Iranian Red Crescent Medical Journal
Year:2020 | Volume:22 | Issue:6|Papers Count:10

Introduction: Nevus lipomatosus cutaneous superficialis (NLCS) isuncommonand can be encountered in various medical specialties. In this study, we report a rare case of solitary pedunculated nevus lipomatosus cutaneous superficialis in a middle-aged female patient and highlight its clinical and histopathological features. Case Presentation: A 43-year-old Malaysian female patient presented to our center with a 2-cm long and 1-cm wide solitary, fleshcolored nodule over the anterolateral aspect of her thigh. Excisional biopsy was performed, and the histopathology report showed NLCS. There are three types of NLCS, namely the solitary, multiple, and generalized forms. The etiology of NLCS is usually idiopathic, with no gender or familial preponderance. NLCS is usually misdiagnosed and should be differentiated from nevus sebaceous, connective tissue nevus, neurofibroma, lymphangioma, hemangioma, and focal dermal hypoplasia (also known as Goltz syndrome). Conclusions: In conclusion, NLCS is rare and benign condition, which should be differentiated from other malignant skin conditions as it is commonly misdiagnosed. Therefore, physicians and surgeons should be aware of its clinical and histopathological features.

Introduction: 17 alpha-hydroxylase deficiency (17-OHD) is an infrequent autosomal recessive disorder in adrenal and gonadal steroidogenesis due to the CYP17A1 defect. Affected girls are characterized by delayed puberty, absence of secondary sex characteristics at puberty, and primary amenorrhea. Affected boys show female or ambiguous genitalia. Hormone imbalances result in varying degrees of hypertension and hypokalemia. The increase in corticosterone levels prevents the development of typical adrenal insufficiency symptoms. Glucocorticoid and sex steroid supplementation is the preferred treatment. Case Presentation: We reported two phenotypically female siblings, aged 14 and 25 years, with the 17-OHD from Ankara, the capital city of Turkey. The younger child had a 46, XX karyotype and the older had a 46, XY chromosome pattern. Another feature of the second patient (aged 25 years), was the presence of a large myelolipoma in her right adrenal gland. Conclusions: 17 alpha-hydroxylase patients are usually diagnosed late, and unlike patients with other forms of congenital adrenal hyperplasia, hypertension is the major finding, and 10%-15% of patients have normal blood pressure at diagnosis. The delay in diagnosis causes hypertension and renovascular changes, psychological problems, osteoporosis, and irreversible damage to breast tissue.

Context: The purpose of this analysis was to explore the effects and safety of Pulmonary Surfactants (PS) combined with budesonide in Bronchopulmonary Dysplasia (BPD) by a meta-analysis of Randomized Controlled Trials (RCTs). Evidence acquisition: Literature searches were performed in PubMed, the Cochrane Library, EMBASE, the China Knowledge Network, and the Wanfang database to collect data from RCTs. The primary outcomes were BPD incidence and BPD-related mortality, while the secondary outcomes were BPD-related complications. Bias was evaluated by the Cochrane risk assessment tool. The RevMan 5. 3 software was used for the meta-analysis, and the Egger’ s test was used for publication bias assessment. Results: A total of 720 subjects were enrolled from six RCTs, including 352 in the experimental group and 368 in the observation group. The BPD incidence (RR = 0. 42, 95% CI [0. 37, 0. 89], P < 0. 001) and BPD-related mortality (RR = 0. 54, 95% CI [0. 38, 0. 89], P < 0. 05) differed significantly between the two groups. Significant differences were also found in intraventricular hemorrhage, infection/sepsis, Retinopathy of Prematurity (ROP), and Patent Ductus Arteriosus (PDA). There were no significant differences in the incidence of PDA, Neonatal Necrotizing Enterocolitis (NEC), hyperglycemia, and hypertension. Conclusions: The intratracheal instillation of pulmonary surfactants with budesonide can reduce the incidence of BPD and BPDrelated mortality with no increased risk of short-term complications.

Background: The cardinal symptoms of gastroesophageal reflux disease include heartburn (pyrosis) and regurgitation. Conventional treatment is done by proton pump inhibitors. In Persian traditional medicine, several herbs (single or combined) have been used to treat gastrointestinal disorders. Objectives: This study aimed to assess the effects of Pistacia lentiscus (mastic) and Coriander Triphala on reflux symptoms compared to omeprazole in a double-blinded randomized clinical trial. Methods: In a double-blinded, multicenter, randomized clinical trial, we assessed the effects of Pistacia lentiscus L., Coriander Triphala, and omeprazole on the symptoms of GERD in Tabriz, Iran, in 2018-2019. Thus, 105 patients with GERD symptoms were assigned randomly to three groups as group A (Pistacia lentiscus L., 1000 mg/TDS), group B (Coriander Triphala, 1000 mg/TDS), and group C (omeprazole, 20 mg/day plus five placebo capsules per day). The assessments were done at the beginning and the end of the study using FSSG, VAS, RS, and GERD-HRQL questionnaires. Results: In the beginning, no significant differences were observed between the groups in the background characteristics. There wasnostatistically significant differencebetweenPistacia lentiscus, Coriander Triphala, andomeprazole in theimprovementof FSSG, VAS, GERD-HRQL, and reflux scores. In all groups, the FFSG, VAS, reflux, and GERD-HRQL scores significantly decreased and improved after four weeks of intervention comparedto the respective baselines. The FSSG score improvements after four weeks of intervention were 73. 68%, 83. 33%, and 68. 62%, in groups A, B, and C, respectively. The VAS score improvements were 66. 66%, 75. 00%, and 62. 50% in groups A, B, and C, respectively. Improvements in GERD-HRQL were 90. 00%, 91. 28%, and 82. 00%, in groups A, B, and C, respectively. Reflux improvements were 66. 66%, 80. 00%, and 66. 66% in groups A, B, and C, respectively. Conclusions: The results showed that Pistacia lentiscus and Coriander Triphala are as effective as omeprazole in the treatment of GERD.

Introduction: COVID-19 is an emerging disease that has been spread all over the world. Not all the dimensions and manifestations of the disease have yet been fully explored. One such manifestation is vascular thrombosis that occurs in the lungs and other vessels. However, it is often ignored or mistaken for pulmonary manifestations. Herein, we presented a case with dominant pulmonary embolism manifestations. The COVID-19 symptoms were detected in the patient a few days after heart surgery, and he was appropriately treated and discharged. Case Presentation: The patient was a 62-year-old man visiting with the signs and symptoms of pulmonary embolism. In the CTangiography, massive pulmonary embolism was reported in the right and left pulmonary arteries of the patient. Moreover, the patient’ s echocardiogram showed a clot in the right ventricle in addition to severe right ventricular dysfunction. The patient underwent emergency heart surgery to remove the clot. In the 3-4 postoperative days, the pulmonary manifestations of COVID-19 emerged. The throat swab test was positive for COVID-19, and the patient received treatment. After receiving appropriate treatments for about two weeks, the patient was discharged with good general health. Conclusions: The presented case had the primary pulmonary embolism symptoms. However, in the 2-3 postoperative days, he showed the COVID-19 symptoms and received treatment. Pulmonary embolism can be a manifestation of COVID-19.

Background: Increasing in emergency department need to critical care, the number of intensive care unit bed worldwide is inadequate to meet these applies. Objectives: The aim of this study was to investigate the effect of waiting for admission to the Intensive Care Unit (ICU) in the Emergency Department (ED) on the length of stay in the ICU and the mortality of critically ill patients. Methods: This retrospective cohort study carried out between January 2012-2019 patients admitted to the ICU of a training and research hospital. The data of 1297 adult patients were obtained by searching the Clinical Decision Support System. Results: The data of the patients were evaluated intwogroups as those considered to be delayedandnon-delayed. Itwasdetermined that the delay of two hours increased the risk of mortality 1. 5 times. Hazard Ratios (HR) was 1. 548 (1. 077-2. 224). Patients whose ICU admission was delayed by 5-6 hours were found to have the highest risk in terms of mortality (HR= 2. 291 [1. 503-3. 493]). Astatistically significant difference was found in the ICU mortality, 28-day and, 90-day mortality between the two groups. ICU mortality for all patients’ general was 25. 2% (327/1297). This rate was 11. 4% (55/481) in the non-delayed group and 33. 3% (272/816) in the delayed group (P < 0. 001). The 28-day mortality rate for all patients’ general was 26. 9% (349/1297). This rate was found to be 13. 5% (65/481) in the non-delayed group and 34. 8% (284/816) in the delayed group (P < 0. 001). The 90-day mortality for all patients’ general was 28. 4% (368/1297). This rate was 14. 1% (68/481) in the non-delayed group and 36. 8% (300/816) in the delayed group (P < 0. 001). Conclusions: Prolonged stay in the ED before admission to the ICU is associated with worse consequences, and increased mortality.

Background: The prevalence of type 2 diabetes mellitus (T2DM) has increased dramatically in the past 30 years. TheWorld Health Organization has prepared an action plan to stop the increase in diabetes and obesity by 2025. Objectives: This study was conducted to assess the effect of pilates on body composition and some biochemical parameters in women with T2DM on a high-complex-carbohydrate diabetic diet or a low-carbohydrate/high-monounsaturated fatty acids (MUFA) diet. Methods: This experimental study was conducted on 120 woman patients with T2DM, referring to the Fatih Medical Park Hospital’ s Internal Medicine Department, Istanbul, Turkey, between December 2018 and June 2019. Participants were divided into 4 groups and were followed up for 12 weeks. The mean participants’ age was 41. 67 3. 83 years. The first group received a low-carbohydrate and high MUFA (LC, MUFA) diet, the second group received a low-carbohydrate and a high-MUFA diet and did pilates (LC, MUFA + PL), the third group received a higher complex carbohydrate (HCC) diet, and the fourth group took the HCC diet and did pilates (HCC + PL). Results: According to the applied intervention method, there were significant differences between the preliminary and final measurements of bodymass index, body fat percentage, muscle mass, and fasting blood glucose, insulin, HbA1c, total cholesterol, highdensity lipoprotein (HDL), low-density lipoprotein (LDL), and triglyceride (TG) values (P < 0. 05). In this study, only an increase in body muscle composition of the women in the LC, MUFA + PL group was found significant (P < 0. 05). The highest decrease in body fat ratio was determined again in the LC, MUFA+ PL group (P< 0. 05). HDLlevels of thewomenwhodid pilates increased significantly than other groups (P < 0. 05). Conclusions: In the treatment of diabetes, the patient should be evaluated with a multidisciplinary team. Diet and exercise are important non-pharmacological interventions in the treatment of diabetes.

Background: High dose intravenous (i. t. ) injection of methylprednisolone (MPSS) for spinal cord injury (SCI) is clinically controversial. Objectives: This study aimed to investigate whether i. t. MPSS would have a beneficial effect on SCI and whether or not it is a safe operation for SCI patients. Methods: An animal experiment was conducted to explore the safety and feasibility of i. t. Administration of MPSS. Male Sprague-Dawley rats were randomly divided into four groups: (1) sham group, i. t. injection of normal saline (NS) (n = 25); (2) control group, SCI surgery (created using the Infinite Horizon IH-400 impactor) with i. t. injection of NS (n = 25); (3) i. t. MPSS1 group, SCI with i. t. injection of MPSS by a pulse therapy (n = 25); (4) i. t. MPSS2 group, SCI with i. t. injection of MPSS intermittently (n = 25). Malondialdehyde (MDA), superoxide dismutase (SOD), and inflammatory cytokines in serum were measured at 6h, 24h, 48h, 7d, and 14d after surgery with commercial assay kits. Glial fibrillary acidic protein (GFAP) level was observed at 14 days after surgery by immunohistochemistry. Motor evoked potentials (MEP) and somatosensory evoked potential (SEP) were monitored and recorded separately before surgery and 1, 7, and 14 days after surgery. Also, locomotor function was evaluated using the Basso, Beattie, and Bresnahan (BBB) locomotor rating scale. Results: The results showed that the levels of MDA and SOD, and three inflammatory cytokines, including IL-1b, IL-6, and TNF- were reduced in i. t. MPSS groups than that of the control group (all P < 0. 05). The expression of GFAP was inhibited after i. t. MPSS treatment. The amplitude was reduced, and the latency period of SEP and MEP recovery was prolonged (all P < 0. 05) after MPSS administration. In addition, the recovery of limb function (BBB score) was significantly ameliorated (P < 0. 05) in SCI rats treated with MPSS compared with the control group. Conclusions: Our results demonstrated that i. t. MPSS was a potential strategy for reducing the secondary damage after SCI, especially the MPSS pulse therapy.

Background: Organizational culture is the most essential tool of an organization to increase the resilience of personnel in a healthcare system. Promoting organizational culture is an effective factor in increasing job satisfaction and reducing psychological burden, and burnout in nurses. Objectives: This study aimed to investigate the influence of organizational culture on resilience by mediatory effects of occupational stress, job satisfaction, and burnout in nurses using structural equation modeling. Methods: This cross-sectional study was conducted among 712 nurses working in seven hospitals in Tehran during the 2018-2019. The participants were selected by thee stratified random sampling method with proportional allocation. In detail, after determining the number of samples of each hospital, sampling was performed using a random number sequence. The data gathering was performed by using questionnaires. Data were analyzed by the SPSS, version 23. 0, and LISREL, version 8. 8. Results: We found a significant positive correlation between organizational culture and job satisfaction (r = 0. 29) and resilience (r = 0. 21) (P < 0. 05). There was a significant negative correlation between organizational culture and occupational stress (r =-0. 22), and burnout (r=-0. 14) (P < 0. 05). The goodness of fit index (GFI) for organizational culture, occupational stress, job satisfaction, burnout, and resilience was 0. 97, 0. 97, 0. 98, 0. 96, and 0. 95, respectively. RMSEA index for organizational culture, job satisfaction, burnout, and resilience was 0. 069, 0. 093, 0. 057, and 0. 050, respectively, which showed that the model is appropriately fit. Conclusions: The findings of the present study indicated that promoting organizational culture and reducing occupational stress and burnout can improve job satisfaction and mental health in nurses.

Background: Mesobuthus eupeusvenomis amemberof Buthidae family, which can enter the blood circulation exerting detrimental effects on body organs, such as the liver and kidney through inflammation. Cyclosporine, known as an anti-inflammatory drug, is used to treat many inflammation-associated diseases. Objectives: In this study, cyclosporine was selected to inhibit the scorpion toxin effects on rat organs. Methods: This experimental study was conducted in the Razi Vaccine and Serum Research Institute, Agricultural Research Education and Extension Organization, Karaj, Iran, from June to November 2019. Fifty male rats were randomly divided into five groups of 10, including the control (10 mg/kg olive oil i. p), M. eupeus venom (10 mg/kg i. p. ), cyclosporine 10 mg/kg (venom 10 mg/kg for 30 min i. p followed by cyclosporine 10/kgmgfor 7 day i. p. ), cyclosporine 20 mg/kg (venom 10 mg/kg for 30 min i. p followed by cyclosporine 20 mg/kg for 7 day i. p. ), and cyclosporine 30 mg/kg (venom 10 mg/kg for 30 min i. p followed by cyclosporine 30 mg/kg for 7 day i. p. ). After treatment with cyclosporine, the liver and kidney function was analyzed by calculating some biochemical enzymes, including serum glutamate-pyruvate transaminase (SGPT), serum glutamic oxaloacetic transaminase (SGOT), nitric oxide (NO), interleukin-2 (IL-2), malondialdehyde (MDA), creatinine, and urea via ELISA and spectrophotometry. Then, to determine the rate of apoptosis in tissue, terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling method was done. Results: At the end of the study, the results showed a significant elevation in SGPT (164. 5 10 vs. 126. 2 7, P < 0. 0001), SGOT (190. 37  11 vs. 148 10, P < 0. 0001), NO (24. 4 1. 17 vs. 17. 4 1. 4, P = 0. 02), and MDA (0. 42 0. 05 vs. 0. 22 0. 04, P < 0. 0001) in the venom group compared with the control group. There were no significant differences in the urea, IL-2, and creatinine between the venom and control groups. However, the group receiving cyclosporine (30 mg/kg) showed a significant decline in SGPT (96. 42 5. 7 vs. 164. 5  10, P < 0. 0001), SGOT (144. 57  9. 24 vs. 190. 37  11, P < 0. 0001), urea (28. 83  1. 32 vs. 38. 83  1. 6, P = 0. 00), creatinine (0. 023  0. 01vs. 0. 29 0. 005, P < 0. 0001), and MDA (0. 10 0. 01 vs. 0. 42 0. 05, P < 0. 0001), as well as increased apoptosis rate (P < 0. 05), compared with the venom group. No significant difference was observed between the cyclosporine and venom groups in NO and IL-2. Conclusions: Cyclosporine at a dose of 30 mg was able to decrease inflammatory responses and induce apoptosis rate. Therefore, it could be a suitable drug for patients bitten by a scorpion sting.