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Rhabdomyosarcoma (RMS) is the most common pediatric soft-tissue sarcoma, mostly involving the genitourinary (GU) tract, head and neck, and extremities. This study reports the long-term outcome of two infants with recurrent GU-RMS who underwent combination therapy with chemotherapy (ChT) and salvage brachytherapy (BT). An 18-month-old girl with vaginal bleeding and a 7-month-old boy with urinary retention presented with a diagnosis of vaginal, and bladder/prostate embryonal RMS, respectively. Surgical resection and ChT were done for both patients. However, both developed local recurrences after one year and subsequently, underwent second-line ChT and salvage interstitial high dose rate BT. The clinical target volumes for the first and second patients were treated to a totaldose of 32 Gy in 10 fractions and 35 Gy in 10 fractions, respectively, with two fractions delivered per day with a 6-h interval between fractions. After 9 years of follow-up, both patients are alive with natural growth and no late complication or evidence of recurrence. Our report shows that BT (for patients with no prior history of irradiation) could result in long-term disease-free survival in well-selected pediatric patients with recurrent GU embryonal RMS without inflicting expected adverse effects of external beam radiotherapy. [ABSTRACT FROM AUTHOR]

Background: Cervical cancer, the most common gynecological cancer, is a matter of concern, especially in developing countries. The present study investigates survival rates, associated factors, and post-treatment follow-up status in cervical cancer patients. Study Design: A retrospective cohort study. Methods: This study was conducted on 187 patients referred to an academic referral cancer center in Iran from 2014-2020. Overall survival (OS) and event-free survival (EFS) were evaluated using Kaplan Meyer analysis. The event was defined as recurrence, metastasis, or death. Results: The patients came for post-treatment visits for a median of 36 months (interquartile range [IQR]: 18-51). The median OS and EFS were 24 and 18 months, respectively. The 1- and 3- year OS rates were 90% and 72%, respectively. The 1- and 3- year EFS rates were 76% and 61%, respectively. Stage ≥ III (hazard ratio [HR]: 3.1, 95% confidence interval [CI]: 1.5, 6.5, P < 0.001) and tumor size > 4 cm (HR: 2.5, 95% CI: 1.2, 4.9, P = 0.006) predicted lower OS. The most common histopathology was squamous cell carcinoma (SCC) (71.1%) with non-significant higher 3- year OS (HR: 0.62, 95% CI: 0.33, 1.16, P = 0.13). No significant difference in OS was found between adjuvant and definitive radiotherapy in both early and advance-staged patients (Log-rank = 0.7 P = 0.4, log-rank = 1.6, P = 0.2, respectively). Conclusion: As evidenced by the obtained results, the survival of patients was lower compared to that in developed countries. Higher stage and tumor size led to shorter survival. The histopathology and type of treatment in comparable stages did not have any significant impact on survival. [ABSTRACT FROM AUTHOR]

Introduction: The COVID‐19 pandemic has caused significant morbidity and mortality thus far. Considering the historical uses of high‐voltage X‐ray beams for unresolvable pneumonia, we aimed to assess whether low‐dose whole‐lung irradiation (WLI) could provide any benefits for patients with refractory COVID‐19 pneumonia. Methods: Eleven patients with refractory COVID‐19 pneumonia were treated with WLI to a total dose of 1 Gy and compared to 11 patients in a matched control group from June to November 2020. The study's primary endpoint was improvement of chest X‐ray severity score (CXRS), followed by changes in mean oxygen (O2) saturation and 28‐day mortality as secondary endpoints. Results: The final CXRS was significantly lower in the WLI group (8.7 ± 2.5) compared to the control group (12.3 ± 3.3) (P: 0.016). Change of CXRS from the first to the last chest X‐ray was −2.2 ± 3.1 for the WLI group and 0.7 ± 3.9 for the control group, which showed a trend for lower CXRS in the WLI group (U = 30, p: 0.085). Mean O2 saturation showed insignificant improvement in the first 24 hours after radiotherapy (mean difference: 2.5 ± 4.1, Z=−1.6, P value: 0.11). Overall survival after 28 days was 32% in the WLI group and 11% in the control group (P: 0.48). The reason for death in many patients was not merely respiratory failure, but also other adverse situations like pneumothorax, cardiogenic shock and pulmonary thromboembolism. Conclusions: Low‐dose WLI could improve the CXR severity score and O2 saturation in severely ill COVID‐19 patients, but larger studies are required to determine its impact on mortality. [ABSTRACT FROM AUTHOR]

Byline: Saber. Azami-Aghdash, Hossein. Jabbari, Fariba. Bakhshian, Leila. Shafaei, Soheyla. Shafaei, Kasra. Kolahdouzan, Mohammad. Mohseni Context: Due to expansion of chronic diseases and increase of health care costs, there is [...]

Here, we report a very rare case of mixed spinal tumor comprising of malignant glioblastoma and schwannoma, who was initially treated with tumor resection and adjuvant chemoradiation, but relapsed three years later with grade 3 ependymoma. [ABSTRACT FROM AUTHOR]

Definitive radiotherapy was effectively used for treatment of de novo hypopharyngeal SCC in a previous esophageal cancer patient with a history of Fanconi anemia, resulting in a complete clinical response. [ABSTRACT FROM AUTHOR]

Objectives: Many patients with breast cancer (BC) require cardiotoxic anthracycline-based chemotherapy. We intended to assess the early cardiotoxic effects of doxorubicin utilizing cardiac magnetic resonance (CMR) imaging. Material and Methods: Forty-nine patients including 21 otherwise healthy females with BC at a mean age (±SD) of 47.62 ± 9.07 years and 28 normal controls at a mean age (±SD) of 45.18 ± 4.29 years were recruited. They underwent CMR and transthoracic echocardiography at baseline and 7 days after four biweekly cycles of doxorubicin and cyclophosphamide. Biventricular functional, volumetric, global strain, and tissue characterization findings were analyzed and compared with those of 28 controls. Results: In post-chemotherapy CMR, 4 patients (19.04%), three symptomatic and one asymptomatic, exhibited evidence of doxorubicin cardiotoxicity. Significant differences in biventricular ejection fraction, left ventricular end-systolic volume index, and all 3D global strain values were noted after chemotherapy in comparison with the baseline (all P < 0.05). More than half of the study population showed a significant change in all right ventricular global strain values. One patient (4.76%) exhibited evidence of diffuse myocardial edema in post-chemotherapy CMR, and 3 patients (14.28%) showed myocardial fibrosis. The study participants were clinically followed up for 4-10 months (mean = 7 months). Overall, 8 patients (38.09%) complained of dyspnea on exertion and fatigue on follow-up. None of the CMR markers was associated with the development of symptoms. Conclusion: Our investigation revealed striking changes in CMR parameters in the follow-up of BC patients treated with cardiotoxic chemotherapy. These exclusive CMR features assist in the early initiation of preventive cardiac strategies. [ABSTRACT FROM AUTHOR]

Although people living with human immunodeficiency virus and other comorbidities are expected to experience more grievous consequences with corona virus disease 2019 (COVID‐19), recent cohort studies did not indicate this. Antiretrovirals (ARVs) might have a prophylactic role in these patients. The purpose of this study was to review the most recently published articles on the possible role of ARVs for pre‐ or postexposure prophylaxis against COVID‐19. From June to October 2020, we searched scientific databases using specific key words to identify ongoing trials or articles published before October 2020 investigating any subgroups of ARVs for prophylaxis against COVID‐19. Apart from molecular docking studies, in vitro, animal, and human studies are very limited for evaluating the prophylactic role of ARVs against severe acute respiratory syndrome‐corona virus 2 (SARS‐CoV‐2) infection. According to our findings, there is no definite evidence to support use of protease inhibitors for this purpose, despite the promising results of molecular studies and limited clinical evidence for ritonavir‐boosted lopinavir, darunavir, and nelfinavir when used early in the course of the disease. Nucleotide/nucleoside reverse‐transcriptase inhibitors (NRTI) also have shown binding affinity to main enzymes of SARS‐CoV‐2 in molecular, in vitro, and animal studies. NRTIs like tenofovir and emtricitabine might exhibit a prophylactic role against SARS‐CoV‐2 infection. In conclusion, currently there is no evidence to justify the use of ARVs for prophylaxis against COVID‐19. [ABSTRACT FROM AUTHOR]

Background: COVID-19 could cause severe complications in those with pre-existing conditions such as cancer. Here, we aimed to assess the outcome of COVID-19 in hospitalized patients with a history of cancer. Methods: In this retrospective cohort study, we extracted medical records of patients with any cancer history among hospitalized patients with COVID-19. Our patients were admitted between February 20th and July 15th, 2020. The primary outcome was death, and the secondary outcomes were overall survival, COVID-19-specific mortality, admission to intensive care unit (ICU), and hospital stay. A group of individuals without cancer history was selected from the COVID-19 cohort and matched for age, gender, and pre-existing conditions. We utilized univariate and multivariate logistic regression to analyze the association between studied variables and primary outcomes. Results: We identified 46 patients with cancer and COVID-19. The median age was 63, and 54.3% were male. According to the univariate logistic regression analysis, death was 5.3 (CI95%: 1.75-15.85) times more probable in cancer patients than controls (p=0.003). The multivariate analysis adjusted for having cancer and sex, age, and having any comorbidity showing this figure was 5.5 (CI95%:1.8-16.8) (p=0.003). The 30- and 90-day COVID-19 specific mortality was 30% (CI95%:17-43) and 33% (CI95%: 20-46), respectively. Conclusion: Patients with COVID-19 with a history of cancer have a considerably higher risk of death irrespective of age, gender, and other pre-existing conditions. Patients with advanced cancers and concurrent bacterial infections need the most vigorous care. [ABSTRACT FROM AUTHOR]

Follicular dendritic cell sarcoma responded dramatically to chemotherapy with gemcitabine and docetaxel. [ABSTRACT FROM AUTHOR]

Radiotherapy of extensive malignant scalp lesions has always been a challenge for radiation oncologists considering the proximity of critical structures. We treated a 39-year-old patient with extensive scalp squamous cell carcinoma with application of adjuvant concurrent chemoradiation and external beam radiation therapy (EBRT), followed by high-dose-rate (HDR) surface brachytherapy boost using an exclusively designed mould, and assessed the radiation dose reaching planning target volume, brain, and optic structures. Comparison between conventional planning with sole EBRT and combined treatment planning with EBRT and brachytherapy, assured the use of the latter treatment to avoid high radiation doses from reaching critical organs at risk without compromising the required dose for planning target volume. [ABSTRACT FROM AUTHOR]

An 80‐year‐old man with multiple comorbidities presented to the emergency department with tachypnea, tachycardia, fever, and critically low O2 saturation and definitive chest computerized tomography scan findings in favor of COVID‐19 and positive PCR results in 48 hours. He received antiviral treatment plus recombinant human erythropoietin (rhEPO) due to his severe anemia. After 7 days of treatment, he was discharged with miraculous improvement in his symptoms and hemoglobin level. We concluded that rhEPO could attenuate respiratory distress syndrome and confront the severe acute respiratory syndrome coronavirus 2 virus through multiple mechanisms including cytokine modulation, antiapoptotic effects, leukocyte release from bone marrow, and iron redistribution away from the intracellular virus. Highlights: –Recombinant human erythropoietin can rapidly correct anemia and symptoms associated with COVID‐19–Through cytokine modulation, rhEPO exerts its cytoprotective and anti‐apoptotic effects in COVID pneumonia.–rhEPO takes iron away from intracellular virus into the bone marrow, undermining the viral enzymatic requirements. [ABSTRACT FROM AUTHOR]

Purpose: ST depression resolution (STD-R) in ECG is a prognostic factor indicative of successful fibrinolysis or angioplasty in the treatment of ST elevation myocardial infarction (STEMI) and subsequent mortality. We conducted this study to determine the clinical significance of STD-R and its predictors in patients with anterior STEMI undergoing primary percutaneous intervention (PPCI). Methods: Admission documents of all patients with diagnosis of anterior STEMI who were admitted to a specialty heart center and underwent PPCI since July 2018 until July 2019 were examined. The amount of ST elevation and depression in all 12 leads of a standard ECG at admission and 90 minutes after PPCI was measured and resolution was determined. All patients were followed-up for 10.8± 4.0 months. Results: A total of 179 patients had ST depression besides elevation in the first ECG. Female gender, diabetes, not smoking, lower hemoglobin, and higher platelet counts were significantly more common in the group with less than 50% resolution of ST depression. STD-R < 50% was significantly associated with the incidence of in-hospital acute heart failure and major adverse cardiac events (MACE) (p value: 0.025 and 0.012, respectively) and resolution of ST elevation ≥ 50% was associated with reduced in-hospital mortality (p value < 0.0001). According to Kaplan–Meier curve, survival in the two groups of STE-R ≥ 50% and STE-R < 50% was significantly different (Log rank: 31.18, p value< 0.0001). Conclusion: STD-R can be considered to have high predictive power, like STE-R for predicting incidence of in-hospital acute heart failure and major adverse cardiac events. [ABSTRACT FROM AUTHOR]

We determine the frequency of initial misdiagnosis and inappropriate treatment with antiplatelets/anticoagulants in the emergency department (ED) and the resultant clinical outcomes in patients with acute type A aortic dissection (AAOD). Medical records of patients with a final diagnosis of AAOD admitted from March 2004 through October 2015 to our tertiary-level heart hospital were evaluated. Patients with suspected dissection in ED were compared to those with initial misdiagnosis regarding demographics and clinical presentation, laboratory and echocardiographic findings. Our primary outcome was hospital mortality in two groups. Long-term mortality after discharge was our secondary outcome. Among 189 patients, 47 (24.8 %) were initially misdiagnosed and received antiplatelets/anticoagulants in ED (Group F), and 142 (75.1 %) were appropriately diagnosed in ED (Group T). The mean age in group F was 60.4 ± 15.0 vs. 57.4 ± 16.0 years in group T (p = 0.260). In group F, 70.2 % were male vs. 60.6 % in group T (p = 0.311). Hospital mortality was 48.9 % in group F vs. 43.7 % in group T (p = 0.645). Long-term mortality was significantly higher in group F (55.6 vs. 21.2 %, p = 0.007). Univariate hazard ratio (HR) of initial misdiagnosis for long-term mortality was 2.56 (95 % CI 1.08-6.06, p = 0.031). In multivariate Cox regression analysis with adjustment for age and type of management (surgical/medical), initial misdiagnosis lost its significance for predicting long-term mortality (HR 2.14, 95 % CI 0.89-5.13, p = 0.086). Initial misdiagnosis of AAOD is a common problem. Hospital mortality is not significantly affected by receiving antiplatelets/anticoagulants. Although long-term mortality is higher in patients with initial misdiagnosis, it is not an independent predictor for long-term mortality. [ABSTRACT FROM AUTHOR]

Background: Although acute type-A aortic dissection (AAOD) is more common in males, the course of the disease may differ in females. Objectives: We aimed to investigate the gender-related differences in patients with AAOD with regard to clinical presentation, short-term and long-term mortality. Patients and Methods: Medical records of 192 patients with a confirmed diagnosis of AAOD in a University Heart Center from March 2004 through October 2015 were evaluated. Clinical information, hospital mortality, and long-term survival were explored with regard to gender. Propensity matching was performed to adjust for baseline differences. Kaplan-Meier survival analysis was used to determine the impact of gender on long-term mortality. Results: Among 192 patients, 71 (37.0%) were females. The women were older (65.7 ± 13.8 vs. 53.9 ± 15.1 years, P < 0.001). Hypertension (77.5% vs. 56.7%; P = 0.006) and diabetes mellitus (12.7% vs. 0.1%; P = 0.001) were more common among women than men, while active smoking was significantly more prevalent in men (46.7% vs. 9.9%; P < 0.001). The frequency of various clinical presentations was not different between the two groups. Among men, 71.7% were surgically managed compared to 67.6% among women. In-hospital mortality was 50.7% in women and 42.1% in men and remained statistically similar after matching. For long-term survival female to male hazard ratio (HR) was 1.24 with 95% CI: 0.85 - 1.81 (P = 0.257), which basically remained unchanged after propensity matching, HR was 1.13, 95%CI: 0.73 - 1.73 (P = 0.300). Conclusions: In patients admitted with AAOD, there was no gender-related differences in clinical presentation and type of management. Similarly, hospital and long-term mortality did not differ with regard to gender. [ABSTRACT FROM AUTHOR]

Background: Electrocardiography (ECG) offers some information that may be used to prognosticate acute type A aortic dissection (AAOD) for short- and long-term mortality.Methods: We retrospectively analyzed the electrocardiograms of patients with AAOD admitted from March 2004 to March 2015. The frequency of ECG findings and their prognostic value on hospital and follow-up mortality were investigated. Findings pertaining to coronary involvement and troponin level were also examined.Results: A total of 120 men and 64 women were admitted. Acute ischemic changes were reported in 38.0%, whereas T inversion was the most common recorded abnormality, which occurred in 38.6%. Acute ST-elevation myocardial infarction was detected in 16.3%. Troponin increased in 36.6%; 21.9% of the patients underwent coronary angiography among which 70% were normal. Coronary involvement or troponin increase was not different in patients with acute ECG changes. During hospitalization, 45.7% of the patients died. In multivariate analyses, ST elevation in lead aVR was associated with higher hospital death (odds ratio, 5.30; 95% confidence interval, 1.09-25.73; P = .038), whereas QRS greater than 120 milliseconds was associated with long-term mortality (hazard ratio, 2.45; 95% confidence interval, 1.25-3.76; P = .006).Conclusion: Acute ischemic ECG changes are common in AAOD, and a completely normal ECG is infrequently encountered. Acute ECG changes were not associated with the increased troponin or the presence of coronary lesions in angiography. [ABSTRACT FROM AUTHOR]

Background: It is believed that healthcare staff play an important role in minimizing complications related to urethral catheterization. The purpose of this study was to determine whether or not healthcare staff complied with the standards for urethral catheterization. Methods: This study was conducted in Imam Reza teaching hospital, Tabriz, Iran, from July to September 2013. A total of 109 catheterized patients were selected randomly from surgical and medical wards and intensive care units (ICUs). A questionnaire was completed by healthcare staff for each patient to assess quality of care provided for catheter insertion, while catheter in situ, draining and changing catheter bags. Items of the questionnaire were obtained from guidelines for the prevention of infection. Data analysis was performed with SPSS 16. Results: The mean age of the patients was 50.54 ± 22.13. Of the 109 patients, 56.88% were admitted to ICUs. The mean duration of catheter use was 15.86 days. Among the 25 patients who had a urinalysis test documented in their hospital records, 11 were positive for urinary tract infection (UTI). The lowest rate of hand-washing was reported before bag drainage (49.52%). The closed drainage catheter system was not available at all. Among the cases who had a daily genital area cleansing, in 27.63% cases, the patients or their family members performed the washing. In 66.35% of cases, multiple-use lubricant gel was applied; single-use gel was not available. The rate of documentation for bag change was 79%. Conclusion: The majority of the guideline statements was adhered to; however, some essential issues, such as hand hygiene were neglected. And some patients were catheterized routinely without proper indication. Limiting catheter use to mandatory situations and encouraging compliance with guidelines are recommended. [ABSTRACT FROM AUTHOR]

BACKGROUND: A pacemaker implantation is considered major life event for cardiovascular patients, so they will probably have very interesting experiences of living with this device. The aim of this study was to explore the experiences of cardiovascular patients living with the pacemaker. METHODS: In this qualitative study, 27 patients were chosen through purposive sampling to achieve data saturation, and their experiences were examined using semi-structured interviews. The patients' statements were recorded with their consent and analyzed using content analysis method. RESULTS: Participants' experiences included three main themes: "Problems and limitations," "feeling and dealing with pacemaker", and "sources of comfort" and 10 sub-themes including: physical problems, financial problems, social problems, the first encounter, the feeling of living with the pacemaker, how to cope with pacemaker, satisfaction with pacemaker, good family support, hospital and hospital staff performance, and role of religious beliefs. CONCLUSION: Planning to solve social problems, identifying and changing feelings of patients using pacemakers, reinforcing the resources of comfort especially family support seem to be necessary steps for improving quality of life and impact of using pacemaker. [ABSTRACT FROM AUTHOR]

Introduction: Studying mental and physical health and their determinants is an important issue, especially among future health providers. Methods: This is a sectional-analytical study whose target population was students who had participated in the 4th National Olympiad of Medical Sciences Universities in Tabriz, Iran, held in February 4-7 2013.Web-based designed questionnaires were sent to all 328 participating students' emails containing our questionnaires that were designed as web-based through Google Drive was sent to all available email addresses of our target population. Questionnaires consisted of student life stress inventory (SLSI), SF-36 (Short Form Health Survey), and College Self- Efficacy Inventory (CSEI), which were translated to Persian and revalidated. The data were analyzed using SPSS ver.19 software. Results: 59 students completely filled the questionnaires and enrolled in the study. In the area of student life stress inventory, the total score of the participants ranged from 79(13.73%) to 168(63.73%) with a mean of 130.74(40.05%) and SD of 21.51(10.84%). On the college selfefficacy scale, participants' scores ranged from 62(40.79%) to 152(100%) with a mean of 114.29(77.10%) and SD of 22.82(14.20%). On the Sf-36 form, participants scored 72.28±14.09% on average (Min=44.03%, Max=98.75%). The Spearman correlation coefficient test indicated that all correlations between variables were statistically significant (p<0.001). Conclusion: It can be concluded that adopting additional methods to increase self-efficacy and decrease stress amongst medical students in the academic population will lead to improved mental and physical health, which can help national improvement of science. [ABSTRACT FROM AUTHOR]