Caspian Journal of Internal Medicine最新文献

Background: Patient management and necessary supportive treatments, an accurate prognosis of the illness is essential for patients with acute pancreatitis. Thus far, no diagnostic technique has demonstrated superiority over the other in terms of clinical judgment. The aim of this study was to examine the predictive accuracy of the Bedside Index for Severity in Acute Pancreatitis (BISAP) score in contrast to Ranson's criteria.

Methods: Our research is a retrospective cross-sectional analysis. Inclusion criteria encompassed patients admitted to the emergency department with acute pancreatitis. Exclusion criteria comprised individuals with liver, heart, or renal failure upon admission or during hospitalization. Each patient's demographic data, including age, gender, education level, and consciousness level, were considered. Statistical analysis was conducted using SPSS 16 software with a significance level set at p <0.05.

Results: Out of 286 patients, 221 were diagnosed with moderate acute pancreatitis, while 65 were diagnosed with severe acute pancreatitis. Among these patients, 5 (7.1%) succumbed to complications related to pancreatitis, including 3 males and 2 females. Both the BISAP and Ranson criteria demonstrated significant capability in assessing the severity of both moderate and severe acute pancreatitis with a 95% confidence level. The analysis revealed a statistically significant area under the curve for both criteria (P= 0.002).

Conclusion: Although BISAP and Ranson have both good accuracy and efficacy to determine the severity of pancreatitis, BISAP scoring criteria have higher prognostic accuracy.

Background: Multiple sclerosis (MS) is an autoimmune disorder of the central nervous system (CNS). Prognostic markers are essential for predicting disease progression and managing its impact. Oligoclonal bands (OCBs) are significant laboratory findings in MS, yet their prognostic role remains uncertain. This study aimed to evaluate the role of OCBs in the short-term progression of MS.

Methods: We enrolled patients diagnosed with Relapsing-Remitting MS and conducted a follow-up for five years, during which we monitored their Expanded Disability Status Scale (EDSS) scores. Clinical manifestations were compared between patients with positive and negative OCBs. Statistical analysis was performed using SPSS 26.

Results: Among the 140 participants, 41 (29%) were OCB-negative and 99 (71%) were OCB-positive. No significant differences were found regarding sex, age, family history, associated disease, and EDSS scores between the two groups at the beginning of the study. Throughout the five-year duration of the study, there was no disparity in the EDSS scores of patients belonging to the two groups. Notably, the mean number of relapses was 1.37 in OCB-negatives compared to 1 in OCB-positives, which was statistically significant (P=0.03). In other words, after 5 years, despite the high rate of recurrence in patients with negative OCB compared to patients with positive OCB, there was no difference in terms of prognosis (EDSS progress) between the two groups.

Conclusion: While the presence of OCBs in patients with MS does not demonstrate a significant prognostic impact over a five-year follow-up period, it could potentially influence the rate of recurrence.

Background: Leptomeningeal carcinomatosis involves the diffuse infiltration of neoplastic cells in the central nervous system, affecting 5-8% of leukemia, breast, and lung cancer cases. Gastric cancer instances are rare, mostly in poorly differentiated adenocarcinomas. We report the first Peruvian case, featuring gastric adenocarcinoma.

Case presentation: A 51-year-old woman presented with severe headache, vomiting, dizziness, blurred vision, tinnitus, bradyphrenia, reduced verbal fluency, sixth cranial nerve paresis, and non-reactive anisocoric pupils. Pleocytosis was found, with positive cytology for metastatic adenocarcinoma in cerebrospinal fluid, and a solid gastric mass defined as poorly differentiated adenocarcinoma. Due to her condition, the patient did not receive oncological management, evolving unfavorably and passing away twenty days later. Leptomeningeal carcinomatosis should be considered in patients with advanced cancer and meningeal symptoms. It is more predominant in women, with an average age of 53.84 years. Clinical presentation of leptomeningeal carcinomatosis varies, and diagnosis involves neuroimaging and cerebrospinal fluid cytology. Prognosis is unfavorable, often leading to fatality. Treatment protocols lack standardization, and personalized approaches, including targeted and systemic therapies, are explored for improved outcomes. The exceptional aspect of our case lies in the unique diagnosis of an abdominal tumor following the manifestation of neurological symptoms.

Conclusion: It is important to suspect this condition among the causes of meningitis, especially in the presence of an underlying malignancy.

Background: Congenital anomalies can pose challenges during electrophysiology (EP) procedures in patients with tachyarrhythmias, making diagnosis and management of these cases quite difficult. An interrupted inferior vena cava, an uncommon congenital defect, is especially rare without associated congenital heart disease. In this setting, catheter ablation from femoral vein access becomes more challenging.

Case presentation: A 23-year-old male with no cardiovascular risk factors or prior cardiovascular disease presented with atrioventricular reentrant tachycardia that converted to sinus rhythm after adenosine administration. The patient was scheduled for an electrophysiology study with catheter ablation if indicated. During the procedure, catheter advancement into the right atrium was unsuccessful, raising suspicion of an interrupted inferior vena cava (IVC). Radiofrequency ablation was subsequently performed successfully via the subclavian vein approach. Post-procedural computed tomography (CT) imaging confirmed interruption of the IVC.

Conclusion: Accessing via the subclavian vein can facilitate catheter ablation when an interrupted inferior vena cava is present.

Background: COVID-19 could exacerbate the symptoms of autoimmune diseases such as multiple sclerosis (MS). Literature shows an increase in the incidence of relapse in patients with MS after COVID-19. We designed this systematic review and meta-analysis to estimate the pooled incidence of MS-relapse after COVID-19.

Methods: We performed a systematic search in PubMed, Scopus, EMBASE, Web of Science, and Google scholar. Gray literature including references of the references and conference abstracts were also searched to find relevant articles. We extracted data regarding the total number of participants, the name of the first author, publication year, country of origin, mean age, mean disease duration, mean Expanded Disability Status Scale (EDSS), and the number of patients with relapse after COVID.

Results: A literature search revealed 5160 articles, after deleting duplicates, 2270 remained. After careful evaluation of the full texts, twelve studies were included for meta-analysis. Totally, 1595 patients with MS who had a history of COVID-19 were evaluated. Most studies were done in Iran. The mean age of included patients ranged between 35 and 49 years, and mean durations of the disease were between 7and 15.4 years. The incidence of relapse ranged between 2% and 20% in included studies.The pooled incidence of relapse after COVID-19 was 7% (95%CI:5-10%) (I2=64%, p<0.001).

Conclusions: The results of this systematic review and meta-analysis show that the pooled incidence of MS-related relapse after COVID-19 is 7%.

Background: Oxidative stress has been well established to participate in the pathology of coronary artery disease (CAD). Sestrin family of proteins have recently emerged as important suppressors of oxidative stress. However, only few studies have reported the levels of sestrins and their clinical significance in CAD patients.

Methods: Participants were ninety patients referred to the cardiac angiography unit for cardiac angiography. Thirty-two subjects were diagnosed as having stable CAD, twenty patients had unstable CAD and thirty-eight subjects had no CAD. All patients underwent angiography and the severity of coronary stenosis was calculated by modified Gensini score. The levels of glucose, triglyceride, total cholesterol, HDL, LDL, hs-CRP and hematological parameters were determined in the fasting blood samples by routine methods. Plasma levels of sestrin-1 and sestrin-2 were measured by ELISA.

Results: Although the plasma levels of sestrin-1 were significantly lower in both case groups compared with the control group (P<0.001), there were no significant differences in sestrin-1 levels between the two patient groups. The levels of sestrin-2 were also significantly lower in both CAD groups than in controls (P=0.001), but no significant difference was found between stable and unstable patients. In the whole study subjects, plasma sestrin-1 and sestrin-2 showed negative correlation with the coronary artery score. By multivariate analysis only sestrin-2 levels were significantly related to CAD severity.

Conclusion: Our findings showed a negative association of sestrin levels and the coronary stenosis severity.

Background: Regular physical activity promotes health that can affect liver health, particularly modulating liver enzymes. The objective of this study was to assess the association between physical activities and elevated liver enzyme levels in the population of the Prospective Epidemiological Research Studies of the Iranian Adults (PERSIAN) Guilan cohort study (PGCS).

Methods: This cross-sectional study was conducted on 10,519 individuals from the PGCS population. The demographical and clinical data of participants were collected. The study involved measuring the levels of physical activity and liver enzymes, including alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and γ-glutamyl transferase (GGT). The study assessed physical activity intensity using standardized classification based on the energy costs of different activities, which was calculated through questionnaires administered in three tertiles. The relationship between physical activity and elevated liver enzymes was examined using the Cochran-Armitage test for trend and logistic regression.

Results: The average age of individuals was 51.52±8.90 years, and 53.6% were women. The prevalence of elevated ALT, AST, and GGT decreased with increasing physical activity (p<0.001, 0.010, and <0.001, respectively). According to fully adjusted model, participants with low physical activity levels had higher odds for elevated ALT and GGT compared to the participants with high physical activity levels (OR=1.15, 95% CI: 1.04-1.31 and OR=1.37, 95% CI: 1.16-1.61, respectively) (p<0.05).

Conclusion: Higher physical activity levels were associated with a lower prevalence of elevated liver enzymes, suggesting that regular physical activity may positively affect liver health.

Background: Opportunistic infections such as mucormycosis, are spread in COVID-19 patients due to the use of corticosteroids therapy. This study aimed to determine the prevalence of mucormycosis in patients infected with the delta strain of the COVID-19 virus and evaluated some effective factors in the prevalence and patient prognosis.

Methods: This study was performed on 44 COVID patients with co-infection to mucormycosis who were admitted to Shahid Beheshti Hospital, Kashan in 2022. The COVID diagnosis was based on clinical signs and a positive PCR test, the diagnosis of mucormycosis was based on a positive laboratory report of fungi culture medium. The patient outcomes were recorded and CALL scoring system was used to determine the severity of the disease. The results were analyzed by descriptive statistics using SPSS 16 software.

Results: Of 44 COVID patients infected with mucormycosis, 26 (59.1%) had diabetes. All 44 patients had a history of taking steroids with an average daily dose of 48.77±65.15 mg. Twenty-six (59.1%) patients were admitted to the ICU, 18 (40.9%) required intubation. Sixteen (36.4%) patients died. A significant decries observed in lymphopenia after treatment of patients (p<0.0001). CALL scores using showed that 33 (75%) patients had severe risk factors.

Conclusion: Uncontrolled diabetes and hypertension are the two most common risk factors of mucormycosis in COVID patients. High use of glucocorticoid drugs and immune suppression are predisposing causes for opportunistic organisms. Accurate laboratory diagnosis of mucormycosis plays an important role in treatment of patients and in controlling the disease.

Background: Uterine cancer ranks among the leading causes of mortality in women, particularly prevalent in countries with low to moderate income levels. Present treatment and healthcare success rates are assessed by the survival rate index. This study aimed to determine the uterine cancer survival rate in Asia.

Methods: Five international databases were analyzed to perform this systematic review: Medline/PubMed, ProQuest, Scopus, Web of Knowledge, and Google Scholar, until the end of August 2021. The Newcastle-Ottawa quality assessment form was utilized in the evaluation of quality for cohort studies. "I2 statistic and Cochran test were used to check the analysis process and assess the heterogeneity among the studies. Also, the study year was used as the basis for a meta-regression analysis.

Results: The study covered 75 papers in total. The survival rates of uterine cancer after one, three, five, and seven years are 76.68% (95% CI, 66.76-78.61), 63.56% (95% CI, 58.60-68.37), 59.04% (95% CI, 55.62-62.43), and 57.86% (95% CI, 51.16-64.42) according to the random model. Furthermore, according to the outcomes of the meta-regression, there was no correlation found between the study year and the survival rate.

Conclusions: Compared to European and American countries, Asian countries have a poorer uterine cancer survival rate, which makes it crucial to improve the survival rate of patients through ensuring early diagnosis of the disease in its early stages and providing new diagnostic methods, modified surgical techniques, and targeted therapies.