Background: Primary CNS lymphoma (PCNSL) is a rare form of extranodal lymphoma, representing 3 to 4% of brain tumors. We aim to report the clinicopathological features and predictors of survival in patients with PCNSL. Materials and Methods: This retrospective study was conducted at Shifa International Hospital, Pakistan. Patients diagnosed with PCNSL from 2018 to 2023 were included. Hans algorithm was used to further categorize cases of high grade lymphoma. Data was analyzed using IBM® SPSS Statistics Software Version 26. Results: Fifty-two patients were diagnosed with PCNSL during the study period, out of whom twenty-seven patients had complete clinical and laboratory data available. From these 27 patients, 14 (52%) were male. Mean age was 48.78 ± 13.46 years. Twenty-four (88.9%) patients were immunocompetent and none had HIV infection. On radiology, a solitary lesion was seen in 19 (70.4%) patients with parietal lobe being the most common location in 8 patients. 26 patients were diagnosed with High grade Non Hodgkin B-Cell Lymphoma whereas one patient had Low grade Non Hodgkin B-Cell Lymphoma. Seven patients expired, with median survival of 5 months (range 1 – 31 months). Ki-67 proliferative index >80% was the only factor identified as significantly associated with decreased overall survival (p<0.05). Conclusion: PCNSL is a rare and aggressive disease. High Ki-67 proliferative index is a significant predictor of overall survival in these patients. Lack of association of HIV, frequent occurrence of Bcl6 positivity and a single case of Low-grade lymphoma were unique features identified in our study population.
Cytomegalovirus (CMV) infection is one of the most important causes of mortality and morbidity in hematopoietic stem cell transplant (HSCT) recipients. There are many guidelines for CMV prevention, diagnosis, and treatment. However, in resource-limited settings, the implementation of international guidelines is constrained by some differences in epidemiology, diagnostic methods, and drug availability. This study develops a national guideline for CMV management based on the healthcare context in Iran. The Guideline Development Group (GDG) is a multidisciplinary team that consists of experts in hematology, oncology, infectious diseases, virology, pharmacology, epidemiology, and methodology that develops the guideline. To have a systemic approach, a literature review was conducted based on relevant studies about CMV management in HSCT recipients from 2000 to 2025. The quality of evidence is assessed through the GRADE methodology and Delphi process. The guideline includes recommendations for risk stratification, surveillance, diagnostic methods, prophylactic strategies, and management of resistant/refractory infections. However, considering limited access to anti-viral agents such as Letermovir in Iran, alternative approaches are designed to have a feasible and effective protocol. Therefore, the guideline integrates international evidence with local healthcare real settings to provide an implementable protocol for CMV management. The context-adapted guideline results in optimized resource utilization and reduces variability in practice. Considerably, the establishment of a national registry system and periodic updates can strengthen CMV control in Iran healthcare system.
Background: Breast cancer and its treatments significantly impair patients’ health-related quality of life (HRQoL). Spiritually oriented interventions, such as Dhikr therapy — the rhythmic recitation of Islamic holy words and phrases — aim to promote physiological and psychological relaxation. Although such approaches have shown promise in improving quality of life, evidence on structured, group-based Dhikr programs in oncology populations remains limited. This study aimed to evaluate the effectiveness of a six-session group-based Dhikr therapy program on HRQoL in women with breast cancer. Materials and Methods: This two-arm, parallel-group randomized controlled trial included 60 women aged 25–55 years with confirmed breast cancer. Participants were randomly allocated (1:1) to either the intervention group (n=30), which received a structured 6-week group-based Dhikr therapy, or the control group (n=30), which received standard oncology care. The intervention consisted of weekly 90-minute sessions incorporating Quranic reflection, gratitude practice, guided visualization, and facilitated group sharing. The primary outcome was HRQoL, assessed using the EORTC QLQ-C30 and QLQ-BR23 questionnaires at baseline and within one week after intervention completion. The trial was registered with the institutional ethics committee (IR.SBMU.CRC.REC.1403.005). Statistical analysis was performed using SPSS v.31. Continuous data are presented as mean ± SD and categorical data as frequencies (%). Group differences were assessed with independent t-test, Mann–Whitney U, and chi-square tests as appropriate. Intervention effects on HRQoL were analyzed by two-way repeated-measures ANOVA. Significance was set at P ≤ 0.05. Results: Compared with the control group, women in the Dhikr therapy group showed statistically significant improvements in all domains of the QLQ-C30: Symptom subscale (mean change: −17.40 vs. +9.38; P < 0.001), Function subscale (+9.58 vs. −20.08; P < 0.001), Single Items subscale (a global symptom index; −14.26 vs. +9.08; P < 0.001), and total score (intervention: 53.89 ± 32.51 to 75.83 ± 19.25; control: 70.28 ± 22.07 to 52.22 ± 16.07; P < 0.001). Similarly, the intervention group demonstrated significant improvements in the QLQ-BR23: Symptom subscale (−10.97 vs. +5.14; P = 0.001) and Function subscale (+15.41 vs. −32.91; P = 0.001), while the control group showed deterioration in both subscales. Conclusion: A structured, group-based Dhikr therapy program improved both general and breast cancer-specific HRQoL among women with breast cancer. These findings support the integration of culturally appropriate spiritual interventions into standard supportive oncology care.
Hair loss is a commonly encountered condition that often causes significant distress with diverse etiologies, including androgenic, autoimmune, inflammatory, and aging-related mechanisms. Current therapeutic options, such as minoxidil and finasteride, often exhibit limited efficacy and are associated with adverse effects, necessitating the exploration of safer and more effective alternatives. This review aims to explore the therapeutic potential of mesenchymal stem cell (MSC)-derived secretome as a novel cell-free approach for hair restoration. A narrative review of recent preclinical, in vivo, and early clinical studies was conducted to evaluate the role of MSC-secretome components, including growth factors, cytokines, extracellular vesicles, and exosomes, in modulating key pathways involved in regeneration of hair follicle. In vitro and ex vivo models demonstrate that MSC- secretome enhances the proliferation, migration, and survival of dermal papilla cells and hair follicle stem cells by activation of Wnt/β-catenin, IGF-1, VEGF, and PI3K/AKT signaling pathways via paracrine signaling. In vivo animal models of alopecia indicate accelerated anagen initiation, follicle reactivation, improved dermal papilla function, and reduced inflammatory mediators following treatment with MSC-conditioned medium or exosomes. Early clinical evidence, including topical MSC-conditioned medium application in alopecia areata, suggests improved follicular density and hair shaft thickness without significant adverse effects. In conclusion, MSC-derived secretome represents a promising, cell-free strategy for hair regeneration. Future research should prioritize optimizing production protocols, standardizing active components, validating potency assays, addressing regulatory and manufacturing challenges, and conducting well-designed clinical trials to ensure consistent therapeutic outcomes.
Background: Mesenchymal stem cells (MSCs) have emerged as a promising strategy for tissue regeneration. Although hypoxia or lipopolysaccharide (LPS) has been shown to affect the regenerative capacity of MSCs, their combined effects on MSCs are still unknown. We examined the effects of hypoxia and LPS on MSC migration rates and paracrine expression. Materials and Methods: Umbilical cord-derived MSCs (UC-MSCs) were isolated and characterized. Wound scratch assays assessed migration and proliferation under hypoxic conditions, LPS supplementation, or both. The expression of paracrine factors was analyzed by quantitative real-time polymerase chain reaction (qRT-PCR). Results: Twenty-four hours post-scratching, the gap closure in UC-MSCs after both hypoxia exposure and LPS treatment was significantly enhanced than those in the control group (p=0.008) or those subjected to individual treatments (p=0.028 vs. hypoxia and p=0.0021 vs. LPS). Serum-supplemented media further maximized these synergistic effects. Combined hypoxia and LPS did not affect vascular endothelial growth factor (VEGF) mRNA levels. In contrast, both hypoxia exposure and LPS treatment decreased the transcript levels of hepatocyte growth factor (HGF), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and transforming growth factor-β (TGF-β). Conclusion: These findings indicate that the combination of hypoxia and LPS treatment affects the proliferative capacity of UC-MSCs, thus enhancing the MSC migration rate. However, hypoxia and LPS together reduce the expression of paracrine factors in UC-MSCs, potentially attenuating the immunomodulatory efficacy of UC-MSCs in tissue injury microenvironments.
