Journal of Research in Medical Sciences
Volume:29 Issue: 7, Aug 2024

One of the most appropriate methods for analyzing longitudinal data is multistate model. This study has aimed to evaluate the risk factors of transfer to local recurrence (LR), distant metastasis (DM), and death in rectal cancer patients through multistate survival analysis.

This is a retrospective cohort of rectal cancer patients in Mashhad, Iran. Multistate models were applied to show the difference between the significant risk factors affecting death and recurrence in different defined transitions. Risk factors include age, sex, primary surgical technique, tumor location, postoperative tumor stage, circumferential or distal resection involvement, surgery time, and surgical complications.

A total of 280 eligible patients with a median (interquartile range) survival time of 60 (42-76.2) months were investigated. Based on Cox proportional  ultistate model, the hazard ratio (HR) of DM increases by 3%/1?year increase in age (P = 0.018). The HR of DM and the HR of LR in patients with postoperative disease Stage II/III were 3.06 and 2.53 times higher than patients with cancer Stage 0/I (P < 0.05). When the resection margins of distal or circumferentialwere involved, the HR of DM was 3.58 times higher than those patients without involvement. In the extended multistate model, time of DM was a significant predictor of death (P = 0.006).

Age and margin involvement in DM path and stage in LR and DM path had a significant effect; however, no effective variable was seen on the death of patients with recurrence. The time of metastasis also had an effect on the path of death.

The objective of this study was to investigate cognitive performance and brain volume profile in patients with neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS).

In a historical cohort study, 29 MS patients, 31 NMOSD patients, and 20 healthy controls (HCs) underwent neuropsychological assessment using the Minimal Assessment of Cognitive Function in Multiple Sclerosis  MACFIMS). Patients with MS and NMOSD also underwent a 1.5?tesla magnetic resonance imaging scan and high?resolution three?dimensional T1?weighted MPRAGE sequence.

The Symbol Digit Modalities Test scores were significantly lower in MS (mean [standard deviation (SD)] =44.1 [14]) and NMOSD (mean [SD] =45.5 [14.3]) patients compared to HCs (mean [SD] =57 [9.5], P < 0.001). Scores of the Controlled Oral Word Association Test were also lower in MS (mean [SD] =25.9 [9.8]) and NMOSD (mean [SD] =24.6 [10.2]) patients compared to HCs (mean [SD] =36.6 [9.8], P < 0.001). Additionally, the MS group performed worse on the Brief Visuospatial Memory Test (BVMT) compared to the NMOSD group (9.4 ± 3.4 vs. 7.1 ± 3.7 P < 0.001). In MS patients, there was a significant correlation  between all cognition scores and total brain lesions, as well as between every test except BVMT?Revised with thalamic volumes. In NMOSD patients, a correlation was found between gray matter volume and the learning phase of the California Verbal Learning Test?II as well as between total lesion percentage and verbal memory and information processing speed.

Both NMOSD and MS patients experienced impairment of information processing speed, working memory, and verbal fluency, whereas visuospatial memory impairment was only observed in MS patients. Despite lower total brain lesion and less thalamic atrophy, patients with NMOSD are at risk of cognitive impairment. Microscopic structural abnormalities may be a possible cause.

The current study aims to assess cardiovascular risk factors (CVRFs) among diabetic versus nondiabetic nonalcoholic fatty liver disease (NAFLD) patients. NAFLD is the most common hepatic disorder worldwide which is directly associated with diverse CVRFs such as type 2 diabetes mellitus (T2DM) and metabolic syndrome (MS).

The current cross?sectional population?based study has been conducted on 1031 NAFLD patients. After excluding 340 prediabetes patients, the NAFLD patients were divided into T2DM and normal blood glucose (NBG). Then, CVRFs were compared between the two groups.

Out of 691 NAFLD cases included in the study, 337 (48.8%) patients had T2DM. In the T2DM and NBG groups, the body mass index (BMI) was 31.2 ± 4.6 and 29.9 ± 4.3 kg/m2, respectively (P = 0.001). The waist circumference was 102.2 ± 10.2 and 97.6 ± 10.6 cm, respectively (P < 0.001). The systolic blood pressure was 123.3 ± 15.6 and 119.6 ± 13.6 mmHg, respectively (P = 0.043).The triglyceride levels were 191.9 ± 104.7 and 176.5 ± 89.6 mg/dL, respectively (P = 0.042). Generally, these factors were significantly higher among the diabetic patients. Besides, cardiovascular disease (CVD), hypertension, and MS were statistically more prevalent in NAFLD patients with T2DM (P < 0.001) than nondiabetic NAFLD patients. In multiple logistic regression models, the odds ratioof CVD, hypertension, and MS was 2.18, 2.12, and 6.63 for patients with T2DM compared with NBG, respectively. Adjustment was made for age, sex, BMI, smoking, and physical activity.

CVRFs were higher in NAFLD patients with T2DM than NAFLD patients with NBG.

Apnea testing is mandatory to confirm brain death; however, it is unsafe for patients who have substantial hypoxemia without ventilator support. We used a new modified apnea test without the need to disconnect the patient from the ventilator in the present study and compared the outcomes and complications of the new method to the widely used oldmethod.

The current study was conducted on people suspected of having brain death. Both the old and new apnea tests were carried out on the same individual. In the new modified method, instead of hyperventilating and then separating the brain death from the ventilator, the induced hypercapnia method was used, and instead of performing repeated arterial blood gas (ABG), thetarget ETCO2 was obtained, and at the time of the target ETCO2, ABG was also checked followed by comparing ETCO2 with PaCO2.

Thirty patients, including 25 (83.3%) males and 5 (16.75%) females, were included in the study. The results showed significant improvement in terms of O2 saturation and heart rate (HR) using the new modified apnea test compared to the common test. Systolic blood pressure, diastolic blood pressure, and the frequency of complications were improved in the new modified test.

The modified apnea test produced better results in terms of O2 saturation, HR, and other clinical factors, while it does not require disconnection from the ventilator and repeated ABG assessment. Therefore, it can be used to successfully diagnose brain death in high?risk individuals suffering from severe hypoxia.

Malaria, transmitted by Plasmodium parasites and anopheline  mosquitoes, continues to be a leading cause of global disease and death. This retrospective investigation from 2018 to 2023 examines the epidemiological attributes of malaria in Saravan, southeastern Iran. It seeks to evaluate the prevalence, transmission causes, local population impact, and health system effects.

Blood samples from suspected malaria cases in Saravan health centers were collected for this analysis. Each positive case was detailed with demographic data in a questionnaire. The SPSS 26 statistical program scrutinized data with t?tests comparing the variables.

The study indicated fluctuating malaria cases peaking in 2023, with an annual parasite incidence. (API) of 17.27. Plasmodium vivax was the predominant species (P < 0.001), with the majority of cases in individuals over 15, notably males. A significant number of cases were reported in September (20.7%).

The findings emphasize the persistent malaria challenges in Saravan, accentuating the urgent need to strengthen prevention and control strategies. Reducing disease burden demands focused approaches, including improving  revention and treatment programs, enhancing surveillance systems, developing health infrastructures, and implementing localized therapies, especially considering recent climatic and rainfall patterns.

The implementation of human research involving children and adolescents  necessitates a nuanced understanding of the distinct ethical complexities and sensitivities that arise. This study aimed to conduct a comprehensive review of ethical guidelines for research with these populations by extensively examining existing standards and applied studies. The review revealed a myriad of challenges inherent in the involvement of children and adolescents as research subjects. The most important ethical challenges relate to the principles of bioethics and their compliance with human studies involving children/adolescents, informed consent, and risk assessment in studies on children/adolescents. To facilitate appropriate participation of youth in research endeavors, meticulous planning is required, inconjunction with a re?examination of the definitions of ethical principles in pediatric research, close monitoring of potential risks and benefits, and the utilization of a combination of innovative and traditional approaches to obtain informed consent that adheres to ethical standards. Performing research with children and adolescents requires special considerations to address the unique ethicalissues that can emerge. By adhering to ethical guidelines tailored specifically to these vulnerable populations, researchers can help ensure that studies are  conducted in an appropriate and responsible manner.

Obstructive sleep apnea (OSA) commonly coexists with lung disease. However, the association between OSA components and lung function remains unclear. This study estimated STOP?BANG scores according to lung function using nationwide Korean data.

Three thousand and two hundred eighty adults with available STOP?BANG scores and spirometry data were analyzed. Multivariate regression models were applied to estimate STOP?BANG scores according to lung function.

Approximately 28% of participants had abnormal lung function, and the characteristics were diverse. The significant factors associated with abnormal lung function included the STOP?BANG score. In  ultivariate regression analyses, individuals with abnormal lung function had significantly higher STOP?BANG scores than those with normal lung function (odds ratio: 1.19; 95% confidence interval: 1.10–1.29; P < 0.001), and this difference was remarkable in men.

Our results suggest that screening and management of OSA components are warranted to prevent impaired lung function.