The association between quality of life and diabetes: the Bushehr Elderly Health Program

BACKGROUND AND OBJECTIVE

Considering the importance of diabetes and its increased prevalence with aging, this study aimed to evaluate the association between diabetes status and quality of life (QOL) and the determining factors in individuals over 60.

METHODS

Two thousand three hundred seventy-five individuals including 819 (34.5%) with diabetes, aged 69.4 ± 6.4, from Bushehr Elderly Health Program (BEHP) were enrolled. We categorized the participants as non-diabetic, controlled diabetic, and poorly controlled diabetic. The QOL was assessed using the SF-12 questionnaire. The physical (PCS) and mental (MCS) component summaries of QOL were estimated. We compared the SF-12 domains and components between the categories using ANOVA. Further, the association of diabetes status with PCS and MCS was assessed after adjustment for possible confounders including age, sex, depression, cognitive impairment, physical activity, and other relevant factors using linear regression analysis.

RESULTS

Individuals with diabetes had lower PCS (40.9 ± 8.8 vs. 42.7 ± 8.6, p-value < 0.001), and MCS scores (45.0 ± 10.2 vs. 46.4 ± 9.4, p-value < 0.001) compared to participants without diabetes. No significant differences were observed in PCS or MCS scores between controlled or poorly controlled individuals with diabetes. Diabetes status was associated with PCS and MCS scores in univariable analysis. Regarding physical component of QOL, after adjusting for other confounders, poorly controlled diabetes was significantly associated with PCS [beta: -1.27 (-2.02, -0.52)]; some other determinants include depression [-7.66 (-8.51, -6.80)], male sex [3.90 (3.24,4.57)], and good physical activity [1.87 (1.17,2.57)]. As for the mental component, controlled diabetes was significantly associated with MCS [-1.17 (-2.13, -0.22)]; other contributing factors include depression [-14.35 (-15.34, -13.37)], male sex [1.97 (1.20,2.73)], good physical activity [-1.55 (-2.35, -0.75)], and smoking [-1.42 (-2.24, -0.59)]. BMI had an inverse association with PCS [-0.19 (-0.26, -0.13)] and a direct association with MCS [0.14 (0.07,0.21)].

CONCLUSION

Individuals with diabetes exhibited reduced QOL scores. Upon adjusting for other variables, it was found that uncontrolled diabetes correlated with decreased PCS scores, whereas controlled diabetes was linked to lower MCS scores. Factors such as depression and being female were identified as contributors to diminished QOL in both physical and mental aspects. These results have the potential to guide healthcare decision-making, facilitating the creation of tailored interventions aimed at improving the QOL for individuals with diabetes, with a specific focus on women and depression.

Hodgkin lymphoma novel management; A 20-year retrospective study

Introduction: Hodgkin lymphoma (HL) is one of the pediatric and adult cancers, with the treatment of chemotherapy alone or combined with radiotherapy. Objectives: We aimed to evaluate the consequences and outcomes of the treatment with or without radiotherapy in a retrospective study. Patients and Methods: We carried out a cross-sectional retrospective study by referring and reviewing records for all patients admitted to Motahari hospital with HL diagnosis from 1995 to 2016. The Ann Arbor staging system classified the staging of disease. Results: Totally, 35 patients enrolled in our study that 54.3% were female, and 45.7% were male patients. The mean age of patients was 10.08±6.38 years. 10 (28.6%) cases classified in stage 1, 13 (37.1%) case in stage 2, 9 (25.7%) cases in stage 3, and 3 (8.6%) cases in stage 4. 30 patients (85.7%) were treated by chemotherapy and 5 (14.3%) patients with chemotherapy and radiation combination. In our study, the overall survival was 97.1% of patients treated with chemotherapy alone, and one patient died due to drug side effects. That is comparable with other studies that treated patients with chemotherapy and radiotherapy. Conclusion: According to our findings, chemotherapy without radiotherapy as initial treatment in HL would have similar results to concomitant radiotherapy and chemotherapy, so considering the cost and harms of radiotherapy, we suggest a limitation of radiotherapy to patients with resistant diseases that do not respond to chemotherapy solo-protocols.

Giant parathyroid adenoma: a case report

BACKGROUND

Giant parathyroid adenoma is a type of parathyroid adenoma weighing > 3.5 g and having a size of more than 2 cm.

CASE PRESENTATION

This report describes giant primary parathyroid adenoma with reference to the literature. We report the case of a 48-year-old Persian man referred to the clinic with knee and lower back pain. He had a history of mitral valve replacement and several episodes of bilateral nephrolithiasis. After a thorough assessment, a neck mass with a possible thyroid origin was detected, but further assessment showed it was of parathyroid origin. The resected mass was 9 × 6× 4 cm and weighed 122 g, and histopathology showed a giant parathyroid adenoma.

CONCLUSION

Giant parathyroid adenomas that weigh more than 110 g and are larger than 8 cm can lead to significant hypercalcemia. Despite giant parathyroid adenomas and high parathyroid hormone levels, a calcium crisis may not always occur in these patients, and the masses may be initially misdiagnosed as a thyroid mass.

Echocardiographic and laboratory findings in coronary slow flow phenomenon: cross-sectional study and review

Background

Coronary sow-flow phenomenon (CSFP) is defined as slow passage of the contrast injected into the coronary arteries without distal obstruction of the vessel.

Methods

The present study was a cross-sectional, descriptive-analytical study performed at the Seyed-al-Shohada Heart Center during 2018–2019. The eligible patients based on the inclusion and exclusion criteria were divided into the study group showing the CSFP and the control group with normal epicardial coronary arteries.

Results

The study included 124 patients. 67.9% of the study group and 39.4% of the control group were male patients (p-value = 0.001), and the mean patient age was 52.18 ± 12.55 and 51.77 ± 10.36 years in the study and control groups, respectively (p-value = 0.18). The study group had a significantly higher BMI than the control group (p < 0.05) and also a higher prevalence of smoking and hypertension. The variables of ALC, Hct, Plt, MPV, RDW, Cr, triglyceride, TC, and LDL, were higher in the study group. Given the echocardiographic findings, the mean E wave was significantly lower in the study group, while the control group had a significantly higher GLS (p-value = 0.01). Also, left anterior descending artery was the most common artery involved with CSFP.

Conclusion

The CSFP was significantly more common in men, smokers, hypertensive patients, and patients with high BMI. Moreover, these patients had significantly higher platelet count, MPV, LDL, and FBS. Some other laboratory variables were also higher in these patients. Given the echocardiographic findings, mild diastolic dysfunction and low GLS were also observed in the study group.

Heroin Intoxication Through Damaged Skin in a 7-Year-Old Girl

Transdermal opioid intoxication has only been reported for pharmaceutical fentanyl and buprenorphine patches. Here, we report a rare case of heroin poisoning through damaged skin. A seven-year-old girl with an impaired level of consciousness and difficulty breathing was brought to a local hospital about one hour after burning with boiling water. She had a small second-degree burn on the right elbow. Clinicians were initially unable to obtain any reliable history from relatives about the cause of altered mental status. However, with a clinical suspicion of opioid poisoning, naloxone therapy started, and the patient was moderately improved. She underwent a coma workup; then she was referred to a tertiary care hospital. Further investigation revealed that after the burning, the mother left home to seek for a burn ointment from a neighbor, and the heroin-dependent father sprinkled some heroin powder over the burned area. Heroin was absorbed through the damaged skin and poisoned the child unintentionally. After three days of clinical management, the patient was discharged from the hospital in good condition without any complications. Heroin can be absorbed through damaged skin and cause poisoning. Diagnosis requires strong clinical suspicion, and an appropriate naloxone therapy may be life-saving.

<p>Chronic Perioral Tuberculosis Skin Lesions in a 21-Year-Old Male</p>

Cutaneous tuberculosis is a rare form of tuberculosis infection that may lead to chronic lesions of skin and be missed in diagnosis due to location of the appearance of the lesions. This is a very rare case of peri-oral cutaneous tuberculosis in a 21-year-old man with no other specific sign of symptoms of tuberculosis infection but mimics signs of Herpesviridae family infection. The biopsy of the lesions and Ziehl–Neelsen stain revealed the diagnosis of cutaneous tuberculosis. By the beginning of the treatment of this unusual form of tuberculosis, the lesions had begun to fade and after 8 months, they were totally faded.

Plasmapheresis, Anti-ACE2 and Anti-FcγRII Monoclonal Antibodies: A Possible Treatment for Severe Cases of COVID-19

In March 2020, the WHO declared the COVID-19 disease as a pandemic disease. There have been studies on the COVID-19 to find a certain treatment, but yet, there is no certain cure. In this article, we present a possible way to treat severe cases of COVID-19. Based on the previous studies, there are similarities between the spike antigens of SARS-CoV and SARS-CoV-2 viruses. It is expected that these similarities (structural and affinity to the receptor of ACE2) can lead to the same pathophysiological activity of the virus by the use of ACE2 and FcγRII (the antibody-dependent enhancement mechanism). Therefore, we propose a way of washing out (by plasmapheresis) the possible antibodies against the spike protein of the virus out of patients’ plasma to stop the antibody-dependent enhancement (ADE)-mediated infection of the immune system cells at the first phase of the treatment and simultaneous use of the anti-ACE2 with anti-FcγRII monoclonal antibodies at the second phase. We propose these procedures for the patients that have no significant response for typical anti-viral, ARDS and conservative therapies, and the disease persists or progresses despite sufficient therapies.

Hemitruncus Arteriosus in a 10-Day-Old Neonate with Patent Ductus Arteriosus and Thrombocytopenia

Hemitruncus arteriosus refers to an uncommon congenital cardiovascular abnormality. It usually presents in infancy and leads to the development of pulmonary hypertension, heart failure, and in severe cases maybe death. Herein, we reported hemitruncus arteriosus in a 10-day-old neonate with respiratory distress, patent ductus arteriosus, and thrombocytopenia.

Color Doppler Ultrasonography in Evaluating the Outcomes of Pyeloplasty in Ureteropelvic Junction Obstruction

Purpose

To evaluate the accuracy of Color Doppler ultrasonography for diagnosing post pyeloplasty elimination of obstruction in Ureteropelvic Junction Obstruction patients.

Methodology

Patients with the diagnosis of UPJO enrolled in the study and underwent open pyeloplasty. Three to 6 months after the operation, patients were recalled and underwent isotope scan as the gold standard test and renal color Doppler ultrasonography to assess the success rate of pyeloplasty.

Results

A total of 39 patients were evaluated and analyzed. The average follow-up time for patients was 9.1 months. The success rate of surgery in the study population was 100%. The mean RI of the affected side before the operation was 0.69 ± 0.01 and after the pyeloplasty, it reached to 0.65 ± 0.01. The difference between the mean RI of the affected side before and after the operation is 0.04 (P < 0.001). Age, type and severity of obstruction and the technique of surgery did not have any impact on these parameters. The difference between the RI of the affected and healthy side was termed ΔRI. ΔRI before and after the operation was 0.084 and 0.014, respectively. The decrease of ΔRI in the case of pyeloplasty is 0.07 on average (P < 0.001), which can be predicted for pyeloplasty success.

Discussion

Color Doppler ultrasonography can be used as a non-invasive, fast, non-expensive, and available modality for evaluating the outcome of pyeloplasty instead of the nuclear scan or IVP.

A rare case of brucellosis with dermatomal pattern of cutaneous manifestation

Brucellosis is a systemic disease which may involve any organ or system of the body, and is listed in the differential diagnosis of many diseases. In spite of described cutaneous involvements, skin manifestations are not common in brucellosis, particularly papulonodular lesions with dermatomal patterns that may overlap with dermatomal skin lesions. This may prevent correct diagnosis and treatment in practice, harming patients’ health and leading to financial costs to the health system and patient. In this case, at first, due to left thigh and buttock skin lesions and dermatomal pattern, the patient was diagnosed with Herpes zoster infection. After medical treatment and no improvement of lesions, the patient was referred to the infectious clinic with low back pain; magnetic resonance imaging (ordered by a neurosurgeon) suggested infectious spondylodiscitis. At the infectious ward, brucellosis spondylitis was diagnosed and a biopsy was taken from dermatomal lesions. The patient’s follow-up after 1, 2, and 3 months revealed that treatment of brucellosis had led to healing of lesions. Surprisingly, the histopathological assessment of the biopsy suggested psoriasis vulgaris. This was a rare case of manifestation of cutaneous brucellosis which could not even be diagnosed by histopathological assessment.