Namazi Hospital

<h3>Background & Aims</h3> Little is known about outcomes of liver transplantation for patients with non-alcoholic steatohepatitis (NASH). We aimed to determine the frequency and outcomes of liver transplantation for patients with NASH in Europe and identify prognostic factors. <h3>Methods</h3> We analysed data from patients transplanted for end-stage liver disease between January 2002 and December 2016 using the European Liver Transplant Registry database. We compared data between patients with NASH versus other aetiologies. The principle endpoints were patient and overall allograft survival. <h3>Results</h3> Among 68,950 adults undergoing first liver transplantation, 4.0% were transplanted for NASH – an increase from 1.2% in 2002 to 8.4% in 2016. A greater proportion of patients transplanted for NASH (39.1%) had hepatocellular carcinoma (HCC) than non-NASH patients (28.9%, <i>p <</i>0.001). NASH was not significantly associated with survival of patients (hazard ratio [HR] 1.02, <i>p =</i> 0.713) or grafts (HR 0.99; <i>p =</i> 0.815) after accounting for available recipient and donor variables. Infection (24.0%) and cardio/cerebrovascular complications (5.3%) were the commonest causes of death in patients with NASH without HCC. Increasing recipient age (61–65 years: HR 2.07, <i>p <</i>0.001; >65: HR 1.72, <i>p =</i> 0.017), elevated model for end-stage liver disease score (>23: HR 1.48, <i>p</i> = 0.048) and low (<18.5 kg/m²: HR 4.29, <i>p</i> = 0.048) or high (>40 kg/m²: HR 1.96, <i>p</i> = 0.012) recipient body mass index independently predicted death in patients transplanted for NASH without HCC. Data must be interpreted in the context of absent recognised confounders, such as pre-morbid metabolic risk factors. <h3>Conclusions</h3> The number and proportion of liver transplants performed for NASH in Europe has increased from 2002 through 2016. HCC was more common in patients transplanted with NASH. Survival of patients and grafts in patients with NASH is comparable to that of other disease indications. <h3>Lay summary</h3> The prevalence of non-alcoholic fatty liver disease has increased dramatically in parallel with the worldwide increase in obesity and diabetes. Its progressive form, non-alcoholic steatohepatitis, is a growing indication for liver transplantation in Europe, with good overall outcomes reported. However, careful risk factor assessment is required to maintain favourable post-transplant outcomes in patients with non-alcoholic steatohepatitis.

CONTEXT: Cytotoxic T-lymphocyte associated antigen 4 (CTLA-4) polymorphisms have been widely examined for their associations with autoimmune thyroid diseases [Graves' disease (GD) and Hashimoto thyroiditis (HT)], but their relative population effect remains unclear. OBJECTIVE: The aim was to generate large-scale evidence on whether the CTLA-4 polymorphisms (A49G and CT60) and haplotypes thereof increase the susceptibility to GD and/or HT. DESIGN, SETTING, AND PARTICIPANTS: Meta-analyses of group-level data were reviewed from 32 (11,019 subjects) and 12 (4,479) published and unpublished studies for the association of the A49G polymorphism with GD and HT, respectively (PubMed and HuGeNet search until July 2006). There were 15 (n = 7246) and six (n = 3086) studies available for the CT60 polymorphism, respectively. Meta-analyses of individual-level data from 10 (4906 subjects) and five (2386) collaborating teams for GD and HT, respectively, were also reviewed. MAIN OUTCOME MEASURES: Association of gene variants and haplotypes with GD and HT was measured. RESULTS: Group-level data suggested significant associations with GD and HT for both A49G [odds ratios 1.49 (P = 6 x 10(-14)) and 1.29 (P = 0.001) per G allele, respectively] and CT60 [1.45 (P = 2 x 10(-9)) and 1.64 (P = 0.003) per G allele, respectively]. Results were consistent between Asian and Caucasian descent subjects. Individual-level data showed that compared with the AA haplotype, the risk conferred by the GG haplotype was 1.49 (95% confidence interval 1.31,1.70) and 1.36 (95% confidence interval 1.16,1.59) for GD and HT, respectively. Data were consistent with a dose-response effect for the G allele of CT60. CONCLUSION: The CT60 polymorphism of CTLA-4 maps an important genetic determinant for the risk of both GD and HT across diverse populations.

Thyroid hormones are totally involved in the regulation of body weight, lipid metabolism, and insulin resistance. Therefore it is anticipated that thyroid hormones may have a role in the pathogenesis of non alcoholic fatty liver disease (NAFLD) and non alcoholic steatohepatitis (NASH). In this study, we reviewed the current literature on the association between thyroid dysfunction and NAFLD/NASH. A search for English language medical literature reporting an association between thyroid dysfunction and NAFLD/NASH in humans was conducted across PubMed, ISI Web of Science, and Scopus in August, 2013. Out of 140 studies initially identified through the search, 11 relevant articles were included in the final review. Thyroid dysfunctions in the form of overt or subclinical hypothyroidism are prevalent among patients with NAFLD/NASH. Hypothyroidism appears to be an independent risk factor for NAFLD/NASH in some studies; however, other newly published studies failed to find such an association. The results of the studies on the role of thyroid abnormalities in NAFLD/NASH are inconsistent, and further research is recommended to determine the relationship between hypothyroidism and NAFLD/NASH and the underlying mechanisms.

BACKGROUND: The complexity of patients' condition and treatment processes in intensive care units (ICUs) predisposes patients to more hazardous events. Effective patient safety culture is related to lowering the rate of patients' complications and fewer adverse events. The present study aimed to determine the effect of empowering nurses and supervisors through an educational program on patient safety culture in adult ICUs. METHODS: A randomized controlled trial was conducted during April-September 2015 in 6 adult ICUs at Namazi Hospital, Shiraz, Iran. A total of 60 nurses and 20 supervisors were selected through proportional stratified sampling and census, respectively, and randomly assigned to the experimental and control groups. The intervention consisted of a two-day workshop, hanging posters, and distributing pamphlets that covered topics such as patient safety, patient safety culture, speak up about safety issues, and the skills of Team Strategies and Tools to Enhance Performance and Patient Safety. Data were collected through a hospital survey on patient safety culture. Eventually, 61 participants completed the study. Data were analyzed using descriptive statistics, independent-samples t-test, paired-samples t-test, and Chi-square test. P < 0.05 was considered statistically significant. RESULTS: In the experimental group, the total post-test mean scores of the patient safety culture (3.46 ± 0.26) was significantly higher than that of the control group (2.84 ± 0.37, P < 0.001). It was also higher than that of the pre-test (2.91 ± 0.4, P < 0.001). Additionally, significant improvements were observed in 5 out of 12 dimensions in the experimental group. However, dimensions such as non-punitive response to errors and the events reported did not improve significantly. CONCLUSION: Empowering nurses and supervisors could improve the overall patient safety culture. Nonetheless, additional actions are required to improve areas such as reporting the events and non-punitive response to errors. TRIAL REGISTRATION: IRCT2015053122494N1 . Date registered: March 2, 2016.

Variables important in predicting the final postsurgical outcome of 435 patients who sustained missile head wounds during the Iran-Iraq War were evaluated over a 99-month period. The type of projectile, site of injury, and presence or absence of foreign material did not seem to have a significant effect on the final outcome. Of the patients with a perforating type of injury, 48.8% had a poor surgical outcome as compared with 19.9% with a penetrating type and 15.6% with a tangential type. This difference is statistically significant (chi 2 = 14.7 and 17.1, respectively; p less than 0.001). The most important factor in predicting overall outcome was the Glasgow Coma Scale (GCS) score at the time of admission. Mortality and morbidity contributing to a poor surgical outcome were noted in only 6% of patients with a GCS score at admission of 13 to 15, in 24.6% of those with a GCS score of 9 to 12, in 57% of those with a GCS score of 6 to 8, and in 65% of those with a GCS score of 3 to 5. Of the 71 patients who died, 75% had a score of 3 to 8. Perforating projectiles or those traversing two or more dural compartments were statistically significant in contributing to mortality and morbidity (chi 2 = 17.2; p less than 0.001). The incidence of focal neurological deficit was 100, 90.6, 88, and 52.2% in patients with GCS scores of 3 to 5, 6 to 8, 9 to 12, and 13 to 15, respectively. The two best predictors of mortality in this group of patients were a low GCS score and infection.

*Assistant Professor, Department of Surgery, Pahlavi University Medical School, Saadi Hospital, Shiraz, Iran. **Professor and Chairman, Department of Pathology, Pahlavi University Medical School, Shiraz, Iran. ***Instructor, Department of Surgery. Pahlavi University Medical School, Shiraz, Iran. Departments of Surgery and Pathology, Pahlavi University Medical School, Shiraz, Iran

AIM: To investigate the epidemiology of Helicobacter pylori (H. pylori) infection among the healthy asymptomatic population in Iran and countries of the Eastern Mediterranean Region. METHODS: A computerized English language literature search of PubMed, ISI Web of Science, Scopus, and Google Scholar was performed in September 2013. The terms, "Eastern Mediterranean Regional Office (EMRO)" and "Helicobacter pylori", "H. pylori" and "prevalence" were used as key words in titles and/or abstracts. A complementary literature search was also performed in the following countries: Afghanistan, Bahrain, Djibouti, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Palestine, Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, The United Arab Emirates, and Yemen. RESULTS: In the electronic search, a total of 308 articles were initially identified. Of these articles, 26 relevant articles were identified and included in the study. There were 10 studies from Iran, 5 studies from the Kingdom of Saudi Arabia, 4 studies from Egypt, 2 from the United Arab Emirates, and one study from Libya, Oman, Tunisia, and Lebanon, respectively. The overall prevalence of H. pylori infection in Iran, irrespective of time and age group, ranged from 30.6% to 82%. The overall prevalence of H. pylori infection, irrespective of time and age group, in other EMRO countries ranged from 22% to 87.6%. CONCLUSION: The prevalence of H. pylori in EMRO countries is still high in the healthy asymptomatic population. Strategies to improve sanitary facilities, educational status, and socioeconomic status should be implemented to minimize H. pylori infection.

Two hundred twenty-three of 255 consecutive patients underwent cerebral angiography 16.9 +/- 11.6 days (SD) after high velocity missile injury to the head over a 29-month study period. Shell fragments were the most frequent projectiles (73.7%), and penetrating wounds were the most frequent injuries (61%). During the study, 2 patients (1 with an ophthalmic and the other with an anterior cerebral artery aneurysm) presented with delayed traumatic intracerebral hematoma; the first patient had had negative angiography 90 days earlier, and the second patient was admitted from a rehabilitation center after operation in another center 25 days earlier for a penetrating left frontal shell fragment injury. Six of 223 patients (2.7%) had dormant aneurysms (4 middle and 2 anterior cerebral arteries). Seven of 8 patients were operated on again to exclude their aneurysms from the cerebral circulation. Two of 8 patients died postoperatively (1 within 24 hours and another 51 days after discharge from the hospital in a vegetative state). Fragments penetrating temporal, temporoparietal, or pterional areas had a significantly greater chance of causing arterial injury (chi 2 = 11.46, P less than 0.001). There was a significant chance of having an aneurysm if a hematoma was seen at operation or on computed tomography of the head (chi 2 = 4.18, P less than 0.05). The penetrating mode of injury and shell fragments crossing the midline were two variables for which the statistical significance had a P value of 0.08. It is concluded that war casualties with penetrating shell fragment injuries near the pterion, especially when harboring intracerebral hematomas, should undergo cerebral angiography to rule out vascular injuries of the brain.

PROBLEM: Primary Immunodeficiency Disorders (PiD) are a heterogeneous group of genetic disorders, with different modes of inheritance. This study was accomplished in order to determine the frequency of consanguineous marriages in the families of patients with PiD. METHOD: In this study, the records 515 Iranian PiD patients were reviewed during a 25-year period. RESULTS: The mean proportion of consanguineous marriages was 65.6% among PiD patients, while the overall rate was 38.6% in the country. The rate of consanguinity was 77.8% in cellular immunodeficiencies, 75.8% in combined immunodeficiencies, 72.5% in defects of phagocytic function, 58.6% in other immunodefiiencies, 54.1% in predominantly antibody deficiencies, and 50% in complement deficiencies. Moreover all patients with immunodeficiency associated with other diseases had consanguineous parents. Such marriages were most common in the parents of patients with Chediak-Higashi syndrome, severe combined immunodeficiencies, primary CD4 deficiency, ataxia-telangiectasia, selective IgG class deficiencies, chronic granulomatous disease, and Schwachman syndrome. CONCLUSIONS: It is important to inform the general population about the dangers of consanguinity, which is very common in some areas such as Iran. Premarital examination to avoid genetic diseases could be suggested, especially in a community where the rate of consanguineous marriage is high.

Drug resistance is the main culprit of failure in cancer therapy that may lead to cancer relapse. This resistance mostly originates from rare, but impactful presence of cancer stem cells (CSCs). Ability to self-renewal and differentiation into heterogeneous cancer cells, and harboring morphologically and phenotypically distinct cells are prominent features of CSCs. Also, CSCs substantially contribute to metastatic dissemination. They possess several mechanisms that help them to survive even after exposure to chemotherapy drugs. Although chemotherapy is able to destroy the bulk of tumor cells, CSCs are left almost intact, and make tumor entity resistant to treatment. Eradication of a tumor mass needs complete removal of tumor cells as well as CSCs. Therefore, it is important to elucidate key features underlying drug resistance raised by CSCs in order to apply effective treatment strategies. However, the challenging point that threatens safety and specificity of chemotherapy is the common characteristics between CSCs and normal peers such as signaling pathways and markers. In the present study, we tried to present a comprehensive appraisal on CSCs, mechanisms of their drug resistance, and recent therapeutic methods targeting this type of noxious cells.

BACKGROUND: In late December 2019, a viral pneumonia known as coronavirus disease 2019 (COVID-19) originated from China and spread very rapidly in the world. Since then, COVID-19 has become a global concern and health problem. METHODS: We present four patients in this study, selected from among patients who presented with pneumonia symptoms and were suspicious for COVID-19. They were referred to the intended centers for COVID-19 diagnosis and management of Shiraz University of Medical Sciences in southern Iran. Two nasopharyngeal and oropharyngeal throat swab samples were collected from each patient and tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using real-time reverse-transcriptase- polymerase-chain-reaction (RT-PCR). The samples were also tested for influenza viruses and the complete respiratory panel. RESULTS: In the present report, four patients were diagnosed in the starting days of COVID-19 disease in our center in southern Iran with co-infection of SARS-CoV-2 and influenza A virus. CONCLUSION: This co-infection of COVID-19 and influenza A highlights the importance of considering SARS-CoV-2 PCR assay regardless of other positive findings for other pathogens in the primary test during the epidemic.

The World Health Organization, has declared the recent multiregional outbreak of monkeypox, a global public health emergency. Monkeypox is a zoonotic viral infection endemic to the west and central Africa. It belongs to the Poxviridae family, the Chordopoxvirinae subfamily, and the Orthopoxvirus genus. The Poxviridae family generally consists of complex, large, enveloped, and linear double-stranded DNA viruses. The initial clinical symptoms of monkeypox are often fever, severe headache, lymphadenopathy, myalgia, and fatigue. The skin lesions typically erupt within 1-3 days of the onset of fever. The rash tends to be more localized on the face and extremities than on the trunk. Monkeypox is often a self-limiting infection, and symptoms last from 2 to 4 weeks. It is isolated from various species, but the exact natural host is uncertain. Monkeypox is transmitted by close contact with infected humans or animals. Currently, no specific medication is available for monkeypox, and the existing therapeutics are the anti-viral agents approved for smallpox infection, including tecovirimat, cidofovir, and brincidofovir. Additionally, the U.S. Food and Drug Administration has approved Vaccinia Immune Globulin Intravenous for treating vaccination complications. It is diagnosed by PCR. There are currently two vaccines licensed by the U.S. Food and Drug Administration. According to the WHO guidance, the first-generation smallpox vaccines held in national reserves of some countries are not recommended as they do not meet the current safety and manufacturing standards. The interim guidance indicates that new and safer (second- and third generation) vaccines for smallpox, may be beneficial for monkeypox prevention, including JYNNEOS, which has been approved for the prevention of monkeypox. Human monkeypox was first reported in 1970. Since then, it has caused several outbreaks, mainly in central and west Africa. The first monkeypox outbreak outside of Africa occurred in the United States in 2003, linked to contact with infected pet prairie dogs. More recently (2018-2021), monkeypox cases have been reported in travelers from Nigeria to the United Kingdom, Israel, Singapore, and the US. Since May 2022, multiple monkeypox cases have been confirmed in several non-endemic countries, raising the concern of an emerging global pandemic. This review is an updated overview of our current state of knowledge regarding monkeypox virology, pathophysiology, clinical characteristics, epidemiology, vaccines, diagnosis, and treatment options.

Sixty cases of congenital scoliosis over a 13-year period were studied. The female:male ratio was 1.4:1. The deformity usually presented itself first either at 2 or 8-13 years of age. A positive family history was present in five cases, and parental consanguinity was observed in 40% of patients. Five patterns of deformity were recognized. Hemivertebra was the most common type, and unilateral unsegmented bar with contralateral hemivertebra was the most severe and most progressive pattern of deformity. Thoracic curves were more prevalent while larger curves were more commonly seen in the thoracolumbar area. The curves measured >40 degrees in 70% of the patients who had reached maturity. The curve progression index was 9 degrees for unilateral unsegmented bar with contralateral hemivertebra, and 6 degrees without contralateral hemivertebra. This index was 1.5 degrees for hemivertebra and complex type of deformity, and 0.5 degrees for block vertebra. Unbalanced fully segmented hemivertebra was next after the two types of unsegmented bars in terms of potential for progression. Presence of fused ribs on concave side of lower thoracic curves increased the rate of curve progression. Spinal dysraphism, diagnosed in 20% of cases, was the most commonly associated anomaly.

BACKGROUND & OBJECTIVE: Though sensitive screening assays for detection of hepatitis B virus surface antigen (HBsAg) are available, occasional cases of post-transfusion hepatitis B virus infection (PTH) still occur. The present study was undertaken to assess the prevalence of anti-hepatitis B core (anti-HBc) positivity and presence of HBV-DNA in serum sample of healthy blood donors negative for both HBsAg and anti-HCV antibody in Shiraz, Iran. Since anti-HBc detection is not mandatory in Iran, we evaluated whether anti-HBc detection could be adopted as a screening assay for safety of donated blood. METHODS: Two thousands serum samples negative for both HBsAg and anti-HCV collected from healthy blood donors were tested for the presence of anti HBc antibody. All samples positive for anti-HBc antibody were then investigated for determination of anti-HBc titre, anti-HBs titre, HbeAg and anti-HBe antibody by enzyme immunoassay (EIA). Every sample that tested negative for HBsAg but positive for anti-HBc alone or in combination with other serological markers was also examined for the presence of HBV-DNA by polymerase chain reaction (PCR). RESULTS: Of the 2000 samples tested, 131 (6.55%) blood samples were found to be positive for anti- HBc. HBV DNA was detected among 16 of 131(12.2%) anti-HBc positive specimens. Further, there was an association between the titration of anti-HBc antibody and the intensity of expected PCR product band. The liver function test results were all in normal range except in 4 of 16 HBV-DNA positive subjects. The mean levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in HBV-PCR positive subjects were 14 IU/l and 23.7 IU/l respectively. INTERPRETATION & CONCLUSION: Anti-HBc antibody should be tested routinely on blood donors volunteers and if the sample found positive regardless of anti-HBs titre, the blood should be discarded. Further testing for HBV-DNA would be appropriate to follow up the donor for HBV infection.

Long non-coding RNAs (lncRNAs) comprise a vast repertoire of RNAs playing a wide variety of crucial roles in tissue physiology in a cell-specific manner. Despite being engaged in myriads of regulatory mechanisms, many lncRNAs have still remained to be assigned any functions. A constellation of experimental techniques including single-molecule RNA in situ hybridization (sm-RNA FISH), cross-linking and immunoprecipitation (CLIP), RNA interference (RNAi), Clustered regularly interspaced short palindromic repeats (CRISPR) and so forth has been employed to shed light on lncRNA cellular localization, structure, interaction networks and functions. Here, we review these and other experimental approaches in common use for identification and characterization of lncRNAs, particularly those involved in different types of cancer, with focus on merits and demerits of each technique.

Abstract Background Observational studies have demonstrated improved outcomes in TBI patients receiving in‐hospital beta‐blockers. The aim of this study is to conduct a randomized controlled trial examining the effect of beta‐blockers on outcomes in TBI patients. Methods Adult patients with severe TBI (intracranial AIS ≥ 3) were included in the study. Hemodynamically stable patients at 24 h after injury were randomized to receive either 20 mg propranolol orally every 12 h up to 10 days or until discharge (BB+) or no propranolol (BB−). Outcomes of interest were in‐hospital mortality and Glasgow Outcome Scale‐Extended (GOS‐E) score on discharge and at 6‐month follow‐up. Subgroup analysis including only isolated severe TBI (intracranial AIS ≥ 3 with extracranial AIS ≤ 2) was carried out. Poisson regression models were used. Results Two hundred nineteen randomized patients of whom 45% received BB were analyzed. There were no significant demographic or clinical differences between BB + and BB − cohorts. No significant difference in in‐hospital mortality (adj. IRR 0.6 [95% CI 0.3–1.4], p = 0.2) or long‐term functional outcome was measured between the cohorts ( p = 0.3). One hundred fifty‐four patients suffered isolated severe TBI of whom 44% received BB. The BB + group had significantly lower mortality relative to the BB − group (18.6% vs. 4.4%, p = 0.012). On regression analysis, propranolol had a significant protective effect on in‐hospital mortality (adj. IRR 0.32, p = 0.04) and functional outcome at 6‐month follow‐up (GOS‐E ≥ 5 adj. IRR 1.2, p = 0.02). Conclusion Propranolol decreases in‐hospital mortality and improves long‐term functional outcome in isolated severe TBI. This randomized trial speaks in favor of routine administration of beta‐blocker therapy as part of a standardized neurointensive care protocol. Level of evidence Level II; therapeutic. Study type Therapeutic study.

INTRODUCTION: The integration of artificial intelligence in mental health care represents a transformative shift in the identification, treatment, and management of mental disorders. This systematic review explores the diverse applications of artificial intelligence, emphasizing both its benefits and associated challenges. METHODS: A comprehensive literature search was conducted across multiple databases based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses, including ProQuest, PubMed, Scopus, and Persian databases, resulting in 2,638 initial records. After removing duplicates and applying strict selection criteria, 15 articles were included for analysis. RESULTS: The findings indicate that AI enhances early detection and intervention for mental health conditions. Various studies highlighted the effectiveness of AI-driven tools, such as chatbots and predictive modeling, in improving patient engagement and tailoring interventions. Notably, tools like the Wysa app demonstrated significant improvements in user-reported mental health symptoms. However, ethical considerations regarding data privacy and algorithm transparency emerged as critical challenges. DISCUSSION: While the reviewed studies indicate a generally positive trend in AI applications, some methodologies exhibited moderate quality, suggesting room for improvement. Involving stakeholders in the creation of AI technologies is essential for building trust and tackling ethical issues. Future studies should aim to enhance AI methods and investigate their applicability across various populations. CONCLUSION: This review underscores the potential of AI to revolutionize mental health care through enhanced accessibility and personalized interventions. However, careful consideration of ethical implications and methodological rigor is essential to ensure the responsible deployment of AI technologies in this sensitive field.

OBJECTIVE: Randomized controlled trials (RCTs) have recently compared intramuscular 17α-hydroxyprogesterone caproate (17-OHPC) with vaginal progesterone for reducing the risk of spontaneous preterm birth (SPTB) in singleton gestations with prior SPTB. The aim of this systematic review and meta-analysis was to evaluate the efficacy of vaginal progesterone compared with 17-OHPC in prevention of SPTB in singleton gestations with prior SPTB. METHODS: Searches of electronic databases were performed to identify all RCTs of asymptomatic singleton gestations with prior SPTB that were randomized to prophylactic treatment with either vaginal progesterone (intervention group) or intramuscular 17-OHPC (comparison group). No restrictions for language or geographic location were applied. The primary outcome was SPTB < 34 weeks. Secondary outcomes were SPTB < 37 weeks, < 32 weeks, < 28 weeks and < 24 weeks, maternal adverse drug reaction and neonatal outcomes. The summary measures were reported as relative risk (RR) with 95% CI. Risk of bias for each included study was assessed. RESULTS: Three RCTs (680 women) were included. The mean gestational age at randomization was about 16 weeks. Women were given progesterone until 36 weeks or delivery. Regarding vaginal progesterone, one study used 90 mg gel daily, one used 100 mg suppository daily and one used 200 mg suppository daily. All included RCTs used 250 mg intramuscular 17-OHPC weekly in the comparison group. Women who received vaginal progesterone had significantly lower rates of SPTB < 34 weeks (17.5% vs 25.0%; RR, 0.71 (95% CI, 0.53-0.95); low quality of evidence) and < 32 weeks (8.9% vs 14.5%; RR, 0.62 (95% CI, 0.40-0.94); low quality of evidence) compared with women who received 17-OHPC. There were no significant differences in the rates of SPTB < 37 weeks, < 28 weeks and < 24 weeks. The rate of women who reported adverse drug reactions was significantly lower in the vaginal progesterone group compared with the 17-OHPC group (7.1% vs 13.2%; RR, 0.53 (95% CI, 0.31-0.91); very low quality of evidence). Regarding neonatal outcomes, vaginal progesterone was associated with a lower rate of neonatal intensive care unit admission compared with 17-OHPC (18.7% vs 23.5%; RR, 0.63 (95% CI, 0.47-0.83); low quality of evidence). For the comparison of 17-OHPC vs vaginal progesterone, the quality of evidence was downgraded for all outcomes by at least one degree due to imprecision (the optimal information size was not reached) and by at least one degree due to indirectness (different interventions). CONCLUSIONS: Daily vaginal progesterone (either suppository or gel) started at about 16 weeks' gestation is a reasonable, if not better, alternative to weekly 17-OHPC injection for prevention of SPTB in women with singleton gestations and prior SPTB. However, the quality level of the summary estimates was low or very low as assessed by GRADE, indicating that the true effect may be, or is likely to be, substantially different from the estimate of the effect. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. COMPARACIÓN ENTRE LA PROGESTERONA VAGINAL Y EL 17Α-HIDROXIPROGESTERONA CAPROATO INTRAMUSCULAR PARA LA PREVENCIÓN DEL PARTO PRETÉRMINO ESPONTÁNEO RECURRENTE EN EMBARAZOS CON FETO ÚNICO: REVISIÓN SISTEMÁTICA Y METAANÁLISIS DE ENSAYOS CONTROLADOS ALEATORIOS: RESUMEN OBJETIVO: Recientemente se han realizado varios ensayos controlados aleatorios (ECA) que comparaban el caproato de 17α-hidroxiprogesterona (17-OHPC, por sus siglas en inglés) por vía intramuscular con la progesterona por vía vaginal para la reducción del riesgo de parto pretérmino espontáneo (PPTE) en embarazos con feto único de gestantes con historial de PPTE. El objetivo de esta revisión sistemática y metaanálisis fue evaluar la eficacia de la progesterona vaginal en comparación con la 17-OHPC en la prevención de embarazos con feto único de gestantes con historial de PPTE. MÉTODOS: Se realizaron búsquedas en bases de datos electrónicas para identificar todos los ECA con embarazos de feto único asintomáticos con historial de PPTE antes de ser asignados al azar a un tratamiento profiláctico, ya fuera con progesterona vaginal (grupo de intervención) o con 17-OHPC intramuscular (grupo de control). No se aplicaron restricciones respecto al idioma o la ubicación geográfica. El resultado primario fue PPTE < 34 semanas. Los resultados secundarios fueron PPTE <37 semanas, < 32 semanas, < 28 semanas y < 24 semanas, la reacción materna adversa al fármaco y los resultados neonatales. Las medidas del resumen se reportaron como riesgo relativo (RR) con IC del 95%. Para cada estudio incluido se evaluó el riesgo de sesgo. RESULTADOS: Se incluyeron tres ECA (680 mujeres). La media de la edad gestacional en el momento de la aleatorización fue de 16 semanas. A las mujeres se les administró progesterona hasta la semana 36 o hasta el parto. Con respecto a la progesterona vaginal, un estudio utilizó gel de 90 mg diariamente, otro utilizó un supositorio diario de 100 mg y el otro utilizó un supositorio diario de 200 mg. Todos los ECA incluidos en el grupo de comparación utilizaron 250 mg semanales de 17-OHPC por vía intramuscular. Las mujeres que recibieron progesterona vaginal tuvieron tasas significativamente más bajas de PPTE < 34 semanas (17,5% vs. 25,0%; RR 0,71 (IC 95%, 0,53-0,95); calidad de la evidencia baja) y < 32 semanas (8,9% vs. 14,5%; RR 0,62 (IC 95%, 0,40-0,94); calidad de evidencia baja), en comparación con las mujeres que recibieron 17-OHPC. No hubo diferencias significativas en las tasas de PPTE < 37 semanas, < 28 semanas y < 24 semanas. La tasa de mujeres que reportaron reacciones adversas a los medicamentos fue significativamente menor en el grupo de progesterona vaginal en comparación con el grupo de 17-OHPC (7,1% vs. 13,2%; RR 0,53 (IC 95%, 0,31-0,91); calidad de la evidencia muy baja). En cuanto a los resultados neonatales, la progesterona vaginal se asoció a una menor tasa de admisiones en la unidad neonatal de cuidados intensivos en comparación con la 17-OHPC (18,7% vs. 23,5%; RR 0,63 (IC 95%, 0,47-0,83); calidad de evidencia baja). Para la comparación del 17-OHPC con la progesterona vaginal se rebajó la calidad de las pruebas para todos los resultados en al menos un grado debido a imprecisiones (no se alcanzó el tamaño óptimo de la información) y en al menos un grado debido al carácter indirecto de los estudios (diferentes intervenciones). CONCLUSIONES: La progesterona vaginal administrada diariamente (ya fuera como supositorio o como gel) desde la semana 16 de gestación es una alternativa razonable, si no mejor, a una inyección semanal de 17-OHPC para la prevención de PPTE en mujeres con embarazos de feto único e historial de PPTE. Sin embargo, el nivel de calidad de las estimaciones del resumen fue bajo o muy bajo según lo evaluado por GRADE, lo que indica que el verdadero efecto puede ser, o es probable que sea, sustancialmente diferente de la estimación del efecto. 17Α-:META: : (randomized controlled trials,RCTs)(spontaneous preterm birth,SPTB)17α-(intramuscular 17α-hydroxyprogesterone caproate,17-OHPC)SPTB。metaSPTB17-OHPCSPTB。 : ,SPTBRCTs,RCTs()17-OHPC()。。34SPTB。37、32、2824SPTB,。(relative risk,RR)95%CI。。 : 3RCTs(680)。16。,36。,90 mg,100 mg,200 mg。,RCTs250 mg 17-OHPC。17-OHPC,34 [17.5%25.0%;RR,0.71(95% CI,0.53 ~ 0.95);]32[8.9%14.5%;RR,0.62(95% CI,0.40 ~ 0.94);]SPTB。37、2824SPTB。17-OHPC,[7.1%13.2%;RR,0.53(95% CI,0.31 ~ 0.91);]。,17-OHPC,[18.7%23.5%;RR,0.63(95% CI,0.47 ~ 0.83);]。17-OHPC,(),()。 : SPTBSPTB,16()17-OHPC,。,GRADE,,。.

MENINGITIS during the first month of life is a rare disease. When it occurs, however, early diagnosis is difficult, therapy is uncertain, and the prognosis is still generally stated to be poor.1 , 2 The literature on this subject began with Macaigne's3 case report in 1873 and was followed in the next seventy years by only a few reports of single cases or small series of cases.4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 In 1943 Flensborg19 was able to gather only 131 cases from the world literature. Debré, Mozziconacci and Berkman,1 in 1954, reviewed 33 cases from the more recent literature, together with 13 of their own cases . . .

BACKGROUND: The probiotic microorganisms are live normal flora that provide nutritional benefits. When probiotic administered in adequate amounts, they also confer a health benefit on the host. Different mechanisms of probiotic effects include the following: stimulating the immune system, modifying the composition of normal intestinal flora and preventing the carcinogenic activity of fecal enzymes. In this study, direct effects of probiotic lactobacilli on tumor cells were investigated. METHODS: Supernatants and bacterial extracts of two standard Lactobacillus species (L. acidophilus and L. casei) were prepared and CaCo-2 cells were treated with them. Probiotic effects on cell proliferation, necrosis, apoptosis, migration and invasion were assessed. RESULTS: The supernatants of Lactobacilli decreased cell proliferation and increased cell apoptosis, however, no significant effect on cell necrosis was reported. In contrast, Lactobacilli extract, reduced cell proliferation and increased cell apoptosis. Lactobacilli extract also led to cell necrosis. Furthermore, both supernatants and cell extracts of the probiotic agents resulted in decreased cells' migration and invasion. CONCLUSION: In this study, it was shown that Lactobacilli probiotics useful effects are not confined to the enhancement of the immune system; however, they effectively suppress the malignant phenotypes of colorectal cancer cells.