Investigation of PD-1 gene variants in patients with endometrial cancer: A case-control study.

Objective: To assess the possible association of two single-nucleotide polymorphisms (SNPs), PD-1.3 (+7146G/A) and PD-1.5 (+7785C/T), with endometrial cancer (EC) susceptibility. In addition, the correlations between these SNPs and available clinicopathologic characteristics of patients with EC were investigated. Materials and Methods: In this case-control study, 147 women with pathologically confirmed EC and 258 age- and ethnically matched healthy women were enrolled between June 2019 and May 2022. Genomic DNA was extracted, and genotyping of PD-1.3 (+7146G/A) and PD-1.5 (+7785C/T) SNPs was performed. Haplotype analysis was also performed. Pearson's chi-square test with Yates correction was used to evaluate differences in allele and genotype distributions. The 95% confidence interval and odds ratio were determined using an unconditional logistic regression model. Results: There were no remarkable differences in the allele and genotype distributions of PD-1.3 (rs11568821) and PD-1.5 (rs2227981) between healthy controls and EC patients. However, there was a remarkable difference in the AC haplotype between the control and EC groups. No association was found between the investigated SNPs and the clinicopathologic features of EC. Conclusion: Our results indicated that the aforementioned SNPs were not related to the risk of EC in the southern Iranian population.

Long-term follow-up of patients with hairy cell leukemia in the south of Iran.

BACKGROUND: Hairy cell leukemia (HCL) is an indolent chronic lymphoproliferative disorder and first-line treatment with either intravenous or subcutaneous cladribine generally leads to long-lasting remissions. METHOD: All 131 patients with hairy-cell leukemia (HCL) were analyzed, with a median follow-up of 91 months. Data is from 2007 to 2020. We evaluated the response rate to cladribine as the first line and the response rate to cladribine with or without rituximab in relapsed patients. Further, we assessed relapse-free survival, complications, and secondary malignancy. RESULTS: After a median follow-up of 91 months, the recurrence rate was 24%. The 5-year and 10-year RFS rates were 85% and 66%, respectively. Adding rituximab to 2-CDA leads to a better response rate than just cladribine (90% vs. 27.3%, p-value = 0.002) in the relapsed patients. CONCLUSION: HCL patients have long-term survival when cladribine is the first line of treatment. Furthermore, adding rituximab to cladribine leads to a higher response rate.

An Evidence-Based Review of Antitussive Herbs Containing Essential Oils in Traditional Persian Medicine.

BACKGROUND: Cough is one of the most common medical symptoms for which medical advice is sought. Although cough is a protective reflex responsible for clearing the airways from secretions and foreign bodies, it can be a troublesome symptom that causes discomfort to patients. Due to the increasing interest in herbal remedies in both developed and developing countries, in the current study, we aimed to overview medicinal herbs containing essential oils used as antitussive agents according to Traditional Persian Medicine (TPM) textbooks. We summarized the relevant scientific evidence on their possible pharmacological effects. METHODS: To collect the evidence for the treatment of cough or "seaal" (cough in ancient books) from TPM sources, five main medicinal Persian manuscripts were studied. The antitussive herbs were listed and their scientific names were identified and authenticated following botanical reference books. ScienceDirect and PubMed online databases were searched for related mechanisms of action of the reported medicinal plants. RESULTS: Forty-nine herbs containing essential oils have been recommended in TPM for the treatment of cough; 21 of them had at least one known mechanism of action for cough suppression in the scientific literature. According to this review, most of the cited medicinal plants were assessed for either nitric oxide inhibitory or antitussive/expectorant activities. CONCLUSION: In addition to advantageous effects of antitussive herbs recommended by TPM, the present review highlighted some recent evidence-based data on these promising herbs that could be used as an outline for future research on their medicinal use.

A Review of Pharmacological Properties and Toxicological Effects of Adiantum capillus-veneris L.

BACKGROUND: Adiantum capillus-veneris L. (Family: Pteridaceae) is a well-known safe medicinal herb used in traditional and modern medicine due to its beneficial pharmacological properties. The current study aimed to compile a review on phytochemicals, pharmacological properties and toxicological effects of this plant. METHODS: An incisive search was conducted through electronic scientific databases including PubMed, Scopus, ScienceDirect, and Cochrane Library using keyword 'Adiantum capillusveneris'. All related in vivo, in vitro, human (English papers), were selected from the beginning up to 1st January 2019. All letters, conference papers, papers dealing with genetics, agriculture, and pure phytochemistry of the herb were excluded. RESULTS: A. capillus veneris revealed various pharmacological activities including the effects on the remodeling of lung alveolar epithelial cells in a hypoxic environment, anti-toxicity properties in liver and testes, anti-hyperglycemic, and wound healing effects in diabetic or non-diabetic patients, protection against damage to fibroblasts via free radicals, activity against testosteroneinduced alopecia, anticonvulsant, depressant, analgesic and anti-nociceptive activities, as well as effects on urinary output, anti-inflammatory, anti-microbial, antilithiatic, hypothyroidism regulatory, anti-cancer, antidiarrheal and antispasmodic, anti-asthmatic and anti-histaminic, and enzyme inhibition (in Alzheimer's, diabetes and skin disorders) activities. CONCLUSION: This plant can be used as a natural potent and safe agent to alleviate numerous medical symptoms and diseases due to its useful pharmacological properties. Thus, further researches are needed in order to compile the clinical effects of this plant via human studies.

Orbital mucormycosis in immunocompetent children; review of risk factors, diagnosis, and treatment approach.

BACKGROUND: Orbital mucormycosis is a rare but potentially severe and troublesome invasive fungal infection that could be occurred even in healthy individuals. The initial clinical presentation is similar to bacterial pre-septal or septal cellulitis, especially in early stages. CASE PRESENTATION: Herein, we describe the successful management of a series of five cases presenting with orbital mucormycosis in previously healthy children. CONCLUSIONS: Orbital mucormycosis is extremely rare in healthy children and maybe life-threatening when diagnosis delayed given a similar clinical presentation with bacterial septal cellulitis. Intravenous antifungal therapy with amphotericin B and timely surgical drainage is live-saving.

A Comparative Study of Injury Severity Scales as Predictors of Mortality in Trauma Patients: Which Scale Is the Best?

OBJECTIVE: To compare the injury severity scales as predictors of mortality in trauma patients to search for the best scale. METHODS: In a prospective cohort study and systematical random sampling conducted from March to September 2017, trauma patients over the age of 13 years were enrolled. The investigated variables were age, gender, systolic blood pressure, heart rate, respiratory rate, injured body region, Glasgow Coma Scale (GCS), injury severity score (ISS), revised trauma score (RTS), trauma injury severity score (TRISS) and the outcome. RESULTS: Totally, 1410 trauma patients were followed up, out of which 68.5% were male. The participants' mean age was 43.5±20.88 years. After adjusting the confounding effects, age over 60 years (OR=7.38, CI [3.91-13.93]), GCS<8 (OR=6.5, CI [2.38-18.16]), RTS<7.6 (OR=6.04, CI [2-13.7]), and TRISS<0.9 (OR=3.09, CI [1.39-6.88]) were determined as the most significant predictor variables for in-hospital mortality. The results of Receiver Operating Characteristic (ROC) curve revealed that TRISS had the highest area under the curve in comparison to other tests that were evaluated. Furthermore, TRISS had the highest sensitivity and specificity for scores higher than 96.15. By contrast, the sensitivity and specificity of GCS decreased for scores higher than 5.5. CONCLUSION: Our results showed that TRISS, RTS, GCS, and ISS were all very effective approaches for evaluating prognosis, mortality and probable complications in trauma patients; thus, these systems of injury evaluation and scoring are recommended to facilitate treatment. TRISS, RTS, and ISS had almost the same sensitivity that was higher than GCS, but GCS had the most specificity. Finally, TRISS was selected as the most efficient scale for predicting mortality.

What factors affect length of hospital stay among trauma patients? A single-center study, Southwestern Iran.

PURPOSE: Trauma is a major health concern. Length of hospital stay (LOS) has been targeted as an important metric to assess trauma care. This study aims to evaluate the risk factors that affect LOS among trauma patients in a trauma center in Southwestern Iran. METHODS: This cross-sectional study was conducted on patients admitted to Rajaee Trauma Center, Shiraz, Iran between January 1, 2018 and December 30, 2018. The inclusion criteria were age above 15 years and having traffic accident injuries, including car, motorcycle and pedestrian injury mechanisms. The exclusion criteria were existing diseases including cardiovascular, cerebral, renal, and pulmonary diseases prior to this study, dead upon arrival or within 48 h after admission, and stay at the hospital for less than 6 h. The risk variables analyzed for prolonged LOS were age, gender, mechanism of traffic accident injury, infection during hospital stay, type of injury, injury severity score, surgery during hospitalization, and survival. Poisson regression was performed to evaluate the partial effects of each covariate on trauma hospitalization (≥3 days as longer stay). RESULTS: This study was conducted on 14,054 patients with traffic accident injury and the mean age was (33.89 ± 15.78) years. Additionally, 74.35% of the patients were male, with male to female ratio of 2.90. The result of Poisson regression indicated that male patients, higher age, combination of thoracic injuries, onset of infected sites, and surgery patients were more susceptible to have a longer LOS. Considering the site of injury, patients with face injuries followed by those with thorax injuries had the highest means of LOS (3.74 days and 3.36 days, respectively). Simultaneous existence of surgical intervention and infection in a patient had the greatest impact on prolonged LOS. CONCLUSION: This study identified that age, gender, mechanism of injury, infection, type of injury, survival, and ISS could lead to prolongation of LOS, but the affect can be reduced by eliminating modifiable risk factors.

Cellular mesoblastic nephroma in infants and children: Report of four cases and review of the literature.

BACKGROUND: Cellular mesoblastic nephroma is rare after infancy, and there are many controversial reports about its clinical presentation and treatment as well as outcome in infants, young children, and adolescents. OBJECTIVES: In this report, we will discuss our experience with four cases of cellular mesoblastic nephroma presented from infancy to childhood (from 18 months of age to 11 years of age). CASES: During 10 years, we had the experience of 4 cases of pediatric renal tumor with the diagnosis of cellular mesoblastic nephroma, which have been followed between 1 year and 6 years. There were three male and one female patients with the age of 1.5, 2, 2, and 11 years. These tumors showed variable characteristics according to the number of mitosis, proliferative rate, necrosis, immunohistochemical markers, and metastatic potential; however, despite of all of these variabilities, all of these patients have done well and all have been well at the end of study. CONCLUSION: Pediatric renal tumors with the histologic diagnosis of cellular mesoblastic nephroma have good outcome even with metastasis, mitosis, and high proliferative rate.

Bilateral renal cell carcinoma of the native kidneys in a 16-year-old boy: Report of a rare case and review of the literature.

Bilateral renal cell carcinoma is rare and most commonly occurs in patients with background of hereditary and genetic diseases. Occurrence of bilateral renal cell carcinoma in native kidneys of a renal transplant patient is even more uncommon, and less than 10 cases have been reported in the English literature. Herein, we report our experience with the youngest renal transplant patient ever reported with bilateral renal cell carcinoma, who presented with intractable urinary tract infection. We also will review all of the reported cases of bilateral renal cell carcinoma in the last 20 years in the English literature according to the presentations, treatment modalities, prognosis, and graft outcome.

Allograft renal cell carcinoma in pediatrics transplantation: A mini-review.

Renal cell carcinoma in the pediatric age group is a rare event, and its occurrence in the allograft (recipient) kidney is an uncommon event. There is no published review study in RCC of allograft kidneys in children and adolescents. In this study, we thoroughly searched English literature (PubMed, Google Scholar, and Google) in order to find all the reported allograft kidney RCCs in the patients who have been transplanted below the age of 18. There have been 12 reports of allograft RCC in this age group. Our result showed that the age of tumor detection according to donor age is lower comparing to non-allograft RCCs, and there is a significant male preponderance. RCC in the allografts is smaller and shows low nuclear grade and has a good prognosis. These findings emphasize the importance of routine allograft ultrasonography which results in earlier detection of RCC with smaller size and better outcome.

Solid Pseudopapillary Tumor of Pancreas: A Clinicopathologic Report from a Single Institution in Southern Iran.

BACKGROUND: Solid pseudopapillary tumor of pancreas (SPTP) is a rare tumor of the pancreas which mostly occurs in young women. Since its first description in 1969, more than 500 cases have been reported. There have been just 2 case reports and 1 review (7 cases) from Iran. In this study, we reported our experience with 22 patients with SPT from the largest pancreaticobiliary center in Southern Iran. METHODS: During 6 years (2012-2017), 22 cases of SPTP were operated on in our center. All of these cases were recruited and after confirmation of the pathological diagnosis, clinical charts were evaluated and all the clinicopathologic findings as well as outcome of the surgery were evaluated. RESULTS: Among the 22 patients, 20 were female and 2 were males. The age range was 15-52 years and the tumor sizes were 3.5 to 17 cm. All of the tumors had preoperative diagnosis by imaging modalities and were operated on with no complication or recurrences. Just one case showed liver metastasis. All of the patients with SPTP in this study were alive and in good condition. CONCLUSION: SPTP is not very rare in our center. In young patients presenting with pancreatic mass, especially in female patients, one of the most important diagnoses is SPTP. Conservative surgery and tumor excision is satisfactory and patients show excellent prognosis even after liver metastasis.

Metastatic Tumors to the Pancreas, a Single Center Study.

BACKGROUND: Most pancreatic masses are primary ductal adenocarcinomas; however, with the advent of new imaging studies and increasing survival of cancer patients, there are more cases with the diagnosis of secondary metastatic cancer to the pancreas. There is no study regarding cancer metastases to the pancreas from Iran. In this study, we retrieved all of the cases with the diagnosis of secondary cancer of pancreas in the affiliated hospitals of Shiraz University of Medical Sciences. METHODS: In 5 years (2012-2017), we evaluated all cases with the diagnosis of any pancreatic tumors and extracted all of the demographic and clinicopathologic findings of the cases with the diagnosis of metastatic pancreatic tumors from the clinical charts and pathology reports. RESULTS: For the duration of 5 years in our center, there were 131 cases of pancreatic tumors with different diagnoses, 9 of which were diagnosed as metastatic cancers from other organs. Two cases were diagnosed with gastric adenocarcinoma, 2 cases were colonic adenocarcinoma, one case was lung small cell carcinoma, 2 cases were renal cell carcinoma (RCC) and one case was gastrointestinal stromal tumor (GIST). The mesenchymal metastatic cancer to the pancreas has been a case of pleomorphic sarcoma of retroperitoneum. CONCLUSION: Pancreas is not a common location for metastases; however, colon, stomach, kidney and lung seem to be the most common primary tumors with metastases to the pancreas. Our report is the first study about pancreatic metastatic tumors from Iran.

Risk factors of mortality in nosocomial infected traumatic patients in a trauma referral center in south of Iran.

PURPOSE: Trauma-related injuries are the leading cause of death worldwide. Some risk factors make traumatic patients susceptible to infection. Furthermore, some mortality risk factors, including length of hospitalization and increasing age, were detected in non-traumatic infected patients. This study aimed to assess mortality risk factors among nosocomial infected traumatic patients in Rajaee trauma center, Shiraz, Iran. METHODS: This prospective cohort study was conducted during a period of 2 years since April 2015 to March 2017 in Rajaee hospital, which is the center of emergency medical services for traumatic injuries in Shiraz, Iran. Centers for Disease Control and Prevention/National Healthcare Safety Network surveillance system criteria were applied to define 5 types of nosocomial infections. The variables analyzed as the risk factors of infection and mortality included sex, age, mechanism of injury, site of injury, injury severity score (ISS), surgical intervention, length of hospitalization, intensive care unit (ICU) admission, and type of pathogen. Then, the incidence of nosocomial infection and also risk factors of mortality in traumatic patients were evaluated. All data analyses were performed using the statistical package for social sciences, version 15 (SPSS Inc., Chicago) and p ≤ 0.05 is considered to be statistically significant. RESULTS: The incidence of nosocomial infection was 7.2% (p < 0.001). Pneumonia was the most common type of infection detected in our study. Infection led to a 7.8-fold increase in mortality of the traumatic patients (p < 0.001). Admission in intensive care units and old age were the main risk factors of mortality in infected traumatic patients. Old age, gunshot and motor vehicle accidents, trauma to extremities and abdomen, higher injury severity score, and prolonged hospitalization, made the traumatic patients more susceptible to infection. CONCLUSION: The really high incidence of nosocomial infection in traumatic patients in Iran depends on some risk factors that should be considered. Also infection increases the mortality rate in the traumatic patients, which could be reduced by eliminating its risk factors.

Incidental Gall Bladder Adenocarcinoma in Cholecystectomy Specimens; A Single Center Experience and Review of the Literature.

BACKGROUND Gallbladder adenocarcinoma is the most common malignant tumor of the biliary tract. Most of gall bladder cancers are detected incidentally only after pathological examination of the surgical specimens. In this study we investigated the characteristics of incidental gallbladder cancers in our center and also reviewed the current literature regarding the diagnosis and treatment of such incidentally detected tumors in the gall bladder. METHODS We retrospectively reviewed all of the cholecystectomy specimens in the archives of Pathology Department in the hospitals affiliated to Shiraz University of Medical Sciences in the study period (2010-2016). Clinicopathological characteristics were extracted from the patients' clinical charts, which included symptoms, radiological findings, laboratory data, and surgical procedures as well as outcome. RESULTS During these 7 years we identified 18 cases of incidental gall bladder cancer, consisted of 13 women and 5 men with the age range of 32 to 85 (62.5 ± 14.2) years detected after pathological study of the resected gall bladders among more than 4800 resected gall bladders. During the period, only two patients were operated on with the impression of gall bladder adenocarcinoma, which was not included in the study. Ten cases were T1 and eight were T2 at the time of surgery. They have been followed up for 1-7 years, during which, six cases of T2 died. All of the T1 cases are alive and symptom free. CONCLUSION By increasing laparoscopic cholecystectomies in our center we observed 0.37% incidental cases of gall bladder adenocarcinoma. Preoperative diagnosis of this cancer in early stages is very difficult and needs high degree of suspicion. The most important predictor of prognosis is the stage of the cancer at the time of surgery. To the best of our knowledge, this is the first report of incidental gall bladder cancer from Iran.

Liver Metastasis of Gastrointestinal Neuroendocrine Tumors: A Single Center Experience.

BACKGROUND: Gastrointestinal neuroendocrine tumors (GI-NETs) are potentially malignant tumors, and their most common location of metastasis is the liver. OBJECTIVES: In this report, we will describe our experience with some clinical and pathologic findings of hepatic metastasis in a group of cases of GI-NETs at the largest referral center of GI and liver diseases in south Iran. MATERIALS AND METHODS: In this four-year study (2011 - 2014), all GI and liver NETs were extracted from the pathology files of hospitals affiliated with Shiraz University of Medical Sciences. After classification based on the world health organization guidelines, the patients were evaluated according to their location, sex, age, and proliferative index. After studying the imaging and clinical charts of liver-NET cases with an unknown primary location, a complete panel of immunohistochemical markers (TTF-1, CDX-2, CK-7, CK-2, etc.) was used to find the primary GI location. Carcinoid tumors from other sites, such as the lung, were omitted from this study. RESULTS: The most common primary site of metastatic GI-NET to the liver in our center was the small intestine, which was also the most frequent location of GI-NET without liver metastasis. No cases of appendiceal-NET were found with liver metastasis. In 8 cases (11.6%) with liver-NETs, no primary location was identified. GI-NETs with liver metastasis had a significantly higher grade and proliferative index compared with NETs without liver metastasis. CONCLUSIONS: Liver metastasis of neuroendocrine tumors in Iran presents in a very similar manner as that seen in western countries. In about 89% of cases with liver-NET, complete imaging, clinical, and pathological studies can help to identify the primary origin of the liver-NET, which is very important in the patient's management.