THE OCCURRENCE OF SUBACUTE THYROIDITIS AFTER THE AMELIORATION OF HYPERCORTISOLISM FOLLOWING TRANSSPHENOIDAL SURGERY IN CUSHING'S DISEASE

Only a few subacute thyroiditis (SAT) cases secondary to hypocortisolemia developed after successfully treating Cushing's disease (CD) have been reported. In this report, we present an SAT case, which developed immediately after discontinuation of steroid treatment for hypocortisolemia after the successful treatment of CD. A 54-year-old female patient who had recently been diagnosed with type 2 diabetes mellitus was admitted to our center with complaints of proximal myopathy and obesity. Serum cortisol did not suppress adequately after the 1 mg dexamethasone suppression test. Pituitary MRI of the patient with increased basal plasma ACTH level revealed a 6 x 5 mm right-sided adenoma. After successful surgical treatment, the patient was given ten months of steroid therapy due to a suppressed corticotroph axis. Shortly after the steroid treatment was discontinued, the patient was admitted with neck pain, fever, and thyrotoxicosis. The patient was diagnosed with SAT, and methylprednisolone treatment was started again. The underlying pathophysiological mechanisms in SAT cases that develop after the treatment of CD can only be speculated. One possible mechanism could be that the glucocorticoid deficiency develops after effective treatment of hypercortisolism alters the immunological responses or generates self-reactive cells and prepares an appropriate environment for the thyrolytic process.

The importance of hypophosphatemia in the clinical management of primary hyperparathyroidism

AIM

The levels of serum phosphorus (P) are low or low-normal in primary hyperparathyroidism (PHPT), and there is an inverse relationship between the levels of parathormone (PTH) and P. However, when considering the diagnostic and surgical indication criteria of PHPT, serum P levels are generally ignored. The aim of this study was to retrospectively evaluate the association of serum P levels with the clinical outcomes of PHPT.

MATERIALS AND METHODS

A retrospective evaluation was made of the data of 424 consecutive patients (370 females, 54 males) with PHPT who presented at our centre.

RESULTS

The mean age of the study population was 57 ± 11.68 years. The mean P was 2.57 ± 0.53 mg/dl. Asymptomatic disease was determined in 199 (47%) patients. Male patients had significantly lower levels of P. Symptomatic patients and patients with renal stones, vitamin D < 20 µg/l, calcium level ≥ 11.2 mg/dl, 24 h urinary calcium > 400 mg/day, or hypomagnesemia, were seen to have significantly lower levels of P (p < 0.05). Hypophosphatemia (hypoP) was found in 202 of 424 patients (47%), and these patients had a higher rate of symptomatic disease (63% to 44%, p < .0001). Of the 61 (88%) patients with moderate hypoP, 54 (88%) had at least one of the surgical criteria. A statistically significant increase in the incidence of hypoP was determined in symptomatic and male patients. In the patients with hypoP, serum PTH and urine calcium levels were found to be higher, and lumbar T-scores and serum vitamin D levels were lower. The patients with hypoP had higher rates of renal stones and osteoporosis (p < 0.05).

CONCLUSIONS

The current study results show that hypoP is associated with a higher risk of osteoporosis and renal stones in PHPT patients. Even if patients are asymptomatic, moderate hypoP may be associated with poor outcomes of PHPT. Therefore, moderate hypoP may be a new criterion for parathyroidectomy, regardless of hypercalcemia level.

Opportunities and challenges of virtual reality-based interventions for patients with breast cancer: a systematic review

BACKGROUND

Breast cancer is one of the most common cancers diagnosed worldwide and the second leading cause of death among women. Virtual reality (VR) has many opportunities and challenges for breast cancer patients' rehabilitation and symptom management. The purpose of this systematic review is to look into the benefits and drawbacks of VR interventions for breast cancer patients.

METHODS

A systematic search was conducted on PubMed, Web of Science, Scopus, IEEE, and the Cochrane Library, from inception until February 6, 2022. The inclusion criteria were: (1) original studies without restriction in study design; (2) a study population consisting of patients with breast cancer; (3) any type of VR-based interventions (immersive and non-immersive); and (5) studies published in English. To assess the risk of bias, the Effective Public Health Practice Project (EPHPP) Tool was used.

RESULTS

Eighteen articles were included in this systematic review. The result showed that VR could provide many opportunities for patients with breast cancer, including reducing anxiety, time perception, pain, fatigue, chemotherapy-related symptom distress levels, and depression severity, as well as improvement in the range of motion, strength, and function. Cybersickness symptoms, the weight of headsets and helmets, the quality of the visual image, and the cost of the equipment are some of the challenges in using this technology on these patients.

CONCLUSIONS

The systematic review showed that VR interventions have opportunities and challenges for patients with breast cancer. VR can be effective for rehabilitation and symptom management and is used in different stages of treatment to improve the condition of patients with breast cancer. However, before using it, the researcher should consider its challenges.

Effect of social media interventions on the education and communication among patients with cancer: a systematic review protocol

INTRODUCTION

Cancer is a leading cause of death worldwide. In addition, it accounted for approximately 10 million deaths in 2020 alone. Information and communication technologies have great potential for improving health education and communication. Social media is one of the technologies that can help patients with cancer and healthcare providers communicate and provide educational information. Social media are increasingly being used for health promotion and behaviour change. This is a protocol of systematic review to identify the effect of social media interventions on the education and communication among patients affected by cancer. This study aims to reveal the steps of conducting research that systematically reviews all studies for the specific objective. This study aims to examine the social media interventions to improve awareness and knowledge about the disease for patients with cancer and improve communication among them.

METHODS AND ANALYSIS

This protocol is reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols checklist. We will include experimental design studies that report the effect of social media interventions on education and communication among patients with cancer or malignancy and any stage of the disease. Interventions will be inclusive, using all social network platforms for patients' communication and education. We will search PubMed, Web of Science, Scopus and the Cochrane Library from inception until 23 May 2022. Two independent reviewers will screen titles, abstracts and full-text articles with conflicts resolved through discussion or by a third reviewer, as needed. All titles, abstracts and full-text papers will be reviewed independently by two reviewers according to the inclusion and exclusion criteria. Discrepancies will resolve by discussion or SRNK if needed. The two reviewers will also independently complete risk of bias assessments for each included study. The descriptive analysis, including frequency and percentage parameters, will be calculated based on the study's variables. Furthermore, we will report the results of the quality assessment of studies in table format. In the result section, a narrative synthesis will be applied to describe and compare the paper's results.

ETHICS AND DISSEMINATION

Ethics approval will not be needed because the data to be used in this systematic review and meta-analysis will be extracted from published studies. It will be disseminated by publication in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42022334691.

Meta-analysis: COVID-19 diagnosis in chest CT—master key for radiologists

Background

COVID-19 was discovered in February in China. Due to the high prevalence of the disease, early detection and rapid isolation of patients are the vital points for controlling the outbreak. The purpose of this study was to determine the correct location of chest CT scan in the diagnosis of COVID-19.

Main text

The current study is a systematic review and meta-analysis. 2959 papers were found in all national and international databases. The study has been reported based on the PRISMA checklist. All analyses were done by CMA Ver. 2 software. The statistical analysis results show that the GGO observation level in the available shape was 46% in CT scan results, and the consolidation observation level in the general form was 33% in CT scan results. Pleural effusion was 7%, and linear opacity observation level was 24% in CT scan results in the general form. The CT scan test sensitivity level was gained 94.7%, and PCR test sensitivity level was achieved as 94.8%. This level was 89% in the early stage.

Conclusion

The chest CT has about 24% higher diagnostic sensitivity than the PCR test, in the early stage. GGO revealed a declining process and also indicates that GGO is an early symptom of the disease in CT scan. Linear opacity is the reason behind the initial dyspnea in coronavirus suffering patients referring to the medical centers. The extra-pulmonary lesions increase in the last stage of the disease that makes the patient’s worse.

Supplementary Information

The online version contains supplementary material available at 10.1186/s43055-021-00457-6.

Using Electronic Data Capture for Cardiovascular Electrophysiology Invasive Procedures: An Important Step Towards Interoperable Clinical Registries

Introduction: The capture and integration of structured data from point of care into clinical registries has been a challenge. However, this effort is very important toward a qualitative patient care and research. Collection, organization and interpretation of clinical data can help to improve evidence-based medicine practices. Worksheets data capture are prevalent, but, not flexible, protected, workflow pleasant, and user friendly and do not support the creation of standardized and interoperable data. The aim of this study was to design and implement an Electronic Data Capture (EDC) instruments to be use in context of cardiovascular invasive procedures.Material and Methods: This descriptive and developmental study conducted in three phases as follows. (1) data standardization according national and international data element templates published by specialized societies; (2) developing of an initial data collection and clinical research workflow (3), establishing of electronic case reports using Research Electronic Data Capture (REDCap) in accordance with the Health Insurance Portability and Accountability Act (HIPAA) privacy rule.Results: Three case report forms was developed that included demographics, medical history, physical examination, laboratory tests, radiology examinations, Electrophysiology (EP) procedures, as well as medications and follow-up information. Data-entry validation criteria have been implementing in electronic data collection instrument to assure validity and precision when data enter in electronic form.Conclusion: This paper describes the process used to create an EDC application. Data collection applications were successfully develop as an a priori step in a clinical research for assisting data collection and management in a case of cardiovascular EP invasive procedures. 

Developing Cardiac Electrophysiology Ontology: Moving Towards Data Harmonization and Integration

Introduction: Cardiac electrophysiology (EP) studies the electrical heart conduction system which is used for diagnosis and treatment of cardiac arrhythmias. In this context, a huge amount of data is generated, requiring efficient and effective access, interpretation, and data analysis from multiple sources in a unified view. To resolve this challenge, this essay presents an ontology to reconcile data heterogeneity problems in this domain.Material and Methods: The cardiac EP ontology was constructed according to the life cycle of ontology building. Structural, functional, and expert evaluation was performed to ensure its quality and usability.     Results: Cardiac EP ontology was developed using protégé environment and implemented in OWL editing tool. It presented a detailed hierarchical structure of the cardiac EP domain with around 324 instances describing cardiac EP-related concepts.Conclusion: Cardiac EP ontology provides an explicit formal description of the concepts, relationships, and properties associated with cardiac electrophysiology making seamless data integration between multiple heterogeneous databases. It also is a useful framework for knowledge representation in knowledge-based systems, as well as for explicit communication between experts in the EP domain.

Development of a minimum data set for cardiac electrophysiology study ablation

BACKGROUND

At present, there is no established national minimum data set (MDS) for electrophysiology study (EPS) ablation, which has led to a lack of standardization and variable assessment criteria in this context.

OBJECTIVE

The objective of this paper was to develop a MDS of EPS ablation as means of establishing an information management system or clinical registry in this field.

METHODS

In this cross-sectional and descriptive study, national and international cardiovascular scientific literature were studied to establish an initial set of data elements. In order to its validity, the population study composed of 15 cardiac electrophysiologists who asked to review the proposed data elements and score them in order of importance using a five-point Likert scale. The items scored as important or highly important by at least 60% of the experts (average score of 3 and higher) were included in the final list of MDS.

RESULTS

An MDS of cardiac EPS ablation was created with nine data classes, including administrative data, past medical history, sign and symptoms, physical examinations, laboratory tests, presenting status of heart conduction system, catheter ablation, postprocedure complications, and discharge outcomes. For each category, required variables data and possible respondents were determined.

CONCLUSIONS

Consensus was reached on a set of core data elements to standardize data collection for cardiac EPS ablation in order to achieve quality improvement and effectiveness indicators for the management of care process and health outcomes.

Design and Evaluation of a Mobile-Based Application for Patients With Type 2 Diabetes: Case Study of Shariati Hospital in Tehran, Iran

Background: With regard to the particularly high prevalence, cost, and number of disabilities associated with diabetes, increasing patients’ knowledge and skills for managing the disease can help minimize the risks of complications. Objective: The present study aimed to design and evaluate a mobile-based application with which patients with type 2 diabetes can increase their knowledge of and skills for managing their disease. Methods: The current developmental-applied study was conducted in 2016 in a library and used a 2-step sectional format. The research population comprised 15 physicians and endocrinologists working in medical centers associated with Tehran University of Medical Sciences and 20 physicians and patients. Based on the library study, a checklist was designed and then distributed among participants. Their responses were analyzed using SPSS software version 20. Results: The data was divided into 4 main sections: identity information (patient demographics), clinical information, education curriculum related to diabetes management, and program requirements for diabetes management, which consisted of 52 subsets. The evaluation of the system by doctors and patients showed that the system has high capabilities. Conclusion: Mobile-based programs can help diabetics control blood glucose levels, reduce diabetes complications, and promote overall health.

A case of surgical instrument left in the abdomen and taken out of the transverse colon

BACKGROUND

Foreign bodies cause an aseptic reaction that does not have specific symptoms and may also result in peritonitis, acute abdominal pain, an intraperitoneal abscess, or intestinal obstruction or perforation. We present a case of a surgical instrument left in the abdomen that passed into the transverse colon via migration after a surgery.

CASE DESCRIPTION

A 36-year-old female patient was operated upon, with a diagnosis of a hydatid cyst in her liver. Approximately 3 years after the surgery, she excreted part of a surgical forceps with her stool while she was defecating. In upright direct abdominal radiography, a surgical instrument was observed in the abdomen. The patient was operated to remove the foreign body from the abdomen. The surgical instrument that was taken out had corroded and turned black. It was observed that the material that had dropped out of the anus and the material that was taken out during the operation were parts of the same surgical instrument. The ascending colon and the abdomen were stitched anatomically. Follow-ups were conducted after the operation, and the patient was discharged with recovery.

CONCLUSIONS

It should be noted that a surgical instrument may be left inside the body of patients who have a history of surgery and that it can migrate.

Hepatic effects of ketamine administration for 2 weeks in rats

The aim of the present study was to investigate the long-term and high-dose application of ketamine on the liver by employing histologic and biochemical methods. A total of 30 male rats were randomly assigned to control and four treatment groups ( n: 6). Saline for control group and different doses of ketamine for four treatment groups (40, 60, 80 and 100 mg kg−1) were administered intraperitoneal twice a day for 2 weeks. Immunohistological staining, light and electron microscopy were used to study tissue specimens. Histopathological changes were more severe and diverse in groups 80 and 100 mg kg−1 day−1, and the least significant change was observed in groups 40 and 60 mg kg−1 day−1. The most important ultrastructural changes were seen in mitochondria and in the rough endoplasmic reticulum. The immunoreactivity of calcineurin was determined as different. Prolonged use of ketamine caused hepatocellualar toxicity and histological changes in hepatocytes in a dose-dependent manner in all experimental groups.

Effects of sugammadex and rocuronium mast cell number and degranulation in rat liver

We investigated the effect of rocuronium- and sugammadex-induced mast cell increase and degranulation in rat portal triads. Forty-two rats, in six groups, received either rocuronium 1 mg.kg(-1); sugammadex 15 mg.kg(-1); sugammadex 100 mg.kg(-1); rocuronium 1 mg.kg(-1) and 5 min later, sugammadex 15 mg.kg(-1); rocuronium 1 mg.kg(-1) and 5 min later, sugammadex 100 mg.kg(-1); or isotonic saline. Total mast cell numbers were significantly higher with rocuronium only, than in all other groups (p<0.003), although in all active groups, the number was greater than the control. Total mast cell number was significantly higher with rocuronium and low-dose sugammadex compared with low-dose sugammadex only. The number of tryptase-positive mast cells with rocuronium only was significantly higher than in all other groups (p<0.003). Tryptase-positive mast cell numbers in both groups receiving both rocuronium and sugammadex were significantly higher compared with both groups receiving sugammadex only. Rocuronium increased mast cell numbers, and degranulation was mitigated by sugammadex. These results suggest that sugammadex may be beneficial in treatment of rocuronium-induced anaphylaxis.

Total intravenous anesthesia for evacuation of a hydatidiform mole and termination of pregnancy in a patient with thyrotoxicosis

Clinical hyperthyroidism is found in approximately 5% of women with a hydatidiform mole, as human chorionic gonadotropin secreted by molar tissue is structurally similar to thyroid-stimulating hormone. A hydatidiform mole occasionally presents with a co-existing viable fetus. Surgical evacuation may be indicated for significant hemorrhage or preeclampsia. Perioperative management in the presence of hyperthyroidism may be complicated by a thyroid storm. We report a case of total intravenous anesthesia with propofol and remifentanil, combined with an esmolol infusion, to control sympathetic hyperactivity during surgery.