Caspian Journal of Internal Medicine最新文献

Background: Varicose veins are a chronic vascular disorder influenced by factors such as inflammation, fibrosis, endothelial dysfunction, and vascular cell activation. This study evaluates the association between ten molecular biomarkers and these risk factors in patients with lower extremity varicosity to enhance understanding of the condition's pathophysiology and highlight potential diagnostic biomarkers.

Methods: A cross-sectional study was conducted involving 126 patients diagnosed with lower extremity varicosity, confirmed by duplex ultrasound, and 108 age- and sex-matched control subjects. Serum levels of ten biomarkers C-reactive protein, interleukin-6, tumor necrosis factor-alpha, and tissue inhibitor of metalloproteinases-1, transforming growth factor-beta 1, procollagen type I N-terminal propeptide, vascular endothelial growth factor, malondialdehyde, endothelin-1, and matrix metalloproteinase-9 were quantified using ELISA. ROC curve analyses assessed the predictive value of these biomarkers.

Results: Patients with varicosity displayed significantly elevated levels of all biomarkers compared to controls, with strong associations to varicosity risk (p < 0.0001). ROC curve analysis revealed high predictive values, with AUCs ranging from 0.858 to 0.939.

Conclusion: The elevated biomarker levels suggest mechanisms including inflammation, fibrosis, endothelial dysfunction, and venous pressure in varicosity. Biomarker monitoring may support early diagnosis and management of varicose veins, enhancing patient outcomes. Future longitudinal studies are advised to further validate these associations.

Background: CML, a blood cancer characterized by excessive myeloid cell proliferation, stems from the BCR-ABL1 gene fusion. This research aimed to uncover why leukemic stem cells resist treatment and explore innovative immune-based therapies to improve patient outcomes.

Methods: This study investigated the immunologic phenotypes (CD8, CD27, CD197, and CD45RA) of T cell subsets (TN, TCM, TEM, and TEF) in the peripheral blood of chronic myeloid leukemia patients in the chronic phase who achieved a complete molecular response to tyrosine kinase inhibitors. The treatment-free remission (TFR) patients were compared to age- and gender-matched healthy volunteers using multicolor flow cytometry for analysis.

Results: Flow cytometry analysis unveiled notable shifts in CD8+ T cell subsets. CML-CP patients showed a marked decrease in central memory T cells (TCM), dropping to 7.2% of the CD8+ population. Conversely, these patients exhibited substantial increases in effector memory T (TEM) and effector T (TEF) cells, rising to 37.6% and 24.4% respectively. The most statistically significant change occurred in the CD8+ TEF subset. CML-CP patients displayed a 24.4% presence of these cells, compared to only 15.7% in control groups. These findings suggest a distinct immunological profile in CML-CP, potentially impacting disease progression and treatment strategies.

Conclusion: Tyrosine kinase inhibitors restore the distribution of memory T cells in patients with chronic myeloid leukemia (CML), but T cell exhaustion remains an issue. This situation highlights the need for alternative activation strategies to enhance immunity.

Background: Kidney stones are a condition that is prevalent in the geriatric group and significantly impairs their quality of life. The formation of stones may be associated with insulin resistance, which can be measured using the triglyceride-glucose (TyG) index.

Methods: This cross-sectional study was part of the second phase of the Amirkola Health and Ageing Project (AHAP) Cohort, which was initiated in 2011 with a focus on individuals aged 60 years and older. The study population included a case group comprising 349 individuals diagnosed with kidney stones and a control group of 349 individuals without kidney stones, matched by age and sex. The data have been analyzed afterwards.

Results: The mean TyG index was 4.77±0.33 in individuals with kidney stones and 4.75±0.34 in the group without kidney stones. The observed difference did not achieve statistical significance. Moreover, after logistic regression analyses, both crude and adjusted logistic regression analyses indicated no statistically significant relationship between the TyG index and the presence of kidney stones in the studied population.

Conclusion: The findings of this study indicate that there is no significant link between the TyG index and the occurrence of kidney stones among older adults.

Background: Thyroid nodules are a significant clinical concern due to their potential for malignancy. Research suggests prolactin, a known mitogen, may contribute to cancer development, and elevated thyroid peroxidase antibody (TPO-Ab) levels are linked to increased thyroid nodularity in hyperprolactinemia. This study investigates the relationship between serum prolactin levels, thyroid nodularity, and TPO-Ab presence.

Methods: Ninety patients were divided into three groups of 30: a control group without nodules, and two case groups with nodules (one TPO-Ab positive, one TPO-Ab negative). Serum prolactin, TPO-Ab, thyroid stimulating hormone, T4, and thyroid ultrasound data were analyzed. Statistical significance was set at p < 0.05.

Results: The mean age of the participants was 46.07±12.40 years, with 16 (17.8%) males and 74 (82.2%) females. Serum TSH, prolactin, and TPO-Ab levels were significantly higher in the case group than in the control group (P=0.041, 0.050, and 0.000, respectively). The case group had more instances of hyperprolactinemia than the control group (35% vs. 13.3%) (OR = 3.5, CI 95% = 1.08-11.38, P=0.031). Furthermore, the TPO-Ab positive group demonstrated greater solidity than the TPO-Ab negative group (93.3% vs 73.3%, P=0.038).

Conclusion: Our study revealed a positive correlation between thyroid nodules and increased serum TSH, prolactin, and TPO-Ab levels. Furthermore, we discovered that TPO-Ab positive nodules exhibit greater solidity and elevated TSH levels.

Background: Differentiated thyroid carcinoma (DTC) comprises nearly 90% of all thyroid malignancies. The main focus of our study was to examine how measuring Tg at multiple time points could predict the persistence and/or recurrence of both local and distant diseases.

Methods: In this retrospective, single-center, observational study, we examined records of all patients who underwent total thyroidectomy for DTC and received radioactive iodine (RAI) ablation/therapy at the Nuclear Medicine of Shahid Beheshti Hospital. Blood samples were collected at two time, approximately 30 days before RAI (Tg-30 and TSH-30) and the same day of RAI, after TSH-stimulation (Tg-0 and TSH-0). During the follow-up period, patients were categorized into the four groups according to the ATA guideline. Group with an excellent response (ER), nodal disease (ND), distant disease (DD) and partial response (PR).

Results: A significant difference between Tg-0 and Tg-30 was observed only in the ER group and the other 3 groups (p<0.001), and no significant difference was observed between the remaining 3 groups (p>0.05). Cut-off point of 1.35 ng/mL for the Tg-30 and 4.7 ng/mL for the Tg-0 was used with best sensitivity and specificity for differentiation of ER vs. ND. A cut-off point of 14.25 ng/mL for the Tg-30 and 40 ng/mL for the Tg-0 was able to correctly identify ER vs. DD.

Conclusion: By using the cut-off values obtained in this study, it is possible to more accurately predict local or distant recurrences. Maybe these patients need a shorter follow-up period that leads to more appropriate treatment decisions.

Background: Takayasu arteritis (TAK) is a rare large-vessel vasculitis that affects the carotid arteries. Increased intima-media thickness (IMT) and atherosclerotic changes are detectable by ultrasonography (US). This study aimed to evaluate detailed carotid sonographic features in TAK and compare them with diabetes mellitus (DM), as well as to assess correlations between sonographic parameters and inflammatory markers.

Methods: In this case-control study, 15 patients with TAK fulfilling the 1990 American College of Rheumatology criteria (2012-2022) and 15 patients with DM were evaluated at Loghman Hakim Hospital. Cardiovascular risk factors, carotid ultrasonography, and serum inflammatory markers were assessed. Data were analyzed using univariate and multiple regression tests (SPSS V24).

Results: Atherosclerotic plaques were found in 46.7% of TAK and 53.3% of DM patients. IMT of common (CCA) and internal carotid arteries (ICA) was significantly higher in TAK (p<0.05). The macaroni sign (P=0.001), turbulent flow (P=0.006), and higher CCA resistivity index (RI) (P=0.047) were characteristic of TAK. ESR and CRP correlated with pre-bifurcation CCA mean IMT (p<0.05). Each unit increase in CRP was associated with a 0.02 mm increase in right CCA IMT (P=0.05).

Conclusion: Carotid ultrasonography is a valuable tool in evaluating TAK. Distinguishing features include the presence of the macaroni sign, turbulent flow, and higher IMT and RI. Increased IMT was associated with elevated CRP.

Background: Cardiovascular diseases (CVDs) are a significant cause of morbidity and mortality worldwide, particularly among the Iranian population. Assessing left ventricular (LV) dimensions and interventricular septum (IVS) thickness is crucial in diagnosing and managing various cardiac conditions. This study aimed to compare LV dimensions and IVS thickness using electrocardiogram (ECG) gated computed tomography angiography (CTA) and echocardiography.

Methods: A cross-sectional study was conducted on 160 Iranian individuals without known CVD from March to September 2023 in Hospital, Tabriz, Iran. Participants underwent both ECG-gated CTA and echocardiography for assessment of LV dimensions and IVS thickness. Measurements were performed by experienced radiologists and cardiologists, respectively. Echocardiography and CTA were analyzed for their correlation using Pearson's correlation coefficient. Statistical analysis was conducted using SPSS V25 software.

Results: The study revealed a significant correlation between various LV dimensions and wall thickness measurements obtained from echocardiography and CTA (p<0.000). Strong and significant correlations were found in measurements taken from different views and regions of the heart, including the parasternal long-axis (PLAX) view, Mid and Base views, and the anteroseptal and inferoseptal regions (p<0.000). Echocardiography measurements also showed significant correlations, with varying strengths.

Conclusion: The comparative analysis of LV dimensions and IVS thickness using ECG-gated CTA and echocardiography demonstrated significant correlations, suggesting the potential clinical utility of both imaging techniques in diagnosing and managing CVD in the Iranian population. The 4-chamber and PSAX methods can be used interchangeably to measure interventricular septum thickness. Further research is required to validate and expand upon these results.

Background: Type 1 diabetes mellitus (T1DM) and celiac disease (CD) are autoimmune disorders with a common genetic basis. Celiac disease often presents asymptomatically, leading to delayed diagnosis and potential complications like anemia and growth delays. This research investigates the prevalence of celiac disease in T1DM patients at the Yazd Diabetes Center in 2022.

Methods: This cross-sectional study, uniquely designed and executed, involved 318 T1DM patients sampled via census. Levels of IgA anti-tissue transglutaminase (TTG) antibodies and serum IgA were measured, with individuals having TTG-IgA levels over 10 U/mL undergoing endoscopy and duodenal biopsy. The data were meticulously analyzed using SPSS V.22, with significance at a p-value < 0.05.

Results: Among the 318 patients, 25 (7.86%), comprising 15 (60%) females and 10(40%) males, underwent endoscopy and biopsy due to elevated TTG-IgA levels. Histopathological analysis revealed four (16%) patients with normal findings: 2 (8%) with Marsh type 1, 1 (4%) with Marsh type 2, and 18 (72%) with Marsh type 3. Patients with TTG levels exceeding 100 were all classified as Marsh type 3. Gender-wise, there was no significant difference in celiac disease type distribution. (P- value= 0.58).

Conclusion: This study's findings, which reveal a celiac disease prevalence in T1DM patients similar to global rates, have significant implications for clinical practice. The importance of routine celiac disease screening for these patients is underscored, as is the urgent need for extensive multi-center studies to deepen our understanding of this relationship and improve patient care.

Background: Human Papillomavirus (HPV) is known to be associated with various types of skin neoplasms. Organ transplant recipients (OTR) are generally at a higher risk for developing skin neoplasms, including those related to HPV, due to their immunosuppressed state. In the current meta-analysis, we aimed to evaluate the frequency of HPV-related skin cancers and related factors among OTRs.

Methods: This meta-analysis study was conducted under the guidelines of the preferred reporting items for systematic review and meta-analysis (PRISMA). The generalized I ² statistics was perfumed for assessing heterogeneity. Odds ratio (OR) and effective size were calculated in comprehensive meta-analysis (CMA) software Version 3. In addition, meta-regression analysis was conducted to examine the temporal trends in the incidence of HPV-related skin cancer among OTRs over the study years.

Results: Out of 417 potentially eligible studies, seven were included for final analysis. The most frequently reported skin cancers in OTRs were squamous cell carcinoma (SCC) and basal cell carcinoma (BCC). The result of meta-analysis also revealed a high prevalence of 61.7% (95% CI: 35.4% - 82.5%) of HPV-related skin cancer among OTRs. The male-to-female ratio was 2.14 (95% CI 0.58-7.87), and the mean time from transplantation to the first diagnosis of skin cancer was about eight years. The frequency of HPV among tumor lesions ranged from 37.7% to 74.1%.

Conclusions: These findings collectively provide insights into the prevalence of HPV among OTRs with skin neoplasms, emphasizing the need for careful consideration of heterogeneity when interpreting the overall estimate.

Background: Musculoskeletal pain is a common and bothersome condition influencing a large segment of the population. It can significantly impact individuals' quality of life and limit daily activities. Traditionally, chamomile (Matricaria chamomilla) has been used for its pain-relieving properties. This systematic review and meta-analysis aimed to investigate the efficacy of chamomile in reducing musculoskeletal pain.

Methods: We searched English language databases including Cochrane, Scopus, PubMed, Web of Science, and Google Scholar for published studies up to July 2024. Studies examining chamomile's influence on musculoskeletal discomfort in humans were included. In-vitro, animal, and observational studies were excluded.

Results: A total of eight studies were analyzed. The findings suggest a potential analgesic effect of chamomile compared to placebo. Additionally, no significant difference was found between chamomile and other pain medication. The studies included in this review, however, exhibited significant heterogeneity.

Conclusions: Chamomile may be a promising alternative for pain management due to its potential analgesic effect and lack of significant difference compared to other pain medication; however, more research is needed.