kayvan latifi

Cardiovascular diseases are the most important diseases of the elderly, and recently the effect of triglyceride glucose (TYG) index as one of the indicators of insulin resistance in type 2 diabetes and coronary artery disease has attracted the attention of researchers. Previous research has shown a link between insulin resistance and coronary artery calcification. Since triglyceride glucose index (TyG) is an index that is easily available, this study aimed to investigate the relationship between triglyceride index and fasting blood sugar and coronary heart disease and diabetes in the elderly of Amirkola.

This cross-sectional study was conducted on the elderly participating in the second phase of the Amirkola Health and Aging Cohort Study (AHAP). The elderly were divided into two groups of 200 people, the first group was diabetics with cardiovascular disease and the second group was diabetic elderly without cardiovascular disease. Patient information including age, sex, body mass index, diabetes, coronary artery disease, history of dyslipidemia, medications, triglycerides, fasting blood sugar, smoking habits, systolic and diastolic blood pressure, cholesterol, creatinine, physical activity, and HbA1c were collected in a checklist. The TYG index was calculated based on the LN formula [fasting triglycerides (mg/dl) × fasting glucose (mg/dl)/2]. Ultimately, SPSS version 25 software was utilized to describe the data using mean, standard deviation, and percentage. The qualitative variables were compared with the coronary artery disease using the chi-square test, while the quantitative variables were compared using the independent t-test in univariate analysis. Furthermore, the process of adjusting for confounding variables was carried out by using multivariate logistic regression.

In this study, 400 diabetic elderly participants were examined based on the relationship between triglyceride glucose index and coronary artery disease. The average age of the elderly with coronary artery disease was 70.46±6.10 and the elderly without coronary artery disease was 70.50±6.49 years. Triglyceride glucose index in diabetic elderly with and without coronary artery disease was 9.3±0.68 and 9.30±0.65, respectively, which was not statistically significant (P=0.92). Mean creatinine (P=0.004), number of comorbidities (P<0.001), and drugs consumed (P<0.001) were significantly higher in diabetic elderly with coronary artery disease. The probability of coronary artery disease in diabetic elderly with cholesterol above 200 mg/dL (OR=0.549, P=0.018) or use of antilipid drugs (OR=2.050, P=0.002) or more than three underlying diseases (356.4=OR- P=0.0001) had more. The mean cholesterol in diabetic elderly without coronary artery disease was significantly higher than that of elderly with coronary artery disease(P<0.001).

Based on the results of the study on diabetic elderly, glucose triglyceride index cannot be an independent risk factor and a suitable tool for the clinical forecast of coronary artery disease in Type 2 diabetes. Triglyceride glucose index alone cannot help in the prognosis of coronary artery disease and finally, the role of triglyceride glucose index in coronary artery diseases and various types of cardiovascular diseases needs more research.

Noninvasive ventilation (NIV) has been used as one of the most promising methods to treat hypoxic respiratory failure in COVID-19.

In this study, the clinical outcomes of 80 patients with acute respiratory failure caused by COVID-19 were evaluated. The disease was confirmed in two methods clinical and radiographic confirmation of disease in patients with an acute respiratory infection (highly suspected) or in some cases with a positive PCR test. The rate of discharge from the ICU without the need for intubation was evaluated as the primary outcome and based on that, the patients were divided into two groups: NIV failure and NIV success. Mortality rate, length of stay in ICU, frequency of intubated patients and laboratory factors of patients as secondary outcomes in two groups were compared.

Regarding the outcome of death and discharge, there was a statistically significant difference between the two groups. Therefore, all patients with corona who were admitted to ICU and received NIV and were intubated due to non-responsiveness to NIV died and the patients were discharged from the hospital without intubation. All the patients investigated in this study, had received antiviral, antibiotic, and glucocorticoid treatment during hospitalization. In this study, the patients who were in the NIV success group and were not intubated had a lower mean age compared to the group without NIV success (54 vs. 67 years, respectively). The number of white blood cells in the NIV success group was 3945.28±10011.21 and in the group without NIV success was 9242.38±17296.16, which was statistically significant (P=0.004). The number of blood neutrophils in the successful and unsuccessful NIV groups was 12.19±83.04 and 4.31±89.49, respectively (P=0.034). The mean APACHEII score in patients in the NIV success group (11.07±5.05) was significantly lower than the group without NIV success (20.16±4.96).

Mortality was higher in the intubated group than in the NIV group. The combination of APACHEII score and respiratory rate one hour after receiving NIV can predict success with NIV.

In patients with stroke, alongside diminished level of consciousness, impaired swallowing and aspiration pneumonia are also common. In some studies, angiotensin-converting enzyme inhibitors (ACEIs) have caused improved swallowing and reduced incidence of aspiration pneumonia in some patients. This study has examined the effects of captopril on reducing the extent of aspiration pneumonia in stroke patients.

A total of 68 patients with brain stroke and diminished level of consciousness hospitalized in Ayatollah Rouhani Hospital, Babol were chosen and randomly assigned into captopril and placebo groups. In the captopril group, in case of blood pressure above 100/70 mmHg, captopril was prescribed with a dose of 6.25 mg three times per day. In the placebo group, vitamin C was given, and in both groups in the case of hypertension, an antihypertensive drug other than ACEI was used. Age, gender, blood pressure, potassium level, and primary underlying diseases were recorded. The two groups were compared with each other daily for 14 days in terms of severity of incidence of pneumonia as well as hemodynamic changes in potassium.

A total of 68 patients with brain stroke were included in the study in two equal 34-subject groups. The two groups had no difference in terms of age, gender, systolic and diastolic blood pressure, initial potassium level, and underlying diseases. In the captopril group, 1 (2.9%) and in the placebo group 6 (17.6%) suffered pneumonia (P < 0.046). The two groups had no significant difference in terms of systolic and diastolic blood pressure, heart rate, and serum potassium.

The results of this study indicated that captopril is effective in reducing the extent of incidence of aspiration pneumonia in brain stroke patients.

Population aging is a global phenomenon and increase in the number of people over 60 yeas of age proves that the world is aging.  An important component of successful aging is maintaining muscle mass and its function throughout life. This study investigated the relationship between vitamin D serum level and muscle strength in the elderly as one of the important components of successful aging.

In this cross-sectional study, out of 1,616 people who participated in the Amirkla Elderly Cohort, 720 people were randomly selected by considering eligibility criteria. The participants were divided according to their Vitamin D serum concentrations: Vitamin D deficiency (20ng/ml>), inadequate (30ng/ml>Vitamin D>20ng/ml), and sufficient (30ng/ml<). Hand muscle strength was measured using DIGI Hand Dynamometer, and quadriceps muscle strength was measured by the MMT clinical grading system that was divided into weak and sufficient according to the standard cut-off point. SPSS V17 was used and data were analyzed using One-way ANOVA, Chi-square, and Spearman's correlation.

This study was conducted in 720 elderly people (360 men and 360 women) in Amirkola, north of Iran. Mean arm muscle strength was 25.84±9.8 and mean quadriceps muscle strength was 22.55±10.4. The average level of vitamin D was 35.15±33.73. There was no significant difference between the three groups in terms of arm and quadriceps muscle strength (P=0.272, P=0.370, respectively). In men, there was a positive correlation between BMI and arm muscle strength and quadriceps muscle strength (r=0.161, P=0.002 and r=0.168, P=0.0001). In women, there was a positive correlation between physical activity and arm muscle strength and quadriceps muscle strength (r=0.19, P=0.0001 and r=0.22, P=0.0001, respectively).

This study showed no significant relationship between serum vitamin D levels and muscle strength.

Traumatic brain injuries cause 14% of mortality in Iran. In this study we want to determine the relationship between laboratory findings and level of consciousness in patients with traumatic brain injury.

In this descriptive cross-sectional study, the data were collected by convenience sampling. 100 patients admitted to the emergency department of the 5th Azar Hospital in Gorgan, were diagnosed with brain trauma. Blood samples were taken from these patients up to 24 hours after injury, and the demographic characteristics of the patients were collected in a checklist. Data were analyzed by SPSS16 software.

The mean age of the patients was 26 ± 0.4 years. Laboratory findings in 100 patients included 73% leukocytosis, 60% increase in creatine phosphokinase (CPK), 82% increase in lactate dehydrogenase (LDH), 33% increase in ESR and 73% increase in protein acute phase (CRP). There was a significant and inverse relationship between the level of consciousness and the level of leukocytosis and creatine phosphokinase. Also, there was a significant relationship between the level of consciousness and acute phase proteins.

There was a significant correlation between the increases of three variables of parameters: leukocytes, creatine phosphokinase and acute phase proteins in patients with traumatic brain injury with decreased consciousness. Also, patients with higher level of consciousness and lower age had better prognosis. Due to the relationship between the level of consciousness and the Glasgow Outcome Scale, some laboratory findings can be used to estimate the level of consciousness and to determine the prognosis of traumatic injuries.

Sporadic lymphangioleiomyomatosis (S-LAM) is a rare disease that generally affects young women and involves the abnormal proliferation of smooth muscle cells (LAM cells) in the lungs (pulmonary LAM). There are two types of LAM, sporadic and LAM with tuberous sclerosis, which is an autosomal dominant genetic disease caused by mutations in the Tsc1 and Tsc2 genes. The most common manifestation of this disease is pneumothorax due to cyst rupture. Median transplant-free survival for pulmonary LAM is 23 years from diagnosis. Factors associated with a poor prognosis are often those associated with a more rapid decline in lung function.

The patient was a 24-year-old woman who presented with pneumothorax and multiple bullae in both lungs. The patient had no family history of respiratory disease, and the patient herself had no symptoms other than mild shortness of breath following activity from a year ago. A lung CT scan was performed for the patient and multiple bullae were evident in both lungs, which confirmed the diagnosis. There was no evidence of involvement of other organs but the lung. For the patient in the ICU with the diagnosis of left pneumothorax, a chest tube was inserted and she underwent mechanical ventilation. Finally, after 24 days of hospitalization, oxygen therapy of the patient was performed with a normal mask, and she underwent left lung pleurodesis with talcum powder, and a few days later, right lung pleurodesis was performed on the patient. On the 36th day of hospitalization, her general condition improved and she was discharged from the ICU. The patient was discharged in good general condition and had no problem on her four months follow-up.

Fortunately, with the diagnosis of LAM for the patient according to the CT scan of the patient's lung, she was treated with insertion of a chest tube and by performing pleurodesis, the recurrence of pneumothorax was prevented. In a young woman with spontaneous pneumothorax, sporadic LAM is one of the differential diagnoses.

Information on the coronavirus infection 2019 (COVID-19) which can clinically range from asymptomatic infection to severe pneumonia, in transplant recipients is still low. Infections are a major cause of death in kidney transplant recipients, and kidney transplant recipients, like other organ recipients, appear to be more vulnerable to a variety of infections due to comorbidities and immunosuppressive drugs that predispose them to infection.

In this study, we reviewed 10 transplant recipients with a mean age of 50.3±11.25 years who were admitted to Ayatollah Rouhani Hospital in Babol due to COVID-19 From April 2019 to September 2019. Four patients were female and six ones were male. Fever (100%) and cough (60%) were the most common symptoms in patients. All patients used standard immunosuppressive drugs (tacrolimus, corticosteroids, mycophenolate, and cyclosporine). The mean level of oxygen saturation at the time of admission in these patients was 87.9±11.3 and in two patients with death outcomes of 57% and 95%, it was at the beginning of hospitalization. The mean leukocytes of patients at the beginning of hospitalization was10470±5784.08 per ml and the mean lymphocytes of these patients were 1081.5±516.05. In the studied patients, the mean of previous years of transplantation was 8/05±7.13 and two patients died 20 years and 5 years after their kidney transplantation. Two patients (20%), aged 57 and 50 years, died from progressive respiratory symptoms and the other eight patients recovered and were discharged from the hospital.We reported COVID-19 infection in ten kidney transplant recipients with different clinical outcomes and periods, which may be a reference for the management of COVID-19 in such patients.

It seems that more information is needed to better understand the effect of anti-transplant immunosuppressive therapy on the outcome of COVID-19 infection in kidney transplant recipients. Long-term follow-up studies and more cases are needed to clarify the diagnosis, outcome, and treatment options for COVID-19 in these patients.

Thyroidectomy is a common surgery in the neck area, in which the application of platysma muscle suture after thyroidectomy is still being discussed. This study was conducted to compare the application (currently common) or non-application of suture for platysma muscle.

In this retrospective cross-sectional study, 117 patients underwent thyroidectomy, among which 63 cases without suturing platysma (control group) and 54 subjects with suturing platysma (Intervention group ) were examined in terms of postoperative pain based on visual analogue scale score measured 24 h post-operation. The samples were also investigated regarding hematoma and seroma, wound infection, length of hospitalization, scarring (1 year after surgery), duration of surgery, and the number of cases using opioids during the hospitalization. Patients with diabetes, previous neck surgery, coagulopathy, and radiation history were excluded from the study. The gathered data were analyzed statistically in SPSS software (version 18) using the Chi-square test and the Mann–Whitney U test. A p-value of less than (0.05) was considered significant.

Based on the findings, the mean age of the patients in the Intervention group was calculated at 51 years, of which 41 and 13 cases were females and males, respectively. In the Intervention group, 34 patients underwent complete thyroidectomy and 20 patients had hemithyroidectomy. The mean age score of subjects in the control group was calculated at 50 years, of which 44 and 19 patients were respectively female and male. No significant difference was revealed considering wound infection, length of hospitalization, created scarring, the amount of opioid use (opioids), and postoperative pain. However, only the length of surgery was different between the groups (P-value<0.05).

There was no difference between wound and surgical complications and cosmetic results between both groups; nevertheless, due to the duration of the surgery and other benefits, such as consuming less thread, not suturing the platysma is recommended.

The case report: The coexistence of physiological changes during pregnancy and infection can sometimes create challenges in the management of these patients. In this report, a term pregnant woman with COVID-19 infection was admitted to the ICU and underwent cesarean section (C-section) under intrathecal anesthesia according to the patientchr('39')s condition. Severe respiratory distress occurred to the patient on the first day after (C-section), and the patientchr('39')s pulmonary parameters were measured with a non-invasive ventilation monitor. It gradually improved during the four days after the C-section.  The C-section reduced the lung performance for 24 hours in a patient with COVID-19 infection, but eventually the lung symptoms improved.

Remifentanil is a narcotic drug used in anaesthesia for establishment of hemodynamic stability. The purpose of this study was to compare the effects of remifentanil and fentanyl on urine excretion.
In a randomized clinical trial, 60 patients, who were candidates for elective surgery for lumbar posterior spinal fusion, were divided randomly into two groups of 30 as remifentanil – propofol (R) and fentanyl- propofol (F). Maintenance of anaesthesia drugs in group R included 100 mcg/kg/min propofol and 0.5- 0.25 mcg/kg/min remifentanil. It included 100 mcg/kg/min propofol and 5- 0.5 mcg/kg/min fentanyl in group F. Vital signs and urine output were recorded every half an hour.
The mean age of patients was 49.5± 12.7 years. Urine output in group R showed significantly greater reduction than in group F (p Urine output in patients undergoing lumbar posterior spinal fusion who received remifentanil was less compared to the fentanyl group.