Effects of melatonin and N-acetylcysteine on aluminum phosphide poisoning in rats.

Introduction: Aluminum phosphide (ALP) poisoning is one of the deadliest types of poisoning in the world. The antioxidant properties of melatonin and N-acetylcysteine and their effects on reducing cell death have been identified. The aim of this study was to evaluate the effects of N-acetylcysteine and melatonin in the treatment of aluminum phosphide poisoning in rats. Materials and Methods: Fifty male Wistar rats weighing 200-250 g were tested in five groups of ten. The first group was the control group; the second group received (10 mg/kg) of ALP, the third group received (10 mg/kg) of ALP and (10 mg/kg) of melatonin, the fourth group received (10 mg/kg) of ALP and (10 mg/kg) of N-acetylcysteine, and the last group received (10 mg/kg) of ALP and (10 mg/kg) of melatonin and N-acetylcysteine. The plasma of samples was isolated, and the activity of antioxidant enzymes (glutathione S-transferase (GST), Superoxide dismutase (SOD), and catalase (CAT)) was analyzed. Results: The concentrations of CAT, GST, Glutathione, GSH were decreased in plasma, liver, and kidneys of mice treated with aluminum phosphide; also, the concentrations of aspartate aminotransferase (AST), ALT, and AlK were increased (P < 0.05), while the activity of SOD did not change significantly (P > 0.05). Treatment with N-acetylcysteine and melatonin led to an increase in the activity of CAT, GST, and GSH in plasma, liver, and kidney. After the administration of N-acetylcysteine and melatonin to mice, the levels of all enzymes were close to normal, and the mice survived for 12-15 hours after administration. Discussion: The administration of N-acetylcysteine (NAC) and melatonin at a dose of 10 mg/kg improves hepatic manifestations and prevents liver necrosis; also, they are considered potential therapeutic agents in the treatment of this poisoning.

Investigation of maternal and perinatal outcome in a population of Iranian pregnant women infected with COVID-19.

Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in pregnant women might affect both maternal and neonatal outcomes. Based on the inconsistency between the results of the previous studies and the lack of data about the possible vertical transmission of SARS-CoV-2, we designed the present study to investigate the maternal and perinatal outcomes in 182 Iranian pregnant women infected with COVID-19. Among 40 PCR tests conducted on neonatal throat samples, 11 tests were positive. Among the assessed women, 22 women needed ICU admission and 30 premature labors occurred. There were significant associations between ICU admission and many parameters such as the presence of dyspnea (P < 0.001), COVID-19-related CT scan findings (P = 0.003), need for a ventilator (P < 0.001), and low O2 saturation (P < 0.001), all of which indicate the critical situation of patients. Notably, the cause of delivery was significantly different in both groups, with labor pain and fetal distress being the most frequent causes of delivery in non-ICU and ICU-admitted patients, respectively. Moreover, delivery route (P = 0.003), frequencies of IUGR (P = 0.042), neonatal death (P = 0.008) and asphyxia (P = 0.016), Apgar score (P = 0.003), and gestational age at delivery (P = 0.009) have been associated with ICU admission. The present investigation exhibits association between the critical situation of pregnant women affected with COVID-19 and some adverse neonatal outcomes.

A systematic review and meta-analysis on tubal ligation and breast cancer risk.

BACKGROUND: Based on previous studies, it has been hypothesized that tube sterilization may be associated with a lower risk of breast cancer. This study aims to investigate the relationship between tubal ligation and the risk of breast cancer through a systematic review and meta-analysis. METHODS: In this systematic review and meta-analysis, PubMed/Medline, Web of Science, Scopus, and Google Scholar were searched for relevant non randomized studies published up to November 2020. Then, we screened the papers to include the eligible papers in the meta-analysis. Finally, we pooled the extracted results of individual studies to estimate the summary effect size. All analyses were done using Stata software version 13 (Stata Corp, College Station, TX). RESULTS: Four hundred sixty-four papers were retrieved from PubMed/Medline (160), Scopus (165), and Web of Science (139), and 21 papers from Google Scholar and manual search of references in selected full texts. After the removal of duplicates and screening of the papers, 11 articles (6 cohort and 5 case-control study) were included in the final analysis. The results of cohort (RR = 0.99, 95% CI = 0.97-1.0, I2 = 21.1%) and case control studies (OR = 0.87, 95% CI = 0.62-1.12, I2 = 88.9%) revealed that tubal ligation was not significantly associated with breast cancer risk. CONCLUSION: According to our findings, tubal ligation cannot be considered as a risk factor associated with breast cancer risk.

Low-dose ketamine as an analgesic agent in the emergency department: Efficacy and safety.

Introduction: Interest in using low-dose ketamine (LDK) as an alternative analgesic to manage acute pain in the emergency department (ED) has increased. The aim of this systematic review was to compare and evaluate the analgesic effect and safety of LDK for the management of acute pain in the ED. Method: Databases were searched and all published articles that met the inclusion criteria were used. Electronic research was conducted on a total of 85 articles, and 13 articles that were relevant in terms of content, topic, and aim were selected for further review. The studies were analyzed and categorized after review. Results: The results demonstrated that in 53.84% (7 of 13) of articles, a significant reduction or more than 50% reduction in pain in the group of patients treated with ketamine (alone or combined with other analgesics) was reported. However, in 46.15% (6 out of 13) of the reviewed articles, no significant difference was observed between the pain reduction in the groups treated with ketamine alone and ketamine with other analgesics. The highest decrease in numerical rating scale (NRS) score was 6 and the lowest was 1. There was also a 100% reduction in NRS score in 14 of 30 patients treated with 0.15 mg/kg ketamine and 0.5 mg/kg hydromorphone. Conclusion: According to the results of the present study, the use of LDK as an analgesic with low side effects can be suggested. However, further research is needed to determine the appropriate concentration with fewer side effects.

Uterine involvement in epithelial ovarian cancer and its risk factors.

BACKGROUND: Epithelial ovarian cancer (EOC) is an extremely aggressive and lethal carcinoma. Specific data that identify high-risk groups with uterine involvement are not available. Thus, this study aimed to evaluate a gross number of women with EOC to obtain the frequency of uterine involvement and its risk factors. METHODS: This retrospective observational study was conducted on 1900 histologically confirmed EOC women, diagnosed and treated in our tertiary hospital from March 2009 to September 2020. Data including their demographic, medical and pathological findings were collected. RESULTS: From 1900 histologically confirmed EOC women, 347 patients were eligible for participations. The mean age of study patients was 51.31 ± 11.37 years with the age range of 25 to 87 years. Uterine involvement was detected in 49.6% (173) of the patients either macroscopic (47.4%) or microscopic (52.6%) types. Uterine involvement was significantly associated with having AUB (P-value = 0.002), histological type of ovary tumor (P-value < 0.001), ovarian cancer stage (P-value < 0.001), and abnormal CA-125 concentration (P-value = 0.004). Compared to the other study patient, the patients with metastatic uterine involvement had significantly higher stage (p-value< 0.001), higher grade of ovary tumor (p-value = 0.008), serous histological type (p-value< 0.001), and a higher level of CA-125 concentration (p-value< 0.001). on the other hand, the patients with synchronous uterine cancer were significantly younger (p-value = 0.013), nulliparous (p-value< 0.001), suffered from AUB symptoms (p-value< 0.001) and had endometroid histological type (p-value = 0.010) of ovary cancer in comparison to other study patients. CONCLUSION: Considering the high prevalence of uterine involvement in EOC patients, ultrasound evaluation and/or endometrium biopsy assessment should be done before planning any treatment.

Aggressive angiomyxoma of the pelvis surgical management in a case with delayed diagnosis.

INTRODUCTION AND IMPORTANCE: Aggressive angiomyxoma is characterized as a non-capsulated soft mass with the ability to progress to surrounding tissues but without metastasis to distant tissues. Slowing tumor extension leading delayed tumor diagnosis, expression of different types of hormonal receptors, therapeutic ineffectiveness of noninvasive treatment approaches and misdiagnosis have remained as the major challenges for managing this tumor. CASE PRESENTATION: Herein, we described a case of aggressive angiomyxoma located in the posterior of the uterus and vagina that as successfully managed surgically to remove tumor mass followed by gonadotropin-releasing hormone (GnRH) agonist to prevent tumor recurrence. CLINICAL DISCUSSION: Surgical resection is the treatment of choice in aggressive angiomyxoma with complete success rate, however despite such successfulness, about two-thirds of patients experienced postoperative recurrence rate that could be prevented by hormone-based therapy especially GnRH agonist. CONCLUSION: Aggressive angiomyxoma is a rare tumor with locally invasive behavior. As misdiagnosis is common imaging like MRI with DWI should be considered. The best treatment is surgical resection by experienced surgeons in tertiary referral hospitals. Even with complete resection, the recurrence rate is high. So adjuvant medical treatment seems to be necessary.