Repository of Research and Investigative Information Isfahan University of Medical Sciences
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The impact of lacrimal gland characteristics on the clinical presentation of lacrimal gland prolapse in candidates for upper eyelid blepharoplasty
No full textBackground lacrimal gland prolapse (LGP) is a rare yet significant condition in oculoplastic surgery, characterized by the downward displacement of the lacrimal gland leading to upper eyelid bulging. This study aimed to understand LGP's defining characteristics and clinical implications for accurate diagnosis and tailored treatment planning. Methods The research, enrolled 496 candidates for upper eyelid blepharoplasty. Initially, all patients underwent an examination in an upright position to identify lateral eyelid bulging, the "supine test" was then performed. Surgical exploration was carried out for those with a positive supine test. Measurements of gland prolapse length and thickness were recorded, with glands classified based on thickness (thin = 2.5 mm). Dacryoadenopexy was performed to secure prolapsed glands using non-absorbable sutures, followed by skin closure. Results The average age of 48.39 years predominantly comprising females. Findings revealed an incidence of LGP around 22. Patients with LGP were significantly younger than those without, suggesting evolving aesthetic demands. The supine test demonstrated a 90 positive predictive value for LGP. Analysis of the prolapsed lacrimal gland characteristics indicated that the average length in patients with upright prolapse was significantly larger (8.33 +/- 3.12 mm) than in those without (6.03 +/- 2.91 mm, p = 0.001). The odds ratio analysis revealed that each millimeter increase in gland length correlates with a 29 increased likelihood of upright eyelid bulging (OR: 1.29, 95 CI: 1.106-1.509, p = 0.001). However, the thickness of the gland and the presence of superotemporal pre-aponeurotic fat did not significantly influence the clinical manifestation of LGP. Conclusion This study challenges existing assumptions about LGP by revealing a higher incidence, particularly among younger individuals, indicative of evolving aesthetic demands possibly influenced by social media. The supine test proves valuable for LGP assessment. Gland characteristics, especially length, significantly impact clinical manifestation, underscoring the need for tailored approaches. Surgeons should navigate LGP diagnosis and treatment with precision, considering both gland and fat prolapse for comprehensive care and aesthetic results
Comparing umbilical cord arterial blood gas findings in pregnancies with and without gestational diabetes mellitus following elective cesarean section: a multicenter retrospective cohort study in Iran
No full textBackground: Gestational diabetes mellitus (GDM) is linked to adverse fetal outcomes like macrosomia and neonatal hypoglycemia, with its global incidence increasing. While prior research indicates GDM may impair placental function and fetal oxygen delivery, direct evidence is limited. This study compares umbilical cord arterial blood gas measurements in pregnancies with and without GDM. Methods: This retrospective study analyzed medical records from four hospitals in Tehran, Rasht, Ahvaz, and Isfahan in Iran, focusing on term singleton pregnancies (gestational age >= 37 weeks) that underwent elective cesarean sections between January and July 2024. Exclusions included maternal age 45 years, pre-existing diabetes, thyroid, hypertensive, malignant, metabolic, or autoimmune disorders, intrauterine growth restriction, hypertensive disorders of pregnancy, and substance use during pregnancy. GDM was diagnosed using a 75-gram oral glucose tolerance test at 24-28 weeks. Primary outcomes included umbilical cord arterial blood gas measures (potential of hydrogen pH, partial pressure of carbon dioxide PCO2, partial pressure of oxygen PO2, bicarbonate HCO3, and base deficit). The neonatal outcomes were measured as secondary outcomes. Statistical analyses utilized Chi-square, Fisher's exact, and independent t-tests. Results: Data from 430 pregnancies, including 87 with GDM, were analyzed. Pregnancies with GDM showed significantly lower pH (7.33 +/- 0.08 vs. 7.36 +/- 0.06, P-value = 0.006) and greater base deficit (-1.82 +/- 3.79 vs. -0.50 +/- 2.74 mEq/L, P-value = 0.003). However, no significant between-group differences were observed in PCO2, PO2, or HCO3 (P-value > 0.05). Furthermore, we observed no significant differences in the mean birthweight, 1-minute, or 5-minute Apgar scores (P-values > 0.05), while neonates in the GDM group required more resuscitation (28.7% vs. 12.0%, P-value < 0.001) and neonatal intensive care unit admissions (34.5% vs. 16.9%, P-value < 0.001). Conclusions: Pregnancies with GDM showed higher umbilical cord blood acidity, indicating impaired placental function and reduced fetal oxygenation. These findings underscore the need for enhanced monitoring, such as regular fetal surveillance and close glycemic control, along with timely interventions like early neonatal resuscitation protocols and preparedness for neonatal intensive care unit admissions, to mitigate impaired fetal oxygenation in GDM
Magnetic resonance imaging-based biomarkers of multiple sclerosis and neuromyelitis optica spectrum disorder: a systematic review and meta-analysis
No full textBackground/Objective Multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) are neuroinflammatory conditions with overlapping clinical and imaging features. Distinguishing between these diseases is crucial for appropriate diagnosis and management. Magnetic resonance imaging (MRI) may have the potential to differentiate these disorders. Nonetheless, studies exhibit inconsistencies regarding which MRI measurements most effectively distinguish between these disorders. Hence, this review aimed to evaluate the differences in MRI volumetry between people with MS (PwMS) and people with NMOSD (PwNMOSD). Methods A systematic search was conducted across PubMed/MEDLINE, Embase, Scopus, and Web of Science up to May 12, 2024, to identify studies assessing conventional and volumetric MRI in PwMS and PwNMOSD. The standard mean difference (SMD) of MRI measurements and its 95 confidence interval (CI) were estimated using R version 4.4.0 with a random-effects model. Results Forty-eight original studies that assessed conventional MRI measurements in 2592 PwMS and 1979 PwNMOSD were included. The meta-analysis revealed that PwMS had significantly higher T2 lesion volume (SMD = 1.51, 95 CI: 0.53 to 2.48, p = 0.002) and T1 lesion count (SMD = 1.08, 95 CI: 0.56 to 1.6, p < 0.001) than PwNMOSD. PwMS also exhibited significantly reduced thalamic volume (SMD = -1.26, 95 CI: -1.8 to -0.73, p < 0.001) and grey matter volume (GMV) (SMD = -0.65, 95 CI: -0.92 to -0.37, p < 0.001). Other MRI volumetry, such as the brain and putamen volumes, showed more pronounced atrophy in PwMS. Conclusion Significant differences in MRI volumetry between MS and NMOSD highlight the potential of MRI as a critical diagnostic tool. These findings emphasize the need for standardized MRI protocols and advanced imaging techniques to enhance diagnostic accuracy and clinical management of these conditions
Exploring STK3 in melanoma: a systematic review of signaling networks and therapeutic opportunities
No full textMelanoma is an aggressive cancer that disregards both the MAPK and Hippo signaling pathways. This systematic review explores STK3 function in the Hippo pathway to regulate networks and its therapeutic potential in melanoma. From 1991 to 2024, we studied how STK3 interacts with the MAPK/ERK pathway to promote apoptosis and inhibit tumor growth. STK3 controls cell growth, apoptosis, and metastasis via the Hippo and MAPK pathways. It is a melanoma tumor suppressor. Some ways to target STK3 are to directly activate it, stop downstream effectors like YAP/TAZ from working, or use existing BRAF inhibitors together with other methods. Despite advancements, challenges in STK3 drug development persist, warranting further investigation. This review examined the role of STK3 in the development of melanoma and identified potential vulnerabilities for therapeutic intervention
Diabetic Healthy Eating Index (DHEI) in relation to blood sugar levels in children with type 1 diabetes
No full textBackground Diet quality can effect on blood sugar control in diabetic patients. Objective This study purposed to evaluate quality of the diet, its relationship with blood sugar levels in diabetic children. Methods This cross-sectional study was conducted on 82 patient aging 3 to 18. Individual data were collected via questionnaires. Patient's diet quality was evaluated with the Diabetes Healthy eating Index (DHEI) and collected data were analyzed. Results DHEI average score was 39.1 +/- 7.8 which was weak. In case of compliance to nutritional recommendations, the highest percentage for good compliance was observed for five index components including, trans fatty acids (100), cholesterol (73.0), vegetable (59.8), dairy and saturated fatty acids (59.8), carbohydrate and fiber (57.30). Poor compliance was observed for three index components including, oil and fat (81.70), fruit (59.8), meat and eggs (52.40). Moderate compliance was observed for diversity (92.70) and total fat percentage (78). No significant linear relationship was observed between DHEI and blood sugar levels. After adjustment for potential confounders, those in the higher than median of DHEI compared with the lower than median had lower odds of high fasting and post-prandial blood sugar, but this association was not significant. Conclusion Low diet quality, defined as a DHEI score < 50, was observed in this population that needed modification. No relationship was found between DHEI and blood sugar control. Proper nutritional education seems necessary for diet quality improvement and blood sugar control
Comprehensive Iranian guidelines for the diagnosis and management of maple syrup urine disease: an evidence- and consensus- based approach
No full textMaple Syrup Urine Disease (MSUD) disease is a defect in the function of the Branched-chain 2-ketoacid dehydrogenase complex (BCKDH). It is caused by pathogenic biallelic variants in BCKDHA, BCKA decarboxylase, or dihydrolipoamide dehydrogenase. The brain is the major organ involved in MSUD. MSUD happens in about 1 in 86,800 to 185,000 live births. According to some diversity in the management of Iranian patients with MSUD, the development of a national guideline is essential. This guideline is provided through a literature search on articles in PubMed, Scopus, Web of Sciences, Cochrane, and Embase databases from 2001 to 2022 accompanied by a consensus of physicians of different centers in Iran who are experts in the diagnosis and management of this disease. This article considers pathogenesis, epidemiology, clinical manifestations, diagnosis, treatment, and monitoring of MSUD patients with limited recourse
The Association of Diet With High Phosphatemic Index With Odds of Nonalcoholic Fatty Liver Disease
No full textAim: A high intake of dietary phosphorus with an effect on the serum phosphorus level may affect the health status and predict the occurrence of some clinical disorders. Therefore, in the current study, we aimed to determine phosphatemic index (PI) according to serum levels of phosphorus after intake of different foods and assess its association with the odds of nonalcoholic fatty liver disease (NAFLD).Methods: The current study was conducted with case-control design on 225 newly diagnosed NAFLD cases and 450 controls aged 20-60 years. Dietary intake data were collected by a validated food frequency questionnaire. The PI was calculated as the area under the curve (AUC) of serum phosphorus after eating test food divided by the AUC for the food supply containing an equal quantity of phosphorus. Multivariable logistic regression models were used to evaluate the NAFLD odds according to tertiles of the PI score.Results: The median (IQR) of dietary PI in participants of case and control groups was 83.9 (55.8-114.2) and 82.1 (52.6-119.6), respectively. In the age and sex-adjusted model, there was no statistically significant association between PI and the odds of NAFLD (OR = 1.47; 95 CI: 0.98-2.19, Ptrend = 0.065). However, in fully adjusted model, after controlling the effects of age, sex, waist-to-hip ratio, smoking, dietary intake of energy, dietary fiber, physical activity, and socioeconomic status, the odds of NAFLD increased across tertiles of PI (OR = 1.97; 95 CI: 1.08-3.58, Ptrend = 0.028).Conclusions: Our results suggested that a diet with a higher PI score may contribute to an increase in the odds of NAFLD independent of common confounders
Development and Evaluation of SYBR Green Real-Time PCR for Rapid and Specific Identification of Trichophyton indotineae
No full textBackgroundSince 2017, dermatophytosis caused by the newly introduced species Trichophyton indotineae has gained new interest worldwide due to the rise in terbinafine resistance and difficulty in the treatment of recalcitrant infections. Distinguishing T. indotineae from other Trichophyton species based on morphological features is impossible and DNA sequencing is necessary for accurate identification. Though early identification of the species is not solely sufficient for the treatment of infected cases, it is important for clinicians to take the next appropriate modalities such as antifungal susceptibility testing especially when the patients have extensive skin lesions recalcitrant to therapy by terbinafine. Here, we developed a rapid diagnostic scheme using SYBR Green real-time PCR for the specific detection/identification of T. indotineae.MethodsDNA was extracted from 397 dermatophyte isolates and two SYBR Green real-time PCR assays targeting the C120-287 and E054-58 intergenic loci were developed. Using a collection of 132 T. indotineae and 128 non-T. indotineae strains, all had already been identified by ITS-PCR-sequencing and 137 unknown dermatophyte isolates, the assays were evaluated.ResultsIn both real-time PCR assays, 130 out of 132 T. indotineae strains were positive while all non-T. indotineae species were negative. Among 137 unknown tested isolates, 72 were identified as T. indotineae based on two real-time PCR assays, while 65 showed no peak and were considered non-T. indotineae. Based on PCR-sequencing as the reference standard, the SYBR Green real-time PCR assays demonstrated a sensitivity of 98.48 and a specificity of 100.ConclusionThe developed diagnostic assays using SYBR Green real-time PCR provided a rapid and accurate method for the distinction of cultured T. indotineae isolates and can be considered to evaluate for the detection of T. indotineae directly from clinical samples
Severe Left Main Coronary Artery Stenosis as the First Finding in Newly Diagnosed Chronic Coronary Syndrome: Incidence and Clinical Predictors
No full textSevere left main coronary artery (LMCA) lesions (>= 50 stenosis) portend a poor prognosis and require urgent revascularization. In this study, we identified the incidence and clinical predictors of severe LMCA stenosis in patients with chronic coronary syndrome (CCS) who had undergone coronary angiography for the first time. Using a nationwide database registry, all the patients with CCS who had undergone coronary angiography were included. Patients were classified based on having severe LMCA stenosis and they were compared based on the recommended therapeutic strategy after angiography. A multivariable binary logistic regression model was developed to identify the potential predictors of a severe LMCA lesion. Among 40,161 patients with CCS, a severe LMCA lesion was detected in a total of 1556 participants (3.87 3.69; 6.07). The multivariable logistic regression identified age (odds ratio OR: 1.04 1.03;1.04), male gender (OR:2.56 2.28; 2.89), dyslipidemia (OR:1.19 1.06; 1.34), and peripheral arterial disease (PAD) (OR:3.68 1.06;12.83) as predictors of a severe LMCA stenosis. Approximately 4% of patients with newly diagnosed CCS may suffer from severe LMCA disease. Age, male gender, dyslipidemia, and PAD are among the predicting factors of a severe LMCA stenosis and can be utilized in risk stratification of patients with CCS at greater risk of severe LMCA stenosis
Prevalence and Clinical Parameters Associated With Chronic Total Occlusions in Patients With Chronic Coronary Syndromes: Insights From a Nationwide Registry
No full textBackground and Aims: The prevalence of coronary chronic total occlusions (CTO) among patients with chronic coronary syndrome (CCS) and their associations with clinical factors have received limited study. We analyzed a national database registry to determine the prevalence, location, and parameters associated with coronary CTOs. Methods: We identified all CCS patients without prior coronary artery bypass graft surgery (CABG) who underwent coronary angiography in the Persian CardioVascular Disease Registry (PCVDR). We compared the baseline demographics and characteristics of patients with vs. without at least one CTO lesion. We used logistic regression analysis to identify parameters associated with coronary CTOs. Results: Among the 40,161 patients with CCS who underwent coronary angiography between March 2019 and December 2023, 6805 (17.86) had at least one CTO. CTO patients were significantly older (64.43 +/- 8.96 years vs. 62.64 +/- 9.54 years, p < 0.001) and more likely to be men (75.3 vs. 54.4, p < 0.001). The left anterior descending artery (70.4) and right coronary artery (16.5) were the most common CTO lesion locations. Older age (adjusted odds ratio aOR 95% confidence intervals CI 1.024 (1.021-1.028), male gender (aOR 2.865 (2.685-3.058), any smoking (aOR 1.256 (1.145-1.378), diabetes mellitus (aOR 1.372 (1.288-1.460), and dyslipidemia (aOR 1.166 (1.096-1.239) were independently associated with the presence of a CTO. Conclusion: Approximately 1 in 5 CCS patients without prior CABG undergoing coronary angiography in this national database registry had a CTO. Advanced age, male gender, history of smoking, diabetes mellitus, and dyslipidemia were associated with higher likelihood of coronary CTOs