Mazandaran University of Medical Sciences

Abstract: Amiodarone, a widely prescribed antiarrhythmic drug, is associated with significant thyroid dysfunction, including both hypothyroidism and hyperthyroidism. This systematic review and meta analysis aim to synthesize the available evidence on the prevalence, types, and management of amiodarone induced thyroid dysfunction (AITD) in patients on long term therapy. We conducted a systematic review and meta analysis of studies that examined thyroid dysfunction in patients receiving long term amiodarone therapy. A comprehensive search of PubMed, Google Scholar, and the Cochrane Library was performed, identifying studies published between 1990 and 2024. Eligible studies included prospective or retrospective cohort studies and randomized controlled trials (RCTs) reporting on the incidence of hypothyroidism, hyperthyroidism, and management strategies in this population. Twenty three studies, with a combined population of 12,000 patients, were included in the final analysis. The pooled incidence of hypothyroidism was 14.3% (95% confidence interval [CI]: 12.1%–16.9%, P < 0.001) and hyperthyroidism was 6.7% (95%CI: 5.1%–8.4%, P < 0.001). Geographical variation in incidence was noted, with higher rates of hyperthyroidism in iodine deficient regions. Amiodarone induced hypothyroidism was generally well managed with levothyroxine without discontinuing amiodarone. Amiodarone induced hyperthyroidism required either antithyroid drugs (for Type 1) or corticosteroids (for Type 2). Thyroid dysfunction, especially hypothyroidism, is common in patients receiving long term amiodarone therapy. Regular thyroid function monitoring is essential to manage this condition effectively. Further studies are needed to improve the management of amiodarone induced hyperthyroidism and optimize long term outcomes for these patients.

Achilles tendon ruptures are recognized as one of the most widespread musculoskeletal injuries. Tendon injuries are a notable clinical challenge, primarily due to the restricted regenerative capacity of the tissue and the associated risks of fibrosis and incomplete functional recovery. Recent studies suggest that cell-free therapies, including stem cell-derived secretomes, may facilitate tendon regeneration. Additionally, mechanical stimulation through exercise can enhance tissue remodeling. This study aimed to investigate the combined effects of tendon-derived stem cell (TDSC) secretome and treadmill-based rehabilitation on Achilles tendon regeneration in a rat model. TDSCs were isolated from rat Achilles tendon and characterized using morphology, cytochemical staining, and flow cytometry. In vitro scratch assays were performed to assess cell migration and wound healing in a laboratory setting. The secretome was collected from fourth-passage TDSCs and incorporated into a collagen-based, injectable hydrogel. A total of 42 adult female Wistar rats were categorized into eight distinct experimental groups, including injury-only, treadmill-only, secretome-only, and treadmill + secretome groups. A surgical procedure was performed to induce a partial rupture of the Achilles tendon, followed by the injection of a secretome-loaded hydrogel at the site of injury. Subsequently, a structured treadmill training program was initiated post-surgery. Regenerative outcomes were evaluated using footprint analysis, histological staining (hematoxylin and eosin, periodic acid-Schiff, and Masson's trichrome), and biomechanical testing. In vitro scratch assays demonstrated that TDSCs treated with secretome exhibited enhanced migratory capabilities. Flow cytometry confirmed the identity of these mesenchymal stem cells (MSCs). In vivo studies showed that the combination therapy group (secretome-loaded hydrogel and treadmill training) achieved superior histological recovery. This group exhibited organized collagen bundles, aligned spindle-shaped tenocytes, minimal inflammation, and restored extracellular matrix integrity. PAS staining indicated reduced glycosaminoglycan degradation, while Masson's trichrome staining revealed partial collagen maturation. Additionally, footprint analysis showed improved functional performance, with the combination group achieving significantly higher Achilles functional index scores. Biomechanical testing confirmed enhanced tensile strength and elastic modulus, approaching values comparable to those of intact tendon healing. The synergistic application of TDSC-derived secretome along with treadmill training significantly improved tendon regeneration, matrix remodeling, and functional recovery. This cell-free, bioactive approach offers a promising therapeutic alternative for enhancing tendon recovery.

Toxoplasma gondii is a ubiquitous parasitic protozoan that can cause neurological and psychiatric disorders, potentially impacting human emotional behavior. This study aimed to explore serological and molecular evidence of T. gondii infection in opioid abusers in northern Iran. In this case-control study, opioid abusers who were referred to substance abuse rehabilitation centers in Mazandaran Province, northern Iran, were enrolled. Blood samples were collected from the participants to perform a serological assay to detect T. gondii IgG and IgM antibodies. A polymerase chain reaction (PCR) test was also conducted on buffy coats of the blood samples. The study comprised a total of 474 participants, with 239 individuals being opioid abusers and 235 healthy individuals serving as the control group. The results indicated that 163 opioid abusers (68.2%) were positive for T. gondii IgG, whereas 76 (31.8%) were negative. Among the control group, 63 individuals (26.8%) tested positive for T. gondii IgG, whereas 172 (73.2%) tested negative. This difference was statistically significant according to p = 0.01, odds ratio (OR) = 2.67, and 95% confidence interval (CI) = 1.03-4.15. In addition, 7.1% (17/239) of the case and 2.1% (5/235) of the control groups were PCR positive for Toxoplasma DNA. This difference was statistically significant (p = 0.01; OR = 2.96; 95%; CI = 0.94-7.01). In contrast, all of the participants were negative for T. gondii IgM antibodies. Our findings demonstrated that the sero-molecular prevalence of latent T. gondii infection in opioid abusers is significantly higher than that in healthy individuals. This suggests a potential correlation between T. gondii IgG antibody positivity and PCR results with opioid abuse.

We aimed to assess the 5-year survival probability of childhood cancer in Iran, utilizing data from eight population-based cancer registries across the country. The study employed data from 1809 childhood cancer patients aged 0-14 years, diagnosed between 2014 and 2016. Patients underwent active and passive follow-up procedures, and cases with uncertain vital status were excluded. We used the relative survival method to estimate age-standardized net survival probability for childhood cancer in Iran. The 5-year net survival for leukemia was 67.85% (95% confidence interval [CI] = 64.57, 70.90), while for central nervous system (CNS) cancers, it was 48.63% (95% CI = 43.21, 53.82). An analysis of regional disparities revealed a significant discrepancy of 14.56% in the 5-year survival of childhood leukemia, from 56.96 % in West Azerbaijan to 71.52% in Fars province. The geographical disparity in the 5-year survival of childhood CNS cancer became more pronounced, with a staggering 57.33% difference ranging from 73.50% in Khuzestan to 16.17% in Isfahan provinces. The study highlights low childhood cancer survival rates in Iran and calls for a robust surveillance system, public awareness campaigns, implementing national clinical practice guidelines, and financial support from government and NGOs to improve patient outcomes.

This study aimed to identify which aspects of incident reporting culture predict the willingness of nurses to report errors. In this cross-sectional study (2021), a census sampling method was used to recruit 251 nurses with at least one year of experience in general wards across three hospitals in Northern Iran. Data were collected via a self-report questionnaire and analyzed using both descriptive and inferential statistics. Two dimensions of incident reporting culture- "learning from errors" (ß=0.234, 95% CI: 0.088 to 0.380) and "error management" (ß=0.029, 95% CI: 0.013 to 0.235)-significantly predicted nurses' willingness to report errors. This study is among the first to identify specific dimensions of incident reporting culture that could enhance nurses' motivation to report errors.