Journal of Research in Medical Sciences最新文献

Background: Coronary artery disease (CAD) is a significant complication of type 2 diabetes mellitus (T2DM). The relationship between long-term glycemic variability (GV) and CAD severity remains uncertain. This study aimed to investigate the association between long-term GV and the extent of CAD in individuals with T2DM.

Materials and methods: This retrospective cohort study included patients with T2DM who underwent coronary angiography. Mean-HbA1c was calculated for each patient. GV was assessed by measuring the standard deviation (SD) and coefficient of variation (CV) of HbA1c measurements. The severity of coronary artery lesions was evaluated using the SYNTAX scoring system. Linear regression analyses were performed to assess the differences in SYNTAX scores among different mean-HbA1c groups, as well as SD-HbA1c and CV-HbA1c quartiles.

Results: A total of 115 diabetic patients were included in the study. The mean-HbA1c cutoff value of 7.5 was derived from the receiver-operating characteristic curve. Fifty-six patients had a mean-HbA1c of 7.5 or lower, whereas 59 patients had a mean-HbA1c above 7.5. Univariate analysis revealed that patients with mean-HbA1c above 7.5 had significantly higher SYNTAX scores compared to those with lower mean-HbA1c levels (12.79 vs. 7.33, P < 0.05). There was no significant correlation observed between SD-HbA1c, CV-HbA1c, and SYNTAX scores in both univariate and multivariate analyses.

Conclusion: This study suggests that higher mean-HbA1c levels are associated with increased severity of CAD in individuals with T2DM. However, long-term HbA1c variability, as measured by SD-HbA1c and CV-HbA1c, does not appear to have a significant impact on the severity of CAD.

Background: Gastric cancer (GC) is one of the top causes of cancer death worldwide, with 98% caused by Helicobacter pylori. The diverse disease presentation, asymptomatic H. pylori infection, and ineffective therapies lead to late diagnosis and high mortality. Chronic inflammation caused by H. pylori causes genetic and epigenetic modifications. Hence, this systematic review will address H. pylori-related DNA methylation, histone modifications, and RNA alteration in GC.

Materials and methods: A comprehensive search of PubMed and Scopus was performed for publications from 2017 to August 2022. Studies involving GC regardless of type and location, H. pylori infection regardless of virulence factors, and epigenetic changes (DNA methylation, histone modification, and RNA alteration) were included. Studies of epigenetic changes in GC unrelated to H. pylori were excluded. All types of studies were taken into the analysis.

Results: A final analysis includes 26 manuscripts, comprising 10 reviews and 16 original articles. Methylation levels in various gene promoters having a role in host defense, cell integrity and cell cycle, DNA repair, and apoptosis were altered in H. pylori infection preceding GC. In addition, H. pylori regulate specific genes through histone modifications. Different MicroRNA expressions were found in H. pylori GC patients, some acting as a tumor suppressor and influencing drug resistance. H. pylori eradication, to a certain extent of disease, can revert these epigenetic changes.

Conclusion: Understanding the exact mechanism leading to carcinogenesis is required for GC early diagnosis and precise therapy to alleviate the disease burden.

Electrocardiographic alterations of ventricular repolarization have already been reported in cases of myocarditis following coronavirus disease-19 (COVID-19) vaccine, but it is not clear how long they persist. A 21-year-old female presented with chest discomfort and diffuse myalgia a week after receiving the first dose of a messenger RNA (mRNA) COVID-19 vaccine. The 12 leads standard electrocardiogram unveiled negative T waves in anterior and inferior leads, while her troponin-I values resulted in the upper limit. A mild form of post-COVID-19 vaccine myocarditis was diagnosed since the echocardiogram excluded major systolic alterations and pericardial effusions. The patient refused hospitalization, but luckily, she remained hemodynamically stable, presenting a quick clinical response to oral non-steroidal anti-inflammatory therapy. However, the electrocardiographic abnormalities required weeks for resolving. In our case, the later normalization of electrocardiographic anomalies was not associated with an ominous clinical course.

Background: Osteoporosis is the leading pathological cause of skeletal fragility. The aim of this study was to investigate the relationship between the consumption of refined grain and osteoporosis in postmenopausal women with and without osteoporosis.

Materials and methods: This case-control study involved 356 menopausal women aged 45-85 in Tehran, Iran. The age-matching methodology has been used to mitigate the confounding influence of age. The dual-energy X-ray absorptiometry was utilized to evaluate the bone mineral density. The bone mass status was assessed using the World Health Organization (World Health Organization) criteria. All the participants were divided into two groups based on their T-score: the osteoporosis group and the nonosteoporosis group. A convenience sampling method was applied to select the participants, comprising two groups: case (n = 178) and control (n = 178). Data were gathered utilizing demographic and anthropometric information questionnaires, a validated 147-item food frequency questionnaire, and a physical activity questionnaire. SPSS-27 was used for statistical analyses and P < 0.05 was considered statistically significant.

Results: The findings revealed substantial disparities in body mass index (P < 0.001) and physical activity (P < 0.001). The mean ± standard error of the mean consumption of refined grains was greater in participants with osteoporosis (case) (316.76 ± 12.49) compared to the control group (271.50 ± 13.29) (P < 0.001). Upon adjusting for confounding variables, the consumption of refined grains was positively associated with a risk of osteoporosis (odds ratio = 3.26; 95% confidence interval: 1.16-9.17, P = 0.025; Nagelkerke R² = 0.610).

Conclusions: We found an association between refined grain consumption and osteoporosis. Additional research is necessary to comprehend this relationship.

Background: Renal impairment (RI), the most common comorbidity in acute decompensated heart failure (ADHF) patients, leads to cardiorenal syndrome. Fractional excretion of sodium (FENa), an indicator of sodium handling by the kidney, is widely used to assess natriuresis, the underlying treatment of ADHF. The aim of this study was to investigate the association of FENa with RI and 1-year cardiovascular mortality.

Materials and methods: This prospective study was implemented in the Persian Registry of Cardiovascular Disease/Heart Failure study context. Any individuals over 18 years suffering from ADHF admitted to the emergency department were eligible to be recruited in our study. We excluded the patients with previously untreated chronic comorbidities, who died during hospitalization, and without follow-up and other etiologies rather than cardiovascular diseases since discharge. Baseline demographic and clinical data gathered. RI was defined as a 0.3 mg/dL rise of creatinine during admission. The primary and secondary clinical outcomes were RI and cardiovascular mortality, respectively.

Results: During the study period, 158 patients were recruited, with 103 (65.1%) developing RI and 25.68% of the population expired. Higher blood pressure, overall furosemide dose, as well as lower FENa, and serum creatinine on admission were prevalent among patients who developed RI. Greater serum sodium levels on admission and discharge, a lack of a history of ischemic heart disease, and hyponatremic status during admission were associated with a higher mortality rate. The Pearson correlations demonstrate the significant association of FENa with creatinine alterations (P = 0.001, r = -0.47). The linear regression analysis demonstrates the significant association of FENa with creatinine alteration during admission (B = -1.43, 95% confidence interval [CI] [- 1.86, -1.002], P = 0.001). Multiple logistic regression demonstrates no significant association of prediction of FENa with creatinine alterations (odds ratio [OR] =0.33, 95% CI [0.09-1.19], P = 0.091). The logistic regression analysis revealed no association between FENa and 1-year mortality (OR = 0.85, 95% CI (0.26-2.75), P = 0.79).

Conclusion: A lower FENa on admission indirectly predicts the development of RI in patients with ADHF. Meanwhile, FENa is unable to predict 1-year cardiovascular mortality.

Background: Healthcare-associated infections (HAIs) remain a critical challenge, particularly in trauma patients admitted to intensive care units (ICUs), who are at increased risk due to invasive procedures and prolonged hospitalization. This study aimed to investigate the prevalence, types, causative pathogens, and antibiotic resistance patterns of nosocomial infections in trauma patients.

Materials and methods: In this retrospective cross-sectional study conducted from March 2019 to March 2020, 45 trauma patients who developed nosocomial infections 48 h after ICU admission were analyzed. Data were collected from the hospital records and the Iranian Nosocomial Infection Surveillance System.

Results: Of 557 trauma patients admitted to the ICU, 45 (7.9%) developed 65 episodes of HAIs during the study, of which 12.3% (8/65) were polymicrobial. Ventilator-associated events (VAE) were the most common infection type (58.2%), followed by bloodstream (20.9%), surgical site (14.9%), and urinary tract infections (6%). Acinetobacter spp. was the most frequently isolated pathogen (49.4%), followed by Klebsiella spp. (27.7%). High levels of antibiotic resistance have been observed, particularly in Gram-negative bacteria. No statistically significant associations were found between infection type, trauma severity, or underlying comorbidities.

Conclusion: VAE and multidrug-resistant Acinetobacter species are major concerns in trauma patients in the ICU. Strengthening infection prevention protocols, especially ventilator care practices, and implementing antimicrobial stewardship programs are essential for mitigating infection risk. Furthermore, enhanced surveillance systems, targeted antibiotic therapy guided by local antibiograms, and multicenter research collaborations are strongly recommended for addressing the emerging threat of antibiotic-resistant nosocomial infections.

The rise of systems biology has improved the understanding of complex disorders such as chronic kidney disease by providing predictive and comprehensive models. Despite the abundance of omics data, translation to clinical solutions remains a challenge. Artificial intelligence (AI), especially generative AI, promises to fill this gap through mining, integration, and processing of diverse and intricate raw data for the generation of actionable knowledge. Recently introduced AI tools have shown great potential in clinical nephrology for improved diagnosis and prognosis. This approach is also promising for the identification of novel therapeutic targets, repurposing of already approved drugs, and precision nephrology. The rapid advancement of this technology is definitely associated with critical ethical and legal concerns for which the scientific community needs to be prepared.

Organ transplantation represents a critical therapeutic intervention for patients with end-stage organ failure or hematological malignancies, often serving as a last-resort treatment. Among these, bone marrow transplantation (BMT) is vital but complex, as it induces profound and long-lasting immunosuppression. Patients undergoing BMT are highly vulnerable to opportunistic infections due to concurrent chemotherapy, radiation, and immunosuppressive therapies. Legionella infections emerge as a significant threat, accounting for considerable morbidity and mortality in hospitalized immunocompromised individuals. These infections often progress rapidly to severe pneumonia, with high mortality rates compared to those infecting immunocompetent people. Early and accurate diagnosis remains challenging due to nonspecific clinical presentations and limitations of conventional microbiological methods. Consequently, timely detection using advanced diagnostic tools and therapeutic intervention is necessary. This comprehensive review critically observes the epidemiology, risk factors, diagnostic methods, clinical manifestations, and treatments of Legionella in BMT recipients. It emphasizes the need for institutional prevention protocols to alleviate the exposure risks to reduce the burden of Legionella-related complications in high-risk BMT recipients.

Although bariatric surgery is recommended for obesity treatment, there is an increasing trend toward comorbidity-related indications. The effects of bariatric surgery on mortality are inconsistent. This meta-analysis aimed to assess metabolic surgery versus usual care on mortality among patients with obesity and type 2 diabetes. we searched six databases for articles comparing bariatric surgery with usual care in terms of mortality. The terms used were bariatric surgery, metabolic surgery, lifestyles, usual care, gastric banding, bypass surgery, biliopancreatic diversion, gastric bypass, sleeve gastrectomy, and Roux-en-Y gastric bypass. The search engine was set for articles from inception up to June 2024. Out of the 1960 studies retrieved, 1810 were retained after the removal of duplication; from them, 75 full texts were eligible, and only 26 studies were included in the final meta-analysis. The study included 866,159 patients (167,152 patients who underwent bariatric surgery and 699,007 usual care patients) and 91,211 deaths. Mortality was lower among patients with bariatric surgery compared to usual care (3.1% vs. 12.6%), odds ratio = 0.43, 95% confidence interval (CI), 0.32-0.58, Chi-square = 1638.20, and P < 0.001, I ² for heterogeneity = 99%, and the standard difference = 24. Mortality was higher in bariatric surgery in subgroup meta-analysis on patients with type 2 diabetes (2.6% versus 2.0%), odds ratio, 0.63, 95% CI, 0.42-0.95, Chi-square = 101.04, and P = 0.03 I ² for heterogeneity = 95%, and the standard difference = 5. Bariatric surgery was associated with lower mortality in patients with obesity compared to usual care, but higher mortality in subgroup meta-analysis in type 2 diabetes. Larger, well-controlled trials are needed.

Background: Cardiac involvement in sarcoidosis is associated with high mortality but is often underrecognized due to diagnostic challenges. Advanced imaging modalities like Cardiac Magnetic Resonance (CMR) and Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) are highly sensitive for detecting myocardial inflammation and scarring, aiding in the diagnosis and management of cardiac sarcoidosis. The objective of this study was to characterize the imaging features of cardiac sarcoidosis in Iranian patients using these advanced cardiac imaging modalities.

Materials and methods: This multicenter prospective study included 42 Iranian patients with biopsy-proven extracardiac sarcoidosis who met the Japanese Circulation Society criteria for cardiac involvement. All patients underwent CMR to evaluate myocardial function, edema, scarring, and strain. 28 patients also underwent FDG-PET/CT to assess active myocardial inflammation.

Results: In our study of 42 cardiac sarcoidosis patients (50% male, mean age 47.14±14.33 years), CMR revealed reduced left ventricular ejection fraction (34.2±13.7%) in 83.3% of patients, with late gadolinium enhancement (LGE) present in 88.1%. LGE was most frequent in the basal anteroseptal and mid inferoseptal/anteroseptal segments, with midwall (35.5%) and subepicardial (23.7%) patterns predominating. Global strain analysis showed impaired values: longitudinal -10.08±4.14%, radial 15.38±8.55%, and circumferential -10.79±4.63%. Mean T1 and T2 values were 1054.60±50.98 ms and 52.59±4.53 ms, respectively. FDG-PET demonstrated active disease in 67.9% of cases, predominantly involving the apical septum, basal inferolateral, and mid inferolateral segments. The left anterior descending artery territory showed the highest involvement in both active inflammation (44.3% of affected segments) and scarring (39.2% of affected segments).

Conclusion: CMR and FDG-PET provided comprehensive assessment of cardiac involvement in this Iranian cardiac sarcoidosis cohort, with predominant basal and lateral wall involvement. Regional differences highlight the importance of population-specific studies.