Acta Medica Iranica
Volume:58 Issue: 4, Apr 2020

Adipose tissue-derived hormones known as adipokines, like leptin, have multiple bioactions. Notwithstanding the key roles of leptin in regulating energy homeostasis and metabolism, its cardiovascular functions are complex and not fully understood. This study aimed to investigate the association between serum concentrations of leptin and lipid profiles in patients with valve calcification. Seventy-two patients with valve calcification and 72 healthy individuals participated in this case-control study. The serum levels of biochemical markers and leptin were measured by the standard enzymatic methods and enzyme-linked immunosorbent assay (ELISA) technique, respectively. Significantly increased serum concentrations of FBS (P=0.001), urea (P<0.0001), creatinine (P=0.018), P (P<0.0001), LDL-C (P=0.011) and lower Ca (P=0.006), and HDL-C (P<0.0001) levels were observed in patients compared to controls. There was no significant difference in the serum level of TG and TC of patients than controls. Systolic and diastolic blood pressures were significantly increased in patients relative to controls (P<0.0001). However, a significantly diminished serum level of leptin was observed in patients than controls (P<0.0001). The correlation analysis demonstrated that the serum leptin concentration is negatively correlated with creatinine, but it is positively correlated with systolic blood pressure (P=0.0302, P=0.0362, respectively). There was no statistically significant association between serum levels of leptin and lipid profiles. Our findings indicated dyslipidemia and reduced serum leptin concentrations in patients with valve calcification, suggesting the role of lipid abnormalities and reduced leptin levels in the development and pathogenesis of valve calcification diseases.

Insulin resistance in gestational diabetes increases maternal and fetal complications. Tumor necrosis factor-alpha (TNF-α) is an inflammatory factor associated with insulin resistance. The aim of this study was to determine the association between pregnancy serum TNF-α level and postpartum insulin resistance in patients with gestational diabetes mellitus. 50 pregnant women, including 25 cases of gestational diabetes and 25 healthy pregnant women, were evaluated. First, during the third trimester of pregnancy, serum TNF-α level of all cases were measured. Two months after delivery, based on the obtained results from insulin levels and a 2-hour glucose tolerance test, HOMA-IR and HOMA-B were calculated, and the association between serum TNF-α level and insulin resistance was determined. Data were analyzed using independent t-test, Mann-Whitney, and chi-square test in SPSS software. The mean serum level of TNF-α in women with gestational diabetes mellitus was higher than healthy subjects, but there was no significant difference between the two groups. The serum level of insulin, HOMA-IR and HOMA-B indices in women with gestational diabetes mellitus were higher than healthy subjects, with a significant difference in all of the measures between two groups (P=0.0001). There was no significant correlation between TNF-α and HOMA-IR levels in insulin-resistant mothers two months after delivery (r=−0.33). Also, no significant correlation was detected between pregnancy TNF-α levels and HOMA-B index. Despite the higher serum levels of insulin, HOMA-IR, and HOMA-B in the diabetic group, the serum TNF-α level did not show any correlation with insulin resistance after delivery.

Various methods are used in order to describe the heart rate patterns of the fetus. The use of electronic monitoring during labor is widely accepted today. The aim of this study was to compare the neonatal outcomes of continuous Fetal Heart Rate (FHR) monitoring to intermittent auscultation among low-risk pregnant women during labor. This randomized clinical trial was conducted among 900 low-risk pregnant women who met inclusion criteria and were admitted to maternity wards of academic hospitals of Mashhad University of Medical Sciences for labor. They were randomly divided into two groups: the intermittent auscultation group and the Continuous FHR monitoring group. The pregnancy and neonatal outcomes were compared in two groups; data were processed in SPSS16 software. P less than 0.05 was considered as significant level. In this study, the first and fifth minutes Apgar scores, the rate of NICU admission, advance resuscitation requirement, neonatal seizure incidence, and the neonatal or fetal death did not differ significantly between two groups (P>0.05). In the Continues monitoring group, the rate of cesarean section due to fetal distress and operative vaginal delivery was significantly higher rather than the other group (P=0.001). The results of this study showed that continuous FHR monitoring in low-risk pregnancies during labor increases the risk of cesarean and instrumental delivery without improving neonatal outcomes.

The experience of pre-operative anxiety in patients is a common and accepted issue; however, anxiety can potentially increase the patients' need for care, the level of post-operative pain, and ultimately patients' morbidity and mortality. The goal of this study was to determine the patients' pre-operative anxiety level right before they undergo surgery in the operating room. This study was conducted as a prospective cross-sectional study. Accordingly, completed State-Trait Anxiety Inventory questionnaires as well as demographic and contextual variables of 230 patients undergoing surgery were evaluated. Data analysis was taken out using SPSS v24. P of less than 0.05 was considered significant. 230 patients with an average age of 48.95 (14.68) years were enrolled. The frequency of mild, moderate, and severe anxiety among the patients was 50.8%, 37%, and 12.2%, respectively. The analysis revealed that the patients' age, gender, occupation, awareness about the type of anesthesia, and place of residence, as well as the type of anesthesia, had no significant correlation with the patients' pre-operative anxiety. However, a significant difference was found regarding patients’ pre-operative anxiety level and their educational, marital, awareness of post-operative complications, and trait anxiety status as well as their history of anesthesia. Therefore, to reduce post-operative complications, it is recommended that the patients with these characteristics be given priority for interventions aimed at reducing pre-operative anxiety.

Estimation of breast tumor size is one of the most important diagnostic measures in determining the appropriate treatment. Mammography and ultrasound are the main methods for determining the size of breast tumors. The aim of this study was to compare the correlation between tumor size calculated by breast ultrasound and mammography with the results of pathologic measurements in malignant breast masses. Patients diagnosed with breast cancer by pathologic examination underwent mammography and ultrasound to determine the size of the tumor. The largest observed diameter in ultrasound and mammography was recorded as the tumor size. The mean (SD) tumor size measured by ultrasound (23.58±9.38 mm) was significantly less than the actual size based on histopathologic examination (28.87±11.17 mm) (P=0.008). However, there was no significant difference between the measurements performed between mammography (26.54±10.46 mm) and histopathology (P=0.18). The correlation coefficient between mammography and pathologic examination (r=0.61) was higher than the correlation coefficient between ultrasonography and pathology (r=0.5). Mammography, compared to breast ultrasound, had better accuracy in determining the size of malignant breast masses.

Anesthetized patient management for pediatric patients with pulmonary arterial hypertension (PAH) is a major challenge. The aim of this study was to evaluate the ability of dexmedetomidine to reduce pulmonary arterial hypertension in patients with pulmonary arterial hypertension undergoing cardiac surgery. Sixty-six patients with pulmonary arterial hypertension underwent the study. Patients were randomly divided into two groups: group D received a dexmedetomidine injection in a dose of 1 μg/kg in the first hour and then decreased to 0.5 μg/kg/hr, injection continued after surgery until extubation in the post-anesthetic care unit (PACU). Group C received normal saline 0.9% in a similar volume. Pulmonary artery systolic pressure (PASP) and systemic systolic blood pressure (SSBP) were recorded during and after the surgery in the post-anesthetic care unit. Needing vasodilators, sedatives, extubation time, and the length of ICU stay were recorded for all patients. Patients in the dexmedetomidine group showed a significant reduction in Pulmonary artery systolic pressure and Pulmonary artery systolic pressure/systemic systolic blood pressure rates during surgery and during the first 24 hours in the post-anesthetic care unit (P<0.001). The dexmedetomidine group, in comparison with the control group, needed a significantly lower dose of a vasodilator (P<0.001) and a lower dose of sedation (P<0.001). It is concluded that the use of dexmedetomidine during the surgery in children with pulmonary hypertension reduces pulmonary artery systolic pressure during and after the surgery.

Occult hepatitis B (OBI) is a major challenging clinical entity characterized by the absence of hepatitis B surface antigen (HBsAg). The persistence of OBI may progress to fibrosis, cirrhosis, and hepatocellular carcinoma. This study was aimed to investigate the prevalence of OBI among HD patients. In the present cross-sectional study, 89 sera samples of hemodialysis individuals were tested for HBsAg and HBc-IgG by Enzyme-linked Immunosorbent Assay (ELISA). In addition, the HBV DNA has tested in sera and peripheral blood mononuclear cell (PBMC) samples by nested-PCR. Out of 89 patients, 51(57.3%) were males, and 38 (42.7%) females. The ages ranged from 24 to 90 years (with a mean of 57.5±1.37 years). All the sera samples had normal levels of Aspartate Aminotransferase (AST) and Alanine Transaminase (ALT) but had high levels of Creatinine (Cr) (6.9±2.17) and Blood Urea Nitrogen (BUN) (61.83±2.03). 2/89 (2.2%) sera samples were positive for both HBsAg and HBc-IgG test; in addition, HBV DNA was detected in both sera and their PBMC samples. The sera of 15/89 (16.85%) were only positive for the HBc-IgG test, including 10/51 (19.6%) males and 5/38 (13.2%) females (P=0.5). The high 16.85% prevalence OBI has been found among HD patients. To manage OBI infection, screening of HBV DNA should be implemented for HD patients by sensitive molecular means such as nested-PCR and real-time PCR.

- To evaluate the correlations between changes in radiological parameters and clinical outcomes following adult spinal deformity (ASD) surgery. Radiological assessments are necessary for evaluation of deformity magnitude and choosing the appropriate surgical approach. Some studies have demonstrated the correlation between radiological parameters and pain and disability among patients. However, few studies have evaluated changes in both coronal and sagittal radiological parameters following the surgical treatment of ASD and its correlation with clinical outcomes. Radiological parameters include: pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS), lumbar lordosis (LL), and PI minus LL (PI-LL), and Cobb’s angle and three clinical outcome measures include: visual analog scale (VAS), Oswestry Disability Index (ODI), and Short Form-36 health survey (SF-36), were assessed at baseline and 6 and 12 months after surgery. A total of 95 patients were included. Mean VAS scores and ODI significantly improved from 7.09±2.1 and 61.07±13.6 to 2.64±1.6 and 31.8±16.1 respectively, after surgery (both P<0.001). All items of the SF-36 survey, as well as all radiologic measures, improved significantly following surgery (both P<0.001). We found a significant negative correlation between pre-operative SS and VAS scores (r= -0.307, P=0.002). Energy (r= -0.262, P=0.010) and social functioning (r= -0.248, P=0.015) scales of SF-36. PI-LL was positively associated with ODI (r=0.223, P=0.030) before surgery and energy scale (r= -0.262, P=0.010) of SF-36 after surgery. Surgical treatment of patients with ASD improves clinical outcomes, and in line with previous studies, restoration of sagittal alignment has a more important role in the enhancement of patients’ function and quality of life.

Numerous variations of vessels arising from the aortic arch have been reported. One of the common anatomical variations in the right subclavian artery originating as the last branch of the aortic arch. This report demonstrates two cases of the retroesophageal right subclavian artery in an adult male and female. To highlight the significance of a retro esophageal right subclavian artery, especially its clinical and surgical implications. Multi-slice computed tomography (CT) of a case of an anomalous vessel. This report shows a retro esophageal subclavian artery originating as the last branch from the postero-lateral aspect of the thoracic aorta at the vertebral level T4. No abnormality was seen neither in the heart nor in no other vascular system in this region. Radiologists mainly encounter a retroesophageal right subclavian artery incidentally and are usually described as asymptomatic, but several clinical conditions have been associated with this kind of occurrence.