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Abstract Background Estrogen receptors express in nearly 70% of breast cancers (ER-positive). Estrogen receptor alpha plays a fundamental role as a significant factor in breast cancer progression for the early selection of therapeutic approaches. Accordingly, there has been a surge of attention to non-invasive techniques, including circulating Cell-free DNA (ccfDNA) or Cell-Free DNA (cfDNA), to detect and track ESR1 genotype. Therefore, this study aimed to examine the diagnosis accuracy of ESR1 mutation detection by cell-free DNA in breast cancer patientsthrough a systematic review and comprehensive meta-analysis. Methods PubMed, Embase, and Web of Science databases were searched up to 6 April 2022. Diagnostic studies on ESR1 measurement by cfDNA, which was confirmed using the tumour tissue biopsy, have been included in the study. The sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were considered to analyse the data. Results Out of 649 papers, 13 papers with 15 cohorts, including 389 participants, entered the meta-analyses. The comprehensive meta-analysis indicated a high sensitivity (75.52, 95% CI 60.19–90.85), specificity (88.20, 95% CI 80.99–95.40), and high accuracy of 88.96 (95% CI 83.23–94.69) for plasma ESR1. We also found a moderate PPV of 56.94 (95% CI 41.70–72.18) but a high NPV of 88.53 (95% CI 82.61–94.44). We also found an NLR of 0.443 (95% CI 0.09–0.79) and PLR of 1.60 (95% CI 1.20–1.99). Conclusion This systematic review and comprehensive meta-analysis reveal that plasma cfDNA testing exhibits high sensitivity and specificity in detecting ESR1 mutations in breast cancer patients. This suggests that the test could be a valuable diagnostic tool. It may serve as a dependable and non-invasive technique for identifying ESR1 mutations in breast cancer patients. However, more extensive research is needed to confirm its prognostic value.

Background and objectivesThis study aimed to investigate the possible prognostic significance of interferon alpha–beta receptor subunit 2 (IFNAR2) and tyrosine kinase 2 (TYK2) expressions.MethodsWe conducted a retrospective study including COVID-19 adult patients. All blood samples were collected before any interventions. The expressions of IFNAR2 and TYK2 were assessed using real-time PCR in venous blood samples of 54 cases and 56 controls. The transcript quantities of IFNAR2 and TYK2 genes were assessed using a Delta-Ct method.ResultsOur findings show no significant differences in gene expression levels for IFNAR2 and TYK2 between patients who required oxygen (O2) therapy and those who did not (p-value = 0.732 and p-value = 0.629, respectively). Likewise, there were no significant differences in IFNAR2 and TYK2 expressions between patients hospitalized for less than 7 days and those hospitalized for 7 days or more (p-value = 0.455 and p-value = 0.626, respectively). We also observed a weak correlation between IFNAR2 expression and CRP (p-value = 0.045, r = 0.192). There was a negative correlation between the expression levels of IFNAR2 and TYK2 transcripts in COVID-19 patients (p-value = 0.044; partial correlation coefficient = -0.283). Additionally, IFNAR2 and TYK2 were significantly downregulated in the COVID-19 group compared to healthy subjects (p-value = 0.002 and p-value = 0.028, respectively). However, neither IFNAR2 nor TYK2 expression was significantly different between the case subgroups based on COVID-19 severity. The IFNAR2 ΔΔCt (B = -0.184, 95% CI: -0.524–0.157, p-value = 0.275) and the TYK2 ΔΔCt (B = 0.114, 95% CI: -0.268–0.496, p-value = 0.543) were not found to be significant predictors of hospitalization duration. The area under the curve (AUC) for IFNAR2 expression is 0.655 (p-value = 0.005, 95% CI: 0.554–0.757), suggesting its poor discriminative value.ConclusionWe were unable to comment definitively on the prognostic power of IFNAR2 and TYK2 expressions in COVID-19 patients, and larger-scale studies are needed. The principal limitations of this study included the lack of longitudinal analysis and limited sample size.

Abstract Aim This study aimed to investigate psychiatric disorders in Iranian female patients with fibromyalgia (FM). Design Female patients, newly diagnosed with FM, were interviewed by a psychiatrist for psychiatric assessments during a 2‐year period. Methods The diagnosis of the psychiatric disorders was based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM‐5), and sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI). Results In total, 159 patients with the mean age of 42.15 ± 9.89 were recruited in this study. Over 92% of the cases were also diagnosed with at least one type of psychiatric disorder. Sleep disorders (SDs, 90.57%), mood disorders (MDs, 52.83%), personality disorders (PDs, 40.25%) and anxiety disorders (ADs, 16.98%) were the most prevalent diagnoses among these patients. The logistic regression results correspondingly showed that suffering from Cluster‐B PDs was associated with a higher prevalence rate of somatic symptom disorders (SSDs), with a p‐value of 0.019 and an odds ratio (OR) of 2.7.

Abstract Background Vitamin C is an essential water-soluble nutrient that functions as a key antioxidant and has been proven to be effective for boosting immunity. In this study, we aimed to assess the efficacy of adding high-dose intravenous vitamin C (HDIVC) to the regimens for patients with severe COVID-19 disease. Methods An open-label, randomized, and controlled trial was conducted on patients with severe COVID-19 infection. The case and control treatment groups each consisted of 30 patients. The control group received lopinavir/ritonavir and hydroxychloroquine and the case group received HDIVC (6 g daily) added to the same regimen. Results There were no statistically significant differences between two groups with respect to age and gender, laboratory results, and underlying diseases. The mean body temperature was significantly lower in the case group on the 3rd day of hospitalization (p = 0.001). Peripheral capillary oxygen saturations (SpO2) measured at the 3rd day of hospitalization was also higher in the case group receiving HDIVC (p = 0.014). The median length of hospitalization in the case group was significantly longer than the control group (8.5 days vs. 6.5 days) (p = 0.028). There was no significant difference in SpO2 levels at discharge time, the length of intensive care unit (ICU) stay, and mortality between the two groups. Conclusions We did not find significantly better outcomes in the group who were treated with HDIVC in addition to the main treatment regimen at discharge. Trial registration irct.ir (IRCT20200411047025N1), April 14, 2020

Background and purpose: Hydatidosis is one of the most prevalent zoonotic diseases around the world that is endemic in Iran too. In rural areas, there is a higher risk of infection. To the best of our knowledge, no study was done on seroprevalence of hydatidosis in Qaemshahr, north of Iran, so, we aimed to investigate this condition and its risk factors in patients attending Qaemshahr rural health centers using ELISA method. Materials and methods: A total of 403 serum samples were collected. The participants completed a researcher-made questionnaire. Then, anti-echinococcus­­ granulosus antibody was analyzed using ELISA method. Data analysis was done applying logistic regression in SPSS V24. Results: Eleven cases (2.73%) were found positive for anti-echinococcus granulosus antibody. There were no significant differences between seropositivity and gender, consumption of raw vegetable, non-chlorinated water and contact with dog and soil (P>0.05), but significant relationships were seen between anti-echinococcus granulosus antibody and abdominal pain and consumption of wild vegetables (P< 0.05). Conclusion: In this study, the prevalence of hydatidosis was similar to other parts of Iran. Further studies considering lifestyle and other variables are suggested in all areas of Mazandaran province with similar climate to Qaemshahr.

Introduction: Efficacious therapies are urgently required to tackle the coronavirus disease 2019 (COVID-19). This trial aims to evaluate the effects of atorvastatin in comparison with standard care for adults hospitalized with COVID-19. Methods: We conducted a randomized controlled clinical trial on adults hospitalized with COVID-19. Patients were randomized into a treatment group receiving atorvastatin + lopinavir/ritonavir or a control group receiving lopinavir/ritonavir alone. The primary outcome of the trial was the duration of hospitalization. The secondary outcomes were the need for interferon or immunoglobulin, receipt of invasive mechanical ventilation, and O2 saturation (O2sat), and level of C-reactive protein (CRP) which were assessed at the onset of admission and on the 6th day of treatment. Results: Forty patients were allocated and enrolled in the study with a 1 to 1 ratio in atorvastatin + lopinavir/ritonavir and lopinavir/ritonavir groups. Clinical and demographic characteristics were similar between the two groups. CRP level was significantly decreased in the lopinavir/ritonavir + atorvastatin group (P

Scleromyxedema (SM), a rare progressive cutaneous mucinosis with a systemic involvement, presents with progressive dermal mucin depositions, causing skin thickening. In addition to the skin involvement and paraproteinemia, patients with SM also have other complications. The systems which are commonly involved include the gastrointestinal, musculoskeletal, pulmonary, cardiovascular, renal, and central nervous systems. Scleromyxedema is difficult to treat. We present a patient with severe Scleromyxedema with cutaneous, gastrointestinal, musculoskeletal and renal manifestations. Following failed therapeutic attempts, she responded to treatment with intravenous gammaglobulin (IVIG), prednisolone, and azathioprine. As a result of treatment with IVIG, the patient showed dramatic improvement in her clinical symptoms and remained in remission throughout the course of combination IVIG infusions and prednisolone. We concluded that an IVIG-prednisolone combination may be an effective novel treatment of Scleromyxedema.

Introduction: Fecal impaction (FI) is a disorder characterized by the inability to evacuate large mass of compacted faces at any level of lower GI tract. The population with highest risk for FI includes elderly patients with neuropsychiatric disorders such as Alzheimer disease, schizophrenia, Parkinson disease, dementia, and severe stroke. Clozapine is an antipsychotic drug that can cause constipation and in some cases, progress to bowel obstruction and finally FI. Opium is a well-known etiology for constipation and its' concomitant use with clozapine can have an additive effect on this complication. Case Presentation:We present a 63-year-old man who had been treated for schizophrenia with clozapine (100 mg/TDS for 30 years) and who was using opium for about 20 years. This patient was presented with a history of constipation for 4 weeks, characterized by lack of urge to defecate as well as hard stool. We used a combination of normal saline and glycerin in our patient. In this case, successful therapy was focused on keeping the mechanical balance of colon, to clear out FI. Conclusions: We concluded that in patients who take opioids or with a history of psychotic disorders who had been treated with antipsychotic drugs, especially low-potency, first generation antipsychotics and clozapine presenting with abdominal pain and constipation should raise immediate concern. [ABSTRACT FROM AUTHOR]