Caspian Journal of Internal Medicine最新文献

Background: Sarcopenia is a serious public health problem because of its impact on human health and health care system. The prevalence of sarcopenia in elderly undergoing maintenance hemodialysis is increasing, with various components underlying the geriatric assessment.

Methods: This research used a cross-sectional study approach involving 40 samples taken by total sampling according to inclusion and exclusion criteria. The study population was the entire population aged ≥60 years, male dan female, who routinely undergo hemodialysis at the HD installation at Dr. Soetomo Hospital Surabaya. Data analysis was performed using SPSS Version 25.0.

Results: The research subjects were dominated by 62.5% male elderly with a median age of 64 years (60-93 years). The median duration of hemodialysis was 4 years (0.5-21). The proportion of sarcopenia was 82.5%. From the results of bivariate analysis, it was found that nutritional status as measured by MNA was the only component of CGA associated with sarcopenia p=0,002 (OR 25; IK 95% 3,302-189,259).

Conclusion: Nutritional status is an independent predictor of the incidence of sarcopenia to severe sarcopenia in geriatric patients with chronic kidney disease undergoing maintenance hemodialysis.

Background: Glycated hemoglobin A1c (HbA1c) level is related to increased cardiovascular diseases (CVDs) and death, even in non-diabetic subjects. Although in ST-elevation myocardial infarction (STEMI) cases, the association between HbA1c and coronary artery disease (CAD) remains unclear.

Methods: This cross-sectional study was conducted on 167 non-diabetic STEMI patients undergoing primary percutaneous coronary intervention (PCI). The SYNTAX score was utilized to evaluate CAD severity. Cases were categorized into three groups based on the HbA1c levels: <5%, 5.1-5.9%, and 6-6.5%.

Results: SYNTAX scores significantly increased in the cases with 6 to 6.5 HbA1c levels compared to the other group (28.9±9.5 vs 21.2±5.2 vs 13.7±4.5, P=0.000). Additionally, death was more elevated in this group (4% vs 0% vs 0%, P=0.006).

Conclusion: Higher HbA1c levels are strongly associated with coronary atherosclerosis in non-diabetic patients that present with non-diabetic STEMI. Consequently, in non-diabetic STEMI patients, HbA1c may be able to predict the severity of CAD.

Background: Hypothyroidism and leptin deficiency are two common endocrinopathies in β-thalassemia major patients (β-TM). Changes in leptin levels may lead to changes in thyroid hormone levels in thalassemia patients through suppression of the hypothalamus-pituitary-thyroid axis. Hence, we aimed to evaluate their correlation in β-TM patients.

Methods: A cross-sectional study was conducted on transfusion dependent β-thalassemia patients receiving chelation treatment between 2018 and 2019. Tri-iodothyronine (T3), thyroxine (T4), thyroid stimulating hormone (TSH), and leptin were measured for each participant. Data analyzed by SPSS, p< 0.05 was considered as significant.

Results: One hundred and twenty-six β-TM patients aged between 10 and 30 years old participated in the study, including 55 (43.7%) females and 71(56.3%) males. TSH abnormality was prevalent among 13 (23.6%) females and 10(14.1%) males. Leptin level was significantly lower in males (6.65±7.27 VS 2.41±2.79, p<0.01). TSH was correlated with leptin in all (r=0.393, p<0.01), females (r=0.387, p<0.01), males (r=0.387, p<0.01), adolescents (r=0.512, p<0.01), young adults (r=0.287, P=0.01), underweights (r=0.483, p<0.01) and normal weight (r=0.301, P=0.03) thalassemia patients. T4 was correlated with leptin in all (r=0.201, p=0.02), females (r=0.281, P=0.03), males (r=0.281, P=0.03), and adolescents (r=0.280, P=0.03) β-TM patients. T3 did not correlate with leptin in all groups of the patients.

Conclusion: In summary, leptin levels were significantly lower in males, and TSH abnormality was common in both genders. Therefore, screening for endocrine issues may benefit these people. Furthermore, leptin exhibited a correlation with TSH and T4. This may support the role of leptin on thyroid function in β-TM patients.

Background: Multiple myeloma is still one of deadliest malignancies known. Although many attempts to prognosticate the disease have been done like the International Staging System (ISS), most of the proposed prognostic tools are based merely on laboratory tests and hence prone to analytical errors in large and high-volume centers. This study aims to evaluate the prognostic effectiveness of histopathologic components of bone marrow and compare it to the results of laboratory-based prognostic tools.

Methods: This cross-sectional study, bone marrow specimens of 93 multiple myeloma patients underwent aspiration and biopsy evaluated. The primary outcome was overall survival (OS) based on plasma cell percentage. The secondary outcomes were also OS based on angiogenesis using IHC marker CD34, nuclear atypia level, BM involvement pattern and the presence of fibrosis in bone marrow specimens. All biopsy specimens assessed using light microscopy on Hematoxylin and Eosin and IHC staining. Giemsa staining assessed for aspirate specimens.

Results: Of 93 patients, 63.4% were dead. Median survival was 34.0 months (95% CI [24.6; 43.3]) and the average age at diagnosis was 65 years (highest 84 and lowest 40). Patients with bone marrow plasma cell count of over 70%, had a hazard ratio (HR) of death of 4.7 times more than those with plasma cell count between 10-25%. Similarly, diffuse infiltration pattern (HR 4.67) and blastic morphology (HR 4.17) associated with a significant worse prognosis (p=0.03).

Conclusion: Comparing to laboratory-based ISS, wider HR of death spectrum in this study proposes a potential more precise, robust and easy-to-use prognostication tool.

Background: Pulmonary alveolar microlithiasis (PAM), a rare autosomal recessive pulmonary disease, is mainly characterized by extensive calcium phosphate microliths deposition in the alveoli. The major mutation, causing the characteristic of this disease, occurs in solute carrier family 34 members 2 (SLC34A2), which is placed on chromosome 4p15.2. SLC34A2 encodes sodium-phosphate cotransporter type IIb, NPT2b, which plays a critical role in the transportation of phosphate ions from pulmonary alveoli into type II pneumocytes.

Case presentation: Herein, we have reported a 50-year-old male presented with recent sore throat, fever, and sweating. Radiological findings revealed bilateral micronodular pattern with diffuse ground glass attenuation in lower regions. Subsequent histologic examination of lung biopsy confirmed intra-alveolar accumulation of calculi and the diagnosis of PAM. In addition, we reviewed the literature narratively to clarify different aspects of PAM.

Conclusion: In this paper, we presented a sporadic case of PAM which was suspected with chest x-ray and confirmed by HRCT and trans-bronchial lung biopsy. We hope that it can help clinicians to be more aware of this condition and make proper diagnosis.

Background: Studies have shown that carotid intima-media thickness (CIMT) is an indicator of cardiovascular events and mortality and its increase has correlation with severe airflow obstruction in patients with COPD. The aim of this study was to investigate the association between pulmonary function and CIMT in COPD patients.

Methods: This study was performed on two groups of patients with and without COPD (cases & controls) who were referred to pulmonary clinics. Demographic, clinical, and laboratory tests were recorded in questionnaire. Spirometry was performed in cases and FVC, FEV1, and FEV1/FVC were measured. CIMT was determined via ultrasound.

Results: Our results indicated that right carotid IMT was 0.51±0.112 mm and 0.65±0.131 mm in the control and case groups, respectively (p< 0.001). Left CIMT was 0.48±0.089 mm and 0.68±0.113 mm in the control and case groups, respectively (p< 0.001). FEV1 and FEV1/FVC had an inverse and significant correlation with IMT of the carotid (both right and left carotid).

Conclusion: The results indicated an inverse association between carotid IMT and lung function test in COPD patients.

Background: Granulomatosis with polyangiitis (GPA) is a rare disease affecting medium-small vessels, causing granuloma formation and inflammation. This study aimed to assess the efficacy and safety of RTX versus Azathioprine (AZA) for maintenance treatment in GPA patients.

Methods: This retrospective cohort study involved a review of medical records of recently diagnosed GPA patients undergoing maintenance treatment with RTX or AZA. The main variable was the frequency of relapses within an 18-month follow-up period. Additionally, the study compared changes in BVAS.WG score (The Birmingham Vasculitis Activity Score-Wegner specific) and Damage (vasculitis damage index (VDI)), mortality, and treatment complications between the two groups.

Results: Among the 43 patients receiving RTX maintenance treatment, 8 (18.6%) experienced relapses during 24 months follow-up, while 14 (66.6%) out of the 21 patients receiving AZA relapsed (Hazard Ratio = 6.9 and 95% confidence interval = 1.95-19.3, p <001). Notably, the increase in the BVAS-WG score was significantly lower in the RTX group compared to the AZA group (p <001). The cumulative steroid dose was 143±21 mg in the RTX group and 125±25 mg in the AZA group (P = 0.1). Treatment side effects were similar in both groups (p >0.05).

Conclusion: Maintenance treatment with RTX is associated with better treatment response and lower relapse rate compared to AZA. There was no difference in treatment complications between AZA or RTX in maintenance treatment.

Background: Irisin, a myokine implicated in metabolic hemostasis, have been investigated in relation to type 2 diabetes mellitus (T2DM), yet findings on its serum levels and association with diabetic complications such as nephropathy remain inconsistent. This study aimed to assess the relationship between serum irisin levels and renal function in T2DM patients.

Methods: A cross-sectional study was conducted involving 140 individuals diagnosed with T2DM. Demographic, anthropometric, and clinical data were recorded. Fasting blood samples were collected to determine serum irisin levels using the ELISA method. Additional biochemical measurements included fasting blood glucose, creatinine, HDL, LDL, triglycerides, HbA1c, and urinary albumin. Correlations between irisin levels and these parameters were analyzed. Patients were divided into two groups based on glomerular filtration rate (GFR) and albumin-to-creatinine ratio (ACR) to assess associations between irisin levels and renal function.

Results: No statistically significant difference in serum irisin levels was observed between patients with reduced renal function (GFR≤60) and those with GFR>60 (10.45±6.54 vs. 13.32±10.59 ng/ml, P=0.08). In stratified analysis by ACR, patients with nephropathy displayed a non-significantly lower irisin level than those without (11.70±8.18 vs. 13.38±11.51, P=0.33). Serum irisin showed no significant correlations with FBS (P=0.05), insulin (P=0.06), LDL (P=0.96), HDL (P=0.61), or BMI (P=0.42).

Conclusion: Lower irisin levels in T2DM patients with reduced renal function or nephropathy may indicate a potential role for irisin in diabetic renal disease progression. Serum irisin could serve as a prognostic biomarker for diabetic nephropathy pending further validation.

Background: Pyoderma gangrenosum (PG) can be related to a range of systemic and hematologic diseases. The relationship between systemic lupus erythematosus (SLE) and PG has rarely been discussed.

Case presentation: In this case study, we report on an SLE patient who presented with PG. The patient is a 53-year-old woman with the chief complaint of developing painful erythematous pustules on her right flank 3 days after hysterectomy surgery. In the span of 3 months, the patient was treated with antibiotics and intra-lesional corticosteroids with no improvement. Meanwhile, she developed symptoms such as polyarthralgia, pleural effusion, hemolytic anemia, and thrombocytopenia, while anti-dsDNA came out positive.

Result: Based on pathology results in combination with clinical and para-clinical findings according to the SLICC criteria for SLE 2012, our patient was diagnosed as an active case of SLE presenting with PG. We also searched for and gathered the latest articles on this issue (from 2017 until 2022) to present the most updated review study on the topic in this article.

Conclusion: Considering the abundance of PG and SLE concomitance reported cases (more than 30), it might be time to pay more attention to SLE as the underlying cause of PG and keep in mind that any unhealing ulcer in patients with connective tissue disorders should be evaluated for PG. Considering the various treatment options for PG, it is essential that the treatment of choice should cover symptoms of both PG and the underlying disease.