Review


The outbreak of the novel SARS-COV-2 and its following complications has caused an almost unprecedented chaos throughout the world in recent years. Although a series of vaccines have been proposed recently in order to reduce the risk of mortality and morbidity of this disease, an ultimate and reliable cure has yet to be discovered. One of the major complications of Covid-19 is the outburst of a series of inflammatory responses in the respiratory system of the patients, which eventually causes a hypoxemic pneumonitis and accounts for most of the Covid-19 patients’ mortality. It is suggested that a group of inflammatory cytokines such as different interleukins are responsible for this complication, therefore drugs which can influence this system may be useful in reducing this exaggerated inflammatory response which is dubbed the ‘cytokine storm’. In this article we review potential treatment options for reducing the inflammatory response and discuss some clinical trials and case reports related to the drugs interfering with responsible interleukins in order to quench the cytokine storm.


 


Visual Practice

Research/Original Article


Evaluation of surface expression of platelet markers and left ventricle ejection fraction in patients with coronary artery disease

Fateme Ghanbari, Hesamaddin Gordan, Mohammad Esmail Gheydari, Mersedeh Karvandi

School of Medicine Students' Journal, Vol. 3 No. 2 (2021), 1 June 2021
https://doi.org/10.22037/smsj.v3i2.30452

Background and Aims: Surface expression of  platelet markers enhanced during ischemic events and appear to play an important role in myocardial repair. Stromal cell-derived factor-1 (SDF-1) is one of these factors which its effects Mediated through CXCR4 and CXCR7 receptors. In our study we are going to determine the the surface expressions of platelet markers  and the changes of left ventricle ejection fraction in patients with coronary artery disease.


Materials and Methods: This descriptive cross-sectional study measured the superficial expression of platelet indices (SDF-1R, CXCR4, and CXCR7) and its association with the changes of the left ventricle ejection fraction in patients with coronary artery disease who have referred to Taleghani Hospital, Tehran in 2016-2018.


Results: Among all patients referred to Taleghani Hospital with symptoms of coronary artery disease, 57 patient had inclusion criteria. this study demonstrated that mean SDF1 and CXCR4 level were respectively 1.1 and 2.3 which there  were significant difference between those with severe EF reduction comparing to the rest of the groups (respectively P<0.002 & P<0.004 ). The mean CXCR7 value of all patients was 3.5 (SD= 0.27) and showed a significant difference in patients with severe (6) and low (4.7) ejection fraction reductions compared to those with moderate (2.5) and normal (2.8) ejection fraction reductions (P<0.009).


 

Background & Aim: we aimed to evaluate the expression of HER2 marker in differentiated thyroid cancers and its correlation with tumor size and stage.


Materials and Methods: this is a cross-sectional study that was performed at Tehran Shohada-E-Tajrish hospital from 2015 to 2019. Patients with differentiated thyroid cancer were enrolled in the study. Patients’ baseline characteristics and tumor properties were recorded. Expression of tumor marker testing was conducted with IHC. Analysis was performed with SPSS version 20.


Results: fifty cases of thyroid cancer with a mean age of 46.6 years (78% females) were evaluated. 86% of cases were PTC, 10% FTC, and 4% hurthle cell carcinoma. HER2 positivity rate was 34% totally. HER2 positivity in FTC and PTC patients was 40% and 34.9%, respectively. 84% of patients had a sporadic tumor. HER2 positivity rate in sporadic tumors was 28.6% and 62.5% in familial cases (p=0.063). HER2 status did not correlate with clinicopathologic factors, significantly.


Conclusion: with the findings of our study, HER2 can’t be considered a prognostic factor associated with clinicopathologic parameters.

Case Report


The Late presenting Bochdalek hernia; A Case report and review of literature

Farid Imanzadeh, Sepand Tehrani Fateh, Shaya Alimoghadam, Naghi Dara, Mohsen Rouzrokh, Amirhossein Hosseini

School of Medicine Students' Journal, Vol. 3 No. 2 (2021), 1 June 2021
https://doi.org/10.22037/smsj.v3i2.33718

We report a 22-month-old boy who referred due to nausea, vomiting, abdominal pain and watery non-bloody diarrhea and after thorough evaluation, a large defect in the left postero-lateral side of diaphragm and presence of bowel loops, spleen, stomach and left lobe of liver in the left hemi-thorax were detected. So, he was operated and managed with the impression of Bochdalek hernia. We have also reviewed the similar case reports in the past 10 years, briefly, in order to map the presentations and clinical course of cases with Bochdalek hernia which were diagnosed late, for giving physicians a better insight on this issue.

Letter to Editor


Slides with English text that are explained in Persian

Alireza Monajemi , Minoo Yaghmaei

School of Medicine Students' Journal, Vol. 3 No. 2 (2021), 1 June 2021 , Page 1
https://doi.org/10.22037/smsj.v3i2.35590

The common pattern of presentation in the Iranian medical community is lengthy English text in slides that are presented orally in Farsi, both in conferences and classrooms. In this paper, we aim to further explore this phenomenon based on a theory in the domain of cognitive science named the cognitive load theory (CLT).


According to Atkinson and Shiffrin's model introduced in 1968, human memory consists of three parts: sensory memory, working memory, and long-term memory. Information first enters the sensory memory, and if received adequate attention and reaches the level of consciousness, it enters the working memory, which, unlike the other two memories, i.e, sensory and long-term memory, has a limited capacity (1). Interestingly, working memory has two separate and independent channels for processing visual and auditory information with a limited and predetermined capacity (dual-channel theory). As a result, the speed of learning in humans restricts (2).


In 1988, Sweller proposed a theory of learning called the CLT, in which the three key components of the cognitive structure, i.e. memory systems, learning processes, and types of the cognitive load imposed on the working memory, were merged. According to this theory, because of the limited capacity of the working memory, any factor that imposes an excessive load on this memory will disrupt the learning process (2). Here three types of loads are introduced:


1. Intrinsic load is related to the task. The more complex the information that must be processed by the working memory, the greater the load imposes. – Cont.

Visual Practice


Several foreign bodies thoughout the torso following a shotgut injury

Zhale Nahavandi, AmirHossein Aghdaee, Seyyed Mojtaba Nekooghadam

School of Medicine Students' Journal, Vol. 3 No. 2 (2021), 1 June 2021
https://doi.org/10.22037/smsj.v3i2.36009

A 50 year old man with a history of posterior bullet shot with a shotgun was presented to the hospital 18 hours after the accident complaining of abdominal and gluteal pain. He had stable vital signs, no respiratory distress, and no active bleeding. Physical examination revealed abdominal tenderness and generalized abdominal guarding.
After a primary survey, a complete abdominopelvic ultrasonography and whole body computed tomography (CT) scan were performed (Figure 1) and revealing several bullet fragments (confirmed with Hounsfield scale) in paraspinal and abdominal wall, mesenteric fossa, pererectal and prenephric area, intestinal surroundings and illiac fossa (Figure 2 and 3).
One of the bullet fragments was observed in left inferior renal calyx (Figure 4). Moreover another fragment was touching aortic arch (Figure 5).
Afterwards, the patient underwent explorative laparatomy. About two liters of blood clot was observed in pelvic fossa. Also evidences of spleen injury and pancreas head and rectum hematoma with no active bleeding was observed. All four quadrants were packed, drainage was applied for pancreas. Since there was no fragment in aortic intima, no intervention was needed.
After post-operative antibiotic therapy and other follow-ups such as urologic assessments, the patient was discharged.
After two weeks, the patient was again referred to the hospital with pain in the site of drainage tubes. In laboratory tests amylase levels was 162 (U/L) and lipase levels was 83 (U/L). Plural effusion and atelectasis were observed in left lung CT scan (Figure 6) which did not need invasive intervention. Accumulation of spleen subcapsular fluid was observed in abdominopelvic CT scan. Loculated fluid collection was observed in pancreaticosplenic and paracolic areas (Figure 7) which led to diagnosis of pancreas drainage infection. The patient was treated with wide spectrum antibiotics and the symptoms were resolved. Also, there was the possibility for lead poisoning with lead bullet fragments, therefore serum levels of lead were examined after two months. The results showed a high level of lead concentration in serum (29 µg/dL). The patient was treated with antioxidant and vitamin C and asked to refer to the hospital every 2 months to check the lead level and have it under control. Administrating chelating agents such as dimercaptosuccinic acid and calcium disodium EDTA should be considered if the serum lead level is increased in the follow-up. Moreover, with the possibility for secondary adverse effects due to retained fragments, such as fistula formation, visceral adhesion, recurrent infection, et Cetra, the patient was advised to do frequent imaging checkups. According to similar cases and new studies, the presence of the lead in the bullet fragments won’t be causing any contraindications for magnetic resonance imaging but may cause some artifacts thus the alternative imaging tests such as CT or X-ray graphy are suggested. There’s also no evidence for the pellets movements and visceral organs injury after MRI in shotgun injury cases.