literature search revealed 3577 articles, after deleting duplicates 2066 remained. For the meta-analysis, 22 studies were included. Totally, 15599 patients were enrolled while 133 cancers were detected. The pooled prevalence of cancer in MS patients under treatment with rituximab is 1in 100,000 Conclusion: The results of this systematic review and meta-analysis show that the pooled prevalence of cancer in MS patients who received rituximab is 1 in 100,000 cases. (c) 2022 Published by Elsevier Espa & ntilde;a, S.L.U. on behalf of Sociedad Espa & ntilde;ola de Neurolog & iacute;a
Letter Regarding: "Automobile-Pedestrian Injuries: Are Pedestrian Safety Features Associated With Injury Severity?"
No full textPregnancy outcomes in women with mitral valve stenosis: 10-year experience of a tertiary care center
No full textIntroduction Mitral stenosis (MS) is recognized as one of the most common cardiovascular diseases during pregnancy and can result in adverse outcomes including maternal and fetal mortality if not diagnosed and treated in a timely manner. This study aimed to investigate the pregnancy outcomes of women with MS who were treated at the cardio-obstetric clinic in Alzahra Hospital, Isfahan, from 2011 to 2020. Methods A total of 81 pregnant women diagnosed with MS were selected for the study. Their demographic and clinical data, along with echocardiography information-including systolic pulmonary artery pressure (SPAP), severity of MS, and NYHA class-were monitored throughout pregnancy. Additionally, the maternal and fetal outcomes were examined. Results Among the participants, 38.3 were diagnosed with progressive MS, 56.8 exhibited severe stenosis, and 4.9 presented with very severe stenosis. Prior to pregnancy, no cases were classified as NYHA class 3 or 4. However, during the first trimester, six patients (7.4) were classified as NYHA class 3. In the second trimester, 23 patients (28.4) were in class 3, and 1 patient (1.2) was classified as class 4. In the third trimester, 24 cases (29.6) were in class 3, and 14 cases (17.3) were in class 4. Notably, significant changes in NYHA class were observed throughout pregnancy (P < 0.001). Furthermore, 16 of participants required percutaneous balloon mitral commissurotomy, highlighting the severity of their condition. Additionally, 2.5 experienced decompensated heart failure and another 2.5 developed arrhythmia after delivery. Unfortunately, there was one case (1.2) of mortality due to complications from MS. The study also documented one stillbirth (1.2), 11 cases (13.6) of spontaneous abortion, 17 cases (21) of induced abortion, six cases (7.4) of birth anomalies, three cases (3.7) of prematurity, and four cases (4.9) of intrauterine growth restriction, underscoring the critical need for careful management. Conclusion The results of the study suggest that cardiac function in women diagnosed with MS typically declines during pregnancy. Furthermore, even with optimal treatments, certain complications may still arise
Investigating the Efficacy and Safety of Oral Cicaglocal on Wound Healing After Mohs Surgery in Patients With Skin Cancer: A Randomized, Double-Blinded, Placebo-Controlled Clinical Trial
No full textBackgroundMohs micrographic surgery is the gold standard treatment for skin cancers in cosmetically sensitive anatomic areas, with a cure rate close to 100. Managing post-Mohs surgery wounds can pose challenges, particularly in elderly patients. This study evaluates the Cicaglocal drug, a supplement with bromelain, Centella asiatica, hyaluronan, vitamins, and minerals, for enhancing wound healing post-Mohs surgery.MethodThis double-blinded, randomized clinical trial conducted at Al-Zahra Hospital in 2023 involved 24 patients aged 50-80 with SCC or BCC undergoing Mohs surgery. Patients were randomized into two groups Cicaglocal and placebo. Treatments were administered postoperatively, and outcomes such as erythema reduction, early healing score (EHS), full recovery, and patient and physician satisfaction levels were evaluated 7 and 14 days after initiation. Data were collected through clinical assessments and standardized wound photographs.ResultOral Cicaglocal demonstrated significantly improved outcomes compared to their respective placebo groups in terms of erythema score, EHS, full recovery score, and patient and physician satisfaction levels.ConclusionCicaglocal can enhance wound healing and lead to improved clinical outcomes following Mohs micrographic surgery
A policy context and process analysis to implement the Paris Agreement on climate change in the health system of Iran
No full textBackgroundEnsuring public health is crucial in any policy debate on climate change. Paris Agreement on Climate Change is a global contract through which countries have committed themselves to a public health treaty. This study was conducted to identify the challenges that lie ahead for policymakers and provide an evidence-informed framework for policymaking to increase the resilience of Iran's health system to health consequences of climate change.MethodsA qualitative study using semi-structured interviews was conducted with 25 experts. Purposeful and snowball sampling techniques were used for data gathering. Thematic content analysis was conducted with a deductive-inductive approach. Leichter's model, the stage's heuristic framework, and Kingdon's models were used for analyzing the context and process analysis respectively. MAXQDA 20 software was used.ResultsA total of four main themes and twelve sub-themes were identified concerning various contextual factors, including political, economic, international, and cultural/social challenges. The primary obstacles to implementing adaptation measures were found to be political considerations, economic sanctions, and the low-risk perception held by both the public and policymakers. Additionally, fifteen themes and forty-eight sub-themes related to the process were identified across several areas: agenda setting, which includes the problem stream, policy stream, and politics stream; policy formulation, encompassing governmental and managerial aspects, research, evidence-informed policymaking, and the role of Non-Governmental Organizations; policy implementation, which covers early warning systems, education, inter-sectoral coordination, architecture and engineering, and integrated databases; and policy evaluation, focusing on inadequate evaluation methods.ConclusionsThe study identifies key challenges in implementing the Paris Agreement within Iran's health system, categorized into four main themes: political, economic, international, and cultural/social. Political issues stem from the politicization of climate change and national security concerns. Economically, reliance on oil and sanctions hinder progress, while high technology costs strain resources. Internationally, a lack of binding commitments and technological sanctions impede efforts. Culturally, low public awareness and inadequate inter-organizational collaboration limit engagement. The study emphasizes the need for cohesive policies, enhanced public education, and improved coordination among sectors to effectively address climate change impacts on health
Microbial safety and chemical characteristics of sausage coated by chitosan and postbiotics obtained from Lactobacillus bulgaricus during cold storage
No full textThis study investigated the antioxidant and antimicrobial properties, as well as the volatile compounds, of Lactobacillus bulgaricus (L. bulgaricus) postbiotics (at concentration of 150 and 300 mg/L) and their combination with chitosan coatings (0.5 and 1) on sausage quality (with 100 ppm nitrite) during 40 days of cold storage. The results were compared to a control group, as well as to sausages containing commercial formulation (120 ppm) and reduced (100 ppm) levels of nitrite. To further assess the antimicrobial effects, it also inoculated E. coli and Staphylococcus aureus into the sausages in order to examine how the postbiotics and chitosan coatings impacted the growth of these foodborne pathogens during the 40-day cold storage period. The reults indicated that those containing 300 mg/L postbiotic and 1 chitosan generally met the desired condition for pH, moisture, fat, and total volatile base-nitrogen. These samples also showed the strongest inhibition of mesophilic and psychrophilic bacteria, mold and yeast. Notably, no E. coli or S. aureus were detected in any of the samples, indicating that the postbiotic and chitosan combination effectively inhibited the growth of these pathogens in sausages. The findings suggest that using chitosan coatings and L. bulgaricus postbiotic can enhance the quality of sausages, ultimately lowering the risk of contamination by harmful bacteria and improving overall food safety
The impact of sodium-glucose co-transporter-2 inhibitors on serum sodium and potassium in patients with Heart Failure: a systematic review and meta-analysis
No full textBackground Managing electrolyte abnormalities, particularly sodium and potassium, in patients with heart failure (HF) remains a concern. A novel anti-diabetic drug, sodium-glucose co-transporter-2 (SGLT2) inhibitors, has become suitable for HF patients, improving cardiovascular outcomes. Therefore, we aimed to conduct a meta-analysis to evaluate the effect of SGLT2 inhibitors on serum sodium and potassium. Methods We systematically searched five databases, identifying randomized clinical trials (RCTs) reporting changes in serum sodium and potassium levels with SGLT2 inhibitors compared to comparator groups. Outcomes were presented as weighted mean differences (WMD) and standardized MD (SMD) with 95 confidence intervals (CI). Subgroup and sensitivity analyses were also conducted. Results 13 studies were included, with 13 studies with 10,617 participants reporting on serum sodium and nine studies with 9877 participants on serum potassium. In acute HF, SGLT2 inhibitors did not significantly affect serum sodium (WMD: 1.21 mmol/L; 95 CI: - 0.79, 3.21) or potassium levels (WMD: 0.11 mEq/L; 95 CI: - 0.20, 0.42). Subgroup analyses suggested possible variations by follow-up duration (= 30 days) and drug type, but findings remained non-significant. Sensitivity analysis using the leave-one-out method and risk of bias assessment results showed no considerable changes in the statistical significance of the pooled results. Similarly, in chronic HF, no significant differences were observed for serum sodium (WMD: 0.23 mmol/L; 95 CI: - 0.45, 0.91) or potassium (WMD: 0.07 mEq/L; 95 CI: - 0.29, 0.44). Sensitivity and subgroup analyses based on duration, drug type, diabetes status, renal function, or systolic blood pressure did not reveal clinically meaningful differences across all analyses. For all analyses, Egger's test was non-significant, indicating no strong evidence of small-study effects. Moreover, the trim-and-fill method combined with the funnel plot did not identify any missing studies, and the recalculated effect size remained unchanged. Conclusions SGLT2 inhibitors did not significantly alter serum sodium or potassium levels in acute or chronic HF, suggesting that these drugs can be safe regarding electrolyte disturbances. Additional RCTs are warranted to enhance the robustness of evidence regarding the mechanisms and effects of SGLT2 inhibitors on serum electrolyte levels, considering variations across different types of SGLT2 inhibitors