Acta Medica Iranica
Volume:60 Issue: 5, May 2022

Multiple Sclerosis (MS) is a common chronic disease that affects society, especially young people. In recent years, data sciences have been used extensively to deal with the disease. Machine learning is one of the main data sciences types which has been used to deal with chronic diseases such as MS. This study aimed to identify the applications of machine learning algorithms in MS disease. This study is a systematic review that conducted in 2020. The searches were done in PubMed, Scopus, ISI Web of Sciences, Ovid, Science Direct, Embase, and Proquest scientific databases, by combining related keywords. Data extraction was done by using a data extraction form to follow the trends of this field of study. The results of the study showed that diagnosis of MS was the main application of machine learning in MS (33.3 %); also, assessment (24.24%) and prediction (18.18 %) of the disease were other main applications. The most used data type was medical images such as MRI and CT scans (55.17 %). The most used machine learning algorithm type was Support Vector Machine (SVM) (30 %) as a classification algorithm. The most optimized algorithm for the diagnosis and prediction of MS was KNN. It’s suggested to use machine learning algorithms to diagnose, assess, predict lesion classification, treatment, and severity determining of MS disease. Although the most common form of data used for MS is medical images, it is suggested that other types of data are generated to be used in machine learning algorithms. Considering the optimization rate of the algorithms used, it is suggested to pay more attention to the type of data and study objectives in data analysis using machine learning.

Fibromyalgia (FM) is a chronic musculoskeletal syndrome characterized by pain and fatigue; however, its etiology remains unknown, and various hypotheses and biomarkers have been proposed. This study it is aimed to investigate blood biomarkers in the pathogenesis of FM. The current case-control study has been conducted on 45 females with the documented diagnosis of FM and 45 healthy controls referring to the outpatient clinic of rheumatology in 2018-19. The serum levels of dehydroepiandrosterone (DHEAS), erythrocytic sedimentation rate (ESR), C-reactive protein (CRP), complete blood count (CBC), and thyroid-stimulating hormone (TSH) was measured and compared between the groups. DHEAS serum levels in cases and controls were 27.55±18.80 and 33.55±21.80, (P=0.16), ESR was 29.17±9.75 and 17.37±2.82 (P<0.001), CRP was 4.17±1.53 and 3.53±1.15 (P=0.02), TSH was 3.307±0.27 and 3.41±0.22 (P=0.09), respectively. The two groups were similar in CBC indices, including hemoglobin, hematocrit, white blood cell, lymphocyte, neutrophil, and platelet count (P>0.05). DHEAS was slightly, but insignificantly, lower among the females with FM than healthy cases. On the other hand, the serum ESR and CRP levels were remarkably higher among the females with FM; however, in the normal range, a fact representing the possible traces of inflammation in the pathogenesis of FM.

Acute exacerbations are the important reasons for hospitalization and death in chronic obstructive pulmonary disease (COPD) patients. We aimed to evaluate the relationship between serum concentrations of cardiac troponin I (cTnI) and the outcome of COPD patients visiting the emergency department with acute exacerbation of COPD (AECOPD). In this study, we included 90 AECOPD patients between October 2018 and October 2019. Serum cTnI was measured during the first 24 and 48 hours after admission. Patients were categorized into two groups positive cTnI values (≥0.3 ng/dl) and negative cTnI (<0.3 ng/dl). The outcomes of patients were compared between the two groups. Patients in Positive cTnI group in the first 24 hours and 48 hours compared to patients in negative group had significantly higher rate of in-hospital [(66.7% vs. 3.7%, P<0.001) and (50.0% vs. 3.8%, P<0.001), respectively)] and 30-day mortality rates [(88.9% vs. 3.3%, P<0.001) and (66.7% vs. 5.1%, P<0.001), respectively)]. The number of cases requiring intubation [(100% vs. 12.3%, P<0.001) and (75.0% vs. 12.8%, P<0.001), respectively)] and cardiopulmonary resuscitation (CPR) [(100.0% vs. 5.5%, P<0.05) and (100.0% vs. 5.5%, P<0.001), respectively)] as well as the duration of intensive care unit (ICU) stay [(37.00±14.61 vs 9.83±4.93 days, P<0.001) and (37.00±14.61 vs 9.83±4.93 days, P<0.001), respectively)] were also higher in cTnI positive patients. Increased cTnI during AECOPD is associated with higher rates of CPR, need for mechanical ventilation and in-hospital, short-term mortalities, and a longer ICU stay.

 Fatigue is a common symptom in ankylosing spondylitis. Hypovitaminosis D is one of the factors influencing fatigue during inflammatory rheumatisms. This study aimed to determine the influence of vitamin D deficiency on fatigue in ankylosing spondylitis. In this cross-sectional study, 40 patients with ankylosing spondylitis and 40 patients suffering from low back pain were recruited. Clinical and laboratory data, including vitamin D dosage, disease activity, functional impairment, and quality of life, were evaluated using specific and validated scores. Fatigue was assessed by the FACIT-F score. Both groups of patients were compound of 27 men and 13 women with a mean of 43.55±12.26 years in the study group and 47.77±13.63 years in the case group, respectively. Ankylosing spondylitis was active according to the ASDASCRP score in 67.5% of cases. All patients were suffering from fatigue with a mean FACIT-F score of 21.13. Severe levels of fatigue were noted in 50% of cases. 92.5% of patients were vitamin D deficient with a mean vitamin D of 16.57±7.15 ng/mL. Factors associated with fatigue were: female gender (P=0.05), spinal pain (P<0.001), enthesitis (P<0.001), disease activity (P<0.001), functional impairment (P<0.001), and quality of life (P<0.001). However, smoking was the only factor related to vitamin D deficiency (P=0.05). Vitamin D level was not correlated with fatigue (r= -0.02, P=0.91). In our study, vitamin D status did not seem to have an impact on fatigue in patients with ankylosing spondylitis.

Breast cancer is the most common malignant tumor in women. Some factors, including histological grade, vascular invasion, and metastasis, are known prognostic factors. Many studies have been performed to find more predictive factors such as urokinase plasminogen activator system markers. Here, we tried to evaluate the relationship between Urokinase-type plasminogen activator receptor expression and other histopathologic parameters. 62 malignant breast tumors were enrolled. UPAR immunohistochemistry staining was performed on paraffin blocks. We evaluated the relationship between UPAR expression and histopathologic factors, including tumor size, tumor type, histologic grade, lymph node status, lymphovascular and perineural invasions, and hormone receptors status (ER, PR, and HER2). The patient's mean age was 46.18±10.35 years. We found a positive relationship between UPAR expression and the presence of carcinoma insitu (P=0.027). A negative relationship was observed between UPAR expression and lymph node involvement (P=0.01), the number of involved lymph nodes (P=0.027), and also intensity and percentage of UPAR positivity in the case with lymph node involvement (P=0.005 and 0.029, respectively). UPAR expression is associated with lymph node metastasis which is one of the most important predictors of prognosis in breast cancer. So, it could be used as a favorable prognostic factor in breast cancer.

Lung disease is a common and important contributor to morbidity and mortality in rheumatoid arthritis (RA) patients. Studies have shown that diagnostic methods can reveal hidden pulmonary diseases even in RA patients with no respiratory symptoms. In this study, we assessed pulmonary function tests (PFTs) and chest radiographs (CXRs) in RA patients with more than three years of illness to find a suitable instrument for prospecting RA-induced lung diseases. We conducted a prospective cross-sectional study on 57 RA patients. Demographic, clinical, and CXR data were recorded. Residual volume (RV), total lung capacity (TLC), forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and FEV1/FVC ratio was assessed. According to the FEV1/FVC ratio, patients were divided into three groups: FEV1/FVC below 70% (obstructive pattern) in 5% and between 70% and 85% (normal) in 50%, and above 85% (restrictive lung disease) in 45% of RA patients. Normal X-ray was the most common finding in CXR, and only cystic changes and reticular changes were found in 5% of patients. Analysis showed a significant relationship between abnormal chest images and the duration of disease (P=0.025), but PFT data did not result in any significance. Respiratory symptoms or clinical examinations are positive findings in the evaluation of asymptomatic patients, and using PFT is more rational than CXR. Our data show that there is no correlation between the disease duration and PFT data; hence, asymptomatic patients with a variety of risk factors should undergo further investigation.

Increasing number of patients with kidney stones is a major worldwide concern that needs more attention for recognizing the disease in order to set up suitable prevention systems. In this study, we aimed to assess the prevalence and related risk factors of kidney stones in our local area (Isfahan, Iran). In 2011, we celebrated World Kidney Day (WKD) with several training programs for informing people about kidney diseases. A questionnaire containing demographic data, past medical history, and familial and self-history of kidney disease was fulfilled by each individual who participated in WKD. Blood pressure and body mass index (BMI) were also measured using standard methods. Statistical analysis with SPSS-20 software was done. 556 participants with a mean age of 44.69±15.32 were included in the study, of which 107 cases (19.2%) with a mean age of 50.24±12.33 had a kidney stone, and 449 cases (80.8%) with a mean age of 44.69±15.32 had no history of kidney stone. There were no significant differences between those with and without kidney stones regarding sex (P=0.176), type of daily work (P=0.91), diabetes mellitus (P=0.64), and place of living (urban versus rural) (P=0.92) and BMI (P=0.26). However, there were differences between groups regarding age (P˂0.001), Hypertension (HTN) (P=001), Cardiovascular disease (CVD) (P=0.02), and familial history of kidney stone (P˂0.001). Out of 107 patients with kidney stones, the mean number of urinary excretion of stones was 2.56±2.98. We found a greater prevalence of kidney stones in our local area compared with data from other research studies. Despite some previous studies, comparison of people with and without kidney stones did not reveal differences in the prevalence of DM, type of daily work (low activity versus high activity), and obesity but differences in the field of HTN and CVD were seen.

SCC of the prostate is different from other adenocarcinomas in its treatment and prognosis. Here, the patient is a 57-year-old man with benign prostatic hyperplasia that underwent a prostatectomy and, after one month with hematuria and another follow-up radical cystoprostatectomy with lymphadenectomy and urethrectomy. After recovery, the patient experienced radiotherapy and chemotherapy sessions. So, from a review of other literature, we present our case report of squamous cell carcinoma of the prostate that is more aggressive than adenocarcinoma.

Acute hepatitis B cases with very high viral load are rare in communities. This study presents an experience of treating a patient suffering from severe acute hepatitis B with a very high viral load. A 38-year-old Iranian male was diagnosed with acute hepatitis B with early and progressive liver dysfunction and a very high viral load. Treatment with Tenofovir was started. The complete response to treatment was achieved with multidisciplinary management; the patient was discharged after a week. A history of not being vaccinated against the hepatitis B virus and the job conditions could be the main causes of increased risks for his illness. However, the high viral load can be considered as the cause of severe acute hepatitis B development. The prompt and accurate diagnosis followed by suitable treatment choice led to the most favorable outcome.