shahrzad mohseni

One of the most widely used anti-diabetic drugs is sulfonylureas, which is often used as one of the first-line drugs in the treatment of type 2 diabetes. Due to the effect of the patient's genetic structure on the drug response (personalized medicine), the identification of genetic variations not only reduces the rate of adverse drug reactions but can also predict the effectiveness of drugs. This study aimed to systematically review the pharmacogenomics of glibenclamide in type 2 diabetes.

This systematic review was performed based on PRISMA flowchart. Using the search terms including "variant", “sulfonylurea”, "glibenclamide", "diabetes mellitus", "SNP" or their equivalents, a comprehensive search of the PubMed, Scopus and Web of Science databases was conducted until January 1, 2021. An initial search yielded 125 articles.

Finally, in nine articles included in this systematic review, glibenclamide monotherapy was performed in 3032 patients. Most studies were conducted in China and the most common methods of genotyping were RFLP-PCR and direct sequencing. The most common genes studied were CYP2C9, KCNJ11 and TCF7L2. The results of studies showed a significant effect of CYP2C9 polymorphism on appropriate therapeutic response and KCNJ11 gene polymorphism on failure of glibenclamide treatment.

Among all genetic factors and specific genotypes of proteins involved in the metabolism of glibenclamide, CYP2C9 gene polymorphism has a role in proper response to treatment and KCNJ11 gene polymorphism has a role in treatment failure and hypoglycemic effects of glibenclamide.

 Many treatments make the life of coronary heart patients longer, but they require more psychosocial and spiritual support for a meaningful life. The aim of the present study was to determine the effect of a bioenergy economy (BBE)-based psycho-education package on improvement of vegetative function, forgiveness, and quality of life (QOL) of patients with coronary heart disease (CHD).

 In this clinical trial, using convenient sampling, 40 patients were selected from among patients referring to Bohlool Hospital in Gonabad, Iran, and were randomly assigned to the 2 case and control groups. First, the vegetative function checklist, Forgiveness Likelihood Scale, and World Health Organization Quality of Life (WHOQOL)-BREF questionnaire were completed for all the participants. Then, the case group received 8 sessions of group training for 180 minutes. After the training and the 1-month follow-up, both groups completed the questionnaires again. Finally, all data were analyzed using repeated measures analysis of variance (ANOVA) in SPSS software.

 The results showed a significant difference in heart rate, forgiveness, and QOL and its physical and psychological dimensions between the case group and control group after training (P < 0.05). The post hoc test showed that heart rate decreased significantly in the posttest compared to the pretest and forgiveness, and QOL and its physical and psychological dimensions increased significantly (P < 0.05). However, heart rate increased significantly in the follow-up compared to the posttest and forgiveness, and QOL and its physical and psychological dimensions decreased significantly (P < 0.05).

 It can be concluded that group education based on BEE as a complementary care system was effective on heart rate, forgiveness, and QOL and its physical and psychological dimensions.

Acromegaly is a rare disorder resulting from benign growth hormone (GH)-secreting pituitary adenomas in 90% of the cases. In recent years, many researchers have studied the Ki-67 index level of pituitary tumors and its relationship with demographics, biochemical parameters, clinical behavior, and recurrence rate. This study aimed to evaluate the correlation of Ki-67 index level with clinicoradiological and endocrinological parameters in confirmed GH-secreting pituitary adenomas, as well as with the surgical response and medical treatment after surgery. We collected the medical and pathologic records of 49 patients with GH-secreting pituitary adenoma who underwent surgeries from 2008 to 2017 in Shariati hospital affiliated to Tehran University of Medical Sciences. According to MRI reports, 94% of the tumors were macroadenomas. The MRI findings also revealed the median maximal adenoma diameter of 18.5 mm. About 40% of the patients achieved remission three months after the surgery. Younger patients had a significantly higher Ki-67 index level (P = 0.036). We did not observe any significant difference in the Ki-67 index level regarding gender, tumor type, maximal tumor diameter, tumor invasiveness, tumor secretory type, and remission. Interestingly, the Ki-67 index level was negatively correlated with the insulin-like growth factor-1 (IGF-1) level at the last follow-up (P = 0.02). In logistic regression analysis, patients with higher preoperative GH serum levels had a better outcome. Our results indicated a negative correlation between age and Ki-67 index level. However, there was no association between the Ki-67 index level and some tumor behaviors, as well as short- and long-term remission.

Endometriosis is a debilitating disorder, defined as the presence of endometrial gland and stroma outside of the uterus. It may affect angiogenesis and vascular endothelial growth factor (VEGF) is one of the angiogenic factors that plays an important role in both physiological and pathological angiogenesis. The present study aimed to evaluate the association of VEGF -2549 insertion/deletion (I/D) polymorphism with endometriosis. This case-control study enrolled 244 (100 cases and 144 controls) women who were admitted for laparoscopy or laparotomy for gynecological procedures. Genomic DNA was separated from peripheral blood leukocytes and polymerase chain reaction amplification was performed for genotyping of the VEGF gene Insertion/Deletion (I/D) polymorphism. The frequency of the II, ID, and DD genotype was 14%, 52% and 34% in patients versus 18.8%, 47.8% and 34% in controls. The results did not provide any evidence supporting the endometriosis risk related to the VEGF polymorphism in Iranian women population.

A 16-year-old girl was referred for the evaluation of headache exacerbation and progressive loss of visual field from one month ago. She also suffered from intermittent diarrhea since 12 months ago and secondary amenorrhea, headache, weight loss (4 – 5 kg) and weakness from six months ago. She had a history of transient polydipsia and excessive urine output during this period. Brain Magnetic Resonance Imaging (MRI) reported a 15 x 15 x 9 millimeters mass lesion in the sellar region. It was extended to the suprasellar cistern with mild compression of the optic chiasm and mild thickening of the pituitary stalk with posterior displacement were reported. In an exisional biopsy of pituitary stalk lesion, the pathology result was indicative of Langerhans cell histiocytosis (LCH). The patient underwent four periods of chemotherapy with prednisolone and vinblastin in 28-day intervals followed by one cycle of radiation therapy. In three months follow up after treatment the tumor size was reduced, Levothyroxin and Prednisolone were tapered, and pituitary hormones were improved.

Prophylactic oral calcium supplement has been proposed in patients undergoing thyroidectomy in order to decrease incidence of postoperative hypocalcemia, and the duration of hospital stay. This study aimed to assess the effects of prophylactic oral calcium in patients undergoing total or subtotal thyroidectomy. Forty three patients who were scheduled for total and subtotal thyroidectomy, were randomly allocated to the case (n=23) and control (n=20) groups. Oral calcium carbonate (1 gram q 8 hours) was given to the patients in the case group starting 12 hours before surgery till 7 days post thyroidectomy. Clinical symptoms of hypocalcemia and postoperative calcium levels were compared between the two groups. The mean postoperative calcium level 12 hours after surgery was not statistically different between the two groups (8.9±0.5 vs. 8.5±0.7, p=0.092); while after 24 hours, calcium level was significantly lower in the control group (8.9±0.5 vs. 8.4±0.8, p=0.037). The number of patients who had paresthesia was significantly higher in the control group than case group, at both 12 hours (p=0.02) and 24 hours postoperatively (p=0.04). Duration of hospitalization was significantly lower in the case group compared to the control group (p=0.006). Prophylactic oral calcium supplementation decreases the hypocalcemia related paresthesia after thyroidectomy and shortens duration of hospital stay.

Peripheral lymph nodes, located deep in the subcutaneous tissue, clean antigens from the extracellular fluid. Generally, a normal sized lymph node is less than one cm in diameter. Peripheral lymphadenopathy (LAP) is frequently due to a local or systemic, benign, self-limited, infectious disease. However, it could be a manifestation of underlying malignancy. Seventy-five percent of all LAPs are localized, with more than 50% being seen in the head and neck area. LAP may be localized or generalized. Cervical lymph nodes are involved more often than the other lymphatic regions. Generally, it is due to infections, but most of the supraclavicular lymphadenopathies are associated with malignancy. Based on different geographical areas, the etiology is various. For example, in tropical areas, tuberculosis (TB) is a main benign cause of LAP in adults and children. Complete history taking and physical examination are mandatory for diagnosis; however, laboratory tests, imaging diagnostic methods, and tissue samplings are the next steps. Tissue diagnosis by fine needle aspiration biopsy or excisional biopsy is the gold standard evaluation for LAP. We concluded that in patients with peripheral LAP, the patient’s age and environmental exposures along with a careful history taking and physical examination can help the physician to request step by step further work-up when required, including laboratory tests, imaging modalities, and tissue diagnosis, to reach an appropriate diagnosis.

Hand ischemia is a rare complication of diabetes and some other chronic vascular diseases. Critical hand ischemia causes painful limbs and disability and requires urgent revascularization. There have been a few reports of successful trans-brachial percutaneous angioplasty in the upper extremity in the radial or ulnar artery. Herein, we report the results of the endovascular treatment of a 68-year-old diabetic patient with an ischemic hand ulcer due to the severe stenotic lesions of the infra-brachial arteries. The patient underwent successful angioplasty via the retrograde trans-femoral technique to avoid the drawbacks. At the first week of post-procedural follow-up, the patient’s finger was warm with a well–healing wound and reduced pain. In the next two months, he had no complaint of pain or active ulceration; the ulcer was well healed, and the hand was warm.The present case shows that history taking and physical examination should be followed by upper-extremity arteriography for the evaluation of hand ischemia. The trans-femoral approach enabled us to perform percutaneous catheterization for both diagnostic and interventional purposes. Not only is this strategy useful even for the severe stenotic disease of the distal parts of below-the-elbow arteries but also it avoids the unpleasant complications of antegrade brachial cannulation.

Transsphenoidal surgery (TSS) is the most effective treatment for acromegalic patients, and two major factors that have been suggested as useful predictors in assessing this therapy’s success are: tumor size and preoperative basal growth hormone (GH) levels. The aim of this study was to illustrate the relationship between some predictor factors and transsphenoidal surgery (TSS) outcomes and its remission rate.Patients and A total of 20 patients underwent TSS by 4 neurosurgeons in 4 university hospitals in Tehran and were followed up for 1 year. An oral glucose tolerance test was performed at 1 week after surgery and then 3, 6, and 12 months after surgery. Moreover, Insulin Growth Factor- 1 (IGF-1) was measured at 6 and 12 months after surgery. Initial remission was observed in 7 (35%) patients with a recurrence rate of 10%. The nonresponse rate was 55%. The analysis showed a significant relationship between IGF-1 and surgery outcome in the cured patients at 6 months after surgery (P = 0.005). No significant statistical relationship was found between tumor size and the TSS outcome (P = 0.696). Given the high failure and recurrence rates following TSS in Iran, it seems important to pay more attention to diagnosing the disease earlier and improving surgical methods.