Patients In Case Group Research Articles

The role of GSTM1 gene polymorphism in pathophysiology, evaluation, and management of constipation of anorectal outlet obstruction.

Constipation of anorectal outlet obstruction may be caused by mechanical or functional causes. This complication is a debilitating disease that needs proper and timely treatment. Many studies have shown that there is a direct link between constipation and intestinal cancer. One of the most effective ways to prevent or diagnose intestinal cancer is through genetic studies. Evaluation of people's polymorphism shows how much they are at risk for cancer. Therefore, in this study, the GSTM1 gene polymorphism was evaluated in patients with constipation of anorectal outlet obstruction to assess better and manage this disease and investigate the possibility of anorectal cancer in these people. In this regard, 40 people with constipation of anorectal outlet obstruction were compared with 40 healthy people. In the case group (patients), in addition to demographic and clinical evaluations, the anorectal manometric test was used to diagnose the pathology of the disease. Results showed that out of 40 patients with constipation of anorectal outlet obstruction, 5 cases (12.5%) had megarectum, 7 cases (17.5%) had anismus, 10 cases (25%) had Hirschsprung's disease, 5 cases (12.5%) had descending perineum syndrome, 6 cases (15%) had rectal prolapse, 4 cases (10%) had enterocele, and 3 cases (7.5%) were with rectocele. Also, the results of GSTM1 gene deletion polymorphism showed that patients with constipation of anorectal outlet obstruction were almost two times more exposed to the null genotype than the control group (P <0.04). Therefore, in people with both constipation of anorectal outlet obstruction and null genotype (i.e., deletion in the GSTM1 gene), because they do not have glutathione-S transferase, they appear to be at higher risk for anorectal cancer than healthy people with the same genotype.

Factors associated with low back pain in adult: a study in a tertiary care hospital of Bangladesh

Background: Low back pain (LBP) is a very common health problem in humans that may cause disability and can affect work performance and well-being. It can be acute, subacute, or chronic in condition. Although several risk factors of LBP have already been identified like occupational posture, age, depressive moods, body height, or obesity we have not enough research-based data regarding this issue. Aim of the study: The aim of this study was to evaluate the risk factors associated with low back pain in adults. Methods: This cross-sectional observational study was conducted in the Department of Physical Medicine &amp; Rehabilitation, Shaheed Ziaur Rahman Medical College Hospital, Bogura, Bangladesh during the period from July 2019 to December 2020. In total 57 confirmed LBP patients were enrolled as the case group patients and 30 healthy people were included as the control group participants in this study. All the clinical data regarding LBP were collected by using a predesigned questioner. Data were processed analyzed and disseminated by MS Office and SPSS programs as per need. Results: In analyzing the risk factors of low back pain among the participants we observed, 47% of case group participants were used to remain in a sitting position for 0-1 hours per day whereas it was found among 67% in the control group. Moreover, in the case group, 14% of participants used to remain in a sitting position for more than 6 hours per day which was only 7% in the control group. Besides age (p=0.004) among several possible risk factors, in this study, we found a significant correlation of low back pain in the duration of sitting position between the case and control groups, where the p-value was 0.006. Conclusion: Continuation of a long time sitting position is a harmful thing for the human musculoskeletal system. Now a day the lifestyle factors should be assessed with more attention for detecting the basic etiology of low back pain.

Optical Coherence Tomography Angiography Acute of Non-Arteritic Anterior Ischemic Optic Neuropathy

Abstract Background Anterior ischemic optic neuropathy (AION) is divided into arteritic anterior ischemic optic neuropathy (AAION) which accounts for 15% and Nonarteritic anterior ischemic optic neuropathy (NAION) which accounts for 85% of cases. Non-arteritic anterior ischemic optic neuropathy (NAION) is an ischemic change involves the 1 mm thickness of the optic nerve head (optic disc). It affects around 10 cases per 100,000 per year in the age group over 50. Objective To assess the optical coherence tomography angiography peripapillary area pattern in diagnosed non-arteritic acute ischemic optic neuropathy patients within a period from one week to 3 weeks during (acute stage while the disc is still edematous) of acute painless diminution of vision. Patients and Methods We enrolled 20 patients in cases group and 10 patients in control group were enrolled to assess the OCTA peripapillary area pattern in diagnosed NAAION patients within a period from one week to 3 weeks during (acute stage while the disc is still edematous) of acute painless diminution of vision compared to the pattern seen in the normal control group OCTA, FFA and VF (centralized 30-2 SITA strategy) were done to the cases group. But FFA and VF were excluded in the control group. Results The results of our study show statistically significant difference found between the two studied groups regarding central circle perfusion density, middle circle perfusion density (superior, inferior and nasal) and outer circle perfusion density (superior and temporal) while no statistically significant difference found between them regarding middle circle (temporal) and outer circle (inferior and nasal). Conclusion So according to this study in cases of NAION (acute stage), we can depend on perfusion density within the middle and outer circle of Early Treatment Diabetic Retinopathy Study (ETDRS) grid put on the disc and peripapillary area. As, these are the areas affected by decreased perfusion density. While, there is increased perfusion density within the central and middle circles, which could be due to, diffuse disc edema.

The risk factors of first recurrence in ischemic stroke patients in different periods after first attack

Objective: To investigate the risk factors of first recurrence in ischemic stroke patients at different periods after first attack. Methods: The subjects were from the screening population of China National Stroke Screening Survey (CNSSS) from 2013 to 2015. The basic demographic information, stroke history, influencing factors and modified Rankin Scale (mRs) scores were collected by using standardized face-to-face questionnaires. A case-control study was conducted to investigate the risk factors of first recurrence in ischemic stroke patients who relapsed for the first time within 12 months, 24 months and 36 months as the case group and non-recurrent ischemic stroke patients as the control group. Further, the subjects were stratified into different subgroups by age, gender and urban-rural distribution to investigate the risk factors of first recurrence in different periods. Results: Diabetes (OR=1.71, 95%CI: 1.08-2.71) and coronary heart disease (OR=1.55, 95%CI: 1.09-2.19) were significantly associated with the risk of first recurrence within 12 months after the first onset of ischemic stroke. The diabetes was significantly associated with the risk of first recurrence within 24 months (OR=1.94, 95%CI: 1.33-2.83) and 36 months (OR=1.64, 95%CI: 1.15-2.34) after the first onset of ischemic stroke. With the increase of mRs score, the risk of first recurrence within 12 months, 24 months and 36 months in ischemic stroke patients increased significantly. In the same period, the risk factors of ischemic stroke recurrence differed in patients with different age, gender and urban-rural distribution. Conclusions: The risk factors of first recurrence in ischemic stroke patients are diverse at different periods after the first onset of ischemic stroke. In different subgroups, the risk factors of first recurrence and the strength of its corresponding association are also different.

Non-epileptic, stereotypical and intermittent symptoms (NESIS) in subdural hematomas – Evidence for the design of a new therapeutic clinical trial

Background . Transient neurological symptoms (TNS) frequently occur in patients with subdural hematomas (SDH) often posing diagnostic dilemna. Most of those patients will receive a diagnosis of provoked seizures despite negative workup and atypical evolution. Objective . To accumulate evidence about the existence of the distinct NESIS etiology for patients presenting with TNS post SDH, its pathophysiology and optimal management. Methods . An initial single-center, retrospective, case-control study of patients with TNS post-SDH revealed statistically significant clinical and semiological distinctions between cases (negative EEG) and controls (EEG with ictal or interictal activity). Those differences combined with a thorough review of literature led to the creation of a clinical screening score predictive of a negative EEG. When tested retrospectively, the score showed promise in detecting NESIS for patients with TNS. Its predictive value was replicated in a subsequent single-center, retrospective study. Results . In the first study, fifty-nine patients with SDH-associated TNS were included (39 cases and 20 controls). Demographic characteristics were comparable in both groups. Dysphasia and prolonged episodes were associated with a negative EEG. Clonic movements, impaired awareness, positive symptomatology, complete response to antiepileptic drugs and mortality were associated with a positive EEG. Using semiological variables, we created a scoring system with a 96.6% sensitivity and 100% specificity in predicting case group patients. In the second study, 22 patients with TNS and chronic SDH were included. Presumptive NESIS occurred in 13 patients (59%), EEG-proven epilepsy in 4 patients. NESIS patients did not respond to standard anti-epileptic drugs contrary to non-NESIS TNS (14% vs 100%). The differences between both groups support the existence of an alternative etiology than seizures for TNS in our population. We proposed the term NESIS to describe this subgroup and hypothesize that cortical spreading depolarization (CSD) could be its underlying pathophysiology. Relevant studies support the existence of specific treatments (including Topiramate) targeting CSD. Conclusion . With these results in mind, we aim to carry out a prospective randomized clinical trial to assess the efficacy of Topiramate compared to a conventional AED (LEV), known to have little impact on CSD, in a NESIS sub-group. We believe the recognition of this distinct entity, the understanding of its underlying pathophysiology and the creation of a validated clinical screening score can have important prognostic, paraclinical and therapeutic impact in the care we provide to such patients.

Community-onset ESBL– producing enterobacteriaceae urinary tract infection in pediatric patients: Retrospective case control study

Background: Urinary tract infection (UTI) is a common childhood disease with a prevalence of 7.8% that can lead to serious complications including renal scarring. Approximately 80% of UTIs in children are caused by Escherichia coli that are unfortunately accompanied by an increased prevalence of extended-spectrum beta-lactamases (ESBL) - producing strains. This study tries to determine the incidence of ESBL-producing Enterobacteriaceae (PE) UTIs among the pediatric population in Qatar, and predict the relation between multiple antibiotics exposure, antibiotic prophylaxis, recurrent UTIs, prior hospitalizations, prior urinary tract abnormalities as risk factors, and the development of ESBL-PE UTI in the same population. Methods: This is a retrospective case control and cross-sectional study conducted over a period of one year from January 2018 to January 2019. The inclusion criteria were infants and children from 0 month to 14 years old diagnosed with community-onset of urinary tract infection however, exclusion criteria were immunocompromised or cancer patients. Case group was defined as patients who developed ESBL-PE UTI (n = 135), while the control group were patients who developed sensitive Enterobacteriaceae UTI (n = 219). Results: 406 patients were included, 33% of them had ESBL-PE UTI () and 51 were excluded (infection caused by another organism) (). Regarding antibiotics exposure during the preceding 6 months, 28% of the case group patients were prescribed multiple courses of antibiotics versus 10% in the control group. 21% within the case group patients received antibiotic prophylaxis versus 6% in the control group. Furthermore, 21% of case group patients were diagnosed with urinary tract anomalies versus 4.5% in the control group, however no significant statistical difference regarding UTI recurrence was found (p&gt;0.05). 17% of case group patients were hospitalized previously versus 7% in the control group (). Conclusion: The study found that ESBL-PE UTI incidence among pediatric patients was high. Repeated exposure to antibiotics courses, antibiotic prophylaxis, previous hospitalization, and prior UT anomalies may have an impact on this resistance rate.

Effect of gMDSCs on natural killer cell functionality in chronic hepatitis C patients treated with direct-acting antiviral agents

Objective: To investigate the changes of natural killer(NK) cell function, and clarify the effect of granulocytic myeloid derived suppressor cells (G-MDSCs) on NK cell functionality in patients with treatment-naive chronic hepatitis C (CHC) who were cured by direct-acting antiviral agents (DAAs). Methods: Thirteen treatment-naive CHC patients and 13 healthy controls were prospectively included in this study from March 2016 to January 2017. They were divided into case group and control group, respectively. The patients of case group,6 males and 7 females aged 21-65 years old with an average of (37±14),were treated with daclatasvir and asunaprevir combination (DCV/ASV) at the Department of Infectious Diseases, Fifth Medical Center of Chinese PLA General Hospital. While 13 healthy individuals, 6 males and 7 females aged 21-57 (36±11) years old, were enrolled as healthy controls(control group). Flow cytometry was used to determine the immunological characteristics of peripheral blood NK cells subset, and detect the frequencies of gMDSCs in peripheral blood of people in two groups. It was specifically notes that CHC patients of case group would be detected before, during and after treatment. The correlations between gMDSCs and each NK cell subset function were also examined. The impact of gMDSCs on NK cell functionalities and the relevant regulatory mechanisms were explored using co-culture experiments of sorted NK cells and gMDSCs in vitro. Results: Compared with healthy controls, the decreased IFN-γ production[M(Q1,Q3)] [3.182 (2.757, 4.237) vs 6.675 (4.476, 8.280),1.434 (1.127, 2.434) vs 3.045 (1.680, 4.856), 2.611 (1.749, 3.498) vs 5.160 (4.232, 7.683)] and increased CD107a degranulation [9.314 (7.838, 13.543) vs 3.480 (2.938, 6.824), 2.544 (1.366, 4.768) vs 0.552 (0.408, 1.560), 10.339 (9.145, 12.534) vs 3.488 (3.117, 5.651)] (all P<0.05) were found on NK cell and its subsets. The frequencies of gMDSCs and plasma concentration of arginase-1 in CHC patients was significantly higher than that in healthy controls [7.050 (4.180, 12.538) vs 1.440 (0.444, 2.261), 114.278 (68.492, 163.724) vs 64.753 (50.809, 93.278)](all P<0.05). The production of IFN-γ was increased and the secretion of CD107a was decreased in NK cell and its subsets after DAAs treatment (P<0.05). The frequencies of gMDSCs and plasma arignase I levels were also decreased in CHC patients treated with DAAs (P<0.05).The results of the study indicated that the frequencies of G-MDSCs were inversely associated with the levels of IFN-γproduction of NK cells and CD56dim NK cells in CHC patients (r=0.668, -0.750, respectively, both P<0.05). In addition, the frequencies of gMDSCs were positively associated with the expression of CD107a in the CD56bright NK cell subset (r=0.711, P=0.021). In vitro, the inhibition of gMDSCs on the IFN-γ production of NK cells was demonstrated in the co-culture experiments of sorted NK cells and gMDSCs, and blocking arginase I can significantly increase the ability of NK cells to produce IFN-γ, restore NK cell IFN-γ production. Conclusions: gMDSCs in peripheral blood of CHC patients has been shown to suppress NK cell IFN-γ production in an arginase I-dependent manner. Direct-acting antiviral-mediated clearance of HCV is associated with the normalization of NK cell function and gMDSCs frequency.

Incidence of latent tuberculosis in rheumatic diseases after taking immunesuppressive drugs

Tuberculosis remains a serious public health concern. Comorbidity in immunocompromised patients makes its diagnosis more difficult. The present study was conducted to assess the prevalence of positive tuberculin skin test and Chest X-ray changes in patients with rheumatologic diseases treated with immunosuppressive medications in the city of Birjand, Iran. The present prospective study was conducted in 2020 in the city of Birjand, Iran on 40 patients with rheumatologic diseases and 40 healthy people. Inclusion criteria were patients with the diagnosed rheumatic disease under treatment with immunosuppressive drugs. Exclusion criteria were active tuberculosis and changes in chest X-ray in favor of tuberculosis. Purified protein derivative solution was used to carry out a tuberculin skin test and screen both groups for latent tuberculosis and Chest X-ray to ascertain the presence or absence of the radiographic signs of old tuberculosis in the patients' group at the initiation of treatment and six months after. The collected data were recorded in a checklist and then analyzed in SPSS-22 using descriptive and statistical tests. Mean age was 47.32 ± 13.61 years in the case group and 46.40 ± 14.19 years in the control. Also, 7.5% of the case group patients taking immunosuppressive medications were tuberculin skin test positive, but no significant difference was observed between the case and control groups (P value = 0.24). In the positive tuberculin skin test group, 66.6% had spondyloarthritis of whom, 100% were taking Cinnora (Adalimumab). The emergence of latent tuberculosis in rheumatic patients after taking immunosuppressive medications is likely, and clinicians should be aware of its risk.

Study on Homocysteinemia as a Risk Factor of Ischemic Stroke

Despite recent advances, only two-third of all strokes can be attributed to known causal risk factors. Homocysteine (tHcy), a sulfur-containing amino acid, is now considered to be an important risk factor for vascular diseases, along with the established risk factors like hyperlipidemia, hypertension, diabetes mellitus, and smoking. Elevated homocysteine levels play a causal role in the pathogenesis of atherosclerosis, thromboembolism and vascular endothelial dysfunction with an increased incidence of ischemic stroke. This study aimed to find out the association of hyperhomocysteinemia with ischemic stroke. A total of 100 subjects were included in this study, 50 were ischemic stroke patients enrolled as case, and 50 were normal healthy individuals enrolled as control. Serum homocysteine level was measured in both case and control groups. The comparison was made in both groups regarding other common risk factors like diabetes mellitus, hypertension, smoking, dyslipidemia, family history, etc. Among 100 patients, 50 had ischemic stroke and 50 were healthy individuals. In this study, out of all patients, abnormal serum homocysteine level was found in 32% of cases and 12% of controls. The mean (±SD) serum homocysteine level was found 16.50±13.86 μmole/L in cases and 9.46±3.49 μmole /L in the control group. Significant (p&lt;0.05) difference was found between the case and the control. The incidence of hyperhomocysteinemia is higher in ischemic stroke cases than that in age-sex-matched healthy controls. In our study, serum homocysteine was high in both younger age group patients (16.65±14.55 μmole/L vs. 9.52±3.19 μmole/L) and older age group patients (16.33±9.87 vs. 9.35±3.97 μmole/L,) in case and control group respectively. Significant (p&lt;0.05) difference was found between the case and the control. Multiple logistic regression analysis showed that abnormal serum homocysteine is an independent risk factor of ischemic stroke. So we conclude that hyperhomocysteinemia is an important and independent risk factor for the development of ischemic stroke. Hypertension and smoking are important contributory to elevated serum homocysteine.&#x0D; TAJ 2021; 34: No-1: 33-39

A COMPARATIVE STUDY OF MATERNAL OUTCOME IN FIRST-TRIMESTER VAGINAL BLEEDING IN THE DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY, SMS MEDICAL COLLEGE, JAIPUR

Background: The outcome of ongoing pregnancies after first trimester vaginal bleeding is of relevance to women and obstetricians for planning antenatal care and clinical interventions in pregnancy. Hence, this study was conducted to identify the risks associated with first trimester bleed which may facilitate decision making regarding mode, place and timing of delivery during management, which may improve maternal and neonatal outcome.&#x0D; Methods: Hospital based comparative prospective study conducted at Department of Obstetrics and Gynaecology, SMS Medical College &amp; associated Hospitals, Jaipur.&#x0D; Results: APH was found in 4 (8.00%) patients of case group and nil in control group. So, APH was found to be more in the case group than control group but was statistically not significant. Pre-eclampsia was found in 4 (8.00%) in case group and 3 (6.00%) in control group with statistically insignificant difference between the two groups. 26 (52.00%) delivered at the gestational age of ?37 weeks, whereas only 8 (16%) of control group delivered at ?37 weeks. So, the gestational age at delivery of control group subjects was found to be higher as compared to case group subjects and the difference was statistically significant (p=0.001).&#x0D; Conclusion: Threatened miscarriage in early pregnancy increases the risk of adverse pregnancy outcome. In our study, these patients were found to be at an increased risk of preterm delivery, PPROM.&#x0D; Keywords: PROM, Miscarriage, Gestational age

Detection of cardiac autonomic neuropathy in type II diabetic patients using heart rate recovery

Background Cardiac autonomic neuropathy is one of the most insidious complications of diabetes mellitus. It can be detected by abnormality in heart rate recovery, which is defined as decline in heart rate within the first few minutes following a graded exercise stress test. Aim To detect cardiac autonomic neuropathy in type II diabetic patients using heart rate recovery. Patients and methods This study included 45 individuals, 30 diabetic patients in case group and 15 healthy individuals as a control. All participants underwent history taking, clinical examination, laboratory investigations (FBS, PPBS, HbA1c, kidney function test and liver enzymes), comprehensive transthoracic echocardiographic examination, 24 h Holter monitor and exercise ECG test to assess heart rate recovery. Results 30 diabetic patients (7 male and 23 females, with mean age 40±3.5 years) and 15 healthy individuals (4 males and 11 females with mean age 36±5.8 years) participated in this study. Cases group had significant increase in FBS, PPBS, HbA1c and serum creatinine compared to control group. Patients had significant decrease in PNN50, SDNN, LF and HF in the 24 h Holter monitoring as well as significant delay in heart rate recovery at 1st and 2nd minutes compared to control group. Glycemic control and duration of diabetes were the most predictors to abnormal heart rate recovery. Conclusion Heart rate recovery derived from exercise ECG test could be considered as an easy, low cost and widely available tool for detection of cardiac autonomic neuropathy.

The association between primary open-angle glaucoma and Helicobacter pylori infection

Background: Primary open-angle glaucoma (POAG) the most common form of glaucoma is a neurodegenerative disease, which is the third most common cause of blindness worldwide. It is estimated that 60 million people in the world are affected by this disease and 8.4 million are bilaterally blind. Among the various factors that have been implicated in the pathophysiology of this disease is infection with Helicobacter pylori (HP), a Gram-negative bacterium that is commonly found in stomach and present in approximately one-half of the world’s population. Establishment of such a causal correlation will probably have important practical applications as the eradication of H. pylori might lead to developments in the treatment of glaucoma. Objectives: To investigate the association between Primary Open-Angle Glaucoma (POAG) and Helicobacter pylori infection and to observe fluctuations in intra ocular pressure after Helicobacter pylori infection eradication. Design: Duration based, prospective observational study. Participants: 50 patients with documented Primary Open-Angle Glaucoma (POAG) as case group and 50 non-glaucoma participants as control group. Methods: Upper gastrointestinal endoscopy was performed to evaluate macroscopic abnormalities, and gastric mucosal biopsy specimens were obtained for the presence of H. pylori infection tested by Rapid Urease Test (RUT). All subjects underwent detailed ocular examinations including visual acuity, slit-lamp examination, fundoscopy, intra-ocular pressure recording, gonioscopy, GHT to assess visual fields and OCT of optic nerve head.Results: In 90% of POAG patients of case group and in 68% of non-glaucoma participants of control group Helicobacter pylori infection was detected by RUT (P-Value=0.007). Conclusion: H. pylori infection is more frequent in glaucoma patients. It may play a role as a secondary aggravating factor or even may be the primary cause. The establishment of such a causal relationship will probably have important practical applications as the eradication of H. pylori might lead to developments in the treatment of glaucoma.

A high-sensitivity C-reactive protein in assessing severity of asthma: A case control study

Asthma is often believed to be a disorder localized to the lungs, current evidence indicates that it may represent a component of systemic airway disease involving the entire respiratory tract. Despite significant improvements in the diagnosis and management of asthma over the past decade, as well as the availability of comprehensive and widely-accepted national and international clinical practice guidelines for the disease.This is prospective and descriptive study patients were derived among patients with asthma presented for follow -up examination in outpatient Department of pulmonary Medicine of Government Hospital. The patients were on maintenance treatment including inhaled corticosteroids and bronchodilators according to the guideline treatment of asthma. In our present study, a total of 65 patients were included out of which 36(55.3%) were males. In our study, most of the patients were 51-70 years i.e., 36 out of 65(55.4%), followed by 31-50. The mean hsCRP in case group patients are 3.62±0.84 and in control group patients 0.83±0.15. Pulmonary lung function test using Spirometer was done in all the patients (case &amp; control). The FEV1 values are compared against hsCRP values. Statistical significance is assessed using Spearmann’s correlation. Case group patients showing highly significant negative correlation of hsCRP with FEV1.The results of this study indicate increased serum hsCRP concentration in asthma compared to controls. Increased serum hs-CRP correlates positively with severity of asthma and thus can be considered as a tool in predicting asthma status.

Relationship between cognitive impairment and serum amyloid β-protein, adiponectin, and C-reactive protein levels in type II diabetes patients.

This study sought to explore the plausible mechanism of the cognitive impairment of patients with type 2 diabetes by analyzing the levels of serum amyloid β-protein (Aβl-42), adiponectin, and C-reactive protein (CRP). Eighty-four patients diagnosed with type 2 diabetes and 60 healthy people were selected as the participants for this study. Clinical data were collected using self-made questionnaires. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) scale was used to access cognitive functions. The serum Aβl-42 and adiponectin levels were individually determined by an enzyme-linked immunoassay (ELISA). CRP was detected using a Siemens BNP II specific-protein analyzer. Patients in the case group had significantly lower immediate memory, visual span, speech function, attention, and delayed memory scores on the RBANS scale than patients in the control group. The Aβl-42 levels of patients in case group were significantly higher than those of patients in the control group. The age of patients was significantly negatively correlated to RBANS scale subtest scores and standard scores in the case group. The number of years of schooling was significantly positively correlated to immediate memory, visual span, attention, delayed memory scores, and standard scores, but negatively correlated with speech function. After adjusting for age and the number of years of schooling, the Aβl-42 levels of patients in the case group were significantly negatively correlated with immediate memory, attention, delayed memory scores, and standard scores (P<0.05). The adiponectin levels of patients in the case group were positively correlated with RBANS scale subtest scores and standard scores (P<0.05). Type 2 diabetes patients suffered from cognitive impairment. It appears that the mechanism may be associated with increased serum Aβl-42 levels, decreased adiponectin levels and inflammation reaction. The detection of serum Aβl-42 and adiponectin could be used as indicators of the degree of cognitive impairment in patients with type 2 diabetes.

Long-term follow-up of olfactory and gustatory dysfunction in COVID-19: 6 months case-control study of health workers.

PurposeThe study aimed to determine the incidence and long-term evolution of COVID-related olfactory (OD) and gustatory (GD) dysfunction, the recovery timeline, and the association with other symptoms. The secondary objective was to identify the predictive clinical factors for the evolution of these symptoms.MethodsA prospective case–control study was conducted from March 15 to October 15, 2020, in health workers with COVID-19 related symptoms in a tertiary care hospital. 320 patients were included after 6 months of follow-up: 195 in the case group and 125 in the control group. Olfactory dysfunction (OD), dysosmia, and gustatory dysfunction (GD) onset and recovery rate after 6 months follow-up are analyzed in both groups.ResultsThere were 125 (64.1%) in case group patients with OD and 118 (60.5%) with GD. Total or partial recovery OD and GD was found in 89%, mainly in the first 2 months. In the control group, there were 14 (11.2%) patients with OD and 33 (26.4%) patients with GD, with 100% of total/partial recovery.ConclusionIn both groups, OD and GD showed high-resolution rates during the first two months after the onset of symptoms. Nevertheless, 11% of the case group patients did not show any recovery, and the partial resolution was present in 30% of our patients, at the 6 months follow-up. We found a high correlation between OD and GD, both in the appearance of symptoms and in their recovery. Nasal obstruction and dyspnea have been identified as risk factors for the persistence of symptoms.

Peripheral nerve hyperexcitability syndrome: A clinical, electrophysiological, and immunological study.

Peripheral nerve hyperexcitability syndrome (PNHS) is characterized by muscle fasciculations and spasms. Nerve hyperexcitability and after-discharges can be observed in electrophysiological studies. Autoimmune mechanisms play a major role in the pathophysiology of primary PNHS. We retrospectively conducted a case-control study recruiting patients with clinical and electrophysiological features of PNHS. Control patients were diagnosed with other neuronal or muscular diseases. Contactin-associated protein2 (CASPR2) and leucine-rich glioma-inactivated1 (LGI1) antibodies were examined. A total of 19 primary PNHS patients and 39 control patients were analyzed. The most common symptoms for the case group were fasciculations (11/19) and muscle spasms (13/19). Case group patients were likely to demonstrate electrodiagnostic findings of nerve hyperexcitability (17/19) and after-discharges in the tibial nerve (19/19). We found high prevalence of CASPR2 (9/19) and LGI1 (6/19) antibodies in the case group. Primary PNHS patients were likely to show after-discharges in the tibial nerve. The pathogenesis of PNHS is autoimmune CASPR2 and LGI1 antibodies are possible pathogenic antibodies for primary PNHS.

Lacunar-like changes of the chorion: can it be a first-trimester ultrasound sign in predicting worse clinical outcome in cesarean scar pregnancy termination?

Objective To observe the lacunar-like changes in cesarean scar pregnancy (CSP) ultrasonography in first trimester and to explore its relationship with clinical outcome in early pregnancy termination. Methods This is a retrospective case-control study. Patients who were diagnosed as CSP and chose to terminate pregnancy from January 2017 to April 2020 were enrolled. According to occurrence of lacunar-like change in chorion membrane, patients were divided into case and control group. The clinical manifestation, laboratory test, ultrasound data, and outcome were compared. Results Fifty-five CSP patients were enrolled with 20 (36.4%) in case group and 35 (63.6%) in control group. As for ultrasound features, the maximum outer diameter of gestational mass (5.6 ± 2.5 cm vs. 3.9 ± 1.5 cm), the maximum thickness of the chorion membrane (median number 1.1 cm vs. 0.7 cm), the longitudinal diameter of the implanting part of gestational mass in uterine lower segment (3.3 ± 1.8 cm vs. 1.2 ± 0.5 cm), uterine lower segment protrusion incidence (12, 60% vs. 2, 5.7%), and the crown-rump length of fetus (median number 1.7 cm vs. 0.7 cm) were bigger or higher in case group than that of the control group; the minimum thickness of the uterine lower segment myometrium (median number 0.08 cm vs. 0.20 cm) was significantly thinner in case group. CDFI grading of case group was different from control group with more cases in higher grades. As for clinical outcome, the patients of case group showed more frequency of CSP lesion resection under open surgery or laparoscopy (7, 35% vs. 1, 2.86%) rather than suction curettage, more blood loss in surgery (median number 35 ml vs. 20 ml) and more hospitalization days (median number 7.5 d vs. 3.5 d) than control group. Conclusions Lacunar-like change of chorion can be detected in early gestation and may act as a predictor of complicated and worse clinical outcome.

Effect of addition of platelet-rich fibrin to tragal perichondrium graft in the endoscopic trans-canal myringoplasty

BackgroundMyringoplasty operation is the reconstruction of the tympanic membrane (TM) which is performed to prevent recurrent discharge of the ear and to improve the hearing impairment which is caused by TM perforation. Platelets are the key factors in tissue repair mechanisms. They provide essential growth factors, which stimulate fibroblasts to create extracellular matrix deposition and neovascularization. The aim of this study is the assessment of the topical use of autologous platelet-rich fibrin (PRF) in the improvement of myringoplasty success rate.ResultsPatients were divided to two groups, group A included 20 patients who were submitted to myringoplasty operation with adding of PRF from the same patient, and group B included 20 patients who were submitted to myringoplasty operation without adding of PRF. At 6 months postoperatively, the success rate (graft taking) in case group A (95%) was significantly higher than in the control group (70%) (P value = 0.037). Success in terms of hearing gain of the air-bone gap was more than 10 dB achieved in 19 patients (95%) in case group A, and 14 patients (70%) in control group B were with a statistically non-significant difference (P value = 0.079). There was no effect of PRF use on hearing gain in graft-taken cases because hearing gain is related to the closure of TM.ConclusionTopical PRF application over tragal perichondreal graft during myringoplasty is successful, safe, and highly efficient with no complications. PRF improves healing of chronic TM perforations and prevents postoperative infection.

Aortic Elasticity Evaluated by Pulsed Tissue Doppler Imaging of the Ascending Aorta in Different Diseases: A Systematic Review.

Several methods have been applied for the evaluation of aortic elasticity. Pulsed tissue Doppler imaging of the ascending aorta is a noninvasive method applied for the evaluation of aortic elasticity in wide variety of diseases which are reviewed in this study. A comprehensive systematic literature search was carried out in November 2019 using the English databases including PubMed, Scopus, Science Direct, and Embase. All references of eligible articles and published reviews on tissue Doppler imaging were searched for relevant publications. Data were extracted according to predefined criteria (including country of study origin, patient population, number of patients in case and control groups, and results of aortic elasticity evaluation in the specific patient groups compared with controls). Two independent reviewers extracted the data, and the results were checked, compared, and edited by the third reviewer. No formal assessment of the statistics of the primary data was made. The results showed that decreased aortic elasticity is not only present in cardiovascular diseases but also can be identified in diseases of other systems that affect cardiovascular system.

Mecobalamin as a Neuroprotective Effector against Oxaliplatin-Based Chemotherapy in Colon and Rectal Cancer Patients

Palliative chemotherapy prolongs survival and improves quality of life. However, a variety of chemotherapeutics including oxaliplatin can cause severe side effects during treatments, leading to painful symptoms that might result in the interruption of cancer treatment. Although adding oxaliplatin to fluorouracil and leucovorin in adjuvant chemotherapy for colon and rectal cancer may improve disease-free survival, it also increases grade 3–4 sensory neuropathy. Our study aimed to determine whether oral Mecobalamin is neuroprotective against oxaliplatin-induced neuropathy. Forty-six stage III colon and rectal cancer patients receiving adjuvant biweekly oxaliplatin were randomized to oral Mecobalamin (1,500 mg; case group) or placebo (control group). Clinical neurological and electrophysiological evaluations were performed at baseline and after 4, 8, and 12 treatment cycles. Treatment-related toxicity was evaluated based on National Cancer Institute (NCI) criteria. After four cycles of chemotherapy, 9 of 23 patients in the control group and 8 of 23 patients in case group experienced grade 1 sensory neuropathy. After eight cycles, 13 patients experienced sensory neuropathy (grade 2–4 toxicity) in the control group; however, no patients in the case group experienced sensory neuropathy (P &lt; 0.05). After 12 cycles, grade 2–4 sensory neuropathy was observed in 20 patients in the control group, but only in 4 patients in the case group (P &lt; 0.05). We did not observe any significant electrophysiological changes in the case group after 4, 8, or 12 cycles of chemotherapy. Thus, we demonstrated that oral Mecobalamin reduces the incidence of neuropathy in colon and rectal cancer patients receiving oxaliplatin-based adjuvant chemotherapy.