Aflatoxin B1 and viruses' combined pathogenesis: A mini systematics review of invitro and invivo studies.

INTRODUCTION: The combined pathogenesis of Aflatoxin B1 (AFB1) and several viruses such as HBV, EBV and influenza virus have been investigated yet the molecular mechanism of their interaction and possible synergistic effects is not fully understood. OBJECTIVES: The aim of the current systematic review was to review in-vitro and in-vivo studies investigating the combined pathogenesis of aflatoxins and viruses. METHODS: This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. PECO (Population, Exposure, Comparator, and Outcome) criteria for invitro and invivo studies were used to evaluate the eligibility of the studies for systematic review. RESULTS: 21 studies were eligible for qualitative analysis based on the inclusion criteria. Of all the included studies, 9 (42.9 %) were invivo, 7 (33.3 %) were invitro-invivo and 5(23.8) articles conducted only invitro assay. Furthermore 14 (66.6 %) article explored hepatitis B virus (HBV) combination with AFB1, 4 (19 %) studied influenza A virus (SIV), 2 (9.7 %) were about Epstein-Barr virus (EBV) and only 1 (4.7 %) included hepatitis C virus (HCV). CONCLUSION: The limited collected evidence suggests that AFB1 enhanced EBV and influenza virus pathogenesis. AFB1 also operated as a cofactor for HBV and EBV-mediated carcinogenesis. On the other hand HBV and HCV also induced AFB-1 carcinogenesis. Due to the limited amount of included studies and the inconsistency of their results further studies especially on HBV and SIV are essential for better understanding of their combined mechanisms.

Muscular hydatid cyst in Iran: A case report.

INTRODUCTION AND IMPORTANCE: Hydatid disease, caused by the larval stage of Echinococcus granulosus, is a common parasitic infection of humans and herbivores. Although livers and lungs are the most commonly affected organ, hydatid cysts may develop in any body part. Primary muscular hydatid cyst is extremely rare. CASE PRESENTATION: We reported the case of a 40-year-old-woman with the presentation of a soft, mobile, and non-tender lump in the dorsal part of her left upper arm (triceps brachii), which emerged one year ago. Her past medical history was unremarkable. The arm sonography revealed a single uniloculated cystic mass (6.5 cm × 5.5 cm) with a thick wall containing cystic lesions. It suggested the diagnosis of echinococcosis. The patient underwent surgery, and the hydatid cyst was excised. Histopathological examination confirmed hydatidosis. CLINICAL DISCUSSION: Hydatid cysts occur rarely (about 4 %) in muscles even in endemic regions. The study is the first case of hydatidosis found in triceps brachii in Fars province, Iran. In endemic regions, considering the hydatid cyst possibility is very important because it presents with many diversities. As it clinically presents a painless slow-growing mass, may be misdiagnosed with benign soft tissue tumors. CONCLUSION: Although muscular hydatidosis is extremely rare, it should be considered a differential diagnosis of any growing subcutaneous or muscular masses or tumors. Imaging modalities and blood tests are highly relevant for diagnosis. Surgical excision, a choice of treatment, should be done with cautions and is combined with anthelmintic therapy to reduce the risk of recurrence.

The Histopathological Findings in Appendectomy Specimens in an Iranian Population.

BACKGROUND: Appendicitis is one of the most common causes of acute abdominal surgeries. The importance of parasitic etiologies in the pathogenesis of appendicitis is not well known in appendectomy specimens on a large scale in southwestern Iran. The current study aimed to retrospectively assess the demographic data and histopathological records of appendicitis in a 28-year period in Fars province, southwestern Iran. MATERIALS AND METHODS: Histopathological records of 13,013 patients who had undergone surgeries for appendicitis at Dr. Ali Shariati Hospital, affiliated with the Fasa University of Medical Sciences from December 1993 to January 2021 were reviewed and data concerning the patients' demographic data and histopathological records were retrieved from each record. More than 6800 archived microscopic glass slides were also reviewed. RESULTS: From a total of 13,013 histopathological records of surgical excisions of appendicitis that were reviewed over a 28-year period, 8,189 (62.9%) were male and 4,842 (37.1%) were female. Patients' age ranged from 2 to 98 years, with a mean age of 24.68±19.87 years. The most common inflammatory changes were 5,687 (43.7%), 1,228 (9.4%), 670 (5.1%), 522 (4%), and 363 (2.8%) cases of acute appendicitis, suppurative appendicitis, early acute appendicitis, gangrenous appendicitis, and perforated appendicitis respectively. Microscopically, no viral inclusions, fungal elements, and histopathologic findings of bacterial causes were found. Parasitic infections such as helminthiasis were detected in 74 (0.6%) cases aged from 6 to 63. Enterobiasis (Syn. oxyuriasis, pinworm infection) accounted for 73 (98.6%) of the 74 helminthiases, while ascariasis accounted for 1 (1.4%). Out of 74 cases, 29 (39.2%) showed evidence of appendicitis. CONCLUSION: The results suggest that although parasitic agents are minor causes of appendicitis, these agents should be kept in mind during differential diagnosis. However, whether every parasitic infection leads to appendicitis is controversial.

Gastric Perforation in a 60-Year-Old Woman with CMV Gastritis and Amphetamine Abuse Led to Death.

Gastric perforation as a multi-etiological disease is a full-thickness injury of the stomach wall. In this case report, we presented a 60-year-old woman with a history of suicidal behavior referred to the emergency unit with a decreased level of consciousness due to the multidrug consumption (amphetamine and benzodiazepine). Passing 3 days of admission in the intensive care unit, the patient represented severe abdominal distension, lack of defecation, and the absence of bowel sound, which suggested the gastrointestinal (GI) complication. Abdominal-pelvic sonography followed by laparotomy confirmed the gastric perforation, which finally led to the patient's death. Pathological analysis showed that the vast involvement of cytomegalovirus (CMV) in the patient's GI tract resulted in several peptic ulcers. The first report of gastric perforation-related death arises from the partnership of CMV infection and drug poisoning.

Genital exam, a missed piece of the puzzle in medical diagnosis, can be lifesaving in men: A lesson from a case of a state of shock due to duodenal metastasis of testicular choriocarcinoma.

Here we reported a case of a 17-year-old man with a history of weakness, vertigo, nausea, vomiting and dark stool within the last three months prior to admission. He was taken to the Emergency Room in a state of shock. After resuscitation, vital signs became stable, but due to low hemoglobin (HB = 5 g/dl), to find the source of bleeding, endoscopy was performed and a mass in the duodenum was detected. The pathology report was metastatic germ cell tumor. On genital physical exam (PE) there was a mass in the right testis; thus, the patient underwent radical orchiectomy and choriocarcinoma was diagnosed. The patient then received chemotherapy for six months, and he responded well to the treatment. This case report confirmed that genital PE should be part of a patients visit, even when we cannot find logical relation between clinical presentation and genital PE.

Testicular papillary serous carcinoma of ovarian type, a rare case report, however an important timely diagnostic issue.

A 28 years old man presented with left testicular swelling for recent few months. Ultrasonography and Computed tumor scan was in favor of solid cystic mass. The patient underwent left radical orchiectomy. The pathology diagnosis with aid of Immunohistochemistry staining approved the mullerian duct origin. Papillary serous carcinoma of ovarian type(PSCOT) is diagnosed for him. The patient treated successfully he was symptom free in two years follow up after orchiectomy. Timely diagnosis of PSCOT and orchiectomy are the keys of the patient survival; because prior to tumor spreading, the patient can be discharged after orchiectomy without adjuvant treatment.

Iranian Study on Social Determinants of Self-management in Patients with Hypertension Referring to Tabriz Health Care Centers in 2017-2018.

AIM: The present study aims to evaluate self-management status in Iranian patients with hypertension and its relationship with social determinants. SETTING AND DESIGN: This study was carried out in 2017-2018 in health care centers affiliated with Tabriz University of Medical Sciences in Iran. METHODS: A total of 240 patients with hypertension, who referred to health care centers of Tabriz, were invited to fill out the self-management (researcher made) and social determinants of health questionnaires. STATISTICAL ANALYSIS: Spearman correlation was used to determine the relationship between self-management score and its items with items of social determinants of health questionnaire. Also, Pearson correlation Student t-test was used. RESULTS: In this research 197 patients were studied. Mean age of the participants was 56.6 ± 10.1 years. The mean ± SD (standard deviation) of self-management score was 81.51 ± 13.16. The correlation coefficient of self -management with financial ability of securing the education expenses, nutrition and fruits, and health care expenses were 0.228 (P = 0.001), 0.149 (P value <0.05), and 0.28 (P < 0.001) respectively. Also, the correlation coefficient of age with self-management was - 0.206 (P value = 0.004). Item level analysis showed strong significant associations between social determinants and three items related to lifestyle and two items related to monitoring of blood pressure (BP) at home. CONCLUSION: Overall self -management status of the patients was very good. Health centers that plan self -management support programs for patients should consider the social determinants of life style modification and monitoring of BP at home by hypertensive patients.

Scrotal leiomyoma a rare benign intra-scrotal mass could lead to unnecessary orchiectomy.

Leiomyoma is a benign tumor originating from smooth muscle cell, Mostly from uterus. However, in men is a very rare entity. Scrotal leiomyoma is a very rare tumor. Here we presented a case of scrotal leiomyoma in a 71-year-old man. He presented with a slowly growing, painless mass and heaviness in the left testis for 10 years. Due to huge size, testicular attachment and preoperational diagnosis of atypical leiomyoma/leiomyosarcoma, orchiectomy was performed. Pathology report diagnosed leiomyoma. We suggest frozen section diagnosis as a useful tool, to prevent unnecessary procedure.

Primary amelanotic melanoma of the male urethra: A rare entity and diagnostic challenge.

Malignant melanoma (melanoma) is a tumor of melanocytes that usually presents as cutaneous lesions. While melanoma can infrequently appear as a primary tumor elsewhere in the body, it is extremely rare in the urethra and even rarer as amelanotic malignant melanoma. We report the case of a 66-year-old male who presented with painless gross hematuria and lower urinary tract obstructive symptoms in the recent 2 weeks prior to his visit to our clinic. History and physical examination, including external genital examination, abdominopelvic sonography, and urine culture, were not conclusive. Cystourethroscopy revealed a creamy pink fragile mass located in the anterior proximal urethra that extended to the mid portion. Pathological examination of this lesion confirmed the diagnosis of amelanotic malignant melanoma using immunohistochemistry. Radical cystourethrectomy with ileal conduit was subsequently conducted. Although this tumor is extremely rare, urologists and pathologists should consider malignant melanoma as a diagnosis in patients with urethral tumor because of the likelihood of early metastasis and, consequently, poor prognosis. Complete surgical removal of the tumor and use of effective therapies can improve outcomes in these patients.

Protection effect of cerium oxide nanoparticles against radiation-induced acute lung injuries in rats.

INTRODUCTION: Radiation therapy is one of the most common tools for treating cancer. The aim is to deliver adequate doses of radiation to kill cancer cells and the most challenging part during this procedure is to protect normal cells from radiation. One strategy is to use a radioprotector to spare normal tissues from ionizing radiation effects. Researchers have pursued cerium oxide nanoparticles as a therapeutic agent, due to its diverse characteristics, which include antioxidant properties, making it a potential radioprotector. MATERIALS AND METHODS: One hundred rats were divided into five groups of A) control group, intraperitoneal (IP) saline injection was done twice a week; B) bi-weekly IP injection of 14.5 nM (0.00001 mg/kg) CNP for two weeks; C) a single whole thorax radiation dose of 18 Gy; D) a single whole thorax radiation dose of 18 Gy + bi-weekly injection of 14.5 nM CNP for two weeks after radiation; E) bi-weekly IP injection of 14.5 nM CNP for two weeks prior to radiation + a single whole thorax radiation dose of 18 Gy. Thirty days after irradiation, 7 rats from each group were anesthetized and their lungs extracted for histopathological examination. RESULTS: Statistical analyses revealed that CNP significantly decreased the incidence of tissue collapse and neutrophile aggregation in rats receiving CNP before radiation in comparison with the radiation group. CONCLUSION: The results suggested the possibility of using CNP as a future radioprotector due to its ability to protect normal cells against radiation-induced damage.

Serum and Cerebrospinal Fluid Levels of S-100ß Is A Biomarker for Spinal Cord Injury; a Systematic Review and Meta-Analysis.

INTRODUCTION: There is controversy regarding the value of serum or cerebrospinal fluid (CSF) levels of S100 calcium-binding protein B (S-100B) in spinal cord injury (SCI). For reaching a general conclusion, the present meta-analysis was designed aiming to evaluate the value of serum and CSF levels of S-100B protein in detecting the presence of SCI in animal studies. METHODS: An extensive search was performed in Medline, Embase, Scopus and Web of science databases. Screening articles, summarizing them and entering data to checklist and quality assessment of the mentioned articles were done by 2 independent reviewers. Data were analyzed and a pooled standardized mean difference (SMD) and 95% confidence interval (95% CI) were presented. RESULTS: Finally, the data of 7 articles were included in the meta-analysis. Serum level of S-100B had increased as a result of SCI. During the first 6 hours after injury, the level of this protein was very high (SMD=3.8; 95% CI: 2.6 to 5.1; p<0.0001), but as time passed the serum level of the protein had decreased (SMD=0.4; 95% CI: -1.2 to 2.0; p=0.65). In addition, CSF level of the mentioned protein was very high during the initial 6 hours after injury (SMD: 5.8; 95% CI: 3.6 to 8.0), and this elevated level was still observed until 12 hours after injury (SMD: 6.5; 95% CI: 3.7 to 9.3; p<0.0001). CONCLUSION: The results of the present systematic review and meta-analysis show that measuring the level of S-100Β protein in serum and CSF has a potential value in diagnosis of SCI in animal models. This biomarker increases during the initial 6 hours following injury and remains high until 24 hours after that. However, more than 24 hours after the injury, serum level of this protein returns to the level of animals without SCI.

Intravenous Morphine vs Intravenous Ketofol for Treating Renal Colic; a Randomized Controlled Trial.

INTRODUCTION: The main purpose of emergency department (ED) management for renal colic is prompt pain relief. The present study aimed to compare the analgesic effects of intravenus (IV) ketofol with morphine in management of ketorolac persistent renal colic. METHODS: This study is a single blind randomized, clinical trial, on patients who were presented to ED with renal colic, whose pain was resistant to 30 mg IV ketorolac. The patients were randomly assigned to either IV morphine (0.1 mg/kg) or IV ketofol (0.75 mg/kg propofol and 0.75 mg/kg) and the measures of treatment efficacy were compared between the groups after 5 and 10 minutes. RESULTS: 90 patients with mean age of 38.01 ± 9.78 years were randomly divided into 2 groups of 45 (66.7% male). Treatment failure rate was significantly lower in ketofol group after 5 (20% vs 62.2%, p < 0.001) and 10 minutes (11.1% vs 44.4%, p < 0.001). ARR and NNT for ketofol after 5 miutes were 42.22% (95% CI: 23.86 - 60.59) and 3 (95% CI: 1.7 - 4.2), respectively. After 10 minutes, these measures reached 33.33 (95% CI:16.16 - 50.51) and 4 (95% CI: 2.0 - 6.2), respectively. NNH and ARI for hallucination or agitation were 12 (95%CI: 5.8 - 174.2) and 8.89% (0.57 - 17.20), respectively. CONCLUSION: The results of the present study, showed the significant superiority of ketofol (NNT at 5 minute = 3 and NNT at 10 minute = 4) in ketorolac resistant renal colic pain management. However, its NNH of 12, could limit its routine application in ED for this purpose.

Metastatic follicular thyroid carcinoma diagnosed by fine needle aspiration cytology: a report of 3 cases.

BACKGROUND: Follicular thyroid carcinomas (FTCs) usually have a benign clinical course, with an excellent long-term prognosis and a propensity for vascular invasion. The most common sites of metastases are lung and bone. Only a few reports are available on fine needle aspiration biopsy findings from metastatic lesions of FTC. CASES: A 68-year-old man presented with a thyroid mass and skin nodule on the scalp. Skin nodule aspiration revealed metastatic FTC. A 52-year-old woman and 60-year-old man were investigated for chronic anemia. As part of the routine investigation, bone marrow aspiration and biopsy were performed from the posterior iliac crest and diagnosed as metastatic FTC. Further questioning revealed that the patients had undergone thyroidectomy 10 and 13 years earlier. The aspiration material in all 3 cases revealed epithelial cell clusters with marginal (fire-flare) vacuoles. CONCLUSION: Cytologic diagnosis of metastatic FTC has been reported rarely. Marginal (fire-flare) vacuoles aid in making the diagnosis of metastatic FTC.