The Software Comprehensive Meta-Analysis Needs to Be Upgraded Further: Letter to the Editors

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Investigation of breast cancer screening among the women of Khorramabad (west of Iran): A cross-sectional study

Abstract. Breast cancer is the most common women's cancer that more than 90% of the patients can be treated or even cured through early diagnosis. So we intend to investigate the status of breast cancer screening in Khorramabad, a city in the west of Iran. In the present cross-sectional study, the study population included 457 number of 20 to 65 year old women referring to the health centers of Khorramabad during the second half of 2015 to receive health care services. The sampling method was multistage random-cluster. A multi-part questionnaire were used. Fisher exact test, chi-square and independent t tests were used to analyze the data.  The regular self-breast exam (SBE) had been carried out by 12.3% of the women, visiting doctors for regular clinical breast exam (CBE) had been done by 6% of the respondents and regular mammography every one to two years had been performed by 2.4% of the women. A statistically significant relationship was seen between occupation (P = 0.001), regular consumption of contraceptive pills (P = 0.032), history of breastfeeding, history of breast cancer in the first degree relatives (P = 0.001), and a history of cancer in the second degree (P = 0.005) relatives, and the regular SBE. Planning to enhance the women's awareness about breast cancer and the methods of early diagnosis and designing educational programs can be an important step to reduce deaths and disabilities caused by this disease among the women in such deprived cities

The Relationship of Maternal KIR and Parental HLA-C Genes With Risk of Recurrent Spontaneous Abortion: A Regional Study in Lorestan Province, Iran

Objectives: Natural killer cells (NKs) are one of the most important cells which play a key role in fetomaternal immune tolerance. This immune tolerance is induced by the interaction of fetal human leucocyte antigens (HLAs) and maternal killer-cell immunoglobulin-like receptors (KIRs). Hence, we intended to investigate the relationship of maternal KIR, parental HLA-C, and maternal-parental KIR+HLA-C with the risk of recurrent spontaneous abortion (RSA). Materials and Methods: The present regional study in Lorestan province of Iran was conducted as a case-control study on 200 couples. Polymerase chain reaction with sequence-specifc primers (PCR-SSP) was used in order to detect genes. Results: A signifcant correlation was found for maternal KIR2DS1 in combination with paternal HLA-C2 (P=0.0089; OR=2.25). Likewise, a signifcant relation was found for maternal C1C2 in combination with paternal C1 or C2 (P=0.0289; OR=2.25). No signifcant relation was found for KIR genes alone. Conclusions: Our study showed a signifcant relation for maternal KIR2DS1 in combination with paternal HLA-C2 as a risk factor in our region. Investigations on this combination for increasing the success rate of assisted reproduction, for frst trimester abortions occurring after implantation and early placentation, for stillbirth groups, and for successful and unsuccessful pregnancies with malformed embryos and fetuses are suggested

Role of History Taking in Differential Diagnosis of Small Airway Disease: A Pilot Study on 32 Cases

Objectives: Since history taking is still the most important part of a medical diagnosis, we tried to find sensitive and specific symptoms and risk factors in order to differentiate small airway disease from other pulmonary diseases. Social factors as well as related past medical history including using spirits of salt (HCL), gastro-esophageal reflux disease (GERD) and so on were evaluated. Materials and Methods: The present pilot study consists of 32 cases of small airway disease and 28 cases of other pulmonary diseases. The statistical evaluations were performed through 2 × 2 tables using Fisher exact test adjusted with Bonferroni correction for P values and Yate correction for odds ratios. The sensitivities and the specificities were also reported as we aimed. Results: Among the 4 symptoms evaluated, having sputum was against small airway disease (Pc = 0.0184; ORc = 0.23). Lack of sputum was 62% sensitive and 75% specific for small airway disease. Among the risk factors evaluated, using HCL showed the highest accuracy (Pc = 0.0004; ORc = 31.4; Sensitivity = 65%; Specificity = 96%; Accuracy = 80.5%). History taking is still the most important part of a medical diagnosis. Conclusions: Through a suggestive history and physical examination, we can reach a good pretest probability for further evaluation

IgG4-related disease presenting with cholangitis mimicking cholangiocarcinoma: a case report with a literature review

Introduction. IgG4-related disease (IgG4-RD) is currently known as a unique progressive immune-mediated disease creating tumor-like fibrotic masses in different organs of the human body. Case presentation. We report a 23-year-old woman who presented with acute abdominal pain, icterus, and fever. A biliary stricture aroused suspicion of cholangiocarcinoma. In addition, some colon masses were observed, which were suspected to be mucinous carcinoma with appendix origin. The patient underwent a major surgery consisting of cholecystectomy, hepaticojejunostomy, and right hemicolectomy. The post-surgical pathology report for all the lesions and masses was IgG4-RD. Conclusion. The biliary lesion was IgG4-related sclerosing cholangitis. We concluded that IgG4-RD was a rare but important differential diagnosis for solitary or multiple masses and biliary lesions

Review: Autism and KIR genes of the human genome: A brief meta-analysis

Background: Killer cell immunoglobin-like receptors (KIR) are the  transmembrane glycoproteins on natural killer (NK) cells that regulate their functions. Studies show that immune system plays roles in  neurodevelopmental disorders like autism, and NK cell abnormality can be a risk factor in autism spectrum disorders.Aim: This study aims to investigate the role of KIR genes diversity in autism.Methods: In order to find the relevant literature, we used PubMed, Google Scholar and other search engines. Association of each gene was analyzed through chi-square with Yate’s correction (or Fisher’s exact test if necessary). Software comprehensive meta-analysis was used. Both fixed and random effect models were reported.Results: Among fourteen genes of KIR, the risk role of KIR2DS1 and  KIR3DS1 were statistically significant based on fixed effect model. Among these two genes, KIR2DS1 needed random effect model because of its heterogeneity. After applying random effect, its role was not significant. The funnel plot showed no publication bias for KIR3DS1, and its role was  significant based on fixed effect model (P = .028; OR = 1.31).Conclusions: Autism spectrum disorders are accompanied by KIR3DS1 which is an activating gene of KIR. It seems that hyper-activity of NK cells results in inflammation in neuroimmune system that in turn can be associated with autism. The legend of 3DS1 receptor is unknown, and suggested to be investigated. This meta-analysis should be updated in future.Keywords: Autism Neuroimmunology KIR NK cell

A Narrative Review on Nephrotic Syndrome Emphasizing its Correlation With Polymorphism of Angiotensin Converting Enzyme and Renin-Angiotensin System

Numerous meta-analyses have been shown that the nephrotic syndrome is one of the most important reasons of renal failure in children that is monies-taking for health organizations around the world. Because of the global and strategic importance of this issue we intend to investigate the different aspects of nephrotic syndrome to propose our suggestions with a multi-dimensional perspective. Present narrative review is based on scrutinizing the contents of relevant papers searched in PudMed search engine. The correlation of nephrotic syndrome with renin-angiotensin system (RAS) and involving enzymes, in particular angiotensin converting enzyme (ACE), has been investigated in different populations. Nephrotic syndrome in children is usually in two types of minimal change and focal and segmental glomerulosclerosis (FSGS), but more of minimal change. ACE gene has 2 polymorphic alleles of deletion (D) and insertion (I). DD genotype is associated with higher production of angiotensin-II. So it seems that persons with DD genotype are more at risk of renal diseases. Through identifying and screening the involving genetic diversities we can take the prophylactic actions. It seems that early starting of steroid therapy can prevent symptoms of the disease. As well, early starting of supplement administration of vitamin A and E could be a less harmful preemptive measure. Further researches on gene therapy methods is recommended

Effect of Testosterone Enanthate Modeling of Polycystic Ovary on Liver Irs-2 mRNA Expression in Rats: A Brief Report

هناك العديد من النماذج الحيوانية لتكيس المبايض (PCO). يعد استخدام إينونثات التستوستيرون الخارجي إحدى طرق تحريض هذه النماذج. ومع ذلك ، يجب أيضًا دراسة تحريض مقاومة الأنسولين في تقنيات النماذج. لذلك ، تهدف الدراسة الحالية إلى التحقق من تعبير ركيزة مستقبلات الأنسولين (Irs) -2 mRNA في أنسجة الكبد لنموذج PCO الفئران. تم تقسيم تسعة عشر من قئران ويستار إلى ثلاث مجموعات. (1) تلقت مجموعة نمذجة PCO (N = 7) يوميًا 1.0 مجم / 100 جرام من إينونثات التستوستيرون المذاب في زيت الزيتون جنبًا إلى جنب مع الوصول الحر الى ماء الدكستروز ذي  التركيز 5 ٪ ، (2) مجموعة المركبات (N = 6) ، والتي تم التعامل معها مثل مجموعة PCO ، لكنهم لم يتلقوا إينونثات التستوستيرون، (3) مجموعة التحكم (N = 6) مع الرعاية المنتظمة. تم حقن جميع الحيوانات داخل الصفاق لمدة 14 يومًا. تمت دراسة التعبير عن Irs-2 mRNA باستخدام PCR في الوقت الفعلي وتم الإبلاغ عن تغييرات الطي (FC). تم اعتبار متوسط التعبير في المجموعة الضابطة بمثابة المعيار. تم العثور على حوالي 13.4 ٪ تقليل التعبير في مجموعة PCO (FC = 0.874 ، قيمة P = 0.043). لم يتم العثور على انخفاض كبير في مجموعة المركبات (FC = 0.951 ، قيمة P = 0.076). ومع ذلك ، لم يُظهر تحليل التباين فرقًا معنويًا بين جميع مجموعات الدراسة (قيمة P = 0.085). قد يؤدي النموذج الحالي لـ PCO إلى مقاومة الأنسولين على مستوى الكبد بحجم تأثير منخفض عن طريق تقليل تعبير mRNA عن Irs-2. يُقترح دراسة الجينات والجزيئات المعنية في الأنسجة الأخرى لنماذج حيوانية PCO.There are many animal models for polycystic ovary (PCO); using exogenous testosterone enanthate is one of the methods of induction of these models. However, induction of insulin resistance should also be studied in the modeling technics. Therefore, the present study aims to investigate the expression of insulin receptor substrate (Irs)-2 mRNA in the liver tissue of rat PCO model. Nineteen Wistar rats were divided into three groups; (1) PCO modeling group (N =7) received daily 1.0 mg/100g testosterone enanthate solved in olive oil along with free access dextrose water 5%, (2) vehicle group (N =6), which handled like the PCO group, but did not receive testosterone enanthate, (3) control group (N =6) with standard care. All the animals were administered via intra-peritoneal injection for 14 days. Expression of Irs-2 mRNA was studied with real-time PCR and fold changes (FC) were reported. The average of expression in the control group was considered as the calibrator. About 13.4% expression reduction was found in the PCO group (FC =0.874, P-value =0.043). No significant reduction was found in the vehicle group (FC =0.951, P-value =0.076). However, analysis of variance did not show a significant difference between all the groups of study (P-value =0.085). The present model of PCO might induce insulin resistance at liver level with a low effect size via reduction in the mRNA expression of Irs-2. Study of the involved genes and molecules in other tissues of PCO animal models is suggested

Association between metabolic syndrome and prevalent skin diseases : A systematic review and meta-analysis of case-control studies

ACKNOWLEDGMENTSThe authors would like to express their gratitude to the authorities ofRasool Akram Medical Complex Clinical Research DevelopmentCenter (RCRDC) for their technical and editorial assistance.Peer reviewedPublisher PD

Screening role of complete blood cell count indices and C reactive protein in patients who are symptomatic for COVID-19

INTRODUCTION: Diagnosis of COVID-19 is through polymerase chain reaction (PCR) or typical involvement of the lung by the virus in computed tomography (CT) scan. However, PCR is not always available, and also CT scan has a high dose of radiation. This study was performed to find the role of complete blood cell (CBC) indices and qualitative C-reactive protein (CRP) in screening of symptomatic patients.MATERIAL AND METHODS: A diagnostic accuracy study was performed on symptomatic cases in Abadan. Four stepwise logistic regression models were designed that the outcomes were PCR positivity, CT scan positivity, PCR and CT scan positivity, and COVID-19 positivity (i.e., PCR or CT scan positivity). Post-estimation receiver operating characteristics (ROC) curve analysis was performed to report the area under the curve (AUC).RESULTS: A total of 104 patients were studied. The most accurate model was for the prediction of CT scan positivity (AUC = 0.874) in which the predictors were age [odds ratio (OR) =1.063] and CRP (OR = 2.661 for each plus of positivity). The second accurate model was for the prediction of COVID-19 positivity (AUC = 0.828) in which the predictors were white blood cell count (OR = 0.735 for every 1000 counts per μL) and neutrophil per lymphocyte ratio (OR = 1.248).CONCLUSIONS: Higher levels of CRP are associated with and predictor of lung involvement in COVID-19 infection. CRP qualitative levels can be measured before a CT scan if there is no other indication for imaging