Journal of Research in Medical Sciences最新文献

Background: High-normal blood pressure (BP), situated inside the elevated normal range and indicative of potential hypertension, is widely acknowledged as a critical worldwide health issue. High-normal BP levels consist of a systolic measurement of 130-139 mmHg and a diastolic measurement of 85-89 mmHg. Ischemia-modified albumin (IMA) is a sign that tissues are not getting enough oxygen, which is also known as tissue hypoxia. Numerous studies indicate that IMA possesses prognostic relevance in cardiovascular diseases. Our purpose was to investigate the serum IMA levels in patients with high-normal BP.

Materials and methods: The study prospectively enrolled 50 participants with high-normal BP and 50 individuals with normal BP consecutively. Both groups' IMA levels were assessed and compared. All patients' echocardiograms were collected.

Results: The IMA values were markedly elevated in the high-normal group (P < 0.001). The research identified a significant correlation between IMA and high-normal BP, with an odds ratio of 1.725 (95% confidence interval [CI] 1.212-2.506, P < 0.001). An IMA level of 348 ng/L demonstrated a 94% accuracy in predicting high-normal BP, with a 32% accuracy overall (area under the curve = 0.942; 95% CI, 0.894-0.991; P < 0.001).

Conclusion: Our analysis demonstrated a strong correlation between IMA and high-normal BP.

Background: Although there are a few options for the treatment of patients with secondary progressive multiple sclerosis (SPMS), rituximab (RTX) is used as an off-label treatment. This study aimed to investigate the efficacy of RTX on disability status and volumetric magnetic resonance imaging (MRI) findings in SPMS.

Materials and methods: This study was conducted on 31 patients with SPMS treated with RTX 1000 mg intravenously every 6 months. Expanded Disability Status Scale (EDSS), 25-Foot Walk Test (25-FWT), 9-Hole Peg Test (9-HPT), and brain MRI were performed at the baseline and after 12 months.

Results: No significant changes were observed in EDSS, timed 25-FWT, and 9-HPT within 12 months of RTX treatment (P > 0.05). There was a decrease in 9-HPT time in both the right and left hands, but it was not significant. During the 12-month assessment, white matter (WM) and gray matter volumes decreased by -41.48 ± 2.36 and -31.65 ± 8.84, respectively. However, these differences were not statistically significant (P > 0.05). The only significant change was an increase in the volume of deep WM lesions (WMLs) (0.26 ± 0.19 vs. 0.38 ± 0.29, P = 0.024). A significant association was found between the EDSS at the 12^th month and baseline deep WML volume (r = 0.383, P = 0.044).

Conclusion: Our results showed that the level of disability based on EDSS, timed 25-FWT, and 9-HPT did not increase significantly during 12 months of treatment with RTX. These findings suggest that RTX may play a role in disease stabilization and preventing disability progression, especially in the upper limbs. Further studies with larger sample sizes are necessary to confirm this finding.

Coinfections with pulmonary tuberculosis (TB) occur in people with damaged lung structures, chronic malnutrition, and those with compromised immunity. Moreover, it is a common clinical challenge that leads to poor clinical outcomes and contributes to increased morbidity and mortality in patients with TB. Coinfection in the lungs can prolong hospital stay and increase the cost of treatment for TB patients, which imposes a heavy burden on families and society. Therefore, pulmonary TB (PTB) combined with pulmonary infections should be diagnosed and treated promptly. This review describes trends in epidemiology and other factors that influence the incidence of PTB coinfection. Current and emerging diagnoses well as infection treatments are discussed.

Background: Chronic kidney disease (CKD) patients are at high risk of cardiovascular death and malignant arrhythmia. We aimed to determine at which CKD stage, the change in the index of cardiac-electrophysiological balance (ICEB) value is more evident. Consequently, we included patients across all CKD stages in our research.

Materials and methods: A total of 429 patients were followed up at the nephrology and cardiology outpatient clinics between April and November 2023 enrolled in the study. Patients were categorized into five groups based on their glomerular filtration rate (GFR) - Group 1: GFR ≥90, Group 2: GFR = 60-89, Group 3: GFR = 30-59, Group 4: GFR = 15-29 and not on hemodialysis, and Group 5: GFR ≤15 and on hemodialysis. Electrocardiograms were recorded, and ICEB and corrected ICEB (ICEBc) values were calculated for all patients.

Results: The mean age was 52.52 ± 14.58 years, and the total number of female patients was 235 (54.8%). In post hoc analysis, the difference of ICEBc value differed between Groups 1 and 5 (95% confidence interval: 0.0217-0.5226; P = 0.024). There were no statistically significant differences between Group 1 and the other groups. Corrected QT values were significantly different between Group 5 and Groups 1, 2, and 3 (P < 0.001, P < 0.001, and P = 0.005, respectively). The QT intervals were different between Group 1 and Groups 3, 4, and 5 (P = 0.003, P = 0.003, and P = 0.008, respectively).

Conclusion: The study demonstrated that the ICEBc value gradually increased with the progression of CKD stages, with a statistically significant change observed in stage 5. However, there was no significant difference in ICEB values across stages.

Background: To evaluate retinal microvasculature and choroidal thickness in patients with Parkinson's disease (PD) with optical coherence tomography angiography (OCTA).

Materials and methods: Forty-one eyes from 41 patients diagnosed with PD and 41 eyes of 41 healthy subjects underwent retinal and choroidal assessment using swept source DRI Triton OCT (Topcon, Tokyo, Japan). Macular perfusion parameters, including superficial and deep foveal avascular zones (FAZs and FAZd, respectively), superficial capillary plexus (vascular density [VDs]), deep capillary plexus (VDd), and choriocapillaris (VDc), were compared with healthy controls.

Results: The central sectors of the VDs, VDd, and VDc measurements (P = 0.001; P = 0.001; P = 0.001, respectively) and the superior sectors of VDs and VDc (P = 0.001; P = 0.001, respectively) were found to be significantly higher in the study group compared to the control group. FAZs and FAZd values were found to be decreased significantly in PD patients (P = 0.001 and P = 0.001, respectively). Choroidal thickness was significantly reduced (P = 0.007). Central macular thickness measurement did not differ between the groups (P > 0.05). In the multivariate regression model, VDs superior, FAZs, and choroidal thickness variables were determined to have a significant and independent effect in differentiating patients with PD from the individuals in the control group.

Conclusion: PD seems to affect macular and choroidal microcirculation. The reduced choroidal thickness and increased central sectors of the VDs, VDd, and VDc measurements may provide disease activity information. However, more comprehensive studies on OCTA demonstrating clinical utility in PD are needed to support our findings.

Background: Brucellosis is one of the most common zoonotic diseases in the world. The present study was carried out to determine the epidemiological status of the brucellosis and identify the high-risk and low-risk clusters in different provinces of Iran.

Materials and methods: This was an ecological study conducted in the exploratory mixed design. The study population was the individuals with brucellosis in Iran whose data were related to the years 2009-2018. Data analysis has been done using Anselin Local Moran's I, Global Moran's I, Getis-Ord General G, Optimized Hot Spot Analysis, and Pearson correlation coefficient (PCC) in double range α and a significance level of 0.05.

Results: The average annual incidence rate of the disease during the studied years was 19.91 per one hundred thousand. The three provinces with the highest cumulative prevalence rate included Lorestan, Hamedan, Kurdistan and the three provinces with the lowest prevalence rate involved Hormozgan, Tehran and Bushehr. Coldspots of brucellosis prevalence are in south and southwest of Iran and hotspots were observed in the west and northwest. The PCC between the prevalence rate and latitude was negative and not significant (r = -0.253; P = 0.169). However, a negative and significant correlation was found between the prevalence rate and longitude (r = -0.358; P < 0.05), indicating that as longitude increases, the prevalence of brucellosis decreases significantly.

Conclusion: The prevalence of brucellosis in Iran is higher than developed countries and like many developing countries. High-risk areas of brucellosis were found in the western provinces and low-risk areas in the central and southern provinces of Iran. It appears essential to implement prevention and treatment measures in high-risk areas.

Multiple sclerosis (MS) is a chronic autoimmune disease affecting the central nervous system, characterized by the destruction of the myelin sheath of nerves. MS patients treated with rituximab, an immunosuppressive drug, experience reduced immunoglobulin levels, which increases their risk of various infections, including coronavirus disease 2019 (COVID-19). During the COVID-19 pandemic, many of these patients developed long-term symptoms following infection. These chronic symptoms have led to significant complications and, in some cases, increased mortality. In this case series study, we investigated long COVID-19 symptoms in MS patients treated with rituximab and the effects of intravenous immunoglobulin (IVIG) therapy in alleviating chronic symptoms. The results demonstrated that the patients' long-term symptoms responded to IVIG treatment, with significant improvements in respiratory symptoms, fever, immune parameters, and a reduction in C-reactive protein levels. This study highlights the importance of targeted management of long COVID-19 in immunocompromised populations and suggests that COVID-19 patients with immune deficiencies require specific therapeutic approaches.