Novelty in Biomedicine

Background: Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by persistent joint inflammation, pain, and reduced functional capacity. Hand involvement is one of the most common and debilitating manifestations of RA, leading to progressive stiffness, weakness, and limited range of motion. While pharmacological treatments remain the cornerstone of RA management, non-pharmacological interventions such as therapeutic exercises have gained attention for their potential benefits. However, evidence on the effectiveness of home-based hand exercises in improving pain and joint function remains limited.
Materials and Methods: A randomized controlled trial (RCT) was conducted at Imam Hossein Hospital in Tehran, Iran, from 2023 to 2024. A total of 154 RA patients were enrolled and randomly assigned to either the intervention group (n = 77), which received standard pharmacological treatment along with a structured home-based hand exercise program, or the control group (n = 77), which received only standard pharmacological treatment. The intervention lasted four weeks, during which patients in the exercise group performed specific hand exercises designed to improve joint mobility and grip strength. Pain intensity was assessed using the Visual Analog Scale (VAS), while range of motion (ROM) and hand grip strength were measured using a goniometer and a dynamometer, respectively. Baseline and post-intervention assessments were compared within and between groups.
Results: Both groups experienced a significant reduction in pain intensity after four weeks (P < 0.001). However, the difference in VAS score reduction between the intervention and control groups was not statistically significant (P = 0.870). Hand grip strength significantly improved in both the right and left hands in the intervention group compared to the control group (P<0.001). Additionally, ROM in flexion and extension significantly increased in both hands in the intervention group, whereas no significant improvements were observed in the control group (P<0.001).
Conclusion: Home-based hand exercise therapy effectively improved hand grip strength and joint mobility in RA patients, although it did not result in a statistically significant reduction in pain compared to standard treatment alone. Given its accessibility and potential benefits, integrating structured hand exercises into routine RA management is recommended to enhance functional outcomes and promote patient independence. Further studies with longer follow-up periods are needed to assess the sustainability of these benefits.

Background: Cerebral Venous Sinus Thrombosis (CVST) is a significant cause of stroke associated with elevated morbidity and mortality rates, presenting diagnostic challenges. Non-contrast computed tomography (NCCT) is among the initial imaging modalities utilized for patients presenting with neurological symptoms or those who have experienced trauma. Research indicates a potential association between venous Hounsfield (HU) values in brain NCCT and CVST; however, the existing studies in this regard remain limited. This study investigates the relationship between the venous HU value from NCCT of the brain and CVST.

Materials and Methods: This retrospective case-control study was conducted on patients referred to Ali Ibn Abi Taleb Hospital (Rafsanjan, Iran) from the start to the end of 2024. Patients with CVST who were admitted to the neurological emergency department with suspected clinical symptoms were studied as the case group (30 patients), and normal individuals (30 people) were studied as the control group. Patient information, including age, sex, involved vein, and final opinion of radiologists regarding venous involvement, was recorded. The significance level was considered less than 0.05.

Results: NCCT images were compared between the groups. There was no statistically significant difference between the two groups in terms of age, sex, and smoking (P-values > 0.05). The most common site of thrombosis was the superior sagittal sinus (53.3%). The mean attenuation in the CVST group was 63.67 ± 1.9 HU, and in the control group it was 52.03 ± 1.25 HU (P-value < 0.01). Hemoglobin levels were within normal limits in both groups. Still, they were significantly lower in the CVST group (P-value: 0.014), and with a one-unit increase in hemoglobin level, the probability of CVST increased by about 33.2% (95% CI: 1.050–1.690). Frequency of OCP use, previous history of abortion, and previous history of thrombosis did not differ statistically significantly between the groups (all P-values > 0.05).

Conclusion: Higher attenuation in the NCCT of these patients may be used as a diagnostic criterion in the clinic.

Background: Due to fluid overload, hemodialysis patients are at a high risk of cardiovascular complications. Accurate assessment of fluid status is vital for optimal management. This study investigates correlations between Estimated Pulmonary Capillary Wedge Pressure (ePCWP) and clinical parameters in hemodialysis patients to evaluate its utility in fluid management.

Materials and Methods: This clinical study included 40 hemodialysis patients from an Iranian referral hospital. Patients were selected based on strict inclusion and exclusion criteria. Data collection involved comprehensive assessments of demographic, clinical, and examination data, with baseline and post-dialysis measurements obtained. Tissue Doppler imaging and echocardiography were performed before and after dialysis, and ePCWP was calculated. Statistical analyses were conducted using IBM SPSS Statistics, version 26, to explore correlations between ePCWP, bioimpedance measures, and clinical factors.

Results: Significant post-dialysis reductions were observed in systolic blood pressure (mean difference=7.25 mmHg, p<0.001), diastolic blood pressure (mean difference=4.37 mmHg, p<0.001), and weight (mean difference=2.27 kg, p<0.001), alongside a decrease in extracellular water to total body water (ECW/TBW) ratio (mean difference=0.01, p<0.001). However, no significant difference was found in ePCWP before and after dialysis (mean difference=0.881 mmHg, p=0.4). Correlation analysis revealed a moderately positive correlation between EPCWP before dialysis and ECW/TBW (r=0.359, p=0.023). However, it was not significantly correlated with blood pressure and weight.

Conclusion: ePCWP demonstrates potential as a marker for fluid status in hemodialysis patients, especially in settings where bioimpedance analysis is not available. However, its clinical utility requires further validation through larger randomized controlled trials.

Background: Nosocomial infections caused by Acinetobacter baumannii in orthopedic patients represent a growing challenge due to their prevalence, environmental persistence, and high levels of antimicrobial resistance. The increasing prevalence of resistant strains emphasizes the urgent need to improve infection control measures, antimicrobial surveillance, and develop new therapeutic options. This study aimed to determine the prevalence of nosocomial infection caused by Acinetobacter baumannii and its antibiotic resistance status in patients in the orthopedic ward of Imam Hussein Hospital from 2021 to 2024.

Materials and Methods: Bacterial samples from orthopedic surgery patients at Imam Hussein Hospital were collected, stored at -20°C, and re-cultured on blood agar and selective media to ensure purity and accurate identification. Acinetobacter baumannii was confirmed using colony morphology, staining, Triple sugar Iron agar (TSI), and oxidase tests. Antibiotic resistance to imipenem, meropenem, and other antibiotics was assessed via disk diffusion, with colistin MIC determined per CLSI guidelines. Data were analyzed using SPSS version 22.

Results: Of the 680 samples, 45 cultures were positive for Acinetobacter. All 45 Acinetobacter strains tested showed complete susceptibility to colistin. Among other antibiotics, ampicillin-sulbactam was relatively more effective with 17.8% susceptibility. Acinetobacter strains were susceptible to amikacin and imipenem in only one case, and were resistant in 95.6% and 97.8% of cases, respectively. For gentamicin, only one out of 17 tests showed Intermediate susceptibility, and the rest were resistant. For meropenem, one out of 42 tests showed Intermediate susceptibility, and the rest showed complete resistance. All Acinetobacter strains were completely resistant to the antibiotics cefepime, cefotaxime, ceftazidime, ceftriaxone, ciprofloxacin, levofloxacin, piperacillin-tazobactam, and cotrimoxazole. For minocycline, complete susceptibility was observed in both cases. Tetracycline susceptibility was also evaluated in 38 strains, of which only three were sensitive and 35 were resistant.

Conclusion: This study confirms the rising resistance of Acinetobacter baumannii to multiple antibiotics, including cephalosporins, carbapenems, tetracyclines, and ciprofloxacin, limiting treatment to colistin and ampicillin-sulbactam. Hospital-acquired infections pose significant health and economic burdens, necessitating vigilant monitoring of resistance patterns, optimized antibiotic use, and stringent preventive measures, such as hand hygiene and equipment sterilization, to mitigate their impact.

Background: Medical errors are common in the world, but in some wards and some conditions, they need a higher level of concern. Chemotherapy and its related wards are one of the concerning issues. There are limited studies about the occurrence of medical errors in patients who receive chemotherapy. In this study, we aimed to investigate the frequency and types of errors during the preparation and injection of chemotherapy drugs.

Materials and Methods: This cross-sectional study was conducted on patients who were referred to the outpatient chemotherapy department of Imam Hossein Hospital (Tehran, Iran) in 2024. Basic patient data, including age, gender, type of cancer, presence or absence of other underlying diseases, and type of chemotherapy regimen, were extracted. All medication orders during chemotherapy prescribed by the subspecialist physician were reviewed and recorded by the internal medicine specialist assistant under the supervision of the project's supervisory team (clinical specialist, subspecialist, and clinical pharmacy); errors related to the medication process and related to chemotherapy medication errors were identified according to the researcher-made checklist. A statistical significance level was considered less than 0.05.

Results: Three hundred patients were evaluated. Medical errors were observed in 247 (82.33%) patients. Medical errors were significantly higher in patients with metastatic cancers than in patients with non-metastatic cancers (P-value: 0.002).  No hand washes the most common type of medical error (39.27%), and the most common cause was job burnout (33.60) was the most common cause of medical errors.

Conclusion: Medical error frequency during the preparation and injection of chemotherapy drugs in outpatient wards is 82.33%.

Background: Systemic sclerosis (SSC) is an uncommon chronic autoimmune disorder that can involve several organs. The manifestations of SSC occur due to fibrosis in the tissue. Patients with SCC experience stiffness in skin, muscles, and calciumic mass that are known as calcinosis cutis. Extracorporeal shock wave therapy (ESWT) is a safe rehabilitation method that is used in different disorders. The use of ESWT in SSC has not been well-assessed. In this study, we aimed to review the effects of ESWT on systemic sclerosis.

Materials and Methods: We reviewed studies that were published from 2010 to 2023. Five studies were found that evaluated the effects of ESWT on SSC. Fifty-nine patients were assessed in these studies.

Results: The results of studies demonstrated that ESWT reduced pain and skin stiffness. It has remarkable effects on endothelial progenitor cells, endothelial cells, endothelial growth factor, and von Willebrand factor. No side effects were reported in the studies.

Conclusion: This article aims to review the evidence regarding virus-induced anemia, detailing mechanisms such as erythroid progenitor cytotoxicity, chronic inflammation, and treatment-related haemolysis. Diagnostic strategies, ranging from serological assays to pathognomonic bone marrow findings, are discussed to assist laboratory science professionals and clinical specialists in diagnosing, treating, and managing patients with anemia.

Background: Curcuma longa L. is increasingly acknowledged as a chemopreventive agent for cancer and is currently being administered to humans. Nonetheless, the limited number of clinical trials conducted for prostate cancer treatment is significant. Our objective was to conduct a meta-analysis study to evaluate curcumin's tumor-inhibitory effects in humans.

Materials and Methods: PubMed, Embase, Scopus, and Web of Science databases were searched until October 2024 to retrieve relevant articles. The RAYYAN intelligence tool for systematic reviews was incorporated for screening studies. STATA v18 software was used to conduct the meta-analysis. Egger’s test for publication bias assessment was implemented. The JBI critical appraisal tool was used to evaluate the qualities of the included studies. A plot digitizer was used to extract digital data.

Results: This meta-analysis evaluated the effects of curcumin on prostate cancer. Eight studies involving 638 participants were included out of 1,523 articles. The analysis showed that curcumin significantly reduces prostate cancer incidence, with a pooled effect size of -0.91 (95% CI: [-1.68, -0.14], P = 0.02). The results indicated significant heterogeneity among studies, though a slight publication bias was noted.

Conclusion: Curcumin demonstrated a favorable effect on prostate cancer treatment and exhibited inhibitory properties toward prostate tumor growth, thereby providing substantiation for additional clinical investigations. Including a limited number of studies resulted in a significant degree of heterogeneity among the included studies, which is a critical point to recognize. As a result, additional randomized controlled trials are necessary to thoroughly evaluate curcumin's efficacy in humans.

Background: Anemia is a serious blood disorder characterized by the bone marrow's inability to produce new blood cells, which can be either acquired or inherited. Exposure to viral infections can lead to anemia, including diseases caused by parvovirus B19, Epstein-Barr virus, cytomegalovirus, human immunodeficiency virus, hepatitis C virus, varicella-zoster virus, and SARS-CoV-2. While these infections are often subclinical in immunocompetent individuals, they can become critical and cause anemia in high-risk populations, such as immunocompromised individuals or those with underlying conditions like sickle cell disease, particularly in infants and pregnant women.

Materials and Methods: The search was performed using PubMed and Google Scholar for articles published from 2000 to 2024.The primary search string was: ("anemia" OR "erythroid aplasia") AND ("virus" OR "viral infection"), "Parvovirus B19", "Human Immunodeficiency Virus" OR "HIV", "Hepatitis C Virus" OR "HCV", "SARS-CoV-2" OR "COVID-19", "Varicella-Zoster Virus" OR "VZV", "Cytomegalovirus" OR "CMV", and "Epstein-Barr Virus" OR "EBV".

Results: Viral infections are important causes of anemia, through various mechanisms. Parvovirus B19 causes aplastic anemia by targeting red blood cell precursors, while HIV leads to anemia through chronic disease. Hepatitis C causes anemia via bone marrow suppression. SARS-CoV-2 disrupts iron metabolism through inflammation. Other viruses like CMV mainly cause anemia in immunocompromised patients.

Conclusion: This article aims to review the evidence regarding virus-induced anemia, detailing mechanisms such as erythroid progenitor cytotoxicity, chronic inflammation, and treatment-related haemolysis. Diagnostic strategies, ranging from serological assays to pathognomonic bone marrow findings, are discussed to assist laboratory science professionals and clinical specialists in diagnosing, treating, and managing patients with anemia.

Background: Histamine H2 antagonists (H2RAs) are hypothesized to inhibit suppressor T-lymphocyte function, with preliminary evidence from randomized trials suggesting potential prolongation of survival in patients with operable and inoperable gastric and colorectal cancers. In this meta-analysis, we aimed to investigate the impact of these antagonists on the survival rate.

Materials and Methods: The PubMed, Scopus, and Web of Science databases were searched through October 2024 to retrieve relevant papers. Study screening was performed using the RAYYAN software, and meta-analysis was executed with STATA version 18. Publication bias was assessed via Egger's test, and study quality was evaluated using the Joanna Briggs Institute (JBI) critical appraisal tool. Graphical data were digitized using Plot Digitizer.

Results: Initially, 181 articles were identified; after screening and applying inclusion criteria, six studies were included (three for colorectal cancer and three for gastric cancer). A random-effects model was employed, measuring standardized mean difference (SMD) in survival. In colorectal cancer patients, H2RAs were associated with a 5.4895% increase in survival compared to controls (95% CI: 0.49–10.47; P=0.03), predominantly driven by cimetidine. In gastric cancer, survival increased by approximately 2.38% in the treatment group, though not clinically significant.

Conclusion: Current evidence suggests a potential survival benefit of H2RAs, particularly cimetidine, in colorectal cancer, but insufficient for gastric cancer. Larger, well-designed randomized controlled trials (RCTs) are required to confirm efficacy and optimize therapeutic protocols.