Journal of Research in Medical Sciences
Volume:25 Issue: 6, Jun 2020

Aortic stenosis (AS) is the most common primary valvular disease. Currently, there is no pharmacological approach for the medical management of AS. We investigated the effect of osteoporosis therapy with alendronate on hemodynamic progression in patients concurrently affected by AS and osteoporosis.

In this observational prospective study, we enrolled 37 women more than 60 years old with diagnosis of AS and concurrent osteoporosis from August 2017 to December 2019. These patients were treated with alendronate 70 mg every week added to their routine treatment for AS, and their outcomes were compared with 33 patients only affected by AS. Echocardiographic changes and N‑terminal‑prohormone of brain natriuretic peptide (NT‑pro‑BNP) level were evaluated during about 2 years of follow‑up.

The mean follow‑up time for the treated and nontreated groups was 20.89 ± 2.73 and 20.84 ± 2.76 months, respectively. Mean gradient (P = 0.02) and peak gradient (P = 0.04) of aortic valve were significantly different between the groups after follow‑up. Aortic valve area was decreased 0.09 cm2 in the treated group by alendronate and 0.23 cm2 in the other group (P = 0.001). Furthermore, NT‑pro‑BNP was significantly decreased in patients treated by alendronate (P = 0.01), but it was increased in nontreated patients (P = 0.04).

Treatment with alendronate in patients with AS and concurrent osteoporosis slows down the progression of stenosis and improves their prognosis. This study could open a new pathway for the treatment of AS. Further studies, particularly randomized controlled clinical trial, should be done for providing more evidence.

Nonalcoholic fatty liver disease (NAFLD) has become one of the major diseases plaguing worldwide. Several studies reported its association with ischemic heart disease (IHD). This study aims to determine the relationships between severity of steatosis with glycemic control and carotid intima‑media thickness (CIMT) among a high‑risk population of type 2 diabetes mellitus (T2DM) with proven IHD.

This was a cross‑sectional study involving patients aged between 18 and 65 years diagnosed with T2DM with IHD (n = 150). Ultrasonography of the abdomen to determine NAFLD severity category and CIMT measurements was performed by two independent radiologists. NAFLD was graded according to the severity of steatosis (NAFLD‑3, NAFLD‑2, NAFLD‑1, and NAFLD‑0). Comparison between different stages of NAFLD (NAFLD‑3, NAFLD‑2, NAFLD‑1, and NAFLD‑0) was analyzed using Chi‑square and analysis of variance tests for categorical and continuous variables, respectively.

The prevalence of NAFLD was 71% (n = 107). NAFLD‑1 was detected in 39% of the patients, 32% had NAFLD‑2, no patients with NAFLD‑3, and 29% had non‑NAFLD. There were no patients with NAFLD‑2 having higher systolic and diastolic blood pressure, weight, body mass index, waist circumference, total cholesterol, triglycerides, high‑density lipoprotein cholesterol, and low‑density lipoprotein cholesterol. Glycated hemoglobin (HbA1c) concentration was highest within the NAFLD‑2. NAFLD‑2 showed higher mean CIMT. Every 1% rise in HbA1c for patients with NAFLD significantly increases the CIMT by 0.03 mm (95% CI: 0.009, 0.052, P = 0.006).

These findings suggest additional atherosclerotic risks within the NAFLD‑2 group with significantly higher HbA1c and CIMT compared to the NAFLD‑1 and NAFLD‑0 groups. It is, therefore, vital to incorporate stricter glycemic control among patients with T2DM and IHD with moderate NAFLD as part of atherosclerotic risk management strategy.

One anastomosis gastric bypass (OAGB)/mini gastric bypass is now considered to be a safe and efficient method for morbidly obese patients but has complications and adverse events such as other surgical procedures. The present paper outlines the need for and the nature of revisional surgery in the long‑term following OAGB in accordance with the preferred reporting items for systematic reviews and meta‑analysis guidelines. A literature search was carried out in PubMed. All articles on OAGB for which the authors described a patient needing revisional surgery in the long term after OAGB were examined.

Type 2 diabetes mellitus (T2DM) is a metabolic disorder with growing prevalence and increasing economic burden. Based on the role of genetics and epigenetic factors on T2DM, we aimed to carry a systematic review and meta‑analysis for all miRNA gene polymorphisms and risk of T2DM.

A computerized literature search was carried out on PubMed, Web of Science, Scopus, Embase, as well as references of relevant review/meta‑analysis. Key search terms were “Diabetes Mellitus, Type 2,” “MicroRNAs,” and “Polymorphism, Single Nucleotide.” All types of observational studies from January 1, 1992, to November 30, 2019, were included, without language restriction. Data analysis was performed using R programming language (3.5.2). Level of heterogeneity was obtained by Cochran’s Q test (P ˂ 0.05), and subgroup analysis was performed based on ethnicity.

Thirty‑two polymorphisms from fifteen articles were included. Meta‑analysis was carried out based on minor allele frequencies. Seven studies with 2193 cases and 3963 controls were included for rs2910164 polymorphism. In subgroup analysis, there were significant results in Caucasian population in dominant model (odds ratio [OR] =1.12; 95% confidence interval [CI]: 0.83–1.51), homozygote model (OR = 1.78; 95% CI: 1.06–3.00), heterozygote model (OR = 1.77; 95% CI: 1.03–3.05), and recessive model (OR = 1.78; 95% CI: 1.07–2.96). Four studies with 2085 cases and 1933 controls were included for rs895819 polymorphism. Overall, there was no significant result for association with rs895819, but subgroup analysis revealed that minor allele significantly decreased the risk of T2DM in Caucasians by recessive model (OR = 0.34; 95% CI: 0.18–0.66), dominant model (OR = 0.70; 95% CI: 0.52–0.94), homozygote model (OR = 0.32; 95% CI: 0.16–0.62), heterozygote model (OR = 0.37; 95% CI: 0.19–0.74), allelic model (OR = 0.67; 95% CI: 0.52–0.85).

The minor allele of rs2910164 may increase the risk of T2DM by leading to lower level of miR‑146a. In contrast, minor allele of rs895819 may decrease the risk of T2DM by leading to higher level of miR‑27a.

The clinical relevance of epithelial‑to‑mesenchymal transition (EMT) in colorectal cancer (CRC) progression has been highlighted over the last decade. Several EMT‑inducing transcription factors (EMT‑TFs) have been implicated in the regulation of EMT, including Twist, Snail1, Slug, ZEB1, and ZEB2. Here, this meta‑analysis aimed to predict the risk of distance metastasis and overall survival in CRC patients with high expression of EMT‑TFs.

All eligible studies were searched in PubMed, Scopus, and Web of Science databases. The search was carried out to include literatures published as late as September 1, 2018. In overall, 16 studies that investigated the relationship between EMT‑TFs with distance metastasis and survival in CRC patients were included. In meta‑analysis, a pooled hazard ratio (HR) and odds ratio (OR) were estimated for associations.

The results of this review indicated that expressions of all EMT‑TFs are significantly correlated with poor overall survival in CRC. Moreover, there are a significant association between Twist (OR, 1.46; 95% confidence interval [CI], 1.03–2.09), Slug (OR, 3.43; 95% CI, 1.98–5.93), and ZEB2 (OR, 2.42; 95% CI, 1.09–5.40) expression with distance metastatic in CRC patients.

These findings suggest that the overexpression of EMT‑TFs plays a key role in increasing the risk of distance metastasis as well as decreasing overall survival in CRC patients.

Nonalcoholic fatty liver disease (NAFLD) has become one of the major diseases plaguing worldwide. Several studies reported its association with ischemic heart disease (IHD). This study aims to determine the relationships between severity of steatosis with glycemic control and carotid intima‑media thickness (CIMT) among a high‑risk population of type 2 diabetes mellitus (T2DM) with proven IHD.

This was a cross‑sectional study involving patients aged between 18 and 65 years diagnosed with T2DM with IHD (n = 150). Ultrasonography of the abdomen to determine NAFLD severity category and CIMT measurements was performed by two independent radiologists. NAFLD was graded according to the severity of steatosis (NAFLD‑3, NAFLD‑2, NAFLD‑1, and NAFLD‑0). Comparison between different stages of NAFLD (NAFLD‑3, NAFLD‑2, NAFLD‑1, and NAFLD‑0) was analyzed using Chi‑square and analysis of variance tests for categorical and continuous variables, respectively.

The prevalence of NAFLD was 71% (n = 107). NAFLD‑1 was detected in 39% of the patients, 32% had NAFLD‑2, no patients with NAFLD‑3, and 29% had non‑NAFLD. There were no patients with NAFLD‑2 having higher systolic and diastolic blood pressure, weight, body mass index, waist circumference, total cholesterol, triglycerides, high‑density lipoprotein cholesterol, and low‑density lipoprotein cholesterol. Glycated hemoglobin (HbA1c) concentration was highest within the NAFLD‑2. NAFLD‑2 showed higher mean CIMT. Every 1% rise in HbA1c for patients with NAFLD significantly increases the CIMT by 0.03 mm (95% CI: 0.009, 0.052, P = 0.006).

These findings suggest additional atherosclerotic risks within the NAFLD‑2 group with significantly higher HbA1c and CIMT compared to the NAFLD‑1 and NAFLD‑0 groups. It is, therefore, vital to incorporate stricter glycemic control among patients with T2DM and IHD with moderate NAFLD as part of atherosclerotic risk management strategy.

We evaluated the sequential changes of interleukin (IL)‑10 and IL‑13 serum levels with tuberculosis (TB)‑related radiographic changes during pulmonary TB (PTB) treatment.

In this cross‑sectional study during two consecutive years, forty cases with PTB were recorded, and finally, 24 cases were completed the study. Serum levels of IL‑10 and IL‑13 were measured on admission time, and 6 months later. Furthermore, chest radiography was performed on admission and 6 months later in the treatment course.

Radiography at the baseline indicated pulmonary infiltration in all patients (n = 24). Fifteen (62.5%) cases had abnormal and 9 (37.5%) cases had normal radiography at the end of 6 months treatment course. IL‑10 and IL‑13 upregulated during the treatment time course, and their relationship with radiographic changes shifted from negative (r = −0.14 and P = 0.71) on admission to positive (r = 0.80 and P < 0.001) at the end of 6 months treatment course in normal radiography group. IL‑10 level at the start of the treatment was 121.90 ± 88.81 in patients with normal and 82.68 ± 41.50 in patients with abnormal radiography (P = 0.31).

Sequential increase in IL‑10 and IL‑13 during PTB treatment course may have a role in clearing the TB‑related radiographic infiltration and preventing scar formation.

Although laparoscopic cholecystectomy (LC) is the gold standard approach for gallbladder diseases, this sometimes may face difficulties and require conversion to open surgery. The preoperative ultrasonographic study may provide information about the probability of difficult LC, but the data in this term are uncertain. We assessed the value of preoperative ultrasonographic findings for the prediction of LC’s difficulty.

The current prospective clinical trial was conducted on 150 patients who were candidates for LC due to symptomatic gallstone. All of the patients underwent ultrasonography study preoperatively, and then, LC was performed. The surgeon completed a checklist regarding the easy or difficult surgical criteria. Finally, the values of ultrasonographic findings for the prediction of LC difficulty were evaluated.

Among the 150 included patients, 80 had easy LC and 70 had difficult LC. Statistically significant differences were found between the two groups of easy and difficult LC regarding gallbladder wall thickness (P = 0.008), stone impaction (P = 0.009), and gallbladder flow (P = 0.04). The area under the curve (standard error [SE]) for the thickness of the gallbladder wall, flow in the gallbladder wall, and stone impaction was 0.598 ± 0.048, 0.543 ± 0.047, and 0.554 ± 0.047, respectively (P < 0.05). The highest specificity was for gallbladder wall flow (100%). Binary logistic regression showed that stone impaction had predictive value for determining difficult LC (odds ratio = 3.10; 95% confidence interval: 1.03–9.30; P = 0.04).

Although a significant difference was observed between two groups in terms of impacted stone, flow in the gallbladder wall, and thickness of the gallbladder wall, only stone impaction had predictive value for determining difficult LC.

Functional dyspepsia is a common chronic digestive disorder. The purpose of this study was to compare the effectiveness of dialectical behavior therapy and anti‑anxiety medication in patients with functional dyspepsia.

The present study was a randomized, controlled clinical trial with sixty patients who were suffering from functional dyspepsia that identified by the ROME III criteria. Patients were divided into three groups by using pre‑ and posttest design, including Group A (dialectal treatment and pantoprazole), Group B (anxiolytic drug treatment and pantoprazole), and Group C (no intervention, only pantoprazole were used). The Beck Anxiety Inventory and the patient assessment of Gastrointestinal Symptom Severity Index Questionnaire were completed by the patients after receiving the written consent. Finally, the data were analyzed using the Statistical Package for the Social Sciences software version 20.

There was a significant improvement in the severity of dyspepsia after intervention in all three groups. The greatest decrease in the severity of functional dyspepsia was observed in the dialectical behavioral therapy group as compared to the other groups (Group A: −15.4 ± 6.61, Group B: −3.85 ± 2.77, and Group C: −7.8 ± 4.02; P = 0.001). Furthermore, the Beck Anxiety Inventory scores were statistically significantly improved in all three groups (Group A: −5.75 ± 2.53, Group B: −7.3 ± 3.19, and Group C: −2.60 ± 1.5; P = 0.001). There was a positive correlation between the change in dyspepsia score and change in anxiety score across different intervention groups (r = 0.55; P < 0.001).

Dialectical behavioral therapy can be effective in reducing anxiety and improving the dyspepsia symptoms in patients with functional dyspepsia compared to anti‑anxiety medication or conventional therapy. Therefore, communication between the physicians and psychologists and psychiatrists can have positive effects on the treatment of these patients.