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Background: Latent tuberculosis (TB) can reactivate in immunocompromised individuals, such as cancer patients undergoing chemotherapy, leading to severe complications. Understanding the prevalence of latent TB in this high-risk group is crucial, especially in regions with moderate to high TB burdens., Aim: This study aims to determine the prevalence of latent tuberculosis in cancer patients before chemotherapy and immunotherapy to guide preventive interventions and reduce the risk of TB reactivation., Methods: This case-control study was conducted at Sina Hospital in Tehran, Iran, from 2012 to 2022. A total of 392, including 107 newly diagnosed cancer (case) and 285 non-cancer (control) patients, were enrolled in this study. All patients had received the Bacillus Calmette-Guérin (BCG) vaccine at the age of one. They underwent a thorough clinical examination and were screened using the tuberculin skin test (TST) to detect latent TB. Any active TB cases were identified through acid-fast smear tests. The data collected from the study participants was then analyzed., Results: The results showed no significant difference in the size of TST between cancer and non-cancer patients (cases: median = 2 mm, IQR: 1-12; controls: median = 2 mm, IQR: 1-5; p = 0.09). The prevalence of latent TB was 27.1% in cancer patients and 20.7% in non-cancer patients, with no significant association identified between latent TB and malignancies (P-value = 0.176). Over a median follow-up of 4 years, mortality was significantly higher in cancer patients compared to controls (42.1% vs 1.8%; P< 0.001, OR = 40.64). Additionally, deceased patients exhibited a greater prevalence of latent TB (44% vs 19.3% in survivors; P< 0.001, OR = 3.28), and increased size of TST was associated with higher mortality risk among cancer patients., Conclusion: In conclusion, this study emphasizes the need for vigilant latent TB screening in cancer patients, given the association between larger TST sizes and increased mortality risk. While no direct link between cancer type and latent TB was found, proactive TB management remains crucial, particularly for those undergoing immunosuppressive therapy., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Mortezazadeh, Karimi, Esfandbod, Mofidi, Hemmati, Kashani, Shirsalimi, Seyyed Mahmoudi and Kamali Yazdi.)

Background: Today, survivin is known as one of the most specific cancer proteins; provide unique and practical study opportunities. Clinical value of survivin in gastric cancer (GC) is not yet appointed. To establish the expression level of survivin and its diagnosis value in Iranian patients with GC, we evaluated the association of survivin expression with clinicopathologic factors., Methods: Overall, 60 matched-normal controls with 60 GC samples including 30 cases with evidence of metastasis at time of our study and 30 cases without evidence of metastasis were recruited, in Tehran, Iran during 2008 to 2018. Survivin expression was evaluated by quantitative Real-time polymerase chain reaction (qRT-PCR) and immunohistochemistry (IHC) study., Results: Increased expression of survivin at mRNA and protein levels was found in 86.7% and 71.6% of cases, respectively. Evidence indicated a significant difference in survivin mRNA expression level between tumor and nontumoral (marginal) tissues ( P <0.001). The difference in expression of survivin mRNA was not significant between metastatic and non-metastatic tumor tissues ( P =0.171). Positive immunoreactivity of survivin was observed to be predominantly in the nucleus of tumor cells. A significant difference in survivin protein expression was detected between tumor and non-tumoral tissues ( P <0.001) and between metastatic and non-metastatic tumor tissues ( P <0.001). There was no significant association between survivin mRNA expression and clinicopathological variables. However, survivin protein expression was significantly correlated with perineural involvement ( P <0.018)., Conclusion: This data could be supportive of using survivin as a useful diagnostic marker in GC. Although, more research is needed in this area., (Copyright© 2024 Fanaei et al. Published by Tehran University of Medical Sciences.)

Introduction: Chemotherapeutic agents have the potential to induce neurotoxicity, resulting in a range of symptoms, including mild paresthesia, neuropathic pain, pronounced ataxia, and significant impairment. Taxane-induced neuropathy (TIN) is a prevalent adverse effect and a significant constraint of Taxane-based chemotherapy protocols in treating breast cancer. In this current study, we aim to compare the effects of Venlafaxine and Duloxetine in taxane-induced Neuropathy as well as the quality of life, Depression, and Anxiety in Breast cancer Patients., Methods: The present study investigated breast cancer patients who experienced acute neuropathic pain after receiving paclitaxel treatment, a chemotherapeutic agent. The participants were allocated randomly into two groups, one receiving Venlafaxine and the other receiving Duloxetine. The participants underwent assessments for anxiety, depression, pain, neuropathy, quality of life, and neuropathic pain through the administration of questionnaires at the commencement of the study and after ten weeks following the intervention., Results: Both groups exhibited decreased neuropathic pain, with the venlafaxine group significantly reducing McGill's pain score. Although, the result is not suggestive of a difference between venlafaxine and duloxetine impact on any variables scores., Conclusion: Duloxetine and Venlafaxine effectively treat neuropathic symptoms such as paraesthesia, tingling, and itching. Venlafaxine is also beneficial for relieving pain associated with neuropathy.This trial was retrospectively registered on 1.1.2023 at irct.ir (trial registration ID: IRCT20220115053723N1). URL: https://www.irct.ir/trial/62540/pdf., Competing Interests: Conflicts of interest: Hanieh Radkhah declares she has no competing interests. Mohsen Esfandbod declares he has no competing interests. Mohammad Eslami declares he has no competing interests. Mohammad Amin Khadembashiri declares he has no competing interests. Parnian Shobeiri declares she has no competing interests. Farnaz Etesam declares she has no competing interests., (© 2024 Greater Baltimore Medical Center.)

Background: Breast cancer is the most common cancer in women worldwide. Premature menopause and hot flashes are the main complications of breast cancer treatments. About 40 to 50 percent of breast cancer women who undergo chemotherapy are experiencing premature menopause symptoms, including hot flashes. Some endocrine therapies such as tamoxifen and aromatase inhibitors are associated with induction or aggravating hot flashes. Hot flashes are often debilitating and significantly impair daily functions. Therefore many therapeutic options have been studied so far for the management of this adverse effect. However, there are still some clinical challenges in managing hot flashes in patients with breast cancer., Objective: We aimed to evaluate and compare the efficacy of venlafaxine and citalopram on hot flashes in breast cancer women receiving tamoxifen., Design: We conducted a double-blind, placebo-controlled trial in forty-one, 35 to 65 years old female patients. The study lasted for four weeks, and the follow-up was for two months. Venlafaxine and citalopram treatments started with doses of 37.5 mg or 10 mg, respectively. Venlafaxine and citalopram dosages were increased in the second week to 75 and 20 mg, respectively. The study was conducted during the year 2017., Key Results: The results indicated that the total efficacy was significantly different in groups receiving citalopram, venlafaxine, and placebo. Total efficacy in the placebo group, venlafaxine, and citalopram was 14.3, 53.8, and 64.3%, respectively (p=0.02). During the second week, the efficacy in groups receiving citalopram, venlafaxine, and placebo was 57.1, 53.8, and 14.3%, respectively (p=0.04). Generally, both citalopram and venlafaxine were well tolerated. The associated adverse effects were mild to moderate in both groups., Conclusions: Although citalopram was associated with more adverse effects, including constipation, it was more effective in reducing the frequency of hot flashes when compared to venlafaxine or placebo., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Microplastics (MPs) are a major emerging contaminant in agroecosystems, due to their significant resistance to degradation in terrestrial environments. Although previous investigations have reported the harmful effects of MPs contamination on soil biological properties, still little is known about the characteristics and fate of MPs in biosolid-amended soils and their risks to soil biota, particularly earthworms. We determined microplastics' concentration, size distribution, and chemical composition in 3 sewage sludge biosolids and 6 biosolid-amended agricultural soils. In addition, we assessed the potential short-term risks of MPs to earthworms' (Amynthas Gracilis and Eisenia Fetida) survival rate and fitness in an environmentally relevant exposure study (28 days). Biosolid-amended soils (1000-3100 MPs kg -1 dry mass) showed ≈30 times lower MPs content than investigated biosolids (55400-73800 MPs kg -1 dry mass), with microplastic fragment to fibre ratios between 0.2 and 0.6 and 0.3-0.4 in soils and biosolids, respectively. Total MPs dry mass was also ≈19 times lower in assessed soils (12-26 mg kg -1 ) than biosolids (328-440 mg kg -1 ). On average 77% and 80% of plastic fragments had a lower dimension than 500 µm, while 50% and 67% of plastic fibres had a length of less than 1000 µm in soil and biosolid samples, respectively. Polyethylene (23.6%) was the major source of microplastic contamination in biosolid-amended soils, while polyethylene terephthalate (41.6%) showed the highest concentration in biosolid samples. Spiked polyethylene MPs did not show any significant effect on earthworms' survival rate (93-99%). However, biosolid application significantly (P < 0.05) decreased survival rate of Eisenia Fetida (81%) but showed no significant effect on Amynthas Gracilis (93%). Biosolid amendment significantly (P < 0.05) decreased earthworms' growth rate, with higher impact on Eisenia Fetida than Amynthas Gracilis, while there were no significant differences between control and microplastic spiked treatments. The overall decrease in MPs concentration of earthworm casts, compared with initial MPs concentrations in soil, indicated that the investigated species did not bioaccumulate MPs during the exposure experiment., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Aim  Primary central nervous system lymphoma (PCNSL) is a rare extra nodal non-Hodgkin's lymphoma. The optimal treatment for PCNSL is still unclear. In this study, we present our experience with management of PCNSL in a tertiary care center in Iran. Methods  In this retrospective study, 58 patients with tissue diagnosis of PCNSL were studied. All patients were treated with chemotherapy including intravenous high-dose methotrexate, rituximab and temozolomide and radiotherapy by the same oncologist. Statistical analysis was performed using SPSS. Results  The mean overall survival (OS) in this study was 37.4 ± 13.6 months and the mean progression free survival (PFS) was 35.1 ± 9.8 months. The mean time to progression was 15.2 ± 8.79 months among 8 patients who experienced progression in this series. Finding of a positive CSF cytology was not linked with disease progression, while HIV infection and multifocal involvement at initial presentation were strongly linked to a lower PFS. The single most important factor affecting the OS was the histopathologic type of the PCNSL; two of the three patients who died from their disease in this series had non-B cell PCNSL, whereas only one patient with DLBCL died because of brainstem involvement. Conclusion  The results of this study show a lower rate of HIV-infection in patients with PCNSL as compared to the series from the western countries. Non-B cell histopathology and HIV-infection were found to be associated with the dismal prognosis., Competing Interests: Conflict of Interest None declared., (Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

Background: Microsatellite instability (MSI) is considered a key factor in carcinogenesis and a genetic alteration pattern in many types of cancers such as gastric cancer (GC). Although the role of MSI in colorectal cancer (CRC) is well known, its prognostic impact on GC has not been clearly defined. The assessment of MSI in GC has not been documented in the Iranian population yet. Therefore, this study analyzed the association of MSI status with GC in Iranian patients. Materials and Methods: We compared the frequency of MSI at 5 loci from formalin-fixed paraffin-embedded (FFPE) gastrectomy specimens, between metastatic and non-metastatic cases of GC (N = 60). A panel of five quasi-monomorphic markers and a single dinucleotide marker with linker-based fluorescent primers was used. Results: MSI was observed in 46.6% of cases, including MSI-high (H) (33.3%) and MSI-Low (L) (13.3%). Moreover, the most unstable and stable markers in our study were NR-21 and BAT-26 accordingly. MSI-H and MSI were seen more frequently in non-metastatic tumors (p= 0.028 and p= 0.019, respectively). Conclusion: The current study showed MSI status more frequently in non-metastatic GC which may reflect a good prognostic factor in GC like CRC. Although, larger and more comprehensive studies are needed to confirm this statement. A panel consisting of NR-21, BAT-25, and NR-27 mononucleotide markers appears to be reliable and useful markers for detecting MSI in GC in Iranian patients., (Copyright © 2022 Tehran University of Medical Sciences.)

Objective: Neoadjuvant chemotherapy with 5-fluorouracil (5FU) is one of the most effective treatment options for gastric cancer patients.  However, treatment response varies significantly between patients based on their genetic profile. The purpose of this study was to determine the association between thymidylate synthase (TS) and enolase superfamily member 1 (ENOSF1) polymorphisms, treatment response, and overall survival in patients with gastric cancer., Methods: The TS and ENOSF1 variants were analyzed in formalin-fixed paraffin-embedded (FFPE) tissue from 100 gastric cancer patients receiving neoadjuvant 5FU-based chemotherapy. Polymerase chain reaction (PCR) amplification and restriction fragment length polymorphism (RFLP) were used to determine TS polymorphisms' genotypes, and the Tetra Arms PCR method was used to identify ENOSF1 polymorphisms. Patients were followed for up to five years, and the association between variants, treatment response, and overall survival (OS) was examined., Results: There was a significant association between the TS 5' UTR polymorphism and response to treatment in patients with gastric cancer who received neoadjuvant 5FU therapy (P=0.032). Patients with the 2R3R genotype responded better to treatment, whereas those with the 3R3R genotype did not respond to treatment. Patients with the 2R2R and 3R3R genotypes had the longest and shortest median survival times, respectively, and the observed differences were significant (p=0.003). There was a statistically significant relationship between rs2612091 and chemotherapy response (P=0.017). Patients with genotype AG did not respond to treatment., Conclusion: This study established that the TS 5' UTR and ENOSF1 rs2612091 polymorphisms could be used to predict treatment response and overall survival in patients with gastric cancer who received neoadjuvant chemotherapy based on 5FU.

Background: The most prominent part of the cellular response of the immune system is driven by neutrophils. These cells tend to decline following chemotherapy in patients with leukemia. Neutropenia is an influential factor in the prognosis of cancer patients. Stress reduces white blood cells (WBCs) and neutrophils are linked to an increased risk of infectious diseases after chemotherapy. We investigated the association between neutropenia and perceived stress following chemotherapy. Materials and Methods: We performed a cross-sectional study on 60 patients with leukemia in a university hospital. Participants completed self-report measures, including the demographic data and perceived stress scale (PSS) questionnaire. We compared rates of neutropenia, as a measure of chemotherapy prognosis, 10 days after chemotherapy in different stress levels. Moreover, the number of patients with polymorphonuclear (PMN) under 1000/microliter was compared at different stress levels.    Results: We found that neutropenia is directly correlated with negative stress perception and inversely correlated with positive stress perception. These effects appear more prominent in patients with PMN under 1000/microliter as the number of these patients was significantly more in groups with higher negative stress and less in groups with higher positive stress scores. Conclusion: It can be concluded that stress is correlated with neutropenia, and stress management in patients with leukemia will be accompanied by better recovery outcomes and reduced risk of infectious disease., (Copyright © 2022 Tehran University of Medical Sciences.)

For patients with acute lymphoblastic leukemia (ALL) undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT), total body irradiation (TBI) has been particularly advocated as a part of the conditioning regimen in case of extramedullary involvement in sanctuary sites such as the central nervous system (CNS), to ensure greater tissue penetration. In resource-limited countries lacking TBI facilities; however, ALL patients undergo radiation-free myeloablative conditioning, though its impacts on post-HSCT outcomes of the patients with pre-HSCT CNS involvement have not been analyzed. In this 14-year series of 278 adult (> 18 y) ALL patients undergoing TBI-free busulfan/cyclophosphamide conditioning allo-HSCT, we found that the long-term probabilities of overall survival, disease free survival, relapse and non-relapse mortality were not significantly different between CNS-involved and CNS-spared patients. Moreover, there was no statistically significant difference in the incidence of post-HSCT CNS relapse between CNS-involved and CNS-spared patients. Pre-HSCT cranial radiation therapy (CRT) showed no significant preventive effect on the likelihood of post-HSCT CNS relapse. Through multivariable regression analysis, grade III-IV acute graft-versus-host disease (GvHD), extensive chronic GvHD and post-HSCT relapse were ascertained as independent determinants of mortality (Adj.R 2 = 53.9 %, F (12,265) = 28.1, P < 0.001), while other parameters including Philadelphia translocation, pre-HSCT CNS involvement and CRT were found to have no independent effect. Although this study was not an attempt to compare TBI-based vs. non-TBI conditioning, the TBI-free myeloablative allo-HSCT was shown to be feasible and an option for adult ALL patients with CNS involvement, considering the comparable outcomes between patients with and without CNS involvement., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Trastuzumab is an efficient monoclonal antibody used in the treatment of Her2-positive breast cancer. Despite its prominent effect on Her2-positive patients' disease-free Survival. Trastuzumab-induced cardiotoxicity is still one of the main challenges. Angiotensin-converting enzyme inhibitors (ACE inhibitors) are one of the most potent agents used in heart failure, which also showed confirmed cardioprotective effects against anthracycline and doxorubicin. We aimed to assess the cardioprotective effects of Carvedilol in a randomized clinical trial study. Materials and Methods: sixty non-metastatic Her-2 positive patients (30 cases; 30 controls) were entered into the study via a simple randomization method.Carvedilol was administered for the patients with the starting dose of 3.125 mg twice a day and started 7 days before trastuzumab administration. The dose has been increased in a three-week period to reach 12.5 mg twice a day and continued until the end of therapy. All the patients underwent an echocardiography after receiving Adriamycin and Cyclophosphamide in order to measure basal Ejection Fraction (EF) and Pulmonary Artery Pressure (PAP). Each patient underwent a follow-up echocardiography in 3,6,9 and 12 months after initiation of the treatment. Finally, all the patients went through the last episode of echocardiography 1 month after the end of treatment. All the Measured PAP and EF has been recorded and analyzed Results: EF and PAP changes for both groups had no significant changes during the course of treatment with Trastuzmab (p-value = 0.628 and p-value = 0.723, respectively). Seven patients in the intervention group and 2 patients in the control group presented with EF decrease. Also, 8 patients in the intervention and 9 patients in the control groups showed PAP increase. Conclusion: According to our results, in patients with HER2-positive breast cancer treated with trastuzumab, Carvedilol showed no significant protective effect on trastuzumab-induced cardiotoxicity., (Copyright © 2021 Tehran University of Medical Sciences.)

Consider primary bone lymphoma as an important differential diagnosis of osteomyelitis.In patients who are unresponsive to antibiotics and core needle biopsy result is incoherent with clinical symptoms, consider open biopsy for accurate diagnosis., Competing Interests: None declared., (© 2021 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)

Soil organic matter (SOM) formation involves microbial transformation of plant materials of various quality with physico-chemical stabilisation via soil aggregation. Land use and vegetation type can affect the litter chemistry and bioavailability of organic carbon (OC), and consequently influence the processing and stabilisation of OC into SOM. We used 13 C nuclear magnetic resonance ( 13 C NMR) and hot-water extraction to assess the changes in chemical composition and labile OC fractions during the transformation processes from leaf to litter to SOM depending on land use and vegetation type. The hot-water-extractable OC (HWEOC) decreased from leaf (43-65 g kg -1 ) to litter (19-23 g kg -1 ) to SOM (8-16 g kg -1 ) similar in four land use types: grassland, sugarcane, forest and banana. These trends demonstrated the uniform converging pathways of OC transformation and increasing stability by SOM formation. The preferential decomposition and decrease of labile OC fractions (∑% di-O-alkyl, O-alkyl and methoxyl) from leaf (54-69%) to SOM (41-43%) confirmed the increasing stability of the remaining compounds. Despite differences in the biochemical composition of the leaf tissues among the vegetation types, the proportions of labile OC fractions in SOM were similar across land uses. The OC content of soil was higher in forest (7.9%) and grassland (5.2%) compared to sugarcane (2.3%) and banana (3.0%). Consequently, the HWEOC per unit of soil weight was higher in forest and grassland (2.0 and 1.2 g kg -1 soil, respectively) compared to sugarcane and banana (0.3 and 0.4 g kg soil -1 , respectively). The availability of labile SOM is dependent on the quantity of SOM not the chemical composition of SOM. In conclusion, labile OC fractions in SOM, as identified by 13 C NMR, were similar across land use regardless of vegetation type and consequently, SOM formation leads to convergence of chemical composition despite diversity of OC sources., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: Acute myeloid leukemia (AML) patients are often neutropenic as a result of their disease alone or following their chemotherapy. In this randomized clinical trial the efficacy of Iranian short-acting (PD-Grastim) and long-acting G-CSF (PD-Lasta) were compared in term of time to recovery from neutropenia in de novo AML patients following the consolidation chemotherapy. Materials and Methods: Patients (n = 51) received one or two courses of Cytarabine and Daunorubicin as an induction. If complete remission was achieved, the treatment was followed by high-dose Cytarabine as consolidation chemotherapy. Twenty- four hours after the consolidation chemotherapy, patient were randomized to receive either daily short-acting G-CSF (PD-Grastim) (300 µg/kg) or single-dose long-acting G-CSF (PD-Lasta) (6 mg). Results: The median time to recovery of neutrophils was 11.00 and 13.00 days for short-acting G-CSF (PD-Grastim) (n=22) and long-acting G-CSF (PD-Lasta) (n=29) groups, respectively (U=186.5, P>0.05 two-tailed). Incidence of adverse effects was similar in both short-acting G-CSF (PD-Grastim) and long-acting G-CSF (PD-Lasta) groups. Conclusion: Overall, data show that Iranian long-acting G-CSF (PD-Lasta) was not significantly different with Iranian short-acting G-CSF (PD-Grastim)., (Copyright © 2021 Tehran University of Medical Sciences.)

Pancreatic neuroendocrine tumors are rare neoplasms that comprise 1-2% of all pancreatic tumors. However, they are the second most common solid pancreatic neoplasms. They have a wide range of imaging appearances and they can show common to very rare imaging presentations. Most of the time they are solitary well-marginated enhancing solid mass arising in a certain aspect of the pancreas. We present a case report of a 41-year-old female who underwent clinical work-up for abdominal pain, loss of appetite and weight loss for the past year. Ultrasound, computed tomography, and magnetic resonance imaging show diffuse homogenous pancreatic enlargement without contour deformity or a focal mass. Lymphoma and autoimmune pancreatitis were suggested based on imaging findings but IGg4 level and other lab data were normal. Endoscopic ultrasonography confirmed the diffuse enlargement of the pancreas without peripheral structures involvement. The pathological results of multiple fine-needle aspiration biopsy from all parts of the enlarged pancreas revealed a low-grade neuroendocrine tumor., (Copyright Journal of Radiology Case Reports.)

Introduction: Patients with cancer may have many complications involving their psychosomatic systems, such as sleep disturbance, depression, and anxiety. Thus, many research studies were conducted to reduce these complications. Zolpidem, as a short-term non-benzodiazepine treatment of insomnia, and melatonin as a chronobiological functionregulatory hormone, are commonly used for improving sleep quality. This randomized clinical trial aims to compare the effects of zolpidem and melatonin on sleep quality, depression, and anxiety in patients with colorectal cancer., Methods: In this single-blinded trial, 90 patients with colorectal cancer undergoing chemotherapy who had obtained a score of 5 or higher on the Pittsburgh Sleep Quality Index (PSQI) were randomly divided into two groups (n=45). One group was treated with 10 mg zolpidem at bedtime, and the other group received 6 mg melatonin at bedtime for 30 days. PSQI on weeks 0, 4, 8, Groningen sleep quality scale, Hamilton rating scale for depression, and Hamilton anxiety rating scale questionnaires were performed to assess patients on weeks 0, 4, and 8. The outcome was then analyzed, and P≤0.05 was considered statistically significant., Results: Both zolpidem and melatonin had significant impacts on sleep quality in week 4 (P<0.05). After stopping the treatments, the conditions were noticeably reversed on week 8 (P<0.05). Zolpidem and melatonin were relatively similar in affecting sleep duration, latency, efficiency, and disturbance. None of the two study medications had any considerable influence on anxiety and depression., Conclusion: Melatonin and zolpidem are promising agents for treating sleep complications and, to some extent, depression, and anxiety in cancer patients, according to the present study. However, further clinical trials are recommended to confirm the results of this study., Competing Interests: Conflict of interest The authors declared no conflict of interest., (Copyright© 2021 Iranian Neuroscience Society.)

Henna is a commonly used traditional cosmetic agent, which also holds medical potentials and is used to treat skin lesions including seborrheic dermatitis or fungal infections and also has possible anti-inflammatory effects. It contains lawsone (2-hydroxy-1,4-naphthoquinone) and, therefore, has the potential to induce oxidative hemolysis. Henna-induced hemolysis has been previously reported in children with Glucose 6-Phosphate Dehydrogenase Deficiency. Here, we report an 85-year-old man who developed hemolytic anemia and acute kidney injury following oral consumption of henna to help his dyspnea. He was treated with hydration, bicarbonate, and dexamethasone. Over the course of hospitalization, the patient developed ventilator-associated pneumonia and was treated with antibiotic. He was discharged after one month. This finding is of high importance due to common use of henna, especially among people with false beliefs regarding traditional and herbal medicine, and highlights the role of a full history taking.

While the ecosystem of the Great Barrier Reef (GBR), north-eastern Australia, is being threatened by the elevated levels of sediments and nutrients discharged from adjacent coastal river systems, the source of these detrimental pollutants are not well understood. Here we used a combined isotopic (δ 13 C, δ 15 N) and geochemical (Zn, Pt and S) signatures and stable isotope analysis in R (SIAR) mixing model to estimate the contribution of different land uses to the sediment and associated particulate nitrogen delivered to the Johnstone River. Results showed that rainforest was the largest contributor of suspended and bed sediments in the river estuary (both 33.1%), followed by banana (26.7%, 20.4%), sugarcane (21.5%, 21.4%) and grazing (18.7%, 25.1%). However, bananas and sugarcane land uses had the highest contribution to sediments delivered to the coast per unit of area. This will help land managers to prioritise on-ground activities to improve water quality in the GBR lagoon., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Purpose: The purpose of this study was to compare the efficacy and safety of a proposed bevacizumab biosimilar to those of the reference product in patients with metastatic colorectal cancer (mCRC)., Methods: This Phase III, multicenter, randomized, double-blind (patient- and assessor-blind), active-controlled, 2-armed, parallel-group, noninferiority trial was conducted in patients with histologically verified colorectal cancer with evidence of at least 1 metastasis. Patients with mCRC were randomized 2:1 to receive 5 mg/kg IV of either study drug plus FOLFIRI-3 (with repeated irinotecan 100 mg/m 2 60-min infusion on day 3) or the reference drug plus FOLFIRI-3 every 2 weeks for 1 year. Progression-free survival (PFS) was the primary end point, and overall survival, objective response rate, and time to treatment failure as well as safety and immunogenicity were secondary end points. The population assessable for PFS was per protocol, and the intention-to-treat population was used for sensitivity analysis. Safety was assessed based on reports of adverse events, laboratory test results, and vital sign measurements., Findings: A total of 126 patients were enrolled; PFS values in the biosimilar and reference arms were 232 days (7.7 months) and 210 days (7 months), respectively (P = 0.47). The hazard ratio of the biosimilar arm versus the reference arm was 0.79 in the per-protocol population (90% CI, 0.46-1.35; P = 0.47). The upper limit for the 2-sided 90% CI was lower than the margin of 1.44, indicating that the biosimilar drug was noninferior to the reference drug. The hazard ratio for overall survival in the intent-to-treat population was 0.99 (95% CI, 0.55-1.80; P = 0.99). The difference between other efficacy end points among the groups was not statistically significant. No significant difference was observed in the comparison of the two arms for safety. The antidrug antibody was positive in 1 patient in each arm., Implications: The proposed biosimilar BE1040V was noninferior to the reference product in terms of efficacy in the treatment of mCRC, and tolerability was comparable between the 2 drugs. ClinicalTrials.gov identifier: NCT03288987., (Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.)

Safety of pregnancy occurring after breast cancer treatment has been studied largely, but it is still debatable. These studies have generally showed that overall and disease-free survival in breast cancer survivors with subsequent pregnancy is not less than those without future pregnancy . Also, breast cancer survivors treated with chemotherapy , radiation therapy, or both had no increased risk of congenital anomalies, single gene disorders, or chromosomal syndromes in their offspring. However, it appears that the incidence of preterm labor, low birth weight, and fetal anomalies is higher in these cases.These issues as well as safe time interval from breast cancer treatment to pregnancy , safe contraceptive method after breast cancer, counseling about pregnancy in survivors, and how to follow up the patient for breast cancer recurrence during pregnancy are discussed in this chapter.

To date, no specific pattern of chromosomal abnormalities has been established in gastric cancer (GC). Cytogenetic analysis was performed using G-banding and fluorescence in situ hybridization (FISH) in 9 ascetic fluids from GC patients, and the clustering patterns of chromosomal abnormalities were studied. Twenty-six different types of chromosomal abnormalities were identified. In contrast to structural abnormalities, the gain or loss of chromosomes was infrequent. Moreover, five main clusters of chromosomal abnormalities were identified by clustering analysis. Extensive cytogenetic complexity, specific chromosomal abnormalities and karyotype heterogeneity are the main characterizations of GC. Some of the recurrent and novel chromosomal abnormalities with distinct clustering patterns identified in this study may play important roles for GC initiation and progression and could serve as promising diagnostic and prognostic markers in GC patients.

Introduction: This study aimed to calculate the photon and neutron doses received to the contralateral breast (CB) during breast cancer radiotherapy for various field sizes in the presence of a physical wedge., Materials and Methods: Varian 2100 C/D linear accelerator was simulated using a MCNP4C Monte Carlo code. Then, a phantom of real female chest was simulated and the treatment planning was carried out on tumoral breast (left breast). Finally, the received photon and neutron doses to CB (right breast) were calculated in the presence of a physical wedge for 18 MV photon beam energy. These calculations were performed for different field sizes including 11 cm × 13 cm, 11 cm × 17 cm, and 11 cm × 21 cm., Results: The findings showed that the received doses (both of the photon and neutron) to CB in the presence of a physical wedge for 11 cm × 13 cm, 11 cm × 17 cm, and 11 cm × 21 cm field sizes were 9.87%, 12.91%, and 27.37% of the prescribed dose, respectively. In addition, the results showed that the received photon and neutron doses to CB increased with increment in the field size., Conclusion: From the results of this study, it is concluded that the received photon and neutron doses to CB in the presence of a physical wedge is relatively more, and therefore, they should be reduced to as low as possible. Therefore, using a dynamic wedge instead of a physical wedge or field-in-field technique is suggested., Competing Interests: None

The construction and operation of the Three Gorges Reservoir (TGR), the largest hydropower dam in the world, has had significant consequences for the hydrology of riparian zones along the Yangtze river. Little is known about how such changes in hydrology might affect the levels of nutrients and organic matter (OM) in riparian soils. We conducted a nine-year study on the spatio-temporal dynamics and dominant environmental correlates of nutrients and OM in riparian soils along a 600 km section of the Yangtze. These soils have been exposed to a disrupted hydrological regime since the TGR's establishment in 2008. Vegetation surveys were also conducted from 2012 to 2016 to assess relationships between soil chemical properties and vegetation community properties under altered hydrology. Across the stream gradient, concentrations of total potassium (K) increased by 54% since the TGR's establishment. The opposite occurred for SOM and available K, concentrations of which were 35% and 33% lower in 2016, respectively, than those of 2008. The rate of increase in total K tended to be more rapid at the middle section of the stream gradient. Moreover, concentrations of SOM, total N, total K, and available phosphorus (P) and K tended to be particularly high at the middle section. The spatio-temporal distributions of nutrients were strongly positively related to the contents of fine soil particles (i.e., silt and clay). Moreover, the aboveground biomass was negatively correlated with the nutrient dynamics. Our results indicate that the control of the nutrient release in the middle reaches and lower elevations where fine particles tend to accumulate, will be essential for maintaining the health of aquatic and riparian ecosystems upstream of the TGR., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Low nitrogen (N) content and retention in bauxite-processing residue sand (BRS) disposal areas pose a great challenge to the establishment of sustainable vegetation cover in this highly alkaline environment. The budget and fate of applied N in BRS and its potential environmental impacts are largely unknown. We investigated the effect of combined application of biochars [aged acidic (AC) vs alkaline pine (PC)] and di-ammonium phosphate (DAP) fertiliser on ammonia (NH 3 ) volatilisation, nitrous oxide (N 2 O) emission and N retention in a 116-day glasshouse study. The application of AC to BRS decreased pH (≈0.5 units) in BRS, while PC biochar increased pH (≈0.3 units). The application of AC reduced NH 3 volatilisation by ca. 80%, while PC by ca. 25%. On the other hand, the AC treatment increased N 2 O emission by 5 folds. However, the N loss via N 2 O emission in the AC treatment only accounted for ca. 0.4% of applied N. The reduction in BRS pH and increased retention of mineral N due to the presence of oxygen-containing (phenolic and carboxylic) functional groups in AC may be responsible for reduced NH 3 volatilisation and increased N 2 O emission. This study has highlighted the potential of biochar (particularly aged biochar) in improving N retention and minimising environmental impacts in highly alkaline environments., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Determining the source of sediments and associated nutrients from terrestrial to aquatic environments is critical for managing the detrimental impacts of soil erosion and loss of nutrients from terrestrial into aquatic environment. However, tracing the source of particulate nutrients from different land uses has not been adequately carried out due to methodological difficulties in separating sources, particularly in the Great Barrier Reef (GBR) catchment. The objective of this study was to develop a method to differentiate the sources of particulate nutrients from soils collected from different land uses (combination of beef and dairy grazing, sugarcane, forest and banana) using both geochemical and isotopic signatures. In order to select a discriminative group of signatures, all soil samples collected from each of the land use areas were fractionated to <63 μm size fraction and were analysed for both isotopic (δ 13 C, δ 15 N) and acid extractable geochemical properties (e.g. Zn, Pt and S). Considering the fact that the outcome of tracing models often depends on the type and robustness of the methods used, here we have employed a stable isotope mixing model (SIAR) to evaluate if the suite of selected elements could be used to estimate the relative contribution of different sources for a series of five virtually created sediment mixtures. For the five groups of virtual sediments, the SIAR model provided close estimates to the contribution values of sediment sources with the Mean Absolute Error (MAE) varying from 0.30 to 2.88%. Results from this study show for the first time that the combined use of isotopic and geochemical signatures enable the SIAR model to provide an accurate estimation of source apportionment where a variety of land uses needs to be investigated and shows promise as a valuable new sediment and particulate nutrient tracing tool., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Nitrogen (N) bioavailability is one of the main limiting factors for microbial activity and vegetation establishment in bauxite-processing residue sand (BRS). Although beneficial effects of biochar on reducing N loss in the early stages of BRS rehabilitation have been observed previously, the underlying mechanisms of this complicated process, particularly the interactions between applied biochar and the plant rhizosphere is largely unknown. This glasshouse study (116 days), investigated the coupled effects of biochar and water stress on N bioavailability in the rhizosphere of ryegrass (Lolium rigidum) grown in BRS amended with di-ammonium phosphate (DAP) fertiliser (at rates of 0 or 2.7 t ha -1 ) with and without biochar amendment. The applied biochar was characterised as either aged acidic (AC) or alkaline pine (PC) and was mixed with BRS at a rate of 5% v/v under four moisture regimes (50%, 40%, 20% and 7.5% water holding capacity). Amending BRS with AC and PC biochars increased NH 4 + retention and decreased cumulative NH 3 volatilization within both the rhizosphere and root-free zones compared with fertiliser only treatment. These effects were more pronounced for the AC than PC biochar, suggesting that aged acidic biochar has the great potential for use in rapid establishment of vegetation in BRS disposal areas. The biochar amendment increased cumulative nitrous oxide emissions compared with DAP only treatment, with no significant differences among different moisture regimes. The Control and 20% water holding capacity (WHC) treatment showed the highest dissolved organic carbon (DOC) concentrations compared with other treatments and moisture regimes in the ryegrass rhizosphere, while the highest dissolved organic N concentration were observed in the DAP + AC treatment. Reducing moisture levels below 20% WHC generally decreased microbial biomass carbon (MBC) concentrations and activity in both the rhizosphere and root-free zones of all treatments, while total N generally decreased as moisture levels decreased from 50% to 7.5% WHC. Plant took up more N in the DAP + AC treatment compared with DAP + PC and DAP only treatments, while increasing water stress generally resulted in decreased aboveground biomass., (Copyright © 2018. Published by Elsevier Ltd.)

Soil labile organic carbon (C) and nitrogen (N) pools play a central role in nutrient cycling, while fire is a key driver of biogeochemical cycle, shaping ecosystem structure and functioning. However, how soil labile organic C and N responds to the long-term repeated prescribed fire is largely unknown. In this study, a prescribed fire field experiment in a wet sclerophyll forest established in 1972 in southeast Queensland was used to evaluate the long-term impacts of different fire frequency regimes on labile organic C and N measured by different extraction methods. The fire frequency regimes included long unburnt (NB), burnt every two years (2yrB) and burnt every four years (4yrB). Results revealed that the 2yrB treatment had significantly lower C and N concentrations in hot water and K 2 SO 4 extracts and in density fractions (LF D<2.3 and HF D>1.6 ) compared with the NB treatment. Concentrations of carbohydrate-C in hot water extracts and acid soluble and insoluble organic matter-C in cold-water extracts followed a similar trend. The maximum reduction was observed for carbohydrate‑C (72%) and the hot water extractable N (54%) in the 2yrB treatment compared with the NB treatment, showing these parameters are most sensitive indicators. However, there was no significant difference in most of the above parameters between the 4yrB and the NB treatments, indicating that less frequent fire (4yrB) allows the ecosystem to have sufficient time to recover from fire disturbance and may be a sustainable practice for fire management in this wet sclerophyll forest ecosystem., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Hematopoietic stem cell transplantation (HSCT) with a non-total body irradiation (TBI) conditioning regimen has proven feasible for treating patients with acute lymphoblastic leukemia (ALL). However, it is commonly believed that for extramedullary involvement of ALL in sanctuary sites, such as the central nervous system (CNS), TBI shall not be abandoned. In this study, the outcomes of pediatric ALL patients with CNS involvement (CNS + ) and without CNS involvement (CNS - ) treated with TBI-free allogeneic HSCT were retrospectively compared. The patients received a TBI-free busulfan plus cyclophosphamide conditioning regimen. Comparing CNS + (n = 27) and CNS - (n = 134) patients, the 5-year probabilities of relapse (44.4% versus 41.8%; P = .799), disease-free survival (DFS; 48.1% versus 43.3%; P = .642) and overall survival (OS; 51.9% versus 47.0%; P = .646) were not significantly different. Although transplantation-related mortality (TRM) was higher in the CNS - patients, the difference between the 2 groups was not significant (3.7% versus 12.7%; P = .177). In multivariate analysis, there were no significant between-group differences in OS (P = .502), DFS (P = .424), relapse rate (P = .226), or TRM (P = .117). These findings suggest that HSCT using a non-TBI-containing conditioning regimen can lead to similar outcomes in pediatric ALL patients with and without CNS involvement. TBI-free allogeneic HSCT might be feasible and effective for CNS + ALL patients., (Copyright © 2017 The American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.)

Char as a carbon-rich material, can be produced under pyrolytic conditions, wildfires or prescribed burn offs for fire management. The objective of this study was to elucidate mechanistic interactions of copper (Cu 2+ ) and nickel (Ni 2+ ) with different chars produced by pyrolysis (green waste, GW; blue-Mallee, BM) and forest fires (fresh-burnt by prescribed fire, FC; aged char produced by wild fire, AC). The pyrolytic chars were more effective sorbents of Cu 2+ (∼11 times) and Ni 2+ (∼5 times) compared with the forest fire chars. Both cross-polarization (CPMAS-NMR) and Bloch decay (BDMAS-NMR) 13 C NMR spectroscopies showed that forest fire chars have higher woody components (aromatic functional groups) and lower polar groups (e.g. O-alkyl C) compared with the pyrolytic chars. The polarity index was greater in the pyrolytic chars (0.99-1.34) than in the fire-generated chars (0.98-1.15), while aromaticity was lower in the former than in the latter. Fourier transform infrared (FTIR) and Raman spectroscopies indicated the binding of carbonate and phosphate with both Cu 2+ and Ni 2+ in all chars, but with a greater extent in pyrolytic than forest fire-generated chars. These findings have demonstrated the key role of char's oxygen-containing functional groups in determining their sorption capacity for the Cu 2+ and Ni 2+ in contaminated lands., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

We present a woman referred with underlying non-Hodgkin's lymphoma (NHL) masquerading clinically with Guillain-Barré syndrome (GBS) like syndrome. At first evaluation, chest CT-Scan along with brain and whole spine MRI were normal. Electrodiagnostic studies were in favor of acute generalized polyradiculoneuropathy. Laboratory evaluation revealed hypoglycorrhachia. She treated with plasmapheresis after two weeks; she was discharged from hospital, but neurological recovery was not complete. After 6 months, she came back with acute onset of weakness in lower limbs, back pain, fever and urinary incontinence. Pinprick and light touch complete sensory loss was found beneath umbilicus. Thoracic MRI with contrast revealed a dorsal epidural mass extending smoothly from T8 to T12 (10 cm) with spinal cord compression. She underwent urgent laminectomy for spinal cord decompression. Histological examination revealed small round cell tumor suggestive of malignant T-cell type lymphoma. In cases with Guillain-Barré syndrome presentation, systemic hematologic disorders such as non-Hodgkin's lymphoma should be considered as one of the differential diagnosis of underlying disease.

Background: Depression is a well-known complication of breast cancer, which is known to adversely affect quality of life, prognosis, and survival in breast cancer patients. Celecoxib, a nonsteroidal anti-inflammatory drug, which acts via the selective inhibition of cyclo-oxygenase (COX)-2, has been shown to have antidepressive effects., Objectives: Here, we aimed to compare the efficacy and safety of celecoxib, a selective inhibitor of COX-2, with diclofenac, a nonselective inhibitor of both COX-1 and COX-2 in reducing depressive symptoms and pain in breast cancer patients., Methods: A total of 52 outpatients with breast cancer with mild to moderate depression, who suffered from pain and needed analgesics, participated in the trial and underwent 6 weeks of treatment with either celecoxib (200 mg twice daily) or diclofenac (50 mg twice daily). Participants were investigated using the Hamilton Depression Rating Scale (HDRS). The primary outcome measure was to compare the antidepressant effects of celecoxib and diclofenac., Results: Repeated-measures analysis demonstrated significant effect for Time × Treatment interaction on the HDRS scores: F(1.76, 87.85) = 9.66; P < 0.001. By study conclusion, greater improvement was observed in the HDRS score of the celecoxib group compared with the diclofenac group (P = 0.002). No one experienced remission (HDRS ≤ 7) in either group. Frequencies of adverse events were not significantly different between groups., Conclusion: Celecoxib seems to possess superior antidepressive effects compared with diclofenac in breast cancer patients with mild to moderate depression., (© The Author(s) 2015.)

This study aimed to evaluate how changes in dietary intake among acute lymphoblastic and acute myeloid leukaemia (ALL and AML) patients affect nutritional status after the first induction chemotherapy. Dietary intake was assessed using 24-h recall and a 136-item food frequency questionnaire. Nutritional status was assessed by Patients Subjective Global Assessment questionnaire before starting induction therapy and again after 1 month. All newly diagnosed acute leukaemia patients aged 15 years old and older who attended three referral hospitals for initiation of their induction chemotherapy were included in the sample selection provided that they gave informed consent. A total of 30 AML and 33 ALL patients participated in the study. Dietary intake and nutritional status worsened after the chemotherapy treatment. Dietary intake in terms of macronutrients, micronutrients, food variety and diet diversity score changed significantly after the induction chemotherapy. No significant relationship was found between the changes in dietary indices and nutritional status. Chemotherapy-related side effects as an additional factor to cancer itself could affect dietary intake of leukaemia patients. The effectiveness of an early assessment of nutritional status and dietary intake should be further investigated in order to deter further deterioration., (© 2014 The Authors. European Journal of Cancer Care Published by John Wiley & Sons Ltd.)

Background: Ketamine is used as a general anesthetic for short-term surgical procedures. The aim of this study is to compare the effect of intravenous (IV) ketamine and intramuscular (IM) ketamine in children admitted to the emergency department (ED)., Materials and Methods: This is a clinical trial on 60 patients who were randomly classified into two groups. The first group received IV ketamine (1 mg/kg) and the second received IM ketamine (4 mg/kg). Data were collected before, during, and after the procedure. Time to reach sedation, severity of the sedation, and complications of the drug until discharge were studied., Results: In this study, 60 patients were evaluated. The average length of the procedures was similar in both groups (P > 0.05). According to this study, sedation levels in the two groups in 5, 10, and 15 minutes did not show significant differences (P > 0.05), but there was a significant difference in sedation levels of patients in 30, 35, 40, and 45 minutes during sedation (P = 0.03, P = 0.04, P = 0.03 and P = 0.05). There was no significant difference in the incidence of complications between the two groups., Dicussion: There was no significant difference in complications and level of sedation in both groups, but sedation was longer in the IM group; so, IV ketamine is the desirable approach for orthopedic procedures in sedating children.

Oral mucositis (OM) is a complication of high-dose chemotherapy (HDC) which is frequently observed in hematopoietic SCT settings. Antioxidant agents have been proposed to prevent OM and therefore N-acetyl cysteine (NAC) could have an important role. In the present study, we conducted a double-blind, randomized, placebo-controlled study to evaluate the NAC effect on OM incidence and severity, and also glutathione peroxidase-1 activity. Leukemia patients undergoing allogeneic hematopoietic SCT preceded by HDC were recruited into the study and received either NAC (100 mg/kg/day) (n=38) or placebo (n=42) from the starting day of HDC until day +15 after transplantation. OM was evaluated daily for 21 days after transplantation according to World Health Organization oral toxicity scale. The incidence of severe OM (grades 3-4) was significantly lower in the NAC group (23.7% vs 45.3%, P=0.04). Moreover, the mean duration of OM was significantly shorter in the intervention group (6.24(2.96) vs 8.12(3.97) days, P=0.02). The glutathione peroxidase-1 activity was also significantly higher in the NAC group seven days after transplantation (3.38(2.19) vs 2.41(1.70) ng/mL, P=0.003). It is concluded that parenteral NAC is effective in reducing the incidence of severe cases and the total duration of OM.

Background: Vancomycin is used abundantly in patients undergoing HSCT, especially during neutropenic fever. Despite its widespread use little is known about vancomycin pharmacokinetics in HSCT patients. We conducted this study to investigate vancomycin pharmacokinetic parameters in our HSCT patients and to evaluate current dosing regimen based on trough vancomycin concentrations measurement., Methods: Vancomycin serum concentration at steady-state was determined prospectively in 46 adult HSCT patients who received vancomycin as empirical treatment of neutropenic fever. Individual steady-steady pharmacokinetic parameters were also determined in 20 patients who had two vancomycin levels from an administered dose, assuming one-compartment model. Acute kidney injury was also evaluated in our patients during vancomycin therapy., Results: Mean (±SD) apparent volume of distribution (L/kg) and clearance (mL/min) were 0.6 (± 0.33) and 109.7 (± 57.5) respectively. With mean (±SD) total daily dose of vancomycin 31.9 (±10.5) mg/kg/day that was administered, more than 90% of measured vancomycin trough concentrations were outside the range of 15-20 mg/L and 54.3% of patients had trough concentrations below 10 mg/L. Of 46 patients, 21 patients (45.7%) developed acute kidney injury (AKI) during vancomycin therapy; among them 19 patients were receiving nephrotoxic drug(s) concomitantly., Conclusion: Current vancomycin dosage regimen could not lead to recommended therapeutic serum concentrations in our patients. Large variation in vancomycin pharmacokinetic parameters observed among patients of this study along with difference of vancomycin pharmacokinetics in our study and other similar studies further explain the need for therapeutic drug monitoring and individualization of vancomycin dosing.

Background: Platelet transfusion is required in the acute phase of some thrombocytopenic disorders in order to prevent potentially dangerous hemorrhages.The purpose of this study was to assess the increase in platelet count following a slow platelet transfusion., Methods: Patients suffering from thrombocytopenia due to various underlying diseases were enrolled in the prospective pilot feasibility trial and were randomly divided into two groups. Standard platelet transfusion was administered in one group, while slow transfusion was used in the other. The platelet count was examined at 1 hour, 24 hours, and 1 week following the transfusions., Results: Although the platelet count was higher following 1 hour after transfusion via the standard method, the count tended to be higher 1 week after the transfusion in the slow transfusion group. This difference, however, only turned out to be statistically significant amongst females., Conclusion: A therapy of slow platelet transfusion might be more effective for the prevention of platelet loss. Further studies will be required to strengthen this hypothesis.

Background: Over the centuries, opium has been the most frequent substance abused in the Middle East. There are many controversial aspects about the effects of opioids on the atherosclerosis process, which is still unclear., Methods: All patients who were candidates for coronary artery bypass graft in Tehran Heart Center were registered and evaluated for risk factors such as diabetes mellitus, hypertension, smoking status and duration, opium abuse, involved coronary arteries and left main branch lesion > 50%, carotid stenosis > or = 70%., Results: A total of 1,339 patients were enrolled in the study, of whom 400 (29.9%) were female and the other 939 (70.1%) male. Female patients were omitted from analysis due to the low numbers of female opium addicts. Our study revealed that in the addicted population, the risk of diabetes and hypertension was lower than in the non-addicted group (p < 0.05 for each variable) and fasting blood sugar tended to be less in addicted ones, but the number of involved coronary arteries, left main stenosis > 50% and extent of carotid stenosis was not significantly different between the two groups., Conclusions: Our investigations demonstrate that opium is not cardioprotective, as has been claimed by some previous studies, and does not even decelerate atherosclerosis of carotid arteries in opium-addicted patients, but more evidence is still needed to completely prove the case.

Background: To evaluate the prevalence of abdominal aortic aneurysm in Iranian candidates for coronary artery bypass graft surgery and its associated factors., Methods: Totally, 2843 consecutive candidates for coronary artery bypass graft surgery underwent ultrasonography of abdominal aorta. The relation between abdominal aortic aneurysm with gender, age, smoking, dyslipidemia, hypertension, diabetes, and carotid and coronary stenosis was evaluated., Results: The prevalence of abdominal aortic aneurysm was 2.7% and 0.7% in men and women subgroups, respectively. The prevalence was 3.8% in men older than 65 years. The largest diameter of abdominal aortic aneurysm was 61.7 mm. Only two men had aneurysm larger than 55 mm, which led to changing their surgery schedule to stenting. Gender, age, smoking, smoking more than 40 years, diabetes , hypertension, and significant carotid stenosis were associated factors of abdominal aortic aneurysm., Conclusion: Compared with the results sited in Western studies, the prevalence of abdominal aortic aneurysm is lower in Iran (P<0.0001). Its associated factors in our study were similar to previously published studies. Significant carotid stenosis, a factor not reported previously, was an associated factor in our study. Because of the low prevalence of abdominal aortic aneurysm in our population, screening the candidates for coronary artery bypass graft surgery is not recommended.

Background: The incidence of stroke is 2.1-5.2% in bypass surgery patients with a mortality of 0-38%. This study was designed to evaluate the incidence of significant carotid artery stenosis and its related risk factors in candidates for coronary artery bypass graft (CABG) surgery., Methods: One thousand forty five consecutive candidates for CABG underwent carotid artery Doppler examination in a prospective study. The relation of age, sex, smoking and diabetes history, as well as lipid profile with carotid stenosis, was evaluated., Results: In 1045 CABG candidates with a mean age of 60 years, prevalence of significant carotid stenosis (>60%) was 6.9%. In the patients aged 65 years and older, the rate of significant stenosis was 12.5%. Age >50 years, female gender, hypercholesterolemia and diabetes mellitus are independent risk factors for significant carotid stenosis., Conclusions: Significant carotid stenosis has an earlier appearance in our study. Cost-effectiveness studies are recommended for revising the previous screening protocols.