Iranian Red Crescent Medical Journal
Year:2022 | Volume:24 | Issue:5|Papers Count:9

Background: The most common manifestations of metastatic colorectal cancer are found in the liver, lung, bone, and brain. Cutaneous metastasis is rare in rectal cancer, and it indicates a widespread disease and a poor prognosis. Case presentation: This report and review present a 58-year-old man who was diagnosed with rectal cancer (RC) and underwent abdominoperineal resection. The patient developed a skin lesion (indurated erythema) on his scrotum four months later. Histopathological examination revealed adenocarcinoma with lymphovascular invasion. Results: The primary causes of mortality in people with RC have been reported to be disease dissemination and recurrence. Cutaneous metastasis to the scrotum happens seldom, accounting for less than one percent of the total surface area of the body. Conclusion: Even if an RC patient has been asymptomatic for a long time, skin involvements must be considered by clinicians. Therefore, giving specific attention to all skin nodules, non-healing ulcers, and chronic indurated erythema is essential. Early detection relies heavily on patient engagement.

Background: The role of environmental determinants in the community's resilience in flood, as a predominant hydrological disaster, has not been investigated. Objectives: This systematic review aimed to discuss the role of environmental determinants on communities' resilience in floods using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Methods: A total of 50 relevant papers were extracted, including those on the subject of water resource planning (n=32), soil-plant systems (n=8), and air and climatic factors (n=10). Results: The results revealed that although most studies have investigated climatic factors, biological effects, surface water flooding, and groundwater contamination, the researchers did not have a comprehensive approach to environmental determinants. This study highlighted the role of water, soil, and air, as the main environmental determinants. In addition, the related subdeterminants should simultaneously be considered in flood risk management and community resilience. Conclusion: Eventually, a conceptual model is presented for analyzing the effects of environmental factors on the communities' resilience against floods.

Background: Curcumin is a natural antioxidant known for its neuroprotective properties against cerebral ischemic reperfusion injury. Stroke has the greatest impact on the hippocampus cornu ammonis (CA1) region and leads to cognitive impairment. Objectives: This study aimed to investigate the effect of pretreatment with turmeric extracts before the induction of cerebral ischemia on the structure of the hippocampus CA1 region, learning, and spatial memory. Methods: A total of 32 adult male Wistar rats were randomly divided into four groups: 1) control group, 2) sham group (received dimethyl sulfoxide), 3) ischemia group (15 min bilateral carotid artery), and 4) curcumin group (received 100 mg/kg of curcumin daily for five days before the induction of ischemia). The Morris water maze test was performed to evaluate memory impairment in mice 48 h after ischemia induction. The animals were then anesthetized, and their blood samples were taken for malondialdehyde measurement. Subsequently, the animals’,brains were removed, and the number of neurons, as well as the volume of the layers, were examined using cresyl violet staining. Results: The results of the stereology showed a significant increase in the volume of the CA1 region and its substrates in the curcumin treatment group, compared to the ischemia group. In addition, the number of pyramidal neurons in the treatment group showed a significant increase, in comparison with the ischemia group. Moreover, curcumin administration reduced the spatial memory impairment in the treatment group, compared to the ischemia group. Conclusion: These findings suggest that pretreatment with curcumin can improve memory and learning disorders, as well as hippocampal neuron damage, following ischemia.

Background: While several antivirals have been considered among the candidate repurposed drugs against SARS-CoV-2 infection, limited evidence exists on Atazanavir/Ritonavir. Objectives: This trial was designed to assess the efficacy of Atazanavir/Ritonavir compared to Lopinavir/Ritonavir, another antiretroviral drug investigated in the previous studies. Methods: This randomized, double-blind clinical trial was conducted on hospitalized patients with laboratory or confirmed SARS CoV-2 infection. Patients were randomly assigned (1: 1) to receive either Lopinavir/Ritonavir (200mg Lopinavir+50mg Ritonavir, twice a day) or Atazanavir/Ritonavir (300mg Atazanavir+100 mg Ritonavir, once a day) for up to 14 days during their admission along with the standard care. The primary endpoint was total all-cause death in all patients during the hospitalization period. Secondary outcomes included length of hospitalization. Results: Out of 103 adults included in the analysis 54 and 49 were assigned to Atazanavir/Ritonavir and Lopinavir/Ritonavir groups, respectively. The occurrence of adverse effects, defined as symptoms attributed to the drugs which no longer appear upon the cessation of the drug, was higher for cardiac side effects in Atazanavir/Ritonavir group. No statistically significant difference was observed between the two groups in terms of the length of hospitalization. After adjustment for other covariates in the study, treatment with Atazanavir/ritonavir did not result in a significant reduction in mortality compared to treatment with Lopinavir/Ritonavir. Conclusion: The efficacy of Atazanavir/Ritonavir in this preliminary study was not superior to Lopinavir/Ritonavir in reducing mortality and length of hospitalization in COVID-19 patients. However, the limited efficacy of both compounds does not support their use in primary care for COVID-19 patients.

Background: Soft-tissue sarcomas are cancerous growths of mesenchymal tissues, most commonly arising from fat, muscles, and other connective tissues. Due to the fact that these tumors often lie adjacent to nerves and blood vessels, it is difficult to remove them. Traditional surgery is often carried out according to the operator’, s discretion and experience of local anatomy,however, the surgery bears the risk of damage to nerves and blood vessels. In cases of postoperative recurrence, the local anatomy is often not clear due to scar formation, and the risk of operation would be greater. Case presentation: This report describes the application of three-dimensional (3D) modeling prior to surgery, which can clearly reveal the tumor tissue and the surrounding important nerves and blood vessels. Conclusion: In two operations for recurrent soft-tissue sarcoma of the thigh with complex adjacencies, it was found that 3D models are of great value for preoperative planning and intraoperative navigation. More importantly, these models can improve the success rate of surgery and reduce the operative time.

Background: One of the major long-term complications of diabetes mellitus (DM) is diabetic nephropathy (DN) characterized by persistent albuminuria and a progressive renal dysfunction. Objectives: The aim of this trial was to determine the effects of selenium supplementation on the levels of genes expression associated with insulin, lipid and inflammatory markers in diabetic hemodialysis patients. Methods: This randomized, double-blind, placebo-controlled clinical trial was done on forty diabetic hemodialysis patients. The study subjects were divided into two groups by random to take either 200 µ, g/day selenium (n=20) or placebo (n=20) during 24 weeks. Results: Selenium intake led to upregulation of peroxisome proliferator-activated receptor gamma (PPAR-γ, ) (1. 08+0. 22 vs. 0. 93+0. 18 fold change, P=0. 049), LDL-receptor (1. 06+0. 14 vs. 0. 90+0. 16 fold change, P=0. 008) and transforming the growth of factor beta (TGF-β, ) (1. 15+0. 18 vs. 0. 91+0. 20 fold change, P=0. 002) in the levels of gene expression. In comparison with placebo, in this intervention also reduction of gene expression of tumor necrosis factor alpha (TNF-α, ) (0. 90+0. 19 vs. 1. 08+0. 19 fold change, P=0. 014) and interleukin-1 (IL1) (1. 00+0. 11 vs. 1. 12+0. 15 fold change, P=0. 020) were detected. In this study, gene expression of vascular endothelial growth factor (VEGF) (1. 02+0. 13 vs. 0. 96+0. 18 fold change, P=0. 333) and (IL-8) (0. 98+0. 20 vs. 1. 03+0. 17 fold change, P=0. 458) were not affected by selenium supplementation. Conclusion: Selenium supplementation during 24 weeks had positive effects on gene expression associated with metabolic status inflammatory markers in diabetic hemodialysis patients.

Background: Geriatric nursing is professional holistic care that requires special attention and the development of professional competence. No valid and reliable tool exists to evaluate professional geriatric competencies (PGC) of nursing students in professional practice which remains a debatable issue in nursing education. Therefore, the present study was conducted to fill data scarcity. Objectives: The present study aimed to develop a Geriatric Nursing-Specific Mini-CEX (GN-Specific Mini-CEX) tool to evaluate the professional geriatric competencies of internship nursing students. Methods: The present study is descriptive observational quantitative with a cross-sectional design. The Geriatric Nursing-Specific MiniCEX tool was developed in seven skill domains and 40 items based on the core competencies of geriatric nursing, published literature, and expert opinions. Delphi method was applied to evaluate the face and content validity, and reliability was determined using Cronbach's alpha test through a pilot test. The modified tool was scored between 1 to 9 in each item of skill domains with a total score of 40 to 360. Higher scores indicate a higher professional geriatric competence for nursing students. Then, 160 internship undergraduate nursing students were selected by convenience sampling from Mashhad University of Medical Sciences (MUMS) as one of the major medical sciences universities of Iran, in January 2020. One-day workshop of evaluators was held in two sessions and the professional geriatric competencies of students were evaluated by implementing case studies. The results were analyzed with inter-rater reliability and descriptive statistics. Results: ICC values for seven components of geriatric nursing-specific Mini-CEX ranged from 0. 639 to 0. 919, indicating an acceptable level of reliability for this scale. The mean score of overall geriatric competence was (M= 6. 12, SD=. 33), which indicated that the geriatric competencies of students enrolled in the study were at a satisfactory moderate level. The highest and the lowest mean scores were observed in history taking /communication (M= 6. 71, SD=. 71) and physical examination skills (M= 4. 99, SD=. 67), respectively. Conclusion: The results of this study indicate the feasibility of using new developed geriatric nursing-specific Mini-CEX tool to evaluate the professional geriatric competencies of nursing students through implementing case studies in professional clinical settings. The data obtained from the present study could be useful for nursing education to evaluate and redesign a curriculum for integrative core geriatric competencies as a process of quality improvement.

Although it was initially believed that the coronavirus disease 2019 (COVID-19) only attacked the respiratory system, reports over time demonstrated that this disease could attack the gastrointestinal tract (GIT) as well. The predominant presenting symptoms in patients infected with COVID-19 were gastrointestinal (GI), resulting in GI pathological changes. While clinicians’,concerns are mostly related to respiratory system manifestations, GI symptoms should be monitored and managed appropriately. This review summarizes the essential information about COVID-19 GIT infection in terms of pathogenesis, major pathological changes, microbiological bases of infection, the possibility of feco-oral transmission, the severity of associated symptoms, the major radiological findings, the impact on GI surgery, the role of therapeutic agents in induction or magnification of GI symptoms, and a pitfall on the nutritional supplementation in COVID-19 patients.